Qi Spot

The past month has been brutal, scheduling wise.  I shan’t bore my handful of readers with the details of the non-essentials.  One of the things keeping me busy though, is having a 4th year medical student rotate with me in Traditional and Integrative Medicine.  For a whole month, I have a future M.D. to “convert” to Chinese medicine heh heh.

Anyway, during one of our rounds, she mentions to me that the subject of Chinese herbal medicine was brought up during her rounds with another doctor.  This other doctor encouraged her to study Philippine herbs instead of Chinese herbs because obviously, using indigenous resources is more cost-efficient than importing from China.  Also, indigenous materia medica would also be more apt and appropriate for the environment in which it grows.  Ma Huang works well in northern China for example, but not in tropical Philippines.

This got me thinking.  Just what IS the essence of Chinese medicine?  When I talk to most westerners about Chinese materia medica, most people think of stuff like Ginseng or Cordyceps.  In other words, they think about the individual materials.  Some folks with more experience might think of individual formulas – I know of a local nephrologist who actually tells patients with stones to take an over the counter stone “melting” formula from China with much success.

But is that what Chinese medicine is?  The individual materia medica?  The Formulae?

No.

The World Health Organization defines traditional medicine as “the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.”  If used outside it’s indigenous culture, it is termed alternative or complementary medicine.  (http://www.who.int/mediacentre/factsheets/fs134/en/).

Hence, the idea of medicine is not the drugs, not the acupuncture, not the materia medica.  I’ve even given this example to medical students – if for example, a person takes a certain common antibiotic but uses it for “off-label” purposes (as is rampant in the Philippines), is that person practicing medicine?  Sure, that person is using a medical tool, but not based on the knowledge, skill, and practice on which the art of medicine is based.

Chinese medicine, it can be imputed, is not about the individual materia medica.  It is about the unique theory that the practice is based on.  In particular, Chinese herbal medicine is not about the individual materia, it is about how they are used and the framework in which they are used.

Ephedra has it’s specific indications in Chinese Medicine.  Weight loss is not one of them.  Therefore, using ephedra in weight loss  - even if the ephedra is a commonly used Chinese materia medica – is not practicing Chinese medicine.

American Ginseng is grown in Wisconsin in the United States.  Frankincense and Myrrh are more associated with the Middle than the Far East.  Yet all are used in Chinese herbal medicine so long as they can be made to fit within the tradition.

So how do I reconcile my student’s story with this?

Philippine herbs can be studied and classified according to the system of Four Natures and Five Tastes.  Once this is done, it is a matter of substituting appropriate local medicinals for the imported ones, but STILL WITHIN THE FRAMEWORK OF CHINESE MEDICAL THEORY.  Let’s take a formula – Dang Gui Bu Xue Tang – with two ingredients Dang Gui and Huang Qi.  What if we can find two local materials that can be used to replace either one (with dose adjustments of course).  We could help more people at less cost.

That would be a true integration of cultures.

A few weeks ago, there was a news story about smugglers arrested for bringing in Cordyceps sinesis specimens into India. (http://qi-spot.com/2009/11/26/cordyceps-smugglers-arrested/).  Cordyceps is traditionally used for strengthening the Lung, and thus, immunity.  Apparently it is also useful for cancer.

An episode of “House, MD” (season 4 episode 6, “Whatever It Takes”) has Dr. Greg House mentioning that Cordyceps sinesis has been used experimentally to treat cancer in monkeys.  I applauded this recognition of Cordyceps in the ordinarily traditional medicine-hostile program (see season 1 episode 20, “Love Hurts”) but let’s get the facts out in the open:

First, the article with comments:

New Insights Into Mushroom-Derived Drug Promising for Cancer Treatment (http://www.sciencedaily.com/releases/2009/12/091223094729.htm)

ScienceDaily (Dec. 24, 2009) — A promising cancer drug, first discovered in a mushroom commonly used in Chinese medicine, could be made more effective thanks to researchers who have discovered how the drug works. The research is funded by the Biotechnology and Biological Sciences Research Council and was carried out at The University of Nottingham.

Ho ho, no evil sheriff?  I’m just wondering how knowing how it works makes it “more” effective.

In research to be published in the Journal of Biological Chemistry, Dr Cornelia de Moor of The University of Nottingham and her team have investigated a drug called cordycepin, which was originally extracted from a rare kind of wild mushroom called cordyceps and is now prepared from a cultivated form.

Dr de Moor said: “Our discovery will open up the possibility of investigating the range of different cancers that could be treated with cordycepin. We have also developed a very effective method that can be used to test new, more efficient or more stable versions of the drug in the Petri dish. This is a great advantage as it will allow us to rule out any non-runners before anyone considers testing them in animals.”

Oh no, once again western medicine wants to concentrate on a leaf instead of the whole tree… on one plant instead of the whole forest.  They want to isolate one ingredient from the whole package in the cordyceps plant.  Instinctively one might say, “what’s wrong with that?”  Well, the concept is similar to macrobiotics: you go for the whole food instead of the individual nutrient.  Tamiflu is derived partly from the shikimic acid found in star anise, and it is known for toxicity (even if rarely).  On the other hand, star anise is ALSO used for flu and is so much more relatively safe that it is used as a flavoring spice in everyday dishes.  The difference? Perhaps the whole package is more well balanced than just taking an individual isolated component!

Cordyceps is a strange parasitic mushroom that grows on caterpillars (see image). Properties attributed to cordyceps mushroom in Chinese medicine made it interesting to investigate and it has been studied for some time. In fact, the first scientific publication on cordycepin was in 1950. The problem was that although cordycepin was a promising drug, it was quickly degraded in the body. It can now be given with another drug to help combat this, but the side effects of the second drug are a limit to its potential use.

Sweet Mother of God.  This is precisely my point.  Can’t we just use the whole herb itself? Unlike Ganoderma, it is easier to grow in culture.

As we can see here, the typical ugly head of western pharmacology peeks from the shadows.  Instead of taking the herb as a whole, they isolate the ingredient cordycepin.  Unfortunately Cordycepin doesn’t last long in the body.  But obviously, it does so when in original cordyceps form!  Kinda like eating only the seaweed wrapper in sushi.  But instead of admitting to the wonderful balance in mother nature, we try to screw things up by manipulating the medicine even more.  So western pharma does what it does best: add another drug.  Then side effects… then add another drug… and another… and another…

Dr de Moor continued: “Because of technical obstacles and people moving on to other subjects, it’s taken a long time to figure out exactly how cordycepin works on cells. With this knowledge, it will be possible to predict what types of cancers might be sensitive and what other cancer drugs it may effectively combine with. It could also lay the groundwork for the design of new cancer drugs that work on the same principle.”

The team has observed two effects on the cells: at a low dose cordycepin inhibits the uncontrolled growth and division of the cells and at high doses it stops cells from sticking together, which also inhibits growth. Both of these effects probably have the same underlying mechanism, which is that cordycepin interferes with how cells make proteins. At low doses cordycepin interferes with the production of mRNA, the molecule that gives instructions on how to assemble a protein. And at higher doses it has a direct impact on the making of proteins.

On the other hand, I applaud the fact that this research is being taken seriously.  Once more understanding is gleaned as to how these things work, it will be less easy for blind skeptics to dismiss the power of Chinese medicine.

Article:

Biotechnology and Biological Sciences Research Council. “New Insights Into Mushroom-Derived Drug Promising for Cancer Treatment.” ScienceDaily 24 December 2009. 26 December 2009 <http://www.sciencedaily.com­ /releases/2009/12/091223094729.htm>.