More Thoughts on Chinese Medicine

I was just re-reading my last post (I know, I know – I’m gazing at myself again). And I realized that, in that post, I appear to be fairly open to Chinese medicine. But being open to it does not necessarily mean that I embrace it completely. I’m pretty much a doubting Thomas when it comes to alternative medicine. You gotta’ show me before I’ll believe. And by show me, I mean the usual peer reviewed controlled clinical trial.

Sure, I can tell you anecdotes about how I’ve seen Chinese medicine work. I once had a patient who failed to conceive with modern infertility treatment but became pregnant after only one treatment with acupuncture. Another whose baby was overdue and who actually broke her membranes and went into labor while at her first acupuncture treatment (I remember asking her just where the doc put the needle.) I saw the video made in China by one of my medical school professors, showing a man undergoing major abdominal surgery with acupuncture as the only anesthetic. And I even had a patient cure her migraines with Chinese herbs.

I do believe that acupuncture taps into some very real physical phenomena. The latest thinking is that accupuncture affects the release of neurotransmitters and neurohormones that mediate pain, blood pressure, and other bodily functions. It doesn’t work for everything, though, and needs verfication in clinical trials. But I’ll admit that I’ve toyed around with the thought of getting formal training in acupuncture and trialing it in my menopausal patients.

But you know what? I don’t think I could stand take sitting for hours in a classroom with a straight face listening to someone talk about the flow of Qi (pronounced Chi). I’m sorry, but the way Chinese medicine explains itself is still too steeped in non-scientific silliness for me to completely embrace its teachings. Don’t tell me my Qi is blocked – Talk to me in real biologic terms. It’s not meridians, and it’s not Yin and Yang. It’s neurotransmitters and antibodies and cytokines and calcium channels and renal tubule function and LH and FSH and estrogen receptors. And if you dont know how it works, that’s okay. I can handle that.

I always say that the human body is the car we’re being asked to repair without ever having a manufacturer’s manual. But Chinese medicine teaches like they have the manual, and the manual says that the engine runs on Chi. ‘Cmon, guys. It’s the 21st Century. Can you at least try to make it relevent to what we’ve learned about the human body since you came up with this stuff in the 5th century?

Now, Chinese medicine uses herbs a lot. And it’s no suprise that they have found, as has Western medicine, that certain plants have medicinal properties. This is good. But they still have to prove that they work. Of course I have no way of knowing if they’ve proven anything, because we really don’t have access to the Chinese medical literature. And if I did, who knows if it would be filled with well done clinical trials, or just lots of articles about Qi.

I do know that some of the plants and compounds we use in the West are actually quite similar to those in Eastern medicine. For example, some Chinese herbal remedies used to treat menopausal symptoms, when analyzed, are found to have estrogen in them. Black Cohosh, an herb used in China as well as in the West, probably helps hot flashes. But just try to find out what’s really in the mixtures the Chinese practitioners hand out.

It’s not that I distrust Chinese practitioners themselves. I believe that, for the most part, traditional Chinese practitioners are sincere and ethical in their practice. And I don’t think they’re in it for the money. They don’t overcharge their patients for saliva hormone levels and hair metal screens, or try to sell them thousands of dollars worth of vitamins and powders. And they don’t do infomercials.

But their way of practicing is based on traditional mixtures, mixtures that vary from province to province. You can never really know what you are getting, even if they tell you the name, because every area has it’s own recipe for that name. (Sort of like Gumbo in Louisiana.) And honestly, I’m not sure that the Chinese docs themselves know what’s in their mixtures. And that’s a little scary.

It makes no sense to me that here in America, where every food manufacturer is required to list ingredients on the package, Chinese practioners are allowed to hand out medicinal herbs without regulation. And Americans are more than willing to take them. Usually the very same Americans that are screaming at the FDA about Vioxx. (Not that I’m defending Merck. No, no. One of these days I’ll post on what I really think about Big Pharma.)

It’s the complete blind faith that some of my patients have in Chinese remedies, when it is accompanied by complete distrust of anything Western medicine has to offer, that irks me. Nothing drives me crazier than to sit and have a patient grill me for a half hour about the potential side effects of anything I prescribe, then tell me she’s taking Chinese herbs whose name she doesn’t even know.

Let me warn you. Chinese herbs have been found to be tainted with poisonous heavy metals. One Chinese herb, Aristolochia, has been found to cause kidney failure, kidney cancer and death. If you are going to use Chinese medicine, please, please ask your practitioner for a detailed list of what he’s giving you. If he can’t do it, don’t take it. And unless you can tell me exactly what you are taking, don’t ask me to support you in using it. If I don’t know what’s in the bottle, I can’t recommend it. Sorry.

The NIH now has an office of complementary medicine, and clinical trials using chinese herbs and acupuncture are being published everyday. I have no doubt that some treatments will prove to be as, or more, effective than Westen medicine for some conditions. I’m just going to wait for a little more objective data before I climb on board.

Look, you want to try acupuncture? Go ahead, knock yourself out. It won’t hurt, and it may even help. And one day, who knows? It might even be me who’s sticking the needles in you. Just don’t let it keep you from getting the health care you need.

As for cupping, another traditional Chinese Medicine practice, well, it’s just plain wierd. Even if Gwyneth is doing it…

Picture Credits: Li Shih-Chen, 1518-1593. From the National Library of Medicine, Classics of Traditional Chinese Medicine, an Online Version of an Exhibit held at the NLM , NIH , October 19,1999-May 30, 2000. Gwyneth courtesy BBC. Category: Second Opinions

19 Responses to More Thoughts on Chinese Medicine

  1. I just read your Narcissus post. You are me. I check Sitemeter about eighty times a day. I wouldn’t be surprised if they serve a restraining order on me.

    Oh, and I agree with you about Chinese medicine.

    And your recipes are great.

    I’m going back to my blog now…

  2. I love your site and check it every day. I’m a ghost writer for a doctor who runs an alternative medicine practice and sometimes I wonder if she’s a fraud. However, I do believe that there is truth in the things that I write about, simply because I refuse to write anything that I can’t find peer reviewed studies to back up. In some ways, it’s my job to make sure that she doesn’t come off looking too “cooky” and because I tend to be more skeptical (and lean towards the more scientific answer) this works out well.

    On cupping… I’ve had it done several times and it’s the only thing that can get rid of my back pain! I’ve tried everything from muscle relaxers to pain relievers to exercise and accupuncture has been my saving grace. But the accupuncturist makes all of the difference because I’ve been to a bad one and all she did was hurt me more. Just thought that I would chime in with my two cents.

  3. Slightly off topic here…I made your corn muffin recipe two days ago and I have to say that they are very yummy. Unfortunately, it wasn’t as sweet as I would have liked because I did not have maple syrup handy.

    I do have a question for you though…have you tried adding cheese to it??? I’m thinking of trying it out but I’m hesitant about what it would taste like.

  4. OK, you want cytokines and receptors–but what are THEY but molecules, molecules are atoms, atoms are particles, which are actually waves….sounds like Chi to me!

    Your many valid points about anybody taking ANY unknown substance should be any patient’s credo.

    But for anybody in Women’s Health to call for double-blind studies as a means of supporting Western Medicine over alternative—PLEASE!

    Where are the double-blind studies about IUDs? Where were double-blind studies forty years ago when people started writing scripts for synthetic hormones? Where are they now comparing bio-identical hormones to synthetic?

    The studies show no benefit from electronic fetal monitoring versus regular stethescope monitoring for uncomplicated patients, yet how many women are intimidated into being confined to bed during labor by being hooked up to a monitors?
    Who did episiotomies for over thirty years before bothering to look at any data????
    Who’s looked at the effects of fetal ultrasound versus the benefit? Why is there a massive spike in Optic Nerve Atrophy that coincides directly with the diagnostic fetal ultrasound rate? Any relationship to fetal ultrasound and the massive increase in autism?

    Western Medicine, especially obstetrics and women’s health, is only occasionally scientific.

  5. Anonymous:

    Excellent points, every one. Allow me to respond:

    Waves = Chi. Great idea, I like it. I’ll believe it when you prove it, or at least get me a little closer to that proof than we are so far.

    Western Medicine = only occasionally scientific. Well, I think it’s more than occasionally so, but if your point is that it is not always scientific, you’re right. And it’s not always correct, even when it tries to be scientific.

    If you are trying to point out that Western medicine, and Women’s Health, is rife with practices that were started years ago, were not based on randomized trials, and which have since been proven wrong, you won’t get an argument from me. There is a large movement in medicine called Evidence-based Medicine that is turning Medicine inside out asking the question: “What proof is there that this treatment is effective?” (See the web site for the Cochrane Review database for a great example of this approach.) I believe that this is a good thing.

    I only ask you to take some of your skepticism and apply it as well to Eastern medicine as well. It is not Chinese medicine per se that I have problems with. It is that I see so many people who have blind faith in Chinese medicine combined with complete distrust of Western medicine. Don’t accept a Chinese treatment blindly, any more than you would accept an unnecessary episiotomy for an uncomplicated childbirth.

    I for one would love to learn more about Chinese medical practices. I do believe that in the end, it will be a combination of East and West that will serve our patients best.

    Unfortunately, I am usually unable to find the information I need to determine the safety and efficacy of most Chinese medical treatments for my patients. Perhaps with the opening of the world wide web in China, as well as easy translation tools, we will be able to get access to the Chinese medical literature and really start to understand their treatments. But what information I am able to get up till now is, in my opinion, based mostly upon terms and beliefs that have not evolved or updated since their inception in the 5th Century or earlier. I just cannot believe that the Chinese had the whole thing figured out correctly at that juncture. Sorry. I need more.

    A simple list of ingredients and dosages on a bottle would be a start.

  6. Proof?Just how many Americans die from prescription drugs each year?–We will never know,death is filed as this or that failed,but,almost never is the failure linked to western drugs.Why?,liability and insurance.Both east and west rely on Faith, that it works,a strong will can over come the negitive of both applications. Peace

  7. I can’t help but wonder if Mr. Anonymous feels that doing away with “Western” medicine would be the appropriate course of action. I find the way that alternative medicine fanatics such as him/her manage to convince themselves that all drugs and all doctors are somehow bad. How many would die without the use of medications? What is the life expectancy in China? It’s a lot higher since “Western” medicine infiltrated it’s borders that’s for sure.

  8. There are many points in your posting that I can address, however, having come across this site by chance, I’ll chose to comment on the journal reference that you included.

    You wrote, “One Chinese herb, Aristolochia, has been found to cause kidney failure, kidney cancer and death.” Your link led to Pub Med’s abstract from the journal Nephrology Dialysis Transplantation, and was associated with the Department of Nephrology, Hôpital Erasme, Brussels, Belgium. The conclusion at the end of the abstract that you referenced was, “The relationship between the cumulative ST-AF (Stephania tetrandra replacement by Aristolochia fangchi) dose and the renal failure progression rate confirms that regular ingestion of Aristolochia sp. extracts is causally involved in the onset of chronic interstitial nephropathy leading to ESRD (end-stage renal disease).”

    The participants in the study were taking the herb in a concoction for “slimming purposes”, as aristolochia is a known diuretic. “Weight loss” is not listed as part of the herb’s indications in the Materia Medica. The full article at notes that patients in the study with end-stage renal disease (ESRD) ingested what the study referred to as “significantly higher cumulative doses of ST–AF” than the chronic renal failure (CRF) group (192±13.1 g vs 138± 16.3 g).

    The traditional dosage for Aristolochiae fangchi Radix is 4.5-9 grams. (1.)

    This study had groups of patients taking as much as * 45 times * the drug’s traditional dosage, and concluded that it had adverse affects.

    Imagine doing a study of patients taking 45 times the standard dosage of some pharmaceuticals (outside of their intended purposes) and contemplate how those results would look.

    Furthermore, Chinese Herbal Medicine: Materia Medica , 3rd Ed (1.), lists Aristolochiae fangchi Radix in its section of obsolete substances with unacceptable toxicity. “The substances in this section are considered obsolete because the toxicity/benefit ratio is too high to be acceptable. While some of them may be useful under very special circumstances, due to their toxicity, we feel it is best to recommend that they not be used at all”.

    On the toxicity of Aristolochiae fangchi Radix:
    “This is the main herb involved in Belgian slimming cocktail neuropathy (BSCN). Irrational use of this herb by physicians who were not properly trained in Chinese medicine, in combination with cascara powder, acetazolamide, Belladonna extract, and Magnoliae officinalis Cortex, together with intradermal injections of artichoke extract and euphyllin and a low calorie diet, caused progressive renal fibrosis in at least 53 (possibly more than 100) young women. While the entire approach was reckless, it is clear that the kidney damage only occurred after the Chinese herbs were added to the slimming cocktail, which demonstrates their participation in the toxic mechanism. A recent study showed a high percentage (46%) of urothelial carcinoma among 39 patients who had taken the Belgian slimming cocktails, which gives credence to the notion that cumulative doses of aristolochia are a significant risk factor for urothelial carcinoma.” (If you wish further information, a list of known chemical constituents of the herb is available in this reference, including volatile oils, organic acids, alkaloids, amides, and other constituents.)

    It had traditionally been used for edema and swelling. “However, because of the toxic properties of Aristocholia, Aristolochiae fangchi Radix is no longer used in the West and will soon no longer be used in China.”

    (1.) Bensky, D., Clavey, S., Stoger, E. (2004). Chinese Herbal Medicine: Materia Medica (3rd Edition). Seattle, WA: Eastland Press.

  9. Anonymous:

    Thanks for the info, especially the reference to Materia Medica. It’s just the kind of reference I need.

    No question that Aristalochea is harmful, especially when used in extremely high doses, as you point out. Just goes to show why knowing ingredients and dosing is so important.

    If your point was that Chinese medicine is harmful only when misused by non-Chinese practitioners outside of China, I suspect that you are right.

    The problem is that I practice here in the US, and my experience with my patients is that they have no way of knowing the real credentials of the alternative practitioners they see, and have no idea of what they are taking herb wise. For all I know, what’s in their bottle could be 45 times the recommended dose in China.

    As a physician, I have to practice in the United States, where Chinese medicne and it’s treatments are not regulated.

    I know what you’re thinking. Please don’t point out the flaws in the US FDA or big pharma. I know what they are. They are the devil I know, and I have developed methods for dealing with them that I believe protect my patients as best I can while helping them as much as I can. I can read the original studies on any new drug I prescribe. I can discuss side effects with my patients.

    I can see the ingredients and dose on the bottle.

  10. I absolutely agree with listing ingredients.

    > my experience with my patients is that they have no way of knowing the real credentials of the alternative practitioners they see

    National certification exists for acupuncture and Chinese (Oriental) Medicine. Many US states also have state certification boards. Patients should always ask for practitioner credentials.

    > Thanks for the info, especially the reference to Materia Medica. It’s just the kind of reference I need.

    I agree. However, the responsibility is on you to do the research before you form your opinions. Journals on acupuncture and Chinese Medicine exist in English, published in the US, Europe, China and elsewhere. I encourage you to seek them out.

    Please exercise restraint in lumping together all non-Western medical practices based on anecdotal experience.

    PS: I almost chose not to reply to your original posting initially, as there is a near-constant barrage of misinformation, or lack of information, against acupuncture and Chinese Medicine. I cannot possibly respond to it all. I can only invite those who wish to know more to actively seek out the scientific literature.

  11. So, Anon:
    I know you are anonymous, but tell us a little about yourself. What do you Do? How is it you come to have so much expertise in Chinese Medicine? Are you a patient or a pcatitioner of Chinese medicine?

    Just curious… You comments are intersting and thought provoking, would love to have a sense of who I’m corresponding with.

  12. just compare how many people die in the use of modern medicine compared to traditional chinese medicine? sometimes we dont need scientific explanations but proof and truth! compare americans and chinese people and open your eyes which is healthier!!!!

  13. Hi,

    This is an excellent reference.

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    I am Yi Song, the founder of HolliBalance (A center holistic well being). I have always been interested in the effects of Chinese healing modalities. My grandparents served as private physicians of Chinese leaders and my ancestors were Chinese emperor’s palace doctors. My goal since my early childhood has been to relieve human beings from suffering of disease. I am a national board (National Certification Committee on Acupuncture and Oriental Medicine) Certified Diplomat in Oriental Medicine and a Licensed Acupuncturist in Massachusetts. I am devoted to having HolliBalance offer the essence of Chinese healing to the West.

    This is the high time when people must come to know that the Chinese medical system developed over 5,000 years encompasses a wide spectrum of self-cultivation and health maintenance beyond what is advocated today for a healthy living.

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  14. Chinese medicine are the very seccessful treatment for many diaease and have been using since centuries for the treatment of many disease. the thing I like most is it no side effects quality. For this reason herbal medicines are successfully apply for many serious skin conditions like lupus, Melanoma, acne,and Vitiligo
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