So What Is Chinese Medicine

With the start of a new trimester here at NUHS, and -- for many -- the start of a new school year, it's the perfect time to break it down. Just what is Traditional Chinese Medicine? How does acupuncture fit into the picture? Do you have to use herbs, too? What about tui na, qi gong, and tai chi? Let's not forget about my personal favorite -- dietary therapy!

Traditional Chinese Medicine (TCM) has arguably five branches, and I'm going to give it to you as I understand it. After two full years in the Acupuncture and Oriental Medicine Program, a first professional master of science degree program, I think I'm finally scratching the surface of what the ancient Chinese had to offer.

Acupuncture

photo of woman receiving acupunctureThis is the big guy, right? Acupuncture is the most well-known branch of TCM today in the U.S., involving the insertion of needles into specific points on the body. While some other fields offer an abbreviated, "stick it where it hurts" method, we TCM acupuncturists take the entire body, its functional organ systems, and each person's general constitution into consideration when deciding where to stick the needles. I know it's confusing when you say your back hurts and I put needles in your legs, ears, and hands, but just trust me. It's all connected through energy meridians. This is also why we ask you about your poop when you come in for knee pain.

Moxibustion

photo of Chinese herbYes, it smells just like marijuana, but it's actually a different herb called ai ye in Chinese pinyin, artemesia argyi in Latin, or Mugwort in plain old English. It does come in a tightly rolled stick form, we do light the end, but instead of smoking it we hold it near an acupoint on the body. After a few minutes of pecking the moxa stick close enough to provide penetrating heat but never burning you -- I promise -- you will reap the benefits of not only pain relief but tonification of certain organ systems and the freecoursing of energy through particular meridians. It feels great, but you will have to explain to people for the rest of the day why you smell like marijuana.

Herbs

photo of Chinese herbsLike many medical systems, from western naturopathy to Indian Ayurveda, TCM has a unique Materia Medica, or giant book of herbs, their properties, and their medicinal uses. While you don't have to "do herbs," most students at NUHS work towards the full MS of Oriental Medicine (which includes the herbal coursework in addition to the acupuncture work). Interesting fact: not all "Chinese herbs" are plant-derived. Many are actually minerals, such as salt or arsenic, or animal-derived, such as deer penis or flying squirrel feces. Just seeing if you're paying attention (but yes, those are really all in the Materia Medica).

TCM­

photo of garlic and onionsLumps dietary therapy, or food therapy, into the same branch as herbal therapy above. Because I love the application of common foods and nutritional principles so much, I'm awarding it half status as its own category. Some items that we'd call "food," such as garlic or onions, are also included in the Materia Medica as medicinal herbs. They're working together -- that's the point. Who doesn't love the ancient Greek saying, "Let food be thy medicine and medicine thy food?" Thanks, Hippocrates, thy father of western medicine. The Chinese happen to agree!

Tui Na

photo of woman receive a massageCan you pronounce it? Try this: twee nah. Good job. This is most easily compared to the practice of massage. Often called "Asian Body Work," these pushing and pulling movements applied by the TCM provider to the patient's body accomplishes many of the goals of general massage, such as relaxation and improved circulation of blood and energy.

Cupping

photo of cupping treatmentThis is also where we are going to mention the practice ofcupping. Stick a fire into a glass cup to create a vacuum that pulls toxins out of the blood and releases the exterior in a "wind-cold invasion" and you have a happy patient. In my admittedly limited clinical experience, everyone loves cupping, but mind your manners. The clinic is not an a la carte menu for your pleasure. Let the intern and the clinician decide which modalities are best for your condition each day.

Qi Gong

photo of qi gong practitionerAnother new phrase for the day. Practice: chee gong. Not so bad, is it? Qi gong offers the practitioner a chance to step back, relax, and renew his or her own energy and well being. Maybe you've seen images of elderly Chinese individuals at the park, wondering why they are punching the air in slow motion. That was a group of people cultivating their qi. As Dr. Yurasek tells us interns, "You can't give it if you don't have it!" Thus, practice your qi gong postures and movements before you head in for your clinic shift.

So, there it is--most of Traditional Chinese Medicine. We could also tie in tai chi or talk about gua sha, but I have to save something for next time! If you haven't tried TCM, now is a great time. Interns are fresh off a nice two-week break, white lab coats are pristine, and everybody's anxious to try out their skills. See you in clinic!

The Twins I Found in My Garden

Nope, I did not find human remains in my garden plot. I didn't even find live children playing in there. What I'm talking about is the Siamese onion I pulled out of my soil this week during a particularly fruitful harvest.

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It had two huge shoots, and I thought I was pulling two separate onions. To my surprise, two smallish and oddly connected onions popped out. They had grown too close together, no doubt because I planted them too close together this spring. Technically, my then 3-year-old son was doing the dropping-in of the onion bulbs, so I guess I could blame him on this one. But, I won't. I'm not trying to blame anyone, or even to suggest that there is something inherently wrong with my Siamese onion twins.

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Here's their cousin(s), Extra Heads Tomato, as I called him.

What's going on here? I've recently heard about the French trend of embracing ugly produce. OK. I like heirloom tomatoes with their colorful streaks and odd plump shapes. I'm in. What's the big deal with how many lobes my vegetables have? I'm just going to eat them anyways. After a few chomps of the teeth, any tomato is going to be a total train wreck of juice, seeds, and goo.

This spring, when I planted my vegetables, I tried to open myself to what the garden wanted. Peppers over there? Sure. Potatoes in vertical containers? Alright. Make a 6-foot-tall wall of rusty metal for the snap peas to climb? You got it.

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In my Daoist journey to become more natural, harmonious, and simply of less resistance to the energy of the universe, I tried to be mindful that the garden didn't need to look perfect. Whatever it was -- that would be perfect. I don't know if was the Dao De Jing or the Tai Chi, but over the past couple of years, I've realized that I intervene too much. I need to spend more time with my mouth shut and my energy open.

As a bad artist in junior high school, I heard and repeated the phrase, "Nature isn't perfect, so you don't have to be," and used this mantra as my own whenever my mountain and tree scenes came out all wrong. Bob Ross would not have been proud. My little trees were not happy. They always looked upside down and sad. I was forcing them. I was forcing them to be perfect, with each branch directly across from another. The result was that it never looked right. It never looked real.

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As the season progresses, the trimester break approaches, and the peppers and tomatoes ripen, I remind myself that it is perfect. It doesn't have to look like it, but it...just...is.

Essential Oils or Chinese Herbs

Are essential oils (EOs) the answer to the challenging questions of how to locate, transport, store, and prepare Chinese herbs? I'm starting to think so. The more I use EOs in everyday life, in everything from cleaning my kitchen floor to healing skin wounds, and even to give my beer that summery citrus flavor, the more I see the large overlap between EOs and Chinese herbs.

2014-07-28_booksAs a student of Acupuncture and Oriental Medicine (AOM), mostly derived from Traditional Chinese Medicine (TCM), I respect and value the efficacy of a freshly decocted batch of raw Chinese herbs. I know they work, I've gained a basic understanding of why they work, but I struggle with the practicality of using them either for my family now or for a future patient population.

What are these challenges? First, there are a lot of "herbs" in TCM's Materia Medica (book of medical substances, whether plant, animal, or mineral derived). To stock a shoebox-sized amount of just most of them would require a very large storage room. Some need to be refrigerated, some need to be pulverized just prior to use, and some are illegal to use in the United States. No rhinoceros horn for you!

2014-07-28_shelvesFinding them--even the legal ones--presents yet another stumbling block. Should you order online, feign condition after condition to cache all the prescribed herbs you can squeak out of your clinician at school? Drive to Chinatown and take a stab at which shop has fresh, safe and affordable herbs? Sure enough, within a few days of making each trip to Chinatown myself I realize, "DOH! Now I need that other herb, too!" Back in the car....

After a year or so of engaging in this disorderly and expensive game of cat and mouse, I'd tried all (well, most) of these tactics--even growing some of my own! All legal, of course. Think "mint," not "ephedra." So, what's an AOM student to do? For the past year, this one's been exploring the way that high-quality EOs could fulfill many of the same needs as our Chinese herbs. How? Well, I'm not entirely sure that the properties translate exactly, but many sure seem to do just that. Let's take a look at our good friend, peppermint.

peppermint plantChinese name: Bo he. Common English name: Field Mint. Latin name: Mentha piperita. Same plant...same medicinal properties? I argue "yes." Most basically, peppermint is "cold" in nature. Both West and East agree on that. TCM goes on to add other attributes such as aromatic, acrid, and thus capable of dispelling the common wind-heat invasion (think: yellow snot and sore throat). My western manual of EOs describes peppermint as "anti-inflammatory, antibacterial and invigorating," with primary uses including "congestion, fever, influenza, heartburn." Sounds...pretty...similar!

Sure, the harvesting, processing, and distillation processes change, emphasize, or even exclude some of the chemical constituents, and the final usable product of dried bo he differs greatly in appearance from the bottle of peppermint EO. Does that mean they function differently, though? I used to harvest, dry, and lightly decoct my own bo he when I felt a wind-heat invasion coming on. It worked, as long as I was at home with my own garden and had some time to prepare it all. Lately, I've been easily reaching into my oils cabinet and tapping two drops of peppermint EO into a mug of warm water. Instant peppermint tea? Definitely. Instant medicinal answer to a wind-heat invasion? I say yes again, based on my own experiences.

2014-07-28_peppermintI'm not a chemist or a doctor, but in my experience and increasingly informed opinion, I'm finding that EOs can make a handy substitute for Chinese herbsin many cases. As with raw herbs, quality is of upmost importance when selecting an EO company. Storage, convenience and ease of use are all in favor of EOs, but they are limited in number. I haven't found one called "gecko" or "scorpion," or especially "Bear Gall Bladder," all of which are clutch entries in a TCM Materia Medica.

Conclusion: If you can manage to live and treat without the more exotic or illegal Chinese herbs, then EOs might be a practical substitute much of the time. Imagine the difference between handing a patient a bag full of raw ingredients, a pictorial instruction sheet, and a handshake full of hope that they can execute the cooking process effectively vs. handing the patient a small bottle of EO and the simple instructions to put two drops into a mug of warm water.

Extra considerations abound; this post cannot attempt to cover every angle or offer every comparison point. Granule or patent pills can make Chinese herbs more practical, while some EOs are quite expensive to purchase. Frankincense can easily run $100 per 15 ml bottle. Hey, if it's good enough for the Christ Child, you're going to have to pay up! There are also some pesky mind-blocks when trying to move seamlessly from one medical paradigm to the other. How could a TCM practitioner possibly use hot cinnamon bark and clove bud for a yellow-snot, sore throat sinus infection? Yet, that's exactly what the EO prescription is in that case. Homeopaths have no qualms with the theory of treating heat with heat, but that's not the plan in AOM!

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For now, I'll chalk this entire idea up to just another piece of evidence that an integrated approach to healthcare is truly the best option. Taking what works from any and all medical systems offers our patients the most options for being well. I'm open to that...

How a Clinic Internship Works

I get this question all of the time: "Do you acupuncture people yet?"

Yes, kind of, not really, I don't know what I'm supposed to say exactly. Do I put needles in people? Yes, of course. Should I? Well, that's where you've got me. Technically, I'm not a licensed acupuncturist yet, so I take that to mean that I can't charge people for acupuncture yet. Is it safe for me to needle people? Well, I do have my Clean Needle Technique certificate filed away somewhere....

2014-07-23_internDo I know what I'm doing? Can I help someone feel better? I don't want to be a pretentious jerk and assume the answers are "yes" here, but over the past year I've certainly had some good feedback. As a sometimes full-time and sometimes part-time student in the acupuncture program, I'm somewhere around Tri 5. I've completed a large chunk of the coursework, the whole observation phase in the clinic, and now I'm actively practicing on everyone who schedules an appointment with me in the AOM clinic on campus.

For the next year, I'll continue along in this internship, enjoying the opportunity to test out treatment strategies, hone my diagnosis skills, and figure out if "patient consents to treatment" actually belongs in the "A" or the "P" portion of the SOAP note. I'll do intakes; I'll form diagnostic impressions; I'll pow-wow with Dr. Cai, Dr. Stretch, and any other clinician I can find. I'll needle patients; I'll moxa their cold feet; and I'll do as much moving cupping as my forearm strength permits. If you're really special, I'll do tui na and I'll gua sha you afterward. Want some herbs? Sure, we have raw, granules, or patent pills. Right this way!

While the patient visits are the most important and most fun parts of the clinic internship experience, the clinic lottery is the part that causes the most anxiety among the interns. "Will I get my same shifts next tri?" "Which clinician will I work under?" "Which interns or observers will be on my shift?" All of these panic-stricken questions and many more can be heard all over campus right now -- the infamous Week 12 clinic sign-up and resulting lottery has arrived!

Photo of Stroger buildingSure, interns get to sign up for their preferred shifts and locations for clinic internships. We AOM students have the luxury of choosing the on-campus Lombard Whole Health Center clinic or driving to Stroger (Cook County Hospital) in Chicago for an off-site experience. My 45-minute commute is plenty, so I try to keep it simple and stick to the main campus. There we all are, fluttering around the sign-up sheet in the clinic lounge room, which is busting at the seams on a regular day, elbowing the interns who are actually trying to sit nicely and write SOAP notes that day.

If all goes well, there is a nice white empty slot shining and waiting just for you on the day and time that you've decided would be perfect for your upcoming trimester. In reality, someone else probably agreed and already signed up for that one. In the end, many interns are able to secure an acceptable shift and everyone survives the sign-up week. Some lucky individuals end up in the clinic lottery, where randomly drawn numbers allow devastated interns to play a sort of game-show rendition of "This will be your life next trimester."

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In my two years at NUHS, we haven't lost anyone yet! The sign-up process can be stressful for some, but by the time the next trimester rolls around, we're all just excited to start treating our patients and working with our clinicians to hone our skills. I have one more year of this endearing learning process, and then it's out into the real world for me (again). No more clinicians to ask questions of, no more easily accessible chiropractors down the hall to consult with on orthopedic issues (thanks, Dr. Anderson!), and no more half-days of work! Maybe this whole clinic deal is pretty great after all....

Whoa, I Think I Just Made Kombucha

A friend surprised me a few weeks ago by lending me her continuous brew kombucha set-up. Apparently a "symbiotic colony of bacteria and yeast" (SCOBY) isn't so appetizing to a pregnant lady. "Sure, thanks!" I naively responded. I've had a couple of bottles of kombucha tea over the years...kind of fizzy, kind of yeasty and stringy, yum. I'll give it a shot!

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What really excited me was how much money I could save by brewing the kombucha at home instead of buying it at the store. That stuff can be really expensive, and I can be really cheap. I'm also down with anything that reduces the amount of additives, preservatives, and other artificial baggage that comes with my beverages.

A week later, she shows up at my house and unloads the blessed gift--the kombucha, not the baby--in my kitchen. She starts heating up water, stirring in loose-leaf black tea, requesting all sorts of wooden spoons, cane sugar, and glass bowls. I'm trying to keep up, tossing things over to her so she could work her magic on a new batch of kombucha tea for my tasting pleasure. "It's easy--here's the directions!" Technically she stayed for another hour, but I felt like she ran out right then. I was so less prepared than I knew.

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All week, I tried but failed to resist lifting the lid and looking down into the brewing tea vessel. I imagined all sorts of bacteria riding along from my exhaled breath and taking up shop in the floating white SCOBY. It's a symbiotic colony of bacteria and yeast, and I'm surely going to disrupt the balance in there. Sure enough, at the end of the week, I panicked and almost threw out the entire 2-gallon batch of tea. Relax, Juli...maybe the black spots aren't mold...how could they not be mold? I've left a colony of bacteria and yeast on my counter all week!

Compromise with myself: I'll pick off the top layer of SCOBY (where suspicious black spots appeared), throw that out, and then move on to tasting the brew out of the spigot on the bottom. Deal! Except yuck...apparently my turbinado sugar was a big deal, because it was all wrong. I was drinking apple cider vinegar out of a pretty glass. Next compromise: I will bottle this product as apple cider vinegar and use it for marinating meat, pouring in my laundry, and catching random fruit flies in the kitchen.

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With the first batch of kombucha a near failure, I pressed on. That's the great part about a continuous brew kombucha set-up. You get to try again. Immediately. You actually kind of have to try to again immediately, because that SCOBY is calling out to you, "Feeeeed meeeee!" Armed with the recipe and faced with the challenge of having to do this all by myself this time around, I readied the supplies. Wooden spoon, glass bowl, big boiling kettle of water, sugar, loose-leaf black tea, and a cup of the old batch to use as "starter liquid" for the new batch. And, Go!

I followed directions, poured in fine evaporated cane juice this time instead of big brown bad boy turbinado sugar crystals, and put the lid on that thing for another week. I slept better, knowing that black specks in the SCOBY were most likely the remnants of the loose tea that I couldn't strain out with my low-quality kitchen equipment. This time, I tried even harder, yet still failed daily, to resist lifting the lid, breathing my germs inside the brew. Despite my breath germs, Kombucha Tea Batch #2 was a huge success!

"Holy cow, I think I just made kombucha!" This is stuff you can sell in a store, people!

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Now to challenge myself again, I attempt what is called a "second ferment" of the tea. I bottle up the delicious tangy tea and dump cherries or blueberries into the jars. I leave these jars on the counter for another three days, and then I refrigerate them to stop the fermentation process. Success again! The result was a super tasty, kind of fizzy, fruit infused kombucha batch that I slurped up in the next three days. Looks like I need to squeeze three gallons into that vessel for Batch #3....

Here's a detailed plan and recipe if you want to try this at home: How to Make Kombucha Tea. I promise, it gets easier!