Archive for tag: books

Acupuncture or ER?

No one likes to be wrong. No one likes to admit that his or her medicine is not the best. When a patient walks into the room seeking treatment, we each want to be the one to say, "Yes, we can help you." While acupuncture has successfully treated the masses for thousands of years, and has been recommended by the World Health Organization for dozens of conditions and diseases, it's not the only tool in the shed in 2015.


On Thursday at Cook County Hospital, I sat at the computer in a treatment room entering the subjective information from an existing patient presenting with a new chief complaint -- left calf pain. We'd treated her in the acupuncture wing of the outpatient pain clinic before, but her chief complaint was usually lower back pain. Initially, I thought "another case of sciatica," as I worked through her SOAP note and mentally scanned the best acupuncture points for the job.


"Sharp pain in the back of my leg," she said, gingerly touching her left calf. I asked, "When did it start, and have you had this pain before?" "Yesterday, and NO," she snapped back at me. "It's so swollen and the pain is sharp right here," she added. She confirmed that there had been no trauma to the area, and I released my grip and let the pack of needles slide deeper down into my lab coat pocket.

I'm kind of new here, and I readily admit that my weakness as an acupuncture intern is ruling out contraindications and sorting out red flags before I start sticking needles into the patient. Can I still needle you if your blood pressure is 150/90? Some books say yes, some sources say no. Acupuncture lowers blood pressure, so shouldn't we go ahead and do it? Refer out! Confusion. "It's normal," everyone assures me. "You'll gain that confidence through clinical experience over time." Well, as a third year acupuncture student, I don't feel like it's been enough time. I walk into the head clinician's office and start presenting the case. Something just this patient.


The beauty of my internship at Stroger Hospital is that although it's not set up to be an integrative treatment experience for each patient, it can transform into one in under 60 seconds. Our calf pain patient came into the acupuncture wing of the pain clinic, but upon suspicion of an emergency situation (yes, we were all thinking "Deep Vein Thrombosis" or "DVT" at this point in the show), we went two doors down the hall and snagged an MD intern to evaluate her presentation from a western perspective, too.


He quickly assessed her signs and symptoms and agreed that we needed to rule out a DVT before moving ahead with her regularly scheduled acupuncture treatment at that time. Within seconds, our integrated team had changed course, explained the testing process to the patient, called over to the ER, and had a nurse transport the patient.

For thousands of years the expansive Chinese empire developed what we now call "Traditional Chinese Medicine," or "Oriental Medicine," of which acupuncture and herbs form the foundation. A complete and effective medical system, the doctors not only placed needles, administered herbal formulas, gave hands-on manipulations, moxibustion, and cupping treatments, but also did bone-setting and any other emergency medicine that was required. Today, in the United States, our scope of practice is generally not so extensive as to include bone-setting, but we respect the completeness of the TCM system in its entirety.


This does not mean, though, that we ignore the advancements of other medical systems or technologies. It means that instead of blindly accepting the often too-invasive and side-effect ridden treatment plans of the mainstream western medical system, we utilize only the elements that we see as truly necessary or complementary to a holistic treatment plan. In short, I LOVE DIAGNOSTIC IMAGING. Sure, it's wrong sometimes, giving false positives and false negatives alike, but overall it gives us a somewhat clearer look inside the human body than what we can piece together by looking at a patient's tongue and feeling her pulses.

I'm not saying that modern diagnostic imaging is necessary for an acupuncturist to be effective in treating modern patients, but it is another tool in the shed nowadays. The shed has grown larger in the past 50 years, but it's also full of a lot of junk. Often the expert walks in, picks up the best tool for the job -- the one he's trained to use most confidently -- and steps over the rest. The skill is being adept in choosing those tools that are best suited for the situation, even if they aren't from the same pile.

"The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease." Thanks, Thomas A. Edison. I like that quote. Doctors of Oriental Medicine, herbalists, and acupuncturists generally give herbs as part of a complete treatment plan, but giving a pill to pop -- whether pharmaceutical, peppermint, or deer antler-- is not the only way to help.


The doctor of the future will be truly integrative. He will skillfully diagnose the patient's whole body, mind, and spiritual condition, drawing from both hands-on examination findings and high-tech imaging of internal structures. In the future, when the patient presents with the new chief complaint of acute calf pain and swelling, we can use modern imaging to quickly rule out the DVT and then use acupuncture to treat her condition and balance her body. We can give her qi gong exercises and dietary changes to support her long-term health and wellness. Thomas Edison will be proud.


Further Reading: The Patient Will See You Now: The Future of Medicine is in Your Hands by Eric Topol

Peanut Butter and Me

2015-04-16_1Yep, it's called "peanut butter and me," not "peanut butter and I," because it's about to be used as the object of the sentence -- not the subject of the sentence. Grammar geeks unite! The premise here today is that a line has to be drawn in the sand between peanut butter and me. If we keep our breakfast meeting love affair going much longer, an accumulation of pathogenic phlegm is bound to ruin my life.

Don't go throwing out your peanut butter just yet. It might be fine for you to gobble down a Tablespoon of that rich creamy goodness every hour on the hour. Not for me, though. It's not good for me. One of my favorite parts of Traditional Chinese Medicine is the individualization for each person. It makes me feel special. Even though I'm really put off by the idea that I should not be eating my life-long companion, peanut butter, I still appreciate that the recommendation is personalized for my exact condition of body-mind-spirit.

2015-04-16_2I thought I was good to go. A couple of years ago I honed in on what I thought were the most important concerns encircling peanut butter and me. I knew I wanted to avoid pesticides, so I found an organic peanut butter. In my continued pursuit to ditch all things plastic and sub in glass containers, I found an organic peanut butter in a glass jar. Just peanuts and sea salt. Mmmmm, salt. Bonus points for how reasonably priced it was and how the USDA organic seal means the peanuts were not of the genetically modified variety. Grand.

Then I went on with my life, pleased with my research and findings. I smeared my glorious peanut butter on my hearty slice of organic sprouted grains bread every morning. Starting my day off right, oh yah! Sometimes I'd add a few slices of bananas and really pat myself on the back -- three food groups represented, once you count the liberal pour of cream into my coffee. I should have been feeling awesome...but I wasn't.


What was happening? I was getting damper and phlegmier by the day. It couldn't be my precious breakfast turning on me... could it? I whip out my trusty TCM-friendly food resource, Healing Whole Foods: Asian Traditions and Modern Nutrition, which I highly recommend, and I flip to the peanut butter section. It wasn't fantastic. Tears may have been shed. Here's a summary:

2015-04-16_4Peanuts are warming and sweet, affecting the Lung and Spleen systems in TCM; peanuts lubricate the intestines and harmonize the Stomach. OK, fine so far. Peanuts can increase the milk supply of nursing mothers, clear blood from the urine, treat deafness, and lower blood pressure. Great, but not applicable; moving on. Then the book takes a turn for the worst. Peanuts "greatly slow the metabolism of the Liver. Therefore they should be avoided by overweight, damp, sluggish, yeast-infected, or cancerous persons."

SCREEEEEEEECH, went my brain. I definitely have the damp, sometimes feel sluggish, and of course lose sleep at night wondering if I have every cancer under the sun. Maybe I shouldn't eat the peanut butter? What about moderation? I'm usually on board with everything in moderation. Even the book says peanuts can be helpful sometimes, for some people. "Peanuts can benefit the person with fast metabolism such as the thin, nervous person who digests large amounts of food rapidly." Well, crap. That's not the loophole I was hoping to see.

I scan the book quickly, going through the introduction in the chapter, "Nuts and Seeds," hoping to see any type of justification for me continuing to scarf peanut butter every morning. What's the general guideline they give before branching out to discuss each specific nut? "Nuts all follow a pattern of being rich in fat and protein and therefore should be used ... to tonify thedeficientperson; avoid them in cases ofexcess and dampness." Game over. I, like most overfed, over-stressed, and under-exercised Americans, am a ball of excess patterns. Stasis, stagnation, damp-heat, phlegm. Check, check, check, check!


The only passage I liked in the entire section on peanuts was the justification for eating organic peanut butter. The author notes "Peanuts are often heavily sprayed with chemicals and grown on land saturated with synthetic fertilizers. In addition, they are subject to the carcinogenic fungus aflatoxin. Organic peanuts should therefore be used -- they contain fewer chemical residues, and are less subject to aflatoxin."

Suggestions abound in this section. Nuts are serious. It states to only buy nuts in the shell, because nuts lose their nutrients after being hulled or shelled. Yikes, who's doing that? "Store hulled seeds in dark bottles in cold places... Do not store in plastic. Oil-rich food combines with plastic to form plasticides." Eww. "Toxins tend to accumulate in all seeds, so it is important to buy organic non-sprayed ones." Got it.


What's the conclusion today? Is it a.) Never eat seeds, nuts, or nut butters ever again? No, thankfully, I'm not saying that -- to you or to myself. The better answer is b.) Take your condition into account and eat smaller, less frequent amounts of organic, non-GMO options. Balance it out with other foods that drain damp and transform phlegm. Hint: it's not a banana, unfortunately. Wamp, wamp.

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!


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...

I Want It Now

Over the past four weeks in my "Nutrition and Food Therapy of Oriental Medicine" course, I've been frustrated and slightly puzzled over the subject matter. I'm usually more a go-with-the-flow student in class; I'm sure the instructor knows what we need to cover and how to cover it. This time around, I still think he knows what we need to cover and how to lay it out, but I'm not as easy going about the whole thing for some reason.

Maybe it's because it's springtime, so my Liver wind is swirling and I'm irritable. Perhaps I'm overly critical because dietetics is my personal favorite element of oriental medicine. Maybe I'm just a jerk. I don't know. I want to study therapeutic properties of foods, and I want to right now!


Let me start by saying how much I like this professor and every class I've had with him to date. The theory behind where we stick these needles and which herbal formulas we recommend is absolutely mind blowing. He taught me two years ago that winter has a color and a flavor -- black and salty, for the record. Yet each week, we seem to review the basics -- flavors and temperatures of substances. The course title indicates that the focus of the classwork will be nutrition and food therapy within the framework of oriental medicine, so I keep wanting more -- more detail, more examples, more ideas of how to alter a person's diet in order to improve health.

As we approach the famed Week Five Quiz that now makes an appearance in most classes, I'm starting to second-guess myself. Have we been just reviewing the basics of five-phase theory, or did the professor slip pages of new detail into the lectures when I wasn't looking? I'm sure he worked new information into the framework so smoothly that my associate learning didn't even know what was happening.

My frustration with this class is that I love the topic so much that I can't reach a satiation point. I will never have enough detail about food therapy to be content. I want more, I want it now, and I want to share it with everyone I know...and some people I don't even know yet.

2014-06-04_teaOnce again, springtime has duped me. I'm irritable, I'm impatient, and my Liver is out of control. Feel my pulse, second position on the left wrist. Can you say "wiry?"

As I do from time to time, I realize now it's time to reread the Dao de Jing, or the Tao Te Ching. Same book. Oh, pinyin, you are a beast that cannot be pinned down. The point is that this book, this short, easy to read, little book, can save your sanity. Whenever I feel overwhelmed, overstressed, over Livery in any way, I know it's time to pick it up.

Look at this thing. Lao Tzu, you genius!

"Those who know do not speak.
Those who speak do not know."

I, and just about everyone else, could learn a little something from that eloquent one-liner (two-liner?).

"Rushing into action, you fail. Trying to grasp things, you lose them.
Forcing a project to completion, you ruin what was almost ripe."

I don't even like poetry, but this stuff is literally masterful.

2014-06-04_wordsSo, why I am frustrated in Nutrition class? Why do I want to rush it? Why am I desperately grasping at the next piece of information? It's that "forcing a project to completion" part, that part I love for personal reasons. My procrastination has been vindicated!

As a professor, I often wait until the deadline to return students' papers; as a student, I expect my professors to grade my paper today! Actually, I don't think Lao Tzu would like that part.