Qi Spot

It is but natural for many people to consider their personal philosophies and worldviews as the standard against which others must measure their versions.  I recall an incident from my first year in college.  For me, it was my first time to have classmates who did not know any Chinese, and for them, it was their first exposure to someone (there were two of us, actually), who used a language using a non latin alphabet.  (Filipino, while a malay language, currently uses a latin alphabet).

I wrote some characters on a blackboard.  My newfound friend asked, “so is there like, one character per english letter?” (the answer was no)

I hope you get the idea – for someone exposed ONLY to latin alphabets, it is assumed that the latin alphabet is the standard from which others are based.  Another example:

The Zentraedi Alphabet by Kazutaka Miyatake

The Zentraedi are a fictional alien race in Japanese cartoons, particularly the Macross series by Tatsunoko Productions.  So, an alien race who who have no concept of culture, much less a culture like ours, have an “alphabet” that corresponds one-to-one with English.  Who would have thunk it.

Let’s get this straight, the east is the east and the west is the west.  There is no “gold standard”.

So, this is the mindset people have to overcome.  When inquiring about Qi, therefore, the western mind is looking for a cultural and linguistic equivalent based on the western paradigm.  It’s like an Englishman looking for a Japanese letter representing the sound made by the letters “L” and “R”.  There isn’t any.  There’s a combination of both into one sound but that’s it.

Failing to find a single one-to-one correspondence for the meaning of the word “Qi”, the westerner ends up disappointed and skeptical.

The failure lies in those who are unaware of how to explain Qi, particularly to MDs.

Here is something I wrote in an email about this topic:

“I would start off by saying that most MD’s do not want to hear anything that sounds vaguely “supernatural”.  Of course, to folks like us, Qi isn’t supernatural, it is in fact the basis of everything – hence nature – but that’s not what it SOUNDS like to them.

So I always start by asking members of the audience to explain what they think Qi is, while gently correcting.  I then also show that Qi has a wide variety of meanings depending the context.  I use “sheng qi” (get angry), to explain that in this sense, qi is physiology as the blood rises to the head when one gets angry as sheng qi literally means bring forth qi.  ”Tian Qi” or weather, to imply that Qi has a “communication” and “status” aspect (status as in state of being) as tian means heaven and so tian qi can mean the state of the heavens or the nature of the heavens at a given time.  Qi has a breath or air aspect as when we say hot air balloon or qi qiu (qi ball).

Once that fundamental is established, I then narrow it down to medical terms.  Qi therefore has something to do with physiology, a state of being, a breathing or dynamic aspect.  Hence, when we say “qi flows” it means natural function is present.  If qi is blocked, then function is impaired.”

“(Instead of sounding New Agey by going through the philosophy of Qi is, we can simplify it by just saying)… that “Qi” has many meanings in english, just like the greeks had about seven or so different words for one english word love.  One meaning of Qi with most relevance to the body is physiology.  Acupuncture has been proven to release NO (nitrous or nitric oxide, I forget) which is a vasodilator, making blood vessels larger and facilitating better blood flow – that’s why acupoints with needles turn slight red.  Hence, when we say Qi is unblocked, in biomedicine we can say the physiology is facilitated or made more efficient.  Nothing supernatural, nothing gimmicky, just proper translation of terms.”

Again, this is not a comprehensive explanation of exactly what Qi is, but it is my personal method of explaining it to MDs in such a way as to make the concept more relevant to them.

I know I haven’t blogged in a while – very hectic schedule and all – but I simply must greet my handful of readers a Merry Christmas and a Happy New Year!

Yes, that’s the title of an article published today in the Philippine Star.  (http://www.philstar.com/Article.aspx?articleId=630865&publicationSubCategoryId=63)

The way the headline is written, one would think that the warning issued was against Chinese Medicine as in Chinese Medicine the tradition, such as the medicine I practice.  It does not say “Warning Issued On Chinese Medicines” or “Warning Issued on Fake Chinese Medicine”.  No, it uses the general term “Warning Issued on Chinese Medicine”.

I will quote the article in full here:

MANILA, Philippines – People are urged to exercise caution when taking Chinese medicine.

Speaking to reporters, Leonila Ocampo, Philippine Pharmaceutical Association (PPA) president, said many Chinese medicinal and herbal products are not registered with the Food and Drug Administration (FDA).

Therefore they are considered counterfeit, although legitimate in the country where they were manufactured, she added.

Under Republic Act 8203, or the Special Law on Counterfeit Drugs, fake medicine pertains to unregistered imported drug products, Ocampo said.

Dr. Minerva Calimag, Philippine Medical Association (PMA) food, drugs and cosmetics committee chairman, said security in the country’s coasts is weak, enabling smugglers to bring in counterfeit medicine.

“If fake drugs are coming from outside (the country), our problem is how to secure the borders because there are many channels through which it could come into the market,” she said.

The government must be able to prevent the entry of counterfeit drugs into the country, Calimag said.

The PPA and PMA are members of Samahan Laban sa Pekeng Gamot.

It has been estimated that one of every 10 drugs in the country is fake, based on the cases reported to the FDA.

The country’s pharmaceutical market is steadily growing, making it a target of counterfeiters.

In its website, Samahan has identified Binondo, Manila as among the hotspots for counterfeit medicine.

The funny part is, I actually AGREE with most of what is said in the article.

Yes, there are tons of smuggled Chinese medicine products of questionable integrity.  I am the FIRST to admit that probably half of all over the counter drugs sold in Chinese drugstores are of poor quality or fake.

But in NO WAY should that merit a headline that passes judgment on the Chinese medical tradition as a whole!

Now for the one part of the article I don’t agree with: the idea that if a Chinese materia medica does not pass through the FDA, it should not be used at all.

Hence, let’s ban drinking tea for health purposes.

Let’s ban the use of ginger tea or salabat to relieve sore throat.

Let’s ban the use of eating watermelon to keep cool.

Why? Because those are all examples of using materials in the Chinese tradition, as per my previous post.

Shall I go on?  Let’s not use tawas or alum to relieve body odor.  That’s a materia medica used in Chinese medicine, to relieve Heat which manifests as body odor.

Let’s not massage using ginger oils for body aches, let’s ban medicinal massage, let’s ban…

You get the idea.

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.

I was referred a patient, three months pregnant, for management of migraine, nausea and vomiting.  (Note to skeptics, the patient was referred by her neurologist, which proves that there is definitely a way for east and west to team up.)  One can imagine the thoughts that ran through my mind, “time to review the so-called forbidden points”.

Common sense dictates that the management of a pregnant patient, using whatever medical tradition, requires special care.  Certain drugs can’t be given, certain manipulations are discouraged, etc.  Acupuncture wise, there are points that are traditionally forbidden as strong stimulation on them would cause uterine contractions.  I shan’t mention them here for fear that the less-than-holy might use these points to induce artificial abortions.  Sorry but I don’t want to advocate that.

Anyhow it got me thinking.  The points are forbidden because strong stimulation might cause contractions.  What if no stimulation is done?  This is not an exact science because I have sometimes elicited strong qi sensations from patients despite having just inserting a needle.  To be safe, avoid using aforementioned points then.

The second reason that some points are forbidden during pregnancy is because of anatomic location.  Granted, specialists in acupuncture anesthesia for cesarean sections are used to putting in six inch needles in the abdomen, but the general population, even of highly trained acupuncturists, would rather not risk having needles anywhere near a fetus.

Another school of thought is this: use the non-anatomic (first category) forbidden points, but keep the stimulation down (as mentioned before) and keep the number of needles down.  In other words, it’s not the individual point stimulation, but the sum total of all stimulations that are important to prevent premature uterine contraction.

To be safe, I keep the number of needles down, and avoid the “forbidden” points as much as possible.

And the patient’s symptoms are much improved, btw.