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Explaining Qi to MDs

January 26th, 2011 No comments

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:

Zentradi Alphabet 300x122 Explaining Qi to MDs

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.”
When asked to elaborate, I answered:

“(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.

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I Love Mayo! (the Clinic, not the Condiment) Mayo Loves Acupuncture!

April 5th, 2010 1 comment

Why can’t more western doctors and skeptics adapt the attitude of the Mayo Clinic?

Earlier I had blogged about how a physician from the Mayo Clinic endorses acupuncture for low back pain.  Now I had chanced upon their website primer on acupuncture under the heading “Tests and Procedures”

http://www.mayoclinic.com/health/acupuncture/MY00946

Here are some notable exerpts:

Under “Definition”

Acupuncture involves the insertion of extremely thin needles in your skin at strategic points on your body. Acupuncture originated in China thousands of years ago, but over the past three decades its popularity has grown significantly within the United States.

Traditional Chinese theory explains acupuncture as a technique for balancing the flow of energy or life force — known as qi or chi (chee) — believed to flow through pathways (meridians) in your body. By inserting needles into specific points along these meridians, acupuncture practitioners believe that your energy flow will re-balance.

In contrast, many Western practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. This stimulation appears to boost the activity of your body’s natural painkillers and increase blood flow.

Nice to see that the website presents both theories with neither preference nor prejudice.

Now, under “Why It’s Done”, and this is a beaut.

Scientists don’t fully understand how or why acupuncture affects the amount of pain you feel. Several studies have found that acupuncture has little or no effect beyond that of the sham treatment used in some study participants — the control group — for comparison. The lack of firm results can be explained, in part, by the difficulty of devising a realistic but inactive stand-in for acupuncture. (emphasis mine)


Rob and stunt double I Love Mayo! (the Clinic, not the Condiment)  Mayo Loves Acupuncture!

A Good Stand-In is hard to find.

Difficulty in devising a realistic but inactive stand-in… isn’t that what I’ve been trying to point out for a long time?  How come THEY get it and some can’t? (or won’t?) (see http://qi-spot.com/2010/03/30/how-to-research-acupuncture/)

Now do we remember this line? (http://qi-spot.com/2010/03/20/new-bashing-technique-acupuncture-causes-disease/) Here’s what Mayo has to say:

The risks of acupuncture are low if you have a competent, certified acupuncture practitioner. Possible side effects and complications include:

  • Soreness, bleeding or bruising at the needle sites
  • Internal organ injury, particularly to the lungs, if the needles are pushed in too deeply
  • Infectious disease, such as hepatitis, contracted from reused needles

Again, balanced and fair and most of all, TRUTHFUL.

The rest of the site talks about who is eligible and who is not, how to prepare, what to expect, etc.  And it ends with a balanced note:

The effects of acupuncture are sometimes difficult to measure, but many people swear by it as a means to control a variety of painful conditions.

Several studies, however, show that simulated acupuncture appears to work just as well as real acupuncture. There also is evidence that acupuncture works best in people who expect it to work.

Since acupuncture has few side effects, it may be worth a try if you’re having trouble controlling pain with more-conventional methods.

I post this knowing skeptics will come in and say “see? placebo!” Yet I still do so because I am interested in the truth.  And the truth is any treatment will work better in people who expect it to work.  But the fact that it works in patients who also don’t expect it to work says something.

And yes, darned well worth a try.

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More Musings on Acupuncture Research

April 3rd, 2010 4 comments

One of the greatest frauds being intentionally perpetuated by some unscrupulous agents on both eastern and western medical “sides” is the idea that the two are mutually exclusive and never shall the two meet.  If one’s motivation is merely to profit from the medicine then it stands to benefit the practitioner to see the other side as “competition” and try to discredit it.  On the other hand, if one has in mind the benefit of the patient, then I believe one must at least be open to what the other side shall contribute.

westvseast 300x187 More Musings on Acupuncture Research

Now THIS kind of West vs East I heartily encourage!

On the “alternative” medicine side in general, there is a conscious effort to paint “Big Pharma” as some evil, money-grubbing organization deliberately poisoning the population.

On the “conventional” or western side, there is an effort by a powerful few to brand alternatives as unscientific, or at the very least, incompatible with conventional medicine.

Both are lurid extremes hurting both sides and ultimately the patient.

I acknowledge that it is difficult to reconcile apparently conflicting ideas.  Some acupuncture instructors, when training western MDs, sometimes begin their didactics by saying that the MD must first “forget” western medicine to appreciate eastern medicine.  Boulderdash.

On the other hand, I remember some of my western medicine professors in university commenting on how “primitive” Chinese medicine seems because of Chinese medicine’s use of “nature” terms in it’s vocabulary such as “wind”, “cold” and “dampness”.  It is conveniently forgotten that the root word for the western medical term “inflammation” is in fact, “flame”.

In a spirited email exchange, I was warned that I, being biased towards acupuncture (and freely admitting it, although I am not biased because of financial reasons – I could make a heckuvalot more money as a pure western MD with all the drug company money and laboratory test kickbacks…) might suffer from “cognitive dissonance” when faced with “evidence” that acupuncture apparently doesn’t work.

So what is “cognitive dissonance”?

Changingminds.org defines it thus:

This is the feeling of uncomfortable tension which comes from holding two conflicting thoughts in the mind at the same time.

Dissonance increases with:

  • The importance of the subject to us.
  • How strongly the dissonant thoughts conflict.
  • Our inability to rationalize and explain away the conflict.

Dissonance is often strong when we believe something about ourselves and then do something against that belief. If I believe I am good but do something bad, then the discomfort I feel as a result is cognitive dissonance.

Cognitive dissonance is a very powerful motivator which will often lead us to change one or other of the conflicting belief or action. The discomfort often feels like a tension between the two opposing thoughts. To release the tension we can take one of three actions:

  • Change our behavior.
  • Justify our behavior by changing the conflicting cognition.
  • Justify our behavior by adding new cognitions.

Unfortunately for skeptics I do not feel any cognitive dissonance in my practice of medicine and with the research.  It is because I realize that I am not God. I do not know everything.  No one knows everything.  What we know are bits and pieces of things, and even how they fit together is subject to personal, collective societal and cultural bias. I adapt the attitude of St. Thomas Aquinas thus, as quoted by William G. Most:

william g most More Musings on Acupuncture Research

Father William G. Most

Let us imagine that this theologian is standing on the circumference of a circle. From each of two or more points on the circumference, he tries to draw a line that will reach the center of the circle, that is, the true solution. If he has done his work well, all lines will come to a focus in the center.What will a good theologian do if not all the lines seem to focus? First, he will recheck his work for possible errors. But what should he do if he finds no error? If he is following theological rather than philosophical method, he will not try to make one line focus with another line. Rather he will say: “Now we are in theology, in lofty divine matters. It is not strange if mysteries appear. Therefore, even though I cannot see how to reconcile two lines, yet I must hold both truths.” And so, he will confess simply that he cannot go further.

(Most, William G. Grace, Predestination and the Salvific Will of God, accessed online  April 3, 2010 http://www.catholicculture.org/culture/library/most/getchap.cfm?WorkNum=214&ChapNum=4)

We are not theologians yes, and we are not dealing with “lofty divine matters”.  However the attitude should be the same. What happens if the lines don’t seem to focus? First we check for errors.

Thousands of years of experience shows that inserting a needle in acupoint Hegu relieves pain in general, and the effects are supposedly different depending on the manipulation and the patient condition.  I am but one physician, but I have duplicated this in the clinic.  I know many others who have.  Acupuncture is now accepted in many conventional hospitals in the United States to assist in childbirth (email correspondence with Dr. Eleonor Lazo, MD) Yet the skeptics who would destroy any possible synergy between the two medical traditions would try to use statistics to bash us. They say research shows that it doesn’t work.  When we show them research that shows acupuncture works, they’ll always find something to put it down, such as sample size, or it’s just a preliminary study etc etc, utterly forgetting their own sins (http://qi-spot.com/2010/02/21/another-big-pharma-cover-up/, http://qi-spot.com/2010/02/22/more-magic-numbers-this-time-its-celebrex/) And now apparently Lipitor causes increase in blood sugar too!  So much for peer review.

Is it too much for me, therefore, to suggest that when statistics apparently contradict clinical experience, we examine the statistics first?   It seems to me that when acupuncture is shown to work, the studies are supposedly “faulty” yet perfectly alright when the opposite is apparently shown.  My last post (http://qi-spot.com/2010/03/30/how-to-research-acupuncture/) shows why I believe current research paradigms for acupuncture are imperfect, thus leading to apparent conflicts.

The second problem is how we perceive if something “works”.  Most studies try to compare a treatment to the placebo effect.  I think the placebo effect is like St. Jude Thaddeus – getting a bad rap because of nomenclature.  Selling something known to be placebo is bad – you’re cheating customers.  Encouraging the placebo effect with good bedside manner – is that bad?  Now the argument is that acupuncture is “just a placebo”.  How can acupuncture be just a placebo when there are many studies (I refer the reader to http://www.acupuncture.com.au/articles/archive.html because I am too lazy to cut and paste them now) that show the specific physiological mechanisms of how it works?  A placebo by definition doesn’t do anything.  Acupuncture does something.  The question is is that something it does good?  As I have blogged before, improved sleep is good.  Easier walking is good.  Regular bowel movement is good. More energy is good. Decreased pain is good.  It had previously been pointed out that western medicine by definition should have a greater “placebo effect” due to cultural bias.  Yet acupuncture can work where western medicine doesn’t.  So much for “placebo”.

I also examine motivation.  What is my end point? To prove acupuncture works? No.  I believe it does.  To prove it doesn’t work?  Well, I’m not OUT to prove it doesn’t work, but I AM on the lookout to see where it works best, and where it sucks.  How? By personal study, reading both eastern and western medical journals (although I ignore 60s and 70s Chinese studies as those are ridiculously biased – hello cultural revolution!) By learning from the experiences of clinicians (I think it’s obvious I am biased towards the clinical experiences of great practitioners – lots of clinical pearls there) and from personal experience (I’ve developed some acupuncture manipulation tricks of my own ha ha).   I put a LOT of value on genuine clinical experience by great thinkers.  Edward Jenner was initially ridiculed for proposing his cowpox innoculation theory to protect against smallpox, because it went against the theory of the time.  Yet he was adamant because he was backed by clinical experience.

jenner 300x222 More Musings on Acupuncture Research

Edward Jenner was ridiculed for his ideas, as seen in this contemporary cartoon. (Click to enlarge)

If one is out on a witch hunt, to prove Chinese medicine doesn’t work, then everything you see will be filtered through that lens.  The same accusation can be made against me, that I see everything differently because I believe Chinese medicine works.  In that sense, we’re all bothered by cognitive dissonance!  Skeptics try to rationalize their position by citing statistics (which we know can be manipulated).  We rationalize our position by citing different statistics (which again, we acknowledge are manipulable).

I guess where I’m going with this is: unless we be like what William G. Most describes: true lovers of knowledge acknowledging our intellect is limited, we’ll be going nowhere.  In the meantime, what I do often (of course not always) works for my patients, the advice I give them based on Chinese medicine principles often (of course not always -THAT would be true placebo) works.  So if it ain’t broke, don’t fix it.

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Migraine Madness: How I Truly Began to Believe in Acupuncture

March 29th, 2010 No comments

Acupuncture did wonders for my migraines.  I had it so bad before that i had status migranosus for a week.  Imagine a whole week of having most lights and sounds burn like soldering torches.  Imagine a whole week of misery and pain.  That was the worst, thankfully.  Typically my mood would be trashed, my eyes heavy, and my head pounding.

That was there for years, only mildly relieved by sumatriptan and once I even needed ergotamine given in hospital.  I thought I was doomed to a life of drugs.

Until acupuncture.

One treatment.

Since then, for five years, nothing.  They’ve only began to return mildly recently – time for a “booster treatment”.

Anyway, once can see why I am “biased” towards acupuncture – it worked for me.

It’s also quite nice to see it verified by western medicine:

Acupuncture Eases Migraine Headache Pain
Acupuncture May Be Cost-Effective Option for Treating Chronic Headache

(http://www.webmd.com/migraines-headaches/news/20040315/acupuncture-migraine-headache-pain)

Note the term “cost-effective option”.  This means basically that it’s an option that uses up less money in the long run.  Hence, the patient benefits from the same health effects but at less cost.

By Jennifer Warner

WebMD Health News

Reviewed by Brunilda Nazario, MD

March 15, 2004 — Acupuncture may provide lasting relief from the pain of chronic headaches, such as migraines, according to a new study.

Researchers found that compared with standard medical care, acupuncture offers substantial benefits in preventing headaches and improving the quality of life for people who suffer from frequent headaches, especially migraines.

Acupuncture is commonly used to treat other types of chronic pain, but researchers say this is the first large-scale study to examine the effectiveness of acupuncture under real-life conditions. They say the results indicate that health insurance coverage of acupuncture services should be expanded to include the treatment of chronic headaches and migraine.

Darned right it should.

Pins and Needles Ease Migraine Pain

In the study, published in the March 15 issue of the British Medical Journal, researchers randomly divided 401 adults aged 18-65 years old with chronic headache (at least two headaches a month) — into two treatment groups. Participants had a history of having mostly migraine headaches.

I just found it interesting that six years ago, the BMJ seemed to support articles on acupuncture.  Now it publishes an editorial (not even a news article!) totally biased against it (see previous post).

One group received up to 12 acupuncture sessions during a three-month period in addition to standard medical care, and the other group received standard care alone.

A year later, researchers found those who received acupuncture:

  • Experienced 22 fewer days with headaches
  • Used 15% less medication
  • Made 25% fewer visits to their doctor
  • Took 15% fewer days off sick from work than the control group
  • In my case it was no headaches, 100% less medication, 100% fewer visits and no sick days from work since the acupuncture.

    One session btw.

    Researchers say one limitation of their study is that the control group did not receive a sham acupuncture intervention. Therefore, some of the benefits found among the acupuncture group may have not been caused by the actual treatment but because of the “placebo effect,” which is based on the patient’s expectations of benefit from treatment rather than the effectiveness of the treatment itself.

    But researchers say previous placebo-controlled studies have already shown that acupuncture is superior to placebo in treating migraine.

    In a related study published in the same journal, British researchers found that acupuncture improves the quality of life for people with chronic headaches at a small additional cost. They say the findings show that acupuncture is a relatively cost-effective headache therapy compared with other treatments covered by the National Health Service of the United Kingdom.

    A recent study I found (not online but I have the PDF file) entitled “Efficacy of Acupuncture for the Prophylaxis of Migraine: A multicentre randomised controlled clinical trial” (Lancet Neurology 2006;5:310-16)

    The results were:

    Findings Of 1295 patients screened, 960 were randomly assigned to a treatment group. Immediately after randomisation, 125 patients (106 from the standard group) withdrew their consent to study participation. 794 patients were analysed in the intention-to-treat popoulation and 443 in the per-protocol population. The primary outcome showed a mean reduction of 2·3 days (95% CI 1·9–2·7) in the verum acupuncture group, 1·5 days (1·1–2·0) in the sham acupuncture group, and 2·1 days (1·5–2·7) in the standard therapy group. These differences were statistically significant compared with baseline (p<0·0001), but not across the treatment groups (p=0·09). The proportion of responders, defined as patients with a reduction of migraine days by at least 50%, 26 weeks after randomisation, was 47% in the verum group, 39% in the sham acupuncture group, and 40% in the standard group (p=0·133).

    The “verum” group was defined as receiving true acupuncture, the sham were placed in random points and standard as… standard western medical care.  Note that the condition for success was “reduction of migraine days”.  Personally I find that some patients can respond by having the same amount of headaches but less intensity and duration – they hurt much less and last shorter.

    Anyway the results still show that real acupuncture works better than either sham or standard treatment.  Not statistically significant, but significant to patients.

    And doctors like me.

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    Medicine Done Right

    November 24th, 2009 No comments

    There are physicians who think “conventional” medicine is the only way to go.  There are “natural” healers who think it’s either “natural” or diabolic.  I believe that this writer, Mark Pitstick, got it right.

    Pitstick, Mark.  Chillocothe Gazette.  Posted November 23, 2009, accessed November 24, 2009. <http://www.chillicothegazette.com/article/20091123/OPINION02/911230308/Examining-the-importance-of-orthodox-care>

    Examining the importance of orthodox care

    I’m well aware of the importance of orthodox medical care. I worked in hospitals for six years and have numerous family and friends in the medical field.

    That approach is very important for emergency or crisis care — for example, a broken bone, ruptured appendix, severe trauma or serious illness. Many very intelligent and committed caregivers provide medical and surgical treatment. I wouldn’t want to practice natural health care without that backup system.

    For example, a neighbor nearly had his arm cut off. Even though it was dangling by just a few nerves and blood vessels, medical specialists helped him regain full use of his arm. My brother’s father-in-law had a ruptured abdominal aortic aneurysm 15 years ago. Thanks to emergency treatment, he lived to see his grandchildren mature and to enjoy two great-grandchildren.

    In China, they have an informal saying.  It’s something to the effect of, “don’t go to your acupuncturist if you get hit by a car”.

    My dad developed lung cancer 12 years ago. Half of one lung was removed, and he lived vitally to 80 years of age. All this is very impressive.

    However, drug and surgical treatments have little to offer for many common physical and emotional ailments. What’s worse, the side effects of those approaches can be worse than the original symptoms.

    Andrew Weil, M.D., author of “Spontaneous Healing” and “8 Weeks to Optimum Health” also recognizes the importance of acute medical treatment for emergency situations, but states: “Although allopaths (orthodox medical doctors) give lip service to the concept of preventive medicine, for practical purposes they are unable to prevent most of the diseases that disable and kill people today.”

    That’s why I recommend that my patients have a great orthodox medical doctor as well as a naturally oriented health care team. Ideally, all those practitioners communicate and cooperate so patients receive the most appropriate care.

    The right combination of natural healing approaches often can help you achieve optimal wellness. Some people still don’t know about holistic techniques and subsequently don’t enjoy the potential benefits. Others might try these approaches for a while, but give up when instant results aren’t forthcoming. Natural healing might take time, especially for chronic cases.

    Here’s an overview of the most common natural care treatments. Additional resources are listed for some modalities, and an Internet search will provide much more information.

    In the Orient, acupuncture has been used for millennia as a primary healing modality and anesthesia during major surgery. The safety and effectiveness of this approach has been well documented. In the U.S., acupuncture can be performed by specially trained health care providers: M.D., D.O., D.C., DOM (doctor of oriental medicine), and LAc (licensed acupuncturist).

    Correction, acupuncture is not the main modality for major surgery.  The legendary surgeon Hua tuo (? – 208? AD) used a combination of herbs called Mafeisan to induce anesthesia.  Acupuncture CAN be used for major surgery in theory but since the duration is unpredictable it is usually used for caesarean births (at least from what I’ve seen.)

    When healthy, I get quarterly acupuncture sessions to ensure optimal levels of energy to all parts of my body. If I develop any early symptoms, acupuncture is an important part of my therapeutic program. For example, during a time of extreme stress, I developed a tremor of my right thumb. My alternative medical doctor administered several acupuncture treatments and the shaking went away.

    For information, check the National Center for Complementary and Alternative Medicine (NCCAM) at www.nccam.nih.gov/health/acupuncture.

    Alternative medical doctors might use acupuncture, cranial adjusting, spinal manipulation, chelation therapy, dietary modification, nutritional supplementation, hyperbaric oxygen, homeopathy, heavy metal removal, light therapy, nutritional IV therapy, lifestyle counseling and other modalities.

    In general, they use pro-life methods that work with the wisdom of the body — for example, prescribing probiotics instead of or after antibiotics. Alternative medical approaches assist the body in regaining wellness instead of fighting a war against disease while viewing the body as a passive battlefield. This is a crucial distinction. The intrinsic healing abilities of the human body respond best to supportive natural care.

    Select an alternatively oriented medical doctor (M.D. or D.O.) who uses wellness principles and can identify health problems that require medication or surgery. Doctors who practice alternative therapies can be located via ACAM, the American College of Advanced Medicine; AHMA, the American Holistic Medical Association; and ABHM, the American Board of Holistic Medicine.

    In next month’s article, I’ll discuss chiropractic care, counseling, cranial adjusting, energy healing, holistic dentistry, hypnotherapy, massage, nutritional approaches, physical therapy, skin care and other natural health-care approaches.

    THIS is the way to do it, a healthy yin-yang balance between apparently opposite yet complementary philosophies.  I always liken “conventional” medicine to the shooters and playmakers and “alternative” medicine as the defense.  Sorry for the basketball reference there.

    My personal philosophy is still skewed (if you could call it that) towards Chinese medicine.  However, I am not an idiot.  I recognize it’s limitations.  If a patient needs surgery, I’ll find him a great surgeon to refer to.  If a patient needs those “toxic” chemotherapy or antibiotic drugs I’ll either prescribe them myself or refer to a specialist.  Of course, I’ll always be there to support the patient.

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