Qi Spot

Greetings all! I know it’s been a while since I’ve blogged, so here we go – merry christmas, happy hanukah, happy new year, happy chinese new year happy valentine’s day yada yada been there done that.

What I wish to write about to day is a sharing of a personal experience with some research I’m involved with in the Philippine General Hospital, teaching hospital of the University of the Philippines College of Medicine.

Yes, skeptics, there IS research being done in reputable state universities.  Then again the skeptics have already ignored the research done at the University of Vermont and the University of  Munich (click the links!) so why won’t they ignore this one?

Anyway, the research is supposed to be a cross-sectional study comparing the preventive effects of acupuncture versus propranolol in the treatment of migraine.  What I would like to comment on is the initial procedure that the residents wanted to do.

Initially, the idea of the other researchers was to pick a set of points and use that same set of points on EVERY PATIENT.  Following the principles of traditional chinese medicine, I said that that shouldn’t be the case.  I understand that their objective was to standardize the treatment.  I pointed out that chinese medicine emphasizes the root cause of the headache/migraine and address those causes.  The points to be used depend on those factors, as well as the location and nature of the pain.

This is NOT how to treat headache using acupuncture.

In the end, what the protocol we submitted (which was subsequently approved by the appropriate committees) was that we would come up with a POOL of points to choose from.  Other factors would be there would only be ONE acupuncturist to diagnose, select from the pool and insert/manipulate the needles.  That will try to eliminate skill variation in practitioners.

When that study gets published, you guys will be the first to know about it!

P.S. – Gotta love this study

http://www.healthcmi.com/index.php/acupuncturist-news-online/495-acupunctureceusbrainstrokerepair

Last time, I talked about Suan Zao Ren Tang and mentioned some things about the main ingredient, Suan Zao Ren (Sour Date Seed).  I now present to the reader some excerpts from a 2002 study:

Chen, et al.  Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan in 2002. eCAM Advance Access published online on April 1, 2009.
eCAM, doi:10.1093/ecam/nep018 (http://ecam.oxfordjournals.org/cgi/content/full/nep018)

Let’s go specifically into the part on Suan Zao Ren.

The second most commonly used Chinese herb for subjects with insomnia in our study was Suan-zao-ren (Z. spinosa). It is the chief ingredient in the formula of Suan-zao-ren-tang. In an animal model, Peng et al. (29) reported that Suan-zao-ren had a sedative effect at higher doses and an anxiolytic effect at lower doses. In addition, Zhang et al. (30) indicated that Jujuboside A, one of the components of Suan-zao-ren, produced its sedative–hypnotic effects through effecting the actions of anti-calcium-binding proteins and it inhibited the glutamate-mediated excitatorysignaling pathway in the hippocampus. Jiang et al. (31) also reported that saponins, the main bioactive components of Suan-zao-ren, could prolong the sleeping time induced by barbiturates. In addition, Ma et al. (32) revealed that sanjoinine A, an alkaloid compound of Suan-zao-ren, might regulate GABAergic neurons and further increase the sleeping time and decrease the sleep latency induced by pentobarbital. Notably, there was a case report indicating that Suan-zao-ren could interact with the antidepressant, venlafaxine (Efexor), thereby leading to an acute serotonin reaction (33).

So nice to see that traditional Chinese Medicine is being STUDIED and PROVEN to work.  Here are the research papers cited by Chen et al:

1. Peng WH, Hsieh MT, Lee YS, Lin YC, Liao J. Anxiolytic effect of seed of Ziziphus jujuba in mouse models of anxiety. J Ethnopharmacol ( 2000;) 72:: 435–41. 
2. Zhang M, Ning G, Shou C, Lu Y, Hong D, Zheng X. Inhibitory effect of jujuboside A on glutamate-mediated excitatory signal pathway in hippocampus. Planta Med ( 2003;) 69:: 692–5. 
3. Jiang JG, Huang XJ, Chen J. Separation and purification of saponins from Semen Ziziphus jujuba and their sedative and hypnotic effects. J Pharm Pharmacol ( 2007;) 59:: 1175–80. 
4. Ma Y, Han H, Eun JS, Kim HC, Hong JT, Oh KW. Sanjoinine A isolated from Zizyphi Spinosi Semen augments pentobarbital-induced sleeping behaviors through the modification of GABA-ergic systems. Biol Pharm Bull ( 2007;) 30:: 1748–53. 
5. Stewart DE. Venlafaxine and sour date nut. Am J Psychiatry ( 2004;) 161:: 1129–30.

The other herbs in the formula include Chuanxiong, Fuling, Zhimu and Gancao.  The effects of each material seems obvious at first.  From a Chinese pharmacologic point of view, Chuanxiong regulates liver blood and clears blood stasis, Zhu Mu clears deficiency heat and nourishes yin, Gan Cao harmonizes, but what about Fu Ling?  Fu Ling is known for draining dampness, but it should be noted that it enters the Heart meridian as well and thus, has an effect of tranquilizing the mind and calming the spirit.

I had read somewhere that the formula as a whole lowers epinephrine levels, but have yet to find the actual research stating such.

This formula was first noted in Zhang Zhongjing’s “Essentials from the Golden Cabinet”, around 208 AD.  Truly a brilliant man.

I am a big fan of sleep.  I believe that good sleep is the best medicine, not just laughter.  I would like to write about a patient of mine, a fifty-something male, with complaints of hypertension and insomnia.

I was not the first TCM physician who the patient saw.  He had been given herbs before but his hypertension was still unabated.  When I saw him for the first time, history revealed that he had severe insomnia.  Logic dictates that his hypertension could be due to the lack of sleep.

Acupuncture, however, did not work at all.  I tried the patent remedy Zao Ren An Shen Ye, which helped a bit, but not so much.  Also, his blood pressure was still in the 180/100 range.  Not acceptable to me.

I brought out the heavy artillery.  I decided to use Suan Zao Ren Tang (Sour Jujube decoction).

After three days of taking the formula, the patient followed up.  He is sleeping better and his blood pressure is down to 140/90.  Talk about treating the branch by treating the root!

So what’s so special about Sour Jujube?

Wild Chinese Jujube, courtesy foodsnherbs.com

A lot of people know about Da Zao (jujube or red dates) but what about Suan Zao Ren or sour jujube seeds?

Suan Zao Ren is sweet and sour in flavor, meaning it tonifies and preserves yin and fluids.  It’s nature is neutral so it will neither promote nor modulate physiology and inflammation.  It enters the Heart and Liver meridians so it affects the Mind through the Heart and the Qi through the Liver.  Great Chief herb.

Anyway that’s enough for now.  In a few days we will present an analysis of Suan Zao Ren Tang – the formula itself!

Granted, I haven’t been posting as frequently since coming back from China (more on my busy 2nd week of August later), but I am glad that my humble little nook in cyberspace is being noticed.

30 Best Blogs to Learn More About Acupuncture/ was a blog post dated August 9 that listed (obviously) 30 websites.  The author had divided his 30 blogs into three types – General Alternative Medicine, Acupuncture Specific, and Health Centers.  This blog you’re reading fell into the second category.

Not only did the author post a link to the main site itself, but he/she also posted a link to some articles he/she thought were the best posts.  So my posts are worth rating now! Ha ha.

Unfortunately my name got spelled wrong… as usual.

Evidence Based Medicine

This article (http://www.voxy.co.nz/national/urban-myth-evidence-based-medicine/5/27647) does a good job of presenting the proof that the argument that western medicine is “evidenced based” does not hold water.  Some excerpts:

Studies from 1991 estimated that only 15% of medical interventions practiced by doctors were supported by solid scientific evidence.

More recently it has been estimated decisions made by doctors using such science ranges widely from 11% to 70%. “Hardly ringing endorsement of medicine as science” says Dr Wayne Jonas, author of the AMA’s paper `Scientific Evidence and Medical Practice’. (download PDF here)

Basically, what Jonas is saying is that (and this is especially true for general practitioners or family doctors), physicians tend to rely more on personal experience:

Primary care physicians appear to value evidence types differently than taught in standard EBM and in a way more consistent with the CAM practitioners in the study by Tilburt and colleagues.  Gabbay and le May performed an in-depth observational study of how physicians and nurse practitioners use evidence in making clinical decisions. Rather than systematic evaluation of current evidence from RCTs or even the use of current guidelines, conventional primary care practitioners rely on what Gabbay and le May called “mindlines.” Mindlines involved using tacit, internal guidelines derived from physicians’ own experiences and the opinion of colleagues in “communities of practice.” Indeed, physicians often distrusted the results of RCTs as relevant for the patients they see and instead used opinions of trusted peers.

So how does this affect acupuncture an other so-called unscientific practices?  The article says:

Wrote the study’s high ranking nursing professor authors: “If orthodox medicine is practiced on the basis of scientific evidence, as is claimed by its practitioners, such variations defy explanation,” with them adding, “… in view of such admissions, it seems incredible that medical practitioners have been trying to undermine the practice of complementary therapists because of their lack of an appropriate evidence base.”

This lack of EBM has been a criticism long levelled at holistic or natural health practitioners. Yet just as it’s being revealed how little of modern medicine actually relies on solid science, the global popularity of holistic treatments is itself driving a body of evidence proving their effectiveness. (emphasis mine)

Typical bias – those against chinese medicine will ignore all the evidence proving it, while ignoring evidence against their own positions.

Sources:

“Urban Myth? Evidence-Based Medicine” voxy.co.nz 19 October 2009.  19 October 2009 <http://www.voxy.co.nz/national/urban-myth-evidence-based-medicine/5/27647>