TREATING PEOPLE, NOT DISEASES

July 20th, 2011

Diseases are not isolated discrete entities. There is not something called asthma, or sinusitis, or migraine, distinct from the person suffering from it. A disease isn’t a thing inside you in a little box, separated from the rest of you. It might work that way with something as relatively unsophisticated as a car; maybe if there is something wrong with the gearbox, it does not affect all the other systems (although maybe a mechanic might think otherwise.) But a human being is much, much more complex. Another difference of course is that a human being is alive.

What this means is that medical treatment and health care needs to take cognisance of the person as a whole, and not just focus on the disease. This also has repercussions for medical research: suppose you read that research shows that statin anti-cholesterol medication reduces the risk of death from cardiovascular disease in women who take these drugs: if you are a woman, you might then conclude that you should take statins. However, it seems that such women do not in fact live any longer; they just die of something else. (See Dr. Malcolm Kendrick’s provocative book, “The Great Cholesterol Con”). The question we need to ask of any treatment is not, “does it cure the condition?”, but, “will I be healthier?”.

A simplified model of how a human being works involves thinking of them in terms of a number of systems; the respiratory system, the digestive system, the nervous system, and so on. This is no doubt an over-simplification, but even so it does not take much thought to realise that all these systems are dynamic and inter-related, so that a small change in one of these systems has knock on effects in all the others. For instance, if your digestive system gets upset, maybe through eating some dodgy take-away, this has a knock on effect on all the others because they all rely for essential nourishment on the digestive system processing what you eat. For medical treatment to be really effective, therefore, it needs to take stock of the whole person and not just focus down on one system, or even on one sub-system, as if that system existed in isolation from all the others. It doesn’t.

To understand this, consider the case of Fred. Fred grows up as a fairly healthy child, albeit with a tendency, inherited from his dad, to be a bit on the chubby side. He does well at school and goes to university to study computer science. He enjoys his subject and happily spends long hours studying away; to unwind he goes for a few (or sometimes more than a few) beers with his mates. Already he is developing something of a beer belly, which is perhaps not helped by his reliance on fast food and take-aways. Still, he does not have any major health problems and rarely if ever sees his GP, although he notices that his stools are tending to get loose and, I’m afraid to say, rather smelly.

At this point Fred is beginning to suffer from what in Traditional Chinese Medicine we call ‘Pi Qi Xu’, which basically means a weakness of the main digestive organ, the ‘Pi’. This is weakened by a poor diet, but also by excessive intellectual work (think about the way we link intellectual activity with digestion, as in phrases such as ‘food for thought’, ‘chewing it over’, and ‘digesting information’). Intellectual indigestion causes actual indigestion. A likely consequence of this disharmony is what we call ‘damp accumulation’, an over-retention of moisture in the body, manifesting, for instance, as weight gain around the abdomen, and loose smelly stools, possibly with mucus in them (charming, I know.).

Ten years down the line, Fred has a good job in IT, which unfortunately is fairly desk-bound. He is more over-weight, still fond of a few beers, and the less said about his toileting the better. But he is also struggling a bit now. Never a morning person, he now wakes with difficulty from heavy sleep and is reliant on strong coffee to get him going. Even then he is prone to lethargy and when he gets home from work he tends to slump in front of the telly a lot. He knows he should get some exercise, but the trouble is that his knees ache and are a bit swollen, and any way he hasn’t got the motivation. In Traditional Chinese Medicine this is all more dampness, which typically produces feelings of heaviness, muzziness, dullness and apathy, like being bogged down. Fred’s long-suffering girlfriend knows that something is not right (and if truth be told is not overjoyed by the lack of bedroom action these days, and the snoring), and eventually prevails on him to see the GP. The GP thinks Fred is depressed and prescribes a low-dose antidepressant.

Ten years later Fred is still taking the anti-depressant, which did at least seem to lift his mood for a while, although the effect has worn off and his GP is reluctant to increase the dose. He is snoring badly now and may have sleep apnoea. He also seems to catch colds a lot, and his sinuses are almost constantly blocked with thick mucus which is often yellow. He is also a bit wheezy if he has to walk up a flight of stairs. The dampness has led to phlegm in the lungs and sinuses. This leads to Fred having a lot of dull headaches. Although, as you may have gathered, Fred is quite good at just putting up with less than optimal health, these headaches combined with the sinus problem have really started to get to him. He tries over-the-counter decongestant medication, he goes to his GP to get some better decongestant medication, he tries using olbas oil, but nothing seems to work for very long.

However, for as long as Fred, or the people treating him, just focus on his sinus problem, nothing much is going to happen. Whether you call this disease sinusitis or not, it has not come into existence on its own, but is simply what is, for Fred, the most obvious manifestation of something which has been going on throughout his entire being for at least 20 years. Even if he finds some slick new decongestant pill that does unblock his nose, this is just suppressing a symptom rather than healing a person, and there will no doubt be some side effects from the pill which might even mean he needs another pill. (Possible side effects of one of the most common decongestants include insomnia – which will at least put a stop to the snoring – anxiety, restlessness and a fast pulse). Fred does not need treatment for sinusitis, he needs treatment for his whole being, body and soul.

Hopefully this makes clear why we say treat the person, not the disease. We sometimes talk about treatment principles, which are the goals of treatment. If we think of treating the disease, there is only one treatment principle:

• Clear the sinuses

If, however, we think of treating Fred, the person, there are many treatment principles, some of which might be:

• Clear the sinuses
• Strengthen the digestive system (the ‘Pi Qi’)
• Drain excess moisture from the body (‘drain dampness’)
• Strengthen the respiratory system
• Work with Fred to help him develop the motivation to do more exercise
• Treat the joint pain
• Help Fred develop the motivation, and the understanding, to modify his diet to avoid clogging up his system
• Help Fred to start to consider that he might benefit from cutting down on the beer

The point is that, to really clear the sinuses and keep them clear, we need to apply all of these treatment principles. This is, of course, not the work of a day, and it is undoubtedly easier in the short term to just pop a decongestant pill. It is easier for Fred, who does not have to consider changing his life much. The trouble is that, at best, this approach frees up Fred’s sinuses for a bit, without doing anything to help with his other problems. In the long run it may see him taking several pharmaceuticals – pain-killers for his knees for instance – none of which are addressing the fundamental problems.

But, if Fred gets some kind of treatment which addresses all the principles listed above, by which is meant he gets some form of holistic treatment, and if he is able to work with whoever provides this treatment, he could end up having a life which is a whole lot better than the one he is having. So that is why it is important to treat the person and not the disease.

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THE PERILS OF ‘NORMAL’ LIFE

July 7th, 2011

What makes us get ill? A big factor in a lot of cases is the kind of life we are living; a lot of the patients we see are suffering from symptoms which have been brought on directly or indirectly, by what is regarded in our society as a ‘normal’ life. This ‘normality’ involves a lot of activity. It involves working hard, perhaps for long hours, sometimes in a job which we do not really like. And then, when work finishes, we either keep on pushing our self, making sure we and our family don’t miss out on all the goodies which society has to offer – making sure we see the latest film, buy the best hi-fi, book the best holiday. The advertising industry, of course, ensures that we know that we mustn’t miss out on all these things.

A ‘normal’ life, then, involves pushing ourselves. When our energy has run out and what we really need is to relax and recuperate, what we do is to keep pushing, keep doing, keep achieving, keep getting (or trying to get). In this way we gradually draw on and expend our natural reserves of energy. Periodically we collapse in front of the telly, which unfortunately is not so effective as a means of revitalising ourselves.

This might be fine for a while, but sooner or later – depending on how strong our constitution is – it starts to affect us. Maybe we don’t sleep so well any more, or we start getting headaches, develop digestive problems such as IBS, or start suffering from anxiety or panic attacks. Different people are affected in different ways. Often we are mystified as to why these things are happening to us. This isn’t, after all, what it is like in the adverts. In the adverts, people do all the things we do, and seem perfectly healthy and happy. There must be something wrong with us.

The adverts are misleading. All the time we are being told about what is a ‘normal’ life, about how to be happy and fulfilled, but what we are being told is skewed. And then there is the ‘keep up with the Joneses’ factor. If everyone else has bought their kids the latest high-tech gadget, we are under pressure to do the same. If everyone else is working overtime to make more money, we don’t want to miss out ourselves. We don’t want to be abnormal.

In Chinese Medicine and in traditional Chinese thought in general, a key concept is the balance between Yin and Yang. In this context we can think of Yang as the active, outgoing, achieving aspect of human beings, and Yin as the receptive, reflective aspect. Health involves keeping these two in balance. In our civilization, they are out of balance; there is an over-emphasis on Yang. We don’t spend time quietly, we don’t ever get in touch with the stillness at the centre of our beings (in fact we maybe have no idea that it is even there), we don’t have time to meditate, go for a walk in the woods, or even to just drink a cup of tea for ten minutes whilst doing nothing other than gazing out of the window. (Slobbing out is not the same thing as this at all!)

What this means is that the Yin, which is not nourished in the ways it needs, gets depleted. This happens gradually. Yin deficiency results in such things as insomnia (night is the time of Yin), a low-level anxiety, and muscles that are under-nourished and tight. It can lead to things like migraine and tinnitus. And the more it is depleted, the harder it is to restore it – we can’t nip out to the supermarket and buy Yin, and we can’t just get a pill from the doctor, or a herbal pill from people like us for that matter, which will magically restore it.

This is not to say that acupuncture and Chinese herbal medicine cannot help to restore Yin over a period of time, but if meanwhile we are continuing to live a life which prioritises Yang over Yin, we will probably be just delaying the inevitable. A Chinese medical practitioner worth his or her salt, of course, will be looking to find ways of helping us to realise this as part of the treatment they provide.

We may protest that we have no choice in the matter. We have to push ourselves at work, maybe working long hours at a job we don’t even like, because we need the money. Maybe we’ve got kids who need a lot of attention, not to mention a lot of money. But there is always something we can do to change things; if we understand that our life is out of balance, if we understand what that is doing to us, we will take steps to restore some sort of harmony. The hard part is the understanding, because we are constantly being told, by the advertising industry, by the media in general – or at least some of it – what ‘normal’ is. If we don’t develop the ability to see through this, to be critical of it, we will suffer the consequences. Just accepting what we are told is ‘normal’ without thinking for ourselves is like being one of a pack of lemmings running for the cliff edge.

Fortunately there are places to turn to for support. Rather than just passively sitting in front of the TV when we have run out of steam on an evening, and passively imbibing the same old story, we can look around for alternatives. After all, over the centuries, some quite clever people have taken the trouble to sit down and think about human life and write about it. What is the best way for a human being to live? What is the best way to live a healthy life, healthy on all levels? People have asked these questions, and some of the answers they have come up with are at least worthy of our consideration. (Of course there are some TV programs which are worth watching for the same reasons – the point is not to knock TV, but to knock the passive acquiescence in a way of life which is unbalanced and unhealthy.) And there are groups of people around who are doing this, who are developing wiser ways to live, and we can hook up with some of them, perhaps. There are people around whom, whether they put it in these terms or not, live a life in which the Yin is nourished and the Yang expressed, in equal and balanced measure. Surprisingly enough, they tend to be healthier.

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The Healing Power of Touch

June 29th, 2011

At another clinic where I work in Sherwood, Nottingham, there is a cartoon on one of the notice boards which has been there for as long as I have. It shows an old man in a cloth cap sat in front of a doctor. The old man is complaining of back pain. The doctor says, “Well, at your age you have to expect a few aches and pains. Take two of these four times a day”, and hands the old man a prescription. Then you see the old man getting up to go. There is an arrow embedded in his back.

Admittedly this is a relatively rare cause of back pain, even in Nottingham (Robin Hood and all that.) It is perhaps unfair on doctors (or at least on some doctors) who must see lots of people with back pain and do not have time to examine them all. But I see it as a criticism of a form of health care in which the practitioner does not or even cannot interact fully with the patient – does not look properly at them, does not examine them, does not even touch them. It is probably only recently in the history of humanity that any kind of professed healer could treat someone in pain without even touching them.

I get the impression in my clinical practice that patients only fully feel that I have started to understand their painful condition when I start to examine them. If I put my hand on their back and they say, ‘yes that is where the pain is’, that seems to me important, possibly even the beginning of the healing process. Perhaps they feel that I have somehow validated their experience; maybe with some people if they are just given pills, they may unconsciously believe that they are being told the problem is all in their mind. They need to be interacted with on a physical level to feel they are being taken seriously. If I then say something like ‘yes, this muscle feels very tight’, or ‘it feels unusually warm to the touch here’, (or, ‘you appear to have been shot by outlaws or Native Americans’) this further validates their experience.

Furthermore, how I do this matters. If I do it in a routine, mechanical way, this feels different to the patient than if I do it with sensitivity and awareness. People can tell the difference; we are very sensitive to the way we are touched. Examining a patient who is in pain with a heightened level of care, attention and sensitivity is often the beginning of their healing process.

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IT problems?

June 14th, 2011

Sometimes I see patients whose symptoms seem to be mainly due to IT. The technological revolution has proceeded much more rapidly than biological evolution does, so that human beings aren’t ‘designed’ to be sitting at a desk operating a PC (which is what I am doing right now!). Of course there are physical symptoms that result from such behaviour. You need to try to maintain a good posture, which is easier said than done if you are engrossed in whatever it is you are doing on your PC or laptop. Even then, a lot of such activity is probably going to take its toll on your neck and shoulders, and you really need to address this with the right kind of exercise, something that is going to loosen up the neck and shoulder muscles and stimulate the flow of Qi through the tissues in those areas – in Traditional Chinese Medicine the concept of Qi, which is impossible to translate accurately, includes the idea of physiological and psychological movement and flow; a stiff neck, for example, is one in and through which there is an impairment of this free flow.
　
And then there is the mouse. In my clinical experience using a mouse a lot can lead to something rather similar to tennis elbow, damage to the tendons of the flexor muscles of the forearm. Carpal tunnel syndrome is also a possibility, and holding the forearm in the pronated position (i.e. the position it is in when you are using a mouse!) for extended periods of time may cause tension spreading up the arm into the shoulder, shoulder blade and neck.  Again there are things you can be doing to offset all this; you can get ergonomic mice which claim to reduce the risk of such injury. I’ve trained myself to be ambidextrous as far as mice are concerned, so that the strain is shared between each arm. A problem shared is a problem halved, after all! And again, exercise which gently stimulates the circulation along the meridians of the arm is going to help – meridians are the main pathways of Qi through the body. If you are really clued up you might even invest in some appropriate treatment to prevent problems arising, maybe the occasional massage or acupuncture session to help the arm (and its owner) stay in good nick. Similarly if you use a mobile a lot, there are similar issues. I suspect we will soon start to see more patients with chronic injuries caused by keypad use.
I also see patients who have eye problems as the result of computer use. Dry eyes, lazy eyes, red eyes, and so on. Again, we are not designed to be staring at a screen for hours on end. The advice is to look away regularly, but that is all too easy to forget if you are absorbed in what you are doing, or are working to a deadline. In China, apparently, school kids are taught some eye exercises and massage techniques, so that they are less likely to need spectacles! Such exercises are a must for anyone working with computers a lot; a good Chi Kung teacher or a traditional acupuncturist can teach them.
In Traditional Chinese Medicine, the eyes have a special connection with the liver, which is said to ‘open into the eyes’. This means that someone with a liver disharmony may develop eye problems, but this is a two-way street; damage to the eyes may lead to liver disharmony. A common form of liver disharmony is called liver qi stagnation, where the liver’s important function of maintaining the smooth flow of qi is impaired, something which is exacerbated by not getting enough exercise, and by frustration (as when the computer crashes, goes slow, or just does not do what you want it to do!). Liver qi stagnation can lead to symptoms such as headache, migraine, heartburn, constipation, angry outbursts etc. So an over-sedentary lifestyle which involves a lot of staring at a screen is setting you up for a few problems!
Beyond that, there is the effect on the mind and the spirit. No doubt that depends a lot on what exactly you are doing on your computer, but my sense is that in general it is easy to become over focused and to lose touch with one’s body and, consequently, with one’s emotions. The extreme examples include a South Korean who died after playing a video game non-stop for almost 50 hours – apparently he had a heart attack. My guess is that his body had been protesting at what was happening to it for a long time, but he paid no attention. More moderate examples no doubt abound. I remember treating a young man for something which had been labelled as ‘depression’; he spent a lot of his working day on the computer, and then he came home and, guess what, more computer time. He seemed to have lost touch with himself. My personal experience is that there is something subtly addictive about using things like computers; I notice that when I finish doing something like writing this, I will look for some other things to do here, check my e-mail or look at the news, as if I am somehow reluctant to disengage from the technology. Maybe I’m just lazy, but it seems something more than that. Years ago I went to some lectures by an Oxford university academic who suggested there is something narcissistic about computer use – comparing someone staring into a screen to Narcissus. In Greek mythology Narcissus (who was rather good looking) became so enamoured of staring at his reflection in a forest pool that he could not tear himself away, and so eventually died. Possibly something similar to the South Korean mentioned above.
This all suggests that anyone using technology a lot needs to make sure they keep in touch with themselves on a number of levels. The most basic level is the level of the physical body. Exercise, and especially exercise which includes an emphasis on mindfulness and awareness, is essential. The injuries involved are usually chronic ones, so that the longer that you ignore them for, the more difficult they will be to heal. More subtly is the level of the emotions; too much use of IT may (perhaps depending on what we use it for), start to cut us off from what we really feel, and, in a sense, from who we really are.
　
　
　

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Acupuncture and Oppositional Defiant Disorder

June 7th, 2011

Recently there has been some degree of outrage about a 14 year old “asbo yob” receiving taxpayer funded acupuncture treatment in an attempt to moderate his behaviour. One senses that some of the outrage may stem from the belief that “yobs” should be punished, not given what may be perceived as “feel-good” treatments, but this misses the point completely – if the treatment works and the boy in question stops causing such mayhem, then everybody wins.

However, opposition to the acupuncture treatment also comes from the belief that there is no evidence that acupuncture works for “Oppositional Defiant Disorder” which is – apparently – the diagnosis which has been made in this case. My colleague Sean Barkes was recently asked to discuss this case on BBC Radio Humberside. The debate became one of research availability. Whilst the detractors argue there is no evidence to suggest that traditional acupuncture might be helpful for ODD, Sean argued that there was. My colleague’s point was that there is an abundance of research to show that acupuncture is helpful in improving health in humans, including mental health. Inevitably, physical and mental health status affects behaviour. The other point he was trying to make was that, even if positive research evidence were available relating to the acupuncture treatment of ODD, it would not be relevant for this specific case as it is the cost to society that is the key point here.

There is a lot of research to show that acupuncture has a positive effect on people both mentally and physically; for example, it is at least as effective as anti-depressant medication in treating depression (1), it is more effective than hypnotic drugs (sleeping tablets) at treating insomnia (2), and is at least as effective as drug-therapy for managing migraines (3). Therefore we can say that it is likely to have a beneficial effect in this case. If orthodox solutions have been tried and not been effective, something needs to be done. If we know that acupuncture may have a positive effect on this individual’s mental states, it may well be that acupuncture is worth trying. What, after all, is the alternative? The alternative is probably to lock him up. This, I don’t doubt, would be a whole lot of a bigger financial burden on the tax-payer than a mere £40 a week acupuncture treatment. So there is a case to be made that trying acupuncture may well save the tax-payer a lot of money; furthermore, if it is successful, it may encourage further research in the area, which might just mean that the tax-payer saves an awful lot of money.

It is too simplistic to argue that there is no research to support the use of acupuncture in this case. Evidence for the efficacy or otherwise of any treatment for any condition does not just appear. If you have a condition for which you do not have an effective treatment, you have to try something. If you have positive results, and you can repeat these in a few other cases, you can start thinking about doing some proper research. I would think that the people responsible for trying acupuncture here deserve some credit for a bit of initiative, and in fact for looking for a solution which is much more economical than most.

A further relevant point here is the way that research is done on the effectiveness of a holistic treatment such as traditional acupuncture. Such treatment is targeted at the individual patient, rather than at the specific condition, such as ODD. However, the usual research methodology, epitomized by the Randomized Controlled Trial, focuses down onto the condition, and pretty much ignores the larger context of the patient’s general health. An RCT investigating the effectiveness of a drug to counteract high blood cholesterol, for instance, may conclude that the drug in question is effective in lowering cholesterol levels, but it does not measure or take into account such things as the side effects of that drug. The question such a trial should really address is, do people live longer when they are on the drug in question – and, perhaps, do they have a better quality of life. If people’s life expectancy is not improved by the drug, and if their quality of life is impoverished, then the fact that their cholesterol levels are lowered is of little consequence. This example illustrates the main weakness of modern western medicine, which all too easily falls into the trap of treating the condition rather than the person. It is no good improving one isolated aspect of the person’s health if their overall health suffers.

So similarly in a case like this, one would want some research which investigated, say, whether traditional acupuncture treatment reduces the cost to society of young offenders, rather than whether it helps with ODD specifically. After all, it would be of little consolation to anyone if the lad in question displayed improvement in the symptoms of ODD, such as fewer angry outbursts and less resentment, but continued with a life of crime anyway.

So, far from outrage, a more reasonable response to this story would be to welcome the possibility that a very economical holistic therapy such as acupuncture may have an important part to play in managing these kinds of anti-social behaviours in a cost-effective way. But the research which needs to be done to find out whether this indeed may be a viable approach needs to avoid over-focusing on conditions such as ODD and measure whether there is a reduction in violent and anti-social behaviour.

1. http://www.acupuncture.org.uk/research-fact-sheets/1277-acupuncture-and-depression.html
2. http://www.acupuncture.org.uk/research-fact-sheets/1283-fact-sheet-acupuncture-and-insomnia.html
3. http://www.acupuncture.org.uk/research-fact-sheets/1148-acupuncture-and-migraines.html

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What is Qi?

May 28th, 2011

What is Qi? This is a question we are often asked by patients, since Qi is such a key concept in Traditional Chinese Medicine. And indeed, even if we are not asked, we need to explain about Qi so that the patient can understand better as to what their problem is and how we are treating it. Explaining what Qi is, however, is no easy thing. Sometimes we may talk of energy circulating through the body, but this is only a very rough and ready way of understanding what Qi is.

It strikes me that there are two ways of going about answering this question. The first one is to try to explain Qi from the outside, in the abstract. The second is to encourage understanding from the inside, as an actual experience. It is a bit like if you were to ask what New York was like. One way to answer this would be to read a few books about that city, watch a film, go on the internet, even talk to some New Yorkers. Another way would be to get on a plane and go there. Or even better, to live there for a while – only then, perhaps, will you really know New York.

So you could read some books about Qi, even do some scientific experiments to try to measure it; or you could experience it. How do you experience it? Through self-awareness, especially as mediated by such practices as Qi Gong or T’ai Chi. If you really want to know, the equivalent of living in New York would be practising Qi Gong under the instruction of a master.

Practising Traditional Chinese Acupuncture in the west raises a lot of interesting problems. In particular, there is a lot of effort expended on testing, explaining and understanding this medicine scientifically – the assumption being that only medicine which has been scientifically verified can be useful, and indeed that all medicine can be scientifically verified. This leads to a lot of (quite expensive) effort in trying to understand things like acupuncture and Qi, but this understanding is almost always of the ‘read books about New York’ type, because this is how science works. This means that someone can be an expert in acupuncture and Qi, by which I mean they know all about it, but have no living experience of Qi at all.

In the Zen Buddhist tradition there are several different kinds of Zen. One type is called ‘Mouth Zen’. This is the Zen of people who know and talk a lot about Zen, probably having read hundreds of books about it, but in fact have not the faintest idea what Zen is, probably because they do not practice Zen. This illustrates, I think, the radically different approaches represented by western science on the one hand, and eastern spiritual, martial and medical traditions on the other. Of course the term ‘Mouth Zen’ is derogatory, but it would be wrong to insist that the kind of approach it represents is always inappropriate, only that there are some things (albeit rather important things) which cannot be grasped by it. Qi, and therefore acupuncture, it seems to me, may be one of these things.

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Stiff Necks, Wind and Nature

May 4th, 2011

A few days ago I woke up with a stiff neck. The focus of the discomfort was more or less around a commonly used acupuncture point just below the occiput (the back of the skull), the Chinese name for which point is ‘Fengchi‘, meaning something like ‘pool of wind’. ‘Feng’ is wind, the same word as in the well known term ‘feng shui’, literally ‘wind and water‘. It so happens that all this week it has been very windy, and it also so happens that I have been out in the wind quite a bit, on one occasion more than I would like as I waited on a rather exposed railway station for a train that never came. It also so happens that, instinctively, I don’t like being in the wind.

In Traditional Chinese Medicine, wind is regarded as a potential cause of illness or discomfort, and in fact has been so regarded for thousands of years. Imagine being a Chinese peasant working out in the paddy fields as a cold wind from the north swept across the country; or, if you don’t fancy being a peasant, imagine being an imperial official on the way to a distant outpost in the middle of a storm. That wind surely feels like it is not doing you a whole lot of good. And of course the neck is quite likely to be exposed to the wind.

Still, surely the windy weather here lately and my stiff neck are not related. After all, it wasn’t windy in my bedroom, I’m not one to sleep with the window open. Even though one of the quickest ways wind can affect us in Traditional Chinese Medicine is to give us a stiff neck. People who do sleep in a draught, or even who have an air conditioning unit blowing air on to them while they work, may know what I mean. Again, once I had got my stiff neck, I instinctively wanted to protect it from the wind.

Well, whether or not the wind had anything to do with my stiff neck, one of the beauties of Chinese Medicine is the way it locates us in a landscape, and reminds us of the intimate connection that surely exists between ourselves and the natural (or, in the case of aircon, not so natural) world around us. As such, it is an antidote to what might be thought of as a modern alienation from that world, which if you ask me is not a little involved in the health, (and maybe mental health) problems of many a westerner. As a practitioner of Traditional Chinese Medicine, I am constantly reminded of our connection with things like wind, dampness and cold, and find myself becoming, perhaps, more sensitive to how they affect me. I remember being on a meditation retreat in a somewhat exposed cottage on the North York Moors; one day it was very windy and blustery, and even though I was inside most of the time, I felt a subtle agitation creeping over me. Little children, apparently, can go a bit wild when it is windy outside. Some asthma patients report their symptoms get worse when it is windy.

So health in Traditional Chinese Medicine involves being alive to the way we interact with the world around us, which means being alive to that world. Modern medicine may sometimes poo poo this kind of thing – I remember a GP on TV saying the idea that you can catch a cold by going out with wet hair is an old wives tale – but for me one aspect of maintaining health is being alive to how we are influenced, all the time, by what is going on around us. On a practical level, that might mean wearing a scarf on a windy day. Or it might mean a nice acupuncture needle at Fengchi. But it also means a kind of return to nature.

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More harm than good?

April 27th, 2011

Sometimes we see patients, the most credible explanation of whose symptoms are that they are caused by the pharmaceutical medication they are taking. For instance, a patient presents with depression, fatigue, and nausea. The nausea is so bad that they have a hard job eating at all, which may fully or partially account for the fatigue and perhaps the depression also. If you don’t eat, you have no energy. There is no obvious reason for this patient to be depressed; it has just come upon them.

It turns out that for ten years or so they have been taking three different kinds of medication to treat their high blood pressure. If you look up the possible side effects of these drugs, you find that two of them may cause nausea, two of them may cause depression, and two of them may cause fatigue! But that is just the beginning of the story. A few years after going on these drugs, omeprazole is also prescribed, apparently to prevent ulceration in the stomach. Possible side effects of omeprazole: nausea, fatigue and depression. A few years later, like many other people, the patient is put on simvastatin to lower their blood cholesterol level. Possible side effects of simvastatin: depression, fatigue, gastro-intestinal disturbance.

For two years now the patient is also taking anti-depressants. One of the antidepressants she is currently taking can cause nausea, suppressed appetite and weight loss. The antidepressants don’t appear to be having much effect on the depression.

So why is the patient depressed? Of course one cannot rule out the possibility of some unconscious conflict, even though the patient is clearly sincere in their belief that they have nothing to be depressed about. But to me the most likely reason must be that the cocktail of drugs they are taking is lowering their mood, making them nauseous, and tiring them out. The nausea stops them eating well, indeed makes it difficult for them to eat at all, thus exacerbating the fatigue and depression. They are now taking four different drugs which can cause nausea (plus one which admits only to the more generalised ‘gastro-intestinal disturbance’), four which can cause depression, and four which can cause fatigue! On top of all that, there is the question of how these drugs interact with each other, which is perhaps something of an unanswerable question.

Listening to these stories, it is hard not to start getting depressed oneself. Do they really need to be on all these drugs? For all I know, at each stage in their medical history, whoever has prescribed the next drug may have done their best to weight up the pros and cons of that drug and decided it was the best step to take, and thought hard as to whether the patients problems were caused by the side effects of the drugs they were already on. But the patient themselves is clearly not aware of anything like that having happened. I seriously wonder if conventional treatment is just so over-reliant on pharmaceuticals that that is the only treatment option available, with the results being, sometimes, like this one.

I am not of course advocating that such a patient just stops taking their drugs. But at least questions should be asked. Do they really need the omeprazole, given its possible contribution to the nausea, fatigue and depression? Do they really need the simvastatin? Do they really, in fact, need the antidepressants, if I am right in surmising that the depression is caused by the other drugs? Above all, they need to be able to make an informed choice about what they take.

Suppose this patient had been treated holistically from the start. OK, they start off with high blood pressure. From the holistic perspective of Traditional Chinese Medicine, when a patient experiences a symptom, it is considered that their body and mind are out of balance. Treating this imbalance with acupuncture, and perhaps making suggestions as to how they could take the initiative themselves in restoring harmony, may well have had a knock on effect in bringing down the blood pressure. At least it may have meant that less pharmaceutical intervention was needed – maybe one or two drugs instead of three, maybe a lower dose. Maybe if these drugs still made them feel sick, we could have helped alleviate that nausea.

I’m not suggesting our medicine has all the answers. I’m just questioning whether the conventional approach to cases like this is over-reliant on pharmaceutical medications, and whether, therefore, there does not really need to be a more integrated, holistic approach to patient care, and whether the whole issue of side effects needs to be discussed much more fully and openly with patients, so that they can make an informed choice about their care.

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Taking Time to Recover Properly

April 13th, 2011

I am sometimes slightly shocked at how quickly people go back to work after they have been ill, although I really should not be shocked because I am like that myself! However, Traditional Chinese Medicine (and common sense) should make us think twice before rushing back into the fray. In Traditional Chinese Medicine (TCM) we speak of something called a ‘retained pathogen’; when we are ill with something like the ‘flu, bronchitis or gastroenteritis, we have been ‘invaded’ by a pathogen, i.e. by a disease-causing external agent. (Whilst related to things like viruses and bacteria, a pathogen in this sense is a somewhat broader concept, so that the pathogen can still be active even when the virus or bacteria is no longer traceable.) Getting better involves throwing off that pathogen and recovering from the damage it has done. However, if we do not allow ourselves to recover fully, the pathogen is not fully expelled and lingers within us as a ‘retained pathogen’, causing recurrent symptoms for months or even years. And indeed often we see patients with chronic health problems which seem to have started in this way.

It is tempting to blame modern life on this tendency not to recover fully, although I can’t help wondering whether a medieval peasant farmer whose crops needed bringing in, or whose cattle needed milking, or who had just noticed some rapacious Vikings heading his way, would not have responded in just the same way. Wealthy Europeans did use to resort to spas and sanatoriums to recover from serious illness or injury, but no doubt the more economically challenged did not have that luxury.

However, it seems to me that there is often a harshness in the way we treat ourselves, in the way we drive ourselves back to work, and this is combined with a sort of arrogance and unwillingness to recognise our limitations. Conversely, if we are able to acknowledge that we need to take the time to recover properly, we are acknowledging something fundamental about our nature – we are not superman or superwoman; we are a human being whose health and well-being is contingent on a variety of conditions. If we are able to acknowledge this, it is in fact not only a relief, but strangely empowering. It is a wise and kind person, in fact, who recovers properly from an illness.

And even from the economic point of view, it can be one hell of a false economy to rush back too quickly if you end up one year later with chronic fatigue syndrome.

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The Healing Ritual

April 9th, 2011

A recent piece of interesting research from Harvard(1) seems to show that the placebo effect does not depend on the patient believing that they are having a real, active treatment; even if they know they are receiving a placebo treatment, they may still benefit. This is interesting because, like most people, I had tended to assume that the placebo effect arises because we think we are being given an active treatment, and this belief somehow initiates a healing response – instead, even if we know we are just getting a placebo, we still show improvement!. One of the researchers suggests that what is important is what is called medical ritual.

The term medical ritual brings to my mind the ancient Greek healing centre at Epidauros, dedicated to the Greek god of healing, Asclepius. Here, apparently, the sick would be visited by Asclepius in their dreams and shown the way back to health. No doubt it was a highly ritualised process, a ritual which would probably include the journey to Epidauros, no small matter in those days of course; I think snakes were involved in some way also! With our modern sophistication we may dismiss such treatment as superstitious twaddle, but the research mentioned should give us pause with that.

Because, there is of course a highly ritualised element to most forms of medical treatment. If you go to see your GP, you wait in a special room with a few other nervous people, until you are admitted to the inner sanctum where the doctor is. The doctor has been initiated into the art of healing, and has a special title (‘Doctor’) and probably a lot of strange letters after his name as well, all of which is designed to impress you with his special powers. No wonder you feel a bit over-awed in his presence. You have a short interaction with the doctor, who then writes some strange and long words, words which he understands but which don’t mean very much to you, on a bit of paper which you take away with you and present to someone else in a place called a ‘pharmacy’. You then get given a special bottle of mysterious small circular things which you have to swallow. In some strange way which you don’t understand, this makes you better. (Let’s ignore the side effects for the time being!) It is all very ritualised. And, if the research mentioned above is to be believed, it might not matter too much what is actually in the little pills.

Therefore, we should not be too dismissive of those ancient Greeks, maybe they did get better. We should in fact be respectful of the importance of ritual in human life. When we are ill, especially if we are seriously ill, the healing process is in fact a ritual we need to undertake. Just as the ancient Greeks needed to journey to Epidauros and undergo their ritual dreaming treatment, we need to be doing something equivalent.

This reminds me that the clinic I work in is not just any old building. It is a place of healing, similar in its own modest way, to Epidauros. Even just coming through the door, the healing process has begun. In fact this reminds me of something new patients often say, that their symptoms have been a bit less troublesome on the day or two before they first came for treatment. Occasionally so much is this the case that they may feel a bit of a fraud, as if there is not anything wrong with them really anyway; but it may be rather that they have already started on their journey back to health by ringing up and making the appointment in the first place.

(1) “Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PLoS One, 2010 Dec 22:5(12):e15591”

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