Posts Tagged ‘TRADITIONAL CHINESE MEDICINE’

Stiff Necks, Wind and Nature

Wednesday, 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?

Wednesday, 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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‘Fighting’ cancer or other life-thereatening diseases

Sunday, July 11th, 2010

I was just reading a Telegraph article today entitled “Socialising with others ‘can help fight cancer’”. The headline led me to ‘put pen to paper’.

From my clinical experience, one of the most prevalent causes of disease, whether it be a bad back or whether it be heart disease, is the unconscious refusal or inability to freely and honestly express ourselves as we truly are. The most common example of this is in the work we choose to engage in to earn a living.

The whole idea of recovering from a life-threatening disease, like cancer, being a ‘fight’, I find difficult to get my mind round. My appreciation of disease processes is clearly influenced by my style of medicine, Traditional Chinese Medicine (TCM) with its range of therapeutic techniques, such as acupuncture. TCM is holistic in its approach to healthcare. Holism states that body and mind are inextricably linked so what happens to one will have an inevitable knock-on effect on the function of the other. Holism understands that disease is not some random, chance occurrence that we have little or no control over. Even geneticists attribute only 25% of our state of health to our inheritance. My own personal experience of scrutinising my state of health, and intermittent fall from good health over the years, has yielded a clear connection between this and my thought processes. Scrutinising the health of thousands of others in my professional capacity, and studying research and the clinical experience of others far more experienced and talented than me, has corroborated my conclusions.

Gradually, modern medicine is starting to fully appreciate the huge influence our state of mind has on our health. This is really well summarised in Adrian Leader and    book “Why do People get Ill?” ), available from our online shop. Literally, we are what we think. It is becoming increasingly evident that our thought processes create our diseases, whether they involve physical or mental symptoms, or both. We can say that our heart condition has been brought on by working intensely under stressful circumstances for a prolonged period of time, but what thought processes have led us to work like this in the first place. For example, if during our upbringing, we have thought, for whatever reason, that we needed to ‘achieve’ in order to gain ‘acceptance’ or ‘love’ from our parents, then this might have trained the habit of ‘flogging’ ourselves in our work life.

Holistic healthcare is about helping each individual bring their unconscious motivations into conscious awareness whilst using tried and tested techniques to facilitate recovery from the current disease-state. We do this by stimulating the body’s own, already amazingly well-equipped self-preservation systems. When an individual understands their disease process as part of who they are, they see that there can be no ‘fight’ against cancer because the cancer is a part of them. There is no external ‘enemy’ to fight. They have literally created their circumstances by their thoughts words and deeds in their life to date. Therefore, the only long-term, sustainable solution is through new thoughts, words and deeds. So, in my mind, self-understanding is the key. As far as I can see, achieving self-understanding is a process, often long and arduous, which is why we are often well-advised to seek external help when experiencing a life-threatening disease state.

The word ‘fight’ often implies a struggle. Because of the negative connotations this idea holds, this is just likely to make the process of recovery that much more difficult. So, I believe that our best chance of survival is to embrace the symptoms we are suffering as messages sent from deep inside us as an aid to reaching fullness. This way we can utilise the healing power of love, love of our self and the people around us and of life. Being diagnosed with a life-threatening illness is probably one of the best wake-up calls we will ever get in helping us to express ourselves as we truly are. So let’s embrace it. Or, as the motif on one of the Tai Chi students in my class says: “make tea, not war!”

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Healthcare for the New Millenium

Monday, March 8th, 2010

I was asked to provide comment for the Sunday Times Style Magazine about illnesses that modern medicine has a tough time trying to diagnose and treat. Of course, I draw mainly upon my own clinical experince in making such comment. However, it seems to me that there is a lesson to be learned here on how we manage anything in this country of ours, not just healthcare. Anyway, here was my submission (I wonder how different it looks when it is published?):

“Modern medicine is utterly impressive if you are critically ill, have a  broken leg or some very clearly defined medical problem. The challenge for modern, NHS medicine is where the sufferer’s condition less easily lends itself to simple categorisation into broad groups for generalised treatment, with drugs say. In my experience, healthcare problems such as Chronic Fatigue Syndrome, food intolerances and Irritable Bowel Syndrome, for example, seem to pose difficulties for the GP that Acupuncturists and Traditional Chinese Medical clinicians do not seem to experience. That is not to say that we have a quick-fix solution for patients. It is just that we have certain advantages over NHS methods. For example, we have the luxury of time, generally spending much longer with the patient than is possible in an NHS setting. Also, our diagnostic framework enables us to make a unique diagnosis for each individual followed by a very tailored treatment plan. In this way, the treatment is much more targeted and will involve a process of self-understanding for the patients in terms of development of the illness, its root cause in terms of what they have or have not done to precipitate it, and by deduction, a route out of the situation. It’s a healing process that they can have an active involvement in rather than being prescribed a ‘pill’ and returning to the mêlée of life that has probably caused the problem in the first place.

We have many patients that consult us with a range of disparate symptoms for which they have been prescribed a variety of medications. Each symptom has been treated as an entirely separate problem. However, when we re-diagnose from a Chinese Medical perspective, it becomes very obvious that all these symptoms are part of the same disease process that has been initiated by an unsatisfying job, abusive personal relationship or just a sedentary lifestyle.

Because the NHS is ‘medicine designed for the masses’, the diagnostic approach has become ‘for the masses’. In other words, all sufferers have to fit into a pre-defined medical category. Moreover, the result of this medical categorisation is a standardised approach for all sufferers. This is compounded by the sheer volume pressure that our NHS doctors are faced with. Our quick fix society has seen to it that the doctor’s work is never done. The general attitude to health seems to be “I’ll break myself, but you can fix me” shifting the whole responsibility of healing to the doctor.

There is a parallel here with the business world. Businesses that manage by fire-fighting at the very least fail to grow and at worst they just fail completely. A longer term, big picture strategic management approach to business often reaps rewards that far outweigh the initial investment in terms of time and other resources. I think that our public healthcare systems need to follow a similar approach. As a country, we have proved to ourselves that we cannot just listen to a symptoms and prescribe a symptomatic solution for the patient. If we do, even if this symptom disappears, others follow as the root problem within the life of the individual has not been addressed. A famous Chinese physician, Li Shi Zhen, said “all illness is rooted in life”. I think that public healthcare needs to embrace this philosophy pretty soon if it is to manage the huge demand that it is experiencing for healthcare in this country”

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QI

Tuesday, August 4th, 2009

If you come for some treatment with a Chinese medical acupuncturist, he or she will probably talk to you, sooner or later, about your Qi. Qi, sometimes spelt ‘Chi’, is one of the key concepts of Traditional Chinese Medicine (TCM), a form of healthcare whose roots date back at least 2,500 years. To understand anything about TCM, you need to understand what Qi is, and also to begin to recognise it in your own experience. Whilst for any Chinese person (except perhaps one who has been so thoroughly westernized as to lose touch with their roots), Qi is an everyday reality, as it will be indeed for any westerner who has trained in disciplines such as T’ai Chi or Chi Kung, for many people in the west Qi is still a strange and foreign concept.

Qi is not only a key idea in Chinese Medicine, it is a key concept in traditional Chinese thought, and no understanding of Chinese philosophy, Chinese religion, or, indeed, what may be termed Chinese science, is possible without grasping something of the meaning of Qi. Chinese civilization is of course very ancient and very sophisticated, and the notion of Qi has been central to how the Chinese have understood the human condition for millennia. However, and this is perhaps illustrative of the traditional Chinese approach to life which is so different from the western approach, Qi is not easily defined or tied down.

Qi is sometimes translated as ‘energy’ or ‘vital energy’. Perhaps the key thing to understand about Qi is that, in a healthy person, it flows. It flows all around the body, on the surface and through the interior, in a network of channels or meridians. In fact all movement in the body, including the circulation of blood and other body fluids, is governed by Qi. Qi also warms and invigorates the body, and aspects of Qi are responsible for defending the body against external pathogens, in a way analogous, to some extent, to the western notion of the immune system. Qi includes both what we would call mind and matter; the subtlest thought is a movement of Qi, just as much as is the movement of food through the digestive system. Patients experience Qi as an unusual dull achy or tingling feeling around the needle, or propagating along the meridian from the needle; this feeling arises when the acupuncturist inserts the needle so as to contact the patient’s Qi.

When people started practicing acupuncture in the west, some people scoffed at the notion of Qi and the meridians, because, they thought, in western medicine there was nothing corresponding to them. The meridians do not correspond to blood vessels for example, or to nerves. However, more recently researchers have been investigating the matter further, partly because acupuncture is so obviously effective – no less a body that the World Health Organization1 lists a number of medical conditions for which it considers that research shows that acupuncture treatment is of proven effectiveness.

Some of the research into how acupuncture works from a western perspective2 shows that the meridians may correspond to lines of slightly decreased electrical resistance, which would suggest that Qi may, at least in part, be made up of micro currents of electricity. (Modern acupuncturists sometimes make use of this fact to locate acupuncture points using a simple device to measure variations in electrical resistance on the skin, although whether this is a more effective technique than the traditional palpatory skill of the acupuncturist is open to question.)

Other research projects suggest that the meridians may be related to connective tissue3, the fibrous support structure for body tissues and organs. The insertion of an acupuncture needle into a traditional acupuncture point may cause changes in local connective tissue which are both long lasting and capable of influencing distant parts of the body, since the connective tissue forms a continuous matrix throughout the body. Since nerve fibres are embedded in connective tissue, the needle may also have modulatory effects on nerve signals. The meridian system may also be explained in part by the notion of migratory tracks in interstitial fluid4, the fluid which surrounds the cells which make up the human body; cells such as mast cells (which have, amongst other functions, a key role in the immune system) and fibroblasts (which play a critical role in wound healing)

One can question, however, the necessity of explaining Qi in western scientific terms. Western science and western medicine are of course highly sophisticated bodies of knowledge, but it is perhaps a touch arrogant of us to consider that they are the be all and end all, the only way of looking at the world – after all, from the point of view of Chinese medicine, western medicine is a relatively new form of medicine. It looks at the person from a particular point of view, which gives it both strengths and weaknesses. Chinese medicine represents a different point of view, with different strengths and weaknesses. It will probably prove impossible to fully explain Chinese medicine in western terms, just as it would be impossible to fully explain western medicine in Chinese terms. The wisest course may well be to use whichever medicine is more helpful in the case in question. In modern China, in fact, this is what does happen: hospitals may be split between departments of TCM and of western medicine.

The scientific findings mentioned suggest that Qi is a relatively subtle and complex phenomenon, which is not to be explained by any one western idea but only by a combination of several (micro currents, connective tissue, interstitial fluid etc). Quite a few patients who come for acupuncture treatment are obviously ill, but western medical tests find nothing wrong with them – from a Chinese medical perspective, the problem lies at the level of Qi. At this level western medicine does not operate – western medicine is effective when the problem is more obvious. From this point of view TCM is effective at treating relatively subtle disharmonies which western medicine does not see, and also at preventing these disharmonies escalating and as it were condensing into more severe conditions.

1. WHO (2002): Acupuncture: Review and Analysis of Reports of Controlled Clinical Trials Available from URL http://apps.who.int/medicinedocs/en/d/Js4926e/5.html

2. Reichmanis M et al (1975) Electrical Correlates of Acupuncture Points IEEE Transactions on Biomedical Engineering

3. Langevin H et al (2002) Evidence of connective tissue involvement in acupuncture The FASEB Journal. 16:872-874

4. Fung P (2009) Probing the mystery of Chinese medicine meridian channels with special emphasis on the connective tissue interstitial fluid system, mechanotransduction, cells durotaxis and mast cell degranulation Chin Med 4:10

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TRADITIONAL CHINESE MEDICINE AND DYSTONIA

Saturday, July 25th, 2009

TCM is a system of medicine whose roots date back at least 2500 years, and is still evolving today. It is a holistic practice which evaluates the whole body, rather than just specific symptoms. Any side effects are rare and extremely minor when compared to conventional treatments, and its diagnostic techniques allow for great precision in treating each individual quite specifically, thus creating treatment plans which are equally precise. In effect, TCM encourages the body to regain its natural balance and therefore acts in a more subtle way than conventional medicine. It has a long and clinically verified history of effective treatment for most types of disease. Finally, it is an understandable and empowering system of treatment which helps patients to understand their disease process and thus gives them the opportunity to participate in their healing process.

Treatment in TCM may include acupuncture; the insertion of very fine needles at key points on the body, which helps to regulate the flow of energy known as Qi (pronounced ‘chee’). Other forms of TCM treatment include (but are not confined to) massage, herbal medicine, and a form of therapeutic exercise called Chi Kung. The patient can also take control of their overall health by following advice on diet, relaxation and exercise.

One of the most salient features of TCM is that it is a holistic form of medicine, which is to say that it always sees any health problem within the overall context of the human being as a whole, including the physical, emotional, mental and even spiritual aspects of the person; indeed it also sees the human being as part of the natural world in which we live, as our health is inextricably bound up with what is going on around us.
To do this TCM developed, over the centuries, a non-technical language and conceptual framework to understand illness; one of the most important concepts within TCM is that of ‘Qi’ (sometimes spelt Chi). Qi is the vital living energy of the human being, which circulates around the body in a number of channels, or meridians. Simplifying somewhat, illness arises when there is a problem with our Qi; either there is not enough of it, or it is not flowing freely, or both. Whilst Qi may still be a foreign concept to some westerners, any Chinese person will understand immediately what Qi is and be able to identify it within their own experience, and any westerner who practices the arts of Qigong (Chi Kung) or Taiji (T’ai Chi) learns this awareness from the start of their studies.
We might be tempted to ask what Qi is from a western point of view. There is a growing body of research, especially from China, which is addressing this task; one aspect of Qi would seem to be bio-electrical, the flow of tiny electrical currents around the body. However, countless generations of Chinese medical practitioners, as well as martial artists, meditators, and others, have worked with Qi without any need to understand it from a western point of view.
So how can TCM help dystonia? To begin with it is worth stressing that TCM treatment is always individualised to each patient. Whether the problem is dystonia, back-pain or the common cold, any course of CM treatment begins with a detailed consultation in which the therapist is interested in finding out not only about the problem itself, but also about every aspect of the patient’s health, from their digestion to their temperament, from how they sleep to the quality of their hearing. Pulse taking also has an important part to play in this process – practitioners of TCM are trained to glean a surprising amount of information from a patient’s pulse, paying attention not only to its rate but to numerous other aspects of the pulse such as its strength, width, smoothness and depth. Similarly examination of the patient’s tongue reveals other useful information.
This process enables the practitioner to get a clear picture of what is happening with the patient’s Qi and how the Qi of the different organ systems are interacting. The symptoms of dystonia are then viewed and understood within this context. To illustrate how this works in practice, consider the following case study:
Melissa came for treatment at the Sean Barkes Clinic for spasmodic torticollis which she had been suffering from for over three years. She suffered from neck and shoulder pain, shaking of the head, inability to move the head, and “sickly” headaches. She was having botox injections every three months, which were helping, but she was keen to discover other ways of moving forward. She also suffered from irregular and heavy periods preceded by pre-menstrual moodiness and cramping pain, and costochondritis (a swelling of a rib in the chest making breathing uncomfortable). She also reported hearing loss in her right ear.
Melissa had a demanding job which involved dealing with angry people and conflict on a daily basis, and having to remain calm and professional throughout. Such a situation is likely to lead to ‘Qi Stagnation’ – when our feelings are unable to find expression, the smooth flow of our Qi is impaired. In Melissa’s case it seemed likely that this tendency to Qi Stagnation was affecting her neck and shoulders in particular, but was also a major factor in her problems around period time – if a woman’s Qi is not flowing freely, the transition from one part of the menstrual cycle to the next is likely to be uncomfortable. The costochondritis also suggests Qi Stagnation affecting the chest. The diagnosis of Qi Stagnation was confirmed by taking Melissa’s pulse, which manifested the quality of what Chinese Medicine calls ‘wiriness’ – the pulse feels tense, a bit like a stretched elastic band. Wiriness in the pulse is more often than not caused by Qi Stagnation.
However, there was rather more to it than this. When asked about her sleep, Melissa reported that she suffered from ‘night terrors’ and woke a lot in the night. In Chinese Medicine the quality of our sleep is closely related to the quality of our blood (which is a somewhat different concept in Chinese Medicine than the western idea of blood.) The fact that Melissa also suffered from dry and gritty eyes, and had ‘floaters’ also suggested her blood was a little depleted. In Chinese Medicine one of the main functions of blood is to nourish the muscles and tendons, and if the blood is depleted these can become tense and inflexible. In Melissa’s case the blood deficiency seemed likely to be due to losing a lot of blood during her period, on top of a weakness in her digestive system that manifested in bloating and feeling tired after meals. Thus a picture was beginning to come together as to the main factors responsible for the torticollis.
Melissa was able to come in twice weekly for treatment, and acupuncture was used to smooth the flow of Qi and strengthen the digestive system. We also gave Melissa some tips on how she could modify her diet to nourish her blood and allow the digestive system to improve its functioning. Melissa reported that she felt a lot more energetic than usual, and her period was less problematic both in the run up to it and the actual bleed itself. After three treatments we began to treat the torticollis directly using one or two acupuncture points on the neck and other points lower down the body on the same meridians, to encourage the Qi to flow more smoothly through the neck and down the body. Occasionally we also used Chinese massage techniques to facilitate this process.
After five weeks of treatment Melissa reported that she felt “normal” for the first time in a long time. Her neck and shoulder pain was considerably reduced and her range of movement increased; her consultant told her that she did not need to continue with the botox injections. Melissa continues to attend for regular acupuncture treatment; whilst she was a little nervous at her first visit, being “terrified of injections”, she got over that very quickly and now enjoys coming for treatment. In her own words:
“As acupuncture treats the whole person, not only is my neck straighter and I now have more movement, I feel much better in myself. My husband keeps commenting on the improvement in my general well-being as well as my neck. I have overcome my fear of needles and as well as acupuncture I have had other Chinese therapies: cupping and gua sha, both specifically on my neck, and both appear to be effective.

I went not expecting a miracle cure. I still don’t have full movement but I have achieved a great improvement in my neck. It has also improved other medical conditions that I have suffered from, and I now enjoy it.”

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