Introduction to Traditional Chinese Medicine by David Miller MD, LAc



well thank you all for coming today as you can see there's a lot of interest in having this lecture and what I wanted to do for you guys today and this is really geared towards the medical students who are visiting with us today and is to talk about Chinese medicine as I've come to understand it and to try to help you get a window into this medicine in just a very short period of time but in a way that's sophisticated enough that hopefully you take home some valuable points all right because part of the problem that our community mean the Chinese medical community has is in conveying this information to biomedical practitioners in a way that that makes sense at all because there's a lot of language barriers a lot of language difference when we're talking about the different medicines and so that's sort of a little bit of an attempt to do this and also to organize the discussion a little bit so feel free to ask questions I'll take pauses now and then but just raise your hand or something and and we can have questions can you guys hear me back there Frank can you hear me okay talk a little louder okay I'll try all right good well thank you first to Pacific College for hosting us here this is at the Pacific College of Oriental Medicine in Chicago also thinking to the integrative medical Network which is a a project that I've been working on with Mitch Harris and a couple of other people to try to get lectures like this sort of hopefully high-quality lectures geared towards the professional community and also the public to help understand different aspects of integrative medicine and so Derek's here helping us with that today as well too the objectives of the lecture are multiple and hopefully they'll be even a more a few more that aren't listed here one is to review the known history of Chinese medicine understand the breadth of medical treatments and key concepts that are important to the medicine identify challenges in research because that's always a big question that we have especially when interfacing with a biomedical system is like how do you prove the efficacy of what you're doing and does it make any sense at all and part of whether or not you get good answers from your research is whether you ask the right questions and one of my contentions is that historically up until now lots of the questions that have been asked have not been the right questions and so we'll talk about that a little bit more to also I'd like to ask you guys to be challenged a little bit to think about how you study human physiology one of the ways one of the issues that we have is as we study physiology from a Western medical standpoint we tend to base our fizzy on a cadaveric model and from the cadaveric model we've moved on to using like a lock and key model with you know channels and antigens and mechanisms that bind to things and then cause chemical reactions to happen and that's all good and fine but I want you to think as you go through your week your a couple of weeks you are doing your integrative medicine rotation and also through medical school that you're being taught a very specific way of looking at the human body and what Chinese medicine represents is an alternate way of looking at human physiology also based on observation and that the potential for combining our sets of knowledge together and understanding the human body and the human spirit and the human person in even a bigger way through our dual lenses is is massive I think and offers a lot for for everybody in terms of moving forward with it with a medical care that's really effective for people so also improve awareness of the evidence base for acupuncture and clarify the training so you understand what it means to be an acupuncturist my my path to getting here has been you know a little bit varied I started out studying theoretical mathematics undergrad along with some philosophy and religion I took a year off after that and taught English and was learning German in Germany and then went to a postback program at Bryn Mawr to get my science classes as well – and then did my medical school at Brown University my Pediatrics residency at the U of C and then came to Pacific College ultimately and studied Chinese medicine in a four-year training program welcome to save a seat yeah in a four-year training program to really get a comprehensive look into Chinese medicine I worked for about a year and a half as a hospital I sent Michael Reese hospital before that and I liked a lot of aspects of what I was doing in the hospital I liked the interventions I liked interacting with people there are lots of pros to it but I did feel like ultimately I was being left with treatment tools that predominantly involved pharmaceutical surgery or reassurance and and there was not a lot for me to do in between those pieces and I felt like that there there had to be more ways of working with people in treating people than what I then been taught and that's one of the things that had the question in my head that led me to to continue study since that time I formed an independent practice a solo practice called east-west Integrative Medicine I've worked with Pacific for a long time doing curriculum design that designed a Pediatrics curriculum and a number of other different modules as well as doing disability evaluations which is mainstream kind of Western medicine for a group called Chicago consulting physicians group downtown also real involved in medical politics and things too so the other thing that you guys should should recognize as you do your your weeks in integrative medicine is that what you're doing is to some degree a political act also because there is a mainframe mainstream biomedical community that is calling the shots now and there are aspects of entry into that community that are controlled from within by the medical doctors and as you guys think about things and open your minds and if you start seeing things that like why aren't we using this in treatment you're going to enter into interactions with your peers and with people who are in leadership positions that are going to demand some political changes in order for you to see those results so if you decide you think acupuncture really should be available to your patients you've got to know that acupuncture is not covered under Medicare and Medicaid Services now there's no mandate to cover acupuncture there's no guarantee of cover for acupuncture and so if you want your patients to be able to get that under their insurance there's a whole structure that needs to change in order for that to happen so there is a lag time in terms of when we determine that something is potentially a useful modality for our patients and when our patients can actually access that modality and you guys are going to play a huge role in changing the paradigm that allows people access so so it's it's both an honor and a responsibility so Chinese medicine a lot of what we base our our decision-making on and our approaches on in Chinese medicine is based on historical precedent right so we consider this to be essentially a multi thousand-year-old clinical trial that's been going on and tried on lots and lots of people over many years and we base our thinking process and our decision-making process in classic texts that have been informed throughout millennia in various different ways so one of the oldest existing texts is called the huangdi neijing and the huangdi neijing dates back to the Han Dynasty which runs from about 200 BC to 200 AD in the wine DNA Jing is a very important document this is one version of it here – there's just been a new two volume pollen shield version that's come out that's probably the most authoritative source of it but this is a real nice translation the important thing about the neijing is that it's a compilation document and it represents systems of thought that were in existence prior to its being written and so when I say it represents Chinese medicine as an organized system that's that's what I mean there has been there were hundreds of years of discussions that occurred before that text came out and this is all very easily and clearly documented from an anthropological perspective so people here Chinese medicines 2,000 years old 3,000 years old four thousand years ten thousand years old there's a fuzziness in some of the dates there too that are hard to exactly document what we know it's at least this old and you should know as well that the Wong DNA Jing covers not only just what we would consider sort of biomedicine but also philosophy and sociology and mathematics and ecology and the way people interact with their environment so it's view of medicine and the physical body and how people interrelate with their environments and are affected by it is very much like the biopsychosocial model that was popular in biomedicine when I went to medical school but seems to have faded a little bit over the years depending on what program you're in there are aspects of things discussed in the huangdi neijing that appeared very archaic and archaic may not be quite the right word arcane or hard to interpret and some of that is also a translational issue some of the concepts in the huangdi neijing include concepts of yin and yang Jung not yang Jung and these work or we say to the yin-yang school of the spring and autumn period of Chinese thought so then we get back into 770 to 481 BCE so now we have whole schools of knowledge and debate and thought and academics that were set up around this concept as far back as 770 BC and then in 1993 there was a tune called the Mok Wong Dee tomb in the Hunan province that was excavated and they found this book prescriptions for 52 diseases dating back to ten 65 BC and that was represented the earliest surviving written record of Chinese herbal medicine so the herbal medicine dates back at least then 3,000 years but to have a book that's been compiled implies that people had been using the medicine for a number of hundreds of years probably before that as well so it is safe to say that the Chinese medicine easily dates back you know as far as 3,000 years potentially four to five thousand years if we look at some of the bone oracle findings – but those are a less sort of organized system those get into tribal shamanism which has some ideas that get sort of mathematically encoded and brought forward but are different sort of in how they were applied one thing that gets confused a lot of times as well is this concept of classical Chinese medicine versus traditional Chinese medicine and a lot of times you'll hear people talking about traditional Chinese medicine and they really mean classical Chinese medicine or you'll hear criticisms from your peers about Chinese medicine and they'll say that Chinese medicine was invented in the 50s by Mao right so classical Chinese medicine dates back as far as I just told you there's documentation of it it's not debatable it's anthropology it's medical anthropology it dates back 3,000 years plus that's done traditional Chinese medicine is a distillation that did occur under Mao in the 40s and 50s and there was a couple of things that drove that you know to very much simplify the discussion one was there was a need for medical care to be delivered on a mass to a mass population at a very low cost and another was an increasing interest in Western thought and Western medical ideas so what TCM does is it took all the big thinkers of the time brought them together distilled a system of commonality out of that and then systematized it so that it could be taught to people in much greater numbers and then delivered to the public it took out of the medicine a lot of the thoughts about spirituality philosophy our relationship with nature a lot of these kinds of sort of more interpersonal or spiritual really ideas and and sort of clean that up because that was not generally seen as acceptable to Western thinkers and potentially threatening for for other reasons too so that system even cleaned up like that ends up this is a great sort of overview of that this is a technical book it's not for you to sit down and read but it's just to give you an idea that even when you clean it up that much there's a massive amount of information that you end up with in terms of treating patients and looking at different ways of approaching disharmonies or diseases so you do want to make that distinction Chinese medicine was not invented in the 40s and 50s by Mao TCM is a distillation of classical Chinese medicine that did occur in the 40s and 50s and represents a simplification of classical Chinese medicine so overall I like to think of classical Chinese medicine as understood to be what I would call observational biology and by what what I mean by that is that the medicine seeks to classify behaviors in the context of the life of the people who would have been you know living and and what they were experiencing so if you worked in a damp field in the heart of the Sun they would say that would correlate to specific physiologic dis harmonies that might come from working that environment right and then also would look at certain you know aspects of consciousness that go along with doing that kind of work and also look at what kind of circuitry is within you that allows you to do certain actions so we'll talk about the acupuncture channels later in in a few minutes but I want to sort of change some of the language used from channel 2 may be circuitry for our purposes because I think that even though that may be a little objectionable to some of the Chinese medical community I don't think it has to be I think it actually gives us greater breadth of understanding of how the human organism may work so it looks at things like diet and lifestyle how emotions and outlook affect your physiology they were observing people very very carefully and that was part of the the the approach to learning at that time and it would be hard-pressed for any of us in biomedicine to say that this individual would not have a different set of disharmony than this individual would have right I mean that's kind of like that's kind of basic at the time of course there was no microscope there were no microscopes there was no sort of microbiologic or biochemical you know system set up like we have now and yet there was a systematized way of looking at cause and effect so this really is a clinical trial that's been playing out on literally billions of people over literally thousands of years and the Chinese historically and culturally are pragmatic people they don't tend to hold on to stuff that doesn't work and a lot of times this medicine really developed in a time period where you know people were dying from diseases they weren't interested in just sort of oh I feel somewhat relaxed after my acupuncture treatment they were like my family is dying of cholera what can I do about that right so they were interested in results but also I think we also underestimate the number of times the repetitions of different things have been done over the years and so I just want to point that out as well so core to the concepts of Chinese medicine include the idea that there are observable predictable commonly shared patterns that guide nature in general and health and hence health and human disease in humans that's like the fundamental tenant of Taoism you know we exist in the Dow the Dow has rules some of those rules include yin and yang some of the rules include the transformation of the five phases which you guys do not need to know about at now except that they exist and and so they were looking at systems and people think of Taoism as being very like swishy and flowy and unstructured and Taoism actually is extremely structured it's a tight mathematical system and looks for repetition of patterns in nature and how you can move with those patterns not that the patterns don't exist but how do you respond to them in a way that keeps you most healthy they were deeply deeply concerned with those questions so when we think about the scientific method right you're thinking about observation and description of a phenomenal group of phenomena formulation of a hypothesis to explain the phenomena use of that to predict the existence of other phenomena and then perform experimental tests of the predictions by several independent Behrman tours on billions of people over thousands of years and so Chinese medicine absolutely follows the scientific method in the way it gathered knowledge and in the way it applies knowledge even now as we have new systems that kind of spring up people have ideas about like point protocols and ways of dealing with you know problems that we're facing of pain control or something like that they put out there their system of ideas based on the classic system whole bunch of people go wow that sounds like an interesting idea I'm gonna try that in my clinic they try that on their patients they gather data the data is shared in a community sense and then if it works it kind of hangs around and then more people try it and then if it works it hangs around if it doesn't work people kind of forget about it and move on to something else and so there's a criticism and part of part of what I want you guys to understand too is that I'm responding to criticisms that I don't know if you guys have seen about Chinese medicine but they're made by biomedical physicians and others who say things like you know Chinese medicine is based on a system of mystical beliefs that have no basis in what we understand to be science and should just be discarded outright they will say that very clearly in in their beliefs and I want you to know that that is really really spurious and uninformed so Chinese medicine is rooted in multiple philosophic religious systems but the beauty of that is that that means that a lot of people from very different viewpoints are looking at the same body of information in to some degree coming to consensus so there's an argument about whether the Taoist get credit for the five a system or the Confucians get credit for the five phase system but everybody wants to use the five phase system because it's predictive it's applicable it's observable and and so it's it's usable so there can be debates like that but we want to be careful with that we understand what the real core of the debate is and I just also say that to that that the dynasties in China throughout the thousands of years often were culturally very different from one another they shared common threads but they they had their own flavor each time and yet this medicine was able to persist through all those different dynasties and so that tells me that people from very different sort of cultural Ingles were still able to see truth in this medicine and it tells me is somewhat of like a medical anthropologist that if I'm not understanding it and if it sounds arcane to me that's probably my failing and not the medicines failing and so when we're trying to use language in Chinese medicine we're starting with Chinese characters that then get translated to pinyin that get two interrelated to English in some form and then we try to understand and sometimes that goes through French or goes through German or it goes through some other language before it even gets to us so we're trying to understand this this this medicine from a different time in a different language and and that's pretty challenging so the language of Chinese medicine is based on the observation of natural phenomena mirrored in the human body but it's poetic so if I talk about your heart or I talk about your liver or I talk about wind or I talk about dampness I'm using those as a form of medical jargon and so if I say you experience illness from wind heat invasion right that's a medical jargon for an expression of a pattern that I see clinically it's not necessarily to say that all Chinese people believe all disease comes from wind in there no such thing as viruses that's not what they're saying they're saying when you get sick with certain types of pathogens it presents in a consistent pattern that I can identify and there are also certain cultural and clime are environmental and climatic factors that mirror those same things so if you understand wind you have to understand wind as wind right and the things that wind can do with you when you blow go out it's like Chicago so it's like negative gonna be negative 40 again soon right so wind cold is going to be a problem right but you can also understand wind as seizures because they move around the body in a unpredictable manner very much like wind does and so there's different types of wind like liver wind that is actually a seizure kind of condition potentially there's intestinal wind which is socially embarrassing but seldom life-threatening and and so different ways of using the word wind similarly Chi is a very broad-based term in Chinese medicine you can't talk about Chinese medicine without talking about Chi but you can't pigeonhole the concept of Chi only into some sort of abstract sort of life force idea and not understand it's practical implications in the medicine as well so there is an interest in sort of a vitalism and a life force and an inherent healing ability of the body that's expressed by the word cheap but the word she gets used throughout the medicine in lots of different ways so one of the criticisms I see is that the concept of Chi has no basis in human physiology that's like saying that like emotions and nervous system impulses and environmental you know heat or cold or damp or dry have no basis in human physiology it's a nonsensical statement that just tells me that the person stating it doesn't know enough about Chinese medicine to stay quiet and not say stuff like that because yeah so so what is Chinese medicine I would say in very short it's a self-contained highly incorporative whole medical system with theory developed through the observation of nature and the way individuals are reflected in and are affected by natural processes and environmental conditions that sort of the the the skinny that I would give you right there if you look at Asian medicine in general as I said it's very concerned with with Chi of lifeforce that is one of the implications of Chi but not the only one there's no absolute mind-body split which I think is a really key point and we'll talk about that more it always sees humans part of the natural world and it believes that the body will heal itself if you give it the proper conditions with which to heal itself there's a book that you guys should all read if you haven't have you seen this this is a great book and it's it's right there – I think there's a second dition a second edition out but it's one of the most meticulously referenced books about sort of like looking at mind-body medicine and how thought turns into physical response and so it's it's kind of a psychoneuroimmunology text a little bit but it's written at multiple levels so it's totally professionally you know solid and yet you know a person from the public could read it – so I consider this to sort of be a really critical piece of background reading to do in general because if we're still insisting on a mind-body split were not up to speed with Western medicine because Western physiology would say that that is a bad split to make so Chinese medicine so that's that's the overview so what causes disease from a Chinese medical standpoint so they look at things like wind damp cold heat dry these things are the external pathogenic influences and these can be understood to be both actual external pathogenic influences and also patterns of things that can that can be problematic so heat can be you know environmental heat or it can be like a heat toxin that comes in so sometimes like lead poisoning looks a lot like a damp heat pathogen to me when I see it in kids so it's a way of categorizing phenomena again to the seven emotions the seven emotions very sort of generally said are also said to be a big cause of illness and this is again looking at that mind-body connection and how consciousness affects your physiology and we'll talk about that a little more soon too and then there's sort of broad categories of trauma and indiscretions of diet and lifestyle that can do that too and I just like this chart because this is causes of disease sexual taxation which would seem to be as a big a big no-no because you have to maintain your Jing you have to maintain your essence and your capacity for reproduction for any number of reasons and that that concept Jing in and of itself is more complex than we can address today but this is how detailed they got in their observation and their recommendations if you were this age this is in this type of health this is how many times a day you should be ejaculating those are the rules and if you're violating this then you are not stepping in accordance with the DAO and you have a cause of disease either it's too much sex or not enough sex can both cause disease so I just think that's amusing so pattern recognition overall is the the guiding principle behind how you diagnose in Chinese medicine and so consequent to that there are numerous systems of organizing information and looking at different types of pattern so from that concept we see yin yang theory develop and then qi blood yin yang theory and then there's eight principal patterns five element theory or five phase theory zhang foo theory channel theory extra vessel theory in all of these different ways of looking at things and you even see evolution of thought occurring later in time so you get the the cold damage or six stages of cold invasion theory from the Shanghai Newland which is sort of towards the end of the Han Dynasty but then you get the when Bing that pops up in the 1600s so a very new player in Chinese medicine looking at hot disease and how hot environmental conditions and hot pathogens tend to damage the body and you get schools of thought that build up around those so in the current training in a full Chinese medicine program you're going to study all these different pattern systems so that when your patient comes in you're going to be it will identify what pattern best matches their disharmony and it gives you the treatment principle that follows from that diagnosis can be different to their there are some similarities and diagnosis some differences in diagnosis so one of the differences is potentially looking at tongues differently so in Chinese medicine there's a elaborate system of tongue diagnosis and ways of interpreting this information and you know I I just think that's gotta have some value to it you know from even a biomedical perspective we have a modified piece of skeletal muscle you can't see this kind of thing anywhere else in the body people stick it out and they are vastly different in their appearance and how we could say that a tongue that looks like this does not reflect a different physiologic environment than a tongue that looks like that I don't see how we could make a medical justification of that so in biomedicine we have no system similar to this to diagnose this and yet you know here's this large body of knowledge that applies it on a daily basis in clinics so somewhere in there there's got to be a conversation that could happen pulse diagnosis is also a very structured and complex in Chinese medicine this is not going to be a legible slide but that's that's okay it's not important it's in this book if you would like to look at it more closely but it classifies different pulses is reflective of different types of human physiology so treatment modalities acupuncture is the most well known treatment modality in Chinese medicine but it is not the only treatment modality in Chinese medicine herbal medicine and nutrition which go hand in hand are a huge field and what you should know about the herbs too is you'll see a lot of concerns I've had doctors say oh you know don't take those Chinese herbs they'll kill you like they don't know what they do there's no data on them or anything like that this is a textbook one of two set written by a PhD pharmacologist and licensed acupuncturist and it is full of of data about the herbs including chemical constituents studies that have been done how they work from a Chinese medical standpoint Western Studies on how they work so so criticisms like we don't know anything about how the herbs work or things it is like we know a lot about how they work and yet it's easier to say we don't and to pass them off similarly like the toxicity of herbs is often far overblown and most of the herbs that are used in Chinese medicine have ld50s in meaning safety levels essentially that far exceed anything we do in Western medicine so as we continue to have a hundred thousand deaths per year from medical errors of medications given wrong and other things done like that and while we continue to have massive problems with I just saw a headline saying that opioids are the new biggest drug of abuse for you know young kids like Chinese herbs are not killing people left and right we got to be cautious not to throw stones at our glass house there – from a biomedical standpoint it's a highly structured system very sophisticated and and just fascinating to kind of study queena massage is a therapeutic massage system used in Chinese medicine you'll see things like cupping here and Gua Sha this is moxibustion Gua Sha has an amazing technique that is has been picked up by the physical therapists as well sometimes called graston technique but it's Gua Sha and it's it's a very simple technique that uses a soft edged object literally like a soup spoon to relieve stasis from the tissues and bring it to the surfaces and I've seen people come in with you know chronica of one guy who came with chronic shoulder pain he was getting MRIs there are thousands of dollars of interventions done they wanted to do surgery we did a series of five gwasha treatments on him and he's been good to go for years now like it brought up purple dark stasis from the tissues the first time and the second time lighter the third time lighter and it just cleared up in exactly what it cleared up from a biomechanical standpoint I don't think the research has been done but it changes collagen fibers it brings lactic acid and other byproducts of metabolism out of the tissues it does those things but it's also like it's a soup spoon it costs a dollar to do I mean he could do it at home the treatment cost for some of these interventions is is virtually nil compared to what he went through to get to me before he went to surgery and you don't always get treatments results like that but you do sometimes get treatment results like that Qigong is sort of the you can sort of and make it a little analogous to yoga it's different than yoga in some critical ways but it's it's a vast study of movement and breathing and form there are internal forms of it external forms of it meaning movement based forms where movement is predominant and mental stillness is stressed in other forms where physical stillness is stressed and mental motion is cultivated in very specific ways and then lifestyle modification is huge and insight and outlook modification is huge so I want to talk about that for a second mm-hmm right right so that's a great point so that's a great point so the question is you know not so much the toxicity of the herbs and things but the standardization of the product and and and some safety issues – so I should temper what I said by saying that the the safety of herbs depends on knowing the source of your herbs so herbs can be contaminated with heavy metals and pesticides they can be like substituted one product for another that kind of looks the same you have all different degrees of quality of herbs based on where they're grown and how they're grown so properly cultivated properly sourced herbs are incredibly safe but your patients preferably are not just going somewhere random and buying those products any more than they're going to the gas station to buy their whatever energy drink of the week is happening to keep them going you want them going to someone who knows how the herbs were sourced how to manage them and that they were managed properly so that's the argument for sort of licensure and development of a profession geared around that because then you guys have some quality assurance because it's not realistic for medical doctors to know everything about Chinese herbs nor should you you should focus on being the best medical doctor you can be and if you want to learn a little bit here and there that's great but you know it's sort of like you know recognize recognize where the excellence you know is on both sides there so that's a good point very good point so this is from the neijing and this is the fourth failing of a physician this is the knee translation and he says the fourth failing occurs in counseling when a physician lacks compassion and sincerity when a physician is hasty and counseling and does not make effort to guide the patient's mind and moods in a positive way that physician has robbed the opportunity to achieve a cure so much of all illness begins in the mind and the ability to persuade the patient to change the course of perception and feeling to aid in the healing process is a requirement of a good physician so how do you fit that in with your placebo issues right so people keep trying to design studies where patients lie on the tables and you do standardized acupuncture treatments and you don't talk to them too much and you don't want to influence them and things like that like you can do those studies but that's not Chinese medicine that's not the system in which acupuncture evolved which in the neijing says you should be guiding the patient's thoughts so I would encourage you to think of acupuncture and many of the other modalities as a facilitated cognitive gating essentially rather than a placebo because the whole concept of placebo here is so oversimplified as to be incorrect because it's just not actually a placebo it's it's a different phenomenon that's better understood in this way this was an interesting study done in the journal osteoarthritis published in the Journal of osteoarthritis looking at acupuncture sham and actual for joint pain and you can sort of skim through that but I'll point you to the conclusion in this study the way it was done the sham acupuncture which is a problem in and of itself was not superior to actual acupuncture however acupuncture acupuncture styles they were looking at the styles of the way the acupuncture was was performed had significant effects on pain reduction in satisfaction suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist behavior right and so as we discourage people from influencing the patient in their treatment we move farther and farther away from a treatment that's likely to be effective based on the evidence that we know of how this works that doesn't mean acupuncture is all only a placebo effect but it means you can facilitate its effect by educating your patient and helping them understand what they're supposed to be working on essentially – and so that that's a very challenging idea to create study models for looking at sham models this was there was no sham acupuncture group this is study of acupuncture versus effexor for hot flashes and breast cancer patients they found acupuncture to be equally as effective as effexor for hot flashes which is interesting and of itself now is effects are great for hot flashes you know that's a question but but either way I would rather have acupuncture if I had hot flashes but also the people which I may at some point with acupuncture had fewer side effects more energy and a better sex drive and what this doctor concluded was the one thing you can't be argued by the study is the duration of the effect as well it lasted and the placebo effect doesn't generally last once you stop the treatment you can have some duration of effect from placebos but but they found a much longer duration of effect so something had shifted in the patient's physiology based on the treatment that was not explainable just as a placebo effect so there are challenges to doing Studies on this so the use of traditional pattern recognition has been a big issue if you come in for treatment of asthma I will show you the different patterns coming up soon for all the different things that could be asthma so if you design an acupuncture study to treat asthma you're treating a Western disease modality right you're not treating the pattern modality from which the medicine was was derived and intended to treat controlling for physician influence do you want physicians to be influencing the outcome or not because some studies have already shown that if you intentionally employ that mechanism you already know you're going to get better results so yet why do you want to remove that mechanism what is the motivation for taking the physician out of the doctor's office when you're doing treatments on people and that goes with whatever type of medicine you're practicing subtleties of improvement sometimes people get better over here when you were treating this so you're treating there you know indigestion and their menstrual pain improves it's like you count that as a win well not if you're doing a study on digestion but if you're the patient you do right and then creating a true inert placebo is very different as well too partially because one of the tenets of Chinese medicine is that the body is mapped out in a meaningful way and every point on the body is both mapped out in a meaningful way and responds to to touch and and so there's no point on the body that's inert you know once you've already even cognitively directed a patient's mind to a part on their body technically you've activated the point in some way so that's tricky so also again though just using acupuncture in its original context it's hard for studies to do that because it's such an individualized approach TCM itself has been tried to sort of to some degree standardize things but you're still having to meet the patient sort of where they are so one of the key concepts is that treatment has to be tailored to the individual presenting rather than the DS presenting and you have to alter your treatment as you go along so here's those asthma kinds of diagnoses and this is not an exhaustive list from Chinese medicine so this is called Xiao chuan or wheezing disorders and all of these different things can cause wheezing so if I have an asthmatic who comes in are they an exercise induced asthma neck are they an upper respiratory infection induced asthmatic are they only wheeze when they smell perfume you know what's the conditions of that are they a big fat person or the little skinny person are they eating a good diet of eating a bad diet are they exhausted are they hyper-energetic we don't make those distinction in Western medicine everybody gets out beuter all everybody gets you know some sort of any headquarter whose steroid if you know there are certain severity the standardization of treatment is very routinized based on asthma so if you're going to successfully evaluate you successfully treat Chinese many would say you have to have your right pattern recognition and a lot of the studies that have been done are not paying attention to pattern recognition and that's that's a fault so the other big concept too is that Chinese medical physiology is based on what we say is organ systems and this to me is where it gets interesting as well I mean it's interesting in other places too but this is a very interesting concept rather than individual parts so from Western medicine if we're talking about someone's stomach we're pretty much talking about their stomach their physical stomach I could cut it out of their body and put it on the pathology table and look at it that's their stomach in Chinese medicine we're talking about the stomach system which is this global system that deals with appetite the ability to take in food and break it down but also the same anything that falls into that pattern so the cognitive ability to take in ideas and break them down is part of a stomach kind of function certain appetites and motivations our stomach functions in Chinese medicine and are not in the biomedical model but I'd ask you to consider things like hormones like gralen and oxytocin you know and I don't know how much you've studied those already but gralen is a hormone that controls appetite but also behavior in motivation right it's alters the way a rat runs through a maze and alters the way a rat does problem-solving because it's motivated by food oxytocin is a hormone that's used for breast milk letdown but also pair bonding sexual bonding in in social patterning right so when we look at human physiology from this standpoint we're looking for the big system that Greenland effects and it's not just the physical stomach it's the stomach system is one of the things that affects as does oxytocin so I can't make an exact one-to-one in this length of a lecture but I I'm hoping that you can see how much utility it would have medically to be able to name a global system and how that would be predictive of what we'd be looking for for that system things like rail and oxytocin that we didn't even know existed until recently right we should have been able to predict their existence and and in Chinese medicine we would observe stomach chee and then leave it at stomach G it's also machee but there's things there too and then with the organ system goes a Meridian that in my my interpretation acts out the needs of the organ system it's sort of the external manifestation of what's needed by the organ system to do certain types of work and then base on the the pathway of the the circuitry of that affects lots of different functions sometimes it's just a local function effect sometimes it's a global function effect but this gets into sort of the mapping of the human body and we'll talk about that more in a moment the liver system is a big a big thing too so in the Chinese medicine we're talking to the liver system we're not talking about the liver the physical liver we're talking about a whole system of a function that involves your get-up-and-go its your stress system it's your activity system it's what you use to go hunting gather – it's not just your physical liver so there was a criticism made by a guy teaching a Integrative Medicine course at Stanford of all places who was saying things like oh the Chinese people they just feel your pulse and say your kidneys are weak and it doesn't make any sense and bla bla bla and and he obviously didn't understand the fundamental idea that the kidneys don't mean the kidneys right when you're doing that translation – to just dismiss that idea as you know sort of primitive astiz is essentially racist more than anything else so if you look at the stress system and all the effects of stress has on the body in Western medicine which is what this probably unreadable slide is pointing you towards but there's a reference for it you know it'll talk about how it affects the respiratory system and the musculoskeletal system and the endocrine system in the cardiovascular system we know that stress does all these things but we don't categorize it into a systematic package and in Chinese medicine that packages the liver system and we can map out the different ways the liver system affects other organ systems in various contexts and it has a lot a lot of utility so functional systems are interdependent as well so we have the liver system which is about sort of acting in the world hunting gathering the emotions associated with our anger and stress but positive qualities are compassion and leadership then we have this thing called the spleen system one of the more poorly translated words probably we use storing and containing food metabolism information we tell them so so if you're sitting nicely at a meal and you're eating you know your stomach and spleen systems should be dominant you're in trying to incorporate food into your body if your liver system is dominant then you should be utilizing resources you should be running you should be doing something and well she'd be acting so those two systems stand in contrast to one another and so you get patterns of imbalance when you try to do things out of harmony like eat your you know Big Mac in the car on the way to a meeting that you're stressed about getting to and your honking at people in trying to shove this food down your throat that's a lifestyle indiscretion and leads to a liver spleen imbalances one way of liver spleen imbalance another way of looking at liver spleen and valence we say liver invading spleen and stomach when stress goes to your gut that's liver invading spleen your stomach depending on which part of your gut it goes to in Chinese medicine when stress affects your ability to learn that's another manifestation of liver invading spleen it affects your ability to incorporate information into your mental body which is a very physical kind of thing it's very insulin dependent too as well so lots of these irritable bowel disease kind of pictures we can summarize up as being sort of a liver invading spleen issue and if you look at this diagram from alimentary pharmacology and therapeutics which you probably all have on your bed stand next to your beds you look at the brain bed access up in this little corner here is perception which is probably the most important piece of the entire thing but this looks at the circuitry that we know exists in biomedicine between perception and gut hyper motility right so we have within biomedicine already the understanding that our thoughts affect our physiology in this way and yet when we apply that in the clinic it's only very recently that people would have entertained ideas like doing hypnosis or biofeedback or acupuncture there is actually a center now I believe that at Northwestern that is doing integrative approaches to IBD and kudos for that you know that needs to needs to have happened and and stuff but that is incredibly new that we're entertaining that that whole system is already mapped out completely in Chinese medicine so when we're trying to figure out what is stress do it's all mapped out like you know if people look over over here it's mapped out the students get irritated I think when I show this because I make them learn it but this is you know this is the real HPA axis we learned the HT the hypothalamic-pituitary-adrenal axis but that is is a cadaveric pluck out of the HPA it exists in the context of all these things your neocortex interprets situations and scenarios your limbic system deals with emotions in memory your hypothalamus is a transformer for physical cognitive and emotional experience that translates that into physical response so then all those feedback into one another so what our understanding of these axes is essentially from biomedicine that your mental state can directly affect everything from your adrenal gland to your gonna to your thyroid so your immune system and that's another thing that this scientific base of Integrative Medicine book is really good at it's sort of showing you really clearly so we also have the individuality exists in an environment so whether it's a hot accurate environment a stressful work environment a luxurious / privileged environment or a desolate underprivileged environment you've got to take that into account when you're treating your patient you can't have someone come in and make a recommendation to them without taking into account the context and you can't evaluate their disharmony without thinking about where are they gonna go when they leave your office right that's just good medicine to every physiologic state there's always a corresponding psychologic state and vice versa so whether it's like you know what that child's feeling right now right without me telling you you know his emotion right he's sad he's crying unless there's certain degrees of like Asperger's literally where you have the inability to interpret that kind of information these girls are at the Beatles concert and they have too much joy is the pathology they're exhibiting in Chinese medicine it will lead to spirit departure and essentially fainting on stuff – but their emotions are mapped to a physical pattern right that's predictable and it's it's transcultural it's not individualized and in fact it's even goes to species so if you look at the adult the dominant aggressive dog versus the fearful dog this this is a really cute website and they basically like mapped it out if the dog is doing this it symbolizes that the dog is feeling these emotions right because that's the corresponding physiologic state it's also the most functional state if the dog needs to defend itself it's going to Nash its teeth right and do that – so if we were to look at like the liver channel the liver channel surrounds the mouth and controls certain facial posturing that has to do with grimacing and making that our kind of thing so I could go into like an aggressive liver stance right now and it would be threatening but if color it that way or it may just be competitive or something like that so there's mapable circuitry in the body so what conditions can be treated well it's a whole medical system so really you want to think of it as sort of like you know it's got something to offer for everything you know there are conditions that are better treated and conditions that are better treated in in various other ways and stuff too the World Health Organization gives a long list of conditions that it feels like acupuncture specifically isn't appropriate therapy for we don't need to go through all of those what I would say with some of these – as many of these are actually Western diagnoses so you know in some sense we could actually have a discussion about that – there was a consensus statement on acupuncture that was a big deal that happened back in 98 that concluded that at least in the United States there's clear evidence that acupuncture is effective for these things since that time there have been other consensus statements that have come out and what this slide is which you have in the handout you guys can get is a list of PubMed references to consensus statements about acupuncture so I just saw in some blogs someone was writing well there's no data to support the use of acupuncture anyway it's like holy cow really can you go to PubMed and type in acupuncture and and so these are these are not just individual studies that may or may not be decent these are these are consensus recommendations for various types of conditions and so those are the numbers that you type in to get the study so how does acupuncture work you know that's is a topic of study and debate and it depends on how you look at the the physiology of the human body so we do have some understanding of Western mechanisms that occur when acupuncture is done we know it releases and dodges the opioids in some cases we know that it modulates limbic and subcortical brain activity we know that it can modulate the immune system and then it continued and attenuate the autonomic response to stress those are biomechanical mechanisms which are defined for acupuncture I would argue that acupuncture works in a much bigger way than that we'll talk a little bit about that but we don't have too much time today for that these are some studies that were done looking at functional MRIs and they looked at acupuncture points that or purported to have use for vision and points that were not indicated for visual kinds of things and they looked at the the patterns of light up between visual stimulation acupuncture stimulation of the visual point and non acupuncture points it points it without visual context and looked at the way the the brain lit up for that and so that's kind of interesting they did this also for some auditory points that are supposed to have auditory kind of effects to them to in visual effects this err visual point again light up there 2gb 37 and then they also saw a similar kind of thing for the auditory and so there's actually a large conversation that I would love to have around this type of research that we can't have right now but it's interesting it's an interesting way to go about sort of looking at functionality but you know again remember where are we looking at this as a cadaveric thing in a cellular level kind of what's happening right at the point or are we looking at it as the body is an energetic matrix with circuitry that is standard throughout the species and also observable in animals and is tied in with our thinking and our mood and emotions you know in it you also have to question how deep do you want to go into the physics of this – I mean when you look at the body it's when you look at everything it's mostly empty space right they're rays passing through us right now that we're not even aware of you know and so there's energetic exchanges going on at all levels at all times that we just ignore because we don't need them for survival apparently to pay attention to them but that's physics like that's not that's not even what we would consider biomedicine right now and yet you know again it was only within the last hundred years that we would have believed there was an energetic field around the body and now we can look at things like functional MRIs or EEG Zoar you know lots of different types of medical medical ways of measuring those and that if you want to look at that – this is another book called energy medicine the scientific basis by James Ashman that's one of the classics of energy medicine that's totally worth reading he's got a couple of other books out subsequent to this one and it'll talk about some of the you know how does the energy work in the body what's been done to measure it you know what are different ways of looking at that so that's another good one for your your shelves so I would say another integrated way maybe of understanding how acupuncture works is this the body is not as a specific thing is is illusory that's just not real and it's not in keeping with our understandings of neurology but it's rather a storehouse of experience and associative experience that has evolved over time so this is one of my favorite quotes colors tones smells and tastes are mental creations constructed by the brain out of sensory experience they do not exist as such outside of the brain in short our perceptions are not direct records of the world around us rather they are constructed internally according to constraints imposed by the architecture of the nervous system and it's functional abilities this is from principles of neural science which was the neurology textbook we used at Brown when I went to medical school so this is Western neurology saying the world does not exist as an objective thing that's Buddhism saying that – right but that's also Western neurology saying that the other thing that Western neurology tells us is that the body is mapped out throughout the nervous system in a homunculus fashion so you have a sensory homunculus you have a motor homunculus you have a monkey list throughout your spinal cord you have a monkey less on your cerebellum your red nucleus your frontal lobe the projections from your frontal lobe to two other lobes are mapped out in a somatic topically maintained and preserved way so that says to me the body is using the human form for very important informational organizational reasons or it would not have maintained the structure throughout evolution right and so I put you can't quite tell that's that's that's a bad kitty here's where that picture is and so kitties lore dosing right and so when you tickle kitties back right at the top of its tail Kitty raises its rump in the air and lordosis Bad Kitty and the purpose of that is for mating and the thing that makes cats so amusing is they can't help it whereas humans can inhibit that response sometimes so that tells me that the cat didn't choose to have that part of its body mapped out in that way for that physiologic response its evolutionarily programmed into the circuitry of the cap to do that the cat also has a somatic topic map in its brain people have cut up cats and looked for it there's some interesting Studies on that that's you don't have to cut up the cat but that's the kind of mapping that's a functional systems based circuitry mapping that's inherent in the body and that Chinese medicine has mapped out through its channel system I would put that out as a premise I can't give you the full lecture on that here right now today but if that's true to not believe that that's valuable I I don't understand how you could even make the premise that that's not incredibly valuable to our understanding of how human physiology works so so I'll stop there for that now let me talk about training for Chinese medical practitioners so there's different avenues for training but currently most states require what's called national certification commission for acupuncture and Oriental Medicine standards NCCAOM standards California has its own board that's the other biggest board that's still out there but predominantly this is recognised nationally nationally two to four years of undergraduate college in the university system followed by about a minimum of 1700 hours in a appropriately accredited training program most programs are 3,000 plus hours I can't remember how many program hours this is this is like 4,000 or something when you get to it right the peak um of course – and that includes herbal medicine in it – Chinese medical students get about 450 hours of training or more in biomedicine and the goal of that is not to make them biomedical practitioners but to make them conversant enough in biomedicine to collaborate and to also understand when a condition presents that may better be treated by Western medicine – when to refer that condition because there's certain like acute conditions and really severely progressive rapidly progressing conditions that Western medicine really excels at treating and you want to make sure you don't miss those as well so there's there's fairly comprehensive well very comprehensive to become what's called a licensed acupuncturist be NCCM certified and only after doing that do you sit for what's there they're they're not technically board exams because it's not aboard their certification exams their national certification yet it's essentially the boards is what that is now if you're a medical doctor you can get a short course training in acupuncture that has been around since around 1987 to 2000 it's a 200 hour minimum sometimes 300 hours it depends on the program and then there's a whole system of fellowship that follows from that that involves apprenticeship and logging of hours of your training you should know that this is essentially going to give you an introduction to ideas in Chinese medicine but it won't take you through the full system like the other training whoa because you can't do it in that amount of time it's just not possible so this is an introductory type of approach it's also a protocol eyes type of approach and is often used predominantly for things like pain management and then many of the physicians who do this do go on and study further in terms of trying to increase their knowledge of Chinese medicine but it's not the same training so just just to be clear on that the World Health Organization has actually set out recommended minimal hours this is just for acupuncture it is not for herbal medicine of what should be considered minimal training versus technician level training and how much how much that should be insert of what it should be considered so the World Health Organization has some standards on that too this is obviously an area of contention because a lot of times medical doctors feel like they've gone through so much schooling how could they not possibly know just about everything there is to know about the human body so why can't I just learn acupuncture and just add it on and the answer is because it's an entirely different way of looking at human physiology and a complex whole medical system that demands that you you just evaluate way more information than can be done in that amount of time so there's that to acupuncturists are not called the same thing in all places the entry level certification name so these are like state licensure title names include things like licensed acupuncturists in Illinois do Em's in Rhode Island I can't remember who's a no MD CAS in Wisconsin AP's in Florida so all of those names different based on States so a couple places you can find some more information this is one of the first books that came out that really busted open interest in Chinese medicine a lot of people the web that has no Weaver by Ted Kaptchuk who's now at Harvard doing a lot of placebo research interestingly and has done some just amazing work on that and this is really a technical manual sort of the first part of it is introductory to Chinese medicine and then it becomes more of a technical manual but it's a good source there's a book called between heaven and earth by Ephraim corn golden Harriet buying fog which I don't have with me that's another one Livia Cohen who's a Taoist scholar I believe at Boston University wrote this book – it's a good overview book as well not a technical manual so those are all good good reference sources – hopefully we'll have some good teaching lectures there at some point in the very near future and then the National Center for Complementary of Medicine is one of the National Institutes of Health Institute's and it has a lot of information on Chinese medicine they try to keep up to date on like studies that have been released specifically related to acupuncture Chinese medicine other aspects of Chinese medicine and so that's also a good reference site sometimes your state association websites the NCCM website and a queue finder actually can be one to help you just find a practitioner in Illinois we have the Illinois Association for acupuncture oriental medicine who's the main professional Association along with the asian-american acupuncture Association is the they're both organizations are open to everyone the eight quad-a is is mostly Asian cultural and Ilham has done sort of more general kinds of membership kinds of outreach – but they work in partnership very closely so that's what I want to say and so what kind of questions do you guys have or anybody has feel free or comments also there's a lot of Chinese medical practitioners do too who may disagree with me about things I said please tell me yeah that's a great question so I'm a pediatrician – right that's right my training so my my practice has a lot of outreach to Pediatrics you can and so the answer that is it depends essentially – so you can technically do acupuncture in any age group but what you mean by acupuncture is going to be different so there's all different styles of acupuncture from relatively thick needle heavy stimulation kinds of acupuncture to very light barely putting the needle in Japanese style kind of treatments so you can do light treatments on any age you don't use heavy heavy needling on kids so it depends on what the practitioner is doing right and what they know you can do tween ah at any age and that's an amazing tool to work to work with kids with so like any kid who comes in with like headaches or musculoskeletal plant complaints or sleep disorders or digestive complaints you know start with a tween ah protocol like a massage protocol it's totally safe the family can do it at home they can apply it daily in in many cases the kids love it the parents love it and that works well dietary modifications are part of Chinese medicine that's always core to child care lifestyle modifications are huge in Chinese medicine that's core to child care issues as well so nutrition diet lifestyle herbal medicine can be used very young if you know you're sourcing or your herbs and how to dose um which is not hard you know you just have to know so all of those things can be applied from the birth period when done correctly yeah other questions other comments yeah Texas within the Chinese right that's a great point so the rate the question is have there been major paradigm shifts in Chinese medicine as more documents are revealed and more and more like texts emerge and I would have to say know that there haven't been the fundamental premises of Chinese medicine mmm including like yin yang theory channel theory five phase theory things like that are very stable what you see is differences in application of those theories you see differences in the way pattern recognition occurs so that you have new sort of branches of medicine like the Xiang Han Ling branch that's that's emerging quite strongly thanks to our own Steve bonds a key and a number of other people have different ways of organizing the information but they all have at the core the same fundamental premises about yin and yang five-phase and in those kinds of things so they may organize things slightly differently but they doesn't it hasn't drawn the fundamental theory into question yeah yeah right right well in it depends great great question yeah some acupuncture right so the question is like there there clearly sometimes when when Western medicine shines and we want to be in the emergency room or we want to be on a certain medication or things like that when does Chinese medicine shine and so overall I would say Chinese medicine especially shines in on the early detection of things in the early treatment of things before things become a train wreck so if you can do that that would be ideal that said I have seen amazing results for lots of viscerally based things so GI complaints headaches that fall into that category menstrual disorders fertility issues all of those respond very well to acupuncture lots of different pain syndromes respond well to acupuncture and body bodywork therapies massage too is huge as a wonderful intervention for people as part of a comprehensive treatment system what else anybody I want to throw one out there anything else that you see chronic conditions right there sub clinical conditions are just chronic conditions conditions where people have gone to 20 different doctors no one's been able to figure out what's going on and they don't know how to treat them and part of the reason that this medicine can sometimes be helpful is because you don't need to know the biomechanical mechanism that's messed up to figure out how to treat the person you just need to know their pattern diagnosis and it doesn't mean they always get well but sometimes they get well like amazingly and so it's something if you should absolutely try yeah so chronic conditions knotty conditions like we'd call those things that are hard to sort of pin down are hard to diagnose sometimes could be really well treated great all right well I'm gonna else we'll stop the the sort of form part of lecture hang around we can have conversation and stuff too but thank you all for coming if you have feedback I value that so please let me know and yeah all right thanks you

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