Nobel Prize 2015: A Victory for Chinese Medicine?

Youyou Tu, Winner of the 2015 Nobel Prize in Physiology or Medicine (image from nobelprize.org)

There has recently been a lot of celebration in the Chinese medicine community about the recent Nobel Prize awarded to Youyou Tu for her work with the Chinese Herb, Qing Hao (Artemisia annua). Her work is undoubtedly a victory for humanity’s struggle against infectious disease, but is this really a victory for Chinese medicine, as some would have us believe? Or is it just another example of traditional healing methods being appropriated by—and assimilated into—biomedicine? Without taking anything away from Tu’s remarkable achievement, I would suggest it is the latter.

Let me begin by saying that I understand the enthusiasm within the Chinese medicine community regarding the positive press surrounding this story. Indeed, many of my colleagues have reported an increased interest in Chinese herbal medicine from both their patients and the medical doctors with whom they work. Is this recent interest in Chinese herbal medicine going to translate into its increased acceptance within the medical field? I doubt it. The fact that people have associated this award with Chinese medicine is certainly a benefit to our community, but let us not confuse this tenuous association with the actual practice of Chinese herbalism. To call the isolation of Artemisinin from Qīng Hāo (Artemisia annua) a victory for Chinese medicine is a bit like calling the isolation of Nicotine from the tobacco plant a victory for Native Americans.

Please forgive my reluctance to celebrate, but I see the news coverage in a slightly different light. To me, the implication of the recent press about Artemisinin is that Chinese medicine will continue to be assimilated into biomedicine, and that pharmaceutical companies will continue to mine traditional herbal remedies for the next wonder-drug, without any respect for the systems of medicine from which they are derived.

Artemisia annua (image from wikipedia.org)

Don’t get me wrong—medicine is medicine, and if the pharmaceutical industry finds some new miracle drug for HIV or Cancer in a plant, that is a victory for all humanity, and one worth celebrating. My contention, simply, is that it is not necessarily a victory for the indigenous systems that initially recognized the medical value of these plants. Despite Tu’s nod to Ge Hong, a 4th century alchemist whose book, Zhouhou beijifang (肘後備急方), mentions the use of Qīng Hāo (Artemisia annua) for the treatment of malaria (疟),¹ many of the news stories describing her discovery subtly imply that the isolation and extraction of certain plant alkaloids is an “improvement” or an “evolution” of these ancient methods. Some even spin this as a triumph for “integrative medicine”.

Nonsense!

In my eyes, this is a one-sided victory for biomedicine, and one that advances the false notion that the value of Chinese medicine can only be accepted in the context of that paradigm. Sadly, this notion is sometimes reinforced by members of our own community, who discard traditional methods of Chinese herbalism (e.g. taste and temperature of an herb) for more modern ones (e.g. alkaloid content and pharmacological properties of an herb).

Artemisinin (from wikipedia.org)

We know our place within the American medical establishment, and the isolation and extraction of a drug from a traditional Chinese herb is not going to change that to any significant degree. Are we, as practitioners of Chinese medicine, going to be able to prescribe these isolated extracts? I don’t think so. In fact, if a Chinese herbalist in America were to create a product with Qīng Hāo (Artemisia annua), and put “for the treatment of malaria” on the label, they would be violating FDA regulations, which stipulate that herbs are dietary supplements—not drugs—and therefore cannot be used to treat specific biomedical diagnoses.²

In the end, as many have suggested, and as I concede, the short-term outcome is that more people are interested in Chinese medicine and Chinese herbs. That is a good thing! I do, however, worry about the potential long-term implications for our field.

Finally, I’d like to extend my congratulations to Youyou Tu for her Nobel Prize—it is, as I have previously noted, a victory for humanity—I’ll just stop short of calling it a victory for Chinese medicine.

Notes and References:
1. Zhouhou beijifang (肘後備急方) : Chapter 3, Section 16
又方 青蒿一握。以水二升渍,绞取汁。尽服之。
Another method [for treating malaria]: take one handful of Qīng Hāo and soak it in two shēng (~2cups*) of water. Wring it to get the juice, and take all of it.

*Translation note: The unit of measure used in the recipe, called 升-shēng in Chinese, has changed over time. In Ge Hong’s time (the Eastern Jin dynasty), one 升-shēng was 204.5mL (~1cup), but in the Ming or Qing dynasty, it was closer to 1L. Most of the translations of this recipe that you see in the news translate “2 升-shēng” as “2 liters,” but it is more accurately translated “2 cups.” So the method described by Ge Hong actually yields a far more concentrated medicinal liquid than many news sources, including the one cited below, suggest. (Many thanks to Leo Lok for initially pointing this out to me.)

Author’s note: I think it is also worth noting that, in Youyou Tu’s own words, it was the reference in Zhouhou beijifang (肘後備急方) that marked the “turning point” in her research—a key part of the story that is often glossed-over in the reporting. Previously, Tu’s results had been inconsistent, but the preparation method described in the Zhouhou beijifang yielded the crucial revelation that the temperature of the modern extraction method was too high and was therefore destroying some of the active compounds. Once she and her team began the extraction at a lower temperature, they “obtained much better activity”. This is from a 2011 article in Nature:

The turning point came when an Artemisia annua L. extract showed a promising degree of inhibition against parasite growth. However, this observation was not reproducible in subsequent experiments and appeared to be contradictory to what was recorded in the literature. Seeking an explanation, we carried out an intensive review of the literature. The only reference relevant to use of qinghao (the Chinese name of Artemisia annua L.) for alleviating malaria symptoms appeared in Ge Hong’s A Handbook of Prescriptions for Emergencies: “A handful of qinghao immersed with 2 liters of water, wring out the juice and drink it all” (Fig. 1). This sentence gave me the idea that the heating involved in the conventional extraction step we had used might have destroyed the active components, and that extraction at a lower temperature might be necessary to preserve antimalarial activity. Indeed, we obtained much better activity after switching to a lower-temperature procedure.

http://www.nature.com/nm/journal/v17/n10/full/nm.2471.html

2. FDA.gov


© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content. All translations are mine, unless otherwise noted.

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Opening Pandora’s Box: AOM’s First Professional Doctorate (FPD)

A change is coming in the academic world of acupuncture and Oriental medicine. It’s been a slow, quiet process that has taken over 10 years, and thousands of hours of behind-the-scenes work by school administrators. I’m talking about the First Professional Doctorate (FPD) in acupuncture and Oriental medicine. What? Exactly. Over the past few weeks, I’ve asked many colleagues and students if they have heard of the FPD. Some have, but most have not. Of those who have, very few have any idea what it is and how it differs from the current Doctor of Acupuncture and Oriental Medicine (DAOM) degree. Given this situation, I thought it would be prudent to dedicate a blog post to the subject.

What is the First Professional Doctorate (FPD)?
According to AAAOM, the FPD is: “A professional doctorate that expands and focuses the standards for the present master’s programs.1” While the shift from the master’s to the FPD standard will ultimately benefit the field, this transition is not without its challenges. What makes me say that? Read on…

By Rudolph Ackermann (1764 – 1834) [Public domain], via Wikimedia Commons


A Look At the Numbers
To understand why I would make this claim, one need only look at the hours necessary to obtain a master’s degree in CM/OM/EAM versus the hours necessary to obtain this new FPD. At present, master’s degree programs in this field “must be at least four academic years (a minimum of 146 semester credits or 2625 hours).2” FPD programs, on the other hand, “include a minimum of 162 semester credits of instruction, or its equivalent.3” According to the new standards, the quantitative difference between the previous master’s standards and the new FPD is 16 credits (or 240 hours) of academic instruction. These 240 extra hours consist of: advanced (biomedical) diagnostic studies, patient care systems, collaborative care, “formulating and implementing plans for personal professional development,” and “incorporating scholarship, research and evidence-based medicine/evidence-informed practice into patient care.4” While these standards are intended to prepare graduates for the new landscape of integrative healthcare, it is unfortunate that none of the additional hours are dedicated to fostering a deeper understanding of CM/OM/EAM.

But what about the difference in clinical hours? 870 hours of “integrated acupuncture and herbal clinical training.2” in the master’s program, compared to 1000 hours in the FPD.3 That’s right, folks: 130 clinical hours now separate the master’s graduate and the “doctor” who graduates from an FPD program. That’s not much.

Photo Credit: George Hodan

The DAOM Standard
As a comparison, let’s take a brief look at the minimum standards that current DAOM programs have had to meet. According to ACAOM: “The minimum educational program length for the clinical post-graduate doctorate in Oriental medicine is 1200 hours, 650 hours of which must be in advanced clinical training.5” So, the DAOM graduate has taken a minimum of 3,825 total program hours, compared to 2,625 total hours in the master’s program, and 2,865 total hours in the FPD. That means a DAOM graduate has received a minimum of 1,200 hours more total instruction than the master’s graduate (650 of which are clinical), and 960 hours more total instruction than the FPD graduate (650 of which are clinical).

Nomenclature: The Real Issue
These numbers wouldn’t really be a big deal if there were a clear distinction between the FPD and DAOM titles, but there won’t be. Although one of the schools offering the FPD will confer the title Doctor of Acupuncture and Chinese Medicine (DACM) on their graduates,6 at least two of the accredited FPD programs are conferring the title Doctor of Acupuncture and Oriental Medicine (DAOM).7,8 That’s right: the same title given to the original DAOMs who, as previously demonstrated, have received far more training! This unfortunate situation will no doubt create confusion in the mind of the public. Furthermore, the reason that many students attended the original DAOM programs was to receive further training and—by extension—more credibility in the eyes of their patients. Conferring the DAOM title onto FPD graduates is not only confusing, but it devalues the degree earned by those who graduated from the original DAOM programs.

In addition, the creation of the new FPD missed another opportunity to rebrand “Oriental Medicine”—a term that is offensive to many members of the Asian community—as “East Asian Medicine.” Why not call the FPD graduates Doctor of Acupuncture and East Asian Medicine (DAEAM), or simply Doctor of East Asian Medicine (DEAM) instead?

UPDATE (12/16/2015): At the November 12, 2015 meeting of the Council of Colleges, the council “adopted a motion that ‘DAOM’ be exclusively reserved as the designation for the post-graduate doctoral degree, and that ACAOM be informed of this motion.9

UPDATE (1/25/2016): ACAOM has recently announced “a two-part project to engage the Acupuncture and Oriental Medicine (AOM) field on the pressing issue of Degree Titles and Designations.10

UPDATE (6/6/2016): The Pacific College of Oriental Medicine has discontinued the use of the DAOM title for their transitional doctorate. They have changed the title to Doctor of Acupuncture and Chinese Medicine (DACM).11

UPDATE (8/8/2016): Under pressure from recent graduates of their entry-level doctoral program, the Pacific College of Oriental Medicine issued DAOM degrees to those who demanded them.

UPDATE (9/28/2016): The College of Eastern Medicine at the Southern California University of Health Sciences has recently acknowledged the distinction between the post-graduate and first-professional doctorate standards by changing their FPD degree title from DAOM to DACM.12

From Wikipedia

Woe to the Recent Master’s Graduates
In my mind, the group that really is going to suffer are recent graduates of master’s level programs. To their credit, the Pacific College of Oriental Medicine (PCOM), is offering a transitional doctorate—an “upgrade” to the FPD—for its master’s graduates. Unfortunately, those who have graduated from other master’s programs that do not offer this option, or those who have graduated from schools that haven’t received accreditation for their FPD programs, may be forced to enroll in the (more expensive) post-graduate DAOM program if they want a doctorate.

UPDATE (1/01/2017): The Pacific College of Oriental Medicine has recently announced that they will be opening their transitional FPD program to graduates of all master’s programs.11

Solutions
Hopefully, all master’s graduates who would like to upgrade to the FPD will be given an option to do so by their respective institutions. Unfortunately, this is a process that will take time. The other question is: what to do about those who went through the original DAOM programs? One solution would be to create PhD programs, but that would require schools to obtain additional accreditation, since ACAOM does not currently provide accreditation for PhD programs.

Conclusion
I hope I have answered some of your questions and addressed some of your concerns about the new FPD. It goes without saying that the numbers I have provided are based solely on minimum standards. Some master’s programs go well beyond these standards, closing the distance between master’s graduates and FPD graduates even further. Our profession is still growing, and I hope the dialogue regarding the FPD will continue.

References
1. Guide to the Professional Doctorate (FPD) in AOM, p. 4
https://www.aaaomonline.org/resource/resmgr/docs/fpd-12-18-09.pdf

2. ACAOM Accreditation Manual, p. 26
http://acaom.org/wp-content/uploads/2016/09/160227_acaom_accreditation_manual.pdf

3. Accreditation Standards for the First Professional Doctorate, p. 27
http://www.acaom.org/documents/file/fpd_standards_acaom2013-web.pdf

4. Accreditation Standards for the First Professional Doctorate, p. 6; 45-49
http://www.acaom.org/documents/file/fpd_standards_acaom2013-web.pdf

5. ACAOM Accreditation Manual, p. 51
http://acaom.org/wp-content/uploads/2016/09/160227_acaom_accreditation_manual.pdf

6. American College of Traditional Chinese Medicine
https://www.actcm.edu/dacm/

7. Pacific College of Oriental Medicine
http://www.pacificcollege.edu/acupuncture-massage-programs/san-diego/first-professional-doctorate-fpd.html

8. Southern California University of Health Sciences
http://www.scuhs.edu/academics/cem/daom/

9. CCAOM News (Winter 2015-2016)
http://www.ccaom.org/downloads/newsletters/CCAOM_Newsletter_Winter_2015-2016.pdf

10. ACAOM Hot News
http://www.acaom.org/hot-news/news/?ContentID=2210

11. Pacific College of Oriental Medicine
http://www.pacificcollege.edu/prospective/programs/san-diego/medicine/acupuncture-oriental/doc-0

12. SCUHS College of Eastern Medicine Announcement

College of Eastern Medicine Announcement


© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

Favorite Formulas for the Common Cold (Part 2): Gui Zhi Tang

In my recent article, “Fool’s Cold: The Improper Use of Yin Qiao San,” I promised to share some of my favorite formulas for treating the common cold. This is part two of a series of articles dedicated to that topic. You will note that many of the formulas I share are from Kan Herb Company. As mentioned in part one of this series, I used to work at Kan as an herbal consultant, so I am very familiar with their formulas, and I know the level of quality-control they put into their products (including testing for heavy metals, microbes, and pesticides). While I have yet to be impressed with teapills or tablets from any company, I have found Kan’s liquid extracts to be quite potent.

Gui Zhi Tang

Cinnamon Twig DecoctionIn the previous article, we examined the clinical use of Jing Fang Bai Du San for common colds presenting as wind-cold-damp. What if your patient presents with a classic case of wind-cold? The Huang Di Nei Jing Su Wen (Chapter 19) states: “When wind and cold settle in a person…the skin closes and develops heat. At this time, [the wind and the cold] can be effused through [induced] sweating” (Unschuld, p. 337). Chapter 18 of the Huang Di Nei Jing Ling Shu says: “When the exterior is injured by wind, the interior is opened at the pores..and the body fluids leak from the interior” (Wu, p. 91). These two statements sum up the patho-mechanisms of cold-damage and wind-strike, respectively—the primary exterior wind-cold patterns discussed in the Shang Han Lun. When the Tai Yang is affected, practitioners have a choice between Ma Huang Tang (for cold-damage) and Gui Zhi Tang (for wind-strike), but due to the current FDA status of Ma Huang, I will limit my analysis to Gui Zhi Tang alone. Kan offers Gui Zhi Tang as “Cinnamon Twig Decoction”, and Plum Flower calls it “Gui Zhi Teapills”.

Gui Zhi Tang is indicated for chills and fever unrelieved by sweating, headache, aversion to wind, stiff neck, nasal congestion, dry heaves, and no particular thirst (Bensky & Barolet, p. 35). The tongue will have a thin white and moist coat, and the pulse will be floating and moderate or floating and frail (Bensky & Barolet, p. 35). First mentioned in the Shang Han Lun, Gui Zhi Tang is primarily used to readjust the balance between the yíng qi and the wèi qi. In the body, yíng qi and wèi qi represent an important yin-yang pairing. Elisabeth Rochat de la Vallee suggests that yíng (營) “might mean to establish a military camp…[or] to rebuild or reconstruct,” and that wèi (衛) means “defense…made with a kind of circulation and a regulation of movement” (Larre & Rochat de la Valle, p. 62-63). According to the Huang Di Nei Jing Su Wen (Chapter 43):

“The camp [qi] (yíng qi), that is the essence qi of water and grain. When it is harmoniously balanced in the five depots, and when it is dispersed throughout the six palaces, then it can enter the vessels. Hence, it follows the vessels upwards and downwards, penetrates the five depots and connects the six palaces.

The guard qi (wèi qi), that is the violent qi of water and grain. This qi is fast and unrestrained and cannot enter the vessels. Hence, it moves inside the skin and in the partings of the flesh…

<To oppose this qi, results in disease. To follow this qi, results in healing>” (Unschuld, p. 649).

This statement is echoed again in the Nei Jing Ling Shu (Chapter 18): “The clear qi is the [yíng] qi; the muddy qi is the [wèi] qi. The [yíng] qi is located in the middle of the channels; the [wèi] qi is located outside of the channels” (Wu, p. 90). Due to their relative locations on the exterior and interior of the channels, the wèi qi represents a form of yang qi, and the yíng qi represents a form of yin qi in the body. The dynamic yin-yang activity of Gui Zhi Tang is achieved by the two primary herbs: Gui Zhi and Bai Shao. In this potent pairing, Gui Zhi is yang with its warm, acrid, opening, and outward moving nature; and Bai Shao is yin with its cool, sour, nourishing, and restraining nature.

Let’s take a look at the herbs in Gui Zhi Tang from a Chinese medicine perspective (herbs that the Kan formula omits are marked with an asterisk and herbs that the formula adds are in parentheses):

Gui Zhi: releases externally contracted wind-cold (Benksy & Barolet, p. 36); transforms thin mucous (Bensky, Clavey, & Stoger, p. 9); when used in combination with Bai Shao, “one effects the qi and one effects the blood; one disperses, the other restrains; one is moving, the other is still” (Bensky, Clavey, & Stoger, p. 10).

Bai Shao: benefits the yin and strengthens the yíng qi (Bensky & Barolet, p. 36); preserves the yin and adjusts the yíng and wèi qi (Bensky, Clavey, & Stoger, p. 755); when used in combination with Gui Zhi, “one effects the qi and one effects the blood; one disperses, the other restrains; one is moving, the other is still” (Bensky, Clavey, & Stoger, p. 10).

[Take note of the actions of Gui Zhi and Bai Shao: they constitute a beautiful yin-yang herb pair!]

Sheng Jiang *: releases the exterior and treats nausea (Bensky & Barolet, p. 36); warms the middle burner, releases the exterior and disperses cold (Bensky, Clavey, & Stoger, p. 31).

(Gan Jiang): warms the middle and expels cold (Bensky, Clavey, & Stoger, p. 682); warms the Lungs and transforms thin mucous (ibid).

Da Zao: nourishes and harmonizes the yíng qi and blood, tonifies the middle, and harmonizes the other herbs (Bensky & Barolet, p. 36)

Zhi Gan Cao: tonifies the middle and harmonizes the other herbs (Bensky & Barolet, p. 36); moistens the Lungs and stops cough, and tonifies the Spleen qi (Bensky, Clavey, & Stoger, p. 733).

At its core, Gui Zhi Tang is a formula that readjusts the balance of yin-yang within the body while simultaneously supporting the middle burner. Why is it important to support the middle burner in cases of external invasion? The Systematic Classic of Acupuncture and Moxibustion (Jia Yi Jing) states, “The [yíng qi] issues from the middle burner. The [wèi qi] issues from the upper burner” (Yang & Chase, p. 18). Thus, by supporting the qi of the middle burner, the yíng qi—which has been flowing out as sweat via the pores—is renewed and strengthened.  In this artfully simple, yet effective formula, one group of herbs (Sheng Jiang, Da Zao, and Zhi Gan Cao) supports the middle, while the other (Gui Zhi and Bai Shao) readjusts the yíng-wèi dynamic to restore harmony and order to the body. It should be noted that the Shang Han Lun suggests taking this decoction along with hot rice gruel, and then wrapping up in a blanket until a light sweat is achieved (Mitchell, Ye, & Wiseman, p. 62).

Now let’s look at the composition of Gui Zhi Tang from the perspective of the pharmacological actions of the herbs:

Gui Zhi: antibiotic, anti-viral, diaphoretic, antipyretic, anti-tussive, analgesic (Chen, p. 42); anti-inflammatory and antimicrobial (Rao, 2014).

Bai Shao: antibiotic, antipyretic, and anti-inflammatory (Chen, p. 932); anti-inflammatory and immuno-modulatory (He, 2011); antiviral (Ho, 2014).

Sheng Jiang *: antibiotic (Chen, p. 46); antiviral (Chang, 2013).

(Gan Jiang): regulates body temperature (Chen, p. 451); anti-inflammatory (Choi, 2013)

Da Zao: antimicrobial (Daneshmand, 2013).

Zhi Gan Cao: anti-inflammatory, increases phagocytosis, anti-tussive, expectorant, and antibiotic. (Chen, p. 869-870).

As you can clearly see, even a classical formula like Gui Zhi Tang has pharmacological effects relevant to the treatment of common cold. So, there is no reason to utilize a wind-heat formula like Yin Qiao San—or a modern anti-viral concoction like Gan Mao Ling—to treat wind-cold, simply because of the phytochemical constituents of the herbs contained in these preparations. It is important that practitioners continue to practice Chinese herbalism based on the theories of Chinese medicine—as opposed to practicing biomedicine with Chinese herbs!

References:

Dan Bensky & Randall Barolet, (1990). Chinese Herbal Medicine: Formulas & Strategies.

Dan Bensky, Steven Clavey, & Erich Stoger, (2004). Chinese Herbal Medicine: Materia Medica, 3rd Edition.

JS Chang, et. al., (2013). Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines.

John & Tina Chen, (2004). Chinese Medical Herbology & Pharmacology.

YY Choi, et. al. (2013). Dried Ginger (Zingiber officinalis) Inhibits Inflammation in a Lipopolysaccharide-Induced Mouse Model.

F. Daneshmand, H. Zare-Zardini, & T. Ghanbari, (2013). Crude Extract from Zizphus Jujuba Fruits, a Weapon Against Pediatric Infectious Disease.

Dong-Yi He & Sheng-Ming Dai, (2011). Anti-Inflammatory and Immunomodulatory Effects of Paeonia Lactiflora Pall., a Traditional Chinese Herbal Medicine.

Jin-Yuan Ho, Hui-Wen Chang, & Jim-Tong Horng, (2014). Characterization of the Anti-Influenza Activity of the Chinese Herbal Plant Pawonia lactiflora.

Claude Larre & Elisabeth Rochat de la Vallee, (1996). Essence, Spirit, Blood and Qi.

Craig Mitchell, Feng Ye, & Nigel Wiseman, (1999). Shang Han Lun.

Pasupuleti Visweswara Rao & Siew Hua Gan, (2014). Cinnamon: A Multifaceted Plant.

Paul Unschuld, (2011). Huang Di Nei Jing Su Wen: An Annotated Translation.

Jing-Nuan Wu, (1993). Ling Shu or The Spiritual Pivot.

Shou-Zhong Yang & Charles Chace, (2004). The Systematic Classic of Acupuncture and Moxibustion.


© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

Favorite Formulas for the Common Cold (Part 1): Jing Fang Bai Du San

In my last article, “Fool’s Cold: The Improper Use of Yin Qiao San,” I promised to share some of my favorite formulas for treating the common cold. To avoid creating one monolithic post, I’m going to do a series of articles with each one focusing on a specific formula. You will note that many of the formulas I share are from Kan Herb Company. I used to work at Kan as an herbal consultant, so I am very familiar with their formulas, and I know the level of quality-control they put into their products (including testing for heavy metals, microbes, and pesticides). While I have yet to be impressed with teapills or tablets from any company, I have found Kan’s liquid extracts to be quite potent.

Dispel Invasion (Jing Fang Bai Du San)

Dispel InvasionDispel Invasion is based on Jing Fang Bai Du San (the Plum Flower version is called “Release the Exterior Teapills”). According to Chinese medicine theory, this formula is indicated for wind-cold-damp. I saw a lot of this presentation when I was living and practicing in Santa Cruz, CA. During the fall and winter months, it can be especially cold and damp in the mornings—especially when the fog rolls in. Jing Fang Bai Du San is designed to treat the following symptoms: fever and chills without sweating, pain and stiffness of the head/neck, and body aches/pains; the tongue coat will be thin and white, and the pulse will be floating (Bensky & Barolet, p. 54).

Here are the herbs that comprise this formula along with their relevant Chinese medicine actions (herbs that the Kan formula omits are marked with an asterisk and herbs that the formula adds are in brackets):

Jing Jie: releases the exterior (Bensky, Clavey, & Stoger, p. 14); when combined with Fang Feng and Zi Su Ye, it resolves the exterior (Jiao, 2001, p. 16); used for both wind-cold and wind-heat patterns (Jiao, 2001, p. 16).

Fang Feng: releases the exterior (Bensky, Clavey, & Stoger, p. 17); expels wind-dampness and alleviates pain (Bensky, Clavey, & Stoger, p. 17); when combined with Jing Jie and Zi Su Ye, it resolves the exterior (Jiao, 2001, p. 16).

Chai Hu: raises and disperses to vent the exterior and drain heat (Bensky, Clavey, & Stoger, p. 75).

Qian Hu*: directs qi downward and disperses phlegm (Bensky, Clavey, & Stoger, p. 376); re-establishes the normal flow of Lung qi (Bensky, Clavey, & Stoger, p. 377); rectifies qi and transforms phlegm (Jiao, p. 169).

Chuan Xiong: expels wind and alleviates pain, especially pain from headache (Bensky, Clavey, & Stoger, p. 599).

Qiang Huo: releases the exterior and disperses cold (Bensky, Clavey, & Stoger, p. 20); used in conjunction with Du Huo to treat headache and neck pain from common cold (Sionneau, p. 69); enters the Tai Yang channel (Jiao, p. 169); markedly effective for a subjective feeling of cold (Jiao, 2001, p.19).

Du Huo*: disperses wind-cold-damp and releases the exterior (Bensky, Clavey, & Stoger, p. 324); used in conjunction with Qiang Huo to treat headache and neck pain from common cold (Sionneau, p. 69); exerts a powerful effect for dispelling wind and overcoming dampness (Jiao, 2001, p. 21).

Fu Ling: facilitates urination and leaches out dampness (Bensky, Clavey, & Stoger, p. 268).

Jie Geng: spreads/disseminates Lung qi (Bensky, Clavey, & Stoger, p. 429); alleviates sore throat in conjunction with Gan Cao (Mitchell, Ye, & Wiseman, p. 518; Bensky, Clavey, & Stoger, p. 733); courses wind and resolves the exterior (Jiao, 2001, p. 432).

Zhi Ke: promotes the flow of qi, particularly in the chest (Bensky, Clavey, & Stoger, p. 519); rectifies qi and transforms phlegm (Jiao, p. 169).

Gan Cao: alleviates sore throat in conjunction with Jie Geng (Mitchell, Ye, & Wiseman, p. 518; Bensky, Clavey, & Stoger, p. 733); moistens the Lungs and stops cough (Bensky, Clavey, & Stoger, p. 732).

Sheng Jiang*: releases the exterior and disperses cold (Bensky, Clavey, & Stoger, p. 31).

[Gan Jiang]: warms the middle and expels cold (Bensky, Clavey, & Stoger, p. 682); warms the Lungs and transforms thin mucous (Bensky, Clavey, & Stoger, p. 682).

[Zi Su Ye]: releases the exterior and disperses cold (Bensky, Clavey, & Stoger, p. 12); when combined with Fang Feng and Jing Jie, it resolves the exterior (Jiao, 2001, p. 16); aromatically rectifies the qi (Jiao, 2001, p. 18).

The herbs in Dispel Invasion combine to create a formula that vents the exterior, resolves cold and dampness, opens the Lung and chest, stops cough, alleviates sore throat, and transforms phlegm. Jing Jie and Zi Su Ye work together to release the exterior with their warm acridity, while their relative lightness helps guide the pathogen up and out of the body; Fang Feng assists in this process by contributing additional release exterior properties. In the original formula, the use of Sheng Jiang enhances the release exterior action. Qiang Huo is another warm, acrid herb that releases the exterior and is particularly good for the neck pain that frequently accompanies patterns involving wind-cold, because the herb has a connection with the Tai Yang. In the original formula, Du Huo pairs with Qiang Huo to create an herbal synergy for resolving wind-cold-damp. Fu Ling assists by leaching out dampness through the urine and fortifying the Spleen. The combination of Jie Geng, Zhi Ke, and Gan Jiang moves the Lung qi, stops cough, and transforms phlegm. In the original formula, Qian Hu further amplifies these phlegm resolving capabilities. Chuan Xiong is a clever addition that warms, expels wind, and alleviates pain from headache. Gan Cao harmonizes the formula, stops cough, and also alleviates sore throat in conjunction with Jie Geng.

Now let’s look at the relevant pharmacological actions of the herbs (herbs that the Kan formula omits are marked with an asterisk and herbs that the formula adds are in brackets):

Jing Jie: antibiotic, antipyretic, and analgesic (Chen, p. 50).

Fang Feng: antipyretic, antibiotic, and antiviral (Chen, p. 52).

Chai Hu: analgesic, antipyretic, anti-inflammatory, immuno-stimulant, antibiotic, and antiviral (Chen, p. 85; Law, 2014).

Qian Hu*: expectorant, antibiotic, and antiviral (Chen, p. 700); anti-inflammatory (Sarkhail, 2013)

Chuan Xiong: increases blood perfusion to and reduces swelling of the brain (Chen, p. 616); anti-inflammatory (Kim, 2014; Chen, 2014).

Qiang Huo: antipyretic and analgesic (Chen, p. 54); anti-inflammatory (Blunder, 2014).

Du Huo*: analgesic and anti-inflammatory (Chen, p. 305; Chen, 1995); antibiotic (Chen, p. 305).

Fu Ling: anti-inflammatory (Jeong, 2014);  antibiotic (Chen, p. 384).

Jie Geng: expectorant, anti-tussive, analgesic, and anti-inflammatory (Chen, p. 696); antimicrobial and anti-oxidant (Nyakudya, 2014).

Zhi Ke: moderate effect to relax and dilate the airways (Chen, p. 486).

Gan Cao: anti-inflammatory, increases phagocytosis, anti-tussive, expectorant, and antibiotic. (Chen, p. 869-870).

Sheng Jiang*: antibiotic (Chen, p. 46); antiviral (Chang, 2013).

[Gan Jiang]: regulates body temperature (Chen, p. 451); anti-inflammatory (Choi, 2013)

[Zi Su Ye]: antipyretic, diaphoretic, bronchiodilator, and antibiotic (Chen, p. 44); anti-inflammatory (Huang, 2014; Lim, 2014).

Seen from either the Chinese medicine perspective or the perspective of modern pharmacology, the clinical usefulness of Jing Fang Bai Du San should be obvious. Even more noteworthy, however, is that there is no reason to fall back on Yin Qiao San or Gan Mao Ling to treat colds simply because of the pharmacological aspects of the herbs contained in them. We can still diagnose and treat according to Chinese medicine theory: Jing Fang Bai Du San has antiviral, antimicrobial, anti-inflammatory, and immunomodulatory effects as well. So get back to your practice, and prescribe the appropriate formula for the Chinese medicine pattern that presents! In my next post, I’ll be discussing the use of Gui Zhi Tang to treat common colds…

References

Dan Bensky & Randall Barolet, (1990). Formulas and Strategies.

Dan Bensky, Steven Clavey, and Erich Stoger, (2004). Chinese Herbal Materia Medica, 3rd Edition.

M Blunder, et. al., (2014). Polyacetylenes from Radix et Rhizoma Notopterygii incisi with an Inhibitory Effect on Nitric Oxide Production in vitro.

JS Chang, et. al., (2013). Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines.

Chang-Liang Chen & Dan-Dan Zhang, (2014). Anti-Inflammatory Effects of 81 Chinese Herb Extracts and their Correlation with the Characteristics of Traditional Chinese Medicine.

John & Tina Chen, (2004). Chinese Medical Herbology and Pharmacology.

YF Chen, HY Tasi, and TS Wu, (1995). Anti-inflammatory and Analgesic Activities from Roots of Angelica Pubescens.

YY Choi, et. al., (2013). Dried Ginger (Zingiber officinalis) Inhibits Inflammation in a Lipopolysaccharide-Induced Mouse Model.

BP Huang, et. al., (2014). Anti-inflammatory effects of Perilla frutescens leaf extract on lipopolysaccharide-stimulated RAW264.7 cells.

JW Jeong, et. al., (2014). Ethanol extract of Poria cocos reduces the production of inflammatory mediators by suppressing the NF-kappaB signaling pathway in lipopolysaccharide-stimulated RAW 264.7 macrophages.

She-De Jiao, (2001). Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shu-De.

She-De Jiao, (2005). Ten Lectures on the Use of Formulas from the Personal Experience of Jiao Shu-De.

M. Kim, et. al. (2014). Tetramethylpyrazine, a Natural Alkaloid Attenuates Pro-Inflammatory Mediators.

Betty Yuen-Kwan Law, Jing-Fang Mo, & Vincent Kam-Wai Wong, (2014). Autophagic Effects of Chai Hu.

HJ Lim, et. al., (2014). Inhibition of Proinflammatory Cytokine Generation in Lung Inflammation by the Leaves of Perilla frutescens and Its Constituents.

Craig Mitchell, Feng Ye, and Nigel Wiseman, (1999). Shang Han Lun.

Elijah Nyakudya, Jong Hoon Jeong, Nam Kuen Lee, & Yong-Seub Jeong, (2014). Platycosides from the Roots of Platycodon grandiflorum and Their Health Benefits.

Parisa Sarkhail, Abbas Shafiee, & Pantea Sarkhail, (2013). Biological Activities and Pharmacokinetics of Praeruptorins from Peucedanum Species: A Systematic Review.

Philippe Sionneau, (1997). Dui Yao: The Art of Combining Chinese Medicinals.


© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

Fool’s Cold: The Improper Use of Yin Qiao San

Since I talked about the improper use of Jia Wei Xiao Yao San a few weeks ago, I thought it would be appropriate to focus on another highly misused formula: Yin Qiao San. For many practitioners, Yin Qiao San is the “go to” formula for common colds. It can be found on the shelves of many “natural” grocery stores and health food stores, and it is often marketed to the public as an herbal cold remedy. To find out why this formula is being used incorrectly, read on…

Yin Qiao San: we’ve all used it and recommended it to patients. Unfortunately, the formula is often improperly prescribed—at least when looked at from the perspective of the 温病 wēn bìng (warm disease) herbalists who originally created it. Quick…what’s the primary symptom to differentiate the use of Yin Qiao San from other formulas? Easy, right? It’s sore throat. Wrong. According to most Chinese medicine textbooks, the hallmark symptom of  early stage wēn bìng is measurable fever (Liu, 2005; Maciocia, 2005; Deng, 2004)! That’s right: if you’re going to prescribe Yin Qiao San to a patient, you should take their temperature to confirm your diagnosis.

I became interested in the wēn bìng (warm disease) school while I was still a master’s level student because I felt that my herbal education in warm disease theory was lacking. Despite having classes in the Huang Di Nei Jing, Shang Han Lun, and Jin Gui Yao Lue—classes I was (and still am) extremely grateful for—I felt that I couldn’t make an informed decision about my own clinical practice if I did not explore all the major schools of Chinese herbalism. Since my herbal proclivities tended toward these Han dynasty texts, I was continually frustrated when certain clinical supervisors would force me to give Yin Qiao San to a patient simply because the symptomatology included sore throat. On several occasions, I had successfully treated myself for a cold (with accompanying sore throat) by using a formula from the Shang Han Lun, so I wanted to be sure a better alternative wasn’t available before suggesting Yin Qiao San to a patient. I decided that I would need to educate myself on the wēn bìng style of herbalism in order to properly argue my case, so I went online and ordered Warm Pathogen Diseases by Guohui Liu (2005).

The book was not an actual translation of the original wēn bìng literature, but rather a clinical textbook that focused on this particular school of herbalism. Among other things, I was intrigued to discover that the wēn bìng scholars were big fans of Zhang Ji (Zhang Zhong-jing), the author of the Shang Han Lun and Jin Gui Yao Lue. They created the wēn bìng formulas because they were not having success with Zhang’s classical formulas, and actually incorporated several Shang Han Lun formulas into their repertoire, including Bai Hu Tang and Ma Xing Shi Gan Tang.

Warm Pathogen Diseases by Guohui LiuAs I began reading Liu’s textbook, my own suspicions about the clinical use of Yin Qiao San were vindicated, and I came to appreciate its clever composition. As mentioned above, a measurable fever is the hallmark symptom of early-stage wind-heat (Liu, p. 37). Other key diagnostic symptoms are slight chills and aversion to wind, cough, tongue with red tip and edges, and a floating, rapid pulse (Liu, p. 54). The patient may also present with headache, increased thirst, and sore throat (Liu, p. 198).  Wu Tang (1758-1836), the herbalist who developed Yin Qiao San, had this to say about the treatment of disease:

“Use herbs that are as light as the feathers of a bird for disease in the upper burner; use herbs to lift the Spleen qi and cause the Stomach qi to descend in the middle burner, just like calibrating a scale that should always be in balance; and use heavy and cloying herbs to treat yin deficiency for the Liver and Kidney in the lower burner, like adding a heavy weight to a scale to tip the balance” (Liu, p. 22).

Many practitioners seem to use Yin Qiao San based on the pharmacological actions of the herbs that comprise it, so let’s examine the formula from this modern perspective:

Jin Yin Hua: antibiotic, anti-inflammatory, and antipyretic (Chen, p. 172); antiviral (Shang, 2011).

Lian Qiao: antibiotic, antiviral, anti-inflammatory, and antipyretic (Chen, p. 175).

Jie Geng: expectorant, anti-tussive, analgesic, and anti-inflammatory (Chen, p. 696).

Bo He: antipyretic and anti-inflammatory (Chen, p. 69).

Dan Zhu Ye: antipyretic (Chen, p. 120).

Jing Jie: antibiotic, antipyretic, and analgesic (Chen, p. 50).

Dan Dou Chi: mild diaphoretic (Chen, p. 90).

Niu Bang Zi: antibiotic, anti-inflammatory, and antipyretic (Chen, p. 71).

Lu Gen: mild sedative effect (Chen, p. 118).

Gan Cao: anti-inflammatory, increases phagocytosis, anti-tussive, expectorant, and antibiotic. (Chen, p. 869-870).

Looking at these modern pharmacological indications, one can see why many practitioners are fond of this formula: it reduces fever, stops coughing, reduces inflammation, stimulates the immune system, and inhibits viruses. Unfortunately, using Yin Qiao San based solely on a pharmacological basis is tantamount to practicing biomedicine with Chinese herbs. If we ignore the methods of Chinese medicine (inquiry, observation, tongue/pulse diagnosis, etc.) we may miss an opportunity to use a more effective formula, and we fail to offer our patients a truly “alternative” medicine. Now let’s take a look at the ingredients of Yin Qiao San from the perspective of their traditional Chinese medicine actions:

Jin Yin Hua: a light herb that clears heat and relieves toxicity (Bensky & Barolet, p. 45; Bensky, Clavey, & Stoger, p. 149); vents and disperses wind-heat (Bensky, Clavey, & Stoger, p. 149).

Lian Qiao: a light herb that clears heat and relieves toxicity (Bensky & Barolet, p. 45; Bensky, Clavey, & Stoger, p. 153); used with Jin Yin Hua to treat the early stages of a wind-heat invasion (Bensky, Clavey, & Stoger, p. 253).

Jie Geng: spreads/disseminates Lung qi (Bensky & Barolet, p. 45; Liu, p. 200; Bensky, Clavey, & Stoger, p. 429); alleviates sore throat in conjunction with Gan Cao (Bensky & Barolet, p. 45; Mitchell, Ye, & Wiseman, p. 518; Bensky, Clavey, & Stoger, p. 733).

Bo He: releases the exterior (Liu, p. 200); disperses wind-heat (Bensky, Clavey, & Stoger, p. 47; Bensky & Barolet, p. 45).

Dan Zhu Ye: clears heat (Liu, p. 200; Bensky, Clavey, & Stoger, p. 98); generates fluids and alleviates thirst (Bensky & Barolet, p. 45).

Jing Jie: releases the exterior (Bensky, Clavey, & Stoger, p. 14; Liu, p. 200).

Dan Dou Chi: releases the exterior (Liu, p. 200; Bensky, Clavey, & Stoger, p. 64); releases exterior heat (Bensky & Barolet, p. 45)

Niu Bang Zi: disseminates Lung qi (Liu, p. 200; Bensky & Barolet, p. 45); disperses wind-heat (Bensky, Clavey, & Stoger, p. 50); benefits the throat (Bensky, Clavey, & Stoger, p. 50; Bensky & Barolet, p. 45).

Lu Gen: generates fluids and alleviates thirst (Liu, p. 200; Bensky & Barolet, p. 45; Bensky, Clavey, & Stoger, p. 106); clears heat (Bensky, Clavey, & Stoger, p. 106).

Gan Cao: alleviates sore throat in conjunction with Jie Geng (Bensky & Barolet, p. 45; Mitchell, Ye, & Wiseman, p. 518; Bensky, Clavey, & Stoger, p. 733); disseminates Lung qi (Liu, p. 200); moistens the Lungs and stops cough (Bensky, Clavey, & Stoger, p. 732).

As an herbalist, it’s hard not to marvel at the brilliance of this formula’s composition. Even dedicated Shang Han Lun scholars would have to agree that this is an artfully crafted formula. Yin Qiao San is a beautiful example of Chinese herbal theory, and Wu Tang brilliantly uses herb combinations to maximize its effect. Several of the herbs release the exterior, while light clear-heat and toxin herbs lead the pathogen up and out of the body; other herbs alleviate the sore throat and thirst that frequently accompany early-stage wind-heat invasions.

Preparation

There are some interesting notes in Guohui Liu’s book about the proper preparation of Yin Qiao San. Originally, the juice of fresh Lu Gen was added to the other herbs—most, if not all, modern preparations use the dry form of Lu Gen. The herbs should also be ground into a powder, and then soaked in cold water for 30 minutes in the decocting vessel; the decoction should be brought to a boil using a high flame for approximately eight minutes, or until the fragrance of the herbs fills the air (Liu, p. 202). If the formula is cooked too long, the “light nature and acrid flavor,” of the herbs “will be leached out with the steam, and only the bitter flavor will remain” (Liu, p. 202). In modern terms, this specific indication preserves the volatile aromatic oils in herbs like Bo He and Jing Jie.

Dosage

Gaohui Liu recommends the following dosages of the bulk herb decoction:

Adults: one-half cup six times a day

Children: three to five spoonfuls six times a day

Infants: two to three spoonfuls six times a day

—(Liu, p. 203)

Conclusion

When properly prescribed, Yin Qiao San is an incredibly effective remedy for early-stage wind-heat. It is a beautifully crafted formula, which is supported by—not based on—the pharmacological constituents of its herbs. Compare this to a formula like Gan Mao Ling: a modern preparation for colds that is based purely on the pharmacological constituents of its herbs and “is at direct odds with Chinese medicine’s fundamental theory” (Blalack & Rosenberg, 2012). I’ve run a little long with this article, so I’m going to save my favorite alternatives to Yin Qiao San for the next one…

References

Dan Bensky & Randall Barolet, (1990). Formulas & Strategies

Dan Bensky, Steven Clavey, & Erich Stoger, (2004). Materia Medica, 3rd Edition

Jason Blalack & Z’ev Rosenberg, (2012). Gan Mao Ling and Studying the Classics

John and Tina Chen, (2004). Chinese Medical Herbology and Pharmacology

Tietao Deng, (2004). Practical Diagnosis in Traditional Chinese Medicine

Guohui Liu, (2005). Warm Pathogen Diseases

Giovanni Macciocia, (2005). The Foundations of Chinese Medicine

Craig Mitchell, Feng Ye, Nigel Wiseman, (1999). Shang Han Lun

Shang, Pan, Li, Miao, & Ding, (2011). Lonicera japonica Thunb.: ethnopharmacology, phytochemistry and pharmacology of an important traditional Chinese medicine.


© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

The DAOM: Who Needs It?

Students and colleagues often ask me for advice about the available DAOM programs. I hope the following article with prove useful to those who are considering enrollment in an accredited DAOM program. While one could do an entire doctoral research project on the subject, I hope this will serve as short and practical reference guide for prospective students.

Introduction to the DAOM

So, you’re thinking about obtaining a doctoral degree. Why? Do you have plans to teach? Do you like the idea of calling yourself “Doctor”? Do you want to conduct scientific research? Are you looking for an easy way to defer student loan payments while still advancing your education? If you answered yes to any of these questions, the DAOM may be a good option for you.

The DAOM is a relatively new development in the history of education in East Asian medicine. While many master’s programs have been around for 30 years or more, most DAOM programs have only been existence for 10 years or less. What does that mean to prospective students? It means that—despite certain program standards necessary to achieve accreditation—each school is defining how it will approach the education of its students at the doctoral level. Whereas the goal of most master’s programs is to prepare students for the state and national board exams, the primary outcome of DAOM programs is the completion of a unique Capstone research project. This simple fact means that there is an incredible amount of variance between these programs. In addition, since DAOM programs are still in their infancy, the institutional and administrative problems that most students have experienced in their master’s programs are likely to be worse at the doctoral level.

Why were DAOM programs created?

My understanding is that DAOM programs were created for two primary reasons: to provide advanced clinical training to practitioners, and to create doctoral-level educators for the profession. The benefits to providing acupuncturists and practitioners with additional training are fairly obvious, so I won’t address that here. The need for doctoral-level professors, however, may seem puzzling to those who are not familiar with some of the recent developments in TCM and OM education.

For many years now, there has been a desire among some educators and administrators to create a first professional doctorate program (FPD) for acupuncture and East Asian medicine. The goal of the FPD is to expand upon “the minimum ACAOM standards for master’s programs” (pacificcollege.edu). Last year, ACAOM—the accrediting body for master’s and doctoral programs—began reviewing applications from schools who want to offer this new degree. Some schools are already beginning a transition to the FPD, but in order to legitimately offer these new degrees, the majority of teachers in these programs must have doctoral-level credentials (ACAOM). So, one function of the DAOM is to train teachers for these newly accredited FPD programs. In fact, if you’ve tried to get a job in a master’s program within the last few years, you may have been told that the school is only accepting applications from candidates with a DAOM. This is partly the reason why so many current teachers are enrolling in these programs: they have been “encouraged” to obtain the DAOM by the schools at which they teach. Of course, doctoral-level educators are also necessary for the growth of DAOM programs as well.

The DAOM as a vehicle for research

Not all DAOM students are teachers, some are interested in the potential research opportunities these doctoral programs offer. If you are one of these students, I am sorry to burst your bubble, but is unlikely that any DAOM program will provide the opportunity to conduct high-level scientific research. Unless you personally have connections to a research hospital or university, you will be able to do little more than a meta-analysis of existing data, or a case study involving one or two patients. It’s unfortunate, but true. I am not familiar with any DAOM program that currently has the resources to support the level of research that would be required of a PhD student at a university. In fact, very few—if any—programs have university or hospital connections at all, so you can pretty much forget about that double-blind placebo controlled herb study you had in mind for allergy sufferers, or that multi-tiered acupuncture study on diabetes.

Serving the Disparate Needs of Students

One of the greatest challenges facing DAOM programs is how to accommodate the disparity of student knowledge on any given subject. If you’ve been following my blog, you know that I did my master’s level work at Five Branches University, where I received training in the Huang Di Nei Jing, Shang Han Lun, and Jin Gui Yao Lue as separate required classes. When I began my doctoral work at PCOM, I was shocked to discover that only half of my cohort had received any instruction on the Nei Jing in their master’s programs. Once I started my Capstone research, I understood why this disparity existed: only about 10% of schools teach the Nei Jing as a required class at the master’s level.

Imagine the challenge of creating a doctoral-level Nei Jing class that would simultaneously benefit a student who had taken a semester-long Nei Jing class, and a student who had never studied the text before…it would be practically impossible!  In my experience, this educational divide was never truly bridged; the class I enjoyed the most was taught by Giovanni Maciocia—who gave an incredible presentation on the history and background of the Nei Jing—but many of my fellow students found it boring and academic, because it was simply above their level of understanding. Without some familiarity with the Nei Jing, how can a student benefit from a lecture about the influence of Legalism, Confucianism, and Daoism on the text? In contrast, the remaining Nei Jing classes were far more rudimentary than I would have liked, and I didn’t get much out of them. This example underscores the reality that on any given topic, some students are ready to be taught at the doctoral level, while others are not. This situation has nothing to do with the intelligence or clinical skill of one group of students over another, it simply has to do with the different program goals and curricula at the master’s programs from which these students graduated.

The challenge of bridging these knowledge gaps is very real: DAOM programs will always be forced to serve the needs of one group of students at the detriment of another. So, in any given class, there are students who are not being served. This is a natural extension of the variance in master’s level education: while all programs have certain academic standards to uphold, how they choose to meet these standards varies greatly.

Final Thoughts

To recap: although there are many doctoral programs to choose from, they all take a different approach to the education of their students. In many ways, the variance between DAOM programs is even greater than at the master’s level. Every program has particular strengths and weaknesses, due to their design. Thus, it is unlikely that you will find a doctoral program that meets your needs all of the time, so do your research and choose wisely.


© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

How Acupuncturists Misuse Jia Wei Xiao Yao San

Free & Easy Wanderer (Xiao Yao San) and Free & Easy Wander Plus (Jia Wei Xiao Yao San) are two of the most widely prescribed formulas in American TCM clinics. I have observed this reality on a small scale as an intern at the Five Branches University clinic, and on a larger scale as an herbal consultant for Kan Herb company. American practitioners love to use these formulas, but I’ve had many interactions with colleagues that suggest there is a need for further clarification on their respective indications. Indeed, more than one practitioner has told me, “I use Free and Easy Wander Plus…it has two additional herbs.” Yes, and Brawndo‘s got electrolytes.

Let’s be honest: we live in a culture of excess. Super-sized burgers, Big Gulps, and 5lb tubs of Costco mayonnaise are the norm—but the “plus” in Free and Easy Wanderer Plus (Jia Wei Xiao Yao San) is not synonymous with better. In this case, “plus” does not mean “added value,” or “more effective,” as we are culturally conditioned to think: it is simply a way of indicating that two additional herbs have been added to the original formula. In fact, jiā (加) wèi (味) simply means “add flavor.” It has nothing to do with the effectiveness of either formula.

Free and Easy Wanderer / Rambling Powder (Xiao Yao San)

Xiao Yao San (Free and Easy Wanderer)

Xiao Yao San
(Free and Easy Wanderer)

In most cases that I have observed, treated, or provided consultation for, Xiao Yao San is the appropriate formula choice. It moves Liver qì with Chai Hu (bupleurum root) and Bo He (field mint), and it softens the liver with Bai Shao (white peony root). Bai Shao (white peony root) also nourishes the blood in conjunction with Dang Gui (Angelica sinesis).  Xiao Yao San benefits the Spleen as well, with Bai Zhu (atractylodes root),  Fu Ling (poria) and Gan Cao (licorice root). The combination of these actions makes the formula appropriate for a number of clinical complaints, including: headache, dry mouth, fatigue, reduced appetite and irregular menstruation (Bensky & Barolet, 1990).

Free and Easy Wanderer Plus / Augmented Rambling Powder (Jia Wei Xiao Yao San)

Jia Wei Xiao Yao San (Free and Easy Wanderer Plus)

Jia Wei Xiao Yao San
(Free and Easy Wanderer Plus)

Many practitioners use Jia Wei Xiao Yao San in place of the original formula, which I believe is a mistake. This modification of the formula is much colder, due to the addition of two “cool blood” herbs: Mu Dan Pi (Moutan cortex) and Zhi Zi (gardenia fruit). I taught both of these herbs to students at Five Branches University as their Herbs-1 teacher, so I’m very familiar with them. Zhi Zi (gardenia fruit) is a bitter, cold herb for cooling the blood. In the Wen Bing school, it is often used to treat blood-level heat, which is a severe condition. Mu Dan Pi (Moutan root bark) also cools the blood, but it has mild blood invigorating actions as well. The combination of these actions makes Jia Wei Xiao Yao San suitable for symptoms like: irritability, painful urination, red eyes, dry mouth, or increased menstrual flow (Bensky & Barolet, 1990).

Commentary and Alternative Approaches

Bupleurum, Dragon Bone, and Oyster Shell (Chai Hu Long Gu Mu Li Wan)

Bupleurum, Dragon Bone, and Oyster Shell
(Chai Hu Long Gu Mu Li Wan)

In my opinion, many practitioners use Jia Wei Xiao Yao San to treat the American lifestyle, which is fast-paced and stressful. Unfortunately, the use of this formula to treat lifestyle runs contrary to the actual clinical manifestations thereof. A fast-paced, stressful life is depleting, if anything. It may contribute to vacuity heat patterns, but this type of lifestyle typically leads to deficiency, not excess (blood heat). For stressed, Type-A personalities, Chai Hu Long Gu Mu Li Wan is often a more effective choice for improving mood and anchoring the spirit.

Great Corydalis

Great Corydalis (Yan Hu Suo Zhi Tong Wan)

Augmented Four Substances (Tao Hong Si Wu Tang)

Augmented Four Substances
(Tao Hong Si Wu Tang)

Four Substances (Si Wu Tang)

Four Substances
(Si Wu Tang)

When used to treat menstrual complaints, Jia Wei Xiao Yan San should only be used in cases of excessive menstruation and/or painful urination. If you are using it to treat menstrual cramps based on the blood moving functions of Mu Dan Pi, consider using original Xiao Yao San in conjunction with Four Substances (Si Wu Tang), Augmented Four Substances (Tao Hong Si Wu Tang), or Great Corydalis (Yan Hu Suo Zhi Tang Wan), depending on the presentation. These combinations can often lead to a more desirable clinical outcome than the use of any one of these formulas alone.

Final Thoughts

If you are considering the use of Free and Easy Wanderer Plus (Jia Wei Xiao Yao San) to treat a patient—stop—and ask yourself why. Is it based on the clinical applications of the formula? Or is it based on an assumption that has nothing to do with its herbal composition? I have provided several alternative formulas or formula combinations above: is one of those more specific to the condition your are treating? Whether you stock pills or granules, the appropriate use of formulas—based on an accurate clinical diagnosis—is the single best way to see results with herbs in your clinic.

References

Dan Bensky and Randall Barolet, (1990). Formulas and Strategies.


© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

ALS: A Chinese Medicine Perspective

With the recent attention given to the ALS Icebucket Challenge, I thought it would be beneficial to consider Amyotrophic Lateral Sclerosis from a Chinese medicine perspective.

Ah…the ALS Icebucket Challenge: it’s got everyone from Justin Bieber to George W. Bush dumping buckets of ice-water on their heads; it’s got California environmentalists annoyed because people are wasting water in a drought; and it’s got your—or at least my—Facebook friends divided over whether this awareness-raising publicity stunt is “played out,” “narcissistic,” or “really important.” Before I begin my analysis of ALS from a Chinese medicine perspective, allow me to state the following:

  • I am not suggesting that Chinese medicine cures ALS.
  • I am not suggesting that you should ignore your doctor’s advice or stop conventional treatment if you have ALS.
  •  The following is a theoretical discussion based on a synthesis of ancient Chinese medical literature and modern biomedical research. It is not based on clinical experience with ALS.

 

What is ALS?
According to the ALS Association, Amyotrophic Lateral Sclerosis, or “Lou Gehrig’s Disease,” is “a progressive neurodegenerative disorder that affects nerve cells in the brain and the spinal cord” (ALSA.org). As these nerves die, those who suffer from the disease gradually lose muscle control, until complete paralysis—and ultimately, death—results.

ALS as Atrophy Syndrome
The Chinese character, wěi 萎, meaning “atrophy” or “wilting,” is composed of two parts. The upper part, cǎo 艹, means “grass” or “plant,” while the lower part, wěi 委, means “to fall” or “to hang down” (Scheussler, 512). As I have mentioned in previous posts, I am not a Chinese language specialist, but the concept of a wilting plant seems an accurate and poetic description of the physical atrophy commonly seen in patients with neurodegenerative disorders like ALS.

Atrophy syndrome was first mentioned in chapter 44 of the Huáng Dì Nèi Jīng Sù Wèn, one of the foundational texts of Chinese medicine. What follows is a complex discussion about the various manifestations of atrophy, which requires a rather advanced knowledge of Chinese medical theory to understand. The clinical result of this discussion is that atrophy syndrome is primarily related to dysfunctions involving the yáng míng 阳明, the chōng mài 冲脉, the dài mài 带脉, and the dū mài 督脉: several of the channels that traverse the body. Elsewhere in the same chapter, the yáng míng 阳明 is described as the sea of the internal organs, and the chōng mài 冲脉 is described as the sea of the acupuncture channels (Huáng Dì Nèi Jīng Sù Wèn Chapter 44). According to another classical text of roughly the same time period, the dài mài 带脉 encircles the body at the waist, while the dū mài 督脉 travels up the inside of the spinal column before entering the brain (Nán Jīng Chapter 28).

Chapter 44 of the Huáng Dì Nèi Jīng Sù Wèn gives a very specific acupuncture treatment protocol for atrophy syndrome: the use of spring (yíng 潆) points and transport (shū 輸) points on the affected channels. Modern research suggests that the channels are closely related to interstitial connective tissue planes and that acupuncture points occur at the junctions thereof (Langevin & Yandow, 2002; Ahn, 2010). According to researchers, this interstitial connective tissue “constitutes a continuous network enveloping all limb muscles, bones, and tendons, extending into connective tissue planes of pelvic and shoulder girdles, abdominal and chest walls, neck, and head” (Langevin & Yandow, 2002). This potential link between acupuncture and the connective tissue makes it an ideal adjunct therapy in cases of ALS.

Shun-fa Jiao, a modern Chinese practitioner who has extensively studied the relationship between acupuncture and neurology, states that “[The term] ‘joint junctions,’ [mentioned in chapter 1 of the Huáng Dì Nèi Jīng Líng Shū] refers to the places where the neurofilaments of the anterior lateral sulcus and posterior spinal cord cross to form anterior and posterior roots, and then cross again to form a spinal nerve. After several of these crossovers, they become the nerves that travel throughout the body” (Jiao, p. 57-58). If Jiao’s hypothesis is correct, it would provide even stronger support to the potential benefits of acupuncture in the treatment of ALS.

ALS and the Sea of Marrow

“The brain is the sea of marrow…when the Sea of Marrow is insufficient, it results in revolving of the brain, noises in the ear, weakness of the legs, dizziness with spots, and the eyes without vision” –Huáng Dì Nèi Jīng Líng Shū, Chapter 33 (Wu, p. 133).

In Chinese medicine, the Sea of Marrow (suǐ hǎi 髓 海) is a rather curious term. According to Shun-fa Jiao, whose work with acupuncture and neurology was mentioned above, “Marrow (suǐ 髓) illustrates the changes the channels undergo after they enter the spinal canal” (Jiao, p. 68). Based on this description, and the one given in Chapter 33 of the Huáng Dì Nèi Jīng Líng Shū, a biomedical definition of the Sea of Marrow would likely encompass the brain, the spinal cord, and the cerebrospinal fluid. From this perspective, it should be obvious that the Sea of Marrow plays a large role in neurodegererative diseases like ALS. Clinically, there are two points specific to the Sea of Marrow: Du-16 and Du-20. These two points are both on the dū mài 督脉, which was mentioned above as one of the channels typically affected in atrophy syndromes.

Bridging Two Worlds: Integrating Acupuncture and Biomedical Treatment
As of now, there is no cure for ALS. The only therapy that exists is a pharmaceutical drug called Riluzole. Unfortunately, Riluzole only extends the patient’s lifespan by 2-3 months, and it often causes undesirable side effects like nausea and fatigue (Skidmore, 2007). Without an effective biomedical cure, acupuncture and Chinese medicine must be considered as potential adjunct therapies to manage the symptoms of ALS and to reduce the side effects of Riluzole.

In a recent study, researchers found that integrative therapies, including acupuncture and Chinese medicine, improved subjective symptoms in patients. These patients reported feeling more comfortable, slightly happier, and more energetic; some patients reported more restful sleep and improved appetite as well (Pan, 2013). This study suggests that acupuncture and Chinese medicine have the potential to play a supportive role in conventional ALS treatment, both to improve overall quality of life and to reduce the side effects of Riluzole treatment.

In another study, patients were treated with the following acupuncture points: Spleen-3, Lung-9, Heart-8, and Lung-10 (Lee & Kim, 2013). Do you recall the earlier statement from the Nèi Jīng that one should treat the spring (yíng 潆) and transport (shū 輸) points in cases of atrophy? Spleen-3 and Lung-9 are transport (shū 輸) points, and Heart-8 and Lung-10 are spring (yíng 潆) points! In addition to performing acupuncture, Spleen-3 and Lung-9 were connected to electrical stimulation for 15 minutes at a frequency of 100Hz (Lee & Kim, 2013). The researchers found that this point protocol had a significant influence on SpO2—or oxygen saturation levels—leading them to conclude that acupuncture treatment could positively influence inspiration (Lee & Kim, 2013). Inspiration (aka inhalation), is an active process facilitated by muscular contraction, primarily of the diaphragm and intercostal muscles (Tamarkin, 2011). This finding is particularly noteworthy, since the progressive neuromuscular degeneration of ALS ultimately leads to the failure of the respiratory system.

Other studies suggest that electrical stimulation performed on Stomach-36 elicits anti-inflammatory effects in animal models of ALS (Yang, 2010; Jiang, 2011). Inflammation commonly accompanies the neuronal death that occurs in ALS patients, and many researchers are currently seeking ways to reduce the inflammation that is associated with the disease (ALSA.org/research). If acupuncture can potentially reduce inflammation in ALS patients, why not incorporate this safe and effective therapy into an integrative treatment strategy?

Clinical Protocols and Beyond
In this paragraph, I’d like to take a brief moment to address the acupuncturists who might be reading this article. Hopefully, the discussion presented here has already inspired you to consider how you might treat this disease in your clinic. If not, consider incorporating the information from classic texts and modern research into a comprehensive clinical protocol. At minimum, use Lung-9, Spleen-3, Heart-8, Lung-10, Du-16, Du-20, and Stomach-36. Of course, this protocol is extremely basic, and must be modified according to the patient’s presentation (including tongue and pulse). Consider using other points on the yáng míng 阳明 and dū mài 督脉 based on the patient’s specific symptoms.

A word of caution: while we can learn much from an integrative approach, we must always seek to explain biomedical terms and diagnoses with Chinese medicine terminology—not the other way around!

Herbal Approaches
While much of this article has focused on acupuncture protocols for the treatment of ALS, I’d like to take a brief moment to mention some potential herbal therapies. Of course, before undertaking any course of herbs, consult your doctor or primary healthcare professional.

Based on the symptoms of muscular atrophy, fatigue, and respiratory failure, a comprehensive Chinese medicine approach to ALS treatment would likely involve herbs that boost the qì of the Lung and Spleen. According to Chinese medical theory, the Spleen rules the muscles (Huáng Dì Nèi Jīng Sù Wèn Chapter 5). Note: the term Spleen (脾 pí) refers to a holographic representation of biological and physiological processes, not only to the organ itself. The respiratory issues that occur as the result of ALS suggest that Lung qì deficiency also plays a role in the etiology of the disease. Chinese herbal medicine works best when the formula is tailored to meet the specific needs of the patient, but here are a few potential starting points:

Four Gentlemen Decoction: the most basic formula to fortify the Spleen qì.

Li Zhong Wan: slightly warmer than Four Gentlemen; also used to fortify the Spleen qì.

Shi Chuan Da Bu Wan: fortifies both the qì and blood; includes Huang Qi (Astragalus root) to support the Lung and Rou Gui (Cinnamomi Cortex) to support the Kidney.

Cordyceps: fortifies the Lung and Kidney; helps maintain respiratory health.

Sheng Jiang, Zi Su Ye, Ban Xia, Da Zao, and Gan Cao: a simple formula to ease the nausea that may accompany Riluzole treatment.

Closing Thoughts
Obviously, acupuncture and Chinese medicine have the potential to play an important role as an adjunct therapy to biomedical treatment for patients suffering from ALS. The conventional biomedical treatment for this disease extends life by up to three months, but may produce undesirable side effects like nausea and fatigue. Why not pursue an integrative approach, so that the patient can be as comfortable as possible throughout the duration of the disease?

 

References

ALSA.org

ALSA.org/research

Ahn, et. al., (2010)

Huáng Dì Nèi Jīng 黄帝内经

Jiang, et. al., (2011)

Sun-fa Jiao, (2012) Nine Needles and Twelve Yuan-Source Points

Langevin & Yandow, (2002)

Lee & Kim, (2013)

Pan, et. al. (2013)

Axel Schuessler, ABC Etymological Dictionary of Old Chinese

Linda Skidmore, (2007) Mosby’s Drug Guide for Nurses, 7th edition

Dawn Tamarkin, (2011)

Paul Unschuld, (1986) Nan-Ching: The Classic of Difficult Issues

Jing-nuan Wu (1993) Ling Shu: Or the Spiritual Pivot

Yang, et. al. (2010)

© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

The Crisis of American TCM

Active TeachingAs the first cohort of students I taught embarks upon the final year of their master’s program, I wanted to offer them some words of encouragement. In thinking about what to say, I began to recognize a potential problem that not only affects them, but all current students, teachers, and practitioners of Chinese and East Asian medicine in the United States.

The Rise of the Disempowered Healer
Chinese medicine in America is stuck: the growing number of acupuncturists and practitioners of East Asian medicine has created a new economic market for postgraduate certification programs. Subsequently, we have begun to create a culture of secrecy and certification that is ultimately detrimental to our field. The most recent generation of practitioners is particularly susceptible—we don’t have the experience of our colleagues who have been practicing for 20+ years, so we often compensate for this perceived deficiency with workshops, seminars, and certifications. Let me take a moment to clarify my terms: I am not talking about CEUs required for licensure, I am talking about the myriad of certificated programs that do not adhere to the academic standards of other disciplines, and thusly confer unaccredited titles. We are continually being enticed by teachers who promise to unlock the secrets of Chinese medicine, as revealed to them through arcane lineages that were originally transmitted from the favorite pupil of the Yellow Emperor (or some such thing). In many cases, this leads to complacency: instead of educating ourselves, we rely on others to do it for us. We accept the myth of “secret knowledge.” Simply put, we voluntarily disempower ourselves. In so doing, we gain certifications and techniques, but not true knowledge of the medicine. As a practitioner who graduated within the last 10 years, and as a former teacher, I have witnessed my colleagues—and myself—succumb to this Faustian bargain.

In addition to holding MTCM and DAOM degrees from accredited institutions, I also have several unaccredited certifications, but out of respect for other practitioners and students of the medicine, I no longer list any of these certificated titles on my website or other marketing materials. Let me be clear: I am not suggesting that these certificates have no value—they represent hours of training and study in their respective subjects—they just don’t hold any weight with the greater academic community. When I joined the faculty at Five Branches University, I was not permitted to list any unaccredited certifications in my bio, and though I no longer teach there, I have chosen to follow the standard set by that institution (my master’s-level alma matter). It’s one thing to be proud of one’s accomplishments, but I believe it sends the wrong message about our field to current students, the biomedical community, and the general public when we list certifications obtained through non-accredited sources alongside legitimate degrees and credentials. We should be proud of our master’s degrees, doctoral degrees, and licenses. They are well deserved!

How did this happen?
Many of us are drawn to Chinese medicine because of the mysterious and mystical ideas it seems to hold, only to be frustrated as we wait in vain for the part about dragons and ancient sages who have unlocked the mysteries of the universe. In my experience, few teachers ask students to think critically, and students are often discouraged from doing so, both in the classroom and in the clinic. Seeking the magic within the medicine, students begin to look outside their schools for the “secret knowledge” that isn’t taught anymore. Many of us have entertained romantic notions of stumbling upon an old man with a white beard walking the Chinese countryside, or meditating on the subtleties of nature in a subterranean cave. Unfortunately, while a few of us may attain this fantasy, most won’t. As a community, we need to reject the fallacy of “secret knowledge” that is found somewhere outside of ourselves—a notion that is inherently disempowering. Instead, we must hold ourselves to a higher level of academic rigor and integrity. Only then will we see that there is no veil between ourselves and true understanding of this timeless medicine.

Pedagogy and the Failure of the TCM Educational Model
The first American schools of TCM inherited a model of education from China that did not truly meet the needs of American students. While we have largely adapted the clinical practice of Chinese medicine to meet the needs of the American patient population, we have not—for all intents and purposes—adapted our teaching model to meet the needs of the American student. As part of my doctoral research on pedagogy and ancient chinese medical literature, I referenced Bloom’s taxonomy of educational objectives when composing a curriculum for the Huáng Dì Nèi Jīng. Put simply, Bloom’s taxonomy is a method of grouping learning outcomes in the classroom: ranging from lower-order to higher-order cognitive processes (Bloom, 1956). Unfortunately, many teachers at American TCM and OM schools are basing their learning objectives on lower-order processes, like “remembering” or “understanding.”

Visual representation of Bloom’s taxonomy

Let me illustrate this concept using yīn-yáng theory as an example: a teacher outlines the basic concept of yīn-yáng theory, along with some general associations (yīn=dark, yáng=light; yīn=water, yáng=fire). The lowest-order cognitive process is simply “remembering,” so students are only asked to repeat back the previously mentioned yīn-yáng associations on a test or when questioned in class. The next level up is “understanding,” so students are asked a question like, “What is yīn-yáng theory?” and they are expected to answer something along the lines of, “An ancient Chinese theory about the dynamic polarity of opposites,” and then give a few examples. These lower-order processes are important at the beginning stages of any subject, but they must evolve throughout the semester (and the program) as the students’ understanding of the subject matter deepens.

Ideally, someone who is teaching at the foundational level should begin with lower-order objectives, and as the semester progresses, gradually incorporate higher-order objectives into their lesson plans. Using the same example of yīn-yáng theory, higher-order questions would sound something like, “Analyze how yīn and yáng affect your life,” “Compare yīn-yáng theory with Five Phase theory,” or “Some Chinese scholars believe the full moon is maximum yīn, while others believe it is maximum yáng: what do you think, and why?” How many teachers, even in the final year of a four-year master’s program, ask students to employ these higher-order cognitive processes in the classroom? Not many, in my experience. Even in the final year, most learning objectives seem to be geared toward the memorization of disease patterns and the rote repetition of point and/or herbal prescriptions. The model employed in many American master’s programs is utilitarian in this regard: these programs doggedly prepare students to take State and/or National Board exams, which are largely based on lower-order cognitive processes (specifically recall of information). Unfortunately, this also means that many master’s students graduate without ever really thinking critically about Chinese medicine and the theories thereof. These graduates then go on to teach, and the cycle repeats…and the cylce repeats…a d  t e  c c e  r p a s…until the knowledge is obscured and thus appears secret.

So What?
The lack of higher-order learning objectives in most TCM and OM classrooms does two things: it creates a surface understanding of the practice and theory of the medicine, and it drives students toward external sources of information. In my case, it did the latter. I wasn’t getting the answers or understanding I sought, so I spent most of my free time reading books about the medical classics, ancient Chinese philosophy, or the history of Chinese medicine. By graduation, I had read more than 50 books on these subjects—none of which were required reading! Most of my colleagues thought I was crazy for reading this much in addition to the required texts, but I enjoyed finding answers to my lingering questions. Other colleagues attempted to rectify their academic frustration by becoming involved in outside classes and school-sanctioned electives, or by obtaining certification in some other modality related to Chinese or East Asian medicine. As mentioned above, I took this approach, too. I mention it merely to underscore a point: teachers should give more to their students, and students should expect more of their teachers.

Students should be encouraged to find answers to the questions that intrigue them, and teachers at American schools of East Asian medicine should foster this curiosity in both the classroom and the clinic. Schools need to prepare students for the boards, but also need to challenge them to do more than repeat and regurgitate TCM banalities like, “The Liver is associated with the color green.” American students are hungry for knowledge, and no matter how many times the administration or their teachers tell them: “Just focus on passing the boards for now, and then you can study the things that interest you,” they are going to seek it out!  Furthermore, the students at American TCM and OM schools are being yoked with a crushing amount of student-loan debt, so they should not be forced to look outside of their schools to find the knowledge they are seeking; consequently, the teachers at these schools should not be satisfied with relying on lower-order learning objectives in the classroom or in the clinic.  Weas a communityneed to up our game, or we will never be taken seriously by the greater world of academia.

Integration of Knowledge from Other Disciplines
Most American TCM schools do an admirable job of teaching students how to interface with MDs and other biomedical professionals. Unfortunately, Chinese medicine is a complex discipline and—to accurately articulate its theoretical underpinnings—an understanding of the history, philosophy, and culture of China is required. As teachers, we need to incorporate knowledge from these other disciplines into our classrooms, so that our students can dialogue intelligently with academics in these other fields as well. We also need to do a better job of citing our sources. As a scholar of the Huáng Dì Nèi Jīng, I find it incredibly frustrating when I see a post or an article by a member of our community that says, “According the Nèi Jīng…” without specifically citing from which of the 162 potential chapters the statement originated!

Speaking of the Nèi Jīng: how many students are graduating from their program without even a cursory understanding of this foundational text? How many students know basic Five Phase theory, but have never heard of Zuo Yan, who popularized it (Wang, p. 6)? How many of our colleagues create articles, blog posts, and websites that make statements about acupuncture or East Asian medicine without citing their sources? And how many of us rely on the statement, “According to my teacher…”? That phrase is fine when we are repeating personal insights a teacher has shared with us based on their clinical experience, but it is not acceptable when making specific claims about the medicine. If a teacher makes a statement that is anything but experiential, they should be able to cite a source. That is the accepted standard in all academic disciplines: why should we be any different?

The Remedy
Fortunately, there are literally hundreds of journal articles and books available in English encompassing topics as esoteric as the Magic Square and Nine-star Feng Shui. I know they exist: I read and incorporated many of them into my DAOM research. It’s simultaneously humbling and inspiring to see all the questions that university professors and academics have answered already! And on the flip-side, for those who long for a more modern approach to Chinese medicine, there are scientific articles on biophotons, Bonghan ducts, and fMRI imaging of the brain during acupuncture treatment.

Few teachers or practitioners have time to read these articles, however, because they are working to pay off student loans, and need downtime between managing their practices and attending to worldly responsibilities. This scenario is precisely why I started Dr. Phil’s Chinese Medicine Blog. In the coming weeks and months, I am pledging my free time to the advancement of our field through the dissemination of accurate and reputable information. Whether you want to know more about the translation of Chinese medical terms into English, or are interested in the latest research on acupuncture and PTSD, I’m going to share it with you or tell you where to look. Whether you are a teacher, a student, or a member of the general public who is interested in Chinese medicine, I hope you will find something inspiring, and go in your own direction with whatever you are passionate about. You don’t need an arcane lineage or a certificate to be a great practitioner. You need to believe in yourself. You need to believe in the medicine. Teachers need to believe in their students. Practitioners need to believe in their patients. You hold the secret of Chinese medicine: find your own Dao.

References
Aihe Wang, Cosmology and Political Culture in Early China

Benjamin Bloom, Taxonomy and Educational Objectives Book 1: Cognitive Domain

Bloom’s Taxonomy

Bloom’s Taxonomy Action Verbs

© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

Ebola: Reflections from a Chinese Herbalist

With all the recent news about the Ebola virus, I thought it would be interesting to consider the disease from the perspective of Chinese medicine. **The ideas presented here are purely theoretical, and should not be taken as a substitute for medical care. If you think you have the Ebola virus, see your doctor or go to the nearest emergency room.**

The Ebola Virus

The Ebola Virus

The following is a list of symptoms gathered from the World Health Organization, Centers for Disease Control, Mayo Clinic, and National Institutes of Health:

EARLY STAGE SYMPTOMS

Fever

Headache

Muscle/Joint Pain

Sore Throat

Chills

Weakness

LATER STAGE SYMPTOMS

Vomiting

Diarrhea

Rash

Chest Pain

Internal/External Bleeding

ANALYSIS

Based on the signs and symptoms, Ebola would likely be diagnosed as 温病 wēn bìng (warm disease) in Chinese medicine. Wēn bìng is a term that was first mentioned in Sù Wèn Chapter 31 of the 黄帝内经 Huáng Dì Nèi Jīng (Yellow Emperor’s Inner Classic), the foundational text of Chinese medicine.  Despite this early reference, it wasn’t until the Qing dynasty that the theory developed into a comprehensive doctrine.  In short, 温病 wēn bìng refers to infectious febrile diseases with rapid onset and progression. The Ebola virus’ progression of symptoms lines up well with the “four-levels” progression put forth by Ye Tian-Shi in his 热论 Wēn Rè Lùn (Discussion of Warm Heat) (Liu, 19; Maciocia, 721; Wiseman & Ye, 659).  According to this theory, 温病 wēn bìng moves from the exterior wèi (protective/defensive) level to the qì level to the yíng (constructive) level to the xuè (blood) level (Maciocia, 723; Wiseman & Ye, 659).  As the pathogen penetrates deeper into the body, the signs and symptoms usually become more severe.

The disease typically begins with fever—or a combination of fever and chills—and headache, suggesting that the disease is on the exterior wèi level.  Sore throat is also common when the  wèi level is affected.  According to Chinese medicine, fever (or fever with chills) is caused by the struggle between the pathogen and the 卫气 wèi qì (protective/defensive qì).  The headache is a result of the pathogen attacking the upper portion of the body and disrupting the free flow of qì (Maciocia, 726).  Similarly, the body aches are caused by the pathogen obstructing the muscle layer.

At this initial stage, the formula of choice would likely be Yin Qiao San (Honeysuckle and Forsythia powder), with modifications depending on presentation (including tongue and pulse).  At this stage, one should add Huang Qin (Baical Skullcap root) if the disease is obstructing the Lung and causing shortness of breath or expectoration of yellow sputum, and/or Tian Hua Fen (Tricosanthis root) if there is pronounced thirst.

As the disease progresses to the 气 qì level, the chills (if there were any) will likely abate, and the fever may become more pronounced. At this stage, stronger heat clearing medicinals will be necessary.  A strong heat clearing formula like Bai Hu Tang (White Tiger Decoction) would be most appropriate at this stage.  One should also consider modifying the formula depending on presentation (including tongue and pulse).  Herbs like Zhi Zi (Gardenia fruit) and Huang Qin (Baical Skullcap root) should be added to the formula to support its heat clearing properties.  In cases of strong thirst, Tian Hua Fen (Tricosanthis root) should be added as well.

At any point during these two stages, if a macular papular rash should develop, add herbs like Zi Hua Di Ding (Violet leaf and flower), Da Qing Ye (Isatis leaf), and/or Sheng Di Huang (raw Rehmannia root).

Macular Papular rash

Macular Papular rash

 

 

If there is vomiting/nausea, add Ban Xia (Pinellia ternata) and Sheng Jiang (fresh ginger root).  In cases of diarrhea, consider adding Mu Xiang (Aucklandia root), Yi Yi Ren (Coix semen), and/or Gan Jiang (dried ginger root).

The final stages of Ebola often cause vomiting of blood or some other type of bleeding disorder.  In these cases, the disease has entered the blood level and the blood should be cooled.  Herbs like Sheng Di Huang (raw Rehmannia root), Mu Dan Pi (Moutan cortex), and Zhi Zi (Gardenia fruit) should be utilized at this stage, in addition to other herbs related to the presentation (including tongue and pulse).

 

References:

Huáng Dì Nèi Jīng 黄帝内经

Warm Pathogen Diseases by Guohui Liu

Chinese Medical Herbology and Pharmacology by John & Tina Chen

Formulas and Strategies by Dan Bensky and Randall Barolet

A Practical Dictionary of Chinese Medicine by Nigel Wiseman and Feng Ye

Foundations of Chinese Medicine by Giovanni Maciocia

National Institutes of Health www.nih.gov

Centers for Disease Control www.cdc.gov

World Health Organization www.who.int

Mayo Clinic www.mayoclinic.org

© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.