By Anne F. Davies
By Anne F. Davies
By Angel Careaga
CHIEF COMPLAINT & HISTORY OF PRESENTING ILLNESS
Sixty-three year old male patient, retired Navy, complains of arthritis and decreased
range of motion in the fingers bilaterally. Originally the patient came to the clinic seeking
treatment for dull pain and weakness in the right hip and legs. That condition began after
moving heavy boxes sideways a year ago, and began as a groin pain (possibly related to skiing)
near the inguinal groove, as indicated by the patient pointing, and radiated down the quadriceps
femoris muscle to just under the patella and pes-anserine.
By Anna Strong
This paper’s purpose is to introduce to you a pattern common in traditional Chinese medical diagnosis; this pattern is called Spleen Qi vacuity. The Spleen organ and channel in Chinese medicine has to do with more than the spleen as it is described in Western medicine. In Western medicine, the spleen is responsible primarily for immune function and the recycling of old red blood cells. In Chinese medicine, however, the Spleen is associated with the Earth element and is placed at the center of all the cardinal directions of the compass. It is akin to the center of the body and, like the earth, its job is to cull beneficial nutrients and fluid from the food and drink, and move these beneficial nutrients to where they can be most properly disassembled and reassembled to nourish the body. The turbid matter must descend and leave the body, while the nutritious matter must ascend and travel to where it is most needed. In addition, the Spleen is also responsible for containment of the blood within the vessels and preventing the prolapse of organs.
To provide you with a clinical picture of Spleen Qi vacuity from this perspective, if a patient were to present with the following signs, then the Chinese medical practitioner would be inclined to include a diagnosis of Spleen Qi vacuity: lack of appetite, abdominal distention after eating, fatigue, weakness of the limbs, yellowish complexion, and loose stools. Often, Spleen Qi vacuity leads to what is called dampness, which is fundamentally a problem of poor fluid circulation. The fluid pools and collects, leading the person to feel heavy in the head and limbs, experience nausea, or, have a sense of accumulation in the body, especially in the area above the navel.
If you are wondering what the Chinese medical practitioner looks for when your tongue is examined, there are two characteristics of the tongue that can indicate Spleen Qi vacuity: paleness and swelling, with indentations on the sides called, “teeth marks”. A thicker white coat on top of the tongue indicates dampness.
Consider the following metaphor: in function, the Spleen is like a busy mailroom in a large downtown office building. The mail (aka food and drink) comes in from the outside, and the workers must sort through it, discarding the junk mail as waste, and delivering important documents to the correct businesses above. A properly functioning mailroom will do this task with expedience, no junk mail will collect, and all the businesses will receive the necessary documents in a timely matter. However, let’s say a few of the workers are out sick. The functionality of the mailroom will decrease with similar consequences as to what happens when the Spleen Qi becomes weak: there will be an accumulation of unwanted material, and a delay and lack of beneficial items delivered to the proper places.
How can the Spleen Qi be made and kept strong? The most important thing one can do is eat nutritious foods that are easy to digest. This means a variety of cooked vegetables, warm grains, and lean meats or other proteins. Avoid consuming an abundance of cold, raw, heavily processed, sugared, or oily foods; these will make your Spleen have to work harder. Secondly, it is said that too much worrying or, over-thinking, injures the Spleen. Receiving acupuncture regularly is highly recommended; in addition to strengthening the Spleen Qi directly, one will receive the added benefit of a calm mind free of worry.
By Sesame Pikunas
We live in a culture obsessed with preserving a state of “endless summer.” Summer embodies the warmth, fun and joy of living. It correlates with both the physical heart that pumps blood to warm and nourish our bodies and the spiritual aspect of heart that warms and nourishes our soul. It is a time of celebration, beauty and love. The days are long and hot, people are out outside playing, enjoying the good weather and staying up late. It embodies the feeling of an ultimate childhood summer vacation, no obligations, enjoying time with friends, relaxing and laughing. Summer is the element of fire. It is the burning excitement of love, the warmth of connection, and the beauty of ripeness. Always seeking fun and excitement, rarely stopping to rest, our society perpetuates the long days of summer. We seem to be in need of constant celebration, entertainment and laughter. Before thanksgiving dinner is even digested, we’re already on a race to Christmas. Our attitude is one of fire, constantly consuming, from one fresh new fad to the next, burning the candlestick from both ends. A constant state of go-go-go, fun-fun-fun, and all the while trying to stay young-young-young!
People are constantly seeking to preserve the beauty and vibrancy of their ripe and mature youth. The admiration that used to be given to elders now shines on the young 20 to 30 something’s. Everyone is seeking to halt or reverse the ticking clock of aging. Plastic surgery to stretch and remove the wrinkles of time, implants to imitate the perkiness of long gone ripeness, and fake tanning in December to perpetuate the illusion of summer. The smell of burning fuel is a clear hallmark of civilization. Societies endless quest of haste, convenience, summer, and fun is all being powered by the burning of fossil fuels. We’re dependent on cars to get us there faster, lights to make day of night, and planes to ship summer fruits in any season. The privilege of having and using oil, the blood of the earth, to burn and fuel our society is so cherished that nations are willing to wage war to keep this fire burning. And as the fire keeps burning our planet continues to heat up in a state of global warming.
Our world is loosing much of natures beautiful colors. As if, through all the haste the earth’s blood supply has been exhausted and the world has turned a shade of grey. Burning fossil fuels has filled once clear blue skies with grey smog. Rivers that once flowed blue-green are polluted and grey-brown. Green fields are constantly being paved over with the grey cement of an ever-growing concrete jungle. The rich diversity of nature’s colors are becoming overwhelmed by the sprawl of grey urban development.
Summer is a fun and beautiful time of year so it’s no wonder society could so easily become obsessed with the joy that’s felt there and want to continue it all year. But like nature itself, everything must be in balance. In our homage to summer and the element of fire we’ve lost the strengths of the other seasons and elements. A truly rich and happy society must embrace all elements and maintain their balance in order to survive.
The element of metal contains the wisdom of autumn. Autumn is a period of decomposition. Leaves fall from the trees and rot, giving substance back to the earth. This is sacred. It is this action of decomposing that gives richness, worth, and value. It is essential for our society to recognize the importance of this cycle and incorporate it on a spiritual and physical level. It is time to decompose the current values we hold as a society and compost them into something of true value. It is time to use renewable resources of energy that can decompose into something of value instead of accumulating more filth. The water element is one of cleansing. It is the rains of winter that wash away the rubbish. It is the will to survive and the strength to get through winter. Mentally and spiritually, water embodies the flexibility and fluidity to change. It is this strength and flexibility to change that will ensure our society’s survival.
The element of wood embodies birth, vision, and hope. In order for there to be any changes on this planet we must first perceive the possibility of change, we must plan and strategize ways to actualize the change, and then the growth will come. Like spring, the energy of wood is fresh, motivated and reaching. It is the qualities of wood that will create the change that will reforest our planet.
The element of earth is the mother. It is the season of the harvest and emanates the qualities of abundance, caring, and sharing. It is the playing field, the element that contains and sustains the rest. Therefore, we must nourish this element and the earth itself, for it is our source of nourishment. Only when we think like a mother, with concern for the good of all, will there be peace and abundant nourishment across the planet. Hopefully, by remembering and honoring our connection and unity with nature, we will be able to preserve ourselves and the planet. With the seasons and elements in balance hopefully there will be a true sense of joy in our hearts, no longer fueled by ignorance, greed, vanity, and fear, but fueled with the vision, nourishment, value, and strength of nature. Perhaps by then, the term “global warming” will refer to a true global warming of the heart of humanity.
By Robert A. Vena
The American Psychiatric Association's Diagnostic and Statistical Manual defines Antisocial Personality Disorder (ASPD or APD), as "a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood." It is considered a personality disorder under western medicine classification, crosses all ethnic boundaries, and occurs in about 3% of males and 1% of females within the general population. There are no specific tests to accurately determine whether or not an individual has antisocial personality disorder, but manipulation and deceit are key features of this pattern. The patient must exhibit at lease three of the following specific signs and symptoms in order to be diagnosed: * Failure to conform to social norms, as evidenced by repeatedly committing crimes
* Repeated deceitfulness in relationships with others; repeated lying, use of aliases, or conning of others for personal gratification or materialistic gain
* Failure to think or plan ahead (acting on impulse)
* Irritability, anger, and aggression as shown by repeated assaults on others and frequent incidence of physical confrontations
* Reckless disregard for self-safety and the safety of others
* Consistent irresponsibility, such as failure to establish a pattern of good working habits or honoring of financial obligations
* Lack of remorse or guilt over wrongdoing, as indicated by an indifference towards or rationalization of having hurt, mistreated, or stolen from others
An important aspect of this disorder is that it is not diagnosed in individuals younger than 18 years of age. In order to diagnose, the individual must be at least 18 years of age and have shown the above symptoms since the age of 15.
Individuals suffering with APD have extreme difficulty developing and maintaining positive relationships. They display a callous disregard for the rights and feelings of others, and their social interactions tend to be exploitative and riddled with deceit, manipulation, and dishonesty… all of which are geared towards personal gain and/or gratification. They feel little or no guilt for their actions and believe themselves to be faultless. They become easily frustrated and act out their conflicts in a manner that is both impulsive and irresponsible, oftentimes blaming their actions and behaviors on others. People with this disorder stand an increased risk of drug and alcohol abuse, and often partake in dangerous, promiscuous behavior. They are vulnerable to anxiety, major depression, and other disorders (such as bipolar disorder, narcissistic personality disorder, and self-mutilation), and face an increased risk level of premature death by violent means (such as homicide, suicide, and accidents due to their own extreme daring behavior). Repeated incarceration, troubled marriages, extended unemployment, and homelessness are all common elements in the lives of those suffering with antisocial personality disorder. The exact cause of antisocial disorder is unknown, but there have been many studies done that show support for both genetic and environmental factors in the development of this pattern. It has been found that the disorder is more common among first-degree relatives of those suffering from this disorder than among those in the general population. Criminals exhibiting antisocial personality tend to have criminal records that are more like those of their biological fathers than those of their adoptive fathers. It has also been found that children who have uninvolved parents are more likely to develop this disorder than those who do not. Medications do not treat the behaviors exhibited in those suffering from this disorder, and it has proven very resistant to treatment of any kind. Although behavioral change is an extremely important aspect of treatment, it has been found that punishment rarely modifies or improves the behavior and judgment of these individuals.
With regard to the low rate of success in treatment of this disorder, a significant part of the problem lies with the fact that people who suffer from it rarely (if ever) see themselves as the problem. Instead, they tend to see the world and those around them as having the problems. Therefore, they rarely seek out treatment for themselves. Their failure to conform to the rules of society and criminal behavior more-often-than-not leads to incarceration. If there is any bright side to all of this, it lies with the fact that the disorder tends to remit with time, with a remission rate of about 2% every year in patients over 21 years of age.
Based on my research, antisocial behavior disorder appears to be a type of Kuang condition stemming from a form of Phlegm-Fire Harassing the Heart (or, Phlegm Obstructing the Heart Orifices). The condition most probably begins at an early age, in individuals who have experienced severe emotional turmoil or who have inherited the condition genetically. Left unchecked and untreated over time, this emotional stagnation eventually leads to Qi stagnation, which, in turn leads to the generation of fire that can have an impact on the Heart Orifices and the entire body/emotion system. Looking at this disorder from a Five Elements perspective, it seems almost too easy to see how each of the elements can play a role. After all, the elements are so intimately tied and bound to one another that they really cannot be separated one from the other. It is quite possible that treatment of each of the five elements, in a well-planned and methodical way, can help to bring the system back into balance. But first, we will deal with Fire, the element of the Heart and it’s paired organ systems, the Small Intestine and the Pericardium/San Jiao (or, Triple Burner). When our Shen, or Spirit, declines due to obstruction or imbalance of the Heart and its orifices, our spirit of humanity disintegrates too. And when it reaches a critical point of desperation, the criminal mind gives us a clear signal by shouting out loudly for help.
Within the human organism, it is the Heart that houses the Shen and plays the important role of ‘Emperor’. When the Emperor is ill - when there is an imbalance of Fire - there will be imbalance and chaos throughout the entire organism… both mentally/spiritually and bodily/physically. As stated above, individuals suffering with APD have extreme difficulty developing and maintaining positive relationships. Fire is active… it rises upwards and creates an atmosphere of warmth and love. An individual whose Fire element is out of balance would be incapable of providing emotional warmth and affection to those around him/her. Because their Fire element is out of balance, they are emotionally incapable of maintaining meaningful, long-term relationships with others. They tend to be cold and calculating in their dealings with others and fail to feel any sense of guilt or remorse in the harm that they cause to those around them. The Pericardium serves as protector of the Heart. But not only does it guard the physical heart, it also protects love relationships of any kind. Together with her sister organ, the San Jiao, whose ‘burning spaces’ serve to heat the entire body/mind system, it is responsible for the connection, warmth, and harmony that all our relationships depend on to stay alive. It is quite easy for a person with APD to lie, use deceit, and con others with little or no remorse whatsoever for the hurt they are causing. Clearly, this is a part of the system that may be greatly suffering. It might explain why broken marriage and divorce is such a common occurrence amongst those suffering from this disorder. The Small Intestine holds the role of ‘Separating the Pure from Impure’, which in the emotional sense can be directly related to our mental faculty of distinguishing right from wrong. Sufferers of APD display very little control over this faculty, as is shown by their repeated criminal actions and promiscuously dangerous behavior, which can oftentimes lead to self-inflicted injury and/or their own death.
The Earth is the vehicle upon which we make our way through time and space, and travel across the Universe. It is upon Earth that we move through the never-ending cycle of revolutions, rotations, seasons, nights, days, weeks, months, years, births, lives, and deaths. We are grounded to Earth by our own feet, and Earth is the stuff we are made of. It is this material that feeds and sustains us.
Earth energy is our connection to life itself, and without it the world seems crazy and out of harmony - life becomes chaotic and desperate. It is our connection to Earth that keeps us balanced and centered in life. It provides us a home base, and a center to operate from. Without Earth we are homeless and lost.
The Spleen and Stomach are the paired organs of the Earth element. In Chinese Medicine the Spleen is considered to be the foundation of existence of all the other organs. Without the transforming and transporting functions of the Earth energy of Spleen and Stomach, all other parts of the body would be starving for the energy and nourishment they need. When the Earth energy of the Spleen/Stomach is lacking, one may experience symptoms such as deadness of feeling and a general lack of a sense of connection to the world and life in general.
A lack of harmony within Earth energy may explain the APD sufferer’s repeated incidence of incarceration, extended bouts of unemployment, and homelessness. There is simply no connection to Earth energy there to keep the sufferer in a healthy mindset and desiring a stable and nourishing environment of any kind. It may also explain the sufferer’s consistent display of irresponsibility, such as failure to establish a pattern of good working habits or honoring of financial obligations. The cycles and schedules, routines and timetables of everyday life simply don’t work for these individuals.
Sympathy is the emotion of Earth energy. APD sufferers display no sympathy or compassion whatsoever towards the victims of their crimes.
Metal is the element of structure and strength. It is Metal energy that connects and holds together the vast networks and meridians that lie within us at every level. It is what keeps us upright and what keeps the internal lines of communication open and functioning properly. With an imbalance of Metal comes breakdown of the lines of communication. And once this happens, dissention, rebellion, and disintegration quickly follow.
Rules and laws are the structure that holds our society together. By following the rules, we remain upright citizens. Failure to follow the rules makes us criminal. Using this analogy, it is easy to understand why someone suffering from an imbalance in Metal energy would show total disregard for, and violate the rights of others on such a regular basis. The APD sufferer is consistent in this, and in their failure to conform to social norms, as evidenced by their repeated criminal activity and disregard for the law. These individuals are far from being what society considers upright citizens. The lines of communication within these individuals have long since collapsed, and the revolution is underway and in full swing.
The Kidney and Urinary Bladder are the paired organ system of Water energy. The Kidney is said to house ‘Will Power’ and ‘Ambition’. A person who lacks will power and ambition is expressing an imbalance in Water energy. APD sufferers show a clear lack of will power, and it can be seen in their inability to control their own lives and refrain from repeatedly committing serious crimes and offenses against those around them. As stated above, it is extremely difficult to modify or improve the behavior and judgment of these individuals. This could quite possibly be due to a severe Water energy imbalance, which leaves them with little, or no sense of will power.
The Urinary Bladder is responsible for storage and elimination of fluid waste from the body, and key to this function is its ability to be flexible and to adapt to the constantly changing fluid levels within our bodies. An imbalance in Water energy can quite possibly lead to an inability to adapt to our environment. The APD sufferer’s inability to conform to social norms can very well be attributed to a Water energy imbalance.
Fear is the emotion associated with Water energy. An imbalance in Water may also lead to a decrease in an individual’s capacity to experience ‘appropriate levels’ of fear. APD patients seem to exhibit a lack of fear of consequences and personal harm, as evidenced by their repeated criminal offenses and their life threatening and daring actions.
Wood energy is what keeps us rooted and balanced in life. Without it, we are unable to create roots for ourselves, and we cannot flourish and grow in a positive, healthy way. Perhaps it is due to an imbalance in Wood energy that APD sufferers are unable to create roots for themselves. And maybe this is why we see in them an increased rate of broken marriages and homelessness, and why they frequently make use of aliases.
The Liver and Gallbladder are the paired organ system of the Wood element. In Chinese Medicine, the Liver is seen as a ‘General’ who excels in strategic planning, and the Gallbladder as being responsible for our decision-making capabilities. An imbalance in Wood energy can cause a disruption in an individual’s ability to make good decisions and to think or plan ahead in a constructive manner. As we have seen, APD patients show a glaring inability to make appropriate decisions or to think and plan ahead. They are notorious for acting on impulse, regardless of the possibility of negative consequences that may ensue from their actions.
Anger is the emotion of Wood energy, and ‘Shouting’ is its sound. An imbalance in wood energy can cause an excess of both anger and shouting. APD sufferers seem to experience this excess as seen in their continued displays of irritability, anger, and aggression toward others. These individuals are well known for committing repeated assaults on others, as well as for their frequent incidence of physical confrontations.
As acupuncturists, I believe we can bring some sense of order and balance back into the lives of those who suffer with antisocial personality disorder. In addition to using the acupuncturist’s needle and herbal formulas to bring the elements back into harmony, we can introduce these individuals to relaxation and centering techniques such as meditation, Tai Chi, Qigong, and Qigong breathing exercises.
By doing all that we can to improve the condition of these individuals, we not are not only helping them, but may, in turn, be preventing further harm from coming to those who might be their victims.
Nei Ching: The Yellow Emperor’s Classic of Internal Medicine.
Translated by Ilza Veith, University of California Press, Berkeley, CA., 1972
Connelly, Diane M., Traditional Acupuncture: The Law of the Five Elements – 2nd edition, Tai Sophia Institute, Laurel, MD, 1994
Maciocia, Giovanni, Diagnosis in Chinese Medicine: A Comprehensive Guide, Churchill Livingstone, China, 2004
Maciocia, Giovanni, The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists – second edition, Churchill Livingstone, China, 2006
The Merck Manual of Diagnosis and Therapy – 18th edition, Merck Research Laboratories, Whitehouse Station, NJ, 2006
Wiseman, N. & Ellis, A., Fundamentals of Chinese Medicine – revised edition, Paradigm Publications, Brookline, MA, 1996
Wu, Yan, Practical Therapeutics of Traditional Chinese Medicine, Paradigm Publications, Brookline, MA, 1997
BehaveNet.com, Antisocial Personality Disorder, http://www.behavenet.com/capsules/disorders/antisocialpd.html, accessed November 2009
MayoClinic.com, Antisocial Personality Disorder, http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829, accessed November 2009
MentalHealth.com, Antisocial Personality Disorder, http://www.mentalhealth.com/dis/p20-pe04.html, accessed November 2009
By JK DeLapp
I have been asked by nuherbs to begin writing a new and fun column that I am extremely excited about. Currently, I am unaware of a company in our industry that has had the vision to begin to approach and discuss what the Chinese would say, “Yi Shi Tong Yuan”: Food and Medicine are of the same source.
Respect for the healing properties of food is interwoven into the very fabric of everyday cuisine in Asia. Although several herbs are especially potent and are used very specifically for certain illnesses, many foods and herbs are as common to Chinese Cuisine as are Hamburgers and French Fries here in the US.
In TCM Food Therapy, balance and interrelatedness are the rules of thumb. In this healing tradition, the cook seeks to bring balance to our meals, thus bringing our bodies and minds in balance with the seasons. The Key to this entire process is to bring the various pieces of your artist’s palate (your kitchen) together as part of a whole (your masterpiece of a meal).
For the first article in this series, I thought it would be fun to incorporate a holiday meal, with Easter and Passover just around the corner. I thought it a perfect match for the coming Spring season, as we will be needing to move Liver Qi, and warm and tonify the yang in preparation for Spring’s Growth. But first, I thought it might be helpful to introduce myself!
I learned to cook from my mother, wonderful woman that she is. I am the eldest of three children, and growing up, my father was out of town on business 20-25 days out of the month—so it was only natural for me to be helping in the kitchen.
In college, where I received a BA of Speech Communication from The University of Georgia, I continued to expand on my culinary loves, cooking for friends, family, and—always--for fun.
I was a part of a group of men that started a fraternity on campus (from Animal House to Ancient Medicine…go figure) where I had an opportunity to start a catering company to help fulfill a few of our needs. As an 18 year old kid, I was catering for everything from Greek events for 450 people to dinner parties to dinners where guys were asking their girlfriends to marry them…was an exciting introduction to the professional side of food!
My last year in college, I studied in Avignon, France, in the heart of Provence—and this is where I fell in love with the Art of Food. I went on to teach with a former professor in Paris and Prague for a few months after graduating. My time in Europe taught me that food is more than just something we consume to fuel our bodies—it is the very ground substance with which we nourish our Hearts, our Souls, our Friendships, as well as our bodies. There is a reason we have the saying, “Home is where the Hearth is.”
In 2002, I began working with The Weston A. Price Foundation (www.westonaprice.org ), a non-profit foundation centered around Food, Farming, and The Healing Arts. I went on to work with the Foundation in various fashions—everything from helping organize Organic and Biodynamic farmers, farmers markets in the South Eastern US, as well as helping restaurants source locally grown foods. I’ve had the pleasure to teach workshops and educate healthcare professionals, restauranteurs, and curious laypersons about the importance of local, organic, seasonal foods around the country.
It was through the Foundation that I was first introduction to food as medicine.
Fast forward: I enrolled at Pacific College of Oriental Medicine in San Diego, CA in September of 2008, where I am currently a student. Since beginning my professional pursuit of Chinese Medicine, my interest in food as medicine has continued to flower and bloom.
This Month’s Recipe:
Mint-Rubbed Leg of Lamb:
Though lamb is often paired with mint jelly, this roasted leg lets you leave the jelly jar in the pantry. Serve the roast medium-rare to medium, in its own juices, with a simple arrangement of spring vegetables.__
Especially Good For:
Eating in the wintertime and early spring. Serving to those recuperating from bone surgery or injury, or any illness; those experiencing chronic joint pain; or concerned with minimizing the effects of aging.
This meal will strengthen the Liver and Kidneys; fortifies bones, tendons, and muscles; moves Liver Qi; and warms and arouses the yang in preparation for Spring.
It is a great meal to warm you up on a cool night—and to put smiles on the faces of your family!
5-pound whole leg of lamb (bone in)_
8 cloves garlic_
2 tablespoons dried mint, crushed_(Bo He)
1 tablespoon coarse-ground black pepper_(Hu Jiao)
1/2 teaspoon salt_
3 tablespoons honey_
Fresh mint sprigs (optional)_
Cooked herbed new potatoes (optional--or fresh Shan Yao can be purchased from a local Asian Market)
Steamed carrots (optional)_
Steamed asparagus (optional)__
1. Preheat the oven to 275 Degrees F.
2. Trim excess fat from meat (although I like to leave some on—helps make a delicious au juice to use on the meat and vegetables after cooking). 3. Combine dried mint, minced garlic, pepper, and salt; rub mixture over entire surface of lamb leg. Drizzle honey over lamb leg and rub to coat. Place on a rack in a shallow roasting pan. 4. Place the lamb in the over and roast for 6 hours, or until the meat almost falls off the bone.
5. Increase the oven temperature to 425 Degrees F and roast for another 20 minutes, or until a crisp crust forms. 6. Transfer the lamb to a cutting board and cover loosely with foil and let stand for 15 minutes. Garnish with mint sprigs and serve with cooked herbed new potatoes, steamed carrots, and steamed asparagus, if desired.
Makes about 10 to 12 servings.
By Barbara Ferrero
By BJ DiMartini
OBJECTIVE: To report clinical efficacy of acupuncture treatments with 7 patients suffering from acute and chronic lower back pain (LBP) with sciatica. Activity patterns, pain intensity ratings using the Visual Analogue Scale (VAS), palpation and orthopaedic assessments were recorded every treatment. It should be noted that regardless of whether the condition was acute or chronic, the sciatic pain may be reduced to the absence of pain with acupuncture and electro-acupuncture (EA) treatments. RESULTS: All 7 patients noted either a decrease in pain or complete absence of pain within 6 treatments of either acupuncture or EA. Sciatic pain was reduced to 0/10 VAS on 6 out of 7 patients. The 7th patient presented a decrease with the sciatic pain VAS score following treatment.
This is a case report to show clinical efficacy of acupuncture treatments upon 7 patients suffering from lower back pain with accompanied sciatic pain. According to the National Institute of Health, “Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work.” Further complicating matters is the addition of sciatic pain that occasionally accompanies lower back pain yet further debilitates people from normal daily activities and normal sleeping habits.
Patient 1 (IB) is a 79 year-old female with chronic lower back pain, back muscular spasms and sciatic pain referring down the right gluteus muscles to the iliotibial band, including the lateral calf muscles. Pain was 8/10 VAS upon the first treatment. Acupuncture and EA was conducted 6 times in 6 weeks. Each treatment decreased the level of pain in both the lower back and sciatica. The muscular spasms stopped after the 5th treatment. The pain will return between 3-5 days post treatment, but has not exceeded 5/10 VAS since the 3rd treatment. Her sleeping patterns are now balanced because of the decrease in pain. She is currently continuing acupuncture and EA treatments for relief.
Patient 2 (VD) is a 58 year-old male with chronic lower back pain and acute sciatic pain referring down the left gluteus muscles to the posterior thigh ending at the left popliteal crease. Pain was 8/10 VAS upon first treatment with remarkable discomfort and loss of sleep. Following the 3rd treatment in 2 weeks the pain was generalized in the lower back at 3/10 and the referring sciatic pain was absent. A 5-month follow-up was obtained with the paitent reporting occasional lower back pain no higher than 2/10 VAS. Sciatic pain remains absent.
Patient 3 (DK) is a 43 year-old male with chronic lower back pain and occasional referring sciatic pain to the lateral calf. Pain was 6/10 VAS upon first treatment. Acupuncture was performed with the use of an infrared mineral heat lamp over the lower back. Immediate relief was noted post-treatment. Only one treatment was performed to this date. A follow-up noted a return of intermittent pain from 0/10 to 3/10 VAS with a desire to continue recommended treatments. Sciatic pain remains absent.
Patient 4 (RM) is a 36 year-old male and professional lacrosse player with acute lower back pain and referring sciatic pain down the left gluteus muscles, posterior thigh, and the left popliteal crease. Pain was 4/10 VAS with loss of sleep and decreased energy relating to the pain upon first treatment. A series of 3 EA treatments were conducted within 2 weeks. Stretching exercises were prescribed. Currently, the patient reports minimal discomfort at a 1/10 VAS with an unrelated mild gastrocnemius strain on the left calf.
Patient 5 (BN) is a 66 year-old male with acute lower back pain and muscular spasms referring through the right gluteus muscles down to the right popliteal crease. Pain was 9/10 VAS with loss of sleep and remarkable loss of range of motion. Patient had 3 EA treatments in 2 weeks resulting in a decrease in pain with increase in range of motion and return of normal sleeping patterns. Upon the 4th treatment the lower back pain was a secondary chief complaint and sciatic pain was absent. Following the 5th treatment in 4 weeks the lower back pain and referring sciatic pain were completely gone.
Patient 6 (RU) is a 40 year-old male with acute lower back pain and referring sciatic pain down the left gluteus muscles, posterior thigh, posterior calf and ending at the insertion of the Achilles tendon. Pain was recorded at 8/10 VAS upon the first treatment with lack of sleep caused by the pain. EA was conducted and immediate decrease in pain was noted. The patient surprisingly admitted 1/10 VAS pain upon leaving the office. Follow-up was conducted over the phone of which the patient reported 0/10 pain in the lower back and 0/10 sciatic pain.
Patient 7 (SW) is a 64 year-old male with chronic lower back pain and acute sciatic pain referring into the left gluteus muscles down to the supra-posterior thigh region. Pain was recorded at 6/10 VAS upon the 1st treatment. 2 EA treatments were performed in 2 consecutive days. Upon the 2nd treatment, the sciatic pain was absent and the lower back pain was 1/10 VAS only at certain times of the day with movement.
Acupuncture and EA has shown promising results in past studies with LBP, but more investigation is needed for the purpose of studying sciatic pain with LBP. One study suggests, “One mechanism of action of acupuncture and electrical acupuncture stimulation could be that, in addition to its influence on the pain inhibitory system, it participates in causing a transient change in sciatic nerve blood blow, including circulation to the cauda equine and nerve root.” More investigation is needed to understand the effects of acupuncture and EA with sciatic pain.
Findings show that acupuncture and EA were effective in decreasing lower back and sciatic pain, increasing energy, and regulating sleeping patterns in all 7 patients presented in this report. In addition, acupuncture and EA also promoted well being, thus giving value to the clinical efficacy of treatments for the 5 out of 7 patients who were obese.
By Emily Lee
By the middle of the sixth century BCE, during the transition from the Spring and Autumn Period to the Warring States Period, the Zhou Dynasty was in a state of decline. China was divided into feudal states which were each ruled by their respective noble families and, overall, there was general sense of uncertainty regarding national unification and identity. What we know today as Confucianism developed as an outcome and response to the sociopolitical climate of China at this time and reflects the mindset and values of the people. Also around the beginning of the Warring States Period the beginnings of an oral tradition of systematized medicine began to emerge that was one facet in that reflection of the identity and culture of the Chinese people. As follows, I will discuss this medicine of Systematic Correspondence as an element of Chinese arts and sciences that arose out of Confucian philosophy. I will begin by describing in detail some of the practices and beliefs taught by its ‘protector’, Kongzi (born Kong Qiu, ca. 551 BCE), and held by its followers or practitioners. In this discussion, I hope to illuminate how the philosophy was a commentary of, rather than a prescription for, man’s place in the world and also how it, nevertheless, displayed a perceptible order that could be infinitely extended or divided to every aspect of life for guidance and clarity in difficult times, most specifically to the inseparable union of Chinese medical philosophy and practice.
The time during which Confucius grew up and began to formulate his ideas was one of political upheaval, endemic war, and disorder that severely taxed the entire nation of China. Wealth and possessions were unequally spread amongst the people; and while the majority of the people suffered and struggled, the small population who held positions of authority seemed to have little concept of how to govern in order for all to prosper. Confucius spent untold hours observing human nature and the world around him and devised a prescriptive philosophy, so to speak, that was simple, relevant, rational, and theoretically easy to adapt to any scale. Like any important philosophical model, the teachings of Confucius not only provide a vivid snapshot of the social and political climate of the time in which they were written but proved to be indicative of the Eastern (as opposed to Western), and specifically Chinese, approach to and view of the world, in which the individual is indivisible from their surroundings and anything but mutually exclusive from them. Seen in this way, man (or the body) can be a metaphor for the state of the nation and, conversely, an ordered government can be a metaphor for the human picture of health.
For Confucius the concept of society was misguided - corrupt, even - and, in order to be rehabilitated, it would have to change, rather than try to change the individuals within society itself. But in order to affect this change, the example would have to be set from the most influential or visible level. With the ultimate goal of large-scale sociopolitical reform, Confucius set up a school, known as the ‘Ju Jia’ or ‘School of Scholars’, where he hoped to attract a feudal prince onto whom he could bestow his teachings and plant the seeds of change . Al-though for the most part he only attracted lower-level political figures , his teachings still stressed the importance of learning from the authority of tradition and the exponential value of reciprocity and virtue towards others in everyday life.
Despite the fact that Confucius valued tradition, he believed that with the right training, anyone was capable of attaining- and worthy - of any title or role (sounds like the same sort of argument for tonifying Essential Qi!). Self-cultivation would change the world and this was achieved, to start, from a somewhat moralistically-based education. Under Confucius’s guidance, his students would learn to embody the concept of Jun Zi, or superior man, who, with sincerity, strived to attain moral virtue by practicing reciprocity with his neighbors, ob-serving ritual, crafting a personal sense of propriety, earning the trust of others, being loyal, and showing respect for elders and important relationships in his life. The skill of adhering to these virtues was learned through a balanced education in what we would today call the arts and sciences; because by learning different ways to look at, think about, and study nature, it would be easy (or easier) to understand and relate to others, enabling a good example to be set and followed, reciprocally, by others. Confucius saw societal roles and ranks as being fixed but, as mentioned above, he thought that those roles, whether they were positions of the most or least power and influence, as being commonly (and contemporarily to him) filled by individuals who were unaware of their responsibility, visibility, and effect on those of whom they were in charge. Essentially, Confucius saw that the world could, if restored from the conditions in which he lived, follow an ordered social hierarchy of relationships which implied mutual obligation that would end suffering and allow a more unified China to flourish.
Order and balance within society, whether on a small or large scale (much like that of yin/yang), was a self-evident fact of the larger framework of nature to Confucius, who had a gift or ability to describe its complexity and subtlety in a relevant, comprehensible, and versa-tile way. For this reason, he considered himself to be more of a ‘protector’ of the philosophy which he taught, insomuch that he helped keep it alive, than its creator . And for me, it is this aspect of Confucianism from which it is most obvious to draw a correspondence to the devel-opment of Chinese medicine and medical philosophy. In Chinese medical philosophy, the ordering of the five elements or Zang Fu organs, minus the hierarchy among them , mimics the social order that Confucius described as one option to regaining sociopolitical ‘health’. I think that it is important to note here that although Confucius was prescribing a solution to the problems which plagued China and rendered the parts unable to function as a whole and therefore thrive; he was nevertheless only describing a solution which he thought to be evident in other parts of nature. It is my understanding that, like all influential philosophers and artists throughout history, he was letting nature guide him, and not imposing something artificial onto a naturally occurring order or sequence. In a functioning and prosperous society, people with different roles in society share mutual obliga-tion to one another much the same way that in a holistically- and healthily-functioning person, the organs not only each carry out a function for their own well-being but as a factor for the strength and stability of at least one other. But on an even more basic level, because the oral tradition of a systematized Chinese medicine was beginning to materialize during the Warring States period, the same time Confucius was structuring his teachings on sociopolitical order and reform, the names and responsibilities that correspond to each organ in Zang Fu theory as well as herbal therapy originate in politics and the military. How much Confucius’s teachings in particular, as opposed to the general state of social disorder and political pathology, had an impact on the early systematic structure of Chinese medicine is unclear but, as Paul Unschuld points out, an early textual correlation exists between it and the Confucian cannon as written by a predecessor of Confucius:
“The work of Hsün-tzu...reveals perhaps most clearly the intellectual interconnec-tions between the particular strain of Confucianism that later achieved state ortho-doxy, on the one hand, and the concepts of the medicine of systematic correspon-dence, on the other. A symbolic indication of this close relationship is provided by Hsün-tzu that appears almost verbatim...in the Huang-ti nei-jing, the nucleus of which may have been compiled shortly thereafter. Hsün-tzu remarks,‘The true ruler begins to put [his state] in order while [a condition of] order [still prevails]; he does not wait [until] insurrections [have already erupted] ’. The corresponding passage in the Huang-ti nei-jing reads, ‘The sages do not treat those who have already fallen ill, but rather those who are not yet ill. They do not put [their state] in order only when revolt [is underway], but before an insurrection occurs ’. ”
As is evident in the above passage, the relationship between Confucius’s teachings and early Chinese medicine went beyond an affinity for political and military metaphorical nomenclature and extended to methods of medical practice in terms of always favoring preventative treatment over a reactive one. But to briefly return to the idea that the arts and sciences (medicine among them) are a study and analysis of nature, the doctrines of Confucianism pro-vided an astute description of the world and all its parts in its highest-functioning capacity during a time of social and political turmoil and upheaval in the most simple and applicable terms.
What came to be known as Confucianism, was not the only system of thought or phi-losophy that could be used to understand different aspects of nature in the last six centuries BCE. Unlike Daoism that was concerned with the intangible and guiding reality of Heaven or Naturalism, that focused on the earthly projection of Heaven, the strict Confucian focused on ‘the middle way’, or the present and local, between Heaven and Earth . It left no room for divine or transcendental forces or laws . For hundreds, if not thousands, of years after Con-fucius’s death (and probably even still today), his teachings were used as a guide and reference by later generations of philosophers and political advisors such as Menicus (385?-312? BCE) and Xunzi (310?-219? BCE) , the two closest successors of Confucius, the latter of whom lived to see China united under the Qin Dynasty. In 201 BCE the Han Dynasty captured power and, over the next four hundred years, a united China saw its culture flourish thanks to a stable, centralized, organized, and responsible government . It was also during this time that the first written accounts of a medical philosophy came into use that employed a method of practice based on a system of correspondences both within the body and between man and the world around him. The teachings of Confucius affected positive change on the early social and political reform, reunification, prosperity, and development of China. Those teachings, of which Con-fucius considered himself to be more of a protector than a creator, resulted in the formative development and modernization of a medical philosophy that had once believed in things so far-reaching as the random and uncertain whims of dead ancestors and the effect on the living. Confucianism did not only foster the growth of China but, because of its solid structure formed by elements that included the importance of upholding rites and tradition, being trustworthy and sincere, and striving to lead a virtuous life, it has lasted, in several different forms for nearly 3000 years, remaining all the while wise and relevant from the scale of an individual organ to that of a governing body of the State.
Bloom, Irene. In “Sources of Chinese Tradition, Volume 1”, compiled by William Theodore deBary and Irene Bloom; Columbia University Press: 1999. Eckman, Peter. “In the Footsteps of the Yellow Emperor”; Long River Press: San Francisco, 2007. Sivin, Nathan. In “Sources of Chinese Tradition, Volume 1”, compiled by William Theodore deBary and Irene Bloom; Columbia University Press: 1999.
Strathern, Paul. “Confucius in 90 Minutes”; Ivan R. Dee: Chicago, 1999.
Unschuld, Paul. “Medicine in China”; University of California Press: Berkeley, 1985.
By Alison Warren, L.Ac, Dipl. OM, ABT
Acupuncture research in America is not yet as common as perhaps it should be, and when it is done, it is often subject to much criticism by our western counterparts. Usually this translates into accusations of not being scientific enough, and to be honest, I agree. I believe there is much improvement to be made in our research designs, which hold the potential to bring about change in America’s apprehension.
There is a hierarchy of validity among the different categories of research. To many scientists, experiments are considered the gold standard, as they are meant to establish cause and effect by maximizing control over variables. Among the different types of experiments, a double blind randomized control is held in the highest regard. There are many other means of gathering data, each with their own advantages and disadvantages. Correlation studies tend to be perceived as a step down from experiments, and observational studies are usually seen as quasi-experimental. This perception is a bit skewed however, as many scientists would not disregard a study that yields a high correlation between two variables. The majority of studies about acupuncture are going to be of experimental design. The following are a few main potential complications if our field of research.
We’ve all been taught the qualities of good research. It should be systematic, controlled, valid, reliable, and replicable, but the focus of this paper is where this quality becomes compromised. One inherent problem with our methodology of research is the lack of specificity. We should understand the broad range of variability among individuals better than any health profession. While these individual differences allow this medicine to shine by considering these variables in diagnosis and thus customizable treatments, they can become a hindrance when it comes to research results. It is my belief, however, that this potential hindrance can be significantly minimized by designing research studies with greater specificity. For example, there are mixed results about the efficacy of acupuncture to treat knee pain. Well, what kind of knee pain? There are so many different etiologies of knee pain with varying severity, chronicity, and prognosis – hence the need to determine what injuries were being evaluated. If a study evaluating the effectiveness of acupuncture under the broad topic of “knee pain” includes ACL tears, MCL tears, meniscus injuries, patellofemoral pain syndrome, and arthritis, it is more than reasonable to expect varying results. Furthermore, were these subjects in good health? Were they young or elderly? Have they had prior surgery for the problem? Have there been repeated injuries to the knee? When one begins to dissect the details (which should be our forte), the potential problems begin to become clear, but so do the solutions. We can see then that these are factors that we need to take into account. Here is where we can raise the specificity of a study. I think a better question to ask, for example, would be “How effective is acupuncture in treating anterior knee pain due to patellofemoral pain syndrome?” In answering this question I can then design a study controlling for the above mentioned parameters. Decide what age range I would like to study, what severity range on the pain scale, how long they’ve been experiencing the pain, etc. An 85 yr old obese diabetic male with PFPS who has had previous knee surgery and multiple injuries to the knee is going to respond very differently than a 35 yr old active male in good health with recent onset knee pain. The more specific we can be, the better we can measure results.
The topic of sham acupuncture is a pet peeve among many acupuncturists. I myself find it difficult not to go on a ranting rampage about the topic. One thing that needs to be cleared from the minds of both eastern and western scientists once and for all is this: There is no such thing as sham acupuncture. Uneducated and poorly guided acupuncture perhaps, but not “sham”. As such, it should not be used as the control group for comparison. By definition, the control group should not be receiving the variable being measured. If group A is receiving an acupuncture knee protocol and group B is receiving sham acupuncture…they are both receiving acupuncture. If you stick a needle anywhere in the body, there will be an effect. How much an effect and whether it is the desired effect is another story, but will produce an effect nonetheless. It is my opinion that this is due, in part, to the fact that we too often fail to articulate to western researchers and doctors how this medicine actually works. We can’t criticize a doctor who puts a needle in the toe and doesn’t think it will effect they eye if we have not explained the somatovisceral pathways of the meridians. Likewise, we cannot fault a doctor inserting a needle in a painful site distal to the area of complaint if we do not explain the value of a shi points (and the fact that they too are acupuncture points). It is my belief that this would clear up many misconceptions and cynicism about acupuncture and in doing so, help to refine the way in which the research is carried out.
What then, should we use for comparison? If we revisit our knee pain example, a better study may involve 2 groups who have been seeking the same allopathic care (treated with NSAIDs for example), and then divided into group A, who receives acupuncture, and group B who continues their NSAIDs. It’s important to be clear what you are comparing. Acupuncture versus physical therapy, acupuncture versus an analgesic, acupuncture versus no treatment, are among the numerous examples which could be implemented
On a final note, it would also behoove our profession to elucidate the training we receive in needle technique. When inserting an acupuncture needle, there is a significant difference between an acupuncturist with 4 years of training when compared to a practitioner with 100 hours of training. As such, it is important who is designated to perform the acupuncture protocol in the study.
The above mentioned points are just a few minor details that we can keep in mind when designing a research protocol. They are certainly not all-inclusive, but just a few adjustments that can help improve the value of acupuncture research in America.