Traditional Asian Medicine And Acupuncture

We're going to spend a few minutes talking about all these different aspects the charge of Traditional Asian Medicine and acupuncture and my goal here today is to just give you a taste of what's going on, okay? So the first thing I wanted to mention to you guys is a little bit about the history and we are to heard this a little bit in the in the plenary session is that this has been going on for a long, long time. Traditionally, Asian medicine and acupuncture has been practiced in China for about two thousand five hundred years. It started off as an oral tradition and then gradually made its way into a written tradition. You know that the Chinese language is not based like ours with twenty six characters that then are put together to make words that have rather limited definitions The Chinese language is constructed in making each character represents an idea and all those ideas that spring from it. There are about a hundred thousand Chinese characters. A hundred thousand individual words that look nothing like the other words - that you have to memorize. Then on top of that - learning the character doesn't tell you exactly what the definition is, because the other characters around it will give you a clue about what you're talking about in that context. The acupuncture that came to the States (and I'm not going to level the all these in the interest of time) - The acupuncture they came to the States came first through France. The French were doing most of the initial work and the most of the initial translation. So there are a lot of layers to understanding the vocabulary of Chinese medicine and of acupuncture because we came from this tradition of - first, coming through the French culture and so forth. The next thing, I kind of touched on this already, - The next thing is the parts of Traditional Asian Medicine. Personally I prefer Traditional Asian Medicine as opposed to Traditional Chinese Medicine or Traditional Oriental Medicine. "Oriental" just being kind of offensive to some people that are from Asia. So i try to stay away from that word. And Asian for me, because it's not only Chinese, it's Korean and Japanese and so forth. So really kind of all of the Asian cultures together. That's why I prefer that term you'll hear arguments - about why one is better than the other but that's just my take on it. It's not just about acupuncture, but Traditional Asian Medicine has many, many different components. It's very holistic. So there's a strong emphasis on diet and lifestyle modification. Specifically, you know, eat this food because it's cooling and helps with your liver Qi stagnation, that sort of thing. So lots and lots of specific foods that are targeted for pathology. there's this business of cupping - and i'm just gonna kind of pass this stuff out. I'm concerned that we won't have enough time. So and what you just see what these are like - they make them in glass, they make them in plastic and so forth. The idea behind cupping is... Normally, in physiology, there are only three ways to get things out of the body: you can exhale it you can pee it out and you can poop it out. Those are your three choices. You have to pick one of those. The problem is is that a lot of times pathologies get beneath what we call the immune system layer. In chinese medicine that term is wei qi (or chi). So once you get below the wei qi layer things can kind of lodge there and fester. But it's not so deep it's really neat organ systems - or very deep internally. It's kind of between those two layers. So cupping helps to pull things out from directly underneath the immune system. Literally, what you're doing is lighting a little flame on fire and making suction inside of the cups and placing it on the person's skin. It makes a kind of a hickey. I'm telling you it it sounds weird, but there is nothing better for: musculoskeletal pain, people with colds all sorts of things, especially if they've got a really early on cold. Doing cupping will make that go way way faster and any antibiotics you could possibly prescribe. It's really phenomenal. I'm just going to pass these around so you can take a look at these. Something else that's really interesting about Chinese Medicine is this business of Moxa. Herbs are something that not only are taken internally that can be used externally on the body. Chinese medicine is all about balance; it's all about bringing heat where there's cold, and bringing cold where there's heat. If I need to cool parts of the body, that's a little bit logistically easy, right? I just make you pull your arm out of your sleeve and already your arm is exposed to the ambient air; I can put a needle in there, which we're gonna talk about a few minutes, but that can pull the energy at a little bit more efficiently. Moxa is used to heat; to bring heat to particular areas of the body It's an herb. There's a few different types that I brought here. They're all based on this herb: Mugwart... ...that you make a little piles of. You put it on top of the needle or directly on the skin. Then you light the part that is not actually touching a person skin - and smolders kind of like charcoal. And it warms very very gradually and gently. - also feels phenomenal. It's great for all sorts of indications: great for insomnia, great for pain... ...and so forth. There's this version which is kind of freeform and they make it in little mini cigars that you put on top of the needle, and they also make it in things that looks more like cigarettes. You light the end of it and hover it over the person's skin. It brings a lot of heat to the area. I'll let you guys take a look at these too. Qi gong is a practice of using mindfulness to specifically resolve medical problems. Tui Na is a series of specialized massage techniques. Herbal medicine is another huge part Traditional Asian Medicine. This is kind of like the drugs that go with the rest of the stuff. The idea with herbs is that you have no side effects. When we prescribe medications in western medicine we talk about okay this is going to making urinate a little bit more. The idea is to bring it down your blood pressure, but we're going to do that by making you pee all the time. Side effects. We're going to give you this pill for your cholesterol that make make your muscles a little bit weak. Side effects. Herbal medicine: the principal is that there are no side effects. If there are side effects, then you haven't correctly regulated the person's body - and it's the practitioners responsibility to make sure that there are no side effects. It's very, very gentle medicine. The next thing you want to talk to you guys a little bit is the the theory of how it in medicine is this kind of designed. I'm sure you've all seen this image of the two little fish. Most of the time it's just one little dot and then the other has little dot. The principles here are that this Yin, the in the dark side is Yin. Yin is sleeping and restfulness and night and the moon, but it's also things that are internal and downwardly descending and relaxing and so forth. Yang is then exactly the opposite of that. Yang as the white. It's energy and its outward and it's upward, it's exuberant - and it's daytime and it's activity and so forth You can see here that in the swirl once the maximum apex of the Yin swells then it changes into the Yang. These two things are not really opposite sides of a coin. It's more like rolling waves: one into the other interchanging and so forth. Normally you're going to see a little dot there of the black in the white and the white in the black. The idea there is that there's literally a seed - of one in the other at all times. No matter how excited an exuberant you are, there's always a seed of restfulness and peace, and vice versa. What i like about this particular image is that it demonstrates that there's the seed of one is always growing and forming and exchanging one into the other. these are the symbols, the characters for Yin and for Yang. Yin then is this shade on the dark side of the mountain. Whereas here we have the rays of light showing from the sun. So quite literally shade and brightness or sunlight. The way that manifest in the physiology of the body is that the Yin, the cooling, the liquid, the solid elements are the blood. By contrast the thing that is energy and exuberant and outward and heat is Qi. Qi is a term that may be a little off putting, it's no different then ATP (Adenosine Triphosphate). When we talk about a molecule of ATP it's something that's very, very, very, very tiny and very difficult to see. It's the same idea as Prahana, or the life force and and all that sort of thing in different other forms of medicine. Qi is the formation of what we eat combined with the oxygen that we breathe. Does that sound familiar? We split glucose in half to make two molecules of pyruvate that then are ground-up in the citric acid cycle to make... // give me some love // ...high-energy electrons, right? We don't actually make a whole lot of ATP in the citric acid cycle, but the main goal is to make high-energy electrons The high-energy electrons get dumped into the... ...electron transport chain. If we don't have oxygen at the ended the electron transport chain the whole system stops So in order to make ATP you have to have a combination of the food that you eat, the Gu Qi (phonetically: goo chee) which is a great word combined with the Zhong Qi, which is the oxygen, the air that new breathe that comes out of your chest that makes ATP. Same idea. They just figure this out a long time ago and without a microscope. Qi - is literally the granules of rice combined with the steam that's coming up from the inside of the lid of the pot. The air that your breathe combined with the food that you eat. Where Qi doesn't flow there's disease. Qi and blood - because we're talking about balance, and we're talking about the interplay between these two components together - have to be in harmony all the time. If the Qi is not flowing, then the blood is not flowing, and they both control and regulate each other. Without the flow of Qi, the blood becomes stagnant. If the blood becomes really stagnant and hot, now we have tumors. Temperature control: Qi, because it's energy and heat, is going to be warming. The blood, because it's Yin and absence of Qi, is cold. So this is more Yin. It also is responsible for organ regulation, so there's a whole bunch of different kinds of Qi. Each one of the organs have to have their own strength that Qi - and that the organ has to move in the right direction. So the stomach Qi, for example, if it doesn't go down and instead goes back up - then we have dysfunctional Qi and we have reflux and and heartburn and so forth. You also have the balance with the body fluids and with the blood. Too much Qi, too much heat and you've literally boiled off all the fluids. These folks end up with a red face... and heat rises up to the top of their head and they have migraines... and if they have hypertension. Because all of the the energy and the heat is going in the wrong direction. Too little Qi and the body becomes damp. You guys have all had contacts with patients that you know are eating way too much sugar and they're drinking way too much milk and they're eating way too much cheese and they smell kinda funny and around their knees is kind of that cottage cheesy lookin' and stuff and they probably have a lot of leukorrhea. Their their body type is just kind of dense and and damp and so forth. This is that the principal in Chinese medicine of not having enough Qi; Not having enough energy and the body retains all of those fluids and they literally become damp. Further Qi is responsible for support in structional functions. Not enough Qi in the perineum leads to prolapse because they don't have the energy to hold things up in the pelvis. Furthermore, Qi stagnation leads to pain and blood stagnation leads to pain as well. So both of those things are folding in on each other. Question: Where does cerebral spinal fluid fit in? Answer: it's one of the body fluids. The brain and spinal cord are considered part of marrow. So they're they're linked with bone marrow which is very, very basic functional of genesis for the body. In Chinese medicine the kidneys are very strongly linked with the reproductive organs and reproductive function. So the bone marrow and the brain marrow are also very strongly associated with those organs. The fluid that surrounds them is very nutritive. More specifically, let's talk about the different kinds of acupuncture points. In the ancient textbooks they they talk about two different elements: One are the Shu (phonetically: shoo) and this is an area where the Qi kind of flows through. This is an idea of a kind of bubbling brook, and creating passage between one area of the body and another. The other are the Xue (phonetically: shway): this is where the Qi pools. The idea here is more of a hollow grounded safe place like a root cellar or a burrow or something along those lines. So if you guys will take your your hand along the lateral aspect of your biceps and run it up to where it comes just under your deltoid - there's a little hole there. if you can find it, you'll feel like you're right on top of the bone. and it's probably a little achy. It's on the lateral aspect of your bicep - right under the delt. This is an acupuncture point, and this one is one of these Xue acupuncture points. If you think about this from a cadaver lab, you think about, okay this is the place where there's lots and lots of different fascial planes interdigitating across each other. This is an area where i can touch the skin, but I can very easily access deeper points. The ones that are on top of muscles are more this type the Shu type points, where you're passing from one area to another. There's actually a lot of research out there right now that talks about fascia as being the biomedical equivalent to why acupuncture works. Fascia is not only that white filmy stuff on top of the chicken breast that's holding the skin onto the breast while you're trying to fry it up, but it's also the thing that links all of those compartments together. So it separates and links and connects and joins all of the same time. Because it's able to regulate the pressure inside of its individual compartments, the electrolyte balance, the water balance and so forth - by regulating that within one compartment, it can communicate back to the next. Now, if my acupuncture needles are made of one kind of metal on the shaft and a different kind of metal on the handle, I have already set up an electrical gradient on that needle. Now, I place that needle into one of these Xue points where I'm interdigitating between several different fascial compartments, and the ambient air is cooler than the temperature of your skin and your flesh - now I have an electrochemical gradient going through my little antenna of a needle and interacting with all of the fascial compartments that it's coming in contact with. Now, say I want to warm that up and I want to reverse the direction of the electron flow, then I add some Moxa or I add a laser or I add a heat lamp and I changed the direction of my electron flow. Now it doesn't sound so far fetched to talk about using a needle to fix the stomach - or using something on the toe to work on the neck, because all those compartments are interrelated and I'm just doing it very, very gently. So what do these acupuncture points do? Well they transform, They change Yin into Yang. They transport, they move body fluids or electrolytes or water or energy from one place to another. They regulate the individual channels and organs because each one of the channels has this the name of an organ that it's attached to. The stomach channel happens to run on the front of the body, but the small intestine channel runs up the back of the arm and across the upper part of the back. So the relationship is actually more of internal / external relationship rather than physiologic anatomy - you know one being right on top of the other. The small intestine channel is not right here. they irrigate the surrounding tissues so they changed the relationship between one compartment and another. and that connect on channel to a system as a whole. This is a concept that I want you guys to get. This is the problem with doing acupuncture research, because what they'll say in the acupuncture trials is, (paraphrasing) "well we needled stomach thirty six and it's not really knowing that fix insomnia, but people had a placebo effect." The thing about acupuncture is all the points are connected to the channel, and the channels are connected to organs, and those organs are connected to each other, and the channels are connected to each other. So it's kind of like saying, "well i got on highway 10 in L.A. and now i'm all set in Arizona. That's not possible." Of course it is, because they are connections all along those points that go from point A to point B. You just have to know where did where the exchanges are. This is an example of the spleen channel. The spleen channel starts on the toe, runs out the medial aspect of the calf, the media aspect of the thigh, and you can see that even though the points are kind of in a straight line over here on the middle lateral aspect of the body and the chest. The channel actually interacts with the with the midline. So the point stay here, but that channel kind of zig zags back in-and-out. So, again this idea of connectivity to other channels. It also then connects to the diaphragm, connect to the small intestine, and connects the stomach and the spleen together, and connects to the heart. So all the different channels have a set of organs that they linked up to, they all have a particular tissue type and so forth. The nature of the points art are determined by the channel, so where they are anatomically on the body, the point category, we don't really so much have a time to go into this, but there are particular points on every single channel that are really, really good for pain or for blood in that particular channel. Then there are also these historical an empirical uses, that there are command points. So there are command points for the blood vessel, and there's a command point for the head and neck, and a command point for the face and so forth. Even though this doesn't really - it's not close to the face, doesn't have anything - it's on the large intestine channel - it doesn't really have anything to do with the face - just happens to go up to the face... and it looks like a face. :-) This is the come and point for the face. This is just been determined over a long long periods of time of people saying, (paraphrasing) "oh, well somebody had pain under their eyes and some sinusitis, and I rubbed like this and it got better." Think about it, all of you moms and dads out there when your little child has a stomach ache, what do you do? You don't take them emergently to the emergency room, right? The first thing you do is you rub their belly. And you rub it in a particular orientation. Whether you know it or not, this is the way the large intestine goes. You do that intuitively. Over time the Chinese folks that deduced all of this were incredibly fastidious observers of nature. And they said, (paraphrasing) "Okay, when I push here, the sinuses open. When I push on this other spots, the low back pain gets better. Hey, tell your friend that's got low back pain to rub on this spot, it makes the pain go away." That's how these points were were deduced over time. Now, I want to talk, really quick, about how we put things together acupuncture. This is only one way of constructing at paradigm for choosing what points to treat, but i think this makes a lot of sense from our western perspective. The idea here is are there are five different elements. All of the elements have an organ, and a color, and a tissue, and so forth, associate with them, and the time of day. You can probably guess which organ is associated with water. The bladder. That's the Yang organ, the more external organ - and it's paired with a Yin organ that's more internal, that also has a strong association with water and that would be the... kidneys. The kidneys and the urinary bladder together are water. Then the one that is associated with the heart is fire. So running around and lots of exuberance and joy and so forth that goes with the heart. The heart is a little strangely paired up with the small intestine, but we'll come back to that. The earth is responsible for food and nourishment and so forth. What organ would you associate with that? The stomach. Imagine that you live two thousand years ago, somebody on the battlefield just have their guts split open and they're kind of splayed there and you look and you say, "oh there's a tube that goes from here to this pouch... ...and then there's this solid organ right next to it that has a lot of blood vessels that go between the side of the side of the stomach, the lateral wall of the stomach and the... spleen." So if you're looking at this, and you don't have the benefit of a microscope, you might say the spleen helps regulate digestion with the stomach. Because those gastroepiploics sure do look like there's a lot communication going back and forth between those two organs. So the spleen and the stomach are responsible for digestion. Then the lung and the large intestine get paired up and they are the metal. Then the wood, this idea of the liver and the gallbladder being paired up, so now we've got the two sides are abdomen here, on either side of the fire. The idea here is that all of these generate each other in this orientation. That fired generates earth whenever it burns up, earth generates medal as it hardens, metal controls water whenever it partitions it off, waters nourishes wood, and wood is able to subsist the fire. But there's also this business of a controlling cycle where good controls earth and so forth around in this kind of little star shape in the middle. Liver is kind of like a bulldog. It has to be reigned in all the time or it's just going to attack everything in its path. It's a good emotion in that it's the force that allows little tiny shoots to push up from under the earth and come out and and making new life. But that exuberance can also then develop into anger and frustration, if we are not be able to push up through the earth and become new life. We end up holding all that inside, and then get really really mad at that driver the cut us off on the road. People that run around with a lot of unfulfilled desires on a lot of frustration a lot of anger in their lives... their pathology tends to be that they overheat. And the taste of the spleen and stomach is sweet, so they particularly crave sweet foods, and they develop ulcers and pain in their abdomen any irritable bowel syndrome because they're angry. And whenever they start overeating, then what happens to their kidneys? They become diabetic. Diabetes refers to the polyuria that happens from that. So then they're peeing all the time. So this is one way of putting together a series of pathologies that the Chinese developed over a long long period of time and ways of starting to treat people, because the root of that problem, then is not that you're eating too much sugar - you are - but the ultimate root out the problem is that you're mad, and we have to figure out how to make you less angry. The time of day is also a really kind of fun little game to play. The time of day, for example, for the liver - so your patients that have insomnia... ask them and what time they wake up in the middle of the night. If they had insomnia because they're sad, because their grieving over something, because they're not getting along with their family member, and they just miss their cousin, they just miss their brother, they will wake up at three o'clock in the morning... guaranteed. That is the time of the lung, which is responsible, and the emotion that goes with the longest grief. If they'd wake up in the middle of the night and they're mad and they're having these vivid angry dreams, because their bosses constantly yelling at them in their dreaming about going to work the next morning, they wake up at one or two in the morning, because that's the liver and gallbladder times. That's also the time - for those of you guys that haven't done your surgery rotation - that your gall bladder patience will come in, in the middle of the night because the migrating Myoelectric Complex stimulating CCK (cholecystokinin) and so they're gallstones given the way of the gall bladder neck and a come in at two o'clock in the morning and say, (paraphrasing) "I've got this right upper quadrant pain and i haven't eaten anything." They figured this out a long time ago. Myoelectric Complex The body does that as a housekeeping function. That's why it's bad to eat in the night, because the body is supposed to be resting and wants to just kind of flush everything out and get ready to have that bowel movement first thing in the morning. I have a whole bunch of literature articles I don't like to be guys too much longer, I've got a whole bunch of articles if you want me to show you some of the literature about acupuncture research and we talked a little bit about the difficulties. I don't want to excuse not doing more research in acupuncture, but that premise that two people can be treated the same way is completely antithetical to the way that acupuncture structured. I'm not trying to be cavalier, but really and truly you can't take two people that have hypertension and say that it's coming from exactly the same etiology. Acupuncture treats hypertension and diabetes and insomnia and depression and migraines... Western medicine treats all of these things individually and differently, right? We would give a different pill for each one of those things. Acupuncture says, okay these are all of the symptoms of the underlying cause. So I'm going to treat this stuff up here... but im also gonna fix this root problem down here. So you can't, just like fingerprints, you can't say that these two patients are the same and I can give them the same point prescription. This is just a hurdle that we really need to overcome in the acupuncture community: how can we compare apples and oranges? The same sort of thing with herbal prescriptions. Very, very tricky I'm going to have to skip this part in the interest of getting you guys into another lecture. The last thing, I just wanted to tell you is what your acupuncture colleagues go through to become acupuncturists. Acupuncture training is a masters level program. It's supposed to be four years. It usually ends up being longer than that because the training is very, very rigorous, it's like medical school except they have to cram medical school and residency into four years. It usually ends up being more like five or six because the students are also working, most of the time, full-time in supporting themselves at the same time. It's a masters degree. There's classroom and clinical training. Their boards are the same as their licensing exam. So after they've finished their training they take their boards. it would be like our USMLE. Then we have boards on top of that. They stop at that point; they stop after their licensing exam. They do have to maintain continuing education units and so forth, and they can do acupuncture only masters degrees or ones that are TCM, TOM... like that kind of thing together. There are also doctorate programs that are specialized, and it's usually one to two years of training with the clinical component and research and so forth. Here is a long list of things for more information; you guys all have that in your handouts too. These are some journals that I recommend, that I think a very very helpful. NEJM happens to have a lot of CAM research in it, JAMA not so much. The American Journal of Medical Acupuncture, Journal of Complementary Alternative Medicine and there's a Evidence-Based Complementary Alternative Medicine. Here's some good places to go whenever you're trying to find information and I signed up for medlineplus to have a series of email sent to me every day that keeps me updated on CAM topics. References, you guys, I'm sure, all had a access through your university libraries to Natural Standard. and Natural Standard is a database of every kind of CAM practitioner and herb under the sun. So you can look it up, and find out, "What is Reiki? And what's the training like and what's a good for and what is the research show..." and all that sort of thing. These are a couple of books that I recommend. Lastly, to find out more about training for physicians just go to the American Board of medical acupuncture, it has the complete list of training programs in the United States, with the requirements are, can you do it as a med student, do you have to wait until you're a resident or an attending... and so forth and so on. But i would really recommend you go to acupuncture school because you won't have to, in most states, you won't have to finish, you want to jump through quite as many hoops, but you will understand the medicine so much better. It won't be: if there's pain here, needle here, kind of memorization, but you'll really be able to understand the way that that this whole system is put together. Thanks so much for your time, I will be out at two o'clock this afternoon. at the desk if anybody wants to talk to me ask questions we can do that out ther. Yeah? To my knowledge that has not changed in Illinois. Just bear that in mind. When you're sending your patients for acupuncture know that physicians can hang out a shingle and say that they are acupuncturists with minimal or no training. So know what kind of training they had, in order to say that they're doing acupuncture. Thank you all so much for your time. [applause]