Tuesday, December 25, 2012
Here we are
on the cross of space and time
Contemplating the miracle
This precious pause
In the face of a single undeniable fact:
Here we are.
Wanting to be off the hook
Wanting to be somewhere else
Easier to dream of a sunnier place
Than to enjoy the rainy here and now
Meat-bodies run amok
In this once-great land
Run by corporations for the corporations
We are the herds
We follow the songs
of an invisible shepherd
who seduces us with things we want
And we don't even notice
The browning of the pines
The dying of the squid
Everything surreal, unreal
When viewed on a tiny screen
When I go
I will be grateful for those I have loved
And who have loved me
And that will be enough.
Here we are
Let's make the best of it
Merry Christmas 2012 Happy New Year 2013!
Thursday, September 20, 2012
Note to mushroom lovers: PSYCH! No, I did not find my first chanterelles this early! I wrote this piece one October many years ago for my ACUPUNK column in the Good Times. May the rains begin soon.
Monday, May 07, 2012
Sure enough, pretty soon I started seeing patients who complained of exactly these symptoms. Some got it in the feet. Most got it in the hands, particularly in the pads of their fingers. A few got it in their fingernails, resulting in loose nails that seemed like they were on their way to falling out. Most of these patients were being treated for breast cancer and were on a regimen of the chemotherapeutic agent called Taxol. A few had other cancers and were on other drugs, such as cisplatin or oxaliplatin. I tried all kinds of approaches to treat the neuropathy, from standard acupuncture to non-insertive Japanese acupuncture to cold laser to electrostim. Nothing seemed to help very much.
One day I was inspired to bleed my next neuropathy patient. In the style of Japanese acupuncture that I practice, we are taught to make a tiny incision and draw a small amount of blood wherever we find "blood stasis." Typically, blood stasis is indicated by small purplish venules, which we then prick and squeeze to extract a few drops of blood. But, it occurred to me, the numbness and tingling that characterize peripheral neuropathy could also be symptoms of blood stasis, even with no obvious venules. So, using a lancet, I bled my next patient, making a small incision near the center of each fingerpad, three or four millimeters from the fingernail. Quite miraculously, this seemed to work quite well! In some cases, the neuropathy decreased right there on the table. In most cases, several such treatments eliminated the symptoms. Some took longer, and those who had had chemo months or years before and still suffered from neuropathy took the longest. This technique seems to work well for Taxol but not for the other drugs. And it works better on the hands than on the feet, though I have had success with foot neuropathy as well. It is less effective for nailbed neuropathy, even when the causative agent is Taxol (I still do bleed for nailbed neuropathy, though at the corners of the nails rather than on the fingerpads).
I'm not sure why it works, scientifically speaking. I doubt that it's due to the elimination of toxic chemo agents from the flesh of the fingertips, since the amount of extracted blood is so small. My suspicion is that the healing is a hormetic effect, which is to say a very small negative impact makes the body respond with a positive effect. I theorize that the body reacts to the incision by sending chemicals to repel any microbial invaders and heal the wound, and almost as a side effect the affected nerves are also healed. Perhaps the small capillaries in the extremities are affected by the chemo and work less efficiently than they need to to draw the drug away from the nerves there. Then, when the skin gets pricked, they perk up and do their job better.
I am not a researcher and have done no true clinical studies on this method, though it would be easy enough to do with a large enough patient population. But my own experience convinces me that this is a valuable and simple treatment method for Taxol-induced peripheral neuropathy, so I am putting it out there in the hope that it will help many more people. If you are suffering from chemo-induced neuropathy, I encourage you to try it yourself, or have somebody else do it for you. Just get a pack of lancets at the drugstore (the kind diabetics use to get a drop of blood), and disinfect before and after with rubbing alcohol to avoid any potential infection (especially if your white blood cell count is low). Very quickly poke each affected fingerpad, then squeeze out 5-20 drops of blood and wipe with a cotton ball. Do this a couple times a week for a couple weeks, to give it a fair shake. Good luck!
Monday, January 09, 2012
Friday, September 16, 2011
Thursday, September 01, 2011
*An, “hermitage,” is an interesting character, consisting of a radical denoting a dwelling, plus a phonetic component consisting of a character meaning something like “to cover.” But a further breakdown of this component yields the image of a man, and below it the ancient Chinese character shen, originally derived from the image of two hands extending a rope, and therefore the idea of extension or expansion. And, indeed, a hermitage is a dwelling where a man sits in contemplation until he feels a sense of expansion. I prefer an alternate version of the an character, and a different interpretation: the dwelling radical is replaced with the grass radical, giving the image of a rustic thatched hut. And the character shen has long been associated in Chinese cosmology with the ninth of the twelve Earthly Branches, symbolized in the popular Chinese “zodiac” as the Monkey. So the hermitage (or at least my hermitage) is a place where a person (the human figure with arms and legs akimbo, in the middle) can ingest medicinal herbs (the grass radical on top) and enjoy the easy-going life of a monkey (the shen character, on the bottom, with its tail curving out towards the right). Or, if you prefer, the hermitage is a hut where a monkey sits down, and, expanding his consciousness, becomes a man.
Monday, February 28, 2011
I first met Gus sixteen years ago as a first-year student of traditional Chinese medicine at Five Branches Institute in Santa Cruz, California. He was a couple years ahead of me, and with his long flowing hair and imposing stature (Gus is well over six feet tall), he made quite an impression. But what impressed me more was the depth and breadth of his knowledge. One afternoon during that first year of school, Gus led an herb walk in the alleys around the school. From the gnarled albizzia tree that greeted me every morning as I arrived for class, to the tenacious passionflower vines that took over entire neighborhoods and astounded passers-by with their blooms of alien ultraviolet, to the humble prunella that grew on the edges of dusty walkways, Gus knew the medicinal uses of all these plants. As a newbie to the world of herbal medicine, I was surprised first of all that these plants I had taken for granted had medicinal uses at all, and secondly by how much there was to know about them! For Gus possessed an encyclopedic knowledge of healing plants, and his unrehearsed lectures gave me a first glimpse of how his mind worked – synthesizing Chinese energetics with biochemical understanding and mixing in a dollop of Ayurveda here and a tidbit of medieval alchemy there.
As I got to know him better, I came to understand that Gus’ mastery of herbs came from his own intense curiosity about the world. His passion was the rich, deep realm where mind, spirit, and plants overlap and interact and play. His company, Shamanic Tonics, specialized in “spirit herbs,” and each and every one of his formulations was only offered up to the public after rigorous in vivo testing conducted on himself (and his lucky friends!). I remember one day Gus announced, quite dramatically for him, that he had “tamed the wild mahuang!” Back in those days ephedra was still legal, though the FDA was taking an interest in it due to a few unfortunate incidents in which people had abused it as an “herbal upper” to the point of death. Gus wanted to tone down mahuang’s stimulant properties, and hit on the combination of mahuang and reishi (a spirit-calming and immune system stimulating medicinal mushroom) to do just that. I remember some really fun and interesting hikes trying out that stuff. It came to market as Fungalore, and became quite the hit at dances and parties before mahuang was banned.
Gus was a very spiritual guy, a true seeker, whereas I was and am more of a skeptic. Yet, we had great discussions about everything from Tibetan Buddhism to Shinto animism to Amazonian shamanism. Regardless of our fundamentally different orientations, we shared a deep interest in religion and consciousness. I took an anthropological interest in history and religion as a record of humanity’s attempts to understand the world; for him spiritual traditions were a practical guide for his own explorations of mind and nature. He revealed to me once that he thought we had known each other in a past life. Though I would ordinarily shoot down such a statement in my usual rational way, at the time I paused and savored it, because I had to agree that we shared a bond that, whether or not it involved reincarnation, demonstrated some kind of karmic connection that I could not deny. And, not insignificantly, I took it to mean that he considered me his friend, and that made me happy.
In the years after we finished our master’s degrees in Chinese medicine, Gus moved away from Santa Cruz, settling in Northern California near Mendocino. I think the slower pace of life and immersion in lush forest suited him well. We kept in sporadic touch by email and phone, and every now and then I’d find a package in the mail stuffed with fresh matsutake (Gus and I shared a love of mushrooms), or a sample pack of a new herbal formulation, or an article on kanna or blue lotus or whatever else was occupying his interest at the time. This was typical of Gus: so generous, so giving.
Some years ago Gus gave me a piece of writing he had authored. It was about his fascination with the young god Dionysus. I wish I had kept it, so I could read it over again in my effort to understand him better, to try to understand why he is gone. Because I still don’t understand. I saw Gus a couple of months before he died. We went on a hike in the Berkeley hills with our friend Andy. He was in the process of moving from Mendocino to the Bay Area, and was excited about some new prospects for his company, about reinventing himself and his business. He seemed content. We had a great time; it was like old times, Andy driving like a crazy man, Gus with his long stride leading the way as we hiked, pointing out flowers, talking about plants. He would have made a really great teacher at any Chinese medicine or naturopathic school.
Soon after we became friends, Gus gave me a baby gotu kola plant. Gotu kola is an Ayurvedic herb that is revered for its effects on the brain and nervous system, circulation, and skin. It has since become one of my favorite herbs. Gotu kola is easily propagated, as it spreads runners that put down new sets of roots and establish babies that can be dug up and given away. Over the years I have given away many such babies, to friends and patients, as well as tinctures and teas that I made from the harvested plant (I’ve eaten quite a bit of the fresh leaf as well). I think of the gotu kola as Gus’ good influence, spreading outwards in an infinite web, doing good, humans and plants working together for the betterment of all. Like I said, I’m not so sure about reincarnation. But if anybody would consciously reincarnate as a plant, it would be Gus. Perhaps his consciousness is spreading through the world as gotu kola. Perhaps, every time I take a nibble, I re-enter that Dionysian wave. Perhaps, as I graze, I will get my friend back, just a bit at a time, in subtle explosions of metabolism and neurology, as plant and mind merge and my grief (I hope) slowly diminishes to be replaced entirely by a love and appreciation that grows only deeper with time.
Tuesday, February 16, 2010
Tuesday, August 04, 2009
Title of a June 1, 2009 article in NEWSWEEK by science writer Sharon Begley: “Hooked on a Feeling: This is your brain on a placebo.”
Believe it or not, these articles report on the exact same recent acupuncture research. As their titles reveal, they reach basically opposite conclusions. The research in question, conducted by Daniel C. Cherkin et al and published in the Archives of Internal Medicine, May 11, 2009, under the title “A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain,” utilized a cleverly constructed experiment to try to determine whether acupuncture was effective as a treatment for low back pain. 638 adults with chronic low back pain were split into three groups. One group received “individualized acupuncture,” in which the acupuncturist could use any points he or she wanted, as long as the patient was lying prone. The second group received “standardized acupuncture,” an eight-point combination consisting of the points Du-3, UB-23, UB-40, K-3, and a low back ashi point (an excellent prescription, though the ashi point, referring to a tender point, makes this “standardized acupuncture” somewhat individualized to my mind). The third group received “simulated acupuncture,” or, as acupuncture detractors prefer to call it, “sham acupuncture.” In this group, the patient would lie face down as in the other groups, and the acupuncturist would press an acupuncture needle guide tube against the same points used in the “standardized acupuncture” group, then simulate needle insertion by tapping a toothpick gently against the patient’s skin. None of the patients in any of the groups knew which group they were in, and, presumably, all thought they were receiving some kind of acupuncture. All patients received ten treatments over seven weeks, and outcomes were assessed after eight, twenty-six, and fifty-two weeks using the Roland-Morris Disability Questionnaire and a 0-10 range “symptom bothersomeness” scale.
Much to the delight of acupuncturists everywhere, the results showed that acupuncture “improved function and decreased symptoms,” and, furthermore, the improvement was significantly better than that resulting from usual care, even one year later. Interestingly - and here is the crux of the dispute between the pro- and anti-acupuncture camps – it didn’t make a difference whether a patient received “real acupuncture” of the individualized or standardized variety, or whether they received the non-penetrating “sham acupuncture.”
Now, this is food for thought. It is quite easy for the acupuncture-uneducated reader to leap to the conclusion, as NEWSWEEK’s Begley does, that “the most parsimonious explanation for that finding is inescapable: it is possible to think yourself out of pain.” In other words, if sham acupuncture works as well as real acupuncture, then all acupuncture must work because of the placebo effect.
Let me make my own bias clear: I am an acupuncturist. I believe that there is something going on other than mind over matter when I treat my patients and they get better. I think that acupuncture is a connective tissue therapy par excellence, and that the traditional East Asian approach to treating the human body’s ailments via the skin and connective tissue is far more sophisticated than the cutting edge of conventional medicine.
That said, I believe that there is also something to the whole placebo thing. Of course the placebo effect is part and parcel of how acupuncture works! Placebo effects are part of how any healing method works. It is a credit to the ancient Chinese doctors that they incorporated into their medicine methods that improve clinical outcomes through, to use the medical lingo, “nonspecific effects.” Yes, it helps patients to listen to them! It helps patients to palpate them, to look at them, to spend more than five minutes with them! My hope is that one of the outcomes of placebo research is that conventional medicine will reincorporate some of these things, to give it a softer edge, more compassion, less arrogance, and yes, better outcomes.
It appears to me that acupuncture has reached a tipping point in modern society. There are so many people who have benefited from acupuncture that it is simply getting accepted by the mainstream as a viable therapeutic method. Acupuncture poses a challenge only to those hardcore skeptics who cannot stand the thought that a method utilizing unscientific concepts like “qi,” “the five elements,” and “yin and yang” could possibly work. Their disbelief of acupuncture is akin to someone refusing to believe that a samurai sword can cut because their fundamentalist mind takes issue with the Shinto ritual that dictated the ancient swordmaker’s forging. Such people seize upon a study such as Cherkin’s as proof that acupuncture only works because patients believe that it does. They fail to consider alternate explanations, even though the authors of the study themselves spell out the possibility that “superficial acupuncture point stimulation directly stimulates physiological processes that ultimately lead to improved pain and function.” The research of MacPherson et al with functional magnetic resonance showing that superficial and deep needling elicit similar blood oxygen level-dependent responses in the brain suggest as much (Neuroscience Letters 434, 2008).
My strong suspicion is that acupuncture works not through a single mechanism but through multiple mechanisms. Something very physical happens when you insert a needle through the skin and tap at the surface of a myofascial trigger point until it releases with a palpable and visible fasciculation. Other acupuncture techniques are more “energetic” and mysterious but equally effective. There are entire schools of non-insertive acupuncture that rely on the practitioner feeling a pulsation or tingling where the needle meets the skin (the patient often feels something as well) to assess its effects during a treatment. I believe that this type of acupuncture is a means of interacting with a primitive electrical signaling system that utilizes the body’s connective tissue as a conductive direct current network. Deep needling may or may not utilize the same mechanism to produce its therapeutic effects. Ear acupuncture most likely utilizes yet a different mechanism – probably neural. For Sharon Begley or any other skeptic to decide for the public what “real acupuncture” is represents the height of arrogance. Perhaps there are many types of “real acupuncture,” and “sham acupuncture” is actually a type of real acupuncture!
There is an excellent quote in the book Herbal Emissaries by Steven Foster and Yue Chongxi, in which the authors state (about ginseng, not acupuncture): “Chinese researchers…have focused on how ginseng works, whereas western researchers focus on if it works. This reflects a fundamental difference in research approaches between the East and the West. In Asia, the efficacy of an herb is already established in a cultural context. In the West, we presuppose that traditional uses have no rational scientific basis.” The same could be said for acupuncture. There are already plenty of studies showing that acupuncture is effective for back pain, or nausea, or whatever. It’s great that these clinical studies are getting more sophisticated. But as the response to the Cherkin group’s research shows, people read into these studies what they already believe. The Acupuncture Today article never once uses the word “placebo” in discussing the possible interpretation of the results, and the NEWSWEEK article never once entertains the possibility that acupuncture works by a mechanism other than placebo.
I wish that instead of these sorts of studies, and in addition to better and more placebo research, scientists would do more basic research into how acupuncture actually, physically, works. It’s hard to argue with fMRI imaging that shows that the needling of points associated with the treatment of vision disturbances lights up the visual cortex of the brain (as Cho et al report in PNAS, vol. 95 no. 5, 1998), or that needle twirling at acupuncture points results in mechanical signal transduction in the connective tissue with far-ranging effects (Langevin, in the Journal of the Federation of American Societies for Experimental Biology 16:872-874, 2002). I predict that the next generation of acupuncture research will demonstrate that acupuncture turns specific genes on or off to achieve its effects - and that these studies will be done on (presumably unbiased) non-human mammals. I don’t feel any particular need to validate what I do to skeptics. I’m quite comfortable with the witch doctor element in what I do, and it’s good enough for me that my patients are satisfied with the care they receive. But I do realize that strong scientific evidence would ultimately result in more people benefiting from acupuncture. And I think that fundamental research in the biophysics and biochemistry of acupuncture would serve this end better than clinical research, which somehow just seems to strengthen one’s bias, whatever it might be. Perhaps I am being naïve, and no amount of studies will convince either camp that the other is wrong. For some reason acupuncture rubs some people the wrong way much like astrology or intelligent design do. But I predict that, with or without studies, acupuncture will continue to gain acceptance simply because more and more people are benefiting from it and its usefulness is becoming a matter of conventional wisdom in the same way that people accept the validity of many surgical procedures that have never been tested but continue to be used because of their self-evident efficacy.
If the placebo effect is hokey, then there is something hokey about acupuncture. The placement of needles at acupuncture points, with or without penetration of the skin, is certainly pokey. There is a magic that happens between the mind and the body, and between two interacting human beings, that unites and transcends the hokey and the pokey. That magic is called “healing.” When it comes to healing, maybe the Hokey Pokey IS what it’s all about. Just put your left hand out and I’d be happy to show you.
Monday, April 14, 2008
Some weeks later, my sister came and went, and I noticed the irritated area had spread to the border of my lip. Having nothing else in my medical history to compare it to, I thought I must be in the early phases of an oral herpes outbreak. I called my doctor and convinced her to prescribe me some Acyclovir to knock out the virus. She ordered a five-day course along with regular swishing with Stanford Mouthwash (a combination of cortisone, an antifungal, tetracycline, sugar, water, and artificial red color). I followed her directions dutifully, and the rash did not get worse but it also did not go away.
A few days later I noticed that the rash had spread to the other corner of my mouth, and was making inroads into my upper and lower left lip. It also began to itch. So I went to the doctor, and she confidently announced that I suffered from cheilitis (which, it turns out, just means "cracked lips"), that it was caused by a yeast, and that the cure was Nystatin. I was relieved that we now knew what the problem was, and a little ashamed that I had not gone to see her sooner. I picked up the Nystatin mouthwash at the pharmacy, and rinsed my mouth several times daily, and applied some to the affected skin around my mouth, as she instructed.
So I was very unhappy when, after several more days, my skin problem was not only not gone, it was worse! The Nystatin made the skin angry and red, and my doctor instructed me to discontinue it. I tried all kinds of topical treatments from aloe gel to shea butter to cortisone cream, but they all made things worse. Even Kazi Dama's Magic Balm didn't help. I was getting quite self-conscious around my patients, since, as a health care provider, having weird sores around the mouth was kind of yucky and didn't advertise my skills as a healthy person much less as a healer. Besides, I had to leave in a few days for an NIH conference in Texas, and I did not want to be dealing with this then.
So, unable to get an appointment in time with the dermatologist, I went in to urgent care. The doctor there, perhaps sensing my frustration with my regular doctor, defended his colleague, saying that cheilitis is most often due to a yeast. It was a good guess, he said, and since we had now eliminated both virus and fungus as the cause, the perp was most likely a bacteria. So he prescribed me some MRSA-killing Mupirocin antibiotic ointment. The stuff smelled like cheap Mexican beauty product, but I applied it several times daily as instructed. Unfortunately, it also made my rash worse. The inflammation pretty much circled my entire mouth, turned red and itchy, then over the course of a day or two dried up and calmed down, then the dry skin flaked off. I was initially excited and encouraged by the flaking off part of this life cycle, thinking that it signified a movement towards resolution and cure, but quickly discovered that the rash was only taunting me; that it would cycle through these phases regardless of what I did.
I went to Texas feeling like the Elephant Man and continued my antibiotic ointment regimen even though it was clearly not working. Finally, in a hyperpruritic frenzy at two or three in the morning on the second night of my trip, I decided to take matters into my own hands. I doused my mouth with hydrogen peroxide. My rash hissed and foamed rabidly and I thrilled in the piercing sting and eventual numbness that settled around my beleaguered piehole. The next day the skin around my lips was crusty and dry, but at least it didn't itch and it didn't seem to be entering into the angry red phase of its life cycle.
By the time I returned to Santa Cruz the rash was swollen, red, itchy, and uncomfortable so I purchased some calendula gel and applied it liberally. I was glad to find that it was the one thing so far that didn't seem to irritate the rash. But it didn't get rid of it either. So, being the resourceful type, I ground up some berberine (from the Chinese patent medicine Huang Lian Su Pian) and mixed up a batch of alkaloid-enhanced calendula gel. If there's a microbe there, I reasoned, the berberine might kill it. For my efforts all I got was a ridiculous-looking yellow ring around my mouth and taunts (and some sympathy) from my family.
I started to get scared. What if this rash was some bizarre autoimmune condition, like pemphigus? Can you get pemphigus from cats? (Charlie scratches himself a lot despite the flea and tick medication we give him). What if it was early stage squamous cell carcinoma? I called the dermatology clinic to see if I could get in right away. The earliest appointment they could give me was over a week away. What should I do? I decided I would wage all-out CAM war on the rash. I would cure it by myself before my dermatology appointment! I started taking Huang Lian Shang Qing Wan ("Coptis Clear Heat from the Upper Body Pills") internally and continued the calendula gel (minus berberine) topically. At my friend Gerhardt's insistence I applied some Swiss medicine called NEGATOL (an antiseptic/hemostatic whose chemical name is policresulen). He claimed that if there was something there to kill, NEGATOL would kill it. I figured, with that ringing endorsment and such a promising name, why not? Like the peroxide, it hurt like hell and dessicated the skin around my mouth. I returned to the calendula gel to try to soothe the dry painful skin.
Rather late in the game, I turned to acupuncture. I bled Stomach-40, the connecting-luo point of the stomach channel, since the stomach channel goes to the corners of the mouth and even around it to connect to the Du and Ren Vessels. I got bleeding-happy and also bled Spleen-1 and Liver-1 around the big toe, since visual examination revealed that there was some blood stasis there (my teacher Anryu Iwashina aka Dr. Bear says that before you do anything else you bleed where there's stasis). This got me thinking that my rash might be more a problem of blood stagnation than of heat, dampness, and toxin, so I made a salve of St. Johnswort/gotu kola and Yunnan Baiyao powder and applied it as an experiment this morning. It didn't inflame the skin, but it didn't seem to help much either, so eventually I switched back to calendula gel. I did more acupuncture, to sedate the stomach channel and tonify the spleen, to aim at the dysfunctional channel via its "opposite" partner the pericardium, etc. etc.
The rash settled into a status quo of not itchy and inflamed, but nevertheless chapped and discolored at the edges of the lips. Continuing on the hypothesis that the problem was one of blood stagnation, I began a course of self-treatment three times daily with a cold laser, at 680 nm wavelength. Lasers are used instead of needles by some acupuncturists, and they seem to stimulate unhealthy cells to perk up and regain homeostasis. RISE AND SHINE MOTHERFUCKERS! became my mantra as I blasted my lips with the dazzling red light.
Slowly, the rash subsided. I don't know if this was due to the acupuncture, the herbs, the calendula gel, the NEGATOL, or the red laser. Or if the disease was nearing the end of its natural course. By the time of my appointment with the dermatologist all I had was a faint discoloration of the skin around my lips. I was tempted to blow off the appointment, but, hyperaware of the potential criticism that I hadn't given western medicine a fair shake, I went. Predictably, the dermatologist spent about five minutes with me and prescribed a corticosteroid ointment. "Shouldn't you take a biopsy or a culture?" I asked, visions of pemphigus-unglued skin flapping in my brain. "You read too much," he laughed, and sent me on my way.
I applied the ointment, and at first my skin reacted by getting itchy and slightly inflamed. Here we go again, I thought, overcome with a familiar frustration. But I persisted, and the skin calmed down, and now a week later at about Week 70 of my odyssey I am finally about back to normal (although after a one-day experiment of no cortisone yesterday the rash came back this morning).
What conclusions can we draw from my ordeal?
1) My doctor should have taken a culture at my first visit, to determine what microbe, if any, was involved in my cheilitis.
2) I should have begun the "complementary and alternative" assessment and treatment earlier.
3) Cortisone is a wonder drug.
4) The integrative medicine approach needs to be flexible and open-ended, rather than codified and inflexible.
To expand a little bit on Item 4 above, I'd like to discuss what I see as the conundrum of integrative medicine. Western medicine and most traditional non-western medical systems are unlike each other in many ways, but most fundamentally they are different because western medicine subscribes to the notion of a "standard of care" which follows disease categories and specific diagnoses, whereas non-western medical systems famously "treat the whole person." What does this mean? This phrase "treating the whole person" is so vague as to be meaningless, and in integrative medicine has often come to mean that the patient applies a variety of approaches to their care, often including methods to address the mind (biofeedback, relaxation and visualization, for instance), the body (drugs, massage, herbs), and the spirit (prayer, meditation). In my opinion, the treasure of non-western systems such as traditional Chinese medicine and Ayurveda is not necessarily their ability to treat mind, body and spirit per se, but their ability to treat each patient's constitution or "pattern" and remedy a person's "deficiencies" and "excesses" (to use acupuncture-speak) in a way that is simply outside the paradigm of biomedicine.
To the western doctor, the patient suffers from an active herpes simplex infection (for instance), and the standard of care is to prescibe an antiviral like Acyclovir. A practitioner of traditional Chinese medicine would choose from any of a virtually limitless range of options, depending on his assessment of the patient's condition. Do the lesions present on the stomach channel, or do they manifest on the liver channel or the Conception Vessel? Is the patient primarily yin-deficient, or qi-deficient? Does the deficiency outweigh the current excess manifesting in the outbreak, and will the herb formula prescibed focus more on strengthening the constitution or on quelling the excess fire and dampness? These may be archaic and poetic terms but they are also phenomenological and clinical. In other words, "treating the whole person" is not simply a matter of throwing the patient a variety of practices and nutrients; it is a way of assessing their clinical picture - and treating disease - in a way that is utterly different from western medicine, and is often very effective.
The problem is that the gold standard of integrative medicine when it comes to complementary and alternative therapies is the notion of "evidence-based medicine." Typically, the informed western doctor will only recommend non-western therapies if there is "evidence" (read: scientific studies) that they work. While this makes perfect sense on the surface of things (why recommend something if it hasn't been shown to work?), the multifactorial nature of non-western therapies makes them problematical from the point of view of establishing efficacy. Do separate studies need to be done for the herbal treatment of liver-channel herpes and for stomach-channel herpes? How do you separate out the effects of acupuncture from the effects of herbs? Should practitioners only do one thing at a time? Does scientific evidence have to be established for the treatment of every disease before doctors can recommend a procedure or a style of healing to patients? Should the results of the research prescribe a standard of care for complementary and alternative therapies?
My answer is yes and no. Yes, more research should be done on CAM therapies and the integrative approach. This will only help to legitimize what we do in the medical and scientific communities. But no, this research should not change the heart and soul of what we do into a subcategory of conventional medicine, with standards of care that dictate how we treat. As reactionary as this sounds, I think that we practitioners of non-western therapies should continue to practice as our forebears have been practicing for the last several thousand years. Chinese medicine is an art, in addition to being an empirical multi-faceted clinical science. The Yellow Emperor would roll over in his urn if acupuncturists started practicing out of a book: "for hepatitis B, needle Liver-3." Unfortunately, much of Chinese medicine in the modern age has in fact been reduced to this. My advice to western medical doctors interested in integrative medicine is to seek out the artists, the practitioners who have mastered the non-western therapies on their own terms, who are creative and resourceful and masterful in their approach to treating patients. Collaborate with or employ people whose individual reputations speak for themselves; don't just rely on studies that show that acupuncture (or whatever) is good for treating A, B, or C, and pick an acupuncturist out of the phone book. I am not saying that evidence-based medicine should be tossed out the window. In this age of the Internet there is much that masquerades as integrative medicine that at its core is simply hokum and marketing. Machines that read the resistance at acupuncture points and, hooked up to a computer, miraculously match your "vibration" to the proper homeopathic remedy or electronic frequency spring to mind (beware of any method that uses the word "quantum" in its advertising).
Certainly, physicians should not blindly recommend things with no rational reason for those recommendations. But I would beg a kind of special status for medical systems such as Chinese medicine or Ayurveda. They are backed by a very long history of continuous use that has, on the whole, demonstrated their usefulness in strengthening patients in their ability to heal. My vision for integrative medicine is one of qualified healthcare practitioners from a variety of traditions, working side by side for the good of their patients, each honoring the integrity and value of the others' traditions and experience. In addition to the cumulative and by its nature always incomplete evidence produced by scientific studies, the evidence these practitioners observe in the clinical domain will drive integrative medicine forward into the future.
Saturday, May 05, 2007
Today is May 5th, my son Lukas' birthday, the ancient Celtic fire festival Beltane (give or take a day or two), Cinco de Mayo, and the Japanese festival known as Boys' Day. Although it has since morphed into a more inclusive "Children's Day", all Japanese know that the festival always was and actually still is Boys' Day (girls have their own Girls' Day on March 3). The quintessential symbol of Boys' Day is the koinobori, large carp-shaped streamers that fill with wind and swim in the air from long bamboo poles. We fly our koinobori every May, and I love how it soars through the air, and I love this celebration of my son's life and good health. The Japanese revere the carp as a symbol of strength and determination, because it fights through obstacles with great spirit, swimming upstream, even scaling waterfalls, to get to where it's going. Some time ago my parents sent me a beautiful little silk painting, of a boy hanging onto the back of a big koinobori. And I thought, all of us boys ride on the back of a monster fish. The fish takes us up and down and all over the place, and we hang on because it is one exhilarating ride - truly the ride of our lives, and in some Darwinian sense the reason for our lives. This fish, of course, is our sexuality.
This essay explores the sex drive from a male, East Asian, alchemical/religious perspective. I vacillate between thinking there's something to it and thinking it's delusional nonsense. I like the idea that we can recognize the tremendous energy of our sexuality and put it to spiritual use. But I have this deep suspicion that most people are better off just enjoying sex as sex, rather than trying to control it for supposedly spiritual ends. Anyway, here it is. Happy Boys' Day!
There is a curious notion, prevalent among certain sections of the alternative medicine and New Age subcultures, that one can improve health and possibly even attain states of spiritual perfection, by recycling one’s sperm. There are many ways to do this. You can be celibate, thereby limiting the number of emissions to those few nighttime incidents that are beyond your control. Or, you can have sex, but refrain from ejaculating through the use of certain tricks of sphincter control and qi redirection. Finally, when all else fails, you can push with your finger on the so-called “Million Dollar Point” located between the anus and the scrotum, to block the escape of semen and reabsorb it in your body.
The origins of this practice are lost in the mists of prehistory, but they almost certainly have to do with ancient man’s realization that sperm holds within it an awesome power – the power to co-create life. What if this power could be harnessed for self-cultivation? This is the origin of celibacy in most Asian religious traditions: a focusing inward of life’s energies, rather than the outward focus of the householder or “man of the world.” Many religious sects rejected sex because it represented attachment to the body and the world, the misdirection of life force into karmic entanglements and away from enlightenment. But a few schools, most notably some South Asian tantric traditions and certain Daoist sects in China, figured out how to have it both ways. They opted to utilize the energies generated by sexual activity, and incorporated non-ejaculatory sex into their rituals. Central to the doctrines of these schools is the importance of what the Chinese have termed jing: the primal “substance” variously translated as “essence,” “sperm,” and “sexual energy.”
In China, what was originally a religious practice became somewhat secularized into what we now call “internal alchemy.” In contrast to the earlier external alchemists, who attempted to create an elixir of immortality out of various minerals and herbs, the internal alchemists believed the elixir was to be created within the body, using many different psycho-spiritual techniques. The goal of the alchemist was to take the awesome life-creating power of jing, transform it into the life-serving vitality of qi (life energy), then finally transmute the qi to arrive at the elixir: a refined force of spiritual potency that circulated through the meridians and conferred health and longevity. Some alchemists insisted that the creation of elixir was a purely internal solo process; others believed the dew of immortality was to be found in the merging of yin and yang that occurred during sex. Whether pro-sex or anti-sex, the alchemists all agreed that the conservation of jing was of paramount importance.
What is interesting to me is that these ideas have become so popular now, in the West. In a culture that regards ejaculation as a healthy “clearing of the pipes,” the popularity of sperm retention seems unlikely. But then again, maybe it’s not so strange that our sex-obsessed society has latched onto this particular aspect of Asian culture.
One man is largely responsible for the current popularity of sperm retention. He is Mantak Chia, a self-proclaimed Daoist master from Thailand who runs workshops and has written a whole slew of how-to books on this topic. Chia has managed to cash in on people’s longing for transcendence, as well as their interest in sex. He teaches basic qigong techniques that are central to all Chinese meditation schools and internal martial arts, but I suspect that his popularity is due primarily to the sexual angle of his instruction. He teaches couples ways of squeezing their muscles and clenching their teeth during sex to re-direct their orgasms inward and upward. For practice prior to attempting the real thing, and as a form of self-cultivation in its own right, Chia teaches methods of self-stimulation combined with breathing and visualization: you might call this "transcendental masturbation". Chia has single-handedly made internal alchemy into a booming business.
In case I sound overly critical, let me point out that I am a firm believer in Chinese methods of meditation and self-cultivation. As an acupuncturist, I teach patients qigong techniques to quiet the mind and circulate the qi. But to me, sperm conservation has the ring of neurosis. I believe that sperm retention thinking is part of a broader cultural pattern prevalent in patriarchal Asia, a pattern that fears female sexual vampirism (and female sexuality generally, since women can have all the sex they want without losing jing) and reacts to this fear by hoarding sperm. This pattern appears in folk tales about fox-women preying on young scholars; it shows up in the large number of acupuncture points and herbal formulas designed to treat spermatorrhea (“sperm leakage”); one could even argue that China’s huge Three Gorges Dam is its national jing obsession writ large.
The main reason I object to the currently popular methods of sperm retention is that they exhibit an extremism that runs counter to the generally middle-of-the-road common sense of traditional Chinese medicine. Suppression of a natural outward energy just seems like it would lead to qi stagnation and possibly even medical problems (in fact, I know of several cases of “blue balls” and benign prostate hyperplasia among would-be internal alchemists; one needed a year of acupuncture with a senior Chinese acupuncturist to undo the energy blockage created after attending one workshop). There is a popular saying in Chinese, “xing ming shuang xiu,” which is commonly translated as something like “A sound mind in a sound body.” What it literally means is the dual cultivation (shuang xiu) of self-nature (xing) and life energies (ming). This saying, which lies at the root of all Chinese methods of health improvement and self-cultivation, reminds us that personal conduct and moral bearing, which have to do with xing, are just as important as the development of the life energies that comprise ming. I believe that the commercialization of qigong and related practices in this country has led to an unhealthy overemphasis on the latter, with a concomitant surge in the popularity of the more unusual, and especially sexual, aspects of Asian health culture.
My goal is not to malign practitioners or instructors of qigong and other Chinese health disciplines. Instead, I caution against dangerous literalism of any sort. I resist the idea that the dew of immortality is any one thing. Our jing, the innermost and deepest source of our creativity, is the energy of the universe transforming matter, spreading over the surface of our planet as desire, as streams of lovers, children, descendants, nucleotides, alkaloids, neurotransmitters, brainwaves, photons, memories, music, stories, words, artifacts coarse and fine, a mystery spreading like a plague through these strange, pulsing, living, mortal things that we are. The elixir bubbles forth through all of creation, shimmering and radiant, if only we are present enough to appreciate it.
Thursday, January 04, 2007
Now, don’t get me wrong. The post-feast sloth is a joy in its own right, but the eating is definitely the main event. To prepare a large meal with family and friends, to sit down and eat together when you are hungry is a joy that’s hard to beat. In fact, whether or not it’s the holidays, eating for me epitomizes the joy of being alive.
Clearly, just as evolution has wired us to enjoy sex, we are programmed to enjoy eating. DNA “wants” us to keep on living so that we increase our chances of making babies and hence more DNA. Ergo, we like to eat, and we like to make love.
Speaking of food and sex, Chinese medicine describes our vitality, our qi, as coming from two main sources. The first source is our parents, and by extension our ancestors. This type of qi, called “pre-natal qi,” is passed on genetically and is said to be stored in the kidneys. Pre-natal qi is the qi of sexuality and reproduction, and we only get a finite amount of it. We can’t really build it up, but we can squander it through too much sex and drugs and rock n’ roll. The second type of qi, called “post-natal qi” because we start to absorb it after we are born, comes from the air we breathe and the food we eat. The lungs and digestive system are the domain of this kind of qi.
How can these theories contribute to our health? Well, number one is: don’t over-spend your pre-natal qi through fast living and reckless habits. Younger readers will scoff at this advice, but older readers will nod knowingly. Number two is: keep breathing (if you feel you need help with this, find a good qigong instructor or a yoga class). Number three is (you guessed it): keep on eating.
But what to eat? Since I believe that all food is good, I don’t like to give lists of “good” and “bad” foods. So here are a few health-oriented suggestions instead: Cook your own food. Eat regularly. Don’t overeat (except at infrequent feasts). Eat seasonal, local foods. Incorporate in your own diet what your ancestors ate many generations ago. Eat a varied diet. Set time aside to enjoy your meals.
Ultimately, all diets from macrobiotics to vegan are based more on ideology than on anything else. Often, in the New Age circles in which alternative medicine thrives, there is an unspoken assumption that cleanliness is next to Godliness, that if you could only cleanse all those toxins from your liver or manage to avoid certain karmically incorrect foods, you will ascend to the “next level,” a realm that by definition you are not in now. I’m not arguing that these diets are necessarily unhealthy, but I do think that they can create guilt and neurosis, neither of which contributes to good health.
My own food ideology has to do with honoring our biology, and embracing enjoyment. By honoring our biology, I mean that the human digestive system evolved into its present form over the course of at least two million years of hunting and gathering. What this means is that we are optimally fueled by an omnivorous diet consisting of a large variety of fruits, vegetables, roots, tubers, grains, seeds, and meats. Archeological evidence shows quite plainly that the shift to agriculture, with its reliance on a few key foods, had a disastrous effect on human health (it also triggered the population explosion that we are reeling from today).
As for embracing enjoyment, I believe that pleasure is inherently healthy. Those French studies showing that red wine is good for you probably have as much to do with the attitude towards food of the people studied as they do with the chemical properties of red wine. We will all be eaten one day. But until life eats us, let us eat life! Bon appetit!