A Simple Treatment for Taxol Chemotherapy-Induced Peripheral Neuropathy

About six years ago I started working at a cancer treatment center whose principal doctors, bless their hearts, were open to the idea of their patients utilizing acupuncture as part of their supportive care.  Before I started, I had to attend an interview with the doctors.  One of them asked me if acupuncture could treat peripheral neuropathy.  I wasn't even sure what that was, but automatically replied "Yes!" because I really wanted the job.  Then I went home and read up on neuropathy.  As it turns out, peripheral neuropathy is the medical term for the the numbness, tingling, and pain that can be caused by a number of things, including certain types of chemotherapy.

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!

The Laboratory and the Real Work

Many years ago I started making herbal liqueurs and tinctures for fun.  Along the way I went back to school to learn more about herbs and healing, and ended up with a master’s degree in traditional Chinese medicine and state certification as a Licensed Acupuncturist.  For a couple of years I worked solely as a clinician, but then, to supplement my meager income and to get good benefits for my family, I  took a day job as a research administrator at the local university, and treated people in the evenings and on weekends.

I stayed at my university job for ten years.  It was a good job, with very little supervision and a lot of autonomy.  The scientists that I worked with came to trust and like me, and to rely on me to manage their grants.  We developed a ritual where, with every successful grant submission, we would share a glass of schnapps.  Over the months and years the drink would vary depending on what I had most recently produced: it could be a strong clear liquor made from the plums growing in my yard, or absinthe, or a mix of spring bitters.  Hanging out with my scientist friends, I came to admire them immensely for the work that they did as well as for the individuals that they were.  Many of them work in biomedical research, peering into the workings of cells and the molecular basis of life, and finding out things that are resulting in a deepened understanding of, and eventual cures for, diseases such as cancer and Alzheimer’s Disease.  But the work they did was so different from my work.  Seized by a problem or a question, they devised experiments to test hypotheses, they ran labs that were devoted to figuring out stuff they were interested in.  I distinctly remember once overhearing a researcher in the hallway, remarking incredulously to a colleague, “I can’t believe we get paid to fuck around!”  I knew immediately that he meant “fuck around” in the best sense of the word, as in trying things out, playing, experimenting, figuring out the problem that occupies you.  I wished I had a job where I could get paid to fuck around!

My administration job changed quite a bit in the last year or so.  With the economy tanking, the trend was for fewer and fewer people to do more and more work.  Plus, I had a new boss who managed to turn my job into that of a glorified clerk.  I used to feel like a valued consultant, advising my PIs (Principal Investigators) on grant-related issues, but more and more I felt like an overheated machine, scrambling to stay on top of never-ending bureaucratic tasks that the University would have done better to hire a student helper for.  While I still enjoyed working and hanging out with my PIs, I came to resent the middle and upper management who were, in my view, making bad decisions, ruining my job for me and diminishing the research enterprise at our university.  So, two months ago, I quit my job.

For the first time in a while, I feel a tremendous sense of freedom.  I still treat patients, but now I have some free time to fuck around!  The place I do it is in my lab.  When I left my university job, my PIs gave me a beautiful apparatus for extracting the active constituents from medicinal herbs.  I set it up in my garage this summer, and have really been enjoying experimenting with it.  I should clarify right away that would I actually do in my lab is quite different from what my scientist friends do.  They seek to find out new things: the application of nanomaterials to the detection of cancer, for instance, or figuring out how tRNAs move on the ribosome during protein synthesis.  I am interested in very old things: medicinal herbs and fungi that were first described a couple thousand years ago. My PIs use very expensive cutting-edge technology to arrive at their results, whereas my equipment is very low-tech, consisting of glass columns, jars, grinder, recycled pressure cooker, and coils of copper tubing.  And, they are way smarter than me, have tons of education, and are eminent in their respective fields.  (I myself am something of a hermit and an unknown).  And, my lab is far dirtier than any of theirs (Environmental Health and Safety would probably frown at my spiders-to-wall-space ratio).

Nonetheless, the spirit of fucking around is the same.  Will the MAO inhibition caused by the beta-carbolines in passionflower increase the antidepressant or sleep-inducing effects of some of the other herbs in this formula?  Should I change the ratio of ethanol to water in the solvent to better extract the active polysaccharides from the ganoderma fungus I just harvested?  Or would it be better to do two separate extractions, one in boiling water and one in pure ethanol, and combine them later?  Should I add some fennel seed extract to the absinthe after distillation, to soften and sweeten the final product, or some fresh melissa? How will it affect the final product if I don’t first decarboxylate the herb with heat prior to extracting it?  These are the kinds of questions that occupy me, and that I can play around with on my equipment.  There is also a more sensual aspect to this fucking around.  Tasting my herbal extracts, combining them, mixing them until they taste right to me and make me feel good, this is also an essential part of the process.

There is a sign that hangs over the door that leads from my office to my lab.  The sign says LABOR.  On the one hand, “labor” is the German word for laboratory.  But there is a double and even a triple meaning.  Labor, of course, also means “work.”  And labor is also a special kind of work – the hard work that leads to birth.  I like to think of my laboratory as the place where I do my “real work.”  It’s not that I don’t consider treating patients to be real work, or unimportant work.  But it’s a very different kind of work, so much so that it doesn’t feel like work to me.  I am fortunate in that I have wonderful patients who are more like old friends.  When I see them, we get to catch up on each other’s lives, chat and hang out while I am cupping their backs, sticking them with needles, or what have you.  My work in the lab is different.  There is a certain rhythm that I get into when I am measuring out herbs, grinding them up, mixing them, packing them in the percolation column, mixing solvents, controlling levels of heat and rates of drip.  There is something ritualistic about it that speaks to me at a very deep level.  I am doing real, time-consuming, physical work, work that takes preparation and clarity and an unhurried sense of purpose.  Making a formula is an all-day, or even a multiple-day affair.  At the end there is a final product – an amber-colored or deep green elixir that, when imbibed, has some sort of predictable effect on one’s body and mind.  I think of myself as an essentially creative person, and when I have created a medicine, it feels like a kind of a birth to me.  The labor has produced something unique, and useful, which then goes out into the world, into my community, where it can do good.

All this talk of labor may seem odd for someone who professes to embrace an easygoing kiraku life philosophy.  But, in fact, I am not opposed to working hard.  It’s just that there has to be a balance.  The kind of work that many jobs entail – forty or more hours a week of brain-frying stress while sitting in front of a keyboard processing tasks with little or no relevance to your day-to-day life aside from the fact that they put a roof over your head and food on the table – is just not healthy.  But to do work that you enjoy is a good thing.  My goal is to work hard in the lab to produce herbal medicines for my patients and friends, continue treating patients in a leisurely and enjoyable way, and have time left over for gardening, hiking, and other fun things. 

In Memoriam: Gus Turpin 1963 - 2010

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.

Healing, Authority, and Experiment

Being in the healthcare business, I've had plenty of opportunity to reflect on what it means to be a healer. I have to say that I maintain a certain amount of discomfort around the idea that I am a "healer" at all. The reason for my discomfort is my anti-authoritarian nature. I am so anti-authoritarian that I don't like being an authority! And to be a physician is intrinsically to be an authority. This is the conundrum that I am faced with every day.

It is a great responsibility, to accept a patient's trust, to treat them and to advise them about their health. It is a responsibility I take very seriously. My dislike of being an authority doesn't have to do with an unwillingness to take responsibility. Rather, it has to do with my unwillingness to claim to know anything special. Granted, I went to school and studied hard for years; granted, I have been in practice for eight years and have accumulated a certain amount of clinical experience; granted, I have happy patients who would testify that I helped them with their injuries, their coughs, their premenstrual symptoms, and so on. But when a patient looks at me and says, after I have been poking and prodding and feeling the pulse, "Is it my liver?": what I am thinking to myself is that I don't even know what that means. All I know is that when I assess what is going on and apply needles and herbs, something shifts. Was there something wrong with their "liver" if the liver pulse was wiry? Who the hell knows?

I think that, on the whole, it is True Believers who become successful doctors. Their embracing of a model - whatever model, western medicine, Asian energetics, it doesn't really matter - gives them the authority to say, "Yes, it's your liver, and I have just balanced it." These are the same people who confidently tell their patients that a weekly chiropractic treatment, or regular acupuncture for three months, will make them better. I envy them their confidence, even as I wonder whether their belief in their model, plus the economic motive, has clouded their ethics.

I am not a True Believer. I think that a lot of what passes for medicine is bullshit. I am skeptical, rational, creative, and experimental by nature. I had a teacher once who said, "Medicine is a series of experiments that you engage in with your patients. The more experienced you are, the more refined your experiments get." Most patients prefer authority to experimentation. They don't want to be guinea pigs. They want a doctor who tells them what's wrong with them, then proceeds to fix them. My patients are different. They know that I'm not experimenting ON them; they sense that I'm experimenting WITH them. Like me, they see that there is a playful and curious aspect to healing. They experience healing as an exploration, as an embodiment and metaphor for life.

I think it was Kierkegaard who said, "Life is a mystery to be appreciated, not a problem to be solved." I'd rather help patients explore the mystery, than claim to solve their problems. It is immensely rewarding when they start to feel better as a side effect of this exploration.

We Call It a Practice, But It's Real Life

There are many issues that come up in the practice of East Asian medicine, or really any medicine, in the modern setting. On the face of it, healthcare seems very straightforward: people get sick or hurt, and they come to you for help. You poke them with needles and give them some herbs, and they get better (or not).

But the reality is that we live as part of a society, and as part of an economy, and there is no escaping the fact that the care we provide is in fact a series of financial transactions that accumulate to provide us practitioners with a livelihood. I have struggled with this for a long time, because I have always been troubled by the psychology of on the one hand wanting my patients to get better, but on the other hand wanting them to keep coming back for more treatment so that I could pay my bills. I believe that our need to pay our bills, and our desire to do better than that - to accumulate some kind of wealth and a comfortable lifestyle - has resulted in the industrialization of our medicine. What I mean by this is that even though acupuncture and herbal medicine are supposed to be holistic and natural, economic pressures have forced many of us to adopt a model that is very similar to Western medicine, in which we treat as many patients as possible, using three or more rooms and demanding that we devote only fifteen minutes or less per patient.

It's easy to justify such a style of treatment not only on economic grounds but also with the reasoning that the patients don't seem to mind and in fact derive great benefit from our speedy ministrations. There are whole systems of medicine built on this model. And besides, we argue, when you get good you can just book, you get into a groove and treat those patients, bam bam bam!

But I have to wonder. I think that a large part of the care in healthcare has to do with caring enough about our patients to spend some time with them. Especially with a hands-on medicine like ours. How can you notice that this patient's spleen channel has little lumps and dips along it, or that patient has telltale little blood stagnation venules around UB-40, if you don't have the time to palpate and look? Is it enough to feel the pulse and look at the tongue and, within the five minutes you have allotted, declare your diagnosis and stick a few needles before moving on to the next room? Often, it may be enough. But sometimes, it may not be enough, and we don't make a difference when we could have. And always, we should ask ourselves: is this the best we can do for our patients?

We like to call what we do a practice. The practice of medicine. Or even sexier, a spiritual practice: "The medicine that I practice is just an extension of my spiritual path." This is fine and dandy, but for the patient it's not just practice. It's real life. Their real lives. So I think that for us it should be real life too. Let's take the time to live our medicine the way it was meant to be, with great care and attention and authenticity, even if that means we have to slow down. Slowing down and taking a breath - that's good for you, right? It'll be good for our patients too.

Lab Notes II

Last night was a good night. First, I ground up a bunch of herbs in the big grinder down at the clinic and made some big tea bags of mugicha (roasted barley), dokudami (houttuynia) and jiaogulan (gynostemma). The inspiration was the Japanese dokudami migraine tea that my mom sends us for Sara (who now hasn't had a headache in close to a year). Dokudami is an interesting herb that the Chinese use primarily for hot phlegm in the lungs. It's said to be broadly antiviral and antibacterial, and is mildly diuretic and laxative as well. The Japanese adore this herb; since ancient times it's been valued as a detoxifier, and it's hailed as a panacea for everything from migraines and acne to cancer and malaria. The mugicha's roasted nutty flavor does a good job of masking the more intense flavors in the other herbs. Anyway, I figured I might as well make some migraine tea myself, and experiment with other herb combinations. This one I'm calling CLEAR, with the idea that both the jiaogulan and the dokudami clear heat, damp, and toxins, but that overall the formula is pretty balanced and even slightly tonifying because of the barley and jiaogulan. The companion formula, NOURISH, will also have both clearing and nourishing properties, but will be slightly more nourishing, with nettles and gotu kola instead of the dokudami and jiaogulan. Gus says he would switch the jiaogulan and the gotu kola, and now that I'm treating a new teenaged female migraine patient, I can see how that might actually be a very nice combination: heat-clearing,toxin-flushing, liver-moving and liver-tonifying,but also nerves/brain soothing and calming (remember that in ancient days gotu kola was given to epileptics and the insane - which many migraine sufferers can relate to!). Very satisfying to hold in my hands a final product in professional-looking heat-sealed teabags, and even more satisying to be drinking it right this minute. Mental note: market CLEAR to smokers and people trying to stop smoking, also high cholesterol and high blood pressure, as well as migraine headaches and PMS. NOURISH for stressed-out people, anemia, chronic skin problems, and as a post-menstrual (and general) tonic.

AND, I ran my still for the first time this season! It was a three-hour operation, me sitting anxiously in the garage while the cider warmed slowly, worrying that the copper tubing had gotten crimped, or even worse punctured when I wound it up from the pressure cooker over the beams of the garage and then through my new 2-gallon condenser. Played with Charlie, our adopted stray cat (I'm not sure who adopted whom), who was very active, one moment flopping around on the ground meowing to be stroked, then suddenly shooting into the dark garage after a mouse. Then, about two hours into the operation, a splutter and a start and the moonshine began to flow! I discarded the "head", then proceeded to collect about 200 ml of clear fruity goodness. Around midnight I shut the operation down, feeling like an alchemist who has successfully concentrated the elixir. And an elixir it is! Fruity, floral, but with a firewater kick. I estimate by bioassay a strength of 50-60% alcohol. Looking forward to taste tests with different batches, and trying to establish the differences between the two trees, ripening times of the apples after they're picked, fermentation times and temperatures, distillation times and temperatures, etc.

Cheers!

Lab Notes I

Very active lately on the laboratory front. Finally cleaned out my corner of the garage, moved my herb stuff there, artfully arranged old Ladle Brand bottles, set up the still. Very excited about this next round of distillation. Am constructing new condenser unit that will allow replacement of cooling water while distilling continues. Boiler unit perfectly sealed and works great. Have juiced almost two gallons of apple juice from Tree Number One; will begin fermentation when I reach two gallons. Am so excited! It'll be interesting to compare the final product from Tree Number One versus Tree Number Two. Last year's #2 eau de vie was my favorite of all the experiments. Am looking forward to trying #1.

Improved moxa-making machinery works great. Made a bunch of beautiful fluffy white moxa from last year's mugwort. Also experimenting with using a magnifying glass to focus sunlight on St-36, Sp-6, etc. And left K-4 area which has been sore recently due to fucking up my rib and lower back. Am feeling impending old age, don't bounce back so well anymore. Sunlight moxa feels really good when you get on the edge of burning and move the point around in little spirals. I think it works pretty good. Iwashina-sensei's comment: "Pull away as soon as you feel heat." And, "Please do not forget that applying one time and even number can result in a sedating effect." (I kind of wonder about that odd and even stuff - smacks of typical Chinese numerological thinking that I'm not convinced is therapeutically useful). And, "Be careful not to over do this being carried away by its fun."

Also recently made a new all-purpose balm out of almond oil, beeswax, St. Johnswort, and gotu kola. Makes me think of first time Grossmuetti showed me how to macerate Johannischruut in olive oil many years ago. I really think it's better as a wound-healer than as an anti-depressant. Plus the gotu kola is an amazing skin herb; figured why not use it topically (interesting that they're both brain/nerve herbs and also both good for the skin. Skin as the outer physical boundary of mind? Maybe what's good for the one - antioxidants, circulatory stimulants - is good for the other). A little too herb-stinky for commercial use. The addition of a dollop of sandalwood oil hardly made a difference. Works great on moxa burns, and used it to good effect on Luki's butt, which was hypersensitive and painful from overconsumption of apricot pie.

Will hang up old Garlic Grotto sign, or maybe make a new one: "Ye Olde Brimming Laydle." Gotta get back to work.

Do You Believe in Qi?

We acupuncturists are in a pickle. On the one hand, we want so much to be accepted by the modern world, by science, by the medical community, and by the insurance companies that reimburse us. So we gather respectable-sounding research that validates the things we do, we learn orthopedic testing and ICD-9 codes, some of us even wear white lab coats. On the other hand, we cannot escape the fact that the foundation of our medicine is an invisible “energy” – qi – that is not only not scientifically demonstrated to exist; we ourselves squabble about what it is and what it isn’t. Do you believe in qi? This is a very important philosophical and epistemological question, one that every single one of us acupuncturists would do well to ponder.

There are those who argue that there’s no problem to begin with, that qi is simply air and jingluo the blood vessels; that the ancient Chinese were scientists first and foremost, that there is no need to debate this since, clearly, the ancient Chinese view of health and illness fits very closely to that of modern science. I call this the “It’s Just Air, Nerves, Muscles, and Blood, Stupid” school of thought, perhaps best exemplified by Donald E. (“Deke”) Kendall. I don’t doubt that Mr. Kendall is an excellent teacher and practitioner, and I think that his Dao of Chinese Medicine is a beautiful book. And I think it’s great to have research that shows how acupuncture affects the afferent and efferent nerve pathways, or whatever. But I also think it’s the height of arrogance for Kendall to proclaim that he has finally figured out what those ancient Chinese were really talking about. “Mysteries of Chinese Medicine Finally Revealed!” boasts the order form for his book. Does he really think that everyone including the Chinese had it wrong all this time, and that he has singlehandedly set the record straight? Or does he have an agenda that is distorting his critical faculties? I believe that the answer is “Yes,” on all counts. Mr. Kendall is so invested in integrating East Asian medicine with Western medicine that he has convinced himself that the concepts behind acupuncture, when viewed through the cipher that he provides, are basically identical to concepts from Western physiology.

I believe that words such as qi, xue, jing, shen, zangfu and jingluo have been problematical from the translator’s point of view precisely because they are embedded in a cultural and medical worldview that is intrinsically different - extremely different - from the Western scientific worldview. The problem is not that French acupuncture pioneer Soulie de Morant willy-nilly decided to call qi “energy;” the problem is that qi is a term that has no exact Western equivalent, a term that in the context of acupuncture could justifiably be thought of as a kind of energy. Does it help you in your practice to think of qi as the same thing as the air you breathe or the oxygen that is diffused in your blood? I don’t think so; you probably have an understanding of qi, learned from your teachers, your textbooks, and your clinical experience, as the stuff/non-stuff that animates and constitutes your being, flows through channels in the body, and can be affected with thin metal needles. The main advantage of the Kendall model is that it allows us to sidestep any discussion of the essential differences between Western and East Asian medicine when communicating with people who are not familiar with what we do. This is fine as far as it goes, if your main goal is impressing the chief orthopedist you're having lunch with, or an insurance company representative. My problem with Deke Kendall is not that I disagree with him; my problem with him is that I believe he is misrepresenting East Asian medicine.

But the opposite of redefining our medicine in Western terms – accepting wholesale the concepts of East Asian medicine as literal truth – is also unappealing to me. I don’t believe that I have three hun spirits living in my liver and seven po souls inhabiting my lungs. I don’t think that the categorization of anything and everything into a five phase scheme is necessarily meaningful or productive. And I don’t believe in qi. Or maybe I should say, I don’t believe that qi is any one kind of substance or force or energy or anything like that. Rather, it seems to me that the word “qi” is a descriptor of reality, so that whenever there is a sense of movement or animation, the ancient Chinese evoked qi in their word for it. So whether we are talking about the weather, physical forces, emotions, or bodily or mental functions, “qi” is a handy way to refer to that sense of movement. The Japanese language inherited many of these qi words and phrases from Chinese, and to this day we talk about tenki (“heaven’s qi,” or weather), denki (“electric qi” or electricity), tanki (“short qi” or short temper), and kichigai (“changed qi” or craziness). It’s almost like the English word ending “-ation,” as in “condensation” or “manifestation,” indicating that some sort of process is going on. If some Chinese guy announced publicly his discovery that "-ation" actually means “air,” you’d think he was an imbecile. To argue whether or not “-ation” actually exists is just as meaningless.

One of the things that makes acupuncture so great is that it is based so solidly on empirical observation, on real-time sense data in practitioner and patient, on noticing even minute changes in felt bodily sensations and movement – that is to say, changes in qi. When you feel your patient’s pulse turn from jagged to smooth, that is feeling qi. When you feel a pulsing electrical tingle between your fingers as you hold a needle against your patient’s skin, that is feeling qi. When your patient feels an opening and softening in the chest when you needle a point on the wrist, that is feeling qi. Who cares what qi “really is?” That’s not even the most important question. If we ask instead why it’s so important for us to pin it down, to define it and isolate it, we come to the root of what is wrong with the Western paradigm.

Do you believe in qi? I suspect that most of us do because we are vital beings who cannot help but notice the vitality that flows around and through us. The ancient Chinese noticed this too, and kept meticulous records about the changes wrought via their interactions with this vitality. The five phases, the pairing of yin and yang channels, the order of the transport points, the midnight/noon method, the husband/wife relationship, the “direction” of different zangfu organs, the “qi clock,” the Nei Jing, the Nan Jing – these are all codified records of their observations and experiments. Let’s not pretend that our medicine is something that it isn’t. Let’s instead honor what it actually is, and practice it as well as we can.

Post script: for my most recent (2015) take on this subject, see my article "The Problem with Qi: Vitalism, Science and the Soul of Traditional Chinese Medicine" in the Journal of Chinese Medicine.

The Problem with Oriental Medicine

As a practitioner of acupuncture and Chinese herbal medicine, I cringe a little every time I see the phrase “Oriental medicine.” It shows up everywhere in my profession: in the names of professional organizations and journals, colleges and clinics, on business cards and websites. I don’t care enough about it to air my grievance in letters to editors or diatribes against my colleagues, but this is my blog so I’ll feel free to vent here.

What is wrong with “Oriental medicine?” For starters, “oriental” is a terribly outdated word with colonialist overtones. Something or someone is “oriental” – literally “of the East” (from the Latin oriens, “rising sun”) only from the vantage point of the Occident, i.e., the countries of Europe and the Western Hemisphere. The term developed to distinguish between the powerful “civilized West” and the “mysterious East” that was to be conquered and exploited over hundreds of years of warfare and subjugation. For us to call what we do “Oriental medicine” is about as anachronistic as African-Americans referring to themselves as negroes. Look up the word “oriental” in the dictionary. My American Heritage College Dictionary lists this among the definitions:

"Oriental. Offensive. Used as a disparaging term for an Asian person."

Part of the problem with the word “Oriental” is the implications of strangeness, exoticism, inferiority, and weakness that lie embedded in the term. I suspect that some acupuncturists secretly relish the former associations (“I am a qigong master and an initiate into Oriental mysteries, and I can cure you”), but I submit that none of us would like to be associated with weakness and inferiority, especially in implied contrast with Western – or should I say “Occidental?” – medicine. For a detailed analysis of the Western conceptualization of the “Oriental” as Other, I refer the interested reader to Edward Said’s landmark book titled (aptly) Orientalism.

I have heard arguments in support of “Oriental medicine,” based on the notion of inclusiveness. Following this reasoning, calling our profession “traditional Chinese medicine” or some such would alienate the Japanese, Koreans, Vietnamese, and other non-Chinese practitioners. This may be true, but on top of the derogatory connotations of the word "oriental," the term is in fact overly inclusive: we don't typically mean to include the traditional medicines of the Middle East and India, for instance, when we say "Oriental medicine" - yet, clearly, they are Oriental regions as defined historically and etymologically. I think we should reject “traditional Chinese medicine” for an entirely other reason: because it (the “TCM” of post-Mao China) is a clearly defined style of medicine that not everybody in our profession practices. So what should we call the set of therapies that we collectively practice? Why not simply “East Asian medicine?” One non-Asian practitioner I have come across objects to the term “Asian medicine” because he thinks it discriminates against white acupuncturists (!) But I think that “East Asian medicine” is a purely descriptive term denoting the geographical origin of our art and science in the eastern part of Asia. In fact, under the entry for the word “Asian,” my dictionary states:

"Usage Note: The term Asian is now preferred for persons of South and East Asian ancestry, such as Indians, Southeast Asians, Chinese, Koreans, and Japanese, in place of Oriental, an older term for some of these groups. Oriental has been objected to because it suggests racial rather than cultural identity and identifies the place of origin in terms of its location relative to the West (that is, “from the East”), rather than in absolute terms."

Extending this logic beyond the people in an area to a form of medicine that originated and was developed in various countries within that area, I find “East Asian medicine” to be an accurate, objective, and inclusive term. Why it might be perceived as offensive, or exclusionary, or inferior in any way to “Oriental medicine,” I cannot figure out. “Oriental” is a word best reserved for rugs, if that. Let’s drop it and join the 21st century.