| Articles
-------------
Herb-Drug Interactions
By Mavis A. Bates, L. Ac. and David W.
Miller, M.D., L.Ac.
Introduction
We recently had the opportunity to hear John Chen
speak at this year’s Pacific Symposium in San Diego. John Chen holds
doctoral degrees in both Oriental Medicine and Western Pharmacology, which
gives him the ability to speak about the integration of Chinese herbs with
Western medications at a very high level of expertise. He is also one of
the authors of Chinese Medical Herbology and Pharmacology. Dr.
Chen spoke on the topic of Herb-Drug Interactions.
The topic of herb-drug interactions is critical to
every practitioner of Oriental herbal medicine, since most of our patients
will be on one or more Western medications. Very often these patients
will have conditions that could benefit greatly from our herbal formulas.
Just as often, however, they will be hesitant to take Chinese herbs for
fear of somehow disturbing the homeostasis they may have established with
their meds. Further, we may have misgivings about even suggesting herbs
for these patients, since we may have our own fears that something could
go awry. Thus, it is in the best interests of our patients, as well as
our own best interests, to understand this topic as best as possible.
The study of herb-drug interactions is among the
newest areas of research affecting the modern practice of Medicine.
Hence, information on specific interactions may simply not be available,
as the research has not yet been conducted. For this reason, when
approaching this topic in brief, our best strategy is to generalize basic
understandings of pharmacology rather than to become overwhelmed by, for
example, which specific receptors and ion channels are in play. (The
reader is still encouraged to seek out what other information may be
available about specific herbs and specific drugs. See recommended
reference sources.)
So, that being said, there are two major arenas of
herb-drug interaction: pharmacokinetics and pharmacodynamics.
Pharmacokinetics is the realm of interactions that are either mechanical
or chemical in nature. They include absorption, distribution, metabolism,
and elimination. Pharmacodynamics has to do with how physiologic
responses interplay: e.g. stimulant + stimulant vs. stimulant + sedative.
This has to do with the synergy or antagonism of the actions of the herb
and drug.
Pharmacokinetics
Absorption
This refers to the ability of the drug to get into
the body, to be absorbed, usually from the gastrointestinal tract into the
blood stream. The primary interactive problems affecting absorption are
the following: drug-herb binding, alteration of stomach pH, increased
gastrointestinal motility, and decreased gastrointestinal motility. For
the first two situations, the best solution is to separate drug and herb
dosing by 2-4 hours. The most common drugs we will see causing binding
are the cholesterol lowering, bile acid binding resins, e.g. Questran,
Colestid, Xenical. Watch for these and similar as many other Western
drugs also should not be taken at the same time as these, and patients may
be unaware. Some drugs or herbs, such as antacids, may change the pH of
the stomach, which may prevent the dissolving of other drugs or herbs in
the digestive tract, leading to poor absorption. Calcium carbonate
containing products (Mylanta, TUMS, Hai Piao Xiao) and acid blockers (Prilosec,
Pepcid, Huang Lian and some other Stomach Fire/Stomach Heat clearers) are
examples.
Any laxative/purgative drug or herb or anti-diarrheal
drug or herb can also affect the absorption of other substances. When the
rate of passage through the intestines is accelerated, as with a laxative
substance, the time for absorption of other substances is shortened, and
absorption is lessened. Consequently, herbal dosing may need to be
increased. On the other hand, any herbs or medications that have an anti-diarrheal
effect will slow down the transit time, allowing more time for absorption,
and increasing the bioavailability of other drugs or herbs. The dosage
may need to be decreased to adjust for these changes in absorption.
Opiates will generally slow down the GI tract.
Distribution
Distribution refers to the drug’s ability to get to
the target tissue in the body. Although it is fairly rare for an herb to
interfere with the distribution of a drug, there are a group of drugs
which have a narrow therapeutic index and which are highly protein bound
and warrant special caution. Two fairly common prescription drugs in this
group are Coumadin and Dilantin. The narrow therapeutic index means that
there is a very small window in which the blood levels of these drugs are
both effective and safe. Below that window, their effect is lost. Above
that window, they can have unwanted (life-threatening) effects. Many of
our patients are taking these drugs, and there is very little research to
tell us which herbs may interact badly with either of these drugs. Rule
of thumb: presume the herbs will interact unless clearly proven
otherwise. Dosing strategy: start very low on the herbs, work up slowly,
monitor the patient closely, and in cases where these drugs are “on board”
cooperation with the prescribing M.D./D.O. is critical.
Metabolism
Metabolism has to do mainly with how quickly or how
slowly the liver breaks down a drug or herb. If the liver is working
quickly, the drug or herb will be broken down quickly, and less of that
substance will be bioavailable. If the liver is working slowly, the
breakdown will be slower, and more of the substance will be active. So,
in the presence of liver metabolism altering drugs, we have to either
increase or decrease the amount of herbs prescribed. Common enzyme
inducers: Dilantin, Tegretol, Phenobarbital. Common enzyme inhibitors:
Erythromycin, Tagamet, alcohol, and the anti-fungals ( the “-conozoles”).
In cases of liver disease, presume the metabolism of herbs is lessened.
Elimination
Elimination pathways for drugs and herbs include the
urine (via the kidney), the bile (via the liver), the GI tract, the lungs,
skin, and a number of other minor paths. Of these, the kidney is the most
important If there is any reason to suspect kidney damage, especially
due to the use of certain drugs, it may be necessary to reduce the herbal
dose to prevent unwanted effects. Currently, all herbs containing
Aristolochic acid are considered nephrotoxic by the FDA. Some of these
herbs include: ma dou ling, xi xin, guan mu tong, and guang fang ji. Be
extremely cautious in using these in any patient with kidney compromise.
Also, the aminoglycoside antibiotics, amphotericin B, and methotrexate are
all potentially nephrotoxic and significant caution should be used when a
patient is on these medications.
Pharmacodynamics
Pharmacodynamics refers to understanding how herbs or
drugs affect body functions once the substances are absorbed. If the
actions of the two substances are synergistic, they will reinforce and
amplify one another’s effects. (As do ru xiang and mo yao.) If the
actions are antagonistic, there may be a lessening of the desired
effects. (As with ren shen and lai fu zi.) The research on herb/drug
combinations that are synergistic or antagonistic is still very minimal,
and sometimes these may be difficult to predict. Close monitoring of
patients is critical to picking up these effects. In general, we should
presume a synergistic effect when we have an herbal approach that
parallels a Western approach – e.g. draining damp and diuretic use or
clearing heat and anti-inflammatory use; and we should presume antagonism
when our strategy is counter to the Western strategy – e.g. we want to
boost Qi in a patient who is on sedative medications.
A primary and very important example of a
pharmacodynamic interaction is the combination of warfarin (Coumadin) with
a Blood-stasis-removing or Blood-activating herbs such as dan shen
or dang gui. This herb-drug combination could result in excessive
bleeding, a dangerous outcome for the patient. In this case, the
practitioner should use caution, and consider using a low dose of these
herbs with careful monitoring of the patient. On the other hand,
stop-bleeding herbs with a pro-coagulant action could nullify the action
of the Coumadin, risking the creation of blood clots.
There are four groups of herbs and drugs that have
the highest risks for pharmacodynamic interactions. They are:
§
Sympathomimetics. These include herbs such as ma huang,
which interfere with anti-hypertensive and anti-seizure drugs.
§
Anticoagulants/anti-platelet. These herbs can interact with
drugs such as warfarin, as described above.
§
Diuretics. These herbs include such common herbs as fu
ling. When taken with diuretic drugs they may cause unexpected changes in
blood pressure, even causing hypotension in patients taking diuretic drugs
for hypertension.
§
Anti-diabetics. These include herbs such as zhi mu
and shi gao, or shan yao and huang qi combinations,
which could cause hypoglycemia when used with anti-diabetic drugs.
Conclusion
In his presentation, Dr. Chen provided the
rudimentary tools that we need to begin to understand how herbs and drugs
can be used together safely. It is not a cut and dried story, however,
because much of the necessary research still needs to be done
Drug-herb interaction is an important topic because
we want to help our patients as much as we possibly can. They come to us
with a long list of their medications, and yet we can plainly see that
they could greatly benefit from our wonderful herbal medicines. Clearly,
we want to help without hurting. To give herbs to patients on
prescription medications requires some extra care and thought. To assume
there will be no interactions is neither wise nor informed , however to
neglect to give our patients the full benefit of our herbal pharmacopoeia
is also not doing our full duty and is detrimentally conservative. With
some extra care and attention, we can give our patients the best of both
worlds, safe-guarding the effects of their prescription medications, while
offering the rich world of our own Chinese Medicine.
Sources for more information: Chinese
Medical Herbology and Pharmacology by John and Tina Chen, Art of
Medicine Press, 2004. The PDR for Herbal Medicines and The PDR for
Nurtritional Supplements. For more information on drug-herb interactions,
there is a website called
www.naturaldatabase.com which gives the interactions of most common
Chinese herbs with many commonly used medications. This is a fee-based
website, and you can try it out for a month for about $10. Herb-Med and
Herb-Med-Pro at www.herbmed.org is another good site. (Full access
requires a subscription.) http://nccam.nih.gov/ is the site of the
National Center for Complementary and Alternative Medicine and has a
wealth of free information and links.
Fuku Shin – Abdominal Diagnosis
in Kanpo Medicine
By Tom Hurrle,
L.Ac., Dipl. Ac. & CH
In early November I
attended a 2-day seminar on diagnosis through abdominal palpation and
treatment using primarily formulas from the
Shang Han Lun.
It was sponsored by Honso USA and the Ohio Association of Acupuncture and
Oriental Medicine. The instructor was Nigel Dawes, M.A., L.Ac. Kanpo is
the style of Oriental Herbal Medicine widely practiced in Japan, mostly by
medical doctors (in Japan, the acupuncture license does not include
practice of herbal medicine). 22O Kanpo formulas are recognized by the
Japanese government and covered by national health insurance.
Kanpo medicine is
rooted in the Shang Han Lun.
It is a clinical approach to herbal medicine in which diagnostic expertise
is critical and abdominal palpation is central. Kanpo uses the four
examinations, but the abdominal conformation is usually the key to
determining what formula to give. Concepts of Qi, Blood and Fluids are
used instead of Eight Principles. Nigel presented a “kata”, that is a set
series of movements used to examine the abdomen. Using the same sequence
of movements each time makes it easier to focus on what you are feeling.
The 13 abdominal conformations taught were those of Dr. Otsuka Keisetsu,
a seminal figure who practiced Kanpo for nearly 50 years.
The signs derived from
pulse and abdominal palpation form a
Sho.
Sho literally means to “tell it like it is.”
It loosely parallels the TCM concept of pattern, but Sho incorporates both
diagnosis and treatment strategy. The four exams can be said to form a
picture that corresponds with an herbal formula or a group of similar
formulas. The focus is on accurate diagnosis; the formula that matches the
Sho is given without any further theorization about the pathological
process or treatment strategy. A patient can be described as presenting
with a Ba Wei Di
Huang Wan
Sho. This concept is also used in Japanese
palpatory acupuncture (aka Japanese Meridian Therapy, Traditional Japanese
Acupuncture); it is said “diagnosis is treatment, treatment is diagnosis.”
Kanpo has a focus on
Center Qi (Zhong Qi).
The formulas used tend to have relatively few
ingredients and the daily gram dosage is half or less than modern Chinese
formulas. Because ingredient numbers are low, relative amounts of each
herb per dose are high, giving a narrow but powerful therapeutic effect.
Some result is expected in 5-7 days, so the patient is usually
reevaluated then and the prescription may be changed.
Nigel Dawes practices in
New York City, where he offers a 1-year post-graduate Kanpo internship
program. In 1985 he graduated from acupuncture school in Tokyo; he did
post-graduate work in Kanpo there, as well as further clinical studies in
Beijing. He and Gretchen De Soriano have completed a translation of Dr.
Keisetsu's text Kampo: A guide to
clinical theory and practice to be
published by Elsevier in fall 2007. This is a standard modern classic in
Japan - used in Medical school Kanpo curricula.
The structure of the
seminar was like that of seminars in Japanese acupuncture I have attended,
with a fairly even division between lecture in the morning and hands-on
practice in the afternoon. Nigel has done a lot of teaching and he is good
at it. His lecture was clear and well organized; the handouts excellent.
All attendees had time to practice abdominal palpation under supervision.
Nigel then did a detailed work-up on a couple of students, demonstrating
clinical interpretation of palpatory information.
The group at the seminar
was relatively small, so this was good for practical work. The lecture on
the first day focused on the 13 basic abdominal signs and their associated
formulas one by one. On the second day, Nigel drew more complex abdominal
charts on the board, showing common combinations of signs, offering
possible accompanying symptoms and constitutional types, interpreting them
and suggesting applicable formulas.
On the second afternoon
we were fortunate to have 3 patients of a local practitioner come in. One
had an eight year history of chronic fatigue and fibromyalgia with prior
workplace exposure to toxic chemicals. She reported food allergies,
ulcers, uterine fibroids, poor sleep with nightmares, hypothyroid, etc.
Her whole abdomen was tender to touch, suggesting inflammation. Her pulse
was fine and deep, tongue was swollen with a slight tremble and distended
veins sublingual. Abdominal signs were a splash sound near the fundus of
the stomach, aortic pulsation felt on light palpation around CV 12, and
lower abdomen flaccid around CV4-CV 7 (these are 3 of the 13 patterns
taught). Nigel's suggestion was to pick one direction to start, beginning
by warming cold and treating damp obstruction using Fu Zi Li Zhong Wan.
Observing the diagnostic process was most interesting.
The quality of this
seminar was first-rate. The information was clinically useful for any
practitioner. It will be offered again and I recommend it; the HonsoUSA
web site (www.honsousa.com) has
information.
About Lasers
From The Illinois Acupuncturist
Autumn 2004
About Lasers
by Kathleen Coleton, L.Ac.
Acupuncturists and other health care providers are using cold lasers (3B or less) to treat just about any disease or injury. Recently there have been several news articles proclaiming the benefits of Laser or Light therapy for carpal tunnel syndrome and Fibromyalgia. The trend is to use the term Light Therapy rather than Laser Therapy.
Laser/Light machines are easy and simple to use, but expensive to buy. New lasers units cost $4-5,000 per unit. Unless you plan to use a laser almost exclusively the cost may be prohibitive. However, they are extremely effective, combining light therapy with acupuncture points, Ah Shi points or by treating the specific organ involved. The light is scattered over a larger area rather than point specific as with a needle. This is a gentler way of treating and can be felt by patients as more supportive.
I have not used one enough to state that lasers are more effective than needles or herbs. However, there are fewer problems associated with lasers than needles. No bruises, no fainting, no pneumo-thorax, etc. Children can be easily treated without the fears associated with needle pain. However, some people report fatigue, “pain” or soreness after treatment. This clears within a day or two just like a needle treatment. Patients who refuse to drink the herbs can benefit by being treated in the office with light therapy. Patients often report having an immediate improvement response.
Since there are no needles inserted you can use an assistant to administer the laser treatment after you mark the locations and decide the power you are going to use. Experience shows that dragging the laser to the next point is more effective than lifting the laser to move to the next point. This is like a mild massage or Gua Sha response.
To use one you need to know a few facts and some simple protocols.
* Lasers stimulate light emissions to cause a photon to collide with an excited atom, causing two photons to be emitted. The laser amplifies light, which stimulates cells to activate their own healing action. As the light energy is absorbed, cellular respiration and metabolism increase. The mitochondria are able to produce more ATP, DNA and RNA formation and protein synthesis quicken.
* There have been many generations of lasers. Gallium-Aluminun-Arsenide lasers (GaAIAs), which generate wavelengths of 780-897 Nanometers, are the most effective for treating medical problems. Some of the red and infrared light falls into the visible spectrum.
* Skin is permeable to light at 600-1300 nanometers and is directly proportional to the wavelength applied. Tests show that laser light can penetrate the skin and muscles tissues up to 8” with the most effective penetration being 1-2.5”.
* Power and dosage are the keys to treating with a laser. Not enough power is ineffective. The new medical laser machines purchased today are calibrated to easily apply the correct amount of power during a specific period of time. (1 Joule = 1 Watt/1 Second)
* Common Presentation Pointers are 5 milliwatts (mW). Class III cold lasers range in power from >5-500 mW. Cold Lasers used for acupuncture treatments get the best results when they are 300-500 mW. 50mW is the minimum power which is shown to be effective for therapeutic treatments.
* Lasers may be used safely over metal implants, plastics, and stitches and on persons with a pacemaker. Do not use on skin which has been heated.
Some contraindications are:
1-Do not shine a laser into anyone’s eye.
2-Do not laser over the fontanel’s of an infant.
3-Do not laser over a known or suspected carcinoma.
4-Pregancy.
5-Photosensitity.
6-Over Steroid inject sites.
7-Tattoo sites and dark haired skin.
8-Do not use on skin which has been heated.
Kathleen Coleton, L.Ac. practices Acupuncture in Kansas City, MO and is on the Acupuncture Advisory Committee of Missouri. She is a former AAM board officer. Kathleen graduated in 1994 from the Mid-West College for the Study of Oriental Medicine. She recently completed a 15 hour certification program in Laser Acupuncture at the AAOM conference in Orlando, Florida. To contact Kathleen call 816 822-0500.
NOTE: The ISAA sponsored this Laser Class by Jennifer Blahnik, L. Ac., and David Rindge. L. Ac in March. We are very grateful to Dr. Blahnik for generously donating her entire speaker’s fee to the ISAA for its legislative fund.
Back to top
Acupuncture Offers New Hope for Patients with Macular Degeneration
by Gene Bruno, OMD, L.Ac., FNNAOM
Abstract
Age-related Macular Degeneration (AMD) is the major cause of blindness in the United States in persons over 55 years of age.1 AMD damages the retinal tissue in the macular area causing fine pigmentary stippling, retinal pigment epithelium (RPE) changes, and the development of drusen.2 Drusen are the precipitation of cellular waste materials in the RPE. Reports estimate that over 18 million adults in the United States currently suffer from AMD. Some of these same reports estimate that this will rise to 30 million by the year 2010.3
Traditional therapies offer no treatment for macular degeneration. However, recent treatment of acupuncture points with the use of microcurrent stimulation has shown promising and even remarkable results in stopping and reversing the results of the effects of macular degeneration. Results of clinical studies indicate that microcurrent stimulation can enhance the cellular ATP synthesizing capabilities, specifically in the retina, and thus provide a means to improve visual acuity for AMD patients. Microcurrent stimulation of acupunc-ture points is currently the only viable option for those suffering from AMD.
Research and Clinical Studies
August Reader, MD, a neuroretinologist, and Grace Halloran, PhD, completed a double blind study that indicated positive results from micro-current stimulation for patients with Age-related Macular Degeneration, Retinitis Pigmentosa, Stargardt's disease, and other retinal diseases. Damon P. Miller, M.D., has published the clinical results of the first 120 patients he treated for AMD using microcurrent therapy that showed significant improvement. A preliminary report on the treatment of AMD using auricular acupuncture and electrical Acupuncture was issued by Alston Lundgren. MD. This study involved only 10 individuals, but also showed significant improvement for most patients. In each of these studies, all microcurrent was delivered to the retina via acupuncture points.
Methods
Over a one-year period 42 patients were trained in the use of self-treatment with microcurrent stimulation of acupuncture points for the treatment of AMD. Treatment involved the use of a microcurrent stimulator to treat acupuncture points surrounding the eyes. The microstimulator that was used was the MicroStim 100®. The stimulator was used to deliver micro-current at 250 to 700 microAmps for five minutes. Patients were also educated in the use of nutritional supplements considered supportive for ocular conditions.
Results
42 patients used microcurrent stimulation to treat acupuncture points near the eye. The average age of patients was 77.6 years. Treatment was 2 to 3 times per day, every day. Visual acuity and VF-14 tests were done every three months. Of these initial forty-two (42) patients, 36 (85.7%) showed improvement in visual acuity of 2 lines or more. Three (3) patients showed improvement of one line of visual acuity. Two (2) patients showed no improvement. And one (1) patient lost one line of visual acuity. The average change in visual acuity for all patients was +2.88 lines. VF-14 test results showed a positive change of an average of 35 points.ConclusionIt is important to note that macular degeneration is nearing epidemic numbers in the US. Research and clinical studies validate the effectiveness of using microcurrent stimulation to treat macular degeneration. AMD and other similar retinal diseases are otherwise untreatable by any means, making electrical acupuncture the only current viable option for those suffering from this devastating disease. Dr. Joel Rossen developed the original protocol for using microcurrent stimulation to treat RP and AMD. I want to thank him for his pioneering research and development.
References
1. http://www.csmd.ucsb.edu/faq/faq.html
2. Ibid.
3. http://www.macular.org/disease.html
Gene Bruno is the past president of the AAOM and currently a Director. His practice is located in Salem, Oregon. The summer edition of the American Acupuncturist will contain one of his articles entitled, “Treatment of Age-related Macular Degeneration with Microcurrent Stimulation.” He teaches classes on the treatment of Macular Degeneration. In September 2005 he will be teaching a course sponsored by the Illinois Association of Acupuncture and Oriental Medicine in Chicago.
For further information on Macular Degeneration, please visit Dr. Bruno's website: http://www.acudoctor.com/
Back to top
Aiding and Abetting the Intercourse between TCM and Biomedicine
by David Miller, L. - M. / Ac. - D.
Winter/Spring 2005
Systems and/or philosophies of Medicine cannot be meaningfully separated from their practitioners. Hence, to me, medical systems appear like organisms with each practitioner as an integrated part of the body of the collective whole. Right now I'm looking at the behavior and health status of two organisms. One is Biomedicine; the other is TCM. Biomedicine appears to me to be very hungry. It eats and eats, feeding on data, evaluating its food with "evidence based" eyes (yet often feeding on rancidity). It has neither the time nor the means to sit and digest, as its overall constitution doesn't contain a structure allowing for integration of the information. The data collects. It sits. Journals pile up. Just as one bit is adequately chewed, new fodder is thrust upon it and weighs this dampness down further. Thoughts congeal. Soon the belly aches and any remnant of nutrition passes through undigested.
The Heart of this beast wants to do what's right; it is inherently intelligent and at root benevolently motivated; it has a keen eye and brilliant potential, but it's young and thinks it's old. On top of this, there is a constant threat to the organism's survival. It is driven to unwise action by fear and real threat to livelihood. It is over worked and work-a-holic. It's irritable. It's prone to angry outbursts and irrational behavior; sometimes it even shows outright delusional behavior. It is rigid in its thinking and lacks an inherent flexibility to allow it to adapt to a changing environment. And, it is not having fun. (Oy vey.) In short, this appears to be a Spleen Qi deficient, Liver Qi stagnant, Kidney Qi taxed creature with phlegm-damp accumulating, Liver Yang rising, Heart and Kidney not communicating, sinews not nourished, and potential phlegm-heat obstructing the orifices. Ugly tongue.
The new kid on the block (in this neighborhood) is TCM. TCM is a funny creature. It is fluid yet fixed, it's incorporative yet purist, it's capable of growth without growing, and mutation without transformation of core. Currently in the U.S., it is struggling for a foothold, and seeking a niche in a new body of practitioners, on a new continent and in a new culture. It is struggling with adaptation. There are Western people with Western minds becoming a higher percentage of the body weight, and that means an outlook that oftentimes demands concrete examples in a language which heretofore had not been considered. While earlier, the clinical pattern was the concrete, in this time and place (largely because of Biomedicine), an even more micro- microcosm demands recognition. The clinical pattern in this environment now appears as the theoretical and as the macrocosm. What was yin has transformed into yang, and now we lack yin. Many practitioners are not content now with macro clinical patterns; some have a sense that the Elements should be visible in the microscope, and that the channels in some way have physical counterparts. Actually, none of that is in any way threatening to the core of TCM. It is in fact essential to the core philosophy. TCM is, in this new environment at this time, lacking tangible, bone-building substance at the most fundamental of physical levels, and that is a Kidney Yin deficiency.
These two organisms need each other. TCM's organizational and incorporative capacity, (its strong Spleen) can, I believe, transform Biomedicine's damp and vaporize the phlegm. TCM is nurturing to its practitioners, and can soothe the Liver; and together the two could win tremendous affection from the populace that feeds both. Biomedicine is at a stage where it is sophisticated enough to begin talking to TCM. It can offer TCM access and images to elegant internal patterns which are appealing to the inquisitive, analytic tastes of this being, and deeply nourishing and supportive to its underlying structure. It can offer yin micro-patterns to complement TCM's yang macro-patterns. (There's something about seeing how Oxytocin functionally lights up the Stomach channel that is very anchoring and exciting to many.) Biomedicine is also very strong in emergencies, and could give TCM a more powerful fall-back to acute threat to survival than it's ever had. Overall, I think Biomedicine could powerfully shore-up TCM's Kidneys.
It seems to me, however, that these two organisms aren't really looking to play side by side. The greater environment is changing. To allow either creature to thrive in the long run, a far more sophisticated synthesis is demanded. At some level, both beasts sense this and are attracted to each other at a fundamentally intimate level. I think these two probably should be less interested in sharing office space and trading treatments for general well-being and more interested in sizing each other up for breeding purposes. I feel that with direction from the Hearts of both creatures, their expressive potentials could be blended with respectful preservation of both original cultures. If these two truly are able to know one another, the Jing of the offspring would be dazzling. I, for one, intend to help them mate.
David Miller, M.D., L.Ac., Dipl. O.M. is a Reiki Master-Teacher, and a Board Certified Pediatrician. He graduated from Pacific College of Oriental Medicine in Chicago in April 05. He is currently seeking a position in Chicago where he can practice "Integrative Pediatrics". He resides in Chicago with his partner Lee.
Back to top
Aromatherapy and Acupuncture
From The Illinois Acupuncturist
Winter/Spring 2005
By Anne Degrassi-Kalkis
Aromatherapy has been a part of my life for many years. I couldn't imagine making it through a flu season without the regular use of essential oils. I never forget to take oils with me when I travel, and have used them in various therapeutic ways for my family, friends, and patients. The use of essential oils can be a powerful complement to your TCM or bodywork practice.
Smell has a profound influence on our emotional and physical well being. Just think of the refreshed and cheerful way you feel when you walk out the door on a beautiful spring day. Often old memories and associations can be triggered by a specific scent we have encountered. The sense of smell is 20,000 times more sensitive than our sense of taste, which explains why many species use olfactory messages to attract their partners through pheromones, or to identify their family members. These chemical messages affect various parts of the brain including the cerebral cortex and limbic system, as well as other neuroendocrine processes.
Aromatherapy has been used throughout history in religious ceremonies, as aphrodisiacs, as well as in therapeutic and cosmetic practices. The method of extracting essential oils from plants was initiated by the ancient Egyptians thousands of years ago, who heated plants in clay containers. Aromatherapy has been used extensively in Oriental and Ayurvedic practices. During the Great Plague of the 14th century, cedar, clove, cypress, pine, sage, rosemary and thyme were burned in the street as protection from disease.
The process has been markedly refined since these times and the current methods of extraction are typically through distillation, cold-press, solvent and carbon dioxide extraction of various parts of plants. Solvent extraction can leave traces of chemical residues that can be harmful or affect the biochemical response to the oil, so the other methods are preferred. Essential oils are volatile oils that can readily evaporate and oxidize if not sealed or stored properly. All essential oils are antimicrobial, but some are more powerful than others in this regard, and are frequently employed for this purpose in institutional medical settings.
The use of essential oils in aromatherapy allows the living essence or "qi" of the plant molecules to penetrate tissues, which creates actual physical changes at a cellular, intellectual, emotional, sexual and spiritual level. Chinese Taoists believed that extraction of a plant's fragrance represented the liberation of its soul. Using essential oils in TCM practice allows you to correct disharmonies by addressing the root as well as the branch of a condition, just as you would with herbs and acupuncture. The essence of the oil can resonate at the deepest, yuan qi level, but can also facilitate the wei qi in dispelling external factors.
There are about 300 various plant oils on the market today that can be used for inhalation or absorption through the skin. Ingestion of essential oils is not recommended unless prescribed by an experienced practitioner, as some oils can have a toxic and potentially lethal effect in the body if used incorrectly. Very few oils are used "neat" (undiluted) directly on the skin. They are usually mixed in with a carrier oil, like sweet almond oil, in various strengths (dilutions) depending on use. Only 100% pure oils should be used. Selection should be based on a person's liking, or affinity for that oil, not just on therapeutic characteristics. The oil or blend won't have a positive effect if the recipient can't stand the smell of it, no matter how appropriate the selection is for a given condition. In addition, the oil should be chosen based on its "note" or rate of evaporation, the suitability of which can be determined by the pattern you are treating.
There are numerous methods of delivery for essential oils, such as inhalation, diffusion, lotions/ointments/salves/plasters, and massage. My favorite ways are in the bath, on specific acupoints/regions of the body or in sprays. My 2-year-old daughter loves lavender and chamomile in her bath and children are wonderfully receptive to essential oils. Caution must be used though, as some oils are contraindicated in the very young, or in pregnancy and some debilitated conditions. I frequently use peppermint oil for a migraine, or a blend of eucalyptus, lavender, rosemary, niaouli and thyme in my bath if I feel a respiratory infection coming on. Sandalwood oil rubbed on the neck or on REN 17 is great for a sore throat or chest congestion, very similar to the TCM use (tan xiang) in expanding and releasing constraint in the upper jiao. You can find many of our TCM herbs used in aromatherapy practice, but the actions can often differ significantly as an essential oil.
There are a wealth of resources available on aromatherapy, as well as a few tailored to TCM. Perhaps you were lucky enough to hear Jeffrey Yuen speak at the 2004 Pacific College Symposium. He uses essential oils therapeutically by correlating certain oils for application on specific acupoints. Gabriel Mojay considers the use of essential oils in terms of Five Element Theory. Peter Holmes compares the use of clinical aromatherapy in several systems, including Chinese, Ayurvedic and Greek medicine. I find the field of aromatherapy as well as the TCM aspect of it, fascinating and enlightening, and I hope that you will too.
Ann Degrassi-Kalkis is a student at Pacific College of Oriental Medicine in Chicago, and will graduate December 2005. She has a B.S. in Biology from Governors State University, and worked on the Chicago Board Options Exchange trading floor for 20 years. She received her aromatherapy training at the College of DuPage, with 25 weeks of instruction regarding the characteristics, application, and chemical constituents of over 50 commonly used species of essential oils. Ann has studied numerous other sources on the subjects of aromatherapy, magnet therapy and natural health. Her practice will have a focus on, but will not be limited to, the treatment of infertility.
Back to top
Thai Bodywork
By Lori Howell
What is Thai Bodywork?
There are two main styles of Thai Bodywork in Thailand: Northern style and Southern style. Southern style is often called 'hard' style while the Northern style is gentler. Although there are many commonalities between the two, this article focuses on Northern style. Nuad Bo Ran, Traditional Northern-style Thai Bodywork, is used extensively in Thailand for health maintenance and to regain balance in the body when one or more of the systems has been disrupted. It is a slow, rhythmic, meditative style of bodywork that uses mainly pressing, compressing and stretching techniques to balance the flow of energy in the body. The practitioner follows energy lines called sen on the body that are not wholly different from the Chinese meridian system. The work is done on a mat on the floor to allow the practitioner to use his/her own body weight and to allow for maximum freedom of movement. The practitioner begins at the feet and works his/her way up the body to finish at the head. Thai bodywork may be performed in the supine, prone, lateral recumbent or sitting position and a two-three hour session would include all of these positions.
Thai Bodywork and Thai Herbology are the two pillars of Traditional Thai Medicine. Originally they were practiced in the wats or temples as these were religious, educational, healing and social centers. Today only a few temples offer traditional medicinal services because traditional hospitals have taken over this role. In Thailand Thai Bodywork is a highly valued form of physical medicine.
Who would be a good candidate to receive Thai Bodywork?
Thai Bodywork is a wonderful modality for someone seeking vitalization, relaxation or general health maintenance. It helps to restore balance, increases flexibility, tones muscles and treats a number of disorders including headache, back pain, sciatica, menstrual pain, circulatory, digestive and respiratory problems, etc. In a session every body system is addressed to improve organ function, circulation, and mental health. It is inarguably a choice modality for health maintenance and restoring balance.
Integrating Thai Bodywork in an Acupuncture treatment.
Although acupuncture is performed on a treatment table, it is definitely possible to integrate aspects of Thai Bodywork by concentrating on areas of tightness, whether physical or emotional, and encouraging correct energy flow. Abdominal work for menstrual pain, digestive disorders, constipation, diarrhea, diverticulitis; face and head work for sinus congestion, headache, facial paralysis; feet and hand work for arthritic pain, fatigue, stress, etc. are easily adaptable to table work to supplement treatment by acupuncture. Additionally, techniques may be performed to help relax a patient who is nervous to receive needles or who is otherwise tense and will not benefit fully from acupuncture without opening up prior to treatment. And of course Thai Bodywork may be a useful adjunctive therapy to continue or increase the effects of an acupuncture treatment.
Whether integrated in an acupuncture treatment or used adjunctively, Thai bodywork is an ideal modality to support, strengthen and facilitate treatment goals. Not only does the patient enjoy and benefit from this modality, but the practitioner also benefits from the meditative state and stretching stances so that both parties feel more open, refreshed and balanced- thus creating a relaxed healing environment and relationship.
Locating a Thai Bodywork practitioner.
The International Thai Therapists Association (ITTA) lists bodyworkers who belong to their association and meet their standards for membership. Their website is: www.ThaiMassage.com. For practitioners who have trained in Thailand, look for credentials from the three top schools: Traditional Medicine Hospital of Chiangmai, ITM of Chiangmai and Wat Po of Bangkok.
Lori Howell, L.Ac, Dipl. OM, studied Nuad Bo Ran / Northern-style Thai Bodywork at Buntautuk Traditional Medicine Hospital in Chiangmai, Thailand. She lived and worked in Chiangmai for three years where along with Thai Bodywork she also began her studies in Chinese Medicine. Lori has since returned to the States and has been practicing Thai Bodywork in the U.S. for four years and has completed a Master's of Traditional Oriental Medicine from the Pacific College of Oriental Medicine. She is board certified in Acupuncture and Chinese Herbology and will join the Heartwood Center in Evanston this August.
Back to top
| 
