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DR. STEMMLER’S MONTHLY TEACHING ROUNDS

FEBRUARY, 1999

WHAT’S NEW IN MEDICINE – EAST AND WEST

(Copyright Stemmler, 1999)

 EAST

"Alternative Medicine is Thriving"

In its sixth year of operation, the Office of Alternative Medicine (OAM) at the National Institutes of Health (NIH), has been promoted to a center: the National Center for Complementary and Alternative Medicine. And its budget has been increased from $20 million to $50 million. So far the OAM has funded 13 research centers at universities and other learning institutions, and 50 different research projects are in progress. Institutions funded so far are: Bastyr University, Bethel, Wash., for the study of HIV/AIDS; Columbia University, New York, for Women’s health issues; Harvard Medical School, Beth Israel Hospital and Deaconess Medical Center, Boston, for several medical conditions; Kessler Institute for Rehabilitation, West Orange, NJ, for stroke and neurological conditions; Palmer Center for Chiropractic Research, Davenport, Iowa, for chiropractic; Stanford University, Palo Alto, Cal., for aging; University of Arizona Health Sciences Center, Tucson, for pediatric conditions; University of California, Davis, Calif., for asthma, allergy and immunology; University of Maryland School of Medicine, Baltimore, for pain; University of Michigan, Ann Arbor, for cardiovascular diseases; University of Minnesota Medical School, Minneapolis, for addiction; University of Texas Health Science Center, Houston, for cancer; and the University of Virginia, Charlottesville, for pain.

(From: "Alterations are Ahead at the OAM", JAMA, November 11, 1998 – Vol. 280, No. 18.)

 

COMMENTS:

It is good news that research in alternative medicine is finally (and generously) being funded. Of course, funding does not just go to Chinese medicine or acupuncture studies, but also to the evaluation of vitamins, supplements and American herbs, Yoga and "mind-body" therapies, among many and various alternative modalities. And, while the effect of garlic on the lowering of cholesterol levels, or the action if Valerian on insomnia can be studied just like a drug, more complex treatments like those involving Chinese medicine are not as easy to fit into standard protocols. In addition, few researchers are qualified to treat within the Chinese medical model, and even fewer understand the need for a more comprehensive, all-encompassing, continuously-evolving research protocol. So although it is encouraging to see the doors of academia open to embrace other avenues, we are barely scratching the surface of knowledge and understanding. Therefore, I still expect confusion and misconceptions regarding the indications and efficacy of Chinese medicine for sometime in the future.

 

WEST

"Changes in Physical Fitness and Changes in Mortality"

About 2,000 healthy Norwegian men aged 40-60 years old were given a bicycle test and a questionnaire during the period of 1972 and 1975, and for 91% of them, (those still alive), both were repeated 7 years later, in 1982. In addition, all men had a clinical exam, blood test, spirometry, a chest x-ray, height and weight measurements, and a treadmill (exercise EKG) test on both occasions. Men were graded as to their level of fitness at baseline and follow up, documenting even modest increases in their fitness level. The results were very encouraging. Even small improvements in physical fitness were associated with a significantly lowered risk of death.

(From: Erickssen, G. et al. "Changes in Physical Fitness and Changes in Mortality. The Lancet. Vol. 352. September 5, 1998)

 

COMMENTS:

As suggested by the authors in discussion, physical fitness benefits blood pressure, blood sugar metabolism, serum lipids (cholesterol, HDL, LDL, and triglycerides), platelets, heart muscle electrical functioning, the size of the coronary arteries, and the immune system. Fitness is also suggestive of a normally functioning heart and lungs, good oxygen utilization, good muscle and bone function and a psychological balance. Regular exercise is good for the body, the mind and the soul, as each of these benefit from each other’s optimal function. Feeling physically strong, well-oxygenated and functioning at one’s best, will most likely lead to more positive thoughts, free flowing creativity, and an inner contentment and peace.

 

EAST

"Chinese Herbs for Irritable Bowels"

One hundred and sixteen patients were diagnosed by standard criteria as having irritable bowel syndrome, and then studied in a randomized, double-blind, placebo-controlled trial. Patients treated with a Chinese herbal combination for this condition showed significant improvement over patients treated only with a placebo. On follow up, three and a half months later, after the treatment was completed, the patients in the treatment group had maintained improvement.

(From: Bensoussan, Alan et al. Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine. JAMA, November 11, 1998. Vol. 280, No. 18.)

 

COMMENTS:

All patients in this study were recruited from 2 hospital gastroenterology units and from 5 private practices of gastroenterologists in Sydney, Australia. They had all been thoroughly worked up and had at least 3 months of the following symptoms: abdominal pain or discomfort, abdominal distention, frequent and loose stools, pain relief after bowel movements, mucus in their stools, excessive gas, and a feeling of not having fully evacuated. All had normal colonoscopies or bowel enemas within the previous 3-5 years.

Irritable bowel syndrome is a fairly common condition affecting 20-30% of normal adults. It usually presents at age 20-30 and is most common in women. Orthodox medicine has no clear explanation for this syndrome. Why some sufferers, for example, present mostly with diarrhea, and others with constipation. Some patients also have nausea, vomiting, and heartburn. Others are fatigued and complain of headaches. Another group also seems to be depressed and anxious, and a small fraction of patients have gynocological (pain with intercourse, pain with menstrual periods), and urinary (frequency, urgency) symptoms. Orthodox medical thinking will divide these symptoms into individual categories. So while some patients are given diets high in fiber (if constipated), others are treated with anti-diarrheals. For the spasm and abdominal pain, patients are prescribed antispasmodics and analgesics. For anxiety and depression, they will take a tranquilizer and/or an anti-depressant. If acid indigestion is a symptom, then of course anti-acids and anti-ulcer medications are given. Pain with intercourse and periods, as well as bladder symptoms open up a whole new jar of pills to choose from. Even hypnosis and psychotherapy may be often recommended. Most of the classic approaches are fairly expensive and ridden with side effects. And they are not curative; they only temporarily mitigate symptoms, but the condition of bowel dysfuction never reverses to normal.

The Chinese medical approach does not separate individual symptoms, but rather appreciates the interaction of various symptoms into patterns of dysfunctions of Qi (Energy) and Yin and Yang, as they relate to all organs. It looks at each patient within their own constitution (their "make", their "energetic" designs) and then diagnoses the energetic dysfunctions from their origin to where they are leading. Acupuncture points, moxibustion and herbal combinations are chosen based on these energy dysfunctions, which vary from patient to patient. Dietary prescriptions are also seen as "medicine", since the right diet is one that not only nourishes, but also prolongs life, by preventing disease. Herbs are considered to be food, as much as food is considered to be medicine.

 

While one person may benefit from Qi flow regulative herbs, such as Qing Pi (Green Tangerine Peel), another may need a higher dose of Choi Hu (Bupleurem root) to soothe the liver due to liver Qi stagnation. In fact, both of these herbs were part of a larger herbal formula used in the study above. Whenever dietary advice would be given, one patient may be encouraged to cook a "Lichee gruel", if they have diarrhea before dawn, which indicates a kidney Yang deficiency. To prepare the gruel, combine 50 gm (1.6 oz) of lichee flesh (a delicious fruit that resembles a Kiwi, although smaller, which you can find at Chinese supermarkets) with 10 gm (0.3 oz) of Chinese yam and 10 gm (0.3 oz) of lotus seed in a mortar and grind it. Then cook the mixture in water until soft. Add washed rice and continue cooking until they become thin gruel. Eat in the evening. The amount of rice depends on the amount of water. Use long grain rice and calculate 1-1 cups of water for each cup of rice, depending on your taste for stickier or fluffier rice. Since you have other ingredients in your water, you may want to decrease the amount of rice to half that amount (1 cup of water for cup of rice).

Another patient, when complaining mostly of constipation may be advised to drink "Honey Tea" after each meal, or "Chinese Cabbage Juice". To prepare Honey Tea, combine 3 gm (0.1 oz or roughly a small teaspoon) of tea and 2 ml (0.07 oz or roughly teaspoon) of honey in a cup of hot water, as an infusion and drink it. For Chinese Cabbage Juice, press out the juice from the cabbage, boil and drink it. Of course, depending on the symptoms and how they all come together in each individual, herbal as well as food prescriptions will vary significantly.

And here again is the big difference between Western and Chinese medicine: one disease for all people and one treatment for all, vs. one personone diseaseone treatment.

Christina Stemmler, M.D.


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