Letter to the Editor, Chicago Tribune
In Adam Minter’s article, Testing Traditional Chinese Medicine (Mon, Sept 21, 2015), he discusses the growing popularity of Traditional Chinese herbal medicine in China but fails to address the state of the practice and regulation in this country, only serving to spread fear and misinformation.
Chinese herbal medicines are currently regulated under the Dietary Supplement and Health Education Act of 1994 and the Food and Drug Administration has set standards for good manufacturing practices. Batch testing by independent labs includes screenings for pollutants such as pesticides and heavy metals and verifies the accuracy of the ingredients. Endangered species are prohibited in the United States and the FDA has banned several herbs that contain toxins. Chinese herbs in the US contain less pesticide residue than found in the produce department of a local grocery store since herbs containing any amount are generally refused entry.
Mr. Minter states that in the 70s acupuncture drew the attention of Westerners but he provides no follow up information to span the 45 years history since James Reston’s famous appendectomy. The US currently has 28,000 licensed acupuncturists with 757 residing in Illinois. The National Certification Commission for Acupuncture and Oriental Medicine, a non-profit board established in 1982, is the standard for licensure in 43 states (including Illinois), 98% of the states that regulate acupuncture. A graduate degree in Oriental medicine takes four years to complete and includes study in biomedical sciences, Chinese herbal medicine and acupuncture modalities including 1000 hours of supervised internship.
This growing profession is meeting a demand for safe, alternative options to pain management and chronic diseases that aren’t adequately addressed with Western medicine alone. Patient dependence and abuse of opiate medication has become so problematic that hospitals have created departments to regulate this risk. In January of 2015, the Joint Commission, which accredits hospitals in the US, revised its standards for pain management to include non-pharmacologic strategies including acupuncture, chiropractic therapy, osteopathic manipulative treatment, massage therapy, physical therapy, relaxation therapy, and cognitive behavioral therapy.
The expanding body of knowledge in the area of genomics has helped doctors to identify an individual’s likelihood for side effects to medications and proves that some of us just will not tolerate all drugs and need non-pharmacologic alternatives. Traditional Chinese medicine plays a great role in complementing our healthcare system in these areas, delivering low cost, effective and safe treatment. Integrative medicine programs associated with teaching hospitals in this country have embraced acupuncture and Chinese herbal medicine including Mayo and Northshore University Health System. Chinese herbal medicine still enjoys a safety record well beyond that of pharmaceuticals, which are responsible for 100,000 deaths per year in US hospitals due to adverse reactions from properly prescribed medication.
Since the 70s and in the last twenty years, research on acupuncture in the US has exploded. The National Institutes of health in a 1997 consensus statement recognized acupuncture’s efficacy for postoperative and chemotherapy nausea and vomiting and in postoperative dental pain and it’s usefulness as an adjunctive or alternative treatment for addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma. A recent landmark study in the Archives of Internal Medicine in 2012 showed that in 17,922 patients, acupuncture was effective for back and neck pain, osteoarthritis, chronic headache and shoulder pain.
Research on Traditional Chinese herbal medicine has not appeared as much in American peer reviewed journals as acupuncture. However, a notable trial in the Journal of the American Medical Association in 1998 by Bensoussan and Talley found Chinese herbal medicine significantly improved symptoms of irritable bowel syndrome as rated by both patients and their gastroenterologists without side effects. These are the kind of studies that we need more of—outcome studies that test the efficacy of the traditional system.
Mr. Minter recommends that for TCM to gain legitimacy scientists need to isolate compounds to make them more palatable to the US. While more research on Chinese herbal medicine is welcome, I caution against the reductionist mindset of rendering herbal medicine into isolated compounds. Whole plants (and yes, sometimes animal products are employed) offer a matrix of molecules and cofactors that often have synergistic and protective benefits. Stripping these away in favor of a single isolated compound may lead to adverse reactions and decrease efficacy. Researchers have discovered that an herb’s efficacy is not always easily reduced to a single molecule, as much as we might like to be wooed by the simplicity of this approach. Mr. Minter touts the research on artemisinin, a compound isolated from the Chinese herb qinghao in the 1960s for treating malaria. But now parasites are developing resistance to that compound. A recent study by the University of Massachusetts published in the Proceedings of the National Academy of Sciences found that the whole plant, qinghao, cured mice with artemisinin-resistant malaria. This study underscores the strength of traditional whole plant medicine, which ironically has much to offer the treatment-induced issues of our time.
Traditional Chinese medicine is a thriving, regulated and viable complement to Western medicine in this country and will continue to enjoy demand even while research catches up to its long history of safety and efficacy.
Nicole Hohmann, MSOM (Master of Science in Oriental Medicine), L.Ac. (Licensed acupuncturist
Spring has finally arrived in Chicago, reigniting my love of gardening and plants. Licorice is an herb I use everyday in my Evanston acupuncture practice. Glycyrrhiza glabra is a member of the pea family and one of the few Chinese herbs we all recognize. In Chinese medicine it is added to most formulas to harmonize the flavor and increase the efficacy. It is a valuable herb in its own right, though in Chinese herbalism we typically use herbs in combination, after careful assessment of a person’s patterns of imbalance. This article is not meant to make you buy a bunch (but maybe try to grow it!) but more, to simply appreciate the diversity and wonderful effects of herbs. I hesitate to call any one herb my favorite because my favorite herb or formula is the one that’s going to be most effective for the person sitting in front of me at any given time.
A note about safety: herbs can be very powerful and you can think of their safety in tiers. The first tier being food therapy (very safe for everyday use), including culinary herbs and some adaptogens (herbs that help the body adapt to stress). The second is safe in appropriate circumstances. The third is safe only for short periods in specific circumstances and the fourth tier is toxic. I don’t recommend that anyone use herbs on a regular basis in any tier other than the first, unless recommended by a qualified herbalist. Chinese herbal certification at the national level requires 3,000 hours of training, 1,000 hours of internship, the passing of a rigorous test, and continuing education. If your acupuncturist has DiplCH or DiplOM after their name, then she is national board certified. It’s worth noting that not everything natural is safe, but let us put this statement in context. Over 100,000 people die each year of adverse effects of properly prescribed drugs and another 100,000 die each year of hospital acquired infections. Herbs have very few side effects in general when used appropriately and there are many ways in which side effects are prevented by combining herbs into the formula to offset possible harsh effects. One example is to include aromatic or carminative digestive herbs into formulas that contain tonics, which sometimes can be cloying or difficult to digest.
Importantly, and unlike with drugs, herbs contain many molecules and may have several beneficial effects on the body, which is why herbs tend to be antiviral, antibacterial, and antifungal. Herbs are living organisms, which, like us, need to fight disease and maintain balance in an often stressful environment and use these compounds to do so. When taking herbs, we benefit from this biological intelligence. Also, because of this multifaceted wholeness, some herbs have built in buffers against side effects. One example, willow bark, used by native Americans for pain, contains natural buffers against the harsh effects on the stomach of the salicylic acid it contains. Salicylic acid is a metabolite of aspirin, well known for it’s side effects of ulcers.
But back to licorice. It benefits digestion, moistens the lungs, stops cough and wheezing, moderates spasm and alleviates pain of the legs and abdomen, resolves toxicity and sore throats, moderates and harmonizes herbal formulas. And it’s sweet, fifty times sweeter than sugar. (Of note is that licorice candies seldom contain licorice, but rather anise). Sweet flavored herbs are tonics that strengthen our Qi or vitality and bodily functions. The compound glycyrrhizin is similar in structure to cortisone. This may explain, in part, why it can help when the adrenal function becomes sluggish after prolonged stress. It may also be used topically for eczema and orally for chronic gum infections.
Licorice in a large prolonged dose can raise blood pressure. In Chinese herbal formulas licorice is used in small enough doses not to raise blood pressure. This is another benefit of compound herbal formulas. Using many herbs and capitalizing on synergistic functions allows the herbalist to use smaller doses of each herb and further reduce the potential for side effects. Though it is commonly used in Western herbalism as a single herb for reflux and is phenomenally effective. I have had many patients avoid drugs for reflux by chewing on DGL (deglycyrrhized licorice, in which glycyrrhizin which may raise blood pressure is removed). Unlike antacids, it doesn’t neutralize your stomach acid but helps heal the mucosal lining, has anti-histamine effects and improves digestive function.
Licorice plays a starring role in one Chinese formula in particular: Licorice and Jujube, aka Gan Mai Da Zao Tang, which contains licorice, jujube (Chinese date), and triticale wheat. I’ve had many successes using this formula when appropriate for the individual patient for mood swings, anxiety, fatigue, palpitations and insomnia.
Growing it: I haven’t attempted it yet but here’s info from Rodale’s new herbal written by the ethnobotanist Michael Balick, a great source for the lay herb enthusiast: Licorice grows in full sun, and rich, moist sandy loam. Plant cuttings or divisions in early spring or late fall and water frequently until established. After 3 years roots are ready to harvest. Dry the roots for 6 months in a dark, dry location.
Our Spleen is the main digestive organ in Chinese medicine. It separates the pure from the impure from food and extracts Qi, or vital energy, to be used for proper functioning of our body and mind. The Spleen can become weakened by dietary irregularities such as overeating, skipping meals, eating too much “damp” foods (alcohol, refined sugar, refined flour, dairy, greasy/fried foods) or too many “cold” foods (cold temperature foods like ice water, cold beverages, ice cream as well as cold natured foods like raw veggies).
The vast majority of vegetables should be eaten cooked. Lightly steamed, stir-fried, stewed or baked foods retain the most benefits of the foods and protect the “digestive fire.” Giving food to the Spleen in an already partly digested manner helps the body assimilate it easily without expending extra energy to warm it up first and “cook” it in the gut.
Portions and Timing
Your Ideal Meal
Practice listening to your body so that you can identify the foods and meals that make you feel good and satiated for several hours after eating. Not every diet is right for everyone. There is a lot of scientific information about what is healthy but your body also has wisdom to offer. Understand what makes you unique. If you understand your tendencies to imbalance then you can understand what foods to choose to keep yourself in balance. For instance, people who tend to stagnation and damp disorders may do better with more vegetables and a more cleansing diet. People who are deficient, children, women attempting to conceive, and the elderly may benefit from more nutrient dense foods that strengthen Qi and blood such as animal products. Also your food needs may change according to your life stages, the seasons, your activity level and whether you are ill.
Moderation is key! It’s about balance, not perfection!
When I was in living China, every morning while the “East is Red” was blaring through the University speakers, groups of seniors would congregate in the courtyards that my dorm balcony overlooked and begin a quiet gentle movement routine. Some were flowing together as flocks of birds, some where following their own movements. They were practicing Tai Chi or Qigong, both therapeutic exercises rooted in Chinese philosophy. Research has found that TaiChi can reduce incidents of falling in seniors. Even such modest exercise can have great health benefits and increase our lymph flow, an important part of our immune system.
In America, we like to take everything to the extreme including being either too sedentary, or too active. Everyday I treat people who are victims of each extreme – overexercise injuries and lack of exercise fallout. There have been a couple of thought provoking articles on overdoing it with exercise in the news lately. One described deleterious outcomes with a user of CrossFit who was hospitalized with rhabdomyolysis, a very serious condition. Cross Fit exemplifies the no pain no gain mentality of fitness that takes us away from the awareness of our bodies and forces us into routines that may not be serving us. Even yoga can be overdone. A recent New York Times article investigated a high incidence of hip replacements in women yoga practitioners.
We can use the Chinese medicine lens of YinYang theory to help us understand what our bodies need. I like to think of YinYang theory as a sort of common sense filter. Running, vigorous aerobics and weight training are seen as a Yang exercise – very active and heat generating with more potential for injury. Gentle yoga and Tai Chi are more Yin, or slower, more gentle and with less potential for injury. Power yoga and hot yoga forms are relatively more Yang versions of a Yin type exercise. (Remember the Taiji symbol – even within white there is black and vice versa-even with Yin types there are some that are relatively more Yang). One can still be injured and generate too much heat with these more Yang types of yoga. I do not recommend hot yoga for women experiencing menopausal symptoms such as hot flashing but it may be fine in moderation for colder constitutions. The “Yin yoga” method that has become more popular lately may mislead people into thinking it is safer or more gentle but this style where poses are held for very long times can actually be very challenging and has a greater potential for injury than gentle yoga. Overexercising can be hard on your joints, deplete your Kidney Qi and can hasten osteoporosis (the Kidney is related to the bones in Chinese medicine).
We don’t need extreme Yin or extreme Yang types of exercise but a balance of both moderate aerobic and strengthening (Yang) with gentle stretching and contemplative movement styles (Yin) such as gentle yoga and Tai Chi or Qigong.
How much Yin or Yang we need can change as we age or when we are recoving from an illness or injury. When we are young we can tolerate more aggressive exercise. The seniors in China know they need to slow down but keep moving. Our exercise routines should be ever changing to reflect our own dynamic natures.
What most people really need is some moderate, balanced movement every day. Even just 30 minutes of moderate exercise including walking and 10 minutes of stretching a day can revolutionize how you feel if you are inactive. If you are overactive and have repeated injuries, you may struggle with the idea of reducing your workout but your ability to recover will improve.
More important than someone else telling us exactly how many minutes of exercise we need is to develop an awareness to help us honor our own bodies and our own unique experience. Run it through your own common sense filter. As the Buddha said: “Believe nothing, no matter where you read it or who has said it, not even if I have said it, unless it agrees with your own reason and your own common sense.”
by Nicole Hohmann, MS, L.Ac, Dipl.OM, FABORM
The Energy of Food
All foods have a type of energy and effect on the body according to Chinese medicine. Some are more nourishing, some are more cleansing and may be attributed qualities such as cooling, warming, damp, dispersing, or nourishing to Yin, Yang, Qi or Blood. Yinyang theory emphasizes the relationship of food to a person’s individual constitution or imbalances. In this sense, no food is bad per se (except overly processed foods of course), but will have specific effects on the body and may or may not be beneficial for a given individual at a given time. Chinese medicine also differentiates foods based on their qualities such as Qi and Wei. Wei foods are foods with flavor, have a dense and rich taste and are nourishing: meat, organs, egg, oil, fat, fish and dairy, build up qi and essence. Qi foods are generally vegetables, spices, and tea. They are lighter, less nourishing, help transportation and circulation in the body. Root veggies are more Wei than green and cruciferous veggies. Grains are more Wei than green veggies but have a balance of Wei and Qi. Qi foods are more Yang and Wei foods are more Yin. It is important to have the right balance of both.
Wei Foods (Yin): meat, organs, eggs, oil, fat, fish, dairy.
Qi Foods (Yang): vegetables, spices, tea. Green and cruciferous veggies have the most Qi. Grains have both Qi and Wei. Root veggies have more Wei than green and cruciferous veggies.
More information on energetic qualities of specific foods and which to choose for the various patterns of imbalance are found here.
Three models of food proportion to balance Yin and Yang:
Much of the this article is a summary of Peter Torssell’s “How to Regulate Yin and Yang through Diet” (Journal of Chinese Medicine, No. 94, Oct, 2010), an in-depth analysis of individualized food proportions. Not every diet is right for everyone, nor is the same diet necessarily right for you throughout all of your life or even day to day. For instance, if one develops a dampheat condition, one can eat a more clearing vegetarian diet such as Meal 2. If one is trying to concieve, or post-partum, one can eat a more nutrient dense diet such as Meal 3. If one overeats mostly Wei fatty rich foods one day, one may balance this by eating mostly Qi foods or vegetables the next day. This is why so many people feel improved after a period of detoxification with a vegetarian diet – it counters the build up of heavy Wei foods in the standard American diet. Most of the time, however, we should aim for eating a balanced plate during each meal.
More than half of plate = variety of vegetables and grains.
Remainder = Wei foods
This is the Chinese standard diet and the Mediterranean diet. It is warming, nourishing and enriching, requires a lot of physical activity/regular exercise and is relatively balanced in Yin and Yang. The typical body type suitable for this ratio is thin, muscular, energetic. Also the thin, weaker, paler, somewhat nervous person- those with Yin deficiency, Blood deficiency, and some Qi deficiency patterns.
Vegetables leafy and cruciferous 40%, Grains and root veggies 60% of plate.
This is the balanced vegetarian diet.
It is the most yin of the three meals, cooling, dispersing and cleansing especially when the amount of sugars and carbs are reduced. Warming spices counter the cooling effects such as chili, curry, ginger, garlic as well as eating food cooked versus raw.
A risk with this model is falling into trap of overeating carbs and sugar. It may be damp forming for those with spleen Qi deficiency (too many cold foods can injure the spleen and make it susceptible to dampness) and too dispersing for those with Blood deficiency. One may need to supplement with Vit B12 or add Wei foods such as nuts/seeds, tofu, black beans, goji berries, eggs, cheese, fish or chicken or meat broths to diet if signs of deficiency develop. Animal Wei foods are more nourishing than vegetable Wei foods from a Chinese medicine perspective.
This meal is most suitable for excess Yang body types with a heavy strong build and signs of heat and excess such as a red face, thirst, restlessness, rashes, hypertension. Used for tumors (but not once one has become deficient from chemotherapy), heat type arthritis such as rheumatoid.
One part varied vegetables to one part animal Wei foods.
Many diets are based on this ratio such as traditional diets studied by Weston Price which consisted of less grains and were rich in animal fats, the paleolithic diet (though it eliminates milk, grains, reduces beans and root veggies), the Atkins diet, which does allow milk products, the Candida diet for reducing yeast overgrowth, and the Okinowan diet. Fats and Wei are satiating and cravings for carbs are reduced. Even though the fat ratio is higher, people may actually eat less total calories because of feeling full longer.This model can be used for those with damp-phlegm, yang or yin deficiency and blood deficiency. It reduces damp-phlegm but can be warming. If one has damp heat symptoms, hot spices, fried foods, sugar and alcohol should also be avoided and the vegetarian part of the plate can be enlarged. More cooling or neutral Wei foods can be chosen also: white fish, pork, rabbit, eggs, tofu, aduki beans and mung beans. Red meat and lamb are more warming. It is balanced in terms of Qi and Wei foods and can be beneficial for many health issues especially if choosing warming and cooling foods appropriately. Its tendency to increase yang can be countered by the addition of spices which move qi (most aromatic culinary herbs) and can help the veggie portion nourish Yin.
Meal 3 can also increase the Yin by increasing the amount of quality fat (a Yin type food) as found in grass fed livestock and raw milk. Traditional cultures instinctively knew this way of eating was important in preparation for and during pregnancy. Such a ratio is good for PCOS, diabetes, metabolic syndrome. It is also good for children whose developing brains need fat.
This October I will be presenting a poster at the International Congress for Clinicians in Complementary and Integrative Medicine (icccim.org) on Integrative Treatment Approaches for Fertility with Traditional Chinese Medicine. It is the first annual conference put on by the Consortium of Academic Health Centers for Integrative Medicine and it will be right here in downtown Chicago! Which means I get to go to the conference and also not miss Halloween with my family peeps. Work/family balance being one of my ongoing endeavors. This also means I will get to educate many U of AZ Integrative Medicine Fellowship-trained physicians on how acupuncture can help their patients and help them understand how and when to refer. I am excited to be co-presenting with Dr. Geeta-Maker Clark, a lovely and brilliant Integrative medicine physician in Evanston.