Attitudes toward Eastern medicine often border on one of two extremes. Some people feel complementary care cannot be trusted because it lacks any scientific proof. Actually, science itself stems from a belief system originating from Descartes with its own set of biases. The Nobel Prize laureate in medicine, Paul Nurse, said that science is tentative knowledge (2004). The apostle Paul said, “Now I know in part.” Our science textbooks constantly need updating because we know only “in part.” The West can learn from the East to respect the whole.
The other attitude is at the opposite extreme. Some people who have experienced unsatisfactory outcomes using the Western approach have totally abandoned Western medicine. That is like throwing the baby out with the bathwater. When I visited the exhibit on Chinese astronomy at the Oakland Space and Science Center, I saw the very cumbersome way the Chinese in antiquity told time with a water clock as big as a refrigerator. While we are still using the ancient Chinese astronomers’ method to measure longitude and latitude, I doubt if anyone would want to revert to telling time with a water clock. What we need to do is pick and choose what we want to retain from antiquity. The ancient Eastern approach and the modern Western approach both have their strengths and limitations. If we recognize what they are, we can truly use both disciplines in a complementary way and get the best of both worlds.
The advances made in Western medicine are second to none. Methods of imaging such as CT and MRI scanning, laparoscopic surgery, angioplasty, joint replacement, transplant surgery, fetal surgery, gene research, vaccine development, and genomics are just some that come to mind. The benefits they bring cannot be ignored. There are times, however, when Western medicine has limitations. Ideally, this is when TCM should be considered.
When to Use Eastern Medicine
There is a story of a patient suffering from the common cold. She saw her doctor, who prescribed some pills. She returned two days later to say she had developed a cough and was not any better. He then prescribed some cough syrup. Two days later, she returned to say she was still no better. He then advised her to take a warm bath, open the window wide, and stand in front of it. She said, “But if I do that, I’ll catch pneumonia.” “Well,” he replied, “that’s something I can treat.”
For certain conditions, the Western approach is just not effective. A recent research study showed that the most common formula prescribed for nighttime cough in children was no better than a placebo (Paul 2004; Yoder, et al. 2006). From my experience as a third-year medical student suffering from a nagging cough, I can attest to that fact. We should consider that the Chinese herbal pharmacopoeia is replete with effective remedies for coughs.
Vertigo, the type of dizziness typified by a feeling of spinning, can have two causes. One is a problem with the inner ear or labyrinth where the center of balance is. The other cause is a decrease in blood flow to the brain, a possible warning sign of an impending stroke. Usually, the Western treatment for the labyrinthine problem is a motion sickness pill such as meclizine, which is not very effective. The treatment for the second, more serious problem, is aspirin or, if the patient is already on aspirin, an antiplatelet medication. In both cases, TCM can be of benefit, using herbs that improve circulation to the head such as Rhizoma et Radix Ligustici Sinensis 
and Rhizoma Gastrodiae Elatae 
. For the labyrinthine problem, herbs alone often resolve the problem. For the poor cerebral circulation, herbs that improve circulation to the head can be used as adjunctive treatment. A certain portion of the population is allergic to aspirin; another portion experiences serious GI bleeding from aspirin, and another does not respond to aspirin (Cavallari, et al. 2006). For those patients, mobilizing-blood herbs can be considered in lieu of aspirin.
For kidney stones, the conservative Western approach is to have the patient increase fluid intake in hopes of flushing the stone through the ureter, the conduit that transports urine from the kidney to the bladder. The ureter is a tube whose walls are made of smooth muscle. It is the narrowest part of the entire urinary tract, and it is where most stones become impacted on their way to the bladder. The intense pain accompanying kidney stones is from the smooth muscle wall of the ureter reflexively contracting in an effort to move the stone down to the bladder. Once a stone passes through the ureter, it will easily be excreted in the urine. If the conservative approach fails, Western medicine resorts to invasive measures. One approach is to pulverize the stone using sound waves. Another is to extract the stone surgically. Both of these procedures carry risks. Here, again, we could consider using Chinese herbs such as Achyranthis Bidentatae 
that dilate the ureter by relaxing its smooth muscle wall in combination with herbs that are diuretic such as Caulis Mutong 
. These herbs can be used as adjuncts to the conservative approach.
A patient for whom I prescribed herbs to facilitate passage of his kidney stone told me that after taking the herbal concoction, in addition to passing his stone, he felt, for the first time in his life, that his usually cold hands had become warm. The smooth-muscle-relaxing herb component of his prescription dilated not only his ureter but also his blood vessels. There is a condition called Raynaud’s phenomenon in which the blood vessels to the hands and feet constrict and the extremities can become uncomfortably cold. Western practitioners often prescribe vasodilating drugs such as nifedipine for it. Mobilizing Qi and Blood herbs that dilate blood vessels can also be effective (see chapters 3 and 9).
Another factor to consider when choosing one treatment over another is the risk/benefit ratio. Every treatment involves some risk. For life-threatening diseases, significant risk could be deemed justifiable. Yet drugs with serious side effects are often used for conditions that pose no imminent danger. This is when we should be cognizant of alternatives.
For simple strains, sprains, and tendonitis, accepted Western treatment is nonsteroidal anti-inflammatory drugs (NSAIDs). The first generation of NSAIDs can cause gastritis with GI bleeding and sometimes cause kidney failure. Short-term use to control symptoms might be justifiable, but for chronic use, the benefit does not warrant the risk. We thought the newer generation of NSAIDs called the COX-2 inhibitors would be the solution to the GI bleeding problem, but now we are discovering that they carry a new, unforeseen risk of increasing heart attacks and strokes among some users (see chapter 5). Many conditions for which NSAIDs are being prescribed respond well to herbal therapy and acupuncture.
It is appalling to find advertisements promoting NSAIDs to treat such benign conditions as the common cold. There is a case in which a child was given ibuprofen for a sore throat and developed Stevens-Johnson syndrome, a rare allergic reaction, which ultimately resulted in blindness. Chicken soup, herbs, or homeopathic remedies could have been used without such dreadful consequences.
Recently, higher doses of common painkillers such as acetaminophen and NSAIDs have been linked with hypertension in women (Dedier, et al. 2002). Now, more than ever; alternatives to drugs for treating pain should be considered.
Vasoconstricting drugs, such as phenylephrine, are known to cause hypertension, which can lead to strokes. Many drugs for nasal decongestion contain vasoconstrictors. The risk of a stroke is not commensurate with the benefit of nasal decongestion. Numerous herbs are equally effective and do not cause vasoconstriction.
Many diet pills also contain drugs that are vasoconstrictors. A common component is ephedrine. I used ephedrine as an anesthesiologist to help raise an excessively low blood pressure. Both TCM and Western practitioners have used ephedrine effectively for relieving bronchospasm in asthma and bronchitis. But its use for weight control is not appropriate. There has never been a drug proven to achieve sustained weight loss. Many have serious side effects, and using them is not justifiable. Herbal remedies that work on tonifying Spleen can offer a safer alternative.
In addition to the inherent risk with any surgery coupled with anesthesia, another problem with surgical procedures is scarring. Many patients have recurrences of their pain years after back surgery. Usually, they undergo repeat spine imaging. The common explanation for their pain is arachnoiditis (scarring of the membranes around the spinal cord). I saw a patient who had surgery for carpal tunnel syndrome with scarring that caused symptoms worse than that of her original problem. In such cases, acupuncture could have been a better first option.
For some common disorders, Eastern treatments are simpler and far less expensive. The West treats enuresis (bedwetting) with antidiuretic hormones and elaborate alarm systems to induce a conditioned response from the child with this problem. The Eastern treatment is simpler. It involves adding astringent herbs like Ootheca Mantidis 
to a prescription that tonifies the Kidney. For difficulties with lactation, the West encourages the patient to drink fluids. In addition to fluids, the East offers herbs like Fructus Hordei Vulgaris Germanatus 
and Fructus Oryzae Germinatus 
in a formula along with herbs to tonify the Blood, Yin, and Kidney Qi. For women’s health issues such as premenstrual syndrome, irregular bleeding, menopausal symptoms, and infertility, Western methods of treatment are not all ideal. The Western treatment of PMS is not effective. Hormones for irregular bleeding and menopausal symptoms carry inherent risks. Infertility treatments are enormously expensive and not always successful. Eastern methods for these problems involve little risk, are often effective, and involve much lower cost.
When Not to Use Eastern Medicine
A balanced discussion of Eastern treatments must also include words of caution about their use. Some ancient remedies have withstood the test of time even though they were based on incorrect premises. For example, the TCM treatment for colds and the flu is used even today despite the fact that the treatment is based on the incorrect premise that colds and the flu are caused by the Cold evil.
But in some instances flawed premises have led to flawed treatments. A glaring example is diagnosing “Blood Stasis” as the cause of excessive uterine bleeding. It seems that when the ancients saw women with heavy menstrual bleeding passing clots (actually clots are an indication that the menstrual blood flow is brisker than normal), they assumed the clots were being formed in the uterine vessels and were responsible for obstructing normal menstrual flow (Wiseman 1995, 149). The TCM treatment is to mobilize Qi and Blood (see chapter 3). The intent of this treatment is to dissolve the offending clots in order to restore normal menstrual flow. Some of the herbs in this category act to disperse blood 
. They act in a way similar to antiplatelet drugs like aspirin. They can have an anticoagulant effect and can worsen the bleeding. While there are various causes of excessive menstrual bleeding, excessive clotting is not one of them.
I once saw a patient who had pelvic pain. It was from an ectopic pregnancy. Before she came to me, she had consulted a Chinese herbalist who told her that the cause of the abnormal bleeding was “fire” in the reproductive organs. The diagnosis puzzled me, but I was glad she sought Western medical help in time. Delay would have resulted in severe and dangerous bleeding from her ectopic pregnancy. As I thought about the strange diagnosis the TCM practitioner gave this patient, “fire” in the reproductive organs, I remembered that one TCM teaching attributed early and heavy menstrual bleeding to Blood Heat (Wiseman 1996, 150). The ancients envisioned that the blood in the uterine vessels heated up to such a degree that it boiled over, leading to copious menstrual flow. I could think of only one explanation for this TCM diagnosis of Heat as a cause of heavy menstrual bleeding. The ancients might have observed pelvic inflammatory disease where there is an infection in the fallopian tubes with fever, pain, and heavy bleeding. Before antibiotics, cold-cleansing herbs might have been used to treat such infections. In the age of antibiotics, treating with cold-cleansing herbs is no longer warranted. Cold herbs can dilate blood vessels, resulting in a lowered blood pressure. If used on patients who were bleeding heavily, such treatment could potentially put them into shock.
While I have often treated menstrual irregularities in my integrated practice, I have never found a need to use the mobilizing-Blood or cooling-Blood treatment principles recommended in TCM textbooks. I feel that they are inappropriate and potentially dangerous. If the cause was hormonal imbalance and the bleeding was profuse, I prescribed hormones to control the bleeding quickly. I then used tonifying Kidney and tonifying Blood herbs to restore natural hormonal balance and replenish the blood. If blood tests showed anemia, I would also prescribe iron pills. If I were to choose herbs to control bleeding, I would choose hemostatic herbs such as Folium Artemisiae Argyi 
and tonifying Blood herbs like Gelatinum Asini 
, Angelica Sinensis 
, and Polygoni Multiflori 
.
Another inappropriate use of mobilizing Qi and Blood herbs is ingesting them for sprains, strains, and traumatic bruising. I have seen patients who received this treatment from TCM practitioners actually have side effects such as bloody urine often seen with too high a dose of anticoagulants like coumadin. While using such herbs in liniment form for such conditions is appropriate, ingesting them can be dangerous.
TCM explains diabetes as Yin deficiency (dehydration) caused by Stomach Heat. Ancient practitioners must have seen the diuretic effect of high blood glucose levels where copious volumes of water and electrolytes were lost in the urine leading to dehydration. Insulin, of course, had not been discovered at the time. If this teaching were followed, only treating Yin deficiency for diabetes would result in delaying insulin treatment. Again, I would warn against tenaciously adhering to inappropriate treatment based on the wrong premise.
The Western treatment of congestive heart failure is undergoing change. Diuresis to minimize the fluid volume the heart needs to pump has remained the same, but Western medicine has been shifting its approach away from treating with positive inotropes (drugs that strengthen heart muscle contraction) to beta-blockers. Beta-blockers make the heart beat less vigorously and more slowly in order to minimize its workload. The TCM approach has not made this shift. Radix Ginseng 
might be prescribed according to the older idea of strengthening heart muscle contraction. This approach might overwork the heart, as opposed to the beta-blocker approach, which spares the heart.
Modern drugs have supplanted some old remedies with potential toxicities. These include Cinnabar 
for febrile convulsions, Gypsum 
for fever, and Talc 
for kidney stones. Here, the risks outweigh the benefits.
Often I am asked whether there might be herb-drug interactions when patients taking drugs choose to take TCM remedies also. We must keep in mind that natural products do have medicinal properties. In fact, many of our present day drugs are derived from plants. Aspirin is derived from willow, digitalis from foxglove, birth control pills from yam, the anticancer drug Vincristine from periwinkle, and Taxol from the Pacific yew tree. When combining drugs and herbs, to avoid double dosing, we must be cognizant of the medicinal properties of the herbs. Patients taking the following drugs need to be especially cautious: diuretics, antihypertensives, blood thinners, and antiarrhythmics. Some commonly used herbs have similar actions. This became evident when a Chinese patient came to me for treatment of leg edema and fatigue. She told me that she was on no medications. On her first visit, I found hypertension and some leg edema. As part of my routine studies, I ordered blood electrolytes and found that she had a low serum potassium level. A common cause of low potassium is diuretic therapy, but I had not yet prescribed any diuretics. A rare condition called hyperaldosteronism can also cause low serum potassium. A test I ordered for this condition showed she did not have it. It then occurred to me to ask if she had seen an herbalist for her edema. She said she had. I concluded that the herbalist most likely treated her with diuretic herbs. Just as low potassium can be a side effect of diuretic drugs, it can also be a side effect of diuretic herbs.
A Chinese American psychiatric social worker told me that in the psychiatric ward of his hospital, doctors have become very leery of Chinese herbs. They saw how Chinese patients diagnosed with bipolar mood disorder who had been stabilized with psychiatric drugs rapidly become manic when well-meaning relatives brought them tonifying (Yang) soups. This also occurred when young Chinese women patients with bipolar disorder were brought various concoctions containing Angelica Sinensis 
by their mothers. These herbs tend to be warm and Yang. When combined with antidepressants, also Yang in nature, they can swing a mood disorder excessively toward mania.
Herb-drug interactions are less likely when treating respiratory problems and arthritic conditions because the herbs and drugs used for treating these conditions do not act in the same ways. For bronchodilation, Western drugs tend to stimulate the sympathetic system, which tends to dilate bronchial tubes in preparation for fight or flight. The side effects are from sympathetic stimulation, such as fast heartbeat and tremors. Chinese herbs to help lower lung Qi lack these side effects, so they do not work on the sympathetic system. For arthritis, Western drugs act by blocking the production of prostaglandin, a mediator of inflammation. Chinese herbs for arthritis tend to improve circulation to help the body remove cytokines, the byproducts of inflammation.
How to Use Eastern Medicine
Up to this point, my discussion of Eastern treatments has fallen within the Western paradigm. The focus is on disease. It is important when using Eastern treatments, however, to remember that a major tenet of TCM is to focus not just on the disease but also on the patient and his or her environment. If we simply incorporate Eastern remedies into our Western system, we limit their usefulness.
The Western misapplication of TCM reminds me of a story an old Canadian missionary in Taiwan once told me. For years, the village she lived in had no indoor plumbing, only outhouses with a hole in the ground. Finally, in the early 1970s, she acquired indoor plumbing with an actual toilet with a seat. She was very excited and showed it to a local villager, inviting the villager to try it. “Well, how did you like it?” the missionary asked. To her surprise, the villager answered, “It’s a bother, and I don’t like it very well.” The explanation became obvious when the missionary looked and saw two footprints on the toilet seat.
Some investigators search for and extract the active ingredients in some Chinese herbs to treat disease. Years ago, Dr. K., my ACTCM teacher who had a Western surgical background, told me that Japanese researchers tried just that. They found that using the extracted active ingredients of herbs did not achieve the same effect as when the same herbs were used in a traditional Chinese prescription. The reason for this shortcoming is that these researchers left the patient out of the picture.
In an Australian controlled study on the efficacy of an herbal formula to treat menopausal symptoms, fifty-five postmenopausal women all received the same formula, and then a survey was taken to compare the effect of the herb formula with a placebo. The study concluded that the herb formula was no better than the placebo (Davis, et al. 2001). The problem is that the controlled study assumed that if the subjects were the same age and sex, and had similar health conditions, they were alike. A true TCM study would at least recognize that certain women had certain imbalances, and would sort them into groups to account for the imbalances.
In contrast, an Eastern model was used in another Australian study on the efficacy of Chinese herbal medicine on irritable bowel syndrome. In this study, a TCM practitioner diagnosed each patient and prescribed herbal treatment according to TCM principles. Sorted out this way, the TCM treatments were found to be effective (Bensoussan, et al. 1998).
My friend Pamela, a nurse, told me she was eating large quantities of carrots for beta-carotene, a known antioxidant. I warned her that the Chinese consider carrots to belong to the cool category of foods and that large quantities might be harmful. I later read a study that showed the use of beta-carotene in lung cancer patients actually hastened their deaths (The Alpha-Tocopheral Beta Carotene Cancer Prevention Study Group 1994). This was an enigma to Western researchers, since other studies show beta-carotene to be a preventive against cancer (Cooper, et al. 1999). The Eastern practitioner would explain that beta-carotene treatment could not be applied in a vacuum, without consideration of the patient’s overall balance. A patient’s immune system might be too deficient. Treatment with a cold-type substance like beta-carotene would further lower the patient’s immune response against the cancer. This may well be why many of our double-blind and age-sex matched controlled studies yield conflicting results. These studies assume that a group of matched subjects is homogenous.
We can be misled even in our evidence-based studies if we ignore the genetic and environmental factors influencing health (see chapter 8). In the 1970s, I worked in an English-speaking mission clinic in Taipei, Taiwan. Those were the days before plastic syringes and vacuum test tubes. Blood was drawn using glass syringes and then transferred to test tubes. The ancillary help, such as X-ray technicians and lab technicians, lacked the customary credentials required in the West. They were trained on the job. One day, I happened to be in the lab and saw that the technician had left a glass syringe filled with blood on the countertop. I told her to quickly empty the syringe into a test tube because the blood left in the glass syringe would quickly clot, making it impossible to transfer. She said, “Oh, don’t worry, Dr. Tsang, this is Chinese blood. It will not clot. If it were Caucasian blood, I would transfer it into test tubes immediately because, as you said, it will clot. However, Chinese blood will not. See.” She proceeded to show me that, indeed, the Chinese blood that had been sitting in the glass syringe for fifteen minutes was still in liquid form as she transferred it into the test tube. Indeed, we are not all the same. There are genetic, constitutional, and environmental differences.
With cancer therapy, mainstream medicine has begun to recognize that individuals with the same disease do not all respond to the same drugs in the same way. They came to this realization when using expensive and potentially dangerous chemotherapeutic agents. They discovered that response to drugs was genetically determined. Individual responders could be sorted out by studying their genetic makeup. This approach is called pharmacogenomics (National Center for Biotechnology Information 2004). Allopathic medicine has finally realized that each patient is unique, something TCM has understood for a long time.
Pauline was a nurse in her thirties who saw me for headaches, sleep disturbance, and some bodily aches and pains. After a series of herbal and acupuncture therapies, she recovered, and I did not see her for six months. One day she returned with a recurrence of all her symptoms. When I asked her what happened, she told me she had read about the benefits of Ginkgo Bilobae, and she began taking large quantities of the herb. I asked Dr. Lai whether Ginkgo was as beneficial as Westerners considered it to be. He said that Chinese practitioners do not consider it a particularly valuable herb. It is meant to be used in small quantities, either in cooking or as a small part of an herbal prescription. It was never meant to be consumed the way Americans are consuming it. In fact, a textbook on Chinese herbs states that Ginkgo in high doses is toxic. Toxic manifestations include headache, fever, tremors, irritability, and dyspnea (shortness of breath) (Bensky 1987, 560).
Ginkgo has been touted to have antiplatelet and procirculatory therapeutic effects, but Dr. Lai said that many herbs in the TCM pharmacopoeia are far superior to Ginkgo for dispersing and vitalizing blood. He pointed out that herbs sold on the open market in Asia are like U.S. commodities: when the herb is valuable and scarce, it commands a high price. Ginkgo Bilobae has never commanded a high price in Asia. Pauline’s case demonstrated to me the danger for Westerners who use components of Eastern remedies with a Western approach without considering how these remedies fit into the Eastern paradigm. The result may be further imbalance.
Weight reduction is an area in which herbs are the most misused. Aristolochia Fangchi 
, sometimes used in diet pills, has been reported to cause nephropathy and kidney cancer (Nortier, et al. 2000). This herb was meant to be used only in small doses and for a brief course for coughs. It was never meant to be used on a long-term basis or for weight reduction.
The Importance of the TCM Paradigm
Our curiosity about TCM and our enthusiasm for its remedies must be tempered with care and caution. There is a proper and an improper way to use TCM remedies. The correct way requires using treatments within the TCM paradigm.
The Ben 
(Root)
“The patient was well until two weeks ago when he developed …” This is a very common opening phrase found in medical histories. They usually record the present problem as having begun when acute symptoms began. Was the patient really well until only two weeks ago? Careful history-taking will point a TCM practitioner to an event that gradually threw the patient’s homeostasis off balance far earlier, but the transition can be so subtle that the patient failed to notice the change. Often the practitioner needs to ferret it out of the patient. In my integrated practice, whenever I probed regarding the onset of an illness, patients often related the onset of their symptoms to a particular event. “It started when my second child was born … It started after my car accident … It started in my second year of college.” The common thread in their stories is that the patient was enjoying good health until some stressor tipped the balance, causing the body’s homeostatic mechanism to lose its equilibrium. The Western medical paradigm, lacking the concept of Ben 
, focuses only on the Biao 
or the external manifestation of an imbalance. TCM teaches that if we merely treat the presenting problem (the Biao 
), there is often incomplete resolution of the problem. We need to find and treat the underlying imbalance (the root 
) that led to the problem in order to restore the patient to true wellness. This approach distinguishes TCM from allopathic medicine. It is no wonder that when Westerners use a TCM remedy that treats the Biao 
, they find it ineffective. The prevalent mainstream Western belief that all complementary treatments must undergo evidence based investigation to be deemed effective has missed this important aspect of the Eastern paradigm. The evidence focuses on treating disease, not the patient.
When Jean came to see me for iritis, an autoimmune condition in which the body inappropriately attacks the eye, she was forty-nine. Her doctor had ordered an HLA-B27 antigen test, which was positive. This meant she was genetically prone to certain types of autoimmune conditions like iritis. Her ophthalmologist prescribed steroid eye drops, which helped the eye inflammation, but as soon as she stopped the drops, the iritis recurred. She had been treated by two other TCM practitioners who prescribed cooling herbs for the eye inflammation. The concoctions made her feel weak and lightheaded without improving her eye inflammation. Noting her age, I asked her about signs of menopause, such as hot flashes, palpitations, sleep disturbance, and menstrual irregularities. Of those symptoms, she had palpitations and irregular periods. For six months before the onset of her iritis, her periods were extremely heavy. During that time, she had palpitations and her doctor ordered a treadmill test, which was normal.
I did a TCM analysis of Jean’s case. Her positive HLA-B27 test indicates that she has a genetic predisposition for iritis. She had not developed iritis until age forty-eight, at the onset of menopause when her Kidney Qi was declining. Her heavy periods meant she was Blood deficient. Her palpitations meant she had Deficient Liver Fire (see chapter 2) resulting from menstrual blood loss. My prescriptions for her included herbs not only to calm the eye inflammation (the Biao 
) but also herbs to tonify Blood and Kidney Qi (the Ben 
), and herbs to calm Deficient Liver Fire. With that type of herb prescription, her iritis resolved, she was able to stop the steroid drops, and her palpitations stopped. Despite her genetic predisposition, Jean’s body had been able to keep iritis at bay for forty-eight years. The blood loss and decline of hormonal balance with menopause tipped the balance for her. The steroid eye drops and cooling herbs treated only the Biao 
the iritis. Jean improved only when her Blood deficiency and Kidney Qi deficiency, the Ben 
, were addressed.
The Economics of Energy
The economics of energy is another concept that distinguishes the Eastern from the Western medical paradigm. In 1998, I attended a lecture given by Dr. Rajesh Munglani, a pain management consultant. He spoke about an animal research study that had astonishing results and implications. Normally with an injury, chemicals at the spinal cord level send pain-stimulating messages up to the brain. The brain responds by sending pain-suppressing messages down the spinal cord to neutralize the pain-stimulating chemicals. Munglani, et al. (1996) found that even after the injury had healed, when the animal appeared normal and exhibited no increased sensitivity to painful stimulation, there were still pain-suppressing chemicals found in its spinal cord, indicating that the body remained in an adaptive mode.
Extrapolating this finding to humans, you could say that after an injury, when the wound appears healed and the patient appears to have recovered, the patient’s brain may still be in an adaptive mode, giving only the illusion of complete recovery. This tells me that homeostasis requires hard work and energy. We are normal because our bodies are constantly at work to maintain the status quo. If an extra workload is placed on it, the body might not have enough energy to compensate for the increased burden.
Often patients who have had multiple surgeries still have the pain the surgery was supposed to have cured. Their scars are well healed, the various scans and X-rays show no evidence of the former problem, but the symptoms fail to resolve. It could be that their bodies’ powers of adaptation have just become exhausted. One such patient reported that after surgery, she had not improved. She then tried various other kinds of treatments such as physical therapy and chiropractics. The only thing that seemed to help her was an herbal concoction prescribed by a TCM practitioner to tonify her various deficiencies.
The results of this animal research study could also explain why so many chronic conditions flare when patients become tired or lack adequate sleep. A patient of mine had been in a car accident. Right after, she developed acute double vision because the impact injured the nerve supplying the muscle to one eye. With time, she noticed the double vision resolved, but it sometimes returned when she was tired. Recognizing that there is an economics to our internal energy allocation, TCM approaches the problem by using herbs to add energy when it runs low.
Gearing Treatment to Stages of Disease
Disease evolves in stages. The skeptics who scoff at complementary medicine because it treats patients who are “not very sick” inadvertently diagnosed the problem with allopathic medicine: allopathic treatments are mainly geared for the very sick, but we have far fewer treatments for patients who suffer from early stages of a disease. That truth also explains why Western health care tends to be costly. TCM methods are more effective in early, mild, or chronic stages because they try to detect and treat imbalances in the host to enable self-healing. When conditions become acute or severe, Western methods, which tend to take over or replace bodily functions, are needed.
With conditions such as asthma, Western drugs can be life saving for the acute severe stage. After the patient becomes stabilized, Chinese herbs can be introduced to help reduce the dosage of asthma drugs with their inherent side effects, and, sometimes, drugs can even be discontinued. I would, however, warn against abrupt discontinuation of drugs when just beginning TCM treatment. Response to TCM treatments tends to be gradual. The patient must show improvement before drugs are tapered, and they should be discontinued only if improvement is maintained. It is unfortunate that many Chinese patients regard Chinese herbs and Western drugs to be always incompatible. This misconception can be traced back to the past when Eastern and Western practitioners were more polarized. In order to protect their respective turf, they instilled the fear in patients of dire consequences from mixing the two kinds of remedies. Sadly, I have seen patients inappropriately discontinue needed maintenance drugs such as antihypertensives when they began herbal therapy for such conditions as colds and the flu.
For peripheral vascular disease, the Western treatment is surgical bypass when disease is in an advanced stage. For cases not yet requiring bypass, Western medicine resorts to watchful waiting. Allopathic remedies such as pentoxifylline are not effective, whereas herbs are often effective in improving circulation to the limbs and can forestall the need for surgery.
For degenerative arthritis of large joints, before the advanced stages when surgical replacement is required, again, the Western approach is watchful waiting. Drugs such as nonsteroidal anti-inflammatories for pain relief carry risk. Acupuncture and herbal remedies can relieve symptoms and also forestall the need for surgery.
For patients with coronary heart disease, Western preventive measures such as diet, low-dose aspirin, and cholesterol-lowering drugs are effective mainstays. An adjunct to this regimen could be herbs that also discourage plaque formation. If a coronary artery is more than 90 percent blocked, though, life-saving surgical procedures like angioplasty or coronary artery bypass are needed. After surgery and during convalescence, herbs can be resumed to help hasten recovery and again be an adjunct in preventing further plaque formation.
For diabetes, no one can deny the benefits of Western drugs. Insulin has saved many lives. Newer drugs are now available to help patients who are not insulin dependent, but those drugs still have limitations (see chapter 9). Certain Spleen herbs can be used as adjuncts to drugs for type 2 diabetes.
Many Western drugs actually are directed at interfering with normal functions. Our pharmacopeias are replete with drugs that either block or inhibit: SSRI-type antidepressants are selective serotonin reuptake inhibitors; drugs for acid reflux, also known as PPIs, are proton pump inhibitors. Cheryl Schwartz, a doctor of veterinary medicine who pioneered using TCM for treating animals, writes in the introduction to her book, Four Paws, Five Directions, that she found most of her treatments consisted of prescribing antibiotics and anti-inflammatories. In fact, all of her treatments seemed “anti-something” (1996). NSAIDs, for instance, block the production of prostaglandins, which cause inflammation. Antibiotics interfere with a microorganism’s ability to multiply, but they are taken internally and can affect the host as well. Drugs can be effective in the short term, to quickly resolve an acute condition. But in the long term, when we interfere with normal function, other problems will emerge. For chronic conditions, a complementary approach such as TCM is preferable.
The difference in philosophic influences between East and West has caused their medical paradigms to develop along divergent paths. The West, with its emphasis on analysis, has furthered the understanding of disease processes and refined ways to diagnose and treat using a targeted approach. The East, with its emphasis on wholeness, has directed attention to ways to enhance the host’s ability to fight disease and stay balanced. Ideally, the two approaches can be used to complement one another; this can be done best when there is an understanding of both.
“An invasion of armies can be resisted, but not an idea whose time has come.”