At ACTCM, I selected classes pertinent to my needs and interests. With my background, I felt free to skip classes such as basic anatomy and physiology. By early 1982, after a year of formal classes at ACTCM on herbology and acupuncture and my practicum with Dr. Lai, I quit work in the ER and launched an integrated practice of Western and Eastern medicine. I envisioned my practice to be a virtual Utopia for patients, especially for those in the Chinese community. Up to then, these patients had to triage themselves as to which practitioner, Eastern or Western, to see for their ailments. There was no communication between practitioners of these respective disciplines. If the Eastern practitioner prescribed herbs, patients had to decide for themselves whether to discontinue any drugs prescribed by their Western physicians. Such important decisions were made based on tradition or advice from well-meaning but untrained friends and family. I, as someone trained in both disciplines, would be able to offer them the best of both worlds under one roof. My Utopian vision turned out to be a fantasy. It turned out that my Chinese patients expected only Western medical care from me. If they wanted herbs or acupuncture, they would see their own TCM doctors.
Before opening my dual practice, I sought the advice of Western colleagues who were already using acupuncture in their practices. At that time there was only a handful. One colleague told me that his strategy was to practice the best Western medicine he knew to first gain the acceptance and credulity of his Western colleagues. I became very aware of his sage advice. I remembered how, in medical school, we were indoctrinated to view any disciplines outside of allopathic medicine with condescension. As an intern, I was appalled to hear from an acquaintance who was a world-class ice skater that she was seeing a chiropractor.
When I was working in emergency medicine, John, one of the ER orderlies, came to work with a crick in his neck. The ER staff went to work on John using traction, heat, ultrasound, and injections of Valium and Demerol. Despite all these measures, they could not straighten his neck out. Then one ER colleague thought of trying a chiropractor. We looked in the yellow pages and sent John to a nearby school of chiropractic. After one treatment, he was much better and able to hold his head straight. This experience taught me humility. It also taught me prudence.
My practice began on a small scale. I time-shared an office with an established internist, Ed. I had professional cards printed, indicating I did family practice and acupuncture. I did not mention Chinese herbal therapy on my card. I felt publicizing that aspect of my practice would invite criticism. It was common in Western hospitals to implicate Chinese herbs whenever a Chinese patient presented a problem that was difficult to diagnose. This mentality was convenient and required no objective proof. Chinese herbal treatments and herbalists became easy scapegoats. By the 1980s, acupuncture had already earned some acceptance, so being a physician-acupuncturist was less controversial. I remained a closet Chinese herbalist for many years, known only to the patients I treated. Occasionally, word leaked out about my prescribing Chinese herbs, and I overheard the ridiculing comments some of my colleagues made. I kept up a high standard of Western practice, though, and was therefore able to remain above reproach. I carefully chose to use alternative methods only when Western treatment options had been tried and failed, or when I knew there were no good Western options.
Sometimes I reminisce about the early days in my practice when I was not so busy. Money was scarce, but time was abundant. I had time to sew cloth patient gowns, which I preferred over the stiff, scratchy, disposable paper ones. One patient commented on how comfortable these gowns were, and even inquired as to where she could buy them. I told her that I had them made to order. During my first year, I saw an average of three patients per day. One day, when I was seeing my third and last patient, the receptionist I shared with Ed announced within hearing range of the patient, “Doctor, your next patient called to say he will be a little late.” After my third patient left, I queried the receptionist as to who the next patient was. “The patient who just left was your last,” she replied, “but I didn’t want her to feel lonely.”
Using TCM to Treat Asthma
During my studies, my enthusiasm for TCM overflowed to my friends. When I started my integrated practice, one of my very first patients was my friend Betty, a nurse originally from Hong Kong. Betty was in her forties, and she had suffered from severe asthma since the age of nineteen. She had the classic triad of nasal polyps, aspirin allergy, and bronchial asthma. Her condition was so severe that every night she had to prop herself up with several pillows to breathe. When she went to work, she had to take a few puffs of her inhaler before she could negotiate the hill where her hospital was located. On average, Betty required one or two courses of steroids a year when she had acute flares of her asthma.
The herbal prescription for Betty was one of the first I ever wrote. Besides lowering Qi herbs to improve air flow in her bronchial tubes, it included herbs for clearing sputum, tonifying Yin herbs to help her mucous membranes stay moistened, quelling Wind herbs for her allergic rhinitis, tonifying Kidney herbs (a standard ingredient for treating respiratory problems), and tonifying Spleen herbs to boost her weak immune system. When she saw the prescription I wrote, she laughed aloud. The Chinese characters looked as if a child had written them. My Chinese script was so poor that I was embarrassed to use the customary letterhead for my herbal prescriptions. Instead, I wrote them out on a plain sheet of paper. Word got around the local herbal stores that the writer of my prescriptions was a Caucasian trying to learn TCM. Much later, the herbal storekeepers would say that the writer was an American-born Chinese learning TCM. The reality of my impediment hit home later in my career when my blonde and blue-eyed patient, Donna, told me that when she took my Chinese prescription to an herb shop to be filled, the storekeeper commented, “My, you are very smart. You know how to treat yourself and even write Chinese!”
A month after I began treating her with herbs, Betty called one day to say her asthma was very severe. I made a house call, and indeed found that her breathing was quite labored. In addition to giving her an injection of epinephrine as acute intervention, I tried at the same time to treat her with acupuncture. She still required a course of oral steroids. Once her asthma was under control, I tapered her steroids and continued herbs. That was the last time she ever required steroids. Highly motivated, she faithfully continued the herbs I prescribed, and over a period of about three years, her asthma completely disappeared. As time passed, she needed her inhaler less and less, even when she had to climb the hill to work. After three years, she finally was able to stop the nasty tasting herbs and dispense with her inhaler. Her symptoms have never recurred.
On reviewing her chart, I can see that for the first three years while on the herbs, she still came down with asthmatic bronchitis about once or twice a year, but she no longer required steroids. On her annual physical exam four years after starting the herbs, she had no complaints of wheezing. In order to review Betty’s chart, I needed to return to the office where I had previously practiced. Her present doctor, who took over my primary practice, said with surprise, “I didn’t even know she had asthma.”
My approach to Betty’s case is typical of how I integrated Eastern and Western treatments. When Betty’s asthma was severe and difficult to control, I relied predominantly on Western methods, using TCM treatment as a supplement. After the acute condition was controlled with Western therapy, I continued the TCM therapy while maintaining her simultaneously on Western medication. Gradually, Betty herself recognized that the need for her Western medicine was diminishing and stopped using it. The remarkable aspect of her case is that after three years of TCM treatment, resolution of the problem has been maintained.
Genetics and environment are the two factors influencing health. Each of us is born with a genetic predisposition to certain conditions. In the years before a condition occurs, the body’s inner strength, or Qi, seems adequate to stave off the disease. Then, at a certain point, because of factors in either the internal or external environment, that mechanism decompensates, and the condition becomes manifested. In Betty’s case, this decompensation occurred at the age of nineteen when she began suffering from asthma. The precipitating factors may have been the stress of adjusting to a new country and studying for her future career. TCM’s treatment goal is to restore the body’s own homeostatic balance to the pre-morbid state. With this approach, the disease resolution is more lasting. At present, I think Betty’s predisposition for asthma still exists, and at some time, another stressor could trigger asthma. So far, this has not occurred.
Treating the Ben 
When patients with multiple problems came to see me for herbal therapy, I faced a logistical problem. How could I prescribe herbs for each and every problem? The total number of herbs required couldn’t fit into the pot to be boiled. I subsequently made a remarkable discovery: If I treated the primary problem, or what TCM calls the Ben 
, the accompanying disorders seemed to resolve spontaneously.
A Case of Eczema
Cynthia suffered from severe asthma and eczema. She arrived at my office wheezing and scratching. It was evident that there was a limit as to how many herbs I could prescribe, and I could not address all her problems at once. With that in mind, I began with herbs directed at the most troublesome condition, the asthma. I planned to phase in herbs for the skin after her asthma improved to the point where I could reduce the number of asthma herbs. To my surprise, I found that when Cynthia’s asthma resolved, her eczema also cleared. The Western approach would be to treat Cynthia’s asthma with inhaled bronchodilators and her eczema with topical steroids, as two separate problems. Actually, both conditions were Biao 
, or external manifestations, of the Ben 
, or root problem, a weakened immune system. When I treated her asthma, Cynthia’s prescription contained herbs for boosting her immune system. As that system became stronger, the eczema also resolved.
A Case of Melasma
This phenomenon of everything falling into place when you treat the root problem applied to another patient, Mary. In her late forties, Mary came to see me for perimenopausal symptoms of frequent irregular bleeding and hot flashes. She also had an appointment with a dermatologist to treat the recent brownish discolorations on her face. She had a skin condition called melasma, felt to be caused by an imbalance in female hormones. Melasma is common during pregnancy and may or may not resolve after the pregnancy is over. The Western treatment for it is usually cosmetic, a topical bleaching agent. Once I treated Mary’s menstrual irregularities with cycled doses of the hormone, progesterone, and then stabilized her hormonal balance with herbs, her melasma disappeared, and she no longer needed the bleaching agent.
Diabetic Nephropathy
My first patient, Betty, referred Wilma, who was thirty-three years old when she first came to see me. She had suffered from diabetes since the age of nine. The physician treating her diabetes had just told her that in a matter of five to six years she would need dialysis for kidney failure. At the time, 1985, other than monitoring kidney function, controlling the blood glucose, and perhaps prescribing a low protein diet, there were no known Western remedies to slow the progression of diabetic nephropathy. I treated Wilma using an herbal formula for glomerulonephritis that I had learned from Dr. Lai. The kidney is made of many units called glomeruli, which function as filters, allowing waste products to pass through their pores and into the urine without allowing the bigger molecules such as protein to be lost into the urine. In both glomerulonephritis and diabetic nephropathy, some of the kidney’s glomeruli malfunction and allow protein to pass through into the urine. Wilma’s prescription included herbs to tonify the Kidney, improving circulation to that area, Spleen herbs to help control her diabetes, and herbs often used for respiratory problems that protect the mucous membranes. The mucous membrane herbs help to normalize the filtering membrane of the glomeruli and not allow the pores to leak protein into the urine. By the time I retired from my integrated practice, Wilma, at age forty-nine, maintained her herbal regimen and still had not required dialysis.
Gallstones
Several years into my integrated practice, one of my Chinese church friends referred his sister to me. She was middle aged, slightly overweight, but otherwise in fair health. She described recurring symptoms of right upper abdominal pain that seemed to occur more when she ate fatty foods. My diagnosis of gallstones was confirmed by an ultrasound test. I recommended surgery, but she declined. Shortly thereafter, she returned home to Seattle. Time passed. One day I bumped into her in San Francisco, when she was again visiting her brother. She told me she had taken a patent Chinese herbal medicine called Dam Tong 
(which means “opening up the gallbladder”) and her gallstones had disappeared. This was confirmed by a repeat of her ultrasound in Seattle. Interesting, I thought, and filed the idea in the back of my mind.
Subsequently, Mrs. H., a Chinese Vietnamese refugee, came to see me with symptoms of gallstones. Her case was even more severe in that she had signs of liver dysfunction, indicating that the stones were obstructing the ducts that bring bile to the intestines. Again, the diagnosis was confirmed by ultrasound, and I recommended surgery. She asked if I knew of any other remedy. Understanding Chinese people’s aversion to surgery, I told her my previous patient’s story. I gave her the patent medicine name, Dam Tong, and told her she was on her own as far as trying to find the herbal medicine was concerned. I added that if it did not work, she should return promptly for surgery.
A few weeks later, she called to tell me she was having severe pain. I instructed her to go to the emergency room. A while after she arrived, the pain subsided. I strongly advised her to have surgery. She said, “I’ve been taking this herb medicine for about a month now. Why don’t you order another ultrasound to see if my stones have disappeared?” I told her I believed the severe pain was an indication the stones were still present. Again, I urged her to have the surgery, and she finally agreed.
I arranged for her to have surgery by a Mandarin-speaking surgeon. Mrs. H. was quite anxious, having never set foot in a Western hospital before. Her son stayed with her to translate for her and give her moral support. The next day, the surgery was performed, and that evening I received a phone call from the surgeon. He removed the gallbladder, but to his surprise, there were no stones in it. He further commented that the operating field was quite bloody. (These were the pre-laparoscopic days, when gallbladders were removed under direct vision by opening up the abdomen.)
Later, at a Chinese Home Health facility where I taught a class, I encountered a physician from China. Immigrant physicians from China commonly encountered many obstacles to getting California medical licensure. They therefore often attended such classes in order to find work in a field related to medicine. I asked her if she knew about Dam Tong, and wondered if she knew how it worked to eliminate gallstones. She told me that the herbal formula acts by relaxing the smooth muscles, which is what makes up the walls of bile ducts and blood vessels. When the smooth muscles are relaxed, the ducts dilate, allowing stones, if small enough, to pass through into the intestines. As I reflected on Mrs. H.’s case, it made sense. The severe pain that had required emergency room admission was probably the stones passing from her bile duct into her intestines. When they finally passed, the pain subsided. When the surgeon operated, he found the operative field bloody because the blood vessels around the gallbladder area were also dilated from the Dam Tong.
After that incident, when any of my patients with gallstones requested an alternative to surgery, I gave them the option. If their condition fit the criteria for using ursodiol, a Western drug that can dissolve cholesterol gallstones, I prescribed it in conjunction with Dam Tong. I had found a source of the herb product in Hong Kong, but late in my practice, Dam Tong was no longer available there. Now, newer and equally effective herbal formulations can probably be found.
Peripheral Vascular Disease
Not long after I started my integrated practice, Ed referred one of his patients to me for hay fever and lower back pain. Mrs. A. was in her seventies. I treated her hay fever with herbs and used acupuncture for her back pain. Several months into her treatment course, Mrs. A. asked me if the acupuncture she was receiving also helped circulation. She told me that she had suffered from peripheral vascular disease, which was being monitored by a vascular surgeon. Before seeing me, she could walk only three blocks before leg pain would make her stop because the arteries to her legs were partially blocked. A few months after beginning TCM treatments, she noticed that she was able to walk at least twice as far without pain, and her vascular surgeon recently told her the Doppler examination of her legs showed improved blood flow.
I did not think acupuncture could be responsible for the improvement. Most likely it was the herbs. Shortly afterward, I attended a lecture on the results of research conducted in China on some commonly used Chinese herbs. The speaker told us herbs classified as “quelling Wind 
” (see chapter 4) improve circulation to the peripheral vascular system. Quelling Wind herbs were in Mrs. A.’s prescription for hay fever.
Since treating Mrs. A, I have used an herbal formula combining quelling Wind with mobilizing Qi and Blood 
herbs (see chapter 3) for peripheral vascular occlusive disease. If the disease is not advanced, blood flow generally improves. I once treated an avid golfer who could play only nine holes without the use of a golf cart because of his claudication (calf pain caused by inadequate blood flow to the legs). After treatment, he was able to walk the entire eighteen holes. I have also treated diabetics with the typical nocturnal leg pain from peripheral vascular disease. One patient was in her eighties. On our initial respective examinations, neither her podiatrist nor I could feel the dorsalis pedis pulse in her foot. After my treatment, her pain disappeared, and the pulse became palpable.
Women’s Health
Treating women’s health problems with TCM has been one of the most gratifying aspects of my integrated practice. So often, women’s complaints are written off by Western practitioners because they don’t fit neatly into the Western diagnostic or therapeutic box. In the TCM paradigm, on the other hand, these symptoms not only make sense but are treatable.
Premenstrual Syndrome
One of my gynecology colleagues told me that when he was in training, what he most dreaded attending was the premenstrual syndrome (PMS) clinic, because there was so little that could be done for women suffering from PMS. But TCM shines in this area. I began treating women plagued with PMS, women who came in tearfully relating that they had only two good weeks out of each month. After I treated these women with herbs, their faces would light up with a smile on their return visits. For years, the prevailing Western medical belief was that PMS was only in the minds and emotions of women. Now, it is recognized that neurohumoral changes occur premenstrually. The current Western explanation is that PMS appears to come from an imbalance in the hormones secreted by the ovary. The current Western treatment of choice is antidepressant drugs, which have significant side effects (Grady-Weliky 2003). The Eastern approach is to use herbs that tonify Blood 
, such as Angelica Sinensis 
, combined with herbs that improve circulation to the ovaries, such as Rhizoma Cyperi 
. Using acupuncture to improve circulation to the ovaries is also effective. When the ovaries have an improved blood flow and are healthier, the hormone secretions become balanced, and the PMS symptoms resolve.
Menstrual Irregularities
Some women have irregular or infrequent periods because of a weak pituitary-ovarian axis. Normally, after puberty, the pituitary gland secretes FSH, a hormone that stimulates ovulation. When ovulation occurs, the egg releases estrogen and progesterone into the blood, and the pituitary gland shuts off and does not stimulate the ovaries again until the egg, if not fertilized, dies. The blood levels of the two hormones fall when the unfertilized egg dies, menstruation ensues, and a new cycle begins again with the pituitary secreting FSH.
Western practitioners treat irregular periods with birth control pills, which contain estrogen and progesterone, fooling the pituitary gland to go into its shut-off mode. During the last seven days of the birth control pill cycle, no hormones are taken, the blood levels of estrogen and progesterone fall, and the result is an artificially induced period. After the seven days, the woman resumes taking the hormones. Sensing the hormones, the pituitary gland continues to shut off FSH production, and the ovaries remain unstimulated. If the pill is taken for years, the unstimulated ovaries can “forget” to ovulate. The regular periods induced by birth control pills, like window dressing, make for a good Biao 
, but there is absolutely no benefit for the Ben 
.
For the purpose of contraception, the pill makes sense. For normalizing a weak system in women interested in eventual fertility, it is counterproductive. Herbs and acupuncture, on the other hand, can increase blood flow to the reproductive system and encourage ovarian function to normalize. Allopathic physicians, unaware of this complementary approach, prescribe the pill because for them, there are no other options.
Colds and Flus
One winter day during the flu season, Ed told me he had to take home some sample medication to his wife who was ill with the flu. He asked me to suggest an antibiotic. I told him, “You know the flu is caused by a virus, and antibiotics have no known effect on viruses.” “I know,” he said, “but I have to bring her something. She’s my wife.” Using antibiotics to treat the flu is one example of how allopathic physicians sometimes treat for the sake of fulfilling patient expectations, whether rational or not.
The allopathic medical community acknowledges that the most common overuse of antibiotics is for bronchitis. This overuse has led to an alarming problem: the emergence of strains of bacteria resistant to existing antibiotics. Pharmaceutical companies are constantly doing research to design newer drugs to outsmart the resistant bacteria. In order to recoup research expenses and make a profit, they market the new drugs extensively. Part of the marketing strategy is to give plenty of samples to physicians who, when faced with social pressures such as in Ed’s case, perpetuate this overuse. In many instances, a complementary approach is far less harmful. Some Chinese herbs are known to have antiviral properties. I have often found using these herbs, along with immune-boosting herbs, an effective way to treat colds and flus early and prevent bronchitis from developing.
Hyperactive Airway Disease
I realized I had come full circle in my integrated practice when my mother’s friend enlisted my help for her post-flu cough, a dry, hacking cough that her son, the chest specialist, could not cure. That type of cough was exactly what I had as a third-year medical student when my mother took me to the herbalist. I dutifully used TCM methods to examine her, remembering Dr. Lai’s words: “Any TCM doctor is not worth his salt if he can’t treat a dry, hacking cough. You just tonify the lung Yin.” I prescribed the herbs, and after a week, her cough was gone.
Four years into my integrated practice, I outgrew my timeshare office and moved into my own space. When I first opened my practice, I received gifts of plants from friends and well-wishers. Perhaps because of overwatering, none survived under my brown thumb except for one, a Creeping Charlie plant. As I packed to move, I congratulated my Creeping Charlie, telling it, “You are my only surviving plant that I took care of regularly for four years.” I picked up the pot and found it was very light. Evidently, my survivor was plastic! It survived not because of my care but in spite of it. I tell this story because we as healers often attribute success to our own efforts when actually it comes from the durable nature of the human body. TCM recognizes the body’s innate healing power and employs treatments that enhance that power.