Chinese herb substitution and using local species
I thank you all for your patience as I adjust to my workload. The reality of the situation is that I’m going to have to post what I can, when I can. But, with the onset of clinic I find myself coming up with many new thoughts to share - I’ll do my best to get them up in a timely fashion. Look also for the return of the podcast this week. I know you’ve missed me. :)
Anyway, in a fantastic lecture by Dr. Arnaud Versluys this weekend, I was reinspired to consider a very real problem in Chinese herbal medicine. We use herbs that travel long distances, are sometimes beset with chemical and heavy metal toxicity, are sometimes banned by ill-informed government agencies and some of which are becoming rare and, thus, expensive. Given that I am very serious about a rigorously authentic Shang Han Lun
The particular herb that came up in discussion about this issue was Xi Xin - Asarum - Wild Ginger. I love this herb. It’s used in a couple of indispensible formulas, perhaps most importantly in Dang Gui Si Ni Tang. Most herbalists agree that there’s simply no substitute for Xi Xin, but I’ve seen or heard of people try to replace it with Wu Tou, Yu Jin, Sheng Jiang + Mai Men Dong (?!) and other interesting combinations. Most of these same herbalists agree that it’s simply not the same without Xi Xin.
The ban on Xi Xin for practitioners is ridiculous to the extreme and I’m not going to discuss that here. What I would like to hear people discuss is how they make substitutions in these cases. When an herb you need isn’t around, what do you do? What herbs have you had to learn to live without? I understand that UK herbalists are quite restricted in what they can prescribe - how have my UK readers dealt with this problem? Even when a governmental agency isn’t busy interfering, we sometimes lose herbs. Consider Xi Jiao, rhino horn. Consider the precarious state of Ren Shen, ginseng.
There are a couple of associated questions that come up when one considers this issue. One is - should we simply learn to work with fewer, simpler herbs? Dr. Versluys is known to say that he thinks he could do a fair job of treating patients with only 10 herbs - a set of cooling herbs in each of five flavors and a corresponding set of warming herbs. If you know formula science and architecture, such artistry is certainly possible. Is this the standard towards which we should strive? It seems far superior to the never ending quest for the “perfect herb for cancer” or memorizing five hundred herbs, over half of which are specialized for particular symptoms.
Taking this a little bit farther, we should consider the wisdom of relying on herb sources that can only be accessed by air shipments from another continent. Given peak oil, given the unstable political nature of our planet, given the environmental crisis we find ourselves in… should we at least consider the possibility that we may need to rely on local sources for our herbs at some point in the future?
My friend said an interesting thing to me today. In the course of discussing this various issue he said, “To be true Classical Chinese herbalists, we should use the herbs we find around us.” I didn’t question him any farther on this issue, but I think he’s right from some perspectives. Learning the Chinese herbs and formula science so deeply that it is second nature allows us to look at all plants, animals and minerals with the eyes of a Classical Chinese herbalist. Then it seems at least possible that we could, if necessary, find other materials that meet the needs of our patients.
I’d be interested to hear your thoughts on this rambling post. Doubtless there are many opinions out there - share them here on Deepest Health by responding in the comments. No registration is necessary and you can even post anonymously if you are respectful.
Thanks for reading,
Eric
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Tags: chinese-herb, chinese-herbs, environment, flavors, formulas, herbs, nature, versluysRelated posts
Blog Action Day 2007 : Is Chinese medicine environmentally friendly?
Today is Blog Action Day - one day where many writers come together to blog about a single topic to increase our total impact. This year, the topic is the environment - something near and dear to my heart. In this article, I’d like to suggest that Chinese medicine can easily be a strong part of the solution to our growing environmental problems while also mentioning one area in which Chinese medicine practitioners need to advocate for more ecologically friendly practices.
Balance is as balance does (or vice versa)
One of the most powerful features of Chinese medicine is its ability to bring us into closer harmony with the natural world. In fact, all of the Classics talk about the importance of people’s closeness to and concordance with the processes of Earth. QiBo and Huangdi, some of Chinese medicine’s founding fathers, repeatedly lament the lack of people’s ability to live within nature’s boundaries and point to it as a major cause of disease as well as treatment resistance. Now it could easily become (and in some ways has become) a watered down forceless statement to say that Chinese medicine can bring you into harmony with nature - what does that really mean and why does it matter from an ecological perspective?
Being in balance means simply this - your body is in a physiological state whereby there are no extreme states. No intense cravings, no wildly oscillating emotions, nothing like that. You can sleep. You can smile. When you eat normal food, your guts don’t hurt. You don’t go into sneezing fits at the merest whiff of cat dander. There may be pain, sure, there may be problems of varying kinds - but the body is generally in balance around these points and things are moving in a more or less effortless fashion. When some adverse condition arises, your body is able to respond appropriately.
It is my assertion here that this state of balance, whatever it looks like for a particular individual, produces generally balanced behavior. Balanced behavior is less likely to be destructive in a number of ways. So much of what goes on from an environmental damage perspective comes from people’s unordered responses to life. Think about vices, for instance. So many of these (tobacco, alcohol, coffee) are intensively farmed with the accompanying herbicides and pesticides. Also, a body in balance may be more likely to ask for things that are generally good for it - such as fresh air, long walks and clean water. I know that when I’m the least in balance, I’m least likely to care whether I am drinking filtered water or eating organic food. It just doesn’t matter to me. Maybe I’m the only one.
Ecological medicine
Chinese medicine is generally ecologically friendly. Our equipment needs are minor, we don’t require huge research facilities that use a variety of toxic chemicals to operate. Because many Chinese medicine practitioners are likely to be following the principles set out in the classics, they may be more likely to pay attention to the way their products are produced and the way the electricity for their offices is generated. This is, of course, not always the case and probably less so outside of the Western world. Chinese medicine also doesn’t ask people to consume synthetic drugs, the production of which puts a heavy environmental load on the planet.
But what about herbs? If you’ve thought about it even for a little while, you’ve likely been concerned about the ecological impact of Chinese herbs. I know I have and I’d like to address a couple of the most obvious problems here.
Herbs frequently travel long distances, increasing our dependence on fossil fuels : what to do?
The vast majority of Chinese herbs are produced in Asian countries. If you do not live in an Asian country, it follows that these substance are going to have to be transported to your place of practice. The travel may be considerable and of course this means reliance on significant amounts of fossil fuels. There are a number of things Chinese herbalists can do to reduce their impact. Probably the easiest and most effective behavior is to research the herbs you are procuring from grower to distributor. Where do they come from? How are they transported? Can you find a distributor close by so you can use alternative transportation to get them? Can you find a supply line with a minimal number of links? Can you find a supply line that includes companies that have an ecological frame of mind? This will, of course, require some research - but it will be well spent.
Another possibility is to grow some of your own herbs or form growers coops in your local area. This is energy intensive and there is some question as to the energetic quality of the resulting materials, but I think it is at least something to consider. Going a step further, some people have suggested that instead of using the Chinese species of herbs we should do the research required to find local correlates to all of the herbs. These folks argue that the herbs will be more likely to resonate with our own physiology and the disease patterns we present if they are local. I am not convinced that this is the case and I am by no means sure that we are energetically sensitive enough to discover the Wei and Qi of herbs in an accurate manner today.
Chinese herbs are commonly produced using lots of chemicals in China : what to do?
Simply demand organic, or at least pesticide and herbicide free herbs. This is a very similar tactic as has worked with the organic foods movement. Simply know where your consumables are coming from and how they are grown and when the practices are ecologically damaging, demand better. Only buy from companies/distributors that support best practices - and when that is not possible, communicate your desires to the people you are working with. Finding chemical free herbs is not only good for the environment, but it’s great for your patients and will do a lot to alleviate their fears about taking products produced in China.
There may be other positive and negative environmental impacts of Chinese medicine, but these are the ones I think of most frequently. I’d like to hear what others think on these and related topics - please add your voice in the comments.
Eric
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Acupuncture safety: Is the Clean Needle Technique exam a scam?
At my school, and I believe elsewhere in the US, we are required to take the Clean Needle Technique (CNT) exam before doing acupuncture in the clinic as primaries. My exam is coming this weekend in Portland and boy am I excited. (Yes, that’s sarcasm). To tell you the honest truth, I haven’t thought too much about it - positive or negative. The basic procedure is like this - well in advance of the exam nearest you, you submit a sizable chunk of change (135 dollars right now) and an application. Some time later you receive word that you’re accepted or not. You’re then required to buy a copy of the CNT manual (another 20 bucks plus shipping if your school doesn’t carry it) and assemble a “clean needling” kit consisting of various items. You’re meant to study and practice before the exam, and then give up an entire day where you will apparently be lectured to about blood borne pathogens, the importance of controlling your workspace and using the tube insertion method of needling.
The idea, I think, is to ensure the general public that acupuncturists know about blood-borne pathogens and are doing their best to minimize the risk to patients. I don’t think this is a bad thing. The public, especially the American public, is germ phobic to an extreme. Letting them know that we’re doing our utmost to ensure their safety can only be helpful for the profession. Right? That could be the end of the conversation, but many folks have raised questions about the exam and the whole practice of “clean needling.” I’d like to graze over a few here in hopes of starting a conversation and maybe quieting some of the questions in my own mind.
The “course” and exam
The Clean Needle Technique “course” and exam are administered by the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM) based in Maryland. One of the major gripes I hear about the CNT course revolves around this organization. The question embedded in most of the complaints I have heard is whether or not this group is exploiting students for a profit motive. The assumption is that the group does nothing more than CNT, that CNT is not necessary or even useful and that the group charges unnecessarily for the service. As determined from their website, CCAOM’s primary aim is to improve the consistency and quality of Chinese medicine education in the US through the establishment of applicable standards for acupuncture and Asian medicine schools. They created a separate commission for the accreditation of Chinese medicine schools, now known as the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). They also have committees on a variety of topics not related to CNT and their newsletter suggests that they are still intimately involved in the continuing development of acupuncture and Asian medicine educational standards. For this reason, I do not support the assertion that CCAOM exists solely for the purpose of administering the CNT exam.
Regarding the profit motive… I have no idea how much profit the CCAOM makes from the CNT exam nor do I know what they would do with such a profit. I am always willing to give people the benefit of the doubt with regards to this issue. I know how much work goes into running an organization like this, and I’m disinclined to believe that they are profiting significantly from this practice. However, the regulations around the CNT Manual are absurd. Every person is required to buy their own manual ahead of time, photocopies and reuse of others’ manuals are prohibited. The manual is republished semi-frequently, so even if you had a friend’s - you may not be able to use it. While I understand the need to have an updated book because of the changing understanding of blood borne pathogens, I cannot think of a viable reason to require every student to spend 20 dollars on the manual. Allow photocopies and sharing of manuals - it’s the right thing to do.
There have been questions raised about the efficacy of the CCAOM in administering the exam from the perspective of enhancing patient safety. You can read a recent article in the Chinese Medicine Times about this issue titled OSHA Compliance: How Clean Needle Technique Falls Short in the US. Personally, I feel that the article goes too far in the WRONG direction - which I will discuss in the next section of this post. But the thought that the CNT exam doesn’t even do what it is intended to do very well is disturbing. That’s a lot of money to not even get the job done.
The practice
It is part of the Oregon Acupuncture Association’s code of ethics states that it is a legal requirement to follow Clean Needle technique to practice acupuncture in Oregon. I have not been able to locate that section in the Oregon statues that govern licensure, but several agencies refer to the requirement and I believe it may be a requirement in some way in the national board examinations. It would be interesting to know whether it is an actual legal requirement, and if not, why not.
The question is this - has there ever been any evidence that blood borne pathogens are transmitted by modern acupuncture needles? It seems certain that the risk would be much higher if you were reusing needles or using needles between patients. Few people do this - and it doesn’t seem like a 135 dollar course and exam would be necessary to teach us not to reuse needles. Assuming you are using disposable needles and using them only once - what is the risk? Several articles, such as this one in the Medical Acupuncture Journal indicate that the evidence is quite scarce that acupuncture poses a serious risk of transmitting blood borne pathogens even in highly risky situations. I personally know of no situation in which acupuncture caused any problems, blood borne pathogen or otherwise. In China, it is my understanding that very few if any people practice Clean Needle Technique and I am not aware of any outcry around the propagation of disease by acupuncturists. It seems exceedingly unlikely that the risk is significant. So why the obsession?
It seems to me that it would be smarter and easier for students to make Clean Needle Technique a mandated portion of their acupuncture curriculum (perhaps a couple weeks of the first class) and have a few salient questions concerning it on the national board exam. I cannot at this time think of a substantial reason to support the course and exam as it now stands. I would be delighted to hear any opinions to the contrary with supporting evidence. Have any of you practitioners been involved in any efforts to change or get rid of the requirement?
Eric
Tags: Acupuncture, ccaom, clean-needle-technique, education, exams, law, Learning, professional-developmentRelated posts
7 Ways Chinese medicine is changing the world (for the better)
I’m on vacation - soaking in the five elements on the Oregon coast. Here’s something quick to tide my loyal readers over. No pun intended.
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I’ll admit it, I’m concerned about the state of our planet and our people. I’m not a fatalist, I’m not a Doomsday prophecist. I don’t want to recommend that everyone move out into the woods and start tanning hides. I don’t think buying a shirt at Nordstrom rack is the pinnacle of evil. But, I do worry about global warming. I do wonder what kind of natural environment my daughter will be experiencing when she’s my age. I do think commercialization of our society has gone too far. When I decided to get involved in Chinese medicine I did so because I believed and still believe that it is a vital piece of the solution for many of the problems facing our world today. Here’s 7 reasons why I believe this and why you should, too.
1. Low-tech medicine reduces the impact on the planet. Chinese medicine requires few machines in most of its forms. It uses only simple medicines gleaned from the bounty of the Earth, stainless steel needles and the body of the practitioner. No elaborate high-tech production facilities dumping chemical laden sludge into the rivers and streams. No radioactive materials used in diagnostics. This is important given the rapidly deteriorating nature of our planet’s vital life-support systems. To be sure, there are also environmental challenges in the medicine - mostly related to the harvesting and processing of sensitive plants and animals. Further, the increasing popularity of our medicine has created a “race to the bottom” when it comes to the production of all herbs. This is beginning to be addressed and all practitioners must do everything in their power to put pressure on producers to create an ethical commercial environment.
2. Heals the whole person. Because CM theory regards the person as an integrated whole it inevitably treats the whole. So even though you may be coming in with a complaint of stomach pain, your doctor is likely to be treating a diverse range of imbalances with the aim of relieving your acute symptoms but also preventing their eventual return. If you maintain a relationship with your practitioner, you will inevitably uncover symptoms that you had forgotten about or simply learned to live with - these will be compassionately revealed and dealt with. Eventually, you will emerge as a healthy being on all levels - body, mind and spirit. A whole person interacts with the world in an integral way - and we need integral beings interacting with one another authentically if we hope to continue our evolution as a species.
3. Not involved in a race for progress. Classical Chinese medicine is rooted in ancient soil. It grows and thrives in this soil. To a large extent, progress in our medicine only means delving as far back as we can - absorbing all the wisdom from those amazing human beings who, for whatever reason, had a unique and incredibly accurate understanding of people and their ailments. We do learn from what is going on today, and various practitioners have learned to integrate the understandings of modern medical traditions into the body of the medicine. But there is no obsession with the Next Big Thing. There is no delving too quickly and with too little information into areas of understanding that have potentially disastrous consequences. I count this as a good thing, I believe you can see why.
4. Lends itself well to service for disadvantaged people. The gap between rich and poor is as large now as it has ever been. In the United States, many people live without insurance. The working poor have no recourse either from government programs that won’t help them because they are working or from the world of commerce that won’t help them because they are not affluent enough. People all over the Earth suffer in numbers that cry out in urgent need of assistance. Because Chinese medicine is highly portable and doesn’t require inordinate amounts of time for basic treatment - programs like Acupuncturists Without Borders and Working Class Acupuncture find fertile ground from which to grow. My school, National College of Natural Medicine runs clinics for disadvantaged people and many other schools do the same. I believe this is a field that will only grow as time goes on.
5. As an integral part of the healing process - patient as active participant. Many people have complained that contemporary Western medicine leaves them feeling disenfranchised in their own healing process. People who do not feel in control of their bodies and their fates are inevitably going to act like victims. People who act like victims are unlikely to be working for change, even if they believe it is important for things to change. Chinese medicine creates a space in which people can get to know their bodies and their bodies’ reactions to the environment. A good CM practitioner will encourage the person to be an active participant in their own healing process, extending the therapy at home and simply becoming more aware of their whole self.
6. The philosophical underpinnings of the medicine are what the world needs today. If I had to boil Chinese medical philosophy down to one word it would be “respect.” Respect for your body and mind, respect for balance, respect for nature, respect for other people. As a student, as I delve deeper into the Confucian, Buddhist and Daoist roots of my medicine my feeling of deep gratitude for others and the Universe at large grows exponentially. I believe I pass this on to others as I teach them about the medicine. Given what I said in #5 about patients being, essentially, students as they walk their healing path - each patient is going to learn something about the deep philosophical roots of the medicine they are using. So, practitioners and patients will both be impacted and hopefully deeply affected by the tradition of respect and balance that lies behind everything we do. Hopefully this will have a fractal effect throughout the world.
7. Increased international awareness an important by-product of its dissemination into the West. Particularly in the United States, awareness of other people is not a strong point of the culture. I’m sure you’ve all heard of the terrible studies where US citizens, young and old, couldn’t even say where some of the largest countries in the world are located. This isolationism and lack of interest in places outside of the US is having a range of negative effects on our culture. It’s hard to have compassion for people you don’t even know exist. When a person has a positive treatment from a CM doctor, they tend to have an interest in the philosophy behind the medicine. Sometimes this leads to a broader interest in Chinese culture in general. I know it did for me. I think just this simple process can have a profound impact on people - opening their eyes to the diversity of cultures on our planet. Surely a good thing.
Eric
Tags: Acupuncture, changing-the-world, lists, philosophy, revolution, TheoryRelated posts
Dizzy? Eat some dragon bones.
I ran across a news item today of some interest to my readers. It involves the discovery that some villagers in China were using the fossils of a dinosaur as medicine, apparently not knowing that they were an important artifact. 
“They had believed that the ‘dragon bones’ were from the dragons flying in the sky,” he said.
The calcium-rich bones were sometimes boiled with other ingredients and fed to children as a treatment for dizziness and leg cramps. Other times they were ground up and made into a paste that was applied directly to fractures and other injuries, he said.”
There are multiple problems with the story. Most importantly, we don’t know whether the villagers truly believed that the bones were from “dragons flying in the sky.” There is a Chinese herb known as Long Gu (龍骨) often translated as Dragon Bone. It is included in the category “herbs that calm the Shen/spirit,” and as the article points out - can be used in some cases of dizziness. It is also commonly used for other Liver-related symptoms like irritability, blurred vision and red and painful eyes. It can also be used for insomnia, for leakage of fluids (such as in night sweats and excessive vaginal discharge) and can be used for chronic ulcers on the outside of the body. It’s a useful herb - to be sure.
But what is this about Dragons? The dragon is a potent symbol within Chinese culture in general and that certainly works its way into Chinese medicine. One place to start in investigating Dragon is with the etymology of the character 龍, which can be translated as “a dragon,” or “of the emperor/imperial,” or “a huge extinct reptile.” When the character is combined with others, when the compound does not explicitly refer to something “dragon-y” it tends to confer a sense of nobility or supreme goodness on the phrase. The first point of interest here is, of course, that a “dragon” can simply refer to a large reptile - as the dinosaurs referred to in the news story.
But why call the herb “dragon bone?” While certainly some large reptile bones have been used for Long Gu, the most common Long Gu comes from various fossilized mammal bones. Why dragon? The answer may become clear after a quick look into some of the symbolism related to Dragon.
On the Chinese organ clock that we use so often in our program in Classical Chinese Medicine at NCNM, Dragon is associated with the Stomach. As such, the Dragon’s voracious appetite can be highlighted. The Stomach, our internal dragon, can be thought of as taking in things from the world so they can be transformed into nourishment - whether we are talking about actual food or simply food for thought. This position on the organ clock is related to the following aspects of time: The third month (approximately mid April to mid May), Taurus on the Western zodiac and 7-9am. All of these times are full of activity and ascending energy. The sun is rising! It’s time to get to work! Time to take it all in! There are other aspects to Dragon - but these elements work well together to prove my point.
One aspect of Chinese medical philosophy that is important to understand is the principle of balance. When there is great energy, there must be a great anchor. When there is great dampness, there must be a great capacity to dry. When there is great heaviness, there must be an element of true lightness. So the symbolism associated with the Dragon is all full of energy, all ready to take on the world - to digest! It is imperial - the figurehead, the one given the “mandate of heaven.” Within Long Gu we find a balance. This is one of the heavier herbs and its action is to act as an anchor. An anchor so that the rarefied and active energy of the Shen and the Liver can be calmed. The Dragon resonates with the healthy energy of the organs and functions that Long Gu seeks to heal.
Looking at it this way, maybe it isn’t so ridiculous that the villagers referred to the fossils as the bones of Dragons. Perhaps they were using the more-than-literal meaning when they said this - it’s impossible for me to know for sure. But be sure, when you are investigating Chinese medicine, not to dismiss a concept based on your first understanding of the language used. In Chinese medicine, there is almost always a lot of meaning lurking in every word.
Tags: Character, chinese-herb, chinese-herbs, cultural-differences, news
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