Salt-sensitive hypertension and Classical Chinese Medicine, Part 1
Editor intro
This is a Guest Post by 3rd year Classical Chinese Medicine student (and Chinese medicine blogger) Brandon Brown. Brandon is a friend of mine and an excellent student. He approached me with this paper and I immediately knew it would be a fantastic contribution to the site as many folks have asked me for rigorous examinations of the cross-pollination between Western and Chinese science as expressed in medicine. This will be a 3 part series released over the next 3 days, please feel free to leave comments - Brandon is a regular reader of the site. I should note that he has posted references for the entire series on his blog, you can access those references by clicking on this link. -Eric
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Author intro
The following three posts are from a paper I wrote in the Winter of 2008 for Dr. Edward Neal’s Clinical Physical Diagnosis course at NCNM. It is my attempt to apply classical Chinese medical knowledge to a modern disease processes that is pervasive, salt-sensitive hypertension. In looking at all modern diseases, I believe it is extremely beneficial as CCM practitioners to understand the patho-mechanism as presented to us by current research in Western materialism. Because yang (energy) leads and yin (substance) follows, by knowing the yin we can garner important clues that can allow our yang treatments to strike with more clarity, force, and efficacy. I welcome your thoughts and comments. - Brandon
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Salt-sensitive hypertension : Western science and the macrocosmic view
“The highest good is like water, it settles in the lowest place where people do not like to be.”
Dao De Jing
It is estimated that salt-sensitive hypertension (SSH) accounts for over two-thirds of people over 60 who have primary hypertension . Though there are genetic variants to the tolerance of the amount of salt that effects hypertension, dietary sodium is considered the most important environmental influence. This begs the question: why are some people who are hypertensive experience a salt sensitivity and others do not? The answer to this question may lie in the theories of Chinese Medicine and in the fundamental nature of salt, and its relationship to water and the Kidney. I will first give a summary of hypertension in western terms and discuss current research theories. Following this, I will discuss salt: cultural symbology, the natural formation, and specific references in the medical classics. By so doing, I hope to show how an ancient medicine sheds important light on this modern disease, through the connection of the Kidney and the Heart.
Hypertension - a more Western perspective
Primary hypertension is defined as chronically elevated blood pressure where systolic arterial blood pressure consistently exceeds 140 mmHg or greater. To be considered primary, the hypertension must be idiopathic, and not due to secondary factors such as kidney disease or adrenal tumors, for example. Primary hypertension is considered to be a major risk factor for strokes and cardiovascular disease, and is a leading cause of chronic renal failure . Heart disease is the number one killer in the United States, leading to well over half a million deaths per year.
It was observed in a strict rice and low-sodium diet study performed in 1944 that patients with kidney disease and hypertension were able to lower their blood pressure by as many as 100 mmHg in some cases . Current theories of the pathological mechanism of SSH posit abnormalities in renal sodium transport in the nephron structure of the kidneys . The cause for these kidney abnormalities are thought to be caused by both genetic and environmental factors. Because salt generally attracts water through osmosis, increased blood sodium not excreted by the filtering mechanisms in the kidney causes an increase in the water content of the blood, thereby causing the vessels to swell. This increased swelling, is an increase of “total peripheral resistance of the vasculature”, and is thought to create a long-term load on cardiac output ultimately leading to heart failure. Therefore, we can say that the presence of salt in the blood pushes out from the inside. This is contrary to the renin-angiotensin mechanism of the Kidney, which vasoconstrics and thus pushes in from the outside.
Salt in the Macrocosm
“Ye are the salt of the earth; the best of the human race.”
Jesus Christ in Matthew 5:13
The creation story of salt begins with fresh water falling from the sky as rain, and landing on the elevated earth. The nature of water is to always seek the lowest point of any terrain. The rain water falls on the hills at first as drops, which coalesce to form a trickle, which then join to form streams and these eventually join to form massive rivers, which empty into the sea. On this journey, constant erosion takes place as minerals are stripped from the earth and mountains and carried to the ocean. Because of its polar nature, water acts as a solvent to all matter. Place any material in water, and given enough time, transformation will occur. Metal will rust, vegetation will decay, and other liquids will eventually diffuse and become one with the water. The mineral rich streams, which still taste like fresh water to us, empty into the vast oceans that today are heavily salted and totally unpalatable, even though they are only 3.5% salt . The oceans continue to accumulate more and more salts because over millions of years evaporation extracts the water from the ocean, but not the minerals. The minerals are too heavy and earthbound to be steamed up to the heavens. This process is depicted in Figure 1.
Figure 1: The generation of saltwater
Of special interest in Figure 1 is how it reflects the generating cycle of the 5 Phases (五行). That is, Water falls from Heaven onto Earth and Metal, flowing down to Water, where through the energy of Fire, the fresh water is evaporated upwards toward heaven by the process of Wood. What is left behind is a storehouse of salt. Because of this, we would expect to find that places of warmer climate would have oceans with higher salt content. This is in fact the case, as places such as the Mediterranean Sea have a much higher salinity than that of cold water oceans (the Arctic and Northern Pacific, for example).
Salt is very much a dissolved solid from the Metal sphere. It is highly organized and crystalline, and looks almost identical to ice (Figure 2). Salt was the first currency of the civilized world, due to its value as a preserver of meat. As Richard Manning writes in Against the Grain, it was the ability to preserve and store meat which essentially lead to the creation of wealth and signaled the shift from nomadic hunter-gatherer societies to those of sedentary agrarian caste systems. Earlier than 800 A.D., the Yellow Emperor himself is said to have fought the very first war over the precious commodity . In 450 B.C., iron was put to use to boil sea water in huge pots to extract salt, a method that was used for the next 2000 years. By expediting the evaporative process, larger amounts of salt could be garnered more quickly and thus a greater amount of wealth could be amassed. Even in these ancient times salt stored, or preserved, wealth. To this day, the word “salary” comes from the Latin “salarium”, or “to be payed with salt.”
Not surprisingly, then, salt as a symbol of wealth came to symbolize all that is good. It is common practice to throw salt over the shoulder to ward off the devil, sumo wrestlers throw salt in the wrestling ring to purify it before a match, and placing piles of salt in tombs purifies the soul’s journey from earth to heaven, for example. Throughout history and across the world, in almost every culture, salt has been used in religious, medical, and cultural contexts to purify and clean the soul and the body from evil and disease . Ultimately, however, it is argued that salt is a often a cultural metaphor for semen, and the essence of man.
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In the next article in this three part series, Brandon will dive into the microcosm - discussing the mechanisms above as they reflect into the human body. Look for it coming soon.
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Tags: disease, environment, heart, kidney, macrocosm, metal, nature, salt, Science, water, western research, western-scienceRelated posts
Chinese medicine and cancer : Introduction
One of the things I would like to do as a physician is help people who have various types of cancer. I realize that even this statement will be regarded by some as problematic. Some say that Chinese medicine doesn’t recognize “cancer” as such and that Chinese medicine physicians shouldn’t “specialize” in treating any particular condition. I recognize the points in that argument. However, my partner and I feel a great affinity towards people who have had their lives touched by what Western medicine calls “cancer” in all its variations. It is an affliction that creates great hardship in the lives of many, regardless of what we call it.
I will write a series of posts detailing what I learn as I investigate the range of syndromes that we commonly call cancer. I will be looking at it from different angles. I am fortunate in that I have a variety of approaches to directly observe. Apart from what I will be able to observe in clinic and learn directly from professors, I will be doing literature searches and conversing with my many colleagues flung across the world via the Internet. I hope this series will be helpful for many types of people including my peers and other people who are seeking information about herbs, acupuncture and cancer. I am particularly interested in starting conversation around this issue, so I will try to end every post with a question - please leave your answers (however tentative) in the comments.
What is cancer? Basic Western and Chinese perspectives
From a Western perspective, the most basic way to describe cancer is simply as a disease process in which body cells begin to grow out of control. In general, this happens because of DNA in a cell that becomes damaged and is either (a) repaired, or (b) mitigated by controlled death of the damaged cell. This can happen for many reasons. Further, cancers in various parts of the body grow at different rates, in response to different environmental triggers. This, of course, results in the variable survival rates, symptoms and other features of different cancers. You can have cancer in virtually every part of the body. Causes range from inherited damage to DNA to inhaled toxins to accumulation of toxic by-products in the body and countless other factors. Western medicine has begun to understand cancer fairly well, but the fact is that there is still a ton of work to do. There are a huge number of foundations and government agencies working on finding “cures” for various types of cancer. If you want to learn more about Western perspectives on cancer, or to find resources in that realm - a great starting point is the American Cancer Society. You might also want to check out the National Cancer Institute.
In Chinese medicine, cancer is most often described as either a phlegm or a blood stasis accumulation (or both). Ultimately, cancer is not talked about as such - instead there is a description of masses or tumors. In this way, treatment generally progresses in a manner very similar to other masses and tumors. It is interesting that early on in Chinese medical history, a fairly nuanced way of classifying tumors emerged, based on the color, size, location, painfulness and other features of the mass and its local effects.
As with any other disease, we should start with the basics when we are looking at cancer. Using the essential Ba Gan (Eight Pillar) differentiation can help us get a handle on the disease process we are confronting. Is the imbalance of a Yin or Yang nature? Is it primarily hot or cold? Does it seem to be external (as in a cold) or internal? Is it deficiency or excess? While I’ve heard many simplistic answers to these questions when discussing cancer, I think the truth is probably more complicated. While masses are undeniably Yin in nature, a festering tumor or one in metastasis clearly has Yang qualities. While many cancers have the cold and cooling quality we would expect from a Yin-like disease, others burn brightly and cause great heat both superficially and internally. Regarding the internal or external nature, I think it goes without saying that all cancers are internal - regardless of whether we want to think of them of having been ultimately caused by a penetrating external pathogen. Cancers, too, may have deficient and excess qualities. I’ve obviously answered no questions here, but I’m starting to clarify for myself the deep complexity in a disease with such far reaching effects.
What are the standard approaches to treatment of cancer? Western and Chinese perspectives
Many of us know that the standard treatment options for cancer in the Western medical model are surgery, chemotherapy and radiation. Some folks choose all three of these options, some only one or two. Some people have reported that Western medical doctors (especially at forward-thinking cancer specific research centers) are doing more recommendation of dietary and lifestyle adjustment as a way to manage both the disease and the side effects of the strong Western treatments. This points out the deepest problem with Western medical treatment of cancer - the side effects. Surgery itself has its own recovery process which can be quite difficult for some - particularly those who are quite weak, elderly, or fighting some other disharmony in their body. Radiation and chemotherapy both use agents that are quite toxic for the body. The side effects are many, including the very visible loss of body hair, thinning of the skin surface and often debilitating loss of appetite, nausea and fatigue. Some people consider these to be necessary evils, since these treatments can be quite effective in eradicating some cancers. Still, many people yearn for alternatives - regardless of whether their particular cancer is effectively treated by these methods. Avoiding side effects, improving quality of life and increasing the effectiveness of Western treatments top the list of desired outcomes when people seek Chinese medicine and other natural therapies when treating their cancer.
Chinese medicine uses the basic set of powerful and versatile tools to treat all disease. A full treatment protocol from a Chinese medicine physician will include a Chinese herbal formula, an acupuncture prescription (perhaps involving cupping, needling, moxibustion or a combination of these and other manual therapies) and may also include lifestyle counseling, dietary advice and prescribed Qigong or Taiji movements appropriate for the presenting condition. For phlegm and blood stasis accumulations, the standard treatments will involve both resolving/dissolving the masses directly, promoting general movement throughout the Qi and Blood flow of the body and supplementing any deficiencies that might be accompanying the condition. The dietary advice will be specific for the person, but will probably advise against refined foods, fatty foods and very cold foods - as is the case for most serious conditions. Obviously, a variety of approaches exist - which is what I hope to investigate and communicate as this series progresses.
The many dimensions of the human being and their relationship to cancer
Yesterday, a patient remarked to me how disregarded she felt in the conventional Western medical world as she struggled with serious illness. She felt as though the patient had no interest in her as a person and saw her primarily as a carrier of some “target” to be measured and attacked by the physician. This most certainly impacted her healing process. She remarked how different naturopathic and Chinese medicine practitioners feel to her - she believes they/we see her as a complete person. Most of all, she feels like we treat her as a person at all. With a disease like cancer that is still one of the top 3 causes of death in most industrialized nations, I feel that it is easy for physicians to become detached. This may be a form of self-preservation. To become deeply connected with a patient and then have them die is certainly a difficult occurence. However, I believe as a physician of any modality you have a responsibility to learn how to take care of yourself in such a way that you are able to handle the diverse pressures involved.
Like any disharmony, cancer impacts people on as many levels as they have. Cancer certainly has profound physical effects, any Western treatments they are using have their own physical impacts as well. Cancer also impacts people emotionally. This is true of course in the sense that people are having to reckon with their mortality and the range of issues that comes along with that reckoning. But, from a Chinese perspective, the blockages that come about because of the actual existence of the mass and its Qi and Blood disturbing effects will almost surely be detrimental to the emotional balance of the human being. There are also social and spiritual effects on the person. All of these need to be addressed by the physician and patient in concert if true healing is to take place.
Hope, quality of life and survival
A frequently terminal disease like cancer brings up so many questions, it boggles the mind. There’s nothing simple about it. For instance, should survival be pushed for at any cost? That certainly seems to be the mindset of many people in the medical profession and beyond. What about quality of life? What is included in quality of life? If a person cannot feed themselves or use the bathroom by themselves, but can still engage in lively conversation and interact with loved ones - do they have a decent quality of life? While our focus must always be on promoting balance and well-being regardless of a patient’s disease state, we need to be thinking about these questions if only for ourselves. How do we provide a sense of hope and groundedness when the prognosis seems dire? On a more base level, what responsibilities do we have legally and socially when it comes to treating or not treating patients based on the severity of their condition? These are all questions we should be ruminating and discussing with eachother as a community. I’m sure you have ideas of your own, or perhaps have more questions.
A question for the readers: In your work with people who have cancer (or, if you are not a practitioner, in your personal experience with people with cancer) what are the most important things to keep in mind as you interact with the person? How can you create a healing atmosphere for people who are facing a disease that is often (often erroneously) considered to be a death sentence? Go ahead and share your thoughts in the comments. Don’t worry - thinking out loud isn’t penalized here. :)
Thanks for reading.
Eric
Tags: Cancer, compassion, cure, death, disease, patient care, quality of life, western-scienceRelated posts
Does Chinese Medicine cure disease?
I’m writing an article for a class about using Chinese medicine to deal with common colds and flus. This is one of my passions (I know, weird) and something I feel the general public doesn’t really know about. In the past three years, I’ve suffered two external invasions, one more flu like and one more cold like. During the first two days of both, I went to the clinic. They both resolved the next day, with copious herb intake in the Shang Han Lun style. I’m a believer, you might say. Simply because of my personal experience? No, because of the countless people I’ve seen have similar experiences in clinic.
Everywhere I read about “finding a cure for the common cold” indicates that such a thing has not yet been achieved. The party line goes like this, “While there is no cure for the common cold, there are things you might be able to do to reduce its duration and severity.” Well… yeah. My question is this - how is that not a cure?
The dictionary definitions for cure are many, but the most relevant for our purposes recurrent themes:
A cure is a process
A cure does not indicate that the disease never occurs (that’s more like eradication)
A cure involves treatment
When people talk about “a cure for cancer” I don’t think they mean that cancer would never happen. While a vaccine for cancer (or the common cold) would be nice, usually that doesn’t seem to be what people are discussing. What we want is a way to avoid prolonged suffering and/or death at the hand of the disease process in question. We want, in essence, to reduce the illnesses duration and severity to minimal levels. We want to get better fast and suffer few lasting negative effects from our experience.
I think one other essential piece of the idea of curation involves the ability for the cure in question to be always and everywhere applicable. We wouldn’t call something a cure that sometimes worked and sometimes didn’t. That may be the info behind the claim that no “cure” for the common cold has been found. That being said, under the care of a competent Chinese medical practitioner, I do believe that rectification of cold and flu symptoms can be reliably achieved. If under such circumstances a person still suffers from their symptoms or, perhaps, even worsens (developing phlegm deep in the lungs, for example) this is likely due to some misunderstanding on the part of the practitioner about the pre-existing state of the patient’s body constitution. This is the case, I think, with any medical therapy and any disease. Consider any disorder we consider to be “cured” in modern medical practice. If a person displays with that illness and the therapy is inappropriately applied or some pre-existing condition of the patient renders the therapy ineffective, we don’t cast shadows on the ability of that therapy to be curative for that disease.
For Chinese Medicine, curing a disease simply involves a restoration of the body’s natural balance. Yin and Yang come into appropriate relationship with one another and all the seasons of the body come in their course with a typical expression. The body responds easily to normal daily stresses and no symptoms of blockage (pain, pathological products) exist. Chinese medical therapies, when applied consistently and competently, rectify the state of health for many conditions for many people. Wouldn’t you say?
What is your understanding of “cure”? What would it take for you to consider the common cold to be “cured”? I’ll be interested to read your thoughts in the comments.
Eric
Tags: chinese-herbs, cold, common cold, cure, cure for the common cold, disease, external invasion, flu, healthRelated posts
Isn’t Chinese medicine just a bunch of spiritual mumbo-jumbo pseudo-science?
There are quite a few folks who would like to discount Chinese medicine out of hand. These people are unlikely to be convinced of its benefits until Western materialistic methods so thoroughly confirm it that there is no shadow of a doubt. Really, this group of people want to see all concepts of Chinese medicine translated into Western terms - eventually rendering Chinese medicine as just a quaint alternative way to discuss In my opinion, this promised land of verification is unlikely to be achieved. Much of the benefit of Classical Chinese medicine simply cannot be verified by the current commonly accepted forms of study. This is not to say that some level of verification is impossible to achieve - I think some level can and will be achieved. It simply isn’t likely to come from the land of double-blind placebo controlled studies or the realm of extraction, purification and verification of individual chemicals within herbs. No such verification is necessary, as Chinese medicine grows from its own ground and has internally consistent methods of testing and verification that have yielded a medicine that is remarkably safe and effective.
There are other people who, instead of discounting the medicine out of hand, simply want to strip it of all of the elements that seem to conflict with the findings of materialism. This is what Mao and Co. did when they took the diverse and interrelated parts of ancient Chinese medicine, sanitized them and gave birth to Traditional Chinese Medicine (TCM). This is what many people continue to do. The argument is that discussions of Spirit, demons, elementals and possession are superstition, while Qi and Blood are medicine. To make Chinese medicine relevant, they say, we need to purge it of all of that silly nonsense and retain that which is more reasonable.
To be sure, there are things that should be included in the official canon of Chinese medicine and there are things that should not be included. But to purge things simply because they relate to non-material aspects of being or involve language that some people are uncomfortable with is irresponsible. We need to understand what these things mean, interpret them within their ancient context and understand their relevance. It may be that we find different language is more appropriate for our contemporary context to describe some of these concepts - or it may be simply that we need to discard our prejudice and embrace more complex medical terminology.
Let’s take one concrete example - the concept of Shen 神, often translated as Spirit. Shen is said to be the domain of the Heart, it is also said to be the light of consciousness, the animating principle. It is present in every part of the body, carried in the blood, but it is uniquely carried in the Heart. The primary pathology involving Shen, “Shen Disturbance” is often likened to various forms of mental illness. To illustrate, in the Neijing, Qi Bo says, “神 有 餘 則 笑 不休 ， 神 不 足 則 悲” which can be translated as “When Shen is in an excess state, one has hysteria or mania. When Shen is in a deficient state, one has depression or profound sadness.” Here we can see the emotional dimensions of the Shen. It would be tempting to leave it at that, but elsewhere in the Neijing and other texts we find many different functions and concepts attributed to the Shen. Some of these functions and concepts do relate more to “spiritual” matters as they are seen in many Western cultures. Shen includes all of these things.
I think it is this multifaceted nature of Chinese medical terminology that puts people off of it and compels them to demand that it be as monodimensional as other forms of medicine. Because many terms cannot be easily defined or put in a one-to-one relationship with easily recognized Western medical concepts, people simply dismiss it. However, it is this complexity that make the medicine so powerful. If we take the time to study these concepts, to understand them intellectually as well as experientially we can understand a complex disease like clinical depression much better. I have used this approach trying to understand my own medical problems and have found it to be very helpful in finding new treatment directions.
Eric
Tags: clinic, disease, herbs, language, materialism, nature, neijing, Science, study, tea, traditional-chinese-medicineRelated posts
Top 5 Reasons to make Classical Chinese medicine your medicine of choice
1. Clinical effectiveness: Chinese medicine, particularly when it is practiced in a Classically-based manner, works. In my scant year of clinical observation, I have seen miracles transpire. I have seen people shackled by various conditions, sometimes all their lives, be simply TRANSFORMED after only a few treatments. Many of you have probably seen this as well. It works for patients - and that’s what medicine is supposed to do.
Yes, I’ve read THAT study, too. Studies have flaws - THAT study has been roundly denounced by a number of people in a number of different ways. I’d be glad to discuss it in another post. Think also about this - Chinese medicine works in a manner entirely different from Western medicine. It’s so different, in fact, that placebo controlled double blind studies may simply be ineffective for displaying what it is that Chinese medicine can do. Clinical studies are another matter, and many show the great effectiveness of Chinese medicine. Where those studies have been negative or inconclusive, I feel that it probably has something to do with the level of Chinese medicine being practiced in the study. That’s why I’m hoping to do (and encourage others to do) clinical studies through Helfgott Research Institute. I’ll certainly post about any future results.
2. Doctors who take their time: When you see a Chinese physician for the first time, you will probably be amazed by the intake process. The process is extremely detailed, and Chinese physicians take all of your concerns under advisement - not just those that fit neatly into a simple diagnostic category. Chinese medicine physicians will not dismiss your concerns as “irrelevant” or “psychosomatic,” they will integrate each manifestation of disease into a full diagnosis that will guide a treatment to rectify the balance of your ENTIRE system.
3. Fewer environmental impacts than Western medicine: Chinese medicine doesn’t employ pharmaceuticals or other chemicals in carrying out treatment or diagnostics. The pollutants dumped into our waterways by the pharmaceutical industry are a significant problem. That being said, there are real environmental issues that the CM profession must grapple with, including the problems inherent in importing herbal products from China. Although that is most certainly a post in itself - I want to point out that many American companies are working to find pesticide-free and sustainably produced herbal products. More of this is surely to come.
4. Good cost-benefit ratio: As we all know, the escalating costs of healthcare are leaving many Americans uninsured, causing nearly unbearable pressure on the hospital system and social services. That the wealthiest nation in the world leaves so many people without access to basic care is reprehenisble. Natural medicine in general represents an answer to this problem. Many treatments by Chinese medicine physicians use food therapy and economically priced herbal supplements. Further, you will find that the average office visit for a Chinese medicine doctor is very reasonable considering the great depth of care you receive. Insurance companies are beginning to pick up the cost of these office visits, which is an encouraging sign.
5. Total integration: This medicine doesn’t “rob Peter to pay Paul,” as the saying goes. When your chief complaint is treated, it is treated in order to integrate your entire self - mind, body and spirit. So, for instance, your ongoing treatment for seasonal allergies isn’t going to create dryness in your mucus membranes, difficulty sleeping and pervasive feeling of anxiety. This will reduce your overall discomfort, as well as keeping costs down - you won’t need to buy medicine to treat the problems that your medicines produced!
There are certainly many more reasons you should make Classical Chinese Medicine your medicine of choice - but I hope this list will provide you with some food for thought as you contemplate your health care options. Remember - YOU DO HAVE OPTIONS!
Tags: balance, china, clinic, disease, ego, environment, food, health, helfgott research institute, law, service, study
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