A Rather Misleading Study

According to the American Cancer Society, the medications used in IVF assisted reproductive treatment can cause cancer.  In a recent Medscape editorial, however, Dr. Arefa Cassoobhoy argues that a new study of 250,000 British women proves that exposure to the high levels of hormones used by reproductive specialists does not significantly increase cancer risk.  Based on the size of the study and the fact that the women were tracked for an average of 9 years after IVF care, the results of the British study seem compelling.

The epidemiology of reproductive system cancers in women, however, raises some questions.  For breast and ovarian cancers the mean age is in the early 60’s.  Since the average age of the recipients of IVF treatment in the study was 35 and the researchers followed patients for an average of 9 years, the majority of the women were only studied until age 45.  In other words, the U.K. research team stopped looking at the subjects almost two decades before they were statistically likely to be diagnosed with cancer. 

There is an argument to be made that if cancer occurred more than 9 years after treatment it would not be a direct consequence of the IVF treatment.  Although the better part of a decade may seem like more than enough time to figure out whether or not a carcinogen has resulted in cancer, a review of latency periods challenges this assumption.  In fact, for many kinds of cancer, the time between exposure to a carcinogen and the onset of a cancer, the latency period, is measured in decades.  This explains how a patient who quit smoking 15 or 20 years earlier might still end up with lung cancer.

Given the lengthy duration and notable size of the UCL Great Ormond Street Institute of Child Health study, the good news is that cancer risk from IVF fertility medications during the first decade subsequent to treatment has been shown to be reassuringly low.  But, as the study’s researchers themselves observed, "We cannot exclude the possibility of different risk profiles for any studied cancer on longer follow-up, at ages when most reproductive-related cancers occur."  If we want "to put the IVF-Cancer connection to bed", as Dr. Cassoobhoy suggests, further studies of women who have received fertility medicines and whose age puts them at high risk of developing a reproductive system cancer are essential.

Acupuncture: Expectation or Expertise?

While recently listening to a lecture by Honora Lee Wolfe, co-founder of Blue Poppy and one of the best teachers and practitioner of acupuncture in the U.S.,  I was struck by her comment that the function of an acupuncture point depends on the expectations of the practitioner.  Ms. Wolfe's intriguing observation started me thinking about one of the central conundrums that I have been mulling over throughout my professional career:  what role does intention play in the clinical outcomes of acupuncture treatment?  Now almost two decades into practice, I finally have enough experience to be able to come to some conclusions on this topic.

During my teaching career, I supervised students in clinic for more than a decade.  As a specialist in diagnosis, I carefully reviewed the patient charts to ensure that students developed good diagnoses based on the evidence.  Furthermore, on my watch students were expected to generate logical treatment methods and select points or formulas consistent with their treatment plan.  Occasionally I would run across a case where, despite a diagnosis unsupported by the evidence and a lack of coherence in the clinical process, the patient reported considerable improvement.  When the student practitioners themselves were unable to explain their treatment choices or why they had led to good results, I was perplexed.

Given the deviation from the proven clinical methodology, I came to the only reasonable conclusion:  the sincerity, compassion, and attention of eager students had a beneficial effect on the patient's qi.  If we recall that qi gong and tai ji practitioners tell us that the "mind leads and the qi follows", it is not surprising that the care and concern of a student could positively influence the flow of qi in the body.  These experiences seem to corroborate the theory that intention is a key ingredient in a successful acupuncture treatment.

On the other hand, it would be an egregious mistake to dismiss the critical role of expertise in the effectiveness of acupuncture care.  Although it is difficult to definitively parse out skill from the expectations of the practitioner, clinicians with years of experience have many stories of treatments where the outcomes exceeded anything for which one could have ever hoped.  Of course, there is also no shortage of cases where, despite expectations for great results, success can only be had by reassessing the situation and devising a better treatment plan.  From these experiences one realizes that intention alone simply will not yield the best results. 

I recall a student many years ago who was required, as part of clinical training, to demonstrate the ability to do a point joining needling method.  She selected a point, and I left the room to check on other students.  When I returned, I discovered that she had not joined points with a through-and-through method but, instead, had inserted the needle just into the superficial surface of the skin. When questioned about why she did not perform the required technique, she replied that she had “joined” the points with mental intention alone.

The point of the story, of course, is that intention and action naturally go hand in hand.  Imagining an activity is not to be confused with intending to act a certain way followed by actually performing that act.  I have long contended that great acupuncturists spend a lifetime moving back and forth from study to practice, honing their skills and knowledge through clinical experience, tempered and guided by the insight of historical doctors.  Considering the recent popularity of mindfulness, we should remember that thousands of years ago in the acupuncture classics, doctors were encouraged to bring complete attention to their practice, as if “holding a tiger by the tail.”  Cultivating this serious attitude, we see how both intention and technique could be developed to the highest level in order to provide our patients with superlative results.

Food Additives and Children

For those of you have endured criticism, even ridicule, for worrying about the chemicals in the food we eat, your fears have now gained credibility from a well respected source, the American Academy of Pediatricians or AAP.  The AAP is voicing its concerns over the proven adverse effects of food additives and the chemicals used in packaging, as well as calling for more due diligence in reviewing the safety of other substances not fully vetted for safety.  This statement coincides with the findings of a new study that demonstrates a strong connection between the nitrites and nitrates in preserved meats and mania.  The lead investigator involved in the latter study has gone on record as saying that his research is just the tip of the iceberg of understanding of how diet affects our behavioral health.

Although we touched upon this topic in an earlier blog post, it is impossible to overstate the critical importance of feeding children not only nutritious food but also ensuring their diets as natural as possible. It has been estimated that as much as 70% of the chemicals we encounter in our daily lives have never been tested for long term effects on human health.  As detrimental as these synthetic substances may be to adults, it is only reasonable to assume that the effects on children are much greater.

The AAP is especially calling attention to chemicals likely to leach into our children's food from containers and packaging.  The BPA found in many plastic products, for example, has already been shown to negatively impact human health.  In one study, there was a close correlation between the levels of BPA present in urine and weight gain in the teenage females subjects.  Questions about the safety of food containers adds an additional task to parenting.  Not only do we need to read labels for chemical additives, we should also make sure that packaging is free from risky compounds.

Many parents today, tired of having to constantly discipline their children, take a more laissez-faire approach to diet.  Unwilling to swim upstream against the mainstream current that has come to embrace processed foods, these parents allow their kids to eat all of the things that "normal" kids do.  With many diseases on the rise, however, we have to remember that poor nutrition and the chemicals in many foods may eventually threaten the well-being--even the lives--of our most vulnerable family members.  As a mentor of mine was found of saying, you would never standby while your son or daughter tried to run out into the middle of a busy road.  Why, then, would a parent choose to ignore the very real risks posed by letting children eat foods that might harm them? 

The American Suicide Epidemic - Pt. II

In our last blog, we discussed the remarkable fact that, although prescriptions for antidepressants have increased 65% over the last fifteen years, we have also seen an unprecedented two-decade increase in the number of people committing suicide.  With the high profile suicides of Kate Spade and Anthony Bourdain this week, it is hoped that more attention will be given to this troubling crisis, resulting in better ways to address the American depression epidemic. In our second blog on the topic, we not only explore Chinese medical options for treating depression and preventing suicide but also touch upon some of the underlying factors that may be contributing to the shocking number of people annually who take their own lives here in the U.S.

Studies have shown that, while the rates of depression are typically low in the developing world, people from those countries who then migrate to the United States will, within 7 years, be as likely to be depressed at the rest of us.  This information demonstrates that depression, and suicide, involve not only our own personal health but also reflect the wellness of an entire society.  Despite our high standard of living, life in America today takes a toll on our mental and emotional balance.  Burdened by massive debt, overwhelmed with the flood of information (much of it negative), and often lacking the fundamental support of a solid family structure, it is challenging to stay positive and mentally and emotionally healthy.

Due to the possibility of suicide, any discussion of CAM care for depression must begin with a reminder of how high the stakes are and how important it is to have a Western healthcare professional on the team.  Access to fast-acting medications and the ability to deliver 24/7 care can prevent suicide and save lives.  Without the right sort of oversight and treatment, depression can spiral out of control and transform into a fatal event mercilessly fast.

To the team effort of helping those with depression live better quality lives, Chinese medicine offers both an understanding of unipolar depression and supportive care.  From our TCM perspective, the disease of emotional depression always arises from the pattern of binding depression of liver qi.  In binding depression of liver qi, the global qi of the system is stagnant and depressed, necessitating treatments and self-care which facilitate qi movement.  In the clinic, this translates into the use of acupuncture points to course the liver and acrid, aromatic formulas to move qi and lift the spirit.

For self-care, the Chinese medicine practitioner will recommend regular, moderate exercise to get the qi moving.  This idea is also corroborated by scientific studies that have shown how physical activity can improve mood.  Of course, nutritious food, adequate relaxation, and social interaction can assist in maintaining a good, healthy, and balanced flow of qi.  Even medicinal incense, which delivers an acrid aroma to stir the mind, may be recommended to raise a patient suffering from depression to a more joyful and active emotional state.  Please speak with an experienced, licensed TCM health professional for guidance with these self-care methods and additional ideas about how to get more out of your life

The American Suicide Epidemic - Pt. I

Today we woke to the sad news of the suicide of chef and TV personality Anthony Bourdain whose love of food and acerbic commentary delighted millions.  Bourdain's passing follows on the heels of another celebrity suicide, that of noted fashion designer Kate Spade who took her own life earlier in the week.  Although the suicides of two well-known individuals in the same week may be coincidence, the publication a few days ago of a new CDC report warning about the increase in the number of suicides in America over the last two decades confirms that we are in the midst of a suicide epidemic.

In August of last year, the CDC reported a startling 65% increase in prescription antidepressants in the U.S. during the last 15 years.  Despite the fact that one-in-eight Americans over the age of 12 is now medicated for depression, in half of the states suicides have increased by 30% since 1999.  This raises the obvious question of why the current standard-of-care for unipolar depression is so clearly failing to prevent more individuals from taking their own lives.

Of course, the issue involves a complex web of factors, and it would be unfair and unrealistic to lay all of the blame a the feet of American psychiatry.  According to the CDC findings, 46% of suicides have never received a diagnosis of clinical depression, suggesting that treatment failures only account for about half of suicides.  We can assume that, of the remaining half who are not being treated, some receive regular medical care while others do not.  We can also safely state that some of the individuals who make up the untreated half present with obvious symptoms of clinical depression but remain undiagnosed, while others end up taking their own lives without ever having manifested any signs or symptoms of depression. 

Accordingly, in order to stem the rising tide of American suicides, healthcare professionals need to take steps to ensure that patients who present with the symptoms of clinical depression do not slip through the cracks.  It is also necessary to reach out to Americans who may not regularly see a healthcare professional but need help managing their unipolar depression.  Not only should our public healthcare measures target potential patients, it is also imperative to inform a broader group who might be able to identify a potentially lethal depression in their friends and family members.  In other words, it is high time to raise national awareness regarding suicide.

Finally, we return to the elephant in the room:  why do 54% of suicides occur despite medical treatment?  We must recognize that there currently exists no comprehensive biological model of mood in modern psychiatry, so behavioral healthcare professionals do their best through therapy and the manipulation of certain components of brain chemistry to battle this dangerous disease.  At some point, however, as more and more Americans reach the apex of clinical depression that tragically culminates in self-inflicted death, we need to admit that our current model of care is inadequate and rethink our approach to helping those crippled by this increasingly common mental ailment.  Barring a thorough reassessment of the extant standard-of-care and a fresh, innovative approach to the treatment of depression, it is likely that suicide will continue to rise in rank among the leading causes of death in America.

The Not Quite a Doctor of the Future

A recent article highlighted the sometimes acrimonious dialogue between physicians and advanced practice providers regarding the capacity of the latter to function as PCPs.  Obviously, there are both pros and cons to substituting a nurse practitioner or physician's assistant for an MD.  On the one hand, many APPs bring extensive experience with hands-on patient care as well as a commitment to compassionate service to their work.  These qualities resonate with patients, some of which even prefer an APP as their primary care provider over an MD. 

Conversely, with some states only requiring an additional year in school to upgrade from an RN with a bachelor's degree to a nurse practitioner, many physicians point out that the training most advance practice providers receive could not possibly prepare them sufficiently for independent primary care provision.  Although many clinical encounters involve common conditions, the competent primary care provider must also be trained to identify and treat a broad range of unusual conditions in order to maximize clinical outcomes and minimize patient risk.  12 months of education, many would argue, is simply not adequate to master all of the necessary knowledge and skills.

Barring some major change in the current laws, advanced practice practitioners are, however, here to stay.  Between the support of enthusiastic patients and the cost benefits to healthcare companies, the number of APPs will skyrocket over the next ten to twenty years.  Given the reality of the changing landscape of American healthcare, it is critical to develop efficient and effective models of teamwork and to ensure, above all, that patients continue to enjoy effective and safe healthcare services.  What might this mean for patients and how will CAM providers fit into the new healthcare model?

Currently we see fewer and fewer MDs going into general practice, and salaries for family medicine providers languish far below that of most medical specialists.  At the junction where the disincentives for MDs who would go into family medicine intersect with the growing interest in advanced practice lies a trajectory carrying us towards a revolution in care.  In the American healthcare system of the near future, it is likely that MDs will primarily be specialists waiting on referrals for especially complicated or specialized cases, while APPs will provide the bulk of our basic healthcare needs.

As primary care service shifts from doctors to APPs, new tools will be developed, ranging from diagnostic aids to better treatments, that will allow healthcare workers with less formal training to practice better medicine.  For example, a nurse practitioner will be able to utilize genetic testing to ascertain which type of antidepressant is most likely to afford a good clinical outcome for a particular patient.  As another example, new electronic medical record systems will be introduced that will organize and prioritize data more efficiently.  By organizing medical information better, the APP of tomorrow will be able to avoid mistakes, improve diagnostic accuracy, and track the results of treatment.

Assuming that the torch of responsibility for primary care can be successfully passed from MDs to APPs without a significant impact on clinical outcomes, the immense savings of healthcare dollars will accelerate the evolution towards a system where primary care is exclusively provided by advanced practice practitioners.  Additional impetus in this direction will come from the limits placed on MDs who continue to provide primary care.  Despite their extensive medical training, if the companies that control healthcare services are only willing to employ general practitioners or family medical doctors who can sustain practices with heavy patient loads, inevitable medical mistakes coupled with crippling practitioner burnout will result in more and more MDs relinquishing the reins of primary care to advanced practice practitioners.

For CAM practitioners, the future looks bright.  Advanced practice practitioners tend to be pragmatic clinicians who are open to the consideration of alternative treatments.  Compared to their MD counterparts who spend more than a decade steeped in a singular perspective on healthcare, APPs are often more likely to have a broader background and perspective.  In the Acupuncture and Oriental Medicine community, we look forward to a collaborative effort with advanced practice practitioners to not only provide effective treatments but to also work towards a healthier society. 

Thoughts on the New Shingles Vaccine

For the last two decades, our practice has observed what appears to be a marked increase in the number of cases of shingles.  Not only has this condition apparently become more common, it would also seem to be affecting younger people than in the past.  Of course, clinical impressions do not always accurately reflect the broader national picture.  In this case, however, data from the National Institutes of Health confirm that the number of patients experiencing acute episodes of herpes zoster has dramatically risen as much as 50% in just three decades.

Some medical authorities have attempted to explain the explosion in herpes zoster cases with the theory that our success in vaccinating against chickenpox in children has, ironically, resulted in more cases of shingles in adults.  Like the popular hypothesis that the thimerosal in vaccines causes autism, however, the current studies have found no clear correlation between changes in vaccination protocols or formulation that correlate with changes in the prevalence of disease.  To date, no other compelling theory has been offered to explain the increase.

For British pharmaceutical giant GlaxoSmithKline, however, the present shingles epidemic is less of a mystery than it is a lucrative opportunity.  At the cost of $280 for the two requisite injections, GSK is salivating at the estimate that Shingrix will bring in over $1 billion dollars in revenue by 2022.  The vaccine, a blend of antigen derived from hamster ovaries, fats from salmonella, and herbal extract from soap tree bark, has performed well in clinical trials.  The adverse affects of muscle pain, fatigue, and headache in about half of vaccine recipients notwithstanding, Shingrix not only reduces the risk of getting shingles but also prevents the chronic pain of post-herpetic neuralgia. 

But, rewinding a bit, what of the elephant in the room?  While the manufacturer of Shingrix stands to benefit from the failure of medical scientists to identify a clear cause for the increase in the number of shingle cases, it may turn out to be critical for our public health and wellness to get to the bottom of this conundrum.  There are several important questions to ask.  For example, does the recent success of shingles indicate a widespread decline in the immunity of older Americans?  If a lack of immunity is to blame, then what factors are impairing our bodily defenses?  Or perhaps the problem lies not so much in our immune systems failing to keep the herpes virus in check as it does in as of yet unknown factors catalyzing the dormant pathogen. 

Unfortunately, the new vaccine threatens to lull both the public and healthcare workers into a false sense of complacency.  Disease, as uncomfortable and frightening as it may be, often has a silver lining: illness can be a tap on the shoulder - or slap in the face - from mother nature encouraging us to examine our lifestyles and devise better ways to live.  These "wake up calls" not only help us to make healthier personal choices but can also act as a referendum on societal trends.  Driven by the motivation of enormous profits, however, humanity today seems more inclined to hit the snooze button than learn a valuable lesson.  We do so at our own peril.

 

 

Two Different Standards for Diabetes Testing

At the beginning of this year, the American College of Physicians issued revised guidelines for the drug management of type 2 diabetes.  Central to their recommendations is a target A1C of between 7% and 8% for most patients.  Conversely, for the past several years, the American Diabetes Association has set a goal of an A1C below 7%.  The ACP and the ADA are both influential healthcare authorities whose directives impact the way we practice medicine in America today.

While the discrepancy has led to a robust discussion among physicians, patients are more likely to just end up confused.  How can two authoritative sources disagree on the basic standard for optimal blood glucose levels for those with type 2 diabetes?  Of course, as Dr Shubrook from Touro University argues, there is consensus that diabetes care needs to be tailored to the needs of individuals patients.  Recognizing the value of personalized care, the disparity between the two guidelines can be understood as being representative of a broad spectrum of possibilities that allow physicians to make case-by-case decisions.

It is even more important, however, to grasp that the numerical findings from lab testing are, ultimately, numbers on a page, subject to both a margin of error and different perspectives regarding their relevance.  Disagreements among healthcare professionals are not unique to the interpretation of A1C results but also impact our understanding of cholesterol numbers, blood pressures, and PSA testing.  The use of the PSA test, in fact, has even drawn the sharp criticism of Richard Ablin, the scientist who first identified prostate-specific antigen.

Returning to the subject of blood glucose, it is generally accepted that lower blood sugars are preferable over chronic hyperglycemia, so one wonders why the American Diabetes Association would set a higher average target A1C.  There are two possible answers to this question.  First, according to research, hospitalizations and fatalities in elderly patients treated for elevated blood glucose are, in fact, more often caused by hypoglycemia than hyperglycemia.  Furthermore, other studies have demonstrated that many of the diabetic drugs generate at least one common adverse effect.  Adding to a patient's drug regimen is, therefore, likely to result in additional health issues which also require treatment, trapping doctors and patients in a vicious cycle.

This dilemma for conventional care is actually an opportunity for  AOM (acupuncture and Oriental medicine).  As a Western medical condition, the treatment of diabetes is outside of the scope of acupuncture and Chinese medicine care, but, backed by 2,500 years of success in helping those suffering from diabetes to enjoy a better quality of life, AOM is not dependent on our modern diagnoses or testing to be effective.  The key to getting a good outcome is relying on the unique methodology of traditional Chinese medicine that facilitates authentically personal care.

The process begins with identifying the main complaint and all of the presenting patterns for each patient.  By focusing on the chief complaint, the Chinese medical practitioner sets a pragmatic goal to quickly make a difference in the patient's quality of life, while addressing all of the patterns provides holistic, individualized care to promote long-term wellness.  Although the explicit reduction of blood sugar levels is unrelated to the traditional treatment goals of Chinese medicine, patients who receive Chinese medical care typically report significant improvements in their daily blood glucose readings and A1C levels.

As the number of individuals with type 2 diabetes continues to rise, we need to use all of the resources at our disposable to ensure that patients live the healthiest and longest lives possible.  This means not only availing ourselves of the newest Western treatment options but also employing traditional medicine where appropriate.  When it comes to the epidemic of type 2 diabetes, we just cannot afford to discriminate against useful treatments that can deliver the personal, effective treatment that patients need.

Ode to Caregivers

This short poem was inspired by a friend of mine who has provided care not only for her own family but also for others around her in need.  In addition to being a tribute to one special individual, these words celebrate all of those care givers who show us the capacity of the human heart for compassionate action.

Return to Sender

Burden eased by kind befriender,

A companion steadfast and true,

Broken spirits find their mender,

Begin to walk together through.

 

Courage fierce in the face of strife,

Ne’er daunted by the struggle great,

Relinquish freedom dear in life,

Share another’s fate.

 

Tending care for every need,

No hard request denied,

Proof in doing each small deed,

Of a love implied.

 

Where winding path finds its end,

From suffering and loss break free,

The final gift preparations to dispatch,

A light across the sea.

 

For support never failing trust,

Provide respite from the woe,

Repaying kindness is a must,

Here earnest blessing we bestow.

 

Henceforth from this very day,

Without delay or hinder,

May care equal to that given away,

Be returned to grace the sender.

No Surprise Here - Benefits of Healthful Eating for Kids

This week Medscape posted an article written by gastroenterologist Diane L. Barsky entitled "The Anti-inflammatory Diet's Surprising Benefits in Children."  In her discussion, Dr. Barsky describes a diet that combines traditional Asian and Mediterranean food culture.  This fusion diet is rich in fresh foods, fruits and vegetables, and legumes while minimizing the intake of processed foods, high-fructose corn syrup, and saturated animal fat.  Research has shown that this anti-inflammatory diet benefits children suffering from allergies, asthma, obesity, fatty liver, and, even, ADD and ADHD.

From those of us who consider good diet indispensable for good health, the only thing that is startling is the fact that a medical doctor--a gastroenterologist, no less--would find the multitude of advantages of healthful eating surprising.  Far from being beneficial, our standard diet today is barely even fit for human consumption.  Until very recently in our history, human beings had always eaten fresh, natural foods with less meat and more vegetables.  The modern inventions of trans fats, high-fructose corn syrup, and chemical additives in concert with contemporary farming and ranching have led to what amounts to a long-term experiment to determine if human health can be maintained on a diet of engineered foods.

If the health of adults is affected by poor food choices, it stands to reason that children are even more at risk.  Thousands of years of astute Chinese observation have revealed several important things about children and their diets.  First, our children come into this world with immature digestive function.  For this reason, nature provides us a sublime, nourishing food in liquid form, mother's milk.  Once infants begin reaching out for solid food, it is appropriate to slowly introduce bland, digestible, nourishing food into their diets and wean them off breast milk.  Finally, between the ages of 5 to 6, human beings develop the capacity to digest a wide variety of foods, and our parents can feed us more like adults.  In other words, when it comes to diet, kids are especially vulnerable.

Modern life has resulted, however, in widespread amnesia, and we know longer rely on the grand legacy of human wisdom to feed our offspring.  Fake breast milk, a manufactured blend of powdered beans or animal dairy derivatives enhanced with added chemical nutrients, often replaces nature's live elixir.  Instead of regular meals, we instill a lifetime of comfort eating in infants by feeding them on demand.  Finally, once solid food is on the menu, we rush to try out new and unfamiliar foods, delighted when an expression of happy satisfaction signals that a child has succumbed to the seduction of an adult food.

Putting our faith in food scientists, we reason that if it does not hurt us then it must be safe for our children.  In a time when diet-related heart disease, diabetes, and obesity are epidemic, we are obviously in denial about the safety of our modern diet.  Furthermore, we sadly see all of the negative consequences of contemporary eating most apparently in our children.  The good news is that medical scientists are now gathering the evidence needed to show the dangers of engineered foods designed by their colleagues in the food industry, thus proving scientifically what any observant person with common sense should already know.

The Art of Happiness

In the West, we normally perceive thought and feeling as two distinct phenomena.  Thought is understood as an active process, reflected in certain English idioms such as "giving it some thought" and "spending time thinking about it".  Emotions, feelings, on the other hand, are seen as involuntary responses to experience.  The   language reflects this when we talk about how something or someone "makes us feel".  Although we may complain of "feeling down", the experience of a general emotional state instead of a reaction to a specific cause, this, too, clearly describes a passive process rather than a deliberate action.

Chinese medical theory, however, challenges our normal Western suppositions by grouping thought together with the seven affects of anxiety, sorrow, joy, anger, fear, and fright.  Based on this traditional group, it is evident that the ancient Chinese viewed cognition and emotion as synonymous.  From our modern Western perspective, this attitude towards thought and feeling is bewildering.  How is it possible, one might ask, to lump together the activity of thinking carefully through a math problem, for example, with the sudden feeling of sadness we experience when hearing of someone's death?

Examples both of thought without deliberation and conscious feeling do, however, abound.  We typically refer to the former as instinct or intuition, experiences many cultures tend to associate with certain individuals.  In Western societies, for instance, there is the popular notion of "feminine intuition".  This reveals the fact that, although our culture recognizes inclinations that arise halfway between heart and head, we often characterize these thought-feelings as special gifts instead of identifying them as part of a common human experience.

Conscious feeling, too, is not unfamiliar to us.  Actors are trained to consciously control their feelings with the intention of causing their audience to laugh wholeheartedly or cry bonafide tears.  The power of positive thinking converts optimistic thoughts into a state of joy, and we manipulate our moods with drugs, both prescribed and recreational.  Like the pumping of the human heart, our emotional responses reflect both voluntary and involuntary processes.

With the recognition of the proximity of emotions and thought a comes the potential for a new, revolutionary way of thinking and feeling.  On the one hand, intuition gains credibility as an alternative form of thinking, one where, instead of depending on plodding logic, we can spontaneously leapfrog to a conclusion.  Fundamental to the workings of the mind, our gut feelings and instincts are then seen not as the domain of the chosen few but a natural human response when we need to react urgently.

Perhaps even more relevant to modern life is the realization of how inextricably our moods relate to our thoughts.  While it is not only misguided but potentially fatal to try and will oneself out of a clinical depression, we should also understand that, behavioral illness notwithstanding, we can play a pivotal role in whether or not we wake up on the wrong, or right, side of the bed.  To a great extent, happiness is a choice.  The secret, in turns out, lies in cultivating gratitude and appreciation at every opportunity.  Great expectations and the ability to see the silver lining even in misfortune are the building blocks of a lifetime structured to provide satisfaction and joy.

Beyond the Science of Modern Nutrition

Modern nutritional science can be very confusing.  It often seems that what is vilified one day is redeemed the next, calling into question the reliability of the Western scientific approach to diet.  Eggs have been celebrated as the perfect protein while also being implicated in heart disease.  Last year, a study proclaimed that coffee contributed to longevity, but, just recently, consumer advocates have called for warnings about the carcinogenic compounds in roasted coffee beans.  For decades, by law, all products containing saccharin required a disclaimer label.  After pressure from lobbyists, the FDA announced that it was all a mistake and dropped the legal requirement for labeling.

Every person on the planet needs to eat to live, and many of us rely on science to make judicious dietary choices to improve our quality of life, minimize disease, and promote a long lifespan.  The origin and development of modern nutrition, however, has not generated societal health and wellness in America. On the contrary, as the science has progressed, obesity and disease directly linked to poor eating habits have spiraled frighteningly out of control.

To be fair, many of us ignore the admonitions of health authorities, allowing ourselves to be seduced by addictive treats, persuaded through clever advertising, and won over by convenience.  Case in point, few of us eat the total daily number of servings of fruit and vegetables advocated by nutritional experts, a failing that certainly impacts our health as a nation.  On the other hand, at the behest of nutritionists, the past few decades have seen Americans reduce beef consumption in favor of chicken.  Trading in our sirloins for drumsticks, however, has not paid off in any measurable benefits to health.  Is the campaign against red meat, like the science on the cancer-causing properties of saccharin, the product of bad science?

Ultimately, scientists face a fundamental dilemma handling the daunting chemical complexity of foods.  The scientific method depends on reducing and controlling variables and, at some point, as variables multiply, the dictum known as the Heisenberg uncertainty principle predicts that scientific analysis will become logistically impossible.  The human diet is a perfect example of science hitting a brick wall.

To understand this better, imagine a symphony orchestra.  Just as an orchestral performance is more than the product of a single musician playing an instrument, the foods we eat are complex aggregates of chemicals.  Milk, for example, consists of water, fat, proteins, lactose, minerals, and numerous trace elements, each akin to individual musicians in the orchestra.  Grouping together all the similar components in foodsproteins, for examplelarger units are formed that echo the orchestral instrument sections.  Finally, the skillful coordination of all the sections into a harmonious whole yields the final product:  a unique food, the alimentary equivalent of a performance of Mozart's Requiem.

Not unlike someone who gives all the credit for a performance to the conductor, nutritional science tends to characterize foods based on their primary nutrients.  Instead of identifying the special character of each food, lentils and turkey get tossed together as "proteins", while rice and potatoes fall under the rubric of "carbohydrates".  Although this simplifies dietary recommendations, it ignores the unique effect of each food on human physiology which, in turn, is a function of the sum total of its special chemistry.

Faced with its failure to achieve health through diet, nutritionists have resorted to recommending the traditional diets of healthy societies.  For example, the Mediterranean diet, scientifically proven in studies, is now offered to patients as a template of healthful eating.  This new approach not only avoids oversimplifying the intricate chemical structure of foods but also provides a more practical solution in the kitchen.  For people making real life choices, it is easier, and more enjoyable, to add extra virgin olive oil and garlic to their cooking than it is to attempt to balance the ratio of protein to carbs.

The Good, the Bad, and the Ugly

Several years ago, I was on the train from Albuquerque to Santa Fe, on my way home, when I struck up a conversation with an amicable young woman.  Once I revealed that I worked as a healthcare professional, she freely began sharing her medical story with me.  As a practitioner you find that many people do not hesitate to open up and divulge personal details about their health. 

She had tried Chinese medicine for her condition, with modest success.  In telling her story, she mentioned that the practitioner was a seasoned veteran who had practiced for many years.  I racked my brain trying to think of which senior practitioner she might have seen.  When she eventually remembered the name of the practitioner, I was perplexed and a bit troubled.

The acupuncturist had, in fact, only graduated recently, but it was possible that the patient had just misunderstood something that was said.  I wished the woman well and did not immediately follow up on our conversation.  At some point, however, I went to the practitioner’s website and read the bio the practitioner had posted for prospective patients.  There it was, in black-and-white: the unabashed claim that she had been in practice for well over a decade. 

Honestly, it made me angry.  I have worked hard to build my practice over the years.  Despite the financial struggles, the difficult cases, the emotional heartbreak when your patients do not respond well to care, day by day and treatment by treatment, I have earned the insight and skills of an experienced practitioner.  With that single fraudulent claim, however, I felt someone had robbed me of a prized possession.

We are encouraged to be nice—in academia we use the term collegiality—and to avoid judging or criticizing others, but, when the safety of the public is at stake, there is an obligation to speak out.  Not only did the false claims of my colleague affect me, she was misleading the public by misrepresenting herself. 

I contacted the board and ask them to investigate.  After a phone conversation with the acupuncturist in question, they determined that her previous work in another healthcare field gave her claim nominal legitimacy.  Of course, as my conversation with one of her clients proved, patients go to her clinic under false pretenses and give up on Chinese medical care when, what they perceive to be expert care, does not work.

I was recently reminded of this story after doing some research into a company that provides herbal supplements primarily to doctors who practice CAM.  That founder of the business, responsible for all of the company's formulations, labels herself a naturopath, but provides no history of training or education.  According to the state website, that individual currently holds no professional licenses, medical or otherwise, in California.

This is not the only time I have seen a lack of integrity in complementary and alternative medicine and, sadly, the acupuncture and Oriental medicine field is no exception.  At the student level, I have been privy to cases of blatant cheating and plagiarism.  Among professionals, it is no secret that there are Chinese practitioners who studied and practiced Western medicine in China only to magically transform into TCM experts in the U.S.  Yet another example involves an acupuncturist who only received introductory training in Chinese medicine but is a favorite referral for of Harvard-trained M.D..  The opportunities, unfortunately, for people who wish to embellish, exaggerate, or even fabricate their training, credentials, and experience in CAM are ample.

There is good news.  In my involvement with the accreditation of schools, I have met and worked alongside many individuals with exceptional integrity who are bright, extremely knowledgeable, and committed to excellence in our education system.  This translates into constant progress in AOM education which, in turn, produces professionals with genuine expertise.  Once enough time has passed, those individuals who got by in the past with questionable claims will hopefully be replaced by those who have been well trained to provide safe and effective care.

If you are a colleague, I would ask that you represent yourself accurately.  Be proud of your accomplishments and only publicize titles you have earned.  If you are a novice practitioner, resist the urge to inflate your clinical experience, keep learning, be humble, and work diligently.  Be worthy of the generations of Chinese doctors who risked their lives to find effective herbs, read and reread the classic texts to develop better treatments, and dedicated themselves selflessly to helping patients.

If you are a patient, do due diligence and do not believe everything you read or are told.  Many states have acupuncture boards that maintain websites where you can research a practitioner’s qualifications.  Take a few minutes to confirm that a clinic’s advertising is accurate.  Know that herbs and acupuncture are not always safe and select a professional who has been well-trained to provide the services you need.  Recognize that complex conditions often demand a healthcare provider with at least a decade or more of experience and rely on newer practitioners primarily for simpler complaints. 

Chinese medicine has the power to change lives, but, like all tools, its true potential can only be reached when it is used by an expert.  It is my hope that we here in the West will continue to cultivate our Chinese medical culture to ensure that we do justice to this ancient and profound medicine.

Treating Prolapse with Chinese Medicine

In my 17 years of practice, I have seen many patients, usually middle-aged women, who experience prolapse.  It is rarely a main complaint, suggesting that patients do not expect Chinese medicine to treat their condition.  In this blog, I would like to introduce the TCM point-of-view of prolapse and describe a specific, effective treatment.

Prolapse refers to the inconvenient and often uncomfortable sinking and even external protrusion of bodily organs.  Common areas affected by prolapse include the stomach, uterus, and the rectum.  Western medicine shows relatively little interest in the cause of prolapse preferring, instead, to focus on practical remedies.  In most cases, these solutions involve surgically returning the tissue to its rightful place and using implants, such as metal mesh, to corral the anatomy.

Chinese medicine takes a different view.  Qi, the fundamental resource responsible for all bodily activity, holds or contains the tissues in place.  In patients who are fatigued and weak, any form of leakage, whether spontaneous sweating, uterine bleeding, or rectal prolapse, may be seen as qi failing to contain.  In treating these conditions, the Chinese doctor primarily focuses on boosting function, or qi, to allow the body to pull organs back into place.  Physically lifting sagging tissue, possible with acupuncture, is of secondary importance.

Center-Supplementing, Qi-Boosting Decoction or Bu Zhong Yi Qi Tang is a remarkable herbal formula known for its ability to treat prolapse.  The formulation utilizes huang qi astragalus to boost qi and lift up fallen tissue.  Ren shen ginseng, bai zhu ovate atractylodes, and zhi gan cao licorice root assist astragalus by increasing the available qi.  Chai hu bupleurum and sheng ma cimicifuga, when used in small dosages, gently elevate dropped organs.  Finally, dang gui tangkuei nourishes blood, providing a solid foundation for building qi, and chen pi tangerine peel stimulates movement to prevent the richness of the other herbs from creating stagnation in the gut.

In my clinical experience, this Chinese herbal formula is an effective treatment for many different types of prolapse.  I have used it as a raw herb decoction, a granular blend, and in the form of prepared pill or tablet.  As with most formulas, the best method is crafting a custom prescription designed to meet the specific needs of the patient.  Nevertheless, I have also seen good results with a modest dose of tablets.  One colleague even reported having success treating a horse suffering from prolapse with Bu Zhong Yi Qi Wan pills.

Regardless of the exact Chinese treatment, organ prolapse should never been viewed as a simple structural issue.  Patients with prolapse have a systemic deficit that needs to be addressed to ensure a long-term health and well-being. While fixing a prolapsed region of the body satisfactorily manages a symptom, it is always essential that the physician take the next step to try and identify the root cause.

The Spirit of Chinese Medicine

In modern Chinese medicine, 神 shen, often translated as spirit, is a key concept.  Due to the many and varied meanings of the word spirit in English, this term often leads to confusion, both among patients and professionals.  Here we would like to explain the understanding of this idea within the Chinese culture.

Bob Flaws, who coauthored Chinese Medical Psychiatry, points out that there are three different connotations of the term 神 shen.  The non-medical usage describes a universal consciousness or pervasive animating force and has been compared to the Native American idea of the Great Spirit.  Within a medical context, however, spirit has different implications.  The standard medical usages can be categorized into the broader and more narrow meanings.  Many Western practitioners of Chinese medicine have been taught that 神 shen mainly describes the overall vitality of a patient.  This is the broader usage and, in practice in China, is largely employed to determine the prognosis of a critically ill patient.  This form of spirit is most apparent in the patient's eyes.

Far more important in the daily practice of Chinese medicineespecially here in the West where most clients are ambulatory is the narrow meaning of spirit.  This application roughly equates to consciousness and is the central subject of the study and practice of Chinese medical psychiatry.  For many patients who have diagnosed with a behaviorial health disorder by a Western doctor, the Chinese practitioner will focus on spirit as it is understood in the narrow sense.

Chinese medicine offers a number of statements describing the anatomical and physiological nature of spirit.  The spirit resides in the heart.  It is an accumulation of qi and blood.  When healthy, the spirit remains level in its abode.  During the day, the spirit extends outward through the orifices of the heart and connects to the phenomenological world beyond, retreating to the inner sanctum of the heart at night where it is enfolded by blood and yin.

There are three fundamental ways in which the heart spirit may be out of balance.  First, heat may harass the spirit leading to symptoms such as mania, agitation, or insomnia.  Second, a lack of qi and blood may result in malnourishment and nonconstruction of the heart spirit.  Finally, the orifices of the heart may be blocked, preventing the spirit from productively connecting with the outside world.

A person in a manic state with a predisposition towards heat, a red tongue, and a rapid pulse is an example of the first pathology.  A fragile patient suffering from palpitations, forgetfulness, and difficulty sleeping exemplifies the second case, while a schizophrenic, trapped in an individual experience and unable to connect with common reality, with a slimy tongue fur and slippery pulse, would be diagnosed with blockage of the heart orifices.

As with other translated concepts in Chinese medicine, there is no simple English equivalent for 神 shen spirit.  Only by taking the time to explore the numerous uses within the native culture is one able to get a sense of the true Chinese medical meaning of the term.  Beyond being a stimulating semantic exercise, taking the time to learn more about the Chinese perception of spirit allows us to better utilize, and receive, Chinese medical care intended to address disorders of spirit.  In many cases, a nuanced understanding of the Chinese idea of spirit may make the difference between clinical success and failure.

A Tribute to Miso Soup

For 2,500 years, Asians have been savoring the taste and healthful properties of miso, soybeans magically transformed using salt and a microorganism called koji.  In even more ancient times, Neolithic Jomon people discovered how to make fermented pastes from grains and fish.  For the modern Japanese, miso is a part of everyday life and an essential ingredient in the Japanese cultural identity.

Miso enjoys countless applications throughout Japanese cuisine.  One popular main dish uses fish, mackerel being a favorite, slathered in a thick layer of the rich paste and grilled to perfection.  Another example of the versatility of miso is the drinkers' favorite morokyu, a pleasing side featuring chunky moromi miso as a dip for spears of crisp, chilled cucumber.  In kaiseki cuisine, a dish known as dengaku drizzles creamy white miso on purple medallions of grilled or sauteed eggplant, recalling a crest of snow atop Mt. Fuji.  Even desserts in Japan have utilized this fascinating seasoning.

Of course, the most familiar vehicle for miso, both in Japan and abroad, is miso soup or misoshiru.  All but the most formal of Japanese meals can be accompanied by a serving of this satisfying Japanese soul food, and there is no better way to begin the day than with a bowl at breakfast.  Almost as comforting as a mother's embrace, miso soup can easily become an addiction.

Miso soup is not only good but also good for you.  The soy provides protein made more readily digestible by the traditional kelp base.  Miso is well known for its ability to detoxify, and the active cultures derived from fermentation, when preserved by avoiding boiling, benefit the gut.  As with any soup, adding a cup of miso to your table facilitates eating volumetrically, delivering the sensation of satiety with a modicum of calories.

Some Westerners have been known to whip up faux miso soup, an insipid blend of miso paste in water.  This misinterpretation skips the dashi soup base, the warp and weft necessary for good soup.  Although miso thinned with water may have its applications in the kitchen, it should not be mistaken for an edible dish.

For the real deal, numerous types of dashi can be prepared, but the easiest is simply made from good quality kelpavailable in Asian marketssoaked overnight in water.  After straining out the seaweed, bring the subtle, amber broth to a boil and then allow it to cool slightly.  Set aside a small amount of warm dashi and briskly whisk in a dollop of miso to taste.  Choose red or akamiso for a bolder flavor, white shiromiso for the refined taste preferred in Kyoto, or a blended awamiso when you just cannot chose. For those concerned with sodium, low salt varieties are easily found.

In Japan, miso soup is almost always served with something solid, called gu in Japanese, added into the broth.  Tangy curls of green scallions, a raw egg, cubes of potatoes or soft tofu, or certain types of sea vegetables are the usual suspects.  Any additions should reflect a sensitive appreciation of the seasons, with lighter and more flavorful choices in the spring and summer, while hearty ingredients should be reserved for fall and winter.

Whatever your preference, miso soup can be a great addition to your diet.  Start simply and then explore the plentiful varieties of this versatile dish.  We hope that, like us, you will find this Japanese staple fulfilling to the palate and advantageous to your health.

How Safe and Effective Is the Flu Shot?

This year influenza has been widespread.  We have seen patients who have reported rapid onset of symptoms with severe respiratory symptoms and persistent cough for weeks after infection.  The virulence of the current flu epidemic raises questions about how best to prevent and treat influenza.

Our research has revealed only a single study that broadly evaluated the existing medical literature on the vaccine.  Published in 2011, the authors reviewed 44 years of research and concluded that the treatment modestly reduces flu symptoms.  They found no evidence, however, that the vaccine is effective in those over the age of 65, and their analysis revealed that protection is best in children between the ages of 6 months and 7 years who have received the live vaccine. 

The study contradicts what we are told by our doctors who typically encourage the flu shot.  Is the 2011 study rigorous and reliable?  According to reviews, the research by an American infectious disease team was, in fact, of high quality, and the study was peer-reviewed and selected for publication in The Lancet, a respected journal.  Why then are our healthcare professionals making recommendations not in line with good scientific data?

Keep in mind that the healthcare professionals who interact with patients, by and large, are not obligated to follow the standards especially regarding vaccinationsset by governmental authorities, namely the CDC and the FDA.  These organizations, in turn, make decisions based on research, and meaningful, large-scale studies are usually performed by entities with deep pockets, namely the pharmaceutical companies.  Not surprisingly, independent research often challenges the findings from industry scientists, raising the question of conflicts of interest.

The authors of the 2011 study emphasized in interviews that their research should not be taken as a recommendation against the influenza vaccine.  After all, the meta-analysis did demonstrate some benefit with the flu shot.  The lack of evidence for effectiveness in older patients is attributable to the fact that, since the 1960's, it has been considered unethical to perform RCT studies which deprive high-risk patients of protection against the flu.  Due paradox, public policy likely continue based on assumption rather than scientific findings.

Like the researchers, it is not our intention here to contradict current public health policy.  But with reports that this year's vaccine is less than 10% effective against the H2N3 strain of the flu, public health authorities and researchers should reexamine our current protocols and perform additional research.  Although the medical establishment maintains that standard vaccinations are safe, the government VAERS database demonstrates a wide range of adverse events resulting from vaccines.  In a field where under-reporting is likely, more studies to clearly demonstrate that the benefits of vaccines are worth the risk are desperately needed.

Infertility, Erectile Dysfunction, and Developmental Delays Linked to Popular Painkillers

Two new studies raise concerns about NSAIDs or non-steroidal anti-inflammatory drugs.  While many people are aware that over-the-counter painkillers can result in gastrointestinal disease and liver damage, researchers have uncovered other, more indirect, risks associated with these common medications.  These recent studies suggest that male infertility, erectile dysfunction, and even developmental delays in children may all be linked to the use of popular pain relief options.

One study published in the Proceedings of the National Academy of Sciences of the United States of America investigated the effects of ibuprofen on male reproduction.  In the clinical trial of young men who used ibuprofen, the authors demonstrated that the popular painkiller alters cells in the testicles and impairs hormone production.  The resulting conditions can negatively impact both sperm production and testosterone levels, decreasing fertility and possibly leading to other issues associated with insufficient testosterone. 

Another study unveiled in the January 10th online issue of European Psychiatry describes research that attributes language delays occurring in girls at 30 months of age to prenatal acetaminophen exposure.  The authors determined that the severity of the cognitive impairment increases with the dosage of acetaminophen and higher levels of the drug in the urine.  With as many as 65% of pregnant women in the U.S. using acetaminophen, the findings of this Swedish are alarming and may lead to changes in the standard recommendations given to pregnant mothers.

Given the dangers of opioids in pain management, new evidence of the risks associated with NSAID painkillers paints a bleak picture that leaves few good options for individuals in pain.  The disadvantages of pharmaceutical treatment make it all the more imperative that patients explore alternatives like acupuncture and Chinese herbal medicine.  Public health authorities and insurance companies must adopt decisive policy to promote public awareness of non-pharmaceutical pain management choices to avoid creating additional medical issues stemming from the adverse effects of drug treatment.

What the Opioid Epidemic Really Means

America is in the midst of an epidemic.  Americans are hurting and turning to painkillers to ease their pain.  Unfortunately, opiates pave a road to addiction and death.  In 1999, 4,000 people died from overdoses.  The total number of deaths attributable to opiates skyrocketed to 62,000 in 2015, making the opioid epidemic a greater cause of death in our country than car accidents.  Put another way, prescription drugs end 78 American lives each day.

The feds have responded by declaring a war on prescription drugs and sending their agents out to investigate, prosecute, and penalize.  Cracking down on healthcare providers, government efforts have had the unintended effect of pushing sufferers to turn to heroin to ease their chronic pain.  Of course, the switch from legal to illegal pain management does nothing to reduce the chance of falling victim to an overdose, and many hooked on heroin have ended up on the slab.

Our government is missing the point.  The opioid epidemic is not a drug epidemic but a failure of our current system of healthcare to effectively treat our chronic pain.  With the number of annual prescriptions for pain meds climbing to a staggering pinnacle of 289 million prescriptions in 2016, one thing is clear:  too many patients are left with no better option than to numb their bodies and sedate their minds in order to be able to function.  Revoking the licenses of pharmacists and doctors who demonstrate injudicious or criminal behavior may be a critical stopgap measure, but we ultimately need more innovation and flexibility in our management of chronic pain to get to the root of this problem.

Others have pointed out the absurdity of government policy that is punitive without offering any solutions to the complex dilemma of pain management.  We must always use opiates responsibly to control our aches and pains but we also need to be able to perform simple daily tasks without paralyzing discomfort.  One wonders if, between massive cuts in the healthcare budget and the war on prescription drugs, American patients dealing with chronic pain will be left with no good options beyond biting the bullet and getting through life as best they can despite the agony.

To be clear, this is not a partisan issue or, even, a political issue.  The pain epidemic and the opioid epidemic that follows in its wake is an American healthcare crisis.  Although we need our government to recognize that the American people need its support, not just law enforcement, it is even more important for our healthcare providers to respond to the crisis with new ideas and therapies.

Some good options for pain management do not need discovery but only await formal recognition.  Few alternatives to palliative care with risky opioids are as promising as traditional acupuncture.  As a treatment option, Chinese acupuncture care is methodical, well researched, low cost, and safe.  It can often be used by those who are not be good candidates for surgery and have exhausted other conventional treatments, patients who desperately require relief from chronic pain syndromes, offering them quality of life without the risk of addiction.

Those of us who use acupuncture have been successfully treating chronic pain for decades, but we need a shift on the part of lawmakers who develop policies to incorporate acupuncture care more completely into the mainstream.  Other CAM methods must be explored as well.  Only by first recognizing that Western medicine is failing these patients and then seeking out practical answers for chronic pain conditions will we be able to stem the rising tide of dependence on prescription opiates.  This is the only public health strategy that promises a permanent fix and sets American patients on a course that is safer, healthier, and happier.

Why I Translate

Recently, I decided to get back into the task of translating Chinese medical journal articles into English.  While working through the first selection, I reflected on the process of translation and decided that I wanted to share something with you about my motivation to translate.

Generally speaking, translating Chinese medical material into English is considered an esoteric pursuit.  Even among those in the field of Chinese medicine, most assume that it is extremely difficult, and I have been told by those who have never attempted it that it would simply be impossible for them.  For those of us with experience in this area, we realize that translating Chinese medical writings into English is a technical skill that, in fact, demands only a limited amount of working knowledge.  Blood, sweat, and tears, not a special gift or superior intellect, are the key credentials needed for successful translation.

Having the capability to translate Chinese medical material is a motivation, but there are two far more important reasons why I translate.  First, with the vast ocean of untranslated Chinese medical material that exists, it is up to those of us in the field who cherish this medicine to get to work on building a larger body of high quality resources.  Chinese medicine is still a recent immigrant to the West and, if we want to learn all it has to offer us, we need to hear more from the architects of this system, the doctors in China themselves.  The more we translate from the Chinese the more likely we are to accurately perceive the essence of Chinese medicine before it becomes irrevocably altered in its adoptive home.

The other reason I translate Chinese medical works into English is a personal one:  going back to the source, reading about Chinese medicine in Chinese, allows me a better understanding of the basic logic inherent in the medicine.  As medical anthropologists have shown, every medical system is the product of the culture where it originated, its philosophies, beliefs, history, and its language.  The ways in which we make connections in Chinese medicine--and Chinese medicine is, at its core, all about networks--directly relate to how effectively we practice.  If there is one single thing I have learned in my many years in the clinic, it is that clinical outcomes are clearly the product of practicing Chinese medicine according to its own rules, on its own terms.

If you are a patient, share this with your practitioner in the hopes that he or she will join us in this important endeavor.  If you are a practitioner or a translator, I invite you to participate in our community effort to grow our corpus of professional medical literature and, in the process, dive more deeply into the soul of the medicine.  We will thank you, your patients will thank you, and, once the value of translation becomes obvious to you, you will be thankful to have the opportunity to connect with all of the illustrious Chinese mentors who have taken the time to share their invaluable experience with us.