Many people who contact our program are interested in obtaining more information about utilizing alternative medicine instead of, or as an adjunct to, their allopathic (western medical) treatment. Patients frequently express frustration with the treatment they have received and many people are seeking holistic healthcare, feeling that the philosophies underlying alternative medicine are perhaps more congruent with their views about health, e.g., concepts about preventing illness or that the body has innate healing abilities that may simply need some assistance to be activated. As our group has become increasingly focused on Mind Body medicine, it readily follows that we would be interested in and supportive of other practices that have a similar underlying philosophy and are able to provide safe and effective for our patients.

Certainly, there are large numbers of Americans who are utilizing alternative and/or complementary medicine, and much of that care, patients are paying for out of pocket. Some insurance companies have begun paying for more well known treatments, like acupuncture and chiropractics. Within the Workmen’s Compensation system, chiropractors and acupuncturists are classified as PCPs (primary care providers). The National Institutes of Health has also shown great interest and support with the establishment of the National Center for Complementary and Alternative Medicine (NCCAM). Under the umbrella of NCCAM, there are federally funded programs doing research using alternative and complementary medicine approaches to treat various diseases.

Some of the more commonly used alternatives are acupuncture or acupressure, chiropractics, massage therapy, homeopathy, biofeedback and the various “Martial Arts.” Others include craniosacral therapy, hypnotherapy, Tui Na (Chinese massage), Tai Chi, and Qi Gong, to name a few. The focus of this article will be to briefly look at Traditional Chinese Medicine (TCM), which includes acupuncture and the use of Chinese herbs, but also diet, movement and breathing practices. In California, acupuncturists are licensed to practice upon completion of an accredited program, by taking a state board exam. The initials L.Ac., denote this credential.

Many practitioners believe that TCM has been practiced for 5,000 years. Many of the classic herbal formulas have literally been in use for thousands of years, certainly long enough to see any major side effects that are accounted for by the formula alone; it is important to keep in mind the potential for unknown interactions with western medicines. Some of the first acupuncture needles were made from thin pieces of stone or bone. Today, very fine stainless steel needles are utilized in acupuncture treatments. One of the main differences between TCM and western medicine is that TCM is focused on the energy (Qi – pronounced chee) of the body, versus the material or substance of the body. The primary separation of energy is into that of yin and yang, and illness is viewed as an imbalance of those primary energies. This is one of the reasons that it can be very difficult to do research to prove the effectiveness of the medicine, i.e., it is an entirely different way of viewing, diagnosing and treating patients. It is perhaps somewhat easier to perform controlled trials on the use of Chinese herbs for various disorders. A study done by Bensoussan, Talley, and colleagues was published in the Journal of the American Medical Association (Nov. 1998), which looked at the use of Chinese herbal formulations vs. placebo, in the treatment of IBS. Many of the patients treated with the herbal formulas had significant improvement in their symptoms as rated by the patients and their gastroenterologists. The group of patients that received an individualized formula maintained improvement when follow-up was done 14 weeks later. There is also a great deal of research that has been done in China, but there are issues of having this information translated and published.

It is important to keep in mind that although herbs at this point are classified as dietary supplements, they are truly crude forms of many medicines used today and can have a very powerful impact. By and large they are safe, but it is important to have them prescribed by a skilled practitioner who can provide an accurate diagnosis and balance the herbs properly. Chinese herbs can come in many forms, from small patent pills, to powders and granules, as well as raw herbs from which a decoction (tea) is made. Which form is used is dependent upon the severity of the condition, the willingness or ability of the patient to comply with them and the preference of the practitioner based on his/her experience.

There are many diseases that fall under the broader category of functional GI disorders, including IBS, GERD (gastroesophageal reflux disorder), dyspepsia, and functional constipation. None of these conditions are new to TCM, they are simply diagnosed and treated differently, although there are many correlations to western medicine. Just as we in western medicine know that IBS is a disorder with multiple causative factors, the same holds true in TCM, and would include different diagnoses depending on the primary symptom pattern.

For example, a very common diagnosis in TCM that would include symptoms similar to IBS would be “Liver” Qi overacting on the Spleen. Although there are some similar functions, the concept of the “Liver” in TCM is not related in any way to the understanding western medicine has of that organ; the TCM “Liver” is more comparable to the nervous system. The liver is responsible for the smooth flow of the energy throughout the body, and is very powerful. Some refer to the liver as “the general” of all emotional states. The “Spleen” is also different, and in all likelihood was named such due to a translation error (it’s actual function in TCM is similar to that of the pancreas). In TCM, the “Spleen” is essentially the principle organ responsible for the proper functioning of your entire digestive system. Illness may develop due to our digestive systems being weakened, for a variety of reasons, or because the “Liver” energy has gotten out of control. In TCM, there is a system of checks and balances that exist within the organ systems, and all organs can have an impact on, and are impacted by, other organs in the system. In any event, it is very easy for the “Liver” to overpower the “Spleen” and create all kinds of digestive dysfunction, of which IBS is just one condition. In western medicine, we already have a great deal of knowledge about how stress impacts IBS as well as other functional GI disorders, but there is always more to know, which is what a great deal of our research is devoted to.

The typical treatment for IBS given the above TCM diagnosis would begin with an extensive history, palpation (touching) of the abdomen, as well as pulse taking and examination of the tongue, both of which are common methods of diagnosis. An acupuncture treatment may consist of the use of 10-15 needles, placed a various points that would be chosen based on their ability to alleviate symptoms specific to IBS, tonify (strengthen) the digestive system, as well as others to help with stress reduction (sedating the liver). An herbal formula would be chosen based on the diagnosis, and would be a combination of approximately 6 – 15 different herbs, with the herbs and dosages being custom made to fit that patients particular pattern of symptoms.

As treatment continues, the herbal formula would be modified to address the ever changing needs of the patient. One of the goals would be to treat not only the acute symptoms but also address the underlying cause. Herbs tend to work more slowly and gently that western medications, and as a general rule, the length of treatment will depend on how long the patient has had the disease. Herbs are frequently utilized to extend and enhance the effectiveness of the acupuncture, as most patients in the US are not able to be seen as frequently as would be recommended if living in China, e.g., three times weekly. The practitioner would discuss diet and make suggestions, e.g., perhaps suggesting that the patient not consume cold, raw vegetables as they are hard for an already weakened system to digest. There would also be some discussion of a meditative practice, to allow the system to relax, which is essential for proper digestion as well as for healing.

There are a growing number of acupuncturists who have some type of western background, e.g., nurses, physical therapists, and physicians. For those practitioners, there is a shared vision of working to integrate these two diverse medicines and other alternatives, to allow them to provide all patients with the best possible care. In China, physicians are trained in TCM and western medicine simultaneously.
As with finding any other healthcare provider, it is important to find someone who you feel comfortable with, as positive feelings about this relationship alone can have a profound effect on your health. Ask your healthcare provider(s) for referrals, and talk to friends and relatives about any experience they might have had with alternative medicine. It is also important to find someone who is willing to work with your western PCP, and will refer you to seek western care when appropriate. TCM can be very effective in helping to manage many of the more chronic illnesses, which includes the various GI disorders. Certainly not every patient is ready to move in this direction, and it’s important to respect that. Ideally, we would want all of our patients to feel empowered to look at all the alternatives and determine what is right for them.

Suggested Reading:
Kaptchuk, T. (1983) The Web That Has No Weaver, Congdon and Weed: New York