Toxins In, Toxins Out - Acupuncture and Detox

Lemon juice, cayenne pepper, ice water, dandelion leaves, laxatives, enemas, and pills - does that really sound like the best menu for a healthy, high-functioning body?

Detox diets and cleanses are a hugely popular right now, and New Year's resolutions to get in shape often involve swift and direct action to mitigate the holiday season's less-than-healthy festivities. January will no doubt see a lot of us turning to the internet to find the best way to recover from overindulgence in eggnog and honey-baked ham, but throughout the year I'm asked if there's such a thing as "acupuncture for detox."

This answer, of course, is yes! But maybe not the way most people expect.

Whenever someone tells me they would like to detox, I always ask what sorts of toxins are in their body and how they got there. Part of me expects an exciting Jack Bauer-esque story of intense radiation exposure while diffusing a dirty bomb in the basement of the KFC Yum! Center or contracting an experimental retro-virus in the process of saving the mayor from terrorists, but that's almost never what patients report to me. Usually, it's something along the lines of, "Well, I've kind of been eating a lot of junk lately and/or drinking too much, so I feel like I need to get that out of my system." Yeah, that's a bit of a different story... and luckily an easier fix!

I came across a great article earlier in the month about the non-benefits of popular detox diets and products that made a couple good points. Firstly, there is a distinction between detoxing drugs from your system, especially with regard to addiction, and cleaning out your colon. Secondly, the body is built to filter and remove waste constantly by way of the kidneys, liver, skin, lungs, and intestines, obviously. Basically, you're pretty much pooping all the bad out. Toxins generally don't accumulate in the body because of it's ability to self-cleanse, and indeed I would argue that "toxin" is not really the appropriate word for junk food in the body, unhealthy as it may be. Again, drugs and heavy metal exposure are a slightly different situation, but generally people are not turning to the Master Cleanse for that. The takeaway is really that "detox" sounds like something that would be really beneficial, but "the word [is] being hijacked by entrepreneurs, quacks, and charlatans to sell a bogus treatment" that's really not necessary. 

The Acupuncture Side of Things

In the context of acupuncture, there are generally two very broad diametrical treatment strategies that we employ in any given treatment: 1) supplement and nourish that which is deficient, or 2) drain and sedate that which is excessive. In the ancient Chinese medical texts, there is a lot of dramatic language about how dangerous it is to do the wrong thing at the wrong time. You wouldn't want to add more to a system that is already overly replete, and you definitely wouldn't want to further deplete someone who is already weak. Detox products, recipes, and diets are almost always draining in nature because the goal is the remove something from the body.

The problem lies in the fact that the average detox-seeking patient would most often be diagnosed according to Chinese medicine as having a deficiency condition. The feelings of general un-wellness, which can include fatigue, malaise, sleep problems, body aches, bloating, indigestion, irregular bowel movements, foggy-headedness, and emotional turmoil usually have less to do with poison coursing through your body and more to do with deficiency of the Qi and Blood or a weak Spleen. Stress and overtaxation deplete the Qi and Blood, and poor diet weakens the Spleen over time. Now add a detox protocol that involves precipitating frequent bowel movements with cold, Spleen-damaging ingredients, and it will usually make things much worse. At the very least, it perpetuates the underlying conditions of deficiency which make a person feel the need for another cleanse down the road.

The Spleen, in many ways, is the detox organ of Chinese medicine. Its function is to "separate the clear and the turbid" from the food we ingest, utilizing the nutrients to create Qi, Blood, and the other vital substances that nourish the body and sending waste to the Large Intestine to be expelled. If the food we eat is comprised of more turbid than clear, such as junk food, then the Spleen has to go back to work on transforming and removing waste after it has managed to extract all available nutrients. When the diet is poor, this process gets backed up, and dampness starts to accumulate in the body. Still, this is closer to amassing water weight and fat than harboring actual toxins. The way to treat this is at its source. Acupuncture can be used to strengthen the Spleen, making it more efficient at its job of transformation. There are acupuncture points that are described as being able to powerfully augment the Spleen Qi and awaken and revitalize splenic transformation. Acupuncture can also facilitate a bowel movement in a much safer and less draining way than purgatives and laxatives.

Equally important is what we are putting into our bodies. The best way to "cleanse" the body is with a "clean" diet. There doesn't have to be a dramatic intervention to shock the body into turning over a new leaf. As I mentioned, the body is always working at filtering out the bad. Yesterday's Big Mac is already pretty much out of your system, so why not make today the first day of eating better? Giving your Spleen a break by eating food which is easier to break down and more nutrient rich will be better for the system in the long run. The hallmark of a Chinese therapeutic diet is balance. An easy way to achieve this is with colorful natural foods. If all the colors are represented in a daily or weekly menu, all of the elements the body needs should be met. Since cold and raw foods are harder on the Spleen, these types of foods should ideally be avoided, but balancing them with warm teas and soups helps to mitigate their draining effects. Dairy and processed foods are just going to bog down the Spleen, so they are best avoided.

Eating Healthy Is All Well and Good, But What About Actually Detoxing Off Of Drugs?

Okay, so not everyone who is interested in detoxing wants to do so because of a Dr. Oz fad diet. Sometimes, such as in cases of drug and alcohol addiction, there is a legitimate need for medical intervention. Acupuncture is really good at addressing this, as well. Detoxing from addictive substances is a process made difficult in no small part by cravings and withdrawal symptoms. These are commonly addressed by auricular acupuncture in a treatment plan called the NADA Protocol. Developed by the National Acupuncture Detoxification Association, this protocol has been used successfully to treat addiction in court-mandated drug rehabilitation programs across the country. Ear acupuncture is a bit of a different system than the meridian based tradition of classical Chinese medicine. It's a relatively modern style which interfaces directly with the central nervous system; the NADA protocol uses points to invoke the organs of detoxification - Liver, Kidney, Lung - while also balancing the sympathetic and parasympathetic nervous systems to reduce withdrawal symptoms.

In addition to the NADA protocol, body acupuncture is still done based on a diagnosis. There is still generally a pattern of deficiency that needs to be addressed as drugs and medications delete the body of vital substances and throw the organ systems off balance. This goes for non-habit-forming long-term prescription drugs, too, as well as chemotherapy.  All of that passes through the kidneys and liver, and many damage the stomach and other digestive organs. Part of the "acupuncture detox" treatment may involve support for these organs so that they are better able to handle the metabolism and excretion of medications. When these prescriptions are necessary, especially over the long term, it becomes even more vitally important to have a clean diet. Otherwise, the body is getting a double dose of weird crap to filter and transform! 

Personally, I'd rather eat a balance of steamed and roasted vegetables, high-quality organic meat, and limited amounts of dairy than have a colonic - I don't care how nice the spa is.




Photo credit:
http://emedia.leeward.hawaii.edu/Kamanao/story/why-fad-diets-slow-you-down 
http://www.universityherald.com

Athletic Endurance through Herbal Medicine

I wrote an article last fall about supporting athletes during training to help prevent and recover from injuries. I discussed the Chinese medicine view of tendomuscular health and the role the Liver and Kidneys play in bone strength and keeping the muscles and tendons nourished and lubricated.

 (You can read that here)

Recently, I decided to do a couple of mud run races this summer, starting with the 10-12 mile Tough Mudder race next month. If you're not familiar with the Tough Mudder, it's an obstacle course designed by British Special Forces that includes things like 12-foot walls to scale and 1/2-mile mud crawls under barbed wire and electrified fencing, all along a 10-mile off-road raceway.

In order to train for this, I've started doing some trail running in addition to the circuit training I had started a few months ago. Running the rough and uneven trails of Cherokee Park will help me get used to the type of running required in the event, and the circuit training exercises simulate some of the movements needed to tackle many of the course's obstacles. All of this is pretty hard on the knees, and I'm also pretty susceptible to lateral shin splints. Luckily, taking Chinese herbs are making these a non-issue!

This is a formula that be taken by someone making the jump from cough potato to gym member or a veteran marathoner. It focuses on nourishing and lubricating the muscles to increase strength, endurance, and flexibility while minimizing pain, soreness, and recovery time. Most importantly, it's designed to help prevent injuries.

Because it reduces inflammation, protects the knees, and treats shin splints, this formula is ideal for runners, football players, basketball players, soccer players, and triathletes of all levels from novice to professional.    

• Huang Qi - Astragalus Root - tonifies the Qi, especially the Lung Qi and the Protective Qi, meaning it increases energy, improves breathing, and strengthens the immune system 

• Ren Shen - Ginseng Root - strongly tonifies the Qi and generates fluids, providing an energy boost, as well as lubrication to the body 

• Dang Gui - Chinese Angelica Root - nourishes the Blood and increases circulation

• Bai Shao - White Peony Root - nourishes the Blood, calms and nourishes the Liver, which governs the tendons, stops muscle spasms

• Sha Shen - Glehnia Root - generates body fluids, guides the action of the herbs to the Stomach Meridian (Tibialis Anterior muscle) to treat lateral shin splints

• Mai Men Dong - Ophiopogon Tuber - moistens the Lungs to improve breathing, generates body fluids, guides the action of the herbs to the Stomach Meridian (Tibialis Anterior muscle) to treat lateral shin splints.

• Gou Qi Zi - Goji Berry - nourishes the Liver Blood to nourish muscles

• Sheng Di Huang - Rehmannia Root - nourishes the Blood while clearing heat to reduce inflammation

• Niu Xi - Achyranthes Root - invigorates Blood in the legs, used to reduce pain and inflammation in the knees

• Chuan Xiong - Szechuan Lovage Root - invigorates Blood to reduce pain

• Chuan Lian Zi - Toosendan Fruit - smoothes out Liver Qi to reduce pain

• Ji Xue Teng - Spatholobus Vine - invigorates Blood to reduce pain and inflammation, stretches and relaxes the tendons

• Mu Gua - Chaenomeles Fruit - relaxes the tendons and muscles, unblocks the channels, increases flexibility, and reduces pain

• Hong Jing Tian - Rhodiola Root - tonifies the Qi, together with Huang Qi improves respiratory function, reduces pain and inflammation 

• Zhu Ru - Bamboo Shavings - this can be added to the formula to guide the actions of the herbs to the Gallbladder Meridian, which runs through the IT band 

These herbs are, of course, compounded and cooked into a tea in order to extract all the medicinal properties out of the raw, whole plant parts for maximum potency. Cooking them together allows for the properties of all of the herbs to combine synergistically - something that is not achievable when using pills and powders. Tinctures are okay, but their limited potency makes them ideal for children. Raw decoctions are the way to go!

I take this formula steadily whenever I kick my butt into gear and work out consistently, and it always saves my knees and gives me the boost to keep going. I would definitely recommend using this formula during training regiments or sports seasons. It's completely natural and safe to consume regularly, and with an herbal consultation and diagnosis, it can easily be modified to address more specific muscle groups or other complaints.  

Rapid Fire Q&A

I wanted to take an opportunity to share my opinion on some hot button topics that are brought up a lot during treatment sessions or from inquiring patients. These frequently asked questions may get different responses from different acupuncturists or other types of practitioners, so you should know that the answers in this blog all represent my own opinion. Also, I tried as best as I could to resist the urge to answer all questions with, "Just take herbs."

-Colby

What are your thoughts on probiotics? 

Generally, probiotics are used to improve digestive function by introducing healthy microorganisms into the gut, but this is something that should be achieved by adjusting the diet. Why is digestion a problem in the first place? Usually cleaning up digestion starts with cleaning up the diet. If there's a more significant pathology at work, then I'd rather turn to an herbal formula tailored to the specific diagnosis rather than a general probiotic treatment. Probiotics can be useful after taking antibiotics, but I still feel it's best to reintroduce flora to the gut through the diet.

What about vitamin supplements?

It's the same with vitamins. If you're eating right, there isn't a need to super-dose vitamins. You should be getting all of the proper nutrients from your diet. The argument I run up against is that the typical American diet does not provide enough of the nutrients we need. That's an excuse as much of a reason. Vitamins may not be the same as pharmaceutical medications, but in many cases they still represent looking for answers in a pill rather than in lifestyle adjustments. Vitamins are best absorbed in their natural forms, hence why so much is wasted and excreted from the body in the form of neon green urine when taking supplements. 

How do you feel about coffee? 

I hate coffee. I think it's gross. 99% of people I know have a love affair with coffee that I will never understand. Medically speaking, I kind of feel that same way. Sure, every now and then you see some study that says coffee prevents or treats such and such disease. Ok, fine; but that's extracts from the coffee plant, not anything mixed up at Starbucks, mind you! My thoughts on coffee, from a TCM point of view (and I will say that there are acupuncturists who will disagree with me here), is that it taxes the Kidneys. I really believe that the energy and buzz that comes with drinking coffee is, in fact, Qi activated and released from the Kidneys. Coffee acts as the catalyst for burning your own fuel rather than being the source of that quit boost. Essentially, you're robbing Peter to pay Paul, and eventually you get caught - that's why there's the crash a few hours later, and that's why over time people tend to feel greater levels of fatigue. You're slowing spending Kidney Qi that normally would be stored and preserved for more fun things, like baby-makin'. 

What are your thoughts on cannabis? 

Overall, I'm not a fan. Cannabis has a similar effect on the Kidneys as coffee does. Cannabis also has an effect on the aspect of the spirit controlled by the Kidney, the Zhi ("will" or "willpower"). This is why frequent users tend to lack motivation... Also, I think it's fairly obvious that smoking is bad. Cannabis may not have every chemical that cigarettes do, but inhaling smoke adds pathological heat to the Lungs and weakens the Lung Qi. I do have cancer patients who believe it's an important part of the puzzle for managing some of their symptoms, and I generally don't argue with them. If you're looking to use it to manage pain, however, I'll probably steer you towards a more effective and specific herbal treatment.     

What about St. John's Wort / Echinacea / Milk Thistle / Rhodiola / etc.?

Most of the herbs that are popularly known or you read about on the internet come out of a western/European herbal tradition and are generally different from the Chinese herbs we use (though there are some that overlap). Typically, these herbs are misused, according to their Chinese medicinal properties, which is understandable because most (western) "herbalists" are not really trained, and fewer will have any formal education in the subject. That's why you don't see many apothecaries around, and most of these people work at Whole Foods, etc. The approach to western herbology tends to be symptom management with blanket treatments, i.e. "this is good for headaches" and "this is good for sleep." That's crap. Diagnosis is so, so important! Long story short, we generally use other herbs that achieve the same goals but are much more effective because they correspond to a diagnosis that encompasses all symptoms stemming from a root cause. Oh, I do like echinacea, though! And rhodiola is actually a Chinese herb - you just gotta use it right!

Juice cleanses?

No. Just, no.

Which is best for me: yoga, tai ji, qi gong, or the gym?

Yoga is great for most people - it's just important to choose the right kind for your body type and constitution. I admittedly don't know much about the different types of yoga, but based on my clinical experience, I recommend that patients with Blood and Yin Fluid deficiencies avoid "hot yoga," as the loss of body fluid worsens those conditions. It's also important to be supervised; I see a lot of people who injure themselves trying to do yoga from a video. Tai Ji and Qi Gong I think are universally beneficial. They are considered yang sheng - nourishing life practices that when mastered lead to immortality. It's a great meditative practice, actually, because it engages mind and body, just as yoga does. Again, better to be instructed and supervised. The gym is great, so long as you're not overdoing it. It's important to do rigorous exercise as part of your routine. Getting the heart pumping and the sweat flowing is a good thing. Again, supervised and not to the point of damaging body fluids, which can in turn lead to musculoskeletal injury. I use an herbal formula for anyone starting a new workout regiment or who is routinely sore after working out. You can read about it here: Supporting Athletes and Performers

   

How do you feel about cholesterol and blood pressure numbers and cut off values? 

These are generally used to decide "objectively" whether or not someone needs to be medicated. Again, medication tends to subvert the willingness to make lifestyle adjustments. As far as the numbers themselves, so long as someone is not at high risk for heart failure or stroke in the immediate future, I'm not too concerned with them as long as they're actively engaged with lifestyle adjustments. That can includes diet and exercise, as well as acupuncture and herbs, at least for my patients. There really is a lot to say about the numbers, particularly in that they don't accurately represent the needs of every person's body, but I will say this: they are useful in that they are an objective way to show an MD that Chinese medicine is benefiting the body.

What's the difference between an acupuncturist and doctors and chiropractors who claim to do acupuncture?

Training. MDs, chiropractors, and physical therapists do not have the 4-year education in acupuncture technique, which includes safe needling angle and depth for several hundred acupuncture points, nor do they have but perhaps the most rudimentary understanding of Chinese medicine diagnostics. MDs can legally needle someone with their license and can get acupuncture certificates through weekend workshops for MDs. How can you choose an acupuncture point without knowing the cause of the disease? They do many things well. I don't want an acupuncturist to remove my appendix, but I certainly wouldn't seek a physician to give me acupuncture to help me recover from surgery, either.

How do you know if an acupuncturist is legit?

Acupuncturists must be licensed, though in the state of Kentucky we are called "Certified Acupuncturist" though the state's medical licensure. In order to become licensed, we have to complete a 4-year Master's degree program at an accredited school. Definitely look for these credentials. Beware of so-called "medical acupuncturists," MDs advertising acupuncture, for the reasons stated above. Also watch out for acupuncturists claiming to be doctors of Chinese medicine. Some states call their acupuncturists doctors in their licensure - New Mexico comes to mind - but their training is only at the Masters level. There does exists a doctorate degree in Chinese medicine called a DAOM (Doctor of Acupuncture and Oriental Medicine), which requires advanced training and clinical work, as well as completing and defending a research dissertation. There are only around 50 DAOMs in the country currently, but I am happy to say I will be one of them in the next couple of months!

What about acupuncturists who don't use herbs?

I think there are some situations which require herbs, plain and simple. I can appreciate that there are some practitioners who specialize in sports medicine and think they don't need to use herbs for that (I guess...), and I can appreciate that herbal pharmacies aren't feasible for everyone's private practice. On the other hand, I had classmates who would often say they wouldn't use herbs in private practice because developing that expertise is too difficult. Being an herbalist improves your diagnostic abilities and your acupuncture skills, in my opinion.  

What do you think of community acupuncture?

Really, it's a case of you get what you pay for. It's discount acupuncture at a discount rate. Sure the treatment may only cost $20, but you're only getting $20 worth of acupuncture, and when you don't see results, you've wasted that $20. Community acupuncture is usually done in an open setting with patients sitting together in chairs. Treatment times are short, so there's not enough time for a thorough intake and diagnosis, and because it's done in a much more public setting, there are privacy issues. Also, since there are other people around, and the treatments are done in a sitting position, not all points of the indicated points can be used. There are no herbs. Really, this model is for students to maximize patient exposure, essentially to practice and experiment on patients before going into private practice or working at hospitals. You wouldn't want to see a fledgling doctor or dentist who's bouncing around from person to person in an open room trying to figure out how to be a good practitioner. The advantage of seeing an acupuncturist is that one-on-one time followed by time to lie in peace and relax. I did work in a community clinic at a homeless shelter the semester before I became in intern while at school, and it is definitely a great way to bring the medicine to underserved populations, but that was certainly the most hectic place I've ever seen to treat patients.

What are some books you'd recommend to new patients?

For generally TCM info, I like Between Heaven and Earth: A Guide to Chinese Medicine. It has a lot of good info that's easy to understand. It's what I read before starting acupuncture school. There's a section in there about figuring out what element you are, if that's your thing. The Web That Has No Weaver: Understanding Chinese Medicine is good, too, but it's a little dry. For dietary information, I'd go with The Tao of Nutrition, Healing with Whole Foods, and Ancient Wisdom, Modern Kitchen. The last one was written by two of our amazing teachers who teacher the eastern nutrition classes and advanced herbology classes.  

Who do you like in the game tomorrow?

CARDS

Get Results - Not Pain Control - For Your Ovarian Cysts

I recently asked a patient of mine who had great success in her treatment of a very large and painful ovarian cyst to write about her experience with Chinese medicine for the blog. She is a young healthcare professional who is intimately familiar with western medicine, yet passionately pursues, and even conducts, research on alternative therapies and natural healing. That she has come to value the effectiveness and wide-reaching application of Chinese medicine makes me think that perhaps we are doing a thing or two right! Here is what she has to say:

Ovarian cysts are a problem that most women face; however, mine were abnormal. Most ovarian cysts are fluid filled. Mine were not. My main symptom was pain that radiated down my right side. I had frequent urination, abdominal distention, and an increase in right-sided pain after exercise and coitis. I went to my Gyno numerous times for suggestions on how to decrease the size my ovarian cyst. The suggestions I received were solely focused on pain management with pharmaceutical medication. I could not get any alternative suggestions; therefore, I was forced to take matters into my own hands and conduct research. After conducting research and trying various remedies, one remedy presented drastic results. To have a 7cm cyst go down to a 3cm cyst in the matter of a few weeks was a miracle. Since the change in size of my ovarian cyst, I have been continuously taking Chinese herbs per suggested in order to prevent further formation of ovarian cysts. I am happy to state that my ovarian cyst has ceased. The Chinese herbs were effective and less costly than the frequent visits to the Gyno and pharmacy. I strongly suggest considering an alternative that works with your body rather than against it.

Ovarian cysts vary in their presentation. Some are large and painful, as she describes, while others may be small and go unnoticed. Some women regularly get cysts that come and go with changes in their cycle and are more of a nuisance than anything. Cysts may even occur on the uterine wall or inside the fallopian tube, affecting fertility. Size, location, frequency, and pain are all clues as to how to approach treatment, yet there are some commonalities among different types of cysts according to Chinese medicine. 

Like other masses that can form in body, from lipomas to cancerous tumors, fluid-filled or solid cysts are a manifestation of phlegm and Blood stasis in the body. When there is dampness in the body that is not properly transformed and moved out of the tissues, it can begin to coalesce and condense in the phlegm. Over time, the phlegm becomes thicker until it starts to solidify into a nodule. The same can occur with stagnant Blood; as Blood sits unmoving inside or outside of a vessel, it congeals over time and forms a mass. When the vessels and tissues are blocked by dampness or phlegm, Blood flow is further impeded, so phlegm and Blood consolidation often occur together. Cysts and other masses tend to be some combination of the two, and the ratio of phlegm to Blood in the composition dictates the emphasis of the treatment. Transforming phlegm and invigorating Blood to break up stasis are always key strategies, however. 

Because the root cause of phlegm nodulation is dampness, and because dampness occurs as a byproduct of weak splenic function, acupuncture and herbal treatments must include tonification of the Spleen. The Spleen is also the organ that is responsible for transforming pathogenic turbidity in the body - dampness and phlegm - so it must be bolstered in order to do this properly. The other issue is lack of free flow in the body of Qi and Blood, so they must be invigorated, as well. 

For this case, elements of Xiao Yao San are used as a base formula. It includes Bai Zhu and Fu Ling to fortify the Spleen and Chai Hu and Dang Gui to move Qi and Blood. From there, there formula is modified to target and shrink the cysts. Chuan Xiong, Tao Ren, and Lu Lu Tong are added to increase the Blood invigorating action of the formula.  Chen Pi and Ban Xia are used to transform phlegm. Hai Zao and Kun Bu, which are two species of seaweed, are also used to transform phlegm strongly, but their salty taste also means they are especially useful for softening hardnesses. Ju He, the tangerine seed, regulates Qi and breaks up masses. Xiang Fu and Mu Dan Pi are also used to regulate Qi and Blood and break up stasis. 

This, of course, is not the only combination of medicinals to treat cysts. Depending on the nature of the mass, more powerful Blood movers may be indicated. Since the mass is obstructing free flow, the build up of heat from stagnation may need to dealt with. Malignant tumors are destructive because the mass emanates toxic heat. On the other end of the spectrum, cysts that come and go may be managed with a formula that simply focuses on Qi regulation. Once the symptoms are properly diagnoses, herbal medicinals are highly effective.