Friday, October 16, 2009
Ginseng Update
Just a quick note: my patient who's built like the Hulk and who has raging heat going on inside came in today, and hasn't had a dram of ren shen (Radix ginseng) for the last two days. Already, he says that he's sweating less, and his tongue definitely looks less angry. Hooray! A patient that actually listens!
Herb Soapbox
Well, I just finished watching Current T.V.'s excellent Vanguard. The episode was entitled, "The Oxycontin Express." Watching it, you realize two things: 1) Nothing good ever came out of any Bush administration anywhere, and 2) that with the damage being done by legal drugs, specifically painkillers, the FDAs reasoning for barring herbs to practitioners makes even less sense than ever.
Horrifyingly, eleven people per day in the state of Florida drop dead from overdose on painkillers, mostly oxycodone, an artificial form of heroin. Yet, oxycodone is not banned; not only is it not banned, but it's actively pushed in literally hundreds of "pain management" mills in Florida, most of them in Broward County. Yet, with only a handful of deaths attributed to it, ma huang (Herba Ephedra) is banned for use.
I should point out that I do support the banning of ephedra from supplements and other forms of snake oil. Manufacturers of these supplements are abusing a substance in a way never intended. Contraindications for ma huang in the Chinese medical literature clearly state that dose and duration of it should be limited, as it has a tendency to plunder yin if taken too long. However, as was observed a long time ago, Americans have a tendency to take any kind of hokum-in-a-bottle and ingest it, if it promises happiness, a slender figure, and health. Knowing this, supplement makers will go ahead and abuse medicinals like ma huang, and chen pi (Pericarpium citri reticulatae), if they can make a buck on it. The net result is to make life hard for those of us who have studied these herbs and use them in the way that they're supposed to be used. As a weight loss supplement, ma huang is a terrible idea. As a medicinal, in the right situations, it works almost miraculously. The fact that supplement makers are systematically putting more and more of the Chinese pharmaecopia out of reach is outrageous.
More outrageous is the fact that pain management mills in Florida, the Pusher State, can dispense tons of painkillers, hooking thousands of their fellow countrymen, destroying lives, and that they can do so legally. The problem goes beyond Florida, as well. As was pointed out on Vanguard, the impact is felt as far away as Ohio, as more and more citizens make the pilgrimage to Florida to get their OxyContin fix. In Greenup County, Kentucky, 90 percent, that's 90 percent, of people in jail now are in due to oxycodone related crime; either trafficking in it, stealing to pay for it, or theft of it. There isn't a family in the county (and, I'm betting, the state) that hasn't been negatively affected by oxycodone and its use and abuse. Yet, the FDA has chosen to ban ephedra (and will probably ban other herbs as they become the next season's brand of supplement snake oil) rather than oxycodone and other painkillers.
I should also take this opportunity to point out to all medical doctors who say that we in acupuncture are quacks to take a good look at your colleagues down in God's Waiting Room, and at the damage they're doing. If it waddles like a duck, and makes a distinct sound like a duck...
As an acupuncturist that works in a harm reduction clinic, I should also point out that I have a lot of patients coming to me for pain. Most of them are addicts trying to get their lives together. Usually, they come to me for help with pain because they themselves are afraid of oxycodone, and have explicitly told me so. If former heroin users are afraid to go near it, then everyone else should be terrified of the stuff.
Horrifyingly, eleven people per day in the state of Florida drop dead from overdose on painkillers, mostly oxycodone, an artificial form of heroin. Yet, oxycodone is not banned; not only is it not banned, but it's actively pushed in literally hundreds of "pain management" mills in Florida, most of them in Broward County. Yet, with only a handful of deaths attributed to it, ma huang (Herba Ephedra) is banned for use.
I should point out that I do support the banning of ephedra from supplements and other forms of snake oil. Manufacturers of these supplements are abusing a substance in a way never intended. Contraindications for ma huang in the Chinese medical literature clearly state that dose and duration of it should be limited, as it has a tendency to plunder yin if taken too long. However, as was observed a long time ago, Americans have a tendency to take any kind of hokum-in-a-bottle and ingest it, if it promises happiness, a slender figure, and health. Knowing this, supplement makers will go ahead and abuse medicinals like ma huang, and chen pi (Pericarpium citri reticulatae), if they can make a buck on it. The net result is to make life hard for those of us who have studied these herbs and use them in the way that they're supposed to be used. As a weight loss supplement, ma huang is a terrible idea. As a medicinal, in the right situations, it works almost miraculously. The fact that supplement makers are systematically putting more and more of the Chinese pharmaecopia out of reach is outrageous.
More outrageous is the fact that pain management mills in Florida, the Pusher State, can dispense tons of painkillers, hooking thousands of their fellow countrymen, destroying lives, and that they can do so legally. The problem goes beyond Florida, as well. As was pointed out on Vanguard, the impact is felt as far away as Ohio, as more and more citizens make the pilgrimage to Florida to get their OxyContin fix. In Greenup County, Kentucky, 90 percent, that's 90 percent, of people in jail now are in due to oxycodone related crime; either trafficking in it, stealing to pay for it, or theft of it. There isn't a family in the county (and, I'm betting, the state) that hasn't been negatively affected by oxycodone and its use and abuse. Yet, the FDA has chosen to ban ephedra (and will probably ban other herbs as they become the next season's brand of supplement snake oil) rather than oxycodone and other painkillers.
I should also take this opportunity to point out to all medical doctors who say that we in acupuncture are quacks to take a good look at your colleagues down in God's Waiting Room, and at the damage they're doing. If it waddles like a duck, and makes a distinct sound like a duck...
As an acupuncturist that works in a harm reduction clinic, I should also point out that I have a lot of patients coming to me for pain. Most of them are addicts trying to get their lives together. Usually, they come to me for help with pain because they themselves are afraid of oxycodone, and have explicitly told me so. If former heroin users are afraid to go near it, then everyone else should be terrified of the stuff.
Wednesday, October 14, 2009
Crazy Heat
Working at SACHR, I see a lot of patients that have hepatitis, or that have HIV. Recently, I just began treating a woman with both. She has hep A and C, HIV, and diabetes. Heat is the byword for this woman. Her pulse is rapid and thin, and her tongue is scarlet. She has, perhaps, the first truly scarlet tongue I've seen without the aid of hard candy.
Her hepatitis has given her hepatomegaly, and she has a hard time breathing due to crowding of the abdomen. She also has lots of phlegm. While not jaundiced, her skin does have heat papules covering her upper chest, which makes sense since heat rises.
So far, I've only been giving her palliative acupuncture. Her last treatment focused on trying to clear some of her heat. Liver 2 was a prime point, and she also received Kidney 6, L.I. 11, Pc 7, and Stomach 40 for phlegm. I also used GB 41 to move some of her Liver qi.
I intend to follow up with this patient intently, and am currently waiting for her doctor to send me her Liver work-up. More to follow.
Speaking of heat, sometimes a little bit of knowledge is indeed a bad thing. Another of my patients at SACHR has been coming regularly to me for about two weeks, and has loads of heat in him. This patient is actually quite robust. Just two days ago, when he thought I was in the treatment Sanctuary, but wasn't, he tried to open the door. He twisted the locked door-knob with such force that he destroyed it. So far, he has almost always presented with a red tongue, especially near the tip and front, with a dry yellow coat. He has a lot of hunger, and is thirsty a lot. He also suffers from gastritis. He almost always presents with a sweat, staining his clothes.
This case drove me crazy, as I would give treatments to clear heat, and nothing I did seemed to work. The last three treatments have focused on clearing heat from the ying/nutritive level; although not delirious, he does have some history of mental illness (currently under control). Points that I used were Pc 8, Sp 10, L.I. 11, Heart 3, and Pc 7. At times, there would be a slight improvement, but nothing substantial.
Today, however, as he was getting ready to leave, he let slip a vital piece of information that he hadn't told me before. He was regularly taking ren shen (Radix ginseng)! Not just regularly, but daily, both Chinese and Korean varieties! Suddenly, it all made sense. I'd clear heat, and then he'd go and put it right back in. I don't blame the patient; I blame marketing. Drink makers and marketers have been touting the wonderful effects of ginseng and you can even find it in neighborhood bodegas. As wonderful an herb as ginseng is, like the saying says, too much of a good thing is a bad thing. What's worse is that this is precisely the kind of abuse of herbs, in ways that the compilers of all Chinese materia medica never dreamed of in their darkest nightmares, gets herbs banned from the market in this country. The latest casualty in this country is ma huang (Hb. ephedra). It's impossible to get, all because Orioles pitcher Steve Belcher abused ephedra and inadvertently killed himself. I say abused ephedra, although I'm sure he and thousands of people like him didn't think they were abusing it. After all, the makers of diet pills were putting it in their product, and they wouldn't do anything to harm you to make a buck, would they?
Bottom line: more people across the USA abuse oxycontin than abuse heroin, cocaine, and alcohol combined, but it's still prescribed legally. One ill-informed athlete uses ephedra in a way never intended in any Chinese medical text, in a manner that flouted all the traditional contraindications, and winds up killing himself, and suddenly it's too risky, nope, sorry, training or not, you can't have it. There's something very wrong with this picture.
Her hepatitis has given her hepatomegaly, and she has a hard time breathing due to crowding of the abdomen. She also has lots of phlegm. While not jaundiced, her skin does have heat papules covering her upper chest, which makes sense since heat rises.
So far, I've only been giving her palliative acupuncture. Her last treatment focused on trying to clear some of her heat. Liver 2 was a prime point, and she also received Kidney 6, L.I. 11, Pc 7, and Stomach 40 for phlegm. I also used GB 41 to move some of her Liver qi.
I intend to follow up with this patient intently, and am currently waiting for her doctor to send me her Liver work-up. More to follow.
Speaking of heat, sometimes a little bit of knowledge is indeed a bad thing. Another of my patients at SACHR has been coming regularly to me for about two weeks, and has loads of heat in him. This patient is actually quite robust. Just two days ago, when he thought I was in the treatment Sanctuary, but wasn't, he tried to open the door. He twisted the locked door-knob with such force that he destroyed it. So far, he has almost always presented with a red tongue, especially near the tip and front, with a dry yellow coat. He has a lot of hunger, and is thirsty a lot. He also suffers from gastritis. He almost always presents with a sweat, staining his clothes.
This case drove me crazy, as I would give treatments to clear heat, and nothing I did seemed to work. The last three treatments have focused on clearing heat from the ying/nutritive level; although not delirious, he does have some history of mental illness (currently under control). Points that I used were Pc 8, Sp 10, L.I. 11, Heart 3, and Pc 7. At times, there would be a slight improvement, but nothing substantial.
Today, however, as he was getting ready to leave, he let slip a vital piece of information that he hadn't told me before. He was regularly taking ren shen (Radix ginseng)! Not just regularly, but daily, both Chinese and Korean varieties! Suddenly, it all made sense. I'd clear heat, and then he'd go and put it right back in. I don't blame the patient; I blame marketing. Drink makers and marketers have been touting the wonderful effects of ginseng and you can even find it in neighborhood bodegas. As wonderful an herb as ginseng is, like the saying says, too much of a good thing is a bad thing. What's worse is that this is precisely the kind of abuse of herbs, in ways that the compilers of all Chinese materia medica never dreamed of in their darkest nightmares, gets herbs banned from the market in this country. The latest casualty in this country is ma huang (Hb. ephedra). It's impossible to get, all because Orioles pitcher Steve Belcher abused ephedra and inadvertently killed himself. I say abused ephedra, although I'm sure he and thousands of people like him didn't think they were abusing it. After all, the makers of diet pills were putting it in their product, and they wouldn't do anything to harm you to make a buck, would they?
Bottom line: more people across the USA abuse oxycontin than abuse heroin, cocaine, and alcohol combined, but it's still prescribed legally. One ill-informed athlete uses ephedra in a way never intended in any Chinese medical text, in a manner that flouted all the traditional contraindications, and winds up killing himself, and suddenly it's too risky, nope, sorry, training or not, you can't have it. There's something very wrong with this picture.
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