What Lies Within
I am always fascinated by what goes on in other people's practices. What people do they see? How much do they charge? How often do they treat people? Do they use acupuncture or herbs or both? How do they decide? A thousand and one questions, some of which are merely voyeuristic and others which can shed light on our own work and inform the way we practice.
As a snapshot of my practice, in a 9 day period recently, I treated 113 patients. Their ages ranged from 4 months to 70 years. 10 were new patients. There was a wide range of symptoms and conditions:
|Heart and circulation||6||7|
Of course, these conditions are a summary of the main presenting complaint. A good number of people want to be well and therefore attend regularly, perhaps every 2 months or at the change of the seasons, to maximise their health. This is particularly true of other holistic practitioners that come for treatment. In other cases, for example, those categorised as 'general', the symptoms may be non-specific such as tiredness or lethargy or just not 'feeling right'. In addition, some patients have more than one complaint such as depression with acne. I have listed these only under the first or main condition.
I almost always give people Chinese herbs in addition to treating them with acupuncture. I find that herbs are very nourishing and supportive. The addition of Chinese herbal medicine to my practice made a great difference to who I saw. Now, I see people who have disease which is deeper and may be more severe. I find that people respond quicker when also treated with herbs so that the course of treatment is shorter and smoother. Although people can complain about the taste of herbs, virtually all of them take the herbs. Sometimes they have to add fruit juice or occasionally I get encapsulated powders for them. Practising in London after I qualified in herbal medicine, I started with dried herbs. When I moved to Ireland some 12 years ago I began a herbal dispensary based on herbal powders. I find these very effective, easy to take and easy to store. I also use tinctures from time to time.
I generally see people at 3 or 4 week intervals, particularly if they are taking herbs, as these support them in the intervening weeks. I may see people more frequently, even weekly, for more severe disease or with psychological difficulties where more support is needed. In acute cases, I can see people daily or on alternate days.
So, to a practical example of someone I saw recently with high blood pressure. A common enough situation these days and frequently complicated by the use of prescribed drugs. The conventional view is that although interventions such as relaxation and dietary changes can somewhat affect high blood pressure, there is an inevitability about the need for prescribed medication. This is not my view and I frequently see patients who are seeking more healthy alternatives to control their blood pressure. They are often successful in this.
The important point for us to remember as practitioners of Chinese medicine is that high blood pressure (whatever your definition of that term) is only one indication of an imbalance and it is the person themselves and their energetic state which is paramount. In addition, a raised blood pressure reading is not generally seen as a 'symptom' in Chinese medicine and so we have our usual strategies of enquiry and observation to achieve a diagnosis. Giovanni Maciocia in his book, The Practice of Chinese Medicine, makes the point that as high blood pressure is not a recognised syndrome in Chinese medicine, we have to apply information from symptoms such as headaches or dizziness. Bob Flaws in his book, The Treatment of Modern Western Medical Diseases with Chinese Medicine, lists 8 syndromes which may be accompanied by high blood pressure. These can be generally summarised as Liver Yang Rising, Liver over-activity due to Kidney deficiency, turbid Phlegm, Blood Stasis and deficiency of Qi, Yin or Yang.
A 50 year old man (Mr W) came for a consultation in January of this year who had been taking medication for high blood pressure for the past 3 years. His medication was:
• nifedipine 20 mg daily
• captopril 50 mg daily
At his consultation, he had a history of recurrent urinary tract infections for the past 6 months for which he had received several courses of antibiotics, urgent urination, nocturia once or twice each night, dark and cloudy urine, haematuria, low back pain and fatigue. He was dark and swollen around his eyes. His stools tended to looseness. He would have to go to bed at 8 pm. because he felt so tired. His blood pressure was 190/110.
His tongue was pale, swollen and trembly, pulse soft on the right, little force, slippery. I made a diagnosis of Kidney Yang Deficiency with Damp Accumulation.
One of the points about all medication for high blood pressure is that they affect the kidneys. This is inevitable as blood pressure control is carried out by the kidney and therefore a diagnosis of high blood pressure implies an abnormality in kidney physiology. If you check out the adverse effects of such drugs, you will see that they can cause urinary symptoms, protein in the urine and raised serum urea and creatinine levels. All of these indicate damage to kidney function. Indeed, all patients are recommended to have a urine test as well as serum urea and creatinine levels before receiving drugs such as captopril.
I decided to focus on tonifying his Kidney Yang and treated him with acupuncture as well as giving him Jin Gui Shen Qi Tang:
Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 24 g
Shan Yao (Radix Dioscoreae Oppositae) 12 g
Shan Zhu Yu (Fructus Corni Officinalis) 12 g
Mu Dan Pi (Cortex Moutan Radicis) 9 g
Fu Ling (Sclerotium Poriae Cocos) 9 g
Ze Xie (Rhizoma Alismatis Plantago-aquaticae) 6 g
Rou Gui (Cortex Cinnamomi Cassiae) 5 g
Fu Zi (Radix Aconiti carmichaeli praeparata) 3g
In some jurisdictions, Fu Zi (Radix Aconiti carmichaeli praeparata) is illegal and amendments have to be made to the formula.
The acupuncture points I used were Fuliu (KI 7) with moxa, Guanyuan (Ren 4), Zusanli (ST 36) with moxa and Zhongwan (Ren 12).
Interestingly, at the same time as I was treating Mr W, I saw a woman of 35 years with high blood pressure - 170/110 - on a routine check. The conventional clinic she attended recommended her to come back for a recheck a month later. Fair enough and sensible advice. It is considered good medical practice not to diagnose high blood pressure on one or even several readings but to take it regularly over several weeks. After a month, the blood pressure was 150/98 due to a combination of lifestyle changes, Chinese herbal medicines and acupuncture. Nevertheless, she was given captopril.
So, it is clear that the likely scenario for Mrs T is to be a repeat of Mr W's story some years down the line. She checked out captopril on the internet (not from any prompting from myself, I may add, although perhaps she read my mind!) and was shocked at what she found. She decided herself to stop it and is had regular weekly acupuncture treatments. Her blood pressure for the first month or so of treatment was 140/90 occasionally rising to 150/95. She feels well and is confident that her blood pressure will be controlled by the changes she has made to her diet, exercise levels and work practices. Her blood pressure, some 6 months later is normal and she is well.
And Mr W? He had blood tests for his kidney function - 3 years delayed - but welcome nevertheless. These were normal. He stopped his captopril after the first consultation with myself on my recommendation. The reason for this is that if someone is taking a drug and develops symptoms which are known to be associated with that drug, action has to been taken quickly to prevent further damage. The only exception to this is where the drug is being taken to preserve life. I also suggested he have a 24 hour blood pressure monitoring and a urine test - the latter to be done some 2 or 3 weeks after stopping the captopril.
I gave him dietary advice as well as Chinese herbal medicine and acupuncture. After 3 weeks, he returned for treatment. His 24 hour blood pressure monitoring was normal (no captopril and only taking nifedipine). His urine test was normal, no blood, no protein. He then took his nifedipine every second day for 2 weeks and then stopped. His blood pressure at that time was 140/90 to 140/95. At his last visit in June, his blood pressure is 130/85 and he is well with no symptoms. He is very pleased with his progress and continues to pay attention to his diet and exercise levels.
Stephen Gascoigne qualified in medicine in 1976 in Liverpool, UK and worked for 6 years in hospital and general practice. Stephen trained in acupuncture in China and subsequently in Chinese herbal medicine in London with the esteemed Vietnamese practitioner, Tinh Thong Nguyen. Stephen is the author of The Chinese Way to Health (Connections, 2000), an introduction to Chinese medicine and its methods for the general public and two textbooks for students and practitioners of holistic medicine - The Clinical Medicine Guide (Jigme Press, 2001) and The Prescribed Drug Guide (Jigme Press, 2003).