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| Traditional Chinese Medicine |
| Feature Articles - Alternative | ||||||||
| Sunday, 30 September 2001 | ||||||||
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When many people think of Asian or Chinese medicine, they may think only of acupuncture. However, in the ancient practice of Traditional Chinese Medicine (TCM), herbs are often more important than acupuncture, especially for the treatment of chronic conditions. Comparatively little has been written on the subject of Asian herbology and addiction, although antiquated Chinese texts include remedies for intoxication, hangovers, and detoxification. The earliest existing written texts in Chinese medicine encourage moderation in all things and specifically discourage overindulgence in alcohol, food, and sex. The advantages of using Chinese herbs include the ability to treat both the underlying imbalances, "the root," and the symptoms themselves, "the branch." In general Chinese medicine does not compartmentalize health problems into physical versus emotional/mental issues, which makes it a good match for addiction as a disease that affects all aspects of the person's life. Chinese medicine holds additional appeal because side effects are few, if properly prescribed and taken, and because the herbs and herbal formulas are not addictive. Thousands of years old, traditional Chinese herbal medicine entails the use of plant substances, flowers, leafs, stems, bark, roots, as well as minerals and animal substances. All have specific functions, actions, indications, natures and flavors. Chinese herbs are typically not used individually. Rather, the Chinese mix herbs together in classic combinations or formulas that combine herbs to match syndrome patterns and maximize the benefit. These synergistic formulas are then modified based on the individual client's presenting needs as determined by an experienced practitioner. Chinese herbal medicine is distinct from Western herbal medicine (although there are some herbs that both share). In general, Chinese medicine relies on pattern discrimination and its own diagnostic system that does not correspond to Western medical diagnostic patterns. For example, from the perspective of TCM, a diagnosis of addiction might have several different patterns. Chinese diagnosis identifies imbalances (excesses and deficiencies) in yin and yang and related substances (qi, blood, essence), and pathogenic factors (heat, damp, phlegm, cold, etc.). Chinese herbal formulas may be taken in several different forms: teas (decoctions made from bulk herbs), granules (powered herbs then mixed with water), pills or tinctures. (Note: Tinctures often have alcohol as the liquid substrate and should be avoided by recovering persons.) Taking a substance, even an herbal one, poses challenges for addiction treatment because the assumption of active addiction is that an outside source will bring relief. This reality of the disease provides further argument for offering herbal medicine in concert with other therapeutic interventions and for the proper education of Chinese medicine practitioners regarding the nature of addiction. Herbal formulas to treat addiction Remember that Chinese herbal med-icine is based on its own diagnostic system, not on a Western biomedical diagnosis. Treat what you find based on the individual's presentation of signs and symptoms (signs in Chinese medicine include readings of the person's tongue and pulses). It is important to match the correct formulas with the presenting picture. Although many Chinese formulas are available "over the counter" in health stores and the like, seeking the expertise of someone trained in TCM or a doctor of Oriental medicine (DOM) is critical. Using the wrong herbal medicine can lead to problems, including worsening of symptoms. Chinese herbs have distinct properties with predictable effects on the body. For example, giving a person who has a "heat" condition herbs that are hot in nature may cause more harm than good. Some patients will need more kidney support, some more liver invigoration. Nothing works for everybody and there are contraindications for most formulas. In treating addiction, the recovery adage "Keep it simple" applies to herbal detoxification strategies as well. It is important to not try to address too much at once. Patients will often complain of a variety of symptoms and feel an urgency to fix everything at once. Generally, these patients will have a great deal of what Chinese medicine would consider heat and heat symptoms. As a general rule, it is best to avoid tonic (strengthening) formulas at this stage and focus on detoxification strategies. The following are examples of herbal formulas based on the clinical experience of the Jin Hua research group (Scott, 1994): Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Formula). This formula is believed to be effective for clearing heat from the liver and the heart, the organ systems most affected by heat during detoxification. It also brings down liver yang, sedates and calms the spirit and unlocks the three yang stages. Indications for this formula include: irritability, restlessness, insomnia, hysteria, mania, constipation, delirium, convulsions, palpitations and a sensation of fullness in the chest. Huang Lian Jie Du Pien (Coptis and Scute Decoction) is used for clearing heat from all three Burners of the Triple Burner (a Chinese organ system with no direct correlation in Western anatomical understanding). Stronger in heat clearing than Chai Hu Jia Long Gu Mu Li Tang. This formula clears heat in the blood, relieves toxic heat, drains fire, drains damp heat, cools liver and heart heat. Indications for this formula include: mania, nose bleed, insomnia, dry mouth and throat, high fever, bad breath, bleeding from excess heat, delirium, palpitations, blood in the stools or urine, boils, carbuncles, incoherent speech, anxiety, emotional instability, and dysentery. The following are some formulas that prove useful in the post-acute detoxification stages of recovery. Remember to consult a Chinese herbalist prior to use. Jia Wei Xiao Yao San (Bupleurum and Peony Formula/ "Augmented Free and Easy Wanderer") is excellent for clearing heat and moving stagnated liver blood and qi. It is often used after the initial detoxification stage. This formula is very useful in the recovery process and can be used for many months or even years, and is often used to treat patients with Hepatitis B and/or C, or with cirrhosis of the liver. It is also indicated for depression, angry outbursts, red skin rashes, menstrual and premenstrual disorders, irritability, as well as constipation. Tian Wan Bu Xin Dan ("Heavenly Emperor's Formula") can be useful after the initial detoxification process. It is a great formula for yin deficiency fire of the heart and kidney. This formula nourishes yin and blood, tonifies the heart, calms the spirit, and strengthens the will. Indications for this formula include nervousness, insomnia with restless sleep, hyperactive thyroid, forgetfulness, inability to think or concentrate, anxiety as well as fatigue. Dan Shen Jia Liu Jun Zi Pian ("Six Gentlemen" augmented with Salvia). This is a very good formula for depression and anxiety. It is a great formula to circulate qi and blood, cool the blood, clear phlegm, build qi, tonify the spleen and stomach, calm the spirit and soothe the nerves. Often with addiction there is a root depressive disorder which contributes strongly to the addictive cycle. This is an effective formula acting as a catalyst for psychological processes. It is indicated for depression, anxiety, and irritability due to constrained emotions, restlessness, fatigue, weak digestion and lack of appetite due to depression, palpitations and mental disorders, or dizziness due to phlegm accumulation. It is useful for people engaged in psychotherapy, as it helps lighten and free the emotions while providing support. A recently translated article, "Opioid Addiction & Chinese Medicine," by Bob Flaws, Dipl.Ac.& CH, FNAAOM (2000) appears on the web site for Chinese Medical Psychiatry: A Textbook and Clinical Manual, newly published by Blue Poppy Press, and co-authored by Flaws and James Lake, MD. The authors explain that their extensive review of available Chinese texts only yielded this one chapter on the subject of addiction. The article cites a 1998 book on herbal treatments by Li Xi-ru, Shen Jing Jing Shen Yi Bing Gu Qin Xiao Fang (Ancient & Modern Effective Formulas for Neurologic & Psychiatric Disease) published by Science & Technology Press, Beijing, 1998, with a chapter on opioid addiction. Li explains the nature and flavor of opioids and postulates five primary differential diagnoses for opioid addiction and withdrawal. The bulk of the article expands on the herbal formulas Li recommends, including illustrative case histories for each. Growing international research There is a growing body of research literature addressing Chinese herbal medicine from around the world, most concerning the effects of individual herbs (or their derivatives). The fact that Chinese herbs traditionally are used in combinations complicates research as we know it because more than one substance is involved and has to be considered. Considerable excitement was generated by studies at Harvard University and the University of North Carolina. Scientists as the universities reported that the extracts of the herb Ge Gen (kudzu, pueraria) reduced alcohol consumption. Kudzu appears in the earliest-known Chinese herbal text, The Divine Husband-man's Classic of the Materia Medica (Shen nong ben cao jing), believed to have been written in the Han Dynasty (206 B.C.-25 A.D.), and again in the formulas in the Shang Han Lun, attributed to 142-220 A.D., a treatise on the symptoms and treatments of febrile disease. In the U.S., kudzu is best known as the vine engulfing vast areas of the South. A Harvard study (Keung et al., 1993) demonstrated that the active ingredient from the kudzu root (daidzin), reduced hamster alcohol consumption by 50 percent, and reduced cravings. These findings were confirmed in subsequent animal trials. A more recent study (Keung et al., 1996) comparing pure daidzin to crude diadzin (closer to the pure herbal form), found the latter to be ten times more effective. Researchers conclude that while daidzin is the major active principle, the other constituents in the herb increase the effect. University of North Carolina researchers have been working with a compound of Chinese herbal extracts including kudzu and sweet orange. Scott E. Lukas, MD, director of the Behavioral Psychopharmacology Research Laboratory at the McLean Hospital of Harvard Medical School is now conducting double-blind, placebo-controlled trials of kudzu extract and its effects on human subjects in laboratory drinking settings. A recent double-blind pilot study in a U.S. veteran's hospital (Renaud, 2000) yielded insignificant outcomes using kudzu extract with 48 chronic alcoholics. The authors found no statistical significance on self-reported craving or sobriety between kudzu and a placebo, during the four months after release from a 30-day program. The authors admit that the overall drop-out rate was extremely high (higher the first month in the placebo group by a factor of 10). Renowned Chinese medicine researcher, Pat Culliton, MA, DAc notes, "I am not sure any conclusions can be drawn about the effectiveness of kudzu based on this particular study." The Center for Addiction and Alter-native Medicine Research (CAAMR) in Minneapolis, Minn., one of the first centers to study complementary and alternative medicine set up with federal funding in recent years, focuses on issues related to addiction. Two of the three lines of research in process at CAAMR address herbal treatment for addiction. CAAMR claims to be the first facility to conduct randomized controlled trials of Chinese herbal formulas. Jeffrey Albrecht, MD, leads a team of researchers conducting a randomized, placebo-controlled preliminary human trial of an herbal formula for the treatment of Hepatitis C symptoms. The formula involves Chai Hu (bupleurum) and nine other Traditional Chinese Medicinal herbs. Outcome measures will include Hepatitis C symptoms, blood tests of liver function and viral load, as well as quality of life indicators. This study builds on the experience of Uli Beyendorff, Dipl. Ac., CH, at the Hennepin Faculty Associates Alternative Medicine Clinic. According to Beyendorff, the trials with methadone-maintained clients reportedly will have enough participants to permit statistically significant findings. The other CAAMR herbal project examines the efficacy and safety of using a kudzu-based Chinese herbal formula in the treatment of chronic alcoholism. Under the leadership of Dr. Milton Bullock, the randomized placebo trials will look at alcohol use, craving, health status, psychological status, treatment drop-out and relapse rates, gender differences, and adverse effects. The CAAMR trials are important because they involve actual formulas (as opposed to single herbs or isolated extracts) and employ rigorous Western scientific method with real addiction treatment populations. As a result, these studies come much closer to clinical reality. Addiction treatment - with a cup of tea The Pacific Complementary Medicine Center in Stockton, California has been offering Ju Hua (chrysanthemum) tea along with National Acupuncture Detoxification Association (NADA) ear acu-puncture since 1995. Teresa M. Chen, PhD, reports that the tea was questioned because clients of the juvenile court diversion program who received ear needling and the chrysanthemum tea were giving clean urines 99 percent of the time. Such incredibly high rates of drug-free urinalysis samples made clinicians and administrators suspect that the tea might be changing the samples. Chen consulted with several toxicology experts who concurred that the tea would not disguise or mask evidence of illicit drug use (Cooley, 2000). The program believes strongly in the benefits of the tea and continues to serve it, now after urine samples have been collected. The only herbal formula that has been widely used in addiction treatment settings thus far is actually a composition of Western herbs rather than Chinese herbs. The tea, dubbed, "Sleep Mix," was developed to complement the NADA acupuncture for addiction protocol (and can be purchased from Nutracontrol, phone: 212-929-3780). Because use of the tea is taught along with the ear needling technique, there are hundreds of programs in the United States alone implementing this herbal agent. Michael O. Smith, MD, DAc, concocted the formula: three parts chamomile to one part each of peppermint, yarrow, hops, skullcap and catnip, a modification of sleepy-time tea. These traditional Western herbs, as Smith writes, "are reputed to calm and soothe the nervous system and tend to stimulate circulation and the elimination of waste products." Sleep Mix promotes kidney and liver function, cleanses the body through perspiration, calms digestive discomfort, and promotes sleep. The tea is especially suited for alcohol withdrawal symptoms, says Smith. Anecdotally, programs that make tea available have reported a voluntary decrease in the use of benzodiazepines. Even more dramatically, a large public detoxification program, Hooper Center in Portland, Oregon, discovered accidentally that the seizure rate went up when the program ran out of Sleep Mix tea and dropped again when the tea was returned. Many programs give Sleep Mix in tea bags so it is more like having a cup of tea than taking a medication. Tea adapts well to different philosophies, settings, and modalities along the continuum of care. Addiction counselors will recognize the importance of good sleep as support to the recovery process. Sleep disturbances such as insomnia, restless sleep, disturbed dream, or "using dreams" plague patients in both acute and post-acute stages of withdrawal, and may lead to unclear thinking, impulsiveness, and relapse. Sleep Mix helps clients to sleep without mood-altering, addicting properties. (A Chinese herbalist can prescribe other herbal formulas to assist with sleep-related problems.) Related problems Chinese herbal medicine can successfully treat co-occurring diseases and problems that addicts often experience. Sequellae of addiction such as abscesses, liver, and kidney diseases may also benefit from herbal care from an experienced practitioner. HIV/AIDS and Hepatitis B and C are rampant within addicted and recovering populations, and herbal remedies often prove very effective interventions in the treatment of these disorders. Chinese herbal formulas in conjunction with traditional and non-traditional counseling strategies also prove useful in treating depression, anxiety, bipolar disease, post-traumatic stress disorder (PTSD), and other responses to emotional, physical and/or sexual trauma. Chinese herbal medicine can also provide effective, non-addictive pain management treatment. Often people in early recovery find that getting clean unmasks chronic physical or dental pain, which becomes a relapse trigger if unaddressed or addressed with Western painkillers. Current research confirms the effectiveness of herbs such as Yan Hu Suo (corydalis) in modulating pain. G John Scott, LAc is a Doctor of Oriental Medicine currently in practice in Albuquerque, New Mexico. He has been in private practice since 1982, is president of Golden Flower Chinese Herbs Inc., and has been active in promoting oriental medicine on a local, state, and national level. He also has taught classes in the field and has been active in research. Claudia Voyles, LAc, combines 20 years of experience in the fields of addiction and mental health treatment with academic training and licensure as an acupuncturist. She conducts a private practice in acupuncture. In addition, she facilitates activist labors aimed at improving access to acupuncture-based treatment.
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