Can we learn from naturopathy

[Guest guest]

It has been suggested that we have little to learn from naturopathy and

the traditions it embraces (such as eclecticism). In fairness, I know

this has been done polemically as devil's advocate. but I do think we

have some things we can learn from naturopathy, despite its apparent youth.

If we can learn from western med, then we can learn from naturopathy.

 

I thought I would give an example to illustrate a point. I saw a patient

with rheumatoid arthritis and perimenopausal symptoms. she was diagnosed

as kidney yin and yang xu, liver qi constraint, dampheat, blood stasis. I

prescribed accordingly.

 

she also saw the naturopath in my office. After doing a physical exam and

lab/stool/food allergy tests, he gave supplements for digestion like

enzymes, intestinal flora, glyconda plus some herbs for candida (oregano

and goldenseal - similar to say combining huo xiang and huang lian). He

also prescribed a combination of natural DHEA, testosterone, estrogen and

progesterone in small doses balanced according to lab analysis. she also

received black cohosh based on eclectic indications for both joint pain

and perimenopause. Plus she took boswellia (a relative of ru xiang) and

willow bark, both which move blood in TCM terms (willow also dispels wind

damp). He advised the patient on yoga classes, relaxation tapes and

recommended some visualization classes for pain management. He advised

various stretching and strengthening exercise plus weekly spinal

manipulation (osteopathic style).

 

The patient did quite well, going into complete remission for at least 4

years now (which I have come to consider typical for my RA patients when

using such an integrative protocol, BTW). One of the most interesting

things was in tracking her progress with lab tests, we observed that herbs

lowered the need for hormone supplementation by leading to increased blood

levels despite unusually low doses.

 

Arguably, he addressed all the same treatment principles I did. But not

all with a single herbal formula and perhaps not with as much specificity.

for instance, liver constraint is not attacked with herbs, but with

relaxation, yoga, exercise. clearly these get at the root of the causes

of liver constraint, though they are not liver constraint specifics. But

this tendency to work with general, rather than specific healing

approaches is somewhat a hallmark of naturopathy. I was trained in

naturopathic philosophy by Jared Zeff, former dean at NCNM, also an L.Ac.

who taught at Emperor's in the 80's. The idea was that most diseases were

self limited. Many others required merely supportive care in order for

healing to occur. By removing the obstacles to cure, one got better most

of the time. thus, general things like good diet, digestive support,

exercise, relaxation took care of most problems. If this did not work,

then general therapies like hydrotherapy, massage, manipulation were the

next level. If this did not work, then specific therapies that worked

with information networks were used, such as homeopathy and acupuncture.

finally,one would use herbs and possibly drugs if imbalance had deranged

the body at the biochemical level.

 

We can fault naturopathy for not always having as sophisticated an

approach as TCM, but perhaps this is because it is not necessary most of

the time (and yet it can be specific as needed, such as the selection of

remedies based on tongue, pulse and generalities). I think the

naturopathic emphasis on the healing power of nature is something we need

to embrace more and not always be so interventionist. I think our talks

about placebo and Jim Ramholz recent comments on how sophisticated

diagnosis is probably only necessary for less than 25% of patients

underscores this point. My main interest in TCM is the focus on treatment

strategies. I think that is the most illuminating thing about it. We can

apply these treatment strategies using many different methods, not limited

to chinese herbs. the chinese texts place a high premium on good diet.

We should never forget how much of a difference this can make and never

feel silly advising our patients to do what their mothers told them or

what they hear on TV all the time (eat right and exercise; quit smoking,

sleep well).

 

In my experience, Relaxation and exercise relieve liver constraint. Bland

wholesome diet, enzymes, flora and bitters clear dampheat. Massage and

exercise move blood. And all these things just make the herbs work better.

And they do actually get at the root of chronic illness (diet, exercise

and emotions). I always try and put these things into a TCM context and

do not just prescribe willy-nilly. but we can use this to our advantage.

these are cheap and free ways of getting to the root of illness. If we

encourage our patients to utilize them so that they will only need to see

us when things get out of hand, it will pay off nicely in loyalty and

referrals. It is always better to give people ways to take care of

themselves, right (teach a man to fish ....)?

 

I think we also take a cue from naturopath's holistic use of lab tests. I

was disenchanted with naturopathy when I began my studies because it only

seemed to give lip service to holism. It was only much later that I

became aware of the holistic method within this field. Naturopaths use

various tests to determine functional imbalances that may underly diverse

chronic illness, such as impairment in intestinal permeability or liver

detoxification pathways. These derangements, among many, can be the root

of any major health problem, thus patients with the same disease may end

up with different treatments. So there is the same emphasis that TCM has,

which is that the symptoms are the branch and there are invisible factors

at work that constitute the root. And that these invisible factors can be

discovered by special means such as the four exams of TCM or modern lab

testing. The fact that lab testing has been used reductionistically in

western medicine is a flaw of the medicine, not the science.

 

Naturopaths also interpret conventional lab tests differently than MD's.

I remember asking my colleague what actually was different in his

interpretation of a standard CBC and chemscreen. He said he identified

imbalances even if all blood levels were technically in the reference

range. though I honestly don't recall the actual details of his analysis,

he said it was more important to him to assess the relationships between

aspects of the test. So 2 aspects might both be in the correct absolute

reference range, but out of the best ratio with each other. A well known

example of this in western medicine is the relationship between total

cholesterol and HDL/LDL ratios. It is only in the past 10-15 years that

it has become clear that the ratio is more of a factor than the total and

that bad ratio can be a harbinger of illness even if total is OK.

Apparently this holds true for many measurable factors in the body and

there is solid research to support all of this. Western medicine ignores

a lot of this data perhaps because they have nonpharmacological solutions

and thus drug companies are not promoting therapies to address many of

these functional imbalances.

 

This way of interpreting lab tests as a series of relationships and using

multiple, perhaps, subclinical derangements to identify " root " patterns

reminds me of Bob Flaws suggestion that when we are able to correlate lab

tests with TCM patterns, we will most likely discover it is not a single

variable that confirms a pattern, but multiple ones. I would now suggest

that it might be about ratios and relationships more than absolute values.

Perhaps it would be interesting to learn exactly how modern naturopaths

are interpreting standard lab tests to see if such a method would be

useful in developing a way to either confirm, validate or screen for

various TCM patterns. some of you may ask why? Several reasons. TCM is

a low tech medicine. Because of this, it is cheap and relatively

noninvasive. Regular use of lab tests increase costs. On the other hand,

tests would appease the demand of insurance companies for confirmed

diagnosis.

 

But I am not calling for regular use in practice, but rather basic

research to confirm what we do. If we prove our methods are valid and

measurable (perhaps in some novel way as described above), then we would

be in a position to argue that our low tech methods actually work the way

we say they do. I want to make sure we preserve our methods in the face

of modern science. And as Kuhn suggested, the way to do this is to first

test the limits of normal science in order to initiate a paradigm shift.

Either way, I think such research would be illuminating. As many of you

know, I to a philosophy espoused by Ken Wilber that all events

in the manifest world have measurable correlations. Note that I did not

say causes. I have no idea whether physical changes come first or

" energetic " changes precede. I suspect they are simultaneous occurrences.

Succinctly put, if TCM causes measurable biochemical changes in patients

with western diseases, then TCM patterns must also be measurable in some

fashion. We can show fibroids sinking on ultrasound; why wouldn't we also

expect to see a series of variables related to blood stasis or liver qi

constraint normalizing in their ratios and relationships, as well. We can

craft truly holistic research or let the reductionists do it their way.

But it will come down to research one way or the other unless I missed

some dramatic cultural shift in the last five minutes. :-)

 

 

 

Chinese Herbs

 

 

" Great spirits have always found violent opposition from mediocre

minds " -- Albert Einstein

[Guest guest]

 

I certainly appreciate naturopathy and the various approaches it

embraces. My original training in the healing arts was at a

quasi-naturopathic school, the Santa Fe College of Natural Medicine, in

the mid-70's. I think integrative medicine makes more sense with

naturopathy than with western medicine because of its use of 'natural'

therapeutics and its more holistic bent, at the same time it has access

to the resources of biomedical testing and some procedures.

 

At the same time, I am wondering if you are running into that wall

that most of us have hit, which is the incomplete nature of TCM

education and literature in the West. Those of us who practice Chinese

medicine came to it out of some sense of conviction, and the language

barrier is a double-edged sword and road-block. It is difficult to

find native Chinese teachers with good English teaching skills and true

familiarity with our culture, and even more difficult to find native

English-speaking teachers and practitioners of Chinese medicine with

good Chinese language skills. Until recently, much of the translated

material was poorly rendered, and, presently, too few of us have access

to the body of literature that constitutes the bulk of our medicine.

As a result, two trends have developed: 1) the desire to eclectic

approaches to medicine 2) an empirical approach to Chinese medicine

based on here-now clinical results, on 'what works for me' and what

doesn't. In my opinion, the Chinese medicine field will only grow if

we gain more access to the Chinese medical literature, sooner than

later. Otherwise we may suffer from integration, dilution and new

hybrids that are not based on a complete understanding of the original

subject.

 

I have nothing against open-mindedness about medicine, and I think we

should have access to everything. I love to read about all kinds of

medicine. But Chinese medicine is a vast ocean, and, again, I must say

we have only scratched the surface.

 

Good minds like to continue to enquire and study. It is still much

easier for me to reach for a book on homeopathic philosophy, or Jewish

texts on medicine, than to struggle through a Chinese text. It is

exhausting to get through Chinese language works. This particular mine

field is holding most of us back, and there is no easy answer to this

problem, other than to roll up one's sleeves and do it, slowly but

surely. It is like marriage. Once the honeymoon and romantic phase

has passed, it takes work to keep the marriage going.

 

 

On Friday, December 20, 2002, at 09:26 AM, wrote:

 

> It has been suggested that we have little to learn from naturopathy

> and the traditions it embraces (such as eclecticism). In fairness, I

> know this has been done polemically as devil's advocate. but I do

> think we have some things we can learn from naturopathy, despite its

> apparent youth. If we can learn from western med, then we can learn

> from naturopathy.