Traditional Chinese medicine (TCM) is having a really good week. And a really bad week. On the Sept 26th Beijing Hour show (audio podcast is above), Paul and I talk about two major news stories this week regarding TCM. The good news comes from a prestigious medical award being awarded to a Chinese pharmacologist for her discovery in the 1970s of artemisinin, an extract of a famous Chinese herb which is now the cornerstone of malaria treatment all over the world. I think it’s the prime example of how good research can discover wonderfully effective treatments from Chinese herbs. The bad news comes from a China Daily article discussing how “among all academic theses on acupuncture indexed by the Science Citation Index (SCI), a leading world thesis index system, only 5 percent are from the Chinese mainland.” How can China, the birthplace of acupuncture, be an almost non-player in the research of its own creation? Click on the above audio links to find out.

You can listen to all my previous podcasts at the podcast archive. My Beijing Hour guest hosting is usually every Wednesday morning arounf 7:35AM. You can always listen to the Beijing Hour on EZFM 91.5, which is broadcast from 7-8am every weekday by host Paul James. EZFM is the popular bilingual radio station on the CRI Radio network, broadcasting here in Beijing and on multiple stations all over the world, as well as live online here.

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Dr Livingston: As you mentioned, ganmao in Chinese Medicine (CM) is not
actually a diagnosis. CM diagnoses what in Chinese is called a 证,
sometimes translated as “syndrome” or “pattern”, and ganmao is merely
a 病, or “disease”. CM treatment is not based on “disease”, but rather
on “syndrome”. Since, as you mentioned, there are many different
possible “syndromes” that could present when someone comes down with
ganmao (such as wind-cold, wind-heat, etc), there are many different
types of treatment, and there is no one-size-fits-all treatment for
ganmao, or any other disease for the matter, in CM. Thus in Chinese we
say 同病异治- same disease, different treatment. Furthermore, CM
infectious disease theory, of which ganmao is a part, is extremely
complex, and to be well versed and clinically effective in it requires
years and years of study and practice.

As for the OTC CM preparations you mentioned, I don’t personally find
any of them to be very effective. There are a couple reasons for this.

First, because they are prepared medicines there is no way to modify
them to fit the patient’s “syndrome”, so even if used by a competent
CM physician based on solid diagnosis, unless the remedy somehow
perfectly fits the patient, results will be less than optimal.

Second, these preparations are generally just not as strong as loose
herb prescriptions. The latter of course also have the further
advantage of being tailored to fit the patient.

Third, many of these preparations are based not on CM ideas of herb
function/traditional pharmacology, but on western medicine/modern
pharmacology. Ban Lan Gen Ke Li is a prime example: it’s used solely
because it has anti-viral properties, not because of it’s traditional
actions and indications. Chinese herbs used in this manner cease to be
Chinese Medicine, and are just Chinese herbs used according to western
medicine. One can of course do this, but the advantages of proper CM
methodology are not used, and the anti-viral function is quite mild,
so this method is really neither here nor there, and it’s quite
ineffective. In fact, Banlangen Keli/Chongji, etc, is really only
useful to try and prevent ganmao, is moderately effective at best for
this purpose, and is completely worthless for treating people who
already have ganmao. In fact, I also think it’s almost useless to
prevent ganmao as well. Other preparations such as Shuang Huang Lian
Kou Fu Ye are also based on this methodology, and are moderately
effective at best.

Ganmao Qingre Keli is for wind cold with a bit of internal heat.
Because many ganmao are the result of wind cold, this one is actually
not too bad for early stage wind cold ganmao with slight chills and
aversion to wind and cold, mild cough, runny nose, etc.

Yin Qiao Jie Du Pian is for wind heat ganmao, with very very mild
chills, slight aversion to heat, slight thirst, mild cough, runny
nose, etc.

However, ganmao symptoms and “syndromes” change very rapidly, so it’s
much more complicated than this. And there are actually 100′s of
prescriptions for ganmao as there are so many different ways it can
present, so limiting oneself to these few preparations is a guaranteed
path to mediocre efficacy. Similarly, if a non-MD were to only “learn”
how to use a couple antibiotics they would also be less than optimally
effective, to say the least.

As for studies, there are certainly many studies in Chinese, but
probably not much in English. But again, because CM is by nature
individualistic, it doesn’t lend itself to RTC style studies, the
object of which is to eliminate as much individual variation as
possible. Therefore, a study of 100 people with ganmao using one
preparation is bound to show mixed results: the small number of
patients that are perfectly fit for the prescription will do well,
those that are more or less fit for it will do ok, those that aren’t
fit will do poorly, and some people that have a completely opposite
syndrome with suffer side effects. So, RTC studies don’t mean much for
CM physicians. If you want to take CM herbs and do RTC studies on
their effectiveness, you can of course do that, but this is not CM,
and is not an evaluation of CM, but rather just an evaluation of an
herb’s modern pharmacological function.

Me: Your insights are very helpful. It seems that indeed I may never be comfortable in recommending CM for my patients, in terms of those basic TongRen-style famous packaged formulas. We do have a TCM doc here and I will make more recommendations to see him directly. Although, I’m still disturbed that I won’t be able to recommend more packaged items. After all, it’s only pharmacology. Plenty of western OTC Rx can be very effective; we know that Tylenol or ibuprofen is extremely effective for fever in almost everyone. Why would we assume that all these famous CM packaged products are “weaker” than individual CM Rx?

DL: Actually, it isn’t “only” pharmacology. If you use Chinese herbs based
purely on modern pharmacological knowledge of the herbs, then you are
not using them according to CM principles, and thus they cease to be
Chinese Medicine and become the same as pharmaceutical drugs, only
weaker in most cases. Of course pharmacology is always at play- it’s
not that “intention” (“intending” to use an herb according to CM or
according to modern pharmacology) changes what that herb does to your
body! The key point is diagnosis, and since western medicine doesn’t
differentiate/diagnose in the same way as CM, the medicine isn’t
applied in the same manner/situation. This is really the key point. If
these prepared medicines are given in the appropriate situation (as
determined by CM diagnostic and treatment methodology) they can be
quite effective, although as I mentioned earlier, they are generally
not as effective as bulk-herb prescriptions/decoctions because: 1)
they are not tailored to the individual; 2) the dose is typically
smaller than bulk-herb formulas/decoctions.

Me: If And if the evidence for things like banlangen is so weak, why does every Beijinger, including my staff and my wife, take them?

DL: People in China all have heard that banlangen has antiviral properties
(it does, but pretty mild), it’s been marketed and promoted as a
ganmao remedy, and it’s often an ingredient in government endorsed
ganmao prophylactic formulas, so the overall impression is that it’s
good for ganmao. But in my own experience, and that of many of my
teachers and colleagues, it is really only useful in prophylaxis, and
for this it is quite mild, but that’s not to say ineffective.
Furthermore, this use is not a traditional use of the herb, but one
based purely on pharmacological knowledge, and so it cannot be
considered Chinese Medicine, even though it is a Chinese herb. This is
an allopathic use of the herb, which is of course fine, but not really
that effective. CM can be used to prevent ganmao, and can be quite
effective (I take herbs often for this purpose, and rarely get sick
even when people around me are all sick), but again, it must be done
according to CM principles (otherwise it’s not CM, hehe) in order to
get decent results. Simply, what CM does in this regard is strengthen
and harmonize physiological function, which, among other things,
improves immune system function.

Me: By the way, I take these medicines myself! My wife is a Beijinger and every time I have ganmao she makes me take one banlangen and one ganmao package, 3 times a day. I wish I could say I notice a difference, as it’s always hard to tell with ganmao whether I’d be getting better anyway.

DL: If you don’t notice a difference then I would say there is not much
effect. If ganmao is treated properly with CM, it is quite effective.
If treated at the first sign, most ganmao can be cured in a day or
two, or at the very least be prevented from developing into a full
blown ganmao. If later stage, it should noticeably reduce symptoms and
speed up recovery time. Anything less than that is a poor result
unless it’s due to a particularly nasty strain of flu, or to a
patient’s weak or debilitated constitution.

The Bottom Line

Thanks so much, Greg, for your insight. After your comments, I’m now even less sure that I’ll be able to properly prescribe any Chinese medicines without more proper training. I think I will ultimately become what you describe as a more allopathic doctor using certain pre-made Chinese medicines if there is good evidence. Yes, as you say, it wouldn’t any longer be considered a traditional Chinese medical use, but I’m comfortable with that, as long as the data is there and the disease condition is clear.

(Most of this article was originally printed in an earlier MyHealth Beijing article; I am reposting some archives as I am on vacation now. I return to work on May 2nd at my new position at Beijing United Family Hospital, where I continue my family medicine practice but also am their new Group Director of Clinical Marketing and Communications for their national chain of hospitals.)

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These days many people know about the availability of natural medicines like herbal remedies, homeopathy, and the use of vitamins and minerals to treat and prevent disease. However, not many people are aware that there is a profession that is highly specialized in the use and prescription of natural medicines. A naturopathic doctor (N.D.), or naturopath, is very well educated when it comes to the appropriate use of nutritional supplements, herbal remedies, and other alternative treatments. Naturopaths are also knowledgeable about interactions between drugs and natural medicines. You might be asking yourself, what exactly is naturopathic medicine? How do I recognize a formally trained, licensed naturopath? And what can naturopathic medicine do for me? Let’s begin with a brief synopsis about the origins of naturopathic medicine.

History

Naturopathic medicine has been around in its primitive form since pre-historic times. In those days there was likely a “healer” in the village or a wise elder who knew what herbs and plants were useful for what condition. They were also aware of which foods were beneficial for which maladies; and what foods to avoid when ill. All ancient cultures have their traditional healing wisdom, the Persians, Native Americans, East Indians, Chinese… The list goes on and on. Hippocrates, a Greek physician who is considered by many to be the father of modern medicine, described the concept of “the healing power of nature” almost 2500 years ago.

Naturopathic medicine as it is known today developed in Europe in the late 1800’s before coming to North America. Dr. Benedict Lust popularized the term “naturopathy” and used it to describe a medical practice using herbal remedies, homeopathy, acupuncture, nutrition, lifestyle counseling and manipulative therapy. In the early 1900’s he opened many naturopathic colleges and healing centers in the United States. Naturopathic medicine flourished in North America until antibiotics and surgery took centre stage during the 1930’s and 40’s. This trend continued until the last few decades, when people began to look for alternatives to conventional medical treatments.

Philosophy

Treating the root cause of disease is the fundamental purpose of naturopathic medicine. A visit with a naturopathic doctor takes a long time, because many aspects of a person must be studied, their diet, lifestyle, medical history… Everything must be considered in order to understand the underlying cause of disease. The goal is not to treat the symptoms, although at times the symptoms must be alleviated. The goal is to find out the why, not just the what. Like a detective, a naturopathic doctor must put all the clues together to discover the cause. For example, why does this individual suffer from migraines? Could it be a reaction to stress? Perhaps a trigger in the environment, or maybe an unknown food sensitivity? While relieving the pain is important, to treat the cause is imperative in order to prevent further migraines from occurring. Thus the cause and therefore the prescription will be unique to each individual.

One of the most important principles of naturopathic medicine is that the body has the innate ability to heal itself. We see this phenomenon in everyday situations, if we get a cut or a cold, our body will naturally heal the wound and eventually cure the cold. This is true for most people and in most situations. A naturopathic doctor uses natural medicines to help the body heal itself. Naturopathic treatments can give the body that extra boost it needs to heal faster and more efficiently. For example, if a person’s body is too weak to handle a simple cold, complications can arise such as secondary bacterial infections. These become harder for the body to treat by itself. If natural medicines that support the immune system are given, we can potentially avoid complications like bronchitis or pneumonia. There are also extreme situations in which the body is struggling to heal itself, for example when someone has a disease like cancer. In this case, natural medicine can help strengthen the body and counteract the side effects of conventional therapies like radiation or chemotherapy.

Education

To become a licensed naturopathic doctor one must go through a long and rigorous process that is both challenging and extremely rewarding.

Naturopaths must first receive a university Bachelor degree and complete certain pre-requisites such as biochemistry, anatomy and physiology. Then they apply to a naturopathic college that is accredited by whatever organization is responsible for that country. In Canada it is the Council on Naturopathic Medical Education (CNME), which is recognized by the US Department of Education. The naturopathic program is 4 years and is very intense. Courses include histology, embryology, and immunology, as well as pharmacology and other medical sciences. The naturopathic component includes botanical medicine, nutrition, traditional Chinese medicine, and homeopathy. There is also one year of clinical experience. By the time someone graduates from a naturopathic college they would have completed over 4200 hours of classroom and clinical training.

The next step to become a licensed N.D. is to successfully complete the licensing exams. In the US and Canada these are administered by the Naturopathic Physicians Licensing Examinations (NPLEX). After this process is complete, an ND must continue learning in order to maintain their license. The science of natural medicine is constantly being developed, so continuing education is critical to stay current and well informed.

The Naturopathic Advantage

Naturopathic doctors are trained primary care providers who can help a person optimize their health through diet and nutritional supplements. They empower and educate their patients, helping them make healthier choices. They can also treat disease, from acute conditions like ear infections to chronic conditions like Alzheimer’s. The methods they use are gentle and many have stood the test of time, some still being used after thousands of years. Naturopaths are also trained to recognize when to refer a patient. This is important because there are times when the perspective of a different professional is needed, when further investigations are warranted, or when natural medicines are not enough. A naturopathic doctor is your best resource to find a healthy balance between natural and modern medicine.

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This is the first illustrated book ever published in English about the basic theories of traditional Chinese medicine (TCM).
It is concise, yet vivid, and easy to comprehend. Filled with hundreds of lively illustrations, Zhou Chuncai introdues the subject systematically, comprehensively and enjoyable, guiding the reader step by step through the enigmatic world of TCM.

The book covers:

• Theories of Yin-Yang and Five Elements, the Basic Theories of TCM
• Doctrine of Visceral Manifestions
• The Basic concepts of Qi, Blood and Body Fluid
• Pathogenic Factors in TCM
• Treatment based on syndrome differentation
• Eight Therapeutic methods in Chinese medicine

It’s As Easy As It’s Going To Get…

Readers are probably familiar with the Dummies series of books which for two decades have provided simple how-to guides for hundreds of topics. So you can consider this book as a Dummies guide to TCM. It covers all the basic theory, as well as more practical issues of which famous medicines work for what diseases. The very cute illustrations make this far more readable than any other text I’ve seen on TCM, and studying TCM literally probably can’t get any easier than this. But honestly that isn’t such high praise, as it’s still very difficult reading, and understanding TCM is never easy.

After finishing this book, I must confess that I still have almost no deep grasp of TCM theories. The illustrations help a lot, but the underlying structure remains completely obscure to me. More importantly for me, I am less inclined than before to think of TCM as a serious approach to health. It’s elegant and poetic and provides nice basic instructions on good health, but the underlying scientific basis for almost any of it remains unproven. After reading this, I feel fairly done with my attempts to understand TCM. I’ve tried, and I’ve researched, and I am more comfortable than ever that TCM has little to add to my medical practice. I still will continue my attempts to find herbs that work.

Where To Buy

My wife ordered it for 34 kuai on joyo.com; I see it here on the English language site Mandarinbooks.com, as well as douban.com. I’m sure the local bookstores can order it as well.

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One of my continuing goals in China is to find traditional Chinese medicines and practices that I can integrate into my Western, allopathic-style family practice. As I’ve reported a few times, I’ve been struggling to find Chinese herbal medicines that I am comfortable prescribing, usually due to lack of evidence for a clear benefit.

As for acupuncture, there are actually a lot more well-designed studies done on this field when compared to Chinese herbs, mostly because Europe and the West have become very interested over the last couple decades and are funding better clinical trials. The evidence trail is building, which is great for everyone. So, what works, and what doesn’t?

The New York Times has a very readable article last week which covers this issue. The gist of the article discusses the most recent, well-designed studies on back pains and other disorders; the studies usually show no difference between acupuncture and placebo (usually a “sham” needle that doesn’t penetrate the skin). In other words, the best studies lately are usually showing that most of the perceived effect from acupuncture is simply a placebo effect.

These recent findings are by no means surprising, as most of the best studies have been reporting similar conclusions for many years. The best collection of acupuncture research is from the Cochrane Review Group, which performs the world’s most rigorous reviews of all treatments, including alternative medicines. They have an outstanding collection of the best literature on acupuncture which details the best evidence regarding a number of acupuncture treatments. Unfortunately, as many other researchers have noted, the only treatments for which acupuncture is even mildly effective are for musculoskeletal problems and nausea. There is some evidence of effectiveness for treatments for IVF, as well as insomnia. But many well-designed studies have specifically shown no benefit over placebo for a host of other treatments. The Cochrane group also commonly finds that the quality of studies is very poor and cannot recommend either for or against.

Readers should be aware that this is not simply a Western bias against alternative medicines; in April a group from Beijing Hospital published in a  Chinese journal a similar literature review of acupuncture for insomnia, and couldn’t even make a conclusion because the studies were so poor:

Regarding the assessment of the therapeutic effect, measuring scales are often adopted in overseas studies, while in domestic researches, self-drawn standards are frequently used. In conclusion, there have had no high-quality clinical trails about acupuncture treatment of primary insomnia in China at the present, and the related evaluating methods could not definitely confirm the efficacy of acupuncture in relieving insomnia. Therefore, a strict and scientific clinical trail scheme being in line with evidence-based medicine is urgently needed in the coming studies on acupuncture treatment of primary insomnia.

The Cochrane’s reports cover a lot of therapies that I’m sure many readers have tried. Here’s an example of Cochrane’s findings on the most common acupuncture treatment — low back pain:

Thirty-five RCTs covering 2861 patients were included in this systematic review. There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain. For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months. The results also show that for chronic low-back pain, acupuncture is more effective for improving function than no treatment, in the short-term. Acupuncture is not more effective than other conventional and “alternative” treatments. When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.

For depression:

“…Thirty trials, and 2812 participants were included in the review and meta-analysis, however there was insufficient evidence that acupuncture can assist with the management of depression.”

For migraines:

In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects. Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.

For insomnia:

Seven studies were eligible for inclusion in the review, involving 590 participants. The studies were of low methodological quality and were diverse in the types of participant, acupuncture treatments and sleep outcome measures used, which limited the ability to pool the findings and draw conclusions. Currently there is a lack of high quality clinical evidence supporting the treatment of people with insomnia using acupuncture. More rigorous studies are needed to assess the efficacy and safety of various forms of acupuncture for treating people with insomnia.

Other reputable sources of evidence include the National Center for Complementary and Alternative Medicine. Also, the excellent evidence-based blog The C.A.M. Report has a section on acupuncture studies. Another blog, Science-Based Medicine, has a section on acupuncture. And I’ve started to read a couple of recently published books which also take a rigorous, evidence-based review of alternative medicines, and I recommend them to my readers. One is called Trick or Treatment: The Undeniable Facts About Alternative Medicine; the other is called Snake Oil Science: The Truth About Complementary and Alternative Medicine. Both can be downloaded via Amazon.com as an e-book. The New England Journal of Medicine has a book review of Trick or Treatment.

Does It Even Matter What The Science Shows?

Many readers may remark that complementary medicine, even if it is just a placebo effect, is still better than nothing. And I think that’s partly true; the placebo effect is simply a person believing and hoping they will get better. It’s an amazing and profoundly humbling revelation that simply believing in healing can set off a biochemical cascade which can boost your immune system and help your body to heal itself. The placebo effect is proven time and again in every study ever done. It’s called faith, and it’s crucial in any illness and is crucial just for living. Here’s a nice quote from the New York Times article:

…acupuncture believers say it doesn’t really matter whether Western scientific studies find that the treatment has a strong placebo effect. After all, the goal of what they call integrative medicine, which combines conventional and alternative treatments like acupuncture, is to harness the body’s power to heal itself. It doesn’t matter whether that power is stimulated by a placebo effect or by skillful placement of needles.

“In general in integrative medicine, when patients are involved in their healing process, they have a tendency to do better,” said Angela Johnson, a practitioner of Chinese medicine at Rush Children’s Hospital in Chicago who is conducting a pilot study of acupuncture to relieve pain in children. “I believe that’s part of the reason why they get better.”…

But one of the problems of relying on alternative medicines (which probably are a placebo effect) would be that you are losing valuable time in getting proper, effective treatment for something which may be serious. Also, you will potentially be spending a lot of your personal money for treatments no better than a placebo.

My Bottom Line

I personally feel that if a patient wants to try acupuncture for musculoskeletal problems like back pains, then they are welcome to try. It’s usually very safe, and sometimes can help; it’s also an interesting experience to do at least once. For almost all other treatments, I would try to pull up Cochrane Database evidence for such treatment and show my patients, and let them make their own decisions.

Hopefully by now, my long-term readers are convinced that evidence-based medicine is the most proper method of testing therapies, and that all treatments of any culture’s medical systems should be tested and proven with rigorous clinical trials. So, I hope we are all open-minded enough to believe that when the best trials show no benefit for a specific treatment — whether mainstream or alternative — then doctors shouldn’t recommend that, and consumers should think twice before wasting their money on it. On the flip side, doctors such as myself should be open-minded and recommend alternative treatments that are proven to work. There just aren’t that many…yet?

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1. I’m too lazy to research
2. I’m too busy to research
3. I’ve tried to research but can’t find convincing evidence

The answer, of course, is D: “all of the above”. But I refuse to give up, and I still love the idea of fusing the best of Western and Eastern medicines into my practice. So, here are my favorites:

Nin Jiom Syrup for cough - everyone likes this medicine (pictured above), as it tastes really good. That’s because it’s mostly pure honey with a lot of herbs thrown in. I like this syrup even better than the western-style Robitussin syrups mostly because they all work about the same — which means not very well. Since none really work well, you might as well avoid the many side effects from Robitussin-style syrups which often make people feel a bit loopy or too wired, due to the pseudoephedrine and allergy ingredients. I like to combine Nin Jiom with western medicines like Tylenol Cold pills or oxymetazoline nasal spray.

San Huang Pian （三黄片）for constipation – This formula has many uses, but I personally like this one for general constipation. People who are stuck can take 1-3 pills before bedtime for a couple nights to get results. I’m told you should only use this occasionally and not every day, and I only recommend this to healthy adults who would like to try an alternative to their usual constipation therapies. The best way to keep your bowels healthy and loose is always a proper diet and hydration, plus exercise.

Watermelon Frost Lozenges for sore throats – There are a lot of cough drops and sore throat lozenges out there, but many are simply pure candy and ineffective. Watermelon frost (xigua shuang han pian 西瓜霜含片） is an ancient remedy for the throat, and I’ve found these lozenges to provide fairly good relief for the typical sore throat and cough.

Xue Zhi Kang (血脂康 胶囊) for high cholesterol – as I’ve mentioned before, this patented formula from red yeast rice has fairly strong evidence to lower cholesterol. There’s a good reason for that — much of the natural ingredients are similar to the prescription lovastatin. I’ve tried this medicine with a couple low-risk patients and had good results, although one patient had the same muscle aches he experienced with Lipitor and other statins.

The Jury Is Still Out…

I’m still looking for hard evidence that the wildly popular common cold medicines ban lan gen ke li or gan mao qing re ke li actually work. I am still deciding on many other medicines, including yunnan baiyao, a famous powder good for bleeding and burns.

What Chinese medicines do you use? Please leave comments below; it’d be fun to spark a reader conversation about pros/cons and personal experiences.

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Testimonials. Anecdotes from individuals who have used the product are no substitute for scientific proof. If the product’s claims were backed up with hard evidence, the manufacturer would say so.

So, if you see any website with big top banners linking to testimonials and not to research/evidence, then forget about that product. A testimonial is scientifically worthless; that patient could simply be one of the ~30% of people who benefit from the placebo effect of any pill.

As for my favorite websites, I like:

• Mayo Clinic supplement lists
• National Center for Complementary and Alternative Medicine
• Natural Medicines Database Clinical Management Series

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For many expats, living in a busy metropolitan city like Beijing has many advantages. Benefits include exposure to a different language and culture, a plethora of delicious foods to excite the palate, and the chance to live unique, life altering experiences. However, there is also one major disadvantage, namely our exposure to pollution and toxins. Thankfully our bodies can deal with these unwanted substances through a process called detoxification.

Modern World, Modern Issues

It seems that “detox” is quickly becoming one of today’s top health related buzz words, but the fact that our bodies are capable of cleansing our system of toxic materials is nothing new. We have 5 organs of detoxification: our skin, our liver, our kidneys, our bowels, and our lungs. These organs not only help our body dispose of metabolic wastes -for example the bi-products of cellular respiration- but also rid the body of toxins that are harmful to our system.

What is new, however, is the vast amount of synthetic chemicals that have been created in recent history and that are now floating around our planet. On a daily basis we come in contact with tens of thousands of man-made chemicals; in our personal care products, our cleaning supplies, and even the food we eat. Greenpeace estimates that approximately 100,000 new synthetic chemicals are produced in the world every year. Most of these chemicals do not have any long term studies related to safety. We have no knowledge of how these chemicals -specifically their molecules- interact with the cellular components of our bodies; much less how they interact with each other. Recently it was discovered that Bisphenol-A (BPA), a chemical found in many plastics -including baby bottles- is a hormone disrupter and can potentially cause a multitude of problems in the body. Bisphenol-A easily leaches into water or food that has been heated in plastics containing BPA. It is then ingested, by adults and infants alike. Thankfully, BPA has been legally banned in Canada and other countries are following suit.  Harmful chemicals like heavy metals can accumulate in various tissues, including fat, blood,  lymph, and even hair.  These aren’t the only chemicals that can be found in the human body. Some studies have found over 200 chemicals in the umbilical cord blood of newborns, including chemicals used in flame retardants and industrial lubricants. Particularly alarming is the fact that the short and long-term effects of having these chemicals in our systems are not fully understood.

Detoxification Simplified

From a naturopathic point of view the concept of detoxification is quite straightforward. By using techniques that support and enhance the work of the organs of elimination, we can help our bodies speed up, or make the process of releasing unwanted toxins more effective. This is commonly referred to as doing a detox.

For example a light detox can be done by eating organic whole foods and avoiding common allergens like dairy, wheat and gluten. Consuming organic products decreases the toxic burden on our bodies. During a detox avoiding processed foods, like frozen dinners, soft drinks and luncheon meats, decreases our exposure to food additives and preservatives. These provide no nutrition and instead add more unwanted chemicals to our system. Usually when following this type of diet weight loss occurs. Many toxins are stored in fat and are thus released when the fat stores are utilized.

Fasting for Health

A fast is another, more powerful, method of detoxification that should only be done under the supervision of a licensed naturopathic doctor. When people hear the word fast, they often think of a water fast. This type of a fast involves drinking only water for 24 hours or more. It is best to avoid water fasts as they can be debilitating and can also cause detoxification to happen too quickly, leading to more intense side effects. Juice fasts are a great alternative that provide a source of energy, as well as valuable vitamins, minerals and enzymes. During a fast the amount of chemicals consumed is greatly decreased. Its benefits are like those of a detox diet only more intense. The importance of drinking clean, pure water during a fast cannot be underscored enough. Keeping hydrated is essential to our health. During a detox the organs of elimination are kept busy releasing all of the unwanted substances, therefore making sure we have enough water and fluids to “flush” out toxins is vital.

Saunas: A Tool for Detoxificiation

Saunas are often used in conjunction with dietary modifications in a detox protocol. The best saunas for this purpose are called far infrared saunas. These saunas emit a form of heat energy that gently raises body temperature, thus increasing the rate of metabolic reactions in the cells. This causes a higher release of waste products. Fat stores are mobilized, sweat production is increased and thus toxins -along with water and other minerals- are released through our skin.

More Research is Needed

The process of detoxification is an area of medicine that has not yet fully been explored. There are many questions that need to be studied further, including the clinical applications of detoxification. Recent studies have shown promising results with the use of infrared saunas in the treatment of fibromyalgia and Chronic Fatigue Syndrome.  Both of these conditions are a medical mystery, the exact cause of which is still unknown. Could these conditions be caused by a buildup of toxins in the body? With the ever increasing rates of cancers, should we not ask ourselves if this has something to do with the massive amount of chemicals that we are exposed to? Reproductive disorders are also on the rise.  Could these man-made chemicals be to blame?

Small Steps Make a Difference

A visit to a naturopathic doctor can assist you in making changes that can contribute to a healthier lifestyle. Naturopathic doctors are trained to help their patients create a customized detoxification plan. In lieu of your own personal detox protocol, try having a “detox day” once a week or even once a month. Keep your diet clean by avoiding as much pesticides, artificial colours and flavours, preservatives, and food additives as possible. Eat as much raw fruits and vegetables as you can, and avoid fried or BBQ’d foods. On your “detox day” drink plenty of pure filtered water, herbal teas, as well as freshly squeezed fruit and vegetable juices. The effects of our contact with toxins are often cumulative, so every little reduction in exposure helps.

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Yoga is considered a mind-body type of complementary and alternative medicine practice. Yoga brings together physical and mental disciplines to achieve peacefulness of body and mind, helping you relax and manage stress and anxiety. Traditional yoga philosophy requires that students adhere to this mission through behavior, diet and meditation. But if you’re just looking for better stress management — whether because of life’s daily hassles or a health problem you’re facing — and not an entire lifestyle change or way of life, yoga can still help.

Don’t know how to do yoga, or don’t have time? The Mayo Clinic also has a nice video to guide you through the basic poses.

Tai chi is another eastern art that emphasizes movements and balance. It can be quite graceful, and it is lovely here in Beijing to watch the hundreds of elderly Beijingers performing their morning tai chi routines in the parks. Who can benefit from tai chi? Here’s what they say in their review:

The intensity of tai chi varies depending on the form or style practiced. Some forms of tai chi are more fast-paced and exerting than are others, for instance. However, most forms are gentle and suitable for everyone. So you can practice tai chi regardless of your age or physical ability — tai chi emphasizes technique over strength. In fact, because tai chi is low impact, it may be especially suitable if you’re an older adult who otherwise may not exercise.

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OK, What’s Different?

#1 Difference: Chinese patient expectations - Last week I had another of many similar encounters: a young Chinese woman came in with typical common cold symptoms of runny nose and cough, and otherwise was fine. She made it very clear, very quickly, that she expected me to give her not just antibiotics, but IV antibiotics. Even after I explained to her that she only had a virus, she was quite flustered and still asked for the IV, telling me “you are very different than a local hospital”. Ahhhhh, yes indeed…

It is indeed true that we expat clinics are different than local hospitals. It’s common knowledge that Chinese hospitals have a startlingly high rate of antibiotic use, especially IV therapies, for viral illnesses that do not need antibiotics — like the common cold. It’s called “perverse incentives”: since deregulation in the 1980′s most Chinese hospitals rely on the revenue from prescriptions and procedures to pay their bills. So, Chinese patients are used to IV antibiotics for their colds; now, many newly-wealthy Chinese walk into a super-expensive expat clinic — and they only get over-the-counter meds and not even prescription antibiotics? You see the dilemma here.

Fortunately, with a lot of explanation and education — which they usually do not get from their 3-minute interaction with their local doctor — most patients will understand. And many also realize that their luxurious 15-20 minutes with the expat doctor, plus the organized appointment times and mellow waiting rooms, often make the extra expense worth it.

#2 Difference: Everyone’s super-healthy — or falling apart. In general, most Beijing expats are really healthy. They’re trim, they dress well, they’re at the gym 3 times a week, they eat organics off the farm — and they love it here. But there’s that other side of the expat world, the darker side that also loves it here but for less healthy reasons. That’s the type that smokes and drinks and sleeps around far more than they would ever consider doing back at home. I’m mostly concerned about the businessman mentality here, where it’s culturally accepted, if not indirectly coerced, to binge drink and smoke at business dinners — not to mention the implication that success allows you to have mistresses. I see a lot of broken marriages as well as alcoholism and chronic bronchitis in these types of expats, and I wonder if their often phenomenal business success was worth the trade-off in their physical and family health.

I feel that this is a major expat issue that I’ve been trying to address in my clinic and here on this website, and I hope to continue to show people a healthier lifestyle alternative — that you don’t have to sacrifice your family and your health to be successful in China. After all, when we are all old and at death’s door, will we be looking back upon our lives and thinking about our economic success, or fame, or business partners? Of course not; we’ll be thinking about our legacies of family and children and loved ones.

#3 Difference: Weird Diseases. As a family doctor, I see the full spectrum of diseases running through my community. I quickly noticed after coming to China (from a Sonoma county rural clinic) that the frequency and severity of chronic diseases was much lighter here. That’s for a good reason; few people with a major chronic disease would be physically qualified, much less interested, to work halfway around the world in the demanding, fast-paced business world of China.

So, my Beijing clinic days are filled less with out of control diabetics and alcoholic hepatitis patients, and more with acute stomach flu and the various respiratory Beijingitis syndromes. But I also get to see some unusual, more tropical-style diseases, as well as ones that are mostly wiped out in the West. For example, rabies (unfortunately) is a real issue here, while back in the States we’d never be running to the doctor every time a neighbor’s hamster bit your finger. And with all the travelling that expats do, I deal a lot more with tropical diseases with cool names like scombroid, schistosomiasis and ciguatera.

#4 Difference: Expats Are Cool. One definite perk is simply talking to my patients and listening to their stories as to why they are here and what adventures they are having. The range of countries and interests is fascinatingly broad, and my inner world is far wider just from living in Beijing and meeting such a diverse group.

OK, What’s The Same About Working Here vs America?

Well, that’s just not as interesting as the differences, is it? Perhaps for a later piece…

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