Hangzhou Chinese Medicine

2006-03-23T23:43:00.000-08:00

From "In Touch Zhejiang" magazine, April 2006

No matter where I have practiced medicine, women always make up the majority of my patients. This is not because women are more often sick than men, but, I believe, because women are generally more concerned with their health. It may also be that men tend to play down their discomfort due to macho tendencies, and/or fear of doctors. Whatever the case, in general, if women feel there is a problem with their health they will seek help in a timely manner and on their own accord, whereas many men have to be falling apart before they go to a doctor, and even then some will have to be dragged in kicking and screaming. And so, I have always had more female patients.

This suits me just fine. I like women (I’m married to one, in fact), and Chinese medicine (CM) has a lot to offer women. Thus I have been led to study a lot of CM gynecology. You may wonder, what exactly is CM gynecology? Gynecology is the study of women’s health, and CM gynecology is the study of women’s health from a Chinese medicine perspective. Simple. Well, not really.

CM has been discussing, researching and treating women’s health problems for over two thousand years, so there’s a lot of information on the subject. The result of this long history of interest has led to an extremely profound understanding of gynecology and to many effective means to treat various gynecological complaints.

As always, one of the main strengths of CM is its holistic understanding of physiology. This allows the practitioner to unravel the often complex etiology of gynecological disorders and get to the root of the problem. It also empowers patients by giving them an understanding of their condition, by which they are all too often baffled. There are many occasions where WM is unable to determine the cause of someone’s ailment, and even though the explanation that CM is able to give is somewhat esoteric and possibly odd sounding, there is something common and natural about it that allows even a layperson to grasp.

For example, a typical presentation might be as follows. Female, mid-thirties, chief complaints are fatigue, dizziness, menstrual irregularities, and emotional disturbances. History reveals long periods with heavy menstrual bleeding from menarche until several years ago, but now menstruation is scant and irregular with moderately severe PMS; appetite is so-so; easily bloated and tired after meals; bowel movements are dry and difficult; frequent insomnia and dream disturbed sleep; bruises easily. Patient also complains of occasional bouts of anxiety with palpitations, a short temper, and inability to concentrate. Hair is thin and often comes out in clumps, fingernails are thin and brittle, skin is dry, complexion is pale. Tongue is pale and puffy with a thin coating, and pulse is thin, weak, and deep, the Liver pulse is particularly weak. Her WM doctor served a valuable purpose by running various tests to rule out severe illness, diagnosed her as anemic and gave her iron pills, but taking them leads to increased constipation and no significant improvements. The MD has no explanation or solution for the emotional and menstrual complaints. The patient is confused as to why she feels this way and is desperate for a solution.

After doing an intake, I always take time to explain and discuss the diagnosis and etiology of the problem with patients, then we discuss treatment options. For this part, I explain, one must not confuse CM anatomy and physiology (designated here by capitalization: Liver, Heart, Spleen, Blood, Qi, etc.) with the modern understanding--they are not the same.

This patient has a textbook case of Liver and Heart Blood Deficiency, Spleen Qi Deficiency, and Liver Qi Stagnation. Let’s discuss the etiology. The heavy menstrual bleeding from menarche was likely caused by Spleen Qi Deficiency, one function of Qi being to “control” the blood, maintaining its place in the blood vessels, and in the case of menstruation, regulating the amount of blood loss. Insufficiency of Qi led to an inability to “control” the blood, and accounts for the heavy bleeding and easy bruising. The Spleen also manufactures Qi and Blood, making these from the food we eat. Spleen Qi deficiency led to decreased production of Qi and Blood, which combined with the heavy menstrual periods eventually led to Liver Blood Deficiency, and the WM diagnosis of anemia. The Liver Blood is the source of the menstruation, and insufficiency eventually led to scant and irregular menstrual periods. Liver Blood Deficiency causes the Liver Wood to become inflexible, leading to Liver Qi Stagnation, which accounts for the PMS and short temper. According to Five Phase Theory, Liver (Wood) is the Mother of the Heart (Fire), and the Spleen (Earth) is the Son of the Heart. Insufficiency of the Mother leads to malnourishment of the Son, and insufficiency of the Son depletes the Mother. Here, Liver and Spleen insufficiency led to Heart Blood deficiency, resulting in anxiety with palpitations, insomnia, and poor concentration. Blood nourishes the hair, skin and nails, and deficiency led to dry hair falling out in clumps, thin nails, and dry skin. Blood is a type of body fluid, and deficiency of fluids caused the stool to be dry and difficult. The combined Qi and Blood Deficiency caused the fatigue and dizziness. The pale tongue and thin, weak, deep pulse confirm the diagnosis of Qi and Blood Deficiency.

Upon learning there is an explanation for the condition, the patient usually feels relieved-- the problem is not “all in the head” as some may have hinted (an incredibly belittling and frustrating suggestion), and a solution is at hand. And so we discuss treatment. Treatment is aimed at strengthening the Spleen, nourishing the Liver and Heart Blood, and regulating the Liver Qi. This is done primarily with herbs, but acupuncture is complimentary and can be performed in addition if the patient is agreeable. Dietary and lifestyle recommendations are also implemented. After a couple weeks the patient feels noticeably better, but treatment continues for a few more months until the condition is resolved, at which point the dietary and lifestyle changes are maintained to help prevent relapse and promote general wellbeing.

This is a very typical case and I see variations of these sorts of problems on a regular basis. It is also a relatively simple case, but CM is capable of addressing far more serious and complex problems. In fact, CM can treat the entire range of gynecological problems, from minor PMS and menstrual irregularities, to uterine fibroids, endometriosis, and infertility. That is not to say that CM can cure all of these conditions. Some can be cured, some not, but in almost all cases a measurable benefit can be derived. CM gynecology is a wonderful treasure and I hope that more and more women around the world will become aware of and benefit from its brilliance.

copyright©2006 Greg A. Livingston

2006-03-17T22:41:00.000-08:00

From "In Touch Zhejiang" magazine, March 2006

Vive La Differential
Doctor Livingston diagnoses diagnosis

Diagnosis is a key component to all medical systems, be it Western, Chinese, or any other, for only through correct diagnosis can correct treatment be applied. Each type of medicine has its own unique diagnostic system, which is largely a product of the culture and times in which it was developed, and which serves to guide treatment within its system of medicine.

For example, Western Medicine (WM), a.k.a. biomedicine, has undergone most of its development since the advent of modern science, is based primarily on modern scientific research, and its diagnostics are based largely on modern scientific methods such as lab tests, x-ray, MRI, etc. The results of these tests help lead to a WM diagnosis, which guides WM treatment. Chinese Medicine (CM), on the other hand, developed long before modern science, largely out of observation of the exterior of the body using the five senses- sight, hearing, smell, touch, and taste- and its diagnostic methodology is correspondingly comprised of what are called the “Four Diagnostic Methods”: looking, listening/smelling, asking, and touching. The results of these examinations help lead to a CM diagnosis, which guides CM treatment.

The ancient Chinese learned through experience that the condition of the interior of the body was reflected in various predictable ways on the outside of the body, and that through the Four Methods a person’s physical condition could be reliably diagnosed. Since they had no recourse to modern methods such as lab tests and MRI, they of necessity developed this methodology to a highly sophisticated and accurate degree. Thus, each of the Four Methods gives the clinician a huge amount of diagnostic information, which when amassed leads to a profound understanding of a patient’s condition, a.k.a. diagnosis.

If you have ever been to a CM physician, you are familiar with the routine. The patient sits at the side of the doctor’s desk and places their wrist on a small pillow on the desk. The physician then places three fingers on the patient’s radial artery, just proximal to the wrist, and conducts an examination of the pulses. Both the right and left wrists are examined, sometimes simultaneously, but typically in turn. This type of examination belongs to the fourth of the Four Methods- touching, although it is often seemingly done first. If the physician is highly skilled, after this examination he or she will frequently be able to tell the patient, without having asked a thing, not only what their current problem is, but an amazing amount about their medical history and some predictions about future health.

To those who have never experienced this, it sounds completely implausible that an examination of the radial pulses could be so revealing. But it is in fact quite true that the pulse contains a huge amount of diagnostic information, if only one has the skill to decipher it. That said, it is merely a misunderstanding that most people believe the CM physician’s diagnosis was arrived at purely through pulse examination, for as soon as the patient enters the room, the physician has begun examination via the first two Methods- looking, and listening/smelling.

Looking entails observation of the patient’s overall build, the way they walk, the face, ears, eyes, hands, fingernails, tongue, etc. Listening includes noting the patient’s voice, respiration, and any other sounds the patient may make, such as sighing, laughing, crying, etc. Smelling is a survey of any odor the patient may emanate. All of this, combined with the pulse, gives the physician a good idea of the patient’s condition, thus the seemingly miraculous pulse-diagnosis in fact includes three of the Four Methods. All that remains is Asking.

CM physicians ask many of the same questions that a WM physician might ask, although there are generally more, and often some seemingly unrelated, questions. This is because CM has a holistic understanding of physiology. In other words, there are no unrelated phenomenon in the body, so any question is relevant and therefore fair game.

Recently I was at a party where I was one of only a few foreigners. The local partygoers were surprised to meet a foreign CM physician and wanted to test my skill, the ultimate test of a CM physician supposedly being the ability to tell what problem a person has solely by taking the pulses. One young woman offered up her wrists for examination. I reluctantly agreed, examined her pulses and, of course, at the same time conducted my Looking and Listening/Smelling exams. Lucky for me her condition was relatively straight forward, and after a few minutes I guessed she had a problem with her stomach related to stress and emotional upset. In amazement she announced to the group that the previous day she had undergone endoscopy (an examination of the upper gastrointestinal tract, including the stomach) to determine why she was suffering from stomach pain, which did in fact get worse when she was under stress or emotionally upset. Everyone was astonished at my pulse-diagnosis skills, “hao lihai!” But little did they realize I had conducted a near complete CM exam, shy only one Method- Asking, before I made my pronouncement.

Immediately afterward, a middle-aged gentleman, clearly wanting to ensure my first diagnosis wasn’t a fluke, asked if I would mind checking his pulses. His condition wasn’t as obvious to me, but after a few minutes I guessed he had problems with his liver. Not quite- gallstones, he informed the group. Well, I was in the ballpark, anyway. In fact, in CM, gallstones frequently belong to what is called Liver and Gallbladder Damp-Heat. So I wasn’t exactly wrong, it’s just that CM diagnosis was not designed to diagnose biomedical disease (although sometimes it is possible to do so), but rather to diagnose pathology according to the CM understanding of physiology. In this patient’s case, his gallstones (a biomedical WM diagnosis) were related to Liver and Gallbladder Damp Heat (the CM diagnosis I had arrived at from my examinations). I was thinking he might have hepatitis, which is often related to Liver and Gallbladder Damp Heat, but his Damp Heat had manifested as gallstones. My CM diagnosis was not wrong, but my guess as to the corresponding biomedical (WM) disease was off by a fair bit.

This brings up an important point, best illustrated by a saying that all CM physicians know well. 同病异治，异病同治 Same Disease Different Treatment, Different Disease Same Treatment. In other words, ten people with the same WM/biomedical disease (gallstones, for example) may all receive different treatments- they all have different CM diagnoses; while ten people with completely different WM/biomedical diseases (gallstones, hepatitis, gastric ulcer, etc.) may all receive the exact same treatment- they all have identical CM diagnoses. So in the end it doesn’t matter a whole lot what a patient’s Western medicine diagnosis is- the Chinese Medicine diagnosis guides the Chinese Medicine treatment.

Copyright©2006 Greg A. Livingston

2006-03-17T22:24:00.000-08:00

From "In Touch Zhejiang" magazine, February 2006

Fertility, Virility, and Libido, Libido, Libido

Last month I promised to discuss the significance of circadian rhythm and the body’s biological clock as it relates to one of society’s favorite topics- sex. For those of you who failed to make it through last month’s article on the circadian relationship to depressive disorders, hopefully this will be of more interest to you.

If you read last month’s article, you will recall that the body’s physiological functions are heavily affected by the cycles of light and dark that comprise Earth’s 24-hour day. This relationship of physiology to time is called chronobiology, and is also known as circadian rhythm. The fundamental moderator of this relationship is the pineal gland- a tiny gland residing in the base of the brain. A quick review: darkness increases pineal gland synthesis of melatonin, while bright light restricts it. The basic pattern is that serum (blood) concentrations of melatonin are low during daylight hours and increase to a peak during the dark. Melatonin prepares the body for its sleep-time rejuvenatory processes by making one feel sleepy and shutting down certain metabolic functions, the reproductive system being one.

Irregular sleep patterns adversely affect the body’s chronobiology. This leads, in part, to an increase in serum melatonin levels during the day when the levels should, in fact, be quite low.

The effect of melatonin on the reproductive system can be summarized in one word: anti-gonadotropic (gone = seed, trophe = nourishment). Anti-gonadotropic means inhibition of the growth and/or function of the gonads, gonads being the testes in men and ovaries in women. Melatonin inhibits the secretion of gonadotropic-releasing hormone, which leads to decreased secretion of the various hormones that are responsible for promoting the functions of the reproductive system. In other words, if one’s circadian rhythm is off and melatonin levels do not follow their normal ebb and flow, this can lead to various forms of sexual and reproductive dysfunction.

Before you freak out and worry that your erratic lifestyle and sleep schedule has already caused irreversible damage to your gonads, let me explain that reproductive problems, like nearly all health problems, usually develop over time, gradually proceeding from mild to severe. At first, a malfunctioning biological clock may not yield any overt signs or symptoms of illness, but over time, and in conjunction with other factors, problems can arise such as decreased libido, impotence, and male and female infertility.

In cases of infertility where the problem is purely hormonal (i.e., in women the fallopian tubes are unobstructed, the uterus is normal, etc., and in men the testes are normal) a strictly followed sleep schedule is an important part of a natural treatment approach. As in last month’s article, early to bed and early to rise- this is the way to regulate the body’s circadian rhythm.

That said, I am not suggesting that regimenting sleep alone can reverse infertility, but without this component a cure is more difficult to achieve. Similarly, idiopathic cases of impotence and decreased libido can often benefit from a regular sleep schedule, but it’s not likely the panacea of all sexual dysfunction. Most cases that have progressed to such a level of dysfunction require further intervention, be it western medicine, or something like Chinese medicine, which has a good record of success treating such problems, and without the side-effects and invasive procedures of western medicine.

Treatment with Chinese medicine begins with implementation of healthy lifestyle practices, including appropriate sleep, diet, and exercise. Then herbs, acupuncture, and/or moxibustion are used to correct imbalances in the body that cannot be easily rectified through lifestyle practices alone.

While Chinese medicine can be used to treat problems that have already developed, one of its great strengths is prevention. The ancient Chinese knew about chronobiology and described it in enormous detail. They also knew that disturbing the body’s natural rhythm was a cause of disease. And so came the knowledge that early to bed and early to rise, makes a man healthy, wealthy, and wise.

Copyright©2006 Greg A. Livingston

2006-03-17T22:05:00.000-08:00

From "In Touch Zhejiang" magazine, December 2005/January 2006

Chronobiology: not a Swiss watch

Winter is fast on its way, with the days getting colder and the nights getting longer. Christmas and New Year will soon be upon us and it’ll be time again to make merry with family and friends. ‘Tis the season to be jolly. Right?
Well, that’s what they say. But many people suffer from depression this time of year. Partly it’s social- feeling lonely while others are celebrating with family and friends, and of course, many foreigners living here in China will be missing their families. But there’s a physical component as well- SAD.
Seasonal Affective Disorder, SAD, is a form of depression that occurs primarily during winter months as a result of the shorter days and subsequent decreased sun exposure wreaking havoc on the body’s circadian rhythm. What is going on here and is there anything to be done about it?
The human body, like plants and most other life on Earth, is affected by the cycles of light and dark that comprise Earth’s 24-hour day. These biological effects are called circadian rhythms (circa, about + die, day) and play a vital role in virtually all life on Earth. In humans, bright light (until recently only found during daytime hours) causes a tiny gland in the base of the brain, the pineal, to turn off, while darkness turns it on. Thus, in the evening, when it gets dark, the pineal switches on and begins to produce melatonin out of the melatonin precursor serotonin. Melatonin levels then increase and serotonin levels decrease (because serotonin is being turned into melatonin). Melatonin causes one to feel sleepy and shuts down certain metabolic processes, notably those of the digestive and reproductive systems, so the body can carry out its rejuvenatory functions during sleep. In the morning, bright light from the sun shuts the pineal off, melatonin levels decrease, serotonin levels increase (it’s no longer being made into melatonin) and we feel vibrant and awake. This is the physiological basis of the circadian rhythm in humans.
Winter’s shorter days mean less sunlight and this means the pineal gland is on more of the time, making melatonin out of serotonin. This in turn leads to decreased serotonin levels- the suspected cause of SAD. Of course, the further from the equator the shorter the days, which explains why SAD occurrence increases with distance from the equator. So what can you do to keep your biological clock ticking properly?
The first thing, and for some of you this will be worse than when I suggested not eating ice cream, is go to sleep early and get up early. This is the way humans evolved and there’s no getting away from it- it’s built in to our physiology and going against it disturbs the all-important circadian rhythm. It’s no coincidence that all over the world you will find the equivalent of the saying, “Early to bed, early to rise, makes a man healthy, wealthy and wise.” Staying up late deprives the body of the best sleeping hours in the night, and so another saying goes, “An hour of sleep before midnight is worth two after.”
Furthermore, staying up late almost always means sleeping in late. This denies the body the opportunity to fully shutdown pineal production of melatonin during the day, which is achieved most effectively by exposure to bright morning light. Thus melatonin levels are higher and serotonin levels lower than they should be during the day, leading to depression, fatigue, loss of appetite, and decreased reproductive function and libido (more on that next month). Regardless if one suffers from depression or not, it’s always best to maintain this sort of sleeping schedule. However, when truly suffering depression a healthy sleep schedule is critical if a natural approach to recovery is desired.
Ideally, one should be in bed by 9pm, but before 10pm is acceptable. Wake around 5-7am and immediately open all the curtains in the house to let the light in. Then expose yourself, to the light that is, sunning your face (close your eyes and face the sun) for a few minutes. If there’s insufficient natural light one can use artificial light to achieve the same effect.
Secondly, eat a diet rich in tryptophan. Tryptophan, one of the “essential” amino acids, is a precursor of serotonin, so a deficiency in the diet will lead to decreased serotonin. Some examples of tryptophan-rich foods are: seaweed, soy products (tofu, soy milk, etc.), bananas, dates, figs, peanuts, almonds, pecans, sesame seeds, legumes, fish, meat and dairy products. Note, tryptophan is better absorbed in the brain when consumed as part of a high carbohydrate meal, so super-size some fries with your order.
Thirdly, get sufficient exercise. Exercise is crucial to maintain good health and has been shown to help with depression. Do whatever you enjoy- working out in a gym, hiking, biking, swimming, yoga, martial arts, etc. Yoga and martial arts are particularly recommended as they include “internal” practices that help regulate and harmonize the
physiology.
Finally, if lifestyle and dietary changes are not enough, a visit to the doctor may be in order. Chinese medicine quite effectively treats depression, regardless of the cause, but for severe cases it may be necessary to integrate with western medicine (the psychiatric pharmaceuticals are strong and fast acting) and psychological counseling. In those cases, continued use of Chinese medicine can help reduce the need for and alleviate the side effects of the pharmaceuticals and speed up the overall recovery. In more moderate cases, Chinese medicine alone may suffice.
Acupuncture, the effects of which can often be felt immediately with many patients reporting a marked sense of wellbeing after treatment, helps regulate the circadian rhythm, calms the mind, elevates mood and also treats many of the accompanying symptoms of depression such as fatigue, loss of appetite, insomnia, etc. Chinese herbs are typically prescribed in addition to acupuncture or as the sole form of treatment in cases where the patient doesn’t want acupuncture. Diet and lifestyle counseling are important components and each patient receives advice tailored to their particular condition.
In all cases, whatever modality of Chinese medicine is used, treatment is tailored to the individual’s condition and does more than just treat the depression. CM views the body as an organic whole, so treatment is not aimed at symptoms per se, but at harmonizing the body’s physiology in general. This in turn leads to reduction of most or all of a patient’s various symptoms, seemingly related or not, and not just relief from the chief complaint (depression, in this case) for which the patient came to the clinic seeking treatment. Side effects are few, if any, and virtually never as severe as those from psychiatric meds.
Everyone can benefit from following the above lifestyle recommendations, and with that alone some will stave off any effects of SAD they may have otherwise incurred. But if you or someone you know is suffering from a bout of winter-blues, or a more severe form of depression, it’s worth considering consultation with a Chinese medicine physician. Here’s wishing you all a cheerful holiday and a happy new year!

Copyright© 2005 Greg A. Livingston

2006-03-17T22:02:00.000-08:00

From "In Touch Zhejiang" magazine, November 2005

Mai oh mai oh mai
Points of contention needle skeptical minds

In last month's article I stated that the "mai" ("vessels" being my translation; "meridians" or "channels" as some others would have it) were in fact the blood vessels and not invisible "meridians" circulating Qi and blood through the body. Some readers may have been relieved to hear this and others may have cursed me for being reductionistic. If in fact you are of the latter camp, you are correct to say this view is somewhat reductionistic.

That said, the ancient Chinese were still likely describing anatomical blood vessels- yes, as in, the flexible little pipes that enable blood flow. So which is it, blood vessels or meridians? In Chinese medicine when an “either or" question is posed, the answer is often a perplexing, "Yes", meaning, "Yes, it is both this and that." However, taking "this" as the blood vessels, "that" is still not invisible meridians. And this leads us to the first of three questions that are the topic of this essay: What exactly are the “mai”?

The second issue is this: If, on the subject of anatomical entities, the “mai” are in fact blood vessels, is the acupuncturist sticking needles into (gulp!) the blood vessels? Thirdly, how in any case does acupuncture work?

Here’s the situation: The “mai” are indeed the blood vessels, but they are more than that. This, by the way, is typical of Chinese medicine: the functions attributed to the organs by the ancient Chinese do not necessarily correlate with modern understanding of physiology, although we should not infer from this that the ancient Chinese were wrong. Their paradigms for anatomy and physiology are unsurprising, since the ancients didn’t have the hardware that makes possible the study of anatomy and physiology at a microbiological level. They were relying instead upon outwardly observable physiological phenomenon gleaned through the “four methods” of examination (looking, smelling/listening, asking, and palpating) in their efforts to develop their physiological model.

Some people have called the result a “physiology of systematic correspondences”. In this model, the various systems (organs, vessels, etc.) are based upon “correspondences”, i.e. related physiological phenomenon, and not solely, as in modern medicine, on the physiological function of the anatomical structures themselves. For example, a phenomenon like dry eyes could be attributed to the liver, and insomnia could be attributed to the heart. Modern physiology would say this is incorrect, but the point is that the Chinese idea of the organs is different than that of Western medicine. The “mai” therefore are in fact a physiological system of corresponding phenomenon, not just the anatomical blood vessels. Whew. If you’ve made it this far the rest is easy.

OK, so aside from blood vessels, what are the “mai”? Let’s first look at what the ancient Chinese had to say, then, at the risk of being reductionistic, we can try to make some correlations to modern physiology. According to the ancient Chinese, the “mai” are a network that links all the parts of the body together- the interior of the body is connected to the exterior, the top to the bottom, the back to the front, the right to the left, and the organs to their related parts and to each other, and so on. This looks a lot like the nervous system, which we know is a sort of communication network in the body, and as it turns out, the nervous system is heavily involved in the physiology of acupuncture and thus the “mai” themselves. In addition, the “mai” distribute nutrients to all the parts of the body. This looks a bit like the cardiovascular system, distributing nutrients such as glucose and oxygen throughout the body via the blood and blood vessels. Of course it would, again, be reductionist to say that the “mai” are simply the blood vessels and nerves, and as we will see in the following discussion of how acupuncture works, there is much more than these two systems involved in the physiological response to acupuncture.

So what exactly is happening inside the body upon insertion of an acupuncture needle? Again, there are two ways to explain this- first according to the ancient Chinese, and second (anti-reductionists cringe here) according to modern physiology. The traditional explanation, very simply put, is that the needles regulate the flow of Qi and blood in the body, and since all illness is, again simply put, due to disharmony in the flow of Qi and blood, acupuncture can be used to treat disease. The modern explanation is extremely long and requires a solid background in anatomy and physiology to be understood, but here’s a brief synopsis.

First of all, in answer to the previously posed question, the needles are not being inserted into blood vessels (big sigh of relief here)- well, not vessels of any significant size, anyway. They are however touching capillary beds, which are dense networks of extremely fine blood vessels. In fact, what sets an acupuncture point apart from other places in the body is its high density of capillaries and nerves. This is what makes it more responsive to the needle. The needle touches this spot, stimulating the nervous system to send a signal to the brain informing of the breach of the skin by a foreign object. The brain then sends descending control signals back to the insertion point to help mediate the defense response that the body is mounting against the foreign body. Because of the highly integrated nature of the nervous system, the descending control signals from the brain also travel to and affect other parts of the body. This, however, is not random, and the ancient Chinese mapped out these affects in great detail.

Interestingly, much of what they noted corresponds with modern understanding of the nervous system. For example, there are points on the upper part of the back that are used to treat ailments of the lung and heart. This is the region where nerves exit the spine to innervate those organs. Obviously, the Chinese had very early on developed a basic understanding of the nervous system, which they, at least in part, attributed to the “mai”. So the “mai” are in fact a conglomeration of various structures and functions belonging, but almost certainly not limited to the blood, vascular, nervous, and immune systems.

So what is the point of this sort of analysis? In order to develop a deeper and more comprehensive understanding of Chinese medicine, and medicine and the human body in general, it is important to use all available tools and knowledge. Traditional Chinese physiology and modern biomedical physiology are both valid, but attempting to make direct correlations between the two is difficult and we run certain risks- crude reductionism being one of them. Part of the problem lies in the fact that the field of modern biomedical physiology is still under development and there are many things that cannot be explained using that model.

Therefore we should not be looking for a complete biomedical explanation of Chinese medicine, but never the less, a partial explanation can certainly be of use, and may even help guide clinical thinking and practice. As long as we proceed carefully, critically review our hypotheses, and avoid stubborn dogmatism, the combination of these two views leads to greater insight. And this brings us closer to our ultimate goal: the prevention and treatment of disease.

Copyright© 2005 Greg A. Livingston

2006-03-17T21:34:00.000-08:00

From "In Touch Zhejiang" magazine, October 2005

Circulating Misinformation

Dear Dr. Livingston, I’ve heard that Chinese medicine (CM) is very effective, but I have a hard time understanding and accepting some of the ideas found in CM, for example, Qi (sometimes translated as “life force” or “energy”), and acupuncture “Meridians” (the invisible structures in the body through which Qi is purported to “flow”). This sounds like metaphysical quackery to me. Could you please clarify? Sincerely, Skeptic

Dear Skeptic,

Chinese medicine was developed long ago and is couched in the language of the times. When we view CM terminology through 21st century eyes it’s easy to be confused, and this confusion causes some to dismiss CM as metaphysical nonsense. It’s dependent upon us to understand what the ancients were actually talking about, and to avoid errantly projecting a metaphysical world-view onto something which is not.

I’ll start with the word Qi, and begin by saying that it is not a metaphysical “energy”. Qi is not a single entity. It is a word used to describe phenomenon, and in particular it refers to the myriad phenomenon that infuse movement and life into things. You might say this sounds a lot like a “life force”, but this is far too narrow and misleading, as in different contexts Qi can mean different things. For example, Chinese medicine refers to specific types of Qi, each of which refers to very specific phenomenon either in the body or the environment. So Qi cannot be defined simply as one thing.

What the word Qi is used to describe in its more general sense is, in fact, very ordinary. There is nothing mystical about it. Some people say they can “feel Qi”, as if they were endowed with a supernatural ability, but these people are deluding themselves if they think they are unique in this way, for everyone “feels” Qi. Have you ever felt happy or sad? Hot or cold? Pain or pleasure? This is experiencing the Qi in your body and environment. That said, if one cultivates oneself through certain practices such as meditation, martial arts, yoga, etc., it is possible to become especially sensitive to, and even consciously effect one’s own physiological processes. This sensitivity can be described as the ability to feel and “guide” Qi. But again, this is not a mystical phenomenon and can be attained by any dedicated individual.

Qi in the context of CM contains this general meaning as well as more precise meanings when specific types of Qi are involved. For example, “Qing Qi”, literally “Clear Qi”, is in the air and is inhaled by the Lung through which it enters into the blood. This is clearly a reference to oxygen, but since the ancients had no way of knowing this, they called it a type of Qi, and in fact, it is a type of Qi. Shui Gu Zhi Qi, literally “Water and Grain Qi” is the Qi contained in food and drink, the Essence of which, extracted by the Spleen and Stomach, eventually ends up in the blood and nourishes the various tissues of the body. What is this other than the nutrients in food? Again, a type of Qi. “Wei Qi”, “Defensive Qi”, protects the body from invasion by external pathogenic factors. Looks like the immune system, right? Another phenomenon described by the word Qi. Are you starting to get the picture?

Finally, let’s discuss the so-called acupuncture “meridians”. First, “meridian” (“an imaginary great circle on the earth's surface passing through the North and South geographic poles”) is a mistranslation of the Chinese word “mai” and leads one to picture an invisible line or structure running through the body. A better translation is “vessel”, as in blood vessel. It is my opinion, although it’s impossible to know for sure and not every CM doctor shares my view, that the ancient Chinese were describing real anatomical structures, i.e. blood vessels, and not invisible meridians. The ancient Chinese made meticulous anatomical studies and recorded their findings in detail. They described the “vessels” as structures in the body through which Qi and blood flow. I’ve already shown above how Qi is not a mystical energy and can in fact be things as mundane as oxygen, glucose, and white blood cells, all of which are found circulating within the blood in the blood vessels. Why would the ancient Chinese, who were so concerned with fine anatomical detail, be so inconsistent as to invent a network of invisible meridians, say that the blood flowed within them (when they must have observed that the blood was contained within the blood vessels), and then even go so far as to use the character “mai”, which to this day is one of the characters used to denote “blood vessel” (xue mai).

To me this interpretation doesn’t make sense, and looks like the work of someone who was either: 1) projecting a metaphysical world-view; and/or 2) unwilling to give the ancient Chinese credit for being able to accurately describe real anatomy and physiology. The Frenchman, Soulie de Morant, who first translated Qi as “energy” and “jingmai” as “meridian” is likely guilty of both.

What is more likely is that the ancient Chinese were actually describing the cardiovascular system, and were in fact the first in the world to discover blood circulation (Harvey’s discovery came over 1500 years later). This is hardly the work of metaphysicists. Rather, it is the result of careful observation and highly intelligent reasoning, both of which the ancient Chinese are well know to have excelled in.

So Chinese medicine is not “metaphysical quackery”. On the contrary, it is real medicine based on a profound and unique understanding of real anatomy and physiology, and the people of China and the world are blessed to have inherited such a formidable medical system. When we encounter things like CM and other ancient traditions from around the world it’s imperative we apply sound logic and reasoning to our investigations and interpretations, otherwise we run the risk of dismissing valuable knowledge. If CM had been discarded in such a way the world would have lost a priceless treasure chest of knowledge.

Copyright© 2005 Greg A. Livingston

2006-03-17T15:12:00.000-08:00

Interview from "In Touch Zhejiang" magazine, September 2005

Why Dr. Livingston doesn't presume.

Hangzhou is home to many long-term foreign residents doing a myriad of strange and interesting things. Once such resident is Dr. Greg A. Livingston, an American born and raised in San Francisco now living in Hangzhou and working as a Chinese Medicine Physician at North American International Hospital. Last month, Dr. Livingston wrote an article for IT, so this month we wanted to find out more about the man who told us not to eat ice cream and try to put an end to the rumor that he is descendant from the infamous Dr. Livingstone of the Congo.

IT: So, the first question many people will want to ask is how did you, a westerner, become interested in Chinese Medicine?

Dr. G: In my late teens I developed an interest in sustaining and promoting my own health and longevity and began looking into various ways to improve my well-being. When I got around to taking an in-depth look at Chinese Medicine I was quickly hooked. Not only did CM have a long history of efficacy, it had a long history of critical-thinking doctors who developed the medicine in as scientific as way as possible given the times, and it had a massive modern infrastructure behind it both in China and abroad that was dedicated to further research and development of the medicine. This suited me very well- a holistic medicine based on sound practice and development over the ages that was undergoing modern scientific scrutiny and development. I was soon enrolled in a four-year “Master of Science in Chinese Medicine” program in the US, and when I graduated (1997) I came to study and practice in China for two years.

IT: What do you like most about CM?

Dr G: CM is a holistic medicine, which means there is an understanding of the organism as a whole and of the relationships between various parts of the body. Therefore, when a disease manifests in one part of the body it is possible to determine where it originated and what part it may affect next, and then it can be treated at the origin and prevented from afflicting other parts of the body. In CM, all illness is described as having a root (original cause) and a branch (symptoms). CM is famous for it’s ability to treat the root of disease, eliminating symptoms that may have been around for years but were seemingly unrelated and which, using Western medicine, were only able to be controlled, but not eliminated. Furthermore, with its subtle diagnostics, CM can be used as a preventative medicine thus helping one avoid disease in the future and promoting well-being and longevity. Finally, if CM is practiced well there are few if any side effects. These are a few of the great strengths of Chinese medicine.

IT: So what is your opinion of Western Medicine (WM)?

Dr G: All medical systems have their strengths and weaknesses, including CM and WM. WM is fantastic in its profound understanding of the body on a microscopic level and its ability to successfully treat and/or control a lot of serious diseases. A world without antibiotics, surgery, insulin, or blood pressure medication would not be pretty. That said, WM has its limitations, especially in that it has yet to develop a holistic view of the body. In many cases WM treats the symptoms of disease (the “branch”) because it doesn’t know what the “root” of the disease is. Ultimately, it’s the integration of Chinese and Western medicine that provides the best results. If you know the strengths and weaknesses of both systems, know when it’s appropriate to use what, and know how to integrate CM and WM treatments, then you get the best of both worlds.

IT: What about the limitations of CM?

Dr. G: CM is best suited for treating chronic conditions, although in the proper setting (an integrated Chinese-Western medicine hospital) it can be used in the treatment of severe acute disease. CM lacks the modern understanding of physiology and the diagnostic tools of WM. But again, this is not a problem since one can easily integrate the two. What CM lacks can be made up for with WM and vice-versa. Of course, CM is not a panacea, otherwise I’d be immortal (laughs). It’s excellent in the treatment of many diseases, of some use in other conditions, and of little use in some others. However, for most conditions there’s some benefit that can be derived, so I always encourage people to look into it to see if CM might help their condition.

IT: What kinds of patients typically come to see you?

Dr. G: I practice general internal medicine, which means I see all types of patients with all types of problems: common colds, diabetes, digestive problems, headaches, menstrual irregularities, insomnia, allergies, etc. The majority of my patients happen to be women, probably because women are generally more concerned with their health than men, so I do a lot of gynecology, and this is one area where CM really excels, offering treatment for many conditions that WM has little or no treatment. For example, painful menstruation, irregular menstruation, PMS, infertility, anemia, etc.

IT: So, in terms of examination and treatment, what exactly do you do?

Dr. G: Examination includes the 4 traditional CM exams: “look, smell, ask, palpate”. This means carefully looking at the person, smelling for unusual odors, asking questions, and palpation of the body including pulse diagnosis. I also use WM methods such as lab tests, imaging, etc., when appropriate. Diagnosis will usually be given in both CM and WM terms, and then treatment is usually pure CM. If a patient needs WM treatment I will refer them to an MD. I use herbs, acupuncture, exercise, diet, and lifestyle advice to treat my patients. Not every patient needs or gets all of the above. For example some are scared of acupuncture, so I skip it. I only use sterile, single-use disposable needles in my practice, so there is no need to worry about infection.

IT: How is your treatment different from the typical local TCM practitioner?

DR. G: The main difference is that I spend a lot of time with my patients, explaining things and inviting them to be involved in the decision making process and their treatment. Most patients know very little about CM. They’re curious and want to know what’s going on, and they often want to be involved, so I routinely give dietary and lifestyle advice to complement the treatments. In addition, the extra time also allows me to develop a deeper understanding of patients’ conditions and get at the root of their problems. This is especially important when treating the complex, chronic conditions that often appear in our crazy, modern society.

IT: Thank you, Dr. Livingston, for taking time to talk with us.

Dr. G: You are most welcome. CM is a wonderful medicine and I hope this interview will encourage some of your readers to try it if they ever have the need.

2006-03-17T14:51:00.000-08:00

From "In Touch Zhejiang" magazine, August 2005:

It's not the humidity, it's the eat.
Chinese medicine has a no sweat summer diet for you

As anyone who's spent a summer in Hangzhou knows, the heat and humidity are a formidable combination. For most people summer is merely uncomfortable, but there are illnesses that can arise, and many chronic diseases are exacerbated, as a result of what Chinese Medicine (CM) calls Summer Heat. Fortunately, CM provides ample lifestyle and dietary advice to help prevent Summer Heat disorders and keep you comfortable in the heat.

First, limit your exposure to the elements. Minimize time spent in the sun, especially during midday, and when you do go out, don a hat (straw is coolest), take an umbrella, or walk in the shade. Regarding air-conditioning, it's best to set your AC to a moderate temperature, say 26 degrees C., so your body remains acclimated to the high outdoor temperatures. Avoid having the AC blow directly on you- this is especially important when sleeping and for children.

Second, take care what you eat. The main principles of a healthy summer diet are to prevent accumulation of damp and heat, and strengthen the digestive system. You can do this by eating foods that are ‘cooling’ and/or have a slight diuretic effect, and by avoiding or reducing intake of ‘hot’ and ‘damp’ foods, such as deep-fried, greasy, fatty and spicy foods, rich sweets, and alcohol. You may be thinking there's nothing left worth eating, but don’t despair.

When eating meat, choose leaner cuts, and eat less beef and lamb as they are both very warming. Chicken, fish, duck, rabbit, and pork are all good choices. Next, increase your intake of fresh fruits and vegetables. In addition to their superb nutritional value, most seasonal summer fruits and vegetables have a cooling nature perfect for summer- eat a wide variety and to your heart’s content. As for grains, rice is well suited as it’s easy to digest, strengthens the digestive system, and is mildly diuretic. For those of you who enjoy rice porridge, eat with gusto- it’s extremely easy to digest, strengthens the digestive system, and drains damp-heat, and if you happen to get sick it’s one of the best foods for recuperation. Wheat, millet, oats and most other grains are also fine, but because they lack the diuretic action of rice can lead to accumulation of dampness. They are better suited for cooler weather, but as grains are generally very moderate in nature it’s ok to eat whichever ones you prefer.

Finally, here is a list of foods to avoid and to eat more of, some suggestions for preparation, and a Note of Caution: Please try to avoid becoming a food fanatic. If after reading this article you decide a strict, exclusionary diet of cooling alfalfa sprouts is the best thing for you, then I have failed miserably and offer my sincerest apologies to you and those with whom you routinely dine. What I would rather suggest is a diet of moderation, where even moderation can be practiced in moderation. Therefore, if you decide to eat grilled lamb kebobs at your favorite Xinjiang restaurant on the hottest, dampest day of the summer, then temper it with a side of cucumber salad and a glass of watermelon juice. Hmm, I think I know what I’ll be having for lunch today. To your health!

Avoid or reduce: deep-fried, greasy, fatty and spicy foods, rich sweets, alcohol, beef, lamb. French fries, pizza, ice cream, chocolate, cakes, etc.

Eat more of these cooling foods: silk melon: cook in soup or stir fry with green soy beans; winter melon: cook in soup or stir fry; cucumber: raw- slice thin, dress with soy sauce, vinegar, and a touch of sesame oil, or cook in soup; bitter melon: not to everyone’s liking, but for those who indulge, do so with confidence- packed with vitamins and antioxidants, and clears the summer heat and damp. Slice thin, blanch, then stir-fry with a bit of Sichuan pepper corn; tofu: nice and cooling. For the more adventuresome, order a dish of tofu with 1000 year egg; green tea: drains damp and heat, high in antioxidants, and perks you up on those oppressively hot days; watermelon: one of the best things to combat Summer Heat- eat as much and as often as you like; pear; peach; honeysuckle flower: steep to make tea. Clears heat and toxins- drink regularly to help reduce acne; chrysanthemum flower: steep to make tea; mung bean soup: make a relatively thick soup, add sugar or honey to taste- a classic summer heat antidote; sour plum drink: quenches thirst.

copyright© 2005 Greg A. Livingston

2006-03-17T14:26:00.000-08:00

Hello, and welcome to my blog. By way of introduction, my name is Greg Livingston, and I am a Chinese medicine physician, living, working, and studying here in Hangzhou, China. I am a westerner (from San Francisco originally) and have been studying and practicing Chinese medicine (abbreviated "CM" from here on out) for 12 years now. Currently I practice at an international hospital, and am a Ph.D. candidate in Chinese internal medicine at Zhejiang University of Chinese Medicine. And yes, the Ph.D. is all in Chinese.

I don't have time to write exclusively for this site, but I write for a couple local monthly English-language magazines here in Hangzhou, and I will be posting those articles here. I hope you enjoy the articles, and I greatly welcome your comments.

Unfortunately, I myself am unable to view the actual site due to the Chinese gov't firewall, and most people living in China will also be unable to view it. There's nothing political about my writing, and in fact, I think the Chinese gov't would approve of my writings because they tend to promote Chinese culture. But the firewall is indiscriminate. That said, I am able to access the backside of the site, so can post and moderate, etc. So if you care to leave comments, when I have time, I will try to respond.

Best wishes from Hangzhou, PR China.

Greg Livingston