Advanced Oriental Reproductive Medicine Fellowship – Training Program in China.

INTRODUCTION:

The Advanced Oriental Reproductive Medicine Fellowship will be an intensive one week of observations, lectures and discussions. This Fellowship is the only advanced education course offered by us. It is created for Chinese Medicine Reproductive Specialists who already possess all the basics in reproductive medicine and are experienced practitioners. As such, it is exclusive to members of the American Board of Oriental Reproductive Medicine (www.aborm.org) and members of Clinical Excellence in Fertility Professionals (www.thefertilesoulcefp.org). The 4th Fellowship Training Program will be in May 2015. Read on and write in if you are interested.

“The Fellowship in Nanjing is an intensive submersion into how Chinese Medicine, with a specific focus on reproductive health & fertility, as practiced in its home country. In daily clinic sessions it is not unheard of to see 60 or more patients per shift.”

Participants will observe the combined use of Western and Chinese medicine to treat both male and female infertility. The aim of the course is not only for participants to have the clinical experience of observing famous Chinese medicine doctors from the best gynecology hospitals in Nanjing, but also be part of a select group to learn more and discuss about how these doctors run their practice.

“There is nothing to replace the experience of being there-the sights, sounds, smells, the information! It will take your practice to a whole new level. There are things I saw and hear that I could only have seen and heard because I was in China.”

“The lecture and case discussion sessions were a valuable addition to the clinic observation. These sessions truly made it possible to decoct and extract the most valuable information from the observation sessions.”

“The doctors that were selected are some of the best in the field of Reproductive Medicine/Gynecology so it was very focused on what we see in our daily practices. Clinically, it was incredible to see the way the different doctors created herbal formulas and their theories on how to treat infertility were much more diverse than what we learn here in the States. TCM doctors in China are able to prescribe Western medications as well as herbs so it was invaluable to see how the two were used hand in hand. I learned a lot that I have already started applying in my practice.”

To find out more, or to register, follow the arrows below.

Mastering Herbal Formulation

How does one put together a herbal formula?

Many of you who read this will already have gone through much material regarding the expansive pharmacopoeia utilized in Chinese Medicine. Many would also find familiar the core set of formulas laid out in TCM textbooks.

“markov, thanx a lot for the great lectures you gave if us last term, they totally gave a new approach to herbs and formulas, also to think out of the box when it gets to deal with individual herbs in/out a formula.. please let me know when you’ll be back in town to have other sessions
kind regards and loads of gratitude.”

Click  to watch our snippet from “FOCUS ON TCM GASTROENTEROLOGY”

And if you are interested, check out (click) our FOCUS ON TCM GASTROENTEROLOGY course.

In our opinion, the more you see, the more flexible you become with the use of herbs in a formula. Most people are stuck to the main formulas and find it difficult to move away from it. Our aim is to help you encounter different possibilities using a comparative approach to learning. This will help you to set up a system for learning that is systematic and directed. What you catch will ultimately be yours. Together we will go through various case studies within each disease category, and in the process learn how herbal formulation it is done outside of the classroom.

A systematic means to mastering the art…

It is important that the classics are included in the course material. Classics allow you to understand the historical roots of a modern herbal prescription. That said, we want to give you more. We want to share with you a straightforward approach to creating empirical formulas that have clinical relevance. This hands-on approach can be immediately applied to your practice.

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Critique of a Medicine God

伤寒有五:有中风,有伤寒,有湿温,有热病,有温病。 – 难经

In the time of Mr. Zhang Zhongjing, all externally contracted diseases were classified Cold Damage (伤寒).

Cold Damage was the umbrella term for all classifiable infectious diseases then. The Classic of Difficulties gives us the five sub-categories: Wind Strike (中风), Cold Damage (伤寒), Damp-Warmth (湿温), Hot Diseases (热病) and Warm Diseases (温病).

Zhang’s classic tome On Cold Damage is revolutionary. Why? Because it unveils a theoretical framework for classifying disease based on the signs and symptoms exhibited. Mr. Zhang used a six-channel theretical framework, which later people have come to understand as a mapping out of the diseases process – from the 3 yang channels into the 3 yin channels. During the disease process, the sick person would manifest heat and cold symptoms. This language of heat and cold is the bedrock upon which herbs (also classified thus) were chosen to deal with the illness.

In fact, after Zhang’s time, later scholars spent much time writing and interpreting his work, which was a theoretical masterpiece, then as it is today.

A copious half of the book focuses on the Greater Yang (太阳) channel, which later scholars have understood as the first pass, the initial encounter with disease. Whether or not this has any basis, we will find a heavy documentation with regards to Wind Strike (中风) and Cold Damage (伤寒), both of which see the disease etiology as Wind or Cold entering the body. Both these ‘external pathogens’ then begin a process that moves inward from the outside, and when it reaches the innermost parts, the person dies.

In China today, within the sub-culture of Chinese Medicine, there are the people who still hold steadfast to such an understanding of diseases; they use this theory to treat disease. Even though the Cold Damage sect are a minority today, and many practitioners see it as one of many systems, there are those who swear by this one framework only.

In the earlier time notwithstanding, from the late Han up till the early Song dynasty, almost everyone used Mr. Zhang’s framework to treat diseases.

法不离伤寒,方必遵仲景。

There was a running phrase: The method should not depart from On Cold Damage; the method should abide by Zhang Zhongjing’s.

论伤寒不读仲景书,犹如为儒者不知有孔子《六经》也。

We can see here how he had become a medicine god that some had come to follow without too much critical thought. In fact, the herd who saw Zhongjing as the one and only also came up with other self-uplifting aphorisms, like this one in particular: If one discusses Cold Damage but does not read Zhang Zhongjing’s books, it’s like saying you are Confucian but not know the Six Classics of Confucius.

Many of the doctors before the Song era would be using herbs in a formulaic manner as dictated in On Cold Damage. While likely that such manner of practice works sometimes, it may not be the most effective method if used blindly.

Two formulas and their variants were used and stuck to for goodness knows how long, only because they were created by the much-revered Zhang Zhongjing. Cinnamon Twig Decoction (Gui Zhi Tang) was the solution for Wind Strike, while Ephedra Decoction (Ma Huang Tang) was used to treat Cold Damage. On hindsight, these are formulas with herb components more suitable for diseases linked to Wind and Cold. Are these formulas suitable for other sub-categories like Damp-Warmth, Hot Disease and Warm Disease? Perhaps yes? Perhaps not too.

An aside: Herbs are classified into the framework accorded in the Chinese Medicine framework, by flavor and by the channels they enter. This was a theoretical framework borne of an ancient past, and while they no longer sound scientific to the intellectuals of today, this framework was discussed and improved upon by the intellects of many a foregone era.

Zhugong (朱肱) in his book Living Scroll of Cold Damage-type Patterns (伤寒类证活人书) was vocal about the need to use herbs more flexibly.

“桂枝汤自西北二方居人,四时行之无不应验。自江淮间,唯冬及初春可行,自春末及夏至以前,桂枝证可加黄芩半两,夏至后有桂枝证,可加知母一两、石膏二两,或加升麻半两。若病人素虚寒者,正用古方,不再加减也。” – Zhugong

Zhugong voices a very reasonable suggestion regarding the use of Cinnamon Twig Decoction, which is warm in nature. He says that the people in the north can use it to good effect at any time of year, but for the people in the south, only in the the winter and early spring should it be used. From the end of spring to the peak of summer, we should add Skullcap (黄芩). After the peak of summer, consider adding Anemarrhena (知母) and Gypsum (石膏), or Cimicifuga (升麻). If the person is of deficient-Cold constitution, use the original formula.

Beautiful. Zhugong is suggesting that we add herbs of a cold nature to an essentially warm-natured decoction. In a nutshell, he encourages the act of modifying the original decoction depending on geography, season and personal constitution.

During the Jin-Yuan era, discussion was rife and tempers flared. One man who emerged within this pre-revolutionary mess as a man named Liu Wansu (刘完素) who later came to be known as the founder of the ‘cold sect’ (寒凉派). His focus was on the use of ‘cold’ herbs to remove the ‘heat’ characteristics of most externally contracted disease. An analogous phrase using today’s medical jargon would be “inflammation is the substance of all infectious disease.”

Mr. Liu was most famous for getting patients to ‘shit out’ the pathogen, although he also applied vomiting and perspiration to his repertoire of treatment methods. While the form of his methods is congruous with that used during the medicine god’s era – vomit, sweat, shit – the substance of his core herbs couldn’t be more different from Mr. Zhang’s.

Would Zhang have have declared war on this different manner of treatment? We don’t know, but being of open mind and ingenious spirit, Zhang might have found resonance with Liu’s ideas. But why did those who made him a medicine god raise such a ruckus?

Counter-stimulation, Acupuncture & Pain Relief

[See video above] New technologies for Virtual Reality, as evidenced by Snow World, add fuller dimension to the evolving idea of pain relief.

The idea of counter stimulation – where sensory stimulation reduces our perception of pain, either locally or distally – is not new. We do it all the time, clenching our faces in pain or wriggling our toes when the masseur presses down hard at one spot. It’s instinctive for most of us to rub our bruises as if that act of rubbing takes the pain away. But it does – most of the time – until we stop rubbing or putting pressure on the spot. And remember how you would slap that itch away.

Today, we understand it as a crowding out of pain, where we interfere with the sensation of pain by creating other sensations that our sensory nerves detect and send to the brain. These sensations may include different types of touch (rubbing, pressing, slapping) or different temperatures (hot, cold). That’s how it works, but let’s move on to review some approaches developed through the centuries.

Traditional approaches: Massage and Acupuncture as Counter-stimulation

One would postulate that massage and acupuncture probably came about as described above, when parts of the body that were painful were rubbed to ease the pain. These points – called A-shi points – are still indicated in massage or acupuncture treatment, and we understand intuitively that most times it makes sense to stimulate the spot that is painful. The pricking of the skin with a needle is understood to give this effect.

But I think it’s often more than this. Rubbing your bruised arm is not just counter-stimulation – it may also relax the muscles by creating warmth, or help disperse chemical mediators in the area. In a similar way, the effect of acupuncture is much more. Some say it causes the brain to release enkaphalins (endorphins) or regulates the release of neurotransmitters as serotonin, dopamine et al. Some points certainly have more marked endocrine effect, and may cause a variety of changes in our body chemistry, dilating vessels and bringing in the healing salvation of blood to the area, or boosting the production of hormones that the body is in need of but not making. It runs a large gamut, and may not be as easy to pin down as we’d like.

Gate theories are also used to explain the effect of acupuncture on pain perception and on motor function.

  • Gate control theory sees pain perception as controlled by a gate between the place you’ve been pricked (locatin of impulse generation) and the brain. We know that pain travels via sensory nerve fibers to be relayed to the brain. But this gate closes up and blocks off the transmission of pain IF the pain impulses are getting through too much too quickly. The thin C fibers have been found to exhibit such a “gate” function.
  • Gates may not just exist in sensory fibers. When implicated in motor fibers, stimulation of the fibers – whether by massage, acupuncture or exercise – reopens a closed gate, hence enabling motor impulses from the brain to reach muscles or internal organs. This is not just useful for treating impaired muscle function, but may also be helpful when we think that nerves leading to certain organs are “blocked.”

Traditional Approaches: Counter-irritants

I put counter-irritants in a different category, because whether correct or otherwise, I think of counter-irritants as liniments or ointment that are rubbed on painful parts of the body.

In general, application of a counter-irritant will not only crowd out the primary course of pain (e.g. arthritis) but will also induce inflammation. Inflammation involves vasodilation, blood moving in with oxygen to nurture the local area and with neutrophils and macrophages to get rid of any byproducts, and perhaps other chemical mediators that will assist in healing.

So, the idea here is that inflammation inadequate with chronic pain. We may thus need to induce inflammation – in moderation – to aid healing.

This may be over-simplifying it, but counter-irritants are:

  • analgesic: by crowding out the primary source of pain.
  • vasodilating: by inducing benevolent inflammation.

This would be a good explanation for why moxibustion, baguan and gusha are TCM treatments that may be both analgesic and beneficial to the healing process.

Can natural statins damage your liver?

Some time back, over a dinner conversation, someone brought up the topic of Hongqu (红曲), also known as Red Yeast Rice Extract. Hongqu has now been popularized as a natural statin, useful for the prevention or treatment of high blood cholesterol (高血胆固醇). Almost immediately, the topic moved on to the danger of using Chinese medicinal herbs, citing the case where someone suffered liver damage eating Hongqu. So what really went wrong? Is Hongqu really that harmful?

The enzyme, high blood cholesterol and LDL:

In the liver exists this enzyme called HMG-CoA reductase. If left on its own, this enzyme is able to create cholesterol from HMG-CoA. In many older people, there is a tendency to see excess cholesterol clogging up the blood vessels.

High blood cholesterol levels is related to high blood LDL levels. LDLs carry cholesterol from the liver (where it is mainly produced) into the blood vessels for use in other parts of the body. Therefore, when there is high blood cholesterol, there is usually high blood LDL. Usually this is a sign that your blood vessels are clogged up by cholesterol.

Statins, their effect and side effects:

Different statins include fluvastatin, atorvastatin, lovastatin and simvastatin. Available commercially, pharmaceutical statins work by inhibiting the action of the enzyme HMG-CoA reductase. When the enzyme is inhibited, HMG-CoA can no longer become cholesterol. This reduces the amount of cholesterol produced by the body. LDL is also reduced as a result.

That said, statins are broken down in the liver, hence increasing its workload. Liver damage is a possible side effect.

Important Information:

 

  • Side effects include dizziness, heartburn and muscle weakness.

 

 

 

  • Statins increase the risk of heart attack, unstable angina, and stroke is you stop taking it suddenly.

 

 

 

  • Studies have found that grapefruit juice enhances level blood levels of these statins, with the associated side effects. Therefore, you should be careful when taking grapefruit juice with statins.

 

 

 

  • Statins may lower the production of Coenzyme Q10 in the body. Coenzyme Q10 provides energy for every cell, and is crucial especially for helping our heart beat. Therefore, levels of Coenzyme Q10 are usually supplemented when using statins.

 

 

Hongqu as a natural statin:

Hongqu contains monacolins, compounds that are similar in structure to statins. Monacolins inhibit the same enzyme inhibited by statins. Hongqu is also called a natural statin. You may ask, how could it have caused liver damage if it is a natural herb?

It could have been used together with prescription statins like simvastatin and lovastatin. It could also have been due to misuse by the patient. More likely, the patient was not aware that even Hongqu overworks the liver despite being a natural product.

The lesson to be learned:
Yes, even natural statins are able to damage your liver. This is because of the way statins work.

是药三分毒.

The person who blamed Hongqu for causing liver damage must be aware that prescription statins are just as harmful. In the end, it is more a matter of how you use the medicines you have. Medicine (药) is synonymous to poison (毒) in Chinese Medicine. The lesson to be learned is to respect medicine and to use it with care.

By the way, there is an ongoing debate now in the States on whether or not to give Hongqu the status of a prescription drug. Of course the drug companies don’t want that to happen, since synthetic drugs like lovastatin are already making them alot of money.