Improving Health Through Meridians

The other major treatment modality commonly used in traditional Chinese medicine (TCM) is acupuncture. I've read a text on acupuncture now and I'll be honest, it is much more confusing than I expected. In fact, it doesn't make any sense to me at all. I'm inclined to say that it is crazy, hocus-pocus stuff. Two reasons why I don't say this is because people have been using it for thousands of years with results, and I've seen the results myself this month, though I don't think they are as dramatic as the results seen with cupping. I'll try my best to explain at least the general principles, but as I mentioned, I don't understand them well myself.

In TCM, it is believed that the organs are connected through channels called meridians, and that anything that inhibits the flow through the meridians causes disease. Here's the thing: the meridians don't physically exist. There are maps of where these meridians should be, but when you dissect through the tissues there are no such channels there. Here's the other thing: some of the organs themselves don't physically exist (see triple burner), and often the organs that do physically exist have completely separate functions in TCM than they do in Western medicine. For example, Western medicine views the liver as having important functions in protein synthesis, digestion, and lipid and sugar metabolism. In TCM, the liver is important in thinking, consciousness, and planning with insight. It is called the general of the armed forces. So if a patient comes in with anxiety and panic attacks with symptoms of palpitations, it is likely that the heart and/or brain won't be treated at all. Instead, the liver will be treated along its meridian points as it is too excited and causing an imbalance with the other organs.

Besides history, TCM uses other clues to help diagnose the deficiency needed to be treated. Of most importance is the tongue, including size and consistency, and the pulse. Checking three points along the radial pulse on both the right and left arms and using a complex system of describing each of the six pulses helps determine which organ system is unhealthy. There are other diagnostic aspects, such as a person's color and smell and their body temperature over different parts of their bodies. There are other aspects of treatment as well, such as certain people tend to have deficiencies in certain organs (called their constitutional factor), and certain organs are excited during some parts of the day while deficient on other parts of the day, and on and on and on. The more you read, the more confused you get because things get more and more complex and abstract. The thing is, people claim it works, and have made this claim for thousands of years. I'm going to try to explain below why maybe it shouldn't be ruled out as an option for some people and what benefit can be gained from using such thinking to treat illness. I will do this using a patient example.

A patient has epigastric pain. After doing an EKG and chest x-ray and ruling out cardiac causes, they are diagnosed with GERD, or acid reflux. They are then placed on a PPI medication, like protonix or prilosec. Everyone diagnosed with GERD will be placed on a PPI. Why? Because it's first line for acid reflux. And why is it first line? Because the proton-pump inhibitor has been shown to reduce the amount of acid production, improve symptoms, and reduce complications such as peptic ulcers and erosive esophagitis. This has been done using double blinded, randomized, placebo controlled studies, the highest level of evidence known. Treatments for pretty much every disease in Western medicine uses this study-backed concept, meaning everyone gets basically the same treatment for the same disease (with some variations here and there for specific details, allergies, etc). I love evidence based medicine because it gives me a purpose when selecting treatments and I know that statistically speaking I am doing what is best for the patient. Here is the problem with this approach: Not everyone responds to the first line medicines, and sometimes people don't respond to the second or third line medicines. Often at this point Western docs often throw their hands in the air and can't offer much else.

Whereas Western medicine uses a very scientific approach to diagnosis and treatment, TCM uses a much more individualized style. If five people walk into a TCM doctor's office and are diagnosed with acid reflux, it is likely that each person will receive a different treatment because their treatments are based on which "organs" are deficient in qi. To the TCM doc, the patient's acid reflux symptoms have nothing to do with excess acid production or H. pylori infection, so a PPI may not even help. So whenever usual treatment modalities don't work, I think that TCM and acupuncture can teach us to think outside of the box and use a different approach instead of just throwing our arms up in the air and not knowing what to do. Of interest, most of the patients the doctor I am with sees have failed many treatment modalities Western medicine has to offer and don't know where else to turn, which is why he is so busy.

In case you were wondering, there have been several randomized controlled studies trying to assess the effectiveness of acupuncture. These studies have shown mixed results, many concluding that there is insufficient evidence to suggest or not suggest acupuncture as a treatment option. It should be noted that randomized controlled studies are a relatively new phenomenon (1950s), and they frequently don't focus on patient-oriented outcomes, instead they focus on physiologic outcomes. For example, studies might show drug A is better than drug B for acid reflux, not because there is better subjective pain control, but because drug A inhibits more proton pumps than drug B. Also, rigorous randomized controlled studies are difficult and expensive to design and carry out. Major pharmaceutical companies sponsor many studies and frankly it's difficult for acupuncture to get the kind of funding necessary for the large studies needed to be accepted in Western medicine.

Up next, my own personal experience with TCM.