CHAPTER 2 The Continuum of Medicine

WHEN WE GET SICK, physically or emotionally, often the first questions we ask are how and why did this misfortune befall us? These questions have been asked for millennia. In ancient times, illness was attributed to the supernatural. Afflicted people thought they were being punished by a god, possessed by an evil spirit, or hexed by some malignant force. Various legends and myths were created in all societies in an effort to explain the how and why of disease. “Cures” were generally ritualistic and of a spiritual nature, administered by the “doctor” of the group. These healers went by different names in different cultures—shaman, curandero, kahuna—but they all blended their understanding of culture, community, and physical environment to create rituals and remedies to treat illness within their tribes.

Over time, as nature was better understood, the realization came that diseases were caused by real-world phenomena and not by supernatural forces. With this awareness came a shift in the role of the shaman. The shaman continued to be the spiritual leader of the group, but the physical health of the community was left to others—the herbalists, the bonesetters, and the surgeons who were the doctors of the tribe. Even though the shaman and the doctor now had different responsibilities, there remained a consistent understanding of health and healing. They knew that the health of an individual was more than the correct functioning of the body. True healing involved the patient’s mental and emotional well-being. In many ancient traditions, doctors realized that to view their patient as a complete person, they had to consider all aspects of that patient’s life; medical conditions, relationships within the family and community, and daily habits would all influence the quality and quantity of the patient’s life-span. Those daily habits were, and still are, the cornerstone of health maintenance. These physicians encouraged adequate sleep, nutritious food, and exercise. Not only was physical exercise recommended, but mental discipline and quiet concentration of the mind were promoted for complete well-being of the body, mind, and spirit. Through these methods, the physician helped people maintain good health and recover from illness.

The following discussion of the history and philosophy of Western and Eastern medicines will shed some light on how and why doctors in each discipline approach patient care the way they do. We then discuss the science behind the Eastern healing arts and the current trend toward integrating these two medical systems.

The History and Philosophy of Western Medicine

The birthplace of Western medicine was ancient Greece, and its father was a physician named Hippocrates (460–360 BCE). Hippocrates felt that a clear understanding of the patient’s way of life and constitution was essential in order to provide appropriate medical care. He particularly emphasized balance in daily living regarding food and exercise. In ancient Greece, the human body was thought to be composed of three material substances: blood, water, and bile. These substances were called “humors.” Additionally, the humors were associated with certain qualities (hot, cold, moist, and dry) and elements (earth, air, fire, and water). Perfect health was considered to be the ideal equilibrium of the humors, qualities, and elements within each individual, and disease was the result of imbalance among these components.

Even prior to the birth of Hippocrates, Greek philosophers and physicians were fascinated with the natural world and, like the Chinese, used observations of their environment to explain human growth and development. It was thought that the universe consisted of pairs of opposite qualities, such as hot and cold, moist and dry. Harmony between these pairs was considered paramount, as an imbalance could result in disease. This principle of paired opposites is also seen in the Chinese theory of yin and yang, which we discuss below.

Another parallel between Eastern and Western medical thought was the concept of “vitalism.” This is the notion that within the human body there is an active and intelligent force that instinctively maintains the health of the whole person. This “vital force” is similar to the Chinese concept of qi.

This idea of a dynamic energy within every individual was central to the art and science of medicine in Europe until after the Renaissance, during the Scientific Revolution (1450–1630 CE). During the Scientific Revolution, doctors were able to use advancing technology to examine the intricate workings of the human body and the environment. For example, in 1609, the light microscope was invented and, for the first time, doctors and scientists could see organisms that were invisible to the naked eye. They called such organisms microbes. Over the next two centuries, into the 1800s, an understanding of these organisms developed. It was proven that microbes, further classified as bacteria, viruses, or molds, could cause disease. Once it was known that specific organisms caused specific diseases, treatments were created that could cure many illnesses that previously resulted in severe disability or death. Over time, vaccines were invented that could prevent some diseases altogether. The study of microbiology and the development of antibiotics and vaccines are some of the most significant discoveries of Western medicine.

With this astounding success in the treatment of infectious disease, Western physicians realized that, if they could find the cause of an illness, they might be able to develop a cure. From this point onward, the study of medicine focused on the search for the simplest single explanation for the origin of a whole host of ailments. By the time the Industrial Revolution in Europe was in full swing, the study of medicine was influenced greatly by the societal changes of the era. Factories emerged, and every part of the production process was compartmentalized. No longer did an artisan see the creation of an item through from start to finish. Rather, a worker manufactured one portion of the item, then passed it on to the next worker and then the next, until completion. This preference for fragmentation became pervasive in Western medicine. Technology gave physicians and scientists the ability to break down biochemical and physiological processes into ever-smaller component parts. This has led to an unprecedented understanding of the complexity of the human body.

New discoveries are still being made: from the understanding that a person’s constitution can be passed down to offspring to the complete mapping of the human genome, from realizing that living things are made up of cells to understanding how these cells function and how we can use modern medicine to change these processes. New drugs, new surgical techniques, and new therapies are continually being discovered, trialed, and then, if successful, offered to patients. One of the main difficulties of this explosion of knowledge is how to master it and implement it correctly. The production line increased efficiency during the Industrial Revolution, with each worker perfecting a certain aspect in the manufacturing process. Modern medicine has also undergone a similar division of labor.

With the increasing complexity of biomedicine, it has become impossible to know everything about the human body, how we get sick, how we heal, and all the possible therapeutic interventions that can be used for every possible illness. Medical students the world over gain basic knowledge in anatomy, physiology, and biochemistry, then branch out to learn about the many causes of disease and how to cure or improve a patient’s condition. Upon graduating from medical school, young doctors in most countries are required to train further. They choose from many branches of medicine and become specialists in that field. Even doctors who want to become family physicians do a three-year residency in general medicine to hone their skills. Others choose from general surgery, internal medicine, obstetrics and gynecology, psychiatry, radiology, and pathology. After completing at least four years in their specialty, they can then subspecialize—they can focus on the medical or surgical aspects of every single body part or process. From the brain to the feet and everything in between, you can find a subspecialist to meet your needs.

But, even as a subspecialist, it is difficult to keep up with every new scientific discovery in the field. Subdividing and specializing medical research and care is a way of trying to achieve this impossible task. Similarly, the search for the single underlying cause of a particular disease is a way for modern medicine to develop treatments that hope to correct problems at the cellular, genetic, or molecular level of the body. In many instances, this approach has been spectacularly successful. For example, the discovery of the underlying cause of type 1 diabetes led to the discovery of insulin and methods to isolate it from animal sources and manufacture it synthetically, and now even to transplant the cells that create insulin and allow a diabetic to survive. Without the curiosity and ingenuity of physicians and scientists, this and other medical breakthroughs would not exist.

For many conditions, however, this reductionist approach has not been successful, or has even created more problems. The biomedical model of seeking out a solitary cause of an illness may overlook the possibility of interplay among many factors that can contribute to a disease. These factors can be specific to an individual, such as genetics, family environment, and personal life experience, or they can be factors that affect the community at large, such as environmental pollution, food additives, and poor access to markets with fresh produce or green spaces in which to exercise.

The dynamics of the origin of disease are highly complex, especially with respect to the chronic diseases of Western societies, such as heart disease, type 2 diabetes, autoimmune conditions, and some gastrointestinal disorders. For many of these conditions, the biomedical model may not be the best way to institute effective health care. A growing body of evidence suggests that optimizing the way we eat, move, think, and sleep can do more to reverse chronic illness than medications or surgery. Adopting such lifestyle changes may even prevent these conditions in the first place.

The importance of what we eat and our level of activity, sleep quality, and calmness of mind are not new concepts in medicine at all. In Western medicine, these concepts were vital millennia ago and are reemerging today. Increasingly, students of Western biomedicine are being trained to consider all aspects of an individual and their illness. This patient-centered model is called “biopsychosocial medicine.” Practitioners who hold this viewpoint evaluate not just the biological cause of a disease but the psychological, emotional, spiritual, and socioeconomic factors involved. All these elements can both affect and be affected by the disease process. Through this understanding, more and more medical practitioners are able to help patients heal and maintain optimal health.

The History and Philosophy of Eastern Medicine

Before discussing the chronology of Eastern medicine, an appreciation of its philosophy is extremely important. The principles of Eastern medicine hinge on the concept that man is inseparable from the universe. This notion comes from the observations and practices of Daoism. Daoism is a philosophical system that was reportedly founded by Laozi (b. 604 BCE). Laozi formulated the tenets of Daoism, but it was his students and followers who wrote the majority of the formal texts that are the foundation of this philosophy. Prior to the advent of Daoism in China, as in every primitive civilization, the ancients observed the changes that took place over time in the world around them. They noted the cycles of the moon, planets, and stars. These celestial patterns were correlated to weather changes, growing seasons, and animal migrations. Daoism grew out of this naturalist school of thought as it attempted to understand man’s place in the order of the universe. This law of nature is called “the Dao.” In English, this translates as “the Way” or “the Path.” The Dao represents the basic principles from which all phenomena follow, including all aspects of human behavior.

In addition to recording the ideas of the Dao and the phases in the physical world that change over time, Daoist thinkers helped formalize the concept of the unity of opposites within nature. This is the basis of yin-yang theory, for which Eastern medicine is known. By starting with the concept of opposition to describe the relationship between two entities, Daoists formulated a dynamic view of the world that could be used to explain universal processes. A classic example of this mode of thought is the observation that there is always a sunny side and a shady side to a hill, wherein one can say this side of the hill is sunny only by comparing it to the shady side. Labels are given to each item being described—as either yin or yang—depending on its degree of substantiality. If something is more passive and receptive in nature, it is yin; if it is more active and dynamic, it is yang. But these definitions have meaning only when compared one to the other. Any of the pairs that embody yin and yang cannot be separated and are not absolute.

The yin-yang experience is a fundamental factor in the development of the Daoist metaphysic. Far from designating yang as “something” and yin as “nothing,” Daoism recognizes that both are active and that one creates the other.1 For example, the ceramic of a teacup would be considered yang and the space within the teacup considered yin. It is the space that is filled and makes the ceramic useful as a teacup. The yin and the yang of the cup are inseparable.

From this thought arises the realization that the part and the whole must exist simultaneously. The infinite exists at every singular point in space, and eternity is found in every individual moment. The Daoist consideration of the infinite and the yin-yang experience infuses itself into the practice of Eastern medicine by virtue of the fact that dysfunction within the patient, known as the pattern of disharmony, cannot be viewed separately from the patient herself. The part and whole exist together and define each other.

In addition to the concepts of Dao and yin-yang, the recognition of the phases of the universe was developed into the theory known as Wu Xing, or Five Phases. Wu Xing has also been translated as Five Elements, however, many scholars state this is incorrect. The word “element” implies a component part or constituent ingredient. The word “phase” denotes a dynamic process. In his iconic book, The Web That Has No Weaver, Dr. Ted Katpchuk describes the Five Phases as patterns that occur in dynamic systems. Each phase has a designated name and displays a set of particular characteristics.² The phases are known as Wood, Fire, Earth, Metal, and Water. The names of the phases are not as important as each set of characteristic qualities and functions. Wood represents growth. Fire represents maximal growth that has reached its apex and will plateau or decline. Metal is emblematic of decline. Water denotes a profound state of rest that has reached its nadir and will shift toward growth or activity. Earth represents balance.³ If you imagine a pendulum swinging to and fro, the Earth Phase would be the moment at which the pendulum is hanging straight down. The patterns of the Five Phases can be seen in the ebb and flow of all natural and even man-made phenomena: human growth, maturation, and decline; the changing of the seasons; economic expansion and recession; the rise and fall of political powers.

As long ago as the fourth century BCE, the Five Phases were used to understand and interrelate naturally occurring events. This understanding was applied to medicine as well as other disciplines, including astrology, social politics, and natural sciences.⁴ Using this paradigm, Daoist physicians looked at the human body as a microcosm of the universe and sought to use the natural laws of the universe to maintain a harmonious balance. They acknowledged that this balance must occur internally and also with the patient’s external environment. Following the principles of Daoism, which emphasize moderation and equilibrium, the patient would be cautioned to follow the middle path in all aspects of life: to rest but also exercise, to work but have time for leisure, to eat a variety of healthy foods but neither too much nor too little. By achieving this equilibrium, the movement of the intelligent vital force within the body (called qi) would be smooth. This free movement of qi would maintain optimal health.

In 1973, in the Chinese province of Hunan, a famous archeological dig discovered silk texts that discussed subjects as diverse as astrology, art, military strategy, philosophy, and medicine. There were even two copies of Laozi’s Dao De Ching, found in the Mawangdui tombs (King Ma’s Mound). Scientific methods were used to date the texts from approximately 200 BCE; the tomb itself had been sealed in 168 BCE. The medical texts cover physiology, illness, surgery, herbal treatments, and what has been translated as “macrobiotic hygiene.” Macrobiotic hygiene involves not only the body but also the spirit; this section discusses longevity, sexuality, and diet. Breathing and physical exercises are recommended to treat illness and cultivate health, and there are also writings on magic and incantations.⁵

Illness is described in the Mawangdui medical manuscripts as the result of a disturbance in the movement of qi within the eleven vessels of the body. These vessels that contain qi are different than the arteries and veins that contain blood. The treatment that was advocated at the time involved cauterization of the qi vessels. There is no mention of using acupuncture needles to correct the flow of qi. Instead, the medical practitioners who wrote these manuscripts advocated the use of food, herbs, breath control, and exercise to improve the flow of qi and achieve a long and vibrant life.

This approach to good health was formalized in the classic medical text of the Han dynasty (206 BCE–220 CE), the Huang Di Nei Jing (The Yellow Emperor’s Classic of Internal Medicine). It is thought that this text is a compilation of medical writings from practitioners of earlier centuries, which takes the form of a discussion between the Yellow Emperor (Huang Di) and his minister; it is significant in that it was the first known text to move away from shamanism and supernatural causes of disease. Like the Mawangdui medical manuscripts, the Huang Di Nei Jing discusses the prevention and treatment of illness through diet, exercise, and herbs. Acupuncture theory is well described in the second volume of this text. The principles of energy flow within the body (qi), yin-yang theory, and diagnostic techniques are also discussed.

Around the first century BCE, the art of acupuncture using metal needles was formalized. Some researchers of Chinese medical history state that acupuncture arose from the practice of using sharpened stones and bones to lance infected skin, allowing the body to heal. However, scholars such as Donald Harper and Paul Unschuld state that the vessel theory and treatment paradigm delineated in the Mawangdui medical manuscripts was the necessary precursor to acupuncture theory as described in the Huang Di Nei Jing.⁶

Through trial and error, the Chinese determined that placing acupuncture needles at specific sites would give consistent and reproducible results. By the time the Huang Di Nei Jing was written, the intricate system of acupuncture points and qi flow within acupuncture channels was well established. Twelve paired principal channels, or vessels, were described, meaning that the channels were duplicated on each side of the body in a mirror image. These paired channels are named for organs of the body. The channels are kidney, heart, small intestine, urinary bladder, spleen, lung, large intestine, stomach, liver, san jiao,⁷ pericardium,⁸ and gallbladder.

The channels can directly influence the named organ, but they also affect other areas and physiological processes. Additionally, eight “extraordinary” channels are noted. These special channels run in various directions, over and through the body, connecting the principal channels and acting as reservoirs of qi. Acupuncture theory is discussed in more detail later in this chapter.

As in all ancient civilizations, the Chinese used indigenous plants, minerals, and animals as medicine. Chinese herbology predates acupuncture, probably by thousands of years, but until the development of written language the use of these medicinals was not documented. Several very famous texts categorize Chinese herbs and explain their function. Shen Nong Ben Cao Jing (The Divine Farmer’s Materia Medica) was written in the early Tang dynasty (452–536 CE), but it is actually a compilation of much earlier writings. The book discusses the attributes of 365 herbs, the majority of which are still used today.

Dr. Zhang Zhong Jin (150–219 CE) was renowned for his text, the Shang Han Lun (Treatise on Cold Damage). This is the oldest formulary to group patient symptoms into clinically useful categories. Zhang Zhong Jin was also the first to link diagnoses derived through the principles of yin-yang theory and the Wu Xing (Five Phases) with standardized herbal treatments.

One of the most celebrated physicians in the history of Chinese medicine was Dr. Li Shi Zhen. He lived during the Ming dynasty and in 1578 wrote his masterpiece, the Ben Cao Gang Mu (Compendium of Materia Medica). Li Shi Zhen traveled across China in search of medicinal herbs. After twenty-seven years of diligent work, the Ben Cao Gang Mu was completed. It documents 1,892 distinct herbs and more than eleven thousand formulas. This comprehensive text remained the official materia medica for China for the next four hundred years.

Two other noteworthy Chinese doctors are Hua Tuo (145–203 CE) and Sun Si-Miao (581–683 CE). Hua Tuo was well known, especially for his surgical skills and the development of a particular type of exercises that he called Five Animal Play (Wu Qin Xi). Sun Si-Miao stood out not only for his talent as a healer, but also for his humanity. Although the emperors of the Tang dynasty wanted Sun Si-Miao as the palace physician, he declined and worked for all people. In his writings, he instructed doctors to be of good moral character and to treat all patients equally, regardless of their class or wealth.

Around the time of Sun Si-Miao, during the fifth and sixth centuries, Eastern medicine spread from China to Japan, Korea, and Vietnam. Through trade via the Silk Road, knowledge of this system of medicine eventually arrived in the Middle East and Europe, with little more than passing interest outside Asia until much later. As European colonization of East Asia increased, more Western physicians became curious about these techniques. France had colonized Vietnam, and so French physicians who traveled there were exposed to the successes of acupuncture and herbal formulas. From the eighteenth century onward, the French were at the forefront of Western investigations of Eastern medicine. Later in this chapter, we discuss the science of acupuncture and other Eastern healing modalities in greater detail.

An increasing percentage of the general population has benefited from Eastern medicine over the past century, but in the United States very few were able to take advantage of this powerful medical system prior to the 1970s. Until then, acupuncture was illegal in America. Even though it was practiced and well respected throughout Europe, Britain, Canada, Japan, and other Asian countries, both practitioners and patients who sought to use this medicine risked arrest in the United States. For this reason, very little documentation remains of the early history of Eastern medicine in America; there are, however, some accounts dating as far back as the nineteenth century. In 1974, California became the first state to legalize the practice of acupuncture, after which most other states began to follow suit. Acupuncture training and credentialing became more formalized, but a few states still remain in which there is no acupuncture practice act to regulate the profession. In all states except Hawai‘i, a medical doctor or osteopath may practice acupuncture, for which most states require approximately three hundred hours of acupuncture training; such a practitioner is called a medical acupuncturist. A licensed acupuncturist who is not a physician will have completed approximately three thousand hours of training in acupuncture and herbology. This also would include hundreds of hours of Western biomedicine such as anatomy, biology, chemistry, physiology, and pharmacology.

Whether a medical or licensed acupuncturist, the mark of an excellent practitioner is the willingness to refine the art and science of Eastern medicine. Collaboration between acupuncturists and other health-care practitioners is happening more frequently in clinics, hospitals, and academic institutions. The drive to comprehend the mechanism of action of acupuncture, qigong, tai chi, yoga, and meditation has fueled thousands of basic research studies and clinical trials. In the discussion that follows, we provide a brief summary of the current understanding of how these therapies can heal the human body.

The Science behind Eastern Healing Modalities

From Asia to Europe to the rest of the world, interest in and use of Eastern medicine has grown during the past century, surging over the last fifty years. Several components of Eastern medicine have been subject to scientific scrutiny in the West, but also in their countries of origin. The elements of Eastern medicine (including Indian, Tibetan, and Chinese practices) that have been most researched are meditation and breath control, yoga, qigong, tai chi, herbal remedies, and acupuncture.

Regulation of the breath has been used for millennia to calm the mind and heal the body. Even without a modern understanding of how the brain and body communicate, the ancients formulated breathing techniques that balanced the autonomic nervous system. This is the part of your brain, nerves, immune, and endocrine systems that determines your state of relaxation. The autonomic nervous system is composed of the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system initiates the release of stress hormones when your brain perceives that you are in danger. These hormones cause your heart rate to elevate, your blood pressure to rise, and make glucose available to fuel your muscles in preparation for combat or evasive maneuvers. This reaction is known as the fight-or-flight response. In contrast, the parasympathetic nervous system calms all these processes and returns the body to a normal state of activity. Slow, deep breathing stimulates the main nerve of the parasympathetic nervous system called the vagus nerve, which in turn releases hormones and neurotransmitters that slow your heart rate, lower your blood pressure, and generally bring your body into balance.9 The benefits of calming the nervous system include decreasing chronic inflammation, thereby decreasing your risk of chronic illness.

Controlling the breath is often one of the first steps employed in meditation. There are many different types of meditation—Buddhist, Hindu, Zen, Tibetan, Daoist, mindfulness, and many more. Depending on the ideology associated with the practice, the goals of meditation can range from relaxation and stress relief to compassion and spiritual enlightenment. Meditation usually results in a sense of calmness and clarity that can be difficult to describe. Numerous medical benefits have been attributed to meditation, and scientists are investigating how meditation affects the brain and overall health.

When a person meditates, the electrical activity in the brain changes. This is true of any change of state such as intense concentration or emotion, drowsiness, sleep, and dreaming. These patterns of electrical activity are called brain waves and are measured by electroencephalography (EEG). Brain waves, also known as neural oscillations, have different frequencies. In addition, a wide range of patterns, combinations of frequency and amplitude are associated with different stages of sleep and wakefulness. For instance, you can be awake and in a state of deep concentration as you are trying to solve a problem or you can be awake but daydreaming and inattentive. Each of these states of wakefulness has different patterns involving each of the frequencies, but in different proportions, and can involve different areas of the brain. Simply stated, the higher frequency brain waves are associated with cognitive processing and alertness (beta waves). Lower frequencies are associated with sleep (delta waves). In between are frequencies associated with wakefulness (alpha waves) and deep relaxation, daydreaming, and meditation (theta waves). Combinations of delta and theta waves are important in memory processing. The state of mind between alpha and theta waves is said to be one of increased creativity.

Through the use of functional magnetic resonance imaging (fMRI), researchers have discovered that meditation increases the amount of gray matter in the brain, which is made up predominantly of the cell bodies of neurons,¹⁰ and also seems to slow the natural loss of gray matter that occurs as we age.¹¹ Depending on its location within the brain, gray matter is involved with a variety of functions such as learning, memory, emotional regulation, and perspective. It seems that meditation can actually keep your brain younger and calmer.

A meditative state can be achieved during qigong, tai chi, and yoga. All these practices incorporate slow deep-breathing patterns, which confer all the benefits of seated meditation. These forms of moving meditation have additional advantages. During these practices, we move in well-defined patterns, stretching all the muscles in the neck, torso, arms, and legs. Stretching has many benefits, such as decreasing pain, improving blood circulation, increasing range of motion, and improving balance. For some time now, the cellular changes that occur with stretching have been studied. Dr. Helene Langevin and her team at Harvard demonstrated that by gently stretching the connective tissue of mice, inflammation at a site of injury was reduced. There was also an increase in the concentration of resolvins, which are cellular mediators that help coordinate the resolution of the acute inflammatory episode.¹² Later, using a similar rodent model and injecting breast cancer cells into the mice, Dr. Langevin found that gentle connective tissue stretching enhanced the response of the immune system and slowed the tumor growth by half.¹³ This finding may offer an explanation for why many researchers have noted a lower risk of death from all causes, including recurrence, in cancer patients who exercise.¹⁴

An additional benefit of slow-moving, breath-focused exercise relates to the way the body utilizes oxygen. Dr. Peter Anthony Gryffin has compared the amount of oxygen in the blood during and after aerobic exercises like running and slow, mindful exercises like tai chi and qigong. It was previously known that the amount of oxygen in the blood, a measurement called blood oxygen saturation, either stays the same or goes down during aerobic exercise as oxygen is being utilized by the large muscle groups, heart, and lungs. During slow-moving, breath-focused exercises, blood oxygen saturation initially goes up, then drops significantly for a short period of time before it returns to baseline. Dr. Gryffin’s research suggests that this drop in blood oxygen saturation represents increased oxygen metabolism and diffusion throughout the whole body, since no excessive strain is placed upon the muscles and cardiovascular system as it is during aerobic exercise. Because of this unique difference in oxygen metabolism, Dr. Gryffin coined the term Metarobics to describe exercises that are neither aerobic, like running or swimming, nor anaerobic, like weight lifting. Metarobic exercises include tai chi, qigong, yoga, and other forms of moving meditation. This improved oxygen metabolism may account for many of the health benefits realized by practitioners of tai chi and qigong, such as decreased levels of chronic inflammation, improved immunity, and enhanced healing.¹⁵

Along with meditation, breath regulation, and movement, herbs are a mainstay in Eastern medicine, as well as in every medical tradition around the world. The healing properties of plants have been known for thousands of years, but not until the last two hundred years have specific biologically active compounds been extracted and used as drugs. As technology advanced, the medicinal properties of herbs were documented, particularly in China, where sophisticated combinations of herbs are used alongside modern pharmaceuticals in clinics and hospitals that integrate Western and Eastern care. The constituent components of these herbs, the ways they are metabolized, and how they affect the body continues to be documented. These plants have naturally occurring compounds that, depending on the herb, can act as antibacterials, antivirals, antifungals, hormone modulators, neurotransmitters, anti-inflammatories, antidepressants, or sleep aids. It is not within the scope of this book to discuss the biochemistry of all the herbs available to a qualified practitioner, but it should be noted that many of the formulas around today have been prescribed effectively in Asia for more than a thousand years.

The concept of using plants as medicines was well established throughout the world, but it was the mystery of acupuncture that fascinated the French. This led to various scientific experiments that laid the foundation for modern acupuncture research.

During the mid-twentieth century, the French and the Chinese performed a number of experiments that began to explain how acupuncture works. There is no single, simple explanation for acupuncture’s mechanism of action. Each scientist added new information, helping to fill in the pieces of the puzzle.

In the 1940s and 1950s, Niboyet designed a series of experiments that showed electrical resistance is lower at acupuncture points than elsewhere on the body. This means electricity will pass into the body more easily across the skin at an acupuncture point than across the skin at a non-acupuncture point. Niboyet also demonstrated that electricity flowed more easily along the same acupuncture channel than between channels that were not as strongly related to each other. These results were confirmed by other scientists in the 1960s and 1970s.¹⁶

The acupuncture channel itself has remained an elusive entity. Our understanding of acupuncture channels and how acupuncture works has changed over time. Acupuncture channels are intimately associated with the neural, immune, and endocrine systems of the body. For example, modern acupuncture researchers note the channels that run on the inner arms almost exactly follow the paths of the nerves. Though the ancient Chinese were aware of the existence of the structures we call nerves, they did not know their function. They could not have known that electrical signals travel along nerves, having no knowledge of electricity.

Understanding that the effect of acupuncture is mediated via electricity was the first step in uncovering its mechanism of action. Over the past half century, the unfolding of this knowledge began by seeking evidence that these channels do exist. They were thought to be different than the known vascular or neurological systems that have been defined by modern medicine. The first piece of indirect evidence of the existence of acupuncture channels is that many patients experience a feeling of heaviness, achiness, or warmth around the acupuncture needles during treatments. These sensations can radiate from the needles, either circumferentially or linearly. When moving linearly, this feeling of warmth or achiness travels up or down the area of the body being needled. Modern Chinese researchers call this phenomenon “propagated sensation along channels.”¹⁷ They suggest that this sensation represents the movement of a corrective signal to an area determined by the acupuncture point that has been used. The target zone for the propagated sensation need not be a local area. Needling particular points on an arm or leg can reproducibly create a response in another part of the body. For example, certain points on the hand can alleviate back pain, a point on the lower leg can decrease discomfort of the opposite shoulder, and a well-known combination of points can initiate labor. We do know that the sensations elicited by acupuncture are an essential part of the signaling process and are caused by the activation of different types of nerve fibers.¹⁸

The speed of the propagated sensation has been noted to travel at one to ten centimeters per second. This velocity varies among subjects and with the intensity of the needling. This rate is much, much slower than the speed of nerve impulses, so it cannot be attributed simply to nerve conduction. The brain itself may also be involved in the perception of this sensation. Some studies have reported that amputees who are aware of phantom limbs are able to feel the propagated sensation within the absent limb when needled along a channel associated with the limb in question. This indicates that there must be some central nervous system involvement in the appreciation of this sensation.

When an acupuncture point is needled, a lot happens on the cellular level. There seems to be another mechanism at play, aside from direct activation of the nervous system. When the needle is inserted, it is manipulated to create sensation. This manipulation causes a mechanical change in the tissue. Researchers have demonstrated, using magnetic resonance imaging and ultrasound elastography, that a slow-moving wave is generated through the tissue that has been needled. There is also a shift in calcium ions that creates a biochemical signal that appears to be separate from the electrical signal of the nerve fibers.¹⁹

Western science has added a great deal of supporting evidence for the existence of a communication network from acupuncture points to the rest of the body by documenting the effects of acupuncture on blood chemistry, body temperature, and hormone levels. With respect to blood chemistry, acupuncture has been shown to modify levels of glucose, cortisol, triglycerides, and cholesterol. Although the mechanism of action is not well understood, acupuncture seems to assist the body in achieving balance. In medicine, this equilibrium is called homeostasis.

Acupuncture has also been shown to cause an increase in the body’s surface temperature. This is caused by the dilation of vessels, resulting in increased blood flow. The increase has been documented at a rate three times higher than that of pretreatment flow. Not only does the surface temperature of the needled skin increase locally, but it also increases at the same area on the other side of the body.²⁰ Increased blood flow improves oxygenation within the tissue and may speed healing.

A great deal of research has been performed regarding acupuncture’s effect on hormone and neurotransmitter levels, particularly with respect to pain relief. Some of these neurotransmitters include serotonin, norepinephrine, substance P, GABA (gamma-aminobutyric acid), and dopamine. All these compounds work together to diminish the brain’s perception of pain.

Another way pain is decreased is through the release of cortisol, which has an anti-inflammatory action. The release of cortisol is controlled by levels of adrenocorticotrophic hormone (ACTH), and acupuncture has been shown to increase the discharge of this substance.

Finally, acupuncture modulates the body’s internal production of opioids, leading to pain relief through a different pathway. Opioids are narcotic-like compounds; those produced in the body are called endorphins, which attach to receptors located on cell membranes, resulting in decreased pain. There are several different types of endorphins, and each acts at a different site within the brain and spinal cord to relieve pain. Interestingly, it appears that certain endorphins (beta-endorphin and met-enkephalin) also interact with the immune system. A surge in the levels of these endorphins can lead to increased activity of natural killer cells, a type of white blood cell that defends the body from foreign microbes and cancerous mutations.²¹

For all the various effects that acupuncture produces, the specific mechanism of action has not yet been completely discovered. As we have seen, electricity is a principal mediator of information that is passed along through the body, creating numerous physiologic changes.

Several theories exist regarding the ways in which these processes are regulated. Most concentrate on the effects produced by the passage of electrical current through the body. There is no doubt that the human body utilizes electricity in its everyday functioning. Western medicine has used this information to create many diagnostic tests and therapies.

In the heart, the interpretation of the electrical signals seen on an electrocardiogram (EKG) allows a physician to diagnose a heart attack or cardiac rhythm disturbance. If a patient’s heart suddenly stops beating, electricity is applied to the person’s chest via a device called a defibrillator in an effort to “kick-start” cardiac activity. Smaller amounts of electricity are also used to change irregular rhythms to regular ones.

The electrical signals from the brain can be studied to help diagnose epilepsy or sleep disturbances. We can assess the health of these systems by recording the speed of electrical impulses through the nerves and muscles.

Even skin healing, which we tend to take for granted, requires electricity to activate the restorative process. Electrically, the skin can be described as a battery, with the negative charge inside each cell and the positive charge on the exterior surface. When the skin is breached, either by trauma or by inserting an acupuncture needle, the “battery” is short-circuited, and now the charge on the skin surface is negative. This negative charge seems to be an initiating factor in healing and activates the body’s system of repair. It has been shown that this negative charge, described by Dr. Robert Becker as a “current of injury,” can last several days following an acupuncture treatment.²²

Dr. Becker, an American orthopedic surgeon, performed a fascinating series of experiments involving electrical current and limb regeneration in salamanders and frogs. Even though salamanders and frogs are closely related, salamanders can spontaneously regrow lost limbs, but frogs cannot. Through his research, Dr. Becker discovered that the tissue over the salamanders’ limb stumps displays a relatively negative charge compared with other points on the animal. The frogs did not exhibit this negative charge. When he applied the appropriate electrical current and created a negative charge over the area of the frogs’ missing limbs, the frogs’ limbs regenerated just like the salamanders’ did.²³ Dr. Becker’s work has led to the creation of electrical devices that accelerate bone healing. These devices are used in cases in which broken bones are not healing well. In the past, it was sometimes necessary to amputate limbs that would not heal. By using electricity to enhance bone healing, Dr. Becker’s discovery has decreased the need for amputation in such circumstances.

As well as the electrical component of the energy within the human body, there is also a magnetic constituent. Without this, magnetic resonance imaging (MRI) would not be possible. Studies called functional MRIs are used to observe the electromagnetic changes within different areas of the brain in response to acupuncture needling.

Other devices have been developed that can measure electromagnetic fields that come from diverse parts of the body. Such devices have demonstrated that electromagnetic fields exist around acupuncture points and that the intensity of these fields changes following acupuncture treatment.²⁴ Some researchers suggest that acupuncture points act as amplifiers by increasing the signal that moves along the channel.

Identifying the exact tissues through which these electromagnetic signals pass is a subject of ongoing study. Evidence suggests a variety of mechanisms through which bioelectrical information is transmitted. These mechanisms include the following:

Electron-rich fluid that naturally bathes the tissues of the body, organized into tiny pockets now recognized as the interstitium, a newly defined organ²⁵
Perineural cells (cells that are adjacent to nerves)
Proteins such as hormones and neurotransmitters that regulate communication between cells
The fascia, a fibrous tissue that surrounds and connects every component of the body, from nerves, arteries, and veins to each muscle and organ

In his superb book The Spark in the Machine, Dr. Daniel Keown explains the role that fascia plays in the body, including its electrical properties. Fascia is composed of collagen. Collagen is a protein that accounts for 30 percent of the proteins in our body. Proteins are made of amino acids. In collagen fibers, these amino acids are arranged into three threads that twist around each other like three-stranded rope, lending incredible tensile strength to the tissues in which it is found. These include bones, ligaments, tendons, cartilage, arteries, and connective tissue. Just as it sounds, connective tissue connects and surrounds all our organs and muscles. Collagen even creates the lattice of the interstitium and interacts directly with the fluid inside these bundles, potentially allowing communication between body systems.²⁶

Dr. Keown explains that, because of its molecular structure, collagen can act like a crystal and generate small currents of piezoelectricity when it undergoes mechanical stress. If a substance is piezoelectric, it will generate a change in electrical charge when it is compressed then returns to its original shape. We take advantage of piezoelectricity when we use pilot lights on a gas grill to create a spark, igniting the flame. Collagen is also a semiconductor, meaning that collagen can conduct electricity, but not as well as a metal such as copper. It can also act as an insulator, but not as well as glass. So, with every movement you make, your tendons, muscles, and bones undergo mechanical strain, and the collagen generates an electrical current. Collagen is an integral part of the fascia that connects the top of your head to the tip of your toes. Dr. Keown describes this as “an interconnected, living electrical web.”²⁷

When an acupuncture needle is inserted into the body, it makes contact with this “living electrical web.” The acupuncturist will usually manipulate the needle until both the patient and the practitioner are aware of a certain sensation. The patient may feel an ache or a slight electrical zing at the insertion site, and this feeling may propagate along the body part that is needled. The acupuncturist can feel this through the needle. This sensation is called “de qi,” or “the arrival of the qi.” Even if the needle is inserted into an area that is not classified as an acupuncture point or is not along the channel, this sensation may be felt. This is because the fascia wraps the whole body, not only along acupuncture channels. Just as the blood flows through large vessels and tiny capillaries, so too does piezoelectricity traverse the whole body.

Knowing about the “body electric,” researchers have tried to explain the location of acupuncture channels and points, forming hypotheses regarding the way in which bioelectromagnetic information travels through the body. Zhang and Popp theorize that electromagnetic energy travels in waves. These waves bounce off the physical structures in the body such as bones, nerves, and skin, creating interference patterns, similar to the way waves of water reflect off the sides of a pool. As they change direction, the waves combine with others, creating higher waves, or canceling each other out. Zhang and Popp suggest that acupuncture points and channels occur at areas where bioelectromagnetic waves have combined to form new waves of higher amplitudes, and that acupuncture needles can be used to change the body’s electromagnetic field.

Acupuncture needles may influence the state of the body through more than one single path. The human body is a complex system, and it seems likely that the ways in which acupuncture affects it are manifold. In an effort to tease apart the specific mechanism of action, researchers over the years have designed studies comparing true acupuncture with different sorts of pretend acupuncture, called sham acupuncture.

Sham acupuncture has been variously described as needling prescribed points superficially, needling non-acupuncture points, needling points that have not traditionally been used for the condition being treated, or using retractable needles to simulate the experience of true acupuncture without the actual needle insertion.

In numerous studies, sham acupuncture has been shown to be almost as effective as true acupuncture. Those that doubt the usefulness of acupuncture interpret this as placebo effect; however, whether using shallow needling, alternate points, or retractable needles, the collagen in the connective tissue of the body is still compressed. The piezoelectric property of collagen is activated whenever these tissues are compressed and microcurrents of electricity are generated. The body’s response to the energetic input of sham acupuncture may not be as pronounced as when the points are actually needled, but the body responds nonetheless. This explains why, in some studies, sham acupuncture can be more effective than no treatment and almost as effective as “real” acupuncture, particularly if the sham acupuncture involves skin penetration. One interesting finding in a recent systematic review of acupuncture trials in the treatment of several types of chronic pain is that penetrating sham acupuncture more closely approximates the pain-relieving effect of true acupuncture than does the non-penetrating sham.²⁸

Prior to today’s clearer understanding of the physiological effects of acupuncture, many considered the improvements patients experienced to be the result of the placebo effect, which has been seen in medical practice for centuries. The word “placebo” comes for the Latin meaning “to please.” The idea was that a doctor would give a patient a pill or treatment that was inert. If a pill, there was no active substance in it; if a treatment or surgery, there was no actual intentional repair of any structure. In spite of this inertness, a large number of patients actually improved or were cured. Historically, placebos have been used to encourage the patient’s expectation that they would recover. From a research standpoint, placebos are used in an effort to ensure that the experience that both the study group and control group undergo is as close to the same as possible. This is done in an effort to isolate the one active substance or intervention that is creating a change in the patient’s condition. Introducing a placebo group into a randomized controlled trial is a common occurrence, but as we have seen, sometimes placebos confuse rather than clarify the results.

Even when a study involves a simple cause-and-effect response, such as testing a new drug, it is impossible to separate the human reactions of the participants, both patients and researchers. Medical anthropologists, such as Claridge and Helman, have pointed out for some time that there is a “total effect” of a drug or intervention that goes beyond the actual biochemical or physiologic nature of the treatment. The components that make up the total effect include the characteristics of the drug or treatment itself (even down to the color of the pill), the characteristics of the patient (age, gender, genetics, education, experience, personality, expectations), the characteristics of the researcher (personality, age, gender, attitude, professional status), and the setting in which the study is taking place.²⁹

None of the above attributes can be removed from the clinical trial, and all of these characteristics are present within the study and placebo groups. This may, in part, explain why some patients who receive the active substance experience a negative clinical response and some within the placebo group improve.

So, does this mean that the positive clinical results experienced by placebo group patients are a figment of their imagination? No. In many studies, the improvements seen in the placebo group can be objectively identified. These changes are not just qualitative, meaning the patient describes a state of improved health. The differences can also be measured quantitatively, such as findings of lower blood pressure and lower cholesterol levels, and the decreased use of painkillers.

How can these changes be occurring? There is a great deal of interest in the physiologic effects of the placebo. Around the world, researchers are documenting changes that occur in the immune system, the brain, the spinal cord, and the biochemical balance of the body in response to a placebo.

In many of these studies, patients are not told they are receiving a placebo. For many health professionals, this presents an ethical dilemma in the use of placebos in general practice. Interestingly, at Harvard’s Program for Placebo Studies, Dr. Ted Kaptchuk and others created a randomized controlled trial to look at the feasibility of using placebos without deceiving the patient.³⁰ All the patients had irritable bowel syndrome (IBS). The patients were randomized either to the open-label placebo group or the nontreatment control. Both groups received the same amount of time, counseling, and attention. Both groups were asked not to change any aspect of their usual routines for the duration of the study, such as starting a new diet or exercise program. Both groups had stable disease. The difference came at the end of the first interview, when the patients found out to which group they were assigned. The open-label group was told the pills they would take were “placebos, made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes.”

The truly fascinating outcome of Kaptchuk’s study was that even though patients knew they were taking placebos, their IBS symptoms improved more than those of the control group, which did not receive any pills. The statistically significant changes in the control group were decreased symptom severity and increased symptom relief. There was also a trend toward improved quality-of-life scores at the end of the study period for those taking placebos. Remember that these patients knew there was no medication of any sort in their pills, and yet they felt better. This demonstrates that the power of the mind to heal the body is astonishing. Eastern medicine has always recognized that fact and uses it to full advantage by incorporating meditation, qigong, and tai chi into patient care. Further research will shed light on this intriguing phenomenon. Even though the mechanism of action is not fully understood, we can still benefit from the positive physiologic changes that acupuncture and mind-body interventions produce.

Western Health-Care Providers and Eastern Medicine

Conventionally trained physicians all over the world are seeking ways to help their patients move toward optimal health. There is a strong sense among Western health-care providers that pharmaceutical and surgical interventions may not be enough to correct the course of modern diseases, the majority of which are caused by poor lifestyle choices. There is no doubt that under certain circumstances, medications and surgery can be lifesaving; however, medicine often does not get to the root of the problem and acts only as a temporary fix. Increasingly, doctors, physician assistants, and nurse practitioners recommend integrating complementary therapies into regular medical care.

Even without the input of a health-care provider, people are choosing to use supplements, herbs, and treatments that are not considered standard in Western medicine. The National Institutes of Health (NIH) regularly conduct surveys of tens of thousands of adults regarding their use of complementary or alternative medicine; approximately one-third of those surveyed use these therapies. Western practitioners now commonly ask their patients if they are using any other supplements, herbs, or alternative healing modalities. In fact, medical students are now taught to ask these questions as a matter of course, and academic health centers for integrative medicine can be found in such prestigious schools as Harvard, Tufts, Stanford, the University of Toronto, and the Mayo Clinic, to name but a few. Medical students are now learning about other traditional health systems so they can understand how these treatments can be safely integrated into conventional care. Hospitals are also offering non-allopathic healing services. The American Hospital Association released a survey in 2011 demonstrating that 42 percent of their member hospitals provided these modalities, representing an increase from 37 percent in 2007.31

These complementary therapies cover a wide range of options and healing systems. Depending on practitioners’ interests and experience, they may suggest adjunctive Western therapies such as biofeedback, relaxation techniques, massage therapy, health coaching, and lifestyle medicine programs. Or they might consider Ayurvedic medicine that incorporates yoga, meditation, herbs, and dietary therapies based on the patient’s underlying constitution. Yet again, they may refer their patients to a practitioner of Eastern medicine. Like other healing systems, Eastern medicine is composed of various strands: dietary therapy, exercise, qigong, tai chi, meditation, bodywork, herbal formulas, and acupuncture. All these complementary therapies are aimed at improving the physical, mental, and emotional health of the patient and modifying underlying behaviors that contribute to chronic disease.

Many medical practitioners and patients will have preferences regarding which therapeutic intervention to use. After discussing the options, they may decide to stick with one traditional system entirely or mix and match depending on circumstances. For example, someone may respond well to Ayurvedic dietary therapy but have mobility problems and find it too difficult to get down on the floor to practice yoga. That person might do better with tai chi or qigong. Both of these Eastern practices will improve strength and balance as well as provide the preparation for meditation that yoga confers.

We too have our preferences. Our training in both Western and Eastern medicine has shown us that these two systems work extremely well together, and we are not alone. Over the span of two decades, the percentage of Western physicians who have a favorable opinion of Eastern medicine has increased fourfold. In 1998, only 20 percent of respondents held a positive view of Eastern medicine; when the survey was repeated in 2009, that number had exploded to 80 percent!³²

Even the US military has embraced a component of Eastern medicine. In 2007, the US Air Force asked Dr. Joseph Helms, the founding president of the American Academy of Medical Acupuncture, to develop acupuncture protocols to treat conditions commonly found in combat veterans: post-traumatic stress disorder (PTSD) and pain, both acute and chronic. From 2008 to 2013, the US Department of Defense funded medical acupuncture training for hundreds of military doctors under the guidance of Dr. Helms. When this funding was no longer available, Dr. Helms created the Acus Foundation, a not-for-profit charitable organization, to continue training military health-care providers in medical acupuncture. Acus partnered with Nellis Air Force Base, training all the primary care physicians so that any patient could receive an acupuncture treatment at any visit upon request or recommendation. In the first year of this pilot program, opioid prescriptions dropped by 45 percent, muscle relaxant prescriptions decreased by 34 percent, and $250,000 was saved because of fewer referrals to civilian pain-management specialists.³³

Although you may not have access to a primary care provider who is also a skilled acupuncturist, you can rest assured that a great many Western physicians are genuinely interested in incorporating Eastern therapies into conventional medical care. Your doctor may already know a number of reputable practitioners of Eastern medicine and would be happy to refer you. Some patients are reluctant to bring up the topic of incorporating Eastern medicine into their usual treatment plan. They are worried that they will offend their doctors. In this day and age, with all the emerging evidence demonstrating the effectiveness of acupuncture, meditative practices, and lifestyle changes, most physicians are open to adding these strategies to regular care. If your doctor is offended, we respectfully suggest you find a new primary care provider.

You will not know how your doctor feels about integrating Eastern and Western medicine until you have the conversation. As we discussed in our first book, True Wellness, there may be several reasons that your primary care provider has not spoken to you about these modalities. It may be that your doctor doesn’t know whether Eastern medicine would be useful for your particular condition. Or she may not have access to reliable practitioners of Eastern medicine to whom she can send you. Or she may not want to suggest a therapy that might incur additional costs to you if your health insurance doesn’t cover these services. These reasons should not prevent you from discussing treatment options with your doctor.

To have a meaningful discussion, you should come to the appointment prepared. You need to do a little homework. Since the inception of the internet, most physicians are very comfortable with patients who have done some online research about their illness and are happy to go through the downloaded information with you. If you are going to present your doctor with such information, it is important that it has come from reputable sources. The World Health Organization report on acupuncture is a good place to start. You could also search the websites of several prominent medical centers that offer Eastern medical services and see what conditions they commonly treat.

You should call your health insurance company to see whether Eastern medical services are a covered benefit and, if so, which providers are in the network. If this option is unavailable to you, you can cover the expense yourself, understanding that within three to five treatments you will know whether they are beneficial. If you live near a school of Eastern medicine, there will be a community clinic where you can receive care for a reduced cost.

Now that you have determined for yourself whether Eastern medicine is a suitable modality for your condition and how you can access that care, you will feel more comfortable broaching the subject with your doctor. Generally, the situations in which patients explore options outside of biomedicine are those in which the patient is not improving. In cases where the problem is acute, Western treatment options usually solve things quickly. For patients with chronic conditions, healing may be slower and require greater effort on the part of the patient and the physician. This is particularly true for patients who suffer from anxiety, depression, or sleep difficulties. Often both parties become frustrated with what appears to be a lack of progress. Eastern medicine is well suited to treating people in such circumstances. As we have mentioned previously, some patients do worry that their doctor would be offended at the suggestion of a complementary therapy but, in truth, that rarely happens. In our experience, most Western practitioners are interested only in their patients’ well-being and are delighted at the prospect of successful treatment through Eastern medicine.

Occasionally, in difficult cases where a patient has not improved with conventional treatments, a physician may feel a sense of failure or embarrassment that she has not been able to help that person sufficiently. Following an honest and respectful discussion of Western and Eastern treatment options, often doctors and patients alike are relieved that a new plan has been formulated. Although the Western physician may not be administering the Eastern treatment herself, she would still be a part of your health-care team and would certainly do her best to facilitate this new aspect of your care where possible.

Finally, it is very important that you keep your doctor aware of any non-allopathic treatments that you are undergoing. Even if you have decided on your own to seek the help of an Eastern medical practitioner, your Western doctor needs to know this, particularly if you are taking any herbs or supplements. Many medications can interact with herbs, supplements, and foods, leading to dangerous situations in which the actions of drugs are either accentuated or diminished, resulting in medical complications.

Keep in mind that acupuncture and herbs, while extraordinarily effective, are not the only components of Eastern medicine. Acupuncture and herbs are treatments given to you by a skilled professional. But healthy food, moderate exercise, and a quiet mind are the foundation of Eastern medicine as well as many other healing traditions. Although both your Western and Eastern health-care providers can offer you encouragement and effective strategies for improving your physical and emotional well-being and sleep, only you can enact these changes to achieve optimal health.