8

East Meets West

How to Use Modern Western Medicine and Traditional Eastern Medicine to Heal and Enjoy a Better Quality of Life

I’M A Board-Certified Cardiologist and a biomedical scientist. From my medical training and experience as a doctor, I hold a long-standing faith in the value of what we call Western medicine. But, since my spinal cord injury, I’ve learned that there are tremendous benefits to be found in Eastern (or Asian) medicine and complementary medicines and therapies.

The story behind my knowledge of Eastern medicine is one of friendship, compassion, and medical brilliance. It begins with Dr. Guoyong Yin, an orthopedic surgeon from Nanjing, China, who was a research fellow in my laboratory. In 2010, Dr. Yin introduced me to Dr. Jianan Li, the President of the Zhongshan Rehabilitation Hospital in Nanjing, China. Dr. Li told me that I had made an excellent recovery, but he thought that I could make much more progress if I devoted more time to rehabilitation and less time to being a CEO. He offered me the opportunity to stay in Nanjing for three to six months to perform intense rehabilitation for six hours daily. After I stepped down as CEO, Dr. Li and I discussed a rehab program, and he arranged for me to stay for six weeks in the fall of 2017.

My time there was the most profound healing experience to date. The rehabilitation approach was what we call integrative medicine: Western medicine combined with complementary medicine. In my case, traditional Chinese medicine (TCM) was the complementary approach.¹ The success of this approach involves the following:

• A holistic understanding of you as a person and a focus on using your strengths to improve function through complementary therapies, especially massage and acupuncture

• The technique of improving one movement and the muscles necessary for that movement, which translates into significant improvements in other movements and muscles

• An approach that focuses on improving physical function, especially walking, to improve sensation

The Chinese Diet

It should be noted that significant changes in my diet occurred while I was in China, most notably an increase in fish consumption and a decrease in processed carbohydrates (bread, cereal, pasta, and other baked goods). These changes altered the composition of my gut microbiome (the bacteria that live in the colon and are responsible for the strength of the immune system), which led to a number of beneficial effects on my health.

The Chinese diet’s role in optimal health became widely known in 2006 after the publication of The China Study,² by T. Colin Campbell and Thomas M. Campbell (updated in 2016³). From huge studies conducted in China and Taiwan, they concluded that the typical American diet had too much protein and fat. They emphasize following a whole-food plant-based diet, with no processed foods or supplements. Although it advocates for a predominantly plant-based diet, The China Study also recommends seafood as an excellent source of protein. Significant research supports that advice; omega-3 fatty acids found in wild-caught ocean-dwelling fish are beneficial to the heart and brain.⁴ A recent randomized trial showed, in patients with elevated triglyceride levels, the risk of CVD events was significantly lower among those who received 2 g of icosapent ethyl, a purified fish oil.⁵ Plus, research shows that meat-derived proteins undergo metabolism in the gut that produces toxic products (e.g., trimethylamine N-oxide, TMAO) that can harm some of the body’s organs, especially blood vessels in the heart and brain.⁶

Integrative Medicine

Integrative medicine refers to the use of conventional Western medicine in tandem with complementary medicine. This is different from complementary and alternative medicine (CAM), which includes use of alternative medicine in place of Western medicine. Examples of complementary medicine include acupuncture, acupressure, Ayurveda, aromatherapy, massage, and meditation.⁷ Examples of alternative medicine include many elements of traditional Chinese medicine (TCM), such as mixtures of various plant and animal materials specific to that tradition given as pills, tinctures, creams, and other topical formulations. I’ve found the most success in combining Western conventional medicine with complementary medicine, but you may want to experiment to see what works best for you.

The fact that more than 50 percent of Americans now use some type of CAM on a routine basis indicates just how mainstream Eastern medicine has become in the US.⁸ And, within the ANI population, the rate of CAM use is even higher than in the general population.⁹ So, if this is all new to you, be assured that many others find benefit from these approaches to healing.

Eastern and Western Philosophies

The philosophy of TCM assumes that the forces, which govern the cycles of change in the external world are duplicated within our bodies and minds. TCM emphasizes the importance of understanding the laws of nature and abiding by these laws rather than resisting them. The human body is regarded as a microcosmic reflection of the universe. The goal of TCM is to maintain the body’s harmonious balance both internally and in relation to our environment.

TCM focuses on mechanisms in the human body that regulate function. Western philosophy approximates Eastern philosophy in its approach to the mind, which requires two actions of faith. First, the mind is the seat of thought that arises from the brain’s activity. The development of functional MRI has enabled us to see which parts of the brain become active when you think. Simple thoughts, like move my finger, activate a small amount of the motor cortex that controls the nerves in your hands. More profound thinking, especially with an emotional component, activates many more areas of the brain. Second, the mind exists outside of sensory perception. This means that there’s no physical manifestation of the brain that you can sense (headaches don’t count). The mind represents the highest level of human intellect and is the source of questions regarding the existence of mankind and the universe. This has led to an experimental approach to understanding the forces that control our world, which can be used to control the body’s interactions with the world. Over the last 150 years, medicine has been profoundly affected by an approach in which each disease is reduced to a single cause that may be treated with a single drug. A classic example is streptococcal pneumonia, for which treatment with penicillin dramatically improved recovery from what had previously been a fatal illness.

Traditional Chinese Medicine (TCM)

Eastern medicine, particularly TCM, observes and describes the functions of the body based on the harmony between humans and nature, as exemplified by the concept of qi. The three most important concepts in TCM are qi, yin/yang, and five elements.

• Qi is frequently translated as vital energy. It is believed that it permeates all things, can assume different forms, and travels through channels (or meridians) in the body. When a person’s qi is described as stagnant, depleted, collapsed, or rebellious, TCM is used to restore positive energy. A skilled TCM practitioner determines the nature of a patient’s problem and prescribes acupuncture, herbal medicines, massage, meditation, and other therapies to restore balance and maximize qi.

• Yin and yang are complementary opposites—light and dark, good and bad, noisy and quiet, strong and weak, and so on—that describe all things in nature. Yin represents the more material, dense states of matter, while yang represents the immaterial, more rarefied states of matter. TCM therapies seek to restore the balance of yin and yang.

• Five elements (wood, water, fire, earth, and metal), along with yin and yang, form the basis of Chinese medical theory. Each of these elements can generate or counteract another element. Most vital organs, acupuncture meridians, and emotions are assigned an element, providing a global description of the person’s overall health as measured by the strength and symmetry of their qi.

Traditional Chinese Medicine (TCM) Therapies for ANI

Acupuncture, a key component of TCM, involves the insertion of thin, sterile metal needles into specific locations (acupoints) located on fourteen main energy channels (meridians) distributed throughout the body.¹⁰ These meridians are associated with specific organs, like the liver (Figure 15). There are fourteen acupoints in the liver meridian, which extends from the groin to the liver, and then from the liver to the nipple, and ultimately to the right ear.

Acupuncture treatments are customized for each individual, meaning that two patients with the same injury will often receive different treatments. I found that acupuncture was effective for pain relief of my right arm and shoulder, which had experienced complex regional pain syndrome (CRPS) for many years. Clinical studies have shown that acupuncture is useful for four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.¹¹ You may also choose to seek out acupuncture if you have CRPS, neuropathic pain, and problems with bladder and bowel function.

Figure 15. Diagram of Meridians

Massage

The two major effects of massage that are consistent in clinical trials are a decrease in pain and a decrease in muscle soreness after exercise. The most likely mechanism for decreasing pain is based on the gate control theory, which states that pressure signals are transmitted faster than pain signals, thus closing the pathway for pain signals to the brain.¹² The decrease in muscle soreness is probably due to the ability of massage to increase flow through arteries, veins, and lymphatics. Increased blood and lymphatic flow should reduce inflammation, according to multiple reviews of massage clinical trials, which show decreased biomarkers of muscle damage and inflammation.¹³ The utility of massage for pain reduction may be greater with some massage techniques, especially those that increase blood flow, and hence decrease the stimuli for inflammation. I recommend that you try several types of massage and several practitioners to find the combination that works best for you.

The most common styles of massage include the following:

• Pressure-point techniques (also referred to as shiatsu, trigger point, and acupressure), which most closely resemble the types of massage found in China. A massage technique that is popular in TCM but little known in the US is tui na. Tui na uses rapid tapping with the thumb to loosen tendons and muscles, as well as kneading, rolling, pressing, and rubbing. There are other types of massage that you can try, each with its own “style.”

• Swedish massage (long, gliding strokes; kneading)

• Deep-tissue massage (such as Rolfing and Hellerwork)

• Craniosacral therapy (gentle touch to the joints of the skull)

• Neuromuscular massage (digital pressure and friction to release areas of strain in a muscle)

I’ve found massage to be the most valuable complementary therapy—so much so that I go twice weekly for a one-hour session. Pressure-point massage techniques work best for me, and my home health aides use an electric massage tool to relax my shoulders and arms during the day and before I go to bed.

The massage therapist is frequently more important than the type of massage. Most states have license or certificate programs that establish a certain level of knowledge and expertise, and I encourage you to check the therapist’s credentials. Ask the massage therapist to explain the anatomy of your problem and their approach to it. People with ANI have many of the same problems as nondisabled people, so you need not necessarily seek out a specialist—an excellent massage therapist will be just as excellent for you.

Meditation and Mindfulness

Meditation and mindfulness have origins in multiple medical philosophies and are now used universally (see chapter 4 for more). Clinical trials show that both meditation and mindfulness promote overall health by increasing calmness and reducing stress (see chapter 2). These techniques can benefit everyone—whether you’re healthy, injured, or ill. And if you’re living with an injury, they can be a powerful part of your healing and improving your quality of life.

Mindfulness is the practice of maintaining complete awareness of one’s thoughts, emotions, and experiences on a moment-to-moment basis. It’s a simple tool you can use throughout your day. Mindfulness promotes clear thinking, compassion, and open-mindedness. Multiple studies show significant benefits of mindfulness to decrease chronic pain.¹⁴ Among possible mechanisms are greater perceived control of pain that results from a decreased emotional response to pain.¹⁵ An easy approach to mindfulness is the three-element practice of “Pause, Presence, Proceed” popularized by the University of Wisconsin.¹⁶

Pause: Stop and take a breath.

Presence: Make yourself aware of what is happening in your environment, focusing on body sensations, thoughts, and emotions.

Proceed: Communicate with those around you using compassion and positive words to address the issues that you became aware of while practicing presence.

Meditation involves engaging in mental exercise for the purpose of reaching a heightened level of awareness. While there are many forms of meditation (religious, self-realization, transcendental, Tibetan Buddhism, and Zen Buddhism, among others), practices share many common features, so your choice will be determined by your relationship with your teacher and/or which meditation practices you find most beneficial. Meditation has myriad health benefits, especially for cardiovascular health.¹⁷ It has been shown to lower blood pressure, decrease biomarkers associated with heart attacks, improve cardiac function related to coronary artery disease, and provide positive effects on biopsychosocial measures: biological (physical and mental health), psychological (mood, personality and behavior), and social (culture, family and socioeconomic).¹⁸

The process of starting meditation has an easy mnemonic¹⁹: SOLAR.

Stop: Find a quiet place where you will not be disturbed for at least five minutes; pause and begin.

Observe: Pay attention to what is happening moment by moment.

Let it be: Let everything be as it is without reacting to it or trying to change it.

And Return: Come back to the present moment, remembering to pause, breathe, and feel.

My Meditation Practice

I meditate every morning before I get up to start the day. I usually wake at 7:00, and my home health aide comes in at 7:15, so I have fifteen minutes to meditate and then perform a few physical exercises. Once I’m fully awake, I take a survey of my entire body, feeling how all of my limbs are lined up and making sure that I’m in a comfortable position. Then I imagine myself in a state of complete relaxation, almost floating. At the rehab facility, I would do this outdoors, reclined in my wheelchair. I would watch the clouds float by in the sky, feel the wind against my face, and listen to the sound of the leaves moving in the trees. Now, I watch the trees and sky through our big bedroom window and listen to the sounds of the wind and my house. I focus on breathing and the phrase let it be, because I find this relaxes me the most. I stop when my inner clock lets me know that seven or eight minutes have gone by. This seemingly simple daily practice allows me to begin my day with a sense of relaxation and clarity. You may be thinking, I don’t have time for that, but I assure you, you do. And it will be time well spent. Once meditation becomes a habit, you won’t want to skip it.

Yoga and Tai Chi: Mind/Body Therapies

In the United States, yoga is by far the most widely practiced of the Eastern mind/body practices. Modern yoga, which originated in India, has three main components: postures/poses (asanas), breath control (pranayama), and meditation (samyama). Poses range from simple stretching positions to more complicated, difficult postures. Breath control is slow, deep, diaphragmatic breathing that helps you achieve a state of relaxation.

There are many reasons why people practice yoga, but for the vast majority, it’s simply one part of a healthy lifestyle. Many studies have investigated the health benefits associated with yoga. Most randomized controlled studies that compare yoga with no intervention or treatment as usual find statistically significant benefits in several domains. These include physical health, decreased stress, improved quality of life, reduced pain, and improvement in symptoms of many diseases. However, when compared to exercise, the benefits from yoga are about the same, suggesting that you should choose whichever activity you enjoy more. In terms of pain, there’s strong evidence that yoga can decrease pain, especially low back pain.²⁰ Despite the limitations in physical movement associated with ANI, yoga can be an important component of rehabilitation. The key is to use modified poses and props, as described in Iyengar yoga, like pillows, blankets, and bolsters to enable therapeutic yoga exercise.

Overall, the studies of yoga for ANI show improvements in strength, flexibility, and relaxation.²¹ However, for neuropathic pain, there are limited data on the use and effectiveness of yoga. Matthew Sanford, a noted yoga teacher and person with an SCI, says that performing yoga reunites the mind-body connection and, in so doing, decreases pain, including neuropathic pain.²² It should be noted, however, that some of the yoga positions are quite difficult for ANI survivors to perform and may cause injuries, especially to muscles and ligaments. Therefore, I recommend that you start with Iyengar yoga.²³ Check with your therapy team about which poses would be safe for you to try.

Tai chi involves dancelike movement and martial arts movement in conjunction with mindfulness. There are many styles of tai chi, just like yoga, so they both have universal appeal. Both activities occur in classes and so provide an opportunity for significant social interaction. Which activity you choose is a personal preference (and you can do both if you want to!).

Herbs and Supplements

Over the last ten years, the most commonly used CAM therapies have been herbal and dietary supplements, with expenditures of $12.8 billion for nonvitamin, nonmineral natural products.²⁴ There are hundreds of commonly used herbs derived from traditional Chinese medicine. They’re often available in grocery stores, pharmacies, and health food stores; common herbs include ginseng, ginkgo, wolfberry, astragalus, cinnamon, curcumin, ephedra, ginger, peony, and salvia. Unfortunately, some of these natural products can be unhealthy, especially at higher doses. For most CAM medicines, efficacy and toxicity are based on traditional knowledge rather than laboratory analysis. Because the amounts of active chemicals are often not listed on the medicine bottles, and there’s no way to know the exact preparation, it’s difficult to take the same dose each time and expect the same effect. This is particularly problematic if you switch from one manufacturer to another; the same CAM herb or supplement from a different source might have twice as much active ingredient per pill, leading to a toxic overdose.

Medicines derived from plants are used in Western medicine as well, and many have been with us a long time; aspirin was originally found in the bark of willow trees, and the first statin drug to lower cholesterol was found in rice. Unfortunately, using TCM medications can place you at substantial risk for harm, because of poor quality control of ingredients and manufacturing. Also, there are few clinical trials that show significant benefit compared to placebo. For these reasons, I don’t recommend TCM supplements. You may find that your doctor can guide you in a careful use of them. If so, the subject is worthy of a thorough discussion.

 

Everything You Need to Know

Thoughtful integration of aspects of traditional Eastern medicine with Western medicine have greatly enhanced my recovery. As you explore the various options available to you, here’s what you need to know:

• Integrative Medicine (the combination of Western medicine with traditional Eastern medicine/therapies) offers many benefits as you continue your recovery.

• Several traditional Chinese medicine (TCM) treatments are known to benefit health, most notably acupuncture, massage, and tai chi. All can decrease pain and promote nerve and muscle recovery.

• Adopting the Chinese diet, which emphasizes a whole-food plant-based diet and decreased animal protein (except for seafood) can improve your overall health.

• Meditation and mindfulness are practices that promote clear thinking, compassion, and physical relaxation—all beneficial as you work through rehabilitation therapies.

• Yoga has been shown to decrease pain, especially lower back pain.

• There are hundreds of herbs and supplements in the United States, many of which are derived from traditional Chinese medicine. Because there is no standardization of ingredients and frequently no quality control in manufacturing, they pose a substantial risk for harm, so talk to your doctor before use.