Integrating Medicine with Women Health

Bindi Zhu, M.D. (China) Ph.D. and Ileana Bourland, MSOM, Lic.Ac.

Dr. zhu' Speech at Women Partners in Health

1.    Today we'll talk about integrating Chinese and western medicine. In the past couple of years alternative and integrated medicine has received more and more media attention. Just last week Time magazine featured one of the pioneers of integrated medicine, Andrew Weil, was on the cover. He studied at Harvard and did research in South American looking for medicinal plants. Many of you have probably already read many of his books and articles.

2.    Conventional medicine and Chinese medicine work so well together because their strengths are almost diametrically opposed. Like a good marriage, each partner should complement each other's strengths and weaknesses while maintaining the same goals, in this case, good health.

3.    You are all familiar with western medicines strengths. I'll mention a few of them: trauma, medical and surgical emergencies, fungal, bacterial, and parasitic infections, replacement of damaged hips, knees, bones and other articulations, and cosmetic and reconstructive surgery.

4.    Let's talk about Chinese medicine and how it's different from western medicine:

a.    One of the main things we talk about in Chinese medicine maintaining the body's relative balance, or balancing the yin and yang. Although certain syndromes have some characteristics in common, you have probably seen that each person has their own unique way of presenting symptoms. In Chinese medicine it's very important take into account the individual's unique constitution when making a diagnosis.

b.    The ancient Chinese medical doctors concentrated on identifying how the body functions and how those functions depend on each other. Chinese medicine treatment modalities stimulate the body's natural healing potential by treating root causes of dysfunction, rather than just symptoms.

c.     Another important concept we talk about in Chinese medicine how to boost the immune system. We try to strengthen the body's natural defenses to enhance the body's ability to maintain and heal itself. We use Chinese herbs to do this. Recent research indicates that many of these herb have large amounts of anti-oxidants. For example, gou qi zi, also known as wolfberry and Lycium Barbarum, has the highest ORAC (oxygen radical absorbance capacity) value of any other food by volume.

d.    In many ways, western and Chinese medicine come from two very different points of view. Chinese medicine originated from experimentation with medicinal substances from animal, plant, and mineral sources and pressure points, that is, exact three-dimensional points of varying sizes located subcutaneously called acupuncture points. Empirical evidence collected from these experiments combined with Daoist and Confucian philosophy produced the body of knowledge that today we call Traditional Chinese Medicine or TCM.

e.    Daoism's influence extends not only to Chinese medical theory, but also to its practice. It recognizes the limitations of coercive power and encourages “leading, not dominating,” much the same way an acupuncture needle guides Qi or an herbal formula supports the immune system to fight off disease.

f.      In China, acupuncture is a small part of traditional Chinese medicine. Herbal medicine is used more and, often, in combination with western pharmaceuticals. China has taken traditional Chinese medical philosophy and uses it side by side with western medicine in hospitals today. If you go into any hospital in China you will see these two systems used together, seamlessly. Chinese medicine is not considered "alternative medicine" in China but is a mainstream system that plays an important role in providing health care alongside Western medicine. Maybe someday we’ll adopt a system similar to this one.

g.    This idea seems to be spreading to the West where 94 per cent of the 125 United States medical schools reported offering selective courses in complementary or alternative medicine. In Austin we don't have a medical school, but we have a students who come up from the University of Texas medical school at Galveston for interenships at my clinic.

5.    Although Chinese and conventional medicine appear very different on the surface, in many situations they work very well together. More and more scientific studies are being authored in the West to support the large body of research already available in the East.

6.    What other kinds of problems does acupuncture help? Many, including women's health issues:

a.    Traditional Chinese medicine (TCM) recognizes womens’ health issues as pattern-related syndromes. Instead of treating symptoms, the root cause is addressed by treating each person as a whole. Women using TCM typically experience a dramatic improvement in all their symptoms whether they deal with infertility, endometriosis, PMS, ovarian cysts, or menopause.

b.    Low back pain during pregnancy:

                                               i.     Several studies show the efficacy of acupuncture and auricular acupuncture to treat lower back and pelvic pain during pregnancy.

                                              ii.     Yale University is currently conducting an NIH-funded study that will last three years using ear acupuncture for lower back pain during pregnancy.

                                            iii.     In 2004 JAMA published a study from Brazil where acupuncture was used to relieve back pain during pregnancy. Average pain reduction in the study group decreased by at least 50 per cent over time and only decreased 15 per cent in the placebo group. The researchers reported the use of paracetamol was also lower in the acupuncture group. These results indicate that acupuncture seems to alleviate lower back pain and pelvic pain during pregnancy, as well as to increase the capacity for some physical activities and to diminish the need for drugs, which is a great advantage during this period. (Guerriero da Silva 2004)

                                            iv.     You'll find a list of these studies on the page of references.

c.    Labor pain/induce labor

                                               i.     In a study using electro-acupuncture a significant increase in frequency and strength of uterine contractions was found in the electrically stimulated women compared with the placebo-group women. Subjects were randomly assigned to either a treatment condition, consisting of the application via surface electrodes of a 30-Hz current to the points "spleen 6" (lower leg) and "liver 3" (foot), or a placebo condition, in which the equipment was attached but not activated. (Dunn 1989)

d.    Breech presentation

                                               i.     In November of ’98 JAMA published a study where moxibustion was used to correct breech presentation. After 1 to 2 weeks of daily treatments with moxibustion 75 per cent of the fetuses in the intervention group were cephalic versus 48 per cent of the control group. (Cardini 1998)

                                              ii.     In 2004 an Italian group of researchers found that the proportion of cephalic version was lower in the observation group, where 36 per cent of the infants were cephalic at delivery, than the active-treatment group, where 55 per cent were cephalic. (Neri 2004)

e.    PMS

                                               i.     The success rate of AP in treating PMS symptoms was 77.8%, whereas it was 5.9%. in the placebo group. The positive influence of AP in treating PMS symptoms can be ascribed to its effects on the serotoninergic and opioidergic neurotransmission that modulates various psychosomatic functions. (Habek 2002)

f.    Dysmenorrhea

                                               i.     Acupressure at Sanyinjiao (Spleen 6) has been shown to be very effective in reducing primary dysmenorrhea. (Chen 2004)

                                              ii.     A study in 2003 used acupuncture to treat primary dysmenorrhea. 93 per cent of the women who received acupuncture either did not have reoccurance of primary dysmenorrhea, no longer needed medication for the condition or did not experience symptoms 2 years after the acupuncture treatment compared to 4 per cent of the women who used sham acupuncture. (Habek 2003)

g.    Menopause

                                               i.     In China, most menopausal women use Traditional Chinese Medicine (TCM), particularly Chinese herbs, instead of hormone therapy. A history of long-time use and thorough documentation make it the treatment of choice for these menopausal women.

                                              ii.     The treatment protocol for reclaiming this hormonal balance ties in to the individual's personal constitution, immune system, stress level, emotions, and other illnesses. For example, although many women may come into the clinic diagnosed as menopausal, each may demonstrate a different combination of possible symptoms. Some typical symptoms include hot flashes, night sweats, palpitations, insomnia, heavy menstrual flow, dryness, alternating chills and fever, mood swings, depression, poor memory etc.

                                            iii.     The benefits of using Chinese herbal medicine seem great when compared to possible side effects from hormone replacement therapy.

h.    Infertility

                                               i.     When discussing female infertility, in Chinese medicine we describe the hypothalamic-pituitary-ovarian axis as a responsibility of the Heart, Liver, Kidney, and Uterus[1] organ systems. These systems are responsible for fertility, pregnancy, and the regualation of the menstrual cycle.

                                              ii.     Traditional Chinese medicine considers the Kidney the foundation of fertility. Its main functions are to "store essence, dominate human reproduction and development, dominate water metabolism and the reception of qi, produce bone marrow to fill up the brain, dominate bone, manufacture blood, manifest in the hair, [and] open into the ear."[2]

                                            iii.     Chinese medicine prepares the body for conception by bring it back in to balance. For different women this might mean fine tuning and regulating the menstrual cycle, raising low sperm count and motility, correcting hormonal imbalances, eliminating immune system incompatibilities, easing tubal obstructions, relieving stress-related dysfunction, reversing ejaculatory defects and correcting erectile dysfunction.

i.    Morning sickness

                                               i.     Acupuncture and acupressure are very effective nonpharmacologic methods for the treatment of hyperemesis gravidarum for morning sickness.

                                              ii.     Habek showed in 2004 the efficiency of the morning sickness treatment with acupuncture of Pc 6 was 90%, with acupressure of Pc 6 was 63.6%, with placebo "sham" acupuncture 12.5%, and with placebo acupressure 0%. CONCLUSION: Acupuncture (p < 0.0001) and acupressure (p < 0.1) are. (Habek 2004)

j.    Migraine

                                               i.     Migraine is a typical "women's disease": the fluctuations of sex hormones, in particular estrogens, during woman's reproductive life show a direct and major influence on migraine course. Even if during pregnancy a high percentage of migraineurs report an improvement of symptomatology, it is still controversial how to manage migraine crises occurring during pregnancy, considering that almost all drugs are partially or totally contraindicated during gestation. (Allais 2003)

                                              ii.     JAMA reports in 2005 that the Centre for Complementary Medicine Research in Munich, Germany, conducted a study on migraine headaches where acupuncture was found to reduce the number of days participants had headaches by 50 per cent when compared to the control group. Their headaches were reduces by 15 per cent. (Linde 2005)

k.    Irritable bowel syndrome

                                               i.     Besoussan et al showed in 1998 that irritable bowel syndrome responds well Chinese herbal medicine. In 1998, JAMA reported a study where patients were divided in to 3 groups: individualized Chinese herbal formulation, a standard Chinese herbal formulation, and a placebo group. Those who received Chinese herbal medicine had significant improvements in bowel symtom scores as rated by patients, compared to those in the placebo group. On follow-up 14 weeks later after completion of treatment, out of those three groups only the individualiazed Chinese herbal medicine group maintained improvement. (Bensoussan 1998)

References

Allais G, Bosio A, Mana O, Airola G, Ciochetto D, Terzi MG, De Lorenzo C, Quirico PE, Benedetto C. Migraine during pregnancy and lactation: treatment of the acute attack and non-pharmacological prophylactic strategies. Minerva Med. 2003; Aug;94(4 Suppl 1):27-38.

Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial. JAMA. 1998; 18: 1585-9.

Cardini F, Lombardo P, Regalia AL, Regaldo G, Zanini A, Negri MG, Panepuccia L, Todros T. A randomised controlled trial of moxibustion for breech presentation. BJOG. 2005; 6:743-7.

Cardini F, Weixin H. Moxibustion for Correction of Breech presentation: a randomized controlled trial. JAMA. 1998; 18:1580-4.

Chen HM and Chen CH. Effects of acupuressure at the Sanyinjiao point on primary dysmenorrhoea. J Adv Nurs. 2004; 4:380-7.

Coyle ME, Smith CA, Peat B. Cephalic version by moxibustion for breech presentation. Cochrane Database Syst Rev. 2005; 2:CD003928.

Cummings M. Acupuncture for low back pain in pregnancy. Acupunct Med. 2003; 1-2:42-6.

Dunn PA, Rogers D, Halford K. Transcutaneous electrical nerve stimulation at acupuncture points in the induction of uterine contractions. Obstet Gynecol. 1989; 2:289-90.

Habek D, Barbir A, Habek JC, Janculiak D, Bobic-Vukovic M. Success of acupuncture and acupressure of the Pc 6 acupoint in the treatment of hyperemesis gravidarum. Forsch Komplementarmed Klass Naturheilkd. 2004 Feb;11(1):20-3.

Habek D, Cerkez Habek J, Bobic-Vukovic M, Vujic B. Efficacy of acupuncture for the treatment of primary dysmenorrhea. Gynakol Geburyshilfliche Rundsch. 2003; 4:250-3.

Habek D, Habek JC, Barbir A. Using acupuncture to treat premenstrual syndrome. Arch Gynecol Obstet. 2002; 1:23-6.

Kemper KJ, Sarah R, Silver-Highfield E, Xiarhos E, Barnes L, Berde C. On pins and needles? Pediatric pain patients' experience with acupuncture.  Pediatrics. 2000; 105:941-7.

Forrester M. Low back pain in pregnancy. Acupunct Med. 2003; 1-2:36-41.

Guerreiro da Silva JB, Nakamura MU, Cordeiro JA, Kulay L Jr. Acupuncture for lower back pain in pregnancy—a prospective, quasi-randomised, controlled study. Acupunt Med. 2004; 2:60-7.

Jones AE. Managing the pain of primary and secondary dysmenorrhea. Nurs Times. 2004; 10:40-3.

Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J. Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Scand. 2004; 3:246-50.

Linde K, Streng A, Jurgens S, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. 2005;17:2118-25.

Neri I, Airola G, Contu G, Allais G, Facchinetti F, Benedetto C. Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.  J Matern Fetal Neonatal Med. 2004; 4;247-52.

Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slotnick RN. A randomized controlled trial of nerve stimulation for relief of nausea and vomitting in pregnancy. Obstet Gynecol. 2003 Jul;102(1):129-35.

Ternov NK, Grennert L, Aberg A, Algotsson L, Akeson J. Acupuncture for lower back and pelvic pain in late pregnancy: a retrospective report on 167 consecutive cases. Pain Med. 2001; 3:204-7.

Wedenberg K, Moen B, Norling A. A prosepective randomized study comparing acupuncture with physiotherapy for low-back and pelvoc pain in pregnancy. Acta Obstet Gynecol Scand. 2000; 5:331-5.

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