Ally not adversary...

Acupuncture and Western medicine...

My education has been eclectic. My first schooling took place at a tiny private school in a rural county nestled on the morning side of the Blue Ridge. The headmaster was simultaneously obsessed with classical education and corporal punishment. It was a small weird place.

Every year, we would have Classical Day. This involved coming to school in a toga (required), participating in foot races and javelin throwing (optional) and attending the slave auction (required). Available currency was predicated by grades in Latin and Greek (I took both) and failing grades gave slave status. This is how I purchased my classically-impaired boyfriend at a slave auction. Did I say it was weird? It was the 80’s.

Those of us who graduated this classical version of the Hunger Games have become, in spite of this rough start, a good group of accomplished folks. One compatriot from this time is now a skilled doctor, dedicated both to his craft and his patients. Recently, he asked me to sum up what acupuncture might have to offer his patients. This led to considering how acupuncture is perceived by Western medical professionals in general.

Some doctors are willing to concede that acupuncture has helped their patients. Others consider it quackery at best¹, and view acupuncturists as dangerous distractions rather than allies in their patients’ healthcare.

As an acupuncturist, I am your ally. The starting point for this foray will be my standard questions in the initial acupuncture consultation.

“Who is your primary care?”

As a practitioner of East Asian medicine, I want my patients to have a primary care doctor. I want a medical professional tracking their health from a Western perspective. Even if the person is ‘healthy’, seeking acupuncture as added benefit, I want to know they have a doctor ordering blood work and checking vitals. While anyone can order bloodwork off the internet, the average human does not have the know-how to interpret it. No, AI is not a viable alternative to medical care. If the patient is medicated therefore grappling with a chronic condition, this is vital. At this point, I also check in with the person’s relationship with their doctor. Are they happy with it? Unhappiness with your medical provider is not an acceptable reason for not seeing them. Find another one.

We then start discussing the health concerns that have brought them to acupuncture. At its simplest, people come to acupuncture because they want to feel better. They are often on multiple medications and express the desire to reduce dosage or eliminate them.

“Have you discussed this with your prescriber?”

I do not prescribe. This is not my scope of practice. While acupuncture can be supportive in reducing or eliminating medications, changes in dosage are outside my realm and require supervision from the prescriber. With acupuncture, I have assisted folks to reduce or eliminate a variety of medications, ranging from Vicodin to Lisinopril, as well as over the counter items like PPI’s. Anything prescribed is always managed from the prescriber end, not by me. And I make that clear. We also discuss how to have this conversation with their prescriber.

“I want to get off my blood pressure medication.”

“Why? are you experiencing side effects? What are they?

No, I just don’t like medications.

I have a lot of conversations about trade-offs. As in, there is no free lunch. Yes, there are side-effects to blood pressure medications. Compared to the side effects of uncontrolled high blood pressure, the choice is clear- take the bloody medication.

Are you taking your blood pressure daily? And keeping a record of it?

Telling your doc you want to lower blood pressure meds is not enough (nor should it be). However, should you present them with a record of regular blood pressure readings, thus demonstrating a level of personal responsibility, they will take it seriously and if needed, adjust dosages. I take blood pressure readings (both arms) in the initial consultation. This occasionally leads to my saying the following statement.

“Your blood pressure is high. I need you to sort this out with your doctor before starting acupuncture.”

There is a cadre of Western medicine avoidants who end up in acupuncture looking for help. The last thing they expect is for me to send them to a doctor. Sorry, folks- it happens. And more often than one might expect…

“What supplements are you taking? And please tell me why you started taking them and how long you’ve been taking them. Followed by “Do you feel they are helping you?”

Medical professionals rail against Doctor Google, my beef is with the internet in general. It’s a minefield out there, people. I have decades of study and experience with Western herbs. Yet when I Google search an herb, the result isn’t just garbage, it’s garbage cut and pasted a thousand times. Yes, there is some good info out there in the ethers. But without some background in the field, it is challenging to separate the wheat from the chaff. The world of supplements is just as cuckoo.

Sidenote- if the internet or Instagram tells you that acai or goji berries or berberine is going to solve ALL your problems, this is a marketing , not medicine.

I separate both herbs and supplements into two categories- daily drivers and ‘do you know what you’re doing?’ B complex, taken in the morning, is an example of a decent daily driver. B vitamins support proper functioning of the body’s methylation cycles. It’s water soluble- you will eliminate any not used by the body. B complex is preferable to supplementing single B vitamins (like B12) and more reliable than multivitamins (most are crap). In contrast, melatonin is a widely used supplement in the ‘do you know what you are doing’ category.

“Are you aware that melatonin interacts with medications?”

Melatonin is the only hormone sold over the counter. HORMONE. Tread carefully. Dosage is important. Studies indicate that listed content of melatonin supplements varies dramatically from what is shown on the label.² Melatonin affects the immune system differently depending on the dosage. This is not to be played with either with adults or children. Especially with children given the potential effect on the HPG axis.

Because melatonin has potential interactions, my recommendation as an acupuncturist to my patients is that they address the lifestyle choices affecting melatonin production rather than bandaiding via supplementation. And to talk with their prescriber or pharmacist about possible interactions.

I also want to know why someone is taking a particular supplement. Bright idea? Recommendation from a functional medicine doctor? “It seemed like a good idea” is not good enough. And I want to know that they are benefiting from it. I have no financial interest in this game as I do not sell supplements. If a patient is taking a vitamin or herb, there needs be some benefit from it. Take probiotics, for example. We know about as much about them as we do the surface of the Moon. As in, we know a little but not a lot. I have frequently encountered patients with recent onset of mild complaints- digestive disorder, bloating, weight gain. And can often trace it to the probiotic they started 3 weeks ago. Probiotics can raise or lower histamine levels (some are histamine neutral). Probiotics aren’t good or bad, they are just complex. And the fact that they can be grabbed off the shelf from Walmart (please don’t) doesn’t make them safe or clearcut. Which leads to one of my favorite tiny soapboxes…

Gummy vitamins are not vitamins. They are weird gummy bears that could be dangerous to overindulge in. Especially if there are small children in the house…

Whoever came up with the gummy vitamin idea is a genius. An evil late stage capitalist genius who only cares about profits, but still a genius. If you like gummy bears (I do), eat gummy bears. In moderation. I also counsel my patients not to source their supplements from drugstores, big box stores, grocery stores or Amazon. Invest your money wisely in a supplements that are well made, standardized and preferably do not contain magnesium stearate (filler- why are we paying for filler!?!?). Or titanium dioxide to make it pretty and white or propylene glycol to defrost your internal winter windshield (you don’t have one). If they are currently on a medication that negatively affects nutrient levels, we discuss that as well. For example, statins lower CoQ10 therefore supplementation can be helpful.

Do you have a diagnosis of your condition from your doctor?

This question comes up particularly when the problem is pain- knee, neck, back etc. I want to read the MRI report about their back pain rather than hear “Well, I’ve been seeing my chiropractor³”. This is vague and not helpful. I want to know if there is herniation, stenosis etc. as this can inform acupuncture treatment. More importantly, I want a hit on much responsibility the person is taking for the condition. And whether the condition is being monitored by their primary care.

What sorts of treatment have you have for this condition? Were they helpful and how did it help?

I am, at times, gobsmacked by the number of folks who expect their back pain or acid reflux or insomnia to improve by the time tested method of continuing the same behaviors that potentially set up the condition…

Diabetes- No, I haven’t changed my diet. I thought the Metformin was taking care of that. Do I exercise? No.

High cholesterol- see above.

Sleep issues- How do I spend the two hours before bed? I eat dinner, answer work emails and then collapse in bed to watch Netflix until I fall over…

Back pain- Physical therapy? No, why would I do that? Exercise? I don’t have time to exercise. Walking? Lady, it’s cold out there. I’m waiting until the weather gets better.

(Newsflash- West Virginia has as many days of precipitation as Seattle. You will wait in vain. We have about 10 gorgeous “what a lovely day to be outside” days a year. Invest in something other than cotton hoodies, ankle socks and tennis shoes and get outside.)

Tiny soapbox #2- at what point did the weather become someone else’s fault? Rather than our responsibility to dress/respond appropriately for the season?

Primary care docs are enmeshed in a system that demands the impossible. They have at best, 15 minutes to address complex issues. These issues can be instigated by or at least, abetted by lifestyle choices. Do they have time to address this? No, they don’t. That’s a system problem, not a doctor problem.

As an acupuncturist, I have the time to have these conversations. It is not my job to tell people what to do (as much as I might occasionally want to). However, I do hold it as my responsibility to inform them if their behaviors are actively contributing to the very thing that brought them in the door. And offer them reliable resources and referrals they can use to make changes.

I’m an ally, not the adversary.

Choosing acupuncture does not necessitate leaving Western medicine. They work well together! They come from different viewpoints and hold different strengths. Western medicine is frankly miraculous when it comes to imaging, testing, surgery and acute trauma. However, in the case of chronic conditions, it is generally limited to medications that ameliorate but do not resolve the issue.

For example, acid reflux is common, exceedingly uncomfortable and can lead to worsening conditions like Barrett’s esophagus. Commonly prescribed proton pump inhibitors can reduce or eliminate discomfort. However, we are learning that long term use of PPI’s can lead to increased risk of bone fractures, nutrient deficiencies and potentially, cognitive impairment. How does the acupuncture approach differ?

As an acupuncturist, I seek to understand why the person has acid reflux. There can be multiple causes- emotional stress affecting vagus nerve function, poor/inappropriate for the person diet, and/or interesting lifestyle choices. As a practitioner, I take the time (and have the time as I exist outside the insane time constraints of modern healthcare) to learn not only what my patients eat, but how and when as well as clues to their emotional environment as well. I am able to work as old-time family doctors once did- having knowledge not only of the patient’s body and mind, but the emotional environment as well.

In a polarized world, it might be easy to assume that acupuncturists are opposed to Western medicine. That I might be encouraging my patients to get off the omeprazole. East Asian medicine, for all its basis in energetics, is deeply based in common sense. Frequently, I find myself saying things like “Well, at your age, eating pizza at 10 pm is a guaranteed way to experience acid reflux.”

True story- a Canadian friend of mine in his 70’s was told by his primary care that due to some genetic testing results, he should avoid gluten. A year later, I asked him if he had noticed any changes. “No.” “Nothing?” “Well,” he said slowly, “the acid reflux I’ve had my entire adult life is gone.”

Acid reflux simply tells us that something is wrong. It could be dietary, emotional stress or from an East Asian perspective, a glitch in the qi-descending function of the stomach. As an acupuncturist, my work is to discern the why, craft a hypothesis from my findings and then via acupuncture treatment test this hypothesis. I also counsel my patients that acupuncture is not magic. As in, acupuncture cannot undo the damage of late night red sauce consumption.

Both acupuncture and Western medicine involve detective work. The difference is the the starting point. Modern Western medicine, constrained by time and the pharmaceutical-industrial complex says- acid is the problem, reduce acid. Acupuncture says the acid is the symptom, find the problem. We might even suggest that acid reflux is an appropriate physiological response given the situation and circumstances…

Cancer treatment is another area where acupuncture shines. Acupuncture does not treat cancer. However, it can be enormously supportive treating the side effects of cancer treatment. Nausea, exhaustion, sleep disturbances- again and again, I have seen these symptoms improve with acupuncture treatment.

Tiny soapbox #3- “Oh,” you say, “that’s just the placebo effect”. Years ago, I heard a doctor say, “What if the placebo effect is simply the amazing ability of the body to heal itself?” Western science frowns upon the placebo effect because it complicates drug trials. As an acupuncturist, I am grateful for the body’s ability to heal.⁴

Some doctors are less than complimentary about complementary therapies. Take Vinay Prasad⁵, for example. I have heard Prasad dismiss acupuncture as quackery several times. However, I’m not going to throw Vinay baby out with the bathwater. I hold that the practice of a medical art entails reading widely, educating oneself constantly and always learning, especially from those we disagree with. Medicine is an art. And art is an expression of the life/lives/culture from which it emerges. Both in Western medicine and acupuncture, there is a foundation to be learned, but its practice, its interface with complex human beings is an art.

"The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head." Sir William Osler

Acupuncture has a track record of at least 1,000 years. But why? As it has traveled through time and cultures, it changes. This is how living complex systems operate. A bit like us, you might say. This flexibility has allowed acupuncture to morph and adapt over the centuries so that it still holds value today. Acupuncture is still changing- TDP lamps replacing moxa, the use of micro-protocols like Battlefield Acupuncture or NADA. Western medicine is still changing. Hell, science just discovered the interstitium. And yes, we in acupuncture have been blathering on about it for over 1,000 years. And yes, acupuncture with toothpicks works.⁶ Humility in the face of Nature is a wise choice.

‘Ally’ is an interesting word. It comes from the Latin ligare to bind. And binding entails holding together disparate forces that would not occur otherwise. Alliances come together in times of need to accomplish a greater goal. We’ve done it before- Germanic tribes allying with the Romans, Russia joining the Allies in 1941. Allies are not converts, accomplices or even partners. They’re often dramatically different in nature, bound by common purpose. In our delightfully polarized world, this is not done. We want 100% buy-in or nothing.

Enough, I say. Times are hard. And getting harder.

There is no lack of illness and suffering in the world. Might we engage in this endeavor together?

1. Vinay Prasad does. Just because I disagree with his opinion on this matter does not preclude my respect for his view on conservative care. We all need to listen outside our bubble…

2. https://jamanetwork.com/journals/jama/fullarticle/2804077

3. This is not a knock on chiros- simply a plea for a diagnosis.

4. During Covid, I did a deep dive into books about medicine written by doctors. It’s some superb reading. One of my faves is God's Hotel- her writing on ‘tincture of time’ places all of us as practitioners right where we belong. Humility- we’re not doing nearly as much as we’d like to take credit for…

5. I have followed Vinay Prasad, Marty Makari and Adam Cifu for about 4 years, John Mandrola for over a decade. Firstly, if you are not following Sensible Medicine, you are missing out. Secondly, if your opinion of Makari and Prasad has been informed by media coverage since their appointments to the current administration, please do your research. Go listen to their podcasts and read their books. Go primary source, rather than opinion. They are physicians dedicated to public health and conservative healthcare. Conservative healthcare is not cutting healthcare subsidies. It is a sane approach to a healthcare system controlled by the financial interests of health insurance and pharmaceutical industries.

6. Here’s an interesting place where Western and East Asian views differ. The West say, “Toothpicks- acupuncture is a sham!” We say, “Acupuncture points don’t particularly care what you stimulate them with!”.