Jeff Gould, LAc, DiplAc, DiplCH Johns Hopkins Integrative Medicine and Digestive Center Blending Traditional Healing with Modern Biomedicine
Fire = inflammation, heat, burning sensations, bloody stools, rapid bowel transit Dampness = borborygmus, tenesmus, gas, bloating, diarrhea, mucus, yeast infections Wind = migraines, tremors, itching and dermatological conditions, external infections
Chinese Dietary Therapy Looks at the energetics of food vs. essential vitamins, minerals and other nutrients. Uses food to promote health but ALSO to treat illness. Designs meals using the 5 flavors: sweet, sour, acrid, bitter, and salty, to build and circulate energy.
How some foods and other substances can exacerbate your symptoms: Foods that may increase fire and exacerbate inflammation, e.g., coffee, soda, overly spicy foods, alcohol, smoking cigarettes, and marijuana Foods that may increase cold and decrease your ability to digest efficiently, like ice cold beverages Foods that may increase dampness and produce excess gas or to which you may have a sensitivity, e.g., gluten, dairy, cruciferous vegetables, and legumes
Acupuncture The insertion of tiny, filiform needles at specific points on the body to promote health and treat specific illnesses. The treatment may include electroacupuncture.
Goals of Acupuncture in Trea=ng IBD Cool heat and drain fire: reduce inflammation, slow bowel transit time to improve absorption of nutrients, decrease GERD if present Warm the physiological fire and expel cold: improve normal digestion Consolidate the stool: reduce diarrhea Drain dampness: reduce gas, bloating, distention, tenesmus
Powering Up! Where the mind goes, the Qi follows
Acupuncture Demonstra=on
Chinese Herbal Medicine Herbs may often be safely used in conjunction with drugs. The whole herb is used, not a concentrated or isolated active ingredient, leading to fewer side- effects. Formulas can be tailor- made to address a patient s unique constellation of symptoms and modified each day or week as symptoms change.
Examples of Individual Herbs with a Diges=ve Func=on Ginger and pinellia to treat nausea and vomiting Tangerine peel and cardamom for gas and bloating Rhubarb root and hemp seed for constipation Coptis and gardenia seed for reflux White peony for abdominal and other muscle cramping Turmeric for abdominal pain and inflammation Coix and white atractylodis for diarrhea
Diagnosing IBD: Differen=a=on of Syndromes Identify the full constellation of signs and symptoms This includes digestive s/s as well as those not generally considered to be digestive in nature
A Pa=ent Presents with a Diagnosis of IBD Dietary history, both from the Western perspective of micronutrients and the Chinese perspective of the energetics of food Digestion: appetite, taste of foods, presence of gas, bloating or distention, presence of reflux, nausea, or vomiting, cravings, any unusual tastes in the mouth Bowel Movements: diarrhea, constipation, frequency, urgency, presence of mucus, undigested food, or blood in the stools, sludginess of the stool, do you feel better or worse after a bowel movement?
A Pa=ent Presents with a Diagnosis of IBD cont. PLUS The Ten Questions : Presence of headaches or dizziness Visual issues, e.g., redness, dryness, floaters, etc. Cognitive symptoms, such as decreased mental clarity Lung issues, such as excess production of mucus, shortness of breath, and seasonal allergies, skin conditions Sleep patterns Presence of different types of fever or unusual sweating patterns
A Pa=ent Presents with a Diagnosis of IBD cont. Overall energy, better or worse with activity Abnormal menstrual patterns Abnormal bleeding or bruising patterns Predominant emotions Effects on libido and sexual health issues The tongue The pulse
Based on the differen=a=on of syndromes as determined by all these gathered data, we generate a treatment protocol, which may include dietary changes, acupuncture, an herbal formula, and nutri=onal supplements.
Ex. Biomedical Diagnosis of Moderate Ulcera=ve Coli=s Involvement of more than the distal colon Inflammation process extending to at least the splenic flexure Frequent, loose, bloody stools (up to 10 per day) Mild anemia not requiring blood transfusions Abdominal pain that is not severe Low grade fever Adequate nutrition is usually maintained
Chinese Medicine Differen=a=on Damp Accumula=on with Spleen Deficiency All the digestive information provided by the biomedical diagnosis, including: Incessant diarrhea with stool that is watery or sticky with pus, mucus, and or blood. Dull pain and distention in the abdomen. Malabsorption and malnutrition are common. Epigastric fullness and discomfort after eating. Decreased sense of taste, poor appetite, and lack of thirst
Chinese Medicine Differen=a=on Damp Accumula=on with Spleen Deficiency cont. PLUS Fatigue and lack of vitality Lower than normal libido, possible ED in men and orgasmic problems in women Shortness of breath, excess mucus production Disturbed sleep, unusual dreams Sallow complexion Short term memory problems and lack of clarity of thought
Chinese Medicine Differen=a=on Damp Accumula=on with Spleen Deficiency cont. Irregular menstrual cycle Possible presence of skin conditions, including weepy rashes Unusual sweating patterns, e.g., head, chest, groin Flat or suppressed affect Flabby or large tongue with teeth marks and thin or thick white coat Weak and thready pulses
Treatment Protocol Dietary 1. Decrease consumption of heat- producing products, e.g., coffee, soda, alcohol, marijuana, and spicy foods 2. Decrease consumption of damp- producing foods, e.g., fewer grains, dairy, sugar, and candy 3. Consider possibility of food sensitivities Acupuncture 1. Select points that clear heat, reduce dampness, strengthen digestive function, and consolidate the stool, e.g., SP- 9, LV- 2, GB- 34, ST- 36, SP- 8, ST- 25
Herbal - Shen ling bai zhu san Ginseng, Poria, and Atractylodes Macrocephala Powder Radix Ginseng/ren shen Rhizoma Atractylodis Macrocephalae/bai zhu Sclerotium Poriae Cocos/fu ling Honey- fried Radix Glycyrrhizae Uralensis/zhi gan cao Radix Dioscoreae Oppositae/shan yao Semen Dolichoris Lablab/bai bian dou Semen Nelumbinis Nuciferae/lian zi Semen Coicis Lachryma- jobi/yi yi ren Fructus Amomi/sha ren Radix Platycodi Grandiflori/jie geng
Joos, S, Brinkhaus, B, Maluche, C, Maupai, N, Kohnen, R, et al. Digestion, 2004; 69: 131-139
Methods: Prospective, randomized, controlled, single- blind clinical trial Primary outcome measure: changes in the CD activity index (CDAI) after treatment and assessment of entering remission (CDAI score 150 points) Secondary outcome measures: Changes in quality of life (IBDQ) and general well- being (VAS) Changes in serum markers of inflammation (α₁- acid glycoprotein and C- reactive protein) 51 patients with mild to moderately active CD (true acupuncture n =27, sham acupuncture control n= 24) received 10 treatments over 4 weeks with a 12 week followup
Results: True acupuncture CDAI decreased significantly from 250 ± 51 to 163 ± 56 points, which remained stable in the 12 week followup. Remission occurred in 11 patients, near remission in 4 (CDAI between 150-160) Sham acupuncture group CDAI decreased from 220 ± 42 to 181 ± 46 points, considerable, but less superior. Remission occurred in 8 patients Both groups reported improvements in quality of life and general well- being, no significant difference between groups α₁- acid glycoprotein concentration fell significantly only in the true acupuncture group after 4 weeks No significant changes in C- reactive protein
Conclusions: Apart from a marked placebo effect, traditional acupuncture offers an additional therapeutic benefit in patients with mild to moderately active CD
Acupuncture and Moxibus=on in the Treatment of Ac=ve Crohn s Disease: A Randomized Controlled Study Strengths of the Study Randomized, controlled, single- blind Both objective and validated subjective measures utilized Diagnosis confirmed by endoscopic biopsy within 2 years of participation Clear inclusion/exclusion criteria 12 week followup Weaknesses of the Study Comparison problems with sham acupuncture not inert All true acupuncture patients received the same core points, but each also received additional points based on differentiation Some patients received an additional therapy, moxa Not replicable as performed