Traditional Chinese Medicine and Western Medicine: Yin and Yang?

As an increasing number of individuals in society seek alternatives to traditional western medicine, the important question raised is: “are these alternatives truly effective – and more importantly are they safe?”

 

Traditional Chinese Medicine (TCM) has been practiced in Australia since the 19th century when the Australian gold rush brought many Chinese migrants. The WHO survey of Australia in 2000 described over 1100 practitioners of Chinese Medicine graduating in that year and that there were also over 23 professional associations present that represented different aspects of Chinese Medicine. One can only assume that in 2017 these figures are now higher.

 

TCM is increasingly mainstream, here and overseas. In a National Health Survey in the USA in 2007, over 3 million people confirmed that they had used acupuncture in the previous year, 2.3 million practiced Tai Chi and 600,000 practiced Qi Gong.

 

Despite these numbers, up to now scientific analysis on the effectiveness of these therapies has been fraught with complexity: due to many factors including the differing ideologies of Traditional Chinese Medicine and Western Medicine, and the lack of prior engagement between the differing practitioner groups.

 

Traditional Chinese Medicine dates back 2500 years and it is based on the philosophy of Taoism. It is based on the Qi, the Yin and Yang. The Qi is the vital energy that pervades the body. The forces of Yin (negative energy) and Yang (positive energy) are balanced but when that balance becomes altered so is the Qi and an individual becomes sick. According to TCM teaching, one’s organs are part of a system called Zang Fu. Zang organs manufacture and store while Fu organs transmit and digest. The imbalance between Zang and Fu then makes the individual sick.  Unlike western medicine, TCM is customised to the individual and hence additional ingredients can be included dependent on the individual’s Yin-Yang. As a result, formulations differ from patient to patient, making it challenging to study.

 

TCM tries to avoid invasive methods and uses external techniques or herbal medications to help the balance Yin and Yang and allow the Qi to flow again.It encompasses many different practices: acupuncture, Chinese Herbal Medicine, Tui Na (Chinese Therapeutic Massage), Tai Chi and Qi Gong (movement and posture therapy that help with mental focus and coordinated breathing), Moxibustion (burning a herb and hence heat therapy above acupuncture point) and Cupping therapy.

 

Furthermore additional traditional systems of medicine exist in other Asian countries such as Kampo in Japan which was originally based on the Chinese Medicine. The Japanese Ministry of Health formally recognised the practice of Kampo and hence it is covered by National Health Insurance. Similarly throughout Asia traditional Chinese Medicine is practiced alongside Western Medicine and funded through public health insurance.

 

What is the evidence for Chinese Medicine?

 

Western Medicine has set rigorous methods by which to assess the safety and efficacy of treatments. The best accepted mode of analysis in medicine is a randomised controlled trial. This is where individuals are allocated a treatment at random and therefore by chance receive one of several clinical interventions. One of these interventions will be the new treatment under study, one may be the standard of current treatment and/or one may involve no intervention at all (what is called a placebo eg a ‘sugar pill’).  Consequently in Western Medicine when a new drug is made available, it has been assessed by a randomised control trial in a large population to demonstrate its benefit over current therapy and doses and formulations are fixed.  The problem with applying this to Chinese medicine is that the treatments are often individualised to align the yin and yang.  Even trying to assess the benefits of something as standardised as acupuncture is difficult: how do you organise a ‘placebo arm’ to the trial? Needling an individual as an obvious treatment that is hard to sham.

 

As a result, there are few randomised control trials with traditional chinese medicine.

 

Furthermore studies in Chinese are not widely available to western doctors with our limited access to translated texts. Over the last 15 years a number of studies have been performed and published in Western societies but have not involved full collaboration with Traditional Chinese Medical practitioners. Collaboration between western societies and Chinese medical practitioners needs to be encouraged if validity of treatment is to be sought.

 

So what does the evidence say?

 

Systematic reviews of acupuncture cannot reach a definitive conclusion regarding its benefits, due to the problems mentioned above. Some studies have shown that Tai Chi has benefits with respect to improving balance and stability in people with Parkinson’s disease, and improves pain management in those with arthritis of the knee and fibromyalgia.

 

The US government and WHO recommended that if an individual is planning to use TCM, they should alert their usual medical practitioner and check the experience of the TCM practitioner, the evidence for the therapy being offered and also not substitute it for conventional therapy.

 

When can Chinese Medicine help Western Medicine?

 

While straight comparison of TCM and Western medicine is still challenging, it is important to review how TCM can support Western medicine.

 

Skin Disorders

 

Oral and topical medications in TCM have been used for eczema/ atopic dermatitis for many years but unfortunately the randomised control trials using the formulations have been flawed.  However Xiao-Feng-San (XFS), a 13-herb formula, was studied in a randomized trial in Taiwan. 47 Patients with severe intractable Atopic Dermatitis were treated for eight weeks with oral XFS  or given placebo (n = 24). There was a significantly greater improvement in the the area of skin involvement and symptoms associated in the XFS group compared with placebo. These differences, except for the redness score, were still significant four weeks after the completion of treatment. Preliminary observational studies suggest that the combination of Chinese herbal therapy and acupuncture may be more effective than herbal therapy alone. Further controlled clinical studies are needed.

 

Asthma

 

There is increasing scientific evidence to support the use of Traditional Chinese medicine (TCM) herbal therapy for asthma with a number of differing therapies being used including anti-asthma herbal medicine intervention (ASHMI), which has received new drug approval for investigation in the US.  14 herbs make up ASHMI but a modified form of just three is also available that contains Ling-Zhi (Ganoderma lucidum), Ku-Shen (Sophorae flavescentis), and Gan-Cao (Glycyrrhiza uralensis). Preliminary data suggest that ASHMI is safe and effective for mild to moderate asthma. One trial compared ASHMI against steroid treatment which is commonly used in moderate asthma flares and found there was nearly equivalence in ASHMI to steroids. The advantage of ASHMI is that its side effect profile is not as great as steroids. Furthermore it did not appear to interact with other drugs and hence could be used along with other therapies. However while this is enticing larger trials are required to remove any effects by chance.

 

Low Back Pain and Arthitis

 

Well-designed clinical trials have found that both acupuncture and sham acupuncture are more effective than control interventions for low back pain. Similarly in over 1000 patients with knee arthritis allocated acupuncture, sham acupuncture versus physiotherapy and pain killers, the rates of success were similar for acupuncture and sham acupuncture but greater than standard therapy. The concern with these results is that the recruits for this trial may have had preconceived ideas about the benefits of acupuncture and this may have affected the results. The study demonstrated that acupuncture was safe providing clean sterile needle practices were followed.

 

Antimalaria Therapy

 

In the 1960s after many attempts to eradicate malaria, the number of cases rebounded and increased pressure existed to find treatment. In Beijing a national project was set up by the Chinese government and over 240 herbal preparations were studies with Qinghaosu (artemesinin) the most promising.  In 2005 the World Health Organisation embraced this drug in a combination therapy that is now used widely in Africa.

Other trials in drugs for Alzheimer’s disease, Leukaemia, and heart disease are all currently being explored.

 

The downside: Side Effects of TCM

 

The difficulty with Traditional Chinese Medicine is trying to ensure that each component of the herbal medicine is known, what are are its side effects and how does it interact with other conventional medication.  Cases that highlight the risks include the development of sudden kidney failure in a number of individuals in the UK, Spain, Belgium  and Japan who had taken a TCM weight loss therapy. This was confirmed to be due to the presence of toxic agents (fenfluramine and diethylpropion) which reduced the blood supply to kidneys. It appeared that therapists had not appreciated that some species of the Mu Tong plant contained these kidney toxins.

Consequently it is important that patients know the compounds they use. In China and places like Taiwan often Western and traditional chinese medicines are used concurrently and side effects understood in an Asian population. In Western countries  the interactions are not fully documented or known.

Consequently there is still a lot to be done to align the science and balance of TCM with Western Medicine. With increased collaboration, there is potential for great benefit.

 

References

http://www.uptodate.com/contents/chinese-herbal-medicine-for-the-treatment-of-allergic-diseases

http://bmjopen.bmj.com/content/3/12/e003906.full

http://www.nature.com/nm/journal/v17/n10/full/nm.2471.html

https://nccih.nih.gov/health/whatiscam/chinesemed.htm

https://nccih.nih.gov/health/whatiscam/chinesemed.htm

http://apps.who.int/medicinedocs/en/d/Jh2943e/9.3.html

The First Fleet: The Convict Ships in need of Telehealth

The medical story behind the First Fleet is a triumph of public health and a reminder to us all that a healthy, clean environment and good diet can go long way.

As we prepare to commemorate another Australia Day, it’s a timely reminder of how far medicine has come since the epic voyage of the First Fleet.

 

The Industrial Revolution in the 18th century displaced large numbers of former workers who flooded into cities in search of work. Cities became overcrowded and people often turned to crime to survive. In Britain, the prisons filled and the authorities began housing prisoners (convicts) in rotten prison ships called hulks. But as the prison population continued to climb, Britain looked beyond its shores.

 

Britain first used colonial North America as a penal colony. Merchants would transport the convicts and then auction them off to plantation owners. Up to 50,000 British convicts were sent to America by this route, but after the American War of Independence ended in 1783, the newly formed USA refused to accept any more of Britain’s convicts. In December 1785, Orders in Council were issued in London for the establishment of a penal colony in New South Wales (Australia).

 

On 13 May 1787, the First Fleet left English shores on one of the world’s greatest sea voyages. The Fleet comprised 11 ships carrying up to 1500 people and their required stores. They travelled for more than 15,000 miles over 252 days without losing a ship. Their route went southwest to Rio de Janeiro, east to Cape Town, then via the Great Southern Ocean to Botany Bay with its mission to set up Australia’s first penal colony. 16 convicts were lost to fever before the ships set sail but only forty-eight people were recorded to have died on this epic journey, a death rate of just over three per cent.

 

It is from the diaries of surgeons such as Arthur Bowes Smyth that we have learned of the harsh conditions and medical illnesses endured on this journey. Bowes Smyth had primary responsibility for the 100 female convicts on board the Lady Penrhyn, and to his credit all except one survived the eight-month voyage. This is particularly remarkable when one recalls that his stock of medical equipment was very limited, and that there were no medical provisions at all for children, or for the babies born on the voyage.

 

While Bowes Smyth made no secret of his dislike for the convict women, the new penal colony in New South Wales would need a healthy workforce. Therefore he was greatly concerned for their health and well-being, and one can detect, in some entries of his journal, a certain sense of pride in a job well done. Captain Philip himself was enlightened about hygiene and diet on the ship’s fleet, and was probably correct in his claim that the convicts were in better health by the time they left Rio de Janeiro than when they had left Portsmouth five months before.

 

Conditions had not been kind for the convicts on the journey to Rio. Tropical rainstorms stopped convicts from exercising or drying their wet clothing., and the heat and moisture below decks provided a perfect medium for vermin, ticks and other parasites to flourish. Dysentery, typhoid, smallpox and cholera plagued convicts and sailors alike. The ship’s bilges became foul-smelling and Captain Phillip gave orders that the bilge-water was to be pumped and cleaned out daily. On these ships where these orders were ignored, a number of convicts fell sick and died.

 

The fleet reached Rio on 5 August and stayed for a month to prepare for the next onerous stage of the trip.  In Rio they cleaned and repaired the ships and took on board large quantities of food and water for the Pacific Ocean crossing ahead. Bowes Smyth records that the female convicts’ clothing had become infested with lice and were promptly burnt. With no clothes immediately available they were then issued with clothes made from rice sacks. The convicts largely remained below the deck during this month while the officers explored Rio and were entertained by its inhabitants.

 

The first fleet finally left Rio de Janeiro on 4 September to run before the westerlies to the Cape of Good Hope in Southern Africa, where the boats again replenished their stores and stocked up on plants, seeds and livestock for their arrival in Australia.

 

Assisted by the gales in the “Roaring Forties” the heavily-laden ships surged through the violent seas. In the last two months of the voyage, the Fleet faced challenging conditions, spending some days becalmed and on others covering significant distances. As they reached Van Diemen’s land a freak storm damaged some of the sails and masts of the ships.

 

What is most impressive about the voyage of the First Fleet is that its death rate was relatively low compared to late 18th century standards. It was recorded at7/month per 1000 convicts. By comparison, the death rate on the Second Fleet was seven times higher, and its convicts were in a much weaker condition on arrival in New South Wales, with a further 16% dying shortly afterwards. The Reverend Johnson documented that the Second Fleet survivors who landed were “ wretched, naked, filthy, lousy and many of them utterly unable to stand, to creep or even to stir hand at foot”.  It was decided that inadequate provisions and crowded conditions on board were the causes. Government regulations subsequently stipulated that a naval surgeon should superintend every transport vessel. When this rule was relaxed, a further rise in the death rate ensued. From 1800 onwards, surgeons were reinstated and, after 1805, placed on the same ranking as army medical officers, with authority over all disciplinary and medical matters.  By 1815 this included also the ventilation and cleaning of the vessel. Such measures meant the death rates fell significantly to 2.4/1000/month. To demonstrate the effectiveness of these measures the equivalent death rate on emigrant ships crossing the Atlantic to America was nearly double – for a journey that was half as long.

 

The medical story behind the First Fleet and its journey across stormy oceans is a triumph of public health and a reminder to us all that healthy, clean environment and good diet can go long way.

 

References

http://www.femaleconvicts.org.au/docs/seminars/Voyages_HamishMaxwellStewart.pdf

http://www2.sl.nsw.gov.au/archive/discover_collections/history_nation/terra_australis/journals/bowes_smyth/index.html

https://www.britishmuseum.org/research/publications/online_research_catalogues/paper_money/paper_money_of_england__wales/the_industrial_revolution.aspx

http://sydneylivingmuseums.com.au/stories/why-were-convicts-transported-australia

How to avoid sun damage and heat stress

We all love hot summer days at the beach or on a family picnic, but we all know too well how quickly skin damage, eye damage and heat stress can happen when we are having a load of fun in the sun!

Some exposure to sun is healthy whist too much causes disease, so it is wise to take note of how to avoid the negative side effects of too much sun.

6 quick points to note and remember about the sun and our reaction to it:

1. A little sunshine has health benefits but too much causes disease.
2. Sunshine dehydrates the body, damages skin and causes skin cancer, photo-aging, cataracts and eye tumours (benign and malignant).
3. Sunshine replenishes vitamin D stores, reduces myopia (shortsightedness) and reduces depression.
4. If blood vitamin D levels are truly low, dietary supplementation (fish) plus vitamin D supplements are probably safer than increasing sun exposure.
5. Don’t be fooled by cloud cover! The sun’s rays can pass through thin and hazy clouds.
6. Remember to slip, slop, slap, seek shade and slide on a pair of “sunnies”.

 

The ancient Greeks believed that Apollo the Sun God harnessed his chariot to take the sun across the sky. He was seen as a healer and the God of Medicine but also the God of Plague who spread diseases and pestilence.

Just as Apollo encompassed both cure and disease, so does the sun. Sunlight is made up different ultraviolet (UV) frequencies. UVB is the frequency responsible for sunburn, skin cancer, hyperpigmentation, and photo-aging: in fact UV radiation is responsible for 80% of our skin’s fine lines, wrinkles and sagging.

However sunlight has other effects too.

 

Sun and the skin

Certain skin types are more vulnerable to the effects of the sun (white skin with blue eyes more than dark brown to black skin). But everyone regardless of skin type is at risk. Photoprotection is crucial for ALL skin types. This includes sun avoidance at peak hours, sunprotective clothing and sunscreens

 

1.     Sun Avoidance

A score >3 on the World Health Organisation UV Index is when sun protection measures are required. Australia is consistently above 3 all year round except in the winter months in certain regions. In January the UV index is extreme.

Don’t be fooled by cloud cover! The sun’s rays can pass through thin and hazy clouds.

 

2. Sun Protective Clothing

Hats, long sleeves shirts, collars are all recommended particularly on hot summer days when prolonged sun exposure may occur. Some clothes have been given a ultraviolet protection factor (UPF rating). A UPF 50 allows only one 50th of UV radiation to filter through to your skin.

 

3. Sunscreen: Which to use?

Broad spectrum sunscreens with high sun protection factor (SPF 30+), particularly those with ingredients that protect against UVA1 (e.g. Zinc oxide, titanium dioxide and avobenzone) are preferred for those going out in the Australian sun. Cosmetics that use broad spectrum protection with an SPF 15- 30 are preferred to those only containing UVB filters.

 

Sunscreen in children:

Parents should avoid direct exposure to baby’s skin in the first year if possible. But this can be difficult, so The Australian College of Dermatologists recommend sunscreens be used at any age when exposed to the sun if clothing/shade is not available. Since infants have an immature skin barrier, oil-based emulsions such as titanium dioxide or zinc oxide are preferred as they have broad spectrum protection and minimal irritation.

 

How much to put on and when?

Sunscreen must be applied liberally and frequently.  If you don’t put enough on, it wont work. The teaspoon rule is a good guide in children: 1 teaspoon to face and neck, 2 to back and front torso, 1 teaspoon to each arm, 2 to each leg.

It should be applied 15- 30 minutes prior to sun exposure to allow a protective film to form. Reapply every 2 hours, even for those that are water resistant.

 

SUNBURN: top tips

●     Moisturiser cream may help soothe the skin.

●     If pain is associated, try non steroidal ant-inflammatory analgaesics like ibuprofen (e.g. Nurofen)

●     Do not de-roof blisters, as this may lead to infection. Cover the blisters with gauze.

●     Ensure you drink plenty! Sunburned skin loses moisture faster.

●     Do not go out into the direct sunlight until your sunburn has resolved

 

SUN and the EYES

Eye Sunburn: Photokeratitis and photoconjunctivitis

Just like sunburn to the skin, eyes that are exposed to excessive UV radiation become red, sore and sensitive. Prolonged exposure can also cause eye tumours (benign and malignant) and cataracts. Hence, wear sunglasses (preferably with large / wraparound lenses) that block 99-100% UVA and B radiation. Don’t be fooled by a dark tint alone. A dark tint does not necessarily mean that the sunglasses fit this criteria. Your kids need them too.

 

SUN : The benefits

Vitamin D

Sunlight (especially ultraviolet B, UVB) is essential for the synthesis of vitamin D which helps us absorb calcium and phosphate from our food. When levels of vitamin D are low, there is a risk of bone disease. In children this is called Rickets (suffered by Tiny Tim from A Christmas Carol, along with TB) and is rarely seen in Australia. In grownups, especially the elderly, inadequate vitamin D causes Osteomalacia and can cause fractures when elderly people fall.

It is also suggested (but not definitively proven) that vitamin D has a role in preventing heart disease, cancer and asthma.

The amount of sun exposure required to get the benefits of Vitamin D depends on skin type, geography and UV index. Given the risks of sun exposure,  dietary supplementation (fish) plus vitamin D supplements would seem safer if blood vitamin D levels are truly low.

 

Depression: Seasonal Affective Disorder

We all feel uplifted with the big bright blue skies of an Aussie summer. Consequently it is not surprising to note that some patients describe increased depressive symptoms in late autumn and winter which improve once summer arrives. Such cyclical symptoms are part of Seasonal Affective Disorder. In addition those with bipolar disease may describe increased symptoms of mania or hypomania in the summer but less so in the winter. It is postulated that sunlight may have a direct effect on serotonin levels and thereby account for these changes in mood.

 

Myopia (Shortsightedness)

Studies suggest that if children spend less time in the great outdoors, then short sightedness /myopia can ensue. The prevalence of myopia has doubled in the USA and Europe over the last 50 years and links with the amount of sun exposure/light have been suggested.

 

In conclusion

Just like anything else, enjoy the sun sensibly and take in moderation! In particular, wear good quality sunscreen and sunglasses and remember to ‘slip, slop, slap, seek and slide’.

 

References

http://wiki.cancer.org.au/policy/Position_statement_-_Risks_and_benefits_of_sun_exposure

http://www.bom.gov.au/jsp/ncc/climate_averages/uv-index

http://www.nature.com/news/the-myopia-boom-1.17120

http://www.webmd.com/eye-health/features/how-to-pick-good-sunglasses#1

Sunscreens: an overview and update. J Am Acad Dermatol 2011: 64:748

Clothing reduces the sun protection factor of sunscreens. Br J of Dermatolof 20102: 162:415

Sun Protection and Skin Examination practices in a setting of High Ambient Solar Radiation: A population based Cohort Study. JAMA Dermatol 2015: 152:982

Sunscreen Use: Controversies, challenges and regulatory aspects. Br J Dermatolo 2011: 165: 255

Latest App Version

The latest version of the My Emergency Dr App has just been released to the iOS App and Google Play stores.

As an introductory offer a flat fee of $50 will be charged for initial consultations. Please see our website for the full schedule of fees for subsequent consultations.

So to avoid long waits in Emergency and to get the peace of mind you are looking for download the latest version now and have access to a specialist emergency doctor at the touch of a button.

The Future is Here

The future of healthcare has launched in the form of an app that puts you directly in touch with an emergency specialist doctor. Save time by avoiding the hospital trip and long wait.

Meet My Emergency Dr; the smartphone app that connects you with emergency specialists and provides help when you need it. If you or a family member are sick, the team of Emergency Specialist Doctors at My Emergency Dr can remotely assess you, make a diagnosis, provide expert medical advice and in many cases arrange the treatment you need.

CEO Dr. Justin Bowra, a senior emergency physician and founder of ConnectedMed understands the importance of quick access to doctors qualified in emergency medicine, and wants to make emergency healthcare more accessible to Australians.

“Our vision at My Emergency Dr is to give every Australian urgent video access via your smartphone to an Emergency Specialist, wherever they live and whenever they call. All of our doctors are qualified specialists in Emergency Medicine. Simply download the app and connect to an Emergency Specialist who will be able to assist you wherever you are.”

My Emergency Dr provides urgent assessment and diagnosis. The service does not replace 000, but will provide a convenient way of getting urgent diagnosis and medical advice from a qualified emergency specialist without having to wait at a hospital.

Dr. Bowra intends the service to work with the patient’s GP, and providing references to pathologists, imaging services and pharmacists. “Registered clients have 24 hour-a-day immediate phone and video access to a team of Emergency Specialists who can remotely assess, diagnose and arrange treatment.

My Emergency Dr will email you a copy of the consultation record to take to your GP. If medications need to be organised, we can email you an electronic prescription. Similarly, we can also email you referrals for x-rays or blood tests.”

You can download My Emergency Dr from the App Store or Google Play
Open it and follow the instructions provided.