There's an old Chippewa saying:

"There's two sides to every story—
and then there's the truth."

reprinted from Alternative Therapies journal January 1999 Issue

Case Report Insensitive To Nuances of Chinese Medicine

A recently published article by Guchuan Zhu, L.Ac., LH, and Vincent N. Jarvis, MD, MS, titled "Using Chinese Herbal Medicine to Control Diarrhea Caused by Antiretroviral Drugs" (Case Reports, November 1998), was of special concern and inspired me to write the following remarks.

From a biomedical point of view, the information given in the study is adequate and comprehensive. However, the Chinese medicine aspect of the study is seriously flawed—often the case in studies that attempt to combine or integrate Chinese medicine with biomedicine.

The authors write that "diarrhea is roughly divided into 2 categories: one produced by a bacterium...." This statement cannot possibly be a categorization of a bian bing/disease pattern in Chinese medicine. Chinese medicine does not classify disorders according to a bacterium or any biomedical terminology without classical reference to bio-organisms that cause the disease. This is a grafting of biomedicine onto Chinese medical theory and is not universally accepted in the profession.

Furthermore, the authors cite an acupuncture text as the source for their classification (Chinese Acupuncture and Moxibustion, which oversimplifies much of its material), then choose a prescription from an herbal text (Prescriptions of Traditional Chinese Medicine). Chinese medical professionals do not choose their internal medicine diagnoses from acupuncture texts, and then choose prescriptions from herbal/internal medicine texts. The first classification, called "excessive diarrhea," is not explained or defined as a technical term except in a biomedical light. In A Practical Dictionary of Chinese Medicine (Paradigm Press, 1998), the Chinese term xie is translated as diarrhea, which is classified according to 3 groups:

1. Causation: han xie, cold diarrhea; re xie, heat diarrhea; shu xie, summer heat diarrhea; shang shi xie, food damage diarrhea; xu xie, vacuity diarrhea.

2. Morbid bowel or viscus: pi xie, spleen diarrhea; wei xie, stomach diarrhea; xiao chong xie, small intestine diarrhea; da chang xie, large intestine diarrhea; shen xie, kidney diarrhea.

3. Causes: tong xie, sloppy diarrhea; jiu xie, enduring diarrhea; chen xie, early morning diarrhea; hua xie, efflux diarrhea; zhu xie, outpour diarrhea; sun xie, swill diarrhea; xia li qing gu, clear food diarrhea.

As the authors mention, the most general categories of diarrhea are vacuity and excess (deficient and excessive). However, this is not enough information on which to base a bian zheng lun zhi determination of treatment by identified pattern. A practitioner of Chinese medicine must diagnose each individual patient by pulse, tongue, symptoms, and signs. None of this essential information is given in this study.

Whereas Shen Ling Bai Zhu San (the Ginseng, Poriae, and Atractylodes powder the authors used in their report) may be effective in the treatment of diarrhea for some patients suffering with diarrhea as a result of antiretroviral drug use, without differential diagnosis of each patient, the treatment cannot achieve maximum effectiveness.

Although strong pharmaceutical medicines can be a powerful influence on a patient's condition, Chinese medicine recognizes individual sensitivity to these medications (ie, not all patients have the same side effects with each medication), as well as individual predisposition to symptom patterns. Many patients have complex mixtures of heat and cold, vacuity and excess. It is our job to determine these patterns before administering treatment by herbal medicine or acumoxatherapy.

Without this as a basis, studies such as these are only about using nostrums to treat side effects of medications. One could use homeopathic medicines, Western herbal preparations, or other pharmaceuticals as well. This study demeans Chinese medicine, rendering it a handmaiden of biomedical treatment. No attention is paid to its philosophical rigor or to a standard methods of diagnosis and treatment. No professional journal would tolerate such shoddiness from Western medical practitioners; likewise, it should not be tolerated from our peers in Chinese medicine. [emphasis mine]

If medical institutions are to use the best of alternative therapies along with modern biomedicine, then it is necessary for studies, treatment protocols, and articles to express the best of all medical systems. used.

Z'ev Rosenberg, L.Ac.
Chair
Department of Herbal Medicine
Pacific College of Oriental Medicine
San Diego, California
(reprinted by permission of the author)

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