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Archive for March, 2010

16
Mar

By Lilly Rogers, Pacific College of Oriental Medicine

Insomnia is more than tossing and turning. It’s more serious than an inability to fall asleep early and has more debilitating effects than are commonly recognized. An estimated 32 million people suffer from insomnia in the U.S. Oriental medicine, with its focus on healing whole syndromes rather than individual symptoms, is widely used as an insomnia remedy and has shown great success treating those who experience insomnia.

Insomnia may present itself in different ways. For some, the inability to fall asleep is the most noticeable insomnia symptom while others are unable to reach a deep level of sleep and are startled awake by every noise. Any insomnia symptom would frustrate most sleepers, but night after night for months or years, the most serious issues of insomnia accumulate – the daytime effects. These can include physical tiredness, difficulty concentrating and feeling depressed, irritable or lethargic. Oriental medicine is a great insomnia remedy . It focuses on patients’ individual insomnia symptom and builds a whole-healing plan from each symptom. It also has been widely successful in treating depression, stress and physical pain.

While these are standard symptoms of a poor night’s sleep, they are magnified by chronic conditions and can have severe negative setbacks in a person’s life. True insomnia is defined as poor sleep followed by daytime fatigue. Because sleep needs, such as number of hours, varies for different people, the real issue of insomnia is quality of feeling during the day.

Insomnia may have a number of causes, including stress, depression or anxiety; irregular work schedules; medications, drug or alcohol abuse; major life changes; chronic pain, hyperthyroidism or arthritis. Acupuncture and herbs for insomnia have high success rates with each insomnia symptom and can therefore treat insomnia at its root.
 
A study published recently in the American Journal of Chinese Medicine, reports that patients who received acupressure and transcutaneous electrical acupoint stimulation (TEAS) experienced a significant improvement in their insomnia symptom, including problems of fatigue, sleep quality and depression. The results from this study suggest that acupressure or TEAS might have an important role in managing patients with fatigue, poor sleep quality and depression.

Oriental medicine relates insomnia to the heart. Of course, an insomnia remedy would include a complete diagnosis and treatment system that would focus on each individual, and the many syndromes that are differentiated within the context of insomnia would be explored. Other organ systems and syndromes may be involved, and until the body is brought back into balance through Oriental medicine treatment such as herbs for insomnia and acupuncture, each insomnia symptom will continue.

One contributor to insomnia, stress, weakens the function of the Liver, which in turn affects the health of your nerves. According to the 5 Element Theory, the relationship between the Liver and nerves flows both ways, causing the function of the Liver to be weakened from the accumulation of things that “get on your nerves.” Stress-related insomnia is often accompanied by another nerve-induced problem: restless leg syndrome. This can make bedtime even more of a battle for sleep. When your Liver is unbalanced and being asked to deliver energy it does not have, uncomfortable symptoms are your body’s way of signaling the need to get things back into harmony, the need for an insomnia remedy .

Acupuncture has a calming effect on the nervous system. It clears obstructions in the muscle and nerve channels, facilitates the flow of oxygen-enriched energy and relaxes the system. Common noted benefits of acupuncture include deeper breathing, improved digestive abilities, better sleeping patterns, decrease in various pains and a general sense of well being, which are all excellent treatments for insomnia. General acupuncture protocol for the treatment of chronic insomnia includes 10 initial treatments at two to three treatments per week, followed by a two to four week observational period and possibly one treatment per week.

Acupuncture and herbs as an insomnia remedy can greatly improve sleeping patterns, but in order to successfully and completely resolve sleep disturbance one must address all the contributing factors. Oriental medicine helps do this by treating the whole person and focusing on bringing the entire body into balance. Other suggested actions include:

Learn to relax physically

Techniques such as yoga, meditation, biofeedback and progressive relaxation, as well as acupuncture and massage, can help your body become more restful.

Have a regular bedtime

If you are not asleep after an hour, get up, go to another room and do something relaxing until you feel sleepy. Don’t try to force yourself to sleep.

Reduce food and drinks that increase sleep problems

Heavy meals before bedtime, late afternoon or evening consumption of alcohol, chocolate, tea, coffee and caffeinated soda should be avoided. Consider adding herbs for insomnia to your diet as well.

Keep in shape

Regular exercise helps with stress and reduces fatigue, both of which can exacerbate insomnia. Systems such as Tai Chi or Qigong are gentler exercises that balance staying fit with staying relaxed.

Treat physical problems

If physical pain or discomfort is a factor in the inability to fall asleep, don’t put up with it. Acupuncture has proven successful in treating pain associated with arthritis and many other physical conditions.

Nutritional Counseling and Lifestyle Changes

Nutrition can contribute to the cause and cure of insomnia. Excess protein and the over reliance on stimulants and quick-energy foods contribute to fatigue by weighing on the liver, kidneys and intestines. Quick fix foods increase the depletion of the body-mind energy reserves. Tailoring a diet that includes foods such as whole grains, beans, vegetables and fruits to the individual replenishes energy and diffuses built-up stress.

Chinese Herbal Medicine and Supplements
 
Chinese herbs and herbal medications are also useful in combating insomnia. An Oriental medicine practitioner can recommend an insomnia remedy to best suit individual insomnia symptoms. Herbs for insomnia such as longan fruit, golden thread, sour jujube seed, fossil bone or mimosa bark may be prescribed.

Insomnia should not dictate when or for how long you sleep. It can be frustrating and scary when any disease or disorder takes away control. Oriental medicine will lead you back to a place of balance and calm, giving you the power to lay insomnia to rest.

16
Mar

An excellent article by Andrew Ellis at Spring Wind herbs in Berkeley on some truisms, as well as many misconceptions, about pesticides and sulfur in Chinese herbs.  While this article was intended for practitioners, I think it has some valuable information for everyone interested in Chinese herbal medicine who may be concerned about their source.  

Click here to read the article (a pdf/Adobe Acrobat file).

13
Mar

That’s right, the computer is perhaps one of the leading causes of modern day neck, shoulder, arm and hand pain.  While we cannot magically make the pain disappear without also losing that keyboard or the stress that may accompany the time you spend on your machine, ergonomic adjustments can help to make your quality of life better over the long-term.

Patients with these issues who know me know that I often refer people to my favorite local expert in ergonomics, Deedee Savant, P.T.  Now Deedee is appearing in video online.  She just made me aware of one that’s on Savantmd.com.  For more on the ergonomic adjustments that make a positive difference, check her out at SavantMD.com, and watch the video below…

13
Mar

It’s not officially spring yet, but looking out from my window here in the office, it’s my favorite time:  when the two trees across the street shed their white blossoms.  As soon as the wind blows on a beautiful day like today, the blossoms fall like snow, covering the parking lot and all that’s around them.  Especially gorgeous on a Saturday with no cars in the lots.  I’ve attached a video that perhaps will show some of the blossoms as they fall.  Enjoy!  And remember to set your clocks forward tonight…

Trees Shedding Blossoms Across the Street from Our Office

Spring Blossoms (Video)

10
Mar

A common question I get from patients relates to whether or not it’s ok to take Chinese herbal medicine alongside western/modern medical pharmaceuticals.  While I do not prescribe as many herbal medicines as many of my contemporaries, and while most herbs do not interact in dangerous ways with most pharmaceuticals, there are exceptions.  It’s best to be well informed about herb-drug interactions, and no one I know of is more qualified to comment on this than my friend and colleague John Chen, a trained doctor of Chinese medicine as well as a doctor of western pharmacology.  His response to this concern appears below (excerpted with Dr. Chen’s permission)…

Concurrent Use of Herbal Medicines and Pharmaceuticals – Pharmacokinetic Interactions

by Dr. John Chen, Ph.D., Pharm.D., O.M.D., L.Ac.

The practice of medicine is now at a crossroad: countless patients are being treated simultaneously with both Western and Oriental medicine. It is quite common for a patient to seek herbal treatment while taking several prescription medications. According to JAMA, in 1997, an estimated 15 million adults in the United States (representing 18.4% of all prescription pharmaceutical users) took prescription drugs concurrently with herbal remedies and/or vitamins.

As the general public grows increasingly more open to the use of herbs and supplements, both patients and the health professionals who care for them are becoming more alert to the potential for occasional adverse herb-drug interactions. Safety has become a major topic of discussion. Even though herbal remedies are classified as dietary supplements, it must be noted that if used incorrectly, herbs, like any substance, may adversely affect patients. The safest route of access to herbal therapy is through a well-qualified herbalist.

Although Chinese herbal medicine has been prescribed safely by professionals in the West for many years now, and a great deal of research has been amassed in China, there is still a lack of formal studies that are published in the West to document the safety and efficacy of combining herbs with prescription drugs. Some questions posed by Western healthcare professionals or patients are difficult to answer quickly with documented specifics. However, with some general insights into pharmacology, one can foresee possible interactions and take appropriate precautions to prevent incompatible combinations.

The concept of ‘interaction’ refers to the possibility that, when two (or more) substances are given concurrently, one substance may interact with another, and/or alter its bioavailability or clinical action.
The net result may be an increase or a decrease in the effectiveness of one or both substances. It is important to note that interactions may yield positive effects (achieving better therapeutic effects at lower dosage) or negative results (creating unwanted side effects or adverse reactions). Most of the possible interactions may be classified in two major categories: pharmacokinetic and pharmacodynamic.

Pharmacokinetic Interactions

‘Pharmacokinetic interactions’ refer to the fluctuation in bioavailability of herb/drug molecules in the body as a result of changes in absorption, distribution, metabolism, and elimination.

Absorption
Absorption is the term that describes the process of the physical passage of herbs or drugs from the outside to the inside of the body. The majority of all absorption occurs in the intestines, where herbs or drugs must pass through the intestinal wall to enter the bloodstream. Several mechanisms may interfere with the absorption of drugs through the intestines.

The absorption of herbs may be adversely affected if herbs are administered with drugs that may promote binding in the gastrointestinal (GI) tract. Drugs such as cholestyramine (Questran), colestipol (Colestid) and sucralfate (Carafate) may bind to certain herbs, forming an insoluble complex that decreases absorption of both substances. Because of the large size of the insoluble complex, few or no molecules of either substance pass through the intestinal wall.

Herb absorption may be adversely affected in the presence of drugs that change the pH of the stomach. Antacids, cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), ranitidine (Zantac), and omeprazole (Prilosec) may neutralize, decrease, or inhibit the secretion of stomach acids. With this subsequent decrease in stomach acidity, herbs may not be broken down properly in the stomach, leading to poor absorption in the intestines. To minimize this interaction, herbs are best taken separately from these drugs by approximately two hours.

Drugs that affect gastrointestinal motility may also affect the absorption of herbs. GI motility is the rate at which the intestines contract to push food products from the stomach to the rectum. Slower GI motility means that the herbs stay in the intestines for a longer period of time, thereby increasing the potential absorption. Conversely, more rapid GI motility means that the herbs stay in the intestines for a shorter time, which may decrease absorption. Drugs such as haloperidol (Haldol) decrease GI motility and may increase herb absorption; while drugs such as metoclopramide (Reglan) increase GI motility and possibly decrease herb absorption.

Therefore, it may be necessary to decrease the dosage of herbs when the patient is taking a drug that decreases GI motility and increases overall absorption. Likewise, it is probably helpful to increase the dosage of herbs when the patient is taking a drug that increases GI motility and thus decreases overall absorption.

Distribution
After absorption, herbs or drugs must be delivered to the targeted area in order to exert their influence. ‘Distribution’ refers to the processes by which herbs or drugs (once absorbed) are carried and released to different parts of the body. Currently, it appears that the majority of herbs and drugs do not have any clinically-significant interactions affecting distribution, and thus can safely be taken together. The exception seems to be if a drug has a narrow range-of-safety index and is highly protein-bound, in which case interaction with other substances might occur during the distribution phase. Examples of drugs that have both a narrow range-of-safety index and a high protein-bound ratio include warfarin (Coumadin) and phenytoin (Dilantin).

Unfortunately, it is very difficult to predict whether an individual herb will interact with either one of these drugs because there are no known tests or experiments documenting such interactions.

Metabolism
Once metabolized by the liver, most herbs and drugs become inactive derivatives. The rate at which the liver metabolizes a substance determines the length of time it stays active in the body. If the liver were induced to speed up its metabolic rate, herbs and drugs would be deactivated at a more rapid pace, and the overall effectiveness of ingested substances would be lower. On the other hand, if the liver were made to slow its metabolism, herbs and drugs would be deactivated at a slower pace and the overall impact of the substances would be greater.

In general, drugs that induce greater liver metabolism do not exert an immediate effect. The metabolism rate of the liver changes slowly, over several weeks. Therefore, the effect of accelerated liver metabolism is not seen until weeks after the initiation of drug therapy. Some examples of pharmaceuticals that speed hepatic metabolism are: phenytoin (Dilantin), carbamazepine (Tegretol), phenobarbitals and rifampin (Rifadin). Therefore, herbs given in the presence of one of these products may be deactivated more rapidly, and their overall effectiveness lowered. Under these circumstances, a higher dose of herbs may be required to achieve the desired effect.

In great contrast, drugs that inhibit liver metabolism have an immediate onset of action. The rate of liver metabolism may be greatly impaired within a few days. Pharmaceuticals that slow or inhibit liver metabolism include: cimetidine (Tagamet), erythromycin, ethanol, fluconazole (Diflucan), itraconazole (Sporanox) and ketoconazole (Nizoral), among others. When a patient takes these drugs concurrently with herbs, there is a higher risk of herbal components accumulating in the body, as the ability of the liver to neutralize them is compromised. If the herbs are metabolized more slowly, their overall effectiveness may be prolonged. In this case, one may need to lower the dosage of herbs to avoid unwanted side effects.

Depending on the half-life in the body of drugs that influence liver metabolism, it may be necessary to increase or decrease the dosages of herbs for weeks or even months after discontinuation of the pharmaceutical substance, along with consistent monitoring.

Elimination
While the liver neutralizes incoming drugs and herbs, the kidneys are responsible for eliminating the substances and their metabolites from the body. If the kidneys are damaged, then the rate of elimination is slowed, leading to an accumulation of active substances in the body. Important examples of drugs that damage the kidneys include amphotericin B, methotrexate, tobramycin and gentamicin. As a safety precaution, when prescribing herbs for a patient who is currently taking or has recently taken one of these drugs, it may be wise to lower the dose of herbs to avoid unnecessary and unwanted side effects.

Summary of Pharmacokinetic Interactions
The pharmacokinetic interactions listed above include both theoretical and actual interactions. Though such interactions are possible, the extent and severity of each interaction will vary depending on the specific circumstances, such as the dosages of all substances, the inherent sensitivity of each patient, individual body weight, and metabolic rate.

Summary: Concurrent Use of Herbal Medicines and Pharmaceuticals
Historically, herbs and drugs have been presumed to be very different treatment modalities that have rarely, if ever, been used together. The line that separates the use of herbs and drugs, however, has blurred in recent decades as the lay public gains increased accessibility to multiple treatment modalities. It is not uncommon for one patient to seek care from several health professionals for an ailment. As a result, a patient may easily be taking multiple drugs, herbs, supplements, and vitamins concurrently. It becomes difficult to predict whether the combination of all these substances will lead to unwanted side effects and/or interactions. It is imprudent to assume that there will be no interactions. On the other hand, it is just as unwise to abandon treatment simply for fear of possible interactions. The solution to this situation is in the understanding of pharmacokinetic and pharmacodynamic herb-drug interactions. By understanding these mechanisms, one can recognize potential interactions and take proper actions to prevent their occurrence.

—–

About the Author

John K. Chen, L.Ac., Pharm.D., O.M.D., Ph.D.

Dr. John Chen is a recognized authority in both western pharmacology and Chinese Herbal Medicine. He teaches at the USC School of Pharmacy, Emperor’s College, Yo San University of TCM, OCOM, Five Branches, AOMA and ACTCM. Dr. Chen’s most recent published work is Chinese Medical Herbology and Pharmacology (2003, AOM Press) and Chinese Herbal Formulas and Applications (2008, AOM Press) for which he was lead author.

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