Acupuncture & Traditional Chinese Herbal Medicine Clinic
Corona Virus
By Scott Smallwood – Barefoot Doctor Clinic, Traditional Chinese Herbal Medicine, Sunshine Coast, Buderim, 20th February 2020
The 2019-20 Coronavirus disease has so far caused an estimated 2,000 deaths in China and 8 outside China. The estimated fatality rate from the disease is 2-3% so based on this it is possible that up to 100,000 people have been infected with the virus. 80% of people infected have a mild form of the disease with symptoms similar to the common cold. The incident has caused global economic disruption and the WHO has declared it to be a “Public Health Emergency of International Concern”.
Coronavirus or COVID-19 is caused by SARS-CoV-2 which is closely related to the Severe Acute Respiratory Syndrome or SARS virus. In 2002-03 the SARS virus originated in China, spread to 30 countries, infected 8,400 people and claimed 900 lives.
COVID-19 is a zoonotic disease which means it has spread from animals to people. The origin of the outbreak has been traced to a so- called “wet” market in mainland China. The environment for the disease is set by the close interaction between people and live and dead animals in this type of market.
There is no current known cure for the disease. Infected people who develop pneumonia type symptoms or acute respiratory distress can be provided symptom management and supportive measures in a hospital setting . This approach is basically aimed at keeping the patient alive until the immune system can run its course and the body can recover.
As with any health disaster of this magnitude there is a resulting frantic rush to develop treatments, preventions and vaccines. The Chinese government is currently running around 80 clinical trials to evaluate treatments and the World Health Organisation (WHO) is providing input into trial design and administration to ensure results are of the highest quality possible. A number of these trials are examining the use of Traditional Chinese Medicine (TCM) herbal medicines for the disease. Other trials are looking and various pharmaceutical drug options.
Although there are no results for these trials yet we could use historical evidence in relation to the 2002-03 SARS outbreak to give an indication of the role that TCM could play. A search of the major medical databases shows numerous studies into the use of Chinese herbal medicine for the SARS virus. In order to get straight to the highest quality evidence we can look for any “Cochrane Reviews” into the subject. These reviews are considered to be the current highest form of medical evidence in any area as they examine all available studies at the time of their compilation. All studies are then evaluated for their methodology and the quality. Any substandard studies are excluded from the conclusions formed by the review.
A Cochrane Review in relation to TCM herbal medicine and SARS was completed in 2012 (Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS). Liu X, Zhang M, He L, Li Y Cochrane Database Syst Rev, 2012 Oct 17;10:CD004882).
In this review information on 12 trials including 640 patients and 12 different Chinese herbal medicines were included. The following conclusions were reached based on the available evidence;
“We did not find that Chinese herbs combined with Western medicines decreased mortality versus Western medicines alone. 2 herbs may improve symptoms, 5 herbs may improve lung infiltrate absorption, 4 herbs may decrease the dosage of corticosteroids, 3 herbs may improve the quality of life of SARS patients, 1 herb may shorten the length of hospital stay.”
The above information indicates that TCM herbal medicine can be effective in decreasing the severity of SARS type viruses although they are not of assistance in the extreme stages of the disease when the patient is close to death. Based on these findings it would be reasonable to expect that Chinese herbal medicine could be of assistance in the management of the current Coronavirus outbreak. Chinese herbal medicine would be most effective if it were able to be used along side of Western medical treatments and drugs.
One final point to consider is that TCM herbs are not usually used individually. TCM herbal medicines are traditionally used together in a “formula” that is based on the patient’s specific symptoms and medical history. These formulas need to be put together by an experienced and qualified TCM herbalist.
This article has examined the usefulness of TCM herbs in regards to a serious epidemic. The TCM medical system also has a long history of use with various infectious diseases and under the direction of a TCM herbalist can be applied to many of the regular medical issues faced by Australians in 2020. There are of course areas where Western medicine should be the main therapy but different medical systems have their strengths and weaknesses and a TCM professional is often able to treat certain conditions or symptoms that are not fully catered for by other medical systems.
If you are considering using a TCM herbalist in Australia a search of the Australian Government AHPRA website can provide lists of qualified people in your area. https://www.ahpra.gov.au/registration/registers-of-practitioners.aspx
Herbal Medicine, Sunshine Coast, Scott SmallwoodBarefoot Dr Clinic, Buderim Qld 4556
Chronic Fatigue
By Scott Smallwood – Barefoot Doctor Clinic, Acupuncture, Sunshine Coast, Buderim
In 2015 researchers at Columbia University in the USA were able to identify specific blood biomarkers that are common in chronic fatigue following infections such as Epstein Barr (Glandular Fever). These scientists including Dr Mady Hornig and Dr Ian Lipkin concluded that this type of chronic fatigue is a specific biological illness rather than a psychological one (ie it’s not all in their heads). After testing 298 patients and 348 healthy controls they saw that patients with this type of condition for less than 3 years had high levels of cytokins indicating that “the immune response becomes like a car stuck in high gear”. It was only after 3 years that the fatigued immune system then displayed different responses. These findings are very much in line with the Traditional Chinese Medicine (TCM) concepts of “lingering pathogens”. TCM diagnostics are also able to identify what state the immune system is in following these illnesses through it’s system of pattern differentiation. Specific treatments can then be employed on an individual basis.
Acupuncture Sunshine Coast, Scott SmallwoodBarefoot Dr Clinic, Buderim Qld 4556
Ross River Virus, Bahrma Forest Virus
By Scott Smallwood – Barefoot Doctor Clinic, Sunshine Coast, Buderim, Sunshine Coast, 2015
Under current Queensland Health guidelines there is “no specific drug treatment for Ross River Virus (Fever) or Barmah Forest Virus Infection”. Current treatment guidelines are for “managing the symptoms that develop” (Qld Health website Feb 2015). These two viral infections are contracted through being bitten by mosquitos carrying the virus and are relatively common. They have similar symptoms, which include fever, headache, fatigue, painful joints, joint swelling, muscle tenderness, and skin rashes. The initial symptoms usually last less then one week but joint pain and fatigue can last up to 6 months. In my experience there is often a clear link between the lingering symptoms and numerous cases of chronic fatigue that can last a number of years
Traditional Chinese Medicine (TCM) has long recognised and treated both the acute presentation of such diseases and “lingering pathogens”. These persisting pathogens refer to the effect on a person’s health by a disease that the body has been unable to fully resolve. The actual symptoms can be different for each individual. It is highly likely that the 2,000 year old treatment protocols that I draw upon were originally employed in the treatment different types of pathogens than the ones we are discussing here as viruses change and mutate over time. The treatment however often proves to be successful and I believe that the reason for this is that the TCM approach is to treat the body and its immune system and as a secondary approach also attacks the virus directly. The main base formulas that I use to treat these viruses come from Dr Zhang Zhongjing.
The information contained in this article is drawn from both recognised TCM historical and modern literature and from my personal experience in treating roughly 4-6 cases per year for the past 20 years of my TCM practice.
Dr Zhang Zhongjing wrote his famous treatise the Shanghan Lun sometime before 220 AD. It is recorded that Dr Zhang has lost 75% of his extended family to infectious diseases and was therefore very motivated to improve the knowledge on treatment of these illnesses. Of the acute phase symptoms joint pain can be the most troubling to patients and in the chronic lingering stage it is commonly a continuation of these pains as well as chronic fatigue that have the biggest impact on a person’s well being.
In Traditional Chinese Medicine (TCM) and in the writings of Dr Zhang Zhongjing the joint aches are described as being caused by an“external wind damp invasion”. This terminology can seem quite strange to the modern interpretation of illness but in essence the two diagnoses are almost identical. External wind damp invasion is just another way of describing swollen painful joints that have been inflicted on the body by some external source. The fact that we now know that this is a virus rather than “wind and dampness” makes no difference to the tried and tested TCM treatment protocols.
The two main formulas that I use as a base that is then modified depending on the patient are Gui Zhi Tang and Xiao Chai Hu Tang. There are specific modifications for almost any additional symptom that a patient may experience. These symptoms can include anything from excess thirst through to mental confusion. As a TCM practitioner I must always take care to refer to the patient’s GP if any of these symptoms are considered to be “red flags”, dangerous, or requiring further investigation. The Shanghan Lun makes the specific modification of the addition of the herb Bai Zhu for a predominance of swollen painful joints (dampness). I however believe that something has been lost in the many translations over thousands of years from ancient Chinese text up until modern Chinese text today. I use the closely related herb Cang Zhu for this symptom as it has a stronger effect on clearing dampness and “releasing the exterior” (ie driving out external infections).
In the chronic phase of the illness there is often one part of the treatment that I use which is based on a modern understanding of the illness. In the treatment of post viral chronic fatigue, that can last many years, the primary course of herbal medicine usually lasts for 4 weeks. With some patients at around the 3 weeks mark there can be a significant worsening of their fatigue. If this happens we then use a high dose of a 4 herb mix that has been shown by modern research to have clear antiviral actions. This usually resolves this stage of the treatment / illness and the patient’s energy levels then often rapidly improve. I also use this treatment principle for chronic illness resulting from Epstein Barr Virus (Glandular Fever).
As in every field of medicine there is of course not often a 100% cure rate and there are some patients that I am unfortunately unable to help. This being said, in my experience traditional Chinese herbal medicine can be effective in alleviating the negative affects on many peoples state of health and wellbeing after they have contracted Ross River Virus, Barmah Forest Virus, or Epstein Barr Virus.
Copyright – Scott Smallwood- 2015
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Herbal Medicine Sunshine Coast, Scott SmallwoodBarefoot Dr Clinic, Buderim Qld 4556
Acupuncture for Rotator Cuff Shoulder Injury
Supraspinatus tendinitis is an injury that I see in my clinic almost every week and I also see people doing exercises that can cause this injury on an almost daily basis. So here we go I’m going to do the right thing and tell you how to avoid this injury (no Christmas presents for my kids but happier shoulders around the world)
Rotator cuff tears are one of the most common shoulder injuries and of the four rotator cuff muscles the Supraspinatus (S-S) is the most regularly injured (Williams GR et al 2004, Wikipedia). When the humerus (upper arm) is raised above a 90 degree angle to the body then the S-S muscular-tendon junction area where it passes under the acromium (Fig 1) can become “impinged” or squashed under the bones of the acromium.
The shoulder joint and associated muscles are an amazing piece of engineering. It allows us to push, pull or lift heavy objects and also allows us to reach high overhead and pick a tasty piece of fruit from a tree. One very common source of supraspinatus tear or inflammation occurs when we then go and lift heavy objects over the head. Often this injury is caused by work activities like holding a heavy drill overhead. This can be difficult to avoid for some people. An example of a totally avoidable action is people doing military press or overhead dumbbell raises in the gym. Not only are these exercises avoidable but I believe that that the principles of anatomy and physiology show that they are not really necessary.
Why raise heavy weights above your head in a gym ? Trying to get some nice delts ? (deltoid muscles). All of the three sections of the deltoid originate from different parts of the shoulder and then attach onto the shaft of the humerus (upper arm bone). Their common purpose is to move the arm. Please feel free to do your own research from a reliable source on human biology and physiology or you can trust me that the front section of the deltoids can be worked with bench press or push ups. Other muscle recruitment will normally take care of the middle delt but for bodybuilding for example they can be worked with dumbbell side fly’s (to 90 degrees only). If you go beyond 90 degrees the muscle is not worked or loaded any better and you risk debilitating injury to the S-S). Many athletes that I have seen have injured their shoulder at the gym and not during their main sport. Back to the delts, the rear ones can be worked with any pulling action such as seated rows (lat pull downs or the pull through the water in kayaking. These movements are very stable for the complex shoulder joint and therefore a lot of weight can be put into them, so go ahead on this one, load em up to work em hard).
So our S-S muscle wants to know where this relationship is going. Are you gonna treat her right or will somebody end up getting hurt ? Scientists (Reilly P, et al, 2003) showed that there was “shearing between the layers of the supraspinatus tendon” when they applied a downward pressure force to the upper arm bone (humerus) of ten fresh frozen people who were kind enough to donate their bodies to science on their passing. Maximum strain was reached at 120 degrees from the body (an equivalent angle to when you are about 1/3 the way through that good old military press exercise (I reckon they call it the military press not because it is a superior exercise of the armed forces but because there is a high body count of dead or wounded supraspinatus muscles !) This “Shearing” of the tendon can be slow to heal depending on the amount of future re-injury, the age and general health of the patient and any poor biomechanics that have contributed to the injury (Biomechanics is a whole extra subject in itself).
Let’s take a look at possible treatments from the two major medical systems in the world right now that are both equipped with surgical and drug treatment options. These systems are modern “Western” biomedicine and traditional Chinese medicine including Acupuncture and Chinese herbal medicine.
A search of the Pubmed medical database has shown the following evidence for Western medicine. Two ultrasound guided platelet rich plasma injections (ie your own blood) into the injury area showed a bit better effect than a single point very basic acupuncture treatment of two sessions (Rhs DW et al 2013). I wouldn’t expect to fix anyone like this so I reckon double nothing is still nothing. Another study showed that at 1 year follow up these plasma injections had shown no improvement (De Jonge S et al 2011). In terms of surgery, out of 75 thrower athletes with supraspinatus impingement from injury 60% of them were disappointed after a surgical debridement (removal of injured tissue) and none of the professional or international athletes were very satisfied (Riand N et al 2002).
Sometimes the body deposits calcium into a tendon tear to try and repair it. This can then cause restricted movement and pain. A Western treatment where they use an ultrasound to guide a needle to the calcium which is then jabbed a few times to break it up and steroids are then injection to heal more quickly has shown good results (Lubojacky J 2009). Surgery to remove the calcium has shown “excellent” results but a lengthy recovery process (Diehl P et al 2011).
In terms of injecting stuff into a torn tendon one review of all current evidence (Hart L 2011) Noted that corticosteroid injection could be helpful in the short term but “may be worse that other treatments in the intermediate and long terms”. The same study concluded that injections of Sodium Hyaluronate can be beneficial in the short and long term. One study (Vad VB et al 2005) showed that the steroid injection had better outcomes if also irrigated with 50-75ml of saline.
Now just looking at the “surgery” side of Chinese medicine in the form of Acupuncture. Is there any current scientific evidence to indictate why the very busy and industrious nation of China may have persisted with this system for at least 2,500 years ? One study (Neal BS et al 2012) noted that through “facilitation of tendon blood flow and fibroblast activity” acupuncture may have a role to play in the treatment of tendinopathy. Another (Lin W et al 2012) reported that specialist acupuncture techniques can treat calcifying tendinitis and lead to good clinical outcomes, however this study involved only one patient. In another generalized shoulder study it was shown that “acupuncture may be an effective treatment for chronic shoulder pain” (Lathia AT et al 2009).
Here’s four examples of this problem treated at my clinic this year.
- 17 year old semi professional surf lifesaving ironwoman with supraspinatus tear of the left shoulder diagnosed through physical examination. At commencement of my treatment the patient was only able to train at 20-30% of her required capacity and nationals were in 9 weeks. Through the use of acupuncture needles at various points in her legs only the patient was back in full training in six weeks and competed well at the nationals (8 treatments were given in total)
- 59 year old female who was unable to receive western medicine treatment for calcifying tendinitis of the S-S because the physician said that the calcium deposits were so big that they would just break his needles. Patient reported a 100% improvement in her condition (based on decreased pain and restricted movement) after 6 acupuncture treatments using point in the legs only.
- 62 year old diabetic patient diagnosed with S-S tendinitis and associated bursitis by ultrasound. Was not responding to any of the many different techniques of Acupuncture treatment after 4 attempts. Patient was then given systemic anti-inflammatory herbal medicine (Dr Daniel Weber’s Panaxea ICC formula) for 2 weeks and then acupuncture was resumed. The patient continued on the herbs and reported a 90% improvement after 4 further treatments.
- 58 year old male who injured his shoulder 12 months prior trying to stop an empty shipping container from sliding onto a co-worker. No ultrasound or other imaging had been undertaken to confirm the nature of the injury but a S-S tear seemed likely from the symptoms. After 5 treatments we were able to greatly improve the patient’s digestion and ankle problem but were unable to make any significant change to his shoulder. I suggested that he get some extra diagnostic scans and we could discuss possible treatment options. I am waiting to hear back on this one.
So there you have it, try not to hurt your shoulder and if you do I hope that I have given you a bit of an idea on different treatment options. Remember, the only medicine you want is good medicine, it’s not important what name it goes by.
Acupuncture Sunshine Coast, Scott SmallwoodBarefoot Dr Clinic, Buderim Qld 4556
Acupuncture Sunshine Coast, Scott SmallwoodBarefoot Dr Clinic, Buderim Qld 4556
