TCM Kongress Rothenburg odT

The 44th TCM Kongress 2013

What I learnt

There is a resurgence of classical acupuncture, that TCM is recognised as just a brand, that there are amazing research findings in all countries and that the European experience of medically trained health workers is allowing acupuncture to be integrated within hospitals – especially for cancer and in many other gaps of care.

I will return yearly as I had a full 5 days – two seminar.workshops first) of discovering new things, and of finding peers.

First report

Gua Sha

Review of ‘Gua Sha, A Traditional Technique For Modern Practice’ 2nd edition

Having listened to Dr Arya Neilsen’s empassioned speaking at the 44th Rothenberg Kongress on her work at Beth Israel Hospital, and then again in two presentations on the Science Day, I was reminded of how I used to have great results using the spoon and the fingers methods – and that I had stopped mostly.

With rapt attention I remembered how such a simple tool had often worked better than needles – and when myself decades ago, a sick student had walked in exactly at the entry into Tai Yang division the night we were covering the subject. Armed with just cups and a spoon – she got off the table well, having been diabolically ill moments before – no needles – just Gua Sha . . completely no symptoms . . magic!!

Where has this information been? Dr Neilsen explains how what was written out in the branding of ‘TCM’ has been not to our medicine’s advantage.  Possibly due to the herbalisation of the TCM and constant reinforcement politically and academically, the practical and effective methods less graceful, less aesthetically pleasing are missed.

Much like my 30 year study of the folk/home remedy of navel cupping to release stored cold so the body’s yang can reassert itself – after appropriate moxa work. Home remedies were passed down – they worked – everyone knew about them – no one needed teaching.

Now we have her 2nd edition Gua Sha book full of research and extensive information that really allows a totally different explanation as to the anatomy and physiology of our bodies. A must read for anyone interested in how acupuncture works.

The initial several chapters outline how a body and acupuncture work. It is fascinating reading, backed up by extensive coverage of all angles, before Dr Neilsen goes into the process and cases of using Gua Sha.

She brings Gua Sha into the C 21st through the extensive use of small mammals and electronic gadgetry. (I love the bit about the mouse not being harrned). She explains in elegant explanations exactly how and why the Cou Li (level between the aura and skin, encompassing the Lou vessels – the paths of Qi – and how effective Gua Sha is at removing any and all stagnation – however deeply held. Revelations upon understandings for this senior practitioner. A must get book!

Dr Neilen shows thus alternative way of getting whatever is stuck in the meridians to move. Anyone wishing to assist anyone with pain – congestion would do well to invest in this book. It explains far more than how and why Gua Sha works.

The body holds such a wealth of information stored in the fascia – as those studying orthobionomy, any Bowen, or myofascial therapist will attest – and we have here at our fingertips a time honoured and meaningful way to alter permanently – and now backed up by Doppler and MRI research – exactly how and what happens with Gua Sha.

Why ever would we choose needles – especially in Hep B when we can Gua Sha? Or for any pain or inflammation – why would we not change the HO1 levels ? See more in her fully referenced and research full 2nd edition.

My story

Having spent the past 30 years using a cup on the navel and seeing massive instant tongue changes – and profound body alterations that are permanent – I had stopped Gua Sha – as it seemed to be not needed after the other folk remedy I thought.

When back in my clinic, I was keen to see what would happen and started Gau Sha to see if there was any residual congestion in a lot of patients. The ones I used it on had to have blanching with my palm on their back. A few I used Gua Sha instead of the navel cupping, The weather had changed from 25 C to a low of 8 overnight an many were now suffering form weather changes.

They complained – it hurt – and also wore me out!!!  I figured the latter was just me not using muscles before – and I would get used to this – especially as most of my patients do get massage after their treatment as I find that extremely valuable to clear out any left over congestion.

I was surprised that I did not get the results Dr Neilsen does – but then I have extensively pulled the stuckness from all with the navel cupping, with clearing their eight extras (reservoirs of perverse qi) and have been using moxa and gouging massage on any obstructions – after clearing all scars I can find.

The only case where it really made a huge difference was on someone who had fallen off a ladder 3 metres onto the concrete – and had still residual movement and pain symptoms. This is after a year – and massive work, especially massage after all cupping, moxa and needling, I had also sent him to a very different physiotherapist who had moving a lot of inner problems. We still had maybe 2% trouble left.

I started with Gua Sha and was heartened to see after the time it took, that there was discolouration on the side that had been affected. It felt different than before to him!! No tongue changes – but he felt freer. I worked on the unaffected side first. I do this to allow the upset side to calm down, and to at the person as to what to expect.

I have ordered the video to learn more of how she goes about this as I may well have missed something!! After her extensive work on this traditional and effective technique, I am sure she has some tricks . .We can always learn more.

Find out more http://www.guasha.com/aboutauthor.html

Buy the book http://www.us.elsevierhealth.com/Health-Professions/Complementary-Medicine/book/9780702031083/Gua-sha/

 

2nd report – Hugh McPherson on depression study. (Science day)

I am very interested in how acup is presented in trials – as to me 0 it seems I know no one who would use the points of the treatments in general that are studies – so what is this saying about misrepresenting what is out there, and what actually works?

(My errors, if any as I was dictating and listening and thinking in tangents concurrently as we all do)

Pilot studies are important – show you where you are going.

He did 5 major grant proposals – Acup vs usual care.

But no ‘placebo’ control – this was seen as a major criticism.

Are we asking the right question?

Should be – how do acup usually use acup?

Whereas the design reviewers what to treat it like a dangerous drug.

Researchers want equipoise. BUT to be a practitioner – we want to do what is best for the patient.

So – without using sham control – (so our ethics are congruent), what to do?

His reviewers comments were all –ve reviews because of this.

Solution – three arm trial.

THREE QUESTIONS in the depression study to be answered.

1)    – Is acup clinically/cost effective?

2)    – Counseling

3)    – How does the acup and counseling compare?(adjust for time and attention)

(RCT) – acup and usual care (pharmacological assistance) – up to 12 sessions – 40%

– counseling and usual care as above                                                         40 %

– usual care alone –                                                                                       20%

Outcome measures –

Primary outcome at 3 months                                                PHQ9

Bodily pain                                                                             SF36

Beck depression inventory 11

EQ – 5D

Analysis

Intention to treat.

Analysis of co variance at 3 months

And at 12 months.

Cost effectiveness at 12 months.

Setting – 27 primary care practices across UK – bypassing the GPs

Eligibility – over 18 years old.

Diagnosed as being depressed by GP

Baseline score 20+ on BD1 – 11. (So all were moderate to severely depressed).

Why did he want them?

Was a focus group as most others were only testing mildly depressed people.

(Big problems with self harm and suicide though – esp for acup who may not be used to seeing such severe cases).

Excluded – recently bereaved

755 patients – 302 (40%) x 2 and a ‘control’ group of 151.

He had the resources to keep going so spent 18 months ongoing recruiting – and not through GPs – and local acup took over . .

Could sign up to have text messages – and of the 70% who did – 90% responded.

Were asked to gauge their mood changes – 1 – 9

Mostly were women – average age 44.

First time dep and usually over 25 years depressed (!)

67% reported severe depression

69% taking prescribed depression medication

Acup – mean of 10 sessions.

Counseling  mean of 9 of the 12 on offer.

Counseling – was non directed, humanistic

Acup = no protocol – whatever the practitioner wanted to do – just no magnets or herbs. Did their own diagnosis.

73 acup, 61% were female.

2741 sessions

99% were TCM diagnosis

Stuck Liver Qi primary – 47% secondary – 25%

Sp Qi Xu and damp – 16% primary, 18% secondary

Common points – Sp 6, Liv 3, St 36, Co 4 (I wondered why no Delphi at least – I would not be doing this for rdepression) .. .

Found short term change ..

66% also given other info . .

42% got dietary advice

30% exercise and

25% relaxation

What changes did they make?

Mechanism is about change – not the needling

Measures of empathy and attention – with enablement . .

Graph – can’t do ..

Clinical outcomes – 0.27% effect size at 3 months.

0.39%  acup

Areas under the curve – same for the interventions.

Acup vs counseling – no sig. differences – after adjusting for contact time.

Time for difference on text messages was 10 – 11 weeks.

Counseling cost more (Pounds 5,000 vs 3,000) – and so adjusted, acup was cheaper and more benefit.

No adverse events.

Of the 755 patients – 3 unrelated deaths. (all in acup group)

Duty of care . .

Limitations – non specific effects unmeasured.

We don’t know what aspects of the treatment worked.

Potentially – both counseling and acup are ‘placebo’.

Thoughts – Use ‘acupuncturists’ care’ instead of ‘acupuncture’ in all terminology.

(is all about the labeling again).