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Treatment of Post Traumatic Stress Disorder with Integrative Medicine: A Case History

Author: Shay Ravid, Shai Shorer, Alon Reshef, Elad Schiff, Maitri Shacham Leslie Cohen & Boaz Bloch

Post-traumatic stress disorder (PTSD) is a complex multifactorial mental disorder with unknown aetiology and heterogeneous presentations. Due to its complexity, in order for treatment to be effective, the treatment approach should be individualised, integrated and multidisciplinary, and address the four major biopsychosocial components: (1) genetics, age, sex, race and existing medical conditions; (2) diet, lifestyle and smoking; (3) depression, anxiety, stress or excessive anger; and (4) social support system, quality of marriage and finances. The use of complementary and alternative medicine (CAM) has proved itself to be safe and effective for many disorders, and its application in the treatment of mental disorders is increasing. This article presents a case study in which an integrative approach that combined psychiatric medicine and Traditional Chinese Medicine was effective in helping the patient return to her normal lifestyle.

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Chinese Nutritional Therapy: Case Studies

Author: Toby Daly

This article presents cases from the author's clinical practice that responded favourably to dietary intervention in order to to illustrate the utility and effectiveness of dietary intervention based on Chinese medical pattern differentiation. The author hopes that these case studies will inspire practitioners to incorporate this powerful and accessible tool into their own clinical work.

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Acupuncture Treatment of Pi Disease in the Shang Han Lun

Author: Hui Zhang

As defined in the Shang Hang Lun (Discussion on Cold Damage), pi (痞, glomus) refers to a condition characterised by distention or fullness, pain and/or other discomfort in the stomach and chest region. There are 11 different patterns of pi disease, many of which correspond to common digestive disorders involving dysregulation of Spleen and Stomach qi, i.e. rebellious Stomach qi and sunken Spleen qi. According to the Shang Han Lun (Discussion on Cold Damage), a patient may present with pi-disease when a cold pathogen invades from Taiyang due to the wrong use of purging methods. Pi-disease may also correlate with a pattern of qi xu (deficiency) in the middle jiao. If the ascending-descending dynamic is disturbed, water or phlegm may be retained in the middle jiao and chest, manifesting as pi disease. This paper analyses the eleven patterns of pi disease in the Shang Han Lun, including cold pi, exterior yang xu, heat pi, shaoyang pi, water pi in the middle jiao, sanjiao water pi, water pi in chest, chest phlegm pi, rebellious phlegm pi, xu pi and lower jiao xu li (watery stools) after pi disease. Commonly used acupuncture points that treat pi disease by supplementing the qi of the middle jiao and balancing the ascending-descending dynamic of the Spleen and Stomach are given, including Gongsun SP-4, Yinlingquang SP-9, Pishu BL-20, Zusanli ST-36, Neiguan P-6 and Zhongwan REN-12.

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An Interview with Z'ev Rosenberg

Author: Z'ev Rosenberg and Daniel Maxwell

Z’ev Rosenberg is a practitioner, teacher, author and elder statesman of the Chinese medicine profession. This interview was conducted in late 2018 following the publication of his book, Returning to the Source: Han Dynasty Medical Classics in Modern Clinical Practice.

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Electro-Acupuncture for Visual Rehabilitation after Ischaemic Stroke: A Case Report

Author: Tanya Love

Objective: To observe the effects of electro-acupuncture on visual function in patients with recent visual loss from a cerebral vascular accident.

 Patient: An 84 year-old male incurred a cerebral vascular accident that resulted in moderate to severe visual impairment.

 Intervention: Electro-acupuncture tailored according to a traditional Chinese medicine diagnosis (three treatment sessions per week for nine months - 108 treatments).

 Main outcome measures: Visual field-testing before and after the series of treatments. The acupuncturist also performed crude visual field testing before and after each treatment session (Donder's Test).

 Results: Visual field and visual acuity improved over 80 per cent over a period of nine months.

 Conclusions: This case suggests electro-acupuncture may help patients with post-stroke visual symptoms. These results must be interpreted cautiously because of the small sample size. More case reviews and a randomised controlled pilot study are feasible and warranted.

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Applied Chinese Facial Diagnosis: Three Case Studies

Author: Elisa Bergquist

Chinese facial diagnosis is one of the oldest observational skills and diagnostic techniques available for practitioners of Chinese medicine. However, in modern Western clinical practice, not all practitioners fully understand or utilise facial diagnosis. Since ancient times, the first thing to be checked by the physician was the facial complexion and the light emitting from the eyes, otherwise known as the shen. Most modern practitioners employ pulse and tongue diagnosis within their clinical practice, but over time thorough facial diagnosis has become less commonly taught, and is therefore under-utilised. Used solely or together with tongue and pulse diagnosis, facial diagnosis can help a practitioner pinpoint the pathophysiology of many conditions in the early stages, thus preventing disease. Three case studies are presented here to demonstrate the advantages of Chinese facial diagnosis within a clinical setting. To illustrate what was observed in each patient’s case, a photograph was taken before and after the consultation and treatment. The key facial signs are explained in the context of the patient’s disharmony and the change produced from the acupuncture treatment. Further discussion, application and research of Chinese facial diagnosis within a Chinese medicine clinical practice is still necessary.

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Why Randomised Placebo-controlled Trials are Inappropriate for Acupuncture Research

Author: John McDonald

Although real acupuncture usually outperforms usual care or no treatment in research studies, when compared to sham acupuncture the differences are often small. This has been described as a ‘paradox in acupuncture research’. Is it because acupuncture is just ‘theatrical placebo’? Or because sham acupuncture is not inert?

 Or perhaps because the real acupuncture used in the study was not optimal? This paper addresses the first two questions.

 The randomised placebo-controlled trial (RCT), often referred to as the ‘gold standard’ for healthcare research, were designed to measure a single variable while attempting to control for all others. They were first developed to assess medications, but are problematic as a research model for assessing complex skillbased therapies including acupuncture, psychotherapy and surgery. There is now evidence that shows that sham acupuncture protocols used in trials to date have not been inert and in fact produce effects that real acupuncture does not. This has caused a consistent underestimation of the effect size of real acupuncture.

 Another factor impacting on acupuncture research is the prevailing understanding of placebo, which according to popular science is responsible for 30 per cent of all treatment effects. In fact, research is now suggesting that placebo effects may be much more complex than previously imagined, and may involve the genetic predisposition of subjects. Estimates of both the effect size and prevalence of placebo in studies have varied wildly, suggesting serious problems with how placebo has been measured.

 This article explores these problems with acupuncture research, and concludes that comparative trials analysed using network meta-analysis to produce a ranked order of therapies in terms of effectiveness, safety and cost effectiveness - is much more useful for developing clinically relevant practice guidelines than the current model of RCTs analysed via systematic reviews.

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Grace and Power: In Memory of Charles 'Chip' Chace

Author: Tianying Sun

This article is an obituary for the East Asian medicine practitioner, author and teacher Charles ‘Chip’ Chace

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The Chinese Medicine Treatment of Anorexia Nervosa

Author: Yuning Wu, Celine Leonard, case study by Esther Denz

This article presents the treatment of anorexia nervosa with Chinese medicine (Chinese herbal medicine and acupuncture). It is excerpted from a forthcoming clinical manual on the treatment of infertility with Chinese medicine.

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Book Reviews in this issue