Acupuncture, Part I: An Overview

2008/May/12 17:12

I know I’ve talked about this series on acupuncture with several readers and friends. It was first postponed because we went off-line for one week, and now is further delayed because last week I remembered to bring the medical releases to the clinic, but...forgot the camera. *smacking forehead* My next opportunity to take photos of the test subject is next week. Yes, I should ask the acupuncturist whether forgetfulness can be treated with needles, too.

So begging your indulgence for this dense post, I’m going to go ahead with a quick overview of acupuncture. The next post will cover the clinic experience — what to expect and what it feels like. A third post will look at the homework you can anticipate when you’re back from the clinic (yes, there’s homework).

moore

CHI

When you think of acupuncture, you probably think of needles. Lots of them. And while this is certainly a defining aspect of acupuncture — versus say, acupressure or massage — it really isn’t the heart of it. Instead, to understand how acupuncture works, we have to re-visit the concept of Chi (chee), also spelled Qi, or Ki (kee) in Japanese (as in Rei-ki).

“Chi” is probably one of the most difficult concepts for the Western mind to wrap itself around. It is defined here by a physician trained in Traditional Chinese Medicine (TCM), identified only as Dr. Fang, in Dr. David Eisenberg’s (MD) seminal book on TCM, Encounters with Qi (W.W. Norton & Co., 1985):

‘Qi means that which differentiates life from death, animate from inanimate. To live is to have Qi in every part of your body. To die is to be a body without Qi. For health to be maintained, there must be a balance of Qi, neither too much nor too little.’ (page 43)

In English, it is most often translated as "universal life force," or "vital essence." TCM understands Chi as existing not only within the body, but also in the environment — we take in nutritional Chi by the foods we eat, and breathe in air Chi by respiration.

TCM envisions the body’s Chi as existing in and running through channels, or meridians, that are interconnected and that affect each other in different relationships. Each meridian is linked to a major organ in the body, and is often named after the organ with which it is associated (e.g., the Lung Meridian). Through the meridians, Chi circulates through the healthy body in a defined pattern, delivering needed nutrition to organs and removing wastes and toxins. When there is an imbalance in one meridian, it can cause a domino effect in the other meridians, both behind and forward of the unbalanced or blocked channel. If left untreated, the body’s Chi becomes weak and leaves the body susceptible to both internal and external factors that can precipitate disease and illness.

It is the role of the TCM physician not to diagnosis the disease or condition (pneumonia, migraine, back pain, etc.), but rather the underlying root of the imbalance in the body’s Chi. The condition is merely a symptom of a deeper issue — the physician is interested in Why the pneumonia, migraine, etc., has been able to overcome the body’s protective Chi. In every case the answer will be different because each patient will have different circumstances that bring on their health crisis. Therefore, two people who enter a TCM physician’s office with the same complaint (e.g., migraines) are likely to have completely different treatment regimes.

For we who are accustomed to the treatment model, “You have this condition, take this pill” this takes a moment to sink in. It is the meaning of “Holistic” — that individuals require treatments tailored for their individual circumstance. Wow, what a concept. And that is the feel-good side of holistic practices: you’re not just a condition, you’re an individual. The flip-side of holistic practices (acupuncture included) is that these treatments are not magic bullets, and they often don’t provide immediate relief of the symptoms that bring us to the TCM physician’s clinic. Sometimes symptoms will even get worse for awhile, before they get better.

The thing to keep in mind is this: the series of circumstances that finally brings on physical symptoms in the form of disease or illness are often the result of years, even decades, of accumulated poor practices (lousy diet, poor sleep habits, lack of exercise) and environmental influences (stress, weather, trauma). It won’t be undone in a day, a week, or even a month. As for worsening symptoms, this is also something recognized in Western medicine. My father suffers with large tophi (uric acid crystallizations) that leave his hands and knees deformed and painful. His internist warned him that the low-purine diet he was prescribed should slowly dissolve the acid crystals, but that as the crystals dissolved they would re-enter the blood stream before being eliminated through the kidneys. The sudden influx of uric acid in the blood could trigger a painful gout attack, in which case his medication dosages would be adjusted. Eventually the tophi should be eliminated; and if he maintains a sensible diet, the gout attacks also minimized.

DIAGNOSIS

In TCM, diagnoses are made in terms of Chi: Is there enough Chi? Is it active (Yang) or stagnant (Yin)? What channels/meridians are affected? What internal and external factors are affecting the meridians?

To reach a diagnosis, the physician will use carefully defined techniques, some of which have been chronicled, practiced, and adapted for 2000 years. These include pulse-taking, examining the tongue, specific questioning, and observation of the patient's speech, smell, color and appearance. We will touch on those more in the next part in the series, The Clinic Visit.

ACUPUNCTURE

So how does acupuncture work? The theory behind TCM is simple enough: restore balance to the body’s Chi and the body can begin to heal itself. A primary use for acupuncture is the stimulation of points along affected meridians to allow Chi to travel as it should on its appointed route.

TCM teaches that there are 12 meridian pairs running symmetrically along the left and right sides of the body, 2 non-paired meridians that run along the midline of the torso and head, and collateral meridians which are points that connect meridians to one another. Each meridian has a defined number of points; some have as few 9, others over 60; for a total of over 300 points.

In acupuncture, meridian points are influenced with the insertion of long, thin needles, which may also be used to conduct a mild electric current. The needles can release accumulated Chi in a blocked meridian (in much the same way accumulated water is released when a pipe is cleaned), or stimulate slow-moving or stagnant Chi to circulate more freely (imagine fresh water coming in to a tidepool), or divert Chi from one meridian to another. In each case, the goal is to restore the open circulation of Chi.

Another use for acupuncture is pain management and anesthesia. Even non-TCM physicians can use acupuncture to manage pain in chronic illnesses such as fibromyalgia or diabetes. In these cases, needles are inserted at meridian points which are thought to release endorphins into the body to lessen pain. This can be used in conjunction with meridian points that also support body functions that contribute to the patient’s comfort and well-being in managing his overall condition (e.g., blood cell production, elimination of toxins by the liver and kidneys, etc.). Acupuncture has also been used in lieu of or with local anesthetics to control pain during surgery or painful treatments.

FINDING A PRACTITIONER

Finally, if you're considering acupuncture for yourself, Dr. Kidson offers some practical advice about choosing a practitioner and what to expect. First, she cautions that most governing bodies of complementary medicine do not allow their registered members to advertise (Yellow pages listing or "Accepting new patients" notices in newspapers are allowed), so be wary of flyers that promote acupuncture for specific illnesses; in fact, your best bet may be to seek personal recommendations. Second, consider whether you are interested in pain management only or a more holistic approach, then check whether the acupuncturist you are interested in has earned a degree (a longer more comprehensive program with an holistic approach) or taken course work in treating symptomatic pain. During your first appointment, describe your condition and ask whether the practitioner can treat it, what the limitations of treatment are, and how long you might expect treatment to continue; the practitioner should be willing to recommend other treatment options if you don't show improvement over time. To these I would add, familiarize yourself with the licensing requirements in your jurisdiction; every country — and in the U.S., every state — has different requirements and allows different titles to be used. You can read Hawaii's regulations regarding acupuncture in full: H.R.S. §436E: Acupuncture Practice (I could no longer find these readable on-line, this link will download a PDF file to your computer).

I didn't pick up Dr. Kidson's book until after my second treatment, so it was sheer good fortune that we found the TCM practitioner we did. Although she limits her practice here to acupuncture and herbology, she also trained as a medical doctor specializing in acupuncture in her home country. Her training allows us to talk to her about our medical conditions, and she has advised us when to seek further Western medical diagnoses too. In the next part of this series, you'll meet the charming Dr. Wong, D.Ac., in her clinic.

Tags: Healing

No Bacon Butty? Try a Ham on Poi Muffin

2008/May/08 08:09

Over at the Golden Arches, there are often featured items that cater to local tastes, like the occasional Taro or Haupia Pies in Hawaii. If I were the man with the curly red wig, this is what I would have on the breakfast menu over there. A breakfast sandwich with char-siu ham, furikake-dressed egg cooked medium-soft in a butter-kissed poi english muffin. No need cheese, it's too tasty already.

This is going out to Sandy in San Antonio, who asked in December what a Bacon Butty was (at first we thought it was "bacon buddy" — it was referenced on a British sitcom). I've had no luck finding any back bacon on Oahu, and regular or Canadian bacon really isn't the same. With Hawaii's historical ties to England, you'd think you could find more British products around here (bangers, yes; back bacon, no). I know my little creation bears absolutely no resemblance to a Bacon Butty, but hey, it hits the spot for grease and whimsy. Have you had better luck making a Bacon Butty? (Read a BBC report on the scientific method to the perfect bacon butty)

Tags: Hawaii

Crispy Nori-Wrapped Walu & Shrimp with Papaya Coulis

2008/May/05 04:11

The three times we've gone out to dinner for our anniversary here in Hawaii have all been disappointments. So this year I decided to make something at home instead. Armed with a new cookbook from local chef Elmer Guzman (recommended by Laurie in Alaska!), I borrowed ideas from 2-3 different dishes to create this: a nori-wrapped walu and shrimp lumpia and a citrusy papaya coulis.

Walu is sold here as "Hawaiian butterfish" but is properly known as Escolar — a very white, flaky and oily fish that is actually banned in Japan and Italy because it can cause intestinal upset if not prepared properly (grill or pan-fry to release the oils that cause upset) or if consumed in too great a quantity (no more than 6 oz. per person). But I'm not scared! I love the unusual firm but most texture and mid flavor, and especially enjoyed this preparation. However, any firm flaky fish, such as tilapia, cod, halibut, snapper or even catfish would do well as a substitute here.

I love the flavor of nori in this, and I think it makes for a nice presentation, but if it would dissuade you from trying this, then feel free to leave it out. For the coulis, I paired the papaya with lime juice — a winning local flavor combination — and added a splash of wine vinegar for acidity to cut through the oiliness of both the walu itself, and the deep-fired shell. If you can find nigella, also called onion seeds, at a health food store (in the bulk spice section) or an Indian grocer, the peppery black seeds make a wonderful counterpoint to the flavors in the coulis and fish; otherwise, black sesame seeds or even crushed papaya seeds can be used for presentation.

It was a great marriage of contrasts and balance — crispy yet meltingly soft fish, and sweet but tart fruit sauce.
Kind of like a couple I know. . .

CRISPY NORI-WRAPPED WALU & SHRIMP W/PAPAYA COULIS
(inspired by The Shoreline Chef, by Elmer Guzman)
For the Papaya Coulis:
1 ripe papaya, peeled, halved and seeded
sea salt
1/2 tsp. raw sugar
2 tsp. white wine vinegar, or 3 tsp. rice wine vinegar
2 tsp. fresh lime juice

Place all ingredients except lime juice in a small saucepan. Using a hand or stick blender, puree papaya until smooth. Cook over medium heat until it just starts to bubble, about 10 minutes. Then reduce heat to low and simmer an additional 5 minutes. Remove from heat and add lime juice. Taste and correct seasoning — you shouldn't "taste" vinegar or salt at all, only the papaya and lime.

For the Shrimp Filling:
6 oz. shrimp, peeled and coarsely diced
1 large piece of dried Chinese black fungus (tree ear, or mok yee), rehydrated and cut in slivers
sea salt
ground white pepper
2 tsp. sake or Chinese rice wine
1 stalk of Chinese flowering chives, or flat garlic chives
1/2 tsp. corn starch

Combine all ingredients, and leave to marinate at least 20 minutes, but no longer than 2 hours in fridge.

3-4oz. of walu, tilapia, cod, halibut or other firm flaky fish, filet cut into 4 equal pieces
(This step is only necessary if you are using Walu. For other types of fish, I would skip this.) Pan-fry each filet piece in a lightly oiled skillet over medium-high heat. Brown all sides. Lay on paper towels to cool completely.

To assemble:
4 sheets of lumpia or egg-roll wrappers (covered with a lightly dampened cloth while working)
2 sheets of nori for sushi, each cut in half
water, to seal rolls

To Finish:
Nigella, or onion seeds
Flowering chives

Preheat oil in wok or other deep-fryer to 375F.
Lay lumpia wrapper on clean dry surface. Place nori in center of wrapper (you may have to trim nori so it doesn't cover the top end of the wrapper, or you won't be able to seal it).
Place fish on nori near the bottom edge, and a few spoonfuls of shrimp on fish (see photo at left).
Bring bottom end to cover fish/shrimp, then fold sides to center around filling (middle photo).
Keeping gentle pressure on the filling as you roll (to keep it tight), roll to the top. Wet top edge of wrapper with water (photo at right), before last roll to seal.
Repeat 3 more times.
walu_lumpia_rollstart

Fry 2 at time so they don't crowd the wok. Cook for about 5 minutes total, turning lumpia over after 3 minutes. Remove to paper towels to drain. Repeat with remaining lumpia. If using flowering chives, make certain they are completely dry (or it will splatter and you will burn yourself), and hold one end of chives and briefly dip flowering end into hot oil. Drain.

To serve, slice each roll in half on a sharp diagonal. I originally wanted to serve this on a bed of chewy soba noodles, but in the end I was really craving rice so that's what we had this time. Buckwheat soba noodles would also go well with both the fish and the coulis. Place fish on and around rice or noodles, drizzle coulis around edge of plate and sprinkle with nigella. Garnish with chives.

walu_lumpia07

Tags: Fish, Local produce, Recipes

Pears, Blue Cheese & Walnuts w/Baby Greens

2008/May/04 05:19

salad_bleupoire_fan

We don't have green salads very often, but our hands-down favorite is this pear, blue cheese & toasted walnuts on a bed of baby greens. Now pears, nuts and cheeses can also serve as a or pre-dessert or dessert course, and I actually prefer this salad after the entree. The acriditiy in the walnuts and mustardy, nutty vinaigrette is the perfect foil for the play between the sweet pears and salty, musky cheese. This is another one of those dishes where the synergy in the whole surpasses the sum of the individual parts.

Of course, the star here is the blue cheese so use the best quality you can find, Maytag and Amish blues are our favorites in the US; Roquefort (Papillon brand, if available) in the Continent. The pears, too are important; search out ones with a creamy texture when ripe such as Bartletts/Williams or Packhams. Oriental/nashi pears are delicious, but the synergy is not present when we tried this combination. And don't forget the walnuts. I don't like walnuts — in any recipe where I can substitute another nut or omit them completely, I will do it in a New Your minute! But there's something about the tannins in the skins and the slightly sweet taste brought on by the toasting that makes the walnuts a crucial part of the synergy. The salad seems "flat" without them — see, we did try to leave them out once!

PEAR, BLUE CHEESE & WALNUTS WITH BABY GREENS AND HAZELNUT VINAIGRETTE
For 2 people
Place salad plates in refrigerator to chill for at least an hour.

1/2 cup walnuts
Preheat small counter top oven to 400F/200C. Position oven rack to the highest tier. Chop nuts coarsely and place them on a tray. When oven is fully pre-heated, place nuts in top rack and roast for one minute, then turn off heat and lave oven door closed until pan completely cools. Meanwhile, prepare vinaigrette and salad.

For the Hazelnut Vinaigrette:
1 tsp. Dijon-style mustard
1/4 tsp. sea salt
fresh ground black pepper
1/8 tsp. raw sugar
1 tsp. lemon juice
2 tsp. white or red wine vinegar
1/4 cup hazelnut oil (or walnut oil)

In a small bowl, put mustard, salt, pepper, sugar and lemon juice and whisk well to dissolve salt and sugar. Add vinegar and whisk again until incorporated. Add all of the oil, and whisk vigorously to emulsify. Set aside.

2 firm-ripe Bartlett, or other creamy type, pears
4 cups of baby greens, or mache
2 oz. chunk of Maytag or other quality blue cheese

Peel pears, then quarter lengthwise and remove core. Slice each quarter lengthwise into 3-4 pieces.
Place 2 cups of greens on each chilled plate. and lay 2 quarters (1/2 pear) over greens.
With a fork, separate small chunks of cheese and scatter over salad. Add cooled walnuts.
Drizzle Vinaigrette over all and serve immediately with or without sliced baguettes on the side.

Tags: 5-A-Day, Fruits, Recipes

Three Tastes

Tao in the Kitchen