New patient, ancient medicine.
May 16, 2024 4:21 AM   Subscribe

I had my first session with a traditional Chinese medicine practitioner last week. Yay! What questions should I be asking her?

I have a welter of digestive and other ailments (longterm Lyme among them) for which I went to an acupuncture session with a traditional Chinese medicine doctor last week. She is Chinese and went to medical school in China, and I sought her out specifically for being from the culture that brought us this great library of healing practices.

During the session, I felt the "heaviness" described by many when they experience acupuncture. And she managed to loosen up one of my chronically stiff shoulders with needles in the right places.

She prescribed me an herbal formula two of whose ingredients appear to be on point for digestive problems. However, my silent acid reflux continues to bubble away like a little volcano. (I've already eliminated a bunch of foods that aggravate acid reflux, most notably caffeine and chocolate, and am following her suggestions as well.) I am seeing a plain old (well-regarded) Western-style GI next week, God willing, and I may take a multidisciplinary approach to this problem.

We communicate in Spanish since she's in Madrid. Her first language is one of the many Chinese spoken languages, mine is English, and so communication is a bit hampered. However, I can always enlist the help of the admin assistant out front (who's a student of Chinese medicine) for interpretation.

I have several book recommendations from a reliable source on Chinese medicine, one of which I've already begun reading (The Web That Has No Weaver by Ted Kaptchuk).

I see her again on May 29, God willing. What should I be asking my doctor? I've already asked her for foods and ways of serving food that I should avoid.
  • Diagnosis (although it will not be in terms I will grok fully as an uneducated Westerner)?
  • Foods and practices to seek out?
  • Anything else?
I am not interested in recommendations for Western approaches, like the kneejerk PPI prescription for GERD. I'm already aware of the viable ones.
posted by rabia.elizabeth to Health & Fitness (9 answers total) 3 users marked this as a favorite
I saw an acupuncturist/ Chinese medicine doc for about a year. She was a white lady like me, but well trained at a reputable school.

I didn’t find any of the diagnostic information she could share useful. To my Western ears if all sounded kind of fanciful. I think as a patient the primary benefit of diagnosis is to be able to learn more about your condition and to communicate it with other health care providers in a concise way. The diagnosis info she has was stuff like “hot liver” (I’m making this up - I don’t remember exactly). I’m not saying this isn’t a valid diagnosis in this system, but it wasn’t useful for learning more or communicating.

Instead I would ask about timeframes and changes - when should you start to notice a change? What kinds of changes can you expect? What does it mean if nothing changes? Are there other alternatives to what is being done now if no change is seen?

I think your foods and practices question is great - what can you be doing to supplement the acupuncture and herbs?
posted by jeoc at 4:50 AM on May 16 [2 favorites]

I saw a TCM practitioner in the US, about my "acid reflux" among other things. Like jeoc, I could not make sense of the diagnosis information he gave me. The TCM diagnoses include western-sounding words, but don't really mean the same thing. That made it harder for me to trust them, and I never did take any of the herbs suggested.

About the acid reflux though, mine turned out to be irritable bowel syndrome, which I found out on my own after ruling out other conditions via endoscopy, ultrasound etc. The solution was simply avoiding foods with FODMAPs that my digestive system has trouble with. Consider looking up FODMAPs and the IBS elimination diet before going for anything more invasive.
posted by residual delays at 5:41 AM on May 16 [2 favorites]

Mod note: One comment removed. Please avoid disparaging remarks about Traditional Chinese Medicine and let's focus on helping the OP, thanks.
posted by Brandon Blatcher (staff) at 5:44 AM on May 16 [2 favorites]

Best answer: Having a preview of how TCM views body organs, food, and so on may help you understand a little more.

The entire TCM is about "maintaining balance", like keeping your body in the optimum balance between "heat-y-ness" vs "cold-y-ness" (not official translation), your organs in balance with each other, even as the influence of the sun and the moon ebbs and wanes, and how what you ingest affects that balance, and how TCM "counter-balances" all that to maintain the balance to keep everything in harmony. It is very much rooted in tao-ism. Things out of balance will display outward signs to the body parts they are connected to. Some examples given are: brittle nails and dry eyes may indicate your liver is out of balance, while cracked lips may indicate some problems with the pancreas.

When TCM prescribes something, not EVERYTHING goes toward the treatment of the organ(s) in question. The doctor also has to balance out the "side effects" caused by that specific ingredient to your body as not to knock OTHER organs out of balance, then there's also how the correction itself may need yet ANOTHER balancing ingredient. Which is why TCM prescription often ended up looking like a potpourri mixed with garden clipping; dozens of ingredients, yet only a handful that seems applicable to your symptoms.
posted by kschang at 6:55 AM on May 16 [4 favorites]

Ask where the herbs are sourced; occasionally Ayurvedic and TCM herbs have been found to be contaminated with heavy metals (cadmium, mercury) and others have endotoxins that are demonstrably bad for you in the doses being used (looking at you, Aristolochia fangchi; in at least one case they intended to use Stephania tetrandra but made a mistake). This is not a "well, it's homeopathic" dosing, it can be a "well, now you have liver cancer" dose.

...and I'm not joking about the mercury; I personally tested a relatives' Ayurvedic "weight loss tea" and the mercury was well above acceptable limits. Like, if their tap water had that much mercury the EPA would be swooping in on helicopters. It was appalling (testing for mercury is complicated, by the way, and difficult to do for solids [you can't just use test strips]. Liquids are [somewhat] easier).

Some manufacturers are substantially better than others; the mercury is sometimes added on purpose by less reputable suppliers. I have no idea where the cadmium keeps coming from. None of the foregoing is a condemnation of either Ayurvedic or TCM principles, it's instead a condemnation of modern supply chain shenanigans. You can have similar risks by just eating something with cinnamon in it, if the suppliers are bastards (as they have been).
posted by aramaic at 10:24 AM on May 16 [5 favorites]

I used Chinese medicine and acupuncture to offset the impact of surgery and help support my system through chemo. It is important to let your western medicine doctor know about the herbs (get names listed in English or Spanish) you are taking in case they conflict with your prescribed medicines, and visa versa. Eg, my Chinese practioner prescribed lemon grass tea, but my chemo doctor requested that I don't take it for the first 3 days after a chemo treatment due to it working against the intent of the chemo.
posted by Thella at 11:39 PM on May 16

Anyway, to answer your original question, what should you talk to your doctor about, I would recommended you just go ahead list out the complaints that you have, which you probably already did at your first visit. But if your list is a bit long, maybe explain the priority, like which is bothering you the most (seems to be GERD at the moment).

If you are already following western advice, i.e. avoiding sour foods (vinegar, citrus), caffeine, alcohol, spices, etc., and it's not helping, relay that too. That may or may not be useful information, but doctors consider wide variety of factors. Did you also tell your doctor what you drank before and during the meal? At what temp?

This is my own thought, but have you been keeping a food journal just to track what seems to help and not help with your GERD?
posted by kschang at 1:44 AM on May 17

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posted by Brandon Blatcher (staff) at 7:45 AM on May 18

I'm seeing a Chinese medicine doctor, too, for chronic health issues. I found it fascinating to hear him explain the diagnosis but not, ultimately, of any practical use to me. Even as a Chinese person with some command of the language and a cultural understanding of the language around food and constitution (cold, hot, damp, etc.), the art of diagnosis is too complex for a layman to be able to understand. It also involves knowledge of the organ systems in a framework that is totally incongruent with the way we've been taught in Western science education: the words are the same, but mean different things entirely.

What might be useful to ask is, "What is my constitution?" She might then say something like, "cold and damp," or "qi deficiency," and the basic patterns can be Googled to get a list of foods one should avoid or consume, or what activities one should do.

It might be most efficient to make a list of your favourite foods / foods you consume quite often, and just present them to her to OK or to nix. Then neither of you will miss anything major that you shouldn't eat.

I'd also ask what time of day to take your herbs — with or without food, and which foods to avoid eating with it. It can matter!

I hope you get relief from your acid reflux soon, but don't be dissuaded if you don't see immediate improvement in symptoms. (Though, of course, it's great if you do.) Chinese medicine doesn't prioritize addressing symptom relief on a one-to-one, immediate basis, like Western medication does — the idea is that the herbs and acupuncture will very slowly heal your body and restore your overall health, and the symptoms will eventually subside as the system heals. Digestive issues and a long-term ailment like Lyme are perfect candidates for the type of disease that TCM is good at fixing. For an acute and life-threatening problem, I would of course go to a Western doctor. And most Chinese citizens feel the same way: in China they often use a mixture of both in hospitals. Western medicine to address acute needs, along with Chinese medicine to address overall health.

Anyway, I've been seeing my doctor for 6 months now and am only just beginning to see improvements, and this matches the timeline that he told me to expect at my first appointment. The rule of thumb is, the longer the problems have been going on, the longer it will take to fix them.

I also want to note that this is the third or fourth time I'm seeing a Chinese medicine doctor, and the first time I'm seeing actual results. Just like in any profession, some TCM doctors are more skillful than others. Knowing what I know now, one red flag is an acupuncturist who will put literally 50-100 needles all over your body, in the same way every session: that can indicate a very 101-level, unsubtle approach to acupuncture. My current doctor has a lifetime of experience and will usually do no more than a couple dozen very specifically placed needles, and alter the pattern every appointment based on the changes and progress he's seeing in my body.

My Chinese medicine doctor also recommended The Web That Has No Weaver, so that's a great place to start reading.
posted by fire, water, earth, air at 10:58 PM on May 18 [1 favorite]

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