by Mary
Shomon
In this interview, Dr. Patrick Purdue, Doctor of Oriental Medicine and Acupuncture Physician, talks about the role of Traditional Chinese Medicine for thyroid conditions. Dr. Purdue is a graduate of the Florida Institute of Traditional Chinese Medicine. He completed an eighteen month postgraduate
program in Traditional Chinese Medicine gynecology, and regularly attends
over 80 hours of continuing education yearly. His practice focuses on
women's health, gastrointestinal conditions and autoimmune diseases.
Mary Shomon: Can you tell us about your background, how you became
interested in Chinese medicine, and what training you underwent to become
a
Doctor of Oriental Medicine and acupuncturist?
Dr. Purdue: I really got involved in studying Traditional Chinese
Medicine
(TCM) in an around-about way. About 13 or 14 years ago, my youngest
daughter
Dana began to have recurrent middle ear infections. At the time, I was a
commercial photographer shooting images for brochures, catalogs and so on.
One of our neighbors was an MD, and so we took her to him and he put her
on
the standard 10-day course of Amoxicillin. The condition resolved, but
she
got another one not too long afterward. Another course of Amoxicillin
resolved that one. But the episodes of ear infection began to become
frequent and closer together. Then her tonsils and adenoids became
swollen
and inflamed, and her nasal passages were chronically congested. So she
got
to the point of being on antibiotics all the time and was on steroid
inhalers
for the congestion. The MD then suggested it was time to have her tonsils
and adenoids removed, and have tubes put in her ears. That's when we
decided
that there had to be another way. Luckily, we found a chiropractor who
practiced nutritional medicine, and who quickly discovered that she had a
dairy allergy. We took all dairy products out of her diet and she shortly
afterwards became completely well and had no more ear infections. So I
thought, here they were going to do all this surgery on her, not to
mention
the fact that she'd been on all sorts of medications for the better part
of a
year, and all it was was a simple allergy which the doctor didn't even
think
to check out.
I decided I wanted to figure out how to help out other
people
with natural medicine. Not long afterwards I learned of the TCM medical
school in a neighboring town, 20 minutes from my home. I checked into the
program and found out I'd have a three year commitment. Now at this point
in
time I knew absolutely nothing about TCM. All I cared about was that I
already had the basic entry-level college requirements done, and it was a
year less time commitment than conventional medical school or chiropractic
college. I figured I could suffer through three years of anything to get
a
primary care provider's license so I could practice nutritional medicine.
It
was in the first couple of weeks of school in my first semester that I
fell
in love with TCM. It is the world's oldest professional medical system.
Basically, saying that the program is three years long is a bit deceiving
(a
change in state law will increase the training by one more year starting
next
year). We were using the Shanghai Medical College five year curriculum
squeezed into three years. This was done by not spending time on subjects
for which our license does not allow us to do (prescribe pharmaceuticals,
do
surgery, etc.), and squeezing the rest into five and a half month long
semesters and 18 hours a week in class. When it became time for the
internship phase of the training, we were still required to be in class
for
eighteen hours plus complete our internship requirements. It has been the
most rewarding thing I've ever done.
Incidentally, since I began studying
this medicine none of my three daughters have had an antibiotic or any
other
prescribed drug. It is unusual in our culture for people to go for over
ten
years without an antibiotic or other medication.
Mary Shomon: The basic premise behind Chinese Medicine is the idea of
harmony, the balance of yin and yang. Can you provide a bit of an
overview
of this concept for those who are unfamiliar with it?
Dr. Purdue: Most people have heard of yin and yang, and most have seen
the
yin/yang symbol. The interpretation of yin and yang in TCM physiology is
a
bit different than the definition of those terms in other arenas, such as
the
martial arts or Taoist philosophy. Yin, represented by the dark field in
the
yin/yang symbol, equates in medicine to body fluids such as blood, and to
the
actual structure of the body itself. It is cool in temperature. Yang,
represented by the white field in the yin/yang symbol, equates to function
and movement. It is warm in temperature.
So, for example, the liver as
an
organ structure is yin, but its function is yang. So obviously, if we
have a
balance between structure and function, that organ or body is in balance
and
everything is working well. And, if you recall, the yin/yang symbol has
the
opposite color "eyes" in each field. This implies that nothing is 100%
yin
or 100% yang, that each contain elements of the other.
Our goal in TCM is
to
help the body achieve balance between structure and function.
The other
important idea in TCM is the concept of "qi" (pronounced "chee"). It
often
gets interpreted as "energy," and, loosely, this is correct. There are
many
forms of qi in TCM. For instance, "clear qi" is their word for the air
that
we breathe. "Heart qi" is the beating of the heart. "Stomach qi" is the
action of the stomach churning up the food. Qi is a yang function. Qi
is
considered the "commander of the blood." There is a famous statement
about
pain in TCM which reads, "If there is pain there is no free flow. If
there
is free flow there is no pain." This implies that as long as the qi and
blood are flowing smoothly one has no pain. Any pain, anywhere in the
body,
is due, in TCM terms, to a blockage or impairment in the flow of qi and
blood. So our job, through the use of dietary modification, medicinal
formulas or acupuncture, is to remove the obstacles so that qi and blood
flow
smoothly, or so that function is restored. This is the "return to
balance."
Mary Shomon: In Chinese medicine, health is considered balance and
disease
is evidence of imbalance. Can you describe what Chinese medicine feels
can
upset those balances?
Dr. Purdue: Diseases in TCM are thought to be the result of extremes, or
overabundance, of the "six qi," and the "seven affects." The six qi are
wind, cold, summer heat, dampness, dryness and fire. The seven affects
are
joy, anger, anxiety, thought, sorrow, fear, and fright. The six qi are
considered, in excess, to be external disease sources, and the seven
affects
are, again in excess, considered internal disease mechanisms. Another
ancient text also describes the "seven damages," which are food damage,
anxiety damage, drink damage, sexual intemperance damage, hunger damage,
taxation damage, and channel-network/construction-defense damage
("channel-network" refers to the acupuncture channels, and
"construction-defense" refers to the mechanisms that build and repair the
body, and the immune system).
So the idea here is that excessive amounts
of
any of the above can create a problem in one or more organ systems in the
body and eventually lead to disease. For instance, too much joy can
affect
the heart (we've all heard of people who laugh so hard they die of a heart
attack). People with conditions of phlegm congestion are considered to
have
too much dampness. Those who are under stress and worry too much are
prone
to problems due to anxiety and too much thought.
We are in the beginning
of
flu/cold season at the moment. What are our environmental conditions
currently? We have more wind than usual, cooler temperatures, and dry
conditions. "Wind-cold" is the TCM description of a group of symptoms
that
include pronounced aversion to cold with mild fever, headache, generalized
body ache, absence of sweating, nasal congestion and runny nose, cough,
clear
thin phlegm, and absence of thirst. This is different than "wind-heat"
which
has the symptoms of cough with thick phlegm, generalized fever, sweating,
aversion to wind, dry mouth, sore throat, and yellow nasal mucus. In the
West, we'd recognize all of the above symptoms as signs of the flu, and
all
would be treated with more or less the same medicines. In TCM, these are
two
distinctly different disease "patterns" and would require two different
treatment strategies.
TCM, in addition to the above "six qi" and "seven
affects," recognizes external injury (trauma), "toxic qi" or "pestilential
qi" (roughly equivalent to our idea of bacteria, viruses, parasites, and
so
on), and food poisoning as disease-causing mechanisms. They are treated
based upon the pattern of symptoms that result.
Mary Shomon: Chinese medicine treats disease by attempting to restore
balance to the body. Many different ways are used to diagnose the
imbalances. Can you tell us about some of them?
Dr. Purdue: Information used to determine a diagnosis is gathered through
the "four examinations." These are inspection, smelling and listening,
inquiry, and palpation. Under palpation are included touching the body to
determine the type of pain in an area (i.e. sharp, stabbing, aching pain,
etc.), zheng jia ji jiu (literally, "conglomerations, concretions,
swellings
and gatherings" -- in other words, cysts, tumors, edema, and so on), and a
very sophisticated method of pulse diagnosis. There are 28 different
types,
or qualities of pulse. To feel these and know what they mean is a high
art.
A lot of information as to what is happening in the body can be derived
from
pulse diagnosis. Under inspection is included tongue diagnosis, which,
like
pulse diagnosis, is a high art in TCM and can also be very revealing as to
what is happening in the body. And, since modern TCM is constantly
evolving,
modern techniques such as X-ray and blood lab could technically be
included
under "inspection."
Once information from the four examinations is
gathered,
a pattern diagnosis is developed. This type of diagnosis is a statement
about the unique combinations of symptoms that describe that one patient
in
front of the practitioner. So, in other words, I could have ten female
patients diagnosed by their conventional MD gynecologists as having a
uterine
myoma, or fibroid tumor, but in our medicine they may have ten completely
different patterns and therefore receive ten very different treatments.
Mary Shomon: Chinese medicine does not appear to place much importance on
the thyroid gland as a separate entity. Can you explain this a bit?
Dr. Purdue: During the development of TCM, which began over 25 centuries
ago, they were not aware of the existence of what we call the endocrine
system, which, of course includes the thyroid gland. In fact, the
existence
of the endocrine system wasn't known about in the West either until a
little
over a hundred years ago. So it isn't that there isn't much importance
placed upon the thyroid gland, they just didn't know of its existence
until
the last hundred years.
Of course, in modern TCM, current
state-of-the-art
knowledge of anatomy and physiology are vigorously studied. However, just
because TCM up to a hundred years ago didn't know about the existence of
the
endocrine system, the symptoms caused by thyroid imbalances, or any other
endocrine imbalance, would certainly be described and addressed in TCM
pattern diagnosis. Again, you could have 10 people with the Western
medical
diagnosis of "hypothyroidism," but they may well have, according to TCM,
10
unique, separate patterns of symptoms. And that's what we address.
For
example, let's say a patient comes in with nodules on the neck that are
firm
and rubbery accompanied by a dry mouth and throat, a red tongue, and a
rapid
pulse that has a smooth feel, but is rather thin and firm. We contrast
this
patient with a second one who also has nodules or masses in the neck but
of a
more firm, rocklike hardness, are immobile and cause no skin
discoloration.
The tongue is normal or slightly pale, and the pulse is not rapid. In
conventional Western medicine, both patients may be diagnosed with goiter,
would have blood tests done to determine thyroid hormone levels, and both
be
given the same medication, maybe in different dosages. In TCM, these are
two
completely different patterns and would receive two different medicinal
formulas. In the same way, not everyone with hypothyroidism has hair
loss,
or depression, or dry skin, or fatigue, and so on. So different
treatments
are required depending upon the entire constellation of that one patient's
symptoms.
So just because TCM did not describe a thyroid gland per se,
the
symptoms of hypo- and hyperthyroidism are well described in the
literature.
That being said, the famous physician Sun Si-Miao, who lived from 581 -
682
AD, was said to have used what we now know are the thyroid glands of
animals
to treat goiter. So, whether or not TCM described a thyroid gland as we
know
it, they obviously had some awareness of this gland and developed various
treatments for it.
Mary Shomon: Chinese medicine would rather work to keep the body in
balance
than to have to treat diseases after the fact. One popular saying goes
"Chinese doctors believe that the superior doctor prevents disease, while
the
mediocre physician treats disease only after it has appeared." In what
ways
do you think patients can prevent thyroid disease, and can you touch upon
some tools Chinese medicine provides to help thyroid problems?
Dr. Purdue: The saying you quoted is attributed to the same Sun Si-Miao
mentioned previously. He was quite an innovator. In addition to the use
of
thyroid gland to treat goiter, he used the liver of animals to treat night
blindness, scallion stalk for catheterization, and really advanced
acupuncture theory for tough conditions. I believe the quote went
something
like, "The superior doctor has no patients [because he taught them proper
diet and lifestyle habits to prevent illness], the inferior doctor treats
disease [meaning that doctors who only spend their time treating disease
are
missing out on the most important aspect of medicine -- prevention]."
He was quite an innovative physician in
developing ways to treat disease. In a word, the basic TCM approach to
preventing any disease is moderation. Eating a diet that is nutritious
and
healthy, without having extremes of sweets, hot and spicy and so on,
keeping
oneself balanced emotionally, moderate exercise, and protecting oneself
from
environmental extremes is the way to health and long life.
Of course, who
can so this nowadays? America is a land of extremes. Even when one
attempts
to "do the right thing" health-wise, we have a very stressful culture on
many
levels and I have very few patients who can stay above this stress. We
also
have air conditioning vents overhead, and ceiling fans. This ensures
that,
according to TCM theory, we are constantly exposed to an excess of wind,
one
of the "six qi" disease mechanisms. So the best advice for all is to do
the
best one can. Depending upon how strong your constitutional nature is,
you
can keep yourself mostly well by avoiding the extremes of external and
internal disease causes as described previously.
Mary Shomon: How does Chinese medicine view a thyroid problem such as
hypothyroidism?
Dr. Purdue: Whenever any patient comes to me, regardless of the problem,
I
have them fill out a very thorough health history. I invite them to bring
in
any lab tests they have. I proceed through the "four examinations," and
then
add up all the signs and symptoms I find. This then leads me to a pattern
diagnosis, which, as mentioned earlier, will be a statement of that
particular patient's uniqueness. A properly worded pattern diagnosis will
lead me to a treatment principle, which is a statement of how to proceed.
This, in turn, leads the way to a basic medicinal formula which has to be
altered to fit the patient's uniquenesses.
So, what symptoms might we
have
in hypothyroidism? Let's say the patient's complaints are hair loss, dry
skin, mental depression, cold hands and feet, weight gain and disturbed
sleep. All classic hypothyroid symptoms. But let's say this patient also
has dizziness on occasion, blurry vision at night, low back and knee
soreness
and weakness, night sweats, lateral rib achiness, red eyes, acne, breast
distention, is easily angered, has a bitter taste in the mouth, and feels
bloated and gassy after meals. To treat only thyroid symptoms would be
missing the boat with this patient. Additionally, we couldn't help this
patient with the same medicinal formula that we'd treat another patient
with
who may have the exact same hypothyroid symptoms but an entirely different
range of other symptoms. So I would treat this patient with a very
complex,
customized medicinal formula (we use concentrated powdered extracts of
herbs
that we load into gelatin capsules) probably consisting of 15 to 25
ingredients, dietary instructions (this patient would need to avoid hot
and
spicy foods, iced drinks with meals, raw foods, frozen desserts, sugar,
and
excessively sour foods and drinks), and regular, moderate exercise. I
would
also encourage the patient to meditate every day as a way to unload some
of
the stress in her life.
I would also put her on various nutritional
supplements. Though nutritional supplements may not sound "Chinese," I'll
never forget what my gynecology instructor once said in a lecture. He
said
that the major contribution of Chinese medicine is not herbs and
acupuncture.
These were incidentals. The major contribution of TCM is its way of
thinking about a case, the whole thinking process. In fact, he said, if
Western MD's thought like a TCM physician when they prescribed
pharmaceuticals, the amount of adverse reactions they encountered would be
dramatically reduced. So, in that spirit, I have no trouble using TCM
theory
applied to Western nutritional supplements, and even homeopathy, if I
think
those will help the case.
Mary Shomon: How does Chinese medicine view a thyroid problem such as
hyperthyroidism?
Dr. Purdue: Well, again, one can look at some of the classic hyperthyroid
symptoms such as weight loss, rapid heartbeat rate, elevated body
temperature, insomnia, and profuse sweating, but have other symptoms that
would need to be factored in. So let's say we have a patient with the
above
symptoms who also has a reddish facial complexion, gnawing hunger, acid
regurgitation, frequent belching, and ringing in the ears. This patient
could not be treated with the same formula and treatment as someone with
the
same hyperthyroid basic symptoms but a different group of other symptoms.
We
would follow the same approach as described for hypothyroid cases which
would
involve a customized formula to treat the patient's uniquenesses, dietary
advice, and other lifestyle suggestions as appropriate. Our medicine is
based upon pattern diagnosis rather than a Western-style disease
"label."
Mary Shomon: When someone has an autoimmune thyroid condition (such as
Hashimoto's, Thyroiditis, or Graves' disease), what are your thoughts
about
using some of the common "immune-boosting" Chinese herbs such as ginseng,
codonopsis, astragalus, schisandra, and isatis.
Dr. Purdue: This is a very good question to ask since a lot of people are
under the impression that because TCM is "old," and autoimmune conditions
are
"new," that they would not have a treatment approach. So, if you don't
mind,
I'd like to explain our approach to autoimmune conditions briefly before
answering your questions about whether or not the herbs you asked about
would
be appropriate.
Another famous Chinese physician from the past was a
fellow
named Li Dong-Yuan. He was one of the four great master physicians of the
Jin-Yuan dynasties period, which spanned a period of time from 1115 - 1368
AD
His classic work is a text entitled Treatise on the Spleen and Stomach.
In
this text, he proposed a very complicated set of diagnostic principles and
a
group of treatments that is so involved that this was not taught to us in
school. I had to learn about it during numerous, extensive postgraduate
programs. When one understands what he was describing as far as
conditions
and symptoms, it is clear that he was observing, diagnosing and treating
what
we would call autoimmune diseases. So there is definitely nothing "new"
about these conditions. And though Dr. Li figured out ways to approach
and
treat these conditions he still approached the condition in front of him
in
the same basic way, pattern diagnosis based upon the four examinations,
treatment principle, medicinal formula.
Now to answer your question about
the herbs you mentioned. Once one understands the TCM description of
these
medicinals, which is completely different than the Western pharmacological
description of their actions, one can safely determine if a medicinal is
appropriate. In some, and certainly not all, conditions of autoimmune
disorder there may be an appropriate use for the medicinals which are
labeled
as being "immune-boosting" in the West. Ginseng, codonopsis and
schisandra
are thought to be "adaptogens" in the West, meaning that they tend to
normalize function. Astragalus has been found to increase the activity of
white blood cells, and there are several doctors who use it heavily in the
treatment of cancer patients as there is some evidence that astragalus can
"switch on" natural killer cells, the specialized white blood cells that
target malignancies. Isatis has shown to have anti-viral activity and has
even been used in some AIDS research. And even in the Western literature
it
is somewhat controversial as to whether these herbs actually "boost" the
immune system in a way that could be a problem for autoimmune patients. However, this has nothing to do with the TCM description of these herbs
function. In addition, the formulas that we use are polypharmacy. Many
ingredients are involved and the synergistic interactions of the medicinal
ingredients changes the function of the herbs if they were used
individually.
So the moral of this story is that patients should not experiment with
these
medicinals on themselves, particularly in autoimmune conditions, and
should
seek the skills of a TCM practitioner who knows how to work these
formulas.
This is not an easy medicine to practice. It is far from the simplistic
Western herbal approach of "if you have a headache take feverfew, and if
you
have a bellyache take peppermint tea." It is serious medicine, and should
not be experimented with lightly.
Mary Shomon: Are there any books or websites you think are of particular
interest to someone who wants to learn more about Traditional Chinese
Medicine?
Dr. Purdue: Sure. A great book that explains this whole thing about
pattern
diagnosis and so on is The Web That Has No Weaver by Ted Kaptchuk. Blue
Poppy Press (1-800-487-9296) is a publisher of really excellent TCM
textbooks
used in the schools, and also has very good publications for the lay
public.
The following websites are also good sources:
Mary Shomon: How can people contact you?
Dr. Purdue: Patrick Purdue, D.O.M., A.P.
12800 Indian Rocks Rd., Suite #1
Largo, FL 33774
727-593-9898
e-mail: PPurdue10@aol.com
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