What Is It?
Traditional Chinese Medicine (TCM) is marketed as a set of theories and practices developed over centuries in China. In reality, it is a label applied to a varied and inconsistent set of practices drawn from a variety of competing traditions, as well as many modern innovations. The term “traditional” is a misnomer for the companion animal applications of TCM in particular, since historically most TCM concepts and techniques were not applied to pets. The more abstract theories were only held to apply to humans, and the pragmatic use of herbs and other remedies were mostly reserved for agricultural and working animals.The application of theories and practices under the label of TCM to pets is quite recent. The primary methods of treatment in TCM include acupuncture, herbal remedies, a manipulative therapy called tui-na, and alterations in diet.
Though much historical Chinese folk medicine was pragmatic (applying various treatments to symptoms by trial-and-error) TCM as it is packaged today in the West includes a number of theoretical concepts that are variants of Daoist metaphysics and folk cosmology. The fundamental nature of the universe and everything in it is conceived as a condition of balance between opposing aspects of existence known as Yin and Yang. Cold and heat, dark and light, old and young, and so on are seen as examples of this balance between opposites, and all diseases are believed to arise from a disharmony or loss of balance between Yin and Yang. Infectious organisms, toxins, trauma, and other causes of illness recognized by scientific medicine are not considered as true causes in the TCM paradigm, but as manifestations of disharmony. According to Huisheng Xie, the leading figure in veterinary TCM in the United States, “no disease occurs if Yin and Yang maintain a relative balance.”
Yin and Yang are also identified with particular temperaments, organs of the body, seasons, and other features of living organisms and the environment, and this is taken to illustrate the centrality of these concepts and the balance between them to all features of the universe. This notion of balance between forces represented by the five elements (earth, air, fire, water, and wood) or bodily fluids bears a strong resemblance to the humorism of ancient Greece and Rome, India, and many other cultures. Humorism, practiced in the West until the twentieth century, identified imbalance in humors (blood/air, yellow bile/fire, black bile/earth, and phlegm/water) as the cause of all disease and associated these humors with pairs of opposites such as heat and cold, winter and summer, and so on. Practitioners of humorism attempted to maintain and restore health by restoring balance among the humors, much as TCM practitioners attempt to rebalance Yin and Yang. This was accomplished through bloodletting, herbal remedies, cauterization, and many other practices common to historical and contemporary TCM. This humorist model and the associated practices were abandoned in the West with the advent of modern scientific medicine.
The concept of Yin and Yang is applied to health through an intricate system that varies significantly between individual doctors who employ TCM. In general, practitioners evaluate the appearance of the tongue, the pulse, and a host of other characteristics of individual patients to categorize the problem in terms of excess or deficiency of Yin and Yang. Individual treatments are assigned as promoting or reducing Yin and Yang, so the remedies are chosen based on the categorization of the problem. Egg and banana, for example, are cooling foods, while garlic and ginger are warming foods. Herbs, acupuncture points, and other treatments are assigned in the same way by tradition, taste, or other criteria.
The names of organs are used in categorizing a disorder according to the TCM system, but it is important to note that this is a metaphorical use of these names, associating certain functions and Yin or Yang with certain organs, somewhat like the metaphorical use of the heart as a symbol for strong emotions (as in “He followed his heart”) and the association of bile with bitter or hostile temperament (as in “You’ve got a lot of gall!”). These names do not imply the anatomical or physiological relationships understood in scientific medicine. This makes it possible, for example, to adjust the Gall Bladder function in a species like the horse, which doesn’t actually have a gall bladder.
A couple of case examples from Dr. Xie’s text will illustrate the general thought process of TCVM.
1. Signalment: Seven year old, female spayed Labrador Retriever
Primary Complaint: Separation Anxiety
History ad Physical Findings: From a western perspective, the dog has all the signs of separation anxiety. Acupuncture treatment did not help much. She has been on the herbal formula Long Dan Xie Gan Wan for signs of Liver Stagnation.
Her tongue is slightly red and dry and her gums are tacky. Her eyes are red. Her pulses are thready and fast.
Assessment: This is a Yin Deficiency Pattern (Deficient Heat), specifically a Heart Yin Deficiency pattern. The Yin Deficiency can be determined from the red, dry tongue (Heat signs) and the thready and fast pulse. The association with the Heart is based on the major complaint of separation anxiety because this is due to a Shen (Spirit or Mind) disturbance. Of the five Yin organs, the Heart is the one that houses the Shen. Separation anxiety and other behavior problems are mostly related to the Heart. The treatment strategy is to balance Yin and Yang by enhancing Yin. The acupuncture points An Shen, HT-7, Da Feng Men, and KID-3 as well as the herbal formula Shen Calmer (Modified Tian Wan Bu Xin Dan) are recommended for this case.
2. Signalment: A thirteen year old female spayed American Eskimo dog.
a. Cushing’s disease which has been treated with Mitotane for the past four years.
b. Seizures which began last month and clustered about once a week.
d. Generalized stiffness with weak hind end. There is no limping, but the dog’s gait is very stiff. The dog takes three to four steps then huffs and puffs and lies down.
e. Generalized lethargy, weakness, lack of energy.
Physical Findings: Pulse is thin and fast; Ravenous appetite and thirst; Bilateral cataracts; Deafness; Panting Constantly; Poor teeth and gums; Rose colored thin ocular discharge; Stool dark brown and foul smelling; Chronic urinary incontinence, all day, all the time; Draining pressure sore on left hip; Pot-bellied with muscle wasting; Tongue is pink with thin coating
Assessment: This can be considered a Deficient Heat (Yin Deficiency) condition, with a Qi Deficiency and Internal Wind. The old age, weakness, urinary incontinence and lethargy indicate a Qi Deficiency. The fast pulse, thirst, ravenous appetite, constant panting and foul smelling stool can indicate Heat. Seizures are caused by Internal Wind.
The treatment strategy is to use acupuncture to balance Yin and Yang by enhancing Yin and clearing the Wind. In addition, acupuncture can be used for the stiffnedd while using Chinese Herbal medicine for the internal organ problems. Acupuncture points such as GB-20, LIV-3 and GV-20 may be beneficial for the seizures (Wind). The points KID-3 and SP-6 may be beneficial for Yin. Two herbal formulas may be beneficial: Tian Ma Gou Teng Yin for Internal Wind and Suo Quan Wan for incontinence and Kidney Qi Deficiency.
Clearly, TCM has an intricate theory and methodology. One can undertake years of training and study in this system, and it is possible to obtain advanced degrees, even PhDs in the subject. This can create the impression that the system must be rational or else why would it be so complex and so academic. As I’ve discussed many times before, however, the strength of adherents’ faith in and idea, the number of adherents, or the length of time the idea has been around are not reliable indicators of whether the idea is true. The theories and practices of humorism dominated Western medicine from the time of Ancient Greece into the twentieth century, yet they were mistaken and ineffective. And the appearance of scientific or academic legitimacy conveyed by Tooth Fairy Science and Quackademic Medicine is equally unreliable. Any idea, regardless of its source, must stand or fall on the merits of reliable, objective evidence. And in reality, TCM does not have the lengthy pedigree as a unified and coherent system its proponents claim anyway. And as I’ve discussed in previous articles, it isn’t even all that popular in China.
Does It Work?
So is there such evidence to support the theories and practices of TCM? Well, the theoretical foundations claimed as the basis for TCM involve undetectable energies and spiritual forces, so they amount to a religious belief system more than a model of the functioning of living organisms. This, of course, cannot be tested by any scientific means and so must either be believed on the basis of faith and personal intuition or experience or rejected on the same basis.
These theories have no consistent relationship to the scientific understandings of anatomy, physiology, or other factors in health and disease. Contrary to popular misconceptions, TCM diagnoses and treatment guidelines are not simply a different set of metaphors for describing the same things scientific medicine talks about. Acupuncture points, for example, do not consistently correspond to detectable anatomical features. And as already pointed out, the use of organ names in TCM is purely metaphorical. So the TCM system of understanding health and disease is entirely separate from the scientific system and cannot be integrated with it, whether or not scientific and TCM treatments are used together.
Much of TCM theory and practice cannot be tested scientifically, but some interventions can. Of course, this raises the theoretical issue of whether or not they should be. Since the way medical problems are categorized and interventions are assigned is based on a metaphysical ideology not compatible with scientific explanations of the world, there is no underlying biologic plausibility to these processes. The only reason to consider investigating them seriously is the belief of those who practice and receive them and, which is a deeply unreliable indicator of the validity of ideas generally. Still, on a pragmatic level any method that is sufficiently popular is likely to draw additional adherents on the basis of testimonials alone, particularly with the added allure of Orientalism TCM has. Therefore it is worthwhile to examine at least some of the claims made for such an approach in an objective scientific way and see if there are any indications of real effects despite the lack of a plausible theoretical foundation and the largely manufactured history claimed for TCM.
Because the TCM system is complex and involves multiple modes of treatment, each of these specific practices must be tested independently. It makes no more sense to ask “Does TCM work?” than it does to ask “Do drugs work?” Penicillin works for certain kinds of bacterial infections, but not for cancer, depression, or a broken toe. Similarly, acupuncture may have detectable effects for some conditions and not for others. Scientific medical research is not about validating or invalidating an entire philosophy or world view, but about identifying the effects of specific interventions on specific problems under specific conditions. If the argument is made that TCM fundamentally cannot be examined in this way, then it must be considered a belief system or faith healing practice, not a branch of medicine, and it should be practiced or dismissed on the basis of personal faith like any other religion. If, however, TCM is to be taken seriously as a medical approach, it must be pass or fail the same tests of legitimacy as any other healthcare approach.
I will look at each of the major branches of TCM treatment separately to discuss the scientific evidence concerning their effects.
This is probably the most thoroughly studied and understood of the TCM interventions, and I have written about it extensively. In brief, the evidence in humans shows some mild beneficial effects for subjective symptoms such as pain, nausea, depression, and so on. These effects appear to be largely psychological as they can be elicited by needling practices that are “incorrect” according to any of the various semi-official lists of points and methods (or even by non-penetrating needles or poking patients with toothpicks), and they follow the usual patterns of placebo effects (stronger if presented confidently rather than hesitantly, not consistently detectable through blinded, objective measurement variables, etc). It does not appear that the actual physical manifestations or overall course of any disease is significantly altered by acupuncture, but the psychological benefits of the treatment ritual may be sufficiently beneficial for some patients to be worthwhile.
There is little research on the clinical benefits of acupuncture in companion animals, and no replicated, high-quality studies. There is as yet no reason to believe the results of such research would be different from those seen in humans, but the case has not yet been conclusively made. In any case, the confident claims of benefit almost universally made by practitioners of acupuncture are certainly not justified by scientific evidence.
For more information, see my previous posts concerning acupuncture, the Science-Based Medicine acupuncture section, and the excellent summaries in Snake Oil Science by R. Barker Bausell and Trick or Treatment: The undeniable Facts about Alternative Medicine by Edzard Ernst and Simon Singh.
2. Herbal Remedies:
Like herbal medicine in general, this is a complex area in which there is as yet little reliable data. Herbal remedies undoubtedly contain pharmacologically active compounds, so there is reason to believe they could have clinical effects. TCM remedies in particular are often mixtures of multiple plant and animal products, as well as contaminates and often conventional pharmaceuticals, so the pharmacology of these mixtures is complex. Since particular remedies have been assigned by tradition and personal experience to influence Yin and Yang, and since the TCM theories by which they are selected have no relationship to the causes of disease as understood by scientific medicine, there is no scientifically plausible reason to believe these remedies, whatever chemicals they contain, should be safe or effective for particular medical conditions. We have, as usual, only anecdote and tradition to support the use of these products.
A recent article provides an example specific to TCM. Certain fungi that parasitize insects have been used in TCM practice, as part of the remedy Dong Chong Xia Cao, believed to tonify Yang and promote youth and vitality. Like most ethnobotany traditions, this fungus was used for a great variety of unrelated conditions. It turns out to contain a compound which suppresses inflammation and immune function (despite the inevitable claims that the remedy “enhances” the immune system) and has a variety of other effects in vitro and in lab animals experiments. These functions make this compound potentially useful in the treatment of autoimmune diseases such as multiple sclerosis, once extracted from the original fungus and purified. However, the original substance has unacceptable toxic side effects, so it had to be modified to make it a safe and useful medicine.
This example illustrates quite nicely how the process of identifying and making use of potentially medicinal compounds in plants and other natural sources differs from the haphazard traditional use of herbal products. Advocates of herbal medicine are correct when they claim that many medicines come from plants. What they ignore or fail to mention is that these medicines are almost always safer and more effective once they have been isolated from the chemical soup of whole plant products, tested according to a thorough understanding of the relevant physiology and disease mechanisms, and often modified to be safer and more effective than the original compounds. And these plant-derived medicines frequently turn out to be useful in ways that bear little to no relationship to the traditional uses of the plants themselves.
There have been many studies of Chinese herbal preparations, including in vitro, lab animal studies, and clinical trials. Many of these are problematic in that they are small, of poor methodological quality, and often published in alternative medicine journals and Chinese medical journals, which very rarely publish any negative studies, suggesting a severe publication bias. And from a theoretical point of view, studies of individual Chinese herbal remedies for medical conditions defined in standard scientific terms make little sense. From a scientific point of view, there is no reason to think that plant products selected on the basis of undetectable energies and other mystical concepts should be effective. And from the point of view of TCM, using individual remedies utilized to treat disease as defined by conventional science makes no sense because the appropriate treatment should be comprehensive and individualized diagnosis and management of the patient according to the TCM system.
Nevertheless, some attempts to study these herbal preparations in this hybrid way have been made. Though positive results are occasionally reported, there is no repeatable, high-quality evidence to support the use of any particular remedy for any specific condition, and overall the evidence is sparse, of poor quality, and not encouraging.
Given that there are thousands of plant and animal products that have been used in TCM for innumerable purposes, it would be astounding if a few did not turn out to have some positive effects consistent with their traditional use. It is far more likely, given the existing data and the experience with investigations of other herbal medicine traditions, that most traditional uses will not be validated and that the beneficial compounds in the original materials will only prove beneficial once isolated, purified, modified, and tested according to conventional scientific practices, as with the example of Dong Chong Xia Cao already discussed.
A number of Cochrane Reviews of Chinese Herbal Medicines are available, and they generally report the quality and quantity of the evidence for most indications to be insufficient to justify a recommendation. A systematic review of all individualized herbal medicine studies, including those utilizing TCM, found, “There is a sparsity[sic] of evidence regarding the effectiveness of individualised[sic] herbal medicine and no convincing evidence to support the use of individualised[sic] herbal medicine in any indication.” More research seems appropriate, but not based solely on traditional uses of combination products selected on the basis of metaphysical criteria. As with any pharmacologically active preparation, thee herbs should be studied by first identifying potential active compounds, examining their chemical and biological properties in pre-clinical laboratory testing, verifying their safety, and only then proceeding with clinical trials for those that seem promising.
3. Tui Na:
Tui-Na is a manipulative therapy with features resembling massage and also chiropractic, though it is guided by the same theoretical and traditional principles as acupuncture. It is usually offered in conjunction with acupuncture and the other interventions associated with TCM, and there is a great scarcity of scientific research on its purported effects. It is usually included in global TCM treatment, so few studies exist examining it independent of acupuncture, herbs, and other TCM interventions. One example, looking at tui na for degenerative spinal disease in the neck (cervical spondylosis) found no good evidence of benefit.
It is tempting to lump this therapy in with massage, which like acupuncture has benefits for pain, anxiety, and other symptoms with a significant psychological component but which has not been demonstrated to meaningfully affect the outcome of any specific disease process. However, I have not found any detailed comparisons of different manual therapies and their relative effects, so this would just be speculation.
Is It Safe?
As with efficacy, the safety of TCM has to be evaluated in terms of the individual interventions employed. Acupuncture has known risks, including infections, trauma to nerves and muscles, and even death from inadvertent penetration of the chest with needles, which allows air to enter and collapses the lungs. Recently, the former president of South Korea was seen by doctors for a cough and ended up needing to have an acupuncture needle surgically removed from one of his lungs. A recent review suggests that these risks are small, and can be minimized with proper training and regulation of acupuncturists, but they are not non-existent, and in the face of questionable evidence for real benefits, even small risks seem hard to justify.
The risks of herbal remedies are likely much greater, though they are hard to evaluate in the absence of meaningful government regulation and monitoring. Herbal remedies contain active chemical compounds, and these can have direct toxic effects and they can interfere with other medications. TCM remedies have been repeatedly found to be contaminated with toxic metals, such as lead and mercury, and even conventional pharmaceuticals.
Chinese herbal remedies containing a plant called Aristolochia have been known to cause kidney failure. Deaths have been caused by the remedy ma huang due to the chemical stimulants it contains, and this product has been banned by the Food and Drug Administration (FDA). And herbal remedies have been found to be contaminated with lead and other toxins as well as pharmaceuticals. A list of references below is given illustrating the considerable risks associated with untested and unregulated herbal preparations in general, including TCM remedies, can be found here.
I am not aware of any reports of harm from tui na therapy.
The theoretical concepted promoted as the rationale for Traditional Chinese Medicine are essentially religious in their origins. They do not correlate with recognized physical phenomena understood by science, and they apparently cannot be evaluated by scientific means. The specific interventions employed in TCM, acupuncture, herbal remedies, tui na, and dietary manipulation, have not been extensively evaluated through high-quality controlled clinical testing. By far the most research has been conducted on acupuncture, which appears to have placebo benefits for subjective symptoms regardless of whether it is applied according to TCM principles or not. Most herbal remedies in TCM have not been scientifically evaluated. A few have shown promise for some conditions, but a few have also proven deadly, and potentially dangerous contamination with toxins and undisclosed pharmaceuticals is apparently common. There is no reliable evidence base concerning the safety or efficacy of TCM for pets. The few studies available do not show a consistent pattern of significant benefits.
“Seizures are caused by Internal Wind.”
oh please! recurrent seizures in a dog with cushing’s disease are often caused by a growing pituitary tumor. the dog should have been evaluated and treated by a neurologist and endocrinologist. ellen
Traditional: based on customs usually handed down from a previous generation
Chinese: a native or inhabitant of China
Medicine: the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease
These three words stuck together, when considered as an “art”, definitely make people part with their money. Getting well has nothing to do with it. As we know in “traditional” veterinary medicine, sometimes animals just get better, or get better in spite of us. TCM cannot claim more.
It is a problem that enough veterinary professionals have uncritically bought into TCM, a system beset by proven unreliable methods of diagnosis and treatment.
However, I find it even more alarming that at least one veterinary school has conferred an impression of legitimacy to this belief-system-beset folkloric approach by instituting a TCVM internship that participates in the intern-matching program.
dr. robinson posted: “I find it even more alarming that at least one veterinary school has conferred an impression of legitimacy to this belief-system-beset folkloric approach by instituting a TCVM internship that participates in the intern-matching program.”
if the university of florida college of veterinary medicine (http://tinyurl.com/4xxxxa8) teaches tcvm and other alternative therapies masquerading as real medicine, is their dvm program as rigorous and reputable as other veterinary schools? ellen
Ellen asked if the U of FL program is as rigorous and reputable as other veterinary schools. I’m not sure if the AVMA accreditation folks know about the fallacies and folklore inherent in TCVM and whether it impacts their view of the school.
However, I have seen notes for neurology on the web that prompted me to write the article, “TCVM’s Silk Road May Lead to Detour”, accessed at http://www.veterinarypracticenews.com/vet-practice-news-columns/complementary-medicine/tcvm-silk-road-may-lead-to-detour.aspx as my April 2010 Complementary Medicine column in Veterinary Practice News.
“Course notes from one institution suggest how curricula may transmute the focus from the hard-won advances of modern medicine to the elementary ideas of prescientific society.
As an example, neurology students are hearing that some seizures stem from accumulated wind, phlegm and heat that turn patients’ tongues pale and pulses slippery. Treatment entails expelling evil influences and opening orifices. Students are informed about a scorpion-silkworm TCVM “herbal” combination that supposedly stops seizures. It doubles as a remedy for dogs, cats and horses that are “screaming and foaming at the mouth.”
For hydrocephalus, why spend time talking about brain malformations? TCVM holds that hydrocephalus happens on account of kidneys having dysfunctional family relationships with other organs: “The kidney does not nourish the child (liver) leading to stagnation of blood and qi. The grandparent (kidney) does not control the grandchild (heart) leading to mania. The grandchild (kidney) becomes rebellious and insults the grandparent (spleen) leading to accumulation of damp. As such, hydrocephalus can be thought of as the result of a spleen deficient damp pattern, where the accumulation of damp affects the mind and heart.”
Under the new paradigm of TCVM neurology, the differential diagnosis for dogs suffering from acute intervertebral disk disease includes yang deficiency, yin deficiency or a combined yin-yang deficiency. One neurosurgeon recommends a TCVM cure containing strychnine and aconite, both considered highly toxic.
Are students prompted to ask just how much strychnine and aconite a dog or cat can safely consume over weeks, months or a lifetime? Are they told that the exact amounts of these potentially lethal compounds cannot be known, as recipes are closely guarded “family secrets” and thus proprietary? Are they being encouraged to prescribe untested, unregulated remedies with unknown mechanisms and dubious or toxic ingredients in undisclosed amounts mainly because their teacher sells or promotes them? Is this the education that veterinarians selecting careers safeguarding our public health or defending our country in the military need to have to fulfill their obligations?”
It seems to me that the more TCVM replaces scientifically grounded information in veterinary school curricula, students may suffer, their patients may suffer, but ultimately those promoting and selling TCVM herbs to these students may see their influence and their bottom line swell. I guess it’s a Yin-Yang effect.
“TCM as it is packaged today in the West includes a number of theoretical concepts that are variants of Daoist metaphysics and folk cosmology”
For more about cosmology/astrology and Chinese medicine, I recommend reading Ben Kavoussi’s article, “Astrology with needles” on the Science-Based Medicine website at http://www.sciencebasedmedicine.org/index.php/acupuncture/astrology-with-needles/
thank you for sharing your insights and expertise, dr. robinson. 🙂 the fact that tcvm and other anti-scientific therapies are infiltrating veterinary school curricula is disturbing. are veterinary students demanding this type of curriculum or is it market-driven ($$)? ellen
I wish acupuncture was spelled zackupuncture so at least acupuncture is not number acupuncture is number one on the list of treatments promoted at the Florida vet school. I suspect my old neurology professor who came from teaching at the Ohio state vet school can be given some of the credit for this fla vet school acupuncture promotion. Sad to say most of the back surgery we were doing at Ohio state about the time she was teaching me neurology around the time Nixon went to china does not work either. If the Doxie had blown a disk my now acupuncture promoting neurology teacher and my classmates would watch it go to surgery and get a surgical scar that denotes a unproven remedy. Now the Florida vet school has another unproven remedy they can promote and teach with needles rather than surgical knives.
Art Malernee dvm
Art Malernee dvm
Fla lic 1820
“are veterinary students demanding this type of curriculum or is it market-driven ($$)?” — ellen
In my well over a decade of teaching veterinary students, I have never heard a veterinary student demand or even politely request that time spent on science be replaced with courses in metaphysics and metaphors.
They *do* want to know how to address their clients’ concerns and questions about complementary and alternative medicine; they also want guidance in how to steer clients away from harmful, ineffective treatments and toward scientifically based, evidence-informed options.
To fill this need, I teach a course entitled “Critical Overview of Complementary and Alternative Medicine” that is an elective for 3rd year students. I cover approaches such as medical acupuncture, rehabilitation, massage, and herbal prescribing, and include explanations of the mechanisms of action and evidence of safety or harm, effectiveness or ineffectiveness, and examples of how these are used typically in veterinary treatments.
My intent in teaching this course is to cultivate critical thinking, intellectual curiosity, and an appetite for evidence-based, or at least evidence-informed, method of practice. I not only encourage them to critically examine what I teach them but also recommend they look for and ask about substantiation regarding the conventional methods they are learning from other professors.
With critical thinking as the foundation, when I cover homeopathy, TCVM, and dubious diagnostic techniques including surrogate applied kinesiology and iridology, I try at first to describe the principles, philosophy, and practice approaches with as straight a delivery as possible. Sometimes I can’t help it and we all have a good laugh at the absurdity of it all.
Other times, like when I describe an approach such as TCM and the facts about why and when it “was born” (i.e., in the Communist Era as an instrument of the Communist Revolution), the expressions on their faces disclose the appropriate emotions of a critical thinker — a mixture of confusion as to why veterinarians in the modern era and in North America are buying into this folkloric approach from another place and time, one that still lacks verification from its diagnostic approaches to its treatments.
I know some of them are torn between the natural inclination to believe what a person of authority, i.e., a professor, is teaching at the front of the class while at the same time they are employing their critical thinking skills. I give them this opportunity to experience this cognitive dissonance in a classroom where I support their willingness to confront me and ask questions so that they can withstand the peer pressure like I have experienced from CAVM colleagues. Their letter-writing campaigns against me began in 1998 when I started the medical acupuncture course at CSU and continue to this day. They would vastly prefer that no one mention that the emperor is indeed unclothed, and work as a collective to try to intimidate those who dare to speak the truth.
Even students that come to visit me from other veterinary schools are seeking me out in ever greater numbers specifically because they know they won’t be fed nonsense and metaphors. I applaud their ability to sidestep the hype about TCVM and other unscientific CAVM techniques. Those who want a lineage to follow and a guru to worship don’t seek me out, I suppose.
FVMA 82nd Annual Conference: Alternative Medicine
Congestive Heart Failure: A TCVM approach
Lauren Frank DVM, MPVM, CVA and Huisheng Xie DVM, PhD
College of Veterinary Medicine, University of Florida, Gainesville, FL USA
Summary: “TCVM alone can be successfully used to treat early and mild patterns of heart failure. For moderate to severe cases of CHF, TCVM can be combined with conventional medications to promote and maintain quality of life.”
skeptvet and drs. robinson, goldman and malernee:
if a patient with congestive heart failure is treated with appropriate cardiac medication and science-based interventions, why is tcvm even necessary? what about potential drug-herb interactions? i can’t imagine that a cardiologist would condone the use of herbs because they’re essentially untested drugs. –ellen
dr. robinson said: “Their letter-writing campaigns against me began in 1998 when I started the medical acupuncture course at CSU and continue to this day.”
thanks again for your very thorough reply, dr. robinson. i always learn a lot from your posts. 🙂 you seem to be in-between the two extremes: the skeptics and the cavm proponents. that’s a difficult position to defend–you’ve got guts! –ellen
“skeptvet and drs. robinson, goldman and malernee:
if a patient with congestive heart failure is treated with appropriate cardiac medication and science-based interventions, why is tcvm even necessary? what about potential drug-herb interactions? i can’t imagine that a cardiologist would condone the use of herbs because they’re essentially untested drugs. –ellen”
I think it’s an embarrassment for the veterinary profession when modern day clinicians practice what I call “black box medicine”. That is, considering that there are far more unknowns than knowns and that, therefore, TCVM products remain largely a mystery for veterinary usage, herbalists are selling and dispensing mixtures about which they know very little. That is, they can match the metaphor their master taught them applied to a product with the metaphor by which they learned to interpret the color of a tongue and other unvalidated diagnostics. What goes on in between, i.e., what’s in the product, whether it works, what the ingredients do and whether they interact with drugs or other supplements, and what their adverse effects might be, remain a mystery.
I can’t understand how a cardiologist would tolerate or promote this method of practice, either.
Here is how its promoted on the internet. Are there any MD schools that offer aacupunture internship. How about DO schools? Sorry about my previous post. I cannot figure out how to get my ipad to scroll and let me see what i have typed in the comment box. It was a bad post even for me. I would be interesting how quality would be evaluated when vet schools are measured if acupunture was part of the evaluation. If a school was offering a internship in Homeopathy i bet that would mark them down.
2. ACUPUNCTURE IS PART OF THE CURRICULUM OF DVM
PROGRAMS AT AVMA-ACCREDITED VETERINARY MEDICAL
Two-week Acupuncture Clinical Rotation (VEM 5876, elective) has been
offered annually at the University of Florida College of Veterinary
Medicine (UFCVM) since 2001. An average of 60 junior and senior
veterinary professional students take this rotation annually. Eight interns
have completed Acupuncture Internship Programs at UFCVM since 2004.
UF VMC Acupuncture Service is open from Monday through Saturday
with an average weekly caseload of 30 to 50 patients. The majority of the
cases are in house referrals from other services at VMC or outside referrals
from other veterinarians. Cases include oncology, dermatology, neurology,
endocrinology, renal disorders, musculoskeletal, gastrointestinal,
respiratory, cardiovascular, and behavioral issues.
Acupuncture is not only a part of the curriculum of the DVM program at
the University of Florida, but also at other respected, AVMA-accredited
veterinary schools across the US and around the world. Worldwide, the
AVMA-accredited veterinary medical schools which teach acupuncture
include: University of California Davis, University of Tennessee,
Washington State University, Oklahoma State University, Murdoch
University, and University of Minnesota.
art malernee dvm
“Worldwide, the AVMA-accredited veterinary medical schools which teach acupuncture
include: University of California Davis, University of Tennessee,
Washington State University, Oklahoma State University, Murdoch
University, and University of Minnesota.”
This is an interesting statement, and I’m not quite sure how true it is. Yes, there may be practitioners of acupuncture on staff at these places, but I don’t know how much acupuncture is being taught to students insofar as instructing them in how to do it, based on my experience teaching acupuncture to individuals from these institutions.
In addition, it’s curious how or why they leave CSU off the list. Perhaps it is because I do not endorse, nor do I promote, TCVM as a substitute for a science-based education for veterinary students, that CSU was omitted. Nevertheless, CSU professional veterinary medical (PVM) students first learn about the neuroscience of acupuncture in their first year in the neurobiology course (lecture and laboratory demonstrations); I lecture to students in the pain and holistic medicine clubs about medical acupuncture, and they can then delve more deeply into acupuncture during independent study rotations and senior rotations. They also learn about acupuncture and other integrative medical modalities during their junior elective called, Critical Overview of Complementary and Alternative Medicine. During their senior year, CSU PVM students can enroll in my Medical Acupuncture for Veterinarians, in which they spend 4 weeks learning how to perform and practice medical acupuncture. It’s technically a continuing education program but is scheduled in their senior rotations if they choose that pathway. We actually have a parallel track just to accommodate student rotations beginning in 2012 because the AVMA now wants 2-week rotations instead of 1-week.
Again, though, the difference between CSU and U of FL is that I have eliminated TCVM from the training and approach it mainly as neuromodulation, consistent with modern science.
I’m not sure how human medical schools compare insofar as acupuncture instruction being integrated into the curriculum. In the 1980’s when I was in osteopathic medical school, I opted to work with a D.O. who practiced acupuncture and other holistic modalities as an elective for certain rotations.
Congestive Heart Failure: A TCVM approach
Lauren Frank DVM, MPVM, CVA and Huisheng Xie DVM, PhD
College of Veterinary Medicine, University of Florida, Gainesville, FL USA
Summary: “TCVM alone can be successfully used to treat early and mild patterns of heart failure. >>>>
The medication many vets use in florida to treat early signs of heart disease, as the standard of care, our best studies show, do not do any good either, so treating the patient with “ying and yang” may have better outcomes than using real medicine since there would be more side effects from using our cardiac drugs early before the patient is in congestive heart failure.
art malernee dvm
fla lic 1820
I just read a article today in Vet News by Narda promoting scientific acupunture. The article promoted studies showing acupunture works just a well as the back surgery we do on dogs. I suspect thats because, long term, our best randomized studys show neither back surgery or acupuncture works. We need to expand the roll of the FDA to approve how doctors make money with knives and needles. We need studies using sham surgery and sham acupunture not studys that compare the scar or needle mark of two unproven remedies. If a group of nurses will allow randomized removal or not of their ovaries to see if they die sooner or later, plenty of people and pet owners will be willing to volunteer to take a bullet or not by agreeing to sham back surgery and sham acupuncture trials. Otherwise two unproven remedies will continue as the standard of care until science finds something that does work for the problem. Sad to say tons of money and time will be wasted until science finds a solution to bad backs.
art malernee dvm
fla lic 1820
We live in Dubai in the United Arab Emirates. My Pekengese is 14years old. Last year he had cluster seizures for a day he was on Seizure meds that was slowly weaned off by the Dr. This is when he started getting anxiety attacks in the night. He would pant non stop, wander around the house not knowing what he wanted make a wee on the bed I started sleeping on the floor with him to comfort him. Around 2 months ago I started him on gingko and bacupa. I am a great believer in holistic treatment. We even went thru several reiki sessions with him. He improved a lot, we take walks on the beach, rides in the car.I read about Bach Flower Remedies, and started giving him rescue remedy with aspen and mimulus we had a great week he slept very well ,no stress, over the past 2 days he has started panting again. He doesn’t sleep at all. I can see him fighting sleep. I gave him some COQ10 as I am so afraid of his little heart with all the panting. I also started giving him slippery elm last week as he has IBD and I think one of the reasons he gets afraid is when his tummy gripes, he gets afraid if he hears noises as well.
Can someone please help me, is there any other holistic treatment that I can give him to sleep and calm his nerves at night my vet has prescribed Anipryl but I am so worried about the side effects, Please someone help me…. point me in the right direction, My mum is at home with him all day so he is never left alone. We have home cooked for him for 14years. He eats boiled chicken breast, with pumpkin green beans, squash, kale. I used to give him Magnesium,Krill Oil, vitamin C, and B complex but i stopped all this as i don’t know if all these vitamins are too much for him he used to eat an organic boiled egg every morning i stopped that as well as i am not sure if its too much for him. Other than this issue my heartbeat is so lively, and playful and i will do anything , anything at all to make his life happier, Yesterday my Chinese Dr gave me some jujba seeds otherwise known as ziziphi spinosae .He asked me to bash them up and boil them in 500ml of water for 20 min and then administer the water to my dog in the afternoon and in the night. Can you please advise me about the toxic levels of these seeds is the concoction safe fr my dog .Please help in Dubai we do not have any holistic therapies and I have to beg for help on the internet
Please please let me know
Thank you so much
I’m sorry that you are in this position, but I have to be clear that trying untested remedies with unknown ingredients like ground up seeds is far more dangerous than using licensed medications like Anipryl. Anipryl is not a consistently effective medication in my experience, and the research on it is limited. But we know MUCH more about what it does and how it works than we do about the concoctions used in TCM. And as I have discussed elsewhere such remedies are often contaminated with toxins or undisclosed pharmaceuticals.
So while we live in an imperfect world and I cannot offer a perfect solution, I can tell you that it is far safer to follow the advice of your veterinarian that to experiment with folk remedies.
Good luck with your friend.
Skeptvet said: “…I can tell you that it is far safer to follow the advice of your veterinarian that to experiment with folk remedies.”
Except when the vet is a TCM practitioner, using substances without evidence of safety or effectiveness.
Agusta, I would strongly suggest seeing a regular vet, one who is less likely to prescribe TCM, and at least rule out new seizure activity, cognitive disfunction, even brain lesions. In a 14-year-old dog, there are numerous health issues that could cause the symptoms you describe, so it would make sense to narrow it down and treat accordingly. TCM cannot treat such diseases as mentioned.
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Just as Western Medicine for humans espouses the limited model of Pharmaceutical drugs and surgery and refuses to embrace other types of healing practices, we find the same types of skeptics within the field of Veterinarian Medicine, with the same limited capacity to heal due to an inability to embrace any other orthodoxy other than the western model. And it is this type of limited understanding that produces professional jealousy and criticism of other modalities while offering their own tired trite idea that portends to be “the” only true answer. I have been a professional healer and patient on all sides of this equation for more than 30 years and I can say beyond any shadow of doubt that TCM works and TCVM works. It actually heals through the root of the problems not by putting a bandaid on a symptom. Limiting a patient to a lifetime of drug usage when they can be healed is unethical and immoral and simply because you don’t understand concepts such as Wind Phlegm doesn’t mean it doesn’t exist. And no, closing your eyes, ears and minds won’t help, but closing your mouth about a concept that you know nothing about will, unless you have that temerity and high enough self esteem to admit you don’t have the answer and either research it or refer to a TCVM vet who may. I have used both systems to treat my own dogs with epilepsy and have found TCVM and Homeopathy to offer treatments that work to stop seizures, not just through sedation with Phenobarbitol, but through elimination of the imbalances that have caused it. As a matter of fact I dealt with this situation twice in the past year and found Acupuncture, Chinese herbs and Homeopathy to provide complete relief where my traditional vet takes a “we don’t have anything, lets wait and see if they continue approach.” Shame on you vets above for trying to dissuade people from seeking other options for an ill pet and for demeaning your TCVM COLLEAGUES. Criticizing other health professionals in other fields indicates how insecure you are about your own level of training, not that other systems of care don’t work. Limited training has caused you to become critical of any other options, but the real tragedy is how many unsuspecting patients you take down with you. IF you will try opening your “phlegm misted minds” instead of simply regurgitating your limited views on a trusting public you might actually heal yourself! Or..you can always take a Phenobarbitol.
All of this is simply to say you believe in it so you think everybody else should believe in it regardless of the evidence. This blithely ignores the abject failure of pre-scientific medicine, including Chinese medicine, to meaningfully improve human health for thousands of years, and the unprecedented success of science and science-based healthcare in the last two centuries. You apply inaccurate stereotypes to science-based healthcare and try to dissuade people from making choices based on evidence rather than faith and testimonials. It is really quite arrogant to think your own belief and experience so infallible that any doubt or criticism must be based in ignorance or fear or greed or some other malign motive. I know plenty about TCVM, and I know that it is a modern collection of myths and pseudoscientific beliefs and unproven therapies masquerading as an ancient tradition of effective healthcare.
You are entitled to believe whatever you want, but no one is obliged to take your word for anything or refrain from challenging what you say just because you don’t like to have your faith or experience questioned. If you have evidence other than your own belief and anecdotes, you are welcome to share it. It you just want to pitch a fit because the rest of us don’t accept everything you say just because you believe it, no one is obliged to respect that or take your claims seriously.
MY GOODNESS AREN’T WE TOUCHY WHEN SOMEONE HAS AN OPPOSING OPINION. BUT TRULY, I AM SORRY THAT WHAT I SAID OFFENDED YOU, IT WAS NOT MY INTENTION. I ASSUMED YOUR SITE WAS UNBIASED AND IT GETS MY IRE UP TO READ REMARKS THAT I BELIEVE UNQUALIFYINGLY DISPARAGE SOMETHING WITH SUCH IMMENSE VALUE.
But wo/man…holy cow…you talk about pitching a fit? YOU REALLY don’t like it when someone has an opinion contrary to yours do you? Where do you get your “evidence” that TCM and other healing modalities are abject failures? WRONG! No one, not even myself, white washes all achievements of modern medicine. Many are immense. Just look at Dr. Ben Carson, now their is a shining example. However, I wouldn’t say it has been a complete unprecedented success either. When western medicine crawled into the sak with the banking and pharmaceutical industry and completely abandoned all holism in their training and to this day kills more people through iatrogenic illness and pharmaceutical errors than ever before, not to mention the constant mess of over prescribing toxic drugs that do more harm than good….poor Robin Williams and that nasty old ZOLOFT…. Or how about the great “success” of the cancer industry…talk about “too big to fail”! So do we really even need to touch on the aspects of free choice or greed too?? That would take up the rest of the space on my hard drive. So you might want to read FORBIDDEN MEDICINE by Ellen Brown it will save us both alot of time.
But returning to the great, magnificent, amazingly successful use of TCM/TCVM, it has been a staple of ancient and modern society for at least four centuries longer than western medicine and that has nothing to do with “psuedoscience” or “myth” as you so UNQUALIFYINGLY refer to it, but more to do with centuries of actual testing, treatment and massive studies on its effectiveness. But again, I am not telling people that western medicine is useless, or that TCM or TCVM is all they need, I don’t need to, as a very large and savvy segment of the population already understand the benefits and shortcomings of western medicine and TCM. Which is why with all its great “success” more and more people are turning to healthcare like TCM and TCVM.
You see, I believe in a balanced unbiased approach. When I need surgery, Western medicine is a great place to go for it. Physicians are extremely well trained and actually offer a service that can save lives, if doesn’t force them to refi their home to access it. And thank the good Lord, TCVM is much more affordable than my regular vet because when I need foundational healing or some emergency services for issues such as a snake bite for my quad kids, I look to professionals such as Acupuncturists/Chinese Herbalists for that. And as far as my “testimonies” go, believe them..don’t..they are what they are, my ego has no stake in it. And I don’t need a “rat pack” of like minded people to reinforce it for me, I already did my homework. But if it is evidence that you need, you could spend two lifetimes studying it and not finish it, all you have to do is educate yourself. You see, I have an open mind and believe that everyone has a stake in their own healing and should not be dissuaded by others, but encouraged to seek out their own information and choices for themselves and you should too. I am not asking for anyone to “take my word” for anything! By all means, please find out for yourself!!
Just like you, they need to manage their own health, not put it in the hands of the mythological GOD/DOC/VET or trust a bunch of biased bloggers angry posts! Talk about fear and loathing! Find your own “EVIDENCE” learn something new!
But remember, if your blog is posted on a public domaine and you trash someone else or a concept that YOU can’t back up, at least TRY to have the skin for it when someone calls you out, because you really don’t accept opinions other than your own with any grace at all! So…HELLO and GOODBYE! All of this simply to say…. PITCH ON!!
You are totally projecting all the emotion in this discussion. I’m not hurt, offended, or upset at all. I simply think you are doing what many proponents of pseudoscience do, which is mischaracterizing science-based medicine and classifying criticism as motivated by ignorance or ill intent. I think, as I said, that the power of your own faith in what you believe makes it seem obvious and makes demands for real scientific evidence seem somehow misguided. The “immense value” you see in TCVM is, as I’ve pointed out, merely your opinion. You have not, I note, provided any actual evidence for it, it is simply something you believe.
As far as the history of TCVM, it is both irrelevant (since the length of time people have believed something says nothing about whether that belief is true) and mistaken. TCM is largely a 20th century mélange of practices cobbled together by Mao to produce an ideologically acceptable form of healthcare in a place and time devoid of scientifically trained doctors. The notion of thousands of years of unbroken history behind the edifice of TCM is simply a myth popular among proponents of it. Some of the individual practices have, of course, been around a long time, others are more recent, and many were viewed by their practitioners as incompatible with each other until they were shoe-horned into the modern vision in the 1950s. As an example, the real history of veterinary acupuncture is quite different from the myths promulgated about it.
As for the popularity of TCM, this is also irrelevant (wildly popular ideas are wrong all the time) and not nearly as solid as you suggest. As another example, acupuncture is far less popular than proponents often suggest.
As for bias, mine is in favor of scientific evidence, and you haven’t offered any. I have looked at the evidence for TCVM, and it is nearly non-existent and not generally very encouraging. Some of the herbal remedies may turn out to have medical value, but not in cooling/warming/tonifying Yang and all of that nonsense, but as chemical compounds with physiologic effects.
It seems pretty silly to accuse me of being overly emotional when you are shouting in all caps, trying to make my personality rather than the scientific evidence the issue, and providing nothing but your own zeal to back up your claims.
First, CAPS do not always mean someone is shouting, it can mean the writer doesn’t want you, the reader, to miss the point! Because if we are going by what we “believe” now and not the “scientific” facts, you are assuming that I was angry like you! And we aren’t playing the “it is all your projection” either! I am taking my cues from the TONE of what you wrote. If I were to analyze the content of your response by itself, I and most anyone else would easily surmise that you were REALLY P.O.d!! By your logic, you can assume I am shouting but I am supposed to take your word for it that you were not REALLY angry. I think my CAPS trump your content. Sorry,you can’t have it both ways, trying to come across as completely logical and unemotional when you really want to rip peoples heads off that don’t think just like you.
But you are really missing the point completely Spock/ett! ???? Nothing about TCM is irrelevant any more than the Large numbers of patients that doctors bury through “science”. And my faith has nothing to do with your site spouting opinions without backing them up and YES it has everything to do with how all of this that we are jabbering about works! Since when has SCIENCE EVER had all the answers?? Science has been and always will be used against humanity on a daily basis…it does not make it useless to civilization any more than it makes it the only tool we have. You allow science to do all of your thinking and feeling for you. Do you REALLY believe in anything?? That nothing can work without a double blind study to prove it? Do you really believe that no amount of personal experience enters in to subjective research? All we have to do is THINK about something and it changes it molecularly…. it changes the equation. Another interesting read for you would be, Dr Candace Perts, The Molecules of Emotion. It actually has “research” to back it up. Sites like yours amaze me, that people such as are on it actually purport to KNOW so much and actually know so very little about what they are trashing. Chiropractic, Acupuncture, Homeopathy, Vitamins and Herbs… Have been used for eons without any studies at all, and it doesn’t make them any less effective.
I have seen sites like this one before and all they attract are like minded,-close minded people, who never have faith in anything that is not in black and white on a piece of paper.
I took a tour through your site and all I saw was “no this doesn’t work”‘ ” no”‘ “no”‘ “no” “no”! And you all have no ideas about how much you don’t know!! In my rather large corner of the world YOU would be the ones people would be looking at as though you had half a brain! sorry…I’m just saying…. you don’t know what you don’t know!
But enough if this little repartee…. God Bless You with your endeavors. But i truly hope someone that someone that accidentally reads your site doesn’t decide that they have NO hope because your site told them to never ever believe in anything that is not backed by scientific PROOF!!
Are you an atheist too? I mean you cannot see Him..and it has never been the focus of a big double blind study…. Well some parts of faith and prayer have. And guess what??? That is real too!
Jesus said to him, Thomas, because you have seen me, you have believed: blessed are they that have not seen, and yet have believed.
You really should see a therapist, J Sehler.
Or to put it in terms you may understand better:
OH MY GOD, J SEHLER!!! YOU REALLY SHOULD SEE A THERAPIST!!! IMMEDIATELY!!! BEFORE YOU LITERALLY RIP SOMEONE’S HEAD OFF!!!!
You really do a remarkable job of making my point for me. When I ask for evidence, you not only complain about my lack of faith in alternative medicine but suggest that faith by itself, at least faith in what you happen to believe, is a virtue. Faith is simply a feeling and a commitment to believe in something regardless of the evidence. What one has faith in might be true or it might not, but the faith itself isn’t evidence either way. You need your beliefs to be true, so you reject the very notion that they might be mistaken or that any kind of evidence could be worth more than the strength of your belief.
You have nothing to offer but the complaint that anyone who doesn’t believe what you believe is ignorant, foolish, blind, blah, blah, blah. Your arrogance and self-righteousness is astounding. You say that I don’t know what I don’t know, yet you loudly proclaim that you know what you know and that doubt is simply ignorance or error. That is not a virtue but simple fanaticism and lack of humility.
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I’m sorry but when highly esteemed veterinary neurologist Dr. Dewey writes an acupuncture book:
There has to be some more inherent science to TCVM than what you would like to believe.
That is known as the Appeal to Authority fallacy. The fact that something is believed to be true by smart people is not actually evidence that it is true. There are Nobel laureates who believed in homeopathy, eugenics, telepathy, and all sorts of nonsense. Intelligence and education, sadly, are not fully effective at providing immunity to bad ideas.
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