The
Natural
Therapist
EDITION 35 NO. 2 | WINTER 2020
ISSN 1031 6965
Winter 2020 Blood Stasis in East Asian Medicine
Herbs and Cytokine Storm Risk The Official Journal of THE AUSTRALIAN NATURAL THERAPISTS ASSOCIATION
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Contents Edition 35 No. 2
|
ANTA's Social Media Policy inside now!
Winter 2020
19
26
Herbs and Cytokine Storm Risk
Endometriosis - A New Approach to Treatment
Kerry Bone investigates the concerns raised
Brittani Doherty explores the new
about certain herbs acting on the immune
research and information around treating
system deleteriusly enhancing the cytokine
endometriosis, which warrants the need to
response during acute respiratory viral
take a new approach to the treatment and
infections.
management of the condition.
38
41
46
Huang Lian Jie Du Tang (Coptis & Scutellaria Decoction)
Australian Herb Profile Sterculia quadrifida R. Br.
Rethinking Chronic Pain: A Holistic Approach
Blood Stasis in East Asian Medicine
Andrew Pengelly researches about the
Ananda Mahony explores a holistic approach
Kaitlin Edin investigates blood and its
Tony Reid writes about TCM formula Huang
Peanut Tree (Sterculia quadrifida) including
to chronic pain. By using the biopsychosocial
movement in East Asian Medicine. Blood
Lian Jie Du Tang, its recent studies and
the traditional uses, its antimicrobial action,
(BPS) model individual treatments may
cannot be discussed without the Qi, which
psychological effects.
antioxidant action, antiviral (Hepatitis C)
encompass an integrative approach by using a
forms a Yin-Yang, a complementary pair.
action and its immunomodulatory action.
range of different strategies.
Therefore, you need to know one to know
From the Chair 6
Executive Officer Report
31
ANTA News
8 Police Checks required for membership 10 ANTA’s Social Media Policy 12 ICNM Event Overview 14 NICM Event Overview 16 Guild Insurance Partnership 52 Dealing with COVID-19 in Practice
the other.
EDITION 35 NUMBER 2 – WINTER 2020
ISSN 1031 6965
ANTA BRANCH CHAIR PERSONS
The
Natural Therapist
The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with the Australian Consumer Law under the Competition and Consumer Act 2010. ANTA accepts no responsibility for breaches of the Australian Consumer Law by contributors or advertisers. Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and its contributors.
Elizabeth Greenwood • National President • Director of ANTA • National Naturopathy Branch Chair • ICNM Ambassador • CPE/Seminar Chair • CMPAC Director • Registration Chair • Website & Media Chair • ANTAB Committee Member • ANRANT Committee Member Warren Maginn • National Vice-President • Director of ANTA • National Nutritional Branch Chair • TGA Chair • Ethics Panel Chair • ANTAB Committee Member • ANRANT Committee Member Justin Lovelock • National Treasurer • Director of ANTA • National Homeopathy Branch Chair • Constitution & Policy Chair • CMPAC Director • ANTAB Committee Member • ANRANT Committee Member Shaun Brewster • Director of ANTA • National Myotherapy Branch Chair • ANTAB Chair
• Health Fund Chair • ANRANT Committee Member Kaitlin Edin • Director of ANTA • National Acupuncture Branch Chair • ANTAB Committee Member • ANRANT Committee Member Isaac Enbom • Director of ANTA • National Remedial Therapy Branch Chair • ANTAB Committee Member • ANRANT Committee Member Mark Shoring • Director of ANTA • National Multi-Modality Branch Chair • ANTAB Committee Member • ANRANT Committee Member
The
Natural Therapist
Marketing & Production Tasha Kemsley Circulation Enquiries 1800 817 577
Editorial & Advertising Enquiries thenaturaltherapist@anta.com.au Membership Enquiries info@anta.com.au
Tony Reid • Traditional Chinese Medicine Industry Advisor Jim Olds • Executive Officer • Company Secretary • Business Plan Chair • CMPAC Director • ANRANT Chair
ANTA NATIONAL ADMINISTRATION OFFICE T: 1800 817 577 | F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 W: www.anta.com.au
ANTA Executive Welcome Winter 2020
From the Chair Since the beginning of the COVID-19 lockdown, we have been amazed and on occasion, shocked at some reactions from within our industry to stop Health Workers from providing services to their healthy clients with legally endorsed therapies. Fabricated, pseudo-epidemiology projections were circulated to justify the means being forced on our Members to stop them from operating their small businesses. It may surprise some that most of this obfuscatory and punctilious behaviour emanated from one source. The second most startling revelation was from State Governments placing all Remedial Therapists, Musculoskeletal Therapists and Myotherapists into the same category as massage parlour operators and banning them from operating their Health Services safely and lawfully. Leaders from four of the most prominent professional associations in Australia approached all State and Territory Governments to gain clarity over the out of scope regulatory restrictions which emerged under the lockdown conditions. The Australian Natural Therapists Association, the Australian Traditional Medicine Society, the Myotherapy Association of Australia and the Massage and Myotherapy Association joined forces and used their resources to filter through the false and misleading information being used to stop our members practising under the National Code of Conduct for Unregistered Health Professionals. Unregistered “Allied Health� practitioners fall squarely under this Code of Conduct and were mistakenly targeted due to the false and misleading information being generated by the unethical and unprofessional therapists in our midst. I want to thank Shaun Brewster, ANTA National Myotherapy Branch Chair and the entire ANTA Board of Directors, the Chief Executive Officers
Winter 2020
from each of the three associations and their respective Board of Directors for collaborating on this project to restore the right to practice for all our Members who lawfully chose to do so. Even though these therapists, by accident or design, were relegated to a category with massage parlour operators and banned from operating, they supported the collective association efforts to restore their lawful right to operate authentic health provider clinics. It is now history, Remedial Therapists, Musculoskeletal Therapists and Myotherapists were restored to practice under the National Code of Conduct for Unregistered Health Professionals. This is the appropriate and lawful instrument they were practising under prior to the obfuscation of their profession and cessation of practice operations. Further to this ANTA has engaged a lobbyist to ensure this type of misinterpretation at State Government level, should never happen again! During this challenging period, our ANTA National Council met frequently to secure the right to continue practice for all ANTA Ingestive Therapists. This challenge was to compare modes of practice to similar practitioners who were allowed the right to practice under Telehealth Consulting Services. ANTA National Council also lobbied the Private Health Funds to obtain health fund rebates for all Nutritional Medicine Members, this has been successful to a point but only applies throughout the COVID-19 restriction period. As a result of the overuse and misuse of social media by a minority of Traditional and Natural Medicine practitioners, ANTA National Council also revised the ethical and professional guidelines for all ANTA Members involved in the use of social media for disseminating information to their colleagues. This policy is now advanced and will be reviewed from time
PAGE 6 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
ANTA Executive Welcome Winter 2020
to time to ensure relevance and professionalism is evident in our Members’ use of social media. Our integrity as an association remains strong, our ability to add useful and relevant input to a collaborative group for the benefit of all therapists across Australia is evident and we will continue to communicate with likeminded associations for the best possible outcomes for our Members.
your emails and are back in the office now. A month without phone calls is a long time and we look forward to getting operations back to normal. We hope you all understand how we have dealt with the lockdown, thank you for your patience. Enjoy your practice and stay safe.
Finally, but by no means last are the intrepid office staff at your National Administration Office, you may be aware our entire staff began working from home around April 1. We are aware you have had no direct line into the office to call since then and for that, we apologise. Our staff have worked diligently to answer all
Regards
Jim Olds
ANTA Fellow ANTA Executive Officer & Company Secretary BHSc MST, BHSc Comp Med, GC Higher Ed, MSC, Dip Nut, Dip RM, Dip TCMRM.
Want to win a free book? You have the potential to win a free book through ANTA. Each month ANTA runs a Book Giveaway on Facebook. Conditions of entry are simple, all you have to do is follow the instructions listed on the post! Good luck!
THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 7
ANTA News Winter 2020
ANTA News
Important!
New Condition of Membership Working with Children Check or National Crime Check
ANTA has been advised by Health Funds that all members will now require a Working with Children Check (paid or voluntary) or a National Crime Check to be eligible for Health Fund recognition and ANTA Membership going forward.
Membership status might be in jeopardy.
Please be aware that all Australian States have different policies and procedures when it comes to these Checks. ANTA requires your document to be either emailed or uploaded within the ANTA Member Centre by 30 June 2020. If this is not completed your Health Fund and
As an association recognising practitioners within the healthcare industry, ANTA has an obligation to ensure the public's safety by ensuring all members have a completed and clear criminal history check.
CMBA registered members do not need to complete this requirement as it is a condition of AHPRA registration.
ANTA Partners with Guild Insurance
ANTA is pleased to announce that from April 1, 2020, ANTA’s preferred insurance company is Guild Insurance. Every so often partnerships need to be re-evaulated, that is why during 2019 ANTA National Council undertook a due diligence process to evaulate our Members’ needs with insurance. Guild offers a wide range of attributes that our Members need including qulity of the policy coverage, legal support, commitment to education and risk management, understanding of the profession, pricing and ease of access to the insurer. If you would like to get a free and easy quote, please contact Guild Insurance on 1800 810 213, or visit www.guildinsurance.com.au/professional/natural-therapists
PAGE 8 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
ANTA News Winter 2020
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T
! u Yo
ANTA offers thanks during COVID-19 During these difficult times, ANTA National Council and Administration Staff would like to share their thanks and understanding for the sometimes ever changing amount of information. We are thankful with everyone that reached out for clarification around COVID-19 as it shows that ANTA Members are aware of the ever changing restrictions being made to their businesses and livelihoods. If you need support and regular updates, please check the ANTA homepage. ANTA Staff, National Council and other associations have been working together to try
and find absolute answers from each State and Territory Government’s and Health Minister’s in relation to specific natural therapy modalities. ANTA would like to offer its gratitude to members for their understanding during this hard and confusing time. For resources, please visit/call: COVID-19 Hotline – 1800 020 080 Financial Support Information – See ANTA website homepage Beyond Blue Support Service – 1300 224 636
2020 Bursary Awards The ANTA Bursary Awards have been established to encourage and assist students to maximise the opportunities provided in their education and assist students to achieve their aims and goals in natural therapies. ANTA believes that as far as possible a student’s financial situation should not be an impediment in the pursuit of a career in natural therapies. ANTA selects 12 students to receive an ANTA Bursary Award of $1,000 and also 12 months free ANTA membership (to be taken up when the course is completed).
How it works
If you are an ANTA student member you are eligible to apply for an ANTA Bursary Award. All you have to do to apply is send ANTA an assignment you have completed as part of your studies. The opportunity for students to receive an ANTA Bursary Award has significantly increased and students are encouraged to lodge their Bursary submission before July 31.
2020 Graduate Awards
The ANTA Graduate Awards have been established to reward achievement and to assist graduates with their careers. ANTA Graduate Awards consist of 12 months complimentary ANTA membership and $200. A total of 12 ANTA Graduate Awards will be provided each year (six awards in the January-June period and six awards in the July-December period). The ANTA Graduate Awards are open to all graduates in all disciplines/modalities accredited by ANTA and who have completed course(s) recognised by ANTA. Students who have
graduated and join ANTA will be automatically included and assessed for an ANTA Graduate Award.
How it works
When a graduate joins ANTA, their academic transcript will be assessed by a panel in the categories of course unit achievement, consistency, clinical practicum and overall achievement. All graduates are considered for the ANTA Graduate Awards.
THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 9
ANTA Social Media Policy Winter 2020
ANTA Social Media Policy People are increasingly moving their lives online and into the virtual world, and practitioners are no exception. This is an exciting, rapid and informative platform for practitioners to gather and share ideas, information and current events. Due to the inherent lack of control in the online environment, there is an increased need for consideration around data confidentiality, the sharing of appropriate information, and the subjectivity of personal interpretation. All practitioners must adhere to the requirements of respectful professional conduct (in any public or private communication online) as outlined in the ANTA Code of Conduct. ANTA would like to support healthy discussions and the professional interaction of our practitioners and have developed the following guidelines for our virtual practitioner community.
DEFINITIONS:
Social Media refers to any internet-based tool, created for users to upload and download information. Social Media is distinct from Industrial Media, (such as newspapers, television, and film), which are created primarily for delivering one-way information to the visitor/consumer, and generally require significant resources, as well as adherence to standards and verification processes to publish information. Social Media comprises relatively inexpensive and accessible tools that enable anyone (even private individuals) to publish or access information. Social Media includes (although is not limited to): • Social Networking & Micro-Blogging platforms (e.g. Facebook, Instagram, Twitter, Weibo, etc.) • Video and Photo Sharing websites (e.g. Flickr, Tumblr, YouTube, Vimeo, etc.) • Website Blogs (including sites hosted by 3rd parties, with a ‘Comments’ or ‘Your Say’ feature) • Wikis and Online Collaborative Repositories (e.g. Wikipedia, etc.) • Forums, Discussion Boards and Online Groups (e.g. Whirlpool, Quora, Reddit, etc.) • Internal Communication technologies (e.g. Qmaster Chat, MS Sharepoint, Teams, etc.) • Online Meeting & Conferencing Tools (e.g. Skype, Zoom, Viber, Whatsapp, Slack, Discord, etc.) • Instant Messaging Technologies (e.g. Short Message Service (SMS), Messengers, etc.) • Online Multiplayer Gaming & Streaming (e.g. Twitch, Ustream, Mixer, In-Game, etc.) • Geo-Spatial Tagging platforms (e.g. Foursquare, etc.)
SCOPE & CONTEXT:
These tools and technologies facilitate the widespread publication and sharing of information, opinions, and digital files, and therefore readily constitutes engagement in public discourse, discussion, advertising, exchange of data, and public presentation, to a broad audience. Therefore, whether an online activity is able to be viewed by the public or is limited to a specific group of people, health professionals (and students of association-approved courses) need to maintain professional standards and be aware of the implications of their actions, as in all professional circumstances. Health professionals need to be aware that all information circulated on social media may end up in the public domain, and remain there, irrespective of the intent at the time of posting. Health practitioners should also be aware of their ethical and regulatory responsibilities when they are interacting online, just as when they interact in person. This policy provides guidance to health practitioners on understanding their responsibilities and obligations when using and communicating on social media.
GUIDELINES:
When using social media, member health practitioners should remember that the National Law, National Code of Conduct for Registered and Non-Registered Health Professionals, Advertising guidelines (see section 133 of the National Law), ANTA’s Code of Conduct, and ANTA’s Privacy Policy, all apply.
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ANTA Social Media Policy Winter 2020
Accredited Health Practitioners should only post information that is not in breach of these obligations by: • complying with professional obligations • complying with confidentiality and privacy obligations (such as by not discussing patients or posting pictures of procedures, case studies, patients, or sensitive material which may enable patients to be identified without having obtained consent in appropriate situations) • presenting information in an unbiased, evidencebased context, and • not making exaggerated, unethical or unsubstantiated statements or claims Note: Additional information may be provided from professional bodies and/or employers, which aims to support health practitioners’ use of social media. However, the legal, ethical, and professional obligations that accredited health practitioners must adhere to are set out in ANTA’s policies and guidelines.
Whether using social media for official use, or in a private capacity, members must not do anything which could bring themselves or the profession into disrepute. It should be noted that the nature of social media means the following private activities may increase the risk of reputational damage and therefore require caution and discretion: • posting personal images, information or links • disclosing one’s own and others’ personal information • expressing approval or disapproval of individuals or organisations (especially within the practitioner’s professional network) • engaging in public debate, particularly about or involving the profession (such as with journalists, authorities or public figures) Note: As part of ANTA’s Codes of Conduct members have a professional responsibility to provide an inclusive and supportive environment, free from discrimination, harassment or bullying, in their use of social media and all public interaction. All ANTA members are personally responsible for any content they post online using social media sites or other electronic communications.
behaviour, which apply to accredited health practitioners whether they are interacting in person or online. Health practitioners are expected to behave professionally and courteously to colleagues and other practitioners, including when using social media. The National Code of Conduct also articulates standards of professional conduct in relation to privacy and confidentiality of patient information, including when using social media. For example, posting unauthorised photographs of patients in any medium is a breach of the patient’s privacy and confidentiality, including on a personal Facebook site or group even if the privacy settings are set at the highest setting (such as for a closed, ‘invisible’ group). 2. Legal Obligations Related to Advertising Section 133 of the National Law imposes limits on how health services delivered by registered health practitioners can be advertised. These limits apply to all forms of advertising, including through social media and on the internet. For example, the National Law prohibits the use of testimonials in advertising. Testimonials should be removed from all publicly viewable locations in the control of the practitioner. The Advertising guidelines provide further guidance about how the legal restrictions on advertising under the National Law and other relevant legislation apply to social media.
REFERENCES:
AHPRA Code of Conduct (for Registered Health Professionals). COAG National Code of Conduct for Unregistered Health Professionals. https://www.coaghealthcouncil.gov.au/ NationalCodeOfConductForHealthCareWorkers Kerridge, Lowe & Stewart (2013). Ethics and Law for the Health Professions 4th Edition. Michael Weir (2016). Law and Ethics in Complementary Medicine 5th Edition.
POLICY SUMMARY FOR REVIEW:
1. Professional Obligations The National Code of Conduct contains guidance about the required standards of professional
For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 11
ICNM Overview Winter 2020
Elizabeth Greenwood
ANTA President ICNM Australia/New Zealand Ambassador International conferences are an opportunity to expand your knowledge and networks. At the International Congress on Naturopathic Medicine (ICNM) there are many highly educated, interesting and inspiring people to meet. Below are a few of the presenters who gave inspirational presentations with highly practical and relevant information, while developing strong professional networks and long lasting connections with fellow presenters, exhibitors and attendees in 2019. Abstracts for presentations open soon! For more information visit - http://icnmnaturopathy.eu/en/
Naturopathic Medicine – Integrated Aromatherapy Solutions to Heal the Whole Body, Mind and Heart Paracelsus stated that poison is in everything, and nothing is without poison. If you know your poison, you will find your remedy. In nature, there is an anecdote for every un-made condition and symptom as well as a solution to the source of all suffering. Within nature you will find essential oils that are the solution to all imbalances. They are the most concentrated of all healing modalities which are derived from over 600 plants globally. Each plant has a signature, a chemistry, historical significance and blends well with other essential oils to address multiple symptoms of the body, mind and soul. See beyond essential oils and feel nature through the wisdom of aromatic plants.
Michael Scholes, Master Herbalist England
PAGE 12 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
ICNM Overview Winter 2020
Comprehensive Naturopathic Interventions: Management in Cancer Cancer is likely to affect almost 40% of the world’s population. In the US it is the second leading cause of death. Naturopathic interventions have the opportunity to make significant impact in reducing cancer incidence and improving outcomes once a diagnosis of cancer is made. Clinical cases of cancer treated comprehensively with systematic naturopathic interventions integrated simultaneously with various levels of conventional care were presented. Naturopathic screening tests can help to identify increased risk of cancer diagnosis and be useful in monitoring for disease return after successful treatment. Interventions include diet, phototherapy, physiotherapy, acupuncture, mistletoe, vitamin C and curcumin.
Eric Blake, ND, MSOM, D.Ac United States of America
Naturopathic Legacy: In Their Own Words Over a century of naturopathic medicine has generated a long, robust trail of literature that reveals our vibrant history. From the publications of Benedict Lüst and his many colleagues of the 20th century, we discover clinical pearls that are highly relevant today as we grapple with acute and chronic morbidities. Our founders and elders from that era insisted that nature was the heart of the medicine. Their unwavering faith in the power of nature produced an outstanding record of therapies and tools. Their philosophy and clinical practice, predicted on vis medicatrix naturae, manifested abundant books, serial publications, beautiful sanctuaries of healing and popular sanitariums which spanned the continent.
Sussanna C. Czeranko, ND Canada
The Future of Medicine – The Dynamic Role of Mind, Body and Spirit in the Mystery of Illness and the Healing Journey Throughout human history, illness and disease have always been understood through a bigger context than just the physical body. The modern split between science and religion and the reverence of reductionism has reduced our understanding of the disease proves and created the primary medical goal of symptom relief and surgical or drug-based cures that come from outside the patient. But questions often remain for many patients, especially when confronting idiopathic, incurable or lifethreatening illnesses or the modern epidemic of mental health disorders. Drawing upon different mind-body philosophies and having effective tools and techniques to support our patients on their deeper healing journey is crucial in modern naturopathic practice and one that brings much reward and satisfaction.
Karen McElroy, ND Australia
THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 13
NICM Overview Winter 2020
Influential Women in Natural Therapies: A Legacy for the Future An International Women's Day Event Overview
From left, Petrea King, Judy Jacka, Kerryn Phelps, Alan Bensoussan and Vicki Kotsirilos
The 8th of March every year is International Women’s Day (IWD), a day to highlight, recognise and celebrate equal rights and access for women the world over. The theme in 2020 is “an equal world is an enabled world” 1. Those who observe it are called to action on gender equality, the celebration of women’s achievements and raising awareness against bias. On the 11th of March this year, in honour of IWD, the NICM Health Research Institute presented an inaugural one-day symposium entitled Influential Women in Natural Therapies: A Legacy for the Future. The line-up of speakers was impressive, notably Dr Judy Jacka, Vice Chair of the Jacka Foundation, a life member of ANTA and a driving force in the field
of Naturopathy; Petrea King, Founder and CEO of Quest for Life Foundation whose very presence is a reassurance; Professor Kerryn Phelps, Adjunct Professor to NICM Health Research Institute, Western Sydney University, former President of the Australian Medical Association and GP who has and continues to advocate and navigate the political landscapes within medicine and the broader community. Other speakers included Associate Professor Vicki Kotsirilos, Founder of Australasian Integrative Medicine Association, Associate Professor Lesley Braun, Director of the Blackmores Institute, Gail O’Brien AO, Patient Advocate and Board Member of Chris O’Brien Lifehouse, Lucy Haslam, Founder of Australian Medicinal Cannabis Alliance Health, and Professor Caroline Smith, Dean of Graduate Studies
PAGE 14 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
NICM Overview Winter 2020
at Western Sydney University. The full day program of topics covered research, policy, advocacy and implementation, and as is so often the case within the natural and complementary medicine space, the focus was on the ingestive modalities of herbal medicines and the agenda of integrative practice. It is an interesting notion this term and act of integration. Integrative Medicine as a term suggests there is both a call to predominance as it acquires its own capitalisation (integrative to Integrative), and yet it seeks to embrace those medicines, practices and practitioners who, by the ruling hegemony of history, culture, gender and class, have been ‘othered’. Medicine we can probably all agree has a diversity of forms that provides treatment for cure, improvement of symptoms, and/or the reduction of suffering. The scientific reductionist approach to Medicine has been “critical for the advancement of cell biology and molecular science” 2 and has given us wonderful medicines, and deeper understandings of the human universe. And yet enmeshment, interconnectivity, context and language - the substrates of all meaningful endeavour - have been largely ignored by reductionism. First Nations healers, herbalists, acupuncturists, psychologists and others recognise that the understanding of the human being in a vacuum is a nonsense. The interplay of form, function and context is paramount.
and custodianship are no longer the ‘other’ but are now an ‘essential’ part of the story of who we are as human beings and how we care for our world. In my mind Medicine at its best is an art, a process and an approach that has enough internal resilience to break when it needs to and heals itself with inclusiveness, not ‘integration’. In this era of evidence and practice-based medicine in any case, it is “what works” that stays, and what doesn’t is appropriately left to wither from the field of Best Practice. As I looked around the sleek and modern conference space, (provided in part with funding from The Jacka Foundation of Natural Therapies whose work and aims are to further Naturopathy and Natural Therapies more broadly), replete with women of distinction, I gave thanks to the Elders past, present and emerging, and the membership of ANTA for my seat in the audience. Here was an embodiment of the recognition, embrace and honouring of women’s equality, and a growing respect for different kinds of knowing, which contribute to that enabled world. And an enabled world is an inclusive one, for the benefit of all. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
Kaitlin Edin
Acupuncturist | Eastern Herbal Medicine Chinese Medicine Practitioner National Acupuncture Branch Chair - ANTA
As we know, Medicine and its evolution are coupled with societal change. As the changed community values grow in strength and insistence, the pressure on the structure of Medicine, among many other institutions, threatens to break the conventional models of care. The driving forces of change shift the shape of what is considered ‘otherness’ and the logic of integrating those ‘othered’ wisdoms and lore becomes ‘innovative’, ‘progressive’ and ‘forward thinking’. Integration then is part of the cyclical nature of all life - the folding in of the outliers to the middle is inevitable. In the past century many of those drivers and agents of change have been women, environmentalists and First Nation custodians. Women, the environment
From left, Judy Jacka and Petrea King
THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 15
Guild Insurance Winter 2020
Insurance for Natural Therapists What You Need to Know Guild Insurance understands that for some people, insurance is a grudge purchase. People buy insurance because they need to, not because they want to. And sometimes not everyone understands why it’s needed but they’re told it is. At Guild Insurance, we want to be sure ANTA Members understand what insurance they need, why and what they’re covered for; we want to be sure they see the benefit.
Think about what could go wrong before it does
When thinking about the need for insurance, it’s easy to think ‘it won’t happen to me’. However, Guild Insurance’s 55+ years of experience insuring professionals tells us it does happen and to people like you. While you no doubt do what you can to manage the professional risks you face, they can never be completely avoided. And that’s why insurance is an important part of your risk mitigation. The following information has been written to provide an overview of three types of insurance for professionals, with case examples to show why it’s needed.
Professional Indemnity
Professional indemnity insurance is for professionals who provide advice or a service to customers. It protects against legal costs and claims for damages to third parties (typically customers) which may arise out of an act, omission or breach of professional duty in the course of the professional’s business. What does this mean for you? Unfortunately, there’ll be occasions where a professional’s work results in a patient suffering an injury or other loss due to the treatment or therapy provided. When this occurs, the patient may take legal action against that professional to recover their losses or receive compensation for what’s occurred. A professional indemnity policy is there to protect the professional, their assets and their reputation, should such a claim be made against them. Example: A remedial massage therapist performed treatment on a patient without getting the complete medical history. The patient had some underlying disc issues which were aggravated during the treatment. As the patient was ultimately referred to a specialist for treatment, they sought reimbursement for medical expenses as well as incidental expenses and time away from work.
PAGE 16 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
Guild Insurance Winter 2020
Public Liability
Public liability provides protection when a person has sustained an injury (not in the course of treatment) or property has been damaged and the professional is considered responsible while operating their business. Example: A patient entered a premises for therapy. The carpet on the floor was raised and the patient tripped over and injured themselves. The patient was unable to work for 3 months due to the injuries sustained.
Products Liability
Product liability provides protection when a person has sustained an injury (not in the course of treatment) or property has been damaged as a result of the products used or supplied by the professional in the course of their business. Example: A patient had an adverse reaction to the oil used in treatment and developed a burning rash which required hospital treatment. The patient took action against the practitioner for costs and damages. If you want to find out more about different types of insurance and how they protect you, visit guildinsurance.com.au or call 1800 810 213.
Guild Insurance Limited ABN 55 004 538 863, AFS Licence No. 233 791. This article contains information of a general nature only, and is not intended to constitute the provision of legal advice. Guild Insurance supports your Association through the payment of referral fees for certain products or services you take out with them.
THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 17
ANTA Member Article Winter 2020
Kerry Bone
Founder and Director of Research at MediHerb Principal of Australian College of Phytotherapy Adjunct Professor of New York Chiropractic College
Herbs and Cytokine Storm Risk Introduction
Concerns have been raised that certain herbs acting on the immune system might deleteriously enhance the cytokine response during acute respiratory viral infections. These
concerns are not supported by a detailed analysis of the published scientific and traditional literature.
What are Cytokines?
to an excessive level in the later rampant stage of an infection. In other words, improving efficiency does not imply subsequent overproduction. The opposite is more likely to be true (see below).
Cytokines are a large group of molecules comprising proteins, peptides and glycoproteins that are secreted by specific cells of the immune system. They are signalling molecules that mediate and regulate both immunity and inflammation. Cytokine is a general term: other group names are used based on function, cell of secretion or target of action. For example, cytokines made by lymphocytes can also be referred to as lymphokines, while interleukins are made by one leukocyte and act on other leukocytes. Chemokines are cytokines with chemotactic activities. Interferons are named for their ability to indirectly interfere with viral infection1. Cytokines are in effect the language of the immune system and play a critical communicative role in initiating and sustaining both the innate and adaptive immune responses to an invading pathogen. Just because an agent (such as a medicinal plant) facilitates cytokine signalling release in the early stages of an immune response does not necessarily mean it will drive that cytokine response
Cytokine Storm
Exuberant immune responses induced by the later stages of an infection have been described as a “cytokine storm� and are associated with excessive levels of proinflammatory cytokines and widespread tissue damage2. A range of pathogens have been observed to cause this response, but the reasons why the cytokine storm affects only certain individuals during an infection and not others are not fully understood. The term was first used in 1993 to describe the effects of graft-versus-host disease. In 2003, cytokine storm was shown to be associated with severe reactions to influenza viruses and subsequently to various viral, bacterial or fungal infections. While there is no agreed definition of what a cytokine storm exactly is, it is characterised by a marked severity of infection due to an activation cascade that leads to an autoamplification of cytokine production3. It is in fact an autotoxicity induced by the pathogen.
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It is worthwhile to explore how a cytokine storm develops during a viral infection. It has been proposed that our response to a respiratory virus occurs in three stages: stage I, an asymptomatic incubation period with or without detectable virus; stage II, a non-severe symptomatic period with the presence of virus; stage III, a severe respiratory symptomatic stage with a high viral load4. During the incubation and non-severe stages, a specific adaptive immune response is required to eliminate the virus and to preclude disease progression to the severe stage. This in turn requires a dynamic innate immune response, which will of course involve the efficient local release of cytokines as signalling agents. Therefore, any strategies that boost immune responses at the early stages are regarded as important4. When a protective immune response is impaired, the virus will propagate, and massive destruction of affected tissues may occur. In this event, damaged host cells induce chaotic innate inflammatory responses in the lungs that are largely mediated by proinflammatory macrophages and granulocytes, and a cytokine storm results4. In other words, a cytokine storm is a late stage manifestation of the viral disease that occurs only when the immune system fails to contain the virus. It is not the manifestation of an overactive immune response directly targeted at the infection, in fact it is quite the opposite. Surely this argues for the intensive use of immune support during stages I (late stage prevention) and II (early acute management) to avoid its occurrence?
Overview of Herbs and Cytokine Storm Risk
While cytokine storm was first linked to a viral infection in only 2003, it has clearly been a feature of such infections since time immemorial. Hence, we are not dealing with a new phenomenon when it comes to observations about herbs and their role to prevent and reduce infection. There is no suggestion from traditional western herbal writings, including those of such well-documented groups like the Eclectics (who accumulated considerable experience during the Spanish flu pandemic5), that the use of immune herbs aggravated viral infections. Also, a range of traditional Chinese formulations (several containing the immune herb Astragalus) have been used extensively in China during various recent viral epidemics, with no suggestion of their exacerbating cytokine storm.
Echinacea Root
First it should be pointed out that the key role of Echinacea root is for infection prevention. In the modern prescribing context, it plays a secondary role during the actual viral infection. Antiviral herbs such as licorice and sweet wormwood (the latter in pulsed doses) and other immune herbs such as Andrographis and holy basil become more important in acute phase management (although Ellingwood very much regarded it as a frontline remedy during all acute infections, see below). Hence, concerns about cytokine storm and Echinacea root are not really that relevant to its current best clinical use. But even given this, there is no evidence that Echinacea root will inappropriately stimulate the cytokine response during an acute viral infection and cause harm. From the monograph I wrote in Principles and Practice of Phytotherapy (second edition): Cytokine antibody arrays were used to investigate changes in pro-inflammatory cytokines released from human bronchial epithelial cells exposed to a rhinovirus6. Virus infection stimulated the release of at least 31 cytokine-related molecules and most of these were reversed by simultaneous exposure to the Echinacea extracts. The lipophilic extract of E. purpurea root was less active than the expressed juice of the aerial parts in this regard. However, in uninfected cells these cytokines were stimulated by Echinacea, with the lipophilic extract being more active. There is still much to understand about the way Echinacea root impacts the human immune system. Each in vitro study by its nature can provide just a narrow insight into a few specific aspects of immune function, with any clinical relevance potentially confounded by bioavailability, dosage issues and local tissue factors. The in vitro studies probably of most relevance are the ones investigating alkylamides, since these compounds have proven bioavailability.
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Research has been particularly insightful into one aspect of the mode of action of Echinacea alkylamides7. A lipophilic extract of E. purpurea strongly stimulated TNF-alpha mRNA synthesis in peripheral monocytes, but not TNF-alpha protein production. In other words, the Echinacea-induced new TNF-alpha transcripts (mRNA) were not translated into TNFalpha itself. When monocytes were treated with LPS (lipopolysaccharide or endotoxin, a powerful stimulator of the immune system) TNF-alpha protein production was substantially increased. However, co-incubation of monocytes with LPS and Echinacea extract resulted in a strong inhibition of this effect of LPS. Investigation over a longer time-span revealed that the lipophilic Echinacea extract, via interaction with CB2 receptors, modulated and prolonged TNF-alpha production following immune stimulation. The results of this study suggest that Echinacea acted more as a modulator or facilitator of the immune response, rather than as an immune stimulant. In resting monocytes it prepared them for a quicker immune response by inducing TNF-alpha mRNA. However, in overstimulated monocytes (as in the case of LPS or viral damage that induces cytokine storm) storm it first reduced, and then extended their response in terms of TNF-alpha production. In particular, these key findings challenge the concept that traditional Echinacea extracts will “overstimulate and wear out” the immune system if taken continuously. Note: I have subsequently added the words highlighted in blue blue. The highlights in yellow are for emphasis. So, on the evidence we have to date, a lipophilic extract of Echinacea root rich in alkylamides will prime the immune response before virus exposure but will then tone it down and sustain it once the virus takes hold. Exactly the opposite of the misinformed concerns based on a superficial and one-dimensional analysis of the published literature. Interestingly, the Eclectic physician Ellingwood actually noted the value of a lipophilic extract of Echinacea root for conditions that seem quite akin to cytokine storm (we now know that sepsis is typically characterised by an initial intense inflammatory response or cytokine storm) when he wrote in 19198: “It is the remedy for blood poisoning, if there is one in the Materia Medica. Its field covers acute autoinfection, slow progressive blood
taint, faults of the blood from imperfect elimination of all possible character, and from the development of disease germs within the blood. It acts equally well, whether the profound influence be exerted upon the nervous system, as in puerperal sepsis and uremia… In pleuritis, in bronchitis, in peritonitis, especially pelvic peritonitis from sepsis; in hepatitis and nephritis and cystitis always at the beginning of the acute stage before much structural change has occurred, it may be given, and will retard and often throw off the attack.” and again8: “I am convinced that success in certain cases depends upon the fact that the patient must have at times, a sufficiently large quantity of this remedy in order to produce full antitoxic effects on the virulent infections. I would therefore emphasise the statement which I have previously made that it is perfectly safe to give echinacea in massive doses—from two grams to half an ounce every two or three hours—for a time at least, when the system is overwhelmed with these toxins.” and8: “In septic peritonitis it (Bryonia) may be given alternately with aconite, or aconite and echinacea, the latter remedy directly controlling the sepsis.”
Astragalus
In Traditional Chinese Medicine (TCM), Astragalus is generally contraindicated in acute infections, except where there is chi deficiency. However, as mentioned above, it has been used in TCM formulations to treat recent viral epidemics but is more often included in preventative formulations9. As per the TCM guidelines, Astragalus is particularly indicated for prevention when a person has compromised immunity and/or resilience. Hence, Astragalus can be safely taken for prevention but is best stopped once acute symptoms develop (unless there is advice to the contrary from a skilled TCM practitioner). There is no suggestion from any research that its use only prior to an infection will increase the risk of cytokine storm once an infection takes hold (and the Astragalus has been subsequently
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stopped). In fact, this is extremely unlikely. In one clinical trial, Astragalus (by injection) reduced inflammatory cytokines10. This was in patients undergoing heart valve replacement (HVR). Astragalus was found to decrease the inflammatory cytokines TNF-alpha and IL-8 and increase the level of the anti-inflammatory cytokine (IL-10), thereby exerting an anti-inflammatory activity in patients after HVR.
Elderberry
The use of the black elderberry (Sambucus nigra) during acute respiratory viral infections is relatively new, arising from research conducted in the 1970s. Initial investigations revealed antiviral activity, and this remains a research focus11. However, later research has indicated a potential role for the herb in enhancing immune responses, especially cytokine production12. Meta-analysis certainly supports its benefit when administered during acute viral infections13. The exact mode of action of elderberry is not fully understood, and since its bioavailable components have not been determined (other than the polyphenolics which have relatively low bioavailability), in vitro studies need to be interpreted with great caution. As noted above, by their nature every in vitro study on a herb can provide just a narrow insight into a few specific aspects of immune function, with any clinical relevance potentially confounded by bioavailability, dosage issues and local tissue factors. Hence, what we can glean from clinical studies is bound to be more reliable. One such trial in 473 patients (including many with confirmed influenza A and/or B) found that a combination of elderberry and Echinacea root given as soon as possible for 10 days after symptoms developed was as effective as the antiviral drug oseltamivir14. There was no suggestion of harmful effects or induction of cytokine storm (the authors used the term septic shock to flag this possibility). In fact, adverse events were higher in the antiviral drug group. No hospitalisations were
reported during the investigational period in either treatment group. In another large trial involving 312 economy class passengers travelling from Australia to an overseas destination, participants took elderberry continuously from 10 days before flying overseas until five days after arriving at the travel destination15. Most cold episodes occurred in the placebo group (17 versus 12), however the difference was not significant (p = 0.4). Placebo group participants had a significantly longer duration of cold episode days (117 vs. 57, p = 0.02) and the average symptom score over these days was also significantly higher (583 vs. 247, p = 0.05). This data suggests a significant reduction of cold duration and severity in air travellers. The herbal treatment was well tolerated, with no serious adverse events. These and other human trial results strongly imply that concerns over what is essentially a food precipitating a life-threatening adverse event during an infection (cytokine storm) are merely theoretical.
Medicinal Mushrooms
As with Astragalus, the main role of medicinal mushrooms is for infection prevention and they can be discontinued during acute infection onset to make way for other higher priority treatments. Research suggests that the branched chain betaglucan polymers found in the fruiting bodies of various mushroom species seem particularly adapted to heightening immune vigilance against potential pathogens. The interaction of mushroom beta-glucans with immune cells involves distinct pathways, especially as revealed by the recent discovery of the dectin-1 receptor. Innate immune cells express pattern recognition receptors (PRRs) such as dectin-1, toll-like receptors, and mannose receptors on their cell surfaces. These PRRs recognise pathogens by binding to highly conserved pathogen-associated molecular patterns such as beta-glucan (from fungi), mannan, and lipopolysaccharide (LPS).
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The immunomodulating activities of innate immune cells are augmented by the binding of beta-glucans to dectin-1 expressed by macrophages or dendritic cells. Upon binding beta-glucan, innate immune cells then activate adaptive immune cells such as B and T lymphocytes or natural killer cells by secreting various cytokines16. But as before, these cytokines are acting as signalling agents and are released only in low and localised amounts. Interaction of mushroom beta-glucans with the dectin-1 receptor may even be able to “train” the innate immune response17. Trained (innate) immunity (TI) can be induced by a variety of stimuli, of which BCG (Bacillus Calmette–Guérin vaccine) and betaglucan have been particularly studied. Both BCG (via NOD2 signalling) and beta-glucan (via dectin-1) can induce epigenetic changes that lead to TI. Interestingly, because of the discovery of TI, BCG is currently being investigated as a prevention for acute respiratory viral infection amongst 4000 healthcare workers18. There is clearly no concern about triggering a cytokine storm with this powerful agent, presumably because its role, like the medicinal mushrooms, is preventative.
Herbs and Fever Management
One aspect that seems to have been largely overlooked when discussing herbs for managing viral infections is the important role of diaphoretic herbs in stage II. Their appropriate use could prove to be critical in preventing the development of cytokine storm. A diaphoretic is an agent that literally is used to promote sweating, and in the context of a fever, diaphoretic herbs were used to manage the febrile phase of an infection. In modern herbal practice, diaphoretic herbs are still considered appropriate in fever management, including remedies such as Mentha x piperita (peppermint), Achillea (yarrow), Sambucus (elderflower), Matricaria (chamomile), Tilia (lime flowers) and Asclepias tuberosa (pleurisy root). Their objective is to help to facilitate the fever as a “slow burn” (usually the range 100 – 102°F or 37.8 – 38.9°C), ensuring that this important physiological response is supported, but kept at a level that is comfortable, restorative
and not harmful to the person. They work best when taken hot, as in an infusion or decoction. In the classical model of pathogenesis, induction of fever is mediated by the release of pyrogenic cytokines such as tumour necrosis factor (TNF), interleukin (IL)-1, IL-6, and interferons into the bloodstream in response to exogenous pyrogens from infecting agents19. These are the same cytokines that are largely responsible for cytokine storm. Hence, diaphoretic herbs might well reduce the risk of developing cytokine storm during an infection. This might be disregarded as idle speculation, except for the Eclectic experience with diaphoretic herbs during the Spanish flu pandemic, where they were regarded as key remedies. Drawing from just one of the many testaments to the value of diaphoretic herbs from that time, as reviewed by Abascal and Yarnell5: “One physician, who saw 10 – 35 patients with influenza per day during the epidemic began treatment by mixing 2 teaspoons of boneset and 1 teaspoon of pleurisy root tinctures in a cup of hot water. This was given immediately with a second dose 15 minutes later, a third dose half an hour later, and a fourth dose an hour after the first dose. He reported that this treatment typically reduced a fever of 103 – 104ºF by 3 – 4ºC in a few hours. Yet another physician reported that boneset was always a significant remedy in influenza.” We now know that boneset contains low levels of pyrrolizidine alkaloids, so other diaphoretic herbs (see the above list) should be used instead.
Conclusions
Concerns have been raised that certain immune acting herbs might deleteriously enhance the cytokine response during acute respiratory viral infections and trigger or increase the risk of cytokine storm. Such concerns do not differentiate between the initial role of cytokines during an infection as immune signalling agents versus their later role in promoting an inflammatory response. In particular, cytokine storm is a chaotic, intense and unregulated response to massive necrotic tissue destruction that is unlikely to be capable of further augmentation by any agent, much less a
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relatively benign medicinal plant. Neither traditional use, clinical trials nor modern pharmacology (when interpreted in the appropriate context) support any concerns about common immune herbs increasing the risk of cytokine storm during an infection. In fact, the opposite is more likely to apply since these herbs will support a focussed initial immune response, including enhanced cytokine signalling, and thereby reduce the risk of any
infection progressing to the stage III development of cytokine storm. Herbs are best given in combination, and such informed use of herbal prescribing can lower the risk of side effects and improve clinical outcomes. In the context of reducing the risk of cytokine storm after an infection has taken hold, the potentially valuable role for the inclusion of diaphoretic herbs in the treatment protocol needs to be given due attention.
For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
PAGE 24 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
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ANTA Member Article Winter 2020
Brittani Doherty
Bachelor of Health Science (Nutrition) Advanced Diploma (Nutritional Medicine) ANTA Accredited Member
Endometriosis - A New Approach to Treatment Introduction
Endometriosis is somewhat of a mystery, one that has a multifactorial, yet largely unknown etiology. With more research going into the area, more understanding is given. With the
more recent information in mind, it warrants the need to take a new approach to the treatment and management of the condition.
The Typical Presentation of Endometriosis
What is Endometriosis?
It is estimated that endometriosis affects one in ten Australian women all of whom may present with a wide range of varying symptoms. The most common presentation is pain. This pain can range from mild to severe and can be described as a dragging pain in the pelvis. There may be pain present during intercourse or when going to the toilet to defecate. Abnormal bleeding may be present, also with clotting and a longer cycle overall. Premenstrual symptoms commonly associated with endometriosis include irritability and tension, breast tenderness, insomnia, bloating and constipation which resolves once the period comes1.
Symptoms That May Warrant Further Investigation:
• Intense period pain • Pain during intercourse • Pain worsening toward the end of the period • Pain before periods and at ovulation • Pelvic pain on one side • Fertility issues • A family history of endometriosis
Endometriosis is a condition where the endometrial tissue starts to grow elsewhere in the body2. Normally the endometrial tissue is found within the uterus, lining the walls of the uterine cavity. How the endometrial tissue is relocated is unknown with multiple theories yet to be confirmed. The lesions can be found almost anywhere in the body, but more commonly within the pelvic cavity, the fallopian tubes, ovaries, peritoneum, the bladder and even the bowel. Although not as common, it’s also been found on the intestines, colon, rectum, vagina, on the skin, within the lungs, the spine, and brain! These lesions act as normal endometrial tissue, being stimulated by the hormone estrogen to swell and bleed with each menstrual cycle. This is known to be the major cause of the pain experienced by sufferers as these lesions and cysts are growing in the wrong place, causing pressure. These lesions may also lead to the development of scar tissue formation which can ultimately affect the function of other organs and result in complications such as infertility.
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The Medical Approach
The medical approach is generally one of two options: drugs or surgery. The drugs prescribed are oral contraceptive pills to supply the body with synthetic hormones to induce a pregnant or menopausal state, which means that they suppress ovulation and aim to reduce menstrual flow and further lesion stimulation. The most common surgical procedure is a laparoscopy which involves the removal of endometrial lesions and cysts. The laparoscopy is considered the gold standard in terms of diagnostic tools, meaning that upon the diagnosis being made the surgical removal of lesions can also be completed. Occasionally microsurgery might need to be undertaken to remove adhesions from fallopian tubes or pelvic cavity. The surgery is a rather invasive approach and many women have reported still experiencing pain post-surgery, sometimes more severe than before.
How Nutritional Medicine can be Applied
Previously it was thought that due to the estrogen sensitivity the endometrial lesions have, hormonal correction should be the primary focus. This may not be the case anymore, as it is known that endometriosis is a multifaceted condition, therefore, the approach to treatment should be so as well. Taking a new approach to the treatment for endometriosis offers new insights into the presentation of the condition, meaning that treatment interventions will differ from patient to patient depending on how endometriosis presents for them: 1. Pain is the biggest complaint, and this is due to the inflammatory component of the condition. Targeting this first and foremost can bring great relief to a suffering woman, and thankfully is an area where natural remedies like nutritional medicine really shine. 2. The Immune System must also be considered. More recent research has shown the significance of the body’s immune response to this disease, in cases of endometriosis, the immune system synthesises inflammatory cytokines and autoantibodies that further inflame the lesions and further stimulate their growth while reducing the activity of natural killer cells3. 3. Oxidative Stress has more recently become an area of focus with studies identifying a clear imbalance between reactive oxygen species (ROS) and antioxidants that are thought to play a role in the inflammatory nature of endometriosis. Production of ROS occur due to normal metabolic
functions, however, in cases of endometriosis the ROS are thought to interfere with cell proliferation and have negative effects within the peritoneal cavity4. 4. Hormonal Balancing is also to be considered, enhancing the body’s sensitivity to progesterone whilst supporting the body’s elimination and detoxification pathways in terms of clearing estrogens.
A New Approach to Treatment
Taking a new approach to the treatment of endometriosis can be a great opportunity to seek out advice from a functional medicine practitioner. As a guide, the below interventions are supported by the current literature, making them appropriate considerations for use. Moving forward, a new approach to take towards treating endometriosis can, and should at least target one of the following. Ultimately it will be dependent on the individual’s presentation of endometriosis: 1. Managing Pain The inflammatory nature of the condition is primarily responsible for the pain experienced. However, the severity of the pain itself is not a clear indication of the severity of the condition. Women with severe endometriosis might present with minimal pain, whereas a woman with intense debilitating pain may only have a mild case. Specific herbal and nutritional remedies, as well as modified diet and lifestyle, can significantly reduce the discomfort and promote quality of life for those suffering. • Turmeric: A common culinary herb which has been shown to target endometrial tissue specifically, providing anti-inflammatory as well as analgesic properties. The curcumin in turmeric has been shown to suppress endometrial cell proliferation, it also addresses all areas of the inflammatory cascade that occurs in chronic inflammation5. • Evening Primrose Oil (EPO): Is comprised of fatty acids which are beneficial for hormone health as they provide the building blocks for the cell membranes and steroid hormones. EPO may be used therapeutically in the management of endometriosis as its metabolised to produce series 1 prostaglandins (PGH1 specifically). These prostaglandins possess anti-inflammatory effects within the body as well as reduce excess collagen production, platelet aggregation, regulate T-lymphocyte function and reduce scar formation6. • Anti-inflammatory Diet: Ensuring the diet is further reducing inflammation is paramount. The
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ANTA Member Article Winter 2020
common culprits in a typical inflammatory diet are sugar, gluten, dairy and vegetable oils. However, the diet must be modified to suit the individual, identifying and removing any and all of the aggravating foods in their diet, or foods that may trigger an allergic response. This can range from high histamine foods, to FODMAPS and so on. • Culinary Herbs: Considering the use of common culinary herbs are a simple and ineffective treatment. Ginger and cinnamon along with turmeric in foods and drinks can be used accordingly. These are known for their anti-inflammatory, pain relieving and blood stimulating properties that help to not only manage the pain but also reduce blood stagnation and prostaglandins7. 2. Immune Support When it comes to enhancing immune function, the gut is always of primary focus. The immune response to endometriosis is not too dissimilar to other common autoimmune conditions each with intestinal hyperpermeability at their core. • Zinc: Works to repair intestinal permeability and supports the immune system as well as reducing inflammation and promoting wound healing of endometrial lesions. The removal of gluten from the diet can be further supportive, as gluten is known to increase intestinal permeability. • Probiotics: Probiotic supplementation is of benefit, as the presence of lipopolysaccharides is linked with the presentation of endometriosis, these are endotoxins in the outer membrane of gram-negative bacteria8. • Sugar-free Diet: Dietary application as per above, including anti-inflammatory foods, herbs and removing refined sugars as these are known to weaken the immune system. 3. Balancing Hormones Balancing hormones can be done through two mechanisms.
One is to support the body’s detoxification pathways, i.e. through liver and bowel clearance, to assist in the clearance of estrogen, and two is to provide nutrient cofactors that increase cellular sensitivity to progesterone. • Hormone Synthesis: Zinc, vitamin B6, and magnesium work synergistically together to support the production of progesterone9. Magnesium also plays a role in the detoxification of estrogen in the liver and bowel, with a deficiency contributing to estrogen excess via aromatisation. • Hormone Metabolism: The inclusion of cruciferous vegetables, like broccoli, support healthy estrogen metabolism. 4. Reducing Oxidative Stress Oxidative stress occurs through a number of processes and is a key area of targeting treatments. The accumulation of iron within the pelvic region, environmental toxin exposure and the elevated estrogen/ estrogen excess are all major contributors to oxidative stress10. • N-acetyl-cysteine (NAC) is a bioavailable form of cysteine that promotes glutathione synthesis (the body’s major antioxidant). NAC provides not only anti-inflammatory and antioxidant actions but also targets pathways in the liver to promote detoxification. Clinical trials have also found that supplementation with NAC for 12 weeks resulted in decreased endometrial cyst size and reduced pain scores in participants11.
Conclusion
There is a lot to consider when it comes to endometriosis that can leave both practitioners and patients feeling overwhelmed. For those suffering from this condition, it is strongly advised to seek out care from a trained professional for the appropriate treatment and management of endometriosis. Considering functional medicine can be of great benefit, as this approach considers and treats the person as an individual and not just the disease.
For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
PAGE 28 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
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Sage Advice...
The use of Sage (Salvia officinalis) spans several thousand years. It has a long history of use in cooking, for medicinal purposes, and traditional medicine. Salvia officinalis has a longstanding use as a traditional herbal remedy that can enhance memory and improve cognitive functions. Sage has various functions and uses relating to cognitive function, including improving attention, alertness, learning, memory, secondary memory, cognition, and cognitive decline1. Additionally, Sage can improve mood and reduce anxiety, inflammation, and oxidative stress1.
Some Research for Sage for Memory and Cognition
A randomised, placebo-controlled, double-blind, five-period crossover study investigated the acute effects of standardised extract of Salvia officinalis on cognitive performance in older adults2. Assessments were at 1 hour, 2.5 hours, 4 hours, and 6 hours post-treatment. Significant enhancement of secondary memory performance was found at all testing times. One capsule dose (1,200mg) had significant improvements for the delayed word recall task at 1-hour (P = 0.036) and at 2.5-hour post-dose (P = 0.002) with trends for the 4-hour (P = 0.130) and 6-hour timepoints (P = 0.17). The dose of 2,155mg (2 capsules of Sibelius Sage is 2,400mg) found significant improvements in delayed word recall at 1-hour (P = 0.0004), at 2.5-hour (P = 0.0005), and 6-hour post-dose (P = 0.019). Sage has been found to inhibit acetylcholinesterase, an enzyme that metabolises and breaks down acetylcholine. Acetylcholine plays an essential role in the formation of memories and cognition1. 1
McEwen B. Sage advice for cognitive improvement. JATMS, 2020:26(1): 6-8. Scholey AB, et al. An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers. Psychopharmacology (Berl). 2008;198(1):127-39. 2
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ANTA Member Article Winter 2020
Tony Reid
M.Ac (Acupuncture) M.TCM (Traditional Chinese Medicine)
Huang Lian Jie Du Tang (Coptis & Scutellaria Decoction) Introduction
Huang Lian Jie Du Tang (HLJDT) was first recorded in ‘Medical Secrets of an Official’ (wai tai mi yao), by Wang Tao, 752 CE, a work in 40 volumes that covers every branch of medicine and contains over 6,000 formulas. HLJDT was originally used for severe conditions in which a virulent pathogen (Heat Toxin or Fire Toxin)
pervades the three Jiao (i.e. upper, middle and lower body compartments), thus affecting all bodily systems1, 2. In ancient times HLJDT was given to soldiers before battle, both to reduce their anger so they would not become confused as well as to prevent excessive bleeding when injured3.
Huang Lian Jie Du Tang
Korea, HLJDT has been approved for use in palliative care and for atopic dermatitis by the Ministry of Health Labour and Welfare of Japan and the Korean Food and Drug Administration4. In addition, recent research has focused on the formula’s actions on the central nervous system (CNS), in line with the description of the therapeutic actions of Coptis, the formula’s major herb, given in the earliest Chinese Materia Medica, the Shen Nong Ben Cao Jing (The Divine Farmer’s Classic on Materia Medica), circa first century BCE.
Two of the three ‘yellow’ (huang) herbs in this formula (Coptis – huang lian and Phellodendron – huang bai) contain a variety of potent alkaloids (including berberine and palmatine), while the other yellow herb (Scutellaria – huang qin) contains a multitude of different types of flavonoids. The fourth ingredient, Gardenia fruit (shan zhi zi) contains several different iridoids and iridoid glycosides. These compounds are collectively responsible for the biological activities of HLJDT, providing a broad-spectrum antimicrobial action as well as antiinflammatory and antipyretic effects4. It is therefore suitable for treating a variety of acute infections and inflammatory conditions. In China and Japan, it is used in the treatment of septicaemia, pyemia, dysentery, acute gastroenteritis, acute hepatitis, acute cholecystitis, pneumonia, urinary tract infections, stomatitis, periodontitis, meningitis, encephalitis B, insomnia, hypertension and sequelae of stroke1, 2. In Japan and
The Formula: Huang Lian Jie Du Tang
The original formula contains four ingredients: Coptis, Scutellaria, Phellodendron and Gardenia. Table 1: The Formula for Huang Lian Jie Du Tang Coptis Chinensis, root (huang lian):
30%
Scutellaria baicalensis, root (huang qin):
20%
Phellodendron amurense, stem bark (huang bai):
20%
Gardenia jasminoides, fruit (shan zhi zi):
30%
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The TCM Actions of Each Ingredient are as Follows1, 2:
• Coptis root: Clears Damp-Heat, purges Fire from the Heart and from the middle and upper Jiao • Scutellaria root: Clears Damp-Heat and purges Fire from the upper and middle Jiao • Phellodendron stem bark: Clears Damp-Heat and purges Fire from the lower Jiao • Gardenia fruit: Drains Heat or Fire from the whole of the three Jiao, clears Damp-Heat and promotes diuresis, clears Heat Toxin
The major herb in HLJDT, Coptis rhizome, is described in Shen Nong’s Materia Medica (shen nong ben cao jing), from the first century BCE, with the following actions: ‘Coptis is bitter. It is nontoxic, treating mainly Heat Qi, eye pain, injured canthi, and tearing. It brightens the eyes and it also treats intestinal afflux, abdominal pain, dysentery, and, in females, genital swelling and pain. Protracted taking may improve the memory.’5. A commentary from Qing dynasty physician, Chen Nian-zu (1753 - 1823 CE), further explains: ‘When the Classic says it mainly treats Heat Qi, [it means that] it eliminates all Heat in the Qi division. Intestinal afflux, abdominal pain and dysentery are all diseases [that may be] ascribed to Damp-Heat in the middle [Jiao, i.e. Spleen-Stomach]. Genital pain and swelling are an illness caused by Damp-Heat below [in the lower Jiao]. Coptis eliminates DampHeat. So, these are all its indications.’5.
Research on Huang Lian Jie Du Tang
A considerable number of studies on the effects of HLJDT in humans and animals has been carried out in China since the 1960’s and they are often cited in more recent compilations, including the standard tertiary texts1, 2, 6. However, much of this material is of questionable quality, and many of the original papers are now unavailable for scrutiny. Additionally, Chinese researchers have only begun to adopt
acceptable international standards, for both conducting as well as reporting clinical research since the early 2000’s. With this caveat, there are Chinese studies demonstrating the efficacy of HLJDT in the following conditions: septicaemia, pyemia, acute gastroenteritis, bacteria dysentery, acute hepatitis, acute cholecystitis, encephalitis B, meningitis, cerebrovascular accident, sequelae of stroke, transient cerebral ischemia, pneumonia, otitis media, pelvic inflammatory disease, vaginitis, post-surgical infection, abscess, acne, impetigo herpetiformis, eczema of the anus, urinary tract infection, stomatitis, periodontitis1, 2. Additionally, and with the same caveats, HLJDT has been shown to have the following pharmacological effects: antipyretic, antispasmodic (on the smooth muscle of the GIT), anti-ulcer, anti-diarrhea, hepatoprotective, antioxidant, analgesic, antiinflammatory, antihypertensive, antihyperlipidemic, hypoglycaemic, anticholesterolemic2.
Recent Studies in Human Subjects
Good quality evidence in humans from studies undertaken since 2000, show that HLJDT is clinically effective in the following scenarios: • Prevention of stomatitis and diarrhea in patients undergoing cytotoxic chemotherapy for cancer. In a study on 40 patients with acute leukemia there was a significant preventive effect on mucositis caused by anticancer agents, with marked reductions in stomatitis and diarrhea in the group taking HLJDT 7 • Reduction of plasma triglyceride levels and enhancement of plasma albumin concentration, thus improving the microcirculation via lipid and protein metabolism, measured in 20 healthy male subjects. This helps to explain the formula’s effectiveness in the treatment of cerebrovascular accident8 • Augments the therapeutic actions of Yi Gan San (YGS) in the treatment of a) the behavioural and psychological symptoms of dementia, b) tardive dyskinesia due to antipsychotic medication, and c) irritability, impulsivity and aggression. Three case studies from Japan in which one dementia patient, one middle aged patient on risperidone (anti-psychotic) and one young adult responded partially to treatment with YGS, showed dramatic improvement (i.e. complete or almost complete resolution of symptoms) with the addition
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ANTA Member Article Winter 2020
of HLJDT to the regimen9 • Improves intestinal barrier function in critically ill patients after abdominal surgery, to promote recovery of gastrointestinal function (together with electro-acupuncture treatment)10 • Potential to delay the progression of Alzheimer’s Disease by reducing production of amyloid beta-142 protein and phosphorylated Tau protein, which lead to amyloid plaque formation and the development of neurofibrillary tangles, respectively11
Recent Studies on Animals
A 2019 review on the phytochemistry, pharmacology and pharmacokinetics of HLJDT cites 174 papers, most of which are in vivo animal studies, conducted within the past 15 years4. This material is of a far better quality than that upon which the abovementioned textbooks have relied upon and give a much more accurate picture of the scope of HLJDT’s pharmacology and its potential therapeutic effects. The pharmacological actions of HLJDT are summarised below4,12,13: • Anti-tumour: Inhibits proliferation of cancer cells (hepatocellular carcinoma and myeloma cell lines) • Hepatoprotective: Restoration of liver function after cholestatic injury (bile duct ligation in rats) • Anti-inflammatory: Reduces inflammatory response to a broad range of irritants via various pathways, effective in animal models of gingivitis, inflammatory bowel disease, gastritis, sepsis, rheumatoid arthritis and dermatitis • Anti-allergy: Suppresses allergic and inflammatory mediators in cultured mouse macrophage cells, which have been stimulated by lipopolysaccharide • Hypolipidemic: Lowers blood triglycerides in high fat diet induced hyperlipidaemia (rat model) • Anticholesterolemic: Lowers total cholesterol and low-density lipoprotein (LDL) cholesterol in type 2 diabetic rats • Hypoglycaemic: In rat diabetes type 2 model, with actions on the gut (increased GLP-1 secretion) to promote insulin secretion and action on pancreatic beta cells (hypertrophy, hyperplasia and increased insulin secretion) • Neuroprotective in various CNS diseases:
Including animal models of ischemic stroke and Alzheimer’s Disease • Antimicrobial and anti-viral: Against candida albicans, pseudomonas aeruginosa and N1H1 influenza virus (‘swine flu’) • Modulates microbiota: Reduction in pathogens and increase in short chain fatty acid producing (i.e. probiotic) bacteria in mouse model of type 2 diabetes • Protection of gastric mucosal barrier: In ethanoland aspirin-induced injury Thus, while good quality evidence for this formula’s therapeutic actions in humans is at present quite limited, the above pharmacological actions may serve to support its use in the treatment of hyperlipidaemia, tumours, arthritis, sepsis, cardiac damage, liver injury, kidney disease, cerebral ischemia, type 2 diabetes, Alzheimer’s Disease, fungal infection, inflammatory bowel disease, gastritis, atopic dermatitis and gingivitis. Best available evidence to date indicates that the complete formula composed of the four herbs, Coptis, Scutellaria, Phellodendron and Gardenia in a 3:2:2:3 ratio, has much better therapeutic effects than any one of the herbs on its own or any combination of three herbs used together4, 14, 15. Moreover, the neuroprotective effects of HLJDT are mediated, at least in part, by compounds formed by the interaction of components of Coptis with those of Scutellaria during decoction of the formula16.
Psychological Effects of Huang Lian Jie Du Tang
Although somewhat overshadowed by the formula’s powerful antimicrobial and antiinflammatory effects, traditional use of HLJDT also involves conditions due to ‘Heart Fire’. In TCM this syndromepattern is conceptualised as follows: The Heart is the seat of consciousness and the activities of consciousness (the Spirit, or shen in TCM). When the
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Heart is affected by pathogenic Heat, this readily develops into pathogenic Fire, as the Heart, belonging to the Fire phase of the Five Elements, is most susceptible to the effects of Heat. Pathogenic Fire is extreme Heat, which causes more severe disturbances to normal functioning and tends to spread to other systems, disrupting their function. The normal functions of the Spirit are all of the nature of Fire: the clarity of conscious awareness, the reactivity of the emotions, as well as the motivating force provided by the emotions – all have the quality of Fire: illuminating, warming and activating. Thus, when Fire becomes excessive (i.e. pathogenic), it means that the normal controls that regulate our mental and emotional activities begin to fail and these activities now operate in an unconstrained manner and tend to become extreme. This may lead to mental confusion, and overly excitable emotions that demand expression. This is the psychological aspect of Heart Fire syndrome17,18. The use of the formula, generally as an adjunct, in treating predominantly psychological disorders due to Heart Fire (e.g. agitated type of depression, insomnia, behavioural and psychological symptoms of Alzheimer’s Disease, etc.) is supported by findings
in animal studies. HLJDT has been shown to reduce glutamate and gamma-aminobutyric acid (GABA) induced excitotoxicity and maintain the function of cholinergic neurons under conditions of ischemic injury19, 20. In addition, the formula has marked antiinflammatory effects within the CNS, which may be mediated, at least in part, by antioxidant actions and the effects on the liver (affecting the liver-brain axis) and on the gut microbiota (affecting the gut-brain axis)21, 22.
Dosage
Based on the dosages used in the human trials cited above, the equivalent dose of HLJDT capsules is 9 – 10 capsules, twice daily; and for HLJDT pills (a.k.a. Coptis and Scute Formula) is 40 pills, twice daily. HLJDT is available as Antitox 2 Formula (CM175) in capsules, and Huang Lian Jie Du Wan pills (Coptis and Scute Formula) BP049 in pills, from Sun Herbal Pty Ltd.
For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
Ultra-micronised Palmitoylethanolamide combined with physical therapies is effective for low back pain By Brooke Schiller BHSc(Nat & NutMed), BCom
Lumbar disc hernia (LDH) is the most common cause of low back pain (LBP) and sciatica. It is prevalent in approximately 9% of the population worldwide, impacting substantially on quality of life, and creating economic burden.1 Several changes in the biology of the intervertebral disc are thought to contribute to LDH, which results in the stimulation of nerve fibres leading to pain.2 Traditional treatment of LDH includes surgery and steroid injections. Unfortunately surgery carries a risk of recurrence and injections have been linked with various adverse events. A study in patients with chronic LBP who were treated with the sole intervention of a daily functional rehabilitation session showed that only small improvements in pain intensity at short-term follow-up were observed compared to placebo. This suggests that a multifaceted approach is needed. Palmitoylethanolamide (PEA) is an anti-inflammatory, analgesic, and neuroprotective mediator that acts at several targets in the central and peripheral nervous system.1 It has pain-relieving effects in various chronic pain conditions with different aetiologies, and it has been reported that PEA may exert both receptor-mediated and non-receptor-mediated effects at different cellular and tissue sites.1 The transcription factor peroxisome proliferator-activated receptor alpha (PPAR-α) has been identified as a possible target for the anti-inflammatory action of PEA.1 PEA may also elicit anti-inflammatory activity on other members of the PPAR family. PPARs are found on dorsal root ganglion sensory neurons and glial cells. PEA may activate these receptors and modulate both the perception and transmission of peripheral pain signalling and spinal pain amplification
mechanisms, thereby exerting its influence on different types and phases of pain.1 Most clinical trials with PEA have focused on formulations with particles that were subjected to a fluid jet micronisation process. This process yields particles with a defined maximum size profile of 6–10µm that is much smaller than that of naive PEA. This smaller size provides a higher surface-to-volume ratio, thus creating increased potential energy of the particles leading to better solute solubility and superior biological efficacy.1 In a recent clinical trial, 120 patients suffering from lumbosciatica (95) and lumbocruralgia due to multiple herniated discs in the lumbar spine (25) were given 600mg ultramicronised PEA twice daily for 20 days in combination with daily functional rehabilitation, followed by 600mg ultramicronised PEA once daily for 40 days.1 Numerical pain scale (NRS) scores decreased from 6.3 at baseline to 3.7 and 2 at 30 and 60 days respectively. Both the physical and mental component of the quality of life questionnaires also significantly improved at the 30 and 60 day time points. These results suggest that PEA, especially when combined with physical therapies, may be part of a multifaceted approach to supporting chronic pain that seems to be resistant to conventional therapies. For further clinical support, see BioMedica’s technical sheet ‘PEA: A novel anti-inflammatory compound’ at biomedica.com.au Full reference list available upon request.
BioMedica Nutraceuticals P 1300 884 702 For technical support simply register for an account at www.biomedica.com.au
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ANTA Member Article Winter 2020
Andrew Pengelly
ND, DBM, PhD
Australian Herb Profile Sterculia quadrifida R. Br. Family: Malvaceae (prev. Sterculiaceae)
Introduction
The Peanut Tree can be found growing in the suburbs of Brisbane, and along the banks of the Brisbane River. Aware that the Peanut Trees’ distinctive seeds are edible, I searched the literature and found some well-documented traditional uses from both Australia and
Indonesia, while noting the species has been the subject of numerous research papers focused on medicinal applications.
Botany
flowering. Greenish, lemon-scented flowers grow in racemes, followed by the spectacular fruit, in the form of bright red, hard follicles containing up to 8 smooth seeds. This distinguishes them from true kurrajongs which have hairy bristles surrounding the seeds. The species distribution ranges from Coraki area in northern NSW up to Cape York, New Guinea and South East (SE) Asia. Fresh seeds readily germinate within 15 days of sowing1.
First a note on the taxonomy. As one of the common names suggests this tree is related to the more well-known kurrajongs (Brachychiton spp.) found throughout eastern and northern Australia. Both plants were once classified in the Sterculiaceae family, notable as containing the cacao tree (Theobroma cacao), the source of cocoa and chocolate. One distinguishing feature of the Sterculiaceae family is the follicular fruit, which splits down one side of a single carpel when ripe. In other Malvaceae such as Hibiscus spp., the fruit is a capsule, splitting open to reveal several carpels. A more technical difference is found in the anthers having two cells, while in other Malvaceae they have a single cell1.
Sterculia quadrifida is a tree of medium height and spreading habit. The simple leaves are alternately arranged, up to 15cm in length. As with members of the kurrajong (Brachychiton) genus, the trees may lose some or most of its leaves in the spring, pre-
Common names: Peanut Tree, Red-fruited kurrajong, Faloak (Indonesia)
The tree was discovered and named by Robert Brown, the botanist on board the famous Matthew Flinders expedition. At Brisbane’s Mt. Cootha Botanic Gardens there is a trail created in the “footsteps” of Robert Brown, featuring a selection of species that he observed and named, with notes on botanical features and Aboriginal uses. Other Sterculia species have medicinal properties. S. urens, a species native to India, produces an exudate known as kayara gum, an ingredient in pharmaceutical, food and industrial products with
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ANTA Member Article Winter 2020
similar uses to guar and tragacanthe gums2.
Traditional Uses
An infusion made from the leaves and bark, or juice squeezed from the inner bark has been used to relieve sore eyes, while crushed leaves have been used for treatment of wounds and skin complaints3, 4 . Aborigines also used the heated leaves for relief of bites of insects, stringrays and stonefish5. The natural distribution of S. quadrifera extends into SE Asia. The bark, roots and leaves are used for a wide range of conditions, including treatment of typhus, ulcers, diabetes, hepatitis, anemia and rheumatoid arthritis as well as to increase stamina and reduce fatigue. Traditional preparations include bark decoctions and an instant tea made from ground bark and ginger6, 7, 8.
Constituents
S. quadrifida fruits are a good source of protein, fat, carbohydrates and minerals—notably potassium, calcium and magnesium5. The following compound classes have been reported in the literature: alkaloids, flavonoids, terpenoids, steroids, triterpenoids6. Indonesian specimens contain high levels of flavonoids, as measured by quercetin equivalents, and high levels of total phenolics measured as gallic acid equivalents9. High concentrations of the condensed tannin epicatechin - an active constituent of green tea - have been isolated from the stem bark of this species10. An alkaloidal amine was isolated by authors Rollando et al. (2019)7.
Antimicrobial Action
A selection of Australian medicinal plants were studied for potential antibacterial activities. Water extracts of S. quadrifida were active in terms of either inhibition of growth or reduction in cell growth for all bacteria (gram positive and negative) tested, including Methicillin-resistant
Straphylococcus aureus (MRSA) and the fungal pathogen Candida albicans. On the other hand, methanol extracts demonstrated no inhibitory effects at all, indicating the active constituents are water soluble, possibly tannins11. In a separate study, weak anticandidal activity was demonstrated for S. quadrifida bark using different solvents. The methanol extract of the bark turned out to be the strongest7.
Antioxidant Action
In an antioxidant study of traditional Australian medicinal plants measured using DPPH and ABTS radical scavenging (ROS) activity, S. quadrifida leaves showed slight ROS activity. However, in a study conducted on 24 Indonesian traditional medicines using the same methods, S. quadrifida root demonstrated the most potent antioxidant action9. Another Indonesian study compared the antioxidant action of different plant parts, using a DPPH method. The parts included leaves, root bark, new and old regrowth stem bark and previously unstripped bark, and the new regrowth stem bark was found with the strongest antioxidant. All parts tested were more potent when compared to the standard antioxidant quercetin8. Another Indonesian study tested the instant foloak drink with added ginger referred to above using the DPPH method, however the antioxidant capacity was relatively weak6.
Antiviral (Hepatitis C) Action
Water extract of the stem bark was shown to inhibit hepatitis C virus (HCV) replication at different points in the life cycle, in vitro. The action was correlated to the presence of epicatechin, a known anti-HVC agent10. In a separate study, water, ethanol and methanol extracts of S. quadrifida bark were shown to inhibit HCV without showing any toxicity when cultured with healthy human cells12.
Immunomodulatory Action
S. quadrifida bark was shown to stimulate phagocytosis and nitrous oxide in macrophages in mice, demonstrating enhancement of the innate (non-specific) immune system, but without influencing production of lymphocytes or antibodies13. The stimulation of phagocytosis in macrophages is consistent with the findings of an in vitro study, in which the stem bark extract also demonstrated cytotoxic effects against hepatocellular carcinoma cells14. Authors Rollando, Sitepu, & Monica (2018)15 found cytoxic activity against breast cancer cells produced by an alkaloidal amine they isolated from an ethyl
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ANTA Member Article Winter 2020
acetate extract of S. quadrifida bark. On the basis of this finding, the lead author hypothesised there was potential for S. quadrifida and another traditional Indonesian plant extract derived from flowers of Hedyotis corymbosa to be used in conjunction with the chemotherapy drug Cisplatin for breast cancer treatment. The combination stimulated proapoptosis proteins leading to increased apoptosis (cell death) induction in breast cancer cells16. The combination appears to act synergistically, increasing sensitivity of cancer cells and potentially reducing the dose of the chemotherapeutic agent.
Conclusion
Despite long traditions of medicinal use of S. quadrifida in Australia, Indonesia and elsewhere, scientific evaluation is quite recent, most of the research reports from this species having been published since 2018. For the species to become a “listable” herb for inclusion in complementary medicines, we cannot rely on the Indonesian studies, since there may be differences in the phytochemistry and other aspects. There will need to be a safety evaluation conducted, involving animal studies. In the meantime it can be regarded as a “folk medicine” and food, also as a tonic given the reputation for treating fatigue. Members of ANTA are well-placed
to experiment with this plant, following the long history of traditional use in Australia and Asia. Note: This article was first published in Newsletter vol. 9, of the Indigenous Plants for Health Association, in December 2019. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
Andrew Pengelly, President of the Indigenous Plants for Health Association (IPHA) is an incorporated association formed with objectives of raising awareness, sourcing grants and sponsorship for sustainable production of indigenous plant-based products. For more information, visit:
https://indigenousplantsforhealth.com/
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ANTA Member Article Winter 2020
Ananda Mahony
B.App.Sc (Naturopathy) Grad. Cert. Human Nutrition Grad. Cert. Science of Pain Management
Rethinking Chronic Pain: A Holistic Approach
We have all felt pain at some time in our lives and as health care professionals many of us are treating patients with persistent pain in our clinics. In acute pain, once the injury or trauma heals, the pain stops. But chronic pain is something different. Chronic pain persists and represents a global health epidemic, frequently exacerbated by untreated or poorly treated pain. Current care relies on a biomedical model of pain, which reduces pain to neurophysiology alone without seeing the complex social and emotional context of pain.
At a time when one-in-five Australians experience persistent pain and up to 80% are not receiving best-practice care, it is time to rethink chronic pain1. What does that mean for our patients and us as health care practitioners treating chronic pain? That more often than not, our patients won’t have a diagnosis or reason for their chronic pain, and even if there is, the current biomedical model fails to serve. We must reconsider how we think about pain and the approaches we use to help our patients manage it. As complementary health care professionals, we are at the front line of health care and education and
can influence patient outcomes. And not just with our individual modality or therapy but also through education and appropriate referral for therapies that help contextualise and explain pain to our patients. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Pain is not an accurate measure of tissue health. Pain is a protector. Acute pain is an important warning system that provokes behaviour change, to help avoid further injury and allow for tissue healing. By contrast, in chronic pain the system becomes too protective which is not helpful. When pain persists the nervous system and brain become hypersensitive to perceived threat and amplify it, increasing pain severity and even generating pain without tissue damage or cause. This is often accompanied by heightened responses in other systems. Critically two-thirds of those with persistent pain can’t trace the onset to a single event.
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How does chronic pain present? • There is often a poor correlation between demonstrable pathology and pain intensity • Frequently there is no evidence of its existence on a scan or test • Pain can exist without any specific cause, but it can also be associated with surgery, trauma or another health condition • Pain can occur as a stand-alone issue or as a symptom of another condition • Pain can move, occur anywhere in the body or at multiple sites and get worse with time • An individual in pain can have one form of pain or multiple forms • It can be constant, intermittent or recurrent (migraines for example)2 There are many secondary impacts of chronic pain, amongst them a significant interference on daily living, quality of life, social and emotional function. Individuals in chronic pain experience worse general health status and there is a strong association with comorbidities including anxiety, depression, insomnia, fatigue, sedentary lifestyle and weight gain; also related to secondary medical outcomes such as increased risk of type 2 diabetes and cardiovascular events3. Often the relationship between chronic pain and co-current comorbidities is bidirectional, with worse outcomes seen compared to isolated disorders4. Family members are also impacted with higher reported family stress and financial burden overall.
What Factors Contribute to Chronic Pain
As outlined, chronic pain isn’t a linear relationship with peripheral input (nociceptive messages). Nociception is a means of communication to the central nervous system; however, pain and suffering are reactions, which are strongly influenced by anticipation of future consequences, real or imagined and by past experiences5. An individual’s thoughts, emotions and social processes have a powerful impact on the brain and spinal cord, engaging pathways that change pain pathway responsiveness6. These psychosocial factors have the ability to directly alter the experience of pain by influencing spinal and brain neuroplastic processes. The role of thought, mood and social influences creating neuroplastic change takes the understanding and therefore management of chronic pain far beyond the a biomedical approach and in fact allows the view that pain is created through the interplay of pathology (biomedical), genetics, emotion, memory, thoughts, beliefs and
social factors such as support available and previous life experiences. Understanding the role of psychosocial factors in chronic pain cannot be underestimated. For example, psychosocial factors have been found to have just as much impact as biomedical or biomechanical factors for ongoing back pain disability7. Psychological vulnerability including somatization, depression, fear avoidance and late return to work have all been found to be risk factors as have social factors such as low job satisfaction, peer support and job control8,9. Collectively these factors contribute not just to the sensation and severity of pain, but also the chronicity and disability associated with chronic pain. The take home message is that the experience of pain is the result of so much more than peripheral input from an injury or trauma. While it might be a factor, chronic pain is complex and individual. Chronic pain involves maladaptive neuroplasticity in the periphery, spinal cord and brain and is influenced and sustained by numerous psychosocial factors. To focus on the periphery alone leads to limited outcomes. Rather, the focus to understand and treat pain needs to be on all the factors that contribute including peripheral, spinal, brain, psychosocial inputs as well as overall individual health. Therefore, effective pain management needs to include the prudent use of treatments to reduce input from the periphery, be they pain medications, herbs, supplements or physical therapies along with approaches that modify central processes, address psychosocial inputs and support an individual’s whole health.
Social
A Holistic Approach
The biopsychosocial (BPS) model is widely accepted as the predominant framework for understanding the experience of chronic pain and its negative consequences. This model takes a broad and holistic view of the factors that contribute to an individual’s chronic pain and the interaction between biological / biomedical (genetic, biochemical, trauma), psychological (mood, behaviour, affect) and social factors (familial, previous trauma, community, workplace etc). The BPS model informs us that the
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Biolo
ANTA Member Article Winter 2020
individual experience of pain isn’t a reductionist experience, rather it is moulded by the complex and dynamic interactions acknowledging that we are unified humans, and everything matters!
research to support its effects12. PNE has been shown to reduce pain, disability, fear of re-injury and improves function, coping skills and selfmanagement. It also reduces healthcare utilisation.
Even though considered best practice, there is a lack of awareness within both the healthcare system and broader community about BPS approaches and as such a biomedical approach to treatment often predominates, even within complementary therapies10. The upshot is that optimal treatment options simply aren’t widely available to those in chronic pain and the focus on structures, diagnosis, medications and invasive treatments continues without considering wider treatment options11. Importantly there needs to be a redirection from investigations into the cause of pain and towards obstacles for recovery.
Within our clinic I run a community-based pain education program called PainWISE, a PNE program developed in Australia. Additional to existing care, PainWISE is a referral-based program aimed at enhancing existing treatments. This program teaches individuals to retrain and react differently to pain and builds self-efficacy. PainWISE enhances the potential for social and community connection, reducing isolation and risk of chronicity and importantly, builds a network of practitioners with a shared understanding of persistent pain.
The Biopsychosocial Model of Pain in Action
ogy
Applying a BPS model to pain from the very beginning, in which the psychosocial elements are given as much weight as the biological helps both patients and practitioners deal with the fact that biomedical causes of pain are frequently not clear in persistent pain. The key to patients accessing treatment based on the BPS model is the awareness that individual treatment may encompass an integrative approach and optimally will include the development of an overall treatment plan across multiple health care professionals. As complementary health care professionals, we are in a prime position to help treat and manage chronic pain.
Psychological
2. Set Biomedical Boundaries Setting boundaries around pain medication is key to avoid chasing external solutions such as increased medication use or other biomedical and surgical approaches and instead focussing on broader treatment options. Medication deprescribing (with the patient’s GP or specialist) and the importance of self-management strategies are key considerations. Adherence to pain self-management strategies is associated with improvements in pain, mood and increased functional ability. Using strategies such as active pacing, goal setting, thought challenging and stretching, and sticking to them, is predictive of better outcomes than passive treatment such as excessive rest and reliance on pain medications13. 3. Mind-Body Approaches Psychological approaches for pain have demonstrated evidence14. Examples include use of mindfulness or meditation techniques to reduce nervous system sensitisation and pain intensity and cognitive behavioural approaches to identify
A general approach to treating chronic pain is to address any identifiable underlying causes of pain, apply a whole system approach, be patient centred, integrate both complementary and conventional options and in addition to our individual modalityspecific approaches apply key BPS strategies including: 1. Pain Neuroscience Education (PNE) Specifically, helping patients understand the neuroscience of pain rather than a biomedical approach to pain. Understanding how and why it hurts is therapy in its own right, with significant THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 43
ANTA Member Article Winter 2020
and help change unhelpful beliefs supporting self-efficacy and management. Referral to a pain psychologist for assessment may be necessary particularly as coexisting mental health issues are common with chronic pain. 4. Encourage Social Connection The importance of social interaction is critical for individuals in chronic pain. Loss of connection hurts and this can translate to increased physical pain15. It is also associated with worse outcomes including persistence of pain and loss of work. Reconnecting or maintaining social connection with friends, family, workmates and community, or connection to purpose helps with recovery. 5. Movement is Medicine Movement is critical to the recovery process. Engaging in activity or exercise appropriate to the individual and their level of ability helps to maintain function and reduce pain and disability. Activity in the open air and out in nature also helps calm the nervous system16. See tamethebeast.org for more information. 6. Promote Healthy Nutrition Poor nutrition is known to contribute to systemic and central nervous system inflammation, which plays a role in chronic pain. Nutritional interventions can influence individual experiences of inflammation and pain. Dietary patterns such as those in the ModiMed diet help to reduce inflammation and the risk of co-morbidities such as depression, anxiety and obesity17. 7. Manage Comorbidity Treatment approaches that focus solely on reducing or treating the cause of pain often ignore exacerbation from pain-related comorbid conditions, and as such are not routinely effective18. Comprehensive patient-centred care beyond the management of pain to help improve prognosis and quality of life is needed. Commonly seen comorbid issues with pain are sleep issues, depression, anxiety and obesity.
Conclusion
Based on the above recommendations, it is
not surprising that a treatment formulation for an individual with chronic pain could be quite comprehensive and involve a number of health care professionals. Within our clinic, a multimodality team approach includes enrolment in the PainWISE program with potential for input from a physical therapist, a naturopath / nutritionist, a hypnotherapist or acupuncturist. Referral to psychology, exercise physiology, a general practitioner or yoga practitioner is commonplace. Individual treatment strategies are prioritised and paced with regard to modality and patient preference. While, at first this approach may seem overwhelming, it is important to remember that the BPS model has been shown to have better longterm outcomes than biomedical approaches which is hugely significant when it comes to an individual’s experience of chronic pain and quality of life. For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles
pain management Let’s Conquer Chronic Pain Together Easy to understand chronic pain education based on the latest neurological research
PainWISE Chronic Pain Education Program Learn more about how we work within your treatment plan to get the best results for your patients
vibepainmanagement.com.au/practitioners enquiries: ananda@vibenaturalhealth.com.au
PAGE 44 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
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ANTA Director Article Winter 2020
Kaitlin Edin
Acupuncturist | Eastern Herbal Medicine Chinese Medicine Practitioner National Acupuncture Branch Chair - ANTA
Blood Stasis in East Asian Medicine
Introduction Blood and its movement are key concepts in East Asian Medicine (EAM). However, it is difficult to have a discussion of Blood without also discussing Qi, as they form a Yin-Yang Blood & Qi
Qi, can be, and is understood in many ways. It is a qualitative rather than a quantitative term, and in everyday usage it covers a range of meanings and contexts. It is most often translated as an immaterial vital force, oxygen, breath or energy. As a principle it is dynamic. All movement involves Qi1. The relationship and interdependence of each may be described in this way: Qi is said to generate, move and hold the Blood, while Blood nourishes Qi2. Physiologically we know Blood nourishes and moistens the body and carries in it a range of chemical (molecular) components. But in EAM Blood is also said to ‘provide the material foundation of the Mind’ 2. The Classical texts refer to ‘Blood is the Mind of a person’, and ‘(w)hen Blood is harmonised, the Mind has a residence’ 2. As the Yin counterpart of the Qi, the concept of ‘Blood’ in EAM has a much broader range of influences and activities than those that are recognised by Western science.
pair and are complementary to one another. Therefore, we need to know one to know the other. Put another way, and to further develop that idea of Blood nourishing the Qi, ‘the central function of the blood is to nourish the Spirit (shen) and to carry its influence on every part of ourselves’3. In a way, we could say that the Blood itself holds the unifying role, and has both a physiological aspect as well as an immaterial aspect, being the substrate for the memory and ancestral Qi (DNA and genes), emotions, psyche and the spirit or spirits of a human being.
Blood & Blood Stasis
When we discuss Blood and more specifically Blood stasis or stagnation, (what the Japanese call Oketsui) it is important to remember both aspects of Blood, the material Yin aspect and immaterial (Yang or Qi aspect) are affected and treated. For Lonny Jarrett (author), the emotional or psychic factors that create Oketsu are as significant as the physical factors because the most ‘fundamental
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stagnation in life is the kind that comes when the true self has been forgotten’3. It is one of the aspects of EAM that I love so much. It gives us not only a framework to recognise and understand the emotional components of health, but a way to physically treat and recognise the somatic effects of emotions, trauma or stress in a manner that does not require us to necessarily know the story or delve into personal issues. By treating Oketsu (particularly) where we find it, we will, by the virtue of the body’s own interconnectedness, treat and help to heal the internal landscape. Whether it’s an improved sense of wellbeing, an insight, a shift of behaviour or a disclosure from a patient, it is well to remind yourself that when Qi and Blood move in the ways we want them to, the medicine is manifesting and assisting healing on both the physical and psychological levels.
Blood Stagnation & Stasis: What is it, where does it come from and why should we be concerned about it?
As a student I had only a cursory understanding of Blood and its relationship to the internal organs of the Liver, Spleen and the Heart, which seemed both obvious and unremarkable. The concept of Blood stagnation and stasis I remember was taught as a prescribed list of classical symptoms; the sharp stabbing pain, purple colouration of nails, skin and tongue, and/or dark menstrual Blood with clots. With this approach I had very little sense of the mechanisms that create Oketsu in the first instance. It became a thing in my mind rather than an integrated process. It was only when I discovered the texts of Dr Ju-Yi Wang and then Dr Yoshio Manaka that I began to get a deeper and richer awareness of Blood and the effects of its stagnation and stasis on the body as a whole.
Blood which is stagnant or not moving well through the microcirculation is usually deficient, (of nutrients) and stagnation or stasis will often affect the ability of the Blood to make new Blood, ‘for once blood stasis has manifested, it is difficult for the body to naturally eliminate and it tends to remain permanently’ 1. It can then ‘give rise to conditions such as bacterial infections, bruising easily, spontaneous bleeding and blood coagulation…’ 1. ‘In Western medical terms, inhibition of lymphatic tissue and venous return may reduce the ability of the body to fight against pathological occurrences (such as abnormal cell division, mutations and formation of tumours)’5. If it’s in the microcirculation, in the fine capillary networks of the body, in the lymphaticii flow and connective tissue that we need to think about Blood stasis , then it’s not hard to realise that it can be created from ‘the by-products of the natural breakdown of the cellular elements of blood, including the after effects of fever; local swelling, edema and discolouration due to trauma or bruising; incomplete menstrual flow’ 1; but also ‘other pathological occurrences (which) may include the development of inflammation, muscular tightness, swelling, edema and pain’5. This then opens up a wider spectrum of signs and symptoms many more readily observed in clinic. These include pigmentation changes in the skin and mucus membranes, red or brown moles and/or dry and rough skin in broad areas over the shoulders and around the neck and thoracic region, or there may be calluses on the feet and around the heels. For those who do regular massage those hard and tight knots of congestion in the muscle and fascial layers
Dr Ju-Yi Wang reminds us that ‘while the heart gives movement to the blood, sending it through the body, and the liver stores the blood in the deepest levels, it is the spleen which…on one hand gathers the necessary constituents to provide the nutritive aspect of the blood, and on the other, it gathers the blood at the level of the microcirculation to bring it back into the vessels’4. And this idea of the microcirculation is one to keep front of mind because Dr Yoshio Manaka identifies ‘Blood stasis is a condition where some obstruction has occurred in the microcirculation’ 1. Suddenly the idea was no longer a thing, but a way of understanding that Blood stasis as a pathological agent can occur in many conditions and situations where we may not traditionally think about it. It put life back into the terms, for now they meant something THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 47
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(kori) around and between the shoulder blades are generally indicative of Blood stasis, especially if they don’t seem to go away with treatment. Conditions such as whiplash, broken or fractured bones, strains and sprains, surgeries and scar tissue, poor posture, or chronic stress and emotions can all affect the muscles of the neck and shoulders causing disturbances of the lymphatic and venous return and creating an ‘anatomical obstruction of the free flow of blood and lymph from the head and the limbs to the trunk’5. ‘Menstrual disorders and psychological or emotional issues will often present as blood stasis progresses’ 1 and the clinical reasoning is twofold. Firstly, because any stagnation of Blood is related to or affects the Liver organ, and the Liver has many connections to our ability to manage stress, enjoy good sleep and regulate menstrual bleeding in women (among other roles). It also affects the Spleen, which together with the Pericardium creates the Chong Mai and rules the uterus. As a corollary ‘Blood stasis is heavy and typically remains in the lower abdominal regions. Since the left common iliac vein is larger than on the right, more blood stasis can be found on the left side, resulting in palpable reactions at the surface of the abdomen in the lower left abdominal quadrant’ 1. ‘This kind of stagnation will often directly affect the liver, because the accumulation of toxins absorbed by the rectal veins can then cause the portal vein to become congested, which will with time irritate the Liver’5. Blood stagnation and stasis then is often to be found at the root of many of the complex problems that practitioners see in clinic these days, and ‘is understood as the origin of many internal disorders causing pain’5.
Treatment Considerations and Guidelines
‘A general rule in many traditions of Eastern medicine is the requirement of moving stagnation concurrent with or before using methods that tonify’3. Whether it’s coming from an internal source (i.e. Qi, Blood, heat, cold, phlegm) or an external one (i.e. wind, damp heat or cold), ‘if we tonify without clearing stagnation, the risk is we will make matters far worse’3. It is useful to articulate here that what EAM calls ‘Cold, Heat or Damp in Western terms is understood as viruses, bacteria, moulds/yeasts/fungi respectively’6. With this in mind, all initial diagnostic evaluations (and indeed most treatments to some degree) from an EAM practitioner will seek to identify, assess and treat the identified pathogen, stagnation or stasis of Qi and Blood. ‘Assessing the degree of Blood stasis
can be critical to formulating a prognosis’7 as well as understanding how readily the patient responds, how long the treatments are needed, and how successful the practitioner is in addressing the underlying causes of the condition. Chinese herbal formulas like Gui Zi Fu Ling Wan, Tao Hong Si Wu Tang, Xue Fu Zhu Yu Tang and Wen Jing Tang are used often in cases that have long standing and obvious Blood stasis (and depletion). The first two are used a great deal in menstrual disorders, but acupuncture, including moxibustioniii and cupping, bloodletting and ion pumping treatmentsiv can also be effective in the treatment (of Oketsu)’ 1. In fact, acupuncture and moxa are excellent treatment choices for patients who cannot take herbs due to possible interactions with other medications they may be taking, or who are simply non-compliant with taking medicinals.
Acupuncture for Oketsu (Blood Stasis) in the Abdomen
Japanese style acupuncturists will often use hara (abdominal) diagnosis to discern Blood stasis in the abdomen, as this is a primary site, other than the head, where lymphatic and venous return is compromised, and Blood stasis tends to manifest. ‘The primary diagnostic sign is palpation pain or hardness in a triangular area between Kd15 and St27. The focal diagnostic point of Oketsu is found around St27’7 on the patient’s left side. It is important to remember that palpation of the abdomen should be with soft hands and not done to elicit pain. Tenderness and pressure pain will show in the reflex areas without prodding. When this kind of Oketsu is found at St27, the treatment is to needle Lr4 and Lu5 on the patient’s left side. ‘The practitioner should keep one hand on the patient’s abdomen at the Oketsu sign and palpate the acupuncture points with the other hand. Needles are inserted at the exact angle and location that have reduced the pressure pain in the abdomen’7. Lr4 should be needled first, usually at a 15° to 45° angle upwards, with the flow of the
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meridian. This point alone will normally reduce the pressure pain and tightness on the reflex area of the abdomen by 50 - 85%. Lu5v is then needled in the same way, with the flow of the meridian at the same angle and will usually reduce the pressure pain in the abdomen by another 15 - 35%7. This style of finding the point that releases the pressure pain in a reflex area is a feature of the Japanese style acupuncture and meridian therapy strategies and one that allows for immediate feedback in the treatment. Bilateral needling of Nagano’s immune points may also be added to this treatment. These points are found between the area of Li10 to Li11, which should be palpated to find nodules or ‘geloses’ (sometimes referred to as ‘gummies’), and then needled or treated with direct rice grain moxa (Okyu). Sometimes two needles are inserted into the geloses to achieve better results5. Okyu can be applied to Lu5 as well for good effect, especially if there are underlying respiratory issues to the Oketsu in the abdomen5. Obvious forms of Oketsu in the abdomen include endometriosis and inflammation of the fallopian tubes, which are considered as excess conditions that affect the Spleen. Whether your patient complains of symptoms or not, the diagnostic reflex areas for palpation and pressure pain will generally show at St28, Kd13 and around the Dan Tien (the area below the umbilicus). When these areas of tenderness are found, the major treatment points generally used are Sp5 and Lr5. When needling Sp5, using a dispersing technique, and ensure that the pressure pain at St28 is being significantly released. If you or your patient prefer moxa, Okyu can be
applied for 30 to 50 rounds9. There are profound 5 Phase connotations to the use of this point with moxa. Sp5 is the metal point of the Spleen channel (yin earth channel), and as such it is considered a dispersion point. The application of Okyu moxa with its yang characteristics, which is also quite dispersive, can be employed as a way of using ‘fire’ to subdue or regulate the metal point, (according to the ke cycle) while still supporting and nourishing the yin earth channel (according to the sheng cycle). ‘Clinically the use of Sp5 has a strong anti-inflammatory effect on the abdomen and pelvic cavity’5. When needling Lr5, which is located halfway between the medial malleolus and Lr8, ensure that it reduces the palpation pain on Kd13. ‘Considered an essential point for irritation of, and inflammation in the mucus membranes and for scar tissue within the abdomen, Lr5 is also used as a point to assist detoxification of the Liver. It has the added benefit of treating bladder infections and gout pain’5. Mucus membranes may be considered one of those places internally ‘where the smallest blood vessels intersect with the interstitial fluids surrounding the cells’4, and this is a practical way to understand how the Spleen governs Blood and holds the flesh at the microcirculatory levels. Other important points to consider with any kind of gynaecological symptoms are to check Kd2 for palpation or pressure pain. As the fire point on the kidney channel, when it is painful, it will often indicate inflammation in the channel. To reduce the pressure pain, use Kd7 and Kd10 (Metal/Water
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points), needle and then check that the reflex point (Kd2) has reduced its sensitivity. Metal/Water point combinations can be used on all the yin and yang meridians when there is palpation pain in the fire points of the channels. Supporting points to use for gynaecological issues and especially endometriosis include GB34 and SJ4 or SJ5, which when used together will engender the Dai mai and the Yang wei mai. This point pairing can be needled or given okyu, usually 7 - 10 rounds9. If you wish to use them with a stronger balancing focus with the eight extraordinary meridians, use either SJ4 or SJ5, together with GB34 on opposite sides to each other. If you use them on the same side, the points will tend to treat a more structural alignment of the Shaoyangvi.
A Few Notes on Moxa ‘Kyuji’ – Okyu aka Rice Grain or Thread Moxa
Most acupuncturists in the West, unless they have done specific training, don’t really learn much about moxa, its broad application and its many styles. If they think of moxa at all, they think of the pretty smelly and smoky cigar-style moxa sticks that are used in an indirect way, never applied directly to the skin. The smell and the smoke have meant this style of moxa hasn’t had good take up in recent times in the modern clinic. However, moxa offers so much more than this most basic of applications, is richly varied in technique and has benefitted from Japanese specialisation. ‘Moxa specialists in Japan are separately licensed from acupuncturists’ 10 and yet most acupuncturists from meridian therapy lineages both in Japan and those trained in the West (say those who have studied in the applications and techniques of Ikeda, Nagano, Manaka and, or Toyohari) all use Okyu. This direct form of moxa, and by direct it means that the moxa punk or wool is rolled into cones of varying sizes, placed on the body at specific points, lit and allowed to burn down to, or just above the skin level. The larger cones (chinetskyu) or heat perception moxa cones are used more for the qi level and generally are not burnt to the skin level, while the rice grain size and smaller (toonetsukyu) cones
are used to treat more ‘chronic conditions by affecting the stagnated blood and disease which is manifesting at the blood or deeper level’ 10. The modern use of this kind of moxa with adequate training is not intended to blister or to scarvii although the possibility is always there. If you haven’t been trained in direct moxa, while I urge you to develop the skills of this really wonderful technique, there are a few options that you can use instead that give some of the benefits of moxa treatment with a lot less risk. The first is a tiger warmer, the second is Choseikyu or platform moxa. Both kinds of moxa are considered isolated or indirect forms but can be used by acupuncturists on the patient as an alternative to using rice grain moxa and are certainly helpful when giving moxa to those patients unfamiliar with the therapy. Both forms of moxa application can also be provided by the practitioner to the patient for home treatment. Once the patient has been instructed on where to put the choseikyu or where to best use the tiger warmer for their condition, they can continue the use of the moxa at home. In any modern setting where a small amount of smokiness is tolerated, these are acceptable alternatives to the direct moxa.
Conclusion
It is helpful to remember that any impediment to the free flow and circulation of Qi and Blood in the body will create a degree of stasis and stagnation at the Blood level. Whether due to structural changes from surgery, anatomical factors such as poor posture, chronic stress affecting the musculature or aging, or indeed physiological causes; damage on internal organs from medications, genetic predispositions, environment, lifestyle or aging, the extent of Blood stasis should always be in the mind of the practitioner. Many conditions that we might not previously have considered to be issues of blood stasis, are with a deeper understanding of the microcirculation realised to be just that. Addressing these microcirculatory changes as soon as they appear, or with consistent treatment if they are long standing will improve health outcomes. Acupuncture and moxa are excellent treatment choices, especially for those patients who can’t or won’t take herbal prescriptions.
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How are Practitioners dealing with COVID-19? An interactive chat with ANTA Members
Recently, ANTA Director Shaun Brewster sat down for a chat (via Zoom) with two ANTA members, about their experience and how they have adapted during the COVID-19 pandemic. These interviews provide a snapshot of how two individuals have managed during this time
and what they have done to ensure they can continue providing their valuable services to their community. The interviews are also available in the ANTA Member Centre.
Peter Mullen is a Naturopath, Nutritionist and Herbalist and is the owner of Mullen Natural Health in Newcastle, New South Wales. Shaun – Hi Peter, for anyone that is watching this, can you give a little bit of a run down on yourself and your business. Peter – Yes of course. I run a Naturopathic clinic and I am a Naturopath, and I graduated in 1987 and have been in practice for 31 years. I have been around the block a time or two and health has changed a bit over time and, obviously, now we are being forced to look at how we do business a lot more closely as well. As one of my good patients said while we were talking virtually (via Zoom), this is really the virus we have all been preparing for. We are a Naturopathic practice with five Naturopaths with eight or nine Care Assistants (CA) helping patients making appointments; my wife runs the marketing department, and my daughter does the social media. It is a very family-orientated practice. I get to do what I love which is PAGE 52 | WINTER 2020 | THE NATURAL THERAPIST VOL 35 NO. 2
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being able to see patients, and I do a lot of training for the other practitioners in clinic. First and foremost, it is about my patients and I really love helping and talking with them. Shaun – Fantastic. It is great to hear from a practitioner who’s been in the industry as long as you have and who is still enjoying it. It’s times like these when restrictions are put upon us and we are having to adapt and change, to do what we love, and needing to do that well is important. So, as a result of the current restrictions, how has your business pivoted and changed specifically? Peter – We have not worked out all the kinks yet, with day to day changes and areas that need improving. The first thing, four Naturopaths are working from home, starting with Skype, Zoom and phone consultations. Practitioners then notify the CA’s who follows up with the patients for payment and other mailings. We also have a pick-up station for prescriptions, etc. Once these restrictions came into effect, we closed the clinic to patients and made these changes straight away. Our priority is the health of the staff and patients. The pick-up station is at the front door, clients call us, and we have the parcel on the table ready to go for when the client comes past. That is working well. Last year we started up a practice called The Herb Bar, and we have set that up as an acute consultation situation, so even if a patient hasn’t come in through the normal consultation process, they can ring up, and speak to the practitioner and do a small consultation and can be advised of some supplements, so that has worked well just to be available for everybody at any time. We also had to change all our texts, phone messages, and emails to let people know about the changes we were making. The biggest thing this situation has confirmed, even more for us as Naturopaths in business, is that we need to keep in touch with our patients. All the practitioners have phoned their clients personally to see how they are and if they need any more support. We really need to keep in touch and look after the communities we have built and nourish and nurture them to know that we are there for them. That is really a big thing. We are doing more social media posts, Facebook Live interviews and really trying to keep sending that message of keeping positive and surviving this. As a business we have also registered for the Government’s JobKeeper program, which has passed through Parliament, which allows us to keep all our admin staff. We have also sent reminders out to patients for the following few days, and the clients are holding to the appointments and are adapting to the new consultation platform, either via Skype or a phone consult. During this time, we are going to focus on the jobs we do not have time for, including revamping our blogs and updating other resources. Shaun – You mentioned before that this is a really good time to reach out to your clients to let them know that you are here, and I think that is a really good point from a personal point of view as well, that our patients, clients, friends and family may be feeling very isolated, as we are, and those who are usually seeking care from someone like yourself, the feeling or thought that it might stop can be a very intimating thing for some people, especially those who regularly rely on their health practitioner. Even just a simple phone call or email can mean a lot, to let them know you are still there. Peter – Yeah, absolutely, and my feeling on this is always the same, that once you have been a patient or around the practice, that you are a patient for life. This is what community is all about, as someone has taken the time and effort, spent the money to come and see you and put faith in you, therefore you need to be there for them. As time frees up a little bit, and as staff time frees up, we can put more of an effort in. Shaun – Have you noticed any limitations with the way you have interacted with your clients, because you are not sitting face-to-face and have the physical rapport? What limitations are there when consulting over the phone or via Skype - things that would limit the effectiveness of the treatment and other things? Peter – Well, the big thing is not having the person sitting in the room with you. One great thing we have as practitioners is the way we engage and are present when talking with someone, so that can still happen. For a lot of my patients, their biggest issue is not having that hug that I normally give them upon arrival. That is a major thing I am missing now. The physical exam makes things a bit more challenging, especially with someone that has gut health, seeing their nails and tongue. You can still see their nails and tongue by holding them up to the screen, but it is not as clear. Something that I always do with my patients is iridology, so I am missing that as I am not so sure on how to get a good enough image on someone’s eye. So, things like this are a challenge. THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 53
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Shaun – In your opinion, what are some of the advantages of this current situation, from a practitioner and business point of view? Peter – One of the positives is the way it has impacted our opening hours. I am working from the office, along with the office staff, but the other practitioners are working from home. So that means we have not had to staff the premises for as many hours each week. We generally work later Wednesday and Thursday nights and now we can close the clinic at a more respectable hour or can even start a little bit later. We have found that the practitioners can work to a more flexible schedule as consultations are online. The CA’s can contact the patient the next day and deal with the payments and natural medicines and making their next appointment. So condensing business hours, does seem to be saving our patients a lot of transit time as well. Now, unfortunately, my wife is here to hear this, but I will say it anyway… so far with my online consultations, I am running on time with my patients more effectively. Like a lot of practitioners, a problem of ours is that we don’t always stick to our times, so I am finding that patients are happier to get on, talk about what we need to talk about then get off, especially with a set period of time. So, I am finding that good so far. Shaun – So, do you think after this situation, some of the changes will continue to be used in some capacity? Peter – Look, it will be very interesting to see Shaun. I think some things will stay and some people may actually enjoy having consults like this, but I think a pretty large amount will return to normal, but it’s all pretty unknown. I think we will be doing more online stuff; we did a lot of Facebook before, but probably focus on more community building. But what I think will come out even more, is the future proofing of our business in case something like this happens again, then we are prepared. I think one of the best things we can do moving forward, is to try and nurture and build our community base. So, I think every practitioner needs to build that base of people or loyal patients, so that if something like this happens again, then we have a bigger base to work with to keep our businesses going and keep looking after people. We already do some online programs and I think we will investigate doing more stuff online. Shaun – So, would you say that the patient responses have been positive? Peter – I have been amazed at the adaptability and resilience of our staff, coming up with great ideas and suggestions, as well as my patients. It’s kind of interesting, a lot of my older patients, who I would have thought would be rattled and more stressed, have actually had a lot more common sense than my other patients. I have been amazed with how resilient people have been, and then some of my patients haven’t been very keen to do what needs to be done. Shaun – Peter, this has been great, and it is been nice to talk to someone who has managed to find a way to adapt and innovate in a forced isolation. We must innovate, we must adapt, otherwise we will be left behind, as there is no other choice. It has been great to see you doing that with your entire business with all staff working together, which I think is brilliant. Peter – The biggest challenge I see now is our new patients. We need new patients, as others have gotten better or moved away or decided that it’s not for them. So, we need our new patients coming in, to keep the business topped up, but to keep the practitioners base growing, which has been the biggest challenge. One last thing - my wife has been great with all the ideas. As I have said, I’m great with the patients, but my wife is great with the goings on of the business side. It has been a family and team effort. Shaun – Well that is great. I am sure she is sitting off to the side smiling and happy with the recognition. Thank you for your time today Peter. Peter – Thank you, Shaun.
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Chris Steffanoni is a Sports Therapist, Nutritionist and owner of Aligned Sports Therapy in Melbourne, Victoria. Shaun – I’m chatting with Chris Steffanoni today, he has come on to talk about his experience through this COVID-19 time and how it has affected him as a therapist, some of the things he has observed and some of the changes he has had to make. Thanks for joining me Chris, can you please introduce yourself, who you are, what you do, what type pf practice you run? Chris – Hi Shaun. I’m Chris Steffanoni,and I’ve trained as a sports therapist which amongst other things involves a lot of remedial therapy work. I essentially contract out of a couple different clinics, primarily out of a chiropractic clinic and a physio-based clinic. I have been working for about five or six years now, and even though I trained in a strong sports background, about half of my clients are into sports. So, we see a full range of different clients and injuries. Shaun – And what do you think would be the main thing that has changed in the way you have be treating during this time? Chris – I think as practitioners, we can sort of get stuck in ruts at times. We do the same or similar things over and over again, and this has been a bit of a hand grenade thrown into everyone’s lives, a lot of uncertainty and stress, and its really forced me to evaluate how I treat. A few weeks ago, it was hard to evaluate if I was going to continue practising or not. I’m also a nutritionist, so I can also do that remotely. So, just having a good think about which patients genuinely need us, while keeping myself, my family and everyone safe in the process. So, I think it has been a very good time to reflect. Shaun – How has it affected you in a day-to-day consultation setting, with the clients you see, has it changed the duration or the way you administer the therapies you use? Chris – Definitely time has been straight forward. It became clear, that exposure time is serious. The longer people are exposed to other people, the risk is higher, so with regard to reducing the time of treating each patient, that decision was made very easily. I really need to be on the ball with getting that client in, and quickly determining what the priorities and goals are going to be. I also put a lot of focus into thinking about what the most effective tools are for treating each client. This is still evolving for me, often it is a combination of some manual work, dry needling and exercise prescription. As we know, when people are coming in with an injury, specific exercises are one of the best things we can do to treat someone. Whether you are a Remedial Massage Therapist or Myotherapist, you have a strong background in hands on modalities and exercise, but hands-on are our bread and butter. Now, I have put a lot more effort into giving clients tools and exercises that they can do at home to help themselves. Shaun – So, with that reduction in time for treating clients, I’m sure it has sharpened up the treatment skills and changed the paradigm for a lot of people. Patients come to see us for a service and an outcome. If we can achieve the outcome in less time, then we should. If we can do that, it’s a good thing. Ultimately, we can also see more clients in a day. It’s forcing us to think. Chris – I think when you first start treating, you want to see people for 3 hours because you have no clients but I have been in practice for a few years, and yesterday I saw more clients in a day than I ever have before. Shaun – Well that’s great. Obviously it is heartening to see confidence in the community, and that they can still go out and see a health practitioner because they know they will still get looked after. Chris – Yeah, and one of the things I’ve always been conscious of, is not trying to encourage people to come in if to see me if they don’t need to. Some people still want to come in unnecessarily for a treatment, because getting a session just makes them feel good. Those people I’ve actively discouraged from coming in for now. It has, however, given me a lot of confidence that there are people out there that really need to see me. THE NATURAL THERAPIST VOL 35 NO. 2 | WINTER 2020 | PAGE 55
ANTA Member Article Winter 2020
Shaun – What have you observed in the broader community as far as other practitioners and how they are interacting? Chris – In terms of other practitioners, it has been really interesting as we are quite fragmented in a sense, we have multiple organisations, and often receive different advice. I’m seeing new clients that would normally see another practitioner, as they are not practising right now. I’m trying to be upfront and have communications with the other practitioners about their clients, as we have a duty of care that there is continuity with the client’s care. Shaun – Have you noticed associations be more vocal or communicative at this time? Chris – Yeah, I think from a practitioner’s point of view, we probably do not put in too much thought into the value that our associations provide. I think it has become very clear in the last few weeks, that the associations, and all those involved, do a hell of a lot of work in terms of guidelines have been changing and clarified. There is no doubt that the clarity we now have has happened as a result of the work that associations have been doing behind the scenes with the Health Departments and Governments. ANTA doesn’t have Twitter, which always bugs me, but there has been plenty of Facebook updates and a great deal of social media posts, which has been important, and people do not appreciate that as much as they should. The relationship between the practitioner and the association should be close, and the more involved we all are, the better the outcome is for everyone. Shaun – Great, some good observations there. I’m enjoying hearing that from you, as there has been some negative chatter on social media in the last few weeks. But there have been some good news stories also, people coming together and having conversations, basically some relationships have been built off the back of this experience. We just have focus on the good. Chris – Yes, the relationships between the associations as well. You are all communicating, and I’m not sure how much communication there was in the past, but only good can come of that. Shaun – Absolutely, I agree. Thank you, Chris, thank you for your time today. Chris – Thank you, Shaun.
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