The Natural Therapist - ANTA Journal - March 2017

The Official Journal of the Australian Natural Therapists Association (ANTA)

C L I N IC S

SCRAPING

W EL L N ES S

GREAT ARTICLE

GREAT ARTICLE

GREAT ARTICLE

For Ethics

for Pain

for Arthritis

The Natural Therapist Practicalities of Ethics Scraping to treat chronic pain

+ ANTA NEWS, GRADUATE AWARDS, ANTA SEMINARS, ARTICLES AND MORE IN THIS ISSUE

The emotions in Traditional Chinese Mecicine Turmeric for Arthritis Beef Consumption

www.anta.com.au

ISSN 1031 6965

RELIABLE MINERAL TESTING HAIR TISSUE MINERAL ANALYSIS Minerals are the ‘spark plugs’ of life – essential for growth, healing and wellbeing.

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BONE TISSUE AND MUSCLE SUPPORT COMPLEX Reparen is made from monobasic calcium phosphate which is a ready source of biologically friendly, easily broken down essential Ionic Calcium.

Reparen may assist with bone strengthening, tissue repair and the relief of muscular cramps and spasms as well as healthy heart function and cellular bioenergy.

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If symptoms persist, seek the advice of a health professional.

Australian Red Marine Phytoplankton

SUPERFOOD AND NATURAL MEDICINE Dunaliella salina microalgae is one of nature’s richest sources of carotenoids and important daily nutrients.

For optimal daily functioning the body requires a wide range of nutrients.

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CO N T E N T S TNT JOURNAL 5

Executive Officer’s Report

A warm welcome to all ANTA practicing and student members

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ANTA News & Awards

ANTA announce Bursary Award winners for 2017

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Workers Compensation

Massage therapy fees order 2017

13

13 Practicalities of Ethics Ethics within the clinic

16 Scraping to treat chronic pain Techniques in scraping for chronic pain

22 The Emotions in TCM The paradigm of the 5 elements in TCM

36 Turmeric for Arthritis

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Turmeric and its benefits for arthritis sufferers

40 Decreasing Beef Consumption A global change of thinking is required

42 Urinary Tract Infections Urinary tract infections are rapidly increasing

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VOLUME 32 NUMBER 1 - MARCH 2017 ISSN 1031 6965 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 Australian Laws. ANTA accepts no responsibility for breaches of Australian 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 authors.

ANTA NATIONAL ADMINISTRATION OFFICE

ANTA BRANCH CHAIR PERSONS Jim Olds - President National Multi-Modality Branch Chair Director of ANTA Director of CMPAC ANTAB/ANTAC Chair Ethics Panel Chair Justin Lovelock - Treasurer Director of ANTA Director of CMPAC Constitution & Policy Chair ANTAB/ANTAC Committee Member ANRANT Committee Member Tanya Morris National Naturopathy Branch Chair CPE / Seminar Chair Director of ANTA Media/Web Chair ANTAB/ANTAC Committee Member ANRANT Committee Member

Jeanetta Gogol - Vice President National Remedial Massage & Myotherapy Branch Chair Healthfund / Workcover Chair AHRPRA PRG Rep Director of ANTA ANTAB/ANTAC Committee Member

T: 1800 817 577 F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 australiannaturaltherapistsassociation.com.au

Warren Maginn National Nutrition Branch Chair Registration Chair Director of ANTA TGA Chair ANTAB/ANTAC Committee Member ANRANT Committee Member

Executive Officer Brian Coleman

Brian Coleman Company Secretary Executive Officer Director of CMPAC ANRANT Chair Business Plan Chair

THE NATURAL THERAPIST

Marketing/Production Steven Venter Circulation Enquiries 1800 817 577 Editorial & Advertising Enquiries steven@anta.com.au Membership Enquiries info@anta.com.au General Enquiries info@anta.com.au THE NATURAL THERAPIST Volume 32 No.1

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THE 2017 INTERNATIONAL CONGRESS ON

NATURALMEDICINE THE MOST SIGNIFICANT ANNUAL EVENT HELD IN THE NATURAL MEDICINE INDUSTRY

Saturday 10th - Monday 12th June | Crowne Plaza Hunter Valley

MASTERING THE MICROBIOME – A CONTEMPORARY TARGET FOR ALLERGY, PSYCHOPATHOLOGY, METABOLIC DISEASE AND BEYOND...

PRESENTERS INCLUDE: Dr Jeffrey Bland – Founder and President of the Personalized Lifestyle Medicine Institute, CEO – Kindex Therapeutics

In 2017, The International Metagenics Congress will share the latest updates in this fast-paced field, explaining how the trillions of microorganisms living on us and inside of us are connected with everyday clinical presentations such as allergies, immune dysfunction, digestive disorders and chronic health issues such as cardiometabolic disease, obesity and psychological disorders.

Professor Rob Knight – Co-founder of the American Gut Project and the Earth Microbiome Project

Unite with leading global researchers and expert clinicians to unravel the complexity of the microbe-human relationship and the molecular mechanisms that govern pathological processes, gain deeper insight into evidence-based strategies for intervention and identify the areas where the science is still in its infancy.

Dr Gregor Reid – Pioneer in probiotic research and chair of Human Microbiome and Probiotics at the Lawson Health Research Institute

We encourage you to book in and pay in full now to secure your seat and avoid dissapointment.

SEATS SELLING FAST! BOOK NOW!

• Full Congress manual • Congress gift pack • Morning tea and refreshments upon arrival • Healthy and delicious full buffet lunch • Afternoon tea • Coffee, tea and purified water • A light dinner on Saturday night

Complimentary bus transfers available from Newcastle and Sydney airports to the Crowne Plaza Hunter Valley.

Please contact your Area Sales Manager for details.

E

I NT E

REGISTRATION INCLUDES:

IN

AT

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2017

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For a full list of presenters, see our Congress page on the Metagenics website.

Price is $795.00 incl. GST each per person.

(Same price applies in New Zealand).

NA L C O T IO N NA

G

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Call 1800 777 648 to book today. For further information visit our website metagenics.com.au

Dr Keith Berndtson – Medical Practitioner specialising in Chronic Inflammatory Response Syndrome (CIRS)

URAL MED

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MET4981 - 02/17

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Executive Officer’s Report – March 2017 A warm welcome to all new ANTA practising members and ANTA student members.

If you require any information, advice or assistance please feel free to contact the team in the ANTA National Administration Office on 1800 817 577 or info@anta.com.au Statutory Registration - National Regulation & Accreditation Scheme (NRAS)

ANTA members who joined with Advanced Diploma qualifications are not affected by the ASQA decision to cease delivery of Advanced Diplomas.

Members with Advanced Diploma qualifications are not required to upgrade to Bachelor degree level qualifications.

As long as members with Advanced Diploma qualifications maintain continuous ANTA membership and abide by health fund provider register requirements they will continue to be ANTA members and registered as providers with health funds.

Health Funds Audits

ANTA continues to push for the inclusion of natural therapy practitioners under the NRAS. ANTA has provided Ministers, government departments, government advisors, registration boards, health funds and colleges with a detailed submission on the statutory registration of Naturopathy, Western Herbal Medicine and Nutritional Medicine.

The ANTA submission is the first detailed submission for Naturopathy, Nutritional Medicine and Western Herbal Medicine developed by the profession and presents evidence for the statutory regulation of Naturopathy, Western Herbal Medicine and Nutritional Medicine (Nat/WHM/NM) in Australia under the National Registration and Accreditation Scheme for the Health Professions (NRASHP).

The submission applies the process outlined in Attachment B of The Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions (IGA), which outlines six criteria to be met before registration of any health profession is considered. The IGA states ‘it was envisaged that other health professions would be added over time. The submission focus is on all of these criteria with a special focus on Criterion 2 which requires that the occupations’ practice presents a serious risk to public health and safety which could be minimised by regulation.

The submission seeks to demonstrate that registration of these three health professions is justified and will provide evidence of the risk to public health and safety and the reasons why current regulatory mechanisms are insufficient in minimising this risk. In achieving that goal, the submission is cognisant of the COAG Best Practice Regulation Guidelines (COAG guidelines) which requires any regulatory response to first find a case for action, any decisions made should consider self-regulation, co-regulation and non-regulatory options and it should provide the greatest net benefit for the community which is proportional to the issue being addressed.

Health funds are conducting regular audits of associations.

Completion of 20 hours of CPE is one of the areas health funds focus on and we are very pleased to see the positive response by members to ensure their CPE records are up to date.

It is encouraging to see members have taken full advantage of the CPE facilities ANTA provides such as the ANTA e-Learning Centre, free ANTA webinars, free ANTA seminars, free access to IMGateway scientific and e-learning resources, EBSCO Host research database and eMIMS Cloud to name but a few.

It is also satisfying to see the new processes we introduced to ensure members renew their professional indemnity insurance and first aid qualifications on time has paid dividends and this process has been instrumental in ensuring ANTA members are audit compliant.

We have received notification from health funds they will be continuing their ongoing program of detailed analysis of receipts issued by members of all associations to ensure compliance with health funds provider terms and conditions.

We have also received advice from health funds that they are continuing to monitor claim and receipting profiles of all providers to identify any variations when compared with profiles of their peers.

If a practitioner’s receipting profile shows any abnormalities, the practitioner will be required to provide additional information and meet with health fund management to explain the variations in receipting practices. Important information regarding health fund reviews of providers is outlined on the ANTA website and detailed in the previous edition of The Natural Therapist. We recommend members read this information and contact us if you require further clarification.

FREE ANTA National Seminars

ANTA is continuing to discuss with Ministers, government departments, government advisors and AHPRA the submission prepared by ANTA and the benefits of registering Naturopathy, Western Herbal Medicine and Nutritional Medicine under the NRAS. As discussions and developments occur on the push for registration, we will keep ANTA members informed.

Advanced Diplomas - Naturopathy, Western Herbal Medicine, Nutritional Medicine & Homeopathy We continue to remind members of the decision by ASQA to cease delivery of these programs. Colleges have also been given an extension of time until 2018 in which to teach out these courses and award graduates with their qualifications. ANTA has been in contact with colleges to advise graduates who have completed accredited HLT Advanced Diploma courses will be eligible to join ANTA.

The ANTA seminar held in Brisbane in March was a huge success and feedback regarding the presentations has been fantastic. We will contact members by email to advise them when the next Free ANTA seminar is being held in their State in 2017. All ANTA members including students can register to attend ANTA seminars free of charge.

FREE ANTA Webinars We are continually adding outstanding webinars to this collection and I recommend members to log on the members section of the ANTA website and check them out. Viewing of the webinars is a great way to keep up with the latest developments and earn CPE points.

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Stay informed and up to date

To stay in touch with the latest information make sure you visit the ANTA website, members centre and ANTA Facebook.

Updates containing a wealth of information are also sent to members by ANTA e-News regularly.

Changing your contact details or clinic address Don’t forget to let us know asap if you change your email address, postal address, telephone or clinic addresses. This information is essential for us to contact you, keep you updated and to ensure your clinic addresses are registered with health funds.

ANTA National Student Bursary Awards for 2017

and to make arranging insurance a much simpler process for all members. In the next few weeks we will be announcing some exciting changes to the way members can organise their insurance and we are sure it will greatly simplify the process for members.

Advertising and Promotion of ANTA Members in national magazines Due to the success of our advertising and promotion of ANTA members in national lifestyle magazines, we have expanded our promotion to include banner advertisements on magazine e-News and newsletters. This program has been successful in raising public awareness on the benefits of consulting with an ANTA accredited practitioner.

Natural Therapies App

The submissions received from students for the ANTA National Student Bursary Awards for 2016 were outstanding and we are excited to advise submissions for the 2017 ANTA Bursary Awards can now be lodged on the ANTA website. To date ANTA has provided more than $120,000 to students to assist them with their study and careers.

ANTA will again be providing another 12 x $1000 Student Bursary Awards in 2017.

Free Legal Advice for ANTA Members The facility provided to ANTA members through our supplier of professional indemnity insurance Arthur J Gallagher (incorporating OAMPS) has been a huge success with numerous members taking advantage of this free service.

30 minutes of free legal advice is available for: • ANTA members who have a professional indemnity policy with Arthur J Gallagher • Issues regarding professional indemnity policies and/or claims • Any other issues regarding your practice such as employment contracts, employment disputes, tenant agreements, leases, ownership of client records, restraint of trade etc To obtain 30 minutes of free legal advice contact the Arthur J Gallagher Specialty Risks team on: • • •

free call - 1800 222 012 email - specialtyrisks@ajg.com.au This offer is provided to ANTA members

by Arthur J Gallagher in conjunction with White & Mason Lawyers

ANTA is the only association with an App that promotes natural therapies and ANTA members to the public. The App is free and the public can complete instant searches for an ANTA member on their phone and at the same time set up an appointment with an ANTA member in a matter of seconds.

Members details are updated on the App regularly. For more information go to www. naturaltherapiesapp.com.au Upgrade of Member Engagement Management software We are in the final stages of upgrading software to provide members with a range of real time services and facilities including online communities, updating of members profiles, streamlined communications across all devices, automation of processes, real time updating of information, searchable online directories, interfacing with social media and much more. This is an exciting project which will provide members with a range of benefits not seen before in the natural therapy profession and we look forward to introducing these benefits to members in 2017 as we progressively roll out this project.

Contact us if you require any advice, support or assistance – we value your feedback Any members requiring advice, support, assistance or has feedback on ways in which we can improve our member services please feel free to contact either myself or the team in the ANTA National Office at anytime on 1800 817 577 or info@anta.com.au Our Administration team is ready to assist you.

Professional Indemnity Insurance Regards We have been working with our preferred supplier of professional indemnity insurance Arthur J Gallagher to improve services

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Brian Coleman Executive Officer

Important Announcement by ANTA Membership & Professional Indemnity Insurance “Latest innovation by ANTA makes Membership and Professional Indemnity Insurance solutions simple, easy to arrange and manage”.

ANTA has recognised the need to simplify the membership and insurance process and in a first for the natural therapy professions, ANTA is pleased to announce that under a new arrangement with Arthur J Gallagher (ANTA’s preferred insurance solution provider), ANTA now has a full time insurance broker based in the ANTA National Administration Office.

This is a very exciting development and ANTA has recognised the need to provided an easy solution for graduates and member insurance requirements in a “one stop shop, “your membership and insurance needs are now handled under “one roof” Graduates joining ANTA and existing members will be able to make membership enquiries, discuss membership issues, arrange new insurance policies, renew policies, make payments, update policies, ask questions regarding insurance and resolve issues simply by contacting the ANTA National Administration Office on 1800 817 577 or insurance@anta.com.au.

No need to make separate calls to contact Arthur J Gallagher (ANTA’s preferred supplier of insurance) as all your membership, insurance requirements and questions can now be handled and resolved in one call when you contact ANTA directly.

This initiative by ANTA will streamline the membership and insurance process and provide members with a simple process to ensure health fund provider registration remains continuous.

It is also a great development for graduates, members and the natural therapy professions as it allows ANTA and Arthur J Gallagher to work closely together in the ANTA Administration Office to resolve any insurance issues for members and deliver a better service for members.

Members who are not currently insured with Arthur J Gallagher can participate in this new streamlined process by simply calling the ANTA office and discussing their insurance requirements. Changing insurance to Arthur J Gallagher who are now working closely with ANTA ensures your policy meets your needs, maintains your health fund provider registration and at the special rates for ANTA members.

Call ANTA on 1800 817 577 to discuss your membership and insurance requirements * ANTA receives no commissions, payments or incentives from Arthur J Gallagher whatsoever and this has enabled ANTA to provide this service to members and graduates at no additional costs or rate increases.

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ANTA Free Seminar - Brisbane

ANTA Graduate Awards

A great turn out of members for the ANTA Seminar held in Brisbane on 11th March.

ANTA recently announced the launch of the ANTA Graduate Awards to reward achievement and assist graduates with their careers.

Outstanding Presenters including:

The ANTA Graduate Awards consists of 12 months complimentary ANTA membership (membership extended for a further year at no cost) and $200.00.

• • • • • •

Elizabeth Greenwood Daniel Roytas Jim Olds Prof Michael Weir Shaun Brewster Tony Reid

The ANTA free seminar will be coming to your State in 2017 and members will receive an invitation to attend by email prior to the seminar.

A great way to keep updated, informed on the latest developments and techniques and to undertake your CPE “all free”

Graduate Awards are provided every year and are open to all graduates who have completed a course recognised by ANTA. Students who graduate and join ANTA are automatically included for assessment for an ANTA Graduate Award.

Throughout 2017 ANTA will be announcing further recipients of ANTA Graduate Awards.

The recipients in the first group of ANTA Graduate Awards for 2017 are: Name

Course of Study

State

Rebecca Fink

Nutritional Medicine

NSW

Jennifer Bingham

Naturopathy

VIC

Deborah Smart

Nutritional Medicine

QLD

Amanda Opperman

Naturopathy

WA

Congratulations go to the above recipients on their achievements and being selected to receive an ANTA Graduate Award. ANTA will contact each recipient to present them with their award.

The ANTA Graduate Awards are ongoing throughout 2017 and for further information on how to participate in the ANTA Graduate Awards follow the link listed below.

ANTA Free Seminar Dates 2017 The dates and venues for our seminars in 2017 are: Sat 11 March - Brisbane

Hotel Grand Chancellor Brisbane

Sat 20 May - Perth

Hotel Rendezvous Scarborough

Sat 5 Aug - Sydney

Rydges Hotel Parramatta

Sat 25 Nov - Melb

Pullman Mercure Albert Park

www.australiannaturaltherapistsassociation.com.au/bursary/anta_graduate_ awards.php ANTA Members Deborah Smart and Jenny Bingham were recently awarded a ANTA Graduate Awards. Deborah and Jenny also provided a short inspirational story on why they studied Nutritional medicine and commenced practising. ““I was diagnosed with Multiple Sclerosis in 2005, a already quite advanced in both brain and spinal cchord, and reacted badly to the medications p prescribed by my neurologist. My search for personal healing led me to Nutritional Medicine p which, over many years of study, helped me to w e eventually control disease progression using a nutrigenomic approach to diet and supplementation. n I now want to help as many people as possible with autoimmune disease and chronic conditions pursue a wellness and live life to the full, no matter what their w diagnosis. I now practice in the Narangba Valley d Medical Centre.” - Deborah Smart M

“I think there are a lot of us really struggling, unhappy, fearful and frustrated because of health u iissues. I personally know those feelings. What iinspires me is the hope that I can provide some answers and a plan to improve people’s lives by a iincreasing their wellbeing, so they can be their most vibrant, happy selves and get on with living a really great life with their family and friends”. - Jenny g Bingham.

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ANTA Continuing Professional Education (CPE) Hours Guidelines What is CPE: Continuing Professional Education is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care.

Why is CPE Necessary: CPE is an important part of providing professional healthcare services to patients and ensures practitioners regularly update their clinical skills and professional knowledge.

ANTA requires members to complete 20 CPE hours annually (Jan – Dec).

Completion of 20 CPE hours annually is a requirement for ongoing provider recognition with all Health Funds and WorkCover Authorities. Note: If you do not complete 20 hours of CPE annually, Health Funds and WorkCover Authorities can terminate your provider recognition.

Each year Health Funds carry out audits of members records to ensure 20 hours of CPE are completed by all members annually.

Make sure you lodge online or send to ANTA, details of 20 hours of CPE you have completed by the end of each year.

CPE reinforces ANTA’s natural health philosophy.

Other Benefits of CPE: • members are kept informed and up-todate with the latest developments • facilitates communication and networking • encourages further study • enhances professional standing within the community Required CPE Hours: ANTA members must accumulate a minimum of 20 CPE Hours per annum (Jan – Dec).

At least 50 % of CPE hours undertaken must be related to the modalities you are accredited in by ANTA. Note: Hours in excess of 20 completed in the current year are not able to be carried over to subsequent years.

Members registered with CMBA/AHPRA must abide by CMBA CPD/CPE Guidelines (http:// www.ahpra.gov.au/chinese-medicine.aspx) for the modalities of acupuncture and chinese herbal medicine and also submit their CPE to ANTA. CPE Activities: Members can undertake CPE hours in many ways including the following: • • •

attending ANTA free seminars – details of seminars are regularly posted on www. anta.com.au researching scientific information on IMGateway - free access for members on www.anta.com.au researching scientific information on EBSCO - free access for members on www.anta.com.au

• • • • • • • • • • • • • • • • • • • •

CPE Seminars: ANTA National CPE seminars are held in each state annually and are free for all ANTA members ANTA and other CPE seminars are communicated to members via the ANTA website, ANTA e-News and in “The Natural Therapist”. Members should regularly check the ANTA website for details of seminars.

Maintaining your own personal online CPE Record: ANTA provides members with simple easy to use online facilities to complete and lodge their CPE hours in their own personal and permanent CPE online record fully maintained on the Members section of the ANTA website (Note: your CPE history is retained for future reference and you should not delete any of your online CPE records).

ANTA members can as an example, undertake research on EBSCO, IMGateway scientific resources, view videos of ANTA seminars etc and then record those CPE hours on their personal CPE record all in the one session via the ANTA website.

To submit/view your CPE hours online with ANTA: • • • • •

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researching scientific information on eMIMS Cloud – free access for members on www. anta.com.au participating in research projects involving or related to natural therapies viewing seminar videos and seminar presentations - free access for members on www.anta.com.au completing courses on ANTA e-Learning Centre -free access for members on www. anta.com.au giving lectures/tutorials giving CPE seminar presentations undertaking further study completing short courses contributing an article to the ANTA journal “The Natural Therapist” and ANTA website contributing an article to other relevant journals, magazines and publications reading articles in the quarterly ANTA journal “The Natural Therapist” subscribing to and reading other professional publications and journals attending webinars viewing online, DVD’s or videos on relevant topics listening to recordings on relevant topics radio/tv broadcasting on relevant topics reading and researching information on topics relevant to your practice attending local practitioner groups/workshops volunteer work with community groups involving natural therapies Note: First Aid and CPR courses are not recognised or accepted as CPE by Health Funds

Log onto the “Members Login” section of www.anta.com.au using your username & password click on “Your Profile” then click on “Submit CPE Hours” key in your CPE activity (date, description, hours) you can view your CPE hours recorded online at any time by clicking on “View CPE Hours”

Maintaining your own manual CPE Record: Members not wishing to take advantage of the ANTA online CPE record can keep their own manual CPE Hours record which should include the following minimum information shown in the example below: Maintaining your own manual CPE Record: Members not wishing to take advantage of the ANTA online CPE record can keep their own manual CPE record which should include the following minimum information shown in the example below: CPE Hours Record Year: (insert year) Name of Member: ANTA Member Number: Date of CPE

Description of CPE Activity Completed

C P E Hours

(Note: the following CPE activities are provided as examples) 22nd March

Attended ANTA Free Seminar

5

3rd April

Remedial Therapy research on EBSCO

3

4th May

Naturopathy e-learning module IMGateway

2

30th June

Read ANTA Journal – The Natural Therapist June edition

1

1st July

ANTA Seminar videoKerry Bone Presentation

1

11 August

ANTA e-Learning articles

2

5th September

Completed short course Stress & Wellness

4

30 October

Attended webinar-Herbal Remedies

2

TOTAL CPE HOURS

20

Members who do not record and maintain their CPE hours in their own personal online file via the ANTA website, can maintain their own manual record as shown in the example above and submit their CPE Hours Record to ANTA prior to the end of each year in the following ways: • by email to info@anta.com.au • by fax to (07) 5409 8200 • by post to ANTA PO Box 657 Maroochydore Qld 4558 (Note: members should keep a copy of their manual CPE Activity for their own records and for any audits of their practice undertaken by ANTA, Health Funds or WorkCover) Make sure you lodge online or forward to ANTA details of 20 hours of CPE you have completed by the end of each year. Health Funds carry out annual audits of members records and if you have not submitted 20 hours of CPE activity to ANTA, Health Funds will de-register you as a provider.

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NSW State Insurance Regulatory Authority (Works Comp) up-dated guide and massage therapy fees for 2017 Explanatory Note

Insurer means the employer’s workers compensation insurer Massage Therapist means any person providing Massage Therapy services.

Treatment by a “masseur” is medical or related treatment covered under the Workers Compensation Act 1987. For the purposes of this Order, the term “masseur” is interchangeable with “Massage Therapist”. This Order sets the maximum fees for which an employer is liable under the Act for reasonably necessary treatment by a Massage Therapist of a worker’s work related injury.

Massage Therapy services refers to treatment services delivered by a Massage Therapist and is limited to soft tissue massage targeting specific musculoskeletal injuries. Each service is to be billed according to Schedule A.

This Order provides that approval by workers compensation insurers must be sought for certain Massage Therapy services. Workers are not liable for the cost of any medical or related treatment. Employers are liable for the cost of treatment. Employers are only liable to pay as a maximum the amounts for Massage Therapy services set out in this Order.

This Order applies to treatment provided on or after 1 January 2017, whether it relates to an injury received before, on or after that date.

The incorrect use of any item referred to in this Order can result in penalties, including the Massage Therapist being required to repay monies to the State Insurance Regulatory Authority (the Authority), that the Massage Therapist has incorrectly received. Workers Compensation (Massage Therapy Fees) Order 2017.

1. Name of Order This Order is the Workers Compensation (Massage Therapy Fees) Order 2017 2. Commencement This Order commences on 1 January 2017.

3. Definitions In this Order: the Act means the Workers Compensation Act 1987. the Authority means the State Insurance Regulatory Authority as constituted under section 17 of the State Insurance and Care Governance Act 2015.

Allied Health Recovery Request (AHRR) means the form to be used by the practitioner to communicate to the insurer about a worker’s treatment, timeframes and anticipated outcomes.

4. Application of Order

5. Maximum fees for Massage Therapy The maximum fee amount for which an employer is liable under the Act for treatment of a worker by a Massage Therapist, being treatment of a type specified in Column 1 of Schedule A to this Order, is the corresponding amount specified in Column 2 of that Schedule.

6. Treatment provided interstate Any Massage Therapy treatment related services provided to a NSW worker in a State/Territory other than NSW must be paid in accordance with the fee that applies in that State/Territory but must not exceed the maximum fee for the treatment or service as specified in this Order.

In such instances the service provider number is INT0000 and the payment classification code is the one that is relevant to NSW Massage Therapists, as defined in Schedule A in the column headed “ITEM” of this Order.

To provide services, the service provider should adhere to the NSW Workers Compensation system requirements including, but not limited to submission of Allied Health Recovery Requests and pre-approval by the insurer for services. Pre-approval by the insurer is required prior to any treatment being provided except for services provided within the first 48 hours of the injury happening.

Further information is available in the NSW workers compensation guide for allied health practitioners.

7. Nil fees for cancellation or non attendance

Pre-approval by the insurer is required prior to any treatment being provided except for services provided within the first 48 hours of the injury happening.

Approval can only be given for up to eight 8 consultations per AHRR. If treatment is ongoing after the submission and approval of the initial AHRR, the practitioner is required to submit additional AHRR’s and they must be approved by the insurer before treatment can be delivered in each such case.

Consultation and treatment includes: • • • • • • •

history taking assessment/re-assessment goal setting and treatment planning treatment/service clinical recording communication with referrer, insurer and other relevant parties, and preparation of an Allied Health Recovery Request when indicated.

GST means the Goods and Services Tax payable under the GST Law. GST Law has the same meaning as in the A New Tax System (Goods and Services Tax) Act 1999 of the Commonwealth.

No fee is payable for cancellation or non-attendance by a worker for treatment services with a Massage Therapist.

8. Goods and Services Tax (GST) (1) Massage Therapy services are subject to GST. (2) An amount fixed by this Order is exclusive of GST. An amount fixed by this Order may be increased by the amount of any GST payable in respect of the service to which the cost relates, and the cost so increased is taken to be the amount fixed by this Order. This clause does not permit a Massage Therapist to charge or recover more than the amount of GST payable in respect of the service to which the cost relates.

9. Requirements for invoices All invoices must be submitted within 30 calendar days of the service provided and must be itemised in accordance with Schedule A and comply with the Authority’s itemisedrequirements (see http://www.sira. nsw.gov.au/workers-compensation/health-practitionersworkerscompensation/invoicing ) for the invoice to be processed.

10. No pre-payment of fees Pre-payment of fees for reports and services is not permitted.

Independent consultant review means a review by an Independent Consultant approved by the Authority. Massage Therapists should participate in Independent Consultant reviews.

THE NATURAL THERAPIST Volume 32 No.1

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10 THE NATURAL THERAPIST Volume 32 No.1 www.mediherb.com.au Orders & Technical Support: 1300 654 336 Email: orders@integria.com Order Online: www.myintegria.com

A N TA - N E W S

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Schedule A Maximum fees for Massage Therapists (including interstate practitioners)

Item

Column 1 Type of Treatment

Column 2 Maximum Amount (excl GST)

RMA001

Consultation & treatment (60 minutes duration)

$80.60

RMA002

Consultation & treatment (45 minutes duration)

$60.40

RMA003

Consultation & treatment (30 minutes duration)

$40.30

WCO005

Fees for providing copies of clinical notes and records.

The maximum fee for providing hard copies of clinical records is $38 (for 33 pages or less) and an additional $1.40 per page if more than 33 pages.

What should I do now?

• • •

Read the Complaint Handling Standards that now apply to all Victorian health service providers. https://hcc.vic.gov.au/ healthcare-providers/handling-complaints Read the Code of Conduct that now applies to Victorian general health service providers. https://hcc.vic.gov.au/healthcareproviders/non-registered-providers Update the complaints section of your website and clinic information with the following, or similar:

If you are not satisfied with our service, please let us know. We aim to resolve any issues you may have with our service quickly and fairly.

If the clinical records are provided electronically, a flat fee of $38 applies.

An important update on what’s new in Victorian health complaints.

The office of the Health Complaints Commissioner (HCC) has now replaced the office of the Health Services Commissioner. This is the result of new legislation, the Health Complaints Act 2016 (Vic),

If you remain dissatisfied with our response, you may contact ANTA or the Health Complaints Commissioner (HCC).

HCC information and materials are available as follows: • • • • •

Download a copy of the Code of Conduct: In brief (A4). https:// hcc.vic.gov.au/sites/default/files/code_of_conduct_a4_summary_ poster.pdf Download a copy of the Code of Conduct: Full text (A3). https:// hcc.vic.gov.au/sites/default/files/code_of_conduct_full_text_a3_ poster.pdf Download ‘Expect safe and ethical healthcare’ poster (A3). https:// hcc.vic.gov.au/sites/default/files/media/9080_hcc_quality_a3_fa_ lr.pdf Request ‘Making a complaint’ brochure (DL). mailto:hcc@hcc.vic. gov.au?subject=Request%C2%A0’Making%20a%20complaint’%20 brochure%20(DL) Request ‘My health records, my rights’ brochure (DL). mailto:hcc@ hcc.vic.gov.au?subject=Request%20’My%20health%20 records%2C%20my%20rights’%20brochure%20(DL)

eMIMS updates and editions to Drug, Herb and Food Supplement Interactions Database

The core work of resolving complaints about health services and the handling of health information in Victoria remains the same, however there are several important changes of which you should be aware.

The Interactions Database can be accessed on eMIMS or IMGateway which are both available to all ANTA members free of charge on the members section of the ANTA website www.anta.com.au

The new legislation includes a much broader definition of a ‘health service’, partly describing it as an activity performed “to assess, predict, maintain or improve the person’s physical, mental or psychological health or status”. This means the HCC has jurisdiction over a wide range of non-registered providers they were previously unable to deal with (i.e. this includes fitness trainers, personal trainers, spiritual healers, yoga instructors etc). In addition, anyone will be able to make a complaint, not just consumers themselves.

Members should be aware that under the National Code of Conduct all practitioners must be fully aware of Drug, Herb, Food and Supplement interactions and we recommend all members to regularly use the eMIMS and IMGateway resources available free of charge on the ANTA website.

The new legislation includes a Code of Conduct for non-registered practitioners (including natural therapists) or those practising outside their area of registration. This provides a minimum standard that nonregistered practitioners will be required to meet, as well as grounds for complaints or investigations. The Code of Conduct is very similar to the requirements of the ANTA Code of Professional Ethics. A copy of the Code of Conduct, as well as information about how to make a complaint to the HCC, must be able to be accessed by your clients.

The Interactions Database continues to expand, now including over 950 interactions . Recent additions include comprehensive advice on interactions between commonly consumed traditional medicines, supplements with a range of conventional medicines.

The new legislation sets out complaints handling standards to which all health services must comply.

Good complaints handling serves all parties. Effective, timely and responsive complaints handling at practitioner level can help improve efficiency and service quality. As practitioners and frontline staff you have an important role in resolving complaints, and we recommend you encourage your clients to raise their concerns with you in the first instance so that you have an opportunity to resolve the complaint without the need to involve ANTA or the HCC. If you are unable to resolve the complaint with your client, the client can lodge their complaint with ANTA or the HCC. THE NATURAL THERAPIST Volume 32 No.1

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ANTA - N E W S

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ANTA UPDATES - ANTA ADVICE, UPDATES AND RECOMMENDATIONS ANTA Response to recent media reports on Complementary Medicines Recent media reports have suggested that complementary medicines and supplements are ineffective.

The popularity of complementary medicines and supplements has never been greater in Australia and many Australians are voting with their feet and increasingly turning to natural therapies and complementary medicines as part of their health care.

Natural therapies and complementary medicine is thriving in Australia and brings many opportunities for greater personal choice in health care and in the growth of small and medium business. Natural health care professionals say the reason for this is that the public are generally satisfied with the treatments and therapies they receive because they are beneficial.

The status of the natural health industry is recognised and acknowledged internationally and the ideal of combining biomedicine with natural therapies and complementary medicine is now widespread in global health care thinking.

Many people have benefited from natural health care, leading to less dependence on conventional medicine solutions and a more effective spread of successful health care options.

Most importantly, because the nature of natural health care is holistic, factors such as lifestyle and nutrition are incorporated into the treatment and advice and an integrated approach with conventional medicine often means that hospital care is avoided for many conditions. This takes pressure off an already over burdened health system, where minor ailments can be successfully treated without the need for medical intervention or drugs.

Natural health care is widely acknowledged and is part of government accredited training and education which helps to ensure safety and quality. Government agencies and departments such as the Dept of Health and Ageing, Australian Health Practitioners Registration Agency, Tertiary Education Quality Standards Agency, Australian Skills Quality Authority, Therapeutic Goods Agency, Australian Securities and Investments Commission etc all have regulatory authority over the education, training and delivery of quality natural health care services in Australia.

The public want the best health advice and to protect the public’s safety and interests, ANTA has in place high quality education and training requirements for accrediting ANTA members. The public are assured their health and wellbeing is the focus and priority of all ANTA accredited members.

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To support the continuous quality improvement approach adopted by governments, ANTA has lodged a submission with Federal and State Governments for the inclusion of naturopaths, nutritionists and western herbal medicine practitioners in the National Registration and Accreditation Scheme (NRAS).

Notwithstanding the unsubstantiated claims made by the members of the Australian Medical Association (AMA) and the Friends of Science (FoS) in media reports, it is incredible that these organisations would suggest that the above government agencies would acquiesce to anyone practicing or providing illegal, unsafe or unproven natural therapies or complementary medicines.

A review of complaints published by the NSW Health Care Complaints Commission shows that between 2012 and 2016 there were 8,864 complaints received relating to medical practitioners.

During the same period the NSW Health Care Complaints Commission received 35 complaints in total in relation to naturopaths, nutritionists, homeopaths and natural therapists.

These statistics in NSW and similar statistics published by the other States speak for themselves and it is ludicrous for the AMA and FoS to suggest there are serious problems with natural health care and complementary medicines.

ANTA Registration Submission Update A big thank you to all the ANTA members and practitioners of other associations who have contacted ANTA to provide their feedback and support for the ANTA Submission for the Registration of Naturopathy, Western Herbal Medicine and Nutritional Medicine under the NRAS administered by AHPRA. The ANTA Registration Submission was not only lodged by ANTA on behalf of ANTA members but also the vast majority of practitioners who support statutory registration.

The submission is currently with Federal and State Health Ministers, COAG Health Council (CHC), Australian Health Ministers Advisory Council (AHMAC) and the Health Workforce Principal Committee (HWPC) who have acknowledged the ANTA submission and are in the process of working their way through the submission.

ANTA will be having further discussions with Health Ministers, CHC, AHMAC & HWPC regarding the submission.

ANTA has also received a huge amount of support for the registration submission from

Colleges, Universities, Health Funds and other interested parties.

A copy of the ANTA Registration Submission can be downloaded from the ANTA website homepage www.anta.com. au ANTA will also be including presentations on registration in the ANTA Free Seminar Series in 2017.

The Australian Institute of Health and Welfare has released two new Burden of Disease Study Series reports: Contribution of vascular diseases and risk factors to the burden of dementia in Australia Report: http://www.aihw.gov.au/publicationdetail/?id=60129557759 Media Release: http://www.aihw.gov.au/ media-release-detail/?id=60129557760 This report describes a range of modifiable vascular risk factors for dementia, and estimates their individual and combined contribution to the burden of dementia in Australia. Vascular risk factors in this study include smoking, physical inactivity, mid-life high blood pressure and mid-life obesity, as well as vascular diseases that act as risk factors for dementia-diabetes, stroke, atrial fibrillation and chronic kidney disease.

It uses burden of disease estimates from the Australian Burden of Disease Study 2011 and evidence in the literature that shows a link between these vascular risk factors and development of dementia in later life. It shows that about 30% of the total dementia burden in Australia is due to the joint effect of the vascular risk factors examined; highlighting the potential for preventing dementia and reducing dementia-related burden.

Diabetes and chronic kidney disease as risks for other diseases Report: http://www.aihw.gov.au/publicationdetail/?id=60129557755 This report aims to provide a more comprehensive picture of the full health loss attributable to diabetes and chronic kidney disease (CKD). It quantifies the impact of diabetes and CKD on the burden of other diseases for which there is evidence of a casual association (linked diseases) to estimate the indirect burden caused by these 2 diseases.

It uses disease burden estimates from the Australian Burden of Disease Study 2011 and extends the standard approach for analysis of risk factors to model diabetes and CKD as risk factors. When the indirect burden due to linked diseases was taken into account, the collective burden due to diabetes was 1.9 times as high, and CKD was 2.1 times as high, as their direct burden.

Practicalities Of Ethics Within The Clinic Jeanetta Gogol

W

hatever modality you practice, whether you are an experienced practitioner or a new graduate we all at some time appreciate refreshing or consolidating good clinic practices. Identifying and acknowledging issues that could arise before a concern arises is part of good business practice. Avoid practitioner complacency. Here are a few tips.

Try to assess and see your clinic room from your patient’s perspective, try evaluating it through their eyes. Your clinic environment should be relaxed; calm and a welcoming space ensuring it is safe, secure and promotes a professional environment.

A well presented, proficient practitioner will project confidence within the clinic.

At all times try to present a positive attitude and if you are unsure of a patient’s health condition/issues or feel the situation may be beyond your scope of training you should explain to the patient that you believe referral to a practitioner with expertise relating to the condition is the best course of action.

Patient privacy can never be taken for granted, ensure your patients confidentiality and personal discretion is taken into consideration at all times. Protect yourself and your patients from misconduct- sexual, emotion or physical abuse.

Place toys made available for children in the appropriate place remembering cleanliness is a priority as they are a breeding ground for passing on contamination. Maintain magazines and electronic viewing appropriate to your cliental. Awareness of patient’s cultural and religious beliefs also need to be taken into consideration.

Try to grow a network with other health professionals and always reply in a timely manner to communications from professionals and patients by either electronic, paper or verbal communication.

All practitioners and patients are individuals, unique in personality, abilities and issues; refrain from negative discussions or general discussions that can be overheard by anyone. Respect is earned along with admiration and both go hand in hand to achieve successful outcomes for patients and the development of a successful practice.

Industry networking involves respect and effective communication and utilising this will always make you open to new ideas, methods and technology. This in turn will assist in growth as a confident, effective well respected practitioner within your field of expertise.

We all get tired, busy, overwhelmed both professionally and personally, it happens to us all at one point or another. A key to success is to remember to always treat you patient as you wish to be treated yourself. A smile goes a long way and is contagious - try it patients love it.

For your perusal further: Information, policy documents, ethics, webinars and research resources to maintain compliance and assist in developing a successful practice are available on the ANTA website www.anta.com.au members section at all times.

Patient records and the privacy act we are all aware of and abide by, but remember to ensure patient records and information is kept secure and from view of other patients and members of the public.

Within the clinic/treatment room; always assess temperature, lighting, smell, table and chair heights, textures of linen and cleanliness.

During consultations keep communication clear and concise, ensure the patient clarifies the information you have provided is understood.

Growing trust with your patients ensures that two way communication between patient and practitioner is open and clear.

THE NATURAL THERAPIST Volume 32 No.1

13

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THE NATURAL THERAPIST Volume 32 No.1

THE NATURAL THERAPIST Volume 32 No.1

15

Scraping to Treat Chronic Pain George Wu

S

craping techniques (such as Chinese guasha, and western graston) are very useful techniques to release soft tissue chronic pain.

Traditional Chinese Medicine believes that when a part of the human body is in pain, because of its respective meridians being blocked and Qi cannot flow, scraping special parts of the body can take the toxin out of the body, and reopen the meridians.

Modern researches prove that scraping can promote local microvascular circulation and improve the metabolism, therefore remove pain factors from this area faster. The scraping procedure also releases endorphins which reduce the pain by regulating the pain receptors¹.

In clinical experience, a lot of soft tissue chronic pain is due to previous injury, repetitive overuse and inflammation. Medical practice may look for natural therapy, such as massage, cupping and acupuncture to help reduce these pains.

In my clinical practice, I find the scraping treatment is the best choice in some conditions, especially for tennis elbow, Achilles tendonitis and plantar fasciitis.

The Scraping technique involves using a specific tool to scrape the affected area to introduce a controlled amount of microtrauma, so that it will invoke an inflammatory response that will then augment the healing process.

The scraping tools can be stones, steel, even a soup-spoon or anything easy to handle with a smooth edge.

The Scraping technique treatment should be performed once a week for six consecutive weeks.

The scraping normally takes 10-15 minutes. The amount of force that is used depends on the patient’s pain tolerance and the practitioner’s skill and knowledge.

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THE NATURAL THERAPIST Volume 32 No.1

S craping / Chronic Pain

G e o rg e Wu

There is a report that said as a result of the Scraping treatment, the success rate is above 90% in tennis elbow, Achilles tendonitis and plantar fasciitis. Most people could find immediate partial relief to their pain after first treatment.

Tennis Elbow Tennis elbow is a condition that the forearm muscles and tendons, which extend the wrist and fingers become damaged from repetitive overuse. This leads to pain and tenderness on the outside of the elbow. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB)

Achilles Tendonitis The Achilles tendon is a large tendon; it is an extension of calf muscles, running down the back of the lower leg attaching to the heel bone. Achilles Tendonitis is a term that commonly refers to an inflammation of the Achilles tendon or its covering. It is a type of overuse injury.

Performing scraping to treat tennis elbow: 1.

2.

One hand holds patient’s pain elbow, the other hand use a scraping tool to scrap around the lateral epicondyle of humerus.

One hand holds the patient’s wrist and makes it flex so that the wrist extensor muscle is being stretched. Then use a scraping tool to scrape from the lateral epicondyle to the wrist, following the extensor muscle fibre.

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S craping / Chronic Pain

G e o rg e Wu

Performing scraping to treat Achilles tendonitis: 1.

2.

Lie legs flat on bed; one hand holds the ankle, whilst the other hand scraps the calf muscle from distal to proximal.

Flex the knee at a 90 degree angle, and extend the ankle to stretch the Achilles tendon. One hand holds the foot; the other hand scraps the Achilles tendon’s sides and back, from the heel towards the calf muscle.

Performing scraping to treat plantar fasciitis: Flex the knee at a 90 degree angle, and extend the ankle to stretch the Plantar Fascia and then scrape the ligament from the toes to the heel

Plantar Fasciitis The plantar fascia is the flat band of tissue (ligament) that connects the heel bone to the toes. It supports the arch of the foot. Plantar fasciitis is inflammation of the plantar fascia, due to overstretching or overuse.

References 1 Sumei Yu the principle of GUASHA [J] (Journal of Beijing Sport University, 2007, 30 (6); 798-800./ (6)

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THE NATURAL THERAPIST Volume 32 No.1

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Protection for your way of life Arthur J. Gallagher Insurance Brokers ANTA members are required to have a current professional indemnity (PI) insurance limit of at least $1m – rising to $2m for Bupa Provider registration, and $5m for Chinese Medicine Registration through CMBA. They are also required to hold public liability insurance to cover damages and legal expenses arising from personal injury to a third party (patient) or damage to their property.

But although insurance is a requirement, for many natural therapists it remains a grudge purchase – something we really struggle to get excited about and something we don’t always see the true value of. That’s because we generally only really see the worth of insurance at claims time and, touch wood, we can go many years without having to make a claim at all.

Still, claims can and do happen. And when they do, they can be extremely stressful. Luckily, ANTA members are in a position of strength because ANTA has negotiated substantial savings on combined PI and public liability insurance with our endorsed insurance broker, Arthur J. Gallagher (AJG). Several thousand ANTA members get their insurance through AJG, and the partnership has many benefits for members, including: Value: As a natural therapist, if you were to source your own cover for public liability and professional indemnity the prices can top $1000 per year. Depending on the limits of liability you need, ANTA members might only pay between $149-$336 per year, thanks to our group purchasing power.

Tailored cover: Arthur J. Gallagher’s natural therapist’s insurance solution was created with flexibility squarely in mind. More than 1200 approved modalities can be covered, including multi-modalities, so it’s a great fit for almost any practitioner.

This isn’t the case with every insurance policy. For example, if you’re qualified in homeopathy and myotherapy, you may only be covered for myotherapy under your insurance policy. If a claim were to arise from your homeopathy work, you could find that the insurer will not pay out.

Time saver: As a society we’re more time poor than ever. It can take a long time to do your own insurance research – and understanding the small print in insurance contracts isn’t always straightforward. The tailored policy for ANTA members removes a lot of the guesswork and frees up more of your time to focus on your business or yourself.

Support when you need it: Thankfully, claims incidences in the natural therapies profession are quite low. However, as mentioned above they do happen and they can be extremely stressful when they arise. An advantage of arranging insurance through ANTA’s endorsed broker is that they will help you through the claims process if required and act as your advocate so you don’t have to go it alone.

So while insurance might not be front-of-mind for most natural therapists, it’s a decision that should be taken seriously. To check out your options with Arthur J. Gallagher, call 1800 222 012 or visit www.ajg.com.au/anta

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THE NATURAL THERAPIST Volume 32 No.1

Endorsed by:

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Insurance that’s in perfect harmony with your business Arthur J. Gallagher is the endorsed insurance broker of ANTA with more than 15,000 natural therapy clients across Australia.

We don’t just provide insurance. We offer tailored protection for your way of life, and three ways to avoid pain: OUTSTANDING VALUE ANTA’s group purchasing power means we’re able to offer members great cover at competitive rates BROAD WORDING Because our policy is tailored for your profession, it provides cover that really responds when you need it to MULTI MODALITIES When we say we’re flexible, we mean it. Add any of 1200+ approved modalities to your cover at no extra cost

For an informal chat about your insurance needs, contact us on 1800 222 012 or visit ajg.com.au/anta Arthur J. Gallagher & Co (Aus) Limited. Operates under AFSL No. 238312. Any advice provided in this document does not consider your objectives, financial situation or needs. You should consider if the insurance is suitable for you and read the Product Disclosure Statement (PDS) and Financial Services Guide (FSG) before buying the insurance. Arthur J. Gallagher & Co (Aus) Limited.

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The Emotions In Traditional Chinese Medicine Tony Reid

22 2 2

THE T HE H E NA NAT N NATURAL A AT TU UR URA RA R AL TH T THERAPIST HERA ERA ER RAP PIIS PIS IST Volume Vol Vo Vol olum o ume um um me e 32 32 No.1 No.1 No 1

The Emotions in Traditional Chinese Medicine Abstract 1

The paradigm of the Five Elements provides a practical framework for understanding the emotions in health and disease. The relationships that are described within this paradigm allow effective therapeutic interventions in patients with emotion based problems, utilizing various physical and psychological modalities. The basic concepts of this paradigm are discussed along with the general principles of its clinical application, so as to provide a context for further discussion on herbal formulas and treatment protocols.

Introduction Traditional Chinese medicine (TCM) has long recognized the importance of psychological factors, particularly the emotions, in health and disease. In the Nei Jing, the major TCM source text from the 1st Century BCE, the question is posed: ‘Why is it that after using the various treatment modalities ... the patient does not recover?’ The reply follows: ‘To completely heal a person, acupuncture, herbs and these other modalities are only one aspect of the treatment. You must also come into synchrony with the patient in many other ways… When patients lack the confidence to conquer illness, they allow their spirits to scatter and wither away. They let their emotions take control of their lives. They spend their days drowned in desires and worries, exhausting their Essence (jing) and Qi and Spirit (shen). Of course, then, even with all these other modalities, the disease will not be cured.’ (Ni, 1995, pp. 53-4) The above statement may appear to correlate closely with Plato’s famous words from Charmides: ‘And therefore if the head and body are to be well, you must begin by curing the soul; that is the first thing’ (Stevenson, 2009). However, the underlying logic of TCM is quite different from that of western science and the Greco-Roman tradition. In general, TCM is not analytical, and while both deductive and inductive reasoning are used to a limited extent, a synchronistic world view predominates. In other words, TCM is based upon meaningful connections between things that are not explained by causality.

Thus, when approaching TCM, it should always be borne in mind that synchronistic logic plays a very important role, without necessarily diminishing the usefulness of analysis and linear cause and effect thinking when appropriate. Another essential feature of TCM is the use of several different theoretical paradigms, each of which may furnish useful clinical outcomes when applied in the right way, and in an appropriate situation.

These considerations are exemplified in the theory of the Five Elements and the way in which the various relationships between individual Elements may be applied in clinical practice.

This statement follows on from a criticism of the ancient Greek physicians who were unable to

cure many diseases. ‘As you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the soul.’

Juxtaposed against the gamut of our emotions is the uniquely human ability to reason within the context of a set of principles or a moral code. This reasoning faculty is latent in children and needs to be developed, refined and strengthened during adulthood. As such, our ability to reason is the complementary opposite of our emotional life (in terms of Yin-Yang), the careful application of which is a manifestation of emotional intelligence (Goleman, 1994). At this point, let us review and reconsider the Five Elements theory from this perspective.

The Five Elements: the divisions of cyclic change The Five Elements theory, which is based on Yin and Yang, is a more elaborate paradigm wherein phenomena are grouped into five categories. In this way, correlative relationships are established for items within a category (e.g. for the Liver and Gall bladder within the Wood element), while various types of relationships are described for similar items within different categories (e.g. the ‘generation’ and ‘control’ sequences, as discussed below).

In terms of Yin-Yang, a further differentiation gives: Yang within Yin (emerging or young Yang); Yang within Yang (mature or full Yang); Yin within Yang (emerging or young Yin); Yin within Yin (full or mature Yin). In addition to these four stages we have the point of balance, or the ground upon which they manifest. Thus, we have the Five Elements wherein Qi (universal life-energy) undergoes five stages of transformation – Wood (young Yang), Fire (mature Yang), Earth (point of balance), Metal (young Yin), and Water (mature Yin), and these denote five different types of activity that occur within a repetitive cycle. As summarized in the Nei Jing: ‘The universal yin and yang transform into the five earthly transformative energies, also known as the five Elements that consist of wood, fire, earth metal and water.’ (Ni, 1995, p.8) Every observable phenomenon is seen as an expression of these transformations. A clear example is the cycle of growth and activity that occurs during the seasons of the year (specifically related to food crops). Spring is the time of germination and new growth. This is the emerging Yang and is related to Wood. Summer is the period of active growth and is the mature Yang, related to Fire. In autumn the harvest occurs and this is the emerging Yin, related to the Metal.

Finally, winter is the time for storage and dormancy, which is the mature Yin, related to Water. In addition, there is a period of ripening and maturing of the crops, which occurs in late summer. In this period the activities of growth and decline are momentarily balanced. This period is the fifth season and belongs to Earth.

The emotions according to the Five Elements The following analysis of human emotional responses is primarily based on the theory of the Five Elements (wu xing).

The Chinese term signifies five different types of activity within a repeating cycle. In addition, the Five Elements may be also be understood in a static way and be applied to structures, locations and directions. (For more detailed discussion, see: Maciocia, 2014; Maciocia, 2005; McDonald & Penner, 1994; Kaptchuk, 2000) The dynamic application of this theory is, in general, more important in medicine. Emotions in themselves are dynamic, in that they rise and fall, change from one to the other (sometimes quite rapidly) and motivate our behavior to a very large extent. Thus, in TCM, emotional states may readily be understood and acted upon using the paradigm of the Five Elements.

A more static example is seen in a description of the four cardinal directions: North, South, East and West – a simple division into four.

In the northern hemisphere, the South is the related to the path of the sun, a hotter climate, and the source of hot winds (Fire); the East is the direction from which the sun rises (Wood); West is where the sun sets (Metal) and North is the location of the colder regions, from which arise the cold winds (Water). However, a system of co-ordinates must have a reference point. Thus, the initial fourfold division receives a fifth when we include the center or reference point (Earth).

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Th e E m o ti o n s Another helpful way to understand the dynamic nature of the Five Elements is to analyze the progress from ‘potentiality’ to ‘actuality’, where a specific result is derived from a sequence of activities.

• • •

The initial plans and decisions are made, the necessary performers and materials are gathered together in an organized way.

The specific activities are carried out.

The final result is achieved.

Wood is the state of potential activity in which all the components are prepared, organized and made ready to provide the preconditions for the stage of actual activity.

Fire represents the stage of actual activity directed towards the end result. Immediately preceding the completed action, when the processes involved in the active stage (Fire) are about to produce the result, the potential for producing this specific result is at its greatest and, in fact, the result is now inevitable. This is Metal, when the momentum of the activity needs to be restrained, controlled and guided towards the finishing point. The specific result is Water. Thus, we have: • • • •

Wood – potential activity Fire – actual activity Metal – potential result, restraint of activity Water – actual result

Let us take the act of driving a car to a specific destination as an example: •

• • •

Wood – making the decision to go to this destination, determining the route to follow, gathering together the driver, car, road-map etc., making sure that there is adequate fuel, oil, water, etc., and then inserting the key into the ignition, i.e. preparing to move.

Fire – starting the engine and driving safely to the destination, i.e. moving.

Metal – the destination comes into view, the brakes are applied and the car slows down, i.e. preparing to stop Water – The destination is safely reached, i.e. stopping and arriving.

Thus, we have our basic system of four stages; all on one plane, as it were – goal directed physical activity and tangible results. From the Yin-Yang perspective, we can infer that there should also exist a complementary factor that gave birth to these various activities. This complementary factor is the background of the many possibilities, against which this whole process occurs, and out of which one particular pathway is chosen. This is also the realm in which the tendency to activity and the tendency towards latency are in a state of balance, with neither predominating. This is Earth. In addition, after the end result of this sequence has been reached, there is also a return to Earth, which represents the period in which there exists the undefined potential for further activities, from which a single pathway is chosen and a new sequence of events arises to create another result.

This background of possible activities is an undifferentiated state (i.e. Yin), from which arises the differentiated state of one specific sequence of events leading to a particular result (i.e. Yang). In the example given above, the stage pertaining to Earth exists in the period before the decision has been made to go to this particular destination, where there are

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To ny R e i d very many other possible destinations. Earth is also reached again on arrival at the destination, in the period of time before the next sequence of activities, when there are any number of possibilities for further action. Thus, Earth represents the period between completed activity and potential activity, where Yin and Yang are momentarily in balance. (Porkert, 1974, Ch.1) Medical application of the Five Elements In TCM all of the structures and functions of the human body and psyche are classified according to this system. The items that are listed within each element correspond with one another, i.e. they have a very close relationship, which is not necessarily of a causal nature. Moreover, all of the physiological, structural, psychological and pathological aspects within each element are ‘represented’ by (or line up behind) the specific ‘zang’ organ (solid viscus) belonging to that element and are considered as attributes of that particular organ. Thus, when a person is prone to crying, although we can see that the tears flow from her eyes, from the broader perspective of the Five Elements, the crying ‘comes from’ the Liver and may denote a disorder of that organ. The following chart summarizes the medical correlations within the Five Elements.

Element

Wood

Fire

Earth

Metal

Water

Dynamic

Potential activity

Actual activity

Undifferentiated world of possibility

Potential result

Completion of activity

Yin-Yang

Young Yang

Mature Yang

Balance

Young Yin

Mature Yin

Development

Germination

Growth

Ripening

Harvest

Storage, seed

Season

Spring

Summer

Late summer, monsoon

Autumn

Winter

Climate / Pathogen

Wind

Heat

Damp

Dryness

Cold

zang organ

Liver

Heart

Spleen

Lung

Kidney

fu organ

Gallbladder

Small Intestine

Stomach

Large Intestine

Urinary Bladder

Emotional quality

Self-assertion, righteous indignation

Joy, enthusiasm

Intellectual focus, ability to concen-trate

Instincts, drive towards survival

Will, drive

Pathological Emotion

Anger

Over-excitement

Obsesssion, worry

Sadness, grief

Fear, timidity

Human quality

Planning, decision making

Clarity of consciousness

Ideas, understanding, working memory

Taking in, holding on & letting go

Long term memory concentration

Tissue

Tendons and nails

Blood and blood vessels

Muscle, fat

Skin and body hair

Bones and marrow

Sense organ

Eyes, vision

Tongue, speech

Mouth, taste

Nose, smell, touch

Ears, hearing

Fluid

Tears

Sweat

Watery saliva

Nasal mucus

Mucoid saliva

Sound (or tone of voice)

Shouting

Laughing

Singing

Crying

Groaning

Colour

Green

Red

Yellow

White

Blue black

Injured by excessive

Walking

Staring

Sitting

Lying

Standing

Flavour

Sour

Bitter

Sweet

Pungent (spicy)

Salty

Western Medical correspondences

Hepatobiliary system, emotion and stress-related disorders

Cardiovascular system, brain and psyche

Digestive system including pancreas

Respiratory system

HPA axis, HPG axis, Urogenital system, congenital disor-ders

Table 1: Five Element Correspondences

An important application of Five Elements is in the classification of the internal organs, which are regarded primarily as functional systems within the body and secondarily as physical structures. The major bodily organs are divided into YinYang pairs and each pair is allocated to one of the Five Elements.

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The Yin component of each pair is referred to as the zang organ (viscus, or solid organ), and the complementary Yang organ is referred to as a fu organ (bowel, or hollow organ). The zang organs, as listed above, are regarded as the major representatives of each of the Elements in the body. The other items that pertain to the body, listed under each Element, are generally thought of as the attributes of each specific zang organ. Thus, each of the bodily organs has a vastly different significance in TCM compared to Western biomedicine. This is one of the reasons why the name of the Element (e.g. Wood) and the name of the corresponding zang (e.g. the Liver) may often be used together, e.g. Liver-Wood, or Kidney-Water, in order to emphasize the broader concept behind the organ name.

This sequence progresses in a clockwise direction and represents the natural progression of birth, growth and development. One Element arises out of, or develops from, the previous one. However, there also needs to be a system of controls and checks in place to ensure an orderly progression within the cycle. It is not sufficient that an impulse for growth, development or increase be given and passed on. There must also be a mechanism that limits and directs this impulse in an appropriate way.

The sequence of control or restriction is as follows:

Important Relationships The main relationships amongst the Elements that are used in TCM, are those of generation (or promotion) and control (or restriction).

These are represented by two different orderly sequences from one Element to another, which explain the relationships of nourishment/ promotion and restraint that underlie both normal (i.e. physiological) and abnormal (i.e. pathological) activities.

One can observe in Nature that there are processes that involve cyclical change, in which a series of changes occurs only to return to the starting point and repeat. The seasons are a graphic example of this. Physiological processes, pathological processes and their resolution, as well as the life cycle itself, all progress in such a cyclical manner. In order to apply the Five Elements to cyclical phenomena, the Elements are placed in a specific order, which describes a causal or temporal sequence (i.e. one phenomenon arising out of, or as a direct result of a prior phenomenon), as follows:

This is generally expressed using the same circular diagram as the generation sequence in Diagram 1, above. However, the arrows indicating the relationships are arranged as follows (clockwise, going to the Element after the adjacent one):

This is generally expressed in the following diagram:

Diagram 2: The control sequence

In health, the relationships described by the control sequence serve to maintain an harmonious state. However, when pathology is present, this sequence helps to explain the pathophysiological consequences of various types of imbalance.

In the broadest sense, pathological states may be viewed as excess or deficiency. Excess refers to over-activity of an organ or the presence of pathogenic material that disrupts normal function.

Deficiency refers to functional under-activity or lack of essential bodily materials, which are not present in sufficient quantity to maintain normal physiological activities. According to the control sequence, an excess in one organ (e.g. Liver-Wood) will lead to the organ over-controlling the organ that it normally controls (in this example Spleen-Earth), leading to a pathological deficiency condition in this organ (i.e. Spleen deficiency). On the other hand, when an organ is in a deficiency condition (e.g. the Lung-Metal), the organ this is normally under its control (in this example the Liver-Wood) will tend to develop an excess condition (e.g. Liver excess). Moreover, a deficiency condition within an organ (e.g. Lung-Metal) may allow the controlling organ (in this example, the Heart-Fire) to develop an excess condition.

Diagram 1: The generation sequence.

We need to remember that the control sequence only points to possibilities that may develop in a patient. It is quite possible for a patient to have only a single imbalance, without any of the

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repercussions that are predicted by the control sequence.

This paradigm simply alerts a practitioner to the potential for development of a pathological change that has been detected. This is summarized in the following table.

OrganElement

Consequences of excess condition

Consequences of deficiency condition

Liver-Wood

Spleen-Earth deficiency

Spleen-Earth excess Lung-Metal excess

Heart-Fire

Lung-Metal deficiency

Lung-Metal excess Kidney-Water excess

Spleen-Earth

Kidney-Water deficiency

Kidney-Water excess Liver-Wood excess

Lung-Metal

Liver-Wood deficiency

Liver-Wood excess Heart-Fire excess

Kidney-Water

Heart-Fire deficiency

Heart-Fire excess Spleen-Earth excess

Table 2: The Control Cycle - Pathological conditions

Representation of the psyche according to the Five Elements As can be seen from Table 1, above, our normal healthy psychological faculties are categorised into the Five Element paradigm, together with normal human emotional responses. One purpose in viewing human psychic life in this way, is that a practitioner may assess not only the pathological extremes, but also the deficiencies. If we take self-esteem as an example, a certain level may be regarded as healthy and a positive personal attribute; too much and the person becomes ego-centric and possibly even psychopathic; whereas if a person has too little self-esteem, this may lead to a chronic state of anxiety, frustration or sadness. In this example the psychological states are readily observable, and are within our common experience. Now, by applying the Five Elements paradigm, we can see that low self-esteem correlates with a deficiency state of the Liver, which can be treated by nourishing the Liver Blood.

On the other hand, in excess states, we may need to look for the underlying or associated deficiency, by following the control cycle relationships, in addition to addressing the excess condition of the main organ directly. A patient with an excess condition of the Liver (generally Liver Heat or Liver Fire, manifesting in extreme anger), may also have a deficiency condition in Earth (Spleen). The deficiency may be psychological (lack of a rational perspective, lack of intellectual focus, etc.) and/or physical, i.e. Spleen Qi deficiency, with symptoms of digestive system disorder. A basic principle here is that we must always be grounded by the actual condition of the patient, while allowing the theory to guide us in terms of where to look and what types of questions to ask, ensuring that no important clinical data are overlooked.

Below is a summary chart of emotional states according to the Five Elements. The first row denotes the range of normal healthy responses; the second outlines the extremes of emotion that may become pathogenic; while the third lists the emotional responses that may be generated when the positive ones are lacking. These lists should be understood in the sense that we are translating human feeling states from one culture to another, in which there are considerable differences in the context within

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which these emotions are experienced. This consideration also applies for each individual person under consideration, including the personal biases of each practitioner juxtaposed against the personal biases of each patient.

As Maciocia repeatedly cautions, we should not take this information, nor any conclusions derived from it, too rigidly; rather we should take a broad and flexible approach, utilising it as appropriate. (Maciocia, 2009, pp. 124, 125, 138, 144,145, 147) Element

Wood

Fire

Earth

Metal

Water

Normal healthy emotional responses

Anger (in the sense of righteous indignation, selfassertion, sticking up for your rights)

Happiness, joy in living

Intellectual focus, ability to concentrate

Sadness (in response to some sort of loss)

Fear (i.e. being cautious)

Pathogenic (extreme) emotions

Rage, easily angered

Overexcitement, mania

Being overly intellectual (denial of emotions), obsession, worry

Grief (especially prolonged grief), gloomy disposition

Being overly fearful, anxiety

Pathogenic (deficiency) emotions

Low selfesteem, feeling unworthy, anxiety

Lack of joy, depressed mood

Lack of rationality, carelessness,

Shallow emotional responses, uncaring disposition

Recklessness, lack of a sense of danger

Table 3: Emotional responses and the Five Elements

Maintaining balance As mentioned above, the complementary opposite to our emotional life consists of the more subtle aspects of the psyche: our conscious awareness, our ability to reason, and also what may be referred to as strength of character or moral fiber. In TCM the ongoing development of these faculties, and the commitment to this development, is the cornerstone of mental health and the path to fulfilment of our human potential. On the one hand, these faculties enable one to maintain emotional balance and harmony, while on the other they enable one to grow as a person and make a significant contribution to the welfare of others and to society. These are also classified according to the Five Elements, as in Table 3.

Fire

Clarity of consciousness, sense of appropriateness (especially conduct)

Wood

Planning, decision making, orderliness self-esteem, benevolence, kindness

Earth

Intellect; ability to ponder and predict outcomes, ability to endow things with significance, working memory

Metal

Vitality, boldness, ability to hold on and let go

Water

Will power; ability to follow one’s own path in life, long term memory

Table 4: Psychological faculties

By taking these faculties into account, a practitioner may assess which particular aspects have been neglected and the under-development of which may be contributing to the patient’s present state of emotional imbalance.

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The place of reason and ethics In line with the above comments on the role of our human psychological faculties in maintaining mental health and harmony, the traditional literature affirms that the health of the Spirit in the Heart (i.e. our overall mental health) depends upon the following: • • • • • • •

Moral ideals – having clearly defined values Harmonious relationships with significant others Cultivation of harmony with nature and peace of mind Integrity Self-cultivation: developing talents, skills and abilities to realize one’s potential (for the benefit of others – not for selfaggrandizement) Self-control (to support the above values) Self-reflection (to gain greater self-knowledge, in order to improve one’s relationships, standard of work etc.)

(Dharmananda, undated; Kaptchuk, 2000, pp. 58-66, 157-159; Ni, 1995, pp.1-2; Wu, 1993, pp.40-41; Sivin, 1987, pp. 49-50, 96-99) A TCM practitioner will strive to incorporate these practices and ideals into his/her own life. In this way, the practitioner can model these virtues for the benefit of patients in the clinic and use them as a point of reference to assist in the restoration of mental and emotional balance. As these are perennial values, the same can apply within our own culture.

Practical applications Now that we have seen how the emotions and mental faculties may be classified according to the Five Elements paradigm, let us examine how this aspect of TCM theory is put into practice. One very important underlying assumption is that body and mind are not seen as separate and mutually exclusive; there is no ‘ghost within the machine’ – the machine is part of the ghost and the ghost is part of the machine.

To give a concrete example, in TCM the Liver is inextricably bound up with feelings of anger, self-esteem, the ability to plan and make decisions, etc. In practice, this means that in a patient with issues related to anger, self-esteem, etc., an important part of the TCM diagnosis and treatment involves assessing the state of the Liver and providing physical based therapies for the imbalances detected. On the other hand, when presented with a patient who manifests the physical signs of a Liver imbalance, the TCM clinician will also explore the possible psychological manifestations, and include some form of counselling, if deemed appropriate, along with the physical based therapies.

The other, perhaps more novel practical application is in the use of the relationships between the Elements as discussed above, in particular the control sequence. This relationship may be applied in two ways: diagnostically and therapeutically. In terms of collecting and assessing clinical data, the control relationship may provide important clues as to the physical and psychological repercussions of an initial disorder. To continue with the Liver as an example: ‘In cases of rage, the Liver is in excess and invades the Spleen.’

(Ni, 1995, p.79) This illustrates how the controlling sequence may be applied when a pathogenic emotion has the effect of inducing over-activity (‘excess’) in an organ. According to the control sequence of the Five Elements, this condition of excess in the Liver may lead to under-activity of the Spleen-Earth (equivalent to being ‘invaded’).

In any one patient, this may manifest mainly on a physical level, psychological level or both. Thus, in clinic a patient may present with the symptoms of Spleen Qi deficiency (fatigue, poor appetite, loose stools, etc.) and this will alert the astute practitioner to a possible excess condition in Wood (i.e. the Liver); conversely, in a patient presenting with signs of Liver excess (e.g. Liver Fire) manifesting with extreme irritability and frequent uncontrollable angry outbursts, the practitioner will remember to pay attention to

the condition of the Spleen, on both a physical and psychological level.

The other relevant application of the control sequence to emotion based disorders is in the use of a therapeutically induced emotional response to counteract an emotional disorder. On a mundane level, this is something that we all tend to do as part of any caring or close relationship. As a therapeutic method, it often requires a certain degree of theatrical skill on the part of the practitioner, and may not always produce the intended results.

This is discussed in more detail below.

An important message of caution is appropriate here. The Five Element relationships may readily be intellectualised to create an image of universal orderliness and consistency. However, we need to be very careful when applying this paradigm, to avoid forcing the facts to fit in with our pre-conceived notions. In real-life clinical situations, the Five Elements theory does have its limits.

Some of the relationships described above are clinically useful, while others are not and may even be misleading. The more important applications of this approach are discussed below.

The emotions in TCM Pathogenic emotions are generally grouped into seven broad categories, each of which includes several related emotional states. The ‘seven emotions’ (qi qing) are: • • • • • • •

Anger (includes resentment, frustration, irritability, and rage) Joy (includes excitement, nervousness) Worry (includes some types of anxiety) Pensiveness (includes preoccupation and obsessive thinking) Sadness (includes grief, regret, sorrow, despondency) Fear (includes anxiety, phobias, apprehensiveness) Fright (includes being startled, being shocked, being alarmed ….by something)

Based upon observations of their effects on the body, each of the primary emotions is classified according to the Five Elements.

When unduly prolonged or intense an emotion can directly affect the corresponding zang organ to create pathological conditions.

Anger (Wood) the Liver Joy (Fire) the Heart Worry and pensiveness (Earth) the Spleen Sadness (Metal) the Lung Fear (Water) the Kidney Fright (Wood and Fire) Gallbladder and Heart (scatters the Qi indecisive, confused, lacking courage) Later authors included the Heart and Liver, together with the other organs specified, as additional targets for injury in all of the different types of emotional extremes, as listed above (Maciocia, 2009, p.119) The reason for this is that the Heart controls all conscious mental activities and is the ultimate controller of all the zang and fu organs. Therefore, any pathogenic emotion will adversely affect the Heart and the Spirit (i.e. the state of consciousness) together with the organ to which it corresponds.

Moreover, it is the Spirit in the Heart (i.e. the psychological faculties discussed above) that is responsible for maintaining control and balancing the emotional state. Thus, in the Nei Jing, Ch.5, there is the statement: ‘Overindulgence in the five emotions – happiness, anger, sadness, worry/fear and fright – can create imbalances.’ (Ni, 1995, p.19) The implication here is that a disorder or imbalance of the Heart / Spirit leads one to overindulge in one or more of the emotional states. In addition, the Liver is the centre of ego-based emotional responses in that it is concerned with personal boundaries and sense of self-worth. The Nei Jing refers to the Heart and Liver as the primary sources of human emotional responses:

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‘When the Liver (Qi) is deficient, fear (or a ‘sense of absence ’) will occur; when excess, one will become angry.

When the Heart (Qi) is deficient, sorrow will occur; when excess, unceasing laughter will occur.’ (Chen & Cheng, 1963, p.86) This is the only reference in the entire Nei Jing to emotions ‘coming from’ organs, as opposed to injuring them. Thus, we may conclude from these statements that while various emotions can gravitate to different organs and cause damage to them, the Heart and Liver alone are the source of our emotional life – the good and the bad.

Anger

Fear Fear causes the Qi to descend, as in the involuntary opening of the bowels, urinary incontinence and weakening of the knees, which occur at times of intense fear. The other aspect of this change is that the Kidney Qi (i.e. Water) does not ascend to balance the Heart Qi (i.e. Fire), and this leads to unrestrained Heart Fire.

Over time, this imbalance causes depletion of the Kidney Qi and the Kidney Yin with loss of harmony between the Kidney and the Heart. Common symptoms include insomnia, anxiety, night sweats, dizziness, tinnitus, low back pain, palpitations, irritability, facial flushing, etc.

Included in the concept of pathogenic anger are: resentment, repressed anger, irritability, frustration, rage, indignation, animosity and bitterness. 1.

Alternatively, some authors put ‘fright’ together with ‘shock’ and ascribe them These emotions tend to cause the Liver Qi to become stagnant as to the Kidney and Heart (Maciocia, 2009, pp.134, 144). In clinical practice an well as to counterflow upwards. In addition the stagnant Liver Qi may extreme emotion may affect two or more of the internal orhgans. develop into Fire. Symptoms are often seen in the head and neck, with 2.

This is the rendering used by Ted Kaptchuk in the 2000 edition of Chinese tension in the neck and shoulder muscles, headache, flushed face, Medicine the Web that has no Weaver, p.82. His exposition on the dizziness, tinnitus, thirst, bitter taste in the mouth, red tongue and red psychological aspects of TCM, although brief, is, in my opinion, excellent. blotches on the front of the neck. The stagnant Liver Qi may affect 3.

I have deliberately placed ‘Qi’ inside brackets as this passage makes more the Spleen and Stomach, causing sluggishness of movement with sense if we take the Chinese character ‘Qi’ to refer to Qi in the broad sense, accumulation of incompletely digested materials and poor elimination of in which case its use is purely rhetorical and can be omitted in an English wastes, which may give rise to the production of Damp and Phlegm. The translation.

Phlegm may subsequently be carried upwards (by the Qi counterflow and/or Fire) affecting the throat (e.g. resulting in globus hystericus) or Fright and Shock the head (with headaches, mental dullness, confusion or clouding of consciousness).

A sudden fright or mental shock causes depletion of the Heart and Gallbladder Qi, which may adversely impact on decision In the short term, pathogenic anger tends to create an excess condtion making, judgements, courage and initiative, and the ability to in the Liver, while long term anger, resentment etc. may lead to a take decisive action, especially if a person is repeatedly subject deficiency condition. to such stimuli. In order to cope with the effects of fright or shock, the body draws on the reserves of the Kidney. Thus, the Joy harmonious interaction between the Heart and Kidney may also become disrupted (as discussed above under ‘fear’), in addition While happiness is an ideal and positive state, when it becomes to effect on the Gallbladder, giving rise to anxiety, indecisiveness, extreme (i.e. over-excitement and the desire for excessive stimulation) palpitations, insomnia with dream disturbed sleep, night sweats, it becomes pathogenic. Pathological ‘joy’ disperses the Heart Qi leading dry mouth, tinnitus, etc. to a loss of mental focus and vigilance. It eventually leads to deficiency of the Heart Qi as well as deficiency of the the Gallbladder Qi. Over Injury to the internal organs time the Heart Yin may also become depleted. This may give rise to palpitations, insomnia with dream disturbed sleep, being easily startled In general, extremes of emotion may cause functional or frightened, and over-excitability. derangement of the internal organs, which in turn may lead to further disturbances in emotional responses and mood in a Worry and Pensiveness ‘vicious circle’. On the other hand, any type of primary physical disorder of the internal organs may adversely affect mood and Excessive worrying injures the Spleen Qi. Other related pathogenic emotional responses. Thus, extremes of emotion can not only be states of mind include: habitual pensiveness, too much thinking or the cause but may also be the result of a physical condition. mental work (e.g. cramming for an exam). These factors may cause Spleen Qi deficiency with loss of appetite, epigastric distention after eating, fatigue and loose stools. This condition may lead to Blood A passage from Nei Jing, Ch.19, illustrates how emotional deficiency, which will affect the Heart, giving rise to palpitations, imbalance may affect organ systems outside the one that is insomnia, mental dullness, forgetfulness and depressed mood. Spleen directly affected: deficiency may also give rise to internal retention of Damp and Phlegm with a sensation of heaviness in the head and body, nausea or vomiting, ‘Worry, fear, grief, over-excitability and rage, because they do not etc. follow the creative cycle, may result in a more severe disorder.

Extremes of excitability injure the Heart. When the Heart is Sadness deficient, the Kidney energy overcontrols. In cases of rage, the Liver is in excess and invades the Spleen. Grief causes the Lung This category of pathogenic emotion includes sorrow, grief, to overcontrol the Liver. Fear weakens the Kidney and causes despondency and gloom, which have the effect of initially depleting and the Spleen to overcontrol the Kidney. In excessive sadness, the eventually stagnating the Lung Qi, i.e. creating a deficiency condition Lung Qi becomes deficient and, allowing the Heart to dominate. in the short term, and an excess condition in the longer term. This also These illnesses, induced by emotional extremes, that do not affects the Heart, leading to Qi deficiency and/or Qi stagnation in both follow the typical creative (i.e. generation) cycle, but rather follow the Lung and Heart, with shortness of breath, fatigue, spontaneous sweating, palpitations, insomnia and depressed mood. When prolonged the control pattern.’ (Ni, 1995, p.79) sadness or grief affects the Lung, the resultant stagnation may lead to the development of Phlegm, which may also affect the Heart, causing clouding of consciousness or confusion. In women Lung Qi deficiency can lead to Blood deficiency and amenorrhoea.

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While these secondary effects may not always become manifest in an individual patient, the cascading effect of an emotional extreme is something that the alert practitioner should always bear in mind.

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This is summarized in the following table.

Extreme Emotion (Element)

Primary Injury

Secondary effects

Excitement, happiness (Fire)

Heart (deficiency)

Kidney (excess)

Rage, anger (Wood)

Liver (excess)

Spleen (deficiency)

Grief (Metal)

Lung (excess)

Liver (deficiency)

Fear (Water)

Kidney (deficiency)

Spleen (excess)

Sadness (Metal)

Lung (deficiency)

Heart (excess)

REFERENCES

Table 5: Effects of emotional extremes, according to the control cycle.

Using emotions as therapy According to a passage in the Nei Jing, Ch.5, emotion based disorders may be treated by invoking another emotion to control or balance the extreme emotional state of the patient. (Ni, 1995, pp.20-21) As mentioned above, by taking a more theatrical approach a practitioner may attempt to induce an emotional state in a patient, by utilizing the control cycle of the Five Elements to balance emotional extremes or stuck emotions. As noted by one TCM author: ‘Medicinal herbs alone cannot cure a disorder caused by an extreme emotion. Another emotion should be engaged to reduce the extreme emotions that is causing the disorder in order to strike a balance…. A healing emotion is an invisible herbal remedy.’ (Lu, 2005, p.18) This method may be applied in cases when it is apparent that a patient’s own emotional reactions have caused (and are maintaining) the presenting disorder. According to this sequence, we have the following: • • • • •

In the next part of this discussion, we will focus on the actions of select Chinese herbal formulas and their applications in disorders due to emotional imbalance.

Control anger with sadness Control excessive joy or over-excitement with fear Control worry or excessive pensiveness with anger (or indignation) Control sadness or grief with joy Control fear with thoughtfulness

Eminent TCM practitioners have recorded case histories where they have gone to great lengths, using costumes and disguises to induce a healing emotion and help a patient overcome a condition brought on by an emotional extreme. (Chiang, 2014, pp.37-55; Fruehauf, 2009) In more recent times, the work of Dr Patch Adams is a good example of this approach. (Adams & Mylander,1993) On a more mundane level, we have all experienced the effectiveness of a well-timed joke or humorous comment to help a patient lighten up and stop taking himself and his condition too seriously. Sometimes this is all it takes to establish the rapport that is necessary for the patient to allow healing to take place, by restoring a very broad sense of confidence - not only in the skills of the practitioner and the efficacy of the medicines but also confidence in himself and confidence in the essentially benevolent nature of life itself.

The above discussion has been presented to help maintain focus on the whole person and not just the physical aspects of a patient’s presenting disorder. The influence of Maoism has tended to reduce emotional responses to mere physiological reactions to environmental stimuli (Sivin, 1987, p.287), to be corrected using acupuncture and herbal formulas. This paper favors a twofold path of influence that includes the physical affecting the mental as well as mental affecting the physical. In this way, the place of empathy, ethics, self-discipline and self-cultivation in the healing encounter between practitioner and patient should be regarded as essential; for they are neither more nor less important than the physical treatment modalities that are being employed.

Adams, P., Mylander, M. (1993). Gesundheit!: Bringing Good Health to You, the Medical System, and Society through Physician Service, Complementary Therapies, Humor, and Joy. Rochester, Vermont: Healing Arts Press.

Chai, K. (Chief Ed.), (1998). Basic Theory of Traditional Chinese Medicine. Beijing: People’s Medical Publishing House Chen, B., Cheng, Z. (1963). Classic of the Spiritual Axis with Vernacular Explanation. Beijing: People’s Hygiene Press.

Chiang, H. (Ed.), (2014). Psychiatry and Chinese History. London: Pickering & Chatto Dharmananda, S. (undated). Towards a Spirit of Peace.

Understanding the Treatment of Shen Disorders with Chinese Medicine. From ITM Online. Retreived 27 Feb., 2017 from: http:// www.itmonline.org/shen/ Fruehauf, H. (2009). All Disease Comes From the Heart: The Pivotal Role of the Emotions in Classical Chinese Medicine. JCM (90): 26-35 Goleman, D. (1994). Emotional Intelligence: Why It Can Matter More Than IQ.New York: Bantam Books Kaptchuk, T. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. Chicago: McGraw-Hill Professional Lu, H. (2005). Traditional Chinese Medicine: An Authoritative and Comprehensive Guide. Laguna Beach, CA: Basic health Publications Inc. Maciocia, G. (2009). The Psyche in Chinese Medicine. Edinburgh: Churchill Livingstone Elsevier Maciocia, G. (2005) The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Second Edition. Edinburgh: Churchill Livingstone Elsevier Macicocia, G. (2014). The Five Elements – Clinical Application of the Cosmological Sequence. From Maciocia online, retrieved Feb.2, 2017 from: http://maciociaonline.blogspot.com.au/2014/01/ the-five-elements-clinical-application_10.html McDonald, J., Penner, J. (1994). Zang Fu Syndromes: Differential Diagnosis and Treatment. Toluca Lake, CA: Lone Wolf Press Ni, M. (1995). The Yellow Emperor’s Classic of Medicine: A New Translation of the ‘Neijing Suwen’ with Commentary. Shambhala Publications Porkert, M. (1974). Theoretical Foundations of Chinese Medicine: Systems of Correspondence. Massachusetts: The MIT Press.

Sivin, N. (1987). Traditional Medicine in Contemporary China. Ann Arbor: Centre for Chinese Studies, the University of Michigan.

Stevenson, D. (2009). The Internet Classics Archive. Charmides, or Temperance by Plato retrieved 2nd March, 2017 from: http:// classics.mit.edu/Plato/charmides. * More references available on request.

THE NATURAL THERAPIST Volume 32 No.1

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35

How Turmeric and other natural ingredients can help arthritic sufferers

Mark Waddingham BBiomedSci (Pharm Sci), BSc (Hons), PhD

George Thouas BSc, MRepSc, PhD

Tam Nguyen BMedChem (Hons) 36

THE NATURAL THERAPIST Volume 32 No.1

Tu r m e r i c / A r t h r i t i s

M Wa d d i n g h a m , G Th o u a s, T N g u ye n

Abstract Approximately 4 million Australians suffer from arthritis, a painful and debilitating condition. One of the most common forms of arthritis is Osteoarthritis (OA). Osteoarthritis (OA) is caused when the natural cartilage of the joints become eroded, to cause friction and pain, which can progressively impact upon day-to-day life. There is an increasing awareness of the benefits that complementary medicines can have in managing mild symptoms of osteoarthritis and arthritis. This article highlights the benefits of turmeric (an ancient spice), and other natural ingredients for relieving mild arthritis symptoms and maintaining joint mobility.

pain by comparison to those patients not receiving Meriva® (Figure 3) [7]. Furthermore, Meriva® issued in combination with standard exercise routines used for osteoarthritis management is measurably more beneficial than exercise alone [8].

Figure 2.

Relative Absorption of Curcumin and Total Curcuminoids.

Compared to the unformulated curcuminoid mixture (Natural Form; blue bars), absorption of curcumin and total curcuminoids was 18- and 29-fold greater with Meriva® (orange bars).

Keywords: Arthritis, Osteoarthritis, Cartilage, Movement, Antiinflammatory, Pain, Turmeric

Figure 1. Comparing a normal joint with an Osteoarthritis and Arthritic joint

35

Natural Form 30

Relative Absorption

The joints in your body works mechanically similar to a hinge on a door.

It requires some form of lubrication to function optimally and prevent excessive friction. In our joints, the ‘lubrication’ role is performed by a special tissue known cartilage (Figure 1). Cartilage acts to keep your joints moving freely and to provide protection for your bones [1]. Your body continuously renews this cartilage, but factors such as aging, severe injury, genetic predisposition can interfere with the cartilage renewal process. As a result of less cartilage being produced, “boneon-bone” friction can occur (Figure 1). This causes swelling, discomfort and difficulty of movement, which are symptomatic of earlier onset OA [2, 3].

29

Meriva

25

20

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Figure 3.

Walking distance of patients receiving Meriva® treatment compared to control group at 0 and 8 months of treatment [7].

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For mild cases of OA, complementary medicines can be used to help manage symptoms of pain, aches and help improve joint mobility.

Below are some of the natural ingredients that can be used to help relieve symptoms of mild arthritis and OA. Turmeric

Walking Distance (m)

After 8 Months 300 250 200 150 100 50 0

Curcumin is the main active ingredient that is derived from the ancient spice, turmeric (Curcuma longa). Chinese and Indian traditional medicine have for centuries recognised the health benefits of turmeric.

Health benefits of turmeric include pain relief, accelerate wound healing and manage symptoms of OA [4]. Curcumin helps symptoms of OA by reducing inflammation and preventing the oxidative damage caused by free-radicals [5]. Despite all these benefits, curcumin in its natural form is difficult for the body to absorb. To tackle this problem, Indena® have used a proprietary encapsulation technology named Phytosome®, to develop Meriva® curcumin, which is 20-30 times more efficiently absorbed in the body compared to natural curcumin (Figure 2) [6]. Clinical trials have reported that patients administered Meriva® curcumin exhibited less joint pain and enhanced physical performance, as evidenced by walking almost 4 times longer distances without

Control

Meriva

The treadmill test was performed at a treadmill speed of 3km/hr.

THE NATURAL THERAPIST Volume 32 No.1

37

Tu r m e r i c / A r t h r i t i s

M Wa d d i n g h a m , G Th o u a s, T N g u ye n symptoms (joint swelling and inflammation) and pain, as well as improving mobility, in patients with osteoarthritis [21].

Devil’s claw Devil’s Claw (Harpagophytum procumbens) is native to the Kalahari Desert and has been used in African traditional medicine to ease digestive disturbances and for pain relief. A growing amount of scientific research now suggests that Devil’s Claw contains several active ingredients that are not only anti-inflammatory [9] but assist in inhibiting the complex processes of cartilage degeneration [10].

Several clinical studies have reported that Devil’s Claw extracts given to participants with knee or hip osteoarthritis resulted in improved mobility, reduced pain, stiffness and swelling, and increased self-reported quality of life indices after several weeks of consumption (Figure 3) [11, 12].

Figure 3.

4-Point Physician Assessments for Parameters Related to Osteoarthritis [12]. The 4 parameters measured in this study are: (1) Pain, (2) Limitation of Mobility, (3) Swelling and (4) General Condition scores were all reduced over the course of the study from baseline. Physicians scored each of these parameters out 4, a score of 4 being the most severe.

4-Point Physician Score

2.5

2

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1.5

1.45

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Baseline

Week 6

Week 12

Frankincense The solidified oleoresin gum that is extracted from the Boswellia serrata tree is referred as frankincense. Frankincense has been historically used in traditional Ayurvedic medicine for its anti-arthritic properties, as well as many other conditions [13], so it is no surprise that its clinical value has been intensely investigated. Recent reviews of this clinical evidence have concluded that Boswellia serrata is moderately effective in managing pain and improving physical function in participants with osteoarthritis, although further research to confirm these promising findings is ongoing [14]. Exactly how Boswellia serrata is effective in osteoarthritis is not fully understood, although research suggests that specific active components of the oleoresin can prevent the signalling of key inflammatory pathways that are central in the manifestation of osteoarthritis [15, 16].

Celery Seed & Ginger Root Both celery seeds and ginger root have a long-standing use in Chinese, Indian and European traditional medicine [17, 18]. Ginger root most notably has a wide spectrum of applications and arguably, it’s most common use is to manage motion sickness. Compounds found in ginger root and celery seed extracts have demonstrated anti-inflammatory and anti-oxidant properties in the laboratory research [19, 20]. These properties have translated to both celery seed and ginger root extracts showing promising results in reducing

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THE NATURAL THERAPIST Volume 32 No.1

Summary Supported by scientific evidence, the natural ingredients listed in this article can be used to help manage mild symptoms of osteoarthritis and arthritis, including joint pain, aches and mobility.

References 1.Roach, H.I. and S. Tilley, The Pathogenesis of Osteoarthritis, in Bone and Osteoarthritis, F. Bronner and M.C. Farach-Carson, Editors. 2007, Springer London: London. p. 1-18.

2.Roach, H.I., et al., Pathobiology of osteoarthritis: pathomechanisms and potential therapeutic targets. Curr Drug Targets, 2007. 8(2): p.

271-82.

3.Sokolove, J. and C.M. Lepus, Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations.

Therapeutic Advances in Musculoskeletal Disease, 2013. 5(2): p.

77-94.

4.Gupta, S.C., et al., Discovery of curcumin, a component of golden spice, and its miraculous biological activities. Clinical & Experimental Pharmacology & Physiology, 2012. 39(3): p. 283-299.

5.Pulido-Moran, M., et al., Curcumin and Health. Molecules, 2016.

21(3): p. 264.

6.Cuomo, J., et al., Comparative Absorption of a Standardized Curcuminoid Mixture and Its Lecithin Formulation. Journal of Natural Products, 2011. 74(4): p. 664-669.

7.Belcaro, G., et al., Efficacy and safety of Meriva(R), a curcuminphosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev, 2010. 15(4): p. 337-44.

8.Franceschi, F., et al., A novel phospholipid delivery system of curcumin (Meriva(R)) preserves muscular mass in healthy aging subjects. Eur Rev Med Pharmacol Sci, 2016. 20(4): p. 762-6.

9.Fiebich, B.L., et al., Molecular Targets of the Antiinflammatory Harpagophytum procumbens (Devil’s claw): Inhibition of TNFα and COX-2 Gene Expression by Preventing Activation of AP-1.

Phytotherapy Research, 2012. 26(6): p. 806-811.

10.Chrubasik, J.E., et al., Potential molecular basis of the chondroprotective effect of Harpagophytum procumbens.

Phytomedicine, 2006. 13(8): p. 598-600.

11.Chantre, P., et al., Efficacy and tolerance of Harpagophytum procumbens versus diacerhein in treatment of osteoarthritis.

Phytomedicine, 2000. 7(3): p. 177-183.

12.Wegener, T. and N.-P. Lüpke, Treatment of patients with arthrosis of hip or knee with an aqueous extract of Devil’s Claw (Harpagophytum procumbens DC.). Phytotherapy Research, 2003.

17(10): p. 1165-1172.

13.Siddiqui, M.Z., Boswellia serrata, a potential antiinflammatory agent: an overview. Indian J Pharm Sci, 2011. 73(3): p. 255-61.

14.Kessler, C.S., et al., Ayurvedic interventions for osteoarthritis: a systematic review and meta-analysis. Rheumatology International, 2015. 35(2): p. 211-232.

15.Ammon, H.P.T., Modulation of the immune system by Boswellia serrata extracts and boswellic acids. Phytomedicine, 2010. 17(11): p.

862-867. collagen induced arthritis. Phytomedicine, 2014. 21(6): p. 847-856.

17.Powanda, M.C., M.W. Whitehouse, and K.D. Rainsford, Celery Seed and Related Extracts with Antiarthritic, Antiulcer, and Antimicrobial Activities. Prog Drug Res, 2015. 70: p. 133-53.

18.American Botanical Council, Ginger Root Monograph, in Herbal Medicine: Expanded Commission E Monographs. 2000, Integrative Medicine Communications Austin, TX, USA. 19.Lin, L.Z., S. Lu, and J.M. Harnly, Detection and quantification of glycosylated flavonoid malonates in celery, Chinese celery, and celery seed by LC-DAD-ESI/MS. J Agric Food Chem, 2007. 55(4): p.

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39

W

ith global population growth set to reach over 9 billion by 2050 food security faces environmental, productivity and policy challenges to meet the burgeoning demand.

In Australia, the beef industry is one of the largest agricultural industries, with its off-farm meat value reaching $12.75 billion in 2013-14 (Australian Bureau of Statistics, 2005; Meat & Livestock Australia, 2015). Since its beginning, the role of beef in the food supply for Australians has changed. These changes may be due to diet related diseases and food safety issues that beef consumption is associated with, such as cardiovascular disease and foodborne illnesses. Aside from the health issues, beef consumption has a significant impact on the environment and global food security (Food and Agricultural Organization, 2006). If Australians are more aware and knowledgeable of these impacts, beef consumption may reduce, and fruit and vegetable consumption may increase. In addition to reducing these negative impacts, if beef consumption decreases, Australians can benefit from a decrease in the expenditure on food.

From its historical beginning, the Australian beef cattle industry has grown immensely. The industry started from six cattle that was brought with the first European settlers in 1788 (Australian Bureau of Statistics, 2005). Initially, the growth of beef cattle was slow but this changed during the late 19th century, due to the gold rushes and the use of refrigerated transport, both of which encouraged beef production and consequently, the number of beef cattle reached 8.6 million in 1900 (Australian Bureau of Statistics, 2005; Cottle, & Kahn, 2014). However, due to the two world wars and the Great Depression, growth was minimal during the first half of the 20th century (Australian Bureau of Statistics, 2005). With the introduction of new cattle breeds, beef cattle numbers soared during the 1960s and 1970s, reaching a high of 29.8 million in 1976 (Australian Bureau of Statistics, 2005). Afterwards, the numbers fell due to low world beef prices, the implementation of quotas by key overseas importers, and the drought during the early 1980s, falling to 19.4 million in March 1984 (Australian Bureau of Statistics, 2005). Since 1989, beef cattle numbers has slowly risen to 26.3 million in June 2014, with declines in 2002-03, 2006-08 and 2009-10 due to poor weather conditions (Australian Bureau of Statistics, 2005, 2010, 2012, 2015a).

Akin to beef cattle numbers, beef production has experienced significant growth, although beef consumption per person has fallen in recent decades. In 1944, beef and veal production was approximately 0.5 million tons (Commonwealth Bureau of Census and Statistics, 1948, p.12). In contrast, in 2014-15, beef production was approximately 2.6 million tonnes (Australian

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THE NATURAL THERAPIST Volume 32 No.1

Bureau of Statistics, 2015b). Noting the use of different measurement systems and the exclusion of veal production in the second statistic, it can be seen that beef production has experienced substantial growth over the decades. Conversely, apparent per capita consumption of beef and veal has fallen from a high of 70.3kg in 1977 to 32.2kg in 2013 (Australian Bureau of Agricultural and Resource Economics and Sciences, 2014, p.135). Furthermore, in the past, beef had been the most popular meat of choice in Australia, however it was overtaken by chicken in 2005, indicating a decreased role of beef in the Australian diet (Cottle, & Kahn, 2014, p.4).

The consumption of beef has contributed to cases of foodborne illnesses in Australia. In 2011, 58 people were reported to have contracted foodborne illness from the consumption of beef (OzFoodNet Working Group, 2015). Foodborne illnesses can be caused by incorrect preparation of beef. If beef does not reach a certain temperature during cooking and/or is not stored at low enough temperatures, bacteria may grow rapidly, which increases the risk of foodborne illnesses (United States Department of Agriculture, 2013). Furthermore, foodborne illnesses can be caused by bacteria found in cattle that are transmitted to humans through the consumption of beef, and such bacteria include Campylobacter and Salmonella (Food Standards Australia New Zealand, 2013, p.19, 67).

It has been suggested that high levels of red meat consumption, including beef, may raise the risk of cardiovascular disease due to the increased production of trimethylamine-N-oxide (TMAO) (Koeth, Wang, Levison, Buffa, Org, Sheehy, Britt, Fu, Wu, Li, Smith, DiDonato, Chen, Li, Wu, Lewis, Warrier, Brown, Krauss, Tang, Bushman, Lusis, & Hazen, 2013). TMAO can be produced from the metabolism of L-carnitine, a compound that red meat is rich in, and can lead to atherosclerosis, a disease where the arteries experience an increase in plaque build-up (Koeth et al., 2013; National Heart, Lung and Blood Institute, 2015). Plaque build-up in the coronary arteries increases the risks of coronary heart disease and thus, high consumption of beef may lead to cardiovascular disease (National Heart, Lung and Blood Institute, 2015).

Additionally, the preparation of beef may lead to other diet related diseases. When beef is cooked at temperatures that are too high, it results in the production of heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) (Viegas, Novo, Pinto, Pinho, & Ferreira, 2012). High temperatures during cooking stimulate reactions between sugars, creatine, a compound found in meat, and amino acids, resulting in the formation of HCAs (National Cancer Institute, 2015). While PAHs are formed in the flames when the fat and juices, from the meat being grilled or barbecued over an open flame, drips onto the fire, and the PAHs then stick onto the surface of the meat (National Cancer Institute, 2015).

After being metabolised by certain enzymes, HCAs and PAHs can initiate the formation of cancer through the process of DNA damage

Agr i c u l t u re

Miao Ling Lim

(Muñoz, & Albores, 2011, National Cancer Institute, 2015).

Cancers associated with HCAs and PAHs include colon and prostate cancer (John, Stern, Sinha, & Koo, 2011; Helmus, Thompson, Zelenskiy, Tucker, & Li, 2013).

If Australians are more aware and knowledgeable about the health effects associated with beef consumption, as mentioned above, it may lead to more diets that are higher in fruits and vegetables, and lower in beef. In one study, it was suggested that 18% of all colon cancer cases in Australia during 2010 was attributable the consumption of red and processed meat (Nagle, Wilson, Hughes, Ibiebele, Miura, Bain, Whiteman, & Webb, 2015). Thus, Australians may benefit from better health by decreasing beef consumption.

Another factor in reducing beef consumption is Australians’ awareness and knowledge about the environmental impact of beef production. The production of beef is a significant contributor to climate change as it is responsible for 41% of all global greenhouse gas emissions from the livestock sector, which in turn contributes to approximately 14.5% of total human-induced emissions (Gerber, Steinfeld, Henderson, Mottet, Opio, Dijkman, Falcucci, & Tempio, 2013, p.23).

Furthermore, beef consumption affects global food security in regards to fresh water, land, phosphorus and livestock feed.

Global food security has become an increasingly important issue as it is expected that the global population will surpass 9 billion by 2050 and that there may not be sufficient safe and nutritious food to feed the global population (Food and Agricultural Organization, 2009). Firstly, beef production utilises large amounts of fresh water. The world agricultural sector is accountable for 29% of total fresh water use, where beef production is responsible for one third of that figure (Mekonnen, and Hoekstra, 2012, p.413). A study has suggested that a meat diet for one day uses approximately 3,600L of water, whereas a vegetarian diet uses approximately 2,300L of water (Hoekstra, 2012, p.6). Next, beef production has a high land use. In 2013-14, the agriculture industry utilised approximately 53% of total land in Australia, of which 88% was mainly used for grazing whereas 8% was used for growing crops (Australian Bureau of Statistics, 2015c).

Additionally in 2013-14, total fruit and vegetable production was 98 million tonnes while total red meat production was significantly less at 3 million tonnes (Australian Bureau of Statistics, 2015d, 2015e).

Furthermore, meat production requires more phosphorus than fruit and vegetable production (Cordell, Drangert, White, 2008, p.3). This is important as phosphorous is a necessary nutrient for agriculture (Australian Institute of Health and Welfare, 2012, p.31). In addition, a significant proportion, approximately 35%, of the world grain harvest is used for livestock feed (Brown, 2011, p.172). Thus, if beef consumption decreases, more fresh water, land and phosphorus can be used to produce greater amounts of fruits and vegetables, and more grains can be available for human consumption. As a result, more people may have sufficient access to safe and nutritious food, leading to an improvement in global food security.

Another benefit from reducing beef consumption and increasing fruit and vegetable consumption is a decrease in food expenditure. Beef has been the most expensive meat in Australia since 1984 (Australian Chicken Meat Federation, 2013). According to Table 129, the retail price of beef has risen from approximately $9.73 per kilogram in 1991 to approximately $16.33 per kilogram in September 2014 (Australian Bureau of Agricultural and Resource Economics and Sciences, 2014, p.137). Additionally, in Mercer’s 2014 Cost of Living Report, beef prices ranged from $13 to $33 per kilogram, whereas the prices of fruit and vegetables ranged from approximately $3 to $9 per kilogram (Live in Victoria, 2015).

its beginning, however beef consumption has fallen in recent decades, illustrating the reduce role of beef in the Australian diet.

This decrease may be attributed to the increased awareness about foodborne illnesses and diet-related diseases, such as cardiovascular disease, that beef is associated with. In addition to these health effects, beef consumption can be further reduced if Australians are more aware of the environmental and global food security effects of beef production. A decrease in beef production from a fall in beef consumption may allow more resources to be utilised for the production of fruits and vegetables, which is more resource efficient than beef production. Consequently, more food can be produced, and global food security may improve. Additionally, Australians may benefit from a reduction in food expenditure if they decrease their beef consumption.

References: Australian Bureau of Agricultural and Resource Economics and Sciences (2014). Agricultural commodity statistics 2014.

Retrieved on November 1, 2015 from http://data.daff.gov.au/data/ warehouse/agcstd9abcc002/agcstd9abcc0022014/ACS_2014_1.

0.0.pdf Australian Bureau of Statistics (2005). 1301.0 - Year Book Australia, 2005: Australia’s beef cattle industry. Retrieved on October 28, 2015 from http://www.abs.gov.au/ausstats/ abs@.nsf/Previousproducts/1301.0Feature%20Article23200 5?opendocument Australian Bureau of Statistics (2010). 1301.0 - Year Book Australia, 2009–10: Agricultural Production. Retrieved on October 28, 2010, from http://www.abs.gov.au/AUSSTATS/ abs@.nsf/Lookup/EB2DDFE1DCA0FC79CA2577370016 9CB9?opendocument Australian Bureau of Statistics (2012). 1301.0 - Year Book Australia, 2012: Agricultural Production. Retrieved on October 28, 2015 from http://www.abs.gov.au/ausstats/ abs@.nsf/Lookup/by%20Subject/1301.0~2012~Main%20Fe atures~Agricultural%20production~260 Australian Bureau of Statistics (2015a). 7121.0 - Agricultural Commodities, Australia, 201314: Livestock. Retrieved on November 7, 2015, from http://www.abs.gov.au/AUSSTATS/ abs@.nsf/Latestproducts/7121.0Main%20Features42013 -14?op endocument&tabname=Summary&prodno=7121.0&issue=2013Australian Bureau of Statistics (2015b). TABLE 8. Red Meat Produced - Beef: All series (tonnes). Retrieved on November 10, 2015 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/ DetailsPage/7218.0.55.001Sep%202015?Open Document chicken.org.au/page.php?id=4 Australian Institute of Health and Welfare (2012). Australia’s Food & Nutrition 2012. Cat. no. PHE 163. Canberra: AIHW. Brown, L.R. (2011).

World on the Edge: How to Prevent Environmental and Economic Collapse. New York, N.Y.:W.W. Norton & Company Inc. Commonwealth Bureau of Census and Statistics (1948).

Report on Food Production and the Consumption of Foodstuffs and Nutrients in Australia. Retrieved on November 11, 2015 from http://www.ausstats.abs.gov.au/ ausstats/free.nsf/0/F4880E8D3B0DEED4CA25790B0012F4 A0/$File/43060_1946_47.pdf * Further References on request

In conclusion, it can be seen that beef cattle numbers and beef production in Australia has significantly increased since THE NATURAL THERAPIST Volume 32 No.1

41

Urinary Tract Infections in Women: A systematic review of Randomised Controlled Trials

By Sharon Abel

U r i n a r y Tra c t I n fe c t i o n ABSTRACT Background Recurrent Urinary Tract Infections (RUTI) are a common presentation in females, the incidence of anti-biotic resistant pathogens causing Urinary Tract Infections (UTI) is rapidly increasing resulting in reduced efficacy of prophylactic anti-biotic therapy.

Sharon Abel Contributing/risk factors for RUTI’s are as follows; bladder calculus, fistula, immunocompromised patients, spermicides, sexual activity and genetic history in premenopausal women, however incontinence, premenopausal history of UTI, non-secretor status and residual urine post voiding are risk factors for postmenopausal women (Gupta & Trautner 2003, p.31).

Objective

It has been ascertained that previous prophylactic antibiotic therapy is associated with an increased risk of RUTI (Mandal et al. 2012, pp.848).

In females suffering from RUTI, is there a safe & efficacious route of administration utilizing a Lactobacillus spp. strain to replace antibiotic prophylaxis to reduce activity of uropathogens resulting in decreased recurrence of UTI.

Acute uncomplicated cystitis occurs in 50-80% of women in the general population, of which 30-40% will suffer recurrence within a three month period, this may then result in an average of 2.6 infections per year (Gupta & Trautner 2003, pp.30-31).

Design

The standard antibiotic therapy & prophylaxis for UTI is; trimethoprim (sulphamethoxazole), ciprofloxacin, fluoroquinolones, cephalosporin’s, other B-lactams & nitrofurantoin. There are increasing trends of resistance to antimicrobials including the fluoroquinolones, this resistance is highest from E.coli particularly in elderly males, women and inpatients (Bistori et al. 2013, pp.10531058; Mandal et al. 2012, pp.843-849).

A systematic review was conducted searching databases for Randomized Controlled Trials (RCT) testing the efficacy and safety of both oral and intravaginal probiotic therapy for recurrent urinary tract infections.

Results Eight databases were searched with 5 randomized controlled trials ascertained as appropriate to establish safety and efficacy of using a Lactobacillus spp. strain via oral or intravaginal administration for reducing RUTI. Both oral and intravaginal administration were ascertained as safe with minimal adverse events experienced. Oral administration was safe however was rarely successful in re-inoculation of vaginal microflora, whereas minor irritation occurred with intravaginal suppositories, it is hypothesised that this was due to the base matrix rather than the probiotic strain, this route of administration was successful in vaginal re-inoculation and was able to reduce the recurrence of urinary tract infections.

Conclusion Intravaginal but not oral administration of a Lactobacillus spp. strain is effective in achieving urogenital epithelium adhesion resulting in an approximate 50% reduction in RUTI, these results need to be replicated via further randomized controlled trials on a larger scale in order to be confidently transferred to the target population within the community.

INTRODUCTION Background Urine is usually sterile, therefore when a pathogen invades the genito-urinary tract this and adjacent structures are impacted upon causing an inflammatory response (Bakaj et al. 2013, pp.441-444).

Symptoms of UTI can be asymptomatic or can present with; frequent voiding, urgency, fatigue, dysuria, nocturia, mild abdominal pain, pain of the suprapubic region, haematuria and incontinence (Nosseir et al.

2012, pp.347-354).

Pathogens causing UTI can be gram-negative and gram-positive bacteria, the most common being Escherichia coli (80%) followed

by Staphylococcus saprophyticus and less commonly pathogens from the Enterococcus, Klebsiella, Enterobacter and Proteus species (Kodner & Thomas Gupton 2010, p.639; Gupta & Trautner 2003, pp.30-34).

Women who have had two or more infections in six months or three or more in one year meet the traditional definition of RUTI, however from a clinical perspective any second episode of UTI warrants investigation (Gupta & Trautner 2003, pp.30-34).

This UTI recurrence is most commonly due to reinfection rather than relapse unless it occurs within two weeks of prior infection (Gupta & Trautner 2003, pp.30-34).

Therefore a safe and efficacious preventative treatment needs to be ascertained in order to reduce the global impact of anti-biotic resistance as well as reducing the prevalence/incidence of RUTI. Design, methods & selection criteria The following eight databases were searched; Ebscohost, PubMed, BioMed Central, Gale PowerSearch, Informit, Cochrane library, Sciencedirect & Proquest. Key search terms were lactobacillus + urinary tract infections, only primary research of human-clinical randomized controlled trials (RCT) published from 2001-2015 were included.

Refer to Appendix 1. for in depth information regarding the search terms used, applied limitations and the relevant RCT found from each database, for the 8 databases searched 32 results were found with only 5 relevant RCT identified.

Data extraction The data to be extracted will include the population, sample size, intervention, control, length of trial, and outcome measures including data regarding the reduced incidence or a decrease in the period of time to reinfection of UTI in women (Brain Research Imaging Centre 2010).

SUMMARY OF TRIALS Refer to Appendix 2. for a summary of each RCT included in this paper.

A study by Kontiokari et al. (2001, pp. 1571-1573) was conducted to determine the efficacy of using cranberry-lingonberry juice vs Lactobacillus GG by oral administration & control to reduce RUTI over a 12 month period, 150 women were enrolled that tested positive for presence of E.coli.

Kontiokari et al. (2001, pp. 1571-1573) randomized 50 women to 3 groups; 1. Cranberry-lingonberry 50ml per day for 6 months 2.

100ml/4 x 1010 Lactobacillus GG 5 days per week for 12 months 3.

Open control group. Kontiokari et al. (2001, pp.1571-1573) treated the baseline UTI with standard anti-microbials and started the trial upon a negative urine culture, colonisation was assessed at 3 & 12 months with questionnaires completed at 3 months. Kontiokari et al.

(2001, pp.1571-1547) reported Lactobacillus GG was not efficacious in reducing RUTI however in contrast a 20% reduction was seen in the Cranberry-lingonberry group.

THE NATURAL THERAPIST Volume 32 No.1

43

U r i n a r y Tra c t I n fe c t i o n

Sharon Abel

Colodner et al. (2003, pp.767-769) performed a randomized trial in postmenopausal women researching the oral administration of Lactobacillus rhamnosus GG for efficacy in vaginal colonisation over one month in respect to reduction of RUTI.

Beerepoot et al. (2012, pp.704-712) conducted a randomized, doubleblind, noninferiority trial in 252 postmenopausal women who self-reported having at least 3 UTI’s in the 12 months prior comparing the efficacy of prophylaxis with anti-biotic therapy vs a probiotic over 15 months.

Colodner et al. (2003, pp.767-769) randomized 21 participants aged 4975 to two groups; A. 100ml yoghurt containing 109 cfu of L.rhamnosus GG once daily for one month, B. 109 cfu of L.rhamnosus GG twice daily for one month. Colodner et al. (2003, pp.767-769) advises that rectal/ vaginal swabs were taken at baseline and within the last two days of the trial, reporting results as follows; L.rhamnosus GG was not found rectally or vaginally at baseline, both group A & B had rectal colonisation of 81% & 76.2% respectively at trial completion, however vaginal colonisation was minimal with only 3 in group A and 1 in B but at insignificant levels.

Beerepoot et al. (2012, pp.704-712) randomized 127 participants to the antibiotic group receiving 480mg at night of trimethoprimsulfamethoxazole and 2 placebos during the day, 125 participants to the probiotic group receiving 1 capsule of Lactobacillus rhamnosus & Lactobacillus reuteri twice daily and 1 placebo at night.

Czaja et al. (2007, pp.1-9) conducted a double-blind, randomized placebo-controlled trial in 30 premenopausal women aged 18-35 with a history of RUTI to assess the safety & tolerance of a vaginal suppository of L.crispatus vs placebo for 5 days with follow up over 6 months..

Beerepoot et al. (2012, pp.704-712) could not ascertain noninferiority in the probiotic group, however this treatment demonstrated higher efficacy in complicated UTI, there was a statistically significant reduction in antibiotic resistance compared to the antibiotic group and therefore it was advised that although noninferiority was not ascertained this treatment protocol may be efficacious in prophylaxis for RUTI in considering the incidence of antibiotic resistance.

Czaja et al. (2007, pp.1-9) excluded those from the trial with a history of uro-genital pathologies/abnormalities other than RUTI, both groups inserted 1 suppository daily for 5 days the intervention containing 5 x 108 cfu of L.crispatus, two clinical follow ups and one telephone contact occurred for data collection.

Czaja et al. (2007, pp.1-9) advised no severe adverse effects were experienced by either group however some vaginal discharge, external genital irritation, vaginal candidiasis & asymptomatic mild inflammation of the lower urinary tract occurred, it is hypothesised that any irritation may have resulted due to the base matrix, two women in the L.crispatus group developed a UTI. Stapleton et al. (2011, pp.1212-1217) conducted a double-blind, randomized placebo-controlled trial to assess the safety/efficacy of intravaginal suppositories of L.crispatus (Lactin-V) compared to placebo in reducing the recurrence of UTI in 100 premenopausal women with a history of uncomplicated RUTI over 10 weeks.

Stapleton et al. (2011, pp.1212-1217) clinically confirmed and treated UTI via standard therapy pre-trial commencement with physical examinations & interviews taking place at weeks 1 & 10 or upon symptomatic presentation.

Stapleton et al. (2011, pp.1212-1217) reported that 15% of the L.crispatus group experienced a UTI recurrence compared to 27% in the placebo group, this being a reduction in occurrence by close to 50%.

Refer to Table. 1 for further in depth results.

Data topic.

L.crispatus group

Placebo group

Number of participants with a recurrent UTI during the trial

7

13

Percentage of UTI recurrence

15%

27%

Most common causative pathogen

E.coli

E.coli

Percentage of vaginal colonisation at 10 weeks

93%

68%

Percentage of reports of the following adverse events; vaginal itching, discharge & moderate abdominal pain

56%

50%

Beerepoot et al. (2012, pp.704-712) collected data at baseline & monthly until 3 months post administration via urine/faecal specimens, vaginal swabs (ascertaining colonization) and a questionnaire including ascertaining the level of E.coli antibiotic resistance. In summary

Refer to Appendix 3. for detailed results from this trial.

DISCUSSION The RCT’s used within this review will now be assessed for their quality in accordance with a scoring system outlined by Jadad et al. (1996, pp.1011), this scoring system identified two studies of high quality scoring >4, whereas the remaining studies had a total quality score < 3. Refer to Appendix 4 for the scoring system used and results.

Kontiokari et al. (2001, pp.1571-1573) had a reduced quality score of 3 due to the trial not being double-blind, whereas Colodner et al. (2003, pp.767-769) was reduced in quality not only via lack of double-blinding but also the method of randomization was not outlined. In contrast Czaja et al. (2007, pp.1-9) conducted a randomized, double-blind clinical trial however failed to outline the methods incorporated.

Stapleton et al. (2011, pp.1212-1217) & Beerepoot et al. (2012, pp.704712) both achieved a quality score of 5, they were randomized, doubleblinded trials outlining methods in detail, further they were both precise in outlining withdrawals and dropouts.

In regard to bias Czaja et al. (2007, pp.1-9) identified that products for both intervention and control were provided by Palo-Alto, however they claim this did not impact upon their methodology, data analysis or outcomes. As this trial claimed to be randomized and double-blind it would have been beneficial for the methods to be provided for an objective standing to be made regarding this statement. The remaining four trials utilised in this paper did not claim any conflicts of interest nor were any identified.

Whilst Kontiokari et al. (2001, pp.1571-1573) & Beerepoot et al. (2012, pp.704-712) had a reasonable sample size the remaining three had small sample sizes which impacts upon confident transfer to the wider target population.

Dosages throughout each trial were within an appropriate range for therapeutic administration, however the route of administration impacts upon the efficacy of Lactobacillus spp. in preventing UTI’s (Braun & Cohen 2007, p.525).

Kontiokari et al. (2001, pp.1571-1573), Colodner et al. (2003, pp.767-769) & Beerepoot et al. (2012, pp.704-712) utilized oral administration and could not correlate this route as efficacious in re-inoculating the vaginal microflora, however Czaja et al. (2007, pp.1-9) ascertained safety of using vaginal suppositories as a route of administration and Stapleton et al. (2011, pp.1212-1217) furthered this via their high quality double-blind, randomized, placebo-controlled trial that this route of administration is effective in re-inoculating the vaginal flora leading to a risk reduction of RUTI by nearly 50%.

Colodner et al. (2003, pp.767-769) & Beerepoot et al. (2012, pp.704712) did not use a placebo in their trials which may have impacted upon establishing if Lactobacillus spp. is efficacious compared to placebo, this would have increased the strength of the trial and established grounds for further research if appropriate.

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THE NATURAL THERAPIST Volume 32 No.1

U r i n a r y Tra c t I n fe c t i o n Kontiokari et al. (2001, pp.1571-1573) & Beerepoot et al. (2012, pp.704712) both undertook their trials over 12 months, whereas Czaja et al. (2007, pp.1-9) was undertaken over 6 months followed by Stapleton et al. (2011, pp.1212-1217) at 10 weeks and Colodner et al. (2003, pp.767-769) only assessed their research over 4 weeks.

Kontiokari et al. (2001, p. 1571-1573) conducted specific research for prophylaxis against E.coli & although the probiotic was not ascertained as efficacious, cranberry-lingonberry juice was and may be an alternative to antibiotic prophylactic treatment, however the sample size was small and the trial ended prematurely due to the supplier of the cranberry-lingonberry juice ceasing production, the length of the trial between the intervention and the control was inconsistent due to this, also the route of administration was unable to re-inoculate the vaginal microflora.

Colodner et al. (2003, pp.767-769) was successful in gastrointestinal reinoculation but failed via oral administration to improve vaginal colonization, the trial did not identify trial conditions for participants as the other trials did, the sample size was small with a short trial & was not placebo controlled.

Czaja et al. (2007, pp.1-9) was of reasonable quality and reported increased compliance with extensive follow up with data being drawn via use of participant symptoms diaries rather than in retrospective recall, it was however a small sample size with a self-reported inability to accurately document vaginal colonization and the significance in reducing RUTI was not ascertained due to study design.

Stapleton et al. (2011, pp.1212-1217) was a high quality trail with a reasonable duration however a longer length as well as a larger sample size may have resulted in increased efficacy, it did not compare the interventions with anti-microbial therapy which may have further strengthened its findings.

Although Beerepoot et al. (2012, pp.704-712) did not establish noninferiority for their intervention they have established a possible efficacious prophylactic treatment for RUTI, weaknesses of this trial were; target of 280 participants was not reached, clinical recurrences prior to enrolment were not clinically confirmed by urinalysis.

•

•

•

•

•

•

•

• There were no drug-herb-nutrient interactions advised in the trials incorporated in this paper.

CONCLUSION

Sharon Abel colonization by orally administered lactobacillus rhamnosus gg’, The israel medical association journal, vol.5, no.11, pp.767-9, viewed 1 September 2015, <http://www.ncbi.nlm.nih.gov/pubmed/14650098>.

Czaja, CA, Stapleton, AE, Yarova-Yarovaya, Y & Stamm, WE 2007, ‘Phase 1 trial of a lactobacillus crispatus vaginal suppository for prevention of recurrent urinary tract infection in women’, Infectious diseases in obstetrics and gynecology, vol.2007, no., pp.1-9, viewed 1 September 2015, <http://www.ebscohost.com>.

Gupta, K & Trautner, BW 2013, ‘Diagnosis and management of recurrent urinary tract infections in non-pregnant women’, British medical journal (clinical research edition), vol.346, no., pp.1-5, viewed 1 September 2015, <http://www.ebscohost.com>.

Jadad, AR, Moore, RA, Carroll, D, Jenkinson, C, Reynolds, DJ, Gavaghan, DJ & McQuay, HJ 1996, ‘Assessing the quality of reports of randomized clinical trials: is blinding necessary’, Control clinical trials, vol.17, no.1, pp.1-12, viewed 1 September 2015, <http://www.prosit. de/images/3/36/Assessing_the_Quality_of_Reports_of_Randomized_ Clinical_Trials_Is_Blinding_Necessary.pdf>.

Kodner, CM & Thomas Gupton, EK 2010, ‘Recurrent urinary tract infections in women: diagnosis and management’, American family physician, vol.82, no.6, pp.638-643, viewed 4 September 2015, <http:// www.aafp.org/afp/2010/0915/p638.html>.

Kontiokari, T, Sundqvist, K, Nuutinen, M, Pokka, T, Koskela, M & Uhari, M 2001, ‘Randomised trial of cranberry-lingonberry juice and lactobacillus gg drink for the prevention of urinary tract infections in women’, British medical journal (clinical research edition), vol.322, no.7302, pp. 1571-1573, viewed 1 September 2015, <http://www. ebscohost.com>.

Mandal, J, Acharya, NS, Buddhapriya, D & Parija, SC 2012, ‘Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant escherichia coli’, The indian journal of medical research, vol.136, no.5, pp.842-9, viewed 1 September 2015, <http://www.ebscohost.com>.

Nosseir, SB, Lind, LR & Winkler, HA 2012, ‘Recurrent uncomplicated urinary tract infections in women: a review’, Journal of women’s health, vol.21, no.3, pp.347-54, viewed 1 September 2015, <http://www. ebscohost.com>.

Stapleton, AE, Au-Yeung, M, Hooton, TM, Fredricks, DN, Roberts, PL, Czaja, CA, Yarova-Yaroovaya, Y, Fiedler, T, Cox, M & Stamm, WE 2011, ‘Randomized, placebo-controlled phase 2 trial of a lactobacillus crispatus probiotic given intravaginally for prevention of recurrent urinary tract infection’, Clinical infectious diseases, vol.52, no.10, pp.1212-7, viewed 1 September 2015, <http://www.ebscohost.com>.

In conclusion whilst a high level of efficacy in using a Lactobacillus spp. strain via oral administration has not been ascertained it was established that this is a safe method of administration with minimal adverse events and a reduction in the incidence of anti-biotic resistance was attainable, however Stapleton et al. (2011, pp.1212-1217) has provided a strong foundation for the efficacy of using Lactobacillus spp, particularly Lactobacillus crispatus as an intravaginal suppository to re-inoculate host vaginal flora, this leading to an approximate 50% reduction in the recurrence of urinary tract infections, the population in this trial however was small, further doubleblind, randomized, placebo-controlled trials on a larger scale are warranted with these findings to assist in further development of an efficacious and safe alternative for prophylactic treatment that does not see the global issue of antibiotic resistance rising further.

REFERENCE LIST •

•

•

•

• •

Bakaj, A, Ruci, E & Lika, M 2013, ‘The study of infectious agents of the urinary tract infections in durres, albania’, Albanian journal of agricultural sciences, vol.12, no.3, pp.441-444, viewed 4 September 2015, <http://www.ebscohost.com>.

Beerepoot, MAJ, Riet, G, Nys, S, van der Wal, WM, de Borgie, CAJ, de Reijke, TM, Prins, JM, Koeijers, J, Verbon, A, Stobberingh, E & Geerlings, SE 2012, ‘Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women’, Archives of internal medicine, vol.172, no.9, pp.704-12, viewed 1 September 2015, <http://www.ebscohost.com>.

Bitsori, M, Maraki, S & Galanakis, E 2013, ‘Long-term resistance trends of uropathogens and association with antimicrobial prophylaxis’, Pediatric nephrology, vol.29, no.6, pp.1053-8, viewed 1 September 2015, <http://www.ebscohost.com>.

Brain Research Imaging Centre 2010, How to write a paper – systemic review, viewed 4 September 2015, <http://www.sbirc. ed.ac.uk/documents/advice%20on%20how%20to%20write%20a%20 systematic%20review.pdf>.

Braun, L & Cohen, M 2007, Herbs & natural supplements: An evidence based guide, 2nd edn, Churchill Livingstone Elsevier, Sydney.

Colodner, R, Edelstein, H, Chazan, B & Raz, R 2003, ‘Vaginal THE NATURAL THERAPIST Volume 32 No.1

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By Peter Kington TO BOOK: China Books 1800 448 855/ 03 9663 8822 or info@chinabooks.com.au ADELAIDE – SUNDAY, 24th SEPTEMBER 2017 8:30am – 4:45pm The Treatment of Thyroid disease, other Autoimmune disorders and Male Fertility with Chinese Medicine

By Peter Kington TO BOOK: Acuneeds Australia 1800 678 789/ 03 9562 8198 or info@acuneeds.com SYDNEY – SUNDAY, 22nd OCTOBER 2017 9:00am – 1:00pm Better IVF Outcomes with Chinese Medicine

By Peter Kington TO BOOK: China Books Sydney 1300 661 484/ 02 9280 1885 or info@chinabookssydney.com.au MELBOURNE – SUNDAY, 12th NOVEMBER 2017 9:00am – 1:00pm Supporting Men’s Health and Improving Male Fertility with Chinese Medicine

By Peter Kington TO BOOK: China Book 1800 448 855/ 03 9663 8822 or info@chinabooks.com.au

INNOV_15417

AUG MAY APR

BRISBANE – SUNDAY, 19th MARCH 2017 9:00am – 2:00pm The Treatment of Thyroid Disease and other Autoimmune Disorders with Chinese Medicine By Peter Kington TO BOOK: Chinese Herbal and Acupuncture Supplies 07 3852 2288 or admin@chineseherbalsupplies.com.au

BRISBANE – SUNDAY, 27th AUGUST 2017 9:00am – 2:00pm TCM Support for Age-related and Lifestyle disease: Pain, Musculoskeletal Inflammation, Headache and Metabolic Syndrome (Inc. Type 2 Diabetes and Cardiovascular Support)

By Peter Kington TO BOOK: Chinese Herbal and Acupuncture Supplies 07 3852 2288 or admin@chineseherbalsupplies.com.au

SEP

BRISBANE – THURSDAY, 9th MARCH 2017 6:00pm – 9:00pm EMOTIONAL IMBALANCE: How to Diagnose and Treat the Effects of Emotion-based Disorders By Tony Reid TO BOOK: Acuneeds Australia 1800 678 789/ 03 9562 8198 or info@acuneeds.com

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MAR

Master of Reproductive Medicine (UNSW), Bachelor of Health Science (Acupuncture) (ACNM), Graduate Certificate of Higher Education (UQ), Bachelor of Arts (UQ) and Master of Letters (UNE). Peter has been in full time practice since 2005. He teaches at the Endeavour College of Natural Health and writes and presents professional development seminars for TCM practitioners across Australia and for eLotus in the USA. Peter has presented for Sun Herbal since 2014.

TONY REID Master of Acupuncture, Master of TCM (UWS). Sun Herbal Director.

Tony has over thirty years’ experience as a practitioner, educator and author in TCM. He is a popular and sought after lecturer, speaking at seminars, conferences and tertiary institutions – throughout Australia, Europe and also in China. Tony is a regular guest presenter with ANTA, regularly contributes articles to several professional journals both in Australia and overseas, and publishes ‘Clinical Focus’ bulletins for healthcare professionals.

30/01/2017 5:41 pm