How do you measure 'liver fire rising?'
As more patients turn to traditional Chinese cures from herbs to acupuncture, scientists
struggle to test their effectiveness
By Anne Barnard, [B]Globe Staff, 7/10/2001
Kenneth Kwong never expected to dabble in ancient Chinese medicine.
A physicist at Massachusetts General Hospital, Kwong developed a revolutionary technology
that gave scientists live views of the brain in action, opening new horizons in the study of memories,
language, and even the lure of cocaine.
Lately, however, Kwong also uses the machine, called functional MRI, to study acupuncture, a
2,500-year-old Chinese medical practice that tends to get little respect in places like Mass General's
plush research center in Charlestown. Traditional acupuncturists believe they are regulating the flow of
a life-energy called Qi through mysterious channels in the body called ''meridians,'' but Kwong wanted a
more scientific explanation.
''I personally thought it was kind of a long shot, but you never know,'' Kwong said. He ended up
discovering that acupuncture slows metabolism in an area of the brain that is active at times of anger or
fear.
After years of watching patients turn in growing numbers to so-called ''alternative medicine,'' a growing
number of researchers are giving herbs, acupuncture, and other ancient healing arts a much closer look.
Researchers from Boston to Beijing are using the tools and vocabulary of Harvard Medical School to
test herbal remedies and an array of other treatments long viewed by scientific medicine as mystical and
unproven - and hoping that honest exchange will bridge some formidable communication gaps between
traditions that take completely different views of illness, the body, and the role of medicine.
The National Institutes of Health has a $92 million budget this year, up from $2 million in 1992, to
study alternative remedies: gingko biloba to prevent Alzheimer's disease, yoga for insomnia, massage for
lower back pain. State universities from Maryland to California have set up research centers on the
topic, and Harvard this year followed suit with a $10 million institute for what it prefers to call
''complementary and integrative medical therapies.''
In one local study, at Mass General's main campus in Boston, researchers are trying to cure high blood
pressure with acupuncture. With 180 patients, $1.4 million in federal funding, and all the strictures of
scientific research methodology, the study asks whether the treatment works - and whether it works
better when it includes traditional Chinese diagnoses such as ''liver fire rising.''
Collectively, the researchers hope to sort out which work, which are harmful, and which could lead to
new insights into microbiology, physiology, and drug development. They are also playing catch-up
with the American public, which spent roughly $27 billion on alternative dietary products and medical
treatments last year, most of it out of pocket, and mostly without consulting their physicians, according
to Dr. David Eisenberg, who heads Harvard's new center and was one of the first US medical students
to study in China in the 1970s.
Meanwhile, some practitioners of traditional Chinese medicine - perhaps the most developed form of
alternative medicine - are welcoming the scrutiny as a chance to prove how much they have to offer.
They note that their techniques are based on thousands of years of recorded case histories and are
practiced alongside conventional medicine in Chinese hospitals. At a recent conference on the US and
Chinese medical systems, Eisenberg was mobbed by Chinese scientists offering business cards and eager
to team up with him.
''We want to join the modern scientific world, and to convince the modern medical arena to accept this
service,'' said Keji Chen, a leading authority on integrating Eastern and Western medicine and a professor
at the Chinese Academy of Traditional Medicine in Beijing.
The encounter is still a sometimes uneasy one - something that was on display in June when 600
Chinese health care professionals descended on Cambridge to exchange ideas with local researchers at
the conference, run by Harvard Medical International and held at the Massachusetts Institute of
Technology.
Some traditional practitioners were wary of the new attention from academic medicine, fearing that
conventional doctors simply want to debunk the competition, or cash in on it. Scientists from both
countries fretted that, by definition, Chinese medicine is hard to test. Scientific trials depend on
standardized doses of medication. In traditional Chinese medicine, a different herbal mixture is made for
every patient. Western medicine looks at discrete ailments and tries to fix them. Traditional Chinese
medicine tries to restore a sense of balance in one's relationships to one's body, to society, and to
nature. And how do researchers study the placebo effect in a trial of acupuncture, when the patient
knows whether they've been stuck with a needle or not?
Eisenberg suggested ways to disguise the treatment - for example, there are spring-mounted needles that
prick but don't go as deep as in acupuncture. But others worried more broadly: When the lens of one
tradition is aimed at another, can the one being examined come out untarnished? Will Chinese medicine
try to adapt and lose its soul?
Eisenberg reassured the crowd by saying, in Mandarin, ''Real gold does not fear even the hottest fire.''
The key, he said, is a new generation of researchers who know both cultures, both languages, and both
styles of medicine. From one side, there is Dr. Qunhao Zhang, trained in China as a traditional doctor,
now a postdoctoral fellow at Mass General. From the other, there is Dr. Simin Liu, an internist at
Brigham & Women's Hospital who said he came to listen because his mother told him her traditional
remedies work better than his advice.
Some researchers bend over backward to insist they are sober scientists, not enthusiasts looking for data
to support their beliefs.
''The purpose is not to prove that all Chinese medicine is right,'' said Dr. Kathleen Hui, a University of
Michigan-trained microbiologist who convinced Kwong, the physicist, to look at acupuncture.
''I want to show what is good, what can be improved, what should be discarded,'' she said, jabbing the
air with her hand to indicate good riddance for any method that might turn out to be, in her view,
''trash.'' This way, she added, ''we can improve Chinese medicine.''
Hui, 76, is so cautious she can barely be persuaded to describe her findings, published last year in
Human Brain Mapping. ''Don't write, `Secrets of Acupuncture Revealed,''' she pleads.
With no grant funding, her team worked for free on Sundays. Kwong, who was raised in Hong Kong but
went only to conventional doctors, ran the functional magnetic resonance imaging machine. It
photographs slices of the brain, detecting which areas are active by tracking oxygen metabolism. As a
subject lay inside the cylinder, acupuncturist Jing Liu - whom Hui chose by going undercover as an
acupuncture student and finding the best teacher - inserted needles into a commonly used spot, near the
thumb joint.
Research on 13 people showed that the parts of the brain affected by conscious sensation are less
affected by acupuncture than by a normal pinprick. But what really excited them was that deeper areas
of the brain, such as the amygdala, which regulates emotions, decreased their activity during
acupuncture. Heightened activity in the amygdala is associated with emotions such as anger and fear.
Hui will say only that the research suggests interesting avenues for research on how acupuncture works.
Liu, who describes himself as ''more of a partisan,'' has a different take: He thinks it will eventually
prove the existence of Qi.
Liu wants insurance companies to start covering acupuncture. ''It works,'' he said. ''There is no doubt.''
Mass General is working to test that claim. It already uses acupuncture for pain relief. But now,
cardiologist Randall Zusman, Qunhao Zhang, and others are investigating its effect on blood pressure, in
a study funded by the National Institutes of Health.
Zusman was skeptical when he was first approached by Leslie A. Kalish, a specialist in clinical trial
design at the New England Research Institute who wanted to set a standard for how to study alternative
medicine. ''I'm a pill-pusher,'' he said.
But he is impressed with the drop in some patients' blood pressure - though he won't know until after
the study is over whether they are getting acupuncture or placebo. Patients are randomly assigned to
three groups: one gets standardized acupuncture, one gets a placebo version with random needlepricks.
The third gets individualized acupuncture based on a traditional Chinese diagnosis. Practitioners look at
patients' tongues to see if they are ''hot'' or ''cold'' and identify problems with organ systems and their
relationship to the senses, the weather, and other factors. A common diagnosis in patients with high
blood pressure is ''liver fire rising,'' which often correlates to excess anger and stress.
Acupuncture, Chinese diagnosis, and blood pressure evaluation are done by different people, to prevent
bias.
Zusman pointed out that lowering cholesterol was only recently proven clinically to improve health -
though doctors have been urging it for years. Western and Eastern medicine are more similar than some
doctors like to admit, said Nelson Kiang, the Harvard neurobiologist and grandson of a Chinese healer
who organized last month's conference. ''You try this and that, and what seems to work, you do.''
To participate in the study, call 617-724-0407.
This story ran on page C1 of the Boston Globe on 7/10/2001. |
