Best. Available Technology

One of the hurdles I faced as a former research scientist practicing Traditional Chinese Medicine (TCM) was the lack of clinical testing, clear objective markers, or scientific proof proving the efficacy of our medicine. This gap in scientific validation has led to skepticism and a lack of acceptance within the broader medical community. 

To remain relevant, especially as our autonomy is being encroached upon by MDs and physical therapists performing dry needling and trigger point work, we cannot shy away from these conversations. Since the beginning of my practice over 20 years ago, I have used laboratory tests to confirm the efficacy of treatment, particularly for patients with autoimmune diseases, endocrine issues, kidney neuropathy, and catastrophic diagnoses. This approach provided concrete evidence of clinical recovery, which was crucial for me as a new provider.

Best Available Technology (BAT)
In clinical toxicology, we strive to use something called Best Available Technology (BAT). Testing often begins with qualitative methods, such as TLC, to determine the presence or absence of certain compounds. This is followed by quantitative methods, such as HPLC, ELISA, or GC-MS, to measure the levels of these compounds accurately. Quantitative analysis aims for the lowest detection levels, rigorously compared to controls and spiked samples of the same matrix. Since these results must withstand scrutiny in a court of law, labs maintain chain of custody and sample handling, ensuring the utmost accuracy and reliability. This rigorous methodology naturally translated to my practice in functional medicine and orthopedics.

Challenges in TCM Education
My journey through acupuncture school highlighted significant challenges. There were glaring deficits in scientific rigor and scholarship within the program. Professors made claims that were both erroneous and unverifiable, such as curing schizophrenia with a single dose of herbal tea. I struggled with aspects of TCM education that included "point function" descriptions or choosing points based on symptoms because, as a scientist, I needed to understand it objectively. OM concepts like ‘mobilize the vessels’ or ‘the arrival of qi’ were never defined in a clinical context: What do those ancient terms in OM even mean in terms of a technique? How do I facilitate that? Half the time, the answer to these questions reminded me of Sister Mary Agnus in catechism: Because that is the point prescription.

Overcoming Skepticism in the Early Years
As a scientist, it was clear to me from the beginning that laboratory tests should be used to confirm improved outcomes just as standard orthopedic tests document a return to normal function for orthopedic cases. I took my first classes in functional medicine while I was an intern in acupuncture school with added coursework to refine my skills in orthopedics and muscle testing. Clinical medicine allowed me to objectively measure the effectiveness of qualitative treatment styles like acupuncture without relying on “point-prescription.” I needed to discover for myself if there was a clinical benefit to acupuncture beyond sedation. Did liver enzymes decrease? Did kidney values improve? Were there changes in HbA1c levels, triglycerides, etc.? Did viral load diminish?

At the beginning of my practice, understanding and medical acceptance for acupuncture were in their infancy. As a new provider, establishing trust and cooperation from other doctors was essential. Labs demonstrated efficacy to uninformed clinicians who were dubious about TCM and unclear as to how to support their clients. I faced a lot of skepticism in the first decade, with significant triangulation from other clinicians who ridiculed their patients for seeking acupuncture and flat-out denied clinical improvements. I can't tell you how many clients have come back saying, "My doctor said they must have had the wrong diagnosis." Even though they documented your kidney decline for years? "Yeah, he said they must have been wrong. Your treatments could not have done that." Another favorite was, "Well, this has clearly resolved, but she doesn’t know why."

In the early years, we had particular success with HIV and cancer patients, both long-time patients struggling with polypharmacy, and clients who were treatment-naive and wished to remain free of medication as long as possible. After a few months of care, clients consistently showed restored clinical functioning in labs, significantly reduced viral load, and huge subjective improvements in quality-of-life issues like sleep, fatigue, and body pain. Using clinical markers to measure qualitative treatments was the most obvious way to document success with TCM. Perhaps foreshadowing my later work with trauma and neurogenic disease, we observed repeatedly how shock or trauma could undo six months of clinically documented successful treatment overnight.

The Need for More Objective Research
The danger of a qualitative medicine like TCM with such subjective methodology is that it leaves us susceptible to projection, denial or magical beliefs. Rather than acknowledging our limitations with understanding the medicine when I was in school, there was (and still is) a tendency to project blame on the patient in the form of "they don't want to get better." I’ve experienced this numerous times as an acupuncture patient myself with unskilled needling, where I was blamed for being “needle sensitive” rather than considering that perhaps the needle technique needed refinement. These early experiences, however, led me to gentle, palpation-based practices that aligned more closely with my treatment preferences.

While the lack of objective understanding in our medicine is distressing, it is helpful to recognize that similar challenges exist in Western medicine, though they are rarely acknowledged. As a scientist, it has been tough to accept that if you ask 20 TCM providers for a diagnosis and treatment plan, there will likely be 20 different answers. However, one of my long-term clients, a respected MD, once shared that if the average patient heard the debates that occur during grand rounds that degenerate into anger and name-calling, they would a) be horrified and b) realize that there is no absolute medical fact, only medical opinion. This insight helped me understand that the challenges of subjectivity and variability are not unique to TCM but are also present in Western medicine, albeit less publicly acknowledged.

How TCM Patterns Change with Time
As our culture has shifted into chronic sympathetic dominance, the patterns associated with TCM must be updated to reflect current issues. As a US-based provider, for example, I rarely see patterns of true deficiency. The patterns observed during the time of Nei Jing and Nan Jing were influenced by food scarcity, manual labor and the absence of sugar, artificial light, TV, or constant external bombardment. Food scarcity is never an issue with my clients. But a near constant state of overwhelm is! Sympathetic dominance and the fight-flight-freeze response were not even known when the modern iteration of TCM was developed. Trauma was not on the radar prior to WW1, with early cases of ‘shell shock.’ An understanding of the autonomic nervous system and primitive reflexes were in their infancy. There was no such thing as mental health. Polypharmacy was not an option, and to quote Will Ferrell in Spirited: "Back then, the leading cause of death was January." (Andrus., Spirited, 2022)

Integrating Modern Neurological Insights into TCM
Our approach must evolve to address these new issues. Revitalizing our understanding of the sinew channels provides us with a visibly objective, reproducible style for the first time, and suggests at least in part, a neuro-pathomechanism for TCM which has eluded us. Embracing objective criteria fosters a more professional and scientifically grounded practice, ensuring better outcomes for patients and practitioners alike. This approach mitigates the risks associated with subjective interpretations and personal biases.

It also removes the stigma of being “New Age” or weird because we can communicate what we are treating in clear medical language. We use the same clinical markers employed in neurology, physical therapy (PT), and occupational therapy (OT) to accurately assess the impact of our work. This includes evaluating cognition, fine motor function, and vestibular work, enabling us to verify that our treatments promote neuroplasticity by restoring vagal tone.

The objective, visible nature of working with the sinews is invaluable to patients: the first time you effectively restore proper vagal tone through a chronic spastic area that the patient can see and palpate is an experience that cannot be taken away. This is not in their imagination – it can be palpated and photographed. (Real quotes: “I could watch this all day.” “OMG I am striped like the Hamburglar!” along with some more colorful variants) It also strengthens compliance because they feel more empowered to render self-care because they understand what it means.

A neurologically informed approach to TCM enables us to adapt our medicine for contemporary conditions that include spasticity and trauma. It provides illumination into vague terms that have yet to be defined clinically, such as running piglet syndrome and phlegm misting the mind. And on a more personal note, it also enables many of us who are trauma survivors to achieve the healing that we facilitate in so many other patients.