“We Must Have the Courage to Do What Is Medically Necessary”
Dear Editor:
I have some thoughts on the September 2024 cover article, “Do You Have an Anti-Fat Bias? Probably.”
This topic is currently trending heavily in mainstream health care. In the U.S., where 60% of the population is overweight, there is an increasing tendency to normalize obesity, rather than see it as pathological. Nevertheless, ICD-10 includes nine codes for obesity, so mainstream medicine clearly views being overweight as a medical condition.
In her article, Ms. Summerquist proposes providing Chinese medical care without consideration of body weight. The author also challenges the view that, based on weight alone, dampness is a legitimate diagnosis for heavier patients. She questions whether providing dietary guidance for overweight individuals in a Chinese medical practice is appropriate. Her assertion is that it is societal prejudice, not medical reasoning or necessity, that often drives how we treat overweight patients.
In fact, inspecting the bodily form has long been a key part of the inspection examination and is necessary for accurate diagnosis. This is clearly stated in Tietao Deng’s Practical Diagnosis in Traditional Chinese Medicine – a textbook representative of many historical and modern diagnostic manuals, in which bodily form is one of four general categories for inspection, along with spirit, color, and bearing.
Omitting any of these essential components from the established diagnostic process can produce incomplete, or even erroneous, diagnoses.
Furthermore, there is long-established consensus that obesity is pathognomonic of a phlegm-damp accumulation pattern. Just as spider nevi and varicosities are viewed as observable blood stasis, so, too, excess body weight is understood as nothing other than visible phlegm. In the words of noted CM authority Bob Flaws, varicosities and obesity are “eureka” indicators for these patterns.
Ms. Summerquist observes that overweight patients may present with spleen qi vacuity or yin vacuity. Spleen qi vacuity often engenders phlegm-dampness – following the axiom “the spleen is the source of the formation of phlegm”; while enduring phlegm-dampness can result in depressive heat, which taxes and consumes yin.
In other words, spleen qi vacuity and yin vacuity in overweight patients are not actually alternatives to a phlegm-damp accumulation diagnosis, but rather parts of a complex presentation with multiple, concomitant patterns.
Sun Si-Miao advocated diet and lifestyle counseling prior to inserting needles or prescribing any medicinals. In my practice, I introduce many patients to the life-transforming ideas of Chinese dietetics, especially when diet is a primary cause.
By shifting the discourse from trigger topics like counting calories or minimizing fats to concepts like the qi and flavor in food or harmonizing with the Chinese organ clock, habitual defensive patterns drop and patient participation increases.
We must always maintain professional objectivity and be sensitive and compassionate. In the case of embarrassing or uncomfortable topics, we must also, however, have courage on behalf of our patients to do what is medically necessary. Failing to do so not only risks rendering our care ineffective; it could even put lives at risk.
David H. Price, LAc, MOM, BA
Thoughts on Pregnenolone Supplementation
Editor’s Note: The following is in response to Bill Reddy’s September 2024 column, “Embracing Harmony: Pregnenolone’s Role in Alleviating Menopausal Symptoms.”
Dear Editor:
While pregnenolone may in fact help to alleviate symptoms of menopause in some women, I would never recommend it to women without doing a dried urine test for hormones first to get a baseline, and then to monitor what the woman’s body is doing with this “mother” hormone, especially given the doses the author recommends titrating upward toward.
It would be nice, yet naive, to believe that the body’s intelligence would take pregnenolone and convert it to exactly what a particular woman needed. We must remember that in the 21st century, biochemical and hormonal pathways are impacted by toxins, nutrient deficiencies, and stress, among other things.
The dried urine hormone panel would guide the menopausal hormone supplementation in many ways. It would provide information on the health and condition of a woman’s estrogen detoxification pathways, along with a thorough assessment of her progesterone, androgen and the stress hormone levels (cortisol and cortisone).
We’d be remiss to blindly supplement a woman with pregnenolone if she is already stressed with high cortisol levels, unless we knew that the pregnenolone supplementation was not feeding the cortisol pathway. Likewise, we would not help a menopausal woman with pregnenolone if she were converting it to estrogens, and she had poorly functioning estrogen detoxification and was still producing more-than-adequate estrogen in cells other than her ovaries.
This woman would be better served by supplementing with estrogen detoxification support and bioidentical progesterone, which in addition to providing the needed effects of progesterone, would oppose excess and potentially carcinogenic estrogen levels.
John McCarthy, LAc, Dipl. Ac.
“IT Would Be Nice To See the Human Aspect of the Medicine”
Dear Editor:
Tempted by Kyle Schmid’s article, “Tips for Optimizing the Patient Journey,” I opened the May 2024 issue of Acupuncture Today with the hope of learning something about patient care. Not knowing that he is a product learning specialist for the Jane App, I was disappointed to read what is essentially an advertisement for a product, rather than gain some insight into clinical care.
What a sad, missed opportunity on the part of Acupuncture Today to not offer the reader an actual opportunity to expand their awareness regarding the experience they give their patients!
Imagine an article, perhaps in several parts or installments, in which the patient’s journey is discussed and described from when they enter the clinic and follows their diagnosis, treatment, and follow-up education. It might even include an installment about how a diagnosis can change (or not) depending on what the desired focus of the treatment is, and any further education that is given.
In order to optimize the patient’s journey, there needs to be a goal (other than making money). That goal should be agreed upon and reassessed as the journey evolves. The online portal, or face of a practice, whose character can be managed by an app (such as Jane), is nice, but not necessarily imperative to a positive outcome.
It would be nice to see the human aspect of the medicine reflected in what limited periodical literature there is in the field. One often doesn’t know what an audience knows unless they are willing to ask – and listen.
Emily Sablosky, LAc, DACM
Editor’s Note: The Letters to the Editor section serves as a forum for readers to provide feedback, pro, con or otherwise, on articles published in Acupuncture Today. Submit your letter for consideration to editorial@acupuncturetoday.com. Please include your full name and degree(s)/certification(s). Submission is acknowledgement that your letter may appear in a future issue.
