Chinese Medicine and Healthcare Choices: Iatrogenesis

This initiates a series of postings to this blog about the Chinese medical perspective on maintaining good health. It is intended for the educated layperson. The classical Chinese medical texts name three categories of causative factors in illness. Internal factors are the unruly emotions. I will save that for another post. The external factors are those of climate. I will address these in a later post as well. Here I would like to talk about the miscellaneous causes of illness. This is a grabbag of causes that are neither internal or external, though they have some elements of both depending on how one defines things. Miscellaneous causes include diet, exercise and iatrogenesis to mention the most prominent.

It is important to remember that disease in Chinese medicine is not caused by a lack of acupuncture and herbs. Thus the best way to keep well and get well is to eat right and exercise. Diet can also be extended to include those herbs and nutritional supplements that are intended for long term use to maintain good health. These range from things like Ginseng to Coenzyme Q. Finally, due to high incidence of drug side effects damaging quality of life or even injuring organs, plus the slim but significant possibility that one will die from misuse of a prescribed drug, it is best to avoid drugs unless absolutely necessary. This last concern in called iatrogenesis and means doctor caused illness. This latter issue is today's topic.

Iatrogenesis is not a new phenomenon. The Chinese have been concerned about it in every major herbal text written for 2000 years. The main theme throughout Chinese history has been the relief of suffering and restoration of function without causing any further harm. A reasonable and ethical approach at a time when there was no way to predict or study adverse drug interactions in advance. This led to the development of a wide range of prescriptions that effectively treat many symptoms, improve health without iatrogenesis. This is perhaps the greatest secret power of Chinese Medicine. In my practice, the beginning of a downward spiral of health for most patients usually begins with a drug prescription for a common complaint such as Prozac for depression, Atenolol for hypertension or Nexium for Gastroesophageal Reflux Disorder.

Now let me be clear. Most people have no problem with the drugs they are prescribed. They work well and cause no unacceptable side effects. However a very large minority of the population has tremendous problems. This may be due to genetic variations that make them more likely to have side effects or interactions. Pharmacologists are hopeful that they will be able to correlate these differences in drug response with the human genome over the next decade, which will revolutionize drug therapy....maybe, but we have heard this before. I am personally confident this is true. I got into Chinese Medicine in part because conventional medicine seemed at a dead end in the mid eighties. However I don't feel that way any longer. When this will all manifest is anyone's guess? And it will be piecemeal. In the mean time, we have Chinese medicine to at least tide us over or console us if this new trend in pharmacology is just one more failure.

Interestingly, the way Chinese medicine has approached medicine in order to make it safe is to consider the very same terrain as modern genomic pharmacologists are. In other words, the Chinese herbalists of old focused on the differences between people with the same disease and discovered that different herb therapies were more effective in some than others. They also discovered that giving the wrong therapy to someone might relieve some symptoms, but worsen overall health. Through trial and error and a sophisticated holistic view of the body, the Chinese largely succeeded in this enterprise. In my experience, most patients with a given disease as defined in modern pathology tend to cluster around a similar set of traditional Chinese diagnostic categories. However, there are often significant nuances that lead to at least slight adjustment of standard formulas. There is also a smaller number of people with any given disease who present outside the norm with signs and symptoms pointing towards a range of other diagnostic categories.

It is these folks as a group who respond very poorly to western drugs. They often are sensitive in all areas of life (emotional, food allergies, etc.). These persistent differences in chronic illnesses have often been referred to as constitutional factors in the Chinese medical literature. While affected by the environment, they are largely inborn to some degree. Most veteran Chinese medicine practitioners will agree with the observation that patients have recurring tendencies that affect their health regardless of lifestyle choices. So while good diet and exercise keep most people healthy, some folks will have dangerously high blood lipids as a result of their genes. Because the Chinese scholars of old assumed that different people with superficially similar symptoms were actually different on a deeper invisible level, their medicine reflects this. Western medicine is just catching up with this idea and with a vengeance. All the cutting edge modern medical literature is about correcting malfunctions at the source (what the Chinese call the root) and tailoring prescriptions based on inborn traits.

For now, the best bet for most patients is to try Chinese medicine first. If the herbs work and cause no problems, its win-win. Many people end up on drugs for symptoms that are either not connected to a known illness (constipation or joint pain, for example) or connected to a poorly understood illness (lupus, for example). Many of these drugs are quite dangerous. Bextra for pain or Methatrexate for Lupus. So since the drugs are not curative, but only relieve symptoms, may damage organs and have not been shown to have long term benefit, one is always better off with noniatrogenic herbs that work to your satisfaction. While herbs may have unknown long term side effects, some of these drugs have known short term side effects including liver and kidney failure. So you couldn't really do any worse.

I would submit that if you are taking an herb that relieves your symptoms and causes zero side effects and no common lab tests show organ damage, it is a pretty good bet you are safe. Especially if you are the type who usually has adverse reactions to everything. A few final caveats, though. See someone who is fully trained. Ask whoever your herbalist is to practice full disclosure of training and/or certification and/or licensure. Do not trust anyone who makes claims of cure. There is little evidence that Chinese Medicine can cure diseases like cancer, diabetes, even chronic hepatitis or lupus. But recall that in order to prevent these illnesses, the real task is to eat right and exercise (addressed in later posts) and avoid ingesting dangerous substances. In many cases, the best modern medicine can offer is symptom control. If Chinese medicine offers equal relief in many cases with few or no side effects, then there is a net gain for the patient. In those rare cases when true cure occurs, then its just icing on the cake.