BOOK REVIEW: Pain: Considering Complementary Approaches by NCCIH

Pain: Considering Complementary ApproachesPain: Considering Complementary Approaches by National Center for Complementary and Alternative Medicine
My rating: 4 of 5 stars

Online here

 

The National Center for Complementary and Integrative Health (NCCIH) has put out a new edition (dated 2019) of its pamphlet (about 50 pages) about how useful various complementary practices are in helping patients reduce, or cope with, pain. The NCCIH is a center in the National Institutes of Health (NIH) that serves as a clearinghouse for information about how alternative and complementary practices perform in treatment of various ailments. While alternative (instead of mainstream medicine) and complementary (in conjunction with mainstream medicine) are quite different, in almost all cases this work herein is reporting on the latter basis. The complementary practices in question include: yoga, taiji, meditation and mindfulness, massage, acupuncture, chiropractic manipulation, relaxation methods, and others.

Complementary approaches to treatment of pain is a particularly salient topic these days as the mainstream medical approach (giving patients pills to gobble down) has resulted in what many have called a “crisis” of opiate addiction. So, if it’s possible to reduce the grip of pain with practices that at best have numerous other health benefits and at worst do no harm, than that’s a pretty good outcome.

Chapters three through eleven form the pamphlet’s core, and all but the last of those look at one complementary practice each, including (in order): acupuncture, massage, meditation, relaxation techniques, spinal manipulation, taiji (a.k.a. tai chi, or tai chi chuan), yoga, and dietary supplements and herbs. Chapter 11 discusses a few additional (less popular) practices. These chapters follow a three-prong approach: 1.) is it safe? 2.) does it help mitigate pain? and 3.) where can I find more information? [Spoiler alert: In almost all cases the answer to #1 is roughly “Yes, for most people, but possibly not for you. Check with your doctor,” and to #2 is usually something like: “there is some preliminary evidence that in certain cases certain people may have benefited.”] The chapters before (ch. 1 & 2) and after (ch. 12 to 14) provide background context and additional information.

On the positive side, it’s great that this information has been gathered together and packaged into a readable format with pictures and easy to read text.

On the down side, this was clearly a document put together by a committee of bureaucrats in consultation with lawyers. It is so laden with qualifiers and spongy speak that it’s impossible to discern how strong the evidence is for the various practices or how one compares to another. I felt that they could have given the same information in a three-column table in which the first column is the practice, the second column is “can’t hurt to try*” [*provided your physician concurs,] and the third column would be “nah, this stuff is fake.” [Spoiler alert: almost everything besides homeopathy would have the first column checked, but the consensus seems to be that homeopathy is pseudo-scientific quackery designed to sell water at medicinal prices.]

This booklet is available on the web for free, so if you’re interested, check it out. But don’t expect to come away with any profound insights. It’s not that kind of booklet.

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BOOK REVIEW: Principles of Tibetan Medicine by Dr. Tamdin Sither Bradley

Principles of Tibetan MedicinePrinciples of Tibetan Medicine by Tamdin Bradley

My rating: 3 of 5 stars

Amazon page

Full disclosure: let me first state that I’m a scientific-minded person and skeptic by nature, and if you’re expecting a review by a true believer, you may be disappointed.

A couple of questions may arise from the disclosure above. First, why do I feel I need to make such a commentary? Well, because this is a book about a system of medicine (i.e. gso-ba rig-pa) that developed within a country that was isolated for centuries and in which every aspect of knowledge was infused with and influenced by religious belief—both pre-Buddhist and Buddhist. Because of this, while some of the advice offered is surely sound, some of it is—from a skeptic’s point of view—bat-shit crazy. For example, there are herbal and dietary preparations to aid in digestion that may be completely sound and reasonable, and then there is the idea that Zombie spirits (one of 18 types of evil spirits) cause constant shivering.

The second question is, “If I’m not a believer, why read the book and review it?” For one thing, as I indicated above, I don’t think that just because the beliefs behind the “theory” of this system of medicine are baseless, it means that there is nothing in the book that is true or of value. The theory is that there are three kinds of energy (Loong, mKhris-pa, and Bad-Kan) and that excesses or deficiencies cause health problems. But it’s a 2500 year old system of healing; certainly they learned a thing or two in the process. It’s quite possible that they have learned things that scientific medicine has not. (Consider for example, Tibetan Buddhist monks have repeated and verifiably demonstrated capabilities—i.e. consciously controlling autonomic systems, that Western medicine would have thought impossible.)

The analogy that I always use is with kid’s Christmas presents. Parents hide the presents, and tell the kids that if there’s any tampering with them the kid won’t get anything but a lump of coal (you say that was just my parents?) Anyway, the kids find the packages, but are afraid to invasively tamper with them. Therefore, they feel the heft of them, they shake them, and they listen to said shakes. From that limited investigation, they develop a theory. The theory may be spot on, it may be completely wrong, or over several gifts it’s probably a combination of wrong and right. However, the question of whether the present does what it’s supposed to (i.e. bring joy) is not closely connected to the child’s theory, because it’s based on the parent’s observation of what the kid likes. That, my friends, is why systems of healing that are based on notions that are empirically wrong sometimes produce good results.

Second, while I’m a believer in science, I don’t always believe that Western medicine (rooted in science as it may be) consistently does a good job. Part of this is the fault of economists, policy types, as well as lazy patients who’ve created a system in which medicine only pays off if it can cut one open or give one an expensive medication. This leaves room for alternative systems of medicine that may not be so scientific, but that allow for the fact that changing patient behavior is often key to improving health.

I’ve taken a long time to get to the actual review, but I thought the reader should know from whence this reviewer was coming. The book is a little under 200 pages long. Its 11 chapters are logically oriented, and it’s easy to navigate the book. The author writes in a readable style, and jargon and foreign terminology aren’t a problem. It doesn’t have an index, but each chapter is broken up into many smaller subunits–so finding what one is after shouldn’t be hard.

The chapters cover the history of Tibetan Medicine, the nature of gso-ba rig-pa, the theory of Tibetan Medicine, causes of illness, human anatomy and physiology (not of the physical body as we know it), common diseases and illnesses, treatment techniques involving changing diet and behavior, medicinal treatment, representative case histories, and the nature of the Tibetan Medicine physician.

It’s not clear who the target audience for this book is. It’s not a self-help book as the implication is that the patient should see a doctor of Tibetan Medicine and not self-prescribe. Furthermore, while the book provides a good overview of Tibetan Medicine, it’s not an all-inclusive description by any means. The book seems to have been written primarily to make individuals aware of Tibetan Medicine and to give enough insight into the system that readers can differentiate it from Traditional Chinese Medicine or Indian Ayurvedic Medicine, both of which display similarities and differences.

I’d recommend this book if you’re interested in alternative approaches to healing, or if you’re interested in Tibetan culture in detail.

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Wat Po v. Chiang Mai Massage: A North / South Divide?

One of the sculptures in the Thai Yoga outcrop at Wat Po.

One of the sculptures in the Thai Yoga outcrop at Wat Po.

In September I attended the General Thai Massage and Foot Massage courses at Wat Po. The teacher from whom I first learned Thai Massage (a.k.a. Thai Yoga Bodywork or Nuad Bo Rarn) was trained in Chiang Mai by various teachers, and the style he teaches reflects that northern heritage. I was curious to see how the style of massage varied in the south from the northern approach that I had already learned. Would I be in uncharted waters? Or would the Wat Po course merely be a refresher of what I had already learned? These questions were on my mind as I began the course.

 

The answer turned out to be somewhere in between. The Wat Po approach wasn’t radically different from what I had already learned, but neither was it a carbon copy. One could clearly see the common origin of these styles. For yoga practitioners, a reasonable comparison would be to imagine you studied Bihar yoga, and then you sat in on an Ashtanga Vinyasa class. Most of the postures would be similar if not the exact same—e.g. a downward dog is a downward dog. However, the sequence is a little different, you may run into a posture or two that you hadn’t seen before, and there will be many little differences in points of emphasis and so on. The same could be said of two martial arts that have a recent common ancestor art. (However, I think martial arts evolve more rapidly than other systems of movement because there is a life and death urgency to adapt to local conditions, and so martial arts can diverge rapidly.)

 

I won’t get into every little difference in this post. For one thing, the first course I took was a 60 hour (10 day) course, and the Wat Po course was only half as long (5 day / 30 hours.) Therefore, some of the apparent differences might have more to do with the need to conform to time limitations than true stylistic differences. The Wat Po course was designed to impart a sequence that could be done in an hour-and-a-half bodywork session. The first course I took taught some material that was redundant in the belief that one could tailor one’s sequence to the recipient’s needs and / or the masseuse’s preferences.

 

As an example, at Wat Po we didn’t learn any massage of the chest or abdomen, but I was shown (in fact, I was recipient of) the Wat Po approach to abdominal massage and it was pretty much the same as I’d learned previously. In my earlier learning, the approach to energy lines was to stretch (longitudinally) the limb, then apply palm pressure, then work the line (typically with the thumbs), and then one would repeat the palm pressure and finish with a repeat of the stretch. At Wat Po, they went straight for the energy line (sen) and followed that with the palm pressure work. I have no way of knowing whether this difference was more due to timing or style.

 

Before getting into the differences, I will talk a little about similarities. The general approach was the same (e.g. the recipient is fully clothed in a light, comfortable garment(s)) and the massage is ideally given on a thin, dense mattress/pad on the floor–rather than on a table. The general principles of sequencing were the same. Namely, one began at the feet and worked in the direction of the head. Also, when working on a limb, one began at the distal end, worked toward the torso, and then back toward to the starting point. Also, energy line work was done before the stretches.  There were four positions in both styles: supine, side, seated, and prone, and—unlike many other forms of massage—the supine position was at the fore (i.e. neither style emphasized the prone position and back work over the supine in the way other varieties of massage often do.) Both styles of massage (as probably all massage) began with a brief introduction and questioning designed to make sure the individual didn’t have any contraindicated conditions. Both styles of Thai massage began with a moment of prayer or contemplation—this is similar to some styles and different from others and speaks to the traditional nature of Thai massage.

 

IMG_0031

The side and seated sequences were the most similar between the two styles.  I learned more in these sequences in the longer (Chiang Mai) course, but what was included in the Wat Po course was largely the same. Where the stretches were of the same type, they tended to be virtually identical. By that I mean to say that both styles had stretches that weren’t taught in the other style, but where that was not the case, the stretches were indistinguishable. For example, the pictured variant on sarpasana / bhujangasana [snake / cobra backbends] was done in the same manner in either style. (I learned more stretches in the first—Chiang Mai–course, because it was longer.)  Over all, the energy lines (sen) tended to be identical, but there weren’t always the same number of them, nor were the same ones always emphasized. There were some differences in the feet lines that I’ll get into below.

 

Now let’s get to the differences. Starting with some small differences, the manner of palm pressure work was different between the two systems. In the Wat Po style, there was always one fixed point that one hand locked in place while the other hand applied palm pressure. I had previously learned to use both hands in a rhythmically alternating series of palm pressure applications.

 

One little difference that I found interesting involved the technique of closing the little flap over the ears at the end of the face and head massage (both styles close off the ears.) I had been taught to very gently release pressure so as to avoid any kind of popping that might disturb the recipient. However, at Wat Po the instructor taught to vigorously pull the fingers away—resulting in a pop. My guess would be that the idea was to get the recipient’s attention so that one could transition them from the face massage (which notoriously puts people to sleep) to a wakeful state so they could follow instructions for the stretches that followed. (We were taught face massage as part of the seated sequence. Previously, I had learned that this was an option, but that it was easier to do the face massage from supine so you didn’t have to worry about the recipient falling asleep and possibly falling over literally.

 

A final little difference was how the blood stop was done for the lower extremities. At Wat Po, they did the leg blood stop with both legs straight, whereas I had previously learned this technique with an open groin, i.e. the knee pointed out. (Both ways work about the same, but I think it might be a little less awkward to do it with the groin open as one is not in as close of proximity to the recipient’s privates.) The blood stop for the arm was identical.

 

The energy lines are one of the most fundamental aspects of Thai massage, and one would expect little variation in them between styles. This proved largely, but not entirely, true. For example, the leg lines were the same (as one might expect because one cannot stray too far from some lines without getting onto bone.) Also the points at the top of the shoulder, around the neck, the base of the skull, and the scapulae were the generally the same–except more or fewer points might be employed from one style to the other.

 

The arm lines were almost the same. The line on the back of the arm was the same, and the line that goes up the middle of the inner arm was the same. However, there was a second inner line that ran in line with the little finger along the lower edge of the arm (presuming the arm is straight out from the shoulder as it is for massaging the inner arm in both styles.) The lines of the back that were used were different. In my (not very accurate) diagram, the lines 1 and 3 were emphasized in the Chiang Mai style, but 1 and 2 were the lines used in the Wat Po system.

 

Back diagram_CM

 

The greatest divergence in lines and points was in the area of the feet. The best example of this can be seen in the lines of the sole. In the Chiang Mai style I’d previously learned there were five lines that radiated from a point where the heel transitioned into the arch about midway across the foot and went toward the base of each toe. The Wat Po style had three lines that were more or less parallel in line with the big toe, middle toe, and the little toe.  See diagrams.

 

 

The Chiang Mai 5 lines of the sole.

The Chiang Mai 5 lines of the sole.

The Wat Po 3 lines of the sole.

The Wat Po 3 lines of the sole.

 

In summary, the difference between these two styles wasn’t that great. In many cases the techniques were exactly the same, in most they were marginally different, and only rarely were they completely different.  I don’t really have a preference between the two styles. I think which would be a better experience comes entirely down to the skill of the masseuse / masseur.