Short history of the Chinese term for ‘nerve’

The following is a syndicated post from the blog “Aowen Chinese Medicine 奧文中醫: Chinese medicine in words and pictures,” by Nicolaas Herman Oving (practitioner, translator, and educator in the field of Chinese Medicine). It originally appeared at http://ovingchinesemedicine.com/uncategorized/short-history-on-the-chinese-term-for-nerve/.

I originally wrote this in response to a colleague who suggested that the Chinese term for ‘nerve’, 神經 [shénjīng], implied that the Chinese conceived of this concept as meaning: ‘links of transmission (經) of spirit (神)’. Over the years I have shared it with students and in some discussion groups as well. The feedback I received has encouraged me to correct, expand, and polish it. I also added some illustrations in this new version. I hope you will enjoy it.

I am greatly and gratefully indebted to Hugh Shapiro for his thorough research on this topic.

Introduction

Can we say that the nerves are ‘the links for the transmission of spirit within us’? Is that the way the Chinese saw it when they began to use the term 神經 [shénjīng] for ‘nerve’? When I heard that I had serious doubts, mostly because the Chinese already had an elaborate system of transportation in the body, consisting of channels, vessels, and a network of smaller conduits. I simply could not imagine that when descriptions of the nerve and the nervous system reached China, they thought: “Ah, that’s what was missing, that could be the vehicle for spirit transmission!”

I was prepared to give it the benefit of the doubt, though, and decided to see if there was any evidence for it. The combination of the two characters 神 and 經 by itself (be it very interesting) is not enough for me to believe that it became part of Chinese medical philosophy in the way that my colleague had put it.

I specialize in the Chinese-English terminology of Chinese medicine, a medicine that I have practised as well. Besides my studies in Chinese languages and cultures I have done studies in lexicology and terminology. A brief introduction to what terminology is and how it works in our field of knowledge can be found here.

Of importance for the following is: A term is only a term when it has a definition. A definition describes the concept that is conveyed by the term. When a term is translated into another language, the definition does not change. This principle is a prerequisite for adequate translation and communication in any specific subject field. There is nothing special about it; it is the way knowledge is communicated in this world. Nevertheless, it often is overlooked in one particular field of knowledge, namely Chinese medicine.

 

<Anatomiae amphitheatrvm, Robert Fludd, 1623>

 

So, it is the definition of ‘nerve’ that applies to 神經 and vice versa. There are many ways new terms are formed and for the Chinese terminologies of Chinese medicine and that of biomedicine (a.k.a. Western medicine) there are some specific problems. When the Chinese create new terms for concepts that they did not invent themselves, like ‘nerve’, what they are doing is trying to understand what the foreign term means (by investigating the definition of the concept) and then come up with a term for it in their own language.

If you translate that new word back into the foreign language without taking into account what definition is attached to it, you can come up with something different. And that is what happens when you translate 神經 as ‘spirit transmission’ or ‘lines for the transmission of spirit’, or ‘spirit channel’. Regardless of the problem that both characters have multiple meanings (an ignoramus could say that 神經 means ‘divine menstruation’), what you are doing when you follow this method, is giving a new and different definition to an existing term. And that makes communication in any discipline very difficult if not impossible.

The compound word 神經 [shénjīng] in the meaning ‘nerve’ is interesting because as a term it raises several questions. Imagine a doctor in China who comes into contact with Western anatomy for the first time in history. What would you say they will think? They see drawings of human bodies with lines, read the description of this new concept, and why o why don’t they come up with something like 腦經 ‘brain channel’, 腦氣經 ‘brain qì channel’ or another combination that fits what they read and see?

 

<De humani corporis fabrica, Andreas Vesalius, 1543, Basel>

As an aside:

The word 腦 [nǎo] in Chinese has the same definition as ‘brain’ – like many other anatomical words that were invented in different cultures without intercultural exchange. Think of ‘blood’, ‘heart’, ‘little toe’, ‘nose’, etcetera – all very straightforward terms, because they mean the same for everyone in all cultures and times.

Such questions occupied my brain when I was thinking about what my colleague brought forward, and they motivated me to search for references. And guess what? I found (at least part of) an answer to this intriguing issue that could make it even more intriguing. I have tried to summarize the story.

 

The history

The concept ‘nerve’ was first translated into Chinese by Johann Schreck (1576-1630), a member of the Society of Jesus who, before he sailed to China as a Jesuit missionary, had an impressive reputation in European courts as a gifted healer. Working with a Chinese scribe, he prepared a translation into Chinese of a Latin text in two parts, namely on anatomy & physiology and on perception, sensation, & movement (by Caspar Bauhin, first published in 1597 in Basel).

 

<Theatrum Anatomicum, C. Bauhin, 1605, Frankfurt>

After Schreck had served the Chinese rulers with his knowledge of astronomy (medicine and medical translation were private occupations) for a while he died, and Adam Schall (1592-1666), who had traveled on the same boat as Schreck, found a Chinese scholar, Bi Gongchen, whom Schall asked to translate the text into (more polished) literary Chinese. It was published in a single volume together with a text by Matteo Ricci, one year before the collapse of the Ming dynasty (1644).

In the text, entitled ‘Western Views of the Human Body, an Abbreviated Treatise’ (Taixi renshen shuogai ), ‘nerve’ is translated as 細筋 [xìjīn], which literally translates as ‘fine sinew’. The choice for 筋 ‘sinew’ reflects the understanding of nerves in Europe at that time. ‘Nerve’ and ‘sinew’ were, for instance, used interchangeably in early 17th century texts on anatomy. Also, the Latin ‘nervus’ means ‘bow-string, tendon, sinew’.

 

<Taixi renshen shuogai>

In Schreck’s text nervous function is explained by using the concept of 氣 qi circulation. The ‘fine sinews’ contain qi and no blood, and when they are cut, people lose their ability to move, etc.. The book did not give the Chinese much reason to become interested in an alternate method of healing, and the concept of nerves did not take hold in China until much later.

In Wang Qingren’s Yilin gaicuo (‘Corrections of Errors in the Forest of Medicine’), which after publication in 1830 became one of the most widely read medical texts in China (as it still is today), we find no mention of a term for ‘nerve’. Dr. Wang, however, recorded several anatomical notions that were revolutionary for Chinese medicine and in several ways heralded a period of modernization. For our story it is relevant that he presented anatomical ‘proof’ for what Li Shizhen had claimed in the Bencao gangmu, namely that the brain, and not the heart, was the mansion of the original spirit.

 

<Yilin gaicuo, Wang Qingren>

It was Benjamin Hobson (1816-1873), a medical missionary from England, who instigated renewed attention for the concept of nerve in China. With his text ‘A New Theory of the Body’ (Quanti xinlun, published in 1851) he had considerably more influence than Schreck. In the chapter on the brain and the nervous system, he introduced the term 腦氣筋 [nǎoqìjīn], which literally translates as ‘brain – qi – sinew’, that is, the sinew through which brain qi travels.

 

<Quanti xinlun>

Although China was in the middle of a modernization movement, in the beginning of the 20th century, the concept of the nerve was still not easy for the Chinese to digest. Of the twelve different words that had been invented for ‘nerve’ since the beginning of the 17th century, five made it to the shortlist of a terminology committee meeting held in Shanghai in 1916. The purpose of that meeting was to standardize Chinese terms for numerous scientific concepts coming from the West and biomedicine was the most important subject. The term for ‘nerve’ was debated for over two hours before 腦經 ‘brain channel’ or ‘brain tract’ topped 神經 ‘spirit channel’ by eight votes to seven.

Why did it take 300 years for the concept of nerves to take hold in China?

1. It was not particularly relevant for Chinese medicine.

2. It was associated with the Western notion of ‘volition’. The Greek term for ‘motor nerves’ was, translated literally, ‘capable of choosing, purposive’. The action of nerves was inseparable from exercise of will. In the West, volitional action was a crucial defining feature of identity. For the Chinese, who did not hold such a view of identity, the idea of incorporating nerves into medical theory was not attractive.

 

<Theatrum Anatomicum>

The term 神經 came to China via a different route. It was introduced in 1902 as a translation of the Japanese shinkei, which is written with the same characters. In 1774 it was coined by a Japanese doctor trained in Chinese medicine. He came up with the word after studying a post-Vesalian Dutch text on anatomy.

The story of the Japanese doctor resembles that of Wang Qingren. He went to an execution ground to observe the dissection of a cadaver in order to see whether the illustrations in the Dutch text made sense. When he was convinced that they did, he formed a translation group to study and translate the text, and that text is seen as the seed of biomedicine in Japan. He judged that the Dutch term zenuw (nerve) corresponded with keimyako – 經脈 [jīngmài], channels and vessels, and the term zenuw-vogt (nervous fluid), he argued, pointed to shinki – 神氣 [shénqì].

神氣 in Chinese medicine can mean several things: 1. spirit, vigor 2. In the Neijing, ‘spirit qì’ refers to the spirit, channel qì, right qì, the blood, and the yáng qì of the bowels and viscera. < Practical Dictionary of Chinese Medicine>. It is interesting to note that the Dutch word ‘zenuw’ (nerve) is directly related to the English word ‘sinew’.

Combining 神氣 and 經脈, our Japanese doctor-translator formed the neologism shinkei 神經 which consists of the first part of these two terms. Historians have not found evidence that the Chinese of the early 20th century were aware of the history of the term (namely that qì was part of its original full version), and argue that that is one of the reasons they favoured 腦經 [nǎojīng] as translation of ‘nerve’ in 1916.

Another note is that the word 神經 [shénjīng] already existed in classical Chinese as a designation for a genre of esoteric books. The Japanese shinkei 神經 is a new construction, derived from words unrelated to that classical meaning.

In the text mentioned below Hugh Shapiro asks the important question: Why then, did they eventually adopt the term 神經 [shénjīng] for ‘nerve’? According to Shapiro the reason can be found in the fact that thousands of Chinese trained in Japan and came back to China with Japan’s analysis of biomedicine in their luggage – accompanied by the terminology the Japanese used. Biomedicine (a.k.a. Western medicine) rapidly gained ground as part of the movement in China to modernize and catch up with the West. But more importantly, the Chinese were interested in the pathology of the nerves – a thing that was never described by the Jesuits who introduced the anatomy. And the Japanese doctors instructed the Chinese in nerve pathology as they had translated it from biomedicine.

 

<brain dissection, Japan, 18th century>

The concept of nerves as such did not appeal to the Chinese medical professionals (they didn’t really need it) but when they studied the illness neurasthenia as described by the biomedical literature of that time, they connected it to their understanding of depletion. In fact, neurasthenia, in Japanese shinkei shuijaku and Chinese 神經衰弱 [shénjīng shuāiruò], became much more important in China than in the countries where the idea originated but soon was discarded. Also, the foreign idea of ‘nervousness’ became very common in 20th century China.

Shapiro further argues that this can inform us that the Chinese and Western concepts of emotional and corporeal depletion were rather close, and that this is often overlooked when the differences between the two medical systems are discussed.

I might add that the ideas about several pathologies as described by Wang Qingren in connection to his, for China, rather new and revolutionary ideas about the brain and other anatomical parts, have contributed to the development of a more open view in Chinese medicine towards ‘facts’ instead of rigidly adhering to ‘theories’ only.

 

<Utriusque Cosmi …, Robert Fludd, early 17th century>

Literature

– Hugh Shapiro’s contribution in: ‘Medicine Across Cultures: History and Practice of Medicine in Non-Western Cultures’, a collection of essays edited by Helaine Selin (Kluwer Academic Publishers, 2003)

– Bridie Andrews’ Introduction in Yi Lin Gai Cuo – Correcting the Errors in the Forest of Medicine, and the chapter ‘On Brain Marrow’ in that book (published by Blue Poppy Press, 2007)

see also:

– Marta Hanson’s keynote lecture: Jesuits and Medicine in the Kangxi Court (1662-1722).

 

Why I Treasure the “Divine Farmer’s Classic of Materia Medica”

This blog is derived from the introductory material in my translation of the Shén Nóng Běncǎo Jīng 神農本草經, published last year by Happy Goat Productions. For more information on this book, see the listing in my online store here. This summary was compiled in preparation for the annual conference of the Shen Nong Society, which will be held in March 24, 2018 in New York City and where I will be a keynote speaker. See here for more information. The lovely illustrations of medicinals here were created by Maria Hicks, MSOM, LAc for inclusion in my published translation of the Shén Nóng Běncǎo Jīng. Please visit Maria’s website here for more information.

 

Shen Nong, by Guo Xu (1503)

Shen Nong, by Guo Xu (1503)

 

It is not just because I am also a farmer with dirt under my nails that the “Divine Farmer’s Classic of Materia Medica” (Shén Nóng Běncǎo Jīng 神農本草經) has always been one of my favorite books. As a critical historian and teacher of classical Chinese medicine, I firmly believe this little book to be one of the most important, foundational texts of this medicine that I love so dearly and have dedicated my life to. For this reason, I produced a bilingual literal translation of this text last year and continue to promote this text and its teachings to anybody who will listen. Whether you are a practicing physician or pharmacist, a fellow “herb head” and plant lover, a historian of early Chinese culture and natural science, or just curious about one of the most ancient texts from early Chinese literature, you may enjoy listening to what the Divine Farmer has to say.

One reason for the importance of this text is obviously the ancient origin of the knowledge contained therein and its association with Shén Nóng, a name that translates literally as “Divine Farmer.” This ancient semi-mythological culture hero of Chinese civilization has been celebrated for thousands of years in China for the invention of agriculture, among many other achievements. A text from the second century BCE called Huáinánzǐ 淮南子 recounts the following legend:

Longdan, drawing by Maria Hicks

Longdan, drawing by Maria Hicks

In ancient times, the people subsisted on grasses to eat and water to drink, picked fruits and nuts from the trees and ate the meat of snails and clams. They frequently fell ill due to being injured by poisoning. For this reason the Divine Farmer began to teach the people how to sow and cultivate the Five Grains and assess the suitability of land and soil for dryness and moistness, fertile or rocky ground, and high or low elevation. He tasted the flavors of the hundred herbs and sweetness and bitterness of the water in their springs, letting the people know what places to avoid and what places to draw near to. During this time, he encountered seventy poisons in a single day… 
古者,民茹草飲水,采樹木之實,食蠃蠬之肉。時多疾病毒傷之害,於是神農乃始教民播種五穀,相土地宜,燥濕肥墝高下,嘗百草之滋味,水泉之甘苦,令民知所辟就。當此之時,一日而遇七十毒。

In addition to his association with agriculture, bibliographic records and citations from the Han dynasty on connect Shén Nóng’s name to titles on the subject of “nurturing life”  (yǎng shēng 養生), or in other words, the prevention of illness and preservation and optimization of health for the purpose of prolonging one’s lifespan or even attaining immortality by transcending the limitations of the mortal body.  The content as well as the value judgments inherent in the categorization of medicinals in this text will show the astute reader the significance of this association with a tradition not primarily concerned with treating illness but with preventing it and with promoting longevity or even immortality instead. It is no coincidence either that the single other key figure associated with the text, namely the historical figure Táo Hóngjǐng 陶弘景 (see below), is better known in Chinese history as the founder of the Shàngqīng 上清 (“Supreme Clarity”) school of Daoism. His biography aptly depicts him as a hermit who specialized in academic, religious, and alchemical research into methods of transcending the limitations of the natural human body by transforming it into a refined immortal existence, similar to the emergence of a butterfly from the chrysalis.

Gancao, linoleum print by Maria Hicks

Gancao, linoleum print by Maria Hicks

“Materia medica” is the standard English translation for the Chinese term běncǎo 本草 (“roots and grasses”), which denotes a category of literature that has a long and illustrious, if somewhat overwhelming, history in Chinese medicine. The trusted catalogue of Chinese medical literature Zhōngguó Yī Jí Kǎo 中國醫籍考 (“Investigation of Chinese Medical Literature”), published in 1819 by the Japanese scholar Tanba no Mototane, lists no fewer than 2,605 titles in this category, a number that does not include the subsequent category of shízhì 食治 (“Materia Dietetica”)!  In this catalogue, the title Shén Nóng Běncǎo Jīng (“Divine Farmer’s Classic of Materia Medica”) appears as the first book in the category of běncǎo 本草. Although recorded as a text in three volumes in the bibliography of the Sui 隨 dynasty (581-618 CE), the original, if we can even speak of a single source at all, has unfortunately not survived. Due to later scholars’ respect for the information contained in this work, however, we have countless copies of the preface and the text of the individual entries, as quoted in the major materia medica literature from classical times on. With some minor disagreements on the placement and order of individual substances in one or the other of the three categories, scholars agree that the original text contained descriptions of 365 medicinal substances, classified into the three categories of “upper,” “middle,” and “lower” in accordance with their effect on the human body and their association with Heaven, Humanity, and Earth, respectively. The preservation of this treasure trove of early Chinese knowledge about the natural world may be due mostly to the efforts of one of the earliest and most illustrious proponents of this text: the above-mentioned scholar, author, and Daoist practitioner Táo Hóngjǐng 陶弘景 (452-536), style name Yǐn Jū 隱居 (“Living in Hiding”). 

As Táo’s preface to the text shows, it was already obvious to scholars in the early sixth century that the information contained in the various materia medica texts associated with the Divine Farmer did not come directly from his pen but had been expanded on in the process of oral transmission over several thousand years: 

Cheqianzi, drawing by Maria Hicks

Cheqianzi, drawing by Maria Hicks

The old explanations all refer to a “Divine Farmer’s Classic of Materia Medica.” I consider this to be reliable. In the past, in his rule of Under Heaven, the Divine Farmer drew the trigrams of the “Classic of Changes” to provide access to the dispositions of the supernatural entities; set up the plowing and planting of fields to save people from death from terminal injuries; and promulgated [information on] medicinals and the curing of illnesses, to rescue from the fate of premature loss of life and injuries. These three Teachings (lit. “Dao”) were [then] enriched and illuminated by passing through large numbers of sages. King Wén and Confucius added judgments, images, and commentaries, acclaiming humanity and heaven through obscurity. Hòu Jì and Yī Yǐn disseminated the Hundred Grains, bestowing their benevolence on all living people. Qí Bó, Huángdì, Péngzǔ, and Biǎn Qùe provided guidance and support with great fervor. In this way, the [Divine Farmer’s] beneficence has circulated and remained alive. And even though three thousand years have gone by, the people still rely on it to this day!
Nevertheless, before the time of the Yellow Emperor, written characters were not yet transmitted and the six lines [from the Classic of Changes] were bequeathed to posterity with finger gestures, while the tasks of sowing and reaping were transmitted by means of pictures…
舊說皆稱《神農本草經》,余以為信然。昔神農氏之王天下也,畫易卦以通鬼神之情;造耕種,以省煞害之弊;宣藥療疾,以拯夭傷之命。此三道者,歷群聖而滋彰。文王、孔子, 彖象繇辭,幽贊人天。后稷、伊芳尹,播厥百谷,惠被生民。岐、皇、彭、扁,振揚輔導,恩 流含氣。並歲逾三千,民到於今賴之。但軒轅以前,文字未傳,如六爻指垂,畫象稼穡。。。

While in pursuit of immortality, alchemical transformation of the body, and transcendence of this mundane world in his hermitage on Mount Máo, Táo Hóngjǐng collated and compiled the materia medica information of his times into first a shorter three-volume, and then a longer seven-volume version of a so-called “Classic of Materia Medica.” Making matters a bit confusing, he titled the first one Shén Nóng Běncǎo Jīng 神農本草經 (“Divine Farmer’s Classic of Materia Medica”) and the second one Běncǎo Jīng Jí Zhù 本草經集註 (“Collected Comments on the Classic of Materia Medica”). Their content overlaps substantially, and these texts have themselves been lost in their original version. Nevertheless, because the text of Táo’s materia medica, regardless of the version, has been quoted and expanded on innumerable times by later authors, it has been possible to reconstruct the original with considerable confidence. 

Baishao, linoleum print by Maria Hicks.

Baishao, linoleum print by Maria Hicks.

In his preface to the “Collected Comments,” Táo mentions that the original information of the text, referred to by its abbreviated title as Běn Jīng 本經 (“Root Classic”), was first written down during the Hàn dynasty in four volumes, one containing general information and the other three containing monographs on medicinal substances in three categories associated with Heaven, Humanity, and Earth respectively. Táo further explains that his work includes an expansion of the original 365 substances by another 365 substances and commentaries by himself and by “famous physicians” (míng yī 名醫) on such topics as alternate names, information on growing, harvesting, preparation, and storage, and medicinal uses, which he set off from the original text by using a different ink color. Táo’s collected commentaries were subsequently published separately under the title Míng Yī Bié Lù 名醫別錄 (“Separate Records by Famous Physicians”). More importantly, however, the text of his original “Classic of Materia Medica” and the commentary by himself and the “Famous Doctors” has been preserved and expanded upon ever since, ensuring not just their survival but their continued preponderance as one of the pivotal texts in the traditional literature of Chinese medicine.

In contemporary Chinese bookstores, editions of the Shén Nóng Běncǎo Jīng are ubiquitous but unfortunately not consistent in regard to the order, numbering, and classification of substances. This does not need to concern the practitioner who is merely looking for information contained in the individual monographs. It can, however, cause serious headaches to critical scholars or translators like myself who are trying to publish a new version of the text. Táo Hóngjǐng himself had already mentioned categorizing the monographs both in the original three tiers of upper, middle, and lower, and in accordance with their natural origin into “precious stones” (yù shí 玉石), “herbs and trees” (cǎo mù 草木), “insects and wild animals” (chóng shòu 蟲獸) and “fruits, vegetables, rice, and grains” (guǒ cài mǐ gǔ 果菜米穀), as most scholars believe he had done in his own edition. Modern English-language editions follow either of these two models and can therefore differ in structure and order of individual entries.

Juhua, drawing by Maria Hicks

Juhua, drawing by Maria Hicks

For the Western reader, a bigger problem than these editorial issues is the translation of many terms that simply do not have accurate direct equivalents in modern English. The character 毒 , for example, is most commonly translated as “toxin” or “toxic,” depending on its grammatical function. Most importantly, it is used in each entry of the text in the phrases wú dú 無毒 or yǒu dú, 有毒, translated as “non-toxic” or “toxic” respectively. For each substance, the text gives information on the “toxicity” right after the categorization into the Five Flavors (wǔ wèi 五味, namely sour, salty, sweet, bitter, and acrid) and Four Qì (sì qì 四氣, often translated as “thermodynamic qualities,” namely cold, hot, cool, and warm). Given the use of this text as a materia medica, in other words, as a collection of information on substances recommended for human consumption for the purpose of improving or preserving health and longevity, we are led to wonder: Why would a full third of this text be classified as “toxic,” namely the so-called “lower” category of medicinals that are associated with earth, identified as “assistants and messengers,” and said to “eliminate the evil qì of cold and heat, break up accumulations and gatherings, and cure diseases”? And then there is the middle category of “vassals” who are “in charge of nurturing the Heavenly nature,” about whom the text warns: “Some of them are toxic and some are not, so deliberate their suitability carefully!” Why would the substances with the highest efficacy, which are actually able to “treat disease” (zhì bìng 治病), be classified as the lowest category, directly contrary to the way in which most modern doctors would rank them?

To cite just one example, the medicinal effect of the substance Qínjiāo 秦艽 (book 2, line 70, Zanthoxylum bungeanum or “Shenxi pepper”), which is classified as toxic, is described in this way: “It treats wind evil qì, warms the center, gets rid of cold-related bì impediment, makes the teeth firm, grows the hair on the head, and brightens the eyes.” These effects certainly make it look like a highly useful substance. More significantly, the text continues: “Consumed over a long period of time, it lightens the body, makes the complexion beautiful, allows you to withstand aging, increases the years, and facilitates the breakthrough of spirit [illumination].” How do we reconcile this description, and the advice on long-term consumption, with its classification as “toxic”? This entry might in fact shed light not only on the meaning of 毒 (“toxic/toxin”), but also on two other phrases of great significance throughout this text: The phrases jiǔ fú 久服 (“consumed over a long time”) and tōng shén 通神, which I have ended up translating with considerable awkwardness as “facilitate the breakthrough of spirit [illumination].” 

Guizhi, linoleum print by Maria Hicks

Guizhi, linoleum print by Maria Hicks

Let us first return to our consideration of the meaning of toxicity in The Divine Farmer’s Classic of Materia Medica. When we look at the categorization of substances as toxic (or the sub-category of slightly toxic) or non-toxic, it becomes clear that our contemporary, whether scientific or popular, meaning of “toxic” does not fit neatly into the ancient Chinese meaning of 毒. For example, why are shíliúhuáng 石硫黃 (sulfur; book 2, line 96) and Máfén (hemp seed; book 2, line 95) categorized as “toxic” when Dānshā (cinnabar, a.k.a. mercuric sulfide; vol. 1, line 90) and Féngzǐ (wasp, Vol. 1, line 118) are said to be “non-toxic”? For an answer, we need to recall the primary intention and authorship and audience of the information contained in this text. Today, the Divine Farmer’s Classic of Materia Medica is considered one of the most important classics in Chinese Medicine and is therefore treasured deeply by students and practitioners of this form of medicine. For many centuries, physicians have found insights in this text into the medicinal effect of substances for human consumption, to support their practice of treating disease and alleviating their patients’ suffering. Nevertheless, we must never forget that our modern understanding of the scope and goals of “medicine” or of “materia medica” was very different from the early notions of 醫 (“medicine”) and of běncǎo 本草 (lit. “roots and grasses”). As expressed in most classical medical literature in one form or another, the creators of the early Chinese classics, for example, idealized the approach of “treating disease before it arises” (zhì wéi bìng 治未病). Even more drastically, many if not most of the leading researchers of natural science in early and medieval China were actively engaged in efforts to physically and spiritually transform their natural body and transcend the limitations of its mortal human form (xíng 形), to avoid or transform death and turn into spirit immortals (xiān 仙). We must never forget this alchemical background, which differs so greatly from our own intentions for the use of “medicinal” substances.

From this perspective, the character 毒 “toxin/toxic” takes on a different meaning. Looking at its etymology, it is a combination of the two characters 生 shēng (“life”), or 草 cǎo (“grass”) over 毋 (“do not!”), aptly paraphrased by the famous Swedish linguist Bernhard Karlgren as “forbidden herbs.” Early variations of the graph include the characters 刀 dāo (“knife”) or 虫 chóng (“insect”), both things that are associated with harming people. So in other contexts, the character can safely be equated with the English term “toxin,” which is why I have chosen to do so here as well. The issue, in other words, is not that the Chinese character 毒 means something different from the English word “toxin,” but that it carries a specific meaning here that we must keep in mind. I used to explain it as “medicinal efficacy” in the context of this book, but such an explanation only works if we are clear on the different meaning of “medicinal” in the early texts: Yes, treating disease was one desired outcome of using natural substances, but the actual transformation of the physical body, which in cases like the long-term consumption of cinnabar and other minerals might involve inflicting real and permanent harm on it, was a higher and more important goal, associated with the connection to Heaven. 

The long-term consumption of substances aimed at the gradual alchemical transformation of the physiological body is therefore an essential aspect of the information presented in The Divine Farmer’s Classic of Materia Medica. The reader can gain a better understanding of the specific goals of this alchemical transformation by looking at the effects of substances described after the phrase jiǔ fú 久服 (“consumed over a long time”). The most important effects are related to three actions: lightening the body (qīng shén 輕身), staving off aging (or extending the years or some variation thereof, nài lǎo yán niān  耐老延年), and, the most difficult phrase to translate in the entire book, “facilitate the breakthrough of spirit [illumination] (tōng shén 通神). The goal of preventing or reversing aging requires no more explanation here. Similarly, “lightening the body” is an effect that the reader can experience on a personal level. In my mind, I read it literally, in the sense that the body feels light and airy, instead of being weighted down in such a way that it requires effort to keep it upright or move limbs. 

Baizhi, drawing by Maria Hicks

Baizhi, drawing by Maria Hicks

Resolving the conundrum of translating the expression tōng shén 通神, or its common relative tōng shénmíng 通神明, proves much harder. I have changed my translation dozens of times, from the awfully prosaic “unclog the spirit” to the unclear “connect [the body’s?] spirit/s with [Heaven’s brightness?],” to my current choice, “facilitate the breakthrough of spirit [illumination].” There are almost as many possibilities for interpreting and translating this phrase as there are readers and translators. Neither tōng 通 nor shén 神 are characters that are easily translatable into any modern language. In the case of shén 神, the English “spirit” or “Spirit” may express the connection to Heavenly Spirit, or to spirit in the sense of a person’s vitality or esprit, but it leaves out the plurality of “spirits” that inhabit the human body, surround it in the natural environment, and connect it upwards with Heaven. Those of you who practice Chinese medicine or any of the Chinese arts of self-cultivation know that shén is just shén, and that “spirit,” whether in the singular or plural, is indeed a questionable and uneasy English rendition of one of the most important concepts in Chinese culture. Etymologically, you could perhaps explain it as the act of “stretching upward toward something sacred,” a place or entity that most people associate with the Chinese concept of “Heaven.” 

Concerning the character tōng 通, it implies the idea of connecting, of penetrating through something all the way to the end, of unclogging, as in the medical action of tōng jīng 通經, of unclogging the channels, or the menstrual period, by removing obstructions, of restoring free flow. Again, this is perhaps a concept that is more easily grasped by experiencing the effect of this action on the human body in person. In the oldest Chinese dictionary Shuō Wén Jiě Zì 說文解字, the character 通 is defined as 達, “to reach.” In addition, the classical meanings of the character include notions like “to pervade,” “to comprehend,” “to move forcefully,” and “to communicate and interact.” In my mind, especially in the phrase tōng shénmíng 通神明 (“facilitate the break-through of spirit illumination”), the medicinal substance that is said to have this effect allows the light of the spirit or spirits to shine through, to illuminate the farthest reaches of “Under Heaven” like the supercharged beam of a magical flashlight. Ultimately, this phrase may just be impossible to express in a modern Western language but can only be grasped on a non-rational level, because it is beyond the limitations of our linguistic capacities. 
In conclusion, I hope that you enjoy pondering these sorts of conundrums as much as I do and that this text invites you to ponder a few new ones.

“Be patient towards all that is unresolved in your heart and try to love the questions themselves… Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.”    (Rainer Maria Rilke, Letters to a Young Poet)

 

Mutiny Bay (Whidbey Island) on Dec. 25, 2017

Mutiny Bay (Whidbey Island) on Dec. 25, 2017

 

Cytotoxicity and inhibition of leukemic cell proliferation by sesquiterpenes from rhizomes of Mah-Lueang (Curcuma cf. viridiflora Roxb.).

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Cytotoxicity and inhibition of leukemic cell proliferation by sesquiterpenes from rhizomes of Mah-Lueang (Curcuma cf. viridiflora Roxb.).

Bioorg Med Chem Lett. 2017 Dec 13;:

Authors: Anuchapreeda S, Khumpirapang N, Rupitiwiriya K, Tho-Iam L, Saiai A, Okonogi S, Usuki T

Abstract
Curcuma cf. viridiflora Roxb., also known as Mah-Lueang in Thai, belongs to the Zingiberaceae family and is grown from rhizomes. The rhizome of the plant has been used for medicinal purposes, in particular, to treat paralysis in Thai traditional medicine. However, no biologically active compounds have been reported from Mah-Lueang yet. In this study, natural compounds were isolated from Mah-Lueang and structurally determined by spectroscopic methods, including electrospray ionization mass spectrometry and nuclear magnetic resonance. The four isolated compounds were identified as furanodiene (1), dehydrocurdione (2), germacrone-4,5-epoxide (3), and zedoarondiol (4). These sesquiterpenes were investigated for antileukemic activities against KG1a and Molt4 cells. Leukemic cell proliferation is regulated by the Wilms’ tumor 1 (WT1) transcription factor. Compound 1 showed the strongest cytotoxicity against both KG1a and Molt4 cells. Noncytotoxic concentrations (20% inhibitory concentration values) of all compounds were able to decrease the WT1 protein expression and total cell numbers in both cell lines. The four compounds showed good inhibitory activities for WT1 protein expression. Compounds 3 and 4 showed excellent antileukemic activities for both cell lines. In summary, four sesquiterpene compounds with antileukemic activities against the KG1a and Molt4 cell lines were identified in Mah-Lueang extracts.

PMID: 29274817 [PubMed – as supplied by publisher]

Curcuma comosa reduces visceral adipose tissue and improves dyslipidemia in ovariectomized rats.

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Curcuma comosa reduces visceral adipose tissue and improves dyslipidemia in ovariectomized rats.

J Ethnopharmacol. 2017 Dec 19;:

Authors: Sutjarit N, Sueajai J, Boonmuen N, Sornkaew N, Suksamrarn A, Tuchinda P, Zhu W, Weerachayaphorn J, Piyachaturawat P

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Curcuma comosa Roxb. (C. comosa) or Wan chak motluk Zingiberaceae family, is widely used in Thai traditional medicine for treatment of gynecological problems as well as relief of postmenopausal symptoms. Since C. comosa contains phytoestrogen and causes lipid lowering effect by an unknown mechanism, we investigated its effect on adiposity and lipid metabolism in estrogen-deprived rats.
MATERIALS AND METHODS: Adult female rats were ovariectomized (OVX) and received daily doses of either a phytoestrogen from C. comosa [(3R)-1, 7-diphenyl-(4E, 6E)-4, 6-heptadien-3-ol; DPHD], C. comosa extract, or estrogen (17β-estradiol; E2) for 12 weeks. Adipose tissue mass, serum levels of lipids and adipokines were determined. In addition, genes and proteins involved in lipid synthesis and fatty acid oxidation in visceral adipose tissue were analyzed.
RESULTS: Ovariectomy for 12 weeks elevated level of serum lipids and increased visceral fat mass and adipocyte size. These alterations were accompanied with the up-regulation of lipogenic mRNA and protein expressions including LXR-α, SREBP1c and their downstream targets. OVX rats showed decrease in proteins involved in fatty acid oxidation including AMPK-α and PPAR-α in adipose tissue, as well as alteration of adipokines; leptin and adiponectin. Treatments with E2, DPHD or C. comosa extract in OVX rats prevented an increase in adiposity, down-regulated lipogenic genes and proteins with marked increases in the protein levels of AMPK-α and PPAR-α. These findings indicated that their lipid lowering effects were mediated via the suppression of lipid synthesis in concert with an increase in fatty acid oxidation.
CONCLUSIONS: C. comosa exerts a lipid lowering effect in the estrogen deficient rats through the modulations of lipid synthesis and AMPK-α activity of adipose tissues, supporting the use of this plant for health promotion in the post-menopausal women.

PMID: 29273438 [PubMed – as supplied by publisher]

Human body donation in Thailand: donors at Khon Kaen University.

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Human body donation in Thailand: donors at Khon Kaen University.

Ann Anat. 2017 Dec 20;:

Authors: Techataweewan N, Panthongviriyakul C, Toomsan Y, Mothong W, Kanla P, Chaichun A, Amarttayakong P, Tayles N

Abstract
BACKGROUND: Culture, society and spirituality all contribute to variability in the characteristics of human body donors and donation programmes worldwide. The donors and the body donation programme at Khon Kaen University, northeast Thailand, reflect all these aspects of Thailand, including the status accorded to the donors and the ceremonial acknowledgment of the donors and their families.
METHODS: Data from the programme records and from surveys of samples of currently registering donors and recently received donor bodies are analysed to define the characteristics of both registering and received donors, including motivation, demography, socio-economic status, health, and use of the bodies.
FINDINGS: The body donation programme at Khon Kaen University currently has a very high rate of registration of body donors, with gender and age differences in the patterns of donation. Registrants include more females than males, a long-standing pattern, and are an average age of 50 years.The bodies of 12% of registrants are received after death and include more males than females. Both sexes are of an average age of 69 years. Males had registered their donation eight years prior to death and females ten years prior. Current registrants identified altruistic motives for their decision to donate, although the coincidence of body donation by a highly revered monk with a surge in donations in 2015 suggests that Buddhism plays a primary role in motivation. The opportunity to make merit for donors and their families, and respect shown to donors and the nature of the ceremonies acknowledging the donorsand their families, including the use of the Royal Flame at the cremation ceremony, all contribute to decisions to donate.
CONCLUSIONS: The characteristics of body donors and the body donation programme at Khon Kaen University are reflective of Thai society and the centrality of Buddhism to Thai culture.

PMID: 29274383 [PubMed – as supplied by publisher]

Medicinal plants used for hypertension treatment by folk healers in Songkhla province, Thailand.

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Medicinal plants used for hypertension treatment by folk healers in Songkhla province, Thailand.

J Ethnopharmacol. 2017 Dec 08;214:58-70

Authors: Neamsuvan O, Komonhiran P, Boonming K

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Hypertension is the most dominant risk factor for the development of cardiovascular, kidney, and eye diseases. In Thailand, illness and hospitalisation in the modern public health system due to high blood pressure is increasing. However, some Thai people have turned their attention to the use of herbal medicines for healthcare. Therefore, this study aimed (1) to study the folk knowledge of hypertension treatment and (2) to study plant utilisation in the treatment of high blood pressure by Songkhla folk healers.
MATERIALS AND METHODS: Field surveys and semi-structured interviews about theories of disease, principles of healing, and herbal usage (plant species, parts used, preparation, and application methods) were gathered. The data were analysed by descriptive statistics. The literatures regarding medicinal plants used in any traditional medicine, antihypertension activity, and toxicity was reviewed.
RESULTS: Most healers believed that hypertension was caused by the disorder of fire and wind elements in the body. The medicinal plants containing hot and mild tastes, which had the potential for treating problems in the wind element, were applied. A total of 62 species were used for hypertension treatment. Most plants were in the Asteraceae, Piperaceae, Rutaceae, or Zingiberaceae family (4 species each). Herbal medicines were preferred to be prepared by boiling (78%) and consumed by drinking 1 teacup before 3 meals each day (26%). Piper retrofractum and Cleome viscosa had the greatest Frequency of Citation (FC = 6, n = 14). Thirty-seven species have been reported for use in traditional medicine. Twenty-four and 46 species have already been investigated for antihypertension activity and toxicity, respectively.
CONCLUSION: Identifying medicinal plants that have been tested by experienced folk doctors would provide an opportunity for people to choose and consume local herbs that are easy to access in their local area. However, the remaining plants that have not been studied for antihypertension activity and toxicity should be further analysed to confirm their efficacy.

PMID: 29229570 [PubMed – as supplied by publisher]

Ethnomedicinal plant diversity in Thailand.

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Ethnomedicinal plant diversity in Thailand.

J Ethnopharmacol. 2017 Dec 11;214:90-98

Authors: Phumthum M, Srithi K, Inta A, Junsongduang A, Tangjitman K, Pongamornkul W, Trisonthi C, Balslev H

Abstract
ETHNOPHARMACOLOGICAL RELEVANCE: Plants have provided medicine to humans for thousands of years, and in most parts of the world people still use traditional plant-derived medicine. Knowledge related to traditional use provides an important alternative to unavailable or expensive western medicine in many rural communities. At the same time, ethnomedicinal discoveries are valuable for the development of modern medicine. Unfortunately, globalization and urbanization causes the disappearance of much traditional medicinal plant knowledge.
AIM OF THE STUDY: To review available ethnobotanical knowledge about medicinal plants in Thailand and to estimate its diversity.
METHODS: Information about ethnomedicinal uses of plants in Thailand was extracted from 64 scientific reports, books, and theses produced between 1990 and 2014. Plant identifications in the primary sources were updated to currently accepted names following The Plant List website and the species were assigned to family following the Angiosperm Phylogeny Website. Use Values (UV) were calculated to estimate the importance of medicinal plant species (UVs) and families (UVf). Medicinal use categories, plant parts used, preparations of the medicine, and their applications were noted for each use report.
RESULTS: We found 16,789 use reports for 2187 plant species in 206 families. These data came from 19 ethnic groups living in 121 villages throughout Thailand. The health conditions most commonly treated with medicinal plants were in the categories digestive system disorders, infections/infestations, nutritional disorders, muscular-skeletal system disorders, and genitourinary system disorders. Plant families with very high use values were Fabaceae, Asteraceae, Acanthaceae, Lamiaceae, and Zingiberaceae and species with very high use values were Chromolaena odorata (L.) R.M.King & H.Rob., Blumea balsamifera (L.) DC., and Cheilocostus speciosus (J.Koenig) C.D.Specht. Stems and leaves were the most used plant parts, but also other parts of the plants were used in medicinal recipes. The most common way of using the medicinal plants was as a decoction in water.
CONCLUSION: We found 2187 plant species that were used in traditional medicine in Thailand. Of these a few hundred had high use values, suggesting that they may produce bioactive compounds with strong physiological effects.

PMID: 29241674 [PubMed – as supplied by publisher]

How to Summarise the Evidence Base

Earlier this week, a survey of the content of local acupuncturists websites performed by Daniel Ryan, a computer developer, was published in the New Zealand Medical Journal. The article was full of inaccuracies of all shapes and sizes and its successful journey through the peer-review process left many scratching their heads.

As one small example, Ryan writes ‘The UK’s National Institute for Health Care Excellence (NICE) no longer recommends using acupuncture for the treatment of any health conditions.” In reality (where the rest of us live), a number of NICE Guidelines do indeed recommend acupuncture (for instance, this one on the management of tension-type headache).

But what’s more worrying is his response when the errors in his publication were pointed out: “Of course they would say there were mistakes. I’ve backed up all my statements . . .” In the above example, he backed up his statement about what all NICE guidelines recommend by citing one single guideline that does not. Even if you don’t have a research, medical or science background (which, incidentally is a pretty good description of Daniel Ryan), obviously the reference wasn’t a valid or logical way to support the point. If the New Zealand medical journal wants to allow submissions from lay people off the street, they should consider some sort of mentoring program or additional writing support for non-researchers.

To offer a counter-opinion, the media contacted Kate Roberts of Acupuncture NZ, who holds a Masters and is currently undertaking a PhD. She provided a fully referenced and eloquent counter-point to Ryan’s piece. Poor quality and unsubstantiated claims aside, the article sparked some media attention in New Zealand where the consensus is that the lay PseudoSkeptics came out looking, if it’s possible, even sillier than usual.

Skeptics of a Feather

All that said, what’s more interesting is the response of esteemed Yale neurologist and die-hard Skeptic Steven Novella, MD to the publication and how he weighs in on how to evaluate ‘what the evidence says’ about an intervention, in this case, acupuncture. Amazingly, he seems to defend Ryan’s shoddy attempt at scholarship, demonstrating that he will pretty much support literally anything that agrees with his views on acupuncture.

In his response to the NZ Acupuncture Website-aganza, he accuses Roberts, of ‘mischaracterizing’ the medical literature when she points out that as a whole, the clinical research supports the use of acupuncture for a wide variety of conditions. In contrast to her ‘distortion’ of the literature, he offers some lessons in how to provide a thorough, unbiased and accurate review of the clinical and scientific evidence for acupuncture.

So how do you accurately characterize the scientific literature for an intervention, according to the ‘science-based’ way of doing things? On what basis can Dr Novella demonstrate that Kate Roberts is ‘simply wrong’ about what the medical literature says? Here are the steps.

1) The science-based ‘because I said so’ gambit

Novella starts out teaching us about the acupuncture literature thusly: “A science-based review of acupuncture finds that the claims made for it are highly implausible and there is no single indication for which there is robust evidence of efficacy.” Well, that’s the end of it, eh? I guess we can all go home now, a ‘science-based review of acupuncture’ says that acupuncture definitely doesn’t work.

Curious as to how I had missed such a definitive evidence-based debunking and clicking on the link to the review in question, I’m actually taken to a reprint of an opinion piece written by Steven Novella himself and co-authored by David Colquhoun. Well, that’s funny, I wonder how Dr Novella could confuse an essay he wrote about his own opinion with a piece of independent, high-quality, science-based scholarship? It’s almost as if Dr Novella thinks his op-ed piece is actually a ‘science-based review.’

So let’s take a little segue into the misleading use of the word ‘review’ to make something sound objectively scientific that really isn’t. There are systematic reviews (like the ones we will touch on in a moment) that give very little leeway into what is included in order to arrive at a roughly accurate picture of what the literature shows about a particular clinical area. Then there are non-systematic or ‘narrative reviews,’ and these too should have some modicum of rigour (a textbook might be considered an example) but do allow for cherry-picking.

Novella’s anti-acupuncture Op-Ed piece (appearing alongside a pro-acupuncture opinion piece, which for some reason Novella never mentions) can hardly even be described as a narrative review. It can only be considered a ‘scientific review’ in the same way my nephew’s Christmas list can be considered a ‘scientific review’ on his opinion of what he’d like Santa to bring him. There are no rigorous or objective criteria for what is included and no a priori methods. It’s tantamount to an essay about the author’s feelings on the subject which is fine, but ‘science-based review of acupuncture’ it certainly is not. It’s actually a little bit incredible that Novella still references this essay, where he rests his entire argument on excluding the entirety of the basic science literature into acupuncture’s mechanisms before cherry-picking a couple of studies and then concluding that acupuncture only works a little.

2) Do a ‘random search of Pubmed, use ‘what comes up’ to make generalizations about the literature

Novella’s next step in ‘fairly and rigorously’ evaluating the clinical evidence of acupuncture is to take a ‘random’ stroll down Pubmed where, to everyone’s total amazement, he finds some systematic reviews of acupuncture that are negative. (Gasp!) This is the type of exercise that non-researchers who agree with the point the author is making love but will leave actual researchers cringing. There’s probably a reason why I’ve never seen the methods section of a systematic review start out by saying ‘we decided to pop on over to Pubmed and do a little looky-loo and, by gosh, wouldn’t you know! The first bunch of studies that we happened to look at agreed with our hypothesis. <Mic drop>’

Of course, when I just did a ‘random’ search of Pubmed for systematic reviews of acupuncture, the first reviews were positive. But of course, like Dr Novella’s odd and fairly ironic exercise into lit review, this doesn’t tell us what the literature as a whole shows. And while Dr Novella indicates that he understands that this sort of ‘search’ is complete bologna, it doesn’t stop him with wasting our time with it rather than looking at actual high-quality reviews of the literature as a whole.

So, what evidence does Kate Robert and other researchers use to support the position that acupuncture is backed by clinical evidence?

According to Steven Novella, ‘acupuncture does not work.’ This is scientific fact based on an opinion piece that Novella wrote in 2013, which he amazingly agrees with, and a quick search on Pubmed. Unbiased, rigorous scientific review at its finest.

But Kate Roberts, myself and others (NICE, the NIH, the Royal College of Obstetrics and Gynaecologists, the Cleveland Clinic, Harvard . . .) claim that as a whole, the clinical literature of acupuncture supports its use for a variety of conditions.

Novella muses: “I won’t speculate about the honesty of proponents like Roberts – I don’t know what she really believes, but that does not really matter. It is possible that she simply has a very different idea of what constitutes scientific evidence than I do. I (sic) my experience when a proponent of alternative medicine claims that a treatment is evidence-based or backed by science they mean that there is some study somewhere that was positive.”

So what is Roberts basing her position on? A single study? Well, fortunately, Kate, who holds a Masters of Science and is currently undertaking a PhD, told us what she was basing the interview that Novella is referencing. She based her assertions about what the clinical evidence for acupuncture shows, not on an essay she wrote about her own opinion or a ‘random’ search of Pubmed, like Novella suggests we do, but on the most recent review of all systematic reviews for acupuncture to date.

The review, conducted this past January by Stephen Janz, who holds a Masters in Public Health and Dr John McDonald, PhD, “draws on two prior comprehensive literature reviews, one conducted for the Australian Department of Veterans’ Affairs (DVA) in 2010 and another conducted for the United States Department of Veterans Affairs (USVA) in 2013. The research identified by these reviews was pooled, then a search of further literature from 2013 to 2016 was conducted. Trials were assessed using the National Health and Medical Research Council (NHMRC) levels of evidence, with risk of bias assessed using the Cochrane GRADE system. Results have been tabulated to indicate not just the current state of the evidence, but to indicate how the quality and quantity of evidence has changed from 2005 to 2016. In this review, 122 conditions across 14 broad clinical areas were identified and, of these, only five conditions found ‘no evidence of effect’ for acupuncture. The level of evidence was found by this review to have increased for 24 conditions.” 1

Parting thoughts

Why Dr Novella would omit a recent review of all systematic reviews of acupuncture from a discussion of what the evidence shows, never mind fail to mention that this (amongst other publications) is what Mrs Roberts supported her assertions, is unclear. Perhaps it’s for a similar reason as to why his opinion piece omits all basic science literature on how acupuncture works before pretending to attempt a discussion of the evidence. If we weren’t talking about misinforming the public about a treatment that’s more effective and safer than what’s routinely offered to them, one could even try to find some humour in it.

Novella leaves us with this thought: “We are left with a situation in which acupuncture proponents claim that acupuncture works for a long list of medical indications, and claiming that this is supported by evidence. Meanwhile the actual evidence, fairly and rigorously evaluated, is negative.”

Yes, acupuncture proponents, as well as dozens of independently conducted biomedical guidelines and the top medical institutions in the world, find that the scientific evidence as a whole does indeed support its use for a growing number of conditions, based on the best available published evidence. Meanwhile, ‘the actual evidence’ (by which Novella presumably means his 2013 op-ed piece) ‘fairly and rigorously evaluated’ (by Novella, himself!) ‘is negative.’

Streaming data from a smartphone application: A new approach to mapping health during travel.

Streaming data from a smartphone application: A new approach to mapping health during travel.

Travel Med Infect Dis. 2017 Nov 15;:

Authors: Farnham A, Röösli M, Blanke U, Stone E, Hatz C, Puhan MA

Abstract
BACKGROUND: New research methods offer opportunities to investigate the influence of environment on health during travel. Our study uses data from a smartphone application to describe spatial and environmental patterns in health among travellers.
METHODS: A prospective cohort of travellers to Thailand used a smartphone application during their trips to 1) answer a daily questionnaire about health behaviours and events, and 2) collect streaming data on environment, itinerary, and weather. Incidence of health events was described by region and trip type. The relationship between environmental factors and health events was modelled using a logistic mixed model.
RESULTS: The 75/101 (74.3%) travellers that completed the study answered 940 questionnaires, 796 (84.7%) of which were geolocated to Southeast Asia. Accidents occurred to 20.0% of participants and were mainly in the Thai islands, while self-rated “severe” mental health events (21.3%) were centred in Bangkok. The odds of a health event were higher in Chiang Mai (2.34, 95% CI: 1.08, 5.08) and on rainy days (1.86, 95% CI: 1.03, 3.36).
CONCLUSIONS: Distinct patterns in spatial and environmental risk factors emerged in travellers to Thailand. Location based tracking could identify “hotspots” for health problems and update travel advice to target specific risk groups and regions.

PMID: 29155137 [PubMed – as supplied by publisher]

Inhibitory effect of Phlai capsules on skin test responses among allergic rhinitis patients: a randomized, three-way crossover study.

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Inhibitory effect of Phlai capsules on skin test responses among allergic rhinitis patients: a randomized, three-way crossover study.

J Integr Med. 2017 Nov;15(6):462-468

Authors: Tanticharoenwiwat P, Kulalert P, Dechatiwongse Na Ayudhya T, Koontongkaew S, Jiratchariyakul W, Soawakontha R, Booncong P, Poachanukoon O

Abstract
BACKGROUND: Zingiber cassumunar Roxb., commonly known as Phlai in Thai, has been used as a traditional medicine in Thailand for the treatment of various diseases, including inflammation and chronic airway disease.
OBJECTIVE: The purpose of this study was to assess the antihistaminic effect of Phlai on skin testing.
DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: This was a randomized, open-label, three-way crossover study. Twenty allergic rhinitis (AR) patients were enrolled. In randomized sequence, patients received a single dose of Phlai capsules (100 or 200 mg) or loratadine (10 mg) with a washout period of 1 week between each treatment.
MAIN OUTCOME MEASURES: Skin prick testing for histamine and common aeroallergen (house dust mite) were performed before treatment and after 1, 2, 3, 4, 6, 8, 12 and 24 hours of treatment. The main treatment outcomes were the mean wheal and flare responses to the skin prick test after treatment.
RESULTS: Both 100 mg and 200 mg Phlai doses suppressed wheal and flare responses to house dust mite allergen, but only 200 mg of Phlai capsules significantly suppressed wheal and flare responses to histamine. Repeated measures analysis of variance showed that loratadine caused more wheal and flare suppression than Phlai capsules in responses to the histamine skin prick test. However, there were no significant differences among the effects of 100 mg Phlai capsules, 200 mg Phlai capsules and loratadine in suppression of wheal and flare induced by the mite skin prick test. Both doses of Phlai were well-tolerated with no adverse events.
CONCLUSION: Both 100 mg (compound D 4 mg) and 200 mg (compound D 8 mg) Phlai capsules, when taken as a single therapeutic dose, inhibited skin reactivity to histamine and mite skin prick tests in AR patients.
TRIAL REGISTRATION: Thai clinical trial registry (TCTR20160510001).

PMID: 29103416 [PubMed – in process]