July 13, 2001
Kenneth Kwong never expected to dabble in ancient Chinese medicine.
A physicist at Massachusetts General Hospital, Kwong developed a revolutionary technology that gave scientists live views of the brain in action, opening new horizons in the study of memories, language and even the lure of cocaine.
Lately, however, Kwong also uses the machine, called functional MRI, to study acupuncture, a 2,500-year-old Chinese medical practice that tends to get little respect in places like Mass General’s plush research center in Charlestown. Traditional acupuncturists believe they are regulating the flow of a life-energy called Qi through mysterious channels in the body called ‘ ‘ meridians,” but Kwong wanted a more scientific explanation.
ÒI personally thought it was kind of a long shot, but you never know,” Kwong said.
He ended up discovering that acupuncture slows metabolism in an area of the brain that is active at times of anger or fear.
After years of watching patients turn in growing numbers to so-called Òalternative medicine,” a growing number of researchers are giving herbs, acupuncture and other ancient healing arts a much closer look. Researchers from Boston to Beijing are using the tools and vocabulary of Harvard Medical School to test herbal remedies and an array of other treatments long viewed by scientific medicine as mystical and unproven – and hoping that honest exchange will bridge some formidable communication gaps between traditions that take completely different views of illness, the body and the role of medicine.
The National Institutes of Health has a $92 million budget this year, up from $2 million in 1992, to study alternative remedies: gingko biloba to prevent Alzheimer’s disease, yoga for insomnia, massage for lower back pain. State universities from Maryland to California have set up research centers on the topic, and Harvard this year followed suit with a $10 million institute for what it prefers to call Òcomplementary and integrative medical therapies.”
In one local study, at Mass General’s main campus in Boston, researchers are trying to cure high blood pressure with acupuncture. With 180 patients, $1.4 million in federal funding, and all the strictures of scientific research methodology, the study asks whether the treatment works – and whether it works better when it includes traditional Chinese diagnoses such as Òliver fire rising.”
Collectively, the researchers hope to sort out which work, which are harmful and which could lead to new insights into microbiology, physiology and drug development. They are also playing catch-up with the American public, which spent roughly $27 billion on alternative dietary products and medical treatments last year, most of it out of pocket, and mostly without consulting their physicians, according to Dr. David Eisenberg, who heads Harvard’s new center and was one of the first U.S. medical students to study in China in the 1970s.
Meanwhile, some practitioners of traditional Chinese medicine – perhaps the most developed form of alternative medicine – are welcoming the scrutiny as a chance to prove how much they have to offer. They note that their techniques are based on thousands of years of recorded case histories and are practiced alongside conventional medicine in Chinese hospitals. At a recent conference on the U.S. and Chinese medical systems, Eisenberg was mobbed by Chinese scientists offering business cards and eager to team up with him.
ÒWe want to join the modern scientific world, and to convince the modern medical arena to accept this service,” said Keji Chen, a leading authority on integrating Eastern and Western medicine and a professor at the Chinese Academy of Traditional Medicine in Beijing.
The encounter is still a sometimes uneasy one – something that was on display in June when 600 Chinese health care professionals descended on Cambridge to exchange ideas with local researchers at the conference, run by Harvard Medical International and held at the Massachusetts Institute of Technology.
Some traditional practitioners were wary of the new attention from academic medicine, fearing that conventional doctors simply want to debunk the competition, or cash in on it. Scientists from both countries fretted that, by definition, Chinese medicine is hard to test. Scientific trials depend on standardized doses of medication. In traditional Chinese medicine, a different herbal mixture is made for every patient. Western medicine looks at discrete ailments and tries to fix them. Traditional Chinese medicine tries to restore a sense of balance in one’s relationships to one’s body, to society and to nature. And how do researchers study the placebo effect in a trial of acupuncture, when the patient knows whether they’ve been stuck with a needle or not?
Eisenberg suggested ways to disguise the treatment – for example, there are spring-mounted needles that prick but don’t go as deep as in acupuncture. But others worried more broadly: When the lens of one tradition is aimed at another, can the one being examined come out untarnished? Will Chinese medicine try to adapt and lose its soul?
Eisenberg reassured the crowd by saying, in Mandarin, ÒReal gold does not fear even the hottest fire.Ó The key, he said, is a new generation of researchers who know both cultures, both languages and both styles of medicine. From one side, there is Dr. Qunhao Zhang, trained in China as a traditional doctor, now a postdoctoral fellow at Mass General. From the other, there is Dr. Simin Liu, an internist at Brigham & Women’s Hospital who said he came to listen because his mother told him her traditional remedies work better than his advice.
Some researchers bend over backward to insist they are sober scientists, not enthusiasts looking for data to support their beliefs.
ÒThe purpose is not to prove that all Chinese medicine is right,Ó said Dr. Kathleen Hui, a University of Michigan-trained microbiologist who convinced Kwong, the physicist, to look at acupuncture.
ÒI want to show what is good, what can be improved, what should be discarded,Ó she said, jabbing the air with her hand to indicate good riddance for any method that might turn out to be, in her view, trash. ÒThis wayÓ, she added, Òwe can improve Chinese medicine.Ó
Hui, 76, is so cautious she can barely be persuaded to describe her findings, published last year in Human Brain Mapping. ÒDon’t write ÔSecrets of Acupuncture Revealed,ÕÓ she pleads.
With no grant funding, her team worked for free on Sundays. Kwong, who was raised in Hong Kong but went only to conventional doctors, ran the functional magnetic resonance imaging machine. It photographs slices of the brain, detecting which areas are active by tracking oxygen metabolism. As a subject lay inside the cylinder, acupuncturist ling Liu – whom Hui chose by going undercover as an acupuncture student and finding the best teacher – inserted needles into a commonly used spot, near the thumb joint.
Research on 13 people showed that the parts of the brain affected by conscious sensation are less affected by acupuncture than by a normal pinprick. But what really excited them was that deeper areas of the brain, such as the amygdala, which regulates emotions, decreased their activity during acupuncture. Heightened activity in the amygdala is associated with emotions such as anger and fear.
Hui will say only that the research suggests interesting avenues for research on how acupuncture works. Liu, who describes himself as
I Imore of a partisan,” has a different take: He thinks it will eventually prove the existence of Qi.
Liu wants insurance companies to start covering acupuncture
It works,” he said. ‘ ‘There is no doubt.”
Mass General is working to test that claim. It already uses acupuncture for pain relief. But now, cardiologist Randall Zusman, Qunhao Zhang and others are investigating its effect on blood pressure, in a study funded by the National Institutes of Health.
Zusman was skeptical when he was first approached by Leslie A. Kalish, a specialist in clinical trial design at the New England Research Institute who wanted to set a standard for how to study alternative medicine. ‘ ‘ I’m a pill-pusher,” he said.
But he is impressed with the drop in some patients’ blood pressure – though he won’t know until after the study is over whether they are getting acupuncture or placebo. Patients are randomly assigned to three groups: one gets standardized acupuncture, one gets a placebo version with random needle pricks.
The third gets individualized acupuncture based on a traditional Chinese diagnosis. Practitioners look at patients’ tongues to see if they are “hot” or “cold” and identify problems with organ systems and their relationship to the senses, the weather and other factors. A common diagnosis in patients with high blood pressure is Òliver fire rising,Ó which often correlates to excess anger and stress.
Acupuncture, Chinese diagnosis, and blood pressure evaluation are done by different people, to prevent bias.
Zusman pointed out that lowering cholesterol was only recently proven clinically to improve health – though doctors have been urging it for years. Western and Eastern medicine are more similar than some doctors like to admit, said Nelson Kiang, the Harvard neurobiologist and grandson of a Chinese healer who organized last month’s conference. ‘ ‘You try this and that, and what seems to work, you do.”