TCM Diagnostics Applied to Parasite-Related Disease by Laraine Crampton, M.A.T.C.M., L. Ac. Capstone Advisor: Lawrence J. Ryan, Ph.D. Presented in partial fulfillment of the requirements for the degree Doctor of Acupuncture and Oriental Medicine Yo San University of Traditional Chinese Medicine Los Angeles, California April 2014 TCM and Parasites/Crampton 2 Approval Signatures Page This Capstone Project has been reviewed and approved by: April 30th, 2014 ____________________________________________________________________________ Lawrence J. Ryan, Ph. D. Capstone Project Advisor Date April 30th, 2014 ________________________________________________________________________ Don Lee, L. Ac. Specialty Chair Date April 30th, 2014 ________________________________________________________________________ Andrea Murchison, D.A.O.M., L.Ac. Program Director Date TCM and Parasites/Crampton 3 Abstract Complex, chronic disease affects millions in the United States, imposing a significant cost to the affected individuals and the productivity and economic realities those individuals and their families, workplaces and communities face. There is increasing evidence leading towards the probability that overlooked and undiagnosed parasitic disease is a causal, contributing, or co- existent factor for many of those afflicted by chronic disease. Yet, frustratingly, inadequate diagnostic methods and clever adaptive mechanisms in parasitic organisms mean that even when physicians are looking for parasites, they may not find what is there to be found. Examining the practice of medicine in the United States just over a century ago reveals that fully a third of diagnostic and treatment concerns for leading doctors of the time revolved around parasitic organisms and related disease, and that the population they served was largely located in rural areas. By the year 2000, more than four-fifths of the population had migrated to cities, enjoying the benefits of municipal services, water treatment systems, grocery stores and restaurants. On the surface of things, it might be easy to think that a largely city-based population, separated from some exposures and supported at presumably higher levels of hygienic protection, would be less prone to parasitic illness. The century also saw a shift in attention and training in the medical profession, not only in the U.S. arena of allopathic medicine, but also in contemporary Traditional Chinese Medicine (TCM), such that the majority of practitioners may have little or no training and skills in recognizing the presence of parasitic infection. Ancient classical texts in TCM included an inherited wealth of wisdom in observation and treatment of parasitic disease, but current entry-level TCM education in the U.S., although excellent in many respects, significantly overlooks addressing this public health issue. Unless and until public and professional education catches up on this topic, and more extensive and successful diagnostic TCM and Parasites/Crampton 4 methods are commonly used, there is a gap in health care training on, attention to, and perception of parasite-involved disease. One of the goals for this study was to develop some sense of whether the traditional, natural, diagnostic methods of TCM might bridge this gap by reliably identifying pathognomonic signs of parasitic involvement in disease patterns. A lesser, but still useful, goal, is to establish a historical context for and to shed light on the current patterns of practitioner skills and awareness, as well as education and training given, on parasitic illness. To pursue this information, components of literature review and survey of health care professionals on training and experience in the area have been employed. A retrospective case review of nine individuals affected by parasitic infection provided the opportunity to delve deeply into the information gleaned by TCM diagnostic approaches of health history, questioning, and pulse assessment. Significant obstacles to TCM research processes also became clear through this project, resulting in suggestions for future improvements. TCM and Parasites/Crampton 5 Acknowledgements I might not have chosen this particular research path, were it not for Dr. Robert Doane, L.Ac., and Dr. Tina Chen, L.Ac., who urged me to consult Kevin Cahill, M.D about my own health history. Dr. Cahill, physician, educator and author of many books, including Tropical Medicine: A Clinical Text, is a hero to countless individuals whose health has been restored, and (in many cases) communities strengthened, thanks to Dr. Cahill's diligence, experience and skills in research, diagnosis and treatment of parasite-related illness. Dr. Stuart Garber, DC, PhD, was kind enough to listen to my puzzlings over my research interests, which led to the ‘ah-ha!’ moment of focus and confidence in my topic and research direction, to my lasting gratitude. Dr. Doane and his staff in Poulsbo, WA, provided invaluable assistance in giving me access to case files for this study. Dr. Mao Shing Ni gave me a powerful introduction to natural healing twenty-two years ago. The Ni family commitment to the medicine and education through Yo San University gave me opportunity to pursue valuable training and self-cultivation in Traditional Chinese Medicine. I had the good fortune to meet William Stuppy, M.D., tireless researcher and physician, who kindly made his research available, and answered many questions as I began this study. Lawrence Ryan, Ph.D., and Andrea Murchison, D.A.O.M., and superlative faculty offered much guidance and encouragement to this first Healthy Aging cohort, ensuring that no obstacle of doubt, hesitation or daunting challenge remained obstructive for long. Dr. Lawrence Lau ensured that my time of study in Shanghai, China was not only a terrific learning experience, but also well-guided and enjoyable. Dr. George Lamoureux, LAc, now D.A.O.M., has been a steadfast friend and TCM and Parasites/Crampton 6 encouragement as we had fun (and commiserated as needed) in this doctoral journey. An anonymous benefactor bridged financial chasms that might otherwise have stalled my studies, allowing me to continue the delicate balancing of my private practice with time for teaching and focusing on research and writing. I am in your debt, Anonymous, with much gratitude. Carolyn and Ross Hansen-Arnold, Patty Cogen and Larry Stein, and Patrician McCarthy, your hospitality at key points in my doctoral process provided not just shelter, but joy and conviction as I pursued this goal. Thank you. Not least, I remember my mother, Dorothy, who quietly struggled with complex health issues, but never complained, and never gave up in thinking the best of her children; and my stepfather, Jack, whose last conversations with me in 1996 included his hopes that my studies in Chinese medicine would bring new hope, new healing resources, for him and others facing devastating illness. May my efforts here honor their memory. TCM and Parasites/Crampton 7 Table of Contents Approval Signatures Page ................................................................................................... 2 Abstract ............................................................................................................................... 3 Acknowledgements ............................................................................................................. 5 Chapter 1: Introduction .................................................................................................... 10 Allopathic Perspectives ................................................................................................. 11 Factors and Vectors ....................................................................................................... 12 Examples of these dynamics. .................................................................................... 15 1910-2014: Parasites Losing Visibility in the Western Clinic.................................... 17 Attention to Parasites by TCM Professionals in the West ............................................. 21 Recovering the Whole ................................................................................................... 23 Bilateral Obliviousness to Parasitism ............................................................................ 24 First-hand experience and interest ............................................................................... 24 Terms pertinent to this study .................................................................................... 26 Chapter 2: Review of Literature ........................................................................................ 30 Statement of Research Question/Research Objective .................................................. 30 Development of TCM Approaches to Diagnosis of Disease ...................................... 30 History, East and West, Electronic Abundance and Diplomacy .................................... 31 Overview of Literature Review Process ........................................................................ 32 Evolving Health Care Practice in the U.S., 1900-2000: ............................................. 32 TCM education and training regarding parasitic illness: ........................................... 33 Below the Radar in TCM ........................................................................................... 33 TCM and Parasites/Crampton 8 TCM approaches to diagnosis and treatment of parasitic illness ............................. 34 Science and Western Medicine approaches to parasites ......................................... 36 Science and Western Medicine approaches to identifying and treating parasites .. 37 CDC and NIH Resources ............................................................................................ 39 The Internet, TED, TEDMED, blogs, electronic news sites, newsletters, and more. . 40 Implications for International Relations and Diplomacy. .......................................... 41 Chapter 3: Method ........................................................................................................... 44 Focus of Investigation ............................................................................................... 44 Methods of Approach ............................................................................................... 44 Areas and Populations of Inquiry .............................................................................. 45 Inclusion/Selection Criteria ....................................................................................... 45 Tabulation and statistical analysis: ............................................................................ 47 Chapter 4: Results ............................................................................................................ 49 Survey Results ............................................................................................................... 49 Case Reviews ................................................................................................................. 51 Demographics ........................................................................................................... 51 Complexity of Illness .................................................................................................. 51 Key Indicators Survey ................................................................................................ 51 Pulse Factors ................................................................................................................. 52 Refractory to Care, or Paradoxical Response to Care ............................................... 54 Multiplicity of disease and chronic disease factors .................................................. 54 Health history and risk factors ...................................................................................... 55 TCM and Parasites/Crampton 9 Mood and Resilience ..................................................................................................... 55 Chapter 5: Discussion ...................................................................................................... 57 Summary of Findings .................................................................................................... 57 Implications for Theory ................................................................................................. 58 Implications for Practice ............................................................................................... 58 Limitations of this study ................................................................................................ 59 Diagnostic accuracy and specificity .......................................................................... 59 Scope of Practice Hindrances ........................................................................................ 62 Big Arenas of Application. ......................................................................................... 64 Recommendations for Future Research ....................................................................... 64 Conclusion ......................................................................................................................... 66 References……..…………………………………………………………………………60 Appendix A: Transcript of private e-mail communication…………………………...64 Appendix B: Sample patient survey …………………………………………………66 Appendix C: Extended questions for senior practitioner interviews……………………………..69 Appendix D: List of pathogens ……………………………………………………….73 Appendix E: Alphabetic index of parasitic diseases………………………………….76 Appendix F: Neglected parasitic diseases in the United States………………………81 Appendix G: Pulse factors images…………………………………………………….84 Appendix H: Case Review: Specific Patient Data……...…………………………….86 TCM and Parasites/Crampton 10 Chapter 1: Introduction Complex, chronic disease in the United States takes a tremendous toll on the health of millions of people. This burden also costs greatly to and through those individuals in productivity and economic factors. Our general health care system does a reasonably good job of dealing with acute illness and injury. It excels in addressing conditions requiring surgery, or managing basic chronic conditions by medication. However, for those who have complicated illness, the reality can be more struggle with health care providers than receiving precise, curative, answers. All too often, individuals suffering multiple, persistent, symptoms that do not fit common disease templates run into more trouble: they hear from their physicians pronouncements that translate perilously close to 'it's all in your head', or, 'you must be doing something wrong.' There are factors in complex chronic disease in the United States that have, for quite some time, either been overlooked or misinterpreted. Among them are a wide array of symptoms and disease patterns that arise from two broad categories: ○ the presence of undiagnosed sub-acute and/or chronic parasitic infection ○ the role of any stage of parasitic infection in silently complicating co-existing or pre-existing disease. This diagnostic gap exists in part because of low levels of awareness, among contemporary health-care professionals, of the incidence and manifestations of parasite infection in the U.S. population. Attention to and education about parasitic infection in contemporary U.S. medical schools is limited, whether institutions representing the medicines of west or east. This lack of