Natural Medicine for Your Mood Dr. Peter Sheng
Medical Director, Integra5ve Health & Medicine
Peter Sheng, MD • Dr. Sheng provides integra5ve medicine, combining tradi5onal Chinese medicine with conven5onal Western medical care, including acupuncture.
• His integra5ve care is backed by 20 years of experience as a board-‐cer5fied physician in internal medicine and oncology. He has helped many pa5ents survive life-‐threatening illnesses, overcome severe pain and manage chronic diseases. And he has helped them live beJer in the process.
POTUS: A Stable Genius
• Lee BX, ed. The dangerous case of Donald Trump: 27 psychiatrists and mental health experts assess a president. New York: St. Mar5n’s Press, 2017.
• Dr. Jeffrey Lieberman: Psychiatrists diagnosing the president-‐-‐-‐moral obliga5on or ethical viola5on leJer to the editor NEJM Dec 17, 2017
Psychiatry is a vulnerable profession Too many missteps in the past Formal diagnosis requires examina5on, blood tests, imaging
Psychiatry: a Vulnerable Profession human mind non-palpable • How do we diagnose mental disorders? • Evolu5on of psychiatry: DSM-‐V (I to V) diagnos5c sta5s5cal manual
• Are blood tests valid? Neuroimaging study? • Room for improvement? sure • The era of neurotransmiJers: oversimplified? dopamine, epinephrine, norepinephrine, acetylcholine serotonin, GABA, endorphine/opioids, melatonin-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐etc Dr. Jeffrey Lieberman The untold story of psychiatry
Neurotransmitters: Excitatory & Inhibitory
• Epinephrine: fight or flight • Norepinephrine: focus, alertness • Serotonin: mood • Dopamine: regula5ng motor, reward system, mo5va5on
• Acetylcholine: memory • GABA: inhibitory, seda5ve • Glutamate: excita5on
More Than Just Neurotransmitters
• Human emo5ons very complicated • Many chemicals interac5ng with one another • Neuron circuitry/ac5on poten5al • Gene5cs: extra or fewer gene copies • Medica5ons may not make it just right I am not against use of meds, just not too much or too long medica5ons may overdo it-‐-‐-‐side effects
How Do We Diagnose Depression?
The Stigmata
• We need our families and friends to understand that the 100 million Americans suffering with mental illness are not lost souls or lost causes. We are capable of gecng beJer, being happy, and building rewarding rela5onship. Patrick Kennedy
• How come every other organ in your body can get sick and get sympathy, except the brain. Ruby Wax
• A tale of mental illness-‐from the inside Elyn Saks Ted Talk
My Thoughts
• Psychiatry as a complicated, evolving field • Emo5onal disorders common: beware of over/under dx & treat • Avoiding professional help common: s5gma5zing • Integra5ve approach needed: cogni5ve behavioral therapy, psychotherapy, group • Rx drugs for mood? I am not against them as indicated if severe thought disorder some describe flat affects on SSRI be aware of drug-‐drug/ herbs interac5ons dura5on? who take them off? short & long term effects?
Natural medicine for a happier you Putting it all together
• Acupuncture, supplements, vitamins Chinese medicine based on pulse & tongue • Physical ac5vi5es, yoga, TaiChi • Sleep/sleep hygiene • Circadian rhythm/light exposure • Medita5on • Support group, expressive therapy, cogni5ve-‐behavioral therapy-‐-‐etc
Substance induced Mental disorder start & stop • Alcohol • Amphetamines • Cocaines • LSD • Marijuana • PCP • Opioids • Seda5ves
Depression as an Example
• How good is acupuncture? Studies mixed. Report bias. • How good are an5-‐depressants? response 40-‐70%; placebo 20-‐30% beJer for severe depression, used early research methodology some side effects (SD, weight) • Mild to moderate depression may try natural therapy first do not over-‐analyze one’s self
Poor Mental Health due to a medical condition
Anxiety, Depression, ADD/ADHD, PTSD
• Exercise helps: earlier during the day, mix & match • Healthy nutri5on: less carb. Mediterranean, IntermiJent fas5ng? • Supplements: O-‐3 faJy acids, Zinc (careful with long term use) • Melatonin, chamomile, valerian, hops, magnesium • L-‐theanin, 5-‐HTP, SAM-‐e • Essen5al oil: levander, sweet orange • Chinese herbs: mix &match (my specialty)
Doctor-Patient Communication how do we communicate feeling?
• Health care providers rely on pa5ents’ narra5ves • Pa5ents’ stories subject to bias, interpreta5on, internet-‐-‐-‐etc • Pa5ents come with diagnosis: e.g. PTSD or fibromyalgia
• Clinicians interpret pa5ents’ story, more poten5al bias • Introducing Chinese pulse dx. Pulse tell the story: shape, regularity, pulse rate, strength, amplitude, jump, depth at 6 posi5ons
• Put pa5ents in different diagnos5c categories: syndrome differen5a5on 8 principles: Yin/Yang, Cold/Heat, Exterior/Interior, Deficit/Excess
Testimonial
• I was experiencing physical symptoms from a racing heart to sleeplessness and memory loss. Thought something was going with my thyroid. My blood work looked fine but I feel awful. The acupuncture and Chinese medicine made all the difference. I took 8 weeks of therapy. It was a gradual thing—
it was like a 5pping point that brought me back in balance—feeling good! My energy is back. Tina W.
Acupuncture & Brain Matters
• Trea5ng a variety of emo5onal disorders • Definitely seda5ng, improves sleep, treat mild, moderate depression • Study results mixed for depression, used as adjunc5ve mostly
• Neurophysiological basis of needling therapy balancing the autonomic nervous system hormones/neurotransmiJers secreted Evidence of elevated neurotransmiJers in CSF
Frequently used Points for Relaxation
Ear Acupuncture
Practice of Acupuncture
• Gauge 32-‐-‐ 36 Needles, 1”-‐1.5” Long (up to 3”) • Number Of Needles Varies • 365-‐1,000 Acupuncture Points • Dura5on Of Treatment: 20-‐60 Minutes • 5-‐10 Sessions Needed, Maybe More, Weekly or B.I.W • Many Styles: TCM, French, Korean etc My personal style is distal balanced method • Safe, If One Stays Away From Chest Area • Electric S5mula5on Used Some5mes
Where is personalized medicine?
Pulse telling the whole story Chinese Pulse Diagnosis
• To understand their emo5onal feeling, we rely on their narra5ves • Par5al, biased, subjec5ve, using common medical terms • Choice of words influenced by internet search, friends-‐-‐etc • Trained by the medical profession: chief complaint • No chief complaint; there are mul5ple complaints, maybe causally related
• Pulse represents an easy portal to understand my clients • Pulse guides herbal prescrip5ons Even ICD-‐10 codes osen just describe the condi5on
Panic Disorder Case Example #1
• 20 y/o female college student, intermiJent panic aJacks • Worse past 3 years, unable to drive • No meds, no supplements • Hands cold, pulse thin, deep, disappears upon pressing • Les 2nd posi5on very weak (liver or emo5on)
weak cons5tu5on, poor circula5on, introverted, unable to let feeling out important to boost Qi=blood=energy=func5on
Panic Disorder Case Example #2 • young male, anxiety/panic aJacks for years • does eat healthy, meditate and exercise regularly • PCP suggests an5depressant and Buspar, to no avail. • seeking alterna5ve help • 2 acupuncture sessions, discussed medita5on & guided imagery • pulse: weak L 1st positon indica5ng weak blood flow to brain, sugges5ng another component: ADD/ADHD
explore different forms of medita5on
Case Example • Cindy, a 60 year old female lung cancer survivor over 3 years • Progressive fa5gue and cogni5ve decline • Treated with chemo, Opdivo, experimental drugs. Off treatment now • S/P whole brain radia5on for brain mets • Mul5ple E.D. visits & hospital admissions over 12 months: TIAs? • Rapid improvement with acupuncture & Chinese herbs BeJer blood flow to the brain with herbal blood movers • Now able to engage in meaningful conversa5ons; walking w/ a walker she was in a wheelchair
5-‐yr survival up to 16% for stage 4 lung cancer Dr. Julie Bramer
Stroke, Chemo Brain & Radiation Brain
• Huge unmet need • In breast cancer 30% aser chemo • Memory issue, declined execu5ve func5oning • Definite MRI/fMRI changes of brain, inflamma5on from cytokines? • No clear solu5on • My take: decreased blood flow to brain, verified by pulse • Chinese herbal blood movers
ADHD: 2 Different Cases
• 37 y/o young mother of 2, seen for chronic migraine • L 1st pulse weakà ADHD, chronic stress • Drama5c improvement with one acupuncture/herbs
• 14 y/o junior high student, always hot • ScaJered mind • Pulse strong throughout, esp. R 2nd pulse • Improved aser acupuncture & cooling herbs ( I can do math)
TIA or Hemiplegic Migraine?
• Linda, 62, nurse. Difficulty driving to work one day • E.R. : TIA. Neurologists: migraine. 2 MRIs brain normal • Head empty feeling, poor memory, les side slightly weak, generalized weakness, unable to return to work. No headache.
• Pulse, weak throughout, esp. L 1st posi5on (heart & brain) • Acupuncture, Chinese herbs, exercise. • Back to work 3 months later; Ireland trip 6 months later Chinese medicine trea5ng circula5on
Pulse Diagnosis: Left Radial Pulse