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I honestly can't keep up with Dr. Oz's daily trend-making recommendations. I think it was a year or two ago that he implored us all to jump on the krill oil bandwagon. Most people I know are getting their (yes, super trendy) Omega Threes from flaxseed or, less commonly, evening primrose oil (EPO) and/or borage oil.

But there seems to be an increasing amount of evidence (should I write "evidence"?) that fish or at least "marine" (which I guess includes algae and other sea critters that are not technically fish) sources might be superior to the seed sources.

I am interested in this only because there seems to be a potential use (or at least potential benefit with sufficient probability to explore) in cardiovascular health, cognitive function (especially in the elderly), depression and/or other mood disorders and possibly even dermatology! So I wanted to know more.

Behold, appears in my Inbox last week Consumer Labs' up-to-the minute review and thoughtful discussion of all of the aforementioned. Super helpful, super thorough, super credible--and with even a twist of bitchiness is one looks closely enough! I particularly enjoyed that.

This post threatens to grow unmanageable, so let me try to give away the ending here:

Bottom Line
Marine (includes fish, algae, krill) sources of EPA and DHA oils "offer a wide range of potential benefits" for

  • mental health
  • treating inflammatory diseases (which would include some skin problems)
  • "and even cancer prevention"
Importantly, they conclude that where cardiovascular health is concerned, eating fish twice (or more) weekly is more effective than taking fish oil supplements.

Here are the recommended dietary sources of oily fish (per AHA):

  • anchovy
  • bluefish
  • carp
  • catfish
  • halibut
  • herring
  • lake trout
  • mackerel
  • pompano
  • salmon (farmed probably has higher levels of PCBs)
  • striped sea bass (isn't this on verge of extinction?)
  • albacore tuna (see above and also mercury concern)
  • whitefish
Dose (and relative proportion, EPA to DHA) appears to Important. And MORE IS NOT NECESSARILY BETTER. (Large doses (>2-3g per day) have been shown to suppress immunity. Source cited for this is an animal study: Fenton, Prostag Leukotri EFAs, 2013,

That said, I recall reading (but cannot find source/citation just now) that if one is using fish oil for mood disorders or depression, twice the 1,000 mg daily dose (i.e., 2g daily) is recommended. I will look for the source.

Mehmet's fancy krill oil is, not surprisingly, the costliest of all the options. And there doesn't seem to be much evidence that it is superior to the others. The only difference is the inclusion of the antioxidant carotenoid phytochemical called astaxanthin. But the CL watchdogs have discovered that only really 1-2 companies actually have krill oil with this rhapsodized constituent naturally occurring. That's right, the others ADD IT IN after the fact!

I will have to summarize the rest (and there is so much to tell!) tomorrow. If you are feeling flush with cash, you can become a CL member supporter and read it all first-hand today. I think a year's access only sets you back sixty bucks. And now I see they have NPR type options where they bill you $2.46-3.00 a month, depending on whether you opt for 12-month or 24-month commitment.

I see they also just did a review of 41 different "probiotic" products. (I can explain the quotation marks later.) Will have to get to that later this month.
Why is there not a Treatment Action Group or Project Inform for syphilis?

Because it only affects whores and poor people?

(I would also like to finger the "acupuncture" schools (lamentably restricted to teaching only a Traditional Chinese Medicine curricula in the U.S.). If there are effective post-exposure prophylaxis ("PEP) and/or maintenance type (in the case of HPV and HSV) herbal remedies for many of these sexually transmitted infections, why do we not study and learn them!!?? Of course, I suspect i know why...)

Let me admit at the outset that I am no expert on either syphilis or infection control. But personal experiences and experiences of friends over the past several years have somehow managed to reach a boiling point and I now need to ask if there are people out there working on this.

My self-described Aha Moment came when I began to look at how other countries and cities, mostly in Europe (because I often think that, especially in terms of medical care, everything (okay, most things) in Europe are done better than here) approach testing and treatment of this said to be elusive spirochete.

But let's start with my 3 principle questions:

  1. If we have a vaccine against Lyme (or even if the vaccine is useless, at least a vast vaccine R&D program), why do we not have one for syphilis? I understand that they are both spirochete infections.
  2. If there is a Morning After (PEP) treatment (e.g., single 2g oral dose of azithromycin; multiple (also oral) dose ceftriaxone, even 20-day oral doxycline) for suspected or presumed exposure, why is it not used? (Yes, I am well aware of the "risk of spreading drug resistance" arguments, but I am not all that moved by them--including the same argument against episodic (as opposed to lifelong continuous...which is what the pharmaindustrial complex wants us to do) PEP for HIV.)
  3. If there are better ways to administer benthazine penicillin-G shots (in Europe they are using oral medications and, when they must administer IM penicillin, they divide it into two doses (after first warming the vial with their hands)--one into left and one in right glut), why are they not being used in the U.S., or at least in NYC? At the AHF clinics in Los Angeles, the medical assistants gently massage the area after administration and instruct folks to walk up and down stairs after the shot to facilitate dissemination (questionable choice of words, I know) of the viscous material throughout the muscle tissues. And in the Navy, the boys are sat down after shot and coached to gently rock back and forth on a chair for 15 minutes before they are allowed to leave the clinic office. Still others have patients lie down quietly for 15-30 minutes after, to monitor them and make sure they are okay before heading off, presumably home to go to bed! When this is not done, there are an alarming number of reports of syncope or at very least of having trouble walking for times varying from 3 days to several weeks! Hematomas even.

And can we talk about the alarmingly high number of false positive EIA tests--especially in folks unlikely to have some in contact with said pathogen? This topic also deserves its own separate post, as it turns out this can vary by lab and "testing algorithm" (basically "reverse sequence screening" vs. the "traditional" method) choice, but here's what CDC reported in 2011:

For this report, data from five studies of reverse sequence syphilis screening were analyzed to determine whether CDC should provide additional recommendations for serologic test- ing and patient management when reverse screening is used. ... In addition, an even higher overall per- centage of nonreactive confirmatory treponemal tests (31.6%) was found in this analysis, compared with the earlier report (17.2%). That the percentage of patients with nonreactive screening treponemal tests in the low-prevalence population was 2.9 times that of the high-prevalence population suggests that these EIA/CIAs were false-positive results.

This, from Current Opinion in ID, 2012 echos this concern: "Recent reports suggest that the reverse screening algorithm may result in increased patient follow-ups, overtreatment, and potentially higher cost." 

CDC continues to recommend that nontreponemal tests be used to screen for syphilis and that treponemal testing be used to confirm syphilis as the cause of nontreponemal reac- tivity. The traditional algorithm performs well in identifying persons with active infection who require further evaluation and treatment, while minimizing false-positive results in low prevalence populations. However, if reverse sequence screening is used, CDC recom- mends that a specimen with reactive EIA/CIA results be tested reflexively with a quantitative nontreponemal test (e.g., RPR or VDRL) (Figure). If test results are discordant, the specimen should be tested reflexively using the TP-PA test as a confirmatory treponemal test. Patients with discordant serologic results by EIA/CIA and RPR/VDRL testing whose sera are reactive by TP-PA testing are considered to have past or present syphilis; if sera is TP-PA nonreactive, syphilis is unlikely

Note that they are talking about TP-PA and not FTA. Most of the more budget-minded MD offices in NYC I have talked to are using the FTA (technically called FTA-ABS) as confirmatory test. But CDC says, "no, no, no"--especially if you are using a cheap lab with poorly trained technicians. Let's look at their exact wording:

Traditionally, the FTA-ABS test has been considered the gold standard treponemal test and still is used by some laboratories. However, the FTA-ABS test has lower specificity than other treponemal tests. In addition to inherent subjectivity, the FTA-ABS test also requires trained personnel and a dedicated fluorescence microscope. For these reasons, CDC recommends that the FTA-ABS test not be used to confirm discordant treponemal screening results. Based on published sensitivity and specificity data, the TP-PA test currently is considered to be the most suitable confirma- tory treponemal test.

I find that in our current dysfunctional medical system physicians are all too eager to treat and skimp on the physical exam (but also understand that nearly every physician, NP, PA I spoke with says that they have not seen the textbook syphilitic "chancre" or lesion in their entire career!) and "talk time." While I realize we are living in the country of 3-minute MD (if you even see MD) consults, we must also remind ourselves of what we should be aiming for:

When making management decisions, clinicians always should consider data other than the results of serodiagnostic tests. An assessment is needed of the patient's sexual risk factors and medi- cal history, especially history of previous treatment for syphilis. A physical examination also should be performed to assess for evidence of syphilis, especially primary disease (e.g., ulcerative genital or anal lesions). If the traditional algorithm is used and the initial nontreponemal test is nonreactive, patients with suspected primary syphilis should be treated and then retested with a nontreponemal test in several weeks. Previously untreated patients with discordant sera and a reactive TP-PA should be treated according to CDC's 2010 STD Treatment Guidelines.

I only bring this up because (and, no, I do not have an MPH but I believe that is probably a good thing because all the effective preventive health programs I have seen in my 50 years have come from the community and not from public health experts) when someone with "latent" (and this whole definition of latency will require another entire blog post) or "secondary" (ditto) or god forbid tertiary syphilis (or Lyme disease for that matter) really does need multiple IM injections of b-penicillin, wouldn't you A) not want to hurt them B) not want to traumatize them and C) want them to return on their own accord for the second and third injection?

Here is a nice review, albeit it from 2007, in arguably the premier ID journal in the English language, Clinical Infectious Diseases. Maybe we can make this a virtual journal club. Let's read this, use the CID website to find more recent papers that have cited it, and report back in a week or so for further discussion.

Here is the link again:

Clinics and hospitals in Europe (and probably Canada and Brazil and Japan and Korea: I will look into that now) have figured this out and modernized (and humanized) their approach to syphilis control accordingly, why has it not happened here?

Not all of the answer is our shit-ass fee-for-service health care system, but it probably explains part of it. I hope someone will write in and enlighten me. In the mean time, I will keep looking at what other cities in the U.S. and what the aforementioned countries do.

Finally, in case someone else finds a great comparative review of current testing & treatment guidelines across multiple countries with respectable infection control numbers, please let me know!
We all know of pelvic floor exercises by now. And I am told Chinese men have their own version of Kegel exercises to keep their junk in prime form as they age. But in the past two weeks I have been told by two different people (both of them, for what it's worth, from Russia) that it is eye exercises (and not bil lutein or bilberry or goji berry or Ju Hua or anything else for that matter) that are the ticket to staving off eye glasses in our 40s or 50s and reclaiming our dimly lit restaurant menu reading moxie.

(More on the old Chinese junk exercises later...)

Here is a handy Presbyopia Reduction Eye Exercise chart, thoughtfully provided free and without the nowadays ubiquitous commercial noise from a Dr Ray Gottlieb (PhD osteopath).

Thank you Natalya. Thank you Tatiana!

While we're on that other topic, a naturopath reminded us last week that there are over 200 medications capable of causing erection problems. Men's Health once had an Erection Offenders most unwanted list, but seems their link has also lost its power. Here are some others:

  • from
(I only disagree with the characterizations of the effect of SSRIs (and probably also SNRIs). It has been my (and friends') experience that SSRIs lead to delayed or lack of ejaculation--particularly during the first couple of days, weeks or even months after starting to take them (most likely because they down-regulate (or antagonize) the sympathetic nervous system--and that's the half, the "fight or flight" side, of the autonomic nervous system required for ejaculation (the parasympathetic nervous system, or the "rest and digest" side, is needed in order to get an erection. Thank you, Dr. Olga!). They do not, however, at least in most people, lead to inability to get erection or to soft or short-lasting erections. Guys who suffer from psychogenic E.D. or performance anxiety may actually experience better, longer, harder erections with some of the SSRIs--they will just have trouble, er, finishing.)

Medicines that can affect sexual function

Antidepressants are the medicines most frequently implicated in causing sexual dysfunction. This is because they work by altering levels of chemicals in the brain. In particular, SSRIs increase serotonin levels, which inhibits sexual function.

Blood pressure lowering (antihypertensive) medicines are also implicated, although the mechanism by which they cause sexual problems will vary from medicine to medicine.

The table of medicines below lists the sexual side effects that some people have reported during their use. This list is not exhaustive.

Remember, not everyone experiences side effects with medicines and your sexual difficulties may be completely unrelated to your medication, even if it does appear in this list.

AntidepressantsMain usePossible effect on sexual function
MAOI antidepressants (eg moclobemide, phenelzine)DepressionDecreased sex drive, impotence, delayed orgasm, ejaculatory disturbances
SSRI antidepressants (eg fluoxetine)DepressionDecreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
Tricyclic antidepressants (eg amitryptiline)DepressionDecreased sex drive, impotence, delayed or absent orgasm, ejaculatory disturbances
AntiepilepticsMain usePossible effect on sexual function
AntihypertensivesMain usePossible effect on sexual function
ACE inhibitors (eg enalapril, lisinopril)High blood pressure, heart failureImpotence
Alpha-blockers (eg prazosin, doxazosin)High blood pressure, enlarged prostateImpotence, ejaculatory disturbances
Beta-blockers (eg atenolol, propranolol and including timolol eye drops)High blood pressure, angina, glaucomaImpotence
Calcium channel blockers (eg verapamil, nifedipine)High blood pressure, anginaImpotence
ClonidineHigh blood pressureImpotence, decreased sex drive, delayed or failure of ejaculation
MethyldopaHigh blood pressureImpotence, decreased sex drive, ejaculatory failure
Thiazide diuretics (eg bendroflumethiazide)High blood pressureImpotence
AntipsychoticsMain usePossible effect on sexual function
Phenothiazines (eg chlorpromazine, thioridazine)Psychotic illnessEjaculatory disturbances, decreased sex drive, impotence
RisperidonePsychotic illnessImpotence, ejaculatory disturbances
Cholesterol lowering medicinesMain usePossible effect on sexual function
Fibrates (eg clofibrate, gemfibrozil)High cholesterolImpotence
Statins (eg simvastatin)High cholesterolImpotence
OtherMain usePossible effect on sexual function
BenzodiazepinesAnxiety and insomniaDecreased sex drive
CimetidinePeptic ulcers, acid reflux diseaseDecreased sex drive, impotence
Cyproterone acetateProstate cancerDecreased libido, impotence, reduced volume of ejaculation
DisulfiramAlcohol withdrawalDecreased sex drive
FinasterideEnlarged prostateImpotence, decreased sex drive, ejaculation disorders, reduced volume of ejaculation
MetoclopramideNausea and vomitingDecreased sex drive, impotence
OmeprazolePeptic ulcers, acid reflux diseaseImpotence
Opioid painkillers (eg morphine)Severe painDecreased sex drive, impotence
ProchlorperazineNausea and vomitingImpotence
PropanthelineGut spasmImpotence
SpironolactoneHeart failure, fluid retentionImpotence, decreased sex drive

Read more: 
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I felt I had to share this (before looking into the claim) because it was so provocative. Enteric- coated peppermint oil is the answer.

Okay, I can't help myself. I just did a little search and came up with a couple of reports that look credible and useful.

From Univ of Maryland (Integrative) Medical Center:

Irritable Bowel Syndrome (IBS)

Several studies have shown that enteric coated peppermint capsules can help treat symptoms of IBS, such as pain, bloating, gas, and diarrhea. (Enteric coated capsules keep peppermint oil from being released in the stomach, which can cause heartburn and indigestion.) However, a few studies have shown no effect. One study examined 57 people with IBS who received either enteric coated peppermint capsules or placebo twice a day for 4 weeks. Of the people who took peppermint, 75% had a significant reduction of IBS symptoms. Another study comparing enteric coated peppermint oil capsules to placebo in children with IBS found that after 2 weeks, 75% of those treated had reduced symptoms. Finally, a more recent study conducted in Taiwan found that patients who took an enteric coated peppermint oil formulation 3 - 4 times daily for one month had less abdominal distention, stool frequency, and flatulence than those who took a placebo. Nearly 80% of the patients who took peppermint also had alleviation of abdominal pain.

Source: Peppermint | University of Maryland Medical Center 
University of Maryland Medical Center 

And here, how embarrassing, is a 1997 paper from the Journal of Gastroenterology, what also found it useful.

Forty-one patients on Colpermin (79%) experienced an alleviation of the severity of abdominal pain (29 were pain-free); 43 (83%) had less abdominal distension, 43 (83%) had reduced stool frequency, 38 (73%) had fewer borborygmi, and 41 (79%) less flatulence. Corresponding figures for the placebo group were: 21 patients (43%) with reduced pain (4 were pain-free), 14 (29%) with reduced distension, 16 (32%) with reduced stool frequency, 15 (31%) with fewer borborygmi, and 11 (22%) with less flatulence. Symptom improvements after Colpermin were significantly better than after placebo (P < 0.05; Mann-Whitney U-test). One patient on Colpermin experienced heartburn (because of chewing the capsules) and one developed a mild transient skin rash. There were no significant changes in liver function test results. Thus, in this trial, Colpermin was effective and well tolerated.

Seems CVS, Walgreens, Amazon and others have known this long before I found out as well. 

Finally, here is a .pdf of enteric-coated peppermint oil for treatment of small intestine bacterial overgrowth (there's, surprise, an acronym for it too!: SIBO). I guess I still have alot to learn.

Chinese herbal formulas for your liver

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I just saw Shawn's post about his doc advising him "not to expect" his HBV viral load "to do down on its own." Now I want to prove him wrong! Gauntlet, considered thrown down. I have been reading lots of new research (well, new to me) and will try to condense it down and post it here over the coming week.

(The post that follows was originally loaded up in March of this year.)

I feel a bit of a fool for not realizing that Ray Schinazi had single-handedly cured hep C and at the same time rid the world of the need for interferon (à la sofosbuvir and the promise of a soon-to-be FDA approved all oral treatment regimen). Then quickly selling his company to the Gilead goliath for a cool $11 billion.

I will have to catch up on my NATAP reading to see what the latest is on expected availability of this miracle drug ( says mid-2013 for the single drug and 2014 for the FDC). And I understand that the initial enthusiasm (100% clinical cures for genotype 1; 75% clinical cures for genotypes 2 & 3, with more recent data on efficacy in genotypes 4-6) has mellowed a bit.

If others out there have beat me to the punch in experimenting, successfully one hopes, with herbology--Chinese, Taiwanese, Japanese, Korean, Tibetan, Ayurvedic, Indigenous American or otherwise, please share your experiences.

In the meantime, I will report on 2 or 3 classic formulas (Shu Gan Tang, Chai Hu Shu Gan Tang, Xiao Chai Hu Tang, for starters) that, over the centuries, have proved good for your "gan" (anglicized pinyin for liver in Mandarin): reducing inflammation, slowly (reversing?) fibrosis, encouraging the growth of new hepatocytes.

While personally I prefer the freshly brewed broth-like Chinese herbal potions, this is not terribly practical and eventually a bit costly for chronic administration, there are some reasonably effective tablet and granule products at many of the better herb companies. The Hepatoplex series, as well as Ecliptex and Milk Thistle 80, of Oakland, CA-based Health Concerns, are four tablet forms that come to mind. (Opinions vary on whether or not the recommended dosage is adequate, although the company says that the dosage labeling is based on 150-pound body weight, and one might want to adjust accordingly. Thrice daily dosing is often not practical, so the total daily dose is often divided by two and taken morning and late afternoon or early evening.) Depending on your constitution and individual presentation, there might also be other, less liver specific, formulas that can help you.

Ruth aka "Misha" Cohen, out in SF, most recently at the Cancer Research Institute at the UCSF School of Medicine, has of course been focusing on Chinese medicine and hep C for a good part of the past 20 years or so. Her 2007 Hep C book (and various YouTube type streaming videos) might also be a valuable resource. In addition to the tableted formulas mentioned above, Dr. Cohen in her book recommends Enhance, Clear Heat, and then a variety of more specialized formulas according to  the person's individual constitution and/or symptoms.

Mike is due to complete his five-year licensing program in East Asian medicine in the spring of 2014 and is eager to return to the working world. He looks forward to applying the fruits of his study and life experience to helping people minimize the use of life-long drug taking and to discover more effective management of conditions for which suboptimal or no effective treatment currently exists.

In 2013 he presented his insomnia research at the biannual meeting of the Society for Acupuncture Research at the University of Michigan (Ann Arbor, MI) and to the Center for Integrative Medicine at the University of Maryland School of Medicine in Baltimore, MD. He currently serves as a peer reviewer for The American Acupuncturist, a quarterly research journal of the American Association of Acupuncture and Oriental Medicine. He can be reached in New York City at mbarr (AT)

From 1990 until shortly before it closed its doors, he was part of the clinical research team at St. Vincent's Hospital in Greenwich Village, NY. His research and that of his colleagues has been presented at medical conferences world-wide and published within the pages of The New England Journal of Medicine, Lancet, Annals of Internal Medicine, Clinical Infectious Diseases and others. With Dr. Ramon A. Torres, he co-authored chapters for two medical textbooks. From 1992 to 1994 he served on the Immunology and Primary Infection committees of the AACTG of the National Institutes of Health/National Institute of Allergy and Infectious Diseases.

(Note to readers: This post addresses the issue of facial nerve Bell's) palsy due to viral infection. The research review and treatment algorithm do not apply to facial nerve palsy of other etiologies; for example, traumatic injury or stroke.)

As many a Poz reader likely already knows, my longtime friend and ACT UP brother (long ago relocated to the encantadora gay Bay) woke up with half of his face paralyzed a day or so ago.

The dreaded inflammation of and subsequent compromise of cranial nerve VII.

It's a frightening experience, as you might imagine. It happened to me during a high-stress period in my life around 2005 or so. And a woman in my program here at Pacific had it as a sequela of Lyme disease. The NINDS tells us that, "Bell's palsy afflicts approximately 40,000 Americans each year: men and women equally and can occur at any age, but it is less common before age 15 or after age 60.  It disproportionately affects people who have diabetes or upper respiratory ailments such as the flu or a cold." They might need to update this to include Borrelia burgdorferi infection (aka "Lyme").

(If I may add parenthetically here.. if I were a woman (or man for that matter--although I am told the risk is much less for young men) in my 30s or 40s infected with Lyme, I would seriously consider seeing a Chinese herbalist once my Lyme had been successfully (or, worst case scenario, unsuccessfully) treated in order to "soothe" my immune system so as to minimize the risk of developing any secondary autoimmune disorders. This is one thing I am convinced that Chinese medicine does really well--again, assuming you have an experienced or resourceful and thoughtful herbalist.)

That said, the Traditional Chinese Medicine ("TCM") teaching of and treatment approach to Bell's palsy has long infuriated me. We are taught that it is caused by a "pathological Wind" and are quaintly instructed to, well, "expel" the Wind and maybe "warm the channels" and "restore the qi mechanism" to the (exclusively Yang) meridians that originate or end in the face: Stomach, Large Intestine, Urinary Bladder, and 3 others.

At a Society for Acupuncture Research conference I was attending in Ann Arbor this past spring, this peppy group of Chinese (TCM) researchers (from Chengdu TCM University) enthusiastically reported their results of electro-acupuncture on a rather large group of hospital patients who presented (quite early I must say) with this facial nerve palsy. "Symptoms resolved completely or near completely within 7-10 days in nearly 80% of the people," they gushed. Sounds great but guess what: symptoms resolve completely or nearly completely within 7-10 days in people who do absolutely nothing! Folks who seek prompt (and I mean PROMPT) medical attention will very likely be prescribed an antiviral medication (typically an acyclovir (anti-HSV) product: if memory serves, valacyclovir is actually much more effective than the old acyclovir; or, where Lyme disease is implicated, I imagine doxycycline would be used) and a short course of prednisone (to reduce the inflammation). Under these conditions, I have seen the facial paralysis dramatically improve within a mere 24 hours. And disappear almost completely with 2-3 days. (Thank you, Dr. Shay! Isn't it great when you have a physician who knows what s/he's doing?)

I have heard numerous tales of exuberant acupuncturists (through no real fault of their own; they were just doing what they were taught in this country's woefully remedial, largely TCM-dominated acupuncture schools) recounting how their rigorous training and deftly honed acupuncture skills "cured" their patients' Bell's palsy in 3 months, 2 months, sometimes 1 month. It causes me great sadness and embarrassment for someone who hopes one day to count myself among their fold. For better or worse (and only a fool would argue for the latter), we do not live in the time of the mythical Yellow Emperor or even Zhang Zhongjing, and, as such, we as students of this medicine in a post-Galenic, post-Renaissance, post-Enlightenment era of bioscience and best evidence methods need to apprise ourselves (remember Harvey, Hunter, Virchow, Lister, Taussig?) of the entire constellation of treatment options in cases like this--and choose the best possible modalities for our patients. Sometimes it is acupuncture; sometimes it is Chinese herbal medicine (but not in the case of Bell's palsy!); but it might also be CBT, deep tissue massage, physiatry, hypnosis, chiropractic, guided self-care, breathing exercises, or yes, even surgery or prescription pharmaceuticals.

From what I have seen, acupuncture can be a useful adjunct to Western medicine--but it should not replace it. My advice to a family member would be to seek Western med first. If after 7-10 days symptoms have not resolved 90% or so (sometimes there is an eye that won't quite close on its own, or a slight asymmetry if one looks really, really closely), then you might want to seek out a (highly trained and experienced) acupuncturist. Of course, it doesn't hurt to pursue the two in parallel (if you're flush with cash, have good insurance and live somewhere where this is an option) from Day 1 (okay, Day 2), but there is not yet any compelling evidence to show that acupuncture shortens the time to resolution of symptoms.

I am not aware of any Chinese herbal formulas that are effective (certainly not Qian Zheng San), but am open to the prospect of a utility for moxibustion--it's just that I am pretty sure I would not want people burning things on my face! Since some of these "Yang" channels of the face begin (or end) at the finger and toes, it of course possible that the moxibustion could be done there.

I had a long discussion with the woman from the China research team and the impressive fellow who heads up the University of Maryland's integrative medicine program. He, and another very impressive researcher from Stanford who also did the Mandarin-English translations during the session, and I agreed that the studies that need to be done in acupuncture for facial nerve palsy are ones that look at differences in time to resolution of symptoms--West medicine or no rx +/- acupuncture. To my knowledge, these studies have still not been competently performed. Until then, it's all (as, sadly are many aspects of TCM acupuncture) an article of faith.

This has been my experience and observation over the past 5 years. I welcome corroborative and dissenting first-hand evidence.

Mike is due to complete his five-year licensing program in East Asian medicine in the spring of 2014 and is eager to return to the working world. He looks forward to applying the fruits of his study and life experience to helping people minimize the use of life-long drug taking and to discover more effective management of conditions for which suboptimal or no effective treatment currently exists.

In 2013 he presented his insomnia research at the biannual meeting of the Society for Acupuncture Research at the University of Michigan (Ann Arbor, MI) and to the Center for Integrative Medicine at the University of Maryland School of Medicine in Baltimore, MD. He currently serves as a peer reviewer for The American Acupuncturist, a quarterly research journal of the American Association of Acupuncture and Oriental Medicine. He can be reached in New York City at mbarr (AT)

From 1990 until shortly before it closed its doors, he was part of the clinical research team at St. Vincent's Hospital in Greenwich Village, NY. His research and that of his colleagues has been presented at medical conferences world-wide and published within the pages of The New England Journal of Medicine, Lancet, Annals of Internal Medicine, Clinical Infectious Diseases and others. With Dr. Ramon A. Torres, he co-authored chapters for two medical textbooks. From 1992 to 1994 he served on the Immunology and Primary Infection committees of the AACTG of the National Institutes of Health/National Institute of Allergy and Infectious Diseases.



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