AOMA Blog

Join AOMA Student Amy Babb in a conversation on how she uses Traditional Chinese Medicine in daily life with nutrition and mind-bodywork.

Cupping is a technique where a glass or plastic cup or bamboo jar is suctioned onto the body and allowed to sit for about ten minutes or is moved around with oil used for lubrication. This technique stimulates circulation, relieves swelling, and greatly enhances an acupuncture treatment. 

 
Cupping is used for many conditions including: 

back pain,  

shoulder pain,  

neck pain,  

gastrointestinal disorders,  

common colds,

influenza,  

cough and asthma


"The cupping method has the function of warming and promoting the free flow of qi and blood in the meridians, dispelling cold dampness, diminishing swellings and pains." (Chinese Acupuncture and Moxibustion, Cheng Xinnong).  


The suction created during a cupping procedure penetrates deep into one's tissues and can help the release of toxins from the body. Cupping therapy is most commonly done on one's back. There are several yang meridians on the back which are stimulated by the cupping therapy allowing the internal energy to flow through the whole body.

 
The two most common ways of suctioning the cups to the body are "fire" cupping and manual suction cupping. To do "fire" cupping, the practitioner will light an alcohol soaked cotton ball on fire and briefly place the fire inside the glass cup, creating a vacuum. Then he or she will quickly place the cup on the skin. The amount of suction can then be adjusted by sliding or moving the cup. Manual suction cups use a pump to create the vacuum between the cup and the soft tissue.

 
Cupping can leave marks on the skin which indicates that the stagnation or disease has been moved from the deeper tissue layers to the surface, aiding in the healing process. The marks from a cupping treatment can range anywhere from light pink to dark purple circles. It is rare for these "hickies or bruises" to be painful and they will dissipate in a few days.

 
All of the practitioners at AOMA can perform cupping. Call to make an appointment today! Or request an appointment online.

Kirsten Hurder-Karchmer was teaching linguistics at the University of Texas when she began having some serious auto-immune health issues.  After seeing several medical doctors and having surgery she turned to AOMA faculty member Jamie Wu for acupuncture and Traditional Chinese Medicine treatments.  Amazed by the results, Kirsten started looking into acupuncture as a career choice.  She recalls, “I was already a teacher and thought that to be a good doctor, it required a great deal of patient education, so it seemed like a good match for me.”

Kirsten states, “I was instantly interested in gynecology because I saw that when you regulate a woman’s menstrual cycle, so many other problems are also resolved.” Upon graduation from AOMA in 2000, she was invited to help open the first women’s clinic in the AOMA professional clinic with faculty member Dongxin Ma.  In 2001 Kirsten opened her current business in Austin, the Texas Center for Reproductive Acupuncture (TCRA), where she and her team specialize in infertility, ovulation disorders, and recurrent pregnancy loss.  Success led to additional locations in San Antonio and Plano. Kirsten said, “Last year alone the clinic in Austin saw 220 patients, had 159 pregnancies and only 4 miscarriages. That is less than a 4% miscarriage rate in a risk population that should be more around 40%.”

The Austin and San Antonio clinics are fully integrated with western medical doctors, operation and recovery rooms, and technology such as ultrasound machines.  In the Austin center Kirsten and her team collaborate with reproductive embryologists and urologists to help couples create families, and with Reproductive Medicine Associates of Texas to conduct research.  Kirsten says, “We are currently conducting three large scale studies on the effects of acupuncture on in vitro fertilization (IVF), acupuncture anesthesia for oocyte retrieval or egg collection and recurrent pregnancy loss.” This research will be collected and published in the scholarly journal Fertility and Sterility in the next year or two.

Kirsten furthers her mission to change the face of health care through membership in the American Board of Oriental Reproductive Medicine, doing research and developing training at one of the most successful reproductive acupuncture clinics in North America.  She is becoming a leader and pioneer in her field of recurrent pregnancy loss. Her tip for success is, “The more I learn Western medicine the better I understand Chinese medicine.  We can pioneer a new kind of medicine, but acupuncturists have to learn as much or more, if they want to integrate, than most doctors.”

After thoroughly studying OB/GYN and reproductive embryologist medical texts, Kirsten has been able to strengthen her ability to communicate with medical doctors and overlap Eastern and Western medicine.  This deeper understanding has allowed her to build some amazing relationships with the physicians in her field.  She responds, “Now they come to us when they get stuck for a bit of voodoo opinion.” Dialogue with medical doctors has helped Kirsten to speak in layman’s terms about Chinese medicine to make it more accessible to people of all backgrounds.

In conjunction with Dr. Francisco Arredondo, Kirsten and her team plan to open the nation’s first fully integrated center for underserved women experiencing recurrent pregnancy loss. The Hope Center will open in Austin and San Antonio in 2012.

Michael Still began his collegiate studies at the University of Texas with a focus on traditional Western medicine. His father was a physician, and Still had an interest in pursuing a similar career path. While still at UT as an undergrad, Still’s father battled and finally succumbed to cancer. The experience of seeing his father’s suffering as the disease did not respond to traditional Western medical treatments left him with many questions in regards to society’s reliance on conventional medicine. In Still’s words, “Weren’t there other methods to help this incredible man?”


Still found himself lost in many ways following his father’s death, but he also began to discover himself. He returned to college to study neurobiology and was particularly fascinated by the embryonic development of the nervous system. Through his interest in martial arts, Still was lead to apply for acupuncture school.  He believes the experience of studying with renowned doctors from China with backgrounds in both Western and Chinese medicine will benefit him in his future pursuits.  “These are talented, brilliant people—these are people who want to be mentors and welcome questioning in pursuit of knowledge.”  Still also spends a good portion of his time at in the AOMA Graduate School of Integrative Medicine’s library, where he says the resources are extensive and current. “My Western medical understanding has increased exponentially,” he says.


Acupuncture is a safe and affordable form of health care that has been scrutinized by practitioners for over 10,000 years. The most well-known traditional Chinese medical procedure, acupuncture is the practice of inserting thin needles into the body at specific points to relieve pain or treat a disease. Acupuncture triggers spontaneous healing reactions in the body, and scientific studies have proven its efficacy for treating inflammation, pain, depression and a host of other disorders. Chinese medicine unites the parts with the whole, linking the health of organ systems to the health of the individual and linking individuals to the world around them. The relationships between the mind, body, and spirit play an important part in this holistic system of health care.

 

To become an acupuncturist, one must attend an accredited school and obtain a master’s degree. The degree in Texas is a Master of Acupuncture and Oriental Medicine. Usually a graduate program in this field takes around four years to complete. After passing the national exams one can apply for licensure in whichever state they will be practicing.

 

The use of acupuncture is on the rise in the United States.  Between 1997 and 2007 the number of visits among adults nearly tripled, rising from 27.2 to 79.2 per 1,000 adults. According to the National Health Interview Survey (NHIS), approximately 3.1 million adults in the United States used acupuncture in 2006, a 47 percent increase from the 2002 estimate.

The demand for acupuncture could soon outweigh the number of practitioners that can currently fulfill that demand. There are many possibilities for acupuncture and Chinese medicine practitioners. Most chose to work in private practice or work with a group of practitioners, like a massage therapist or chiropractor, at a holistic health or rehabilitation center. As acupuncture is growing in demand, opportunities to work in pain management clinics and hospitals are becoming more available. The military is also becoming more open to employing acupuncturists to research post-traumatic stress which has shown positive results for treating veterans. There are also opportunities to travel with acupuncture by working for groups such as Acupuncturists without Borders or island hopping on cruise ships.

There is increasing scientific evidence proving the efficacy of acupuncture for the treatment of medical ailments including chemotherapy-induced nausea, autoimmune disorders, chronic back pain, hypertension and allergic rhinitis.  Acupuncture is also used for fertility, facial skin tightening, weight management, and a host of other common complaints.



The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Alternative Medicine (NCCAM) are major contributors to this conversation. They recently published research that found acupuncture is effective at controlling the pain and improving the functionality of knee osteoarthritis.  The National Health Interview Survey is another organization that produces research and they concluded in 2007 that back pain was the most commonly and successfully being treated by acupuncture, followed by joint pain, neck pain, severe headache/migraine, and chronic pain.  Clinically acupuncture has been tested to be a safe and natural way to maintain and restore health. Recognition of Chinese medicine as an important and necessary part of American health care is increasing. Coverage of acupuncture by major health insurance plans is on the rise, and compared to traditional Western medicine, acupuncture and Chinese medicine are less expensive. Acupuncture can also decrease reliance on prescription drugs, making it a safe, affordable and accessible healing modality.



Still is still young--in his early 20s--and plans to attend a Western-style medical school upon graduation from AOMA.  He is deeply interested in the integration of both perspectives of medicine and challenging society’s views of Chinese medicine. His passion for teaching will assist in this pursuit, as he believes education is the best way to bring the two worlds together. Of the medicine he says, “I feel part of greatness in a journey to change how we practice medicine.”

All students at the AOMA Graduate School of Integrative Medicine are required to study both acupuncture and herbs. Some students tend to gravitate toward one or the other of those disciplines, as is the case with AOMA alumnus David Jones, who sees himself more as an “herb guy.”

Before entering graduate studies at AOMA, Jones earned his Bachelor of Arts degree in Advertising from the University of Texas at Austin. Although he knew AOMA was located in Austin, he didn’t know much about it until he began exploring options to go back to school. He finally decided to enroll at AOMA for graduate studies after he sat in during a class and thought it was, as he says, “the coolest thing ever.”

AOMA is known for drawing some of the finest professors from China, making its herbal program one of the most comprehensive and challenging in the country. During Jones’s studies at AOMA, he was especially attracted to the herbal curriculum because of his long-time interest in the chemistry of medicinal plants, and he wanted to take advantage of the knowledge and experience the professors at AOMA had to offer him in this rigorous program.

Following his 2006 graduation from AOMA, Jones chose the path many graduates do, launching a small acupuncture practice with a well-stocked herbal dispensary and working hard for the three years that it normally takes to build a successful practice. However, in 2007, AOMA alumnus and friend Jeanine Adinaro pitched Jones the idea that eventually led to the formation of Third Coast Herb Company (TCH). Jones says, “It was one of those ‘this might just be crazy enough to work’ moments.”

While Jones still sees a few acupuncture patients, he says most of his time is focused on building Herbalogic into a national brand. Although he acknowledges it is a lofty goal, “We have a pretty good start on it. We sell retail in about 60 outlets in four states and all 17 Texas Whole Foods. We have recently extended ownership to two nationally recognized marketing and branding professionals who bring over 40 years of experience to the table and we have hired on a couple of brokers so you can buy Herbalogic from Fayetteville, Arkansas to Boerne, Texas. We also have a large number of happy practitioners. Although we sell mostly retail our line makes a very accessible entry point to herbs for some patients who are resistant to the idea of barks, bugs, lizards and leaves” Jones says. “To develop the line, we made a list of the most common ailments we saw in the clinic. We then matched those ailments with herbal formulas we knew would work really well and work really well in an extract form.” The original five conditions the business partners decided to address are allergies, insomnia, stress, low energy, and musculoskeletal pain. Four new formulas are currently being tested and as Jones says, “some of them are going to change lives.”

Jones and Adinaro have seen the company through challenges. “You just have to be flexible, be prepared to revise your business plan again and again, and never lose sight of your goal. One of my goals is to sell one million units in a year. If we can do that, then I get to have touched people’s lives with Chinese medicine a million times,” Jones says. The most satisfying aspect of his business is, Jones says, “is when someone I don’t know sends us an email telling us how much our products helped them or when I have practitioners call us to tell us a story about how much our products helped a patient.  We are passionate about Chinese herbs and to see someone who may have only had this small exposure to them spreading the word is one of the reasons we went into business.” 

Reprinted from HerbalEGram, Volume 7, Number 10, with permission from the American Botanical Council. www.herbalgram.org.

A patented Chinese herbal medicine has successfully completed Phase II clinical trials in the United States and will soon begin Phase III investigations, raising the possibility that it could become the first Traditional Chinese Medicine (TCM) product to obtain drug approval from the US Food and Drug Administration (FDA).1

The product, Compound Danshen Dripping Pill (also referred to as Cardiotonic Pill), is produced by Tianjin Tasly Pharmaceutical Co. Ltd. in Tianjin, China. It contains the extract of the root of Chinese salvia (Salvia miltiorrhiza; known as danshen in Chinese), the extract of the root of notoginseng (Panax notoginseng; known as sanchi or tien-chi ginseng), and synthetic borneol, an active ingredient that replaces the more expensive natural borneol found in cardamom (Elettaria cardamomum var. cardamomum), ginger (Zingiber officinale), and other spices.1,2,3 According to Tasly’s website, the pill is sold as a prescription drug in China, Vietnam, Pakistan, South Korea, India, and the United Arab Emirates and reportedly is taken by about 10 million people every year to treat angina and coronary heart diseases.3 Last year, its international sales brought in a reported $148 million.

Danshen has been used in TCM for many years to improve patients’ circulation and to treat cardiovascular diseases.3 The oldest documented record of danshen as a medical agent is found in Shen Nun Ben Cao (The Divine Husbandman’s Classic of the Materia Medica), dated at about 200 CE.4 Consumers in the United States are currently able to buy and use danshen and notoginseng either as whole, raw herbs or in herbal dietary supplements. An FDA drug approval would give Tasly protection of market exclusivity for the pill’s ingredient combination, specifically in dripping pill form and for the cardio-indication as a prescription drug, because it specifically intends to treat and prevent disease.5 (The product cannot qualify for over-the-counter drug regulation because the condition it intends to treat is not a self-diagnosable, self-treatable, and self-limiting condition.)

“This product, known earlier as Fufang Danshen Pian (tablet of salvia with other ingredients), has been used in China for many years, and there have been efforts to get it approved for use outside China for decades,” said Subhuti Dharmananda, PhD, director of the Institute for Traditional Medicine and Preventative Health Care in Portland, Oregon (e-mail, September 16, 2010).

"The biggest problem,” he said, “is that it is for very serious cardiovascular disorders—mainly angina pectoris—and so it is difficult to integrate it into modern medicine. There were some previous concerns about borneol being potentially toxic, but I think that has been alleviated in recent years. Also, the problem of inconsistency of the botanical constituents is a big issue. In particular, notoginseng grows in southwestern China, an area with difficult climatic conditions that can lead to considerable variability of the chemistry in the root.”

In order to conduct human clinical trials, a product must be designated by FDA as an investigational new drug (IND), which requires varying levels of evidence that the product is safe for testing in humans and that the clinical protocol is suitably designed.5 (Compound Danshen Dripping Pill was the first TCM product to obtain IND designation in the United States in 1997.2) Then, Phase I consists of testing the drug within small groups to determine safety, dosage range, and side effects, and in Phase II researchers study the drug on a larger group of people to determine safety and efficacy. In its third phase of clinical trials, Compound Danshen Dripping Pill will be studied on large groups of people to confirm efficacy, monitor side effects, compare it to commonly used treatments, and collect safety information.6

If Phase III investigations are completed, Tasly can decide to submit a new drug application (NDA) to FDA, which then considers if the drug used for its intended purposes is safe and effective, if the benefits outweigh any known adverse side effects, if the drug’s proposed labeling is appropriate, and if the drug can be manufactured in a way that preserves its identity, strength, quality, and purity.7

An FDA drug approval for Compound Danshen Dripping Pill, which could take 10 years from the beginning of Phase III trials, might be significant, as it entails official recognition of the safety and efficacy of an herbal preparation in the conventional healthcare system, said William Morris, PhD, DAOM, LAc, president of the Academy of Oriental Medicine at Austin, TX (e-mail, September 23, 2010). “But it could also mean that there is a trend toward ‘pharmaceutical herbs,’” Dr. Morris added.

Additionally, of the near 3,000 medicines currently in development stages in the United States, only 25 new drugs were approved in 2009, evidence of the extreme difficulty in bringing a new drug to market in the United States.8 It now costs a reported $800 million to $1.3 billion to conduct the research and development needed to bring a new drug to the market, and generally takes 10 to 15 years for most new drugs to go from the laboratory to market.8,9

“If the drug successfully gains approval in the US through the NDA process, it will be the first time a multi-sourced botanical ‘new’ drug—one derived from more than one plant [or] plant part—is approved by FDA, and the first botanical to achieve a cardiovascular indication,” said Freddie Ann Hoffman, MD, a former FDA official and founder of HeteroGeneity, LLC, a Washington, DC-based consulting firm that advises companies seeking to market botanically-based drugs (e-mail, August 17, 2010). Dr. Hoffman noted that there are approximately 450 IND and pre-IND applications for botanicals that have been submitted to FDA.

Many botanical product sponsors experience great difficulty in completing the FDA clinical trial process due to the complex chemical nature of the products’ multiple plant components. To address this situation, in June of 2004, FDA released Guidance for Industry for Botanical Drugs.10 This document advises potential botanical drug sponsors by describing both the application process and recommending how chemically complex products might satisfy the requirements of FDA’s rigorous drug review and approval process. Though presenting somewhat different regulatory policies for botanical INDs than those applied to other drugs, including a somewhat easier process for Phase I and II trials, the document states that botanicals are still treated like any other new drug in order to gain full drug approval.5

According to the FDA Center for Drug Evaluation and Research (CDER) Botanical Review Team, the most difficult issue for new botanical drugs is how to ensure "therapeutic consistency" of all marketing batches, which is typically easier for synthetic, purified small molecule drugs (e-mail, C. Rice [FDA], August 17, 2010). The Botanical Review Team noted that it thinks a comprehensive approach can address this situation. “Besides conventional [chemistry, manufacturing, and controls] measures, the sponsor may use clinically relevant bioassay, clinical dose-response data, and testing multiple batches in Phase III clinical trials to demonstrate the consistency of a botanical drug product.”

Scientists working with single-herb botanicals and TCM products, which usually are mixtures of herbs, also face challenges in showing evidence that each component of their complex mixtures contributes to the product’s claimed effects. This requirement may be impossible for botanical researchers to meet before FDA revises the related regulation, said the FDA Botanical Review Team.

Additionally, few conventional health professionals in the United States practice TCM, said Dr. Hoffman. “Therefore the product and its uses must be ‘translated’ into US medical practice. This goes for claims, dosage forms, and schedules (consumers want once- or at most twice-a-day dosing). Although the indication may be derived from traditional use, the pivotal clinical study (or studies) must address what will go in the drug’s Package Insert—the prescribing information for the health practitioner. The US approach to medicine is not individualized in the same way that TCM is practiced.”

Though difficult, it is not impossible for botanicals to successfully complete FDA’s drug approval process. In 2006, FDA gave drug approval to Veregen® Ointment (Medigene AG, Martinsried/ Munich, Germany), which contains a proprietary blend of phytochemicals produced from a partially purified water extract of green tea leaves (Camellia sinensis, Theaceae).10 Veregen was the first botanical approved as a drug under the 1962 federal law known as the Kefauver-Harris Amendments, which requires drugs to be proven both safe and effective prior to being marketed in the United States.

No botanicals have achieved drug designation since Veregen (C. Rice, e-mail, August 17, 2010), and it is possible that Compound Danshen will also fail to obtain FDA drug approval.

“While entering into Phase III usually means that there is sufficient interest on the part of the sponsor to proceed—based on prior studies—the success of the trial lies strictly with the data itself, which determines whether FDA can approve the drug for marketing,” said Dr. Hoffman. “Even drugs produced by large, global pharma companies, which have gone through rigorous preclinical testing, can ‘miss the mark’ in Phase III.” Some examples include Medivation's drug Dimebon for Alzheimer's disease,11 Merck’s HIV drug vicriviroc,12 and Inspire Pharmaceuticals’ Prolacria for the treatment of dry eye disease.13

—Lindsay Stafford

References

1. Chinese patent traditional medicine first time passes U.S. FDA crucial clinical trials. Xinhua. August 7, 2010. Available at: http://www.news.xinhuanet.com/english2010/china/2010-08/07/c_13434173.htm. Accessed August 12, 2010.

2. Xiaohui Z, Xinfeng Z, Xin Z, Shixiang W, Yinmao W, et al. Determination of the main bioactive metabolites of Radix Salvia miltiorrhizae in Compound Danshen Dripping Pills and the tissue distribution of Danshensu in rabbit by SPE-HPLC-MS. J Sep Sci. 2007:30;851–857.

3. Herbal medicine. Tianjin Tasly Pharmaceutical Co. Ltd. website. Available at: http://www.tasly.com/en_web/Product_list1.aspx. Accessed August 18, 2010.

4. Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press Inc., 2001;636-637.

5. Amin R, Bayne H. FDA issues final guidance for industry regarding botanical drug products. HerbalGram. 2004; 64:52-53. Available at: http://www.cms.herbalgram.org/herbalgram/issue64/article2741.html.

6. Understanding clinical trials. ClinicalTrials.gov website. Available at: http://www.clinicaltrials.gov/ct2/info/understand#Q01. Accessed August 18, 2010.

7. New drug application (NDA). Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/NewDrugApplicationNDA/default.htm. Accessed August 18, 2010.

8. Pharmaceutical Research Companies Receive Approval for 34 Innovative Treatments in 2009. New Drug Approvals in 2009: Presented by America’s Pharmaceutical Research Companies. The Pharmaceutical Research and Manufacturers of America. Available at: http://www.phrma.org/new_drug_approvals. Accessed October 1, 2010.

9. Woodcock J, Woosley R. The FDA critical path initiative and its influence on new drug development. Annu Rev Med. 2008;59:1-12.

10. FDA approves special green tea extract as a new topical drug for genital warts; expert says development marks the birth of a “new industry.” HerbalGram. 2007;74:62-63. Available at: http://www.cms.herbalgram.org/herbalgram/issue74/article3120.html.

11. Carroll J. Medivation's Dimebon fails Phase III for Alzheimer's, shares collapse. FierceBiotech. March 3, 2010. Available at: http://www.fiercebiotech.com/story/breaking-news-medivations-dimebon-fails-phase-iii-alzheimers/2010-03-03. Accessed October 1, 2010.

12. Horstmann A. Merck defers seeking FDA approval of Vicriviroc for treatment-experienced HIV patients. The AIDS Beacon. February 2, 2010. Available at: http://www.aidsbeacon.com/news/2010/02/02/vicriviroc-not-approved-for-treatment-experienced-hiv-patients/. Accessed October 1, 2010.

13. Inspire Pharmaceuticals stops Prolacria development program, amends agreement with Allergan. The Associated Press. August 25, 2010. Available at: http://www.finance.yahoo.com/news/Inspire-Pharma-amends-apf-3388997606.html?x=0&.v=1. Accessed October 1, 2010.