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Little doubt exists that telemedicine, or more properly telehealth, is here to stay unless COVID-19 wipes us out, sends us back into the stone age, or so ruins the economy that even this non-face-to-face healthcare treatment is no longer available. The virus has certainly made people afraid to venture out of their homes and turn to video calls. More likely, COVID-19 will result in the expansion of telemedicine, not just in the United States, but around the world, albeit expanding in different ways.

Telemedicine is hardly new. Healthcare providers began experimenting with telemedicine by phone and radio in the early 20th century. In the 1960s and ’70s, NASA funding and the rise of television allowed the possibilities to take shape. Since the 1990s, the increased use of personal devices and the Internet have led to more and more telehealth applications. But resistance to telemedicine has remained, at least until the stimulus of the coronavirus pandemic, based largely on reimbursement issues. And both practitioners and patients have been reluctant to adopt the practice because it eliminates the human touch. For Chinese medicine and acupuncture practitioners, it’s particularly important to have the person-person interactions to perform the four-diagnostic approaches, Inspection, Listening/Smelling, Inquiring and Palpation. One expert summarizes the history and future of telemedicine as follows:

Telemedicine has been used to improve patient outcomes for more than 50-years. Transmission of digital and video imagery, or store-and-forward telehealth, has been a standard of radiologists since the 1980s. But widespread access to broadband has enabled clinicians to offer video consults to their patients as a regular part of their practice. By 2016, more than 60% of healthcare providers offered their patients some form of virtual interaction for services. By 2017, that number had risen to 76%- and it shows no signs of slowing down.

Covid-19 has very quickly mandated that entire health care segments go virtual. Telemedicine lets patients remain inside their homes to slow the spread of the virus and hospitals can better prepare for a surge of patients into emergency rooms and intensive care units. Many acupuncture practitioners started telehealth to help their patients while staying home to avoid spreading of the virus.

So, what are we talking about? Yes, any reader could probably come up with a definition of telemedicine or maybe even telehealth, but for compliance issues, let’s make certain that we know what we are talking about Telehealth is actually the broader concept, although sometimes the terms are used interchangeably. The U.S. Department of Health and Human Services notes that telehealth’s definition is broader in scope than that of telemedicine, covering remote healthcare services that are both clinical and non-clinical. The term “telemedicine,” on the other hand, is limited to remote clinical services. Subsequently, the American Telemedicine Association uses the two terms interchangeably, both encompassing a wide definition of remote healthcare.

But even though telehealth is the broader concept, let’s start with telemedicine.

Although a number of definitions exist, one of a number of accurate ones is “the remote delivery of healthcare services, including exams and consultations, over the telecommunications infrastructure”. Telemedicine allows healthcare providers to evaluate, diagnose and treat patients without the need for an in-person visit. Patients can communicate with physicians from their homes by using their own personal technology or by visiting a dedicated telehealth kiosk. A perhaps more simplistic definition is “the treatment of people who are ill, by sending information from one place to another by computer, video, etc.” Note that telemedicine does not include the use of audio­ only telephone, facsimile machine, or email.

Telehealth, on the other hand, is broader, “the use of electronic information and telecommunications technologies to support long-distance clinical health care, professional health-related education, public health, and health administration.”

In summary, The World Health Organization notes the difference between telehealth and telemedicine, “where telehealth uses computer-assisted telecommunications to support management, surveillance, literature and access to medical knowledge, while telemedicine uses telecommunications solely to diagnose and treat patients”.  So, most traditional Chinese medical practices fall under the heading of telehealth and can be used.

Make sure to check with your state of licensure for more details on your state requirements for Telehealth and Telemedicine and how that pertains to Acupuncture and TCM modalities.

Covid-19 Was In The House

TCM & COVID-19
Our skills don’t just benefit our patients, but our families as well

Amy Mager, DACM, L.Ac., FABORM, Dipl.OM

In December 2019, we were all hearing about COVID-19 in China and Europe. On March 1st, the first case arrived in Westchester, NY. My Mom’s elder community went into immediate lockdown. Upon hearing that news, my husband and I spoke of retrieving 5 of our 6 children who were in school or working in NY, Boston and Philadelphia. We knew it was a risk to bring them home and that one or more of them more than likely had been exposed to COVID-19 despite me sending them N95 masks to wear on the subways and when out in public. All of my children were given Yu Ping Feng San to take to build their Wei Qi. They each also had Xiao Chai Hu Tang if they started to experience symptoms and were taught when and how to use it. In the words of my father, of blessed memory, “It’s better to have it and not need it, than need it and not have it.”

As acupuncturists and practitioners of TCM, we were dutifully watching videos from all of our teachers, particularly from John Chen. Learning, ordering herbal medicines (some of which were already out of stock), and planning for what we knew was coming. In mid-March, as many states shut down, COVID-19 was in the HOUSE – our house. Two of my sons had the version that began with a huge and sudden chill, then came fever (no one fevered over 101.5 in the house due to TCM and other supportive tx), cough, nausea, diarrhea and severe headache. Jia Jian Xiao Chai Hu Tang as needed until the symptoms shifted. Shortness of breath was the biggest challenge with the fever. We switched to Jia Jian Qing Fei Tang for their specific symptoms of cough and shortness of breath – Jia Jian with the herbs listed below. My goal was to keep them out of the hospital. So along with TCM we used oregano oil, Vitamin C 1,000 mg 4x/day, Vitamin D3 in a gelcap 4,000 iu/day, Zinc 30 mcg day, NAC, N-acytlcysteine both long and short acting and Kali Bichromium 30C to open the lungs. The NAC and Kali Birchromium both do what Tian Hua Fen does: thin mucus and break up phlegm obstruction.

The shortness of breath experienced in this virus, due to the tenacity of the phlegm, made me want to address the phlegm from different directions. Dr. CS Cheung, Founding President of ACTCM, drilled into us that we have diagnosis, treatment principle and treatment grids in TCM. When we know the functions of a drug or herb or supplement, add it to the grid. This phlegm is thick and tenacious. To open tubules I added eucalyptus chest rub which resolves phlegm and opens tubules and added Sang Bai Pi, Pi Pa Ye, Xing Ren, Tian Hua, Jie Geng and Ban Xia to my herbal formulas. Instead of the typical 1-2x/day, my children (ages 16-27) received 6-8 doses/day.

Goals: keep them 1. out of the hospital and, 2. keep their fever under 103 (if possible), to make their recovery as easy as possible. We were pushing electrolytes all day. We kept the boys separated upstairs on the third floor.

The first two young men to go down responded well. Two days later, one of their sisters presented with a profound earache and throbbing headache behind her eye. Two days later, it was my other daughter. I addressed their symptoms with a different variation of Jia Jian Xiao Chai Hu Tang and later a variation of Qing Fei Tang. We took temperatures with an infrared thermometer and found the last pulse oximeter to be had in Springfield, MA in early March and monitored their pulse oxygenation rates. The girls’ oxygen levels dipped as expected and went down to 93/94 which we could coax up by putting them on their bellies and percussing their backs. Meanwhile, I was having symptoms and was still taking care of the children because my husband did not know the difference between the formulas, or how to take them. Each of my children was unwell for 7-10 days. Two of them got better and then got worse, with significant shortness of breath. Just like when children have whooping cough, sitting with them, breathing with them, in through their nose and out through their mouths, and not panicking matters. Eyes were on the prize which was keeping all of us out of the hospital.

I treated all of the children as I treat patients: by determining diagnosis, treatment principle, and guiding formula. Can we use a patent? Do we want to? Knowing what form of herbs the patient is willing to take does matter. I have patients who would willingly take herbs in the following formulations: as a tincture, granules as tea, granules in capsules and those who would take patents only.

As we were preparing for Passover in the time of COVID-19, child number 6 went down, and child number 3 came home. He came home later than everyone else, was mostly quarantining but had seen his best friend, whose roommate ended up in an ICU to treat COVID-19 by the time he came home. Number 6 had severe headache, fevered for 9 days, was treated appropriately and recovered more easily than those who had cough and shortness of breath. My husband and child number 3 were either impervious or asymptomatic. Neither of them expressed any symptoms.

All of them recovered (although some did have some tachycardia when standing up too quickly for a few weeks and weakness with activity) for several weeks. They did not think they were doing too much too soon but it was too much for their bodies. I liken it to postpartum. Many women want to get up and start to do too much too quickly. In postpartum care, womens’ breasts and their lochia/post birth bleeding are their barometers. Do too much, you bleed more. Do too much, you will get clogged milk ducts. Really don’t pay attention, you may develop mastitis. COVID-19 recovery is a process, not an event. Treating what we see with TCM if we cannot physically get to our patients makes a difference. Knowing what we know and using our skills and the medicine to treat our family? Priceless.

*The information provided here is for healthcare professional practitioners only. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

It is my pleasure to introduce the newest addition to the TCMCeuticals line — MindKalm®, a new formula designed to soothe Liver Qi stagnation with phlegm misting the mind disturbing the Shen. As its name suggests, MindKalm® helps unlock the mind by transforming phlegm, clearing heat and moving the stuck energy of the Liver Qi to clear the mind, creating more peace and harmony within. This formula may help people experiencing emotional distress and mind-body imbalance due to phlegm heat and Liver Qi stagnation*.

*The information provided here is for healthcare professional practitioners only. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

It is a privilege to discuss my thoughts on TCM and Acupuncture and relate some of my observations on the incorporation of its use in Western hospital settings. As a native of Singapore, I am a third-generation practitioner of Traditional Oriental Medicine. One could say I was raised in the medicine.  Both my grandfathers were herbologists and TCM doctors.  While holding earlier business-related degrees from Brigham Young University/Hawaii, I earned my Cardiovascular degree from Santa Fe College in Gainesville, Florida and my Traditional Chinese Medicine Training from East-West College of Natural Medicine in Sarasota, Florida and with that received National Board certification with NCCAOM.  In the last 19 years of practicing both Eastern and Western medicine and running 3 private practices in Florida and Arizona, I have also worked in the Catherization Lab at Bayfront Medical Center in St. Petersburg, Florida; and most recently as a member of the Integrative Medical Team of Banner M.D. Andersen Cancer Center in Gilbert, Arizona.

After cross-country moves from Florida to Alaska and then Arizona, my husband and I settled in Scottsdale/Mesa Arizona where I established 2 practices. It was an exciting opportunity in 2017; I was invited to join the Oncology Integrative Team at M.D. Andersen in Arizona.

TCM has come a long way from the 70’s to present day, from being illegal to practice to now integrating medical practices in some hospitals.  We are standing on the shoulders of many that have come before with their hard work and diligence. I do believe we still have a long way to go. There are different levels of acceptance of TCM practices in hospitals across the US and this varies from state to state. From research acupuncturist working with herbal studies and acupuncture protocols to establish evidence based science to hospitals who just wants acupuncture as an alternative modality because there is a demand. Overall, there is still a lack of understanding and doubt of TCM in the western medical world.

There is definitely an increase in awareness of and interest in the benefits of TCM through the years. This leads to conversations and demands from the healthcare system we presently have. With the participation of the insurance system, that awareness and interest heightens.  Hospitals particularly in the world of oncology are beginning to see the benefits of how acupuncture can help cancer patients alleviate the discomfort and pain that comes with post cancer treatments such as radiation and chemotherapy.  Many patients ask for complementary and alternative medicine (CAM) methods to enhance the efficacy of their cancer treatment, to boost their immune system, and to reduce side effects and increase tolerability of conventional cancer care.  Hence, it is refreshing to see the various forms of alternative care such as yoga, massage, and even essentials oils that facilitate that demand in those hospitals.  Acupuncture a well-established part of TCM and 1 of the oldest treatments, is one of the most frequently requested and offered treatments. In the area of nausea, neuropathy, xerostomia, cancer related fatigue, dsyphsia etc. has led to positive results.

Below are some thoughts that I have observed that might help speed up a true integration that will benefit future patients.  Namely: Increase the amount for evidence based studies on both acupuncture and herbal medicine, secondly, as practitioners we need to work together and bring a unifying effort to have Acupuncturists and Doctors of Traditional Chinese Medicines recognized as key health care providers in ALL 50 states. With this recognition, comes the respect our branch of health care deserves, and along with the compensation equal to other branches of medicine. Lastly, a strong encouragement to all Colleges of TCM to instill in all their graduates a higher level of respect for our selected practice of medicine – one that has now stood the test of time for over two thousand years.

Recently, I had the opportunity to travel to China with TCMZone and a team of TCM colleagues to receive further training on TCM.  I have seen integration of western medicine such as chemotherapy and radiation, and Chinese herbal infusion used on patients post cancer treatments. The results were phenomenal and I can only hope the day will come when our branch of medicine will take its place as equal part of the treatment protocol in our hospitals as well.

*The information provided here is for healthcare professional practitioners only. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

By: Sherri Taylor, L.Ac.

This month we are focusing our attention on TCM for digestive conditions. Digestive conditions are vast and common and TCM offers powerful therapies to support a healthy digestive system*.  Our TCMCeuticals® Digestive line consisting of three (3) formulas for the upper, middle and lower jiao are the fundamental digestive formulas for your practice.  Our formulator, Dr. Haihe Tian’s comprehensive TCMCeuticals® digestive line consists of Esophageal Balance for the upper jiao, Digestive support for the middle jiao and Colon Harmony for the lower jiao*.  These three (3) formulas address the most common patterns of digestive imbalance and are based on Dr. Tian’s years of clinical experience in G.I.*.  Read the description below for Chinese Medicine pattern indicated for each of these formulas.

Esophageal Balance– is appropriate for the upper GI tract and upper jiao.  It is indicated for an excess heat pattern with liver overacting on the stomach.  The chief ingredients in this formula make up Zuo Jin Wan.  The function of this formula is to clear heat and direct rebellious qi downward.  The remaining ingredients assist with directing the rebellious qi downward and preventing chronic conditions*.

Chinese Medicine Pattern– Liver overacting on the stomach with heat*.

Esophageal Balance contains the following ingredients:

**Huang Lian (Chief Herb)

**Wu Zhu Yu (Chief Herb)

These 2 ingredients are the chief herbs that make up Zuo Jin Wan.  Other ingredients include: Chai Hu, Huang Qin, Xiang Fu, Duan Wa Leng Zi, and San Qi.

Digestive Support– promotes the function of the stomach, and middle jiao.  The Chinese Medicine pattern is mainly for Qi stagnation in the stomach.  This may be due to over eating or poor dietary habits.  Digestive Support is also useful for digestive problems due to emotional upset*.

Chinese Medicine Pattern: Spleen and Stomach Qi deficiency with Liver Qi stagnation*.

Digestive Support contains the following ingredients:

**Chai Hu (Chief Herb)

**Xiang Fu (Chief Herb)

**Both of these herbs work together to spread the Liver Qi, regulate the emotions, decrease pain, and balance Liver and Spleen disharmony*.  Other ingredients are Zhi Ke, Da Fu Pi, Xiang Yuan, Fo Shou, Zi Su Geng, Chao Bai Shao, Zhi Gan Cao, and Yan Hu Suo.

Colon Harmony– assists with harmonizing the lower GI tract to help correct the imbalance of   function and bacteria in the lower jiao.  This formula raises the Spleen Qi, improves Spleen function, and soothes the liver*.

Chinese Medicine Pattern- Spleen Yang deficiency with Liver Qi stagnation*.

Colon Harmony contains the following ingredients:

**He Ye (Chief Herb)

**Ge Gen (Chief Herb)

**Xiang Fu (Chief Herb)

These three herbs are the main herbs in this formula. Primarily, these three (3) herbs raise the Spleen Qi and assist with the liver Qi stagnation*.   Other ingredients to assist with this action include Chai Hu, Chao Bai Zhu, Chao Bai Shao, Shan Yao, Rou Gui, and Zhi Gan Cao. 

*The information provided here is for healthcare professional practitioners only. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Oriental medicine practice and utilization in America is in such an exciting period of growth and expansion, and I feel so blessed to be in practice at this time. I did my training in the mid 1990’s in Miami, FL and got my license in early 1997. The times have changed so much, on every front, that many of my students seem so shocked when I tell them stories ‘of the old days’, even though in the grand scheme of things, it was not that long ago.

The most vital aspect of this is the massive increase in awareness of and interest in all aspects of oriental medicine that regular and average citizens have.  This has occurred rapidly and exponentially.  One benefit of this is that doctors and large medical institutions have followed along.  Sometimes driven from the patient level up, and other times because high level accreditations have begun requiring integrative methodologies and integrative medicine departments. And acupuncture is at the top of the list of the most required and desired integrative practices.

I ran a private practice, renting clinical space, in a community hospital based breast cancer center because of a fabulous and progressive Medical Director there. We began this in 2005 and this continued and thrived until 2015, when the hospital created a fully comprehensive Integrative Medicine Department.  It was quite a journey and project, with many trials and tribulations to get to that point, but I am since then happily part of a full department and a well supported program.  I am a full time employee along with a full support staff, a second, part time acupuncturist, a nurse practitioner, and a full time Integrative Medicine Doctor, trained by Andrew Weil.  We partner with other departments and programs throughout the hospital that provide massage, yoga, diet and nutrition, mindful meditation, and exercise.

Integrative practice, whether hospital based or not, is not suited for everyone, nor is everyone suited for it.  I love it and find it compelling and stimulating, but it also has challenges and requires compromises.  TCMzone has asked me to do a webinar with them this month.  I will be sharing and providing a wide spectrum of information about hospital based integrative acupuncture practice, including aspects of my own experience.  I will cover the major topics for those curious about hospital based practice.  In a second webinar, also this month, I will cover necessary components and attributes of good quality professional medical records.  This is a vital aspect that we must all strive to do well, especially as we seek greater utilization and more respect by patients and the overall health care system.

Since 2000, I have been a teacher at several schools in our profession, all in Florida.  I absolutely love being a teacher.  I teach in the classroom and continuing education.   I have learned so much from teaching and preparing lectures. I have learned so much from my students. The interaction in the classroom and in seminars is invigorating, and every year the enthusiasm, passion and drive of those in our profession increases.  As someone in the later portion of their career, this is beautiful and I can only imagine how much further they will all take us.

From 2004 to 2010 I had the pleasure to serve as President of the Florida State Oriental Medicine Association (FSOMA). This was an amazing experience and I learned so much and met so many people, all working hard to spread the word and power of oriental medicine, helping us all move forward and come out of the shadows.  FSOMA recently decided to undertake an expensive and difficult task, to challenge the Florida Board of Physical Therapy that had decided to add ‘dry needling’ to their scope. This took great courage and hard work, and required that lots of money be raised.  Just days ago the judge for the case ruled that the Board of Physical Therapy overstepped their authority and ruled against their ability to add ‘dry needling’.  The judge ALSO ruled that ‘dry needling’ IS acupuncture. This is huge.  And this is all extra special because too often acupuncturists do not adequately or consistently enough step forward and donate the kind of money these issues and battles require. This topic is likely not done here in Florida, but the good news is that it has stirred us up and unified us.

Going in to my 22^nd year of being licensed and practicing, I have seen and learned and experienced many things. All the way from the days when acupuncturists were arrested for practicing, to having patients of mine tell me that their doctors told them not to do acupuncture. I have seen the amount of licensees in Florida triple and the myths and misconceptions of acupuncture fade away. It is an exciting time for us all and the future will only bring more.

It is a delight to be a webinar presenter for TCMzone.  TCMzone has recorded versions of webinars we have done in the past, available for earning CEUs and NCCAOM PDA’s, including the required topics of Ethics and Safety, including Herbal Safety.

*The information provided here is for healthcare professional practitioners only. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Medicine is the only profession I ever considered. I earned my medical degree from Beijing University of Chinese Medicine in 1987 and then my Masters of Science in Integrated Clinical Medicine. I have always believed that every patient deserves personalized treatment and so this is how I conduct my practice. Based on the individual conditions, I design a treatment plan specific to each person using acupuncture, herbal treatments, dietary recommendations, and lifestyle counseling.  In order to customize my herbal treatments I find using TCMzone granule packets to be the absolute best methodology for a safe, effective, and simple plan.

First, the granule packets are safe for my patients. Not only are the TCMzone granules manufactured at GMP facilities and tested for quality assurance before packaged. The packets themselves offer a sense of confidence to my patients when they open them for the first time at home. Each dose comes sealed and labeled with lot number, name and amount, adding to higher patient compliance.

Second, the TCMzone granule packets are effective. This comes down to manufacturing and quality standards. However, the TCMzone packets in both single herbs and formulas also allow me, as the practitioner, to customize my herbal protocols for each patient condition. I can modify a granule packet formula by adding sealed single herbs to the protocol or I can build my own herbal formula using the single herb packets to address specific conditions.

Finally, the granule packets are convenient. They are simple in packaging for my patients to use. They are easy to open and pour into water to make their daily tea, drinking half in the a.m and remainder in the evening. They are also easy for my patients to travel with and to carry. They can keep the granule packets in their purse, luggage, pockets and take during their travels or work day.  This dosage form offers my patients convenience, which is essential when taking Chinese herbs.

*The information provided here is for healthcare professional practitioners only. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.