The Qi-Unity Report Interviews Mitch Stargrove

Mitch Stargrove teaches at Oregon College of Oriental Medicine. He practices at A WellSpring of Natural Health in Beaverton, Oregon, both as a licensed acupuncturist and a naturopathic physician along with his partner, Lori Beth Stargrove, ND. He is the developer and editor-in-chief of IBIS - the Integrative BodyMind Information System (MedicineWorks.com 1992-2009) as well as editor and co-author of Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies (MosbyElsevier 2008). Stargrove teaches “History of Medicine: East and West” at the Oregon College of Oriental Medicine and has previously taught “The History of Medicine” at National College of Naturopathic Medicine. Both schools are in Portland, Oregon. He is currently serving as a history editor in the landmark Foundations of Naturopathic Medicine publishing project.

QUR: You have studied both AOM and naturopathic medicine. How well do you think these modalities work together?

The experience of vitality, a trust in nature, and an emphasis on personal self-cultivation based on embodying perennial values are fundamental to both Chinese and naturopathic medicine. Likewise, the Minnesotan in me welcomes the pragmatic open-mindedness of both traditions. I have been known to call myself a “Chinese Naturopath” when teaching history of medicine to the first year students at Oregon College of Oriental Medicine (OCOM).

I have always loved the simple shamanic magick of acupuncture and the enduring wisdom of the three worlds model of the body and the cosmos as embodied in the three jiao. I feel very much at home with Chinese medicine. However, I have always felt equally at home with the natural medicine traditions of the West. Jung frequently told Westerners that they didn’t need to go to the East for meaningful spiritual insights and experience; that the mythic and esoteric traditions of Western civilization could provide rich roots for personal spiritual development. Furthermore, I tend to squawk when people refer to the allopathic tradition of conventional medicine as “Western medicine” since homeopathy and American eclectic herbal medicine are among the many traditions of Western medicine, to say nothing of Lakota or Cherokee medicine.

Ultimately, the confluence of many inspirations and teachers, therapies and traditions has put me in a place where many of us feel like we have landed, as pioneers in a new medicine that we can practice more readily than we can articulate, and which all see as helping our patients, but we also know that we are learning, discovering and creating together everyday. The principles of natural medicine are timeless, but our expression is a fresh and unique response to opportunities and challenges never before encountered in medicine anywhere. Thus, as an historian and student of Chinese culture, I have a deep love and respect for the worldview and the medicine, but I am not a sinologist or language specialist. So, ultimately, while respecting scholastic rigor and the strident emphasis on accuracy in translation and claims of some contemporary teachers, I really focus most on primary experience, my own and that of my patients, as being the only real information I have. I apply metaphorical and systems theory approaches to physiology and pathophysiology, therapy and health. That way, in the end, I like to stand on the foundation of accurate transmission of the Chinese and other traditions, and then improvise through insight, experimentation and discovery. It’s like playing jazz—you experience the feel of the blues tradition and learn to play chord changes, then you can expand your improvising and aim for the expressive genius of Charlie Parker or John Coltrane.

Many of my patients refer to me as their acupuncturist rather than any other type of doctor because that is the component that they can most readily identify. In clinical practice my intake combines Chinese questioning, pulse and tongue, homeopathic nuances of history and response pattern, naturopathic and osteopathic structural analysis, and a humble respect for the privilege of sharing each individual’s story and life myth. I weave together several hands-on therapies such as acupuncture (influenced by Chinese, Japanese, and American teachers) and gentle musculoskeletal manipulation with Chinese and Western herbs, dietary and nutrient recommendations, and initial homeopathic prescriptions with the aim of removing the obstacles to self-healing and supporting vitality and self-discovery.

Through subsequent visits I might also incorporate medical astrology and guided imagery journeys, provocative life experiments and constitutional homeopathy. Amidst an evolving and varied mix of interventions, I remind each patient that they are “driving,” and that I am just a passenger with some maps of possibilities.” I prefer treating as little as possible so as to cultivate the person’s independence, aware of their own inner self-healing powers and confidence in their own evolutionary momentum. In particular, I enjoy quoting ancient Daoist philosophy and then reframing it in terms of the model of self-organizing systems and information theory. Thus, clearing the noise from their system, enhancing their ability to pay attention and learn from the feedback of experience plays a more central role than fixing diagnoses or abiding by externally imposed rules and restrictions.

Ultimately, I love doing acupuncture with people because it is really a “magical” art of breaking up old bodily habits, hitting the reset button to tune them into primordial health and the effulgent generosity of the universe, and invoking power and dreams to manifestation for a better life. They always leave different, better, clearer and stronger, than when they came in. I especially love pointing out to them that we didn’t add anything to them, like a drug, herbs or even food; we just reorganized them—then I see them smile with that “Aha!” smile and a sparkle in their eyes. Heaven and Earth are communicating and the qi is flowing, just the way it really is all the time. I began to weave these various models and therapies together in the years before I entered school and, as the years proceed, I don’t know how to separate them. Fortunately every patient tells you in words, voice tone or gesture what is going on with them and what they need.

QUR: In what ways do your different educational backgrounds complement each other?

I came to natural medicine through community organizing and food co-ops on the one hand and Daoist philosophy and “Western” shamanic herbal traditions on the other. I came to Oregon to weave those streams together into a career that was meaningful, revolutionary, and prosperous. As a student of OCOM during its birthing, literally within NCNM, I studied both as a student as a classmate with Satya Ambrose, ND, LAc who came from Boston to set up a Chinese medicine program at NCNM while also working toward her naturopathic doctorate. Through Satya and several others from the New England School I studied the acupuncture lineage of Dr. James Tin Yau So.

Going to naturopathic school in the morning and early afternoon, going to acupuncture classes in the later afternoon and evening, and then going home to study both alone or with friends meant the two programs were always intertwined. That’s also simply the reality of being in Portland, which could reasonably be considered the - or at least an - epicenter of natural medicine in the world. After graduating from OCOM and then NCNM I had the privilege of working with Eric Stephens, LAc the other co-founder of OCOM. Based on my trajectory I guess I was bound to be a postmodern American eclectic acupuncturist.

Both schools and cultures emphasized an empirical and vitalistic approach with an openness to and respect for both tradition and innovation. Still, I often bemoaned the tendency in the naturopathic world to hide from the esoteric aspects of the Western medical traditions, especially in contrast to the Chinese openness to the subtle and “magickal”. If you are defensive about vitalism and trying hard to be accepted as “scientific” then it’s awkward to be upfront about alchemy, astrology and subtle energetics. Sure “TCM” is a modernist and materialist school of Chinese medicine, but I was never subject to an exclusivist “TCM-is-Chinese medicine” view except in those Foreign Language Press textbooks. When Heiner Fruehauf, PhD moved to Portland to set up a classical Chinese medicine program at NCNM, I was happy to build relationships with many of those folks and have been especially honored to study the JinJing Gong school of qigong with Heiner’s master Prof. Wang Qingyu. Ultimately, I see a beautiful creative community here in Portland where service and compassion, vision, and real-world outcomes are all valued and healthy disagreements are welcome.

QUR: Your recent book on drug interactions should be very helpful to practitioners. How does your book differ from earlier attempts to write books on this subject?

I see my nearly two decades of tracking and assessing drug-herb and drug-nutrient interactions as just another expression of Midwestern pragmatism and visionary enthusiasm aimed at respecting patient choices and bringing together whatever works in a sensible collaborative strategy. Together with renowned nutritional oncologist Dwight McKee, MD and English medical herbalist Jonathan Treasure, I recently published a 900+ page text (and online database) on the good and bad and the when and the how of interactions. We first put out a CD on the subject in 1999, so this is really a second edition with five years of actual content creation. Our approach is broad and deep, it is comprehensive in the sense of comprehending the issues and data. Sure we have lots of footnotes, literally 300 pages or so of citations and reference literature bibliography that’s on a CD to save paper, but we are unique in emphasizing a clinical perspective foremost with a heavy bias toward facilitating the therapeutic relationship. Unlike most if not all other books or resources on the subject which have been done by PharmDs or academic MDs (or higher hands), ours was put together and reviewed by clinicians who have practiced this medicine daily for decades with primary focus being on oncology and family practice.

We sought to change the framework and the language of the interactions discussion. All the substances that patients are taking need to be put on the table and treated equally as therapeutic agents with an eye toward efficacy and safety, and tactics and strategy, not viewed as “natural” or “drugs” but like the Chinese herbalists do, according to what they do, how they do, or don’t work together, and how they fit together in an individualized and evolving strategy. Unlike other texts on the controversial subject of interactions, we emphasize real world assessments of the scientific literature and clinical implications with the goal of presenting practical suggestions for safe and effective mixing and matching of herbs and nutrients with pharmaceutical drugs.

Specifically, we review the available literature from a wide range of disciplines, separate the well-documented and reasonable interactions from the preliminary, speculative, and ill-founded, and then assess each substantiated interaction according to its character, the volume and quality of evidence, and the probability of a clinically significant effect. Overall, we found that most interactions are beneficial, such as when nutrients are supplied to counter depletion by drug or when herbs or nutrients synergize to increase the therapeutic activity of a drug therapy or otherwise mitigate the adverse effects of drugs.

Certain herbs or nutrients simply won’t be effective or could cause problems when taken concomitantly with specific drugs. Either their pharmacology is antagonistic or they are strategically at odds. However, more often clinical management of timing, dose titration and/or sequential application can neutralize potential conflicts. In notable situations, interference is simply inherent, such as when an herb or nutrient accelerates the body’s detoxification processes and hence the breakdown of a medication with toxic properties. Strategic collaboration among healthcare professionals applying integrative principles highlights the single biggest challenge and opportunity presented by the interactions dynamic in clinical practice. For example, if a patient is on hypertensive medications, and I prescribe nutrients and herbs that enhance his / her healthy function and reduce dysfunction, then the patient’s blood pressure will drop. That would be great in isolation, but the patient will develop low blood pressure if he or she maintains the originally prescribed drug doses. Thus, we need to increase the herb/nutrient dosage levels while gradually reducing the medication dosage levels. This can ideally be accomplished by working in concert with the MD who prescribed the drug.

We position ourselves as ultimately quite conservative, with a pragmatic and open-minded approach, using a judicious reading of the literature, respect for patient empowerment, and enhancing therapeutic outcomes as our highest values. The preface of the text discusses shortcomings in the interactions literature and what we have done to raise the standard of the discussion through innovative methods and models.

In each monograph we use the literature review and explication of clinical implication and practical suggestions to embed assumptions of full disclosure, conscious choice and medical pluralism. We enjoy debunking much of the ill-founded hype and hysteria in the popular press and medical publications. A high percentage of claims about herbs and nutrients are simply not based on clinical experience or scientific evidence. Thus, we consider it our duty to track down the original case reports and analyze the details of research papers so that we can uncover and rectify spurious and misleading claims that get perpetuated by writers who apparently never dig into the sources of some oft-repeated claims.

Further, unlike other authors, we don’t label herbs and nutrients as “supplements.” We are not health food stores working under DHSEA, and I am quite sure that when we say “tonify” we mean something quite different than meeting minimal survival levels of RDAs. Sure, when a nutrient is countering a depletion, it might be a “supplement,” but we are using natural substances as therapeutic agents, and no strategy can be effective unless all agents are treated equally without regard to their origins. While no one seems willing to push back when we emphasize the primacy of respecting patient choice, sometimes we end up getting criticized for accepting the reality of conventional drug therapies, but more often we get surprised looks for saying that herbs and nutrients are potent and need to be treated with respect. Still, that is the reality of the patients who come to see us and our job is to help move them from disease to recovery to enrichment and enlivenment.

On a practical level we don’t see the point of basing a patient’s life around drug dosing and stable blood levels as an end in itself. Sure, we need to respect the narrow therapeutic range of many medications, but what is the real goal? If taking warfarin means that you aren’t supposed to eat the dark green vegetables that are known to benefit the cardiovascular system then are we getting our priorities upside down? Not that you should go tinkering with dosing of warfarin or any other medication without appropriate monitoring and management, but titrating the levels of drugs to suit the evolving patient status makes the most sense. As an ND in Oregon, I can prescribe hundreds of drugs and soon will be able to prescribe nearly all commonly used ones.

I rarely initiate a pharmaceutical prescription apart from thyroid or bioidentical hormones and the infrequent antibiotics for pneumonia or a kidney infection. Many patients who come to see me are already taking certain medications and they would like to expand their therapies beyond narrow reliance on them, wean themselves off them, or work to enhance overall safety and efficacy through natural medicine. Thus, the point is continuity of care and the ability to craft an individualized program of herbs and nutrients, as well as acupuncture, homeopathy, lifestyle changes, etc. to treat their problems, reorganize the underlying patterns, and improve their lives as healthy creative people.

After all, wouldn’t most patients prefer to use the minimum drug doses necessary to achieve the intended effects? Wouldn’t a sensible MD or pharmacist agree with that agenda? It certainly makes sense from the standpoint of minimizing risk of adverse effects, let alone reducing financial costs. Even more so, where does the question of living for stable drug levels logically lead? Should we avoid exercise and just sit on the couch because increased blood flow from invigorating activities will usually increase the rate of drug metabolism? Should we all eat cardboard because the nutrients in healthy foods might interfere with, enhance the action of, or alter the metabolism of certain drugs? All that says nothing of how informational therapies such as acupuncture and homeopathy can alter drug metabolism by enhancing physiologic function and treating the underlying condition(s). Ultimately, are we treating a disease or working to improve the healthy function and daily life experience of the person who is the patient?

QUR: What cultural barriers do you think hinder the movement toward a truly integrative approach to medicine?

The cultural barriers that might limit the emergence of natural medicine traditions as the core and foundation of integrative healthcare are the same ones that threaten our survival as a species and as a planet. I am working to manifest and build living institutions that evolve the ideal of a process-oriented approach implied by the integrative approach to collaborative care. Of course, there are the big and deep issues like antagonistic dualism underlying anti-Earth and anti-body cultural prejudices, reductionist approaches to science and knowledge, and disconnected political and economic institutions that adversely affect a lot more than medicine. However, in the world we make within our own lives and communities, dogma, lingering illusions of modernism and naïve fantasies about our own traditions might be the biggest factors in slowing what I hope is an inevitable process toward a healthier, more comprehensive and more proactive approach to health, medicine and culture.

The traditions of natural medicine are historically dominant and will subsume scientific advances in the service of increasing demand by the public for safe, effective and less expensive healthcare based on health promotion rather than just disease treatment. We get results that patients appreciate and tell their friends and family about, and when we don’t help get people better we need to be frank and sincere in supporting them through the incurable. Ultimately, how can the momentum of natural medicine fail when conventional medicine doesn’t comprehend tonification or have a model for vitality and inner peace as core to healthy physiology? Do we have any other choice in our practices and in our daily lives?

QUR: Could you please introduce IBIS and some of the history behind how it developed?

While launching my acupuncture practice and working through the last year of naturopathic education I saw an emerging challenge facing me and my colleagues: As we get busier, when and how will we be able to access all the valuable educational and reference materials we have accumulated over the years and would presumably continue to gather? My response was to design a multidisciplinary database named in honor of Tahuti, the ancient ibis-headed Egyptian god of books and wisdom, medicine and alchemy. I gathered together over one hundred students, faculty and experienced practitioners from the naturopathic and Chinese medicine community in the Pacific Northwest to create IBIS (initially the Interactive BodyMind Information System). When it was first released in 1992 after four year of development, the first edition of IBIS compiled 12,000 pages of data including therapeutic perspectives on 282 conditions organized from the most “dense” (e.g., bodywork, nutrition and herbs) to the more subtle (e.g., acupuncture, homeopathy and psychospiritual approaches) and nearly 5000 associated materia medica files.

Framing it all as a giant hypothesis rather than a catalog of “answers”, we were free to ask not just what did the “scientific evidence” show but what did the classics of each field tell us and what were experienced practitioners actually doing in their practices. We were describing more than prescribing. Not only was IBIS the pioneer multidisciplinary therapeutic database published, it also provided innovative tools for clinicians to append their own notes into the database structure and track patients for simple outcomes research analysis. Beyond quality, depth and comprehensiveness in gathering of the spectrum of natural medicine traditions, my secret agenda was to make sure the esoteric and controversial aspects of those traditions didn’t get lost in all the rush to modernization and acceptance in the marketplace. So, on the one hand I wanted to tap into the Jing root nourishment of our traditions and the great physicians and healers of the past, and on the other, create a place for innovation, discovery and collaboration. Over the subsequent nearly two decades, IBIS became a familiar tool to many practitioners and students throughout the breadth of the natural medicine world, with over 10,000 users.

QUR: How do you feel IBIS will facilitate the movement toward integrative medicine?

The model of IBIS achieves the goal of reframing healthcare options through its very structure and method. It shows that many perspectives on each issue exist, that different approaches have worked through history, and that conventional medicine has a distinct but often limited place in the whole scope of opportunities. IBIS embodies what I call the Galenic dilemma and presumably offers a model to reconcile some deep theoretical issues and avert the damaging compromising some of us foresee as potentially harmful trends. In ancient Rome, Galen, the real father of Western medical practice, started out as an experimenter, a rebel, an empiricist, but as he built up his body of knowledge he increasingly began to frame it in a rational construct of idealized disease entities and increasingly formulaic responses. Hence the problem any Chinese medicine practitioner or homeopath faces when confronted by a patient (or another practitioner) with a conventional diagnosis: yes, but what kind of arthritis, asthma, irritable bowel, dermatitis, etc.? Who is having the problem, and how are they experiencing it? Once we start to answer these question we can do a differential diagnosis and start to address the pattern of which the diagnosed condition is just one aspect and work to support that individual’s response to the distortion, distress and limitations expressed in the disease process. Thus, in IBIS, if you look up a condition such as low back pain or eczema you will soon find yourself going through that narrow doorway into hallway where each room is full of possibilities and a presentation that moves you from the problem to the pattern(s) to the person. This way IBIS enables a practitioner or student to craft multi-modality treatment strategies or simply to learn more about what other practitioners are prescribing for their shared patients. Moving beyond being overwhelmed and being able to quickly access a huge range of options makes the process of dialogue, collaboration, and care delivery much easier without forcing anyone to operate at a lowest common denominator level— which compromises a practitioner’s traditions, models and methods. The ability of practitioners to track and assess clinical outcomes also challenges us to be skeptical about our therapies and refine our application of them over time.

QUR: You have mentioned that use of TCM theory can help to guide practitioners on how to advice patients on allopathic drugs. How does this work?

When people ask me what I think about the much-lauded vision of “integrative medicine” I have been known to mention Gandhi’s response when asked what he thought of Western civilization: “It would be a good idea.” More than just taking substances or procedures out of the context of various natural medicine traditions and applying them within the conventional allopathic model, such as St. Johns Wort for “depression,” I emphasize that the deeper and lasting value of natural medicine traditions comes from their philosophies and models, their view of the cosmos, and the vital intelligence within self-organizing systems of nature.

Qi is the best innovation that acupuncture can bring to medicine, not just treatments for generic low back pain, indigestion or migraines. Especially in light of the issues posed by interactions, I will always assert that there is a lot more value in applying the methods and models of Chinese medicine and homeopathy to personalize care for patients than there is in incorporating individual practices or substances into conventional models. Thus, I would rather use Chinese differential diagnosis to sort appropriate antidepressant drugs for patients diagnosed with generic “depression” than to apply Chinese or Western herbs within a materialist reductionist diagnostic and care model. Ultimately, our first loyalty has to be to our patients and their health rather than to our professions or favorite therapies.

QUR: Where can practitioners learn more information about the wiki you are developing for IBIS?

After twenty years of developing IBIS as software, first on floppy disks and then on CD-ROMs, I am happy to be moving into a new approach that will open IBIS up to a quantum leap in content and collaboration. We are flipping IBIS from a static content edition-based model to a Wiki-like structure with tools for community members to build the content to include all that they feel is important to have available. So when someone cares a lot about a topic, be it an herb or formula, an acupuncture technique, a diagnostic method or bodywork technique, they won’t need to send it to me to put into my “next edition” file; instead, they can join and share what they know and the resources they have found to be valuable. As the communities grow we will have real peer review because as we all know the people in natural medicine are enthusiastic, sometimes even nearly obsessive about the medicine they practice.

Around this growing encyclopedia, starting with 12,000 pages of IBIS as the foundation, we will be hosting profiles and communities, blogs and forums through a social networking system for practitioners and students, general public members, institutions and businesses. So, if you want more than the gossip and meandering of Facebook or MySpace you will be able to connect with your friends and colleagues, build new relationships, and cultivate the future of natural medicine and integrative healthcare. We already know that it will be fun, help us serve our patients better, and enhance the quality of the discussion of healthcare options. That’s why we call it “choicesforhealth”. You’ll be able to learn more through www.MedicineWorks.com