Online Health Chat with Jamie Starkey, LAc, and Galina Roofener, LAc
June 25, 2014
Herbal therapy is important in traditional Chinese medicine. It has been used for centuries in China, where herbs are considered fundamental therapy for many acute and chronic conditions. Like acupuncture, Chinese herbs can address unhealthy body patterns that manifest in a variety of symptoms and complaints. The aims of Chinese herbal therapy are to help you regain balance in your body and to strengthen your body’s resistance to disease. Chinese herbs may be used to:
- Decrease cold/flu symptoms
- Increase your energy
- Improve your breathing
- Improve digestion
- Improve your sleep
- Decrease pain
- Improve menopausal symptoms
- Help regulate menstrual cycles (if infertility is an issue)
Chinese herbal therapy can also be valuable following cancer treatment to aid the body’s recovery from the after-effects of chemotherapy and/or radiation. Chinese herbs are useful in the rehabilitation from many chronic diseases, as well. Chinese herbal therapy may be recommended when you have multiple symptoms or symptoms that are hard to pinpoint, or if you have exhausted traditional medical options and nothing seems to help. Chinese herbal medicine may also be useful when you need therapy to counteract side effects of prescription medications. Finally, Chinese herbal therapy is beneficial as preventive medicine.
About the Speakers
Jamie Starkey, LAc, is the lead acupuncturist at Cleveland Clinic’s Center for Integrative Medicine. She earned a Master’s degree in acupuncture at the American Institute of Alternative Medicine in Columbus, Ohio. She completed a clinical internship in the Acupuncture and Moxibustion Outpatient Department (an affiliate of the China Academy of Traditional Chinese Medicine) at Guang AnMen Hospital in Beijing, China. Jamie is a Diplomate of Acupuncture with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) and holds her acupuncture license from the Ohio State Medical Board. Additionally, Jamie is a Level II Reiki practitioner.
Galina Roofener, LAc, is a nationally board-certified, and Ohio- and Florida-state-licensed acupuncturist. Galina received her degree in oriental medicine from East West College of Natural Medicine, in Sarasota, Fla. She also earned a Doctor of Naturopathy degree from Trinity College of Natural Health in Warsaw, Il. She has received multiple certifications in various modalities of alternative and complementary medicine.
Let’s Chat About What You Should Know about Chinese Herbal Therapy
Moderator: Welcome to our chat today with Cleveland Clinic acupuncturists and oriental medicine specialists Jamie Starkey, LAc, and Galina Roofener, LAc. We are thrilled to have them here with us to share their knowledge about Chinese herbal therapies.
Pjs1982: How is the Chinese herbal treatment approach different from the Western pharmaceutical way of treatment?
Jamie_Starkey,_LAc: In conventional medicine, a person’s chief complaint is often solely identified and treated, sometimes with no regard to co-morbidities. For example, if you complain about irregular periods, you may be prescribed a contraceptive pill that will make your period more regular. However, adjuvant symptoms such as irritable bowel, headache, irritability and neck pain will not be affected. The Eastern Medicine approach to treatment is slightly different. When you come to an Oriental Medicine practitioner, you will be questioned about all of your symptoms. The goal in Eastern Medicine is to address the underlying cause of all of these symptoms, thus we say we are treating the “patterns of disharmony.”
ldydolphin: Is there a list of which herbs to take for which purposes?
Jamie_Starkey,_LAc: Chinese herbal medicine is not a substitute for conventional medical treatment. There are specific conditions that Chinese herbal medicine can help manage. You can visit our website to get a full list of conditions we routinely see here at the Tanya I. Edwards MD Center for Integrative Medicine.
goldfish: Are herbal medicines available online or would I have to go to a medical practitioner to obtain them?
Galina_Roofener,_LAc: You must see a certified Chinese herbalist for a prescription that is correct for YOU.
lindsay: Why are Chinese herbs called formulas? What does that mean?
Jamie_Starkey,_LAc: Frequently, patients present with multiple symptoms; for example, irregular periods, PMS, irritable bowel, headache, irritability and neck pain. An herbalist will need several herbs to address all of these symptoms, so he or she will combine these herbs in a very specific order. This combination of herbs is called an herbal formula. Combining the herbs also enhances their therapeutic potential and safety of use.
loveitaly: Do Chinese herbs interact adversely with traditional medications?
Jamie_Starkey,_LAc: When taking Chinese herbs, you do need to be incredibly mindful of drug-herb interactions, which is why it is crucial that you see an herbalist who is very well versed in drug-herb interactions and who can work very closely with your prescribing physician.
Galina_Roofener,_LAc: Herbs may interact with conventional medicines. That is why we request your medical records and limit the number of Western drugs to five for acceptance into the Herbal Clinic. We accept children older than 12 in our Herbal Clinic.
theoneandonly: How frequently do I need to see an herbalist?
Galina_Roofener,_LAc: It depends upon whether your condition is acute or chronic. The more acute and severe conditions oftentimes require more frequent visits to the herbalist; however, the treatment period will be shorter. For example, if you have a common cold, taking a dose of Chinese herbs for one week may be sufficient. On the other hand, if you have been sick for 30 years, you may have to take herbs for a much longer span of time.
loveitaly: What are the most commonly treated conditions in Chinese medicine?
Jamie_Starkey,_LAc: The most common reasons Chinese herbs are used are to:
- Decrease cold/flu symptoms
- Increase your energy
- Improve your breathing
- Improve digestion
- Improve your sleep
- Decrease pain
- Improve menopausal symptoms
- Help regulate menstrual cycles (if infertility is an issue)
ldsuz: How do I know who to make an appointment with? How do I find a good herbalist?
Jamie_Starkey,_LAc: You can go to your state oriental medicine association and/or visit the National Certification Commission for Acupuncture and Oriental Medicine's website to look for a certified practitioner in your area: www.nccaom.org/find-a-nccaom-certified-practitioner.
Zee: Which herbs would improve mobility in someone with arthritic hips and knees?
Galina_Roofener,_LAc: The effectiveness of herbs depends upon which type of arthritis you have: osteoarthritis, rheumatoid or psoriatic. Additionally, results are variable depending on how severe the arthritis is, complete cartilage deterioration or inflammation, etc. Therefore, I would need to know the type of arthritis you have.
Jamie_Starkey,_LAc: Acupuncture is also a great option to manage pain in the hips and knees secondary to arthritis.
loveitaly: Is Chinese Medicine effective for epilepsy?
Jamie_Starkey,_LAc: Chinese Medicine may be helpful in managing symptoms related to epilepsy, especially in decreasing frequency, intensity and duration of seizures. However, it is not a cure.
Galina_Roofener,_LAc: Chinese herbal therapy may be a valuable addition to your regimen. Effectiveness depends on the severity and length of the time that you have had your condition. Herbs will not cure epilepsy but may be beneficial in reducing severity and frequency of the attacks, as well as in addressing coexisting issues, such as sleep, digestion, anxiety, etc.
ommom: Which herbal therapies can be used to replace Cipro® (ciprofloxacin) to treat chronic pouchitis?
Galina_Roofener,_LAc: There are herbs that have antibiotic actions and can be used instead of or in combination with conventional antibiotics. For example, Huang Qin, LianQiao. It is also important in chronic conditions to regulate the immune system to increase your resistance to disease. That is why we normally administer herbs in formulas and not as single herbs.
ommom: Are there any internal and/or external herbal therapies that can be used to heal an anorectal abscess and anal fistula?
Galina_Roofener,_LAc: Yes, there are herbs can be administered orally and as enemas, douches, poultices, suppositories, etc. The type of herbal therapy depends on the specific need of the patient.
bigjohn40: Are there herbs that can help with COPD?
Jamie_Starkey,_LAc: A recent 2014 systematic review published in the journal Evidenced Based Complementary and Alternative Medicine looked at approximately 176 clinical trials, both in Chinese and English. While they did note that the Chinese herbs, as an adjunct therapy to conventional medicine, were helpful in improving clinical symptoms of COPD and improving quality of life scores, the authors concluded that more large-scale double-blind studies needed to be performed.
We are unable to tell you specifically which Chinese herbs are helpful in your specific condition because a licensed Chinese herbalist would need to spend a considerable amount of time with you, reviewing your past and current medical condition. We have a very sophisticated process by which we diagnose disorders. Rather than treating the symptoms, we treat the pattern of symptoms with which the patient presents. As a result, your herbal prescription is very patient-centered and tailored to your specific needs. It is also imperative that the herbalist know your current list of medications to mitigate any potential drug-herb interactions. In addition, the herbalist should work very closely with your pulmonologist.
Quality of product is crucial, so speak with your herbalist about the products they are offering. At the Tanya I. Edwards MD Center for Integrative Medicine, we take a considerable amount of time investigating the products we recommend and use only pharmaceutical-grade herbs.
Gail Ann: Can Chinese herbal therapy help a person who has hypothyroidism?
Galina_Roofener,_LAc: We do have herbal medicines that can be used for thyroid issues. Which herbs should be used depends on whether or not you take thyroid replacement medicines. To answer whether herbs would be used in addition to medication or in lieu of medication depends on what the exact problem is: Hashimoto, Grave’s or simple hypothyroidism, in addition to the levels of TSH, T4, Free T3, Reverse T3, PTO etc. Chinese herbalists would work in conjunction with your physician to create the best treatment plan for your condition.
goldfish: Are there specific Chinese medicines that successfully treat nocturia?
Galina_Roofener,_LAc: We have many herbs available for nocturia.
Gail Ann: Is there any Chinese herbal medicine that can be prescribed to aid in dissolving kidney stones?
Galina_Roofener,_LAc: There are Chinese herbs that may be useful for stones in the kidneys as well as the gallbladder. However, before you explore herbal therapy, you must have a urinalysis and ultrasound done to determine the size of the stones, their location and composition. Then, the exact herbs and their usage safety can be determined.
more info: Would Chinese herbal therapy help for the pain of shingles or chronic kidney disease?
Galina_Roofener,_LAc: The sooner you come to the Herbal Clinic, the more effective we will be. Herbs that we use for shingles are perfectly compatible with antiviral medicines. You may want to include acupuncture into your treatment regimen, as well.
wilsx4: Have there been any herbal therapy successes in treating children with high-functioning autism?
Galina_Roofener,_LAc: There is no data to support that herbal therapy can “cure” autism. However, it may possibly help to mitigate some of the issues that are a result of the diagnosis, such as gastrointestinal and focusing problems. We accept children 12 and older in our Herbal Clinic. In addition, a child with autism may benefit from acupuncture, as well as a consult with a physician who specializes in integrative medicine.
kdavis3220: Are there any treatments for plantar fasciitis?
Jamie_Starkey,_LAc: Acupuncture is a fantastic option for plantar fasciitis to help with reducing pain and inflammation. Also, be sure you have consulted with your orthopedist or podiatrist to look into custom made orthotics.
barack: Can herbal therapy help with hair loss?
Galina_Roofener,_LAc: It depends on the cause of the hair loss. If it is patchy alopecia, stress related, we can be very successful. If it is genetic alopecia, not so much. There are myriad causes in between on which herbs can have some effect.
mmartincin: Can herbal medicine help with high blood pressure?
Galina_Roofener,_LAc: There is a possibility that herbs may be a useful therapy for you. To determine which herbs need to be used is similar to Western medicine -- it depends on the cause of the high blood pressure. Is it a problem with your kidneys and you need diuretics? Is it a problem with blood vessel tension? Is it stress related? To answer whether herbs would be used in addition to medication or in lieu of medication depends on what is the exact problem and what are your current blood pressure levels.
Jamie_Starkey,_LAc: You may also want to include acupuncture into your treatment regime as an adjunct form of therapy. It is endorsed by the World Health Organization for the treatment of hypertension. In addition, a meta-analysis published in 2014 in Evidence Based Complementary and Alternative Medicine looked at acupuncture in the treatment of essential hypertension. The authors concluded that acupuncture WITH anti-hypertensive medicines yielded the most benefit. Acupuncture would not pose any contraindications with your conventional treatment.
janiceasad: Can Red Panax Ginseng really help you lose weight and give you energy?
Galina_Roofener,_LAc: There may be many reasons why you are tired and gaining weight. Red Ginseng is NOT an answer for tiredness. In the lingo of Traditional Chinese Medicine, we say that some tiredness comes from deficiency, and stimulants such as Ginseng or B group vitamins may have a good effect. But tiredness may also come from stagnation. Then, you will feel much better after movement/exercise. In this case, you need completely different herbs, for example Chai Hu, Bai Zhu, etc. You always want to see a Chinese herbalist to determine what your scenario is and to get the proper herbal prescription for you. You may also want to check your thyroid and make sure that your levels are within functional parameters. Our integrative medicine physicians are best qualified to address this issue.
kdavis3220: Are there any herbal supplements to treat ADHD?
Galina_Roofener,_LAc: Chinese herbs may be very useful. There are about six different patterns of disharmony that will manifest as ADHD symptoms, so to tell you which herbs need to be used, a Chinese herbalist must see the patient in person with frequent follow-up visits. You should keep in mind that treatment may take a long time. We accept patients 12 and older in our Herbal Clinic at Cleveland Clinic. There are plenty of studies that confirm dependence of ADHD on the diet, so you want to eliminate sugar and coloring agents from the patient's diet and explore food sensitivities.
er19vp: Can Chinese herbs help with infertility?
Galina_Roofener,_LAc: There is a possibility that Traditional Chinese Herbal Medicine may be a good choice for you. Usually, if a person is younger and the gynecologist is unable to pinpoint a specific cause for infertility, there is a good chance that acupuncture may be sufficient. Oftentimes, if you are older or have polycystic ovary syndrome, low ovarian reserve or premature ovarian failure, acupuncture may be not enough to address the issue so you may benefit from the addition of Chinese herbs. You should be prepared to take herbs and acupuncture for at least three to six months to have a result.
JanetE: I heard that the Chinese herb Corydalis is good for pain. How much I should take?
Galina_Roofener,_LAc: Corydalis (Yan Hu Suo) is good for pain, but only for pain that is in a fixed location, is stabbing in quality and gets better with warmth. It is not suitable for other types of pain or in people who are prone to bleeding, in which case other herbs would need to be added to the formula. This is why herbal formulas (compilation of a few herbs) are oftentimes used in Traditional Chinese Medicine. They are far better at addressing complex cases.
Western Medicine has many types of drugs that are effective in treating different types of pain. Eastern medicine is exactly the same, as we have many herbs that work for different types of pain. It is important that you see a board-certified Chinese herbalist to determine if Corydalis is a good choice for you, and she or he will calculate the dosage of herbs based on your weight and many other factors.
ldsuz: Can Chinese herbal therapy help with general aches and pains, joint swelling/pain and lethargy?
Jamie_Starkey,_LAc: Chinese herbal medicine could be helpful for the aches/pains, swelling and lethargy. Those symptoms could also be a sign of underlying pathology, which is why I would encourage you to seek out a physician who practices integrative medicine, who could do a thorough assessment of your condition. Once you've addressed potential allergies, blood deficiencies or gut issues, a Chinese herbalist could be helpful.
wondering: Can Chinese herbs help prevent cancer? If so, which ones?
Galina_Roofener,_LAc: There are no studies determining the effectiveness of Chinese herbs in the prevention of cancer designated by cancer category. Cancer manifests in that cell communication fails = disease = disharmony. It takes a long time for cancer to develop, so cancer is the final manifestation of long-term, existing patterns of disharmony. Chinese herbal therapy is designed to correct patterns of disharmony in the human body. There are plenty of studies regarding influence of lifestyle and nutrition on the prevalence of cancer and other diseases. Herbs that are incorporated along with lifestyle and diet changes can be a great tool to keep your body clean from environmental toxicity and to adjust nutrigenomic expression of cancer genes.
goldfish: Is there a Chinese herbal remedy that successfully treats overactive bladder and incontinence?
Jamie_Starkey,_LAc: There are various herbal formulas that could help address overactive bladder.
Chaney: How do I know that the Chinese herbs used by Cleveland Clinic are safe?
Jamie_Starkey,_LAc: Chinese herbal medicines ARE regulated by the FDA. Chinese herbal medicines are held to cGMP regulations under Title 21 CFR 111. Our herbal products are manufactured at a highly reputable facility, Kaiser Pharmaceutical (KPC), which holds the following certifications:
- TGA-PIC/S GMP (Therapeutic Good Administration)
- USDA-NOP (US Department of Agriculture, National Organic Program)
- NSF-cGMP (National Sanitation Foundation)
- ISO 9001:2008 (International Accredited Forum)
- ISO 17025:2005 (Taiwan Accreditation Foundation)
- GMP (Good Manufacturing Practice)
Each batch of herbs is tested utilizing the most modern technology by independent testing agencies upon arrival in the USA. Each batch of herbs is produced with a Certificate of Analysis (COA). Herbs are tested for:
- Species Authentication
- Sulfur Dioxide Detection
- Pesticide Residuals Detection
- Aflatoxin Detection
- Heavy Metal
- Aristochic Acid Detection
Our compounding herbal prescriptions are filled by a fully FDA- and ISO-accredited herbal pharmacy.
Dirk: What is the educational requirement for a Chinese herbalist?
Jamie_Starkey,_LAc: To become a Licensed Chinese Herbalist, you need to hold a license in Oriental Medicine. This involves four years of general college prerequisite (exactly like you would do for medical school or other advanced degree programs) followed by four years of Oriental Medicine college. Our education consists of approximately ¾ of our time spent on the study of Oriental Medicine and approximately ¼ of our time on the study of Western Medicine. We have to pass four very vigorous board-certification exams.
Galina_Roofener,_LAc: On a personal note: before I became an Oriental Medicine practitioner, I used to be an RN. For seven years I taught Western anatomy, physiology and pathology. Honestly, Chinese herbs are the most difficult subject that I have ever studied!
MamaKegs: Is melatonin a Chinese herbal therapy? Is it safe to use long term?
Galina_Roofener,_LAc: Melatonin is not an herb. It is a hormone that your body makes naturally in the darkness. As with all hormones, you should be very careful using melatonin. You may benefit from a consult with our integrative medicine physician regarding the benefits of melatonin use for your particular situation.
judymaya12: Can you use Chinese herbal therapy if you are on Coumadin?
Galina_Roofener,_LAc: No. Coumadin has a very narrow safety margin. You may be at greater risk for bleeding.
Sassypants: Is it safe to take herbs when I take medications?
Galina_Roofener,_LAc: We do not accept patients who are on warfarin/Coumadin or interferon, have liver or kidney failure, or are on active chemotherapy. I review your medications to make sure that there are no potential negative interactions. An herbal formula is carefully constructed by taking into account current medication and supplements, your age, weight and severity of your condition. Usually, I recommend taking herbs at least two hours apart from the rest of your drugs and supplements.
You will also be instructed to avoid taking any new supplements or herbs while you are on a Chinese herbal formula without prior discussion with me to avoid any possible interaction. Please remember that “natural” does not automatically mean safe and harmless! Chinese herbs are a prescription, and should be treated as such.
ommom: Do you have a list of companies that are safe to purchase Chinese herbs from? Are there reputable companies that sell herbs grown in the USA?
Galina_Roofener,_LAc: You must see a board-certified Chinese Herbalist to get diagnosed and receive an herbal prescription. Your herbalist will have herbs from a reputable company in the office or will give you reputable source information.
Risks and Worries
rambofro: What effects do Chinese herbal therapies have on the risk of bleeding during surgery?
Galina_Roofener,_LAc: Herbs may have very different effects. Some may cause increased bleeding, for example Dan Shen (Salvia Root); some may stop bleeding, for example, San Qi (Notoginseng); and some may relieve pain and speed up postsurgical recovery. If in doubt, stop all of your supplements, including herbs, at least three days before the surgery (or longer, based on your surgeon’s instructions). Resume herbs with permission of your physician after the scars have healed.
rambofro: Where can I learn more about any potential risks, side effects or serious interactions of Chinese herbal therapies with my prescription medicines?
Galina_Roofener,_LAc: Unfortunately, there is not one major resource on drug – Chinese herbal formula interactions. Keep in mind that herbs that are combined as a formula have different effects than a single herb on its own. Your best source is a board-certified Chinese herbalist who will review your active medication list and assess possible interactions. As a general practice, to minimize the chances for interaction, we recommend taking herbs two hours apart from the rest of your medications and supplements.
howdy: My Chinese herbalist has prescribed Xiao Yao San for me but she is located very far from me and I cannot make the next appointment. Should I buy a refill on line?
Jamie_Starkey,_LAc: I strongly advise against purchasing a refill online! A Chinese herbal formula is a PRESCRIPTION and should be administered only by a licensed herbalist. The product should be sourced from a reputable pharmacy. Otherwise, you are taking a risk that what you purchased is the incorrect species, is contaminated, etc., which will have no therapeutic value or, worse yet, may be harmful to you altogether. A Chinese herbal formula works on resolving the underlying reason why you are sick. Herbal formulas may need to be adjusted (different dosage or single herbs within the formula may need to be added/subtracted) frequently, depending on any changes in your symptoms.
mmartincin: Can you discuss the science behind acupuncture and how it works?
Jamie_Starkey,_LAc: Acupuncture has been a form of therapy for approximately 3,000 years. Modern science and researchers have been studying the various mechanisms involved in the treatment and how it influences the body to produce a therapeutic effect. In summary, there are several mechanisms at work. The needling process has a significant influence over your nervous system, both peripheral and central. fMRI studies show that acupuncture treatment significantly increases the release of endorphins. Endorphins are your body's natural opiate, which acts as both a pain reliever as well as a mood enhancer. Locally, the needling procedure has an effect on various neurotransmitters, such as adenosine. In addition, studies have shown that acupuncture has an influence over the inflammatory effect, in essence, acting as an anti-inflammatory by reducing the expression of cytokines. Studies also support that acupuncture has an influence over the immune system, increasing natural killer cells. The actual needling process can also mechanically release active trigger points in muscles that may be causing spasm and pain.
Lee433: Is there anywhere in the greater Cleveland area where you can get training as an herbalist and/or acupuncturist?
Jamie_Starkey,_LAc: Training as an acupuncturist and herbalist is a minimum graduate-level degree. Unfortunately, there are no schools in the greater Cleveland area. You may want to visit The Accreditation Commission for Acupuncture and Oriental Medicine's website to search for accredited schools by state: www.acaom.org/find-a-school/.
Gail Ann: Do you accept blood test, ultrasound and CT results that have been secured in Canada for use in determining treatment? Would you work with a physician in Canada to create the best treatment plan for a patient's condition?
Galina_Roofener,_LAc: We do accept imaging and lab work from other countries as long as reference ranges are included, but keep in mind that Chinese herbal therapy needs to be monitored frequently and is dependent on the condition. I may need to see a patient weekly. So it is always more advisable to find a local practitioner that you can visit frequently.
loveitaly: Is there a maximum number of acupuncture sessions for treating Meniere's disease and vertigos?
Jamie_Starkey,_LAc: Meniere’s disease and vertigo are very stubborn to address in BOTH Eastern and Western Medicine. I generally recommend eight to 10 sessions of acupuncture as one course of treatment and then re-assess for therapeutic efficacy. If I do not see any results, then I may refer the patient to another clinician, because sometimes a different style of acupuncture (Japanese or Korean, for example) may help. Or, I need to make the determination if you are just not responding, at which point we would discontinue treatment.
Moderator: I am sorry to say that our time with Jamie Starkey, LAc, and Galina Roofener, LAc, is now over. Thank you for sharing your expertise and time to answer questions today.
Galina_Roofener,_LAc: Thank you for the great questions. It is always my pleasure to see your interest. I will be looking forward to next time.
Jamie_Starkey,_LAc: Thank you to everyone who participated in today's web chat. It was a pleasure answering your questions. Our Tanya I. Edwards MD Center for Integrative Medicine website is always a great resource should you have any future questions regarding Chinese or integrative medicine.
To make an appointment with Ms. Starkey or Ms. Roofener or any of the other specialists in our Center for Integrative Medicine at Cleveland Clinic, please call 216.986.HEAL (4325). You can also visit us online at clevelandclinic.org/integrativemedicine.
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