Wednesday, December 1, 2010

Janna Weiss - Abstracts

Dissertation Abstract

Janna Weiss, Ph.D.
The University of Texas at Austin, 1998
Supervisor:  Beryl B. Simpson

This dissertation focuses on the relationship between traditional medical concepts and corresponding medicinal plant use through a comparison of diagnosis and treatment among the Chatino of Oaxaca, Mexico (and to a lesser extent among the Zapotec and Chinantec) and Chinese medicine.  Both cultures classify symptoms and medicinal plants according to similar medical concepts such as "heat," "cold," "blood" and "wind."  This correspondence between symptom and plant folk classification forms an important basis for treatment.  Diagnostic concepts of Chatino medicine were examined in depth, based on two years of ethnomedical and ethnobotanical fieldwork in Oaxaca, Mexico.  A detailed ethnographic description of Santa Cruz Zenzontepec, the main study site, and a presentation of Chatino medicine comprise a major portion of the dissertation.  Theoretical issues, such as classification by personalistic and naturalistic etiologies, that pertain to the comparative study of Non-Western medicine and are relevant to an appreciation of the importance of diagnosis to plant use are addressed.  Chatino and Chinese medical concepts are discussed in a cross-cultural context, delineating areas of comparability and divergence in the medical concepts and their associated symptoms.  Chinantec plants for blood from Browner’s published data were analyzed for possible correlation between chemical components and the traditional illness categories using cluster analysis.  Patterns of broad chemical classes corresponded to the illness categories.  A procedural method for systematic examination of the relationship between plant chemistry and plant use was developed and the results should be predictive for plants with analogous uses across cultures.  


Weiss, J. Integration of acupuncture in a psychiatry department.  International Scientific Conference on Alternative, Complementary and Integrative Medicine Research, University of California San Francisco School of Medicine and Harvard Medical School, May 17-19, 2001.  Alternative Therapies in Health and Medicine 2001.  7:S35. 

Purpose: To document integration of acupuncture into a hospital psychiatry unit in Israel.  
Methods: Standard ethnographic participant observation method was employed.  Fieldwork formally commenced in February 1999 supported by an Israeli government grant.  
Results: A close-knit multidisciplinary psychiatric team introduced acupuncture into inpatient care in the context of a pilot outcome study.   Staff resistance to and gradual acceptance of a lone acupuncturist (JW) and integration of acupuncture in a hospital setting became independent objects of inquiry and interest apart from therapeutic outcome.  A 1-year period involving interviews, seminars, and Helsinki Committee approval preceded patient contact.  After several months of participation in the department on a limited and trial basis, the work was significantly restructured.  Issues addressed include: timing and criteria for patient referral, practitioner-patient ratio, site of treatments, minimum number and frequency of treatments, participation in the main weekly staff meeting, designation of a staff liaison, guidelines for a treatment "contract," and adoption of a research protocol using pair-wise comparisons.  Staff interaction with the acupuncturist included informal "corridor" conversations, acupuncture treatment of interested staff members, observation of treatments, attendance at seminars on acupuncture and psychiatry, and weekly staff meetings. Patients expressed enthusiasm for acupuncture at group sessions and also individually, influencing staff opinion.  Nurses perceived a reduction in use of SOS medication for patients receiving acupuncture.  The acupuncturist was excluded from the weekly staff support group that defines who is a "true" staff member and from most discussions with the two designated primary practitioners on a per case basis.  The acupuncturist gained familiarity with departmental procedure, psychiatric terminology, and a team approach to treatment, as well as clinical experience in the treatment of psychiatric disorders.  Staff interactions and personal observation altered the acupuncturist's understanding and acceptance of psychiatric diagnoses and practice.  
Conclusions: Integration of acupuncture in the Department of Psychiatry was a process of educational exchange and mutual acceptance at a professional as well as a personal level.  Our experience provides a working model for the integration of acupuncture in hospital psychiatry and reflects issues associated with the integration of complementary medicine in mainstream medicine generally.  


Weiss, J.  Pilot study of acupuncture and herbal medicine for psychiatric disorders.  International Scientific Conference on Alternative, Complementary and Integrative Medicine Research Poster Abstracts, University of California San Francisco School of Medicine and Harvard Medical School, San Francisco, CA, May 17-19, 2001.  Alternative Therapies in Health and Medicine 2001.  7: S35-S36.  
Purpose: To assess therapeutic outcome of acupuncture and herbal medicine in the treatment of psychiatric disorders.  
Methods: 27 inpatients and 11 outpatients (3 adolescents, 8 adults) received individualized acupuncture treatment from a traditional Chinese practitioner (TCP) in 1999.  5 outpatients received Western herbal formulas in conjunction with acupuncture.  Patients also received routine psychiatric treatment. Outpatients refusing medication, with serious side effects, or unsuited for psychotherapy or pharmacotherapy were referred for acupuncture. Non-psychotic inpatients were eligible for acupuncture.  Treatment length averaged 30 min.  Outpatients received 1-2 treatments per week and inpatients 2-3 per week.  Therapeutic outcome was ranked on a scale of 1-5 by patients, a psychiatrist and TCP.  
Results: Therapeutic outcome could more readily be assessed for outpatients than for inpatients due to the intensive multidisciplinary inpatient treatment program.  7 outpatients (2 adolescents, 5 adults) who followed through with a minimum number and frequency of treatments showed marked improvement.  For outpatients with marked improvement the total number of visits ranged from 9 to 41 for adults and a minimum of 7 visits for adolescents.  All 5 outpatients (1 adolescent, 4 adults) receiving herbs had marked and sustained improvement.  Psychiatric disorders with marked improvement include conversion disorder, anxiety disorder, and chronic resistant major depression.  Side effects of psychiatric medications such as tremor, apathy and constipation improved dramatically.  Significant reduction in psychiatric medication was obtained. 9 of 27 inpatients received a minimum course of 10 or more treatments.  Late referral was the main reason for not completing a course of treatment.  15 inpatients received 8 or more treatments.  Nurses noted a reduction in SOS medication for inpatients receiving acupuncture.  Patients reported a feeling of well-being or calm after individual acupuncture sessions and a reduction in symptoms.  Chinese medicine considers a wider range of target symptoms than psychiatry.  Disorders treated cover a broad spectrum of Chinese medical diagnoses.  Several case studies will be presented. 
Conclusions: Individualized acupuncture alone or combined with herbal therapy seems to be effective in treating a range of psychiatric disorders. Efficacy of acupuncture for psychiatric disorders is dependent on the amount and frequency of treatments.  Use of herbs appears to enhance efficacy. Results of this pilot study warrant further work. 

Weiss, J. Case studies of psychiatric outpatient treatment of women with acupuncture and herbal medicine. Women’s Mental Health Conference, Ben Gurion University, Beersheba, October 16, 2002.

Project Description: Six outpatient adult women and one adolescent were treated with acupuncture alone or combined with herbal medicine in the context of a one-year pilot study of the use of acupuncture and herbal medicine for inpatients and outpatients for a range of psychiatric disorders at an Israeli hospital.  Disorders treated include moderate and major depression, chronic, major, resistant depression, conversion disorder, and anxiety disorder.  Chinese medical diagnosis incorporates physical as well as emotional symptoms and offers a novel approach to the assessment and treatment of psychiatric disorders consistent with current multifactorial models of mental illness.  
Research Objectives: To identify psychiatric disorders potentially suitable for treatment with acupuncture and herbal medicine as an alternative or adjunct to routine psychiatric care.  
Methods: Six adult psychiatric outpatient women were referred for individualised acupuncture or a combination of acupuncture and herbal medicine administered by an experienced practitioner on a weekly basis.  Patients also received routine psychiatric treatment. Outpatients refusing medication, with serious side effects, or unsuited for psychotherapy or pharmacotherapy were referred for acupuncture.  3/7 women received a minimum course of 9 treatments.  Ten treatments constitute a standard course of treatment.  One adolescent received 7 treatments for conversion disorder.  Five case histories are presented, including one in which treatment was discontinued after 4 treatments.
Results: Disorders showing marked improvement include major depression, chronic major resistant depression, conversion and anxiety disorders.  Outcome is dependent on the number and frequency of treatments received.  Acupuncture and herbal medicine provide promise as powerful tools in the treatment of psychiatric disorders.

Public Health & Health Education

Weiss, J.  A model for adolescent health education with traditional medicine and medicinal plants. 9th International Congress on Ethnopharmacology, Nanning, China, August 22-25, 2006     


Purpose An outdoor non-frontal course for adolescents was designed and implemented to impart basic skills and knowledge in the areas of traditional medicine, medicinal plants and interpersonal communication. Course goals included increased awareness of (1) the body in health and disease, (2) plants as medicine and food as medicine, (3) the importance of dosage, (4) the relationship between emotions and the body, (5) the role of nature and the environment in relation to health and disease, as well as (6) enhanced self-esteem through a positive group experience, (7) empowerment through acquisition of basic healing skills, (8) interpersonal communication skills and guided imagery.  
Methods During 3 consecutive semesters, 3 heterogeneous groups of 25-27 adolescents, ages 12-15, met in the wadi behind the school for 90 minutes each week, for a semester-long science elective at the Reali Haivri School, Haifa, Israel (January 2004-June 2005). The course was led as a facilitated group. Activities included Mesoamerican healing rituals, medicinal plant preparations, Chinese medicine, guided imagery, art, and interpersonal communication games.  Results Qualitative assessment was based on student responses, course popularity, the author’s participant observation and documentation. The course increased physical and emotional self-awareness, facilitated a constructive group process, imparted basic skills for preventive health care, enhanced appreciation of nature, of traditional medicine and medicinal plants, and otherwise met the stated goals.  
Conclusions The course fills a lacuna in adolescent preventive health education. The course has yet to be assessed quantitatively and applied in diverse cultural settings, for which it is expected to be well suited.

Weiss, J. Traditional medicine in public health discourse. International Society of Ethnopharmacology Panel Session, “Ethnopharmacology, Public Health and Health Education,” 10th International Congress on Ethnopharmacology, Sao Paolo, Brazil, September 17-19, 2008.  Session chair and speaker. Invited.  

Traditional medicine continues to contribute to the diagnosis, treatment, management and alleviation of major public health problems worldwide.  Despite the large numbers of traditional medical practitioners who are the primary health care practitioners for much of the world, and the significant contributions of traditional medical knowledge to public health, traditional medicine continues to be marginalized or even denigrated by Western public health professionals.  I will present traditional medical approaches to major public health problems, focusing on infectious diseases, women’s health and violence.  Violence is a major public health issue that has not been linked to traditional medicine in the public health discourse.  For each of these areas, I will highlight successful public health projects incorporating traditional medical practitioners and knowledge.  I suggest adopting a holistic approach to public health, by expanding existing models for incorporating traditional medical practitioners and knowledge in public health, and by addressing major public health problems through treatment and health education in a comprehensive, holistic manner.   
Weiss, J. Traditional medical approaches to the safe use of medicinal plants. International Society of Ethnopharmacology Panel Session, “Safety Matters: Side Effects of Plants Used in Indigenous Medicine and their Impact on Public Health,” Dr. Michael Heinrich, 9th International Congress, International Society of Ethnobiology, Society for Economic Botany, International Society of Ethnopharmacology, University of Kent, UK, June 13-18, 2004.  Invited.
Traditional healers are both conservative and innovative in their approaches to medicinal plant selection and use.  While innovation entails experimentation and risk taking, conservatism, enhanced by tradition, underscores a concern for safety.  Examples are given from Chatino, Chinese, Arab and Western herbal medicine, and from my own experience as a practicing herbalist.   The Chatino of Oaxaca, Mexico, prefer low doses of single herbs taken one to three times.  The Chinese prescribe large formulas of as many as 10-15 herbs, totaling 40-50 grams of dry herb per day, which contain only small amounts of each herb, 3-10 grams.  In the case of gentle herbs, large doses are needed to be effective.  Use of small amounts of individual herbs in a formula appears to be a relatively safe method of medicinal plant use that can obtain significant results with sustained use.  In addition to dosage and toxicity, accurate diagnosis is essential to safety, to ensure that existing symptoms are alleviated and not exacerbated.  Safety and efficacy are closely linked and are affected by the same factors.  An understanding of traditional approaches to safety with regard to medicinal plant use can serve in the implementation of programs combining scientific and traditional knowledge and practice to enhance the safety and efficacy of medicinal plant use in traditional societies.