Dr. Angelica Kokkalis, O.M.D L.Ac.

The term “Traditional Chinese medicine” T.C.M., makes reference to a number of practices, especially acupuncture, moxibustion and herbal formulas and their theoretical basis that has developed in China during a period of about 2,500 years. A theory of nature –and of health and disease– was set forth in the concepts of two essential forces yin and yang, the five elements, six climatic influences, seven emotional factors, eight principles of therapy, fourteen meridians, and other notions numbered as an aid to memorizing the information.

Ancient but Still Alive

The Huang-di Nei-jing or Inner Classic of the Yellow Emperor is the source of all Chinese medical theory, the Chinese equivalent of Hippocratic corpus. Complied by unknown authors between 300 and 100 B.C.E., it is the oldest of the Chinese medical texts. The knowledge and theoretical formulations it contains are the basic medical ideas developed and elaborated by later thinkers.

In China today, the primary textbooks used to train traditional doctors are contemporary interpretations and clarifications of Qing dynasty (1644-1911) formulas and commentaries. These books are, in turn, clarifications of Ming dynasty (1368-1644) reworkings, which are also reworkings of earlier material. This process goes all the way back to Han dynasty (202 B.C.E.-220 C.E). Such transmission through the dynastic pathway not only preserved and encapsulated the original sources, but also elucidated and reformed them.

The Yin-Yang And The Five-Element Theory In T.C.M.

T.C.M. considers everything has two sides, they are called Yin and Yang. The Yin and Yang are philosophical terms in ancient China, referring to the things or characters opposite to each other. The condition which appears as active, external, upward, hot, bright, functional, exciting and hyperactive is attributive to Yang. The condition which appears as asthenic, internal, downward, cold, dim, material, inhibitive and declining is attributed to Yin.

Yin-Yang theory is widely used in T.C.M., for explaining the physiological and pathological phenomena of the human body and for directing the diagnosis and treatment of a disease. For example superficial syndrome, heat syndrome, sthenic syndrome are attributed to Yang. Interior syndrome, cold syndrome, asthenic syndrome are attributed to Yin.

The five element theory is a theory based on philosophy in ancient China, classifying the material characters and the mutual relationship of the five elements which are considered as the essential constituents of the material universe. Their motion is in accordance to certain rules (germination, restriction, etc). In T.C.M. the five element theory is mainly used for explaining the properties of the five viscera organs (liver, heart, lung, spleen, kidney) of the human body, their mutual relations, physiological phenomena and pathological changes. It also serves as a guide for diagnosis and treatment. The five element cycle is arranged in a definite order..

T.C.M. considers that heart is fire, liver is wood, spleen is earth, lung is metal and kidney is water, which are the five viscera organs.
The term for five viscera organs do not completely match those used in western medicine from the stand point of anatomy and physiology. In T.C.M they are considered functional systems and their suffering causes disease. So the physiology and pathophysiology in T.C.M are very important.

Vital substances in T.C.M.

• Vital energy is the motive force of internal organs and the tissues of the body as well. It has five functions: a) promotion function b) warming function c) defensive function d) checking function e) nourishing function.
• Blood is an important component of the body derived from the refined substance of the food through a series of complex processes. It circulates in the blood vessels to nourish all parts of the body.
• Body fluids. For instance, sweat, saliva, stomach fluid, intestinal fluid, urine etc. Their function is to moisten the skin, the hair, the muscle, the throat, the joints etc.

Meridians

Meridians are important components of the human body. Meridians and their collateral’s act as an important route for circulating vital energy and blood, connecting viscera with extremities, communicating the upper with the lower and the interior with the exterior and regulating the activities of viscera and other parts of the body. The meridians play a important role in joining the tissues and organs of the body to build up an organic entity.

There are fourteen regular meridians in the body and they are the main passages connecting different parts of the body in which the vital energy and blood circulates. The meridian energy flows through the meridians in regular vicious cycle by definite order.

Selection of treatment based on the differential diagnosis

Making a diagnosis and selecting the treatment is based on the analysis and comprehension of the clinical data collected by the four methods of examination with the basic theories of the five viscera organs (liver, heart, lung, spleen, kidney) meridians and pathogens.

Four Methods of Examination:

1. Inspection: Observing the patient’s mental status, posture, appearances of the tongue and its fur, the quality of urine, feces and other excretions and secretions.
2. Listening and smelling: Listen to patient’s voice during speaking, breathing, coughing and moaning, and to smell the odor of the secretion and excretion.
3. Inquiring: Interrogate the patient about his present illness, past history, menstruation and childbirth history, living and food habits, as well as age, native place, occupation and other related information.
4. Palpation: Various parts of body surface of the patient are palpated for the purpose of investigating the condition of the pulse, chest, abdomen and extremities to establish a diagnosis.

Major therapeutical methods in T.C.M.

A. Methods of treatment by Chinese herbal medicine

Treating a disease in Chinese medicine focuses on ridding the body of the invading pathogens, restoring normal circulation and flow of blood and Qi, promoting emotional harmony and fortifying the Kidney/Vitality system. Effective treatments include acupuncture, warming needle, point injection therapy, Qi Kong, moxibustion, herbal and dietary therapies, cupping, scrapping, massage and exercise.
There are eight methods of treatment used in Chinese herbal medicine.

• Diaphoresis therapy; It possesses the actions of antipyretic, promoting eruption, reducing edema and antirheumatic by inducing perspiration.
• Emetic therapy; Elimination of harmful substances from the throat, esophagus and stomach by the application of drugs or physical stimuli that can induce vomiting.
• Purgation therapy; A treatment of eliminating the undigested food by the application of mild purgatives.
• Regulating therapy; Includes various treatments such as the dispersion of stagnated liver-energy, the coordination of the functions of the liver and spleen or of the liver and stomach.
• Warming therapy; Expelling cold by warming the meridians, rejuvenating the depleted Yang, lowering fever with drugs of sweet flavor and warm nature.
• Heat – clearing therapy; A treatment of clearing away the heat with cold natured herbs, applicable to febrile diseases of heat – syndrome.
• Invigoration therapy; A therapy for various types of asthenia syndrome, generally classified into invigoration of vital energy, toning the blood, invigoration of Yin and Yang.
• Dispelling therapy; A treatment for dispersing stagnated energy, blood stasis, phlegm-wetness, undigested foods.

Herbal therapies are best for functional disorders, hormonal imbalances, and “organic problems” (change in tissue structure). The effects of herbs are usually seen after several days of regular use, rather than immediately, but once the effects are established, they often persist for a long time. The use of acupuncture plus herbs usually provides the most dramatic results.

B. Dietary Therapy

Avoiding foods that produce dampness or mucous that may further obstruct the flow of Qi and blood in the channels, therefore exacerbating the pain.
Foods to avoid:

• Cow milk products (milk, cheese, butter, ice cream, etc.).
• Night shade vegetables (tomato, eggplant, peppers, potato).
• Deep fried and fatty foods.
• Cold foods.
• Wheat. Alcohol. Coffee. Sugar.

C. Methods of treatment by acupuncture and moxibustion

Acupuncture therapy; Application of metal needles such as filiform needle, intradermal needle and plum-blossom needle are used to stimulate certain specific superficial definite locations for the treatment of a disease. In cases of blood transmitted disease or skin lesions electro-acupuncture or laser beam acupuncture is applicable.
Acupuncture is a very safe system of health care when done by a well-trained practitioner. It feels like a needle prick but nothing like getting an injection. During the treatment the patient will experience some sensations of energy movement, but not pain. Most people fall asleep when left with the needles, and wake refreshed and relaxed.
The number of treatments varies according to the condition. Acute problems may respond with just a few treatments. A chronic problem that exists for years may require a longer series of treatments. Treatments are usually once or twice a week.
Moxibustion therapy;A method of applying therapeutic heat produced by ignited moxa wool or roll, over the well defined skin surfaces. The moxa is made by an herb called “Artemisia Bulgaris”.

D. Other methods of treatment

Massage; a) Also called pushing and grasping; a method of prevention and treatment of diseases by applying various massage manipulation, or by passive movements of extremities. b) One of the eight manipulations of bone setting, used for relaxing the muscles, dissipating blood stasis and promoting subsidence of swelling.
Qigong (breathing exercise); A mental and physical self training for the prevention and treatment of diseases and also for health care and prolongation of life, by which life activities are self-adjusted and self-controlled with the help of the inducement of mind and the regulation of respiration and spirit.
Cupping; Using heated cups, cupping is designed to vastly increase circulation to affected areas, ridding toxins and waste products that aggravate inflammation and introducing the tissues to fresh nutrients and oxygen.
Scrapping; Using tools made from antler horn, to break scarring on soft tissue, release muscle congestion, usually used in combination with cupping and electroacupuncture.
Therapeutic exercises; Taiji, Gong fu, jogging five animal exercises and other exercises prevent disease and strengthen the human body.

Acupuncture Analgesia

Over the past 45 years knowledge about the physiological basis of control of pain has increased more than at any time in the history. This growth has been based mainly on studies on the neural and neurochemical basis of inhibition of pain at various levels of the central nervous system such as the spinal cord, the brain stem, and higher subcortical center. Although acupuncture was introduced in the Western world as early as in the 1600 century it remained largely unknown until the first reports of operations under acupuncture analgesia were reported from China. Research on the neurochemical mechanisms of acupuncture analgesia has been conducted in the Department of Physiology, Beijing Medical University since 1965. More than300 papers have been published, most of them in Chinese.

Can modern and Chinese medicine be combined?

Not only can the two systems of medicine be combined, they can enhance each other’s effects. Chinese herbs may make it possible to take a lower dosage of modern medicines, to reduce their side effects, and obtain a better overall effect. Modern drugs may provide emergency relief for serious conditions that will allow long-term application of Chinese herbs the rest of the time.
It is advised that modern drugs be taken at a different time (e.g. an hour apart) from herb combinations in order to avoid any chance of interaction, and that monitoring of the effects of the drugs be continued, and perhaps increased, while an herb therapy is being used. Acupuncture is compatible with virtually all modern techniques.

Concluding remarks

Traditional Chinese medicine can be considered an art, and it can claim to be a science. But the important question is: Does it work? Is Chinese medicine just an interesting philosophical curiosity or is it a viable system of healing? Can it treat what the West defines as real diseases? And can Western science measure its results and appreciate its value?
Because of the unique history of modern China, traditional medicine has been the subject of comprehensive study and testing over the past forty five years.
Western clinical studies of traditional Chinese medicine, by proving its practical efficacy, have helped it win its battle for survival in the twentieth century, and promise it a place in the future of medicine.

Acupuncture has been used in China for at least 2,000 years to treat a variety of disorders. The use of acupuncture for the treatment of drug addiction was discovered serendipitously in 1972 by Wen, a Hong Kong neurosurgeon conducting a series of studies on the analgesic properties of acupuncture. Heroin addicts who volunteered to be subjects reported that their opiate withdrawal symptoms were lessened on the days when they received their acupuncture treatments. Wen undertook a series of uncontrolled studies on the use of acupuncture in the treatment of opiate addiction and reported positive results. Over the last 40 years, numerous studies have been undertaken investigating acupuncture for the treatment of various addictions, including opiates, tobacco, and alcohol. Many of these studies report beneficial effects of acupuncture. Not infrequently however, investigations of acupuncture for the treatment of drug addiction suffer from problems of design and assessment.

Mechanism of Acupuncture

The mechanism by which acupuncture may constitute a treatment for chemical dependency has not been fully investigated, although it has been conjectured that acupuncture, perhaps mediated by the release of endogenous opioids, modulates neural circuits in the mid-brain also affected by drugs of abuse. Han JS, Zhang RL (1993) Drug and alcohol Dependence(USA) 31, 169-175 Traditional Chinese theories of acupuncture involving ‘the rectification of chi deficiency or excess in various organ systems’, have not been adequately tested with in Western biomedical frameworks. In 1993 the HANS Acupoint Nerve Stimulator was used to treat 212 heroin addicts subjected to abrupt abstinence. Diagnosis was made according to the Diagnostic and Statistical Manual of Mental Diseases, third edition. The results from that study indicated that the mechanisms of HANS for heroin detoxification may be two fold:

• The release of endogenous endorphins and enkephalins by 2Hz may substitute the need for exogenous opioids
• The release of dynorphins by 100Hz may suppress the withdrawl syndrome.

The use of HANS in the post-detoxification period may help to prevent the recurrence of drug abuse, which may be even more important than its role in acute detoxification.

U.S. Studies

Auricular acupuncture is an increasingly popular intervention for the treatment of cocaine addiction in the United states.

Currently, approximately 200 clinics, in 32 states, offer auricular acupuncture for the treatment of this disorder (Smith 1991). Despite its increasing popularity, auricular acupuncture has been evaluated in relatively few studies for the treatment of cocaine addiction Lipton et al., 1992; Margolin et al., 1992; Smith,1988.

Clinical reports suggest that auricular acupuncture induces a feeling of relaxation that reduces craving for cocaine and facilitates patient participation in counseling and rehabilitation.

To the best of our knowledge, the literature contains only two controlled studies of acupuncture for the treatment of cocaine addiction. One study conducted at Lincoln Hospital, D. Lipton,V. Brewington, and M. Smith, unpublished data and the second one from the Substance Abuse and Treatment Unit, Department of Psychiatry, Yale University school of Medicine.

Cocaine use was determined by urine toxicology screenings. Depression was assessed by using the Beck depression inventory. Self-representation was assessed using the modified selves Questionnaire etc.

The authors report a positive finding for acupuncture insofar as subjects who received real acupuncture and remained in treatment for over 2 weeks had significantly lower levels of benzoylecgonine in urine screens compared to the placebo group. Sixty-one percent of women and 36% of men who entered the study completed the entire 8-week course of acupuncture treatment. All of the women and 60% of the men who completed the study attained abstinence. Among the HIV-positive patients 38% completed the study, of these individuals 83% attained abstinence.

In the pharmacotherapy trial, retention in treatment was excellent, and abstinence rates were modest. In the acupuncture study, the retention rate was lower, but the patients who remained in treatment did extremely well. No subject reported dropping out of the studies because of an adverse response to acupuncture treatments.

Subjects who attained abstinence in these studies exhibited decreased Beck Depression Inventory scores, a shift in self-representation away from “addict” and toward desired “non-addict” self-schemata, decreased craving, and increased aversion to cocaine cues.

Concluding Remarks

In views of the widespread use of acupuncture in the treatment of drug addiction and the relative success of previous studies it is my opinion that this procedure warrants further controlled investigation as a treatment for cocaine addiction in opiate populations.

Because of the unique history of modern China, traditional medicine has been the subject of comprehensive study and testing over the past forty five years.Western clinical studies of traditional Chinese medicine, by proving its practical efficacy, have helped it win its battle for survival in the twentieth century, and promise it a place in the future of medicine.

Some English-Language Sources

Han JS, Zhang RL (1993) Drug and alcohol dependance (USA) 31, 169-175

Chen XH, Han JS (1994) American Journal of Acupuncture 22, 47-53

Department of Philosophy of Medicine and Science, comp. Theories and philosophies of Medicine. New Delphi: Institute of History of Medicine and Medical Research 1973.

Fung, Yu-Lan. A History of Chinese Philosophy. 2 vols. Translated by Derk Bodde. Prinston, N.J.: Prinston University Press 1973.

Huard, Pierre, and Wong, Ming. Chinese Medicine.New York, Toronto: World University Library, McGraw-Hill, 1968.

Leslie, Charles, ed. Asian Medical Systems. Berkeley, Calif.: University of California Press.

Porckert, Manfred. The Theoretical Foundations of Chinese Medicine. M.I.T. East Asian Science Series, Vol. 3. Cambridge, Mass.: M.I.T. Press, 1974.

Ted J. Kaptchuck. The Web That Has No Weaver. Congdon & Weed, Inc, New York, 1983.

Mayer, D.J., Price, D.D. Rafii, A.1977. Antagonism of Acupuncture Analgesia in Man by Narcotic Antagonist Naloxone. Brain Research. 121:368-72.

Mayer, D.J., Price, D.D. Rafii, A.1975.Acupuncture Hypalgesia:Evidence for activation of a central control system as a mechanism of action. First World Congress Pain Florence, p.276 (abstr)

Mc Leennan, H., Gilfillan, K, Heap, Y. 1977. Some Pharmacological Observations on the Analgesia Induced by Acupuncture in Rabbits. Pain 3: 229-38.

Han, C. S., Chou, P.H., Lu, C.C., Jen, M. F. 1979. The Role of Central 5-hydroxytryptamine in Acupuncture Analgesia. Sci. Sin. 22:91-104.

Mayer, H.L., Price, D.D. 1976. Central Nervous System Mechanisms of Analgesia. Pain 2:379-404.

Han J.S., Terenius L 1982. Neurochemical Basis of Acupuncture Analgesia. Ann. Rev. Pharmacol. Toxicol. 22:193-220.

Liu X. 1986. The Role of Nucleus Raphe Magnus in Acupuncture Analgesia and its Control by Some Higher Analgesia Structure. Acupuncture Research 9:91-100.

Links:

http://www.acupuncture.com/conditions/acuaddict.htm
http://biblioteca.universia.net/ficha.do?id=5309729
http://acudetox.com/
http://acupuncture.com/research/addiction.htm

Reproduced with permission from the Lafayette Joural and Courier, HEALTH & FITNESS, TUESDAY, MARCH 23, 2004

It’s “not voodoo; it’s another way of healing,” says Ross, who underwent surgery to mend a torn ligament in her throwing arm.

Her coach, Purdue javelin coach Rodney Zuyderwyk, says he’s confident she’ll make the U.S. team that will compete in Athens in September. This past winter, she was throwing rub­ber-tipped practice javelins in­doors further than she did at the same point in 2002.

“Everything is strong, and her technique is better than it used to be,” he says.

In 2002, Ross, of West Lafayette, became the NCAA champion with a throw of 195 feet, 8 inches, shattering the American record of 192 feet, 3 inches. Less than a month lat­er, she won the U.S. Championships with a throw of 197 feet.

“I was on fire,” says Ross, now 26 and a rock-solid 5 foot 10, 207 pounds. “I’d step onto the runway, and no one wanted to be there. After one throw at the (U.S. Championships) it was over.”

At the World Cup in Madrid in September 2002, she opened with a throw of 183 feet. On the second throw, she dropped her light arm too much, came over too hard on her left leg and felt a “pop” in her right elbow. She made two more throws and fin­ished fifth in the world.

The 2002 Purdue graduate continued to train, but sus­pected that something was wrong. Doctors found that she had torn the ligament in her throwing arm.

“I thought, ‘This is not hap­pening,’ ” she says.

In December 2002, surgeons mended her elbow with liga­ment taken from her leg. When the bandages came off, her world-class arm was withered and weak. Previous injuries to her knee and back hurt. Barely able to walk, she was depressed and withdrawn. She didn’t want to talk about it.

“I was a mess,” she says. “I felt I was losing everything.”

But ever the competitor, Ross has spent more than a year get-ting better through rehabilita-tion, throwing, weight lifting, massage, chiropractic and acupuncture.

Her strategy is simple, she says: “You visualize where you need to be, and you put all your cookies in one jar.”

“She’s gone through a pretty rig­orous rehabilitation. There’s been a slow progression, week to week,” Zuyderwyk says. “That competitive spirit is definitely what motivates her.”

Ross is $40,000 in debt and so­liciting donations to pay her ex­penses to meets in Texas and Kansas in April. A good showing there would qualify her for the U.S. Olympic Trials July 9-11 in Sacra­mento, Calif.

The top one, two, three or four javelin throwers there will repre­sent the United States at the 2004 Olympics this fall.

“I am so ready to go,” Ross says. “I need to get out on the runway and throw.

I’ve been out so long, but I’m still Number 2 in the nation. Only one person has beaten 197 feet,” she says.

Kim Kreiner, a 2000 Kent State University graduate, had a throw of 199 feet, 8 inches in August 2003.

A native of Edinburg, Pa., Ross took up the javelin in 10th grade. At Purdue, she was Big Ten cham­pion twice and a four-time AU-Amer-ican. She always dreamed of com­peting in the Olympics.

Ross credits acupuncture for much of her recovery. She was in­troduced to it in California, where she underwent rehabilitation at the Olympic Training Center.

In April 2003, she was referred to West Lafayette’s Dr. Angelica Kokkalis.

“We have an unbelievable rela­tionship as doctor-patient and as friends,” Ross says of Kokkalis. I’ve made unbelievable progress. I feel more balanced, more centered. I’ve healed.”

Kokkalis inserts approximately 60 super-fine disposable acupunc­ture needles into various parts of Ross’s skin, at different angles. They stimulate the nervous system and its energy to release substances to the blood that kill pain and reduce inflammation.

As the needles are inserted, Ross feels heat and sensations of ener­gy movement, but no pain. She leaves feeling refreshed and re­laxed.

Kokkalis is a doctor of Oriental medicine, specializing in pain con­trol and wellness management. She has a practice at Meridian Health Care in Lebanon.

She spent years in China, learn­ing traditional Chinese medicine and formerly was director of Chi­nese medicine at the Center for Complimentary Medicine and Pain Management at St. Vincent’s Hos­pital in Indianapolis.

Speaking of Ross, Kokkalis says, “She not only was Number 1, she still is. Her recovery is a miracle.”

Ross’s Olympic dream has pro­vided a motivator like no other.

“She wouldn’t have recovered if she didn’t want this,” Kokkalis says.

A native of Greece, Kokkalis will accompany Ross to Athens if she makes the team so acupuncture treatments can continue.

Ross works out at Purdue, where Jim Lathrop is her weight coach.

She turns to Michael Tebo for massage therapy. Michael Haville is her chiropractor.

“She has put in a lot of hard work, and she has been very pa­tient,” says Zuyderwyk, who works with her almost daily. “That com­petitive spirit is what allows her to not hesitate when other people with that kind of injury would pro­tect themselves.”

Throughout, he says, “the Olympics has basically been her drive, getting ready for the Olympics … she is on track:”

As the U.S. trials get closer, she’s determined to stay focused, get plenty of sleep and concentrate on staying healthy and strong. She’s a volunteer coach at Purdue.

She says herjob as a part-time social worker with Community Ventures in Living is providing an invaluable perspective. She helps handicapped people with basic liv­ing skills.

“I’ve become more thankful,” Ross says. “Some of these people can’t get out of their chair. Some can never walk or even talk.”

She calls the last Yk years of her life “a hard road,” but she’s convinced that it all happened for a reason.

Because of her injury, she has overcome challenges, grown stronger and made priceless friend­ships.

“I have to do this,” she says.”… the competitor in me won’t die.”

Acupuncture Analgesia

Over forty years of research have been devoted to Acupuncture Analgesia. On November 3rd 1997, the National Institute of Health sponsored a NIH Consensus Development Conference to evaluate the scientific and medical data on the uses, risks, and benefits of acupuncture procedure for a variety of conditions. Most of the research was on diverse pain conditions. Since 1965 the research team of Professor Jisheng Han, of Beijing Medical University Health and Science, has devoted themselves to the clarification of the neurochemical mechanisms of pain relief by acupuncture. Over 300 scientific papers have been published in the past 4 decades.

The ancient healing art of acupuncture seems to be revitalized in the era of modern medical sciences due to the identification of its high costeffectiveness and the partial unraveling of its scientific mechanisms of action. Hubei Science and Technology Press has published in 1998, in English, the summary of the research achievements on the Neurochemical Basis of Pain relief by Acupuncture obtained in the years 1987-1997 by Professor Jisheng Han. The use of modern scientific methodology is absolutely essential for the clarification of the scientific basis of acupuncture therapy. Research on the physiology of acupuncture has been contributing to the development of neuroscience from the molecular level to the behavioral. High-quality scientific research will certainly pave the way for the acceptance and more popular use of acupuncture and related techniques for the benefit of patients suffering from chronic pain and many other functional disorders.

Commonly treated conditions:

Based on clinical experience, the World Health Organization advises that over 300 types of illness lend themselves to acupuncture treatment. A partial list includes:

Gastrointestinal Disorders

Food allergies, indigestion, diarrhea, constipation, anorexia, peptic ulcer, gastritis, colitis, irritable bowel.

Urogenital disorders

Urinary tract infections, incontinence, prostatitis, sexual dysfunction, infertility.

Gynecological Problems

PMS, menstrual difficulties infertility, fibrocystic disease, menopause problems.

Respiratory Problems

Asthma, emphysema, allergies, chronic bronchitis, sinusitis.

Muscle and Joint Pain

Arthritis, tendonitis, bursitis, neck and shoulder pain, whiplash, sciatica, TMJ

Circulatory Disorders

High blood pressure, angina, muscle cramps, anemia, atherosclerosis.

Immune System Disorders

Chronic fatigue syndrome, AIDS, rheumatoid arthritis, candidiasis, lupus.

Endocrine Disorders

Diabetes, hyper/hypothyroidism.

Emotional Problems

Stress, insomnia, depression, anxiety.

Addictions

Alcohol, nicotine, sugar, recreational drugs, medications.

Pediatrics

Bedwetting, hyperactivity, asthma.