Mazin Al-Khafaji's work has interested me for years. In February 2014, we invited him for the second time to speak at the Southwest Symposium in Austin, Texas. This time, for a three-day lecture entitled, "Dermatology and Chinese Medicine," which focused upon treatment strategies.
Al-Khafaji is a Doctor of Chinese Medicine in Shanghai, China, Lic Ac, FRCHM, MATCM. His journey is fascinating and highlights an important area of practice, which I believe will grow in importance here in the U.S. I am delighted to speak with him about his background and to introduce his work to a wider audience for Acupuncture Today.
Q: Mazin, you have been involved at the forefront of Chinese medicine for more than 30 years and are known as one of the leading clinicians and teachers of Chinese medicine in the West - where did it all start?
A: I was originally brought up in Baghdad, Iraq, and later sent to boarding school in the U.K., where my mother came from – so I guess my roots place me right in between East and West. Ever since childhood, I seemed to see the world from an unusual perspective and I have always been open to thinking outside the box.
The Chinese way of thinking came naturally to me – as I said, maybe I had less far to go in terms of adapting my way of thinking, being the product of two cultures, and coming from the Middle East, I was half way there! But in reality, it was as a teenager in the late 70s that I came across a little shop in the hussle and bussle of Soho in London – with a long queue of people snaking all the way round the corner. On closer inspection, it turned out to be a Chinese herbal shop, like the ones you find in Chinatown everywhere. The lady doctor there had built up quite a reputation for achieving incredible results for skin diseases. People came to see her from far and wide as a last resort and were willing to wait outside her shop from 5 a.m. to be able to see her. This intrigued me no end and I set out to discover more.
At that time, it was impossible to study herbal medicine in the West, there were neither teachers nor study materials available. I decided there and then to first study Acupuncture and Chinese language, if that was what it took, and then to travel to China and study Herbal Medicine there. That is what I did and a mere ten years later, I graduated from the Chinese Herbal Medicine Course in Shanghai alongside my Chinese classmates.
Q: Living in China in the early eighties must have been an experience. Would you explore that for us?
A: It sure was. Despite communism loosening its grip, Deng Xiao Ping being in power and free markets just starting to spring up (this was way before Tian An Men), it was a confusing time. There were steam engines on trains. Dominating colors were grey, blue and khaki. There was marching, early morning exercise to military music. Periodically, there were political campaigns such as the memorable Spiritual Pollution Campaign, where none Chinese where to be avoided as they were deemed polluting to the Chinese. There we were, trying to study Chinese language and medicine, to make friends, yet people coming close to us were either designated "wardens" who had to report back on us at the Friday afternoon political meetings, or took the risk of being punished by the state. My situation was okay as I had an official scholarship by the Chinese government, (a first for a foreign person to study Chinese Medicine!) so I had access to areas others could not easily reach. However challenging and difficult, I remember those times as one of the more incredible periods of my life and still marvel at the fantastic experiences I had. I feel truly grateful to all my many humble and modest teachers and the lifelong friends I made during that time.
Q: What were the next steps in your journey?
A: After four years of solid hard work I left China in 1987, and since then have been in practice in the U.K. – where I now run a big teaching clinic with a choice of specialist consultants, a herbal dispensary, decoction making facilitates and a small cream and ointment production unit alongside my personal practice. I went back to China in 1991, and several times since to study with renowned specialists and I have a huge collection of Chinese medical texts – which to this day I study and gain inspiration from. Originally, I graduated as a Doctor of Internal Medicine, but I now specialize mainly in Skin, Auto Immune and Allergic Disease.
Q: Why did you choose to, and why should practitioners of Chinese medicine in the West, specialize?
A: Experiencing the true difficulties and challenges of clinical practice in my early days, I realized that by focusing mainly on certain types of conditions I could develop a greater insight into treatment protocols and approaches, which would otherwise always remain elusive if I saw all-comers. I also reasoned that if I could encourage others to do the same, then the standard of Chinese Medicine would be raised and we could as a group offer the very best chance of success to our patients for a whole range of conditions that I know Chinese Medicine can be very effective for.
This is what to this day I try to encourage at my clinic and when I am lecturing. We all have the potential to unlock the incredible scope of practicing the true art of Chinese Medicine. The important thing is to focus on what you really want to achieve, without being sidetracked, and I have been lucky to be able to follow my dream.
Q: Please tell us more about the treatment of skin disease.
A: An astonishing 20% of all medical consultations are for a skin disease. What I find so interesting about treating the skin, aside from the fact that Chinese Medicine has a real and enduring answer to many of those chronic diseases that frankly modern medicine can only palliate, is that it has such a strong visual component.
You can see for example what Heat, Damp, Toxin or Wind actually looks like and you can chart the progress of your treatment very easily. There is no where to hide when you treat skin disease - it either gets better or not. As an aside, I take detailed pictures of all my skin patients which makes it even easier to see what effect my intervention has had. Most people are put off treating skin disease because they are daunted by the variety and apparent similarity of one condition to another. In fact, with precise guidance, 70% of the most common presentations are easily differentiated.
Q: Do you follow a particular school or style of practice in Chinese medicine?
A: I draw on a wide variety of approaches. I have studied the classics as well as texts of respected doctors from China that I have discovered over the years. What has proved most suitable for the inflammatory diseases that I see a lot of, is the theories and concepts of Wen Bing (Warm Diseases), so I would say that acts as my primary guide. Having said that, whatever works I incorporate into my repertoire. I like to take away what I learn from my studies and the classics and go back to my clinic to find my own theoretical understanding based on the results I achieve in my practice.
Q: You are known as an innovator and a trailblazer in the field. Please tell us more about your life and practice.
A: It's simple really. I have deliberately evaded the lure of the big bright lights and kept my set up "small and beautiful" in a little town by the sea in the South of England. I walk or cycle to work, my consulting room overlooks a beautiful garden where I have planted a collection of favorite Chinese herbs. I also run my own dispensary with raw herbs that I source and import myself directly from trusted suppliers in China: from field to patient! I have the option to adjust the stock I hold at any time (presently about 500+ different raw herbs) and to introduce new herbs and processing mechanisms in line with new treatment approaches I try out – so I constantly develop new creams and washes and other topical products for my patients that I can make up on the spot since I have got my own development laboratory set up.
I set my marker very high, but I develop and evolve my original clinical approach through self-study and clinical application, and I have adapted my treatment methods many times – my students can attest to that! I collect clinical data, for example I have been blood testing all patients on herbal treatment at my clinic for over twenty years. I have amassed a huge amount of data on liver function tests of patients undergoing treatment with Chinese herbs. By the way, the results suggest that herbs are a very safe option! Overall, I don't think things are written in stone. I keep adjusting, I learn and I change.
Q: I have not heard you mention granules, rather, only bulk herbs. Is there a reason for that?
A: Yes, I only use raw herbs. For me, they work. I see hundreds of patients every month and the treatment outcomes speak for themselves. In my opinion the results achieved using the traditional methods of raw decocted herbs far surpass any other form of administration.
The main advantage to patent remedies is that you retain the supremely important option to alter a classical formula by adding or removing ingredients to suit the exact pattern the patient presents with. The major advantage over granules and powders is the extraction and intermingling that occurs with the cooking process, which is where the true magic of herbal medicine through synergistic interactions comes into play. This is pretty much absent or underrepresented with the other forms of administration. I often use the analogy of cooking tasty food. Imagine the result of taking the desiccated ingredients of a recipe and simply adding water to rehydrate them. You certainly won't end up with the same flavours or nutritional value that you would do if you cooked the ingredients together from the beginning.
Q: Would you please speak about the quality and safety of herbs?
A: Herbs are natural products; there can be a vast variation in quality. For centuries, the Chinese have graded medicinal ingredients to reflect this variation. Where and how an herb was originally grown, how it was harvested and processed so that it can be used medicinally is of crucial importance. In China, there are five commonly marketed classes of quality for most herbs and the difference in price can be substantial, however this ultimately reflects the difference in an herb's efficacy and the results one can expect to achieve in clinical practice.
Q. How is your dispensary different to a commercial herb supplier?
A: I cater to my own patients, so my priorities have always been distinctly different to running a wholesale business.
It was always benefit before profit and quality over quantity. Our first concern is not commercial interest, but the enhancement of the therapeutics.
We pursue methods that we know from experience produce results. This ranges from the frequent use of preparing the material or, "pao zhi", to our modern decoction service, to the daily manufacturing of bespoke herbal products such as syrups or pills for individual patient's requirements. It is of the utmost importance that we know what we prescribe and that what goes into our medicines is what we think it is, and of course that it is of the best available quality for the purpose.
Q: Tell us more about how your decoction facility?
A: During one of my visits to China many years ago, I became aware that decoction service had become the preferred method of preparing herbs in Chinese hospitals. I recognized that this method would overcome many problems associated with patients having to prepare their own herbs. This delivered outstanding and consistent outcomes. Therefore, in 2003 I started importing the machinery required to decoct and pack the herbs, and I have never looked back. Patient compliance is without a doubt much improved. The decocted liquid herbs, because of high pressure cooking in sealed units is around 30 percent stronger than can be achieved on stove tops at home, actually are more palatable, somehow smoother and therefore easier for patients to drink. Gone are the problems traditionally associated with decocting such as the need to remember to soak and cook the herbs daily, adding ingredients before or at the end of cooking, the smell associated with preparation at home and so on. In my experience in the past, this could end up draining the last bit of resolve from patients who were able to cope with all the inconveniences, but were finally unable to deal with the uproar from other family members because of the smell.
Q: What about topicals for skin patients?
A: In addition to consuming medicine internally, for disorders of the skin we have the extra advantage of being able to apply them directly to the diseased areas, so topicals are paramount – always guided by the requirements of my own practice and the need of my patients. It all started out 27 years ago in my kitchen!
No doubt the biggest amount of time I have spent in later years has been on improving my creams, ointments, lotions, tinctures, washes etc. You see, although traditional ointments can be very effective, being in essence medicated oils with very finely powdered herbs and bees wax added to make the product, they tend to be very greasy and messy and not so user friendly. The science of making creams (an emulsion of oil and water) was never developed in traditional Chinese medicine, so I have experimented by drawing upon the best from traditional and modern methods and finally achieved to make products that are both effective and easy to use. I still make and use a more traditional ointment, but have added other products to supplement their use.
Q: You are the co-author of the international best-seller, "Manual of Acupuncture". Why do you only speak about herbs?
A: It's true – it took us over eight years of painstaking work to write the Manual! Yet I have left acupuncture behind and only use it to treat family and friends. In real life there are too many choices and my true passion lies with the practice of herbal medicine, and the art of applying it.
Q: Your way of practicing Chinese Medicine has inspired many. How can others learn more about what you do?
A: I have been teaching since the late 80s. I often speak at conferences and symposiums, and have run the "Dermatology Diploma Course" in London over the last ten years and am now happy to announce that I will be bringing it to the U.S. My lectures are highly practice-oriented and geared towards solving real problems encountered in every day clinical environments. I love to be able to share the insights I have developed over the years with my students, so they can take away what they learn and apply it in their own practice straight away. The biggest buzz I get is when a student tells me that they have managed to achieve a result in their clinic by successfully applying what I have learned and passed on to them from my observations. It really is one of my greatest privileges and pleasures.
Click here for previous articles by William Morris, DAOM, PhD, LAc.