Diseases – American Institute of Acupuncture

Acute Leukemia

acuherb — Thu, 17 Dec 2015 05:22:52 +0000

LeukemiaÂ Â is a type of cancer in which abnormal white blood cells grow in an uncontrolled manner. The white blood cells divide, multiply, and then spread out of control. This interferes with the production of normal blood cells.

Understanding how normal blood cells are formed offers greater insight into leukemia. Most blood cells are formed in the bone marrow and by the other organs in the lymph system. The marrow is the soft, sponge-like center of large bones. In the marrow of a healthy person marrow, very young cells called stem cells multiply and mature into three types of cells: white blood cells, red blood cells, and platelets. Each type has a specific job to do in the body.

White blood cellsÂ fight infection by destroying bacteria aÂ Leukemind viruses that invade the body.
Red blood cellsÂ carry oxygen from the lungs to all parts of the body.
PlateletsÂ help form blood clots, which control bleeding when a person is injured.

The lymph system consists of the bone marrow, lymph nodes, spleen, thymus, and tonsils. This system produces B-and T-lymphocytes (types of white blood cells). The B-lymphocytes fight infection by making substances called antibodies, which attack germs in the body. T-lymphocytes help to destroy invading organisms as well as cancer cells.

In leukemia, the marrow produces too many immature or abnormal white blood cells.Â As a result the leukemia cells crowd out the marrow and leave very little space for the normal blood cells to grow. Consequently, the number of healthy blood cells drops, and causes frequent infections, anemia, and bleeding problems.

This year about 31,500 Americans will be diagnosed with leukemia, including 28,800 adults and 2,700 children, and approximately 21,500 persons will die of leukemia. The chances of survival depend on the type of leukemia, the age and health of the person, and the medical treatment one receives. An average of 65% of people with leukemia survive for one year after diagnosis. This rate drops to about 44% five years after diagnosis.

Leukemia is grouped in two ways. One way is by the type of white blood cell that is affected. The other way is by how quickly the disease develops and worsens. This grouping is important because the speed with which leukemia progresses and the types of therapy that are given vary.

There are two main types of white blood cells: granulocytes and lymphocytes. Leukemia involving granulocytes is calledÂ myeloid or myelogenous leukemia. Leukemia involving lymphocytes is leukemia.

Leukemia can be eitherÂ acuteÂ orÂ chronic. Acute leukemia progresses quickly with many immature cells. Chronic leukemia progresses slowly with more mature, normal looking cells.

The two ways of grouping leukemia usually results in four main types of leukemia:

	Acute myelogenous leukemia (AML)Â is a common leukemia in adults from the ages of 50 to 70 years old. It is also called acute nonlymphocytic leukemia (ANLL). Acute promyelocytic leukemia, a subtype of leukemia, is associated with bleeding disorders.
	Acute lymphocytic leukemia (ALL)Â is the most commonly diagnosed in children under the age 10, but it also affects adults of ages 65 and older. Most ALL cases involve B-cell lymphocytes. The good news is that the 5-year survival rate of ALL has dramatically improved from 38% in the mid-1970s to 60% in the late-1990s. Survival rates for children with ALL have increased from 54% to 82% over the same period.
	Chronic myelogenous leukemia (CML)Â occurs mainly in adults from 50 to 70-year-old, but a small number of children may get CML. People with CML usually have a mutated gene called the “Philadelphia” chromosome where a part of one specific chromosome is attached to a different chromosome.
	Chronic lymphocytic leukemia (CLL)Â usually affects older adults and can run in families. Persons with CLL may feel well for years without treatment.

Acute leukemia is a malignant proliferative disease that originates from blood producing tissues in the body. It is characterized by symptoms that include anemia, bleeding, fever and infiltration symptoms such as enlargement of the spleen liver and lymph nodes.

Acute leukemia, also referred to by its common subtypes of acute lymphocytic leukemia (ALL) or acute myelogenous leukemia (AML), is a modern medical term that cannot be found in the ancient Chinese medical classics. However, its symptoms are similar to some TCM diseases. Acute leukemia symptoms fall under Traditional Chinese Medicine (TCM) disease categories of “pulmonary tuberculosis”, “hectic fever due to yin-deficiency”, “acute febrile diseases due to insidiousÂ pathogensÂ “, “blood disorders”, “saber”, “subcutaneous nodules” and ” abdominal masses”.

	Pulmonary Tuberculosis:Â This disease causes the same kind of fever and anemia symptoms as in acute leukemia, and is mentioned in the famous medical classic “Sheng Ji Zong Lu” written in 1118 A.D. The title means a collection of medical records.
	Hectic fever due to Yin-deficiency:This is a low-grade fever similar to those experienced in leukemia. It results from a yin deficiency and is mentioned in the medical classic“Treatise on the Causes and Symptoms of Diseases” written in 610 A.D.
	Acute febrile diseases due to insidious pathogens: These diseases cause similar high fever symptoms as in acute leukemia associated infections.
	Blood disorders:Â These conditions produce the same bleeding symptoms such as nose bleeds, gum bleeding and blood in the stool.
	Saber:Â Named after its shape, this is the inflammation of the axillary (armpit) and neck lymph nodes caused by tuberculosis bacteria.
	Subcutaneous nodules or abdominal masses:Â This TCM condition presents as infiltration symptoms such as enlargement of the lymph nodes, liver and spleen.

Causes

Western Medicine

Although there is no proven cause for leukemia, the disease is known to affect people of both sexes and all ages. It is also observed that leukemia affects more males than females, and is more often found in white people than in black people. On a positive note many people with one or more of known risk factors for leukemia never develop the disease, but most people who do develop the disease have no risk factors at all. Researchers have identified several possibilities for leukemia which are:

	Age
	Researchers believe that the chances of a normal gene changing into a cancerous gene increases with age. More than half of people who develop leukemia are over the age of 60.
	Smoking
	There have been reports of an increased risk of AML with cigarette smoking because it may trigger certain changes in a cell’s genes.
	Ionizing radiation
	A small percentage of leukemia cases are linked to exposure to high doses of radiation. For example, the survivors of the atomic bomb explosions at Nagasaki and Hiroshima in 1944 subsequently saw an increased incidence of leukemia. However, it has not been proven that exposure to large amounts of low-energy radiation from electric appliances, diagnostic imaging tests, or living near power lines will cause leukemia.
	Certain genetic conditions
	Scientists do know that most types of leukemias are associated with specific gene mutations. People who have rare genetic syndromes are at a higher risk of developing the disease. One example is Down’s Syndrome, in which there is a 20-fold risk of getting leukemia. Studies have shown that sex and ethnicity are factors in the disease as well. It is observed that leukemia occurs in males more often than in females, and in white people more often than in black people. The incidence of leukemia is high in Jewish people from Eastern Europe, but low in Asians.
	Chemical exposure
	Workers who have a long-term exposure to high levels of solvents such as benzene have a high rate of leukemia. Benzene is used in making medicines, dyes, and many other products.
	Drug therapy
	Certain drugs used to treat cancer called alkylating agents may also cause leukemia anywhere from two to nine years following treatment for various forms of cancer. The antibiotic chloramphenicol was associated with an increased risk of childhood ALL in mainland China.
	Rare viruses
	Human T-cell leukemia virus (HTLV-1) has been associated with the adult T-cell leukemia/lymphoma, which is often seen in geographical areas like the Caribbean and Japan.

Chinese Medicine

The major cause of leukemia is aÂ qiÂ deficiency andÂ pathogenÂ invasion that disturbs the harmony and balance of the body. The ways in which these conditions lead to leukemia symptoms are described below:

1.	When the vital qi (vital energy) is deficient,Â pathogensÂ can more easily invade the body and affect the normal functions of theÂ heart,liver, nutrient qi and blood. When this happens, TCM febrile disease symptoms such as high fever, bleeding, coma and convulsion can occur.
2.	If the body’s internal organs, especially theÂ spleenÂ andÂ kidney,Â yin and yang, qi and blood, become exhausted after a long period of months or years, the production of qi, blood, essence and bone marrow decline. This leads to leukemia related symptoms such as anemia and fatigue.
3.	A vital qi deficiency and pathogen invasion also affect qi and blood movement and the distribution of body fluid inside the body. Abnormal disturbances of these substances can cause blood and body fluids to leak out from theÂ TaiyinÂ (lung and spleen),Â ShaoyinÂ (heart and kidney) andÂ JueyinÂ (pericardium and liver) meridians, or the disturbance can cause them to accumulate and mix together. When this happens, they transform into a mass or nodule inside the body leading to infiltration symptoms such as liver, spleen or lymph node enlargement.

Symptoms

Western Medicine

With an acute onset of leukemia, symptoms appear and quickly worsen. However, the early symptoms of leukemia may be overlooked because they are similar to the flu or other common illnesses. In chronic leukemia, symptoms may not appear for a long time. In general, they are mild at first and gradually worsen. Chronic leukemia is often found during a routine medical check-up before there are any symptoms.

While signs and symptoms for each type of leukemia differ, common symptoms of leukemia include the following:

	Fever, chills, and other flu-like symptoms
	Frequent infections
	Slow healing of minor cuts
	Loss of appetite and/or weight loss
	Persistent weakness, fatigue, and pale complexion
	Swollen or tender lymph nodes, liver, or spleen (more common in ALL and CML)
	Unexplained and easy bleeding or bruising
	Tiny red spots (petechiae) under the skin
	Swollen or bleeding gums due to clumping of white blood cells
	Sweating, especially at night
	Bone or joint pain
	Headaches, nausea and vomiting, blurred vision, and seizures if the leukemia cells collect in the brain or spinal cord
	Swelling of testicles or soreness in the eyes or skin

Chinese Medicine

TCM practitioners will examine the individual, and categorize the symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present during the different stages of the disease. Acute leukemia can be classified into following types:

I. Acute Attack Stage:Â This first phase of the disease is when abnormal white blood cells crowd the bone marrow and blood so that normal blood cells such as red blood cells, normal white blood cells, and platelets cannot be made in their normal amounts. There are four disharmony patterns under this stage.

1.	Damp and Heat Type
	Individuals have symptoms like a fever that cannot be relieved after sweating, and do not experience an aversion to cold temperatures. Dizziness, fatigue, a full feeling in the stomach and abdominal areas, and diarrhea are common. The urine appears dark yellow and comes in scanty amounts. In serious conditions, individuals will additionally suffer from severe joint pain.
2.	Noxious Heat Type
	Individuals suffer from a high fever, heavy sweating, and a pounding, throbbing pain in the head. Abnormal blood circulation symptoms such as bleeding from the nose, gums, or blood in the stool or urine can be present. The skin may also have a bruised appearance or haveÂ petechiae. The blood coagulation problems may cause life threatening symptoms in severe cases such as unconsciousness and bleeding into the brain.
3.	*Accumulated Mass Type*
	Masses or nodules appear beneath the skin of both sides of the neck, axilla (armpits) and inguinal regions (groin area). Individuals may experience severe and persistent bone pain, accompanied with restlessness and fever.
4.	*Interior Liver-Wind Stir- Up Type*
	Symptoms include severe pounding, throbbing pain in the head, impulsive vomiting, and a stiff neck. These can progress to more serious symptoms such as convulsions, spasms, and even paralysis of the face. In the most severe cases individuals experience an irregular and intermittent pulse, which leads to coma and finally death. The most severe cases occur when the leukemic cells enter the brain and impair its functioning.

II Remission Stage:Â The remission stage is when individuals are recovering from leukemia or are cured from it. This phase begins when the symptoms and signs of leukemia disappear, and the number of white blood cells and other blood cells in the blood or bone marrow return to normal. There are two disharmony patterns grouped under this stage.

1.	Deficiency of Qi and Yin Type
	Individuals have symptoms like heart palpitations, and shortness of breath. The complexion appears wan and sallow, and the body’s skin itself appears withered and pale. Additional symptoms that may be present include fatigue, poor appetite, chapped lips, dryness of the mouth and throat, restlessness, fever, spontaneous sweating or night sweats.
2.	Deficiency of Qi and Blood Type
	Individuals have pale lips, nails and a pale complexion. The skin may appear bruised in certain areas and the mucous membranes inside of the mouth can haveÂ petechiae. Dizziness, vertigo, distension and fullness in the abdomen, poor appetite, and heart palpitations that worsen with activity may also be present.

Diagnosis

Western Medicine

Medical history:Â Diagnosing leukemia involves several steps. Your doctor will want a detailed medical and family history to help decide if you are at risk for developing leukemia (for more information, refer to the section on the causes of leukemia). Other information includes the kind and duration of symptoms you are experiencing.

Physical exam:Â Your doctor will conduct a routine physical exam and will look for the swelling in the liver, the spleen, and lymph nodes.

Investigations:

If your doctor suspects you have leukemia, you will be referred to an oncologist. An oncologist is a doctor who specializes in diagnosing and treating cancer. He will request further blood tests and bone marrow examination. These procedures will help the doctor confirms the diagnosis, determine the type of leukemia, and to decide upon what kind of treatment is necessary.Â

Blood tests:Â A sample of blood is examined under a microscope to determine the number and the type of blood cells. Most people with leukemia have too many white blood cells and not enough red blood cells or platelets. If the results of the blood tests are not normal, your doctor may do a bone marrow biopsy.

Bone marrow aspirate and biopsy:Â A sample of bone and marrow cells is removed by inserting a long, hollow needle into the hipbone. These cells are stained and examined under a microscope. This test can confirm the diagnosis and reveal the type of leukemia.

Marrow is taken by syringe

Bone marrow aspiration and biopsy

Lumbar puncture:Â A small needle is inserted through the back to take out a sample of the fluid that surrounds the brain and spine. The fluid is then examined under a microscope to see if leukemia cells are present.

Imaging:Â One or more of the following tests are done to create a picture of the inside of the body and to see how far the leukemia has spread. These tests include X-rays, computed tomography (CT scan), magnetic resonance imaging (MRI), bone scan, and ultrasound.

Immunologic studies:Â This is an antibody-antigen reaction. An antibody is a protein made by lymphocytes, which is capable of interacting with a foreign substance (antigen), to inactivate it. This study will identify the antigens on the surface of cells. For example, the ALL may be either B-cell subtypes or T-cell subtypes.

Cellular and genetic analysis:Â The following new tests have improved the diagnosis of different types of leukemia and the measure of disease progression. Currently, these tests are not routinely done outside of the clinical trials.

	Flow cytometryÂ also uses the antibody-antigen reaction method. In this test, a sample of bone marrow, lymph node, or blood is treated with special antibodies attached to fluorescent molecules and passed in front of a laser beam. Each antibody sticks only to a certain type of leukemia cell and the laser causes leukemia cells to give off light.
	Cytogenetic studiesÂ are done to identify defects in the chromosome that may signal the presence of leukemia. The genetic association is especially higher in CLL. In CML, the Philadelphia chromosome is found in more than 90% of all cases.

Deciding on treatment:Â It is recommended to get a second opinion about the diagnosis and treatment plan. Doing this may help the person to confirm the diagnosis and review the proposed course of treatment. In many centers where leukemia is treated, the person may be asked to participate in clinical trials (treatment studies). Clinical studies help doctors find out whether a new treatment is safe and effective.

Â Chinese Medicine

Determining the circumstances and manifestations of a disease through inquiry, and by observing the individual’s symptoms are important in TCM. Diagnosis is based on the followingÂ four examination techniques.

Through these four techniques a variety of symptoms and signs will be used to identify the individual’s disharmony pattern. This is crucial because at the various stages of a disease, a variety of disharmony patterns are present which require different types of therapy. This is why individuals with the same disease are often treated very differently by their TCM practitioner.

A TCM practitioner will not diagnose an individual with acute leukemia. Instead, he or she will diagnose the individual with a disharmony pattern. Particular attention is paid to the following points for differentiation of the various disharmony patterns.

1.	Distinguishing the locations of the illness to find out which organs or systems are involved.
2.	Distinguishing the nature of illness to decide whether the syndrome is yin, yang, excess or deficiency type.
3.	Distinguishing the stage of illness to classify the disease in its acute or remission stages.

Acute leukemia commonly has the disharmony patterns described below:
I Acute Stage of Acute Leukemia

1.	Damp and Heat Type
	This often occurs in the early stage of leukemia, and is mainly caused by a mild deficiency ofÂ qi, and extreme excess of pathogenic heat. Dampness is produced when theÂ stomachÂ andÂ spleenÂ cannot function properly to transform and transport nutrients. As the dampness accumulates over time, it turns into a heat evil which can inflict damage to the body. Upon examination, the tongue is red and covered with yellow, greasy fur. The pulse is rapid.
2.	Noxious Heat Type
	This usually occurs at the time when normal blood cell production of white blood cells, red blood cells andÂ plateletsÂ is exhausted due to the overproduction of leukemic cells in the bone marrow and blood. At this stage, noxious heat is extremely excessive, and the remaining vital qi is sparse. Noxious heat and other toxic waste products are produced when the organs hyperfunction and an increase in metabolism is created that results in material consumption of substances such as nutrients and body fluids. As a result, the noxious heat damages theÂ meridiansÂ and blood and causes bleedingÂ symptoms. Upon examination, the tongue is red and dry and covered with yellow, dry fur. The pulse feels rolling and rapid.
3.	Accumulated Mass Type
	Noxious heat and phlegm evils transform into masses when they stagnate, and block theÂ collaterals(part of the meridian system) in the course of leukemia. Upon examination, the lips and tongue appear pale, and the tip and the margin of the tongue exhibitsÂ petechiae. The pulse feels deep and fluttery.
4.	Interior Liver-Wind Stir-Up Type
	This usually occurs at the terminal stage of acute leukemia, and develops from the stirring up of interior wind evils. In this stage, the body accumulates excessive noxious heat, which consumes body fluids and damages the blood and meridians. This triggers endogenous pathogenic wind that seriously disturbs the movement of qi and blood. Wind evils affect theÂ liver, which is responsible for helping with the flow of qi and blood. The wind evils are the result ofyin deficiency, hyperactivity of liver-yang or excess heat evils. This type can also be caused by phlegm evils blocking the clear orifices such as the mouth. Upon examination, the tongue appears red and dry is coated with little or no fur. The pulse is stringy and rapid.

II Remission Stage of Acute Leukemia

1.	Deficiency if Qi and Yin Type
	This occurs in a late stage of leukemia when the body is trying to recover from the damage the disease has inflicted. Qi and yin have been exhausted for a long period and the heart, spleen and body fluid distribution are no longer functioning normally. Upon examination, the tongue appears red and is covered with scanty or scaled fur. The pulse feels deep, thready and rapid.
2.	Deficiency of Qi and Blood Type
	This also occurs at the late stage of leukemia where the body is starting to recover. During this stage, vital qi begins to convalesce, and the heat, wind or damp evils start to disperse. The body is getting better from the illness, but the impaired organs, qi and blood are still very weak. Upon examination, the tongue is pale and swollen with indented margins, and covered with a thin, white fur. The pulse sign is deficient and heavy or soft and thready.

Click here to see the development of leukemia from a TCM perspective

III Differentiating acute leukemia from other illnesses

In the clinical diagnosis of TCM, acute leukemia should be differentiated from other similar diseases.Â

1.	Consumptive Disease
	This is a disease caused by insufficiency of vital qi and blood, or organ deficiency. When the individual experiences fever and anemia, it should be distinguished fromaplastic anemia, which comes under the category of consumptive disease. In the whole course of this type of disease, there are no nodules or abdominal mass, so it is easy to differentiate.
2.	Blood Disorders
	Blood disorders involve spontaneous bleeding diseases such as thrombocytopenia (not enoughÂ plateletsÂ to clot the blood), abnormal blood vessels and blood coagulation factor deficiencies. These specific blood disorders can be detected in leukemia patients through blood tests.
3.	Fever Caused by Exogenous (external) evils
	This type of fever is usually induced byseasonalÂ pathogens. It usually presents with persistent high fever and excessive interior heat. Interior heat is produced when there is a pathological disturbance in the physiological functions of the qi, blood, body fluids and organs. With this type of fever, the individual’s blood parameters are normal, and it is easy to recover from the fever. However, leukemia sufferers usually have a persistent low-grade fever, but when it is complicated by infections, the temperature will be high.

Note:Â If a TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual see a western doctor for further follow up.

Treatment

Western Medicine

New and more effective ways of treating leukemia are being discovered annually. Many people with the disease can live for many fruitful years and be cured.

Doctors design a treatment plan to fit each individual’s needs. They consider the type of leukemia, how far it has spread, and whether the person has had other cancer before. The person’s age, symptoms, and general health are other factors of consideration.

Although acute leukemias show a more aggressive course, they are more often curable than chronic leukemias. The treatment of acute leukemia attempts to kill leukemia cells so they never grow back. Most doctors say that a person is cured if he or she shows no symptoms for five years after treatment. Chronic leukemias are less often curable. The treatment of chronic leukemia attempts to delay the leukemia from getting worse and to manage symptoms.

Treatment of acute leukemia usually involves three stages:Â 1) induction for remission, 2) post remission, and 3) therapy at the time of relapse. In addition, preventive therapy for leukemia in the brain is given to persons with ALL.

The standard treatments for adult leukemia are chemotherapy and bone marrow transplantation. Radiation and immunotherapy are used in specific types of leukemia. Since the leukemia cells spread throughout the body, surgery cannot cure this disease. However, surgery is done in some cases of lymphocytic leukemia. For example, if the spleen is swollen a doctor may take out the spleen.

RadiationÂ uses X-rays or other high-energy rays to destroy leukemic cells. It is administered either to the whole body or to only one area. Radiation is used for leukemia in the central nervous system (which includes the brain and spinal cord and in the testicles). It is also used for pain caused by spinal cord compression or expansion of bone marrow as a result of the leukemic cells crowding the bone marrow.

ImmunotherapyÂ tries to get the body to fight leukemia. It uses protein made by the body or created in a laboratory to boost, direct, or restore the body’s defenses against disease. Use of Interferon-alpha helps to strengthen the immune system and may delay the progression of the CML.

ChemotherapyÂ is the most common way to treat leukemia. Chemotherapy means drug therapy in which various drugs are used either in combination or as a single agent. Drugs taken by mouth or injected into a vein enter the bloodstream and kill leukemia cells in most part of the body. This is called systemic chemotherapy.

Rapidly multiplying cells often are more sensitive to the effects of chemotherapy. Most anti-leukemic drugs interact with DNA, the genetic material contained in all human cells. This interaction changes the DNA in such a way that the cancer cells are killed or are prevented from producing more cancer cells. Unfortunately, rapidly dividing normal cells in the body are also affected by these drugs, which can cause serious side effects.

Therapy for induction of remission.Induction refers to initial chemotherapy given to the person with leukemia to induce or produce a complete remission. Complete remission means there are no signs or symptoms of leukemia, and the number of white blood cells and blood cells in the blood and marrow is normal. The success of treatment depends on factors such as the ability to tolerate intensive treatment, the patient’s age, and the type of drug regimen.

In AML, the typical induction regimen consists of a combination of anti-cancer drug cytarabine and either one of the anthracyclines: daunorubicin, mitoxanthrone, or idarubicin. This regimen results in 60 to 80% of persons having complete remission.

One exception is the treatment of patients withÂ acute promyelocytic leukemia (APL), a subtype ofÂ AML. In APL, a defect in the retinoic acid receptor prevents the normal growth of promyelocytes (precursors to normal myeloid cells). The all-trans-retinoic acid (Tretinoin), a vitamin A derivative, causes leukemia cells to mature and die. This drug is used in addition to the chemotherapy. Another drug, arsenic trioxide, also is available to treat APL.

InÂ ALL, the most commonly used drugs are vincristine, cytarabine, cyclophosphamide, L-asparaginase, and prednisone.

InÂ CML, drugs like hydroxyurea or interferon have been used. A newly approved oral drug, imatinib mesylate (Gleevec) has been successful in promoting remission among the people enrolled in clinical trials. Its effect on long term survival still needs to be seen.

InÂ CLL, chlorambucil, fludarabine, and cyclophosphamide are commonly used in treatment. Chlorambucil produces a 5-year survival in 48% of people affected. With prolonged use, however, the disease becomes resistant to these drugs and progresses.

Post-remission therapy.Â Once the person with leukemia achieves a complete remission and recovers from the adverse effects of induction therapy, post-remission chemotherapy begins. This therapy tries to kill any remaining leukemia cells. Without further treatment, leukemia will recur in the majority of persons. The same drugs may be administered in a modified schedule or in doses.

In AML, high-dose cytarabine is used in persons less than 55 years old. This results in a long-term disease free survival of 5 years by 15 to 50%.

In ALL, the person continues to receive chemotherapy but in smaller doses. A typical maintenance regimen consists of low-dose oral methotrexate and 6-mercaptopurine. In order to stay in remission it may be continued up to several years.

Therapy at the time of relapse.Relapse refers to the return of leukemia cells, which were once absent, in the bone marrow. Response to further chemotherapy following relapse is usually poorer than the initial response after the induction therapy. For patients with an eligible donor, bone marrow transplantation (BMT) is an option and it may improve chances of survival.

Leukemia in the brain.Â Certain types of leukemia have a tendency to spread to the nervous system. To prevent or to treat this, doctors may inject a drug into the spinal fluid to destroy any cancer cells. This is known as an intrathecal method of administration. Radiation or high doses of systemic chemotherapy are given at the same time with intrathecal chemotherapy.

Bone marrow transplant (BMT). Bone marrow transplants offer some people with leukemia the best chance for a cure. It is usually performed when the leukemia is in remission but has high risk for relapse ; does not respond fully to the treatment, or relapses after treatment. In order to perform the transplant, higher doses of chemotherapy drugs are given. These high dose drugs effectively destroy the person’s leukemia cells. They also kill the normal infection-fighting cells of the bone marrow. To compensate for this destruction, healthy marrow cells are taken from the donor whose tissue type is the same as or almost the same as the person with leukemia. These are infused or transplanted into the person’s bloodstream through an intravenous (IV) catheter. It is hoped that the transplanted bone marrow will produce healthy white blood cells on its own.

There are two types of marrow transplants. In theÂ autologous marrow transplantation, the person’s own healthy bone marrow that has been saved and “cleansed” of leukemic cells are re-infused to replace marrow that was destroyed. In theÂ allogenic transplantation, marrow from a donor with a match of all six cell-markers, known as human leukocyte antigens (HLA), is used to replace the diseased marrow. The healthy marrow may be obtained from either identical twins (best match), or HLA-matched brother or sister, and more recently, from a person who is not related to the person with leukemia.

Based on most clinical studies, the overall survival rate among the different types of BMT was similar. BMT is successful about 50% of the time when measured two years after the treatment. There was a higher relapse rate in autologous BMT due to the failure of getting rid of all the leukemia cells. However, more persons died in the allogeneic BMT due to the complications.

Complications from treatment

Chemotherapy related complications

	The goal of chemotherapy is to destroy leukemia cells, but the drugs are not yet sophisticated enough to only target cancerous cells. In the process healthy cells, especially fast dividing cells such as the hair, skin, mouth, stomach, and intestines, may be destroyed. As a result, the person may lose hair, and suffer from dry skin, mouth sores, and an upset stomach. Fatigue is also a common side effect.
	Chemotherapy lowers patients’ normally functioning blood cells to very low levels. This results in an increased risk of infection and bleeding. The person must often take antibiotics to treat infections, and receive transfusions of red cells and platelets to restore the normal functions of these cells.
	Chemotherapy causes the rapid breakdown of leukemia cells, resulting in the release of cell-contents into the bloodstream. This can damage the person’s overall health and be especially damaging to the kidney. The condition is known as “tumor lysis syndrome” However, this problem can be prevented with special drugs (allopurinol and bicarbonate) and by drinking extra fluids.

Transplant related complications

After an allogenic bone marrow transplant, a person becomes at risk forÂ graft-versus-host disease (GVHD).Â This occurs when the donor’s marrow does not exactly match the person’s marrow. A battle between donor cells and host cells endangers the person’s health. Using drugs that suppresses the person’s immune function can reduce this problem.

New treatments:

Scientists and physicians are constantly searching for new and better ways to treat leukemia. Their effort focuses either on improving the efficacy of current drug therapy, reducing its side effects, or trying to attack leukemia cells in new ways.

Chinese Medicine

In TCM, the treatment of acute leukemia is based on the type of disharmony pattern.

ACUTE STAGE:

1. Damp and Heat Type:

Therapeutic aim:Â Due to an accumulation of damp-heat and toxic pathogens in the whole body, treatment focuses on clearing away heat and dampness evils, eliminatingÂ pathogens, and removing toxic substances.

Example of Prescription:Â Chaiqin Chenling decoction with modification

chai hu	chinese torowax root
huang qin	baical skullcap root
long dab cao	chinese gentian
zhi zi	cape jasmine fruit
chen pi	dried tangerine peel
fu ling	Indian bread
ban xia	pinellia tuber
ze xie	oriental water plantain rooti
zhu ling	chuling
bai zhi	large head atractylodes rhizome
lu gen	reed rhizome
she she cao	herba hedyotis diffusa
qing dai	natural indigo

2. Noxious Heat type

Therapeutic aim:Â This is caused by excessive noxious heat in the interior, and the disturbance of nutrientÂ qiÂ andÂ blood. Treatment includes clearing away heat evils, removing toxic substances, and clamping down on blood circulation to stop bleeding.
Example of Prescription: Shuiniujiao Dihuang decoction with modification

shui niu jiao	buffalo horn
sheng di	dried rehmannia root
dan pi	tree peony bark
chis hao	red peony root
yin hua	honeysuckle flower
lian qiao	weeping forsythia capsule
zhi zi	cape jasmine fruit
sheng shi gao	gypsum
bai hua she she cao	herba hedyotis diffusae

For delirium caused by intensive heat, Zixue pill, Zhibao pill or Angong Niuhuang pellet is helpful.

3. Accumulated Mass type

Therapeutic aim:Â This is caused by stagnant phlegm lingering in the interior and blocking theÂ collaterals (meridians). Therefore, treatment includes promoting blood circulation, removing obstruction in meridians, and softening and resolving hard masses.

Example of Prescription:Â Taohong Siwu decoction with modification

tao ren	peach kernel
hong hua	safflower
chuan xiong	szechwan lovage root
dang gui	chinese angelica
di huang	rehmannia root
chis hao	red peony root
hai zao	seaweed
bie jia	turtle shell
sheng mu li	fresh oyster shell
zhe bei	thunberg fritillary bulb
xia ku cao	spike of prunella

4. Internal Liver-Wind Stir Up Type

Therapeutic aim:Â Individuals with this type are in the most critical condition. Emergency treatment includes using aromatic drugs for resuscitation, and suppressing the hyperactiveÂ liverÂ to relieve theÂ wind syndrome.

Example of Prescription:Â Zhengan Xifeng decoction

huai niu xi	achyranthes root
sheng long ku	unprocessed fossil fragment
sheng bai shao	white peony root
tian dong	asparagus root
sheng mai ya	fresh germinated barley
dai zhe shi	ochre
sheng mu li	fresh oyster shell
xuan shen	figwort root
chuan lian zi	szechwan chinaberry fruit
yin chen hao	virgate wormwood herb
gui ban	tortoise shell
gan cao	liquorice root

Additionally, Zixue pill and Angong Niuhuang pellet can be taken with water.

REMISSION STAGE:

1. Deficiency of Qi and Yin Type

Therapeutic aim:Â The toxins and heat evils impair heart-qi, and burnÂ primordial yin. As a result, treatment benefits the qi, nourishes the heart, aids theÂ yinÂ and invigorates theÂ kidney.

Example of Prescription:Â Shenmai, Erzhi plus Dihuang decoction with modification

bei sha shen	coastal glehnia root
mai dong	dwarf lilyturf tuber
wu wi zi	chinese magnoliavine fruit
nu zhen zi	glossy privet fruit
han lian cao	ecliptai
gou qi chi	barbary wolfberry fruit
sheng di	dried rehmannia root
dan pi	tree peony bark
fu ling	indian bread
yi yi ren	coix seed
bai ji li	puncturevine caltrop fruit
gui ban	tortoise shell

For individuals with residual toxic substances:

she she cao	herba hedyotis diffusae
ban zhi lian	chinese lobelia herb

2. Deficiency of Qi and Blood Type:

Therapeutic aim:Â This type is caused by the deficiency of both qi and blood. In TCM, theÂ spleenÂ is responsible for the production of blood and qi. TheÂ kidneyÂ is responsible for storing the essence, which is the source for blood and qi. Therefore, treatment includes replenishing the qi, nourishing the blood, and invigorating the spleen and kidney.

Example of Prescription:Â Danggui Buxie decoction plus Sijun, Bazhen decoction with modification

huang qi	milkvetch root
dang shen	pilose asiabell root
dang gui	chinese angelica
bai zhi	large head atractylodes rhizome
fu ling	indian bread
shu di	processed rehmannia root
qi zi	barbary wolfberry fruit
nu zhen zi	glossy privet fruit
e jiao	donkey-hide gelatin

For individuals with residual toxic substances and hyperactivity of minute collaterals (meridians):

she she cao	herba hedyotis diffusae
xiao ji	field thistle herb

Prevention

Western Medicine

Prevention of leukemia is often difficult because the exact causes of leukemia are not understood.

	Do not smoke.


	Avoid exposure to various chemicals such as benzene. The degree of risk from these chemicals depends on the intensity and duration of exposure.


	Take safety precautions when working with hazardous chemicals or radiation exposures. Follow the environmental safety rules written to protect the workers in the industry.


	There are no special tests recommended for detecting the leukemia early. The best way to detect leukemia in initial stage is to report anyÂ symptomsÂ to the doctor right away. Persons with inherited genetic illnesses that are known to increase the risk of developing the disease should talk to their doctor about having regular checkups.

Chinese MedicineFrom TCM’s viewpoint, prevention includes two aspects:

1.	Preventing the onset of disease
2.	Preventing the progression of disease

Prevention of Disease Onset:

Stay away from evils such as wind and heat that invade the body and cause disease is important. Eat a proper diet, exercis regularly, maintain peace of mind by having an optimistic outlook on life. Get enough rest, and maintain a balanced lifestyle.

Prevention of Disease Progression:

Individuals who suffer from acute leukemia should maintain an optimistic attitude, and actively participate with doctors in deciding treatment options. Keeping up good personal hygiene, eating a moderate diet, avoiding smoking and alcohol and avoiding overstrain or mental excitement are also important ways to prevent disease progression.
Special attention should be paid to following conditions:

	When bleeding symptoms like the appearance of large body bruises, nose bleeding and gum bleeding occur, strict bed rest is recommended.
	Leukemia sufferers are more susceptible to exogenous (external) pathogens, so they should be kept in a warm, clean and ventilated room, which should be sterilized regularly to prevent infection.

38 Natural Alternatives for HIV

acuherb — Thu, 10 Jul 2014 20:18:35 +0000

Fortunately, natural substances are being researched for their therapeutic value for our immune health. “Superbugs” develop due to repeated, frequent and multiple different antibiotic prescriptions. Plant products have historically been consumed and utilized for their anti-microbial and holistic benefits. Here are 38 natural substances which indicate potential benefit for people with HIV.

Whey proteinÂ concentrate supplementation canÂ stimulate glutathioneÂ synthesis and, possibly,Â decrease the occurence of associated co-infections.
CurcuminÂ is an effective treatment forÂ HIV-associated diarrhea.
A polyphenol and antioxidant richÂ fruit and vegetable concentrateÂ has therapeutic value in HIV patients due to enhanced proliferation, which could restore disturbances inÂ T-cell homeostasis.
Neem leafÂ extract safelyÂ increases CD4 cellÂ levels in patients with HIV/AIDS.
SeleniumÂ supplementation suppresses the progression of HIV-1 viral burden andÂ improves CD4 count.
Cinnamomum zeylanicumÂ has therapeutic activity in HIV-associatedÂ oral candidiasis.
Elderberry, green tea and cinnamonÂ extracts rich in certain flavonoid compounds were shown toÂ block HIV-1 entry and infection.
LicoriceÂ contains the compound glycyrrhizin which hasÂ significantly inhibits HIV replicationin the peripheral blood mononuclear cells from HIV-seropositive patients.
Sumac (Rhus chinensis)Â contains compounds withÂ anti-HIV activity.
LactoferrinÂ (from milk) mayÂ inhibit HIV virus infection in children.
The use ofÂ Alternanthera pungensÂ herb tea by HIV-infected patients may lead toÂ significant increase T lymphocytesÂ and decrease in biomarkers of oxidative stress, and might help in theprevention of the opportunist diseases.
Plasma antioxidant capacity can be increased by long-term ingestion of polyphenols fromÂ fruit juices or fruit-vegetable-concentrateÂ in HIV-seropositive patients.
American ginsengÂ reduces oxidative stress in patients taking the antiviral medication zidovudine without altering drug pharmacokinetics.
Korean ginsengÂ improves treatment outcomesÂ in HIV-infected patients on antiretroviral therapy.
Glycyrrhiza uralensis (TCM herb)Â improves immune function in HIV-infected patients.
Guduchi (Tinospora cordifolia)Â hasÂ therapeutic activity as an ajunctÂ to HIV/AIDS management.
Lemon juice and lemongrassÂ have therapeutic value in the treatment ofÂ oral thrushÂ in HIV/AIDS patients.
Tea treeÂ is an effective therapy for fluconazole-refractoryÂ oropharyngeal candidiasis.
St. John’s wort (H. perforatum)Â inhibits HIV-1 viral infection.
Lignans found withinÂ SchisandraÂ demonstratesÂ anti-HIV virus activity.
Seawead (S. fusiforme)Â inhibits HIV-1 infectionÂ in T cells, primary human macrophages, microglia, and astrocytes.
Black and green teaÂ contain compounds whichÂ inhibit HIV-1 entry.
Olive Leaf extractÂ exhibitsÂ anti-HIV activity.
Lentin, a novel and potent antifungal protein fromÂ shitake mushroomÂ exhibits inhibitory effects on activity of human immunodeficiency virus-1Â reverse transcriptase and proliferation of leukemia cells.
Chrysanthemum morifoliumÂ contains a flavonoid withÂ anti-HIV activity.
Croton tiglium, Cynomorium songaricum, Xanthoceras sorbifolia, and oleanolic acid derivates exhibitÂ anti-HIV activity.
Hyssop and Dittrichia viscosaÂ haveÂ anti-HIV-1 activity.
PomegranateÂ exhibitsÂ antiviral activity against HIV-1.
A polysaccharide fromÂ Rooibois leavesÂ has aÂ strong anti-HIV activity.
Rosa damascenaÂ contains compounds withÂ anti-HIV activity.
Rose flowersÂ contain compounds with with human immunodeficiency virus (HIV) type 1reverse transcriptase inhibitory activity.
Carnosic acid, a component found withinÂ Rosemary,Â inhibits HIV-1 protease.
Phyllanthus niruri (syn. P. amarus)Â inhibit wild-type HIV virus andÂ reverse transcriptase inhibitor-resistant variants.
CalophyllumÂ brasilienseÂ and Clusia quadrangulaÂ exhibitÂ HIV-1 inhibitory activity.
Melissa, Sweet Basil, Perilla, Prunella vulgaris and SavoryÂ hasÂ potent anti-HIV-1 activity.
Black cohoshÂ contains a compound Actein which exhibitsÂ potent anti-HIV activity.
Black and green teaÂ contain compounds whichÂ inhibit HIV-1 entry.
Blue-green algaeÂ extracts inhibitÂ reverse transcriptases activity, including that of HIV-1.

RHEUMATOID ARTHRITIS

acuherb — Thu, 10 Jan 2013 21:58:18 +0000

More than one in seven Americans experience the nagging pains and physical limitations of arthritis. There are more than 100 forms of arthritis. Rheumatoid arthritis is among the most debilitating of them all, causing joints to ache and throb and eventually become deformed. Sometimes these symptoms make even the simplest things â€” like opening a jar or taking a walk â€” difficult to manage.

Â Â Â Â Unlike osteoarthritis , which results from normal wear and tear on the joints, rheumatoid arthritis is an inflammatory condition. The exact cause of it is unknown. But it’s believed to be caused by the body’s immune system attacking the synovium â€” the tissue that lines the joints.

Â Â Â Â Rheumatoid arthritis affects about 2.5 million Americans and about 20 million in the world. It’s three times more common in women than in men and generally strikes between the ages of 20 and 50. But rheumatoid arthritis also can affect very young children and adults over age 50.

Â Â Â Â There’s no cure for rheumatoid arthritis. But with proper treatment, a strategy for joint protection and changes in lifestyle, you can live a long, productive life with the condition.

Signs and Symptoms

Â Â Â Â The signs and symptoms of rheumatoid arthritis may come and go over time. They include:

Â Â Â Â Pain and swelling in the smaller joints of your hands and feet Overall aching or stiffness of the joints and muscles, especially after sleep or after periods of rest Loss of motion of the affected joints Loss of strength in muscles attached to the affected joints Fatigue, which can be severe during a flare-up Low-grade fever Deformity of the joints as time goes on

Â Â Â Â Rheumatoid arthritis usually causes problems in many joints at the same time. Joints in the wrists, hands, feet and ankles are the ones most often affected. The disease can also involve your elbows, shoulders, hips, knees, neck and jaw. It generally affects both sides of the body at the same time. The knuckles of both hands might be one example.

Â Â Â Â Small lumps, called rheumatoid nodules, may form under the skin of your elbow, your hands, the back of your scalp, over your knee or on your feet and heels. These nodules can range in size â€” appearing as small as a pea to as large as a walnut. Usually the lumps aren’t painful.

Â Â Â Â In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the lining of your heart and lungs, the lungs themselves and, in rare cases, your blood vessels.

Â Â Â Â Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity â€” called flare-ups or flares â€” alternate with periods of relative remission, during which the swelling, pain, difficulty in sleeping and weakness fade or disappear.

Â Â Â Â The flexibility of your joints may be limited by swelling or deformity. But even if you have a severe form of rheumatoid arthritis, you’ll probably retain flexibility in many joints. You may also have less pain than the appearance of deformed joints suggests.

Causes

Â Â Â Â As with other forms of arthritis, rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your joints. When you have rheumatoid arthritis, white blood cells â€” whose normal job is to attack unwanted invaders such as bacteria and viruses â€” move from your bloodstream into your synovium. There, these blood cells appear to play an important role in causing the synovial membrane to become inflamed.

Â Â Â Â This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins also can damage cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.

Â Â Â Â Some researchers thinks that rheumatoid arthritis is triggered by an infection â€” possibly a virus or bacterium â€” in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create a susceptibility are. People who have inherited these genes will not necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited.

Medical Advice Timing

Â Â Â Â See western or Chinese doctor if you have persistent discomfort and swelling in multiple joints on both sides of your body. Your physician can work with you to develop a pain management and treatment plan. Also seek medical advice if you experience side effects from arthritis medications. Side effects may include nausea, abdominal discomfort, black or tarry stools, changes in bowel habits, constipation or drowsiness.

Screening And Diagnosis

Â Â Â Â Rheumatoid arthritis symptoms, your doctor will likely conduct a physical examination and order laboratory tests to determine if you have this form of arthritis. A blood test that indicates your erythrocyte sedimentation rate ( “seed” rate) can indicate the presence of an inflammatory process in your body. People with rheumatoid arthritis tend to have abnormally high seed rates. The seed rates in those with osteoarthritis tend to be normal.

Â Â Â Â Another blood test looks for an antibody called rheumatoid factor. Four out of five persons with rheumatoid arthritis eventually have this abnormal antibody, although it may be absent early on in the disease. It’s also possible to have the rheumatoid factor in your blood and not have rheumatoid arthritis.

Â Â Â Â Doctors may take X-rays of your joints to differentiate between osteoarthritis and rheumatoid arthritis. A sequence of X-rays obtained over time can show the progression of arthritis.

Complications

Â Â Â Â Rheumatoid arthritis causes pain and may also cause fatigue and stiffness. It can lead to difficulty with everyday tasks, such as turning a doorknob or holding a pen. Dealing with the pain and unpredictability of rheumatoid arthritis can also cause depression.

Â Â Â Â In the past, people with rheumatoid arthritis may have ended up confined to a wheelchair because damage to joints made it difficult or impossible to walk. That’s not as likely today because of better treatments and self-care methods.

Treatment

Â Â Â Â Treatments for arthritis until today western medicine still depends on steroid for the western world, it is to help to reduce pain and to delay. Oriental medicine has her special theories and methologies to treat RA very effective. Â Dr. Wang in Acuherb Clinic use his prescription herbal medicine plus his traditional Acupuncture skill treated over 5o RA cases, 95% Â RA effective control and clinically cured, for more information you contact Acuherb Clinic Dr. Wang.

Acupuncture for Diverticulitis

acuherb — Fri, 05 Oct 2012 16:42:57 +0000

Diverticular disease is pathology of the colon thought to be due to weakening of the colon wall that may be caused by increased intra-colonic pressure. Small hernias, protrusions or pouches occur in the colon wall and these can trigger inflammation. Diverticular disease can be asymptomatic until inflammation occurs at which point it is labelled Diverticulitis with typical signs and symptoms of tenderness (particularly on the left side), bloating, cramps, alternating diarrhoea and constipation and occasionally heavy rectal bleeding. Diverticulitis may cause an inflammatory accumulation blocking the intestines and this can be difficult to differentiate from cancer of the colon.

In Western society diverticular disease is more common in women. It may be present in 50% of 60-80 year olds and in 100% of those over 80. 10-20% of these sufferers may go on to develop diverticulitis. Prior to onset of Diverticulitis there may be a history of bowel problems such as constipation, particularly in patients with low fibre diets heavy in refined carbohydrates and fat.Â ¹Gascoigne (2001: 245) suggested there is a clear correlation between incidences of diverticular disease in the Western world and our low intake of dietary fibre.

Western medical treatment is often in a supportive role only, treating the acute symptoms with painkillers, antibiotics and bed rest. If intestinal obstruction occurs then surgery may be suggested (¹Â Gascoigne, 2001: 245).

Diverticulitis and TCM

Diverticulitis falls within the category of lower abdominal pain, bloating and constipation; however, depending on the individual other signs and symptoms such as diarrhoea, anxiety and insomnia may also need to be considered. Diverticulitis is caused by chronic deficiencies of the bodyâ€s energies and vital fluids (Qi, Yin and Yang), usually as a result of getting old and an unsuitable diet over many years. If not checked these deficiencies inevitably lead to stagnation of Qi and Blood causing fullness, bloating, pain and discomfort. If the disease is allowed to progress then further disharmony may occur such as internal Dampness, Heat or Cold causing symptoms such as cramps, vomiting, chills and fevers (²Â Flaws and Sionneau, 2005: 233-34).

After a detailed consultation the TCM practitioner will make a pattern diagnosis, such as â€˜Qi & Yin deficiency with Qi stagnation & Blood stasisâ€ and a treatment plan is discussed. TCM offers many options for treatment and in the case of diverticulitis treatment will usually be by acupuncture and dietary advice, Chinese herbal medicine may also be advised. The treatment will be over a number of sessions and will concentrate on rebalancing and nourishing the body with the aim of lessening or negating the pathological signs & symptoms and calming any anxiety or mental disturbance. At each treatment session the case is reviewed and treatment modified as the condition responds.

Is Acupuncture HelpfulÂ in the treatment of Diverticulitis?

Clinical experience suggests that acupuncture often produces good results in cases of abdominal pain, constipation, diarrhoea and in managingÂ the emotional aspects of disease.

³Â Schneider et al., (2007) concluded in their systematic review of gastrointestinal diseases that the quality of life for sufferers improved significantly with the use of acupuncture.

⁴Â Takahashi (2006) reviewed acupuncture for functional gastrointestinal disorders and concluded that acupuncture may be beneficial. Takahashi anticipated that acupuncture will be used in addition to Western therapies to better manage the disease and significantly reducing the cost of treatments.

References:

¹Â Gascoigne, S. (2001) The Clinical Medicine Guide A Holistic Perspective. Chippenham: Antony Rowe.

²Â Flaws B, Sionneau P. (2005) The Treatment of Modern Western Medical Diseases with Chinese Medicine. Second Edition. Boulder Colorado: Blue Poppy Press.

³Â Schneider A, Streitberger K, Joos S. (2007) Acupuncture treatment in gastrointestinal diseases: A systematic review.Â World Journal of Gastroenterology, 13(25), pp. 3417-3424.

⁴Â Takahashi T. (2006) Acupuncture for functional gastrointestinal disorders. Journal of Gastroenterology,Â 41, pp. 408â€“17

Â

Ulcerative Colitis

acuherb — Wed, 22 Aug 2012 18:56:11 +0000

By Dr. Kenneth Wang

Ulcerative colitis (UC) is a chronic medical condition characterized by inflammation of the inner lining of the colon and rectum.

The inflammation usually begins in the rectum and lower intestine and spreads upward to the entire large intestine, which causes ulceration of the surface of the colon, and results in pus, mucus, and bleeding. The disease commonly starts gradually, with non-bloody diarrhea progressing to bloody diarrhea with symptoms slowly worsening over the course of a few weeks. In about 20 percent of patients, the initial attack of ulcerative colitis is associated with bloody diarrhea and other severe symptoms, with inflammation extending into the colon.

Ulcerative colitis commonly follows a chronic intermittent course, with long periods of remission interspersed with acute attacks lasting weeks to months.

Sections of Large Intestine

Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the large intestine. Based on characteristic signs like persistent diarrhea, rectal bleeding, fever, abdominal cramps and weight loss, TCM puts the chronic condition under the categories of “protracted diarrhea”, “protracted dysentery”, “bloody stools”, or “organ intoxication”.

In China, TCM treatment in the diagnosis of ulcerative colitis was first reported in 1958; however, similar clinical experiences can be tracked to a very early period. In theÂ Han dynasty, the symptoms were recorded in a TCM classic,Â Jinkui Yaolue (Synopsis of the Golden Chamber), which proposed to treat ulcerative colitis byÂ therapeuticÂ approachesÂ like detoxifying, cleansing, warming, astringing and consolidating. The author also formulatedÂ Pulsatilla Root Decoction (bai tou weng tong)Â andÂ Peach Blossom Decoction (tao hua tang)Â specifically for the condition. This established an important foundation for exploring the mechanism of the disease and developing relevant treatment methods. Modern TCM after many years of clinical studies concluded that herbal administrations along with herbal enemas are a better way to control symptoms and can maintain a longer remission from the disease.

Pulsatilla root

In respect to herbal usage, traditional prescriptions usually contain ingredients that fortify theÂ spleen, replenishÂ qi, clearÂ heatÂ and expelÂ dampness. However, specialists have found that mere application of herbs to activate circulation and remove stasis can also achieve similar results.

Ulcerative colitis is a common and complex clinical condition, TCM treatment has its unique advantage.

Â Causes

Ulcerative colitis primarily affects young adults, but it can occur at any age from five to eighty years and women tend to be more commonly affected than men. It is a worldwide disorder with high-incidence areas that include United Kingdom, the United States, northern Europe and Australia. Low-incidence areas include Asia, Japan, and South America.

The causes of ulcerative colitis remain unknown. The major theories include infection, allergy to food component, genetics, environmental factors, and immune response to bacteria or otherÂ antigens.

InfectionÂ : Although use of antibiotics has been shown to improve treatment of active ulcerative colitis, no specific bacteria or virus have been isolated despite many attempts; therefore ulcerative colitis is unlikely to be due to a simple infection. Organisms such asÂ shigellaÂ and pathogenicÂ E. ColiÂ have been investigated as possible infectious agents but they have not been associated with the etiology of the disease.

Food AllergyÂ : The majority of patients with ulcerative colitis are found to be sensitive to milk and this led to claims that food allerg ies , particularly to milk, were the cause of the disease. Although some studies suggest that about twenty percent of patients with ulcerative colitis can benefit from a milk-free diet, there is very little scientific evidence to prove dietary allergy as the etiology of ulcerative colitis.

Environmental FactorsÂ : Other environmental factors proposed as contributing factors in the etiology of ulcerative colitis are oral contraceptives and smoking. The use of birth control pills was found to be more common in women with ulcerative colitis compared to women without the disease. Many studies have shown that ulcerative colitis is more common in nonsmokers than in smokers. The risk of developing ulcerative colitis is shown to be highest for previously heavy smokers, especially within the first two years of cessation. Smoking has shown to alter the function of the cells in the inner lining of the colon but the exact mechanism of the protective effect of smoking is unknown.

GeneticsÂ : There is some evidence that support the theory that ulcerative colitis may be due to genetic factors. The relatives of patients with ulcerative colitis are more likely to have the same disease compared to the general population and approximately ten to twenty percent of patients affected also have at least one other family member with the same disease. Numerous genes with a possible association with ulcerative colitis have been identified. Possible mechanisms proposed for genetic factors contributing to the cause of ulcerative colitis include metabolic defects and connective tissue disorders.

Autoimmune DiseaseÂ : The current leading theory suggests that ulcerative colitis is an autoimmune disease, where the body’s own immune system triggers an inflammatory response against an antigen in the intestinal wall. In this theory, the patient’s immune system mounts an immune response against an antigen, either food particles or microbial organisms which the immune cells recognize as foreign objects, and this immune response triggers inflammatory effects. However, because of similarities between proteins on the cells of the inner lining of the colon and the antigens (dietary or microbial), the patient’s own immune system is activated against the cells on the surface of the colon. Once the immune cells are activated, inflammatory mediators are released which not only cause tissue damage but also amplify the immune response and promote further inflammation in the inner lining of the colon.

Ulcerative colitis is a systemic disease that affects many parts of the body, although patients mainly manifest with intestinal symptoms. In TCM understanding, the problem is closely associated withÂ organÂ dysfunction, in particular theÂ spleen, that cause a failure to self regulate the intestinal environment. TCM specialists generally agree that constitutional weakness, invasion ofÂ exogenous pathogens, anÂ unbalanced dietÂ andÂ emotional factorsÂ all contribute to the development of the problem. The pathogenesis is described below:

Damp-heat in the large intestineÂ
In TCM theory, theÂ large intestineÂ is a hollow organ belonging to the digestive system; it receives the “impure” parts of digested food from the small intestine and continues to absorb water from these materials. At the end of the process,Â stoolsÂ are formed and excreted through the anus. Digestive problems, whether resulting from either external or internal origin, tend to retainÂ dampnessÂ in the intestines, and will further transform intoÂ damp-heatÂ Â in the long run. When the damp-heat pathogens disturb the transmission process in the large intestine, diarrhea will occur; and if the intestinal membrane is irritated, the passing stools will have pus and blood.

Liver overacting spleenÂ
In TCM, theÂ liverÂ promotes flowing and spreading movements, which is embodied in three functional aspects: regulating qi, regulating emotions and enhancing the digestive processes. Long-term emotional stimulation cause a state called “liver stagnation”, not only making the blood and qi flows sluggish, but also interfering with the digestive functions in the spleen andÂ stomach. This facilitates damp-heat to accumulate in the large intestine.

Spleen and kidney deficienciesÂ
The spleen rules transformation and transportation, which means it is the primary organ in regulating digestion. On the other hand, theÂ kidneys‘ warming and propelling activities enable the spleen to work properly. Deficiencies in these two organs lead to a chronic state, which causes intestinal problems such as persistent or intermittent diarrhea to occur.

Blood stasis and qi congestionÂ
Long duration of diarrhea leads to a depletion ofÂ bloodÂ andÂ qi, which causeÂ pathological wastesÂ to form inside the intestines. They can in turn act directly or indirectly on the organs, and give rise to more complex conditions.

SymptomsÂ

Major symptoms of ulcerative colitis are diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. The onset of symptoms is usually slow and insidious and often symptoms have been present for weeks or even months before patients seek medical help. Patients often experience frequent bowel movements of small volume and fecal incontinence. Other symptoms include fever, pain and weight loss.

In general, the severity of symptoms correlates with the severity of the disease. More generalized symptoms such as fever, fatigue, and weight loss are more common if inflammation is extended to all or most of the colon. If the disease is confined to the rectum, the only symptoms may be persistent desire to empty the bowel or spasm of the rectum with or without bloody diarrhea. Some patients, especially elderly patients or those with inflammation confined to the rectum, may complain of constipation and hard stools.

Classification of disease severityÂ
Severity of disease is categorized as mild, moderate, or severe according to clinical symptoms.

Mild:Â diarrhea and rectal bleeding are usually the only symptoms. Patients experience less than four stools daily, with or without blood.

Moderate:Â typical symptoms are five or six bloody bowel movements per day and bloody diarrhea is often associated with large amount of mucus and pus. Incontinence is often a problem especially when the rectum is severely inflamed. Abdominal pain may also be present in addition to low-grade fever and fatigue.

Severe:Â patients experience frequent episodes of bloody diarrhea (more than six bloody stools daily) and they may become anorectic and nauseated. In severe attacks, patients may vomit and experience symptoms of anemia such as breathlessness, ankle swelling, and fatigue. Weight loss, fever, fast heartbeat, dizziness, and severe cramping or abdominal pain can also occur with severe cases of the disease.

Other organ systems affected by ulcerative colitisÂ

Skin:Â most rashes are related to drug therapy, which can cause an allergic skin reaction or photosensitivity reaction to sulfasalazine and 5-aminosalicylic acid (5-ASA). A condition calledpyoderam gangrenosum, an inflammatory bacterial dermatitis with pus and ulceration, is a rare skin condition that occurs in patients with ulcerative colitis and it occurs principally on the trunk or the limbs.

Mouth:Â oral ulcers occur in about ten percent of patient s with active ulcerative colitis.

Eyes:Â inflammation of the eyes occurs in approximately five to eight percent of patients with active ulcerative colitis. Corticosteroid eye drops are useful for controlling symptoms of inflammation.

Joints:Â in approximately ten to fifteen percent of patient s with an acute attack of ulcerative colitis, larger joints (knees, hips, ankles, wrists, and elbow) become hot and swollen. This condition resolves as the disease goes into remission.

Liver disease:Â in severe attacks of ulcerative colitis, minor elevations in liver enzymes are common and the level returns to normal once remission is achieved. However, in about three percent of patients with ulcerative colitis, a major liver complication can occur in which chronic inflammation of the bile duct can lead to progressive liver disease. The cause of this liver disease is unknown and there is currently no satisfactory treatment for this condition.

TCM identifies ulcerative colitis according to the severity and symptoms exhibited in each individual; these are then allotted into differentÂ disharmony patternsÂ or syndromes. Basically, physicians pay special attention toÂ bowel habitsÂ such as frequency, quantity, nature, form, color and smell of the stools, as well as the presence of accompanying physical sensations.

Damp-heat in theÂ large intestine
There is usually acute onset of this type. The diarrhea is violent and foul smelling and with a large amount of pus or blood. There is a burning feeling in the anus, abdominal pain and cramps, a rumbling noise and distention that diminishes after defecation. Other accompanying signs are fever or alternating chills and fever, poor appetite, dry mouth, and scanty yellow urine.

Damp-cold in theÂ spleen
Diarrhea with excessive mucus or watery thin stools,Â tenesmus, abdominal cramps and rumbling noise are also experienced. There are accompanying signs like a bland taste in mouth, stomach stuffiness, no appetite, headache, generalized heaviness, and clear urine.

Qi and Blood stagnationÂ
Diarrhea with alternative solid or loose stools, sticky with mucus or darkish bloody contents; straining to pass a small amount of stools may occur each time; there are also constant stabbing pains at a fixed location that can be aggravated by pressure. Other accompanying signs may be abdominal masses, distention, chest fullness, poor appetite and a darkish facial complexion.

LiverÂ stagnation and spleen weaknessÂ
Symptoms are always triggered by emotional stimulation. Usually, diarrhea immediately comes after abdominal cramps; there are loose stools full of mucus with some pus or blood. There are also tenesmus, chest oppression, sighing, irritability, poor appetite and frequent passage of gas. Some individuals may present with alternating diarrhea and constipation.

Spleen qi deficiencyÂ
Individuals develop alternating diarrhea and loose bowels, and undigested foods may present in the stools. The loose bowels and frequency are worsened by poor lifestyle habits or consumption of greasy foods. The abdominal cramps are dull in nature and can be relieved by palpation. Other accompanying signs are lack of appetite, gastric fullness after meals, fatigue, sallow complexion, frequent passage of gas, irregular menstruation or even rectal prolapse.

Spleen andÂ kidneyÂ deficienciesÂ
Individuals develop a chronic persistent diarrhea that usually contains undigested foods. Diarrhea typically occurs early in the morning after an episode of colic around the navel, and then throughout the day. Other symptoms include fatigue, cold body and extremities, soreness in the lumbar and knees, abdominal dull pain that diminishes with exposure to warmth, profuse clear urine or frequent urination at night.

It should be noted that during the course of ulcerative colitis, the above syndrome patterns may appear alone or in complex form. An experienced physician can accurately identify the pattern.

Diagnosis

The diagnosis of ulcerative colitis is made from the patient’s medical history, a stool examination, sigmoidoscopy findings, and biopsy of specimens from the rectum or colon.

Stool SamplesÂ
Stool samples from patients with ulcerative colitis contain pus cells, red blood cells, and commonly eosinophils (a type of white blood cells). Since inflammation of the colon due to infections can also produce symptoms similar to those of ulcerative colitis, stool samples are examined to exclude parasitic, amoebic or bacterial infection.

SigmoidoscopyÂ
Sigmoidoscopy allows the physician to find typical features of ulcerative colitis in the colon, such as swelling, small bleeding points, and ulceration of the inner lining of the colon. For patients with longstanding disease, pseudo polyps may also be seen. Colonoscopy is sometimes necessary for determining the extent of the disease, especially in severe attacks.

Sigmoidoscopy

BiopsyÂ
Because the findings from sigmoidoscopy can also be found in other medical conditions such as infectious inflammation of the colon, biopsies of the tissue in the colon are necessary to confirm diagnosis of ulcerative colitis. Patients with Crohn’s disease can also have a medical history and symptoms similar to those of ulcerative colitis and several biopsies via colonoscopy may be needed to confirm a diagnosis of ulcerative colitis.

Differential DiagnosisÂ
Patients with Crohn’s disease, which usually also involves the small intestines, often present with symptoms similar to ulcerative colitis. Endoscopy and x-ray s of the small intestine are sometimes necessary to correctly diagnose ulcerative colitis. Other differences between ulcerative colitis and Crohn’s disease are found in laboratory values and biopsy specimens.

In TCM understanding, ulcerative colitis is mainly due to internal weakness of theÂ spleenÂ andÂ stomachÂ that result in transmission disorders of theÂ large intestine. Triggering factors likeÂ exogenous pathogens, an improper diet andÂ emotional stimulationÂ further disturb the internal disharmony and make the symptoms worse.

DuringÂ diagnosis, TCM physicians rely onÂ special skillsÂ to gather health information from patients so that appropriateÂ therapeutic strategiesÂ can be undertaken.

Damp-heat in the large intestineÂ
TCM diagnostic criteria for this type of ulcerative colitis include diarrhea with pus and blood, a burning feeling in the anus, abdominal cramps, fever and scanty yellow urine. On examination, the tongue is red and covered by yellow greasy coating; the pulse isÂ rollingÂ andÂ rapid.

A red tongue covered by yellow greasy fur.

Damp-cold in the spleenÂ
Diagnostic criteria for this type are diarrhea with mucus or watery stools,Â tenesmus, abdominal cramps, stomach stuffiness, generalized heaviness and clear urine. On examination, the tongue is pale and covered by white greasy coating; the pulse isÂ hesitantÂ and slow.

Qi and Blood stagnationÂ
Diagnostic criteria for this type of ulcerative colitis include diarrhea with mucus or darkish blood, straining for defecation, fixed stabbing pain, distention, belching and a darkish complexion. On examination, the tongue is purple with bleeding spots; the pulse is taut and hesitant.

Liver stagnation and spleen weaknessÂ
Diagnostic criteria for this type of ulcerative colitis includes diarrhea triggered by emotional stimulation; attacks usually come after abdominal cramps, chest oppression, belching and frequent passage of gas. On examination, the tongue fur is thin, white and greasy; the pulse isÂ taut.

Spleen qi deficiencyÂ
Diagnostic criteria for this type of ulcerative colitis includes loose bowels made worse by poor lifestyle habits or consumption of greasy foods, undigested foods in the stools, lack of appetite, distention, fatigue and sallow complexion. On examination, the tongue is pale and covered by white fur; the pulse is weak andÂ thready.

Spleen and kidney deficienciesÂ
Diagnostic criteria for this pattern are early morning diarrhea that comes after an episode of colic, undigested food in the stools, cold body and extremities, soreness in the lumbar region and knees, and frequent urination at night. On examination, the tongue is pale; the pulse isÂ deepÂ and thready.

According to TCM experience, damp-heat in the large intestine, qi and blood stagnation, spleen qi deficiency are the most common types of syndrome patterns; while spleen and kidney deficiencies are usually seen in the late stage of ulcerative colitis .

Treatment

The goals of treatment of ulcerative colitis are to induce and maintain remission of symptoms and inflammation of the inner lining of colon. Treatment options are determined according to the extent of the inflammation and the severity of the disease.

5-Aminosalicylic Acid (5-ASA)Â
The majority of patients with ulcerative colitis have mild or moderate disease with inflammation involving areas close the rectum. In these patients, rectally administered preparation of 5-aminosalicylic acid (5-ASA) is the best treatment option. Rectal preparation of 5-ASA is available as an enema, foam, gel, or suppository, which are equally effective. For patients who prefer oral therapy, sulfasalazine and 5-ASA derivatives (mesalamine, olsalazine, and balsalazide) are also effective in the treatment of mild to moderate ulcerative colitis, although rectal preparations have higher remission and improvement rates.

Sulfasalazine is less effective than corticosteroids for active disease and its major role in the management of ulcerative colitis is to maintain remission once the active inflammation has resolved. However, side effects from sulfasalazine such as headache, nausea, and vomiting can be severe. Rash and infertility in males are also commonly reported with sulfasalazine therapy.

Mesalamine, olsalazine, and balsalazide have been developed to minimize adverse effects seen with sulfasalazine therapy. These new 5-ASA derivatives are shown to be as effective as sulfasalazine in both treating active ulcerative colitis and maintaining remission with fewer side effects.

CorticosteroidsÂ
For patients whose symptoms are inadequately controlled with 5-ASA, corticosteroids are used in active disease.

Hydrocortisone is available as an enema, suppository, or foam for rectal administration. For patients with severe ulcerative colitis, oral corticosteroid is used. Prednisone and cortisone are commonly used oral corticosteroids for severe ulcerative colitis but prolonged use can cause many long-term side effects, including osteoporosis and cataract. For patients with severe disease requiring hospitalization, intravenous corticosteroid is also available.

Although corticosteroids deliver fast and reliable remissions of the active ulcerative colitis, these drugs do not change the underlying disease course and they were shown to be ineffective in maintaining long-term remission with continued use. Therefore, corticosteroids should be used to treat active disease and should be used to maintain remission of the disease.

Immunosuppressive AgentsÂ
Immunosuppressive agents are often used to allow reduction or elimination of corticosteroids and also to maintain corticosteroid-induced remissions of the disease. The immunosuppressive agents used in ulcerative colitis include azathioprine (AZA), 6-mercaptopurine, and cyclosporine.

Azathioprine and 6-mercaptopurine are most widely used immunosuppressive agents used in ulcerative colitis. These drugs are especially useful in patients who are having repeated relapses from their disease once corticosteroids have been discontinued. It may take up to 6 months for these drugs to achieve a therapeutic effect. Both azathioprine and 6-mercaptopurine are associated with minimal side effects which include nausea, fever, and diarrhea. Pancreatitis and liver dysfunction can also occur and rare occurrence of bone marrow suppression with these drug warrant regular monitoring of blood counts.

Cyclosporine is used for patients hospitalized with severe ulcerative colitis who do not respond to high doses of intravenous corticosteroid s . Although oral formulation of the drug is available, only intravenous administration of cyclosporine has been shown to provide favorable effects in severe ulcerative colitis. It has much faster onset of therapeutic efficacy compared to azathioprine and 6-mercaptopurine, but is not found to be as effective in maintaining remission. Unlike azathioprine and 6-mercaptopurine, cyclosporine is not associated with bone marrow suppression but can cause kidney toxicity.

SurgeryÂ
In patient with ulcerative colitis, surgery is performed to remove the colon in the following situations:

	Severe attacks not responding to medical treatment
	Perforation or dilatation of the colon during a severe attack
	Cancer due to ulcerative colitis

TCM believes that the major pathologies of ulcerative colitis includeÂ spleenÂ andÂ stomachÂ dysfunctions, intestinal turbid accumulations, andÂ bloodÂ andÂ qiÂ disturbances . Therefore, TCM treatment strategies are to restoreÂ organÂ functioning, eliminate turbid accumulations and harmonize the flows of qi and blood.

In clinical applications, if individuals have obvious pus, mucus or bloody loose bowels, physicians will focus on clearingÂ pathogensÂ likeÂ damp-heatÂ or damp-cold, so as to improve the bowel environment. Afterwards,Â tonifying methodsÂ are employed to overcome the internal weakness and promote a longer remission period.

Prescriptions according toÂ syndrome differentiation

Damp-heat in the large intestineÂ
Therapeutic aim: Clearing damp-heat, harmonizing blood and qi.Â
Sample prescription: ModifiedÂ Peony Decoction (Shao Yao Tang)

In the prescription, the peony root and angelica root enrich the blood; the betel nut, costus root and rhubarb promote qi flow, the thread rhizome and skullcap root clear damp-heat and detoxify. The whole combination resolves the pathogenic accumulation in the large intestine, enabling the bowel to resume its normal transmission process.

In the prescription, the atractylodes rhizome and root enhanceÂ fluid metabolismÂ in the spleen; the magnolia bark and tangerine peel regulate qi flow to dispel damp-cold; the poria, water-plantain root andÂ chu-linginduce urination; cassia bark and ginger promote warmth to expel coldness. The whole combination enables the intestinal functions to perform normally by enhancing spleen functioning and dispelling damp-coldÂ pathogens.Damp-cold in the spleenÂ
Therapeutic aim: warming and dissolving dampness, harmonizing blood and qi
Sample prescription: ModifiedÂ Weiling Decoction (Wei Ling Tang)

Qi and Blood stagnationÂ
Therapeutic aim: regulating blood and qi flows to arrest diarrhea and pain.Â
Sample prescriptionÂ : ModifiedÂ Decoction for Removing Blood Stasis in the Lower Abdomen (Shao Fu Zhu Yu Tang)

In the prescription, the cattail pollen, angelica, lovage and squirrel feces nourish blood and promote tissue regeneration; the corydalis rhizome, peony root and myrrh promote blood and qi flows to arrest pain; the fennel, ginger and cassia bark warm theÂ meridianÂ to dispel blood stasis. The whole combination improves the circulation in the large intestine so as to arrest diarrhea and pain.

Liver stagnation and spleen weaknessÂ
Therapeutic aim: soothing liver, invigorating spleen, expelling dampness, arresting diarrhea.Â
Sample prescription: ModifiedÂ Essential Formula for Diarrhea with Pain (Tong Xie Yao Fang)

In the prescription, the atractylodes root invigorates the spleen; the peony root works on the liver; the tangerine peel regulates qi flow and expels dampness; the ledebouriella root assists the above herbs to work properly. The whole combination invigorates the spleen and expels dampness to arrest diarrhea, soothes the liver and regulates qi to arrest pain.

Spleen qi deficiencyÂ
Therapeutic aim: Replenishing qi, invigorating spleen, consolidating intestines to arrest diarrhea.Â
Sample prescription: ModifiedÂ Powder of Ginseng, Poria & Atractylodes (Shen Ling Bai Shu San)

In the prescription, the ginseng, atractylodes root and poria are the main ingredients to replenish qi and invigorate the spleen; the hyacinth bean, coix seed, lotus seed and yam enhance the water metabolism of the spleen which helps to drain dampness and arrest diarrhea; the amomum fruit promotes the digestive process; the balloonflower regulate the water passages and the liquorice acts as a buffer.

Spleen and kidney deficienciesÂ
Therapeutic aim: warming and tonifying the spleen and kidney, consolidating the intestine to arrest diarrhea.Â
Sample prescription: ModifiedÂ Immortal Organ-Nourishing Decoction (Zhen Ren Yang Zang Tang)

In the prescription, the poppy capsule is used in high dosage to consolidate the intestine and arrest diarrhea; cassia bark warms theÂ kidneyÂ and spleen; both herbs are the main ingredients. The nutmeg and myrobalan fruit provide warming to arrest diarrhea; the ginseng and atractylodes root replenish qi; the angelica and peony root replenish blood; the costus root and liquorice root act as buffer.

Herbal enemas

An enema is the procedure of introducing liquids into the rectum and colon via the anus. Herbal enemas help improve problems affecting the lining of the bowel such as abrasions, edema, ulcers and bleeding, therefore effectively relieving the intestinal symptoms.

Herbal enemas for ulcerative colitis must be carried out in medical or hospital environments. Before the procedure is undertaken, the lower bowel must be cleaned properly; drip a warm herbal preparation slowly into the colon; let the liquid be retained for at least 4 hours so as to obtain the full herbal effects. Do once a day for ten days, and then rest for 4 days before repeating the treatment. Patients usually feel an improvement after 3 courses. Selection of herbs is based on individual cases, below are some suggested ingredients:

Clearing damp-heat accumulation

bai tou weng	Chinese pulsatilla root	Radix Pulsatillae
ye ju hua	wild chrysanthemum	Flos Chrysanthemi Indici
pu gong ying	dandelion	Herba Taraxaci
huang lian	golden thread rhizome	Rhizoma Coptidis
bai jiang cao	patrinia	Herbal Patriniae

Removing blood and qi stagnation

dan pi	peony tree root bark	Crotex Moutan Radicis
huang qin	baical skullcap rootÂ	Radix Scutellariae
huai hua	pagoda tree flower	Flos Sophorae
san chi	notoginseng	Radix Notoginseng
da huang	Chinese rhubarb	Radix et Rhizoma Rhei

Soothing liver and invigorating spleen

bai ji	common bletilla tuber	Rhizoma Bletillae
chai hu	bupleurum root	Radix Bupleuri
bai shao	white peony root	Radix Paeoniae Alba
yu jin	turmeric root tuber	Radix Curcumae
wu yao	lindera root	Radix Linderae

Tonifying spleen and stomach

huang qi	astragalus	Radix Astragali
dang shen	pilose asiabell root	Radix Codonopsis Pilosulae
bai shu	largehead atractylodes root	Rhizoma Atractylodis Macrocephalae
chen pi	dried tangerine peel	Pericarpium Citri Reticulatae
dang gui	angelica root	Radix Angelicae Sinensis

Pilose asiabell root

Acupoint therapies

Stimulation ofÂ acupointsÂ not only enhances the immune modulation effect, but also mobilizes the innate healing power inside the body. For the localized problems like inflammation, ulcers, muscular spasms and sluggish flow, acupuncture and moxibustion are particular effective and thus facilitate structural recovery.

Suggested acupuncture methods:
Major points: navel’s four-point (one-thumb-width apart from the navel, located in three, six, nine & twelve o’clock),Â tian-shu, guan-yuanÂ &Â qi-hai;Â
Assist points:Â da-chang-shu, zhang-qiang, pi-shu, wei-shu, zu-san-liÂ &Â san-yin-jiao.

When applying, first punch the four-point needle in 0.3-0.5 cm deep and rotate for about 30 seconds, stimulate the four locations in a clockwise sequence, noÂ needle retention; then select one more major point and 2-3 assist points for stimulation, retain the needles on the locations for 15-20 minutes, moxa cones can be attached for heating during this time. Do this once daily or every two days, ten times is one course.

MoxibustionÂ can also be used to boost the weakened systems, particularly for individuals with chronic symptoms. Below are suggested protocols:
Major points:Â zhong-wan, tian-shu, guan-yuanÂ &Â shang-ju-xu;
Assist points:Â pi-shu, shen-shu, da-chang-shu, zu-san-li, tai-xi, tai-chong, san-yin-jiaoÂ &zhong-iv-shu.

Each time, select 1-2 major points and heat for 30-40 minutes; while select 2-3 assist points and heat for 15-20 minutes. Do this once daily or every two days, 15-20 times is one course.

Systemic Lupus Erythematosus

acuherb — Wed, 22 Aug 2012 18:36:43 +0000

By Dr. Kenneth Wang

Systemic lupus erythematosus (SLE) is a chronic, inflammatory disorder ofÂ connective tissueÂ that usually arises without obvious cause and is regarded as anÂ autoimmune disease. It affects many different organ systems of the body and varies in severity between patients and, over time, within the same patient.

Typical features of SLE are a symmetrical red rash to the face, arthritis and progressive damage to the kidneys.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect the joints and many organs of the body, commonly the skin and kidneys. The disease course can range from mildly episodic to severe, and can be fatal. Symptoms vary from individual to individual and are characterized by remission and exacerbation. The complex presentation of the disease can make diagnosis difficult.

No definitive term exists for SLE in the ancient Chinese medical classics. Individuals are diagnosed with different syndromes according to the presentation of symptoms and are treated according to the disharmony patterns displayed under these syndromes.

	Symptoms of fever and skin rash are diagnosed asÂ yin-yang poisoning,Â Prurigo, itching dermatitis of the face, cheek sores and solar dermatitis syndromes.
	Joint pain, muscle pain andÂ Raynaud’s phenomenonÂ are classified asÂ bi-syndrome.
	Heart involvement, causing symptoms of palpitations and shortness of breath, is referred to asÂ palpitationÂ syndrome.
	Nervous system symptoms are grouped asÂ hysteriaÂ syndrome.
	Symptoms resulting from multipleÂ asthenia syndromeÂ organ systems involvement are classified as . This can then lead toÂ consumptive disease.
	Kidney involvement is defined asÂ kidney deficiency.

The kidneys are very important in TCM and are considered (as in Western medicine) to be commonly involved in SLE.

As SLE is a disease that can affect the whole body and involve several organs, different syndromes or disharmony patterns may occur at the same time and present a multiplicity of symptoms.

Causes

The cause of SLE remains unknown, although it is thought that genetic, hormonal, immune and environmental factors have a role. The reasons that support this are:Â

	Relatives of patients with SLE are at increased risk of developing the disease.
	The disease is more often seen in both of a pair of identical twins than it is in fraternal (non-identical) twins.
	Prevalence of the disease in certain races also implies a genetic (inherited) influence in the occurrence of SLE.
	Evidence for hormonal abnormalities is based primarily on the observation that SLE is much more common among women in their childbearing years.

Many abnormalities of theÂ immune systemÂ occur in patients with SLE. The reason for this remains unclear and it is not known which are primary and which are secondary causes. These abnormalities in immune regulation are thought to result from loss of “self” (substances belonging to the body) tolerance. This means that SLE patients are no longer totally tolerant of all their self-antigensÂ and consequently anÂ immune responseÂ develops to these antigens.Â

From the traditional Chinese medicine (TCM) viewpoint, the major cause of SLE is an inborn insufficiency that disturbs the balance ofÂ yin and yang. SLE may be acquired whenÂ environmental pathogensÂ (dryness, dampness, cold, summer-heat, wind and fire evils) affect this balance. Inborn insufficiencies or acquired disorders also lead to depletion of vital energy (qi) and yin fluid. This can cause impaired functioning of the body and a defect in resistance to illness.

Ancient TCM classics like theÂ Jinkui Yaolue (Summary from the Golden Chest)Â refer to diseases that poison the yin-yang balance. Constitutional or bodily weakness enables environmental pathogens to invade the body. This disturbs the harmonious balance of yin and yang and illness results. As an example, over-exposure to sunlight, considered to be a heat evil, causes the accumulation of heat and toxic pathogens in the body, and this in turn triggers organ system damage. Diseases where yang is dominant in the body present withÂ yang-type symptoms, such as flushing of the face, high fever, dislike of heat, dark-colored urine or constipation. Diseases dominated by yin present withÂ yin-type symptoms, such as pallor, cold limbs, an aversion to cold, pale urine or watery stools.

Parallels can be made with Western medicine’s understanding of SLE. For example, SLE is a result of the malfunction of the body’s immune system, which in TCM can be interpreted as a yin and yang imbalance. Genetic and environmental factors are also known to play a role in the development of SLE. It has been suggested that a virus may be partially responsible for its cause. This thinking is in line with the TCM concepts of environmental pathogens and an inborn deficiency being linked to the occurrence of SLE.

Symptoms

The onset of SLE can be highly variable, as can be the progression of the disease. Early symptoms may be non-specific and include muscular pain, nausea, vomiting, headaches, depression and easy bruising. Sometimes symptoms are more specific and more than one may be present. Symptoms may be mild or severe, fleeting or persistent.

General symptoms

	FatigueÂ occurs in virtually all patients with SLE and may be experienced with the onset of SLE or only with a relapse of the disorder.
	Swelling of the ankles is common.
	There is often a gain or loss in body-weight.
	Low-grade fever is seen in 80 per cent of patients.
	It is usually an episodic disease (occurs from time to time).

Skin and mucous membranes
The skin is affected in over 70 per cent of cases. Often, rashes occur after exposure to ultraviolet light and such exposure may lead to major flares involving other organ systems as well. Abnormal sensitivity to sunlight is experienced by about half of all patients with SLE and is more common in those who are fair and light-skinned.

Typical ”butterfly” distribution facial rash seen in SLE.

A classical characteristic of SLE is the “butterfly” rash that occurs across the face. Hair-loss is also common. Mouth ulcers occur frequently in active disease, but they may be relatively painless. A painful throat may accompany a flare.

Vascular system (blood vessels)Â
A disorder of the vascular system known asÂ Raynaud’s phenomenonÂ occurs in 20 to 30 per cent of patients. Classically, the fingers turn white followed by a bluish cyanotic hue, finally replaced by a red flush as dilatation of the blood vessels occurs. The full three-color change does not always happen, but excessive sensitivity of the hands to the cold is common.

Musculoskeletal system
Painful and arthritic joints are the most common symptoms of SLE and experienced by almost all patients. Symptoms can occur in any joint and often clear up in one to three days. Fingers, hands wrists and knees are the most commonly affected. Less frequently, ankles, elbows, shoulders and hips are involved. Stiffness on waking can last several minutes.

Renal system
In 50 per cent of SLE patients, the kidneys become involved. There may be rapid onset of an acute and painful kidney inflammation or traces of blood or protein may be found on analysis of the urine. Urinary tract infections are common.

Nervous systemÂ
Nervous disorders occur in virtually all SLE patients. Anxiety and/or depression are common in response to the illness and the threat of loss of health, family and job. The prospect of disability and dependency can be very distressing.

Symptoms may include insomnia, loss of appetite, constipation, palpitations, diarrhea, over-breathing, memory loss, emotional instability, confusion and decreased concentration. Seizures (convulsions) occur in more than 10 per cent of patients. The incidence of stroke, with resulting abnormalities of sensation and power, is similar.

Headaches are a frequent complaint and are usually due to stress and tension. Migraine occurs in 20 per cent of patients.

Cardiorespiratory systemÂ
Chest pain, cough and breathlessness occur frequently. These result from a variety of processes involving the lungs, the lining of the chest wall and diaphragm. Pain on breathing is commonly experienced and is often accompanied by chest discomfort. It may be worsened by lying down.

Gastrointestinal tract
Involvement of the gastrointestinal tract is common. Up to 25 per cent of patients have esophageal complaints, including difficulty swallowing. Indigestion, abdominal pain, nausea and vomiting are also common.

Blood
Anemia occurs in at least 50 per cent of patients. On laboratory analysis, abnormalities in the blood cells and clotting mechanisms are commonly found.

TCM practitioners will examine the sufferer and categorize the symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present during different stages of the disease. The presentation of SLE is often complicated, but some common patterns can be classified:

	Excessive toxic heat accumulation
	Individuals present with persistent high-grade fevers, the appearance of a rash on the face or other areas, joint pain, muscle soreness or pain, fatigue, thirst and a desire for cold drinks. Irritability, insomnia, constipation and production of dark-colored, scanty urine are also common. In severe cases, loss of consciousness, delirium, muscle spasms, bruising or petechiae (small, flat blood spots under the skin), the spitting up of blood and the presence of blood in the urine or stool may also occur. Exposure to sunlight and the ingestion of certain foods or drugs are factors that can exacerbate the disease and induce flare-ups.
	bloodÂ yin deficiency
	In this deficiency there is a persistent low-grade fever, a hot sensation in the chest, palms and soles of the feet, irritability, fatigue and a reluctance to speak. There is general swelling of tissues, redness of the face, spontaneous perspiration and night sweats, and loin and joint pain.
	Toxic factor attacking theÂ heart
	Symptoms include palpitations, shortness of breath, chest fullness with a feeling of oppression and local heat, spontaneous perspiration, pallor and cold limbs.
	KidneyÂ yin deficiency
	Individuals usually experience pain in the back, legs and feet, limb weakness and a sensation of hotness in the face. In more serious cases, sores appear in the mouth and on the tongue, hot sensations are felt in the chest, palms and soles of the feet, and the individual feels emotionless. Sometimes low-grade fever and swelling may be present.
	Impairment of theÂ liverÂ due to heat
	In this disharmony pattern, pain in the upper sides of the abdomen, abdominal distension, irregular and painful menstruation in females, skin rashes, bruising, insomnia, dizziness and loss of appetite are commonly experienced.

Diagnosis

The diagnosis of systemic lupus erythematosus can be difficult. The disease may present in many different ways and most of the laboratory tests carried out on patients with SLE are not specific. For these reasons, other diseases have to be carefully considered before a diagnosis of SLE can be made. Physicians should always consider the possibility of SLE in a disease which is affecting many systems of the body, especially those involving the skin and joints of young women.

In 1982, the American College of Rheumatology compiled a list of 11 criteria, at least four of which should be present, not necessarily at the same time, to make a diagnosis of SLE. In some patients, only one or two criteria may be present initially and after several weeks, months or even years do the others appear. These criteria are:

	Characteristic “butterfly” rash on the face
	Generalized skin rash
	Mouth ulcers
	Arthritis
	Sensitivity to ultraviolet light
	Inflammation of the lining of the chest wall or the membrane surrounding the heart
	Renal (kidney) disorder
	Nervous system disorder
	Low red or white blood cell count
	Positive antinuclear antibodies
	Positive lupus anticoagulant

These last two are immunologic laboratory tests.

Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and symptom observation. Diagnosis is based on the traditional four examination techniques:

	Questioning: The TCM practitioner will establish the medical history of both the patient and his family.
	Observation: Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
	Listening and swelling: The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
	Touching: Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In SLE, the disharmony patterns present at different stages during the course of the disease and can be described as follows: :

	Excessive toxic heat accumulation
	In TCM, it is held that the occurrence of SLE is closely related to over-heating of theÂ heart meridian. The heart controls the blood and blood vessels. When the heart pumps, blood is transported within the vessels around the entire body. The heart,Â bloodÂ and blood vessels are thus united by their common activities. When heat pathogens are congested in the heart meridian, it means a serious invasion of the internal organs has occurred. The qi and blood bring these pathogens to every part of the body, damaging internal organs, muscles and skin along the way. On examination, the tongue appears red or dark red and ulcerated, or sores may be present on the inside of the mouth. The tongue may be coated with a fur that is greasy and yellow, dry and yellow, greasy and white, or the fur may be absent altogether. The pulse feels taut and rapid.
	Blood yin deficiency
	When the body accumulates too many heat pathogens over a period of time, the body fluids dry up and organs will not function properly. This decreases the production of blood andÂ kidney essenceÂ and leads to a morbid condition of general weakness with sweating, low-grade fevers and hot sensations in the palms and soles of the feet.On examination, the tongue appears red with a white fur coating or with no coating. The pulse sign feels thready, rapid and weak.
	Toxic factor attacking the heart
	Impairment of the functioning of several internalÂ organsÂ signals involvement of the heart and a serious effect to the bloodflow. Individuals present with pallor, palpitations and cold extremities.On examination, the tongue is pale and coated with thin white fur. The pulse feels thready, weak, or choppy.
	Kidney yin deficiency
	This occurs usually in a late stage of the disease when the pathogens finally invade the kidney. Kidney-yin refers to the fluid andÂ essenceÂ stored in the kidneys. The invading pathogens cause a deficiency in the amount of this fluid and essence and the kidneys begin to over-function. This is the yang part of the kidney compensating for the loss of yin and creates aÂ virtual fireÂ in the kidneys. This produces back pain, limb weakness and heatsymptoms such as fever or tongue sores.On examination, the tongue appears bulky, moist and pale. The tip of the tongue may also be red. The pulse feels deep, thready and weak.
	Impairment of the liver due to heat
	Heat pathogens dry up body fluid and this leads to inadequate nourishment for theÂ liver. In TCM thinking, the liver helps regulate qi and blood movement, and the digestive function of theÂ spleen. Individuals with this disharmony pattern present with pain in the liver region, bleeding problems or loss of appetite.On examination, an enlarged liver and spleen may be palpable.

Treatment

The management of SLE should be comprehensive and include drug and non-drug treatment. Therapy is individualized for each patient depending on the manifestations of disease and their severity.Â

Corticosteroids
SystemicÂ corticosteroidÂ therapy is the mainstay of treatment in SLE. However, not all patients require steroids, and steroids can do more harm than good. When needed, oral maintenance doses of prednisone or prednisolone are usually prescribed.

Severe symptoms affecting the whole body, such as sustained high fevers and severe blood disorders, often need to be treated with higher doses of corticosteroids. Involvement of organs such as the heart, lungs, and central nervous system also usually requires treatment with corticosteroids.

A topical steroid is usually prescribed for skin rashes.

NSAIDs
Mild symptoms of arthritis and muscular pain are usually managed with non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, naproxen and ketoprofen. More severe symptoms may need an antimalarial agent and occasionally low doses of corticosteroids may be required.

Antimalarials
The antimalarials chloroquine and hydroxychloroquine possess anti-inflammatory properties and have been found of benefit in treating inflammatory conditions which have an immunologic basis. They are usually used when other first-line therapies (such as NSAIDs) fail. They are prescribed for more severe skin and joint manifestations of SLE.

Immunosuppressants
As long-term corticosteroid therapy, particularly at the higher doses, tends to cause side-effects, immunosuppressants such as azothiaprine, cyclophosphamide and methotrexate are sometimes added in an attempt to lower the dose of corticosteriod required. These drugs suppress theÂ immune response. As immunosuppressants themselves pose a risk of long-term toxicity they need to used with care, but can be useful in the treatment of acute and severe organ involvement.

Psychiatric support
The threat of a chronic disease can be very stressful. Visiting a doctor frequently and having many laboratory tests with long waits for the results can be an emotional burden.Â Emotional support in the treatment of SLE is essential. It is also important that patients have extensive rest.

Preventive measuresÂ
All possible means to prevent provocation or exacerbation of SLE should be undertaken. Â As SLE is an episodic disease and is characterized by exacerbation and remission, it is extremely important to withdraw therapy slowly when an exacerbation has quieted down. This avoids unnecessary drug toxicity.

Patients with SLE need a to see their doctors at least once every three to six months, even if the disease is inactive.Â Patients with active disease must be assessed more frequently.

Treatment of SLE from a TCM perspective will depend on the symptoms of the individual patient. In addition to herbalÂ decoctionsÂ used to alleviate disharmony pattern symptoms, treatment may include acupuncture for relieving pain and stiffness in the joints, andÂ qi-gongÂ to help focus the energy of the body in fighting the disease and strengthening the mind.

Examples of decoctions used for the different disharmony patterns

Excessive toxic heat accumulation

Therapeutic aim:To clear away heat and toxins, cool down the blood, protect theÂ yin, remove obstructions in theÂ meridiansÂ and clear up rashes.

Prescription:Â Qingying decoction

shi gao	gypsum
shu di huang	processed rehmannia root
mai dong	dwarf lilyturf tuber
zhi mu	common anemarrhena root
niu xi	achyranthes root

For individuals with high fever, poor concentration and delirium, the dosages of heat-clearing drugs should be increased or the following added:

shang shi gao	unprocessed gypsum
huang lian	golden thread
da huang	rhubarb

Some patent Chinese medicines likeÂ Purple Snowy Pill, Bezoar Bolus for ResurrectionandÂ Treasured BolusÂ can be taken at the same time.

Yin blood deficiency

Therapeutic aim:To replenish the yin, nourish and cool down theÂ blood, and eliminate toxins.

Prescription:Â Modified Zhibai Dihuang pill

zhi mu	common anemarrhena root
huang bai	amur cork-tree
shu di	processed rhemannia root
shan yu rou	Asiatic cornelian cherry fruit
shan yao	common yam root
ze xie	oriental water-plantain root
dan pi	tree peony bark
fu ling	Indian bread

For individuals withÂ spleenÂ deficiency add:

bai zhi	large head atractylodes root
chen pi	dried tangerine peel
fu ling	Indian bread

In cases of very high fever add:

yin hua

honeysuckle flower

For dizziness add:

ju hua	chrysanthemum flower
chuan xiong	Szechwan lovage root

Toxic factor attacking the heart

Therapeutic aim:To nourish the yin, replenish theÂ qi, calm the mind, and clear away heat and toxins.

Prescription:Â Modified Huanglian antidote decoction

huang lian	golden thread
huang qin	baical skullcap root
huang bai	amur cork tree
zhi zi	Cape jasmine fruit

For spleen deficiency add:

dang shen	pilose asiabell root
bai zhi	large head atractylodes root

For individuals with a feeling of chest fullness add:

hou po	magnolia bark
su geng	perilla stem

For yin deficiency add:

yu zhu	fragrant Solomon’s seal rhizome
huang jing	agastache or Solomon’s seed
dong chong xia cao	Chinese caterpillar fungus

Kidney yin deficiency

Therapeutic aim:To nourish the yin, tonify theÂ kidneys, activate the blood circulation and eliminate toxins.

Prescription:Â Modified Siwu decoction

dang gui	Chinese angelica
chuan xiong	Szechwan lovage root
shu di	processed rehmannia root
bai shao	white peony root

For dampness-heat symptoms in the lower burner add:

che qian zi	plantain seed
Bi xie	long yam
qu mai	Chinese pink herb

For individuals with backache add:

tu si zi	dodder seed
chuan duan	Himalayan teasel root

For joint pain add:

ji xue teng	suberect spatholobus stem
shen jin cao	common club-moss herb
liu ji nu	diverse wormwood herb
xu chang qing	paniculated swallow-wort root

Impairment of the liver due to heat

Therapeutic aim:To nourish the yin, cool down the blood, eliminate toxins, activate the blood circulation, clear away blood stasis and remove obstructions in the meridians.

Prescription:Â Modified Xiefu Zhuyu decoction

tao ren	peach seed
hong hua	safflower flower
dang gui	Chinese angelica
sheng di	common yam root
chuan xiong	Szechwan lovage root
chia hao	red peony root
niu xi	achyranthes root
jie geng	platycodon root
chai hu	Chinese tororwax root
zhi qiao	orange fruit
gan cao	liquorice root

For individuals with severe blood stasis add:

san leng	bur-reed tuber
e zhu	zedoary rhizome
yi mu cao	motherwort herb
chuan xin lian	andrographis herb
gui jian yu	winged spindle tree

For severe abdominal distention and pain below the ribs add:

hou po	magnolia bark
chen pi	dried tangerine peel
xiang fu	nut-grass

For qi deficiency and residual heat toxins add:

huang qi	milk-vetch root
qin jiao	large-leafed gentian
wu she	black snake

For over heated blood and a well-defined rash add:

ji guan hua	cockscomb
mei gui hua	rose
ling xiao hua	trumpet creeper flower

Dr. Wang who is expert on treatment of SLE Â RA with his spacial prepared herb medicine in over thirty year experience in clinic and Â with Acupuncture treatment can very good control the disease and stop pain joint swollen.

Stroke

acuherb — Wed, 22 Aug 2012 03:31:26 +0000

By Dr. Kenneth Wang

Stroke, sometimes called “brain attack” or in earlier times “apoplexy,” is medically known as a cerebrovascular accident (CVA). It occurs when a blood vessel is so severely blocked or damaged that part of the brain is deprived of oxygen long enough for brain tissue to die. It is one of the most common causes of death and disability worldwide.Â

While some people die from their first stroke about 25 percent of people who suffer a stroke die within one month. Many people recover but are left with brain damage of different degrees, depending on what part of the brain has been affected. If it occurs in the speech area the victim may be left with no speech, or may forget a second language learned in childhood. If it affects the “motor area” controlling movement, the person may be left paralyzed on one side of his body. Stroke is more common in “first world” countries where people survive childhood infections that still kill many people in “third world” countries. Because vaccination, cleaner water systems and antibiotic use have effectively reduced deaths from infectious diseases, death from stroke occurs in older people and is often caused by lifestyle habits.Â

How a stroke happens:
Strokes are commonly caused in three ways.Â

1.Hemorrhage
This occurs when an artery bursts and bleeds into brain tissue. The part of the brain that should have been supplied with oxygen by that artery is deprived of oxygen and begins to die off.Â

2.Thrombosis
A thrombus is a clot. If it forms in an artery supplying a part of the brain, the blood supply will be blocked and damage occurs because that part of the brain is deprived of oxygen.Â

3.Embolus
This is the most common cause of stroke. It occurs when a clump of tissue, usually a blood clot, forms deposits blocking arteries somewhere else in the body (often the carotid arteries in the neck), and then breaks off and gets stuck in a small artery in the brain.(See above picture) Again, this prevents a part of the brain from getting oxygen so the cells in that part of the brain die.

Chinese people in ancient times classified the type of stroke according to where it originated. Mostly they thought stroke was caused by an invasion of exogenous pathogens (factors from outside the body that invade it and cause illness), and called this a true stroke or exogenous stroke. Stroke induced by endogenous pathogens (factors originating from inside the body causing disease) were labeled as stroke-like or called an internal stroke. Now, according to modern day Traditional Chinese Medicine (TCM) understanding and clinical practice, stroke is thought to be mostly due to internal factors.

These factors whether originating from inside or outside the body are generally attributed to “wind evils.” Wind evils are negative influences that upset the healthy balance of the body. The Chinese likened these influences to being knocked down by a natural wind because of their sudden onset and lingering, changeable nature. In ancient China, the disease was referred to as “zhongfeng,” which literally translated means “wind stroke.” According to Chinese medicine theory, stroke is not thought of as a disease affecting the brain only. It can affect either the meridians or a whole range of organs (viscera).

An early definition of a stroke can be found in the classic medical book namedÂ “Huang Di Nei Jing” (The Yellow Emperor’s Classic of Internal Medicine), written during the Han Dynasty (approx. 200 B.C). Under this book’sSuwen (The Book of Plain Questions) section, stroke is described in the following manner. “The organ’s acupoints are the doors for evil winds to flow into the body. When wind flows inside the body, it will turn into internal wind-evils. If allowed to stay inside, the internal wind evils cause stroke.” This book also described stroke related symptoms such as hemiplegia (paralysis on one side of the body), difficulty in speech, and facial distortion. (See diagrams above) Another TCM medical classic named “Synopsis of the Golden Chamber” (300A.D.), stated that stroke was mainly caused by a lack of blood in small vessels, a lack ofÂ qiÂ flow, and the invasion of outside evil winds into the body. The symptoms of a stroke were described according to what part of the body the evil winds invaded. It stated “if a evil wind invades the collaterals (these are part of the meridian system and they run more on the surface of the body), the skin and muscles feel numb. When it invades the channels (these are also part of theÂ meridian systemÂ and they run deep and vertical in the body), the body will become seriously ill. When it invades the hollow organs or Fu-organs which consists of theÂ stomach,Â small intestine,Â large intestine,Â gall bladderandÂ bladder, the body will become unconscious; and when it invades the solid organs or Zang-organs, which consists of theÂ liver,Â heart,Â lungs,Â spleenÂ andÂ kidneys, speech difficulties and drooling can occur.” This book also divides stroke into two categories, strokes involving the meridians and strokes involving the viscera or organs. Stroke in the later medical classics like “Â A Thousand Golden Prescriptions“, “Medical Secrets of an Official” and “Â Prescriptions for Saving Lives“, have similar classifications. Much progress was made understanding stroke in theÂ Jin and Yuan Dynasties, and consequently many more TCM prescriptions were developed or improved for treatment of this disease.Â

Stroke is characterized by a combination of symptoms such as a sudden fall, unconsciousness accompanied by hemiplegia (paralysis on one side of the body), an appearance of facial distortion or the presence of a speech disorder. In minor cases, individuals may not suddenly collapse or lose consciousness. Instead, they may just suffer from hemiplegia (paralysis on one side of the body) and facial distortion.

Â Causes

High blood pressure is a leading cause of stroke.

Other factors that make people more likely to suffer stroke are:

	Smoking
	Atherosclerosisa condition where fatty deposits build up in and weaken arteries. If those deposits build up in the carotid arteries, the large arteries in the neck, the chances of stroke are very much increased because the risk of embolus is so great.
	Having heart disease, especially atrial fibrillation (a condition where the upper chamber of the heart, the atrium, develops an irregular beat). This irregular beat makes the blood flow more slowly so that clots form on the walls of the atrium. Pieces of these clots break off and travel to the brain where they block blood vessels, causing strokes.
	Obesity
	Being male
	Taking oral contraceptive pills, which make the blood more likely to form clots.
	Having blood disorders interfering with normal clotting.
	Having high blood fat and/or blood cholesterol levels.
	Diabetes

Â In TCM theory, stroke is not just considered an illness of the brain. It affects theÂ meridians, other organs and blood vessels as well. It is thought to be caused by internal and external influences that induce a build up of qi and blood and create a high pressure state, which ultimately leads to a stroke. This is similar to western medicine’s understanding of high blood pressure being a risk factor for developing a stroke.

The mechanisms by which a stroke occurs and causes bodily damage are complicated. At least four external factors and six internal factors have been identified that contribute to this process. The external risk factors that contribute to the development of a stroke include the hypo- functioning or under functioning of the liver and kidney, improper diet and body overstrain, emotional disturbance, and aging and weak body constitution. These lead to further problems inside the body that upset its natural healthy balance. The six internal influences that contribute to a stroke are deficiency states such asÂ yin deficiencyÂ andÂ qi; deficiency an excess of fire (sometimes referred to as excessive heat) such as liver-fire and heart-fire; wind evils such as endogenous wind originating from inside the body and exogenous wind originating from outside the body; an accumulation of phlegm; stagnant qi flow and blood stasis. These six factors will interact with each other under certain conditions to bring forth diseases such as a stroke. The TCM mechanisms by which a stroke occurs are further detailed below.

How the under- functioning or hypo- function of the liver and kidney cause a strokeÂ

A yin deficiency occurring from old age, hypo-function (under-function) of both theÂ liverÂ andÂ kidney, or an excess of sexual activities can all lead to a gradual exhaustion of germ cells and blood. Germ cells are the sperm and egg cells. Germ cells and blood come from the same source in TCM. When germ cells decrease with age, production of blood declines. This leads to relativeÂ yang excessÂ in the body, and causes wind evil to build up inside. Stroke will finally develop if the wind evils are not removed from the body.Â

When the kidney, which belongs to water of theÂ five elements, fails to nourish the liver- a wood element – a liver-yang excess is produced that transforms into an internal wind evil. The wind evil is responsible for causing the stroke. Alternatively, stroke may be also caused by an insufficiency of liver-yin. This occurs when heat is produced due to the dryness of the blood. The heat makes the wind evil flow upwards in the body which affects theÂ meridiansÂ and obstructs orifices (openings of the body). This in turn causesÂ qiÂ andÂ bloodÂ flow to become stagnant which can cause a stroke.Â

How excess fire or heat causes a strokeThe kidney belongs to the water of the five elements. When kidney yin is exhausted, it cannot restrict a build up of fire or heat in the body caused by mental stress, emotional disturbances or an extreme excess ofÂ heart-fire. Excess heat causes depression and confusion, and induces too much qi and blood to ascend to the brain, which leads to a stroke.Â

Accumulation ofÂ phlegmÂ andÂ dampnessÂ
Over consumption of food and drink leads to spleen malfunction. In TCM, theÂ spleenÂ is responsible for transforming food and drink into qi, and transporting it to the lungs where it can be distributed throughout the body to nourish it. When it malfunctions, an accumulation of dampness develops which leads to a build up of phlegm. When this phlegm cannot be removed, it transforms into heat and then an evil wind; all of which exert negative influences on the body and cause illness. The build up of phlegm, heat and wind all disturb the meridians and brain, which can lead to a stroke.

Alternatively, phlegm can accumulate when there is a liver-yang excess. It is produced when wind evils builds up in the liver and a person overworks or is unable to sleep at night. One of the liver’s main functions is to support the flow of qi throughout the body, so a build up of wind evils accompanied by phlegm disturbs the meridians and causes the circulation of qi to stop. This results in unconsciousness, which is a serious symptom of a stroke.Â

How old age, body weakness and qi deficiency allow evil influences to invade the body and cause strokeÂ

When a person experiences old age, a qi deficiency or has excessive thinking and fatigue, qi flow and blood circulation are damaged especially in the small collaterals of the meridians. Pathogens (any substance that causes an illness) take this opportunity to invade the body, which leads to further stagnation of qi and blood flow. This lack of normal qi and blood movement within the body causes a loss of nourishment to the tendons and muscles, which ultimately can lead to numbness of skin and muscles often seen with stroke.Â

A weak body constitution can cause a chronic accumulation of phlegm-dampness and allow exogenous pathogens (any substance originating from outside the body that causes an illness) like wind to invade the body. These wind and phlegm evils block the meridians and orifices (any body opening like the mouth) and lead to stroke symptoms such as hemiplegia (paralysis on one side of the body).Â

Symptoms

The symptoms experienced by someone having a stroke depend on which part of the brain is being deprived of oxygen. Sometimes people get early warning signals that they may soon suffer a stroke when they suffer “mini-strokes” otherwise known as “transient ischemic attacks (TIA’s).” People who suffer from mini-strokes have all the symptoms of stroke, but recover completely within a few hours or days. If a clot is slowly forming or a small hemorrhage has developed, early signs may give enough warning for effective medical treatment to be started. These signs should be taken seriously and qualified medical help should be immediately sought.Â

The most common warning signs of a stroke are:

	Weakness down one side of the body. Depending on how much of the brain is affected, this can range from “clumsiness,” where weakness makes it hard to lift the arm or leg and to hold or carry things, to complete paralysis down one side of the body. If this weakness occurs as part of a transient ischemic attack (TIA) or “mini stroke”, the sufferer often thinks they are just getting old, are a bit tired or perhaps slept in the wrong position.
	A numbness/ loss of feeling in a part of the body.
	Sudden inability to tell hot from cold.
	A sudden problem with vision-blurred vision, double vision or loss of part of the visual field (part of the picture just disappears).
	Dizziness, nausea, or feeling unsteady when standing or walking.
	Difficulty walking and sudden `clumsiness’: leaning to one side or falling to one side and bumping into objects when walking.
	Sudden problems remembering words or actually speaking. Speech may (understood from last sentence) become slurred.
	Sudden problems understanding what people are saying.
	Dribbling
	Confusion
	Episodes of loss of consciousness.
	Difficulty swallowing

Less common symptoms include sudden, very severe headaches, described by neurologists as an intensely painful headache, which comes on ‘like a thunderclap’. This symptom, when it occurs, is most often felt when the stroke is being caused by hemorrhage.

Because a stroke often sees a sudden onset and rapid change in clinical symptoms, the symptoms’ degree of seriousness can differ greatly. In TCM, stroke symptoms are differentiated according to what area the stroke affects. Strokes affecting themeridiansÂ mainly impair superficial parts of the body. Individuals, who suffer from this kind of stroke, usually have symptoms that are not too serious and their prognosis is favorable. On the other hand, strokes involving the internalÂ organsÂ (viscera) deeply impair normal body functioning. These individuals usually experience serious and severe symptoms and have a less favorable outcome.

Strokes Involving the Meridians

Meridian System

Meridians are pathways in which the qi and blood circulate and through which the organs and limbs are connected, allowing the upper-lower and interior-exterior portions of the body to communicate.

Channels run in straight fixed courses

Collaterals run crisscross in the body

Stroke involving the meridians is considered to be minor. Symptoms include numbness of the muscles, skin and limbs, difficulty in walking, an appearance of a crooked mouth, difficulty speaking and hemiplegia (paralysis on one side of the body).

If the individuals suffering from this type of stroke have a lack or stagnation ofÂ qiÂ andbloodÂ flow in the small collaterals of the meridian system, other symptoms may be present such as an aversion to cold temperatures, fever, muscular stiffness, and joint soreness. On physical exam, there may be a thin white film covering the tongue and the presence of a floating and rapid pulse.

If this type of stroke is caused by either a liver-yin or kidney-yin deficiency, wind and phlegm evils that result from these conditions will flow upwards in the body and cause symptoms of dizziness, blurred vision, headache, tinnitus (ringing in the ears), irritable sleeping, and deep yellow-colored urine. On physical exam there may be the appearance of a red tongue with a stringy, thready and rapid pulse.Â

Strokes Involving the Viscera (Organs)

A serious stroke is usually associated with symptoms of a sudden collapse or loss of consciousness and usually involves the muscles, limbs or joints. It can be differentiated into stroke bi-syndrome and collapse syndrome.Â

Stroke of Bi-syndrome
This is due to an accumulation of wind-phlegm evils inside the body, leading to an obstruction of the orifices (openings to the body such as the mouth). The general clinical manifestations are sudden coma, unconsciousness, trismus (persistent contraction of the masseter muscle which helps close the jaw and chew food), clenching of fists, constipation and no urination.Â

Additional symptoms such as fever, flushed face, irritability, rough breathing sounds, and halitosis (bad breath) belong to theÂ yangÂ bi-syndrome of stroke. On physical examination, these individuals may have a red tongue with a yellowish and greasy covering, and a stringy and rapid pulse.Â

Symptoms like sleepiness, snoring, pale facial appearance, purple lips, and cold limbs belong to theÂ yinÂ bi-syndrome of stroke. On physical examination, there may be a white and greasy tongue covering and a deep, moderate and rolling pulse.

Stroke Collapse-syndrome
This condition occurs when there is a dissociation of yin and yang in the body, meaning these two forces are unable to work together and create balance to maintain a healthy state. It is a life threatening condition that can be caused by a severe and prolonged deficiency of vital qi. The main symptoms are a sudden collapse, unconsciousness, weak and superficial breathing, cold limbs, and a loss of control of urination and defecation (ability to stool). The eyes appear shut and the mouth is open.Â

When symptoms such as the appearance of a red face, profuse greasy sweating, cold limbs, faintness and the presence of a thready pulse start to diminish, it indicates the exhaustion of true-yang and that a person is dying.

Stroke Sequelae
After obtaining emergency treatment for a stroke, many individuals regain consciousness, resume eating and drinking, and regain control of normal urination and defecation (stooling). However, some symptoms may not return to normal and remain as stroke sequelae. Symptoms such as hemiplegia (paralysis on one side of the body), difficulty in speech, an appearance of a crooked mouth, puffy and weak limbs, stiffness, limb contraction and spasm, or muscle wasting (atrophy) can be present long after the stroke occurs and may not be able to be reversed back to normal functioning. For these individuals, rehabilitation such as physical, speech and occupational therapy are used by western doctors to help regain some amount if not all of the lost body functions. TCM practitioners can also assist in this process by using techniques such as Chinese medicine, acupuncture, acupressure, massage, moxibustion and tai chi exercises to help strengthen the muscles, relieve lingering pain and restore the normal flow of qi throughout the body.Â

Differentiating a Stroke from Epilepsy and Syncope (Fainting)
When there is a loss of consciousness or the presence of a coma, it is important to differentiate whether the cause is from a stroke, syncope (fainting), or epilepsy since the treatment for each of these conditions will be different.Â

Stroke:Â
When a person experiences a major stroke, there are usually other accompanying symptoms such as facial distortion, the presence of a crooked mouth or paralysis down one side of the body. After the stroke has occurred and a person regains consciousness, these symptoms usually remain and may not get better over time without other medical interventions.Â

Syncope:Â
This condition is a temporary sudden loss of consciousness caused by a lack of blood flow to the brain. This condition usually lasts for a short amount of time, and the person may have a pale complexion and cold limbs while unconscious. Stroke symptoms such as paralysis on one side of the body and facial distortion are not present. Individuals generally return to normal functioning once consciousness is regained.Â

Epilepsy:Â
Epilepsy is a chronic disease where the brain cells do not function properly this causing seizures. Typically, an epileptic seizure is characterized by an altered state of consciousness and may involve convulsions of one part or the entire body. Other symptoms that can occur with a seizure include drooling, foaming at the mouth, making abnormal sounds and having abnormal eye movements. An epileptic seizure generally lasts only for a short period. When individuals regain their normal conscious state, the symptoms experienced during the seizure are gone. They may have a headache and feel extremely tired, but otherwise have normal functioning.Â

Diagnosis

Diagnosis in TCM is based onÂ four examination techniques. The first is “questioning.” The TCM practitioner will want to know what the individual’s current complaints are, and will need their medical history and family health history. The second technique is “observation.” Physical features of the body such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and examining the area of pain all offer clues as to what the problem may be. Observation of the tongue is particularly useful as a gage to assess illness. The third technique is “hearing and smelling.” Smelling the sputum and breath and listening to the sounds coming from the chest offer additional clues. The last technique used in examination is “touching.” Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about the body’s imbalance.Â

With stroke, the TCM practitioner will want to diagnose whether it involves the meridians or the viscera (organs) in order to make appropriate treatment decisions.Â

During the acute stage of a stroke involving the meridians, the TCM practitioner will assess the individual for symptoms of:

	Distortion of mouth and tongue
	Numbness
	Difficulty in speech
	Hemiplegia (paralysis on one side of the body)

During an acute stage of a stroke involving the viscera, the TCM practitioner will assess the individual for symptoms of:

	Hemiplegia (paralysis on one side of the body)
	Distortion of mouth and tongue
	Paraesthesia of one side of body
	Difficulty in speech
	Unconsciousness
	Problems excreting urine or stool

Note:Â If a TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she will normally recommend the individual see a western doctor for further follow up. In the case of a stroke where an individual is experiencing any of the above symptoms, it should be taken very seriously and the appropriate medical care should be sought out preferably in an emergency setting.Â

If the stroke symptoms are stable and have remained longer than half a year, they are considered to be sequelae symptoms.Damage has already been done to the body that usually cannot be reversed back to its original state of functioning. TCM practitioners in these cases will try to help these individuals gain back as much functioning as they can.Â

Treatment

Generally, for the acute phases of stroke affecting the meridians or organs, herbal decoctions or remedies are mainly be used for treatment. The use of acupuncture and moxibustion may also be used as additional therapy. During the recovery phase, stroke sequelae symptoms will be principally treated with acupuncture,(click here to seeÂ moxibustionÂ techniques) and accompanied by some Chinese medicine. It is always best to seek the advice of a qualified Chinese medicine practitioner before undergoing such treatment, so they can form a correct diagnosis and monitor an individual’s response to therapy. The following are some examples of prescriptions and acupuncture points that can be useful for treating stroke.Â

Strokes Involving the Meridians

Therapeutic aim:Â ExpelÂ wind evils, eliminateÂ phlegm, enrich the blood and remove obstruction in theÂ meridianÂ channels.

Prescriptions for strokes involving the meridiansÂ

Acupuncture and Moxibustion:Â
Mainly acupuncture or moxibustion is applied along theÂ Arm-YangmingÂ andÂ Leg-YangmingÂ meridians. Acupuncture with purgation techniques are used.Â

Acupoints for hemiplegia(paralysis on one side of the body):
Jian Yu, Qu Chi, Shou San Li, Wai Guan, He Gu, Huan Tiao, Zu San Li, Yang Ling Quan, Feng Long, Jie Xi, Kun Lun, Tai Chong.Â

Additional acupoints for facial distortion such as a crooked mouth:Â
Di Cang, Jia Che, Qian Zheng, Feng ChiÂ

Additional acupoints for dizziness and blurred vision:Â
Bai Hui, Feng Chi, Feng Fu, He GuÂ

Additional acupoints for difficulty with speech:
Lian Quan, Ya Men, Jin Jin, Yu Ye, Tong LiÂ

Additional acupoints for contracted fingers:Â
Ba Xie, Hou Xi, San Jian, Da Ling.

Additional acupoints for numbness foot toes:
Tai Chong, Tai Xi, San Yin Jiao, Ba FengÂ

Additional acupoints for tinnitus (ringing of the ears) and irritable sleeping:Â
Shen Yu, Guan Yuan, Tai Xi, San Yin Jiao

Strokes Involving the Viscera (Organs)
Â	Â
1.	Stroke of Bi-syndrome

Therapeutic aim:Â Restore consciousness, eliminate phlegm, suppress the hyperactive liver and dispel the wind evils.Â

(a).

Treatment for yang Bi-syndrome of strokes

Therapeutic principle:Â clear liver-yang excess by eliminating wind-evils, extinguish the fire (or expel the evil heat influence), expel phlegm and restore consciousness.Â

Prescriptions for yang Bi-syndrome of strokesÂ

Acupuncture and moxibustion:Â
Mainly the acupuncturist can apply acupressure, acupuncture or moxibustion to the twelve Well-points. (On each of theÂ twelve meridians, there is one special point known as the well point, which makes up the twelve well points.) When using acupuncture it is best to prick with a three-edged needle to cause bleeding.Â

For unconscious persons:Â
Shi Xuan, Ren Zhong, twelve Well-point, He Gu, Lao Gong, Feng Long, Tai Chong, Xing Jian.Â

Additional acupoints for facial clenching:
Jia Che, xia Guan, He GuÂ

Additional acupoints for abundant expectoration:Â
Tian Tu, Feng Long, Yin Ling Quan, San Yin JiaoÂ

(b).

Treatment for yin Bi-syndrome of stroke

Therapeutic principle:Â restore consciousness by warming up the body, remove phlegm and arrest wind-evils.Â

Prescriptions for yin Bi-syndrome of strokesÂ

Acupuncture and moxibustion:Â
It is best to use a filiform needle with mild reinforcing and attenuating acupuncture techniques.Use the same acupoints as for the yang Bi-syndrome of stroke, plus Zu San Li and San Yin Jiao.Â

2.	Collapse Syndrome of Stroke

Therapeutic principle:Â Restore vital energy (qi) from collapsing and replenish the depleted yang.Â

Prescriptions for Collapse Syndrome of StrokeÂ

Acupuncture and moxibustion:Â
Acupuncture is applied to the large collaterals of the Ren meridian, also known as the “Conception Vessel Meridian“. A big moxa roll should be used with moxibustion along these collaterals.Â

Acupoints: Guan Yuan (monkshood moxibustion), Shen Que (Salt interposed moxibustion).Â

Stroke Sequelae
Â	Â
1.	Hemiplegia

Therapeutic principle:Â Benefit qi by activating blood circulation and promote the flow of qi and blood in the meridians.

Prescriptions for Stroke Sequelae

Acupuncture and moxibustion:Â
The same acupoints along theÂ Yangmingmeridians that used for Stroke Involving the Meridians are suggested for hemiplegia (paralysis on one side of the body).Â

Additional acupoints for individuals with qi deficiency: Dan Zhong, Zu San Li.

Additional acupoints for individuals with yang hyperactivity: Fen Chi, He Gu and Tai Chong.

Additional acupoints for individuals with yin deficiency: San Yin Jiao, Zhao Hai and Tai Xi.Â

2.	Difficulty with speech

Therapeutic principle:Â Eliminate phlegm for resuscitation.

Prescription:Â Jieyu Decoction (See the treatment of Stroke Involving the Meridians)Â

Acupuncture and moxibustion:Â Use Lian Quan (triple puncture technique), Tong Li and Feng Long acupoints.Â

3.	Facial Distortion such as Crooked Mouth

Therapeutic principle:Â Break up the evil wind and make the crooked mouth return normal.

Prescription:Â Qianzheng Powder (See the treatment of Stroke Involving the Meridians)Â

Acupuncture and moxibustion:Â Use Di Cang, Xia Guan, Jia Che, Feng Chi and He Gu acupoints.Â

4.	Other Therapies

Scalp acupuncture:Â Select the part of the scalp that is opposite of the paralyzed part of the body. Use the acupuncture zones that correspond to the type of stroke injury i.e motion zone, zone for motion sensation of feet, and speech zone for the patients unable to speak.

Hydro-acupuncture therapy:Â Danshen injection, Chinese angelica (dang gui) injection, Safflower (hong hua) injection, Cerebrolysin injection, Citicoline (cytidine diphoshate Choline) injection and other injections of traditional Chinese medicines or Western medicines can be injected into the acupoints of Shou San Li and Zu San Li on the paralyzed part of the body.

Massage therapy:Â Relevant parts of the body are selected to have massage therapy in accordance with clinical symptoms.

Prostate Cancer

acuherb — Tue, 03 Apr 2012 01:53:34 +0000

By Dr. Ken Y Wang

Prostate cancer is one of the most common cancers affecting men, especially elderly men in their sixties, seventies and eighties. It has been suggested that if every man lives long enough, he will eventually develop prostate cancer. In western countries, it is the cancer most frequently found in men after skin cancer. The disease is less common among Asian men, though rates in Asian populations are rising; something thought to be due to the increased levels of red meat and animal fat in Asian diets.Â

The prostate is a walnut shaped gland that wraps itself around the urinary outlet tube, the urethra, just under the bladder and in front of the rectum in human males. Females do not have this organ or any equivalent organ. The prostate produces a protein-rich fluid that nourishes and supports the sperm produced by the testicles. The sperm and prostatic fluid together form the semen ejaculated by males during orgasm.

As men age, the prostate enlarges, a condition known asÂ benign prostatic hypertrophy, and symptoms caused by pressure on the bladder and the urethra develop. These include more frequent urination, a difficulty starting urination, pain on urinating and difficulty passing urine. In some cases, when the prostate enlarges the cells undergo a cancerous change. In many men, this happens so slowly they never know they have cancer. Some cases have been diagnosed as an “incidental finding” during the post-mortems done on men who have died from other causes. But in others, the cancerous change can be rapid and the prostate cancer can spread beyond the prostate into other organs, usually the bones of the pelvis and spine, before the man has symptoms. There is new evidence that a particular tumour gene, known as P53 indicates whether the man has a tumour likely to spread rapidly or grow slowly. If P53 is present in the tumour, it is usually a much more aggressive and dangerous cancer.

The incidence of prostate cancer is low in China, but has risen significantly in recent years. This is thought to be due to lifestyle changes such as eating increased levels of red meat and animal fat. The current western thinking about prostate cancer did not exist in ancient China. Instead, prostate cancer would have been described according to its symptoms of “strangury”, “retention of urine” (inability to urinate) and “haematuria” (blood in urine). In Traditional Chinese Medicine (TCM) like western medicine, “strangury” means dribbling urination and frequent urination with prickling pain or pain radiating to the lower abdomen. This symptom can also be present in other health conditions such as certain types of venereal disease, benign prostatic hypertrophy, and some bladder diseases. “Retention of urine” occurs when the prostate enlarges, as is often the case with prostate cancer, and blocks the bladder’s outflow.Â

The TCM perspective of how fluid is processed and urine is made is important in the development of prostate cancer:
Because there is no historical understanding of the prostate organ in Traditional Chinese Medicine, the organs that control urine production and excretion play a crucial part in the treatment of prostate cancer. TheÂ lung,Â spleenÂ andÂ kidneyÂ all have roles in fluid metabolism and in regulating its distribution. TheÂ upper, middle and lower burnersÂ act together as the distribution pathway for body fluids. All body fluids will gather finally in the kidney, where they will be separated into fluid that can be reused by the body or “turbid’ water that cannot. The “turbid” water is then sent to theÂ bladderÂ for excretion as urine. TCM describes this fluid regulation and the excretion function as “vaporization“. The bladder, as in western medicine, is responsible for storing and excreting urine. Disharmony of the bladder can lead to urinary problems such as incontinence or difficultly urinating. Kidney function complements bladder function so a problem with the bladder often indicates kidney problems as well. The kidney organ, in TCM, is additionally responsible for sexual function.

Understanding how urine is formed from a TCM perspective

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Causes

TCM believes health is achieved whenÂ yin and yangÂ are in harmony. The body’s physical form belongs to yin while the body’s activities or functions belong to yang. Because both the body’s physical form and functions are dynamically balanced, they mutually restrict and depend on one another. Hence, in TCM disease results from either a deficiency of vital energyÂ (qi)Â (diagnosed as a deficiency of yin fluid or a deficiency of yang qi) or an excess of the “pernicious evils” (excess of yin evils or yang evils).Â Pernicious evils are factors outside the body that cause disease. The conflict between resuming vital energy and getting rid of the “pernicious evils” is what allows the disease to either progress or transform back to a healthy state.

According to TCM theory, prostate cancer is caused byÂ heat, stasisÂ orÂ deficiencyproblems. Heat is considered a pernicious evil. (See above for definition.) Stasis or deficiency problems, which are described below in more detail, stem from a deficiency of vital energy (qi).

Heat:

The concept of heat includes two types: “damp-heat evil” and “hyperactivity of excessive ministerial fire.” Damp heat evil occurs when there is an over consumption of greasy foods and alcohol. This leads to a malfunction of theÂ stomachÂ andÂ spleenÂ and causes a build up of damp heat that flows downwards, attacks the bladder and impairs theÂ vaporization functionÂ responsible for fluid regulation. (See definition section.) Symptoms like dribbling urine, frequent urination with or without prickling pain and periodic retention of urine can develop when this happens.

Ministerial fire is the source of heat power in the human body. In TCM, it is believed that when a man is overly sexually active, theÂ kidneyÂ essence is consumed and the internal ministerial fire becomes excited. The excessive ministerial fire is a kind of “evil fire” which makes the body produce heat. This “evil fire” affects theÂ lungs,Â bladderÂ andÂ triple burnerÂ and impairs the passage of body fluids. As a result, symptoms of urinary frequency and dribbling urine with prickling pain may occur.Â

Stasis:Â

Stasis occurs when a particular substance cannot flow smoothly. In TCM, stasis happens when there is stagnation ofÂ qiÂ or blood flow. TheÂ kidneysÂ play an important part in the vaporization of body fluids. In this process, fluids are separated by the kidneys to ones that can be reused by the body or into “turbid water” which is eventually excreted as urine. When the emotion rage impairsÂ liverÂ function, the surrounding vital energy or qi stagnates and cannot flow properly, eventually transforming into an “evil-fire.” As the “evil fire” accumulates in theÂ lower burner, the vaporization process is affected and so is normal urination.

Qi is the commander and controller of the body’s blood. Once qi flow stagnates, blood circulation will not be smooth, and this can lead to difficulty urinating and to bloody urine (haematuria).Â

Deficiency:Â

Deficiency problems refer mainly to kidney failure, which results from the damage done by the above mentioned causes of heat and stasis. In summary, sexual excess and improper diet both lead to an accumulation of damp heat and ministerial fire, which contribute to qi stagnation and blood stasis. These, in turn, eventually exhaust kidney –yin, which is the foundation supplying fluid to the entire body for moistening and nourishing purposes. Once kidney yin is completely exhausted, kidney failure will ensue.Â

Other Causes of Prostate Cancer:
Other factors associated with the development of prostate cancer are still under further investigation.
These include:Â

	high levels of male hormones
	excessive sexual activity
	gonorrhea
	other causes of urinary tract infections
	A chronic intake of greasy food leading to a disorder in hormone metabolism.

Symptoms

Modern TCM practitioners mostly follow western theories when assessing prostate cancer symptoms. Initially there may be no symptoms present at all. When the prostate cancer enlarges to a level where it blocks urinary outflow, dribbling urination, frequent urination with prickling pain or pain radiating to the lower abdomen (strangury) and urine retention are commonly seen. Haematuria (blood in the urine) usually appears at a later stage of disease involvement.Â

The presence of damp heat in the body or overstrain strangury can cause thirst with a lack of desire to drink, constipation, burning and stabbing pain during urination, or dribbling urine. Overstrain strangury means the body is overworking and makes the strangury symptoms more severe.Â

Stagnation of qi flow and blood stasis are usually present when urine retention occurs. (See causes section.) Symptoms related to these conditions include lower abdominal distension, localized pain, difficultly urinating or inability to urinate.Â

Haematuria can be a manifestation of hyperactive and excessive ministerial fire. Related symptoms arising from excessive ministerial fire include face blushing, excessive thirst, feeling annoyed or distracted, insomnia, urinary hesitancy and pain on urination.Â

Other signs that may be present with prostate cancer:

The tongue signs:Â

Individuals with damp heat usually have a red tongue with yellow and greasy fur. Those with blood stasis have a dark tongue with pinpoint bruises, and those who suffer from exhausted kidney yin have a red or deep red tongue without fur.Â

The pulse signs:

A rolling and rapid pulse is present in people with damp heat problems. Individuals with blood stasis often have a hesitant pulse, and those with kidney–yin exhaustion have a soft, thready and weak pulse.Â

Prostate cancer is famous for being silent: that is, causing no symptoms able to warn of its presence. Many are diagnosed during a routine physical examination or after a screening blood test known as a Prostate Specific Antigen (PSA) has been done. When symptoms do appear, they are usually similar to those caused by enlargement of the prostate (benign prostatic hypertrophy-described in the definition section).Â

These include:

	Increased urinary frequency, especially at night
	Difficulty starting urination
	Difficulty passing urine
	Pain on passing urine

Symptoms more suggestive of prostate cancer include:

	Blood in the urine
	Pain in the pelvis and spine
	Weight loss
	Night sweats
	Severe tiredness

Diagnosis

Diagnosis of prostate cancer mainly depends on western methodologies because the concept of a prostate organ did not exist originally in Traditional Chinese Medicine. Examination of a man’s prostate organ through the rectum is usually done during routine physical check ups to detect its size and texture. Ultrasound and CT (computed tomography) scans are very helpful for diagnosis and locating areas to which the disease may have spread. Other measures include looking for cancer cells in prostatic fluid or from a fine needle biopsy of the prostate. Recently prostate specific antigen (PSA) blood tests have been used to screen for early prostate cancer in older men, usually those over fifty.Â

Prostate cancer can only be differentiated from benign prostatic hypertrophy by using modern medical investigations. Benign prostatic hypertrophy occurs when the prostate gland enlarges and puts pressure on the bladder and urethra (the urinary outflow tract from the bladder). In TCM and western medicine, there are no big differences between prostate cancer and benign prostatic hypertrophy symptoms. Likewise, the TCM tongue and pulse signs are similar for both conditions. However, benign prostatic hypertrophy, while able to cause significant discomfort and put dangerous backpressure on the kidney, is not a form of cancer and does not metastasize (spread to other parts of the body).

In TCM, the diagnosis is not prostate cancer per se but rather a classification of its symptoms into five different syndromes, which are outlined below. The general progression of prostate cancer from a TCM perspective goes from damp-heat flowing downward in the body to stagnation of qi and blood stasis to hyperactivity of heart-fire and hyperactivity of excessive ministerial fire, finally leading to kidney failure.

Diagnosis is based on four important examination techniques. The first is “questioning.” The TCM practitioner will want to know important information such as what your current complaints are, your past medical history and family health history. The second technique is “observation.” Looking at the physical features of the body such as the face, tongue, hair, nails, sputum and area of pain all give clues as to what the problem may be. The third technique is “hearing and smelling.” Smelling the sputum and breath and listening to the sounds coming from the chest are important. The last technique used in examination is “touching.” Feeling the pulse is a cornerstone of TCM diagnosis and gives the TCM practitioner a lot of information about imbalance in the body. If the TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat he or she may recommend that the individual see a western doctor for further follow up.

Features of the TCM syndromes associated with prostate cancer are:Â

Damp-heatÂ
Damp-heat is heavy and likes to flow downward and accumulate in the lower burner (bladder, large intestine) region, which results in frequent, difficult and/ or urgent urination. The tongue appears red with a yellow and greasy covering, and the pulse is rolling and rapid with this syndrome.Â

Kidney-Yin Exhaustion
Under normal conditions, kidney–yin & kidney–yang restrict, promote, and depend on each other in order to maintain a dynamic balance of yin & yang. This means the kidneys are kept in a constant state of functioning where they are not over or under functioning. When kidney–yin becomes exhausted and cannot perform its usual functions, kidney yang cannot be kept in check and the body experiences virtual heat symptoms. These symptoms manifest as urinary frequency and urgency, dry throat, restlessness, dry and hard stools, hot feelings in the palms, lower back, knee soreness and weakness of the lower extremities. The tongue appears red without a mossy covering, and the pulse feels thready and soft.Â

Decline of Kidney-Yang
This type is seldom encountered but is very serious. Kidney-yang is the main source of energy for life’s activities. Therefore, if kidney–yang declines, the body will be unable to perform warming and promoting functions, causing a yang-deficiency in many other organs, which may lead to death. Individuals usually feel weak and fatigued. They have pale complexions, cold limbs, sore loins (waist area) and experience an aversion to cold temperatures. Urinary symptoms associated with this condition include urinary frequency, dribbling urination and a weak urine stream. The tongue appears pale with a thin fur layer, and the pulse feels deep and weak.

Stagnation of QiÂ
When qi movement is sluggish, it causes improper fluid circulation. Symptoms related to improper fluid circulation include difficulty urinating, inability to urinate, emotional depression, irritability, quick temper and chest and abdominal distension. The pulse is stringy, and the tongue is red with a yellowish, thin fur. Those who also have blood stasis (poor blood flow) will have a dark tongue with pinpoint bruises and a hesitant pulse.Â

Hyperactivity of Heart-fire
A kidney–yin deficiency can also affect the heart by disrupting its normal functions and creating a “heartÂ fire evil” or heart-yang excess. When this happens, the blood vessels become damaged and the blood leaks out. Urinary symptoms related to this condition include haematuria (blood in the urine), prickling pain on urination and dark-colored urine. Other symptoms include insomnia, feeling annoyed and the presence of boils on the mouth and tongue. On examination, the tongue usually has a red tip, sometimes with a prickly appearance and a thin or yellowish fur coating. The pulse feels thready and rapid.Â

If one suffers from hyperactivity of excessive ministerial fire, symptoms such as hyper-sexuality, a red tongue with a thin or yellowish fur and a rolling and rapid pulse will be present. (See causes section under heat for further explanation.)

Treatment

Surgery

If the cancer has been diagnosed early, is still within the prostate gland itself and is of a type considered unlikely to spread rapidly, surgical removal of the entire prostate, an operation known as a radical prostatectomy, may be considered. However, this operation has a high rate of complications, leaving up to up to sixty percent of men impotent and more than ten percent with incontinence (where they cannot control urine flow). This is because the nerves controlling these functions are very close to where the prostate sits under the bladder. The sphincter, a muscle that holds the bladder closed, is located just above the prostate and is also vulnerable to damage during surgery. In expert hands, that is, when done by a surgeon who does many of these procedures at a hospital where the operating theatre and nursing staff are very experienced in prostate surgery, the complication rates are much lower. Some surgeons in top American hospitals report incontinence in only two percent of their patients and impotence in ten percent. For this reason, choosing your surgeon very carefully once you have been diagnosed with operable prostate cancer is essential. It is worth getting several opinions and asking each surgeon for their post-surgery complication rates. If they will not give you this information, ask your usual medical adviser to help you find out who has the lowest complication rates.Â

Radiotherapy

Those men whose tumours are too advanced for surgery, who are considered unsuitable for surgery, or who would like to avoid the complications of surgery, may be given radiotherapy, where a radiation beam is directed at the prostate to burn away the cancer. This treatment may also be used to burn away secondary prostate cancers in the pelvic bones and spine to stop the pain caused by such tumours. In the right men, who are carefully selected according to the size and stage of their tumour, brachytherapy, a treatment where tiny radioactive implants are inserted into the prostate cancer, has been very successful.Â

Chemotherapy

Advanced tumours or those thought likely to spread even after surgery may be treated with a combination of drugs able to kill cancer cells, known as chemotherapy. Doses and courses vary according to the oncologist’s assessment of which chemical is likely to be most effective but courses are usually given over several months.Â

Hormone therapy

Because prostate cells are very sensitive to the male hormone testosterone, hormone therapy is given, usually as a long-acting injection, to block the effect of testosterone and delay the spread of advanced prostate cancer. Sometimes both testicles are surgically removed to achieve the same effect without using drugs. Unfortunately, this has marked side effects such as breast development, impotence, loss of sexual desire, and a change from a low to a higher voice, but it can effectively slow down the progression of the disease.

There are many ways to treat prostate cancer after a definitive diagnosis has been made. Western treatment methods: hormone therapy, surgery, chemotherapy and radiotherapy are important for curing or arresting disease progression. (See western medicine section.) However, due to the different side effects each option causes (i.e. inability to control urination, impotence and loss of sexual desire), these clinical methods still have limitations.Â

TCM focuses on holistic healing and creating a harmonious balance in the body. The yin and yang philosophy is central to achieving balance and is used to identify good and evil health influences, distinguish between body excesses & deficiencies and to regulate the functions of the organs, qi, and blood. TCM can complement western medicine by helping to increase therapy efficacy, improve quality of life and in some cases prolong the lifespan.Â

Surgery is an area in which TCM treatments can be especially useful. The mere act of surgery causes damage to a person’s body by exhausting its healthy energy and increasing blood loss causing an imbalance of yin and yang. TCM herbal preparations and other treatments such as acupuncture or qi gong used before and after the operation can reduce the damage from intra and post-operative complications, improve operation tolerance and promote health restoration. Before surgery, TCM preparations that invigorate qi, enrich the blood, strengthen the spleen and nourish the kidney and liver are generally chosen. Afterwards, preparations that tonify qi, nourish yin, promote blood circulation, resolve blood stasis, regulate the function of the spleen and stomach and improve the function the kidney and liver are used to restore the body’s health. Herbal prescriptions are adjusted when complicating factors such as a build up of phlegm, dampness, stasis, toxins and heat evils are impeding recovery. Aside from surgery, TCM herbal preparations have been shown in research studies to improve the efficacy of chemotherapy and radiotherapy and reduce their side effects. When deciding what herbal treatments to take, it is always best to consult a qualified TCM physician who can plan follow up visits with you to monitor how successful a particular treatment has been and to ensure the right care is being given.

Below are some examples of selected herbal prescriptions that are used by TCM doctors to treat the different syndromes associated with prostate cancer.Â

Pathogenic Damp-heat accumulation in lower burnerÂ
Therapeutic aim: Clear away damp-heat in the lower burner
Prescription: Sanmiao pellet

cang shu	atractylodes root
huang bai	amur cork-tree
niu xi	twotooth-achyranthes root

Addition for individuals with dribbling after urination:Â

shi wei	shearer’s pyrrosia leaf
bi xie	dioscorea hypoglauca root
tu fu ling	glabrous greenbrier root

Addition for individuals with haematuria: (Blood in urine)

da ji	Japanese thistle herb
xiao ji	field thistle herb
niu xi	twotooth (charred)

Therapy for Kidney-Yin ExhaustionTherapeutic aim:Â Nourish kidney–yin.Prescription:Â Zhibai Bawei pelletÂ

zhi mu	common anemarrhena root
huang bai	amur cork-tree
sheng di	rehmannia root
shan yu ru	Asiatic cornelian cherry fruit
fu ling	Indian bread
ze xie	oriental water plantain root
shan yao	common yam root

Addition for individuals with severe cases:

gui ban

tortoise shell

Therapy for Decline of Kidney-YangTherapeutic aim:Â Warm and nourish kidney–yang.Â
Prescription:Â Jisheng Shenqi pelletÂ

shu di	rehmannia root (processed)
shan yu ru	Asiatic cornelian cherry fruit
shan yao	common yam root
niu xi	twotooth-achyranthes root
che qian zi	plantain seed
fu zi	prepared common monkshood daughter root
rou gui	cassia bark

Addition for individuals with severe cases:

lu jiao shuang	(degelatined)deerhorn
or	or
lu rong	pilose antler
ren shan	ginseng

Syndrome differentiation must be accurate when using these medicinal substances for warming and nourishing kidney–yang. They should not be used for those withhyperactivityÂ of excessive ministerial fire.Â

Therapy for Hyperactivity of Heart-fireTherapeutic aim:Â Eliminate heart-fire.Prescription:Â Daochi powderÂ

sheng di	rehmannia root
zhu ye	bamboo leaf
sheng gan cao	unprocessed liquorice root
mu tong	vine of clematis armandi

Addition for individuals with urgency or dribbling after urination:

niu xi tan	charred twotooth-achyranthes root
ren dong hua	honeysuckle flower
tu fu ling	glabrous greenbrier root

Therapy for Stagnation of Qi
Therapeutic aim:Â Regulate the functional activities of vital qi.Â
Prescription:Â Chenxiang powderÂ

chen xiang	Chinese eaglewood wood
shi wei	pyrrosia leaf
chen pi	dried tangerine peel
Huang bu liu xing	cowherb seed
dong kui zi	cluster mallow seed

Addition for individuals with blood stasis:

tao ren	peach seed
hong hua	safflower

Peptic Ulcer

acuherb — Tue, 03 Apr 2012 01:43:44 +0000

By Dr. Kenneth Wang

Peptic ulcer disease (PUD) is a mixed group of disorders that involve the gastrointestinal (GI) tract. The stomach and duodenum (upper part of the intestine) are the most common locations where ulceration occurs. The rate of occurrence of PUD is variable and depends on ulcer type, age, gender and geographic location. For example, in Japan, stomach ulcers occur at five to ten times the rate of duodenal ulcers, while in the United States and most European countries duodenal ulcers are about two times as common as stomach ulcers.

Individuals with chronic peptic ulcer disease will experience periods of remission and recurrence of the disease, while acute peptic ulcers are limited to a specific patient population and clinical scenario. When left untreated, PUD may result in serious complications such as gastrointestinal bleeding and cancer. Stomach ulcers are much more likely to result in death or disability due to a greater likelihood of causing hemorrhage, perforation, or obstruction. In addition, while duodenal ulcers are almost never cancerous, approximately 55% of stomach ulcers are cancerous.Â

Peptic ulcer is a terminology that belongs to modern medicine; there is no mention of it in the history of Traditional Chinese Medicine (TCM). Instead, because of the nature of its symptoms, it is categorized as “stomach ache” or “epigastric pain.” It is associated with theÂ spleen,Â liverÂ andÂ gall-bladderÂ because these organs play an important role in the development of the disease.Â

According to theÂ five elements theory, the spleen andÂ stomachÂ belong to earth, and the spleen has an interior-exterior relationship with the stomach. Both of these organs are responsible for the digestion, absorption and transportation of food, and control blood production and its circulation.Â

The liver and gall-bladder belong to wood and they jointly regulateÂ qiÂ (vital energy) and the emotions, enhancing digestion and blood flow. In normal circumstances, wood (liver and gall-bladder) restricts the earth (spleen and stomach) which means that the spleen and stomach are under the control of the liver and gall-bladder. If the liver is hyperactive, it unduly restricts functioning of the spleen, causing an imbalance in the body. According to the five elements theory, the resulting situation is described as “wood overacting on earth.”

Causes

According to TCM, peptic ulcer can be caused by any of the following:Â

1. Dietary injury
Diet is an important cause of Â stomachÂ disorders. The stomach receives and ripens food; theÂ spleenÂ transforms and transports refinedÂ nutrient essenceÂ up towards theÂ lungs, whilst the stomach sends waste down towards the intestines. The descending function of the stomach corresponds with the ascending function of the spleen, and this is crucial in ripening, transporting and transforming nutrient essence and wastes in theÂ middle burner. Improper eating habits affect the stomach easily which leads the stomach-qi to flow in the wrong direction, and results in nausea, vomiting, hiccups or belching.

2. Emotional distressÂ
Emotional problems have a profound influence on stomach disorders. When emotions such as anxiety, pensiveness, grief and anger predominate,Â liverÂ yang ascends and liver qi stagnates which, in turn, affects the functioning of the spleen and stomach. In the absence of the liver’s regulatory function, the spleen cannot successfully transport and transform food into qi and blood, and the stomach cannot send waste down to the intestines. This causes epigastric pain, belching or nausea.

3. Weakness of spleen and stomach
This may be due to genetic constitutional weakness, or mental over-exertion over a long period. A person tends to get digestive problems like a poor appetite, vomiting or diarrhea, and possibly also muscle weakness and low energy. When attacks fromÂ pathogenic factorsÂ become more serious, stomach disorders occur easily.

Symptoms

Gastric pain, a major manifestation of peptic ulcer, usually occurs in the epigastric region or upper abdomen. Episodes of pain may be periodic, rhythmic or chronic. If seasonal, the pain usually occurs in late autumn, and the nature of pain is manifested as a dull, stabbing, distending, burning or hunger pain. Among the different types of pain, intermittent mild dull pain is most frequent. This usually lasts one or two hours but, in rare cases, it can last several days. The pain can be relieved by alkaline drugs or food. Along with pain, associated symptoms are belching, sour regurgitation, excessive saliva, nausea or vomiting.Â

The location of gastrointestinal (GI) ulcer can be implied by the symptoms. People with stomach ulcers usually complain of pain being caused or worsened by food. They also describe the pain as being widespread over the lower abdomen. When someone has a duodenal ulcer the pain is typically described as sharp and burning in nature with a specific point of tenderness. In contrast to stomach ulcers, people with duodenal ulcers usually experience relief of pain with food.

Other symptoms of a duodenal ulcer include a feeling of abdominal pressure, fullness or hunger. People with duodenal ulcers may also be awakened at night due to the normal nighttime peak in acid secretion. It is important to be aware of “alarm symptoms” which can be present in people who have serious complications from peptic ulcer disease (PUD) such as bleeding or people with stomach cancer. These “alarm symptoms” include weight loss, vomiting, back pain, vomit that has the appearance of “coffee grounds” and dark tarry stools.

Diagnosis

Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and observation of symptoms. A diagnosis is based on the traditional four examination techniques:

1.	QuestioningÂ The TCM practitioner will establish the medical history of both the patient and his family.
2.	ObservationÂ Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
3.	Listening and smellingÂ The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
4.	TouchingÂ Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

For details, please see article on “What to Expect from a TCM Doctor’s Examination“.Â

TCM practitioners will usually begin with a thorough investigation of the patient’s complaints and categorize the symptoms under special syndrome groups known as “disharmony patterns.” The disharmony patterns are present at different stages of a disorder. The practitioners will look at both the major manifestations, and “disharmony patterns” which are described below:Â

1. Qi stagnation
The patient feels distending pain in the epigastric region, and fullness and oppression in the hypochondrium (the upper lateral sides of the abdomen). These symptoms would worsen with emotional disturbance, and can be relieved by discharge of intestinal gas or belching. The patient tends to sigh, has a poor appetite and experiences oppression in the chest and sour regurgitation. On examination, the tongue is covered by a thin white fur, and the pulse isÂ taut.Â

2. Heat retention
The patient feels a burning pain in the epigastric area. Eating offers no obvious relief; instead, it may even make the symptoms worse. The mouth is dry with a bitter taste. Other symptoms include thirst and a desire for cold drinks, sour regurgitation, irritability, clamoring stomach and constipation. On examination, the tongue is red with yellow fur, and the pulse is taut orÂ rapid.Â

3. Yin deficiency
The patient feels a dull, burning epigastric pain which becomes worse on an empty stomach. Other associated symptoms include thirst and a disinclination to drink, dryness of the mouth, poor appetite, retching, constipation, and a feverish sensation in the palms, soles and chest. On examination, the tongue is red and dry, with cracks in the central portion. It is covered with little or scattered, cracked fur. The pulse isÂ threadyÂ or rapid.

A pale tongue with indented margin, the cracks in the central portion indicate spleen and stomach dysfunction.

4. Deficient cold
The patient feels a dull epigastric pain which tends to ease with warmth and massage. An attack can be easily induced or worsened by over-exertion. The pain worsens on an empty stomach. Although the pain can be relieved by eating, abdominal distention will follow. Other associated symptoms are fatigue, sleepy, reluctance to speak, and loose stools. On examination, the tongue is pale and bulky with indented margin, and it is covered by a thin white fur. The pulse isÂ deep, thready or slow.

5. Blood stasisÂ
The patient experiences a fixed, stabbing pain in the epigastric area. But when the pain becomes extreme, it sometimes radiates towards the chest and the back. This may be accompanied by coldness of the limbs, sweating, vomitting blood or blood in the stools. On examination, the tongue is dark purple, and may have bruises or patches on the surface. The pulse isÂ hesitant.

In general, during the pathological course of peptic ulcer, the above syndromes develop at different stages. In the early or active stages of peptic ulcer, qi stagnation and heat retention syndromes are quite common. TCM terms these as a sthenia orÂ excess (shi) syndromesÂ in which the body offers a relatively strong resistance.Â
In the late or recovery stages of peptic ulcer, yin deficiency and deficient cold syndromes are more common. TCM terms these as a sthenia orÂ deficiency (xu) syndromesÂ in which the body’s resistance is very weak.Â
Blood stasis syndromes can develop at any stage, but occurs mostly in the middle and late stages. The syndrome has a deficiency nature but presents excitatory signs, or having both excess and deficiency syndromes inter-mixed.

Treatment

In TCM, treatment for peptic ulcer is based on “disharmony patterns,” or therapies according to the western symptoms of peptic ulcer syndromes. An alternative is to integrate western and Chinese approaches to create a synergetic effect on the disease, thus enhancing clinical efficacy. The following are brief introductions to TCM approaches:

A. Treatment based on TCM syndromes

Qi stagnationÂ

Therapeutic aim:Â Soothing the liver to regulate qi. Commonly used prescriptions are modifiedÂ chaihu shugan tang, sini sanandÂ xiaoyau san.

Sample of Prescription:Â chaihu shugan tang

chai hu	Chinese tororwax root
chen pi	dried tangerine peel
shao yao	peony
zhi ke	bitter orange
zhi gan cao	liquorice root (processed with honey)
chuan xiong	Szechuan lovage
xiang fu	nut grass

Heat retention

Therapeutic aim:Â Soothing the liver and eliminating heat. Commonly used prescriptions are modifiedÂ huagan jian, zuojin wanÂ andÂ banxia xiexin tang.

Sample of prescription: banxia xiexin tang

ban xia	pinella tuber
huang qin	baical skullcap
gan jiang	fried ginger
ren shen	ginseng
zhi gan cao	liquorice root (processed with honey)
huang lian	golden thread
da zao	common jujube fruit

Yin deficiency

Therapeutic aim:Â Nourishing yin to strengthen the stomach. Commonly used prescriptions are modifiedÂ
yiguan jian, yangwei tangÂ andÂ liuwei dihuang tang.

Sample of Prescription:Â yiguan jian

sha seng	adenophora
mai dong	dwarf Lily-turf
dang gui	Chinese angelica root
sheng di	dried rehmannia root
qi zi	Chinese wolfberry fruit
chuan lian zi	toosendan fruit

Deficient cold

Therapeutic aim:Â Warming the middle burner to strengthen the spleen. Commonly used prescriptions are modifiedÂ huangqi jianzhong tang, sijun zi tang, lizhong tang and liangfu wan.

Sample of Prescription:Â huangqi jianzhong tang

huang qi	Mongolian milkvetch root
gui zhi	cassia twig
zhi gan cao	liquorice root (processed with honey)
da zao	common jujube fruit
shao yao	peony
sheng jiang	fresh ginger
yi tang	maltose

Blood stasis

Therapeutic aim:Â Activating blood to resolve stagnation. Commonly used prescriptions areÂ xuefu zhuyu tang and gexia zhuyu tang.

Sample of Prescription:Â xuefu zhuyu tang

dang gui	Chinese angelica root
sheng di	dried rehmannia root
tao ren	peach seed
hong hua	safflower flower
zhi ke	bitter orange
chi zhao	common peony root
niu xi	twotooth achyranthes root
jie geng	balloonflower root
chuan xiong	Szechuan lovage
chai hu	Chinese tororwax root
gan cao	liquorice root

During the treatment, herbs like liquorice root (gan cao), tendrilleaf fritillary bulb (chuan bei), common bletilla tuber(bai ji), notoginseng (san qi) rhubarb (da huang) are added in the prescription for additional relief of dyspeptic symptoms. Some prescriptions to astringe (lessen) acid secretion are effective for related complaints, e.g. mixed powder of thunberg fritillary bulb(zhe bei mu) and cuttle-fish bone (wu zei gu) can be used.Â

B. Single Proven Prescription

In practice, a lot of recipes have been proved effective against the disease but were not listed in medical journals. These recipes do not follow any particular diagnostic rules in TCM but are used only when the disease is confirmed as peptic ulcer. For example pearl powder is effective in providing relief from symptoms and speeding up the healing of an ulcer.Â

C. Acupuncture andÂ moxibustion

This method is used to provide pain relief, and commonly applied according to theÂ differentiation of the affected meridian. For example, in the case of liver and stomach disharmony, acu-points in theÂ Leg Yang Ming Stomach MeridianÂ andÂ Leg Jue Yin Liver MeridianÂ are chosen.Â

Osteoporosis

acuherb — Fri, 30 Mar 2012 19:57:55 +0000

Osteoporosis is a debilitating condition of skeletal fragility that predominantly affects women and is particularly common in the elderly. It is a metabolic bone disease characterized by a parallel reduction in bone mineral density and bone matrix, leading to deterioration of theÂ micro-architecture of boneÂ tissue and impairment of the structural integrity of trabecular bone (the inner part of bone that consists of a meshwork of bony bars with numerous interconnecting spaces containing marrow). The consequence is that although the bone tissue has normal composition and proper mineralization, the bone mass (density) is reduced and the bone becomes more fragile. To establish a diagnosis of osteoporosis, the individual bone mineral density is compared with the peak bone mass measurement in the healthy young adult. This comparison is made by means of standard deviation (SD) units (T scores). Clinically, a patient is said to suffer from osteoporosis if his/her bone density falls 2.5 SD below the mean of normally mineralized bone, calculated in comparison to age-, sex-, and race-matched controls (a T score ofÂ Â 2.5). For example, compared to standardized bone density measurements of the total hip ofÂ 833 mg/cm², in osteoporosis, the same measurements will be lower than 648 mg/cm²(World Health Organization). If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair the ability to walk unassisted and may cause prolonged or permanent disability, or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain and deformity.

Multiple etiologic factors of osteoporosis have been identified, which give the various disease types their names.

	Postmenopausal, estrogen-deficient osteoporosis
	Age-related osteoporosis
	Diet-related bone loss
	Disuse osteoporosis
	Endocrine-mediated bone loss
	Disease-related bone loss
	Drug-induced bone loss
	Heritable osteoporosis

Statistics

Osteoporosis is a major public health concern that affects more than 28 million Americans, 80 per cent of whom are women. Women are more likely than men to develop osteoporosis because, as a group, they have lighter bones, less total calcium, and also lose bone at a rate three times greater than that of men. In the US today, 10 million individuals have the disease and 18 million more have low bone mass, placing them at increased risk for osteoporosis. Ten per cent of African-American women over the age of 50 years have osteoporosis; an additional 30 per cent have low bone density that puts them at risk of developing osteoporosis. Significant risk has been reported in people of all ethnic backgrounds.

The disease accounts for more than 1.5 million fractures per year in the US: one out of every four women by the age of 70 develops an osteoporotic fracture; and one in two women and one in eight men over the age of 50 will have an osteoporosis-related fracture in their lifetime. These fractures include the following (approximate figures):

	300,000 hip fractures
	700,000 vertebral fractures
	250,000 wrist fractures
	300,000 fractures at other sites

Osteoporosis is defined in Western medicine as loss of bone density. The disease is most commonly seen in women and is characterized by reduced bone mass, deterioration of bone tissue and an increased risk of bone fractures. It is induced by a physiological degeneration within the body that affects the formation and loss of bone tissue.

The skeleton is the frame of body that protects the internal organs and allows movement. Cavities within the bone store bone marrow, which nourishes the bones and helps manufacture cells such as red and white blood cells and platelets. TCM believes that bone growth is controlled by theÂ kidneysÂ and that the bone marrow is derived from the essential qi or essence of the kidney, calledÂ jing. In recent years, many bone disorders have been successfully cured by TCM practitioners through treatment of the kidney.Â

In the traditional Chinese medicine (TCM) classicÂ Huang Di Nei Jing (The Yellow Emperor’s Medicine Classic), bone diseases with similar symptoms to osteoporosis were given names like “bone flaccidity syndrome,” “withered bone syndrome,” “arthralgia syndrome” and “bone atrophy syndrome.” These syndromes refer to various kinds of bone diseases, but share the common symptom of reduced bone mass. Modern TCM practitioners believe that the features ofÂ “bone flaccidity syndrome”Â andÂ “bone atrophy syndrome”Â are most consistent with today’s understanding of osteoporosis.

Causes

Bone quality is a significant factor that affects the development of osteoporosis. This parameter is determined by bone mass (as measured by bone density) and also by theÂ micro-architecture of bone. Bone density at any given time depends on both the peak bone density achieved during development and subsequent adult bone loss. Collectively, these affect the relative intactness of bones, with respect to tensile strength, fragility and freedom from fatigue damage. Many studies demonstrate the ability of bone density to predict fractures, especially fragility fractures (those caused by minor trauma). The risks vary depending on the populations studied and on the technique of measuring the bone density.

Nonmodifiable risk factors

	Advanced age :Â Bone density increases dramatically during puberty in response to gonadal hormone release and eventually reaches values in young adults that are nearly double those of children. After peak bone density is reached, bone density remains stable for years and then declines.
	Gender :Â Considerable evidence suggests that bone loss begins before menses cease in women and in the third to fifth decade in men. In women, once the menopause is established, the rate of bone loss is accelerated several-fold. The chances of developing osteoporosis are greater for woman because they have less initial bone tissue and lose it more rapidly because of the changes involved in the menopause.
	*Family history and personal history of fractures as an adult :*Â Susceptibility to fracture may be, in part, hereditary. Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass. A personal history of a fracture as an adult also increases fracture risk.
	Race :Â Caucasian and Asian women are more likely to develop osteoporosis..

Potentially modifiable risk factorsÂ

	Bone structure and body weight :Â Small-boned, fair-skinned, and thin women are at greater risk.
	Estrogen deficiency :Â Normal or early menopause (brought about naturally or because of surgical removal of the ovaries) increases the risk of developing osteoporosis. A menstrual history of late-onset menses, or of amenorrhea (absence of menstrual periods) also increases risk.
	*Lifestyle :*Â Stress, smoking, excess alcohol consumption, and a sedentary lifestyle are associated with the development of osteoporosis.
	*Diet :*Â A high intake of caffeine, phosphorous, or protein, and a diet poor in calcium and vitamin D affect bone formation.
	Poor eyesight :Â Impaired eyesight despite adequate correction can lead to falls.
	*Poor health/frailty Medications :Â A number ofÂ drugs*Â taken for other conditions can have an affect on osteoporosis, either because they interfere with bone formation or accelerate its loss.
	Chronic health problems :Â Diseases such as chronic liver disease, chronic liver failure, endocrinopathies (eg, diabetes, hyperthyroidism), malabsorption syndromes, rheumatoid arthritis, and chronic anorexia can also be risk factors for osteoporosis.

From TCM’s viewpoint, osteoporosis is caused by aÂ kidneyÂ deficiency. As people get older, theÂ essential qi (jing)Â of the kidney gradually declines and results in a lack of nutrients for the bones to grow and function properly. This causes the bones to become fragile and break or deform easily. Bone fractures can be hard to heal due to the lack of nourishment and kidney deficiency.

The causes of kidney deficiency leading to osteoporosis are as follows:Â

Exhaustion of kidney essence.
Kidney essenceÂ may be depleted in one of three ways:

	A congenital deficiency (a deficiency you are born with) and the aggravation of external factors, such as excessive sexual activities and frequent childbirth, cause the kidney essence to become severely depleted. This leads to loss of bone nutrients.
	The elderly are especially vulnerable to osteoporosis if they do not take good care of their bodies because the depletion of kidney essence accelerates with age.
	Exogenous pathogensÂ can easily invade and damage the kidney whenÂ vital qi (energy)Â is insufficient. This causes the development of osteoporosis. .

Acquired Deficiency
Under normal conditions, theÂ spleenÂ andÂ stomachÂ are responsible for changing digested nutrients intoÂ qi,Â blood, and acquired (postnatal)Â jing. Over-consumption of alcohol and food can damage the spleen and stomach and reduces the amount of jing available to nourish the bone, bone marrow and muscle. Additionally, when the stomach and spleen dysfunction, a decline in formation of qi and blood results and this can contribute to osteoporosis development.

Invasion of exogenous pathogens
Osteoporosis can occur when external cold and dampness evils, which are exogenous pathogens, invade the body and impair the vital qi (energy) andÂ kidneyÂ qi. This leads to a deficiency ofÂ kidney essence (jing)Â and a failure in the bone marrow to replenish the nutrients needed to retain bone strength. Other symptoms such as lumbago (back pain) and arthralgia (joint pain) can occur when cold and dampness evils stagnate in the tendons and joints, blocking the circulation of qi and blood in that area.Â

TCM followers believe that external cold and dampness pathogens can invade the body under the following conditions:

	Living in cold and moist areas for a long time
	Exposure in a windy place while drinking alcohol
	Bathing or taking a shower while sweating
	Eating too much cold food and
	Lying in damp and moist open areas such as wet grassy fields.

Symptoms

The clinical symptoms of primary osteoporosis are:

	Lumbago (back pain)
	Decrease in body height and /or hump back (kyphosis) giving a stooped appearance
	Bones that easily fracture
	Difficulty in breathing due to malformation of the back limiting the amount of air that can be inhaled.

Persons with osteoporosis will also be diagnosed with a TCM disharmony pattern. (See diagnosis section). Each disharmony pattern displays different symptoms, which are described as follows:

1.	Yin deficiency of theÂ liverÂ andÂ kidneys
Â	The individual experiences soreness and pain in the back and loins, weakness in the loins and knee joints, general weakness and fatigue, dryness of the mouth and throat, a hot sensation in palms and soles, and night sweating or spontaneous sweating.
2.	BloodÂ deficiency and excessive dampness
Â	This manifests as soreness and pain in the back and loins, a hump back, pale complexion, heart palpitations and dizziness. There may also be pain and soreness in the joints or the lower limbs may be swollen.
3.	*Retention of dampness andÂ kidneyÂ deficiency*
Â	This disharmony pattern is characterized by lower back pain, localized chills, weakness and soreness in the loins and knees. In severe cases the lumbar vertebrae (lower back bones may collapse or a hump back develop. Additional symptoms are a cold feeling in the limbs, urinary frequency, and an aversion to the cold. The symptoms may be aggravated in a cold environment or with a drop in the ambient temperature.
4.	*Asthenia-syndrome of superficiesÂ and interior dampness retention*
Â	The individual suffers from pain in the hip and back, joint swelling, sweating and has an aversion to wind (coldness). A sense of heaviness may also be felt.
5.	*Cold in the superficies and heat in the interior*
Â	The symptoms here are body aches and sweating, and an aversion to cold temperatures. Additional symptoms can include dry mouth, thirst, and constipation.
6.	*Marrow deficiency andÂ channel bi-syndrome*
Â	The individual experiences pain in lumbar region. In severe cases, the lumbar vertebrae may collapse or a hump back may occur. Joints can become deformed and develop limited movement. Individuals may also experience dizziness, heart palpitations, and shortness of breath.

Diagnosis

Osteoporosis is an insidious disease that can remain silent for decades before the bone is weakened to the point that it sustains a spontaneous fracture. The earliest signs of osteoporosis are often associated with compression fractures of the spine characterized by an episode of acute pain in theÂ middle to low thoracic or high lumbar regionÂ . Decrease in height and appearance of a dowager’s hump are reliable indicators of the early progress of the disease. Also, the patient often reports early satiety and a bloated feeling after eating only a small amount of food.Â

A bone mineral density (BMD) test is the only way to diagnose osteoporosis and determine an individual’s risk for future fracture.Â It measures the density of the bones (bone mass) and will indicate whether medication is needed to help maintain bone mass, prevent further bone loss and reduce fracture risk. The BMD test is accurate, painless and noninvasive. It is also possible to determine the rate of bone loss and/or monitor the effects of treatment if tests are conducted at intervals of a year or more.

Criteria approved for BMD tests are summarized below:

	estrogen-deficient women at clinical risk of osteoporosis.
	vertebrate abnormalities on x-ray suggestive of osteoporosis (osteopenia, vertebral fracture)
	primary hyperparathyroidism – abnormal function of the parathyroid glands itself which result in high level of blood calcium.
	monitoring response to an FDA-approved medication for osteoporosis.

For an uncomplicated patient with osteoporosis, aÂ laboratory work-upÂ may be recommended in addition to a BMD test.Â

Based onÂ four examination techniques, TCM practitioners will diagnosis osteoporosis according to its clinical symptoms and further characterize it by the disharmony patterns displayed by each individual. At various stages of disease, different disharmony patterns are present and individuals with the same disease will be treated differently depending on the type of disharmony pattern they have.Â

The common disharmony patterns of osteoporosis are:

1.	Yin deficiency of the liver and kidneys
Â	When the body perceives that it is inadequate in bone marrow, theÂ liverÂ andÂ kidneyÂ will hyper-function to compensate. This results in a relativeÂ yin deficiencyÂ inside the body.Â Virtual “fire”Â is produced and presents as heat symptoms. On examination, the tongue is red with a scanty thin fur coating. The pulse feels thready and rapid.
2.	Blood deficiency and excessive dampness
Â	Improper functions of theÂ spleenÂ andÂ stomachÂ lead to a decline in the production of blood and bone marrow, plus an accumulation of dampness. It gives rise to a non-smooth flow ofÂ bloodÂ andÂ qi, which in turn supply inadequate nutrients to the bones. People may feel weakness, back pain or joint pain. On examination, the tongue is pale and covered with greasy fur. The pulse sign is deep and rolling.
3.	Retention of dampness and kidney deficiency
Â	The kidneys govern water, produce marrow, dominate the bones and manufacture blood. The kidney yang energy is the source of all heat in the body. Kidney deficiency occurs when cold and dampness evils damage the kidneys. This results in inadequateÂ kidney essence (jing)Â to supply the bone marrow and causes deterioration of the bones. Symptoms can manifest as back pain and hump back. On examination, the tongue is pale and covered with white greasy fur. The pulse feels deep, thready and stringy.
4.	Asthenia-syndrome of superficiesÂ and interior dampness retention
Â	This is a morbid condition resulting from the exposure toÂ exogenous pathogensÂ in a person whose organs, like the spleen and stomach, are in a hypo-functioning state. When the body accumulates lot of evils (most likely dampness and coldness), stagnation of qi flow in the meridians and the joints occurs and results in impairment of organ and bones, which leads to symptoms of sluggishness, tired and heavy limbs, and joint pain. On examination, the tongue has a white coating. The pulse sign is deep and rolling.
5.	Cold in the superficies and heat in the interior
Â	This morbid condition results from the wind and cold evils that accumulated in the superficial regions of body has invaded interiorly and transformed into heat evil. This process manifests as both heat and cold syndromes clinically. These syndromes cause kidney damage and lead to failure supply ofÂ kidney essence (jing)Â for bone growth. On examination, the tongue is red and covered with white greasy fur, or yellow-colored fur. The pulse feels thready, stringy and rapid.
6.	Marrow deficiency andÂ channel bi-syndrome
Â	When marrow is seriously exhausted, the body skeleton loses nutrients. The accumulated evils block the channels orÂ meridiansÂ that are the paths for transportation of nutrients and this accelerates the bone deterioration. The person presents with serious symptoms like severe bone or joint pain and bone distortion. On examination, the complexion may appear pale or dark in color. The tongue is dark red, and covered with white greasy fur. The pulse feels deep and stringy.

Treatment

A blend of Western and TCM approaches can be of benefit in the treatment of osteoporosis. Often a combined treatment produces better outcomes than the exclusive use of one method. It is best to get the advice of a TCM practitioner who knows what is best for you and your condition. The treatments described below are some approaches that may be taken to treat the different TCM syndromes associated with osteoporosis.

1. Yin deficiency of liver and kidney

Therapeutic aim:NourishesÂ yinÂ forÂ kidneyÂ andÂ liver, replenishesÂ jingÂ and marrow.

Prescription:Â liuwei dihuang pellet with modification

gan di huang	dry rehmannia root
shan yu rou	Asiatic cornelian cherry fruit
huai shan yao	common yam root
fu ling	Indian bread
dan pi	tree peony bark
gou qi chi	Barbary wolfberry fruit
chuan duan	Himalayan teasel root

In this prescription, rehmannia, cornelian cherry and wolfberry are used to nourish the yin of the liver and kidneys; peony bark clears away heat evil and nourishes yin. Common yam and Indian bread invigorate the spleen and eliminate dampness evil; they also counteract the greasy properties of the other herbs. Teasel rootÂ tonifiesÂ the kidneys and strengthens tendons and bones.Â

2. Blood deficiency and excessive dampness

Therapeutic aim:Â Nourishes the blood and dispels dampness evils.Â

Prescription:Â Danggui Shaoyao powder plus additional supplement

dang gui	Chinese angelica
bai shao	white peony root
fu ling	Indian bread
bai zhu	large head atractylodes root
ze xie	oriental waterplantain rhizome
chuan xiong	Szechuan lovage root
fang ji	four stamen stephania root
gui zhi	cassia twig
gan jiang	dried ginger
gan cao	liquorice root

In the prescription, angelica, peony root and lovage root are used to activate blood circulation and nourish the blood. Cassia can remove obstruction in the meridians, activate blood circulation, and relieve joint pain. Indian bread, atractylodes root, waterplantain rhizome, and stephania root are used to invigorate the spleen and eliminate dampness evil. Ginger and liquorice root warm the middle burner and ease the stomach. Additionally, angelica, peony root, and lovage root can stimulate blood production. Indian bread, atractylodes root and cassia also eliminate the dampness evil and relax the tendons, as well as nourishing the tendons and bones.

3. Retention of dampness due to kidney deficiency

Therapeutic aim:Â Warms theÂ yangÂ and dispels dampness evils.Â

Prescription:Â zhenwu decoction plus additional supplementÂ

zhi fu pian	prepared common monkshood daughter root
bai shao	white peony root
sheng jiang	fresh ginger
fu ling	Indian bread
bai zhu	large head atractylodes root
gui zhi	cassia twig
bu gu zhi	malaytea scurfpea fruit
chuan duan	Himalayan teasel root
sang ji sheng	Chinese taxillus herb
xing ling pi	epimedium herb
ji xue teng	suberect spatholobus stem

In the prescription, monkshood and epimedium are used to warm the yang or the body. Ginger, Indian bread and atractylodes warm theÂ middle burnerÂ (spleen and stomach) and promote the secretion of urine. Peony root, cassia and spatholobus nourish the blood and remove obstruction in all the meridians. Scurfpea, teasel and taxillus nourish the kidney and strengthen the bones, loins, and legs.Â

4.Â Asthenia-syndrome of superficiesÂ with interior dampness retention

Therapeutic aim:Â Strengthens the middle burner, benefits theÂ qi, harmonizes nutrients and defends qi. It does this by providing a yang energy in the body derived from the digestion and absorption of foods by theÂ spleenÂ andÂ stomach. This helps protect the skin and muscle, provides resistance against theÂ exogenous pathogensÂ and regulates the secretion of sweat.

Prescription:fangyi huangqi decoction with modification

sheng huang qi	fresh milkvetch root
fang ji	four-stamen stephania root
sheng jiang	fresh ginger
da zao	Chinese date
gan cao	liquorice root
gui zhi	cassia twig
bai shao	white peony rooti
cang zhu	atractylodes root
sheng long ku	unprocessed fossil fragment
sheng mu li	fresh oyster shell

In the prescription, cassia, ginger, date, liquorice and milkvetch are used toÂ tonifyÂ the stomach, nourish the middle burner, and benefit the qi. Peony root nourishes the qi and regulates the blood circulation. Stephania and atractylodes eliminate dampness evil and relieve joint pain. Fossil and oyster shell arrest premature ejaculation and sweating. The synergistic action of the herbs in this recipe consolidate body resistance, eliminate fluid retention, replenish the kidney and blood, and nourish muscles and bones.Â

5. Cold in the superficies and heat in the interior

Therapeutic aim:Â Expels superficial pathogens and clears away heat evil.

Prescription:Â Yuebi Jiashu decoction with modification

ma huang	ephedra
cang zhu	atractylodes root
sheng jiang	fresh ginger
da zao	Chinese date
jiu gan cao	liquorice root
shang shi gao	unprocessed gypsum
fang ji	four-stamen stephania root
mu gua	papaya

In the prescription, ephedra, ginger, date and liquorice provide pungent and warming properties to warm the middle burner, invigorate the stomach, and relieve the exterior symptoms. Gypsum can clear away interior heat evil. Stephania, papaya, and atractylodes eliminate dampness evil and relieve joint pain.

6. Marrow deficiency andÂ channels bi-syndrome

Therapeutic aim:Â Nourishes the marrow and smoothes the flow of qi and blood in all meridians.

Prescription:Â yougui pellet with modification

shu di huang	processed rehmannia root
shan yao	common yam root
shan zhu yu	Asiatic cornelian cherry fruit
gou qi chi	Barbary wolfberry fruit
jiu gan cao	liquorice root
du zhong	eucommia bark
rou gui	cassia bark
zhi fu zi	prepared common monkshood daughter root
wu she	black snake
xing ling pi	epimedium herb
cang zhu	atractylodes root
gou ji	cibot rhizome
sang ji sheng	Chinese taxillus herb

In the prescription, monkshood, rehmannia, cassia, cornelian cherry, eucommia, cibot and epimedium invigorate the kidneys and strengthen the tendons and bones. Atractylodes and taxillus eliminate dampness evil and relieve joint pain. Liquorice helps regulate stomach function and benefits vital qi (energy).