kidney – American Institute of Acupuncture

Ulcerative Colitis

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

By Dr. Kenneth Wang

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

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

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

Sections of Large Intestine

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

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

Pulsatilla root

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

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

Â Causes

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

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

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

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

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

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

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

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

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

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

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

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

SymptomsÂ

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

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

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

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

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

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

Other organ systems affected by ulcerative colitisÂ

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

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

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

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

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

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

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

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

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

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

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

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

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

Diagnosis

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

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

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

Sigmoidoscopy

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

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

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

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

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

A red tongue covered by yellow greasy fur.

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

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

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

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

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

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

Treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prescriptions according toÂ syndrome differentiation

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

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

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

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

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

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

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

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

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

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

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

Herbal enemas

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

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

Clearing damp-heat accumulation

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

Removing blood and qi stagnation

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

Soothing liver and invigorating spleen

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

Tonifying spleen and stomach

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

Pilose asiabell root

Acupoint therapies

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

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

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

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

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

Prostate Cancer

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

By Dr. Ken Y Wang

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

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

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

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

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

Understanding how urine is formed from a TCM perspective

Â

Causes

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

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

Heat:

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

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

Stasis:Â

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

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

Deficiency:Â

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

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

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

Symptoms

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

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

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

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

Other signs that may be present with prostate cancer:

The tongue signs:Â

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

The pulse signs:

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

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

These include:

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

Symptoms more suggestive of prostate cancer include:

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

Diagnosis

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

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

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

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

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

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

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

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

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

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

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

Treatment

Surgery

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

Radiotherapy

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

Chemotherapy

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

Hormone therapy

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

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

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

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

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

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

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

Addition for individuals with dribbling after urination:Â

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

Addition for individuals with haematuria: (Blood in urine)

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

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

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

Addition for individuals with severe cases:

gui ban

tortoise shell

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

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

Addition for individuals with severe cases:

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

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

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

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

Addition for individuals with urgency or dribbling after urination:

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

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

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

Addition for individuals with blood stasis:

tao ren	peach seed
hong hua	safflower

Osteoporosis

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

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

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

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

Statistics

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

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

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

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

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

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

Causes

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

Nonmodifiable risk factors

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

Potentially modifiable risk factorsÂ

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

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

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

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

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

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

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

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

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

Symptoms

The clinical symptoms of primary osteoporosis are:

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

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

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

Diagnosis

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

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

Criteria approved for BMD tests are summarized below:

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

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

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

The common disharmony patterns of osteoporosis are:

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

Treatment

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

1. Yin deficiency of liver and kidney

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

Prescription:Â liuwei dihuang pellet with modification

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

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

2. Blood deficiency and excessive dampness

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

Prescription:Â Danggui Shaoyao powder plus additional supplement

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

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

3. Retention of dampness due to kidney deficiency

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

Prescription:Â zhenwu decoction plus additional supplementÂ

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

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

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

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

Prescription:fangyi huangqi decoction with modification

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

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

5. Cold in the superficies and heat in the interior

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

Prescription:Â Yuebi Jiashu decoction with modification

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

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

6. Marrow deficiency andÂ channels bi-syndrome

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

Prescription:Â yougui pellet with modification

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

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

Multiple Sclerosis

acuherb — Wed, 28 Mar 2012 19:09:03 +0000

By Dr.Ken Y. Wang

Multiple Sclerosis (MS) is a neural disorder with an unknown triggering mechanism. This chronic, slowly progressiveÂ autoimmune diseaseÂ 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 ofÂ kidney essenceÂ or obstruction of theÂ meridiansÂ byÂ windÂ andÂ phlegm.

When dizziness, vertigo and unsteadiness predominate, TCM classifies it asÂ vertigo syndrome. This usually caused byÂ exogenous evils invasion(especially wind-fire or phlegm-dampness), impairment ofÂ qi (vital energy)Â orÂ bloodÂ flow orÂ organÂ 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 integratedÂ immune modulation effectsÂ Â 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 theÂ lung,Â liver,Â spleenÂ andÂ kidney. It is possible that the organs are attacked byÂ exogenous factorsÂ like heat, dryness, dampness and wind evils, which give rise toÂ yang-qiÂ 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 fromÂ kidney essenceÂ 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 orÂ emotional stimulationÂ 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 stomachÂ
In TCM, one of the major functions of the spleen and stomach are transforming food intoÂ nutrient essenceÂ that is used to manufacture qi and blood. Under-functioning will lead to malabsorption and indigestion, andÂ dampnessÂ orÂ phlegmÂ 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, headÂ orificesÂ 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 evilÂ
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 theÂ meridiansÂ 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 internalÂ heat, which will then cause further damage to the organs, and result in various symptoms.

Flaring up in lung heatÂ
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 andÂ 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 kidneyÂ
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 ofÂ damp-heat evilsÂ 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.Â

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 forÂ 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 heatÂ
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 disseminationÂ
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 meridianÂ
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 spleenÂ
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 kidneyÂ
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 yangÂ
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 theÂ 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 heatÂ
This usually occurs in the late stages of a MS relapse. Invasion ofÂ heat evilsÂ give rise to symptoms like fever, thirst, irritable and urinary difficulty, whileÂ phlegmÂ invasion tends to cause obstructions and interfere with theÂ 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 isÂ rollingÂ and rapid orÂ tautÂ and rolling.

Damp-heat disseminationÂ
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 isÂ hesitantÂ and rapid.

Blood stasis accumulated in meridiansÂ
Features ofÂ blood stasisÂ 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 spleenÂ
In TCM, theÂ spleenÂ is the source of nutrients while theÂ lungsÂ 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 liverÂ
TheÂ kidneyÂ stores essence while theÂ liverÂ 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.Â Yin deficiencyÂ 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 yangÂ
This pattern usually results from enduring yin deficiency;Â kidney yangÂ 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 isÂ deepÂ 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, expellingÂ wind, clearingÂ heat, resolvingÂ phlegm, activatingÂ bloodÂ and unblocking theÂ meridians. In the late stages or the remission period, strategies should focus on fortifying theÂ kidney, replenishingÂ essence, soothing the liver, nourishing the blood, supplementÂ qi (vital energy)Â and reinforcingÂ spleen. Nevertheless, it is recommended that treatment be based onÂ syndrome differentiation.

Meridian obstructions by phlegm and heatÂ
Therapeutic aim:Â Clear heat, resolve phlegm, smooth and unblock meridiansÂ
Sample prescription:Â 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 disseminationÂ
Therapeutic aim:Â Clear heat, resolve dampness and strengthen jointsÂ
Sample prescription:Â 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 meridiansÂ
Therapeutic aim:Â Replenish qi and blood, and activate circulation.Â
Sample prescription:Â Sacred Healing DecoctionÂ (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 spleenÂ
Therapeutic aim:Â Consolidate qi, invigorate the spleen and stomach.Â
Sample prescription:Â Power of Gingeng, Poria and Atractylodes (Seng Ling Bai Shu San)

In the prescription,Â 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:Â Invigorate liver and kidney, nourish yin to clear heat.Â
Sample prescription:Modified Zuogui Drink

In the prescription, the cornus fruits,Â 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 clearÂ virtual heat.

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

In the prescription, the Â epimedium, eye-grass rhizome,Â morindaÂ 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 asÂ bai-hui, qu-bin, shuai-gu, feng-chiÂ andÂ 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:Â jian-yu, qu-chi, wai-guan, he-gu, shou-san-li;Â
Paralysis in the lower limbs:Â huan-tiao, bi-guan, feng-shi, zu-san-li, yang-ling-quan, san-yin-jiao, xuan-zhong, kun-lun, mai-bu;Â
Speaking difficulties:Â lian-quan, he-gu, tong-li, ya-men;Â
Dysphagia:Â tian-tu, lian-quan, fu-tu, feng-chi, he-gu;Â
Urinary retention or incontinence:Â guan-yuan, qi-hai, zhong-ji, shen-shu;Â
Constipation:Â zu-san-li, yang-ling-quan, tian-shu, da-chang-shu, zhong-wan;Â
Blurred vision:Â jing-ming, tai-yang, guang-ming;Â
Facial distortion:Â 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 asÂ fu-tu,Â bi-guan,Â zu-san-li, cheng-shan, yang-ling-quanÂ andÂ 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 someÂ 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 likeÂ jian-yu, he-guandÂ 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 likeÂ yang-guan,huan-tiao, jie-xiÂ andÂ 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.

Gout

acuherb — Fri, 13 Jan 2012 18:11:45 +0000

Â

Gout

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

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

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

Causes

Gout mainly originates from the invasion and accumulation of Â pathogensÂ Â in the meridians. This leads to a disturbance ofÂ bloodÂ andÂ qiÂ circulation in the limbs. Gout is considered to be caused by both endogenous (originating from inside the body) and exogenous (originating from outside the body) factors.

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

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

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

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

If attacks of bi-syndrome are frequent and lengthy, meridian obstruction and blood stagnation leads to a disturbance in the metabolism of body fluids. Accumulated substances in the fluids are transformed intoÂ phlegmÂ and the deeperÂ organsÂ become affected.

Symptoms

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

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

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

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

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

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

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

Diagnosis

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

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

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

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

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

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

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

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

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

Treatment

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

Herbal therapy

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

Prescription:Â Modified Yiyiren decoction.

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

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

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

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

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

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

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

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

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

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

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

Non-herbal therapy

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

The commonly used acupuncture points for pain relief are:Â

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

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

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

Prevention

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

Dietary control: eat a balance diet and avoid eating animal organs, bean products and fermented food such as preserved salty fish.

Abstain from drinking alcohol.

Maintain moderate body weight.

	Try to avoid the risk factors of gout, such as stress, over-tiredness, low body temperature and accidents that may damage joints.
Â	Â
	Drink plenty of water to encourage the excretion of toxins.

	Western medicine taken for the condition should be on advice of a doctor. Both TCM and Western doctors should be informed of all the therapies being used to relieve gout symptoms.
Â	Â
	Individuals with a family history of gout should undergo regular check-ups as they may be predisposed to the disorder.

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

Colorectal Cancer

acuherb — Thu, 29 Dec 2011 18:20:28 +0000

Colorectal Cancer

Colorectal cancer is a Western medical term and is not specifically discussed in classical TCM texts. However, the main symptoms and signs of the disease are recorded in the following conditions:

	Intestinal mass ‘chang ji’: refers to movable abdominal mass accompanied by pain or distention.
	Bloody stools ‘chang pi’: refers to projectile bleeding from the rectum during defecation. This is due to the attack ofÂ wind evilsÂ in theÂ stomach, leading to prolonged accumulation ofÂ dampness evilsÂ in theÂ large intestine. It affects the distributing areas ofÂ Shao Yin meridiansÂ finally.
	Abdominal mass ‘zheng ji’: the mass seen over the abdomen. When it is always palpable and immovable, accompanied by localized pain is named as “zheng”, and that with intermittent occurrence, movable and accompanied by wandering pain is named as “ji”.
	Organ intoxication ‘zang du’: refers to a dark reddish bloody discharge due to prolonged organ damage. This causes inflammation of the lining of the large intestine due to accumulation of toxic material in theÂ organs.
	Hematochezia ‘bian xue’: passage of bloody stools; due toÂ heat evilsÂ damaging the vessels and lettingÂ bloodÂ escape into the surrounding tissues. It also present when there is accumulation of virulent dampness evil in the large intestine, deficiency ofÂ spleenÂ yang and stomach yang, or accumulation of wind evil at the yinfen level (the deeper level of the body).
	Diarrhea ‘xia li’: Excessive and frequent evacuation of watery feces, usually indicating gastrointestinal distress or related disorder.
	Rectal carcinoma blocking the anus ‘suo gang zhi’: a carcinoma causing narrowing of the rectum and anus, resulting in the discharge of slender feces and foul fluid, and accompanied by tenesmus (painful, ineffectual straining to empty the bowel).

All these TCM conditions present similar symptoms to colorectal cancer. The TCM physicians usually consider all of the above conditions during consultation.

Causes

According to TCM, formation of cancer is generally due to the depletion ofÂ disease preventing factorsÂ andÂ yin-yangÂ disharmony of the body, which can result in different types of pathological phenomena, such as qi stagnation, blood stasis,Â phlegmÂ condensation, toxicÂ heatÂ accumulation, andÂ dampnessÂ collection. These morbid conditions interact with each other and cancer may form when they further interact withÂ external pathogenic factors.

The usual causative factors are as follows:

Improper Diet
TCM takes food very seriously and regards theÂ middle burnerÂ Â (body region where theÂ spleenÂ andÂ stomachÂ are located) as the area for digestion. The digestive organs are vulnerable to inappropriate and unbalanced dietary habits, for example, excessive eating, greasy diet, over consumption of alcohol, and unclean foods. When theÂ transportation and transformationÂ processes are affected, undigested foods remain too long in the region and brew into dampness and heat evils. These evils accumulate and infuse downward into theÂ large intestine, causing qi stagnation, and blood stasis in the intestines. The dampness, heat, stasis, and toxic materials all blend together and may cause cancer over time.

Emotional Problems
Extreme emotional conditionsÂ like pensiveness and anxiety leads to under-functioning of the liver and affects the movement ofÂ qiÂ (vital energy) mainly, causing the formation of internal pathogenic factors such as dampness and phlegm. When these evils further stagnate, they transform into toxic heat evils, which then infuse downward and invade the intestines. This gives rise to qi stagnation and blood stasis in the intestines. Cancer may occur after a long period if the condition persists.

Uncontrolled Chronic Dysentery or Diarrhea
Persistent diarrhea leads to depletion of qi (vital energy) in the body which affects the spleen. In TCM, when the spleen cannot perform its transportation and transformation functions to send the pureÂ nutrient essenceÂ upward to the heart and lungs where it is transformed into qi and blood for body nourishment, qi (vital energy) movement becomes abnormal and results in a morbid state. Impure substances orÂ retention of phlegm and static fluidÂ then build up. When this condition lasts for long periods, the internal equilibrium is disturbed, and cancer can easily form.

Symptoms

In TCM, colorectal cancer has a similar clinical presentation to Western medicine; however physicians also focus on changing symptoms, the individual’s constitution, and the order in which symptoms appear. TCM practitioners first carry out a comprehensive consultation to gather an accurate picture of the internal disharmonies before implementing treatment. See article on“What to Expect from a TCM Doctor’s Examination”. The usual disharmony patterns caused by colorectal cancer are as follows:

1.Â Downward migration ofÂ damp-heat
Individuals present with abdominal cramps, diarrhea with mucous and bloody stools and tenesmus (painful, ineffectual straining to empty the bowel). There is a burning sensation in the anus and a palpable abdominal mass. Other associated symptoms include fever, aversion to cold, thirst, mouth dryness and general weakness.

3. Interior retention ofÂ bloodÂ stasis2. Excessive accumulation of poisonousÂ pathogens
The main presentations are poor appetite, feverish sensation accompanied with chest oppression, thirst, abdominal distention and cramping and severe diarrhea with mucous stools (which are dark purple in color).

Individuals present with an abdominal mass accompanied by fixed and persistent pain, abdominal distention, straining when defecating, diarrhea with pus and blood, a grayish complexion and a skinny appearance.

4. Deficiency in qi (vital energy) and blood
Individuals present with a pale complexion, light-colored lips and nails, general weakness, shortness of breath, bland taste in the mouth, poor appetite, full sensation in the epigastric region, tenesmus (painful, ineffectual straining to empty the bowel) orÂ anal prolapseÂ Â in severe cases, malnutrition and a skinny appearance.

5.Â Yang deficiency in spleen and kidneyÂ
Individuals present with a pale complexion, general malaise, apathy, aversion to cold temperatures, limb coldness and poor appetite. There can also be abdominal pain and distention, diarrhea in the morning and weakness and soreness in the lumbar (lower back) and knee regions.

6. Yin deficiency in liver and kidney
Individuals have a skinny appearance, dizziness, ringing in the ears, hot sensation in the chest, palms and soles, insomnia with nightmares, lumbar soreness, leg weakness and constipation with or without abdominal pain.

Diagnosis

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

Questioning: The TCM practitioner will establish the medical history of both the patient and his family.

Observation: Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.

Listening and Smelling: The odor of sputum and breath and listening to chest sounds 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.

TCM practitioners will usually begin with a full investigation of the patient and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present at different stages of a disorder. See article on “Principles of Diagnosis” In addition to manifestations of colorectal cancer as mentioned previously, practitioners also use pulse and tongue examination to obtain a diagnosis.

1. Downward migration ofÂ damp-heat
The major diagnostic presentations are abdominal cramps, diarrhea with mucous and bloody stools, tenesmus (painful, ineffectual straining to empty the bowel and bladder), and a burning sensation in the anus. On examination, the tongue is red, and covered by yellow and greasy fur. The pulse isÂ rollingÂ and rapid.

2. Excessive accumulation of poisonousÂ pathogens
The major diagnostic presentations are poor appetite, fever with dysphoria (an emotional state characterized by anxiety, depression, or unease), thirst, abdominal distention and cramping, diarrhea with mucous feces (which are copious and dark purple in color). On examination, the tongue is red, and covered by yellow or dried yellow colored fur. The pulse isÂ surgingÂ Â and rapid.

3. Interior retention of blood stasis
The major diagnostic presentations are fixed and persistent abdominal pain and grayish complexion. On examination, the tongue is dark and purple in color, and covered with brusied spots. The pulse is hesitant orÂ tautÂ orÂ knottedÂ and intermittent.

4. Deficiency inÂ qiÂ (vital energy) and blood
The major diagnostic presentations are pale complexion, light-colored lips and nails, general weakness and shortness of breath. On examination, the tongue is pale with a thin and white coating; the pulse is deep andÂ thready.

5. Yang deficiency inÂ spleenÂ andÂ kidney
The major diagnostic presentations are pale complexion, aversion to cold temperatures, limb coldness and diarrhea in the morning. On examination, the tongue is bulky and the pulse is deep, thready, and weak.

6. Yin deficiency inÂ liverÂ and kidneyÂ
The major diagnostic presentations are constipation, wasting of body tissue, dizziness, ringing in the ears, and a feverish sensation in the chest, palms, and soles.
On examination, the tongue is dark red and covered by scanty fur. The pulse is thready and taut, or rapid and thready.

Treatment

Various TCM therapies can be used at any stage of the disease or in combination with Western treatment at any time. Individuals can benefit from its preventative effects, improve their quality of life or boost the immune system, relieve or eliminate adverse effects caused by chemotherapy, and even help in the palliative care of terminal cancer patients. The following methods are for general information only; a qualified physician should always be consulted for treatment options. Self-treatment is not recommended.

Treatment based on TCM differential diagnosis

Physicians select theÂ treatment methodÂ according to TCM differential diagnosis, the “disharmony patterns” made by analyzing the collected data. All these remedies are adjusted to suit specific individual conditions.

Downward migration of damp-heat
Therapeutic aim:Â to clear away heat in order to drain dampness. Commonly used prescriptions areÂ huaihua diyu tang,qingchang yin, orÂ baitouwengÂ tang.

Sample prescription:Â baitouweng tangÂ (ç½é ç¿æ¹¯)

bai tou weng	Root of Chinese Pulsatilla
huang lian	Rhizome of Chinese Goldhread
huang bai	Bark of Chinese Corktree
qin pi	Chinese Ash Bark

Excessive accumulation of poisonous pathogens
Therapeutic aim:Â to clear away heat to cool blood, remove stasis, and detoxify the body. Commonly used prescriptions arewuwei xiaodu yiÂ andÂ huanglian jiedu tang.

Sample prescription:Â huanglian jiedu tang(é»ƒé€£è§£æ¯’æ¹¯)

huang lian	Rhizome of Chinese Goldhread
huang qin	Root of Baikal Skullcap
huang bai	Bark of Chinese Corktree
zhi zi	Fruit of Cape Jasmine

Interior retention of blood stasisÂ
Therapeutic aim:Â to clear away heat to cool blood, remove stasis, and detoxify the body. Commonly used prescriptions arewuwei xiaodu yiÂ andÂ huanglian jiedu tang.

Sample prescription:Â xiefu zhuyu tangÂ (è¡€åºœé€ç˜€æ¹¯)

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

Deficiency in vital energy (qi) and bloodÂ
Therapeutic aim:Â to replenish qi and nourish the blood. Commonly used prescriptions areÂ guipi tangÂ andÂ bazhen tang.

Sample prescription:Â guipi tangÂ (æ¸è„¾æ¹¯)

bai shu	Large Head Atractylodes Root
fu ling	Indian Bread
huang qi	Mongolian Milkvetch Root
long yan rou	Logan Aril
suan zao ren	Spine Date Seed
ren shen	Ginseng Root
mu xiang	Root of Common Aucklandia
zhi gan cao	Liquorice Root (processed with honey)
dang gui	Chinese Angelica
yuan zhi	Root of Thinleaf Milkwort
sheng jiang	Rhizome of Common Ginger
da zao	Common Jujube Fruit

Yang deficiency in spleen and kidney
Therapeutic aim:Â to warm and tonify the spleen and kidneys. Commonly used prescriptions areÂ zhenling baishu sanÂ andsishen wan.

Sample prescription:Â shenling baishu san(åƒè‹“ç½è¡“æ•£)

ren shen	Ginseng Root
fu ling	Indian Bread
bai shu	Large Head Atractylodes Root
bai bian dou	White Hyacinth Bean
huai shan	Chinese Yam
lian zi	Seed of Hindu Lotus
sha ren	Fruit of Villous Amomum
yi yi ren	Seed of Job’s Tears
jie geng	Balloonflower Root
gan cao	Liquorice Root

Yin deficiency in liver and kidney
Therapeutic aim:Â to nourish and tonify the liver and kidney. A commonly used prescription isÂ zhibai dihuang wan.

Sample prescription:Â zhibai dihuang wan(çŸ¥æŸåœ°é»ƒä¸¸)

shu di	Processed Rhemannia Root
shan yu rou	Asiatic Cornelian Cherry Fruit
huai shan	Chinese Yam
dan pi	Tree Peony Bark
fu ling	Indian Bread
ze xie	Oriental Water-plantain Root
zhi mu	Common Anemarrhena Rhizome
huang bai	Bark of Chinese Corktree

External Treatment

Treatments other than the oral drugs include acupuncture, plasters, sauna, and massage. These methods are commonly applied to localized lesions according to the presentation of symptoms.

Acupuncture
To relieve pain and vomiting, selected acu-points are:
zu-san-li, tian-shu, he-gu, xia-ju-xu, nei-guan, and da-chang-shu.

Topical application of drugsÂ Moxibustion
This is suitable for colorectal cancer patients who have complications such as ascites (free fluid accumulating in the abdominal cavity). Selected acu-points are:
tian-shu, zhong-wan, xia-wan, guan-yuan, shen-quel.Â
Recommended treatment is 2-3 times daily.

This refers to local application of pounded fresh medicinal herbs or moisturized medicinal powder over the affected part. They are applicable for local infections, ulcers, swelling, pain and injuries. In this case, individuals can apply to relieve pain caused by cancer, e.g. toad paste.

Enema
This refers to the introduction of a liquid into the bowel via the rectum, to be either expelled or retained. It is suitable for individuals with bloody stools. For example, a TCM decoction is prepared using the bark of Chinese Corktree (huang bai), root of Baikal Skullcap (huang qin), root of Redroot Growwell (zi cao), rhizome of Japanese Fleeceflower (hu zhang), common Picria herb (ku shen), and fruit of Japanese Apricot (wu mei).

TCM patent drugs or simple folk remedies

TCM has many patent drugs or simple folk remedies for relief of symptoms. Physicians usually prescribe these to complement other treatments.

Qi-gong

This method is beneficial for regulating the body and mind, strengthening the constitution, and relieving the adverse effects of radiotherapy or chemotherapy. Patients select relevant exercises in consultation with their physician. A desirable result can only be achieved by long-term and persistent practice.

For example:

First prepare by adopting a half standing and half sitting posture; hold the arms tight at the side with the each hand in a fist; the two feet are a shoulder’s width apart and the eyes are slightly closed.
Slowly start to inhale, grab the ground with the toes, contract the groin area, and lift up the anus.

Concentrate on making the breath (qi) si

Prevention

TCM methods of prevention and management are similar to Western medicine, please see Western section for reference; nursing management is a characteristic of TCM. TCM physicians concentrate on the following:

Psychological consultation and reassurance
Both the physician and family members should try to relieve the patient’s mental burden through language and behavior, so as to build up the patient’s self-confidence to fight the cancer. Patients can also help by practicing qigong. Keeping good personal hygiene, eating a moderate diet, avoiding cigarettes and alcohol, and keeping stress to a minimum, are also important ways to prevent disease progression.

Food and dietary therapy
Patients should have multiple small meals everyday; the food should be light and easily digested, and cover all essential nutrients. The daily diet should include an increased intake of fiber and fruit.Â TCM functional foodÂ has a long history, and the use ofÂ tonicsÂ taken with food pre-date their use as medicine. Combined with food, tonics are absorbed better and are seen as an ideal way to keep bodily functions in check.

Porridge of Water Caltrop Therapeutic benefits: used as a tonic to invigorate the stomach and nourish the intestines.
Â
Ingredients:
10-20 pieces	water caltrop	Â
1 tablespoon	honey
about 1 cup	glutinous rice
Â
(Job’s tears, lotus seed or the seed of Golden Euryale (qian shi) can replace water caltrop with the same results.) Method: Peel off the skin of the water caltrop and cook in a pot with sufficient water; when it turns into a semi-paste, add the glutinous rice and further cook into porridge. Add one tablespoon of honey before serving.

Other functional foods like dried mushrooms, white and black fungus, and fresh mushrooms are also recommended. These foods enhance the immune system and improve the body’s constitution.

Atherosclerosis

acuherb — Thu, 29 Dec 2011 18:06:58 +0000

Atherosclerosis

AtherosclerosisÂ of the heart, better known as coronary heart disease, is classified in Traditional Chinese Medicine (TCM) as chest pain syndrome. It is characterized by pain in the chest, which may progress towards the back. Patients can also have shortness of breath, especially when lying flat. Symptoms of heart atherosclerosis have been mentioned in ancient medical texts as far back as the Han Dynasty (206BC-220AD). The famous medical work,Â Huang Di Nei JingÂ included a detailed description of this disease, saying, “Patients with chest pain syndrome may have pain inside the chest, fullness and distention in the lower chest, pain in the back of the shoulder as well as pain in the upper arm.” Another example of early writing on this subject is the description in theÂ Synopsis of the Golden ChamberÂ written by the famous Chinese medical doctor Zhang Zhong Jing who was also from theÂ Han Dynasty. He wrote, “Chest pain syndrome usually presents as wheezing and cough, pain in the back of the shoulder and shortness of breath. The pulse at the first position will be slow and sinking while the pulse at the second position will appear rapid with slight tightness. In this case, Gualou Shebai Decoction ( Melon pedicel and Longstamen onion bulb ) should be used.” Since then, other works dealing with the symptoms, diagnosis and different treatments for atherosclerosis have been written at different times.

Causes

According to TCM theory, chest pain syndrome has the following causes:

1. Weakened health due to aging
According to TCM theory, elderly people gradually suffer a decline inÂ kidneyÂ qi, resulting in different health problems. Declining kidney functions may be manifested as kidneyÂ yinÂ deficiency and/or kidneyÂ yangÂ deficiency. A deficiency in kidney yang can lead to yang deficiencies of the five yin organs (liver,Â heart,Â spleen,Â lungsÂ , andÂ kidneys), which means that the functional aspects of these organs will have insufficient support. As a result, heart yang becomes deficient and fails to perform normal functions. On the other hand, if kidney yin becomes deficient, there will be insufficient yin nourishment of the five yin organs leading to heart yin deficiency. (In western terms, heart yang may actually be understood as the pumping action of the heart and is related to the sympathetic nervous system’s excitatory influence on the circulatoryÂ system. Heart yin, on the other hand, may be understood as metabolic nourishment of the heart. It is related to the parasympathetic nervous system’s inhibitory influences.) Deficiency of both heart yin and yang will ultimately lead to poor circulation ofÂ qiÂ andÂ bloodÂ Â in the body, since the heart is responsible for “ruling” the blood. Consequently, qi will become too stagnant to “push” the blood around the body, and blood stasis (a condition where the blood
Â is unable to flow smoothly) will occur. Blockage of the blood vessels in the heart andÂ meridiansÂ Â can then lead to chest pain. In western terms, this is known as angina.

2. Improper dietÂ
If our diet contains too much fatty and greasy food, digestion will be harmed. In TCM, it is said to affect theÂ spleenÂ harmony. As a result, the spleen cannot transform food and liquids into a nutritive essence used for qi and blood formation and then transport this essence throughout the body. The untransformed fluids and food start to accumulate and gradually form into an unhealthy dampness called “phlegm.” Phlegm dampness is one of the pernicious evils that has viscous (sticky) and stagnant properties. Therefore, it blocks the vessels and inhibits the flow of qi and blood, which in turn leads to chest pain.
The relationship between a person’s diet and chest pain in TCM is very important. This thinking is similar to the western medical view that eating too much cholesterol and fat is a factor in the development of atherosclerosis.Â

3. Emotional disorderÂ
As already discussed, unhealthy phlegm dampness will lead to stagnation of qi and blood, which is considered a main cause of chest pain. Sometimes, emotional disorders lead to the formation of phlegm dampness. For example, “thinking too much”, (earth elementÂ of the five emotions), will harm the spleen (earth element of the five organs). Without healthy transformation of the spleen dampness will accumulate. Anger (wood elementÂ of the five emotions) also affects the liver (wood element of the five organs). As a result, theÂ liverÂ can lose its spreading
properties and fail to maintain the smooth flow of qi. The constrained liver qi will finally form into liver fire. It burns the body fluids and turns them into viscous (sticky) and unhealthy phlegm, which leads to chest pain.

4. Attack of coldness evilsÂ
In TCM, “coldness” is associated with increased viscosity (stickiness) and stagnant properties. An example of this is oil which becomes viscous and does not pour easily when it is cold. As coldness belongs to yin, its influence will inhibit heartÂ
yang. Without sufficient heart yang, the heart cannot “rule” the blood properly. Therefore, heart vessels and meridians become blocked, and chest pain results.Â

Symptoms

In TCM, the symptoms of chest pain syndrome depend on the disharmony patterns.

1. Blockage of heart vessels due to a blood stasis patternÂ
WhenÂ qiÂ becomes stagnant and blood stasis occurs, the patient feels sharp pain in the chest that stays in one spot because the blood is unable to circulate. (It should be noted that since blood stasis belongs to excessive evils, the pain is sharp. If the problem is due to deficiency, the pain is dull.) . Being classified as a yin evil, blood stasis will cause problems in yin environments, especially nighttime. Therefore, people with this problem usually feel more pain at night. On examination, the tongue appears dull and purple, and the pulse feels choppy and sinking, both of which are signs of blood stasis.

2. Blockage due to a phlegm dampness patternÂ
An accumulation of unhealthy phlegm dampness constrains the heart yang, making the patient feel an obstructing pain in the chest. As the nearbyÂ heart meridianÂ is blocked by the dampness, the pain progresses to the back of the shoulder. Since phlegm dampness is related to disharmony of the spleen, and the spleen rules the four limbs, individuals with this pattern may feel tired and have a heavy feeling in their limbs. They will also have a cough and shortness of breath. On examination, the tongue coating looks greasy and turbid, and the pulse feels smooth.

3. Deficiency of both qi and yinÂ
Qi is essential for pushing or circulating blood throughout the body. Yin properties are closely associated with blood. If qi and yin are deficient, blood flow will be slowed, leading to blood stasis. As a result, these patients experience paroxysmal (sharp, spasmodic) pain, which occurs from time to time. Insufficient yin nourishment of the heart causes it to beat faster and palpitations to occur. TheÂ yin deficiencyÂ can also result in a relative excess of yang or illusionary yang, which is not a trueÂ yang excessÂ because it is caused initially by yin deficiency symptoms. The relative yang excess rises to the head, leading to dizziness and blurred vision. Patients may look pale and fatigued and have difficulty speaking. Shortness of breath due to qi deficiency can also be present. On examination, the tongue appears red with teeth marks, and the pulse feels weak.

4. Deficiency of heart yangÂ
Deficiency of heart yang causes disharmony of qi and blood flow and presents with symptoms of dull chest pain and shortness of breath. If the condition is severe, the pain may even spread to the entire back. Without sufficient heart yang, palpitations and spontaneous sweating will occur since sweat is thought to be the “fluid of the heart”. The pain is usually projected to regions along theÂ heart meridianÂ and progresses to the inner side of the upper arm and the armpit. On examination, the tongue looks pale, and the pulse feels frail, sinking and weak.

5. Obstruction of heart yangÂ
Obstruction of heart yang is usually triggered by an attack of cold evils. As a result of the cold attack, the yang qi movement cannot flow smoothly and becomes obstructed, causing pain in the chest. In severe cases, the pain radiates to the whole back and progresses along theÂ heart meridian, affecting the inner side of the upper arm and armpit. After each episode, spontaneous sweating usually occurs. On examination, the tongue has a white coating, and the pulse is sinking and weak. Sometimes it may feel slow.

6. Deficiency of kidney yangÂ
A person withÂ kidneyÂ yang deficiency will have cold limbs, an aversion to cold and suffer from loin (waist) pain A kidney deficiency often causes fatigue and frequent urination. As discussed before in the ‘Causes’ section, a kidney yang deficiency can lead to a deficiency of heart yang, which in turn, results in chest pain.

Diagnosis

1.	Blockage of heart vessels due to ae blood stasis pattern.
2.	Blockage due to a phlegm dampness pattern
3.	Deficiency of both qi and yin
4.	Deficiency of heart yang
5.	Obstruction of heart yang
6.	Deficiency of kidney yang

Detailed descriptions of these have been given in the “symptoms” section.

According to TCM theory, individual with chest pain syndrome should be differentiated from either a fluid retention syndrome in the throat, stomach pain or emergency heart pain.

Fluid Retention Syndrome in the Thorax (Chest):
‘Fluid retention syndrome in the thorax’ is an accumulation of fluid dampness in the thorax. Its presentation is similar to chest pain syndrome. Both lead to chest pain, but fluid retention syndrome is usually associated with persistent distension of the lower chest region, which will be aggravated by coughing, spitting and breathing. Shortness of breath might also be present.

Stomach Pain:
Some forms of chest pain originate from the stomach area and can easily be confused with chest pain syndrome. However, stomach pain is usually associated with hiccupping, flatulence (gas) and regurgitation of stomach acid.

Emergency Heart Pain:
Emergency heart pain is a complication of chest pain syndrome. It is marked by persistent, severe heart pain. Patients look pale, have purple lips, cold limbs and sweat. The pulse is frail and weak. This is an emergency and must be treated immediately by trained medical staff, preferably in a hospital emergency room.

Treatment

TCM treatments are syndrome basis, below are the usual clinical syndromes associated with atherosclerosis:

1. Obstruction of heart-blood

Therapeutic aims:Â activating the blood and removing the obstructions.

Sample of Prescription:Â (1) Dan Shen Drink (ä¸¹åƒé£²)

dah shen	Red sage root
tan xiang	Sandalwood
sha ren	Fruit of Villous Amomum

In the prescription, red sage root specializes in activating the blood and removing the blood stasis, moreover, it can ease the pain that induced by the stasis. The sandalwood warms the middle burner and helps to regulate the qi circulation in the region. Villous Amomum fortifies the transforming and transporting functions, which help to dispel the qi stagnation in the middle burner. The three herbs interact and promote each other to resume the balance of the heart.

Sample of Prescription:Â (2) Decoction of Driving out Stasis in the Mansion of Blood (è¡€åºœé€ç˜€æ¹¯)

dang gui	Chinese angelica root
chi shao	Red peony root
chuan xiong	Szechuan lovage
tao ren	Peach kernel
hong hua	Safflower flower
chai hu	Hareâ€s ear root
zhi qiao	Orange fruit

In the prescription, angelica, lovage, kernel and safflower flower specialized in activating the blood and removing stasis; hareâ€s ear regulates the liver functions, orange fruit enhances the qi circulation. The qi dominates the blood movement, as a result, the bodyâ€s blood circulation can be improved and cardiac pain is eased.

2. Obstruction of turbid phlegmÂ
Therapeutic aim:Â dispelling the turbid phlegm.

Sample of prescription:Â Decoction of Melon pedicel, Longstamen onion bulb and Pinella tuber (ç“œè”žè–¤ç½åŠå¤æ¹¯åŠ æ¸›).

Prevention

TCM always stresses balance and harmony. Paying attention to the following points will help individuals maintain good cardiovascular health.

1. Healthy diet
According to TCM theory, the diet is closely related to spleen health, which in turn is essential for the transformation of food into qi and blood in the body. The accumulation of dampness from improper spleen function is the main cause of chest pain syndrome. Hence, it is extremely important to maintain a healthy diet and avoid fatty, greasy foods.

2. ExerciseÂ
Appropriate exercise helps promote qi and blood flow in the body. Their smooth circulation is essential to maintain cardiovascular health. However, individuals need to avoid over-exercising, as this can exhaust too much qi in our bodies. This is especially important for people who are deficient in qi or yang because over-exercising can trigger chest pain syndrome. It is a good idea to get the advice of your healthcare provider before starting an exercise regimen.Â

3. Emotional healthÂ
Proper relaxation and rest are also important for good cardiovascular health. Lack of relaxation and rest can lead to emotional disorders. In TCM, this is said to harm the health of the liver or spleen. The liver maintains the smooth flow of qi while the spleen is essential for transforming fluid and food. If disharmony occurs in these organs, the circulation of qi and blood will be affected which, in turn, causes blood stasis and finally leads to chest pain.Â

Acute Leukemia

acuherb — Mon, 26 Dec 2011 22:28:07 +0000

Â Acute Leukemia

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

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

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

Causes

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

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

Symptoms

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

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

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

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

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

Diagnosis

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

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

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

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

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

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

II Remission Stage of Acute LeukemiaÂ

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

III Differentiating acute leukemia from other illnesses

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

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

Treatment

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

ACUTE Â STAGE:

1. Damp and Heat Type:

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

Example of Prescription:Â Chaiqin Chenling decoction with modificationÂ

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

2. Noxious Heat type

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

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

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

3. Accumulated Mass type

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

Example of Prescription:Â Taohong Siwu decoction with modificationÂ

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

4. Internal Liver-Wind Stir Up Type

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

Example of Prescription:Â Zhengan Xifeng decoction

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

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

REMISSION STAGE:

1. Deficiency of Qi and Yin Type

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

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

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

For individuals with residual toxic substances:Â

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

2. Deficiency of Qi and Blood Type

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

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

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

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

she she cao	herba hedyotis diffusae
xiao ji	field thistle herb

Prevention

From TCM’s viewpoint, prevention includes two aspects:

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

Prevention of Disease Onset:

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

Prevention of Disease Progression:

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

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

Asthma

acuherb — Thu, 22 Dec 2011 02:40:45 +0000

Â Asthma

Asthma is classified, in Traditional Chinese Medicine (TCM), as wheezing and/or panting syndromes. It was first described in the ancient medical bookÂ Summary of the Golden Chamber. Asthma was mentioned as a kind of “cough resulting from the ascending movement ofÂ qiÂ (panting).” A narrowed airway caused a whistling sound during breathing, which was described as a “chicken sound in the throat.” Another medical book,Â Treatise on the Causes and SymptomsÂ of DiseaseÂ (610 AD), also pointed out other asthma characteristics such as its “regular recurrence” in individuals.Â

Although both of these syndromes are associated with asthma in western medicine, they have distinct differences. The Chinese term for wheezing is “xiao.” A wheezing syndrome is characterized by congestion with phlegm (bronchial secretions) and gasping which produces a whistling sound in the “throat.” (The word “throat ” refers to the whole respiratory tract). It also is associated with rapid breathing and shortness of breath. In severe cases, these symptoms cause difficulty lying down.Â

The Chinese term for panting is “chuan.” A panting syndrome is characterized by rapid breathing, an open mouth, dyspnea (difficulty breathing) and elevated shoulders. Elevated shoulders occur when individuals have persistent difficulty breathing and need to use their shoulder muscles in addition to their chest muscles to support respiration. In western medicine, this is referred to as the use of accessory breathing muscles.Â

Wheezing and panting syndromes can occur simultaneously or alone. TCM treats asthma according to the classification patterns and symptoms the individual exhibits.

Causes

Asthma presents as a wheezing and/or panting syndrome.

Wheezing syndromes are caused by:Â

1.	Pernicious evils (environmental factors leading to illness). These include wind, summer heat, dampness, dryness, cold and fire.
2.	Improper diet
3.	Emotional disturbance
4.	Stagnation ofÂ liverÂ qi (When the liver is healthy, it maintains the smooth movement of qi though its flowing and spreading functions.)

These factors impair the organs, (lung,Â spleenÂ andÂ kidneys), responsible for fluid metabolism. As a result, an accumulation of unhealthy dampness in the body, known as “phlegm,” occurs. Obstruction of the airways develops when phlegm rises withÂ qi. Phlegm also hinders the movement of qi. When this happens, the lungs cannot descend and disseminate qi properly. As a result, the airway will narrow and phlegm and qi will fight each other, producing a wheezing or whistling sound in the throat.

Panting syndromes are mostly caused by lung and kidney disharmony.

Normally, the lungs descend and disseminate the different types of qi to the rest of the body. If lung disharmony is present, panting will occur. There are several reasons for this:Â

1.	The attack of wind-heat or wind-cold (two types of pernicious evils) leads to a problem with regulating sweat. Normal sweat regulation is important for the healthy dissemination of lung qi.
2.	SpleenÂ disharmony causes problems with the body’s digestive functions and results in an accumulation of dampness or “phlegm.” When the phlegm is sent upwards to the lungs, it affects their normal descending properties.
3.	Emotional disturbance
4.	Emotional disorders lead to either stagnation of qi orÂ liverÂ disharmony. As the lungs rule qi, and the liver rules the flowing and spreading of qi, any stagnation will cause disharmony of lung function.

Kidney disharmony also plays a role in panting syndromes. TheÂ kidneysÂ rule the grasping of qi (the regulation of healthy inhalation), and the lungs rule qi (regulation of breathing). A deficiency in either the lungs or kidneys can lead to a panting syndrome.Â

Symptoms

Asthma symptoms are grouped into different classification patterns depending on their manifestations.

Exacerbation periodÂ
During an exacerbation of asthma, two different clinical patterns can present. These are the cold and heat types. Cold and heat influences are either environmental or physiological factors that trigger the exacerbation. They both belong to the “pernicious evils” in TCM.

1.Cold type asthmaÂ
Cold influences cause stasis (a condition where the flow of a substance is either slowed down or stopped), just as oil becomes viscous (thick) when its temperature is lowered. When a cold influence affects the body, phlegm turns white, thick and sticky, and it is not easily loosened with a cough. Cold phlegm has stasis properties, which lead to chest congestion and obstruction of qi movement and breathing. This results in wheezing and a feeling of chest tightness and fullness. Lastly, the lungs lose their ability to descend and disseminate qi properly.Â

Phlegm is a manifestation of anÂ excessive yin pattern. (YinÂ is usually used to describe material things.) An accumulation of phlegm leads to an imbalance, which results in an excess of yin and a relative deficiency ofÂ yang. This causes a dim and bluish complexion, cold limbs, an aversion to cold temperatures, and a preference for warm drinks. Individuals may only sweat a small amount because the cold symptoms are unable to escape to the exterior of the body. People with cold type asthma have a white and greasy or white and slippery tongue coating and a floating, tight pulse.

2.Heat type asthmaÂ
Heat influences have “excitation” properties which manifest asÂ excessive yang patterns. They produce yellow, sticky and thick phlegm and coarse breathing. As lung qi is reversed from its normal descending flow, a paroxysmal cough and a roaring wheezing sound occur because of an accumulation of “heat phlegm.” With the flare up of “heat phlegm,” individuals also experience chest discomfort and thirst. People with heat type asthma have a red face and a red tongue with a yellow, greasy coating. The pulse usually feels slippery and rapid.Â

Non-exacerbation periodÂ
During a non-exacerbation period, the symptoms of asthma can be classified into deficiencies of theÂ lungs,Â spleenÂ andÂ kidneysor any combination of these.

1.Deficiency of lungs
Normal lung function affects the health of some exterior body parts such as the hair, skin and sweat glands. If the exterior is weak and lacks sufficient support fromÂ protective qi, (a type of qi which acts like the immune system), the body is easily attacked by the “pernicious evils” (environmental factors which cause illness). With weakened lung qi, spontaneous sweating and an aversion to wind occur. Because the lungs open into the nose, individuals may experience sneezing and nasal congestion with a clear discharge. Deficient lungs cannot properly rule qi, which leads to symptoms of shallow breathing and a cough with thin, white sputum. Individuals with a lung deficiency look pale and have a tongue with a thin white covering. A thin and weak pulse is felt upon palpation.

2.Deficiency of spleenÂ
The spleen is an essential organ in TCM. It is responsible for digestion and transforming food into food essence, which is in turn transported to the lungs and distributed to the rest of the body. A spleen deficiency can cause asthma, because when it is unable to transform fluids, phlegm accumulates. People with a spleen deficiency have poor appetites and can develop epigastric (stomach region) problems, loose stools or even diarrhea. The spleen is also essential for production ofÂ qiÂ andÂ bloodÂ and rules the limbs. A deficiency can cause fatigue, shortness of breath and a low voice. A pale tongue with a thin, greasy or white, slippery coating and a thin, soft pulse are the usual signs of spleen deficiency.

3.Deficiency of kidneysÂ
The kidneys rule the grasping of qi, which is responsible for healthy, deep inhalation when breathing. If there is a kidney deficiency, qi is said to be unable to return to its origin, (the kidney region), and shallow breathing occurs. The shallow breathing becomes worse on exertion and leads to wheezing or shortness of breath. The kidneys also rule the bone and are responsible for producing bone marrow. Soreness and weakness of the waist and legs and insufficient nourishment of the brain causing ringing in the ears are other symptoms that can occur with a kidney deficiency. If the kidney deficiency belongs to a yang deficiency, individuals have cold limbs and an aversion to cold, but if the deficiency belongs to a yin deficiency, individuals have red cheeks, night sweats and afternoon hot flashes.

Diagnosis

Differentiation between chronic cough and asthma
Asthma or wheezing/panting syndrome is associated with episodes of remission and serious exacerbations, whereas a chronic cough is persistent and does not go away. They can be further differentiated by the characteristics of the cough. With a chronic cough, the coughing sound is usually stronger than the wheezing sound. With asthma, the reverse is true. In general, the wheezing sound is stronger.

Differential classification of disharmony patternsÂ
Asthma belongs to a disharmony pattern featuring both excessive pernicious evils and deficient normalÂ qi. Mainly an excess of pernicious evils, (environmental factors that cause illness) causes exacerbations of asthma. This type of asthma is associated with coarse breathing and a high-pitched wheezing sound. Each breath is long and deep with a rapid expiration time. The pulse is strong, and generally, the body is not in a weak state.Â

The non-exacerbation period is related to a deficiency of normal qi. Asthma due to deficient normal qi is associated with weak breathing and a low wheezing sound. The breath is short and not smooth. There is usually a long history of asthma, where the individual experiences difficulty with inspiration. This deficient-type of asthma is associated with a sinking and weak pulse or a thin and rapid pulse .

After differentiating between an excessive evil type and a deficient normal qi type, it is also necessary to distinguish the type of phlegm (hot or cold) and identify the disharmonious organs. Details of the corresponding symptoms are listed under the “Symptoms Section”.Â

The major disharmony patterns of asthma are as follows:Â

Exacerbation:Â
1. Cold type asthmaÂ
2. Heat type asthmaÂ

Non-exacerbation:Â
1. Lung DeficiencyÂ
2. Spleen Deficiency
3. Kidney Deficiency

Treatment

The TCM treatment strategy for asthma is based on the diagnosed disharmony patterns.

Cold type asthmaÂ
This type of asthma is caused by the cold evils, the therapeutic aim is to remove the cold evils by warming the lungs. In addition, this decoction helps remove the phlegm and relieve the wheezing.

Decoction examples:
Shegan mahuang decoction

She gan	(Blackberrylily Rhizome)
Ma huang	(Ephedra)
Gan Jiang	(Zingibier or dried ginger)
Xi xin	(Manchurian Wild Ginger)
Ban xia	(Pinella Tuber)
Zi wan	(Tartarian Aster Root)
Kuan dong hua	(Common Coltsfoot Flower)
Gan cao	(Liquorice Root)
Wu wei zi	(Chinese Magnoliavine Fruit)
Da zao	(Chinese Date)

In this decoction, She gan and ma huang are responsible for relieving the cough and wheeze, easing the throat and removing the phlegm. Gan jiang, xi xin and ban xia warm the cold phlegm in the lung and reverse the movement of qi. Zi wan, kwuan dong hua and gan cao relieve the cough and remove the phlegm. Wu wei zi stops the lung qi from traveling in the wrong direction and relieves the cough. Da zao helps support the normal qi in the body.

Other related patterns
Wind-Cold tightensÂ the lungs
Wind-cold is an exterior syndrome because it is a pernicious evil which attacks the body from the outside first. The therapeutic goal is to relieve this exterior syndrome with herbs, which are pungent in flavor and warm in property. This helps theÂ lungsÂ to resume their dissemination ofÂ qiÂ and provides relief of the asthma symptoms.Â

Decoction ExampleÂ
Modified powder of huagaiÂ

Ma huang	(Ephedra)
Xing ren	(Bitter Apricot Seed)
Gan cao	(Liquorice Root)
Su zi	(Perilla Fruit)
San bai pi	(White Mulberry root-bark)
Chen pi	(Dried Tangerine Peel)

Heat type asthma
Because this type of asthma is caused by heat evils, the therapeutic goal is to clear away the heat and resume the dissemination of lung qi. Treatment will also remove phlegm and relieve coughing.

Decoction ExampleÂ
Ding chuan decoctionÂ

Ma huang	(Ephedra)
Huang qin	(Baical Skullcap Root)
San bai pi	(White Mulberry Root-Bark)
Xing ren	(Bitter Apricot Seed)
Ban xia	(Pinella Tuber)
Kuan dong hua	(Common Coltsfoot Flower)
Su zi	(Perilla Fruit)
Bai guo	(Ginkgo Seed)
Gan cao	(Liquorice Root)

In this decoction, ma huang restores the lungs’ ability to disseminate qi. Huang qin and san bai pi clear away the heat in the lung and restore the liquefying function of the lungs. Xin ren, ban xia, kuan dong and su zi remove the phlegm and redirect qi’s movement to descend. Bai guo arrests lung qi. Gan cao keeps the other herbs in balance and supports the body’s normal qi.

Other related patternsÂ
Heat retention in lungsÂ
The therapeutic aim is to clear away lung heat and remove phlegm.

Decoction ExamplesÂ
Maxing shigan decoction with modification

Ma huang	(Ephedra)
Xing ren	(Bitter Apricot Seed)
Shi gao	(Gypsum)
Gan cao	(Liquorice Root)
San bai pi	(White Mulberry Root-Bark)
Huang qin	(Baical Skullcap Root)
Chuan Bei mu	(Tendrilleaf Fritillary Bulb)

Stagnation of phlegm dampness inÂ middle warmer(spleen and stomach)Â
The therapeutic goal to expel the phlegm and support the qi descending function of the lungs. This decoction also helps relieve wheezing.Â

Example decoctionÂ
Daotan decoction combined with sanzi yangqin decoctionÂ

Dan nan xing	(Bile Arisaema)
Zhi shi	(Immature Orange Fruit)
Ban xia	(Pinella Tuber)
Chen pi	(Dried Tangerine Peel)
Fu ling	(Indian Bread or Poiria)
Gan cao	(Liquorice Root)
Bai jie zi	(Mustard Seed)
Su zi	(Perilla Fruit)
Lai fu zi	(Radish Seed)

Lung Deficiency
TheÂ lungsÂ are responsible for governing the health of protective qi, which is part of our immunity. When lung disharmony occurs the aim is to restore normal lung function and consolidate the exterior and protective qi in the body so illness can be avoidedÂ

Decoction examplesÂ
Yu ping feng powderÂ

Huang qi	(Milkvetch Root or Astragalus)
Bai zhu	(Largehead Atractylodes Rhizome)
Fang feng	(Divaricate Saposhnikovia Root)

In this decoction, huang qi and bai zhu support qi and consolidate the exterior. Fang feng also helps support exterior consolidation and in addition removes wind evils. Wind evils usually attack the lungs when the exterior of the body is weak.

Shengmai decoction and erchen decoction with modificationsÂ

Ren shen	(Panax Ginseng)
Mai dong	(Dwarf Lilyturf Tuber)
Wu wei zi	(Chinese Magnoliavine Fruit)
Huang qi	(Milkvetch Root or Astragalus)
Ban xia	(Pinella Tuber)
Ju hong	(Red Tangerine Peel)
Fu ling	(Indian Bread or Poiria)
Gan cao	(Liquorice Root)
Zi wan	(Tartarian Aster Root)

This is another example of a decoction used to restore lung function.

Spleen Deficiency
TheÂ spleenÂ is responsible for transforming fluids into substances that are essential to maintain health. Therefore, in order to restore the healthy balance of the spleen, it is necessary to support the spleen’s transformation function and remove the excess unhealthy fluids known as phlegm.Â

Decoction exampleÂ
Liu junzi decoctionÂ

Dang shen	(Tangshen or Radix Codonopsis)
Bai zhu	(Largehead Atractylodes Rhizome)
Fu ling	(Indian Bread or Poiria)
Gan cao	(Liquorice Root)
Chen pi	(Dried Tangerine Peel)
Ban xia	(Pinella Tuber)

In this decoction, dang shen, bai zhu, fu lin and gan zao are excellent combination herbs for strengthening the spleen and replenishing qi. Chen pi and ban xia are good for removing phlegm and regulating qi. All the herbs in this combination work together to support the spleen’s transformation function.Â

Kidney DeficiencyÂ
TheÂ kidneysÂ also play an important role in regulating healthy breathing. Therefore, the treatment goal is to replenish the kidneys and support their qi grasping function so healthy breathing can be resumed.

Decoction exampleÂ
Jingui shengqi pillÂ

Di huang(dry) or sheng di	(Rehmannia Root)
Shan zhu yu	(Asiatic Cornelian Cherry Fruit)
Shan yao	(Common Yam Rhizome)
Fu ling	(Indian Bread or Poiria)
Ze xie	(Oriental Waterplantain Rhizome)
Mu dan pi	(Tree Peony Bark)
Gui zhi	(Cassia Twig)
Fu zi	(Prepared Common Monkshod Daughter Root)

This is a famous decoction for supporting kidney yang. Di huang is good herb for nourishing the kidney yin. It is usually supported by sha zhu yu and shan yao which enhance the spleen’s functions. As di huang has certain wet properties, ze xie is added to remove the excessive fluids and regulate the fluid channels. Fu lin helps support the spleen and transform fluids. Dan pi releases and clears away liver fire resulting from deficient heat. After this, fu zi and gui zhi are added to support the kidney yang. Fu zi helps replenish the yang and dispels the cold while gui zhi warms the meridian so there can be smooth movement of fluids inside the blood vessels.

Other related patternsÂ
Yin difficiency of lungs and kidneysÂ
The therapeutic aim is to nourish the yin and keep the yang in its original place without overwhelming other organs.

Decoction exampleÂ
Liuwei dihuang decoction combined with shengmai decoctionÂ

Sheng dior di huang	(Rehmannia Root)
Shan zhu yu	(Asiatic Cornelian Cherry Fruit)
Shan yao	(Common Yam Rhizome)
Mu dan pi	(Tree Peony Bark)
Fu ling	(Indian Bread or Poiria)
Ze xie	(Oriental Waterplantain Rhizome)
Tai zi shen	(Heterophylly Falsestarwort root)
Mai dong	(Dwarf Lilyturf Tuber)
Wu wei zi	(Chinese Magnoliavine Fruit)

Â Prevention

Prevention is essential for maintaining the health of asthma patients. The following issues should be remembered:

1.	Pay attention to changes in the weather; because, they can trigger asthma exacerbations.
2.	Pay attention to environmental influences such as the pernicious evils, which cause illness.Â
3.	Keep healthy and avoid getting a cold or the flu.
4.	Avoid smoking and keep away from other stimulating substances cause asthma exacerbations such as smoke and pollens.
5.	Stay on a simple, healthy diet. Avoid eating raw, cold, greasy or pungent food. Also avoid eating shrimps or crabs.
6.	Get adequate rest. Avoid exhaustion and mental stress because they can trigger asthma.
7.	Exercise daily to keep your body healthy and strong.

References

1.	Beijing University of Traditional Chinese Medicine:Â Traditional Chinese Internal Medicine, Academy Press, (2000).
2.	Guang Anmen Hospital (Traditional Chinese Medicine Institute of China):Â The Diagnosis and Treatment Principle of TCM, Publishing House of Ancient Books of TCM, (1989).
3.	Kelly, William N.Â Textbook of Internal Medicine,3rd Edition, Philadelphia & New York: Lippincott-Raven, (1997).
4.	National Institutes of Health,Â Expert Panel Report 2:Guidelines for the Diagnosis and Management of Asthma, NIH publication No.97-4051, April 1997
5.	Zhang Enqin,Â Clinic of Traditional Chinese Medicine (I), Publishing House of Shanghai College of TCM, (1990).
6.	å¼µä¼¯è‡¾ç‰ï¼šã€Šä¸é†«å…§ç§‘å¸ã€‹ï¼Œä¸Šæµ·Â ä¸Šæµ·ç§‘å¸æŠ€è¡“å‡ºç‰ˆç¤¾ï¼Œ(1993)ã€‚

All about TCM Kidney

acuherb — Thu, 03 Nov 2011 17:24:31 +0000

An Overview of TCM Kidney

The TCM understanding of the kidney is more extensive than the Western understanding of the anatomical kidney, regarding it as the root of life and the origin of our individuality as human beings. It is no wonder that the kidneys are considered to be one of the most important organs in the body in TCM. They perform genital, urinary, endocrine, skeletal, blood, and central nervous system functions as well as store primordial yin and primordial yang (known as inherited or kidney yin and yang) which are attributive to the water and fire elements of the body respectively.

The major physiological functions of the TCM kidneys include:
1. Storing essence for reproduction, blood production, growth and development, and preventing evils or pathogens from invading the body.

2. Controlling water/fluid balance in the body.

3. Helping to control respiration through the grasping of qi.

4. Producing strong healthy bones and bone marrow.

5. Producing healthy hair.

6. Connecting with the ears to control hearing.

7. Opening into the urethra and anus.

Kidney Properties

The Huang Ti Nei Ching (The Yellow Emperor’s Medicine Classic) states: “Kidneys control the storage of essence, so they are also the root for sealing up substances and storing them.” The kidneys possess sealing and astringent (consolidating) properties. These properties allow them to gather and hold on to substances such as essence. If the essence leaked out freely, there would not be sufficient amounts for all the bodily functions that rely on it. Inherent fire (part of inherited or primordial kidney yang) that is kept in the kidney should also be hidden and not be over exposed. The simultaneous storing of the primordial fire and primordial water (part of primordial or inherited kidney yin) means the kidneys provide a place for the essence (yin) to motivate the power of our human vitality (yang). Only the kidneys’ sealing and astringent properties can prevent them form escaping and extinguishing their existence. Therefore, the kidneys are not suitable to carry out dispersing and expelling functions.

Clinically, most kidney diseases are due to a deficiency of some sort and present as an asthenia syndrome. Tonification is the usual method of treatment for deficiencies because it tries to replace the missing elements in the body. However this is not absolute, sometimes a sthenia syndrome can be the cause of a kidney problem. Sthenia syndrome, which is the opposite of asthenia syndrome, occurs when there is a strong body resistance to fight off exogenous evils. Fever is a common symptom with a sthenia syndrome. In this case, a reducing method is applied to help decrease the body’s resistance. It is not uncommon to have sthenia symptoms in a deficiency state. Remedies for replenishing vital energy (qi) and expelling the pathogens or evils are generally used in these instances. It is important to weigh the predominant symptoms carefully when generating a diagnosis and apply the correct treatment method to avoid further deterioration.

Conclusion

Since the kidneys affect so many vital bodily functions, maintaining their health is an essential part of disease prevention in Chinese medicine. Retaining youth and vitality is also closely linked with good kidney functioning. This is why the kidneys’ importance in health maintenance cannot be overlooked.

Understanding Kidney Yin and Kidney Yang
The theory of yin-yang is a conceptual framework used for observing and analyzing the material world in ancient China. The theory permeates all aspects of traditional Chinese medicine. It serves to explain the organic structure, physiological functions and pathological changes of the human body, and in addition guides clinical diagnosis and treatment and prevention.

When The theory of yin and yang is used to explain the organic structure of the human body; the physical form pertains to yin, while activities or functions pertain to yang. The physical forms are the material basis for functions, while functions are the motivating power for physical forms. They are mutually complementary. TCM views the kidneys as the center of the body’s yin and yang, the “congenital foundation,” or the origin of life. In other words, the kidneys store the primordial yin and primordial yang (also called kidney yin and yang), which is the place where nutrients are stored and physiological functions take place.

Kidney yin, also called primordial yin, true yin or true water, is the foundation of theyin fluid of the whole body; it moistens and nourishes the organs and tissues.
Kidney yang, also called primordial yang, true yang or true fire, is the foundation of the yang qi of the whole body; it warms and promotes the functions of the organs and tissues.
Kidney yin provides energy for physiological functions while kidney yang promotes storage of kidney yin. Kidney yin and yang are mutually dependent, promoting and restraining each other, leading to an internal harmony of yin and yang, and healthy functioning of the body’s organs. It is the dynamic interaction between the two that maintains the normal life activities. The third chapter of Suwen (The Book of Plain Questions) confirms this by saying, “When yin is stabilized and yang well-conserved, the spirit will be in harmony; separation of yin and yang will cause exhaustion of essence and Qi.” This statement implies the mutual relationship of yin and yang.

When imbalance Occurs

When the balance of kidney yin and kidney yang is disrupted, pathological changes take place and illness occurs.

Presentations of kidney yin deficiency include: soreness and weakness of the lumbar regions and knees, dizziness, ringing in the ears, hearing problems, a dry mouth and throat, a hot sensation in the palms, soles and chest, spontaneous sweating, constipation, and seminal emission. The pulse is weak or fine and rapid; the tongue is red and covered with a light coating of fur. Kidney yin deficiency syndrome always produces signs of yin vacuity internal heat.

Presentations of kidney yang deficiency include: soreness or cold sensation in the knees and lumbar regions, aversion to cold, cold limbs, spiritual fatigue, difficulty in urination, enuresis, incontinence, declining libido, or impotence in severe cases; female sterility, and general edema may also appear. The pulse is fine or fine and deep; the tongue is bulky, moist, and covered with white fur. Kidney yang deficiency syndrome always produces signs of yang vacuity internal cold.
Kidney yin and kidney yang always influence each other, since they are mutually dependent. Therefore if kidney yin suffers long-term damage, kidney yang will be affected and result in depletion of both yin and yang. This is called “impairment of yin affecting yang” and vice versa.
This is why in routine TCM therapies, tonifying yin will also support yang and tonifying yang will also support yin, or tonify both yin and yang at the same time, by this means the state of equilibrium are restored. According to the clinical diagnosis, yang and yin are invigorated to different degrees. In the Ming dynasty (1368-1644), a notable physician, Zhang Jiebin (1563-1640) had the celebrated idea that “The body is prone to deficiency rather than excess. It is necessary to warm and tonify kidney yin and kidney yang from time to time, and to use cold-cool and potent drugs with caution. Therefore the kidney, which is the root of all the organs, can be consolidated.” He also claimed that “when tonifying the yin, yang should be protected, not suppressed, and vice versa.” This concept is generally accepted today, and many of his formulas relating to kidney tonification are still popular.
In respect to deficiency in kidney qi and kidney yang
Kidney yang deficiency and kidney qi deficiency have similar presentations; however they can still be differentiated clinically. Manifestation of kidney yang deficiency follows the rules of yang vacuity internal cold; therefore it usually presents cold symptoms, e.g. cold and pain in the lumbar area and cold limbs. Kidney qi deficiency is a common clinical diagnosis and does not usually present with cold symptoms. When the kidney’s astringent or storage functions are poor with a kidney qi deficiency, associated symptoms appear, e.g. frequent urination, copious amounts of clear urine, incontinence, enuresis, seminal emission, abortion, or miscarriage.

Kidney yang deficiency and kidney qi deficiency represent different stages of a process; improper management of kidney qi deficiency leads to kidney yang deficiency; in contrast, proper management of kidney yang deficiency leads to less severe symptoms of a kidney qi deficiency and then gradual recovery to the normal state.

In respect to kidney qi and kidney essence
In ancient times, Qi belonged to yang and was called yang-qi. Therefore, kidney qi belongs to yang, and represents all the functions of the kidney. On the other hand, the body’s essence, blood, and fluid are generally called yin essence in TCM. Yin essence is material basis for the body’s physiological functions as well as the kidneys as a whole. Manifestation of kidney yin deficiency follows the rules of yin vacuity internal heat; therefore it usually presents heat symptoms, e.g. a dry mouth and throat, a hot sensation in the palms, soles and chest. However deficiency in kidney essence does not usually present with the heat symptoms.

Simply speaking, citing the analogy of yin and yang, kidney essence is the material basis, kidney qi is the functional force. Kidney essence and kidney qi are complementary and closely associated.

Conclusion

Imbalance of kidney yin and kidney yang leads to many diseases, and affects all organs of the body. For accurate diagnosis of a condition, it must be first ascertained whether there is a deficiency of yin or yang, before identifying the organs involved. For example in chronic nephritis, chronic renal failure, or senile kidney deficiency diseases, the usual TCM syndromes are kidney qi deficiency, kidney yang deficiency, qi deficiency in the kidney and spleen, yang deficiency in the kidney and spleen, kidney yin deficiency, yin deficiency in kidney and lung, yin deficiency in kidney and liver. Careful diagnosis can increase the effectives of treatment.

1. Kidneys store essence (jing)

Essence, which is also called “essential qi” or jing is considered to be the underpinning of all aspects of organic life. Stored in the kidneys, it is the material basis for all kinds of functional activities and is responsible for human growth and development. In effect, kidney essence is what makes up our human vitality. The stored essence is comprised of congenital jing (also called congenital essence) and acquired jing (also called acquired essence).
Congenital jing:
Congenital jing originates from the kidney itself and is made from the sexual energies of the parents when they procreate. Thus, “congenital jing” forms the basis for prenatal growth in the womb and nourishes the developing embryo and fetus. It also determines the constitution and characteristics a person will have throughout their life. After birth, congenital jing is stored in the kidneys and is nourished by acquired jing. It gradually becomes the material for our development and reproduction. Thus it also sometimes referred to as “reproductive jing.”

Acquired jing:
Acquired jing is often called the “jing of the organs” because this jing originates from them. It is obtained from ingested foods and fluids through the action of the stomach and spleen. The digested food and fluids are first transformed into nutrient substances in the stomach, and then further transformed into nutrient essence by the spleen. This nutrient essence or acquired jing is mainly responsible for irrigating and nourishing the organs so they can maintain their daily functions. Extra-acquired jing that is not being used is stored in the kidneys and can be used for nourishing the organs on demand. This process results in acquired jing being repeatedly replaced in the kidney; the extra jing is stored, sent out as required, and then replaced by new jing.
Although the above two jings are from different sources, both are mutually dependent on the other in order to function properly. Because congenital jing forms the essence of us as humans it is needed initially to produce acquired jing. This is sometimes referred to as “congenital jing creating acquired jing.” At the same time, acquired jing is needed to nourish and support the congenital jing, which is referred to as “acquired jing providing congenital jing”. Often these two types of jing are collectively referred to as “kidney essence” since their functions and origins depend on one another and cannot exist independently.
2. Kidneys rule water
The kidneys play an important role in water movement and balance of the whole body. They do this through a kidney yang process called vaporization. Vaporization is the process by which fluids are separated into clean and turbid (unclean) portions. Clean fluid is “vaporized” by the kidneys and sent back to the lungs for redistribution throughout the body while turbid fluid is sent to the bladder by the kidneys for excretion as urine. This type of regulation of body fluids is also called the “opening and closing of the water gate.”

Having a balance between kidney yin and yang functions are necessary for normal functioning of the opening and closing of the water gate and the regulation of fluid movement which both control urination. However, when kidney-yin and kidney-yang are unbalanced, the opening and closing of the water gate is abnormal, disturbing normal fluid movement. For example, in the case of a yang-deficiency and yin-excess, there is more closing than opening of the water gate, which leads to problems of urine production and excretion. This gives rise to symptoms of scanty urine and edema (generalized swelling). In the case of a yin-deficiency and yang-excess, there are many more incidences of opening the water gate, and problems like polyuria (excess urine production) will appear. Other organs, like as the lungs, Spleen and bladder, are also dependent on the vaporization function of the kidney to regulate fluid movement. Therefore, the kidneys’ vaporization control on the opening and closing of the water gate is crucial in balancing the fluid movement throughout the body.

3. Kidneys rule the grasping of qi

One way that Qi enters and leaves the body is through normal respiration. The kidneys grasp the qi that is inhaled through the lungs to help regulate respiration. Although respiratory functions mainly depend on the lungs, inhaled qi must flow down and be grasped by kidneys for smooth respiratory movements to occur. Since normal respiration depends on mutual regulation by the kidneys and lungs, sayings such as “the lungs are the master of qi, the kidneys are the root of qi, the lungs exhale qi and the kidneys inhale qi” are commonly used to describe this relationship.
In order for the kidneys to be able to grasp the qi, they must have an abundance of stored kidney essence and their astringent or grasping and holding functions must be intact. When a kidney deficiency develops and there is a failure to grasp the qi, the qi does not flow down to the kidney and leads to symptoms such as difficulty inhaling with longer exhalation times, shortness of breath, wheezing, spontaneous perspiration, and fatigue.

4. Kidneys rule the bones

Kidney essence is needed for healthy bones. Essence stored in the kidneys is transformed into bone marrow, which provides the nutrients for bone development and blood formation. When kidney essence is abundant, the bone cavities can be fully occupied with marrow and the bones become strong. Through this process the kidneys contribute to bone growth and reconstruction.
When depletion of kidney essence occurs, the bone cavity empties, as marrow is no longer able to fully occupy the space. This results in bone weakness or growth retardation. Clinical presentations include delayed closing of the fontanels (delayed fusing of the skull bones) in babies, difficulty walking, osteoporosis, and fractures related to bone weakness or brittleness.

Teeth are considered to be remnants of bone in TCM and therefore are also dependent on kidney essence for their health. One particular TCM saying that illustrates this concept is: “Teeth are the manifestation of the kidneys, but their root is the bones.” Teeth problems associated with a kidney deficiency include delayed growth of teeth in children or teeth falling out in early adulthood.

5. Kidneys manifest in the hair

Head hair depends on blood for its nourishment and TCM believes hair is the remnant of blood. Since the kidneys play a role in transforming stored essence into blood, they are thought to be the origin of hair. If the stored kidney essence and blood are abundant, hair will appear bright, shiny, and healthy. On the other hand, hair loss or other hair disorders can indicate a kidney or blood deficiency. For example the elderly or those with chronic diseases, who have a depletion of kidney essence, may have hair that appears withered and falls out easily. In these cases, the TCM physician will replenish the kidney essence and nourish the blood to amend the problem.

6. Kidneys open into the ears

In TCM, the ears are conside red to be an opening to the kidneys. It is no surprise then that hearing relies on nourishment from essence stored in the kidneys. A famous TCM classic Yilin Gaicuo (Errors Corrected from the Forest of Physicians)published in 1830 said, “The two ears communicate with the brain, and all the sound they perceive comes from the brain too.” When kidney essence is transformed into the marrow, part of the marrow collects to form the “sea of marrow” which makes up the brain and spinal column, which are responsible for neurological functions as well as intelligence. If the kidney essence is abundant then so will be the sea of marrow resulting in acute hearing. However, if the sea of marrow is unable to be nourished by kidney essence then hearing disorders like tinnitus (ringing in the ears) or deafness appear. In the elderly, increasing deafness coincides with the age-related depletion of kidney essence.

7. Kidneys dominate anterior and posterior orifices

“Anterior orifice” refers to the urethra (the tube that urine passes through from the bladder to the outside of the body) and male/female genitalia, which provide urination and reproduction functions. Although the storage and excretion of urine is related to the bladder, it is dependent on the kidney’s vaporization function for the production of urine. Therefore, disorders in urination such as enuresis (involuntary leakage of urine), incontinence, frequent urination, scanty urine and inability to make urine, are the result of the kidney’s inability to carry out the vaporization function properly.

“Posterior orifice” refers to the anus, which excretes stool or feces. Although stool is mainly transmitted by the large intestine to the anus for excretion, the spleen plays an important part in digestion and stool production through its transformation and transportation functions. These functions need the support of the kidney to perform normally. Kidney yang provides a warm force while kidney yin provides nourishment for the spleen. In this way, the kidneys indirectly affect stool excretion. When a kidney yang deficiency is present, the spleen loses warmth and the large intestine becomes cold and under performs, leading to problems such as diarrhea. On the other hand, when kidney yin is deficient, the large intestine does not have adequate fluid for nourishment and constipation results.