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By Dr. Kenneth Wang

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

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

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

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

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

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

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

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

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

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

 Causes

High blood pressure is a leading cause of stroke.

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

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

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

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

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

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

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

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

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

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

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

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

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

Symptoms

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

The most common warning signs of a stroke are:

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


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

 

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

Strokes Involving the Meridians


Meridian System

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

Channels run in straight fixed courses

Collaterals run crisscross in the body

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

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

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

Strokes Involving the Viscera (Organs)
 

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

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

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

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

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

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

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

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

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

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

Diagnosis

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

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

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

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

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

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

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

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

Treatment

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

Strokes Involving the Meridians

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

Prescriptions for strokes involving the meridians 

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

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

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

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

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

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

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

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

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

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

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

Prescriptions for yang Bi-syndrome of strokes 

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

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

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

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

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

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

Prescriptions for yin Bi-syndrome of strokes 

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

2. Collapse Syndrome of Stroke

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

Prescriptions for Collapse Syndrome of Stroke 

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

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

Stroke Sequelae
   
1. Hemiplegia

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

Prescriptions for Stroke Sequelae

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

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

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

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

2. Difficulty with speech

Therapeutic principle: Eliminate phlegm for resuscitation.

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

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

3. Facial Distortion such as Crooked Mouth

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

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

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

4. Other Therapies

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

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

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

 

 

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

By Dr. Ken. Wang

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

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

 

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

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

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

Causes

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

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

Click here to see structure of the Neuromuscular Junction

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

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

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

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

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

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

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

Symptoms

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

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

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

The symptoms experienced are commonly these: 

 

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


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

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

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

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

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

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

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

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

Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Treatment

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

Therapeutic regimens for disharmony patterns

Qi-deficiency in the spleen and stomach


Therapeutic aim: To Tonify the spleen and benefit the qi

Prescription: Buzhong yiqi decoction (modified)

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

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

Yang-deficiency in the spleen and kidneys

Therapeutic aim: To warm and tonify the spleen and kidneys

Prescription: Yougui bolus (modified)

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

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

 

Yin-deficiency in the liver and kidneys

Therapeutic aim: To nourish and invigorate the liver and kidneys

Prescription: Zuogui bolus (modified)

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

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

 

Deficiency in both qi and blood

Therapeutic aim: To invigorate and replenish the qi and blood 

Prescription: Bazhen decoction (modified)

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

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

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

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

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

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

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

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

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

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

 

]]> Contact Dermatitis http://acuherb.us/contact-dermatitis/ Thu, 29 Dec 2011 20:15:20 +0000 http://acuherb.us/?p=1386

Contact dermatitis

 

Contact dermatitis describes an acute inflammatory condition of the skin or mucosa that results from contact with certain irritant substances or stimulants. The condition occurs in all ages and both sexes, but there is a higher incidence in children than the elderly and women are more commonly affected than men. A characteristic of the disease is a history of exposure to allergenic substances prior to the inflammatory episode. Such substances or stimulants can include medicated plasters, ointment, lacquer, plants, certain materials used in clothing and contact with animals. The distribution of the lesions on the skin corresponds to the points of contact with the irritant and is largely limited to those areas.

The disease has an acute onset. Typical symptoms include itchiness, a burning sensation, and swelling and tenderness of the lesions. Systemic involvement can occur in severe cases. Once irritants are removed and proper treatment given, the condition will usually resolve within one to two weeks. However, further exposure to the causative agent will cause a re-occurrence.

In traditional Chinese medicine (TCM) contact dermatitis is not recognized as a disease as such, but as a collection of symptoms. From a TCM viewpoint, diseases of the skin are included in the category of surgical trauma and they are described in many ancient surgical classics. As there is no general term in TCM for contact dermatitis, the condition is referred to by names which describe both symptoms and causative agent. Examples of these include: 

“lacquer sore”
“plaster rubella” from Chinese herbal poultices
   
“commode ringworm” (inflammation of the buttocks caused by newly lacquered, old-style commode seats)
“pollen sore”, and
“tar sore”(tar was formerly commonly used in China to waterproof furniture.)

Causes

The lungs and spleen have a powerful influence in contact dermatitis as they are the main organs that promote and support skin function. In TCM, skin and hair are the barriers of exogenous evils invasion, the protective qi that enhances its integrity is regulated by the lungs. Therefore skin diseases are always viewed as indicating a lung disharmony. The spleen is responsible for extracting nutrients from food and for transporting fluids throughout the body, and impaired function can contribute to unhealthy skin and swelling. In TCM, it is considered that contact dermatitis can be caused by both endogenous (originating from inside the body) and exogenous (originating from outside the body) factors.

Inborn susceptibility (endogenous causes) 
The incidence of contact dermatitis is influenced by body constitution and is more likely to occur in individuals with a congenital/inherited predisposition to the disorder. In cases of congenital deficiency, the skin and tissues beneath are loosely bonded. This means that the protective qi is weak and that the body is more prone to a flare-up of fire evil or to the development of  internal wind evil . Contact with certain substances, such as lacquer, drugs, plastic, rubber products, dyes or plants, facilitates transformation of  heat evil internally in the body. The conflict between blood and qi against the heat evil triggers the skin disease.

Environmental pathogen invasion (exogenous causes)
In situations where external pathogens are allowed to invade the body directly, excessive fire evil will develop and accumulate. Circulation of blood and qi in the surface areas of the body becomes disturbed and does not flow smoothly. This in turn damages the integrity and function of the skin causing dermatitis. 

Symptoms

The main symptoms of contact dermatitis are the appearance of a rash accompanied by an itchy, burning sensation and swelling. The rash may develop into clusters of red papules (raised spots) or, in severe cases, blisters. Scratching of the rash causes exudation (leakage) and an exacerbation of the irritation. On rare occasions, swelling and tenderness of the eyelids, lips and perineum can occur.

Contact dermatitis usually results in excessive stimulation of body functions. It is described in TCM as an asthenia syndrome and results from a relatively strong body-resistance in fighting excessive pathogens . The usual presentation in an asthenia syndrome is fever, thirst, irritability, abdominal discomfort, constipation and dark-colored urine. Severity varies with the progression of the disease.

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

Excessive fire accumulation
This form of contact dermatitis presents with acute onset. The skin at first appears pink, or with a red rash, and there is a distinct margin and edematous accumulation of fluid in the tissues base. The rash then develops into clusters of papules (raised spots) and is accompanied by a burning sensation and itchiness. Associated systemic symptoms include mouth dryness, thirst, fever, irritability, dark urine and constipation.

Excessive fire mixed with dampness 
This is a more serious form of the condition. The red papules are edematous and blisters develop which may be as large as an egg-yolk. If the rash is scratched, fluid will leak out. The rash can be extremely itchy and the lesion may become swollen and create a sensation of burning. Systemic upset includes mouth dryness and poor appetite.

Blood deficiency accompanied by wind and dryness accumulation 
With repeated relapses of the disorder, the skin lesions become thickened, dry and scaly. The lesion may also develop lichen-like changes (skin develops a thickened leathery appearance). The severity of the irritation results in scars on the skin from excessive scratching.

Diagnosis

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

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

Contact dermatitis is commonly diagnosed by the following disharmony patterns: 

Excessive heat accumulation
From the TCM viewpoint, all allergenic substances are regarded as evils or pathogens . Hypersensitive reactions of the body are the result of accumulation of evils, impaired functioning of organs or disruption to the circulation of  blood and qi. The pathogens induce internal changes and encourage the accumulation of excessive heat evil . This disturbs the movement of qi and blood in the skin and gives rise to a burning itchy rash. On examination the tongue is red and covered by a thin layer of yellow fur. The pulse is taut and slippery.

Excessive fire mixed with dampness 
The lungs have an important role as regulator of the protective qi . The spleen provides nutrients for the skin. If the lungs and spleen are functioning poorly, external pathogens can readily invade the body and fire and dampness evilsaccumulate. The evils stagnate on the skin meridians causing the appearance of a bullous or blistered rash with edema and leakage of fluid. On examination, the tongue is red and covered with a yellow greasy fur. The pulse is slippery and rapid.

Blood deficiency and wind and dryness accumulation
If the spleen is not functioning properly, there is a decline in acquired jing (essence) and nutrients in the body and this affects the production of blood. This reduction in blood supply causes the skin to lose nutrients. It becomes prone to the development of wind evil and this can turn into dryness evil. The skin appears dry, scaly and thickened. On examination, the tongue is pink and covered with a thin fur. The pulse is taut, thready and rapid.

Differential diagnosis
Contact dermatitis can be differentiated from other skin disorders such as acute eczema and facial erysipelas (an acute bacterial infection of skin) by the following features:

In acute eczema, the skin lesion may appear in several forms, there is symmetrical distribution in certain locations and the margins of the rash are usually hard to identify. The condition is of longer duration and can become chronic. There is no obvious contact history with particular substance that could be responsible for the skin condition.
Facial erysipelas presents with severe systemic symptoms such as chills, high fever, headache and nausea. The rash appears as a red patch of inflamed skin with underlying swelling. The edge of the patch is palpably raised and clearly defined. There is a burning sensation in the lesion and it is tender but not itchy. There is not contact history.

 

Treatment

Internal Therapy

Traditional Chinese medicine aims at a holistic approach. Skin diseases are associated with internal disharmony between yin and yang and are the superficial presentations of internal damage.

1. Excessive heat accumulation


Therapeutic aim:To eliminate heat and toxic materials, cool the blood and clear the rash.

Prescription 1: Puji xiaodu dissolution drink (reduces rashes of the face and head).

ban lan gen isatis root
lian qiao large head atractylodes root
huang qin baical skullcap root
huang lian golden thread
yuan shen figwort root
ma bo puff-ball
niu bang zi great burdock achene
bo he peppermint
jiang can stiff silkworm
chen pi dried tangerine peel
jie geng platycodon root
chai hu Chinese tororwax root
sheng ma cimicifuga rhizome
gan cao liquorice root

Prescription 2: Liangxie jiedu decoction (for rashes on other parts of the body).

shang di dried rehmannia root
chia hao red peony root
jin yin hua honeysuckle flower
lian qiao weeping forsythia capsule
ban lan gen isatis root
pu gong ying dandelion
ye ju hau wild chrysanthemum flower
dan pi tree peony bark
zi cao gromwell root
huang qin baical skullcap root

 

2. Excessive heat mixed with dampness


Therapeutic aim: To disperse heat and dampness evils and to eliminate toxins and swelling.

Prescription: Longdan xiegan decoction.

chai hu Chinese tororwax root
huang qin baical skullcap root
long dab cao Chinese gentian
zhi zi Cape jasmine fruit
che qian zi plantain seed
shang di dried rehmannia root
dang gui Chinese angelica
ze xie oriental water plantain root
gan cao liquorice root

 

3. Blood deficiency and wind anddryness accumulation

Therapeutic aim: To disperse heat and wind evils, nourish the blood and re-hydrate the skin. 

Prescription 1: Xiaofeng powder.

dang gui Chinese angelica
sheng di dried rehmannia root
fang feng divaricate saposhnikovia root
chan tui cicada slough
zhi mu common anemarrhena root
ku shen light yellow sophora root
hu ma common flax
jing jie fine-leaf schizonepeta herb
cang zhu atractylodes root
niu bang zi great burdock achene
shi gao gypsum
gan cao liquorice root


Prescription 2: Danggui decoction

sheng di common yam root
chuan xiong Szechwan lovage root
jing jie fine-leaf schizonepeta herb
fang feng divaricate saposhnikovia root
bai ji li puncture vine caltrop fruit
dang gui Chinese angelica
he shou wu fleece flower root
bai shao white peony root
huang qi milk vetch
gan cao liquorice root

External therapy

Of greatest importance in the treatment of contact dermatitis is the identification of the causative agent and its subsequent avoidance. Therapeutic approaches in skin lesions are also important. In order to facilitate healing, any substance used should be mild, non-stimulating and simple to apply. The following are examples:

For simple rashes: Sanhuang lotion or indigo powder lotion.
In cases of severe exudation and erosion of skin lesions: Moist dressings should be applied soaked with the following decoction:
  lu cha green tea
  ma chi xian purslane herb
  huang bai amur cork-tree
  yang di cao emilia sonchi folia
  shi wei pyrrosia leaf
  pu gong ying dandelion
  sang yu mulberry leaf
Where erosion and scarring have occurred on the skin lesion: Indigo emulsion.
In cases of scaling, thickening, coarse or lichen skin: Black soybean-distillate ointment.
Examples follow of some folk prescriptions which can be applied to skin lesions:

1. Fresh ground purslane herb.
2. If vesicles appear on the rash, the following decoction can be used as a wash or soak:
  huang qin baical skullcap root
  huang bai amur cork-tree
  ma chi xian purslane herb
  ming fan alum
 
3. Where the lesion has been scratched and there is exudate, washing or soaking with this decoction is useful:
  shang di yu fresh garden burnet root
  huang bai amur cork-tree
 
4. Fresh ground mung beans.
5. Fresh balsam pear.

Acupuncture and moxabustion
As contact dermatitis is seen as an asthenic (excessive) syndrome, acupuncture given using reduction or purgative therapeutic methods at two to four points can be helpful. Acupuncture points: chi-ze, qu-chi, he-gu, qu-ze, zu-san-li, wei-zhong, san-yin-jiao.

Dietary therapy
A congee made from mung bean and coix (raw Job’s tears) seed can also be beneficial.

 

Prevention

Prevention of contact dermatitis depends on the following:

Investigation of the medical history to identify irritants for future avoidance.
If the irritant is occupation-related, working procedures should be modified or the environment improved to avoid the irritant. Precautionary measures should be re-enforced such as the wearing of protective clothing and gloves to cover the skin if working with an irritating substance.
Hot baths should be avoided when a rash is present as this may make the condition worse. Lesions should not be scratched. If Western drugs are needed, they should be applied only under medical advice.
   

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. Seafood, spicy and hot food trigger the body to produce more wind, heat or dampness evils, which are causative factors in contact dermatitis. 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 persons who are edematous have fluid retention and a greasy diet avoided in cases of diarrhea. For contact dermatitis, a balanced diet should be eaten. Individuals susceptible to this disorder should avoid alcohol, and eat less seafood or spicy and hot food. Drinking plenty of water is also advisable to clean the toxins from the body and prevent illness. 

]]> All about TCM Kidney http://acuherb.us/all-about-tcm-kidney/ http://acuherb.us/all-about-tcm-kidney/#comments Thu, 03 Nov 2011 17:24:31 +0000 http://acuherb.us/?p=960

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.

]]> http://acuherb.us/all-about-tcm-kidney/feed/ 1 TCM model of the body http://acuherb.us/tcm-model-of-the-body/ Thu, 11 Aug 2011 20:11:31 +0000 http://acuherb.us/?p=421

TCM’s view of the human body is only marginally concerned with anatomical structures, but focuses primarily on the body’s functions[ (such as digestion, breathing, temperature maintenance, etc.):

“The tendency of Chinese thought is to seek out dynamic functional activity rather than to look for the fixed somatic structures that perform the activities. Because of this, the Chinese have no system of anatomy comparable to that of the West.”

—Ted Kaptchuck, The Web That Has No Weaver

These functions are aggregated and then associated with a primary functional entity – for instance, nourishment of the tissues and maintenance of their moisture are seen as connected functions, and the entity postulated to be responsible for these functions is xu? (blood)- but this is mainly a matter of stipulation, not anatomical insight.

The primary functional entities used by traditional Chinese medicine are qì, xu?, the five zàng organs, the six f? organs, and the meridians which extend through the organ systems. These are all theoretically interconnected: each zàng organ is paired with a f? organ, which are nourished by the blood and concentrate qi for a particular function, with meridians being extensions of those functional systems throughout the body.

Qi

Main article: Qi#Traditional Chinese medicine

TCM distinguishes not only one but several different kinds of qi (?). In a general sense, qi is something that is defined by five “cardinal functions”:

  1. Actuation (??, tu?dòng) – of all physical processes in the body, especially the circulation of all body fluids such as blood in their vessels. This includes actuation of the functions of the zang-fu organs and meridians.
  2. Warming (??, pinyin: w?nxù) – the body, especially the limbs.
  3. Defense (??, pinyin: fángyù) – against Exogenous Pathogenic Factors
  4. Containment (??, pinyin: gùshè) – of body fluids, i.e. keeping blood, sweat, urine, semen etc. from leakage or excessive emission.
  5. Transformation (??, pinyin: qìhuà) – of food, drink, and breath into qi, xue, and jinye (“fluids”), and/or transformation of all of the latter into each other.

Vacuity of qi will especially be characterized by pale complexion, lassitude of spirit, lack of strength, spontaneous sweating, laziness to speak, non-digestion of food, shortness of breath (especially on exertion), and a pale and enlarged tongue.

Qi is believed to be partially generated from food and drink, and partially from air (by breathing). Another considerable part of it is inherited from the parents and will be consumed in the course of life.

In terms of location, TCM uses special terms for qi running inside of the blood vessels and for qi which is distributed in the skin, muscles, and tissues between those. The former is called yíng-qì (??), its function is to complement xuè and its nature has a strong yin aspect (although qi in general is considered to be yang). The latter is called weì-qì (??), its main function is defence and it has pronounced yang nature.
Qi also circulates in the meridians. Just as the qi held by each of the zang-fu organs, this is considered to be part of the ‘’principal‘’ qi (??, pinyin: yuán qì) of the body[49] (also called ?? pinyin: zh?n qì, ‘’true‘’ qi, or ?? pinyin: yuán qì, ‘’original‘’ qi).

Xue (blood)

In contrast to most of the other functional entities, xu? (?, “blood”) is correlated with a physical form – the red liquid running in the blood vessels. Its concept is, nevertheless, defined by its functions: nourishing all parts and tissues of the body, safeguarding an adequate degree of moisture, and sustaining and soothing both consciousness and sleep.
Typical symptoms of a lack of xu? (usually termed “blood vacuity” [??, pinyin: xu? x?}) are described as: Pale-white or whithered-yellow complexion, dizziness, flowery vision, palpitations, insomnia, numbness of the extremities; pale tongue; “fine” pulse.[54]

Jinye (bodily fluids)

Closely related to xu? are the j?ny? (??, usually translated as ‘’body fluids‘’), and just like xu? they are considered to be yin in nature, and defined first and foremost by the functions of nurturing and moisturizing the different structures of the body.Their other functions are to harmonize yin and yang, and to help with secretion of waste products.
J?ny? are ultimately extracted from food and drink, and constitute the raw material for the production of xu?; conversely, xu? can also be transformed into j?ny?.Their palpable manifestations are all bodily fluids: tears, sputum, saliva, gastric juice, joint fluid, sweat, urine, etc.

The zang-fu

Main article: Zang-fu

The zàng-f? (simplified Chinese: ??; traditional Chinese: ??) constitute the centre piece of TCM’s systematization of bodily functions. Bearing the names of organs, they are, however, only secondarily tied to (rudimentary) anatomical assumptions (the f? a little more, the zàng much less). As they are primarily defined by their functions, they are not equivalent to the anatomical organs – to highlight this fact, their names are usually capitalized.

The term zàng (?) refers to the five entities considered to be yin in nature – Heart, Liver, Spleen, Lung, Kidney -, while f? (?) refers to the six yang organs – Small Intestine, Large Intestine, Gallbladder, Urinary Bladder, Stomach and S?njia?.
The zàng’s essential functions consist in production and storage of qì and blood; in a wider sense they are stipulated to regulate digestion, breathing, water metabolism, the musculoskeletal system, the skin, the sense organs, aging, emotional processes, mental activity etc.[63] The f? organs’ main purpose is merely to transmit and digest (??, pinyin: chuán-huà) substances like waste, food, etc.

Since their concept was developed on the basis of W? Xíng philosophy, each zàng is paired with a f?, and each zàng-f? pair is assigned to one of five elemental qualities (i.e., the Five Elements or Five Phases). These correspondences are stipulated as:

  • Fire (?) = Heart (?, pinyin: x?n) and Small Intestine (??, pinyin: xia?cháng) (and, secondarily, S?njia? [??, ‘’Triple Burner‘’] and Pericardium [??, pinyin: x?nbaò])
  • Earth (?) = Spleen (?, pinyin: pí) and Stomach (?, pinyin: weì)
  • Metal (?) = Lung (?, pinyin: feì) and Large Intestine (??, pinyin: dàcháng)
  • Water (?) = Kidney (?, pinyin: shèn) and Bladder (??, pinyin: p?nggu?ng)
  • Wood (?) = Liver (?, pinyin: g?n) and Gallbladder (?, pinyin: d?n)

The zàng-f? are also connected to the twelve standard meridians – each yang meridian is attached to a f? organ and five of the yin meridians are attached to a zàng. As there are only five zàng but six yin meridians, the sixth is assigned to the Pericardium, a peculiar entity almost similar to the Heart zàng.

Meridians

Acupuncture chart from the Ming Dynasty (c. 1368-1644)

Main article: Meridian (Chinese medicine)

The meridians (??, pinyin: j?ng-luò) are believed to be channels running from the zàng-f? in the interior (?, pinyin: l?) of the body to the limbs and joints (“the surface” [?, pinyin: bia?]), transporting qi and xu? (blood). TCM identifies 12 “regular” and 8 “extraordinary” meridians; the Chinese terms being ???? (pinyin: shí-èr j?ngmài, lit. “the Twelve Vessels”) and ???? (pinyin: qí j?ng b? mài) respectively. There’s also a number of less customary channels branching off from the “regular” meridians.

 

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