Qi – American Institute of Acupuncture

Ulcerative Colitis

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

By Dr. Kenneth Wang

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

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

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

Sections of Large Intestine

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

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

Pulsatilla root

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

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

Â Causes

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

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

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

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

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

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

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

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

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

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

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

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

SymptomsÂ

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

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

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

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

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

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

Other organ systems affected by ulcerative colitisÂ

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

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

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

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

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

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

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

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

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

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

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

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

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

Diagnosis

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

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

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

Sigmoidoscopy

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

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

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

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

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

A red tongue covered by yellow greasy fur.

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

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

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

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

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

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

Treatment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prescriptions according toÂ syndrome differentiation

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

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

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

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

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

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

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

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

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

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

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

Herbal enemas

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

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

Clearing damp-heat accumulation

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

Removing blood and qi stagnation

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

Soothing liver and invigorating spleen

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

Tonifying spleen and stomach

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

Pilose asiabell root

Acupoint therapies

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

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

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

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

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

Shen ç¥ž

acuherb — Fri, 29 Jun 2012 19:55:32 +0000

ShenÂ ç¥ž

Shen can be translated as “Spirit” or “Mind”, and implies our consciousness, mental functions, mental health, vitality, and our “presence”.

Shen lives in the Heart, where it retires to sleep during the night. If the Shen is disturbed, there may be insomnia. Shen is specifically said to live in the Blood Vessels (part of the system of the Heart) and to be nourished by the Blood. In TCM pathology, therefore, deficient Blood may fail to nourish the Shen. Alternatively, Heat (of various Organs) may disturb the Shen.

State of the Shen is said to be visible in the eyes. Healthy Shen produces bright, shining eyes, with vitality. Disturbed Shen produces dull eyes, which seem to have a curtain in front of them – as if no one were behind them. Often seen in those with long-term emotional problems or after serious shock (even a shock that occurred a long time ago.)

Healthy Shen depends on the strength of the Essence (stored in Kidneys) and Qi (produced by Spleen and Stomach). Thus, Shen is dependent on the Prenatal Jing and the Postnatal Jing. If Essence and Qi are healthy, the Shen will be nourished. As mentioned above, the Shen lives in the Blood Vessels, part of the Heart system in TCM. Blood is closely related to Qi in TCM, and is formed from the Postnatal Jing derived from food and fluids, hence Blood formation is simultaneous with that of the formation of Qi.

Jing, Qi and Shen are the “three treasures” in TCM. They represent three different states of condensation of Qi, ranging from Jing (more fluid, more material) to Qi, more rarefied, and Shen, more rarefied and immaterial.

This triad corresponds to the Heart, Stomach/Spleen and Kidneys.
SHEN	HEART	HEAVEN

QI	STOMACH/SPLEEN	PERSON

JING	KIDNEYS	EARTH

The Six extraordinary Organs

acuherb — Fri, 29 Jun 2012 19:50:40 +0000

The Six extraordinary Organs

Marrow
Brain
Bone
Uterus
Vessels
Gallbladder

Marrow

Marrow is controlled and produced by the Kidneys, and equivalent to the brain and spinal cord.
Marrow includes Brain marrow, Spinal marrow, and Bone marrow
Marrow nourishes the Brain and Spinal Cord through the Jing
Nei Jing “If the Sea of Marrow is abundant, vitality is good, the body feels light and agile, and the span of life will be long. If it is deficient there will be dizziness, tinnitus, blurred vision, fatigue, and a great desire to lie down”
If the Marrow is Xu: Brain and Spinal cord are not adequately nourished and become deficient

[Â Top of PageÂ ]

Brain (Sea of Marrow)

Controlled by the Kidney

Controls intelligence, memory, and the five senses

Related to Heart

Heart Blood nourishes the Shen and mental activity

Related to Liver

Controls circulation of Qi

Helps smooth flow of emotions

[Â Top of PageÂ ]

Bone

Controlled by the Kidney, and any bone problem is treated through Kidneys
Stores bone marrow (“Simple Questions,” chapter 17, “The bones are the residence of Marrow.”)
The Chinese concept of “Marrow” should not be confused with bone marrow as defined by Western Medicine. In TCM, the function of Marrow is to nourish the Brain and spinal cord and to form Bone-Marrow. Bone Marrow produces Bone; it was not recognized that bone marrow produces blood as in Western thinking.
If Jing and Marrow are deficient, the Bones lose nourishment, cannot sustain the body and there will be inability to walk or stand.

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Uterus (Zi Cong, Baby Palace)

Controlled by the Kidney, especially the Jing
Controls reproduction and menstruation
Needs a rich supply of Qi, Blood, and essence for good function
Related to the Liver, especially Liver Blood

When Liver Blood is Xu

Menstrual problems

Sterility

Kidney Xu and Jing Xu

Sexual and reproductive disorders

Related to Conception Vessel

Pregnancy channel

Must be free of obstruction in order for pregnancy to occur

Related to Chong channel

The Sea of Blood must be abundant for fertility

Both the Chong Mai and Ren Mai originate in the Uterus

The Uterus is supported by the Heart and Spleen because of their production and circulation of Blood

[Â Top of PageÂ ]

Vessels

Controlled by the Heart

Heart controls movement of Blood through the Vessels

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Gallbladder

Extraordinary because the GB does not receive food and water like other Fu organs and does not communicate with the exterior

Stores Bile

A pure refined substance

The Internal Organ Relationships

acuherb — Fri, 29 Jun 2012 19:10:31 +0000

The Internal Organ Relationships

Heart and Lungs
Heart and Liver
Heart and Kidneys
Liver and Lungs
Liver and Spleen

Liver and Kidneys
Spleen and Lungs
Spleen and Kidneys
Lungs and Kidneys
Spleen and Heart

Heart and Lungs

Heart governs Blood, Lungs govern Qi: relationship is that of Qi and Blood.

Qi and Blood are interdependent. Blood nourishes Qi but Qi pushes the Blood.

Heart moves the Blood but relies on Lung Qi to assist.

Lungs produce Ying (and Wei) Qi. Ying Qi flows with the Blood in the Vessels.

Heart and Lung connect via the Zong Qi (Chi of the Chest)

Deficient Lung Qi can lead to stagnation of Qi in the Heart and this can lead to stagnation of Blood of the Heart, with symptoms such as palpitations, chest pain, blue lips.

Excessive Heart Fire can dry up Lung fluids and cause dry cough, dry nose and thirst.

In practice, Heart and Lung Qi are often deficient at the same time because of their close relationship.

Sadness often depletes both Lung and Heart Qi.

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Heart and Liver

The heart and the Liver are related via Blood.

Heart governs Blood, Liver stores Blood and regulates its volume. These two activities must be coordinated and harmonized. If Heart Blood is deficient, this may disrupt Liver’s ability to regulate Blood (dizziness, excessive dreaming).

Deficient Liver Blood can cause Deficient Heart Blood (palpitations and insomnia).

Heart stores Shen and Liver rules smooth flowing of the emotions.

Shen and emotions mutually support each other. Weak Heart and Shen may lead to depression and anxiety. Or, when Liver Qi stagnates, this constrains emotions and can weaken the Shen.

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Heart and Kidneys

Mutual assistance of Fire and Water.

Heart belongs to Fire element and is in Upper Burner. (Fire is Yang and corresponds to movement).

Kidneys belong to Water element and are in Lower Burner. (Water is Yin and corresponds to stillness).

Heart & Kidney must be in balance as they represent two fundamental polarities of Yang and Yin (Fire & Water).

Heart Yang descends to warm Kidney Yin while Kidney Yin ascends to nourish Heart Yang. This constant interchange is referred to as “mutual support of Fire and Water”.

Kidney Yang Deficient:Â
Kidneys cannot transform fluids; these can overflow upward to Heart.

Kidney Yin Deficient:Â
Yin cannot rise to nourish Heart Yin. This can cause overactive Heart Fire (mental restlessness, insomnia, agitation, etc.)

Both these situations represent loss of communication between Heart and Kidney.

Heart and Kidneys are Common Root of Shen and Essence (Jing). The Heart houses She, while the Kidneys store Jing.

Shen and Jing have common root. Jing is fundamental substance from which Shen is derived, in other words, Shen is external manifestation of Jing.

Prenatal Jing is the foundation of the Shen, Postnatal Jing provides nourishment for the Shen.

Normal mental activity needs good supply of Jing.

Weak Jing: Shen will be weakened and person will lack vitality, willpower, self confidence.

When Shen is disturbed by emotional problems, Jing will not be directed by the Shen and the person will feel tired and lack motivation.Â

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Liver and Lungs

Reflects the relationship of Qi and Blood.

Lungs govern Qi, and the Liver regulates and stores the Blood.

They rely on each other in that the Liver relies on Lung Qi to regulate Blood, and the Lungs rely on Liver Qi to smoothly move Qi.

Deficient Lung Qi can affect Liver’s smooth movement of Qi (fatigue, depression, cough and hypochondriac pain).

Liver Qi can stagnate in the chest and interfere with the Lung’s function of descending (cough, dyspnea, asthma).

Stagnation of Liver Qi can cause Liver Fire to rise and injure Lung Yin (Hypochondriac pain, coughing blood, pain on breathing).

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Liver and Spleen

When healthy, Liver Qi aids Spleen in digestion, and ensures smooth flow of bile to aid digestion.

By ensuring smooth flow of Qi in all directions of the body, Liver ensures that Spleen Qi flows upwards in its right direction.

Stagnant Liver Qi disrupts Spleen ability to transform and transport food and fluids and to “raise the pure”. (abdominal distension, hypochondriac pain, diarrhea).

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Liver and Kidneys

Based on mutual exchange between Blood and Jing.

Kidney Jing contributes to the making of Blood. (Jing produces bone marrow which is connected with manufacture of Blood in the body).

“Liver and Kidneys have a common origin”.

“Essence and Blood have a common source”.

Kidney Yin nourishes Liver Yin (including Liver Blood).

Deficient Kidney Jing may lead to Blood becoming Deficient (dizziness, blurred vision, tinnitus).

Kidney Yin fails to nourish Liver Yin, causing hyperactivity of Liver Yang (blurred vision, tinnitus, headaches, irritability, dizziness.

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Spleen and Lungs

Mutually assist each other.

Spleen extracts Food Qi and sends it up to the Lungs where it combines with air to form Zong Qi.

Spleen relies on Lung descending function to assist in the transformation and transportation of food (diaphragm movement helps Middle burner – “pumping” action).

Lung descending function also assists Spleen in the transformation of Body Fluids. Lung Qi weak, descending function impaired, Spleen cannot transform and transport the fluids, causing edema.

Deficient Spleen Qi: Food Qi deficient and production of Qi impaired (especially of Lung Qi: tiredness, weak limbs, breathlessness, weak voice) (Earth not producing Metal).

Spleen Deficiency: fluids not transformed but accumulate to form Phlegm, which settles in Lungs and impairs Lung function. “The Spleen forms Phlegm, the Lungs store it.”

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Spleen and Kidneys

Relationship is one of mutual nourishment.

Spleen: Root of Post-Heaven Qi (Foundation of Postnatal Existence)

Kidneys: Root of Pre-Heaven Qi (Foundation of Prenatal Existence)

The Postnatal Essence (Postnatal Jing) is formed from the food we eat and the air we breathe. The Spleen therefore plays the most important role in the formation of Postnatal Essence.

The Postnatal Essence is stored in the Kidneys together with the Prenatal Essence. Where Spleen Qi is weak, Postnatal Essence will not be produced as effectively, and the Kidney will have less Postnatal Essence to store.

Prenatal Essence assists in the production of Qi via its active aspect (Original Qi): the Original Qi provides the necessary energy for the transformation and transportation of the substances and formation of Qi: this affects the Spleen’s function.

Spleen and Kidneys support one another regarding transformation/transportation of Body Fluids.

Where Spleen Qi is weak, and Body Fluids are not able to be transformed and transported, these accumulate to form Dampness, which can interfere with the Kidney’s function regarding fluid metabolism (which then makes the Dampness worse).

Where Kidney Yang is Deficient, there is not enough heat for the Spleen to transform Fluids: this can cause Dampness or edema, chilliness and diarrhea.

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Lungs and Kidneys

Important relationship with regard to Qi and Fluids

Qi

Lungs send Qi and Fluids down to the Kidneys. Kidneys hold down the Qi and evaporate some of the Fluids, then send fluid vapor back to the Lungs to moisten them and the Lung then sends Fluids to moisten the skin.

Lungs send Qi down the Kidney and Kidneys hold down the Qi. Therefore they have an important communication regarding respiration

Communication regarding Zong Qi and Original Qi.Â
Zong Qi (in the chest) flows down to connect with the Original Qi from which it is nourished. Original Qi flows up to the chest to assist with the production of Qi and Blood in the Upper Burner.

The Lung function of governing Qi and respiration depends on the Kidney function of receiving Qi.

Where Kidney energy is weak: impaired reception of Qi. Kidneys fail to hold Qi down and Qi flows back up to the chest (“rebels”) and obstructs the Lung’s descending function. Result is asthma, cough and dyspnea (unable to inhale deeply).

Fluids

Lungs control Water passages and send Fluids down to the Kidneys. Kidneys evaporate some fluids and send them back up to the Lungs to keep Lungs moist. “Kidneys govern Water and the Lungs are the upper origin of Water.”

Deficient Lung Qi: Lung cannot send fluids downwards and Lung cannot communicate with Kidneys and Bladder (edema, especially of upper body).

Deficient Kidney Yang: Kidneys cannot transform and excrete Fluids in the Lower Burner. These Fluids then accumulate to form Dampness or edema (especially of lower body). Because of the close relationship of Lungs and Kidneys regarding fluid metabolism, this accumulation of Fluids can eventually affect the Lung and impair Lung’s descending and dispersing function.

Deficient Kidney Yin: leads to deficiency to Fluids in the Lower Burner. Fluids fail to rise to moisten the Lungs, causing Deficiency of Lung Yin (dry throat at night, dry cough, night sweats and feeling of heat in the palms and soles of the feet).

Deficient Lung Yin (can arise from smoking, or after a long febrile disease involving the Lungs). This implies Deficient Fluids in the Lungs, inability of Lungs to send Fluids to Kidneys, which then results in Deficient Kidney Yin. (Smokers usually end up with depleted Kidney Yin as a result of this mechanism).

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Spleen and Heart

Interrelated via the Blood.

Spleen provides Food Qi for the formation of Blood.

Deficient Spleen Qi can lead to Deficient Blood, which can cause Heart Blood to be Deficient (resulting in palpitations, dizziness, poor memory, insomnia).

The Urinary Bladder

acuherb — Fri, 29 Jun 2012 19:06:36 +0000

Functions of the Urinary BladderÂ

“Bladder is like a district official; it stores the fluids so that they can be excreted by its action of Qi transformation.”Â

Bladder has wider sphere of activity than in Western medicine. Stores/excretes urine but also has role in transformation of fluids necessary for the production of urine.Â

Bladder Removes Water by QiTransformation
“Dirty” or “impure” part of fluids is sent by Small Intestine to the bladder, which further transforms them into urine. Bladder then stores and excretes urine.Â

Bladder function of transforming fluids depends on the Kidney Yang. If Kidney Yang is deficient, Bladder will lack Qi and heat to transform fluids and symptoms will include profuse, clear urine, frequent urination or even incontinence.Â

Bladder and Small Intestine both depend on Kidney Yang and both work together to move fluids in Lower Burner.

The Liver

acuherb — Fri, 29 Jun 2012 19:00:06 +0000

Functions of the LiverÂ

Liver Ensures Smooth Flow of Qi
Stores the Blood
Controls The Sinews
Manifests in the Nails
Opens into the Eyes
Houses the Hun (Ethereal Soul)

Liver Ensures Smooth Flow of QiÂ

It is extremely common to find Stagnation of Liver Qi in clinic. Liver ensures smooth flow of Qi throughout all the body, in all directions.Â

Any activity that depends on Qi relies on the Liver’s “flowing and spreading”.Â

The Smooth Flow of Liver Qi Affects Three Main Areas

Emotions
The emotional state is seriously affected by the Liver’s function of “Flowing and Spreading” Qi. When it flows normally, emotions are approximate and easy. When the spreading of Qi impaired or the circulation of Qi restrained, there will be emotional depression, frustration, repressed anger, and physical symptoms.Â

There is a relationship between emotional state and Liver Qi. “Anger makes Qi rise and Blood stagnate in the chest.”Â

Stagnation along channels related to Liver: hypochondriac and costal pain, “plum pit Qi“, chest oppression, swollen/tender breasts and genitals, lower abdominal pain.Â

Digestion and Bile Secretion
Digestion and the Liver – Five element: Wood controls Earth.Â

The Liver’s function of spreading Qi aids the Spleen and Stomach’s digestive functions, and is important to ensure harmonious Qi movement in Middle Burner. But Stagnant Liver Qi can “invade” or “attack” the Stomach or Spleen (Wood overacts on Earth).Â

Smooth flowing of Liver Qi affects bile flow. Stagnant Liver Qi can obstruct bile flow (bitter taste, belching, or jaundice).Â

Menstruation

Stores Blood

Regulates volume of Blood according to physical activity
When at rest, Blood returns to Liver (Liver contributes to restoring energy). When body is active, Blood nourishes muscles to enable them to perform.Â

Blood regulation function influences energy level: if this function impaired, lack of Blood (= nourishment) where needed, hence easily tired.Â

If Liver Blood is deficient, there can be muscle cramps, tics and twitches or tremors/shaking in muscles. (Liver Wind from Blood Deficiency)

Regulates menstruationÂ
Liver is very important in gynecology. If Blood storage function is abnormal, e.g. Liver Blood is deficient, menstrual problems e.g. amenorrhea, oligomenorrhea. If Liver is Hot or Excess, menorrhagia or metrorrhagia can occur.Â

If Liver Qi stagnant, Liver Blood can stagnate (dysmenorrhea, PMS, dark clots).Â

Liver malfunction influences energy of Ren Mai & Chong Mai which are closely related to uterus.

Blood& Liver function reciprocally affect each other. Where Blood is Deficient or Hot, Liver function can be affected. If Liver function abnormal, can affect quality of Blood. For example: If Liver is Hot, Blood can become Hot (causing skin eruptions, eczema, etc.: Blood becomes heated by being stored in a hot “container”).

Controls Sinews

Sinews (tendons) depend on Liver Blood to moisten and nourish them so they can contract and relax as needed (smooth movement of joints and good muscle action). Deficient Liver Blood leads to lack of nourishment in the tendons, which leads to contractions, spasms, impaired extension/flexion, numbness of limbs, cramps, tremors, muscle weakness, etc.Â

The Liver controls the Sinews (tendons), or the contractile aspect of the muslces. The Spleen controls the muscles, or the mass or bulk. Liver imbalances are more likely to affect movement, and Spleen weakness more likely affects flaccidity, atrophy, etc.Â

Manifests in the Nails

The finger and toe nails are the outgrowth of sinews and are influenced by Liver Blood. When Liver Blood is deficient, the nails will lack nourishment and become dark, indented, dry, cracked, brittle, etc.Â

Opens to the Eyes

Liver Blood nourishes and moistens eyes and gives capacity to see. Liver Blood deficient: blurred vision, myopia, “floaters” color blindness, dry “sandy” eyes. If heat in Liver, eyes bloodshot, sore and burning.Â

Houses the Hun

The Hun is also called the ethereal SoulÂ

Hun is related to ability to be resolute, to plan and have creative drive and assertiveness. When the Liver is out of balance in excess for instance, this becomes anger.

Influences Rising and Growth

Energy moves up and out like tree (Wood element). The liver also relates to growth in the sense of personal growth, ability to change. People who feel stuck in life or a situation usually have Liver Qi Stagnation.Â

Controls Planning

Liver gives capacity to plan. Said to be like General of an army (Gall Bladder gives ability to make decisions, hence very closely linked).

The Kidneys

acuherb — Fri, 29 Jun 2012 18:56:57 +0000

Functions of the KidneysÂ

Store the Jing and rule birth, growth, development, reproduction, and sexuality
Produce Marrow, fills up the Brain, and rule the Bones
Rule Water and Water Metabolism
Control inspiration and the grasping of Qi
Open into the Ears
Manifest in the head hair
Control the two lower orifices
Residence of the Zhi (Will Power)Â
1. Kidney Yin and Kidney Yang are the foundation of the Yin and Yang of the whole body.
2. Kidney Yin and Kidney Yang rely on each other for their existence. Kidney Yin provides material basis for Kidney Yang. Kidney Yang provides necessary Heat for all Kidney functions.

Store the Jing and rule birth, development, and reproduction

Jing is the (material and immaterial) substance most intimately connected to life itself. It is the creator of life and is the foundation for differentiation into Yin and Yang. The Kidneys are sometimes referred to as the “Root of Life” because Jing is the basis for reproduction, growth, and development. It flourishes as we grow and develop, and wanes as we grow old. The Kidneys are said to govern these processes at it stores the Jing.

Jing (Essence) the precious substance has two types:

Prenatal Jing: Inherited from parents

Postnatal Jing: Partly replenished from food and fluids

Prenatal Jing determines our basic constitution, vitality, and strength. It is the basis of sexual life and the formation of sperm and egg. It is the foundation for differentiation into Yin and Yang. Insufficient Jing can cause infertility, impotence, problems relating to growth, reproduction, premature senility, etc.Â

Postnatal Jing is the refined essence extracted from the food by the internal Organs, particularly the Spleen.Â

Kidney Jing provides material basis for both Kidney Yin and Kidney Yang.Â

Produces Marrow, Fill up the Brain and Spinal Chord, and Control the Bones

Jing is also the organic foundation for production of marrow.Â

Marrow is the common substance of bones, bone marrow, brain (“sea of marrow”) and spinal cord.Â

Kidney Jing produces Marrow, which generates spinal cord and “fills up” brain: therefore Kidney has relationship with brain. Strong Jing nourishes brain and memory/concentration, etc. will be good.

Jing inadequate to nourish the brain: poor memory and concentration, dull thinking. Therefore Kidneys also govern bone marrow and bones (and teeth, which are said to be the outgrowth of bones).

Kidneys Governs Water and Water Passageways

Kidneys belong to Water element

They govern the transformation and transportation of body fluids in many different ways. For example, the Kidneys control flow of Body Fluids in Lower Burner. The correct balance of Kidney Yin and Kidney Yangproduces normal regulation of the opening and closing of the “gate” of urination.Â
In disease, Kidney Yin and Yang imbalanced (not enough Yang or not enough Yin). Where Yang is deficient, “gate” stays open: profuse and pale urination. Where Yin is deficient, “gate” stays closed: scanty and dark urination.

Control inspiration and the grasping of Qi

While the Lungs govern respiration, the Kidneys play an important role in normal breathing. The Kidneys assist the Lungs during inhalation by “Grasping the Qi“. In this relationship, the Lungs are called the “Foundation of Qi“, and the Kidneys are called the “Root of Qi“. When the Kidneys fail to Grasp the Qi, respiratory illnesses can occur, such as chronic asthma.

Opens into the Ears

Ears related to Kidneys: Kidney Jing nourishes ears and enables proper functioning. Weak Jing, weak hearing or tinnitus.Â

Manifest in the head hair

Abundant Kidney Jing nourishes hair: hair then grows well and is healthy and shiny. Weak Kidney Jing: thin brittle, dull, or falling hair, premature graying.Â

NOTE: Liver Blood also has to do with hair color and shine, but Kidney Jing is instrumental in production of Liver Blood.Â

Controls the Two Lower Orifices

The Kidneys control the front orifice, which is the urethra (and spermatic duct in males), and the rear orifice, which is the anus.Â

These are functionally related to the Kidneys.Â

Urethra related because Kidney provides the Bladder with the Qi necessary to transform urine (weak Kidney Qi produces leaking of urinary incontinence).

Deficient Kidney Qi or Kidney Jing can cause spermatorrhea or nocturnal emissions.Â

Anus anatomically related to Large Intestine but functionally related to Kidney. If Kidney Qi is weak, there may be diarrhea or prolapsed anus.Â

Houses the Will Power

Will Power (Zhi), including concepts of staying power and motivation, depend on Kidneys.Â

Dr. Wang has long term experiences on treatment infertility, Kidney YangÂ Collapses, Â including man and woman with ENCARE herbs Â and acupuncture combination skills, and has help many patients fire the kidney fire on with herb medicine.

The Spleen

acuherb — Fri, 29 Jun 2012 18:54:33 +0000

By Kenneth Wang

Functions of the SpleenÂ

The Spleen is central Organ in production of Qi.

Called the “Foundation of Postnatal existence”. Extracts Food Qi (Gu Qi) from food and liquids taken into Stomach. Food Qi is basis for formation of Qi and Blood.

Governs transformation and transportation

Controls the Blood

Controls the muscles and the four limbs

Opens into the mouth and manifests in the lips

Controls the raising of Qi, the “raising of the pure”

The Spleen houses thought

Governs Transformation and Transportation

Transformation/transportation of Gu Qi (Food Qi)Â
Spleen is central Organ in production of Qi. Stomach “rots and ripens” ingested food and drink, and prepares the way for the Spleen which separates and extracts the GU Qi (food Qi) and refined essence from the digestate.Â

Food Qi goes upward to the Lungs in the Upper Burner. Food Qi combines with air to form Zong Qi and goes to the Heart to form Blood. Flavors are distributed to the various organs, sweet to the Spleen, salty to Kidney, bitter to Heart, sour to Liver, pungent to Lung.

Transformation/transportation of FluidsÂ
Spleen also separates usable from unusable fluids ingested. Pure “clear” part goes upwards to the Lungs for distribution to the skin. “Turbid” part goes to Intestines for further separation.Â

In health, transforming and transporting function of Qi ensures good digestion, good appetite, normal absorption, regular bowel movements. Impaired function, poor appetite, bad digestion, abdominal distention, loose stools.Â

When transformation/transportation of fluids impaired, fluids can accumulate to form Dampness and then Phlegm.Â

“The Spleen likes Dryness and hates Dampness”. Its transformation and transportation function can be impaired by Damp e.g. Damp-forming foods like salads, dairy, etc.Â

Spleen Yang, essential to the process, impaired by excessive consumption of cold liquids (esp. ice water, ice cream, etc.) Conversely, Deficient Qi or Yang of Spleen can CAUSE internal Dampness.

Spleen Controls Blood

Keeps Blood in VesselsÂ
If Spleen Qi healthy, Blood circulates normally (see also Liver) and stays in vessels. Deficient Spleen Qi or Deficient Spleen Yang, Blood may spill from vessels = hemorrhages, subcutaneous bleeding, etc. (petechiae, purpura) Also, especially lower body hemorrhage, e.g. metrorrhagia can be caused by Xu Spleen Qi.

Important role in Blood formation.Â
(Food Qi extracted by Spleen sent to Lung and to Heart to form Blood with assistance of Yuan Qi from Kidney). To tonify Blood, always tonify Spleen.

Controls the Muscles and Four Limbs

Food Qi eventually goes to nourish all tissues in the body, transported throughout body by Spleen. Particularly directed to the muscles. Weak Spleen Qi: fatigue, muscles weak or even atrophied. Tonify Spleen in fatigue.

Opens to the Mouth and Manifests in the Lips

When food enters mouth, chewing prepares food for transformation and transportation. Therefore Spleen related to mouth. Normal Spleen Qi; good sense of taste and moist pink lips.Â

Controls the Raising of Qi

Spleen has Lifting effect along midline of body that ensures that Organs in proper place. When raising function impaired, Spleen Qi “sinks”: prolapse can occur of uterus, Bladder, Stomach, Kidney, or hemorrhoids).

Spleen raises pure Food Qi to Lung and Heart.

Spleen Houses ThoughtÂ

Is residence of I (Yi). Influences our capacity for thinking, studying, concentration, memorizing, etc. Weak Spleen Qi; thinking dull, poor concentration, poor memory, etc. Excessive studying, mental work etc., weaken Spleen.

The Lungs

acuherb — Fri, 29 Jun 2012 18:52:53 +0000

By Dr. Kenneth Wang

Functions of the Lungs

The Lungs are called the “Lid of the Yin Organs”

Rule Qi and Respiration
Control the Channels and Blood Vessels (with the Heart)
Control dispersing and descending
Regulate and move the Water Passages
Control skin, sweat glands and body hair (the “Exterior”)
Open into the nose
House the Po (corporeal soul)
Govern the voice

Governs Qi and Respiration

The first way that the Lungs govern Qi is by taking in air or Pure Qi and exhaling used, impure, or Dirty Qi. This constant exchange in the cycles of breathing maintain the correct function of all body’s physiological processes that need Qi.

The Lungs are also responsible for the actual formation of Qi. Food Qi (Gu Qi) is taken by the Spleen and directed to the Lungs where it combines with inhaled air (with help from Yuan Qi of Kidneys) to form Zong Qi, which is also called Qi of the Chest or Gathering Qi. The Zong Qi regulates involuntary movement of Heart and Lungs in turn is nourished by the Qi of the Heart and Lung. The Lungs then spread this Qi all over the body

Simultaneously formed: “Upright” or “normal” Qi (Zhen Qi) which is divided into Ying and Wei parts.

Lungs open to the Exterior, hence are called the “Tender Organ” because they are vulnerable to attack by exogenous pathogens.Â

Controls Channels and Blood Vessels

Because govern Qi, which is essential to Heart to aid in Blood circulation. The Lungs and Heart are very closely linked (via Zong Qi). Lungs control circulation of Qi not only in Blood Vessels but in the channels. Weak Lung Qi results in Qi being unable to push the Blood to nourish various areas. Hence, e.g. cold limbs, especially cold hands.Â

Controls Dispersing and Descending

Dispersing Function

Lung spreads Wei Qi (defensive Qi) and Body Fluids all over body to area between skin and muscles (The Lungs are related to skin).Â

This ensures that Wei Qi equally distributed under skin to warm skin and muscles and protect body from exogenous pathogens (Symptoms of a “cold” = impairment of dispersing function: exterior Wind Cold obstructs skin, blocks pores and Qi circulation: Qi cannot be dispersed.

Lung spreads Body Fluids (Jin Ye) to skin in form of “mist” to moisten skin and regulate opening and closing of pores and sweating. In health, normal pore function and normal amount of sweating.

Descending Function

Lungs are uppermost Organ (“Lid of the Yin Organs”). Therefore their Qi descends to communicate with Kidney (which “holds down” the Qi).Â

Lungs also direct Body Fluids downward to Kidneys/Bladder. Impairment of descending function: Qi accumulates in chest (cough, asthma, stuffy chest, or accumulation of fluids; upper body edema).

Regulates Water PassagesÂ

Lungs receive refined fluids from Spleen, reduce them to fine mist and “spray” them throughout Exterior under the skin (part of dispersing function). Fluids should be evenly spread and pores should be regulated: otherwise, fluids may accumulate: edema.

Lungs are “upper origin of Water”. Direct fluids down to Kidney and Bladder. Kidneys receive fluids and vaporize them, then send back up to Lung.

Controls Skin and Hair

See above: Lung nourishes skin and hair by spreading Fluids to skin. Impaired Lung function can result in malnourished body hair and skin. Lungs influence Wei Qi, which circulates in skin.Â

Opens into the Nose

Nose is the opening of the Lungs. Lungs govern sense of smell.Â

Houses the Po (Corporeal Soul)

Corporeal soul attached to body. Closely linked to breathing. Directly affected by sadness/grief which constrain its movement and affect breathing.Â

Lungs Govern Voice

Strength, tone and clarity of voice depend on Lung Qi (in health: like a bell). Weak Lung Qi = low voice.

The Relationship of Blood and Qi

acuherb — Fri, 29 Jun 2012 17:28:03 +0000

By Dr. Kenneth Wang

Blood and Qi have a very close relationship. Blood is said to be is a denser form of Qi, and more Yin in nature. Qi and Blood are inseparable, and the Ying form of Qi actually circulates with the Blood in the Vessels. While Blood engenders Qi, Qi is said to command or move the Blood.

The dependency of Qi on Blood can be illustrated as follows: After a patient has experienced heavy Blood loss, they will usually show signs of Qi deficiency, such as weakness, sweating, breathlessness, and fatigue.Â

The dependency of Blood on Qi can be illustrated as follows: After prolonged and heavy sweating injures or depletes the Qi, a patient may develop symptoms of Blood deficiency, with symptoms such as pale face, numbness, palpitations, and dizziness.

Qi Generates Blood

Food Qi is the basis for Blood
Spleen Qi is essential for the production of Food Qi
Original Qi is also essential as a catalyst
Lung Qi is essential for the production of Blood (pushes the Food Qi to the Heart)

Where Qi is deficient, eventually Blood will become Deficient. Where Blood is deficient, one often needs to tonify Qi.

Qi Moves Blood

Blood would be inert without Qi. Ying (Nutritive) Qi flows with Blood in the Vessels.
Lung Qi infuses Qi into the Blood Vessels to push the Blood.

“When Qi moves, Blood follows”. “When Qi stagnates, Blood congeals.”Â
When Qi is deficient or stagnant, it fails to push Blood, which also stagnates.

Qi Holds the Blood

Spleen Qi is responsible for holding the Blood in the Vessels, preventing extravasation. If Spleen Qi is deficient, hemorrhages may occur.

Blood Nourishes the QiÂ (“Blood is the mother of Qi“)

Qi needs Blood for nourishment.
Blood provides a material basis (more Yin) which prevents Qi from “floating” away and producing signs of Empty Heat (see later)

The Relationship Between Blood and Jing

Blood also nourishes and replenishes the Jing (Essence).