TCM – American Institute of Acupuncture

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

Qi (Vital Energy or Life Force)

acuherb — Fri, 29 Jun 2012 17:20:44 +0000

It has been translated as “vital energy”, “life force”, or “Breath” but no single English word will suffice.

This is because of the nature of Qi. It can have different manifestations in different situations.

Qi can even be material and is said to “condense” into matter. This is what occurs according to TCM, when a child is conceived and a human being develops. Qi condenses to form a material being. In pathology, when Qi flow slows down and stagnates, masses, lumps or tumors can appear.

The concept of Qi representing a continuum between immaterial and material is not so far from the concepts of matter and energy in modern physics. Matter is not “solid”, but its particles are vibrating at various speeds; the faster they vibrate, the more rarefied the matter becomes. In the same way, the manifestations of Qi cover the continuum of matter-energy.

Characters for Qi mean “vapor” or “steam” and “uncooked rice”.

This illustrates that Qi can appear in different states ranging from more immaterial like steam to dense and material like rice.

It also illustrates a CENTRAL IDEA in TCM, that the major source of Qi is transformed from the FOOD that we put into our bodies.

Overview of Qi in Traditional Chinese Medicine (TCM)

Ancient philosophers saw human Qi as the result of the interaction between the Qi of Heaven (Yang) and Earth (Yin). They stressed the interaction between a human being’s Qi and the forces of nature.

TCM, following these ancient philosophies, stresses the relationship between human beings and natural forces, both cosmic and local (the environment).

We are under the influence of natural rhythms and cycles, (lunar, circadian and solar cycles) with which we should strive to stay in balance in order to maintain health.
We are susceptible to pathological conditions resulting from attack by pathological climatological energies (wind, cold, damp, heat, summer heat and dryness).Â
1. Qi manifests both on the physical an spiritual/psychological level.
2. Qi is in a constant state of flux and its immaterial/material state constantly varies. When Qi condenses, it accumulates to form physical shape.
  Example: Poor circulation of Qi in the body can result in condensation of Qi to form lumps, masses or tumors.
3. Although there are many types of Qi in human beings, all these types are ultimately one Qi, manifesting in different forms.
4. Qi changes form according to its locality and function.

TWO MAJOR USES OF THE WORD QI IN TCM

1. Qi is a refined substance produced by the internal Organs, to nourish the body, mind and spirit (its form varies according to its location and function).

2. The word Qi is also used to mean the complex of functional activities of a given internal organ.

Example: When we say Spleen Qi, we mean the complex of the functional activities of the Spleen.

Example: Defensive Qi circulates primarily in the Exterior to protect the body. Nutritive Qi circulates in the Interior, to nourish the Organs. These two are different manifestations of Qi. When either is unable to perform its functions, specific pathological symptoms will result.Â

The various forms of Qi are discussed below. However, it is first important to understand another vital substance: JING.

Prostate Cancer

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

By Dr. Ken Y Wang

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

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

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

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

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

Understanding how urine is formed from a TCM perspective

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Causes

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

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

Heat:

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

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

Stasis:Â

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

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

Deficiency:Â

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

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

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

Symptoms

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

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

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

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

Other signs that may be present with prostate cancer:

The tongue signs:Â

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

The pulse signs:

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

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

These include:

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

Symptoms more suggestive of prostate cancer include:

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

Diagnosis

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

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

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

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

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

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

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

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

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

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

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

Treatment

Surgery

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

Radiotherapy

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

Chemotherapy

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

Hormone therapy

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

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

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

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

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

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

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

Addition for individuals with dribbling after urination:Â

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

Addition for individuals with haematuria: (Blood in urine)

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

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

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

Addition for individuals with severe cases:

gui ban

tortoise shell

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

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

Addition for individuals with severe cases:

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

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

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

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

Addition for individuals with urgency or dribbling after urination:

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

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

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

Addition for individuals with blood stasis:

tao ren	peach seed
hong hua	safflower

Peptic Ulcer

acuherb — Tue, 03 Apr 2012 01:43:44 +0000

By Dr. Kenneth Wang

Peptic ulcer disease (PUD) is a mixed group of disorders that involve the gastrointestinal (GI) tract. The stomach and duodenum (upper part of the intestine) are the most common locations where ulceration occurs. The rate of occurrence of PUD is variable and depends on ulcer type, age, gender and geographic location. For example, in Japan, stomach ulcers occur at five to ten times the rate of duodenal ulcers, while in the United States and most European countries duodenal ulcers are about two times as common as stomach ulcers.

Individuals with chronic peptic ulcer disease will experience periods of remission and recurrence of the disease, while acute peptic ulcers are limited to a specific patient population and clinical scenario. When left untreated, PUD may result in serious complications such as gastrointestinal bleeding and cancer. Stomach ulcers are much more likely to result in death or disability due to a greater likelihood of causing hemorrhage, perforation, or obstruction. In addition, while duodenal ulcers are almost never cancerous, approximately 55% of stomach ulcers are cancerous.Â

Peptic ulcer is a terminology that belongs to modern medicine; there is no mention of it in the history of Traditional Chinese Medicine (TCM). Instead, because of the nature of its symptoms, it is categorized as “stomach ache” or “epigastric pain.” It is associated with theÂ spleen,Â liverÂ andÂ gall-bladderÂ because these organs play an important role in the development of the disease.Â

According to theÂ five elements theory, the spleen andÂ stomachÂ belong to earth, and the spleen has an interior-exterior relationship with the stomach. Both of these organs are responsible for the digestion, absorption and transportation of food, and control blood production and its circulation.Â

The liver and gall-bladder belong to wood and they jointly regulateÂ qiÂ (vital energy) and the emotions, enhancing digestion and blood flow. In normal circumstances, wood (liver and gall-bladder) restricts the earth (spleen and stomach) which means that the spleen and stomach are under the control of the liver and gall-bladder. If the liver is hyperactive, it unduly restricts functioning of the spleen, causing an imbalance in the body. According to the five elements theory, the resulting situation is described as “wood overacting on earth.”

Causes

According to TCM, peptic ulcer can be caused by any of the following:Â

1. Dietary injury
Diet is an important cause of Â stomachÂ disorders. The stomach receives and ripens food; theÂ spleenÂ transforms and transports refinedÂ nutrient essenceÂ up towards theÂ lungs, whilst the stomach sends waste down towards the intestines. The descending function of the stomach corresponds with the ascending function of the spleen, and this is crucial in ripening, transporting and transforming nutrient essence and wastes in theÂ middle burner. Improper eating habits affect the stomach easily which leads the stomach-qi to flow in the wrong direction, and results in nausea, vomiting, hiccups or belching.

2. Emotional distressÂ
Emotional problems have a profound influence on stomach disorders. When emotions such as anxiety, pensiveness, grief and anger predominate,Â liverÂ yang ascends and liver qi stagnates which, in turn, affects the functioning of the spleen and stomach. In the absence of the liver’s regulatory function, the spleen cannot successfully transport and transform food into qi and blood, and the stomach cannot send waste down to the intestines. This causes epigastric pain, belching or nausea.

3. Weakness of spleen and stomach
This may be due to genetic constitutional weakness, or mental over-exertion over a long period. A person tends to get digestive problems like a poor appetite, vomiting or diarrhea, and possibly also muscle weakness and low energy. When attacks fromÂ pathogenic factorsÂ become more serious, stomach disorders occur easily.

Symptoms

Gastric pain, a major manifestation of peptic ulcer, usually occurs in the epigastric region or upper abdomen. Episodes of pain may be periodic, rhythmic or chronic. If seasonal, the pain usually occurs in late autumn, and the nature of pain is manifested as a dull, stabbing, distending, burning or hunger pain. Among the different types of pain, intermittent mild dull pain is most frequent. This usually lasts one or two hours but, in rare cases, it can last several days. The pain can be relieved by alkaline drugs or food. Along with pain, associated symptoms are belching, sour regurgitation, excessive saliva, nausea or vomiting.Â

The location of gastrointestinal (GI) ulcer can be implied by the symptoms. People with stomach ulcers usually complain of pain being caused or worsened by food. They also describe the pain as being widespread over the lower abdomen. When someone has a duodenal ulcer the pain is typically described as sharp and burning in nature with a specific point of tenderness. In contrast to stomach ulcers, people with duodenal ulcers usually experience relief of pain with food.

Other symptoms of a duodenal ulcer include a feeling of abdominal pressure, fullness or hunger. People with duodenal ulcers may also be awakened at night due to the normal nighttime peak in acid secretion. It is important to be aware of “alarm symptoms” which can be present in people who have serious complications from peptic ulcer disease (PUD) such as bleeding or people with stomach cancer. These “alarm symptoms” include weight loss, vomiting, back pain, vomit that has the appearance of “coffee grounds” and dark tarry stools.

Diagnosis

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

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

For details, please see article on “What to Expect from a TCM Doctor’s Examination“.Â

TCM practitioners will usually begin with a thorough investigation of the patient’s complaints and categorize the symptoms under special syndrome groups known as “disharmony patterns.” The disharmony patterns are present at different stages of a disorder. The practitioners will look at both the major manifestations, and “disharmony patterns” which are described below:Â

1. Qi stagnation
The patient feels distending pain in the epigastric region, and fullness and oppression in the hypochondrium (the upper lateral sides of the abdomen). These symptoms would worsen with emotional disturbance, and can be relieved by discharge of intestinal gas or belching. The patient tends to sigh, has a poor appetite and experiences oppression in the chest and sour regurgitation. On examination, the tongue is covered by a thin white fur, and the pulse isÂ taut.Â

2. Heat retention
The patient feels a burning pain in the epigastric area. Eating offers no obvious relief; instead, it may even make the symptoms worse. The mouth is dry with a bitter taste. Other symptoms include thirst and a desire for cold drinks, sour regurgitation, irritability, clamoring stomach and constipation. On examination, the tongue is red with yellow fur, and the pulse is taut orÂ rapid.Â

3. Yin deficiency
The patient feels a dull, burning epigastric pain which becomes worse on an empty stomach. Other associated symptoms include thirst and a disinclination to drink, dryness of the mouth, poor appetite, retching, constipation, and a feverish sensation in the palms, soles and chest. On examination, the tongue is red and dry, with cracks in the central portion. It is covered with little or scattered, cracked fur. The pulse isÂ threadyÂ or rapid.

A pale tongue with indented margin, the cracks in the central portion indicate spleen and stomach dysfunction.

4. Deficient cold
The patient feels a dull epigastric pain which tends to ease with warmth and massage. An attack can be easily induced or worsened by over-exertion. The pain worsens on an empty stomach. Although the pain can be relieved by eating, abdominal distention will follow. Other associated symptoms are fatigue, sleepy, reluctance to speak, and loose stools. On examination, the tongue is pale and bulky with indented margin, and it is covered by a thin white fur. The pulse isÂ deep, thready or slow.

5. Blood stasisÂ
The patient experiences a fixed, stabbing pain in the epigastric area. But when the pain becomes extreme, it sometimes radiates towards the chest and the back. This may be accompanied by coldness of the limbs, sweating, vomitting blood or blood in the stools. On examination, the tongue is dark purple, and may have bruises or patches on the surface. The pulse isÂ hesitant.

In general, during the pathological course of peptic ulcer, the above syndromes develop at different stages. In the early or active stages of peptic ulcer, qi stagnation and heat retention syndromes are quite common. TCM terms these as a sthenia orÂ excess (shi) syndromesÂ in which the body offers a relatively strong resistance.Â
In the late or recovery stages of peptic ulcer, yin deficiency and deficient cold syndromes are more common. TCM terms these as a sthenia orÂ deficiency (xu) syndromesÂ in which the body’s resistance is very weak.Â
Blood stasis syndromes can develop at any stage, but occurs mostly in the middle and late stages. The syndrome has a deficiency nature but presents excitatory signs, or having both excess and deficiency syndromes inter-mixed.

Treatment

In TCM, treatment for peptic ulcer is based on “disharmony patterns,” or therapies according to the western symptoms of peptic ulcer syndromes. An alternative is to integrate western and Chinese approaches to create a synergetic effect on the disease, thus enhancing clinical efficacy. The following are brief introductions to TCM approaches:

A. Treatment based on TCM syndromes

Qi stagnationÂ

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

Sample of Prescription:Â chaihu shugan tang

chai hu	Chinese tororwax root
chen pi	dried tangerine peel
shao yao	peony
zhi ke	bitter orange
zhi gan cao	liquorice root (processed with honey)
chuan xiong	Szechuan lovage
xiang fu	nut grass

Heat retention

Therapeutic aim:Â Soothing the liver and eliminating heat. Commonly used prescriptions are modifiedÂ huagan jian, zuojin wanÂ andÂ banxia xiexin tang.

Sample of prescription: banxia xiexin tang

ban xia	pinella tuber
huang qin	baical skullcap
gan jiang	fried ginger
ren shen	ginseng
zhi gan cao	liquorice root (processed with honey)
huang lian	golden thread
da zao	common jujube fruit

Yin deficiency

Therapeutic aim:Â Nourishing yin to strengthen the stomach. Commonly used prescriptions are modifiedÂ
yiguan jian, yangwei tangÂ andÂ liuwei dihuang tang.

Sample of Prescription:Â yiguan jian

sha seng	adenophora
mai dong	dwarf Lily-turf
dang gui	Chinese angelica root
sheng di	dried rehmannia root
qi zi	Chinese wolfberry fruit
chuan lian zi	toosendan fruit

Deficient cold

Therapeutic aim:Â Warming the middle burner to strengthen the spleen. Commonly used prescriptions are modifiedÂ huangqi jianzhong tang, sijun zi tang, lizhong tang and liangfu wan.

Sample of Prescription:Â huangqi jianzhong tang

huang qi	Mongolian milkvetch root
gui zhi	cassia twig
zhi gan cao	liquorice root (processed with honey)
da zao	common jujube fruit
shao yao	peony
sheng jiang	fresh ginger
yi tang	maltose

Blood stasis

Therapeutic aim:Â Activating blood to resolve stagnation. Commonly used prescriptions areÂ xuefu zhuyu tang and gexia zhuyu tang.

Sample of Prescription:Â xuefu zhuyu tang

dang gui	Chinese angelica root
sheng di	dried rehmannia root
tao ren	peach seed
hong hua	safflower flower
zhi ke	bitter orange
chi zhao	common peony root
niu xi	twotooth achyranthes root
jie geng	balloonflower root
chuan xiong	Szechuan lovage
chai hu	Chinese tororwax root
gan cao	liquorice root

During the treatment, herbs like liquorice root (gan cao), tendrilleaf fritillary bulb (chuan bei), common bletilla tuber(bai ji), notoginseng (san qi) rhubarb (da huang) are added in the prescription for additional relief of dyspeptic symptoms. Some prescriptions to astringe (lessen) acid secretion are effective for related complaints, e.g. mixed powder of thunberg fritillary bulb(zhe bei mu) and cuttle-fish bone (wu zei gu) can be used.Â

B. Single Proven Prescription

In practice, a lot of recipes have been proved effective against the disease but were not listed in medical journals. These recipes do not follow any particular diagnostic rules in TCM but are used only when the disease is confirmed as peptic ulcer. For example pearl powder is effective in providing relief from symptoms and speeding up the healing of an ulcer.Â

C. Acupuncture andÂ moxibustion

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

Hepatitis

acuherb — Mon, 23 Jan 2012 18:14:51 +0000

Hepatitis

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

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

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

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

Causes

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

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

Symptoms

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

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

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

Diagnosis

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

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

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

Note:Â If a TCM practitioner suspects there might be a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual see a western doctor for further follow up.

Western Medicine Diagnosis

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

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

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

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

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

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

Treatment

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

Stagnation of dampness-heat evil in middle-burner

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

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

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

Stagnation of live-qi and spleen deficiency

Prescription:Â xiaoyao powder plus addition or deduction with jinhua power

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

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

Yin deficiency in liver and kidney

Prescription:Â xiaoyao powder plus zishui qinggan drink

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

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

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

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

Obstruction of the collaterals by blood stasis

Prescription:Â Yiguan decoction plus addition or deduction with Huayu decoctionÂ

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

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

Excessive heat and toxin

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

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

Prevention

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

Western Medicine prevetion

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

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

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

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

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

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

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

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

Gout

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

Â

Gout

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

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

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

Causes

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

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

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

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

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

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

Symptoms

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

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

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

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

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

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

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

Diagnosis

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

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

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

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

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

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

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

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

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

Treatment

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

Herbal therapy

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

Prescription:Â Modified Yiyiren decoction.

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

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

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

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

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

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

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

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

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

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

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

Non-herbal therapy

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

The commonly used acupuncture points for pain relief are:Â

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

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

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

Prevention

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

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

Abstain from drinking alcohol.

Maintain moderate body weight.

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

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

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

Contact Dermatitis

acuherb — Thu, 29 Dec 2011 20:15:20 +0000

Contact dermatitis

Contact dermatitisÂ 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:Â

	“lacquer sore”
	“plaster rubella” from Chinese herbal poultices
Â	Â
	“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 ofÂ exogenous evilsÂ invasion, theÂ protective qiÂ that enhances its integrity is regulated by theÂ lungs. Therefore skin diseases are always viewed as indicating a lung disharmony. TheÂ spleenÂ 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)Â
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 Â internal wind evilÂ . Contact with certain substances, such as lacquer, drugs, plastic, rubber products, dyes or plants, facilitates transformation of Â heat evilÂ 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.Â

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 andÂ perineumÂ 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 excessiveÂ pathogensÂ . 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 dampnessÂ
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 accumulationÂ
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

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

Contact dermatitis is commonly diagnosed by the following disharmony patterns:Â

Excessive heat accumulation
From the TCM viewpoint, all allergenic substances are regarded as evils orÂ pathogensÂ . Hypersensitive reactions of the body are the result of accumulation of evils, impaired functioning ofÂ organsÂ or disruption to the circulation of Â bloodÂ andÂ qi. The pathogens induce internal changes and encourage the accumulation of excessiveÂ heat evilÂ . 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 dampnessÂ
The lungs have an important role as regulator of theÂ protective qiÂ . The spleen provides nutrients for the skin. If theÂ lungsÂ andÂ spleenÂ are functioning poorly,Â external pathogensÂ can readily invade the body and fire andÂ 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 acquiredÂ jing (essence)Â 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 intoÂ 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 betweenÂ yin and yangÂ and are the superficial presentations of internal damage.

1.	Excessive heat accumulation

Therapeutic aim:To eliminateÂ heatÂ and toxic materials, cool theÂ bloodÂ and clear the rash.

Prescription 1:Â 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:Â 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:Â To disperse heat andÂ dampness evilsÂ and to eliminate toxins and swelling.

Prescription:Â 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 anddrynessÂ accumulation

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

Prescription 1:Â 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:Â 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:

Â	lu cha	green tea
Â	ma chi xian	purslane herb
Â	huang bai	amur cork-tree
Â	yang di cao	emilia sonchi folia
Â	shi wei	pyrrosia leaf
Â	pu gong ying	dandelion
Â	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:

Â	huang qin	baical skullcap root
Â	huang bai	amur cork-tree
Â	ma chi xian	purslane herb
Â	ming fan	alum

3.	Where the lesion has been scratched and there is exudate, washing or soaking with this decoction is useful:

Â	shang di yu	fresh garden burnet root
Â	huang bai	amur cork-tree

4.	Fresh ground mung beans.
5.	Fresh balsam pear.

Acupuncture and moxabustion
As contact dermatitis is seen as anÂ 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.
Â	Â

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.Â

Colorectal Cancer

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

Colorectal Cancer

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

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

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

Causes

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

The usual causative factors are as follows:

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

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

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

Symptoms

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

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

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

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

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

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

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

Diagnosis

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

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

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

Listening and Smelling: The odor of sputum and breath and listening to chest sounds offer additional clues to the patient’s health.

Touching: Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

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

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

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

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

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

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

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

Treatment

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

Treatment based on TCM differential diagnosis

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

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

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

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

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

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

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

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

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

dang gui	Chinese Angelica Root
sheng di	Dried Rehmannia Root
tao ren	Peach Seed
hong hua	Safflower Flower
zhi ke	Bitter Orange
chi zhao	Common Peony Root
niu xi	Twotooth Achyranthes Root
jie geng	Balloonflower Root
chuan xiong	Szechuan Lovage
chai hu	Chinese Tororwax Root
gan cao	Liquorice Root

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

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

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

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

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

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

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

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

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

External Treatment

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

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

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

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

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

TCM patent drugs or simple folk remedies

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

Qi-gong

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

For example:

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

Concentrate on making the breath (qi) si

Prevention

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

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

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

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

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

Human body constitutions in TCM

acuherb — Thu, 03 Nov 2011 21:06:04 +0000

Human body constitutions in TCM

The constitution of each person is influenced by congenital and acquired factors, and this varies from person to person. In the other words, the body’s metabolism, functioning of organs and organ structure all combine to determine our susceptibility to pathogenic factors.In TCM, there are five different types of physical constitutions: neutral, yin and cold, yang and hot, phlegm and dampness, and dry.

1. Yang and hot type

Individuals have a sturdy body. They often feel hot, experience dryness of the mouth, prefer cold drinks when thirsty, have a reddish complexion, are easily annoyed, and tend to suffer from insomnia. They usually discharge scanty urine of a dark color, and have hard stools. Upon examination of the tongue, it appears red with a yellowish coating, or may have no coating at all. Such individuals are very sensitive to high temperatures.

2. Yin and cold type

Individuals have a frail body. They usually feel cold, have an aversion to wind, and their limbs are cold. They prefer hot or warm food and drinks, are reluctant to speak, get easily tired and have a pale or whitish complexion. They usually discharge clear urine frequently, stools are soft, and tend to suffer from diarrhea easily. Upon examination of the tongue, it appears pink and bulky with a whitish coating. Such individuals are very sensitive to cold temperatures.

3. Phlegm and damp type

A person of this constitution perfers sweet food. They experience heaviness in the body, dizziness, and tire easily. They look fatigued and sleepy in day time, and snore easily during sleep. Such people have a low metabolic rate. They tend to become overweight or bloated due to retention of water. The person may look fat but is drained of energy. The tongue looks moist and bulky, and is covered with a greasy coating. Such people are very sensitive to damp weather.

4. Dry type

Individuals belonging to this constitution feel thirsty easily and experience dryness in the eyes, throat, lips and skin. When common flu is prevalent, they will usually have a cough without mucus. Such people tend to be skinny and do not put on weight easily. Their common complaints are itchy skin, nose or eyes, and constipation – all due to lack of lubrication. They are very sensitive to low levels of humidity.

5. Neutral type

This type of person does not have any of the above complaints. They look healthy with normal skin color. They have proper appetite and sleep, and do not feel hot or cold easily. Their urine and stools are normal. The tongue is normal upon examination.

It should be emphasized that in reality, people usually have a mixed physical constitution, for example, cold and dry, damp and hot, or cold and deficient. Therefore, it is difficult to classify one type individually as more than one type of constitution may be present. When planning a balanced diet, it is necessary to mix different flavors and energies according to the individual’s needs. Embracing Chinese dietary advice is a process to shift to a more balanced diet. It does not mean you should restrict your diet; you may give up some foods but you will find a whole variety of foods you may have never tried before.

All about TCM Kidney

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

An Overview of TCM Kidney

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

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

2. Controlling water/fluid balance in the body.

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

4. Producing strong healthy bones and bone marrow.

5. Producing healthy hair.

6. Connecting with the ears to control hearing.

7. Opening into the urethra and anus.

Kidney Properties

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

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

Conclusion

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

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

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

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

When imbalance Occurs

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

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

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

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

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

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

Conclusion

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

1. Kidneys store essence (jing)

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

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

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

3. Kidneys rule the grasping of qi

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

4. Kidneys rule the bones

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

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

5. Kidneys manifest in the hair

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

6. Kidneys open into the ears

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

7. Kidneys dominate anterior and posterior orifices

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

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