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DIABETES MELLITUS(PART THREE)

04/30/2013 11:08:00

DIABETES MELLITUS(PART THREE)

by Clinton J. Choate

According to TCM, diabetes mellitus is classified as upper,middle or lower xiao-ke (wasting and thirsting syndrome) and is generally characterised by thirst, hunger, frequent urination and wasting (see footnote). Cloudy urine and sugar in the urine may also accompany these symptoms, each of which is said to have a predominant symptom: excessive thirst in the upper jiao (Lung), excessive appetite in the middle jiao (Stomach) and excessive urination in the lower jiao (Kidney). In reality there is usually a mixture of all the symptoms, although one often predominates slightly. By analysis of the symptoms, one should be able to determine which organ, whether the Lung, Stomach or Kidney is most yin deficient and therefore have a focus for treatment.

• Upper xiao-ke syndrome is characterised by Lung heat drying up body fluids leading to great thirst, restlessness,dry cough, dry skin, hoarseness, dry red tongue with or without cracks, a thin yellow tongue coating, and a forceful rapid pulse especially at the cun (distal) position.

• Middle xiao-ke syndrome is characterised by Stomach fire leading to excessive appetite and constant hunger,desire to drink cold liquids, burning sensation in the epigastrium,constipation, a red tongue with a thick yellow coating,and a slippery-forceful-rapid pulse.

• Lower xiao-ke syndrome is characterised by Kidney yin deficiency where there is excessive urination (clear or turbid),dry mouth at night, night sweating, sore back and aching bones, red-peeled tongue, and a deep-thready-rapid pulse.

• Lower xiao-ke syndrome with deficiency of both Kidney yin and yang (with the latter more pronounced) is characterised by frequent urination of turbid urine especially at night, soreness and weakness of the lower back and knees,aversion to cold, lassitude, impotence, a pale red tongue with teethmarks and a white tongue coating, and a deep thready-weak pulse.

Xiao-ke is attributed to three main factors: improper diet,emotional disturbance, and a constitution that is yin deficient1:

• Improper diet refers to irregular eating and drinking habits which damage the transporting and transforming functions of the Spleen and Stomach. The accumulated food in turn generates internal heat that consumes the fluids,thus bringing on wasting and thirsting.• Prolonged emotional disturbance contributes to wasting and thirsting by hindering the flow of qi. Over-thinking damages the Spleen. Anger, resentment and frustration lead to constrained Liver qi which transforms into heat and fire and consumes the yin of the Lung and Stomach. Excessive worry damages the Kidneys and weakens the qi.• When an individual is constitutionally yin deficient, factors such as prolonged stress or illness, overwork or excessive sexual activity can consume the essence. The result is Kidney yin deficiency that can be mixed with Lung and Stomach yin deficiency symptoms as well as with Kidney yang deficiency.

Herbal medicine treatment

While acupuncture is a distinctive feature of traditional Chinese medicine, China’s herbal medicine has many parallels to, and is a part of the general quest for effective medicines to treat illness. Our ancestors recognised their dependence upon nature in both health and sickness. Led by instinct, taste and experience, they used plants, animal parts and minerals that did not belong to their usual diet.Until well into the 20th century, much of the pharmacopoeia of scientific medicine was derived from just this typeof herbal lore. Today in the United States, about one quarterof the prescriptions dispensed by pharmacies contain atleast one active ingredient derived from plant material.The 20th century has also seen a revival of more natural medicine as an outcome of increasing disenchantment with conventional medicine. By utilising natural substances together in their whole form in accurate formulations, effectiveness will be maximised and side effects minimised. This is contrary to conventional medicine that extracts or synthesises active chemicals that often, over time, produce drastic side effects due to their partiality.The following section lists the herbs and herbal formulationsthat, through time-tested usage and modern pharmacologicalresearch have demonstrated their effectiveness intreating xiao-ke. Two of the more frequent formulas usedfor this purpose in China and Japan today were first describedin the book Jin Gui Yao Lue, written around 200 CE.One is Ba Wei Di Huang Tang (Eight-Ingredient Pill withRehmannia) which was originally prescribed for persons showing weakness, fatigue and copious urination soon after drinking water. In some cases, this may have been diabetes as we know it today. The other is Bai Hu Jia RenShen Tang (White Tiger Plus Ginseng Decoction), which was prescribed for severe thirst and fatigue. This formula,considered ideal for diabetes of recent onset, is used more frequently for this today in Japan than in China2.1.

Representative herbs and formulas for treating according to the three jiao differentiation

Upper jiao

Excessive thirst predominant (Lung yin deficiency).

Treatment Principle: clear heat and moisten the Lung.

Single Herbs

Xi Yang Shen (Radix Panacis Quinquefolii)Zhi Mu (Radix Anemarrhenae Asphodeloidis)Bai He (Bulbus Lilii)Sha Shen (Radix Glehniae Littoralis)Wu Mei (Fructus Pruni Mume)Mai Men Dong (Tuber Ophiopogonis Japonici)Ge Gen (Radix Puerariae)Sheng Di Huang (Radix Rehmanniae Glutinosae)Huang Qin (Radix Scutellariae Baicalensis)Tian Hua Fen (Radix Trichosanthis)

Formulas

1. Bai Hu Jia Ren Shen Tang (White Tiger Plus GinsengDecoction):

Shi Gao (Gypsum), Zhi Mu (RadixAnemarrhenae Asphodeloidis), Zhi Gan Cao (RadixGlycyrrhizae Uralensis), Geng Mi (Semen Oryzae).Action: Tonifies qi, clears qi-level heat, drains Stomach fire,generates fluids, and alleviates thirst.Modifications• substitute Xi Yang Shen (Radix Panacis Quinquefolii) forRen Shen (Radix Ginseng), and omit Geng Mi (SemenOryzae).• combine with Tian Hua Fen (Radix Trichosanthis), LuGen (Rhizoma Phragmitis Communis) and Mai Men Dong(Tuber Ophiopogonis Japonici).

2. Er Dong Tang (Asparagus & Ophiopogon Combination):

Tian Men Dong (Tuber Asparagi Cochinchinensis), MaiMen Dong (Tuber Ophiopogonis Japonici), Tian Hua Fen(Radix Trichosanthis), Zhe Bei Mu (Bulbus FritillariaeThunbergii), Huang Qin (Radix Scutellariae Baicalensis),Gan Cao (Radix Glycyrrhizae Uralensis), Ren Shen (RadixGinseng) and He Ye (Folium Nelumbinis Nuciferae)3.Action: Nourishes yin, generates fluids, clears deficient heat.

3. Mai Men Dong Yin Zu (Ophiopogon and TrichosanthisCombination):

Mai Men Dong (Tuber OphiopogonisJaponici), Zhi Mu (Radix Anemarrhenae Asphodeloidis),Fu Ling (Sclerotium Poriae Cocos), Zhu Ru (Caulis Bambusaein Taeniis), Xi Yang Shen (Radix Panacis Quinquefolii), GeGen (Radix Puerariae), Wu Wei Zi (Fructus SchisandraeChinensis), Tian Hua Fen (Radix Trichosanthis), Sheng DiHuang (Radix Rehmanniae Glutinosae), Gan Cao (RadixGlycyrrhizae Uralensis)4.Action: Nourishes yin, clears Lung heat, relieves coughing.

Middle jiao

Excessive hunger predominant (Stomach yin deficiency).

Treatment Principle: clear Stomach heat and promote fluids.

Single -Herbs

Zhi Mu (Radix Anemarrhenae Asphodeloidis)Huang Lian (Rhizoma Coptidis)Shan Zhi Zi (Fructus Gardeniae Jasminoidis)Sheng Shi Gao (Gypsum)Huang Jing (Rhizoma Polygonati)Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)Mai Men Dong (Tuber Ophiopogonis Japonici)

Formulas1. Yu Nu Jian (Jade Woman Decoction): Shi Gao (Gypsum),Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae),Zhi Mu (Radix Anemarrhenae Asphodeloidis), Mai MenDong (Tuber Ophiopogonis Japonici), Niu Xi (RadixAchyranthis Bidentatae).Actions: Eliminates intense heat or fire from the Stomach; toreplenish the yin.

2. Zheng Yi Cheng Qi Tang (Increase the Fluid and Order theQi Decoction): Da Huang (Rhizoma Rhei), Mang Xiao(Mirabilitum), Xuan Shen (Radix ScrophulariaeNingpoensis), Mai Men Dong (Tuber OphiopogonisJaponici) and Sheng Di Huang (Radix RehmanniaeGlutinosae)5.

Actions: Enriches yin, generates fluids, drains heat andunblocks the bowels

Lower jiao

Excessive urination predominant

1. Kidney yin deficiency

Treatment principle: Nourish and reinforce Kidney yin, eliminate deficiency heat.

Single Herbs

Ze Xie (Rhizoma Alismatis Plantago-aquaticae)Fu Ling (Sclerotium Poriae Cocos)Shan Zhu Yu (Fructus Corni Officinalis)Shan Yao (Radix Dioscoreae Oppositae)Huang Bai (Cortex Phellodendri)Bie Jia (Carapax Amydae Sinensis)Huang Jing (Rhizoma Polygonati)Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

Formulas

1. Liu Wei Di Huang Wan (Six-Ingredient Pill withRehmannia).

2. Zuo Gui Wan (Restore the [Left] Kidney Pill).

3. Da Bu Yin Wan (Great Tonify the Yin Pill)6.

4. Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron,and Rehmannia Pill). Quells ascending yang in the mingmen with such symptoms as frequent small amounts of concentrated dark urine.

2. Kidney yang deficiency

Treatment principle: Tonify Kidney yang; astringe urine.

Single Herbs

Fu Zi (Radix Aconiti Carmichaeli Praeparatae)Ze Xie (Rhizoma Alismatis Plantago-aquaticae)Rou Gui (Cortex Cinnamomi Cassiae)Fu Ling (Sclerotium Poriae Cocos)Shan Zhu Yu (Fructus Corni Officinalis)Shan Yao (Radix Dioscoreae Oppositae)Mu Dan Pi (Cortex Moutan Radicis)Lian Xu (Stamen Nelumbinis Nuciferae)Lian Zi (Semen Nelumbinis Nuciferae)Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

Formulas

1. You Gui Wan (Restore the [Right] Kidney Pill).

2. Jin Gui Shen Qi Wan -(Kidney Qi Pill from the GoldenCabinet).

3. Qi Wei Du Qi Wan (Seven Herbs to Guide the Qi Pills)7:

Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae),Shan Zhu Yu (Fructus Corni Officinalis), Shan Yao (RadixDioscoreae Oppositae), Wu Wei Zi (Fructus SchisandraeChinensis), Mu Dan Pi (Cortex Moutan Radicis), Fu Ling(Sclerotium Poriae Cocos), Ze Xie (Rhizoma Alismatis Plantago-aquaticae) plus

4. Suo Quan Wan (Shut the Sluice Pill).

All replenish the yang [vital function] of the Kidney towarm the lower part of the body and curb excessive urination.

Formula 4 should be combined with either 1, 2 or 3 to further help the Kidney reassert its control over the functions of the Bladder to reduce frequency of urination.

2. General Treatment with Modifications8

The clinical presentation of patients with diabetes can be summarised as yin deficiency with dryness and heat. As an empirical treatment Liu Wei Di Huang Wan (Six-IngredientPill with Rehmannia) together with Yu Nu Jian (Jade WomanDecoction) can be used.

Modifications

• To address high cholesterol add Shan Zha (FructusCrataegi), He Shou Wu (Radix Polygoni Multiflori) andSang Ji Sheng (Ramus Loranthi seu Visci).• To address coronary artery disease add Gua Lou Pi(Pericarpium Trichosanthis), Dan Shen (Radix SalviaeMiltiorrhizae) and Jiang Xiang (Lignum DalbergiaeOdoriferae).

3. Modern Research Formula:“EquilibriumTM”9

EquilibriumTM is a herbal formula developed jointly by professor Xiao-Ping Zhang of Anhui Hospital of TraditionalChinese Medicine and Lotus Herbs Inc. It is an empirical formula designed to treat patients with diabetes mellitus. It has been used successfully for over 30 years in China and has helped several thousands of patients with diabetes mellitus.

Western Therapeutic Action

• Lowers blood glucose

• Lowers blood cholesterol

• Improves blood circulation to the coronary arteries and peripheral parts of the body

Ingredients

Xi Yang Shen (Radix Panacis Quinquefolii)Shi Gao (Gypsum)Zhi Mu (Radix Anemarrhenae Asphodeloidis)Xuan Shen (Radix Scrophulariae Ningpoensis)Huang Qi (Radix Astragali)Shan Yao (Radix Dioscoreae Oppositae)Cang Zhu (Rhizoma Atractylodis)Bai Zhu (Rhizoma Atractylodis Macrocephalae)Dan Shen (Radix Salviae Miltiorrhizae)Hong Hua (Flos Carthami Tinctorii)Lian Zi Xin (Plumula Nelumbinis Nuciferae)Lian Xu (Nelumbinis Nuciferae Stamen)

This formula addresses both the cause of, and the symptoms that arise from, yin deficiency with dryness and heat.

Explanation

Xi Yang Shen greatly replenishes the vital essence of the body and promotes the secretion of body fluids. Shi Gao and Zhi Mu are a commonly used pair to treat heat in the middle jiao. Together they sedate Stomach fire and relieve thirst by generating fluids. Xuan Shen enters the Lung,Stomach and Kidneys to replenish the vital essence and simultaneously clear heat. Huang Qi and Fu Ling strengthen the Spleen and enhance its function of transportation and transformation. Bai Zhu and Cang Zhu strengthen theSpleen and dry up dampness. Dan Shen and Hong Hua activate blood circulation and enhance the overall effectiveness of the herbs. Activation of blood circulation will also reduce the risk of atherosclerosis by preventing build-up of cholesterol on the inner walls of the blood vessels. Lastly Lian Zi Xin and Lian Xu tonify the Kidneys and control frequent urination.

Formula explanation according to modern research

Diabetes mellitus is defined simply as a rise in blood glucose level. Its clinical manifestations, however, are much more complicated than its definition. Patients with diabetes mellitus are frequently plagued by various complications such as visual disturbance, and increase in blood cholesterol and lipid levels.Treatment of diabetes mellitus therefore, must focus on treating the cause and the symptoms simultaneously. XiYang Shen is most commonly used for its effect to tonify qi. In terms of western physiology, tonification of qi enhances the ability of the cells to utilise glucose as energy and prevent synthesis of glucose. Clinically, Xi Yang Shen has demonstrated its effectiveness in lowering blood glucose and cholesterol levels10. Shi Gao and Zhi Mu also lower blood glucose levels and relieve indigestion, whilst XuanShen and Cang Zhu lower blood glucose levels and reduce build-up of cholesterol within the blood vessels. The combination of these herbs has excellent hypoglycaemic effects and reduces the risk of long-term atherosclerosis11.

Dan Shen and Hong Hua are used to improve the blood circulation and minimise long-term complications. Studies have demonstrated that Dan Shen improves micro-circulation to the peripheral parts of the body, increases blood flow to coronary arteries, and lowers both blood cholesterol and blood sugar.

4. Individual Herb Properties

Ze Xie (Rhizoma Alismatis Plantago-aquaticae)

Sweet, bland, cold. Enters the Kidneys and Bladder. Promotes urination, leaches out dampness without injuring yin, and lowers blood pressure and blood glucose. In classical texts Ze Xie is recommended as an adjunctive herb for wasting and thirsting syndrome.

Zhi Mu (Radix Anemarrhenae Asphodeloidis)

Bitter, cold. Enters the Lung, Kidneys and Stomach. Clears heat, quells fire and generates fluids. Combine with TianHua Fen (Radix Trichosanthis).

Tian Men Dong (Tuber Asparagi Cochinchinensis)

Sweet, bitter, cold. Enters the Lung and Kidneys. Moistens the Lung and nourishes the Kidneys; used for patterns of deficiency of Lung and Kidney yin.

Huang Qi (Radix Astragali)

Sweet, neutral. Enters the Spleen, Lung and Heart. Strengthens the Spleen and benefits qi. Used for deficient Spleen and Stomach with fatigue and lack of appetite. Tonifies the Lung and stabilises the exterior. Combine with Shan Yao and Sheng Di Huang (Radix Rehmanniae Glutinosae) for wasting and thirsting.

Cang Zhu (Rhizoma Atractylodis)

Acrid, bitter, warm, aromatic. Enters the Spleen and Stomach.Dries dampness and strengthens the Spleen. Initially raises blood glucose then significantly lowers it.

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Bitter, sweet, warm. Enters the Spleen and Stomach. Tonifies the Spleen and benefits qi, dries dampness. Used for such symptoms as fatigue, poor appetite, nausea. Increases assimilation of glucose and lowers plasma glucose levels.

Dang Shen (Radix Codonopsis Pilosulae)

Sweet, neutral. Enters the Spleen and Lung. Strengthens qi,nourishes fluids, tonifies the middle jiao. In general the functions of this herb are analogous to Ren Shen (RadixGinseng) although not as strong. Clinically used to tonify the qi of the Spleen and Lung. Dang Shen has a vasodilatory effect on terminal blood vessels.

Shi Hu (Herba Dendrobii)

Sweet, slightly salty, bland, cold. Enters the Stomach, Lungand Kidneys. Nourishes deficient Stomach yin. Combine with Mai Men Dong (Tuber Ophiopogonis Japonici) and Tian Hua Fen (Radix Trichosanthis) for abdominal discomfort associated with Stomach yin deficiency.

Shan Yao (Radix Dioscoreae Oppositae)

Sweet, neutral. Enters the Spleen, Lung and Kidneys. Benefits the Lung and nourishes the Kidneys (yin and yang).Combine with Tian Hua Fen (Radix Trichosanthis) for irritability and thirst associated with injured fluids.

Ren Shen (Radix Ginseng)

Sweet, slightly bitter, slightly warm. Benefits yin and generates fluids. Tonifies the Lung and benefits qi; strengthens the Spleen and Stomach; benefits the Heart and calms the spirit. Some patients can lower their insulin requirement by taking this herb.

Gan Cao (Radix Glycyrrhizae Uralensis)

Sweet, neutral (raw); sweet, warm (honey-baked). Enters all twelve primary channels (principally the Stomach and Spleen). Tonifies the Spleen and benefits qi: commonly used for Spleen deficiency patterns.

Gou Qi Zi (Fructus Lycii Chinensis)

Sweet, neutral. Enters the Liver and Kidneys. Nourishes and tonifies the Liver and Kidneys; used for yin and blood deficiency.

Di Gu Pi (Cortex Lycii Chinensis Radicis)

Sweet, cold. Enters the Lung, Kidneys and Liver; quells fire from yin deficiency, alleviates cough from Lung heat, lowers blood pressure. First slightly raises serum glucose then steadily lowers it; does not counteract the hyperglycaemic effect of adrenaline.

Sang Shen Zi (Fructus Mori Albae)

Sweet, cool. Enters the Liver and Kidneys. Nourishes yinand blood. Combine with Ji Xue Teng (Radix et CaulisJixueteng) for yin deficiency.

Mai Men Dong (Tuber Ophiopogonis Japonici)

Sweet, slightly bitter, slightly cold. Enters the Lung, Stomach and Heart. Nourishes yin and clears heat. Experimentally has lowered serum glucose, speeded recovery of Islets of Langerhans, and increased glycogen storage levels inrabbits with artificially induced diabetes mellitus.

Huang Bai (Cortex Phellodendri)

Bitter, cold. Enters the Kidneys, Bladder and Large Intestine.Eliminates heat and dampness, sedates fire and detoxifies,reduces deficiency heat. Increases pancreatic secretions,lowers blood pressure and blood sugar.

Huang Jing (Rhizoma Polygonati)

Sweet, neutral. Enters the Spleen and Lung. Tonifies the Spleen; used for deficiency of Spleen or Stomach and debility after prolonged illness. Tonifies essence after a chronic wasting disease. Combine with Shan Yao (Radix Dioscoreae Oppositae) and Huang Qi (Radix Astragali).

Yu Zhu (Rhizoma Polygonati Odorati)

Sweet, slightly cold. Enters the Lung and Stomach. Nourishes yin and moistens dryness. Used for Lung and Stomach dry heat or deficient yin patterns with cough, dry throat,irritability, thirst and intense hunger, and

He Shou Wu (Radix Polygoni Multiflori)

Bitter, sweet, astringent, slightly warm. Enters the Liverand Kidneys. Tonifies the Liver and Kidneys, nourishes blood, benefits the essence; used for deficient yin or blood patterns. Decreases absorption of cholesterol; initially increases serum glucose, then lowers it.

Fu Ling (Sclerotium Poriae Cocos)

Sweet, bland, neutral. Enters the Heart, Spleen and Lung.Strengthens the Spleen and harmonises the middle jiao;transforms phlegm and eliminates dampness.

Wu Mei (Fructus Pruni Mume)

Sour, warm. Enters the Liver, Spleen, Lung and Large Intestine. Generates fluids, alleviates thirst: used for thirst from deficiency heat or deficient qi and yin. Combine withTian Hua Fen (Radix Trichosanthis) for thirst and irritability from injured fluids.

Ge Gen (Radix Puerariae)

Sweet, acrid, cool. Enters the Spleen and Stomach. Nourishes fluids and alleviates thirst, especially from Stomach heat. Combine with Tian Hua Fen (Radix Trichosanthis) and Mai Men Dong (Tuber Ophiopogonis Japonici) for thirst.

Xi Yang Shen (Radix Panacis Quinquefolii)

Sweet, bitter, cool. Enters the Lung, Stomach and Kidneys.Benefits qi, generates fluids and nourishes yin; especially good for deficient yin with heat signs such as weakness,irritability and thirst. Combine with Shi Gao (Gypsum) and Zhi Mu (Radix Anemarrhenae Asphodeloidis) for thirst where fluids are injured.

Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

Sweet, slightly warm. Enters the Liver, Kidneys and Heart.Nourishes the yin especially of the Kidneys. Lowers blood pressure and serum cholesterol.

Sheng Di Huang (Radix Rehmanniae Glutinosae)

Sweet, bitter, cold. Enters the Liver, Kidneys and Heart.Clears heat, cools blood, nourishes yin and blood and generates fluids. Used for deficient yin patterns with heat signs and injury to body fluids. Lowers serum glucoselevels. Combine with Xuan Shen (Radix crophulariae Ningpoensis) for excessive thirst, irritability and a scarlet tongue.

Wu Wei Zi (Fructus Schisandrae Chinensis)

Sour, warm. Enters the Lung and Kidneys. Restrains essence.Used for deficient Lung and Kidney patterns. Calms the spirit. Recent reports state this herb increases usage of both liver glycogen stores and serum glucose. Combine with Dang Shen (Radix Codonopsis Pilosulae) and Mai Men Dong (Tuber Ophiopogonis Japonici) for symptoms associated with exhaustion from qi and yin.

Xuan Shen (Radix Scrophulariae Ningpoensis)

Salty, slightly bitter, cold. Enters the Lung, Stomach and Kidneys. Nourishes yin, clears heat. Lowers blood sugar,dilates blood vessels.

Tian Hua Fen (Radix Trichosanthis)

Bitter, slightly sweet, sour, cool. Enters the Lung and Stomach.Quells heat, promotes fluids. Combine with Sha Shen(Radix Glehniae Littoralis), Mai Men Dong (Tuber Ophiopogonis Japonici) and Sheng Di Huang (Radix Rehmanniae Glutinosae) for injury to yin from Stomach heat.

5. Review of herbs with hypoglycaemic effects12

Wu Jia Pi (Cortex Acanthopanacis Radicis)

Cang Zhu (Rhizoma Atractylodis)

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Ze Xie (Rhizoma Alismatis Plantago-aquaticae)

Ren Shen (Radix Ginseng)

Di Gu Pi (Cortex Lycii Chinensis Radicis)

Mai Men Dong (Tuber Ophiopogonis Japonici)

Huang Bai (Cortex Phellodendri)

He Shou Wu (Radix Polygoni Multiflori)

Huang Jing (Rhizoma Polygonati)

Sheng Di Huang (Radix Rehmanniae Glutinosae)

Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae)

Xuan Shen (Radix Scrophulariae Ningpoensis)

6.Herb pairs with hypoglycaemic effects13

• Zhi Mu (Radix Anemarrhenae Asphodeloidis) and ShiGao (Gypsum): best used when there is Stomach heatpresent.

• Xuan Shen (Radix Scrophulariae Ningpoensis) and CangZhu (Rhizoma Atractylodis): best used when there is yindeficiency with excessive damp present.

• Shan Yao (Radix Dioscoreae Oppositae) and Huang Qi(Radix Astragali): best used when Spleen deficiency symptomsare present. Do not use the honey-processed Mi Huang Qi.

7. Example of a herbal prescription14

Basic formula

Ren Shen (Radix Ginseng) 6-10gDang Shen (Radix Codonopsis Pilosulae) 30gSheng Shi Gao (Gypsum) 30gZhi Mu (Radix Anemarrhenae Asphodeloidis) 10gHuang Lian (Rhizoma Coptidis) 10gE Jiao (Gelatinum Asini) 10gBai Shao (Radix Paeoniae Lactiflorae) 18gTian Hua Fen (Radix Trichosanthis) 15-30gGe Gen (Radix Puerariae) 30gShan Yao (Radix Dioscoreae Oppositae) 15gHe Shou Wu (Radix Polygoni Multiflori) 30gDan Shen (Radix Salviae Miltiorrhizae) 15gChuan Xiong (Radix Ligustici Wallichii) 12gHuang Jing (Rhizoma Polygonati) 15-30gMai Men Dong (Tuber Ophiopogonis Japonici) 15-30gTian Men Dong (Tuber Asparagi Cochinchinensis) 15gSheng Di Huang (Radix Rehmanniae Glutinosae) 15g

Modifications

• Upper jiao symptoms predominant: add Bai He (BulbusLilii) 10g, Wu Mei (Fructus Pruni Mume) 10g, Tian Hua Fen(Radix Trichosanthis) 30g, Sha Shen (Radix GlehniaeLittoralis) 30g.

• Middle jiao symptoms predominant: add Shu Di Huang(Radix Rehmanniae Glutinosae Conquitae) 30g, Shi Gaoconstipation.(Gypsum) 30g, Huang Jing (Rhizoma Polygonati) 15g.

• Lower jiao symptoms predominant: add Rou Gui (CortexCinnamomi Cassiae) 6g, Fu Zi (Radix Aconiti CarmichaeliPraeparatae) 6-10g, Hong Shen (Radix Ginseng) 15g.

• If thick greasy yellow tongue coating: add Cang Zhu(Rhizoma Atractylodis) 15g, Bai Zhu (Rhizoma Atractylodis Macrocephalae) 20g, Jin Qian Cao (Herba Jinqiancao) 30g.

• If loose stools or diarrhoea: add Yi Yi Ren (Semen CoicisLachryma-jobi) 30g, Mu Xiang (Radix Saussureae seuVladimirae) 15g. Subtract: Sheng Di Huang (Radix RehmanniaeGlutinosae).

• If blood stagnation and pain: add Tao Ren (Semen Persicae)10g, Hong Hua (Flos Carthami Tinctorii) 6g.

The above formula, with additions and subtractions, is provided only as a general guide since each patient’s signs and symptoms must be considered when prescribing thei rown individualised formula. The formula represents a one day’s dose. Herbs are combined in a non-reactive, glass or ceramic cooking pot covered with water and brought to aboil. Reduce to simmer for 20-30 minutes with lid slightly ajar. Strain off liquid and repeat process a second time,simmering the herbs 30-40 minutes. Combined brewing should result in 3-4 cups of liquid. Drink warm or hot.

8. General patent formulas for diabetes

The traditional method of preparing Chinese medicine is to boil and simmer raw herbs in an earthen ware pot in accordance with strict instructions. Preparation and actual consumption of the medicine can take one to three hours. To make it more convenient, and to help insure patient compliance,medicinal formulations are now prepared for use in more than 30 different intake forms. These include pills,powders, granules, tablets, capsules, gelatins, medicinal wines and waters, medicinal teas, oral liquids, syrups,sprays, concentrates, injections and plasters.

Following is a partial listing of Chinese patent formulations currently used for the treatment of diabetes and its complications. Inclusion does not imply endorsement by the author, rather they are offered for the reader’s further investigation and study.

Ci Wu Jia Pian

A single herb (Acanthopanax senticosus) patent used tosupport endocrine gland functions in general and particularly in order to increase insulin production and to decrease blood sugar. A member of the Araliaceae family, and analogous to Siberian Ginseng (Eleutherococcus senticosus), this herb has been used for over 2000 years for its adaptogenic(normalising) and energising properties.

Specific Juk Tsyn Wan

Produces saliva, quenches thirst; relieves fever, alleviates mental uneasiness; vitalises blood activity, nourishes the Kidney; invigorates the nervous system and improves appetite.

Kwang chow United Manufactory of Chinese Medicine,PRC Yuechung Pills, a.k.a. Yu Quan Wan [Jade Spring Pills]

Nourishes yin, strengthens the Kidneys, Lung, and Spleen;dispels phlegm-heat; relieves thirst; circulates fluid; regulatesthe appetite; calms the spirit. A classical formula for“sugar urine disease”, used for both juvenile and insipiddiabetes in mainland China. The United Pharmaceutical Manufactory, Sichuan, PRC.

Xiaoke Wan, a.k.a. “Diabetes Pill”15

Widely prescribed in Chinese hospitals and clinics todayfor reducing glucose levels and alleviating symptoms ofdiabetes and other related diseases. Xiaoke Wan has proven to be especially effective for treating mild and moderate cases of diabetes in which the pancreas is still partially functioning. The herbal components are Shu Di Huang(Radix Rehmanniae Glutinosae Conquitae), Huang Qi (RadixAstragali) and Tian Hua Fen (Radix Trichosanthis)which have the action of nourishing the Kidneys and yin,benefiting qi and promoting the production of fluids. In addition it also includes a small amount of the oral antidiabetic drug Glibenclamide. Zhong Yi Brand, Guangzhou Pharmaceutical Company Ltd., PRC. (see Appendix: ClinicalResearch).

Yu Xiao San 880516

Designed to restore pancreatic function and to proliferate insulin beta cells, Yu Xiao San has been shown to gradually and effectively lower blood-sugar levels and increase insulin secretion. In addition it has been shown to regulate carbohydrate metabolism, improve blood circulation, lower blood cholesterol and increase immune response. The main herb components are Ramulus Euonymi Alatae, Niu BangZi (Fructus Arctii Lappae), Wei Ling Xian (Radix ClemetidisChinensis), Di Gu Pi (Cortex Lycii Chinensis Radicis), EZhu (Rhizoma Curcumae Zedoariae), Jie Geng (RadixPlatycodi Grandiflori), Li Zhi He (Semen Litchi Chinensis)and Ren Shen (Radix Ginseng). This patent is currently also being produced in the US and marketed as a health food.(see Appendix: Clinical Research).

Sugar-Reducing and Pulse-Invigorating Capsule17

Effective in replenishing qi, nourishing yin, activating blood,and resolving stagnation. It has been proven clinically effective in correcting abnormalities in blood rheology,improving fat metabolism, enhancing the function of the islets of Langerhans, lowering blood sugar and alleviating clinical symptoms of diabetes. The formulation, which includes such herbs as Huang Qi (Radix Astragali) and Sheng Di Huang (Radix Rehmanniae Glutinosae), is noted for its effectiveness against the chief vascular complications of diabetes by reducing myocardial anoxia, (oxygen deprivation of heart tissue), improving left heart function, stimulating blood circulation to the brain, resisting coagulation,resolving thrombosis, and dilating the arteries of the legs. It also has some proven benefit in early diabetic retinopathy and renal disease. (see Appendix: Clinical Research).

Ji Wei Ling capsules, Zhong Ji Ling powders and others18

A group of herbal preparations produced by the Special Department of Diabetes Medical Research, Xi Yuan Hospital to treat diabetic cardio-cerebral vascular disease and diabetic neuropathy. Statistics include 3,690 cases with complete medical records that demonstrate an overall effective rate of 95.2%. Many patients were noted to have regained their health to a degree where they were able to discontinue western medicine and insulin, thereby greatly decreasing their chances of diabetic complications. (see Appendix:Clinical Research).

Appendix: Clinical Research

Testing for Effectiveness of Commercially Available Patent medicines

Xiaoke Wan

Indicated in cases of polydypsia, polyuria, polyphagia,emaciation, fatigue, sleeplessness, lumbago, and elevated sugar levels in blood and urine, Xiaoke Wan as a combination herbal and western drug (see footnote) treatment for diabetes, has been the subject of many studies to establish its level of effectiveness. In one recent study (1994) a control group of 22 patients were selected to take Xiaoke Wan as part of a one month clinical study in the treatment of diabetes by acupuncture. At the end of the trial period among the 22 control group participants, 12 cases were rated as effectively treated, 8 cases as markedly effective and 2 cases as ineffective. All but two of the patients showed decline in blood sugar and urinary sugar excretion and improvement in symptoms. More than one-third of the patients had marked improvement. Clearly none of these patients could be considered “cured” of diabetes, which would suggest sustained fasting blood-sugar levels below100mg/dl, but as previous studies confirmed, Xiaoke Wan was demonstrated to be quite effective. “Markedly effective”was defined as having initial symptoms essentially disappear and their fasting blood-sugar levels drop to below 130mg/dl, and the 24-hour urine-sugar content was reduced by 30% or more compared to the beginning of treatment. For those deemed “effectively treated” symptoms were improved but not resolved, and fasting bloodsugar levels dropped to below 150mg/dl and the 24-hour urinary excretion declined by at least 10% from initial values. If these standards were not met the treatment was deemed ineffective.

Yu Xiao San 8805

From Feb. 1992 to Oct. 1992, 10,618 cases were selected based upon the diagnostic criteria established for diabetes mellitus by the World Health Organization. The patients were drawn for clinical assessment from the China Beijing Chao Yang District Red Cross Hospital and from 48 comparable hospitals nationwide.

Treatment Criteria

• Clinical recovery: The preferred criterion: FPG (FastingPlasma Glucose) <6.1 mmol/L (110 mg/dl), HbA1c <6.8%;symptoms and complications recovery; discontinuing medicationafter 3 months or more.• Prominent Effect: FPG <7.8 mmol/L (140 mg/dl), HbA1c<8%; symptoms improved and complications reduced.• Effective: FPG reduced 3.33 mmol/L (60 mg/dl), HbA1c <9%.• Ineffective: No evidence of symptom improvement andreduction of criteria established for diabetes mellitus.

Results

After 4 months of treatment and monitoring, of patientswith Type 1 diabetes, 84 (6.80%) demonstrated clinicalrecovery, 106 (8.58%) prominent effect, 144 (11.65%) someeffect, and 902 (72.98%) no effect. Over the same period,1794 (19.12%) patients with Type 2 diabetes demonstratedclinical recovery, 2346 (25.01%) prominent effect, 3835(40.88%) some effect, and 1407 (15.00%) no effect. Overall totals were 1,878 (17.69%), 2,452 (23.09%), 3,979 (37.47%)and 2,309 (21.75%) respectively.

Two Case Reports

• Mrs. W.Age: 56; height: 5’6"; weight: 150 lbs.1990.5: Tested blood glucose at 200mg/dl, diagnosed asDiabetes II, took oral hypoglycaemics two tablets twice aday.1994.9.10: Began treatment with Yu Xiao San 8805 twotablets four times a day, and continued oral hypoglycaemics.1994.9.25: FPG level at 140-160mg/dl.1994.10.12: FPG was 112-140/dl. Reduced oralhypoglycaemics to one tablet.1994.11.12: Stopped oral hypoglycaemics. Fasting bloodglucose was 93-136mg/dl.1994.12.12: FPG was 90-128mg/dl. Continued Yu Xiao Sanfor three months for consolidation.Up to 1995.8: Monthly monitored blood glucose level 100-110mg/dl.

• Mr. G.Age: 44; height: 5’7"; weight: 152 lbs.1990.6: Rapid weight loss, tested blood glucose at 405mg/dl, diagnosed as Diabetes I, hospitalised on insulin injection,20 units once a day.1992.8.20: FPG was 117mg/dl. Started Yu Xiao San 8805 twotablets four times a day and continued injection.1992.9.5: FPG 115-120mg/dl.1992.10.5: FPG 105-109mg/dl, lower blood sugar reaction.Reduced insulin 4 units.1992.10.29: FPG 90-111mg/dl. Reduced insulin 4 units.1992.11.20: FPG 95-115mg/dl. Reduced insulin 2 units.1993.1.15: FPG 90-120mg/dl. Stopped injection and continued Yu Xiao San 8805 two tablets four times a day for three month consolidation.Up to 1995.8: Maintained blood glucose level 90-140mg/dlafter discontinuance of any medication.

Yu Xiao San 8805 was developed by Dr. Chong Lianjin,Director of The Red Cross Hospital in Beijing, as a herbal product to restore pancreatic function and to increase insulin beta cells. It has undergone experimental tests both in China and the United States with good results and has been used by diabetics in over fifty countries worldwide. No adverse or allergic reactions have been reported from its use nor has damage to the liver, kidney or any other organs. It is currently used by the Asian Diabetes Association, RedCross Hospital in Beijing and several State Hospitals inChina as a medical treatment for Type II Diabetes.

The following is excerpted from a study appearing in 1994 on the effectiveness of Sugar-Reducing and Pulse-Invigorating Capsule in treating vascular complications of diabetes. It was conducted at the Guang An Men Hospital,China Academy of Traditional Chinese Medicine, Beijing.The effect of the formula on the signs and symptoms,biochemistry, haemodynamics, and the fibrinolytic system were observed and the results compared with those in a 159 patient control group who did not receive the capsule. All patients under observation were non-insulin dependent diabetics with fasting blood sugar of between 150-240mg/dl, and had one of the following complications: vascular hypertension, coronary heart disease, cerebro vascular disease, vascular disease of the extremities, retinopathy, or renal disease. Blood stasis was diagnosed when there were two of the following symptoms and signs, or there was one symptom or sign along with one abnormal laboratory finding, or there were two or more abnormal laboratory findings. Symptoms and signs included cyanosis or ecchymosis over the face, lips or tongue, sublingual engorged veins, precordial (heart) pain, numbness or cold aching in the extremities with cyanosis of the toes, blurring of vision,dizziness and headache, amnesia or dementia, dysarthria(imperfect speech articulation due to damage to the peripheral nervous system) and hemiplegia, and a hesitant,slow pulse with missing beats, or a deep or very slow pulse.The abnormal laboratory findings included increased blood coagulability, abnormal blood rheology, decrease infibrinolytic activity, increased platelet aggregation, and impediment to the microcirculation. The study group consisted of 625 diabetic patients most of which had been diagnosed as having both deficiency of qi and yin with concurrent blood stasis. Two control groups were used with the first taking dimicron 80mg 2-3 times a day and the other a tablet prepared by the Academy plus a Western oral hypoglycaemic agent. For purposes of the study a 3 month duration of treatment was established.

Results Criteria

• Marked Improvement: after 3 months of treatment, thesigns and symptoms basically subsided, 5 items of theblood rheology and 2 items of the fibrinolytic system wereimproved, fasting blood sugar < 110mg/dl, urine sugar in24 hrs < 5g, or blood sugar and urine sugar were lowered by50% or more as compared with pre-treatment values.• Effective: after 3 months of treatment, signs and symptomswere distinctly reduced, 4 or more items of the bloodrheology and fibrinolytic system improved, fasting bloodsugar <150mg/dl, urine sugar dropped by 30% or more ascompared with pre-treatment values.• Ineffective: after 3 months of treatment, the above criteriaof effectiveness were not met.

Results

After 3 months of treatment and monitoring, of 625 patientswho took the Sugar-Reducing and Pulse-Invigorating Capsule,95 (15.2%) experienced marked improvement, 388 (62.08%)experienced effective results, and 142 (22.72%) were ineffective.In the two control groups, results were: 1. of 57cases, 6 (10.52%), 31 (54.39%) and 20 (35.09%); 2. of 102 cases,10 (9.81%), 57 (55.88%) and 35 (34.31%).An analysis of the difference in therapeutic efficacy amongthe various TCM diagnostic types showed that cases with deficiency of both qi and yin had a general efficacy of81.89%, while those with i. predominance of yin deficiency and heat, and ii. deficiency of both yin and yang, were 63.38% and 63.03% respectively, indicating that the capsule was best suited for cases with deficiency of both qi and yin.As for the relationship between the course of treatment and its efficacy, it was observed that when the capsule was administered for 1-3 years or longer, there was a gradual increase in its effectiveness, showing the lasting and steady action of the capsule.

Summary

The authors report that vascular disease in diabetes and the symptom-complex of blood stasis in traditional Chinese medicine share the same pathological basis, namely impediment to circulation causing blood stagnation. The proportion of cases with vascular disease and blood stagnation within the diabetic population varies, with its distribution increasing in the order of i. yin deficiency with heat preponderance,ii. deficiency of both qi and yin, and iii. deficiency of both yin and yang. It was observed that the severity of the complications also increase in that order, indicating that both the modern medical classification of vascular disease and the TCM symptom complex of blood stasis followed rules of distribution common to both and had a common trend toward development. Vascular disease and the symptom-complex of bloodstasis are considered to be two different expressions of the same pathological change, the latter being the clinical manifestation of the former, and the former the pathologic basis of the latter, the two being reciprocally causative. Diagnosis of signs and symptoms indicate that deficiency of yin is the basis for diabetes, deficiency of both qi and yin is the basic diagnostic type of the disease, and blood stasis is its chief accompanying symptom complex. Therefore, replenishing qi, nourishing yin, and invigorating the blood are the main treatment principles for vascular disease in diabetes. Replenishing qi plays the leading role, nourishing yin the supportive role, and invigoration of blood the required role, the three working together to counteract the pathogenic factors and reinforce the body resistance at the same time

In the 625 cases of diabetes the capsule was shown to correct normalities in the blood rheology, haematocrit,erythrocyte sedimentation rate, platelet aggregation, fibrinogen and fibrin decomposition products, improve lipid metabolism, increase the function of the islets of Langerhans cells, lower blood sugar and alleviate clinical symptoms.The total effectiveness reached 77.28%.Clinical observation of the effect of the capsule on the chief vascular complications showed that it had the actions of nourishing yin and replenishing qi of the Heart, reducing myocardial ischaemia and anoxia, eliminating abnormalities in the ECG and improving functioning of the left heart.Brain CT proved that the drug had the actions of invigorating the blood, resisting blood coagulation and dissolving thrombosis, thereby improving blood circulation to the brain tissue and playing a beneficial role in cerebral infarction.Ultrasonic Doppler testing showed that the formulation could dilate the arteries of the lower extremities and increase their blood flow. Fluorescein angiography of the ocular fundus (concave interior of the eye) and ophthalmoscopic examination showed that the formula was effective in the prevention and treatment of early diabetic retinopathy. It also somewhat improved the relevant biochemical indices and clinical symptoms of renal complications of diabetes.Administering the formula did not harm the heart, liver,kidney or any other internal organs and is considered to bea safe and effective traditional Chinese medical preparation for prevention and treatment of vascular complication of diabetes.Ji Wei Ling capsules, Zhong Ji Ling powders, Jin Li Da oralliquids, Jin Li Da powders, and Tong Xin Luo capsulesUnder the leadership of Wu Yi Ling, Medical Director of theDiabetes Research Institute in Xi Yuan Hospital, anotherapproach to the pathology and treatment of diabetes withTCM has been developed, namely that the pathology ofdiabetes lies in the abnormal function of the Spleen. This leads to imbalance and disorder of fluid transportation and utilisation, thereby hampering normal absorption of nutrient seven though the diet may be more than adequate. Great thirst, despite drinking copious amounts of water, is caused by the Spleen’s inability to transport fluid to the Lung.Emaciation is caused by the Spleen’s inability to move fluid(food essence) from the Stomach. This gradually leads to i.Spleen and Kidney deficiency, ii. deficiency of yin andyang, and iii. blood stagnation. Blood stagnation alone may lead to such serious complications as stroke, hemiplegia and heart disease. It was noted that the treatment approach developed for diabetes at the Diabetes Research Institute therefore encompassed more than the traditional idea of “invigorating yin and clearing away heat”. On the basis of the above observations a series of herbal preparations have been formulated.

9. Clinical notes

• Non-insulin dependent diabetes mellitus: Prescribed herbs in therapeutic dosages, in combination with a sound diet and exercise program, provide clinically effective results often within 3 to 4 weeks. Clinical effectiveness is defined as a significant reduction in blood glucose level with less fluctuation throughout the day.

• Herbal medical treatment should always overlap with western medical treatment for at least 1 to 2 weeks before the dosage of any conventional diabetic drugs can be reduced.

• Patients should never discontinue taking conventional diabetic drugs abruptly, as there is risk of developing hyperglycaemia or diabetic ketoacidosis.

• Insulin dependent diabetes mellitus: Prescribed herbs in therapeutic dosages can help reduce the dosage and frequency of insulin injections, however it can never totally replace the need for supplemental insulin in insulin dependent patients.

Notes

1 A detailed discussion of the patho-mechanisms involved inXiao-Ke can be found in Part II of this article (published in theJournal of Chinese Medicine issue 59, January1999.2 Dharmananda, Subhuti, Institute for Traditional Medicine (itmOnline), Rev. Sept. 1996. http://www.europa.com/~itm/index.html3 Chen, John K., Treatment of Diabetes Mellitus with ChineseHerbs, Lecture Notes presented in conjunction with CAAOMand Lotus Herbs, Inc., 1998. Contact Lotus Herbs at UStelephone (626) 916-1070.4 Hsu, Hong-Yen, and Hsu, Chau-Shin, Commonly UsedChinese Herb Formulas with Illustrations, Oriental Healing ArtsInstitute, 1980.5 Chen, J. K., Treatment of Diabetes Mellitus with Chinese Herbs.6 Li Cheng-Yu, Fundamentals of Chinese Medicine, East AsianMedical Society, Paradigm Pub. 1985.7 Chen, J., Treatment of Diabetes Mellitus with Chinese Herbs.8 Ibid.9 Ibid.10 Yen, Zheng Hua et al. American Ginseng, Chinese Herbology,Zhiyin Publishing Company, 1998, p 738.11 Zhang, Xiao Ping, Treatment of Endocrine Disorders withHerbs, Presentation given by Professor Zhang at seminarhosted by California Association of Acupuncture and OrientalMedicine, July 1998.12 Hsu, Hong-Yen, and Kuwaki, Takahide, Diabetes Mellitus andChinese Herb Formulas, Bulletin of the Oriental Healing ArtsInstitute, Vol 3, No.1, p.13, 1978.13 Chen, J., Treatment of Diabetes Mellitus with Chinese Herbs.14 Herb Formula provided by Heming Gu, Acupuncturist and Herbalist, Los Angeles, CA15 Chen DC, Gong DQ, and Zhai Y.,

Journal of Traditional Chinese Medicine 14(3): 163-166, 1994.

16 China Guide Web site at http://www.china-guide.com/health/diabetes.html17 Lin L, et al., A Clinical Study on Treatment of VascularComplications of Diabetes with the Sugar-Reducing and Pulse-Invigorating Capsule, Journal of Chinese Medicine 14(1): 3-9,1994.18 Window on China Web site at http://china-window.com/zhongy/zyxxzx/yl/eylyjs.htmlAdditional bibliography1 Yeung, Him-Che, Handbook of Chinese Herbs and Formulas Vol.II

, Institute of Chinese Medicine, 1996.2 Fratkin, Jake, Chinese Herbal Patent Formulas-A Practical Guide,Institute for Traditional Medicine, 1986.3 Bensky, D. et al., Chinese Herbal Medicine-Materia Medica,

Eastland Press, 1986.4 Bensky, D. et al, Chinese Herbal Medicine-Formulas andStrategies, Eastland Press, 1990.

Clinton J. Choate, L.Ac., MTOM, Dip.NBAO, received his traditionaloriental medical training in both the US and China. He has been inprivate practice in Santa Monica, California for the last 10 years.

MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE

04/17/2013 16:06:00

MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE

DIABETES MELLITUS (PART TWO)

by Clinton J. Choate

There are two words in the Chinese language for diabetes:the traditional medical name ‘xiao-ke’ which means “wasting and thirsting”, and the modern term ‘tang-niao-bing’ which means “sugar urine illness”. Discussion of diabetes by its traditional name appears in all the earliest texts,including the Yellow Emperor’s Inner Classic (Neijing).

Traditionally, it is divided into three types: upper, middle and lower. Each type reflects the predominance of one of the three main symptoms (thirst, hunger, and excessive urination)and is intimately related to the Lung, Spleen and Kidneys respectively. Yin deficiency is usually associated with all three types. A traditional diagnosis of wasting and thirsting may include illnesses besides the modern entity of diabetes and vice-versa i.e. someone with tang-niao-bing (i.e. diabetes) would not necessarily have xiao-ke. For the purposes of this discussion, diabetes mellitus will be analysed according to the traditional category of xiao-ke or wasting and thirsting disease. It is believed to be related to eating fatty or sweet foods in excess, to emotional disturbances and to a constitution that is yin deficient.

According to TCM, irregular food intake in the form of over-consumption of fatty, greasy, pungent and sweet food,hot drinks and alcohol impairs the transportive and transformative functions of the Spleen and Stomach, which in turn generates internal heat. The accumulated food turns into heat that consumes fluids thereby creating thirst and hunger. In the

Simple Questions (Su Wen) it is explained that “ ... fat causes interior heat while sweetness causes fullness in the middle burner. The qi therefore rises and overflows and the condition changes into that of wasting and thirsting”1.

Long-term internal heat injures yin and consumes bodyfluids. When body fluids are consumed, they fail to nourish the Lung and Kidneys. The pathological changes seen in diabetes therefore always include yin deficiency and dryheat. These factors mutually influence each other: yin deficiency leads to dry heat, dry heat to yin deficiency.Prolonged emotional disturbance may contribute to wasting and thirsting by hindering the flow of qi. Over-thinking damages the Spleen whilst anger, resentment and frustration lead to constrained Liver qi. Stagnant Liver qi transforms into fire, which then consumes the yin of the Lung and Stomach. A passage from the Spiritual Axis (Ling Shu) elaborates “The five inner [yin] organs are soft and weak and prone to symptoms of wasting heat. When there is something soft and weak there must be something hard and strong. Frequent anger is hard and strong and the soft and weak are thereby easily injured”2.

• When dry heat consumes Lung fluid, the ‘Lung fire’ gives rise to great thirst, with the consumption of large quantities of water and a dry mouth. The tongue is red with a yellow coating and the pulse floating and rapid.

• When heat is retained in the Stomach and Spleen there is excessive appetite and constant hunger. Large appetite and excessive eating, thinness and constipation characterise ‘Stomach fire’. The tongue is red with a yellow coating andthe pulse rapid.

• When a person is constitutionally yin deficient, overwork,prolonged stress or illness, excessive sexual activity and pregnancy can consume the essence. The result is deficiency of Kidney yin which can in turn lead to blazing of Kidney fire. ‘Kidney fire’ is characterized by frequent,copious urination, cloudy urine (as if containing grease),progressive weight loss, dizziness, blurred vision, soreback, ulceration or itching of the skin, and vaginal itching.The tongue is red with scanty or no coating and the pulse is fine and rapid. All three patho-mechanisms involve the mutual exacerbation of yin deficiency and dry heat scorching Kidney yin essence and the fluids of the Lung and Stomach. Yin deficiency is primarily associated with the Kidneys, andaccording to the principle that detriment to yin affects yang,Kidney yang deficiency is also invariably observed in prolonged cases. Therefore xiao-ke syndrome may also occur when there is deficiency of Kidney yang.

Differentiation and treatment according to the three burners

By analysis of the patient’s overall symptoms it should become apparent which organ, whether the Lung, Spleen orKidneys, is the most yin deficient. The focus of the treatment can then be established as concentrating upon relieving deficiency heat in the upper, middle or lower burners.Although there are usually combinations of patterns seen in the diabetic, such as Lung qi and yin deficiency with phlegm and heat, for simplicity the focus will remain with the classical differentiation of yin deficiency in the three burners.

Upper Burner

For upper wasting (injury of body fluids by Lung heat) the treatment principle is to strengthen the function of the Lung, tonify yin and clear heat.

Principal clinical manifestations

• excessive thirst or desire for liquids is predominant.Other possible manifestations are• dry throat and mouth• dry cough• hoarse voice• night sweats• emaciation• flushed cheeks• tidal fevers• red tongue with a thin, dry, yellow coating or no coating• thready, or wiry and rapid pulse

Typical points

Feishu BL-13Chize LU-5Gaohuangshu BL-43Yuji LU-10Lianquan REN-23Zusanli ST-36Taixi KID-3

Explanation

Feishu BL-13 clears heat, whether excess or deficient, fromthe Lung and upper warmer and tonifies Lung yin. ChizeLU-5 clears heat from the Lung, alleviates cough andregulates the water passages. Yuji LU-10 clears Lung heatand benefits the throat. Gaohuangshu BL-43 nourishesblood and yin, tonifies deficiency, cools heat and treatsnight sweating. It is said to tonify the Lung, Spleen, Stomachand Kidneys and can thus be used in any of the threepatterns of disharmony, but due to its location in the upperwarmer is most recommended for this pattern, especiallywhen there is great deficiency accompanied by deficiencyheat. Lianquan REN-23 stimulates the production of bodyfluids*.Zusanli ST-36 assists Feishu BL-13 in strengtheningthe Lung according to the principle of tonifying the mother(i.e. a point from the earth Stomach channel) to strengthenthe child (the Lung corresponding to the metal phase). TaixiKID-3 tonifies the Kidneys, nourishes yin and helps supportthe Lung.

Middle Burner

For middle wasting (injury of yin by Stomach dryness) the treatment principle is to clear Stomach dryness and heat and tonify yin.

Principal clinical manifestations

• excessive appetite or propensity to hunger predominates.Other possible manifestations include• halitosis• dry lips• painful swelling or bleeding of the gums• burning sensation in the epigastrium• preference for cold drinks• constipation• red tongue with a thick yellow coating and redulcerous tip• rapid, full pulse

Typical points

Zusanli ST-36Neiting ST-44Sanyinjiao SP-6Neiguan P-6Zhongwan REN-12Pishu BL-20Weishu BL-21Weiguanxiashu (M-BW-12)Taixi KID-3

Explanation

Zusanli ST-36 clears Stomach dryness and benefits Stomach yin and is classically indicated for “heat in the middle warmer with propensity to hunger”4. Neiting ST-44 clears Stomach heat. Sanyinjiao SP-6 benefits the Stomach andtonifies yin and body fluids. Neiguan P-6 regulates themiddle burner and clears heat. Zhongwan REN-12 harmonisesthe middle burner and tonifies the Stomach. PishuBL-20 and Weishu BL-21 benefit the Spleen and Stomachand both were classically indicated for remaining thin despite large food intake5. Weiguanxiashu (M-BW-12) nowadays known as Yishu (Pancreas Shu) was first mentioned in the

Thousand Ducat Formulas by the great 7th century physician

Sun Si-miao for wasting and thirsting disorder. It is able to clear heat and generate fluid 6. Taixi KID-3 tonifies the Kidneys and nourishes yin, and due to the central role of the Kidneys in housing the original yin is able to support the yin of the whole body.

Lower Burner

For lower wasting (exhaustion of Kidney essence and Kidneyyin) the treatment principle is to strengthen the function of the Kidneys and nourish essence.

Principal clinical manifestations

• Excessive urination predominates.Other possible manifestations include• lower lumbar pain• weakness of the legs• constipation• blurred vision• dizziness• malar flush, afternoon fever• poor memory• nocturnal emission• red tongue with scanty coating• thin and rapid pulse

Typical points

Guanyuan REN-4Qihai REN-6Taixi KID-3Rangu KID-2Sanyinjiao SP-6Shenshu BL-23Jingmen GB-25

Explanation

Guanyuan REN-4 benefits essence, tonifies and nourishes the Kidneys and benefits the Bladder. Qihai REN-6 tonifies the Kidney qi. Taixi KID-3 tonifies the Kidneys and nourishesyin. Rangu KID-2 clears deficiency heat and regulates the Kidneys. Sanyinjiao SP-6 benefits the Kidneys and nourishes yin. Shenshu BL-23 tonifies the Kidneys, nourishes yin and essence and treats excessive urination. Jingmen GB-25 (the front-mu point of the Kidney) combines with its back-shu point Shenshu BL-23 to tonify the Kidneys, benefit the water passages and control urination.

Treatment method (for all three patterns)

If possible treat as frequently as daily or every other day.Needles are retained for 30 minutes. Apply reinforcing method mainly. In cases of severe heat, apply reducing method.

Discussion

Patients commonly present with mixed patterns (i.e. symptomsof more than one burner). Treatment should be given according to the predominant clinical manifestations. Where there are clear signs of two of the excesses, e.g. thirst and excessive appetite, treat both. Furthermore additional points may be added according to clinical presentation. Flexibility in treatment is therefore necessary, for example:

• If there is thirst, a yellow dry tongue coating and an overflowing pulse, select points from yangming channel such as Quchi L.I.-11, Jiexi ST-41, Hegu L.I.-4 etc.

• If there is yin deficiency and uprising of yang, with symptoms such as low-grade fever, night sweats, malar flush,deep-red tongue body and a fine and rapid pulse, select Dazhui DU-14 and Yinxi HE-6 to clear deficiency heat.

• If night sweating is severe, add Houxi SI-3.

• Kidney deficiency can lead to qi deficiency. Alternatively heat can consume Stomach yin leading to qi deficiency. In the case of qi deficiency symptoms such as shortness of breath after exertion, spontaneous sweating, and a deep,thready pulse, apply moxibustion to Qihai REN-6 and Guanyuan REN-4.

• In the case of Kidney yang deficiency with cold limbs,lower limb oedema, copious urination, a pale tongue with white coating, and a thready, deep, and weak pulse, apply moxibustion to Mingmen DU-4 and Guanyuan REN-4.

• For increased appetite accompanied by muscle atrophy,add Pirexue (N-BW-10) [0.5 cun lateral to the lower borderof the spinous process of the sixth thoracic vertebra, corresponding to one of the Huatuojiaji (M-BW-35) points],Weishu BL-21 and Zhongwan REN-12.

Note: The following points are indicated for wasting and thirsting disorder in a variety of classical Chinese texts7:Yinshi ST-33, Feishu BL-13, Guanyuanshu BL-26,Xiaochangshu BL-27, Pangguangshu BL-28, Yishe BL-49,Rangu KID-2, Taixi KID-3, Yangchi SJ-4, Renzhong DU-26,Qimen LIV-14, Guanyuan REN-4, Jinjin/Yuye (M-HN-20),Weiguanxiashu (M-BW-12), Xingjian LIV-2, DuiduanDU-27, Chengqiang REN-24, Shenshu BL-23.

Note: The following combinations are indicated for wasting and thirsting disorder in a variety of classical and moderntexts:

• Severe thirst of wasting and thirsting disorder: YongquanKID-1 and Xingjian LIV-2 (Ode of One Hundred Symptoms)8.

• Wasting and thirsting disorder with great desire to drink:Rangu KID-2, Yishe BL-49 and Guanchong SJ-1 (Classic of Supplementing Life with Acupuncture and Moxibustion)9.

• Wasting and thirsting disorder with great desire to drink:Rangu KID-2, Yishe BL-49, Chengjiang REN-24 andGuanchong SJ-1 (Thousand Ducat Formulas)10.

• Wasting and thirsting disorder: Ranggu KID-2, ChengjiangREN-24, Jinjin (M-HN-20), Yuye (M-HN-20), RenzhongDU-26, Lianquan REN-23, Quchi L.I-11, Laogong P-8,Taichong LIV-3, Xingjian LIV-2, Shangqiu SP-5 and YinbaiSP-1 (Great Compendium of Acupuncture and Moxibustion)11.

• Kidney deficiency wasting and thirsting disorder, absence of sweating, difficulty in moving the lumbar spine,distension of the abdomen and pain of the lateral costal region: Yishe BL-49 and Zhonglushu BL-29 (Classic of Supplementing Life with Acupuncture and Moxibustion)12.

• Thirst and emaciation: Chengqiang REN-24, ShentangBL-44, Guanchong SJ-1 and Rangu KID-2 (Prescriptions for Universal Benefit

)13.

• Thirst and emaciation: use up to 100 cones of moxa atGuanyuan REN-4 (Book of Bian Que’s Secrets)14.

Weiguanxiashu (M-BW-12), Feishu BL-13, Pishu BL-20,Shenshu BL-23, Zusanli ST-36 and Taixi KID-3. For excessive thirst add Shaoshang LU-11, Yuji LU-10 and GeshuBL-17. For increased appetite accompanied by emaciation of the muscles add Pirexue (N-BW-10), Weishu BL-21 andZhongwan REN-12. For frequent urination add GuanyuanREN-4, Fuliu KID-7 and Shuiquan KID-5 15.

Ear acupuncture

In auricular diagnosis one can identify subtle problems of the body by detecting areas of the ear which are discoloured,flaky, or have tenderness or high skin conductance.Unilateral pathology is generally represented by ear points on the same side.The practitioner should first stimulate the appropriate local points corresponding to specific body symptoms, for example pain of the foot is treated by selecting the ear region corresponding to the foot, on the ear of the affected side if unilateral and on both ears if bilateral.If a point is not reactive, exhibiting neither increased skin conductance nor heightened tenderness, it is usually omitted from the treatment plan. The master points are then stimulated, followed by the functional points indicated by specific treatment plans. Treat ipsilaterally or bilaterally,5-10 points per ear, using as few needles as possible. Retain needles for 20-30 minutes, and treat once to three times a week.

Specific Treatment Plan for Diabetes Mellitus16

Master Points: Point Zero (just anterior to point Stomach),Shenmen, Endocrine Hormone (Internal Secretion).Functional Points: Pancreas, Liver.The following points may be added according to the dominant symptoms17:

Thirst: Endocrine, Lung, Thirst.Hunger: Endocrine, Stomach.Frequent urination: Endocrine, Kidney, Bladder.

Increasing insulin: Pancreas

Moxibustion

• dryness in the mouth: burn 100 cones at XiaochangshuBL-27

18.

• frequent urination: moxa can be burned at the tips of the little finger and toe, as well as at points along the cervical vertebrae (e.g. Dazhui DU-14)

19.

Diabetic complications

The following passage on diabetic complications is derived from a valuable article on Diabetes by Nicholas Haines published in The Journal of Chinese Medicine, issue 43, September 1993, page 5.

Cataracts, night blindness, blindness

Patterns involved: Kidney yin deficiency, Liver blood deficiency,Liver yin deficiency and Liver yang rising.

Cataracts

Usually require surgical intervention. One can, however,slow the progression of cataract formation by selecting points according to the above differentiations.

Night-blindness

A progressive disorder with underlying Kidney yin deficiency and Liver yin/blood deficiency. It is unlikely that complete night-vision can be restored; however there should be improvement and/or a slower amount of deterioration with treatment. Tonify Kidney and Liver yin with the following points: Shenshu BL-23, Ganshu BL-18, DanshuBL-19, Qihai REN-6, Zusanli ST-36, Taixi KID-3, TaichongLIV-3.

Blindness

Often due to hemorrhage caused by a combination of Spleen qi deficiency and Liver yang rising. Loss of vision may be temporary or permanent depending on where the bleeding occurs. Even in the case of irreversible loss of vision, it is important to subdue the Liver yang and tonify the Spleen to prevent further bleeding.

• Subdue ascendant Liver yang and wind by using reducing or neutral technique at the following points: TaichongLIV-3, Xingjian LIV-2, Fengchi GB-20, Baihui DU-20, HeguL.I.-4.

• Support the Spleen and Liver and Kidney yin using reinforcing technique at the following points: Ququan LIV-8,Taixi KID-3, Sanyinjiao SP-6, Shenshu BL-23, Ganshu BL-18.

Deafness

Patterns involved: Kidney yin deficiency. This is a progressive development and most likely irreversible. To prevent further deterioration select points with the action of tonifying the Kidneys and nourishing yin.

Oedema

Patterns involved: Spleen yang deficiency, Kidney yang deficiency. Oedema usually starts with the feet and gradually affects other parts of the body. The oedema tends to be recurrent.

• Tonify the Spleen and Kidneys using a reinforcing method and/or moxa at the following points: Pishu BL-20, ShenshuBL-23, Shuifen REN-9, Qihai REN-6, Zusanli ST-36, TaixiKID-3.

Skin infections, ulcerations and decay

Patterns involved: deficiency heat (from yin deficiency)and ying qi deficiency failing to move blood which blocks the collaterals, causing decay through stagnation and lack of nourishment. Failure of body fluids to circulate causes dampness and heat to arise by virtue of stagnation.This is usually seen on the extremities or an area with reduced blood supply, like the hips or buttocks, and is due to poor circulation and/or an elevated level of blood sugar.Both conditions promote an environment for infections.The areas will usually appear red and purple with yellowpus or clear yellow liquid on the surface. The “yellow pustype” is normally seen on the extremities, and the “clear yellow fluid type” occurring as sores at pressure areas like the elbows and buttocks. A small cut, abrasion or localised pressure usually initiates diabetic infections. A “yellow pus type” would be classified as a damp-heat type with poisons(du), and a “clear yellow liquid type” as a yin-deficiency ulcer.Local needling is to be avoided. Distal points to remove stagnation in the affected channels should be employed. In addition a topical, dilute solution may be applied, made of a tincture of 100ml Huang Bai (Cortex Phellodendri) and 50ml Pu Gong Ying (Herba Taraxaci Mongolici cum Radice) to which 2g of Yunnan Bai Yao (Yunnan Province WhiteMedicine) Powder is added.

Reduced peripheral circulation and neuropathy

Patterns involved: blood stagnation, blood deficiency, qideficiency, yin deficiency, yang deficiency or cold stagnation.Treat according to differentiation.Impairment of blood circulation and blockage of the collaterals by blood stasis creates poor peripheral circulation that manifests as purple or dark limbs with markedly decreased sensitivity. This complication will often be combined with skin infections and decay.

Strokes and hemiplegia

Patterns involved: long term yin deficiency and deficiency heat which condenses body fluids and leads to the formation of phlegm, or prolonged dampness condenses into phlegm, or prolonged yin deficiency leads to interior wind that carries the phlegm upwards. Phlegm blocks the channels and obstructs the Heart orifices.Onset can present as any one or a combination of the following: severe headache, dizziness, loss of consciousness,aphasia, convulsions, facial paralysis, hemiplegia,numbness of the face and limbs, a wiry and slippery pulse and a red tongue with a greasy yellow coating.• Clear fire and phlegm, and subdue Liver wind with the following points: Baihui DU-20, Renzhong DU-26, FenglongST-40, Taichong LIV-3, Yongquan KID-1, hand jing-wellpoints.

Concluding Remarks

• Acupuncture, although proven to be clinically effective in reducing blood sugar and normalizing endocrine function,is most effective when used as part of a comprehensive treatment programme.• Among diabetic patients, the body’s resistance to diseaseis usually low, rendering it more susceptible to infection.Therefore careful attention must be placed on sterilisation of the needles and the puncture site.

Appendix One

The following is an acupuncture protocol for diabetes developed by Master Dong and related by Miriam Lee20. Three points are used:• Sanyinjiao SP-6 is said to regulate the original (yuan) qi which is stored in Kidneys.• Lougu SP-7• Shenguan (Extra) i.e. Kidney Gate, located 1.5 cun distal to Yinlingquan SP-9

According to Master Dong, these three points are so potent in normalising internal secretion imbalances they are known as the “Three Emperors”. Since wasting and thirsting disorder is characterised by excess of yang and deficiency of yin,the yin earth channel (Spleen) is favoured over its yang partner (Stomach).

Discussion

When the body is out of balance it craves sweets, and excess of the sweet taste drains the Spleen. Sweet cravings are usually satisfied by candies, cookies, pastries, and soft drinks made from sugar, a refined, super-concentrated extract. Such refined sugar, with far different characteristics from more complex carbohydrates, is a potent yang substance that generates excessive heat of a false kind which leads to deficiency of yin.

Appendix Two

Three Prescriptions According to Dr. Richard Tan's Balance Method

The ‘Balance Method’ was developed by Dr. Tan through his clinical research on the application of “I-Jing/Bagua”theory to acupuncture. It incorporates universal concepts and applies fundamental acupuncture theory that is often overlooked in Western acupuncture training. The method basically relies on balancing the point prescription accordingto the relationships between the channels as found in the I-Jing/Bagua, and upon the “image” of the symptomatic body area. Traditional point functions combined with ahshi qualities are used to guide point selection,however clearing the channels remains the primary focus.Dr. Tan advocates that the way to address an imbalance of any kind, including the symptoms of the diabetic condition,lies in achieving a “global balance”. An example would be to use yin channel points (-) on the Upper Right Extremity(URE) with yang channel points (+) on the Upper Left Extremity (ULE); i.e. URE (-); ULE (+); LRE (+); LLE (-). One to four extremities can be used in a given treatment. Body and head points may also be incorporated, for example balancing the upper front torso with the lower back torso. The method is most effective when fewer than 6-8 needles are used and they are placed remote to the site of pain or imbalance. Local ahshi points are used to identify the principal site and channels affected but are not directly needled.

Diabetic with a tight, wiry pulse URE: Tongli HE-5; ULE: Waiguan SJ-5, Hegu L.I.-4; LLE:Sanyinjiao SP-6, Lougu SP-7, Yinlingquan SP-9; LRE: ZusanliST-36.Diabetic ImpotenceULE: Waiguan SJ-5; LLE: Sanyinjiao SP-6, Lougu SP-7,Yinlingquan SP-9; URE: Ling Ku (proximal to Hegu L.I.-4 and just distal to the intersection of the first and second metacarpal bones); LRE: Yinbao LIV-9 a1, a2, a3 (i.e. YinbaoLIV-9 and two points located one and two cun proximal toYinbao LIV-9, together known as the “Upper San Huang”points by Master Dong).

Note: This prescription is designed to move energy up and down through the genital region.Diabetic bilateral symmetrical peripheral neuropathy in the feet 1.5 cun insertion into bilateral Baxie (M-UE-22) and bilateral Ling Ku penetrating towards Houxi SI-3.

Note: If the patient has a burning sensation in the feet thatare cold to the touch, the prognosis is poor.

CHINESE SYSTEM OF FOOD CURES

“Proper diet is the foundation for life-long good health” Chinese nutrition differs uniquely from modern Western nutrition in that it determines the energetic and therapeutic properties of foods rather than analysing them solely according to their chemical constituents. For example Spinach is cooling, strengthens all the organs, lubricates the intestines, quenches thirst and promotes urination.One application for diabetes to strengthen the digestive organs and clear heat is to boil tea from spinach and chicken gizzards and drink 1 cup three times a day. Another is to eat spinach cooked with seaweed to help clean the blood and reduce swellings. This is beneficial when a diabetic develops itchy skin, rashes or hot skin eruptions.Furthermore, Chinese nutrition takes into consideration such factors as the person’s body type, age and vitality level, the geographical location, yearly seasonal influences and the method of preparation in determining the appropriate diet. Used both as a healing and disease prevention system, the distinct advantage of Chinese nutrition lies in its ability to adapt to the changing needs of an individual.

In case of illness, rather than solely focusing on treating the particular disease, the whole person and their interrelated bio-chemical and bio-energetic systems can be addressed.Sugar in the urine, as one of the most important symptoms of diabetes, was included in the Chinese medical classic A Collection of Diseases, by Wang Shou, published in

752. For the first time in Chinese medical history diabetes was listed among the eleven hundred diseases. The author recommended pork pancreas as treatment for the disease,and also recommended a special method of testing sugar in the urine: the patient was asked to pass urine on a wide, flat brick to see if ants gathered to collect the sugar.This method of testing urine was more than ten centuries ahead of Richard Thomas Williamson (1862-1937), who invented a test for the same purpose. The Chinese author’s treatment using pork pancreas was similar to modern treatment by insulin.

In Chinese medicine however, thirst, weight loss, fatigue, and sugar in the urine are considered the key symptoms of diabetes. When a patient recovers from any of these symptoms, the diabetes treatment is considered successful.

Food Remedies for Diabetes

Clinical Report “A Food Treatment of Diabetes”21.

Steam 60% wheat bran and 40% all-purpose whole wheat flour; add an adequate amount of vegetable oil, eggs and vegetables. Eat at meals to relieve diabetes.The proportion of wheat bran was decreased as the condition improved. No drugs or nutritional supplements were given in this treatment. Among the 13 diabetes cases treated, blood sugar dropped to below 140 mg/dl in 3 cases and to 180 mg/dl in 7 cases; after treatment (lasting from 5to 90 days), sugar in the urine changed from ++++ or +++ to negative in 10 cases; but in general, sugar in the urine changed to negative within one month along with the disappearance of neuritis associated with diabetes.

Vegetable and Grain Remedies

Bamboo Shoots

: Cooling. Strengthens the Stomach, resolves mucous, promotes diuresis. Add generously to stir-fryvegetable dishes or blend bamboo shoots and celery juice,warm and drink 1-2 cups a day.

Bok Choy

: Cooling. Clears heat, lubricates the intestines, quenches thirst. Steam or lightly stir-fry as a side dish orblend with cucumber as a juice.

Celery

: Cooling. Tonifies the Kidneys, strengthens the Spleen

and Stomach, clears heat, promotes diuresis, lowers bloodpressure. Combine celery, yam and pumpkin and bake tomake vegetable pie or lightly boil celery juice and drink 1-3 cups daily. Can also blend daikon radish, celery, carrot,and spinach as a juice and drink one or two cups a day.

Corn Silk

: Neutral, sweet. Promotes urination, affects the Liver and Gall Bladder, lowers blood sugar. Boil corn silk with watermelon peel and small red beans in water. Drink as soup for the relief of chronic nephritis with oedema and ascites.

Millet

: Cooling. Benefits the Stomach and intestines, promotes urination. Steam millet with yams and a few dates.

Mung Bean

: Cold, sweet. Clears heat, quenches thirst,resolves oedema in the lower limbs. Make soup from mungbeans, barley and rice. Or soak 100mg. mung beans overnight;boil in 3 cups water over low heat; drink twice a day.Or grind mung beans into powder and take 15g powder dissolved in warm water twice a day.

Mushroom (Chinese Black or Shitake)

: Neutral, sweet. Strengthens the Stomach, promotes healing, lowers blood pressure,counteracts cholesterol, lowers blood fat levels. Eat fresh orsoak, blending with the soaking water; heat like soup andtake on an empty stomach to clear toxins from the intestines.Or bake until it appears burned on the surface; eat 10gtwice a day.

Pearl Barley

: Cooling. Promotes diuresis, strengthens the Spleen, clears heat. Blend barley and water, boil and drinkthe liquid. Or cook soupy barley and eat as a porridge.

Pumpkin

: Cooling. Dispels dampness, reduces fever, particularly beneficial for diabetes. Eat a slice of pumpkineveryday it is in season. For a main dish bake a pie withpumpkin, yam and potato.

Snow Peas

: Cold. Strengthens the middle warmer, detoxifies, promotes diuresis, quenches thirst. Cook snow peas,blend and drink as a juice half a cup twice a day.

Soy beans

: Cooling. Clears heat, detoxifies, eases urination,lubricates the Lung and intestines. Drink plain soymilk oreat tofu to relieve heat conditions. Steam tofu, cool, add sesame oil and thin julienne slices of raw squash.

Soybean Sprouts

: Cooling. Promotes diuresis, clears heat,especially in the Stomach. Boil for four hours; drink tealukewarm. Continue over a period of one month to relievehypertension.

Spinach

: Cooling. Strengthens all the organs, lubricates the intestines, quenches thirst, promotes urination. Boil tea from spinach (including the roots) and chicken gizzard;drink 1-3 cups a day.

String Bean (Green Bean)

: Neutral, sweet. Kidney and Spleen tonic. Boil 50g dried string beans (with the shells) in water.Drink as a soup once a day to relieve thirst and frequent urination. Or blend stringbeans, cucumber and celery asjuice and drink 1 cup daily.

Sweet Potato (Yam)

: Neutral, sweet. Strengthens the Spleen and Stomach, tonifies qi, clears heat, detoxifies. Steam millet with yams and a few dates or cook soup with wintermelon. Or mix 50g yam powder with 10g American Ginsengpowder. Dissolve 15g in warm water each time; drink3 cups a day as a therapeutic dose.

Sweet Rice (Glutinous)

: Warm, sweet. Used as an energy tonic. Benefits the Spleen, Stomach, and Lung. Relieves excessive urination, perspiration, and diarrhoea. Cook 50gsweet rice with 60g Job’s tears (Yi Yi Ren, Semen CoicisLachryma-jobi) and 8 red dates. Eat as a side dish at mealsto provide general support.

Tomato

: Slightly cooling. Promotes body fluids, quenches thirst, strengthens the Stomach, cools blood, clears heat,calms the Liver. Eat one raw tomato daily on an emptystomach.

Turnip

: Cooling. Clears heat, removes dampness. Boil with tops as a side dish.

Water Chestnut

: Cold, sweet. Relieves fever and indigestion; promotes urination; benefits the Lung and Stomach. Boil 5water chestnuts in water with 1 fresh mandarin orange peel.Drink as a tea to relieve hypertension. Or peel 100g water chestnuts and chew them slowly in the morning and evening.

Winter Melon

: Cooling. Clears heat, detoxifies, quenches thirst, relieves irritability, dispels dampness. Particularly effective in regulating blood sugar. Make soup from cabbage,yam, winter melon and lentils. Or drink three cups of fresh winter melon juice a day. Oral administration of 50-60ml of the juice per dose has shown good results in clinical trials 22.

Wheat Bran

: Cool, sweet. Benefits the Stomach23. Recipes Winter Melon Soup6 pints (3.5 litres) vegetable broth, 3 cups chopped andpeeled winter melon, 2 carrots, 2 celery stalks, 1 onion, 12mushrooms (Chinese Black or Shitake), stems removed, 6oz(170g) tofu noodles or finely sliced baked tofu. Cook until tender (about 25 minutes) Season with 1tsp chives, 1Tbs tamari, and 1tsp peanut oil. Serves 4.

Stuffed Pumpkin

Cut the top off a small pumpkin; clean out the seeds andstrings; save the lid. Fill with the following mixture: 3 cupscooked rice or barley, 1Tbs crushed, toasted sesame seeds,2-3 sliced celery stalks, 1Tbs parsley, 1tsp thyme, 1tsp sage,half tsp rosemary, and 1Tbs tamari. Cover with pumpkin lid and bake at 350 degrees for 1 to 1.5 hrs. A fork will easily go into the pumpkin when cooked. Serves 4-6.

Azuki Bean and Squash Casserole1cup azuki beans soaked overnight, two 6-inch pieces of kombu seaweed, 1 small butternut squash, kabuchi or other winter squash. Cover beans and kombu with water andsimmer for about 1 hour, adding water as needed. Then addthe cubed and peeled squash. Cook until tender (about half anhour). Stir in a pinch of sea salt or 1-2 tsp tamari. Serves 4.

Case report

Twenty-five diabetes patients were treated at the Canton College of Traditional Chinese Medicine with 250g dried bitter melon slices boiled in water each day. The changed levels of their blood sugar taken 2.5 hours after meals, and of their urine sugar taken 24 hours after meals, were both statistically significant. The same method has subsequently been applied to diabetic rats, and also resulted in a significant decrease in the level of blood sugar. The same report concludes that the effects of dried bitter melon are remarkably similar to those of insulin. It was also suggested that when 100g fresh clams are boiled in water with the dried bitter melon slices, the results should be better.

Animal Product Remedies

Abalone

: Neutral, sweet, salty. Detoxifies; sharpens vision. Contraindicated for persons with a weak digestion. Boil 20-25g abalone with 250-300g fresh radish in water. Drink as a soup once every other day. Repeat 6-7 times as a treatment program. This is a time-honored recipe in Chinese folk medicine for diabetes.

Beef

:Neutral, sweet. Used as a Spleen, Stomach, qi and blood tonic. Boil lean beef with yam to make soup.

Clam (freshwater)

: Cold, sweet, salty. Detoxifies, sharpens vision; acts on the Liver and Kidneys. Freshwater clam saliva is especially beneficial for diabetes. Boil 150g chiveswith 200g clams and suitable seasoning.

Milk

: Cow’s milk is neutral and sweet with a descending action. Used as a Lung and Stomach tonic, produces fluids and lubricates the intestines, benefits the Heart, Lung andStomach. Contraindicated with diarrhoea or mucous discharge.Mix equal amounts of cow’s and goat’s milk. Drinkthe milk as a substitute for tea or juice to improve physical condition and help reduce frequency of urination.

Pork

: Neutral, sweet, salty. Used to lubricate dryness; benefits the Spleen, Stomach and Kidneys. Cut up 100g lean pork and boil in water with 100g Job’s tears over low heat for 2 hours. Eat as a side or main dish. In the 1846 Chinese diet classic New Collected Works of Proven Dietary Recipes,pork pancreas was used as an ingredient in several dietary formulas to treat diabetes. One recipe called for boiling apork, beef, or lamb pancreas in water with 200g yam;seasoning with salt and dividing into 4 parts; one part to be eaten every day for 4 days. Another instructed to cut up a pork pancreas and bake it over a low heat until dry and then to grind into powder, 3-5g to be taken in warm water at each meal. And another called for washing the pork pancreas and removing all white fat, then cutting into thin pieces,boiling over low heat in water with 20g corn silk, and seasoning with salt; one portion to be eaten daily.

Fruit Remedies

Crab Apple

: Neutral, sweet and sour. Quenches thirst; astringes, benefits the Heart, Liver, and Lung. Boil 10 partiallyripe fresh crab apples in an adequate amount of water until the water is reduced by half. Drink the soup and eat the fruit to quench thirst and relieve diarrhoea.

Guava

: Warm, sweet. Astringent and constrictive, relieves frequent urination and diarrhoea. Crush 90g fresh guavas;squeeze out the juice and drink before meals.

Plum

: Neutral, sweet, sour. Produces fluids, promotes urination and digestion, benefits the function of the Liver andKidneys.

Strawberry

: Cooling. Lubricates the Lung, promotes body fluids, strengthens the Spleen. Drink 1 small glass of freshjuice daily during the summer.

Mulberry

: Slightly cold. Quenches thirst, detoxifies, tonifies the Kidneys, lubricates the Lung, relieves constipation,calms the spirit, promotes diuresis. Boil mulberries as a teaand drink half a cup at a time.

Eating Guidelines to Promote Healthy Digestion

• The dining area should be clean and pleasantly arranged,free of foul odours, and with plentiful fresh air.

• During meals and for a least one hour afterwards anupright posture of the torso should be maintained.

• Liquids should be consumed sparingly at meals. Sipping green tea during or after meals is beneficial.

• A wide variety of seasonal foods should be included in thediet, however fruit and sweet foods should be minimised.

• Three to four light meals should be eaten at regular times each day. The largest meal should be taken at mid-day and the evening meal should be consumed at least 2 hours before bedtime. When mental or physical demands are high, natural, complex carbohydrate snacks are encouraged.

• After meals some light movement, such as a stroll in the fresh air, is highly recommended.

A Chinese proverb says“100 paces after each meal will allow one to live a healthy100 years”.

Notes1 Simple Questions (Su Wen) chapter 47.2 Spiritual Axis (Ling Shu) chapter 46.3 Nanjing Seminars Trancript, Qiu Mao-lian and Su Xin-ming.

Journal of Chinese Medicine, 1984.4 A Manual of Acupuncture,

Peter Deadman and Mazin Al-Khafaji with Kevin Baker, Journal of Chinese MedicinePublications, 1998, p.158.5 Ibid. p.279.6 Ibid. p.571.7 Ibid.8 Ibid. p. 338.9 Ibid. p339.10 Ibid. p339.11 Ibid. p339.12 Ibid. p309.13

Acupuncture A Comprehensive Text, O’Connor, J. and Bensky,

D., Eastland Press.14 Ibid.15 Ibid.16 Oleson, Terrence, D., Ph.D.,

Auriculotherapy Manual – Chinese and Western Systems of Ear Acupuncture, 1990, Published by Health Care Alternatives.17

Acupuncture A Comprehensive Text, O’Connor, J. and Bensky,

D., Eastland Press.18 Ibid.19 bid.20 Lee, Miriam, O.M.D.,

Insights of a Senior Acupuncturist, Blue Poppy Press, 199221 Bever, B. O. and Zahand, G. R., 23. A Food Treatment of Diabetes

(8) Ch.7, p.112.22 Ibid.23 Ibid.

MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE

04/05/2013 11:34:00

MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE

DIABETES MELLITUS(PART ONE)

by Clinton J. Choate

1. Background

There is nothing new about diabetes; it has been a medical problem since antiquity. The name which was originated by Aretaeus (30-90 CE) came from the Greek words meaning ‘siphon’ and ‘to run through’, signifying the chronic excretion of an excessive volume of urine.Diabetes mellitus, because of its frequency, is probably the single most important metabolic disease and is widely recognized as one of the leading causes of death and disability in the United States. It affects every cell in the body andthe essential biochemical processes that go on there.Diabetes has been linked to the western lifestyle, as it is uncommon in cultures consuming a more primitive diet.As cultures switch from their native diets to more commercial foods, their rate of diabetes increases, eventually reaching the same proportions seen in western societies.A great deal of research has been conducted into the possible aetiology of diabetes. Most of the prevalent ideas can be classified under one of the following categories:heredity, endocrine imbalance, dietary indiscretion and obesity, sequelae of infection, and severe and continued psychic stress. Although genetic factors appear important in determining susceptibility to diabetes, environmental and dietaryfactors are also important in its development and many have been identified. A diet high in refined fibre-depleted carbohydrate is believed to be the causative factor in many individuals, while a high intake of high-fibre complex carbohydrate foods is protective against diabetes.Obesity appears to be a significant factor, particularlyconsidering the fact that 90% of Type 2 (see below) sufferersare obese. Even in normal individuals, significant weight gain results in carbohydrate intolerance, higher insulin levels and insulin insensitivity in the fat and muscle tissue.The progressive development of insulin insensitivity is believed to be the main underlying factor in Type 2 diabetes.Weight loss can correct all of these abnormalities inmany instances and significantly improves the metabolic disturbance of diabetes in most cases.What has become apparent through years of research is that the diabetic condition is not simply a matter of one or two things having gone wrong. It is a complex condition with a multitude of metabolic imbalances. Consequently,the conventional medical approach of simply using insulin or oral drugs to treat diabetes is incomplete and the person relying on them to prevent long-term complications remains at risk.

About Blood Sugar

Carbohydrate is the active fuel of the body and is ordinarily the main source of energy of the tissue cell. In the normal digestive process, food sugars and starches (carbohydrates)are changed into sugar glucose. This is stored in the form of glycogen (animal starch) in the liver and muscles for later use as a body fuel, at which time it is reconverted into glucose. Blood sugar rises somewhat after eating, and in healthy individuals returns to normal levels in about anhour or two. The amount of glucose in the blood is controlled mainly by the hormones insulin and glucagon. Too much or too little of these hormones (or if they are somehow ineffective) can cause blood sugar levels to fall too low(hypoglycaemia) or rise too high (hyperglycaemia). Other hormones that influence blood sugar levels are cortisol,growth hormone and catecholamines (epinephrine and norepinephrine).The pancreas, a gland in the upper abdomen is responsible for producing insulin and glucagon. The pancreas is dotted with hormone-producing tissue called the islets of Langerhans, which contain alpha and beta cells. Whenblood sugar rises after a meal, the beta cells release insulin.The insulin helps glucose enter body cells, lowering bloodglucose levels to the normal range. When blood sugar drops too low however, the alpha cells secrete glucagon. This signals the liver to release stored glycogen and change itback to glucose, raising blood sugar levels to the normal range. The result of the disturbed metabolism of glucose causes an abnormal accumulation of sugar in the blood stream and the diabetic condition.

Blood Sugar Ranges

The quantity of glucose in the blood seldom exceeds 160milligrams / decilitre (mg/dl) of blood shortly after food sugar has been absorbed, nor seldom falls below 60 mg/dlduring fasting. This increases about 2 mg/dl per decade after age 30. Some mild diabetics will have normal fasting blood sugar values and values in the diabetic range only after meals. Occasionally very mild cases will have values within normal at both times and the diabetic tendency will be evident only when these persons are required to handle more than an ordinary amount of carbohydrate.In the fasting state, blood sugar can occasionally fall below 60 mg/dl and even to below 50 mg/dl and not indicate a serious abnormality or disease. This can be seen in healthy women, particularly after prolonged fasting.Blood sugar levels below 45 mg/dl in a woman or 55 mg/dl or less in a man indicate a strong possibility of hypoglycaemia.Higher-than-normal blood sugar levels, for example 140mg/dl or higher after an overnight fast, can indicate diabetes mellitus. In moderately severe diabetes, after-mealvalues of 250-350 mg/dl are not unusual. If a person with diabetes develops hyperglycaemia and it is left untreated,the result can lead to coma or death.Diabetes is characterised by three well-known syndromes,polydipsia (excessive thirst), polyphagia (excessive hunger) and polyuria (excessive urination). Laboratory findings reveal high blood sugar and glucose in the urine and as the metabolic derangement worsens, excessive ketone bodies in the blood and urine. The accumulation of these produces acidosis which, if not counteracted, can result in coma and death.There are three main types of diabetes:

• Type 1 or 'Insulin-Dependent Diabetes Mellitus'(IDDM) also known as 'Juvenile Onset Diabetes'.

• Type 2 or 'Noninsulin-Dependent Diabetes Mellitus'(NIDDM) also known as 'Adult Onset Diabetes'.• Gestational diabetes.

Type 1 Diabetes (Insulin-Dependent DiabetesMellitus/IDDM)

Insulin-dependent diabetes is considered an autoimmune disease in which the immune system attacks the insulin producing beta cells in the pancreas and destroys them. The pancreas produces little or no insulin and it is then almost certain that life-long insulin replacement will be necessary.The exact mechanism for the body’s immune system attackto the beta cells is unknown but the most likely causes areviral infection, genetic factors and free radicals.Interest has been generated lately in the strong evidence linking exposure to a protein in cow’s milk (bovine albumin peptide) in infancy to the autoimmune response and subsequent Type 1 diabetes. In detailed studies1 it was shown that patients with Type 1 diabetes were more likely to have been breast-fed for less than three months and to have been exposed to cow’s milk or solid foods before the age of four months. Since the cow’s milk protein can enter the mother’s breast milk, in cases of family history of diabetes it is recommended that the mother avoid cow’s milk while breast-feeding.IDDM accounts for about 5 to 10 percent of diagnosed diabetes in the USA and develops most often in children and young adults, but the disorder can appear at any age. Symptoms usually develop over a short period, although beta cell destruction can begin months, even years, earlier.Over time both Type 1 and Type 2 diabetes are accompanied by many severe complications, such as blindness,renal failure, lower- limb amputations, cardiovascular disease and stroke. For those with Type 1 diabetes the object is not to find a way to get off insulin but rather to prevent the long-term complications. It is encouraging to note that modern research has demonstrated the amount of insulin required could be reduced through appropriate life style modifications and the likelihood of consequent complications significantly lowered.

Type 2 Diabetes (Noninsulin-Dependent DiabetesMellitus/NIDDM)

The most common form of diabetes is noninsulin-dependent diabetes. About 90 to 95 percent of people with diabetes have Type 2. In the USA more than 16 million people, over 7% of the adult population, have Type 2 with 600,000 new cases diagnosed each year. In many patients, the initial diagnosis of Type 2 diabetes is delayed perhaps by as much as 10 years because symptoms are often absent or very mild during its early stages.Type 2 diabetes usually develops in adults over the age of 40 and is most common among adults over age 55. It is particularly common among the elderly and in many minority populations, including African Americans, Hispanic Americans, American Indians and Asian and Pacific Islander Americans, in whom it may occur in 10–50% of adults.Type 2 diabetics typically have elevated levels of insulin,often producing two to three times the normal amount.Rather than an insulin deficiency condition it is an “insulin resistance” condition whereby the body loses its ability to properly respond to the signals given by insulin. We now know that excess insulin brought on by insulin resistance is not only associated with elevated blood sugar levels, but also with high blood pressure and increased rates of atherosclerosis.In the treatment of Type 2 diabetes, dietary modification has been found to be of primary importance and should be diligently followed before using drug intervention since most cases can be controlled by diet alone. For all Type 2 diabetics an effective treatment approach should employ a broad-based therapeutic regimen. Such a regimen would incorporate appropriate diet, prescribed exercise, stress reduction techniques and a substantial amount of specific nutritional supplements. If adequate control of blood sugar levels remains problematic, conventional treatment with insulin and oral agents can be initiated.

Gestational Diabetes

Gestational diabetes develops or is discovered during pregnancy.This type usually disappears when the pregnancy is over, but women who have had gestational diabetes have a greater risk of developing NIDDM later in their lives.

2. Presenting Symptoms

The clinical manifestations of diabetes in the order in which they usually appear are:

• frequent, copious urination• excessive thirst• rapid weight loss• excessive hunger• drowsiness, fatigue• itching of the genitals and skin• visual disturbances• skin infections• slow healing• paraesthesia in the hands or feet

Other signs of diabetes include lingering influenza-like symptoms, loss of hair on the legs, increased facial hair,small yellow bumps anywhere on the body (known asxanthomas-cholesterol) and inflammation of the penileskin.In most juvenile cases the earliest symptoms noted are increased urination, thirst and hunger. Other symptoms include irritability, nausea or vomiting, weakness and fatigue.Physical findings in the adult are mostly attributable to complications, and the first sign of the disease may besome dermatological, circulatory, neurological or visual complications.

3. Laboratory diagnosis

The laboratory diagnosis of diabetes depends on finding glucose in the urine together with an elevated blood sugar.The newest routine diagnostic test for diabetes is a fasting plasma glucose test rather than the previously preferred oral glucose tolerance test. A confirmed fasting plasma glucose value of greater than or equal to 126 mg/dl indicatesa diagnosis of diabetes.In certain clinical circumstances physicians may still choose to perform the more difficult and costly oral glucose tolerance test. When a doctor chooses to perform this test a confirmed glucose value of greater than or equal to 200 mg/dl indicates a diagnosis of diabetes. According to World Health Organisation standards an oral glucose tolerance test is performed by administering 75 grams of an hydrousglucose dissolved in water and then measuring the plasma glucose concentration 2 hours later.

Monitoring the Diabetic Patient

There appears to be a strong relationship between bloodsugar levels and the development of the complications ofdiabetes. Specifically, when blood sugar levels are chronically elevated, the risk of complications is very high. To reduce the risk of developing complications it is important to control elevations in blood sugar by careful monitoring.The availability of home glucose monitoring kits makes this easier now than in the past.

4. Complications or Sequelae of Diabetes

Sometimes a complication of diabetes may give a clue to the presence of the disease. The principle complications or sequelae associated with diabetes are retinopathy, neuropathy,nephropathy and arteriosclerosis. Whether these are the unavoidable consequences of the diabetic state overtime or whether they may be influenced by controlling the diabetes through aggressive monitoring, treatment and life-style management, including diet and supplements,remains a central topic.One of the largest, most comprehensive diabetes studies conducted to date 2 showed that keeping blood sugar levels as close to normal as possible through aggressive management slows the onset and progression of eye, kidney and nerve diseases caused by diabetes. In fact it demonstrated that any sustained lowering of blood sugar helps, even if the person has a history of poor control.Specifically it found that lowering and maintaining more constant blood sugar levels reduced the risk of eye disease by 76%, kidney disease by 50%, nerve disease by 60% and cardiovascular disease by 35%.Since the discovery of insulin nearly 70 years ago, the patterns of morbidity from diabetes have changed. Where the major causes of death were ketoacidosis and infection,they are now the microvascular and cardiovascular complicationsof diabetes (renal failure and myocardial infarction).These complications are responsible for a reduction in the life expectancy of a newly diagnosed insulin dependent diabetic by about one-third. The basis of managing diabetes in the 90’s is an improvement in the life-style of the diabetic and prevention of complications responsible for morbidity and mortality in diabetes.

Neuropathy (nerve disease)

Diabetic neuropathies are among the most frequent complication of long-term diabetes. It is estimated that 60%to 70% of diabetics have mild to severe forms of nervous system damage. The femoral nerve is commonly involved giving rise to symptoms in the legs and feet. Pain is the chief symptom and tends to worsen at night when the person is at rest. It is usually relieved by activity and aggravated by cold. Paraesthesias are a common accompaniment of the pain. Cramping, tenderness and muscle weakness also occur but atrophy is rare. Advanced femoral nerve disease is a major contributing cause of lower extremity amputations.Nerves in the arms, abdomen and back may also be affected. Symptoms may include impaired heart function,slowed digestion, reduced or absent perspiration, severe oedema, carpal tunnel syndrome, alternating bouts of diarrhoea and constipation, bladder atony, urinary and faecal incontinence and impotence.With respect to sexual impotence, diabetes is probably the single most common disease associated with erectile failure (termed neurogenic impotence in the diabetic). Since diabetes is a metabolic disease with vascular and nervous system complications and an erection involves all levels of the nervous system from the brain to the peripheral nerves,lesions anywhere along the path may be responsible for erectile failure. It has been estimated that close to 50% of diabetic males have some degree of erectile dysfunction.Neuropathies usually improve with the control of the diabetes. Severe or chronic changes may require several weeks or months to show maximum improvement.

Retinopathy (eye disease)

Changes occurring in the eye which are distinctive of diabetes involve the narrowing, hardening, bulging, haemorrhagingor severing of the veins and capillaries of the retina. This is a serious complication known as retinopathy and may lead to loss of vision. Visual changes in the earlier stages may include diminished vision, contraction of the visual field,changes in the size of objects or photophobia. In the more advanced stage, termed 'proliferative retinopathy',haemorrhages, retinal detachment and other serious forms of deterioration are observed. When the disease progresses to this late stage total blindness may occur.It usually takes between 10-13 years for diabetic retinopathy to develop and it is present in some degree in most diabetics who have had the disease for 20 years. In only about half of the diabetics who develop it however, is vision markedly impaired and blindness occurs in only about 6%. Still,diabetes is the leading cause of blindness in adults 20 to 74 years old and is estimated to cause from 12,000 to 24,000 new cases each year. Two other complications of diabetes, cataracts and glaucoma, can also lead to loss of vision The development of laser therapy will probably reduce the prevalence of diabetes-induced blindness, however this therapy is not without occasional side effects (haemorrhage,retinal detachment and loss of visual field) and istherefore indicated only for the more serious conditions.

Arteriosclerosis (vessel disease)

The diabetic state is associated with earlier and more severe vascular changes than normally occur at a given age. Cardiovascular-renal disease is the leading cause of death among diabetics. Atherosclerosis can be accurately described as the end stage of Type 1 and Type 2 diabetes, since the vast majority of diabetes patients will die from an atherosclerotic event. Most commonly these events are cardiovascular in nature (an estimated 60% to 65% of diabetics have high blood pressure) although 20-25% of atherosclerotic events may be cerebrovascular or microvascular. The incidence of coronary occlusion in persons with clinical diabetes has been estimated at from 8-17% with diabetic adults having heart disease death rates about 2 to 4 times as high as the general population. The risk of stroke is also found to be 2 to 4 times higher in people with diabetes. Arteriosclerosis obliterans in the lower extremities, a form of peripheral vascular disease, may produce disturbances in sensation, decrease in muscular endurance, intermittent claudication on effort, absence of peripheral pulses in the lower legs and feet and gangrene, and ultimately lead to amputation of the extremity. Diabetic gangrene usually involves the toes, heels or other prominent parts of the feet and is precipitated by trauma, infection or extremes in temperature. Needless to say, careful attention to proper foot care, avoidance of injury and consistent use of methods to improve peripheral circulation, including withdrawal from tobacco use in any form, are critical for the diabetic.The aetiology of large vessel disease is multi-factorial in the diabetic as well as the non-diabetic population with lipoprotein metabolism, hypertension, physical activity,obesity, cigarette smoking, stress, personality and genetic and racial factors all playing a part.

Nephropathy (kidney disease)

Nephropathy is a common and important accompaniment of diabetes and one that in young diabetics takes precedence over heart disease as a cause of illness and death. As with eye changes, there is a wide variation in the type and degree of renal damage. Nephropathy is less frequent than retinopathy and where it occurs is also a development of long standing diabetes. Nevertheless, diabetes is the leading cause of end-stage renal disease in the US, accounting for about 40% of new cases. In 1995, a total of 98,872 people with diabetes underwent dialysis or kidney transplantation and 27,851 developed end-stage renal disease.One study3 reported that among 200 juvenile diabetics who survived 20 years after onset, one half had evidence of renal disease. Another study found that the majority of these patients have hypertension and two thirds show significant albuminuria, but the fully developed nephrotic syndrome of hypertension, proteinuria and oedema occurs in less than 10% and renal function is impaired in only one half to three quarters of those patients.Like other long-term complications, good blood glucose control goes a long way towards reducing the risk of diabetic nephropathy. In addition to monitoring the blood sugar levels, periodic monitoring of a diabetic patient’s kidney function (blood urea nitrogen, uric acid, creatinine and creatinine clearance) is important.

Hypoglycaemia

If there is too much insulin in the body compared to the amount of blood sugar, and the blood sugar falls below normal levels, a condition known as hypoglycaemia occurs.This problem of hypoglycaemia due to insulin or oral hypoglycaemic drugs is much more common in Type 1 than Type 2 diabetes since the Type 1 diabetic is directly injecting insulin. If too much insulin is administered, or the person misses a meal or over-exercises, hypoglycaemia may result. In this condition, commonly referred to as insulin shock, the brain is deprived of an essential energy source. The first sign is mild hunger, quickly followed by dizziness, sweating,palpitations, mental confusion and eventual loss of consciousness. Before the condition reaches emergency proportions, most diabetics learn to counteract the symptoms by eating a sweet or drinking a glass of orange juice.In some cases, the only effective measure is an intravenous injection of glucose.

Digestive Disorders

Based on the 1989 US National Health Interview Survey,diabetics are more likely than the general population to report a number of digestive conditions, including ulcers,diverticulitis, symptoms of irritable bowel syndrome, abdominal pain, constipation, diarrhoea and gallstones.

Oral Complications

Periodontal disease, which can lead to tooth loss, occurs with greater frequency and severity among diabetics.Periodontal disease has been reported to occur among 30%of people aged 19 years or older with Type1 diabetes.

Infections

Studies in clinic, community and hospital populations indicate that diabetic subjects have a higher risk of some infections,including asymptomatic bacteriuria, lower extremity infections, re-activation tuberculosis, infections in surgical wounds and group B streptococcal infection. Population based data suggest a probable higher mortality from influenza and pneumonia.

Complications of Pregnancy

The rate of major congenital malformations in babies born to women with pre-existing diabetes varies from 0% to 5% among women who receive preconception care, to 10% among women who do not receive preconception care. Between 3% to 5% of pregnancies among women with diabetes result in death of the new-born; the rate for women who do not have diabetes is 1.5%4.

Ketoacidosis

Another acute complication more likely to occur in the IDDM is ketoacidosis, a condition caused by a lack of insulin leading to a build-up of ketoacids. Chemical compounds called ketones are one of the natural by-products of fat metabolism. Excessive ketone bodies are formed by the biochemical imbalance in uncontrolled or poorly managed diabetes. The condition known as diabetic ketoacidosis can directly cause an acute life-threatening event, a diabetic coma.The possibility of ketoacidosis is suggested by:

• Confusion or coma, the patient almost always appearing extremely ill.• Air hunger - an attempt to compensate for metabolic acidosis.• Acetone odour (fruity) invariably on the breath.• Nausea and vomiting almost always present.• Abdominal tenderness which may mimic viral gastroenteritis.• Extreme thirst and dry mucous membranes.• Diabetic history (present in about 90% of cases).• Weight loss.

Before the discovery of proper treatment by insulin and other intravenous injections, acidosis was the chief cause of death among diabetics. Today diabetics can use a simple urine dipstick at home to measure the level of ketones(excreted ketoacids) in the urine.

5. Conventional Medical Treatment

Insulin was the first, and remains the primary means of treatment for Type 1 diabetes and is administered by subcutaneous injection. This method is necessary since insulin is destroyed by gastric stomach secretions when it is taken by mouth. Insulin injections must be balanced with meals and daily activities, and glucose levels must be closely monitored through frequent blood sugar testing. Many diabetics need inject insulin only once a day; others require two or more injections. The usual time for a dose of insulin is before breakfast. The dosage is initially established according to the severity of the condition, but it often has to be reassessed as one or another of the variables in the person’s condition changes.During the past several years a large number of different classes of drug therapies for patients with both Type 1 and Type 2 diabetes have been developed. The concept of genetic re-engineering of insulins to produce insulin analogs(synthetic insulin) with improved properties has enhanced the ability to affect glycaemic control with fewer adverse reactions. For Type 2 patients, the number of orally active antidiabetic agents has increased from one class of agents (the sulfonylureas - sulfa drugs) to the current total of four classes of agents. The three new classes include agents of potentially even greater glycaemic efficacy, such as Biguanide ‘Metformin’; agents directly improving the underlying insulin resistance of Type 2 diabetes, specifically thiazolidinediones such as ‘Troglitazone’; and finally agents that alter the rate of hydrolysis and absorption of oligosaccharides, such as the alpha-glucosidase inhibitor ‘Acarbose’.The sulfonylureas as a group have proven to be not very effective. After three months of continual treatment at an adequate dosage, only about sixty percent of Type 2 diabetics are able to control blood sugar levels using these drugs. Furthermore these agents generally lose their effectiveness over time. After an initial period of success they fail to produce a positive effect in about thirty- percent of the cases at best.In addition to being of limited value, there is evidence that the sulfonylureas actually produce harmful long-term effects. Tolbutamide has been reported to be associated with increased cardiovascular mortality. Other major side effects of the sulfonylureas are hypoglycaemia, allergic skin reactions, headache, fatigue, nausea, vomiting and liver damage. Common examples of sulfonylureas include Chlorpropamide(Diabinese), Glipizide (Glucotrol), Tolazamide(Tolinase) and Tolbutamide (Orinase).

Metformin has been used in the management of Type 2 diabetes in more than 90 countries for over 30 years. It was approved for use in diabetes patients in the United States in1995. Metformin reduces the excessive hepatic glucose production that characterizes Type 2 diabetes. With reduced hyperglycaemia, glucose uptake by peripheral tissues is enhanced while insulin levels remain stable or decline.Metformin also lowers elevated cholesterol and lipids,particularly the serum levels of triglycerides. Frequency of adverse effects is low at the doses needed to obtain the desired metabolic effect.Troglitazone is a member of a new class of drugs that are 'insulin sensitizers'. It was selected on the basis of its effect to lower glycaemia without increasing insulin levels, its ability to improve lipid levels and absence of significant side effects or adverse events in short-term human studies.The new generation oral drugs do have a specific and beneficial place particularly for patients who are on an appropriate diet and exercise program, have attained an optimal weight and are still unable to adequately control blood sugar levels. However with the increased number of oral antidiabetic agents soon to increase even further, the medical emphasis upon management of hyperglycaemia inType 2 diabetes with these agents will likely increase.Realistically this is the easiest and least time-consuming response that can be made by practitioners to the impact of managed care plans. However to prescribe these agents alone and in combination for even minimal degrees of hyperglycaemia without an adequate trial of diet and exercise will only serve to accentuate the problem. For the noninsulin dependent diabetic, dietary and life style changes can often provide adequate remediation.

Medical Cost Attributed To Diabetes

Medical cost for persons with diabetes are higher because they visit physician’s offices, hospital outpatient departments and emergency rooms more frequently than their non-diabetic counterparts and are more likely to be admitted to hospitals and nursing homes. One estimate of the total health-care expenditures for diabetes in the USA is approximately $100 billion per year in both direct and indirect costs, or about 12% of all health-care expenditures.

6. Nutritional Therapy

Meal Planning

A non-diabetic produces the constantly varying amounts of insulin necessary for obtaining energy from glucose. A diabetic cannot achieve this balance. Beyond the basic requirements to provide adequate calories and necessary nutrients, there are marked differences in diet strategy for the two major groups of diabetic patients: Type 1 insulin dependent non-obese patients and Type 2 obese patients who do not require insulin. Patients who are on insulin therapy must schedule their meals to provide regular caloric intake. In overweight patients, special attention must be given to total caloric consumption.There is no need to disproportionately restrict the intake of carbohydrates in the diet of most diabetic patients. In fact,Dr. H.P. Himsworth demonstrated in 1930 that if carbohydrates were taken out of the diet and replaced by either protein or fats, a person would quickly develop insulin resistance and diabetes5. The key here is in the choice of high-fibre complex carbohydrates.One of the first dietary rules for all diabetics is to avoid all sugar and foods containing sugar, such as pastry, candy and soft drinks. While these refined sugars and other simple carbohydrates like white flour must be carefully watched,most diabetics are actually encouraged to eat more complex carbohydrates - the same bulky, fibre-rich unprocessed foods that are now recommended for everyone. Vegetables are ideal. For example, a diabetic can eat a large plate of spinach that contains as much carbohydrate as a table spoonful of -sugar, without suffering any ill effects.Spinach, asparagus, broccoli, cabbage, string beans and celery are among the so-called “Food Exchange Group A” vegetables that the American Diabetes Association (ADA)says can be generously included in the diabetic diet. What makes these complex carbohydrates special is their ability to slow down the body’s absorption of carbohydrates by helping to delay the emptying of the stomach and thereby smoothing out the absorption of sugars into the blood.Whole grain cereals also have this ability.Fully one third of diabetic patients in clinical surveys have hyper-lipidemia, clearly indicating the need for dietary management. The most sensible approach is to limit the amount of fat in their diet and to substitute polyunsaturated fats for the saturated type when possible. Fish and poultry are especially recommended instead of fatty cuts of meat. Greasy, fried foods are strongly discouraged.Obesity is much more likely in people who eat a high-fat diet, which is often a high calorie diet, since each gram of fat contains nine calories instead of the four calories in each gram of protein or carbohydrate. With obesity comes an increased risk of a variety of problems, not the least of which is adult-onset diabetes.Overweight diabetics, by carefully calculating the proper daily calorie intake for their body weight and activity level,and never exceeding it, can usually bring their weight downto an optimal level - a level which is actually 10% less than the standard height and weight charts recommend.

“The overweight diabetic who successfully brings their weight back to normal usually experiences a dramatic improvement in their condition. Indeed the symptoms often virtually disappear,” says Charles Weller M.D. in his book The New Way to Live with Diabetes6. He goes on to state “Weight reduction and control can bring this incurable disease closer to complete remission than any medication.”The need to reduce fat is reflected in the standard diet and food exchange lists prepared by the ADA that restricts the intake of fat to 35% of calories. The reduction of saturated fats to one-third of the fat intake by substituting poultry,veal and fish for red meats, and the reduction of cholesterol to less than 300 mg/day are stressed. The carbohydrate content is 40-50 per cent of total calories, with unrefined carbohydrates recommended to the exclusion of refined and simple carbohydrates.

Currently another diet, known as the ‘HCF (high-carbohydrate high plant-fibre) diet' popularised by James Anderson7 has substantial support and validation in the scientific literature as the diet of choice in the treatment of diabetes.It is high in cereal grains, legumes and root vegetables and restricts simple sugar and fats. The calorie intake consists of 70-75 per cent complex carbohydrates, 15-20 per cent protein and only 5-10 per cent fat, and the total fibre content is almost 100 grams/day. The positive metabolic effects of the HCF diet are many: reduced after-mealtime hyperglycaemiaand delayed hypoglycaemia; increased tissue sensitivity to insulin; reduced cholesterol and triglyceride levels with increased HDL-cholesterol levels; and progressive weight reduction.In general the HCF diet is adequate for the treatment of diabetes. However improvements can be made, primarily by substituting more natural (primitive) foods wherever possible. The Modified HCF or MHCF diet recommends a higher intake of legumes, along with restrictions of several foods allowed on the HCF diet, namely processed grains,and excludes fruit juices, low fibre fruits, skimmed milk and margarine. It is noteworthy that if patients resume a conventional ADA diet, their insulin requirements return to prior levels.Many diabetics have found it beneficial to eat smaller,more frequent meals, rather than the two or three big meals most people consume daily. Researchers have found that multiple frequent feedings tend to keep blood cholesterol levels lower, for the diabetic and non-diabetic alike.

Vitamins and Minerals

Generally a well-balanced diet rich in vitamins and mineralsis one of the most important factors in the control of diabetes and prevention of diabetic complications. One reason for stressing the need for proper levels of nutrientsis the excessive urination experienced by the diabetic.Normally the body reabsorbs glucose and other water soluble nutrients. When glucose rises to levels above 160-170mg/dl, as it does quite frequently in even well controlled diabetic patients, it acts as an osmotic diuretic. This process overwhelms the kidney’s ability to reabsorb glucose and other water-soluble nutrients, thus the increased urination, and substantial losses of nutrients such as vitaminsB-1, B-6 and B-12 and the minerals magnesium, zinc and chromium pass out along with the urine. Consequently diabetes and its complications are as much a result of nutritional wasting as of elevated blood sugar.In an article in the

American Journal of Clinical Nutrition where 247 studies were reviewed

8, it was found that Type1 (IDDM) diabetics generally had deficiencies in zinc, calcium,magnesium and the more active form of vitamin D.Those with Type 2 diabetes (NIDDM) generally were found to be low in zinc and magnesium and often low in vitamins B6 and C.The physical body needs all these water-soluble nutrients to maintain the integrity of its organ system. Perhaps one of the most important nutrients is magnesium. The medical literature is full of studies showing that diabetic patients invariably have lower blood levels of magnesium than normal, also with higher urinary losses. In a landmark study conducted in 1978 by Dr. P. McNair and titled Hypomagnesemia, a Risk Factor in Diabetic Retinopathy

9, it was demonstrated that diabetics with the lowest magnesium levels had the most severe retinopathy, and that low magnesium levels were linked significantly to retinopathy more than any other factor. The article argued that simply elevating the magnesium concentration with supplements would protect the eyes.Other nutrients are also attracting serious attention. Researchers in London recently reported that vitamin D is essential for the islet cells in the pancreas to be able to secrete insulin properly 10. Their studies have shown that individuals with the lowest vitamin D levels experienced the worst blood sugar-handling problems and had a greater risk of developing diabetes. They found that those with greatest risk of developing vitamin D deficiency included the elderly who were either institutionalised or stayed indoors,those living in climates where sunlight is scarce several months a year, and those with indoor sedentary jobs. In an effort to eliminate the widespread vitamin D deficiencies in the institutionalised elderly, over 80% of those individuals are now being given 800 IU/day vitamin D3 supplements.Other researchers have found that the diabetic is unable to convert carotene into vitamin A. It is advisable therefore for the diabetic to ingest at least the recommended dietary allowance of vitamin A from a non-carotene source such as fish-liver oil. Diabetics and others on low-fat diets often need supplemental amounts of this fat-soluble nutrient.Also recommended is a vitamin E supplement, ranging from 400-1200 IU per day and a vitamin C supplement ranging from 1000-4000 mg per day to help prevent small vessel disease of the extremities.Brewer’s yeast is another food supplement that is recommended for the diabetic patient. The yeast is a rich source of chromium-containing GTF (glucose tolerance factor) which is able to potentiate the insulin in our bodies. GTF also contains amino acids such as glutamic acid, glycine, and cysteine. Both brewer’s yeast (9 gm/day) and trivalent chromium (150-1000 mcg/day) have been shown to significantly improve blood sugar metabolism when taken for several weeks to months. As a side benefit it has also been found that brewer’s yeast and chromium supplementation lower elevated total cholesterol and total lipids, and significantly raise the levels of HDL-cholesterol, the beneficial or protective fraction of cholesterol.Chromium is found in foods as both inorganic and organicsalts. Brewer’s yeast contains a form of chromium with high bioavailability, chromium–dinicotinic acid–glutathione complex. The bioavailability of chromium in liver, American cheese and wheat germ is also relatively high. Chromium is also available from a variety of sources including whole grains, potatoes and apples with skins, spinach, oysters,carrots, and chicken breast. Recent research has identified certain varieties of barley grown in Mesopotamia to be some of the richest sources of chromium. A 1996 study of 180 Type 2 diabetics, carried out in China under the guidance of Dr. Richard A. Anderson11, found that 500 mcg of chromium picolinate taken twice daily for four months lowered the fasting glucose level to an average of 129, compared to 160 in those taking a placebo. In addition, glycosylated haemoglobin (a test of longer-term glucose tolerance) averaged an almost normal level of 7.5%in those taking chromium - significantly lower than those on placebo. All of the effects of chromium appear to be due to increased insulin sensitivity.

Another exceptionally useful trace mineral to combat diabetes is vanadium, which lowers blood sugar by mimicking insulin and improving the cells’ sensitivity to insulin. A growing body of human research shows that vanadium compounds, most notably vanadyl sulfate, consistently improve fasting glucose and other measures of diabetes.These benefits were often extended for weeks after the mineral supplementation was discontinued.In addition to taking supplements, diabetics are encouraged to eat the widest possible variety of permitted foods to ensure getting the full range of trace elements and other nutrients. It is interesting to note that certain nutrients like vitamins B1, B2, B12, pantothenic acid, vitamin C, protein and potassium - along with small frequent meals containing some carbohydrate - can actually stimulate production of insulin within the body.

Cautions

1. Fish oil capsules or supplements containing large amounts of para-aminobenzoic acid (PABA) can elevate blood sugar.

2. Supplements containing cysteine interfere with absorption of insulin by cells.

3. Extremely large dosages of vitamins B1 or C may inactivate insulin. Dosages listed above are within normal ranges.

7. Botanical medicines

Since antiquity, diabetes has been treated with plant medicines.The following herbs appear to be the most effective,are relatively non-toxic and have substantial scientific documentation to attest to their efficacy.

European Blueberry (Vaccinium myrtillus)

Traditional herbalism places great value on European Blueberry leaves, a.k.a. Bilberry, as a natural method of controlling or lowering blood sugar levels when they are slightly elevated. Results have shown the leaves have an active ingredient with a remarkable ability to reduce excess sugar in the blood. To use, steep two to three handfuls of leaves in 4 cups hot water for half an hour. Drink three cups a day.Modern research has demonstrated the berries or extract of the berries offer even greater benefit. The standard dose of the extract is 80-160 mg three times per day.

Gymnema sylvestre

Native to the tropical forests of India. Used to lower bloodsugar and help repair damage to pancreatic cells. Therapeutic dosage is 400 mg/day. A good source is a preparation by Natrol as a single herb 5:1 extract containing 300 mg.

Bitter melon (Momordica Charantia)

Composed of several compounds with confirmed antidiabetic properties. 50-60 ml (about 2 oz) of fresh juice per day has shown good results in clinical trials. Charantin, the key ingredient extracted by alcohol, is a hypoglycaemic agent composed of mixed steroids more potent than the drug Tolbutamide that is often used to treat diabetes.

Onion and Garlic

The common bulbs, onion and garlic, have significant blood sugar-lowering action as well as lowering lipids, inhibiting platelet aggregation, and reducing blood pressure.

Fenugreek

Fenugreek seeds have demonstrated anti-diabetic effects in experimental and clinical studies. Administration of the defatted seed (in daily doses of 1.5-2g/kg) reduces fasting and after-meal glucose, glucagon, somatostatin, insulin,total cholesterol and triglycerides, while increasing HDL cholesterol levels.

Salt Bush (Atriplex halimu)

Rich in fibre, protein, and numerous trace minerals, including chromium. Human studies in Israel have demonstrated improved blood glucose regulation and glucose tolerance in Type 2 diabetes. Dosage used in this study was 3g per day.

Ginkgo biloba

Gingko biloba extract improves blood flow in the peripheral tissues of the arms, legs, fingers and toes and is therefore an important medicine in the treatment of peripheral vascular disease. It has also been shown to prevent diabetic retinopathy. Dosage of the extract standardised to contain 24% ginkgo flavoglycosides is 40-80 mg three times per day.

Ginseng (Panax ginseng)

Ginseng, besides reducing fasting blood sugar levels and body weight, can elevate mood and improve psycho-physiological performance. Therapeutic dosage is 100-200 mg daily.

8. Status of diabetes research

In recent years, advances in diabetes research have led to better ways to manage diabetes and treat its complications. Major advances include:

• New forms of purified insulin, such as human insulin produced through genetic engineering.• Better ways for doctors to monitor blood glucose levels and for people with diabetes to test their own blood glucose levels at home.• Development of external and implantable insulin pumps that deliver appropriate amounts of insulin,replacing daily injections.• Laser treatment for diabetic eye disease, reducing the risk of blindness.• Successful transplantation of kidneys in people whose own kidneys fail because of diabetes.• Better ways of managing diabetic pregnancies,improving chances of successful outcomes.• New drugs to treat NIDDM and better ways to manage this form of diabetes through weight control.• Evidence that intensive management of blood glucose reduces and may prevent development of microvascular complications of diabetes.• Demonstration that anti-hypertensive drugs called ACE-inhibitors prevent or delay kidney failure in people with diabetes.

9. Diabetes in the year 2010 - what will the future bring?

Although there are no definitive preventative measures that can be taken against diabetes at this time, except for identifying persons at high risk and encouraging appropriate dietary and exercise guidelines, research into the causes and control of this disease continues to provide the possibility of new cures. With the discovery of insulin in the 1920’s and the development of oral hypoglycaemic drugs in the1950’s, a person who has diabetes can live an active and productive life. The importance of early detection and proper management of this chronic disease cannot, however,be emphasised too strongly.The therapy of insulin-dependent diabetes will surely be altered dramatically over the next few decades. One can project that there will be improved strategies for glucose control in established IDDM. This will include the wide spread use of mechanical devices, which will involve both implantable glucose sensors and implantable insulin infusion systems; and successful pancreas, islet or beta cell transplantation, in the absence of the need of immunosuppressive therapy to prevent rejection.An inhaled form of insulin, under development for several years, appears to be ready for wide scale application by the year 2000. Recent studies conducted at the Universities of Miami and Vermont involving Type I and Type II patients demonstrated that inhaled insulin is at least as effective as injected insulin in controlling the symptoms of diabetes and has no side effects. The delivery system,whereby a finely powdered form of insulin is inhaled directly into the lungs, promises to greatly simplify management of both forms of diabetes. Powdered insulin requires no refrigeration and since it is absorbed into theblood stream though the lungs, there will generally be no need for hypodermic needles. Type I patients will still require an injection of slow-acting insulin at bedtime12. In the future it may also be possible to administer insulin in the form of a pill or patch. All of these advances will change the face of diabetes, as we know it.Moreover, we will see the application of immune intervention strategies at the time of onset of IDDM, with the reversal of the disease process. Ultimately, these strategies will be applied earlier in the sequence during a stage that we do not yet recognise as clinical diabetes. In these individuals otherwise destined to develop IDDM, the disease will be prevented.Part Two of this article to be published in the next issue will cover the traditional Chinese medicine treatment of diabetes, including differentiation,needling prescriptions, dietary medicine, individual herbs and herbal prescriptions.

References1

Encyclopedia of Natural Medicine, M. Murray and J. Pizzorno,

Revised 2 nd Edition 1998, p.4072 New England Journal of Medicine, 329(14), Sept. 30, 1993.3 National Diabetes Data Group, National Institutes of Health, Diabetes in America, 2nd Edition. Bethesda, MD: National

Institutes of Health (“NIH”) Publication No. 95-1468. Ch.1 p.134 U.S. Department of Health and Human Services, Centers forDisease Control and Prevention, November 1997, NationalDiabetes Fact Sheet:

National estimates and general information on diabetes in the United States. Atlanta, GA: NIH Publication No.98-39265 Julian Whittaker,

Health & Healing, Sept. 1995, Vol. 5, No 9, p.26 Charles Weller, M.D.,

The New Way to Live with Diabetes.7 Encyclopedia of Natural Medicine, M. Murray and J. Pizzorno,Revised 2nd Edition 1998, p.414

8 Elson Haas, Staying Healthy with Nutrition, 1992, Ch. 5, p.100

9 P. McNair, Hypomagnesemia- A Risk Factor in Diabetic Retinopathy

, Diabetes, Nov. 1978, 27 (II): 1075-7710 Diabetologia ; 97; 40:344-347

11 Clinical Diabetes, Vol. 15, No. 1, Jan/Feb 199712

An Outline of Diabetes Mellitus and its Treatment by Traditional ChineseMedicine and Acupuncture

03/08/2013 15:34:00

An Outline of Diabetes Mellitus and its Treatment by Traditional Chinese Medicine and Acupuncture

Abstract

Diabetes Mellitus (DM), with its rapid growth rate, is becoming an alarming threat to human health, especially indeveloping countries such as China, India, Indonesia and Russia. Even though western medicine can contribute to the control and treatment of DM, it is generally unable to cure it. Traditional Chinese Medicine (TCM) can buildup the diabetic patients’ resistance to disease, strengthen immunity and promote metabolism. Therefore there are advantages in combining TCM with western medicine in the treatment of DM.This article reviews the history of DM diagnosis by TCM, as well as the pathogenesis of DM from the viewpoints of both western and Chinese medicine. TCM treatment (both herbal medicine and acupuncture) is also reviewed,and treatment methods and formulas are suggested for different patterns of disharmony.TCM diagnoses and treats disease based on an integrative analysis and differentiation of signs and symptoms,including the cause and nature of the illness, as well as the patient’s physical and emotional condition. It can therefore act as a well-tried protocol for the long-term recuperation of diabetic patients.

Introduction

A diabetes mellitus (DM) epidemic is underway. An estimated 30 million people worldwide had diabetes in 1985, but by1995 this number had shot up to 135 million1. In the ear 2000 the World Health Organisation (WHO)estimated that the number of people worldwide with diabetes amounted to 177 million, with the expectation that this will reach 300 million by 2025. The top 10 countries, in terms of numbers of sufferers, are India,China, USA, Indonesia, Russia, Japan, UAE, Pakistan,Brazil and Italy respectively. By 2025, in developed countries most people with diabetes will be aged 65years or more, while in developing countries most will be between 45-64 years old, thereby affecting their most economically productive years2. Much of theincrease in DM is occurring in developing countries as a result of population growth, ageing, unhealthy diets, obesity and sedentary lifestyles. According toa recent report by the WHO in December 2004, 3.2million deaths are attributable to diabetes every year:one in 20 of all deaths3.

Many of these diabetes related deaths are from cardiovascular complications. Most of them are premature deaths, occurring at an age when the people concerned should still be contributing to society economically. This situation is increasingly stretching health-care resources.

In recent years, thanks to the rapid developmentof molecular biological technologies including genomics and proteomics, western medicine has had a more thorough understanding of the genetic factors involved in DM. The identification of the human genome and the genes responsible for diabetes could contribute to the introduction of gene therapy in DM

4 and potential application of proteomics and metabomics has also been adapted5.

In traditional Chinese medicine (TCM), DM is most closely related to ‘xiao ke’ (wasting and thirsting) syndrome, which was first mentioned in the

Su Wen (Essential Questions) of the Huang Di Nei Jing (Canon

of Medicine, 200BCE to 100CE). Chinese and western medical researchers have conducted extensive investigation into DM and its treatment, and this is briefly reviewed in the following article.

Differences and similarities between wasting & thirsting syndrome and diabetes mellitus

‘Xiao’ (wasting) indicates excessive hunger, frequent urination and wasting. ‘Ke’ (thirsting) refers to excessive thirst, and drinking much without being able to quench the thirst. Xiao ke (wasting and thirsting)syndrome has the symptoms of “san duo yi shao” (3 excess, 1 less), i.e. polydipsia, polyphagia, polyuria and emaciation. Actually glycosuria (elevated urineglucose levels) is also very common.Diabetes was first discovered and named by an English physician Thomas Willis in 1672. It is a group of metabolic disorders with one common manifestation: hyperglycaemia, with or without the presence of “sanduo yi shao”. If these symptoms are less than obvious,then diagnosis will be based on laboratory tests.

According to the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus6, the disease is classified into four types:

1. Type I diabetes mellitus (formerly known as insulin-dependent diabetes mellitus or IDDM).

2. Type II diabetes mellitus (formerly known as noninsulin-dependent diabetes mellitus or NIDDM).

3. Gestational diabetes mellitus (GDM).

4. Other specific types.

In addition, DM may have many complications that are not present in xiao ke (wasting and thirsting)syndrome, such as visual disturbance, impotence,amenorrhoea and frequent infections. Conversely, xiaoke (wasting and thirsting) syndrome is diagnosed by the presence of “san duo yi shao”. These symptoms may be caused by factors other than DM, such as fever, dehydration or kidney diseases. Obviously xiao ke (wasting and thirsting) syndrome and DM are not identical, yet they have some similar clinical symptoms.

Research into the pathogenesis of diabetes by western medicine

From the western viewpoint, general aetiological factors for DM include genetic background, viral activity and diet. It is believed that viral activity,particularly herpes-type viruses known as cytomegalovirus may initiate the diabetic syndrome. Aging and poor nutritional status may trigger dormant and low activity viruses.

1. Type I Diabetes Mellitus

Type I DM may account for 5-10% of all diagnosedcases of diabetes and usually affects children.Although the exact cause is not known, autoimmune,genetic and environmental factors are thought to be involved. Pancreatic ß cells destruction leads to insulin deficiency, which subsequently triggers DM. On the other hand, it has become a recognised fact that the susceptibility genes of type I DM are located at the Major Histocompatibility Complex (MHC). Genetic research has shown that DR3 and DR4, as well as DQ alleles, especially the non-aspartic acid (Asp)-57 of DQß1 alleles and arginine (Arg)-52 of DQ∞1alleles, are strongly associated with the developmentof DM7,8.

2. Type II Diabetes Mellitus

The prevalence of DM is increasing in many countries all over the world, of which around 90-95% are type II DM. Most patients have symptoms appearing around or after age 40. Type II DM is often associated with a strong genetic predisposition; the likelihood of normal diabetic patients’ family members also being becoming diabetic is 4 to 10 times higher than fornormal individuals 9. On the other hand, oxidative stress has been implicated in the pathogenesis of DM10. Aging, obesity, unhealthy diet11 and sedentary lifestyles such as prolonged TV watching12 are

all associated with type II DM. In addition, the American Diabetes Association (ADA) reported that hypertension was also a risk factor for type II DM13.

3. Gestational Diabetes Mellitus

Gestational DM is a form of glucose intolerance that is diagnosed in some women during pregnancy, more commonly among obese women and women with a family history of diabetes. It develops in 2 to 5%of all pregnancies but usually disappears when the pregnancy is over. Women who have had gestational diabetes are at increased risk for later developing type II diabetes. In some studies, nearly 40% of women with a history of GDM developed diabetes in the future14.

4. Other specific types

Other specific types of DM result from specific genetic conditions, surgery, drugs, malnutrition, infections and other illnesses. Such types of DM may account for 1 to 2% of all diagnosed cases of diabetes15.

Pathogenesis of diabetes mellitusaccording to traditional Chinese medicine

The pathogenesis for DM is complicated: there are many causes. According to TCM analysis and differentiation of diseases, based on pathological changes of the zangfu organs and their interrelations,all organs are mutually affected. They have reciprocal causation and mutual interference. Traditionally, the disease can be caused by constitutional factors, disorder of the zangfu, improper diet, emotional stress, intemperance in sexual life, etc. Moreover, diabetic patients are normally attracted to greasy and pungent foods which tend to hinder digestion and finally lead to qi obstruction and blood stasis.

Recent research has demonstrated that emotional factors may stimulate the ventromedial hypothalamus(VMH), subsequently affecting the sympathetic nerve and impairing insulin secretion, finally leading to hyperglycaemia. The relatively recent discovery by western medicine that emotional stress is one of the main causes for DM is comparable to the TCM understanding nearly two thousand years earlier that emotional factors involving stagnation of Liver qi might trigger xiao ke.

Zangfu

The pathological changes in DM are focused in the Lung,Spleen (and Stomach), Kidney and Liver, with the Kidney as the key organ. Although the four organs have their own functions, they often mutually influence one another.

1 Lung

Qian Qiu Hai16 propounded that the Lung was the organ in charge of purification and descending of Lung qi and regulating qi, blood and body fluids. Dryness and heat injure the Lung and consume yin fluids, leading to thirst,restlessness and a dry-hot tongue. Furthermore, when dryness and heat injure the Lung, it may fail to regulate the water passages giving rise to polyuria.

2 Spleen

Xiong Man Qi17 thought that Spleen qi deficiency was associated with DM. Throughout the entire disease course,most patients have some degree of Spleen qi deficiency.Shao et al.18 thought that the dryness and heat deriving from yin deficiency, the qi deficiency due to yang failure,and the blood stasis that are all seen in DM, were actually secondary patterns. The primary cause was sinking of Spleen qi, and this underlay the entire course of the disease.Pan Chao Xi19 proposed that as the Spleen failed to spread food essence, water and fluid could not be distributed upward which then led to thirst. Also because water and food essence were unable to be distributed upward and thus spread elsewhere, this led to polyuria and glycosuria.This approach sees the Spleen failing to free food essenceas being the root cause in the pathogenesis of DM.

3 Kidney

Another school of thought argues that the Kidney is central to the pathogenesis of the disease (”yi shen wei ben:Kidney is the primary onset”) arguing that DM is caused either by Kidney yin deficiency or by Kidney (both yin and yang) deficiency. The Kidney governs water metabolism and stores jing (essence). Kidney deficiency leads to water diffusion (shui fan) and therefore causes polyuria. When Kidney deficiency fails to cause contraction and arrest discharges, essence (jing) subtly exits with the urine and therefore the urine is “greasy”. Since body fluid exits excessively, dryness leads to restlessness and polydipsia.

Kidney deficiency also fails to nourish the bones, causing lumbago and knee pain. Chronic Kidney yin deficiency can lead to the impairment of yin which then impedes the generation of yang. Combined yin and yang deficiency can lead to Kidney qi failure which is then even less able to arrest body fluids. Polyuria will thus become more serious, such that patients may even need to urinate after each drink.

4 Liver

Zou Ru Zheng20 pointed out that the pathological characteristics of the Liver are that it is easily depressed,easily heated, and easily made deficient. Liver qi depression, heat and deficiency, caused by the failure to smooth and regulate qi, affects jin ye (body fluids) and therefore insulin secretion. As the occurrence of DM is mainly due to the absolute or relative insufficiency of insulin secretion, Liver qi stagnation is fundamental to the pathogenesis of DM. In addition, the emotional factors related to Liver qi stagnation can directly induce DM.

Qi and blood

Zhou Shu Ping21 noted that diabetic patients have qi deficiency symptoms at the non-symptomatic stage.Because of this underlying deficiency, there is an inability to create and hold jing (essence), leading to its loss. As a result, yin deficiency develops until it obscures the root cause of qi deficiency.According to clinical manifestations, most diabetic patients have symptoms of blood stasis. This may be caused by qi obstruction, injury to jin ye (body fluid) by evil fire, qi deficiency, accumulated cold due to yang deficiency, or blocking of the collaterals by phlegm dampness.Symptoms of blood stasis may be present through the entire course of the disease22.

Diabetes mellitus treatment by traditionalChinese medicine

The incidence of DM is high and it has many complications,some of which Western medicine is unable to completely cure. However, TCM has had more success in the treatmentof some complications, with a direct effect on the improvement of insulin levels and receptor binding sensitivity.

Zangfu treatments

1 Lung dryness

Clinical manifestations

• polydipsia• dry mouth and tongue

• polyuria • reddened tongue borders, thin yellow tongue coating

• full (hong) and rapid (shuo) pulse or wiry (xian) and smooth (hua) pulse

Treatment principles

•clear evil heat • moisten dryness • improve secretions and quench thirst

Acupuncture treatment

Yishu M-BW-12, Feishu BL-13, Taiyuan LU-9, HeguL.I.-4, Yuji LU-10, Shaofu HE-8. The back-shu pointsare punctured obliquely medially 0.5-0.8 cun.

The other points are punctured perpendicularly 0.5-l.0 cun, using

even needling technique. Needles are retained for 10-20minutes.

Herbal treatment

Gan Lu Xiao Ke Tang Jia Jian (Modified Application of Sweet

Dew Diabetes Decoction), which comprises: Sheng DiHuang (Rehmanniae Radix), Mai Men Dong (OphiopogonisRadix), Dang Shen (Codonopsitis Radix), Tian Men Dong(Asparagi Radix), Tu Si Zi (Cuscutae Semen), Shan Zhu Yu(Corni Fructus), Xuan Shen (Scrophulariae Radix), HuangQi (Astragali Radix), Dang Gui (Angelicae sinensis Radix),Fu Ling (Poria). The herbs were ground and filled intocapsules. Each capsule contained 1.8g powder, which wastaken 3 times a day with 3 months as a therapeutic course.

Research

An Bang Yu 23 applied this formula to treat 102 diabetic patients. Of these 30 showed marked improvement, 57improved, but 15 failed to respond to the treatment. Thetotal effective rate was 85%.

2. Spleen yin waning and deficiency

Clinical manifestations

• fatigue • lassitude • poor appetite or fullness felt over the epigastric region• thirst but no desire to drink • feverish sensations in the palms, or night sweats • flushed cheeks • dry hard or unsolid stool

• scanty yellow urine • frequent urination • pale lips and tongue with scanty or peeled coating • fine (xi) and rapid (shuo) pulse

Treatment principle

Invigorate the Spleen and replenish yin.

Acupuncture treatment

Yishu M-BW-12, Weishu BL-21, Zhongwan REN-12,Zusanli ST-36, Sanyinjiao SP-6. The back-shu points are punctured obliquely medially 0.5-0.8 cun, the other points are punctured perpendicularly 0.5-l.5 cun, using even needling manipulation. Needles are retained for 10-20minutes.

Herbal treatment

Zi Zao Jiang Tang Tang Jia Wei (Moistening to Reduce Blood Glucose Decoction with Added Flavours), which comprises: Ge Gen (Radix Puerariae) 30g, Shan Yao (RadixDioscoreae Oppositae) 30g, Cang Zhu (fried RhizomaAtractylodis) 6g, Huang Qi (Radix Astragali) 30g, XuanShen (Radix Scrophulariae Ningpoensis) 15g, Fu Ling(Sclerotium Poriae Cocos) 20g.

Research

Wu Xiao Ling 24 applied this formula to treat 15 diabetic patients. Of these 12 showed marked improvement, 2improved, but 1 failed to respond to the treatment. Thetotal effective rate was 93%.

3 Spleen and Stomach (yang) deficiency

Clinical manifestations

• cold limbs • facial oedema • pale complexion

• fatigue and lassitude • abdominal fullness • poor appetite

• lack of thirst • loose stools • clear profuse urine

• body oedema • whitish moist tongue with tooth prints at the

borders with either a thin white coating or a white smooth greasy coating

• deep (chen), slow (chi) and moderate (huan) pulse

Treatment principle

Warm the Spleen and invigorate qi.

Acupuncture treatmentTaibai SP-3, Gongsun SP-4, Sanyinjiao SP-6, ZusanliST-36, Neiting ST-44. The back-shu points are punctured obliquely medially 0.5-0.8 cun, the other points are punctured perpendicularly 0.5-l.5 cun, using even needling manipulation. Needles are retained for 10-20 minutes.

Herbal treatment

Shen Ling Bai Zhu San Jia Jian (Modified Ginseng, Poria and Atractylodis Macrocephala Powder), which comprises:Dang Shen (Codonopsitis Radix) 15g, Bai Zhu (Atractylodismacrocephalae Rhizoma) 10g, Huang Qi (Astragali Radix)15g, Chen Pi (Citri reticulatae Pericarpium) 10g, Cang Zhu(Atractylodis Rhizoma) 10g, Fu Ling (Poria) 20g, Jiao ShanZha (charred Fructus Crataegi) 15g, Ban Xia (Pinelliaeternatae Rhizoma) 10g, Ze Xie (Alismatis Rhizoma) 10g,Hou Po (Magnoliae officinalis Cortex) 10g, Shan Yao(Dioscoreae Rhizoma) 20g.

Research

Zhang Song Ming 5 applied this formula to treat 15 diabetic patients. Of these, 6 achieved notable curative effects, 8improved, but 1 failed to respond to the treatment. Thetotal effective rate was 93%.

4 Disturbance of the Spleen owing to dampness

Clinical -manifestations

• poor appetite and reduced food intake • abdominal fullness

• loose thin stool • lassitude • white greasy tongue coating

• soft (ru wu li) pulse

Treatment principle

Invigorate the Spleen and dispel dampness.

Acupuncture treatment

Danshu BL-19, Yanggang BL-48, Pishu BL-20, SanyinjiaoSP-6, Yanglingquan SP-9. The back-shu points arepunctured obliquely medially -0.5-0.8 cun, the otherpoints are punctured perpendicularly 0.5-l.5 cun, using even needling manipulation. Needles are retained for10-20 minutes.

Herbal treatment

Jian Pi Tang Jia Jian (Modified Strengthen the Spleen Decoction), which comprises: Chen Pi (Citri reticulataePericarpium) 9g, Huang Qi (Astragali Radix), 30g ShanYao (Dioscoreae Rhizoma) 30g, Fu Ling (Poria) 30g, BaiZhu (Atractylodis macrocephalae Rhizoma) 15g, Gan Cao(Glycyrrhizae Radix) 12g, Ren Shen (Ginseng Radix) 9g.

Research

Liu Yong 26 applied this formula to treat 54 diabetic patients. Of these, 51 achieved notable curative effects orimproved, while 3 failed to respond to the treatment. Thetotal effective rate was 94%.

5. Kidney yin deficiency

Clinical manifestations

• polyuria • greasy urine • excessive thirst

• emaciation • lumbago • aching knees

• dry red tongue with a thin coating • deep (chen), fine (xi) and rapid (shuo) pulse

Treatment principle

Nourish yin and strengthen the Kidney.

Acupuncture treatment

Yishu M-BW-12, Shenshu BL-23, Sanyinjiao SP-6, TaixiKID-3, Zhaohai KID-6. The back-shu points are puncturedobliquely medially 0.5-1.0 cun. The other points arepunctured perpendicularly 1.0 cun using reinforcing needling manipulation. Needles are retained for 10-20minutes.

Herbal treatment

Zi Shen Qing Gan Tang Jia Jian (Modified Nourish the Kidney and Quench Fire in the Liver Decoction), whichcomprises: Sheng Di Huang (Rehmanniae Radix) 30g,Shan Zhu Yu (Corni Fructus) 12g, Shan Yao (DioscoreaeRhizoma) 30g, Fu Ling (Poria) 12g, Ze Xie (AlismatisRhizoma) 12g, Huang Qi (Astragali Radix) 30g, Shan ZhiZi (Gardeniae Fructus) 12g, Dang Gui (Angelicae sinensisRadix) 12g, Bai Shao (Paeoniae Radix alba) 12g, XuanShen (Scrophulariae Radix) 12g, Yin Yang Huo (EpimediiHerba) 12g, Mu Dan Pi (Moutan Cortex) 9g, Cang Zhu(Atractylodis Rhizoma) 9g, Chai Hu (Bupleuri Radix) 9g.

Research

Yang Shan Dong 27 applied this formula to treat 70 diabetic patients. Of these, 24 achieved notable curative effects, 41improved, but 5 failed to respond to treatment. The totaleffective rate was 93%.

6. Kidney yin and yang deficiency

Clinical manifestations

• frequent urination • greasy urine • dark complexion

• lumbago • cold limbs • impotence • dry, pale tongue with a white smooth coating

• deep (chen), fine (xi) and soft (wu li) pulse

Treatment principle

Nourish yin, promote yang and tonify the Kidney.

Acupuncture treatment

Sanyinjiao SP-6, Zusanli ST-36, Guanyuan REN-4, GanshuBL-18, Shenshu BL-23. The back-shu points are punctured obliquely medially 0.5-0.8 cun, the other points arepunctured perpendicularly 0.5-l.5 cun, using even needlingmanipulation. Needles are retained for 10-20 minutes.

Herbal treatment

Gu Yin Jian Jia Wei (Arresting Yin Decoction with Added Flavours), which includes: Shu Di Huang (RehmanniaeRadix preparata) 15g, Shan Zhu Yu (Corni Fructus) 10g,Xu Duan (Dipsaci Radix) 10g, Dang Shen (CodonopsitisRadix) 15g, Fu Ling (Poria) 15g, Mai Men Dong(Ophiopogonis Radix), 15g, Huang Jing (PolygonatiRhizoma) 15g, Gan Cao (Glycyrrhizae Radix) 10g, Tu Si Zi(Cuscutae Semen) 15g, Wu Wei Zi (Schisandrae Fructus)10g, Shan Yao (Dioscoreae Rhizoma) 30g.

Research

Shao Sheng Kuan 28 applied this formula to treat 34 diabetic patients. Of these, 26 achieved notable curative effects orimproved, while 8 failed to respond to treatment. The totaleffective rate was 76%.

7 Liver disharmony

Clinical manifestations

• irritability • proneness to anger • excessive thirst

• yellow urine • red face and eyes • dizziness

• bitter taste in the mouth • dry throat • dry hard stool

• red tongue with a yellow coating • wiry (xian) and rapid (shuo) pulse

Treatment principle

Disperse stagnant Liver qi.

Acupuncture treatment

Fengchi GB-20, Taichong LIV-3, Sanyinjiao SP-6, FuliuKID-7. The back-shu points are punctured obliquely medially 0.5-0.8 cun, the other points are punctured perpendicularly 0.5-l.5 cun, using even needling manipulation. Needles are retained for 10-20 minutes.

Herbal treatment

Xiao San Duo Tang Jia Jian (Modified Application of Resolve Three Poly Decoction), which comprises: Tian Hua Fen(Trichosanthis Radix) 9g, Zhi Mu (Anemarrhenae Radix)10g, Huang Lian (Coptidis Rhizoma) 9g, E Jiao (Asini CoriiColla) 9g, Huang Jing (Polygonati Rhizoma) 15g, Shi Gao(Gypsum fibrosum) 30g, Shan Yao (Dioscoreae Rhizoma)15g, Ren Shen (Ginseng Radix) 5g, Bai Shao (PaeoniaeRadix alba) 15g, Zheng He Shou Wu (steamed Polygonimultiflori Radix) 15g, Mai Men Dong (OphiopogonisRadix) 15g, Di Gu Pi (Cortex Lycii Chinensis Radicis) 9g, JiZi Huang (egg yolk) 2 pieces.

Research

Qiao Bao Jun 29 applied this formula to treat 50 diabetic patients. Of these, 23 achieved notable curative effects, 21 improved, but 6 failed to respondto treatment. The total effective rate was 88%. Ni et al.

30 explored the clinical effect of Dan Zhi Xiao Yao San

(Cortex Moutan Radicis and Fructus Gardeniae Ease Powder) in treating DM, concluding that the formula could soothe the Liver to relieve qi depression, which iseffective in treating DM and could improve the symptomsof DM patients.

Qi and blood treatments

1 Qi and yin deficiency with blood stasis

Clinical manifestations

• emaciation • thirst • dry throat • lassitude

• dizziness and headache • numb aching body, or oppressed feeling and aching in the chest • dry stool • deep red tongue with purple spots on edges • fine (xi) and hesitant (se) pulse

Treatment principle

Reinforce qi and replenish yin, activate qi and stimulate the -collaterals.

Herbal treatment

Bu Yang Huan Wu Tang Jia Wei (Tonify Yang to Restore Five Tenths Decoction with Added Flavours), which comprises: Huang Qi (Astragali Radix) 60g, Chuan Xiong(Chuanxiong Rhizoma) 15g, Di Long (Pheretima) 15g,Dang Gui (Angelicae sinensis Radix) 12g, Tao Ren (PersicaeSemen) 10g, Hong Hua (Carthami Flos) 10g, Chi Shao(Paeoniae Radix rubra) 20g. The following herbs maybeadded as appropriate: Quan Xie (Scorpio) 6g, Wu Gong(Scolopendra) 1 piece, Dan Shen (Salviae miltiorrhizaeRadix) 15g, Sheng Di Huang (Rehmanniae Radix) 12g, YuZhu (Polygonati odorati Rhizoma) 12g.

Research

Wei Jiang Lei 31 applied this formula to treat 30 diabetic patients. Of these, 12 achieved notable curative effects, 14improved, but 4 failed to respond to the treatment. The total effective rate was 87%.

2 Accumulated cold due to yang deficiency with blood stasis

Clinical manifestations

• fatigue • lassitude • intolerance of cold • numb, aching body

• cold limbs • symptoms worse with the cold • cardiac pain

• oedema dull pale tongue • enlarged veins under the tongue

• white smooth tongue coating • deep (chen), fine (xi) and soft empty (wu li) pulse

Treatment principle

Reinforce qi and warm yang, invigorate qi to relieve pain.

Herbal treatment

Shen Qi Jiang Tang Tang Jia Jian (Modified Application of Radix Scrophulariae and Membranous Asparagus Blood Glucose Reducing Decoction), which includes:Huang Qi (Radix Astragali) 30-45g, Gui Zhi (RamulusCinnamomi Cassiae) 6-12g, Da Huang (RhizomaRhei) 6-12g, Xuan Ming Fen (Natrii Sulfas Exsiccatus)3-6g, Xuan Shen (Radix Scrophulariae Ningpoensis)12-15g, Gan Cao (Radix Glycyrrhizae Uralensis) 3g,Sheng Di Huang (Radix Rehmanniae Glutinosae)12-15g, Mai Men Dong (Tuber OphiopogonisJaponici) 12g, Tao Ren (Semen Persicae) 9-12g.

Research

Qian Qiu Hai 32 applied this formula to treat 20 diabetic patients. Of these 11 achieved notable curative effects, 7improved, but 2 failed to respond to treatment. The total effective rate was 90%.

3. Phlegm obstruction and blood stasis

Clinical manifestations

• obesity • heavy, regular aching at affected parts of the body

• dull purple lips • aching limbs, or cardiac pain

• sticky dry mouth thick tongue coating

• dull purple tongue with purple spots • slippery (hua) or choppy (se) pulse

Treatment principle

Resolve phlegm, invigorate blood circulation, remove blood stasis and stimulate the collaterals.

Herbal treatment

Shen Qi Tao Ren Tang Jia Jian (Modified Codonopsis Pilosula

and Semen Persicae Decoction), which comprises: HuangQi (Astragali Radix) 30g, Dang Shen (Codonopsitis Radix)30g, Shi Gao (Gypsum fibrosum) 30g, Dan Shen (Salviaemiltiorrhizae Radix) 30g, Cang Zhu (AtractylodisRhizoma) 15g, Tao Ren (Persicae Semen) 6g, Hong Hua(Carthami Flos) 6g, Dang Gui (Angelicae sinensis Radix)12g, Zhi Mu (Anemarrhenae Radix) 20g, Chuan Xiong(Chuanxiong Rhizoma) 6g, Sheng Di Huang (RehmanniaeRadix) 30g.

Research

Gao Xiu Zhen 33 applied this formula to treat 20 diabetic patients. Of these 1 achieved notable curative effects, 19improved, and none failed to respond to the treatment.The total effective rate was 100%.

4 Liver qi stagnation leading to qi obstruction and blood stasis

Clinical manifestations

• thirst • fatigue • lassitude • loss of appetite

• abdominal distension • depression • irritability

• vexation • insomnia • excessive dreaming

• hypochondrial aches • hypomenorrhoea with blood clots

• deep red tongue, or with purple spots

• wiry (xian) and fine (xi) pulse

Treatment principle

Adjust qi flow and invigorate blood circulation, remove blood stasis and stimulate the collaterals.

Herbal treatment

Xiao Yao Jiang Tang San Jia Jian (Modified Application of Blood Glucose Reducing and Ease Powder), whichcomprises: Chai Hu (Bupleuri Radix) 9g, Bai Zhu(Atractylodis macrocephalae Rhizoma) 12g, Bai Shao(Paeoniae Radix alba) 10g, Chuan Xiong (ChuanxiongRhizoma) 9g, Dang Gui (Angelicae sinensis Radix)10g, Sheng Di Huang (Rehmanniae Radix) 10g, GouQi Zi (Lycii Fructus) 10g, Fu Ling (Poria) 9g, ZhiMu (Anemarrhenae Radix) 30g, Xiang Fu (CyperiRhizoma) 9g.

Research

Guo Xi Jun34 applied this formula to treat 60 diabetic patients. Of these 42 achieved notable curative effects, 15improved, but 3 failed to respond to treatment. The total effective rate was 95%.

Auriculotherapy

Alternatively, ear acupuncture therapy may also be tried.Selected auriculopoints include: Pancreas, Endocrine,Kidney, Triple Heater, Vagus, Ear Shenmen, Heart and Liver. Three to five points are selected each time. Moderate needling stimulation is given, and the needles are retained for 20 minutes. The treatment is conducted once every other day with 10 sessions forming a therapeutic course35.

Conclusion

Diabetes is a chronic metabolic disease that has a significant impact on the health, quality of life and life expectancy of patients, as well as on the health care system. Most of the morbidity and suffering found in diabetics result from prolonged hyperglycaemia leading to many severe complications such as CVA, gangrene, nephropathy,retinopathy, acromelic necrosis (diabetic foot) and coronary heart disease. Diabetes and its complications are not easily managed by western medicine, and therefore itis advantageous to combine TCM with western medicine to treat DM. Macrocosmically, TCM views the human body as a whole. Any excess or shortage of vital substances, including qi , blood and body fluid, will cause disharmony and thus lead to ill health. Therefore the main treatment principleof TCM is to r-estore the body’s homeostasis by using herbal remedies, acupuncture and lifestyle changes 36.

As a holistic treatment, TCM has some advantages intreating DM. It diagnoses and treats diseases based on an overall analysis of signs and symptoms, and thereby restores yin/yang balance and harmony of qi and blood,as well as dredging the channels. Different and highly flexible treatment strategies can be employed which match the remedies to different patterns of disharmony,often achieving better therapeutic efficacy

37. It is especially noteworthy that Chinese medicine can build up diabetic patients’ resistance to disease, strengthen immunity and improve metabolism 38. Although DM is not an acute disease leading to immediate death, once it occurs, it is very difficult to achieve a full recovery. Even though the majority of diabetic patients survive, they still carry the disease for the rest of their lives. Exercise, diet, weight control and lifestyle adjustment continue to be essential and effective means of improving glucose homeostasis. In this respect,Chinese medicine is particularly appropriate for the long term recuperation of diabetic patients. As

Ru Men Shi Qin (Confucians’ Duties to Their Parents) cautioned: “If the patient does not watch their diet, does not avoid sexual excess, and does not stabilise emotion, the disease will keep going”.

William Chi-Shing Cho, B. Sc. (Hons.), M. Phil., C. Sci., FIBMS(UK), FHKIBMS, is a Scientific Officer (Medical) working in the fields of cancer and diabetes for more than ten years at the largest hospital (Queen Elizabeth Hospital) in Hong Kong. He received his bachelor’s degree and master’s degree at The Chinese University of Hong Kong, and is undertaking his Ph.D Degree atthe School of Chinese Medicine in Hong Kong Baptist University.He has registered as a Chartered Scientist at The Science Council(UK) and is a Fellow Member of both the Institute of BiomedicalScience (UK) and Hong Kong Institute of Biomedical Science. He possesses extensive research experience in the United States and the Netherlands. He has profound knowledge in TCM, diabetes and cancer research, genomics and proteomics.

Dr. Kevin Kin-Man Yue is an expert in biochemistry and specialises in research into diabetes. His field of study includes the complications of diabetes, blood vessel diseases due to diabetes and genetic transformation. Dr. Yue graduated from the University of Liverpool, United Kingdom in 1985 and subsequently obtained his PhD in Biochemistry at the same university in 1989. He conducted his post-doctoral research at the Universities of Leicester and Manchester, and has lectured in Clinical Biochemistry at Queen’s University of Belfast, United Kingdom. He is an internationally famous molecular biologist working in the field of diabetes mellitus with an array ofinternational publications.

Dr. Albert Wing-Nang Leung is the Deputy Head of the School of

Chinese Medicine in Hong Kong Baptist University. Dr. Leungobtained his PhD degree in Biochemistry in Australia in 1981 and possesses extensive research experience in major institutes in Australia, Switzerland, Japan and the United States. His research activities mainly focus on photodynamic therapy, pharmacologyand diabetes. In addition to being engaged in research in Biochemistry and Life Science for many years, Dr. Leung is also a Chinese medicine practitioner and a Member of the Election Committee (Chinese Medicine Subsector) of the legislative Council. He has made great efforts in the development of Chinese medicine in Hong Kong.

Notes1. World Health Organization(2002) Diabetes: the cost of diabetes

[Online]. Available at http://www.who.int/mediacentre/factsheets/fs236/en/[Accessed 5 May2005].2. Wild, S., G. Roglic, A. Green,et al. Global prevalence ofdiabetes: Estimates for theyear 2000 and projectionsfor 2030. Diabetes Care. 27:1047-1053, 2004.3. Unwin, N. and A. arlin.Diabetes action now: WHOand IDF working together toraise awareness worldwide.Diabetes Voice . 49(2): 27-31, 2004.4. Sieradzki, J. The role of genetic studies in finding the etiopathogenesis of abetes mellitus. Przegl Lek. 57(3): 3-6,2000.5. Cho, C.S. Proteomics – leading biological science in the 21st century. Science Journal.

56(5):14-17, 2004.6. R e p o r t o f t h e E x p e r tCommittee on the diagnosisand classification of diabetes mellitus. Diabetes Care. 26:

S5-S20, 2003.7. Festenstein, H, J. Awad andG.A. Hitman. New HLA DNA polymorphisms associated with autoimmune disease.Nature. 322: 64-67, 1986.8. Bao, M.Z., J.X. Wang, J.S.Dorman, et al. HLA-DQbeta non-ASP-57 allele andincidence of diabetes in Chinaand the USA. Lancet. 2(8661):

497-498, 1989.9. Qian, R.L., Z. Yang andZ.F. Tong. The 21st century

diabetes mellitus prophylaxisand treatment. Henan Medical

University Publishing House.29:3-4, 2000.10. Yue, K.K., W.S. Chung, A.W.Leung, et al. Redox changesprecede the occurrence of oxidative stress in eyes and aorta, but not in Kidneys of diabetic rats. Life Sci. 73(20):2557-2570, 2003.11. Cockram, C.S. Diabetesmellitus: perspective from theAsia-Pacific region. Diabetes. Res. Clin. Pract.

50(2): S3-7,2000.12. Hu, F.B., M.F. Leitzmann,M.J. Stampfer, et al. Physicala c t i v i t y a n d t e l e v i s i o nwatching in relation to riskfor type 2 diabetes mellitusin men. Arch. Intern. Med.161(12): 1542-1548, 2001.13. Liu, G.X. Type II diabetesm e l l i t u s e p i d e m i cc h a r a c t e r i s t i c s . H u b e i Preventive Medicine Magazine.14(1): 4-5, 1993.14. Ben-Haroush, A., Y. Yogevand M. Hod. Epidemiology of gestational diabetes mellitus and its association with Type2 diabetes. Diabetic Medicine.

21(2): 103-113, 2004.15. Hoet, J.J., B.B. Tripathy, R.H.Rao, et al. Malnutrition anddiabetes in the tropics. Diabetes Care.

19: 1014–1017, 1996.6. Qian, Q.H. Combining Chinese andWestern medicine for diagnoses and treatments. Shanxi Science andTechnology Publishing House,Shanxi, pp. 50-51 and 79-83, 1999.17. Xiong, M.Q. Spleen deficiencyis the important pathogenesis of hectic thirst. Guangzhou Traditional Chinese Medical College Journal. 7:3-14, 1991.18. Shao, A.R., et al. A discussion of thedropping of Spleen vital energy isthe basic pathogenesis of diabetes mellitus. Shandong TraditionalChinese Medical College Journal. 18(2):96-98, 1994.19. Pan, C.X. New research intothe causes, pathogenesis and treatment of diabetes mellitus.Jiangsu Traditional Chinese Medicine.21(1): 1-3, 2000.20. Zou, R.Z. The Liver diagnosis indiabetes. China Medicine Journal.13(1): 17-23, 1998.21. Zhou, S.P. A discussion of vital energy deficiency as the key to diabetes mellitus. New Traditional Chinese Medicine. 31(2): 5-6, 1999.22. Zhan, R.W. The Fourth National Diabetes Mellitus (Hectic Thirst).Academic Conference Papers Collection. p. 284, 1995.23. An, B.Y. Clinical investigation ofSweet Dew Diabetes Decoction treating 102 non-insulin dependent diabetes cases Chinese MedicineJournal. 12(6):31, 1985.24. Wu, X.L. Fujian Chinese Medicine.2:23, 1983.25. Zhang, S.M. Anhui Chinese MedicalCollege Journal. 4:21, 1988.26. Liu, Y. Sichuan Chinese Medicine.7(11):9, 1989.27. Yang, S.D. Shanxi Chinese Medicine.6:241, 1992.28. Shao, S.K. Shanxi Chinese MedicalCollege Journal. 2:21, 1989.29. Qiao, B.J. Henan Chinese Medicine.4:21, 1988.30. Ni, H., G. Liu and S. Luo. Clinicalstudy in treating type 2 diabetes mellitus according to Liver inTCM. Chinese Journal of Integrated Traditional and Western Medicine.20(8):577-579, 2000.31. Wei, J.L. The analysis of reinforcing Yang and restoring the five viscera decoction treating 30 diabetes cases.Zhejiang Chinese Medical Journal.4:178, 1989.32. Qian, Q.H. Practical diabetes treatment and health care. Jinan Shandong University PublishingHouse, 1993.33. Gao, X.Z. Zhejiang Chinese MedicalCollege Journal. 1:15, 1989.34. Guo, X.J. Beijing Chinese Medical College Journal. 14(3):36, 1991.35. Meng, H., Wang, S.R. and Wang, W.Lectures on acupuncture. World J.Acup-Mox. 10(4):70, 2000.36. Cho, C.S. Chinese medicine to viewmodern life. Vitality. 1:48-49, 2004.37. Cho, C.S. Personalized medicine.Popular Medicine. 10:74-75, 2004.38. Cho, C.S. Strengthen our immunity:nutrition, exercise, health andpsychology. Vitality. 8:30-33, 1997.

THE TREATMENT OF THYROID DISEASES BY ACUPUNCTURE

02/11/2013 11:21:00

THE TREATMENT OF THYROID DISEASES BY ACUPUNCTURE

By Dr. Sheng Canruo, Nanjing Seminars, London September 1985

This lecture discusses hyperthyroidism and goitre and excludes hypofunction of the thyroid. In TCM this disease belongs to the category of 'Qi Yin'. ('Yin' hererefers to swelling, enlargement, tumour etc. in the neck caused by accumulation ofphlegm).

TCM considers that there are three causes leading to thyroid enlargement. All three involve phlegm.

Explanation of phlegm

Phlegm derives from accumulation or stasis of body fluids inside the body. The Chinese term is 'Tan Yin'. 'Tan' is thick and sticky, and 'Yin' is thin. Both are the pathological products of body fluid. The existence of phlegm (Tan) often leads to diseases of the respiratory system, neurosis, schizophrenia, cerebro-vascularaccident, epilepsy, arthritis, enlargement of the thyroid due to various causes, TB of bones and joints, tumours, cancer etc. Those caused by excess fluid (Yin) include chronic or acute gastritis, exudative pleurisy, bronchitis, asthma, and oedema dueto nephritis.Body fluids are derived from water and food, which are transformed by the zangfu and sanjiao and distributed to different parts of the body. The 'clear' is absorbed and the 'turbid' discharged as sweat and urine. Three zang fulfil water metabolism:

1. The SP Yun Hua (transportation and transformation) function

2. The LU function of dispersing and regulating water passages

3. The KID function of dominating and evaporating water

Among the three zang involved, the SP is predominant. SP-Yang-Xu may fail totransport the body fluids up to the LU, and to descend water to the KID.Under abnormal conditions, for example invasion of exogenous pathogenic factors,irregular food intake, overstrain and stress, there may be an imbalance of yin and yang and the zangfu:

1. If this leads to hyperactivity of yang the body fluids will be decocted orconcentrated, giving rise formation of phlegm.

2. If there is hypofunction of yang and preponderance of yin, the body fluids will transform into 'Yin' (excessive body fluids).In other words, phlegm pertains to yang and excessive fluid to yin.

Phlegm (Tan) is thick and sticky and can affect any part of the body. Excessive fluid(Yin) is thin, and only affects the zangfu and the body cavity - not the head andlimbs.

Phlegm can cause diseases in five ways: wind-phlegm, phlegm-damp, phlegm-heat,phlegm-dryness and phlegm-cold. It may affect various zangfu and regions of thebody as follows:

Phlegm obstructs the LU

- cough

- hoarse breathing

- shortness of breath

- chills

- fever

Pulse: Floating

Phlegm mists the HE

- mental dullness

- incoherent speechweeping and laughing without reason

- if severe, coma

Tongue: yellow coating Pulse: Wiry, Slippery

Phlegm affecting the ST

- fullness in the epigastrium

- borborygmus

- loose stools

- generalised heavy sensation

- lethargy

Pulse: Slow, Soft

Phlegm affects the LIV

- hypochondriac pain

- belching

- dizziness

- vertigo

- obstructive sensation in the throat

Tongue: thin sticky coating Pulse: Wiry, Slippery

Phlegm affects the KID

- shortness of breath

- cough with frothy sputum

- soreness of the lumbar region

- darkish complexion

Pulse: Deep, Fine

Phlegm remains in the chest and hypochondrium

- hypochondriac pain, worse after coughing

- shortness of breath

- symptoms worse when turning the body

Tongue: thin white coating Pulse: Deep, Wiry

Phlegm remains in the bone cavities and jingluo

- swelling of joints

- hemiplegia

- TB of cervical lymph nodes

- thyroid enlargement

AETIOLOGY AND PATHOLOGY

Enlargement of the thyroid occurs due to accumulation of phlegm in the jingluo which pass through the neck.

1. Emotional changes such as depression, anger and sudden fright may cause stagnation of Qi of the HE and LIV, leading to obstruction of the jingluo. Prolonged stagnation of Qi may lead to accumulation of body fluids and the formation of phlegm. Phlegm mingled with stagnation of Qi blocks the jingluo in the neck.

2. Irregular food intake impairs the function of the ST and SP in transforming Qi and blood, and leads to the formation of phlegm which blocks Qi circulation -hence stagnation of Qi and accumulation of phlegm. If this condition is prolonged,the normal circulation of Qi and blood is impaired and the stasis of phlegm andblood leads to pathological changes of the thyroid such as goitre. If in addition the patient has prolonged stagnation of LIV-Qi which has transformed to Fire, there may be irritability, mental restlessness, palpitations etc. This corresponds to hyperthyroidism in Western medicine. Hyperactivity of LIV-Fire may consumeLIV-Yin and affect the KID, leading to KID-Yin-Xu and hence low-grade fever.

3. Pregnancy, lactation and puberty are physiologically related to the Qi and blood ofthe LIV, REN and DU channels. Disharmony of Qi and blood in the LIV may easilystir up LIV-Fire and lead to stagnation of Qi and blood, and hence thyroid disease.In other words during the time of pregnancy, lactation and puberty is is easier todevelop LIV disharmony and thyroid disease

DIFFERENTIATION AND TREATMENT

1. Stagnation of LIV-Qi

Clinical manifestations:

- thyroid enlargement

- mass is soft and without pain (Qi is non-substantial)

- stuffiness in the chest

- hypochondriac pain

- symptoms may worsen with emotional changes

Tongue: thin white coating Pulse: Wiry

Treatment principle:Soothe the LIV, regulate Qi and relieve stagnation.

Points:Shenmen HE-7Zhigou SJ-6Yanglingquan GB-34Ganshu BL-18Qimen LIV-14Shuitu ST-10

Method: Reduce. Treat every other day.

This is the most commonly-seen syndrome.

2. Obstruction by phlegm and stagnant Qi

Clinical manifestations:

- enlargement of thyroid (feels much larger than in first syndrome)

- stuffiness in chest

- poor appetite

- sometimes nausea

Tongue: white sticky coating

Pulse: Wiry, Slippery

Treatment principle:Resolve phlegm and regulate Qi

Points:Jianshi P-5Fenglong ST-40Tianzhu BL-10Neck-Futu L.I.-18Fengchi GB-20

Note: Jianshi P-5 and Fenglong ST-40 are combined in the treatment of all phlegm diseases, eg acute epilepsy; mental disorders; upward attack of phlegm which affects the head, leading to headache, heavy sensation etc; acute attack of angina pectoris;retention of food leading to stuffiness in the chest and fullness in the epigastrium;twitching in the limbs (accompanied by mental clarity) due to wind-phlegm; facialspasm.

Method: Reduce. Treat daily.

This syndrome mostly refers to goitre.

3. Hyperactivity of LIV-Fire

Clinical manifestations:

- thyroid enlargement

- fast temper, irritability

- excessive sweatinghot face

- bitter taste in the mouth

Tongue: slightly red, thin yellow coating Pulse: Wiry, Rapid

Treatment principle:Clear the LIV and reduce Fire.

Points:Shenmen HE-7Taichong LIV-3Sanyinjiao SP-6Taixi KID-3Zhaohai KID-6

Method: Reduce. Treat daily.

This syndrome mostly corresponds to hyperthyroidism.

CONCLUSION

In China acupuncture is applied to treat thyroid enlargement in many places.Research has been done on changes in iodine during acupuncture treatment.Clinical experience shows that acupuncture is quite effective, especially for simple goitre. After treatment, enlargement gradually disappears and iodine increases.During the early stage of treatment, the effect is very marked. After a certain period,some enlargement remains and the further effect of treatment is much slower.Generally in treating disease, when the pathological changes are severe, the initial effects are rapid and marked, but at a later stage, when the pathological changes are relatively minor, the therapeutic effect is slow and more difficult to obtain.

THE DIFFERENTIATION AND TREATMENT OF PARKINSON'S DISEASE ACCORDING TO TRADITIONAL CHINESE MEDICINE

01/11/2013 11:59:00

THE DIFFERENTIATION AND TREATMENT OF PARKINSON'S DISEASE ACCORDING TO TRADITIONAL CHINESE MEDICINE

LI GENG HE, ZHONG XIN HOSPITAL, SHANGHAI

TRANSLATED BY PIA MARIA STREIFF

INTRODUCTION

Parkinson’s disease manifests with specific symptomssuch as trembling, stiffening of the muscles, restrictionof movement and finally the obstruction of certain reflexes of the body. In the majority of cases it affects old people, and it is generally treated with Western drugs such as atropine and scopolamine. Results of basic theoretical neurological research also advise the use of levodopa and amantadine. These medicaments, however,can only improve the symptoms of the illness andwill not stop its progression, more over they induce considerable side effects. Since this is a disease of old age,my method of treating it according to TCM might also be beneficial to research done in the field of geriatric disease.The most important clinical symptoms and signs are:- trembling, usually in the feet and hands or neck- muscular rigidity- impaired movement- stooping posture- oculogyric crises- facial expressions are hindered (incessant crying or smiling expression).According to the differentiation of symptoms and signs in TCM, the disease has a very strong relation to both Liver and Kidney. It appears either as a result of long standing obstruction of Qi and stagnation of blood,which dries out the Liver channel, or as a result of deficiency of both Qi and blood. The root of this diseaseis therefore in the Liver.

Parkinsonism appears most often in patients over fifty years of age. In the ancient classics of TCM we can find early references to this point. The

Neijing states:

“When the age of forty years is reached, the Yin-Qi reduces itself by half.” “Yin-Qi reduces itself by half”means that the Kidney-Yin has already been reduced byhalf, and deficient Yin is then not able to restrain Yang(water fails to nourish wood). The Liver is the ‘resolute organ’; it must receive Kidney-water and be moistened by it. If this does not happen, symptoms of wind such astrembling, stiffness and progressive impairment of movement will appear.

From the point of view of TCM this is a manifestation of insufficiency of Liver-Yin.The Neijing also states: “The Liver is of basic importance to movement; it stores the Hun (i.e. it is concernedwith mental activities); its brilliance is reflected in the fingernails and its fullness in the muscles, where it produces Qi and blood.”A further quote from the Neijing says: “The East generates wind, wind generates wood, wood generates sourness, sourness generates the Liver, Liver generates muscles ..... in terms of matter it means wood, in the body it means the muscles and therefore the Liver, in terms of change it is to push.”

Luo Guo Gang’s collection Hui Yue Yi Jing (‘Collected Medical Writings Through a Looking Glass’) from the Qing dynasty says: “Everything that is sudden and rigid, comes from the Liver, and is not influenced by exterior wind. The Liver, like wood, corresponds to the East; it stores blood and it regulates wind; when theLiver-Blood is diseased, it fails to nourish the muscles;when the muscles and tendons are affected, rigidity and giddiness will occur.”

The Zheng Zhi Zhun Sheng (‘Criteria for the Treatment of Disease’) says: “Trembling of both hands, often seen simultaneously with uncontrolled tremor of the head, is due to inability of the tendons to restrain, which belongs to Liver wind.” It also says: “The neck is the meeting point of all the Yang channels. When the Liver-Qi rushes upwards, then the head will start moving by itself ..... when it spreads into the four limbs, then hands and feet will move and the head will stay still.” It also says: “This illness is rarely seen in younger years;towards the end of middle age it occurs more often, in older years it is especially common.”As we can see, the classical Chinese medical compilations recorded the connection between the functioning of the Liver and the main symptoms of this disease.We can therefore also refer to them to discover the treatment of this condition.

aetiology and pathology

1. The storage of blood.

The Liver stores the blood, whichis instrumental to all the organs and to the muscles. The tendons and muscles rely on nourishment by blood in order to move, to push, and indeed to function in general.If the blood fails to nourish the muscles, stiffening,rigidity or atrophy of the muscles will occur. The Neijing says: “Any dizziness through wind comes from the Liver.” Therefore trembling, dizziness and similar symptoms are connected to wind arising due to Liver-Blood deficiency. The Neijing also says: “Everything that is sudden and rigid, relates to Liver wind”. We can therefore interpret symptoms such as stiffening of the muscles and impairment of bodily movements and gestures as signs of deficient Liver-Qi.

2. The governing of muscles.

The Liver regulates movementand shows its brilliance in the nails. The S

uwen states in the Luo Lun (‘Discussion of Fistulas’): “The Liver governs the tendons and membranes of the body.”Tendons and membranes are there to link joints and muscles, as in the saying: “the tendons restrain the bones to benefit the structure of the body.” Only when theLiver-Blood is sufficient and warming, can the Qi be raised to the tendons, where it is used to nourish and moisten them and so ensure proper motor control. Therefore,when Liver-Blood is insufficient, it does not nourish the tendons and so gives rise to trembling of hands and feet, numbness in the limbs and irregular movement.

3. The Liver is concerned with tactics and mental agility.

Amongst the twelve organs the Liver occupies the role ofthe general. It is the pivot of wisdom and astuteness, and is therefore intimately connected to agility of mind. The Liver stores the Hun (one aspect of the soul). Injury to the emotions and the will result in unrestrained rashness;the Hun and the Po (the spiritual and the physical,sentient aspect of the soul) will be in turmoil; the Liver-Qi is disrupted and the mind not at rest, which will result in symptoms of fright and shock, indications of an affected spirit.

4. A number of Parkinson’s disease patients also have symptoms of stagnation of blood, such as a darkish purple tongue, ecchymosis, abnormal sensation, discomfort or pricking pain. For these cases, herbs to move the blood and dissolve stagnation have to be added to a basic prescription to tonify the Kidney and the Liver.

Stagnation of blood is of course also related to the functioning of the Liver. The Liver stores the blood and adjusts its flow in the whole body. When Liver-Qi stagnates, Liver-Blood also fails to flow, which can lead to stagnation of blood. The symptoms of stagnation of blood are very varied, therefore the application of the principle of ‘moving the blood and clearing stagnation’will vary every time as well. As with stroke patients, the method of ‘moving blood and dispersing wind’, is often used. (“In order to treat wind, first treat the blood; when the blood flows, the wind will clear of its own accord”.)The wind spoken of in this case is interior wind, resulting from deficiency of Liver-Blood or stagnation of Liver-Qi.

5. In clinical practice we come across some patients who show deficiency of both Qi and blood. The theory of TCM describes the relationship between Qi and blood as follows: “Qi is the master of blood, and blood is the mother of Qi”, and: “Qi rides with the blood.” As Parkinson’s disease arises when Liver-Blood is insufficient,according to the theory of “diseased Yin will affect Yang”, longstanding Blood-Xu will lead to deficiency of Qi. The resulting condition of Qi and blood Xu is considered to be very complicated and difficult to treat.

6. In the treatise “Parkinsonism and its relationship to the Liver in TCM” the connection to the Kidney is also discussed. The Yi Zong Bi Tan states that “Liver and Kidney have the same origin.” “To treat deficiency in wood, it is necessary to tonify the Kidney. The Liver-Qi will then not rebel, and the Liver-Blood will be nourished.The water for this comes from the source of water(Kidney), the wood relies upon it in order to flourish.”The Liver stores the blood, the Kidney stores the Jing.Liver-Blood necessarily relies on Kidney-Jing for its nourishment; only then can it fulfil its function. In the same manner, only plentiful Liver-Blood can be transformed into Kidney- Jing, and contribute to its abundance.When Kidney-Jing withers and dries up, Liver-Blood is insufficient, therefore we say that Liver and Kidney are of the same origin. This illustrates the fundamental relationship between Parkinsonism and theKidney in TCM.

7. Parkinson’s as an age-related disease can also be seen as a product of senility. Research shows that Chinese herbal remedies to tonify the Kidney and to replenish the Jing have a considerable success to counteract senility.We therefore stress the importance of tonifying the Kidney in our treatment.This disease therefore has to be treated according to the specific circumstances. Both the branches and roots have to be considered simultaneously. Deficiency has to be tonified, and fullness has to be dispersed. Both dispel stagnation and create new blood; regulate the Ying and the Wei and harmonize Qi and blood.

differentiation and treatment

1. KIDNEY AND LIVER YIN XU

Major symptoms

- stiffening and rigidity of the body- incessant tremors- to-and fro-tremor of the head- tinnitus and blurred vision- five palms hot- sore and weak lower back and limbs- dry stool.

Tongue red with scanty coating.Pulse thin and rapid or wiry, thin and rapid.

Treatment principle

Nourish Liver and Kidney with tonics in order to strengthen the blood.

2. STAGNATION OF QI AND BLOOD

Major symptoms

- trembling of the head and limbs- rigid or trembling neck- incessant fixed pain or numbness of the body- gloomy dull colour of the face

Tongue: dark red or purplePulse: thin and irregular

Treatment principle

Move the blood and disperse stagnation; tonify the Liverand Kidney.

3. DEFICIENCY OF QI AND BLOOD

Major symptoms

- pallid face- whole body listless- difficulty in movement- spontaneous sweating- fear of cold- little appetite- unformed stool- oedema.

Tongue: palePulse: thin and deep pulse.

Treatment principle

Strong tonification of Qi and blood.

treatment

Due to the simultaneous occurrence of both stagnationof blood and deficiency of Yin of the Liver and Kidney,we decided that the basic prescription should have the action of tonifying Liver and Kidney, moving blood and clearing the channels.

It consists of:Shu Di Huang (Radix Rehmanniae GlutinosaeConquitae)Huai Niu Xi (Radix Achyranthis Bidentatae)Dang Gui (Radix Angelicae Sinensis)Gou Ji (Rhizoma Cibotii Barometz)Shou Wu (Radix Polygoni Multiflori)Bai Shao (Radix Paeoniae Lactiflorae)Dan Shen (Radix Salviae Miltiorrhizae)Ji Xue Teng (Radix et Caulis Jixueteng)Mu Gua (Fructus Chaenomelis Lagenariae)Add or deduct according to symptomsWith Qi Xu add:Dang Shen (Radix Codonopsis Pilosulae)Huang Qi (Radix Astragali)Bai Zhu (Radix Atractylodis Macrocephalae)Shan Yao (Radix Dioscoreae Oppositae)Zhi Gan Cao (Radix Glycyrrhizae Uralensis)

With Blood Xu add:E Jiao (Gelatinum Asini)Sang Shen (Fructus Mori Albae)Han Lian Cao (Herba Ecliptae Prostratae)

With stagnation of Blood add:Hong Hua (Flos Carthami Tinctorii)Tao Ren (Semen Persicae)Chi Shao (Radix Paeoniae Rubra)Su Mu (Lignum Sappan)Di Bie Chong (Eupolyphagae seu Opisthoplatiae)Shan Jia Pian (Squama Manitis Pentadactylae)Chuan Xiong (Radix Ligusticii Wallichii)With obvious stiffening of the muscles add:Jiang Can (Bombyx Batryticatus)Gou Teng (Ramulus Uncariae Cum Uncis)Chan Yi (Periostracum Cicadae)Di Long (Lumbricus)

TREATMENT

With a stiff neck add:Ge Gen (Radix Puerariae)With sore,numb and painful arms add:Jiang Huang (Rhizoma Curcumae)With numb and painful body and limbs add:Chuan Niu Xi (Radix Cyathulae)With sore and aching body or joints add:Hu Jiao (Fructus Piperis Nigri)Jin Que Gen (Caragana Sinica)Wei Ling Xian (Radix Clemetidis Chinensis)Xu Chang Qing (Cynanchum Paniculatum)Qin Jiao (Radix Gentianae Macrophyllae)With headache and dizziness add:Bai Zhi (Radix Angelicae)Ge Gen (Radix Puerariae)Chuan Xiong (Radix Ligustici Wallichii)Ju Hua (Flos Chrysanthemi Morifolii)Xia Ku Cao (Spica Prunellae Vulgaris)

In recent years we have compiled over 300 case histories.As this disease is a chronic condition, it is difficult toachieve a complete cure, therefore we isolated 40 cases for our clinical analysis.Data to measure the curative effect

1. Treatment with Chinese herbs: the first group of patients took Chinese herbal remedies exclusively. The dose was one package a day, taken in the morning andthe evening. The period of time that the medication was taken varied greatly. The longest was 450 prescriptions,the shortest 14. 30 cases used Chinese herbs for 3 months or longer.2) Combined treatment:

Some 30 patients used western drugs, e.g. artane, amantadine etc, at the same time as having Chinese herbal treatment. Most of them were able to gradually reduce the dose of Western drugs after using Chinese herbs, and eventually stopped taking them

3) Standard of effectiveness:i. Excellent effect: The subjective symptoms improvedgreatly, there was a renewed ability to cope with everyday life and work, obvious symptoms like trembling,rigidity and stiffness, impaired movement, speech problems,abnormal gait and posture were much improved.ii. Good effect: The subjective symptoms and main symptoms improved.iii. Daily effects: Subjective and main symptoms changed from day to day.4) Results of treatment: Because the results of this survey

cannot be measured exactly, we will only include thetreatment results of the 30 patients who took Chinese herbs for longer than 3 months.

Group I : 6 cases, 20%Group II : 13 cases, 43.3%Group III : 11 cases, 36.6%

The connection between different types and treatment success is as follows:

Cases 1 2 3

Stagnation of Qi and Blood 9 6 3 -

Liver and KIdney Yin-Xu 17 - 10 7

Qi and Blood Xu 4 - - 4

As we can see, in cases of stagnation of Qi and blood, the results are very promising, whereas in cases of deficient Qi and blood they are very poor.

Case history

Male, 55, worker. Initially he experienced lack of strength and difficulty of movement of the left arm. After one year, precise movements became difficult and he developed tremors whenever he concentrated. After two years the symptoms began to affect the left arm as well, he developed involuntary quickening of gait, and experienced a fixed, incessant pain in the right scapula.

Examination:Fixed facial expression, intermittent tremors when the limbs were at rest, (right arm ++++, left arm++); with increased muscle tension the limbs assumed a cogwheel position, (right arm +++, left arm ++), stiffneck (+), slow body movements, festination gait (a tendency to break into a run). Tongue darkish purple, thinwhite coating; Pulse: thin and irregular. Diagnosis: Insufficiencyof Kidney and Liver, stagnation of Qi andblood.After one month of taking Chinese herbs, the patient had greatly improved, movement was almost normal and his muscle tension much better. Posture and gait were nearly normal. Three months later he had basically recovered and started to work again.

CONCLUSION

1. Parkinson’s Disease is considered to be an illness of the later years and is rarely seen in patients under forty years of age. The Neijing says: “When the age of forty years is reached, the Yin-Qi reduces itself by half.” Yin-Qi means Yin blood and Yin Jing. According to TCM,Liver and Kidney are of the same origin, and Jing andblood mutually promote each other. Therefore methods of tonifying Liver and Kidney , blood and Qi prove effective in clinical therapy. The herbs used are often sour in taste and enter the Liver.

2. In clinical practice, three types of Parkinsonism can be differentiated: i. Stagnation of Qi and blood, ii. Yin deficiency of Liver and Kidney, iii. Deficiency of Qi andblood. The most important amongst them is the Liver and Kidney deficiency type. The other two can transform and change into this type. Treating the physical tremors means involves treating wind, and the principle“to treat wind, treat the blood first” should be applied.When the blood flows, the wind will clear of its own accord. ‘Decreasing Yin influences the Yang’ means that when Yin withers, the Yang will also become deficient.Therefore the greater the age of the patient, the higher the incidence of deficiency of Qi and blood will be, and the lower the treatment success.

3. In clinical practice, we discovered that if patients combine Western and Chinese medicines, their symptoms improve, and at the same time Western medication can be reduced. The alleviation of side effects by reducing the dose of Western drugs and replacing them with Chinese herbs is considerable.

Parkinson's Disease

12/26/2012 11:17:00

PARKINSON'S DISEASE

by Yufang Xue

Parkinson’s disease is the most common central nervous system disorder. It is an idiopathic, slowly progressive degeneration of automatic and gross motor function. Parkinson’s disease is characterised by impaired movement,muscular rigidity, resting tremor, and postural instability.In the United States, 50,000 new cases of Parkinson’s disease are diagnosed in the geriatric population per year. This is a rate of one in two hundred.

Aetiology and pathology of Parkinson’sdisease in TCM

Tremors of the hands, rhythmic contraction and relaxation of antagonistic muscles, difficulty in movement and rigidity, stiff limbs, a staring look and mask-like face etc.are all common manifestations of Parkinson’s disease.At the later stage of the disease, all movement is reduced in speed and frequency. The patient often sits immobile,walks taking small, shuffling steps, talks slowly with monotonous speech and a low voice, and writes in progressively smaller handwriting. Many of these are typical signs and symptoms of internal wind associated with liver disharmony in TCM. Parkinson’s disease usually occurs in patients over 50 years old. Chinese medicine believes that overwork, excessive sexual activity, improper diet and emotional stress are all common and important pathogens for many diseases. If these pathogens last a long period of time they will eventually give rise to kidney deficiency. Furthermore, senility,the late stage of life, is characterised by decline of kidney essence. This is why geriatric diseases always present with an underlying kidney deficiency pattern. As the liver and kidney share the same origin, kidney deficiency leads to both liver and kidney deficiency. Malnourishment of the tendons due to this deficiency results in stirring of liver wind internally.

From a TCM perspective, the main manifestations and age of onset of Parkinson’s disease indicate that the disease relates primarily to liver and kidney disharmony and liverwind.

Pattern identification and treatment principles of Parkinson’s disease

Parkinson’s disease is characterised by signs and symptoms of liver wind. In clinical practice, this degenerative condition often overlaps with other chronic geriatric diseases such as hypertension, high cholesterol, coronary artery disease,arteriosclerosis and diabetes. These are commonly associated with phlegm and blood stasis. In Chinese medicine, the pathogenesis of Parkinson’s disease includes both root deficiency and excessive manifestations such as wind, phlegm,qi stagnation and blood stasis. Patterns of Parkinson’s diseaseare represented by a progressive continuum from mild to severe. Qi and blood deficiency begins the disease progression.Left untreated or aggravated, the condition often degenerates into deficiency of liver and kidney. Wind-phlegm is then prone to obstruct the channels leading to blood stasis with endogenous wind. Finally, at the severe end of the spectrum,yin and yang both become deficient. As a result, the general treatment principle is “nourishing yin and extinguishing wind”. Nourishing liver and kidney yin treats the root and extinguishing wind focuses on eliminating its manifestation. “Invigorating blood and transforming phlegm” is an additional principle applied because blood stasis and/or phlegm are patterns that appear often in this disease. The specific treatment plan will be different in different stages of the disease and with different patients. Generally speaking, Parkinson’s disease is a chronic and difficult disease requiring a long period of treatment with acupuncture and herbs. In the acupuncture treatment of Parkinson’s disease, although the selection of acupuncture points is primarily based on patterns, some special empirical points are also important. Secondly, keep in mind that due to the long treatment period and the need for frequent treatments, it is important to avoid overuse of commonly used points. To do this, organise acupuncture points into groups and alternate them each time, and supplement acupressure of the points at regular intervals.

For the herbal treatment of Parkinson’s disease, the following two aspects should be taken into account. First of all, the functional state of the spleen and stomach is not strong in the elderly. Herbs that move qi to promote the spleen and stomach’s functions are commonly used, therefore, to prevent the nourishing herbs from cloying. Secondly, herbs that invigorate blood and transform phlegm are warm, pungent and scattering and have a tendency to injure body fluids, blood and yin. Itis important, therefore, to select relatively mild herbs for eliminating blood stasis and phlegm. Ultimately,maintaining mood, changing lifestyle and practising some oriental exercises such as qigong and taiji are equally as important as herbs and acupuncture in preventing and treating Parkinson’s disease.

Acupuncture treatment of Parkinson’s disease

Body acupuncture

Main Points

: Taixi KID-3, Ganshu BL-18, Taichong LIV-3, Ququan LIV-8, Sanyinjiao SP-6, Guanyuan REN-4, FengchiGB-20, Fengshi GB-31 and Hegu L.I.-4.

Explanation

: In this acupuncture prescription, Taixi KID-3,the yuan-source point of the kidney channel, is effective at nourishing kidney yin. Ganshu BL-18 and Ququan LIV-8,the back-shu point and he-sea point of the liver channel respectively, restore the liver function. These three points nourish kidney and liver yin to treat the root.The spleen and kidney are the root of post- and pre- heaven respectively, and thereby the source of liver yin. SanyinjiaoSP-6, the meeting point of the spleen, liver and kidney channels,and Guanyuan REN-4, the meeting point of the Conception vessel with the spleen, liver and kidney channels, can tonify the liver. Both REN-4 and SP-6 strengthen the function of the first three points in treating the root.Fengchi GB-20 (Wind Pool) and Fengshi GB-31 (WindMarket) are points of the gall bladder channel which interiorly-exteriorly connects with the liver channel, and are effective at extinguishing liver wind.There is a Chinese saying that states, “In order to extinguish wind one should invigorate blood first; with the free flow of blood, wind will be diminished automatically.”Taichong LIV-3 and Hegu L.I.-4, comprise “the four gates,”a point combination which is effective at moving qi and invigorating blood, and thus assisting in extinguishing liver wind. In the above prescription, five of the nine points focus on nourishing yin to treat the root and four of the nine points mainly extinguish wind to treat the manifestations.

Modifications

• add Qihai REN-6 and Zusanli ST-36 to tonify deficient qiand blood.• for pronounced liver and kidney yin deficiency, addShenshu BL-23, Zhaohai KID-6 and Yanglingquan GB-34.• add Yinglingquan SP-9 and Fenglong ST-40 when thechannels are obstructed by wind-phlegm.• for cases with blood stasis and endogenous wind addGeshu BL-17 and Xuehai SP-10.• when both yin and yang are deficient add Zhaohai KID-6,Mingmen DU-4, Qihai REN-6 and Zusanli ST-36.• add Dazhui DU-14, Shaohai HE-3 and Houxi SI-3 in caseswith severe tremor.• add Tianshu ST-25 and Qihai REN-6 for constipation.• add Chengjiang REN-24, Lianquan REN-23 and FuliuKID-7 to relieve dry mouth and numb tongue.

Scalp acupuncture

The commonly used scalp locations are the chorea, motor,leg motor and sensory areas. Use the thoracic cavity area in cases with palpitations and chest oppression. Lastly, the stomach area is effective for epigastric distention and reduced appetite.

Some other commonly used techniques

Pricking to bleed

Blood stasis is an important pathogenesis in many chronicand difficult diseases. In the treatment of Parkinson’s disease,pricking to draw blood is an empirical and effective method. The frequently used points are Quze P-3, WeizhongBL-40, Dazhui DU-14 and Taiyang (M-HN-9).

Moxibustion

Moxibustion is also used frequently in practice, especially for patterns involving yang qi deficiency. Dabao SP-15,Qimen LIV-14, Shenque REN-8 and Zusanli ST-36 are the most commonly used points for moxa treatment which is especially effective for the rigidity of muscles and limbs.

Herbal treatment of Parkinson’s disease

Herbal PrescriptionUse a combination of Di Huang Yin Zi (Rehmannia Decoction) and Tian Ma Gou Teng Yin (Gastrodia-Uncaria Decoction)

with variations:

Tian Ma (Rhizoma Gastrodiae Elatae), GouTeng (Ramulus Uncariae Cum Uncis), Long Gu (OsDraconis), Mu Li (Concha Ostreae), Niu Xi (RadixAchyranthis Bidentatae), Du Zhong (Cortex EucommiaeUlmoidis), Fu Shen (Poriae Cocos Pararadicis Sclerotium),Sheng Di Huang (Radix Rehmanniae Glutinosae), Shi Hu(Herba Dendrobii), Bai Shao (Radix Paeoniae Lactiflorae),Rou Cong Rong (Herba Cistanches), Hai Zao (HerbaSargassii), Jiang Can (Bombyx Batryticatus), Chuan ShanJia (Squama Manitis Pentadactylae), and Bie Jia (CarapaxAmydae Sinensis).

In this formula, Sheng Di Huang, Shi Hu, Bai Shao, RouCong Rong, Niu Xi, Du Zhong and Bie Jia nourish liver and kidney yin, while Du Zhong and Rou Cong Rong also warm yang to “get yin through yang”. Niu Xi also subdues uprising of liver yang to extinguish liver wind. Tian Ma,Gou Teng, Long Gu and Mu Li extinguish liver wind powerfully. Fu Shen, Hai Zao, Jiang Can and Chuan ShanJia mainly transform phlegm, invigorate blood, activate the channels and extinguish interior wind. Fu Shen also calms the heart shen to help extinguish wind, and promotes the spleen and stomach to prevent the cloying effect of the nourishing herbs and to help digest the “stone and shell”herbs.

This herbal formula has three important features: i.focusing on both the root and the manifestation, ii. tonifying the liver and kidney extensively together with strengthening the spleen, and iii. treating the basic patterns together with other common associated pathogens.

Modifications

• add Huang Jing (Rhizoma Polygonati), Dang Gui (RadixAngelicae Sinensis) and Bai Zhu (Rhizoma AtractylodisMacrocephalae) to tonify deficient qi and blood.• add E Jiao (Gelatinum Asini), Gui Ban (PlastrumTestudinis), Mai Men Dong (Tuber Ophiopogonis Japonici)and Wu Wei Zi (Fructus Schisandrae Chinensis) for pronounceddeficiency of liver and kidney yin.• add Shui Zhi (Hirudo seu Whitmaniae), Dang Gui (RadixAngelicae Sinensis), Ji Xue Teng (Radix et Caulis Jixueteng)and Lu Lu Tong (Fructus Liquidambaris Taiwanianae)when the channels are obstructed by wind-phlegm.• for cases of blood stasis with endogenous wind addHuang Qi (Radix Astragali), Hong Hua (Flos CarthamiTinctorii) and Tao Ren (Semen Persicae).• when both yin and yang are deficient add Ba Ji Tian (RadixMorindae Officinalis), Lu Jiao Jiao (Colla Cornu Cervi) andWu Wei Zi (Fructus Schisandrae Chinensis).• add Zhen Zhu Mu (Margarita) and Bai Ji Li (FructusTribuli Terrestris) in cases with severe tremors.• add Mu Gua (Fructus Chaenomelis Lagenariae) andQuan Xie (Buthus Martensi) for rigidity and tightness ofmuscles and limbs.• add Dan Nan Xing (Rhizoma Arisaematis cum FelleBovis), He Ye (Folium Nelumbinis Nuciferae) and CangZhu (Rhizoma Atractylodis) to relieve high cholesterol orobesity.• add Tao Ren (Semen Persicae) and Huo Ma Ren (SemenCannabis Sativae) for constipation.• add He Shou Wu (Radix Polygoni Multiflori), Shi ChangPu (Rhizoma Acori Graminei) and Yuan Zhi (RadixPolygalae Tenuifoliae) in cases with numb tongue andslurred speech.

Case example

A 75-year male patient had experienced tremors of his upper limbs and reduced intelligence for three years. A medical examination showed that the patient had “impaired circulation in the brain and shrinking brain.” He was diagnosed with Parkinson’s disease. He had lost flexibility of facial expression, experienced uncontrolled tremors,rigidity and impaired movement of the arms, inability tohold utensils, poor memory, forgetfulness, soreness and weakness in the lower back, dry stool, concentrated urine,dim complexion without lustre, a slightly puffy and mildly trembling tongue, a thin and yellowish greasy tongue coating, and a wiry, slippery and fine pulse.

Acupuncture treatment

Body acupuncture prescriptionGroup 1: Taixi KID-3, Taichong LIV-3, Xuehai SP-10,Fenglong ST-40, Yanglingquan GB-34, Jianyu L.I.-15, QuchiL.I.-11, Hegu L.I.-4 and Sishencong (M-HN-1).Group 2: Zhaohai KID-6, Ququan LIV-8, Sanyinjiao SP-6,Guanyuan REN-4, Zhongwan REN-12, Shousanli L.I.-10,Waiguan SJ-5 and Baihui DU-20.Group 3: Fengchi GB-20, Yamen DU-15, Shaohai HE-3,Houxi SI-3, Geshu BL-17, Pishu BL-20, Shenshu BL-23,Fengshi GB-31 and Qiuxu GB-40.

Explanation

Group 1: Taixi KID-3, Taichong LIV-3 and Xuehai SP-10nourish liver and kidney yin. Yanglingquan GB-34 relaxesand strengthens the sinews and calms interior wind. XuehaiSP-10 and Hegu L.I.-4 together with Taichong LIV-3 moveqi and blood to extinguish liver wind. Fenglong ST-40together with Xuehai SP-10 transforms phlegm. JianyuL.I.-15, Quchi L.I.-11 and Hegu L.I.-4, a chain and lock point combination, move qi, invigorate blood and activate thechannels, and are especially good for tremors of the arms.Sishencong (M-HN-1) calms the spirit and settles the will totreat reduced intelligence.

Group 2: Zhaohai KID-6, Ququan LIV-8, Sanyinjiao SP-6and Guanyuan REN-4 nourish liver and kidney yin to treatthe root directly, and extinguish interior wind to treat the manifestation indirectly. Zhongwan REN-12 and SanyinjiaoSP-6 fortify the spleen and regulate the stomach to transformphlegm. Shousanli L.I.-10 and Waiguan SJ-5 are localpoints for tremors of the upper limbs. Baihui DU-20 opens the orifices and calms the spirit to help intelligence.

Group 3: Fengchi GB-20, Shenshu BL-23, Fengshi GB-31and Qiuxu GB-40 nourish liver and kidney yin and extinguish interior wind. Geshu BL-17 invigorates blood to help extinguish wind. Pishu BL-20 fortifies the spleen to dissolve phlegm. Shaohai HE-3 and Houxi SI-3 are local points for disorders of the upper limbs. Yamen DU-15 calms the spirit to treat reduced intelligence.These three groups of points were rotated at each treatment.

Method

30 gauge needles were used with even method and retained for 30 minutes.Three treatments were given every week.

Scalp acupuncture

: Commonly used areas included the chorea, motor, leg motor and sensory areas. One area was used each time. The needles were manipulated rapidly (20 to 30times per minute, lifting and thrusting while rotating) to induce a hot, numb and/or heavy needle sensation for about 2 minutes. The needles were manipulated again every 10 minutes and were retained for 30 minutes. Electricity was applied at a frequency of 10-20 HZ/minute, and an intensity of 20-30 V for 20 minutes.

Pricking and bleeding method:

Weizhong BL-40 and Dazhui DU-14 were used alternately, pricking one point each time,every other week. If necessary, cupping was applied to ensure proper bleeding.

Herbal treatment

Sheng Di Huang (Radix Rehmanniae Glutinosae) 12g, ShanZhu Yu (Fructus Corni Officinalis) 9g, Yuan Zhi (RadixPolygalae Tenuifoliae) 12g, Bai Shao (Radix PaeoniaeLactiflorae) 12g, Bie Jia (Carapax Amydae Sinensis) 15g, BeiMu (Bulbus Fritillariae) 9g, Hai Zao (Herba Sargassii) 9g,Mu Gua (Fructus Chaenomelis Lagenariae) 9g, Gui Zhi(Ramulus Cinnamomi Cassiae) 12g, Tian Ma (RhizomaGastrodiae Elatae) 15g, Long Gu (Os Draconis) 30g, Niu Xi(Radix Achyranthis Bidentatae) 9g, He Shou Wu (RadixPolygoni Multiflori) 12g, Chuan Xiong (Radix LigusticiWallichii) 9g, Fu Shen (Poriae Cocos Pararadicis Sclerotium)15g, Mu Xiang (Radix Saussureae seu Vladimirae) 6g,Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 6g.ExplanationSheng Di Huang (Radix Rehmanniae Glutinosae), ShanZhu Yu (Fructus Corni Officinalis), Bai Shao (Radix PaeoniaeLactiflorae), Bie Jia (Carapax Amydae Sinensis), Niu Xi(Radix Achyranthis Bidentatae), Chuan Xiong (RadixLigustici Wallichii) and He Shou Wu (Radix PolygoniMultiflori) nourish liver and kidney yin intensively to treatthe root of the disease. Bai Shao (Radix Paeoniae Lactiflorae)and Niu Xi (Radix Achyranthis Bidentatae) together withMu Gua (Fructus Chaenomelis Lagenariae) also strengthenand relax sinews to calm interior wind. Tian Ma (RhizomaGastrodiae Elatae) and Long Gu (Os Draconis) together with Bie Jia (Carapax Amydae Sinensis) anchor uprisingliver yang and extinguish liver wind powerfully. A small dosage of Gui Zhi (Ramulus Cinnamomi Cassiae) warms kidney yang to “get yin through yang” and also helps other herbs in transforming phlegm. Bei Mu (Bulbus Fritillariae),Hai Zao (Herba Sargassii) and Mu Gua (Fructus ChaenomelisLagenariae) together with Gui Zhi (Ramulus CinnamomiCassiae) transform phlegm. Fu Shen (Sclerotium PoriaeCocos Pararadicis), Mu Xiang (Radix Saussureae seuVladimirae) and Zhi Gan Cao (Radix GlycyrrhizaePraeparatae) together with Gui Zhi (Ramulus CinnamomiCassiae) and Bai Shao (Radix Paeoniae Lactiflorae) regulate the middle burner to strengthen the source of yin and transform phlegm. Yuan Zhi (Radix Polygalae Tenuifoliae)and Fu Shen (Sclerotium Poriae Cocos Pararadicis) together harmonise the kidney and heart to calm the spirit and settlethe will.

Preparation method

: All the above herbs were ground into powder. He Ye (Folium Nelumbinis Nuciferae) 30g wasboiled in 600 ml of fresh water and strained and the resultingdecoction was used to boil and then simmer the herbalpowder, with 30g each of honey and pork bone marrow.This final decoction was made into small pills to be taken20g at a time, three times a day, half an hour after meals.After the patient received Chinese medicine treatment for three months, most clinical signs and symptoms were obviously reduced. After four months treatment, the patient had a lustrous complexion with a variety of facial expressions,quicker reactions, normal sleep and a good mood.Only occasionally did he experience small amplitude uncontrolled tremors of the arms. After two further months of similar treatment, his clinical manifestations entirely disappeared.

Dr. Yufang Xue, Ph.D., is a professor of Chinese medicine diagnosticsand internal medicine at the American Academy of Acupuncture andOriental Medicine (AAAOM). Dr. Xue has received his bachelor’sdegree at Nanjing University of TCM, a masters degree from ShandongUniversity of TCM, and his Ph.D from Guangzhou University of TCMwhere he acted as the associate professor.

The Treatment of POLYNEURITIS by TCM

11/26/2012 17:28:00

The Treatment of POLYNEURITIS by TCM

*Other poisons include carbon monoxide, lead, mercury, copper,nitrobenzol, organophosphates and thallium, and drugs such as diphenylhydantoin, isoniazid, nitrofurantoin, thalidomideand vincristine.

Polyneuritis may occur also in arteriosclerosis,beriberi, chronic gastrointestinal disease, leprosy,pellagra, porphyria, rheumatoid arthritis, systemic lupuserythematosus, and many infectious diseases. Editor by Sun Pei Lun

Polyneuritis, or multiple (peripheral) neuritis, is an inflammation which affects symmetrically distributed peripheral nerves. The causes are always systemic or constitutional leading to degeneration or atrophy of the nerve fibres of the small nerves. The origin of this degeneration involves some kind of poison, either absorbed or produced by the body, which circulates with the blood. The most common source of these poisons is alcohol, the next most important is arsenic, followed by infections, diabetes, gout, diphtheria and typhoid fever*.Polyneuritis as a rule is slow to manifest, even in the case of diphtheria. In most cases it begins with vague pains and a sensation of tingling in the limbs. This is followed by weakness and wasting of the muscles of the feet, legs, hands and arms or other parts of the body, wrist drop,loss of voice, dyspnoea, weakness of cardiac function,loss of sensation in scattered areas of the skin,swelling of the feet and loss of deep reflexes.

Aetiology and Pathology

Polyneuritis belongs to the TCM categories of wei and bi

syndromes. Invasion by damp-heat or cold dampness is the principal cause, leading to injury to the tendons and muscles. These exterior pathogens, however, will only injure the body in cases of pre-existing deficiency of the Liver and Kidneys. The Liver stores the blood which nourishes the tendons, and the Kidneys store jing which generates marrow and nourishes the bones. When the Liver and Kidneys are deficient, therefore, there will be weakness of the tendons and bones which allows penetration of exterior pathogens. The pathogens block the circulation of qi and blood which then fail to nourish the tendons, muscles and bones, resulting in weakness and swelling.

General Clinical Manifestations

• Loss of sensation, motility and nourishment in the distal extremities.• Pain of the fingers and toes, or a sensation that one is wearing gloves or slippers; in some cases these sensations spread proximally.• Motor disturbance manifesting as loss of muscular force and developing into muscular atrophy, wrist-drop,abnormal (steppage) gait or deformity.• Impaired nutrition of tissues resulting in coldness,thinning, dryness and cracks of the skin.• In severe cases there will be quadriplegia, urinary retention or incontinence, dyspnoea, or difficulty in speaking or swallowing.

Differentiation and Treatment

1. Invasion by damp-heat

Clinical manifestations

• Numbness• Slight swelling of the distal extremities, especially of the lower limbs• Myalgia• Itching• Steadily increasing weakness• Heaviness of the body• In some cases dyspnoea or difficulty in speaking or swallowing• Retention or incontinence of urine

Tongue: red body with a yellow greasy coatingPulse: slippery (hua) and rapid (shuo)

Treatment principle

Clear heat, transform dampness and dredge the collaterals.

Herbal treatment

Modified Si Miao San (Four Marvel Powder):Chao Huang Bai (Dry-fried Cortex Phellodendri) 10gCang Zhu (Rhizoma Atractylodis) 10gChuan Niu Xi (Radix Cyathulae) 10gYi Yi Ren (Semen Coicis Lachryma-jobi) 15gBei Xie (Rhizoma Dioscoreae) 10gZe Xie (Rhizoma Alismatis Plantago-aquaticae) 10gMu Gua (Fructus Chaenomelis Lagenariae) 6gChi Fu Ling (Sclerotium Poriae Cocos Rubrae) 10gTu Fu Ling (Rhizoma Smilacis Glabrae) 10gXi Xian Cao (Herba Siegesbeckiae Orientalis) 10g

Acupuncture

Taibai SP-3Sanyinjiao SP-6Yinlingquan SP-9Hegu L.I.-4Quchi L.I.-11Fenglong ST-40Taichong LIV-3Zhigou SJ-6 Method Reducing.

2. Invasion by cold dampness or obstruction ofthe channels by wind-cold

Clinical manifestations

• Numbness of the limbs with shooting pain• Cold limbs• Symptoms improved with heat and exacerbated with movement• Limping gait• Pale or purple skin

Tongue: pale body with a thin white coatingPulse: wiry (xian) or tight (jin)

Discussion

This pattern is often encountered in cases of polyneuritis due to poisoning or to chronic metabolic disturbance.

Treatment principle

Expel wind, dispel cold, warm the channels and dredge the collaterals.

Herbal treatment

Modified Qiang Huo Sheng Shi Tang (Notopterygium Decoction

to Overcome Dampness):Qiang Huo (Rhizoma et Radix Notopterygii) 10gDu Huo (Radix Duhuo) 10gGao Ben (Rhizoma et Radix Ligustici Sinensis) 10gChuan Xiong (Radix Ligustici Wallichii) 10gFang Feng (Radix Ledebouriellae Sesloidis) 10gMan Jing Zi (Fructus Viticis) 10gLu Jiao Jiao (Colla Cornu Cervi) 10gXi Xin (Herba Asari cum Radice) 5gRou Gui (Cortex Cinnamomi Cassiae) 5gHong Hua (Flos Carthami Tinctorii) 5gMa Huang (Herba Ephedrae) 6gGan Jiang (Rhizoma Zingiberis Officinalis) 10g

Acupuncture

Taibai SP-3Sanyinjiao SP-6Yinlingquan SP-9Waiguan SJ-5Hegu L.I.-4Dazhui DU-14Dazhu BL-11Method Reducing.

3. Deficiency of qi and blood

Clinical manifestations

• Numbness of the four limbs• Weakness• Muscular atrophy or paralysis• Diminished appetite• Abdominal distention• Diarrhoea

Tongue: palePulse: thready (xi) and forceless (wu li)

Discussion

This pattern is frequently encountered in cases of polyneuritis due to malnutrition and consumptive disorders.

Treatment principle

Activate the Spleen and Stomach, tonify qi and nourish blood.

Herbal treatment

Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction):

Dang Shen (Radix Codonopsis Pilosulae) 10gBai Zhu (Rhizoma Atractylodis Macrocephalae) 10gChi Fu Ling (Sclerotium Poriae Cocos Rubrae) 10gZhi Gan Cao (Radix Glycyrrhizae Praeparatae) 5gShu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 10gBai Shao (Radix Paeoniae Lactiflorae) 10gChuan Xiong (Radix Ligustici Wallichii) 10gDang Gui (Radix Angelicae Sinensis) 10gRou Gui (Cortex Cinnamomi Cassiae) 5gChao Huang Qi (Dry-fried Radix Astragali) 10gLu Jiao Jiao (Colla Cornu Cervi) 10g

AcupunctureTaibai SP-3Sanyinjiao SP-6Xuehai SP-10Taixi KID-3Xuanzhong GB-39Dazhu BL-11Qihai REN-6Method Tonification with moxibustion.

4. Liver and Kidney deficiency

Clinical manifestations

• Muscular atrophy• Paralysis of the limbs• Numbness of the limbs• Pale or purple skin• Lower back pain• Dizziness• Fatigue• Slight fever or evening fever• Heat sensation in the body• Night sweating

Tongue: red body with a scanty or peeled coatingPulse: thready (xi) and forceless (wu li), or slightly rapid(shuo).

Discussion

This pattern is frequently encountered in the terminalstage of polyneuritis or during convalescence.

Treatment principle

Nourish the Liver and Kidneys and clear empty heat.

Herbal treatment

Hu Qian Wan (Hidden Tiger Pill)

Chao Huang Bai (Dry-fried Cortex Phellodendri) 10gChao Zhi Mu (Dry-fried Radix AnemarrhenaeAsphodeloidis) 10gShu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 10gDuan Gui Ban (Calcined Plastrum Testudinis) 20gLu Jiao Jiao (Colla Cornu Cervi) 10gXuan Shen (Radix Scrophulariae Ningpoensis) 10gMu Dan Pi (Cortex Moutan Radicis) 10gGou Qi Zi (Fructus Lycii Chinensis) 10gTu Si Zi (Semen Cuscutae) 10gChuan Xiong (Radix Ligustici Wallichii) 10g

In case of deficiency of both yin and yang add:Yin Yang Huo (Herba Epimedii) 10gBu Gu Zhi (Fructus Psoraleae Corylifoliae) 10gBa Ji Tian (Radix Morindae Officinalis) 10g

Acupuncture

Taibai SP-3Zhaohai KID-6Fuliu KID-7Sanyinjiao SP-6Zusanli ST-36Guanyuan REN-4Qihai REN-6Baihui DU-20Method Tonification with moxibustion if indicated.

Sun Pei Lun holds a Master’s Degree in TCM and is a teacher at the Nanjing College of TCM.Translated from Médecine Chinoise et Médecines Orientales.

Acupuncture treatment according to The Six Conformations of the Shanghalun

11/09/2012 16:55:00

ACUPUNTURE TREATMENT ACCORDING

THE SIX CONFORMATIONS OF THESHANGHAN LUN

by Stephanie Bekooy & Arnaud Versluys

Abstract

For close to two thousand years, the Shanghan Lun (Treatise on Cold Damage) has provided the framework for thetreatment of acute external diseases, based on the sixconformations or channels. It has offered Chinese herbalpractitioners a range of powerful yet subtle treatments tofollow the complex, and sometimes rapid, changes that suchdiseases manifest. Although the Shanghan Lun does include some acupuncture treatments, they form a relatively minorpart of the text. Such is the flexible nature of acupuncture,however, that appropriate treatments can be formulatedfor the different stages of development of disease throughthe six conformations.

Keywords

: Shanghan Lun, Treatise on Cold Damage, six conformations, acupuncture, febrile diseases.

Introduction

The Treatise on Cold Damage or Shanghan Lun is one of the most respected texts in the history of Chinese medicine andShanghan Lun classicists have always tried to closely adhere to the original text when treating patients. This characteristic methodology is often the goal for modern practitioners inboth herbal and acupuncture prescriptions.The

Shanghan Lun mentions acupuncture therapy thirty three times, but few of these references are specific, and acupuncture-based treatments are never discussed in detail. However, the six conformations grid along which theShanghan Lun is outlined lends itself remarkably as a clinical guide for acupuncture and moxibustion treatment.

The six channels or conformations are the physical representations of the six climate influences or six qi in nature (taiyang is cold water, yangming is dry metal, shaoyang is ministerial fire, taiyin is damp earth, shaoyin is imperial fire and jueyinis wind wood). In the body they form the six pairs of handand foot channels directly linked to these six qi.The goal of this project is to provide a framework foracupuncture and moxibustion therapy based on the Shanghan Lun rationale of the six conformations. Although specific point prescriptions will be discussed, the intention of this paper is to reveal a methodology for point selection that can be applied to any

Shanghan Lun-based herbal therapy.

As the original Shanghan Lun formulas are concise, the extrapolated point selections need at all times to reflect the same precision.

Methodical considerations

Starting from a detailed understanding of the sequential nature of the six conformations, we have analysed the herbal prescriptions as stipulated by the original author with regards to the actions, herbs selected and channels addressed. To extrapolate the herb prescriptions into point prescriptions, we then considered the specific attributesof point qualities. The point selection went far beyond individual, sometimes symptomatic, actions and delved into the realm of channel specificity, yuan-source and luoconnecting qualities, shu-transport point actions, back-shu and front-mu points, channel intersections, local and distal combinations, hand and foot channel connections, specific functions of points, needling versus moxibustion etc.As in a herbal formula, the single ingredient is subordinate to the whole. The goal of the acupuncture prescription was to employ the points as a balanced team on a joint mission.

Point selection for the discussed disorders is influenced by three further conditions: i. the external/internal relationshipof the affected channel within the six conformations, inother words yangming is internal while taiyin is internal,ii. the control [ke] cycle of the five elements as part of the pathomechanism, for example wood disease affecting earth,and iii. the patterns of disease progression in six confirmation pathology as outlined in chapter 74 of the Internal Classic of the Yellow Emperor [huangdi neijing].Keeping these considerations in mind, it is possible to builda rationale for point prescription based on Shanghan Lun thought. Once the proper diagnosis of illness is determined and the herbal treatment selected, the practitioner is able to examine the actions of the formula and translate those actions into point choices. The acupuncture treatment can then work in conjunction with the herbal formula to more directly address the six confirmation diagnosis.

1. Taiyang

Wang Haogu of the Yuan dynasty paints a striking picture of the six conformations is his book called These Things Are Hard to Find Out About

[cishi nanzhi]: “The yin water within yang is taiyang. It is the premier ofthe three yang and its [pathologies] can [either sequentially] progress along the channels or by bypassing channels. The yang earth within yang is yangming. Man’s yangming is the earth of the middle continent and governs intake without exit; if taiyang progresses into here, then this is called passage along the channel. The yang wood within yang is shaoyang. It regresses upward into yangming or progresses downward into taiyin. If taiyang passes into here, then this is called channel-bypassing progression.The yin earth within yin is taiyin. Upward regression into shaoyang is compliance, downward progression into shaoyin is turmoil. This is the upward and downward passage. If taiyin passes into taiyang, then this is regression due to [initial] wrong purgation. The yang water within yinis shaoyin. Upward regression into taiyin is compliance, downward progression into jueyin is genesis; if taiyang progresses into here, then this is passage from surface to interior. The yin wood within yin is jueyin. Upward regression into shaoyang is excess, continued progression into taiyang is spontaneous recovery.”

Notesi. Taiyang is the first and foremost channel and its pathologies can pass from one channel into the next in line (progressalong channels) or can jump over (bypass) channels directlyinto a deeper channel.ii. Yangming Stomach belongs to earth. The earth elementhas two aspects; one is a yang aspect (a fu), i.e. the Stomach,and one is a yin aspect (zang) which is the Spleen. Thereforeyangming is the yang earth of the yang channels and taiyinis the yin earth of the yin channels.iii. Yangming “governs intake without exit” means that oncediseases reach the yangming fu, they do not then pass intoany other zangfu, so diseases do not exit from yangminginto other conformations.iv. The taiyin channel lies deeper than shaoyang, thus upwardpassage into shaoyang indicates recovery and compliance,while deeper passage into shaoyin indicates worsening ofthe disease and is called turmoil.v. Taiyin passing into taiyang means that there wasan original taiyang pattern that has been purged withherbs like Da Huang (Radix et Rhizoma Rhei), creating ataiyin pattern with damaged Spleen yang and diarrhoea.This then slowly recovers (spontaneously over time) andpasses back into the original taiyang channel showing onceagain taiyang symptoms (because the taiyang pattern wasnever resolved).vi. “The yang water within yin” indicates that shaoyinconfirmation governs the Kidney water element but alsohouses the imperial fire.vii. Passage into jueyin is genesis because amongst the yinchannels, jueyin holds the most potential for spontaneousyang recovery as it is the most ‘yang’ channel of the yinconformations.viii. Taiyang progressing into shaoyin: taiyang Bladderand Small Intestine and shaoyin Kidney and Heart standin exterior and interior relationship, hence passage fromtaiyang into shaoyin is called surface to interior passage[biaoli chuan].

ix. After completion of a six-fold cycle of progression, jueyin disease re-exits from taiyang which indicates recovery ofyang energy.

The taiyang channel is the great yang channel of the coldwater of the north. Gui Zhi Tang (Cinnamon Twig Decoction) is the crown formula in the Shanghan Lun used to treat external cold wind invasion on this channel. The formula contains warm, acrid herbs intended to free the flow ofyang and dispel wind, as well as sour and sweet herbs toharmonise the nutritive [ying] and protective [wei] qi andto prevent passage of the pathogen into the interior. The formula has five ingredients of which Gui Zhi (RamulusCinnamomi Cassiae) is a warm and pungent herb thatfrees the flow of yang, liberates the surface and disperseswind-cold. Bai Shao (Radix Paeoniae Lactiflorae) is bitter,sour and cool; it mildly clears heat while astringing fluidsand protecting the body from fluid loss due to sweating.Used in a 1:1 ratio, they work together to release theevils from the exterior while simultaneously retainingphysiological yin fluids; this makes Gui Zhi and BaiShao the foremost combination to balance the nutritiveand protective qi. Gui Zhi is combined with Sheng Jiang(Rhizoma Zingiberis Officinalis Recens) to release theexterior, while Sheng Jiang is combined with Zhi GanCao (Radix Glycyrrhizae Praeparatae) to harmonise thecentre. The sour taste of Bai Shao combined with thesweetness of Zhi Gan Cao, engenders fluids to replenishthe nutritive qi, which has potentially been damaged bythe sweating. Pungent Gui Zhi, combined with sweet ZhiGan Cao and Da Zao (Fructus Zizyphi Jujubae), tonifiesyang and strengthens the protective qi. The replenishing offluids helps prevent the penetration of the pathogens intothe yangming layer, while the tonification of qi preventspassage into yangming and taiyin. The combination of Gui Zhi with Bai Shao moves blood to extinguish windand course stasis to prevent passage into shaoyang andthe engendering of stagnation fire.

The disease thus remains superficial, and is easily alleviated.

Gui Zhi Tang treats exterior wind invasion not only with precision and elegance, but also with a measured sense of foresight by protecting all layers of the body.The equivalent acupuncture treatment should strive tohave the same actions. It should free the exterior of windcold pathogens by promoting the flow of yang in the taiyang channel, harmonise the nutritive and protective, as well as strengthen the middle jiao.

The following point treatment is suggested as an equivalent for

Gui Zhi Tang: Shenmai BL-62, Houxi SI-3, Jinggu BL-64, Dazhong KID-4, FengchiGB-20 and Zusanli ST-36.

Shenmai BL-62 has the specific effect of clearing wind andcold from the external layer and treating heat effusion, neckstiffness, and nasal congestion with watery discharge.When Shenmai BL-62 is combined with Houxi SI-3, theYang Motility (Yang Qiao) vessel is activated and the yangenergy of the Governing (Du) vessel mobilised. This accessesreserved qi from the Bladder and Small Intestine channelswhile simultaneously activating them. Both actions aid inthe clearing of congestion in the two involved channelsand in the strong promotion of yang flow on the wholebody surface.Houxi SI-3 in its own right also assists in clearing windand relaxing the sinews, and, because it is the confluentpoint of the Governing vessel, assists in the opening of theback and thus freeing the flow of yang energy.Jinggu BL-64 is the yuan-source point of the Bladderchannel. As such, it is able to strengthen Bladder qi andhence, the protective yang (the interplay between Kidneyyang and Kidney yin creates a vapour called Kidney qi,just as the interplay between Bladder yang and Bladderfluids – urine - creates a vapour called Bladder qi, which isthen disseminated through the Bladder channel to protectand warm the surface of the whole body). Beyond this,Jinggu BL-64 strongly dispels wind.

The combination ofJinggu BL-64 with Dazhong KID-4 activates the host/guestrelationship between the Bladder and Kidney channels.This strengthens the Bladder channel by accessing its yangresources stored in the Kidneys, because contained withinthe taiyang channel is the shaoyin imperial fire.Fengchi GB-20 is one of the primary points for dispellingexternal wind. It is the junction point of the Gall Bladderchannel with the Yang Linking (Yangwei) and Yang Motility(Yangqiao) vessels and the Sanjiao channel. The Yang Linkingvessel is in charge of the exterior of the body, thus furtheringthe resolution of the surface. Needling Fengchi GB-20 willnot only circulate the body’s yang energy, but also freethe neck and occipital region which are being invaded bywind and cold. Fengchi GB-20 is mentioned in the originalShanghan Lun for simultaneous use with Gui Zhi Tang in case of taiyang wind-cold invasions.Zusanli ST-36 is the main tonification point; it is ableto protect and strengthen the middle jiao and thereby prevent the illness from penetrating into the yangming layer. Zusanli ST-36 also nourishes the centre in order to strengthen the nutritive and protective qi derived from food and water qi. Moreover, Zusanli ST-36 has the specific effect of harmonising the nutritive and protective qi. It is a point of the sea of water and grain and as such it tonifies any deficiency condition.

The needling of points on the yangming channel to prevent passage from the taiyang channels into yangming is mentioned in line 8 of the original text: “If it isabout to pass to another channel, needle the foot yangmingto prevent passage …”Analogous actions can be seen between the use of ShenmaiBL-62 and Houxi SI-3 and the use of Gui Zhi (Ramulus Cinnamomi Cassiae) to free the flow of surface yang energy.Jinggu BL-64 and Dazhong KID-4 show affinity with the yinand yang regulating functions of Gui Zhi and Bai Shao (RadixPaeoniae Lactiflorae), while Jinggu BL-64, as yet anothersurface releasing point, assists the main point combinationin the sense of Sheng Jiang (Rhizoma Zingiberis OfficinalisRecens) assisting Gui Zhi to enhance the sweating. This point combination must be needled until the patient breaks intoa mild sweat. Fengchi GB-20 releases the yang energy onthe neck to melt the frozen waters of the taiyang that causeneck rigidity and headaches. Zusanli ST-36 strengthens theinterior like Da Zao (Fructus Zizyphi Jujubae) and Zhi GanCao (Radix Glycyrrhizae Praeparatae) to prevent collapse ofpathogens, while it also harmonises the Stomach like ShengJiang. This needle protocol skillfully simulates

Gui Zhi Tang.

The acupuncture prescription frees and strengthens theexterior, releases exterior wind, harmonises the nutritiveand protective qi, protects the fluids and strengthens andprotects the middle jiao.Point protocols can be modified just like herbal formulas.A typical modification of Gui Zhi Tang is Gui Zhi Jia Ge Gen Tang (Cinnamon Twig Decoction Plus Kudzu). As line

14 of the Shanghan Lun states: “When in taiyang disease [there is] stretched stiff nape and back, but also sweating and aversion to wind, it is treated with Gui Zhi Jia Ge Gen Tang.” Gui Zhi Jia Ge Gen Tang is Gui Zhi Tang with the addition of Ge Gen (Radix Puerariae) which treats taiyang wind-cold invasion with initial passage into the yangming channels. Ge Gen aids in resolving the exteriorand relieving heat effusion, while ascending nourishingfluids to the congealed channels of the neck and shoulders.The results are the reduction of pain and stiffness of theneck because the wind is released, the surface yang is freedand the tendons are nourished.Points to consider adding to the Gui Zhi Tang protocol are Tianzhu BL-10 and Jugu L.I.-16. Tianzhu BL-10 has a special affinity for the neckregion, both because of its location and because it is thebifurcation point of the Bladder channel, from which onebranch of the channel descends through the nape to meet with Dazhui DU-14 and Taodao DU-13 before traveling to Dazhu BL-11, whilst the other branch descends to FufenBL-41, lateral to the second thoracic vertebra. Its actionsare to dispel wind and cold, clear the Bladder channel,relax the sinews, and strengthen the back. As such it is a clear choice to represent the relaxing actions of Ge Gen.Jugu L.I.-16 is a yangming Large Intestine channel pointand directly addresses the congested channel to whichthe initial taiyang pathogens have started to migrate.

Ifpurged, it eliminates evils from the shoulder region andtreats local pain and stiffness of the neck and shoulders.Furthermore Jugu L.I.-16 is a point of the Yang Motilityvessel which has an affinity with the taiyang Bladder channel and therefore is a physical crossing of taiyang qi and yangming qi, and is thus ideal to treat combined disease.In case of cold invasion causing a taiyang and yangming combined pattern of stiffness of the neck and nape, the point prescription may also be supplemented with FengfuDU-16 as mentioned in line 24 of the original text.

2. Yangming

The yangming channel is the yang brightness channel of thedry metal of the west. It is the two yang (taiyang is threeyang, yangming is two yang, and shaoyang is one yang)and is dry in nature, containing taiyin dampness within for physiological balance. Conformation pathologies manifestboth as channel patterns and fu patterns. The channel patterns are the superficial invasion of pathogens at the periphery, while the fu patterns indicate the internal collapse of the pathogens into the corresponding fu. For yangming, the channel pathology will manifest with a severe clash ofthe body’s yang with the invading pathogen and create superficial heat symptoms, of which the four ‘big’ signs(fever, thirst, sweating and pulse) are the most representative.

The formula of choice for this yangming channel patternis Bai Hu Tang (White Tiger Decoction). Its ingredients are Shi Gao (Gypsum), Zhi Mu (Radix AnemarrhenaeAsphodeloidis), Gan Cao (Radix Glycyrrhizae Uralensis)and Geng Mi (Semen Oryzae).

Shi Gao is the only herb inthe commonly used materia medica that is extremely cold,while also pungent and dispersing. It strongly clears heatwhile opening the surface and promoting sweating. Shi Gaois also mildly sweet, which allows it to enter the middlejiao and cool the Stomach without damaging the alreadythreatened fluids. Furthermore, combining Shi Gao withZhi Mu will help regenerate those diminished fluids. ZhiMu clears heat while moistening the Stomach, offering relieffrom the heat induced imminent dryness. Zhi Mu combinedwith Shi Gao clears and protects what the scholars of theQing dynasty Fever School regarded as the nutritive layerand prevents the qi layer heat from penetrating deeperinto the fluid realm. Geng Mi strengthens the middle andprotects against the cold of the other herbs, and it is always used to protect and regenerate the fluids of the middle jiao in the prevention of dryness of the fu. Gan Cao is sweet and benefits the middle jiao, and in combination with Geng Miserves to protect the Stomach fluids through its qi and yin tonifying actions.The focus of the acupuncture treatment must be the swift clearing of yangming channel heat while protecting,preserving and even engendering nutritive fluids.

A point prescription that acts in concert with Bai Hu Tang is:

Neiting ST-44, Quchi L.I.-11, Dazhui DU-14, Hegu L.I.-4 andFuliu KID-7.Neiting ST-44 is the ying-spring point of the Stomach channel,and as such has strong abilities to clear heat, drain yangmingfire and clear heat effusion. A reducing technique shouldbe used when needling this point to further encourageheat release.Quchi L.I.-11 is the he-sea point of the Large Intestine channel and clears cold damage induced incessant heat effusion with thirst and copious sweating. As with NeitingST-44, a reducing technique should be applied.Dazhui DU-14 is the junction point for all the yang channels and can clear excessive heat from all of them. It releases the exterior and clears heat by promoting sweating in the same way that Shi Gao opens the surface through its pungent taste and clears heat with its cold nature while preventing fluid and qi damage through its latent sweet taste. Dazhui DU-14 also firms the exterior to arrest the heavy perspiration and reinforce fluid retention. Last but not least, Dazhui DU-14 reinforces the qi that is damaged due to the dry heat and excessive sweating of the yangming channel pathology.Hegu L.I.-4 is the yuan-source point on the Large Intestinechannel, and as a yuan-source point on a yang channel itcan strongly dispel excess pathogens from the channel.Hegu L.I.-4 activates the channel, circulates qi and bloodto clear obstruction and, when combined with Fuliu KID–7,stops copious sweating. When Hegu L.I.-4 is reducedand Fuliu KID-7 is tonified, strong sweat will be cleared.

As the Kidney is the source of the true water, all fluids inthe yangming originally draw from the shaoyin Kidneywater resources.A yangming fu pattern is the internal counterpart ofthe channel pattern and represents a mutated or moreadvanced stage of the illness. The bowel pattern occurs when yangming fluids are depleted.

The prime formula choice is the Cheng Qi Tang family. The name anslates as ‘qi ordering decoction,’ suggesting that the movements ofthe Stomach and Large Intestine must be smooth and incontinuous harmony to allow unobstructed passage and elimination of the transmutated heat-induced dry stool stagnation. Three modifications of one formula exist in orderto treat the specifics of this yangming bowel disease. Theircommon action is restoration of the movement of qi to expel solids or matter, while clearing heat and dryness.

The strongest of these formulas is Da Cheng Qi Tang

(Major Order the Qi Decoction) which focuses on theintensity of the fullness and stagnation. Da Cheng Qi Tang greatly descends yangming, purges heat and dry masses, and the saltiness of Mang Xiao will also moistendryness and soften masses. Da Cheng Qi Tang consists

of Hou Po (Cortex Magnoliae Officinalis), Da Huang(Radix et Rhizoma Rhei), Mang Xiao (Mirabilitum) andZhi Shi (Fructus Citri seu Ponciri Immaturus). Hou Pois the emperor herb and is used in the largest amount tomove qi stagnation via its pungent taste, and descendyangming via its bitter taste, without congealing thepathways due to its warm nature. Hou Po eliminatesthe intense bloating and pain due to the congestion.Da Huang purges fire from the Large Intestine, moves qiand blood and pushes out the old to make room for thearrival of the new. Mang Xiao is a salty, cold herb that canpurge stagnant heat and soften hardness. It has a softerheat purging effect than Da Huang and is moistening.Zhi Shi assists Hou Po in eliminating the fullness of theStomach and the costal regions. It breaks up stagnant qiand reduces accumulation by descending Gall Bladderqi to induce the natural downward flow of Stomach andLarge Intestine qi, thus resulting in the expulsion of stasisand stool from the body.

Xiao Cheng Qi Tang (Minor Order the Qi Decoction) contains the same herbs as Da Cheng Qi Tang, minus the Mang Xiao. This suggests that its moistening and softening properties are not needed. Da Huang is able to expel the stool without the additional assistance of Mang Xiao, andthe purging effects of the formula are more moderate. The use of Da Cheng Qi Tang versus Xiao Cheng Qi Tang should be based on the amount of abdominal discomfort the patient is experiencing. When the fullness is more moderate, Xiao Cheng Qi Tang prevails.

Considering the common core pathology, it is appropriateto apply the same needle protocol for both Xiao Cheng Qi Tang and Da Cheng Qi Tang. While the strength of the treatments should be modified to distinguish between the formulas,the same actions are required, and the same points are beneficial.

Suggested points are: Shangjuxu ST-37, ZhigouSJ-6, Tianshu ST-25, Zhaohai KID-6 and Hegu L.I.-4.Shangjuxu ST-37 is the Large Intestine lower he-sea pointand has a strong descending action on the Large Intestineand Stomach qi. When heat and stagnation are effectivelycleared, fullness, distention and pain are reduced. Whenreduced, Shangjuxu ST-37 can purge the Stomach and LargeIntestine qi to eliminate obstruction, and thus is similar tothe use of Da Huang in the Cheng Qi Tang formula family.

Zhigou SJ-6 is the jing-river and fire point of the Sanjiaochannel, and as such has the ability to clear heat in allthree jiao. Zhigou SJ-6 regulates qi and moves the qi of theintestines, which means that it also moves stuckness of thestool. The use of Zhigou SJ-6 in this prescription simulatesthe use of Zhi Shi in that it moves and descends Gall Bladderqi to course Stomach and Large Intestine qi downwards,thus utilising the controlling cycle of wood over earth.Tianshu ST-25 is the Large Intestine front-mu point.Since Tianshu ST-25 and Shangjuxu ST-37 are both LargeIntestine points on the Stomach channel, both fu andchannels are strongly regulated and cleared of repletionwhen these points are needled with a reducing technique.The moving aspect of Tianshu ST-25 and its ability torelieve fullness is a simulation of the heavy use of HouPo in

Da Cheng Qi Tang.

Zhaohai KID-6 tonifies Kidney yin, abates heat andmoistens dryness. It clears scorching heat from the intestines,regenerates fluids, and regulates the lower jiao.Hegu L.I.-4 has the ability to move qi and soften massesand hardness. Together with Zhaohai KID-6 it can beused to simulate the two main functions of Mang Xiao.When combined with the more purging point ShangjuxuST-37, they especially simulate the Mang Xiao/Da Huang combination.Tiao Wei Cheng Qi Tang (Regulate the Stomach and Order

the Qi Decoction) is used when dryness in the Stomach is the key manifestation of the fu pathology. It Comprises DaHuang, Mang Xiao and Zhi Gan Cao. This time it is Hou Poand Zhi Shi that are absent from the formula, which indicatesthat the emphasis of the treatment is not on moving qi andclearing fullness. Instead, the main focus is to moisten theStomach, not by adding moisture but by eliminating dryness,for the absence of dryness is the precursor of the revivaland presence of moisture. The moistening action providedby Mang Xiao and the tonifying effects of Zhi Gan Caoallow the qi of the Spleen and the yin of the Stomach to benourished.

An acupuncture equivalent for Tiao Wei Cheng Qi Tang would be a modification of the prescriptions given above. Because Zhi Shi and Hou Po are removed in Tiao Wei Cheng Qi Tang, Zhigou SJ-6 and Tianshu ST-25 would not be included in the needle prescription. Zhongwan REN-12 can be added, however, needled with a tonifying technique, to protect and strengthen the middle jiao and Stomach. Zhongwan REN-12 is the Stomach front-mu point and is the junction point of the Lung, Pericardium, Liver,Small Intestine, Sanjiao and Stomach channels. As such, it is designated as the hui-meeting point of all the fu. It is able to treat any Stomach disorder while strengthening digestion and building qi and blood. Because it focuses so strongly on the middle jiao, the actions of Zhongwan REN-12 can here be compared to those of Zhi Gan Cao to harmonise the middle. And as a point on the Conception vessel it has the ability to access and promote yin fluids.Shangjuxu ST-37 is still used to duplicate the actions ofDa Huang, while Zhaohai KID-6 and Hegu L.I.-4 are kept to move, moisten and soften.

3. Shaoyang

The shaoyang channel is the lesser yang channel of the ministerial fire. Its pathologies are marked by stagnation of the ministerial fire, which is physiologically propelledby the jueyin Liver wind contained within it. This ‘stuck fire’ causes the typical symptoms of a bitter taste, dry orsore throat and blurry vision, along with a possible seriesof discomforts at pivotal hinge areas of the body, such as the eyes, ears, throat, ribs etc. Shaoyang pathologies are said to be located ‘half on the exterior and half in the interior’. The famous Xiao Chai Hu Tang (Minor Bupleurum Decoction) is the formula of choice for shaoyang patterns.Its actions harmonise the shaoyang layer by simultaneously eliminating excess and strengthening deficiency, while coursing wind and mildly opening the surface. It strengthens the middle jiao to protect the taiyin Spleen and,therefore, the entrance of pathogens to the yin layers of thebody.

Xiao Chai Hu Tang clears pathogens without putting either the exterior or the interior of the body in jeopardy.It comprises Chai Hu (Radix Bupleuri), Huang Qin (RadixScutellariae Baicalensis), Ban Xia (Rhizoma PinelliaeTernatae), Sheng Jiang (Rhizoma Zingiberis OfficinalisRecens), Ren Shen (Radix Ginseng), Da Zao (FructusZizyphi Jujubae) and Zhi Gan Cao (Radix GlycyrrhizaePraeparatae). Chai Hu courses congestion and clears thepathogen from shaoyang by relieving the surface. HuangQin clears the flare-up of the ministerial fire. Chai Huworks on the external channel portion of shaoyang whileHuang Qin drains evil in the shaoyang Gall Bladder.Ban Xia and Sheng Jiang harmonise the middle by downbearing Stomach qi counterflow as well as dryingand warming Spleen dampness. These actions address the prevalent nausea and dislike of food intake caused by the external evils threatening taiyin. Ren Shen, Da Zao andZhi Gan Cao protect the taiyin by strengthening Spleen substances, thus preventing collapse of evils into the inconformations.

The acupuncture simulation of Xiao Chai Hu Tang should posses the same harmonising effects achieved through thedispersion of pathogens, the clearing of stagnant fire, andthe protection of the threatened Spleen. Suggested points are:Waiguan SJ-5, Zulinqi GB-41, Qimen LIV-14, YinlingquanSP-9 and Zusanli ST-36.

Waiguan SJ-5 is the premier harmonising point forshaoyang. It is the luo-connecting point of the shaoyangSanjiao channel and connects with both the interior jueyinPericardium, freeing interior pathogens, and the YangLinking vessel, thus freeing the exterior and treating pathologies of a pivotal and alternating nature. WaiguanSJ-5 outwardly resolves the exterior and disperses wind,while it inwardly courses the stagnation of interior heat.This makes its actions comparable to those of Chai Hu.Zulinqi GB-41 is the shu-stream wood point of the GallBladder channel. It functions like Huang Qin in the clearingof stagnant ministerial fire and the transforming of dampheat that originated from the stagnation in the Sanjiao branchof the shaoyang system. Zulinqi GB-41 is also the exit point from the Gall Bladder channel to the Liver channel and as such affects the qi of both channels. It functions as the last line of defence against transmission of pathogens from the Gall Bladder to the Liver. By coursing the Liver and GallBladder qi, their ascending and descending functions are reinstated in the body. The combination of Waiguan SJ–5 with Zulinqi GB-41 frees the exterior and interior of the whole shaoyang system and further addresses the Girdling vessel [Dai Mai], a hinge area prone to qi stagnation heat and Sanjiao hot dampness.Qimen LIV-14 is the front-mu point of the Liver and thejunction point for the Liver and the Spleen. It is the point of choice for relieving wood overacting on earth as mentioned in line 108 of the original text: “ … this means the Liver is exploiting the Spleen and it is called restraint. One should needle Qimen.” Further it is quoted in the original lines143 and 216 as the foremost point for shaoyang disorders manifesting, for example, as heat entering the blood chamber.Needling Qimen LIV-14, the middle jiao is protected, wood qi is heavily coursed, and chest or rib-side fullness is cleared.

As the Liver Front-mu point, Qimen LIV-14 is useful for any Liver or Gall Bladder disease, but it is especiallyappropriate for shaoyang disease due to qi stagnation, with symptoms manifesting on the sides and intercostal areasof the body. Qimen LIV-14 is also the junction point withthe Yin Linking (Yinwei) vessel from which the Yin Linking vessel penetrates the diaphragm and crosses the breast area.Stagnation of this channel is often prevalent in shaoyang pathologies and leads to symptoms of chest fullness, rib pain and Heart vexation.Yinlingquan SP-9 is well known for its abilities to clear dampness and fortify the Spleen. It is the he-sea water pointon an earth channel and as such is important for removing excess fluids from the body.

Dampness is the primary pathology of the Spleen and debilitates its ability to ward off pathogens from entering the taiyin layer. YinlingquanSP-9 here acts like Ban Xia and Sheng Jiang by transforming dampness through both warming and strengthening the Spleen.Zusanli ST-36 is combined to further strengthen and protect the middle jiao. Its effects are those of strong tonification,comparable to the combination of Ren Shen, Da Zao and Zhi Gan Cao in the formula. The focus here is not as much on drying and warming, as is the case with Ban Xia and Sheng Jiang, but on strengthening and protecting. ZusanliST-36 is one of the points of the sea of water and grain andthe earth point on an earth channel. In combination with Yinlingquan SP-9, it strengthens Spleen and Stomach qi and builds earth to govern fluids and dry dampness. Because Xiao Chai Hu Tang

dedicates five out of seven herbs to protecting taiyin, it is clearly a primary goal of the formula and an integral part of the concept of harmonisation of shaoyang;therefore, it should be the primary focus in the acupuncture treatment as well.

4. Taiyin

The taiyin channel is the great yin channel of the damp earth of the centre. When evils enter the taiyin realm, thepathology will always manifest as ‘yin’, for the taiyin is a yinchannel and dampness is a yin quality. The pathology will always transform from the inherent dampness and causethe typical signs of loss of appetite, bloating and fullness,nausea and possible loose stool or diarrhoea.

According theShanghan Lun, Li Zhong Wan (Regulate the Middle Decoction) is the treatment of choice for taiyin syndrome. Its actions are to dry dampness, construct the centre and tonify the qi of the middle jiao. By these actions, the dampness is cleared through drying and transforming, and the Spleen weakness is resolved through warming tonification. The ingredients of Li Zhong Wan are: Gan Jiang (Rhizoma Zingiberis Officinalis), Ren Shen (Radix Ginseng), Bai Zhu(Rhizoma Atractylodis Macrocephalae) and Zhi Gan Cao(Radix Glycyrrhizae Praeparatae).

Gan Jiang is the taiyinherb of choice and enters the centre directly to warm anddry the muddy earth. It is not dispersing like Sheng Jiang,but very stable in its action. It is both warming and dryingand benefits the yang of the Spleen. It creates the yangmingdryness environment that is physiologically contained within taiyin but is now pathologically impaired. RenShen tonifies taiyin qi and replenishes deficiency. Bai Zhu strengthens the effects of both Gan Jiang and Ren Shen.It is bitter warm and thus assists Gan Jiang in drying theSpleen. It is also sweet, which boosts taiyin Spleen qi andthus supports and enhances the actions of Ren Shen. ZhiGan Cao is a middle jiao tonic in its own right and alsohas the ability to harmonise the centre. The overall results are to warm the Spleen, dry and transform dampness and strengthen qi.

The acupuncture point protocol appropriate for taiyin disease should also assume this straightforward approach:Yinlingquan SP-9, Zhongwan REN-12, Tianshu ST-25,Zusanli ST-36, Pishu BL-20, Weishu BL-21.Yinlingquan SP-9 is a taiyin-pattern point of choice because of its simultaneous ability to treat dampness and tonify the Spleen. A point of the taiyin channel, it possesses the dampness transforming effects of Bai Zhu, the dampness drying effects of Gan Jiang and the qi tonifying effects of Ren Shen, and can transform dampness and leach water from the Spleen. When the point is tonified, the Spleen qiis strengthened, yang is boosted and the proper functionsof the middle jiao are reinstated.Zhongwan REN-12 is the Stomach front-mu point andthe hui-meeting point for all the fu. It is a major pointfor all digestive dysfunctions and has strong middle jiao building and regulating abilities. Its strengthening actions are comparable to Ren Shen, while its harmonising actions are similar to Gan Jiang. Although suitable for both excess and deficiency conditions, Zhongwan REN-12 shouldbe reinforced in taiyin conditions. It regulates both the upward and downward flow in the middle jiao, resolving the principal pathology of inversion of turbid yin and clearyang, manifested as vomiting and diarrhoea.Tianshu ST-25 is the front-mu point of the Large Intestine.Implied by the name ‘tianshu’ or ‘celestial pivot’, it fulfills ahinge function that reinstates the ascending and descendingfunction of the middle jiao. Especially combined withREN-12, it assists in regulating the pivotal functions of theSpleen and Stomach.

Zusanli ST-36 in this prescription acts as a combinationof Gan Jiang and Bai Zhu, as well as a combination ofRen Shen and Bai Zhu. When needled with a tonifyingtechnique, it is the main point on the body for strengthening and harmonising the middle jiao. When Zusanli ST-36 is combined with Zhongwan REN-12, the ability to strengthen deficient conditions of the middle jiao is enhanced considerably, and the Stomach is strengthened through allowing fluent descent of turbid yin. When combined with Tianshu ST-25, the middle realm is strengthened to anchor Spleen qi and prevent the collapse of clear yanginto the intestines.Yin confirmation disorders indicate deficiencies of thebody’s warming functions and energetic resources stored in the zang. Although the Shanghan Lun advises against the use of moxa in warm diseases (lines 114, 115 and 116),it encourages moxa to warm cold patterns with diarrhoea and vomiting (line 325). Pishu BL-20, as the back-shu pointof the Spleen, directly accesses the Spleen zang. Though needling this point has an overall tonifying effect, to truly warm the Spleen it should be treated with direct moxa.The effects of this are exactly those of Gan Jiang - both warming and appropriately drying the Spleen. The yangis restored, and the qi is returned. When warmed, theSpleen is better able to handle the water it is supposed to control. To further encourage the Gan Jiang effects of the point prescription, it is also appropriate to apply direct moxa to Weishu BL-21 to restore Stomach dryness and revive Stomach functions.

5. Shaoyin

The shaoyin channel is the lesser yin channel of the imperial fire of the South. It embodies the true fire in the body and contains the cold water of the north for physiological balance. The main symptoms for a typical shaoyin cold transformation pattern are somnolence, syncope and reversalflow cold extremities.

The Shanghan Lun utilises Si Ni Tang(Frigid Extremities Decoction) as its primary formula for shaoyin cold. The ingredients are Fu Zi, Gan Jiang and ZhiGan Cao, of which Fu Zi and Gan Jiang are both pungent, hot herbs and therefore are extremely warming and dispersing.Although focused on the Heart and Kidney, Fu Zi is a very volatile and moving herb; it has the capacity to warm all three jiao and is the premier herb to return yang. Gan Jiang warms yang, but is focused more on the middle jiao. It strongly reinforces Fu Zi and amplifies its heating actions because Fu Zi is volatile and Gan Jiang is anchoring. GanJiang goes directly to the centre and stays put, hence it builds the centre and allows the functioning of the middle jiao to be reinforced. This returns the production of postnatal qi to the body. The sweet and pungent combination of Fu Zi and Zhi Gan Cao strongly supplements Heart yang,warming the depleted imperial fire so as to return essential heat to the body.

The point protocol to simulate Si Ni Tang is: ShenmenHE-7, Taixi KID-3, Guanyuan REN-4, Xinshu BL-15, ShenshuBL-23 and Mingmen DU-4.Shenmen HE-7 is the yuan-source point of the Heartchannel with the ability to strongly tonify all deficienciesof the Heart. The imperial fire is stoked, and the yang ofthe Heart is tonified.Taixi KID-3 is the yuan-source point of the Kidney channel and tonifies all Kidney deficiencies. Here it is used to warmthe Kidneys, whose water has become excessively cold due tothe lack of Heart fire. Cold of shaoyin Kidney and Heart leads to somnolence and the demise of shen, which in severe cases lead to the occurrence of syncope. The classical instructions of the Neijing advise the needling of Taixi KID-3 behind the ankles to rescue syncope.

1 The simultaneous use of both the yuan-source points of the Heart and Kidney greatly revives the essential shen of the shaoyin confirmation. Guanyuan REN-4 strengthens the body’s primordial [yuan] qi. If the purpose of Si Ni Tang is to warm pre- and post-natal qi, Guanyuan REN-4 itself embodies these actionsby warming and circulating the original qi, and as a result all other qi is fostered. Guanyuan REN-4 simulates the combined actions of Fu Zi, Gan Jiang and Zhi Gan Cao.Despite this already complete action, it is wise to further supplement the body and speed the return of the warmth of life, hence the combination with Shenmen HE-7 and TaixiKID-3 to re-establish Heart and Kidney communication.The necessity for further warming is attained by direct moxa treatments to Xinshu BL-15, Shenshu BL-23 andMingmen DU-4. Moxa treatments are especially indicated in shaoyin patterns and the original text mentions moxa most elaborately in the shaoyin chapter (lines 292, 304, 325etc.). Direct moxa to Xinshu BL-15 and Shenshu BL-23 brings heat and tonification immediately to the pathologically cold Heart and Kidneys. Both are warmed and nourished, andyang is returned. Direct moxa to Mingmen DU-4 has the critical action of restoring pre-natal qi derived from yang.

The Governing vessel supervises and gathers the yang ofthe whole body, while the name ‘mingmen’ means ‘gate of life’. Treating Mingmen DU-4 revives life by restoring yang.Due to its location between the Kidney back-shu points, the jing-essence can be activated with this point, for the true prenatal fire is stored by the ‘gate of life’. The actions of this combination of points will warm the body like Fu Zi,but also have the anchoring effect of Gan Jiang. The yangis strongly augmented, both the pre and post-natal qi arewarmed, and the intense cold is dispersed, thus givingrise to a renewed Heart and Kidney communication andrestoration of life itself.

6. Jueyin

The jueyin chapter in the Shanghan Lun predominantly discusses parasitic ailments and fainting disorders, but the basic nature of the jueyin channel is best described by the famous Qing dynasty physician Wu Qian in his Golden Mirror of the Medical Doctrine [yizhong jinjian]:

“Jueyin governs the Liver and is the mansion of blood.”

This essential observation is further clarified by hisQing dynasty contemporary Huang Yuanyu in Dangling Explanations of Cold Damage

[shanghan xuanjie]: “The Liver steers the nutritive blood, flowing through the channels and collaterals and infusing the joints; when the warm qiof jueyin wanes, then nutritive blood becomes cold and unsmooth, failing to warm the joints and fill the channels and collaterals, thus causing reversal cold in hands and feet with a thin pulse on the verge of expiry.”

Alongside the parasite-formula Wu Mei Wan (Mume Pill), Dang Gui

Si Ni Tang (Tangkuei Decoction for Frigid Extremities) is truly the primary formula for use in Liver jueyin circulatory disease. In jueyin disease, the wind and cold influences have passed through the many layers and penetrated to the jueyin realm, chilling and constricting the channels and cooling the Liver. The result is cold and blood deficiency of the Liver with impaired flow that requires building,warming and circulating.

Dang Gui Si Ni Tang contains Dang Gui (Radix Angelicae Sinensis), Gui Zhi (RamulusCinnamomi Cassiae), Bai Shao (Radix Paeoniae Lactiflorae),Xi Xin (Herba Asari cum Radice), Tong Cao (Medulla Tetrapanacis Papyriferi), Da Zao (Fructus Zizyphi Jujubae)and Zhi Gan Cao (Radix Glycyrrhizae Praeparatae).

DangGui’s sweet and pungent nature warms and nourishes theLiver and moves the blood. It is one of the primary bloodbuilding herbs and has direct affinity with the Liver. GuiZhi warms the vessels, and thus has affinity for the Heart.It circulates blood through the vessels and allows it to reach the extremities. It also disperses the cold remaining fromthe original taiyang layer penetration. Bai Shao astringes fluids and courses the Liver while pacifying the blood layer so that its movement will not become chaotic. It is used in the same dosage as Gui Zhi so that the pungent, sour and sweet flavors can interact to harmonise both yin and yang opposites. Xi Xin enters the taiyang and shaoyin to warm the body inside and out while arresting cold-induced pain. Tong Cao frees and opens channels and collaterals to promote smooth flow of Liver qi, blood, yin and yang,and it mildly drains rebellious ministerial fire contained within jueyin that has been stirred by the stagnation. As its name indicates, ‘Tong Cao’ is ‘the herb that frees and deobstructs’. Da Zao and Zhi Gan Cao tonify the middlejiao to assist in the production of qi and blood.It is important that the suggested point prescription forthis manifestation of jueyin disease focuses on warming, building the blood and coursing the Liver stasis.

A possible point protocol to simulate the jueyin blood treatment is:Gongsun SP-4, Neiguan P-6, Taichong LIV-3, GuangmingGB-37, Geshu BL-17 and Ganshu BL-18.

Gongsun SP-4 and Neiguan P-6 are used in this protocolfor their ability to stimulate the Penetrating (Chong) andYin Linking vessels. They build the blood which is storedby the Penetrating vessel as an extension of both the Heartand Liver. These two points connect above and below by coursing the blood through the vessels and eliminating stagnation of qi within the blood.Taichong LIV-3 is the yuan-source point of the Liver channel. When needled with a reinforcing technique,this point strongly tonifies the Liver and thus has a direct effect on the blood. It regulates the Liver qi and promotes smooth flow.Guangming GB-37 is the luo-connecting point of the GallBladder channel, and when it is needled in combination with Taichong LIV-3 it stimulates the guest/host relationship in the wood element channels. GuangmingGB-37 has yin and blood tonifying properties that make these two points an important combination in building the blood as well as coursing and strengthening Liver qi.Further, Guangming GB-37 addresses the smooth flowof wood qi contained within wood blood and pacifiesthe flare-up of congested shaoyang ministerial fire that is contained within jueyin.Geshu BL-17 is the hui-meeting point for the blood.Needling this point with a reinforcing technique directlyaccesses the blood and efficiently assists in its production and circulation. Moxa is indicated in the treatment of jueyin disease, as mentioned by the original author in lines 343,349 and 362. Here we can apply moxa over Geshu BL-17 towarm the blood in the body and promote free circulation by expelling constricting cold.Moxa over Ganshu BL-18 will complete one of the strongest warming, moving and building treatments the Liver can receive. The Liver is directly addressed via its back-shu point,the cold is quickly dispelled and Liver blood is built.

Conclusion

As the original clinical guide, the Shanghan Lun offers insight into diagnosis and herbal treatment from the very roots of classical medicine. The differentiation system employed lends itself directly to the identification of the indicated channel. The structure of the herbal formulas addresses the pathologies with precision, foresight and a deep understanding of nature and the human body. Through understanding the rationale behind the herbal formulas,one can design equally concise and widely applicable acupuncture point prescriptions. These prescriptions can elegantly accompany the prescribed formula in the treatmentof the impaired confirmation. In this way, the diagnosis, the treatment plan, the herbal formula and the acupuncture protocol can all work in conjunction to consistently and effectively clear the pathology, thus fulfilling the goal of any classical Chinese medicine clinician.

Acknowledgements

The authors would like to express a heartfelt ‘thank you’to Drs. Jim Cleaver, L.Ac. and Jessica Atkins, L.Ac. fortheir relentless editorial support in the preparation of this manuscript.

Sources Shan, Yutang. Selected Annotated Point Combinations for

Shanghan Lun Acupuncture and Moxibustion. Beijing, P.R.

China: People’s Medical Publishing House, 1984.Yu, Bohai, et al.

Collection of Famous Works on Cold Damage, the Golden Cabinet, and Warm Diseases [shanghan jingui wenbing mingzhu jicheng]. Beijing, P.R. China: HuaxiaPublishing House, 1997.Wu Qian,

Golden Mirror of the Medical Doctrine [yizhong jinjian]. Beijing, P.R. China: People’s Medical PublishingHouse, 1963.Meng Jingchun, et al.

Translation and Explanation of the Elementary Questions Classic of the Inner Classic of the Yellow Emperor [huangdi neijing suwen yishe], Shanghai, P.R. China: Shanghai Science & Technology Publishing House,1959/06.Deadman, Peter; Al-Khafaji, Mazin; Baker, Kevin.

A Manual of Acupuncture. East Sussex, England: Journal of Chinese

Medicine Publications, 1999.Mitchel, Wiseman, Feng.

Shanghan Lun: On Cold Damage.Brookline, MA, USA: Paradigm Publications, 1999.

Stephanie Bekooy, MSOM, B.Sc., L.AC. is a recent graduate from the Master of Science in Oriental Medicine programme at the School of Classical Chinese Medicine of the National College of Naturopathic Medicine. Ms. Bekooy conducted her graduation research on classical acupuncture and the Shanghan Lun and under the supervision of

Dr. Versluys produced a thesis on the topic. Stephanie is currentlyin private practice in Portland, OR, USA, and can be reached at svbekooy@yahoo.com

Arnaud Versluys, ABD/Ph.D., M.Sc., B.Sc., L.Ac. is one of the few Western scholars to have received his full medical training in China. He spentover 10 years at the Chinese medical universities of Wuhan, Beijingand Chengdu, where he consecutively pursued his Bachelor, Masterand Doctorate degrees in general Chinese medicine and acupuncture.He is currently assistant-professor at the School of Classical Chinese Medicine of the National College of Naturopathic Medicine in Portland,OR, USA. Arnaud can be reached at ersluys@ncnm.eduEndnotes1Versluys Arnaud (02/2004 ). Discourse on the Classical Needling Techniques in the chapter ‘Official Needling’ ofthe Spiritual Axis Canon.

The Journal of Chinese Medicine. Number 74. 24-31.

Wei Syndrome

10/23/2012 17:03:00

WEI SYNDROME

by Dr. Su Xin Ming

The following lecture was given by Dr. Su Xin Ming during the recent Further StudiesCourse in Nanjing. Whilst the quality of the lecture and the interpretation was excellent, itwas not possible to check the text of this lecture with Dr. Su and this should be borne inmind when reading it.

Wei syndrome in TCM includes weakness of the limbs, impairment of movement of thelimbs, and subsequently (late stage) muscular atrophy. It is most often seen clinically affecting the lower extremities. The Nei Jing ("Canon of Medicine") refers to "Wei Pi"."Wei" means withered, as in plants when they fail to receive a sufficient supply of waterand nutrients. Atrophy can be seen when muscles, tendons and bones are deprived ofnourishment. "Pi" means "failure of the foot to touch the ground". All similar clinical manifestations are summarised as Wei syndrome. This category therefore includes poliomyelitis and infantile paralysis, serious multiple neuritis, myelitis, progressive myoatrophy, myasthenia gravis, hysteric paralysis (often seen in the acupuncture clinic),periodic paralysis due to muscle weakness and sequelae due to inflammation of the CNS.Acupuncture therapy may only be used to alleviate the symptoms of the above unless due to functional rather than organic disturbances.

AETIOLOGY

1) Pernicious warmth and heat injuring the lung and stomach.

This is due to exogenous pathogenic factors which injure LU directly and ST indirectly, by invading the LU via the mouth and nose and resulting in continuous high fever. Longstanding retention of heat consumes LU-Yin resulting in low-grade fever. LU-Heat will further exert a harmful influence on ST resulting in general consumption of yin fluid.Deficiency of yin fails to supply muscles, tendons and bones leading to atrophy.

2) Invasion of exogenous damp - injuring muscles and tendons.This may be due to a number of causes: a) fog or mist, eg going to work early, beforesunrise in foggy misty conditions, or working on water or in high mountains b) coveringthe body with wet clothes after profuse sweating c) working or living in a wet place d)living for a long time in a lowland area.

3) Irregular food intake.Irregular food intake means eating at irregular times. This causes weakness of ST and SP resulting in failure of ST to produce nutrients to nourish muscles etc. This category also includes overindulgence in greasy, pungent food and alcohol which give rise to dampheat in ST and SP.

4) Sexual excess:Sexual excess (including frequent nocturnal emission) results in loss of KID-Jing and weakness of KID and LIV. The KID stores Jing (the material base maintaining normal physiological activity of the zang-fu) and controls bones, whilst the LIV stores blood and controls tendons. As a result of KID and LIV Xu, the tendons and bones are deprived of nourishment, resulting in atrophy.Wei syndrome is broadly classified as of Shi and Xu types, and it is important to differentiate between them.

DIFFERENTIATION OF SYNDROMES AND TREATMENT

1) Injury of yin fluid due to heat in the LU:

Clinical manifestations:Fever softness and weakness of the 4 extremities will follow subsidence of fever; drynessof skin accompanied by restlessness and thirst; cough; dryness of throat; urine yellow and concentrated; dry stool.

Tongue: body red, fur yellow.Pulse: thready and rapid.

Pathology:Invasion of LU and ST by pathogenic heat consumes yin fluid which fails to nourish muscles. LU fails in supplying fluid to moisten skin (LU dominate skin) therefore dry skin. Yin Xu leads to hyperactivity of fire - in this case the HE is affected therefore restlessness. Retention of pathogenic heat in the LU interferes with dispersing function therefore cough. Sore throat is due to heat in the LU channel which passes through the throat.

Treatment principle:Clear heat and moisten LU.Prescription:Dazhui (Du-14) Feishu (BL-13) Chize (LU-5) Liangqiu (ST-34) Zusan]i (ST-36) Sanyinjiao(SP-6) Taixi (K1D-3) Lidui (ST-45).

Explanation of prescription:Du-14 meeting of all yang channels with Du channel which governs yang channels .Du-14 is known as yang within yang. Dispersing Du-14 will eliminate heat.BL-13 to clear heat in LU.

LU-5 to reduce and cool LU.

ST-34 Xi-Cleft point, used for acute disorders; here used both to eliminate heat in ST andas a local point for the limbs.

ST-36 used according to the principle of "selecting points from Yangming channels totreat Wei syndrome". To strengthen ST to produce yin fluid to nourish tendons andmuscles.SP-6 to tonify yin.KID-3 to promote water, to tonify yin of KID.ST-45 to eliminate heat in Yangming channels.

The above prescription can be used to treat infantile paralysis or myelitis.*

2) Invasion of pathogenic damp-heat:

Clinical manifestations:Weakness and relaxation of the lower extremities; fever may be observed but not high; insome cases slight swelling and numbness of the lower extremities; stuffiness in chest and epigastric region; yellow urine.

Tongue: yellow sticky fur Pulse: rapid

Pathology:Weakness and relaxation of the lower extremities is caused by invasion of the jingluo ofthe lower extremities by pathogenic damp-heat. Invasion by damp-heat leads to slightswelling and numbness. Retention of damp-heat internally leads to stuffiness in chest and epigastric region.

Treatment principle:Eliminate damp and heat.

Prescription:Dazhui (Du-14), Quchi (L.I.-11), Hegu (L.I.-4), Femur-Futu (ST-32), Fengshi (GB-31),Zusanli (ST-36), Yinlingquan (SP-9) .Explanation of prescription:Du-14, L.I.-11, L.I.-4: this is a routine prescription used to eliminate heat and is here usedto eliminate damp-heat (^). These three points must be punctured two or even three times a day. Retain needles for over 30 minutes and manipulate every 5 to 10 minutes. ST-32,GB-31: used for weakness of lower extremities; can also be used for infantile paralysis orsequelae of wind-stroke (use even manipulation) .ST-36 to strengthen SP and ST to eliminate damp (T). SP-9 to strengthen SP and eliminatedamp (^).

3) Weakness of ST and SP:

Clinical manifestations:Little food intake; loose dilute stool; sallow and withered complexion.Tongue: flabby and tooth-printed with thin white fur.

Pulse: thready, weak and forceless.

Pathology:Xu of ST and SP results in poor appetite. Loose stool is due to Xu of SP - SP fails totransform- fluid which descends to the large intestine. Stool may contain semi-digested orundigested food. Weakness of SP and ST and subsequent failure to produce sufficient qiand blood gives rise to facial pallor.

Treatment principle:Tonify SP and strengthen ST; strengthen muscles and bones.

Prescription:Pishu (BL-20), Weishu (BL-21), Zhangmen (LIV-13), Zhongwan (REN-12),Zusanli (ST-36), Taibai (SP-3), Biguan (ST-31), Yaoyangguan (Du-3).

Explanation of prescription:BL-20, BL-21, LIV-13, REN-12: combine Front-Mu and Back-Shu points of ST and SP in two groups and use in alternate treatments (T).ST-36 general tonic point; to aid the effect of the above four points (T).SP-3 Yuan-Source point of the SP channel (T) . To strengthen function of the SP intransportation and transformation; frequently selected for loose stools containingundigested food.All the above points may be treated with needling combined with moxibustion.

In syndromes 1) and 2) moxibustion is contra-indicated.ST-31 to help the movement of the thigh by tonifying tendon and bone. With Femur-Juliao(GB-29) and Huantiao (GB30) it is often used to promote the function of the lower extremities and aid movement of the hip joint in infantile paralysis and wind-stroke. Du-3 the only point of the Du channel used for the lower extremities. Often used for weakness and atrophy of legs with the above points.

4) Xu of LIV and KID:

Clinical manifestations:Gradual onset, also appearing at late stage of other Wei syndromes; atrophy of muscles especially of lower extremities; soreness of the lumbar region; tinnitus; vertigo; blurring of the vision; nocturnal emission; incontinence of urine and enuresis.

Tongue: red body, little fur.Pulse: deep and thready.

Treatment principle:Tonify LIV and KID.

Prescription:Ganshu (BL-18), Shenshu (BL-23), Mingmen (Du-4), Yanglingquan (GB-34)Taixi (KID-3) Guanyuan (REN-4), Add Tinghui (GB-2) in case of tinnitus. Add Fengchi(GB-20) and Zanzhu (BL-2) in case of dizziness and vertigo.Explanation of prescription:BL-18, BL-23 to strengthen LIV and KID (T).Du-4 treat with needle only if KID-Yin-Xu symptoms are present (T); use moxibustion ifKID-Yang-Xu. GB-34 controls tendons (T).KID-3 to strengthen KID. (T)REN-4 a point where original yin and original yang gather (ie KID-Yin and KID-Yang).Used to treat either KID-Yin-Xu or KID-Yang-Xu (T).

The first two syndromes are seen in the early stage of Wei syndrome. In the later stage thelatter two syndromes are usually seen. In addition to acupuncture treatment, functionalexercises are generally recommended as wel I as physiotherapy ..nd massage. The earlierthe condition can be treated, the better are the results that can be expected.Editor's note:It must be stressed that to obtain successful results in the treatment of Wei syndrome,prolonged treatment may be necessary. In China treatment is given daily or every otherday, in courses of ten treatments, and in some cases many courses are required. As the"Essentials" says, "as wei syndrome requires a long period of treatment, it is necessary towin the patient's co-operation and confidence".

INFANTILE PARALYSIS - POLIOMYELITIS

This is also classified as Wei syndrome. It is frequent]y seen in children aged 3 to 5 yearsbut can occur in adults. Usually occurs in late summer/early autumn. At the onsetcontinuous high fever is seen accompanied by discomfort, and frequently with gastrointestinal symptoms and cough. 1 to 6 days after subsidence of fever, paralysis can beobserved. This most]y involves the dower extremities, but it may involve the upperextremities or even the throat, with difficulty in swallowing. In a very few patients theremay be coma, convulsions and even sudden death.In the ear]y stage there may be pain, especially pain on pressure, a]] over the body.Children are restless if covered with heavy bed clothes, dislike being touched, and may complain of stiffness of the nape or soreness of the back and loins, with inability to turnover in bed. There may be spasm of the leg and in some cases vibration of the 4 extremities.Ear]y paralysis can affect any part of the body, with the lower extremities being the most common; in some cases one and in some cases both limbs. It is rare to see the upper limbs affected or the upper and lower limbs of both sides. Occasionally the face may be paralysed. If there is paralysis of the abdominal muscles there will be ballooning of the abdomen when children cry. If the bladder is affected there will be incontinence or retention of urine. There is no pain in the later stage when paralysis is evident. Eventually there occurs atrophy of the muscles and serious deformity.

Aetiology:Invasion of toxic pathogenic heat injures the jingluo causing obstruction of jingluo andstagnation of qi and blood. Tendons, muscles and jingluo are finally deprived ofnourishment.Treatment:In the early stage treat to disperse exogenous pathogenic factors, using for example:Dazhui (Du-14) Waiguan (SJ-5) Hegu (L.1.-4). In case of high fever add Quchi (L.I.-11).In case of vomiting and diarrhoea add Neiguan (P-6) Tianshu (ST-25) Zusan]i (ST-36).In case of convulsion and coma treat these as priority eg convulsions: Yintang, Taiyang,Sifeng, Shixuan(all Extra points).

coma: Renzhong (Du-26), Shixuan, Hegu (L.I.-4), Taichong (LIV-3). Treat respiratory symptoms such as cough or dyspnoea according to clinical manifestations.

Treatment of paralysis:Principle:In the early stage remove obstruction of jingluo by activating circulation of qi and blood.In the late stage tonify LIV and KID and warm up jingluo.Paralysis of upper limbs:Dazhui (Du-14) Jianyu (L.I.-15), Jianzhen (S.I.-9), Tianzong (S.l.-11), Waiguan (SJ-5), Hegu(L.I.-4) and HuatuoJiaji points of the 5th to 7th cervical vertebrae.Paralysis of lower limbs:Yaoyangguan (Du-3), Huantiao (GB-30), Femer-Juliao (GB-29), Biguan (ST-31), Fengshi(GB-31), Yanglingquan (GB-34), Zusanli (ST-36), Xuanzhong (GB-39), Jiexi (ST-41), Kunlun(BL-60), Qiuxu (GB-40), HuatuoJiaji points of 1st to 5th lumbar vertebrae.Divide prescription into two groups and use alternately.In case of facial paralysis use routine points.Paralysis of nape:Tianzhu (BL-10), Shenshu (Du-12), Tianrong(S.I.-17) Paralysis of abdominal muscles:Zhongwan (REN-12) Tianshu (ST-25) Qihai (REN-6) Daheng ( SP-15); treat once daily with no retention of needles.The earlier treatment for infantile paralysis is given the better the therapeutic results. Poor results are obtained after 2 to 3 months. In treating later than this use points such as Ganshu (BL-18), Shenshu (BL-23), Taixi (KID-3).

MYASTHENIA GRAVIS

There are three kinds of patients:1) Paralysis of optical muscle2) Paralysis of nerve connecting lower part of brain3) General myasthenia gravis of whole body

1) May involve one or both eyes; upper eyelids droop down; usually there is double vision; frequently seen in clinic, usually in children.

Treatment:Yangbai (GB-14) through to Yuyao (Extra), Zanzhu (BL-2) Sizhukong (SJ-23) Yanglao (S.I.-6), Hegu (L.I.-4), Zusanli (ST-36).2) Main symptom is difficulty in swallowing especially on eating and drinking; inability to speak clearly, with a strong nasal sound; insufficient strength to chew food.

Treatment:Neck-Futu (L.I.-18) Tiantu (REN-22), Fengchi, (GB-20), Jiache (ST-6), Xiaguan (ST-7),Tongli (HE-5), Zusanli (ST-36).This prescription may also be used for difficulty in swallowing due to epilepsy.3) Develops from first two syndromes or seen at onset; involves weakness of muscles usually around joints.

Treatment:Use points similar to those used to treat upper and lower extremities in infantile paralysis.Treat once daily in early period of myasthenia gravis and every other day in chronic cases