It's That Time of the Month Again

                                                                                            

            It has become a cultural norm here in America that accompanied with a monthly menstrual cycle is pain. Women load up on Midol and Motrin every month to alleviate symptoms of abdominal and lower back cramping, breast tenderness, ovulation pains, ovarian cysts and every other type of pain associated with a period. Patients are placed on birth control to reduce said symptoms and regulate their periods, and sometimes the treatment is to completely stop their cycles all together. The link that many doctors and patients don’t recognize is that abnormal cycles can actually be a precursor to a more serious problem, such as infertility.

                One of the most common western diagnoses for painful periods is Endometriosis. This is when viable endometrial tissue is present outside of the uterine cavity. In Chinese Medicine this will present with symptom of blood stasis leading to the accumulation of damp heat and fire in the lower jiao. When there is blood stasis in the lower jiao, there will be a lack of blood flow to important reproductive organs. This will lead to a lack of nourishment causing infertility. Damp heat in the lower jiao will present as inflammation and cause blockages that must be resolved for fertility to be possible (2).

                Western medicine classifies dysmenorrhea as pain or cramping in the lower abdomen accompanied by other symptoms: sweating, headaches, vomit, nausea, diarrhea and tremors occurring just before or during menstruation. There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea occurs in women under the age of twenty with no pathological pelvic disease present. Secondary dysmenorrhea occurs in women over the age of twenty and is usually linked to some pelvic pathology. Risk factors for dysmenorrhea include age, smoking, high BMI, early menarche, null parity, long and heavy menstrual flow and a family history of dysmenorrhea (1).

                Common patterns associated with dysmenorrhea include Spleen Qi and Kidney Yang Xu with a Chong and Ren Disharmony; Kidney Qi Xu with Blood Stagnation; Kidney Yin Xu with LQS and Blood Heat; Spleen Qi and Blood Xu (3); and Excessive Heat or Cold (1). The first pattern is typically associated with luteal phase defect or polycystic ovarian syndrome which can both cause infertility or miscarriage early on in pregnancy. Kidney Qi Xu with Blood Stagnation is common in women with autoimmune disorders or anti-phospholipid syndrome and can cause miscarriage at any time during pregnancy. Kidney Yin Xu with LQS and Blood Heat is commonly seen with anti-sperm antibodies or hyperthyroidism. Spleen Qi and Blood Xu are connected to hypothyroidism, luteal phase defect or incompetent cervix (3). Excessive heat will produce early and heavy periods, whereas excessive cold will produce scanty or delayed periods (1).

                Chinese Medicine views the regulation of blood to be the main treatment of any menstrual disorder. The three main herbs used in any formula for menstrual irregularities are Dang Gui, Bai (Chi) Shao, and Sheng Di Huang. Dang Gui is known as the “female ginseng” for its abilities to regulate menstruation, tonify the reproductive system, relieve pain, reduce PMS and reduce symptoms of menopause (2). Acupuncture points will focus on the Spleen, Kidney and Liver meridians since these are the three meridians most closely associated with menstrual disorders. SP 8, 10 and LV 5 are primary points to move blood and stop pain. SP 6, LV 3, ST 36, KD 6, BL 18, 20 and 23 are good points to nourish the menstrual reservoir. Zi Gong and Ti Tuo are local points that can be used to move stagnation and relieve pain, as well as points on which to use needle Moxa to warm the UT.

                For many reasons, dysmenorrhea and infertility are best treated with the use of both Western and Eastern Medicine. Western medicine has mounds of technology that can visually show where dysfunction is happening in the body and show levels of hormones associated with menstruation and fertility. Many western medicines are very fast and effective for treating the primary concern, but they produce harsh side effects that can be moderated by Chinese herbs to ensure a quick and effective treatment. In the treatment of women’s health, one is good, but two is better.

Works Cited:

                1. Hong, Ju, Mark Jones and Gita Mishra. “The Prevalence and Risk Factors of Dysmenorrhea.” Oxford Journals, Medicine and Health, Epidemiologic Reviews 10.1093 (2013): Web. 27 Dec. 2013.

                2. Zhou, J., and F. Qu. "Treating Gynecological Disorders with Traditional Chinese Medicine: A Review." African Journal of Traditional, Complementary and Alternative Medicines 6.4 (2010): 494-517. NCBI. Web. 8 Dec. 2014. 

                3. Zhao, Liqin. "The Treatment of Recurrent Spontaneous Miscarriage." Journal of Chinese Medicine 101 (2013): 13-18. Print.                                                                               

Every Step I Take

      Housed in the first metatarsophalangeal joints on some unlucky patients’ there live a buildup of monosodium urate crystals. These ungrateful house guests cause their host severe attacks of pain and inflammation in the peripheral joints, commonly known as gout. Gout is caused by high levels of uric acid in the blood. Generally, uric acid is filtered out by the Kidneys, however, if the Kidneys are not filtering properly, or there is too much uric acid in the body then it will become deposited elsewhere, usually in joints. It is considered to be the most common form of inflammatory arthritis. People who suffer from gout may also suffer from kidney stones being that uric acid crystals may deposit there as well (1).

            From a Western perspective, gout has causative factors that include a high prevalence of uric acid in the blood as well as a low uric acid renal clearance rate, diets rich in meats, seafood and other purine rich foods, alcohol consumption, use of diuretics, chronic renal disease, hypertension, obesity and osteoarthritis. There is also believed to be a genetic component contributing. Factors that are believed to be preventative against gout are the consumption of dairy products, coffee, Vitamin C and increased water consumption. Gout is treated in western medicine with the use of NSAID’s, corticosteroids, colchicine (all to reduce inflammation) as well as medicines to reduce the amount of uric acid in the bloodstream (1).

Traditional Chinese Medicine finds gout to have two excess patterns and two deficiency patterns: Liver Qi Stagnation gout; Damp Heat Joint Bi; Spleen Qi Deficiency gout; Kidney Deficiency gout. Being that the Liver governs the tendons, diseases affecting the joints point towards a liver imbalance. Considering the painful and inflamed nature of the disease, this can be seen as stagnation of liver qi combining with damp pathogens and producing heat. Over time the heat will dry out the damp and turn it into a phlegmy consistency.  Bi syndromes are characterized by pain in the body that is intensified by external pathogens: wind, damp, heat and cold. Gout is considered to be a Damp Heat Joint Bi because of its tendency to become worse with the ingestion of alcohol, fried and fatty foods (3.)

The spleen is the main organ associated with digestion. It also has a tendency to produce dampness when not functioning properly. The connection to the spleen can be clearly seen in the inability to digest purines. The symptoms; inflammation, redness, swelling and pain can be related to a Damp Heat syndrome that is rooted in a Spleen Qi Deficiency. The connection with the kidneys is seen in the fact that the uric acid is filtered through the kidneys. A constitutional, or lifestyle induced kidney deficiency will prevent them from filtering properly leading to a buildup of uric acid crystals (3).

Gout can be treated with internal medicine based on the diagnosis. For the branch (Damp Heat) the formula Juan Bi Tang can be used to treat the heat Bi with the addition of herbs to drain damp such as Cang Zhu and Fu Ling. For an underlying Spleen Qi Deficiency, the formula Liu Jun Zi Tang can be prescribed along with Juan Bi Tang. A pattern of Liver Qi Stagnation with heat would improve with the formula Dan Zhi Xiao Yao San. A constitutional Kidney Deficiency can be treated with the formula Er Xian Tang if the deficiency seems to be affecting Yin and Yang equally. A general point prescription for gout could include points such as ST36, ST40, SP6, SP9, Ren12, LI4, LV3 and Master Tang’s Wu Hu 3.

Works Cited

1.       http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046529/?report=classic

2.       http://www.livestrong.com/article/219171-chinese-remedies-for-gout/

3.       http://agelessherbs.com/gout-and-tcm/

I've Fallen and I Can't Get Up

Imagine sleeping all day and still feeling exhausted. Imagine days filled with headaches, confusion, muscle and joint aches, trouble concentrating, possibly even fevers and sore throats without any possibility of relief. This is what life is like for people suffering from chronic fatigue syndrome. The leading causes of chronic fatigue syndrome are the Epstein-barr virus, the human herpes virus-6 and inflammation in the immune system (2). Upon initial onset, symptoms present mimicking the flu (1). It is more commonly seen in women age 30-50 and risk factors increase with prior illness, stress, genetics and environmental factors (2).

Western medicine has no cure for chronic fatigue syndrome at the present time (2). It also runs the risk of being improperly diagnosed considering the signs and symptoms will often overlap with those of fibromyalgia (3). The ways to manage symptoms include a healthy diet, cognitive behavioral therapy, a regulated sleep schedule, and medicines to reduce pain, anxiety and depression. A doctor may also suggest the patient to rest when feeling worn out, breaking larger tasks into smaller ones that are easier to manage, balancing life between activity, rest and sleep, and tackling larger tasks over the course of the week instead of all at once. Ways to reduce the pain are with relaxation techniques such as biofeedback, deep breathing, hypnosis, massage therapy, meditation and yoga. Some people recover within six months to a year, and some people never quite recover (2).

Traditional Chinese Medicine sees chronic fatigue syndrome in terms of six different patterns: Spleen Qi and Yang Xu (fatigue over a long period of time); LQS overacting on the Spleen/Stomach (alternating loose stools and constipation); Heart Xue/Ying Xu (palpitations and insomnia); Kidney Qi and Yang Xu (morning diarrhea and frequent urination); Phlegm Obstruction and Damp Retention (plum pit qi and a heavy sensation); and Heat Toxicity (sore throat and swollen lymph nodes).

The basic prescription regardless of the D&D is ST36, DU20 and PC6 along with the auricular points; adrenal, sub cortex and endocrine. For Spleen Qi and Yang Xu the points Ren 6,12 SP6, and BL 20,21 should be added and the formula Shi Quan Da Bu Tang should be employed. For less cold symptoms, the formulas Si Jun Zi Tang or Bu Zhong Yi Qi Tang should suffice. For LQS overacting on the Spleen/Stomach the points GB 8,20,34 LI4, LV 3,14 and ST 19,25 should be added along with the formula Xiao Yao San, or Yue Ju Wan if there is more constrained Qi. Heart Xue/Ying Xu should be treated with the points HT 6,7 SP 1,6 and BL 15,17. A good base formula to be administered in this case would be Gui Pi Tang. For Kidney Qi/Yang Xu the points Ren 4,6 SP6, GB34, KD3, DU4, and BL23 can be used along with the formula You Gui Yin, or Jin Gui Shen Qi Wan. Phlegm Obstruction and Damp Retention would require use of the points SJ5, ST40, SP9 and Ren22 in addition to the formula Er Chen Tang or Ban Xia Hou Po Tang. Heat Toxicity would benefit from the points DU14, LI 4,11 ST44, LV2 and SP21 and the formula Qing Hao Bie Jia Tang or Dan Zhi Xiao Yao San can be enlisted to help (1).

One other thing to keep in mind when treating chronic fatigue syndrome is that often people with such suppressed immune systems will also suffer from hypersensitive allergic reactions. These kinds of reactions can halt progress towards recovery. In these cases strengthening the LU Qi is going to be of upmost importance on the road to recovery. This can be helped with the points LU7, GB31 and cupping on Ren8 (1).

Commonly, treatment needs to be continued for a minimum of three months to maintain lasting results (1). During this time it is important to educate the patient on lifestyle changes as well as dietary changes to ensure their continued recovery after discontinuing treatments. Being that the word "chronic" is in the name of the disease, this usually tells us that it took a while to come on. This can lead us to expect that it will take an equal amount of time to fully recover. It is important that the patient realizes that it will be a slow process and is willing to commit to, and be proactive in their own recovery. As practitioners, we have to give patients the tools as well as the knowledge on how to use them, and then the rest is up to them.

Works Cited:

1.      http://www.acupuncturetoday.com/archives2005/aug/08wang.html

2.      http://www.nlm.nih.gov/medlineplus/ency/article/001244.htm

3.      http://cid.oxfordjournals.org/content/32/6/938.full

1 - 2 - 3 strokes you're out!

                According to western medicine, strokes can be separated into two categories: ischemic strokes and hemorrhagic strokes. More commonly are ischemic strokes which occur when a blood clot forms in the brain and blocks the blood flow to the brain. Another way an ischemic stroke can occur is if a blood clot forms in another part of the body and breaks free and gets lodged in the brain (an embolism). Within the category of hemorrhagic strokes, there are two subcategories: subarachnoid hemorrhage and cerebral hemorrhage. A subarachnoid hemorrhage occurs when a blood vessel in the brain ruptures, filling the spaces inside the brain with blood. A cerebral hemorrhage occurs when an artery inside the brain ruptures and fills the surrounding tissues with blood (1).

                Ischemic strokes can occur when plaque builds up in the blood vessels, or if there is a deformity in the valves of the heart due to endocarditis (2). To treat ischemic strokes, blood thinners, anti-platelet agents and clot busters are used to restore blood flow to the brain. In severe cases, procedures to widen the artery (angioplasty) or to remove the plaque from the artery (carotid endarterectomy) are used (1). Hemorrhagic strokes are most commonly caused by high blood pressure, second to that being trauma or an aneurysm (1, 2).  Treatments of hemorrhagic strokes are different because prescribing blood thinners can often make the bleeding worse. Instead, a patient will be prescribed medication to lower blood pressure if the stroke is due to high blood pressure. If the stroke is not due to high blood pressure, surgery might be performed; such as an aneurysm clipping or coil embolization (3).

                In Chinese medicine, strokes relate to the Spleen, Liver and Kidney systems. Certain life style choices put stress and strain on the body which create weaknesses of Qi, Xue and Yin, in turn, allowing the body to be overcome by wind, phlegm, fire and stasis. Detrimental life style choices include; emotional stress, overwork without enough rest, excessive physical activity, irregular eating habits, poor appetite and excessive strenuous activity. The patterns associated with stroke are: Liver Wind, Liver Yang Rising, Qi or Xue Stasis, or Phlegm Fire. This blocks the flow of blood to the brain, leading to a stroke (4).

                Common formulas to treat stroke are Zhen Gan Xi Feng Tang in cases of Liver Yin Xu allowing for Liver Yang Rising; Bu Yang Huan Wu Tang in cases of Qi Xu leading to stasis; Ren Shen Zai Zao San to be administered immediately after the stroke; Tong Qiao Hou Xue Tang in cases of a mild Xue Stagnation; Tian Ma Gou Teng Yin in cases of excessive Liver Wind; or Zhong Feng Hui Chun Wan in cases of Phlegm Fire.

Works Cited:

1.       http://www.medicalnewstoday.com/articles/7624.php

2.       http://www.everydayhealth.com/stroke/stroke-types-ischemic-and-hemorrhagic.aspx

3.       http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/treatment.html

4.       http://www.altmd.com/Articles/TCM-for-Stroke