I Just Can't Help Myself

                Mental intruders, anxiety inducers, time consumers: these are just a few ways to classify compulsions and obsessions characterized by Obsessive Compulsive Disorder (OCD). From the woman who counts repetitively, to the man who cleans incessantly, these rituals cross the line from belonging to a healthy individual to a pathological individual when they interfere with daily life and consume all daily thoughts (1). The Diagnostic and Statistical Manual of Mental Disorders states that the essential characteristics of OCD consist of recurrent obsessions that require time spent of more than one hour a day, cause a great deal of stress and anxiety, and that the person is aware that the obsessions are irrational and excessive (2).

                Western medicine has not been able to track down a solid pattern as to why OCD occurs in some people and not others, though there does sometimes seem to be a genetic component. The one thing they have noticed is that the disorder involves much fear and anxiety. Some common obsessions include fear of germs or intruders, violence or hurting loved ones, sexual imagery, conflicting thoughts with religious beliefs or organizing. Some people become hoarders due to the fear of throwing anything away that they may need. Some people repeat the same actions over and over again due to doubt that it was done the first time. Some people perform actions a certain number of times due to superstitions about “bad numbers”. People who suffer from OCD do not get satisfaction from performing rituals; they simply have a brief lapse in anxiety that returns within seconds after the ritual has finished (1).

                In the West, OCD is treated with psychotherapy and medication. Exposure and Response Prevention Therapy is a form of Cognitive Behavioral Therapy that has been designed to lower the anxiety levels of a person with OCD through exposure to the things the patient most fears. The patient makes a list of what they fear and of what they think will happen if exposed to that fear. They are then put in situations where they are exposed to the very thing they fear the most. They are asked to rate on a scale of 1-10 where their anxiety lies and over the next couple of minutes they remain exposed until their anxiety level lowers to a 2-3. This procedure repeats itself until the initial spike of anxiety is 2-3, and the time taken to come down from the initial spike is within seconds (3). This type of therapy is effective because it shows the patient that their anxiety can be calmed without performing rituals, or avoiding the anxiety inducing situation all together.

                Eastern medicine has come to the same conclusion that the root of OCD lies within fear. Fear resides within the kidneys and can arise from a deficiency of kidney Jing, Yin, Yang or Qi. This relates to why there is sometimes a genetic component in OCD where if the parents have weak Jing at the moment of conception, this will be passed onto the offspring as a weak pre-natal Jing. Of course, manifestations of OCD can be seen in relation to other organs as well. Water is the mother of wood and if water is deficient then it fails to nourish wood which could give rise to Liver Blood deficiency, or Liver Qi stagnation. Blood deficiency can give rise to internal wind which can be seen in tics and tremors often associated with OCD rituals, as well as Qi stagnation can give rise to irritability and anger. Water controls Fire and when water is deficient it is unable to control fire which can give rise to Heart Fire or Heart Blood deficiency. This can be seen in OCD symptoms such as poor sleep, easily startled, palpitations, poor memory and restlessness (2).

                Whatever the symptoms, strengthening the kidneys will be of upmost importance when treating OCD with acupuncture and herbal medicine. The main points to treat the kidneys are DU4, Ren4, BL23, KD3 (Qi), KD6 (Yin), and KD7 (Yang). If the symptoms lie more within the liver a good combination would be KD10 with LV8 - using kidney water to nourish liver wood. If the symptoms lie more within the heart then the Buddhist triangle (HT7, PC6, and LU9) would be good to calm the spirit and nourish the heart. A good herbal formula with which to begin is Jin Gui Shen Qi Wan due to its mild action in tonifying Kidney Qi and Yang, and in turn, Yin and Jing. This can be modified for liver symptoms by adding the formula Yi Guan Jian to address the live deficiency and stagnation. This can also be modified for heart symptoms by adding the individual herbs Shi Chang Pu to clear the mind or Suan Zao Ren to help with sleep disturbances. Many practitioners will also advise their patient to ask themselves throughout the day, “how much am I like water at this very moment?” At first, they may not feel very much like water at all, but overtime they can see themselves flowing freely and becoming more and more uninhibited (2).

1.       http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

2.       Kraft, Norman. “Unquiet Waters: Obsessive Compulsive Disorders & Chinese Medicine.” Oriental Medicine Journal Spring/Summer 2000: 37-50. Print.

3.       http://www.alexianbrothershealth.org/abbhh/ocd-anxiety/_exposure-response-prevention

Baby Got Back

                Spinal stenosis is a disorder of the spinal column that typically occurs in the cervical or lumbar vertebrae. This paper will discuss the signs, symptoms and treatment options for lumbar spinal stenosis. Pain, numbness or weakness of the legs occurs due to a narrowing of the spinal canal, which in turn puts pressure on the spinal cord and surrounding nerve roots. Symptoms may also present mimicking sciatica if the sciatic nerve is impinged. It is characterized as a degenerative disease, and for this reason, usually seen in people over fifty years of age. Of course, people who are born with back problems may develop signs and symptoms earlier (1).

                From a western point of view, two common causes of spinal stenosis are arthritis in the joints, and increased size in the ligaments surrounding the joints. Arthritis happens as the discs between the vertebrae lose moisture and begin to collapse, decreasing the space between the vertebrae. This upsets the balance of the spinal column as the weight transfers to the facet joints, and also decreases the space in the foramen where the nerves exit. Over time, the facet joints wear out their protective cartilage and the body will grow new bone (bone spurs) where the cartilage was to support the vertebral column. All of this leads to a narrowing of the spaces where the nerves pass through. Typically, leaning forward will alleviate symptoms, as it increases the space between the facet joints, and standing upright or walking long distances will aggravate the pain (1).

                Western doctors can perform a number of tests to get a better idea of what exactly is going on. An X-ray will show if there is a degeneration of vertebral discs or bone spurs. An MRI will make it possible to view the surrounding soft tissues as well as the nerves and spinal cord. A CT scan will show if a nerve root is being compressed. Based on these results, the doctor may suggest cortisone injections to decrease the swelling and pain around the joint. However, this will not help with the weakness in the legs and it is inadvisable to have these injections more than three times per year. The may suggest chiropractic manipulation, physical therapy, lumbar traction, NSAIDs or surgery. There are two surgical options; the first being laminectomy and the second being spinal fusion. During a laminectomy the doctor will remove bone, bone spurs or ligaments that are pressing on the nerves. During a spinal fusion, the arthritic joints between the vertebrae are permanently fused together to prevent further degeneration (1).

                In Chinese Medicine, typical patterns for back pain can be seen as Kidney essence or Qi Xu, Qi and Xue Stagnation, or Bi syndrome (2). Being that the Kidney’s govern bone, when bone spurs occur there is a Xu of Kidney Qi. If there are congenital back problems, in TCM it could be seen as a Kidney essence Xu. Trauma to the area or strain to the area over time (over lifting or improper lifting of heavy objects) can lead to local Qi and Xue Stagnation. Likewise, and invasion of Wind Cold Damp can get lodged in the area creating inflammation and pain.

                For a treatment I would focus on points to nourish the Kidneys, Liver and Spleen such as KD3, LV8, SP6, SP10, ST36, BL18, BL21, and Ren 6. I would add points to move Qi and Xue such as LI4 and LV3, as well as open the DU: DU60 and SI3 and I would do warming techniques, such as Moxa, on DU4 and BL23. I would also consider electro stimulation from the most reactive Hua Tuo’s in the lumbar joints to BL40 to open up the lower back.

                Du Huo Ji Sheng Tang is the standard formula for eliminating wind dampness with an underlying Qi and Xue Xu. I would try this formula first if the patient presented with clear Bi syndrome symptoms, such as symptoms are affected by weather changes. Predominantly, though, I would focus a formula on building the Kidneys, such as Jin Gui Shen Qi Wan to nourish Kidney Qi and Essence. I would consider adding Chuan Xiong or Ji Xue Teng to move stagnation as well as Du Huo to guide the action to the lower half of the body.

1.       http://orthoinfo.aaos.org/topic.cfm?topic=a00329

2.       http://www.acupunctureforallergy.com/Conditions.html

I'm Working Hard; but This Dust Mask Hardly Seems to be Working

            Invisible, odorless, virtually undetectable, isocyanates are a silent killer amongst workers in many professions including painters, foam-blowers and manufacturers of chemicals, polyurethane foam, insulating materials, surface coatings, car seats, foam mattresses and more (1). Auto-motive paints typically come separated into two parts; paint and hardener. The effect of the two combined is that the paint will dry faster and, ultimately, be more durable and last longer than the paint alone (2). While this may be desirable from the perspective of a buyer, it comes at a great cost to the manufacturer.

                Unless burned or generated into a dust, the finished product (car paint) is not toxic, however, the application of the paint is highly toxic. When the paint and hardener are mixed they form an isocyanate. This isocyanate can then be absorbed through the skin and mucous membranes or breathed in through the lungs. Though the amount of isocyanates that are produced during this process is small, overtime, the repeated exposure to them may potentially cause irreversible and life threatening side effects (2).

                The most notable symptoms that one will experience first upon being exposed to isocyanates are irritation to the eyes and mucous membranes, or rashes on the skin. Some more long term conditions that one can expect to develop are asthma, chemical bronchitis or less commonly, hypersensitivity pneumonitis. The symptoms of asthma and chemical bronchitis will present with coughing, shortness of breath, wheezing and chest tightness. Continued exposure to isocyanates will cause one to develop a sensitivity to them causing him/her to have an asthma attack with just the tiniest bit of exposure, and possibly without any exposure at all (1). Hypersensitivity pneumonitis will present with symptoms mimicking the flu such as fever, muscle aches, headaches, dry cough or cough with phlegm, chest tightness and difficult breathing. As this condition turns more chronic, one can expect these symptoms to also include more difficult breathing, fatigue and weight loss (2).

                As of right now, the ways for Western medicine to treat isocyanate poisoning are to treat the symptoms of asthma or bronchitis. The main way they work to prevent symptoms from getting worse is to advise the employee to change professions. Ways for employers to protect their employees against exposure are by installing ventilation systems, tightly covering products containing isocyanates to prevent evaporation, providing supplied-air respiration equipment, gloves, face shields and clothing made out of butyl rubber. Simple dust masks will not prevent the inhalation of isocyanates (2).

                The liver is the organ that is directly involved in the metabolism of most toxins. For this reason, many naturopaths will advise a patient with chronic chemical exposure to engage in a detoxification diet for several months to cleanse the liver. This diet includes: low fat consumption to increase fat metabolism, limited intake of sugar and highly processed food, no caffeine, tobacco and alcohol, high fiber to absorb the toxins, limited red meat – mostly protein from organic vegetables, foods with antioxidants, at least 64oz of water a day and a daily multi-vitamin. The incorporation of milk thistle is also very powerful to increase glutathione production, thus, increasing the detoxification effects (3).

                Though there are no specific case studies regarding the treatment of isocyanate poisoning with traditional Chinese medicine, it appears that the two main organs involved are the lungs and the liver. From a five element perspective, this can be seen as Wood insulting Metal. The two main points I would use to treat this are the exit point on the liver channel (LV14) and the entry point on the lung channel (LU1) to drain the excess liver into the deficient lung. In the acute stage of chemical poisoning I would focus a formula on clearing toxic heat from the body such as Huang Lian Jie Du Tang. This is a perfect formula to drain fire toxins from all three burners for a patient with a strong constitution, however, I would discontinue as soon as symptoms disappear to prevent damaging the yin. For a patient who has had years of exposure I would focus more on tonifying qi and less on clearing toxins. Si Jun Zi Tang would be perfect in such a case to tonify qi and strengthen the spleen, and therefore the lungs.

Works Cited:

1.        http://www.cdph.ca.gov/programs/hesis/Documents/iso.pdf

2.        http://www.sp2.org/newsletters/sp2vol1iss8/sp2vol1iss8topic.php

http://www.healthline.com/galecontent/chemical-poisoning#4

How Would You Like Your Berger?

                Berger’s disease, more commonly known as IgA Nephropathy, is an autoimmune disease that injures the kidneys when IgA antibodies accumulate in the kidney tissues. IgA is the immunoglobulin that normally attaches itself to an infection in the body, inducing an immune response. With IgA Nephropathy, there is a defective form of IgA which attaches to another IgA molecule instead of an infection, forming an immune complex in the kidneys. Not knowing the difference, the body works to fight, just as it would an infection (6). This leads to inflammation and damages walls of the glomeruli (filtering units in the kidneys), inhibiting their ability to filter toxic waste through the blood and out of the body. This damage also allows for substances to spill out into the bladder. As can be expected, this is problematic, and over time leads to chronic kidney failure, requiring dialysis or a kidney transplant to sustain life (1).

                IgA Nephropathy is believed to have a genetic component to it and may remain asymptomatic for many years, only showing signs once one is entering end stage renal failure. Key symptoms that develop are hematuria, proteinuria, peripheral edema, high blood pressure, polyuria (especially at night) and pain in the lower back or below the ribs. Being that these symptoms will only become prominent in the later stages of the disease, the only way to definitively diagnose IgA Nephropathy early on is by examining a biopsy of the tissue in the kidneys to check for IgA deposits (1).

                Some ways that western medicine prevents progressive kidney damage are by limiting protein consumption, lowering high blood pressure and incorporating a fish oil supplement to slow loss of kidney function. As stated above, once a patient develops kidney failure their options are limited to dialysis or a kidney transplant. In half of transplant cases IgA deposits will reappear in the new kidney, however, it is uncommon to lose the transplanted kidney seeing as the symptoms are significantly milder and are suspected to be due to antirejection drugs.

                IgA Nephropathy is just starting to become a common disease and for that reason there is not a terrible amount of information on it. Based on my research of the symptoms and my knowledge of TCM I have come up with my own hypothesis on how to treat it. Autoimmune disorders are considered Xu conditions due to their chronic nature (2). In the case of IgA nephropathy, possibly a deep rooted Yin Xu is to blame where there is an inability to support the functions of repairing and maintaining the walls of the glomeruli; more specifically, KD Yin (the location of the deposits) and Essence Xu (the genetic nature of the disease). At this stage, I would focus on tonifying KD Yin with acupuncture points such as KD3, KD6, BL 20, BL23, SP6 and Ren4. I would consider Zou Gui Wan or Liu Wei Di Huang Wan as herbal prescriptions.

                At the later stage, I would diagnose blood stasis (IgA buildup) generating heat (inflammation). Here, I would consider points to clear heat, move blood stasis and reduce inflammation in the kidneys such as LI11, SP10, KD2, BL17, LI4, LV3 as well as open the Chong to move blood and the Ren to regulate Qi and blood. I would also change the formula to Tao Hong Si Wu Tang to move blood stagnation as well as tonify. The end stage I would diagnose as KD Yin & Yang Xu, Yang Xu prominent (peripheral edema, polyuria, proteinuria, hematuria, lower back pain). Here, I would add the points DU4, KD7, BL13, BL22, SP9 and ST28. I would prescribe You Gui Wan at this point because it warms and tonifies KD Yang, as well as incorporates herbs that tonify KD Yin.

                There is one alternative therapy out that helps with the symptoms and progression of IgA Nephropathy. Micro-Chinese Medicine Osmotherapy is a topical combination of herbs that is applied to penetrate to the kidneys to repair them. These effects take a while to appear, however, the results are longer lasting (3). The ingredients of this formula are not stated.

Works Cited:

1 http://www.patmoore.org/Bergers%20disease.htm

2 http://www.itmonline.org/arts/autoimmune.html  

3 http://www.kidney-support.org/treatment-options/1859.html

4 http://www.kidneyfailureweb.com/treatment/242.html

5 http://kidney.niddk.nih.gov/kudiseases/pubs/iganephropathy/

6 http://www.unckidneycenter.org/kidneyhealthlibrary/iganephropathy.html

First Post

Hello! My name is Ella and I am currently a student of acupuncture and herbal medicine at the Colorado School of Traditional Chinese Medicine. I was inspired this summer by some research assignments in Clinic Forum and decided I would like to start a blog to continue researching western topics and relating them to Chinese medicine. I intend for this to be multifaceted: 1. to, obviously, increase my education on common diseases I will encounter in clinic. 2. to form a discussion board between fellow acupuncturists/students who would like to contribute their ideas or counter mine so we can all learn. 3. to be an easy read for people who would like to know more about this medicine to gain a little insight into Eastern theories and the way we treat. I'm going to try to write a new post every week, however, forgive me if I get a little behind. Hope you enjoy!