VITILIGO, or leukoderma, is a chronic skin condition that causes loss of pigment which results in irregular pale patches of skin. The precise cause of vitiligo is not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. The population incidence worldwide is considered to be between 1% and 2%.
PATTERNS AND HERBAL FORMULAS
1. Wind-Damp + Qi and Blood disharmony: localized white discolorations on the face, neck, and back of the hand; round, oval, or irregular shape discolorations with a smooth suface Tu Fu Ling 30-60g Jin Yin Hua 12g Wei Ling Xian 9g Sheng Gan Cao 6g Cang Er Zi 15g Fu Ping 6g Xi Xian Cao 6g Bai Ji Li 6g Wu Shao She 6g (Zaocys)
2. Wind pathogen: Wind attacks the pores and causes Qi & Blood stagnation, which closes the pores and prevent Blood from nourishing the skin Han Lian Cao 9g Bai Zhi 6g He Shou Wu 6g Bai Ji Li (fried) 6g Bai Ji Li 6g Zi Cao 4.5g Zao Xiu 3g (Rhizoma Paridis) Dan Shen 3g Ku Shen 3g Cang Zhu 2.5g
Formula 1: Activate Blood, expel Wind, harmonize Qi & Blood He Shou Wu 30g Sang Shen 30g Bai Ji Li 18g Bai Jiang Chan 12g Chi Shao 12g Chuan Xiong 12g San Leng 15g E Zhu 15g Fang Feng 15g
Formula 2: Harmonize Qi & Blood Sheng Di 12g Dan Shen 12g Gou Teng 12g Bai Ji Li 12g Dang Gui 6g Fu Ping 6g Ji Xue Teng 3g Ye Jiao Teng 9g
EXTERNAL FORMULAS: Actions: Harmonize Qi & Blood, activate Blood, open the collaterals Method: Soak the herbs in 600ml of 70% alcohol for 7 days before applying to the skin
External 1 Bai Fan 80g Wu Bei Zi 80g Fu Zi 80g Bu Gu Zhi 80g
External 2 Bai Fan 80g Bai Bu 80g Fu Zi 80g Bu Gu Zhi 80g
1. Damp-Heat: diarrhea, abdominal distention, fatigue, weakness, lack of appetite, slight fever, white greasy coating, soggy rapid pulse 9.0g Hua Shi 6.0g Huang Qin 6.6g Yin Chen 2.4g Huo Xiang 2.4g Lian Qiao 3.6g Shi Chang Pu 2.4g Bai Dou Kou 2.4g Bo He 3.0g Mu Tong 2.4g She Gan 3.0g Chuan Bei Mu 3.0g Bai Hua She She Cao 3.0g Mu Dan Pi 3.0g Ban Lan Gen 3.0g Jin Yin Hua
2. Heat enters Ying-Blood level: fever, vomiting blood, delirious speech, dry mouth, thirst, red tongue with yellow coat, thready rapid pulse 60g Shi Gao 6.0g Sheng Di 6.0g Shui Niu Jiao 4.0g Huang Lian 4.0g Zhi Zi 4.0g Jie Geng 4.0g Huang Qin 4.0g Zhi Mu 4.0g Chi Shao 4.0g Xuan Shen 4.0g Lian Qiao 4.0g Dan Zhu Ye 4.0g Gan Cao 4.0g Mu Dan Pi 4.0g Bai Hua She She Cao
3. HT and SP deficiency: fatigue, emaciation, palpitations, lack of appetite, loose stool, white tongue coat, thready and weak pulse 15g Bai Zhu 15g Fu Shen 15g Huang Qi 15g Long Yan Rou 15g Suan Zao Ren (fried) 7.5g Ren Shen 7.5g Mu Xiang 3.7g Zhi Gan Cao 3.7g Ji Xue Teng 3.7g Tu Si Zi
4. Qi and Yin deficiency: slight fever, cough, dry mouth and throat, decreased appetite, fatigue, weakness, slight pale tongue, no coating, thready rapid pulse 9.0g Mai Men dong 3.0g Wu Wei Zi 9.0g Ren Shen 6.0g Nu Zhen Zi 6.0g Han Lian Cao 6.0g Ji Xue Teng
5. Yin deficiency + Phlegm: slight fever, emaciation, phlegm nodules under the skin, cough, red tongue, white coating, thready and slippery pulse 6.0g Zhi Mu 6.0g Huang Bai 24g Shu Di 12g Shan Zhu Yu 9.0g Mu Dan Pi 12g Shan Yao 7.0g Fu Ling 7.0g Ze Xie 6.0g Bei Mu 6.0g Zhu Ru 6.0g Mu Li 6.0g Hai Zao
6. SP and KD deficiency: fatigue, weakness, decreased appetite, loose stool, pain in lower back and knees, white coating, thready and weak pulse 8.0g Ren Shen 8.0g Huang Qi 8.0g Shu Di 8.0g Shan Yao 8.0g Shan Zhu Yu 8.0g Mu Dan Pi 8.0g Fu Ling 8.0g Ze Xie 8.0g Tu Si Zi
7. KD Yang deficiency: fatigue, weakness, low back and knee pain, cold body and limbs, white coating, deep and thready pulse 16g Shu Di Huang 8.0g Shan Yao 8.0g Shan Zhu Yu 6.0g Fu Ling 6.0g Ze Xie 6.0g Mu Dan Pi 2.0g Rou Gui 2.0g Fu Zi 4.0g Yin Yang Huo 4.0g Tu Si Zi 4.0g Ba Ji Tian
Formula 1: latent HIV, without any apparent symptoms 8.0g Dang Shen 8.0g Huang Qi 8.0g Bai Zhu 8.0g Fu Ling 8.0g Ku Shen 8.0g Tu Fu Ling 8.0g Da Qing Ye 8.0g Bai Hua She She Cao 8.0g Lian Qiao 8.0g Huang Lian 8.0g Zhi Gan Cao
Formula 2: Kaposi's Sarcoma, Turbid-Phlegm on channels 6.0g Xuan Shen 6.0g Mu Li 6.0g Bei Mu 6.0g Shan Ci Gu 6.0g Ban Xia 6.0g Jiang Chan 6.0g Xia Ku Cao 6.0g Hai Zao 6.0g Dan Nang Xing 6.0g Bai Jie Zi 6.0g Bai Hua She She Cao 6.0g Huang Yao Zi
Formula 3: AIDS symptoms of Yin deficiency + Exterior pathogen and fever 6.0g Yu Zhu 6.0g Bai Wei 6.0g Jie Geng 6.0g Bo He 6.0g Dan Dou Chi 6.0g Sheng Di Huang 6.0g Mai Men Dong 6.0g Bei Mu 6.0g Ban Lan Gen 6.0g Da Qing Ye 6.0g Jin Yin Hua 6.0g Tian Zhu Huang 6.0g Gan Cao
DESCRIPTION: TB is an infectious bacterial disease transmitted primarily by air that commonly affects the lungs but also can involve almost any organ of the body. The kidneys, bone, and meninges are the most common sites where TB spreads. AGE: most common in children and in adults over age 60; LIFESTYLE: overcrowded conditions and malnutrition are risk factors; GENDER, GENETIC: not significant factors
CAUSE: The bacterium Mycobacterium tuberculosis causes most cases of TB and is usually transmitted in airborne droplets that are produced when an infected person coughs. Although many people are infected with the bacterium at some point in their lives, only a small proportion of these people develop TB. People with reduced immunity are more likely to develop TB. This includes people who are infected with HIV, those who have diabetes mellitus, and those who are taking immunosuppressant drugs.
SYMPTOMS: Initial Stage: Cough, which may be dry, and generally feeling unwell; Later Stage: Persistent cough, greenish or yellowish sputum, chest pain when inhaling deeply, shortness of breath, fever, poor appetite and weight loss, excessive sweating at night, fatigue
DIAGNOSIS: Chest X-rays, CT scanning, analysis of sputum, TB skin test, bronchoscopy, exam samples of tissues from other than the lungs
TREATMENT: Antibiotics are generally effective, but should be taken for at least 6 months. Without treatment, tuberculosis can be a lethal infection. Therefore, early diagnosis is important. Those individuals who have been exposed to a person with TB, or suspect that they have been, should be examined by a doctor for signs of TB and screened with a TB skin test.
PREVALENCE: In the United States, it is estimated that 10-15 million people are infected with the TB bacteria and 22,000 new cases of TB occur each year.
1. LU Yin deficiency: Dry cough, scanty sputum, hemoptysis, blood-streaked sputum, tidal fever, fatigue, red tongue especially anterior third, no tongue coating, thready and rapid pulse 9.0g Shu Di 9.0g Sheng Di 9.0g Dang Gui 3.0g Bai Shao 3.0g Gan Cao 2.4g Jie Geng 2.4g Xuan Shen 4.5g Chuan Bei Mu 4.5g Mai Men Dong 4.5g Bai He 4.5g Bai Ji 4.5g Ce Bai Ye 4.5g Xian He Cao
2. Yin deficient Fire: Steaming bone fever, afternoon fever, night sweating, cough, scanty sputum, possibly greenish sputum, hemoptysis, emaciation, irritability, thin white and dry tongue coating, thready and rapid pulse 9.0g Chai Hu 9.0g Bie Jia 9.0g Di Gu Pi 4.5g Qin Jiao 4.5g Dang Gui 4.5g Zhi Mu 4.5g Bai Bu 4.5g Bai Ji
3. Qi and Yin deficiency: steaming bone fever, afternoon fever, night sweating, cough, shortness of breath, dull chest pain, heat sensation in the palms and soles, insomnia, dreaming, irritability, easily angered, emaciation, spermatorrhea or irregular menstruation, dark red tongue, thready and rapid pulse 9.0g Tian Men Dong 9.0g Sheng Di 9.0g Mai Men Dong 9.0g Shu Di 9.0g Shan Yao 9.0g Bai Bu 9.0g Sha Shen 9.0g Chuan Bei Mu 9.0g E Jiao 9.0g Fu Ling 9.0g San Qi
4. SP and KD Yang deficiency: Cough and asthma, shortness of breath, spontaneous sweating, pallor, cold hands, feet, and body, aversion to cold food, reduced appetite, indigestion, emaciation, pale tongue with white coating, thready and rapid pulse 9.0g Dang Gui 9.0g Ren Shen 9.0g Sheng Di 9.0g Shu Di 9.0g Bai Zhu 9.0g Huang Qi 4.5g Chi Fu Ling 4.5g Bai Fu Ling 6.0g Tian Men Dong 6.0g Mai Men Dong 6.0g Chi Shao 6.0g Bai Shao 6.0g Zhi Mu 6.0g Huang Bai 6.0g Wu Wei Zi 6.0g Chai Hu 6.0g Di Gu Pi 4.5g Gan Cao 4.5g Chen Pi 4.5g Hou Po
Formula 1: Tonify deficiency and expel germs Bai Ji 18g Bai Gu 18g Mu Li 15g Zhen Zhu Mu 15g Chuen Bei Mu 12g E Jiao 6g Hu Huang Lian 3g
Formula 2: Open LU, expel pathogens, nourish dryness and dissolve phlegm Ma Huang (honey fried) 5g Ma Huang Gen 5g Ku Xing Ren 9g Bai Zi Ren 9g Tao Ren 9g Yu Li Ren 9g
ACUPUNCTURE Right side: LU7, KD6 Left side: Tonify SP3 & LU9; Sedate HT8 & LU10
WESTERN REVIEW Definition: Spinal stenosis is narrowing of the vertebral openings which can cause pressure on the spinal cord or spinal nerves. Signs and symptoms: Symptoms include pain in the neck or back, and numbness, weakness, or pain in the arms, legs, or feet. Symptoms often occur gradually. Some people may not experience any symptoms. Causes: Diseases such as arthritis or scoliosis can cause spinal stenosis; it occurs more often in people over 50 years old. Traumatic injury is another cause of spinal stenosis. Western treatment: Medications, physical therapy, braces, surgery
TCM PATTERNS Spinal stenosis belongs to "Muscle-Bone Bi syndrome" or "Back/Leg Pain" according to TCM disease differentiation.
1. Wind-Cold-Damp: Spinal stenosis with symptoms worsened by windy and damp weather, pain alleviated by warmth, difficult to turn body, pain does not subside even when lying down, thin and white tongue coating, deep pulse
Treatment principle: Expel pathogen, open collaterals, tonify Kidney, nourish Blood 9g Du Huo 6g Sang Ji Sheng 6g Du Zhong 6g Huai Niu Xi 6g Xi Xin 6g Qin Jiao 6g Fu Ling 6g Rou Gui 6g Fang Feng 6g Chuan Xiong 6g Ren Shen 6g Gan Cao 6g Dang Gui 6g Bai Shao 6g Shu Di Huang
2. Blood Stasis: Spinal stenosis caused by trauma, severe low back pain, aversion to touch, inability to turn body, difficulty walking or moving, purple tongue, hesitant and wiry pulse
Treatment principle: Move qi and blood, remove blood stasis, stop pain 3.0g Tu Bie Chong 6.0g Dang Gui 1.2g Ru Xiang 1.8g Zi Ran Dong (duan) 1.2g San Qi
3. KD Yang deficiency: Spinal stenosis, dull lower back pain, prefers massage or touch, low back and knee weakness, cold body and limbs, pale and abundant urination, thin and white tongue coat, deep and weak pulse
Treatment principle: Tonify and warm Kidney Yang 13g Shu Di Huang 6.0g Shan Yao (fried) 4.5g Shan Zhu Yu 6.0g Gou Qi Zi 6.0g Lu Jiao Jiao (fried) 6.0g Tu Si Zi 6.0g Du Zhong (fried with ginger juice) 4.5g Dang Gui 3.0g Rou Gui 3.0g Fu Zi
4. KD Yin deficiency: Spinal stenosis with dull lower back pain, irritability, insomnia, dry mouth and throat, heat sensation in 'five palms,' red tongue, scanty or no coating, thready and rapid pulse
Treatment principle: Tonify Kidney Yin 13g Shu Di Huang 6.0g Shan Yao (fried) 6.0g Gou Qi Zi 6.0g Shan Zhu Yu 4.5g Chuan Niu Xi 6.0g Tu Si Zi 6.0g Lu Jiao Jiao 6.0g Gui Ban Jiao
5. Under-nourished Bones and Sinews: Spinal stenosis with Cauda Equina Syndrome, difficulty controlling bowel and bladder, frequent urination, incontinence, constipation, numbness around the genitals, impotence, progressive numbness or weakness of the legs
Treatment principle: Tonify Liver and Kidney, nourish muscle and bones 30g Shu Di Huang 1.5g Ma Huang 9.0g Lu Jiao Jiao 6.0g Bai Jie Zi (fried) 3.0g Rou Gui 3.0g Gan Cao 1.5g Pao Jiang
LONG YAN ROU (Arillus Longan) If a patient comes in and you notice that they look anxious or restless, or if they have neurosis due to chronic stress, then Long Yan Rou is definitely a good herb to incorporate into their formula. Long Yan Rou is good for the chronic stress of modern life. Chronic stress is taxing on the Heart blood. Long Yan Rou both tonifies the Heart blood and calms the Shen. The fruit itself is soft and sweet, and it can be compared to chocolate because eating just makes people feel better. HT7 is the acupuncture point that has the same actions as Long Yan Rou, to tonify Heart blood and calm the Shen. This is an essential herb for psychological disorders including symptoms of neurosis and palpitations.
1. PALPITATION If a patient body condition is such that just a little tension causes palpitation, increased breathing rate, or panic, Long Yan Rou has to be given in a dose of 12-20 grams. Below is an example formula for this type of case: Long Yan Rou 12-16g Suan Zao Ren 6-8g Fu Shen 6-8g Zhu Ru 4-6g Zhi Shi 3-4g
CASE. A high-school senior has a lot of anxiety and tension, is not sleeping well, and has a foggy feeling in her head. She studies a lot; her family is very strict and has expectations for her to enter an ivy-league university. Dang Gui 8g Long Yan Rou 8g Suan Zao Ren 6g Fu Shen 6g Shan Zhu Yu 6g Yuan Zhi 4g Shi Chang Pu 3g
2. INSOMNIA If insomnia is a result of over thinking, with thoughts running through the mind unstoppably, the pattern is Heart blood deficiency. Insomnia can occur in many patterns, but there are two basic types: excess and deficiency. Excess fire can blaze up to cause insomnia, or deficiency fire can result from Heart blood deficiency. The most important aspect of the differential diagnosis is to determine whether the case is excess or deficient. For Heart blood deficiency pattern insomnia, use this combination: Suan Zao Ren (fried) 16-20g Long Yan Rou 8-12g Ye Jiao Teng 4-6g Yuan Zhi 3-4g
CASE. A 36 year old teacher has the main complaint of insomnia. About five months ago she experienced a lot of stress at work with a particular student and with issues among the faculty. The work issues have resolved since then, but she still has very disturbed sleep with thoughts just running through her head all night. She wakes easily, and even though she is very tired she can't sleep. Now her body is starting to feel very heavy all the time and she is becoming very sensitive emotionally. Last month her MD prescribed some insomnia medication for her. It works when she takes it, but now she can't sleep at all if she doesn't take it. She doesn't want to be addicted to sleeping pills so she didn't take the medication for the last couple of nights. Her head feels so heavy and she just wants to lie down even though she can't sleep. Suan Zao Ren (fried) 20g Long Yan Rou 12g Ye Jiao Teng 6g Yuan Zhi 4g Ling Zhi 3g (Reishi mushroom) Da Zao 5pcs
3. ANXIETY/NEUROSIS/PHOBIA/Side effect of Xanax Long Yan Rou can be used for anxiety, which in severe cases may result is shaking tremors of the hands or body. The Heart is the king organ. If the king has anxiety, then all his citizens will also lose their confidence. In the case of the body, the limbs are the citizens and the trembling reflects the imbalanced energy of the Heart.
Xanax is a benzodiapene frequently prescribed for anxiety and panic disorder. If taken for an extended period of time, side effects manifest as Heart blood deficiency, or in a more progressed case as Heart and Gall Bladder deficiency. The symptoms escalate from the realm of anxiety into the realm of phobia, as the patient's tolerance for the drug increases and higher dosages are required. Of course these symptoms also occur when the patient tries to reduce the dosage or quit the drug. The concurrent use of an herbal formula which includes Long Yan Rou can greatly help to reduce the symptoms of panic and anxiety associated with decreased dosage or cessation of Xanax. First try Wen Dan Tang or a modified version of Wen Dan Tang. If that doesn't work well, then the Heart blood deficiency must be targeted first. Wood is the mother of fire, so if the Heart blood is deficient then the Liver blood will be strained too. Shu Di Huang and Dang Gui can help to rectify the Heart and Liver blood deficiency. This is an example formula: Shu Di 12g Dang Gui 8g Long Yan Rou 8g Suan Zao Ren 8g Fu Shen 6g Bai Zi Ren 6g Da Zao 6pcs
CASE. A 39 year old woman of thin body type has the chief complaint of insomnia and phobia. She has lived alone since she got divorced five years ago. Her MD diagnosed anxiety and neurosis and prescribed Xanax. She took the medication for some time, but then decided that she didn't want to be dependent on a drug so she just quit the medication by herself without any supervision from her MD. She is now also experiencing tinnitus and aural hallucinations. Shu Di 12g Dang Gui 8g Long Yan Rou 8g Suan Zao Ren 8g Gou Qi Zi 6g Shan Zhu Yu 6g Fu Shen 6g Ling Zhi 3g (Reishi mushroom) Sheng Jiang 3pcs Da Zao 5pcs
TIP: GUI PI TANG vs. WEN DAN TANG vs. GUI PI WEN DAN TANG (1) Gui Pi Tang: A patient presents with a thin body constitution, a thin tongue body or with the normal thin white coating, pale skin, palpitations, other blood deficiency symptoms, and sweaty hands and feet. Choose herbs in the Gui Pi Tang family (Long Yan Rou, Suan Zao Ren, Dang Gui, Yuan Zhi). (2) Wen Dan Tang: A patient presents with a thick tongue coating, phlegm symptoms or is overweight, and there is evidence of weak Stomach function, also nausea and a stifling sensation in the chest, and the face is dark or there is darkness below the eyes. Choose herbs in the Wen Dang Tang family (Ban Xia, Fu Shen, Zhu Ru, Zhi Shi, Shi Chang Pu). (3) Gui Pi Wen Dan Tang: Occasionally in a complicated case, a patient may have both phlegm and blood deficiency symptoms concurrently. Then combine both formulas together to make Gui Pi Wen Dan Tang.
TCM PATTERNS It's hard to find Sleep Apnea topics in the Chinese Medicine textbooks. However, since the 1990s, there have been many articles published in various Chinese medical journals on this condition. Let me introduce some TCM patterns according to the articles:
1. External Wind-Heat: Wind-Heat pathogen may congest and obstruct the Qi mechanism and the orifices. Therefore, there is a failure in the transportation of Yin fluid which collects and inhibits the free flow of the throat.
2. Internal LV & LU Heat + External Wind Cold: LV/LU Fire is blocked by Wind-Cold, then internal and external pathogens may join together to block the throat and nose.
3. Yang deficiency: Internal damage due to medication, diet, or overwork may lead to Yang deficiency which may also lead to failure to move and transform Yin fluids. These fluids can be transformed into Phlegm, and lodged in the throat and block its free flow.
4.Deficiency (SP Qi) + Excess (Phlegm, Stasis): SP Qi deficiency leads to lack of transformation and transportation. This leads to phlegm, stasis, and inhibition of the Qi mechanism. So the root is deficiency and the branch is excess. In its early stage, there is a SP/LU Qi deficiency or LU/KD Qi deficiency, while in the later stage, LU, SP, KD are all deficient.
5.Dampness: Being overweight, smoking, and drinking as a lifestyle can cause Phlegm Dampness, Qi stagnation, and Blood stasis.
6.Phlegm and Heat: These two pathogens mutually binding and causing depression and obstruction of the Qi passageways.
HERBAL FORMULA Basically, you can choose formulas according to the patterns of TCM. I want to introduce one of my favorite formulas from the articles. 8g Ma Huang 9g Yi Mu Cao 6g Jie Geng 6g Gan Cao
1.Ma Huang (Hb. Ephedra) TCM: Disperses the LU Qi, like its shape of a tube, it opens the airway BIO: Soothes and opens the bronchi, relaxes the smooth muscles, and harmonizes the respiratory center
2.Yi Mu Cao (Hb. Leonuri Hterophylli) TCM: Activates the blood and transforms stasis BIO: Excites the respiratory center and improves microcirculation
3.Jie Geng (Rx. Platycodi Grandiflori) TCM: Diffuses the LU and disinhibits the throat, dissolves phlegm BIO: Mucolytic effects, anti-inflammatory, antitussive
4.Gan Cao (Rx. Glycyrrhizae) TCM: With Jie Geng, disinhibits the throat, resolves toxins BIO: Mucolytic, anti-inflammatory, antitussive
In Oriental Medicine, no matter what is the cause, Sleep Apnea is due to inhibition of the Qi mechanism of the throat and non-diffusion of the Lung Qi. This formula focuses on the symptoms (Qi, Blood, Phlegm accumulation in the airway). If you know the root problem, modify this formula accordingly.
ACUPUNCTURE I would personally use Korean Yin-Yang Balancing and Five Element Haromnizing treatments for this case. Most Sleep Apnea is the obstructive type, not central type, and the problem is in the Lung channel. You can press both LU1 points (front-mu of Lung) and find the more painful side.
1.Yin-Yang balancing: Tonify LU10(fire) and LU5(water) on the more painful side, and sedate LU10(fire) and tonify LU5(water) on the opposite side. This is Korean Yin-Yang balancing theory.
2.Five-element harmonizing: For Five Element treatment, there is a very special and intricate pulse reading technique so I can't explain it here, but you can use the Four Needle Technique of Tonification of LU (tonify SP3, LU9, sedate HT8, LU10) by using the five-element points. When you do this treatment, apply it on opposite side from the more painful LU1.
WESTERN MEDICINE REVIEW DEFINITION: Repeated temporary interruption of breathing during sleep, which occurs 10 seconds at least 5 times/hour. This condition may be life-threatening if low oxygen level reaches a critical point. ● Age: 30-50 years; also in children ● Gender: More common in males ● Lifestyle: Being overweight, drinking, alcohol, and smoking are risk factors ● Genetics: Not a significant factor
TWO TYPES: OSA & CSA (1) OSA (Obstructive Sleep Apnea) ● OSA occurs when the air passages in the upper respiratory tract become obstructed during sleep; the most common culprit is the soft tissue of the pharynx. ● Obstructed breathing leads to low levels of oxygen in the blood, causing a person to respond by waking up and taking a deep, snorting breath. ● Being overweight (particularly around the neck area) or having a large tongue or a small mouth can also cause or contribute to the obstruction. ● In children, enlarged tonsils or enlarged adenoids are the most common causes leading to OSA. (2) CSA (Central Sleep Apnea) ● If the region of the brain and the nerves that regulate breathing do not function normally this causes breathing to be impaired. ● Causes of central sleep apnea include brain damage as in head injury or a stroke.
SYMPTOMS: The symptoms of OSA develop gradually. CSA may develop suddenly, depending on the cause. Often another family members notices the problem before the patient does. ● Symptoms of both types can include: restless, unrefreshing sleep, daytime sleepiness, poor memory and concentration, headache in the morning, loud snoring, change in personality, impotence , frequent night time urination ● Severe cases, can cause daytime sleepiness enough to cause accidents when driving. Taking sleeping drugs or drinking alcohol may aggravate the symptoms. ● Left untreated, complications such as an irregular heartbeat, high blood pressure, and pulmonary hypertension can occur.
DIAGNOSIS: Endoscopy of the nose and throat, X-ray or CT scanning of the head and neck, Sleep studies, Oxygen levels in the blood, Heart rate
TREATMENT ● Mild OSA: avoid sleeping drugs and alcohol ● Overweight: losing weight may help, try to sleep on the side, which may relive the symptoms ● Caused by high altitude: SA should disappear when you acclimatize or return to lower altitudes ● Caused by enlarged tonsils or adenoids: surgery may be necessary to remove them. In some cases, OSA is treated by surgically reconstructing the soft palate. ● If the cause is not treatable, or if you do not wish to have surgery: CPAP (Postive Airway Pressure Device = Positive Pressure Ventilation) may help and is often the first treatment offered. Dental appliances are another option. ● CSA: drugs that stimulate breathing may help ● TCM: CSA is difficult to treat with western medicine, but is a better candidate for treatment by TCM than OSA. For Central Sleep Apnea, studies have shown that sleeping in the lateral position can be helpful. More research must be done.
CLINICAL INDICATION OF HUANG LIAN (Coptidis Rhizoma)
These days, our modern lifestyle tends to create a lot of stress and psychological disorders; in other words a lot of fire. Many patients turn to acupuncture for help with disorders that have been caused by the seven emotions, the internal cause of disease. In order to achieve internal harmony, water must rise and fire must descend. If the fire is not descending, use Huang Lian. Huang Lian is well known for clearing heat; it actually draws down stagnated heat in the upper jiao through the lower jiao.
1. Stress Symptoms including pain in the area of RN17, chest oppression, irritation, red eyes, indigestion, and sensations of heat in the head but cold hands and feet indicate imbalance of the Autonomic Nervous System. For acute stress Xiang Fu, Chai Hu, Chen Pi, and Qing Pi are important herbs.
Substantial stress lasting for five to ten years can be classified as chronic stress. This often occurs in people in their 40's and 50's experiencing more responsibilities at work and in the family. For stress which stagnates qi causing heat in the chest, 4.5-6g of Huang Lian can open the chest.
Case: A 40 year old woman has been having marriage difficulties and financial stress for seven years. She began to experience stifling sensations in the chest and chest pain. Her cardiologist could find no evidence of any heart problem. She complains of a stuffy feeling in the center of her chest (RN17 area), and says that when this sensation is severe even breathing is difficult. Sometimes when she lies down she feels like there is something on her chest, so she doesn't sleep well. She has a bitter taste in the mouth and cold hands and feet. A good formula for her is: Long Yan Rou 12g Suan Zao Ren 8g Huang Lian 4g Zhi Zi 3g Zhu Ru 3g
2. Gastritis Some people are sensitive and get stressed easily, and tend to over think things and worry too much. As a result they have indigestion, nausea, and pain or discomfort in the epigastric area, especially around RN14 and RN15. Even though this is a middle jiao problem, the treatment principle must focus more on clearing heat from the Heart than on strengthening the Spleen.
3. Cold Hands and Feet This is not the case of true cold. In this case, there is heat in the chest but the abdomen, hands and feet feel cold. Other symptoms probably include chest discomfort, bitter taste in the mouth, or dry mouth. In this situation, the heat is stuck in the chest instead of being distributed evenly throughout the body. Even though Huang Lian is a cold herb, using it in this case will warm up the abdomen, hands and feet. Huang Lian (wine-fried) 8g Chi Shao 6g Dang Gui 6g Mu Dan Pi 4g Chai Hu 4g Chen Pi 4g Gui Zhi 2g
4. Thyroid People with hyperactive thyroid glands can suffer tachycardia, palpitations, diarrhea, frequent urination, fatigue of the whole body and irregular menstruation. An unstable emotional state often accompanies this condition, causing the patient to be easily angered, irritable, and full of anxiety and worry. In addition they often are very sensitive to hot weather and constantly have hot and sweaty palms. The right combination of herbs including Huang Lian can help to reduce the symptoms. Long Yan Rou 12g Huang Lian (fried) 6g Mai Men Dong 4g Wu Wei Zi 4g Sha Shen 4g Xia Ku Cao 3g Zhi Zi (fried) 3g
5. Hair Loss Modern life is a stressful paradigm. It's easy to picture a business man with a red face and hair that's thin and brittle with hair loss occurring in a circular pattern at the top of the head. This condition is based on Kidney yin deficiency; the Kidney yin cannot grasp the Heart fire. In a state of harmony, the Kidney water rises up and the Heart fire descends. But when Kidney yin is deficient, the Heart fire may flare up and dry the blood in the head, preventing the hair from receiving nourishment. Someone in this condition may also suffer from insomnia, or heat in the upper body and cold in the lower body. The treatment principle is to bring the fire down from the head, and also to tonify blood since hair is the surplus of blood. Bai He Shou Wu 12g Shu Di Huang 12g Dang Gui Body 4g Dang Gui Tail 4g Huang Lian 4g Chuan Xiong 3g Wu Yao 3g Hong Hua 2g
CLINICAL INDICATIONS OF HUANG QI (Astragali Radix) The most common Huang Qi cases you will see in the clinic include skin and membrane disorders, spontaneous sweating, edema, and somnolence.
1. SKIN DISORDERS
a. Chronic Ulcers, Behcet's syndrome: The Lung governs the qi and the skin, and Huang Qi tonifies the Lung very well. Huang Qi is effective in treating continuous, chronic, inflammatory ulcers, including mouth ulcers which occur with fatigue as in Behcet's syndrome. Huang Qi's ability to treat mouth ulcers is limited to the etiology of qi deficiency, and does not include mouth ulcers caused by excess heat. Huang Qi has the action of generating flesh and discharging pus. So Huang Qi + Ren Shen can tonify the qi, while Huang Qi + Gan Cao can expel the pus. The result is healing chronic ulcers resulting from fatigue. The following formula may be used for Behchet's syndrome:
Huang Qi, 20-30g Ren Shen, 8-10g Gan Cao, 4g Jin Yin Hua, 8g Lian Qiao, 6g
b. Post-surgical tonic: For surgical wounds that aren't healing fast enough, use Huang Qi. Again, Huang Qi has the action of generating flesh and discharging pus. Huang Qi + Dang Gui can tonify the qi and blood to generate flesh and promote the healing process. This is the perfect tonic to aid in recovery after surgery:
2. SWEATING Huang Qi tonifies the Lung. The Lung governs Wei qi, which controls the pores, so Huang Qi can treat Spontaneous sweating disorders. Huang Qi sweating will occur all over the whole body, often excessively, and worse after activity. A thin, emaciated person with pale and thin skin is a good candidate for a Huang Qi patient.
CASE: A patient comes to the clinic complaining of severe fatigue and excessive sweating. Even very simple activities like hammering a single nail cause fatigue and sweating.
3. EDEMA According to TCM, there are three organs involved with edema: Lung, Spleen, and Kidney. Huang Qi edema is related to the Lung, and will occur with fatigue or be exasperated by fatigue. This edema may manifest upon waking as swollen tongue with teeth marks and edema of the eyes or anywhere. It also may occur after work or tiring activities as the shoes don't fit on the feet or the rings don't fit on the swollen fingers. We call this Pi Shui ("skin water"), and in this situation Huang Qi may be selected as the king herb.
Huang Qi is effective especially when the patient's MD has ruled out kidney problems, and the use of diuretics didn't help or maybe even caused greater fatigue. We can refer to this condition as “Functional Edema" since there are no detectible physical problems. The condition of qi deficiency, especially when the patient is tired also, diminishes the body's ability to regulate water metabolism. This can also occur as a result of indigestion.
CASE: A patient complains of edema around the eyes and on arms upon waking every morning. After the day's activities, the edema in her upper body disappears, but her legs are swollen every night. This has been going on for quite some time. The patient's MD could not find any kidney disorders upon testing. She has already been to an acupuncturist for this problem, and was prescribed an herbal formula which only made her more tired. You identify her pattern as qi deficiency and assume the previous acupuncturist gave her diuretics. The best formula for this patient will be:
Huang Qi, 12-20g Ren Shen, 4g Gui Zhi, 3g Chen Pi, 3g With Stomach disorder: + Bai Zhu 6g, Fu Ling 6g
4. SOMNOLENCE Constant sleepiness or drowsiness can be caused by qi deficiency, or chronic qi stagnation as a result of chronic qi deficiency. This patient always wants to lie down to rest.
CASE: A patient complains of fatigue. He sleeps regularly at night, but he is sleepy all day long, and he even stays in bed all day every Sunday. He never feels rested and refreshed, and mentions a heavy feeling in his head.
Huang Qi, 12-20g Sheng Ma, 4g Shi Chang Pu, 3-4g Bo He, 3-4g
5. TONGUE, PULSE, AND DOSAGE
TONGUE: The Huang Qi tongue will have teeth marks and a thin, white coating. Qi deficiency alone will create a pale or slightly pale tongue with teeth marks, but qi deficiency with damp-phlegm can cause a white coating. So the signs of teeth marks plus white coating signify qi deficiency with damp-phlegm, which Huang Qi + Bai Zhu + Fu Ling can treat.
PULSE: The Huang Qi pulse is weak, of course, because of qi deficiency. It may be forceless, thready, deep, or even scarcely perceptible.
DOSAGE: When used as the king herb, the dosage of Huang Qi is 12-20 grams. The dosage should be adjusted to reflect the degree of qi deficiency. For Behchet's syndrome, up to 30 grams may be used.
1. Melasma is also known as chloasma or the mask of pregnancy when present in pregnant women. 2. Melasma is yellow or brown pigmentary discoloration of the skin, manifesting as macules on the face. The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, upper lip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration. 3. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or hormone replacement therapy (HRT) medications. 4. It is also prevalent in men and women of Native American descent (on the forearms) and in men and women of German/Russian Jewish descent (on the face). 5. In TCM, Melasma is known as mian chen (dusty complexion).
DIFFERENTIATION AND FORMULAS
1. LV Qi stagnation Chai Hu 10g Qing Pi 10g Chen Pi 10g Chuan Lian Zi 10g Dang Gui 10g Fu Ling 12g Bai Shao (fried) 12g Bai Zhu 12g Hong Hua 6g Ling Xiao Hua (Flos Campsitis) 6g Sheng Di Huang 15g
2. LV Fire Qing Pi 10g Chen Pi 10g Mu Dan Pi (fried) 10g Zhi Zi (charred) 10g Ze Xie 15g Bai Shao 10g Tu Bei Mu (Tuber Bolbostemmatis) 15g Ling Xiao Hua (Flos Campsistis) 10g Ji Guan Hua (Flos Celosiae Cristatae) 10g Mei Gui Hua (Flos Rosae Regosae) 10g
3. SP Damp Huang Qi (fried with honey) 12g Dang Shen 12g Bai Zhu 12g Fu Ling 12g Dang Gui 12g Hong Hua 6g Ling Xiao Hua (Flos Campsitis) 6g Sha Ren 6g Bai Fu Zi 6g Sheng Ma 6g Shan Yao 30g Dong Gua Pi 30g Zhi Gan Cao 10g
4. SP Damp-Heat Lian Zi 6g Yi Yi Ren 6g Sha Ren 6g Jie Geng 6g Bai Bian Dou 6g Fu Ling 6g Ren Shen 12g Gan Cao 3g Bai Zhu 12g Shan Yao 12g Hua Shi 18g Huang Bai 6g Huanb Qin 6g Ze Xie 6g
5. KD Yin Deficiency Zhi Mu 10g Huang Bai 10g Sheng Di Huang 15g Shan Yao 15g Shan Zhu Yu 10g Fu Ling 10g Mu Dan Pi 10g Ling Xiao Hua (Flos Campsitis) 10g Ji Guan Hua (Flos Celosiae Cristatae) 10g Chai Hu 6g
6. HT Yin Deficiency Huang Lian 10g Huang Qin 10g E Jiao 10g Sheng Di Huang 15g Tong Cao 6g Mai Men Dong 15g Ji Guan Hua (Flos Celosiae Cristatae) 10g Ling Xiao Hua 10g
Formula 1: Activate Blood, Cool Blood Dang Gui 10g Chuan Xiong 10g Chi Shao 10g Shu Di Huang 15g Sheng Di Huang 15g Bai Zhi 10g Nu Zhen Zi 15g Zi Cao 10g
Formula 2: Move Qi, Activate Blood Zi Cao 15g Qian Cao Gen 7.5g Bai Zhi 7.5g Chi Shao 7.5g Su Mu 7.5g Hong Hua 7.5g Hou Po 7.5g Si Gua Luo 7.5g Mu Tong 7.5g
Formula 3: Regulate Qi and Blood Chai Hu 6g Dang Gui 9g Chi Shao 9g Bai Shao 9g Sheng Di Huang 15g Mu Xiang 6g Zhi Ke 9g Dan Shen 9g Chuan Xiong 6g Yi Mu Cao 15g Ze Lan 9g Niu Xi 15g Zhi Gan Cao 6g
EXTERNAL USE:Grind into fine powder and mix with water to form a thin paste. Use instead of soap; massage into face for 10 minutes 2 times per day. Mung Bean powder 90g Bai Ju Hua 30g Bai Fu Zi 30g Bai Zhi 30g Salt 15g Bing Pian 1.5g
There are various methods for stroke prevention. Of course, lifestyle factors such as diet, exercise, and stress reduction can not be emphasized enough. As an acupuncturist, you can offer important acupuncture and moxa treatments.
OVERVIEW OF MOXA & ACUPUNCTURE FOR STROKE PREVENTION
Moxa can be used to prevent stroke by applying moxa to ST36 + GB39 and ST36 + LI11 alternatively. When you apply moxa to ST36, apply a little more moxa to one side for each treatment, and alternate between the left side and right side receiving more. The rhythm and movement of life is balanced overall, but the balance is dynamic. When we dance or walk, we shift from left leg to right leg, back and forth. To direct the same amount of energy into both sides at the same time wouldn't be natural.
Acupuncture can be used to prevent stroke by needling DU9, SI12, UB12, GB20, and DU16. Note that most of these points have the word "wind" in the name. If atrophy has occurred in the trapezius muscle on one side, then also needle UB10 on the “sunken" side.
DISCUSSION OF SPECIFIC POINTS
1. ST36 (Leg Three Mile) In modern acupuncture, ST36 may be broadly applied to treat almost any condition, including the prevention of disease. ST36 in combination with GB39 or LI11 can prevent stroke. For stroke prevention, I recommend alternating treatments of ST36 + GB39 and ST36 + LI11.
2. GB39 (Suspended Bell) GB39 is the “boss point" of its area. It is the Influential Point of Marrow, and as such can benefit the brain and head. It can be used for headache, especially headache related to hunger or food retention. Moxa at GB39 can help to prevent stroke, and additionally has the effect of boosting T-cell counts and strengthening the immune system. It is a good point to help people cope with the side effects of chemotherapy.
The location of GB39 is different according to the text; it is 3 cun above the external malleolus, but some say posterior to the fibula while others say anterior to the fibula. Actually, they are both correct. The posterior location should be used for needles, while the anterior location should be used with moxa.
3. LI11 (Crooked Pond) Academically, LI11 is indicated for clearing heat. Clinically, LI11 is one of the 8 best points for stroke, and one of the 10 best points for hemiplegia. Moxa can be used to prevent stroke by applying moxa to ST36 + GB39 and ST36 + LI11 alternatively.
4. DU9 (Reaching Yang) DU9 is used to help prevent stroke. Heat which rises up becomes wind. DU9 is the so-called "first gate" or "windscreen" for blocking the Lower Dantian from rising up. To prevent stroke, one method is to reinforce the "windscreen gates." Needle these points from lowest to highest: DU9, SI11, GB20, DU16, and DU17.
5. SI12 (Grasping Wind) SI12 is called "Prevent Wind," and it is indeed used for stroke prevention. As with all points with "wind" in the name, it is located in the upper back/neck region (except GB31). Heat is the pathological derivative of qi, and when heat intensifies enough to rise to the head, it is called wind. We can consider the imaginary line created by the scapular spines across the upper back as the borderline between heat and wind. SI12, then, stands at a critical point in the body's defense against wind, and can be thought of as "border patrol." Since SI12 is the crossing point of four channels (LI, SI, SJ, GB), this reinforces its ability to relax the upper back and neck area. People who hold a lot of tension in that area are at a higher risk for stroke. SI12 is also effective in treating "stomach wind," the occurrence of heat and fever after eating.
6. UB12 (Wind Gate) UB12, "Wind Gate," is where exterior wind enters the body. It is better for exterior wind than GB20 "Wind Pool" or DU16 "Wind Mansion." They all can treat interior or exterior wind, but UB12 is mainly for exterior wind, as the name tells us.
7. GB20 (Wind Pool) GB20, "Wind Pool," is the most significant point in the back of the head and neck area. We can call this point the "boss point" or "king point" of that area. Whenever there is a king, there are always some supporting ministers. If GB20 is the king, then UB10 is the minister; if DU20 is the king, UB7 is the minister. Because of its ability to treat wind, GB20 is a great point for Bell's palsy, stroke, hemiplegia, chronic headache, stiff neck, cervical disc problems, and even high blood pressure.
8. DU16 (Wind Mansion) Named "Wind Mansion," DU16 can treat either exterior or interior wind. Actually, DU16, GB20, and LI4 can all treat either internal or external wind. There are four points in the head and neck area with "wind" in the name: DU16, GB20, SI12, and UB12. UB12, "Wind Gate," is geared more to treating exterior wind.
9. UB10 (Celestial Pillar) In cases of stroke, innervation to the left and right sides may become unbalanced. If the trapezius muscle appears atrophic on only one side, needle UB10 on the sunken side, plus DU14 to balance both sides of the trapezius.