Osteoporosis: A TCM Perspective

This presentation was given by Jessica Robbins Winter quarter 2011. 

Osteoporosis is termed in Western language as "The thinning of bone tissue and loss of bone density over time." Osteoporosis literally means "porous bones". The bones become fragile due to the deterioration of the microarchitecture of bone tissue and the impairment of the structure of trabecular bone, which is the inner part of bone containing marrow. The subsequent fragility leads to an increased risk of fracture.

TCM holds that the kidneys govern bone growth and marrow is manufactured by the kidney's essence called "jing", also known as essential Qi. Therefore, a weakening of the bones (dubbed in western terms: "osteoporosis") is reflective of a functional impairment of the body's essentail Qi. Essential Qi is made of congenital jing (post-natal jing), which exists from conception acting as a "Blue Print" for development, carrying on from the jing of the parents and is then later supplemented by acquired jing (post-natal jing) from food and fluids transformed by the stomach and spleen. Therefore, adequate post-natal jing is imperative for the maintenance of the body's limited supply of pre-natal jing.

• "Essential Qi, which comes from the parents provides the body's basic matter and is the basis for all growth and development of the body. During childhood, essential qi is in development, as is in the child., and henceforth Qi mirrors the development and decline for the entire human life cycle. For all these reasons, Chinese Medicine considers the Kidney to be the root of all QI. TCM, the Kidney is the key to human growth and development because it is the root of all Qi and jing and is, therefore, the imetus for all the  body's ability to grow and develop. As Qi and jing develop and decline, so does the human body's development and abilities, for qi and jing are the essential energies of life. 

      It is interesting to note the similarity between the western ideology that maintains that our maximum bone density is reached in our thirties and after that our density gradually wanes- and that of TCM which holds that "Essential Qi" is something we are born with and build up while we are young. And as we get older, we start to draw on this reserve. As a proper diet, exercise and treatment, we can slow the rate with which we use are Essential Qi or even build it back up. The later idea of preventative measures is also stressed from a western medical perspective as well (i.e. calcium supplements, vitamin D therapy, weight bearing activies).

WHAT CAUSES OSTEOPOROSIS FROM A TCM PERSPECTIVE?
Osteoporosis is largely a result of some form of kidney deficiency caused by various different disharmony patterns which in some ways damage the kidney and its production of jing. As was previously mentioned, the kidneys store essential qi, which gradually decreases with age resulting in inadequate amounts of nutrients for the replenishment of bones since less jing is circulating through the channesl. Thus bone becomes fragile and are more susceptible to fractures and deformations.


Disharmony Patterns:
1. Exhaustion of Kidney essence:

• A congenital deficiency (a deficiency you are born with) and external factors, such as excessive sexual activities and frequent childbirth leading to the depletion of kidney essence and a subsequent loss of bone nutrients.
• The elderly are particularly vulnerable to osteoporosis if they do not take good care of their bodies because depletion of kidney essence increases with age (much in line with western thought). 
• External pathogens easily invade and damage the kidney when Qi is compromised. This can cause the development of osteoporosis as well.

2. Retention of dampnesss and kidney deficiency

• The kidneys govern water, produce marrow, dominate the bones and manufacture blood. The kidney yang energy is the source of all heat in the body. Kidney deficiency occurs when cold and dampness evils damage the kidneys. This results in inadequate kidney essence (jing) to supply the bone marrow and causes deterioration of the bones. Symptoms can manifest as back pain and hump back. 
• Tongue is pale and covered with white greasy fur.
• Pulse feels deep, thready and stringy.

3. Acquired Deficiency

• Normally the spleen and stomach are responsible for transforming digested food into qi, blood and acquired (post-natal) jing. Yet, over-consumption of alcohol and food (stagnation) can damage the spleen and stomach and reduces the amount of jing available to nourish the bone, bone marrow and muscle.
• This acquired cause is a combination of blood deficiency and excessive dampness in TCM terms. Improper functions of the spleen and stomach lead to a decline in the production of blood and bone marrow, plus an accumulation of dampness. It gives rise to a non-smooth flow of blood and qi, which in turn supply inadequate nutrients to the bones. People may feel weakness, back pain or joint pain. 
• Tongue is pale and covered with greasy fur.
• Pulse is deep and rolling.
• Herbs for these include: Dang gui- blood tonic, bai shao, fu ling-spleen tonic, drains dampness, gan jiang-spleen qi tonifier

dang gui

4. Invasion of exogenous pathogens

• Osteoporosis can occur when external cold and dampness invade the body and impair the vital qi (energy) and especially kidney qi. This leads to deficiency of kidney essence (jing) and a failure in the bone marrow to replenish the nutrients needed to retain bone strength. Other symptoms such as lumbgabo(back pain) and arthralgia (joint pain) can occur when cold and dampness evils stagnate in the tendons and joints, blocking the circulation of qi and blood in that area.

•  

TCM practitioners believe that external cold and dampness pathogens can invade the body under the following conditions:

1. living in cold and moist areas for a long time
2. exposure in a windy place while drinking alcohol
3. bathing or taking a shower while sweating
4. eating too much cool food
5. lying in a damp and moist open area such as wet grassy fields

As a result someone with such pathogenic invasion, also known as Asthenia-syndrome of superficies and interior dampness retention, will show symptoms of sluggishness, tired and heavy limbs and joint pain.

• Tongue has a white coating
• Pulse is deep and rolling
• Herbs: Sheng huang qi and fang ji, sheng jiang(fresh ginger), da azo (chinese date), gan cao(liquorice root), gu zhi (cassia twig) and bai shao(white peony root)

Gui Zhi

Points for Kidney Yang Deficiency:
UB 23-Kidney Shu
GV 4- tonifies yang
KD 3 and 7- Tonifies Kidney
*UB 52- Tonifies Kidney and strengthens will power
ST 28- moves fluids in the lower warmer
SP 9- Resolves dampness

TCM for Thyroid Disorders

This presentation was given by Genie Ulshoffer Winter 2011 quarter.

Women account for the majority of Thyroid disorder with a ratio of 4 to 1 over men for Hyperthyroid, 8 to 1 for Hypothyroidism and are 2 to 1 more likely to suffer from thyroid tumors.

GENERAL SIGNS AND SYMPTOMS: An overactive (Hyperthyroidism) or underactive (Hypothyroidism) thyroid can result in increased allergies, skin problems, fatigue, nervousness, gastrointestinal problems, sleeping too much or too little, gaining or losing weight, swelling, various types of pain.

There have been some studies done that suggest acupuncture and TCM can be very helpful in the treatment of Hypothyroidism. One study at the Shanghai Medical University in China worked with 32 patients with Hypothyroidism and treated them for a year with Chinese herbs for the kidney meridian as compared to a controlled group of 34 on Western medicine and at the end of the study, the clinical symptoms of hte patients on Chinese herbs were markedly improved. This validates that Hypothyroidism is closely related to deficiency of kidney energy.

WESTERN MEDICINE EXAMINATION:
There are a basic six things doctors look for when trying to diagnosis Hypothyroid which are weight gain, dry skin and hair, hoarse voice, fatigue, cold tolerance and puffy facial feature. Howerver there are many more symptoms that can be present including depression or irritability, aches and pains, constipation, menstrual problems (irregular), recurring infections, high cholesterol, infertility, poor memory and concentration, low libido, headaches, carpal tunnel syndrome, dry eyes or blurred vision, eye brow loss (outer one-third), easy to bruise, tingling in hands and feet.

Although the split between Hypothyroidism (thyroid gland does not make enough thyroid hormone) and Hyperthyroidism seems to be the more common initially. This is because many times in treating the Hypothyroidism with Western medicine it doesn't just balance the thyroid more often than not it changes it to Hyperthyroidism. This is because it is very hard to regulate the levels of hormones through the use of drugs. And sadly can result in the destruction of the thyroid gland itself.

Research shows the main reason behind ithe disease is a problem with the autoimmune process. Additional root causes included but are not limited to inflammatory disorders of the thyroid including Hashimoto's disease, lodine deficiency, stress, poor diet, inactivity, pregnancy, hormone imbalances especially with regards to estrogen, progesterone, cortisol and DHEA, Surgery on or radiation of the thyroid, certain medications like lithium and synthetic estrogen and failure to the pituitary gland.

This would lead us to looking at Alternative course of action and of course Traditional Chinese Medicine.

TRADITIONAL CHINESE MEDICINE EXAMINATION:
There are two patterns of Yang Deficiency that are differentiated for hypothyroidism:
1. Spleen/Kidney Deficiency: In the pattern of Yang Deficiency with Spleen and Kidney deficiency, the key symptoms are: lassitude, sleepiness, poor memory, dizziness, ring in the ears (tinnitus), weakness of the lower back and knees, aversion to cold, dry skin, dry hair, constipation, edema, impotence(men), and irregular periods(women).
Tongue: pale, puffy tongue body with tooth marks along the edge: white sticky tongue coating.
Pulse: Deep and thin or deep and slow

2.Heart/Kidney Deficiency: In the pattern of Yang Deficiency with the Heart and Kidney Deficiency, the characteristics symptoms are heart palpations, chest congestion and pain, sleepiness, feeling cold.
Tongue: Pale, tender tongue body with a white, slippery coating.
Pulse: Deep, slow.

Acupressure points: 
* For a balancing effect on the thyroid: Triple Warmer 17
* For depression: Lung 1
* For fatigue: Bladder 23 and 47
* For constipation: Ren 6
*Additional points: Large Intestine 4, San Jiao 3-6, and Ren 22
* Stomach 36 (Sea of Nourishment Point) for good measure since it benefits stomach and spleen, tonifies Qi   and blood, dispels cold, strengthens body, brightens eyes, regulates nutritive and defensive Qi and the intestines. Raises yang expels wind and damp, resolve edema.

Since the thyroid hormones are mostly converted in the liver and the kidneys it would seem that tonifing these two meridians would have a positive effect.

TCM HERBS:

Rou Gui

Cinnamon (rou gui) and aconite (fu i) are very useful herbs for treating Yang Deficiency. Kidney Yang Tonic (Jin Gui Shen Qi Wan) is the leading herbal formula for treating the symptoms of hypothyroidism. Formulas such as Right Restoration formula (You Gui Wan) are also widely used.

aconite (fu zi)

Eleuthero

Additional herbs shown to help: American Ginseng, Asian Ginseng, Astragalus, Bitter Melon, Bupleurum, Chinese Scullcap, Corydalis, Dong Quai, Eleuthero, Fo-Ti, Garlic, Ginger, Ginkgo biloba, Green Tea, Licorice and Ligustrum.

   A classical recipe for Yang Deficiency is also very appropriate for Hypothyroidism: add pepper, 3g; ginger, 20g; and tangerine peel, 10g to about half a pound of fresh carp. Cook with an appropriate amount of water, and simmer for one hour over a low flame. Eat three servings a week.

DIET: 
Recommended foods: Includes adding Iodine rich foods from the sea if available in your area, such as kelp, nori, kombu and wakame. Fish and seal salt are also good sources. Adding essential fatty acids found in walnuts, flaxseeds and fish are very important to the thyroid function.
Foods to avoid: Raw vegatables known as goitrogens can suppress thyroid function: these include kale, broccoli, cauliflower, cabbage and Brussels sprouts. However, cooking these vegetables inactivates the goitrogens so they are safe. Avoid drinking tap water, because most tap waters are full of fluorine and chlorine, which both inhibit your ability to absorb iodine.

Additional Alternative tools:
Massage: A full body massage will help reduce stress, improve circulation and improve energy levels.
Reflexology: Working in the area corresponding to the thyroid can help to tonify
Aromatherapy: Geranium oil will help regulate the thyroid hormone along with helping to lift fatigue and depression.
Sources:
Student Manual on the Fundamentals of Traditional Chinese Medicine Fourth edition
 http://healingdeva.com/thyroid_acupuncture.htm
 http://www.tcmpage.com/hpthyroid.html

Arthritis with TCM

This case study was presented a few weeks ago by one of my classmates, Ron Tanigushi. This is work and research done all by him. Big kuddos to Ron and thank you for giving me permission to share this on my blog! :)

Arthritis- it is a degenerative inflammatory disease that attacks the joints in the particular, causing symptoms of stiffness, swelling, pain and loss of the normal range of motion. It is especially common in elderly people, although rheumatoid arthritis can occur in young  people as well.

Various types of Arthritis-
Osteoarthritis, rheumatoid arthritis, infectious arthritis, chemically induced arthritis, temporomandibular join t syndrom (TMJ), juvenile rheumatoid arthritis, ankylosing spondylitis and gout are all types of arthritis that are differentiated in conventional Western Medicine. The most commonly seen forms of arthritis are osteoarthritis and rheumatoid arthritis.

Western Treatments for Arthritis
The most common Western Treatments are drugs that reduce inflammation. Drugs known as, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and gold compounds; and steroid-based drugs such as corticosteroids and immunosuppressive drugs are widely used for arthritis and provide short-term relief. Although, these drugs can relieve pain and decrease inflammation they do nothing to cure the disease. In attition, long term use of these medications can produce side effects such as stomach irritation, gastritis and ulcers.

TCM for Arthritis-

In traditional Chinese patterns of disharmony, the various types of arthritis fall typically under the category of "Painful Obstruction Syndrome or Bi Syndrome"."

Bi Syndrome manifests as pain, soreness, or numbness of muscles, tendons and joints. It refers to an obstruction of the circulation of Qi and Blood in the channels usually caused by the result of the body being "invaded" by the external  pathogenic factors in Wind, Cold, Heat, or Dampness. However, it is usually a combination of wind, dampness and cold.

In an acute attack of wind, cold and dampness, symptoms include joint pain that gets worse with cold and is relieved with warmth, a feeling of heaviness or numbness in the limbs, limited mobilty of the affected area, and possibly , a  slow pulse.

A more chronic arthritis condition is generally associated with an underlying deficiency of the vital substances involving the liver and kidneys, in view of their relationship to the tendons and bones.

The symptoms manifested by an individual will depend on which external pathogenic factor is strongest.

Four Main Patterns of BI SYNDROME

1) Wind Pattern (Wind Bi)

     a. This happens when a person is exposed (unprotected) to wind, for a long time.

     b. Symptoms and Characteristics

         ~ pain that moves from joint to joint is very typical of any wind pattern.

         ~ Joint soreness

         ~ Movement of joints is limited

         ~ There is often fever

         ~ An aversion to wind or windy weather

      c. Tongue- a thin white tongue coat

      d. Pulse- a floating pulse

      e. Leading herbs for treatment- Ledebouriella (Fang Feng) and Ephedra (Ma Huang)

2) Cold Pattern (Cold Bi)

     a. This pain has a fixed location.

     b. Symptoms and Characteristics

         ~ severe pain in a joint or muscle.

         ~ Applying warmth to affected area relieves pain.

         ~ Exposure to cold increases pain.

         ~ Movement of joints is limited.

     c. Tongue- a thin white coat, cold, pale and wet. (Puddles of Saliva).

     d. Pulse- a wiry, slow and tight pulse.

     e. Aconite and Ephedra. Ephedra b/c it is a hot herb.

3. Damp Pattern (Damp Bi) 

    a. The pain has a fixed location and is aggravated by damp weather.

    b. Symptoms and characteristics

        ~ Pain, soreness and swelling in muscles and joints

        ~ A feeling of heaviness and numbness in the limbs.

    c. Tongue- a white sticky tongue coat.

    d. Pulse- soggy, slow pulse (slippery)

    e. Leading herbs for treatment- Coix (Yi Yi Ren), also good for the spleen and Lancea atractylodes 

       (Cang  Zhu).

4. Heat Pattern (Hot Bi)

    a. Can develop from any of the above three patterns.

    b. Burning pain in a fixed area.

    c. Symptoms and Characteristics

        ~ severe pain and hot-red-swollen joints.

        ~ Applying cold to the joints generally relieves pain.

        ~ Fever

        ~ Thirst

        ~ Anxiety

        ~ Aversion to wind

    d. Tongue- A yellow, dry tongue coat.

    e. Pulse- A slippery, rapid pulse

    f. Leading herbs for treatment- Anemarrhena (Zhi Mu), Gypsum (Shi Gao) and Cinnamon (Gui Zhi).

A time tested herbal formula for joint pain is Joint Strength (Du Huo Ji Sheng Wan). This herbal combination was written down about twelve hundred years ago, during the Tang Dynasty. It contains herbs that relieve pain, as well as herbs that nourish and strengthen the joints. It has been used by millions of people over the last millennium. You can take it over a long period of time without worrying about the side effects.

zang fu theory and depression

Over the last few weeks my class has been presenting case studies on different disease patterns according to the Zang Fu theory. I decided to look into more disease patterns such as depression and found some AMAZING information.

To give a short explanation of Zang Fu theory first the translation is " "theory about solid organ-hollow organ". It is the model of the body according to TCM. The Fu organs are yang and include the gallbladder (the gallbladder is also an organ belonging to a set of special organs "Curious" which include the brain, vessels, and the spinal cord). Their function is to  receive, breakdown and absorb food and fluids needed to manufacture the vital substances... (yang organs will never store vital substances.. discussion about that in class the other day.. ;) ).. Yang organs also transport and excrete waste. They are also external. The five organs that are Zang are the heart, lung, spleen, liver and kidney. These organs nourish the body and are yin. Their job is to produce, transform, regulate and store vital substances. Yin organs not yang organs store all vital substances. The Zang organs are also home to our emotions. Each organ holds a specific emotion. The heart holds the spirit also known as "SHEN", the spleen holds excessive worry, liver stores anger, fear and fright are stored in the kidney and the lungs hold grief and the inability to "let go".

If one of these Zang organs or more than one become disturbed or there is a flow interruption, there will be an emotional state of imbalance of some sort. In all cases the SHEN is the primary target to be hit and especially for depression. In a lot of cases the liver and the lungs are greatly disturbed as well, but always the Shen. There are several different patterns of disharmony concerning depression and Chinese Medicine, below described.

Lung Qi Deficiency- characteristics of this type include the following: aversion to speaking, weak voice, shallow breathing, fatigue, dislike cold, catches colds easily, will have a bright white complexion. Depression manifests as the "inability to let go" . The tongue will be pale and have a thin white coating. The pulse will be thin.

Liver Qi Stagnation- characteristics include moodiness, poor appetite, irritablity, hypochondriac, muscle tension, chest pain.Tongue will be dusky and the pulse is wiry-weak. Things to avoid if the liver qi is stagnant would be things such as heavy meals that are complex, spicy foods, coffee, black tea, soda, alcohol, beef and lamb are too heavy of meats. Should eat more basics. For example instead of cutting up a bunch of fruit and making a fruit salad, eat one fruit at a time since the body is already agrivated and irritated taking on too many flavors could irritate the digestive system. Something very important in having liver qi stagnation is to have a creative outlet. If there is no creative outlet, you begin to feel trapped and stuck.. hence stagnation! Eat plenty of broccoli and water with lemon.

Qi and Phlegm clashing- depression manifests as something being caught in the throat. Characteristics include a feeling of feeling tight in the chest as well as the throat and having a hard time swallowing.  Thinking unclearly is very common since the attack of phlegm causes you confusion and the feeling of being scattered.  Lack of appetite and having a hard time waking up in the morning are also characteristics of this type depression. The tongue will be slimy or will have a sticky coating. The pulse will be slippery or wiry.

So here we have a few causes of depression according to Chinese Medicine. Here are a few things to help with these disharmonies:

1. Gong Qi
2. Meditation
3. Exercise
4. Herbs such as St. Johns Wort for anxiety, insomnia, mild to moderate depression, passionflower for calming the nervous system, and ginseng which helps the body to resist stress.    

Epilepsy and TCM

What is epilepsy? According to Western Theory the definition of Epilepsy is a neurological disorder or excessive activity in the brain. According to Eastern Theory (TCM) , epilepsy is phlegm blocking the collaterals and heart cavities involving usually the liver, spleen and kidney organs.

Before major diagnosis can begin, there must be determination of brain damage. By that examining the patients history, physical exams, brain scans and some other modern technology is in order to perform. If brain damage is found, you would take on scalp acupuncture, herbs for injury and herbs for brain functioning. If there is no brain damage, more examinations are to be given.

Liver Wind- This is when an Epileptic attack is occuring. Liver wind, also known as liver wind stirring internally, is internal wind rising from major imbalances of qi/blood and yin/yang. What happens is liver and kidney yin have been extremely depleted and therefore it deprives the liver yang and its qi of nourishment and counterbalancing. This results in erratic movement such as tremors and convulsions or paralysis. This also leads to seizures and sudden loss of consciousness.

Three main causes of liver wind- 1. Extreme heat with upflaming of liver-fire generating wind, 2.liver-yin deficiency with liver-yang rising and 3. Liver-blood deficiency.

Description of Tongue: Deep-red, stuff with thick yellow coating.
Pulse: Wiry, rapid and full.

Points to use: LIV 2 to clear liver fire, Liv 3 to resolve liver qi stagnation, Du 16 and Gallbladder 20 to expel wind from the head, DU 20 to clear head, SI 3 with UB 62 to descend yang and Kid 6 for night time epilepsy.


Liver-yang rising causing Wind- liver yang becoming hyperactive causing wind to stir and fire qi to float upwards. Also when liver kidney yin is depleted and yin is unable to constrain yang. This combination is deficiency and excess, usually stirred on by emotional factors, especially in extreme states of anger, resentment, frustrations. Signs of this are dizziness, shaking head, trembling of limbs, sluggish speech, stuff tongue preventing speech, convulsions, deviation of the eyes and mouth.

Description of the tongue: red, no coat (peeled), and deviated
Pulse: floating-empty or wiry-fine and rapid.

Phlegm Fire Attacking Spirit- Kuang Zheng:  is a Fire (Yang) pattern that is usually complicated with Phlegm covering the Heart, mind, spirit, Hun (ethereal) and Po (physical) soul (Dian Zheng).  This manifests as blockage accumulating and causing Heat until the point of bursting resulting in Fire surging upwards. This pattern is often seen in Schizophrenia, Bipolar manic-depression, neurosis, hysteria, menopausal syndrome, gram-negative sepsis, encephalitits, apoplexy, or epilepsy.  It may be caused by severe emotional problems that cause stagnation and turn to Fire, a diet of rich spicy hot and greasy foods, and external pathogenic invasion. 
Tongue: red, yellow greasy coat
Pulse: rapid and slippery
Points to use: DU!, Ren 15, ST 40 for Dizziness, DU for mental disorders, GB34 for dizziness, Liv 3, These points are to all calm the liver and clear phelgm. 


Herbal Recommendations:

Dragon Bone is a Spirit Stabilizing substance. It calms the Liver and suppresses hyperactivity of Liver Yang. This results in a strong calming effect which can be described as both sedating and tranquilizing. Dragon bone has a profound calming effect on the heart, being one of the primary natural substances known for calming excitability and palpitation.

Dragon bone is an extremely useful therapeutic substance. Dragon bone, being a mineral, is rich in calcium and other trace minerals that can benefit the body in many ways. It is used to relieve irritability, chronic and acute anger, tension and dizziness caused by hyperactivity of Yang. Dragon Bone has wonderful benefits for those experiencing mental and emotional agitation, palpitations, insomnia and chronic or acute anxiety. In Chinese medicine, it is even used for epilepsy induced by terror and for manic behavior.

Valerian is another herb widely used in Europe to help with stress and anxiety, which can often trigger convulsions and seizures. It has a long record of use for epilepsy. 

 Passiflora incarnata (passionflower) mentioned above has valuable sedative and tranquillizing powers. It is a well known remedy for sleeplessness and for stress. It also has painkilling properties. It is often used for treating palpitations, asthma, high blood pressure and muscle cramps. There are many species of passiflora, quite a few of them have similar properties. 

Gou Teng has long been used to help with convulsions in Chinese medicine. It was first recorded for use in AD 500. Stems and thorns are collected in winter. It is a sedative and antispasmodic and is mainly used for easing tremors, siezures, spasms, headaches and dizzyness. It is also used by the Chinese to reduce high blood pressure. It must only be taken under medical supervision. 

Herbs and oils to stay away from include the following: clove, cinnamon, nutmeg, black pepper, wormwood, basil, rosemary, ginkgo and white willow.

Please do take note that I am not an expert at this. I am not a doctor nor an herbalist. I did all this research simply online and from my gathering of notes on what I have learned so far. Always consult with your primary doctor if you are interested in taking herbs. Do not try and treat yourself if you are unsure of anything you may have! :)