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! :)

Part One Tongue Diagnosis in class

A few weeks ago while we were in class I took pictures of all of our tongues before we went outside to practice some Qi Gong. After about half an hour of Qi Gong we came back inside and took more photos of our tongues to see if there were any changes. We also do this with our pulses (that will be another blog entry coming soon). We take our pulse before Qi Gong and then after wards. Pulse diagnosing is hard. Most of the time I don't think I even do it right, but it's fun! lol... Anyways, I gathered some photos of my classmates and wrote out what some of these indications could be. I will say after looking at these photos, cropping them and examining them, it gets sort of funny. I mean I can only look at someone's tongue for so long before there is this weird, giggly humor emerging!

 

Tongue#1: pale coloring of the tongue, scallops on the sides, looks like a slight coating on the tongue and dry, also swollen. Significance: blood deficiency due to dry pale coloring, spleen qi deficiency due to scallops, the coating would be normal except for the dryness. With dryness there could be a blood or yang deficiency, exterior attack of wind/cold or wind/heat. 

Tongue#2: purple/reddish body color, pale, thick, swollen with scallops on the side and a small crack in the upper Jiao burner. Significance: the coloring of the tongue could be head and blood stasis, pale would be blood deficiency, crack in the middle of the tongue indicates deficiency of stomach qi and the swelling of the sides could be a deficiency of the spleen qi or spleen yang.

: 

Tongue#3: Thin, pale red and wet with slight scallops on the edges more in the middle and lower Jiao with a red tip at the end and cracks around the center(stomach/spleen area). Significance: pale and red and wet signify a yang deficiency, possible spleen yang deficiency, the redness at the tip could be heat from the heart channel, scallops indicate spleen qi deficiency.

Tongue#4: transverse cracks in the middle jiao, red tip, thick coating of tongue gray towards the lower jiao,slightly swollen and wet. Significance: purple spot in the middle signifies blood stasis or/and heat in stomach,  gray and thickening- damp-cold in the spleen, or somewhere in the interior, red tip- heart fire and the transverse cracks in the middle could be the first stages of yin deficiency also deficiency of stomach yin.

Tongue#5: red, wet and shiny coloring of the body, long, tongue is rolled, the coating is towards the root which is yellow and two lines going down toward the tip of tongue. Significance: red, wet and shiny signify heat also stomach or/and kidney yin deficiency, rolled under generally signifies deficiency of heat in the heart, yellow coating presents damp-heat.

 

Tongue#6: red with no coating, red at the tip, scallops on the edges with a long vertical crack in the center, tongue is rolled under and seems to be shiny and wet. Significance: red, shiny, and wet again, signify heat. There doesn't appear to have a coating and that could signify yin deficiency with heat which goes for the tongue rolled under as well. Cracked in the center indicates deficiency of the Stomach yin. 

Tongue#7:  red coloring with yellow/whitish coating, greasy, slight scallops on the edges. tip rolled over, with spots in the back of the lower Jiao and swollen. Significance: heat in the nutritive or blood levels, swollen indicates heat in the stomach and heart, yellow coating in the lower jiao indicates heat and phlegm or maybe damp-heat in stomach and intestines. Scallops- qi deficiency.

Tongue#8: Red, wet, shiny and no coat, especially red at the tip, slight small crack in middle jiao, and short in length. Significance: red and shiny coloring indicate stomach and/or kid yin deficiency, with peeled (meaning no coat) possible heat from stomach. Red at tip= heat, short in length could indicate internal cold if body was pale, heat stirring liver wind.

Tongue#9: Red and dry, red at the tip, thin white coating more towards the lower jiao, tongue is swollen, and purplish towards the center of the tongue. Significance: red, dry with a slight coating indicates heat from excess burning body fluids, purplish in the center could be blood stasis and heat in the stomach, the swelling indicates damp-heat in stomach or spleen, heart heat or/and yang deficiency with dampness in spleen or kidney.

Tongue#10: Pale red coloring, slight line in the middle of tongue, scallops on the sides and the edges, tongue seems to be not rolled under or over, looks to be slightly moist. With the exceptions of the scallops the coloring looks to be normal. Significance: coloring is pretty normal, scallops indicate a spleen qi deficiency.

These pictures were taken before we did Qi Gong. The following pictures below are now pictures of the same tongues after Qi Gong performed. 

Tongue#1

 

Tongue#2

 Tongue#3

Tongue#4

Tongue#5

Tongue#6

Tongue#7

Tongue#8

Tongue#9

 Tongue#10

Do you see any changes after wards? I find it easier to be able to tell changes in doing the pulse easier after Qi Gong. The pulse is very easy to change so any exercise you do would change that instantly. However the tongue is more accurate in being able to tell what is going on with the body because it doesn't change so quickly.