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