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HEAT FROM QI STAGNATION

2012-05-26T17:27:00.001-07:00

When Qi stagnates it frequently gives rise to Heat. This is why emotional stress which leads to Qi stagnation usually leads to Heat and that is why the tip of the tongue (reflecting the Heart and the Shen) becomes red.

Heat from Qi stagnation has the same characteristics and clinical manifestations as those of Full Heat but it differs in the treatment principle. To clear Full Heat, we use herbs and formulae from the category of AClearing Heat@ or AClearing Organ Heat@. To clear Heat deriving from Qi stagnation, we need to use herbs and formulae from the AMoving Qi@ category and adapt them to clear Heat.

Although we always stress Liver-Qi stagnation, practically all organs may suffer from Qi stagnation and I will discuss particularly three: Liver, Lungs and Heart.

a) Heat from Liver-Qi stagnation

Hypochondrial or epigastric distension, a slight feeling of oppression of the chest, irritability, melancholy, depression, moodiness, propensity to outbursts of anger, a feeling of lump in the throat, a feeling of heat, red face, thirst, pre-menstrual tension, irregular periods, pre-menstrual breast distension, heavy periods.

Tongue: red on the sides, with coating.

Pulse: Wiry, especially on the left side and slightly Rapid.

Acupuncture

P-6 Neiguan, G.B.-34 Yanglingquan, LIV-14 Qimen, LIV-3 Taichong, T.B.-6 Zhigou, LIV-2 Xingjian.

Prescription

Dan Zhi Xiao Yao San Moutan-Gardenia Free and Easy Wanderer Powder.

Three Treasures: Freeing the Sun.

This tongue has red sides (especially the left one) while the rest of the tongue has a normal colour. This is from Liver-Qi stagnation giving rise to Heat.

b) Heat from Lung-Qi stagnation

A feeling of lump in the throat, difficulty in swallowing, a feeling of oppression or distension of the chest, slight breathlessness, sighing, sadness, slight anxiety, depression, crying, breast distension in women, feeling of heat, thirst, red cheeks.

Tongue: slightly Red on the sides in the chest areas.

Pulse: very slightly Tight on the right cun position.

Acupuncture

LU-7 Lieque, ST-40 Fenglong, Ren-15 Jiuwei, P-6 Neiguan.

Prescription

Ban Xia Hou Po Tang Pinella-Magnolia Decoction plus Zhu Ye Folium Phyllostachys nigrae.

Three Treasures: Open the Heart.

Lung-Qi stagnation derives from sadness, grief, shame, guilt and especially worry: it affects throat and chest. In women it also affects the breasts.

c) Heat from Heart-Qi stagnation

Palpitations, a feeling of distension or oppression of the chest, depression, a slight feeling of lump in the throat, slight shortness of breath, sighing, poor appetite, chest and upper epigastric distension, dislike of lying down, weak and cold limbs, pale complexion.

Tongue: slightly Pale-Purple on the sides in the chest area.

Pulse: Empty but very slightly Overflowing on the left cun position.

Acupuncture

HE-5 Tongli, HE-7 Shenmen, P-6 Neiguan, Ren-15 Jiuwei, Ren-17 Shanzhong, LU-7 Lieque, ST-40 Fenglong, L.I.-4 Hegu.

Prescription

Mu Xiang Liu Qi Yin Aucklandia Flowing Qi Decoction.

Ban Xia Hou Po Tang Pinellia-Magnolia Decoction.

Both prescriptions plus Zhu Ye Folium Phyllostachys nigrae and Lian Zi Xin Plumula Nelumbinis.

Three Treasures: Open the Heart.

Heart-Qi stagnation may derive from sadness, grief, worry, shame and guilt.

This tongue shows a slightly purple colour in the chest area on the left. This may reflect Qi stagnation of Heart or Lungs or both.

DIAGNOSIS, PATTERNS AND TREATMENT OF HEAT

2012-05-25T13:50:00.000-07:00

Heat is an extremely common pattern in practice and it is therefore very important that we understand its aetiology, pathology, diagnosis, patterns and treatment. To give an idea of the frequency of Heat in practice, in my clinic in England in a database of over 2500 patients, 46% had a red tongue and 32 a pale tongue. In other countries with a warmer climate, I suspect the incidence of red tongue (and Heat) would be even higher. One reason why Heat is so common is that it is often the consequence of emotional stress, but this will be discussed later.
I have decided to write something on Heat also because I find that even in Chinese books, the subject is not discussed properly and the terminology used is often not precise as they sometimes use the terms "Heat" and "Fire" interchangeably and they are not.
The discussion of Heat will be structured under the following headings:
Aetiology of Heat
Full Heat
Heat from Qi stagnation
Empty Heat
Distinction between Heat and Fire
Damp-Heat
Phlegm-Heat
External Heat
Latent Heat
Yin Fire
Heat and the 4 LevelsAETIOLOGY OF HEAT

First of all, when we talk about the aetiology of Heat, we mean Full Heat (or Wind-Heat), not Empty Heat. This is because Empty Heat derives from Yin deficiency, so the aetiological factors that lead to Yin deficiency eventually lead to Empty Heat. In my experience, the most important aetiological factor leading to Yin deficiency is overwork: I do not mean excessive physical work but Aoverwork@ in the sense of working long hours without adequate rest, leaving home in the early morning and returning in the late evening for years on end. This life habit is also combined with stressful situations at work (or the commute) and irregular eating. All these factor combine to deplete Yin of the Stomach, Liver and Kidneys. Yin deficiency eventually leads to Empty Heat.

In my experience, there are three major causes of Full Heat: emotional stress, diet and an external pathogenic factor that penetrates into the Interior.

a) Emotional stress

All emotions eventually lead to Heat and that is why a red tip of the tongue is so common and also such a reliable indicator of emotional stress.

Initially, emotions affect only Qi and do not cause Heat directly: they cause either Qi stagnation or Qi deficiency or both. Thus, initially (and I stress initially), all emotions affect Qi only. Emotions such as worry, pensiveness, anger, fear, shame and guilt cause Qi stagnation; emotions such as sadness and grief cause Qi deficiency. However, also the emotions that cause Qi deficiency, often also cause a concomitant Qi deficiency. For example, sadness and grief weaken Lung-Qi: a weak Lung-Qi in the chest leads to come impairment in the circulation of Qi in the chest and therefore to some Qi stagnation as well.

After some time (and this may not be very long, e.g. weeks), Qi stagnation leads to Heat. As all emotions affect the Heart, the tip of the tongue becomes red. All emotions affect the Heart because the Heart houses the Shen and the Shen is the one that recognizes and feels the emotions. When we say AI feel angry@ who is that AI@? It is the Shen of the Heart. Anger will affect the Liver automatically but it is the Heart who Afeels@ it.

This picture shows a good example of red tip. The tip is bright-red (a different shade than the rest of the tongue body) and it is also swollen.

b) Diet

First of all, it is important to realize that when we say Adiet@ in the context of aetiology of disease, that includes drinks. Indeed, excessive consumption of alcohol is probably the main source of heat in a diet. Any type of alcohol is hot and the higher the alcohol content, the hotter the drink. Thus, vodka is hotter than wine.

Apart from alcohol, all meats are hot (or warm) but especially lamb and beef: therefore excessive consumption of these two types of meat is also a source of heat. All wild meats are also hot, e.g. pheasant, grouse, rabbit, deer, elk, reindeer, wild boar, etc.

Apart from the above foods, most spices are also a source of heat, e.g. mace, ginger, curry, cumin, chilly, etc.

c) External pathogenic factor penetrating into the Interior

An external pathogenic factor frequently penetrates into the Interior if it is not expelled at the Exterior stage. When this happens, every external pathogenic factor has the tendency to change into Heat: thus, even Wind-Cold can turn into Heat once in the Interior. Indeed, this is exactly what happens in the 6 Stages patterns from the Shang Han Lun: the Tai Yang stage is characterized by Wind-Cold and this can transform into the Yang Ming stage of Stomach-Heat. Of course, external Wind-Heat and Summer-Heat have even a stronger tendency to turn into Interior Heat.

I find this aetiology of internal Full Heat actually quite common, especially for Lung-Heat. Many people suffer an invasion of Wind-Heat: if the Wind-Heat is not expelled at the exterior stage, it may go into the Interior and turn into Lung-Heat or Lung Phlegm-Heat. This is more likely to happen when antibiotics are resorted to. This is called Residual Heat, i.e. Heat left over from an invasion of Wind-Heat. It is very common in children.

This type of Lung-Heat is often symptomless but the tongue shows it very clearly with a redness or red points in the front third. The tongue below has red points in the front third (Lung area).

CLINICAL MANIFESTATIONS OF HEAT

The general clinical manifestations of Full Heat are a feeling of heat, red face, thirst, anxiety, red face, dry stools, scanty-dark urine, a Rapid-Full pulse, and a red tongue with yellow coating.

Beyond these, it is difficult to generalize as other manifestations will depend on the organ affected. Note that some of these symptoms and signs may be caused by Empty Heat too and therefore tongue and pulse are important to differentiate Full from Empty Heat: in Empty Heat the tongue is without coating and red and the pulse must have some Empty quality and especially Floating-Empty.

Aside from the above clinical manifestations, there are other diagnostic guides which indicate Heat. Any raised, red skin eruption which feels hot, indicates Heat. For example, acute urticaria normally takes this form. As for pain, any burning sensation indicates Heat. For example, the burning sensation of cystitis, or a burning feeling in the stomach. Any loss of blood with large quantities of dark-red blood, indicates Heat in the Blood. As far as the mind is concerned, any condition of extreme restlessness or manic behaviour, indicates Heat in the Heart.

a) Lung-Heat

Cough, slight breathlessness, feeling of heat, slight chest ache, thirst, red face.

Tongue: Red in the front third with yellow coating.

Pulse: Overflowing on the right cun, possibly slightly rapid.

Acupuncture

LU-5 Chize, LU-10 Yuji, LU-7 Lieque, L.I.-11 Quchi, LU-1 Zhongfu, BL-13 Feishu.

Prescription

Qing Bai San Clearing White Powder

b) Stomach-Heat

Burning epigastric pain, thirst, acid reflux, nausea, vomiting soon after eating, excessive hunger, foul breath, a feeling of heat.

Tongue: red in the centre with a yellow coating.

Pulse: Rapid and slightly Overflowing on the Right-Middle position.

Acupuncture

ST-44 Neiting, ST-34 Liangqiu, ST-21 Liangmen, Ren-12 Zhongwan, Ren-13 Shangwan, L.I.-11 Quchi, L.I.-4 Hegu, Ren-11 Jianli.

Prescription

Bai Hu Tang White Tiger Decoction.

Yu Nu Jian Jade Woman Decoction.

Qing Wei San Clearing the Stomach Powder.

c) Liver-Heat

Irritability, propensity to outbursts of anger, temporal headache, dizziness, red face and eyes, thirst, bitter taste.

Tongue: Red with redder sides and dry-yellow coating.

Pulse: Wiry-Rapid.

Note: this pattern is usually described as ALiver-Fire@ in Chinese books. Liver-Fire is a more

intense form of Liver-Heat. I will discuss the difference between Heat and Fire later. The clinical manifestations listed above are those of Liver-Heat.

Acupuncture

LIV-2 Xingjian, LIV-3 Taichong, G.B.-20 Fengchi, Taiyang extra point, G.B.-13 Benshen, Du-24 Shenting. In case of headaches: G.B.-1 Tongziliao, G.B.-9 Tianchong, G.B.-8 Shuaigu, G.B.-6 Xuanli.

Prescription

Long Dan Xie Gan Tang Gentiana Draining the Liver Decoction.

Dang Gui Long Hui Tang Angelica-Gentiana-Aloe Decoction.

Please note that these prescriptions are for Liver-Fire. Therefore, for Liver-Heat, I would reduce the dosage of the bitter-cold herbs such as Long Dan Cao Radix Gentianae scabrae and Huang Qin Radix Scutellariae.

d) Heart-Heat

Palpitations, thirst, mental restlessness, insomnia, feeling of heat, red face.

Tongue: Red with redder tip and yellow coating. In more severe cases the tip could also be swollen.

Pulse: Overflowing-Rapid especially on the Left-Front position.

Note: this pattern is usually described as AHeart-Fire@ in Chinese books. Heart-Fire is a more intense form of Heart-Heat. I will discuss the difference between Heat and Fire later. The clinical manifestations listed above are those of Heart-Heat.

Acupuncture

HE-9 Shaochong, HE-8 Shaofu, HE-7 Shenmen, Ren-15 Jiuwei, Du-24 Shenting, Du-19 Houding.

Prescription

Dao Chi San Draining Redness Powder.

Please note that this prescription is for Heart-Fire. Therefore, for Heart-Heat, I would reduce the dosage of the bitter-cold herbs such as Huang Lian Radix Coptis.

e) Spleen-Heat

The Spleen can have Heat! Of course, it is much more prone to Cold but the pattern of Spleen-Heat does exist and it is usually combined with that of Stomach-Heat. The clinical manifestations are listed below.

Burning epigastric and/or abdominal pain, excessive hunger, red tip of the nose, dry lips, thirst, dry stools, feeling of heat, yellow complexion.

Tongue: red on the sides, middle section, with dry-yellow coating.

Pulse: Overflowing (especially on the right guan position) and slightly rapid.

Acupuncture

SP-2 Dadu, L.I.-11 Quchi, ST-44 Neiting, Ren-11 Jianli.

Prescription

Xie Huang San Draining the Yellow Powder.

This tongue is red on the sides in the middle section (Middle Burner): this is more apparent on the right side. The sides of the tongue usually reflect the Liver but when they present a pathological aspect only in the middle section of the sides (Middle Burner), they reflect a pathology of the Spleen, in this case Heat because they are red.

NEW THREE TREASURES MANUAL

2012-05-14T11:59:00.003-07:00

A new expanded version of the Three Treasures manual with mental-emotional pattern for each remedy is available for download from http://www.three-treasures.com/downloads/Three%20Treasures%20Manual.pdf

FOCUS ON A REMEDY: CHEMO-SUPPORT

2012-05-12T13:18:00.000-07:00

This blog post is dedicated to the discussion of the remedy Chemo-Support which is intended to minimize the side effects of chemotherapy. This remedy was formulated 15 years ago and it has been used by many patients undergoing chemotherapy.

CHEMOTHERAPY SIDE-EFFECTS FROM THE POINT OF VIEW OF CHINESE MEDICINE

If we analyze the side-effects or chemotherapy, there are important differences between various cytotoxic drugs and one could conceivably formulate an individual Chinese herbal formula for each. However, one can identify common characteristics among the above side-effects. We can attempt to group the side-effects according to the Chinese pathological pattern induced by the various cytotoxic drugs. Looking at the side-effects of each drug, four patterns in particular stand out:

1. DEFICIENCY OF QI, BLOOD AND YIN

Hair loss, diarrhoea, nail ridging, bone-marrow suppression, malaise, fatigue, depression, loss of appetite, neurological damage, dizziness, constipation, numbness, tingling, paraesthesia of hands and feet.

2. ST-QI REBELLING UPWARDS

Nausea, vomiting.

3. STOMACH HEAT

Mouth ulcers, stomatitis, stomach ulcers.

4. BLOOD HEAT

Haematuria, fever, skin reactions, cystitis.

Thus, we can deduce from the analysis of the above patterns that cytotoxic drugs cause the following:

1. Qi, Blood and Yin deficiency (of Stomach, Lungs, Liver and Kidneys)

2. Stomach-Qi rebelling upwards

3. Stomach Heat

4. Blood Heat.

The treatment principles to adopt are therefore (the herbs used are indicated in brackets):

Tonify Qi, Blood and Yin (Huang Qi Radix Astragali, Ren Shen Radix Ginseng, Ling Zhi Ganodermae, Mai Men Dong Radix Ophiopogonis, Dang Gui Radix Angelicae sinensis, Nu Zhen Zi Fructus Ligustri lucidi, Huang Jing Rhizoma Polygonati)

Subdue rebellious Stomach-Qi (Lu Gen Rhizoma Phragmitis, Ban Xia Rhizoma Pinelliae preparatum, Sha Ren Fructus Amomi)

Clear Stomach Heat (Lu Gen Rhizoma Phragmitis, Zhi Mu Radix Anemarrhenae)

Cool Blood (Mu Dan Pi Cortex Moutan)

ANALYSIS OF INDIVIDUAL HERBS IN CHEMO-SUPPORT

- Huang Qi Radix Astragali: tonify Qi and raise immune response.

- Ren Shen Radix Ginseng: tonify Qi.

- Ling Zhi Ganodermae: tonify Qi and Blood and raise the immune response.

- Mu Dan Pi Cortex Moutan: cool Blood.

- Zhi Mu Radix Anemarrhenae: clear Heat.

- Fu Ling Poria: resolve Dampness.

- Chen Pi Pericarpium Citri reticulatae: resolve Dampness, stop nausea.

- Mai Men Dong Radix Ophiopogonis : nourish Yin.

- Dang Gui Radix Angelicae sinensis: nourish Blood

- Ban Xia Rhizoma Pinelliae preparatum: resolve Phlegm, subdue rebellious Stomach-Qi, stop nausea and vomiting.

- Lu Gen Rhizoma Phragmitis: clear Stomach-Heat, stop vomiting.

- Nu Zhen Zi Fructus Ligustri lucidi

- Sha Ren Fructus Amomi: move Qi, resolve Dampness, stop nausea.

- Huang Jing Rhizoma Polygonati: tonify Qi, nourish Yin and Jing.

- Gan Cao Radix Glycyrrhizae uralensis: harmonize.

PHARMACOLOGY OF CHEMO-SUPPORT INGREDIENTS

I shall report only the pharmacology of the above plants that is relevant to chemotherapy, immune function, inflammation, digestion or carcinoma. Thus, for each plant, there are many other pharmacological actions not reported below. These data are not available for all of Chemo-Support=s ingredients.

It should also be noted that such data are reported for reference only as they reflect a reductionist view of the action of herbs that is at variance with the Chinese medicine view. Some of the research studies reported present a doubly-reductionist view: firstly, they use single herbs and secondly, many of them use single constituents of a herb. By contrast, Chinese medicine uses only formulae composed of several herbs. It is a well-know fact that first of all, the action of a herb is more than the sum-total of the actions of its individual constituents and secondly, the synergistic action of the herbs within a formula is more than the sum-total of its individual herbs.

Furthermore, many of the studies reported are based on animal experiments which could be criticized on ethical grounds.

HUANG QI Radix Astragali

Constituents

2'4'-dihydroxy-5,6-dimethoxyisoflavone, kumatakenin, choline, betaine, polysaccharides, glucoronic acid, folic acid.

Pharmacology

1. Enhancement of immune function

The decoction given to mice increased the phagocytic activity of the reticuloendothelial system. Oral administration or nasal spray of Huang Qi offered protection against the common cold. Intraperitoneal administration of the polysaccharides from the root of Astragalus membranaceus antagonized the atrophy of immune tissues such as spleen, thymus and intestinal lymph nodes as well as leukopenia caused by immunosuppressant prednisolone in mice. Intraperitoneal administration of the homogeneous fraction of the polysaccharides astragalan I and II increased the weight and cell number of mouse spleen. Two months of oral treatment with the herb in subjects susceptible to common cold greatly increased the levels of SIgA and IgG in the nasal secretion.

2. Antibacterial effect

In vitro, Huang Qi was effective against Shigella shigae, Bacillum anthracis, Streptococcus hemolyticus, Corynebacterium diphtheriae, Diplococcus pneumoniae, Staphyloccus aureus.

3. Prevention of renal toxicity in chemotherapy

A double-blind trial of 49 patients undergoing chemotherapy showed that the decoction of Huang Qi Radix Astragali and Fu Ling Poriae markedly reduced the incidence of renal toxicity. Rats with experimentally-induced glomerulonephritis, when treated with Huang Qi had significantly less proteinuria than control groups as well as milder pathological tissue changes.

4. Effect on endurance

Decoction of Huang Qi given to mice significantly increased their endurance in swimming tests.

5. Endocrine effect in patients undergoing radiotherapy

In a randomized clinical trial, the plasma hydrocortisone level in stage II carcinoma of the cervix was observed. The average level in 18 patients before and after irradiation were 8.0 and 6.1 Fg/100ml, whereas the before and after levels were 9.5 and 9.1 Fg/100ml in patients who received a decoction of Huang Qi Radix Astragali and Nu Zhen Zi Fructus Ligustri lucidi for two months.

6. Anti-inflammatory effect

Intravenous dose of 5 mg/Kg or oral dose of 50 mg/Kg of astramembranin I inhibited the increase in vascular permeability induced by serotonin or histamine in rats.

7. Hepatoprotective effect

Intravenous administration of 10 mg/Kg of astramembranin I induced accumulation of cAMP in rabbit plasma.

REN SHEN Radix Ginseng

Constituents

Triterpene saponins, aglycone protopanaxadiol, aglycone protopanaxytriol, aglycone oleanolic acid, water-soluble polysaccharides, polyynes.

Pharmacology

1. Endocrine effect

Animal tests proved that ginseng stimulates the pituitary gland to increase the secretion of ACTH, which in turn stimulates the adrenal gland.

2. Effect on endurance

Mice administered a single extract of ginseng recorded a 132% increase in duration of swimming compared with a 179% increase in mice given the extract for 7 days.

3. Immunologic effect

Ginseng increases the function of the reticuloendothelial system. Administration to guinea pigs promoted antibody production against leptospira and influenza virus. The percentage of tumour-bearing mice and weight of the tumour decreased in mice bearing sarcoma S ₁₈₀ and ARS following dosages of ginseng. Ginseng may also increase the activity and and reduce the toxicity of other anti-tumour agents.

4. Haematologic effect

Ginseng extract demonstrated protective and stimulant actions on bone marrow, increasing red and white blood cell numbers, and also hemoglobin in normal and anemic animals.

5. Effects on the nervous system

An intraperitoneal injection of 50mg/kg of Ren Shen for 5 days has a stimulating effect as it increases the amounts of dopamine and norepinephrine in the brain stem. However, Ren Shen solution 40% taken orally reacts as a sedative. Therefore, due to its dual effective nature, Ren Shen provides an adaptogenic effect for the body suffering various stresses.

LING ZHI Ganodermae

Constituents

Ergosterol, lysozyme, acid protease, amino-acids, polypeptides, saccharides, sterols, lactones, alkaloids and polysaccharides.

Pharmacology

1. Cardiotonic action. The tincture had a significant cardiotonic action on the isolated frog heart.

2. Action on coronary circulation. Injection of an extract given to dogs rapidly increased the coronary flow by 44%.

3. Regulation of immune function and inhibition of allergic reaction. Ling Zhi accelerated the clearance of I-labelled protein in the blood of albino mice, indicating its ability to enhance the phagocytic action of the reticuloendothelial system. The polysaccharide fraction of Ling Zhi markedly increased the phagocytic ability of abdominal macrophages of mice against chicken erythrocytes. These facts suggest that the polysaccharides can increase non-specific immunologic function of the body.

MU DAN PI Cortex Moutan

Constituents

Paenol, paenoside, pasenolide, paeniflorin, volatile oil and phytoesterol.

Pharmacology

1. Antimicrobial action

The decoction of the root showed strong antibacterial action in vitro against, Bacillus subtilis, Escherichia coli, Salmonella typhi, Salmonella paratyphi, Proteus vulgaris, Staphylococcus aureus, Streptococcus haemolyticus, Doplococcus pneumonia and Vibrio cholerae.

2. Anti-inflammatory action

Paenol given intragastrically inhibited swelling of rat paws induced by dextran. Paenol inhibited the increase of intra-abdominal capillary permeability of mice and cutaneous capillary permeability of guinea pigs caused by acetic acid. The methanolic extract, the glycosidic fraction and paenol inhibited blood platelet aggregation.

3. Hypotensive effect

The blood pressure of dogs with essential or renal hypertension was significantly reduced after oral administration of 5 g/Kg of the decoction of the root bark for 5 days and 10 g/Kg for two more days.

4. CNS effects

Intraperitoneal or oral administration of paenol decreased the spontaneous activity of mice, antagonized caffeine-induced hyperactivity and prolonged cyclobarbital-induced sleep.

FU LING Poria

Constituents

Beta-pachyman, machymic acid, ergosterol, choline, histidine, potassium salts.

Pharmacology

1. Antineoplastic effect

Pachymaran produced an inhibition rate of 96.88% against sarcoma in rats. Topical application of the methanolic extract of the herb (2 mg/100 ìl) significantly reduced the percentage of tumour-bearing mice and the number of tumours per mouse induced by DMBA plus TPA..

2. Effect on immune function

Oral administration increased phytohemagglutinin-induced lymphocyte transformation rate and increased serum IgG.

3. Effect of digestive system

The herb inhibited gastric ulcer provoked by pylorus-ligation and decreased gastric secretion and free acidity in rats. The herbs also protected rats against CCl₄-induced hepatotoxicity, reducing GPT activity and preventing necrosis of hepatocytes.

CHEN PI Pericarpium Citri reticulatae

Constituents

Dlimonene, citral, hesperidin, neohesperidin, tangeretin, nobiletin, citromitin, 5-O-desmethylcitromitin, inositol, vitamin B₁.

Pharmacology

1. Actions on the gastro-intestinal smooth muscles

The herb decoction inhibited the motility of the isolated small intestines of mice and rabbits.

2. Action against gastric ulcers

Daily injections of methylhesperidin for 6 days markedly reduced the incidence of ulcers and inhibited gastric secretions.

3. Anti-inflammatory action

Both hesperidin and methylhesperidin had vitamin P-like actions. Hesperidin inhibited the inflammatory reaction of croton oil granulation in rats. Intraperitoneal dose of 10 mg/Kg of hesperidin inhibited increased permeability caused by histamine in mice.

MAI MEN DONG Radix Ophiopogonis

Constituents

Ophiopogonins A, B, C, and D (steroid saponins), beta-sitosterol, amino-acids.

Pharmacology

1. Antibacterial action

The herb inhibits Staphylococcus albus, Bacilus subtilis, Escherichia coli and Salmonella typhi.

2. Immunologic effect

Intraperitoneal administration of 12.5 g/Kg of the herb to mice significantly increased the weight of the spleen and phagocytosis of the macrophages; it also counteracted the reduction in white cells due to cyclophosphamide.

3. Effects on blood glucose

Intramuscular administration of 1 ml/Kg of the 50% decoction of the herb increased blood glucose level in rabbits.

DANG GUI Radix Angelicae sinensis

Constituents

Ligustilide, n-butylidene phthalide, palmitic acid, beta-sitosterol, beta-sitosteryl palmitate, sucrose, vitamin B₁₂, nicotinic acid, folic acid, folinic acid, biotin, vitamin A and E.

Pharmacology

1. Effect on coronary flow

Perfusion of the 2% fluid extract into the isolated heart of guinea pigs significantly dilated the coronary vessels and increased coronary flow.

2. Effect on platelet aggregation

The aqueous extract of the root and its ingredient ferulic acid inhibited rat platelet aggregation and serotonin release.

3. Effect on immune system.

The herb enhanced the phagocytic function of abdominal macrophages of animals.

4. Anti-inflammatory effect

The aqueous extract of the root decreased vascular permeability. The inhibitory activity in mice by oral administration was comparable to that of aspirin; like aspirin, it also inhibited the release of 5-HT and other inflammatory substances.

BAN XIA Rhizoma Pinelliae preparatum

Constituents

Methionine, glycine, beta- and gamma-aminobutyric acids, alkaloids 1-ephedrine and trigonelline, phytosterol, glucoronic acid.

Pharmacology

1. Anti-emetic action

The stir-fried tuber had an anti-emetic action in emesis induced by morphine or digitalis. The decoction of the herb prevented early vomiting caused by deslanoside as well as emesis caused by orally-administered copper sulfate.

2. Anti-neoplastic action

The aqueous extract had a marked inhibitory action on animal tumours such as sarcoma, liver carcinoma and cervical carcinoma.

3. Anti-inflammatory action

The tuber has a PAF-antagonism effect due to the lignans.

SHA REN Fructus Amomi

Constituents

Essential oils, saponins, zinc, copper, iron

Pharmacology

1. Gastrointestinal effect

A low-level decoction of Sha Ren has been proved to stimulate the intestines of rats and rabbits. Sha Ren helps to relieve bloating, spasms and pains, and diarrhea

2. Effect on nausea

11 patients suffering from nausea were given 2 grams of powdered Sha Ren orally 3 times a day with good results.

Patients appetites have also been improved with Sha Ren

LU GEN Rhizoma Phragmitis

Constituents

Coixol, tricin, asparamide, D-xylose, L-arabinose, D-glucose, D-galactose, vitamins B₁, B₂ and C.

Pharmacology

1. Antibiotic effect

Decoctions of Lu Gen have shown an in vitro antimicrobial effect against beta-hemolytic Streptococcus.

ZHI MU Radix Anemarrhenae

Constituents

Timosaponin, mangiferin, sarsasapogenin, markogenin, neogitogenin, anemarns

Pharmacology

1. Antipyretic effect

Subcutaneous injection of the aqueous extract of the rhizone (4g/kg) decreased the body temperature of rabbits inoculated with Escherichia coli.

NU ZHEN ZI Fructus Ligustri lucidi

Constituents

Oleanolic acid, acetyloleanolic acid, betulin, lupeol, salidroside, mannitol, oleic acid, linoleic acid, palmitic acid.

Pharmacology

1. Incremental effect on white blood cells

The fruit increased white blood cells in leukopoenia due to chemotherapy or radiotherapy in mice.

2. Effect on immune function

The fruit promoted lymphoblast transformation and increased the number of cells with haemolytic plaques. The in vitro restorative effect of the aqueous extract of the herb was studied in cancer patients and in normal healthy donors. Using the local graft versus host (GvH) reaction as a test assay for T-cell function, the extract affected an immune restoration in 9 of 13 cancer patients with an increase in local GvH reaction from 32.3 / 36.1 mm³ to 118/ 104.9 mm³; these results suggest the herb contains powerful immune stimulants.

3. Antineoplastic action

The extract given by intragastric administration to mice gave a 49% inhibition rate against cervical cancer. The extract of the herb has been found to reverse tumour-associated macrophage suppression; these data suggest that the herb has cancer chemopreventive properties.

4. Effect on leukopenia

The injection of an extract of the fruit given once or twice daily could be used in cancer patients to prevent and treat leukopenia caused by chemotherapy.

5. Anti-inflammatory effect

Paw oedema in rats was inhibited by oral administration of 12.5 or 25 g/Kg of the decoction of the herb for 5 days.

HUANG JING Rhizoma Polygonati

Constituents

Flavonoid glycosides, cardiac glycosides, alkaloids, amino-acids, resin.

Pharmacology

1. Antibacterial effect

The decoction inhibited Staphylococcus aureus in vitro.

2. Effect on blood glucose

Oral administration of the extract of the herb to rabbits gradually increased blood glucose level but decreased it afterwards.

GAN CAO Radix Glycyrrhizae uralensis

Constituents

Triterpenes glycyrrhizin, flavonoids berniarin, umbelliferone, ferulic acid, sinapic acid, amino-acids, biotin, beta-sitosterol.

Pharmacology

1. Glucocorticoid-like action

Injection of glycyrrhizin in healthy subjects increased free cortisol levels in the blood. Intraperitoneal administration of a low dose of glycyrrhizin to rats caused atrophy of the thymus gland and increased weight of the adrenal gland suggesting a cortico-tropin-like action; in patients with mild Addison=s disease requiring daily intramuscular injection of 12.5 mg of cortisone, concurrent daily intramuscular dose of glycyrrhizin increased urinary free 17-hydroxycorticosterone and decreased the conjugated 17-hydroxycorticosterone.

2. Mineralocorticoid-like action

The extract reduced the urinary volume and sodium excretion and increased potassium excretion in various animal species.

3. Anti-inflammatory action

The anti-inflammatory effect of the herb resembles that of butazone or hydrocortisone; cotton pledget-induced granulation, formaldehyde-induced paw swelling and subcutaneous granulomatous inflammation in rats were all inhibited by glycyrrhetic acid.

4. Effect on the immune system

Glycyrrhizin inhibited egg-white-induced allergic reaction in guinea pigs. Glycyrrhizin inhibited the degranulation of mast cells elicited by the histamine liberation agent, Compound 48/80, so that it suppressed the release of the allergy mediators.

5. Anti-ulcer action

Injection of the herb extract produced significant inhibition of ulcers in albino rats, together with marked reduction in gastric juice and free acid. In many clinical studies on the use of Gan Cao for ulcers, the effectiveness was usually around 90%.

6. Anti-neoplastic action

Glycyrrhetinic acid inhibited the transplanted Oberling-Guerin myeloma in rats.

7. Effect on lipid metabolism

In rats with atherosclerosis, Gan Cao lowered cholesterol levels and stopped the progression of the lesions.

8. Antihepatotoxic effect

Oral administration of the extract of the herb showed hepatoprotective effects against carbon tetrachloride-induced cytotoxicity in rats; it markedly abated hepatic degeneration and necrosis, promoted the recovery of hepatocellular glycogen and ribonucleic acid and also lowered serum glutamic pyruvic transaminase. Glycyrrhizin and glycyrrhetic acid are able to prevent the development of cirrhosis.

DOSAGE AND PROTOCOL

Chemo-Support works better if it is started some time before the beginning of chemotherapy and continued for about two weeks after the end. It is important to note that “during the treatment” means during the course of treatment, i.e. also in the days of break from the treatment. The dosage is as follows:

- Two weeks before start of treatment: 2 tablets a day

- Four days before the start of treatment: 2 tablets twice a day

- During the treatment: 3 tablets three times a day

- After the end of the treatment for about 4 weeks: 2 tablets twice a day

It is best to take the tablets away from meals, i.e. about 1 hour before or after a meal, swallowed with hot water. The tablets should also be taken separately from other medication, at least 1 hour away. If the patient feels very nauseous and finds it difficult to swallow the tablets, these could be crushed and powdered, immersed in a small amount of hot water with three slices of fresh ginger and the water sipped slowly.

The dosage during treatment indicated above should be adjusted according to the severity of the side-effects and the above dosage could be reduced or increased.

If the patient is receiving both chemo- and radio-therapy and is taking both Chemo-Support and Radio-Support, the dosage of each should be reduced. Adjustments can be made according to the patient’s side-effects and timing of therapies in this situation by using a higher ratio of Chemo-Support during the days surrounding chemotherapy or when its side-effects are heightened. Similarly, the dosage of Radio-Support can be increased if the side-effects experienced from radiotherapy are more severe, or during the days surrounding the administration of radiotherapy.

Chemo-Support should be discontinued approximately four weeks after the end of the treatment when the condition should be reassessed and a different formula given. By contrast, Radio-Support should be continued for at least 6 weeks after the end of radiotherapy.

ACUPUNCTURE TREATMENT OF CHEMOTHERAPY SIDE EFFECTS

Acupuncture can be used to great effect, in conjunction with Chemo-Support to reduce the side-effects of chemotherapy. Indeed, acupuncture can complement the use of Chemo-Support by tailoring the treatment to the specific side-effects suffered by the patient. The following are suggested point combinations for specific symptoms and signs.

Fatigue

Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu.

Nausea, vomiting

Ren-13 Shangwan, P-6 Neiguan, ST-34 Liangqiu, ST-36 Zusanli. In addition to acupuncture, the following massage technique is very effective to combat nausea and vomiting: apply a massage oil liberally to the lower legs, make a loose fist with your hands, starting from ST-36, massage downwards along the Stomach channel using the knuckles of the index fingers all the way down to the ankle and then massage upwards along the Spleen channel using your thumbs. This technique harmonizes the ascending and descending of Stomach- and Spleen-Qi, stimulating Stomach-Qi to descend and Spleen-Qi to ascend.

Alopecia

BL-17 Geshu (with direct moxa cones), ST-36 Zusanli, SP-6 Sanyinjiao, LIV-8 Ququan, BL-20 Pishu, BL-23 Shenshu. Add Shou Wu Pian or Glorious Sea to Chemo-Support.

Myelo-suppression

BL-17 Geshu (with direct moxa cones), BL-11 Dashu (with direct moxa cones), BL-20 Pishu, BL-23 Shenshu.

Stomatitis, mouth ulcers

ST-44 Neiting, L.I.-4 Hegu, L.I.-11 Quchi.

Cystitis

Ren-3 Zhongji, BL-63 Jinmen, BL-28 Pangguangshu, BL-32 Ciliao, SP-9 Yinlingquan.

Fever

L.I.-11 Quchi, KI-2 Rangu, Du-14 Dazhui.

Skin rash

L.I.-11 Quchi, SP-10 Xuehai.

Diarrhoea

ST-25 Tianshu, ST-37 Shangjuxu.

BIBLIOGRAPHY

1) Perry M, Anderson C, Dorr V, Wilkes J, The Chemotherapy Sourcebook, Williams & Wilkins, Baltimore, Maryland, 1999.

2) Skeel R, Handbook of Cancer Chemotherapy, Williams & Wilkins, Baltimore, Maryland, 1999.

3) Zhu YP, Chinese Materia Medica, Harwood Academic Publishers, Amsterdam, 1998.

4) Bensky D and Gamble A, Chinese Herbal Medicine Materia Medica, Eastland Press, Seattle, 1993.

5) Chang H.M. and But P.P.Hay, Pharmacology and Applications of Chinese Materia Medica, World Scientific, Hong Kong, Vol. I, 1986.

6) Chen J K, Chen T T, Chinese Medical Herbology, Art of Medicine Press, City of Industry, CA, USA 2004.

BACTERIA IN THE FOETUS AND ASTHMA

2012-04-30T02:05:00.000-07:00

An article in the New Scientist reports a new discovery about bacteria in the foetus. It was previously thought that the foetus could not be affected by bacteria from the mother in the womb and that they could only get bacterial contamination from the mother's vagina at birth. New research shows that this is not so and that bacteria in fact colonize the foetus’s gut in the womb.

This has two interesting implications in Chinese medicine, one to do with the idea of Toxic Heat from the uterus and the other with the aetiology of allergic asthma.

According to Chinese medicine, we are all born with "Toxic Heat from the uterus". Dr J. Shen used to give new-born babies a herbal formula to eliminate such Toxic Heat: its elimination would prevent that person from suffering from skin diseases later in life.

Pilar Francino and her colleagues at the University of Valencia in Spain collected and froze the meconium of babies from 20 women. They removed the outer layers of each sample to rule out any bacteria picked up after birth, then looked for bacterial DNA.

The team not only identified bacteria in the babies' meconium - which before then was thought to be sterile - they found bacterial communities so developed that they seemed to fall into two categories. Around half of the samples appeared to be dominated by bacteria that produce lactic acid, such as lactobacillus, while the other half mostly contained a family of enteric bacteria, such as Escherichia coli.

Francino's team checked up on the health of the infants at 1 year of age, and again at 4. The group were surprised to find that infants born with more lactic acid bacteria were significantly more likely to develop asthma-like symptoms, while those born with more enteric bacteria were at a greater risk of eczema.

This is a fascinating finding that, to me, further confirms my view that the aetiology of allergic asthma is congenital (either from the parents or due to events in the womb during gestation). It is also interesting that one group of bacteria would predispose the child to asthma and the other to eczema, which further confirms the common aetiology of allergic asthma and eczema. Furthermore, the presence of these two groups of bacteria affects precisely the organs that are linked in Chinese medicine, i.e. lungs and large intestine.

INFERTILITY FROM ENDOMETRIOSIS

2012-04-26T20:51:00.000-07:00

The following is a case history from a Spanish practitioner who self-prescribed Women's Treasure remedies for endometriosis and infertility.

“My name is Rosana. I am 28 years old; I have had very frequent vaginal infections as well as cystitis for approximately 15 years (until I was 25); 5 years ago, I was diagnosed as having endometriosis with lesions of about 5 cm in diameter. I started studying Chinese medicine in the hope of finding a solution to this. The periods had been very painful with dark clots and lasting 7 days with brownish discharge before and after. My periods came every 35 days with leucorrhea. My tongue was pale with teeth marks on the side, red points on the root and tip and a thick coating on the root. The sublingual veins where of a dark color. I diagnosed myself with Yang Xu of both Spleen and Kidney with Dampness in the Lower Burner, Heart-Heat and Blood stasis in the Uterus and Liver.

I took the following Women´s Treasure remedies: Harmonizing the Moon during phases 1 and 4, Unicorn Pearl during phase 2 and Clear the Palace during phase 3; I took these for 9 or 10 months; to my huge surprise the last abdominal ultrasound showed I had “absolutely nothing” and so I started trying for a baby. I was totally amazed that after only one month I got pregnant and I am now in my third month or pregnancy and feeling very healthy. I would like to thank Giovanni Maciocia for his work and distribution of privileged information as well as for the courses and seminars given. Thank you very much!!!”

CANDIDIASIS

2012-04-24T19:33:00.000-07:00

A practitioner asked me to give her an indication of the acupuncture treatment for vaginal candidiasis. I suggested using the Ren Mai (with LU-7 Lieque on the right and KI-6 Zhaoahi on the left) plus Ren-3 Zhongji, Ren-5 Shimen, BL-22 Sanjiaoshu, ST-28 Shuidao, SP-9 Yinlingquan.

I always use the Ren Mai in genital problems, especially in women. The point Ren-3 directs the treatment to the genital system. The points Ren-5 (Front-Mu point of the Lower Burner), BL-22 (Back-Shu point of the Lower Burner), ST-28 (called "Water Passages") and SP-9 are aimed at resolving Dampness which is usually the cause of candidiasis.

The patient reported that, after only 5 days, her symptoms disappeared. She had been suffering from this problem for years.

External use of Three Treasures remedies

2012-04-17T15:16:00.000-07:00

Maria Gryllaki, a Greek practitioner, reported an interesting external use of the Three Treasures remedies. She used Expel Toxic Heat on a herpes lesion on the lip and Clear Lustre on a red rash on her neck. She ground the tablets and mixed them with some water to obtain the consistency of a paste. She applied the paste to the skin lesions and she reports that, within one hour, the paste dried up and she felt the heat going.

This is what she reports: "Results in both cases were amazing! Symptoms were gone right away!"
The composition and clinical application of the remedies can be found on www.three-treasures.com (Username "threetreasures", password "nanjing"). Powerpoint presentations on these remedies can be found on www.maciociaonline.com.

MIRROR NEURONS: THE ARENA OF SHEN AND HUN?

2012-02-05T19:16:00.000-08:00

In 1992 an Italian neurophysiologist in Parma was doing brain research using macaque monkeys. They were specifically researching an area of the brain called F5, located in the premotor cortex.

      Area F5 contains millions of neurons that specialize in coding for one specific motor behaviour: actions of the hand, including grasping, holding, tearing and, most important, bringing objects (food) to the mouth. As Iacoboni explains "For every macaque these actions are as basic and essential as they come. We Homo Sapiens are grasping and manipulating objects from the moment we fumble for the snooze button in the morning until we adjust our pillows at bedtime. All in all, we perform hundreds, if not thousands, of grasping actions every day."¹ That it why the Rizzolati team chose area F5 for close investigation.
    One day the neurophysiologist Vittorio Gallese was moving around the lab during a lull. A monkey was sitting quietly in the chair; suddenly as Vittorio reached for something, he heard a burst of activity from the computer that was connected to the electrodes surgically implanted in the monkey’s brain. To an experienced neurophysiologist, this signalled a discharge from the pertinent cells in area F5. Vittorio immediately thought that this was strange as the monkey was sitting quietly not grasping anything, yet the neurons affiliated with the grasping action had fired nevertheless.
     Through many other painstaking experiments, the neurophysiologist came to the discovery that, within the F5 motor area, there are dedicated neurons (about 20%) that fire not when one performs an action but when one watches someone else performing an action e.g. grasping, bringing objects (usually food) to the mouth, kicking a ball, playing tennis, etc. They even fire when one simply hears a word such as "kick". Mirror neurons imitating a grasping action fire even when the object grasped is hidden from view (behind a screen), but not if the monkey knows that there is no object.
    Crucially, mirror neurons are involved in predicting the meaning of a certain action: this is essential in communicating and relating to others. Iacoboni says: "The action recognition process implemented [by the mirror neurons] is some sort of simulation or internal imitation of the observed action. Given that our own actions are almost invariably associated with specific intentions, the activation in my brain of the same neurons I use to perform my own actions may also allow me to understand the intentions of other people."²    For example, if I watch someone grasping a cup soon after having an argument with that person, thanks to the mirror neurons, I know whether he or she is grasping the cup to get a drink or whether they are about to throw the cup at me. Quiet simply, mirror neurons differentiate between the same action associated with different intentions.
    After years of experiments by many different neurophysiologists, mirror neurons are now thought to be involved in much more than "imitating" motor actions in one’s brain when watching someone else performing a motor action. They are now thought to be involved in emotional bonding, empathy and language.
It is now thought that mirror neurons play a role in empathy, the capacity to feel other people’s emotions. The brain area connecting mirror neurons to the limbic system (responsible for our emotions) is the insula. In other words, we feel and understand the emotions of other people thanks to our own mirror neurons which are activated by the sight of someone’s smiling, frowning, crying, etc. Thus, "our mirror neurons fire when we see others expressing their emotions, as if we were making those facial expressions ourselves. By means of this firing, the neurons also send signals to emotional brain centres in the limbic system to make us feel what other people feel."³
    Essential to this empathy based on mirror neurons are other people’s facial expressions that trigger the firing of our mirror neurons. To James (of the James-Lange theory of emotions), this phenomenon means that "our mental life is knit up with our corporeal frame, in the strictest sense of the term."⁴ Incidentally, that is the connection between emotions and the Po in Chinese medicine.
    Mirror neurons also play a role in the development of a sense of self. Social context is critical in developing a sense of self. Isolation seems to inhibit the ability to develop a sense of self; rich social context facilitates it. The presence of others, the continuous relations and interactions one must have with others facilitates the development of our sense of self. Mirror neurons fire when we observe actions and when we perform those same actions. There is a strong link between social environment and a sense of self and this link is at least partly due to mirror neurons.
    There is now a mirror neuron hypothesis in relation to autism. In autism there is an "imitation deficit", i.e. the child is unable to translate from the perspective of another individual to one’s own perspective. It is now believed that the key neural deficit in autism is a dysfunction of mirror neurons. As Iacoboni says, "a deeply felt mirroring that moves people closer to each other and makes emotional connectedness possible seems to be the main deficit of patients with autism."⁵
    What has all this to do with Chinese medicine and, in particular, with Shen and Hun? I think there are interesting connections between the role of Shen and Hun and mirror neurons. Shen and Hun together are responsible for emotional empathy and relating to others. Consider the Chinese ideogram for "shen".

    The right side of the ideogram is very interesting: it is pronounced "shen" and it means "to express, to explain, to stretch, to extend".

   The last two meanings, "to stretch" and "to extend", are crucial to an understanding of what the Shen does. It is responsible for "extending" towards others, for connecting with others, for emotional connection and empathy. In other words, for the function of the mirror neurons.
    However, the Shen cannot perform that function alone: it relies on the help of the Hun and that is why ancient books say that Shen and Hun are related work in unison (they are both Yang in nature), as opposed to the relation between Po and Jing (both Yin in nature).
    How does the Hun help the Shen? The Hun is responsible for a different type of consciousness than that of the Shen. It is responsible for intuition, planning, life dreams, ideas, inspiration and, incidentally, also artistic inspiration. How does the Hun perform these functions? Through its movement: the Hun is always moving in the sense of searching, exploring ideas, nurturing life dreams, etc. Without the input of the Hun the Shen would be an inert consciousness. The input of the Hun is therefore essential for the Shen to perform its function of relating and connectedness with others. Again, this is the Chinese medicine equivalent of the function of mirror neurons.
    The movement of the Hun has to be just "right", not too much, not too little. If the movement of the Hun is deficient, the person may become depressed; if the movement of the Hun is excessive, the person may be slightly "manic". I relate autism in children to a deficient movement of the Hun that leads to an impaired function of the Shen in relating to others. As we have seen, this has been related to a dysfunction of mirror neurons.
    Conversely, I relate hyperactivity in children to an excessive movement of the Hun and, interestingly, hyperactive children are often artistic (which is a function of the Hun).
    How does one stimulate the movement of the Hun? I use the Gall-Bladder channel and especially GB-40 Qiuxu. To restrain the movement of the Hun, I use LIV-3 Taichong. Other points that regulate the Shen and Hun and Du-24 Shenting and GB-13 Benshen.

1. Iacoboni M, Mirroring People, Picador, New York, 2009, p. 10.
2. Ibid., p. 30.
3. Ibid., p. 119.
4. Calhoun C, Solomon R, What is an Emotion?, Oxford University Press, 1984, p. 125.
5. Iacoboni, Mirroring People, p. 175.     The left part of the ideogram (by itself pronounced shi) indicates something spiritual, it evokes heaven and stars, also an ancient altar for sacrifices, signs from Heaven. I like the word "numinous" in relation to this quality of Shen.

Herbal Sentinel - Yin: a case history

2012-01-22T09:58:00.000-08:00

The Three Treasures remedy Herbal Sentinel - Yin was formulated to strengthen the Wei Qi and therefore resistance to pathogenic factors in persons with either an active Yin deficiency or a constitutional tendency to it. Usually, Chinese remedies that strengthen the Wei Qi are all Yang tonics and this would not suit someone with a Yin deficiency or a tendency to it. The following case history, sent by Jason Smith from Spain, is a good example of this.

A 16-year-old boy sought help for various issues. He is a professional basketball player.

First of all, he generally feels cold and this is very much aggravated when he is doing sports (practices at least about 5 hours/day). The cold feeling is accompanied by profuse sweating.

He also complains of severe lumbar pain that started at the age of 13. His memory is bad and has difficulty retaining names, data, and concentrating.

He reports feeling a “lump” coming out of the stomach into the throat. His eyes are very itchy. He feels very tired and experiences a feeling of heaviness of body and legs, where he also experiences pain. He also experiences dry throat in the evening, and drinks cold water. He has also dry and chapped lips.

He wakes up in the middle of the night with unpleasant dreams and occasionally sweats at night. He has tinnitus all the time and cannot hear well from one ear (varies from one to the other). He also experiences problems in his right knee. He complains of abdominal distension after eating; appetite is good.

There is also asthma with difficulty in inhalation when doing sports, along with a strong propensity to catching colds and spontaneous sweating.

He sometimes feels pain in the lateral rib cage. He has mood swings, ranging from extreme happiness to crying for no reason.

The tongue is slightly red without coating in the centre and front third (Stomach and Lung areas). The tip is red. There are some shallow Stomach cracks in the centre. There is a yellow rootless coating on the root.

DIAGNOSIS

The patterns involved are Yin deficiency of the Stomach, Lungs and Kidneys with some mild Empty Heat (evidenced by the thirst, feeling of heat during the night and red tongue). The tongue shows the deficiency of Stomach- and Lung-Yin since it lacks a coating in the centre and front third; the Kidney (Yin) deficiency is evidenced by the memory loss, lumbar pain, tinnitus and fatigue. The dry eyes point out to Liver-Yin deficiency although there are no other symptoms of it.

There is also a secondary Kidney Yang deficiency because of the cold feeling when doing sports, but, because of the redness of the tongue and the partial lack of coating, the Yin deficiency is predominant and so must be treated accordingly. The fact that the asthma is on inhalation confirms the fact that the Kidneys are weak.

Lung-Qi is deficient as there is spontaneous sweating and propensity to catching colds.

The feeling of heaviness of the body and legs, along with pain in the legs is due to Dampness in the Cou Li space. The Dampness (Damp Heat) is confirmed by the sticky, rootless, yellow coating at the back of the tongue. This is also evidenced by the abdominal distension after eating.

TREATMENT

The main focus of the treatment was tonifying Kidneys, Lungs and Spleen. I chose to tonify Lung- and Kidney-Yin with the Three Treasures remedy Herbal Sentinel - Yin, that tonifies Lung-, Spleen- and Kidney-Qi to strengthen the immune system and also nourishes Lung- and Kidney-Yin. This remedy is meant for people who need a boost to Wei Qi but who have a constitutional Yin deficiency (or tendency to it).

With acupuncture, I used the Ren Mai with the opening and coupled points (LU-7 on left and KI-6 on right), along with points such as Ren-4, Ren-6, Ren-12, Ren-17, KI-3, KI-7, ST-36.

Three months after the treatment all the symptoms have greatly improved. Sleep is much better, breathing issue is almost resolved, the patient is emotionally much better, the fatigue is also better and the memory is coming back.

The patient also had vitiligo on the medial side of the leg and the ankle. Interestingly, with the above treatment, the area around KI-3 Taixi is starting to regain its colour. The patient also feels his hair is growing much stronger now. Treatment still continues.

Finally, Giovanni always says that one of his teachers, Dr Shen, always discouraged heavy exercise as he believed it weakens Kidney-Yang. This case is a good example of this.

FOCUS ON A REMEDY: PEACEFUL SUNSET

2012-01-15T16:36:00.000-08:00

Chinese geriatrics has been dominated by the idea that aging is due to a decline of Kidney-Jing and therefore the way to slow down aging is to tonify the Kidneys. Of course this is true, Kidney-Jing does decline with age and, indeed, aging itself is due to such decline.

However, the major diseases of the elderly i.e. coronary heart disease, cancer and stroke, are due to Full conditions such as Phlegm, Blood stasis, Heat and Internal Wind. These Full conditions account for most of the morbidity and mortality of the elderly. Nobody dies purely from Kidney deficiency!

Besides the above three major diseases mentioned above, many of the symptoms and signs of old people are also due to Phlegm and Blood stasis. For example, it is easy to attribute poor memory in the elderly to a decline of Kidney-Jing (the Kidneys nourish the Brain) and, indeed, it can be. However, poor memory may also be due to Phlegm obstructing the Brain. The same applies to dizziness.

Alzheimer’s disease is another case in point. Of course, it is partly due to the declining Kidney-Jing not filling the Sea of Marrow and not nourishing the Brain. However, if we look at the pathology of this disease, there are fluid-filled ventricles in the brain: this is a manifestation of Phlegm. There are neurofibrillary tangles and plaques which are also a manifestation of Phlegm. Amyloid fibers aggregate around blood vessels which is a manifestation of Blood stasis. Thus, in Alzheimer’s disease, besides a Kidney deficiency there is also Phlegm and Blood stasis.

The remedy Peaceful Sunset was formulated for the treatment and particularly prevention of diseases of the elderly due to Phlegm, Blood stasis and Internal Wind. It also nourishes Yin as so many elderly people suffer from Yin deficiency. This remedy may be used simply for prevention in the elderly and the tongue is a very good indicator for its use. The tongue indicating the use of this remedy would be:

Swollen = Phlegm

Purple = Blood stasis

Stiff, Moving or Deviated = Internal Wind

Without coating = Yin deficiency

I see many elderly people who are apparently without many symptoms and yet the tongue presents the above features. If the tongue is as described above, the use of Peaceful Sunset is indicated.

The tongue illustrated here is that of an apparently healthy 64-year-old lady who came to me purely for rheumatic aches and pains. She was “healthy” by all accounts and her blood pressure was normal. And yet, her tongue is Swollen indicating Phlegm, Purple pointing to Blood stasis and Deviated which is due to Internal Wind. Moreover, the coating is missing in parts and the tongue is red which indicates Yin deficiency with Empty Heat. The combination of all these factors points to the likelihood of this patient suffering a stroke.

There is more on geriatrics in the blog of December 2010.

Maciocia's E-books

2011-12-30T19:28:00.000-08:00

Five of my books are now available as e-books on the Kindle platform and two on the Nook platform.

KINDLE:

1) The Psyche in Chinese Medicine
2) The Practice of Chinese Medicine
3) La Pratique de la Medecine Chinoise (French)
4) Les Principes Fondamentaux de la Medecine Chinoise (French)
5) Leitbahnen der Akupunktur (German)

Available here at amazon.com

NOOK:

1) The Psyche in Chinese Medicine
2) The Practice of Chinese Medicine

Available here at barnsandnoble.com

THE TRIPLE BURNER - RELATIONSHIP WITH PERICARDIUM

2011-12-04T19:05:00.000-08:00

This is the 6th and last instalment of the discussion on the Triple Burner.

6) Relationship between Triple Burner and Pericardium
Although they are interiorly-exteriorly related, the relationship between Pericardium and Triple Burner is somewhat tenuous: such a relationship is more applicable to the channels, rather than to the organs themselves.

The Nei Jing and Nan Jing always refer to the "5 Zang and 6 Fu" (omitting the Pericardium), but also to the "12 channels" (including the Pericardium). Originally the Pericardium was not considered as separate from the Heart; the two were considered a single organ, which is perfectly logical considering their close anatomical relationship. In fact, when the Ling Shu lists the Yuan points of the 5 Zang in chapter 1, it lists Daling (P-7) as the Yuan point of the Heart.1
A passage from Chapter 38 of the Nan Jing makes it clear that the Pericardium and Heart were, in those times, considered as one organ. It says: "The Zang are 5; only the Fu organs are 6: why is that so? The Fu organs are 6 because of the Triple Burner...it has a name but no form, and its channel pertains to the Hand Shao Yang. [The Triple Burner] is a Fu organ and that is why these are 6."2

This passage is revealing because of its starting question: in fact, the very question "the Zang organs are 5, why are there 6 Fu organs?" implies that it is taken for granted that the Heart and Pericardium are part of the same organ and that therefore it is strange that the Fu organs are 6. The answer explains that the Fu organs are 6 due to the existence of the Triple Burner.

However, within the reply, it says that the Triple Burner "has a name but no form" thus implying that the Triple Burner is different from the other regular Fu organs and their total makes 6 only by adding the Triple Burner.3 The passage also makes clear that the Triple "has a name but no form", i.e. it is not really an organ like the others but a complex of functions: however, it does say that there is a channel associated with it.

Chapter 39 of the Nan Jing is even more specific about the fact that the Triple Burner is not actually associated with a Zang organ: "Each of the Zang organs has a Fu one associated with it. The Triple Burner is also a Fu organ but it is not associated with any of the Zang organs. That is why some say that there are only 5 Fu organs."4

Chapter 25 of the Nan Jing specifically addresses the conundrum that there are 11 Internal Organs but 12 channels: "There are 12 channels but 11 Internal Organs (5 Zang and 6 Fu), why? One channel [jing] has two separate vessels [mai] in the Arm Shao Yin [Heart] and Heart Master [Xin Zhu, Pericardium]. The Pericardium has an Exterior-Interior relationship with the Triple Burner, both have a name but no form [you ming er wu xing], and that is why there are 12 channels." This passage is extremely revealing because it confirms that Heart and Pericardium were seen as one, when it says that one channel [jing] has two separate vessels [mai] in the Arm Shao Yin [Heart] and Heart Master [Xin Zhu, Pericardium].

With regard to the question of 5 Zang and 6 Fu, the author of the Nan Jing seems to be playing games with the reader because, in chapter 39, it says that the Zang could be considered to be 6 and the Fu 5! It says: "There are 5 Zang and yet 6 Fu, how is that? One speaks of 6 Fu but they are actually 5. Although one speaks of 5 Zang, there are actually 6. The Kidneys are two Zang: the left is the Kidney and the right is the Ming Men. The Ming Men houses the Spirit (jing shen). In men it stores the Jing in women it houses the Uterus. The Qi of the Ming Men penetrate the Kidneys. That is why there are 6 Zang. How come there are 5 Fu? [That is because] Each Zang is associated with a Fu, the Triple Burner is a Fu but it does not belong to any of the 5 Zang: that is why there are 5 Fu."5

With the development of the channel theory, the Triple Burner was associated with the Pericardium (given their corresponding position on the arm) and their number totalled 12, including the Triple Burner and Pericardium channels.

Although the Pericardium and Triple Burner channels are exteriorly-interiorly related within the 5-Element scheme, this feels like a somewhat "forced" relationship to make a square shape fit in a round hole, i.e. the 5 Elements into 12 Channels. In fact, some Chinese teachers and doctors go so far as saying that the Pericardium and Triple Burner organs are not interiorly-exteriorly related as the other organs are.

As channels, the Pericardium and Triple Burner channels have a close and symmetrical relationship; they occupy symmetrical positions on the arm. The Triple Burner belongs to the Shao Yang channels which are the "hinge" between the Tai Yang and the Yang Ming channels; the Pericardium pertains to the Jue Yin channels which are the "hinge" between the Tai Yin and Shao Yin channels. Being the "hinge" implies that these channels can connect the Yang and Yin channels, i.e. the Triple Burner connects the three Yang and the Pericardium the three Yin.

The Pericardium and Triple Burner channels are symmetrical in so far as the former provides the opening point of the Yin Wei Mai (P-6 Neiguan) and the latter of the Yang Wei Mai (T.B.-5 Waiguan): the Yin Wei Mai links all the Yin channels and the Yang Wei Mai all the Yang ones. This is another reason why the Triple Burner and Pericardium channels connect the three Yang and three Yin of the arm respectively.

The "Medicine Treasure" even says that the Triple Burner is interiorly-exteriorly related to the Ming Men.6 Since the Ming Men is also called the "Minister Fire", this explains the attribution of Triple Burner to Fire and specifically Minister Fire in the 5-Element context. The Pericardium is obviously closely connected to the Heart and naturally belongs to the Fire element, hence the connection between Pericardium and Triple Burner within the Fire Element and their name of "Minister Fire".

The "Selected Historical Theories of Chinese Medicine" clarifies the relationship between the Triple Burner and Pericardium: "The Heart is the Emperor who has a Minister. The Triple Burner cavities are like a capital which houses both the Emperor and the Minister. The Pericardium in the centre of the chest is like a palace that houses only the Emperor. The palace is inside and is Yin, the capital is outside and is Yang; hence the Triple Burner is a Yang organ and the Pericardium a Yin organ".7

In exploring the relationship between Pericardium and Triple Burner, there is an interesting symmetry between the location of the Back-Shu point of Heart and Kidneys (Shao Yin) and those of Pericardium and Triple Burner. The Heart and Kidneys communicate with each other and their Back-Shu points are BL-15 and BL-23 respectively. The Pericardium and Triple Burner’s Back-Shu points are symmetrical in that they are one point above those of the Heart and Kidneys, i.e. BL-14 and BL-22 respectively.

The Back-Shu point of the Pericardium is naturally just above that of the Heart because of the close anatomical connection between the two organs. The Back-Shu point of the Triple Burner is just above that of the Kidneys because of the Triple Burner being the "envoy" or "ambassador" of the Yuan Qi as it emerges from between the Kidneys (see previous blog post).

Clinical application
There are interesting clinical applications of the Triple Burner and Pericardium channels in the mental-emotional sphere.

First, emotional stress makes the physiological Minister Fire of the Kidneys rise and become pathological: when the Minister Fire is pathological, a person has "Heat". All emotions tend to cause Qi stagnation first and stagnant Qi easily generates Heat: that is why, in mental-emotional stress, the tip of the tongue (reflecting the Heart and the Shen) is red. As we have seen above, chapter 38 of the Nan Jing even says that the Ming Men (same as Minister Fire) is the residence of the Spirit (Jing-Shen). Zhu Dan Xi said: "Not a day goes by in people’s lives that the Minister Fire is not stirred."

The Triple Burner and Pericardium channels affect the mental-emotional state because emotional stress makes the Minister Fire rise towards these two channels; therefore when the Minister Fire is aroused by emotional problems and it rises towards the Pericardium and Triple Burner channels, points of these channels can be used to clear Heat and calm the Mind.
In this context, I use particularly P-6 Neiguan to stimulate the movement of the Hun when the person is depressed, or P-7 Daling to calm the Shen when the person is anxious.

There is another interesting clinical application of the Triple Burner and Pericardium points related to their being "hinge" channels, i.e. the Triple Burner (Shao Yang) is the hinge between Tai Yang and Yang Ming and the Pericardium (Jue Yin) is the hinge between Tai Yin and Shao Yin. Being the "hinge" on a psychological level means that these channels are "mediators" in the sense that they can affect a person's capacity to relate to other people and points of these two channels can therefore be used especially for depression: for this, I use T.B.-3 Zhongzhu and P-6 Neiguan.

1. Ling Shu, p 3.
2. Nan Jing, p. 94.
3. Ibid., p. 94.
4. Ibid., p. 95.
5. Nan Jing, p. 110.
6. Wang Xin Hua 1983 Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan), Jiangsu Scientific Publishing House, p. 2.
7. Ibid., p. 161.

Chronic constipation

2011-11-21T16:16:00.000-08:00

The following is a case history sent by Jason Smith, a practitioner in Spain.

A 37-year-old woman complained of chronic constipation. She has a bowel movement every 3 days and the problem is aggravated by emotional stress (she works in a lawyer’s office and she finds the work stressful). Occasionally, the bowel movements increase in frequency and she may even go 3 times in one day. The stools are hard and dry.

In the past two months, she developed a distending pain in the abdomen every time she eats. She has a feeling of the food not going down which causes her breathlessness. She has a burning sensation in the epigastrium.

She has abdominal distension after eating, feels sleepy after eating and has a very slow and difficult digestion.

Feels very irritable and feels like crying before the period. She says she feels like crying but is unable to. She reports being very frustrated by her job. She occasionally has a feeling of lump in the throat. Twice she had pain in the coastal region.

At night she experiences tingling and numbness of her legs. She says her memory is bad. She goes through periods of insomnia (both difficulty in falling asleep and waking up in the middle of the night); her periods are very scanty periods and her nails brittle. The periods comes regularly every 32 days and last four days; there are some dark clots but no pain.

She has occasionally a throbbing headache on the temple and behind the eye when stressed at work. Her hair falls out (she says this occurs during the change from spring to summer and summer to autumn).

Her tongue is very thin, slightly reddish purple (especially on the sides) with a yellow rootles coating that is thicker on the root. The tip is very red.

Diagnosis
The patterns involved are Liver-Qi stagnation (constipation, distending pain, costal pain, feeling of lump in throat) as well as Spleen-Qi deficiency and Dampness in the digestive system (difficult digestion, sleepy after eating, yellow coating thicker on the root).

There is also Liver-Blood deficiency (scanty periods, hair falling out, brittle nails, insomnia). The Blood deficiency occasionally gives rise to Liver-Yang rising causing the throbbing headaches.
There is also some Liver-Blood stasis (purpe tongue, dark clots), but this is not a major pattern.

The rootless coating also shows some Stomach-Yin deficiency which causes the burning feeling in the epigastrium.

The pulse is not Wiry which indicates that the Liver-Qi stagnation is secondary to the Liver-Blood deficiency.

There are the interesting symptoms reported of abdominal distension with a feeling of the food not going down which causes her breathlessness: I attribute these symptoms to rebellious Qi of the Chong Mai.

Treatment
She was treated with acupuncture and some Three Treasures and Women´s Treasure remedies. She was prescribed Smooth Passage (morning) to treat the three patterns of Liver-Qi stagnation, Spleen-Qi deficiency and Dampness, and Central Mansion (afternoon) to nourish Stomach-Qi and Stomach-Qi and resolve Dampness. These two remedies were taken every day. Freeing the Moon was added during phase 4.

Two weeks after taking the remedies the bowel movements started occurring on a daily basis, with the stools returning to a normal consistency. Over the following weeks, the patient reported feeling much better and more relaxed on a mental-emotional level, and without any feeling of lump in the throat, reacting "normally under stressful conditions". One month later, the bowel movements where back to normal and she reported feeling "very well, as I hadn´t felt in years." Treatment still is being conducted.

Recurrent bronchitis: a case history

2011-11-21T15:57:00.000-08:00

The following is a case history sent by Jason Smith, a practitioner in Spain.

The patient is a 20-year-old girl seeking help because she had a bronchitis three years ago and ever since then she has been very prone to catching colds that always end in bronchitis and pneumonia. Enquiring about how it started, her first bronchitis was after studying very hard to be admitted in university. In the mornings, she coughs and expectorates some phlegm.

She feels cold in general with very cold feet although her hands are always very hot; in the past months she started having a feeling of heat rising up to the head being worst during the acute attacks of bronchitis. Three months ago, she started sweating at night (face and forehead). She also has a dry mouth at night. She used to like warm drinks but now she feels thirsty and needs cold drinks.

Recently she lost weight, losing as much as 10 kg (22 lb) in only three months. She has a pale face but with malar flush (red cheekbones). Her lips are purple. She has bad sleeping habits (goes to bed at 5 am and gets up 2 pm) and for the past three months she wakes up in the middle of her sleep for no apparent reason.

When she has colds she always has a fever, sore throat, profuse sweating, cough and green nasal mucus occasionally with blood. Always shows aversion to wind.

She now feels tired and her legs feel sometime heavy. Her bowel movements are regular (twice a day) but she occasionally has constipation. Her urine is pale but the first one in the morning is dark. She suffers from abdominal fullness after eating. Her appetite is decreased, and she complains that her “stomach is closed”. Has had Candida infections in the past.

In the past three months, she has been getting lower back pain as well as spontaneous sweating and occasional tinnitus.

She feels depressed and her mental state fluctuates, sometimes crying for no reason.
She suffers from throbbing headaches on the lateral sides of head lasting 2 days with nausea: this happens once a month, sometimes with the period but not always. Lately she has experienced floaters.

Her period has always been very irregular (coming between every 15 and 45 days) and extremely painful (before and during) with stabbing pain alleviated by heat. The period lasts 8 days with profuse bleeding (the first four days with heavy bleeding, not much on the 5th day, and profuse the last three days). The menstrual blood is red with clots; brown the last day. She started taking the pill two months ago and her last period was very scanty with brown bleeding.

The tongue is pale and slightly swollen on the sides but slightly red and without coating in the centre. There is a sticky-yellow, rootless coating on the root. The tip is red.

Diagnosis
There are many patterns involved:
1) Deficiency of Lung-Qi (spontaneous sweating, propensity to catching colds).
2) Phlegm in the Lungs (cough and expectoration of phlegm in the morning. This is a residual pathogenic factor that has lingered ever since her first invasion of Wind three years ago with her first bronchitis, and that accounts for the repetitive bronchitis and pneumonia.
3) Kidney deficiency (lower backache, tinnitus, getting thinner, rootless and lack coating). This is a deficiency of both Kidney-Yin and Kidney-Yang as evidenced by the simultaneous cold and hot feelings.
4) Stomach-Yin deficiency with mild empty Heat (tongue red without coating in the middle)
5) Spleen-Yang deficiency (tiredness, abdominal distension).
6) Liver-Blood deficiency (floaters, pale sides of the tongue)
7) Liver-Blood stasis (menstrual clots, purple lips, painful periods)
8) Liver Qi stagnation (moodiness, crying, depression)
9) Liver-Yang rising (throbbing headaches) that is probably due to the Blood deficiency and
Kidney-Yin deficiency
10) Cold in the Uterus (period pain alleviated with application of heat). The Cold in the Uterus leads to Blood stasis.
11) Damp-Heat in the Lower Burner (feeling of heaviness of the legs, candida infection, sticky-yellow coating at the root of tongue).

Treatment
There are many patterns and therefore many treatment options. I decided to start by eliminating the residual pathogenic factor in the Lungs because that is the pattern that is causing the most morbidity. After that has been cleared, I would proceed to treat the other underlying patterns.
She has been given Central Mansion (Three Treasures remedy) to tonify Spleen-Qi, Stomach-Yin and Lung-Qi together with Resolve Phlegm (Little Treasures remedy) to treat the residual pathogenic factor. She has been treated for the past 5 months and she has only had one cold that did not progress any further. The next step will be strengthening the Kidneys.

Note
Note that although Resolve Phlegm is part of the pediatric range Little Treasures, it eliminates residual Phlegm in the Lungs and it can indeed be used in adults.
Finally, please note also how there are four Liver patterns: Liver-Qi stagnation, Liver-Blood stasis, Liver-Yang rising and Liver-Blood deficiency. It is common for the Liver to manifest with several patterns simultaneously: this does not happen with other organs.

THE TRIPLE BURNER AS A SYSTEM OF CAVITIES AND A THREE-FOLD DIVISION OF THE BODY 4) and 5)

2011-10-30T21:06:00.000-07:00

4) The Triple Burner as a system of cavities
The Triple Burner is a system of body cavities. There are many cavities in the body, some large, some small. For example, the chest cavity, the abdominal cavity, the pelvic cavity, the joint cavities, the space between skin and muscles, the space above the diaphragm, the spaces in between the Membranes, and the spaces between these and the abdominal cavity. Such cavities are called Cou in Chinese medicine; the term Cou is usually used in conjunction with Li meaning "texture". Although the term Cou Li is often used to indicate the space between skin and muscles, such space is only one of the cavities of the body.

The cavities of the body are generally irrigated and lubricated by various fluids and the Triple Burner controls these cavities also because it controls the transformation, transportation and excretion of fluids in all parts of the body. Moreover, the Triple Burner controls the movement of Qi in and out of such cavities. This movement is the "entering and exiting" of Qi in the Qi Mechanism discussed in the last Clinical Tip. The entering and exiting of Qi in and out of the cavities is extremely important both for the proper circulation of Qi and for the transformation and transportation of body fluids in and out of such cavities.

The abdominal cavity contains the Membranes (Huang): these include the superficial and deep fascia, the mesentery, the omentum and the stroma enveloping all internal organs. The superficial and deep fascia are connective tissues that envelope the muscles. The mesentery is the double layer of peritoneum attached to the abdominal wall and enclosing in its fold the abdominal viscera. The omentum is a fold of peritoneum passing from the stomach to another abdominal organ. The stroma is the framework, usually of connective tissue, of an organ. The Membranes (Huang) have the function of wrapping, anchoring and connecting the organs. In other words, the organs in the abdominal cavity are not in a kind of vacuum connected by acupuncture channels. The occupy a solid space that is surrounded by Membranes. The Triple Burner is responsible for the movement of Qi in and out of the Membranes.

Therefore, when seen as a system of body cavities, the Triple Burner is not an organ but a complex of cavities outside or in between the internal organs. The "Classic of Categories" (Lei Jing, 1624) by Zhang Jing Yue says: "Outside the internal organs and inside the body [i.e. between the skin and the internal organs], wrapping the internal organs like a net, there is a cavity that is a Fu. It has the name of a ditch but the shape of a Fu [Yang organ]."1 He also said: "The Internal Organs have substance; the cavities are like a bag that contains that substance".2 The Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan) says: "There is a Minister Fire in the body which moves within the cavities and up and down in between the Membranes: it is called the Triple Burner".3

In the chest cavity, the Triple Burner controls the entering and exiting of Qi which is governed by the Zong Qi. In the abdominal and pelvic cavity, the Triple Burner controls the transportation and transformation of Qi in the Membranes. In the space between skin and muscles, the Triple Burner controls the diffusing of Wei Qi and the entering and exiting of Qi in and out of that space. This function of the Triple Burner regulates the flow of Wei Qi in this space, the opening and closing of pores and sweating. In the joint cavities, the Triple Burner controls the entering and exiting of Qi and fluids in the joint capsules: this contributes to irrigating and lubricating the synovial membranes.

To summarize, the body cavities are:

the chest cavity
the abdominal cavity
the pelvic cavity
the joint capsules
the space between the skin and muscles
the space above the diaphragm
the spaces in between the Membranes
the spaces between the Membranes and the abdominal cavity.

The Triple Burner’s function of controlling waterways, that of governing the movement of Qi and that of controlling cavities are all inter-related and depend on each other. For example, the transformation of fluids depends on the ascending/descending and entering/exiting of Qi in the body cavities.

Clinical application
With regard to the Triple Burner governing the body cavities, I would single out two areas of clinical significance.

a) The first is the "space between the skin and muscles", generally referred to as the Cou Li space (although this term encompasses other spaces too). This is the space where the Wei Qi circulates and where sweat is. We should not interpret "space between skin and muscles" in a strict, Western, anatomical sense: it is not literally the space between skin and muscles in an anatomic sense but in an energetic sense. It is the Exterior of the body where Wei Qi circulates and where the Luo channels course.

The Triple Burner regulates the entering and exiting of Wei Qi and sweat in and out of this space and when its function is normal, sweating is physiological (not too much not too little), Wei Qi circulates normally and protects from invasions of external pathogenic factors. When the entering of Qi prevails over the exiting of Qi, the Cou Li space is said to be "tight" or "closed": when this happens, the person does not sweat enough and, if he or she succumbs to an invasion of Wind, they will not sweat and will have a temperature. When the exiting of Qi prevails over the entering of Qi, the space is said to be "lax" or "open" or "not consolidated". When this happens, the person will suffer from spontaneous sweating and if they suffer an invasion of Wind, they will not have a temperature. They will also be prone to invasions of Wind.
To regulate the Cou Li space one needs to regulate the Triple Burner and the Wei Qi with points such as LU-7 Lieque, LU-9 Taiyuan, L.I.-4 Hegu, ST-36 Zusanli and BL-13 Feishu.
For example, to consolidate the Cou Li space one can use LU-9 Taiyuan, L.I.-4 Hegu, BL-13 Feishu and ST-36 Zusanli. To "relax" the Cou Li space, one can use LU-7 Lieque and L.I.-4 Hegu.

b) The second area of clinical significance is the Qi movement in the abdomen. As discussed above, the abdomen contains the Membranes (Huang) which are the structures that are in between the organs and between these and the skin. When there is stagnation of Qi in the abdomen, this is not only in the channels but also in the Membranes and this contributes to the feeling of distension or fullness of the abdomen.

To regulate the Triple Burner in the abdomen and relax the Membranes, one can use Ren-5 Shimen (Front-Mu point of the Triple Burner), Ren-6 Yuan point of the Membranes (Huang) and BL-22 Sanjiaoshu (Back-Shu point of the Triple Burner).

5) The Triple Burner as a three-fold division of the body
Chapter 31 of the Nan Jing that describes the Triple Burner as the "avenue of water and food" also describes the three divisions of the body: "The Triple Burner is the avenue of water and food, and the beginning and end of Qi. The Upper Burner extends from below the heart and diaphragm up to the mouth of the stomach; it is charge of receiving and it does not discharge. It is treated via the Tan Zhong point [Ren-17] which is 1 cun and 6 fen below the point Yu Tang that is in between the breasts. The Middle Burner is located at the central duct of the stomach [Zhongwan]; it does not extend any further up or down; it controls the processing of water and food and it is treated at the sides of the umbilicus [ST-25?]. The Lower Burner starts above the upper opening of the bladder; it separates the clear from turbid; it controls discharge and it does not intake; it acts as a transmitter. It is treated one inch below the umbilicus [Ren-6 or Ren-5?]. Hence, one speaks of a Triple Burner. It collects at Streets of Qi [Qijie, ST-30].

Chapter 18 of the Ling Shu also describes the three-fold division of the body into three Burners: "The Upper Burner comes out from the mouth of the stomach, it runs along the gullet, passes the diaphragm and spreads in the chest. The Middle Burner comes out at the stomach. The Lower Burner comes out at the lower end of the small intestine and pours into the bladder."

The three-fold subdivision of the body is discussed in several passages of the Nan Jing in conjunction with pulse diagnosis, i.e. assigning the three pulse positions cun, guan and chi to the Upper, Middle and Lower Burner respectively. The Mai Jing (Pulse Classic) also has the same assignment of pulse positions: "The Cun position governs the Upper Burner including the skin and hair up to the hands; the Guan position governs the Middle Burner including the abdomen and back; the Chi position governs the Lower Burner and the lower abdomen up to the feet."

Chapter 18 of the Nan Jing says practically the same: "The Cun position is ruled by Heaven and reflects diseases from the chest to the head; the Guan position is ruled by Person and reflects diseases between the diaphragm and umbilicus; the Chi position is ruled by Earth and reflects diseases from the umbilicus to the feet."

1. Cited in Wang Xue Tai 1988 Great Treatise of Chinese Acupuncture (Zhong Guo Zhen Jiu Da Quan), Henan Science Publishing House p. 46.
2. Wang Xin Hua 1983 Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan), Jiangsu Scientific Publishing House, p. 161.
3. Ibid., p. 159.

E-PETITION FOR OUR FREEDOM TO USE HERBAL MEDICINES

2011-10-18T23:25:00.000-07:00

The UK Government has set up a website inviting individuals to post e-petitions. When a petition reaches 100,000 signatures, it must be discussed by the House of Commons. As you know, the Traditional Herbal Medicinal Products Directive by the European Union entered into force on 30 April 2011. While the Directive sounds "reasonable" in that it offers registration for herbal remedies, such registration is not open to remedies with more than 2-3 ingredients, which therefore eliminates all Chinese herbal remedies. Moreover, even if registration were available, the cost is absolutely prohibitive making it out of reach of small or medium-sized herbal companies.

Although the European Directive is in force and the UK government itself cannot repeal it, it is perfectly within the UK government's right to simply refuse to implement it or to "quietly" ignore it: after all, this is exactly what the majority of European countries are doing (luckily for us).

The following is the text of the e-petition (which need to be kept short):

The Traditional Herbal Medicinal Products Directive (THMPD) by the European Union entered into force on 30 April 2011. This Directive effectively bans perfectly safe herbal medicines taking away the public’s freedom to choose the treatment they want. The Government should announce that it will not implement this needless European Directive.

Click here to see and sign the petition.

If you are in the UK, I would be grateful if you could sign the e-petition and ask your family, friends and patients to do the same: it would be a powerful signal if we could reach the goal of 100,000 signatures.

THE TRIPLE BURNER (3)

2011-09-25T17:35:00.000-07:00

In the last Clinical Tip (September 2011) we discussed the role of the Triple Burner as the avenues of fluids, a view deriving primarily from the Nei Jing. In the previous Clinical Tip (August 2011), we discussed that of the Triple Burner as the agent of the Yuan Qi, a view deriving primarily from the Nan Jing. We shall now discuss the view of the Triple Burner in relation to the movement of Qi.

3) The Triple Burner governing movement of Qi
Chapter 38 of the Nan Jing mentions the function of the Triple Burner in governing all Qi in the body. “The Triple Burner stems from the Yuan Qi; it governs all Qi in the body, it has a “name but no form”, it belongs to Hand Shao Yang, it is an external Fu.”1

This short passage summarizes most of the aspects of the Triple Burner:
1) It stems from the Yuan Qi (discussed in the August Clinical Tip).
2) It governs all Qi of the body (we shall see how below).
3) The Triple Burner has “a name but no form”, i.e. it is not an actual organ but a function.
4) It pertains to the Shao Yang with the Gall-Bladder.
5) It is a Fu.

Let us explore now the meaning of the Triple Burner governing the movement of Qi. The movement of Qi in general is called the “Qi Mechanism” (Qi Ji 气机). This Qi Mechanism consists in the ascending/descending and entering/exiting of Qi in different places and different organs. Each organ has a particular direction of flow of Qi, e.g. Spleen-Qi ascends while Stomach-Qi descends. In each channel, Qi flows in an upward or downward direction. As acupuncturists, we are very familiar with the ascending/descending movement of Qi.

We use this movement every time we insert a distal and a local point to treat a particular problem along a channel. For example, when we use L.I.-1 Shangyang (for example) and L.I.-15 Jianyu to treat a pain in the area of the acromio-clavicular articulation of the shoulder, we are making use of the ascending/descending movement of Qi along the Large Intestine channel. By stimulating the ascending/descending movement of Qi in the channel, we are removing the obstruction and therefore the pain.

We are somewhat less familiar with the “horizontal” movement of Qi, i.e. entering and exiting of Qi. Qi enters and exits in and out of various structures and organs. For example, Qi enters and exits the space between skin and muscles, the Membranes, the joint capsules, and all other cavities. Moreover, Qi “enters and exits” in every part of the body among the Tai Yang, Shao Yang and Yang Ming and among the Tai Yin, Jue Yin and Shao Yin.

Take the shoulder as an example. On the scapula we have Tai Yang (Small Intestine channel), on the lateral side of the arm we have the Shao Yang (Triple Burner channel) and further forward the Yang Ming (Large Intestine channel). Within this zone of the body, the Tai Yang area is on the most Yang area (the scapula), the Yang Ming on the most Yin area (because it is near the Lung channel) and the Shao Yang in the middle: this ties in with the view that the Tai Yang “opens onto the Exterior”, the Yang Ming “opens onto the Interior” and the Shao Yang is “the hinge”. Exactly the same reationship exists in the Yin between Tai Yin (most exterior of the Yin), Jue Yin (the hinge) and Shao Yin (most interior of the Yin).

The “Avenues of Qi” (Qi Jie 气街) described in chapter 52 of the Ling Shu are another example of the entering and exiting of Qi (“horizontal movement of Qi”): “In the chest Qi has streets; in the abdomen Qi has streets; in the head Qi has streets; in the lower legs Qi has streets. Therefore if [there is a problem with] Qi in the head, stop it at the brain; if [there is a problem with] Qi in the chest, stop it at the front of the chest and at the Back-Shu points; if [there is a problem with] Qi in the abdomen, stop it at the Back-Shu points and at the Chong Mai on the right and left of the umbilicus which is the Moving Qi [or Dong Qi]; if [there is a problem with] Qi in the lower legs, stop it at ST-30 Qichong [here called Qijie] and at BL-57 Chengshan.”2
Notice how it recommends the use of points in the front and the back for each area: in the chest, use the front of the chest and Back-Shu points; in the abdomen Back-Shu points and Chong Mai points; in the legs, ST-30 (front of leg) and BL-57 (back of leg). This suggests a “horizontal” movement of Qi within each area.

The Triple Burner controls the ascending/descending and entering/exiting of Qi in the Qi Mechanism. One of the words most frequently used in Chinese books to describe this function of the Triple Burner is tong 通 which means “free passage”, “to pass through”, “penetrate”: this describes the function of the Triple Burner in ensuring that Qi passes through in the Qi Mechanism, in all the cavities and in all organs. This whole process is called “Qi Transformation by the Triple Burner”: the result of the Qi transformation is the production of Nutritive-Qi (Ying Qi), Defensive-Qi (Wei Qi), Blood and Body Fluids. That is also why the Triple Burner is said to control “all kinds of Qi”.

The “Central Scripture Classic” (Zhong Zang Jing, Han dynasty) says: “The Triple Burner is the three original Qi of the body, it is the Yang organ of clear [Qi], it controls the 5 Zang and 6 Fu, Ying Qi and Wei Qi, the channels and the Qi of the interior and exterior, left and right, above and below. When the Qi of the Triple Burner has free passage, Qi passes freely into interior, exterior, left, right, above and below. The Triple Burner irrigates the body, harmonizes interior and exterior, benefits the left and nourishes the right, it conducts upwards and descends downwards.”3

As mentioned in the previous Clinical Tip, chapter 66 of the Nan Jing also confirms that the Triple Burner controls the movement of Qi in general: “The Triple Burner makes the Yuan Qi separate [into its different functions] and it controls the movement and passage of the 3 Qi [of the Upper, Middle and Lower Burner] through the 5 Zang and 6 Fu.”4 The “3 Qi” are the Qi of the Upper, Middle and Lower Burner: apart from referring generally to all the types of Qi in each Burner, this passage also refers specifically to the Gathering Qi (Zong Qi) in the Upper, Nutritive-Qi (Ying Qi) in the Middle and Defensive-Qi (Wei Qi) in the Lower Burner. Although the Defensive-Qi exerts its influence primarily in the Upper Burner and the superficial layers of the body (the space between skin and muscles), it originates in the Lower Burner from the Ming Men. Chapter 18 of the Ling Shu says: “Ying Qi originates from the Middle Burner; Wei Qi originates from the Lower Burner.”5

Chapter 38 of the Nan Jing also confirms that the Triple Burner exerts its influence on all types of Qi: “The Triple Burner stems from the Yuan Qi: it supports all of the Qi.”6 Chapter 31 confirms the influence of the Triple Burner on the movement of Qi in all parts of the body: “The Qi of the Triple Burner gathers in the avenues of Qi [Qi Jie]”.7 This means that the Triple Burner is responsible for the free passage of Qi in all channels but also all structures (such as cavities) of the body.

Thus, the Triple Burner’s function in governing the movement of Qi is quite similar to the Liver’s free flow of Qi and indeed, there are many similarities. With regard to the movement of Qi, it is useful to compare and contrast this function of the Triple Burner with those of Liver in ensuring the free flow of Qi.

The Liver ensures the free flow of Qi and this aids the ascending and descending of Qi in all organs, and especially in the Stomach, Spleen and Intestines: the Triple Burner's influence on the ascending/descending and entering/exiting of Qi extends to all organs. Moreover, the Triple Burner controls the entering and exiting of Qi in all parts of the body and especially the body cavities: the Liver has no such function in relation to the body cavities.

Clinical application
As the Triple Burner controls the movement of Qi in the Qi Mechanism. Its points may be used in a similar way to the Liver points to ensure the free flow of Qi. The main point I use to move Qi in the Triple Burner is TB-6 Zhigou.

1. Nanjing College of Traditional Chinese Medicine 1979 A Revised Explanation of the Classic of Difficulties (Nan Jing Jiao Shi). People’s Health Publishing House, Beijing, first published c. AD 100, p. 94.
2. 1981 Spiritual Axis (Ling Shu Jing). People’s Health Publishing House, Beijing, first published c. 100 BC, p. 111.
3. Hua Tuo 1985 Classic of the Central Scripture (Zhong Zang Jing), Jiangsu Science Publishing House, Nanjing, p. 39. Written in Han dynasty.
4. Classic of Difficulties, p. 144.
5. Spiritual Axis, p. 52.
6. Classic of Difficulties., p. 94.
7. Ibid., p. 80.

The famous chapter 8 of the Ling Shu

2011-09-18T16:57:00.000-07:00

Chapter 8 of the Ling Shu (entitled Ben Shen 本神) is quoted very frequently, especially its famous opening sentence. I would like to comment briefly on that sentence and propose a different translation of it.

The opening sentence of chapter 8 of the Ling Shu is: Fan ci zhi fa, xian bi ben yu shen 凡刺之法先必本于神 and the words mean literally “every needling’s method first must be rooted in Shen”. This sentence is usually translated as: “All treatment must be based on the Spirit”. The implication of this sentence is that all treatment must be based on the Spirit (of the patient), whatever interpretation we give to the word “Spirit”.

I propose an alternative translation with two important differences. Firstly, the text uses the word ci which means “to needle”, not “to treat”. If the text had meant to use the term “to treat”, it would have used the word zhi 治which does occur a lot in both the Su Wen and the Ling Shu. Thus, the first difference is that the first half of the sentence is “when needling” rather than “when treating”: this is an extremely important difference.

The second difference is that the “Shen” referred to here may be interpreted as the Shen of the practitioner, not of the patient. Therefore, the whole sentence would mean: “When needling, one must first concentrate one’s mind [Shen]”. If that “Shen” is the Shen of the practitioner, then “Mind” would be a better translation here.

There are other passages in the Nei Jing that would support this view. For example, chapter 4 of the Ling Shu uses the word “shen” to mean the doctor’s skill in palpation and needling. It says: “When pressing on a channel [the doctor is capable of] understanding the disease: this is called shen.”

This different interpretation of the opening sentence of chapter 8 of the Ling Shu is consistent with two factors. Firstly, the Ling Shu is very much an acupuncture text and therefore the reference to concentrating when needling makes sense. Secondly, the advice to concentrate and focus when needling is also found in many places in the Nei Jing. Indeed, the word “shen” is even used occasionally to mean “needling sensation”. Chapter 16 of the Su Wen says: “In Autumn needle the skin and the space between skin and muscles: stop when the needling sensation [shen] arrives.”

There are many passages in both the Ling Shu and Su Wen that stress the importance of concentrating one’s mind when needling. Indeed, chapter 25 of the Su Wen contains a sentence that is almost exactly the same as the opening sentence of the famous chapter 8 of the Ling Shu. In fact, chapter 25 of the Su Wen contains this sentence: “fan ci zhi zhen, bi xian zhi shen” [凡刺之真，必先治神]. I would translate this so: “For reliable needling, one must first control one’s mind [shen].” Note the rhyming of “zhen” with “shen”.

The English translation of the Su Wen by Li Zhao Guo simply translates this sentence as “The key point for acupuncture is to pay full attention.”1 This interpretation is corroborated by the other paragraphs in that chapter which give advice as to how to practise needling. In fact, it says that the acupuncturist should not be distracted by people around or by any noise.

Unschuld, in his new translation of the Su Wen, translates this sentence as “For all piercing to be reliable, one must first regulate the spirit.”2 This translation would contradict mine but a footnote in the same book reports the interpretation of Wang Bing (the editor of the Nei Jing): “One must concentrate one’s mind and be calm without motion. This is the central point of piercing.”3

The central point that stems from an analysis of the famous opening sentence of chapter 8 of the Ling Shu is how to translate the word “Shen”: in my opinion, the word “Shen” can have many different meanings and only one of them is “Spirit”. Another translation of “Shen” is that of “Mind” which, in my opinion is appropriate in many contexts.

I have mentioned above two possible meanings of “shen” in the Nei Jing, one being the skill of the acupuncturist, the other being the needling sensation. In other passages, “Shen” is closely identified with the Vital Essences of the body: this makes sense given the close integration of body and mind (or spirit) in Chinese medicine. For example, chapter 26 of the Su Wen says: “Blood and Qi are the shen of a person.”4 Chapter 32 of the Ling Shu says: “Shen is the refined Qi of water and grains.”5 Chapter 1 of the Ling Shu says: “Shen is the Upright Qi [Zheng Qi].”6

The next step of this investigation would be to define the nature of “Shen” (Mind or Spirit) in Chinese medicine and how that relates to the ancient Greek or Christian concepts of “Spirit” but this would require a very long enquiry that is beyond the scope of this short piece.

1. Li Zhao Guo (translator) Yellow Emperor’s Canon of Medicine, Library of Chinese Classics, World Publishing Corporation, Xi’an, 2005, p. 335.
2. Unschuld P U and Tessenow H, Huang Di Nei Jing Su Wen – An Annotated Translation of the Huang Di’s Inner Classic – Basic Questions, Vol. I, University of California Press, Berkeley, 2011, p. 428.
3. Ibid., p. 428.
4. 1979 The Yellow Emperor’s Classic of Internal Medicine-Simple Questions (Huang Di Nei Jing Su Wen), People’s Health Publishing House, Beijing. First published c. 100 BC, p. 168.
5. Tian Dai Hua 2005 Spiritual Axis (Ling Shu Jing), People’s Health Publishing House, Beijing. First published c. 100 BC, p. 77.
6. Ibid., p. 3.

THE TRIPLE BURNER (2)

2011-08-30T16:08:00.000-07:00

In the previous Clinical Tip (August 2011) we discussed the nature and functions of the Triple Burner as the activator of the Yuan Qi based primarily on the Nan Jing. In this Clinical Tip, I will discuss the second nature of the Triple Burner, i.e. as a system of waterways which is primarily from the Nei Jing.

2) The Triple Burner as a system of waterways
The view of the Triple Burner as a system of waterways is found primarily in the Su Wen but also in the Nan Jing. From this point of view, the Triple Burner is a Fu organ, i.e. it “has a form”. You will remember that the Triple Burner that is the activator of the Yuan Qi has “no form”, i.e. it is a set of functions and not a Fu organ.

Chapter 31 of the Nan Jing describes the Triple Burner as the “avenue of water and food”: “The Triple Burner is the avenue of water and food, and the beginning and end of Qi. The Upper Burner extends from below the heart and diaphragm up to the mouth of the stomach; it is charge of receiving and it does not discharge. It is treated via the Tan Zhong point [Ren-17]. The Middle Burner is located at the central duct of the stomach [Zhongwan]; it does not extend any further up or down; it controls the processing of water and food and it is treated at the sides of the umbilicus [ST-25?]. The Lower Burner starts above the upper opening of the bladder; it separates the clear from turbid; it controls discharge and it does not intake; it acts as a transmitter. It is treated one inch below the umbilicus [Ren-6 or Ren-5?]. Hence, one speaks of Three Burners. It collects at Streets of Qi [Qijie, ST-30]”

This chapter mentions three aspects of the Tripe Burner: first, the Triple Burner as the “avenue of water and food”; secondly, the Triple Burner as the “beginning and end of Qi”; thirdly, the Triple Burner as a three-fold division of the body.

This chapter of the Nan Jing clearly relates the Three Burners to a system of food and fluid digestion, transportation, transportation and excretion. Therefore this function of the Triple Burner would encompass that of the Stomach, Intestines and Bladder. Note that this function of the Triple Burner really has little to do with the Triple Burner channel in the arm: in other words we do not stimulate the transportation, transformation and excretion of food and fluids through the Triple Burner channel but mostly through Ren Mai points: Ren-17 Shanzhong for the Upper Burner, Ren-12 Zhongwan for the Middle Burner and Ren-5 for the Lower Burner. Of course, there are other points too that affect the digestion function of the Triple Burner, such as ST-25 Tianshu for example. These will be listed below.

From the point of view of the Triple Burner as the organ of transformation of fluids and food, there is therefore a convergence of views between the concept of Triple Burner in the Nei Jing and that in the Nan Jing, i.e. between the Triple Burner as an organ and the Triple Burner as a function, even though the starting point of these two classics is different. However, the Nei Jing emphasizes the role of the Triple Burner in its “letting out” function, seeing the three Burners as three avenues of excretion or “letting out”. The Nan Jing, on the contrary, places emphasis on the function of “receiving”, “rotting and ripening” and “excretion” of food and fluids, seeing digestion as a process of “Qi transformation” activated by the Yuan Qi through the intermediary action of the Triple Burner.

Chapter 8 of the “Su Wen” which describes the functions of all the Internal Organs comparing them to “officials”, says: “The Triple Burner is the official in charge of ditches”. This means, that just like the government official who is in charge of irrigation, the Triple Burner is responsible for the transformation, transportation and excretion of fluids. This is one of the most important functions of the Triple Burner. The terms used in Chinese in connection with the Triple Burner influence on the body fluids are often shu which means “free flow” and tong which means “free passage”. Therefore the Triple Burner is like a system of canals and waterways to channel irrigation water through the proper fields and then out: this ensures that body fluids are transformed, transported and excreted properly.

The Triple Burner function in relation to body fluids is closely dependent on its function of controlling the transportation and penetration of Qi (see point 3 below). As described below, the Triple Burner influences the ascending/descending and entering/exiting of Qi in the Qi Mechanism: it is the coordinated and harmonized ascending/descending and entering/exiting of Qi in all organs and structures that ensures that the body fluids also ascend/descend and enter/exit in the proper way in all places. Essentially, the transformation and movement of fluids depends on Qi.

The end result of the complex process of transformation, transportation and excretion of fluids leads to the formation of various body fluids in each of the three Burners. The fluids of the Upper Burner are primarily sweat which flows in the space between skin and muscles; those of the Middle Burner are the fluids produced by the Stomach which moisten the body and integrate Blood; those of the Lower Burner are primarily urine and the small amount of fluids in the stools.
I. The Upper Burner is like a mist
The main physiological process of the Upper Burner is that of distribution of fluids all over the body in the space between skin and muscles by the Lungs in the form of fine vapour. This is an aspect of the Lung diffusing function. For this reason the Upper Burner is compared to a “mist”.
The Ling Shu in chapter 30 says: “The Upper Burner opens outwards, spreads the 5 flavours of the food essences, pervades the skin, fills the body, moistens the skin and it is like mist”.

ii. The Middle Burner is like a maceration chamber
The main physiological processes in the Middle Burner are those of digestion and transportation of food and drink (described as “rotting and ripening”) and the transportation of the nourishment extracted from food to all parts of the body. For this reason the Middle Burner is compared to a “maceration chamber” or a “bubbling cauldron”.

The Ling Shu in chapter 18 says: “The Middle Burner is situated in the Stomach . . . it receives Qi, expels the wastes, steams the body fluids, transforms the refined essences of food and connects upwards with the Lungs”.

iii. The Lower Burner is like a ditch
The main physiological process in the Lower Burner is that of separation of the essences of food into a clean and dirty part, with the excretion of the dirty part. In particular, the Lower Burner directs the separation of the clean from the dirty part of the fluids and facilitates the excretion of urine. For this reason the Lower Burner is compared to a “drainage ditch”.

The Ling Shu in chapter 18 says: “Food and drink first enter the stomach, the waste products go to the large intestine in the Lower Burner which oozes downwards, secretes the fluids and transmits them to the bladder”.

Clinical application
There are many points that stimulate the Triple Burner’s transformation and excretion of fluids. I will list them according to each Burner:

- Upper Burner: Ren-17 Shanzhong, LU-7 Lieque, L.I.-6 Pianli, L.I.-4 Hegu, Du-26 Renzhong (also called Shuigou, i.e. “Water ditch”).
- Middle Burner: Ren-12 Zhongwan, ST-21 Liangmen, Ren-9 Shuifen, Ren-11 Jianli, ST-22 Guanmen, BL-20 Pishu.
- Lower Burner: Ren-5 Shimen, BL-22 Sanjiaoshu, ST-28 Shuidao, BL-23 Shenshu, Ren-6 Qihai, SP-9 Yinlingquan, SP-6 Sanyinjiao, KI-7 Fuliu, BL-39 Weiyang.

When fluids stagnate, Dampness, Phlegm or oedema may arise. In order to activate the Triple Burner to move fluids, I activate each Burner using some of the points above, using more points from the Burner where the fluids stagnate. For example, if there is Dampness in the Lower Burner, I would use several points from those of the Lower Burner plus one or two from the Upper and Middle Burner. This usually means that when I stimulate the transformation, transportation and excretion of fluids, I do not hesitate in using more points than I would normally.

For example, if there is Dampness in the Lower Burner causing a urinary problem I would use these points:
- Lower Burner: Ren-3, Ren-5, BL-22, BL-28, SP-9, BL-39.
- Middle Burner: Ren-9.
- Upper Burner: LU-7.

To give an example from the Middle Burner, if there was Phlegm in the Stomach, I would use these points:
- Middle Burner: Ren-12, Ren-9, ST-21, BL-20, Ren-11.
- Upper Burner: L.I.-4.
- Lower Burner: ST-40, SP-9.

END NOTES
1. 1979 The Yellow Emperor’s Classic of Internal Medicine-Simple Questions (Huang Ti Nei Jing Su Wen). People’s Health Publishing House, Beijing, first published c. 100 BC, p. 59.
2. Medicine Treasure cited in Wang Xin Hua 1983 Selected Historical Theories of Chinese Medicine (Zhong Yi Li Dai Yi Lun Xuan). Jiangsu Scientific Publishing House, p. 2.
3. 1981 Spiritual Axis (Ling Shu Jing). People’s Health Publishing House, Beijing, first published c. 100 BC, p.71.
4. Selected Historical Theories of Chinese Medicine, p. 2.
5. Spiritual Axis, p. 52
6. Selected Historical Theories of Chinese Medicine, p. 2.
7. Spiritual Axis, p. 52

New UK regulations and quality controls

2011-08-21T11:10:00.000-07:00

On reading of the new rules imposed on practitioners by the MHRA in the UK, it is obvious that these have little to do with Quality Controls of herbal remedies or with the “protection” of the public. For example, it is a new rule that the practitioner, not the patient, must pay for any prescription ordered. What has this got to do with quality controls? Be careful, if you let a patient pay a supplier for their herbs, the Government may raid your premises for such a crime!

Furthermore, practitioners are allowed to make up tablets in their own dispensaries but they cannot buy tablets made by herbal manufacturers. Surely, the GMP quality controls applied by herbal manufacturers are better than those of individual dispensaries? Also, a practitioner cannot buy any product for external use from herbal manufacturers but they can make up their own.

These new regulations have little to do with the “protection” of the consumer and more to do with the need of “regulatory” agencies to regulate and of drug companies to eliminate any competition from herbal remedies (no matter how small).

The restrictions imposed on individuals are even worse than those imposed on practitioners. An individual cannot buy a so-called unlicensed herbal medicine on the Internet and it is illegal for an individual to buy a herbal remedy from a country outside the EU. This is totally outrageous: how can a Government agency stop me from choosing the treatment I want?

It is time that we let our elected representatives know what we think of this.

North Korea?

2011-08-21T10:02:00.000-07:00

It is illegal to ask a herbal supplier to send a prescription to a patient...a practitioner must not order anything that is made into tablets...a practitioner can order a custom prescription but it must sent to the practitioner....and at the same address where the consultation took place...the prescription must be put in another bag or container....the practitioner, not the patient, must pay the herbal supplier....the patient should not pay the supplier directly...external oils, liniments and herbal plasters need either a medicine licence or a traditional herbal medicine registration...it is illegal to buy an “unlicensed” medicine on the Internet...you cannot give a patient a prescription which they then buy on the Internet...it is illegal to buy a herbal medicine from a country outside the EU...the Medicines and Healthcare Products Regulatory Agency (MHRA) will police practitioners...legal action may be taken if you are found to be breaking the law...

North Korea? No, the UK.

Obstetrics and Gynaecology in Chinese Medicine - 2nd edition

2011-08-20T16:56:00.000-07:00

We are pleased to announce the publication of the second edition of Obstetrics and Gynaecology in Chinese Medicine by Giovanni Maciocia.

Obstetrics and Gynaeclogy in Chinese Medicine is a complete and detailed textbook of this speciality in Chinese medicine with the pattern diagnosis and treatment with acupuncture and Chinese herbs. The author bases his exposition on modern and ancient Chinese books, always integrated with his long clinical experience. The book deals in depth with gynaecological disorders, diseases of pregnancy and diseases after childbirth. It is complemented by a chapter on childbirth written by an experienced midwife/acupuncturist practising in the busy maternity unit of a UK hospital.

The book deals with the diagnosis and treatment of 64 women's disorders including menstrual irregularities, diseases during pregnancy and diseases after childbirth.

The second edition has been completely revised and new formulae added; in addition, the author discusses the diagnosis and treatment of endometriosis, polycystic ovary and myoma.

www.giovanni-maciocia.com/books/english/obstetrics.html

www.amazon.com/Obstetrics-Gynecology-Medicine-Giovanni-Maciocia/dp/0443104220/ref=sr_1_1?ie=UTF8&qid=1313884728&sr=8-1

REMEDY OF THE MONTH: CLEAR YANG

2011-08-20T12:50:00.000-07:00

The remedy Clear Yang is a variation of the formula Ban Xia Bai Zhu Tian Ma Tang (Pinellia-Atractylodes-Gastrodia Decoction). The original formula is for Wind-Phlegm, i.e. a combination of internal Wind and Phlegm. The variation Clear Yang is aimed primarily at subduing Liver-Yang and resolving Phlegm and secondarily, at nourishing Blood and tonifying the Kidneys.

The combination of these patterns, Liver-Yang rising, Phlegm, Blood deficiency and Kidney deficiency is very common in middle-aged or elderly people. One of the characteristics of Phlegm (which, incidentally, sets it apart from Dampness) is that it is always moving and follows Qi in its movements. Therefore, when there is Liver-Yang rising towards the head, Phlegm follows it to the head.

Another characteristic of Phlegm (which also distinguishes it from Dampness) is that it obstructs the orifices. Obstructing the eyes, it causes blurred vision (which is not always due to Liver-Blood deficiency); obstructing the nose, it causes a blocked nose; obstructing the mouth, it causes a sticky taste; obstructing the ears, it may cause tinnitus; obstructing the Brain, it causes dizziness, heaviness and muzziness (fuzziness).

Therefore, the two main symptoms addressed by this remedy are headaches and dizziness (deriving from Liver-Yang rising and Phlegm). In my experience, the combination of these patterns is the most common cause of chronic headaches and migraine in middle-aged and elderly people. Typically, this person would suffer from two types of headaches: there would be a persistent dull headache (from Phlegm) punctuated by episodes of severe, throbbing headaches (from Liver-Yang rising).

Please note that there must not necessarily be headaches in order to prescribe this remedy: I frequently use it purely for dizziness in the elderly.

Other symptoms of Phlegm that may appear are also nausea and expectoration of phlegm. The tongue is Swollen and with a sticky coating; the pulse is Slippery on the whole and it may be Weak on the Kidney positions.

There are two main differences between Clear Yang and the formula from which it is derived (Ban Xia Bai Zhu Tian Ma Tang). Clear Yang:
1) Nourishes Blood and tonifies the Kidneys (which the classical formula does not do)
2) Has a stronger action in eliminating Phlegm from the Brain and opening the Mind’s orifices (with Shi Chang Pu Rhizoma Acori tatarinowii and Yuan Zhi Radix Polygalae).

Liver-Yang rising towards the head of course causes primarily headaches and dizziness and these are the two main symptoms addressed by Clear Yang.

All the Three Treasures and Women’s Treasure remedies are discussed in detail in the presentations that can be found on http://www.maciociaonline.com/.

The following are three tongues that may be appropriate to this remedy. They are all swollen indicating Phlegm. The first is pale while the other two are red on the sides (indicating Liver-Yang rising).

Recordings of webinars on the clinical use of the Three Treasures

2011-08-20T11:42:00.001-07:00

The Use of the Three Treasures Remedies in Clinical Practice: a series of webinars by Giovanni Maciocia for Eastern Currents.

Giovanni conducted a series of webinars on the clinical application of the Three Treasures and Women’s Treasure remedies for Eastern Currents. Recordings of these webinars can be found on:

www.easterncurrents.ca/seminars/giovanni_maciocia_webinar_series.php

Topics covered so far include:

Depression
Digestive disorders
Endometriosis
Polycystic Ovary Syndrome
Headaches
Menorrhagia/metrorrhagia (Beng Lou)