Moxabustion and Cancer

June 16, 2009 by  
Filed under Chinese Medicine Articles

Moxa and Cancer Traditional Chinese Medicine Case Study

Shanghai Research Institute

by Zhao Cuiying, Chen Yunfei, Zhao Jiazeng, Chen Hanping, Zhang Yingying, and Hong Xian (Shanghai Research institute of Acupuncture and Meridian, Shanghai 200030, China)

moxaAbstract: In the study, the antitumor effect was observed by employing HAC-tumor-bearing mice treated with direct moxibustion on point Guanyuan(CV 4 ) (Group M), subcutaneous administration of liposome encapsulated immunomodulators called IMC(Group IMC), and combination of these two methods (Group M + IMC). Parameters reflecting biological characteristics of tumor cells, including 5 kinds of lectins, mitotic cycle, expression of C-erbB-2 oncogene and counts of AgNORs were further investigated. The results showed that treatment with combination of moxibustion and IMC could significantly lower three lectins (ConA, LCA, RCA) among these five lectins (BSL, ConA, LCA,RCA, WGA), significantly reduce the expression of C-erbB-2 oncogene, the counts of AgNORs and the percentage of phase S in HAC tumor cells (compared with Group IMC). Moxibustion or IMC alone did render a certain degree of influence on the above-mentioned parameters, although most of changes were not statistically significant. The above-mentioned results indicated that the antitumor efficacy achieved by treatment with combination of moxibustion and IMC was mainly through its influence on biological characteristics of the tumor cells, namely, its reducing effect on DNA synthesis or on the proliferating rate of tumor cells and its influence on other biological characteristics of tumor cells.

Key Words: Moxibustion, Immunomodulation, Cytobiology

In the past, most of studies on the mechanism of antitumor action of moxibustion and acupuncture usually paid less attention to the influence of cytobiology. As a matter of fact, the development of cancer in host is a rather complicated biological process. In one hand, it is depended on biological character of tumor cell itself, in the other hand, it has a close relationship with the action or reaction between host and tumor, reflecting both sides of struggle statement between the vital energy and pathogenic factors. As the action of acupuncture and moxibustion shows synchronous regulation with multiways, multi-segment and multi-layers. Therefore in addition to studies on the side of immunology, it is relatively important to further investigate the influence of cytobiology which would promote the efficacy of antitumor effect and popularize its clinical practice.

Materials and Methods

Animals: Female C57BL/6 mice were obtained from the small animal section, Chinese Academy of Sciences (Shanghai ). They were maintained in pathogen-free conditions and were used at age 6-8 weeks.

Tumors: The HAC tumors are MCA-induced ascites carcinoma of C57BL/6 origin. These tumors were generated in our laboratory and were passaged s. c. for seven generations, at which time a cryopreserved vial from the first generation was thawed and transplanted. The single tumor cell were washed in HBSS(Biofluids, MD) counted, and diluted to a concentration of 5 x 105 cells/ml for transplantation. Treatment methods: The HAC-tumor-bearing mice treated with direct moxibustion on point Guanyuan(Group M) (two cones a day for six days, qod. one cone weighs 1. 5 mg). The second mice group treated with subcutaneous administration of liposome encapsulated immunomodulators (Group IMC). The third group treated with these combination of above two methods (Group M + IMC). The control group treated with nothing but the same dose of saline.

Flow cytometry and sorting: Freshly excised tumor tissues(0.5-2 g, wet weight) were minced into pieces smaller than 1 mm3 and washed with PBS. The mixture was poured through double Nitex sheets and harvested suspension. The supernatant was pipetted off. The pellet was placed in whirlpool mixer added with 2 ml absolute alcohol. After the pellet becoming pooled completely, stored at 4oC. Before experiment, the tumor cells should be digested with RNase (100 ug/ml, Sigma Chemical Co. St Louis. Mo) and pepsase (100 ug/ml, Difco Chemical Co. ) and stained with Ethidium Bromide. Then tested by using EPICS-I system of FCS.

Lectin receptor experiment: Preparation of samples: fresh tumor tissues were placed in 10% formalin for fixation. Formal embedding with paraffin, 5 mm serial section. Methods: adoption of enzyme immunoasssay, (ELA).

The expression of C-erbB-2 and AgNORs: The expression of C-erbB-2 refer to references with partly modifications and so did the test for AgNORs.

Results

Tumor cell cycle test: Table I demonstrates that each group show similar statement in phaseG 1, phase G 2 + M, except phase S. In comparison to group IMC, group M + IMC, and group M showed lower percentage of phase S in HAC tumor cells. The changes were statistically significant.

Lectin receptor experiment: The experiment covers 12 kinds of lectins’ binding with tumor cells. Among them, positive binding percentage range from 70%-100%, the other shows lower percentage (0-10 % ). Each group demonstrates different reaction to the binding percentage of tumor cells. The lowest binding percentage of tumor cells takes place in group M+ IMC. The expression of oncogene: According to table 3 the expression of oncogene was reduced in every group, however, the lowest one was group M + IMC. The changes were statistically significant. AgNORs in each group were similar to the expression of C-erbB-2 oncogene, that is to say, group M + IMC was the lowest one which had statistically significant changes.

Table 1. The Percentage of Tumor Cell Cycles

——————————————————————————–

Phase

Group

n

——————————————————————————–

Phase G1 Phase S Phase G2+M

PI

——————————————————————————–

TB 5 33.9¡À4.1 58.3¡À 4.1 7.8¡À3.8 66.1¡À 4.1

M 6 34.2 ¡À4.3 56.9¡À4.5* 8.9¡À1.6 65.8¡À 4.3

M+IMC 5 37.9¡À6.2 53.8¡À4.7** 8.3¡À 6.8 62.1¡À 6.2

IMC 5 29.3¡À6.2 62.7¡À3.8 8.0¡À6.1 70.7¡À 6.2

——————————————————————————–

Table 2. The Changes of Lectin Receptors in Each Groups

——————————————————————————–

BSL CoA LCA RCA WGA

Group n

——————————————————————————–

£­ + + + £­ + + + £­ + + + £­ + + + £­ + + +

——————————————————————————–

TB 10 0 7 3 0 5 5 3 2 5 1 3 6 1 3 6

M 10 2 6 2 1 4 5 6 4 0c 2 5 3 1 7 2

M+IMC 10 5 3 2 5 4 1ab 7 3 0d 5 4 1ef 0 9 1

IMC 9 3 5 1 1 6 2 5 4 0 0 7 2 3 3 3

——————————————————————————–

Table 3. The Expression of C-erbB-2 and AgNORS

——————————————————————————–

Group n C-erbB-2

AgNORS

£­ + (granule/nuclear mean)

——————————————————————————–

TB 9 0 9 2.50¡À 0.70 (n=10)

M 10 2 8 2.60¡À 0.75(n=8)

M+IMC 10 5 5* 2.32¡À 0.59(n=9)#

IMC 9 2 7 3.04¡À 0.71(n=8)

——————————————————————————–

* Compared with group TB, P<0,05. # Compared with group IMC, P<0,05

Discussion

Animal experiment research indicated that there was a connection between the high expression of lectins receptors and hepatic carcinoma or metastasis of hepatic carcinoma. According to the result from test of HAC-bearing-mice’s 12lectins receptors, high positive expression was observed in 5 kinds of lectins receptors. The moxibustion had certain low regulation action on its positive expression. The statistically significant decrease in positive expression of 3 kinds of lectins receptors ConA, LCA, RCA among 5 lectins receptors was observed. It indicates moxibustion especially combination of moxibustion and IMC have certain influence on biological characteristics of tumor cells. Further investigation, including the expression of GerbB-2 oncogene, the counts of AgNORs and changes of tumor cell cycle, was observed that group M+IMC had lower expression of C-erbB-2 oncogene in comparison to control group, lower counts of AgNORs compared with group IMC, and the lowest percentage of phase S HAC-tumor cells C-erbB-2 plays an important role in the tumor cell’s process of development, proliferation and differentiation. It also has close relationship with the occurrence and development of tumor cells. Not only does it lead to malignant transformation but has positive correlation with malignant degree in many kinds of tumors. It has been proved that C-erbB-2oncogene had some correlation with the recurrence and metastasis of adenocarcinoma of breast and lung. The intranuclear transcription level, the number of ploidy and proliferation cycle could be observed through the technique of AgNORs. It would be helpful not only for the diagnosis of benign or malignant tumor, but also for the biological characteristics of tumor cells.

In sum, group moxibustion, especially group M+IMC, has certain antitumor effect, in that it could change the biological characters of tumor cell including speed of synthesis or proliferation, development, the degree of malignance, and other biological behaviors.

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Dysmenorrhea

November 6, 2008 by  
Filed under Chinese Medicine Articles

An Overview of the Pathogenisis and Therapeutics of Dysmenorrhea

by John Ryan Wahnish, D.Ac., L.Ac.

Western Overview and Approach

Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary.

primary dysmenorrhea – Primary dysmenorrhea is menstrual pain associated with ovular cycles in the absence of pathological findings. From the beginning and usually lifelong; manifestation is severe and frequent menstrual cramping caused by severe and abnormal uterine contractions. Pain generally develops one or two years after the first menarche and may progressive get worse with time.

secondary dysmenorrhea – due to some organic cause and usually of later onset; painful menstrual periods caused by another medical condition present in the body (i.e., pelvic inflammatory disease, endometriosis).

The cause of dysmenorrhea depends on whether the condition is primary or secondary. In general, women with primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid — both chemicals which control the contractions of the uterus). Secondary dysmenorrhea is caused by other medical condition. Most often endometriosis is the root problem.  This is a condition in which tissue that looks and acts like endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity – often resulting in internal bleeding, infection, and pelvic pain. Other possible causes of secondary dysmenorrhea include pelvic inflammatory disease (PID), uterine fibroids, abnormal pregnancy, infection, tumors, or polyps in the pelvic cavity.

While any woman can develop dysmenorrhea, the following women may be at an increased risk for the condition: women who smoke, women who drink alcohol during menses (alcohol tends to prolong menstrual pain), women who are overweight, women who started menstruating before the age of 11.

The following are the most common symptoms of dysmenorrhea. However, each individual may experience symptoms differently. Symptoms may include cramping in the lower abdomen, pain in the lower abdomen, low back pain, pain radiating down the legs, nausea, vomiting, diarrhea, fatigue, weakness, fainting, and headaches. The symptoms of dysmenorrhea may resemble other conditions or medical problems.

Western Diagnosis begins with a gynecologist evaluating a patients medical history and a complete physical examination including a pelvic examination. A diagnosis of dysmenorrhea can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, diagnostic procedures for dysmenorrhea may include:

Ultrasound – a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.

Magnetic resonance imaging (MRI) – a non-invasive procedure that produces a two-dimensional view of an internal organ or structure.

Laparoscopy – a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.

Hysteroscopy – a visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.

Counseling with your physician regarding symptoms may increase understanding and lead to activities for stress management.  Other possibilities include surgical and medical treatment protocols for managing dysmenorrhea. This treatment may include: prostaglandin inhibitors (i.e., nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin, ibuprofen) – to reduce pain, acetaminophen, oral contraceptives (ovulation inhibitors), progesterone (hormone treatment), dietary modifications to increase protein and decrease sugar and caffeine intake, vitamin supplements, regular exercise, heating pad across the abdomen, hot bath or shower, abdominal massage, endometrial ablation – a procedure to destroy the lining of the uterus (endometrium), endometrial resection – a procedure to remove the lining of the uterus (endometrium), hysterectomy – surgical removal of the uterus . In the future it is my hope that more and more physicians will refer patients to an Acupuncturist/Herbalist before resorting to their other possibilities.

TCM Overview

Dysmenorrhea (Tong Jing) is a gynecological disorder characterized by cramping pains in the lower abdomen proceeding, during or following menstruation. At times, the pain may radiate to the lower back or sacral region. Fainting may occur with severe pain. The pathology of dysmenorrhea is the impairment of Qi and Blood. The main organs involved are the Liver, Kidney and Spleen. The main channels involved are the Ren and the Chong. Patients with vacuous patterns will experience more pain after the period. The pain will be have a dull quality that is better with pressure. Patients with excess patterns will have more severe pain before the period. The pain is severe and worse with pressure. Frequently patients with excess patterns can have underlying vacuous issues. Although your point selection will be determined by the person in front of you these are some general points used for dysmenorrhea: Ren3, 4, 6, St25(qi), St28(damp), St29 (stasis), Ub32, Ki13, Ki14, Shi Qi Zhui (17th vertebrae point, located below Lumber 5), Pc6, Li4, St36.

TCM Pattern Differentiation

Dysmenorrhea may present as one of these patterns or in combination. Other pattern maybe displaying depending on the individual.

Excess Patterns: More severe pain at the beginning of the period.

  • Coagulation of Cold-Damp: most common.

  • Liver Qi Stagnation and Blood Stagnation

  • Descent of Damp-Heat: uncommon, possibly related to PID (Pelvic Inflammatory Disorder).

Vacuity Patterns: More severe pain following period.

Yang Deficiency with Internal Cold: Kidney and Spleen.

Liver and Kidney Deficiency: Liver (blood), Kidney (essence and qi).

Qi and Blood Deficiency: Mostly Liver and Spleen but can also relate to Lung Heat. Origin may relate to loss of nourishment to the Ren and Chong.

EXCESS

Coagulation of Cold-Damp

Indications

Cold and Pain of the lower abdomen either proceeding or during menstruation; aggravation of pain upon external pressure and some relief with external application of heat; scanty menstrual discharge that is dark in color and contains blood clots; aversion to cold and, occasionally, body aches and pains.
Tongue/Pulse Tongue may present with a white slimy coat. Pulse is deep and tight.
Treatment Method Warm the vessels, dissipate cold, dispel dampness, dispel blood stasis, and relieve pain.
Formulas

Shao Fu Zhu Yu Tang: Lesser Abdomen Stasis Expelling Decoction.

Point Prescription Ren3- excess, St28 – damp, Sp8- xi cleft, Sp6, Ub32, Shi Qi Zhui,  Severe pain add: Ub32, St29.

Liver Qi Stagnation and Blood Stagnation

Indications

Distending pain in the lower abdomen preceding or during menstruation, aggravation of pain with external pressure, difficult menstruation, scanty menstrual discharge that is dark purple in color and contains blood clots, decrease in pain upon expulsion of clots and disappearance of pain with termination of the menstrual period. Some cases may be accompanied by a distended sensation in the chest, hypochondria and breasts.
Tongue/Pulse Tongue is dark with thin whit coat with possible sublingual vein distention. The pulse is deep, wiry, or slippery wiry or choppy.
Treatment Method Soothe the liver, rectify qi, dispel blood stasis, and relieve pain.
Formulas

Ge Xia Zhu Yu Tang: Infra-diaphragmatic Stasis Expelling Decoction

Point Prescription Ren6, Lv3, Sp6, Sp8- pain, Sp10-blood, Ki13-Qi, Ki14-blood, St25-qi, St29-blood, Ub32, Shi Qi Zhui.

Descent of Damp-Heat

Indications

Lower abdomen pain preceding menstruation, aggravation of pain with external pressure accompanied by a burning sensation or distention pain in the lower sacrum. In some cases, there is a recurrent pain in the lower abdomen that becomes more severe with the onset of menstruation. Accompanying symptoms include thick blackish red menstrual discharge containing blood clots, thick yellow leukorrhea, scanty concentrated urine and, in many cases a mild fever.
Tongue/Pulse Tongue is red with yellow slimy coat. The Pulse is rapid and wiry or rapid and slippery.
Treatment Method Clear Heat, dispel dampness, dispel blood stasis, and relieves pain.
Formulas

Qing Re Tiao Xue Tang: Heat Clearing Blood Regulating Decoction.

Point Prescription Ren3, Sp8, St29, Lv3, Ub23, Li4, Ub32, Shi QI Zhui.

VACUITY

Yang Deficiency with Internal Cold

Indications

Cold and Pain of the lower abdomen either during or following menstruation, some relief from pain with external pressure or the application of heat, small volume of dark colored menstrual discharge, weak aching lower back and legs, copious clear urine. The pain has a dull quality. Patients maybe overweight or present with bloating. This pattern is more common with elderly patients.
Tongue/Pulse Tongue has a white moist coat. The pulse is deep.
Treatment Method Warm the channels, warm the uterus, and relieves pain.
Formulas

Wen Jing Tang: Menses warming decoction. Two formulas in this case do share the same name. One of the Wen Jing Tangs is commonly used for amenorrhea nd menstral irregularity. This particular Wen Jing Tangwas first recored in the Jin Gui Yao Lue Fang Lun (Synopsis of Prescriptions of the Golden Chamber).

Point Prescription Ub23, Ren4, St36, Sp6, 10, Ren3, Sp8, Ub32, Moxa.

Liver and Kidney Deficiency

Indications

Indistinct lower abdominal pain either proceeding or following menstruation, some relief from pain with external pressure, thin light colored menstrual discharge, aching lower back and spine, general fatigue, dizzy spells and tinnitus and in some cases tidal fever. Additional signs may present as pail nails, scanty urination or an aching lower back.
Tongue/Pulse The tongue is pale and the pulse is deep and thready or weak and thready.
Treatment Method Supplement the Liver and the Kidney, regulate and rectify the Chong and the Ren, and relieve pain.
Formulas

Tiao Gan Tang: Liver Regulating Decoction

Point Prescription Ub18, 23, Ren4, St36, Ki6, Lv3, 8, St25, Sp6,10.

Qi and Blood Deficiency

Indications

Indistinct lower abdominal pain either proceeding or following menstruation, some relief from pain with external pressure, empty and bearing down sensation in the lower abdomen and pubic regions, scanty menstrual discharge that is light in color and thin in texture, tiredness, fatigue and occasionally dull complexion, loss of appetite or diarrhea.
Tongue/Pulse The tongue is pale and the pulse is weak and thready.
Treatment Method Supplement qi and blood, and relieve pain.
Formulas

Sheng Yu Tang: Additional this formula is good for infertility due to Qi and Blood Deficiency.

Point Prescription Ub23, Ren4, St36, Sp6, Ub32, Du20, Moxa.

Conclusion

When treating a patient with Tong Jing (dysmenorrhea) , do not let all the factors and patterns confuse you. Keep it simple and treat what you see.  A highly respected Doctor once told me, “It’s simple. If they are hot use cold herbs and if they are cold use hot herbs”. I knew it might not be this simple but over thinking the situation can make treating this syndrome tricky as patients tend to manifest with mixed patterns.

Generally, regardless of what pattern you may link to your patient, there will be an emotional factor. Emotional factors or underlying emotional issues might cause the patterns. It is also possible for the pain itself to create an emotional factor.  Calming the shen as well as treating the excess or deficiency pattern will benefit your patient. One may achieve this with the use of herbs, tuina or acupuncture. Also, when your patient is describing their pain, don’t just listen to what they are telling you. Listen to how they are tell you. When people describe their pain they are always telling us more than just the quality of the pain.  A patient’s voice change while they are giving you details is a key to tune into. For example, a patient say’s, “I have pain with my cycle” in a monotone voice. Then you ask the quality of the pain and they reply, “The pain is unbearable.” in a singing, laughing tone. Inappropriate laugher is a sign of the element fire relating to the heart. Now you are tuning into the patients constitution as well as their pathology.

Sources:

Wu, Yan. Practical Therapeutics of Traditional Chinese Medicine. Brookline Massachusetts: Paradigm Publications, 1997.

Maciocia, Giovanni. Obstetrics & Gynecology in Chinese Medicine. New York: Churchill Livingstone, 1999.

Tierney, McPhee, Papadkis. 2001 Medical Treatment and Diagnosis. New York: Lange Medical Books/McGraw-Hill, 2001.

Benskey, D., and Gamble, A.. Chinese Herbal Medicine: Materia Medica Revised Edition. Seattle: Eastland Press, 1993.

Benskey, D., and Barot, R.. Chinese Herbal Medicine: Formulas and Strategies. Seattle: Eastland Press, 1990.

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Respiratory Diseases

November 6, 2008 by  
Filed under Chinese Medicine Articles

Respiratory Diseases by Attilio D’Alberto

Introduction

The aim of this article is to discuss the differences seen in asthma, chronic bronchitis and emphysema in relation to pathophysiology and epidemiology. In addition, the view of Traditional Chinese Medicine (TCM) will be noted.

In general, the function of the airways is to facilitate the movement of gases into and out of the lungs. As the airways branch out from the major bronchi, they decrease in size and lose their cartilaginous support. At the point where the cartilaginous support ceases and the diameter is reduced to 1mm, the bronchi become bronchioles. Rings of smooth muscle joined by diagonal muscle fibers surround the epithelial lining of the bronchioles. Contraction and relaxation of the smooth muscle layer, controls the resistance of airflow through the bronchioles and extends into the wall of the alveolar ducts. The bronchioles are lined with simple columnar and cuboidal epithelium, which contains ciliated and secretory cells. The smooth muscle layer of the bronchioles is innervated and sensitive to chemical mediators. As Porth states (1990, p446) any airway obstruction can result in thickened secretions, spasm of the bronchial smooth muscle, or disease conditions that disrupt the structure of the bronchioles and alveoli.

Asthma, chronic bronchitis and emphysema are all classified as respiratory diseases. As Price and Wilson explain (1992, p548) they all share a common pathophysiological feature: a long duration characterized by an increase resistance to airflow.

Asthma can be divided into two categories, extrinsic or intrinsic. Extrinsic (allergic) asthma is found mainly in children and only in a minority of adult patients. It is caused by the inhalation of pollen, animal dander, mould spores and feather dust. Exposure to these protein-containing allergens even in minute quantities will cause a type I inflammatory response. Intrinsic (idiopathic) asthma is more commonly found in patients over the age of 40 and is triggered by infections, weather changes, emotion, exercise, airborne irritants and drugs such as aspirin (Porth 1990, p448). Both types of asthma are characterized by hypersensitivity of the tracheobronchial tree from external stimuli, leading to constriction of the airways caused by bronchospasm.

Chronic bronchitis and emphysema are classified as chronic obstructive pulmonary diseases (COPD). The most common cause of COPD is cigarette smoking. Chronic bronchitis means a prolonged inflammation of the bronchi. It is a clinical disorder characterized by an excessive production of mucus in the bronchi. It manifests as a chronic cough, with production of phlegm for a minimum of 3 months a year for at least two consecutive years. Emphysema however, can be either centriacinar or panacinar. Centriacinar emphysema mainly occurs in smokers and those already with chronic bronchitis. Panacinar emphysema mainly occurs in the elderly and those with a α¹-antitrypsin deficiency. Both types are characterized by the anatomic alteration of the lung parenchyma with abnormal enlargement of the alveoli and alveolar ducts along with the destruction of the alveolar walls.

Discussion

Asthma is initiated by a type I, IgE immune response. The mast cells of the bronchial tissues release chemical mediators, histamine, slow reacting substance of anaphylaxis, eosinophil chemotatic factors, platelet-activating factors and prostaglandins. These produce bronchial smooth muscle spasm, vascular congestion, an increased vascular permeability, edema, production of thick tenacious mucus and an impaired mucociliary function. When combined with the epithelial cell damage caused by eosinophil infiltration it results in hyper responsiveness of the airways. Referring to figures 1 and 2, the obstruction of the airways by bronchospasm and excessive mucous production increases resistance to airflow especially expiratory. As McCance et al. (1994, p1167) state, the continued trapped air within the lung increases intrapleural and alveolar gas pressure and causes decreased perfusion of the alveoli, with an uneven ventilation-perfusion relationship within the different segments of the lung. This causes early hypoxemia without COâ‚‚ retention, which increases still further hyperventilation through the respiratory system, causing the partial pressure of carbon dioxide in the arterial blood (PaCOâ‚‚) to decrease and pH to increase (respiratory alkalosis).

In Traditional Chinese Medicine (TCM), the pathology of asthma is a combination of phlegm and damp blocking the air passages and impairing the dispersing and descending functions of the Lung (Chen and Li 1996, p188). This impairment of function leads to wheezing, coughing and respiratory obstruction.

Asthma does not discriminate with age and can affect anyone, although the majority of cases are found in children. A sample survey carried out in America during 1996, (http://www.lungusa.org/data/asthma/part2.pdf 25 Nov. 2000) showed that nationally there were 14,596,000 cases of asthma. The figures showed a broad difference between sufferers less than 18 years of age, 4,429,000 (30.3%), to those over 65, 1,445,000 (9.9%). This is contributed to several factors. Individuals who sufferer from asthma will see their respiratory condition either cease or deteriorate into that of chronic bronchitis and emphysema as the attacks become more frequent with age. In addition, new research has shown that the quantity of junk food consumed by children rather than the elderly can cause a greater risk of symptoms. As Seaton (2000, p778) points out a diet that lacks vitamins, nutrients and vegetables will cause a 2-3-fold increase in asthma rates. There were also a higher number of female asthmatics, 8,845,000 (60.5%) than males, 5,751,000 (39.4%). This trend is carried on in chronic bronchitis sufferers.

Chronic bronchitis is characteristic of hypertrophy of the bronchial mucosal glands, an increase in the number and size of goblet cells along with inflammatory cell infiltration and edema of the bronchial mucosa causing excessive mucous production. As McCance et al. (1994, p1167) state, the thick mucous and hypertrophied bronchial smooth muscle obstructs the airways making breathing more difficult, especially expiratory. This trapping of gases in the distal part of the lungs, leads an uneven ventilation-perfusion relationship, hypoventilation, increased PaCOâ‚‚ and hypoxemia. These mechanisms of ball valving, as shown in figure 2, are shared both by asthma and by chronic bronchitis but not emphysema.

In TCM, chronic bronchitis is caused by the weakness of the Spleen and Lung. This results in the impairment of fluid movement and the retention of phlegm. Patients will suffer from syndromes such as a cough, stuffy or runny nose and thin watery sputum (Kaptchuk 1983, p217).

Emphysema can be centriacinar or panacinar depending upon the location. Centriacinar emphysema is characteristic of inflammation of the bronchioles and the destruction of septa within the respiratory bronchioles and alveolar ducts. It mainly occurs in smokers and those already with chronic bronchitis. Whilst panacinar emphysema the whole acinus is involved and is more randomly distributed. It mainly occurs in the elderly and those with a α¹-antitrypsin deficiency. As stated by Porth (1990, p451) alpha-antitrypsin is a proteinase inhibitor; it blocks the action of the proteolytic enzymes that are destructive to elastin and other tissue components in the alveolar wall. This characteristic is only seen in a number of emphysema sufferers. Both types are characterised by the destruction of the alveolar septa, which eliminates parts of the pulmonary capillary bed, increases the volume of air in the acinus and affects airway calibre. This is probably due to the breakdown of elastin within the septa, which makes expiration difficult as the loss of elastic recoil reduces the volume of air that can be expired passively, refer to figure 3. This is different to that of asthma and chronic bronchitis in that tissue damage does not occur, instead inflammation is a common factor. Referring to figure 4 it can be seen that the combination of an increased residual volume and a decreased calibre of the bronchioles will also lead to each part of inspiration being retained in the acinus, and the development of bullae and blebs. This is only characteristic of emphysema sufferers.

In TCM, emphysema is similar to chronic bronchitis. It is caused by external Wind-Cold attacking the Lung, which then develops into Heat. Wind-Heat interferes with the dispersing function of the Lung and allows phlegm to build up. The phlegm blocks the airways and disturbs the normal function of the Lung, giving rise to expectoration of purulent sputum. Patients will often manifest foul smelling sputum flecked with blood (Scott 1984, p7).

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As Price et al. (1992, p550) conclude, chronic bronchitis and emphysema are often found together when patients suffer from COPD. It mainly affects people between the ages of 45 and 65. It usually affects men more than women due to their heavy smoking, although this trend is now reversing as shown in the sample survey carried out in America during 1996 (http://www.lungusa.org/data/copd/copd2.pdf 25 Nov. 2000). Nationally there were 14,150,000 cases of chronic bronchitis, whereas the number of emphysema sufferers was 1, 812,000. As can be seen, there is a higher number of chronic bronchitis sufferers than those of emphysema. This is due to the high number of people who smoke between the ages of 18-44. As the disease progresses throughout their life and is left untreated, it develops into emphysema. In addition, a number of chronic bronchitis patients will die before they reach old age so leaving a lower number of emphysema sufferers. The number of females affected with chronic bronchitis was 8,101,000 (57.3%) compared to the male equivalent of 6,049,000 (42.7%). This is largely a new trend and is probably based upon the fact that more women are now smoking. The number of males affected with emphysema stood at 956,000 (52.5%) whilst the number of females was 866,000 (47.6%). This number of emphysema sex related sufferers’ mimics that of pass trends. This will undoubtedly change in line with chronic bronchitis, as the generation of (predominately female smokers) 18-44 year olds grows older. The age differentiation for chronic bronchitis showed that the largest number were between the ages of 18-44, at 4,904,000 (34.7%). This is due to the heavy smoking of people between the ages of 18-44 and to a lesser degree the quantity of industrial work carried out. This is contrary to that of asthma where the greater percentages of asthmatics are below the age of 18 and do not smoke nor are they exposed to industrial pollutants. However, the highest number of emphysema sufferers was between the ages of 45-64, with 701,000 (38.5%). Emphysema is commonly found in elderly individuals, although it can come secondary to chronic bronchitis and cigarette smoking.

Conclusion

Asthma, chronic bronchitis and emphysema are all characterized by coughing, wheezing dyspnoea and respiratory impairment. This is due to obstruction of the airways that leads to the trapping of gases in the distal part of the lungs. However, in emphysema the retained gas is caused by the breakdown of elastin within the septa. Whereas in asthma sufferers gas retention is caused by bronchoconstriction, whilst in emphysema sufferers gas retention is caused by mucous build up. There is however, an etiological and sequential relationship between chronic bronchitis and emphysema that does not exist with asthma. Asthma is due to an allergic reaction or other factors such as emotion, weather or infections, which triggers bronchoconstriction. Both chronic bronchitis and emphysema are triggered by cigarette smoking and industrial pollutants. Although emphysema may develop in old age or come about from a α¹-antitrypsin deficiency.

As we have seen, asthma is commonly seen in those less than 18 years of age, whilst chronic bronchitis is common between the ages of 18-44 and emphysema is seen mainly in those between the ages of 45-64. There is an additional trend seen in sex related sufferers. There are a higher number of female asthmatics than males. This is reiterated in chronic bronchitis, whilst at present there are a higher number of male emphysema sufferers than female. Although this will undoubtedly change in line with asthma and chronic bronchitis trends as the generation of chronic bronchitis sufferers, deteriorate into old age.

References

Chen, S.Y. & Li, F. (1996). A Clinical Guide to Chinese Herbs and Formulae. Edinburgh: Churchill Livingstone.

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Acupuncture and Emotion

November 6, 2008 by  
Filed under Chinese Medicine Articles

Acupuncture and Emotion by Charles Yarborough, L. Ac.

Several decades ago, the concept of personality as a predictive factor in disease was formally introduced to the West. Appreciation of the Type-A personality, with its hostility, its hurried mindset and polyphasic thinking, drew widespread attention to emotion as a factor in the genesis of disease. Subsequently, another illness-prone personality type-Type D-was recognized by its characteristic suppressing of negative emotions. Western clinical researchers in recent years have scrutinized the relationship between emotion and illness. Can negative thinking, they ask, make a person sick? More recently they have added, in counterpoint: can positive thinking (generated by prayer and imagery) help a person heal? While these questions may pose a fairly binary approach to the matter, binary it must be, since Western clinical studies cannot be conducted on poetic or allegorical explanations of mind/matter such as we find in Traditional Chinese Medicine. For authentic practitioners of Oriental Medicine, however, the interplay of organs/emotions/spirit is inescapable.

An ancient text, the “Huang Ti Nei Ching”, compares the function and position of internal organs to hierarchies found in an empire. It tells us: “The heart is like the minister of the monarch who excels through insight and understanding; the lungs are the symbol of the interpretation and conduct of the official jurisdiction and regulation; the liver has the functions of a military leader who excels in his strategic planning; the gall bladder… excels through his decisions and judgment; the middle of the thorax is like the official of the center who guides the subjects in their joys and pleasures…the kidneys are like the officials who do energetic work and they excel through their abilities….” (1)

In her translation of the “Nei Ching”, Ilza Veith explains that the heart, the spleen, the lungs, liver and kidneys “determine the functions of all the other parts of the body, including the bowels, and also of the spiritual resources and emotions”(2). Logically then, we should consider involvement of these five organs when the issue of emotional problems is presented. Has the comparative weakness of certain organs, we might ask, exposed a patient to illness or to prolonged recovery? Could the illness cause depletion of specific organs, creating a self-defeating cycle? While the practitioner must be careful to leave psychology to the psychologists, he or she will nevertheless recognize patterns of behavior/illness and opportunities for therapy which have been described in ancient texts.

Emotional Concepts

What is the ancient concept of emotions and how does it relate to modern Western clinical practice? In the book Emotions in Asian Thought, Chad Hansen contends the traditional Chinese concept of mind and action does not center on “a mental/intellectual world populated by mental/intellectual objects set off against an external world of physical objects or matter.” Nor does this concept contain the Indo-European “distinction between cognitive and affective states. A single faculty/organ, the xin (heart-mind), guides action rather than separate faculties of heart and mind”(3).

Giovanni Maciocia, in his textbook The Fundamentals of Acupuncture, widens this premise for the purpose of clinical practice. Maciocia notes the tradition of Five Emotions: anger, joy, sorrow, fear and rumination, as well as others, and explains their significance to the practitioner. “The body-mind is not a pyramid, but a circle of interaction between the Internal Organs and their emotional aspects. Whereas Western Medicine tends to consider the influence of emotions on the organs as having a secondary or excitatory role rather than being a primary causative factor of disease, Chinese Medicine sees the emotions as an integral and inseparable part of the sphere of action of the Internal Organs…. Since the body and mind form an integrated inseparable unit, the emotions can not only cause a disharmony, but they can also be caused by it”(4). Anger, according to tradition, affects the liver; rumination taxes the spleen; sorrow depletes the lungs; excessive joy affects the heart, and fear affects the kidneys.

Fear And Panic: A Case Study

“Extreme fear,” says the “Huang Ti Nei Ching”, “is injurious to the kidneys.” An example of long felt fear and its taxing effects on kidneys was presented to me in a phone call last year. “Can you help me?” came a man’s faint voice. “I’m agoraphobic; do you know what that means? Have you ever treated this condition?” I told him I hadn’t treated it but knew that it was a debilitating anxiety disorder marked by fear of public places and situations that are associated with panic attacks. “That’s it,” he said. “I haven’t been away from my house in six years. Only, I get attacks even when I’m at home. Sometimes my heart starts beating like crazy, like I’m going to have a heart attack or go nuts.”

The man’s symptoms conformed to the DSM (Diagnostic and Statistical Manual) requirements for panic disorder. These requirements are four episodes in a four-week period, featuring four of these symptoms: pounding heart, tightness in the chest, shortness of breath, feeling of choking, tingling, faintness, shakiness, trembling, fear of losing control, hot flashes, a sense of unreality and a fear of going insane or dying. To compound these troubles, comments Jerilyn Ross in her book, Triumph Over Fear, while “the fear during an attack is real, raw, crushing, and overwhelming…physicians tend to write off patients as neurotic or hypochondriacal”(5). This may be a monumental oversight if one considers that 2.4 million Americans suffer from panic disorder in any given year (National Institute of Mental Health).

The man on the phone drew a deep breath. “It means you’d have to come to my house,” he said, “since I can’t go out.” I drove to the upscale section of Los Angeles where he lived. His house, a sprawling mass of glass walls and sharply angled stucco slabs, was a specimen of the atomic era. And like the atomic era, it was a vision gone bad. Currently, the expansive yard was overrun with weeds and the many windows were covered by torn, yellowed curtains and sagging, rusty blinds. Kicking aside an empty mayonnaise jar, I walked a wide limestone path to his door.

The man who answered my knock was six feet tall, fifty years old and was clearly a frail version of his former self. Noticeable also were deep brown circles under his eyes (kidney area of the face). While he retained a full head of hair, it was unmanageably dry and had been corralled into a ponytail. “Come in,” he said, waving me into a musty hall. He handed me his dry, bony hand to shake. His name was Frank and for many years he had been a successful stunt driver for television. The “King of Car Chases”, they had called him.

Unfortunately, he had experienced three mishaps in the course of six months, the last of which landed him in a full body cast. Upon recovery from his most recent accident, he found himself unable to drive to work; panic gripped him when he got behind the wheel. He had tried therapy without success (probably a poor choice of therapist), had spent a fortune on therapeutic audiotapes and books and, because of his refusal to take medication, was considered “a faker” by his family.

Based on query and observation, I formed a diagnosis and treatment plan. While many agoraphobics cannot locate the specific cause of their disease (it may be the accumulation/magnification of perceived dangers), Frank’s crippling fear seemed traceable to his continued mishaps and their potential future recurrence. “Kidney Qi energies,” writes Leon Hammer, M.D., in Dragon Rises, Red Bird Flies, “help us to anchor ourselves in the gestalt of the ‘here and now’…”(6). Overall depletion of the kidneys was manifested in a deep, weak kidney pulse (the proximal position on the radial artery), lower back pains, tinnitis, palpitations, dizziness and dark pouches under his eyes. Chronic fear had taxed Frank’s kidney Yin, as his dry hair, skin and acquired boniness attested. He was the shriveled relic of a once-daring stunt driver. His depleted kidneys failed, as the Nei Jing says, “to do energetic work and excel through…ability.” Frank’s abilities were being wasted, although I wasn’t certain the world would be improved by more car chases. Nevertheless, I decided on a therapeutic principle and a “points strategy” as outlined in The Treatment of Disease in TCM.(7) I determined to supplement the kidneys, fill the essence, and fortify the will. My formula would have been a modified “Liu Wei Di Huang Wan”, except that Frank was in terror of herbally-induced panic. Herbs were not an option. Predictably, Frank was also in fear of needles. I therefore gave him a kidney-enhancing mix of shiatsu and tuina, later convincing him to accept but four needles (L14 and LIV3 bilaterally) to “open the gates” and allow Qi to flow.

When I returned to the office, the phone was ringing. Frank was in a panic. The unleashing of the Qi prompted by my nominal needling had caused him alarm, triggering a panic attack. I reassured him and talked him into a calm state of mind, agreeing to return the following day. In subsequent twice-weekly visits, I gave him nothing but acupressure and tuina, always with the purpose of stoking kidney fire. Over the course of several months, he reported gradual improvement and began venturing away from home, driving to the mall with family and attending church. While there are occasional setbacks, his overall outlook is favorable. An increasingly confident and robust Frank is now searching for a qualified therapist… and, at my urging, a desk job.

Anger: A Case Study

“Sickness of the liver,” the Nei Jing tells us, “causes…people… to have fits of anger.” Anger causes Qi-and tempers-to rise. Maciocia reminds us that anger can be considered to include irritability, frustration, rage, indignation, animosity or bitterness. Anger, when expressed appropriately, may not cause harm; when chronic or suppressed, it may become pathogenic. A study published in a recent issue of The Lancet found that the “Type-D personality was a significant predictor of long-term mortality in patients with established CHD [chronic heart disease]…. Personality traits should be taken into account in the association between emotional distress and mortality in CHD”(8). The American Journal of Cardiology concurs: “Anger is the effective state most commonly associated with myocardial ischemia and life-threatening arrhythmias. The scope of the problem is sizable-at least 36,000…heart attacks are precipitated annually in the United States by anger”(9).

When anger causes Qi to rise, symptoms are naturally expressed in the upper part of the body. A patient will often exhibit dizziness, a flushed face, tinnitus and headaches (frequently parietal). His or her tongue may be red due to liver fire, the result of prolonged liver Qi “stagnation” or “repression.” Additionally, rebellious liver Qi may flow sideways, invading the stomach and its paired organ, the spleen. This will result in diarrhea and indigestion.

Liver Qi oppression and its consequences were embodied in a diminutive lady named Mrs. LeBeau. While Mrs. LeBeau may have been petite, her repressed fury was not. She solicited my help with resolving increasingly frequent parietal headaches and indigestion. It took little effort to discover the cause of her illness.

Removing her suede pearl-white gloves and placing them on my desk, Mrs. LeBeau marched to my treatment table and lay down. She then said hello and held out her hand impatiently. Not knowing if she expected me to shake it or kiss it, I took her pulse instead. She was, by her account, “fifty-something,” yet I noticed she had fewer wrinkles than the Chanel pant suit she had poured herself into. Her pulse was “wiry” in the liver position, suggesting pain or repressed anger. Mrs. LeBeau spoke incessantly and admiringly of her husband, a highly successful corporate motivational speaker. She was, she said, the luckiest woman in the world. Her unstoppable eulogizing of Mr. LeBeau, however, was clearly practiced, as if she had delivered the monologue many times previously. It was only as she relaxed that her pace slowed and, eventually, a frown made her lips droop. In a sudden burst of tears she revealed her husband abused her, and she did not love him anymore. Leaving him was a moral impossibility since he had recently been diagnosed with cancer. “And besides,” she sobbed, “it simply isn’t done! Are you or are you not going to offer me a tissue?” It was interesting to note that Mrs. LeBeau’s cosmetic surgeon had removed all facial evidence of intense liver Qi, lines which extend vertically from the inward tips of the eyebrows. Resigned she was to a duplicitous life, attending social functions and televised events wearing a smile that was not her own. Meanwhile, her headaches had become frequent and nearly intolerable. Food, she complained, caused her to bloat and belch and she experienced a continual bitter taste.

While there was little I could do to improve the circumstances of her life, I was able to address, on an energetic level, Mrs. LeBeau’s liver symptoms. Her long-repressed anger forced rebellious liver Qi to flow upward, causing headaches and bitter taste, and to flow “sideways,” toward the stomach/ spleen. The result was indigestion and bloating. If left unchecked, suppressed liver Qi could turn into liver fire, with its attendant violent, unpredictable behavior. My treatment plan was to soften the liver and descend rebellious liver Qi. Modified Xiao Yao was the herbal remedy.

Statistical Proof

My concern for Mrs. LeBeau was further fueled by statistics recently published in Nursing Research. In an article, “Women’s Anger: Relationship of Suppression to Blood Pressure,” we find a 12-year Michigan study of middle-aged men and women which “showed that suppressed anger significantly interacted with elevated blood pressure to produce the highest mortality”(10). It appeared that people with elevated blood pressure who scored higher on anger suppression were five times as likely to die than hypertensive people who expressed it. On reading this, I directed Mrs. LeBeau to a qualified therapist whom she now sees regularly in addition to receiving her acupuncture treatments.

As these case studies show, the management of emotion-associated illness may be slow, requiring great patience and the scrupulous application of ancient Oriental principles to modern dilemmas. Nevertheless, such concepts of emotion, illness, and the expression of character are as pertinent today as they were more than a thousand years ago when Laotse wrote:

“Those who are disturbed by their senses and minds cannot preserve their own character. How much less can they follow the Tao!” (11)

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Names and circumstances have been changed to protect patients’ privacy. Charles Yarborough, L. Ac., NCCA, practices acupuncture in the Los Angeles, CA area.

References:
1. Veith, Ilza. The Yellow Emperor’s Classic of Internal Medicine. Berkeley: University of California Press, 1972, p. 28.
2. Veith, p. 25.
3. Marks, Joel, and Ames, Roger R., eds. Emotions in Asian Thought: A Dialogue in Comparative Philosophy. Albany: State University of New York Press, 1995, p. 183.
4. Maciocia, Giovanni. The Foundations of Chinese Medicine. New York: Churchill Livingstone,Inc. 1989, p. 129.
5. Ross, Jerilyn. Triumph Over Fear. New York: Bantam Books, 1994, p. 19.
6. Hammer, Leon I. Dragon Rises, Red Bird Flies. New York: Station Hill Press, 1990, p. 111.
7. Soinneau, Philippe, and Gang, Lu. The Treatment of Disease in TCM, Vol 1. Boulder: Blue Poppy Press, 1996, p. 250.
8. Denollet, J., Sys SU, Stroobant, N., Rombouts, H., Gillebert, TC & Brutsaert, DL. “Personality as independent predictor of long-term mortality in patients with coronary heart disease.” The Lancet, 1996; 347:417-21.
9. Jain D, Burg M. & Zaret BL. “Prognostic implications of stress-induced silent left ventricular dysfunction in patients with stable angina pectoris.” Am. J. Cardiol, 1995; 76:31-5.
10. Thomas, Sandra P. “Women’s anger: relationship of suppression to blood pressure.” Nursing Research, 1997; 46:324-30.
11. Yutang, Lin, ed. The Wisdom of Laotse. New York; Random House, Inc., 1976, p. 85.
The following books referenced by this article are available from our Online Qi Catalog at or 1-800-787-2600.
The Yellow Emperor’s Classic of Internal Medicine: #B271
The Foundations of Chinese Medicine: #B436
Dragon Rises, Red Bird Flies: #B178
The Treatment of Disease in TCM, Vol. 1: #B079

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TCM ARticles

November 5, 2008 by  
Filed under Chinese Medicine Articles

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