Question and Answers
Trigeminal Neuralgia
| Q: |
I have been unable to find any
information about trigeminal neuralgia, i.e. how to differentiate
and treat it. Do you have any information on it? |
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| A: |
From the TCM point of view, trigeminal
neuralgia (TN) is an affliction of the channels of the face
and is generally due to invasion of these channels by Wind-Cold.
This "Wind-Cold" is different than the one which
causes a cold or flu: it invades the channels of the face
directly. This usually happens because there is an underlying
Blood or Yin deficiency. In the elderly, or people weakened
by various causes, the Wind-Cold stays in the channels of
the face to cause the intense pain. In the elderly, this may
be complicated by other factors such as local Blood stasis
which makes the pain more intense. So, to summarize, there
is invasion of Wind-Cold in the channels of the face, perhaps
complicated by Blood stasis and against a background of either
Blood or Yin deficiency.
The treatment should be to expel Wind from the face and nourish
either Blood or Yin and invigorate Blood if necessary.
The distal points to use are: L.I.-4 (which I find works better
if used on the healthy side, reducing method) with LIV-3 (on
the affected side, reducing method).
T.B.-5 on the affected side (reducing method).
The local points to use are: choose according to affected
branch from among Taiyang, ST-7, SI-18, ST-6, ST-5, even method.
Gentle moxa stick can be used unless there is Yin deficiency
with pronounced Empty Heat (it can be used if there is only
Yin deficiency without Empty-Heat, i.e. if the tongue is not
too Red).
TN is a difficult disease which requires many treatments. |
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Headaches from Raeder's
syndrome
| Q: |
I have been asked to treat a
girl who suffers from severe headaches and has been diagnosed
with Raeder's syndrome. Do you have any knowledge on this? |
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| A: |
Generally speaking, you have to
approach the treatment of this girl as for any other headache,
i.e. analyse the symptoms and signs, decide on a diagnosis
and treat it accordingly. The very first chapter of my book
"The Practice of Chinese Medicine" deals with headaches.
Based on the symptoms connected with Raeder's syndrome, the
most likely cause of this girl's headache is Liver-Yang rising
with local Blood stasis. You need to use both distal and local
points.
Distal points: LIV-2, G.B.-43, T.B-5 all on the side of the
pain plus L.I.-4 on the opposite side.
Local points depend on the location of the headache: usually
G.B.-1, Taiyang, G.B.-9, G.B.-20 all on the side of the pain.
It might also be necessary to nourish Liver-Blood with ST-36,
LIV-8 and SP-6.
I have read about Raeder's Syndrome (which you can find on
<www.medscape.com>) and, although this would not change
the treatment, it might change the prognosis, i.e. it might
be more difficult. However, given her age, I don't think it
will be impossible. |
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Differentiation of Backache
| Q: |
Could you tell me what the TCM
diagnosis would be if (a) someone had back pain and it gets
worse when they are sitting but better when moving, (b) better
with sitting worse with moving and (c) O.K. when sitting but
sore and stiff when they get up then it starts to get better? |
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| A: |
(a) Qi stagnation or Blood stasis
(b) Kidney deficiency
(c) Cold in the back channels |
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Post-viral Fatigue Syndrome
| Q: |
I have a patient who is 48 year
old and suffered from breast cancer 3 years ago. The specialist
told her that she has probably got M.E. as, for the last six
months, she has been suffering from the following symptoms:
very tired, severe muscle fatigue and ache (especially on
her back), difficulty sitting, heavy limbs, poor concentration,
a constant feeling of fullness in the epigastric area and
on the right side of the abdomen, bitter taste, sore throat,
insomnia, scanty dark urine and shivers. Her pulse was Full,
tense and the Kidney position was Weak. Her tongue has teeth
marks on the sides, is a little bit swollen and the coating
is thin-white. Could you advise me about the treatment, including
which points and herbs I should use? |
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| A: |
Judging from the symptoms, it
sounds very much like your patient suffers from Damp-Heat
in the Middle Burner and muscles against a background of Spleen
and Kidney deficiency.
I would concentrate on resolving Damp-Heat first with something
like Lian Po Yin (or Ease the Muscles from The Three Treasures)
and only after some months tonify Spleen and Kidneys with
the herbs.
With acupuncture, it is different as you can do both by using
Ren-12, Ren-9, ST-36, SP-6, SP-9, BL-22, BL-20 and Du-20. |
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Possible side-effect
of Radio-Support
| Q: |
You gave me advice about dosage
of Chemo-Support and Radio-Support concerning a patient of
mine getting chemotherapy and radiation treatment simultaneously.
You recommended she take 6 pills of each per day. After a
few days, she developed bleeding from the nose. She immediately
thought it was the herbs so she reduced the dosage by herself
to 3 pills of each and the nasal bleeding stopped.
Are the herbs moving Blood too much? Do you think that at
the lower dosage she will be getting enough protection? |
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| A: |
There are no Blood-moving herbs
in Chemo-Support but there are in Radio-Support. The nosebleed
could have been from that although I doubt it, but anything
is possible as people's metabolisms are so different and individual.
I think that a lower dose will still afford your patient some
relief from the side-effects. I would probably try again with
the higher dose to see if it was really the tablets or the
radiotherapy itself because this treatment heats the Blood
and can therefore cause bleeding. |
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Loss of Sense of Taste
and Smell
| Q: |
I am treating a woman suffering
from asthma with signs of Phlegm and Heat in the Lungs. She
has another problem which is loss of her sense of smell and
taste, which are reversed with cortisone treatment. As soon
as she stops the cortisone, the problem reoccurs. How do you
interpret the action of cortisone in this respect from the
point of view of Chinese medicine. As cortisone is anti-inflammatory,
it should have a cooling action but why does it lead to symptoms
of Empty Heat? What pathological process do you think is going
on in my patient? |
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| A: |
The loss of sense of smell and
taste of your patient is due to Phlegm-Heat obstructing both
the Lungs and the Spleen, the former leading to loss of sense
of smell and the latter to loss of sense of taste. You cannot
draw direct parallels between the action of Western drugs
and their effect from a Chinese point of view. Probably, cortisone
resolves Phlegm temporarily. Long-term cortisone use does
induce Empty Heat because it weakens Kidney-Yin. |
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Dosage of The Three Treasures Formulae in
Children
| Q: |
Can you use Welcome Fragrance
in an 8-year-old child and what dosage? |
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| A: |
For an 8-year-old child, I would
use a maximum of 4 tablets a day and would probably start
with 3 tablets a day. |
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Dosage and Protocol
of Chemo-Support
| Q: |
An 8-year-old girl was found to
have an inoperable brain tumour (a kind of Astrocytoma) located
in her hypothalamus. She has started chemotherapy and I would
like to give her Chemo-Support. The problems are:
a) She can't take tablets, which cause her to vomit, so I'd
like to give it to her as a tincture but I'm not sure how
it should be prepared.
b) I have doubts about the dosage according to her age
c) Regarding Chemo-Support, many patients get chemotherapy
once a week for 4-5 weeks, or once a month, how should they
take Chemo-Support? |
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| A: |
a) Your patient should take the
tablets dissolved in water.
b) She should take between 4-6 tablets a day.
c) She should take them all the time, every day, i.e. on the
days when she does have chemotherapy and when she doesn't. |
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Breast Cancer
| Q: |
I am treating a 68-year-old woman,
her main complaint being 'shattered nerves'. She has a very
involved medical history, the most relevant points being that
she had her right lung removed 45 years ago and has been on
prolonged spells of antibiotics. She is extremely weak and
her immune system is very depleted. After six treatments she
was diagnosed with breast cancer having found a pea-sized
lump in her right breast and was prescribed tamoxifen. She
was told she was too weak to have a mastectomy. Is Chemo-Support
appropriate for people who are on tamoxifen? |
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| A: |
I don't think your patient needs
to take Chemo-Support. I know Tamoxifen is mentioned in my
newsletter, but its side-effects are quite different than
those from chemotherapy and are not addressed by Chemo-Support
(they are, in my opinion, Damp-Heat). Since your patient has
not had a mastectomy, the treatment principle is to treat
the actual breast mass. This is due to one or a combination
of three factors: Phlegm, Blood stasis and Toxic Heat. From
what you say, I have a feeling that in your patient's case
it is due to Phlegm. She therefore really needs something
to resolve Phlegm, dissolve masses, tonify the Spleen and
harmonize the Chong and Ren. There is no remedy that does
this and it can only be done with a decoction. I would continue
with the acupuncture but paying attention to resolve Phlegm
and harmonize the Chong and Ren. |
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Lung Cancer
| Q: |
I have an elderly patient who
has just been diagnosed with lung cancer. He may have radiotherapy
or the doctors may just decide to give him palliative care.
He has marked signs of Yin deficiency (night-sweating, bright
Red, peeled tongue) as well as Heat signs (thirst, thick-yellow,
dry coating in a small patch on the mid-back section of his
tongue. I presume this is some form of Toxic Heat.
Looking at the individual herbs in your formula, they would
appear to be useful even if he didn't actually undergo the
radiotherapy treatment or is there a special reason why he
should only take them if he undergoes radiotherapy? |
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| A: |
If the patterns treated by Radio-Support
seem to fit, there is no reason why he could not take it.
However, judging from what you tell me and by my experience
with cancer, it sounds like the patient suffers from an underlying
deficiency of Lung-Yin with Empty Heat, but with a super-imposed
condition of Toxic Heat. If this is the case, Radio-Support
is not appropriate. He could actually take a combination of
Clear the Soul together with Ease the Journey - Yin which,
although for the menopause, nourishes Kidney- and Lung-Yin
and clears Empty Heat. |
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Combination of Chemo-Support
and Radio-Support
| Q: |
I have a 48-year-old female patient
with colon cancer. She will be doing 6 weeks of a chemotherapy
drip (24 hours a day) and also receiving radiation treatments
simultaneously (once a day, 5 days a week). She has only just
started both therapies this past week and hasn't yet noticed
any side effects from either therapy.
My question is should she be on Chemo- or Radio-Support or
a combination of both? And at what dose? She had hepatitis
5 years ago and has occasional night-sweats, disturbed sleep,
dizziness, alternating constipation and diarrhoea with blood
in the stools on occasion. |
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| A: |
While she is having both chemo
and radio, I would suggest taking both remedies with a dosage
of about 6 tablets per day each, taken at separate times.
I would recommend Chemo-Support in the morning/afternoon and
Radio-Support in the late afternoon/evening. You can also
vary the dosage according to the severity of symptoms. Usually
the radiotherapy side effects come towards the end of the
treatment so she could take more of the Chemo-Support than
the Radio-Support in the beginning. I also recommend continuing
taking the Radio-Support for at least a month after the end
of the treatment with a dosage of about 6 a day. |
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Multiple Sclerosis
| Q: |
I have been treating a patient
who was diagnosed with Multiple Sclerosis . The following
is her history and I was wondering if you might give me some
advice on how to treat her. I have been mainly trying to build
up her Spleen and Kidneys. I have diagnosed the condition
as Phlegm-Damp accumulation in the leg channels due to a deficient
Spleen; however, there is no numbness of the limbs which is
generally a sign of Phlegm accumulation so would it just be
Damp blocking the leg channels?
The patient is a 29-year-old woman. She has had progressive
weakness of both legs with an inability to balance at times.
At present, she does not experience any weakness of her arms.
Her appetite, sleep and bowel movements are normal. Her legs
and feet are cold and she bruises very easily. Her lower body
feels very heavy and 'off balance'. Her condition is aggravated
by any extreme temperatures and certain positions of the feet
bring on rapid tremors in the legs. |
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| A: |
Generally speaking, one can identify
4 stages in MS:
1) Very early stage: Dampness in the channels causing heaviness
and tingling.
2) Early/Middle stage: Stomach and Spleen deficiency causing
weakness of legs, beginning of atrophy.
3) Middle/late stage: Liver and Kidney deficiency causing
weakness of legs, dizziness, vertigo, atrophy.
4) Late stage: Liver and Kidney deficiency, Liver-Wind with
or without Blood stasis.
All the above symptoms plus tremor and spasms of limbs. If
Blood stasis: pain in the limbs.
I think your patient is mostly at the second stage but with
elements of the 3rd/4th stage as, of course, the staging is
not rigid. I think the main problem in your patient is Stomach
and Spleen deficiency, plus some Dampness (feeling of heaviness)
plus a hint of Liver-Wind (tremor of legs).
I would therefore say the treatment principles are to (in
order of importance):
1) Tonify Stomach and Spleen
2) Resolve Dampness
3) Tonify Liver and Kidneys, subdue Wind
Points:
1)ST-36, SP-6, BL-20, BL-21, ST-31, ST-34, Ren-12
2) Ren-12, SP-6
3) LIV-8, KI-3, LIV-3.
Use also the Dai Mai occasionally (GB-41 on the right, TB-5
on the left) as this drains Dampness form the Lower Burner
and is indicated for Atrophy Syndrome in the Su Wen (Ch.44).
Herbs that tonify the Stomach and Spleen, resolve Dampness
and eliminate Wind-Dampness from the channels would also be
indicated. |
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Calf
Muscle Ache
| Q: |
I would like your opinion concerning
the treatment of a calf muscle problem. The patient is 44-years-old
and appears to be in good health. He runs for general conditioning
4-5 miles per day and 3-5 times per week without incident
for several years. About 2 months ago, he changed jobs and
began working nights. The job requires considerable walking
and standing. Soon after starting this job, he began to experience
tightness and cramping in the upper calf area when running.
I have tried needling local points in the area of greatest
pain with electrical stimulation and have used BL-60 as a
distal point. Cupping and bleeding of the local area has also
been tried with similar results. Do you have any observations
or suggestions? |
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| A: |
I would try using distal points
that are above the area of the pain (which you don't specify
exactly) such as BL-40. I would also use BL-57 as a local
point and maybe Bl-58. Other choices depend on whether the
area is hot or not. If it is hot, I would use SP-10. Another
approach you can try is to use the Small Intestine channel
(related to the Bladder within the Tai Yang) on the opposite,
corresponding side, e.g. S.I.-7. I would not use electricity
nor moxa.
From a Western point of view, you should look into the possibility
of varicose veins (is it hot?): if this is the case, results
would be less good than if it is just a muscular problem.
In such a case, you should definitely use SP-10 and maybe
SP-4.
Finally, I think that running 4-5 miles per day is over-exercise
from the Chinese point of view and it does not do any good:
as my Tai Ji teacher always stressed "fitness is not
the same as health". |
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Chemo-Support
and Oestrogen Production
| Q: |
The formula Chemo-Support contains
Dang Gui Radix Angelicae sinensis which is known to stimulate
the production of oestrogen. Would this not be contraindicated
in oestrogen-dependent breast tumours? |
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| A: |
First of all, I cannot find any
reference in the available literature about Dang Gui Radix
Angelicae sinensis having an oestrogenic effect or containing
oestrogen. The Pharmacology and Applications of Chinese Materia
Medica by Chang and But (World Scientific Publishing Co.,
1986, p. 490) in fact says: "The vaginal smear examination
proved that the herb had no oestrogenic action in mice".
Formulas and Strategies by Bensky and Gamble (Eastland Press,
1993, p. 331) also says: "The herb does not appear to
have any oestrogenic effect". The Handbook of Chinese
Herbs and Formulas by Yeung (1983, p. 178) says about Dang
Gui: "No female sex hormone action". The Xin Hua
Ben Cao Gang Yao (New Pharmacopoeia, Shanghai Science Publishing
House, 1988, p. 346) does not report any oestrogenic action
for Dang Gui.
However, even assuming that Dang Gui did have an oestrogenic
effect, there are several aspects to this question. The first
is of a general nature: herbs do not have a chemical action
like drugs but a balancing, physiological action. If we give
a patient with breast cancer oestrogen, it will stimulate
the growth of the tumour. However, herbs do not work in the
same way as they have a complex, regulatory, physiological
and homeostatic action. For example, Dang Gui can both contract
and relax the uterus depending on the pre-existing state of
this organ, which is a demonstration of herbs' homeostatic
action. Another good example of this principle is Ginseng:
it contains a certain group of saponins that excite the CNS
and another group that depress it. Thus, one cannot say that
"Dang Gui will automatically stimulate the production
of oestrogen".
The second aspect to the question is that the action of a
herb cannot be seen in isolation as it is modified by other
herbs within the formula. Thirdly, It should be remembered
that Chemo-Support, containing Dang Gui, is for administration
only during a chemotherapy course when the body is being blasted
by powerful toxic drugs: it is therefore unlikely that Dang
Gui would be able to stimulate the production of oestrogen
and therefore the growth of the tumour at this time. Once
the chemotherapy is over, I normally stop the remedy Chemo-Support
and prescribe a formula to treat the pattern or patterns underlying
the growth of the cancer: usually, these will be formulae
that concentrate primarily on expelling pathogenic factors
(such as resolving Phlegm and Fire-Poison and invigorating
Blood) rather than tonifying the body's Qi.
Finally, I would say that I do not think that Chinese journals
and books have any formula for breast cancer that does not
contain Dang Gui! |
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