Maciocia Online

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

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1) The Psyche in Chinese Medicine
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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)

E-PETITION FOR OUR FREEDOM TO USE HERBAL MEDICINES

2011-08-18T09:54:00.000-07:00

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 THREE TREASURES ARE BACK

2011-08-12T22:38:00.000-07:00

The FDA’s unjustified hold on the Three Treasures has been lifted and the remedies are therefore back on the market as from today.

In the USA, they can be ordered from Crane-West in California (707 823 5691) and Crane Herb Co. in Massachusetts (508 539 1700).

For a complete list of practitioners in other countries, please visit www.three-treasures.com

OPEN LETTER TO JOHN DALLI EU COMMISSIONER FOR HEALTH

2011-08-10T02:41:00.001-07:00

OPEN LETTER TO JOHN DALLI, EUROPEAN COMMISSIONER FOR HEALTH BY THE ALLIANCE FOR NATURAL HEALTH
24th June 2011

Dear Commissioner
RE: NON-EUROPEAN TRADITIONAL HERBAL SECTOR IN CRISIS
I was one of four experts attending a forum in the European Parliament on 21st June 2011 considering challenges posed by the Traditional Herbal Medicinal Products Directive (THMPD) (Directive 2004/24/EC). These challenges are particularly acute for genuine, long-standing traditional systems of medicine, and especially those that are of non-European origin. The forum was hosted by Michele Rivasi, Bart Staes, Carl Schlyter, Satu Hassi and Heide Rühle of the Greens/EFA group.
We have reported on the event on our website and the organisers ensured the event was video recorded, streamed live and archived.
As you will be able to see from the record of proceedings, the forum was very usefully organised, primarily in Question & Answer format. Questions were asked by a wide range of interests, ranging from non-governmental organisations (NGOs), such as ourselves, to herbalists, practitioners associations, suppliers, scientists and MEPs.

Lack of clarity in European Commission answers
What became astoundingly obvious to the concerned parties present at the forum was the inadequacy of the answers provided by the European Commission representatives, Dr Andrzej Rys, Ms Figuerola Santos and Mr Francesco Carlucci. We are well aware that these representatives were “just doing their jobs”. But when it came to considering the implications of the Directive and its disproportionate impact on long-standing traditions of holistic healthcare, such as those embodied by southern and eastern Asian traditions, their answers were either non-existent or meagre. Even more worrying was the lack of any apparent interest by Ms Figuerola Santos in addressing possible solutions.

The urgent need for clarification
I personally asked three questions during the Greens/EFA forum, and felt that the responses were neither illuminating nor helpful. I had been asked by the hosts to prepare queries, and had actually compiled 17 questions, which were submitted to the organisers a few days before the event. These and other questions are now in the hands of MEPs and will be formulated as formal questions to be asked in the Committee of Environment, Public Health and Food Safety (ENVI).
I write this open letter to you in the spirit of transparency, in the hope—given the severity of issues facing the non-European traditional medicine sector in the EU—that you or members of your staff will comment on the concerns I raise in this letter with a view, on the basis that the problems are acknowledged, to considering possible solutions.
Among my questions raised in the forum, I referred to two of the points that you had made in a response to Giles Chichester MEP on 13th April 2011 (Appendix). In the first point, you indicate that all herbal medicinal products sold in the EU now need to be authorised for sale. You will understand that, given the very broad definition of a medicine (as given in Article 1.2 of amending Directive 2004/27/EC), many manufacturers and suppliers are deeply concerned that Member State competent authorities will now regard their products as unregistered medicines. Since most of these products are presently sold predominantly as food supplements, they are at grave risk of being made illegal by default.
In the second point, you claim there are no additional barriers to the registration of Ayurvedic and traditional Chinese medicine (TCM) products, as compared with products from European traditions. These include products associated with the comparatively recent European, and especially German, phytopharmaceutical ‘tradition’. You may have appreciated, from the report on the uptake of the traditional use registration (TUR) scheme by the European Medicines Agency (EMA) in June 2011, that it is primarily products associated with this European phytopharmaceutical system that are successfully gaining registrations. By contrast, not a single product authentic to the Ayurvedic, Unani, TCM, Tibetan, Thai, southern African or Amazonian—or, indeed, any other non-European—system has yet been registered.

Reasons for lack of uptake of TUR registrations among non-European traditions
Following is a brief crystallisation of the reasons why uptake among the non-European traditions has been non-existent until now:
1. Eligibility limitations. Four key obstacles to eligibility include:
a) The traditional use requirement (which requires at least 15 years’ usage within the EU) for individual products locks out many products that may been used for decades, or even centuries or millennia, outside the EU. It also locks out any modification to a formula that might be appropriate given scientific advances or to meet the needs of a particular target population;
b) Indications for the TUR scheme are limited to minor, self-limiting conditions, yet the Asian traditions cover the entire scope of health conditions;
c) Many authentic poly-ingredient herbal products deal with multiple body systems, by virtue of their complex biochemical and bio-energetic actions. Such actions are not recognised in the existing model of pharmaceutical legislation, and there appears to have been no adjustment made to cater for the different indications and mechanisms of action of products associated with long-standing traditions;
d) Products containing significant mineral or animal ingredients are excluded from the TUR scheme, which is currently limited to herbal ingredients only.
2. Technical limitations. The greatest technical hurdle for most authentic traditional herbal medicinal products, which are often whole-herb or aqueous extractions, are the pharmaceutical and stability standards as set out in EMA guidelines. These are considerably more straightforward for single-herb products or limited combinations, where the herb has been well studied in the West, and for which biomarkers have been identified and included in the Committee on Herbal Medicinal Products (HMPC) monograph listing. The HMPC monographs are strongly Euro-centric in terms of their consideration of herbal species: there appears to have been no effort to balance the monographs being produced with ones for herbs that are used more or less exclusively in the major (or minor) non-European traditions. Since many traditions utilise whole-plant material or aqueous extracts, they experience considerably more difficulty in meeting the EMA guidelines for pharmaceutical standards relative to solvent-extracted, European herbal products that are stabilised in a pharmaceutical base that includes synthetic polymers/preservatives (as is the case for the majority of products that have been registered to date).
3. Excessive cost burden. There are great variations in registration fees being charged by Member State competent authorities, varying from around €2,000 to over €50,000 per product. In addition to this are the often much more substantial costs of meeting the pharmaceutical standards, especially stability and genotoxicity testing. You will be aware that a typical total cost for registration of a single product may range from €100,000 to upwards of €250,000. This is not an obstacle for most European phytopharmaceutical manufacturers or suppliers, where typically a narrow range of products sell in high volumes. However, it is a very significant barrier to the long-standing, non-European traditions—and especially the Asian traditions—as their suppliers are often required to carry a range of 100 to 300 distinct products, each selling at relatively low volumes. If the annual revenue for an individual product line is expected to be, say, €5,000, based on an up-front registration cost of €200,000, it would take 40 years to repay the cost of registration. For a supplier that sold a relatively small line of, say, 100 traditional herbal medicines, the total cost of registration, assuming the same total cost of registration, would amount to €20 million. These amounts are unquestionably out of reach of the small-to-medium sized enterprises (SMEs) supplying products associated with non-European traditional systems.
4. Lack of incentive. There are two major factors that create a major disincentive for manufacturers of non-European traditional products to prepare and submit applications for registrations under the TUR scheme. These are:
a). The fact that any SME in the non-European traditional sector, assuming the major technical and eligibility hurdles facing complex, multi-ingredient, non-European products had been overcome, would still only be able to register a handful of products in their full range, owing to the very high fixed costs involved;
b). There is a very real concern, given the broad EU definition of a medicine, that products receiving medicinal licenses under the TUR scheme will set a precedent that will cause Member State regulators to classify equivalent products also as medicines. This is already happening in some Member States, such as Belgium and the UK. So, if a company were to apply for one or two licenses, it may effectively contribute to a situation where all or many of its other products would be rendered illegal. An understandable position from the standpoint of many suppliers, particularly while the borderline between medicinal and food products remains so diffuse, is to continue selling as many herbal products as possible as a category of food (e.g. functional foods or food supplements). In effect, risking a huge amount of money that SMEs in the non-European traditional sector do not have, on a registration scheme which has been built around European phytopharmaceuticals—and not non-European, long-standing traditions—is not generally regarded as a viable business option for these SMEs. Nor is investing in registration under the TUR scheme a viable option for those whose passion or interest is to ensure continued supply of products associated with these non-European traditions to consumers and non-medically qualified practitioners in the EU.
If you consider the legislative history of the THMPD, it is apparent that the Directive was intended to provide an appropriate regulatory regime for products associated with all the major herbal traditions, where these products are sold directly to the consumer. This obviously includes products used in Ayurveda and TCM. Experience so far shows that the THMPD has not achieved its original objective, and some of the most important reasons for lack of uptake of TURs are laid out in the above four points.
While it might be convenient for your Directorate General to blame any problems facing products associated with non-European traditions on the autonomous actions of Member State medicines regulators, the reality is that these national authorities are culling back these traditions using tools provided them by Brussels. The two key death-knells for products that have been selling as food supplements in the various Member States are increasingly:
• The excessively broad definition of a medicine, and in particular its functional limb (Article 1.2(b), Directive 2004/27/EC) that technically turns all effective natural health products into medicines, and;
• Any product containing one or more ingredients that have not had demonstrable significant use in the EU prior to May 1997, under the terms of the Novel Food Regulation (No 258/1997).
Accordingly, it is inappropriate for the European Commission to lay exclusive blame at the door of the Member States.

Citizens demand action by European and national regulators
It is apparent that the European Commission and the EMA must look urgently at resolving the situation for these systems of healthcare that are used by many millions of Europeans, and which are indigenous to well over one-third of the world’s population. The response from concurrent French, German and English petitions with over 1.1 million signatories between them, and from over 850,000 signatories to the Avaaz petition on herbal medicines, confirms a highly significant measure of citizen concern. Unfortunately, the European Commission’s lacklustre performance at Tuesday’s forum in the European Parliament has done nothing to suggest that the Commission is keen to resolve the unfolding crisis.
The EMA’s Action Plan for Herbal Medicines 2010-2011 addresses a small number of issues of concern, ignores many others, and has yet to implement a significant proportion of its stated actions.

Trying to put a square peg in a round hole
The THMPD was enacted in 2004 and fully implemented on 1st May this year. You say that 7 years should have been sufficient time for products to have been registered. But your Directorate-General failed to acknowledge that the registration scheme had been biased toward European phytopharmaceuticals during the entire 7-year transition phase, and against the much more widely adopted non-European traditions, such as the great Asian traditions of Ayurveda and TCM.
These Asian traditions long preceded your regulatory framework. However, Dr Konstantin Keller, first head of the HMPC, and others within the HMPC did very little during the transition phase to facilitate the registration of non-European products. Conversely, Dr Keller had an intimate knowledge of German phytopharmaceuticals, for which he oversaw registration under German national medicines law while he was responsible in his role in the German regulatory authority, BfArM. Experience now demonstrates that the registration scheme is not favourable to products of non-European traditions. Worse than this, the European pharmaceutical regulatory model is increasingly alienating holistic traditions, such as Ayurveda, TCM and anthroposophical medicine, something that is acknowledged in the final paragraph of your predecessor’s experience report of 2008.
It seems that the criticism you now face from some quarters is down to the creation by the EU of what is effectively a European protectionist tool; one that favours certain products of the European phytopharmaceutical system, and discriminates against those of non-European traditional systems of medicine. What the EU has attempted to do is akin to trying to put a square peg in a round hole. So, rather than trying to force non-European products into a European phytopharmaceutical model, would it not have been better to build a regulatory system around the great, long-standing, non-European traditions? But we understand neither the European Commission nor the EMA was ever serious about getting the necessary technical support from China, India or elsewhere, so perhaps we should not be surprised.

The first step: Acknowledging the problem for non-European traditions
Over the years of discussion between the Member States and your predecessors in DG Enterprise, it has been apparent there has been a very low level of willingness to deal with, or even recognise, the type of problems I raise in this letter.
Creating an efficient, fair and non-discriminatory system of regulation would be neither technically nor legally difficult. Together with our colleagues, other scientists, lawyers and stakeholders across Europe, we have many ideas of how the situation could be remedied.
However, I believe I would be wasting your time—as well as my own—if we were to now delve into the detail of our proposals for regulatory reform if you continue to be resistant to any significant change to the existing regulatory regimes facing herbal products in the EU.
In this light, I will end my letter with two requests:
1. Could I please ask for your comment and clarification on the concerns I have expressed in this letter, and in particular, on the four areas I have outlined (above) in which we claim there is a disproportionate obstacle in the way of products associated with long-standing, non-European—as compared with European—systems of medicine?
2. With respect to the European Commission’s recognition of the inappropriate nature of the TUR scheme for holistic systems of medicine (as stated in its 2008 experience report), will your Directorate General now consider as a matter of urgency the feasibility of a new regulatory framework for the practice of such systems?
I greatly look forward to your written response to these two points. I would like to add that should members of your Directorate General be interested in a meeting of experts and stakeholders related to the non-European sector, to discuss both the challenges faced and possible solutions, I would be very happy to arrange this at a mutually convenient time and place.
Yours sincerely
Robert Verkerk

FOR UK PRACTITIONERS AND PATIENTS

2011-08-10T02:21:00.000-07:00

ALLIANCE FOR NATURA HEALTH -International
e-Alert: Open letters and closed minds

The iniquitous and freedom-killing European Traditional Herbal Medicinal Products Diretive came into force on 1 May. However, the fight is not over and we can still force our governments to repeal it. Please read the press release by the Alliance for Natural Health.

As the days tick on by after the full implementation of the Traditional Herbal Medicinal Products Directive on 1 May, it’s becoming clearer just how devastating the directive will be on herbal products in the European Union (EU). See our top story for a UK online retailer’s perspective on the pain already being felt! The European Medicines Agency's own figures paint a depressing picture while the European Commission appears utterly unwilling or unable to address the issues.

We believe that EU citizens deserve answers to the many questions about the THMPD, and we eagerly await a reply to the open letter we sent to Commissioner John Dalli outlining our concerns. Please keep writing your own letters to your Member of the European Parliament (MEP), and maintain the pressure for answers – and change!

We’d like to remind all our supporters that ANH-Intl is funded entirely on donations. Your contributions have meant we can fund our lawyers so that we can initiate the legal action on the EU herb laws. But if you want us, as an organization, to keep on doing what we’ve been doing – then please keep your donations coming in to the campaign fund. Some of you may not remember that ANH-Intl is not taking a penny/cent/dime out of the legal fund for the extensive work we are contributing to the case. It’s because of our work that we are able to keep the legal war chest so lean, but your ongoing donations are vital to our survival. And you’ll know that the case is turning out more complex and more drawn out than had originally been thought, and extra time with the lawyers costs us money. The extra time is also invaluable in helping us deliver additional information for the case, especially now that the evidence if impact is becoming so crystalline. It only takes a little from a lot of people to make the world of difference to our effectiveness. Why not forego that cappuccino (or herbal alternative) and donate the money to our campaign fund instead? If everyone who supported our work did that on a monthly basis, we would be able to increase our effectiveness dramatically. Will you pass on the word to your social network?

We reviewed an important new book by Martin Walker, one of the longest-standing and most persistent natural healthcare campaigners. Timely information particularly for UK citizens given that a UK National Health Service report was embarrassingly eager to kneel before Brussels on the issue of dietary supplementation, even going to the extent of paying an agency to cook the results for them!

The Triple Burner

2011-08-02T09:40:00.000-07:00

The Triple Burner is probably the most widely discussed topic on Chinese medicine and, over the centuries, there have been many different theories on its nature. In this Clinical Tip, I will try to elucidate the main ideas on the nature of the Triple Burner and it will probably take more than one Clinical Tip.

“Burner” is a translation of the word jiao which means “burned” or “scorched”. It is also called “Warmer” while others choose not to translate it and call it the “San Jiao”. Some Chinese doctors distinguish between two basic views of the Triple Burner, one according to which is has “no form” (which is primarily from the Nan Jing) and another according to which it has “a form” (which is primarily from the Nei Jing). Although this distinction is important (and I will expand on it below), I think there are at least four different ways of looking at the Triple Burner, as listed below.

1) The Triple Burner as the activator of the Yuan Qi
2) The Triple Burner as a system of waterways
3) The Triple Burner governing movement of Qi
4) The Triple Burner as a system of cavities
5) The Triple Burner as a three-fold division of the body
6) Relationship between Triple Burner and Pericardium

1) The Triple Burner as the activator of the Yuan Qi
The view of the Triple Burner as the activator of the Yuan Qi derives from the Nan Jing, primarily chapters 8, 38, 62 and 66.

Chapter 8 of the Nan Jing says: “Sometimes the Cun Kou is normal and yet the patient dies. Why is that? The pulses of the 12 channels all originate from the Yuan Qi. This Yuan Qi is the root of the 12 channels, it is the Motive Force [Dong Qi] between the Kidneys, the root of the 5 Zang and 6 Fu and of the 12 channels, the gate of breathing and the origin of the Triple Burner. It is the spirit that guards against pathogenic factors (or evil influences). Such Qi is the root of humankind; if the root is cut stalks and leaves wither. When the Cun Kou is normal but the patient dies, it means that the Yuan Qi has been cut off internally.

This chapter establishes some very important principles. First, it talks about the Yuan Qi: it says that Yuan Qi is between the Kidneys (like the Ming Men) and that it is the root of the 12 channels, the Triple Burner and the 5 Zang and 6 Fu.

Secondly, it makes a very important statement when it says that this Yuan Qi is the “spirit” (shen) that guards against evils. This is a remnant of “demonic” medicine, i.e. the system of medicine in which disease is due to the invasion of evils spirits and the cure is effected by the shaman.

The clinical significance of this chapter is huge. Firstly, it establishes the idea that the Yuan Qi (and therefore the Kidneys) is the root of the 5 Zang and 6 Fu, of the 12 channels and of the Triple Burner.

Secondly, it establishes the relationship between the Triple Burner and the Yuan Qi (and therefore Ming Men). Later in chapter 66, the Nan Jing says that the Triple Burner is the “envoy” of the Yuan Qi in between the Kidneys. In this chapter 8, the Yuan Qi is also called Motive Force or Throbbing Qi or Moving Qi (Dong Qi).

Thirdly, this passage establishes the principle that the Yuan Qi (and therefore the Kidneys) play a role in the resistance to pathogenic factors. Interestingly, it calls the Yuan Qi the shen that protect from pathogenic factors (or evils).

This is of huge clinical significance because it means that our resistance to pathogenic factors depends not only on the Wei Qi and therefore Lungs but also on the Kidneys and the Yuan Qi (and also Jing due to the extraordinary vessels). In any case, Wei Qi stems from the Lower Burner (chapter 18 of the Ling Shu).

This is of clinical significance not only in resistance to pathogenic factors but also in the pathology of allergic asthma and allergic rhinitis, the root of which is also in the Kidneys, the Jing and the Yuan Qi.

Fourthly, this chapter is significant because for the first time it gives the view of the Triple Burner as the “envoy” of the Yuan Qi stemming from between the Kidneys. From this point of view, the Triple Burner allows the Yuan Qi to spring forth from between the Kidneys and perform its role in various parts of the body. For this reason, BL-22 Sanjiaoshu is just above BL-23 Shenshu.

Chapter 38 of the Nan Jing reiterates the relationship between the Triple Burner and the Yuan Qi. It says: “How come there are 5 Zang but 6 Fu? There are 6 Fu because of the Triple Burner which stems from the Yuan Qi. The Triple Burner governs all Qi in the body, it has a “name but no form”, it belongs to Hand Shao Yang, it is an “external Fu” [or “extra Fu”]. That is why there are 5 Zang but 6 Fu.”

This chapter actually describes four separate important aspects of the Triple Burner: first, it is a Fu organ (which brings the count of Fu organs up to 6); secondly, it stems from the Yuan Qi; thirdly, it governs all Qi of the body; fourthly, it has a “name but no form”, i.e. it is a function rather than an organ (which actually contradicts the first point).

The relationship between the Triple Burner and the Yuan Qi is explained also in the rather obscure chapter 62. This says: “The Zang [channels] have 5 jing, ying, shu, jing and he points; but the Fu have 6 [points], why? The Fu are Yang, the Triple Burner moves in the Yang channels, hence it has an additional shu point called Yuan.”

I personally think that the influence of the Triple Burner on the fact that the Yang channels have an extra shu point is due to the relationship between the Triple Burner and the Yuan Qi and to the fact that the Triple Burner “moves among the Yang” as this chapter says. In other words, as the Triple Burner is the envoy of the Yuan Qi and it moves among the Yang, it could be said to “seed” the Yang channels with its Yuan Qi (deriving from the space between the Kidneys). In fact, the Nan Jing says that the Yuan Qi comes out of the space between the kidneys through the envoy of the Triple Burner and goes to the 5 Zang and 6 Fu and the twelve channels. The reason it seeds only the Yang channels is due to the fact that it “moves among the Yang”.

Chapter 66 of the Nan Jing is the main one that discusses the relationship between the Triple Burner and the Yuan Qi. It says: “Below the umbilicus and between the kidneys there is a Throbbing Qi [Dong Qi] which constitutes a person’s life [sheng ming ]. This [Throbbing Qi] is the root of the 12 channels, also called Yuan Qi. The Triple Burner is the envoy of the Yuan Qi [or it allows the Yuan Qi to separate into its different functions]. It is responsible for the passage of the three types of Qi in the 5 Zang and 6 Fu. “Yuan” is a honorary designation of the Triple Burner. Hence the places where its Qi comes to a halt are called “Yuan” [points]. When the 5 Zang and 6 Fu are diseased, select the respective Yuan point.”

This chapter is the main source for the view of the Triple Burner as the “envoy” of the Yuan Qi: it allows the Yuan Qi to emerge from the space between the Kidneys and it facilitates the Yuan Qi’s differentiation into its different functions in different places.

Thus, the Triple Burner “mobilizes” the Yuan Qi by making it differentiate into its different forms to perform different functions in different places and organs. It is through the Triple Burner that the Yuan Qi can perform its functions. The Yuan Qi is closely related to the Ming Men and shares its role of providing the heat necessary to all the body’s functional activities.

The following are examples of functions carried out by the Yuan Qi which are aided by the Triple Burner:

• The Yuan Qi provides the heat necessary to the Spleen to transform and transport food essence and to the Kidneys to transform fluids. The Middle Burner makes sure that Yuan Qi reaches and assists the Spleen to transform and transport food essences and the Lower Burner ensures that Yuan Qi warms the Kidneys to transform fluids
• The Yuan Qi facilitates the transformation of Gathering Qi (Zong Qi) into True Qi (Zhen Qi). It can do this through the action of the Upper Burner in transporting Qi through the various passages in the chest.
• The Yuan Qi facilitates the transformation of Food-Qi (Gu Qi) into Blood in the Heart. The Upper Burner ensures the smooth passage and transportation of Qi in the chest for this transformation to take place.

Thus, the Triple Burner helps the Yuan Qi to differentiate itself into different forms to perform different functions in different places.

The relationship between the Triple Burner and the Yuan Qi of the Kidneys is reflected in the location of the Back-Shu point of the Triple Burner (BL-22 Sanjiaoshu) just above the Back-Shu point of the Kidneys (BL-23 Shenshu).

From this point of view, the Triple Burner has “no form”, i.e. it is a function and not an actual Fu organ. The Nan Jing says succintly: “It has a name but no form” (you ming wu xing).

Clinical Application

The relationship between the Triple Burner and the Yuan Qi has important clinical applications. It means that the Yuan Qi performs its warming and facilitating function through the Triple Burner. Thus, if we want to activate the Yuan Qi in the different Burners we need to activate the Triple Burner as well and the points I use are as follows:

- Upper Burner: Ren-17 Shanzhong to stimulate the diffusing and descending of Lung-Qi and warm the Lungs
- Middle Burner: Ren-12 Zhongwan and Ren-9 Shuifen to stimulate the descending of Stomach-Qi, the transportation and transformation (yun hua) by the Spleen and the rotting and ripening by the Stomach.
- Lower Burner: Ren-5 Shimen and BL-22 Sanjiaoshu to stimulate the transportation, transformation and excretion of fluids in the Lower Burner.

For example, in case of Dampness in the Lower Burner and specifically in the Kidneys and Bladder causing urinary problems occurring against a background of Kidney-Yang deficiency, one can use Ren-5 Shimen and BL-22 Sanjiaoshu to activate the Triple Burner (or specifically Lower Burner) and Ren-4 Guanyuan and BL-23 Shenshu to tonify the Kidneys and the Yuan Qi. Note how Ren-4 and BL-23 (related to Kidneys) are just below Ren-5 and BL-22 respectively (related to Triple Burner) reflecting the view that the Yuan Qi emerges from between the Kidneys through the Triple Burner.

FOR US CUSTOMERS OF THE THREE TREASURES PRODUCTS

2011-07-15T11:24:00.000-07:00

Some of you may have noticed that the Three Treasures products have not been available in the US for the past 2 weeks. This is due to a hold placed on the products by the FDA: as a result of this hold, we are not allowed to sell any product until the FDA has tested them.

I would like to stress that this situation has NOTHING to do with the Three Treasures themselves and it affects other herbal products made in Taiwan (the Three Treasures are made from KPC concentrated powders).

Briefly, the reason for this hold is that a Taiwan food company has been adding plasticizers to their products. Plasticizers are added to plastics and their use in food is of course illegal. As a result of this, the FDA has placed a hold on all food and herbal products made in Taiwan until they have tested them.

This is yet another example of how the FDA is an agency out of control with too much power: it is a law unto itself and it can do what it likes, damaging one’s business and there is nothing one can do about it (we have taken legal advice). Its hold of the Three Treasures is totally unjustified. Just because some Taiwan food company was adding plasticizers to their products, this has nothing to do with us and our certificates of analysis can easily show that of course there are no plasticizers. This hold is equivalent to a situation where, say, a fridge manufacturer in Japan produces fridges that have a safety fault: as a result of that, we ban all imports of cars from Nissan, Honda and Toyota just because they come from Japan.

SEXUAL LIFE IN CHINESE MEDICINE

2011-07-11T09:28:00.000-07:00

Chinese medicine has always stressed the importance of excessive sexual activity: in this article, I would like to bring to your attention two factors:
- The distinction between men and women in sexual activity
- Insufficient sexual activity as a cause of disease

When discussing sexual activity, Chinese books never distinguish between men and women. There are substantial differences in the sexual physiology of men and women so that excessive sexual activity is less of a cause in disease in women than it is in men. The reason lies in the nature of Tian Gui.

Tian Gui is the generative essence that renders men and women fertile. It is mentioned in the very first chapter of the Su Wen: “When a girl is 14 Tian Gui arrives, the Ren Mai is open, the Chong Mai is flourishing, menstruation starts and she can conceive”. For boys, “When a boy is 16, Kidney-Qi is strong, Tian Gui arrives, sperm is discharged, Yin and Yang are in harmony and he can fertilize.” Thus, Tian Gui is the essence that allows women to conceive and men to fertilize: in women, it is the ova, in men, sperm. Tian Gui is a direct manifestation of Kidney-Jing. In men, loss of sperm therefore implies a loss of Jing and therefore excessive (too frequent) sexual activity may diminish Jing; in women, during sexual activity there is no corresponding loss of Jing as they obviously do not lose ova during sexual activity and therefore there is no corresponding loss of Jing.

While Chinese books always mention excessive sexual activity as a cause of disease, they never mention insufficient sexual activity as a possible cause of disease. This has not always been so as, during past dynasties, all sex manuals explicitly said that sexual activity is essential for the health of both men and women. Indeed, sexual abstinence was viewed with suspicion (as Buddhist nuns were).

Some Chinese doctors considered lack of sex and sexual frustration as a major cause of emotional stress in women. Sexual desire depends on the Minister Fire and a healthy sexual appetite indicates that this (physiological) Fire is abundant. When sexual desire builds up the Minister Fire blazes up and Yang increases : the orgasm is a release of such accumulated Yang energy and, under normal circumstances, it is a beneficial discharge of Yang-Qi which promotes the free flow of Qi. When sexual desire builds up, the Minister Fire is stirred: this affects the Mind and specifically the Heart and Pericardium. The Heart is connected to the Uterus via the Uterus Vessel (Bao Mai) and, in women, the orgasmic contractions of the uterus discharge the accumulated Yang energy of the Minister Fire.

When sexual desire is present but does not have an outlet in sexual activity and orgasm, the Minister Fire can become pathological, accumulate and give rise both to Blood Heat and to stagnation of Qi in the Lower Burner. This accumulated Heat will stir the Minister Fire further and harass the Shen, while the stagnation of Qi in the Lower Burner can give rise to gynaecological problems such as dysmenorrhoea.

Of course, if sexual desire is absent, then lack of sexual activity will not be a cause of disease. Conversely, if one abstains from sexual activity but the sexual desire is strong, this will also stir up the Minister Fire. Thus, the crucial factor is the mental attitude and sexual desire.

With regard to sexual frustration, Qing dynasty’s Chen Jia Yuan wrote very perceptively about some women’s emotional longing and loneliness. Among the emotional causes of disease he distinguishes “worry and pensiveness” from “depression”. He basically considers depression, with its ensuing stagnation, due to emotional and sexual frustration and loneliness. He says: “In women...such as widows, Buddhist nuns, servant girls and concubines, sexual desire agitates [the mind] inside but cannot satisfy the Heart. The body is restricted on the outside and cannot expand with the mind [i.e. the mind longs for sexual satisfaction but the body is denied it]. This causes stagnation of Qi in the Triple Burner and the chest; after a long time there are strange symptoms such as a feeling of heat and cold as if it were malaria but it is not. This is depression”.
Although the above thoughts derive from Dr Chen’s clinical experience with servant girls, Buddhist nuns and concubines and should therefore be seen in the social context of the Qing dynasty, they also have relevance to our times as he is essentially talking about sexual frustration and loneliness and his reference to widows confirms this (in old China widows were shunned and seldom remarried). He perceptively refers to sexual craving agitating the body but not finding a satisfaction in the Heart and mind: besides sexual frustration, he is also referring to emotional frustration and craving for love.

Thus, considering the social position of women in ancient China and the frequency of the above-mentioned emotional frustration, it is no wonder that Qi stagnation occupies such a central place in women’s pathology, and emotional stagnation in women was often the result of sexual frustration, separation, loss and loneliness: these are the recurrent "anger" in Chinese medicine books.

Sexual frustration was a common cause of disease especially from the Song dynasty onwards as Confucianists frowned upon sexual activity and believed that it should be carried out in secret and that there should be no public display of affection (as in modern China). The current pruderie of Chinese medicine and society is clearly a result not so much of the Communist influence but of the Qing dynasty's Confucian influence. It is important to understand, however, that these rules did by no means imply that sex was a “sin” and woman was the origin of such sin as in the Christian view. The Confucianist abhorrence of sexual philandering was determined mainly by the fear that promiscuity might disrupt the sacred family life.

i. Eight Secret Books on Gynaecology, p.152.

PRESS RELEASE FROM THE ALLIANCE FOR NATURAL HEALTH

2011-06-24T09:14:00.000-07:00

Please read this interesting Press Release from the Alliance for Natural Health. I would recommend European practitioners to keep up the pressure on our elected representatives at both European and national level: it is ultimately they, not the so-called regulatory agencies, who are responsible for this iniquitous legislation. If you live in the UK, write to your MP letting them know that we would rather keep our freedom to choose the treatment we want than be "protected" by some regulatory agency.

Alliance for Natural Health Press Release:
24th June 2011

CAMPAIGNERS PRESSURIZE EUROPEAN COMMISSION TO RECOGNIZE DISCRIMINATION AGAINST NON-EUROPEAN HERBAL TRADITIONS
Alliance for Natural Health International issues open letter to European Commissioner for Health & Consumers, John Dalli

The Alliance for Natural Health International (ANH-Intl), a group campaigning for the right to natural healthcare worldwide, has today issued an open letter to European Commissioner John Dalli, responsible for the regulation of pharmaceuticals and foods EU-wide. The letter demands immediate action from the European Commission to prevent further erosion of non-European systems of medicine within the EU. This is the result of the implementation of various EU laws, including the controversial directive on ‘traditional herbal medicinal products.’

The open letter from Dr Robert Verkerk, executive and scientific director of ANH-Intl, has been issued just 3 days after a forum hosted by Michèlle Rivasi and other Green/European Free Alliance MEPs, on the future of herbal medicine within Europe. Concerned parties grilled the European Commission and European Medicines Agency for over 2 hours, but few left any the wiser. Dr Verkerk explained, “The Commission’s responses were lacklustre and hollow, so we felt we had to push the Commission for more answers, particularly on behalf of users of Chinese and Indian systems of traditional medicine within Europe.”

The European Commission has long argued that the drug registration system offered by the EU herbal directive provides no additional obstacles for products of non-European traditions, as compared with European ones. “This position is simply untrue. This is amply demonstrated by the 400 or so registrations under the scheme EU-wide for typical Western herbal products, as against zero for authentic products associated with the great Chinese and Indian [Ayurvedic] traditions, used by well over one-third of the world’s population,” added Dr Verkerk.

The Commission is being asked to respond in the wake of mounting pressure from European citizens. Allied campaign groups, namely Défense Médicine Naturelle and Avaaz, have between them submitted petitions from nearly a million European citizens. The petitions cite concerns about the EU herbal directive’s discriminatory impact on non-European traditional systems of medicine and voice support for ANH-Intl’s proposed legal challenge.

Contact
Dr Robert Verkerk
Executive & Scientific Director
Alliance for Natural Health International
The Atrium, Curtis Road
Dorking, Surrey RH4 1XA
United Kingdom
T: +44(0)1306 646 600
Email: : info@anhinternational.org

EUROPEAN PARLIAMENT LOBBY FOR HERBAL MEDICINE

2011-06-16T09:28:00.001-07:00

EMERGENCY FORUM, BRUSSELS, 21st June to save herbal medicine: be there or view on internet
The Alliance for natural Health, the European Parliament CAM Interest Group and other campaign groups will be in the European Parliament in Brussels to question European regulators, along with concerned Members of the European Parliament (MEPs), over how they are handling herbal products in Europe. The questions will be raised in an emergency forum organised by Greens MEPs.

But this is your chance to ask your own questions! If you can make it to Brussels, please be there. It would be amazing to stuff the seminar room full of concerned citizens to really show European regulators the extent and depth of concern.

If you can get to the European Parliament in person next Tuesday for around midday in readiness for a 13:00h start, you will need to register by sending your full name, address, your passport number and date of birth to michele.rivasi@europarl.europa.eu and satu.hassi@europarl.europa.eu by 16:00h Central European Time, Friday 17 June 2011. It would be wonderful to see as many of you there as possible! Access to the European Parliament can be gained via the Altiero Spinelli entrance on Rue Wiertz 60, B-1050 Brussels (see ASP on map).

If you can't be there, you'll be able to watch the debate live between 13:00-16:00h Central European Time via the following livestream link:
http://greenmediabox.eu/live/thmpd/

We know this is very short notice - but this is an emergency conference, and the scheduling, venue and details have only just been agreed and received by us, which is why we have wasted no time getting this out to you.

Please get this message out as widely as possible to all those you know in Europe (and beyond of course for those who want to view the livestream) who are as concerned as we are.

European double standards for drugs and herbal medicines

2011-06-12T11:42:00.000-07:00

The following is an interesting report of the 3-year struggle to get the European Medicines Agency (EMA) to release data on clinical trials that it was bound by European law to release. It is interesting that European agencies (such as the EMA) cite protection of drug companies commercial interest for not divulging data, while, when it comes to herbal manufacturers, they claim to “protect the consumer”. When I hear that a regulatory agency aims to “protect the consumer” alarm bells ring. (For US practitioners: the EMA is the European equivalent of the FDA.)

BMJ 2011; 342:d2686 doi: 10.1136/bmj.d2686 (Published 10 May 2011)

OPENING UP DATA AT THE EUROPEAN MEDICINES AGENCY
Peter C Gøtzsche, professor
Anders W Jurgensen, PhD student

Nordic Cochrane Centre, Rigshospitalet and University of Copenhagen, Dept 3343, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark

Widespread selective reporting of research results means we do not know the true benefits and harms of prescribed drugs. Peter Gøtzsche and Anders Jørgensen describe their efforts to get access to unpublished trial reports from the European Medicines Agency.

Doctors cannot choose the best treatments for their patients despite the existence of hundreds of thousands of randomised trials. The main reason is that research results are being reported selectively. Comparisons of published drug trials with unpublished data available at drug regulatory agencies have shown that the benefits of drugs have been much over-rated and the harms under-rated. Comparisons of trial protocols with published papers have also shown widespread selective reporting of favourable results.

Selective reporting can have disastrous consequences. Rofecoxib (Vioxx) has probably caused about 100,000 unnecessary heart attacks in the United States alone, and class 1 antiarrhythmic drugs probably caused the premature death of about 50,000 Americans each year in the 1980s. An early trial found nine deaths among patients taking the antiarrhythmic drug and only one among those taking placebo, but it was never published because the company abandoned the drug for commercial reasons.

Allowing researchers access to unpublished trial reports submitted to drug regulatory agencies is important for public health. Such reports are very detailed and provide more reliable data than published papers, but it has been virtually impossible to get access to them. We eventually succeeded in getting access to reports held by the European Medicines Agency (EMA) after three years of trying. Our case has set an important precedent, and we summarise here the process and the arguments.

Our application for access
On 29 June 2007 we applied for access to the clinical study reports and corresponding protocols for 15 placebo controlled trials of two anti-obesity drugs, rimonabant and orlistat. The manufacturers had submitted the reports to the EMA to obtain marketing approval in the European Union. We explained that we wanted to explore the robustness of the results by adjusting for the many missing data on weight loss and to study selective publication by comparing protocols and unpublished results with those in published reports.

The information was important for patients because anti-obesity pills are controversial. The effect on weight loss in the published trials is small, and the harms are substantial. People have died from cardiac and pulmonary complications or have experienced psychiatric disturbances, including suicidal events, and most of the drugs have been deregistered for safety reasons.

A basic principle in the European Union is to allow its citizens the widest possible access to the documents its agencies possess. But there are exemptions, and the EMA refuses access if disclosure would threaten commercial interests unless there is an over-riding public interest. We argued in our first letter to the EMA that secrecy was not in the best interests of the patients because biased reporting of drug trials is common. Furthermore, we had not found any information that could compromise commercial interests in 44 trial protocols of industry initiated trials we had reviewed previously.

Protection of commercial interests
Protection of commercial interests was the EMA’s over-riding argument. It would undermine the protection of commercial interests to allow us access, it said, as the documents represented the full details of the clinical development programme and the most substantial part of the applicant’s investment. Competitors could use them as a basis for developing the same or a similar drug and gather valuable information on the long term clinical development strategy of the company to their own economic advantage.

We explained that the clinical study reports and protocols are based on well known principles that can be applied to any drug trial; that the clinical study reports describe the clinical effects of drugs; and that nothing in the EMA’s guidelines for preparation of such reports indicates that any information included in them can be considered a trade secret. The trial protocols are always sent to the clinical investigators, and it is unlikely that companies would have left in any information that could be of commercial value (such as a description of the drug synthesis). We also noted that the clinical study reports and trial protocols represent the last phase of drug development, which has been preceded by many years of preclinical development. Other companies could hardly use them as a basis for developing similar drugs. In fact, unpublished trial data are generally less positive than published ones, and competitors would therefore be less likely to start drug development if they had access to the unpublished results. Other companies are more likely to be interested in in vitro, animal, and early human studies, and drug companies have no problems with publishing such studies because the results may attract investors.

The European ombudsman, P Nikiforos Diamandouros, considered that commercial interests might be at stake but noted that the risk of an interest being undermined must be reasonably foreseeable and not purely hypothetical. He could not see that access would “specifically and actually” undermine commercial interests. He inspected the relevant reports and protocols at the EMA and concluded that the documents did not contain commercially confidential information. He therefore criticised the EMA’s refusal to grant us access.

Over-riding public interest in disclosure
Even if commercial interests were undermined by disclosure, access would still have to be granted if there was an over-riding public interest. The EMA argued that it could not identify any over-riding public interest and remarked that the evaluation of safety and efficacy of drugs is its responsibility—the EMA constantly monitors drugs and updates its assessment reports and requires changes in product information as appropriate.

We considered this insufficient. Monitoring adverse effects reported by doctors to drug agencies would not have revealed that rofecoxib causes heart attacks. Few such events are reported, and heart attacks are common in people with arthritis. Postmarketing passive surveillance systems can therefore usually not detect whether a drug leads to more heart attacks than expected; randomised trials are needed for this.

We provided more evidence of the detrimental effects of selective publication but to no avail. The EMA continued to claim that we had not documented the existence of an over-riding public interest. We noted that we could not prove this in this specific case because we were denied access to the data, but we drew attention to the fact that the total number of patients in the main clinical studies of orlistat differed according to the source of the information: published reports, the EMA’s website, and the website of the US Food and Drug Administration.

The ombudsman indicated that we had established an over-riding public interest, but he did not take a definitive stance on whether an over-riding public interest existed because this question needed answering only if disclosure undermined commercial interests. He asked the EMA to justify its position that there wasn’t an over-riding public interest, but the EMA avoided replying by saying that we had not given evidence of the existence of such an interest. We believe that we had. Furthermore, the EMA’s argument was irrelevant. A suspect asked for his alibi on the day of the crime doesn’t get off the hook by asking for someone else’s alibi.

Administrative burden
According to the EMA, the redaction of (unspecified) “personal data” would cause the EMA a disproportionate effort that would divert attention from its core business, as it would mean redacting 300,000-400,000 pages. This was surprising. The Danish Drug Agency had not seen the workload as a problem when it granted us access to the reports for the anti-obesity drug sibutramine, which was locally approved in Denmark. The 56 study reports we received comprised 14,309 pages in total, and we requested only 15 study reports from the EMA (the pivotal studies described in the European Public Assessment Reports (EPARs) on rimonabant and orlistat). The ombudsman declared that the EMA had overestimated the administrative burden involved.

Worthlessness of data after redaction
The EMA argued that, “as a result of the redaction exercise, the documents will be deprived of all the relevant information and the remaining parts of them will be worthless for the interest of the complainant.”

From what we know of clinical trial reports and protocols it struck us as odd that they would contain so much personal data that the documents became worthless. The ombudsman noted that the requested documents do not identify patients by name but by their identification and test centre numbers, and he concluded that the only personal data are those identifying the study authors and principal investigators and to redact this information would be quick and easy.

The EMA also remarked that a possible future release of the assessment reports of the EMA’s Committee for Medicinal Products for Human Use and the (co)rapporteur assessment reports “could satisfy the request of the complainants.” These reports were not available and they would have been worthless to us because they are merely summaries used for regulatory decisions.

Maladministration
The EMA was completely resistant to our arguments and those from the ombudsman. However, after the ombudsman accused the EMA of maladministration in a press release on 7 June 2010, three years after our request, the EMA reversed its stance. The EMA now gave the impression that it had favoured disclosure all the time, agreed with the ombudsman’s reasoning, and noted that the same principles would be applied for future requests for access but that it would consider the need to redact part of the documents.

The EMA’s last letter was unclear: “The Agency will do its utmost to implement its decision as quickly as possible, in any case within the next 3 months at the latest. The Agency will keep the European Ombudsman promptly informed of the exact implementation date.”

It was not clear whether the three months was the deadline for sending the reports to us, for implementing its new policy, or both. We received the data we requested from the EMA on 1 February 2011, which in some cases included individual patient data in anonymised format, identified by individual and test centre numbers.

Concluding remarks
According to the EMA’s responses to the ombudsman, the EMA put protecting the profits of the drug companies ahead of protecting the lives and welfare of patients. Moreover the EMA's position is inconsistent because it resisted requests to give access to trial data on adult patients while providing access to data on paediatric trials, in accordance with EU legislation. The Declaration of Helsinki gives authors the duty to make publicly available the results of their research on humans. The declaration also says that, “Medical research involving human subjects must . . . be based on a thorough knowledge of the scientific literature.” If the knowledge base is incomplete, patients may suffer and cannot give fully informed consent9 and research resources are wasted. The EMA should be promoting access to full information that will aid rational decision making, not impede it.

Our case sets an important precedent. On 30 November 2010 the EMA declared it would widen public access to documents, including trial reports and protocols. We recommend that the FDA and other drug regulatory agencies should follow suit. Access should be prompt—for example, within three months of the regulator’s decision—and documents should be provided in a useful format. Drug agencies should get rid of the huge paper mountains and require electronic submissions from the drug companies, including the raw data, which should also be made publicly available.

European ban of herbal remedies - UK

2011-06-12T00:38:00.000-07:00

The European Directive on herbal medicines (which effectively bans all industrially-produced herbal remedies) came into force on 1 May 2011 and it looks like the UK is “dutifully” enforcing it. I wrote the letter below to the Department of Health in answer to an anodyne letter from them re-stating the usual points (undeclared pharmaceuticals in some herbal remedies, etc.), in turn received after writing to Mr Cameron and Mr Lansley.

Let us not give up the fight. Let us bring the fight to our elected representatives, not the regulatory agencies. It is them who are ultimately responsible for legislation and they who need to be elected by us. It is them who impose on us the taxes that are used to design, implement and enforce the very legislation that takes our freedom away. Even if they will not repeal the legislation, they can adopt a very “European” solution and that is to quietly ignore it as many European countries do with most European regulations.

June 3, 2011

Customer Service Centre
Department of Health
Richmond House
79 Whitehall
London SW1A 2NS

Dear Sirs,

European Directive on Herbal Medicines

Thank you for taking the time to reply to my letter addressed to Mr Cameron and Mr Lansley. I would like to make a few comments if I may.

1) Firstly, I would like to say that my letter to Mr Cameron made a political point rather than a medical one. We do not need yet another mammoth European Directive meddling into our affairs and I was urging Mr Cameron to reject it especially since he said he does not want to delegate more powers to the EU.

2) You mention the fact that some herbal remedies have been found to contain undeclared pharmaceutical substances as a reason to have the European Directive on Herbal Medicines. With respect, this Directive has nothing to do with that problem. The addition of undeclared pharmaceutical substances to herbal remedies is of course illegal and the MHRA already has the power to stop that practice: we do not need a European Directive for that.

3) Whenever the issue of the European Directive is raised, the MHRA brings up the same issues that are essentially UK issues: so why do we need a European Directive for that?

4) Your letter mentions the licensing of herbal remedies and that sounds very re-assuring. The problem is that no remedy with multiple ingredients (such as Chinese or Ayurvedic ones) can be licensed; so this seems to me like discrimination against Chinese and Indian herbal remedies.
The second problem is cost: the criteria for licensing are such that the cost of registration (per remedy) is extremely high, 50,000 Euros and upwards. That puts it out of reach of most herbal companies, especially those who would need to register many different remedies. Therefore, while the THMD sounds “reasonable”, it is effectively banning herbal medicines and significantly curbing the freedom of the public to choose the treatment they want.
You may say that the MHRA has a duty to “protect” the public, but what if they do not want to be protected and would rather prefer to decide for themselves which treatment they want? Especially in this Internet age, the public are quite capable of “protecting” themselves and make their own decisions about the suitability of a particular treatment. For example, some years ago the Government was trying to convince the public that GM foods are safe and yet the public overwhelmingly made up their own mind about that and rejected GM foods.

5) It seems totally irrational to punish many good herbal companies with excellent quality controls and high quality of products because a very small minority of companies have added undeclared pharmaceutical substances to herbal remedies. This is equivalent to the police forcing all drivers to register at a very high cost simply because a few drivers speed. If I can make a prediction it is this: the THMD will not raise the standard of herbal remedies on the market because it will put out of business very many good companies with quality products and some of the rogue companies that have been adding undeclared pharmaceutical substances will probably continue doing so.

6) In this Internet age when information is readily available, the public does not need to be “protected” by some nanny agency; moreover, what if they do not want to be “protected” and prefer to keep the freedom to choose the treatment they want? I recently got an email from a woman with ovarian cancer undergoing chemotherapy. She had been taking a herbal remedy to minimize the side-effect of chemotherapy with good results. This has now been banned and she cannot have it any longer. Do you not think that she would rather keep the freedom to choose a remedy that is helping her than be “protected” by you? Indeed Mr Richard Woodfield himself is reported as saying (according to the Daily Express): “There are lots of herbal medicines with only partial evidence of efficacy. The consumer is perfectly able to decide for themselves whether or not they wish to take them.”

7) What is so upsetting about this European Directive is that it a gross infringement of our freedoms. We are always told this Directive is aimed at the “protection of the consumer” but it is not so: it has nothing to do with the protection of the consumer and everything to do with the need of regulatory agencies to “regulate” and the need of the bloated European bureaucracy to “regulate” in order to justify their existence. Indeed, such regulatory agencies are also responsible for licensing of medicines and, presumably, licenses are granted after extensive safety studies and clinical trials. And yet, thousands of people die each year from adverse reactions to drugs and, after such safety studies, many drugs have to be withdrawn from the market (see Vioxx). Which is the greater threat to public health: herbal remedies or medicinal drugs? How does the MHRA “protect” the public in this case?

8) There are grave reports about the European Medicine Agency. European MEPs have refused to sign off the European Medicines Agency's accounts, citing "grave" concerns. The MEPs are worried about the Agency’s lack of independence from pharmaceutical companies. The Nordic Cochrane Centre accuses the Agency of working to protect pharmaceutical profits. In a damning indictment of the EMA, of the type many people had despaired of ever witnessing in the closed environment of the European Parliament, an overwhelming majority of MEPs – 637 to 4! – voted not to sign off the EMA’s accounts.

Yours sincerely,
Giovanni Maciocia

JOY: AN EMOTIONAL CAUSE OF DISEASE?

2011-06-07T21:49:00.000-07:00

It always seems strange that joy should be listed among the emotional causes of disease in Chinese medicine. And yet, it has always been mentioned as an emotional cause of disease since ancient times. Strangely, the Chinese character for “joy” [xi 喜] is the only one of the emotions that is not based on the ‘heart” radical. The character Xi is based on the radical for “drum” plus “mouth”, i.e. beating a drum and singing in happiness. Incidentally, two xi characters next to each other are called “double happiness” and are a symbol of a wedding.

It is interesting that, in the list of emotions as causes of disease, “joy” is always top of the list, followed by anger. For example, these are the emotions listed by Confucius: joy, anger, grief, fear, love, hatred, desire. These are the emotions listed by Lao Zi: joy, anger, worry, sadness, love, hatred, desire. It is interesting that both lists include “love” as an emotional cause of disease! Chen Wu Ze (1174) lists: joy, anger, pensiveness, worry, sadness, fear, shock. These became the widely accepted “7 emotions” of Chinese medicine. Zhang Jie Bin (1624) lists eight emotions: joy, anger, pensiveness, worry, sadness, fright, fear, shock.1

A normal state of joy is obviously not in itself a cause of disease; on the contrary, it is a beneficial mental state which promotes a smooth functioning of the Internal Organs and their mental faculties. The “Simple Questions” in chapter 39 says: “Joy makes the Shen peaceful and relaxed, it benefits the Ying and Wei Qi and it makes Qi relax and slow down.”2 On the other hand, in chapter 2 the “Simple Questions” says: “The Heart … controls joy, joy injures the Heart, fear counteracts joy.”3 Other passages in the Nei Jing clearly refer to joy as a cause of disease. For example, chapter 5 of the “Simple Questions” says: “Joy injures the Heart.”4 Chapter 8 of the “Spiritual Axis” says: “Joy scatters the Heart and deprives it of its residence.”5

Fei Bo Xiong (1800–1879) in “Medical Collection of Four Doctors from the Meng He Tradition” says: “Joy injures the Heart … [it causes] Yang Qi to float and the blood vessels to become too open and dilated …”6

I think that the best (and probably only) way to understand “joy” as an emotional cause of disease is in the light of the three main philosophies of China, i.e. Daoism, Confucianism and Buddhism. I think that “joy” is akin to “desire” and “craving” from the point of view of these three philosophies. Of the three philosophies, Daoism and Confucianism are the main ones because Buddhism was not widespread in China at the time when joy was already considered as a cause of disease, i.e. during the Warring States Period (476-221 BC).

All these three religions (or rather philosophies), for different reasons, advocated emotional restraint and avoidance of “craving” and “desire”. For example, the Daoists shunned social relations and advocated “following the Dao”, “absence of desire” (wu yu) and “non-action” (wu wei). They felt that joy would stop us from following the Dao as much as other emotions such as anger. The great Daoist Zhuang Zi (370-301 BC?) talks about wu qing, i.e. absence of feelings: “What I mean when I say that they [sages] are wu qing (without feelings) is that they do not injure their own persons with likes and dislikes and are always responsive to what is natural without trying to increase life.”7

The ancient Daoist text Nei Ye (Inner Training), older than the Dao De Jing, has this interesting passage on emotions:

The vitality of all people
Inevitably comes from their peace of mind
When anxious, you lose this guiding thread
When angry, you lose this basic point
When you are anxious or sad, pleased or angry,
The Dao has no place within you to settle
Love and desire: still them!
If you are tranquil, you will attain it (the Dao)
If you agitated, you will lose it.8

Indeed, to the Daoists, stimulation has a negative connotation. Zhuang Zi says concisely: “When desire is profound, the force of Heaven is superficial.” This means that desire turns us away from the vitality of Heaven stirring emotions within us that make us stray from the path of the Dao.

Confucianists believed that the true “gentleman” (a mistranslation of the term jun zi that actually applies to both men and women) is not stirred by emotions because these cloud his or her true nature. They used the image of a pond with a muddy bottom. If the water is very still, it becomes clear: if we stir the bottom, the water becomes turbid. The pond is our human nature which is naturally “clear”; if we are stirred by emotions, these will cloud our human nature. Consider this passage from Xun Zi (a Confucianist philosopher, 312-230 BC): “It is ever so that the Heart-Mind [Xin] is naturally full, naturally born and naturally perfected. Should its function be impaired, it is certain to be due to sorrow and happiness, joy and anger, desire and profit-seeking. If we can rid ourselves of sorrow and happiness, joy and anger, desire and profit-seeking, the Heart-Mind [Xin] will revert to its flawless state.”9

The Buddhists considered desire and craving as the very root of human suffering. Greed (excessive desire), hatred and ignorance are at the centre of the Wheel of Life and greed is strangely symbolized by a rooster. According to them, our very existence begins out of the desire and craving of a mind in the Bardo state (the period after death and before the next reincarnation): the mind desires the warmth of a womb and it reincarnates. Later on in life, desire causes our mind to try to grasp objects like a monkey sways from tree to tree (that is why the Buddhist Wheel of Life has, among others, the image of a monkey on a tree).

So, what relevance has this view of “joy”, “desire” and “craving” to us in the 21st century? I think that these emotions are indeed causes of disease and I would call the modern equivalent of these emotions “overstimulation”. I think that this, rather than “joy”, would probably be the best translation of xi. Our society indeed bombards us with objects of craving and it artificially creates “desire” and “craving” through advertising; on the other hand, it provides and fosters substances that overstimulate us.

We are all “overstimulated” by entertainment, frenetic lifestyle, consumerism, coffee, tea, tobacco, alcohol, TV, video games, “recreational drugs”, medicinal drugs, and sexual stimulation.

The main stimulant drugs are:
• Caffeine
• Nicotine
• Cocaine
• Amphetamines
• Prescription drugs e.g. Ritalin® (Methylphenidate), Adderall® (amphetamine and dextroamphetamine), Dexedrine® (dextroamphetamine), Strattera® (atomoxetine), Focalin® (Dexmethylphenidate) etc.

Interestingly, antidepressants are not actually stimulants and do not usually lead to “joy”. My experience with depressed patients on anti-depressants is that these drugs “blunt” all emotions; they do somehow lift depression but at the expense of alertness and enthusiasm. Indeed, some anti-depressants are used for anxiety with some effect.

I think that the ‘blunting” effect of anti-depressants is reflected in the resulting pulse, i.e. a pulse that feels “stagnant” and does not have the healthy “wave” of the normal pulse. It is not Wiry, not Tight but I describe it as “stagnant” and “reluctant”. While most authors see anti-depressants as mood-elevating and stimulants, I do not share that view and the pulse qualities described above seem to confirm this.

Overstimulation, in the broad sense indicated above, makes the Heart larger. This leads to excessive stimulation of the Heart, which in time, may lead to Heart-related symptoms and signs. These may deviate somewhat from the classical Heart patterns. The main manifestations would be palpitations, over-excitability, insomnia, restlessness, talking a lot and a red tip of the tongue. The pulse would typically be slow, slightly Overflowing but Empty on the left Front position. It may seem strange that “joy” or overstimulation makes the pulse slow. This is because overstimulation makes the heart larger and therefore slows down circulation (shock, by contrast, makes the heart smaller).

The points I use for overstimulation are HE-7 Shenmen, P-7 Daling, Du-19 Houding, Ren-15 Jiuwei.

1. Zhang Jie Bin (also called Zhang Jing Yue) 1982 Classic of Categories (Lei Jing), People’s Health Publishing House, Beijing, p. 424. First published in 1624.

2. 1979 The Yellow Emperor’s Classic of Internal Medicine-Simple Questions, p. 221.

3. Tian Dai Hua 2005 The Yellow Emperor’s Classic of Internal Medicine - Simple Questions p. 38.

4. Ibid., p. 38.

5. Spiritual Axis, p. 25.

6. Medical Collection of Four Doctors from the Meng He Tradition, p. 40.

7. Ames RT and Hall DL A Philosophical Translation of the Dao De Jing, Ballantine Books, New York, 2003, p. 47.

8. Roth H Original Tao, Columbia University Press, New York, 1999, p. 94.

9. Lee J Xunzi and Early Chinese Naturalism, State University of New York Press, Albany, 2004, p. 35.

Petition to save herbal medicine in Europe

2011-06-02T22:41:00.000-07:00

To European practitioners and public: please sign this petition from the Alliance for Natural Health to save herbal medicine in Europe. Bring the battle to your elected representatives: they, not the so-called regulatory agencies, are ultimately responsible to reverse this gross infringement of our freedoms.

An EU directive has banned many herbal medicines, denying us safe remedies and feeding the profits of big pharma. Let's raise a massive outcry to push the Commission to reverse the Directive. Let's get to 1 million voices to save herbal medicine. Add your name here:

https://secure.avaaz.org/en/eu_herbal_medicine_ban/?utm_source=The+Alliance+for+Natural+Health&utm_campaign=95058cff75-110602_ANH_Intl_eAlert_No_576_2_2011&utm_medium=email

European Union

2011-05-19T00:48:00.000-07:00

This is particularly for UK practitioners (who are of course also UK taxpayers). If you want to get an idea of the madness and lack of accountability of the European Union, watch this:

http://www.bbc.co.uk/news/uk-politics-13438712

Ah yes, and in the middle of this financial, economic and banking crisis, what is the European Union concerned with? Why, of course, the marketing of herbal remedies..

Distribution of Three Treasures remedies in the UK

2011-05-13T20:11:00.001-07:00

Dear colleague,

As you know, the wretched European Traditional Herbal and Medicinal Products Directive came into force on 30 April 2011. This Directive removes the exemption granted to herbal remedies under Section 12.2 of the 1968 Medicines Act, removing the freedom to prescribe manufactured herbal remedies and the freedom for consumers to buy them. Incidentally, such freedom in England goes back to Henry VIII times. So, once again, England gives up ancient freedoms to be ruled by the unelected and unaccountable European bureaucracy.

However, under the new law, manufacturers are allowed to sell, through retailers, the existing stock within the expiry date provided it was bought prior to 30 April 2011. Therefore, I am pleased to announce that the Three Treasures and Women’s Treasure tablets will still be available for the time being. To order, please contact Balance Healthcare’s distributor, i.e.:

Pure Health Ltd
19 Newhaven Enterprise Centre
Denton Island
Newhaven
East Sussex BN9 9BA
Tel: 01582 380000
Online orders: www.purehealthonline.co.uk

The Three Treasures and Women’s Treasure remedies distributed by Pure Health are exactly the same as before, produced to the same high quality controls. Now more than ever, when we are under unprecedented scrutiny, quality controls are more important than ever. Please note this about the Three Treasures:

- The remedies are produced to standards that exceed GMP standards
- Identification of the herbs is done according to the highest possible criteria eliminating the possibility of the wrong herb being used
- The remedies are (and always have been) free from aristolochic acid
- Certificates of analysis guarantee the absence of heavy metals
- Volatile oils are re-introduced after decoction
- The herbs are decocted together to ensure maximum synergy.

The same resources as before are available to practitioners, i.e.:

• A website dedicated to the Three Treasures and Women’s Treasure with a complete manual, newsletters and case histories on www.three-treasures.com
• A practitioners Forum on www.three-treasures.com where practitioners can ask questions regarding the clinical use of the Three Treasures and Women’s Treasure
• Powerpoint presentations with a detailed description of each remedy and relevant tongues are available on www.maciociaonline.com.
• Practitioners’ hotline with direct access to Giovanni: email suwenherbs@gmail.com

A BLACK DAY FOR FREEDOM IN EUROPE, A SHAMEFUL DAY FOR THE EUROPEAN UNION

2011-04-28T14:47:00.001-07:00

On 1 May 2011, the European Directive on Traditional Herbal Medicinal Products 2004/24/EC will come into force. This Directive has far-reaching (negative) consequences for acupuncturists, herbalists, the herbal medicine industry and consumers of herbal medicine. Quite simply, this is a draconian Directive that limits our freedom to use herbal medicines as practitioner and consumers. Make no mistake, contrary to what our bureaucrats are telling us, this Directive has nothing to do with the protection of the consumer: it has everything to do with the desire and need of Eurocrats to regulate and control.

In this age of the Internet when high-quality information is readily available, the consumer is perfectly able to satisfy him- or herself about the standard of quality controls and efficacy of a particular herbal remedy. For example, hundreds of clinical studies on herbal medicines are available online.

The main motivation for this draconian European Directive is the European political and administrative class’s pathological need to regulate. In the European mindset, anything that is not “regulated” is assimilated to “illegal”. The European bureaucracy needs to regulate to justify their existence and paradoxically, we, the victims of this legislation, are even paying their salaries through taxation. Have you heard that the European Commission has asked for an increase of 5% in their annual budget? At a time when all over Europe (and especially in Ireland, Greece and Portugal) populations are suffering under a regime of economic “austerity” and drastic cuts!

The second reason for the ban is, sadly the lobbying by the powerful drug companies. Hannan says: “Whenever an apparently absurd law of this kind emanates from the EU, ask yourself cui bono — whose interest does it serve? In this case, there is no mystery: the directive was openly lobbied for by large pharmaceutical companies, which saw an opportunity to put their smaller rivals out of business. Not for the first time, big corporations have used the EU to push through rules which national assemblies would never have countenanced. MPs were left in no doubt about how their constituents viewed the proposal. But Brussels fonctionnaires are invulnerable to the ballot box: the EU was designed, in the aftermath of the second world war, precisely to shield them from public opinion”.1

When asked why we need this Directive, regulators churn out always the same trite things: some Chinese herbal remedies contain undeclared medicinal drugs, some have high levels of heavy metals, etc. This is true (although the percentage of above remedies is a tiny proportion of the total), but there are already existing laws against such practices. Such practices could easily be stamped out using existing legislation without this draconian European legislation. In fact, the result of this legislation will be the exact opposite of what it purports to do. A tiny minority of companies will probably continue selling remedies that are already illegal while many reputable herbal companies who do not, and never have, used such practices will be driven out of business. Moreover, as in usual European style, each country will do what they want, we will have the absurd situation that consumers in one country will be able to buy unlicensed herbal remedies online from another European country: hardly a desirable outcome.

By the way, do you know that the long delay (7 years) in the implementation of this Directive was deliberate? Hannan says: “The ban was voted through the European Parliament seven years ago but, as so often, Eurocrats built in a delay, knowing that national ministers were far more likely to agree to an unpopular measure that would blow up in the laps of their successors”. Indeed, in the UK, the Directive was approved by the Blair Labour Government and it has now blown up in the face of Cameron’s Coalition Government.

Why do we need such Directive?
• Six million people in Britain have visited a herbalist at some point in the past two years
• Two million regularly use alternative treatments as a first resort
• Herbal remedies account for just 0.4% of reported adverse reactions.

In theory, the EU Directive sounds reasonable. It is not “banning” herbal medicines: it is “merely” establishing rules for their “licensing”. In practice however, the licensing requirements are such that no remedy with multiple ingredients (such as Chinese or Ayurvedic medicines) can get a licence because it is impossible to meet the criteria for registration.

Secondly, cost. The licensing of each remedy would cost about between € 50,000 and € 100,000 Euro ($ 74,000-148,000) which is therefore impossible to bear for the overwhelming majority of herbal suppliers. Therefore, the practical effect of this legislation is indeed to ban herbal remedies (and, by the way, increase unemployment).

The result of this Directive is that:
• A third-party dispensary service (Product Supplier) can no longer make up individualised raw and powdered prescriptions, batches of pills or capsules
• Patent herbs will no longer be available to any practitioners, whether state regulated or not and will disappear from the UK/ European market. Over-the-counter herbal remedies also will not be available to consumers
• Only health professionals who are statutorily regulated can prescribe or sell “finished” unlicensed medicines and even that is up in the air in the UK

It is ironic that such restrictions on the use of herbal medicines are being introduced at the same time as more and more powerful and dangerous previously prescription medicinal drugs are being de-regulated and sold over the counter without prescription. Such drugs cause a 100 times more side effects and adverse reaction than herbal remedies. This proves that the European Directive has nothing to do with protection of the consumer.

In my opinion, we should fight this European Directive tooth and nail on political rather than medical grounds because that is what this Directive is inspired by. We can argue for the next 10 years that herbal remedies are intrinsically safe but the regulatory authorities will always come back with the same old excuses: undeclared drug ingredients, heavy metals, the one patient who got liver failure years ago, St John's Wort induces cytochrome P450, etc.

It is also a losing battle to argue the medical case with regulatory authorities (although necessary and we should continue doing that) because they are not elected and have a vested interest in “regulating” and “licensing”. By contrast, politicians are elected and all they are interested in is being re-elected. They are therefore more sensitive to the political case: we should tell them en mass that we are not going to vote for them if they do not scrap this Directive.

Why should Eurocrats decide what I can and cannot take for my health? It is a fundamental issue of freedom and we should demand our freedom!

It is ironic that this freedom-killing European Directive is coming into force on 1 May, the day when traditionally the peoples of Europe celebrate freedom and workers’ rights…

1. Daniel Hannan: www.spectator.co.uk Allergic to Freedom Why is Europe taking up arms against herbal remedies? (12.03.2011)

2. Daniel Hannan: www.spectator.co.uk Allergic to Freedom Why is Europe taking up arms against herbal remedies? (12.03.2011)

GIOVANNI ON TWITTER

2011-04-19T18:23:00.000-07:00

Giovanni has a new Twitter account which will be dedicated to short messages on all aspects of Chinese medicine, some with links. @gmaciocia.

ON SHAME

2011-04-17T17:46:00.001-07:00

Since the previous Clinical Tip was about guilt as an emotional cause of disease, it makes sense to discuss now shame as an emotional cause of disease. I think that shame is as common as guilt in Western patients while it could be argued that Eastern societies are more prone to shame than guilt.

Shame may be caused by a feeling of shame about one's behaviour in breaking society’s rules or customs; more commonly, it is an in-born feeling of shame due to one's upbringing. It is a feeling of blame which often makes one feels “dirty”; with shame, one feels that one has to hide from the frowning look of society. One feels observed all the time.

According to Solomon, in small doses, shame is an affirmation of one's autonomy, a confirmation that one will live by one's standards and accept responsibility. In small doses, shame is conducive to self-esteem. However, in larger doses, shame is overwhelming and it is self-demeaning, making one extremely defensive and impotent.

As a cause of disease, we consider the shame that is overwhelming, that is due to one's upbringing and that is not related to one's actions or to have done anything wrong. A person suffering from this shame will always feel as if they had done something wrong and will want to hide.

It is often said that Western societies are “guilt-based” and Eastern ones “shame-based”, so it is useful to explore the differences between shame and guilt. Shame is related more to one's place in society, what people think of us, the feeling that one has to hide because one has done something wrong, something that society frowns upon, something “dirty”.

In other words, as long as we do not do anything that society disapproves of or, most importantly, we are not seen, not found out to be doing something “wrong”, we do not feel shame. By contrast, in such situations we would feel guilty even if nobody sees us doing something “wrong”.

It is certainly true that Eastern societies are shame-based probably due to the strong Confucian influence. As the Confucian ethics is all about social relationships, and about one's “place” in society and conforming to strict rules of conduct and social hierarchy, it is natural that shame ensues from contravening the established rules of society. Thus, people are worried about not being seen to be doing anything that society would frown upon.

What is paramount in shame, is how one appears to the other members of the community, not how one feels inside. Guilt, is a “darker” emotion, more inner-directed, an emotion from which there is no escape, the judgement is there, whether anyone sees us or not. The big difference between guilt and shame is that guilt has no redemption, it “eats” one inside for ever; shame has redemption and repair.

With shame, we have a feeling of being seen doing something wrong (by implication, if we are not seen, we do not feel shame). With guilt, we hear an inner voice condemning us and we cannot escape it.

Wollheim explores the differences between shame and guilt and I have summrized them in this Table.

The term “guilt” (zui) occurs very infrequently in the Analects of Confucius. By contrast, shame (chi) is mentioned in many passages. It is always used with reference to a lapse of responsibility, often accompanied by insult, estrangement and humiliation at the hands of others.

Shame is very ingrained in Confucianist ethics. It is even something that is considered a beneficial “tool” to keep people in line. Consider this passage from the Analects of Confucius:

“The Master said: ‘Lead the people with administrative injunctions and keep them orderly with penal law, and they will avoid punishments but will be without a sense of shame. Lead them with morality (de) and keep them orderly through observing ritual propriety (li) and they will develop a sense of shame; and, moreover, will order themselves”.

This passage is an attack on the Legalists who advocated keeping people in order with strict laws and harsh punishments. In other words, Confucius is saying that laws and punishments may keep social order, but even better is to lead by example so that people will regulate themselves due to the sense of shame from not following the social order.

The importance of shame in Chinese society is also apparent from a study of the penal system and amnesties in ancient China: there is evidence that the ancient courts acted harshly in cases of serious crimes but relied on shame entailed in the process of litigation to discipline the more minor offenders and restore their commitment to social responsibility.

In terms of the effects on Qi by shame, I think that this emotion makes Qi stagnate but also possibly in some cases, sink. Indeed, sinking of Qi is, in my experience, a common result of shame; Dampness also frequently accompanies shame.

When one feels shame, one feels “dirty” and “dirty” is characteristic of Dampness. Thus, shame often manifests with sinking of Qi and Dampness: for example, prolapses, very chronic and stubborn vaginal discharge, excessive menstrual bleeding from sinking of Spleen- and Kidney-Qi, slight urinary incontinence.

1. Solomon R The Passions, Hackett Publishing Company, Indianapolis, 1993, p. 245. 2. R Wollheim, On the Emotions, Yale University Press, 1999, pp. 155-6.

APPEAL TO EUROPEAN HERBAL PRACTITIONERS AND PUBLIC

2011-04-12T11:40:00.000-07:00

The draconian European Directive on herbal medicines is coming into force very soon (at the end of April). This will stop the sale of herbal remedies. We must all make our voice heard to stop this infringement of our freedoms that is being pushed by the European Union under the influence of pharmaceutical multinationals. Please support the Alliance for Natural Health, the Benefyt Foundation and the European Herbal Practitioners Alliance. Please watch the video http://www.savenaturalhealth.eu/ and sign the petition.

ON GUILT

2011-04-02T09:36:00.001-07:00

For all have sinned and fall short of the glory of God 1 Romans 3.23 In the previous Clinical Tip I discussed sadness and grief deriving from loss as a pervasive emotion in Western patients. In this Clinical Tip, I discuss another common emotional cause of disease in Western patients, i.e. guilt. Guilt is a pervasive emotion in Western patients. It is completely missing from Chinese medicine books and one could say that it simply does not exist in the Chinese psyche. It could be argued that guilt is intrinsically related to the Judeo-Christian religions and especially the Christian religion with its concept of “original sin.” I have never seen expressions referring to “feeling of guilt” as an emotional cause of disease in modern or old Chinese books. It could be argued that this is due to the fact that a feeling of guilt is more or less absent in Eastern societies. In fact, the concept of guilt is totally absent in all three major Chinese religions/philosophies of Confucianism, Daoism and Buddhism. Indeed, Confucius did not even believe in the value of punishment for crimes. Fingarette concurs that the concept of guilt is absent in the Analects of Confucius. The Analects do mention the word chi 耻 in several passages but this is shame rather than guilt. Fingarette says: “If we are unaware of the crucial differences in perspective, these texts on chi lend themselves easily to the assimilation of Confucian shame with Western guilt. Although chi is definitely a moral concept, the moral relation to which it corresponds is that of the person to his status and role as defined by li (rituals). Chi looks outward, not inward. It is not, as is guilt, a matter of the inward state, of repugnance at inner corruption, of self-denigration, of the sense that one is as a person, and independently of one’s public status and repute, mean or reprehensible. The Confucian concept of shame is a genuinely moral concept, but it is oriented to morality as centering in li, traditionally ceremonially defined social comportament [behaviour], rather than to an inner core of one’s being.”2 It should be stressed that what concerns us here in dealing with emotions, is not guilt but the feeling of guilt which is totally unrelated to an actual crime or transgression. For example, a person may have committed a crime but feel no guilt at all; conversely, a person may have committed no crime or transgression but feel guilty (which is usually the case in our patients). Guilt (and shame) are considered by some to be “moral” emotions as they bear upon morality. Wollheim says: “The role of the moral emotions is to provide the person with an attitude, or orientation. What is distinctive of the moral emotions is that the attitude is reflexive. It is an attitude that the person has towards himself/herself as a person.”3 Guilt is strongly linked to a sense of self and specifically to a negative sense of self: this is probably an important reason for the absence of guilt in Chinese culture as the self in Chinese culture is not the individualized, inward-looking, psychological self of Western culture, but a socially-constructed self. This may also account for the presence of shame in Chinese culture (related to a social sense of self) and the absence of guilt (related to an individual self). Guilt can manifest in many different ways, e.g.: – Feeling of responsibility for negative circumstances that have befallen oneself or others – Feeling of regret for real or imagined misdeeds, both past and present – Feeling responsible (and guilty) for any negative thing that occurs to members of one’s family or one’s partner – Taking responsibility for someone else’s misfortune or problem. The above are only a few examples of the sort of behaviour induced by feelings of guilt. A feeling of guilt may be due to the transgression of social or religious taboos or from having done something “wrong” which is later regretted. However, a feeling of guilt may also be innate and not related to any specific action. This innate feeling of guilt derives often from upbringing. This latter feeling is indeed the most destructive one. Guilt is self-reproach for some actual misdeeds or an in-born feeling of guilt totally disconnected from any misdeeds. Guilt includes a sense of inadequacy and despair not found in shame. Guilt does not require any particular offence and the doctrine of Original Sin is an example of this. When assailed by a feeling of guilt, a person is one’s own judge and a more ruthless and less reasonable judge than any real judge. Guilt is inwardly-directed and its object is the self; in this sense, it is almost the “opposite” emotion to that of anger as this latter emotion is usually directed at another person. Guilt is based on a moral criteria of having broken a law of morality (real or imagined). The “mythology” of guilt is the doctrine of the Original Sin. The “authority” providing the criteria is absolute and unquestionable. Guilt is a “dark” emotion with no redemption; it is a much “darker” emotion than shame and in my experience, more difficult to “treat” (if that is the right word). As for disharmonies induced by guilt, this emotion can have different effects in different people. First of all, it may lead to Qi stagnation: it affects any organ and especially the Lungs, Heart, Liver and Kidneys. Due to its “dark”, “stagnating” character, the Qi stagnation may cause Blood stasis easily. This Blood stasis may be in any part of the body and any organ but particularly in the Lungs, Heart, Liver and Kidneys. The pulse is Wiry or Firm. Under certain conditions, guilt may also cause sinking of Qi and affects the Kidneys causing some urinary problems or menstrual problems from sinking of Qi. The tongue has a red tip and possibly purple body. When guilt is the emotional cause of disease, the pulse is Wiry or Firm if there is Qi and Blood stagnation. If there is sinking of Qi of the Kidneys, the pulse is Deep and Weak on the Kidney positions, possibly slightly Overflowing on the Heart position and Choppy in general without wave. How does one “treat” guilt? It is possibly the most difficult to “treat”: it is a ‘dark” and deep-seated emotion and that is probably why it easily gives rise to Blood stasis. I generally choose the points depending on the patterns induced by guilt. I generally treat the Heart, Lungs, Liver and Kidneys. Some examples of points used would be HE-7 Shenmen, P-7 Daling, LU-7 Lieque, LU-3 Tianfu, LIV-3 Taichong, KI-4 Dazhong, KI-9 Zhubin, G.B.-13 Benshen, Du-24 Shenting. Of course, possibly with guilt more than any other emotion, a true healing cannot take place without a conscious effort of introspection from the patient with the help of psychotherapy. 1. Holy Bible, New International Version ®. 1984 International Bible Society. Online version www.biblegateway.com [Accessed 2007]. 2. Fingarette H 1972 Confucius - The Secular as Sacred, Waveland Press, Prospect Heights, Illinois, p. 28. 3. Wollheim R 1999 On the Emotions, Yale University Press, New Haven, p. 148.

ON STAGNATION OF LUNG- AND HEART-QI

2011-03-03T16:35:00.000-08:00

Liver-Qi stagnation is one of the most "popular" diagnoses among Western practitioners. Liver-Qi stagnation is certainly very common but, in my opinion, it is over-diagnosed and over-emphasized. Besides that, it is hardly ever mentioned that practically every organ - not just the Liver - may be subject to Qi stagnation. For example, the following organs suffer from Qi stagnation: Stomach, Spleen, Lungs, Heart, Intestines, Gall-Bladder, Triple Burner, Bladder and even the Kidneys.

The present blog will concentrate primarily on Qi stagnation of the Lungs and Heart because such stagnation is particularly common in mental-emotional problems. Related to the over-diagnosis of Liver-Qi stagnation is also the over-emphasis on anger among the emotions. Over-emphasis on anger is, in my opinion, also present in China. It is easy to see why that would be as anger is the most disruptive of the emotions: if you are angry, you rebel and that is not done in China, whether in the Neo-Confucian past nor now. Indeed the very word used in Chinese medicine to indicate "rebellious" (or "counterflow") Qi [ni 逆] means "to rebel", "to disobey", "to defy". The opposite of ni in Chinese medicine is shun [顺] which indicates Qi going the right way. The word shun means :"to obey", "to act in submission to", with a clear political significance. Please note that these two words are already in the Nei Jing.

Whilst it is easy to explain why anger would be over-emphasized in China, I am not sure why it is in the West. By contrast, Lung- and Heart-Qi stagnation is usually caused by sadness, grief or worry: if one is sad, one does not rebel, so the Chinese political system (whether ancient or modern) is not threatened by these emotions. I believe that such emotions, more than anger, are extremely common and pervasive in the patients we see. What are sadness and grief caused by in Western patients? Apart from the obvious causes due to bereavement, very many Western patients of all ages suffer from sadness and grief deriving from various types of loss such as the loss from the break-up of relationships or marriage. In other words, sadness and grief are primarily about loss, whether it be the loss of a dear one from death or the loss of a partner through separation.

McLean (who elaborated the theory of the triune brain) suggests that the origins of human language were most likely in infant-mother interaction, babbling based on vowel-consonant combinations beginning about 8 weeks after birth. He singles out the separation cry - a slowly changing tone with a prolonged vowel sound (aaah), a distressing cry linked with the most painful emotion, separation.

I believe that the sadness and grief deriving from separation are probably the most basic and primordial (and therefore most powerful) emotions that plays a huge role in the mental-emotional problems we see in practice. As for worry, it is easy to see how such an emotion is so prevalent in the West where life has such a hectic pace.

Sadness, grief and worry affect the Lungs directly as they are emotions pertaining to the Lungs, but they also affect the Heart. The Su Wen says in chapter 39: "Sadness makes the Heart cramped and agitated; this pushes towards the lungs' lobes, the Upper Burner becomes obstructed, Nutritive and Defensive Qi cannot circulate freely, Heat accumulates and dissolves Qi."

In women, Lung-Qi stagnation affects the chest and breasts and, in the long run, it can give rise to breast lumps (benign or malignant) as the Lung channel flows on the outside of the breasts. In my experience, in Western women, this is a more common cause of breast lumps than Liver-Qi stagnation.

Dr Xia Shao Nong thinks that breast lumps and breast cancer are due to sadness and grief deriving from widowhood, breaking of relationships, divorce, death of one's children, and bereavement at a young age from the death of ones spouse. These events, especially if they occur suddenly, upset the Mind and lead to Qi stagnation and Qi depletion. It is interesting to note that all the events mentioned by Dr Xia involve separation and loss.

The points I use for sadness and grief are LU-7 Lieque, Du-24 Shenting, Ren-15 Jiuwei, HE-7 Shenmen, BL-13 Feishu and BL-42 Pohu.

As for worry, Chen Wu Ze (1174) says: "Worry injures the Lungs and makes Qi accumulate." Chapter 8 of the Ling Shu confirms that worry knots Qi: "Worry causes obstruction of Qi so that Qi stagnates."

Please note that Qi stagnation may be accompanied by Qi deficiency and this is particularly true in the case of Lungs and Heart. Emotions such as sadness and grief deplete Qi and cause Qi deficiency. However, as deficient Qi in the chest fails to move properly (because it is deficient), some Qi stagnation also ensues.

LUNG-QI STAGNATION
The clinical manifestations of Lung-Qi stagnation are: 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.
Tongue: slightly red on the sides in the chest areas (see blog of 23 March 2010).
Pulse: very slightly Tight on the right-Front position.
Acupuncture: LU-7 Lieque, LU-3 Tianfu, ST-40 Fenglong, Ren-15 Jiuwei, P-6 Neiguan, BL-13 Feishu, BL-42 Pohu. (Please note that ST-40 is used here not to resolve Phlegm but to open the chest. See Blog of 24 August 2010).
Prescription
Ban Xia Hou Po Tang Pinellia-Magnolia Decoction (Open the Heart in the Three Treasures).

HEART-QI STAGNATION
The clinical manifestations of Heart-Qi stagnation are: palpitations, a feeling of distension or oppression of the chest, depression, a slight feeling of lump in the throat, chest and upper epigastric distension, dislike of lying down, weak and cold limbs, slightly purple lips, pale complexion.
Tongue: slightly pale-purple on the sides in the chest area.
Pulse: Empty but very slightly Overflowing on the Left-Front 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. (Open the Heart in the Three Treasures).

GOOD NEWS FOR HERBAL MEDICINE IN THE UK

2011-02-16T20:25:00.000-08:00

There are good news from England in the fight to preserve the freedom to prescribe herbal remedies. As a background, herbal practitioners have been fighting to obtain a derogation from the upcoming European Directive so that they would be able to prescribe unlicensed remedies. This derogation revolved around them being statutorily registered: we have now obtained this.

The UK Secretary of State for Health has made an announcement today about regulation of herbal medicine practitioners. The issue of whether or not practitioners of acupuncture, herbal medicine and traditional Chinese medicine should be statutorily regulated has been debated since the House of Lords Select Committee report on Complementary and Alternative Medicine in 2000.

The Health Professions Council (HPC) has now been asked to establish a statutory register for practitioners supplying unlicensed herbal medicines. The proposal is, following creation of this register, to make use of a derogation in European medicines legislation (Article 5 (1) of Directive 2001/83/EC) that allows national arrangements to permit those designated as "authorized healthcare professionals" to commission unlicensed medicines to meet the special needs of their patients.

Accordingly, a scheme would be created enabling registered practitioners to commission unlicensed herbal medicines to meet the special needs of their individual patients. Safeguards for the public would be provided by a combination of professional regulation and linked medicines regulation, for example, to safeguard manufacturing standards.

If practitioner regulation is in place for the purposes of creating an Article 5(1) scheme this also opens the way to reform Section 12 (1) of the Medicines Act 1968. Under Section 12 (1), practitioners may prepare unlicensed herbal medicines on their own premises for use following consultation with individual patients. It is intended to move to the position that only registered practitioners would be able to operate under Section 12 (1) after regulation of practitioners is in place.

A formal consultation exercise will take place on specific legislative proposals for establishing the register and proposed reforms of medicines legislation later in 2001.

I think we all owe the European Herbal Practitioners Alliance (EHPA) and its chairman Michael McIntyre a huge debt of gratitude. In particular, Michael McIntyre has been fighting tirelessly for the past 10 years in defence of herbal medicine in England and Europe.

MORE ON P-6 NEIGUAN

2011-02-04T10:34:00.000-08:00

I would like to expand on what I said about P-6 Neiguan last month. P-6 Neiguan is a complex point, rich in clinical applications.

Descend Stomach-Qi
P-6 is closely connected to the Stomach channel and, for this reason, it is a major point to make Stomach-Qi descend. For this reason, it treats vomiting, nausea, belching and acid reflux. In order to make Stomach-Qi descend, P-6 combines very well with Ren-13 Shangwan and ST-21 Liangmen. Notice that Ren-13 is better than Ren-12 at making Stomach-Qi descend because it treats specifically the upper part of the stomach.

Descend Heart-Qi
Besides making Stomach-Qi descend, P-6 also makes Heart-Qi descend. Interestingly, Heart-Qi not descending also causes nausea and vomiting; therefore, when we use P-6 for nausea and vomiting we are acting both on the Stomach and the Heart channel. How do we know whether nausea in a patient is due to rebellious Stomach-Qi or rebellious Heart-Qi? In two ways. Firstly, from the pulse: in case of rebellious Stomach-Qi, we will feel that on the right-Guan position (feeling Tight or very slightly Overflowing). In case of rebellious Heart-Qi, the left-Cun position will be slightly Overflowing. Secondly, when nausea and vomiting are strongly associated with the emotional state (i.e. the patient feels nausea when depressed, anxious, worried or guilty), then they are due to Heart-Qi not descending.

Relationship between Stomach and Heart
There is a close relationship between the Stomach and the Heart that has many clinical applications and repercussions. Indeed, in some of the old classics, epigastric pain, i.e. pain below the xyphoid process was called xin tong i.e. Aheart pain@. Modern Chinese books say that the old doctors somehow Aconfused@ stomach with heart pain. I do not agree with this view. I think that the old doctors knew perfectly well the difference between a stomach and a heart pain.
The fact is that there is a broad overlap between the Heart and Stomach both from the point of view of organs and that of channels. One way in which the channels of the Heart and Stomach overlap is through the Divergent Stomach channel and the Great Luo of the Stomach. In fact, the Stomach Divergent channel ascends in the abdomen and then enters the stomach, spleen and heart.

On the other hand, the Great Luo of the Stomach starts in the chest, penetrates the diaphragm, connects with the lungs and exits below the left breast. The pulsation of the left ventricle felt in the fifth intercostal space is called the pulsation of Xu Li and Xu Li is another name for the Great Luo of the Stomach. Therefore, while what we feel in the fifth intercostal space is obviously the heart, from a Chinese perspective, it is also the beating of the Xu Li and of the Zong Qi (the Qi of Heart and Lungs in the chest).

What this means in clinical practice, is that treatment of the Stomach channel is important to regulate the Heart both on a physical and a mental-emotional level. On a physical level, treatment of ST-36 and ST-40 is important to regulate the rhythm of the heart when it is irregular or fast and to make Heart-Qi descend when there is nausea. On an emotional level, treatment of ST-40 calms the Mind and makes Heart-Qi descend, allaying anxiety and worry.
Not by chance, some of the symptoms of myocardial infarction are often digestive such as belching, acid reflux, nausea and vomiting.

HAPPY NEW YEAR OF THE RABBIT!

ON P-6 NEIGUAN

2011-01-03T09:23:00.000-08:00

P-6 Neiguan is one of the most important and most widely used acupuncture points. First of all, let us analyse the name “Nei Guan”. “Nei” means “inner” and there is no disagreement about this. However, the second half of the name “Guan” can have different interpretations. In ordinary, every-day language, “guan” means to “shut”, “close”, “turn off”, “lock up”. If we go to a shop and we find it closed, one would say that the shop “guan le”, i.e. it is shut or “it shut” (in the past). If we interpret “guan” in this sense, then P-6 is an “inner closure”, an “inner stop cock” or something similar. Could it be interpreted in this way? Yes, it could, and in this sense, P-6 would be the point that closes the Yin in the Interior and this should be seen in relation and analogous to T.B.-5 Waiguan, the “outer closure”, i.e. the point that closes the Yang on the outside.

However, the nature of P-6 is such that it is a very dynamic point and this does not fit in with its translation as “inner closure” because “closure” implies to stop something, as for example, when one closes a tap (faucet) to stop the flow of water.
If we look up the other meanings of “guan” (as in Chinese one word can have multiple meanings), we find that it also means “mountain pass”, “critical juncture”, “customs house” or “barrier” (of a customs house). According to G. D. Wilder and J. H. Ingram, Analysis of Chinese Characters, 1922, “guan” is a cross bar of a gate, to shut or bar the gate, a custom-house barrier. The character is composed of the radical “Men” (door). Inside the “door” there is “guan”, which means to pass threads through a web with a shuttle. The script represents the warp of a textile. The down strokes in the lower part represent a shuttle carrying the thread through to form a woof. By extension, it means to fix transversely. The cross bar of the gate passes through the slots and iron loops like a shuttle passing through the warp.

Translating “guan” in this way, would change the meaning of “Nei Guan” entirely. The point would then be an “inner critical juncture” or an “inner barrier” (of a customs house). Notice that it is the barrier of a customs house that is open to let goods through. This would change the nature of the point entirely, making it a dynamic point that is a critical juncture and that lets things through. In my opinion, this reflects the nature and functions of P-6 more accurately. The reference to “fixing transversely” is also interesting as it would be an allusion to the flow of the Luo channels flowing “transversely” in relation to the Main channels that flow “vertically” (P-6 is of course the Luo point of the Pericardium channel).

The “Su Wen” in chapter 8 says: “The Pericardium is the ambassador and from it joy and happiness derive”. The Pericardium is closely related to the Heart and, indeed, the Nei Jing and the Nan Jing constantly refer to the “5 Zang and 6 Fu”, the 5 Zang being the Heart, Liver, Spleen, Lungs and Kidneys, i.e. the Pericardium was assimilated to the Heart: the two could not be separated being so close anatomically. However, chapter 8 of the Su Wen does mention the 12 Organs and it lists their functions including those of the Pericardium. The Su Wen’s reference to “joy” and “happiness” also makes it sound like the Pericardium has similar functions to those of the Heart. Notice however that in this chapter, the Pericardium is called ”Shan Zhong”, i.e. the “centre of the chest” (where Ren-17 is), not the usual “xin bao luo”, i.e. the “luo of the heart’s envelope”. As we shall see, this is because the Pericardium has several different functions corresponding to its multi-faceted nature.

So, the first aspect of the Pericardium’s nature is that it is closely connected to the Heart and that it is in the centre of the chest; the reference to “joy” and “happiness” implies that it somehow houses the Shen in the same way as the Heart does. This is the first clinical use of the Pericardium channel and of P-6, to affect the Shen. Like the Heart, the Pericardium houses the Shen and it therefore influences our mental-emotional state deeply. For example, a deficiency of Blood will affect the Pericardium as well as the Heart, making the person depressed and slightly anxious. Heat in the Blood will agitate the Pericardium and make the person agitated and restless. Phlegm obstructing the Pericardium will also obstruct the Shen causing mental confusion.

Emotions “stir” both the Heart and the Pericardium by agitating the Minister Fire and making it flow upwards to these two organs. Li Dong Yuan said: “Not a day goes by in people’s lives that the Minister Fire is not stirred”. In Chinese medicine, there is this idea that the Minister Fire should be “concealed” in the Lower Burner: it performs its function of warming the organs in the background and it should not be seen. Emotions stir up the Minister Fire and cause it to leave its “place of concealment” in the Lower Burner: that is when the patient suffers from “Heat” and there are symptoms of Heat such as a red face, a feeling of heat, thirst, etc. Notice that emotional stress usually leads to Heat, it never leads to Cold.

The Pericardium houses the Shen (with the Heart)
•Blood deficiency of the Pericardium will cause depression and slight anxiety
•Blood Heat of the Pericardium will cause anxiety, insomnia and agitation
•Phlegm in the Pericardium will cause mental confusion and, in severe cases, mental illness
•The Pericardium affects emotional problems from relationship problems
Although assimilated to the Heart, the Pericardium has an important difference from the Heart channel. The Pericardium channel controls the Qi of the chest and it moves Qi and Blood, more than the Heart channel does. For example, P-6 has an important influence on the movement of Qi in the chest (hence its use for chest pain); the Heart channel does not have such a function. In other words, I use HE-7, for example, to nourish Heart-Blood and settle the Shen while I would use P-6 more to move Qi and Blood in the chest causing physical symptoms such as chest pain and mental-emotional symptoms such as depression (from Qi stagnation).

The second aspect and function of the Pericardium is its relationship with the Liver within the Jue Yin channels: Liver and Pericardium are the Jue Yin channels which are the “hinge” of the Yin channels. Thus, when we use the Pericardium channel, we indirectly use the Liver channel too. In my clinical experience, I use P-6 exactly in this way: besides its other functions, it moves Liver-Qi and stimulates the movement of the Hun (see below).

The Pericardium function on the mental-emotional plane is the psychic equivalent of the Pericardium’s moving of Qi and Blood of the Heart and Lungs in the chest: just as it does that on a physical level, on a mental-emotional level, the Pericardium is responsible for “movement” towards others, i.e. in relationships. Given that the Pericardium is related to the Liver within the Terminal-Yin channels, this “movement” is also related to the “movement” of the Hun from the ego towards others in social, relationships and familial interactions. For this reason, on a mental-emotional level, the Pericardium is particularly responsible for a healthy interaction with other people in social, love and family relationships.

Moreover, the “moving” nature of the Pericardium is also enhanced by its relationship with the Triple Burner as a channel (within the “Minister Fire” channels). As the Triple Burner is responsible for the free flow of Qi (together with the Liver), the Pericardium’s relationship with the Triple Burner accounts for its action in moving Qi and Blood and its mental-emotional function of “movement” towards others.

Thus the Pericardium is a unique organ in that it has three sets of relationships: with the Heart, with the Liver (Jue Yin channels) and with the Triple Burner (within the Minister Fire channels). Notice also how the Pericardium is related to the Jue Yin (the hinge of the Yin) through the Liver and to the Shao Yang (the hinge of the Yang) through the Triple Burner. Thus the Pericardium is doubly the “hinge”: I believe this contributes to its dynamic nature. This makes it such a complex and rich channel with so many interactions and different functions.

The book “An Explanation of Acupuncture Points” (Jing Xue Jie, 1654) confirms this dual nature of the Pericardium by listing the actions of P-6 under the two heading of Heart and Liver. In other words, it lists the Heart-related and Liver-related actions of P-6. Under the Heart-related indications it lists poor memory, chest pain and (when Empty) head and neck ache. Under the Liver-related indications, it lists red eyes, elbow pain and hot palms.

The symptom of head and neck ache is interesting for me as it is something I have noticed frequently in practice, i.e. that P-6 is effective in treating headache, especially occipital and temporal. I believe this is due to the connection between the Luo point of the Pericardium and the Triple Burner channel.

RELATIONSHIP BETWEEN PERICARDIUM AND MINISTER FIRE
The “Minister Fire” (Xiang Huo) is the Fire of the Gate of Life (Ming Men). This Fire is essential to the healthy functioning of the body.
Although many doctors such as Zhu Zhen Heng (1281–1358) identified “Minister Fire” with the Fire of the Ming Men (and therefore the Kidneys), others, such as Zhang Jie Bin (1563–1640), identified the “Minister Fire” with such internal organs as the Kidney, Liver, Triple Burner, Gall Bladder and Pericardium. In fact, the Minister Fire is said to go upwards to the Liver, Gall-Bladder and Pericardium (in so doing it is compared to the “Fire Dragon flying to the top of a high mountain”) and downwards to the Kidneys (in so doing it is compared to the “Fire Dragon immersing in the deep sea”).

Thus, purely from a 5-Element perspective, the Minister Fire pertains to the Pericardium and the Triple Burner (as opposed to the Emperor Fire of the Heart), while from the perspective of the Internal Organs, the Minister Fire is the Fire of the Ming Men pertaining to the Kidneys. However, there is a connection between the two views as the Minister Fire does flow up to the Liver, Gall-Bladder and Pericardium. In pathology, this has an even greater relevance as the pathological Minister Fire (driven by emotional stress) flares upwards to harass the Pericardium causing mental restlessness, agitation, anxiety and insomnia.

NATURE AND FUNCTIONS OF P-6
1) HEART
The Pericardium is closely related to the Heart and P-6 therefore acts on the Heart. I use it primarily to move Qi and Blood, not so much to nourish Blood and the Shen. I use P-6 to move Qi and Blood and P-7 Daling to subdue Qi and calm the Shen.

2) MOVING QI IN THE CHEST
P-6 is an important point to move Qi and Blood in the chest: this is one of the main functions that distinguish it from Heart points. On a physical level, it moves Qi in the chest when Qi stagnation is causing chest pain; it is also very effective for traumas of the chest causing stagnation of Qi and/or Blood. To treat the chest, P-6 combines very well with ST-40 (I usually needle them contralaterally, i.e. one on the right and the other on the left).

3) MOVING LIVER-QI
The Pericardium is coupled with the Liver within the Jue Yin channels (the “hinge” of the Yin). P-6 therefore moves Liver-Qi. When would one want to use the Pericardium rather than the Liver to move Liver-Qi? I would use P-6 especially for mental-emotional problems deriving from relationship problems and causing Liver-Qi stagnation. Using P-6 will treat both the Liver and the Heart simultaneously, which makes it so useful in mental-emotional problems. Another reason for using P-6 to move Liver-Qi is when the symptoms are located in the Upper Burner, for example pre-menstrual breast distension. In this context, P-6 combines very well with LIV-3 (usually contralaterally, i.e. one on the right, the other on the left).

4) THE PERICARDIUM AND THE HUN
As we have seen above, the Pericardium is associated to the Liver within the Jue Yin. The Liver houses the Hun which provides “movement” to the Shen: this “movement” provides creativity, inspiration, planning, sense of direction in life to the Shen. Without these, the Shen would suffer and the person would be depressed. P-6 is excellent to stimulate the movement of the Hun and I therefore use it very frequently in depression (and not only that deriving from Liver-Qi stagnation). When used for depression, I frequently combine it with Du-20 Baihui.

5) P-6 AS LUO POINT
P-6 is the Luo point of the Pericardium channel. As a Luo point, it has a dynamic nature and I use it primarily to move rather than to tonify. I see P-6 as having a “centrifugal” effect. Contrary to it being a point that “closes” (if we interpret “guan” in its name as ‘closing”), I actually see it as a point that opens and moves. In mental-emotional problems, it moves Qi, relieves stagnation and “opens” the patient to a new emotional awareness.

6) P-6 SYNERGISTIC EFFECT
P-6 has a synergistic effect on acupuncture points prescriptions. The addition of P-6 to any prescription increases the therapeutic effect. Just as P-6 has this effect on a physical level, it has one on a mental-emotional level, i.e. it can bolster the effect of a point combination for mental-emotional problems. The Pericardium is the hinge of the Yin channels, and, being the Luo point, P-6 is the “hinge” of the Hinge: in its capacity as “hinge” it connects things.

GERIATRICS IN CHINESE MEDICINE

2010-12-12T13:02:00.000-08:00

The thinking about geriatrics in Chinese medicine has been dominated by Kidney deficiency for centuries. As Kidney-Jing declines as we age, the clinical approach to the treatment of the elderly has been based largely on tonifying the Kidneys.

However, modern diseases of the elderly that account for 90% of mortality (cancer, heart disease and stroke) are characterized by Fullness. Quite simply, we do not die of Kidney deficiency but of Phlegm, Blood stasis and Internal Wind.

The most common pathogenic factors (and those leading to serious diseases) are:
Phlegm
Blood stasis
Internal Wind

Apart from the major diseases of the elderly such as cancer, stroke and heart disease, very many symptoms and signs that occur in old age are caused by Phlegm and/or Blood stasis. The following is a partial list.

GERIATRIC SYMPTOMS/SIGNS
•Otosclerosis: Phlegm/Blood stasis
•Cataract: Phlegm
•Macular degeneration (vascular, lack of blood nourishment): Blood stasis
•Dry eyes: may be due to Blood stasis
•Alzheimer: Phlegm (the neurofibrillary tangles and plaques in the brain are a form of
Phlegm)
•Parkinson: Wind
•Poor memory: is often due to Phlegm
•Brain muzziness: Phlegm
•Dizziness: Phlegm
•Epiretinal membrane: Phlegm
•Macules: Blood stasis
•Dry skin: in the elderly may be due to Blood stasis
•Itching: Phlegm/Wind
•Numbness: Phlegm/Wind
•Hair loss: may be due to Blood stasis

The following three Tables list the major diseases of the elderly with the pathology they are due to:

Many of the symptoms of the elderly are due to Phlegm:
Heart: mental confusion, feeling of oppression in the chest
Gall-Bladder: stones, nausea, inability to digest fats
Joints: bone deformities, pain, rigidity
Lungs: cough with mucus, feeling of oppression of the chest, asthma, breathlessness
Stomach: lack of appetite, digestive problems, hiatus hernia, acid reflux.
Skin: greasy skin, sweating, yellow moles.

TONGUE DIAGNOSIS IN THE ELDERLY
This has already been discussed in a previous blog (April 2010). The major pathogenic factors of the elderly manifest on the tongue with the following signs:

Phlegm: swollen tongue body, sticky coating
Blood stasis: purple, stiff body
Internal Wind: stiff, moving deviated.

For example, if we see a tongue that is swollen, purple and stiff, it indicates all three pathogenic factors of Phlegm, Blood stasis and internal Wind. When I see a tongue like that in an elderly patient, I actively invigorate Blood and resolve Phlegm for prevention.

Purple (especially on sides) = Blood stasis
Stiff = internal Wind

Purple = Blood stasis
Swollen = Phlegm
Slightly Deviated = internal Wind

PULSE DIAGNOSIS IN THE ELDERLY

Pulse diagnosis in the elderly also reflects the fact that their clinical picture is dominated by Full conditions. In fact, in the elderly, the pulse is very often Full and Wiry and/or Slippery, not Weak.

TREATMENT PRINCIPLES IN DISEASES OF THE ELDERLY
Considering the above, I believe the most important treatment principles in the elderly are:
1) Invigorate Blood and eliminate stasis
2) Resolve Phlegm
3) Extinguish (internal) Wind

Some people think that eliminating pathogenic factors (with herbal medicine or acupuncture but especially with herbal medicine) may “weaken” the elderly. I have never found that to be true in practice: if an elderly person has Phlegm and Blood stasis, they will not be “weakened” by resolving Phlegm and invigorating Blood. Of course, one does need to adapt one’s doses to age so that dosages of herbs for the elderly should be lower than those for young people.

Invigorating Blood remedies: Red Stirring (Upper Burner), Stir Field of Elixir (Lower Burner), Harmonizing the Moon (Blood stasis in Uterus)
Resolving Phlegm remedies: Clear the Soul, Limpid Sea
Extinguishing Wind remedy: Clear Yang

Red Stirring = Xue Fu Zhu Yu Tang

Stir Field of Elixir = Ge Xia Zhu Yu Tang

Harmonizing the Moon = Gui Zhi Fu Ling Wan

Clear the Soul = Wen Dan Tang

Limpid Sea = Er Chen Tang

Clear Yang = Ban Xia Bai Zhu Tian Ma Tang

APPEAL TO EUROPEAN HERBAL PRACTITIONERS

2010-12-09T13:05:00.001-08:00

I would like to remind all European herbal practitioners of the looming dangers of the European Union (EU) “Directive” called “Directive on Traditional Herbal Medicinal Products” (THMPD) coming into force in April 2011. This “directive” (note the Soviet-style sound of this word) is the greatest threat to herbal medicine. The EU Directive (formulated and enforced by the unelected and unaccountable European Commission) sets new over-the-counter (OTC) standards adopted in April 2004 with requirement for full implementation by April 2011. In the UK this will replace S12(2) of 1968 Medicines Act for OTC products (see below).

The Traditional Herbal Medicinal Products Directive (THMPD) comes fully into force in April 2011. After this time, only herbal medicines that have been registered under the scheme will be available EU-wide. For a wide range of herbal products, especially those from non-European traditions such as Ayurveda and traditional Chinese medicine, the requirements of the scheme are either impossible to meet or are prohibitively expensive. In many cases, both constraints apply so the result is that virtually no herbal medicines from these traditions have been registered. These products will effectively be banned after April 2011. The ban will also effect medicinal herbs in food supplements, which are used by many thousands of people across Europe to help maintain their health.

The Directive has the following aims:
- Aims to ensure correct identification of medicinal plants and adoption of Good Manufacturing Practice (GMP) by suppliers and manufacturers.
- Requires that OTC herbals demonstrate 30 years safe use for registration, 15 years of which within the EU.
- Monographing herbal safety and efficacy by the European Medicines Evaluation Agency Committee on Herbals.
- Permits limited medicinal claims on THMPD products

Problems with THMPD:
- Cost of licensing high.
- Cost of quality assurance also high.
- Quality control guidelines not workable for multi-herb complexes. This now has been recognised but now no applications for multi-herb complexes will be accepted until this is sorted out. The time for all this is running out as Section 12(2) products must be withdrawn from the market from April 2011 when the THMPD is fully implemented.

In the UK, herbal practitioners have been free to practise their art since the times of Henry VIII:
“Be it ordained established and enacted by authority of this present parliament, that at all time from henceforth, it shall be lawful to every person being the King’s subject, having knowledge and experience of the nature of Herbs, Roots and Waters… to practise, use and minister in, and to any outward swelling or Disease, any Herbs, Ointments, Baths, Pulters and Emplaisters, according to their Cunning, Experience and Knowledge … without suit, vexation, trouble, penalty or loss of their goods.”
The Herbalists’ Charter ordained by Henry VIII, 1543.

In 1968 the UK Medicines Act was enacted:
- Provides legal basis for the supply and sale of herbal medicines.
- Herbal medicines exempt from licensing.
- SI 2130 specifically allows powerful herbal medicines to be prescribed by herbalists.
- The term “herbalist” not defined.

The implementation of the EU THMPD would supercede this Act and would have particularly dire consequences from a medical, social, economic and political point of view as it would at a stroke abolish a freedom that has existed in England since 1543.

I therefore urge European herbal practitioners to support the organizations that are working very hard to oppose or at least mitigate the THMPD before April 2011.

European Herbal and Traditional Medicine Practitioners Association (EHPA): http://www.ehtpa.eu/

Association for Natural Health (ANH): http://www.anh-europe.org/

European Benefyt Foundation: http://www.benefyt.eu/

DAO DE JING
Chapter 30 (partial)
Whoever relies on the Tao in governing men
does not try to force issues
or defeat enemies by force of arms.
For every force there is a counterforce.
Violence, even well intentioned,
always rebounds upon oneself.

Chapter 60 (partial)
Governing a large country
is like frying a small fish.
You spoil it with too much poking.
Center your country in the Dao
and evil will have no power.

Chapter 75
When taxes are too high,
people go hungry.
When the government is too intrusive,
people lose their spirit.
Act for the people's benefit.
Trust them; leave them alone.

Translation by S Mitchell

Ear infections and antibiotics

2010-11-21T19:26:00.000-08:00

A recent issue of the Journal of the American Medical Association carried an interesting article on the use of antibiotics for acute otitis media (AOM) or middle-ear infection. The reference is:
Tumaini R. Coker et al “Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children” - A Systematic Review, in Journal of the American Medical Association, Vol. 304, No. 19, November 17, 2010, pp. 2161-2169.

The objective of the study was to perform a systematic review on AOM diagnosis and treatment with antibiotics. The study selected studies with a criterion standard, observational studies, randomized controlled trials on AOM microbiology and randomized controlled trials assessing antibiotic treatment.

The conclusion of the study was that antibiotics are modestly more effective than no treatment but cause adverse effects in 4% to 10% of children. Therefore, giving children antibiotics for ear infections does little to speed their recovery while raising the risk of some side effects.
The study found that 80 out of 100 otherwise healthy children would recover from an acute ear infection within a few days if given medication only to relieve pain or fever.

The study found that it does not matter which antibiotic is used to treat an ear infection when antibiotics are warranted. It found older types such as amoxicillin work as well as newer and more expensive antibiotics: indeed, newer antibiotics seem to cause more side-effects.

The study was designed to review existing research on the topic for the American Academy of Pediatrics, which is in the process of revising its guidelines for treating uncomplicated acute otitis media. The pediatricians’ group and the American Academy of Family Physicians have suggested that “observation” (i.e. avoiding antibiotics) is an option for treating ear infections in otherwise healthy children between the ages of 2 and 12. See http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1451.

Of the three basic types of ear infections, acute otitis media may benefit from antibiotics because it is often caused by a bacteria. However, it can also be caused by a virus, which will not respond to antibiotics. Another type of ear infection, otitis media with effusion, causes a buildup of fluid in the middle ear. That is also caused by a viral infection, against which antibiotics are ineffective.

This is interesting from the perspective of Chinese medicine. I have observed over and over again in practice that antibiotic treatment seems to have little effect on ear infections (whilst, by contrast, they have some effect on chest infections). One obvious reason for this is that, as mentioned above, some ear infections may be viral. There may be another interesting reason. The ears are on the Shao Yang area of the body; indeed the Triple Burner and Gall-Bladder channels (Shao Yang channels) course around the ears. In the context of exterior diseases, i.e. diseases caused by external Wind, the Shao Yang stage behaves quite differently than the Tai Yang or Yang Ming stages. The Tai Yang stage is a purely exterior stage when Wind is located on the Exterior of the body, i.e. in the Wei portion. The Yang Ming stage, on the other hand, is an interior stage that occurs when the pathogenic factor has penetrated into the Interior and it has transformed into Heat.

The Shao Yang stage is quite different: it is the stage that is the “hinge” between the Exterior and the Interior. Because of this nature, pathogenic factors can get “stuck” in the Shao Yang stage, bouncing between the Exterior (Tai Yang) and the Interior (Yang Ming). When it is on the Exterior, the patient feels cold; when in the Interior, the patient feels hot: hence the famous “alternation of chills and fever” of the Shao Yang stage.

Another characteristic of the Shao Yang stage, and one that is related to its being the “hinge”, is that pathogenic factors can get “stuck” there and remain in the body for a long time. This cannot happen at the Tai Yang stage because, at this stage, either the Wind is expelled or it changes into Heat and penetrates in the Interior. At the Yang Ming stage too, the pathogenic factor is either cleared or it will injure Yin and it will penetrate into the Yin.

Because of the tendency of pathogenic factors to linger in the Shao Yang, this may be a cause for antibiotics not working and for middle-ear infections becoming chronic which, in children, they very frequently do. Moreover, the use of antibiotics may tend to injure the Stomach and lead to the formation of a residual pathogenic factor in the ears that is usually Damp-Heat. A residual pathogenic factor in the ear from the improper use of antibiotics is the most common cause of chronic ear pathology in children.

The remedy Ear Release in The Little Treasures was designed to treat chronic retention of Damp-Heat in the ears in children. See http://www.three-treasures.com/littletreasures/default.html

BL-22 SANJIAOSHU

2010-10-01T10:35:00.000-07:00

Since the previous Clinical Tips were about the Swollen tongue and Phlegm, the use of acupuncture to resolve Dampness and Phlegm and the use of ST-40 to resolve Phlegm, I would like to stay with the subject of fluids pathology and discuss the use of the point BL-22 Sanjiaoshu.
I have mentioned this point in a previous entry as one of the points to resolve Dampness and/or Phlegm. BL-22 is called Sanjiaoshu, i.e. "Shu [point] of the San Jiao" and it is obviously situated just above BL-23 Shenshu, the Back-Shu point of the Kidneys: as we shall see below, this is very significant.
Given that the Triple Burner is an Arm channel, i.e. Arm Shao Yang, and therefore a channel of the upper limbs, why should the Back-Shu point of the Triple Burner be in the lower back near the kidneys and not in the upper back?
The book "An Explanation of Acupuncture Points" (1654) has a very interesting observation. It says that the Pericardium (Arm Jue Yin) has a Back-Shu point at BL-14 Jueyinshu (in the upper back) and the Triple Burner has a Back-Shu point at BL-22 Sanjiaoshu. Notice how the Pericardium has a Back-Shu point in the upper back (not by chance just above the Heart Back-Shu point BL-15 Xinshu) and the Triple Burner has its Back-Shu point at BL-22 Sanjiaoshu in the lower back, just above the Kidney's Back-Shu point BL-23 Shenshu (Fig. 1). "Logically" as the Triple Burner channels is associated with the Pericardium channel, the Triple Burner's Back-Shu point should be in the upper back also because the Triple Burner is an Arm channel (Arm Shao Yang). We shall soon see why it is in the lower back, just above the Kidney's Back-Shu point.

To explain why the Triple Burner Back-Shu point is next to the Kidney's we need to explore the nature of the Triple Burner. The Triple Burner's nature has occupied Chinese doctors for centuries and there are different views of it; as usual in Chinese medicine, different view are contrasting but not necessarily mutually-exclusive ones. For centuries, Chinese doctors have been discussing whether the Triple Burner "has a form" (you xing) or not. The Chinese expression "has a form" means that the Triple Burner is an actual Fu organ; if the Triple Burner "has no form", then it is not like the other Fu but just a complex of functions "without form". Both these views are correct!
Chapter 38 of the Nan Jing has the famous statement that the Triple Burner "you ming er wu you xing", i.e. it "has a name but not a form". The Chinese expression is very elegant in that it contrasts you (it has) with wu you (has no, it does not have) and also rhymes ming (name) with xing (form). Therefore according to the Nan Jing, the Triple Burner has no physical entity like the other Fu organs but it is a set of functions.
What are the main functions of the Triple Burner in the Nan Jing? Chapter 8 discusses the function of the Triple Burner: "This Yuan Qi is the root of the 12 channels, it is the Motive Force (Dong Qi 动气) between the Kidneys, the root of the 5 Zang and 6 Fu and of the 12 channels, the gate of breathing and the origin of the Triple Burner."
Chapter 66 of the Nan Jing further explains the function of the Triple Burner and it is the origin of the famous view of the Triple Burner as the "envoy" of the Yuan Qi. It says: "Below the umbilicus and between the kidneys there is a Throbbing Qi [Dong Qi 动气] which constitutes a person’s life [sheng ming 生命]. This [Throbbing Qi] is the root of the 12 channels, also called Yuan Qi [原气]. The Triple Burner is the envoy of the Yuan Qi [or it allows the Yuan Qi to separate into its different functions]." Figure 2 illustrates this passage.

This is a very important statement that links the Triple Burner not only with the Yuan Qi but also with the Ming Men which is called also the "Minister Fire". It may be because of this that the Triple Burner is said to belong to the “Minister Fire”. The Minister Fire is the physiological Fire of the Kidneys that is essential to all the Zangfu and all physiological processes. It is in the Kidneys but it comes out of the Kidneys through the intermediary of the Triple Burner and that is why the Triple Burner's Back-Shu point is not by chance above BL-23 Shenshu, the Back-Shu point of the Kidneys (Fig. 3).

Notice that I have two different translations of a crucial few words above, i.e. either "the Triple Burner is the envoy of the Yuan Qi" or "it allows the Yuan Qi to separate into its different functions". This second translation was proposed by Steve Clavey and it is one that has great merit. This interpretation means that the Triple Burner allows the Yuan Qi to separate into its different forms in different parts of the body to perform is various functions. The places where the Qi of the Yuan Qi "comes to a halt" are the Yuan points on each channel.
There is another interesting significant symmetry in the location of points and that is the one between BL-22 Sanjiaoshu and Ren-5 Shimen. BL-22 is the Back-Shu point of the Triple Burner and is above BL-23 Shenshu (Kidney’s Back-Shu); Ren-5 is the Front-Mu point of the Triple Burner and is above Ren-4 Guanyuan (a point closely related to the Kidneys). Note that Ren-5 also tonifies the Yuan Qi.
Thus, the location of BL-22 just above BL-23 and of Ren-5 just above Ren-4 (a point that tonifies the Kidneys and is related to Jing) confirms the above view of the Triple Burner as the agent allowing the Original Qi to emerge from between the Kidneys and be activated all over the body to perform its various functions. In practice, I often do use both these points (BL-22 and Ren-5) to stimulate the Triple Burner’s metabolism of fluids.
But going back to the point BL-22 what are its functions? I had the rather lengthy introduction above because some of its functions are related to the Triple Burner's being the "envoy" of the Yuan Qi. We could also call it the “agent” of the Yuan Qi.
The ancient book "An Explanation of the Acupuncture Points" mentioned above breaks down the actions of the point BL-22 according to Upper, Middle and Lower Burner.
- Upper Burner: headache from invasion of Wind-Cold, vomiting and rebellious Qi with digestive symptoms and dizziness.
- Middle Burner: (substantial) masses of the internal organs, a feeling of distension and fullness with emaciation, no appetite, shoulder pain, backache with rigidity.
- Lower Burner: turbidity, diarrhoea, abdominal distension, borborygmi.
Modern books lists more symptoms and these can be found in Deadman and Al Khafaji's "Manual of Acupuncture" (p. 282) and my own "The Channels of Acupuncture" (p. 984-5). Among the indications, modern books mention also the Shao Yang Syndrome, i.e. alternation of chills and fever, bitter taste, dry throat, etc.
From what I can see the old texts do not mention these indications under BL-22; for example, the Compendium of Acupuncture (Zhen Jiu Da Cheng) and the ABC of Acupuncture (Jia Yi Jing) do not mention it. I suspect this is a modern addition inspired by BL-22 being the Back-Shu point of the Triple Burner. However, and this is an important point, the "Triple Burner" that is the "agent" of the Yuan Qi and the Triple Burner as Water passages have nothing to do with the Triple Burner as the Shao Yang channel! In other words, there is an apparent dichotomy between the Triple Burner as the agent of the Yuan Qi and the Triple Burner as the Shao Yang channel. Thus, to treat the Shao Yang Syndrome I would definitely use points from Triple Burner channel and particularly T.B.-5 Waiguan and not BL-22.
Modern books list also oedema, difficult urination, turbid urine, blood in the urine and these indications are indeed also in the old texts. I personally use this point almost exclusively for the Lower Burner and especially to promote the transformation, transportation and excretion of fluids in the Lower Burner, hence the symptoms of oedema, difficult urination and turbid urine. I use this point in all cases of Dampness or Phlegm in the Lower Burner in combinations that I posted on an earlier blog and a previous Clinical Tip.
But another reason why this point would act on the fluids of the Lower Burner is to do with its function with regard to the Minister Fire of the Kidneys. Just like it is the "envoy" of the Yuan Qi, it is also the envoy of the Minister Fire. The Minister Fire heats the fluids in the Lower Burner and this (physiological) heat is essential to the transformation, transportation and excretion of fluids.
Thus, the point BL-22 acts on the fluids metabolism in the Lower Burner for two reasons. Firstly, the point transforms fluids and therefore resolves Dampness because the Triple Burner is a system of waterways for the transformation, transportation and excretion of fluids. The famous chapter 8 that compares the Zangfu to “officials” says that the Triple Burner is the official in charge “of irrigation and controls the Water passages”. Secondly, the point transforms fluids through its activation of the Yuan Qi and of the Minister Fire.
Thus, as the Triple Burner’s Back-Shu point is on the Bladder channel, there is a connection between these two channels. Interestingly, there is another connection between the Triple Burner and the Bladder channels that is highlighted in the “ABC of Acupuncture” (Jia Yi Jing) by Huang Fu Mi. This connection occurs via the point BL-39 Weiyang which is the Lower He point of the Triple Burner. The He points of the Triple Burner, Small Intestine and Large Intestines (all Arm channels) are T.B.-10 Tianjing, S.I.-8 and L.I.-11 Quchi respectively. However, since the organs of these three channels are located in the Lower Burner, these three channels also have three so-called “Lower He” points which are BL-39 Weiyang for the Triple Burner, ST-37 Shangjuxu for the Large Intestine and ST-39 Xiajuxu for the Small Intestine.
The “ABC of Acupuncture” says that the point BL-39 Weiyang, Lower He point of the Triple Burner, is used for abdominal distension and pain with retention of urine. The text specifically says that this is a “Triple Burner disease” and this confirms the nature of the Triple Burner as a system of waterways for the transformation, transportation and excretion of fluids.
In conclusion, there are at least four aspects to the Triple Burner:
1) It is a system of waterways that transport and excrete fluids
2) It is the “envoy” of the Yuan Qi and Minister Fire
3) It is a system of “cavities” (not discussed here)
4) It is a Shao Yang channel that treats mostly problems of the Shao Yang area in the shoulder and head (especially ears) and also the Shao Yang Syndrome from the Shang Han Lun.

ST-40 Fenglong

2010-08-24T01:25:00.000-07:00

The last Clinical Tip discussed the treatment of Dampness and Phlegm and it started with a reference to ST-40 Fenglong. It seems therefore appropriate now to discuss the clinical use of the point ST-40 Fenglong. As I said in the previous Clinical Tip, whenever I mention ST-40 in the course of my lectures, everybody associates it with resolving Phlegm. As we shall see, this point has many other extremely valuable actions.

ST-40's name Fenglong means "Abundant Bulge": this obviously refers to the bulge on the fibularis longus muscle where the point is situated. However, the word feng meaning "abundant" or "rich in" has also another meaning: it refers to the quality of the Yang Ming channels of being "rich in Qi and Blood".[i] Feng, therefore, refers to the quality of the Stomach channel of being rich in Qi and Blood and, because of this, to its use in invigorating the channels. ST-40 Fenglong is the Luo point of the Stomach channel and we shall see what relevance this has in the clinical use of the point.

The main actions of ST-40 Fenglong listed in modern Chinese books are:
a) Resolves Phlegm and Dampness
b) Opens the chest and subdues rebellious Qi
c) Promotes the descending of Lung-Qi and stops cough
d) Calms the Mind and opens the Mind's orifices
e) Invigorates the channels[ii]

The indications related to ST-40 grouped according to its function are as follows:
a) Feeling of oppression of the chest, profuse sputum, swelling of the face, dizziness, headache, swelling of the throat, feeling of heaviness of the body
b) and c) Cough with sputum, breathlessness, wheezing
d) Manic-depression [Dian Kuang], inappropriate laughter, inappropriate elation, desire to ascend to high places and sing, undress, and run around, mental restlessness, "seeing ghosts".
e) Loss of use of the lower legs, atrophy of muscles of the lower leg, difficulty in walking from Deficiency conditions.

This is a very important point since it is the point to resolve Phlegm in all its manifestations and in all parts of the body. However, as discussed in the previous Clinical Tip, this point would eliminate Phlegm only in combination with several other points.

It eliminates substantial Phlegm, such as profuse expectoration from the chest, Phlegm in the form of lumps, such as lumps under the skin, thyroid lumps and uterus lumps, and non-substantial Phlegm such as the one that clouds the Mind and obstructs the Mind's orifices causing mental disturbances or simply headache, dizziness and muzziness of the head. In all these cases this point should be needled with reducing method to resolve Phlegm.

I use the point ST-40 for asthma not so much for its Phlegm-eliminating effect but because it promotes the descending of Qi in the chest area: this point has a strong action on the chest and, for this reason, it has an effect on asthma together with points such as P-6 Neiguan and LU-7 Lieque.

This point's action on the chest is such that I use it also in muscular problems of the chest: for example, it is excellent to move Qi and make Qi descend when there is bruising of the chest and ribs from an accident: in such cases, I combine ST-40 with P-6 Neiguan. Another important action of this point is to calm the Mind, on which it has a profound effect. It can be used in all cases of anxiety, fears and phobias, not only if they are caused by misting of the Mind by Phlegm but also if they are caused by rebellious Qi. Indeed, in my opinion, the Phlegm-resolving effect of this point originally was specific in relation to mental illness, i.e. this point was used to eliminate Phlegm from the Heart's orifices causing mental illness.

Interestingly, the book "An Explanation of Acupuncture Points" (1624) does not make any mention of the effect of ST-40 in resolving Phlegm from the Lungs in Lung diseases, but it does mention the effect of this point in eliminating Phlegm from the Heart's orifices causing Kuang syndrome, i.e. the manic phase of bipolar disorder.

The Phlegm-resolving of this point should not be overemphasized overlooking its other functions. Apart from its use to resolve Phlegm, ST-40 can also be used to subdue rebellious Qi of the Stomach and Lungs when the person is very anxious, and the anxiety reflects on the Stomach function, with such symptoms as tightness of the epigastrium, a feeling of knot in the Stomach or, as some people say, a feeling of "butterflies in the stomach".
ST-40's quality of Luo point is important to understand some of its functions. It departs from ST-40 Fenglong 8 cun above the external malleolus, it flows up the leg and a branch joins with the Spleen channel, it then flows up the torso to the nape of the neck and head where it converges with the Qi of other channels, it then flows down to the throat.
The fact that the Luo channels flows to the neck where it "converges with the Qi of the other channels" makes it an important point to use for Bi Syndrome of the neck. If there is a Stomach disharmony and the patient suffers from chronic neckache, I use the point ST-40 bilaterally with reducing method.

Finally, some of ST-40's actions are also due to its being the Luo point that influences the Xu Li. Xu Li is the name for the Great Luo of the Stomach. The Great Luo of the Stomach is mentioned in chapter 18 of the Ling Shu: "The Great Luo channel of the Stomach is called Xu Li. It penetrates the diaphragm, it connects with the lungs and exits below the left breast. One can feel its pulsation by hand: it is the place where the Gathering Qi (Zong Qi) of the vessels [or channels] is situated."

Although the Ling Shu does not mention ST-40 in connection with the Xu Li channel, I do use ST-40 Fenglong to affect the Xu Li: as the Xu Li flows to lungs and heart and it influences the Zong Qi, I use ST-40 to affect the Xu Li and especially the heart when the pulse is irregular. In other words, ST-40 is an important point to affect the rate and rhythm of the heart.

END NOTES

[i] Yue Han Zhen 1990 An Explanation of the Acupuncture Points (Jing Xue Jie), People's Health Publishing Company, Beijing, p. 102. The book An Explanation of the Acupuncture Points was written in 1624.

[ii] Li Shi Zhen 1985 Clinical Application of Frequently-Used Acupuncture Points (Chang Yong Shu Xue Lin Chuang Fa Hui), People's Health Publishing Company, Beijing, p. 209.

Resolving Dampness and Phlegm with acupuncture

2010-07-16T23:40:00.000-07:00

When I give lectures I often hear that "ST-40 resolves Phlegm": I wish! Resolving Phlegm involves much more than simply using ST-40. In order to resolve Dampness or Phlegm, it is necessary to activate the Three Burners.
The Triple Burner is described in the Nei Jing as the official in charge of irrigation: this means that the Triple Burner is responsible for the transformation, transportation and excretion of fluids in all parts of the body and all organs. This is one of the most important functions of the Triple Burner.
The terms used in Chinese in connection with the Triple Burner’s influence on the body fluids are often shu 疏 which means “free flow” and tong 通 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’s function in relation to body fluids is closely dependent on its function of controlling the transportation and penetration of Qi. 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.
This whole process is called “Qi Transformation by the Triple Burner”: the result of the Qi transformation is the production of Nutritive-Qi, Defensive-Qi, Blood and Body Fluids. That is also why the Triple Burner is said to control “all kinds of Qi”. This sums up the way in which acupuncture can influence the transformation, transportation and excretion of fluids: it can only achieve this through Qi.
Herbal medicine resolves Dampness by using herbs which are actually diuretic (e.g. Fu Ling, Zhu Ling, Ze Xie, Yi Yi Ren, etc.); and it resolves Phlegm by using herbs that are drying (e.g. Ban Xia, Dan Nan Xing, etc.). Acupuncture can resolve Dampness or Phlegm only by regulating the ascending/descending and entering/exiting of Qi in the Qi Mechanism.
Secondly, one must resolve Dampness or Phlegm by regulating the fluid movement, transformation and excretion by the Triple Burner. In my experience, in order to do this, it is necessary to activate all three Burners which means that one should not hesitate to use more points than one would normally use. For example, to resolve Phlegm from the prostate (i.e. Lower Burner), I would use many points from the Lower Burner (listed in previous slide) plus some from the Upper and Middle Burner.
Please note that when we say that we need to “regulate the Triple Burner”, we do not do that by using Triple Burner points necessarily. Many points regulate the fluid metabolism by the Triple Burner and especially points on the Ren Mai: indeed these are the most important ones.

POINTS TO ACTIVATE WATER TRANSFORMATION BY THE THREE BURNERS
- Upper Burner: Du-26 Shuigou, Ren-17, LU-7, LI-4, LI-6, TB-4, TB-6
- Middle Burner: Ren-9 Shuifen, Ren-12, ST-22, Ren-11
- Lower Burner: ST-28 Shuidao, Ren-5, BL-22,, BL-39, SP-9, SP-6, KI-7.

T.B.-4 and BL-64 in combination move Qi in the Triple Burner and activate Water Passages.

NOTE: the three points in blue (Du-26 Shuigou, Ren-9 Shuifen and ST-28 Shuidao) activate the fluid transformation in each Burner. Shui means “water” and those points are therefore “Water Ditch”, “Water Separation” and “Water Passages” respectively. The points in red are strategic points on the Ren Mai that have the same function, Ren-17, Ren-9 and Ren-5 for the Upper, Middle and Lower Burner respectively. As we can see, Ren-9 pertains to both groups of points and that is why this point is such an important point for the metabolism of fluids and a point I would always use to resolve Dampness or Phlegm.
This means that when I resolve Dampness and Phlegm, I do not hesitate to use quite a lot of points to activate all three Burners but giving predominance to the points where the Dampness or Phlegm is situated. For example, if there is Phlegm in the Lower Burner (e.g. prostatic hyperplasia), I would use many points from the Lower Burner but also some from the Middle and Upper Burner. This is an example of such a point combination: Ren-3, BL-22, Ren-5, ST-28, SP-9, ST-40 (Lower Burner), Ren-9 (Middle Burner) and LU-7 (Upper Burner). With variations, this point combination could also be used for Phlegm in the Uterus.

Swollen tongue

2010-07-08T01:34:00.000-07:00

I frequently hear that a Swollen tongue indicates Qi deficiency. It is not so! In my experience, a Swollen tongue indicates Phlegm. But let us start by describing it first. A tongue is "Swollen" when the whole body is larger than normal. Crucially, a Swollen tongue is also somewhat rounder than a normal tongue. In very severe cases of Swollen tongue, the tongue may be almost perfectly round.

Before describing the clinical significance of a Swollen tongue, let us look at the clinical significance of a Thin tongue (i.e. the opposite of a Swollen tongue). As we all know, a Thin tongue indicates a deficiency of fluids, which may be Blood (is the tongue is Pale) or Yin fluids (if the tongue lacks a coating). It follows, therefore, that a Swollen tongue, being the opposite of a thin tongue, indicates that there is an excess of fluids. These "excess" fluids are not normal fluids but the accumulation of pathological fluids, i.e. either Dampness or Phlegm. I personally relate the swelling of the tongue body more to Phlegm than to Dampness (the latter reflected more on the coating).

I attach huge importance to the Swollen tongue: indeed, if the tongue is very swollen, I relate that to Phlegm even in the absence of any other symptoms or signs. This is after all an important aspect of tongue diagnosis, i.e. its preventive value. If a patient presents with a Swollen tongue (as in the picture above) I definitely resolve Phlegm. Please note that resolving Phlegm will not only help any internal disease the patient might have but it would also lead to an improvement of a channel problem as Phlegm obstructs the channels.

Please note that a Swollen tongue may be without coating (we would normally expect a sticky coating). This is not at all unusual and it is seen frequently in the elderly: it simply means that there is both Phlegm and Yin deficiency.

With acupuncture, to resolve Phlegm I would use these essential points: LU-7, Ren-9, Ren-12, SP-6 and ST-40. Other points that may be added are: BL-22, Ren-5, ST-28, KI-7 depending on the type of Phlegm and symptoms.

CHEMOTHERAPY AND CHEMO-SUPPORT

2010-05-29T19:48:00.000-07:00

It is now 16 years since the Three Treasures remedy Chemo-Support was introduced. This remedy aims at lessening the side-effects of chemotherapy by tonifying Qi and Yin, clearing Heat, resolving Dampness and allaying nausea and vomiting. It has been used by hundreds (if not thousands) of patients world-wide. The newsletter of Summer 2005 explains the use of Chemo-Support and this is the link:

http://www.three-treasures.com/newsletters/summer05.html

It is always disappointing to hear about oncologists that still advise their patients against taking Chemo-Support, even after I provide a list of ingredients with their pharmacological effect. One reason oncologists advise against taking this remedy is the "old chestnut" of the alleged conflict between chemotherapy agents and anti-oxidants. The theory behind their opposition is that chemotherapy works by oxidating cancer cells and therefore one does not want to do anything that would prevent that.

The Spring 2010 Newsletter on Chemotherapy and Anti-oxidants deals with this question and I will not repeat the arguments here. Suffice to say that it is far from proven that anti-oxidants interfere with chemotherapy: indeed there is some evidence that they may even work in synergy with it and lessen its side-effects. The link to the Spring 2010 Newsletter is as follows:

http://www.three-treasures.com/newsletters/spring10.html

The second question is; even IF anti-oxidants counteracted chemotherapy, does this apply to Chinese herbs, or at least to the herbs in Chemo-Support? Does the remedy contain anti-oxidants to a level that allegedly might counteract chemotherapy? The answer is an emphatic “No”. There is therefore no reason whatsoever to avoid taking Chemo-Support during chemotherapy.

It pains me to have to tell patients (who frequently write to me) that, if they really have misgivings about taking Chemo-Support, they should follow the advice of their oncologist. I also find it upsetting that, in this age of integrative medicine, an oncologist may know nothing about Chinese herbs and yet advise patients not to take them. I hear this all the time: “My oncologist said that he (or she) does not know anything about Chinese herbs and that therefore I should not take them.” I would have thought that it is their duty to inform themselves about Chinese herbs: anything less is poor care.

THE TONGUE IN THE ELDERLY

2010-04-03T02:08:00.000-07:00

Tongue diagnosis plays a very important role in the prevention of disease especially in the elderly. Middle-aged and elderly patients often show abnormal signs on the tongue in the absence of any obvious disease.
Elderly people often suffer from Internal Wind, Blood stasis, Phlegm, Heat or Yin deficiency or a combination of these. For example, it is common to have Blood stasis with Phlegm; or Phlegm with Yin deficiency; or Internal Wind with Phlegm; or a combination of the above. In the elderly, Blood stasis and Phlegm are so common that there is a saying in Chinese medicine which states “In the elderly, when in doubt, invigorate Blood and resolve Phlegm”.
In such cases, the tongue often shows clear signs of these pathogenic factors and it therefore allows us to treat them before they give rise to disease.
In particular, stroke in the elderly usually derives from a complex pathology involving Internal Wind, Yin deficiency with Empty Heat, Phlegm, and Blood stasis. The tongue of the elderly often points to such a complex pathology years before they may get a stroke. Therefore, if I see a tongue with those signs in an elderly person, I take active steps to treat them.
An example of a complex pathology showing on the tongue would be as follows:

- Deviated, Moving, Stiff = Internal Wind
- Red without coating = Yin deficiency with Empty Heat
- Swollen tongue body, sticky coating = Phlegm
- Purple = Blood stasis

The tongue illustrated here is Reddish-Purple (Blood stasis with Heat), Deviated and Stiff (internal Wind), lacking a coating in the centre, Red body (Yin Xu with Empty Heat), Swollen (Phlegm).
The remedy Peaceful Sunset was formulated to treat such a complex pathology in the elderly.

STICKY AND SLIPPERY TONGUE COATING

2010-03-31T21:47:00.001-07:00

STICKY AND SLIPPERY TONGUE COATING

There are two types of greasy coating: one is called ni 膩which I call "sticky"; the other is hua 滑 which I call "slippery". The sticky coating is more common than the slippery coating. Both types of coating share a common quality of being greasy. The main difference is that with the sticky coating the individual papillae can be seen, while the slippery coating is more greasy and oily so that individual papillae cannot be seen.

Also, the sticky coating is greasy but it adheres firmly to the tongue body; the slippery coating is more oily and seems to "slip" on the surface of the tongue. Another difference is that the sticky coating may be dry (an apparent contradiction but frequent) indicating Phlegm with Dryness of Phlegm-Heat. The slippery coating cannot be dry.

A possible way of visualizing the difference between these two is to imagine spreading a layer of butter on a toothbrush: if we spread it thickly and do not push it down the bristles of the toothbrush will be completely covered and will not be seen. If we spread the butter more thinly and press it down on the brush, the bristles will still look greasy but we can see them.
Both sticky and slippery coating may indicate either Dampness or Phlegm: the sticky coating more frequently indicates Phlegm, while the slippery coating more frequently indicates Dampness.

The tongue on the top right has a sticky coating. The tongue on the top left has a slippery coating on ths sides (while the coating in the central crack is sticky.

Chest and breast area on the tongue

2010-03-23T21:33:00.000-07:00

The “chest” area is on the sides of the tongue, between the centre part and the tip.
The chest area reflects a pathology of three organs: heart, lungs or breast in women.
Changes in this area to look for are:
1) Changes in colour (usually purple or red)
2) Changes in body shape (usually swollen or with teeth marks)
3) Red points

The chest area reflects pathologies of the lungs, heart or breast but in a Western medical sense. A change in the chest area may involve a change in colour or body shape. How to differentiate when a change in the chest area indicates a problem of the lungs or heart or of the breasts in women? A change in the chest area indicates a pathology of the breast in women rather that of lungs/heart when:
- In the absence of an obvious lungs/heart pathology
- Especially when it is unilateral

Examples of lung pathology manifesting in the chest area are chronic asthma or chronic emphysema (in which case the chest area would be swollen and possibly purple). An example of heart pathology is chronic coronary heart disease (in which case the chest area would be purple). As the area on the sides between the centre and the tip reflects the condition of heart/ lungs/ breast, I shall call this the “chest area”.

Apart from a purple colour and a swelling, other possible changes in the chest area are teeth marks that are confined only to the chest area, red points or a peeling of the chest area.

- Teeth marks only in the chest area indicate usually a problem in the breast in women (possible carcinoma) occurring against a background of severe Qi deficiency
- Red points in the chest area indicate Toxic Heat in thelungs or breast
- A peeling (absence of coating) in the chest area indicates a possible problem in the breasts in women occurring against a background of Yin deficiency.

A purple colour in the breast area in women is a potentially serious sign as Blood stasis in the breast may cause cancer. If I see this sign is a woman without symptoms, I would still treat her for Blood stasis in the breast. If I see a woman after she had breast cancer and surgery, I carefully examine the breast area: if it is purple it is not a good sign; vice versa, if it is not purple, it is a good prognostic sign.

In conclusion, as far as the Heart is concerned, we can say that the tip reflects a pathology of the Heart in a Chinese sense, i.e. problems of the Shen, while the chest area reflects a pathology of the heart in a Western sense (e.g. coronary heart disease

SP-4 GONGSUN

2010-03-21T03:05:00.001-07:00

The meaning of the name of the point SP-4 (Gong Sun) is the subject of much discussion. I have never been convinced by the translation of Gong Sun as "Grandfather-grandson" (or rather grandchild). Besides being the Luo point of the Spleen, SP-4 is also the master point of the Chong Mai.

Although the translation of Gong Sun as "grandfather-grandchild" is possible, I think there is at least another possible explanation. "Gong" may also mean "general" and "sun" may also mean "second-growth", i.e. the second growth of a plant after pruning later in the season (like a rose for example). Thus, Gong Sun may be translated as "general second growth". What is this second growth? In my opinion, it is the image of the smaller branches stemming from a central stem. This is the image of the Main channels - the main stem - and of the Luo channels which branch out from the Main channels. This image is consistent with the point SP-4 for two reasons: first, because it is a Luo point; secondly because the Chong Mai controls all Luo channels.

There is another connection between the "second growth" and this point's name. The term "Sun" is also the term used in the Nei Jing to indicate the Minute Luo channels, i.e. the small Luo channels that stem from the Luo channels themselves: thus, while the Luo channels branch off from the Main channels, the Sun Luo branch off from the Luo channels themselves (and they are smaller). Thus, Gong Sun may be translated as "General Sun channels": this translation also makes sense because the Chong Mai controls all Sun Luo channels too.

孙 SUN

Finally, there is another possible and easy translation. Gong Sun was also the family name of the Yellow Emperor and we can therefore interpret this point's name as a reference to the Yellow Emperor. This translation would also make sense because the Chong Mai is the "emperor" of the extraordinary vessels, because it is the centre of the energetic vortex created by them. In old times, the extraordinary vessels were compared to members of a family and the Chong Mai was the "father", i.e. the most important member (in a traditional, Confucian view of the family).

TRIPLE BURNER AND YUAN QI: BL-22 and Ren-5

2010-03-16T01:52:00.001-07:00

The location of the points BL-22 Sanjiaoshu above BL-23 Shenshu and of Ren-5 Shimen above Ren-4 Guanyuan is interesting and it presents interesting parallels. This location can be understood only by reference to Chapter 66 of the Classic of Difficulties (Nan Jing). Chapter 66 of this text states: “The Original Qi is the Motive Force [Dong Qi] situated between the two kidneys, it is life-giving and it is the root of the 12 channels. The Triple Burner causes the Original Qi to differentiate [for its different uses around the body]; the Original Qi passes through the Three Burners and then spreads to the 5 Yin and 6 Yang organs and their channels.”1
According to this view, therefore, the Triple Burner is the “agent” of the Yuan Qi arising from between the kidneys. This aspect of the Triple Burner is related to its transformation and excretion of fluids: in order to transform fluids, the body needs the heat of Kidney-Yang and of the Yuan Qi and this, in turn, needs the agency of the Triple Burner to be activated in all parts of the body to transform fluids.
I shall review below the actions and indications of BL-22 Sanjiaoshu and of Ren-5 Shimen, but only those relevant to fluid transformation.

BL-22 SANJIAOSHU Triple Burner Back-Shu Point
a) Nature
Back-Shu point for the Triple Burner.

b) Actions
1. Resolves Dampness
2. Opens the Water passages in the Lower Burner
3. Regulates the Lesser Yang.

c) Indications
1. Oedema, difficult urination, turbid urine, blood in the urine
2. Alternation of feeling of heat and feeling of cold, headaches, dizziness, bitter taste.

d) Comments
BL-22 is a major point to stimulate the transformation, transportation and excretion of fluids in the Lower Burner. The Lower Burner keeps the Water passages open so that “dirty” fluids may be excreted. This point regulates this particular function of the Lower Burner and thus ensures that the Water passages are open, fluids are properly transformed and dirty fluids excreted.
By stimulating the transformation and excretion of fluids, it resolves Dampness in the Lower Burner and treats such symptoms as urinary retention, painful urination, oedema of the legs, and any other manifestation of Dampness in the Lower Burner.
The effect of this point on the Lesser Yang channels and Lesser Yang Pattern requires an explanation. The Triple Burner is like the “envoy” of the Original Qi (Yuan Qi) emerging from the space between the kidneys; put it differently, the Triple Burner helps the Original Qi to “differentiate” into its different aspects in different parts of the body. Chapter 66 of the “Classic of Difficulties” mentioned above discusses the connection between the Original Qi (in this chapter called Dong Qi, “Motive Force”) and the Triple Burner.
BL-22 is just above BL-23, Back-Transporting point of the Kidneys, so this is the area from where the Triple Burner helps the Original Qi to emerge from the Kidneys and spread to the Internal Organs. Because of its connection with the Triple Burner, this point can be used for the Lesser Yang Pattern.

REN-5 SHIMEN Stone Door
a) Nature
Front-Mu point of the Triple Burner.

b) Actions
1. Opens the Water passages and promotes the transformation and excretion of fluids in the Lower Burner.
2. Strengthens Original Qi.

c) Indications
1. Difficult urination, retention of urine, painful urination, dark urine, oedema, diarrhoea, genital itching, swelling of scrotum, swelling of vulva, swelling of penis

d) Comments
In order to understand the function of this point, one must recall the role of the Triple Burner in relation to Original Qi (Yuan Qi). The Original Qi arises from between the Kidneys and spreads to the 5 Yin and 6 Yang organs via the intermediary of the Triple Burner. Ren-5 is the Front Collecting (Mu) point of the Triple Burner and rouses the Original Qi to circulate to all the organs and channels. It can therefore be used to tonify Original Qi in persons with Kidney deficiency and a poor constitution.
Another important function of the Triple Burner (and specifically the Lower Burner) is to transform and excrete fluids, and to ensure that the Water passages of the Lower Burner are open. Ren-5 stimulates this function of the Triple Burner, and specifically the Lower Burner: its use is therefore indicated for oedema of the abdomen, urinary retention, difficult urination, diarrhoea or vaginal discharge.

CONCLUSION
In conclusion, the location of BL-22 just above BL-23 and of Ren-5 just above Ren-4 (a point that tonifies the Kidneys and is related to Jing confirms the above view of the Triple Burner as the agent allowing the Original Qi to emerge from between the Kidneys and be activated all over the body to perform its various functions.

1. Nanjing College of Traditional Chinese Medicine 1979 A Revised Explanation of the Classic of Difficulties (Nan Jing Jiao Shi), p. 164. People’s Health Publishing House, Beijing, first published c. AD 100.

Spleen-Yin deficiency

2010-02-22T21:21:00.000-08:00

It is often said that the Spleen can suffer only from Yang deficiency: it is true that this is a very common pathology of the Spleen but not the only one. Indeed, the Spleen can suffer from Yin deficiency.

A deficiency of Spleen-Yin does not usually occur on its own but it is associated with Stomach-Yin deficiency. Therefore, the symptoms of Spleen-Yin deficiency resemble those of Stomach-Yin deficiency (a dry mouth with desire to sip liquids, slight epigastric pain, tongue without coating). In addition to these, the symptoms of Spleen-Yin deficiency are dry lips and dry stools. There are particular cracks on the tongue that are typical of Spleen-Yin deficiency: these are small, transversal cracks on the sides (see picture). The formula to nourish Spleen-Yin is sha Shen Mai Dong Tang. If the Spleen-Yin deficiency is mild, Shen Ling Bai Zhu San may be used.

Swine flu

2009-07-31T03:06:00.001-07:00

The new strain of influenza A (H1N1) was first reported from Mexico this year (2009). The spectrum of disease caused by new influenza A (H1N1) virus infection ranges from non-febrile, mild upper-respiratory tract illness to severe or fatal pneumonia. Most cases appear to have uncomplicated, typical influenza-like illness and recover spontaneously.

Most commonly reported symptoms include:
1. cough
2. fever
3. sore throat
4. malaise
5. headache

“Rapidly progressive respiratory disease has accounted for most severe or fatal cases”
From the Chinese medicine viewpoint, this is due to transmission of external pathogenic factor from the Wei Level to the Qi Level with the pattern of Lung-Heat and then eventually to the Ying and Blood Level.

An influenza epidemic or pandemic is a typical Wen Bing disease. This is because it is very virulent and has a strong tendency to enter the Qi level (causing chest infections) very quickly.

Wei Level
The main symptoms of invasion of Wind-Heat are aversion to cold, shivering, fever, sore throat, swollen tonsils, headache and body-aches, sneezing, cough, runny nose with yellow discharge, slightly dark urine, slightly Red sides of the tongue and a Floating-Rapid pulse. It is worth noting that in Wind-Heat too there is aversion to cold as this is due to Wind-Heat obstructing the Wei Qi which therefore fails to warm the muscles. This corresponds to the beginning stages of influenza when the patient has “aversion to cold”.
With our treatment, we should always aim at expelling the Wind at the Wei Level: even though this may not be entirely possible, it will make the symptoms of the Qi Level milder and it will prevent complications.

Qi Level
At the Qi Level-Heat. Wind penetrates into the Interior and it changes into interior Heat or Phlegm-Heat. With influenza, this usually manifests with bronchitis or pneumonia. The Qi Level is a crucial level as the pathogenic factor can be expelled completely or it can get worse by penetrating further into the Interior at the Ying or Blood level.
The Qi Level symptoms are symptoms of Interior Full Heat: high fever, thirst, sweating, feeling of heat, red face.
At the Qi Level-Fire, the tongue is Red with a thick-yellow coating and the pulse is Full and Rapid. As long as there is a coating, the patient is still at the Qi Level. When the coating falls off, the patient is at the Ying or Blood level.

Ying/Blood Level
At the Ying and/or Blood Level, Heat has injured Yin so that the tongue has no coating (and it is Red). The Ying or Blood Levels are always dangerous because it may lead to mortality. Internal Wind may develop at the Blood Level and convulsion in children during febrile diseases always indicate the presence of internal Wind at the Blood Level.
The symptoms of the Ying Level are fever at night, mental confusion, delirium, cold hands, Red tongue without coating. The symptoms of the Blood Level are fever at night, possibly convulsions, maculae, bleeding, Red tongue without coating.

TREATMENT WITH THREE TREASURES REMEDIES
EXPEL WIND-HEAT
Invasions of Wind-Heat manifest with aversion to cold, fever, thirst, sore throat, body aches, headache, tonsillitis, ear infection, cough, Floating-Rapid pulse and tongue red on the sides. This is the remedy for Wei Level. The dosage is at least 9 tablets a day. This is the remedy of choice for influenza: use 12 tablets a day. Expel Wind-Heat should be a stand-by remedy in any household with children.
Please note that this remedy is used only in the beginning stages when the external Wind is still on the Exterior: at this time, the patient will have “aversion to cold” as described above.

CLEAR METAL
Clear Metal was formulated to treat the Qi Level of influenza. The simplest and clearest sign that the invasion of Wind has moved from the Exterior (Wei Level) to the Interior (Qi Level) is that the patient feels no longer cold and does not shiver but feels instead hot and thirsty. The most common patterns at this level are either Lung-Heat of Lung-Phlegm-Heat so that the patient develops bronchitis or pneumonia.
Clear Metal was formulated to treat primarily Lung-Heat at the Qi Level when the patient displays the following symptoms: cough, slight breathlessness, fever, feeling of heat, thirst, tightness of the chest and upper back. Clear Metal has also a strong anti-viral action.
The dosage for an adult is at least 9 tablets per day. This dose can be exceeded in severe cases.

RINGING METAL
Ringing Metal, a variation of Qing Qi Hua Tan Tang Clearing Qi and Resolving Phlegm Decoction can be used for acute chest infections following an invasion of Wind, i.e. when the pathogenic factor is Phlegm-Heat in the Lungs at the Qi level. The main manifestations calling for this remedy in this context are: a cough following a cold or flu, expectoration of profuse sticky-yellow sputum, slight breathlessness, a feeling of oppression of the chest, possibly fever, thirst, disturbed sleep, a Full-Slippery pulse, a red tongue with sticky-yellow coating. The dosage is at least 9 tablets per day.

HERBAL SENTINEL
Herbal Sentinel is the remedy to take for prevention. It strengthens immunity and resistance to viruses and bacteria by tonifying Lung- and Kidney-Qi. It is to be taken continuously as long as the swine flu epidemic continues in dosages of 4 tablets a day (for an adult).
There are two Herbal Sentinel remedies: Herbal Sentinel - Yang and Herbal Sentinel - Yin. The former is for people with a tendency to Yang deficiency (with a Pale tongue); the latter for people with a tendency to Yin deficiency (with a tongue lacking in coating completely or partially).

My favourite point: G.B.-13 Benshen Spirit Root

2009-06-01T23:16:00.000-07:00

a) Nature
Point of the Yang Linking Vessel (Yang Wei Mai).
Meeting point of the 3 Yang Muscle channels of the arm.

b) Actions
- Calms the Mind (Shen) and settles the Ethereal Soul (Hin)
- Subdues Liver-Yang
- Extinguishes Wind
- Resolves Phlegm
- Gathers Essence (Jing) to the head
- Clears the brain.

c) Indications
Manic behaviour, fright
Headache, dizziness
Epilepsy, hemiplegia, convulsions
Vomiting of foamy saliva, epilepsy with foaming at the mouth.

d) Comments
G.B.-13 is a very important point for mental and emotional problems. It is very much used in psychiatric practice for schizophrenia and split personality combined with HE-5 Tongli and G.B.-38 Yangfu.1 It is also indicated when the person has persistent and unreasonable feelings of jealousy and suspicion.
Apart from these mental traits, it has a powerful effect in calming the Mind, settling the Ethereal Soul (Hun) and relieving anxiety deriving from constant worry and fixed thoughts. Its effect is enhanced if it is combined with Du-24 Shenting.
Its deep mental and emotional effect is also due to its action of “gathering” Essence (Jing) to the head. The Kidney-Essence is the root of our Pre-Heaven Qi and is the foundation for our mental and emotional life. A strong Essence is the fundamental prerequisite for a clear Mind (Shen) and a balanced emotional life. This is the meaning of this point's name “Root of the Spirit”, i.e. this point gathers the Essence which is the root of the Mind (Shen) and Spirit. The Kidney-Essence is the source of Marrow which fills up the Brain (called Sea of Marrow): G.B.-13 is a point where Essence and Marrow “gather”. The “Great Dictionary of Acupuncture” says that this point “makes the Mind [Shen] return to its root”2: the “root” of the Mind is the Essence, hence this point “gathers” the Essence to the Brain and affects the Mind. As it connects the Mind and the Essence, it also treats both the Heart and the Kidneys and therefore the Mind (Shen) and Will-Power (Zhi): for this reason, it is an important point in the treatment of depression.
When combined with other points to nourish Essence (such as Ren-4 Guangyuan), G.B.-13 attracts Essence towards the head with the effect of calming the Mind and strengthening clarity of mind, memory and will power. The connection between G.B.-13 and the Essence is confirmed by the text “An Enquiry into Chinese Acupuncture” which has among the indications of this point: “excessive menstrual bleeding, impotence and seminal emissions.”3
G.B.-13 also subdues Liver-Yang and it can therefore be used as a local point in chronic headaches from Liver-Yang rising. It also extinguishes internal Wind and is effective for Wind-stroke and epilepsy. Finally, it resolves Phlegm in the context of mental-emotional disorders or epilepsy, i.e. it opens the Mind's orifices when these are clouded by Phlegm. The “Explanation of the Acupuncture Points” says: “The indications of G.B.-13 show that it eliminates the three pathogenic factors of Wind, Fire and Phlegm from the Lesser Yang, in which cases this point should be reduced.”4

1. Dr Zhang Ming Jiu, personal communication, Nanjing 1982.
2. Cheng Bao Shu 1988 Great Dictionary of Acupuncture (Zhen Jiu Da Ci Dian), Beijing Science Publishing House, Beijing, p. 11.
3. Jiao Shun Fa 1987 An Enquiry into Chinese Acupuncture (Zhong Guo Zhen Jiu Qiu Zhen), Shanxi Science Publishing House, p. 52.
4. Yue Han Zhen 1990 An Explanation of the Acupuncture Points (Jing Xue Jie), People's Health Publishing House, Beijing. Originally published in 1654, p. 334.

Stomach crack on the tongue

2009-05-18T20:55:00.001-07:00

The Stomach crack on the tongue is rather wide and it is in the central section of the tongue (corresponding to Middle Burner). To contrast and compare the Heart and Stomach cracks, the former is rather narrow and runs all along the tongue from near the root to near the tip, while the latter is rather wide and is only in the middle of the tongue. Please see previous posts to see pictures of a Heart crack.
A Stomach crack indicates the tendency to Stomach-Yin deficiency. People with such a crack often have no digestive symptoms but I always recommend treating it by using Ren-12, ST-36 and SP-6.

CHEMO-SUPPORT VETERINARY USE

2009-03-29T04:21:00.000-07:00

The following is a case history on the use of Chemo-Support to counteract the side effects of chemotherapy in a cat. This was sent to me by an American vet.

The case is a cat with lymphoma. An ultrasound revealed nodules in her spleen on 29 November 2007. She had previously had a pancreatic cyst removed surgically. She was given acupuncture and started on Chemo-Support 6 December 2007. She received chemotherapy for her lymphoma twice in Dec 07, but got very ill from it so the owner declined any further injectable chemotherapy. Prednisone and leukeran were started, but she developed diabetes as a result of the prednisone. Her prednisone was reduced and she was started on insulin. I started her on shen ling bai zhu san and a formula to nourish the kidney essence. She has gone through periods of severe anemia (15-17%) that we have managed it with Bvits/iron, homeopathics, managing her prednisone dose, and increasing her Chemo-Support. Although she is receiving a number of supplements and meds, it has seemed that increasing the amount of Chemo-Support was significantly helpful for her.

I have used the formula Chemo-Support in other cat patients with cancer, if they are receiving chemo, or if they need a good blood, qi, spleen tonic with immune modulating effects.

As an aside, I have also found the formula Chemo-Support helpful in immune-mediated disease. In particular I remember the case of a dog with severe immune-mediated arthritis that stabilized once Chemo-Support was started.

My favourite herbal formula - Gan Mai Da Zao Tang

2009-03-04T00:34:00.001-08:00

Gan Mai Da Zao Tang Glycyrrhiza-Triticum-Jujuba Decoction is first mentioned in the Jin Gui Yao Lue by Zhang Zhong Jing (220 AD). It is in chapter 22 “Pulses and Patterns of Complicated Women’s Diseases”. Zhang Zhong Jing says “Women suffering from anxiety are affected by sadness and crying, they are like lost souls [shen ling] and yawn frequently: use Gan Mai Da Zao Tang.”
I use this formula for depression and anxiety occurring against a background of deficiency (which may be of Qi or Blood). I call this one of the “magic” formulae because the very simple ingredients do not explain the profound effect of this formula. In fact, the ingredients (only three) are mild foods: licorice, wheat husks and dates.
Since this formula has only three ingredients, I sometimes add it to another formula I am using. Gan Mai Da Zao Tang is available in the Three Treasures as Soothe the Shen.

Clinical Tip of the Day no. 3

2009-02-24T01:11:00.001-08:00

A red tip of the tongue is very common. The tip corresponds to the Heart and the Shen and a redness of the tip always indicates emotional stress affecting the Heart: the redder the tip, the more intense the stress. Why is the tip affected and why does it become red? The Heart is affected by all emotions as it houses the Shen that feels them. When we feel angry, anger affects the Liver automatically, but it is the Shen of the Heart that “feels” the anger. Thus, a red tip of the tongue may be caused by any of the emotions, e.g. anger, sadness, grief, worry, fear, etc.

Why does the tip become red? The first effect of emotional stress is some Qi stagnation: when Qi stagnates, it frequently gives rise to Heat and hence the redness of the tip. If, besides being red, the tip is also swollen and has red points, it indicates that the emotional stress is even greater.

My favourite points - no. 2

2009-02-14T22:44:00.000-08:00

LU-3 Tianfu (3 cun below axillary fold)
Window of Heaven point. These points regulate the ascending and descending of Qi from the body to and from the head: they do so in the crucial neck area. Therefore, they can both subdue rebellious Qi and promote the ascending of clear Qi to the head.

On a psychic level, LU-3 action in regulating the ascending and descending of Qi to and from the head has a mental-emotional effect. For example, insomnia is due to Qi ascending too much to the head (or not descending from it) while somnolence and forgetfulness are due to clear Qi not ascending to the head. The “Explanation of the Acupuncture Points” (1642) says that LU-3 can make Qi rise to treat forgetfulness, sadness and weeping due to Qi not rising to head. Forgetfulness is an important indication for this point: this is forgetfulness due to clear Qi not rising to the head. According to the “Explanation of the Acupuncture Points”, this point treats forgetfulness by stimulating the ascending of Qi of both Lungs and Heart.

The mention of weeping in this ancient text is interesting. It means that this point treats afflictions of the Lungs from sadness and grief leading to weeping.

Finally, “talking to ghosts” features heavily in this point's indications. Generally speaking, when ancient books mention such symptoms as talking or seeing ghosts among the indications of a point, it means that the point is indicated for relatively serious mental-emotional problems and, in particular, when the Mind is obstructed. Obstruction of the Mind can potentially cause serious mental problems such as manic-depression or psychosis. Again, this point can open the Mind's orifices, i.e. de-obstruct the Mind by regulating the ascending and descending of Qi to and from the head: it opens the Mind's orifices by promoting the descending of turbid Qi from the head and the ascending of clear Qi to the head (which, as we have seen above, is a general function of the Window of Heaven points).

My favourite points

2009-02-10T22:33:00.000-08:00

Du-24 Shenting (Spirit Courtyard)
Du-24 is a very important and powerful point to calm the Mind. It is frequently combined with G.B.-13 Benshen for severe anxiety and fears.

An important feature of this point which makes it particularly useful is that it can both calm and lift the Mind: therefore it is used not only for anxiety and insomnia but also for depression and sadness. It is also used in psychiatric practice for schizophrenia and manic behaviour.

The name of this point refers to its strong influence on the Mind and Spirit. The courtyard was traditionally considered to be a very important part of the traditional Chinese house as it was the one that gave the first impression to visitors; it is the entrance. Thus, this point could be said to be the "entrance" to the Mind and Spirit and its being a courtyard, highlights its importance. Being the "entrance", it controls our relationships with others.

I call this point the "arena of Shen and Hun": this point regulates the movement of the Hun. When the movement of the Hun is excessive, the person is slightly manic; when deficient, the person is depressed. This point regulates the movement of the Hun and the control of the Shen over the Hun.

The point combines very well with Ren-15 Jiuwei to calm the Shen and lift mood in both anxiety and depression.

Clinical tip of the day no. 2 - Heart crack

2009-02-10T02:49:00.001-08:00

The Heart crack on the tongue is relatively common. This crack is in the midline extending from near the root to near the tip; it therefore extends nearly the whole length of the tongue. The Heart crack indicates the constitutional tendency to mental-emotional problems: the deeper the crack, the stronger this tendency. If the Heart crack is accompanied by a change in the tongue-body colour and a red tip, it then indicates actual mental-emotional problems.

The two tongues presented here both have a Heart crack. The worst is the one on the bottom because the crack is deeper.

The view of tobacco in Chinese medicine

2009-02-03T23:18:00.000-08:00

- Tobacco was introduced in China in 1575.

- The Zhen Nan Ben Cao (Ming) concludes that tobacco is pungent in taste, hot and toxic without any medicinal effect.

- The Ben Cao Cong Xin says “People nowadays inhale smoke down to the throat: this damages Blood and the voice.”

- Emperor Chong Zhen (Ming) enacts laws against smoking.

- Qu Ci Shan (Qing) says: “Tobacco is pungent and drying, it burns Jing (Kidneys) and the Fluids, damages the throat, the Stomach and the Lungs…it enters the Heart orifice causing mental confusion as if one were drunk. It makes the tongue coating dark-yellow or black, food and drink have no taste, the medical texts have no treatment for this.”

- Zhao Xue Min (Qing) thought that smoking damages the Lungs, exhausts Blood, injures Shen and shortens life.

The above statements are interesting as they show that, according to Chinese medicine, tobacco is drying, it dries up Fluids and the Jing (Essence). So, Western medicine focusses on the effects of tobacco on the lungs while Chinese medicine considers it to deplete Kidney-Jing as well. This would explain the toxicity of tobacco in pregnancy.

Clinical Tip of the Day

2009-02-02T12:56:00.000-08:00

When treating the elderly, we should not over-emphasize Kidney deficiency.

Yes, most elderly people (though not all) will suffer from some form of Kidney deficiency but the most serious diseases of the elderly are caused by Phlegm, Blood stasis and internal Wind. These three pathogenic factors play a role in the pathology of stroke, coronary heart disease, cancer, high cholesterol, diabetes, hypertension, Parkinson's disease and Alzheimer's.

It follows therefore, that in treating the elderly, we should pay attention to resolving Phlegm, invigorating Blood and extinguishing Wind. These pathologies are also reflected in the pulse of the elderly that is frequently hard, Wiry and Slippery.

Upcoming Workshops

2009-02-02T12:37:00.000-08:00

9-10 May: San Diego. Pacific College of Oriental Medicine. Body-Mind mapping in Chinese medicine: the physio-pathology and energetics of body areas. Advanced tongue diagnosis. Contact Tiffany Hansen thansen@pacificcollege.edu.

16-17 May: Denver, Colorado: CEU workshop on the clinical use of the Three Treasures remedies in Shen disturbances plus Advanced Tongue Diagnosis. For more information, contact: Laura Schlieske at giovanniseminars@gmail.com.

6-7 June: Chicago. Pacific College of Oriental Medicine (Chicago campus). Body-Mind mapping in Chinese medicine: the physiology, pathology and point energetics of the body. Male disharmonies.

22 June: London, UK. The clinical application of the Three Treasures remedies. Balance Healthcare. Contact: jim@balancehealthcare.com.

29-30 August: Los Angeles. Pacific College of Oriental Medicine. The Psyche in Chinese medicine: treatment of mental-emotional disorders. The Extraordinary Vessels. thansen@pacificcollege.edu.

10-11 October: Galway, Ireland. The clinical application of the Three Treasures remedies. PPC. Contact: PPC@iol.ie.

16 October: Amsterdam, The Netherlands. Evergreen Herbals. Seminar on the clinical use of the Three Treasures. Contact: ruys@evergreenherbals.nl

17-18 October: Frankfurt, Germany. The clinical application of the Three Treasures remedies. Formula Pharmaceutics. Contact: waltraud.cornelius@formulapharm.de.

24-25 October 2009: Seattle, Bastyr University: Clinical application of the 8 Extraordinary Vessels and the treatment of male disorders. Contact: Diane Kerner. Email: dkerner@bastyr.edu

14-15 November 2009: Bethesda, Maryland, Maryland Acupuncture Society. Topics to be announced. Contact: Barbra Esher shiatsu@cablespeed.com.