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American Journal of Traditional Chinese Medicine, Vol.3, No.1, 2002

RESEARCH

Study on the Mechanism and Therapeutic Effect of “Oral Liquid of Xiao-Pi-Yi-Shen” for Patients with

Chronic Fatigue Syndrome (CFS)

Tianfang Wang, et al

ABSTRACTTo study the mechanism and therapeutic effects of “Xiao-Pi-Yi-Shen Oral Liquid” (XOL), Relieving Fatigue & Calming Spirit Oral Liquid, used for patients with chronic fatigue syndrome, 48 CFS patients were selected as a treatment group and professionally matched healthy people were selected as a control group. CFS patients with the syndromes of stagnation of liver-Qi and deficiency of spleen-Qi presented significant fatigue, depression and anxiety compared with those in the control group. XOL was found to markedly relieve the above and other related symptoms. The total effective rate was 87.5% according to the reduction of symptoms score. XOL could down-regulate the level of β–END, improve the cytotoxic activity of NK cells, and increase the Ig level of the patients.

Key Words: Chronic Fatigue Syndrome, TCM syndromes of stagnation of liver-Qi and deficiency of spleen-Qi, Xiaopiyishen Oral Liquid (XOL), β-END, ACTH, cortisol, natural killer cell activity, immunoglobulin

1. Introduction

Chronic Fatigue Syndrome (CFS) is characterized by long-standing, debilitating, unexplained fatigue and a variety of associated physical, constitutional, and neuropsychological complaints. The severe fatigue impairs daily function and is often made worse by exertion and exercise. Other

common accompanying symptoms include headache, sore throat, lymphadenopathy, myalgia, arthralgias, sleep disturbance, impairments in concentration and short-term memory, depression, irritability, and so on. CFS was officially named by the Center for Disease Control (CDC) of the U.S.A. in1988. (1) Currently, there is no effective clinical treatment because of its controversial etiology and pathogenesis, although most researchers consider that a disordered neuro-endocrine-immune system caused by a variety of factors such as virus infection, stress, unhealthy habits and overwork could be the major pathogenesis. Under these circumstances, Chinese Medicine could play a significant role both in investigating the mechanism of CFS in terms of TCM and in establishing effective therapeutic treatments. We proposed that the dysfunction of liver and spleen and the disharmony between these two organs could contribute to the genesis of one type of CFS. Many clinical symptoms could be explained by the failure of liver in smoothing and regulating the flow of Qi and blood, the hypoactivity of the spleen in transportation and transformation, and the disharmony between liver and spleen. Stagnation of liver-Qi and deficiency of spleen is a very common TCM syndrome, which has been used in guiding the clinical treatments for numerous disorders. Based on this consideration, “Xiaopiyishen Oral Liquid” was developed, with the functions of tonifying and soothing Qi and harmonizing the liver and spleen. This Chinese medicinal formula has the function of relieving fatigue

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and calming the spirit. The formula is composed of Huang Qi (Radix Astragali Membranaceus), Zhi Ke (Fructus Citri Aurantii), Ren Shen (Radix Ginseng), Chai Hu (Radix Bupleuri), and Chen Pi (Pericarpium Citri Reticulatae), and is used for patients with chronic fatigue syndrome. 2. Methods and Materials

2.1 Subjects: The 48 cases of CFS patients (male: 12 cases with mean ages of 37.3±8.7; female: 36 cases with mean ages of 43.6±9.6) were chosen from chronic fatigue clinics of Beijing University of Chinese Medicine, and all met the criteria for CFS revised by the CDC in 1994 (8) and the criteria of stagnation of liver-Qi and deficiency of spleen-Qi in terms of TCM diagnosis. 30 cases of healthy controls were matched with CFS patients in three aspects: age, gender and occupation.

2.2 Evaluation of Clinical Symptoms: The presenting symptoms of CFS before and after taking the formula were classified as mild (1 point), middle (2 points), or serious (3 points) in the Clinical Symptoms Observing Form, which was designed in combination with Chinese Medicine’s characteristics. The severities of the symptoms of fatigue, depression or irritability, fullness and pain in the chest, hypochondria and lower abdomen were scored as 2, 4 or 6 points separately. For one given patient, the accumulated number of points from both records was used as the total score.

2.3 Measurement of the Severity and Characteristics of Fatigue: The severity and characteristics of fatigue were evaluated. The Fatigue Scale (FS) (9) and Fatigue Assessment Instrument (FAI) (10)

were applied. This 14-item self-rating FS scale can be used to measure severity of fatigue during the preceding 2 weeks. In this scale, 8 items are used to measure physical fatigue and 6 items are used to measure mental fatigue. The 29-item FAI was developed to capture both quantitative

and qualitative components of a respondent’s fatigue in the preceding 2 weeks. The response key for each item is a seven-point Likert scale ranging from “1=Completely disagree” to “7=Completely agree”. The scale is composed of 4 subscales or factors. The first factor measures fatigue severity (Severity, S) and can be used as a quantitative measure of overall fatigue. The second factor is used to assess whether fatigue is situation specific (Situation-specificity, SS). The third factor addresses possible consequences of fatigue (Psychological Consequences, PC), and the fourth factor indicates whether one’s fatigue responds to rest/sleep (Responds to Rest/Sleep, RTR/S).

2.4 Evaluation of Depression State: The Depression Status Inventory (DSI) (11) was used. The depression index ranges from 0.25 to 1--below 0.5 indicates lack of depression, 0.5-0.59 indicates mild depression, 0.60 – 0.69 indicates medium depression and above 0.70 indicates heavy depression.

2.5 Evaluation of Anxiety State: The Self-Rating Anxiety Scale (SAS) (11) was applied. Both patients (before and after taking XOL) and healthy controls were asked to fill out the instrument forms mentioned above under the guidance of doctors.

2.6 Detection of Laboratory Indexes: Venous blood was taken from both patients (before and after taking XOL) and healthy controls between 8 AM and 9 AM for the purpose of detecting the following laboratory indexes: β-end concentration in peripheral plasma (Radioimmunoassay, RIA), ACTH (adreno-corticotropic hormone) concentration in peripheral plasma (RIA), Cortisol concentration in peripheral plasma (RIA), Immunoglobulin in peripheral serum (Simple agar diffusion test) and Activity of natural killer cells in peripheral blood (Isotopic label method).

2.7 Administration: Each bottle of XOL contains 10 ml. of liquid, with 1 ml. liquid

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being equal to 1 g. of raw herbal medicine. The patients took one bottle of this medicine three times per day for a total of two months. During this period, all other related medications were prohibited.

2.8 Standards for Evaluating Effectiveness with respect to Clinical Symptoms: Markedly effective: Clinical symptoms were significantly improved and the total symptoms score was reduced by more than 2/3. Effective: clinical symptoms were partly improved and the total symptoms score was reduced by more than 1/3. Not effective: clinical symptoms showed no change or were worsened and the reduction of the total symptoms score was less than 1/3. 2.9 Statistical Analysis: Both t test and chi-square test, for enumeration data, were performed. T test results are recorded as mean ± standard error. 3. Results

3.1 Characteristics of Subjects: There were no differences in the aspects of age, gender and occupation between CFS patients and healthy controls (see the following tables):

Table 1 Gender and age status in CFS patients and healthy controls

Sex Age (Years) Groups Male Female 20-29 30-39 40-49 50-59

CFS patients (n=48) 12 36 6 15 17 10 Healthy controls (n=30) 7 23 5 9 13 3

Table 2 Occupational status in CFS patients and healthy controls

Occupations Groups Cadre Professional Business Worker Other CFS patients (n=48) 3 24 7 12 2Healthy controls (n=30) 3 22 1 4 0

3.2 Total symptoms scores before and after treatment: The scores of total symptoms after treatment were markedly

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lower than those before treatment (see table 3). In the 48 cases, 10 cases were markedly effective (20.8%), 32 cases were effective (66.7%), and 6 cases were not effective (12.5%). The total number of effective cases was 42 (87.5%), according to the Effect Evaluating Standard for Clinical Symptoms

3.3 Changes in Fatigue Scores The results in Table 4 indicate that the physical fatigue scores, mental fatigue scores and total scores of the FS patient group (before treatment) were all significantly higher than the corresponding data from the healthy control group, and that they decreased substantially after treatment.

Table 3 Comparison of total symptoms scores in CFS patients before and after treatment

Groups Total symptoms scores

Before treatment 41.55±9.41 After treatment 15.16±6.33***

*** Significant difference (P<0.001) compared with before treatment.

Table 4 Comparison of Fatigue Scale scores between different groups

Groups Physical fatigue Mental fatigue Total

Healthy controls 3.77±2.34 1.43±1.50 5.20±3.09CFS patients before treatment 6.62±1.60*** 3.89±1.67*** 10.51±2.76*** after treatment 3.08±1.98### 2.09±1.54### 5.17±3.08###

*** Significant difference (P<0.001) compared with healthy controls.### Significant difference (P<0.001) compared with before treatment.

Table 5 Comparison of different factor scores from theFatigue Assessment Instrument between different groups

Groups S SS PC RTR/S

Healthy controls 3.18±1.37 4.28±1.57 4.56±1.97 5.88±1.86 CFS patients before treatment 5.53±1.51*** 5.52±1.22*** 6.26±1.06*** 5.00±2.05 after treatment 3.28±1.48### 4.98±1.14## 5.01±1.98### 6.46±1.45###

*** Significant difference (P<0.001) compared with healthy controls.## Significant difference (P<0.01) compared with before treatment.### Significant difference (P<0.001) compared with before treatment.

The results in Table 5 indicate that the S scores, SS scores and PC scores of the CFS patient group (before treatment) are all significantly higher than the corresponding data from the healthy control group, and that they decreased significantly after treatment.

The RTR/S scores of CFS patients were lower than corresponding data from the healthy control group (but with no significant difference) and increased markedly after treatment.

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3.4 Changes in Depression Index Scores The depression index scores of the CFS patient group (before treatment) were significantly higher than the corresponding

data from the healthy control group and decreased significantly after treatment (see Table 6):

Table 6 Comparison of depression index scores between different groups

Groups Depression index scores

Healthy controls 0.43±0.11 CFS patients before treatment 0.57±0.09*** after treatment 0.44±0.08###

*** Significant difference (P<0.001) compared with healthy controls. ## Significant difference (P<0.01) compared with before treatment.

3.5 Changes in anxiety scores: The anxiety scores of the CFS patient group (before treatment) were significantly higher than the corresponding data from the healthy control

group and decreased significantly after treatment (see Table 7):

Table 7 Comparison of anxiety scores between different groups

Groups Anxiety scores

Healthy controls 39.48± 7.73 CFS patients before treatment 49.30±11.34*** after treatment 40.17±10.53###

*** Significant difference (P<0.001) compared with healthy controls.## Significant difference (P<0.01) compared with before treatment.

3.6 Changes in Related Laboratory Indexes

Table 8 Comparison of β-end concentration of peripheral plasma in different groups

Groups β-end (pg/ml)

Healthy controls 1605.27±495.18 CFS patients before treatment 1775.52±439.08 after treatment 1498.63±510.67##

## Significant difference (P<0.01) compared with before treatment. The results in Table 8 indicate that the concentrations of β-end of the CFS patient

group (before treatment) were higher than the corresponding data from the healthy

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control group (but with no significant difference), and that they decreased significantly after treatment with readings

even lower than those of the healthy control group.

Table 9 Comparison of ACTH and cortisol concentrations of

peripheral plasma between different groups

Groups ACTH (pg/ml) Cortisol (ng/ml)

Healthy controls 27.40±12.98 162.34±74.12 CFS patients before treatment 30.07±14.89 180.11±66.60

after treatment 30.67±15.89 174.89±60.86

The results in Table 9 show that the concentrations of ACTH and cortisol of the CFS patient group (before treatment) were slightly higher than the corresponding data from the healthy control group (but no significant difference), and that there were no marked changes after treatment.

Table 10 Comparison of immunoglobulinconcentrations of peripheral serum in different groups

Groups IgA IgG IgM

Healthy controls 1.77±0.50 11.17±2.78 1.52±0.55 CFS patients before treatment 1.35±0.58*** 10.30±1.81 1.28±0.48* after treatment 1.53±0.93# 11.16±2.56# 1.42±0.46#

* Significant difference (P<0.05) compared with healthy controls.*** Significant difference (P<0.001) compared with healthy controls.# Significant difference (P<0.05) compared with before treatment.

The results in Table 10 show that the concentrations of IgA and IgM of the CFS patient group (before treatment) were significantly lower than the corresponding data from the healthy control group, and that

the concentrations of IgG were slightly lower with no significant difference. All the concentrations increased significantly after the treatment.

Table 11 Comparison of the activity of natural killer cells in peripheral blood between different groups

Groups Activity of natural killer cells Healthy controls 37.09±7.37 CFS patients before treatment 31.37±8.47** after treatment 37.10±7.06###

** Significant difference (P<0.01) compared with healthy controls.### Significant difference (P<0.001) compared with before treatment.

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The results in Table 11 show that the activity of natural killer cells in the CFS patient group (before treatment) was

significantly lower than the corresponding data from the healthy control group, and that it increased significantly after treatment.

4. Discussion

4.1 The Therapeutic Effects of “Xiaopiyishen Oral Liquid” for patients with Chronic Fatigue Syndrome: In the formula, Huang Qi and Ren Shen have the actions of tonifying Qi and strengthening the spleen. Chai Hu can direct the Qi upward and Zhi Ke directs the Qi downward. When used together, they have a strong effect on spreading and regulating liver-Qi. Chen Pi has the action of regulating Qi, improving the spleen’s function of transportation and adjusting the stomach. The whole formula is intended to restore the function of the liver in circulating the Qi, to enhance the function of the spleen in generating Qi and blood, and can thus be used in treating CFS patients differentiated as having stagnation of liver-Qi and deficiency of spleen-Qi. The medicine can markedly improve the clinical symptoms of CFS patients, with a total effective rate of 87.5% as shown in the change of the total symptoms score. The marked physical fatigue, mental fatigue, depression and anxiety in CFS patients were relieved significantly after treatment, as demonstrated by the changes of the scores on the respective scales, further affirming the therapeutic effect of this formula. In addition, the increased changes of the RTR/S factor correlating the severity of fatigue and depression or anxiety strongly suggests that the way the formula relieves the symptoms is by improving the quality of the sleep. As a result, we propose that one of the mechanisms involved in treating CFS is to regulate emotional activity, which can be achieved by soothing the liver-Qi, relieving constraint and calming the spirit. 4.2 The Regulating Effects of XOL on the Neuro-Endocrine System of CFS Patients

4.2.1 The Regulating Effect of XOL on the β-end Concentration of Peripheral Plasma in CFS Patients: β-end is a kind of endogenous opioid peptide present in the brain and many tissues. Because of its neurotransmitter or hormone role, it has the functions of regulating the autonomic nervous system, the immune system, the cardiac system and mental activities. The actions of opioid peptides on the immune system are unknown. Some researchers showed that the results between in vitro and in vivo experiments are inconsistent. For example, opioid peptides might enhance the function of NK cells in vitro, but suppress the function of NK cells in vivo. (12) Other researchers demonstrated that a higher concentration of opioid peptides might enhance the action of NK cells and a lower concentration might have the opposite effect. (13) There are other research reports about the relation of β-end and immune function in CFS patients. Prieto (14) studied the function of mononuclear cells in 35 CFS patients and 25 cases of healthy controls and found that 85% of the patients had poorly functioning mononuclear cells, but that the functions of those cells could be improved when cultured together with the antagonists of opioid peptides. This evidence suggests that with increased activity the opioid peptides might act on the mononuclear cells of CFS patients by way of the classical receptor pathways, and indicates that the opioid peptides might be involved in the pathogenesis of CFS. Conti’s study (15)

found that the β-end concentration of mononuclear cells of peripheral blood in CFS patients was significantly lower than that in healthy controls, which might have similar implications as studies reported in the past that CFS patients have chronic

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immune activation. They further proposed that the typical fatigue and weakness of CFS patients are related to the lower level of β-end concentration in the central nervous system, because the β-end concentration of mononuclear cells in peripheral blood seems to mirror the β-end concentration in the central nervous system. In a study of congenital insensitivity to pain, Bernardini (16) demonstrated that the high level of β-end in plasma was related to the lowered activity of NK cells.

The results of our study indicate that the β-end concentration in plasma of CFS patients before treatment is higher than that in healthy controls (17) . Also, the content of immunoglobulin and the activity of NK cell are markedly decreased. After treatment, the increased concentration of β-end decreased significantly and the amount of immunoglobulin and the activity of NK cells were significantly increased. This finding suggests that β-end in plasma may contribute to the regulation of immune function in patients with CFS, and that down-regulating the increased β-end could be one of the mechanisms of XOL to enhance the immune function and show clinical effectiveness.

4.2.2 The Regulating Effect of XOL on the Functions of the Pituitary-Adrenal Cortex of CFS Patients: Generally speaking, stress causes increased secretion of ACTH in the pituitary and glucocorticoid hormone in the adrenal cortex, which is a kind of unspecific response of the body to the stress factors. Many studies show, however, that the decreased function of the hypothalama-pituitary-adrenal (HPA) axis reflects a basic physiological change of the neuro-endocrine system and might be specific to CFS. For example, Demitrack‘s study (18) found that the basic level of cortisol and free cortisone of urine in CFS patients is significantly lower than that of healthy controls. The subsequent study of Demitrack (19) confirmed the lower level of HPA of CFS patients in 1998 again and thought it could partly be due to the

weakened action of the central nervous system. In the same study, he also found that the disordered HPA function was different from that found in depression. Scott (20) analyzed by CT the size of the adrenal glands of CFS patients with lowered HPA function and found that the size was reduced by more than 50% when compared to healthy controls. The research of Bearn (21) and Scott (22) did not identify the difference of concentration of ACTH and cortisol between CFS patients and healthy controls, but the research of Demitrack (18)

found that the level of ACTH in CFS patients was increased at night. These controversial findings might be related to the time in which the samples were taken. Kavelaars’s (23) study also did not show any difference of ACTH and cortisol between the two groups. Our study indicated no difference between CFS patients and healthy controls for ACTH and cortisol and “Xiaopiyishen Oral Liquid” also was found to have no action on patients in this regard.

4.2.3 The Regulating Effect of XOL on the Immunologic Function of CFS Patients Past studies showed that most CFS patients had accompanying symptoms related to the disturbance of immune function (24-27) ; hence research on the immune function of CFS patients has been a very hot area. Up to now, the most consistent finding was the decreased activity of NK cells. Changes in the level of immunoglobulin were disputed. Some reports pointed out that the level of IgA/IgG/IgM were generally lower in CFS and that the cytes-mediated immune function, body energy and psychiatric symptoms could be improved after being treated with IgG, but other reports found that the IgG level was increased by 40% in CFS patients (28) . Our own results indicated that the Ig level and the activity of NK cells in CFS patients were significantly decreased compared with healthy controls, and that “Xiaopiyishen Oral Liquid” can reverse the above conditions effectively.

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In conclusion, “Xiaopiyishen Oral Liquid” showed marked effectiveness in relieving clinical symptoms--especially fatigue, depression and anxiety--which were differentiated into the patterns of stagnation of liver-Qi and deficiency of spleen-Qi according to Chinese Medicine. The therapeutic effects of this formula for CFS might be achieved through the regulation of the patients’ disordered neuro-endocrine and immune systems.

Acknowledgements The research was financed by NSFC (National Natural Science Foundation of China) and SATCM (State Administration of Traditional Chinese Medicine).

References

1.Holmes GP,Kaplan JE, Gantz NM, et al. Chronic fatigue syndrome:a working case definition. Ann Intern Med,1988,108:387-389.2. Mawle AC, Nisenbaum R, Dobbins JG, et al. The seroepidemiology of chronic fatigue syndrome: a case-control study. Clinical Infectious Diseases,1995,21: 1386-1389. 3. Dobbins JG, Natelson BH, Brassloff I, et al. Physical, behavioral, and psychological risk factors for chronic fatigue syndrome: A central role for stress. Journal of Chronic Fatigue Syndrome,1995,1:43-58.4.Akinori Masuda,MD. Psychobehavioral and immunological characteristics of adult people with chronic fatigue and patients with chronic fatigue syndrome.5. Krupp.LB, Pollina.D. Neuroimmune and neuropsychiatric aspects of chronic fatigue syndrome. Adv.Neuroimmunol. 1996,6(2):155-167.6. Cleare.AJ, Wessely.SC. Chronic fatigue syndrome: a stress disorder? Br.J.Hosp.Med. 1996,55(9):571-574.7. Tianfang Wang, Cuizhen Zhang, Lin Wang, et al. Thinkings on research approaches of the pathogenesis of chronic fatigue syndrome in both Chinese and western medicine. Journal of Beijing

University of Traditional Chinese Medicine. 22(5):19—23,1999.8. Fukuda.Complete: text of revised case definition. Annals of Internal Medicine, 1994,121(12):953-9599.Trudie Chalder ,Berelowitz ,Teresa ,et al. Development of fatigue scale . Journal of psychosomatic research ,1993,37(2): 147 - 15310.Joseph E .Schwartz , Lina Jandorf , Lauren B.Krupp .The measurement of fatigue :a new instrument . Journal of psychosomatic research , 1993,37(7):753- 762.11. Xiangdong Wang, Evaluating manual of mental health, Chinese Journal of Mental Health, 1993, (supp).12. Shaofen Xu, Neurobiology, Shanghai Medical University Publishing Company, 1992.13. Gang Yang, Endocrine physiology and Pathophysiology, Tianjin Technology Publishing Company,1996.14. Prieto J, Subira ML, Castilla A, et al. Naloxone-reversible monocyte dysfunction in patients with chronic fatigue syndrome. Scand J Immunol ,1989,30(1):13-20.15.Conti F, Pittoni V, Sacerdote P, et al. Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with chronic fatigue syndrome. Clin Exp Rheumatol ,1998 Nov-Dec,16(6):729-732.16.Bernardini R, Tine A, Mauceri, G, et al. Plasma beta-endorphin levels and natural-killer cells in two cases of congenital indifference to pain. Childs Nerv Syst, 1992 Mar, 8(2):83-85.17. Tianfang Wang, Lin Wang, Cuizhen Zhang, et al. The regulation effect of “Oral Liquid of Xiaopiyishen” on β_endorphin of peripheral blood in patients with chronic fatigue syndrome. Journal of Traditional Chinese Medicine 41(7):414-415, 2000. 18. Demitrack M.A., Dale J.K., Laue L.,et al. Evidence for impaired activation of the hypothalamic-pituitary-adrenal axis in chronic fatigue syndrome. Journal of Clinical Endocrinology and Metabolism.1991(73):1224-1234.19. Demitrack MA, Crofford LJ. Evidence for pathophysiologic implications of

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hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann N Y Acad Sci. 1998(840):684-697.20. Scott LV, Teh J, Reznek R, et al. Small adrenal glands in chronic fatigue syndrome: a preliminary computer tomography study. Psychoneuroendocrinology, 1999 (Oct)24(7):759-68 . 21. Bearn J., Allain T., Coskeran P., et al. Neuroendocrine responses to Dfenfluramine and insulin-induced hypoglycaemia in chronic fatigue syndrome. Biological Psychiatry, 1995(37):245-252.22. L.V.Scott, F. Burnett, S.Medbak, et al. Naloxone-medicated activation of the hypothalamic-pituitary-adrenal axis in chronic fatigue syndrome. Psychological Medicine, 1998(28):285-293.23. Kavelaars A, Kuis W, Knook L, Sinnema G, Heijnen CJ. Disturbed neuroendocrine-immune interactions in chronic fatigue syndrome. J Clin Endocrinol Metab, 2000 Feb, 85(2):692-696.24. Barker. E, Fujimura. SF, Faden. MB. et al. Immunologic abnormalities associated with chronic fatigue syndrome. Clin.Infect.Dis., 1994,18(1):136-141.25. Tirelli.U, Marotta. G, Improta. S, et al. Immunological abnormalities in patients

with chronic fatigue syndrome. Scand. J.Immunol. 1994,40(6):601-608.26. Ojo--Amaize--EA, Conley--EJ, Peter--JB. Decreased natural killer cell activity is associated with severity of chronic fatigue immune dysfunction syndrome. Clin Infect Dis. 1994,18(suppl 1):s157-159.27. Komaroff AL & Geiger AM. IgG subclass deficiencies in chronic fatigue syndrome. 1988(1):1288.28. Artsmovich NG Chungunov VS. The chronic fatigue syndrome. Z—Neuropatol—Psikhiatr—Zm—s—s—Korsakova. 1994, 94(5):47—50.

About the Authors: The research was completed by Tianfang Wang, Weiyi Yang, Cuizhen Zhang and Lin Wang from Department of Diagnostics, Yang Jiao and Yanfeng Liu from Oriental Hospital, and Bing Zhang from Department of Teaching Management, Beijing University of Traditional Chinese Medicine. Address correspondence to Wang Tianfang, Department of Diagnostics, Beijing University of Chinese Medicine, Beisanhuan East Road, Chaoyang District, Beijing, China, 100029 or E-mail to [email protected]

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mailto:[email protected]


RESEARCH

Therapeutic Effects of Electroacupuncture at Zusanli (ST 36) on Collagen-Induced Arthritis in Rats

Jianqiao Fang & Tianzheng Zhao

Electroacupuncture (EA), an acupuncture therapy, has been used for several decades in the treatment of many acute and chronic disorders. Currently it is widely applied for pain relief and is effective in checking arthralgia(1,2,3). Recent published data has shown that EA could be used in the treatment of immune-related disorders—it was shown to not only up-regulate immune functions, but also to down-regulate immune responses in some allergic or immuno-suppressive objects (4,5,6). EA has been shown to treat human rheumatoid arthritis (hRA) with satisfactory results (7,8). We once found that EA was effective in controlling the disease conditions in the animal mode of hRA studied in mice (9).

Immunization with type II collagen (C II) is well known as being able to induce inflammatory polyarthritis in rats and susceptible strains of mice (7,8). Although immune mechanisms that include both humoral and cellular immunity to C II have been implicated in the pathogenesis of the disease (10,11), there is much evidence that anti-C II antibodies play an important role in the initiation of the disease (12,13). Collagen-induced arthritis (CIA) in rats is characterized by a severe swelling of the paws associated with a massive infiltration

of inflammatory cells into the joints, and the progression of the disease results in destruction of the joints and severe deformities. Since CIA has both clinical and histological similarities to hRA (7,8), it is widely used to evaluate anti-arthritic agents and to understand the mechanisms of disease.

In this study, we used rat models and investigated the influence of EA, applied at the acupoint equivalent to Zusanli (ST36), on the incidence and development of CIA.

MATERIALS & METHODS

Animals. Male Wister rats, weighing 120-150g, were purchased from the Shanghai Experimental Animal Center (Shanghai, China). They were fed standard rodent chow and water ad libitum.

Induction of arthritis. C II (Sigma, USA), isolated and purified from bovine arthcular cartilage, was solubilized at 4 in 0.01 M acetic acid at 2.0 mg/ml, after which the solution was emulsified in an equal volume of incomplete Freund’s adjuvant (Difco Lab., Detroit, USA) in an ice cold water bath. Each rat was immunized by an

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intradermal injection of 1.0ml (1.0mg C II) of the cold emulsion into the back. Electroacupuncture treatment. The point equivalent to ST36, located in the anterior tibial muscle of the front leg, was selected. Electrostimulation was carried out by a pulse generator (HANS Electrostimulator, Beijing, China). Two sterilized acupuncture needles were inserted into the point ST36 and 5 mm inferior to it. An electrical stimulation pulse with continuous wave and frequency of 2 Hz, 5 mA intensity, was applied using two outlets via two needles. EA stimulation lasted for 30 mom at each treatment. The treatment, begun on day 3 after collagen injection, was given every other day for 10 treatments. The rats in the control group were restrained for 30 minutes in the same rat-holders with no special treatment.

Assessment of arthritis. The clinical symptoms of arthritis were evaluated with a visual scoring system, based on the degree of periarticular erythema, swelling and joint deformity. Rats were checked three times per week. Each lesion of the paws was graded on a scale of 0 to 4, and scores for all four extremities were summed, with a maximum possible score of 16: 0 = normal; 1 = swelling and erythema of one digit; 2 = swelling and erythema of more than two digits or mild swelling and erythema of the entire paw; 3 = progressively more severe swelling and erythema of the paw; 4 = severe swelling and erythema, lack of flexibility. The data were expressed as the percentage of arthritic limbs per group of rats and compared at various time points. The incidence and day of onset of arthritis were also recorded.

Measurement of anti-C II antibody. Blood samples were obtained from the rats by retro-orbital or cardiac puncture under anesthesia. Serum antibody levels to C II were measured using the commercially prepared Rat IgG Anti-type II Collagen Antibody ELISA Kit (Chondrex, Redmond, WA, USA). The assay was done in

duplicate according to the manufacturer’s recommendations. Briefly, type II collagen-coated 96-well microtitier plates were first washed with washing buffer. Wells were blocked with 100 :l of blocking buffer for 1 h at room temperature, and then washed three times. Test serum samples diluted at 1:10000 were added to each well (100:l /well), and incubated for 2 h at room temperature. After washing, 100:l of peroxidase-conjugated goat anti-rat IgG was dispensed into each well. After incubation for 1 h, 100:l of substrate, oeth-phenylene diamine solution was stopped by adding 50:l of 2.5N sulfuric acid approximately 30 min later. The absorbance was read at 490 nm and the results were expressed as U (units) per ml of serum.

Radiological evaluation. The paws of all the sacrificed rats were amputated for radiological examination. Using a cabinet soft X-ray apparatus, radiography was performed with Fuji FR X-ray film under the following conditions: 45 cm distance; 30 mA tube current; and 1.2 sec irradiation time. Radiological assessment of each paw was made in three stages: normal = no obvious abnormal finding; mild = inflammatory signs in tissue, bone destruction in limited paw joints; severe = bone destruction of general paw joints.

RESULTS

Influence of EA on the onset and severity of arthritis. As shown in Table 1, 4 rats immunized with type II collagen developed arthritis on day 11 after immunization. The immunized rats treated with EA did not suffer from arthritis at that time. Up until day 22, eleven immunized rats all developed arthritis, and those treated with EA also showed a high incidence of arthritis. No statistically significant reduction in the incidence of arthritis was observed in EA-treated rats compared with that in non-treated control rats, but on day 11, all limbs in EA treated rats were free of disease. In the time of onset of the disease, a significant difference was found between the EA group

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and the control group, the former with an average time of 15.31±0.56 days and the

latter with an average time of 11.90±0.31 days.

Table 1. Influence of EA on CIA incidence in collagen immunized rats Clinical severity day 11 day 22 Control group EA group Control group EA group Incidence of Arthritis 4/11(36.36%) 0/11(0%)* 11/11(100%) 10/11(90.91%) Incidence of Arthritic limbs 10/44(22.73%) 0/44(0%) * 41/44(93.18%) 36/44(81.82%) * p<0.05 compared to C II immunized control group.

The average arthritic index is one of the important objective signs indicating the incidence and development of arthritis. Therefore, we examined and recorded the arthritic indexes in each rat at different time

points. Table 2 shows that the average arthritic indexes of most of the observed periods were significantly different between the two groups. The rats treated with EA reached an average score of 4.36±0.61, representing a 41% decrease in clinical severity of the disease compared with the immunized control group.

Table 2. Influence of EA on the arthritic indexes of collagen immunized rats d10 d12 d14 d16 d18 d20 d22Control group 0.4±0.3 3.5±0.4 5.7±0.7 9.0±1.0 10.9±1.2 11.8±1.3 13.0±1.2EA group 0 1.6±0.4* 2.6±0.5* 4.8±0.8* 6.6±0.7* 8.9±1.1* 9.4±1.1* *p<0.05 compared to C II immunized control group at each time point.

Influence of EA on serum anti-C II antibody level. An important consequence of immunization with C II is a rapid rise in serum IgG level to C II. Therefore, we next examined the serum IgG anti-C II titers in rats. As shown in Table 3, the anti-collagen

antibodies on day 11 after collagen immunization were at similar levels between the two groups. Compared with the control group, up to day 22 the anti-C II antibody level was lower, but the suppressive effect was minor and not different from each other.

Table 3. Influence of EA on serum anti-C II antibody level(×104U/ml)

d11 d22

Control group 4.22±0.78 22.12±2.34 EA group 4.07±0.42 18.10±2.56

Influence of EA on radiological change of the joints. All diseased paws in each group were examined radiologically to observe the pathological change of the joints. Table 4 shows the radiological stage in the two groups 22 days after collagen injection. The

incidence of severe radiological changes was higher in the control group than that in the EA group, and the average index of radiological changes in all paws showed that the joints in the EA group were less pathologically affected.

Table 4. Influence of EA on radiological changes of the jointsNormal Mild Severe

Control group 3(6.82%) 16(36.36%) 25(56.82%)

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EA group* 8(18.18%) 22(50.00%) 14(31.82%)

Data presented are numbers of paws in the two groups. *p<0.05 comparedto control group.

DISCUSSION

The application of acupuncture results in the modulation of humoral or immune reactions(4,5). In China, the treatment of chronic arthritis with acupuncture showed attenuating effects on the patients (7), but experimental studies about the influence of electroacupunture on the CIA model, which is similar to hRA, are seldom done. Therefore, we performed this study to see experimentally whether EA treatment could be a kind of therapy dealing with rheumatoid arthritis. The present results clearly show that the administration of EA, started on day 3 after collagen immunization, did not significantly affect the incidence of arthritis but delayed the onset of disease, compared with the immunized control group. EA significantly inhibited the severity of arthritis from day 12 to day 22 with lower average arthritic indexes. EA inhibited the anti-C II antibody levels vs. that in immunized control rats but its suppression did not show up as significant. However, pathological changes of the joints and bones of diseased paws could be effectively controlled by EA treatment. This study indicates that application of EA in the early stage of disease may delay the onset of arthritis and attenuate the severity of disease, and in the late stage may prevent the destruction of the bones and joints. It is suggested that electroacupuncture treatment is capable of controlling the development of rheumatoid arthritis.

REFERENCES1. Ulett GA, Han S and Han JS:

Electroacupuncture: mechanisms and clinical application. Biol Psychiatry 44:19-138,1998

2. Liu F: A study on the cumulative effect of repeated electroacupuncture on chronic pain. Sheng Li Ko Hsueh Chin Chan 27:241-244,1996

3. Cui R, Zhao F, Ma C, et al: Influence of 5.7-dihydroxytryptamine on electroacupuncture analgesia and substance P level in central nervous system of the arthralgic rats. Sheng Li Ko Hsueh Chin Chan 27:183-185,1996

4. Chen XD, Wu GC, He QZ, et al: Effect of continued electroacupuncture on induction of interleukin-2 production of spleen lynphocytes afom the injured rats. Acupunct Electrother Res 22:1-8,1997

5. Zhang Y, Du L, Wu G, et al: Electroacupuncture induced attenuation of immunosuppression apppearing after epidural injection of morphine in patients and rats. Acupunct Electrother Res 21:177-186, 1996

6. Kasahara T, Wu Y, Sakurai Y, et al: Suppressive effect of acupuncture on delayed type hypersensity to trinitrochlorobenzene and involvement of opiate receptors. Int J Immunopharmacol 14:661-665,1992

7. Zherebkin VV: The use of acupuncture reflexotherapy in treating patients with rheumatoid arthritis. Lik Sprava 6:175-177,1997

8. Guan Z and Zhang L: Effects of acupuncture on immunoglobulins in patients with asthma and rheumatoid arthritis. J Tradit Chin Med 15: 102-105,1995

9. Jianqiao Fang, Eri Aoki, Ying Y, et al. Inhibitory effect of electroacupuncture on murine

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collagen arthritis and its possible mechanisms. In Vivo 13:311-318,1999

10. Stuart JM and Dixor FJ: Serum transfer of collagen-induced arthritis in mice. J Exp Med 158:378-392,1983

11. Seki N, Sudo Y, Yoshiiokas T, et al: Type II collagen-induced murine arthritis. J Immunol 140:1477-1484,1988

12. Kaibara N, Hotokebuchi T, Takagishi K, et al: Paradoxical

effects of cyclosporin A on collagen arthritis in rats. J Exp Med 158:2007-2015,1983

13. Takagishi K, Kaibara N, Hotokebuchi T, et al: Serum transfer of collagen arthritis in congenitally athymic nude rats. J Immunol 134:834-841,1988

About the Authors: Drs. Fang Jianqiao and Zhao Tianzheng are from Institute of Acupuncture, Zhejiang College of TCM, Hangzhou, China 310053.

15


RESEARCH

Study on the Relationship between PtfV1 and Heart-Qi Deficiency in Patients with Left Ventricular Hypertrophy

due to Hypertension

Chuanhua Yang, et al

PtfV1 signifies a terminal force of the left atrium, which is recorded on an EKG as a negative P wave of lead V1. A normal P wave is either positive or double directed. In the double directed wave a negative wave follows a positive wave. The index of PtfV1 is a product of the negative amplitude and its duration in the P wave. Research has shown that PtfV1 indicates: 1) an enlarged inner diameter of the left atrium, 2) decreased left ventricular compliance, and 3) reduced diastolic function of the left ventricle. A clinical study was performed on patients with left ventricular hypertrophy due to hypertension, in order to examine the correlation between the PtfV1 index and the degree of heart-qi deficiency.

Subjects and method

Subjects: 27 hypertensive in- and out- patients were chosen from the Hospital of Shandong University of Traditional Chinese Medicine between November 1995 and October 1998. The group consisted of 15 males and 12 females between the ages of 42 and 68 (51.5±11.2), who had been suffering from hypertension for 6 to 30 years (16.5±7.9).

Selection criteria: The patients were selected on the basis of the following criteria: essential hypertension, left ventricular hypertrophy, and heart-qi deficiency. The following diseases were ruled out: endocrine and metabolic diseases, secondary hypertension, congestive heart failure, chronic pulmonary heart disease, rheumatic heart disease and myocardiopathy.

Blood pressure was taken 3 times on different days--the systolic blood pressure was ≥160 mmHg and/or diastolic blood pressure was ≥95 mmHg, indicating hypertension.

Left ventricular hypertrophy (LVH) was measured according to Devercux’s standard, which uses Color Doppler Echocardiography to show the presence of left ventricular mass (LVM). Left ventricular hypertrophy is indicated when the index of the left ventricular mass (LVM) is greater than 120g/m2 for male patients, and 115g/m2 for female patients.

In order to qualify as heart Qi deficiency, both heart deficiency and Qi deficiency must be present. The presence of two or more of the following signs and symptoms indicate heart deficiency: 1) palpitation; 2) chest pain and oppression in the precordial region; 3) insomnia or dream-disturbed sleep; 4)

16


forgetfulness; 5) intermittent, knotted or thready weak pulse. The presence of three or more of the following signs and symptoms indicate Qi deficiency: 1) no vitality and fatigue; 2) shortness of breath and disinclination to speak; 3) spontaneous sweating; 4) enlarged tongue or tongue with toothmarks; 5) weak, forceless or soft pulse. (4)

Anti-hypertensive medicine was stopped at least 1 week before the study began.

Methods

The PtfV1 was measured according to Aronow WS’s method (5) , which is the standard used for PtfV1 measurement. The

left ventricular mass (LVM) was measured by a Color Doppler Echocardiogram (ULTRAMARK-9), which was tested by a 2.5 Hz frequency. The left ventricular mass (LVM) was measured according to the standards of the American Association of Echocardiography (6) , and ISFC of WHO (7) . The same technician performed all examinations. Heart-Qi deficiency was measured on a 20-point scale-- palpitation as a main symptom was counted as 4 points, and all other symptoms were counted as 2 points.

Results

The results of the study are presented in Table 1.

Table1 Correlation between the index of PtfV1 and rank of Heart-Qi deficiency

N PtfV1§ Score N PtfV1§ Score N PtfV1§ Score1 0.025 4 10 0.024 10 19 0.022 162 0.025 4 11 0.026 10 20 0.025 163 0.020 6 12 0.020 12 21 0.028 164 0.024 8 13 0.025 12 22 0.025 165 0.020 8 14 0.025 12 23 0.030 186 0.023 8 15 0.023 14 24 0.025 187 0.026 10 16 0.025 14 25 0.025 208 0.023 10 17 0.025 14 26 0.030 209 0.026 10 18 0.030 14 27 0.028 20 Note: r=0.4994, P=0.0102, §=PtfV1 negative value

Conclusion

Essential hypertension is one of the factors of cardiovascular disease. It may cause left ventricular hypertrophy and various heart complications (8). This is because essential hypertension damages the diastolic and systolic function of the left ventricle (9). In fact, patients with hypertension already have signs of cardiovascular damage before left ventricular hypertrophy is diagnosed. The earliest evidence of left ventricular hypertrophy is a decreased ventricular diastolic function, while the ventricular systolic function remains normal (10). Zeng discovered that there was a significant positive correlation between the enlargement

of the inner diameter of the left atrium and a reduction of ventricular diastolic function in hypertensive patients (11). Therefore, the index of PtfV1 may indicate an enlargement of the inner diameter of the left atrium, and reflect left ventricular diastolic function.

From this study, we found that there is a positive correlation between the index of PtfV1 and heart-Qi deficiency. This means that as the degree of heart-Qi deficiency increases the PtfV1 index increases as well. We can conclude that the index of PtfV1 may be one of the indicators of heart-Qi deficiency and may be a useful tool to rank the severity of heart-Qi deficiency. Decreased diastolic function of the left

17


ventricle and an enlarged inner diameter of the left atrium are two of the manifestations of heart-Qi deficiency. About the authors: Drs. Chuanhua Yang and Lu Feng are from the Hospital of Shandong University of TCM, Jinan, China. Dr. Hongwei Liu is from the Qinhuangdao Municipal Hospital, Qinhuangdao, China. Please correspond to Dr. Chuanhua Yang at Hospital of Shandong University of TCM, China 250011. Translated and edited by Ning Ma.

18


CLINICAL TRIAL

A Clinical Study of Fatty Liver Treated by

Tonifying the Spleen and Invigorating Blood Herbs

Yi-Yang Hu, et alIntroduction

This research project aimed at studying how the Chinese herbs Bai Zhu (Rhizoma Atractylodis Macrocephalae), Dan Shen (Radix Salviae Miltiorrhizae), Yu Jin (Tuber Curcumae) and Ze Xie (Rhizoma Alismatis Orientalis) could be effective in treating fatty liver and its effects. The formula was used to treat 53 clinical cases over 3 months; these were compared to 24 cases treated by Dong Bao Gan Tai. We observed the changes of the volume of the liver measured by ultrasonic technology, clinical symptoms, BMI, serum ALT and triglycerides. We found that the formula can improve the figure of the liver observed by ultrasonic equipment, can relieve symptoms, and can lower BMI, triglycerides and ALT. This tells us that the herbs can effectively deal with fatty liver.

Key Words: formula for tonifying the spleen, fatty liver, liver observation by ultrasound, triglycerides

Fatty liver cases have steadily increased due to the increase in the ratio of fat in modern diets. There is no effective treatment for fatty liver (1); we designed this formula according to our clinical experience and pharmacological research. The following is a report of our findings:

Cases and methods1. General data

The patients were diagnosed for fatty liver by multi-ultrasonic exam and CT. There

were 45 male and 7 female cases with ages 42+11. The control group had 24 cases with 17 males and 7 females. Ages were in the range of 50+11.

2. The formula group was treated by taking

the decoction with the 4 ingredients and the control group used the pills Dong Bao Gan Tai produced by DONG BAO Pharmaceutical Comp. Ltd. 3 t.i.d. for 3 months.

3. The following items were observedbefore and after the treatment: (1) Clinical symptoms and signs, BMI; (2) Serum ALT and triglycerides; (3) Liver ultrasonic observation. Total reduction of integral calculation greater than 3 was considered as treatment effective. 4. Statistics: t assay or X2 assay was used.

Results1. Clinical symptoms improvement.

The main symptoms: Fatigue 52 (68.4%), discomfort in the liver area 42 (55.3%), pain in the liver area 28 (36.8%), abdominal distension 22 (28.9%). Total effective rates in the formula group for improving of the symptoms of fatigue, discomfort in the liver area, pain in the liver area and abdominal distension were 91.67%, 85.71%, 86.96% and 88.24% respectively. The control group effective rates were 62.5%, 71.43%, 80% and 60% respectively. The formula group showed better results than the control group for improvement of clinical symptoms (P<0.05).

2. BMI change.In the formula group, 8 cases recovered to normal and 10 declined among 21 abnormal BMI cases, giving an effective rate of 85.7%. Meanwhile the control group had 2 cases returned to normal and 7 cases declined among 16 cases with abnormal BMI. There was a significant difference between the 2 groups (P<0.05).

3. Serum ALT and triglycerides.All patients in the two groups showed a significant decline in ALT. After the treatment, the formula group showed a decline from 91+93 u/L to 45+25 (P<0.01); the control group showed a decline from


65+43 to 42+24 (P<0.01). 37 cases had an abnormal ALT value in the treatment group, of which 20 returned to normal and 13 declined after treatment; in the control group, 8 cases had abnormal ALT, of which 5 cases returned to normal and 2 declined after treatment. 28 cases had higher than normal triglycerides in the treatment group, of which 8 returned to normal and 11 declined after treatment. In the control group, 17 cases had abnormal triglycerides, of which 8 returned to normal and 6 declined after treatment.

4. Ultrasonic Exam.See Table 2 for the decline of integral calculation in both groups. 7 cases returned to normal and 31 declined more than 3 points after treatment in the first group. The effective rate was 73%. In the control group, 2 cases returned to normal and 10 cases declined more than 3 points after treatment. The effective rate was 50%. Comparison of the two groups P<0.05.

Discussion

Fatty liver is a liver disease characterized by triglycerides deposit in the liver; it is caused by a metabolic disturbance. The factors involved could be a high ratio of fat in the diet, high free fatty acids, reduced use of fatty acids, synthesis increase of triglycerides in the liver, and/or VLDL synthesis and secretion problems (2). The incidence of fatty liver is steadily increasing due to a variety of factors, and there is a close relationship between fatty liver and liver fibrosis or cirrhosis (3) so more and more attention is being paid to the treatment of fatty liver.Traditional Chinese Medicine is continuing to study the mechanisms and treatment of fatty liver (4). According to our clinical experience, we believe the main factors for it are imbalanced diet, mental stress, and severe diseases--attacks by which the spleen becomes deficient and phlegm, dampness and blood stasis accumulation in the body is induced. The treatment principles should be tonify spleen, drain dampness, invigorate blood, and disperse liver. We use Bai Zhu

(Rhizoma Atractylodis Macrocephalae) to tonify spleen as a chief ingredient, Dan Shen (Radix Salviae Miltiorrhizae) to invigorate blood, Yu Jin (Tuber Curcumae) to disperse liver and Ze Xie (Rhizoma Alismatis Orientalis) to drain dampness.Apart from a liver biopsy, ultrasound and CT are the most valuable measures for diagnosis. The results demonstrated that the herbs improved the figure of the liver, which means that there was reduced deposit of lipids in the liver tissue. In addition, the patients received benefits from the herbs proved by reduced BMI, ALT, and triglycerides, and improvement of symptoms, so this is a comprehensive formula which is worthy of further research.

References:1. Fan Jian Gao, Li Ji Qiang and Zeng

Min De. The progress of Medical Treatment. China Journal of Liver Diseases, 4(4): 248, 1996.

2. Zeng Min De: Fatty Liver. China Journal of Digestion, 19(3):120, 1999

3. Fan Jian Gao. Relationship of Fatty Liver and fibrosis and its Mechanisms. Abroad Medicine of Digestive System Diseases. 17(2): 92,1997.

4. Liu Yan Ling. Chinese Herb Treatment on Fatty Liver. Academic Journal of Bei Jing University of Traditional Chinese Medicine. 18(5): 54, 1995

About the Authors: Hu Yi Yang*, Hui Ming Xue, Cheng Liu, Ping Liu are Professors of Liver Diseases Institute of Shanghai University of Traditional Chinese Medicine. Please correspond Professor Yi Yang Hu to 530 Ling Ling Road, Shanghai China 200032


CLINICAL TRIAL

Clinical Observations on Treating 166 Infertility Casesby Using Acupuncture and Chinese Herbal Medicine

Guoping Zheng

Infertility has long been a common problem in our human history, and still continues to be a problem in the modern era. Generally speaking, as many as one in every six couples requires help from specialists to treat infertility. Fortunately, Western Medicine has developed various treatment methodologies, especially the new assisted reproductive technology, which does increase the success rate. Despite this, nearly half of the couples among those who get treated by Western Medicine still fail to conceive.

On the other hand, in Asia there has been over a thousand years of history, a huge number of successful cases, and a lot of accumulated experience in treating infertility by using Traditional Chinese Medicine.

The goal of this article is to report the common and effective ways of applying these Traditional Chinese Medicine techniques--especially acupuncture with Chinese herbal medicine--which have been and still are being practiced commonly in China to treat infertility problems, and to report the success rate of my clinical practice in the USA. The results of these observations show that acupuncture combined with herbal medicine DOES cure infertility at a significant rate, and that the treatment provides new hope for those couples

who fail to respond to the Western Medical treatment. In other words, Traditional Chinese Medicine treatment, which includes acupuncture and herbal medicine, can be

used as one of the best alternative therapies for infertility patients.

Clinical Material

166 cases of infertility were treated in my clinic from 1995-2000. All the patients finished at least three cycles of the treatment. The ages of the patients were 27-47 with an average being 37. The average time of infertility was three and half years. Among these cases, 101 had primary infertility and 65 had secondary infertility. All the patients had been evaluated and diagnosed by their western medical doctor and most of them had received regular treatment, including the above-mentioned new assisted reproductive technology. The main causes of infertility were: 62 with ovulatory factor (37%); 31 with tubal factor (18%); 36 with endometriosis (21%); 29 with unexplained factor (17%); 8 with uterine or immune factor (5%).

Treatment Method

TCM periodic therapy, which included both acupuncture and Chinese herbal medicine, was applied to the infertility patients. For one cycle, from day 1 to day 28, the treatment is divided into three treatment phases, and for each phase, different acupoints and herbal formulas are used to stimulate and reach different functions.

F ollicular phase (around day 5 of the cycle until day 11): One or two sessions of acupuncture treatment, using the acupoints CV3, CV4, ST29, Zi Gong, ST36, SP6. For ST29 and Zi Gong, slight electric


stimulation was applied, and for ST36 and SP6, reinforcing methods were used. If the patients had Qi and Blood Stagnation or Blood Stasis, such as with endometriosis or tubal disorder, acupoints LI4 and LR3 were added. All these patients also took herbal medicine to tonify Essence and Blood. The formula was:

Gou Qi Zi (Barbary Wolfberry fruit), 15g; Tu Si Zi (Chinese Dodder Seed), 15g; Shu Di Huang (Rehmannia), 20g; Yin Yang Huo, (Epicedium) 9g; Chong Wei Zi (Leonuvus Fruit), 9g; Huai Niu Xi (Achyranthes), 15g; etc.

One dose per day, and twice a day.

O vulation phase (around day 12 of the cycle until day 16): Two to three sessions of acupuncture treatment, using the acupoints CV3, CV4, ST29, Zi Gong, SP6 and LR3. The points for application of electric stimulation were the same as in follicular phase; LR3 was applied with reducing methods. Herbal medicine was used to tonify kidney, to move Qi, and to induce ovulation. The formula was:

Gou Qi Zi (Barbary Wolfberry fruit), 15g; Tu Si Zi (Chinese Dodder Seed), 15g; Yin Yang Huo (Epicedium), 9g; Dang Gui (Chinese Angelica Root), 9g; Xiang Fu (Nut grass Galingale Rhizome), 12g; Chai Hu (Chinese Thorowax Root), 6g; etc.

One dose per day, and twice a day.

L uteal phase (around day 17 of the cycle until day 28): One to two acupuncture sessions were given. The acupoints used were ST29, Zi Gong (Ex.), ST36 and SP6. For all the points, reinforcing methods were used. The herbal medicine used was to tonify Qi and to strengthen kidney. The formula was:

Gou Qi Zi (Barbary Wolfberry fruit), 15g; Tu Si Zi (Chinese Dodder Seed), 15g; Shu Di Huang (Rehmannia), 20g; Yin Yang Huo (Epicedium), 9g; Dang Gui (Tang Shen Root), 15g; Bai Shu (Large head Atractylodes Rhizome), 12g; Sang Ji Sheng (Chinese Tax illus herb), 15g; etc.

One course of treatment consisted of three cycles. All the patients finished at least one course of treatment.

Results

1. Among the 166 cases, 68 patients became pregnant after application of the above therapies. The success rate was 41%;

2. Looking at each of the infertility groups (arranged by cause of the infertility) and the outcome of the treatments, we have the following results:

Table I. Observation of the effectiveness of the treatment for each cause of infertility

Cause of infertility Number of cases Number of pregnancy cases Success rate(%)Ovulatory factor 62 30 48Tubal factor 31 11 35Endometriosis 36 13 36Unexplained 29 14 48

Note: The results suggest that the success rates of the treatment in the Ovulatory Factor and Unexplained groups are clearly

higher than in the Tubal Factor and Endometriosis groups, which means that the above treatments are more effective for the


groups of Ovulatory Factor and Unexplained, at least.

2. Focusing on the 68 successful cases, the success rate for each treatment cycle is reported as follows:

Table II. Observation of the effectiveness and the duration of treatment in 68 pregnancy cases

Duration of the treatment Number of pregnancy cases Percentage (%)1st cycle 16 24%2nd cycle 17 25%3rd cycle 15 22%4th –9th cycle 20 29%

Note: The results suggest that, among pregnancy cases, about 70% of the patients became pregnant in the first course (first three months) of the treatment. Nevertheless, still close to 30% of the patients became pregnant during the second or third course of the treatment.

Conclusions

Because of various limitations, we are unable to use the standard methods for this clinical observation. However, considering that the average time of infertility of these patients were three and a half years, that all the patients had been evaluated and diagnosed with infertility by their doctors, and that the majority of them had already received regular Western Medical treatment, the results of this observation can still give rise to the conclusion that acupuncture combined with herbal medicine DOES help to cure infertility, and that these remedies may especially provide a new hope for those patients who fail to respond to the Western Medical treatment. In other words, Traditional Chinese Medicine treatment, which includes acupuncture and herbal medicine, can be used as one of the best alternative therapies for infertility patients. Furthermore, when both Western medicine and TCM are combined, it obviously can increase the success rate of the infertility treatment. As a matter of fact, many studies

in China have already shown this result. However, this needs to be proved much more scientifically.

According to a lot of clinical experience and reports in China, kidney tonic herbs have been used for many dysfunctional problems of the reproductive-endocrine system—e.g., irregular periods, dysfunctional uterine bleeding, amenorrhea, dysmenorrhea, PMS, menopause, etc--and most of them had satisfactory results. Many of the studies done on laboratory animals also suggest that acupuncture or herbal medicine may regulate the reproductive-endocrine system. Some of the clinical reports and animal studies have also shown that acupuncture or herbal medicine may also regulate the immune system. Some of the herbs used to improve the symptoms and the pathology of endometriosis cases have already been reported in China. All of these findings have suggested that acupuncture and/or herbal medicine might not only regulate the reproductive-endocrine system and immune system, but also improve the pathologic changes of endometriosis in treating infertility patients.

About the Author: Guoping Zheng, PhD; L.Ac; TCM Infertility Specialist. Address Correspondence to: 63 – 07 Dieterle Crescent, Rego Park, NY 11374.


ABSTRACT

A Clinical Comparative Study on Different Acupuncture Methods for Prevention and Treatment of Toxic and Adverse

Side Effects of Chemotherapy for Malignant Tumors

Yu Fan, et al

In order to study the potential additional therapeutic effects of acupuncture and moxibustion on toxic and adverse effects of chemotherapy, the actions of moxibustion and acupoint-injection on the side effects of chemotherapy in patients with malignant tumors were invesigated.

Sixty-three cases of malignant tumor of the respiratory system and the digestive system were studied; all were in-patients and were definitely diagnosed with cytopathology or histopathology. All of them were treated with combined chemotherapy using the drugs CTX, ADM, VCR, VP-16, PDD, MTX, 5-FU. They were assigned randomly to three groups—a moxibustion group (23 cases), an acupoint-injection group (22 cases) and a Western medicine group (18 cases), determined by sequence of visiting.

In the moxibustion group, Zusanli (ST36) and Sanyinjiao (SP6) were selected. Manipulation: An ignited moxa-stick was applied at 1.5cm over the selected points with mild suspended moxibustion, until local warm-heat was felt without burning pain but showing an aura. The treatment was given in the morning once each day, 10-15 minutes each time for each point. After the end of the moxibustion, light massage was applied on the points for 3-5 minutes each. Six sessions constituted one therapeutic course. The treatment was given for 3 courses, from the 5th day before chemotherapy to the 7th day after chemotherapy.

In the acupoint-injection group, Zusanli (ST36) and Sanyinjiao (SP6) were selected. Medicines: Huang Qi (Astragalus root) Injectio, 2ml each ampule included 4g crude drugs. Manipulation: After the local skin was routinely disinfected, 4ml of the injectio was taken with a 5ml injector with a #5 syringer needle and then was inserted vertically into Zusanli (ST36) and Sanyinjiao (SP6), respectively, with a rapid insertion method. After no blood was withdrawn, a reinforcing-reducing method with lifting-thrusting the needle was adopted. After needling sensation was attained, 1-1.5 ml of the injectio was slowly injected into each point, with tolerable local distention of the point. The treatment was given once daily, 6 sessions constituting one course. The treatment was given for 3 courses, from the 5th day before chemotherapy to the 7th day after chemotherapy.

For the control group, batyl alcohol 100g and leucogen 20mg were orally administrated for 3 courses, 3 times each day, 6 days constituting one course.

WBC count and immunoglobulin (IgG, IgA, IgM) contents were taken the 3rd day before treatment and the 9th day after treatment for all three groups. Results indicated that (1) Before treatment there was no significant difference among the 3 groups in total WBC count (P>0.05). After18 days of treatment, the WBC count in both the acupoint-injection and


moxibustion groups increased and were higher than that of the western medicine control group (P<0.05 or P<0.01), and the acupoint-injection group was better than the moxibustion group in improvement of WBC count (P<0.05). (2) Before treatment there was no statistically significant difference among the 3 groups in the immunoglobulin contents (P>0.05). After 18 days of treatment, the immunoglobulin contents decreased in the control group, but increased in the moxibustion group and the acupoint-injection group to a point significantly higher than that in the control group (P<0.05 and 0.01). The moxibustion group was better than the acupoint-injection group in improvement of immunoglobulin contents (P<0.05).

Conclusion: Both moxibustion and acupoint-injection can prevent and cure the toxic and adverse side effects caused by chemotherapy in malignant tumor patients and different therapies have different effects.

About the Authors: Yu Fan, Huashan Hospital, Medical College of Fudan University, 200040; Zhaomin Yang, the Second Clinical Medical College of Nanjing University of Traditional Chinese Medicine; and Ming Wang, Nanjing Gulou Hospital. This article abstracted from CHINESE ACUPUNCTURE & MOXIBUSTION 21(5): 259-261, 2001.

Analysis of the Therapeutic Effect of Injection of Metoclopramideand Vitamin B6 into Zusanli (ST 36) Point on

the Response of the Digestive Tract After Chemotherapy

Dongxing Ma, et al

Since October, 1997, the authors have adopted injection of metoclopramide and vitamin B6 into Zusanli (ST36) point to treat the response of the digestive tract after chemotherapy in 82 cases of milgnant tumor, with intramusclar injection of Endanxitone used as control in 80 cases. Satisfactory results were obtained, as reported in the following.

Of the 162 cases, 98 cases were male and 64 cases were female; age ranged between 18-85 years old, averaging 48 years old. All the patients were definitely diagnosed with pathological and/or cytological examination. Among them, 58 cases suffered from carcinoma of the stomach, 56 cancer of the lung, 26 mammary cancer, 10 carcinoma of the large intestine, 9 carcinoma of the esophagus and 3 liver cancer. Each patient was treated for 2 cycles at least and 8 cycles at most.

Carcinoma of the stomach, large intestine, esophagus and liver were treated mainly with 5-fluorouracil (5-FU), mitomycin and Cisplatin (or adriamycin); cancer of the lung was treated mainly with cyclophosphamide, adriamycin, Cisplatin, and Etoposide; and mammary cancer with cyclophosphamide, 5-FU, amethopterin (or adriamycin) and Cisplatin. In the therapeutic program, 40mg Cisplatin was administered for 3 consecutive days, properly promoting urination to eliminate dampness, 60mg adriamycin was administered on the first day, and cyclophosphamide was given on the 1st and 8th days.

For the acupoint-injection group, 20 minutes before chemotherapy 30mg metoclopramide and 0.4g vitamin B6 were taken with a 10ml injector and mixed, and then the needle was inserted vertically into Zusanli (ST36) point to a depth of 1.5-2.0cm. When the patient felt distention, numbness, soreness and pain, and no blood was withdrawn, a half of the medical liquid was injected respectively into


the bilateral points, and then the points were pressed for 2-3 minutes.

For the control group, 20 minutes before chemotherapy an intramuscular injection of 8mg Endanxitone was given.

Observed indexes: (1) Grades of response of digestive tract: Grade 0: no nausea and vomiting were found. Grade I: mild nausea and vomiting, 1-2 times each day, did not influence normal life and taking of food. Grade II: obvious nausea and vomiting, 3-4 times each day, influencing normal life. Grade III-IV: severe nausea and vomiting, over 5 times each day, need to rest in bed. (2) Indexes of toxic and adverse effects included headache, dizziness, constipation, restlessness, abdominal discomfort and others. Assessment of therapeutic effects: Complete remission: response of digestive tract was grade 0; Partial remission: grade I; Slight remission: grade II; Ineffective: grade III-IV. Complete remission and partial remission were regarded as effective.

The results indicated that the effective rate for control of response of digestive tract in the acupoint-injection group and the control group was 86.6% and 90.0% respectively, with no significant difference (P>0.05). In the acupoint-injection group, 7 cases had toxic and adverse effects, accounting for 8.5%, and in the control group 21 cases had toxic and adverse effects, accounting for 26.3%, with a statistically significant difference (P<0.05) between the two groups. These results suggest that both the acupoint-injection group and the control group had a similar control rate for response of digestive tract, but that the toxic and adverse effects in the acupoint-injection group were significantly lower than those in the control group.

About the authors: Dongxing Ma, Xubin Bi and Jianmin Guan Zibo Railway Hospital, Shandong Province 255026, Dongqin Ma Shandong Linqu County Yeyuan Central Hospital). Abstracted from CHINESE ACUPUNCTURE & MOXIBUSTION 21(2):75-76, 2001.

Effects of Electroacupuncture on Immunological Function in28 Cases of Chemotherapy

Fang Ye, et al The suppression of both immunity and hematopoiesis induced by chemotherapy is mainly characterized by decreases of T cell subpopulations (CD3, CD4, CD8), activity of natural killer (NK) cells, white blood cell count and humoral immunity. Since 1996, the authors have applied electroacupuncture in the treatment of 28 cases of malignant tumor during the process of chemotherapy with good results as reported in the following.

All the cases were inpatients including 23 males and 5 females. Their ages ranged from 17 to 75 years, averaging 51.8 years.

The duration of illness was between 15 days and 5 years. Of the 28 cases, 9 cases suffered cancer of the lung, 5 cases gastrointestinal cancer, 2 cases mammary cancer, and 12 cases other malignant tumors. All the cases were diagnosed by imaging, cytology and histology.

The points selected were bilateral Zusanli (ST36), Sanyinjiao (SP6) and Neiguan (PC6), and Zhongwan (CV12). The patient was asked to take a supine position. After needling sensation was attained, the needles were connected to a G-6805 electroacupuncture instrument with disperse-


tense wave, at an intensity tolerable to the patient. The treatment was given for 30 minutes, once a day, 5 sessions constituting one therapeutic course with an interval of 2 days between two courses.

T cell subpopulations and activity of NK cells in the patients were measured respectively before electroacupuncture therapy or chemotherapy and after 4 courses of acupuncture treatment. Fasting venous blood was taken from the 28 chemotherapy patients. The collection of all the blood specimens was finished within 2 hours. The monoclonal antibody technique was adopted for measuring T cell subpopulations and the in vitro isotope releasing method was used for determining activity of NK cells.

Results showed that percentages of CD3, CD4, CD8, and CD4/CD8 and NK activity (X+S) in the chemotherapy patients were respectively 52.14+19.00, 24.93+14.51,

26.07+11.82, 1.27+0.79, and 15.51+13.10 before acupuncture treatment and 54.87+20.71, 27.56+14.17, 28.28+11.94, 1.28+0.87, and 17.87+13.57 after acupuncture treatment or chemotherapy with no significant difference (P>0.05), indicating that after acupuncture treatment, immunological function did not decrease in the chemotherapy patients.

Conclusion: electroacupuncture treatment can increase the immunological function in chemotherapy patients, and it is an effective adjuvant therapy for chemotherapy patients.

About the authors: Fang Ye, Qilu Hospital Affiliated to Shandong University, Shandong Province 250012, Shaozong Chen Shandong Province Acupuncture Research Institute, Weiming Liu Qianfoshan Hospital.Abstracted from SHANDONG JOUNAL OF TRADITIONAL CHINESE MEDICINE 20(4): 221-222, 2001.

Treatment of Chemotherapy-Induced Leukopeniawith Acupoint-Injection

Xianzhe Yin, et al

One hundred and four cases of chemotherapy-induced leukopenia were treated with injection of a mixed liquid consisting of dexamethasone, 654-2, ATP, and inosine into bilateral Zusanli (ST36) points. The therapeutic results were satisfactory, as reported in the following.

In this series, all the 127 cases were definitely diagnosed by pathological examination. Of them, 93 were male and 34 female, ranging in age from 12 to 75 years. Thirty-eight cases were carcinoma of the esophagus, 22 cardiac cancer, 21 cancer of the lung, 11 hepatic carcinoma, 8 lymphoma, 8 mammary cancer, 7 carcinoma of the colon, and 12 other kinds of cancer. The patients who had a leukocyte count of

4.0 X 109/L-0.5 X 109/L after chemotherapy were enrolled in the study. They were randomly assigned to the treatment group (104 cases) and the control group (23 cases).

Chemotherapy was suspended when the leukocyte count was below 4.0 X 109/L, and the following treatment was given instead.

In the treatment group, the patient was asked to take a supine or semirecumbent position. After a routine sterilization of the skin on bilateral Zusanli (ST 36), a 5-ml syringer with a No.7 syringe needle filled with the mixed medicine liquid was inserted into Zusanli (ST36) to a depth of 3 cm. A lifting, thrusting and twirling manipulation was


performed until the patient felt local sensation of soreness, numbness, distension or pain. The needles were retained for 5-10 minutes, and then a mixed liquid containing 5mg dexamethasone, 5mg 654-2, 20mg ATP and 0.1mg inosine was injected into each point. The treatment was given once a day.

For the control group, a subcutaneous injection of filgrastim was given in a dose of 75mg, twice daily.

Routine blood examination was performed on the 3rd and 7th days. Criteria for therapeutic effects: Markedly effective: after 3 days of treatment, the leukocyte count was elevated to more than 4.0 X 109/L. Effective: after 7 days of treatment, the leukocyte count was elevated to over 4.0 X 109/L. Ineffective: after 7 days of treatment, the leukocyte count was still below 4.0 X 109/L.

Results indicated that the markedly effective rate was 38.5% in the treatment group and 60.9% in the control group with a significant difference (P<0.05). However, the total effective rate (92.4%) in the treatment group was not significantly different from that (91.3%) of the control group (P>0.05).

Conclusion: The leukogenic effect of filgrastim is faster than that induced by the point-injection, but the effects of the two methods on leukogenesis are basically the same within one week. Considering the high cost and possible side effects of filgrastim, the advantages of acupoint-injection therapy may warrant further study. About the authors: Xianzhe Yin, Deyin Yin, Xinqun, Liu and Xumeng Ding Nanyang Municipal Second People's Hospital, Nanyang City 473012, Henan Province, China.Abstracted from NEW TRADITIONAL CHINESE MEDICINE 32(2): 23-24), 2000.

Clinical Analysis of the Treatment of Chronic Fatigue Syndrome with Acupuncture Combined with Cupping

Weihong Wang, et al

In order to explore the therapeutic methods for dealing with chronic fatigue syndrome, the authors treated 25 cases of this disease with acupuncture combined with cupping, and the Chinese decoction Cai Li Mixture was used as control.

All the cases were out-patients and were randomly divided into the treatment group and the control group depending on the order of visiting.

The treatment group was treated with acupuncture combined with cupping. Of the 25 cases in the treatment group, 18 cases were male and 7 cases were female. The youngest was 19 years old and the oldest was 52. The shortest duration of illness was

8 months and the longest was 5 years. The control group was treated with the Chinese decoction Cai Li Mixture. Of the 25 cases in the control group, 16 cases were male and 9 cases were female. The youngest was 23 years of age and the eldest was 55 years of age. The shortest duration of illness was 7 months and the longest was 3 years.

The Criteria for Chronic Fatigue Syndrome established by the American Center for Disease Control in 1991 were followed. (1) Main symptoms: fatigue continuing for over six months, activity amount is limited and fatigue-induced diseases are excluded. (2) Secondary symptoms: the following symptoms occur simultaneously with or after the fatigue, and continue or occur


repeatedly for over six months: low fever, pharyngodynia, swelling pain of lymphonodi cervicales, flaccidity and weakness of the general muscles, myalgia, fatigue continuing 24 hours after activity, headache, wandering arthralgia, and neuropsychic symptoms such as depression and dyssomnia. (3) Physical signs: body temperature 37.5-38.5 °C, local pharyngitis, and swelling of the neck lymph nodes >1cm. (4) All patients presenting with psychosis and pharmacomania were not enrolled in the study.

For the treatment group, the patient took a prone position, and Dazhui (GV14), Zhiyang (GV 9), Xinshu (BL15), Geshu (BL17), Mingmen (GV4), Shenshu (BL23) and Changqiang (GV1) were routinely disinfected, then acupuncture was given at these points with uniform reinforcing-reducing manipulation and a moderate amount of stimulation, and after the needling sensation was attained the needles were retained for 40 minutes. After the needles were withdrawn, cupping therapy was applied on the Governor Vessel and the first and second lateral lines of the Urinary Bladder Channel of Foot-Taiyang with a big cupping glass having a thick and smooth mouth, with the mouth of the cupping glass and the cupping area smeared thinly with lubricant. The cup was held level or obliquely moved with both hands of the provider grasping the bottom of the cupping glass. After the skin showed red, dark-red or cinnabar dots or patches, and the patient felt a sensation of heat on the back, the treatment was completed. After the end of the cupping therapy, the local skin was cleaned with a sterilized cotton ball, the patient was advised to keep the body warm and not to bathe the day after the treatment. This treatment was given once every six days, 30 days constituting one course, with an interval of 3 days between two courses.

The control group was treated with oral administration of the Chinese medical

decoction Cai Li Mixiture, twice a day, 25ml each time, 30 days constituting one course. The Cai Li Mixture is made by Qingdao Third Pharmaceutical Factory of Haier Group and it consists of Huang Qi (Radix Astragali Seu Hedysari), Ren Shen (Radix Ginseng), Di Huang (Radix Rehmanniae), Shan Zhu Yu (Fructus Corni), Du Zhong (Cortex Eucommiae), Gou Qi Zi (Fructus Lycii), Dang Gui (Radix Angelicae Sinensis), Bie Jia (Carapax Trioncis), Yin Yang Huo (Herba Epimedii), Fu Ling (Poria) and Da Zao (Fructus Ziziphi Jujubae). The mixture has the functions of replenishing essence, invigorating Qi, promoting generation of blood, increasing vitality and invigorating the kidney-Yang.

The criteria for assessment of therapeutic effects: (1) Cured: the symptoms disappeared completely, and the patient resumed normal work and life. (2) Markedly effective: the symptoms disappeared basically, and the patient resumed normal work. (3) Effective: the symptoms obviously improved, but the patient was unable to resume normal work. (4) Ineffective: the symptoms did not improve, and normal work and life still could not be resumed.

Therapeutic results showed that after one month’s treatment, the total effective rate was 92% in the treatment group and 64% in the control group, with a significant difference (P<0.05).

The results of this study indicated that a combination of acupuncture and cupping can have a beneficial therapeutic effect on chronic fatigue syndrome.

About the authors: Weihong Wang, Shijie Wu and Yongjiang Lu Ju County Hospital of Traditional Chinese Medicine, Shandong, China 276500. Abstracted from CHINESE ACUPUNCTURE & MOXIBUSTION 21(8): 481-482, 2001.


EDUCATIONAL SERIES

Introduction to the Fundamentals ofTraditional Chinese Medicine (V)

Ning Ma

The extraordinary organs are a special group of organs in addition to the five Zang and six Fu organs. They are the brain, marrow, bone, vessels, gallbladder and uterus. The name of the extraordinary organs in the Chinese language means unique and eternal. The extraordinary organs are physically like the Fu organs and functionally like the Zang organs. Most of the extraordinary organs are cavity organs, but unlike the Fu organs, they store essence. This is one of the primary differences between the extraordinary organs and the Zang and Fu organs.

The gallbladder is a particularly unique organ in that it is both a Fu and an extraordinary organ. It looks like a pouch and closely relates to the liver, which is its paired organ. Thus, it is one of the six Fu organs. It stores the bile, which is not the excrement of the body. Fu organs traditionally have functions involving bodily excrement, and this is why it also belongs to the extraordinary organs. With the exception of the gallbladder, the extraordinary organs do not have a paired organ. Since "all of the other eleven organs depend on the gallbladder" (translated from the Nei Jing), the synthesizing and coordinating function is another important function of the extraordinary organs.

We have previously introduced the functions of the gallbladder, marrow, bone and vessels in a previous article. This chapter will emphasize the functions of the brain and uterus.

1. Brain

The brain is located inside of the skull. It is composed of the marrow, and hence the brain has the name of " the sea of the marrow". A phrase in the Nei Jing states, "all kinds of the marrow belong to brain". Of all the organs, the brain is one of the most important. As the Nei Jing says: "It will immediately cause death once the needle reaches the brain when you needle the point of Nao Hu (GV17)". The Nei Jing states that "Nao Hu (GV17) is at the edge of the occipital bone and on the Du channel, thus the point has a path to reach the brain. The brain is the sea of the marrow, and contains all essential materials such as essence and yang qi. The true qi will escape once the needle reaches the brain and cause death." (Note that there is some confusion about the location of Nao Hu (GV17). The point of the Nao Hu in the ancient records is actually the point of Feng Fu (GV16) in modern texts.)

The brain is a necessary organ for life, but it is also the most important organ for synthesizing and coordinating all other organ functions. This mainly manifests as two aspects: 1) coordinating the mental and spiritual stages, and 2) synthesizing the cognition processes. In Chinese medicine, the healthy spiritual aspects are Shen of the heart, Hun of the liver, Yi of the spleen, Po of the lung and Zhi of the kidney. Unhealthy emotional states manifest as Xi of the heart, Nu of the liver, Bei of the spleen, Kong of the lung, and Jing of the kidney. The brain is the core organ for conducting the mental and spiritual aspects of these different organs. The Nei Jing states "the brain stores intelligence and spirit". Qingren


Wang, the most famous scholar of the brain in the Qing dynasty, described which organs are actually in charge of the psychological process. He says: "Shen has its body and soul. The body of Shen stores in the heart, but the soul of Shen relies on the brain". "We'd better pay more attention to the Shen in the brain, than Shen in the heart". Therefore, the brain is the chief organ synthesizing all kinds of senses and conducting all of the mental and spiritual states.

"Whenever people see a subject, this subject must have an image inside of their brain" (Ang Wang, 1600AD). Qingren Wang (1700AD) also noted, "intelligence and memory do not belong to the heart, they actually depend on the brain. The ears connect to the brain so that you are able to hear sounds. Eyeballs are linked to the brain for vision by two thin threads. This is why you are able see things. The nose also connects to the brain; therefore, you are able to identify all smells." He also recognized that the brain connects to the spinal cord and has the function of controlling sensation and movement.

Chinese medicine developed in the feudal society during the past 2000 years. Since the heart is the emperor of the body, other organs have no way to play roles above it. The major functions of the human body are distributed among the five organs, such as the lung opening to the nose, the liver opening to eyes, and the kidney opening to the ears. Moreover, body movements and vision, etc. also depend on the blood supply. All treatments follow their organ functions, such as treating the heart to enhance memory, treating the liver to improve vision etc. Unlike Western biomedicine, Chinese medicine did not systematically recognize the brain until the Qing dynasty (1700 AD). Even if scholars anatomically and systematically understood the brain, it was not incorporated into therapeutic theory. However, the brain plays an important role coordinating the functions of organs, and

synthesizing all of the cognitive senses or impressions.

2. Uterus

In traditional Chinese language, the uterus is named "Nu Zi Bao", which means an organ like a specific room in a woman. It is the organ in charge of menstruation and pregnancy. The uterus is located in the lower abdomen, between the bladder and the large intestine, and it connects to the vagina. It is a complicated process to maintain a normal uterine function. The uterus synthesizes and coordinates the functions of "Tian Gui", the Tai Chong and Ren channels, and the organs of heart, liver and kidney to perform all of the female reproductive functions.

Relationship of the uterus with "Tian Gui"

"Tian Gui" is a substance like the female egg, which signifies that the kidney essence is sufficient. The maturity of "Tian Gui" starts with the menarche, and diminishes during menopause. A famous, classical Nei Jing phrase states, "Tian Gui is coming around the age of 14. Once "Tian Gui" becomes mature, the Tai Chong channel starts to circulate the blood, and the Ren channel is able to open to the outside of the body. Therefore, the menstrual periods come regularly, and a woman is able to get pregnant...Tian Gui will be exhausted around the age of 49 so that menstruation will cease. The blood stops circulating in the Tai Chong channel and causes the Ren channel to become empty. At that stage, the woman's face and body will not be as beautiful as before, and she will lose the ability to get pregnant". Therefore, "Tian Gui" determines the development and maturity of female sexual organs, and maintains the function of these organs.

Relationship of the uterus with Tai Chong and Ren channels


The Tai Chong and Ren channels are derived from the uterus. The Tai Chong channel uses the kidney channel to travel up and parallel with the Ren channel. Because of the connection with the Yang Ming channel, the Tai Chong channel has the capacity to regulate blood circulation. Only if the blood is sufficient in the twelve channels, it will spill into the Tai Chong Channel from the Yang Ming channel. Therefore, the Tai Chong channel is also known as "the sea of the blood". The Ren channel meets the three Yin channels of the foot in the lower abdomen, so the Ren channel has the capacity to regulate all of the Yin channels. Thus, the Ren channel is also known as "the sea of the Yin channels". The Ren channel governs the uterus and the fetus. The relationship between the uterus and the Tai Chong and Ren channels is: 1) The Tai Chong and Ren channels are filled with the surplus blood, which is the prerequisite of the menses; and 2) the Ren channel opens and provides an exit for the surplus blood. The functions of the Tai Chong and Ren channels also depend on the role of "Tian Gui" in conducting their proper functioning.

Relationship of the uterus with the heart, liver and spleen

Menstruation is the blood discharged from the Ren channel, and "the blood is the body of the female". Therefore, the normal uterine function relies on the normal functioning of the blood and its related

organs, such as the heart, liver and spleen. Not only menstruation, but also the ability to become pregnant relies on the normal function of the heart, liver and spleen. As stated in the Ji Yin Gang Mu, "the blood comes from the essence of the food and fluids. It fills the Zang and Fu organs and nourishes them. It produces the sperm in men, and the milk and menstrual blood in women". As a result of the uterus' relationship with the Zang organs, disharmony of those organs is often reflected in uterine function. When the heart Shen is disturbed, the menses could become abnormal. When the functions of the liver storing the blood and the spleen controlling the blood are abnormal, excessive vaginal bleeding and irregular periods will happen. When the period is shortened with a small amount of blood flow or amenorrhea, it could be caused by either the spleen not producing enough blood or the liver not storing enough blood. Menstrual disorders are one of the causes of infertility.

Taking into consideration the functions of the organs, channels and "Tian Gui" in relationship to menstruation and pregnancy, one must also consider the physical and mental conditions of the whole body.

About the author: Ning Ma, L.Ac., Department Chair of Clinical Practice, Pacific College of Oriental Medicine, New York, NY 10010


LECTURE

Experience on Treating Mastosis from Professor Bohua Gu

Naiqiang Gu

Dr. Bohua Gu (1916 – 1993), Professor of Shanghai University of Traditional Chinese Medicine, was a famous Traditional Chinese Medicine doctor in China who specialized in surgical trauma. He compiled Practical surgery of Traditional Chinese Medicine and the surgery textbook that is widely used in TCM schools in China. He profoundly influenced Traditional Chinese Medicine in this field. He achieved many accomplishments in treating sores, sepsis, dermatological disorders, acute abdominal syndromes, and breast disorders. He had special insights in differential diagnosis of breast disorders for which he won several awards from the Public Health Department of China. I would like to share his experience in treating mastosis with you.

Mastitis

In TCM, mastitis is called “Ru Yong” – breast abscess. The etiology is external Wind evil, internal Wind evil, and non-external, non-internal Wind evil. The external Wind evil is the most common cause of mastitis. The early stage of mastitis caused by external Wind evil is called “Du Ru” – breast obstruction. When the abscess gets larger, it is called “Ru Fa” –suppurative mastitis, literally meaning “enlarged breast abscess”. The abscess that penetrates from one lobule to another lobule is called “Chuan Nang Ru Yong” meaning “breast abscess transmitted to other compartments”.

Dr. Gu associated good prognosis with early treatment. He found that women who are nursing their first babies have a higher chance of getting mastitis, especially during the first month after delivery. Women who

have flat or inverted nipples have a higher chance of getting breast obstruction.

Differential Treatment of Breast Abscess

Physiology: Qi flows smoothly.Etiology: blockage.Pathogenesis: obstruction.Symptoms: breast distention, swelling, pain, and heat sensation.Treatment principle: unblock the obstruction.Prognosis: relief of pain due to unblocking.

Principle of Using Herbs for Early Stage of MastitisFocusing on dissipating and unblocking the Luo channel.Clearing heat and toxins, but not using too much bitter and cold herbs.Herbs that have functions of expelling toxin from inside to the surface of the body should not be employed too early.Moving Qi and invigorating blood, harmonizing Ying Qi.

Empirical formula: Ru Yong Xiao San Fang –Dissipating Breast Abscess Formula. Chai Hu (Radix Bupleuri) 9g, Su Geng (Radix Perillae Frutescentis) 9g, Jing Jie (Herba seu Flos Schizonepetae Tenuifoliae) 9, Fang Feng (Radix Ledebouriellae Sesloidis) 9g, Lu Jiao Shuang (Cornu Cervi Degelatinatium) 9g, Niu Bang Zi (Fructus Arctii Lappae) 9g, Quan Dang Gui (Radix Angelicae Sinensis) 9g, Chao Chi Shao (Radix Paeoniae Rubra) 9g, Guan Gua Lou (Fructus Trichosanthis) 12g, Pu Gong Ying (Herba Taraxaci Mongolici cum Radice) 12g, Wang Bu Liu Xing Zi (Semen Vaccariae Segetalis) 9g, Si Gua Luo (Fasciculus Vascularis Luffae) 9g, Lu Lu


Tong (Fructus Liquidambaris Taiwanianae) 9g, Qing Pi (Pericarpium Citri Reticulatae Viride) 6g, Chen Pi (Pericarpium Citri Reticulatae) 6g.

Dr. Gu thought that Lu Jiao Shuang (Cornus Cervi Degelatinatium) preserved the property of Lu Jiao in its warmly dissipating and reducing swelling but is not as warm as Lu Jiao, so it will not aggravate the heat syndromes. Therefore, no matter how you modify this formula, you should keep Lu Jiao Shuang.

Breast abscesses very often start with broken nipples. The treatment of “Ru tong feng” can prevent the progression of the disease. Dr. Gu had an empirical formula based on the traditional formula “Sheng Ji San” – Generating Flesh Formula.Lu Gan Shi (Smithsonitum) 9g, Di Ru Shi (Stalactitum) 9g, Hu Po (Succinum) 9g, Hua Shi (Talcum) 30g, Zhu Sha (Cinnabaris) 3g, Bing Pian (Borneol) 0.3g. Grind the above herbs into a very fine powder. Mix with hot lard or raw egg yolk and apply topically.

For sub-acute breast lumps due to mastitis, add invigorating blood and breaking blood stasis herbs to the internally used formula to soften the hardness and dissipate the lumps. External treatment is superficial needling plus application of Da Huang (Rhizoma Rhei) powder topically to dissipate lumps.

Proliferation of the Mammary Gland

Proliferation of the mammary gland makes up 75% of all mastosis. The main symptoms are breast lumps and pain. The symptoms fluctuate with the menstrual cycle.

Proliferation of the mammary gland belongs to the category of “Ru Pi” in the traditional Chinese classics. Dr. Gu thought that the etiology is congealing of phlegm due to Liver-Qi stagnation, internal emotional

trauma, Liver-Kidney deficiency, and Chong-Ren disharmony.

Dr. Gu differentiated proliferation of the mammary gland into three patterns: Liver-Qi stagnation, Chong-Ren disharmony, and phlegm accumulation. Treatment principles and formulas vary according to the characteristics of clinical signs and symptoms.

Liver-Qi Stagnation

Major symptoms are breast distention and lumps accompanied by chest oppression, distention of hypochondria and low abdomen, dysmenorrhea, possible infertility.Main Formula: Chai Hu (Radix Bupleuri) 9g, Dang Gui (Radix Angelicae Sinensis) 9g, Chi Shao (Radix Paeoniae Rubra) 9g, Bai Shao (Radix Paeoniae Lactiflorae) 9g, Charred Bai Zhu (Rhizoma Atractylodis Marcrocephalae) 9g, Ba Yue Zha (Fructus Akebia Quinata)12g, Chuan Lian Zi (Fructus Meliae Toosendan) 9g, Qing Pi (Pericarpium Citri Reticulatae Viride) 5g, Chen Pi (Pericarpium Citri Reticulatae) 5g, Fu Ling (Sclerotium Poriae Cocos) 12g, Zhi Xiang Fu (Rhizoma Cyperi Rotundi)9g, Yi Mu Cao (Herba Leonuri Heterophylli) 12g, Lu Jiao Powder (Cornus Cervi Degelatinatium) 3 (do not cook, mix with decoction)

Chong –Ren Disharmony

Major Symptoms are breast distention and lumps, often accompanied by irregular menstrual cycle, abdominal pain during ovulation, low back pain and ear ringing.Main Formula:Xian Mao (Rhizoma Curculiginis Orchioidis) 9g, Xian Ling Pi (Herba Epimedii) 9g, Tu Si Zi (Semen Cuscutae) 12g, Rou Cong Rong (Herba Cistanches) 9g, Quan Dang Gui (Radix Angelicae Sinensis) 9g, Charred Bai Zhu (Rhizoma Atractylodis Marcrocephalae) 12g, Chao Bai Shao (Radix Paeoniae Lactiflorae) 9g, Zhi Xiang Fu (Rhizoma Cyperi Rotundi)9g, Guang Yu Jin (Tuber Curcumae) 9g, Shu Di (Radix


Rehmanniae Glutinosae Conquitae) 12g, Lu Jiao Pian (Cornus Cervi Degelatinatium) 9g (cook first).

Phlegm Accumulation

Major symptoms: breast distention and lumps with mild pain not closely related to menstrual cycle. There is no general deficiency syndrome. Pathogenesis is mainly fibroadenoma of mammary gland or fibroid tumor of mammary gland.Main Formula:Chai Hu (Radix Bupleuri) 9g, Dang Gui (Radix Angelicae Sinensis) 9g, Chi Shao (Radix Paeoniae Rubra) 9g, Bai Shao (Radix Paeoniae Lactiflorae) 9g, Charred Bai Zhu (Rhizoma Atractylodis Marcrocephalae) 9g, Tao Ren (Semen Persicae) 9g, Yi Mu Cao (Herba Leonuri Heterophylli) 12g, San Leng (Rhizoma Sparganii) 9g, E Zhu (Rhizoma Curcumae Zedoariae) 9g, Tu Fu Ling (Rhizoma Smilacis Glabrae) 30g, Hai Zhao (Herba Sargassii) 12g, Sheng Mu Li (Concha Ostrae) 30g (cook first), Sheng Gan Cao (Radix Glycyrrhizae Uralensis) 3g.

Besides the above three patterns, some diseases of proliferation of the mammary gland, especially cystic proliferation of the mammary gland, belong to patters such as Liver-Qi constraint transforming into fire, Liver-Yin deficiency, Wood-fire overacting, heat in the blood.

Main Formula: Sheng Di (Radix Rehmanniae Glutinosae) 12g, Chi Shao (Radix Paeoniae Rubra) 12, Dan Pi (Cortex Moutan Radicis) 9g, Han Lian Cao (Herba Ecliptae Prostratae) 12g, Bai Hua She She Cao (Herba Oldenlandiae Diffusae) 30g, Jin Yin Hua (Flos Lonicerae Japonicae) 12g, Lu Han Cao 15, Zhi Bie Jia (Carapax Amydae Sinensis) 15g, Zhi Mu (Radix Anemarrhenae Asphodeloidis) 12g, Huang Qin (Radix Scutellariae Baicalensis) 9g, Ban Zhi Lian (Herba Scutellaria Barbata) 15g, Sheng Gan Cao (Radix Glycyrrhizae Uralensis) 5g.

Breast Cancer

Breast Cancer was called “Ru Shi Yong” –breast stony abscess, “Ru Yan” – breast rock, and “Shi Liu Fan Hua Fa” – ripe pomegranate, etc. The etiology is Righteous-Qi deficiency, Qi and blood deficiency, emotional trauma, worry, pensiveness, bottled up emotions and anger, Liver and Kidney deficiency, Chong-Ren disharmony, toxic evil accumulation and/or phlegm accumulation.

Dr. Gu thought that the most common causes of breast cancer are: Liver-Qi stagnation injuring the Liver, and worry and pensiveness injuring the Spleen. Qi cannot flow smoothly in channels and collaterals, therefore clumps accumulate. Overall, invisible Qi and visible phlegm interact and form clumps.

Dr. Gu made two formulas, one focusing on expelling evil while strengthening Righteous Qi, and one focusing on strengthening Righteous Qi while expelling evil.

Expelling Evil to Treat Breast Cancer Formula: Bai Hua She She Cao (Herba Oldenlandiae Diffusae), Lu Han Cao, Feng Wei Cao (Herba Pteris Multifida), Lu Feng Fang (Nidus Vespae), Cao He Che (Radix Paris Polyphylla), She Liu Gu (Radix Amorphophallus Rivieri), Pu Gong Ying (Herba Taraxaci Mongolici cum Radice), Ban Zhi Lian (Herba Scutellaria Barbata), Shan Ci Gu (Bulbus Shancigu), Xia Ku Cao (Spica Prunellae Vulgaris), Tu Bei Mu (Radix Bolbostemma Paniculatum), Tu Fu Ling (Rhizoma Smilacis Glabrae)

Strengthening Righteous Qi to Treat Breast Cancer Formula:Huang Qi (Radix Astragali), Dang Shen (Radix Codonopsis Pilosulae), Sheng Di Huang (Radix Rehmanniae Glutinosae), Huang Jing (Rhizoma Polygonati), Mai Dong (Tuber Ophiopogonis Japonici), Huai Shan Yao (Radix Discoreae Oppositae), Fu Ling (Sclerotium Poriae Cocos), Gu Ya


(Fructus Oryzae Sativae Germinantus), Tian Hua Fen (Radix Trichosanthis), Shou Wu (Radix Polygoni Multiflori), Bai Zhu (Rhizoma Atractylodis Marcrocephalae), Gou Qi Zi (Fructus Lycii Chinensis).

Modern research has found that herbs that strengthen Righteous Qi have the functions of protecting bone marrow, increasing blood count, increasing cell immunity, stimulating phagocytosis in the reticuloendothelial system, balancing the hormones, and inhibiting the growth of cancer cells.

Dr. Gu paid special attention to the Spleen/Stomach when treating breast cancer, which means protecting the Spleen/Stomach by not using too strong herbs to clear heat, invigorating the blood and clearing toxicity because the Spleen/Stomach is the origin of

postnatal Qi. He put emphasis on strengthening Qi, protecting the Spleen/Stomach, not over-attacking, treating the root and the manifestation at the same time, treating the body and the mind at the same time. He is unique among his peers in his differentiation and treatment of breast cancer.

About the Author: Dr. Naiqiang Gu, Former Chairman of TCM External Disease Committee of China Association of Traditional Chinese Medicine and current Instructor of Emperor’s College of Traditional Oriental Medicine. Please correspond to 1807B, Wilshire Blvd., Santa Monica, CA 90403


LECTURE

The Treatment of Coronary Heart Disease (CHD)with Chinese Medicine

Qunhao Zhang

Coronary Heart Disease (CHD) is a major health problem in the United States of America and other industrial countries. It is the number one cause of death in the United States. An estimated 14 million Americans have the disease (about 5 out of every 100 Americans). The Chinese are not immune from this disease, either.

CHD is caused by the development of atherosclerosis in the coronary arteries, leading to segmental stenosis or blocking, hence causing myocardial ischemia. The predominant symptom of this disease is chest pain characterized as radiating to the back accompanied by a sensation of chest fullness. It happens most often in the aging population. The risk factors associated with CHD include cigarette smoking, hypertension, family history, diabetes, obesity, inactivity and high cholesterol, etc. The major treatments include lowering the cholesterol, treating high blood pressure, controlling diabetes, smoking cessation, improving blood circulation, coronary artery bypass surgery, and percutaneous transluminal angioplasty, etc.

The treatment effect of CHD by the above-mentioned modern medical methods is not always satisfactory. Treatment with integrated Modern and Chinese Medicine always gets significant results.

CHD is categorized as “Chest-Bi syndrome”, “Jue Xin pain”, or “Zhen Xin pain (True Heart Pain)” in traditional Chinese medicine (TCM). The well-known

Neijing, a classical TCM book dating to about 2500 years ago, records that “Jue Xin

pain is caused by coldness enveloping the heart”. Prescriptions Worth Thousand Gold for Emergencies (Xianjin Yaofang) also indicate that “coldness involving Five viscera and Six hollow organs results suddenly in Chest-Bi Syndrome”.

From the view of TCM, the basic pathology of Chest-Bi Syndrome is deficiency inside and excess outside. The disease is caused by the deficiency of Chest-Yang, retention of phlegm and fluids, blood stasis in the chest, and disharmony of Qi movement in the chest. The internal causes of the disease are deficiency of heart, liver, spleen and kidney. The external causes include the Seven Emotions, overstrain and coldness. The deficiency of Zang organs is the deficiency of Ben Syndrome (Primary), and stagnation of Qi and blood stasis, accumulation of phlegm and fluid are the Biao Syndrome (Secondary). Clinically, the disease is divided into the following four types:

1.Stagnation of Qi and Blood Stasis

Symptoms: pericardial area pain with fullness in the chest, chest heaviness and shortness of breath, dark tongue with ecchymotic spots, and wiry pulse.

Therapeutic Principles: Invigorating blood circulation and eliminating blood stasis, promoting the flow of Qi to clear the collaterals.Prescription: Modified Xuefu Zhuyu Decoction and Shixiaosan.


Composition: Dang Gui (Radix Angelicae Sinensis), Di Huang (Radix Rehmanniae), Chi Shao (Radix Paeoniae Rubra), Cai Hu (Radix Bupleuri), Jie Geng (Radix Platycodi), Zhi Qiao (Fructus Aurantii), Tao Ren (Semen Persicae), Hong Hua (Flos Carthami), Chuang Xiong (Rhizoma Lingustici Chuanxiong), Pu Huang (Pollen Typhae).

2.Deficiency of Yin and Hyperactivity of Yang

Symptoms: Most of this type belongs to CHD accompanied by hypertension. It is characterized by headache, dizziness, insomnia, bitter mouth, red and dark tongue, and wiry pulse.

Therapeutic Principles: Nourishing Yin and suppressing hyperactivity of Yang, removing blood stasis and clearing collaterals.Prescription: Modified Tianma Gouteng Yin and Gualou Xiebai Banxia Decoction.Composition: Tian Ma (Rhizoma Gastrodiae), Gou Teng (Ramulus Uncariae cum Uncis), Di Long (Lumbricus), Du Zhong (Cortex Eucommiae), Dan Shen (Radix Salviae Miltiorrhizae), Di Huang (Radix Rehmanniae), Long Gu (Os Draconis Fossilia), Mu Li (Concha Ostrea), Gua Lou (Fructus Trichosanthis), Xie Bai (Bulbus Allii Macrostemi).

3.Deficiency of both Heart and Kidney Yang

Symptoms: This type of Chest-Bi syndrome is characterized by severe pericardial area or chest pain, radiating to the shoulder or arm and accompanied by cold, damp perspiration, shortness of breath, cold limbs, pale tongue with white fur, and weak pulse.

Therapeutic Principle:Recuperating depleted Yang to rescue the patient from collapse, warming up and clearing the channels.Prescription: Modified Baoyuan Decoction and Sini Decoction (Decoction for Resuscitation).

Composition: Fu Zhi (Radix Aconiti Lateralis Praeparata), Pao Jiang (Rhizoma Zingiberis), Gui Zhi (Cortex Cinnamomi), Gan Cao (Radix Glycyrrhizae), Hunag Qi (Radix Astragali Seu Hedysari), Ren Shen (Radix Ginseng), Bai Zhu (Rhizoma Atractylodis Macrocephalae).

4.Accumulation of Phlegm and Fluids

Symptoms: fullness and pain in the chest and epigastrium accompanied by poor appetite, anorexia, nausea and vomiting, swollen tongue with white greasy fur, and slippery pulse.

Therapeutic Principle: Drying dampness and removing fluids, relieving the obstruction of Yang to disperse accumulation of pathogens.Prescription: Lingui Shugang Decoction and Gualou Xiebai Banxia Decoction.Composition: Qi Pi (Pericarpium Citri Reticulatae), Mu Xiang (Radix Aucklandiae), Zhi Shi (Frutus Aurantii Immaturus), Ban Xia (Rhizoma Pinelliae), Bei Xie (Rhizoma Dioscireae), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Gui Zhi (Ramulus Cinnamon), Gua Lou (Fructus Trichosanthis), Xie Bai (Bulbus Allii Macrostemi).

As a chronic disease, CHD needs a long period of treatment. Chinese patent medicines are widely popular because they are convenient to take. There are 30-40 kinds of Chinese patent medicines for CHD. Some of the most commonly used and effective are: Di Ao in Cue Kang, Fu Fang Dan Shen Pian, Dan Shen Di Wan, Guano Mai Chung Jib, An In Kang, Guess Guano Tong, Cue Fu Zhu You Kou Fu Yea, Jib In Dan, Shane Ah Dan, Shane Sao Jag Hz Jing, Yu Jian Cao You, Tian Bao Ning, Jing Xin Bao Deng.

About the Author: Dr. Qunhao Zhang M.D., Ph.D., Licensed Acupuncturist, is now working in Massachusetts General Hospital and Harvard Medical School. He is also a former attending physician in Xiyuan


Hospital, China Academy of TCM in Beijing. Contact e-mail: [email protected]

FORUM

Considerations for the Effective Teaching of TCM in the United States

Hui Li

Chinese teachers of TCM in the U.S. are faced with certain challenges. The U.S. and China have different educational systems, different cultural environments, and different kinds of students who are being trained as TCM practitioners. Because of these differences, the effective methods of teaching in China may not be effective in the U.S. The following considerations may be helpful to Chinese teachers trying to adapt to the U.S. teaching environment.

1. Teaching in the U.S. is not the same as teaching in China.

In China the basic class structure involves the teacher as provider of information and the student as receiver of information. Students take notes on the teacher’s lecture and rarely ask questions during the class. Students are force-fed like ducks and are expected to absorb information like sponges. TCM schools are often especially conservative in their teaching techniques. In the U.S., teaching is more interactive. Students frequently ask questions. Classroom activities are often student-oriented, such as structured discussion groups, rather than teacher-centered. Teachers are expected to supplement the textbook material, rather than just present the same material as in the book. Reading from books or from handouts can put American students to sleep. Students expect the teacher to make the class interesting and to encourage student participation. Teachers must also be sensitive to different student

backgrounds, levels, and learning processes, and should individualize their teaching as much as possible to the needs of each individual student. In order to be effective teachers in the U.S., Chinese teachers need to adapt to the U.S. educational system and to student expectations.

2. Most TCM students in the U.S. are adult students.

In China, most students in TCM schools have just recently graduated from high school and teaching techniques utilized are often more suitable for this age student. In the U.S., TCM students are often older than the teacher and may already have advanced degrees, a family, and a successful career. Such students require different kinds of teaching techniques and attitudes on the part of the teacher as compared to those suitable for undergraduate students. These students are independent and can think for themselves, and expect to be treated as such. Since they often have families and outside jobs, their time is very valuable to them; they are not patient with teachers who just repeat what is in the book or who assign meaningless exercises. They are making sacrifices of time and money to be able to attend TCM school and expect that their teachers will give them good value for what they are paying.

3. Teaching TCM means teaching practical skills.


Students learn best by doing and by receiving feedback from teachers. A little theory goes a long way; students need to practice what they learn in order to perfect their learning. Studies by Edgar Dale have shown that students retain 90% of what is taught if they actually get to have hands-on experience; on the other hand, they only retain 20% of what they hear in a didactic lecture. Chinese teachers are often hired because of their wealth of practical experience, not because of their excellence as lecturers. For this reason, it is important that we emphasize the practical aspect of TCM and minimize the theory when teaching our students.

4. In order to be effective, teachers must be able to control their class.

As stated above, students in American TCM schools tend to be more independent than those in China. This is usually a positive quality, but it can have negative aspects as well. One of these is that certain assertive students can easily “take over” the class if not controlled by the teacher. Such students persist in asking questions and taking up class time, carry on conversations with other students while the teacher is trying to lecture, or otherwise assert their individuality and will on the class at the expense of other students. Effective teachers must learn how to subdue such students while at the same time encouraging shyer or less assertive students to contribute their opinions. If the teacher is to be successful in using more student-centered teaching techniques, he or she must learn how to create a balance in the class and how to keep such techniques from getting out of control.

5. TCM was developed in ancient times, but it should not be regarded as a relic of antiquity that remains frozen in time and never develops

TCM is a kind of natural science, not an antique. TCM originally tracks back more than 2000 years and at that time climate,

geography, environment, diet and lifestyle were very different from nowadays. Because of this, some of TCM theory and some of the practical advice concerning treatments for various diseases may not be suitable to modern society, especially modern Western society. Nowadays, it may be hard to see some of the TCM patterns that were prevalent in ancient China. At the same time, we may not find a TCM explanation and treatment from classic literature resources for some of the modern diseases. In fact, recent surveys have shown that over 50% of all diseases observed in modern hospitals are not described in the ancient texts. Teachers of TCM should not slavishly follow the ancient texts, but should adapt them to the modern environment that their students will be facing when they graduate. If teachers can introduce modern TCM research and new developments in the field, it will help to convince students that Chinese medicine is a living science and not just a relic from the past.

6. Language skills can always be improved

Needless to say, it is a difficult task to teach using a second language. American students are usually willing to make an effort to understand what the teacher is trying to communicate, but sometimes students can get frustrated if the teacher’s spoken English blocks communication. TCM in itself is difficult to teach, even when there is no language difference between teacher and students; when the languages are different, the task becomes that much harder and the teacher must make a greater attempt to make sure his or her language is being understood. This is especially true for first-term students, who are not yet used to either the concepts of TCM or to the accents of Chinese teachers. Teachers need to be aware of possible problems in their spoken English—pronunciation, grammar, or vocabulary—that can interfere with student understanding. If they identify such problems, they can then take steps to correct them through further practice or study.


In order to become more effective teachers in the U.S. environment, Chinese teachers of TCM can become more aware of the educational methodology used in the U.S., more responsive to the expectations of adult learners, and more fluent in their language usage. By teaching students how to apply the principles of TCM in the modern American medical environment, they can make a significant contribution to education.

About the author: Hui Li, L.Ac., Senior faculty of Pacific College of Oriental Medicine ( New York campus). Address correspondence to: 915 Broadway, 3rd FL, New York, NY 10010.


FORUM

The Medical Interview as a Psychotherapeutic Process in Chinese Medicine

William J. Kaplanidis

Chinese medicine is an evolving system of science and art that is both complex and diverse. Practiced all over the world, its theories and methods continue to be integrated into various cultures and healthcare systems.

In the United States, particularly in larger cities, Chinese medicine has become more accepted by healthcare professionals and the public. Practitioners of Chinese medicine may be trained in acupuncture, herbal medicine, tuina, qigong, taijiquan and/or other healing practices. Each practitioner may have various methods of reaching a diagnosis and treatment plan. For example, practitioners from China, who are trained in both eastern and western medicine, may emphasize medical concepts during treatments. Practitioners trained as acupuncturists in the U.S. may combine other modalities into their practice such as massage therapy, homeopathy, hypnosis or other complementary methods.

Despite training and experience, there is a therapeutic relationship between practitioner and patient that facilitates healing. In the United States, research has shown that patients place a high priority on how they are treated by their healthcare provider and that many patients are dissatisfied with their relationships with “orthodox” medical practitioners (Mitchell and Cormack, 1999). As with most relationships, communication is the key. Because Chinese medicine is wholistic and primarily deals with energy,

communication can take many forms. It is understood that body, mind and spirit work together and are affected simultaneously. However, the focus of the treatment depends on the intention and awareness of both the practitioner and patient. For example, the Chinese physician may use the four examinations (looking, listening and smelling, asking and touching) to reach a pattern diagnosis such as Liver invading the Stomach and choose appropriate points and herbs for treatment. Although this may be seen as a physiologic or body approach to diagnosis and treatment, there may be associated emotional and spiritual factors. A qi gong healer may diagnose and treat the same patient using Fa Qi or energy transmission and not necessarily use the four examinations.

Chinese medicine offers its practitioners an unlimited source of nonverbal and verbal communication for diagnosis and treatment. This unlimited source can sometimes present problems for practitioners to define their roles with their patients. This can be especially challenging in a multicultural society like the United States. For instance, in addition to providing an acupuncture treatment for a particular organ disharmony, the physician may counsel the patient on matters such as lifestyle or diet. There are many factors involved with physician-patient communication. The medical interview, from the initial intake throughout the course of treatment can be an important therapeutic tool between physician and


patient. Medical interviewing is a basic clinical skill that is essential for all healthcare providers including western and eastern physicians. It was not until 25 years ago that medical schools in the United States began including interviewing skills in their curricula (Coulehan and Block, 2001). Interviewing may be considered the most basic process used for gathering information, problem solving, as well as providing advice, while counseling is a more intensive and personal process (Ivey and Ivey, 1999).

The interview can be utilized as a trust-building tool, diagnostic tool, relationship-building tool and a therapeutic tool (Coulehan and Block, 2001). In addition, the interview gives the practitioner the opportunity to educate patients about Chinese medicine. During the interview the practitioner may explain some of the concepts of Chinese medicine, like qi, organ function, tongue diagnosis, etc. and educate the patient on some of the pathologies that can be effectively treated with Chinese medicine. The unique nature and type of questions asked by the Chinese physician alone will make the patient more aware of what signs and symptoms to observe for follow-up visits. The field of psychology and its theoretical models for counseling can provide the structure and skills necessary to facilitate the therapeutic process. From the initial contact with the patient--whether on the phone, via e-mail, or in person--impressions are made that influence the relationship between physician and patient. The initial stage of the interview usually consists of establishing rapport with the patient in an easy, natural style (Ivey and Ivey, 1999). The person-centered approach, developed by Carl Rogers’ in the 1940’s, believes that people are essentially trustworthy and will develop in a positive and constructive manner if a climate of respect and trust is established. Carl Rogers and his followers identified three therapist attributes or therapeutic core qualities that were important in creating this climate – 1) genuiness or realness 2) acceptance or

caring (unconditional positive regard) and 3)empathy or deep understanding (Coulehan and Block, 2001; Corey, 1986). These qualities can help build trust and rapport with one’s patient and improve one’s information gathering ability. Of course this will lead to a more accurate diagnosis and in turn a better treatment plan.

Part of gathering information from the patient is the Inquiry or Wen-Zhen portion of the Four Examinations in Chinese Medicine. The practitioner must skillfully balance the use of questions and listening to effectively assess the patient. The specific skills of asking questions and listening from a counseling perspective are beyond the scope of this article. However, Coulehan and Block (2001) outline the process and techniques of a basic medical interview. For example, in regards to asking questions, they suggest starting with open-ended questions, then moving to closed questions and menus; asking questions from general to specific and moving from less intimate to more intimate subjects. Practitioners must be aware of how and why questions are asked.

Perhaps the most important tool for the interview process is listening. Ivey and Ivey (1999) believe that listening and attending behavior (culturally and individually appropriate eye contact, vocal tone and speech rate, verbal tracking – keeping to the topic initiated by the patient or consciously changing it, attentive body language) are the foundations of interviewing and counseling. The practitioner must be present, nonjudgmental, and listen to what and how things are said as well as to what is not being said, i.e. what lies beneath the surface (Benjamin, 1981; Coulehan and Block 2001). Physician and author Oliver Sacks states: There is only one cardinal rule: one must always listen to the patient and, by the same token, the cardinal sin is not listening, ignoring. Prior to any and all specific approaches, there must be this general approach, the establishment of a relation, a communication with the patient, so the


patient and physician understand each other. A relationship, moreover, in which the patient is not entirely passive and compliant, believing and doing what he is told, and taking what is “ordered”; a relationship which is, essentially, collaborative. (Sacks, 1992, p. 252).

Patients often complain in anger and frustration that their doctor did not listen to them (Coulehan and Block, 2001). Listening is a skill that can benefit all healthcare providers and their patients. International Interviewing and Counseling (Ivey and Ivey 1999) is an excellent resource for a detailed look at the microskills involved with listening and the interview process. Ekman (1964) acknowledges that “we hear with our ears, but we listen with our eyes and mind and heart and skin and guts as well.” (Benjamin, 1981, p. 46). This is especially relevant to the Chinese medicine practitioner, who listens not only to words but to the energy of the body, mind and spirit.

As mentioned earlier, the training, intention awareness and experience of the practitioner will influence the approach to treatment. In Lonny S. Jarrett’s Nourishing Destiny (1998), he examines the inner tradition of Chinese medicine, which places an emphasis on the psychospiritual basis of illness and the use of Chinese medicine as a tool to aid spiritual evolution. Kaptchuk (2000) in The Web That Has No Weaver discusses the Penetrating Divine Illumination in which the soul meets soul and Spirit reflects Spirit. He states that “the immediate responses of the physician in the clinical encounter-- the words, posture, gesture, questions, attention, intention, genuiness, empathy, compassion, belief, and vision – deeply affect and resonate with the Spirit of another human being” (Kaptchuk, 2000, p. 290).

I believe that the theories and techniques of psychology and counseling can help

illuminate and further the practice of both the beginner and experienced practitioner. It can do this by providing an accessible and useful framework to help integrate the psychospiritual aspects of Chinese medicine with its current practice in the United States.

References

1. Benjamin, A. (1981). The Helping Interview (3rd ed.). Boston: Houghton Mifflin Company.2. Corey, G. (1986). Theory and Practice of Counseling and Psychotherapy (3rd ed.). Monterey: Brooks/Cole Publishing Company.3. Coulehan, J.L. & Block, M.R. (2001). The Medical Interview: Mastering Skills for Clinical Practice (4th ed.). Philadelphia: F.A. Davis Company.4. Ivey, A. & Ivey, M. (1999). Intentional Interviewing and Counseling; Facilitating Client Development in a Multicultural Society. (4th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.5. Jarrett, L. (1998). Nourishing Destiny: The Inner Tradition of Chinese Medicine. Stockbridge, MA: Spirit Path Press.6. Kaptchuk, T. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. Chicago: Contemporary Books.7. Mitchell, A. & Cormack, M. (1999). The Therapeutic Relationship in Complementary Health Care. London: Churchill Livingstone.8. Sacks, O. (1992). Migraine. New York: Picador.

About the author: William J. Kaplanidis, L.Ac., MSTOM, MA is department chair of Allied Arts at Pacific College of Oriental Medicine. Please correspond to William J. Kaplanidis at 915 Broadway, 3rd Floor, Pacific College of Oriental Medicine, New York, NY 10010.


FORUM

Pulse Diagnosis and Latent Heat

William R. Morris

Cause of disease

Just as a fish in water, man lives surrounded by influences. If the water is turbid, the fish wastes away. If the influences are irregular, man falls ill. The most severe influence is that of evil which is taken by the transport channels to the Zang Fu. Jing and Shen are present in the body from the very beginning; they are the foundation of the constitution. The penetration into the interior by evil

moves through the primary vessels and eventually the divergents causing confusion to the Jing-Shen.

The pulse in Latent Heat

Pulse patterns include a rapid arrival or departure in the wave form while the rate remains fairly normal--this may be described as a pounding sensation. Or, there may be a suspicious slippery quality in the arrival.

There may be a tense surface with a slippery turbulence in the Blood depth and clear signs of heat in the Blood (the pulse gets wider as you lift from the Organ depth towards the Qi depth).

Most important: signs of latent heat are those subtle heat signs existing inside a larger picture of normalcy. This is pointing

to the potential of compensation or encapsulation. According to Yang Tiande, latent heat is identified as a pulse of excess nature in the deeper section; the confined pulse fits this picture. Maciocia describes the pulse as fine and rapid this would be true after a substantial damage to the Yin through the attempt to contain Latent Heat over a period of time.


A ropy pulse is due to heat in the blood stream as a result of focal infections such as gum infection or chronic appendicitis.

Qing Hao Bie Jia Tang leads surface-dispersing medicinals to the Kidneys to disperse deep-lying latent Qi pathogens from thermic disease hidden in the Yin aspect. This classic formula is used for the treatment of latent heat that has continued until Yin has been damaged to a relatively remarkable degree. The Qing Dynasty physician Liu Bao-yi used the treatment principle disperse Hidden Evils by nourishing the Zheng Qi (correct or righteous Qi) emphasizing the Kidneys. This concept is expressed in the Formula Qing Hao Bie Jia Tang; the Artemesia (Qing Hao) disperses Heat from the interior out to the surface, and the Bie Jia nourishes Yin and relieves binding of Blood.

Liu also combined Herba Menthae (Bo He) and Radix Rehmanniae Glutinosae (Sheng Di) with the Semen Soja Preparatum (Dou Chi) to nourish the Yin and promote the expulsion of pathogens. Radix Rehmanniae Glutinosae (Sheng Di) has several actions--it relieves Heat in the Nutritive (Ying) level, strongly nourishes the yin, and leads cooling and Heat dispelling herbs to the Kidneys. Mentha (Bo He) disperses Wind Heat. Liu Bao-yi's primary prescription for expelling latent pathogens is Huang Qin Tang, which includes Huang Qin, along with Bai Shao, Radix Glycyrrhizae uralensis (Gan Cao), and Fructus Zizyphi Jujube (Da Zao).

About the Author: William R. Morris, L.Ac., OMD, Dean of Clinical Education, Emperor’s College of Traditional Oriental Medicine, Address correspondence to 1807 B Wilshire Blvd., Santa Monica, CA 90403, or E-mail to [email protected]


TCMA NEWS

The New York 21st Century Chinese Medicine Forum

Dinglun Peng

The New York 21st Century Chinese Medicine Forum was held in New York at The Sheraton Hotel from 11 to 12 August 2001. “Chinese Medicine Meets Modern Science” was the topic of the Forum.

The Forum attracted more than four hundred scholars and specialists to the meeting from China, Canada, Japan, Korea, Hong Kong, Philippines, Singapore, Taiwan, UK, and the United States.

The State Administration for Traditional Chinese Medicine of the People's Republic of China, Shanghai University of Traditional Chinese Medicine, the Shandong University of Traditional Chinese Medicine and the Hubei College of Traditional Chinese Medicine participated in the forum by sending top level delegations.

Many congratulatory letters came to the forum including ones from Dr. She Jing (Deputy Minister of the Ministry of Health & Director of the State Administration of Traditional Chinese Medicine of the People's Republic of China), Hillary Rodham Clinton (United States Senator from New York State), George E. Pataki (Governor of New York State), Sheldon Silver (Speaker of the New York State Assembly), Rudolph W. Giuliani (Mayor of the City of New York), and the Presidents of the Boroughs of Queens, Manhattan, and Bronx.

Ronnie Hausheer (Executive Secretary, New York State Board for Acupuncture), Dr. Tian Xiaoming (Member of the White House Commission on Complementary &

Alternative Medicine), and Dr. Chen Shaw (Associate Director of ODE-V and CDER, FDA) joined our meeting and delivered important speeches during the Forum.

It is well known that modern medicine and Chinese medicine have developed in different periods and are based on different cultural background. Both use various principles--Chinese medicine emphasizes the rebuilding of physical balance and strong physical resistance in order to fight diseases, whereas modern medicine treats the disease directly by removing the cause for the disease or through palliative measures. Moreover, the weapons are divergent. Chinese medicine uses natural herbs or acupuncture, while modern medicine uses chemical compounds and physical procedures including surgery. However, they both treat disease and maintain the health of patients in the west and in the east.

The organizer of the Forum strongly believes that Chinese medicine can benefit modern medicine by helping to maintain the health care of human beings in as yet unimagined ways and thereby revolutionize modern medicine. Also, modern science can discover the secrets of Chinese medicine, including acupuncture, thereby aiding to develop ever further Chinese medicine.

The Forum focused on three key parts:

1. Using modern science to apply Chinese medicine therapy to medical research and practice.


2. Using modern science to discover Chinese herbal medicine and create more effective, safe and complete medicine.3. Using modern science to discover the many applications of acupuncture so as to revolutionize modern medicine

The Forum organizer of the Traditional Chinese Medicine Alumni Association invited 24 speakers who came from China, Canada, UK, Korea, Japan, Singapore, Hong Kong, Taiwan, Philippines and the United States. Among the speakers were world-renowned leaders in Chinese medicine and acupuncture research and practice.

There were many valuable lectures, which were strongly responded to by the audience and which invoked an interesting discussion after the speeches.

Dr. Cao Xiao-Ding (WHO expert advisory member on traditional medicine) gave a lecture entitled “Mechanisms of Neuroimmunologic Regulation by Acupuncture” as one successful example.

Dr. Lu Ai-Ping is the director of the Institute of Basic Theory, China Academy of Traditional Chinese Medicine. His lecture about “Traditional Chinese Medicine

Treatment for Rheumatoid Arthritis” was interesting to many participators due to the prevalence of this affliction throughout the world. The Academician of the Chinese Academy of Sciences, Honorary President of the China Academy of Traditional Chinese Medicine Dr. Wang Yong-Yan's research about Alzheimer’s Disease was of course a focus for senior citizens. Dr. Michael Smith is a pioneer in the use of acupuncture as a means of detoxification. Dr. Zhu Bin (the Associate Director of the Institute of Acupuncture and Moxibustion, China Academy of Traditional Chinese Medicine) talked about his Recent Progress in Acupuncture Medicine. Dr. Chen Shao from FDA gave us some guidelines about how FDA regulates the herbs which are very precious for the practitioners.

The 2-day Forum placed a very strong positive emphasis on developing Chinese medicine evermore and we will continue the effort to facilitate this development.

About the Author: Dinglun Peng, L.Ac. is the President of Traditional Chinese Medicine Alumni & Association. Please correspond to 108-A East 38 Street, New York, NY 10016


UPDATE

Acupuncturist Volunteer Effort and Professional Acupuncturist Response Team

Ning Ma

We will never forget the day of September 11th as the whole world watched the Twin Towers fall. The citizens of New York came together as a community like never before. Hundreds of people devoted themselves to the support of the search and rescue work. They became American heroes. The American spirit has become the new landmark standing on Ground Zero. Acupuncture, the brand new arrival in the United States, had its first opportunity to serve and recompense the country during the horrible tragedy.

Pacific College of Oriental Medicine made contact with the Federal Emergency Management Agency during the first period after the disaster, and set up a volunteer service at Jacob Javits Center 48 hours after the attack. Acupuncture and bodywork therapy treatments were provided to Federal Emergency Management Agency (FEMA) search and rescue crews, the National Guard, and other FEMA personnel and the State Police. The service ran 24 hours a day, and lasted through September 30th.

The organizers recruited more than 300 volunteers from all over New York including New York State licensed acupuncturists, massage therapists and Pacific College clinic interns. All equipment and supplies were donated by over ten acupuncture supply companies. An estimated number of 3000 treatments were provided. A survey of the crews receiving treatment was conducted during the last two days of service, in which they

indicated that acupuncture and massage provided much relief to their physical pain and stress. These treatments helped them recover from the exhaustion due to almost no sleep, especially in the first few days, and relieved the pain from muscle soreness and tension resulting from the hard labor they were doing.

Through this experience, the Federal Emergency Management Agency came to realize the value of acupuncture during the rescue work following a disaster. FEMA asked the organizers to submit a proposal to them to form an agreement that would provide acupuncture and Asian bodywork services during future emergency and disaster efforts.

The Professional Acupuncturists Response Team (PART) was formed as a result of a cooperative effort of members of the New York acupuncture community that coordinated the Javits Center. The National Steering Committee is comprised of professionals associated with Pacific College of Oriental Medicine, Tri-State College of Acupuncture, the Acupuncture Society of New York, and New York College of Wholistic Health Education and Research. Part of its goal will be to organize the acupuncture community at large in order to provide treatments to emergency workers in the event of another disaster occurring anywhere in the United States.


If you would like further information on PART, please call 877-457-2681 or visit the website at nypart.org.

MARKET INFORMATION

The Miraculous Medicinal Effects ofWild American Ginseng

Fong Lam In traditional Chinese medicine, Asian ginseng is often administered in conjunction with herbs for the prevention and treatment of cancer and other serious illnesses. However, little is known in the medical community regarding the medicinal effects of wild American ginseng and its exponential results in combination with Chinese herbs.

In my eight years of practice using wild American ginseng, I have been intimately involved in numerous successful cases. The results from a few of these cases are illustrated in the following examples.

Case 1: A 47-year-old male, diagnosed with a very rare and malignant cancer known as estheoneuroblastoma, had his entire immune system broken down and his body completely edematous. After two months of hospitalization, his body ceased to respond to western medicine. In desperation, his family turned to the use of wild American ginseng for him. While he was in a coma and on a respirator in late October, 2000, he was administered ginseng through a feeding tube. In three days, a total of 11 pounds of fluids were excreted and other symptoms gradually diminished with the use of Chinese herbs. By mid December, 2000, he was healthy enough to be released from the hospital and he returned to work on January 3, 2001.

Case 2: A 38-year-old female had three occurrences of breast cancer. She developed critical heart failure secondary to radiation therapy. Doctors at Johns Hopkins University Hospital declared her condition medically futile. Miraculously, five days after taking fresh wild ginseng, her heart function along with her other medical conditions improved dramatically. In the past year before October, 2001, she was bedridden, but after two months of wild fresh ginseng administration, she was capable of going Christmas shopping with her family.

Case 3: A 69-year-old male suffered from large intestine cancer and dropsy. After receiving treatment of radiation and Chinese medicine for nearly a year, he didn’t make any progress with his medical conditions. However, having consumed fresh wild ginseng for seven days, he was able to get rid of 3000cc of ascites. His dropsy disappeared shortly thereafter.

Case 4: An 80-year-old female was in the late stages of lung cancer. One week before her operation, she began to take 5 grams of wild ginseng per day. One month later, she managed to come to the U.S. from Taiwan to visit her daughter.

Case 5: A 50-year-old male, diagnosed with throat cancer, developed stomatitis secondary to his radiation and


chemotherapy. After 20 days of taking Chinese herbal medicine and wild American ginseng, his stomatitis resolved.

Case 6: A 92-year-old female was sent to the emergency center of Pudong Hospital in Shanghai, China, because of critical myocardial infarction. After taking wild fresh American ginseng for two weeks, her medical conditions dramatically improved. All the doctors involved called her recovery a miracle and encouraged the family to continue with wild American ginseng.

Case 7: A 50-year-old female suffered from severe uterine bleeding during menopause. Hormone replacement therapy and anticoagulant therapy did not alleviate her condition. She was bedridden. But three days after taking wild American ginseng, her bleeding stopped. Ten days later, she returned to work.

Wild American ginseng used with Chinese herbs has been proven to be highly effective in the treatment of many diversified illnesses and diseases, such as diabetes, liver/kidney/gastrointestinal and other organ diseases, alcohol detoxification, abnormal blood pressure and cholesterol control. Furthermore, wild American ginseng promotes sexual potency, longevity, etc.

As American ginseng has substantially different curative effects, it is important that we be able to identify the type of ginseng with medicinal properties and to differentiate between three varieties of American ginseng: wild, woodsgrown and cultivated. It should be noted that cancers and other serious illnesses need to be treated with 12-25 year old wild ginseng. For general health care, woodsgrown ginseng can play an effective role. Characteristics of Wild, Woodsgrown and Cultivated American Ginseng

Wild ginseng is found in mountainous hardwood forests and is difficult to find. The stem of wild ginseng has deep, thin

wrinkles, and is light in texture and weight. Wild ginseng roots found in their natural environment are usually 10 to 30 years old. Roots of 30 or more years old are rare and of high medicinal quality. In wild ginseng, up to twenty-three ginsenosides can be found. Among the three varieties of American ginseng, the wild is the most potent. American and Asian ginseng are viewed as related but are distinctly different medicinal herbs. Since American ginseng is considered mild, cool, and calm, its long-term usage is not harmful.

Woodsgrown ginseng is grown in the forest from seeds of wild ginseng or transplanted saplings, with full maturation at 7 to 10 years. The quality of woodsgrown is between that of wild and cultivated ginseng. Therefore, it is sometimes called semi-wild ginseng. Woodsgrown ginseng can be identified as having fewer wrinkles on the stem than that of the wild. The quality of woodsgrown ginseng of 8 years or greater is close to that of the wild.

Cultivated ginseng is grown on farms and gardens, taking 3 to 5 years to mature before it can be harvested. It can be identified as having only two or three concaves on its stem. Cultivated ginseng does not have the medicinal properties that the wild and woodsgrown ginseng do. Currently, researchers can only identify up to 10 ginsenosides in this variety.

American WildSenergy, Inc. and Its Products

American WildSenergy, Inc., founded in December, 2001 in Flushing, New York, is comprised of family members of cancer survivors, a ginseng expert, medical professionals, a consulting expert from the National Institute of Health, and a consulting physiologist, Laura Murphy, from Southern Illinois University School of Medicine. Dr. Murphy & I will conduct a joint presentation at an international medical conference in Hong Kong in March, 2002. The topic will


be The Treatment of Cancer with Chinese Herbals is Enhanced by Co-Administration with Wild American Ginseng.

The effectiveness and quality of our product WildSenergy, was pre-tested by Dr. Murphy, with results indicating that the combined use of wild American ginseng and Chinese herbal powder exponentially increases the potency of either compound alone. Thus, co-administration of the two dramatically improves the overall efficacy of cancer treatment. This product will bring New Hope to the world.

The mission of American WildSenergy, Inc. is to be the premier provider of high quality ginseng products at the most affordable price. Our goal is to promote health and wellness through our service with honesty, integrity and customer satisfaction.

About the Author: Fong Lam from American WildSenergy, Inc. Please correspondence to P.O. Box 650338, Flushing, NY 11365

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