Chemotherapy and Anti-Oxidants

In the past few years it has become common practice by oncologists to advise patients who are undergoing chemotherapy not to take anti-oxidant supplements. The reasoning behind this advice is that chemotherapy destroys cancer cells by inducing free radicals and by promoting oxidation of the cancer cells.  Antioxidants, on the contrary, do the exact opposite, i.e. they prevent free radicals (by binding to them) and the oxidation of cells. In theory, therefore, it would seem to follow logically that antioxidants may interfere with chemotherapy and reduce its effectiveness. As we shall see, in reality it is not as simple as that.

As oncologists also advise against the use of Chinese herbal remedies during chemotherapy, I shall approach this subject from two angles:

Whether it is true that anti-oxidants interfere with chemotherapy
Whether this applies to Chinese herbs

1. DO ANTI-OXIDANTS INTERFERE WITH CHEMOTHERAPY?

One particular article was influential in shaping the opinion that anti-oxidants interfere with chemotherapy.  This was the article written by Dr Gabriella D'Andrea from the Memorial Sloan-Kettering Cancer Center, New York  in Cancer Journal for Clinicians in 2005.

In this article, Dr D'Andrea states that, "mechanistic considerations suggest that antioxidants might reduce the effects of conventional cytotoxic therapies. Preclinical data are currently inconclusive and a limited number of clinical studies have not found any benefit. Clinicians should advise their patients against the use of antioxidant dietary supplements during chemotherapy or radiotherapy. Such caution should be seen as the standard approach for any unproven agent that may be harmful."

It is interesting that Dr D'Andrea agrees that "preclinical data are currently inconclusive" and yet she still comes to the conclusion that "clinicians shouldadvise their patients against the use of antioxidant dietary supplements during chemotherapy or radiotherapy."  It is also interesting that she should attribute the opinion that antioxidants might reduce the effects of cytotoxic therapy to "mechanistic considerations": as we shall see, they are exactly that, i.e. "mechanistic".

Indeed, Dr D'Andrea takes a mechanistic view in saying "radiotherapy and many chemotherapy agents act by producing free radicals; some vitamins and supplements, including vitamins C and E, are antioxidants and bind to free radicals, preventing oxidative damage."  She continues: "There are considerable in vitro and animal data showing that vitamin C and other antioxidants can protect cells against radiation and chemotherapy.  It seems likely that they would therefore reduce treatment-related toxicities and there are promising, although not unequivocal, data that this indeed is the case.  However, it also follows that antioxidants might protect cancer cells, thereby reducing the oncologic effectiveness of cytotoxic therapy. This is the reason why most oncologists discourage patients from using antioxidants during treatment."

However, Dr D'Andrea herself reports  that  "in vitro studies have reported that vitamins A, C, and E, as well as carotenoids, can enhance the effectiveness of chemotherapy and radiotherapy."  Proponents of antioxidant therapy say exactly this, i.e. that  the protective effects of antioxidants are selective for normal cells, such that they can reduce toxicities without compromising oncologic efficacy. They also say that antioxidants are directly cytotoxic and can actually increase the effectiveness of cytotoxic treatments.

Dr D'Andrea says that  there are in vitro data suggesting a direct antitumor effect for vitamin C but she questions their  validity.  D'Incalci et al reviewed the literature on antioxidants and chemotherapy for the last 15 years and came to much more cautious conclusions than those reached by D'Andrea.

D'Incalci et al say that "Studies have explored the effect of predominantly antioxidant vitamins and folate on efficacy or toxicity mediated by cisplatin and anthracyclins. Cisplatin toxicity in rodents was ameliorated by vitamin E. The design of clinical studies of dietary agents in combination with cytotoxic agents has been very heterogeneous and results have been inconclusive."ii  They conclude cautiously that "whilst preclinical experiments hint at a potential benefit of certain dietary agents, the evidence emanating from clinical studies does not allow firm conclusions to be made. Future studies should explore physiological doses of dietary agent and include pharmacokinetic and pharmacodynamic measurements."iii

Other researchers too contest D'Andrea's conclusions. They maintain that antioxidants given during chemo- and radio-therapy induce apoptosis, a process whereby cancer cells die off in a natural manner.  Cancer cells that die off due to apoptosis are literally digested and removed by phagocytes, thus preventing the inflammatory response induced by chemotherapy.  By contrast, oxidation induced by chemotherapy kills cancer cells in a manner that results in masses of dead cells (with broken membranes) that produce inflammation and toxic response.

All cells have a finite life span and cell death occurs mainly as a result of passive necrotic processes or due to an active process of programmed cell death,  "apoptosis".  Apoptosis is the most common mechanism by which the body eliminates damaged or unneeded cells without local inflammation from leakage of cell contents.

Cells that are undergoing apoptosis exhibit a characteristic pattern of morphologic changes, including cell shrinkage, condensation, fragmentation of the nucleus and bubbling of the plasma membrane, known as "blebbing", chromatin condensation and nucleosomal fragmentation.  The resulting membrane-bound apoptotic bodies are consumed by neighboring cells or by macrophages. In contrast, the necrotic mode of cell death represents a passive consequence of mechanical damage or exposure of the cells to toxins (such as chemotherapy).

However, some antineoplastic drugs kill tumor cells by inducing apoptosis.  As described above, this highly controlled mechanism of cell death is thought to be physiologically advantageous because apoptotic cells are removed by phagocytosis before they lose their permeability barrier, thus preventing induction of an inflammatory response to the dying cells.  In contrast, necrotic cells lyse and release their contents into the extracellular space, thus inducing inflammation.

Shacter et al examined the effects of oxidative stress on chemotherapy-induced cell killing.  They found that H2O2 (hydrogen peroxide) inhibits the ability of four different chemotherapy drugs (VP-16, doxorubicin, cisplatin, and AraC) to induce apoptosis in human Burkitt lymphoma cells.  H2O2 shifts the form of cell death from apoptosis to pyknosis/necrosis, which occurs after a significant delay compared with chemotherapy-induced apoptosis. It can also lower the degree of cell killing by these drugs. These effects of H2O2 can be prevented by the antioxidant agents Desferal, Tempol, and dimethylsulfoxide.

Phagocytosis by monocyte-derived macrophages of VP-16-treated lymphoma cells is also inhibited by H2O2.  Cells killed with H2O2 (with or without VP-16) do ultimately undergo phagocytosis, but this occurs only after they have lost their permeability barrier. Thus, membrane-intact apoptotic cells are recognized and phagocytosed by monocyte-derived macrophages, but membrane-intact pyknotic/necrotic cells are not. The results suggest that chemotherapy-induced apoptosis and phagocytosis of cancer cells may be enhanced by including certain antioxidant agents in the treatment protocol.iv

In other words, there are situations when the oxidative stress induced by chemotherapy itself may actually hinder the effects of chemotherapy and the addition of antioxidants may actually help chemotherapy to work in a more natural, non-inflammatory way (i.e. through apoptosis rather than necrosis).

Dr Kenneth Conklin confirms this in his article "Chemotherapy-Associated Oxidative Stress: Impact on Chemotherapeutic Effectiveness".v  In this article, Dr Conklin says that "Antineoplastic agents induce oxidative stress in biological systems. During cancer chemotherapy, oxidative stress-induced lipid peroxidation generates numerous electrophilic aldehydes that can attack many cellular targets. These products of oxidative stress can slow cell cycle progression of cancer cells and cause cell cycle checkpoint arrest, effects that may interfere with the ability of anti-cancer drugs to kill cancer cells. The aldehydes may also inhibit drug-induced apoptosis by inactivating death receptors and inhibiting caspase activity [the latter would slow down cell disassembly]. These effects would also diminish the efficacy of the treatment. The use of antioxidants during chemotherapy may enhance therapy by reducing the generation of oxidative stress-induced aldehydes.

Dr Conklin also conducted a study on patients who were receiving chemotherapy (anthracyclines) for breast cancer and lymphoma.  Co-enzyme Q10 was administered in conjunction with chemotherapy. Results showed that the administration of Q10 resulted in fewer cardiomyopathy (a side-effect of anthracyclines).  Dr Conklin says in the summary of the study: "There is concern within the oncology community that consumption of antioxidants during chemotherapy will reduce the effectiveness of the treatment.  Cytotoxic antineoplastic agents generate reactive oxygen species (ROS) in biological systems and many oncologists contend that this accounts for, or contributes to, the anti-cancer activity of the drugs. However, all of the drugs have [their own] established mechanisms of action that do not depend [always] upon their production of ROS.  ROS can reduce the efficacy of chemotherapy because they interfere with cell cycle progression and apoptotic mechanisms. Thus, antioxidants should not interfere with the mechanism of action of antineoplastic agents, and may enhance their effects by preventing the impact of ROS on the cell cycle and apoptosis.  The results of the present study support the contention that antioxidants do not interfere with the anti-cancer effects of antineoplastic agents. Additionally, the administration of co-enzyme Q10 during the patients' anthracycline-based chemotherapy appears to have prevented any cardiac damage."

Block et al also reviewed the literature on antioxidants and chemotherapy and came to the same conclusion. Dr Block, of the Block Center for Integrative Cancer Treatment, says: "This review demonstrates that there is no scientific support for the blanket objection to using antioxidants during chemotherapy. In addition, it also appears that these supplements may help mitigate the side effects of chemotherapy."

The study considered  845 articles and 19 trials met the inclusion criteria. Antioxidants evaluated were: glutathione (7), melatonin (4), vitamin A (2), an antioxidant mixture (2), vitamin C (1), N-acetylcysteine (1), vitamin E (1) and ellagic acid (1). Subjects of most studies had advanced or relapsed disease.

The conclusion was that none of the trials reported evidence of significant decreases in efficacy from antioxidant supplementation during chemotherapy. Many of the studies indicated that antioxidant supplementation resulted in either increased survival times, increased tumor responses, or both, as well as fewer toxicities than controls.  15 of 17 trials that assessed chemotherapy toxicities, including diarrhea, weight loss, nerve damage and low blood counts, concluded that the antioxidant group suffered similar or lower rates of these side effects than the control group.

Co-author Dr. Robert Newman, Professor of Cancer Medicine at M. D. Anderson Cancer Center said, "This study, along with the evolving understanding of antioxidant-chemotherapy interactions, suggests that the previously held beliefs about interference do not pertain to clinical treatment."ix  The authors noted that reducing side effects may help patients avoid having to cut back on their chemotherapy dosing, interrupt scheduled treatments, or abandon treatment altogether. This in turn, is likely to favorably impact treatment outcomes.

2. CHINESE HERBS AND CHEMOTHERAPY

How does this affect the use of Chinese herbs during chemotherapy?  Much of the above discussion on antioxidants and chemotherapy actually does not apply to Chinese herbs as they contain few antioxidants and in doses that would be akin to those found in foods.  Beta-carotene, for example, is a powerful antioxidant. Beta-carotene is found in carrots, sweet potatoes, kale, spinach, winter squash, cilantro (coriander) and thyme.

Only Hypericum (St John's Wort) may present some interaction with chemotherapy.  In fact, this herb lowers the availability of some drugs as it activates the drug-metabolizing enzyme cytochrome P450 CYP3A4.  Hypericum is used in Chinese medicine but not widely and it is not included in Chemo-Support.  Very few Chinese herbs contain Vit C and, if they do, it would be in minimal doses.

The only ingredient of Chemo-Support that has a mild antioxidant effect is Dang Gui Radix Angelicae sinensis: considering this is only one out of 16 ingredients, the overall antioxidant effect of Chemo-Support is negligible. In conclusion, eating 2 pound of carrots, drinking a glass of orange juice and a cup of green tea would deliver far more antioxidants than 6 tablets of Chemo-Support. There is therefore absolutely no justification for recommending not to take Chemo-Support while on chemotherapy.

3. CHEMO-SUPPORT: PROTOCOL AND DOSAGE

Chemo-Support works better if it is started some time before the beginning of chemotherapy and continued for about 4 weeks after the end. It is important to note that "during the treatment" means during the course of treatment, i.e. also in the days of break from the treatment. The dosage is as follows:

Two weeks before the start of treatment: 3 tablets a day
Four days before the start of treatment: 2 tablets twice a day
During the treatment: 3 tablets three times a day
After the end of treatment for 4 weeks: 2 tablets twice a day
It is best to take the tablets away from meals, i.e. about 1 hour before or after a meal, swallowed with hot water. The tablets should also be taken separately from other medication, at least 1 hour away. If the patient feels very nauseous and finds it difficult to swallow the tablets, these could be crushed and powdered, immersed in a small amount of hot water with three slices of fresh ginger and the water sipped slowly.

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

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

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

TESTIMONIALS

In the past 2-1/2 years, I have been diagnosed with rectal cancer and liver cancer metastases. I am a 52-year old man.    Throughout my treatment, which has been, to say the least, extremely challenging, I have received acupuncture treatments regularly to relieve the side effects of my chemotherapy and to help me heal from my surgeries.

However, although I have weathered my treatments pretty well, I was continuing to get more and more fatigued with foggy thinking and was beginning to have severe digestive issues.

"My acupuncturist prescribed  Chemo-Support to help me with these side effects.  When I began to take it (in the weeks between my semi-monthly chemotherapy)  I noticed almost immediately that I was able to think clearer and to feel stronger.  In fact, with each subsequent chemo treatment I seem to be more resilient, having less severe reactions to those treatments with more restful sleep, no more digestive issues.  My quality of life has improved tremendously overall, between the acupuncture and now, because of the Chemo-Support."

C.S.

"I have treated over twenty patients with Chemo-Support for an average of four to six months.  I have observed and my patients have reported to find Chemo-Support beneficial for improving energy and in decreasing the side effects of nausea and vomiting."
Lucy Postolova, L.Ac.
Los Angeles, CA

"At [our] clinic we use both Chemo-Support and Radio-Support for many of our patients. I have definitely seen less fatigue in the women I have treated with Chemo-Support. They report that their energy and stamina are improved and there is less occurrence of anemia associated with chemotherapy. One of my patients was referred to me after she had undergone two rounds of chemotherapy. She was exhausted, very depressed, and felt very dry and depleted. She was on  Chemo Support for the last round of therapy and she felt much less exhausted, her energy increased and she had fewer sensations of heat and night sweating."
Robin Germain, L.Ac.
San Francisco, CA

"I have been treating several women with breast cancer who have been undergoing chemotherapy. The patient who is taking Chemo-Support has had considerable improvement with her digestive function. Prior to taking Chemo-Support, she was suffering from burning, painful diarrhea which is no longer a problem. She is very pleased with her herbal treatment."
Dianne Gobrogge, L.Ac.
Wilmington, NC

"We find Chemo-Support to be beneficial in the initial treatment of Stage I and Stage II breast cancer, and especially in combination with other formulas (such as Brocade Sinews with Chemo Support for use with Taxol and Glorious Sea and Chemo-Support when using Navelbine).  Along with acupuncture, Chemo-Support is helpful in supporting the Qi and helping the patient tolerate chemotherapy."
Beverly Burns, L.Ac.
San Francisco, CA

By: Giovanni Maciocia

Clinical trial

"The Treatment of 28 Cases of Lumbar Disc Herniation with Du Huo Ji Sheng Tang (Angelica Duhuo & Loranthus Decoction)" by Shi Chao, Zhe Jiang Zhong Yi Za Zhi (The Zhejiang Journal of Traditional Chinese Medicine), #2, 1994, p. 67.

In this clinical audit, the author reports on their treatment of 28 cases of  lumbar disc herniation using Du Huo Ji Sheng Tang. Of these 28 cases,
11 were men and 17 were women. The oldest was 58 and the youngest was 27 years old.

Twenty of the cases had no history of external injury. The other 8 cases had sustained various injuries from lifting heavy objects, twisting or wrenching, etc. In the majority of these cases, the onset of their disease occurred when they contracted wind, cold, or dampness when they were concurrently (over-) taxed.

In TCM, this condition's pattern discrimination is categorized as assailment by wind, cold, damp evils. However, because this disease is chronic, it is also due to bodily vacuity with liver/kidney insufficiency and thus lack of nourishment of the channels and vessels. Therefore, treatment should boost the liver and kidneys, supplement the qi and blood, dispel wind dampness, and stop bi pain.

The basic formula for this purpose is Du Huo Ji Sheng Tang. The ingredients used were: Radix Angelicae Duhuo (Du Huo), Radix Ledebouriellae Sesloidis (Fang Feng), Radix Ligustici Wallichii (Chuan Xiong), and Radix Achyranthis Bidentatae (Niu Xi), 6g @, Cortex Eucommiae Ulmoidis (Du Zhong), Radix Gentianae Macrocphyllae (Qin Jiao), Radix Angelicae Sinensis (Dang Gui), Sclerotium Poriae Cocos (Fu Ling), and Radix Codonopsis Pilosulae (Dang Shen), 12g @, Ramus Loranthis Seu Visci (Sang Ji Sheng), 18g, prepared Radix Rehmanniae (Shu Di), 15g, Radix Albus Paeoniae Lactilforae (Bai Shao), 10g, Herba Cum Radici Asari Seiboldi (Xi Xin) and Radix Glycyrrhizae (Gan Cao), 3g @, and Cortex Cinnamomi (Rou Gui), 2g, added at the end.

If there was constipation, 10g of Semen Cannabis (Huo Ma Ren) or 12g of Semen Trichosanthis Kirlowii (Gua Lou Ren) were added. If there was an unsoothed stomach venter, Gentiana Macrophylla was reduced to 6g. If there was poor appetite, prepared Rehmannia was changed to raw Radix
Rehmanniae (Sheng Di), 12g. One ji was decocted in water per day and given in 2 divided doses. Typically, 7-14 ji were administered.

Excellent results meant that the patient symptoms relaxed, that their pressure pain disappeared, and that they were able to function normally. Good results consisted of a more than ½ reduction in symptoms, a marked diminishment in pressure pain, and mostly a return to previous functioning. Fair results
consisted of an approximate 1/3 reduction in symptoms, some diminishment in pressure pain, and some improvement in function. Based on these criteria, 4 cases got excellent results, 17 good results, 6 fair results, and 1 case no results.
Thus the total amelioration rate was 96.43%.

I recently received an email from a colleague asking for a help with a patient suffering from chronic fatigue syndrome.  The colleague was asking about the treatment principle to apply.  The patient obviously suffered from a deficiency of Zheng Qi, as all patients with chronic fatigue syndrome do.  But she also had frequent acute invasions of Wind.

The colleague was rightly following the principle that, in the presence of an acute invasion of Wind, one must expel pathogenic factors, in this case expelling Wind, and not tonify Zheng Qi.  In between invasions of Wind, the correct treatment principle is to tonify Zheng Qi, and this what the colleague was doing.

However, the problem was that the patient suffered from very frequent invasions of Wind, so that there was hardly any time to tonify Zheng Qi for a prolonged time.  She was using Three Treasures remedies i.e.  Expel Wind-Heat (a variation of Yin Qiao San) during the acute invasions of Wind and Herbal Sentinel to tonify Zheng Qi in between the acute attacks.

She wrote to me to ask whether taking Herbal Sentinel (i.e. a Qi tonic) during an acute invasion of Wind could strengthen the pathogen.  She was also wondering whether one can go on taking Expel Wind-Heat for prolonged periods as the patient had times when she went from one acute illness to the next, so she could be taking Expel Wind-Heat for weeks, and my colleague was wondering whether this could deplete her Qi or Yin.

Her second question was whether taking Herbal Sentinel during an acute invasion of Wind could strengthen the pathogen.

I will try and answer here her questions.

1) Can one take a remedy that expels exterior Wind for prolonged periods?

The answer is basically: “no”.  Remedies that expel exterior Wind (such as Expel Wind-Heat or Yin Qiao San) by definition should be taken only during an acute invasion of Wind for a few days.  After a few days or a week, either the exterior Wind has been expelled or the pathogenic factor has penetrated into the Interior at which time the patient needs a different treatment.

However, chronic fatigue syndrome presents a different situation and one that is not contemplated in Chinese books.  I have never seen a discussion of chronic fatigue syndrome in any Chinese book: indeed, a Chinese journal years ago published a translation of an article I wrote on chronic fatigue syndrome.

In my experience, chronic fatigue syndrome is characterized by a prolonged course of the disease with deficiency of Zheng Qi and frequent invasions of exterior Wind.  However, the exterior pathogen in such patients is “weak” and it is weak precisely because of the prolonged course of the disease and the prolonged deficiency of Zheng Qi.

So, in such cases, the patient may need to take a remedy that expels exterior Wind frequently, e.g. for a week every few weeks or so.  However, because the pathogen is weak, one can use a small dose such as for example only three tablets of Expel Wind-Heat a day.

2) Can tonifying the Zheng Qi also tonify an exterior pathogen?

Again, in theory “yes”.  However, again, chronic fatigue syndrome is an exception.  As the deficiency of Zheng Qi is very prolonged and the pathogen “weak”, during invasions of exterior Wind in chronic fatigue syndrome, I do occasionally combine expelling exterior Wind with Expel Wind-Heat (Yin Qiao San) with Herbal Sentinel, both in small doses.  For example, I might use 3 tablets or Herbal Sentinel in the morning and 3 tablets of Expel Wind-Heat in the evening.

Note: Herbal Sentinel is a tonic of Lungs and Kidneys to strengthen Zheng Qi and prevent invasions of Wind.   There are two variations of it: Herbal Sentinel-Yang for patient with a tendency to Yang deficiency and  Herbal Sentinel-Yin for patients with a tendency to Yin deficiency

By Giovanni Maciocia

Healthy Aging and Oriental Medicine
Is there a limit to Qi energy reserves?

It is known in fundamental science, that the human form has a limited life span. This is true for most living species. What influences healthy aging of each living organism and especially the human form is unique to each individual based on common factors.
In Oriental Medicine, aging is viewed not by age but by the amount of Qi reserve within the complex of all body systems influenced by its environment.
In ancient times without the knowledge known now as the human genome, Eastern Medicine scholars viewed longevity by a relative quantity or manifestation of the amount of Vital Qi. Qi, known as an essential life giving force that permeates every cell, tissue, and organ, also is the trigger to signal a cell to thrive or die.

Inherited qi, also called Prenatal Qi, influences how much Qi a person is born with. Prenatal Qi is set by family genetic patterns and fetal health during prenatal life. These conditions vary from person to person and sets the stage for the quality and quantity of the Vital Qi someone is born with. It also influences the potential for good health throughout the course of one’s life.
If the Vital Qi could be measured, some would appear to be born with a full vessel filled with Qi while others may have only one half or two thirds full. If the amount of Qi in early life starts out less than full, it is more challenging to attain robust health and longevity.  Although there are recommended suggestions to accelerate or try to catch up on Qi reserve, it is unlikely to reach the same full amount of vitality that some are naturally born with. In a more modern view, few inherent genetic markers can be self-corrected and therefore often impact the quality of long term health. Also known in modern medicine, is that by applying targeted nutritional intervention genetic errors can be redirected and improve outcomes and quality of health.

Preservation of Vital Qi
Factors that impact Vital Qi after childbirth initially have to do with neonatal and early childhood care and nutrition. As a child, Qi is more fragile and needs to be protected. Having a healthy environment emotionally, socially, and as well as nutritionally makes a difference. Exposure to medical interventions, drugs and toxins are best kept to a minimum since these impact the resilience of Qi. Early childhood nutrition builds the groundwork and sustains it in adult life for abundant Qi and blood to thrive.

Everyone is not the Same Constitution
In Eastern Medicine not everyone is expected to age the same way, not only because of the differences in Vital Qi levels or secondary to different genetics within an ethnicity, but because the body is viewed as different constitutional types. These different types pertain more to the laws of nature according to the elements. The five elemental constitutional types are water, wood, fire, earth and metal. Therefore health recommendations are individualized. Suggestions for someone who reflects a constitutional type pertaining more to the element of fire may not receive the same recommendations as one would if they reflected more qualities like the element of earth.
These element specific recommendations support nutrition and diet, exercise, sleep plus herbal formulas and acupuncture points. Those who reflect more of the element of fire would not benefit from spicy foods or a predominantly cooked food diet. Whereas those who reflect more of the earth element may benefit more from cooked pungent foods rather than cold and raw foods. Without personalized dietary choices, even a healthy diet may not build maximum Qi reserve.

Avoiding Excesses and Deficiencies
In order to avoid accelerating aging or damage to Vital Qi certain excesses and deficiencies are to be avoided. Excesses include too much exercise, sexual activity, medications and drugs, alcohol, extreme weather, internal and external toxins and excess emotions and stress. All of these in excess can cause damage to Vital Qi and prevent its consolidation.

Excess exposure to extreme climates can also be detrimental and cause imbalance even if it’s intended for sports and enjoyment. Some are more vulnerable to the outdoor elements and need more protection against overexposure. Wind is an element not well tolerated for those with a weak immune system. Any exercise in the wind is especially depleting.
Lifestyle can support the consolidation of Qi or it can accelerate its decline

Deficiencies that prevent the growth of Qi, include a lack of essential nutrients and food or not enough exercise, or adequate rest, relaxation, and a lack of human connection and affection. Without these vital life supportive qualities, Vital Qi is not nourished and can become depleted more easily.

Eastern medicine’s ancient knowledge shares secrets of increasing
Vital Qi

There are few super foods or vitamins that can increase Vital Qi. But with practice, vitality enhancing exercises like Qi gong, Tai chi, and yoga contribute to preserving and increasing Vital Qi. Ancient yogic breathing combined with movement helps to sustain vital functions and increase the abundance of Qi.

Herbs and Acupuncture
Adaptogenic Chinese herbal formulas are known to enhance Vital Qi and energy. Each formula is designed to adapt to the changes in Vital Qi as the body needs them. Many of these herbs contain active food constituents like bioflavonoids, and vitamins that improve immune function and support hormone activity. Examples of some of the common herbs recommended include shan yao (dioscorea), gou ji berries (lychi), rou cong rong (cistanches), various forms of ginseng, jiao gu lan (gynostemma), plus blood nurturing herbs like he shou wu (polygonum), dan shen (salvaiae), and dang gui (angelicae). (The herbs listed do not include a specific species)

Treatments with Acupuncture are selected based on individual constitutional type. Each point chosen taps into a network of circulating pathways that activate and recharge cellular activity. The beneficial effects serve as a way to consolidate reservoirs of energy stores and remove blockages of Qi that can slow down smooth active organ function. Receiving acupuncture on a routine basis is similar to getting an engine tune up at prescribed intervals to adjust and lubricate all its parts to keep all of its systems running smoothly.

Diet
Diet is known for its direct influence on health, and in Oriental medicine, food selection is also based on elemental constitutional type. There are five flavors that correspond with the five elements which include salty, sour, bitter, sweet, and pungent. Diets that are more individualized are more regenerative for each constitution and promote longevity as well as good digestive health.

Emotions
Balanced emotions can tip the scale between sustained health and depletion. Staying in harmony with one’s elemental constitution and life path helps keep emotions balanced and promotes sustained long-term health.

Optimal Health using Eastern Medicine

5 Vital Steps to Preserve Vital Qi and Longevity

1. Keep a diet diary and review the foods you crave the most.

Look at your diet and see which flavors you eat most often. The flavors you crave may indicate you need more of it in your diet to balance the five elements. It could also mean you are out of balance and what you crave is not beneficial for you. A good example is if you crave sweets. It doesn’t mean you are deficient in the flavor of sweet but may indicate a weak condition in the earth element or digestive system.

If you crave salt it could mean your water element, the kidney, is not concentrating your minerals well enough and you need the extra electrolytes derived from salt.
Himalayan salt from the east is known to be a powerful regulator of the body’s acid alkaline balance. It contains more than 80 minerals naturally without processing. It helps to regulate the brain’s neurotransmitter exchange, stabilizes bone growth and enhances the kidneys functions.

2. Eat according to your elemental constitution but include a balance of all 5 flavors in your diet.

Regardless of your elemental constitution, the digestive tract needs constant warmth to maintain the digestive fire. Digestion involves manufacturing enzymes and maintains a balance between good and bad bacteria. Include a balance between warm and cold foods to help regulate the digestive fire. An excess of either temperature will affect digestion and long term health.

Salty, sweet, sour, bitter, and pungent are common flavors to include in the diet. Bitter flavor is the least often included in the diet but is just as significant as the others. Foods like greens including kale, chard, arugula, broccoli, and green onions are bitter plus coffee, tea, and dark chocolate also have a bitter flavor. Eat these vegetables cooked and raw according to your constitution’s needs. Many herbal formulas use bitter herbs to balance the heart, digestion, and chronic infection conditions.

3. Exercise daily but gently. Begin the day with breathing exercises and add standing exercises like Qi Gong or Tai Chi plus moderate aerobic activity.

Standing Qi Gong strengthens the tendons, ligaments, and joints. It strengthens the Vital Qi to connect the mind and body. It opens up the acupuncture channels and cultivates yang qi to reinforce natural body detoxification and consolidates yin qi to nourish blood and beneficial fluids. It harmonizes internal organs to support the transformation of physical energy into vital sustainable energy.

One common Qi Gong exercise is standing with the feet shoulder distance apart knees slightly bent with the elbows bent and hands positioned as if holding a large imaginary ball. Take steady deep breaths while lightly applying pulsed pressure on the imaginary ball and releasing with each exhale. Practice for 5 -10 minutes daily which will gradually strengthen and enhance continuous sustainable energy.

4. Balanced emotions Self-reflection

Keeping balanced emotions requires time for contemplation and self-reflection. Allow enough quiet time to listen to your internal voice. Stay in touch with what your body may tell you it needs. A time for meditation is best in between meals. Flavors you crave may become more obvious at this time. Thoughts and good ideas may become clearer by allowing this time for them to come quietly into your inner sanctum. After 20 minutes of contemplation without distractions, feelings may surface and can be processed while with a restful mind. Without including this part of health maintenance, imbalanced emotions often lead to stress and excess strain on the body’s balancing systems.

5. Sleep and Self Massage

Sleep is essential to keep the “Shen” or spirit balanced. Without enough sleep Vital Qi cannot regenerate. Over time lack of sleep can create an excess of stress and demand on the body, mind, and spirit.
Create restful rituals before bedtime. Allow 30 minutes before bed to create a quiet and restful environment. Self-massage helps to relieve tension and relax muscles and nerves. Use a long handled massage tool to stroke across the upper back and shoulders. Using mild pressure press along the acupressure channels on both sides of the forearm. Using the fingertips press acupuncture points surrounding the ears and across the forehead. Finally, stroke downward from the scalp to the face several times closing the eyes just before the final moments before sleep.
Take long deep breaths as a way to invite the body to drift into a peaceful sleep.

Horny Goat's Weed Benefits

Horny Goat Weed are from the species (Epimedium). Epimedium is a genus of 63 species of flowering plants in the family Berberidaceae. Legend in China claims that this weed was ingested by some goats. The herder observed the behavior of the animals after consuming the plant and decided that this plant must contain certain properties associated with aphrodisiacs. After many hundreds of years of use, the specific properties of the plant were identified and their methods of action better understood.

Common names
 
Epimedium, also known as barrenwort, bishop's hat, fairy wings, horny goat weed, rowdy lamb herb, randy beef grass or yin yang huo

Active Ingredients

One of the principal active ingredients in Horny Goats weed is "icariin". The concentration may determine much of the potency of each particular species of Epimedium. The icariin works by relaxing smooth muscle tissue, which is different from skeletal muscle tissue. The significance of this is that involuntary tension in the internal tissues can be relaxed, which many believe cause the central nervous system to shift from the so-called fight/flight mode into the rest/restore mode. When this change occurs, many elements of a disease tend to reverse because the body is no longer in a stressed condition. Although this may not cure many problems, especially the ones that are in advanced stages, many people use herbs to manage their condition and obtain some relief.

Habitat

Horny Goat Weed is found growing all over the southern areas of China, but can also be found in the Asian countries that immediately border China, as well as some neighboring European countries. The Chinese name is Yin Yang Huo, or Xian Ling Pi, and it is used extensively in Traditional Chinese Medicine (TCM). It has become popular in the field of Western alternative medicine for use in treating multiple conditions.

One should realize that although the plant may bear the same name, there are close to 60 species of Epimedium plants and over 15 in China that bears the name "Yin Yang Huo." It might be difficult for the layperson to determine the strength and properties of the plant based on the name alone.

Benefits and Conditions

Horny Goat Weed is often used to treat osteoporosis and various sexual dysfunctions. However, other uses of the plant include the treatment of hypertension, bronchitis, coronary heart disease, polio and more. This makes sense because the active ingredient works on smooth muscle tissue. Theese are the tissues that surround the heart. When the heart muscles are under strain, it is easy to visualize how this can cause other problems in the surrounding affected systems.

Secondary benefits can also occur when the smooth muscle tissues relax. The health benefits could extend to relieving fatigue in both the mind and the body, as this herb is employed for this purpose in TCM. It has been used to treat joint pain, numbness, memory problems, painful or cold low back and/or knees, as well as irregular menstrual cycles, spermatorrhea, and impotence. It has been cited as producing an anti-aging effect and can improve the immune system as well as the endocrine system.

Ganoderma Benefits

Ganoderma is not often used in cooking because they are hard and have a bitter taste, although some people do use them in the same dishes that you might use Shiitake mushrooms (Lentinula edodes). But you are unlikely to find them at your favorite market. They are mainly used for purely medicinal purposes and have a number of health benefits. In fact, it is known among practitioners of Chinese medicine as the “king of herbs.”
 
All mushrooms are the “fruit” of fungi as well as the reproductive part. Ganoderma can be found growing up from underground networks called mycelium near organic waste and logs, which are both a good nutrient source. Given the right conditions, Ganoderma can actually be cultivated and used in medicine.

The Eastern world has been using Ganoderma for thousands of years, particularly in China and Japan. Even the ancient kings and emperors drank reishi tea because it was believed that its properties encouraged vigor and long life. They also thought that the tea would increase their wisdom and happiness.

The use of reishi has reached the Western world where these days people are making elixirs from the mushroom for the purpose of promoting vitality and longevity. It is also used to treat certain medical conditions.

Benefits of Ganoderma and Supplements

The benefits of Ganoderma are so well known and proven that you can get them in forms that are much convenient that slicing them up and cooking with them. You can buy them dried, in concentrated tablets, capsules, or even as an extract. In any of these forms Ganoderma can be used as a dietary supplement.

Here is a list of the benefits that Ganoderma have as a daily dietary supplement or in helping to treat certain medical conditions:

· These mushrooms are very strong antioxidants. Antioxidants protect the body from the negative effects of free radicals that are formed inside the body by daily exposure to the sun, chemicals, and pollutants. Ganoderma are proven to boost the immune system, especially when taken with other antioxidant supplements.

· It is believed that Ganoderma can suppress the growth of tumors in people with cancer. It can reinforce the membranes in cancerous cells to keep the tumor from spreading. For this reason, they are often used in efforts to prevent cancers.

· Ganoderma are also beneficial for people suffering from asthma and other respiratory conditions because it seems to have a healing effect on the lungs. They are good for building respiratory strength and curbing a cough.

· Ganoderma have anti-inflammatory properties and are therefore used sometimes for patients who have Alzheimer’s and heart disease. This is based on the idea that inflammation plays a part in each of these conditions. The pain that accompanies other inflammatory conditions like neuralgia and arthritis may also be lessened by Ganoderma supplements.

· As far as benefits for the heart, Ganoderma can improve the flow of blood to the heart and reduce the amount of oxygen the heart consumes. It can help to lower cholesterol and some of the ingredients may help combat high blood pressure.

Ingredients in Ganoderma

So exactly what is in Ganoderma that give it so many health benefits? Scientists have learned one active ingredient is polysaccharides, which contain beta glucan. Beta glucan is known for its ability to enhance the immune system – in fact it is one of the strongest immune system supplements there is.

Another ingredient in Ganoderma is triterpenes. The type found in Ganoderma is a ganoderic acid that has been proven in studies to ease the symptoms of allergies by stopping the release of histamines. It also can improve the body’s use of oxygen and help the liver function better.

Prosperous Earth  is a variation of Liu Jun Zi Tang "Six Gentlemen Decoction from the "Revised Fine Formulae for Women" (Jiao Zhu Fu Ren Liang Fang). In turn, this formula is a variation of the famous Si Jun Zi Tang "Four Gentlemen Decoction" from the "Imperial Grace Formulary of the Tai Ping Era" (Tai Ping Hui Min He Ji Ju Fang) of 1078.

The ingredients of Prosperous Earth are:

Ren Shen Radix Ginseng
Bai Zhu Rhizoma Atractylodis macrocephalae
Fu Ling Poria
Chen Pi Pericarpium Citri reticulatae
Ban Xia Rhizoma Pinelliae
Zhi Gan Cao Radix Glycyrrhizae praeparata
Huang Qi Radix Astragali
Shan Yao Rhizoma Dioscoreae

The first six ingredients form the original formula Liu Jun Zi Tang. Ren Shen and Bai Zhu tonify Stomach- and Spleen-Qi; Fu Ling and Chen Pi resolve Dampness from the Middle Burner; Ban Xia resolves Phlegm; Zhi Gan Cao tonifies the Middle Burner and harmonizes.

I have added Huang Qi and Shan Yao to strengthen the tonic effect and also to strengthen Lung-Qi.

Patterns: Stomach- and Spleen-Qi deficiency, some Dampness in the Middle Burner.
Indications: Poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, slight depression, tendency to obesity, uncomfortable feeling in the epigastrium, lack of taste sensation, weak limbs, Pale tongue, Empty pulse.

Comments

Prosperous Earth  is the main remedy to tonify Spleen-Qi: although it resolves Dampness, the main emphasis is on tonification. However, it contains herbs that resolve Dampness because the simultaneous occurrence of Spleen-Qi deficiency and some Dampness is extremely common. It is not advisable to use tonic herbs in the presence of a Full condition of Dampness.

By Giovanni Maciocia

Ginkgo Biloba, also known as Maidenhair, has been traced back nearly 300 million years making it the oldest surviving tree species on earth! The Chinese have used the plant medicinally for eons but many of the modern applications come from the research of German scientists. Ginkgo is a prescription herb in Germany.

Ginkgo Biloba is especially good when combined with Panax Ginseng.

Ginkgo Biloba extract has proven benefits to elderly persons. This ancient herb acts to enhance oxygen utilization and thus improves memory, concentration, and other mental faculties. The herbal extract has also been shown to significantly improve long-distance vision and may reverse damage to the retina of the eye. Studies have also confirmed its value in the treatment of depression in elderly persons. The ginkgo extract may provide relief for persons with headache, sinusitis, and vertigo. It may also help relieve chronic ringing in the ears known as tinnitus.

In studies, Ginkgo Biloba has been reported as demonstrating anti-oxidant abilities with improvements of the platelet and nerve cell functions and blood flow to the nervous system and brain. It has also been reported as reducing blood viscosity. It's ability to increase vascular dilation, may help reduce retinal damage due to macular degradation and may reverse deafness caused by reduced blood flow.

Recently, extensive research on the herb has been conducted on the healing properties of the leaf extract. Germany and France have run literally hundreds of studies on the leaf extract. These studies along with similar studies in America, have shown significant results. The extract of Ginkgo Biloba has been studied for its effectiveness in the treatment of Acrocyanosis, Alzheimer's disease, Cerebral atherosclerosis, Cerebral insufficiencies, Cochlear deafness, Dementia, Depression, Menopause, Peripheral and cerebral circulatory stimulation, Peripheral vascular disease, Raynaud's syndrome, Retinopathy, Senility, Short-term memory loss, Tinnitus, Vascular Diseases, and Vertigo.

It is said to be effective in improving the blood flow to the hands and the feet as well as stimulating the brain and reducing short-term memory loss. It increases blood flow to the brain, the uptake of glucose by brain cells, and has been said to improve the transmission of nerve signals.

Depression

Patients suffering from varying degrees of vascular insufficiency also noted an improvement in mood while taking Ginkgo Biloba extract. This has prompted a surge of interest in its use as a treatment for depression, especially in the elderly. Many people have found Ginkgo Biloba to enhance other depression treatments and to often even prevent the need for pharmaceutical treatments in mild cases of depression. Those under the age of fifty may also benefit from ginkgo biloba's antidepressant effects. So far though, the greatest level of improvement has been noted with older patients.

Alzheimer's & Mental Function

As more than 300 studies demonstrate, Ginkgo Biloba facilitates better blood flow through out the body, most notably the brain, where it both protects and promotes memory and mental function, even for people with Alzheimer's disease. It also offers a wealth of possibilities in the treatment of many other common ailments.

Alzheimer's

Since doctors are still not sure what causes Alzheimer's disease, we do not have a definite idea of how Ginkgo Biloba works to stabilise, and in some cases, improve the quality of life for those suffering from this degenerative disease. Scientists have noted that Alzheimer's is marked by a major loss of nerve cells in the brain, particularly those in areas controlling memory and thinking. Since doctors have found antioxidants to help slow the destruction of nerves, it is not a stretch to see ginkgo's antioxidant properties helping in this area. The disease is also believed to have a connection to decreased blood flow to the brain. If so, ginkgo's vasodilating effects may be a big help in the treatment process. Either way, prominent doctors and scientists believe ginkgo to be the supplement of choice to help hold off and possibly treat Alzheimer's.


Antioxidant Properties

Although oxygen is essential for life, it can have adverse effects on your body. Unstable oxygen molecules can often be created during our body's normal break down and use of oxygen or can form in response to external factors and pollutants. These unstable molecules, called free radicals, can damage cells and structures within cells. If the genetic material in cells is affected and not repaired, it can replicate in new cells, contributing to cancer and other health problems. These free radicals may also weaken artery walls, allowing fatty deposits that can lead to hear disease. As an antioxidant, ginkgo biloba combats free radicals and repairs molecular damage. A great deal of research suggests that antioxidants such as Ginkgo Biloba may play important roles in preventing or delaying heart disease, cancer and other ills. Antioxidants may even halt the damage to cells, thereby slowing the effects of aging.

Impotency

Another use for Ginkgo Biloba is in the treatment of impotency. The main cause of male impotence is poor circulation and impaired blood flow through the penis, which is often the result of atherosclerosis. Since ginkgo biloba increases blood flow, it's been found to help up to fifty percent of patients after six months of use.

Raynaud's disease

Raynaud's disease is believed to be caused by blood vessels that over react to the cold and spasm, reducing blood flow and there by depriving extremities of oxygen. Ginkgo Biloba may help this condition by widening the small blood vessels, which would keep these spasms from completely blocking the blood flow.

Parkinson's Disease

The lack of dopamine is believed to produce the progressive stiffness, shaking and loss of muscle coordination typical in Parkinson's disease. Doctor's theorise that along with other treatments, Ginkgo Biloba may help symptoms by increasing the brain's blood flow and thereby allowing more of the depleted dopamine to be circulated to the areas that need it most.

Other Conditions

Other uses for which Ginkgo Biloba extract is often recommended include depression, diabetes related nerve damage and poor circulation, allergies, vertigo, short-term memory loss, headache, atherosclerosis, tinnitus, cochlear deafness, macular degeneration, diabetic retinopathy, and PMS.

Strokes

Scientists continue to study the prevention and treatment benefits to stroke patients that are attributed to Ginkgo Biloba. It's believed that by preventing blood clots from developing and increasing the blood flow to the brain, ginkgo biloba may help stop strokes from occurring. It's also believed that the herb inhibits free-radical damage of brain cells after a stroke.

Latin Names
Ginkgo biloba, Salisburia adiantifolia, Salisburia macrophylla

Common Names
Bai Guo, Ginkgo Nut, Japanese Silver Apricot, Kew Tree, Maidenhair Tree, Yinhsing

Properties
Antiinflamatorio, antioxidante, mejora el flujo sanguíneo, fortalece los vasos sanguíneos, relaja los pulmones, tónico del sistema circulatorio, vasodilatador

Indicado para:
Anti-inflammatory, Antioxidant, Improves blood flow, Strengthens blood vessels, Relaxes the lungs, circulatory system tonic, vasodilator

Indicated for:
Acrocyanosis, allergies, Alzheimer's & Mental Function, asthma, cerebral atherosclerosis and/or insufficiencies, cochlear deafness, cramp from walking, dementia, depression, diabetes related nerve damage and poor circulation, diabetic retinopathy, erectile function, headaches, impotency, improving circulation to the brain in the elderly, improving deafness, improving long-distance vision and possibly reversing damage to the retina, intermittent claudication, leg ulcers, macular degeneration, menopause, multiple sclerosis, Parkinson's Disease, peripheral and cerebral circulatory stimulation, peripheral vascular disease, PMS, poor circulation, Raynaud's disease, senile dementia, short-term memory loss, sinusitis, strengthening memory, strokes, tender or painful breasts, thrombosis, tinnitus, varicose veins, vertigo, white finger and spontaneous bruising.

Ginkgo Biloba can interfere with platelet aggregation and, as such, individuals taking anti-coagulants (blood thinners) or antithrombotic medicines, should seek professional guidance.

Individuals who take medications to prevent seizures and individuals who have ever had a seizure should avoid taking ginkgo.

Ginkgo should be avoided two days before and one to two weeks after surgery to avoid bleeding complications.

Ginkgo is not recommended during pregnancy, breast-feeding, or early childhood.

Blood stasis is a common and damaging pathogenic factor that is at the root of many serious diseases. A characteristic of Blood stasis is that it can only occur after a prolonged period of time: thus, it is always a relatively serious pathogenic factors and one that leads to more serious diseases than Qi stagnation: for example, coronary heart disease, abdominal masses, tumours, high blood pressure, stroke, etc. By definition, Qi stagnation cannot, by itself, cause any of the above problems. Thus, whenever we see signs of Blood stasis, we know that the condition is one of long duration and the prognosis is less good than that for Qi stagnation.

1. AETIOLOGY

Blood stasis never arises independently (like Qi stagnation) but is always the consequence of other conditions, usually after a long period of time. Thus, there are no aetiological factors (diet, emotions, etc.) that give rise to Blood stasis by themselves as Blood stasis itself arises from other conditions. The conditions giving rise to Blood stasis are as follows:

Qi stagnation - LIV - HE
Internal Cold - Uterus - ST - HE
Heat or Fire - ST - INT - HE - LIV - UT
Qi deficiency - ST - HE
Blood deficiency - Uterus - HE, LIV
Phlegm - ST - INT - Uterus


2. PATHOLOGY

Blood is related to Qi and to Body Fluids. It is related to Qi first of all because Blood itself is a (very dense) form of Qi and secondly because it relies on Qi for its movement. "Qi is the commander of Blood; when Qi moves, Blood moves. Blood is the mother of Qi; where Blood goes, Qi goes". On the other hand, Blood is part of Body Fluids and is formed from them (with the participation of Gu Qi). Thus, both Qi and Body Fluids pathology may play a role in Blood stasis. For example, Qi stagnation is a very common cause of Blood stasis, while a pathology of the Body Fluids, such as Phlegm, may also lead to Blood stasis. Another pathology of Body Fluids leading to Blood stasis occurs when Heat or Fire condense the Body Fluids and make the blood more dense, leading to Blood stasis. We can review the pathology of the various causes of Blood stasis.

1) Qi stagnation
Qi is the commander of Blood and Blood relies on the pushing action of Qi for its movement; any Qi stagnation may lead to Blood stasis after some time.

2) Internal Cold
Both Full Cold and Empty Cold obstruct the movement of Qi and Yang and may lead to Blood stasis; this also occurs because Cold congeals Blood.

3) Heat or Fire
Heat or Fire injure and condense the body fluids and therefore Blood since Blood is part of body fluids. This may occur in the Heart, Liver, Stomach, Lungs, Intestines and Uterus.

4) Qi deficiency
Qi deficiency may lead to Blood stasis because deficient Qi fails to move and transport and may lead to Qi stagnation and Blood stasis.

5) Blood deficiency
Blood deficiency may also lead to Blood stasis because Blood is the mother of Qi, when Blood is deficient, Qi is also usually deficient, Qi fails to move Blood and Blood stasis ensues. A simultaneous Blood deficiency and stasis is more common in women.

6) Phlegm
There is a strong interaction between Phlegm and Blood stasis as both are pathologies of Body Fluids. Phlegm is a pathological accumulation of turbid fluids, while Blood stasis is a pathological accumulation of Blood; since there is an interchange between Blood and Body Fluids, Blood stasis and Phlegm interact with each other and aggravate each other. A simultaneous condition of Blood stasis and Phlegm is common in the elderly and it is a particular pernicious combination leading to serious diseases which are difficult to treat.

The first three aetiological factors are the most important ones.

CONSEQUENCES OF BLOOD STASIS
Blood stasis can itself become a cause of disease. The four consequences of Blood stasis may be:

Blood deficiency
Bleeding
Dryness
Qi deficiency

3. DIAGNOSIS
The main manifestations of Blood stasis are:

Pain
Swellings, lumps, tumours, masses
Colour purple
Purple tongue
Dark complexion
Dry nails and hair
Bleeding
Maculae
Stiffness
Dreaming a lot
Poor memory
Dark moles
Dark eye sockets
Purple nose bridge
Purple venules visible under the skin, often on the legs
Umbilicus bulging out
Hardness of the abdomen on palpation
Enlarged ends of fingers and toes
Skin not elastic, lustreless, dark, scaly, dry
A history of chronic illness with repeated bouts
Adhesions and scars from surgery
Poor memory
Pulse. The pulse indicating Blood stasis may be Wiry, Firm or Choppy
Irregular periods, painful periods with dark clots, hesitant start to periods, periods starting and stopping, infertility
Fever (sometimes)
Mental restlessness
Thirst with desire to gargle but not to swallow
Abdominal pain


4. TREATMENT PRINCIPLES AND METHODS

a) BEN-BIAO and XU-SHI

Blood stasis is always the Manifestation (Biao) of a condition because it arises from other conditions such as Qi stagnation, Cold, Heat, etc. Blood stasis is a Full condition by definition. Thus, the question arises how to approach a patient who suffers from Blood stasis (Full-Biao) but also from an underlying condition that is the Ben (which, itself, may be Xu or Shi).

The Ben of Blood stasis may be a Deficiency (of Qi or Blood) or a Fullness (Cold, Heat or Phlegm). Thus, treating Ben consists in either tonifying Qi and Blood or in scattering Cold, clearing Heat or resolving Phlegm. Since Blood stasis is always a chronic condition, generally speaking one needs to treat both Ben and Biao simultaneously. However, especially when herbal medicine is used, the question arises whether one should start with a formula to invigorate Blood modifying it to treat the Ben, or start with a formula to treat the Ben modifying it to invigorate Blood. The answer is simple: in more acute cases when the symptoms and signs of Blood stasis predominate, start with a modification of a formula to invigorate Blood and eliminate stasis; in more chronic cases when the symptoms and signs of Blood stasis are less pronounced, start with a modification of a formula that treats Ben. My personal inclination, however, is always to clear pathogenic factors first, i.e. in the case, invigorate Blood and eliminate stasis.


5. THREE TREASURES REMEDIES FOR BLOOD STASIS

STIR FIELD OF ELIXIR
This is a variation of Ge Xia Zhu Yu Tang Eliminating Stasis Below the Diaphragm Decoction. It is used for Blood stasis in the Lower Burner. This is very common in women. It may therefore be used for painful periods from Blood stasis.

INVIGORATE BLOOD AND STEM THE FLOW
This is a very useful remedy in gynaecological conditions. It simultaneously invigorate Blood and stops bleeding. This action is very useful as bleeding from Blood stasis is a common occurrence in gynaecological conditions. For example, this occurs frequently in endometriosis when the periods are very painful and the menstrual blood has dark clots (Blood stasis) but the periods are also heavy. Paradoxically, Blood stasis may aggravate heavy bleeding as the stagnant blood obstructs the uterus so that new blood has nowhere to go and leaks out. In all these cases, the remedy Invigorate Blood and Stem the Flow is very useful.. It is best used in phases 4 and 1.

HARMONIZING THE MOON
This remedy is specific for endometriosis. It not only invigorate Blood but it also "breaks" Blood and dissolves masses. It is used for endometriosis because the endometriosis lesions are considered a form of Abdominal Masses (zheng jia) from Blood stasis.

CLEAR THE ROOT
Clear the Root is not specific for Blood stasis as it also resolves Phlegm and Dampness and clears Heat. However, it also invigorates Blood in the prostate.

By Giovanni Maciocia

More Blood Stasis Formulas:

XUE FU ZHU YU TANG  (Indications: Cardiovascular disorders, such as coronary artery disease (CAD), angina pectoris, and rheumatic heart disease, chondrocostritis, external injury to the chest, and various psychiatric disorders, such as mood disorders, sleep disorders, palpitations, anxiety, agitation, insomnia, a feeling of anxiety at bedtime, irritability, mental confusion, depression, postconcussion syndrome, chronic stabbing headaches, etc.)

FU FANG DAN SHEN PIAN (Indications: heart disease, endocarditis, myocarditis, angina pectoris, bruising and pain of traumatic origin, fixed pain, persistent, severe, acute, sometimes worse at night, and that radiates to the left arm (myocardial infarct) hypertension, palpitations.)

Prosperous Earth  is a variation of Liu Jun Zi Tang "Six Gentlemen Decoction from the "Revised Fine Formulae for Women" (Jiao Zhu Fu Ren Liang Fang). In turn, this formula is a variation of the famous Si Jun Zi Tang "Four Gentlemen Decoction" from the "Imperial Grace Formulary of the Tai Ping Era" (Tai Ping Hui Min He Ji Ju Fang) of 1078.

The ingredients of Prosperous Earth are:

Ren Shen Radix Ginseng
Bai Zhu Rhizoma Atractylodis macrocephalae
Fu Ling Poria
Chen Pi Pericarpium Citri reticulatae
Ban Xia Rhizoma Pinelliae
Zhi Gan Cao Radix Glycyrrhizae praeparata
Huang Qi Radix Astragali
Shan Yao Rhizoma Dioscoreae

The first six ingredients form the original formula Liu Jun Zi Tang. Ren Shen and Bai Zhu tonify Stomach- and Spleen-Qi; Fu Ling and Chen Pi resolve Dampness from the Middle Burner; Ban Xia resolves Phlegm; Zhi Gan Cao tonifies the Middle Burner and harmonizes.

I have added Huang Qi and Shan Yao to strengthen the tonic effect and also to strengthen Lung-Qi.

Patterns: Stomach- and Spleen-Qi deficiency, some Dampness in the Middle Burner.
Indications: Poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, slight depression, tendency to obesity, uncomfortable feeling in the epigastrium, lack of taste sensation, weak limbs, Pale tongue, Empty pulse.

Comments

Prosperous Earth  is the main remedy to tonify Spleen-Qi: although it resolves Dampness, the main emphasis is on tonification. However, it contains herbs that resolve Dampness because the simultaneous occurrence of Spleen-Qi deficiency and some Dampness is extremely common. It is not advisable to use tonic herbs in the presence of a Full condition of Dampness.

By Giovanni Maciocia

I recently received an email from a colleague asking for a help with a patient suffering from chronic fatigue syndrome.  The colleague was asking about the treatment principle to apply.  The patient obviously suffered from a deficiency of Zheng Qi, as all patients with chronic fatigue syndrome do.  But she also had frequent acute invasions of Wind.

The colleague was rightly following the principle that, in the presence of an acute invasion of Wind, one must expel pathogenic factors, in this case expelling Wind, and not tonify Zheng Qi.  In between invasions of Wind, the correct treatment principle is to tonify Zheng Qi, and this what the colleague was doing.

However, the problem was that the patient suffered from very frequent invasions of Wind, so that there was hardly any time to tonify Zheng Qi for a prolonged time.  She was using Three Treasures remedies i.e.  Expel Wind-Heat (a variation of Yin Qiao San) during the acute invasions of Wind and Herbal Sentinel to tonify Zheng Qi in between the acute attacks.

She wrote to me to ask whether taking Herbal Sentinel (i.e. a Qi tonic) during an acute invasion of Wind could strengthen the pathogen.  She was also wondering whether one can go on taking Expel Wind-Heat for prolonged periods as the patient had times when she went from one acute illness to the next, so she could be taking Expel Wind-Heat for weeks, and my colleague was wondering whether this could deplete her Qi or Yin.

Her second question was whether taking Herbal Sentinel during an acute invasion of Wind could strengthen the pathogen.

I will try and answer here her questions.

1) Can one take a remedy that expels exterior Wind for prolonged periods?

The answer is basically: "no".  Remedies that expel exterior Wind (such as Expel Wind-Heat or Yin Qiao San) by definition should be taken only during an acute invasion of Wind for a few days.  After a few days or a week, either the exterior Wind has been expelled or the pathogenic factor has penetrated into the Interior at which time the patient needs a different treatment.

However, chronic fatigue syndrome presents a different situation and one that is not contemplated in Chinese books.  I have never seen a discussion of chronic fatigue syndrome in any Chinese book: indeed, a Chinese journal years ago published a translation of an article I wrote on chronic fatigue syndrome.

In my experience, chronic fatigue syndrome is characterized by a prolonged course of the disease with deficiency of Zheng Qi and frequent invasions of exterior Wind.  However, the exterior pathogen in such patients is "weak" and it is weak precisely because of the prolonged course of the disease and the prolonged deficiency of Zheng Qi.

So, in such cases, the patient may need to take a remedy that expels exterior Wind frequently, e.g. for a week every few weeks or so.  However, because the pathogen is weak, one can use a small dose such as for example only three tablets of Expel Wind-Hea a day.

2) Can tonifying the Zheng Qi also tonify an exterior pathogen?

Again, in theory "yes".  However, again, chronic fatigue syndrome is an exception.  As the deficiency of Zheng Qi is very prolonged and the pathogen "weak", during invasions of exterior Wind in chronic fatigue syndrome, I do occasionally combine expelling exterior Wind with Expel Wind-Heat (Yin Qiao San) with tonifying Qi with Herbal Sentinel, both in small doses.  For example, I might use 3 tablets or Herbal Sentinel in the morning and 3 tablets of Expel Wind-Hea in the evening.

Note: Herbal Sentinel is a tonic of Lungs and Kidneys to strengthen Zheng Qi and prevent invasions of Wind.   There are two variations of it: Herbal Sentinel-Yang for patient with a tendency to Yang deficiency and Herbal Sentinel-Yin for patients with a tendency to Yin deficiency.

By: Giovanni Maciocia

TO TONIFY OR TO EXPEL: THAT IS THE QUESTION

Since the beginning of the history of Chinese herbal medicine, there has been an ongoing debate between different schools of thought as to whether one should tonify or expel. Lui Wan Su (1110-1200), a chief exponent of the School of Cooling, emphasized the necessity of clearing Heat and Fire. Zhu Dan Xi (1281-1358) said that nourishing Yin is the most crucial treatment principle because Yin is depleted by overwork. The School of Eliminating Pathogenic Factors, led by Chang Cong Cheng (1156-1228) advocated vomiting, sweating, purgation and even inducing salivation, sneezing and lachrymation as a way of expelling pathogenic factors, in his view the cause of most pathologies. Li Dong Yuan, the author of the celebrated “Discussion on Stomach and Spleen” (Pi Wei Lun) said that most diseases are caused by a deficiency of Stomach and Spleen induced by overwork and irregular diet and therefore advocated tonifying the Stomach and Spleen as the most important treatment method.
Therefore, it is important to be aware that there is no “set answer” as to when to tonify and when to expel and that one must examine each individual case and come to a decision based on the symptoms and signs of that patient using our own knowledge and judgement.

EMPTY CONDITIONS

Tonics are obviously applicable when a patient suffers from a predominantly Empty condition, manifesting with a deficiency of either Qi, Blood, Yin or Yang, or a combination of any of these. It is important always to bear in mind that we must diagnose whether a condition is Full or Empty mainly from taking the pulse and observing the tongue. For example, a 50-year-old man may complain of tiredness, depression and exhaustion but, on taking his pulse, we find it is Full and Wiry. Therefore we can deduce that his symptoms derive from a Full rather than an Empty condition and it would not be applicable to tonify either with acupuncture or herbs.

CAUSES OF DISEASE IN EMPTY CONDITIONS

As mentioned above, some schools of thought believe that, theoretically, we should never need to prescribe herbal tonics if we ate a proper diet and balanced work and rest in a good way. So this implies that, even eight or nine hundred years ago, humans had a tendency to work too hard, not rest and not eat a good diet, rather than this being a purely 21st century phenomenon! Today, of course, few people live in a way which is health-enhancing and therefore it is often necessary to tonify with herbal medicine. The following are the most commonly seen factors which deplete a patient's energy
1.    Poor diet: our post-natal Qi is mostly affected by what we eat. Eating on the go and eating the wrong foods weaken our Qi. A striving to be "fashionably thin", causing patient's to eat too little or follow fad diets generally leads to a deficiency of Qi and Blood. Patients who have been vegetarian for a long time and have not included good quality protein in their diet often present with severe Blood or Yin deficiency.
2.    Overwork: working long hours and always being on the go depletes our Yin energy. This view was proposed by Zhu Dan Xi (a chief exponent of the School of Yin-Nourishing) in the 14th century and still very much applies to our society today. Many patients leave home at 6am and return at 10pm and expect not to be physically effected by this. Excessive mental work depletes Spleen-Qi and eventually Spleen-Blood. This is commonly seen in practice in students who are studying long hours or those in professions where a lot of mental work is needed.
3.    Emotions: over-thinking and worry deplete Spleen-Qi and Blood. Fear depletes Kidney-Yin and/or -Yang. Grief and sadness deplete Lung-Qi. All these emotions, as well as many others, are widespread in today’s society.
4.    Excessive sexual activity: injures the Kidneys, especially Kidney-Yin (more in men than in women).
5.    Miscellaneous: there are many other "habits" of the Western world today which are severely depleting. For example, women who work hard throughout their pregnancy and go back to work soon after the baby is born will often develop Kidney deficiency and Blood deficiency; excessive exercise, done in the name of "keeping fit" (especially running) consumes our Yang energy.

YANG TONICS

Strengthen the Root
Pattern: Kidney-Yang deficiency, Fire of the Gate of Vitality declining, slight Blood deficiency
Action: Tonify and warm Kidney-Yang, stoke up the Fire of the Gate of Vitality, fill the Essence, nourish Blood, strengthen the Will-Power
Indications: Chilliness, cold feet, cold limbs, lower backache, weak knees, dizziness, tinnitus, depression, exhaustion, impotence, lack of libido, loose stools, pale urination, oedema, lack of drive
Tongue: Pale, Wet
Pulse: Deep-Weak

Unicorn Pearl
Pattern: Kidney-Yang deficiency, Essence deficiency
Action: Tonify and warm Kidney-Yang, nourish the Essence, strengthen the Governing, Directing and Penetrating vessels
Indications: Infertility, backache, dizziness, tinnitus, feeling cold, a history of amenorrhoea, or scanty periods, irregular periods, frequent pale urination, tiredness, depression, a history of miscarriages, pale complexion.
Tongue: Pale, wet
Pulse: Deep, weak

Strengthen the Root is a general Kidney-Yang tonic which may be used for men or women.

Unicorn Pearl is also Kidney-Yang tonic but is specifically for women with gynaecological problems deriving from Yang deficiency.

YIN TONICS

Nourish the Root
Pattern: Kidney-Yin deficiency
Action: Nourish Kidney-Yin and Essence, strengthen the will-power
Indications: Dizziness, tinnitus, sore back and legs, night-sweating, dry mouth and throat in the evening, feeling of heat, 5-palm heat, thirst, lower backache, depression, scanty-dark urine, dry skin and hair, dry stools.
Tongue: Red with rootless coating or no coating
Pulse: Floating-Empty or Weak on both rear positions.

Central Mansion and Prosperous Earth are similar remedies; however, Central Mansion is applicable when the patient has Qi deficiency with some Dampness but also tends towards Yin deficiency. Prosperous Earth, on the other hand, treats solely Qi deficiency.

BLOOD TONICS

Precious Sea
Pattern: Qi and Blood deficiency, Kidney deficiency
Action: Tonify Qi, nourish Blood, tonify the Kidneys
Indications: Tiredness, debility, weariness, depression, loose stools, poor appetite, blurred vision, tingling of limbs, insomnia, poor memory, dizziness, scanty periods or heavy periods, amenorrhoea, irregular periods, pale complexion, palpitations, backache, low libido, infertility.

Brighten the Eyes
Pattern: Deficient Liver-Blood and Kidneys not nourishing the eyes
Action: Nourish Liver-Blood and the Kidneys, brighten the eyes
Indications: Dull headaches around the eyes and eyebrows, blurred vision, floaters, gritty eyes, tired eyes, dry eyes, dizziness, tiredness, dull-pale complexion, scanty periods, depression, insomnia, tingling limbs, poor memory, dry hair.
Tongue: Pale, especially on the sides, thin
Pulse: Choppy or fine.

Growing Jade
Pattern: Kidney-Yin and Essence deficiency
Action: Nourish Kidney-Yin, nourish the Essence, strengthen the Directing and Penetrating vessels.
Indications: Infertility, a history of amenorrhoea or miscarriages, scanty periods, irregular periods, dizziness, tinnitus, a dry throat, a feeling of heat in the evening, backache, depression, slight anxiety, dry stools, dry hair, scanty-dark urine, night-sweating, malar flush.
Tongue: Red without coating
Pulse: Floating-Empty

Jade Spring
Pattern: Stomach-Yin deficiency, Spleen-Yin deficiency, Lung-Yin deficiency, Stomach-Empty Heat
Action: Nourish Stomach-, Spleen- and Lung-Yin, clear Stomach Empty Heat
Indications: Excessive hunger, dry mouth, desire to drink in small sips, dry lips, tiredness, mental restlessness, poor digestion, slight burning epigastric pain, mouth ulcers, dry stools.
Nourish the Root is a general Kidney-Yin tonic which may be used for men or women.

Growing Jade is a Kidney-Yin tonic which is specifically for women=s gynaecological problems.

Jade Spring is a Yin tonic, but for the Stomach, Spleen and Lungs rather than the Kidneys.

QI TONICS

Prosperous Earth
Pattern: Spleen-Qi and Lung-Qi deficiency, Dampness
Action: tonify Spleen-Qi and Lung-Qi, resolve Dampness
Indications: poor digestion, tiredness, slight abdominal distension and fullness, poor appetite, craving for sweets, loose stools, desire to lie down, weak voice, propensity to catching colds, mild depression
Tongue: Pale
Pulse: Weak or Empty

Central Mansion
Pattern: Spleen- and Stomach-Qi deficiency, Stomach- and Spleen-Yin deficiency, Dampness in the Middle Burner, Lung-Qi deficiency
Action: Tonify Stomach- and Spleen-Qi, nourish Stomach- and Spleen-Yin, resolve Dampness, stop diarrhoea, tonify Lung-Qi.
Indications: Loose stools, diarrhoea, poor appetite, poor digestion, a slight feeling of fullness and heaviness of the epigastrium, nausea, weakness of the limbs, epigastric pain, tiredness, late onset diabetes.
Tongue: Pale, slightly Swollen, sticky but thin coating which may be rootless, Stomach crack or cracks.
Pulse: Weak in general, slightly slippery

Brocade Sinews
Pattern: Chronic Wind-Damp Painful Obstruction (Bi) Syndrome with Liver-Blood and/or Liver-Yin deficiency
Action: Nourish Liver-Blood and Liver-Yin, benefit sinews, expel Wind-Dampness from the joints.
Indications: chronic soreness and slight swelling of the joints, dizziness, numbness or tingling of limbs, poor memory, insomnia, dry skin and hair, dry eyes, blurred vision.
Tongue: Pale and thin or Red and thin without coating
Pulse: Choppy or fine, possibly only on the left side.

Precious Sea is specifically for any gynaecological problem that derives from Blood deficiency.

Brighten the Eyes is for Blood deficiency which manifests with symptoms in the head, and specifically in the eyes.

Brocade Sinews is for Bi syndrome with an underlying Blood or Yin deficiency.


By Giovanni Maciocia