Congestive Heart Failure

CHF is a disease which we read a lot about in the USA, and learn how to treat, but rarely see a patient with it. The other day, a 75 year old man came in complaining of chest pain, heart palpitations, and feeling weakness in the legs. His hands and legs were swollen. He had previously been diagnosed with coronary artery diseases. That day, his pulse was fast at 88BPM. He also had a poor appetite, bitter mouth, and shortness of breath when lying flat. His tongue was very red with a thick yellow fur. This was a classic presentation of CHF and a TCM diagnosis of qi and yin deficiency with phlegm fire.

Although Dr. Wang wanted to warm the heart yang to move the water using the formula ling gui zhu gan tang, she knew that he had too much heat and maybe could not take the large dose of gui zhi. Therefore, she used began the treatment with dan shen yin combined with zeng ye tang to move chest stasis and nourish the yin, adding a little gui zhi to test his ability to handle the herb. When he comes back, it is better, she may increase the dose to warm yang and clear the stasis.

Gall Bladder Disease

Yesterday I saw a very interesting case. Many patients come to Dr. Wang for the treatment of abdominal pain and bloating from gall bladder infection, inflammation, and stones. This particular patient was returning to see the doctor. Previously, he was diagnosised with gall bladder disease from a paracytic worm infection. Dr. Wang had prescribed the herbal formula wu mei wan without western medicine.

His digestions was alot better, while the pain was reduced, he still had pain. During this checkup, Dr. Wang ordered an ultrasound to see the condition of GB. Remarkably, the ultrasound revealed that the worms in his gall bladder were dead, killed probably by the wu mei wan. The pain was from stones which remained in his gall bladder. Therefore she prescribed the herbal formula si jin tang with jin qian cao, hai jin sha, ji nei jin, and yu jin to break up the stones, added yi mu cao to activate the blood and drain dampness.

Internal Medicine

I've been in the internal medicine department for two weeks now. Internal medicine in China is only herbal prescriptions, there is no acupuncture or massage. Because Chinese medicine doctors in China can use both Western and Chinese medicine, these doctors use a lot of medical tests- blood tests, x-rays, CT-scans, MRI's, and anything else. One reason is to help them understand the disease, but also they are the PCP of these patients, so they need to know if the patient needs additional intervention.

It is just as busy as the acupuncture, seeing 20-30 patients per day, mostly coming in with GI, kidney, and respiratory diseases, but also a handful of stroke, endocrine, and random other problems. These disease range from ones we mostly read about in the USA, such as the acute one set of stroke, hepatitis B and gallbladder disease, as well as random infections diseases such as schistosomiasis, to others which we see daily in the USA such as back and neck pain, common cold, colitis, ulcers, and prostatitis.

My teacher, Wang Xiao Jun, is a seasoned internal medicine doctor. She loves to explain her diagnosis and formulas, as well as quiz my knowledge. Her formulas are quite elegant with a seamless flow between applying the diseases and symptoms to traditional theories as well as modern science. In short, her formulas are hen lihai (literally very fierce, but can be understood to be awesome, great, or rocking). She is a strong advocate of the theory that chronic diseases cause qi vacuity and blood stagnation, so she frequently ads yu jin or dan shen to formulas as well as dang shen and bai zhu, even when there is no obvious blood stasis signs nor signs of qi vacuity. Her prescriptions often contain a many combinations of treatment methods, aromatic herbs with cold draining herbs to help digestion, qi and blood tonifiers combined with moving herbs, and digestive herbs with blood movers.

The use of the San Fu

Here is something I just wrote up about the treatment of winter diseases in the summer by using the San Fu, the days of most intense heat. This year it was July 20th, July 30th, and August 9th. They are all 10 days apart.
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As an acupuncture student in New York, many of my teachers told me of the ancient tradition of dong xia bing zhi ( the treatment of winter diseases in the summer). An external plaster, consisting of heating herbs, is applied to specific acupuncture points during the San fu, the three summer days of the most intense heat, in order to treat disease of chronic and cold nature often occurring in winter. This tradition of preventative medicine is most often for diseases that are worse in the winter, such diseases of the respiratory system, childhood disease, those with weak constitutions, and chronic pain such as arthritis. After three summers of treatment during the three hottest days, the disease should be cured or significantly better.

I was lucky enough to see this tradition in action here in Changsha at the Hunan University of TCM hospital. Hunan doctors, as well as the patients, are still dedicated to using classical theories and treatments. It is fitting that Changsha, the capital of Hunan, is the city where Zhang Zhong Jing wrote the seminal work, the Shang Han lun (Treaties on Cold Diseases) while he was the governor of this province almost 2000 years ago.

During each of the San Fu, the front lobby was filled capacity with hundreds, if not a thousand people, of all ages waiting for their treatment for their chronic cold diseases. They left the hospital, receiving the herbal plaster patch on points such as Lu 1, Ren 22, and Ub 13 for asthma, Ren 4, Du 4, and UB 23 for kidney deficiency back pain or frequent colds, many with arthritis received application on local ashi points and those with digestive complains used ST 36. Interestingly, these people were not all small and frail, but a number of healthy looking men and women also received treatment, mostly for chronic pain.

As an American overseas student in Hunan, one could say I don't blend in with the crowd. Many patients, proud of their culture's medical tradition, came over to me to report how their diseases were improving. One woman in her 60's told me this is her second year coming for treatment and her bronchitis was much better even after the first treatment and her husband said it helped his back pain. A mother of a 10 year old girl informed me this was the third year of bring her daughter in for treatment, not only is her digestion much better than before, but her frequent winter colds and cough have been reduced to a one a year. Another women in her sixties told me her neck pain, in combination with acupuncture treatment, is now under control.

In Chinese medicine school, we are often taught to avoid excess heating during the summer. However, this is the exception. The treatment is based on the principle "in the summer, nourish yang, in the winter nourish yin." Warm and pungent herbs are used to disperse cold and transform phlegm, warm the lungs, boost the kidney, and secure the root of qi. The tradition says that the use of warming herbs on these special times allow us to treat the root of the disease rather than the branch, therefore eliminating the disease or preventing the symptoms before the winter arrives. Chronic diseases will take a long time to treat, therefore patients should come on each of the San Fu for 3 consecutive years.

This treatment is good for all diseases cold in nature. Respiratory diseases such as chronic bronchitis, asthma, chronic cough, emphysema, those who are easily chilled or catch frequent colds, chronic rhinitis, sinusitis and pharyngitis, in addition patients with a generally weak constitution. This is particularly true for the elderly and children under the age of 14 who suffer from respiratory diseases. Other diseases include chronic diarrhea and enteritis, arthritis caused by cold dampness particularly in the elderly, dribbling or frequent urination, numbness, facial paralysis, and sequel to stroke.

Often referred to as cold moxa- because of the warming effect of the herbs although there is no actual heat added- the formula consists of warming and pungent herbs. There are many possible formulas for this treatment, formula used at the Hunan university was designed by doctors in the acupuncture and internal medicine department, and includes rou gui, zhi fu zi, xi xin, chen xiang, zhi chuan wu, gu sui bu, as well as other herbs. On each of the San fu, apply a small amount on relevant acupuncture points which the pracitioner can individualize for each patient. If you patient cannot come in on the San fu, they plaster can be applied on the day directly before or after the fu. Common points are back shu points, front mu points, points of the du and ren, as well as frequently used acupuncture points for regions of the body (ie St 36 for stomach diseases, LI 4 for diseases of the face) and local ashi points for pain syndromes.

The procedure is simple, but we must be cautious in the preparation of the plaster and the education of our patients. Before applying the plaster, clean the skin. Use gauze or a small bandage to apply a amount slightly smaller than a quarter, do not overfill as all the herbal plaster will fall out. Before applying, the practitioner must inform the patient that these hot herbs may irritate the skin and may cause a burn or a blister. Obviously, this plaster is only for external use, as most of the herbs are extremely toxic, and patients should be instructed to be careful about washing their hands before eating. The plaster should be left on for 4-6 hours. The appropriate feeling is a warming and tingling sensation, when the plaster is dry it can be removed. However, if they feeling a burning or painful sensation, the application should be removed to avoid irritation.

Any patient with decreased sensation, such as those with diabetes and some elderly individuals, should avoid the treatment as they may not detect if their skin is being irritated or burnt. If the patient has a skin disease, allergies to the herbs, recent vomiting or significant bleeding, is pregnant, or has other heat conditions, the treatment should also be avoided. After applying the herbal moxa, patients should be instructed not to eat cold, fatty, sweet, or greasy food. They should avoid seafood for the day as well as spicy pungent foods. If a blister or burn occurs, the patients should keep the area dry and clean, and do not pop the blister. If necessary, they should consulate there acupuncturist or physician.