Diabetes Mellitus Treatment in TCM

25.8 million people in the United States, 8.3% of the total population, have diabetes. It's one of the most prevalent chronic diseases in the country, and it's also one of the most preventable causes for heart disease, high blood pressure, blindness, kidney disease, neuropathy, and amputations. We spent $245 billion on diabetes patients last year with most of that going directly towards treatment. Traditional Chinese Medicine offers an effective and much cheaper alternative to managing diabetes.


Diabetes in Chinese Medicine

Traditionally, diabetes is characterized as xiao ke, wasting and thirsting disorder, but because of the most common symptoms experienced, it is often called duo shi, profuse eating, duo yin, profusing drinking, and duo niao, profuse urination. Diabetes, like most conditions we treat, can stem from several possible causes, according to Chinese medicine. These include congenital essence deficiency, aging, unregulated eating and drinking, and internal damage by the seven affects (meaning lifestyle and emotional factors).

In juvenile-onset diabetes, the cause is attributed to an insufficiency of the essence naturally endowed to newborns from their parents during fertilization. Whenever there is a congenital deficiency of jing, the most primary essence which we store in the Kidney, the child has an inherent tendency towards disease. This can be anything from developmental delays to scoliosis to diabetes (type 1). The nature of the disorders that manifest depend on the quality of jing from the parents, and many, though not all, can be overcome with early treatment.

Adults who develop diabetes later in life typically have a pattern of long-standing heat in the Stomach coupled with Spleen deficiency. The heat may come from over-eating hot, spicy, greasy,

fatty, rich foods or alcohol or from depressive heat of the Liver affecting the Stomach; this causes a large appetite and rapid hungering after meals. The Spleen deficiency may be due to over-eating
sugars and sweets or fatty, rich food, as well. It could also be from over thinking, too little exercise, or over taxation of the body. Spleen deficiency allows for the accumulation of dampness in the body causing obesity. Long-standing Spleen deficiency also accounts for the emaciation and muscular atrophy later in the progression of the disease. Enduring heat eventually damages and consumes the yin fluids of the Stomach and Lung causing thirst. If Lung yin deficiency reaches the Kidney and is complicated by yin deficiency from aging, Kidney yin deficiency may develop. Spleen qi deficiency may develop into Kidney yang deficiency over time. Dual vacuity of Kidney yin and yang can lead to urinary problems and impotence. Chronic deficiency with damp accumulation gives rise to Blood stagnation and a lack of nourishment of organs and tissues, accounting for the neuropathy of the muscles and optic nerves.

Treatment

Treatment of diabetes, particularly type 2, will focus on strengthening the Spleen and Kidney and regulating and transforming dampness. These are the most common aspects of the disease pattern we see clinically, but variations may include: Lung and Stomach heat accumulation with damage to fluids, exuberant Stomach heat, dual deficiency of qi and yin, Kidney yin deficiency, Spleen-Stomach qi deficiency, damp heat obstructing the center, and Spleen-Kidney yang deficiency. Liver qi stagnation and Blood stasis often accompany the main pattern.

Acupuncture and moxibustion are very efficient at bolstering Spleen function, but due to the chronic nature of the disease, most patients choose herbal medicine as a more cost-effective treatment for diabetes. Taking an herbal formula also addresses the condition daily rather than intermittently as with acupuncture. A daily regiment of herbal medicinals helps to treat the condition from the inside on a molecular level and helps to manage blood sugar levels.

Our most commonly used formula for the treatment of diabetes is called Jiang Xue Yuan Jian. It contains Huang Qi, Shu Di Huang, Xuan Shen, Tu Si Zi, Cang Zhu, Nu Zhen Zi, Fu Ling, Zhu Ling, Huang Jing, and Shan Yao. The synergistic effect of the ingredients work to fortify the Spleen, nourish the Kidney, regulate body fluids and transform damp accumulation, quell fire, and redirect heat to warm the yang. It's a good balance of augmentation, dissipation, and harmonization. Patients are able to report normalized blood sugar levels, increased energy, and, in many cases, weight loss and better weight management (though the most significant results are seen in patients willing to make dietary and lifestyle changes).

Lastly, acupuncture and herbs are amazingly effective at healing diabetic ulcerated wounds. In addition to managing the diabetes, there are acupuncture and herbal techniques for healing and regenerating flesh. Getting an open sore to close, finally, and preventing a gangrenous infection can be the difference between a patient continuing to walk or losing a foot. Seems like an easy choice!

 

Supporting Athletes and Performers

As Holistic healthcare practitioners, we place great importance on investing in the health of the community.  It is in this spirit that Meridian will be sponsoring local athletes and performers, using Chinese medicine to support their training and artistic pursuits.

During the spring and summer seasons, we sponsored local athlete Luke. We diagnosed and treated Luke with acupuncture and Chinese herbal medicine to aid him as he competed in numerous marathons, triathlons, and, most recently, his second Ironman competition in Louisville. Luke didn't have specific complaints but wanted to care for his body during his intense training. We focused on boosting energy and endurance, strengthening immunity, and promoting joint health. This helped him to avoid tendon and ligament injuries, recover from workouts faster, and stave off adrenal fatigue over the many months of training and conditioning. We'll get in to specifics below, as we are taking a similar approach with our new athlete, but you can read about Luke's experience and journey in his blog http://lukeapowell.blogspot.com/.


For the fall and winter seasons, we will be working with a local young performer. Jessica is a 22 year old ballerina and teacher with the Louisville Ballet Company. Anyone who's ever done any formal dancing or Pure Barre workouts knows how intense the training regiment for ballet is. It requires high levels of strength, agility, and flexibility, and the body must be in prime condition. She came to Meridian presenting with calf pain and cramping, muscle fatigue, and plantar fasciitis. Doctors weren't able to offer any relief, and the only thing that reduced the pain was taking breaks from dancing - that's not an option!

Her pain was deep within the calf and extended down from the back of knee to the Achilles tendon attachment. Upon palpation, her Kidney and Spleen Meridians were tight, and her Kidney Meridian also had palpable nodulations. The Liver Meridian was thin and warm to the touch, while the Stomach Meridian was tight and warm. Her pulses were thin with the middle positions absent. We diagnosed her as having Liver Yin deficiency and Blood deficiency giving rise to heat.

The fluids that lubricate joint spaces and nourish our body tissues are derived from the body's Yin fluids and Blood, which are manufactured by the Spleen from the food we intake and further differentiated and managed by the Liver and Kidneys. The Liver governs the tendons and sinews, so when it becomes deficient and dry, it cannot properly nourish these tissues, and the body is vulnerable to muscle and ligament injuries. The lack of lubrication and moistening also causes a build up of heat in the Meridians, which can manifest as pain, inflammation, and, eventually, atrophy. Proper support of the Liver and Kidneys (and to a lesser extent, the Spleen) is required to treat and prevent tendomuscular injuries in athletes, particularly since the intense physicality of their activities burns through Yin and Blood much more quickly than the average individual.

We treated our triathlete and dancer in similar fashion with a combination of acupuncture and Chinese herbs. The acupuncture is used to invigorate the Meridians to move out any stagnation lodged in the tissues which may be causing pain. This could be viewed as helping the body process metabolic waste in the muscles, such as lactic acid. Promoting free flow of Qi and Blood also serves to bring fresh nourishment into the tissues. Acupuncture points are also included to bolster the production in Yin and Blood in the Liver, Kidney, and Spleen. Often, a specific point of the Gall Bladder Meridian (which is the Liver Meridian's Yin-Yang pair) is used to strengthen and support the tendons and muscles; one of the names for this point is Jin Hui (筋會), meaning "sinew convergence."

Herbally, we often look to a classical formula which nourishes the Liver and Kidney Yin: Yi Guan Jian. The formula includes Gou Qi Zi to soften the Liver and nourish the Kidney; Dang Gui to nourish and invigorate Blood; Sheng Di Huang to enrich fluids, nourish the Liver, and clear deficiency heat; Mai Men Dong and Sha Shen to moisten and engender Yin; and Chuan Lian Zi, which disperses constrained Liver qi, thereby indirectly reducing pain, and works to counteract the cloying tendencies of the other ingredients. From there we usually modify the formula to increase its focus on joint and muscle health. Herbs which relax, stretch, and nourish the tendons may be added, such as Mu Gua, Shen Jin Cao, and Hong Jing Tian. Huai Niu Xi is added for its action of invigorating Blood, particular in the legs, and Zhu Ru may be used to guide the actions of the formula to the Gall Bladder Meridian, which traverses and penetrates the iliotibial band (IT band).  Lu Xian Cao invigorates Blood and relaxes sinews, and because it enters the Kidney Meridian, which begins on the sole of the foot, it is an effective addition for treating plantar fasciitis.

This is a very effective strategy for repairing or protecting against sports injuries. We would recommend a similar treatment plan for any athlete or dancer, but this is also a great way to stay healthy while doing a workout regime, practicing yoga (particularly hot yoga!), hiking, or another other physical activity.  







   

Preventing Breast Cancer the Chinese Medicine Way

Breast cancer prevention was bought to the forefront of the news last week with Angelina Jolie's announcement of her decision to undergo preemptive surgery to minimize her risk of developing breast cancer. As I understand it, her choice was heavily influenced by her being a carrier of the BRCA1 genetic mutation, an inherited genetic condition that inhibits DNA replication and ultimately increases cancer risk notably. Obviously seeking a surgical solution before the disease manifests is a deeply personal choice, and many are asking themselves whether they would make the same decision. While the National Cancer Institute estimates that 1 in 8 women will be diagnosed with breast cancer in her lifetime, the prevalence of the BRCA1 mutation is only about 1 in 400-800. This means that for most women considering cancer prevention, BRCA1 will not be a factor, and preemptive surgery would be a rather extreme option. So what alternatives does Chinese medicine offer for breast cancer prevention?

Breast Cancer and Chinese Medicine

When we consider cancer in Chinese medicine, we characterize tumors as an accumulation of stagnant Qi and Blood, and usually phlegm and dampness, that has become very dense. This long-standing mass of static Blood builds up heat over time due to the lack of free flow - so much heat that it damages the surrounding tissue. We call this toxic heat or heat toxicity. This is typically allowed to happen against a backdrop of inherent Qi deficiency, meaning the immune function is too weak to break up these clumps of toxic heat and Blood, ie. cancer cells.

The breasts are governed by the Liver, with the Liver Meridian passing directly through the breast tissue. As you may know, the Liver is the organ responsible for ensuring free flow of Qi and Blood through the Meridians, and so dysfunction of the Liver leads to Qi stagnation. The Liver meridian itself is particularly susceptible to stagnation - that is why women experience breast tenderness or develop (temporary) breast lumps during their premenstrual period.

Prevention

Like everything else in Chinese medicine, cancer prevention is all about protecting the Qi. The most important thing is to maintain strong "upright" Qi. Having a strong immune system allows the body to constantly clean up pre-cancerous cells before they can get a foothold. A balanced diet is key; obviously you should avoid or limit processed foods, but be careful about making your diet too limiting, as well. A good rule of thumb is to eat a good variety of things to ensure that all of the 5 elements are represented by your food intake - the easiest way to do this is to enjoy very colorful meals (this means lots of different fruits and vegetables!).

It's also very important to limit stress and negative emotions. This seems like obvious advice that's not always easy to follow, but Chinese medicine places a lot of emphasis on emotional factors as causes of disease. Stress, frustration, anger, unfulfilled desire, and constrained bottled-up emotions all stagnate the Qi because they are emotions associated with the Liver. Experiencing these emotions in excess is very taxing to the Liver, so it's best not to repress them. For some people this means adopting a meditative practice, whether that's guided breathing or something more like Tai Ji or Qi Gong; for others it's physical exercise.

Moving the Qi is very important, as well. Exercise is a great way to move the Qi as the physical activity literally jostles the Qi loose and helps it move through the Meridians. Of course regular acupuncture and herbal treatments can supplement that, but it's very important to remain physically active. And walking doesn't count! I'm talking about something aerobic that gets the heart beating and the sweat flowing.



Lastly, be nice to your Liver. Try to avoid things that add heat to the Liver and the body. That means limit alcohol intake and avoid smoking. Because the Liver organ is associated with the Wood element, it is also related to the sour flavor. Citrus is great for Liver health, and even squeezing lemon juice into your water helps soothe the Liver. Mint, dandelion, kale, spinach, and beets are all great, too.

Later in the week I'll talk a bit about herbs that are used to move Qi and Blood in the breasts, as well as dissipate masses in the breast tissue. I'll also discuss how we care for patients who actually have breast cancer.  


 

Chinese Sports Medicine: Anatomy of a Compound Tibial Fracture

Chinese Sports Medicine: Anatomy of a Compound Tibial Fracture

Today I want to discuss how Chinese medicine can greatly improve the recovery from a compound tibial fracture. If anyone saw the Louisville vs. Duke basketball game last night, you know exactly what kind of sports injury this is. While it's rare to see it occur during a basketball game, it's not uncommon for football and soccer players to break the tibia.

Whereas with a soft tissue injury we can begin acupuncture treatments immediately, a fractured bone needs to be set by an MD before we can go to work. Compound fractures involve the broken bone protruding from the skin and are thus a more serious injury that require surgery.

I discussed how the injury is considered damage to the Meridians, as well as the local tissue and bone, in the last blog: Anatomy of an Ankle Sprain (http://meridianlouisville.blogspot.com/2013/03/chinese-sports-medicine-anatomy-of.html). There is severe stagnation of Qi and Blood, impeding free flow, so there is pain and inhibited ability to heal the damage. The same principles apply here, though with a broken bone the treatment is altered slightly. With a compound tibial fracture, the Foot Yang Ming Meridian will be especially traumatized. The Yang Ming channels are said to be the most exuberantly full (of Qi and Blood) of all the Meridians. Imagine how abundant the Yang Ming of an athlete is! On the one hand, the nature of the injury is considered very serious because that Meridian is involved, but on the other hand, acupuncture can significantly hasten recovery time since this channel, when properly repaired and utilized, can bring a lot of much-needed nourishment to the injured area.

Treatment:

Normally with an orthopedic/sports injury, we would needle at the site of the trauma to break up static Blood that is clumping in the area; however, broken bones are usually set with casts, and so we are only able to needle distal to the injured area. Fortunately, the Meridian system connects the body so thoroughly that invigorating one part of a Meridian increases circulation in the whole Meridian. Assuming the broken leg is casted from below the knee down to the foot, we are able to use points on the thigh and near the toes. If the whole leg is covered, we are able to work with the affected Meridians on the opposite leg or paired Meridians on the arms. Also, in addition to the points we use that are aimed at conditions specifically affecting the lower extremities, treatments would include points indicated for bone conditions. These are points that have been shown to increase osteoblastogenesis, meaning increasing the rate at which new bone cells are created. The Kidney governs the bone, according to Chinese medicine, so strengthening the Kidney Qi also increases osteoblastic activity to help bones grow and heal quicker.

Herbal Treatment:

Taking an herbal formula becomes much more important with a bone injury due to the severity of the injury and the likelihood that the immediate area of trauma will be inaccessible and immobilized. The treatment principles remain the same as with acupuncture: Invigorate Qi and Blood in the affected Meridians to alleviate pain and restore proper flow, promote healing of the damaged tissues, and specifically mend bone. It is vitally important to understand the timeline of recovery - immediately after surgery you cannot invigorate Blood! The focus should first be on healing the blood vessels and recovering from surgery, holding off on the Blood-moving herbs and using herbs that generate flesh, instead (San Qi, Dang Gui, Rou Gui). Once swelling goes down, you can proceed.

As always, the specific formula will need to be custom-tailored to the individual and their injury, but the base formula will be geared towards strongly promoting circulation. Qi-strengthening and Blood-nourishing herbs are usually added to address the blood loss during injury and surgery, and warming herbs may be added if Cold has entered the Meridians, either from immediate icing of the injury or during surgery, since Cold is another cause of stagnation (see the last blog!). Finally, herbs that tonify the Kidney Yang are added to promote bone growth. These herbs can also be taken to treat and prevent stress fractures by strengthening bone.

Here are a few herbs that specifically strengthen and mend bone:

Du Zhong (Eucommiae Cortex):
- Tonifes the Liver and Kidney, strengthens the sinews and bones
-Aides in the smooth flow of Qi and Blood: used to promote circulation, especially in those with weakness of the sinews and bones

Gou Ji (Cibotii Rhizoma):
- Tonifes the Liver and Kidney, strengthens the sinews and bones
- Expels Wind-Cold-Dampness to relieve painful obstruction

Xu Duan (Dipsaci Radix):
- Tonifes the Liver and Kidney, strengthens the sinews and bones: especially good for tonifying without causing stagnation
- Promotes the movement of blood, alleviates pain, and reconnects the sinews and bones: often used for trauma, and especially good for pain and swelling in the limbs from trauma.

Gu Sui Bu (Drynariae Rhizoma):
- Tonifes the Liver and Kidney, strengthens the sinews and bones
- Promotes mending of the sinews and bones: for traumatic injuries such as falls, fractures, contusions, and sprains. Especially good for ligamentous injuries and fractures

Chinese medicine is amazing for treating sports injuries! If there is a specific condition you'd like to learn about, let us know, and we'll blog about how we treat it!

Chinese Sports Medicine: Anatomy of an Ankle Sprain

Chinese Sports Medicine: Anatomy of an Ankle Sprain

One of the most common sports injuries is a sprained ankle, and 75-80% of the time, it's a lateral sprain. This means the tendons and ligaments that stabilize the ankle joint and are located on the lateral side of the foot become stretched too far and tear. This usually happens when the foot is inverted (when someone “rolls” their foot to the outside), and the most common ligament to be torn is the anterior talofibular ligament. Usually there's pain, swelling, and often bruising.

Pathomechanisms:

From a Chinese medicine prospective, not only has the patient damaged the local tissue during the injury, but he has also damaged one or more Meridians that cross the area. Just as when a blood vessel is damaged, circulation is impeded when a Meridian is damage. Qi and Blood cannot flow through the area properly and becomes stagnant. When there is a blockage and no where else for Qi and Blood to flow, it will travel outside the Meridians and blood vessels where it moves chaotically before stopping and clumping. Since Qi is not moving, there is pain. Naturally, damage to the tissue causes Blood to move outside the vessels, as well, and there is bruising. The lack of free flow also causes a build up of heat, thus there is inflammation.

Treatment:

To treat an ankle sprain, we will use acupuncture both at the sight of the injury and away from the trauma. Needling into the area of the injury breaks up the static Blood that is clumping in the area while needling distal to the injury along the affected Meridians draws Qi and Blood away from the area. Additionally, points that have specific actions of invigorating circulation in the lower body or lower extremities may be used. Both needling techniques aim to promote greater circulation and free up the flow of Qi and Blood. This immediately reduces the pain level as the cause of the pain is the congestion in the area. This also works to continue to relief pain as circulation improves over time. Once normal circulating is restored, Qi and Blood can properly move to and through the area to nourish and repair the damaged tissue and Meridians.

Adjunctive Treatments:

Ice is a popular treatment for sports injuries, particularly immediately after the trauma. It is used mostly to prevent or reduce swelling, but swelling is actually a normal and helpful part of the healing process. Swelling is a rush of healthy blood cells to the area to began the repair process. Ice will impede that process. In fact, according to Chinese medicine, cold constricts the flow of Qi and Blood. Compare the flow in the Meridians to water flowing in a stream; in the winter, the stream will freeze and stop flowing. Ice will cause cold to penetrate directly into the site of the injury, often lingering long after the ice is removed. Its constricting and stagnating influence complicates the injury, and treatment will required warming techniques in addition to standard invigorating and circulation-improving treatments.

Bird's Nest: The Ancient Chinese Beauty Secret

On a recent trip to Los Angeles Chinatown, Robert and Karen purchased Yan Wo (燕窝), one of the most exotic and precious herbal medicinals in the Chinese Materia Medica. Yan Wo, also called "bird's nest," is a very strong tonic and such a pervasive part of Chinese culture that the Beijing National Stadium was built to look like it.

The nests are made from the nutrient-rich saliva of swiftlets, which build their nests on high ocean cliffs. The difficulty of harvesting the nests and the amazing restorative properties of the enzymes in the saliva make Yan Wo quite expensive - it is sometimes referred to as "the caviar of the East."

(Isn't Russia in the East...?)

Why do the Chinese pay top-dollar for birds nest? Well, traditional claims and modern research show that it increases vitality, aids digestion, restores sex drive, strengthens immunity, prevents stroke, attacks cancer cells, restores respiratory function, sbenefit pregnant mothers, facilitates normal body function, and repairs damaged tissues.  That's a pretty impressive list, but Yan Wo is most popularly used for its uncanny ability to revitalize and repair the cells and tissues of the face. Wealthy Chinese women (and men) drink soup made from birds next to retain and restore their youthful appearance, firming and brightening the skin.

From a strictly Chinese medicine prospective, Yan Wo is characteristically sweet in flavor, which is typical of Qi and Blood tonifying medicinals; it's also warm in flavor, which allows it to rise up and promote circulate in the head and face. It enters the Lung, Spleen, Kidney, and Stomach Meridians. The first three are the organs primarily associated with vitality as they are the systems which store Essence and generate Qi. The Stomach meridian is also called the Foot Yang Ming Meridian, and it is the Yang Ming Meridians which are more abundant in Qi and Blood. The Stomach Meridian in particular starts just below the eye and descends around the mouth and jawline before plunging down the neck, so it's pathway makes it an ideal channel to tonify in order to restore facial vitality.

Cooking the bird's nest is an all-day process. There are numerous recipes, and at Meridian we add Gou Qi Zi (Goji Berries) and Long Yan Rou (Longan Fruit) to strengthen it's restorative function. Both Gou Qi Zi and Long Yan Rou are typically included in formulas we give to our Facial Rejuvenation clients due to their ability to restore facial cells and tissues. The bird's nest, however, really represents our most powerful herbal tool for Facial Rejuvenation. An order of our Yan Wo soup will run you $80.00, and it's generally taken all at one time once a week.

 More photos of our bird's nest soup, as well as traditional Chinese preparation methods of Yan Wo, can be found on our Facebook page: https://www.facebook.com/media/set/?set=a.429515153800552.1073741826.211970382221698&type=3

Digestive Health and Joint Pain

There's a lot of discussion nowadays about the way certain foods affect our bodies. An especially hot topic is the idea of wheat and gluten sensitivity. It is believed by some that eating foods that contain gluten can trigger an allergic or autoimmune response in the body causing an inflammatory process to occur. As much of our diet includes gluten, this inflammatory process is more or less ongoing, and it can affect the gut or body joints or both. It's unclear if this sensitivity affects only some people or if it affects all of us, just to varying degrees.

Many of my colleagues, classmates, and teachers place greater emphasis on this than I do. I like to think my reluctance to frame the discussion in this context stems more from my preference to view health and wellness through the lens of Traditional Chinese Medicine than from my love of fried chicken...

So What Does Chinese Medicine Say?

Any machine will create heat while running, and when a machine is not running properly or efficiently, it will create more heat. The Spleen and Stomach, the body's chief digestive organs in Chinese medicine, are no different. There's a normal amount of physiological heat produced in the Spleen during digestion which is safely radiated up and out of the body by the Stomach. When the Spleen and Stomach are weak and digestion is poor, however, that heat is not properly funneled outward and instead retrocedes back into the Stomach. As that heat builds up in the Stomach, which is a Yang organ, it starts to spread to the other Yang organs - most commonly the Large Intestine because together the Stomach and Large Intestine are a paired system called the Yang Ming organs. 

When there is heat in the Yang Ming organs, there is a wide range of symptoms and conditions that one can experience: indigestion, vomiting, belching, heartburn, acid regurgitation, peptic ulcers, IBS, Crohn's disease, celiac disease, and on and on. What's more is that this heat can spread to the Yang Ming meridians, as well, causing pain and inflammation along those pathways. 

 

As you can see, the Yang Ming meridians (Large Intestine in the upper body and Stomach in the lower body) cross every major joint. That knee pain, hip pain, ankle pain, shoulder pain, or elbow pain that feels like arthritis is probably caused or worsened by heat built up in your digestive tract and spreading to these channels. Chinese medicine doesn't really point the finger at gluten for causing this type of inflammation in the gut; there's no single culprit. Spleen-unfriendly (or dampness-engendering) foods can include greasy and fried foods, heavy, creamy foods, milk and milk products, sugars, and, of course, processed foods. Even overconsumption of cold and raw foods is said to damage the Spleen. 

The important thing to remember is a balanced diet is the best diet according to Chinese medicine. A good rule of thumb is to have all of the elements represented either in a dish or in a meal by using foods of every color. If your health situation demands that you're limiting your diet in some way - not eating meat, for example - make sure you're balancing your foods to fill that nutritional gap. Keep in mind that the gap created by removing milkshakes from your diet is relatively small :)