In April 2006, as a Mayway consultant, I was called by another European TCM herb company consultant to construct an emergency formula for over 1000 people in the Andaman Islands where there had been a recent outbreak of malaria (shao yang symptoms) that had quickly lead to acute rheumatic syndrome (autoimmune condition). The rheumatic symptoms reported to me were, fever and chills, sweating, thirst, skin rashes, sticky stools either constipation or with diarrhoea. The larger joints of the limbs were red, hot, swollen and difficult to move and felt worse with movement, relief with cold applications. Generally tongues were red, yellow fur and pulses rapid and wiry.

Diagnosis:
1 Shao yang syndrome (malaria – autoimmune rheumatic syndrome)
2 Wind damp heat bi syndrome

Treatment:
1 Harmonise shao yang
a) to relieve malaria
b) to pacify auto immune syndrome

Formula:
Chai Hu 12 Chou Wu Tong 15 Qing Hao 15 Qin Jiao 18
Huang Qin 12 Xi Xian Cao 15 Gan Cao 6 Zhi Mu 12

I received feed back an few months later that the formula had generally been successful but they added Mu Gua to help deal with the damp affecting the digestion. I would of added Bai Dou Kou instead because:
a) clears phlegm damp from middle jiao
b) clears food stagnation and aids food digestion
c) Immune regulator and anti allergic, immune stress with immediate allergies and immune complex disorders, including rheumatoid arthritis
d) antipyretic i.e. remittent fever e.g. malaria
e) balances the majority of cold bitter herbs

Herb Actions:
1 Chai Hu and Huang Qin harmonises shao yang (malaria – auto immune conditions)
2 Gan Cao – cell mediated allergies including auto immune disorders i.e. rheumatoid arthritis with an anti-inflammatory action on mucus membranes i.e. synovial membranes of the joints which is rheumatoid condition. Gan Cao has a glucocorticoid effect (similar to cortico – steroids that control inflammation in auto immune conditions).
3 Xi Xian Cao – Bi Zheng i.e. it expels wind, damp and heat form joints which are red, hot and swollen i.e. rheumatoid arthritis. Xi Xian Cao is anti-inflammatory and will reduce swelling. It also has an immunosuppressive action and can reduce both cellular and humoral immunities. It clears heat and toxins especially from the liver and is used in acute malaria and jaundice conditions. Xi Xian Cao and Chou Wu Tong combine well to treat Bi Zheng and wind rashes.
4 Qin Jiao – Bi Zheng: disperses wind and dispels damp and with its cool nature reduces heat with redness, swelling and inflammation i.e. rheumatoid conditions. Qin Jiao controls any allergic inflammation but especially of the joints, skin and nose (may be used in allergic rhinitis where wind damp, yin and blood xu is part of the patients’ diagnosis). Qin Jiao increases the activity of the adrenal cortex and has a natural steroidal effect (without the side effects). Qin Jiao also treats remittent fevers where there is yin xu i.e. ‘steaming bone’ syndrome especially when combined with Qing Hao.
5 Qing Hao – As an anti-malarial it has replaced chloroquine in parts of Latin America, SE Asia and China. Qing Hao directly causes the death of the malarial parasites and to treat malaria it is a traditional addition to the shao yang formula Xiao Chai Hu Tang (Chai Hu, Huang Qin etc.) Qing Hao may be used to treat autoimmune diseases such as systemic lupus erythematosus with symptoms getting worse for 3-5 days, better after 14 days and significant improvement after 50 days. Skin and joint symptoms were particularly well treated. Various autoimmune disease and allergies are now being treated via anti-malarials such as hydroxycholoquine, which may clinically support the idea that allergies and autoimmune conditions may partially be linked to Shao Yang conditions.

Case: Female d.o.b 1943, referral from osteopath April 2007.
Treatment for lumbago, with aches and pains in muscles and joints. Other symptoms include dizziness, pains (headache) left parietal area, body temp changes from hot to cold throughout the day, shivering, shaking, nausea, IBS with alternating constipation and diarrhoea, rash on face. Tongue: sublingual vein distension, colour purple/green. Large central crack with yellow fur within a strip of thin yellow fur either side.
Left chi pulse = deep soft weak
Left guan pulse – wiry and rolling
Right guan pulse = thin soft rolling.
Past history – farmers daughter with many chemical used on the farm, full range of vaccinations. Medical diagnosis was systemic lupus erythmatosus.
Medications: Plaqunil – anti malarial drug to control lupus (this drug was discovered by chance during the gulf war). Aspirin – pains in joints. Zantac.

Diagnosis
1 Shao Yang syndrome
2 Liver Qi stagnation
3 Spleen Qi xu
4 Kid Yin xu – empty heat
Formula
1 Xiao Chai Hu Tang
2 Qing Hao Bie Jia Tang

Chai Hu 9 Ren Shen Bai 9 Qing Hao 12
Huang Qin 12 Da Zao 12 Qin Jiao 15
Ban Xia 9 Zhi Gan Cao 6 Sheng Di Huang 18
Gan Jiang 6 Mu Dan Pi 9

Gan Jiang – immune regulator, immune stress with immune complex disorder including rheumatoid arthritis, joint pain and spasms. Other symptoms: IBS, food allergies, intestinal colic, pain, spasms, flatulence and nausea.

In allergic rhinitis the altered reactivity is to what may be considered innocuous substances like:
1 Human skin cells (the major constituent of house dust), house dust mite plus other dust produced by insect bodies such as flies, midges, blood worms etc.
2 Mould spores are a major problem found inside and outside throughout the year (in a country like UK or NZ). Allergic fungal sinusitis where fungi are to be found in the mucus of the sinus cavities. In 1996, researchers at the Mayo clinic USA found that 96% patients with chronic sinusitis were reacting to the presence of fungi.
3 Presence of animals, proteins from the saliva of cats and dogs found in their fur, but reactivity to any animal (even snakes).
4 Pollens, especially hay fever season, grass, tree pollens, moss, weeds, and some pollen all year.
5 Chemical allergies found at work (occupational allergies) at home (chemical cleaning products etc.)
6 Foods and drinks i.e. high in histamines that produce allergic reactions affecting especially the nose such as red wines, blue cheeses etc.
7 Air pollution, chemical pollutants affect the immune system directly producing allergic reactions. Nitrogen dioxide, i.e. motor traffic exhaust, gas fires and cookers, kerosene stoves. Sulphur dioxide, especially motor traffic exhaust, mechanical cleaning agents i.e. de-rusting agent. Formaldehyde fumes i.e. from chip board, MDF fire board, household furniture, plastic resin wall, floor tiles etc. Air fresheners, aerosols, tobacco smoke etc.

Pharmaceutical treatments: symptomatic treatments:
1 Cromoglycates (mast-cell blockers) to prevent allergic action before it starts.
2 Antihistamines to block allergic reaction to prevent inflammation.
3 Steroids to reduce inflammation and suppress normal immunity.

Solution Treatment
1 Immunotherapy: a series of small injections with increasing concentrations of the allergen to desensitise the patient
2 Or taken as an oral liquid or capsule form.
3 Homeopathy – similar substance in ultra dilute form.

Conventional TCM treatment of allergic rhinitis
Maybe because in TCM, wei qi (understood as the immune system) can only be wei qi xu i.e. immune deficiency, therefore allergies i.e. allergic rhinitis is seen as wei qi and lung qi deficiency which cannot protect itself from the incoming pathogens (external wind). Therefore treatment is comprised of:
1 Expel external pathogenic factor (wind heat/cold)
2 Reinforce wei qi and lung qi

Example of formula:
Bu Zhong Yi Qi Tang
Yu Ping Feng San
Cang Er Zi Wan
Huang Qi 9 Bai Zhu 9 Chai Hu 9 Gan Cao 9
Ren Shen 9 Fang Feng 9 Chen Pi 9
Dang Gui 9 Sheng Ma 9 Bo He 9
Xin Yi Hua 9 Cang Er Zi 9 Bai Zhi 15

1 Disperse external wind to stop itching and sneezing: Du 23, Co 20
2 Reinforce wei qi: Co 4, St 36
3 Reinforce lung and spleen qi: Lu 9, Bl 13, Sp 3, Bl 20

Modern Chinese Herbal Medical treatment of allergic rhinitis:

Chai Hu 9 Ren Shen 9 Xin Yi Hua 12
Huang Qin 12 Da Zao 12 Cang Er Zi 9
Ban Xia 9 Gan Cao 6 Bo He 6
+ Bai Qian, Qian Hu = phlegm excess
+ Lu Lu Tong, Mu Dan Pi = Xue Yu
+ Fang Feng, Qin Jiao = Wind Damp
+ Wu Wei Zi, Wu Mei = Excess watery discharge
+ Ling Zhi + increase Da Zao = Lung qi xu

Chai Hu and Huang Qin harmonise Shao Yang
Chai Hu clears external pathogen
Huang Qin drains internal heat toxin
Ban Xia clears accumulation of phlegm
Ren Shen (with Chai Hu as envoy) distributes and replenishes Yuan Qi to the San Jiao
Ren Shen, Da Zao and Gan Cao protects Tai yin (lungs and spleen) from further penetration of pathogenic influence (i.e. allergic rhinitis becoming atopic asthma).

SJ5 and GB41 (Yang Wei Mai) to harmonise Shao Yang
SJ5 dispels wind heat and mobilises wei qi and harmonises shao yang
GB41 harmonises shao yang, transforms damp heat and regulates liver qi, clears eyes; redness and sore itchy eyes.
Co 4 clears wind heat and phlegm damp
St 36 regulates and tonifies spleen and lung qi and wei qi
Co 4 + St 36 harmonise wei qi and ying qi
Co 20 clears nose and dispels external wind

Modern research formula for allergic rhinitis
Chai Hu 9 Cang Er Zi 12 Mu Dan Pi 6
Huang Qin 9 E Bu Shi Cao 9 Wu Mei 9
Bai Qian 9 Ku Shen 12 Wu Wei Zi 6
Ren Shen 6 Fang Feng 9
Gan Cao 6
Modern Chinese research formula based on traditional treatment principles i.e. harmonise shao yang, clear heat, disperse wind, astringe fluids, reinforce qi,
but also this formula is based on specific pharmacological actions of the herbs e.g.

Chai Hu: inhibits the effects of histamine on capillary permeability and other antibody formation. Anti viral and interferon inducement = chronic vial infections. NB one theory of allergies or autoimmune conditions is that past viral infections may lead to incorporation of foreign genetic material into certain cell lines, and thus produces foreign markers on those cells. This chronic viral infection is thus half exterior (external invasion) and half interior (incorporation into body cells) and may be seen as latent heat at the shao yang level. Further incoming foreign material (usually proteins) in the form of moulds, house mite, pollens etc. will trigger a reaction where the body tries to expel the (original) viral attack (producing ‘common cold’ like symptoms).

Huang Qin: inhibits mast cells release of enzymes (allergic reactions). Its flavonoids have a marked anti-inflammatory and anti-allergic effect i.e. allergic rhinitis and allergic conjunctivitis. Huang Qin also destroys the rhinovirus i.e. the common cold or flu virus that infects the nose and like Chai Hu may remove the original cause (viral infection) and together they harmonise shao yang.

Bai Qian is an immune regulator, anti-allergic for type 1 allergic conditions, immune stress with sudden allergies i.e. allergic rhinitis. It is also a bronchial relaxant and dilator used for atopic asthma, clearing excessive mucus discharge from nose and lungs.

Wu Mei is anti allergic – counters histamine shock, anti-histamine – protein sensitisation. Astringes nasal discharge (when clear and watery) it also dissolves nasal polyps.

NB Herbs that have anti histamine effects do not suppress the body’s natural immunity nor have drowsy side effects.

Morning sickness is a very common disorder, occurring in 50 – 80% of all pregnant women (Smith 2002).  Symptoms associated with morning sickness can range from not only nausea, vomiting, retching, but excess salivation, cravings, food aversions, intense hunger, heartburn, burping/belching, smell, pica (desire to eat something inedible), tiredness and fatigue (West 2001).  Symptoms are unpleasant, but transitory and usually end by about the 4^th month.  In fact morning sickness is a misnomer as symptoms are by no means contained to the first part of the day.  For some women symptoms can be constant and can last throughout the duration of the pregnancy.

In a few cases, the symptoms can become so all consuming that leading a normal life becomes nearly impossible.  This is called Hyperemesis Gravidarum (HG).  It is defined as ‘a condition of excessively severe and protracted sickness and vomiting occurring as one of the complications of pregnancy’ and occurs in approximately 3-10 pregnancies out of a thousand and can cause severe dehydration in the mother and child.  30 years ago HG was lethal and has taken the lives of such well known people as Charlotte Bronte.  Today HG is a serious condition but fortunately one which is rarely fatal (Whale 2001).

The causes of morning sickness are unknown although there are a number of inconclusive theories: high levels of HCG (a hormone that is generated by the cells that eventually become the placenta), a maladaptive reaction to oestrogen, or progesterone and its inhibitory effect on the gut.  Other factors that may contribute to HG include obesity, nulliparity (never having completed a pregnancy beyond miscarriage/termination), and non-smoking (Whale 2001).  Betts (2003) lists fatigue and high stress levels can increase the risk of morning sickness, as can emotional factors like anxiety and fear.  Some studies have looked at thyroid dysfunction, liver dysfunction and the association of Helicobacter pylori with HG (Whale 2001).

Orthodox treatment includes anti-emetics and fluid administration.  Many women are reluctant to take pharmaceutical medications during pregnancy and so Traditional Chinese Medicine (TCM) can offer a real alternative to alleviate symptoms.

“Women now have an additional option to manage their morning sickness” (Smith 2002).

TCM is an entire healthcare system that has been established for over 2000 years and includes the therapies of Acupuncture, Chinese Herbal Medicine and dietary therapy.  There has been a plethora of research into the effectiveness of acupuncture for treating morning sickness and the results are positive (Smith 2002, Habek 2004, Betts 2006).  One of the most researched acupuncture points is Pericardium 6 – Neiguan – inner pass, which harmonises the stomach and alleviates nausea and vomiting (Deadman 1998).   It is located on the inside of the forearm, about 2 inches above the wrist crease, in between the central tendons.  This is one of the points that is likely to be used with morning sickness, in fact ‘sick bands’ can be worn over this point to provide constant stimulation.  There are a number of different patterns in TCM that may give rise to morning sickness.  In broad terms these can either be from a deficient or overburdened digestive function, an element of cold or heat within the stomach, an abundance of phlegm or emotional instability.  Each patient will be individually diagnosed according to their constitution and symptoms and a personalised point prescription and, if appropriate, a herbal formula will be administered.

There are a number of home remedies that women may find helpful to alleviate symptoms although what works for one does not necessarily work for another as each woman will exhibit her own pattern.  Ginger is possibly one of the best anti-emetics known (Whale 2001), perhaps due to its rich source of zinc (West 2002) or in TCM its ability to warm and settle the stomach.  An indication that ginger may be useful is if warming foods are preferable and help alleviate nausea.  Peppermint may also be useful as it aids digestion, breaks down fats (Whale 2001) and in TCM cools the stomach and regulates the liver.  An indication that peppermint may be useful is if cooling foods are preferable and help alleviate nausea.  These herbs can be taken as teas and are a good way of keeping hydrated.  Even slight dehydration will make the nausea more intense.  Soups are a useful way of taking on fluids.  Bland flavours like potato, vegetable or chicken broths are most tolerated.

Snacks are an important way of maintaining blood sugar levels and literally help to keep the nausea anchored in the stomach.  Depending on your constitution hot or cold foods and dairy products may need to be avoided.  Generally sugary foods should be avoided as should fatty junk food as they only cause more congestion within the digestion.  Citrus fruits and juices may cause increased nausea by aggravating the stomach.  High protein snacks (nuts) before bed and a carbohydrate snack (toast, crackers) on waking may be useful.  Certain foods will definitely increase the nausea and it is important that women take into account what is best for them.

Tiredness inevitably increases the feelings of nausea and so rest is imperative.  Stress is another contributory factor and must be avoided as much as possible.  It is important to stick to a routine of regular appropriate snacks/meals, regular bed times and enough rest.

There are a number of reassuring facts to remember when experiencing this disorder:

·         The vast majority of babies born to even severely hyperemetic women are completely normal and healthy.

·         a ‘normal’ pregnant woman has a 15% chance of miscarrying/stillbirth while the hyperemetic woman has a greatly reduced chance of 3%

·         the blood flow of an hyperemetic woman is twice that of a ‘normal’ pregnant woman (this is the way the body compensates for the lack of nutrient intake)

·         It is true what they say: (in most cases) the sicker you are the better off your baby is

·         THERE IS AN END TO THE DISORDER! (Whale 2001)

References

Betts D (2006)  A Review of Research in to the Application of Acupuncture in Pregnancy.  Journal of Chinese Medicine 80 February 50-55

Betts D (2003) Harmonising the Penetrating Vessel in the treatment of Morning Sickness.  Journal of Chinese Medicine 72 June 36-41

Deadman P & Al-Khafaji M (1998) A Manual of Acupuncture.  Journal of Chinese Medicine Publications, UK.

Habek D (2005)  Success of acupuncture and acupressure of the Pc 6 acupoint in the treatment of hyperemesis gravidarum.  Research in Complementary and Natural Classical Medicine. 11:20-23.  (Research Abstract from European Journal of Traditional Chinese Medicine, Vol 4, No 1, 2005)

Smith C (2002)  Acupuncture Fights Morning Sickness.  http://news.bbc.co.uk/1/hi/health/1842196.stm

West Z (2001)  Acupuncture in Pregnancy and Childbirth.  Churchill Livingstone.

Whale M (2001)  Morning Sickness and Hyperemesis Gravidarum.  Register of Chinese Herbal Medicine News.  Autumn 17-24.

Acupuncture and Chinese Herbal Medicine are effective in treating many disorders of pregnancy such as: morning sickness, threatened miscarriage, abdominal pain, uterine bleeding, oedema and hypertension. 

It can also help alleviate other common problems associated with pregnancy such as: back pain/sciatica, indigestion, constipation, varicose veins, carpel tunnel syndrome, cramps, insomnia, anaemia, haemorrhoids and pelvic pain.

Research has shown that a course of acupuncture prior to labour may reduce the length of labour.

Acupuncture is used clinically for the treament of malposition of foetus.  Studies have shown an 75% success rate.  In general, the treatment of a breech presentation involves the application of moxibustion to a single point.  While simple, this treatment is remarkabley effective and has  no known side effects to mother or baby.

Research has shown that acupucnture is effective for induction of labour by ripening the cervix and initiating contractions throuth points over the sacral plexus and extremities.  Research shows it takes 3 – 60 hours to initiate induction.

TCM  can be helpful for mothers suffering from a range of postpartum conditions including: post-natal depression, persistent lochia (prolonged bleeding), breastfeeding problems, urinary disorders, after pains and haemorrhoids.

Call the Poundbury Clinic to make a booking or contact Louise at acuherbs.co.uk or 07989 950462 for more information.

 I practice in Weymouth and Dorchester, Dorset and can be contacted by email on

Louise at acuherbs.co.uk

 For many women these treatments are too expensive to be able reap the benefits.  But affordable treatments can be achieved by having a number of treatment couches in the same room.  Also called multi-bed clinics.  I am in the process of setting one up at the Poundbury Clinic in Dorchester, Dorset.  Do you think its a good idea?

Contact me 

Louise at acuherbs.co.uk 

Further infomation about TCM and MS

In China this way of treating is common place and there are a few clinics already running in London, like the Gateway clinic in.  It means cheaper treatments and everyone can benefit from each other in terms of learning and healing.