Hashimoto’s disease and its TCM treatment

Tiejun Tang

Hashimoto’s disease is a thyroiditis caused by an autoimmune reaction. This disease was first described by a Japanese doctor called Hashimoto when he was practising in Germany in 1912. The average incidence of this disease is 1-1.5 in 1000. The incidence of women is 15-20 times more than in men. It occurs more frequently in the age group of 30 to 50, but may also be seen at other times.

In some cases, no symptoms may be seen at early stage, but in most cases, symptoms are similar to those of hypothyroidism. Common symptoms include: fatigue, unexpected weight gain, aversion to cold, muscle aches, cramps, tenderness or stiffness, joint pain or swelling, pale skin and puffy face, hoarse voice, constipation, depression, visibly enlarged thyroid.

It is not very clear what triggers this autoimmune disorder. Factors such as iodine, medications, infection, smoking and possibly stress may be involved. If you want to prevent Hashimoto’s disease or stop it developing, you should try to avoid these possible causes.

In Western medicine, this is usually being treated with levothyroxine. This hormone replacement therapy can only partially recover thyroid functions but not regulate the immune system in general. It cannot reduce the level of antithyroid antibody. Patients need to take medicine all their life. For some cases with a large goitre, they may even need surgical operation. After operation they still need to take thyroxine.

In Chinese medicine, it is believed that this disease is due to Qi stagnation, blood stasis and phlegm accumulation in the neck. It falls within the category of Ying Liu (瘿瘤) in the classic text of Chinese medicine. In China, we usually treat this disease with integrated traditional Chinese medicine and western medicine. I believe that the operation and iodine radioactive therapy will accelerate the process of hypothyroidism. Instead, we can use Chinese herbs to remove the liver qi stagnation and blood stasis. We can expel phlegm and soften the goitre by Chinese herbs. I usually use Chaihu （Bupleuri Radix）, Chenpi (Pericarpium Citri Reticulatae), Xiangfu (Cyperus rotundus) for qi stagnation; Chishao (Radix Platycodi), Danshen (Savia miltiorrhiza) and Danggui (Angelica sinensis) for blood stasis; Banxia (pinellia tuberifera tenore), Houpo (Magnolia officinalis Rehd.), Zhebeimu (Fritillaria thunbergii Miq) and Dannanxing (Arisaema Cum Bile) for phlegm accumulation. In the past two decades, there were some different opinions about applying herbs which contain iodine such as Haizao (Sargassum), Kunbu (ThallusLaminariae) and Huangyaozi (Rhizoma Dioscoreae Bulbiferae). Some people believed that this kind of herbs will cause Wolff–Chaikoff effect which is harmful to the thyroid. Some people believed that herbs with iodine content are different from iodine preparation. I think it is still safe to use these herbs for some thyroid diseases with small doses administered for a short time, especially for cases with low iodine. I believe that Chinese herbs have many advantages in treating Hashimoto’s disease and it is good for improving symptoms and reducing side effects of western medicine.

This disease needs proper treatment once it is diagnosed. There are reports of patients with Hashimoto's thyroiditis being three times more likely to have thyroid cancer. (Larson SD. 2007).
To conclude, integrated traditional Chinese medicine and western medicine is always better than any single therapy.

Reference:
Larson SD, Jackson LN, Riall TS, et al (2007) Increased incidence of well-differentiated thyroid cancer associated with Hashimoto thyroiditis and the role of the PI3k/Akt pathway. J Am Coll Surg. 204 (5):764-73.

Western Medicine is a Developing Science

Tiejun Tang
I've published a paper titled Traditional Chinese Medicine is an Undiscovered Science last week. I would like to express my opinion about western medicine in this paper. Western medicine is a part of science but it's a developing science.  
Western medicine has made great contributions to human health since it began to develop 300 years ago. During this period of trial and improvement it did lead to some complications and harmful treatments for the patients. Western medicine is always developing and there are always new experiments and research project results, which often tell you the former treatments, could be harmful or need further developing. But for many patients it is too late. Let’s review the following examples.

Amidopyrine was a commonly used antipyretic and analgesic drug used about one hundred years ago. It had been widely used in Europe and America for more than 40 years. Some doctors found it might cause agranulocytosis in many clinical cases (Discombe G.1952). This lead to many patients dying of agranulocytosis, which was caused by this medicine.

Dinitrophenol was first used in the USA in 1933 as a slimming agent; it accelerates metabolism by 1938, 150 cases of permanent bilateral cataract resulting from its use had been reported (Crawford 1959).

Thalidomide had been widely used in the world for treating morning sickness of pregnant lady in 1950s’ and early 1960s’. Since 1961 more and more reports found that this medicine can cause malformation of neonate, it has now been listed in the contraindication drugs for pregnancy. But it already caused more than 12,000 baby’s malformation in whole globe till 1963. Nearly half of these cases were in UK (Burgio G.R 1981) .

Specialists suggested that the post menopausal women should take female hormones to prevent coronary heart disease and osteoporosis. They called this hormone replacement therapy (HRT). At least 20 million women in developed countries were estimated to be using HRT. Just a few years after, a report from Oxford said, almost 100 epidemiological studies have reported that there is a relationship between the use of HRT and the risk of cancer of female reproductive organs, namely the breast, uterus or the ovaries. The longer the period of use of HRT, the greater the excess incidence of cancer (Beral V.1999).

Some medical specialists also announced taking Vitamins can help to delay senescence. But new studies have found that the long term use of Vitamins can increase the risk of many cancers (Patterson R.E 1997). This has caused great concern for the public.

A few years ago, it was believed that the drug mitoxantrone can help treat multiple sclerosis (Hartung H P 2002), but shortly the public were informed that this medicine can damage the heart function (Zingler2005).

In further research, 60 percent of the 519 cases of clear-cell adenocarcinoma of the vagina and cervix the patient’s mother had received diethylstilbestrol during pregnancy. This was identified by the Registry for Research on Hormonal Transplacental Carcinogenesis (Melnick.S.1987).

Therefore many serious side effects have been caused during our medical development history. How about our current use of medicine? Are they safe? I think even though they are much safer and much more developed than one hundred years ago, there is still a potential risk and care should be taken when they are being used. Nearly all the chemical drugs have some side affects to different extents. Medicine is vital and it plays a major role in human life, and any small mistakes may lead to many people’s death or physical and mental harm. Do not pin all of your hopes on western medicine. You can have second and third choices.

Reference:

Beral V, Banks E, Reeves G, (1999). Use of HRT and the subsequent risk of cancer. J Epidemiol Biostat. 4 (3):191-210.

Burgio G.R. (1981).The Thalidomide Disaster Briefly Revisited. Eur J. Pediatr 136: 229-230.

Crawford R. (1959). Toxic Cataract. BMJ (2): 1231-1232.

Discombe G. (1952). Agranulocytosis caused by amidopyrine. BMJ (1): 1270-1273.

Hartung H P, Gonsette R, Konig N. (2002). Mitoxantrone in progressive multiple sclerosis: a placebo-controlled, double-blind, randomised, multicentre trial The Lancet. 360 (9350): 2018-2025.

Melnick, S, Cole F, Anderson D (1987). Rates and Risks of Diethylstilbestrol-Related Clear-Cell Adenocarcinoma of the Vagina and Cervix N Engl J Med 316: 514-516.

Patterson R.E.,White E., Kristal A.R.(1997). Vitamin supplements and cancer risk: the epidemiologic evidence. Cancer Causes and Control 8 (5): 786-802.

Zingler VC, Näbauer, Jahn K. (2005). Assessment of Potential Cardiotoxic Side Effects of Mitoxantrone in Patients with Multiple Sclerosis Eur Neurol 54(1): 28-33.

Traditional Chinese Medicine is an Undiscovered Science

Tiejun Tang

Since the development of modern medicine originated from the western countries, there has been great differences between traditional Chinese medicine (TCM) and western medicine in their way of understanding the human body and diseases. This difference is contributed to the different basic theories and research methods between the two. Along with the development of modern science, the doubts cast around TCM has never ceased in the modern history of China. Some doubts were even raised by some famous scholars. Even with all these doubts about TCM, great development can still be seen in recent decades. However, there are some people who are keen on raising doubts about TCM in recent years. Some of them had even become famous. Some people said TCM is not science, some considered it pseudoscience. Some people believed TCM is a traditional philosophy with scientific connotation. There are some scientists in UK who published their opinion in newspapers. They believed that acupuncture shouldn't be accepted by NHS. TCM education should not be included in national higher education systems, because there is a lack of scientific evidence. How to evaluate the academic status of TCM? Is it worth doing research on and keeping its existence? My opinion is that TCM should be considered as an undiscovered science.

These anti-TCM people cannot deny the effect of Chinese herbs and acupuncture. Most of their doubts are focused on the basic theory of TCM. The basic philosophy is the foundation for any subject. Is TCM theory an unscientific doctrine? The following evidence about TCM theory can help you get a reasonable answer.

1. Lung regulate the metabolism of body fluid, and is the source of fluid from the upper body.
From the point of western medicine, lung is just an organ for respiration. It carries out the gas exchange function by breathing in and out. But TCM believes lung has a function of regulating the metabolism of body fluid, and it is a source of fluid from upper. Some people believe that this is a silly nonsense. Until 1981, a Canadian scientist de Bold became the first person to report that atria of various animal species produce a hormone involved in the regulation of extracellular fluid volume and electrolyte balance. This atrial natriuretic factor (ANF) is capable of inducing diuresis, natriuresis and vasorelaxation (Brenner et al. 1990). Further studies on experimental cardiomyopathy model shows that the lung is an important source of ANF (Gutkowska and Nemer, 1989)。 In addition, physiological research had found that the lung can regulate fluid metabolism by renin angiotensin aldosterone system. Lung can also produce angiotensin converting enzyme. This enzyme has a function of activating angiotensin Ⅰto angiotensin Ⅱ. This activated angiotensin can stimulate the secretion of aldosterone, a key factor in regulate water and natrium balance. Thus it can be seen that, lung is not simply only a respiration organ, it also plays a very important role in regulating the metabolism of body fluid. This TCM theory originated from Yellow Emperor’s Cannon of Medicine and has found broad application in clinical practice for two thousand years. For example, when treating oedema patient, if diuretic alone doesn’t works, the doctor will add one or two herbs which can disperse lung-qi in their prescriptions. It often shows significant effect. In ancient times, this method was called “Ti Hu Jie Gai”, which means keep the pot cap opened a little while you pour out the water.

2. Kidney dominating the bone
Western medicine believes kidney is an urinary organ. When TCM mentioned kidney control the water metabolism, there is no disagreement from western medicine, but when TCM mentioned kidney dominating the bone, kidney deficiency will cause osteoporosis, tonifying kidney will strengthen the bone and benefit the fracture healing, western medicine did not agree at the beginning. Even up till today, there are still many people who feel confused. The density of bone depends on calcium and phosphate metabolism. Vitamin D is an important substance in regulating this metabolism. However, no matter whether the Vitamin D is synthetical or exogenous, it does not have any activities themselves. After absorption, it has to be transported to the liver. It’ll then change into calcidiol (25-hydroxycholecalciferol) by the action of hydroxylase of the liver, then it’ll change into calcitriol (1,25-dihydroxycholecalciferol) by the action of hydroxylase of the kidney. The Vitamin D receptor (VDR) binds several forms of cholecalciferol. Its affinity for calcitriol is roughly 1000 times that for calcidiol, which explains their relative biological potencies. The gene expression of VDR is controlled by nuclear factor Yin-Yang1（P. Nezbedove 2004）.This magical nuclear factor has many important two way regulation functions on many key gene expressions. It had been named with Yin-Yang by its founder. I think it is the material base of Yin-Yang theory.（T Tang 2004）. Many patients who suffer from chronic renal failure also have osteoporosis because of the decrease of activated Vitamin D. Now more and more people believe that kidney dominating bone is a reasonable theory, because of the new research progress about bone metabolism.

3. Kidney has its opening at the ears.
TCM believes kidney has its opening at ears and many ear problems can be solved by treating kidney. Western medicine feels confused again about this theory. How could there be such close relationship between these two distant and totally different organs? An American otologist had reported that kidney and ear have a great similarity in ultra-structural anatomy, physiological mechanisms of fluid and electrolyte balance and pharmacological actions of certain drugs. The researcher used immunohistochemistry and immunofluorescent staining method to investigate kidney and the lateral cochlear wall. The results showed that kidney and cochlear have antigenically similar epithelial components. (Cedric A 1973）. An affinity column chromatography was used to isolate aminoglycoside receptors from inner ear tissues and kidney. The toxicity of aminoglycosides was explained on the basis of these receptors.(Schacht.J 1979). Another report is from a UK hospital. The prevalence of sensorineural hearing loss, measured by pure tone audiometry, was determined in 66 patients with chronic renal failure and threshold changes following haemodialysis were measured in 31 patients. The incidence of hearing loss was 41% in the low frequency, 15% in the middle frequency and 53% in the high frequency range respectively.（Gatland D.1991）. Both basic and clinical research showed the TCM theory about kidney-ear relation had its scientific evidence.

4. Heart dominating the mind. In TCM theory, the mind and intelligence are dominated by heart. Western medicine believes this ability is due to the function of brain. In my opinion heart dominates the mind is original, brain only dominates the mind as a phenomenon. （T Tang 2004）. This opinion had been supported and referred to by many people. It had been noticed that heart transplant is not simply a question of replacing an organ that no longer functions. To gain insight into the problem of whether transplant patients themselves feel a change in personality after having received a donor heart, 47 patients who had transplants over a period of 2 years in Vienna, Austria, were called for an interview. Fifteen per cent stated that their personality had indeed changed, not because of the donors’ organ, but due to the life-threatening event that they had to go through. Six per cent reported a distinct change of personality due to their new hearts.（Bunzel B 1992）. A ‘heart and soul’ research project had been carried out by a research group at the University of California San Francisco. (Whooley 2010) .They investigated 1024 cases of coronary heart disease from 2000 to 2002. They then carried out follow up studies on these patients for 8 years. More than 30 biological indicators were detected. This group had published 100 papers up till 2010, most of the papers had been published in some famous academic journals. Their research showed many coronary heart disease patients have some psychological problems such as mental depression and sleeping problems. Many related biological indicators have got significant changes in these patients. The results of this large sample research project gives us a solid evidence of the TCM theory of heart dominating the mind.

The above only showed some of the evidence supported by research. To evaluate TCM properly, one should have a deep understanding about TCM and bear a broad sense of scientific view. If someone only use general knowledge of western medicine to criticize the scientific basis of TCM, views will be very limited and one will not be able to see the whole picture. All the evidence mentioned above may still be just tip of the iceberg.

Along with the development of modern science and technology, more and more TCM theories will be seen to be approved in the future. Modern medicine could not solve all the problems of human health. It is not enough and impossible. The side effects of chemical drugs are always inevitable. The resistance of bacteria to antibiotic will emerge one after another. Surgical operations can only solve the problems of some disease. The human health needs the involvement of complementary and alternative medicine. TCM is the most important kind of complementary medicine. To quit TCM means giving up a powerful tool of saving human health. To study and develop TCM should be a wise decision for every government and individual.

Reference :

BRENNER, B. M., BALLERMANN, B. J., GUNNIG, M. E. AND ZEIDEL, M. L. (1990). Diverse biological actions of atrial natriuretic peptide. Physiol. Rev. 70, 655–699.
BUNZEL B, SCHMIDL-MOHL B, GRUNDBOCK A, and WOLLENEK G (1992) Does changing the heart mean changing personality? A retrospective inquiry on 47 heart transplant patients Quality of Life Research 1(4): 251-256.
CEDRIC A. QUICK M.D., ALFRED FISH M.D., CARL BROWN M.D.（1973）The relationship between cochlea and kidney. The Laryngoscope. 83 (9):, 1469–1482.
DEBOLD, A. J., BORENSTEIN, H. B., VERESS, A. T. AND SONNENBERG,H. (1981). A rapid and potent natriuretic response to intravenous injection of atria myocardial extracts in rats. Life Sci. 28, 89–94.
GATLAND D, TUCKER B, CHALSTREY S, KEENE M, and BAKER L.(1991） Hearing loss in chronic renal failure-hearing threshold changes following haemodialysis. J R Soc Med. 84(10): 587–589.
GUTKOWSKA, J., NEMER, M., SOLE, M. J., DROUIN, J. AND SIROIS, P. (1989). Lung is an important source of atrial natriuretic factor in experimental cardiomyopathy. J. clin. Invest. 83, 1500–1504.
NEZBEDOVA.P, BRTKO.J. (2004).1α,25-Dihydroxyvitamin D3 inducible transcription factor and its role in vitamin D action. Endocrine regulation. 38, 29-38.
SCHACHT J.(1979) Isolation of an aminoglycoside receptor from guinea pig inner ear tissues and kidney European Archives of Oto-Rhino-Laryngology, 224 (1-2): 129-134.
TANG TIEJUN. (2004).The nuclear factor Yin-Yang1 and the Yin/Yang theory of TCM. Journal of Shanxi Traditional Chinese Medicine. 25 (3):239-242.
TANG TIEJUN(2004). A joint discussion about heart and brain dominate mind. Chinese Journal of Current Traditional and Western Medicine. 2(5): 443—444.
WHOOLEY MARY A. http://dgim.ucsf.edu/heartandsoulstudy

Crohn's disease and its Chinese medicine treatment

Tiejun Tang

The first time I encountered Crohn’s disease (CD) was at beginning of 1980’s. My teacher introduced us to this disease during our university western medicine lessons. I learnt that CD is an inflammatory disease of the intestine, which can affect any part of the gastrointestinal tract causing a wide variety of symptoms including abdominal pain, diarrhoea vomiting, weight loss, and tiredness. We were told the incidence of CD is higher in western countries and much lower in Asian countries including China. The aetiology of CD is not very clear. Genetics and environmental factors, immune system disorder and bacterial infection can play a role.

The first case of CD I met at Xijing Hospital in 1985. -- a leading hospital in China. I worked as a junior resident physician in the ward of gastrointestinal disease. I acquired much clinical experience relevant to the diagnosis and treatment of CD. We gave the patients sulphasalazine (SASP) as an anti-inflammatory and the steroid prednisone or another immunosuppressive drug. Most of patients improved a lot after treatment, but all the corticosteroids caused significant side-effects following long term use. When we tried to reduce the doses or encourage the patients to stop taking them, their symptoms always got worse. We hence often gave to the patients Chinese herbal decoctions to be taken orally or as an enema which invariably improved their condition. None of the CD patients I came across in my three month’s working experience at the gastrointestinal ward had to go to have surgery.

From 1989 to 1992, I spent three years for my master degree studies at the TCM department of the First Military Medical University. My major was focused on treating gastrointestinal disease with Chinese herbs patented pills. I have read many Chinese medicine classics texts about spleen deficiency. In TCM, the spleen does not refer only to the anatomical spleen of Western Medicine it also refers to the functions of the whole digestive system. According to the theory of traditional Chinese medicine most of digestion and absorption functions are attributed to the function of spleen. Causes of spleen deficiency will manifest as poor digestion and resemble the clinical manifestation of CD. The herbs which tonify the spleen will benefit the digestive functions and relieve the symptoms of CD. I attended the endoscopy clinic to observe the pathological changes of inflammatory bowel disease (IBD). There I observed the difference in histopathological changes between CD and ulcerative colitis (UC). I have measured intestinal local immune function in spleen deficiency patients and animal models. The results of this laboratory based research I undertook showed the local immune function to be significantly reduced in patients with spleen deficiency. After treating with a patented Chinese herbal mix drug, their immune function had been greatly improved greatly [1-4]. The clinical symptoms also improved. Over 100 cases of spleen deficiency were included in these studies. Diagnoses included chronic gastritis, colonitis, UC, and CD. The name of the patented Chinese herbal mix drug is Jianpi Yikang Wan (JPEK). Jianpi means to invigorate the spleen, Yikang means to benefit health, Wan means pill. This pill has a double layer structure, the first or outer layer is absorbed in the stomach and the inner layer in the intestine. The outer layer is composed by Huangqi, Danggui, Dangshen etc which benefit effect at stomach; the inner layer is composed by Baishao, Muxiang, Yanhusuo etc which benefit the intestine. The trade name of this pill called Bupi Yichang Wan. Presently it is the first choice of Chinese herbal remedy for the treatment of IBD.

In China most of IBD is UC, only small part is CD; but in western country CD became a major disease of IBD. The clinical symptoms are very similar between UC & CD. The treatment principle is the same. The herb pills selection is the same – Bupi Yichang Wan. If herb pill is not strong enough, we can prescribe herbal decoction according to different conditions of individual case. The basic prescription is modified Sijunzi Tang and Shenling Baizhu San. If there are mucus in the stool, add Baijiangcao and Baixiapi; if there are blood in the stool, add Baiji and Diyu; if patient have watery diarrhea add Yiyiren and Cheqianzi; if vomiting, add Banxia and Zhuru; if abdominal pain, add Yanhusuo, Chuanlianzi and Baishao etc The original prescription of JPEK is not from me, it’s from my master degree tutor professor Fulin Xu. He is a specialist of gastrointestinal disease in TCM, the dean of TCM department of the First Military Medical University at that time. All my experience is from my tutors. I would like to give many thanks to my tutors, without them I am nothing. A statistics report showed CD affects about 1 in 10,000 people. There are about 60,000 people in the UK with this disease. I practice in UK for five years now. I have met many patient suffer from very bad digestion, they have chronic diarrhea, abdominal pain or distension. Some patients have a scar at their belly. They had been diagnosed as CD. Some of them already had part of intestine removed. In many cases their symptoms often recur after operation. Another report showed CD is associated with an increased risk of small bowel and colorectal carcinoma, including bowel cancer[5]. I would like to tell CD patient Chinese medicine can help you go to better prognosis and avoid unnecessary surgery.

Reference

1. Tiejun Tang. The effect of JPYK pill on T cell subpopulation and immunological function of spleen asthenia mice. Pharmacology and Clinics of Chinese Materia Medica. 1992; 8 (Sep.): 181.

2. Tiejun Tang. The effect of JPYK pill on isoenzyme of rats. Chinese Journal of Integrated Traditional and Western Medicine. 1990; 10(Sep): 96.

3. Tiejun Tang. Quantitative analysis of sIgA in the intestinal juice of spleen deficiency patients. Traditional Chinese Medicine Research. 1993; 6(1): 24.

4. Tiejun Tang. Amylase activity change in the intestinal juice of mice caused by two different animal model of spleen deficiency. Journal of Traditional Chinese Medicine and Pharmacy. 1994; (3): 40.

5. Canavan, C. et al (2006). "Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn's disease". Alimentary pharmacology & therapeutics 23 (8): 1097–104.

Acupuncture is a good solution for Repetitive Strain Injury

Tiejun Tang

Do you have a nice summer holiday? Do you back to you busy work again? Don’t work too hard, because RSI might trouble you at anytime.

In 29th June, I had been invited to give a speech at Central London RSI Support Group. The topic of my speech is Acupuncture is a good solution for Repetitive Strain Injury. This group is composed by many patients suffer from different kinds of RSI (Repetitive Strain Injury). They meet regularly in central London every month and exchange their experience of fighting RSI. Some people attended that meeting, but many people were absent, it might be due to the hot weather or an important match of the world cup at that night. I would like to publish my suggestion to RSI patients in this blog, hope it might give a little help to them.

RSI is an injury of the musculoskeletal and nervous systems which is caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions. A study showed that 68% of UK workers suffered from some sort of RSI, with the most common problem areas being the back, shoulders, wrists, and hands.

Chinese medicine believes most of the pain and numbness of RSI is due to meridian blockage. These blockages can be due to Qi stagnation or blood stasis. Some cases can be due to blood deficiency or liver and kidney deficiency. Classic text of Chinese medicine said: There is an obstruction there is a pain. If the obstruction had been removed the pain will be gone. For those cases due to the deficiency of blood or kidney & liver, they need nourish blood or tonify kidney & liver. In TCM philosophy kidney dominate bone and liver dominate the tendons Joints and tendons are more easy to get overstrain when the liver and kidney deficiency. That mean strengthen liver & kidney is very important in the treatment of RSI.

How to remove the obstruction and how to invigorating the kidney & liver? Acupuncture needles, Tuina manipulation can do those. As for acupoints selection, different disease should use different local points and distance points. To name a few:

Carpal tunnel syndrome points: Baxie (UE22), Neiguan (PC6), Waiguan (SJ5), Daling (PC7), Yangchi (SJ4), Wailaogong (E-UE24);

Tennis elbow points: Quchi (LI11), Shousanli (LI10), Chize (LU5), Xiaohai (SI8).

Frozen shoulder points: Jianyu (LI15), Jianjin (GB21), Jianliao(SJ14), Jianzhen (SI9), Tianzong (SI11), Binao (LI14).

Cervical spondylosis points: Fengchi (GB20), Jingbailao (E-HN30), Jianjing (GB21), Houxi (SI3), Laozhen (E-UE24), Huatuojiaji (neck).

Except acupuncture and Chinese Tuina massage, sometimes we combine cupping, moxibustion, electric acupuncture and Chinese herbal remedy to treat RSI. According to the diagnosis of each individual case we select 2-3 above therapy. It will always help after couple of sessions.

However, the most important thing is to prevent RIS happen. Modified your posture while you working. Adjust your chair, desk, keyboards, mouse and PC screen. Take a break and do some excise after long time working. Try some self massage when you feel strain and ache in some part of your body. Get your acupuncture treatment at the earlier stage of your disease. Hope you had chance to read my blog and keep RSI away.

Why antibiotic doesn’t works in some conditions?

Tiejun Tang

Nearly everybody had the experience of taking antibiotic to treat their disease. Sometimes it works well but sometimes it doesn’t work. Why antibiotic doesn’t works in some cases? There are at least two reasons.

Firstly, antibacterial spectrum doesn’t match the pathogens.
Every antibiotic has its antibacterial spectrum. Usually this spectrum is quite narrow. One antibiotic only can kills one class of bacteria. Even there are some wide spectrum antibiotics but there still can not cover so many different kind of bacteria. Doctors often select antibiotic through an in vitro drug sensitivity test. We have to wait for few days time to get the result of this test. In some emergency case time means the life. Doctor has to select one or two antibiotic through their experience. If the selected antibiotic missed the target bacteria, this antibiotic treatment will be no effect.

Secondly, drug resistance makes its effect greatly discount.
Very similar to other biological race, bacteria have an instinct of avoid being killed. They can change their subtype by change gene expression. That is why when you first time use an antibiotic it works but when you use it at second time it doesn’t works. Doctors have to increase the doses or change a new antibiotic. Pharmacologist have to keep on research for invent new drugs. Sometimes a new antibiotic has been put in clinical use only few month, there are antibiotic resistant strains can be find in some patients. It looks like a race between new antibiotic and its resistant.

When antibiotic doesn’t works, we can not increase too much dosage, because nearly every antibiotic has some side effect. Some of them may causing liver or kidney function damage while detoxify through these organs. Some may cause fateful allergic reaction, or permanent damage of the auditory nerve. How can we do at this condition?

In Chinese medicine, detoxify and clean heat herbs have a very good function in inhibiting or killing many kind of bacteria. For example, Huanglian (Rhizoma Coptidis), Huangqin (RadixScutellariae), Pugongying, (Taraxacum), Diding (Viola philippica Car). The antibiotic effects of these herbs have been proved by many laboratory experiments.

Some tonic Chinese herbs can inhibit bacteria by enhancing immune system of the body. It can help patient to fight and expel the pathogen with their own immune function. For example, Huangqi (Radix Astragali), Danggui (Angelica sinensis), Baizhu (Rhizoma Atractylodis Macrocephalae), Renshen (Radix Ginseng).

Chinese herbs often have a wider antibacterial spectrum. No drug resistance in most of bacteria. Doctors always select different herbs according to symptoms differentia diagnosis. When your antibiotic doesn’t works, why not to try some Chinese herbs? They are green nature antibiotics.

Can Chinese medicine treat cancer ?

Tiejun Tang   

  

“Can Chinese Medicine treat cancer?” Many patients and my students ask me this question in the clinic and classroom. This is a good question, but it is a big topic. I can spend the whole morning to talk on this topic to my students. But in my busy clinical work, I can only give the patients a brief explanation about this question. I write something here about this hot topic. If anyone is interested in this question I can tell them to check my blog and find a more detailed answer.

Cancer was nearly an incurable disease thirty years ago when I was a medical student. Most cancer had a high mortality rate. Due to the development of modern medicine, more and more new techniques have been used to treat cancer. The mortality rate has been greatly decreased. Modern medicine can use surgical operation to remove the tumour. They can poison the cancer cells by chemotherapy, kill the cancer cells by radiotheraphy, burn the cancer by thermotherapy and freeze cancer by cryotherapy. However, modern medicine still has some troubles in the treatment of cancer. Many people still die of cancer every year. Why?

Some patients are too late or too weak for operation after been diagnosed with cancer. Chemotherapy and radiotheraphy not only kill the cancer cell but also kill some normal cells like white blood cells (WBC) and red blood cells (RBC). If the WBC are too low, the chemo has to be stopped because of the high risk of fatal infection. Unfinished chemo will allow the cancer cell to survive and develop. This paradoxical condition is very common in the treatment of cancer.

Chinese medicine can treat cancer by at least two ways. One called Fuzheng (invigorate health) the other call Quxie (expel evil). Fuzheng includes nourishing qi and blood and/or nourishing yin and yang. These herbs can raise WBC and RBC count and increase the immune function of the patient. It can be used to treat side effects of chemo and radio. The chemo can be carried out under the protection of Fuzheng herbs. Quxie includes expelling phlegm, removing the blood stasis, releasing the qi stagnation and detoxification. These herbs have been proved to inhibit cancer cell in vitro or in vivo.

For example, a research report showed During  the cancer treatment, when patients were given Danggui extract and cyclophosphamide (CY), it can prevent the cytotoxicity of CY to hematopoietic and gastrointestinal tissues(1). A study from Taiwan reported that Huangqi Liuyi Tang (HQLYT), which consisted of Huangqi, Gancao and Dazao can enhance the cytotoxic effect of natural killer cells on YAC-1 cancer cells. Significantly delayed the decrease of WBC level caused by chemotherapy drugs, and affected the faster recovery of WBC level to normal state. Enhanced immune function in both in vitro and in vivo studies (2).

In classical texts of Chinese medicine, cancer was recorded as Jiju (mass). Ancient doctors treat Jiju by balancing Fuzheng and Quxie. Deficiency syndrome should use more Fuzheng; excess syndrome should use more Quxie. Sometimes use Fuzheng first, followed by Quxie; sometimes the other way round.

Most of the modern medicine therapies for cancer belong to Quxie, they make the patients weak and tired. In many cases, Chemo has to be stopped because of its side effects. In China doctors always combine traditional Chinese and western medicine together. Many clinical reports show integrated therapy is better than any single therapy.

We shouldn’t only use Chinese medicine to treat cancer, but Chinese medicine can definitely play a very important role in the cancer treatment.

Reference:

1. Marco K C Hui.  Polysaccharides from the root of Angelica sinensis protect bone marrow and gastrointestinal tissues against the cytotoxicity of cyclophosphamide in mice. Int J Med Sci.  2006;3(1):1-6
2. Guan-Cheng Huang. Immuno-enhancement effects of Huang Qi Liu Yi Tang in a murine model of cyclophosphamide-induced leucopenia. J Ethnopharmacol. . 2007;109 (2):229-35..

Hay fever arrives with spring

Dr Tiejun Tang

Weather is getting warmer. Trees and grasses turned to green. Flowers come into blossom. Nature tells us spring is coming. However, not every people can enjoy such a beautiful weather. They always have same symptoms every year at this season, which is frequent sneezing, stuff and running nose, itch and watery eyes. This means you probably have got hay fever.

Hay fever refers to allergic reaction of the nasal mucosa due to excessive sensitivity of the certain part of body to the allergen. It might occurs all year round but mostly happen in spring because the pollen is the commonly allergen. It affects 2 in 10 people in population of the United Kingdom.
Western medicine use antihistamine tablets and nasal spray to treat this disease. It can ease most of the symptoms but may not be so good at relieving nasal congestion. It also makes patient feels sleepy after taking antihistamine tablets.
Chinese medicine believes hay fever is due to the deficiency of Defensive Qi and Wind-Cold or Wind-Heat invades the lung. Acupuncture and Chinese herb medicine can help a lot to cure hay fever from the root.
Acupuncture points selection is varied from case to case. But basic points are Yingxiang (LI20), Hegu (LI4), Yintang(EX-HN3), Baihui(DU20), Shangxing (DU23). In most of the case the nasal obstruction can be released immediately after the needle had been inserted to the certain points.
A total of 61 patients diagnosed with hay fever were randomly allocated to either the acupuncture or the sham acupuncture group, after a 4 weeks treatment the total nasal symptom score (TNSS) was significantly lower than in the control group [1]. The efficacy of acupuncture in allergic rhinitis and other allergic diseases, such as asthma or allergic eczema, appears to be due to the cytokine profile regulation of Th1/Th2 cells and particularly in the expression of IL-10, IL-2 and IFN-γ. [2]

Bi Min Gan Wan is kind of herb pill which has a function of expel Wind and ease the nose blockage. Di Tong Biyan Shui is a spray which is made of Chinese herbs. It can be selected to treat hay fever. These herbs didn’t have any side effect like antihistamine and steroid.

Chinese herbs Yupingfeng San (Jade Screen powder) can build up the immune function of patient^[3]. It can prevent the hay fever occurred. Prevention is a clever choice for people whom have history of hay fever. Treating your disease before it happen, you can keep hay fever away and enjoy a lovely spring.

Reference 

1. Jiaoping Mi. Treatment of persistent allergic rhinitis via acupuncture at the sphenopalatine acupoint: a randomized controlled trial.  Trials. 2018; 19: 28. Published online 2018 Jan 11. doi:  10.1186/s13063-017-2339-z
2. Bettina Hauswald, et al.  Acupuncture in allergic rhinitis A Mini-Review.  Allergo J Int. 2014; 23(4): 115–119.
3. Jian Gao . Antiinflammatory and Immunoregulatory Effects of Total Glucosides of Yupingfeng Powder.  Chin Med J (Engl) . 2009; 122(14):1636-41.

Say Goodbye To Your Period Pain

Dr. Tiejun Tang

Period pain is an unavoidable nightmare for a large number of girls and women. Statistics show that over 50% of menstruating women suffer from dysmenorrhoea. (Dawood, 1993) In most mild cases the pain lasts approximately 24-48 hours. Many girls do not realise more can be done to alleviate period pain. Most accept that their period should always be painful and do not seek treatment. In some severe cases the pain can be much longer and worse, which can result in absenteeism, fainting, or even shock.

Usually, conventional medicine use painkillers, prostaglandin synthetase inhibitors or oral contraception pills to treat period pain. These types of medications can temporarily relieve the pain, but if used long term it can cause side effects in the digestive system and central nervous system.

Is there any method that can release the period pain from the Root without causing side effects? Traditional Chinese Medicine is a very good choice for period pain.

Chinese Medicine believes that period pain can be due to Qi Stagnation, Blood Stasis, Cold Coagulation, and Kidney and Liver Deficiency. Different cases may have a different pathology change and so different treatment principles are applied in various conditions.

If the pain often begins before the period, it indicates more Qi Stagnation. In this condition we can use: Xiangfu (Rhizoma Cyperi), Zhiqiao (Fructus Aurantii), and Chaihu (Bupleurum chinense DC). If the pain often occurs during the period with some clots, it indicates more Blood Stasis. In this condition we can select: Chishao (Red Peony Root), Danggui (Chinese Angelica), Taoren (Peach Seed), and Honghua (Safflower). If the pain often occurs after the period, it indicates more Blood Deficiency or Kidney Deficiency. In this condition these herbs are called for: Danggui (Chinese Angelica), Jixueteng (Caulis Spatholobi), and Xuduan (Radix Dipsaci). If the pain can be relieved by warmth and gets worse by cold stimulation, it indicates Cold Obstruction. In this condition we can use: Xiaohuixiang (Foeniculum vulgare), Wuyao (Lindera aggregata), and Rougui (Cinnamomum cassia).

As well as the use of Chinese herbs, acupuncture is also very effective if the correct points have been selected. Commonly used points are: Guanyuan (RN4), Zhongji (RN3), Guilai (ST29), Sanyinjiao (SP6), Taichong (LV3), Shenshu (BL23), and Ciliao (BL32). Moxibustion is applicable for pain due to the Cold Obstruction.

The ideal time to begin treatment is few days before the period. After 2-3 cycles most cases will see a significant improvement or total alleviation of the menstrual pain. The lower abdomen and lower back must be kept warm during the period, as it is very important for the prevention of period pain.

Women do not need to tolerate the terrible menstrual pain every month. Chinese Medicine can help say goodbye to period pain.


Reference

Dawood, M. Y. (1993). ‘Dysmenorrhea’. Current Obstetrics & Gynaecology. 3, (4), P, 219-224.

Does cold water swimming benefit or harm your health ?

Tiejun Tang
Cold water swimming refers to swimming in water with a temperature of below 14℃. Does this activity benefit or harm your health? Many people ask me this question when they had known I am a winter swimmer. This question can not be answered with a simple yes or no. Let’s analyse the reaction of the human body to cold water stimulation from the point of physiology. In this way you will gain a clearer understanding.

When people get into cold water this stimulates peripheral vasculature to contract. The blood will therefore be redistributed. More blood will enter the heart, brain and kidney. The blood supply of these important organs will thereby be greatly increased. After leaving the cold water the body temperature gradually returns to normal. The peripheral vasculature dilates. The blood distribution returns to normal. During this process the vascular changed from a state of contraction to dilation. Long term repetition of this stimulation increases the elasticity of the vasculature; this is good for preventing arteriosclerosis. That is why winter swimmers have less chance of suffering from hypertension, heart attack and stroke. Cold water swimming also can increase the blood circulation of skin, slowing down the ageing process of the skin and benefiting peoples’ immune system. Most cold water swimmers never catch a cold.

However, cold water swimming does not suit everybody. If someone has been diagnosed with arteriosclerosis, high blood pressure or other cardiovascular diseases, it will not be suitable for him or her to start cold water swimming. This is because sudden cold stimulation will raise blood pressure, and can increase the chance of heart attack and brain stroke. Sometimes it can even cause sudden death. For patients suffering from rheumatoid arthritis, joint pain might get worse after cold water stimulation. For ladies whom have period pain, winter swimming is also not suitable. For epilepsy patients, any kind of swimming is contraindicated.

Generally speaking cold water swimming is a very good sport for most healthy people. It will benefit you without any harm. For some people already suffering certain diseases such as high blood pressure, arthritis and dysmenorrhea etc. it might bring you more harm than good. For severe conditions of these diseases, cold water swimming is strictly forbidden.

If you are suitable for cold water swimming, you should start during summer time. The frequency of your swim should at least 2-3 times per week, gradually entering winter swimming. When the water temperature is below 5 ℃ you should stay in the water no more than 5 minutes.

If you are aware of the above principles, you will get the idea of whether or not you are suitable for cold water swimming and how to best enjoy your swim.

Wuzhualong – An Efficient Herb of South China

Tiejun Tang

Wuzhualong, also called Wuzhimaotao (Ficus simplicissima Lour), is a native herb of south China, which attribute to Ficus of Moroideae. It has been called Southern Huangqi, Local Huangqi and Five Fingers Ficus. It is mild in nature, pungent and sweet in taste. Its channel tropism is Spleen, Lung and Liver. It has many functions including benefiting Qi and invigorating deficiency; smoothing and releasing Qi stagnation; strengthening tendons and dredging meridians; invigorating Spleen and expelling dampness; expelling phlegm and releasing cough. This herb has been widely used in the southern China, especially in the Canton province. My PhD tutor Professor Tietao Deng, often selects this herb in his clinical practice. It can be used to treat many diseases if combined with various other herbs. Dr. Deng’s clinical experience about this herb, are as follows:

1. To benefit Qi and invigorating deficiency its functions are similar to Huangqi

This herb has a function of invigorating Qi, especially to benefit the Qi of Spleen and Lung. This function is similar to Huangqi so it has been called Southern Huangqi. It can invigorate Qi without causing too much Fire. It is less heating than Huangqi, so it is more suitable for patients of southern China living in a tropical climate. Wuzhualong has often been used to treat symptoms that are due to Spleen and Lung Qi deficiency, such as tiredness, shortness of breath, palpitations, poor appetite, abdominal distension, and loose stools. It is often combined with Dangshen, Baizhu and Fuling. If necessary, it can be combined with Huangqi to increase the function of invigorating Qi.

2. To expel Bi Syndrome, dredging meridians, and a combined purging and nourishing function

In southern China there is more incidents of Bi Syndrome due to the damp weather. This syndrome is mainly due to Wind, Cold and Dampness. In some case it is due to Damp-Heat. It causes joint and muscle pain. Professor Deng often uses Wuzhualong to treat Bi Syndrome. Not only does this herb have a tonic function but the ability to expel Wind-Damp and dredge meridians. It has a combined purging and nourishing function in one herb. It can also be combined with other herbs such as Duhuo, Qinghuo, Sangjisheng, Kuangjinteng, Luoshiteng, Xiqiancao, Weilingxian, etc.

3. Invigorating Spleen and Lung, expel phlegm and relieve cough

Chinese Medicine believes “Spleen is the source of phlegm and the Lung is a container of the phlegm”. The patient suffers from Spleen and Lung Qi deficiency must get cough and/or phlegm. Wuzhualong can be used to treat any cough with or without phlegm, and any phlegm with or without cough. In the case of a severe cough, it can combined with Baibu, Xingren, Zhiyuan; in the case of profuse phlegm, it can combine with Banxia, Qianhu and Jiegeng; for Lung Yin deficiency it can combined with Maimendong, Beishashen, Baihe; for cough with superficial syndrome it can combined with Sangye, Jinyinhua and Lianqiao.

4. Promoting urination to expel oedema; regulating menstruation and promoting breast milk secretion

Wuzhualong can also be used to treat oedema through promoting urination. It is more suitable for the oedema due to Spleen deficiency. In this condition it can be combined with Zexie, Fulingpi, and Zhuling; for irregular menstruation it can be combined with Danggui, Xiangfu, Nvzhengzi and Hanliancao; for scanty breast milk after delivery it can combined with herbs such as Wangbuliuxing, Lulutong, Tongcao and Yimucao, etc.

Besides the use of Wuzhualong as a medicine, it can also be used in food therapy. Many Cantonese boil the herb with pork or chicken soup. It has an effect of strengthening the body, expelling Dampness and dredging the Meridians. It can build immune function and prevent disease from occurring. The health wine that is made from Wuzhualong, has become more and more popular in recent years.

Why this herb has such effective functions? The Medicinal Chemistry research showed Wuzhualong mainly containing psoralen, bergapten, aminophenol, glucide, sterol, and coumarin[1]. The pharmacology research shows that this herb has antibacterial, antiviral, and anticoagulant properties, inhibits cancer and regulates the immune system. Some researchers used Cyclophosphamide to inhibit the immune function of mice. They find Wuzhualong can increase the carbon particle clearance index, increasing the thymus and spleen index and raising hemolysin level. The results indicated that Wuzhualong has an effect of improving the immune system [2].

The weather of the United Kingdom is much different from southern China. In general I’ve observed that most British people have a hot constitution because of dietary or genetic reasons. In my opinion Wuzhualong may have a better effect than Huangqi for invigorating Qi. It is also a good choice for dredging meridians, expelling Bi Syndrome and phlegm, as well as releasing cough. If the herb Wuzhualong interests you, have a try.

Reference
1. Jiang Bin, et al. (2005) ‘The Chemical component research on Wuzhimaotao’. Chinese Traditional and Herbal Drugs. 36, (8), p. 1141-1142.
2. Liu Chunling, et al. (2004). ‘An experimental study on Wuzhimaotao’s effect of immune function of mice.’ Journal of Chinese Medicinal Materials 27, (5), p.367-368.

An Incident of aristolochic acid again

Dr. Tiejun Tang
BBC and some newspaper had a negative news about Chinese Medicine today.

Ying "Susan" Wu, 48, of Holland-on-Sea in Essex, has been on trial at the Old Bailey for selling pills containing aristolochic acid to a civil servant.
Patricia Booth, 58, took the pills, bought at Chelmsford's Chinese Herbal Medical Centre, for over five years. She was in her mid-40‘s when she first sought help from the centre in 1997 for stubborn patches of spots on her face.
Aristolochic acid (AA) is a component from some Chinese medicine herbs. It can cause kidney damage if applied improperly in the clinic.

In Belgium, in the early 1990's many people had been diagnosed with kidney damage after taking a kind of Chinese herbal slimmimg tea for one year, which contained AA. In 1998, the UK had two case of kidney failure reported after taking herbs containing AA. Since then any herbs or patent herb products have been strictly forbidden by law in the entire world.

Every qualified Chinese Medicine practitioner should have this knowledge and such an incident should be avoidable.

Some people might simply believe AA is just contained in Aristolochia debilis (Madouling), actually it also exists in many other herbs such as Manshurian Aristolochia Stem (Guanmutong), Aristolochia fangchi (Guangfangji), and Dutchmanspipe Vine (Tianxianteng) et al.

Some herbs only contain a trace amount of AA, and it can still be used safely especially when it was   combined with other herbs. Only the herbs which the chief component is AA should be strictly banned.

Generally speaking Chinese herbal medicine is much safer compared to most chemical drugs, but it doesn’t mean it is a hundred percent safe. It still needs special training and obtaining a standard qualification before practice. Which herb can you choose? What is maximum dosage? How long can your patient take it? If a practitioner failed in answering these questions, he or she will be like a blind driver on the road.

As a TCM practitioner I think this case highlighted the urgent need for the statutory regulation of herbal medicine in the UK. The government needs to take action to speed up the process of statutory regulation of herbal medicine.

I would like to tell the media and the public that in the UK, most of the Chinese Medicine practitioners are qualified and most of the Chinese herbs are very safe. When you select Chinese Medicine treatment check your practitioner’s qualification first. Do not change your opinion about Chinese Medicine just because of one or two very rare incidents.

How to treat rheumatoid arthritis with Chinese medicine?

Tiejun Tang

Rheumatoid arthritis (RA) is a chronic, progressive and disabling auto-immune disease. Statistics show 0.8% of the UK adult population suffer from RA. More than 7 million people in the UK (15% of the population) suffer from long term health problems related to arthritis.

RA in Chinese medicine is diagnosed as Bi syndrome. Chinese medicine believes Bi syndrome is due to the invasion of exogenous pathogenic wind, cold, dampness and heat. These exogenous evils can cause meridian blockage, sluggish qi and blood flow.

Clinical symptoms are marked by pain, soreness, numbness, heaviness, burning sensation, incapability of flexion and extension in muscles, bones and joints, or even accompanied with joint swelling or joint deformity.

If Wind is in excess, patients often describe the pain as ‘moving around’ in the body or limbs / joints. If Cold is in excess, the pain is more contracted, fixed and stabbing. If Dampness is in excess, patients will experience more swelling, a sensation of heaviness, numbness and stiffness in the joints, with less pain.

The principles of treating Bi syndrome should be to expel Wind, disperse Cold, eliminate Dampness, clearing away heat and dredging the meridians.

Many Chinese herbs can effectively release the symptoms of RA.

If the joint pain is located in the upper limbs.

 Qianghuo(Rhizoma seu Radix Notopterygii), Sangzhi (Ramulus Mori), Baizhi (Radix Angelicae Dahuricae), Weilingxian (Radix Clematidis) can be selected.

If the joint pain occurs in the lower limbs, 

Duhuo (Radix Angelicae Pubesentis), Niuxi (Radix Achyranthis Bidentatae), Mugua (Fructus Chaenomelis), Xuduan (Radix Dipsaci) can be selected.

For spinal joint pain 

Duzhong (Cortex Eucommiae), Sangjisheng (Ramulus Taxilli), Gushuibu (Rhizoma Drynariae), Yinyanghuo (Epimedium) should be selected.

Practices may differ between physicians in terms of herb selection, but the intention to eliminate pathogenic factors remain the same. Professor Tietao Deng treats Bi syndrome with a preference for local Cantonese herbs, many of them are from vine category. Such as:

 Kuangjinteng (Caulis Tinosporae), Luoshiteng (Caulis Trachelospermi), Rendongteng (Caulis Lonicerae), Jixueteng (Caulis Spatholobi), Qingfengteng (Caulis Sinomenii), Haifengteng (Caulis Piperis Kadsurae) et al.

Treating disease according to syndrome differentiation is most important in Chinese medicine. Different cases may experience symptoms differently. Therefore, the prescription must be individually modified to suit the individual’s constitution. There is no one prescription that fits all.

Herbal medicine can be used in conjunction with acupuncture, which has proven to be highly effective for the treatment of arthritic pain. The acupoints selection can be local points around the affected joints or the use of distant points to target on expelling Wind,  Cold and Dampness. 

A systematic review included 13 RCTs involving the use of electroacupuncture and manual acupuncture, all showed positive treatment effects on knee osteoarthritis[1]. Another RCT report on treating peripheral joint osteoarthritis with acupuncture had significant and clinical benefits [2]. 

To conclude, as we come to understand that RA is mainly due to wind, cold and dampness, patients should, therefore, be more vigilant on preventative measures. Try to keep your joints warm in cold weather and practice safe manual handling techniques.

Reference: 

1.        Vas J．Evidence from RCTs on optimal acupuncture treatment for knee osteoarthritis--an exploratory review. Acupunct Med. 2007 Jun;25(1-2):29-35.

2.  Manheimer E. Acupuncture for peripheral joint osteoarthritis.Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001977.

We are practicing authentic Traditional Chinese Medicine outside of China

---- A letter to Professor Tietao Deng

Dear Professor Deng

How are you recently? Can’t imagine how time flies, I’ve already come to England for more than two years now. During these two years, I’ve been working in a Chinese Medicine Clinic affiliated with a UK university both as a doctor and a teacher and I’ve gathered much impressions. Thinking about some of the recent criticisms on the practice of Chinese Medicine in China, I feel the need to let you know my experience here and hope that you can spread the ideas to both the supporters and those who disagree. I hope my experience and impression here can exert some influence on the development of Traditional Chinese Medicine in China.

In UK, there are many practising Chinese medicine practitioners. The main difference between the practice here and that in China is that we practise the pure Traditional Chinese Medicine here. This is evidenced as follows:

1. Only Chinese medicine can be prescribed, no Western medicine can be used coherently

It is very difficult to absolutely avoid the use of Western medicine for most of TCM practitioners in China, me included before I came here. However in UK, only pure Chinese herbs can be prescribed. Decoctions, pills and powders are commonly used forms. Everything we use has to be pure Chinese herbs. This country has a very strict legislation for the control of Chinese medicine imports. No patented pills containing any Western medicine are allowed to be imported. As a Chinese medicine practitioner here, we are not allowed to prescribe any Western medicine, or use any Western medicine to treat patients. In this sense, we are compelled to use only pure Chinese herbs. Although this leaves us with no choice but to practise in total independence of Western medicine, on the other hand the therapeutic characteristics of purely using traditional Chinese medicine has fully been shown. In fact, we still can get very good effects for most diseases even without the use of any Western medicine. I personally have a lot of successful cases within my scope of practice.

2. Combining Chinese herbs with acupuncture and other non-drug therapy

In China, most TCM doctors seldom use acupuncture. The doctors of acupuncture department do not prescribe herbs very often. Chinese herbal medicine and acupuncture seem to be divided. However, in ancient time, nearly all the TCM practitioners used both therapies. In the history of Chinese medicine, before the Ming and Qing dynasty, every famous master was very good at both herbs and acupuncture. If we hope that our treatment could be as effective as our ancestors’, maybe we need to follow their way of practice. Only in this way, the real spirit of TCM can be developed. That is the approach we adopt abroad. In the treatment of most of our patients, we combine herbs and acupuncture together. Some other non-drug therapy such as moxibustion, cupping, electric acupuncture, ear seed, tuina massage, cutaneous scraping etc are also applied according to individual cases. With this multi-therapy interaction, the therapeutic effects can be seen much enhanced.

3. Extensive clinical aspect

London is a multi-cultural metropolis. People here are of different races and come from different parts of the world. Their life style, diet, and constitution are varied. The scope of disease is also very different from China. Some diseases which are rarely seen in China could be very common here. The different conditions that we come across here are very wide, including internal disease, surgery, gynaecology, paediatrics, dermatology and ENT disease. We must learn to be a good all-round general practitioner at all times. No matter what disease I encounter, I always remember two important essence of TCM ---- the holism conception and differentiation diagnosis. In my opinion, the holism conception is helpful in breaking through the demarcation of clinical classification; whilst the differentiation diagnosis is applied to analyse all the new problems. In most of the larger TCM hospitals in China, the division of clinical departments tend to be more and more refined. Each department only focuses on one of the zang-fu organs. Isolating a particular area too much may inevitably lead to overlooking other related aspects. In the long run, the holism conception will be diminished; the traditional practice of TCM is also altered. At this stage, shouldn’t we ask ourselves whether we should be developing TCM according to its original concept? Must we follow the Western clinical divisions?

4. Combining teaching with clinical treatment

The university which I’m now working for first started enrolling full time students for a 5 year TCM programme in 1997. Starting from this year, it also started enrolling for a TCM master degree programme. Our students come from all over the world, mainly from Europe. TCM education here has been greatly influenced by higher education of UK. Emphasis is being placed more on practical training. Clinic placement starts at the first term of the first year. As the term progresses, the students will have to take up more and more clinic placement, until they can treat patients independently. After 3-4 years of training, most of the students will be able to master quite skilful acupuncture techniques and will have acquired some knowledge about herbs. During the whole 5 years study, the students spend more time on clinic placement than classroom teaching. Compared to the education in China, UK students have more own time for self study. They have more paper work, case study and presentations to do. The emphasis is more on clinical practice.

Since ancient times, the Traditional Chinese medicine had been passed down from generation to generation by an individual teaching method. Teaching and treating are carried out at the same time. In fact, the students who get high marks in the exam may not necessarily turn out to be good doctors in the clinical environment. Clinic practical training is therefore very important. I feel that TCM education overseas resembles TCM teaching in ancient China more and I think that teachings in China should follow more closely with this trend.

All of the above are the impression I obtained with my work in UK. TCM is a quintessence of Chinese culture. It has been accepted by all races over the world. Many of my students have a great unbelievable enthusiasm to TCM. They are diligent and hard working. Every year, they graduate from here and go to different parts of the world. During these two years, I have treated many patients by applying the clinical experience that you taught me and many unbelievable good results have been achieved. I will report these cases to you in future.
I remember you used to take an undiscovered jade as the metaphor for TCM. I would like to tell you now that this precious gem is already glittering outside China. You can rest assured that TCM will live on forever and be even more and more widely accepted.
Best Wishes
Your student : Tiejun Tang

6th September 2007

Why and How Traditional Chinese Medicine can treat Coronary Heart Disease？

Dr Tiejun Tang
Coronary heart disease (CHD) is a common heart disease. It is caused by narrowing of the coronary arteries, resulting in blood supply insufficiency. It leads to myocardial ischemia changes or anoxic change of the heart. Clinical symptoms include sudden chest pain, an oppressive feeling in the chest and palpitations. In some severe case death will occur.

Statistical data from Department of Health shows CHD is the biggest killer in U.K. More than 1.4 million people suffer from angina. 275,000 people have a heart attack annually. CHD kills more than 110,000 people in England every year [1].

Hypertension, hyperlipidemia and diabetes are common risk factors of CHD. Some unhealthy life style factors such as smoking, alcohol, lack of exercise, stress at work can increase the chance of CHD.

CHD can be diagnosis by ECG, heart ultrasonic scan and coronary angiography.

Western medicine has many advantages in the treatment of CHD, but it still has limitations. For example: there are side effects of most antihypertensive and antilipemic drugs, some of them serious; the high restenosis rate within 6 months after percutaneous transluminal coronary angioplasty (PTCA)[2] ; the high risk and the high financial implication of surgical intervention, i.e coronary bypass.

The symptom of CHD had been firstly recorded in the Neijing (Yellow Emperor's Canon of Medicine 475B.C.-221B.C.) In this classic book angina is named as xiong bi, or xintong. Arrhythmia is named as xinji, or zhengchong. From that time our ancestors began to use Chinese herbs and acupuncture for the treatment of this disease. In modern China we combine traditional Chinese medicine (TCM) and western medicine together to treat CHD. Many clinical and laboratory research published now indicates that some Chinese herbs in addition to acupuncture may have a very good effect for treating the symptoms of myocardial ischaemia with a positive outcome for those patients affected [3,4].

Within the TCM framework the pathology of CHD may be understood to be due to deficiency in the root and excess in the branch. Deficiency of the root includes heart, kidney, spleen, yin and /or yang deficiency. Excess branch include qi stagnation, cold obstruction, phlegm blockage and blood stasis. Different cases will have individual pathology presentation. The treatment principle should vary according to the syndrome differential diagnosis.

If cold obstructing the heart, warming heart method should be selected. Where phlegm is blocking the heart, expel phlegm method should be used; if heart blood stasis, the stagnation need to removed from the heart meridian; if liver and kidney yin deficiency, nourishing yin method should be used; if heart yang deficiency, warming yang method should be selected.

Chinese medicine can prevent CHD by reducing the risk facts such as hypertension, high cholesterol, diabetes and arteriosclerosis.

Herbs functions that inhibit liver yang and nourishing kidney yin often have a good effect on lowing blood pressure. For example: Tian ma (Rhizoma Gastrodiae), Gou teng (Rmaulus Uncariae cum Uncis), Ju hua (Flos Chrysanthemi), Gou qi zi(Fructus Lycii); Herbs functions that remove blood stasis often have good effects on improving microcirculation and increase coronary circulation. For example: Dan shen(Radix Salviae Miltiorrhizae), Chi shao (Radix Paeoniae Rubra), San qi (Radix Notoginseng), Chuan xiong (Rhizoma Ligustici Chuangxiong); Some herbs can reduce cholesterol, like Shan zha (Fructus Crataegi), Ze xie (Rhizoma Alismatis), Jue ming zi (Semen Cassiae), He shou wu (Radix Polygoni Multiflori); Some herbs has function to reduce blood sugar, like Shan yao (Rhizoma Dioscoreae), Mai men dong (Radix Ophiopogonis), Tian hua fen (Radix Trichosanthis), Shu di huang (Radix Rehmanniae Praeparata).

Chinese medicine selects different herbs according to different condition. Sometimes decoction may be used and sometimes patent pills may be prescribed. Usually herbs combined with acupuncture will make the treatment more efficient.

In the treatment of CHD Chinese medicine have showed the following advantages:

Firstly, Chinese medicine has a Multi-target effect. One decoction or pills contains several different ingredients. Each ingredient acts on different pathology change. It can treat disease from the branch to the root at same time.

Secondly, it is nature therapy, nearly no side effect. You can bring your blood pressure down without getting side effect such as dry cough, headache or edema; you can reduce cholesterol without damage your liver function.

Thirdly, the effect of Chinese medicine is stable and sometimes it has a bidirectional regulating function. Compare to western medicine, it has much less rebound effect on blood pressure. Some herb pills not only simply reduce blood lipid, it has a balance or regulation function. For example, our research shows Kaixin capsule can balance among the subfractions of lipoprotein and inhibit arteriosclerosis[5].

Few years ago the UK Government had committed to reducing the death rate from CHD and stroke and related diseases in people under 75 by at least 40% (to 83.8 deaths per 100,000 population) by 2010. Can we hit this target this year? I suggest all the patients and doctors have a second idea, it maybe a better solution in fighting against CHD.

Reference
1. http://www.dh.gov.uk/en/Healthcare/NationalServiceFrameworks/Coronaryheartdisease/index.htm
2. Drachman DE. et.al. Restenosis: Intracoronary brachytherapy. Current Treatment Options in Cardiovascular Medicine. 2002; 4(2) :109-118.
3. Tiejun Tang, Weikang Wu. Progress of Experimental Study in Traditional Chinese Medicinal Herbs Against Myocardial Ischemia. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine. 2003；13 (2):111-113,118.
4. Tiejun Tang. The prosecution and application of rat model of experimental coronary heart disease. International Journal of Cardiovascular Medicine (Chinese Edition) 1999; 1(4): 318-320.
5. Tiejun Tang et al. Effect of Kaixin Capsule on Blood Lipid and Lipoprotein Subfractions in Experimental Rats with Coronary Heart Disease. Journal of Guangzhou University of Traditional Chinese Medicine 1999; 16 (3): 223-225.