Goodbye Asante and Hello Middlesex

Tiejun Tang

I quitted my job at Asante Academy of Chinese Medicine on 15^th August 2013. I had worked in Asante for 8 years and 4 month since April 2005. Eight years is longer enough to keep a lot of memories in my mind, and I had met many very nice colleagues, many lovely students and many patients. Some of them became my good friends. I would like to say thank you to Dr Ke for given me the opportunity to meet so many good people, to teach so many students and to serve so many patients. Thank you to my dear colleagues for everything you did for me in the past days. Thank you to all the staffs of Day Treatment Centre in Whittington hospital.  At the time to say good bye, I send my best wishes to all of you.

Eight years time is nearly a quarter in my 34 years Chinese medicine career. My first job was at Xijing Hospital, the Forth Military Medical University, it last 5 years and ended because of my MSc study. My second job was at the First Military Medical University, it last for 12 years, but these 12 years was interrupted by my PhD study and post doctoral research work at two other universities. Asante work is the longest job in my career without any interruption. Before I came to UK, I had spent 26 years time to accumulate my Chinese medicine knowledge in China. As a medical practitioner, I believe that if you want to give your patient a better service you should continue updating your medical knowledge. That is why I never stop continuing professional development for higher degree. The patient’s precious life and health is in your hand. You cannot make any mistakes at any time.

From September I will join a completely new teaching clinic of Middlesex University which is based near Hendon campus. I will continue my clinical treatment and teaching work in that new clinic. New term will be a new start. I will meet new colleagues, new students and new patients. In this complementary medicine clinic we will have Chinese medicine, western herbal medicine and ayurveda. Three branches of traditional medicine will work together. I think this combination will give patients more benefits. I am very sure the new clinic will become one of the best teaching clinics in complementary medicine field.

If you are my patient or used to be my patient, you are more than welcome to see me at the new teaching clinic of Middlesex university.

You also can see me at my private clinic in Harley street central London. You can book your private or student treatment session online at www.harleystreetchineseacupuncture.co.uk

Acupuncture Pain Clinic in Whittington Hospital

Tiejun Tang

Acupuncture pain clinic in Whittington hospital was established in 2002, just one year after Asante Academy funded. This year is its ten years anniversary. At beginning it opened 2 half days per week, and gradually developed to 4 half days every week. Many current and former Asante staffs used worked in Whittington hospital. I covered one half day weekly since 2005. I am the only person which worked in this pain clinic more than 7 years. I should have something to sum up.

Currently, we provided about 2000 acupuncture treatment every year in this pain clinic. The total number of the treatment in the past 10 years should be about 15,000.

The patients suffered from different kinds of pain. The western medicine diagnosis including: chronic and acute lower back pain, sciatica, arthritis, tennis elbow, frozen shoulder, carpal tunnel syndrome, migraine, trigeminal neuralgia, endometriosis, fibromyalgia, and pain after surgical operation etc. All the patients were referred through their GP. Most of them had got a clear diagnosis through blood test and CT or MR scan. Many of them have taken pain killers for a long time.

We applied acupuncture in every patient and plus cupping in some severe cases. Most of patients have got some improve after 5-10 sessions. In some cases, they have got a significant improvement.

Why acupuncture can release pain? Traditional Chinese medicine theory believes the pain is caused by obstruction of meridians. “There is a blockage there is a pain”. The reason of the obstruction can be different in individual cases. Qi stagnation, blood stasis, pathological cold and phlegm are the common reasons. Acupuncture can regulate the function of Zang-Fu organs, balance Yin & Yang, regulate the circulation of qi and blood and dredge the meridians. “When the obstruction is removed the pain will be subsided.”

About the mechanism of acupuncture release pain, many modern researches have been done. In 1980 there was a report from St. Bartholomew's Hospital of London. The author use Low-frequency electroacupuncture to treat patients with pain. After electroacupuncture the β-endorphin levels in cerebrospinal fluid were rose significantly in all subjects. A recent study showed after electrical acupuncture stimulation at Hegu (LI4), it will cause simultaneously response at blood oxygenation level dependent (BOLD) and cerebral blood flow (CBF).

Except pain clinic we also have cooperation with labour ward of Whittington hospital. We use acupuncture to release the pain before and during the labour. In recent years Asante had opened two more pain clinics in North Middlesex Hospital and Royal Free Hospital. I am sure in the future more and more patients will have chance to get acupuncture service in NHS hospitals.

Reference:

Vicky Clement-Jones(1980). Increased β-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. The Lancet, 316(8201): 931-988.

Yue Zhang (2012). Simultaneous CBF and BOLD mapping of high frequency acupuncture induced brain activity. Neuroscience Letters. 531(1): 1-62.

How to treat urinary tract infection with Chinese herbal medicine?

Tiejun Tang
Urinary tract infection (UTI) is a very common disease. It might occur in any age groups. It is more common in women than in men - it's estimated that half of all women in the UK will have a UTI at least once in their life and one out of every 2,000 healthy men will develop one each year.



If you’ve got urgent frequent urination and pain or a burning sensation when urinating, you might have UTI. A urine sample test can diagnose this disease easily.

Most of UTI are easy to treat if the patients have a good reaction to antibiotic. Many acute UTI can be cured in couple of days. But in some cases, the antibiotic seems no effect or less effect when you use it at second time. Why antibiotic doesn’t work? That is because the pathogenic bacteria can be different in different patient, or even the same patient’s different infection. Usually antibiotic only target on a certain bacteria, if the antibiotic doesn’t match the bacteria, it will no effect. The other reason is bacteria get resistance to antibiotic. In this condition acute UTI will change to chronic one. Mild urethritis might develop into cystitis or even pyelonephritis. What can you do when you facing this situation? Traditional Chinese medicine can help you to get rid of UTI.

Chinese medicine believes the symptoms of UTI are due to bladder damp-heat. Many herbs have a good function to expel dampness and clean away the heat from bladder. When antibiotic doesn’t work on UTI, Chinese herbal medicine often reveals a good effect. To release bladder damp-heat, Bazheng San is the first choice. This traditional formula was original recorded in He Ji Ju Fang -- an authorized pharmacopoeia of Song Dynasty (1151 A.D.) The original formula of Bazheng San contained nine ingredients: Cheqianzi, Jumai, Bianxu, Huashi, Zhizi, Gancao, Mutong, Dahuang and Dengxincao. In this formula Mutong should be removed because it might cause kidney function damage. Tongcao can be selected as an alternative. Huashi is a mineral, it should be removed if there is a legal limitation in some countries. Pugongying and Diding can be added if more white blood cell in the urine. Daji, Xiaoji and Baimaogeng can be added if more red blood cell in the urine or hematuria. According to patients individual constitution more modification on the ingredients and dosage should be done about this formula.

Chinese herbal medicines have a multiple target effect on many bacteria, it never cause resistance. When you have above troubles in UTI treatment, why not to try something new?

Metabolic Syndrome and its TCM Food Therapy

Tiejun Tang
Last month I delivered two lectures, one for TCM Student Society of Middlesex University, the other for the annual general meeting of ATCM. In these two lectures I talked a same topic -- Metabolic Syndrome and its TCM Food Therapy. The audiences are very interested in my talk. Many people ask me for handout, somebody suggest me to publish this paper in ATCM journal. I prefer to put this article in my blog first, to share my knowledge to more readers all over the world.

Metabolic syndrome (MS) is a group of common diseases. It became more and more popular due to the life- style of modern society. Chinese medicine herbs have a good effect in the treatment and prevention of MS. Patients often need a long term treatment. Most of patients don’t like to take the herb decoction for too long time, many treatment have to be terminated for this reason. If we use herbs as a daily food therapy, that will be much more acceptable for most of the patients. In this paper I will introduce some TCM food therapy methods on the treatment of MS.
The definition of metabolic syndromeAlthough the conception of metabolic syndrome originated in late 1950s, but it used to have a different definition. Until Reaven (G.M Reaven 1988) noticed that hyperlipidaemia, hypertension and insulin resistance often cluster together, he put forward the conception of X-syndrome, nine years later Zimmet (P.Z. Zimmet 1997) suggested to use the conception of metabolic syndrome. In 1999 WHO gives the work definition of metabolic syndrome it refers to a clustering of cardiovascular disease risk factors, including type 2 diabetes, hyperlipidaemia, hypertension and obesity.
The diagnostic criteriaThe diagnostic criteria of MS are various in different countries. NCEP (National Cholesterol Education Program) criteria and IDF & AHA (International Diabetes Federation & America Heart Association) criteria are applied in America. EGIR (European Group for the study of Insulin Resistance) criteria are applied in most of the European countries. The WHO criteria (1999) is following:
Require presence of one of:

•  Diabetes mellitus
•  Impaired glucose tolerance
•  Impaired fasting glucose or
•  Insulin resistance

AND two of the following:

•  BP: ≥ 140/90 mmHg
•  Dyslipidemia:TG: ≥ 1.695 mmol/L & HDL-C ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female)
•  Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female),
• or body mass index > 30 kg/m2
•  Microalbuminuria: urinary albumin excretion ratio ≥20 µg/min
• or albumin:creatinine ratio ≥ 30 mg/g

The prevalence of MSThe prevalence of the MS varies with country, race and the definition used. One study in the USA found a prevalence of 44% in the over-60s. A study in the Shanghai found a prevalence of 17.14% (1/6) in the age of 20-74 (Lei Chen. 2003). A report showed that the prevalence of metabolic syndrome in western London is various in different races. South Asians have higher prevalence than African-Caribbeans and Europeans (T.Tillin.2005).
Traditional Chinese medicine’s philosophy about MSAccording to Chinese medicine’s theory MS falls within the category of Xiaoke (消渴) and Xuanyun (眩晕). The etiology of MS is due to: a) Improper diet causing by over eating fat and sweet food; b) Emotional disorder causing by stress work and depression ; c) Spleen deficiency due to many chronic disease; d) Kidney and liver deficiency due to ageing; e) Yin-Yang loose balance and phlegm obstruction; f) Sluggish qi and blood circulation due to lack of exercise; Commonly used treatment principle should be: a) Expel dampness and phlegm; b) Remove the qi stagnation; c) Activate qi and blood circulation; d) Invigorating the spleen; e) Tonify kidney.
Food therapy formulas:

1. Gouqi Juhua Tea
Ingredients: Gouqizi (Fructus Lycii) 10g add 500ml water, boil 2 minute, add Juhua (Chrysanthemum) 10g, green tea 5g，Covered and soak for 30min. Drink once or twice daily.
Clinical application: hypertension, arteriosclerosis, coronary heart disease, diabetes, hyperlipemia, dry eyes and blurred vision.
2. Shanzha Jueming Tang
Ingredients: Shanzha (Hawthorn Fruit) 20g, Juemingzi (Semen Cassiae) 10, Prepare method : add 500ml water, boil for 30 min, drink once a day.
Clinical application: hyperlipemia, cholesterol or triglyceride, hypertension, arteriosclerosis, coronary heart disease, constipation, food retention.
3. Yumixu Tang
Ingredients: Yumixu (Corn Stigma) washed and soaked with boiled water for 5 min, or boil with water for 5 minute, drink once a day.
Clinical application: diabetes, hypertension, cholecystitis, hepatitis, nephritis.
4. Sanqi Shanyao Zhou
Ingredients: Sanqi (Radix Notoginseng）5g, Shanyao (Rhizoma dioscoreae) 60g, Jingmi (rice) 60g. Prepare method: above ingredients add water 500 ml, boiled for 1 hour，drinking the porridge.
Clinical application: diabetes, hypertension, anaemia, irregular menstruation, scanty menstruation.
5. Gegen Fen Zhou
Ingredients: Gegenfen (Radix Puerariae) 30g, Jingmi (rice) 50g; Prepare method ：add water 500 ml, boiled for 1 hour, drinking the porridge.
Clinical application: diabetes, hypertension, coronary heart disease, hyperlipoidemia.
6. Shanzha Shouwu Tang
Ingredients: Shanzha (Hawthorn Fruit) 30g, Heshouwu (Radix polygoni multiflori) 18g, Zexie (Rhizome of Oriental Waterplantain) 12g; Prepare method：Above ingredients add water 600 ml, boiled for 1 hour. Drink the decoction twice a day.
Clinical application:　hyperlipemia, Diabetes hypertension, coronary heart disease．
7. Ju Huai Cha
Ingredients: Juhua (Chrysanthemum) 3g, Huaihua (Flower of Japanese Pagodatree) 3g, Green tea 3g; Prepare method ：Put above ingredients in a cup, add boiled water, soaked 5 minute, drink the tea once daily.
Clinical application:　Hypertension，Headache，Dizzness．
8. Xiakucao Jiangya Cha
Ingredients: Xiagucao (Spike Prunella) 10g, Cheqiancao (Herba plantaginis) 12g; Prepare method: above ingredients washed, and put them in a cup, add boiled water, covered and soaked for 5 minute, drink the tea once a day.
Clinical application：Hypertension，Headache，Dizzness．
9. Danshen lucha Yin
Danshen (Rdix salviae miltiorrhizae) 9g, Green tea 3g; Prepare method： Put Danshen power and green tea in a cup, add boiled water, covered and soaked 5 minute, drink the tea once or twice daily.
Clinical application：Coronary heart disease，Angina，Hyperlipoidemia．　
DiscussionWestern medicine is effective in treating MS but it has to use many tablets at the same time. Patient has to take one table for blood sugar, one for cholesterol, and one or two tablets for control blood pressure. Usually these medicines are quite effective to control sugar, cholesterol and blood pressure, but each medicine will cause some side effects if used long term. These side effects will lead to some new troubles, such as liver function damage, low libido, edema, dry cough, headache, and even heart failure. That is the biggest trouble of west medicine.

Pharmacological research showed the ingredients of Yumixu contains flavone, glycoside, trace element, organic acid, glucide, multi-vitamin. It showed a better effect than 2.5mg Glibenclamide in diabetic patients. There are many effective ingredients in these herbs like tanshinone in Danshen; flavone in Juhua; phytomelin in Huaihua; Notoginseng leaf saponins and flavone in Sanqi; lycium barbarum polysaccharide and Carotene in Gouqizi etc.

Shanzha, Juemingzi and Heshouwu can reduce blood lipid; Juhua, Xiakucao and Gouqizi are good for high blood pressure; Danshen, Sanqi and Gegen can improve coronary circulation and benefit heart. In clinical practice, according to patient’s diagnosis we can select one or two from the nine formulas above. Patients can take the tea or porridge every day or every other day. MS can be get control by daily food therapy. Some MS cases didn’t show a lot of symptoms, many patients didn’t paid enough attention to this disease, but MS put the patients in a high risk of heart attack or stroke. Taking action to reduce the potential risk is better than to wait until the attack has occurred. This is a very important treatment principle of traditional Chinese medicine.

Reference:

1. Lei Chen. (2003). Prevalence of metabolic syndrome among Shanghai adults in China. Chinese Journal of Cardiology. 31(12): 909-912.
2. Reaven GM.(1988). Role of insulin resistance in human disease. Diabetes. 37(12):1595-607.
3. Tillin. T. (2005). Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study
4. Diabetologia 48(4): 649-656.
5. Zimmet PZ et al. (1997). The global epidemiology of non-insulin-dependent diabetes mellitus and the metabolic syndrome. Journal of Diabetes and its Complications. 11(2): 60-68.

Deng’s Herbal Tea

Tiejun Tang
Drinking herbal tea is a very popular for keeping healthy in the southern China. People often drink some herbal tea for clearing heat and detoxification. It is called Liang Cha in Cantonese, mean cold tea. Drinking Liang Cha can keep you away from flu and many other unwell during the hot summer. Deng’s Herbal Tea is a new form of Liang Cha, which was invented by my tutor professor Deng Tietao. Due to its good prescription and excellent pharmaceutical technology, it became one of the most popular healthy products in China.

Deng’s herbal tea is composed of six natural herbs. They are Jinyinhua, Baimaogen, Juhua, Sangye, Pugongying and Gancao. It has heat clearing and detoxification function, so it can be used to treat and prevent common cold and flu which is due to wind-heat. It also has a function of benefiting liver and cooling blood, it can reduce the harm of alcohol and smoking, it is good for heavy drinker and smoker. Because it is good at clearing the heat from lung and stomach, Deng’s herbal tea also can clean acne for any age groups. The modern pharmacology research shows it has an antivirus, immune enhance and diuresis functions.

Deng’s herbal tea has different formulations. Pop can is easier to dink at anytime and any condition. Granule is suitable for family and office worker. Lozenge is easier to carry and taken. Syrup is good for release constipation and moisten lung because it is prepared with honey. There is a no sugar granule special for diabetic population.

The weather of UK is not as hot as southern China. Is it necessary to drink Liang Cha? My answer is yes. For the most British their heat is not from the weather, it is from their life style. According to Chinese medicine’s theory, mutton, lamb, any baked food, chocolate, alcohol and smoking are easy to produce heat or damp-heat. If any one of the above mentioned is your favourite, you probably will have more heat in constitution. You need Liang Cha to expel these pathological fires. Deng’s Herbal Tea is a right choice.

Infertility and its TCM treatment

Tiejun Tang
First of all, I need to identify the concepts of the three key words in this topic.

Infertility: The infertility diagnosis standard of World Health Organization (WHO) is that couples who failed to conceive after 12 months of contraceptive-free intercourse if the female is under the age of 34, or 6 months of intercourse if the female is over the age of 35. Couples who have never been able to conceive are classified as primary infertility, whilst others are called secondary infertility.
TCM: traditional Chinese medicine, which includes Chinese herbal medicine, acupuncture, moxibustion, and electric acupuncture in some conditions.

Treatment: I am very cautious in using the word “treatment” here. A new advertising code had been announced by The Advertising Standards Authority (ASA) in March 2011. The code lays down strict restrictions to advertisements of complementary medicine practices. Wordings such as “cure”, “treatment” are prohibited from the advertisement of our leaflet or clinic website. Some practitioners use wordings like “management” or “help” instead. I never use the word “cure” in my leaflet, because in medicine, it can never be 100% sure that any disease could be cured. I think “treatment” just means the process of a therapy. It doesn’t indicate whether the result will be positive or negative. Why are we not allowed to use the word “treatment” in advertisement? What is the difference amongst “treatment”, “management” and “help”? What a strange code! The code also declared that objective claims must be backed by evidence. Substantiation will be assessed on the basis of the available scientific knowledge. I have two reasons why I used “treatment” here and also in my other blog articles. Firstly, this blog is not a clinic website, hence it is not an advertisement. Secondly, I always show some scientific evidence to support my opinion

The causes of infertility can be due to either the female or male or both parties. In some cases, the cause can be unexplained. In UK the statistic data of 2009 is shown below.

In female infertility the common reasons are shown below.

In a clinical study from Germany (Paulus, 2002), 160 patients who were undergoing assisted reproduction therapy were divided into two groups randomly: embryo transfer with acupuncture (n=80) and embryo transfer without acupuncture (n=80). Acupuncture was performed at 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. The results showed clinical pregnancies were documented in 34 out of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

Another report is from Denmark (Lars G. 2006). Patients treated with IVF/ICSI (intracytoplasmic sperm injection) were divided into three groups. Group 1 received acupuncture on the day of embryo transfer (ET), group 2 on ET day and again 2 days later, and both groups were compared with a control group that did not receive acupuncture. Results showed clinical pregnancy rates were significantly higher in group 1 as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%]) and ongoing pregnancy rates were also higher in group 1 as compared with controls (34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the group 2 (36% and 26%) were higher than in controls, but the difference did not reach statistical difference. Conclusion can be drawn that acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, as compared with no acupuncture.

Acupuncture also has good effect in treating male infertility. In a prospective controlled study, statistical evaluation of the transmission electron microscopy data showed a significant increase after acupuncture in the percentage and number of sperms without ultrastructural defects in the semen. A statistically significant improvement was also detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. (J. Pie. 2005)

In addition to acupuncture, Chinese herbs can also greatly increase the chances of pregnancy. There is an experimental study which showed that Erzhi Tiangui Decoction could significant raise the quality of oocyte in mice (F. Lian 2004). A clinical track study showed Wenshen Antai Decoction can also increase the pregnancy rate after re-transplant of IVF (D. Li. 2009).

Fertility problems affect one in seven couples in the UK. Many couples choose IVF or IUI, but they have to be prepared for the low success rate and the high cost. Much evidence showed that acupuncture and Chinese herbs can treat infertility for both male and female. Only a few reports amongst many were mentioned above. TCM treatment can help get natural pregnancy, prevent miscarriage and increase the success rate of IVF, although the success rate would vary with different treatment plans and different causes of infertility.

Reference:Lian Fang, Sun Zhen-gao, Zhang Jian-wei, et al.(2004). Experimental Study on Effect of Erzhi Tiangui Recipe on Quality of Oocyte in Mice. Chinese Journal of Integrated Traditional and Western Medicine. 24(7):625-7.

Li Dong (2009). Increase of pregnancy rate by Wenshen'antai Decoction combined with assisted reproductive technology in patients with embryo transplant failure. Journal of Beijing University of Traditional Chinese Medicine. 32(2):

Pei J, Strehler E, Noss U. et al. (2005). Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertility and sterility, 84 (1): 141-147

Paulus WE, Zhang M, Strehler E, et al. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil and Steril. 77 (4): 721–4.

Westergaard LG, Q Mao, M Krogslund. et al (2006) Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertility and sterility, 85(5): 1341-1346.

Decoction is the best formulation

Tiejun Tang
There are several different formulations in Chinese herbal medicine. Pills, tablets, powders, capsules are commonly used patent remedies. In addition to these formulations, there is another commonly used formulation – decoction. It means several different raw herbs mixed together, soaked in the water for a period of time and then boiled over fire for about an hour, filtrate them and drink the liquid. It is the most traditional method in Chinese herbal medicine and in my opinion, it is the best formulation. The reasons are below.

Firstly, decoction can give a patient an individual treatment. The treatment principle of Chinese medicine is based on syndrome differentiation diagnosis. In the clinical practice each individual case might need different herbs. Even the same disease with different patient, it may need different prescription because their symptoms are not exactly the same. For example, if two people catch cold at same time. Mr. A has a sore throat, headache, and high temperature; but Mr. B suffers sneezing, blocked and runny nose, with normal temperature. If we treat using a decoction, we will select different herbs according to patient’s clinical manifestation. A good prescription will suit the individual patient only, just like a tailor made suit for an individual person according to their measurements.

Secondly, decoctions have good adaptability. The patient’s symptoms might change during the treatment process. At different stages of the same disease, the patient might need different herbs. We can amend the prescription by changing some herbs or adjusting the dosage of some herbs. It’s better to amend the prescription once a week according to symptoms. Let’s take irritable bowel syndrome (IBS) as an example. Patients suffering from IBS often alternate between diarrhoea and constipation. When diarrhoea happens we need to use Baizhu, Yiyiren, Huoxiang, Peilan etc to tonify the spleen and expel dampness. When constipation happens we need to remove Yiyiren, Huoxiang, Peilan and add Maziren, Juemingzi to moisten the intestine and release constipation. This adjustment can be used more often in some acute diseases and less often in stabile chronic disease.

Thirdly, decoction is more easily absorbed by the patient. After drinking into the stomach, the effective substances in the decoction will be absorbed through the gastrointestinal system and into the blood within half to one hour. The result is much quicker than other formulations.

The disadvantage of decoction is that it requires a little preparation time. The patient needs to spend some time boiling the herbs every day. The other disadvantage sometimes is its taste which is usually quite bitter. You can add some sugar or honey before drinking it. Many people gradually get used to the bitter taste after taking them for a period of time. Some even start to like the "magic coffee", because they get a lot of benefits from the herbal decoction.

Decoction is the best formulation, but a good treatment depends on correct diagnosis. Nevertheless, if disease is misdiagnosed, no formulation will work. However, if you get it right, you are sure to hit the target spot on!

Glandular fever and its TCM treatment

Tiejun Tang

Glandular fever is an infectious disease caused by the Epstein-Barr virus. Some TCM practitioners who were trained in China might not be familiar with this, but its formal name -- infectious mononucleosis, will be more familiar.

The diagnosis of this disease is not difficult. The main points of diagnosis are included in the names of the disease. The clinical manifestations are fever with swollen glands, sore throat, headache, fatigue and muscle ache. These symptoms are similar to flu, except that the patient will have a unique blood test result with monocytes count significantly increased. There may be swollen lymph nodes, enlarged liver and spleen, widespread red skin rash without itchiness.

This disease can occur in any age groups but young people between 10 and 25 years are most vulnerable to this infection. The incubation period from infection to when the symptoms first appear is between 30 and 50 days.

Western medicine does not have any efficient treatment for infections caused by virus. Usually patients will be prescribed medicine such as paracetamol or ibuprofen to ease the symptoms. Antibiotics may be used if the patient developed a secondary bacterial infection of the throat. Steroids may also be prescribed in severe swelling of tonsils.

Chinese medicine diagnosed this disease as Wenbing (温病, epidemic febrile). It is due to wind-heat or wind-cold invading the superficies. The exogenous evils produce heat and toxin. These heat-toxin spread to the blood, it consumes qi and body fluid, then causing qi and yin deficiency at a later stage.

Chinese medicine treats glandular fever with different treatment principles at different stages. In the early stage the diagnosis is due to wind-heat invading the lung, we can use modified Yinqiao San to clear and detoxify wind-heat.  In the middle stage where the heat develops from Wei stage to Qi stage, we need to use modified Baihu Tang to purge the internal fire. In the later stage the heat develops to Ying stage, we select Qingying Tang to clear heat and cool the blood. At the recovery stage, patients usually have qi and yin deficiency symptoms, we should then select modified Zhuye Shigao Tang to clear the remaining fever and tonify qi and yin.

Some Chinese herbs have a good function of inhibiting virus which can be applied to treat glandular fever.  These are Banlangen (Radix Isatidis), Daqingye (Folium Isatidis), Lianqiao (Fructus Forsythiae), Jinyinhua (Lonicera japonica Thunb), Guanzhong (Cyrtomium Rhizome), Huangqin (Radix Scutellariae). If the patient has red skin rash appearing, I would like to add Chishao (Red Peony Root), Mudanpi (Tree Peony Bark), Zicao (Radix Lithospermi), Qiancao (Radix Rubiae), Xuanshen (Radix Scrophulariae) to cool blood. If the patient has qi and yin deficiency, Maimendong (Dwarf Lilyturf Tuber), Zhuye (Folium Phyllostach Lophatheri), Zhimu (Rhizoma Anemarrhenae), Taizishen (Radix Pseudostellariae) can be added.

In addition to Chinese herbal medicine, acupuncture can also be used to treat glandular fever. The commonly used points are Hegu (LI4), Quchi (LI11), Waiguan (SJ5), Dazhui (Du14), Fengmeng (BL12), Feishu (BL13), Xuehai (SP10).  A reducing manipulation can be applied. In some severe cases with high temperature, bloodletting cupping at Dazhui (DU14) is necessary.

Glandular fever usually takes 2-4 weeks to resolve without complications. In about 3 per cent of the cases, it might develop into complications such as pneumonia, anaemia, thrombocytopenia, meningitis or encephalitis. Three percent is a very low chance, but if it happened to an individual person that mean a hundred percent to him/her. Glandular fever should not be ignored.  If a patient has got this disease, he should have plenty of rest, drink plenty of water, and access to a Chinese medicine practitioner. I am sure Chinese herbal medicine and acupuncture can give more help than chemical drugs.

Welcome the right decision from Department of Health

Tiejun Tang

On 16th February the Health Secretary of UK government had announced to Parliament that herbal medicine practitioners will be regulated from April 2012. The four UK health departments have agreed that the Health Professions Council (HPC) should hold a statutory register of practitioners who supply unlicensed herbal medicines to people to enable the supply of herbal medicines to continue after 30 April 2011.

This decision is very good news for all of herbal medicine practitioners including our TCM practitioners. It is also good news for the public because practitioner regulation will be underpinned by medicine legislation which will provide further safeguards to protect public health. Let’s welcome this right decision made by UK government.

The regulatory status of TCM is our hope and dream. Some of colleagues at ATCM had struggled for this target for many years. As a council member of ATCM, I feel very happy to see the good result of regulation. Traditional Chinese Medicine has received great development in the last two decades in UK. There are more than three thousand clinics all over the UK. Chinese medicine became more and more popular in this country. However, some practitioners do not have good qualification. Because there is no status regulation, anybody can practise Chinese medicine here. Many clinics run like a business with the sole purpose of making profits. Some patients enter a Chinese herbal shop irrationally just as they are choosing a Chinese restaurant because they simply do not know where to find advice or recommendation even if they believe in TCM. Many medical mishaps occurred just because of unqualified practice. After April 2012, this condition will not happen again and the public will get better protection, as a register of all qualified practitioners will be kept and made available to the public.

Traditional Chinese Medicine is an Undiscovered Science. This is the title of one of my blog paper last year. TCM origin is from China but it is a common treasure of human beings. It had been widely accepted by almost every country of the world. There is no international border for science, the same for TCM. Chinese medicine is very effective in treating many diseases. For some disease it always works if you get the correct diagnosis and have selected the correct treatment principles. In China the practice of TCM has been strictly regulated by law. All the practitioners must have received at least 5 years training. After they are qualified from university they still need to pass a practice licence examination, any unlicensed practice is illegal. I think TCM practice should be regulated by law in any country for the public’s safety. I would like to say the UK government has made a wise decision this time.

Cold winter is gone, spring is coming. In the UK, TCM’s spring will come very soon.

How to treat Raynaud's Phenomenon with Chinese Medicine?

Tiejun Tang
This winter is extremity cold; many people have very cold hands and feet in such weather. Some people’s cold extremities come by episodic attacks. When the attack occurs, the skin colour changes from white to blue and red. The hands and feet become cold and numb. Some patients describe the sensation as tingling, or painful "pins and needles". The attack is usually triggered by exposure to cold or emotional stress. This phenomenon is called Raynaud’s phenomenon in western medicine. This phenomenon can be subdivided into primary and secondary conditions. The primary form is known as Raynaud’s disease, whereas the secondary form is known as Raynaud’s syndrome.

Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers and toes. This disorder causes vasospastic attacks where the blood vessels in the fingers and toes constrict thus causing a loss of circulation. This phenomenon can affect between 5 to 10 percent of the general population. Women are more susceptible to have the disorder in comparison to men, and it appears to be more prevalent in the winter season of colder climate areas.

In Western medicine the treatment of Raynaud's syndrome is carried out with calcium-channel blockers. These cause the smooth muscle to relax and consequently dilate the small blood vessels. In some patients, doctors use alpha blockers that counteract the actions of norepinephrine. These medicines can often cause some side effects, in which case many patients have to stop using them. These medications may also have a detrimental affect on a growing foetus; therefore women who are pregnant or are trying to have a baby should avoid taking these medications. Unfortunately Raynaud’s is more likely to occur in women of childbearing age.

In Chinese medicine Raynaud’s phenomenon falls within the category of Hanjue (寒厥). It means cold extremities. The interior pathology of this disease is Qi and blood deficiency and Yang deficiency, whereas the exterior pathology would relate to cold invasion within the meridian. The treatment principle should be to nourish the qi and blood, whilst expelling the cold and to warm the yang. This theory can be carry out through the use of herbs, acupuncture and moxibustion.
A herbal prescription suitable for this condition is; Danggui Sini Tang. This would be used as the first choice for this disease, as it is a traditional formula which originates from Shanhanlun, a classic text of TCM, written by Zhang Zhongjing about 1700 years ago. The ingredients include; Danggui (Angelica sinensis), Guizhi (Ramulus Cinnamomi), Baishao (Radix Paeoniae Alba), Xixin (Manchurian Wildginger), Tongcao (Tetrapanax papyriferus), Dazhao（Fructus Jujubae）, Zhigancao (Radix Glycyrrhizae Preparata). If patient have more qi deficiency symptoms, add Huangqi (Radix Astragali) and Baizhu (Rhizoma Atractylodis Macrocephalae). If there is more of a blood deficiency, Jixueteng (Millettia dielsiana) and Heshouwu (Fallopia multiflora) can be add, and if there is more of a yang deficiency, Rougui (Cortex Cinnamomi) and Ganjiang (Dried Ginger) can be included.

With regards to the Acupuncture and moxibustion, these can be very helpful in the treatment of Raynaud’s disease. The acupuncture point selection would include; Mingmen (DU4), Shenshu (BL23), Guanyuan (RN4), Qihai (RN6), Xuehai (SP10), Zusanli (ST36), Baxie (EX-UE9), Bafeng (EX-LE10). Reinforcing manipulation can also be applied. The specific point selection for Moxibustion application should be Guanyuan (RN4) and Shenque (RN8).

I have a student who has been diagnosed with Raynaud’s disease. She often has Raynaud’s attacks during the winter period, but has cold hands and feet all year. She came to see me with regards to this problem last summer, and after few treatment sessions her hands and feet felt a lot warmer. Her Raynaud’s attack did not occur this winter.

Chinese medicine therapy is effective in treating both primary and secondary Raynaud’s phenomenon. It never causes any side effects, and is safe for pregnant women. If you often have cold limbs you need to nourish your qi and blood and warming your meridian pathways at any time during the year, you should not wait until winter. Generally it is better to start your treatment before the attack happens. A good treatment can give you a warmer and more comfortable winter.

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 case? 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 didn’t hit 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 is an antibiotic resistant strains can be find in the clinical. It looks like a race between antibiotic and it’s resistant.

Antimicrobial resistance and persistence are associated with an elevated risk of treatment failure and relapsing infections. They are thus important drivers of increased morbidity and mortality rates resulting in growing healthcare costs.^[1]

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 on inhibit or kill 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 enhance 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 to the most of bacteria.

The antibacterial mechanism of Chinese medicine includes changing membrane permeability, inhibiting protein and nucleic acid synthesis, inhibiting enzyme activity in the body, and controlling the drug resistance of pathogenic bacteria. Chinese medicine can also reverse antibiotic resistance by eliminating drug-resistant (R) plasmids, inhibiting extended-spectrum β-lactamases, bacterial biofilm formation, and bacterial efflux pump activity.^[2]

Chinese medicine practitioner usually selects 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.

Reference:

1.     Huemer M.  Antibiotic resistance and persistence-Implications for human health and treatment perspectives. EMBO Rep. 2020 Dec 3;21(12):e51034.

2.     B-G Liu. Antimicrobial mechanisms of traditional Chinese medicine and reversal of drug resistance: a narrative review.  Eur Rev Med Pharmacol Sci. 2022 Aug;26(15):5553-5561.