Questions & Answers
 

by Giovanni Maciocia

Trigeminal Neuralgia

I have been unable to find any information about trigeminal neuralgia, i.e. how to differentiate and treat it. Do you have any information on it?

From the TCM point of view, trigeminal neuralgia (TN) is an affliction of the channels of the face and is generally due to invasion of these channels by Wind-Cold. This "Wind-Cold" is different than the one which causes a cold or flu: it invades the channels of the face directly. This usually happens because there is an underlying Blood or Yin deficiency. In the elderly, or people weakened by various causes, the Wind-Cold stays in the channels of the face to cause the intense pain. In the elderly, this may be complicated by other factors such as local Blood stasis which makes the pain more intense. So, to summarize, there is invasion of Wind-Cold in the channels of the face, perhaps complicated by Blood stasis and against a background of either Blood or Yin deficiency.

The treatment should be to expel Wind from the face and nourish either Blood or Yin and invigorate Blood if necessary.

The distal points to use are: L.I.-4 (which I find works better if used on the healthy side, reducing method) with LIV-3 (on the affected side, reducing method).

T.B.-5 on the affected side (reducing method).

The local points to use are: choose according to affected branch from among Taiyang, ST-7, SI-18, ST-6, ST-5, even method. Gentle moxa stick can be used unless there is Yin deficiency with pronounced Empty Heat (it can be used if there is only Yin deficiency without Empty-Heat, i.e. if the tongue is not too Red).

TN is a difficult disease which requires many treatments.

Headaches from Raeder's syndrome

I have been asked to treat a girl who suffers from severe headaches and has been diagnosed with Raeder's syndrome. Do you have any knowledge on this?

Generally speaking, you have to approach the treatment of this girl as for any other headache, i.e. analyse the symptoms and signs, decide on a diagnosis and treat it accordingly. The very first chapter of my book "The Practice of Chinese Medicine" deals with headaches. Based on the symptoms connected with Raeder's syndrome, the most likely cause of this girl's headache is Liver-Yang rising with local Blood stasis. You need to use both distal and local points.

Distal points: LIV-2, G.B.-43, T.B-5 all on the side of the pain plus L.I.-4 on the opposite side.

Local points depend on the location of the headache: usually G.B.-1, Taiyang, G.B.-9, G.B.-20 all on the side of the pain.

It might also be necessary to nourish Liver-Blood with ST-36, LIV-8 and SP-6.

I have read about Raeder's Syndrome (which you can find on www.medscape.com) and, although this would not change the treatment, it might change the prognosis, i.e. it might be more difficult. However, given her age, I don't think it will be impossible.

Differentiation of Backache

Could you tell me what the TCM diagnosis would be if (a) someone had back pain and it gets worse when they are sitting but better when moving, (b) better with sitting worse with moving and (c) O.K. when sitting but sore and stiff when they get up then it starts to get better?

(a) Qi stagnation or Blood stasis
(b) Kidney deficiency
(c) Cold in the back channels

Post-viral Fatigue Syndrome

I have a patient who is 48 year old and suffered from breast cancer 3 years ago. The specialist told her that she has probably got M.E. as, for the last six months, she has been suffering from the following symptoms: very tired, severe muscle fatigue and ache (especially on her back), difficulty sitting, heavy limbs, poor concentration, a constant feeling of fullness in the epigastric area and on the right side of the abdomen, bitter taste, sore throat, insomnia, scanty dark urine and shivers. Her pulse was Full, tense and the Kidney position was Weak. Her tongue has teeth marks on the sides, is a little bit swollen and the coating is thin-white. Could you advise me about the treatment, including which points and herbs I should use?

Judging from the symptoms, it sounds very much like your patient suffers from Damp-Heat in the Middle Burner and muscles against a background of Spleen and Kidney deficiency.

I would concentrate on resolving Damp-Heat first with something like Lian Po Yin (or Ease the Muscles from The Three Treasures) and only after some months tonify Spleen and Kidneys with the herbs.

With acupuncture, it is different as you can do both by using Ren-12, Ren-9, ST-36, SP-6, SP-9, BL-22, BL-20 and Du-20.

Possible side-effect of Radio-Support

You gave me advice about dosage of Chemo-Support and Radio-Support concerning a patient of mine getting chemotherapy and radiation treatment simultaneously. You recommended she take 6 pills of each per day. After a few days, she developed bleeding from the nose. She immediately thought it was the herbs so she reduced the dosage by herself to 3 pills of each and the nasal bleeding stopped.

Are the herbs moving Blood too much? Do you think that at the lower dosage she will be getting enough protection?

There are no Blood-moving herbs in Chemo-Support but there are in Radio-Support. The nosebleed could have been from that although I doubt it, but anything is possible as people's metabolisms are so different and individual. I think that a lower dose will still afford your patient some relief from the side-effects. I would probably try again with the higher dose to see if it was really the tablets or the radiotherapy itself because this treatment heats the Blood and can therefore cause bleeding.

Loss of Sense of Taste and Smell

I am treating a woman suffering from asthma with signs of Phlegm and Heat in the Lungs. She has another problem which is loss of her sense of smell and taste, which are reversed with cortisone treatment. As soon as she stops the cortisone, the problem reoccurs. How do you interpret the action of cortisone in this respect from the point of view of Chinese medicine. As cortisone is anti-inflammatory, it should have a cooling action but why does it lead to symptoms of Empty Heat? What pathological process do you think is going on in my patient?

The loss of sense of smell and taste of your patient is due to Phlegm-Heat obstructing both the Lungs and the Spleen, the former leading to loss of sense of smell and the latter to loss of sense of taste. You cannot draw direct parallels between the action of Western drugs and their effect from a Chinese point of view. Probably, cortisone resolves Phlegm temporarily. Long-term cortisone use does induce Empty Heat because it weakens Kidney-Yin.

Dosage of The Three Treasures Formulae in Children

Can you use Welcome Fragrance in an 8-year-old child and what dosage?

For an 8-year-old child, I would use a maximum of 4 tablets a day and would probably start with 3 tablets a day.

Dosage and Protocol of Chemo-Support

An 8-year-old girl was found to have an inoperable brain tumor (a kind of Astrocytoma) located in her hypothalamus. She has started chemotherapy and I would like to give her Chemo-Support. The problems are:

a) She can't take tablets, which cause her to vomit, so I'd like to give it to her as a tincture but I'm not sure how it should be prepared.
b) I have doubts about the dosage according to her age.
c) Regarding Chemo-Support, many patients get chemotherapy once a week for 4-5 weeks, or once a month, how should they take Chemo-Support?

a) Your patient should take the tablets dissolved in water.
b) She should take between 4-6 tablets a day.
c) She should take them all the time, every day, i.e. on the days when she does have chemotherapy and when she doesn't.

Breast Cancer

I am treating a 68-year-old woman, her main complaint being 'shattered nerves'. She has a very involved medical history, the most relevant points being that she had her right lung removed 45 years ago and has been on prolonged spells of antibiotics. She is extremely weak and her immune system is very depleted. After six treatments she was diagnosed with breast cancer having found a pea-sized lump in her right breast and was prescribed tamoxifen. She was told she was too weak to have a mastectomy. Is Chemo-Support appropriate for people who are on tamoxifen?

I don't think your patient needs to take Chemo-Support. I know Tamoxifen is mentioned in my newsletter, but its side-effects are quite different than those from chemotherapy and are not addressed by Chemo-Support (they are, in my opinion, Damp-Heat). Since your patient has not had a mastectomy, the treatment principle is to treat the actual breast mass. This is due to one or a combination of three factors: Phlegm, Blood stasis and Toxic Heat. From what you say, I have a feeling that in your patient's case it is due to Phlegm. She therefore really needs something to resolve Phlegm, dissolve masses, tonify the Spleen and harmonize the Chong and Ren. There is no remedy that does this and it can only be done with a decoction. I would continue with the acupuncture but paying attention to resolve Phlegm and harmonize the Chong and Ren.

Lung Cancer

I have an elderly patient who has just been diagnosed with lung cancer. He may have radiotherapy or the doctors may just decide to give him palliative care. He has marked signs of Yin deficiency (night-sweating, bright Red, peeled tongue) as well as Heat signs (thirst, thick-yellow, dry coating in a small patch on the mid-back section of his tongue. I presume this is some form of Toxic Heat.

Looking at the individual herbs in your formula, they would appear to be useful even if he didn't actually undergo the radiotherapy treatment or is there a special reason why he should only take them if he undergoes radiotherapy?

If the patterns treated by Radio-Support seem to fit, there is no reason why he could not take it. However, judging from what you tell me and by my experience with cancer, it sounds like the patient suffers from an underlying deficiency of Lung-Yin with Empty Heat, but with a super-imposed condition of Toxic Heat. If this is the case, Radio-Support is not appropriate. He could actually take a combination of Clear the Soul together with Ease the Journey - Yin which, although for the menopause, nourishes Kidney- and Lung-Yin and clears Empty Heat.

Combination of Chemo-Support and Radio-Support

I have a 48-year-old female patient with colon cancer. She will be doing 6 weeks of a chemotherapy drip (24 hours a day) and also receiving radiation treatments simultaneously (once a day, 5 days a week). She has only just started both therapies this past week and hasn't yet noticed any side effects from either therapy.

My question is should she be on Chemo- or Radio-Support or a combination of both? And at what dose? She had hepatitis 5 years ago and has occasional night-sweats, disturbed sleep, dizziness, alternating constipation and diarrhoea with blood in the stools on occasion.

While she is having both chemo and radio, I would suggest taking both remedies with a dosage of about 6 tablets per day each, taken at separate times. I would recommend Chemo-Support in the morning/afternoon and Radio-Support in the late afternoon/evening. You can also vary the dosage according to the severity of symptoms. Usually the radiotherapy side effects come towards the end of the treatment so she could take more of the Chemo-Support than the Radio-Support in the beginning. I also recommend continuing taking the Radio-Support for at least a month after the end of the treatment with a dosage of about 6 a day.

Multiple Sclerosis

I have been treating a patient who was diagnosed with Multiple Sclerosis . The following is her history and I was wondering if you might give me some advice on how to treat her. I have been mainly trying to build up her Spleen and Kidneys. I have diagnosed the condition as Phlegm-Damp accumulation in the leg channels due to a deficient Spleen; however, there is no numbness of the limbs which is generally a sign of Phlegm accumulation so would it just be Damp blocking the leg channels?

The patient is a 29-year-old woman. She has had progressive weakness of both legs with an inability to balance at times. At present, she does not experience any weakness of her arms. Her appetite, sleep and bowel movements are normal. Her legs and feet are cold and she bruises very easily. Her lower body feels very heavy and 'off balance'. Her condition is aggravated by any extreme temperatures and certain positions of the feet bring on rapid tremors in the legs.

Generally speaking, one can identify 4 stages in MS:

1) Very early stage: Dampness in the channels causing heaviness and tingling.
2) Early/Middle stage: Stomach and Spleen deficiency causing weakness of legs, beginning of atrophy.
3) Middle/late stage: Liver and Kidney deficiency causing weakness of legs, dizziness, vertigo, atrophy.
4) Late stage: Liver and Kidney deficiency, Liver-Wind with or without Blood stasis.

All the above symptoms plus tremor and spasms of limbs. If Blood stasis: pain in the limbs.

I think your patient is mostly at the second stage but with elements of the 3rd/4th stage as, of course, the staging is not rigid. I think the main problem in your patient is Stomach and Spleen deficiency, plus some Dampness (feeling of heaviness) plus a hint of Liver-Wind (tremor of legs).

I would therefore say the treatment principles are to (in order of importance):

1) Tonify Stomach and Spleen
2) Resolve Dampness
3) Tonify Liver and Kidneys, subdue Wind

Points:

1)ST-36, SP-6, BL-20, BL-21, ST-31, ST-34, Ren-12
2) Ren-12, SP-6
3) LIV-8, KI-3, LIV-3.

Use also the Dai Mai occasionally (GB-41 on the right, TB-5 on the left) as this drains Dampness form the Lower Burner and is indicated for Atrophy Syndrome in the Su Wen (Ch.44).

Herbs that tonify the Stomach and Spleen, resolve Dampness and eliminate Wind-Dampness from the channels would also be indicated.

Calf Muscle Ache

I would like your opinion concerning the treatment of a calf muscle problem. The patient is 44-years-old and appears to be in good health. He runs for general conditioning 4-5 miles per day and 3-5 times per week without incident for several years. About 2 months ago, he changed jobs and began working nights. The job requires considerable walking and standing. Soon after starting this job, he began to experience tightness and cramping in the upper calf area when running. I have tried needling local points in the area of greatest pain with electrical stimulation and have used BL-60 as a distal point. Cupping and bleeding of the local area has also been tried with similar results. Do you have any observations or suggestions?

I would try using distal points that are above the area of the pain (which you don't specify exactly) such as BL-40. I would also use BL-57 as a local point and maybe Bl-58. Other choices depend on whether the area is hot or not. If it is hot, I would use SP-10. Another approach you can try is to use the Small Intestine channel (related to the Bladder within the Tai Yang) on the opposite, corresponding side, e.g. S.I.-7. I would not use electricity nor moxa.

From a Western point of view, you should look into the possibility of varicose veins (is it hot?): if this is the case, results would be less good than if it is just a muscular problem. In such a case, you should definitely use SP-10 and maybe SP-4.

Finally, I think that running 4-5 miles per day is over-exercise from the Chinese point of view and it does not do any good: as my Tai Ji teacher always stressed "fitness is not the same as health".

Chemo-Support and Oestrogen Production

The formula Chemo-Support contains Dang Gui Radix Angelicae sinensis which is known to stimulate the production of oestrogen. Would this not be contraindicated in oestrogen-dependent breast tumours?

First of all, I cannot find any reference in the available literature about Dang Gui Radix Angelicae sinensis having an oestrogenic effect or containing oestrogen. The Pharmacology and Applications of Chinese Materia Medica by Chang and But (World Scientific Publishing Co., 1986, p. 490) in fact says: "The vaginal smear examination proved that the herb had no oestrogenic action in mice". Formulas and Strategies by Bensky and Gamble (Eastland Press, 1993, p. 331) also says: "The herb does not appear to have any oestrogenic effect". The Handbook of Chinese Herbs and Formulas by Yeung (1983, p. 178) says about Dang Gui: "No female sex hormone action". The Xin Hua Ben Cao Gang Yao (New Pharmacopoeia, Shanghai Science Publishing House, 1988, p. 346) does not report any oestrogenic action for Dang Gui.

However, even assuming that Dang Gui did have an oestrogenic effect, there are several aspects to this question. The first is of a general nature: herbs do not have a chemical action like drugs but a balancing, physiological action. If we give a patient with breast cancer oestrogen, it will stimulate the growth of the tumour. However, herbs do not work in the same way as they have a complex, regulatory, physiological and homeostatic action. For example, Dang Gui can both contract and relax the uterus depending on the pre-existing state of this organ, which is a demonstration of herbs' homeostatic action. Another good example of this principle is Ginseng: it contains a certain group of saponins that excite the CNS and another group that depress it. Thus, one cannot say that "Dang Gui will automatically stimulate the production of oestrogen".

The second aspect to the question is that the action of a herb cannot be seen in isolation as it is modified by other herbs within the formula. Thirdly, It should be remembered that Chemo-Support, containing Dang Gui, is for administration only during a chemotherapy course when the body is being blasted by powerful toxic drugs: it is therefore unlikely that Dang Gui would be able to stimulate the production of oestrogen and therefore the growth of the tumour at this time. Once the chemotherapy is over, I normally stop the remedy Chemo-Support and prescribe a formula to treat the pattern or patterns underlying the growth of the cancer: usually, these will be formulae that concentrate primarily on expelling pathogenic factors (such as resolving Phlegm and Fire-Poison and invigorating Blood) rather than tonifying the body's Qi.

Finally, I would say that I do not think that Chinese journals and books have any formula for breast cancer that does not contain Dang Gui!

 
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