Acupuncture Protocols For Shen Disorders
Acupuncture Protocols For Shen Disorders
Acupuncture Protocols For Shen Disorders
References
1. Yang Jinan, Treatment of status epilepticus with acupuncture, Journal of Traditional Chinese
Medicine 1990; 10(2): 101-102.
2. Shi Bingpei, Bu Huaidi, and Lin Liyu, A clinical study on acupuncture treatment of pediatric
cerebral palsy, Journal of Traditional Chinese Medicine 1992; 12(1): 45-51.
3. Wu Lianzhong, Li Huimin, and Kang Ling, 156 cases of Gilles De La Tourette's Syndrome
treated by acupuncture, Journal of Traditional Chinese Medicine 1996; 16(3): 211-213.
4. Tian Lingdi, et al., Composite acupuncture treatment of mental retardation in children, Journal
of Traditional Chinese Medicine 1995; 11(1): 34-37.
5. Liu Hechun, Illustrative cases treated by the application of the extra point sishencong, Journal
of Traditional Chinese Medicine 1998; 18(2): 111-114.
6. Ding Dezheng, Personal experience in acupuncture treatment of mental disorders, Journal of
Traditional Chinese Medicine 2001; 21(4): 277-281.
7. Wu Fengqi, Treatment of schizophrenia with acu-moxibustion and Chinese medicine, Journal of
Traditional Chinese Medicine 1995; 15(2): 106-109.
8. Liu Guizhen, et al., Observation on the curative effect of acu-moxibustion plus systemic
desensitization on anxiety neurosis, Shanghai Journal of Acupuncture and Moxibustion 1998;
17(4): 17-18.
9. Zhang Anren, et al., Effect of acupuncturing houxi and shenmen in treating cerebral traumatic
dementia, Chinese Journal of Integrated Traditional and Western Medicine 1995; 15(9): 519-
521.
10. Shen Weidong and Li Ding, A preliminary clinical study on senile dementia treated by
acupuncture and moxibustion, Shanghai Journal of Acupuncture and Moxibustion 1996; 15(5):
5-6.
11. Yang Xiangtan, 26 cases of senile dementia treated with acupuncture by resuscitation
method, Chinese Acupuncture and Moxibustion 1996; 11: 3.
12. Lai Xinsheng, et al., Analysis of near-term effect of electroacupuncture in treating
vascular dementia, Journal of Traditional Chinese Medicine (Chinese) 1997; 38(6): 340-343.
13. Liang Zhong, et al., 115 cases of senile dementia treated by a combination of
acupuncture and Chinese herb therapies, Chinese Acupuncture and Moxibustion 1998; 12: 712-
714.
14. Liu Guangzhi, et al., Electroacupuncture treatment of presenile and senile depressive
state, Journal of Traditional Chinese Medicine 1992; 12(2): 91-94.
15. Liang Yue, Intelligence three needles and hand intelligence needle applied to treat
depression after cerebral apoplexy, Shanghai Journal of Acupuncture and Moxibustion 1998;
17(2): 27.
16. Wang Hairong, Acupuncture treatment of depressive syndrome after cerebral vascular
accidents, Journal of Traditional Chinese Medicine 2002; 22 (4): 274-275.
17. Zhang Chuanhong, Li Jinbo, and Wang Shu, Treatment of melancholia in Germany by
acupuncture method of resuscitation, Journal of Traditional Chinese Medicine 2004; 24 (1): 22-
23.
Chapter 1
What Is Shen (Spirit)?
The Chinese character for shen, usually translated as "spirit," has two components. To the right is the
character which gives both the basic meaning and pronunciation, shen. In the book Tracing the Roots
of Chinese Characters by Li Leyi (1), the following explanation of the earliest known form of the
character is given: "Graphically, it is the curved lightening flashes appearing in the clouds. The ancient
people believed lightning was the manifestation of god." To the left is the modified form of the
character shi (as used to form a radical, which is the category designator), which Li explains:
"Originally, it was the stone table for offering ceremonial sacrifices to the gods…characters with the
radical shi always pertain to ritual ceremonies, worship, or prayer." Today, this character (shi) more
generally means to make known, to manifest, to show; this is because the ritual ceremonies display the
inner prayer and worship of people. We can say that the Chinese writing character which has been
formed into shen to refer to the spirit implies the manifestations of a person's relationship to god [the
small letter 'g' is used here because the Chinese reference does not specify the personal God, as in the
Western Judea-Christian-Islamic tradition; still there are obvious similarities of ancient ceremonial
sacrifices on stone alters]. Historically, Chinese culture recognizes a creator god, Pan Gu, a trinity of
divine Emperors (Tian Huang, Di Huang and Ren Huang, the emperors of heaven, earth, and man,
respectively) and of divine helpers who come in human form, You Cao, Fu Xi, Shen Nong (2).
The earliest known discourse on shen in the medical context is found in the Huangdi Neijing Lingshu,
in Scroll Two. The document that comes down to us today is believed to have originated during the
Han Dynasty, perhaps around 100 B.C. In a translation by Wu Jingnuan (3), the relevant section on
spirit is titled "The Roots of the Spirit." The section, like others, begins with a question from Huang Di
(the Yellow Emperor) which is answered by Qi Bo (the chief physician), who begins his explanation
this way:
"Heaven abides so that we have virtue. Earth abides so that we have qi. When virtue flows and qi is
blended there is life."
The starting point for an understanding of shen is the meeting place of heaven and earth, which is man.
Heaven is the origin of the spiritual aspect of man and provides ongoing spiritual influences; earth is
the origin of the physical aspect of man and it continues to affect his body; the interaction of heaven
and earth, the spiritual and physical, provides life; the ongoing harmonious interaction of heaven and
earth in man is essential to maintaining life. The physical aspect is described here as qi. There is a
frequent misconception in the West that qi is ethereal or "energetic," and this is a misinterpretation (4);
in the traditional system of thought, qi is substantive but also dynamic, likened to steam and mist.
In the discussion presented in the scroll, there is reference to not only the spirit (shen) , but to two other
entities which should be discussed before proceeding (see chapter appendix for more details). One is
hun, which is translated often (and in this specific text) as the human soul; in fact, it is depicted as a
collection of 3 entities working together. Hun is manifested in dreams, and it is the aspect of the human
that persists after death of the body; thus, hun has a meaning that correlates to some extent with the
idea of the soul in Western thought. When Chinese texts talk about the ghosts of ancestors, they are
referring to hun. The other entity is po (actually represented as 7 entities), sometimes described as the
"animal spirit" but perhaps more accurately portrayed as the physical vitality. Its action keeps the body
alive; it is still active when a person is in a coma or is "brain dead;" it is gone when a person dies.
Neither hun nor po are the same as shen, and po is not the same as qi. We can say that in describing
these three entities, the shen is differentiated from the other two: it is not the human soul nor the vitality
of the human body. From the ancient Chinese view of embryology, the hun and po combine together
with the seminal essence (jing) and give rise to the spirit (shen) .
Shen, hun, and po each have a "seat" in the body, a place where they are said to rest and take residence.
Thus, even though each of them can influence all aspects of the human person, they rely on certain
parts of the person as a base. This situation might be likened to our own experience of working in the
community and interacting with our neighbors, then returning home as a place for recuperation, rest,
family interactions, and maintaining personal identity. Shen rests in the heart and vessels; hun rests in
the liver; and po rests in the lungs. Although these three entities are the dominant concern in the ancient
texts, in keeping with the influential system of five elements, two other organ systems are identified as
having their own spiritual characteristics which are not the same as, but might be likened to, the other
three: yi (intention, planning, thought, wisdom) is associated with the spleen and zhi (will; the strength
to carry out yi) is associated with the kidney.
Though we have all these terms depicting components of the person, it is shen that is the focus of most
discussion in the field of Chinese medicine, because that is the entity that is under the greatest control
via our behavior and it is the entity that displays the greatest influence over body functions. We can
attempt to learn more about the spirit by examining what is thought to harm it and what can be done to
avoid harm or to repair harm, which is a subject of the Lingshu scroll.
There are two types of harm that can come to the spirit, one is external, the other is internal: This
division is also used in the discussion of other physical disorders (another category of causation, one
that is deemed neither strictly external nor internal, is based on activities, such as eating, exercising,
etc.). External harm was viewed as the effect of "dissolute evil," which is often referred to as an
influence of "demons" (5) and, later in Chinese medical history, was shifted into the general category of
"wind" (6). The concept of demons causing disorders in people permeated virtually the entire world in
these ancient times, and demons were most often the causative factor suggested in cases of mental
disorders (particularly outlandish, obviously strange behavior) and neuromuscular disorders
(particularly ones that were sudden and dramatic, such as epileptic seizures). Today, we might convert
this ancient concept to one with more modern characterization, in which something (which we would
not call a demon, but would involve, for example, neurotransmitters and other neural regulators) causes
a dramatic alteration in neurological functions.
According to the Lingshu scroll, such external adverse influences could be avoided by maintaining
strength and balance:
The wise nourish life by flowing with the four seasons and adapting to cold or heat, by harmonizing joy
and anger in a tranquil dwelling, by balancing yin and yang, and what is hard and soft. So it is that
dissolute evil cannot reach the man of wisdom, and he will be witness to a long life.
These few words may seem to be simple instructions, but they are only the outline of what could
constitute entire books of instructions. I would like to offer a brief elaboration to assist with the
discussion of the nature of spirit.
"Flowing with the four seasons" has the meaning of staying in communion with nature. This concern,
expressed already more than 2,000 years ago when cities were simple compared to those we have
today, is not merely about dressing for the weather (which is implied as part of the next statement of
adapting to cold or heat), but it refers to giving attention to many different aspects of nature: the rising
and setting of the sun, the varying weather patterns, the changing plant and animal life, the different
sensations of the body as the day progresses, and so on. Today, we isolate ourselves from nature:
missing the sunrise in favor of an alarm clock; eating according to what is in processed food packages
rather than what has just been grown and harvested around us; dressing independent of the weather and
then relying on artificial heat and cooling; cutting away the forests to live among concrete, asphalt, and
mechanized vehicles. Though there can be no turning back of the clock of progress, there are choices to
be made in living in the modern world, such as the extent to which we relate to the natural setting. This
issue of communion with nature is not about going to the store to purchase organic produce and
encapsulated herb extracts; rather, this is about turning attention to natural cycles, to natural settings,
and to relationships with plants, animals, mountains, valleys, water, sky, sun and moon.
"Harmonizing joy and anger" refers to not allowing any emotion to become dominant or extreme, but it
also refers to the opposite problem of unnaturally avoiding experience of emotions by setting up
barriers. The person who is calm as a result of pursuing wise and healthful practices that lead to a
tranquil and easy nature can enjoy inner strength and healthy life. An important aspect of this is one's
own dwelling place, which should be nurturing, tranquil, and restful. Too often today, much of life
seems a battleground, whether it is at home, at work, or on the road traveling between the two. People
who engage in extreme behavior are a centerpiece of the world of television, which has become an
unintended learning resource for many children as they grow up and develop their attitudes.
Balancing yin and yang (and hard and soft) refers to development of a sense of appropriate response.
Yin is a more withdrawn receptive state of being, while yang is a more outgoing and active state of
being; both have their times for being appropriate. Remaining in a "yin" condition when yang is
needed, or vice versa, results in disorganization of life and harm to the body and spirit.
What the text is calling upon people to do is to adapt a lifestyle that is, at this time in history,
substantially different than the ordinary. It requires turning to the health of the spirit, calmness of the
emotions, and to worship and prayer directed at the heavenly influences and away from the
unconscious pursuit of earthly things that lead toward extremes, while remaining intimately in touch
with nature.
At the heart of the matter is the calmness which comes from an understanding of the relations between
heaven, earth, and man. As the scroll describes, emotions in the extreme, which disrupt calmness, harm
the person's spirit (I have inserted explanatory comments):
Too much joy and happiness can cause the spirit to shrink and scatter and not stay stored [that is, not
return to resting in the heart]. Sorrow and grief can cause qi to be blocked in the foundations so it does
not move [these emotions especially affect the lung, the seat of po, the vitality does not spread through
the body and the person has difficulty with getting around]. Great anger causes confusion and doubt
and a lack of control [anger is associated with the liver, the seat of hun, the soul is no longer able to
command the person, and seemingly random forces take control]. Fear and fearing cause the spirit to be
unsettled, to shrink away and to be nonreceptive [fear is the emotion that, more than any of them,
adversely affects the spirit and the body-one's planning, and will to carry out plans, shrink away and
one is even afraid to be helped].
It may seem odd to worry about experiencing too much joy and happiness. People can place excessive
emphasis on the frequent experience of these emotions; so much so that one ignores other important
aspects of life. As a result, the emotion and its context become false indicators of reality and lead one
astray. This is not to argue against joy and happiness that are a natural outcome of enlightened spiritual
living when harmony has already been attained; rather, it is about a focus on these emotions apart from
such harmonious living. The emotions that have the greatest potential for harm when excessive, in
addition to the dramatic impact of anger, are fear, fright, worry, and anxiety. As the text goes on to
specify: "The heart and mind with frightened and distressed thoughts and anxiety can result in injury to
the spirit."
The prolonged experience of living a fearful life leads to dysfunction, weakness, and premature death.
The Lingshu scroll continues:
Fear and fearing without release can result in injury to the seminal essence [jing]. The injured seminal
essence can cause the bones to be diseased and deficient. At the time of reproduction, the seminal
essence will not descend [this refers to the interchange between essential fluids in the brain and in the
kidney as described in the ancient literature]. Thus, the five viscera, which are the controls and
storehouses of the seminal essence, should not be harmed [by excesses in the emotions; the text
includes a description of visceral harm from each type of emotional excess]. If they are injured it will
result in loss of protection, and the yin [the substance of the body] will become hollow. The yin being
hollow will result in lack of qi [which is important for replenishing the jing]. A lack of qi will cause
death.
The deficiency of bones has many implications. At one level, this applies to the problem of
osteoporosis, where the bones become fragile and readily break (often contributing to health decline
and premature death). It also applies to the bone marrow, the source of blood cells; the spinal cord and
brain are also considered a type of marrow of the spinal column. Further, this deficiency refers to the
movements of the bones; hence, difficulty in walking is considered one of the outcomes of bone
disease, as are severe pains that afflict the bones and joints, such as occurs with osteoarthritis. The loss
of protection means not only susceptibility to external influences, such as cold and heat and infectious
agents, but also loss of protection from internal disruptions that may yield growth of tumors, water
swelling, and failure of the organs to carry out their critical functions.
In sum, shen refers to that aspect of our being that is spiritual and looks to the universe around, and is
not focused on emotions. Shen draws our attention to the divine, contributes to wisdom, virtue, and
calmness, and maintains our whole being in order. The spirit can be harmed by external factors if we
fail to maintain vitality through good habits, physical strength, and adequate nourishment. The spirit
can also be harmed by internal factors, mainly excessive emotions.
These are things that are, to a certain extent, under our control. While many external factors are beyond
our control, our protection from them through lifestyle choices is not. While emotional reactions to
various situations are spontaneous and beyond our control, the ability to return to equanimity is a skill
that can be mastered. To investigate further the critical issues, it will be worthwhile to examine in some
detail the matter of flowing with nature, a basic Taoist concept, so that a path to communion with
nature and inner strength can be identified (Chapter 2), and to look at some of the Chinese ways for
controlling the emotions (Chapter 3). These approaches are said to be related to benefiting the hun
(ordering relations with the outer world) and po (stabilizing the inner world), respectively. After
contemplating these means of staying healthy, it will then be worthwhile to consider Chinese medical
treatments (mainly acupuncture and herb therapies) that can assist those who have been adversely
affected by shen disorders.
References
1. Li Leyi, Tracing The Roots of Chinese Characters: 500 Cases, 1993 Beijing Language and
Culture University Press, Beijing.
2. Wei Tsuei, Roots of Chinese Culture and Medicine, 1989 Chinese Culture Books Company,
Oakland, CA.
3. Wu Jingnuan (translator), Ling Shu, 1993 Taoist Center, Washington, D.C.
4. Dharmananda S, Qi: Drawing a concept, 1997 START Manuscripts, ITM, Portland, OR.
5. Dharmananda S, Disorders caused by demons, 1997 START Manuscripts, ITM, Portland, OR.
6. Dharmananda S, Feng: Drawing a concept; the meaning of wind in Chinese medicine, 1999
START Manuscripts, ITM, Portland, OR.
7. Needham J, Science and Civilisation in China, vol. 2, 1974 Cambridge University Press,
London.
The po is derived from the earth (as if from the soil) and enters and exits the body through the po door
(pohu, acupuncture point BL-42); upon death it returns to the earth. The Chinese practices of burial of
the dead encompass taking care of the po, which eventually blends into the earth and does not retain
separate identity (as an exception, emperors were embalmed so that both po and hun could remain
viable entities, retaining their original form). During life, the resting place of the po is in the lungs (the
po door is at the back, by the lungs). If the qi and yin of the lungs is adequate, the po can remain
vigorous.
One of the earliest discussions involving the hun and po was recorded in the 6th Century B.C., in which
the following was said: "When a fetus begins to develop [into a human form and personality], it is due
to the po. Then comes the yang part, hun. The jing [essences] of many things then give strength to
these, and so they acquire the vitality, animation, and good cheer of these essences. Thus, eventually
there arises spirituality and intelligence [shenming]."
There has been some disagreement in the Chinese literature as to when the po and hun actually arrive.
For example, in the Du Shu Bian (16th century A.D.), it is said that the hun arrives during the seventh
month of pregnancy (signaled by the ability to move the left hand) and the po arrives during the eighth
month of pregnancy (signaled by the ability to move the right hand), rather than the other way around,
with the po being first, which was the more prevalent view; in fact, it was often suggested that the hun
entered the body after birth.
Around 80 A.D., a brief discussion of hun and po was presented in Paihu Tangte Lun (Discussions in
the White Tiger Hall): "Hun expresses the idea of continuous propagation, unresting flight; it is the qi
of the Lesser Yang [associated with liver/gallbladder], working in man in an external direction, and it
governs the instincts (xing)....Hun is connected with the idea of weeding, for with the instincts, evil
weeds [in man's nature or in his spiritual path] are removed. po expresses the idea of continuous
pressing urge on man; it is the qi of the Lesser Yin [kidney/heart], and works in him, governing the
emotions....Po is connected with the idea of brightening, for with the emotions the interior [personality]
is governed."
Here, hun is expressed in terms of outer-directed activity: using the instincts to select a course of action
and to avoid the pitfalls (evil weeds); po is expressed in terms of inner dynamics, adjusting one's
emotional reactions and personality. This reflects the basic yin/yang dichotomy, with yin representing
the internal and yang the external.
In an ancient book describing meditation practice, it was said that one should "be still, as if one had no
hun;" that is, the drive to act, to do things, should be abandoned during meditation, leaving one able to
remain motionless and focused on the inner condition. In a book on Taoism, it is said that one should
"keep your hun from confusion, and it [the Tao] will come of itself, unify the qi and control the
shen....All categories of things are brought into being by this; this is the door of power." Thus, the
practice of meditation, avoiding the stimuli offered by civilization, and calming or regulating the
ambition for outward change (while maintaining the drive for inner transformation, which will then
affect the outer conditions) are activities associated with predominance of the po; searching the outer
world for opportunities, applying thought and personal energy towards significant changes in the
world, and relying on pleasurable stimuli that the world has to offer are associated with predominance
of the hun.
The seven po may have originally been thought to be linked with the seven emotions. The seven
emotions are described variously in English, but one such list is joy, anger, grief, fear, love, hate, and
desire. For each of the emotions, there is an impact on the qi, so that if the emotion is quite intense, the
qi may become significantly disturbed, leading to physical and mental disorders. In the Sanyin Ji Yi
Bingzheng Fang Lun (Treatise on Three Categories of Pathogenic Factors), it is said that "In the
interior of the body reside the jing and shen, the hun and po, the mind and sentiments, mourning and
thoughts. They tend to be harmed by the seven emotions."
It is possible that the three hun were originally thought to be linked to the three major objectives of
human action: relationship to societal authorities (in China, the Emperor and his representatives; in the
modern world, it would include employers, law officers, governors, etc.), relationship to one's spouse
(this would apply also to other relatives of the same generation and to neighbors), and relationship to
one's children (this might also apply to others who are dependent upon your time and resources). It is a
key tenet of Chinese philosophy, most clearly depicted by Confucianism, that relationships with others
are important to both social harmony and to one's own physical and mental health.
It was thought that the hun and po could leave the body, even before death, though only a few of the 10
entities would be involved. Ge Hong, a famous Taoist, wrote during the 3rd century A.D. that: "All
men, wise or foolish, know that their bodies contain hun and po. When some of them quit the body,
illness ensues; when they all leave him, a man dies. In the former case, the shamans have formulas for
restraining them; in the latter, the Book of Rites provide ceremonials for summoning them back. These
po and hun are of all things the most intimately bound up with us, but throughout our lives probably no
one ever actually hears or sees them."
In fact, it has been suggested that the hun, being of yang nature, may often depart the body during life
and travel about, then return. Such adventures include certain dreams, the quasi-dream state that occurs
at the border of sleep and which sometimes involves the sense of floating or sudden movement, and
what we today call "out of body experiences." It is thought, at least in some Chinese communities, that
insomnia, anxiety, fright and other states of mental agitation might arise if one of the hun stayed away
too long. As a matter of diagnosis, patients reporting repeated nightmares are thought to be
experiencing a disorder of the liver; the distressed hun give rise to the nightmare.
It was also believed that one or more of the hun could be virtually forced from the body of a child (less
likely, but still possible in an adult) by a frightful experience; for example, being startled by a stranger.
In such case, the child would become susceptible to disorders such as abdominal distress or epilepsy
that were induced by demons. Other indicators of hun departure include listlessness, fretfulness, and
simple continual sickliness. No doubt, conditions defined in modern times such as autism, attention
deficit disorder, and other mental dysfunctions and psychological conditions have the potential of being
classified, from the Chinese traditional perspective, as due to soul-loss or soul-disturbance. In China,
that was a widespread scare in 1768, in which it was thought that sorcerers were stealing the hun of
numerous people (and using the power of the dissociated hun for their own purposes).
The po could depart, or fail to be given sufficient rest and comfort, because of fright, deficiency of the
jing, or constraint of the lung qi (perhaps due to excessive grief or sadness). In such a case, a person
might suffer from weakened sensory ability, distress of the limbs (such as numbness), or might lose
control of the feces (as the rectum was thought to be regulated by the po; the anus was known in earlier
times as pomen: po gate). In the book Classic of Categories (1624), it is said that "Po moves and
accomplishes things and pain and itching can be felt." Thus, from a diagnostic point of view, pain,
numbness, and itching (as well as other sensory disturbances) and/or experience of serious elimination
disorders (debilitated intestinal function) might indicate a distress of the po.
At death, the hun, being of yang nature, departs immediately, but the po, being of yin nature, departs
more slowly. For some time, there were Chinese rituals, practiced at the time a person lost
consciousness or died, attempting to call back the hun, so that it might reunite with the po, thereby
restoring life and consciousness. It was also thought that if a person experienced a sudden and violent
death, the po and hun might not be satisfied in simply dissolving into earth and heaven, but rather
remain close by, as malevolent ghosts (gui). Such ghosts were thought to be able to cause accidents to
happen and illnesses to arise seemingly out of nowhere.
Detail section of the painting "The Five Hundred Arhats," by Wu Pin (1601) from the book Eight
Dynasties of Chinese Paintings (1980 Cleveland Museum of Art). As explained in Chapter 2, the
Arhats, commonly called Luohan in China, are Buddhist sages who share many ideals with the Taoists.
One of the ideals is the natural state of mind, in which thoughts and ideas flow like water around
obstacles, represented by the stones in the stream of this painting. The Arhats are crossing a turbulent
section of the stream by making good use of those same obstacles, turning them to their advantage. The
characters on either side have a calm and relaxed demeanor; those who are crossing the river are
concentrating on the task at hand, which will soon be gone, just like the water rushing down the stream,
and they will continue on with their journey. Two of the Arhats are crossing right, two are crossing left,
and two are enjoying the experience as they pause on stones in the middle of the stream.
Chapter 2
A Mind that is Free
Confucianism
Confucianism predated both Taoism and Buddhism and is attributed to Kung-fu-tze (pinyin: Kong
Fuzi) whose name was Latinized to Confucius. Confucianism is a complex system of moral, social,
political, and religious teaching aimed at making men worthy of respect. Confucius' ideal person, the
junzi, is not simply the man of virtue, but the man of learning and of good manners. The perfect man
must combine the qualities of saint, scholar, and gentleman. The key element, though, is his moral
force.
There is a well-known Chinese herb formula named for the gentleman described by Confucius, called
Si Junzi Tang; the "Four Gentleman Decoction." This name was given because of the great respect held
for the four major ingredients, as well as for the valuable action of this formula in rectifying the
person's "center" to aid restoration of health. In the book, Confucius Lives Next Door (11), T.R. Reid
describes the term junzi this way:
It is written with two characters that mean royal [jun] and person [zi]. This tells us that traditionally
junzi referred to a prince, an aristocrat, someone who obtained a position of stature and power through
birth. Confucius accepted the basic principle that certain people have the right to hold elite positions,
but then he completely changed the rules for joining the ranks of the elite. To Confucius, the junzi-the
term has been variously translated as "the noble man," "the superior man," the "gentleman"-was a
person who had earned elite status. To be a gentleman, a person had to spend a lifetime studying and
following the rules of virtuous conduct. Just being born right was not enough.
Confucianism laid the way for the development of Taoism by emphasizing the character of the ideal
man. However, Confucianism had the tendency to fall into the nature of a legalistic approach, where
one followed certain rules of behavior, but did not necessarily have the inner nature that would lead to
good results, so the Taoists countered by proclaiming freedom from such rules, emphasizing the
cultivation of the ideal inner condition in harmony with nature. Confucianism itself appears to have
arisen as a move away from an earlier belief system in which a heavenly god ruled over humans. Thus
Confucius shifted the burden of moral behavior to the set of rules, particularly about social and family
relationships. In recent times, the influence of Confucianism on society was best seen in Japan, where it
had been introduced from China around the 12th Century.
References
1. Wu JCH (translator), Tao Teh Ching, 1961 St. John's University Press, New York, NY.
2. Kwok, MH, Palmer M, and Ramsay J, The Illustrated Tao Te Ching, 1994 Barnes and Noble
Books, New York, NY.
3. Feng GF and English J, Tao Te Ching, 1972 Vintage Books, New York, NY.
4. Porter B (aka Red Pine), Lao-tzu's Taoteching, 1996 Mercury House, San Francisco, CA.
5. Henricks RG, Lao-Tzu Te-Tao Ching: A New Translation Based on the Recently Discovered
Ma-Wang-Tui Texts, 1989 Ballantine Books, New York, NY.
6. Hinton D, Chuang Tzu: The Inner Chapters, 1997, Counterpoint, Washington D.C.
7. Kohn L, Early Chinese Mysticism: Philosophy and Soteriology in the Taoist Tradition, 1992
Princeton University Press, Princeton, NJ.
8. Porter B, Road to Heaven: Encounters with Chinese Hermits, 1993 Mercury House, San
Francisco, CA.
9. Hua-Ching Ni, Hua Hu Ching: The Later Teachings of Lao Tzu, 1995 Shambhala
Publications, Inc., Boston, MA.
10. Kohn L, Early Chinese Mysticism, 1992 Princeton University Press, Princeton, NJ.
11. Reid TR, Confucius Lives Next Door, 1999 Random House, New York, NY.
Chapter 3
Emotional Equilibrium
Relax, Be Healthy, Have a Long Life
Emotions often seem to behave like the weather: somewhat unpredictable and beyond control. In the
West, there has been considerable concern about the social and relationship problems associated with
pent-up emotions (particularly in women) and with habitual non-expression of emotions (particularly in
men), so that the very concept of "controlling" emotions is looked upon with suspicion. By contrast,
keeping emotions within certain reasonable bounds is an issue at the forefront of Asian religions and
healing arts; the primary concern there is adopting habits that help one to remain relatively calm. When
tranquility of mind is attained, emotions do not vanish: they are still experienced and expressed, and
emotions remain unpredictable, but their intensity is usually lessened and their potential impact on both
physical and mental health is curtailed. The emotional equilibrium that is desired by the Asian
philosophy translates to spiritual freedom and the ability to flow with nature, as described in the
previous chapter. Many people today have looked to Asia for help in this area, though too frequently
the simple methods advocated there are ignored, with more interest shown in those methods surrounded
by mysticism.
This subject of emotional calm has been an important topic in the field of Chinese medicine. Based on
a long history of seeking good health and longevity, there are specific means of attaining balance and
harmony for emotions that have become incorporated into the Chinese culture, at least for those who
show interest in it. An example of the Chinese approach to having a healthy emotional life is presented
in The Mystery of Longevity by Liu Zheng Cai (1):
The Canon of Medicine (Nei Jing) advises, in summing the experiences of centenarians in remote
times: 'Do not be weighed down by perplexing thoughts; strive to be calm and optimistic; be
complacent [calm in the face of situations that can cause anger]; keep sound in body and mind. This
way, one can live to the age of 100.' The Canon of Medicine recognizes that emotional and
psychological factors are important causes for illness. It indicates that excessive emotion impairs the
internal organs of the human body. 'Anger hurts the liver, joy hurts the heart, brooding hurts the spleen,
and melancholy hurts the lungs.' Hence, it proposes regulating the emotions by 'keeping the heart calm
and cheerful and the mind free of worries.' 'Where can disease come from when the emotional state
maintains inner composure?' Scholars on the art of healthy living in subsequent generations set forth
many specific methods of maintaining optimism in accordance with this principle.
A project of The All-China Association of Traditional Chinese Medicine in the 1980s led to publication
of the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine, published as a 20
volume set. Volume 9 is dedicated to "Maintaining Your Health;" the first chapter begins with mental
health care, and the first section deals with "being open minded and optimistic." The section is
presented here; it represents an overview of the traditional literature on the subject (2):
As the proverb goes, 'Optimism will help you forget sorrow.' An optimistic stable mood and good
mental balance will calm the vital energy and spirit, aid the circulation of blood and qi, and improve
health. The ancient book Guan Zi states, 'The quality of one's life depends on maintaining a positive
happy state of mind. Anxiety and anger lead to confusion of the mind. There can be no mental balance
when anxiety, grief, joy, and anger exist. Thus, desire should be subdued, and disorder be checked.
Happiness and luck will arrive on their own if there is no disturbance of mind.' The book Nei Jing also
points out that one should strive for tranquility and happiness, remaining free from anger, resentment,
and troubled thoughts. It indicates that by avoiding angry moods and a troubled state of mind and by
cultivating tranquility, optimism, and happiness, one will obtain longevity with a sound body which
will not be easily degenerated and with a sound mind which will not be easily distracted. The book
Huai Nan Zi advocates 'happiness and cheerfulness,' which is said to be part of human nature. The
book Zun Sheng Ba Jian also maintains that to tranquilize the mind one should have a happy mood.
These statements indicate that good health is always based on happy and tranquil moods. To keep a
happy mood, one must have a noble spirit, high ideals, an expanded outlook, a sanguine and lively
disposition, and an open and broad mind. While dealing with daily affairs and people, one must not be
disposed to feeling extremely depressed from personal losses. As is said in the book Ji Zhong San Ji,
'Cultivate a good temperament for the sake of mind; tranquilize the mind for the sake of life; avoid
emotional extremes and adopt a care-free attitude.' If one can achieve such equanimity, he will be safe
from unnecessary worries and enjoy an undisturbed mind and a sound body.
Also, to keep a happy state of mind, one should be able to tackle a problem in a composed manner. As
the book Sou Shi Qing Bian says, 'Don't worry about a problem before it has actually manifested don't
worry too much after it has existed, and don't cling to what has already passed; instead; one should
adopt a detached attitude towards coming or going, leaving it alone and checking all emotions such as
anger, fear, desire, joy, and anxiety. That is the way to health and longevity.'
Happiness lies in contentment, which is important not only for physical and mental health, but also in
keeping a happy mood. The book Dao De Jing says, 'There is no sin greater than discontent, and no
error greater than covetousness.' Therefore, knowing what contentment is means constant satisfaction.
The book Zun Sheng Ba Jian maintains, 'Contentment will bring neither abuse nor danger.' Both
statements express the ideal that lasting happiness can be achieved only through contentment. In our
actual life, most anxieties and worries result from going after and coveting fame, a higher status, and
material comfort. In face of such desires, one should always keep in mind: 'There are many others who
have less than I' In so doing, it will be easier for one to refrain from excessive desire and competition,
to remain content with what one has, and to be cheerful and open-minded, so that anxiety will be
expelled, tranquility of soul obtained, and the mind maintained in an optimistic and stable state.
The self-cultivation of one's sense of morality is another important method to maintain optimism, to
which the ancients paid great attention. They professed, 'The kind will enjoy longevity.' The kind here
mean all those who have a well-developed sense of morality. The cultivation of morality involves
devoted attention. The methods discoursed upon by the ancients, such as moderating desires, remaining
content, and being tolerant, kind and courteous are all essential for that purpose. They also believed: 'A
person of great morality is sure to obtain longevity.' The reason why such a person lives a long life lies
in the fact that he is 'apt to cultivate the great-qi', being broad-minded and strong willed as well as
having great ideals and aims; meanwhile, those who respect others will receive respect from others, and
those who are content will enjoy lasting happiness…all of these factors, together with tolerance and
avoidance of anxiety, contribute to a balanced mind and a cheerful mood.
One guarantee of maintaining an optimistic frame of mind is to continuously enrich one's life by
cultivating a great variety of interests and hobbies, such as reading, meeting friends, traveling, fishing,
playing chess, practicing calligraphy, painting, reciting poetry, singing, playing musical instruments,
watering flowers, growing bamboo, etc. There are many discussions handed down from the ancients,
maintaining that such activities can bring on cheerful mood and refine one's sensibility. The book Yi
Qing Xiao Lu says, 'One should always enjoy simple pleasures such as sunshine in winter or shade in
summer, beautiful scenes on a bright day, walking cheerfully with a stick, watching fish in a pond,
listening to birds singing in the woods, drinking a cup of wine or playing a stringed musical
instrument.' What is meant by this quotation is that one should relax the mind, choose and cultivate
one's own hobbies, and increase continually one's interest in life so that comfortable feelings, a stability
of mind and cheerfulness will result, all of which contribute to good health and longevity.
In short, open-mindedness and optimism are important principles in regulating the mind and in health
care. As it has been explained in the book Nei Jing: 'That is why the sages did not concern themselves
with purposeful actions. They cultivated tranquility and developed emptiness of mind. Their way of
health care brought about a substantial longevity.' This points out that those competent at health care
will not do anything they feel reluctant to do, remaining free from whimsical and improper thoughts,
keeping a cheerful and happy mood, cherishing a rich variety of interest, leading a tranquil and
undisturbed life, maintaining a mind which is relaxed, happy, open, and optimistic, this contributes to
longevity.
The book continues with some additional description and advice, with a focus on being careful about
desires, which cause disorder of the body and mind, both in distracting one from essential tasks by
trying to fulfill them and causing one anguish if they are not fulfilled. Although not mentioned in the
text, Buddhism has been one of the dominant sources of the philosophy of maintaining equanimity by
controlling desires through practicing moderation in living and meditation; Buddhism arose in response
to Indian practices that emphasized asceticism as an extreme method of overcoming desires.
The advice about controlling emotions by calming the mind presented in the Encyclopedia was further
developed and described by Yuan Liren and Liu Xiaoming of the Beijing College of Traditional
Chinese Medicine as part of their series of articles on health preservation published in the Journal of
Traditional Chinese Medicine (3). They refer to the "seven emotions" (qiqing) which are first outlined
here:
References
1. Liu Zheng Cai, The Mystery of Longevity, 1990 Foreign Language Press, Beijing.
2. Xu Xiangcai (chief ed.), The English-Chinese Encyclopedia of Practical Traditional
Chinese Medicine, (Vol. 9) 1989 Higher Education Press, Beijing.
3. Yuan Liren and Liu Xiaoming, Health preservation by mental means, Journal of Traditional
Chinese Medicine 1993; 13(2): 144-147.
4. Sun Binyan, Cancer Treatment and Prevention, 1991 Offete Enterprises, San Mateo, CA.
5. Pan Mingji, Cancer Treatment with Fu Zheng Pei Ben Principle, 1992 Fujian Science and
Technology Publishing House, Fujian.
Chapter 4
Acupuncture Points
Table 2: Main points listed for treatment of specified disorders in Chinese Acupuncture and
Moxibustion.
Table 3: Points listed in Highly Valuable Commentaries on Acupuncture and Moxibustion for
selected disorders. The points in the text were differentiated according to whether the treatment should
be acupuncture or moxibustion or both, but this distinction is not presented here.
Table 4: Points listed for each of the specified disorders in the index to A Manual of Acupuncture.
Chinese point names (pinyin) are not included due to large number of points listed.
LU-4, ST-23, ST-41, SP-1, SP-2, KI-1, KI-4, PC-4, PC-7, CV-19, plus
Agitation
other points for combined syndromes (e.g., with heat in the chest)
CV-14, ST-36, LU-10, KI-9, CV-8, GB-39, BL-18, KI-4, PC-8, LV-2,
Anger
LV-13, KI-7, KI-1, GV-12, CV-14, HT-5
Anxiety and worry BL-15, GB-39, KI-12, CV-12, LV-1, LV-5
Apprehension PC-5, PC-6, PC-8
Aversion to people
ST-37, ST-44, GB-17, CV-15
talking
Coma PC-8, GV-26, CV-1
Dementia HT-7, BL-15, KI-4
Depression HT-5, LV-5
Epilepsy, childhood
LU-7, SP-5, GB-13, GV-8, GV-12, GV-21
fright
LI-13, HT-7, HT-8, ST-7, PC-6, LV-5, GV-4, CV-4, plus other points for
Fear and fright
specific types (e.g., sudden fright)
Hallucination LI-5, LI-7, ST-40, ST-41, BL-10, BL-61, GV-12
Laughter, abnormal PC-7, PC-8, LI-7, GV-26, ST-40, HT-7, ST-36, LU-7, LI-5, SP-5, KI-7
Loss of consciousness,
LU-11, LI-1, HT-9, SI-1, KI-1, LV-1, GV-15, GV-26, CV-6, CV-8
stroke
Mad walking ST-23, SI-5, SI-8, BL-8, BL-9, LV-13, GV-19, BL-13
Madness BL-5, BL-9, BL-60, KI-1, KI-9, TB-10, TB-12, TB-13, GB-9 LV-2
Melancholy PC-4, LU-3, SP-5
LU-7, LI-11, HT-3, HT-7, BL-15, BL-43, KI-1, KI-21, KI-3, PC-5, PC-
Memory loss
6, GB-20, GV-11, GV-20, CV-14, M-HN-1, PC-6
Mental retardation KI-4
Ranting and raving KI-14, LI-7, ST-36, KI-9, TB-2, GV-12, LI-6
LU-3, ST-36, SP-1, SP-15, HT-7, KI-6, PC-6, PC-7, PC-8, TB-10, LV-2,
Sadness and weeping LU-10, HT-1, SI-7, GV-11, GV-20, HT-4, GV-16, HT-5, ST-41, HT-8,
SP-7, GV-13, LU-5, BL-15, PC-9
LI-10, LI-15, ST-36, BL-15, BL-23, BL-40, PC-6, PC-8, PC-9, GB-2,
Stroke GB-13, GB-15, GB-21, GB-40, LV-2, GV-16, GV-20, CV-4, M-UE-1,
M-HN-1
Table 5: Summary of 34 main points relied on for mind and brain disorders. The indications presented
here are from A Manual of Acupuncture, selecting only those conditions associated with mind and
brain disorders. To be listed in the table, the point had to be mentioned frequently in the literature cited
above (1-4) and/or in the medical reports (described in Chapter 5), and indicated for several types of
mind and brain disorder. taichong (LV-3) was added to reflect modern applications of the point now
often used in place of xingjian (LV-2); similarly fengchi (GB-20) was added to this table because of the
high frequency of its use in modern practice. Some of the points, such as sanyinjiao (SP-9) and zusanli
(ST-36) are mainly added for tonification therapy, rather than being chosen for specific effects on mind
and brain disorders. Other adjunctive points sometimes employed in formulas, such as the hand points
hegu (LI-4) and houxi (SI-3), are not included in the table because they have few indications for mind
and brain disorders and are not mentioned in the traditional literature in that context, though they are
used in modern practice.
References
1. Chen Yongcan and Yang Meiling, Literature research on screening of the nucleus acupoints for
treating of intellectual disturbances, Journal of Traditional Chinese Medicine 1999; 19(2): 83-
88.
2. Cheng Xinnong (chief editor), Chinese Acupuncture and Moxibustion, 1987 Foreign
Languages Press, Beijing.
3. Shogo Ishino, Treatment of senile psychic disorders with acupuncture and moxibustion,
International Journal of Oriental Medicine, 1999; 24(3): 149-154.
4. Deadman P and Mazin AK, A Manual of Acupuncture, 1998 Journal of Chinese Medicine
Publications, East Sussex, England.
5. Lai Zhongfang, Effect of electro-acupuncture of neiguan on spontaneous discharges of single
unit in amygdaloid nucleus in rabbits, Journal of Traditional Chinese Medicine 1989; 9(2): 144-
150.
6. Lai Zhongfang, Role of amygdaloid nucleus in the correlation between the heart and acupoint
neiguan in rabbits, Journal of Traditional Chinese Medicine 1991; 11 (2): 128-138.
7. Gu Shizhe, et al., Four acupuncture methods for treating mental disorders, Journal of
Traditional Chinese Medicine 2001; 21(3): 207-210.
Background
Before embarking on a description of herbs used in treating shen-disorders, it may be helpful to
examine some categories of illness that have been described particularly in relation to herb prescribing.
Although these have their origins in ancient Chinese medicine, Japanese doctors have given more
attention to them in recent decades than the Chinese, so Japanese sources are frequently relied upon for
the descriptions. The disorders presented here are consistent with various neurotic syndromes.
Practitioners offering natural health care services often encounter patients who have, as part of their
syndrome, a neurotic condition, characterized by worry, lack of clarity, and inability to control their
emotions sufficiently to aid their health. They may present symptoms that are difficult to describe
clearly, with some symptoms that vary or that appear to present conflicting characteristics (especially in
terms of traditional Chinese categories such as hot/cold, dry/damp, etc.), and they may have unusual
responses to therapies that have already been tried. Such patients are likely to have visited many
practitioners in the past and felt unsatisfied with both the diagnosis given and the outcome of treatment.
They usually display, upon further questioning, a close linkage between emotional, behavioral, and
health problems.
Such patients have been given (or are able to find on their own) non-standard disease classifications,
namely those that are not widely accepted in the practice of modern medicine. These diagnoses include
candidiasis, multiple allergies, parasites, heavy metal or other toxicity, chronic fatigue syndrome, leaky
gut, and others for which standard testing procedures do not confirm the disorder (though various
alternative medicine methods may seem supportive). Finding a culprit to blame the condition on,
something separate from the individual's emotions and behavior, is often deemed important. Thus, the
diagnosis may include reference to a toxin or parasite or rare infection, or an impact from modern
society, such as food additives, drugs, or environmental pollutants. Yet, these attributions can be very
misleading because, whether or not they are present, they may have little to do with the symptoms.
A diagnosis for these patients such as "liver qi stagnation," "spleen weakness," or "heart fire," may be
given by practitioners of Chinese medicine. These exotic terms do not carry the risk of labeling the
condition with a term that merely stimulates the emotional reactions to it (e.g., neurosis, hysteria, or
hypochondria). While the Chinese medical terms don't automatically convey such concepts as neurotic
hypersensitivity or chronic anxiety, Chinese writers often translate the traditional terms in that way
when producing translated text books. There is no question among medical doctors in the West-and
those in the East-that physical problems exist in these patients; indeed, such patients may have one or
more standard medical diagnoses along with the unexplained disorders. However, the patient also is
recognized as having functional disorders associated with psychological problems and with behavior
patterns that impair both physical and mental health. Doctors often find that sedative and anti-
depressant drugs provide a certain degree of relief for the patients, though compliance with using the
drugs is often poor because the patients worry about taking them or fear the side effects.
It is not always possible to separate organic diseases from others that might be termed psychosomatic,
neurotic, or related to behavior and thought patterns. As an example, the condition known as chronic
fatigue syndrome has been very difficult for medical researchers to study because there is such a
diverse range of physical and mental conditions that are presented by those who claim to be suffering
from it. Among them are persons who are simply depressed or living an erratic lifestyle that brings
about fatigue, and there are others who have some kind of viral infection (or group of viruses) that may
be identified as the culprit. The infectious agents can wreak havoc on the immune system and cause
fatigue as a side effect, but so can emotional disturbances and the adverse effects of certain activities
and difficult experiences.
Chinese physicians have dealt with complex patients and difficult to diagnose diseases, such as those
depicted above, for many centuries. Examples of relevant disease categories to be presented here
include xue dao zheng (blood course syndrome), baihe bing (lily disease), and meihe qi (plum pit qi).
These syndromes have an interesting underlying unity, which is the accumulation of damp or phlegm-
damp.
It is hoped that by presenting an overview of the way the Chinese have interpreted such patterns and
treated them, practitioners who prescribe Chinese herbs as a part of their practice will be aided in both
understanding and developing therapeutic plans for the unusual syndromes. Specifically, instead of
veering off into a variety of alternative medicine explanations and techniques, practitioners will find
that such problems are amenable to the traditional Chinese medical approach with a focus on herbs.
Acupuncture therapies that address these patterns are also potentially helpful.
Causes of Neurotic Complaints
Although there are many possible causes of complex disorders characterized by neurosis, two appear
especially common from the Oriental view, as presented in the classical and modern literature:
1. Long-term irregularities in diet yield many systemic disorders, starting with a disruption of the
stomach/spleen system and then affecting each of the other organs to some extent, partly
because of primary deficiencies in their nourishment and secondary accumulations of excess
materials (e.g., stagnant blood or fluids). Ultimately, the kidney essence fails to be nourished
and the individual becomes critically weakened and subject to a variety of serious diseases,
including erratic activity of the immune system. A primary outcome is that of the deficiencies of
qi and blood is to allow pathological influences from the outside to penetrate the "empty"
vessels; the deficiency of qi and kidney essence allows internal organs to malfunction and body
tissues to alter into an unhealthy condition. As part of this pattern, the person may become
neurotic about eating and may suffer several functional disorders that cause discomfort. The
origins of this problem might be traced to lack of appropriate parental guidance or influences of
people who have unhealthy habits.
2. Emotional distress causes a variety of dysfunctions and contributes to a person's life being in a
constant state of upheaval and uncertainty. The emotional agitation adversely affects the heart
system, a key regulator for all the other organ systems; it disturbs the sleep and causes one to
use poor judgment in regulating work and rest, and virtually all other activities as well. The
emotional disorders are sometimes the result of frightful or other disturbing events during
childhood.
The two causative factors-habits and emotions-often appear together, as poor dietary habits can lead
one to be emotionally unstable (by failing to nourish the viscera, for example, therefore not allowing
the inner "spirits" to rest), while emotional distress inhibits the functions of the spleen/stomach system
(for example, excessive worry and anxiety impair the "transforming and transporting" functions).
Thus, in many situations a reasonable starting point for making improvements in a complex patient is
by addressing the weakness of the stomach/spleen. Food therapy can have a big impact on healing, with
its main effect being on the stomach/spleen. If a person cannot tolerate ingestion of healing foods and
herbs, then it will be difficult to apply the desired kidney tonics, blood-vitalizing herbs, or other healing
agents without getting adverse reactions. Certainly, the gentle damp-dispersing agents, such as hoelen
(fuling) and atractylodes (baizhu) and the herbs that help moderate the severity of potentially irritating
herbs on the stomach, such as jujube (dazao) and licorice (gancao), can usually be tolerated. Thus, the
formula Si Junzi Tang is often suggested (which has these herbs plus ginseng or codonopsis)
Acupuncture may be essential to reinvigorate the digestive system first, relying on points such as
zusanli (ST-36) and sanyinjiao (SP-6). If a person does not change from an imbalanced diet towards a
more balanced one (in relation to the disorder), it is difficult to heal the body even when the proper
herbal therapies are administered and tolerated. Chinese dietary therapy for those with weak spleen and
stomach often incorporates rice with a small amount of cooked vegetables and meat (it is only slightly
more complex than that). A common error among Western practitioners of Chinese medicine is to focus
on elimination diets (avoiding, for example, dairy, wheat, meat, etc.) rather than to focus on nutritious
diets.
The other starting point for complex problems is the heart system, to be addressed by calming the
spirit. This therapy is usually accomplished by sedating hyperactivity associated with both the liver and
heart systems (liver disorders, particularly those involving liver fire, agitate the heart) and nourishing
deficiencies. When the spirit is calm, the emotions are not so extreme, and the internal cause of disease,
the unbalanced emotional responses, is removed or reduced in its influence. Acupuncture is one of the
important therapies to address these concerns. Of special importance is neiguan (PC-6), which helps
calm the emotions and settle the stomach qi. Mild sedative herbs, such as zizyphus (suanzaoren), biota
(boziren), and albizzia (hehuanpi) can be given to most patients.
There are some herbal formulas that address both the distress of the digestive system and the lack of
control of the emotions, which will be described in the following chapters. But, it should be mentioned
here that the famous Licorice and Jujube Combination (Gancao Xiaomai Dazao Tang), comprised of
the two named herbs plus a type of whole wheat (xiaomai), is a tonic for the stomach/spleen system
and a sedative for the heart system. The use of wheat as a remedy in China may well reflect its natural
content of B-vitamins that were lacking in some diets. In the book 100 Famous and Effective
Prescription (1), the traditional indications for this simple formula are reported to include "frequent
sad feelings, irritability, restless sleep, abnormal speech and behavior in severe cases....," while its
modern applications (in which the formula is usually prepared with some added ingredients) include
"neurasthenia, hysteria, schizophrenia, menopausal syndrome, etc." Here, as in many of the Chinese
texts, menopausal syndrome refers mainly to the mental distress experienced during menopause, more
so than hot flashes, dryness, or other physical symptoms. In the Shanghan Lun (2) and Jingui Yaolue
(3) a combination of ginger, licorice, and jujube was included in many of the prescriptions to help
enhance the effects of the key herbs of the formula. These three herbs benefit the stomach and spleen
system; jujube and licorice, two of three herbs in the above-mentioned formula, also provide calming
effects. Licorice has the traditional indications of calming the spirit and treating palpitation and
melancholy (4).
One of the most popular formulas for tonifying the stomach/spleen and calming the emotions is
Ginseng and Longan Combination (Guipi Tang); it contains the ingredients of Si Junzi Tang. Guipi
Tang will be discussed at some length in the following two chapters. A variety of other methods, aside
from tonifying the stomach/spleen and calming the heart, have been applied in the treatment of these
complex disorders. One can attempt, for example, to harmonize the circulation of qi and blood, get rid
of obstructing accumulated fluids, or clear agitational heat. Several such methods are to be described
here.
Fluid Connection
The three syndromes described here involve different pathologies in the TCM system: stagnant blood
in xue dao zheng, heart fire in baihe zheng, and stagnant qi in meihe qi. All three syndromes also tend
to involve fluid accumulation; unfortunately, this aspect is not emphasized in the modern literature. As
will be seen in the chapter on herb formulas, many of the treatments for these syndromes incorporate
herbs for draining damp. Japanese physicians refer to shuidu (water toxin) and lishui (hidden water),
the concept that accumulated fluids can have a corrupt nature when they accumulate, leading to
production of bizarre symptoms. In the Chinese literature, there is reference to "turbidity" which
implies corrupted fluids, and is especially applied to phlegm (phlegm-turbidity). Both moisture and
phlegm can remain "hidden," particular concern is expressed for hidden phlegm, called "phlegm-mist."
References
1. Dong Zhi Lin and Jiang Jing Xian, 100 Famous and Effective Prescriptions of Ancient and
Modern Times, 1990 China Ocean Press, Beijing.
2. Hsu HY and Peacher WG (editors), Shang Han Lun: The Great Classic of Chinese Medicine,
1981 Oriental Healing Arts Institute, Long Beach, CA.
3. Hsu HY and Wang SY, Chin Kuei Yao Lue, 1983 Oriental Healing Arts Institute, Long Beach,
CA.
4. Hsu CS and Chen MF, Treatment of depression and other emotional disorders with Licorice and
Jujube Combination, International Journal of Oriental Medicine, 1992; 17(4): 187-189.
5. Wu Jingnuan, Ling Shu, 1993 The Taoist Center, Washington, D.C.
6. Unschuld PU, Introductory Readings in Classical Chinese Medicine, 1988 Kluwer Academic
Publishers, Dordrecht.
7. Yakazu Domei, The meaning of Hsieh Tao Cheng [xue dao zheng] and its treatment with
Chinese formulas, Bulletin of the Oriental Healing Arts Institute, 1982; 7(7): 1-10.
8. Shigeru Arichi, Yu KK, and Machiko Sakaguchi, Clinical experience with women's erratic
complaints syndrome, Bulletin of the Oriental Healing Arts Institute, 1981; 6(5): 34-37.
9. Zhang Enqin (chief ed.), Clinic of Traditional Chinese Medicine, 1989 Publishing House of
Shanghai College of Traditional Chinese Medicine, Shanghai.
10. Yamada Terutane, Some personal experiences with the application of Chinese herbal
medicine (VII), Oriental Healing Arts International Bulletin 1986; 11(7): 547-555.
11. Hosono Shiro, Ten lectures on Chinese herbal medicine: I., Bulletin of the Oriental
Healing Arts Institute, 1984; 9(2): 67-83.
12. Yan Dexin, Aging and Blood Stasis, 1995 Blue Poppy Press, Boulder, CO.
13. Yang Shouzhong (translator), The Divine Farmer's Materia Medica, 1998 Blue Poppy
Press, Boulder, CO.
14. Ou Ming, ed., Chinese-English Manual of Common-Used Herbs in Traditional Chinese
Medicine, 1989 Joint Publishing Co., Hong Kong.
15. Ou Ming, ed., Chinese-English Manual of Common-Used Prescriptions in Traditional
Chinese Medicine, 1989 Joint Publishing Co., Hong Kong.
16. Zhang Ru and Dong Zhilin, Modern Clinical Necessities for Acupuncture and
Moxibustion, 1990 China Ocean Press, Beijing.
17. Wang Qi and Dong Zhilin, Modern Clinical Necessities for Traditional Chinese
Medicine, 1990 China Ocean Press, Beijing.
18. Xu Xiangcai, et al., The English-Chinese Encyclopedia of Practical Traditional Chinese
Medicine, 1990 Higher Education Press, Beijing.
19. Yin Hengze, Clinical observation on the therapeutic effect of three formula decoction in
treating 32 cases of chronic fatigue syndrome, Shanghai Journal of Traditional Chinese
Medicine 1999; 3: 19-20.
20. Hsu HY and Hsu CS, Commonly Used Chinese Herb Formulas with Illustrations, 1980
rev. ed., Oriental Healing Arts Institute, Long Beach, CA.
21. Hsu HY, Chinese herb therapy for abnormal sensations in the throat, Bulletin of the
Oriental Healing Arts Institute 1984; 9(2): 63-66.
Painting by Chen Hung-shou (1598-1652). For a time, he lived as a Buddhist monk at a monastery. He
painted numerous nature scenes; in this one, a scholar is enjoying nature under a pine tree emerging
from a towering rock. In his right hand he holds a brush, as he is inspired by the beauty of the scene to
write poetry. From Eight Dynasties of Chinese Painting (1980 Cleveland Museum of Art).
Chapter 7
Herbs
As a result of research done during the 20th Century, modern Chinese practitioners have turned much of
their attention to the principle of treating blood stasis, which was less frequently described in ancient
times. While xue dao zheng usually involved the problem of abdominal stagnation of blood flow,
today's efforts are usually directed at blood stasis affecting the heart and brain, looking particularly at
the problem of strokes and other diseases of aging associated with vascular blockage. Ingredients such
as red peony (chishao), cnidium (chuanxiong), persica (taoren), carthamus (honghua), and salvia
(danshen) are the most frequently relied upon for these purposes.
Thus, one can say that some principles of therapy now have less emphasis than before (i.e., clearing
heat) and others have more emphasis than before (i.e., vitalizing blood), and this is important to
recognize when analyzing formulas described in modern clinical reports from China. Similarly, some
ingredients are less often used, such as animal substances, while others are more frequently used,
especially those plant materials that have escaped worries about toxicity and endangered species status.
References
1. Yang Shou-zhong (translator), The Divine Farmer's Materia Medica, 1998 Blue Poppy Press,
Boulder, CO.
2. Hsu HY, et al., Oriental Materia Medica: A Concise Guide, 1986 Oriental Healing Arts
Institute, Long Beach, CA.
3. State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional
Chinese Medicine and Pharmacology, (Vol. 2) 1995-6 New World Press, Beijing.
4. Editorial Committee, International Conference on Traditional Chinese Medicine and
Pharmacology Proceedings, 1987 China Academic Publishers, Beijing.
5. Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990 rev. ed.,
Eastland Press, Seattle, WA.
6. Zhang Enqin (chief editors), Clinic of Traditional Chinese Medicine, 1989 Publishing House
of Shanghai College of Traditional Chinese Medicine, Shanghai.
7. Hou Jinglun Geng Xiu'e (chief editors), Traditional Chinese Treatment for Senile Diseases,
1997 Academy Press, Beijing.
Chapter 8
Traditional Herb Formulas
Herbs Formulas for Treatment of Shen
Disorders
There are hundreds of herbal formulas useful for shen disorders among the vast collection of Chinese
medical literature. However, a relatively small number of prescriptions have been handed down over
time and collected into texts that are used for the study of Chinese medicine today. These formulas are
the ones most likely to be used by physicians in China and the West, at least as a reference point for
preparing an individualized prescription, but often as a prepared formula ready to administer.
The well-established formulas for treatment of shen disorders may be subdivided into three groups for
purposes of analysis and discussion: those that focus on tonification therapy; those that combine qi
regulating and tonification; and those that combine tonification, sedating, and orifice opening. By
presenting these three groups, it is not intended to suggest that other combinations of therapeutic
principles are to be avoided, but that these three reveal the characteristics of most traditional formulas
used today for shen disorders. Four sample formulas have been selected for each category of
prescription.
Tonification Formulas
Deficiency of qi and blood are considered underlying syndromes that make a person susceptible to a
wide variety of disorders and diseases. Qi and blood fill the vessels to block entry of pathological
influences and they nourish the organs to protect them from deterioration or harmful changes in
structure and function. In addition, qi deficiency leads to insufficient raising of clear yang to the brain,
reducing mental and sensory acuity, while blood deficiency leads to insufficient moistening of the
internal organs, making them less receptive as a resting place for the associated spirit.
The concept of raising clear yang is important to mental function; it was described by Li Dongyuan in
his famous text Pi Wei Lun (1). He noted that:
After water and grain enter the stomach, yang qi ascends. Fluids and qi enter the heart and penetrate the
lungs to replenish the skin and hair and to disperse throughout the hundreds of vessels. The spleen
receives qi from the stomach to irrigate the four limbs and nourish the qi and blood. If, on the other
hand, the stomach is injured by improper food and drink and the spleen is damaged by being
overwhelmed [taxation fatigue], they become deficient….Generally speaking, if the spleen and
stomach are deficient and weak, yang qi is unable to grow and rise up….When the spleen is diseased,
yang qi flows down to overwhelm the kidneys.
In particular, the yang qi ascends to the top of the head, converging at the point GV-20 (baihui; hundred
convergences; and the meeting point for the six yang channels). Since the kidneys nourish the marrow
and brain, the problem of failure of yang qi to flow upward and invigorate the brain is compounded by
downward flow of yang qi inhibiting the kidney (thus weakening the kidney's nourishment of the
brain). Tonifying the spleen qi and raising qi become important, particularly where the brain function
appears impeded (slow thought, reduced sensory function, cloudiness, confusion, poor memory, etc.).
The herbs ginseng and astragalus (usually with licorice) are used for this purpose. Other ingredients
may be added to assist in raising yang qi, such as cimicifuga ( shengma ), which is not one of the tonic
herbs.
In the following list of sample formulas, all have astragalus, ginseng, and licorice for tonifying qi,
benefiting the spleen and heart, and raising clear yang. The formulas all contain constituents of the
main qi tonic formula, Si Junzi Tang (Four Major Herbs Combination) and the main blood nourishing
formula, Si Wu Tang (Tang-kuei Four Combination). Schizandra, an astringent herb, is listed among the
nourishing sedatives, which is how it is often used today. Yiqi Congming Tang is a formula primarily
used for sensory weakness (poor vision or hearing), but it also improves brain function more generally,
so is included here.
Table 1: Tonification Formulas for Shen Disorders.
Qi-Regulating Formulas
Bupleurum is one of the most important of the herbs for alleviating stagnation of liver qi associated
with depression of the mind. All the formulas listed in the table below include this herb; other qi
regulating ingredients are cyperus, citrus, and either chih-shih (immature fruit) or chih-ko (mature
fruit), which are types of citrus fruits. As with the above mentioned tonic formulations, ingredients of
Si Junzi Tang and of Si Wu Tang are included, because deficiency of qi and blood contributes to the
stagnation syndrome affecting the liver.
Table 2: Qi-Regulating Formulas for Treating Shen Disorders.
Sedative Formulations
The formulas described below incorporate three treatment methods: tonification, sedating the spirit, and
opening the orifices. Three of the formulas are modern patents (that have been available for several
decades). Ingredients lists provided for patent remedies such as these should be interpreted with some
reservations, as the manufacturers often do not disclose all ingredients. The other formula, Tianwang
Buxin Dan, is a traditional prescription as well as a patent, so the ingredients of the former version are
widely publicized, though they vary considerably among the texts. The first three formulas listed had
included cinnabar until recently. Polygala, which serves both as a sedative and orifice-opening herb, is
classified here with the orifice-opening group; each formula includes at least one other herb aimed at
resolving phlegm mist (e.g., acorus, bamboo, platycodon). Hoelen and alpinia, which each appear in
two of the formulas, aid in dispersing fluids and thus contribute to preventing development of phlegm-
mist, but are listed separately.
Table 3: Sedative Brain-Nourishing Formulas
Guipi San
(Ginseng and Longan Combination)
renshen Ginseng 15 g
huangqi Astragalus 15 g
longyanrou Longan 12 g
fuling Hoelen 10 g
baizhu Atractylodes 10 g
danggui Tang-kuei 10 g
suanzaoren Zizyphus 10 g
yuanzhi Polygala 10 g
muxiang Saussurea 5g
zhigancao Licorice 5g
dazao Jujube 5g
shengjiang Ginger 5g
In China, codonopsis has been used in place of ginseng for several decades, but the original formula is
with ginseng for rapidly restoring the spleen qi and calming the spirit. For those with a more significant
level of "damp" syndrome (especially with digestive disturbance), one might add to Gui Pi Tang one of
the following:
Er Chen Wan aka Citrus and Pinellia Combination (has citrus, pinellia, hoelen)
Si Jun Zi Tang aka Major Four Herbs Formula (has ginseng, atractylodes, hoelen)
Wu Ling San aka Hoelen Five Herb Formula (has atractylodes and hoelen)
Xiang Sha Liu Jun Zi Tang aka Saussurea and Cardamom Combination (has ginseng, saussurea, hoelen,
atractylodes, citrus, and pinellia)
Xiao Yao San aka Tang-kuei and Bupleurum Formula (has hoelen, atractylodes, tang-kuei, and peony)
While there have not been studies providing clinical evidence for efficacy of Gui Pi Tang, or any of the
herbs mentioned, to alleviate SSRI discontinuation symptoms, it is a characteristic of modern Chinese
medicine practices to select herbs on the basis of symptom patterns, with the expectation of attaining
some level of effect. The symptoms are understood to be a manifestation of an underlying imbalance,
whether described in ancient terms (e.g., qi and blood deficiency) or modern terms (e.g.,
neurotransmitter release and reuptake). That imbalance generates symptoms via common mechanisms
that can be affected by the herbs. Starting an herbal formula along with gradual drug dose reductions
may prevent or minimize the withdrawal symptoms.
APPENDIX 2: Bupleurum and Dragon Bone
Combination for Xue Dao Zheng
Two bupleurum-based prescriptions stand out in the literature related to xue dao zheng: Bupleurum and
Peony Formula, which has already been discussed, and Bupleurum and Dragon Bone Combination
(Chaihu Jia Longgu Muli Tang). Another formula mentioned less frequently is Bupleurum and
Cinnamon Combination (Chaihu Guizhi Tang), which has several herbs in common with Bupleurum
and Dragon Bone Combination. In the book Commonly Used Chinese Herb Formulas with
Illustrations (13) this latter formula is said to treat numerous symptoms, including a variety of
emotional and neurological disorders-nervous exhaustion, neurotic behavior, irritability, and hysteria.
The ingredients for Bupleurum and Dragon Bone Combination are:
References
1. Yang Shouzhong and Li Jianyong (translators), Li Dongyuan's Treatise on the Spleen and
Stomach, 1993 Blue Poppy Press, Boulder, CO.
2. Domei Yakazu, The application of Gui Pi Tang, Bulletin of the Oriental Healing Arts Institute of
U.S.A., 1980; 5(3): 21-28.
3. Unschuld PU, Introductory Readings in Classical Chinese Medicine, 1988 Kluwer Academic
Publishers, Dordrecht.
4. Kunio Matsuda, Bupleurum prescriptions in Chinese herbal medicine, Bulletin of the Oriental
Healing Arts Institute, 1983; 8(1): 21-28.
5. Cheung CS and Belluomini J, Traditional and new interpretation of prescriptions: the
harmonizing group, Journal of the American College of Traditional Chinese Medicine, 1984;
(1): 3-15.
6. Wago Mitani, Kanpo treatment of climacteric disorder, International Journal of Oriental
Medicine 1992; 17(1): 27-32.
7. Yakazu Domei, Clinical experience with Bupleurum and Peony Formula, Bulletin of the
Oriental Healing Arts Institute, 1980; 5(3): 11-20.
8. Hsu HY, Application of Chinese herbal formulas and scientific research: Bupleurum Formula
and Bupleurum and Chih-shih Formula, International Journal of Oriental Medicine 1992; 17(2):
114-120.
9. Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990 rev. ed.,
Eastland Press, Seattle, WA.
10. Cheung CS and Belluomini J, Heart, Journal of the American College of Traditional
Chinese Medicine 1984; (4): 40-58.
11. Maciocia G, The Foundations of Chinese Medicine, 1989, Churchill Livingstone,
London.
12. Ou Ming, Chinese-English Manual of Common-Used Prescriptions in Traditional
Chinese Medicine, 1989 Joint Publishing Co., Hong Kong.
13. Hong-Yen Hsu and Chau-Shin Hsu, Commonly Used Chinese Herb Formulas with
Illustrations, 1980 rev. ed., Oriental Healing Arts Institute, Long Beach, CA.
14. Yakazu Domei, Bupleurum and Dragon Bone Combination, Bulletin of the Oriental
Healing Arts Institute, 1983; 8(7): 42-44.
15. Takahide Kuwaki, Chinese Herbal Therapy, 1990 Oriental Healing Arts Institute, Long
Beach, CA.
16. Hsu HY and Wang SY (translators), Chin Kuei Yao Lueh, 1983 Oriental Healing Arts
Institute, Long Beach, CA.
17. Hsu HY, Chinese herb therapy for abnormal sensations of the throat, Bulletin of the
Oriental Healing Arts Institute 1984; 9(2): 63-66.
18. Iwasaki K, et al., Traditional Chinese medicine Banxia Houpu Tang improves
swallowing reflex, Phytomedicine 6(2): 102-106.
19. Iwasaki K, et al., The effects of the traditional Chinese medicine banxia houpo tang on
the swallowing reflex in Parkinson's disease, Phytomedicine 2000; 7(4): 259-263.
20. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of
Traditional Chinese Medicine, vol. 2, 1993 Heilongjiang Education Press, Harbin.
21. Luo L, et al., Antidepressent effects of banxia houpo tang, a traditional Chinese
medicinal empirical formula, Journal of Ethnopharmacology 2000; 73(1-2): 277-281.
22. Kuribara H, Stavinoha WB, and Maruyama Y, Honokial, a putative anxiolytic agent
extracted from magnolia bark, has no diazepam-like side-effects in mice, Journal of Pharmacy
and Pharmacology 1999; 51(1): 97-103.
23. Cheung CS, Lai YK, and Kaw UA, Mental Dysfunction as Treated by Traditional
Chinese Medicine, 1981 Traditional Chinese Medicine Publisher, San Francisco, CA.
Chapter 9
Sample Herbal Treatment Strategies
Subjects of Study
Chinese medical reports on herbal therapies for shen disorders are spread somewhat randomly
throughout the Chinese medical literature, most being in obscure journals. One of the areas that has
gotten considerable attention is "senile dementia," which involves deterioration of brain function, with
symptoms such as depression, confusion, poor memory, and slow responses. The treatment of this
problem with Chinese herbs is not substantially different than the treatment of other disorders that
affect mental status, particularly in adults. This is because traditional Chinese medicine is based on
general principles of treatment rather than unique ways to combat specific diseases. The therapeutic
approaches described in chapters 7 and 8 are applicable to this condition. For purposes of contrast, the
treatment of attention deficit disorder (ADD) in children will be presented afterward. In both cases, the
therapies described were actually used in clinical practice for dozens or even hundreds of patients, not
merely recommended on the basis of indications for a traditional formula. Claims for success were
presented in the literature, but the frequency of improvement (i.e. "success rate," which was often high)
is not conveyed here because the standards of reporting and analysis in the reports differ significantly
from what is utilized in Western medical studies. Instead, the main focus here is on the selection of
herbs.
Syndrome/Ther
Main Symptoms Key Herbs
apeutic Method
Deficiency of progressive dementia, dizziness,
rehmannia, cornus, dioscorea, ho-
kidney essence tinnitus, insomnia, poor memory,
shou-wu, lycium, eucommia, tang-
[tonification difficulties in speech, dull eyes, and
kuei, zizyphus, polygala
therapy] slow responses
dull expressions, vague mind,
Stagnation of
depression, poor memory, abnormal pinellia, hoelen, acorus, polygala,
phlegm
behavior, involuntary crying or curcuma, chih-ko, citrus, bamboo,
[resolving
laughing, dizziness, heavy head or bamboo sap
phlegm-mist]
limbs, sleepiness
Deficiency of qi dizziness, poor memory, indifferent ginseng*, astragalus, tang-kuei,
and blood expression, dreaminess and light atractylodes, fu-shen, rehmannia,
[tonification sleep, susceptible to fright, pale ho-shou-wu, polygala, peony,
therapy] complexion and listlessness, unable zizyphus
to participate in normal daily * codonopsis or pseudostellaria
activities could be substitutes for ginseng
dizziness, headache, poor memory,
Cerebral blood salvia, carthamus, persica, cnidium,
dementia, stiff tongue and
stasis astragalus, angelica, musk, tang-
incapability of uttering a sound,
[vitalize blood] kuei, red peony
history of apoplexy
The authors suggested that there are two main actions of the herbs in the formulas: to replenish the
kidney so as to nourish the brain and to supplement and invigorate both qi and blood to provide
adequate circulation in the brain. They translated the means by which these actions affect dementia to a
Western idiom as follows:
1. To supply substances needed by the brain and nerve cells to carry out normal metabolism and
regulate cerebral activities; and
2. To invigorate the following activities: blood supply to the heart, immunologic functions,
detoxification of the liver, nutrient absorption of the alimentary system, and utilization of
energy by the body to improve the nutritional and metabolic state, or, in other words, to regulate
the vitality of the whole body to improve mental function and combat senility.
The authors also suggested that if blood-vitalizing herbs are included with the tonic therapies that the
results will be even better than using tonics alone, mainly because of the improved microcirculation.
In a 1999 review from the Ningjin County Hospital of Traditional Chinese Medicine (2), journal reports
were divided into four groups: general differentiation using traditional formulas; treatment based on
differentiation of regulating and nourishing the kidney and heart; treatment based on differentiation of
blood stasis and phlegm obstruction; and treatments based on modern prescriptions. In this
presentation, a number of the prescriptions are designated by their traditional names, but many were
said to be "modified" without specifying the alterations made.
Deficiency of brain and spinal cord: Modified Bushen Yisui Tang (Decoction for Tonifying the
Kidney and Rectifying the Marrow);
Deficiency of heart and spleen: Guipi Tang (Ginseng and Longan Combination);
Hyperactivity of heart fire and liver fire: Modified Tianma Gouteng Yin (Gastrodia and Uncaria
Formula) plus Huanglian Xiexin Tang (Coptis Combination);
Yin deficiency of liver and kidney: Modified Qi Ju Dihuang Tang (Lycium, Chrysanthemum,
and Rehmannia Formula) plus Dingzhi Tang (Emotion-calming Decoction);
Stagnation and obstruction by phlegm and blood stasis: Modified Banxia Baizhu Tianma Tang
(Pinellia and Gastrodia Combination); and
Stagnation of qi and blood: Modified Xiaoyao San (Bupleurum and Tang-kuei Formula) plus
Tongqiao Huoxue Tang (Decoction for Activating Blood Circulation).
Here are two other sets of recommendations, the first attributed to Xu Shizhen, the second attributed to
the work of Zhao Xiangjun:
References
1. Wang Xiaoping and Zhai Mudong, Experience in TCM treatment of senile dementia, Journal of
Traditional Chinese Medicine 1996; 16(4): 299-303.
2. Sun Guanlan, Ren Jianlin, and Sun Qingjun, Advances in TCM treatment of senile dementia,
Journal of Traditional Chinese Medicine 1999; 19(4): 304-312.
3. Fruehauf H, Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs, 1997
Institute for Traditional Medicine, Portland, OR.
Appendix: Frequently-mentioned formulas
In the section of this chapter devoted to treatments for senile dementia, certain formulas were
mentioned repeatedly. Their ingredients are briefly mentioned here for easy reference.
Zuogui Wan: rehmannia, dioscorea, cornus, lycium, achyranthes (or cyathula), cuscuta, deer antler
gelatin, tortoise shell gelatin.
Yougui Wan: rehmannia, dioscorea, cornus, lycium, cuscuta, deer antler gelatin, eucommia, tang-kuei,
cinnamon bark, aconite.
Erchen Tang: pinellia, citrus, hoelen, fresh ginger, jujube, mume.
Banxia Baizhu Tianma Tang (Pinellia and Gastrodia Combination): pinellia, citrus, hoelen, fresh ginger,
jujube, gastrodia, atractylodes.
A traditional acupuncture chart from the Wellcome Trust in London. This chart directs attention to
some of the key zones for treatment to be described in Chapter 10, where the methods outlined in this
booklet are summarized. At the top of the head and coming down the center of the face is the
Governing Vessel, with its important points such as baihui (GV-20) at the top of the head, shenting
(GV-24) at the hairline, and renzhong (GV-26) just below the nose. At each wrist, the chart indicates a
multiplicity of points (along with the pulse taking positions); especially valuable are the Pericardium
points, such as neiguan (PC-6), and the Heart point shenmen (HT-7). At the feet, several valuable
points are shown, especially along the liver and kidney channels, of which yingquan (KI-1), taixi (KI-
3) and taichong (LV-3) are frequently used for shen disorders
. Chapter 10
Summary, Speculation, Suggestions
Acupuncture
The best speculations available to us about the origins of acupuncture point to the likelihood that
needles were used to lance boils and to let out blood from areas where veins looked distended and/or
darkened. The technique was broadened to let out various "evils" including evil spirits, thus allowing
the internal resources to rebuild. Such treatments were thought of as one time interventions. Dou
Hanqing (ca. 1230 A.D.), in his discussion of acupuncture techniques, quoted the famous phrase (1):
"Take a piercing stone-needle and apply it outside to remove the evil and support the true." Referring to
the stone needles, he noted that they could "expel disease and cure evil-there is nothing it can not heal."
As the concepts of disease causation developed, needles were also used to let out wind, cold, heat,
damp, or other pathological factors that had invaded from the environment into the body, often thought
to gain access through the pores. The treatments were still intended to be short and quick, but there
were added considerations about how, when, and where to needle. Dou Hanqing wrote:
The Way of the Doctor-if he can clearly understand the principle of using the needle-is to swiftly
eliminate pain as if it were plucked out by the hand. And to shatter blockages releasing them far and
wide, as dissolving ice. As soon as the mystery of this is accomplished, you eliminate the problems of
early deaths and mistaken treatments.
This medical art developed considerably into what comes down to us as modern acupuncture based on
the concept that one can regulate the body functions through insertion of the needles, not just let things
out and immediately get rid of a disease. The Lingshu (2) is the text that points to the situation that was
evolving from the original concept. In the third scroll, it says:
The unskilled physician grasps only the form when he uses the techniques of acupuncture. The superior
physician understands the spirit: his understanding of man includes both the blood and qi, whether
there is excess or deficiency, whether he should tonify or disperse. The spirit and the guest, the primary
and the evil, meet. The spirit is the primary qi, the guest is the evil qi. "Located at the door" means that
the evil qi pursues the primary qi at those places where it comes out and enters. Don't just stare at
disease! Begin by knowing the evil and the primary qi, and which channels are diseased….The
unskilled physician only guards the gates….The superior physician knows the subtleties; he
understands how to handle qi….
The "form" that the unskilled physician grasps is the inserting of needles into points on the body,
relying only on places of obvious obstruction or the doorways where pathogens can exit. The superior
physician first diagnoses the various conditions of qi, such as deficiency and excess, and adjusts his
needling accordingly. The "evil" is like a guest or invader in the body; the unskilled physician only
stands at the doorway trying to block the entrance of an evil qi or open the door to let it out. The
superior physician tracks down the location of the evil qi in the channels and escorts it to the door. The
spirit or "primary qi" is the normal qi of the body, which the superior physician can coax into action to
help get rid of the pathogenic guest. The disease is not just something stared at, looked at in a cursory
manner; rather, it is to be understood and properly handled.
Over the centuries, considerable effort was applied to determining what points could alleviate spirit
disorders, not solely by serving as a door (spirit gate), but also by adjusting the healthy qi to overcome
the perverse qi. The result of these efforts is a focus on points at the head, on the wrists, and on the feet
and lower part of the legs. I would like to propose that treating this set of points (to be detailed later)
corresponds with the Daoist (Taoist) wandering in the wooded mountain trails. That is, acupuncture
partly serves the role as an in-office version of a trek through the woods.
In walking along these trails, especially with the limited quality of shoes available to them, the Daoists
had their feet and ankles and calves thoroughly and vigorously massaged by the irregular surfaces. At
the same time, their eyes, ears, and nostrils were filled with the sensory stimuli of nature: sky, trees,
mountains, waters, animals, and so on. While enjoying the beauty, fragrance, and sound of their
surroundings, these wanderers also had to stay attentive-whether for dangerous terrain or dangerous
animals. Thus, their nervous systems were entirely alert. In climbing they would sometimes grasp at
branches and stones; for their meals they would be plucking various fruits and making food out of the
natural materials they encountered, thus working their hands and wrists. Today, many people turn
instead to half hour sessions of foot reflexology or rotating specially designed Chinese balls in the
hands for a few minutes, or getting acupuncture for 20-40 minutes to stimulate the qi flow; but then
they do not at the same time encounter nature by sensation, so it is a lesser benefit, it is less holistic.
When the practitioner decorates his office with Chinese nature paintings and even with the charts
showing the flow patterns of the meridians, the patient gets a small glimpse of the desirable encounter;
with the fragrance of moxa and the sounds of a small fountain or gentle traditional Chinese music, the
patient has a sensory experience completely different from what is typically found in a modern medical
office.
Thus, it is proposed, at one level, that the Chinese medicine practitioner is standing in for a nature hike!
In saying this, I am not proposing that people who follow the Daoist path regularly (being out in nature
for hours rather than 30 minutes, and doing so daily rather than once a week) don't sometimes suffer
from shen disorders. Nor do I suggest that all shen disorders might be resolved by Daoist wandering on
rocky paths through forested mountains. However, when practitioners of Chinese medicine refer to the
concept of the body as a microcosm for the universe (as the macrocosm), they are agreeing to the idea
that what goes on within the body needs to be attuned to the world outside, and that is the natural
world. Such correspondence between the inner and outer worlds comes about by interacting with
nature. The acupuncturist directs the patient's attention to the "Tao which is great."
Continuing the quotation from Dou Hanqing, with some slight editing of the translation to make the
point more evident:
What was hidden from your view, can now be distinguished-you are able to understand secrets from the
ancient books of the past. What was hidden was the underlying pattern-to perceive it is to begin to
explain it. Understanding the patterns means enlightenment. The pattern, illuminated and revealed by
those who came before, easily throws its light upon you later scholars.
What are these patterns? He described the flow of qi and blood in the body this way: "Traveling in
ditches or collecting pools, or else running like a stream in a valley, along different pathways. The
pathways here are the tracks. Among the points on the vessels some are called, ditches, pools, streams,
valleys-just as each is in a different position along the track or pathway." That is, the interior of the
body is like nature, and when examining the body, one is looking for how its natural function has been
disturbed-hoping to restore it. The Daoists provided a model for healthy function, which is contained in
the concept of Xiao Yao. A hidden secret is that the needling of patients can mimic the Xiao Yao. This is
not the only way to practice acupuncture, but it is one of the ways.
Herbs
There can be little doubt that the earliest determination of medicinal properties of herbs had to do with
immediate effects of consuming them. In most cases, these were things to be avoided, such as herbs
causing vomiting or diarrhea. However, the effects were utilized for healing-much as ancient
acupuncture was-to let out evils from the body. In such cases, they would typically be taken once or
twice, with the expectation that the disease would change markedly, preferably in the direction of
resolution. The standard methods of therapy mentioned in the Shanghan Lun (3) were types of
purging: vomiting, laxation, and perspiration. They were frequently mentioned in the context of being
used wrongly (like the acupuncturists who only relied on opening the door to let out evil). What was
then introduced in that text was a more sophisticated analysis of disorders and more complex therapies
that involved locating the problem within certain part of the body and addressing it with methods of
tonifying or dispersing or even harmonizing, usually with only a few days of treatment.
There also developed a different concept that some medicinal substances could be taken routinely over
a long period to protect health and gain long life or immortality. Unfortunately, many of these remedies
were not really based on experience of positive outcomes, but on theories that had been worked out by
a few individuals. Some of the substances they advocated did not stand the test of time. Alchemists,
believing in the ability to transform the body in a way that would correspond to chemical
transformations, became involved in using a number of toxic substances. One of the results of the
toxicity was loss of body weight, a change that may today seem beneficial in terms of the problem of
obesity, but was actually part of the harm done to a person through such things as heavy metal
poisoning. To this day, we read of Chinese herbs that had this effect (causing the body weight to
decline), often without realizing that this attribution is not necessarily a positive one. Sometimes this
weight loss effect was attributed to herbs that are non-toxic (such as ginseng), but the herb didn't have
that effect; instead, it was simply included as a listed property because that herb was considered to be
one that could contribute to gaining immortality.
Over time, herb therapies have gone through a variety of changes, especially as they have come to us in
the West. Some herbs that are especially potent in effect, but also potentially causing serious side
effects, have been dropped from the treatments in recent times. These are replaced, in actual practice,
by drugs that also have potent effects and potential for side-effects, but are better studied and better
controlled than the natural substances. For the non-toxic agents, there is a tendency to use very high
doses in China (e.g., 120 grams or more in decoction for a one day dose), and these high doses may
contribute common nutrients, such as vitamins and minerals, as well as any chemical constituents that
are active. In that sense, they serve a function similar to eating nutritious foods or consuming dietary
supplements made with components such as vitamins, minerals, and amino acids. Numerous Chinese
investigations into the herbal remedies have been based on determining the quantity of such things as
trace minerals and amino acids to help explain their effects. Some of the substances used for treating
shen disorders, such as oyster shell and dragon bone and wheat, may have part of their value explained
by the presence of calcium compounds and B-vitamins, things that are as easily attained by consuming
certain foods or supplements (the Chinese diet lacked calcium rich dairy products and relied on milled
rice which lacked vitamin B). It is understood that such minerals and vitamins can have a positive
influence on the function of the brain and nervous system for persons who suffer deficiencies.
In addition to providing what we might consider ordinary nutritional benefits, many of the herbs may
have indirect therapeutic effects on shen disorders. For example, a person who has poor blood sugar
regulation may experience difficulty with mental concentration when blood sugar is either high or low;
herbs that regulate blood sugar may stabilize the mental condition without having a direct impact on the
brain.
At this time, it is difficult to know what ingredients are truly effective in treating shen disorders. Some
herbs have been shown, through laboratory testing, to affect neurotransmitters, such as acetylcholine or
serotonin, and some clinical trials have demonstrated improvements in patient conditions (e.g.,
depression, insomnia, memory, response time). The herbs that are most frequently employed have a
variety of different active components, though there may be a prevalence of steroidal glycosides among
several of the commonly used herbs. The question of which ingredients are active and their mechanism
for various effects on the brain and mind is an area that requires further investigation. China has had a
limited investment in researching herbal effects on shen disorders, partly for political reasons and partly
because of the great difficulty involved in assessing the effects.
Suggested Protocols
I would like to present a protocol of acupuncture and herbs corresponding to the analysis presented in
this booklet that would lead directly to rapid improvement in most patients. This might be considered a
system of treatment that involves some relatively simple choices. By contrast, according to a large
component of the Chinese medical literature, one should undertake an extensive diagnostic overview,
determine a pattern of dysfunction, and treat accordingly, utilizing therapies that are both traditionally
recognized and also influenced by personal training and clinical experience. Is there a way to offer
something that is true to both these intentions? I believe there may be. On the one hand, we have the
complete Chinese medical system, with hundreds of acupuncture points and hundreds of herbs, which
provides for meeting the demands of the methodology called differential diagnosis and treatment. One
can hardly dispense with all of that. On the other hand, numerous practitioners, some of them revered
for their competency, have observed that there are certain acupuncture point sets that can be used
reliably for many patients, or have utilized a small number of herbal prescriptions to help patients with
diverse conditions. The potential value of such an approach based on trustworthy regimens is that it
allows many people to benefit even when the practitioner is not in a position to provide full differential
diagnosis and treatment.. Even in modern medicine, where we have very detailed analyses that lead to
much finer differentiation of diseases than in Chinese medicine, we still sometimes find some central
therapeutic approaches that are relied upon over and over. As a prime example, a relatively safe anti-
inflammatory can have the potential to alleviate a wide range of conditions, both acute and chronic. In
fact, aspirin is one such compound, and this substance is now produced at an estimated rate of 24
million pounds per year. One can similarly think of treatments for mental disorders, such as Prozac
(fluoxetine), for which the U.S. alone used 1.2 billion dosages in one year.
The 20th century acupuncturist Wang Leting (4) had described an acupuncture protocol, called "Old Ten
Needles" for gastrointestinal diseases which can also be chosen and used for other diseases. It was
pointed out that "Generally speaking, the Old Ten Needles can be selected for all kinds of
gastrointestinal diseases regardless of whether they are vacuous [deficient] or replete [excess], cold or
hot." In a similar manner, certain herbal formulas are very broadly used, often for gastrointestinal
disorders and then additionally for other conditions, of which Guipi Tang is a good example mentioned
in Chapter 8.
For shen disorders, I propose the following structures for basic treatment using acupuncture and herbs,
which can be further modified according to the practitioner's decisions
Final Thoughts
To sum up, ancient Chinese therapeutics were originally quite coarse in nature (big needles and lances,
herbs with strong, even toxic, action) and used briefly to affect a change. Later, the system was refined
so that more subtle adjustments could be made. These subtle effects may be seen, in some sense, as a
replacement for components of lifestyle-such as walking through mountain paths and eating a
nutritious diet-that were recommended by Chinese philosophers who thought along the same lines as
the early medical scholars.
In addition to any specific action that might be attained via acupuncture and herbs, it is the interaction
of the physician with the patient that is critical. Chinese medicine offers what for many appears to be a
positive intervention, which contrasts with what is seen as a negative intervention of modern medicine.
The impression about the positive or negative impact of a style of treatment (i.e., Western or Eastern) is
often a matter of interpretation, but the contrasting views provide for an opening in the relationship.
The doctor who offers Chinese medical therapy has at his disposal the Chinese conceptual framework
about health. That acupuncture and herbs tie into a larger picture, namely the interaction of the patient
with the world outside them and, in particular, the spiritual part of their being, may be important for
many people, a key to changing their health.
This is not to say that the Western world can't offer essentially the same thing as does the Asian culture
in terms of this holistic view. It is only that doctors and patients in the Western world have fallen into a
pattern of thinking and acting that some find unsatisfactory. The patient presents a disorder and the
doctor presents a treatment-typically drugs and/or surgery-but there isn't much time to go into other
aspects of a person's health or the concerns have become sufficiently routine ("lose weight, stop
smoking") that they are quickly passed over. In fact, the Western doctor must reserve his or her time for
the technical aspects of diagnosis and medical intervention.
Theoretically, the Western doctor ought to be able to rely on the person's church (or other religious
organization) to take care of the spiritual matters that are important to healing. The person's family
ought to help with maintenance of a healthy pattern of behavior, including diet and exercise. The
culture that a person lives within is supposed to help provide healthy mental and physical activities; and
the medical literature put into layman's terms (popular format) is supposed to tell people what are
generally understood to be healthy or unhealthy practices. But, we find today in our society many
people isolated from their spiritual tradition, from their family, from the better side of their culture, and
skeptical of the general health care teachings (searching instead through various alternatives), so that
they are left without good health and have limited hope. They are looking for something else to fill the
gaps.
Chinese medicine offers an alternative that seems attractive to some. It has the spirituality of Daoism,
for example, that actually fits well with the uncertainties of the modern times, and offers the natural
concepts of yin and yang and five elements that fill a void left by too much technological information
about the chemical make-up of the body and the environment. China has a unique dietary approach
(such as attributing cold and hot or yin and yang properties to foods and herbs) and the physical culture
of taiji quan and qi gong (that strikes many far more harmonious than running and weight lifting). The
Far East has the therapeutics of acupuncture which seems both mysterious and effective, and it has
what is perceived as a more potent form of herbalism than is available in the West (and this perception
may be justified because of the greater reliance on herb therapy).
In order to tap into and gain the most from the Chinese system, its components should not be taken in
isolation. There are cases where acupuncture and/or herbs are simply provided as the sole remedies,
without going into a broader context, and this can be appropriate for injuries or infections. However,
for those with shen disorders, where the mental function, the emotions, and the spirit are all involved, a
focus on techniques of needling and herb prescribing herbs may be too narrow. For that reason, this
booklet begins with an introduction to the underlying concept of the shen and its disorders in relation to
how a person lives.
References
1. Bertschinger R, The Golden Needle and Other Odes of Traditional Acupuncture, 1991
Churchill-Livingstone, London.
2. Wu Jingnuan (translator), Ling Shu, or The Spiritual Pivot, 1993 Taoist Center, Washington,
D.C.
3. Hsu HY and Peacher WG (editors), Shang Han Lun: The Great Classic of Chinese Medicine,
1981 Oriental Healing Arts Institute, Long Beach, CA.
4. Yu Huichan and Han Furu, Golden Needle Wang Leting, 1996 Blue Poppy Press, Boulder,
CO.
Appendix
Quick Reference to Herb Names
This table helps to better identify the Chinese herbal materials mentioned in the text. The common
names that are used throughout the text are those that have been utilized by ITM and the Oriental
Healing Arts Institute for the past thirty years, with a few minor changes. The pinyin terms will help
those who are not familiar with the common names to refer to most Chinese literature. It is a frequent
practice in China to use many different herbs as a source of the same basic item; these herbs have the
same therapeutic action, from the traditional viewpoint. This cross-reference index lists a single,
representative botanical source for the item. The plant part used has been indicated. There is some
confusion in the literature about the designation of fruits and seeds, especially since some plants
produce a structure that is essentially both. There is also some confusion about whether just the tops or
the whole plant is used for some weedy herbs. It may depend on the collection techniques and post-
collection cleaning as to what is actually obtained. Not all the materials listed here are derived from
plants. For animals, the scientific name is given and has the same structure as the botanical names; for
minerals, a common name or a chemical description may be given. The category listing refers to the
Materia Medica section, and is mainly that used in Oriental Materia Medica. The Materia Medica
category does not necessarily define the primary current use of the herb; it does, however, indicate a
major application of the herb.
Left: a representation of a normal peritoneum, the transparent membrane that wraps the pelvic and
abdominal organs. Right: after surgical trauma, fibrous bands of collagen grow as part of the normal
healing process and form adhesions. Adhesions connect tissues or structures that are normally
separate. Adhesions in the abdomen or pelvic area can lead to infertility, pelvic pain, small bowel
obstruction, or the need for repeat surgery (1).
The incidence of adhesions following abdominal surgery is cumulative with multiple surgeries and
female gynecological surgeries give a particularly high rate of adhesions. In one study, autopsy
investigations indicated a 90% incidence of adhesions in patients with multiple surgeries, 70%
incidence of adhesions in patients with a gynecologic surgery, a 50% incidence of adhesions with
appendectomy, and a greater than 20% incidence of adhesions in patients with no surgical history.
Adhesions may occur as the result of tissue damage to the abdomen besides surgery, including
traumatic injury, inflammatory disease, intraperitoneal chemotherapy, and radiation therapy (1).
The most frequent problem with adhesions is a constriction of the small intestine, producing
constipation (sometimes complete bowel blockage, requiring emergency treatments). Abdominal pain
is another common symptom, caused when the bands of scar tissue bind up the internal organs so that
movements pull on them. Linkage of menstruation to changes in bowel function (e.g., inducing
diarrhea) may occur as the result of scar tissue attaching the uterus to the intestine. Adhesions may also
impair fertility in women by causing blockage of the fallopian tubes. It has been estimated that:
At least one-third of women who suffer from pelvic pain have adhesions as a cause of or
contributor to the pain.
Adhesions involving the ovaries or fallopian tubes are responsible for 15-20 percent of female
infertility cases.
Small bowel obstruction is often a surgical emergency and is particularly common after
gynecological surgery.
To prevent adhesion formation, surgeons may now apply a fine fabric barrier to surround the organs,
thus isolating them from the scar tissue strands (the barrier dissolves after the surgery). Although
adhesions can be removed by surgical intervention (adhesiolysis) using a laparoscopic technique (4),
recent studies suggested that such surgery produces limited benefits that are often short-term. Many
patients are treated with multiple adhesiolysis procedures in an attempt to improve the symptoms of
adhesions. Each year, 400,000 adhesiolysis procedures are performed in the U.S., costing the health
care system about $2 billion in hospitalization and surgeon expenses.
Most times, adhesions cause few, if any, notable effects. But, for those who do suffer from their adverse
effects, the question arises as to whether the adhesions can be reduced or eliminated by methods other
than further surgery.
Modified Major Rhubarb Combination: rhubarb (10-30 g), mirabilitum (6-15 g), magnolia (20
g), chih-shih (10 g), persica (10 g), red peony (10 g), and stir-fried raphanus seed (30g)
Adhesion Lysis Decoction: cassia leaf (10g), mirabilitum (6-10 g), magnolia (10 g), lindera (10
g), persica (10 g), red peony (10 g), and stir-fried raphanus seed (10 g).
These formulations could be modified: for severe pain, add 10 grams each of corydalis, frankincense,
and myrrh; for a case with vomiting, add 10 grams pinellia and 30 grams raw hematite.
As in the previous study, these formulas prevented the need for surgery in about 86% of cases.
Presumably, these therapies could be applied to Western patients suffering from constipation that has
not developed into full obstruction requiring hospitalization; the formulas are not inherently different
from traditional herb prescriptions now administered for acute constipation. For example, Major
Rhubarb Combination is routinely sold as a dried extract granule by several Chinese herb suppliers
worldwide.
A limitation of the purgative herb therapy is that while it relieves the immediate crisis, the problem can
return, because the adhesions are not gone. An attempt to resolve this dilemma was designed on the
basis of using Chinese herb therapy to treat the obstructive crisis and then using laparoscopic surgery to
remove the adhesions to prevent further occurrences. By so doing, one can usually avoid emergency
surgery as a result of intestinal obstruction; instead, the surgery can proceed at a time when the
intestinal functions have normalized and a less invasive surgical technique (laparoscopic surgery) can
be utilized. In one study using this two-stage method (9), patients received one of three basic herb
therapies for the intestinal obstruction:
Modified Major Rhubarb Combination: rhubarb, mirabilitum, chih-shih, magnolia, persica, red
peony, and stir-fried raphanus seed;
Euphorbia Obstruction-relieving Decoction: euphorbia (gansui), rhubarb, magnolia, saussurea,
persica, achyranthes, and red peony; or
Entero-adhesion Lysis Decoction: cassia leaf, mirabilitum, magnolia, saussurea, lindera, persica,
red peony, and stir-fried raphanus
In these formulations, rhubarb, euphorbia, and cassia leaf all serve the same function of inducing
peristalsis. The purgative herb is the central ingredient in treatment, while the others are supportive; in
one study (10), euphorbia was used as a single herb to treat intestinal obstruction due to adhesions in
order to prevent the need for surgery.
The desire of most patients would be to alleviate the problem of adhesions before a crisis of bowel
obstruction occurs, and to treat other manifestations of adhesions, such as abdominal pain and reduced
fertility. The Chinese literature appears silent on this issue, but there are some possibilities to be
considered.
Herb Common Name (Pinyin) TCM Functions Uses and Potential Applications
Achyranthes vitalize blood circulation, blood stasis mass in the
(niuxi/chuanniuxi) disperse swelling abdomen, abdominal pain
Arca shell vitalize blood circulation, blood stasis and phlegm mass in
(walengzi) disperse masses, control pain abdomen
blood stasis mass in the
Carthamus vitalize blood, disperse stagnant abdomen, traumatic injury,
(honghua) blood abdominal pain due to stagnated
blood
Cnidium vitalize blood, promote qi
abdominal pain, fibrosis
(chuanxiong) circulation, control pain
Frankincense
vitalize blood, control pain traumatic injury, abdominal pain
(ruxiang)
Myrrh vitalize blood, remove stagnant blood stasis mass in the
(moyao) blood, control pain abdomen, abdominal pain
Persica blood stasis mass in the
vitalize blood
(taoren) abdomen, traumatic injury
Red peony vitalize blood, disperse stagnant abdominal pain, accumulation in
(chishao) blood, control pain abdomen
Salvia inhibit fibrin deposition, promote
vitalize blood
(danshen) fibrinolysis
vitalize blood, promote qi
Sparganium blood stasis mass in the
circulation, disperse mass,
(sanleng) abdomen, abdominal pain
control pain
Succinum vitalizes blood, disperses abdominal pain due to
(hupo) stagnant blood obstruction
Tang-kuei abdominal pain, promotes
vitalizes blood
(danggui) fibrinolysis
Turtle shell disperse stagnant blood, soften
blood stasis mass in the abdomen
(biejia) hardness, disperse accumulations
Zedoaria vitalize blood, promote qi blood stasis mass in the
(ezhu) circulation, control pain abdomen, abdominal pain
REFERENCES
1. Women's Surgery Group, Adhesions,
http://www.womenssurgerygroup.com/conditions/Adhesions/overview.asp
2. Khaitan E, Scholz S, Richards WO, Laparoscopic adhesiolysis and placement of Seprafilm: a
new technique and novel approach to patients with intractable abdominal pain, Journal of
Laparoendoscopy and Advanced Surgical Techniques 2002; 12(4): 241-247.
3. Kavic SM, Adhesions and adhesiolysis: the role of laparoscopy, Journal of the Society of
Laparoendoscopic Surgeons 2002; 6(2): 99-109.
4. Shayani V, Siegert C, and Favia P, The role of laparoscopic adhesiolysis in the treatment of
patients with chronic abdominal pain or recurrent bowel obstruction, Journal of the Society of
Laparoendoscopic Surgeons 2002; 6(2): 111-114.
5. Su Fachun, et al., Clinical observation on Tao Zhi Zhi Po Fang used for preventing intestinal
adhesion after surgical operation, Chinese Journal of Surgery by Integrating Traditional
Chinese Medicine and Western Medicine; 2000; 6(6): 404-405
6. Sun Dechun, et al., A report on 6 cases of adhesive bowel obstruction treated with Major
Rhubarb Combination and sodium hyaluronate, Chinese Journal of Surgery with Integrated
Traditional and Western Medicine, 2001; 7(1): 32-33.
7. Chen Guifeng, 250 cases of adhesive intestinal obstruction treated by integrating Traditional
Chinese Medicine and Western Medicine, Chinese Journal of Surgery with Integrated
Traditional and Western Medicine, 2000; 6 (5): 325.
8. Zhang Jinfang and Wang Zhiqiang, Analysis on 102 cases of adhesive bowel obstruction treated
by integrating Traditional Chinese Medicine and Western Medicine, Chinese Journal of Surgery
with Integrated Traditional and Western Medicine 2001; 7(3): 160.
9. Wang Zhenyu, et al., Laparoscopy and combination of traditional Chinese medicine and
Western medicine in adhesive intestinal obstruction, Chinese Journal of Surgery with Integrated
Traditional and Western Medicine 2002; 8(1): 3-5.
10. Liang Desen, et al., Curative effect of Gansui (Euphorbia kansui root) in treating
adhesive bowel obstruction, Chinese Journal of Surgery with Integrated Traditional and Western
Medicine 2001; 7(1): 33-34.
11. Hsu HY, et al., Oriental Materia Medica, 1986 Oriental Healing Arts Institute, Long
Beach, CA.
12. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of
Traditional Chinese Medicine, vol. 2, 1993 Heilongjiang Education Press, Harbin
13. Wu Dingyuan, Preliminary report of 136 cases of uterine myoma treated by traditional
Chinese medicine, Journal of the American College of Traditional Chinese Medicine 1982 (1):
64-70.
14. Wang DZ, Wang ZQ and Zhang ZF, Study on the treatment of endometriosis with
removing blood-stasis and purgation method, Chinese Journal of Integrated Traditional and
Western Medicine 1991; 11(9): 524-526.
15. Fruehauf H, Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs,
Institute for Traditional Medicine 1997, Portland, OR.
Disorder Articles
Abdominal Adhesions Abdominal Adhesions: Prevention and Treatment
Alopecia Treatment of Alopecia with Chinese Herbs
Alzheimer's Disease: Treatment with Chinese
Alzheimer's Disease
Herbs
Amyotrophic Lateral Sclerosis
Treatment of ALS with Chinese Medicine
(ALS)
Anemia Iron Deficiency Anemia
An Analysis of Chinese Herbal Prescriptions for
Arthritis
Rheumatoid Arthritis
Treating Advanced Arthritis With Chinese Herbs
Asthma Acupuncture Treatment of Asthma
Chinese Herbal Treatments for Attention Deficit
Attention Deficit Disorder
Disorder
Autism Autism
Autoimmune Diseases and the Potential Role of
Autoimmune Disease
Chinese Herbal Medicine
Treatment of Avascular Femoral Necrosis with
Avascular Femoral Necrosis
Chinese Herbs
β-Thalassemia Treatment of β-Thalassemia with Chinese Herbs
Benign Prostatic Hyperplasia
Herbal Therapy for BPH
(BPH)
Yunnan Paiyao: Uses for injury and surgery; gastro-
Bleeding
intestinal, respiratory, and urogenital disorders
Perimenopausal Brain Fog: Acupuncture and Herbs
Brain Fog
to Stimulate Brain Activity
Countering the Adverse Effects of Cancer
Cancer
Chemotherapy
Adjunct Cancer Therapies at IEP Clinic
Prognosis After Diagnosis of Liver Cancer
How Emotions May Contribute to Cancer
Estrogen Dependent Tumors & Herbs: How
Modern Conditions Change Traditional Practices
Countering the Side Effects of Modern Medical
Therapies with Chinese Herbs
Questionable Cancer Therapies I: PC-Spes
Do Herbs, Vitamins, and Antioxidants Adversely
Affect Cancer Therapies?
Cancer Treatment Strategies at IEP
The Treatment of Gastro-Intestinal Cancers with
Chinese Medicine
An Epidemic of Sinus Disorders: Natural
Sinus Health
Treatments with Ayurvedic Methods
Sjögren’s Syndrome Triple Burner (Sanjiao) with reference to treatment
of Sjögren’s Syndrome
Treatment of Throat and Voice Disorders with
Throat Disorders
Chinese Medicine
Treatments for Thyroid Diseases with Chinese
Thyroid Diseases
Herbal Medicine
Treatment of Tinnitus, Vertigo, and Meniere's
Tinnitus
Disease with Chinese Herbs
Acupuncture Assistance for Withdrawal from
Tobacco Addiction
Tobacco Smoking
Tourette's Syndrome: Potential Treatments with
Tourette's Syndrome
Chinese Medicine
Ulcerative Colitis The Use of Jianpiling in Treating Ulcerative Colitis
Uterine Bleeding Chinese Herbal Therapy for Uterine Fibroids
Excessive Uterine Bleeding Treated with Saraca...
The Qi Keeps The Blood Within the Vessels: The
Story of Gui Pi Tang
Uterine Fibroids Chinese Herbal Therapy for Uterine Fibroids
Viral Myocarditis Viral Myocarditis: Coxsackie Virus Infections
Treatment of Tinnitus, Vertigo, and Meniere's
Vertigo
Disease with Chinese Herbs
Vitiligo Treatment of Vitiligo with Chinese Herbs
West Nile Virus West Nile Virus
In any corres
ITM
2017 SE Hawthor
Portland, Oregon
(503) 233-4907 P
(503) 233-1017 F
Offering traditional Chinese medicine (TCM) as an adjunct to modern cancer therapies, with the
primary aim of countering the adverse effects of those modern therapies and secondarily to improve
long-term outcomes, represents a relatively new application of TCM. Experience with this medical
specialty at one of the Institute for Traditional Medicine facilities was outlined in my 2013 report
Adjunct Cancer Therapy at the Immune Enhancement Project (IEP) Clinic (1). In that document,
which focused attention on the acupuncture aspect of the therapeutic program, I referred to the five
zones method and here elaborate that approach to acupuncture point selection (part I). The main focus
of the remainder of the current paper is introducing what I refer to as Six Actions Herb Prescribing,
relaying experience gained in China and at the IEP Clinic in relation to design of herb formulations for
cancer patients (part II)+.
Indications for Five Zone Method Other Methods Usually More Appropriate
Disorders affecting the head Localized disorders, but not the head or along GV vessel
Dysfunctions, injuries, diseases of the brain Disorders affecting primarily the fu organs
Emotional distress and mental imbalances Disorders that do not disturb the mental activities
Peripheral nervous system dysfunction Endocrine dysfunction
Disorders affecting several parts of the body Disorders primarily affecting a single zang organ
Imbalances in yang qi circulation Imbalances of yin essence
The “other methods” include simple needling with two or three points locally or, for more
complex patterns, leaving out one area of the five defined zones: for example, no points of the
head/neck zone, or no forearm points, or no lower leg points; there will usually be more attention
to torso points. In the case of adverse effects of chemotherapy and radiation, because these
medical interventions affect several parts of the body, cause an imbalance of yang qi circulation
(often affecting appetite and sleep as a result), are accompanied by emotional distress, adversely
alter brain activity (the condition sometimes referred to as “chemo brain”) and sometimes the
peripheral nervous system (neuropathy), the five zone method fits well for this application.
For easy reference, I present here a summary of the five zones method as applies to the treatment
of cancer patients at the IEP Clinic, relying on our foundational group of points, the new twenty
needles and their associated points (1):
New Twenty Needles Points:
zusanli (ST-36)
sanyinjiao (SP-6)
taixi (KI-3) Lower Limbs
taichong (LV-3)
hegu (LI-4) Upper Limbs
quchi (LI-11)
neiguan (PC-6)
baihui (GV-20) Head
yintang (Ex-HN-3)
qihai (CV-6) Torso
zhongwan (CV-12)
tianshu (ST-25)
Common additions to the above set were the lower limb points yinlingquan (SP-9; substituted for
SP-6 or added to it), zhaohai (KI-6; substituted for KI-3), qiuxu (GB-40); upper limb points shousanli
(LI-10, frequent substitute for LI-11); shenmen (HT-7; substitute for PC-6 or added to it), lieque (LU-
7), waiguan (TB-5); torso points jianjing (GB-21), danzhong (CV-17; also called shanzhong); and
head/neck points shenting (GV-24; added to GV-20), fengchi (GB-20), and extra point anmian (near
GB-20). In a few instances, two adjacent points on a meridian were needled at the same time, such as
LI-10 and LI-11 or GB-20 and GB-21. For calming the disturbed spirit, some practitioners at IEP also
add ear points.
As an example, multiple sclerosis is a disease that was relatively rare in earlier centuries
(appearing in the late 19th century) and virtually non-existent in China until quite recently. One of its
common manifestations is a progressive difficulty with moving the legs and feet, which then causes
withering of the leg muscles because they are less used. These signs of the disease turned attention of
modern TCM doctors to the ancient literature, as is the common method of determining how to proceed
from the traditional-style pathology and therapeutics to the modern case. They sought formerly
encountered diseases that caused weakening of the muscles, particularly of the legs, with withering of
the muscle mass, a condition known as weizheng (flaccidity syndrome). The texts, starting with the
preferred reference point, the Neijing Suwen, depicted a heat syndrome that caused damage through one
or more of a number of possible mechanisms. The dominant thought was that heat so damaged the yin
that it could no longer sustain the flesh, and the muscles would wither. Treatment strategies for such
conditions—restoring yin and cleansing deficiency heat that remained after the initiating disorder—had
been developed in ancient times and were then suggested by modern practitioners of TCM for patients
with MS (10)
However, upon seeing numerous American MS patients at the IEP clinic, it became evident that
neither a feverish disease nor other fire syndrome was associated with onset of MS, that yin deficiency
was rarely seen as a predominant disease manifestation, and that yin nourishing herbs were of value but
had only limited effect on the current status of the disability or its progression. By contrast, it was
observed that stagnation syndromes were more prevalent.
Along similar lines, a Chinese physician, Cheng Yongde, who saw many patients with ALS,
considered that the application of ancient doctrines was steering treatment in the wrong direction,
working with one of the traditional views of weizheng. I wrote about his considerations in an article on
ALS (11):
Cheng Yongde noted that in the past Chinese physicians mainly relied on the ancient doctrine of the
Niejing Suwen (ca. 100 A.D.) in treating diseases where the muscles atrophy. The basic approach they
take when encountering a disease that causes the muscles to weaken and atrophy is to direct treatment
at enhancing the function of the stomach/spleen system, rooted in the concept that the spleen governs
the muscles. By treating the associated meridians (e.g., yangming meridian), the muscles would be
nourished and invigorated. Cheng believes, instead, that ALS is due to a blockage of the governing
vessel, leaving it unable to regulate the qi and blood flowing to the viscera; then, the limbs are not
adequately nourished by the flow of qi and blood. Therefore, using acupuncture to unblock the
governing vessel is the key to therapy.
The lesson to be gained from these and other such examples is that when we encounter new
disease conditions, the first analysis made through the process of applying standard TCM principles
may need revision as experience and understanding of the new disorder grows; the determination
serving as a starting point may represent only one aspect of the disease process, possibly not the central
one Even if some success is attained initially, it may be only a partial result compared to what is
potentially to be achieved. I chose these two examples because they represent cases where tonification
therapies—to replenish damaged yin on the one hand, and to restore function of the spleen and its
generation of qi and blood to nourish the muscles on the other—did not quite fit the patient
presentations.
In the case of countering the side-effects of chemotherapy and radiation, the early clinical work on
this subject was done in China at a time when there were only a few chemotherapy drugs and when
radiation beams were quite crudely applied (the beam was relatively wide and could only be
approximately aimed at the internal mass). The effects of treatment were drastic and were also largely
uncontrolled by any of the palliative medications that were available. Of particular note was the
frequent occurrence of oral ulcerations and skin irritation from chemotherapy and substantial burning
of the skin (and everything in the path) of the radiation beam. It is not surprising, then, that in an
English language publication based on this early work (12) it was reported that “According to
Traditional Chinese Medicine, radiation and chemotherapy are regarded as an extrinsic external
stimulus which manifest in the form of heated toxin. It invades the body as an external evil damaging
and destroying the normal physiology….”
At the outset, each particular manifestation of this destructive effect was treated by modifications
of well-known traditional formulas, thus, for example: a modified Xuanfuhua Daizheshi Tang (Inula
and Hematite Combination) for treating nausea and vomiting; a modified Guipi Tang (Ginseng and
Longan Combination) for low blood counts; or modified Baitouweng Tang (Pulsatilla Combination) for
burning and inflammation affecting the bowels. However, not long afterward it was realized that one
could address the fundamental impact of the medical treatments by relying on a basic formula suited to
most patients that might then be modified if necessary to address the most severe manifestations in the
individual. Such modification would either be attained by adding herbs for the specific concern or by
providing a second formulation to address the condition.
The dominant treatment method for countering side effects of cancer chemotherapy has been
tonification, and this comes in response to the evident debility caused by the interventions and the
apparent inability of some organs to function, such as the spleen (in relation to the digestive system
disturbances) and the kidney (in relation to the blood system deficiencies). Defensive activity would be
impaired (as revealed by serious infections) and the hair would fall out (indicating blood deficiency).
Because of the interpretation that “heat toxin” damaged the yin and substantially weakened the spleen,
nourishing yin (with moistening herbs like maimendong and herbs that benefit the hair, like nüzhenzi)
and tonifying qi (with herbs that bolster weiqi, such as huangqi, and that protect spleen functions, with
soothing herbs like qianshi and shanyao) became the prominent methods.
By examining formulas that the modern TCM doctors were prescribing for their patients, certain
herbs drew the attention of laboratory researchers. For example huangqi (astragalus) and nüzhenzi
(ligustrum) were announced as being beneficial for cancer patients at a 1983 Chinese conference (MD
Anderson Cancer Center in Houston cosponsored the Chinese conference and provide the site for
research on these two herbs). A pair of related publications suggested that each of these herbs could
have the effect of restoring immune functions in the patients, as illustrated by study of blood drawn
from them and compared to that from a control group of non-cancer patients.
While there is no doubt that cancer patients undergoing modern medical therapies suffer from
deficiency syndromes, some of the modern drugs give less evidence of heat toxin and yin deficiency
than was seen in the past. The circumstances surrounding cancer diagnosis and treatment as well as
physiological effects of cancer treatment also point to the presence of stagnation syndromes, not just
deficiency. The presence of stagnation was originally observed only in passing, for example that
radiation and chemotherapy causes (12, emphasis added): “imbalance of yin and yang, obstruction of
the circulation of qi and blood, disturbance of the function of the organs…” In one of the most
extensive texts about providing herbal support for cancer patients undergoing chemotherapy (13), a
section was devoted to the problem of blood stasis, indicating its importance. Nonetheless, little further
commentary was provided throughout the rest of the book and the formulas routinely incorporated only
one herb, jixueteng (millettia) that might have been classified as being used for this purpose.
Therefore, the emphasis and aim of this article will be to make a broader analysis of the situation and
suggest a more comprehensive way of treatment.
When it comes to herbal therapies, the most fundamental influence driving the original
development of its categories was—and remains—the concept of yin and yang. In the Advanced
Textbook on Traditional Chinese Medicine and Pharmacology (14), where the early history of
Chinese medicine theories is being reviewed and brought forward to the modern times, it is noted that:
In the final analysis, a disease is the result of a breakdown in the equilibrium of the body’s yin and
yang….Thus, a cardinal principle of treatment is to reconcile the two aspects….just as Basic Questions
says, “The yin and yang should be carefully observed and adjusted.” ….Since the theory of yin/yang
underlies the differentiation of syndromes, all pathological changes may be summarized as disturbances
of yin and yang. Any disorders of the exterior and interior, of descending and ascending of qi, all
syndromes of heat and cold, excess and deficiency, any disharmony between the ying and wei systems,
and all disturbances of the qi and blood, are expressions of the disharmony between yin and yang.
Broadly speaking, the following treatment methods are used to balance yin and yang: relieving exterior
syndromes and eliminating interior syndromes; sending up the lucid yang and bringing down wastes;
clearing away the heat and warming the cold; reinforcing the deficient in deficiency syndromes and
reducing the excess is excess syndromes; harmonizing the nutrient and defensive systems; and
adjusting the qi and blood.
This last listing of methods provides subdivisions of yin and yang that depict paired opposites of
bodily conditions, such as deficiency and excess; cold and heat; internal causation and external
causation of disorders; internal manifestation and external manifestation of symptoms and signs. This
set of four pairs gave rise to the standard “eight methods [strategies] of therapy” used in herbalism.
The eight features of an ailment to be addressed by herbs were elucidated by Gou Congshi in the
Bencao Yanyi, published around 1119 A.D. He provided some fairly limiting category descriptions,
which point to the general principles involved allowing for broader applications, writing that (15):
There are eight important points in the treatment of illness...The first is deficiency, signified by the five
signs: fine pulse, cold skin, shortness of breath, polyuria and diarrhea, low appetite for food and drink.
The second is excess, this is signified by the five signs: full pulse, hot skin, bloated abdomen, urinary
retention and constipation, depression. The third is cold, that is, cold in the internal organs [zangfu].
The fourth is heat, that is, heat in the internal organs. The fifth is superficial evil, signifying that the
disease did not originate with a disturbance of the normal qi in the organs. The sixth is internal evil,
that is, the illness did not arise from external causes. The seventh is interior; this signifies that the
disease is not located in the body surface [skin and muscles]. The eighth is the exterior; this signifies
that the illness is not located in the interior portion of the body [internal organs, bones].
And, the basic yin/yang division later yielded the three other pairs: “sending up the lucid yang and
bringing down wastes; harmonizing the nutrient and defensive systems; and adjusting the qi and
blood.”
As the systematic application of herbology grew more complex over the subsequent centuries, the
number of categories of treatment also grew so that in most modern listings of herbs the various
medicinal materials are divided into about two dozen standard categories. In addition to the above
mentioned categories there are such groupings as herbs to: resolve phlegm, sedate internal wind, open
the orifices, sedate the spirit, and astringe discharge.
The number six frequently has been used in Chinese medicine categorization, such as the six
environmental influences, the six disease stages (of the Shanghan Lun), and the six pairs of zang and fu
(with five sets corresponding to the five elements, and the fire element divided into two). It is not a
matter of six being a magical number to which the medical scholars tried to fit many of their concepts,
rather, it is a number of categories that is sufficiently large to account for many phenomena, yet small
enough that the divisions can be remembered and worked with. As will become evident, the six actions
herb therapy comprise about the largest number of therapeutic effects that can be utilized at once
without formulations becoming diffuse and cumbersome.
The “Six Actions Herb Prescribing” that is described here does not represent a proposal for a new
categorization of the herb actions; rather, these are strategies selected as a particular subset of the
roughly two dozen groupings routinely used in modern TCM. To incorporate the important herbs into
these groups, some adjustments are made as to how a few of the herbs might be best categorized for the
current purpose. As an example, chaihu (bupleurum) is categorized in modern Materia Medica with
the herbs for resolving the surface (the cooling subgroup), but this herb is probably more often used in
regulating the flow of qi—influencing the liver’s controlling mechanism and helping to raise clear qi—
so it is placed in what follows with qi regulating herbs. The six actions chosen for inclusion here are
contained within the yin/yang summary that was given in the Advanced Textbook (14) as quoted
above, with a focus on “adjusting qi and blood.” The six actions come from expansion of the pairing of
qi and blood, namely: qi and blood to be nourished; qi and blood to be circulated; clear qi to be raised
up to the brain; and blood to be generated from marrow (the brain and marrow being two extensions of
the kidney organ system).
My selection of these therapeutic approaches was arrived at through recognition that the actions
are both theoretically of benefit in countering the side effects of chemotherapy for cancer and they are
being utilized frequently at the IEP Clinic because practitioners are seeing these as appropriate to the
cancer patients. Experience at IEP is of potential value because the circumstances in China differed
from those encountered here and the changes in modern medical treatment are progressing rapidly with
new drugs, new drug delivery methods, and improved palliative care. In contrast to the continued
reliance on tonification therapy relayed in modern literature, it is proposed here that all six action of
herbs are likely of value in treating cancer patients and that most of them should be combined into a
single treatment, either within a single formulation, or through the combining of two or more base
formulas. This article will focus attention on chemotherapy, but the principles of treatment for
countering adverse effects of radiation therapy are quite similar.
An Orientation to Chemotherapy
The term chemotherapy could be applied to any drug; the term was originally utilized by the German
chemist Paul Ehrlich when he was working on drugs to treat infections: he coined it for any use of
chemicals (chemo-) given to treat disease (therapy). In the realm of cancer treatment, chemotherapy is
most often used to describe drugs that directly inhibit the reproduction of cancer cells (e.g., 5-FU,
taxol, platinum drugs), but it can also be used to depict other strategies, such as drugs that block
estrogens from stimulating cancer cells (e.g. Tamoxifen, Aromatase Inhibitors), which typically involve
a notably different (and often milder) set of adverse reactions. The subject of concern in this article is
the former group of drugs that powerfully inhibit the metabolism and reproduction of cancer cells,
often leading to cell death (apoptosis). A characteristic of their common side effect profiles is that they
tend to also inhibit the metabolic activity and reproduction of other non-cancer cells, having
particularly strong impact on rapidly reproducing cells. Chemotherapy drugs are selected, developed,
and approved for use by virtue of their specificity for inhibiting cancer cells, yet none of the current
widely used agents are sufficiently specific that they don’t produce to a lesser extent the same type of
inhibitory impact on non-cancer cells. Inhibitory effects include bone marrow suppression, impaired
turn-over of gastro-intestinal cells, and reduced mitochondrial activity. While active cancer cells
(those that are reproducing) will die as a result of the treatment, with shrinking of tumor masses, non-
cancer cells are more likely to be functionally inhibited but with relatively limited die-off, so that
recovery of their functions can take place during the days after treatment is withdrawn. Sometimes
adverse effects will persist, especially in the case of neurological damage to peripheral nerves, but for
most patients the production of blood cells and intestinal cells returns to normal or near normal.
The primary approach to chemotherapy adverse effects requires an analysis of the bodily
imbalances that are to be rectified. From the TCM perspective, the ability of the body to regenerate
day to day is primarily a function of the qi and blood and so the inhibition of cellular reproduction by
chemotherapy points to imposed deficiencies of qi and blood. The Advanced Textbook (14) lists five
functions of qi, designated as: promoting, warming, defensive, controlling, and activity. Qi and blood
function as a pair, and in virtually all the ancient medical literature of China, the phrase “qi and blood”
was the basis for what we today often simply depict as qi. The nature and role of blood in TCM is
somewhat less clearly defined than qi, but one of the Neijing Suwen quotations is often utilized to give
a sense of the function of blood: “When the liver receives blood, the vision is normal; when the feet
receive blood, they are able to walk; when the palms receive blood, they are able to hold things; and
when the fingers receive blood, they are able to grasp.”
Once the first dose or two of chemotherapy works its way through the populations of existing cells
to impact their activity and reproduction (about ten days), the physical changes come on very rapidly.
From the first day of obvious symptoms, their severity increase day by day, either until a plateau is
reached or some corrective measures are put in place, with palliative drugs, for example. This rapid
change in the body’s ability to promote its replenishment, control its functions, and be active in
transformation of food essences, with lethargy as one of the signs of the drug actions illustrates the
impairment of qi and blood. The defensive action of qi is today interpreted in terms of immune
responses, so herbs that tonify qi and herbs that are said to enhance immune responses may be gathered
together under the same grouping.
Below is presented a table of herbs that tonify qi, adding to the standard list eleuthero and
gynostemma and medicinal mushrooms (a few of which are described in a separate table); additionally,
two antitoxin herbs that were used in China as anticancer medicinals but are now often designated as
functioning through immune enhancing activity are included in a separate table in this section.
Ginseng tonifies kidney and lung, Useful in virtually all deficiency syndromes; especially
renshen pacifies spirit, invigorates, used with spirit agitation.
raises yang
Panax ginseng
Gynostemma benefits lung; cool A Chinese folk remedy for lung diseases, popularized in
jiaogulan the 1990s, after it was found to contain some active
ingredients of ginseng.
Gynostemma
pentaphyllum
Jujube pacifies spirit, harmonizes Used as an aid to reduce harshness, protect the stomach,
dazao (or hongzao) actions of herbs, protects and harmonize the action of ingredients.
stomach
Zizyphus jujuba
Licorice moistens lungs, harmonizes Often prepared by honey-frying to enhance tonic effects;
gancao actions of herbs, counters used in small amounts in numerous formulas to
toxicity harmonize ingredients.
Glycyrrhiza
uralensis
Cordyceps controls cough and dyspnea Mainly used for chronic asthma associated with kidney
dongchongxiacao deficiency; recently adopted as immune enhancing agent.
Cordyceps
sinensis
Coriolus dispels moisture; warm Developed as a source of immune-enhancing polysaccharides
yunzhi in Japan during 1970s, adopted by China for same purpose.
Coriolus
versicolor
Ganoderma* nourishes all internal organs, Designated as a sedative, this herb is mainly used now for
lingzhi removes toxin, vitalizes blood immune-enhancing and blood-circulating properties.
Ganoderma
lucidum
Oldenlandia antitumor effects Modern applications are mainly for cancer patients; it is an herb
of low toxicity with reputation for inhibiting tumor growth.
baihuasheshecao
Oldenlandia
diffusa
Scutellaria antitumor effects Modern applications of this herb are as an addition to oldenlandia
banzhilian in the treatment of tumors.
Scutellaria
barbata
Herbs that Nourish Blood
Tang-kuei vitalizes blood, moves qi, This is the most widely used blood nourishing herb.
danggui moistens intestines, regulates
menstruation
Angelica sinensis
Lycium nourishes yin, aids vision, Especially used for the combination of kidney- and
gouqizi benefits marrow liver-deficiency syndrome and for eye disorders.
Lycium barbarum
Peony (white cools blood, vitalizes blood, Peony is extensively used for a variety of applications;
peony) baishao astringes liver yin, alleviates red peony (chishao) is used when blood vitalizing is
spasms and pain the main concern.
Paeonia alba
Ho-shou-wu nourishes yin Ho-shou-wu is mostly used when there is kidney and
heshouwu liver deficiency; it is almost always used in formulas
for the hair.
Polygonum multiflorum
Rehmannia nourishes yin, benefits marrow Extensively used in cases of kidney deficiency, and
almost always used when for kidney/liver deficiency.
shou dihuang
Rehmannia glutinosa
The mental state of the patient plays an important role in the course of treatment….Generally speaking,
cancer patients are in low spirits and full of worries….Vexation, hesitation, grief, fear, nervousness,
depression and low spirit should be relieved so as to prevent poor appetite.
While the author believed that the mental state of the patient would be addressed primarily by the
actions and words of family, friends, and medical staff, these conditions persist to a certain extent and
influence the body. As one major consequence, qi circulation can stagnate, thus worsening drug-
induced fatigue, lowering appetite, and altering ability to make decisions.
Further, while qi deficiency is a reasonable means of representing what happens to the person as a
result of the chemotherapy impact on cellular activities, the transporting action of the spleen and the qi
smoothing action of the liver are also inhibited by chemotherapy, so that there is a direct effect on qi
circulation that requires attention.
Both qi deficiency and disturbances in qi circulation impair the free flowing of blood, as does the
decline in physical activity that results from fatigue. In the book Cancer Treatment with Fu Zheng
Pei Ben Principle by Pan Mingji (13), Pan indicates that blood stasis is a problem even before cancer
is diagnosed, before any treatment with surgery, chemotherapy, or radiation. He says:
TCM believes the mechanism of cancer is related to blood stasis….The fact that cancer patients reveal
a state of hyper-coagulation has been gradually accepted….90% of cancer cases reveal, by fingertip
volume pulse wave and microcirculation of the nail fold, that arterial capillaries are spasmodic and
narrow, with decreased or even missing capillary loops. Some may reveal blood corpuscle congestion
and blood flow is intermittently interrupted.
Tissue damage due to surgery or radiation therapy will cause more severe blood stasis in the
affected area. With regard to chemotherapy, Pan notes that blood vitalizing herbs are important to the
comprehensive treatment, including the long-term success of the medical therapies:
Usually, the side effects of chemotherapy can be greatly ameliorated when coordinated with Fu Zheng
Pei Ben prescriptions and [herbs] which activate blood circulation and relieve blood stasis, thereby also
increasing the blood flowing in cancer tissue. It is very helpful when the concentration of chemicals,
immune remedies, and immune lymphocytes increase in the cancer tissues, as the therapeutic effect is
then also greatly increased.
Along similar lines, it is thought that the impact of radiation therapy is improved by vitalizing
blood circulation, because one of the mechanisms of radiation is to introduce high concentrations of
reactive (ionized) oxygen to kill the cancer cells, such that if the cells are at the same time better able to
get oxygen from the blood the effect will be enhanced. Additionally, quick access of immune
substances from the blood will help kill the damaged cells and break them down. Pan referred to this in
a later text (18), saying:
The main function of this medicine [herbs for removing blood stasis] is to ameliorate damage to
microcirculation and add to the flow of blood and oxygen in tumor tissue. It is desirable to bring the
anticarcinogen [drug] into the tumor to help the chemotherapy drugs. One of the reasons why
radiotherapy fails is the lack of oxygen in cancer cells. The medicine for removing blood stasis can
increase the quantity of oxygen in cancer cell and heighten their sensitivity to radiation.
Limited circulation reduces the ability of the severely damaged cancer cells to die, while good
circulation may help the less damaged normal cells recover more quickly. The concern for improving
circulation to tumor cells differs from efforts to halt tumor-stimulated growth of a circulatory system
for a tumor mass, for which the drugs that inhibit the generation of new vessels (angiogenesis
inhibitors) are directed. The tumor needs a blood supply to survive at all, but it is able to utilize a
restricted one quite effectively and especially the restrictions prevent cancer treatments from having
their full effects.
Western practitioners of Chinese medicine raised the concern that activating blood circulation
might promote metastasis of cancer cells. However, metastasis in many cancers is a normal process
that is very difficult to alter, and the Chinese concept is that the primary cause for concern is not the
temporary circulation of the cells, but the adherence of them to other tissues, an adherence that is
needed to allow for new tumor growth. The herbs used for promoting blood circulation are understood
to reduce this adherence and thus inhibit metastatic growths from occurring.
While the formerly mentioned methods of tonify qi and nourishing blood are a good means of
improving qi circulation, additional efforts may be needed. Below are some of the herbs classified as
regulating qi, with a separated section to display the large number of ingredients that are various types
of citrus fruits. It is important to note, however, that herbs in other categories may also regulate qi as a
secondary property, such as chuanxiong (cnidium), so that one can formulate concisely by relying on
those ingredients.
Areca seed dispels moisture Primarily used for abdominal swelling associated
binglangzi accumulation, breaks up with water accumulation. Areca peel (dafupi) is
Areca catechu accumulations sometimes used instead.
Bupleurum raises yang qi, resolves Used for dredging qi from liver constraint;
chaihu surface, cooling especially valued for disorders that combine
internal syndromes with external syndromes.
Bupleurum chinense
Citrus Group resolves phlegm-damp Several members of the citrus family are used to
regulate qi; they are grouped together in a table
(see separate table) displaying some of their slight differences.
Cyperus xiangfuzi alleviates pain, regulates Analgesic for headaches and abdominal pains and
Cyperus rotundus menstruation alleviates stagnation-caused menstrual
irregularities; overcomes mild depression.
Lindera wuyao alleviates pain, warms the Mainly used for lower abdominal pain associated
Lindera strychnifolia kidney with cold kidney; has properties similar to
cinnamon twig (guizhi).
Melia alleviates pain Mainly used for pain in the chest and upper
abdomen (liver area).
chuanlianzi
Melia toosendan
Saussurea alleviates pain, controls Used for mainly for abdominal disorders that
muxiang diarrhea, sedative include diarrhea.
Saussurea lappa or Jurinea
souliei
Chih-ko zhiqiao resolves phlegm, disperses Used for food stagnancy, epigastric aching,
Citrus aurantium accumulations and lung congestion.
Chih-shih zhishi purges gallbladder to produce Used for abdominal stagnation with
mild laxative effect, clears heat
Citrus aurantium and phlegm constipation and for lung congestion.
Blue citrus qingpi resolves phlegm Mainly used for lung disorders with phlegm
Citrus reticulata accumulation and for dispersing soft
swellings.
Citrus strengthens spleen, dries The most widely used qi-regulating herb; it is
moisture and phlegm also used in treatment of most phlegm
chenpi disorders, combined with pinellia.
Citrus noblis
Aurantium lowers up-rushing qi, relieves Used for nausea, vomiting, hiccough, and
jupi stagnation in the chest coughing.
Citrus reticulata
Fu-shou alleviates pain, controls Used for digestive distress with abdominal
vomiting pain and distention.
fushougan
Citrus medica
Carthamus honghua regulates menstruation, Combined with persica in treatments of blood stasis
alleviates pain of injuries causing pain.
Carthamus tinctorius
Cnidium chuanxiong dispels wind, regulates qi, It is the main herb used for headache pain; used in
controls pain, nourishes blood most formulas for qi and blood staganation and in
Ligusticum chuanxiong many formulas for nourishing blood.
Corydalis yanhusuo controls pain, regulates qi Mainly used for abdominal pain syndromes, including
menstrual pain.
Corydalis ambigua
Curcuma regulates qi, disperses Mainly used in cases of qi and blood stagnation with
accumulations accumulation, including treatment of phlegm masses
yujin and other lumps.
Curcuma aromatica
Millettia jixueteng nourishes blood, alleviates Modern applications are mainly for anemia and
Spatholobus suberectus numbness, relaxes tendons promoting microcirculation; traditionally used for
numbness of the legs in the elderly.
Myrrh moyao controls pain, disperses Used mainly for injuries (along with frankincense,
Commiphora sp. swellings, promotes tissue ruxiang) and for swellings, such as abscesses.
regeneration
Frankincense (or mastic) ruxiang controls pain, relaxes Mainly used in treatment of injuries, usually
muscles, reduces bleeding combined with myrrh (moyao), considered useful for
Boswellia carterii peripheral neuropathy.
Red peony chishao clears heat, cools blood Especially used for blood stasis syndrome with blood
Paeonia obovata heat.
Persica taoren moistens the intestines Often used for abdominal blood stasis accompanied
Prunus persica by constipation; combined with carthamus (honghua)
for blood stasis disorders.
Salvia danshen cools blood, nourishes blood, Primarily used for cardiovascular disorders and for
Salvia miltiorrhiza sedative liver fibrosis; also useful as a sedative.
Sparganium (or Scirpus) sanleng regulates qi, disperses mass Mainly used for hard masses (blood stasis type),
especially those in the abdomen; usually combined
Sparganium stoloniferum with Zedoaria (ezhu).
Vaccaria wangbuliuxing regulates menstruation, Primarily used for swelling in the lower abdomen,
Vaccaria pramidata disperses swelling particularly for women’s disorders.
Zedoaria ezhu regulates qi, disperses mass, Mainly used for hard masses, in combination with
Curcuma zedoaria benefits stomach functions Sparganium (sanleng); also for digestive disturbance
with distention.
In the book Essentials of Chinese Medicine (19), there is this explanation of raising of the clear:
This is a characteristic function of the spleen, and refers to both raising clear qi upward and stabilizing
the internal organs in their original locations [i.e., counteracting prolapse].
Controlling the raising up of the Clear: Here, the “clear” means the nutrients that are extracted from
drink and food, and raising the clear means propelling them upward and distributing them. After food
and drink have been digested by the stomach, the spleen extracts the nutrients and, though its function
of raising the clear, delivers them upward to the heart and lung, and thence to the entire body.
If this function of the spleen is normal, all the internal viscera and tissues will obtain enough nutrients
and function well. If it is abnormal, there may appear such symptoms as dizziness, blurred vision, and
fatigue. If clear yang fails to ascend, the clear and the turbid may remain intermixed and sink
downward. This may be manifested by such symptoms as spermatorrhea, vaginal discharge, abdominal
distention, and diarrhea.
The separation of clear and turbid is an important subdivision of the raising of the clear;
“intermixing” of clear and turbid, when their separation is incomplete, can lead to a variety of
abdominal problems and discharges from the lower body. In his essay, Heaven Above, Earth Below,
Cheng Lok-Kwan provides this elucidation (20):
The distinction between clear yang and turbid yin is very important in Chinese medicine. Turbid means
thick, or dense. Turbid does not mean dirty or bad. The head is heaven: it is the highest part of the body.
It is the most yang part of the body, hence, it should be filled with clear yang. If it is, the brain and
senses will function well. The person will be able to perceive the world and communicate clearly, and
respond appropriately. If it is not, then we think either a blockage prevented the clear yang from rising,
or that the body is unable to descend the turbid yin. Either way, the head is now filled with turbid yin.
The senses will be clouded, the head will feel heavy, and the person will not be able to think or speak
clearly.
Here, the concept of raising clear yang is associated with bringing nourishment (which is as aspect
of the qi) to the brain. For raising clear qi and yang, the primary principle is to strengthen the spleen,
particularly with herbs that contribute an upward movement, so that huangqi (astragalus) and renshen
(ginseng) are key items. However, to assure separation of clear and turbid, herbs that promote the
digestive functions of the stomach are utilized: they help to generate a clear qi and to aid the downward
movement to the “thick” digestive materials. Of greatest importance are shenqu (shen-chu), maiya
(malt), and jineijin (gallus) and the aromatic herbs sharen (cardamom), muxiang (saussurea), and
yizhiren (alpinia). To help make sure the channels of flow are clear and open, orifice opening herbs are
used, such as shichangpu (acorus) and yuanzhi (polygala). As an adjunct to these different types of
herbs, those that help filter excess dampness are utilized: they improve spleen function, aid the
separation of clear and turbid, and promote fluid movement to the kidney system. The primary
ingredients relied upon are baizhu (atractylodes) and fuling (hoelen). Some herbs were already
described in the tables above.
While the marrow of Chinese medicine has this overlapping connection to the marrow we
understand by modern medicine that produces these blood cell lines, the marrow of Chinese medicine
also extends to the brain. Therefore, nourishing the marrow along with raising the pure qi and yang, is
important in maintaining good cognitive function, memory, and mental focus, according to the Chinese
medicine system. Some of the herbs for benefiting marrow were already included in descriptions of
blood nourishing herbs.
Many western patients (though certainly not all) reject the decoction form due to the lengthy
cooking procedure, the smell of the herbs while being prepared, and the taste of the decoction when
consumed. The use of dried decoctions to make “instant” teas removes these first two barriers, but
usually imposes a significant cost, and few practitioners or patients realize that the conversion from
100-200 grams of dried herbs in decoctions corresponds to about 20-40 grams of dried decoctions
(made as 5:1 extracts).
By switching to culturally acceptable forms, such as pills, capsules, and tablets, the quantity of
herb materials that can reasonably be ingested is greatly reduced, while the cost may remain relatively
high. Some herbs are successfully used in their powdered form in somewhat modest quantity, and
some extracts that can be put into pill form are more concentrated than the dried decoctions used to
make tea. Therefore, with some careful design, herbal materials in these more acceptable forms may be
utilized, but with the understanding that a significant number of “units” must be consumed to have the
desired impact, that is, to have more than a placebo effect or greater than a barely perceptible outcome.
The effects of tonifying qi and strengthening the spleen, and of nourishing blood and yin are each
supported by several herbs of Pan’s basic formula, but in light of the six herb actions, it is weak in the
areas of circulating qi and blood, and only slightly directed at benefitting marrow.
Use of this particular formulation in the west turned out to be problematic for a number of reasons,
most of them described above in terms of the decoction form of the herbs. The instant tea (dried
decoctions) that were available for use appeared more attractive, and formula selection came from
Japan.
In Japan, the practice of Chinese herbal medicine called Kampo, has been based on selecting
formulas from a group of prescriptions that had been selected by experts in the early 1950s and then
relied upon continuously since then. The problem of countering side effects of chemotherapy was
raised in the 1980s, and the primary formula selected for that purpose was Shiquan Dabu Tang
(Ginseng and Tang-kuei Ten Combination). At that time, and until recently, the Kampo formulas were
provided to the west mainly through Taiwan rather than Japan, and this particular formula was well-
known. It tonifies qi and strengthens the spleen with the ingredients of Si Junzi Tang (Major Four
Herbs Combination) and nourishes and vitalizes blood with the ingredients of Si Wu Tang (Tang-kuei
Four Combination), and also aids the uplifting of clear qi with huangqi (astragalus). A number of its
ingredients are considered important for enhancing immune functions, including renshen, huangqi,
baizhu, and gancao. The formula is relatively weak in the areas of promoting circulation of qi
(danggui and chuanxiong have some effect), and it is also deficient in nourishing the marrow.
Chinese doctors also considered this formula for the same applications, but made various
modifications to better suit their understanding of the needs. As an example (21), the base formula was
modified by adding jixueteng (millettia), huangjing (polygonatum), gouqizi (lycium fruit), heshouwu
(ho-shou-wu), shanzhuyu (cornus), lianzi (lotus seed), and shanyao (dioscorea), which primarily
increased the tonification effects and more closely approximated Pan’s recommended formula; it was
stronger in benefiting marrow than Shiquan Dabu Tang alone.
An effort to get a decoction format was also made. The concept behind it was to suggest turning to
this form of administration for patients recently diagnosed and about to start or just starting
chemotherapy, before the most severe symptoms had set in. The patient would have a chance to get
used to making and drinking decoctions without the presence of nausea, and the result of using the
formula would hopefully reduce the severity of the reactions, permitting continued use of the decoction
for some time. The usual recommendation, provided in advance of offering the first batch of crude
herbs, was to plan on using the decoctions for about three weeks then follow-up with tablets if desired.
The crude herbs were provided in packets that were ready to cook as a tea, and labeled
Astragalus/Oldenlandia Mixture. The intent of the formula was illustrated in the name, with astragalus
already well-known for qi tonifying and immune enhancing effects and with baihuasheshecao
(oldenlandia) being one of China’s “anticancer” herbs. This herb is almost always used in combination
with banzhilian (scutellaria) for cancer patients, and its activity was increasingly attributed to immune-
related functions rather than any direct inhibition of cancer cell growth. Given the concerns about
development of chemotherapy induced nausea that could inhibit use of this form of the herbs,
digestion-promoting, stomach-calming ingredients were included: yizhiren (alpinia), sharen
(cardamom), and shenqu (shen-chu). To help assure the continued distribution of “clear qi,” jiegeng
(platycodon) was included to resolve phlegm and stagnation in the chest. The choice of yizhiren and
sharen was made to also aid the circulation of qi, as these spicy agents would disperse stagnation.
Further, based on the concept that qi and blood deficiency were early adverse effects of chemotherapy,
huangqi in this formula was paired with the blood nourishing agents shudi (rehmannia) and biejia
(turtle shell). Since qi and blood deficiency engendered impairment of blood circulation, jixueteng
(millettia) and danshen (salvia) were also used. The combination of shudi and biejia for nourishing
kidney yin with danshen and jiexueteng for microcirculation were expected to help protect bone
marrow. This formulation was thus an early representation of the six actions approach that this article
has described.
A new tablet formula was then composed, to be one of the potential alternatives to Astragalus 10+,
which made use of an herb gaining interest by Chinese physicians working with cancer patients:
jiaogulan (gynostemma). This herb was not one of the mainline TCM ingredients, but was known
from folk medicine. Researchers discovered that its active components were similar to, and in some
cases the same as, those of ginseng. Based on traditional uses, it also has some of the properties
attributed to jiegeng (platycodon). The following formula, called Gynostemma Tablets (Fu Zheng
Kang Ai Pian), was made for patients with concern about low bone marrow function (22):
jiaogulan Gynostemma
huangqi Astragalus
baizhu Atractylodes
baihuasheshecao Oldenlandia
gouqizi Lycium
heshouwu Ho-shou-wu
danggui Tang-kuei
buguzhi Psoralea
tusizi Cuscuta
The emphasis is on tonifying qi and raising clear qi (huangqi, jiaogulan, baizhu) and nourishing
blood and yin (danggui, heshouwu, gouqizi), but two herbs are included for benefiting marrow, buguzhi
(psoralea) and tusizi (cuscuta), and these two were selected because they were being used in China for
conditions of low production of blood cells, such as in cases of aplastic anemia as well as for
leukopenia secondary to cancer chemotherapy.
This formula returns to the focus on tonification therapy, but was intended to be combined with
another formula, such as one for regulating qi and vitalizing blood, and this is because it lacks the other
methods of therapy that have been identified as of importance for these cases.
Further investigation of Chinese prescriptions for bone marrow deficiencies led to design of a
second formula, called Millettia 9 (Ji Xue Teng Pian) that could be combined with one of the above
combinations (Astragalus 10+ or Gynostemma Tablets or the Astragalus/Oldenlandia Decoction)
providing an emphasis on blood vitalizing to restore microcirculation to the marrow (22):
jixueteng Millettia
danshen Salvia
sangshen Morus fruit
yejiaoteng Polygonum stem
huangqi Astragalus
chuanxiong Cnidium
shudi Rehmannia
xuduan Dipsacus
muxiang Saussurea
In these formulas, jixueteng (millettia) and danshen (salvia) are of particular interest because
Chinese doctors consider these to have both vitalizing and nourishing properties, which is also true of
chuanxiong (cnidium). Yejiaoteng (polygonum stem) is the stem of heshouwu, sharing in its blood
nourishing properties. Muxiang regulates qi circulation, but also helps raise clear qi. Xuduan with
shudi benefit both the yang and yin of the kidney to nourish marrow; xuduan (dipsacus) has the
secondary effect of vitalizing blood circulation. A combination of Gynostemma Tablets and Millettia 9
will contribute to all six methods of therapy, with perhaps a weakness in the area of raising clear qi,
though that is addressed with huangqi (astragalus) and baizhu (atractylodes); regulating qi circulation is
also somewhat limited, accomplished in part with chuanxiong (cnidium) and primarily with muxiang
(saussurea). Still, the Chinese concept that nourishing the blood of the liver allows it to better circulate
qi definitely applies here, and there is considerable focus of these formulas in nourishing blood. This
pair of formulas used together is one which practitioners at IEP have considered especially effective.
The difficulty encountered is delivering these six therapeutic methods with a relatively small
number of herbs, so additional formulation work is underway. Normally, two to three herbs are to be
employed for each therapeutic action, relying especially on herbs that provide more than one of those
actions. Each of these two formulas has 9 herbs, and there are 17 different herbs (though heshouwu
and yejiaoteng could be deemed a single herbal material, so 16); this is comparable to Pan’s base
formula of 15 herbs.
To consolidate multiple formulas into one concise prescription that incorporates all six herb
actions is accomplished by selecting only those herbs that are most critical to the desired effects. A
previous presentation of six actions herb prescribing came about by combining three TCM formulas for
helping patients with multiple sclerosis and other autoimmune disorders. After successful treatment, or
as a result of natural disease variations, when the patient is in a relatively stable condition, a formula
can be utilized to help maintain that condition. In 1998, the formula called Remission Pills (San Fang
Ding Ji Pian; San Fang refers to three formulas) was introduced by ITM for these cases. It involved
the combination of Xiao Chaihu Tang (Minor Bupleurum Combination) to tonify qi, raise clear qi, and
regulate qi circulation, Tao Hong Siwu Tang (Tang-kuei Four Combination with taoren and honghua) to
nourish blood and vitalize blood, and Liuwei Dihuang Wan (Rehmannia Six Formula) to benefit
kidney. Because of the different application, the sixth action did not focus as much on the marrow
aspect of the kidney as would formulas for cancer patients. The formula has 18 ingredients.
An investigation of herb prescribing at the IEP Clinic shows that certain formulations aside from
the usual ones for counteracting adverse chemotherapy effects are used with some frequency. Some are
given only once or intermittently for particular situations that arise, such as using a prescription for
common cold or influenza or a combination suited for an acute injury. The most commonly used
prescription for general use, often given for an extended time, is a tablet called Bupleurum 12 (Tiao He
Pian; the name refers to its harmonizing intent). This is a “constitutional” formula that addresses
general imbalances rather than a specific symptom or disease. Bupleurum 12 is especially useful for
regulating qi and raising qi and yang, the two areas where a combination such as Gynostemma Tablets
and Millettia 9 are somewhat weak. Although I do not advise combining three formulas at once to get
the desired actions (but prefer to design alternative formulas that provide the desired therapeutic actions
with fewer herbs), it is worthwhile to see how the herbs in these three frequently used formulas at IEP
Clinic serve to address the six herb actions:
Action Herbs with Primary Use in the Category Herbs with Secondary Use
Tonify qi huangqi, renshen, jiaogulan, gancao baizhu
Regulate qi chaihu, zhishi, muxiang danggui, chuanxiong
Raise clear qi fuling, banxia, ganjiang huangqi, baizhu, renshen, chaihu
Nourish blood danggui, baishao, shudi, heshouwu, gouqizi, jixueteng, danshen, chuanxiong
sangshen, yejiaoteng
Vitalize blood jixueteng, danshen, chuanxiong, xuduan, baishao, danggui
Benefit marrow buguzhi, tusizi, xuduan shudi, goujizi
In working toward developing more concise formulations, a starting point is the key herbs that
generate the desired actions. Some of the herbs described in this article are clearly central to the
treatment strategy for aiding cancer patients suffering from side effects of their medical therapies,
including huangqi (astragalus), jixueteng (millettia), shudi (rehmannia), baizhu (atractylodes), and
danggui (tang-kuei). The other formula ingredients are best chosen to extend the properties of those
herbs, and in this case, attention to marrow benefiting herbs is distinctly needed. Of the six herb
actions, the regulation of qi has been the weakest aspect of this area of formula development and it is
my hope that this deficiency will be recognized by the explanations provided here and rectified in the
future. While some specific herbal combinations that are used at the IEP Clinic have been described
here, the same approach can be utilized with other formulations, so these serve only as examples for
explanation. Most importantly, the six herb action prescribing method provides a foundation for
designing an effective treatment.
References
1. Dharmananda S, Adjunct Cancer Therapy at the Immune Enhancement Project (IEP) Clinic.
2013 Institute for Traditional Medicine, Portland, OR.
2. Dharmananda S, Acupuncture and Herbs for Mind/Brain Disorders (part I: Acupuncture). 2000
Institute for Traditional Medicine, Portland, OR.
3. Dharmananda S, Towards a Spirit at Peace. 2005 Institute for Traditional Medicine, Portland,
OR.
4. Dharmananda S, Acupuncture for Shen Disorders Update, 2006 Institute for Traditional
Medicine, Portland, OR.
5. Zhang L, Generalized Anxiety Disorder and Acupuncture Treatment. Acupuncture.com 2010: 8
(7).
6. Zhu B, Wang HC, Case Studies from the Medical Records of Leading Chinese Acupuncture
Experts, 2010 Singing Dragon, Philadelphia, PA.
7. Cheng XN (chief editor), Chinese Acupuncture and Moxibustion. 1987 (revised 1999; third
edition 2010) Foreign Languages Press, Beijing.
8. Xu XG (chief editor), Therapeutics of Acupuncture and Moxibustion (vol 6. of The English-
Chinese Encyclopedia of Practical Traditional Chinese Medicine). 1989 Higher Education
Press, Beijing.
9. Dharmananda S and Vickers E, Synopsis of Scalp Acupuncture. 2000 Institute for Traditional
Medicine, Portland, OR.
10. Dharmananda S, Chinese Herbal Treatment for Multiple Sclerosis and Other Flaccidity
Syndromes, Including Myasthenia Gravis and Amyotrophic Lateral Sclerosis. 1996 Institute for
Traditional Medicine, Portland, OR.
11. Dharmananda S, Treatment of ALS with Chinese Medicine. 2003 Institute for Traditional
Medicine, Portland, OR.
12. Cheung CS, Kaw UA, Treatment of Toxic Effects Resulting from Radiation and
Chemotherapy by Traditional Chinese Medicine. 1980 Traditional Chinese Medicine
Publisher, San Francisco, CA.
13. Pan Mingji (compiler). Cancer Treatment with Fu Zheng Pei Ben Principle.
1987/1988 Fujian Science and Technology Publishing House, Fuzhou
14. State Administration of TCM and Pharmacy, Advanced Textbook of Traditional
Chinese Medicine and Pharmacology (v. 1). 1991 New World Press. Beijing.
15. Dharmananda S, Enumerating the Methods of Therapy. 1997 Institute for Traditional
Medicine, Portland, OR.
16. Dharmananda S, Counteracting the Side Effects of Modern Medical Therapies with
Chinese Herbs. 1998 Institute for Traditional Medicine, Portland, OR.
17. Kun J. Prevention and Treatment of Carcinoma with Traditional Chinese Medicine.
1983/1985 Commercial Press, Hong Kong.
18. Pan Mingji (compiler). How to Discover Cancer through Self Examination. 1990
Fujian Science and Technology Publishing House, Fuzhou.
19. Liu L and Liu ZW, Essentials of Chinese Medicine (v 2). 2010 Springe-Verlag, London
20. Cheng LK, Heaven Above, Earth Below. 2011 http://lok-kwan.com/2011/08/21/heaven-
above-earth-below/
21. Wang YR, Influence of Shiquan Dabu Tang (Ginseng and Tang-kuei Ten Combination)
on immune functions after radio- and chemotherapies in tumor patients. Hubei Journal of
Traditional Chinese Medicine 1997; 19(5): 21–22.
22. Dharmananda S. A Bag of Pearls. 2004 Institute for Traditional Medicine, Portland, OR
23. Dharmananda S, Millettia (jixeuteng). 1999 Institute for Traditional Medicine, Portland,
OR.
February 2014
In the Advanced Textbook of Traditional Chinese Medicine and Pharmacology (1) the harmful
impacts of strong emotions on health, as manifest via the internal organ functions, are summarized:
Although emotional factors may impair all five zang organs, they mostly affect the heart, liver, and
spleen. Because the heart controls the mind, heart malfunction may cause palpitations, insomnia,
dream-disturbed sleep, mental restlessness, laughing and weeping without apparent cause, mania,
hysteria, etc. Liver trouble often leads to depression, irascibility, hypochondria pain, sighing, a feeling
of obstruction in the throat, menstrual irregularities, and pain due to distention or a lump in the breast;
these occur because the liver is responsible for the free flow of qi. The spleen controls the
transportation and transformation of nutrients. So, spleen dysfunction gives rise to a poor appetite,
distending pain in the stomach, and diarrhea. Emotional activities may both disturb the function of a
single organ and that of several organs simultaneously. Pensiveness, for instance, injures both the heart
and spleen and leads to the expenditure of heart blood and the impeded transport of nutrients. When
anger injures the liver, the spleen is often involved as well, resulting in the disharmony of both.
The emotional influences on the organ functions are compounded by physical damage to the body;
in the early stages of cancer, the disease itself has not caused much direct physical harm. Yet, the
process of arriving at the diagnosis may have already involved various kinds of invasive tests (e.g.,
biopsy), and if there is a particular tumor site (as opposed to a disseminated disease), initial treatment
will often include surgical removal of a mass. Modern surgical techniques are designed to minimize
damage, but there is always some level of circulatory disruption at the surgical site; sometimes portions
of the body are removed along with the tumor (e.g., mastectomy, colectomy, oophorectomy).
Therefore, accompanying the physical injury, the procedure might leave the patient with the feeling of
never again fully possessing what was there before, as it is either damaged or missing; the traumatic
emotional consequences may be somewhat lessened by knowledge that these surgeries save function
and life or, at the least, that they provide hope for such a result. Still the thoughts associated with loss
of wholeness are not easily overcome and may lead to melancholy and sleep disturbance.
Chemotherapy is the component of cancer treatment that most frequently leads people to seek help
from Chinese medicine; unlike the local damage caused by surgery, chemotherapy has broad influences
on body functions and overall sense of well-being. There has been good reason to pursue this kind of
natural health care assistance. During China’s immediate post-revolutionary period, it was realized that
the attempt to use TCM alone as a treatment for cancer was not yielding significant long-term results.
Therefore, considerable laboratory and clinical research was undertaken with the aim of utilizing the
medical tradition for a different objective: to help people better cope with the adverse effects of
chemotherapy and to improve overall outcomes (e.g., increasing the degree of tumor response, survival
rate, and total longevity). This work, dominated by herbal medicine, generated promising results by
the early 1960s, and the information about this methodology was eventually brought to the Western
world, which was just beginning to adopt Chinese medicine by the mid-1970s. The primary uses of
Chinese medicine in the West were initially directed to other applications, such as treatment of pain
(e.g., arthritis, sciatica, injuries), but by the mid-1990s acupuncture and Chinese herbs became known
as resources for cancer patients. In an evaluation of dozens of surveys conducted with cancer patients
to determine how many were turning to “alternative and complementary medicine” and from which
methods they sought help (2), 81 such surveys from several countries were considered to have useful
data related to Chinese medicine. All but three of the surveys were published during 2000-2010 (the
last year checked); the other 3 were published in the earlier interval 1995-1999. Chinese medicine was
a common means of therapy that the patients utilized, for which acupuncture was by far the most
commonly-tried technique.
The chemicals utilized for cancer treatment are feared for their toxicity and the resulting damaging
effects, which often include fatigue, reduced production of blood cells, irritation of the gastro-intestinal
tract, and loss of hair. The plan to begin chemotherapy heightens the already existing anxiety and fear
arising from the initial diagnosis and any surgical treatment, and the chemicals impair the organs that
have been distressed by emotions. Additionally, the impact of the cancer-inhibiting treatments on bone
marrow (blood-cell-producing stem cells), which is considered an extension of the kidney system as
described by traditional Chinese anatomy and physiology, begins undermining the foundations of the
body, namely, the essence stored in the kidney.
While cancer that is detected early (stages 1 or 2) may require but one course of chemotherapy
lasting a few months, that same undertaking is only the first of many such protocols when the condition
being treated is diagnosed at an advanced stage (stages 3 or 4). In such cases, there will typically be a
series of weekly treatments using one or two powerful drugs followed by a change to another series if
the first was too difficult to tolerate or if it failed to have the desired effect (either immediately or after
a period of temporary success); this process of shifting drugs, each with its unique side effect profile,
might continue for years. As a complicating factor, patients who have treatment-resistant tumors are
increasingly enrolled in trials of new drugs or new combination therapies which provide hope for a
good outcome that was elusive before but also adds the additional worry of being given a placebo
treatment at a critical time. Thus, for those with metastatic cancer or suspected metastasis, there is the
distress of entering a very uncertain future, with the roller coaster of newly offered hope and dashed
hopes. The flow of qi becomes erratic and there is difficulty finding rest day or night; a struggle ensues
in the usually simple task of taking in adequate food and then being able to distribute its nutrients.
In addition to impairing the functions of the internal organs, chemotherapy may cause lasting
damage to peripheral nerves (neuropathy) and brain cells (cognitive impairment); when treating older
patients, there is also potential permanent inhibition of the bone marrow, where the temporary drug-
induced suppression transforms into a progressive collapse.
Radiation is used for some patients to eliminate the last remaining cancer cells at the original cancer
site from which the bulk of the tumor was surgically removed; other times radiation serves as an
alternative to surgery; and this method is often selected for reducing metastatic growths when they are
producing severe symptoms, such as spinal metastases that cause pain. Though the techniques of
radiation have improved dramatically in recent years, reducing damage to surrounding tissue with more
accurate visualization of the tumor location and with far greater focus of the tumor-killing rays, there
are still adverse effects of burning some tissues in the radiation pathway and impairing marrow stem
cells and body energy. Both chemotherapy and radiation typically lead to lowered blood status and
depletion of qi after any prolonged treatment.
Many patients come to the IEP Clinic very soon after receiving their cancer diagnosis (most often,
after surgery, and either just before or just after beginning chemotherapy), though others don’t learn
about what is offered at the clinic until a later phase in their process of responding to the diagnosis.
Indeed, a number of people arrive when last ditch therapies are being pursued, and the patients might
not have become aware that they were reaching the end of their journey with a disease resistant to
known treatments. In advanced cases, the qi is weakened and the functions of the five zang organs are
compromised.
Patients present to the IEP practitioners physical and emotional conditions affected by the stage of
cancer at time of diagnosis and phase of medical intervention they are in, while being confronted with
personal circumstances that affect how they will proceed with treatment. In keeping with the basic
principles of traditional Chinese medicine, each patient is treated according to their unique needs,
which differ not only between patients but also, for any given person, from one visit to another. Yet,
there are aspects of the IEP clinical work that are relatively uniform; the common methods are outlined
briefly here because they may help inform and guide other practitioners less familiar with treating
cancer patients. Based on the description given above, a basic treatment needs to be supportive,
strengthening, and stabilizing for body and mind; such treatment may be categorized as tonifying.
There is also need to release stagnation related to emotional impact on qi circulation, to help resolve the
accumulations associated with cancer growth (qi entanglement, phlegm-dampness, and blood stasis),
and to alleviate the obstructing effects of cancer therapies on qi and blood circulation.
The third mode is Chinese herbs plus nutritional supplements and diet counseling; these sometimes
diverse considerations—involving both Chinese and Western approaches to the analysis and selection
of ingredients—are bound together as one modality for purposes of this discussion based on the
Chinese concept of the close relationship between administering herbs, especially the mild herbs we are
able to use in modern practice, and dietetic treatments. A group of practitioners who have training in
both Chinese medicine and naturopathic medicine are available during one portion of the clinic
schedule to assist IEP patients in the area of diet and nutrition (as well as related concepts of
naturopathic therapies), while Chinese herbs are recommended throughout the program.
These three modes of therapy, covering many aspects of adjunctive care, are not comprehensive.
One could add, for example, qigong exercises and other natural health care approaches from the
Chinese tradition as well as incorporate health care practices from other cultures (e.g., yoga). The three
modes that are provided at IEP fit within the limited availability of physical space, the constraints of
practitioner and patient time for participation, and the primary range of expertise at the Institute for
Traditional Medicine.
The plan described to patients interested in utilizing IEP services is that they will come to the clinic
for acupuncture twice per week during the first several weeks of treatment and at those times when
chemotherapy or radiation is in progress; the frequency may decline to once per week after sessions of
the medical therapy are completed, that is, during periods when there is less physical and emotional
distress. Shiatsu services are made available to an extent that allows for treatment every other week,
which is almost always provided immediately before or immediately after acupuncture. Typical of
supportive shiatsu therapy is pressing along the stomach and spleen meridians, especially the portions
at the legs, and along the triple heater (sanjiao) and heart protector (pericardium) meridians that
traverse the arms. Acupuncture and shiatsu sessions are just a half hour each; in other settings, the
practitioners might spend 45 minutes for an acupuncture visit and an hour for a shiatsu visit, but the
shorter treatment duration fits with the concept of offering more frequent and lower cost treatment.
Herbal and nutritional supplements are often provided in accordance with a basic model of
“supporting normality,” that is, following the “fuzheng” concept developed in China for this purpose,
which would typically incorporate huangqi (astragalus) and baizhu (atractylodes) as spleen qi tonics
and danggui (tang-kuei) and gouqizi (lycium fruit) as liver blood nourishing agents. If the qi and blood
are full, the Chinese doctrine says, then pathological influences will not be able to disrupt normal
functions. One of the common concerns is the bone marrow inhibiting effect of chemotherapy and
radiation, for which various forms of Shengxue Tang (Decoction for Generating Blood) are utilized.
The formulations used in China vary considerably, but two common ingredients are jixueteng (millettia;
spatholobus) and huangqi (astragalus); most other components of such formulas are additional blood-
vitalizing agents and tonics (for qi, blood, and essence). I reviewed several such blood generating
formulas in my 1998 article Countering the Side Effects of Modern Medical Therapies (4) and in my
1999 article Millettia (jixueteng) (5). The clinicians at IEP have reported that this treatment approach
seems to be one of the most effective of the commonly prescribed herbal therapies. The primary
formula used at IEP when patients convey concerns over blood tests showing marked inhibition of
marrow is a tablet comprised of jixueteng, danshen, sangshen, yejiaoteng, huangqi, chuanxiong, shudi,
xuduan, and muxiang.
Standard nutritional supplements recommended to patients include a broad mixture of minerals and
vitamins and a mixture of antioxidants intended to replace the multiplicity of products that are
recommended in the literature. These provide a substantial quantity of the substances that are
purported to be of low quantity in the blood stream (due to reduced food consumption and/or poor
absorption) and in particularly high need in light of the effects of the anti-cancer medical therapies.
A naturopathic consultation is offered close to the beginning of the acupuncture series and may be
followed up from time to time, with average duration between consultations of about three to four
months. At each visit, the patient’s current symptoms, lab test results, drugs, Chinese herbs, nutritional
supplements, and daily activities are reviewed. There may be suggestions made for some additional
laboratory testing, for undertaking certain diet and exercise strategies, and for supplements not
routinely included in the IEP model. Among common recommendations associated with these
consultations are eating multiple small meals to manage the problem of reduced appetite, utilizing
various protein sources (whether isolates or high-protein foods), taking supplemental fish oil and
vitamin D3, using probiotics, taking melatonin for sleep (also used for symptom relief at higher than
usual dosage, such as 20 mg/day), and getting basic exercise (even if limited to 20 to 30 minute walks,
though more is encouraged when possible). Such direct suggestions are supplemented by referral to
specialists who might assist with other methods of addressing unique symptoms or by providing
additional treatment programs.
To encourage the greatest level of participation in the IEP program components, the cost of
treatment is set by a monthly fee that is established on a sliding scale basis, often allowing free
treatment, and currently not exceeding $150/month. The cost to the patient is not influenced by
frequency of acupuncture, shiatsu, or naturopathic consultation, or by the selection or quantity of
prescribed supplements within our basic list. There will be an extra cost for any of the naturopathic
recommendations that are outside the standard supplement regimens and patients will have to incur the
costs or submit to their insurance the expenses associated with any additional laboratory testing that
they pursue in response to suggestions at IEP.
Foundational Acupuncture
During most visits to the clinic by cancer patients, a model point formulation is utilized, which is
modified as appropriate. The acupuncturists at IEP refer to the most commonly selected acupuncture
point set with terms such as “cancer support,” “chemo support,” or “immune support,” and the
variations in designation are not intended to indicate different concepts. The primary strategy begins
with an adaptation of an approach that was utilized by Wang Leting, a TCM practitioner whose work
spanned the pre-revolutionary and post-revolutionary period in China; he practiced for 50 years from
1929-1979. An English translation from the 1984 Chinese book that describes his work is Golden
Needle Wang Leting, which was published in 1997 (6).
Much of Wang’s therapeutic efforts revolved around one particular acupuncture point on the stomach
meridian: zusanli (ST-36). He is reported to have said: “For hundreds of diseases, don’t forget
zusanli,” and “in treating the root, first treat the stomach” and “if a person is diseased and one does not
treat the stomach, on what can they rely for life?” In 1998, I produced an extensive review of zusanli
and its uses to encourage better understanding of the factors that lead to its selection as a key part of the
treatment (7).
Two of Wang’s point formulations serve as inspiration for the foundational acupuncture at IEP. Of
particular interest as an adjunct therapy for cancer patients, there was one which Wang Leting described
as having an effect like that of the herbal formula Shiquan Dabu Tang (Ginseng and Tang-kuei Ten
Combination). This well-known tonic prescription combines the spleen/stomach formula Sijunzi Tang
(Major Four Herbs Combination) with the liver blood formula Siwu Tang (Tang-kuei Four
Combination) plus huangqi (astraglus) and rougui (cinnamon bark). It has been the traditional formula
most frequently recommended for support of cancer patients in recent decades, especially utilized for
this purpose by Japanese and Taiwanese doctors who select from a set of about two hundred traditional
formulations that are covered by national health insurance. In composing the acupuncture point
formula, Wang contemplated the actions of the herbs and compared those with the functions of
acupuncture points; thus, for example, he drew a parallel between needling of hegu (LI-4) and the role
of astragalus because, among other similarities, they both address insufficiency of defensive qi.
Wang also frequently used a formulation which he called Old Ten Needles, the term “old”
referring to a traditional style of acupuncture point selection. He worked with certain key points for
years and then finalized this particular group around 1966. Wang’s primary application for Old Ten
Needles was gastrointestinal weakness and distress, a common concern for the patients at IEP.
The first three points of this small formula are treated bilaterally, making 6 of the 10 points, and the
next four are along the front centerline, so each has one needle, making four more.
By the time this information was relayed in the English language text, many acupuncturists in the
U.S. were already familiar with a slightly different set of ten needles that was relayed by Miriam Lee in
her 1992 book (8).
All five of these points are treated bilaterally. Like Wang, Lee considered zusanli as a key point and
devoted a chapter of her book to using that point alone. Lee had utilized this set of ten needles for a
wide variety of disorders, but especially for disorders causing weakness, fatigue, and depression. Other
variants of this approach, in which a small group of needles comprise a foundational treatment, have
been reported. One of the IEP practitioners had developed his own variant of Lee’s ten needles by
replacing quchi (LI-11) with shousanli (LI-10) and replacing lieque (LU-7) with shenmen (HT-7).
Through adding and subtracting from these insightful formulations, we have the group of points used at
the IEP Clinic for adjunctive cancer therapy, which I now refer to as “New Twenty Needles” (NTN).
These points are still “old” in the sense of common traditional points and combinations, but they are
here used for a new application—in support of patient’s undergoing medical treatments for cancer—
which postdates Wang and Lee’s primary work. Not all these points would be used at one treatment
session, but a total of ten to twenty body points (this count including the bilateral needling, but not
including any added ear needles) would form the basis of one session.
The points that differ from those listed by Wang and Lee are baihui (GV-20) and yintang (Ex-HN-3),
which are especially used in stabilizing the emotional distress common to our patients, and taixi (KI-3),
for tonification therapy to resist the impairing effect of chemotherapy and radiation on the kidney yin
and yang. To better display how these are used, the NTN points can be described in terms of being
“primary” or “secondary”, not to distinguish their relative values, but to draw attention to the fact that
the primary points are being used two to three times as often as the secondary ones.
Due to the relatively short duration of an acupuncture session, 30 minutes, patients are usually treated
on one side of the body, laying face up, without needling of back points (GB-20 is the main exception,
but can be treated because of the curvature of the neck). The usual set of foundational points also
minimizes the need to remove clothing so long as the patient wears loose clothing that allows exposure
below the knee and from the elbow down. For points that are ordinarily needled bilaterally, a patient
might instead receive left-sided and right-sided points that differ; this method would most often occur
if there were unique symptoms on one side; for example, one arm might have swelling from
lymphedema while the other arm remains unaffected.
In my article on zusanli, I relayed an immune enhancing protocol that was being evaluated in patients
whose primary complaint was pain, based on the pair of zusanli and hegu (LI-4); other pairings I
relayed from the Chinese medical literature were zusanli and neiguan (PC-6), reported to be useful for
side effects of chemotherapy and radiation such as poor appetite, nausea, vomiting, diarrhea, dizziness,
insomnia, and fatigue), and zusanli with sanyinjiao (SP-6) that had been provided to patients
undergoing radiation therapy to prevent impairment of white blood cell counts. I pointed out that this
set of four points (zusanli, hegu, neiguan, sanyinjiao) were the main ones employed in a study of
treating pain due to stomach cancer and the side effects of stomach cancer treatment by chemotherapy.
In a more recent study describing treatment of liver cancer patients having postoperative gastroparesis
(9), a set of four primary acupuncture points were: zhongwan (CV-12), zusanli (ST-36), neiguan (PC-
6), and sanyinjiao (SP-6), which is the same set, except hegu is replaced by zhongwan. As can be
seen, this fundamental pattern of treatment applies to chemotherapy and to surgery as well as to
different cancer types.
The general stabilizing effect of the point sets used at IEP is illustrated by similar acupuncture formulas
for treating tremor. In the book Case Studies from the Medical Records of Leading Chinese
Acupuncture Experts (10), a suggested treatment was: zusanli (ST-36), sanyinjiao (SP-6), hegu (LI-
4), taixi (KI-3), taichong (LV-3), shousanli (LI-10), shenmen (HT-7), and fengchi (GB-20), with
xuanzhong (GB-39) and yanglingquan (GB-34) included for specific treatment of tremor. Wang
Leting had compared the acupuncture point yuanglingquan with rougui (cinnamon bark) in Shiquan
Dabu Tang because they both treat upwardly counterflowing qi and both eliminate wind, cold, and
damp.
The foundational acupuncture set also follows a description I provided in a booklet on treating
disturbed spirit (11), which indicated the tendency of Chinese doctors to utilize “five zones” of
acupuncture for spirit disorders, typically treating one to four points in each zone: in the area of the
head (e.g., GV-20, GV-24, yintang); at the forearm-hand area bilaterally (e.g., LI-10, PC-6, LI-4, HT-7),
and on the lower limbs bilaterally beneath the knee (e.g., ST-36, SP-6, KI-3, LV-3). The five zones are
treated together to yield a therapy for anxiety, depression, insomnia, easy crying, and other
characteristic symptoms of shen disorders. The points zusanli (ST-36), tianshu (ST-25), sanyinjiao
(SP-6), taichong (LV-3), quchi (LI-11), neiguan (PC-6), and baihui (GV-20) of NTN are examples of
those commonly used in modern Chinese treatments for persistent anxiety and distress. Renzhong (GV-
26; also called shuigou) is often chosen in China for these psychological conditions—in addition to, or
rather than, shenting (GV-24) or yintang—though this point is not as acceptable for use in the West.
Examples of Chinese medical literature reports on this five zone pattern of treatment include a study of
patients with mental depression (12) that relied on needling the main points baihui (GV-20), shenting
(GV-24), yintang (Ex-HN-3), renzhong (GV-26), anmian (extra point near GB-20), danzhong (CV-17),
neiguan (PC-6), daling (PC-7), shenmen (HT-7), and taichong (LV-3) and treatment of “depressive
neurosis” with herbs and acupuncture (13) using taiyang (Ex-HN-5), shenting (GV-24), qucha (BL-4),
baihui (GV-20), neiguan (PC-6), shenmen (HT-7), sanyinjiao (SP-6), and taichong (LV-3).
For the purpose of calming the disturbed spirit, some practitioners at IEP also add ear points, most
often turning to variants of the “5NP,” referring to Nogier’s Points (NP) that have since been adopted
into the Chinese system. These particular points were initially recommended by Dr. Michael Smith for
the National Acupuncture Detoxification Association (NADA) protocol, namely 5NP = sympathetic,
shenmen, lung, liver and kidney. A simplified version is more commonly applied at IEP, called “3NP”
= shenmen, liver, and kidney. Sometimes, ear point selection varies from these standardized protocols,
simplifying to shenmen alone or by substituting a point in the basic set (e.g., heart replacing lung) or
adding one or two other points to 3NP.
In a recent study of using acupuncture for patients with lung cancer (14), points selected for treatment
were: hegu (LI-4), taichong (LV-3), zusanli (ST-36), sanyinjiao (SP-6), lieque (LU-7), and 3NP. This
pattern is consistent with that used at IEP. As another example, a protocol for cancer patients
monitored for effects on depression and sleep disturbance (15) utilized the points fenglong (ST-40),
yinlingquan (SP-9), xuehai (SP-10), sanyinjiao (SP-6), neiguan (PC-6), yintang (Ex-HN-3), baihui
(GV-20), sishencong (Ex-HN-1; these are four points surrounding GV-20), and ear point shenmen.
Except for the shift of zusanli to fenglong and addition of xuehai, this pattern fits reasonably well with
what is being done at IEP. Sishencong can serve an alternative to using shenting (GV-24) in treating
distress symptoms, and is also sometimes the choice for this purpose at IEP.
The New Twenty Needles and commonly used added points serve multiple functions but especially
help with the emotional distress associated with cancer diagnosis and treatment, supporting immune
functions, alleviating pain, and normalizing the gastrointestinal system. Standard herbal formulas
prescribed to the patients will further support one or more functions of the acupuncture treatment.
However, a sense of success is sometimes more evident in those situations where the patient has
advanced cancer and is not expected to be cured of the disease; the patient may not be able to work or
can only do so to a limited extent: these are difficult situations where a person suffers greatly in a state
of little hope in the absence of such a program of adjunct therapy. For these situations, being able to
tolerate the ongoing chemotherapy attempts is a great achievement and maintaining reasonable pain
control is welcomed; the ability to function, make difficult medical decisions, and be present to family
members accomplishes much in transforming a terrible situation into one which can have many bright
moments.
Below, ten examples of patients with advanced cancer treated at IEP are described. They came to
the program at ages 48-75, which is a typical range for patients at IEP. Most of these patients came to
the clinic with stage 3 or stage 4 cancer (one had indeterminate staging with signs of metastatic
disease); in all but two of the cases conveyed here the patient died, usually shortly after their last visit
to IEP, indicating that they retained activity and mobility until their last few days. Practitioners at the
clinic selected these cases as examples of extraordinary results because of the very favorable feedback
from the patients and their families (sometimes also their doctors) as well as their impression that
individual treatments yielded especially good responses. The patients are not presented here in any
particular order; there were seven women and three men in the collection of cases, and this represents
the roughly 2:1 ratio of female to male cancer patients treated at the clinic. IEP chart notes present any
noteworthy comments made by the patient at each visit as well as the basic details of the treatment
administered (e.g., acupuncture points). The records can be used to determine compliance with
recommended frequency for acupuncture and shiatsu, the dates when chemotherapy or other medical
treatment is initiated or terminated, what symptoms are of primary concern, any reported significant
changes in symptoms, the total duration of participation at the clinic, and, in most instances, the cause
for completion of the treatment program.
1. Patient TV, a 75-year-old man with terminal cancer. He had gone to the hospital in very serious
condition and was diagnosed with stage 4 lung adenocarcinoma (patient was non-smoker) and came to
our clinic about seven months later. Chemotherapy caused notable tiredness, weakness, and fatigue.
However, his primary complaint was severe chest pain, particularly at the primary tumor site; he also
suffered some abdominal pain, and from time to time, felt pain all over his body. He continued to
receive chemotherapy during the first several months of his IEP clinic visits.
He responded very well to acupuncture, with notable pain reduction. Pain would return, but
acupuncture would help control it each time and his appetite improved as well. He received 38
acupuncture treatments, often with electro-acupuncture incorporated for pain control, and 18 shiatsu
treatments over the period of six months before he was no longer able to attend the clinic; he lost
ability to walk and sit-up and then went into a coma and died one month after his last visit to IEP.
It was found that electro-acupuncture (EA) was especially effective for his pain. An example of EA
was hegu (LI-4) to taichong (LV-3) on the left, lingxu (KI-24) to qimen (LV-14) on the right, but the
specific point selection for EA varied. Aside from the usual points selected for cancer support, points
for chest pain such as lingxu (KI-24) and wuyi (ST-15) were commonly used.
The success in this case was the marked pain relief that allowed him a quality of life he would not
otherwise have had during his final months. Pain in late stage 4 cancer is often intractable; patients do
not like taking high doses of morphine or other powerful pain drugs (this patient had been using
oxycodone), as they feel they cannot mentally function at an adequate level. In this case, the
impairment of breathing that occurs with any high dose of such pain drugs would compromise
breathing capabilities that had already been reduced by the lung tumor and would therefore risk
bringing on coma and early death. Despite coming to our clinic with a far advanced cancer condition,
he remained stable during the months of his visits. He most likely succumbed to a circulatory shut
down because of the widespread cancer, lack of physical activity, and reduced nutritional status
associated with low appetite.
2. Patient VI, a 57-year-old woman with terminal liver cancer affecting the bile duct (stage 4), came to
the clinic just after diagnosis; he had undergone exploratory surgery and not had yet started
chemotherapy. She received treatments at our clinic for 15 months, and then planned on moving into
hospice, but died promptly before she could make that transition. Except for the first three months at
IEP, she did not get frequent acupuncture as usual for our protocol; in total she received 88 acupuncture
treatments and 29 shiatsu treatments.
She did well with her chemo treatments, with a relatively low level of side-effects; nonetheless, her hair
fell out, she had fatigue and hot flashes and she did miss one scheduled chemo due to low blood
counts. Practitioner notes after six months of chemo indicated: “generally tolerating chemo well,” and
her tumor responded to the treatment, shrinking by 40%, but radiation was added in an effort to get the
tumor under greater control. After nearly a year of chemo, and then with added radiation, the
practitioner report indicated that she was “feeling well.” A change in the chemo regimen at that point
had obvious deleterious effects, with her reporting notable depletion of energy and developing
neuropathy. The most serious development, however, was shoulder pain attributed to a tumor pressing
upon a nerve. The pain worsened, extending from shoulder to chest, and she was put on morphine.
This last phase of her life included a period between when she was reported as “feeling well” to a
couple of months later when she was reported as “doing o.k. and “pretty good;” but, she ceased coming
to the clinic at that point and died two months later.
This patient was diagnosed at a time when the cancer was advanced and beyond effective treatment.
Nonetheless, combining Chinese medicine, chemotherapy, and radiation, she did well with her
treatments for over a year, and then suffered a rapid decline due to the fact that the tumor remained and
was causing obstruction (pain due to nerve impingement; death likely due to blockage of the liver).
Her acupuncture treatment was mainly categorized as “immune support” utilizing the NTN needle set
and 3NP as described above.
3. Patient JM, a 48-year-old woman, arrived at our clinic with stage 4 colon cancer. She had already
had three surgeries, and several courses of chemotherapy during the year and a half between diagnosis
and coming to our clinic for the first time. Surgery included removal of parts of her colon, ovaries, and
parts of her liver (this last, just three weeks prior to attending our clinic), and she was pursuing
chemotherapy while participating in the IEP Clinic. She had 64 acupuncture treatments, and 16 shiatsu
treatments over a period of 10 months. During most of the time at our clinic the practitioners relayed
that she was feeling well, and on days when chemo side effects were more prominent (with heartburn,
reduced appetite, and nausea), she felt better after getting acupuncture, which was described as “very
helpful” for acid reflux and for nausea. A practitioner noted “acupuncture seems to eliminate post-
chemo GERD.” She did experience hair loss and fatigue as part of the chemo side effects over time.
After completing her course of chemotherapy, she continued to come to the clinic for about 10 weeks;
her hair began growing back (the hair loss had disturbed her), and she was gaining strength, but with
some fatigue. After completing our program, she came in to report that she was “doing really well.”
She continued taking herbal and nutritional formulations that had been previously prescribed. Her
tolerance of the chemotherapy-induced symptoms and her quick recovery from its effects (especially
given the immediately prior history of surgery and chemotherapy) were remarkable. During much of
her time at the clinic she received acupuncture with the basic chemo support concepts. She remains
alive today.
4. Patient CR, a 65-year-old woman, had a diagnosis of ovarian cancer the year before coming to the
IEP Clinic. She had undergone surgery and was treated with chemotherapy for nearly 11 months; her
cancer was at stage 4. She attended the clinic over a period of more than 8 years. After a total of nine
years of chemotherapy, her cancer was deemed untreatable, and she was taken off the last regimen; she
continued to come to the clinic for a few more treatments and then ceased coming because of sudden
deteriorated health. We learned that she passed away two months after her last visit to our clinic; for
the prior two months she had been coming only twice per month for acupuncture.
During her last years at the clinic, the acupuncture frequency was routinely once per week. She
was given general cancer support protocols and was also treated for individual symptoms as they arose;
for example, when she tried her last chemotherapy drug she had a reaction of severely reduced appetite
and that was the focus of therapies with acupuncture and her medications. Throughout much of her
time at the clinic, she did report fatigue or low energy, but on many visits she felt well otherwise, and
she was given the general acupuncture treatment described as “maintenance” or “tune up” or “cancer
support.”
What was remarkable about her case was not only her longevity, but how well she was managing
with ongoing chemotherapy for years. For example, 10 months before she died, it was noted in her
chart that “her CA-125 was going up, but she doesn’t have any symptoms.” Five months before her
death, she was reported to be “eating well, no pain issues,” and she had no insomnia, normal bowel
conditions, but low energy. And in the next month, the practitioner wrote “no complaints today.” One
of our practitioners considered that “part of the reason she did well for years was her personality (not
easily rattled) and that her daughter and family (2 granddaughters) lived across the street…She often
talked about them in treatments.” What eventually caused her death, most likely, were metastatic
tumors in the lungs, which impaired her breathing, along with the final chemo attempt, which appeared
to contribute to a downturn without providing any cancer inhibition; those impairments caused her to
come to the clinic less frequently the last two months and then cease getting acupuncture for about 6
weeks before she died.
5. Patient OA, a 75-year-old man, had breast cancer diagnosed 8 years earlier, followed by liver cancer,
which had been successfully treated 5 years earlier, but then recurred a year before coming to IEP.
There were two tumor-removing surgeries (breast and liver) and a later abdominal surgery for bowel
blockages. He came to the clinic at a time when his cancer was not showing up on scans (the cancer
appeared to be in remission according to his oncologist, and the apparent remission was reported again
a few months later), but he was utilizing doxorubicin-eluting beads, a new type of long-term liver
cancer therapy and he eventually received other chemotherapy treatments because his oncologist was
sure that the tumor growth would resume if not more aggressively pursued. He had considerable
abdominal pain, being treated with morphine. He received 67 acupuncture treatments and 38 shiatsu
treatments over 10 months (this is an unusually high number of shiatsu for this period of time, utilized
to help address pain symptoms). Acupuncture point selection for this patient was somewhat more
varied than for many patients because of the efforts to alleviate certain specific symptoms that arose,
but he did frequently receive general “cancer support” treatment as described above.
He had a number of symptoms, many of them involving pain and/or spasms at several sites,
which would easily vary from one week to the next. Still, this patient reported “feeling well” and
“feeling much better with shiatsu and acupuncture” during the first three months; there were
intermittent reports of him feeling well two months before his death. Fatigue remained a persistent
complaint, but treatment was helping with pains of the middle back, stomach, and head. Chemotherapy
was then discontinued, but a tumor was eventually visualized affecting the bile duct, and he had to have
a drain put in for the bile to bypass the obstruction. Chemotherapy was not resumed, and it appears the
oncologist did not believe further chemotherapy would be of help. The patient, who had been doing
reasonably well at his last visit to our clinic, died within four weeks of that visit.
Despite his advanced age and years of dealing with cancer, the surgeries, and the chemotherapy,
he remained in fairly good health during his time with us; he was known locally as a master musician
and he continued performing for six months after his first visit to IEP. He likely succumbed as the
result of a blood infection associated with the port that had been used for bile duct drainage.
6. Patient LZ, a 51-year-old woman, was diagnosed with stage 3 ovarian cancer a few weeks before
coming to the IEP clinic, having had a debulking surgery for the tumor, and starting chemo just the
week before her first acupuncture treatment. She originally received twice per week acupuncture, but
later took breaks and would come back for a series of acupuncture sessions over a period of about three
years. She then took off about one year and came back toward the end of her life for two treatments;
she died two months after the last treatment.
She managed remarkably well through a long course of various chemotherapy attempts. She was
able to return to work, at least part time and, for a short while, full time, and resumed her active
lifestyle (e.g., going skiing). Her utilization of acupuncture was much less than we advised. During
her first year, she received 49 acupuncture treatments, a rate of just under once per week (she had
started at twice per week, but soon reduced the frequency to once per week), and the second year she
had 30 treatments over a period of 9 months, then was absent for about five months following a skiing
accident (broke both legs), and then another 32 treatments over a year. Because of the lower
acupuncture frequency and taking time off, she probably got much less effect than was possible. It
appears she initially was quite drawn to acupuncture therapy and then was less interested in that
approach: the first year, she did not receive any shiatsu massage, but for the following years, she
arranged to have shiatsu without acupuncture for every other visit. This patient preferred lying in the
prone position, so the standard needling received by most patients was usually not administered in her
case, and her protocol included several points of the Bladder Meridian and Hua Tuo points and
tianzong (SI-11); she might also receive treatment at points of the foundational protocol easily
accessible in that position and compatible with the others chosen.
She often reported fatigue and low energy from chemotherapy, but the focus of treatment would
typically be for pains that arose in different parts of her body. Sometimes, this was from her physical
activities; for example, she reported one day that everything was sore from physical activity
(swimming, hiking, and golfing)
What finally depleted her system, it appears, was non-cancer related surgeries: she had chipped
talus bones which were treated by surgery (two separate surgeries, one ankle at a time), and then rectal
surgery for hemorrhoids. It was right around the time of these surgeries that she ceased getting
acupuncture, retired from her teaching career, and, though we don’t know what happened during this
time, she developed leg lymphedema, probably from the series of lower body surgeries, and was not
able to continue her passion for physical activity. She lived about half hour drive from the clinic and
this lengthy transit, which was time consuming for her, yet something she could do regularly while she
was relatively healthy. With her skiing accident (broken legs) and later surgeries she wasn’t able to
travel to our clinic. So, her location explained why she didn’t get regular acupuncture when it might
have helped for recovery from injury and surgery as well as manage the effects of cancer treatments.
7. Patient LC, a 48-year-old woman, had been diagnosed ovarian cancer just two months before starting
treatment at IEP; she already had surgery and had undergone the first two chemotherapy sessions. The
surgery revealed extensive cancer in her abdomen (categorized as stage 3c, grade 3), and she had a
hysterectomy as well as oophorectomy. She came for acupuncture twice per week initially, but soon
transitioned to once per week and occasionally missed a week. She received a total of 68 acupuncture
treatments and 48 shiatsu over a period of about 19 months.
Her health during the chemotherapy was remarkably stable; she had persistent complaints of
constipation, and did develop some hand neuropathy, but did not experience fatigue and low energy.
After completing her first course of chemotherapy, which was just over three months long, she
rebounded well and her constipation resolved (it would come back as a symptom later). Despite her
basic good health, she developed persistent anxiety and feeling “emotional” overall. Her anxiety was
primarily over the cancer diagnosis, and, in fact, about nine months after starting at IEP she received
the news that the cancer had returned and that the prognosis was poor. A new chemotherapy was
begun, and this produced fatigue and some neuropathy (fingers and toes); she otherwise tolerated it
well. After a CAT scan, she was put on another chemo drug, and this was less well tolerated;
unfortunately, at this time she came in for acupuncture infrequently, and she died four months after
starting that new treatment. Her death did not appear to be due to the new chemotherapy effects, as
after the first treatment or two that “hit her hard” she was tolerating it well; for example, she reported
no neuropathy at her last visit. Her acupuncture treatments were consistent with others for general
support, but because of the substantial abdominal symptoms, she would tend to get needled along
Conception Vessel points that were in addition to those used for most other patients.
In my interpretation, the turning point for her was a loss of will to live when the cancer tests
showed that the disease was progressing. The anxiety that she reported a year and a half earlier—after
her first chemotherapy series which resulted in cancer being undetectable—stuck with her and could
turn to depression. For one of her chemotherapy series, she was in a research protocol and was
convinced she was receiving the placebo. During a later chemotherapy protocol, a practitioner
recorded that her mood was low and that she was “scared”; despite this, the same chart record indicates
“good quality of life,” and there were other reports of her “doing well.” A later note indicated that she
was sad and emotional after having had a liver ultrasound in the morning before her visit to our clinic.
At her last visit to the clinic, about 6 weeks before she died, she reported that a recent MRI showed a
lesion on the pancreas.
While acupuncture helped with emotional distress, she was not getting treatment with sufficient
frequency after the first three months. During her last year at the IEP Clinic, she had taken a
substantial break for nearly four months, and then returned for treatments only once per week during
the final six months. Her tolerance of several courses of chemotherapy was remarkable, and though
she seemed increasingly emotionally defeated, she maintained a relatively good health status through
her time at IEP, with many chart notes indicating that symptoms had improved.
8. Patient CB, a 58-year-old man, was diagnosed with stage 4 bilateral lung adenocarcinoma two
months prior and had his first chemotherapy just before coming to the clinic; he was also scheduled for
a series of radiation treatments for tumors on the spine. He received 250 acupuncture treatments at our
clinic over a period of 32 months and did not receive shiatsu other than three treatments during the last
weeks of his time at IEP. His final visit to us was followed by his transfer to hospice, and then he died
a week after entering hospice.
He was put on a series of different chemotherapy treatments; one of them, which unfortunately caused
apparent allergy reaction with significant itching, did result in shrinkage of the lung tumors (this was
about 9 months into the treatments). He also developed persistent shortness of breath and coughing
that may have been from the presence of the tumors despite their shrinking, or as a reaction to
chemotherapy; this symptom was alleviated to some extent by acupuncture. Unlike most of the other
patients described here, because of the focus on the lung symptoms, he less frequently received the
foundational acupuncture protocol that was given when lying face up, and tended to receive more
points aimed at alleviating breathing problems, with several back points, such as the extra point
dingchuan and Bladder Meridian points (e.g., BL-7, BL-12, BL-13, along with frequent use of KI-3).
For several session, he would sit up for treatment to make it easier to access all the points at once. He
sometimes received needles at the standard points, with frequent addition of chize (LU-5). Overall, he
suffered from fatigue, nausea, and shortness of breath, and then with pain. Though he struggled with
various side effects of the chemotherapy regimens and radiation treatments, he responded well to
acupuncture to keep the symptoms under some control.
After about two years, one of the chemotherapies he tried was an experimental one and he was
convinced that he received the placebo; regardless, his study participation was suspended because his
tumors were growing. Switching then to another chemotherapy, his symptoms stabilized, and his
shortness of breath was better. This stability remained for several months, and his CAT scan showed
the cancer to be stable as well; his blood lab results also looked good. Unfortunately the tumor at his
spine then began growing, so radiation was resumed for that and a tumor in his fibula was also found,
which was likewise treated with radiation. A new drug regimen was also tried, since the former drug
seemed to be losing its beneficial effects, as demonstrated by the growth of these bone metastases. It
was at the time of this transition in medical treatments, with failure of the newly introduced drug to
have substantial tumor-shrinking effects, that he began showing deterioration, with worsening lung
condition, pleural effusion, loss of muscle mass, and increased pain due to bone cancer; he died a few
weeks later, just ten days after his last visit to IEP.
The situation that overwhelmed him was the failure to control the tumor growth more so than the
cumulative impact of multiple drastic cancer drugs and radiation. Most likely, his lungs became unable
to provide sufficient oxygen and even though he was put on oxygen at the hospital, this did not suffice
because of his deteriorated physical condition associated with low appetite and insufficient nutrition.
9. Patient LS, a 57-year-old woman, was diagnosed with stage 4 ovarian cancer three months before
coming to the clinic; she had surgery and started chemotherapy during the month prior to her first
acupuncture session, and was suffering from significant side effects; she was also losing weight. The
cancer had spread over several areas, so that even though she had hoped to discontinue chemotherapy,
it was deemed a necessary treatment; at one point she underwent chemotherapy for a tumor at her left
shoulder. She had 125 acupuncture treatments and 41 shiatsu sessions over a period of 13 months.
She was highly symptomatic at every visit: fatigue, nausea, loss of appetite, constipation, poor sleep,
heartburn, lung congestion, cough, costal pain, and low back pain. Acupuncture and other therapies
helped her manage these symptoms, but could not overcome them; they kept her functioning and there
were occasional reports of her “doing good” or “feeling better emotionally” or that her “back is better.”
Specific benefits were suggested: “ear points helping nausea” as well as general ones, such as this
comment relayed by a shiatsu practitioner nearly four months into the IEP clinical program: “feels like
she is doing well, shiatsu and acupuncture helping a lot.” About two months before her last visit, she
seemed to recognize that she had lost the battle with cancer and practitioners frequently charted her as
being “teary” and “crying” and having experience of panic and anxiety, being overwhelmed; sadness,
and depression. Nonetheless, she kept coming to the clinic regularly until just a few weeks before she
died.
She came on average twice per week for acupuncture as we had recommended, and though she suffered
many symptoms, she had functioned quite well until about three months before her death. In this case,
the turning point appeared to be a dramatic loss of control over her situation, where she became highly
emotional and somewhat disoriented. The chemotherapy, and, perhaps the cancer itself, may have
affected her brain functions, and her situation was not helped by the fact that she developed oral thrush
and then needed considerable dental work, including a root canal. This patient had not been healthy
prior to her cancer diagnosis, having suffered long-term asthma, sinus allergies, and GERD. She had
not given up hope on cancer treatment; even two months before her death, she had been given the
option of palliative care (end of life care) or another try at chemotherapy, and she chose the latter.
10. Patient CM had come to our clinic many years ago, following a 1999 diagnosis of breast cancer
detected during a routine mammogram at age 62. She had a modified mastectomy at that time. Her
cancer was in remission and she came back to the clinic for treatment of other non-cancer related
conditions and health maintenance. Then, more than ten years after her first cancer diagnosis, she came
to the clinic for adjunctive cancer treatment when she was diagnosed with a recurrence of breast cancer
(age 73): she was scheduled at that time for a full mastectomy and then chemotherapy. There were
findings of cancer cells in the lymph nodes an partial evidence of metastatic sites. For the next 27
months, she came for acupuncture 95 times, but especially tried to arrange to have shiatsu, which she
had 65 times. She completed the program in good health; after that, she left on a trip overseas for five
weeks and on her return dropped into IEP for just a couple of follow-up treatments. She is alive today
at age 76.
Her chemotherapy resulted in fatigue and neuropathy, but these had largely resolved once those
treatments ended (some permanent peripheral neuropathy as evident), with her main complaints being
various aches and pains, many of them from physical activities she undertook rather than the
consequences of cancer treatment. Typical of her favorable reports was a practitioner note indicating:
“Doing well, energy better, and walking 2 miles consistently.” This report was six weeks after a course
of side effect laden chemotherapy had been completed. While recovery from its side effects is to be
expected even without intervention, her recovery was remarkably fast: she was beginning to feel
notably better just two weeks after the last chemo treatment. Notes reporting her doing very well are
found intermittently throughout the years of treatment.
The basis for her good outcomes include limited aggressiveness of the cancer she had, with a long
period of remission after the first treatment, and the fact that she was able to remain physically active.
She followed the treatment schedule suggested at our clinic, and pursued several naturopathic
recommendations, and she underwent regular testing by her oncologist, taking the medications and
supplements prescribed by her doctors. These factors likely contributed to her remaining in overall
good health despite suffering somewhat from the immediate reactions to chemotherapy.
References
1. Huang Yarong, compiler, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, volume 2,
1996 New World Press, Beijing.
2. Carmady B and Smith CA, Use of Chinese medicine by cancer patients: a review of surveys. Chinese Medicine
2011; 6:22.
3. Dharmananda S, Zen Shiatsu: The Legacy of Shizuto Masunaga, ITM online articles, 2002:
http://www.itmonline.org/arts/shiatsu.htm
4. Dharmananda S, Countering the Side-effects of Modern Medical Therapies with Chinese Herbs, ITM online
articles, 1998: http://www.itmonline.org/arts/sidefx.htm
5. Dharmananda S. Millettia (jixueteng), ITM online articles, 1999: http://www.itmonline.org/arts/millettia.htm.
6. Yu Huichan and Han Furu, Golden Needle Wang Leting, 1997 Blue Poppy Press, Boulder, CO
7. Dharmananda S. Zusanli: Stomach-36, 1998 ITM online articles: http://www.itmonline.org/arts/zusanli.htm
8. Lee M, Insights of a Senior Acupuncturist, 1992 Blue Poppy Press, Boulder, CO.
9. Sun BM, et.al., Acupuncture versus metoclopramide in treatment of postoperative gastroparesis syndrome in
abdominal surgical patients: a randomized controlled trial, Journal of Chinese Integrative Medicine. 2010;
8(7):641-644.
10. Zhu B, Wang HC, Case Studies from the Medical Records of Leading Chinese Acupuncture Experts, 2010
Singing Dragon, Philadelphia, PA.
11. Dharmananda S, Towards a Spirit at Peace, 2005 ITM Publications, Portland, OR; also available at ITM online
articles: http://www.itmonline.org/shen/index.htm
12. He, QY et.al. A controlled study on treatment of mental depression by acupuncture plus TCM medication, Journal
of Traditional Chinese Medicine 2007; 27(3): 166-169.
13. Zhao JH and Sang P, Clinical observation on acupuncture treatment of depressive neurosis in 30 cases, Journal of
Traditional Chinese Medicine 2006; 26(3): 191-192.
14. Kasymjanova G, et.al. The potential role for acupuncture in treating symptoms in patients with lung cancer: an
observational longitudinal study, Current Oncology 2013; 20(3):152-157
15. Feng Yu, et.al. Clinical research of acupuncture on malignant tumor patients for improving depression and sleep
quality, Journal of Traditional Chinese Medicine 2011; 31(3): 199-202.
September 2013