Case Study: Trigeminal Neuralagia & Sinusitis

Chief Complaint: Female age 63 presented with trigeminal neuralgia facial pain, worse with chronic sinusitis. Onset 7y ago. Worse in winter due to sinusitis: inflammation presses on trigeminal nerve, triggering pain. Swelling of right eye, center of lower eyelid. Frequent associated headaches.

Other symptoms: Celiac disease, food allergies which seem to trigger facial pain. Pain begins 20 minutes after eating offending foods: wheat products or anything with mold. Perennial allergies: onset birth – breast milk: red eyes, sneezing, nasal and sinus congestion. Shortness of breath. Fatigue, bruises easily, heavy limbs, weak muscles. Hypothyroid, diagnosed 47y earlier. RLS: .5mg Clonozepem nightly.

Pain: Described as electric, stabbing, shocking sensation. Over a 5y period, progressed from mild pain to severe pain. Aggravated with pressure applied to the affected area. Headache dull ache, level 8-9 [1-10 scale]. Red/purple coloration on scalp associated with increased pain.

Location: Foot Yang Ming Stomach (ST) meridian of face, in a line from the center of the lower eyelid to the lateral corner of the mouth. Foot Tai Yang, Bladder meridian & Du meridian, Governor’s vessel from vertex of the head to front hairline. Headache: Foot Shao Yang Gallbladder (GB) meridian, along hairline at forehead, left.

Tongue/Pulse: P: Right – hidden, Left – Weak. Tongue: Dusky, puffy with teeth marks. Constraint petechiae and red sides with red tip.

Treatment: Dr. Tan’s Balance Methodacupuncture + custom granule herbal formula. Tx #1: 8 magic points for digestive and lung disorders + ahshi points along the Large Intestine, Pericardium and Heart (HT) meridians between the elbow and wrist crease to treat the GB & ST meridian pain.

Tao Hong Si Wu Tang (Peach Seed & Safflower + Four Substance Decoction) + Sudden Smile Powder (Shi Xiao San) to treat pain due to blood stagnation: stabbing pain and dusky tongue indications poor blood circulation in the affected meridians (Foot Yang meridians + Du channel).

Bu Zhong Yi Qi Tang (Augment the Center to Lift the Qi Decoction) to treat chronic sinusitis and weak Spleen: food allergies, weak, heavy limbs, bruise easily, fatigue, hypothyroid.

Dan Zhi Xiao Yao Wan (Augmented Rambling Powder): T: red edges and petechiae, Shao Yang headaches.

Jade Windscreen: Improve immune function: allergies.

Results: Marked decrease in pain after 1^st acupuncture treatment. Facial pain: 1x/5days, stabbing pain, level 2 [1-10 scale]. Several mild headaches. No ear pain. Decreased facial swelling.

Treatment: repeated acupuncture and herbal formula. Slight modification to herbal formula to address allergies.

Result: After 1 week - Occasional pain: pressure to face causes mild, stabbing pain, level 2. No headache. 1 mild occipital headache, possibly due to caffeine. RLS: 2 nights. No nasal/sinus congestion or shortness of breath, occasional sneezing.

Treatment: Repeated tx #1. Modified herbal formula to increased heat clearing (red tongue).

Result:  One week later: Decreased facial pain: 2 twinges of stabbing pain, level 1. Facial swelling, sensitivity to touch. No RLS. Occasional sneezing, + post nasal drip, no congestion.

Treatment: Repeated tx #1, no HT channel points (no GB pain). Refilled herbal rx with modifications to address post nasal drip due to chronic sinusitis, including andrographitis (chuan xin lian), and facial swelling. Continued weekly acupuncture treatments and herbal therapy, with modifications, based on presenting symptoms for 2 weeks. Then decreased to monthly treatments and continued herbal therapy.

Result: 3 months after initial treatment: In past 2 weeks, no pain, no headache, no sinusitis, pressure or rhinitis. Occasional RLS associated with strenuous activity. Energy normal.       KB

Remedies for Burns, Sunburns & Radiation

Here's a few ideas for burns, including those from radiation:

In my recent post on scar treatment, i discussed Ching Wan Hung burn ointment . It's wonderful for burns of any kind, including radiation. It contains many blood moving herbs with heat clearing properties, to keep the blood circulating in the area, and menthol to clear the heat. It also treats insect bites and hot, red rashes and hives. My patients love it for all of these uses. 

In A Handbook of Traditional Chinese Dermatology,Liang Jian-Hui recommends decoction 60g of licorice root and applying it topically to the area with cold compresses. In Dermatology in Traditional Chinese Medicine Xu Yihou suggests making licorice oil by soaking 10g of licorice root in 100ml of vegetable oil for 24h. then cook on a low heat until the herb turns dark yellow. remove the licorice and use the oil. TCM herbalists often use sesame oil for topical balms, pastes and salves. In my Flying Dragon Liniment for muscle and joint pain, i use a combination of organic sesame, olive, castor and peach seed oils.

For radiation burns some practitioners suggest calendula gel or ointment, or honey. Manuka honey is highly regarded for its anti-bacterial properties. Tai Lahan's, author of Integrating Conventional and Chinese Medicine in Cancer Care: A Clinical Guide uses Spring Wind Burn Creme, citing successful case studies of it's use in her book. Spring Wind Burn Creme is being clinically studied by hospitals to document it's effectiveness in treating radiation burns.

Xu Yihou suggests making aloe cream by first pounding 45g of aloe to extract the juice. Gradually add 10g of gum arabic until the solution becomes milky. Lastly stir in 4.5g of eucalyptus oil. The creme can be applied 2-3x/day.


For ulcerating legions, Xu suggests making egg yolk oil, by heating 10-15 hard boiled egg yolks in a pan over low heat with 1t vegetable oil until a black oil separates. Apply the oil 2-3x/day. 

A colleague, Carrie Denaro, LAc of Blue Lotus Center for Health in San Diego, created this essential oil blend for a patient with favorable results. She says "It greatly relieved the pain and healed the skin":

Blend of 50% emu oil and 50% coconut oil in a 2-ounce jar (+)
10 drops of Blue Tansy essential oil
10 drops German Chamomile essential oil
10 drops Helichrysum essential oil
10 drops Niaouli essential oil
15 drops Lavender essential oil

It will stay solid if the room temperature is fairly cool.  If not keep it in the fridge to keep it solid and it becomes a nice cool soothing balm.

I would add that tamanu oil could be substituted for the emu oil, to avoid using an animal substance.


Xu says mild cases of radiation burns have a favorable prognosis with treatment, but severe cases are difficult to cure.

For sunburns, in Dermatology in Traditional Chinese Medicine Xu Yihou suggests decocting up dandelion (pu gong ye), purslane (ma chi xian), licorice, and a Chinese chrysanthemum (ju hua, flos chrysanthmi indici) applying as a compress 3-5x daily for 15-30 minutes. Manual of Dermatology in Chinese Medicine suggests a similar formula: ju hua, purslane, wormwood (qing hao, herba artemisiae annuae) and a Chinese herb long kui (herba solani).                    


TCM herbalists use a combination of topicals and internal formulas to treat burns. for first degree (redness) and superficial second degree burns (blistering), external treatments may suffice, depending on the intensity of pain. for more severe burns, internal formulas will also be required.     KB

Cat Scratch Fever: Clinical Pearls for Wound & Scar Therapy

so I got into an altercation with my cat this week and wound up with some serious scratches on the eye area of my face. I was concerned about scarring, so i did some research and polled colleagues on their favorite remedies. The following is a compilation of the collective wisdom generously shared:

When the cat scratched my face (he landed on my head after falling) i had blood running down my face. my first imperative was to stop the bleeding. I keep a Chinese patent remedy, called Yun Nan Bai Yao in my medicine cabinet. It's an invaluable first aid to stop bleeding, and it works. Application method: apply the powder with gauze or cotton to the wound, and apply pressure. The herbs cause the blood to quickly coagulate. Add more as necessary until the bleeding stops. It won't take too long, unless it is a deep cut. The Vietcong famously carried Yun Nan Bai Yao with them in Vietnam to treat gunshot wounds because it does the job well. Once the bleeding has stopped you can bandage it up.

After i stopped the bleeding i thought i would leave it and let it rest. I had to go into the clinic, so i flew off a quick plea for help from colleagues and went on my way.

Later that evening i read through the wonderful advice offered. the first thing i learned is that conventional wisdom on wound healing has changed. You may remember the old school advice that says to leave the wounds open to the air to breath once the scab has formed, especially at night. Western medicine has changed is opinion on this, and have found that wounds heal faster if they are kept covered so that they remain moist and juicy. The scabs will produce scars.

Chris Macie writes:

From recent science, as well as tradition, keep open wounds covered, and juicy (as if internal, swimming in nourishment that repairs). Let the dressing plus the medium (be it Res-K or other TCM or traditional herbal, or modern bio-synthetic compounds) take the place of the scab!

The "science" -- couple of years ago, NY-Times Science section, Q&A dept: Question: better to leave wounds open to heal? (Or my Polish grandmother's advice: let wounds breath (open) at night). Answer: NO. Keep covered and in a healing, moist environment. Periodically cleaning and redressing, of course.

This makes sense from a TCM (Traditional Chinese Medicine) perspective. In TCM, we want to prevent stagnation. the scars are a result of Qi and Blood stagnation in the tissues. Keeping the wound moist allows for blood circulation, including the white blood cells and phagocytes to stop infections, and the various biochemicals and proteins needed to stimulate collagen and tissue regeneration. Scabs are dead blood due to blood stagnation. so it makes sense that although they provide a natural band aid to protect an open wound from infection, the stagnation would slow healing and promote the formation of scar tissue.

As the cat's claws were likely dirty, i cleaned the wounds with a mild soap and water solution, removing the scabs. Contrary to popular belief, and according to Medscape, studies do not demonstrate that hydrogen peroxide inhibits bacterial growth. So being as it stings like a #!?#@!, there is no longer a compelling reason to use it to disinfect wounds, though the bubbling action is helpful to loosen dirt and gravel.

An alumnae i interned with at PCOM (Pacific College of Oriental Medicine) Andrea Beth Damsky recalled receiving these directions from a hospital:

Keep the wound moist with Aquaphor or Vaseline. Do NOT use antibiotic ointments or creams such as neosporin because these increase the possibility of an allergic skin reaction. The purpose of the Aquaphor or Vaseline is to keep the wound moist and prevent scabbing, because moisture speeds healing of the skin and scabbing (contrary to popular wisdom) increases the likelihood of tearing the skin and creating scars. Keep the wound(s) covered. Remove the bandages daily, wash gently to remove any crusting or scabbing, reapply Aquaphor or Vaseline; repeat every day until the skin has healed.

I would add, avoid much exposure to sun or wind until your skin has healed, and any exercises that would stretch the skin of your face.

I imagine you are resistant to bandage your face... perhaps it would work just as well to apply the Aquaphor/Vaseline several times daily in lieu of using a bandage?

You could use vitamin E or other oils once the skin has healed over.

Regarding nursing care, Denise Moran of Center for Rejuvenation Acupuncture, with 20 years experience working for plastic surgeons and dealing with wound healing, advises:

If you live in a sunny area and are out in the sun more than 5-10 minutes, you want to be sure the wounds are covered as the sun exposure could permanently pigment the scars. The bad news is that all wounds heal with a scar, the GOOD news is that the face is very vascular and the thinnest skin on our body and heals better than anywhere else.

I don't like to use vasoline because its a petroleum product. Several practitioners suggested Ching Wan Hung burn ointment to prevent scarring. I keep this item in the medicine cabinet, beside the Yun Nan Bai Yao and my Flying Dragon Liniment. Its wonderful for kitchen burns. It contains many blood moving herbs with heat clearing properties, which in Chinese herbal medicine prevent and treat infections, and menthol to clear the heat. It treats insect bites and hot, red rashes and hives. My patients love it for these uses. The blood moving herbs explains it's ability to prevent scarring.

I also keep calendula ointment in my herbal first aid kit. i settled on using the burn ointment as the scratches were red (indicating heat, and possible infection) and to prevent scarring, my main concern on my face. In absence of Ching Wan Hung or infection, i would suggest using calendula ointment, rather than Vaseline. It should not cause any skin irritation, rather it treats that. it is readily available in the natural food stores. Check the ingredients to be sure its a clean ointment. I would avoid Boirion as it uses petroleum ointment.

The following morning i began researching the next step, scar prevention. Several colleagues suggested Resinall-K, a Health Concerns herbal tincture to improve wound healing and prevent scarring. Chris Macie gave a convincing testimonial:

It's an incarnation of a somewhat common hit-medicine for martial injuries; though some forms may be considered proprietary / esoteric. Contains Dragon's Blood, RuXiang (frankincense) & MoYao (Myrrh), YanHuSuo, etc., in suspension with alcohol and glycerin.

[It also contains san qi, the chief blood mover in yu nan bai yao, er cha, safflower and bing pian (borneol) resin.]

When used to continuously coat, even in a sense of immerse, a surface wound, it appears to promote near-seamless epithelial healing. (similar principle as touted in new Western bandage technology recently)

I keep a lot of it in stock; routinely prescribe to patients who have cats.

Couple of years ago I closed a car door completely on distal phalanx of my index finger -- cut to the bone (palmar side). Kept it packed in Res-K for a month or so. Took a total of about 6-months, but now 100% restored flesh & function; very faint scar.

Health Concerns lists the therapeutic actions of Resinall-K as preventing infections, promoting tissue regeneration, stopping bleeding and activating blood circulation. Therapeutic applications include pain and swelling of traumatic injury. When you look at the number of heavy-hitting blood moving herbs in the formula, it makes sense that it will prevent scarring by keeping the area moist, and keeping the blood moving. the alcohol base of the tincture enhances blood circulation. This is why hit liniments for martial arts are alcohol based.

I found a bottle of propolis in my first aid kit which treats infections. The scratches were a bright red at this point, indicating heat and toxins. so i applied the burn ointment and the propolis and bandaged up the scratches.

At the end of the day i picked up the Resinall-K. the propolis seem to clear any infectious process, as red coloration to the scratches had markedly diminished and there was no yellow exodus. I cleaned and reapplied the burn ointment and the Rensinall-K and re-bandaged. Every few hours i opened the dressing and reapplied the burn ointment and Resinall-K.

By the next morning, the redness had cleared, and the scratches were healing nicely. They look rather shallow, so i am less concerned, but still do not wish to have scars around my eye and on my cheek. once the scratches close up and it no longer seems necessary to bandage to keep them moist, i will move on to phase two: scar prevention.

Several colleagues suggested essential oils to prevent scarring. i looked at a couple of formulas, and came up with my own combination, partly based on cost, as purchasing a number of essential oils can add up.

Tamanu oil treats scars and infections, due to its antibiotic, anti-inflammatory properties, so its a keen choice to use as a carrier oil. other options suggested included castor oil, sesame, sweet almond oil, olive and grapeseed (for phytoestrogens) oils. I will probably used a castor/sesame oil combination, as i have these on hand. In my Flying Dragon Liniment for muscle and joint pain, i use organic castor, sesame, peach seed and olive oils.

Mary Elizabeth Wakefield, who has been teaching facial rejuvenation acupuncture for over a decade suggests this essential oil blend to treat keloid scars:

In a 4 oz blue bottle, put 3-4 drops each of: lavender oil, helichrysm oil and rose oil. Fill the rest of the way with a carrier oil (choose from apricot seed oil, grape seed oil or emu oil- which is known for treating scars on its own) Apply twice daily.

as a vegan i cannot recommend emu oil, as it is harvested from these Australian birds, but i did google it and it does have many healing properties.

Helichrysm was suggested by many of my colleagues, so i knew i wanted to use it. One practitioner suggested a blend of bay laurel, clary sage and helichrysum. When i began ordering i noticed the clary sage is about 25% higher in cost than the other oils, so i ordered lavender for its reputation to treat scars and infections, rose for its attributes for the skin, helichrysum as many practitioners suggested it for scarring and bay laurel. as the Snow Lotus helichrysum and rose i ordered are a 10% solution, they must be dosed 10x the # of drops one would normally use.

After 72 hours, the cuts were looking less red and were beginning to close. At this point i felt comfortable going out in public with out the bandage, just applying the burn ointment to keep the area moist, keep the blood circulating and prevent scabbing, which could cause scarring. while at home and overnight i kept the area bandaged up with the burn ointment and Resinall-K which was quickening the healing process. At 96 hours the superficial scratches were beginning to fade, and a couple of small scratches had already disappeared.

By 120 hours the wounds had closed and the scratches were beginning to fade. Therefore (and thankfully, i would add) the bandage was now unnecessary. It is still important to keep the blood circulating to prevent the blood stagnation which causes scarring. The Resinall-K is a dark red and rather messy. in addition to the menthol, the burn ointment has many blood moving herbs. so for practical considerations, i used the Resinall-K at home and the burn ointment in public.

By day 7 the scratches were now a pink coloration. One of the more prominent scratches had markedly faded, 50%. The Resinall-K seemed no longer necessary, so i began the essential oils. I began with the helichrysum neat, as it is in a 10% solution. It has a lite, pleasant citrus-y aroma. After 2 days with the helichrysum, two of the 3 prominent scratches had reduced to 15% visibility. There is now one long and prominent scratch which has faded to a pale pink coloration. I am now considering mixing up the remaining essential oils i ordered - rose, lavender and bay laurel - to help move along the healing of the more visible scratch.

As the sores begin to heal, acupuncturists needle the healing cuts to prevent scarring. Scar therapy also treats older scars. The general technique is to do something we call 'surround the dragon' where we needle the perimeter of the wound or scar. some practitioners needle perpendicular and under the scar tissue to break up the collagen formation, others needle parallel to the scar. Moxa is used to speed the healing. Many practitioners i talked to recommended laser therapy.

Bill Morse describes his experience:

. . .also use non-scarring moxa to excite the tissues and promote regeneration. With the local needles

The scar will often change character as the first sign of therapy. This may be variable. Hard scars become soft and sometimes hard for a bit then soften. Small scars will enlarge, soften and then reduce. There are many patterns. I like to think that there is "retracing" going on - that is, a reversal of the scars history. Many times patients will begin to recall the incident sequence which verifies this theory. Often there is no apparent connection.

Expect results or changes quickly, however thinning to a line may take several months, especially at thin skin areas like the face. Keloid scars are the most difficult to work with and require extensive internally applied herbs and may contra- indicate the use of moxa. Any scar wider that 1/8 inch will require special care and additional time.

I have seen 4 inch bed sores reabsorb completely with needle application only in a matter of days to weeks, but most deep scars require more time.

Denise Moran adds:

scars tend to start to get a little thicker at 3 months so don't be alarmed if that happens. By a year they have come close to healing, but you could still see some improvement. Keep using your oils and needling and any thickening should be at a minimum or non-existent. I treated my dad for 5 days after he had his kidney removed and at 5 months, it was hard to find the scar. So I'd probably start doing face points within about 72-96 (to avoid stirring up bleeding) hours of the injury, but not in the wound.

KB

Herbal Poison Ivy Remedy

I learned a couple of herbal poison ivy remedies in a Kitchen Herbs class I took a few years back. I don't have any feedback as to efficacy, so please add comments with your experiences.

There are two easily accessible Chinese herbs that treat poison ivy. Both are weeds that are ubiquitous in the summer. The first is Ge Gen, or Kudzu powder. You will find this in the macrobiotic section of natural foods stores. Ge Gen is the root of the kudzu vine, which grows over everything in the Southeastern United States: trees, bushes, signs and telephone poles.

You'll find the second in your backyard lawn: dandelion.

You can take dandelion and kudzu internally as a tea. Kudzu is a white powder, and can be used to thicken sauces. Use a tablespoon or so in a tea made with dandelion leaves. Drink several times a day. You can also use kudzu as a skin wash for legions (rash).

Dandelion can be steeped as a tea and added to bath water to sooth the skin. In Chinese herbal theory, dandelion clears heat and toxins, and hones to the Lung, which rules the skin. Poison ivy rashes are red and itchy, indicating heat toxins. You'll want a strong tea for this purpose. Fill the pot with the leaves, cover with water and steep for 30 minutes or so.

Ge Gen, or kudzu releases the exterior. Chinese herbalists also use Ge Gen to relieve neck and shoulder pain, especially associated with colds or cold weather.



Jewel weed grows in the Southeast and is also used to treat poison ivy, though not a Chinese herb. Mash the stems and rub the juice on the skin to sooth outbreaks, or as a preventative before or after possible exposure, as demonstrated in this You Tube video. KB







photo: Muffit, flickr creative commons 2.0

FDA Warns Against Anemia Drugs for Cancer Patients: Chinese Medicine Effective Treatment

The FDA issued a strong warning that will go on labels for three widely used drugs that treat anemia for cancer and dialysis patients: Procrit, Aranesp and Epogen, saying the drugs cause stokes and cardiac problems and speed the growth of malignant tumors. Fortunately for these patients there is a safer therapy available that effectively increases blood cell production: Chinese medicine.

Several organizations have endorsed the use of acupuncture for cancer treatment. The National Cancer Institute notes western studies are beginning to be done that show efficacy of acupuncture in increasing blood cell counts:

Scientific studies on the use of acupuncture to treat cancer and side effects of cancer began only recently. Laboratory and animal studies suggest that acupuncture can reduce vomiting caused by chemotherapy and may help the immune system be stronger during chemotherapy. Animal studies support the use of electroacupuncture to relieve cancer pain. Laboratory and animal studies have also looked at how acupuncture works for cancer treatment, such as the role of acupuncture in stimulating immune functions, including increasing blood cell count and enhancing lymphocyte and natural killer cell activity.

The Mesothelioma society agrees:

Furthermore, animal cancer studies have shown that acupuncture spurs blood cell production and lymphocyte activity. The end result of these processes is an increase in immune functions.

Mesothelioma is a rare cancer caused by asbestos exposure, affecting the lining of the lung.

The Huffington Post also recommends acupuncture for cancer patients to improve blood cell production:

Immune System Modulation: Many cancers and many cancer treatments cause a suppression of the bone marrow, the source of blood cells that are the army of the immune system. Acupuncture increases blood cell production and enhances Natural Killer Cells and Lymphocytes which leads to increased immune response and decreased risk of infection.

Chinese medicine improves red and white blood cell production, including lymphocytes and neutrophils. Though western studies emphasize acupuncture, herbal formulas are particularly important in raising blood cell counts. There are many blood building formulas with a proven track record. In my practice, I have seen blood cell counts markedly improve when acupuncture patients add Chinese herbs to their treatment plan.

Red blood cells are produced in the bone marrow. The bone marrow is part of the Chinese medicine Kidney system. Many kidney tonic herbs and formulas are known for increasing marrow. Chinese herbalists use a strategy of tonifying the Kidney, Blood and the Spleen to increase blood cell counts.

The spleen stores white blood cells. Chinese medicine considers the Spleen an important component of immune function. In Chinese medicine the Spleen responsible for extracting the nutrients from food necessary to build qi (energy) and blood. Patients with low blood cell counts usually suffer from fatigue, so building qi to improve energy is also an important component of treatment. Tonify the Kidney and Spleen improves fatigue. Peony root and angelica are commonly used blood tonic herbs. Ginseng is a famous qi tonic that builds Kidney energy.

I hope that patients and conventional medical practitioners will become more open minded about integrating Chinese medicine as a safe and effective option in treatment plans for cancer patients.

Why Gou Ji Berries?

Gou Ji berries have become a health trend in the past few years. These small red berries were plucked out of Traditional Chinese Medicine's (TCM) Materia Medical (catalogue of herbs and other medicinal substances, like shells and animal products). I've seen it included in a range of products and snack foods, such as smoothies and trail mix. Their popularity has shot up the price and reduced its availability. Lately I have discovered that several of the natural food stores in Asheville, NC are not able to obtain it for their shelves. But contrary to popular belief, this tonic herb should not be used for general consumption.

In Chinese herbal medicine, Gou Qi Zi, Lycii Fructus (lycii berries) tonifies Liver and Kidney yin and blood and brightens the eyes. Yin and yang are polar opposites and in Chinese medicine we use the concept of yin and yang to help explain and treat disease processes in the body. Yin refers to female, quiescence, cool, darkness, earth, feminine, night, moon and water. In the body, substance and blood are yin.

The kidney organ system in Chinese medicine house the root of yin and yang in the body. It also rules the aging process, from conception, through puberty and maturation, as well as decline until eventually we die because the kidney energy has exhausted itself.



The liver in TCM stores blood. For women, at the time of the menses it sends the blood down to the uterus to be expelled. The liver channel begins at the big toe and travels up the inside of the leg, through the genitalia, up the side of the torso to the chest. Then it goes internally up to the eyes and top of the head.

Gou Qi Zi nourishes the qi (energy) and blood of the liver and kidneys. We use it for gyn issues involving deficiency and to tonify the liver and kidney systems when they are weak. It is a commonly used herb for those undergoing radiation and chemo therapy, which burns yin and blood.

In Chinese herbal medicine, we classify herbs according to their temperature. Cinnamon, cardamon, nutmeg, cloves and Sichuan pepper are all warming herbs. Mint and watermelon are cooling. Generally speaking Gou Qi Zi is considered a neutral herb: neither warm nor cold. Of interesting note is a personal antidote mentioned by Zhang Zi-Chun in Essays on Medicine Esteeming the Chinese and Respecting the Western. As a neutral herb, Gou Qi Zi is not considered to have the ability to clear heat. However Zhang disagrees, citing a personal experience when he was waking up feeling hot and drinking a pitcher of water throughout the night. He began chewing 30g of Gou Qi Zi before bedtime. He continued to waken during the night, but didn't feel warm and he reduced his water intake by 50%. (1)

This scenario is commonly seen in perimenopausal women. Traditional Chinese herbalists often include Gou Qi Zi in formulas when treating perimenopause to tonify the kidney yin. This example may show some ability of Gou Qi Zi to clear heat for these women. I frequently use the root of this plant, Di Gu Pi, Lycii Cortex to clear heat for hot flashes.

Because it goes to the eyes, Gou Qi Zi is commonly used for eye problems due to deficiency, such as weakness, floaters and blurred vision. For this purpose, a tea can be made with Gou Qi Zi and chrysanthemum flowers (Ju Hua), using a 10-25 berries and a few dried blossoms. Gently simmer in filtered or deionized water for 10-20 minutes and drink 1-2 cups daily.

Ron Teeguarden notes that good quality berries are thick, bright red, sweet and tender. If they are brownish or dry and crunchy they have been stored too long. (2) The berries can be added to soups, stews and grains, up to a handful per day. Be sure you have blood and yin deficiency before using, by checking first with a traditional Chinese herbalist. KB

______________________________________________________________

1. Bensky, Clavey & Stoger, Chinese Herbal Medicine Materia Medica, 3rd Edition, 2004 Eastland Press, p760.

2. Teeguarden, Ron, Chinese Tonic Herbs, 1985 Japan Publications. p.97.

Chinese Herbal Medicine vs Prescription Drugs

Chinese Herbs work differently than prescription medicines. Drugs generally work to suppress a symptom, not cure a disease. An example is diabetes, cholesterol or hypertension medications that control blood sugar, lipids (fats: cholesterol) or pressure only while you take them. If you stop the drug, the symptom persists.

In contrast to pharmaceuticals, Chinese medicine works to cure the disease. The herbs are slower acting: often they do not provide the immediate effect people have come to expect from drugs, such as pain killers or mind altering drugs: anti-depressants, anxiety and insomnia medications. This is because Chinese medicine is working at a deep level to change the bodily processes perpetuating the disease. Turning the ship is a longer term process than whitewashing over a symptom. Therefore it commonly takes a few days, or 1 -2 weeks to begin seeing results with Chinese herbal therapy. Unlike drugs though, Chinese medicine is often able to cure the disease so that in time the drugs and herbs can be withdrawn and the disease & associated symptoms do not reappear.

Another benefit of Chinese medicine is that it does not cause the undesirable side effects seen from prescription drugs.

For more about Chinese herbal medicine see the Chinese Herbs page of my website: BartlettAcupuncture.com KB

Case Study: Chinese Herbs for Flu

Here’s a little story of a colleague who desperately emailed me earlier this month about an acute stomach flu, seeking suggestions:

I got really really suddenly & violently ill last night - I'm doing much better today. My husband has a final exam in 4 days and it would be really nice if I managed to not pass this on to him.

Three nights ago I stayed with my parents for the night. I was woken shortly after midnight to the sound of pretty wretched vomiting [from her mother]. Last night it was my turn, so it looks like this has a 2 day incubation period. Which would have my husband puking tonight or tomorrow night instead of studying. bad!

Her main symptoms were simultaneous vomiting & diarrhea (sudden turmoil disorder) “Several hours of misery followed” + severe chills and burning pain in the stomach, esophagus and throat. I recommended an herbal formula she might have on hand.

:) I think you may be our hero. I found my bottle of the sudden turmoil formula [her nickname for the herbal formula I recommended] with a whole 12 pills left in it. When my husband started feeling an odd stomach pressure last night we gave him a dose. he said things settled significantly. I won't be sure that he's in the clear until tomorrow with no vomiting, but I've got my fingers crossed and am feeling optimistic.
thank you again.

. . . The week could've been a LOT worse. My husband only ever had one bout of diarrhea, no vomiting at all was pretty much fine. (I think he was eating normally again by the next day. I'm still not quite at normal, but close.) He managed to skip the hours of misery that my parents & I went through. & when I finally got to take my dose of the herbs, it immediately got rid on the awful bouts of heartburn & most of the lingering nausea I'd been having since the vomiting . . . that's far better than the godawful sick we'd had before the herbs. Apparently my mom, who was the first to get sick (10-11 days ago) is still getting queasy after meals, so the two of us got off lightly.

So thank you again, Karoline Gostl, MS, LAc – New York, NY

Study Finds Meditation as Effective as Drugs in Preventing Depression

Looking to avoid depression or the holiday blues? A recent study published in The Archives of General Psychiatry shows that once the depression had been treated, meditation could be used in place of drug therapy. The medications can be discontinued rather than staying on Prozac or Paxil ad nauseaum. I know this is terrific news as I often have patients telling me they do not like taking drugs, esp. staying on them long term. I have many blog posts about meditation and depression you can look at for alternatives to drugs in order to stay happy.

I recently read an interview with a well known Buddhist monk, Thich Nhat Hanh about integrating one's mindfulness practice into daily life to be happy. His ideas illustrate how the study participants were able to be free of depression and medications.

Chinese Medicine is also quite effective in treating emotional disorders: anxiety, depression and more advanced psychiatric conditions. We use a combination of acupuncture and Chinese herbal medicine to address these problems. Acupuncture has well known benefits of reducing stress and releasing endorphins, those 'feel good' biochemicals responsible for the runners high. Often my patients comment after a treatment about how stressed they felt coming in and how much better they feel after.

We use herbs rather than drugs to treat all manner of clinical complaints, including mental-emotional problems. Chinese medicine does an individualized pattern diagnosis. This means that rather than giving everyone with the same complaint the same treatment or herbal formula, we look deeply at the individual nature of each person, and customize the treatment. We call this approach pattern diagnosis.

There are many patterns responsible for psychiatric conditions, too many to name them all here. I would like to describe a couple of common patterns responsible for depression.

Liver Qi Stagnation is a big one, common in our western culture for those under stress. In Chinese Medicine, the Liver is responsible for circulating qi (energy) through out the body, through the channel or meridian system. When we get stressed or tense, we tighten up, and the qi stops flowing. This stuck qi often leads to a physical depression, causing stomach/bowel problems (acid regurgitation, IBS), gyn problems (cramping, moodiness) and hypertension because the qi is not circulating or moving through the organs. Liver patients are irritable, stressed and often have a physical problem in addition to anxiety, depression, insomnia and other emotional problems.

Another common pattern of depression is Yang deficiency. Yang is our body's heat and activity: qi (energy) is yang in nature. When yang is deficient, one feels cold easily or has cold feet. Cold causes qi to slow down, heat causes qi to quicken up. Think ice and boiling water - ice moves at a glacial pace, boiling water has volcanic action. Cold in the body causes qi to slow down in the body, causing a physical depression, which can lead to a mental depression. In this case, the person feels cold, complains of a lack of motivation, just wants to curl up in a ball and retreat from the world.

Once we diagnose the pattern (or combination of patterns involved) we customized the acupuncture point prescription and Chinese herbal formula. A common herb for treating liver qi stagnation is mint. Drinking mint tea is beneficial as it moves and circulates the liver qi, responsible for the qi stagnation. For yang deficiency, warming spices are important to use: cardamom, nutmeg, cinnamon, fenugreek and cloves.

The combination of acupuncture and Chinese herbs is effective in treating mental emotional disorders,and I have successfully gotten many patients off medication. This 2007 study reported on in Psychology Today shows a 50% effectiveness for acupuncture in treating depression. Adding herbal therapy and customizing treatments in private practitioners' offices dramatically increases effectiveness. As a control, studies pick one to 3 protocols, and give them to all participants. Practitioners do much more customization of treatments exponentially increasing efficacy. Dr Allen, the study's author notes in Psychological Science, the precision of needle placement allows for treatment of individuals' personal symptoms—a flexibility drugs just don't offer. KB

The Traditional Chinese Medicine Solution to Flu Prevention

The NY Times reported saturday on the difficulties in developing antibiotics to treat the antibiotic resistant super-viruses which have become common in recent years, causing a serious public health issue. The US is considering subsidies to the pharmaceutical companies to encourage future development. Antibiotics are not typically profitable for the pharmaceutical companies in comparison to drugs for chronic diseases like diabetes, allergies, or HIV. the reason for the lower profit is that antibiotics are only taken for a couple of weeks at which time the disease is cured. Chronic conditions such as high cholesterol, blood sugar disorders, thyroid problems or MS, require lifelong drug therapy as the drugs do not provide a cure. Therefore it is profitable for the pharmaceutical companies to develop drugs to treat these type of disorders. Because of the drug resistant super-viruses, & because flu viruses frequently vary, antibiotics must be changed year to year, so it is more difficult for the pharmaceutical companies to recoup the cost of research and development.

All of this means fewer drugs available to treat flus. So what is one's best strategy for fighting the flu? Prevention.

Prevention means staying healthy. Keeping your body in optimal condition so that the immune system is strong and can prevent the virus from gaining the advantage in the fight. The TCM (Traditional Chinese Medicine) strategy for wellness highlights preventative care and intervening early, before disease takes hold. In contrast, the western health care model dominate in our country does not stress prevention. Rather, doctors wait for disease to get fairly advanced before commencing treatment. While TCM effectively treats both acute and chronic disease, this distinction in emphasis on preventative care is one of the many important differences between the two diametrically opposed systems.

Prevention includes the basics of eating nutritious food (3 balanced meals/day) getting optimal rest (minimum of 8 hours of sleep) and exercising regularly (several times/week) to keep the body strong. A good percentage of Americans are not emphasizing these basics, especially in this deep recession where we find ourselves running faster and faster on the rat wheel to keep from falling farther behind.

Living a healthy lifestyle takes effort and prioritizing. It is imperative for maintaining health and disease prevention. With the cost of health care skyrocketing in this country, it also makes economic sense to protect one's health as disease treatment is becoming more and more expensive, and insurance companies are covering less and less of the costs.

In addition to the basics of healthy diet, sleep and exercise, other aspects of a healthy lifestyle must be incorporated for disease prevention. Stress reduction is a key factor. Stress is well known to cause illness. One of the first questions i ask patients with acute symptoms of any condition is has your stress level increased recently? after years of experience, i have learned that in over 60% of cases increased stress positively correlates with the onset or exacerbation of any health problem, including neck or back pain, headache, high blood pressure, stomach problems (i can't stomach this situation) MS, chronic illness, colds and flu, and so on.

There are many articles in my blog and on the resources page of my website AcupunctureAsheville.com discussing stress reduction. Briefly this involves identifying and eliminating stressors from your life and implementing stress management techniques such as meditation, yoga, qi gong & incorporating quiet time to your life so to help you deal with the life stressors that cannot be eliminated.

Acupuncture and Chinese herbal therapy are helpful in calming the mind so that you are more able to deal with life stress. Acupuncture releases endorphins, the feel good chemicals responsible for the runner's high. Acupuncture and herbs reduce irritability, depression, worrying and treat insomnia, all of which weaken the immune system, causing disease to take hold in the body.

Acu/herbal therapy strengthens the immune system, so it can fight off illness. TCM is effective in treating most health problems, including colds and flu. My patients are continually surprised at how quickly TCM methods eliminate colds and flu, or reduce the symptoms so that recuperation comes easier.

So the TCM solution to addressing super-viruses is three-fold. First: living a healthy lifestyle to stay strong so that a virus would have difficulty overtaking you. I haven't looked at the CDC stats on who dies from super viruses, but i'm sure i can postulate that it is the elderly, weak and infirm in much higher numbers that healthy adults. Being healthy is your number one defense against disease.

Second: integrating preventative care techniques. Regular acupuncture treatments keep the body and immune system strong. This might mean monthly treatments during flu season, and 4-6 weeks intervals at other times of the year. There is an oft used herbal formula to strengthen the immune system and prevent the onset of colds, flu and allergy symptoms called Jade Windscreen. Jade refers to something precious (this effective herbal formula) and windscreen means screening out allergens and germs from entering the body. This formula can be taken long-term, from fall to spring, for allergy or cold and flu prevention.

Other preventative care techniques include stress management activities such as tai qi, qi gong, meditation, yoga, acupuncture and Chinese herbs in addition to eliminating stressors from your life.

Thirdly, beginning acupuncture and Chinese herbal therapy to treat the disease as soon as it strikes and to help the immune system win the battle against the viral onslaught. KB

Poached Pears for Autumn Health

Poached Pears are a autumn/winter favorite of mine. Chinese dietary therapy says pears nourish the Lung system. So those with allergies, sinusitis and frequent colds & flu's, and skin problems should eat them. Each of the organ systems relate to a time of year, when that system is most venerable to disease/disorder. Autumn is time of the Lung, so eating pears now will help protect the Lung against the dryness of the autumn season.

In medieval times, pears were a delicacy (A Partridge in a Pear Tree - lots of pear trees depicted in medieval art). Enjoy Poached Pears for breakfast or a healthy dessert. You could serve them with a chocolate sauce for guests, but i don't think it's necessary: they stand up well on their own sweet flavor.

You may want to add Gouji berries (gou qi zi) to the cooking water. gouji berries tonify the Lung, Liver and Kidney organ systems in Chinese herbal medicine. The dry autumn air injures the Lung Qi and Yin (moistens tissues). Gouqizi moistens Lung, especially useful for a dry cough (though not often used for this purpose by Chinese herbalists). "In folk medicine, 10g of this herbs are steamed and taken 2-3 times a day for" diabetes. (1)

Poached Pears

Whole pears, or halves
nutmeg, cinnamon, cloves
gouji berries, optional

Put pears in a pot with whole nutmeg, cinnamon stick, a few whole cloves. Sprinkle in the gouji berries & add some spring water (1/2"). Cover, bring to boil, then reduce to a simmer for approx. 10 min, until fragrant and tender. remove pears. reduce cooking water to a glaze and drizzled over pears in serving dish. If using whole pears stand them up in the pot. place halves cut side down.

Enjoy! KB

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1. Chinese Herbal Medicine Materia Medica Revised Edition, Bensky & Gamble. Eastland Press, Inc. 1993: p. 234.

Green Tea Improves Effects of Antibiotics

Taking green tea with antibiotics enhances the effect of the drug, according to Matt Van Benschoten, LAc.

Be certain you have a bacterial infection when taking antibiotics. A lab test will show a bacterial process. Antibiotics are useless for viral infections, and you would be taking the drug needlessly. Antibiotics are over prescribed, resulting in super-bacterias which have become drug resistant. Many TCM practitioners (Traditional Chinese Medicine) feel one should only take antibiotics twice in their life: so chose wisely when you decide to take them.

Chinese medicine can treat many of the infections for which antibiotics are prescribed. Many Chinese herbs have known antibiotic and antiviral properties. The anti-viral herbs can prevent viral replication. Sinusitis, cold & flu patients are generally surprised at the strong effect of Chinese medicine in treating these conditions.

After a cold or flu, one may feel tired for some time, or have less energy for exercise and may feel out of breath sooner after running on a treadmill, hiking or on an exercise bike. This is due to diminished lung function. Chinese medicine rebuilds the weakened body during the post-recovery period.

The 8th leading cause of death in the US is influenza. 50,000 people die each year of the flu. The elderly, children, and those who are weakened from chronic disease are most venerable. Also those on chemotherapy, which weakens the immune system are at high risk for diseases such as flu or pneumonia.

Chinese medicine strengthens immune function and weaknesses so that the body has the reserve energy to win the fight against, rather than being over taken by disease processes. KB

Cholesterol: Sugar Raises It, Nuts Lower It, Chinese Medicine Treats It

Most associate cholesterol with a high fat diet. Increased consumption of sugary soft drinks combined with more sedentary lifestyle (sitting in front of computers & electronic devices) have caused the rise in obesity seen since the 1970's. The NY Times reports in Vital Signs that sugar and soft drinks also account for high cholesterol.

A recent study (funded by the nut industry, but confirmed by results in other independent studies) found that eating nuts lowers cholesterol.

In the NY Times Vital Signs column, Roni Caryn Rabin reports:

“Nuts are rich in unsaturated fats, and that is a main driver in lowering cholesterol,” said the lead author, Dr. Joan Sabaté, a professor of nutrition at the School of Public Health at Loma Linda University in California. “They are the richest source of protein in the plant kingdom, and they also contain fiber and phytosterols, which compete with cholesterol to be absorbed. All these nutrients have been demonstrated to lower cholesterol.”

"The more nuts they ate, the greater the effect."

Chinese medicine can support your efforts to lower cholesterol. We work to improving digestive function with acupuncture and Chinese herbal formulas. Some herbs have proven effects in lowing cholesterol, such as hawthorn fruit and red yeast rice. I've seen many patients cholesterol levels improve with acupuncture and herbal therapy. I recommend an initial 3 month course of acu/herbal therapy & lifestyle/dietary modifications, followed by a lipid panel re-test. The results for of the 3 month follow up test are encouraging. When blood lipid levels return to nml i recommend working with the prescribing doctor or pharmacist to begin decreasing statin drugs. Once the drugs have been fully eliminated, we begin reducing the frequency and dosing of acu/herbs. The eventual goal being see if normal blood lipid levels can be retained without the support of acu/herbal or drug therapies, while keeping the dietary/lifestyle modifications in place.

However i will offer the caveat that it is beneficial to get on a regular acupuncture maintenance schedule, be it monthly, seasonally, or on the solstices, to keep the body in top performance level, reduce the effects of stress and maintain a strong immune function.

Here's an article from my website AcupunctureAsheville.com discussing varies dietary suggestions to lower cholesterol, the role of acupuncture and Chinese medicine, & various herbs and supplements, such as red yeasted rice and policosanol. KB

Lowering Cholesterol: Drug-free Solutions

Fox News Interviews Kath Bartlett, MS, LAc About Allergy Treatment

"Do you ever google yourself?" I was asked last week. "It's been a long time", I replied. "Mostly professional stuff comes up: my website, blog, articles I've written and so on".

With this conversation in mind, i put my name in the search box, and hit enter. The expected hits came up. As I scrolled through them I came across an interview I did with Fox News several years ago for an article on allergy treatment using Chinese Medicine. I believe the article was (at least in part) ghostwritten. Manny Alvarez was given the byline, but it was a woman who interviewed me that spring morning.

This is a thoughtfully written article first explaining some basics about TCM (Traditional Chinese Medicine) theory and terminology, then going into the the interview with me about allergy treatment using Chinese Medicine, followed by a 2004 study on TCM treatment of allergies published in Allergy Magazine. KB

Fox News Allergy Interview with Kath Bartlett, LAc

How Chinese Medicine Treats Autoimmune Disorders

Here's an interesting paper written by a CA practitioner about how Chinese Medicine addresses autoimmune disorders, particularly chemical sensitivities. KB

Autoimmune Disorders, Multiple Chemical Sensitivities
and Chinese Medicine
by Matt Van Benschoten, O.M.D., L.Ac.

https://elotus.org/lotus_2010/downloads/articles/2010/article_02_0107_Matt_Final.html


____________________________________________________________________
About the Author

Dr. Van Benschoten is a graduate of the California Acupuncture College of Los Angeles, with 28 years of clinical, research, and teaching experience in acupuncture, Chinese herbal medicine, and medical Qi Gong. He is the author of more than fifty papers on acupoint diagnostic methods, chronic fatigue syndrome, AIDS, autoimmune disease, breast cancer, mercury toxicity, and indoor mold exposure. His clinical practice focuses on multi-drug resistant infections, immune dysfunction, and environmental illness.

Chinese Medicine for Cold and Flu Prevention

I've been getting questions about flu vaccines and Chinese herbs for flu.

The decision to vaccinate is a personal one. One must weigh the risks of side effects from the vaccine against the risk of contracting the flu. For those who are weak, frail or immune deficient there is a stronger argument to vaccinate. Those who are healthy and could mount a strong defense against the flu might want to forgo the vaccine and the risk of side effects incurred.

Chinese medicine can support you in 2 ways:

1. Acupuncture and Chinese herbs can strengthen your overall health and immune function, better preparing you to ward off an attack.
2. Chinese medicine can treat the flu symptoms should you contract it. Patients are generally pleased, even amazed by the results of acupuncture and herbs in treating colds, flu and other respiratory conditions.

I have a few formulas that have been advised in Beijing for use in treating H1N1. All are to be taken upon suspected contact. One is a gargle for sore throat that could be used for any sore throat. The others are specific for the most venerable patient populations: children, seniors and pregnant women. These formulas could be used prophylactically for any suspected contact with cold or flu. They are only to be used for 4 or 5 days as a preventative upon contact.

One frequently used preventative formula for any cold, flu or respiratory illness, including allergies is called Jade Windscreen. It is comprised of 3 herbs (astragalus is one) that are considered a precious (hence the word 'jade') formula to boost immune function and ward off viruses, bacterias and irritants brought in from the external environment (wind-screen). It is often begun in August or early September, 6-10 weeks before the flu or allergy season, and continued through the winter for those who frequently contract colds, flu and allergies or sinusitis. Generally the herbalist will add other herbs to build a constitutional formula suitable for the individual patient being treated.

Periodic acupuncture treatments strengthen the immune system and alleviate stress, which depletes immune function. Making sure you eat well, get adequate rest, don't overwork, exercise regularly and engage in stress reduction activities will keep your body and immune system healthy and strong.

When disease symptoms occur, acupuncture and Chinese herbal formulas can effectively treat the symptoms and strengthen the bodies ability to mount an defense against the attack. KB

Studies Show Chinese Herbs as Effective or Better than Drugs for Endometriosis with Fewer Side Effects

Endometriosis is a condition where endometrial tissue, which normally lines a woman's uterus, is found outside of the uterus. This tissue can grow and shed during a menstrual cycle and cause pain, heavy menstrual bleeding, and infertility. "Medical treatment of endometriosis ranges from symptomatic management with nonsteroidal anti-inflammatory drugs and analgesics to hormonal manipulations that include continual oral contraceptives, progestins, danazol, and gonadotrophin-releasing hormone agonists. However [according to the below study], the benefits are short lived, and symptoms often return to pretreatment levels within six months. Under the best of circumstances, more than a third of patients have symptom recurrence within two or three years after stopping therapy."

Symptoms of endometriosis have been treated with Chinese medicine for hundreds of years. Treatment involving herbal medicine, acupuncture, and dietary therapy have afforded women reduced pain, lighter periods, and restored fertility. While more severe cases of endometriosis may require surgery, Chinese medicine may offer an effective treatment for many women.

Gerry Harringon, Harmony TCM Weblog

Chinese Herbs Show Promise for Endometriosis

By Charles Bankhead, Staff Writer, MedPage Today
Published: July 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

HOUSTON, July 8 -- Chinese herbal medicine provided relief to symptoms of endometriosis that was equivalent or superior to conventional therapies following laparoscopic surgery, a systematic review indicated.

Action Points

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• Explain to patients that Chinese herbal medicine appeared to relieve postsurgical endometriosis symptoms at least as well as conventional medical therapy.



• The findings were based on a retrospective review of a large database and involved a small number of patients.

Herbal medicine achieved symptom relief comparable to that of gestrinone but with fewer side effects, Andrew Flower, PhD, of Southampton University in Ringmer, England, and colleagues reported in the Cochrane Database of Systematic Reviews. The pregnancy rate was similar with either treatment.

Compared with danazol, Chinese herbal medicine led to better postsurgical symptom control with fewer side effects.

"These findings suggest that Chinese herbs may be just as effective as certain conventional drug treatments for women suffering from endometriosis, but at present we don't have enough evidence to generalize the results," Dr. Flower said in a statement.

The authors noted that more rigorous research is needed to assess the potential role of Chinese herbal medicine in treating endometriosis. Investigators initially identified 110 studies for their review. However, all but two had to be excluded because of methodologic flaws.

Medical treatment of endometriosis ranges from symptomatic management with nonsteroidal anti-inflammatory drugs and analgesics to hormonal manipulations that include continual oral contraceptives, progestins, danazol, and gonadotrophin-releasing hormone agonists.

Hormonal therapies provide comparable symptom relief and reduction of endometriosis-related lesions, the authors said.

However, the benefits are short lived, and symptoms often return to pretreatment levels within six months. Under the best of circumstances, more than a third of patients have symptom recurrence within two or three years after stopping therapy, the authors noted.

Additionally, the benefits of conventional therapy have to be balanced against potentially serious adverse effects, the authors continued.

Surgery also carries a risk of serious adverse events, such as bowel perforation and peritonitis, and offers no assurance of long-term symptom relief.

"In summary, current treatments all have high rates of recurrence and their short-term benefits have to be balanced with concerns over immediate and longer-term side effects," they said.

Chinese herbal medicine has a clinical history that dates back to ancient times. Among the medical applications is treatment of symptoms associated with endometriosis.

The origin of Chinese herbs' activity in endometriosis is unclear. Suggested mechanisms have included regulation of endocrine and immune systems, improved circulation, and anti-inflammatory activity.

But no English-language systematic review had been conducted to determine whether Chinese herbal medicine has a role in the treatment of endometriosis.

To address that void, Dr. Flower and colleagues searched multiple databases for randomized controlled trials of Chinese herbal medicine versus placebo, conventional medical therapy, another Chinese herb, or as an add-on to conventional therapy.

Of 110 studies originally considered, only two met the authors' inclusion criteria. All 110 studies were conducted in China and were reported in Chinese.

The two studies involved a total of 158 women whose mean age was 30. Diagnostic criteria included laparoscopic diagnosis, American Fertility Society staging, and vaginal or rectal B-ultrasound.

Additionally, all of the patients had been diagnosed according to traditional Chinese medicine as having stagnation of Qi (vital energy) and blood with an underlying kidney deficiency.

All patients had laparoscopic surgery as primary therapy.

One study compared a Chinese herbal medicine enema and gestrinone. In the second trial, patients were randomized to Chinese herbal medicine pills alone, herbal pills plus an herbal enema, or danazol.

Gestrinone led to a symptomatic relief rate of 93.87% compared with 95.6% for the Chinese herbal medicine enema.

During 24 months of follow-up, 69.6% of women assigned to the enema became pregnant, as did 59.1% of patients treated with gestrinone. Neither difference achieved statistical significance.

No adverse events occurred in patients treated with the Chinese herbal medicine enema. In contrast, 13 of 49 patients treated with gestrinone developed acne, while19 had elevated liver enzymes, and 31 had oligomenorrhea.

In the second trial, oral Chinese herbal medicine alone or in combination with an herbal enema led to significantly greater symptom relief compared with danazol (RR 5.06, 95% CI 1.28 to 20.05 and RR 5.63, 95% CI 1.47 to21.54, respectively).

Additionally, the combined Chinese herbal medicine reduced dysmenorrheal pain significantly more than danazol and resulted in a significantly higher rate of disappearance or shrinkage of adnexal masses (MD -2.90, 95% CI -4.55 to -1.25, RR 1.70, 95% CI 1.04 to 2.78, respectively).

Four of 16 patients randomized to Chinese herbal pills alone had dry mouth, and one patient developed acne. Among 24 patients randomized to herbal pills and an herbal enema, two had dry mouth, while 11 developed rectal tenesmus during the first two weeks of treatment, and one patient had weight gain of 3 kg.

Of 18 patients treated with danazol, 13 developed acne, while three had weight gain of 3 kg, two gained 2 kg, one gained 1.5 kg, two had elevated liver enzymes, and four had oligomenorrhea.

The authors reported no relevant financial disclosures.

Primary source: Cochrane Database of Systematic Reviews
Source reference:
Flower A et al. "Chinese herbal medicine for endometriosis" Cochrane Database Syst Rev 2009; DOI: 10.1002/14651858.CD006568.pub2.