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Oksana Nachataia. “Hepatitis and steatohepatitis in Chinese medicine”.

Continuing the story of the sessions with Professor Wei Yu Qi – representative of the first generation of teachers and practitioners of Tianjin University of TCM, I would like to mention one of his main specializations, namely, the treatment of liver diseases by methods of Chinese Medicine. Masterfully owning recipes of TCM while using diagnostic methods of Western medicine, he successfully helped patients with viral hepatitis, liver cirrhosis, FH, diseases of the spleen. I was fortunate enough to discuss with him issues of treatment of liver diseases and to get answers to questions that I could not find by reading the classics of Chinese medicine and reading modern literature. Without a fine transfer of knowledge and invaluable experience from teacher to apprentice, without explaining how to understand exactly a particular issue in the diagnosis, treatment, preparation of recipes, it’s really hard to master the practical art of TCM. “Theory without practice is dead.” Indeed, a precious experience of generations adorns the crown of Chinese medicine alive sparkling light.

Each of the liver and spleen diseases is a separate big topic in Chinese medicine. Here I will address only the general recommendations of Professor Wei in terms of approach to the classification of these diseases. The fact they are played at the middle jiao, which can be called “the factory of life” for the body. Two main object, “two planets” of middle jiao – liver and spleen – are known to have a multi-faceted, very sophisticated relationship with each other, which maintain the so-called “second heaven” of the body (hou tian) and not only it. Therefore one of the key moments in the treatment strategy – is to correctly identify the root cause of the disease, as well as which of the two organs affected first – the liver or spleen in the understanding of TCM.

Analyzing his own clinical experience, the experience of his teachers, as well as the canons of the ancient treatises, Professor Wei combined causes of disease in several groups.

The first group of factors leads the destruction of liver cells and hepatitis with obvious syndrome of heat and poison, blood heat, stagnant of qi and blood, with a significant increase the level of liver enzymes, and then often to cirrhosis and cancer.

This group includes the viruses that cause viral hepatitis, alcohol abuse, toxic drugs of Western medicine, as well as hepatotropic poisons, some harmful additives in food production. In this case it is necessary to consider these pathogens as a “heat and poison” and approach to treatment is from the standpoint of Wen Bing Xue. This concept applies especially to the viral hepatitis, where Wen Bing theory fits very well. The primary element is liver, which suffers directly. Staying in a morbid state, the liver spreads its pathological effect on the spleen, stomach, brain.  “Tree suppresses the Earth.” The main syndromes are stagnation of qi and blood (qi zhi xue yu), heat and poison (re du), the blood heat (xue re), dampness and heat in the middle jiao (zhong jiao shi re), deficiency of spleen qi (pi qi xu), and the insufficiency of yin of liver and kidney in the later stages.

The second group of factors gradually causes changes in liver tissue, steatosis and obesity, partially metabolic syndrome.

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Oksana Nachataia. Herbs “drivers” for the brain – TCM against encephalopathy.

Dear colleagues!  It seems me interesting to consider cerebrovascular diseases and HBP from the standpoint of an integrative approach. If Western medicine is positioning high blood pressure as one of the main causes of vascular encephalopathy, there is just one single symptom (HBP) among many others in Chinese medicine. Both medical systems are looking at the same problem from different angles.

As strange as it may sound, according to ancient Chinese medicine, the brain – is “an extra organ” in the body. Brain – this is «the arena» in which the disease is played in most cases. But the causes of pathological changes are found at other parts of organism. Brain’s state depends on the proper operation of the so-called “main organs”, ratio of qi and blood, yin and yang.

Various symptoms of encephalopathy should be considered in the context of certain syndromes (patterns) of TCM.

If we imagine a primitive model, the brain is like a beautiful «living lamp» connected to the “Power Station” located inside the organism. Then, in the case of bad work of lamp “power station” should be repaired, because it nourishes, energizes the “lamp” and removes unnecessary substances from “lamp”.

“BIAO –  BEN” principle applies in Chinese medicine. The root of the disease (“BEN”) – is the cause of the disease, predominantly associated with the violation of the internal organs. Manifestations of the brain symptoms is mostly “BIAO” (“branches”), and symptoms are very sharp, except, for example, traumatic brain injury, poisoning toxins, birth defects and malformations of brain tissue and some other cases. As everyone knows, the principle of treatment of diseases in TCM is: “Depending on the severity of symptoms, emphasis is given in the recipe for the treatment of “branches” or “root “of the disease”.  Looking ahead we can say that the special formulas for the treatment of encephalopathy focused mostly on treatment of “branches of the disease”, that is, the rapid relief of symptoms and prevention of cerebral vascular accidents.

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Vladimir G. Nachatoy. An exemplary schema of thinking in setting of syndromic diagnosis in TCM.

Dear colleagues! Undoubtedly, any experienced practitioner in the field of traditional Chinese medicine, yes, probably in any medical system, lines up his own method of thinking and clinical diagnosis. In many ways, it is true, as it brings practical results in the appointment of treatment. But, as I was convinced, in Chinese medicine, there is a great likelihood to succumb to the illusion of some kind of “simplicity and clarity”, especially adhering only fragmentary, sketchy knowledge. In this case, the algorithms of doctor’s clinical thinking may be in contradiction with the classical tenets of diagnosis in TCM, because many important things are unaccounted in the overall clinical picture. Pulse, tongue, four methods of research, of course, it is right and necessary. And it works quite well when the syndrome is obvious, is not complicated and is not changed, and  when only one or at most two syndromes are present in the patient at the time of inspection. Moreover, these syndromes usually appear due to the clearly definable reason, often internal. This situation really is easy in diagnosis, and it is treated  pretty good by recipes of herbs and acupuncture recipes.

But what to do when a syndrome is complicated? If at the same time there is an external (biao), and internal (li) syndrome, if at the same time there are a false excess (jia shi) and true deficiency (zheng xu)? If the syndromes of meridians are present together, as well as syndromes due “five pathogenic factors” which are born inside (“wu xie nei sheng”) and so on. How to understand the root cause of the disease, the mechanism of its development in this case? What should you emphasize in the first place? Of course, all who practice TCM, once studied the theory (Zhong Yi Li Lun) and diagnostics (Zheng Duang Xue), a differential diagnosis (Jian Bie Zheng Duang) and, as I said, many have developed a solid foundation of diagnostic principles which helps them in the practice with patients.

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According to the standard classification of the herbs (Zhong Yao Xue), ingredients of Chinese medicine are combined into groups according to their mechanism of action. Properties of herbs in a group sometimes appear similar, even identical. But is it really? And will be the substitution of one ingredient for another is justified in different situations or not?

In the literature, there is often a bold statement that one ingredient in its absence is easily replaced by another, and an inexperienced doctor thinks that we can expect the same effect from the treatment. In fact, it is far from it. Of course, if you are constrained by a small number of Chinese ingredients and want to somehow help the patient, of course, this change is partially justified. But if you are an experienced doctor, and you have at hand a big choice of ingredients, it is necessary to take into account all the nuances of the distinguishing features of herbs, plants, growing location and more. Only mastered all the information you can refer to the list of herbs and choose the option of replacing one ingredient for another.

The fact is that any complicated recipe is constructed mainly of simple recipes or stable combinations of ingredients (e.g., such as “Er zhi wan”, “Dang gui bu xue tang”, “Si jun zi tang” and many others ). These basic recipes, as well as part of the classic recipes and simple stable combinations of herbs can be taken from treatises Shang Han Lun, Wen Bing Lun, Jin Kui Yao Lue and other ancient texts. Simply mix the ingredients well with each other can be, I think, in the kitchen, experimenting with cooking jelly. This method cannot be applied with the treatment of the individual patient. When you have a patient with his fears and anxieties, sometimes you are the last pillar on which he is pinning his hopes. Unfortunately, not everyone can be helped. But often the aid does not occur because of ignorance of the doctor important nuances of action of the ingredients and their combinations, although the ingredients may be from the same group. My students often come to me with questions, so I decided to write this small article for those who may previously did not think seriously about herbs and frivolous mixed them together, as in a kaleidoscope.

As an example, I would like to compare three ingredients, which transform phlegm and clean heat away from the breast (qing re hua tan), and on their differences and similarities show how much of the herbs from the same pharmacological group can be different from each other. My teachers were very serious of this issue, and the results are not forced to wait.

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Vladimir G. Nachatoy “Pulse in Chinese medicine – where is the truth?”

As known, research pulse is one of the important methods for the diagnosis of TCM. On the topic of pulse diagnosis a lot of books are written, ranging from ancient to modern treatises pulse interpretation systems. Moreover, the interpretation of data on pulse sometimes varies. Even knowing the location of the organs projections in positions cun, guan and chi, as well as the rules of palpation, many experts have difficulties in terms of the truth of the data obtained by the pulse palpation. In this article, I would like to draw attention to the “true” and “false” pulses ( «zheng mai» (chang mai) and «jia mai»). This question seems to me extremely important for proper diagnosis and determination of the main syndrome. During conversations with my teachers, for instance, Professor Zhang Xi Peng gave a very simple and clear explanation.

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Vladimir Nachatoy. Treatment of Shang Han Lun syndromes by acupuncture. Part 2.

1. Tai yin bing.
This syndrome includes a very strong depletion of spleen yang (Pi yang shuai xu) and all the other symptoms of the syndrome Tai Yin. That is, the symptoms of yang deficiency of the spleen is to the fore. But this condition should not be confused with the syndrome of Pi Yang Xu as an organ syndrome due to internal reasons.
Main symptoms:
– Bloating
– Abdominal pain, spasms
– Warm helps and relieves pain
– Cold in the body and limbs
– Loss of appetite
– Possible vomiting
– Mushy stools or diarrhea
– Other symptoms Tai Yin Zheng
– Pale tongue, white coating
– Pulse huan, ruo
Method of treatment: warm the middle jiao, dispel cold, nourish qi, strengthen the spleen. Wen zhong san han, yi qi jian pi.
Acupuncture points: Gong sun (SP 4), nei guan (PC 6), tian shu (ST 25), zhong wan (RN 12), pi shu (BL 20), zhang men (LR 13). The method is “ping bu ping xie” with a greater emphasis on the Bu Fa + “jiu”, especially points “shu” and “mu”.

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Vladimir Nachatoy. Treatment of Shang Han lun syndromes by acupuncture.

Dear colleagues!

Today I would like to start a discussion on the Shang Han Lun, namely that part  which, in my opinion, it is not covered in detail in the medical literature in Russia. The topic of this article – treatment Shang Han Lun syndromes by acupuncture. Perhaps many practitioners already have a lot of experience in this matter. But I would be very pleased if this knowledge will be useful for specialists. My teacher at the Shang Han Lun was the late Professor Liu Gong Wang from Tianjin University of TCM. He was known and beloved by many people . Shang Han Lun just was one of his “crown” topics that brought him fame, among his others great knowledge in the various fields of Chinese medicine. According to him, all the nuances of the treatment system of six meridians in the damage by cold his teacher told him. As you know, until the middle of the last century, the system of knowledge transfer “from teacher to apprentice” was the main method of study of TCM in China.

And only since 50-ies of the last century, higher medical education in China has had its modern form with universities and clinics. During the study, Professor Liu Gong Wang gave me the experience of the proposed system, a combination of points, which he used.  I use this system in my practice. Naturally, you have to assign else a classical herbal recipes of Shang Han Lun (as you know the amount is 112). With the right combination of acupuncture and herbs good result from the treatment does not make long to wait. But, at the same time, if for some reason there is no way to use herbs and Shang Han Lun syndrome is present – what can you do? In this case, the acupuncture will be indispensable for each syndrome. I’ll try to be laconic, and give some practical, frequently used combinations.

  1. Tai yang zheng.

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One of the most interesting terms in theory of TCM is the concept of “qi”. This word is rather difficult to translate into European languages due to a vast number of meanings and associations contained by it. Life impulse, life energy required for metabolism of a micronutrient and many other things – all of these relate to qi. What is the difference between a dead person and a living person? Presence of qi. Even the word “machine” has a hieroglyph qi – in literal translation “a cart with qi”. There is variety of types of qi in an organism, and every physician of Chinese medicine knows about them in all details. Methods of acupuncture and herbal medicine allows addition of necessary types of qi, moving qi upon congestion, directing a flow of qi anywhere it is needed and solving other tasks. This is a foundation of classic Chinese medicine.

But the time flies fast. And medical knowledge is not a rigid dogma. Any medical system is aimed at the tasks which come to the fore in one or another period. Conditions of life change and disease profiles change. So called “noncontagious epidemics” of diabetes, early arteriosclerotic vascular disease, obesity are spoken about more and more. Oncology diseases call attention. Of course, increase of longevity and early detectability affect statistic data. But cancer arises in increasingly younger people, number of diseased increases in all age divisions – and it is an evident tendency.

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“Plants keys” for the treatment of diseases of the pelvic organs.

As you know, there are two mechanisms of comparison of Chinese syndrome and Western nosology if the patient has any specific pathology. This system is practiced in those clinics in China, where both methods of Chinese and Western medicine are used. This trend has spread to almost most of the major research centers and clinics, and thus implemented the concept of synthesis of Western and Chinese medicine.

  1. The treatment of the complaint.” For example, the single symptom “plentiful menstruation” can occur at various syndromes of TCM (“blood heat”, “qi does not keep the blood” and other) and at the different clinical forms (uterine fibroids, functional disorders). Therefore, to determine a treatment strategy it needs to determine the TCM syndrome leading this symptom, as well as the nosological form determined by Western medicine laboratory and instrumental studies. Then choose the best possible treatment methods by determining the proportion of Western and Chinese medicine in each case.
  2. “Treatment of nosology form.” In this case, the patient goes to the doctor with established Western diagnosis. Nosological form should be “split” on TCM syndromes that can occur with this disease. For example, infertility can be caused by shen qi xu, xue yu, gan qi yu jie and others. Then suitable to this case, the method of Chinese medicine organically supplement existing treatment regimen of the patient.

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Systematic approach to diagnosis and treatment of metabolic syndrome in Chinese medicine. Part 1.

In 1981 M. Hanefeld and W. Leoonardt proposed to introduce the term “metabolic syndrome” for combination of several-sorted metabolic imbalances. In 1988 professor G. Reaven made an assumption with reference to his own findings and generalization of other researches’ investigations that insulin resistance, abdominal obesity, hypertension, lipid storage disease (including fatty liver disease) and ischaemic heart disease are signs of pathosis for which he proposed the term “syndrome X”. In 1989 D. Kaplan coined the term “deadly quartet”: obesity, diabetes, hypertension and ischaemic heart disease.

Obviously, scientists of Western medicine have suggested systematic approach to the whole organism by summarizing several metabolic imbalances in one pathosis. They have detected the “backfriend” that could gradually lead to fatal outcome of the patient. Over the last 20 years Western medicine has got significant results in the searching of metabolic disorders. But, it turns out Chinese medicine has a systematic approach to the disease, a clear understanding of the pathogenesis and effective methods of prevention and treatment. But, of course, from the standpoint of it’s theory – as we know, Chinese medicine has always featured an integrated assessment of the state of the body.

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