Acupuncture and Chinese Medicine Blog

Lei Gong Teng's Role in Treating Rheumatoid Arthritis (RA)

Comparison of Tripterygium wilfordii Hook F with methotrexate in the treatment of active rheumatoid arthritis (TRIFRA): a randomised, controlled clinical trial


Objectives To compare the efficacy and safety of Tripterygium wilfordii Hook F (TwHF) with methotrexate (MTX) in the treatment of active rheumatoid arthritis (RA).

Methods Design: a multicentre, open-label, randomised controlled trial. All patients were assessed by trained investigators who were unaware of the therapeutic regimen. Intervention: 207 patients with active RA were randomly allocated (1:1:1) to treatment with MTX 12.5 mg once a week, or TwHF 20 mg three times a day, or the two in combination. At week 12, if reduction of the 28-joint count Disease Activity Score (DAS28) was <30% in the monotherapy groups, the patient was switched to MTX+TwHF. The primary efficacy point was the proportion of patients achieving an American College of Rheumatology (ACR) 50 response at week 24.

TCM Pharmacology of Autism by M.M. Van Benschoten, OMD

TCM Pharmacology of Autism by M.M. Van Benschoten, OMD

Autism is a neurodevelopmental disorder first described by Leo Kanner in 1943. CDC estimates of prevalence are 1 of 68 children born in 2002 with 1 in 42 males for the autism spectrum disorders that include Asperger’s syndrome and pervasive developmental disorder. The prevalence of ASD has increased 37 fold over the past 30 years to more than 1% of US children. Level of impairment varies from nonverbal with severe developmental delay and repetitive behaviors to high functioning with social communication abnormalities.

Onset is most often between 6 months and 2 to 3 years of age. One of the earliest markers at 1 year of age is the inability to point at an object to communicate. Delayed speech and motor skills, seizures, and avoidance of eye contact are common.

Genetic, immune, dietary, and environmental factors combine to induce central nervous system inflammation and impaired neurotransmission. Treatment focuses on speech, language, physical, and occupational therapies to manage specific behaviors. SSRI and antipsychotics may be used to control ritualistic and self injurious behavior.

Air pollution, maternal infections, dairy and gluten intolerance, and genetic abnormalities in neurological and immune systems are potential contributing factors. From a TCM perspective wind, heat, and phlegm are the dominant pathogens as common childhood infections generate internal wind and obstruction of the sensory orifices. Wind and phlegm damage spleen and stomach resulting in food intolerances that intensify the inflammatory process, with phlegm and damp heat disturbing shen.

TCM Pharmacology of Influenza by M.M. Van Benschoten, OMD

TCM Pharmacology of Influenza by M.M. Van Benschoten, OMD

Influenza is a seasonal viral disease that causes illness, hospitalizations, and deaths. From 1977 to 2006 annual flu related deaths in the U.S. varied from 3,000 to 49,000 persons. Death rates from H3N2 viruses are double compared to H3 and type B viruses. Up to 8.5% of pneumonia related and 2.1% of cardiorespiratory deaths are due to influenza. The incubation period for influenza viruses lasts from 1 to 4 days with transmission through direct droplet spread or hand contact.

There are 12 different options for influenza vaccines, including trivalent, quadrivalent, injectable, and nasal mist. Flu vaccine is recommended for all persons over six months of age. Contraindications include egg allergy and previous adverse reactions to flu vaccines. Epidemics of influenza that occur every 3-5 years may infect up to 10% of the population. Vaccine effectiveness may vary from 15-70% in a given year due to constant mutation of the virus that generates antigenic drift.
Specific herbal medicines can assist in improving immune responses to vaccines.

Asparagus (tian men dong), astragalus (huang qi), epimedium (yin yang huo), ganoderma (ling zhi), ginseng (ren shen), isatis root (ban lan gen), and polygala (yuan zhi) increase vaccine titers, IgA antibody production, NK cell activation, and phagocytosis. Adding yin tonics ligustrum (nu zhen zi) and lycium fruit can improve resistance against effects of seasonal air travel and respiratory illness.

Adverse and Paradoxical Reactions to Herbs and Pharmaceuticals: Seven Case Studies by M.M. Van Benschoten, OMD

Adverse and Paradoxical Reactions to Herbs and Pharmaceuticals: Seven Case Studies by M.M. Van Benschoten, OMD

OAdverse responses to pharmaceuticals and Chinese herbal formulas are complex issues that require immediate action. Side effects from prescription medications should be managed by having the patient contact the prescribing MD for instructions on dose reduction or discontinuation. Herbal formulas causing side effects should be stopped, with reexamination and reformulation of the prescription with different ingredients. If this is not an option, after all adverse symptoms resolve, the prescription may be restarted at one half the original dose. If a lower dose is not tolerated, reformulation is in order.

In our experience, food poisoning can sensitize patients to their herbal prescription, which explains initial tolerance followed by gastrointestinal side effects weeks later. This observation coincides with the traditional restriction on raw and cold foods, which are more likely to have bacterial contamination.
In clinical practice, acupuncturists routinely treat the aftermath of extensive pharmaceutical interventions. Drug resistance is common in many diseases, and side effects of prescription medications may persist long after they are discontinued. The case studies below illustrate common conditions seen in the clinic.

Case 1

Mr. A is an 87 year old with stage 4 prostate cancer and hypertension maintained on antihormonal therapy and Terazosin, an alpha adrenergic receptor blocker. After twenty years of treatment with Chinese herbal extracts, his last two prescriptions have caused increased blood pressure, even though the ingredients are antihypertensive and are taken at least one hour apart from the pharmaceuticals.

Infectobesity: Bacteria, Viruses, and Toxins by M.M. Van Benschoten, OMD

Infectobesity: Bacteria, Viruses, and Toxins by M.M. Van Benschoten, OMD

Our clinical experience in the treatment of obesity indicates the presence of a systemic inflammatory state from chronic infections or bacterial overgrowth of the respiratory and digestive systems. Immune responses to common pathogens and normal flora become amplified by animal food based diets, triggering adipocyte proliferation and enlargement. For the most sensitive patients, the response to bacterial toxins and viruses in a single serving of dairy or meat can set off an inflammatory reaction that causes weight gain, chronic recurrent infections, atherosclerosis, diabetes, and cancer. When patients eliminate the source of bacterial and viral overload in their diets, immune system function returns to state of balance in which pathogens are cleared and fat cells are no longer proliferating.

Exposure to environmental toxins can trigger recurrent infections that result in obesity and cardiovascular disease. Dust and mold from old carpeting in a bedroom can induce chronic bronchitis with fatigue and insomnia, increasing TNF and targeting adipose tissues. The use of chlorine based cleaning products, especially liquid bleach as a sterilizing agent in sinks and bathrooms can induce severe respiratory damage, infection, and weight gain. Reversal of these conditions can only occur when a complete history reveals the source of exposure and it is eliminated.

Clinical Application of Five Element Theory to Autoimmune Disease by M.M. Van Benschoten, OMD

TCM Five Element theory describes interacting cycles of energy between internal organ systems with both physiological and pathological effects. This concept is similar to the biomedical understanding of autoimmune disease. Counteracting, encroachment, and violation, xiang ke, xiang cheng, and xiang wu, describe these interactions. Autoimmune responses to common respiratory tract infections and air pollutants can be described as Lung/Metal damaging the other elements and their related internal organs. Autoimmune responses to intestinal flora are related to the Spleen/Earth damaging other organs.

TCM theory states that the Lungs do not like dryness. This corresponds to increased susceptibility to infections from dehydration due to toxic air quality and inadequate water intake. Frequent flyers are often our most challenging cases as the exposure to jet fuel damages yin and wei qi, creating the ideal conditions for chronic infection. Home painting and remodeling, gardening, and toxic dust and chemical exposures from cleaning products can also contribute to cycles of recurrent infection.

TCM theory states that excess of sweet flavor and raw, cold foods damage the Spleen. This is the inflammatory effect of bacterial overgrowth due to food poisoning, high fat and sugar intake. When chronic infections persist due to errors in diet and toxic environments, secondary inflammatory responses become more complex over time and involve more healthy tissues. The TCM correspondences are wind, heat, and damp generating phlegm and blood stasis. Clinical correlations may be considered according to the table below:

Lung/Metal attacking Heart/Fire - arrhythmia, atherosclerosis, cardiovascular disease, hypertension, insomnia

Lung/Metal attacking Spleen/Earth - diabetes, hypoglycemia, fibromyalgia, leukemia, lymphoma

Lung/Metal attacking Kidney/Water - arthritis, osteoporosis, nephritis, myeloproliferative disorders

TCM Pharmacology of Streptococcal Infections by M.M. Van Benschoten, OMD

TCM Pharmacology of Streptococcal Infections by M.M. Van Benschoten, OMD

Streptococcal infections have an incidence of 3.2 to 6.9 cases per 100,000 persons for group A and B type bacteria. Diseases related to group A strep include pharyngitis (strep throat), impetigo, pneumonia, cellulitis, osteomyelitis, otitis media, sinusitis, and meningitis. Outbreaks of group A strep were common before the pasteurization of milk, and recently salad bars have been implicated as a source.

Streptococcus pneumonia, also known as pneumococcus, causes sinusitis, otitis, meningitis, conjunctivitis, pericarditis, and pneumonia. Streptococcus faecalis, also known as enterococcus, can cause urinary tract infection, endocarditis, meningitis, and food poisoning. Streptococcal food poisoning symptoms include diarrhea, vomiting, and abdominal pain. In mild cases, constipation, gas, and bloating may be present. Bacterial overgrowth from refined sugars can include E. coli and Streptococcus faecalis resulting in acid reflux, gastritis, and colitis.

Patients with residual infection after multiple courses of antibiotics can be treated by combining laboratory research on antimicrobial effects of herbs with TCM syndrome differentiation to obtain optimum results. Combining antistreptococcal herbs on the basis of their TCM clinical applications for constipation, diarrhea, cough, sore throat, and fever will provide both symptomatic relief and growth inhibition of the pathogenic factor.

anticonstipation - crataegus (shan zha), curcuma zedoria (e zhu), dandelion (pu gong ying), polygonum cuspidatum (hu zhang), terminalia (he zi)

antidiarrheal - agastache (huo xiang), alpinia officinarum (gao liang jiang), andrographis (chuan xin lian), aucklandia (mu xiang), baphicacanthus (da qing ye), elsholtzia (xiang ru), fraxinus (qin pi), magnolia bark (hou pu), moutan (mu dan pi), paeony (bai shao), sanguisorba (di yu), sargentoxoda (hong teng)

Kidney Disorders: Differential Pulse Diagnosis & Herbal Treatment by Dr. Jimmy Chang!

Great webinar with Dr. Jimmy Chang as he discussed Kidney disorders... more specifically, kidney stones, urinary tract infections, and kidney deficiency and failure.

In class, Dr. Chang talked about the pulse signs for each condition and appropriate herbs to treat the conditions. A class worth watching over and over again!!

To watch the 1 hour class, click here to catch it on the TCM Wisdom Tube!

~Donna Chow, L.Ac.

For more great and FREE recordings of past 1-hr webinars, click here for the TCM Wisdom Tube!

Adverse Reactions, Pharmaceutical Resistance, and Chinese Herbal Medicine by M.M. Van Benschoten, OMD

Adverse Reactions, Pharmaceutical Resistance, and Chinese Herbal Medicine by M.M. Van Benschoten, OMD

How To Explain Acupuncture To Your Patients & Manage Your Practice!

This weekend, 11/2/13-11/3/13, will be 2 great classes with Dr. David Karaba on how to explain to your patients, how acupuncture works (11/2/13) and with Dr. Brad Whisnant on how to build your own private practice and be successful (11/3/13).

Want to get a sneak peek on what these doctors will be talking about?

Check out their FREE 1 hour videos here on our TCM Wisdom Tube:

1. Intro to How Acupuncture Works: Simplify How You Educate Patients and Colleagues with David Karaba - learn what happens to the body when acupuncture is performed so that you can communicate with your patients in this Western world we live in!

2. Intro to Practice Management: Making Private Practice Work with Brad Whisnant - learn key concepts like the location of your practice so that you can do well in a private's not as hard as you think!

~Donna Chow, L.Ac.

For more great and FREE recordings of past 1-hr webinars, click here for the TCM Wisdom Tube!

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