Wellness as a condition of integration in a network of natural substances, opening to the world natural knowledge of ancient remedies, according to the flowing of energies as a vibration of quantum, keeping on the consciousness of our material body in a field of lines, flushing memories of time before time record

According to Traditional Chinese Medicine, the key to health preservation is living in harmony with nature. The following are four methods that can keep you healthy:

Cultivation of Mind

Cultivation of mind is a method of keeping physically and mentally healthy by regulating the spirit, consciousness, and thinking. We need to cultivate mental faculties so as to have a cheerful state of mind and control emotions in conformity with changes in the seasons. In the fall, everything is quiet and cool; yang-qi is weakening and yin-qi is growing stronger. We should restrain ourselves in mental and emotional activities so as to keep the spirit in peace and reservation. In the winter, everything on earth goes into hiding. In compliance with this hiding, we should avoid depleting the spirit with emotionless sexual activity. In the spring, when yang-qi ascends and everything comes to life, we should stay relaxed and pleasant. During the summer, yang-qi is in abundance, and everything is flourishing and beginning to bear fruit or go to seed. Accordingly, we should keep ourselves in a cheerful, vigorous frame of mind as well as discharge excessive yang-qi.

Diet Regulation

We depend on food for existence and health. Irregular eating, poor diet or food addictions will harm your digestion and absorption, resulting in disease. To regulate the diet, we should:

• Balance the five flavors: sour, bitter, sweet, acid and salty. Alternate foods in a pattern to acquire complete nutrition.
• Live on a mainly vegetarian diet of light, simple foods.
• Eat three meals a day at fixed times: breakfast at about 7 A.M., lunch around 12 noon and supper at 6 P.M.
• Avoid eating when in any kind of extreme emotional state.
• Eat moderately at each meal, avoiding overeating or starving oneself.
• Regulate the diet with the seasons, as follows:

Spring
Eat more sweet food than sour to nourish the spleen qi. Eat foods that are light and easy to digest.

Summer
Eat lots of fruits and vegetables, like watermelon, tomato, cucumber, celery. Make Mung bean soup to blear away excess heat.

Autumn
Have more juicy and slightly richer foods like pears, orange, apple. Make thicker vegetable or mung bean soup with a little meat.

Winter
This is the time to eat food that is solid, substantial, warming, like root vegetables and nuts.

Proper Balance Between Work and Rest

Normal work and sports activities are beneficial to the flow of qi and circulation of blood, and heighten the body's capacity to resist disease. Proper rest can relieve the weariness of the body and mind and restore physical strength and mental power. Avoid physical strain through protracted exertion, over-exertion, or exertion when hungry or full. Also avoid mental overexertion; as soon as concentration becomes difficult during reading or writing, it is high time to take a rest.

Temperance in sexual activities is also important. Overindulgence damages health and shortens life span. Avoid sex when:

• You are very hungry or too full.
• It is very cold or very hot.
• Emotions are in excess or out of control
• You are ill, or feeling frail or deficient.
• Body or mind are exhausted.
• You've had too much alcohol to drink.

Conform to Nature

In the spring, rise early to stroll in the courtyard, and go to bed late to respond to the active force of the season. In summer, when everything is growing luxuriantly, we should still rise early and retire late to get the appropriate amount of sunshine to respond to the growth qi of the season. In autumn, fruits are ripe to be harvested, we rise later to respond to the season's shrinkage qi. In winter, ying-qi is in excess, and we should carefully avoid wind and cold by going to bed early and rising when the sun rises so as to respond to the storage qi.

Live in peaceful, secluded surroundings

 Fresh air, plenty of sunshine, excellent ventilation, moderate humidity with no pollution or noise – these qualities make your living space habitable. Houses should face the south with the bedrooms on the east to balance yin and yang and light and shade.

Keep regular hours

You should reasonably allocate your time to labor or work, sports, recreational activities, meals, rest and sleep. Generally, we should get up around 6 A.M., breakfast at 7 and consume plenty of fluid and nutrients. Eat lunch at noon, eating until you're almost full, and then have dinner at 6:00 P.M., eating until you're 70% full. Go to bed around 10 and get 8 hours of sleep. Get two to three hours of exercise a week.

Wear the appropriate amount of comfortable clothing

Dress according to the weather. We should keep ourselves warm in spring and dress so as to feel a bit cool in autumn.

"The sages of antiquity did not treat those who were already sick, but those who were not sick... When a disease has already broken out and is only then treated, would that not be just as late as to wait for thirst before digging a well, or to wait to go into battle before casting weapons?" (Nei Jing)

These words, from a classic Chinese Medical text written 4601 years ago, express the primary importance of Preventive Medicine. They are proof positive that Chinese Medicine has long valued Preventive Medicine above emergency disease intervention.

Historically in China, each village was under the care of one doctor. In return, they took care of him (fed him, clothed him, etc.). What's so different about this from the exchange that goes on in modern healthcare? The traditional Chinese doctor's job was to keep the village from getting sick in the first place. Once people got sick, they were unable to support the doctor. It made more sense for him to keep them well than to wait until they were sick.

The most prestigious position for a Chinese doctor was to become the Emperor's personal physician. However, if the Emperor got sick, the doctor could end up executed. The best physician in China was blessed and cursed; for him, preventive medicine was a matter of life and death!

Traditional Chinese doctors were rewarded for preventing disease, and punished for allowing their patients to get sick. Western Medicine is only rewarded if there are sick patients to cure. If no one got sick, most of our health care industry would quickly go out of business.

These cultural influences may be one reason why Chinese Medicine put so much into developing its complex and effective understanding of the causes of disease. If you've had much experience with Western Medicine, you've probably heard the word 'idiopathic' come up a lot. Idiopathic means literally 'unknown cause.' If you ask persistently, you'll find out that in Western Medicine, quite a lot of diseases are considered idiopathic. I'll refrain from concluding, then, that Western Medicine is 'idiodic.' :) There may be some understanding of the underlying pathomechanisms (the ways the disease progresses from nothing to something), and the untangling of the human genome holds great promise, but for now Western Medicine must admit there is much they do not understand about the causes of disease. This explains their blank-spot in terms of the ability to deliver preventive care.

In Chinese Medicine, the only idiopathic disease is the one you have not properly diagnosed. The advantage of CM's simplicity is its ability to lucidly explain, in its own terms, 99.999% of disease processes, and then to right away be able to suggest preventive solutions. Wouldn't it be nice, if you had a family history of diabetes, cancer, or stroke, to have a Chinese Medical Practitioner suggest preventive solutions for your specific constitution and lifestyle?

This is quite a contrast from our conventional Western Medicine and health care system. M.D.'s enjoy a great deal of respect and prestige. We are fascinated with the saving of lives in dramatic situations. And it's comforting to know that these capable docs are there when we need them. It is not coincidental that the most popular medical TV show in history focuses on the ER. We are interested in action and human drama, and the Emergency Room provides plenty of that! But imagine for a second a TV show about Preventive Medicine. What would the storyline be? Our hero, John Q. Healthy, goes to work (but not for too long), comes home and plays with the kids (showing a great deal of heart), eats moderately and healthily (no fast food), takes time out for spiritual devotions, and connects genuinely with his friends, coworkers and spouse. Not too sexy, is it? Doesn't possess the excess, violence, or drama typical of American culture, does it?

But, forget about TV. Forget about fiction. Let's talk about you... yeah, YOU! Do you want to die of a heart attack? Smother to death in advanced emphysema from a lifetime of smoking? Lose your legs to diabetic neuropathy because of your fascination with rich foods? I hope not!

Fortunately, Chinese Medicine (CM) contributes a great deal to our Western understanding of risk factors and behaviors. Because CM was practiced for over 4000 years without lab tests or visual studies, it developed other methods of disease detection. We are able to catch subtle manifestations earlier, and to reverse imbalances quickly instead of allowing them to worsen over years into life-threatening illnesses that finally show up as a blip on the Western Medical screen. Once we know the nature of your imbalance, we can suggest foods, habits, exercises, and herbal medicines that will stop the disease process in its tracks, or at least slow it down.

Living preventive health doesn't sound like much fun. You don't live fast and hard. You might not get to eat all the rich, greasy, or sweet foods you want. You might have to give up coffee (maybe I'll join you...) and alcohol. You might have to choose a job that doesn't pay as muchl so that you have more time to relax, to enjoy, to nurture yourself and your friends and family. You might not get the vacation in Tahiti. You might not need it. You might choose to move to Tahiti instead. Preventive medicine calls us to re-examine every aspect of our lives, our choices, our values, and our plans.

But relax! The good news is that you don't have to change everything all at once. Don't even think about it. Our goal is to make progress rather than attain perfection. If you choose to embrace Preventive Medicine, you are bucking your culture, the mainstream media, the marketing messages that come from some of the richest and most powerful companies out there. And you are joining a growing society of health. Baby Boomers in particular have flocked to Alternative Medicine... so much so that M.D.'s are following us now! They have changed their schools to put more emphasis on compassion, rapport, and the human side of medicine. They take courses in acupuncture. They are writing books about spirituality.

It's clear that, as challenging as it may be to live healthily, Americans are sick of being sick. They want more life, more happiness, and more health. They want solutions. Practical ones. The kind of solutions that two-thirds of the world's population has already gotten from Chinese Medicine. As more and more qualified practitioners flood a starving American healthcare market, Chinese Medicine (acupuncture and chinese herbs) will play a huge part in that solution.

7 Practical Steps to Preventing Disease with Chinese Medicine:

1. LOCATE a practitioner near you.

2. Give them a CALL. If you have more than one to choose from, interview them. Check on their license. Find out about their education and experience (The requirements vary from state to state; many states rely on the National standards. Other states, like California, have higher standards.). Find out if the practitioner was educated in the formulation of chinese herbs. And, make sure they are a good fit for you personally!

3. VISIT your practitioner a few times, at least. The first visit is usually long, perhaps an hour or more. We're quite thorough - we like to get all the information before making a diagnosis. We can treat effectively with acupuncture before herbs (but of course, it depends on your condition). It takes a pretty accurate diagnosis to get the right herb formula.

4. Get a personalized HERBAL FORMULA for your imbalance, and take it regularly. Get Acupuncture as often as they suggest. You may have a talk with them about your financial constraints, if any. Hopefully it is your practitioner's goal to get you well as quickly as possible. Then, (in #6 below) you can negotiate how frequently you visit for maintenance and prevention.

5. Some practitioners are extreme- they want you to change everything right away, re-arrange your diet, stop eating all the 'bad' things, take lots of herbs, and see them weekly so that they can regularly shame you into healthy living. As a self-confessing coffee addict and former smoker, I understand how difficult it can be to change dietary and lifestyle habits. My belief is that acupuncture, herbs, and dietary therapies exist to help you make the transition from imbalance to well-being both possible and comfortable. Real change takes time; moving too fast can lead to short term mega-progress but ultimately result in relapse and a net gain of zero. My point: take your time, change a few things, and stick with it. Be nice to yourself not only in committing to your own well-being, but also in allowing yourself to progress imperfectly, to be human, to make mistakes. But even if your practitioner nags you a bit, you still might get something out of it. Or you might want to have a talk, or try a different practitioner.

6. Work with them until you feel you have hit a PLATEAU. After achieving a new level of health, it's time to talk about your progress and where you want to go next. Perhaps your insomnia is gone but you want to work on your occasional anxiety attacks.

7. At some point, you may experience total well-being; you might feel that you are functioning optimally. In that case, to prevent illness, return to the practitioner on a seasonal or other basis (for example, if you are a teacher, you might want to return right before school starts to make sure the new stress doesn't knock you down. Just before the Holidays is another time to get in good shape to prevent vulnerability to stress and dietary excess).

Ginger Gives You a Snap

Best known in the West for its antinausea properties, ginger has probably been in the longest continuous use of any botanical remedy in the world. The Chinese use it for both medicinal and culinary purposes, frequently in cooking seafood, since it acts as a detoxifier to prevent seafood poisoning. Besides its popular application for digestive distress, ginger has been found to contain geraniol, which may be a potent cancer fighter. It also possesses anti-inflammatory properties that help relieve pain, prevent blood clots, and inhibit the onset of migraine headaches. Since ancient times, Chinese physicians have regularly consumed ginger tea to keep their vitality fired up.

Secrets of the Evergreen

In ancient times, Taoists living in the mountains of China observed that during snowy winters the only plants exhibiting vitality were evergreens such as pines. Through experimentation, they found a therapeutic use for every part of the pine tree: a physical and mental energy boost from pine needle tea and bark tea, antimicrobial properties in sap, and sustenance from pine nuts as a food. Since then, the pine has become a symbol of longevity in Chinese culture.

A potent antioxidant in pine called pycnogenol protects endothelial cells (which make up the lining of the blood vessels and heart) from free radical damage, serves as an anti-inflammatory, and preserves healthy skin structure. It is one of only a few antioxidants that cross the blood-brain barrier, protecting brain cells from the ravages of free radicals in the blood. Pycnogenol is available in dietary supplement form, but the same beneficial flavonoids can be obtained by eating pine nuts.

Longevity for Your Hair

For many people, losing hair is more distressing than getting older. Hereditary factors obviously play a role in premature hair loss but for many others, hair loss can be reversed by natural methods. Start by eliminating hair care products containing harsh chemicals that can damage hair roots and strip vital nutrients from the follicles. Use only products with natural ingredients. Massage your scalp with your fingers or a hard-bristle hairbrush in a circular pattern. Apply the Chinese herb arborvita to stimulate follicles, improve blood flow, and strip away root-clogging oils. I have used this herb for my patients over the last twenty years with very good success. Of course, stress is a common cause of hair loss. Do your best to reduce it in your life.

What is Chi? Chi is your life force, and it determines your energy level. Chi travels and circulates through the channels of our bodies, similar to the way water flows in a riverbed. When your Chi is weak, it stagnates in these channels instead of powerfully flowing. As you age, you may feel as though you no longer have the energy that you once had. Here below are some ways that you can pep up your energy and unblock your Chi.

Instant Chi-Boosting Activities

Try the following steps to ensure a good solid energy foundation:

Breathe deeply all day. Most people who are under a lot of stress or tension breathe shallowly, up in the throat area. When you breathe deeply into your lungs, you are naturally bringing in more oxygen and activating Chi in your body.

Learn to say no to Chi-robbers. These are activities or places that drain your energy and leave you feeling depleted. Some examples of Chi-robbing activities include watching excessive TV, experiencing too many negative emotions, talking too much, and spending too much time in crowded places.

Wear brightly colored clothing and listen to uplifting music to stimulate the flow of your Chi.

Surround yourself with the inspiring colors of beautiful flowers. A bouquet of flowers has a powerful influence on a person's mindset; they can uplift a less-than-lovely mood and even eliminate stress. In fact, one study showed that people who sat next to an arrangement of colorful flowers were better able to relax during a five-minute typing assignment than those who sat near foliage-only plants.

Have fun and be spontaneous! If you don't enjoy your day, then your energy will naturally become suppressed. Do something that you enjoy everyday. Start now and your Chi will follow.

Foods that Increase Your Chi

To have good Chi, your nutritional intake must consist of a balanced diet of grains, vegetables, fruits, nuts, and seeds, beans, fish, fowl, meat and fruits.

Foods and herbs that possess special Chi-fortifying properties include: brown rice, carrots, chicken, china root, eggs, fish, fox nut, ginseng, green beans, leeks, longan fruit, nutmeg, lamb, lotus seed, oats, onion, pearl barley, potatoes, pumpkin, soybeans, squash, string beans, tofu, turnips, and yams.

Also, keep in mind that to receive optimal benefits from food and herbs, it is crucial that you choose in-season, natural foods with no chemical additives or residues. Also, avoid overeating and under-eating because both will rob you of a consistent source of energy.

Are you often tired after the simplest activities? Do the days drag on until you reach home, only to slump on the couch and crash, unable to enjoy your daily activities? If so, you are suffering from low energy. Energy normally fluctuates according to daily rhythms, which vary from person to person. In general, we have more energy in the morning and wind down toward the evening. However, many people suffer from chronic low energy and fatigue. They start the day tired and end the day tired. The causes of low energy are numerous. But first and foremost, low energy is often a result of stressful living in our modern world. Coping with stressful situations requires a lot of energy, leaving the average person drained and at times depressed. Poor diet also contributes to low energy. Instead of eating foods with a sustainable energy content, most people eat too many foods made of simple sugars, which supply a rapid burst of energy, but burn out fast and furious, leaving us depleted. Lack of exercise is the final nail in the coffin. Exercise helps us deal with daily stresses; without it, the body is rapidly depleted of vital energy.

Energy is qi. The level and quality of a person’s qi define how he or she feels. Chinese medicine recognized the concept of vital energy thousands of years ago and has developed a full understanding of the essential functions and role of qi in health and wellness. As a result, very effective means of addressing low energy have been developed. Once we’ve figured out the underlying cause of the fatigue, I work with internists to create a treatment plan specific to each patient’s needs. Treatment usually consists of acupuncture and herbal therapy for three months or more, depending on the condition. I then counsel each patient on a dietary, lifestyle, and mind-body exercise regimen. In the more than twenty years that I’ve been working with patients with low energy, I’ve helped the majority of my patients overcome their fatigue.

Here are some dietary tips you can begin using. For more advice on herbal therapy, exercise, acupressure, and daily supplements, check out “Secrets of Self-Healing.”

~ Quick Diet Tips ~

• For sustained vitality and energy, the foods you consume must be wholesome, organic, and packed with essential vitamins, minerals, and nutrients. The foods you eat must also be easily digested and absorbed.
• Avoid all forms of processed sugar, including sodas, sweetened juices, and pastries. Sugar is extremely damaging to your energy levels, as the initial rush is followed by a spectacular crash, something we’ve all seen in children.
• Alcohol, coffee, deep-fried and fatty foods, and cold, raw food should also be avoided, as they can injure the spleen and stomach and impair digestion.

Chronic stress seems to be our national disease, especially these days. Millions suffer from symptoms of stress: nervous tension, restless sleep, difficulty focusing and remembering, irritability, and health complications. Generally speaking, stress speeds up aging. Learn the ways to manage stress, and you will look and feel younger.

1. Start your day with meditation
Spend time every day in meditative relaxation, with calming music if you desire. Start with five minutes and work your way to 15 or 20 minutes each day. Meditation is your number one way to reduce the output of stress hormones and avoid adrenal exhaustion, serious threats to your health.

Try this Stress Release Meditation: Breathe consciously, relax, and with each exhale focus on relaxing each area of your body in sequence, starting from the top of your head and moving all the way down to your toes.

2. Manage your mood with diet and herbs
Chinese Medicine considers the liver to be the center of your emotions. To allay stress and balance your emotions, keep your liver healthy and happy:

• Every day, eat lots of green leafy vegetables, barley grass, seaweed - anything high in chlorophyll - to keep the liver in good health.

• Take 500 mg dandelion daily for a month or longer to cleanse the liver and help release built-up anger.

• Take 400 mg white peony root daily for 1 to 3 months to soothe the liver and balance your mood.

• Schisandra berry protects the liver from chemicals and calms the spirit. For emotional anxiety, take 200 mg daily for a month.

Take these herbs anytime during the day and before bed in tea or capsule form. All the herbs are available from health food stores and Eastern medicine practitioners. Many of my patients have had remarkable results with Calm-Fort Elixir, an all-natural formulation of herbs to calm your spirit. For more information, click here.

3. Suppress stress with positive thinking
Instead of letting your thoughts run wild with anxiety, say affirmations to yourself, such as "I can handle the tasks I have ahead of me. I enjoy my responsibilities and fulfill them well." In fact, repeating positive affirmations can actually suppress the cortisol that the adrenal gland releases in times of stress - leaving you peaceful and calm.

4. Get stress out of your head and on paper
Writing in a journal every day can help you release thoughts and emotions that are causing you stress. Write from the position of an observer, recording your thoughts without any judgments. Just write it down so that you can see clearly what is going on inside. The next step is to identify the source of any anger or stress so you can begin to make changes. Looking into your thoughts give you the opportunity to gain insight into your feelings and reflect the underlying issues.

5. Unblock tension with exercise
The constant pressures of your job and family can lead to chronically elevated levels of the stress hormone cortisol, which is a direct cause of muscle and joint pain. Clenched jaw? Lump in your throat? Chronic back and neck pain? These can all be manifestations of stress in your body. Release physical tension and clear these emotional blockages by using massage therapy, exercise, yoga, tai chi, or qi gong to get the circuits moving.

6. A Retreat to Avoid Burnout
Overloading your brain is a recipe for stress and health problems. Information overload is particularly harmful at midlife because we have less tolerance for stress, which can contribute to high blood pressure and heart disease. Press the "reset" button on yourself. Give yourself a retreat from the stresses of modern life. Take one day out of the seven-day week to minimize "screen" time. Don't watch TV, don't check email, and don't look at the news - it will be there tomorrow, and after a day of rest, you will be refreshed and ready to look at them.

7. Perspective from the Natural World
Use nature to reduce stress. Go outside, hike in the woods, walk on the beach, anything that puts you in contact with the natural world. It is difficult to feel stressed when you are surrounded by nature's abundance of vitality and wonder.

Know Yourself

Appreciate who you are. In Taoist healing tradition, this is called
the Wu Dao, "knowing the Way". The Way means your true nature. Take
time to reflect on your life and take inventory of your strengths and
weaknesses.

Ask yourself; What are you good at? What are you not good at? It is
important to accept where you are at and to realize that no one is
perfect. It is then from this place of acceptance that you can create
meaningful change in your life. I encourage you to explore ways to
improve your life. This can be by minimizing the impact of your
weaknesses and do what you can everyday to face your challenges. In so
doing, you are already perfect in every way. This is the essence of Wu
Dao.

Know Your Qi

Qi or vital energy is the fuel of life. If you have an abundance of Qi
you have a strong constitution and abundant vitality. Many of our
patients suffer from decreased vitality causing them to experience
difficulty with normal life challenges. Restoring your Qi is vital for
health and wellness.

It is important to find ways to strength your vitality to create
balance in your life. When your energy is good life's challenges seem
much easier to cope with.

Qi is the foundation of our health and wellness. You can strengthen
your Qi by eating nutritious foods, exercising regularly and getting
adequate sleep. In Chinese Medicine it has been know that regular
acupuncture, herbal tea, meditation and Qi Gong are wonderful ways to
restore your vitality and health and reverse the aging process.

Create Happiness in Your Life

Wu Wei means being empty and engaging your life with openness.
Changing your perspective in life, by welcoming changes as
opportunities to grow your life can become more simplified and richer.

True happiness is created gradually and not purchased at the mall.
When you are happy, life seems more meaningful and less burdensome.
Don't wait for something or someone to make you happy. If you are not
happy now, it is unlikely that you will be happy in the future unless
you change your life. It is common to look outside ourselves for
reasons to be happy. For example when children are unhappy they often
look to the future and long for the time when they are grown up. For
those who are poor they may long to have more money and feel that this
would make them happy. While those who are single often long for the
perfect partner to make their life complete and give them happiness. A
constant longing for things outside of your present situation creates
an endless cycle of unhappiness and is unsettling to your spirit. True
happiness starts with acceptance of self and what is in front of you
today in life and what you have. Remember to embrace life with open
arms and fluidity, approach dangerous situations as opportunities to
learn, and most importantly, create your happiness now and don't wait.

Be Selective with Your Engagement

By knowing yourself and what you can handle allows you to be selective
in life, and thereby guard against over extending yourself. Is it
necessary to keep up with the latest headline news every night? I
would propose that filling yourself with information does nothing to
improve the quality of your life as it even may distract you from
focusing on what is truly important in your life. I suggest being
selective with the information you receive, focus on that which is
essential to your health and well being and minimize the rest. I
invite you to try a simple experiment. Turn off all electrical
information devices by a certain time every night. This includes
computers, TV and Blackberry. Try it for one month and see if you are
more relaxed and have a more peaceful sleep, see if you really miss
the mental stimulation in the evening.

Creating time to be quiet and having free time to daydream and play is
beneficial to your physical and psychological well being. This comes
back to knowing the quality of your Qi.

Compassion

Bo Ai means unconditional compassion. This begins with loving life.
Value and treasure your life, never abuse your talents and bring love
to those who surround you. This includes people, plants, animals, and
even your possessions.

There is nothing more divine and beautiful than showing humility. I
recommend you do something from your heart everyday. This can be as
simple as a smile, or offering a helping hand in your community to
assist others. By bringing more compassion into your life, you have
expanded your capacity for life. It then becomes more difficult to
overload your life.

You will notice these five elements are really about changing your
perspective and attitude in life. It is not about doing more or less
of what you are already doing, but to approach it differently. By
practicing these simple but potentially profound essential elements,
we hope your life will be richer, healthier and happier. If you have
any questions please contact us as your wellness is our priority.

Acupuncture helps people recover from drugs and alcohol problems. It is used in clinics through the United States. Acupuncture can decrease cravings for drugs and alcohol, reduce withdrawal symptoms, relieve tension, and help people relax. Acupuncture treatments, taken enough times, clear the mind, build energy, and give a sense of well being.

According to Chinese tradition, placing acupuncture needles in the ear affect specific organs such as the liver and kidneys. Western science has confirmed that acupuncture treatments change levels of chemicals in the body and act on the nervous system. Acupuncture itself is not a substitute for therapy but is used in addition to counseling and self-help programs.

How it all began

One day in the early 1970's, H.L. Wen, MD., then the only neurosurgeon in all of South China and Hong Kong, was preparing to use electro-acupuncture as surgical analgesia and the patient, who happened to be experiencing withdrawal symptoms from opium at the time, reported his symptoms had disappeared. Wen canceled the surgery and scouted the hospital for other patients in withdrawal. He gave his pre-op procedure to them and their symptoms also ceased. Acupuncture for substance abuse was born.

Why Acupuncture for Detox?

• Reduces the physical symptoms of withdrawal.
• Relieves depression, anxiety, and insomnia.
• Profoundly relieves withdrawal symptoms including cravings, body aches, headache, nausea, sweating, muscle cramping, etc.

The acupuncture detoxification program is an ideal partner with other programs. It alleviates withdrawal symptoms so mental and physical stability are quickly achieved. This gives a new level of comfort allowing for more effective counseling. Twelve Step program participation, or participation in any other treatment program is considered important to sobriety.

In addition, acupuncture...

• Can be used safely with any other health condition.
• Does not utilize other abusable, addictive drugs for treatment
• Can be effectively done on an outpatient basis.
• Is successfully used as a drug detoxification method at over 100 different drug treatment clinics in the United States and is also successfully used for this purpose in at least 25 other countries.

Acupuncture Treatment

Five tiny needles are placed in each ear, and then the clients rest quietly for 45 minutes. This is a good time to relax, meditate or think about changes to be made in your life. In detoxification treatment, points in the ear correspond to specific organs including the lungs, liver, kidneys and nervous system. One of the points is for relaxation. The treatment triggers the release of natural body chemicals, including endorphins, which help reduce cravings for drugs, ease withdrawal symptoms, and increase relaxation.

How Will I feel During the Treatment?

Once the needles have been placed, your ears may tingle or feel warm. Some people even fall asleep. These are normal responses. Some people say they feel very relaxed when they are having a treatment, other's don't feel much at all. Even if you don't feel much you are getting benefit from treatment. Acupuncture is most effective after a series of treatments over a period of time.

The Detoxification Process

During detoxification, your body filters out the toxins that you have been storing up. Blood circulation begins to improve. Sometimes during the detoxification period you may feel achy, not sleep well, be cranky, or even have drug dreams. Please let the acupuncturist know if you have any of these symptoms so that additional acupuncture points can be added to your treatment.

How to Receive Maximum Benefit From Treatment

• Treatment time should be used to sit quietly, relax and reflect or meditate.
  
• Do not smoke cigarettes or drink coffee in the half hour before and after treatment.
  
• Let the acupuncturist know if you have any health problems.

Get daily acupuncture treatments for the first two weeks, then three treatments a week for several weeks, then two treatments per week for several additional weeks. Final treatments should be once a week. If relapse occurs or something stressful happens in your life, then additional treatments are recommended.

In 1972, a Hong Kong neurosurgeon, H.L. Wen, M.D., conducted research that indicated that acupuncture could alleviate symptoms of drug withdrawal, and the modern use of acupuncture for this purpose was born. In drug addiction, exogenous opiates bond to receptor sites normally occupied by endogenous endorphins. One of the ways acupuncture may facilitate withdrawal is by activating the release of previously suppressed natural endorphins, which can then occupy the receptor sites formerly dominated by the narcotic drug. The acupuncture treatment has a naturally calming effect, improves energy and concentration, soothes irritability, and promotes restful sleep. It can also aid the natural cleansing abilities of the liver, kidneys, and lungs.

In 1974 the Lincoln Memorial Hospital in the South Bronx started the first outpatient clinic offering acudetox. In 1985, the National Acupuncture Detoxification Association (NADA) was established to promote education and training in the use of this detox protocol. Acupuncture detoxification evolved rapidly and is now used effectively to relieve symptoms during detoxification, prevent relapse, and support long term recovery. Currently there are thousands of programs throughout the United States and Europe. Acudetox should be used in combination with other treatment modalities such as group counseling, Twelve Step, psychotherapy, or Social Model programs. Properly administered, acupuncture can enhance and support the program goals of virtually any traditional chemical dependency treatment, but loses much of it's efficacy when practiced in isolation.

The treatment protocol developed at Lincoln Hospital in New York, and furthered by NADA, consists of the insertion of five small sterile needles at specific sites on the skin of the outer ear. Treatments are approximately 45 minutes long and are often performed in a group setting. The treatment is painless, leaving most patients relaxed, with increased energy and mental focus, and is complemented by an herbal formula to promote relaxation and assist the body's recovery from the harmful effects of the abused substance. Although originally developed for the treatment of narcotic addiction, the use of acupuncture can effectively enhance treatment for most drugs, as well as alcohol and nicotine.

Generally, patients are treated daily for the first week, tapering gradually week by week. After one month of treatment, most patients who have been consistent with treatment are successful. Drug and alcohol treatment protocol is more lengthy, but follows a similar tapering of treatment over time. Some patients simply do not respond well to treatment in private practice, in which case a treatment center which includes acupuncture is the best option.

 Alzheimer's, Stroke and Parkinson's Disease

"The silent epidemic" is regarded by many as the disease of the 90's. The silent epidemic is a term which refers to neurodegenerative disorders (such as Alzheimer's disease, sequelaes of stroke & Parkinson's disease) which plagues the majority of the geriatric population but is poorly recognized by the society due to their low public visibility and their social isolation. Though neurodegenerative disorders include a vast number of illnesses, this article will attempt to focus its discussion on Alzheimer's disease, stroke sequelaes, and Parkinson's disease. This article will approach these three illnesses from the viewpoints of both Western and Oriental medicine, and will further explore treatment options specifically with acupuncture and herbal therapies.

Neurodegenerative Disorders According to Western Medicine

The fundamental principle in Western medicine is that nerve cells cannot regenerate once they die. Alzheimer's disease, sequelaes of stroke, and Parkinson's disease each involves the death and atrophy of neurons (nerve cells) in the brain. Therefore, this is no cure for neurodegenerative disorder at the present time. All available treatment options focus on symptomatic treatment only.

Though the causes may differ, patients with neurodegenerative disorders are likely to show localized to generalized atrophy of brain cells leading to compromises in both mental and physical functions. Mentally, the patients will exhibit forgetfulness, poor memory, decrease in mental capacity, emotional disturbances, poor speech, etc. Physically, the patients will exhibit partial to complete incontinence, aspiration of food particles, tremor, poor balance, muscle rigidity, muscle paralysis, etc. These decreases in mental and physical functions dramatically reduce the quality of life for the patients and increase the burden of the family and care-takers.

Neurodegenerative Disorders According to Oriental Medicine

Neurodegenerative disorders are complex with an onset that is followed by progressive deterioration. Their clinical manifestations are determined by the location and the seriousness of neurodegenerative disorders. Its pathogenesis is a mixture of deficiency and excess conditions, represented by the deficiency of kidney essence or the blocking of the brain channel by blood stasis (an excess condition) - or both.

The cause of neurodegenerative disorders lies not so much in the brain (though it is the brain that shows the symptoms) as in the kidney, which according to the theories of Traditional Chinese Medicine controls the bone and generates the marrow. From the point of view of disease differentiation through viscera and their interrelations, the root of the disease is due to the deficiency of the kidney and the bone marrow. While the blood stasis and the phlegm accumulation are considered as the symptoms, not the cause. Therefore, the keys to treating neurodegenerative disorders are to tonify the kidney, eliminate the phlegm, remove blood stasis and induce resuscitation.

Treatment of Neurodegenerative Disorders with Acupuncture

According to the theories of Oriental Medicine, the spirit (shen) resides within the heart and the brain. The spirit is affected by the overall mental and physical health of a person. If the spirit is damaged, both the mental and the physical functions of a person would be greatly compromised. Deterioration in mental functions may result in delirium and dementia with the decline in physical functions resembling complications of stroke. Therefore, the treatment for neurodegenerative disorders should focus on awakening up the spirit (shen), opening up the sensory orifices and stimulating the brain. Dr. Zhang's treatment of neurodegenerative disorders and stroke involves awakening the spirit (shen), opening up sensory orifices and stimulating the brain. He focuses his treatment by selecting acupuncture points from the Yin channels. The selection of points are as follows:

Treatment of Neurodegenerative Disorders with Herbs

Dr. Zhang believes the continual use of herbs is the key to recovery for patients with neurodegenerative disorders. Through many years of experience, he has used herbs to successfully treat patients with a decrease in mental and physical functions with such symptoms as poor memory, forgetfulness, slow and delayed responses, tremor, muscular rigidity, poor balance, difficulty walking, slurred speech, tongue stiffness, involuntary salivation, frequent urination and constipation.

The herbal formula of choice is Neuro Plus (Nao Wei Kang Wan), formulated by Dr. H. Zhang after 40 years of clinical experience treating geriatric patients. It functions to tonify the kidney and its essence, regulate Qi and blood circulation, remove blood stagnation and open up the sensory orifices. Clinical applications of Neuro Plus (Nao Wei Kang Wan) include patients with different types of neurodegenerative disorders who exhibit a decrease in both mental and physical functions. In China, many patients who were previously diagnosed with dementia, Alzheimer's, stroke, or Parkinson's have benefited from taking Neuro Plus (Nao Wei Kang Wan) if they exhibited the symptoms and signs listed above.

The recommended dosage is 6 grams per day, or 4 capsules three times daily. The patients will generally begin to show improvements after two to four weeks of therapy. However, for acute type of neurodegenerative disorders such as stroke, the patient should take the herbs continuously for one month prior to making a clinical evaluation. And for chronic types of neurodegenerative disorders such as Alzheimer disease, the patient should take the herbs continuously for three months prior to making a clinical evaluation.

Neuro Plus (Nao Wei Kang Wan) is a patented herbal formula in Tianjing, China and is currently distributed by Evergreen in the United States. The list of ingredients is as follows: morinda (ba ji tian), eucommia (du zhong), lycium fruit (gou qi zi), polygonum (he shou wu), alpinia fruit (yi zhi ren), cuscuta (tu si zi), cornus (shan zhu yu), cordyceps (dong chong xia cao), Ginseng (ren shen), dioscorea (shan yao), astragalus (huang qi), american ginseng (xi yang shen), white atractylodes (ba zhu), poria (fu ling), pseudoginseng (san qi), crataegus (shan zha), leech (shui zhi), salvia root (dan shen), carthamus (hong hua), anteater scales (chuan shan jia), gastrodia (tian ma), tokoro (bei xie), fresh rehmannia (sheng di huang), scolopendra (wu gong), polygala (yuan zhi), acorus (shi chang pu), angelica (bai zhi), testudinis (gui ban) and cornus cervi fragments (lu jiao shuag).

Lifestyle Instructions

 Most people experience feelings of anxiety before an important event such as a big exam, business presentation, or first date. Anxiety disorders, however, are illnesses that fill people's lives with overwhelming anxiety and fear that are chronic, unremitting, and can grow progressively worse. Tormented by panic attacks, obsessive thoughts, flashbacks of traumatic events, nightmares, or countless frightening physical symptoms, some people with anxiety disorders even become housebound. Fortunately, through research supported by the National Institute of Mental Health (NIMH), there are effective treatments that can help.

How Common Are Anxiety Disorders?

Anxiety disorders, as a group, are the most common mental illness in America. More than 19 million American adults are affected by these debilitating illnesses each year. Children and adolescents can also develop anxiety disorders.

What Are the Different Kinds of Anxiety Disorders?

• Panic Disorder—Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.
• Obsessive-Compulsive Disorder—Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.
• Post-Traumatic Stress Disorder—Persistent symptoms that occur after experiencing or witnessing a traumatic event such as rape or other criminal assault, war, child abuse, natural or human-caused disasters, or crashes. Nightmares, flashbacks, numbing of emotions, depression, and feeling angry, irritable or distracted and being easily startled are common. Family members of victims can also develop this disorder.
• Phobias—Two major types of phobias are social phobia and specific phobia. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.
• Generalized Anxiety Disorder—Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.

What Are Effective Treatments for Anxiety Disorders?

Treatments have been largely developed through research conducted by NIMH and other research institutions. They help many people with anxiety disorders and often combine medication and specific types of psychotherapy.

A number of medications that were originally approved for treating depression have been found to be effective for anxiety disorders as well. Some of the newest of these antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Other antianxiety medications include groups of drugs called benzodiazepines and beta-blockers. If one medication is not effective, others can be tried. New medications are currently under development to treat anxiety symptoms.

Two clinically-proven effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy focuses on changing specific actions and uses several techniques to stop unwanted behaviors. In addition to the behavioral therapy techniques, cognitive-behavioral therapy teaches patients to understand and change their thinking patterns so they can react differently to the situations that cause them anxiety.

Do Anxiety Disorders Co-Exist with Other Physical or Mental Disorders?

It is common for an anxiety disorder to accompany depression, eating disorders, substance abuse, or another anxiety disorder. Anxiety disorders can also co-exist with illnesses such as cancer or heart disease. In such instances, the accompanying disorders will also need to be treated. Before beginning any treatment, however, it is important to have a thorough medical examination to rule out other possible causes of symptoms.

References:

National Institute of Mental Health (NIMH)
National Institutes of Health (NIH)

Nutritional and Herbal Therapy for Anxiety

• Include calcium (1,000 mg a day) and magnesium (500 mg a day) supplements to your diet. Try taking half the amount in the morning and half at night to increase better absorption of calcium. Also, take a B complex (50 to 100 mg a day, best in the morning) to decrease stress effects.
• Avoid stimulating foods and drinks: caffeine, sugar, processed foods and alcohol. Avoid foods that commonly cause food sensitivities (peanuts, soy, dairy, wheat, corn, shell fish). Increase consumption of fresh vegetables and whole grains.
• There are  some very safe and effective Chinese herbal formulas that help decrease anxiety and help improve sleep such as Traditions of Tao - Anxiety/Sleepless Formula, a modified An Mian Wan formula
• Kava kavacan help for mild to moderate anxiety.
• St. John's Wort helps with both depression and anxiety.
• Passionflower is helpful for anxiety with insomnia.

As the population of America ages, the most common health concern of physically active baby-boomers is the condition of their joints. It is estimated that 70 million Americans have some form of arthritis. Furthermore, countless Americans undergo surgical procedures for joint injuries every year. Besides obvious traumas, common causes of arthritis include heredity, infections, aging and environment. If left untreated, arthritis and joint problems can be crippling and vastly affect one’s quality of life.

Chances are you or someone you know has arthritis. Arthritis is one of the most common diseases in the U.S. and is the leading cause of disability. According to the Centers for Disease Control and Prevention, one out of every three Americans is affected by one of the more than 100 types of arthritis. These include conditions such as osteoarthritis, rheumatoid arthritis, gout, carpal tunnel syndrome, lupus, Lyme disease, ankylosing spondylitis, bursitis, tendonitis and fibromyalgia to name a few.

The cause of most types of arthritis is unknown. Scientists are currently studying aging, genes, environment and lifestyle factors that contribute to the development of arthritis. The most common symptoms involve pain, stiffness and swelling around the joints or soft tissue. This can contribute to difficulty in daily activities that require movement. Other symptoms may include fatigue, fevers, depression and weight gain.

The one common characteristic of any arthritic condition is inflammation. The inflammation is an immune system response to a foreign invasion (virus), injury or dysfunction (auto-immune response). Conventional treatments include anti-inflammatory agents, steroids and other immuno-suppressant drugs complemented by physiotherapy. The side effects of conventional treatments can be immense and often trouble arthritic patients for the rest of their lives.

There is another way to obtain relief from arthritis without the side effects of taking drugs—the Chinese medicine way. This alternative to western medicine is several thousands of years old with a strong track record of good results.

In Chinese medicine, arthritis is called a “Bi” or “stagnation and stasis” condition. We categorize “Bi” conditions according to their symptomatic characteristics such as location, intensity of pain, amount of heat or inflammation and amount of swelling and disability. For example, arthritic pain that moves from joint to joint is called “Xin Bi” or moving arthritis.

Both external and internal factors can cause arthritis. External causes include invasion by pathogenic factors such as wind, cold or dampness that obstruct the normal flow of Qi and blood, thereby resulting in swelling, stiffness, numbness and pain of the joints and soft tissues. Internal causes include emotional stress weakening the defensive ability of one’s immune system and depletion of the Kidney/vitality system resulting in degeneration of one’s bones, tendons and cartilage.

Treating arthritis in Chinese medicine focuses on ridding the body of the invading pathogens, restoring normal circulation and flow of blood and Qi, promoting emotional harmony and fortifying the Kidney/Vitality system. Effective treatments include acupuncture, moxibustion, herbal and dietary therapy, exercise therapy, cupping and massage.

Acupuncture

Acupuncture has been found to be clinically effective in reducing arthritic pain and improving mobility and circulation. Often, localized acupuncture therapy directly on the joint or tissue itself, with or without electrical stimulation or moxa (heat therapy with the herb mugwort) can be extremely helpful in managing arthritis. This obviously requires obtaining treatments from a licensed acupuncturist.

Herbal Therapy

Herbal therapy is useful in reducing inflammation, nourishing joints and soft tissues and improving one’s energy. It may also be a useful replacement for anti-inflammatory drugs that some people find upsetting to their stomach. Besides relieving arthritic symptoms, it is as important to nourish and prevent the onset of arthritis. There is good news for arthritis sufferer unable to access acupuncture treatments.

Traditions of Tao, a company dedicated to the research of herbal products for modern needs formulated Healthy Joint and Arthritis Elixir to help people nourish and promote the proper function of their joints. It also offers relief of symptoms of arthritis.

The Healthy Joint and Arthritis Elixir is specially formulated based on long years of Ni Family clinical success in helping their patients with joint conditions.

This proprietary formula contains licorice root and peony root, which soothe pain and spasms; notopterygium root and Korean ash bark dispel dampness from the joints and restores flexibility; eucommia bark and mulberry stem nourish the joints; dang gui root, sheng di root and Szechwan lovage root promote proper lubrication of the joints; astraglus root modulates and balances the immune system; Chinese lovage root, peach kernel and safflower support proper circulation; and finally poria root helps proper stomach and digestive function.

Dietary Therapy

Dietary Therapy advocates avoiding foods that produce dampness or mucous that may further obstruct the flow of qi and blood in the channels, therefore exacerbating the arthritis.

Foods to avoid:

• cow milk products (milk, cheese, yogurt, butter, ice cream, etc.)
• night shade vegetables (tomato, eggplant, peppers, potato)
• deep fried and fatty foods
• processed and refined foods
• cold and raw foods (salads, fruits)
• wheat
• red meat
• alcohol
• coffee
• sugar

Exercise Therapy

Exercise Therapy focuses on joint mobility, increasing circulation and strengthening tendons, ligaments and muscles. The best types of exercise include water exercise, taiji, qigong, gentle yoga, stationary bike, walking and light weight-training.

Cupping and Massage

Cupping and Massage are treatment modalities designed to vastly increase circulation to affected areas, ridding toxins and waste products that aggravate inflammation and introducing the joints and tissues to fresh nutrients and oxygen. These techniques are effective for reducing swelling, stiffness and pain.

There is no reason why you cannot live a full and active life, even if you suffer from arthritis. The therapies listed above, either alone or in combination can vastly improve your quality of life if you practice them diligently.

1. Weakness of the Internal Organs:

We already know that the condition of the internal organs is closely related to our health. According to Chinese medicine, there are five Yin organs which are considered the most important for our health and longevity. These organs are the heart, liver, lungs, kidneys, and spleen. Whenever any of these five organs is not functioning properly, sickness or even death can occur. Furthermore, all of these five organs are mutually interrelated. Whenever there is a problem with one, the others are always involved too. For example, gouty arthritis is caused by the improper functioning of the liver and kidneys.

2. Defective Genes:

Only recently it was reported that some forms of arthritis are caused by defective genes, which are inherited from one's parents. According to Chinese medicine, the genes are considered the essence of your being. This essence is responsible for the production of hormones, from which Qi is generated. When this Qi is led to the brain, the spirit is raised. When all of these conversion processes are functioning normally, the immune system is strong and sickness is less likely. One of the main goals of Qigong is learning how to convert the essence into Qi efficiently and lead it to the brain.

3. Weak Joints:

Weak joints can come from heredity or from lack of exercise. The body is a living machine, so the more you use it, the better condition it will be in. Chinese medicine believes that even if you have inherited a weak joint it is still possible to strengthen it through Qigong. When you exercise, Qi is brought to the joint by the movement of the muscles and tendons. This will nourish the joint and rebuild it.

4. Injury:

According to today's medicine, some forms of arthritis are caused by injury to the joints. Although the injury may not be serious, it may have significant results. The injury can affect the muscles, tendons, ligaments, or even the cartilage and bone. Whenever any joint injury, even a minor one, is not treated, the normal smooth Qi circulation in the joint area will be affected. If the situation persists, the Qi imbalance can cause problems such as arthritis.

5. Aging:

Aging has always been the cause of many sicknesses, including arthritis. When you are old, the Qi level in your body is low. Since your system is being deprived of the required amount of Qi, it starts to degenerate. One of the main goals of Qigong practice is learning how to slow down the aging process by building up the Qi in the body.

6. Qi Deficiency:

Qi deficiency is responsible for many problems. It can be caused by emotional depression and sadness, which can lead the Qi inward and make the body Yin. This deprives the outer body of Qi. When this happens, you will generally feel cold. If the problem persists for a long time, the muscles and tendons will be affected by the the lack of Qi, and the joints will be weakened.

Qi deficiency can have other causes, such as the weather. For example, your body's Qi is more deficient in the winter, and there fore, arthritis can be more serious then.

Qi deficiency can also be caused by working for prolonged periods in a damp area, or by exposing your joints to the cold.

7. Tension:

Tension includes both mental tension and physical tension, which are related and cannot be separated. Constant mental and physical tension can increase the pressure on the joints. For example, some people are very tense and grind their teeth in their sleep, which can cause arthritis in the jaw.

A lot of body tension is caused by the emotional disturbance which is related to your mental reaction to stressful events. For this reason, learning how to regulate your mind is an important part of the treatment of arthritis.

2-5. Other Possible Means of Preventing or Curing Arthritis

In addition to the ones already discussed, there are a number of other methods of preventing or curing arthritis. Although many of them are still awaiting scientific confirmation, they may be worth your consideration. However, you must understand that everybody has his or her own unique characteristics, and his or her own unique inheritance. In addition to the habits and lifestyle that each person has developed, everyone's mental and physical structure is different. For example, some people are affected by allergies while others are not. What this means is that you cannot necessarily use the same method to treat different people, even when they have the same disease. Even modern Western medicine has found that the same treatment will not work equally well on all patients. Therefore, do not automatically brush off some of the treatment methods we will discuss. After all, Western medicine is only in its infancy, and it may come to understand and accept these alternative remedies.

1. Diet:

People who are experienced in Qigong have always considered food to be a significant influence on the condition of the Qi in the body. For this reason, diet is one of the main concerns of Chinese medicine. There is a saying: "You are what you eat." It is well known that improper diet is one of the main causes of gouty arthritis. The Chinese have found many different herbs that can ease the pain and reduce the swelling of arthritis. It has recently been discovered that protein, calories, and fats can reduce the inflammation of arthritis. Certain fish oils may interfere with the process of inflammation and therefore reduce the symptoms of rheumatoid arthritis.(*5, *6).

2. Change of Residence:

Since the Qi in your environment can affect the Qi in your body, arthritis sufferers should give serious consideration to this method. If the climate where you live is too damp or too cold, it may be affect ing your arthritis. It has recently been discovered that the Qi in our bodies can be significantly affected by the electromagnetic fields generated by modern technology, and therefore cause some forms of cancer. For example, people who live near high tension power lines tend to get cancer more often than those who do not. Perhaps similar environmental effects on arthritis will be found.

3. Change of Lifestyle:

Your lifestyle affects how the Qi circulates in your body. If you frequently feel ill, especially mentally, you might need to change your lifestyle. How you think and how you coordinate the Qi pattern in your body with the natural Qi is very important for your health. Whenever your Qi circulation is against the "Dao" (nature), you will be sick. You may find that walking for an hour or doing Qigong exercises every morning improves your Qi circulation.

4. Clothing:

What you wear also affects the Qi in your body. In the winter you must stay warm, and especially protect your joints. Joints that are left unprotected can loose Qi very quickly.

It has been discovered that many man-made fibers can adversely affect the Qi distribution and circulation in the body. For example, polyester is known to cause Qi stagnation, and to prevent the body's Qi from exchanging with the environmental Qi. You may have noticed that clothing made of polyester can accumulate a considerable charge of static electricity in the winter. This builds up an electromagnetic field and affects the Qi circulation in your body. There are many other ways of improving the condition of your arthritis. For example, it is reported that sexual activity can stimulate the adrenal glands to produce more corticosteroid, a hormone that reduces joint inflammation and pain. It is believed that sexual activity may also trigger the release of endorphins, a naturally occurring painkilling substance.(*7) You can see from our brief discussion that, if we want to under stand arthritis completely, we must remain humble and continue our study and research. Only then will we be able to reach the goal of a complete care.

Rheumatoid arthritis (RA) is a chronic disease, mainly characterized by the inflammation of the lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in chronic pain, loss of function and disability.

RA progresses in three stages. The first stage is the swelling of the synovial lining, causing pain, warmth, stiffness, redness and joint swelling. The second stage is the rapid division and growth of cells, which causes the synovium to thicken. In the third stage, the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, eliciting more pain and loss of movement. Because of its chronic nature, RA continues indefinitely and may not go away. Frequent flares can occur.

RA affects people differently. For some people, it lasts only a few months or a year or two and then goes away without causing any noticeable damage. Other people may have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods when they feel better, called remissions. Still, others may have a severe form of the disease that is active most of the time, lasting for many years or even a lifetime. This form can lead to serious joint damage and disability.

The cause of RA is unknown. According to Traditional Chinese Medicine, this condition is called Bi Zheng, which is typically divided into four types: Wind-Cold Bi, Cold-Bi, Dampness-Bi and Heat-Bi. Through a thorough examination and consultation, including an assessment of the pulse and tongue, a diagnosis is made. Specific acupuncture points and herbs are prescribed and an appropriate diet is designed for the patient to follow. For Wind-Bi, adding green onions and ginger to your diet will help expel the Wind. For Cold-Bi, choose black pepper and dry ginger. Soy bean sprouts and pearl barley are beneficial for Dampness-Bi. For Heat -Bi, you should consume mung bean sprouts and winter melon.

Generally, your daily diet should include enough fresh vegetables, and foods rich in omega 3 and 6, such as flax seeds, sunflower seeds and walnuts. Supplement 100% of your calcium. During flares, eat more bitter melon and dandelion greens to reduce heat. Add some pearl barley, tofu, celery and Chinese yam to alleviate swollen joints. During remissions, eat more mushrooms such as black wood ear to strengthen your immune system. People suffering from RA should avoid oily and greasy food, dairy, shellfish, seaweed, egg, sugar, alcohol and excessive salt. Depending on your specific condition, consult with a TCM practitioner for an appropriate diet.

WESTERN MEDICINE

DEFINITION: Asthma affects approximately 15 million Americans today. It's a pulmonary disorder characterized by wheezing and dyspnea due to obstruction and inflammation of the airways. Asthma may be triggered by allergy, exertion, irritant particles, weather, psychological stress, etc.

ETIOLOGY: There are many causes of asthma. Allergens such as pollens, smoke, alcohol, house dust and animal hair may trigger an asthma attack. Asthma may also be induced by non-allergy related factors such as exertion, cold air, stress, anxiety, crying, hearty laughing, and viral infection. Common morbidity associated with asthma include sinusitis, allergic rhinitis, gastroesophageal reflux, cardiovascular disease, diabetes, obesity, and hyperthyroidism.

CLINICAL MANIFESTATION: In an asthma attack, there will be a combination of spasm of the bronchi, inflammation of the airways, and increased mucous secretion. In mild to moderate cases, the patients will experience shortness of breath, wheezing, hyperpnea, and use of accessory muscles (such as neck and chest muscles) to facilitate breathing. Anxiety and sweating are commonly seen in asthmatics as they struggle for air. In severe cases, the patients will experience marked respiratory distress, cyanosis, use of accessory muscles, wheezes, lethargy and possibly confusion. Patients with severe asthma may not have any wheezing as there is very little air moving in and out of the lungs.

DIAGNOSIS: Asthma is diagnosed based on the characteristic episodes of wheezing, coughing, dyspnea or chest tightness interspersed with asymptomatic intervals. Objective confirmation is made with repeated spirometry tests performed over symptomatic and asymptomatic periods. Spirometry is a device that measures the breathing capacity of the lungs and is helpful in making the diagnosis, assessing the severity of the illness, and monitoring the effectiveness of the treatment.

If the asthma is allergy-induced, identification of the allergen is very important. Skin test for allergen, blood test for antibodies, and Inhalation Bronchial Challenge Test may assist in identifying the correct culprit. Allergic skin test helps to identify the allergen, but an allergen that causes an allergic reaction on the skin may not necessarily induce an asthma attack. Blood test for antibodies helps to determine the degree of sensitivity to that specific allergen. Additionally, an Inhalation Bronchial Challenge Test can be done to confirm the direct correlation between an allergen and an initiation of asthma attack. Since the patient will have to inhale a diluted solution of the allergen in the challenge test, there is a slight risk of a severe asthma attack.

TREATMENT: Drug treatments of asthma include management of an acute attack and maintenance on a daily basis. Five groups of drugs are commonly used for treating asthma.

1. Beta-adrenergic Drugs: Beta-adrenergic drugs are bronchodilators that relax smooth muscle and widen the airways. They are commonly used for relieving sudden attacks of asthma and preventing exercise-induced asthma. Common examples of Beta-adrenergic drugs includes epinephrine (Primatene Mist or AsthmaHaler), isoproterenol (Isuprel), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire) and albuterol (Proventil or Ventolin). Common side-effects of Beta-adrenergic drugs include increased Heart rate, nervousness, restlessness, headache and muscle tremors.
2. Theophylline: Theophylline also relaxes bronchial smooth muscle and is commonly used to treat and/or prevent bronchial asthma. Common trade names of theophylline include Theo-Dur, Theo-24, Uniphyl and Slo-bid. Common side-effects of theophylline include nausea, vomiting, nervousness, restlessness, insomnia, and in severe cases, seizures and arrhythmia.
3. Corticosteroids: Corticosteroids block the inflammatory response and reduce the asthma symptoms. Systemic corticosteroids (such as prednisone) may be used to treat acute asthma attack and inhalation of corticosteroids (such as Azmacort) may reduce the likelihood of asthma attack through desensitization to allergens. Though effective, long-term use of corticosteroids has a wide range of side-effects including but not limited to poor wound healing, decreased immunity, retarded growth in children, GI bleeding, hunger and weight gain.
4. Cromolyn (Intal): Cromolyn (Intal) inhibits the release of inflammatory substances from mast cells and is used to prevent but not treat asthma. When taken regularly, cromolyn (Intal) is especially helpful in patients who have exercise-induced asthma. Cromolyn (Intal) is relatively safe but has occasional side-effects such as cough and hoarseness.
5. Anticholinergic Drugs: Anticholinergic drugs produce bronchodilation by preventing smooth muscle contraction. Anticholinergic drugs are less potent and have a slower onset of action in comparison with beta-adrenergic drugs. Examples of anticholinergic drugs include atropine and ipratropium (Atrovent).

ORIENTAL MEDICINE

DEFINITION: In Chinese medicine, asthma is called "xiao chuan, " which means wheezing and dyspnea, respectively. Chinese medicine classifies xiao and chuan as two separate illnesses with different treatments. Xiao (wheezing) is characterized by a whistling sound during breathing, increased respiration rate, dyspnea and inability to rest in a horizontal position. Chuan (shortness of breath) is characterized by dyspnea, constant opening of mouth to grasp air, raised shoulder, flared nostrils and inability to rest in a horizontal position. Patients with xiao (wheezing) generally will have chuan (shortness of breath), while patients with chuan (shortness of breath) may or may not have xiao (wheezing). In Western medicine, wheezing and shortness of breath are both considered as symptoms which may be present in many different types of pulmonary syndromes such as asthma, acute bronchitis, chronic bronchitis and emphysema.

ETIOLOGY: In Oriental Medicine, there are many factors that may trigger an asthma attack. Examples include the invasion of the external pathogenic factors, diet, emotional disturbances, congenital weakness and chronic illnesses.

External pathogenic factors, such as cold or heat, commonly induce asthma attacks. Lung dominates the Qi and manifests on the skin. As the environment affects the skin, the change is reflected in the Lung. As the Lung is attacked, its function to regulate water passage becomes impaired, water begins to stagnate and phlegm starts to form. Asthma attacks due to the invasion of external pathogenic factors is most likely to occur when the temperature is cold or if there is a rapid change in weather. External pathogenic factors may also include pollen, cigarette smoke, and any other allergens.

Diet can also trigger an asthma attack. Raw and cold food may injure the Spleen and tend to contribute to the stagnation of fluid circulation and the increase in the production of phlegm. Heavy, sweet, and greasy food tend to create phlegm and heat in the body. Fish, crabs, shellfish and other seafood have also been noted to increase the likelihood of asthma attacks as well.

Congenital weakness and chronic illness are also common causes of asthma. Children with asthma generally have congenital Kidney Qi deficiency. On the other hand, chronic illness, such as patients with chronic cough and recurrent cold/flu, are likely to have Lung deficiency.

Acupuncture and Tuina body work have been proven to be very effective in restoring the back's health. However, the best treatment is always prevention. What are some of the steps you can take towards keeping your back in good shape?

Posture

Would you consider yourself to have a good posture? Most people have poor posture. The way you hold yourself while standing, sitting, lifting, pushing or doing any other activities, determines your back's basic condition. A good way to ensure good posture is to learn Tai Chi.

While standing or sitting, pull your abdomen inward and rotate your hips back slightly so that your lower back is relaxed and your abdomen is not sticking out. Always bend your knees slightly.

Keep your chin tucked inward and shoulders backward to keep your neck straight.

Always bend your knees to lift or pick up something from the ground. Never bend from the waist when lifting.

Make sure you have sufficient arch support to properly align your hips and thus the back.

(See the book Mastering Chi and video tapes, "Tai Chi Chuan, Part One and Two" by Maoshing Ni.)

Exercise and Stretching

Start slow and build up the number of repetitions; never force your body beyond pain. Learn to trust your body's signals. Consistency yields the best results. Take up Dao-In or Yoga to strengthen and align your back.

Lying flat on your back, pull your knees to your chest, alternate each leg and then both legs at the same time. Raise your legs to about 45 degrees and hold for 5 counts then relax. Alternate each leg and then raise both legs at the same time.

Lying on your stomach, raise your legs to about 45 degrees and hold for 5 counts then relax. Alternate each leg and then raise both legs at the same time.

Find a corner wall, lean back with your elbows supporting your weight, and then push your body away from the corner of the wall. Ten repetitions per set.

Diet

Certain foods aggravate inflammation while others soothe it. Some foods irritate nerves while others calm and relax it. Eat a diet filled with generous amounts of vegetables, whole grains, fruits, beans and smaller quantities of fish and poultry.

Bad: deep fried, fatty and rich foods, red meat, coffee, sugar, overly spicy foods, alcohol, refined products, tomato, eggplant, peppers, potato

Good: calcium rich foods such as beans and legumes, leafy greens, seaweed, pineapple, grape and cherry.

Lifestyle

If you have a poor lifestyle and suffer from back pain, chances are you are doing it to yourself. By examining and changing how you live, you will certainly increase your chance of a healthy back for life!

Prolonged sitting, standing or lying down will all contribute to straining and weakening your back. Get up and stretch hourly from sitting. Sleep on your sides with a pillow between your knees. Watch your posture, don't slouch.

Balance activities with rest. After physical exertion, rest your body before attempting something else physical.

Know your limits. Many people stress their bodies to the extreme and expect perfect functioning from their body. Have a healthy, consistent schedule. Wake up and go to bed on time, eat regularly, exercise daily, and watch out when you have to perform beyond what you are normally accustomed to do.

Stress Management

When you are under pressure, your blood pressure goes up, immune system becomes depressed and the muscles of your back contracts, causing spasm which in turn can damage the muscles and the nerves. Effective stress management can prevent you from "internalizing" negative emotions, and free you from its damaging results.

Meditate daily for stress release. Simply set aside 15 minutes or more every day and sit quietly to clear your mind and feelings.

Keep written journals to record your negative emotions and thoughts so that you may release them from your whole being.

Engage in artistic expressions to channel your stress into creativity. Painting, music, poetry, gardening are some means of expression.

Massage

Massage is most likely the most ancient form of self-healing. By activating and touching a certain point or area of your body, you will be able to summon your body's own restorative mechanism.

Stroke with your palms directly on your mid-to-lower back in up and down and circular motions until your back feels warm.

Find and press the tender spots between the 2nd and 3rd fingers and between the 4th and 5th fingers on the back of your hands.

Lie on your back against two tennis balls, one on each side of your upper back between the shoulder blades.

In summary, with good preventive back care as described in this article and a dose of common sense, you can stay away from the troubles of back problems and enjoy a healthy and active life.

Sometimes even with the most careful preventive practices, you may still injure your back and suffer pain and disability. This is the time to seek corrective measures, ones that will help you facilitate your recovery naturally. Chinese Medicine is immensely effective for back problems by employing acupuncture, electrical stimulation, tuina body therapy, cupping, herbal medicine and topical treatments that are used according to each individual's needs. Acute conditions can often be treated within five treatments while chronic conditions may take 10 to 20 treatments

 Carpal tunnel syndrome is a painful progressive condition caused by compression of a key nerve in the wrist. It occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. Symptoms usually start gradually, with pain, weakness, or numbness in the hand and wrist, radiating up the arm. As symptoms worsen, people might feel tingling during the day, and decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In some cases no direct cause of the syndrome can be identified. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. However, the risk of developing carpal tunnel syndrome is especially common in those performing assembly line work.

Is there any treatment?

Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease pain. Cool (ice) packs and prednisone (taken by mouth) or lidocaine (injected directly into the wrist) can relieve swelling and pressure on the median nerve and provide immediate, temporary relief. Stretching and strengthening exercises can be helpful in people whose symptoms have abated. If symptoms last for 6 months or more, doctors may recommend surgery to sever the band of tissue around the wrist and reduce pressure on the median nerve.

What is the prognosis?

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely. To prevent workplace-related carpal tunnel syndrome, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts research on nerve-related conditions such as carpal tunnel syndrome in its laboratories at the National Institutes of Health (NIH) and also supports research through grants to major medical institutions across the country. Current studies include several randomized clinical trials to evaluate the effectiveness of educational interventions in reducing the incidence of carpal tunnel syndrome. Another clinical study is collecting data about carpal tunnel syndrome among construction apprentices to better understand specific work factors associated with the disorder and develop strategies to prevent its occurrence among construction and other workers. Scientists are also investigating the use of alternative therapies, such as acupuncture, to prevent and treat this disorder

References:

National Institute of Neurological Disorders and Stroke

Nutritional and Herbal Therapy for Carpal Tunnel Syndrome

• Riboflavin (Vitamin B2) can be helpful for reducing numbness and tingling and support the nervous system.
• Vitamin B6 can also reduce numbness and tingling.
• Omega-3 fatty acids are essential for reducing inflammation.
• Tumeric, ginger and bromelain (in pineapple) reduce inflammation.

Chinese herbal medicines have been in use for 4,000 years, yet their properties are just now being studied on a cellular and molecular level. Some 500 herbs are currently being used by Chinese doctors, which they can combine to make innumerable remedies. One that has been tested relatively extensively is Juzen taiho-to (TJ-48), which is a hand prepared mixture of ten dried and pulverized herbal plants. In Chinese traditional medicine it has been used to treat cases of extreme fatigue, and anemia. However, recent studies have focused on its ability to reduce the toxicity of anti-tumor agents. Researchers also noted that TJ-48 augments antibody production and activates macrophages by oral administration. The exact mechanism of pharmacological action are still unclear.

Other studies by Chinese and Japanese investigators have shown a role between herbal preparations containing zinc and reduced symptoms of fatigue and related conditions. Tests done by Yu-Q, et. al. demonstrate that the amount of available zinc is much higher in an herbal preparation than in an equal molar amount of zinc sulfate, and the clinical effects are noticeably greater. There are also less adverse side effects with the herbal form. This is because zinc derived from plants is bound to an amino acid, or chelated, which makes it easier to be absorbed by the body and carried to where it is needed. Their study suggested that the herbal preparation they were examining could raise the zinc level and cure anemia.

The importance of zinc to overall body health is well documented. It is a co- factor in 70 enzyme systems, and zinc has been shown to increase the number and efficiency of T cells. When B cells make antibodies they use up zinc; consequently, an adequate supply is necessary for proper functioning of the immune system. Moreover, macrophages are more active when zinc is in good supply. Some studies suggest at least 25mg daily is needed to properly restore and maintain the immune system.

The relationship between the immune system, the thymus gland, and serum zinc levels is being studied by Nicola Fabris of Italy, and was recently reported at an international conference. Zinc can help reverse some of our failing immune functions, he states, by restoring our thymus gland, which usually starts to shrink after the age 60 and is followed by declines in the levels of T and B cells. This drastic shrinkage is caused by a gradual decline of zinc in the body, which seems to spontaneously happen as one grows older. This may be because the body becomes less efficient at assimilating the metal or the amount in the diet decreases. Whichever, the proper size and functioning of the thymus can be restored by daily ingestion of small doses (at least 15mg) of chelated zinc. In one mouse study, the thymus was restored to within 80% of its youthful size. Human subjects also showed increased thymus size and elevated levels of T-cells and active hormones similar to those seen in young people.

Since Chronic Fatigue Syndrome has been connected to certain dysfunctions of the immune system it would stand to reason that restoring it could lead to a reduction or elimination of some symptoms. It is unclear if debilitating fatigue, the most troubling symptom, would be helped by treating the immune system alone.

TJ-48 has been used to treat fatigue historically, and has been shown to be an immunomodulatory agent recently. Parameters tested by H. Yamada included natural killer (NK) cell activity, blastogenesis by PHA, several T-lymphocyte subsets, and serum triglyceride levels. Over one year, the target group showed a remarkable elevation in NK cell activity, with a corresponding reduction in lipo-protein values. One study using mice given lethal doses of tumor inducing chemicals had the death rate significantly slowed by orally administering TJ-48 afterwards for one week. The researchers noted that atrophy of the thymus was less than in the control group, and this they attribute to TJ-48. Similar studies have proven that it is a promising anti- tumor agent, so its traditional use for treating anemia and chronic fatigue are being ignored.

Another herbal preparation with demonstrated anti-tumor properties is Shi-un- kou. It also has the ability to reduce the activity of Epstein-Barr Virus (EBV). It was tested as a mixture and broken down into its constituent herbs for individual testing. Two, Angelica acutiloba and Macrotomia euchroma, proved particularly effective. Since these tests were done on mice, injected with the tumor promotor TPA which artificially allows EBV to overwhelm the immune system, its relevance to CFS patients is not known. However, it has been used to treat fatigue in the past so there could be a connection.

Further exploration of traditional Chinese herbal medicine will no doubt uncover other useful therapies for treating CFS. For now, it seems we will have to be content with reading between the lines of related journal articles, where other important diseases are being investigated

Myalgic encephalomyelitis (ME) is becoming more and more widespread in Western countries. ME is the name most commonly used in the UK, while in the USA it is now called Chronic Fatigue Immune Dysfunction Syndrome (CFIDS). This condition is also variously called "Chronic Fatigue Syndrome," "Postviral Syndrome," or "Postviral Fatigue Syndrome." I personally make a distinction between "true" ME and "not true" ME which I call "Postviral Fatigue Syndrome," and this distinction (and its significance) will be explained shortly.

Western View

ME is still not generally accepted or recognized as a "disease" in Western medicine. The main reasons for this are that there is no accepted test for it and that the same condition may result from a number of different causative factors (e.g. enteroviruses, Epstein-Barr virus, etc.). However, several doctors are researching the aetiology and pathology of ME. In Britain, there seems to be general agreement among those who are researching ME that it is a chronic viral infection. The virus implicated is thought to be a Coxsackie virus, which belongs to the family of enteroviruses. Other researchers think that all the enteroviruses discovered in the last 30-40 years, of which there are 72, are no more than variations of the polio virus, and they believe that ME is nothing but a form of polio. In the acute stage, enteroviruses cause a fever and swollen glands; if not neutralized by the body's immune system, they cause a chest infection and then settle in the intestines where they form a reservoir of infection (hence their name, as entero stands for "intestines"). From the intestines, these viruses display a particular tropism towards nerve and muscle cells therefore settling in the muscles and brain: this explains two of the major symptoms of ME, i.e. poor memory and concentration, and muscle ache. Muscle biopsy samples of 140 patients with clinical symptoms of ME showed that 24% of subjects were positive for the presence of enterovirus RNA. This may not sound like a high percentage but it becomes very significant when compared with a control group of 152 subjects, none of whom showed the presence of enterovirus RNA in their muscle biopsies. Statistically, this is a highly significant finding as P=<0.00001. In the USA, research seems to be oriented more towards the Epstein-Barr virus (the one that causes mononucleosis or glandular fever) as a cause of ME.

Chinese View

From the point of view of Chinese medicine, two main conditions explain the pathogenesis of ME: residual pathogenic factor and Latent Heat.

Residual pathogenic factor

One of the main conditions leading to ME is that of "residual pathogenic factor". If external Wind invades the body and is not cleared properly, or if the person fails to rest during an acute invasion of Wind, the pathogenic factor may remain in the Interior (usually as either Heat, Phlegm-Heat or Damp-Heat). Here, on the one hand, it continues to produce symptoms and signs and, on the other, it predisposes the person to further invasions of exterior pathogenic factors because it obstructs the proper diffusing and descending of Lung-Qi. Moreover, it will also tend to weaken Qi and/or Yin, establishing a vicious circle of pathogenic factor and deficiency.

Apart from Heat itself, Damp-Heat is a very frequent residual pathogenic factor after a febrile disease. There are two main reasons for this. First of all, in the course of a febrile disease, the ascending and descending movements of Spleen and Stomach are upset. Thus, because Stomach-Qi cannot descend, turbid fluids are not transformed, and because Spleen-Qi cannot ascend, the clear fluids cannot be transformed: this leads to the formation of Dampness. Secondly, Heat burns the body fluids which can then condense into Dampness. Once formed, Dampness tends to be self-perpetuating. In fact, Dampness impairs the Spleen transformation and transportation which in itself leads to more Dampness being formed, thus establishing a vicious circle.

Antibiotics are one of the most common causes of residual pathogenic factor in our society. Whilst they do destroy bacteria, from the point of view of Chinese medicine they tend to "lock" the pathogenic factor into the Interior and do not release the Exterior in the beginning stages of an exterior invasion, nor do they clear Heat or resolve Phlegm in the later stages.

Latent Heat

Symptoms of ME appearing without an acute infection can be explained as a manifestation of Latent Heat. The "Simple Questions" in chapter 3 says: "If Cold enters the body in wintertime, it comes out as Heat in springtime." This means that under certain circumstances, a pathogenic factor (which may be Wind-Cold or Wind-Heat) can enter the body without causing immediate symptoms. It then incubates inside the body for some time, turning into Heat; this Heat later emerges, moving towards the Exterior and causing a person to feel a sudden onset of great weariness with dragging limbs and a slight thirst. The patient feels hot and irritable, does not sleep well and passes dark urine. At this time the pulse feels Fine and slightly Rapid and the tongue is Red. This condition, called Latent Heat, is also known as Spring Heat, although it can occur in any season, not just in springtime.

Besides causing the above symptoms and signs, Latent Heat also tends to injure Qi and/or Yin, thus establishing a vicious circle of Heat and deficiency. In the case of ME, Latent Heat usually takes the form of Damp-Heat. This process, the "incubation" of an exterior pathogenic factor in the Interior to emerge as Heat later, explains many cases of ME Latent Heat may move outward to emerge on the surface by itself, as described above; alternatively, it may be "pulled" towards the surface by a new invasion of external Wind, in which case, in addition to the above symptoms of interior Heat, there would also be some exterior symptoms such as shivering, fever, occipital headache, aches and sneezing. The pulse (Fine and Rapid) and tongue (Red), however, clearly point to interior Heat.

Another factor that may draw Latent Heat towards the surface is emotional stress. This may pull Latent Heat outwards, especially when it affects the Liver and causes Heat.

Thus Latent Heat occurs when an individual suffers an invasion of exterior Wind without developing immediate symptoms and the pathogenic factor remaining in the Interior turns into Heat that comes out months later. The underlying reason for this is usually a Kidney deficiency. If the body condition and the Kidneys are relatively good, a person will develop symptoms at the time of invasion of external Wind. This is a healthy reaction. If the Kidneys are weakened by overwork and excessive sexual activity, the body's Qi is too weak even to respond to the invading external Wind. The Wind penetrates the Interior without the person developing exterior symptoms; once in the Interior, it incubates and turns into Heat, which comes out some months later.

The ancient doctors believed in particular that if the Essence is properly guarded and not dissipated, pathogenic factors will not enter the body and Latent Heat will not develop. The "Simple Questions" in chapter 4 says: "The Essence is the root of the body, if it is guarded and stored Latent Heat will not appear in springtime." This concept is very important in practice as it implies that resistance to pathogenic factors depends not only on Lung-Qi (which influences Defensive Qi), but also on Kidney-Qi and Kidney-Essence. In fact, Defensive Qi is spread by the Lungs but it has its root in the Kidneys, specifically Kidney-Yang. Moreover, in chronic, recurrent infections such as ME, Kidney-Qi is very often deficient, leading to a decreased immune response.

Another possible cause of Latent Heat can be immunizations, when attenuated or inert forms of certain pathogenic organisms are injected into the body, by- passing the body's first line of resistance. From a Chinese medical perspective it is as if an external pathogenic factor penetrated the body's Interior directly, completely by-passing the Exterior levels. From the perspective of the Four Levels, immunizations consist in injecting a pathogenic factor (albeit attenuated) directly at the Blood level.

Latent Heat can also take the form of the Lesser Yang (Shao Yang) syndrome, characterized by alternation of shivers and feeling of heat, when the pathogenic factor is "trapped" between the Interior and Exterior: for this reason, when it goes towards the Exterior the person feels cold, when it goes towards the Interior the person feels hot. This pattern is more common in teenagers and young people.

In all the above conditions the underlying cause is overexertion and lack of adequate rest as explained above.

To summarize, three factors can give rise to ME:

1. A residual pathogenic factor (usually Damp-Heat) after an invasion of an exterior pathogenic factor
2. Latent Heat (usually also as Damp-Heat)
3. Lesser Yang pattern (in itself a form of Latent Heat)

The four groups of symptoms that are, in my opinion, essential to diagnose ME are:

1. Chronic fatigue
2. Poor memory and inability to concentrate to the point of forgetting words while speaking, a feeling of "muzziness" of the brain
3. A persistent and intermittent flu-like feeling with shivers, sensations of heat, sore throat, swollen glands
4. Muscle ache and fatigue after the slightest exercise

I personally consider these to be the essential manifestations of what I call "true" ME, by which I mean one characterized by a persistent, chronic viral infection. If one or more of these four groups of symptoms are absent, I call the condition "not true" ME or simply "Postviral Fatigue Syndrome", i.e. a state of fatigue following an acute febrile disease but without a persistent viral infection. Although the aetiology, pathology and treatment of ME and Postviral Fatigue Syndrome are exactly the same, I believe this distinction is important for prognosis as "true" ME is much more difficult to treat and will take longer to respond to treatment.

As for the muscle ache, from the Chinese point of view it is directly related to Dampness: the more Dampness there is, the greater the muscle ache, and vice versa. From a Western perspective, I relate the muscle ache intensity to the viral infection.

Treatment

Every case of ME is characterized by both a Deficiency (of Qi, Yang, or Yin) and a Fullness (usually Dampness or Damp-Heat). However, the Deficiency and the Excess are never absolutely equal as one always predominates. If Deficiency predominates, one must tonify; if Fullness predominates, one must expel Dampness. The pulse and the tongue are essential diagnostic factors to distinguish between a Deficiency condition and an Excess condition. If the pulse is Full and Slippery and the tongue has a thick coating, Excess predominates; if the pulse is Weak or Fine and the tongue has no thick coating, Deficiency predominates. From the point of view of symptoms, the more muscle ache there is, the more the condition is one of Fullness. One cannot differentiate between a Deficiency condition and an Excess condition purely on the grounds of tiredness.

Crohn's disease causes inflammation in the small intestine. Crohn's disease usually occurs in the lower part of the small intestine, called the ileum, but it can affect any part of the digestive tract, from the mouth to the anus. The inflammation extends deep into the lining of the affected organ. The inflammation can cause pain and can make the intestines empty frequently, resulting in diarrhea.

Crohn's disease is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the intestines. Crohn's disease can be difficult to diagnose because its symptoms are similar to other intestinal disorders such as irritable bowel syndrome and to another type of IBD called ulcerative colitis. Ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the large intestine.

Crohn's disease affects men and women equally and seems to run in some families. About 20 percent of people with Crohn's disease have a blood relative with some form of IBD, most often a brother or sister and sometimes a parent or child.

Crohn's disease may also be called ileitis or enteritis.

What causes Crohn's disease?

Theories about what causes Crohn's disease abound, but none has been proven. The most popular theory is that the body's immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestine.

People with Crohn's disease tend to have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or result of the disease. Crohn's disease is not caused by emotional distress.

What are the symptoms?

The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth.

How is Crohn's disease diagnosed?

A thorough physical exam and a series of tests may be required to diagnose Crohn's disease.

Blood tests may be done to check for anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation somewhere in the body. By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines.

The doctor may do an upper gastrointestinal (GI) series to look at the small intestine. For this test, the patient drinks barium, a chalky solution that coats the lining of the small intestine, before x rays are taken. The barium shows up white on x-ray film, revealing inflammation or other abnormalities in the intestine.

The doctor may also do a colonoscopy. For this test, the doctor inserts an endoscope—a long, flexible, lighted tube linked to a computer and TV monitor—into the anus to see the inside of the large intestine. The doctor will be able to see any inflammation or bleeding. During the exam, the doctor may do a biopsy, which involves taking a sample of tissue from the lining of the intestine to view with a microscope.

If these tests show Crohn's disease, more x rays of both the upper and lower digestive tract may be necessary to see how much is affected by the disease.

What are the complications of Crohn's disease?

The most common complication is blockage of the intestine. Blockage occurs because the disease tends to thicken the intestinal wall with swelling and scar tissue, narrowing the passage. Crohn's disease may also cause sores, or ulcers, that tunnel through the affected area into surrounding tissues such as the bladder, vagina, or skin. The areas around the anus and rectum are often involved. The tunnels, called fistulas, are a common complication and often become infected. Sometimes fistulas can be treated with medicine, but in some cases they may require surgery.

Nutritional complications are common in Crohn's disease. Deficiencies of proteins, calories, and vitamins are well documented in Crohn's disease. These deficiencies may be caused by inadequate dietary intake, intestinal loss of protein, or poor absorption (malabsorption).

Other complications associated with Crohn's disease include arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system. Some of these problems resolve during treatment for disease in the digestive system, but some must be treated separately.

What is the treatment for Crohn's disease?

Treatment for Crohn's disease depends on the location and severity of disease, complications, and response to previous treatment. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. At this time, treatment can help control the disease, but there is no cure.

Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person's lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible.

Someone with Crohn's disease may need medical care for a long time, with regular doctor visits to monitor the condition.

Drug Therapy

Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and headache.

Some patients take corticosteroids to control inflammation. These drugs are the most effective for active Crohn's disease, but they can cause serious side effects, including greater susceptibility to infection.

Drugs that suppress the immune system are also used to treat Crohn's disease. Most commonly prescribed are 6-mercaptopurine and a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person's resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteriods can eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.

The U.S. Food and Drug Administration has approved the drug infliximab (brand name, Remicade) for the treatment of moderate to severe Crohn's disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas. Infliximab, the first treatment approved specifically for Crohn's disease, is an anti-tumor necrosis factor (TNF) substance. TNF is a protein produced by the immune system that may cause the inflammation associated with Crohn's disease. Anti-TNF removes TNF from the bloodstream before it reaches the intestines, thereby preventing inflammation. Investigators will continue to study patients taking infliximab to determine its long-term safety and efficacy.

Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem, the doctor may prescribe one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.

Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.

Nutrition Supplementation

The doctor may recommend nutritional supplements, especially for children whose growth has been slowed. Special high-calorie liquid formulas are sometimes used for this purpose. A small number of patients may need periods of feeding by vein. This can help patients who need extra nutrition temporarily, those whose intestines need to rest, or those whose intestines cannot absorb enough nutrition from food.

Surgery

Surgery to remove part of the intestine can help Crohn's disease but cannot cure it. The inflammation tends to return next to the area of intestine that has been removed. Many Crohn's disease patients require surgery, either to relieve symptoms that do not respond to medical therapy or to correct complications such as blockage, perforation, abscess, or bleeding in the intestine.

Some people who have Crohn's disease in the large intestine need to have their entire colon removed in an operation called colectomy. A small opening is made in the front of the abdominal wall, and the tip of the ileum is brought to the skin's surface. This opening, called a stoma, is where waste exits the body. The stoma is about the size of a quarter and is usually located in the right lower part of the abdomen near the beltline. A pouch is worn over the opening to collect waste, and the patient empties the pouch as needed. The majority of colectomy patients go on to live normal, active lives.

Sometimes only the diseased section of intestine is removed and no stoma is needed. In this operation, the intestine is cut above and below the diseased area and reconnected.

Because Crohn's disease often recurs after surgery, people considering it should carefully weigh its benefits and risks compared with other treatments. Surgery may not be appropriate for everyone. People faced with this decision should get as much information as possible from doctors, nurses who work with colon surgery patients (enterostomal therapists), and other patients. Patient advocacy organizations can suggest support groups and other information resources.

People with Crohn's disease may feel well and be free of symptoms for substantial spans of time when their disease is not active. Despite the need to take medication for long periods of time and occasional hospitalizations, most people with Crohn's disease are able to hold jobs, raise families, and function successfully at home and in society.

Can diet control Crohn's disease?

No special diet has been proven effective for preventing or treating this disease. Some people find their symptoms are made worse by milk, alcohol, hot spices, or fiber. People are encouraged to follow a nutritious diet and avoid any foods that seem to worsen symptoms. But there are no consistent rules. People should take vitamin supplements only on their doctor's advice.

References:

National Institutes of Health (NIH)

Nutritional and Herbal Therapy for Crohn's Disease

People with Crohn's disease need to develop better diets, if they have not already. There is a link between a high fat, high sugar diet with low fruit and vegetable intake with that of Crohn's disease. Therefore:

• Increase intake of fruits, vegetables and whole grains and decrease fat and sugar intake.

• Include the good fats: omega-3 fatty acids to your diet. Omega-3 oils provide anti-inflammatory action to help reduce symptoms of Crohn's and may help prevent reoccurrence.

• Take a multi-vitamin/mineral daily to make up for any loss of essential nutrients due to the intestine's decreased inability to absorb.

• Probiotics may be helpful in strengthening the digestive tract and improving absorption and decreasing symptoms of Crohn's.

• The herb, Turmeric,has anti-inflammatory actions and helps decrease symptoms.

• The Chinese herbal formula, Xiang Sha Liu Jun Wan, can soothe inflammation and symptoms of Crohn's disease.

• Regular consumption of Green Tea can also decrease inflammation and protect against cancer.

According to many western medical resources. depression may be the response of the body to an overwhelming and constant stress that seems to the patient to be insurmountable. This stress could be life experiences, food or nutritional deficiencies or excesses, allergies to environmental factors, and numerous other so-called stressors. Regardless of the etiology of the depression, the majority of western MDs diagnose the patient's condition as a depression. The symptomology must be rather significant. Among symptoms falling into the category of a depressive illness, there must be at least five of the following symptoms for a period of at least two weeks. These symptoms are:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest in pleasure in almost all activities most of the day, every day
• Significant weight loss or weight gain without dieting, or major changes in appetite or eating habits
• Insomnia or hypersomnia nearly everyday
• Psychomotor agitation or retardation (anxiety or lack of desire to do any thing)
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness, guilt, desperation, and psychic pain that are ongoing
• Inability to think or concentrate; indecisiveness daily
• Recurrent thoughts of death or suicide, or a specific plan or attempt of suicide

The symptoms cause significant distress or impair social, occupational, or other important functions. In sever cases, hallucinations and delusions may occur, perhaps as a result of the emotional overload. In any case, once the diagnosis has been made, the treatment method is generally very similar from patient to patient. Usually, anti-depressive medications, of which there are many, are administered, and often it takes up to six weeks for the medications to take effect. In many cases, these medications are a saving grace, but in the case of the suicidal depressive, extra measures must be taken to assure that the patient maintains his or her integrity. The general consensus in the western model is that these treatments be accompanied by psychological counseling in order to rebalance and rebuild the person's inner world. Currently, there is a great deal of research and medical attention regarding depressive illnesses. and a significant branch of western MDs are turning to megavitamin therapies. aminoacid. and nutritional therapies as alternatives to drugs. In the not-so-distant future, it seems the trend is coming back home... to nature and its innate wisdom.

Chinese medicine is perhaps one of the foremost therapeutic avenues that invites nature to assist in the rebalancing of the human organism. Since humankind functions on so many levels, from spiritual, to physical, to emotional, each of these strata need be addressed. The somewhat magical art of Traditional Chinese Medicine works beautifully at uniting body-mind-spirit, so that harmony may again be achieved. This is not to say that TCM is a wonder cure because in some in some cases, it may even be ineffective. in which case there are other options and modalities of treatment, from western medicine to Indian or homeopathic medicine. The point is: other options exist, and should not be ruled out.

In TCM alone, there are many approaches to the same problem. The scope of this article is on the five elements and their significance in diagnosing and treating depression. Each element encompasses a symptomological picture that varies from the others. Becoming aware that a patient is depressed does not suffice. It is important to understand and address the individual and unique manifestations of that person's depression. The five elements provide a clear and interesting framework in which many cases of depressive illness can fit, be diagnosed and treated. For the sake of clarity, this article will present each element and its unique manifestations, without addressing the interactions of the elements. Although elemental interdependence is fundamental to the five element theory, it is the goal of this article to highlight the differences among the elements in order to present a clear theoretical model. It should be understood that cases of purely Wood-element depression, for example. would be rare. Usually there is a combination of elements in the same person, which will hopefully become more decipherable through deeper understanding of each element.

The Wood Element

When considering the Wood element, one thinks of the obvious characteristics such as Spring, Wind, Eyes, Tears, Shouting, Anger, Sour, etc. However, there are also more subtle features pertaining to this element that are less obvious, but can be of great value when determining a person's elemental predominance. For example, some of the traits of a Wood case of depression could be that the patient has a great deal of difficulty relaxing or being at ease, that they want to control everything and fall into depression when defeated, and they have a stormy type of personality that is prone to many moods. The Wood personality can be arrogant, confident, aggressive, confrontational, driven and eager. They can be very demanding of themselves and others. and can easily be disappointed at which point they may fall into the clutches of a darkness known as depression. Usually this type of depression has a great well of repressed anger, disappointment, and frustration brewing underneath the surface. The primary issue is control in the Wood cases. As far as their appearance, a Wood type may present with a reddish facial skin tone, reddish eyes, and disgruntled look. Wood types are usually rather tall and slender.

The Fire Element

The Fire type, on the other hand, has quite different features than those of Wood. A Fire element depression most often has to do with relationships and "heartbreak." Most frequently, Fire types feel let-down or disillusioned by love. Their depressions are usually of a cyclical nature in that they get over one heartbreak, and then move on to the next. Their depressions can be quite severe, and they can often become suicidal due to their impulsive, and "living on the edge" character type. Fire predominance includes symptoms of anxiety, chest pains, nightmares of a vivid nature, and a lack of laughter and the ability to feel joyous. Depressive episodes readily deplete heart qi, and can cause the usual Fire related symptoms of palpitations, shortness of breath, mental confusion (due to the heart's relationship to the Shen or cognitive functioning of the individual), and listlessness. Since all emotions have an influence on the heart, the Fire element can transmit imbalances that stem from other organ or emotional disturbances. Yet. in those cases there would be a mixed symptomological picture. As far as appearance is concerned, the Fire types tend to have a reddish face with a rather pointy chin. Their hair tends to be curly, and when in balance they tend to move quickly and to frequently be in a rush. When depressed, however, they tend to feel unmotivated and unable to appreciate the beauty of life that they usually thrive on. Paradoxically, their strong point is also their weak point in that Fire types lean towards vigorous and healthy blood and blood vessels when well, but can easily become depleted in this area when out of balance. Since the heart rules the blood. Fire predominance can lend itself to a host of blood related and mental problems when the individual succumbs to stress and relational pressures.

The Earth Element

The Earth element would encompass its typically characteristic digestive imbalances. However, in depressive episodes, Earth types tend towards significant changes in their eating habits. Some will have no appetite whatsoever, whereas others become ravenous and try to eat in order to fill the dark emptiness inside. It appears to be a way of seeking warmth and comfort. When depressed, Earth elementers become unmovable, perhaps because they have a tendency towards dampness. At any rate, they virtually sink into their depressions and become heavy and unmotivated. The Earth element's energies contribute greatly to the human affect of centeredness, being grounded, peace, calm and compassion. In adversity, the serenity of this element becomes distorted into listlessness, obsessive worry, over concern and their sense of self strongly diminishes as they lose their usual propensity to being grounded.

The Earth element's physical characteristics are unique, and usually quite detectable. They tend to be stockier, more portly, and generally move more slowly than most of the other elements. They often have round faces, and appear rather jovial when in balance. An interesting note is that their body shapes can alter significantly when under the duress of depressive illness. They may fluctuate in weight, depending on their individual tendency to either halt or greatly increase their food intake. A major clue in recognizing Earth element cases is their oral natures. They often need to have something in their mouth - chewing gum, candies, foods. Perhaps this is the reason for their propensity towards being damp and somewhat overweight.

The Metal Element

The Metal element encompasses a great deal of issues regarding giving and taking to and from the environment. Frequently, this element winds up depressed when there is loss or grief. Often these emotions can be repressed and manifest in unusual respiratory difficulties, asthmas, and frequent upper respiratory infections. Commonly, when depressed, Metal types sigh, cry and sob, and lack a sense of boundary between the "self' and others. They are prone to the sufferance of the world, which is termed "weltschmerz'' This is a Freudian term that depicts the person who takes the pains and suffering of the world onto their own shoulders. Therefore, this type of a case may also involve a sense of grieving that seems overwhelming and all-encompassing. The Metal element types are environmentally sensitive, but are also more easily influenced in a therapeutic setting with regards to their emotional status. They often appear with soft weak voices, and pale complexions. They are generally of thin stature and when depressed, appear meager and weak. In many cases, these patients will have rather clear regrets over the past and feel that there is a significant desire to wish things could only have gone differently. These people often feel plagued by circumstance, and therefore grieve over past issues and losses that they hang on to.

In strong contrast to the above mentioned elements is the Water element. This is the most clinically significant and potentially dangerous type of elemental depression. This is the element that is most greatly influenced by the pre-natal Jing - hence, genetics. In these cases, the patient is depressed and does not have any insight into why or any reasons that may have caused the descent into a depressive illness. These patients are most susceptible to severe psychological imbalances, such as schizophrenia, psychoses, and severe major depressive episodes. In many cases. the patient will become despondent and unable to do even the simplest of chores for themselves. Their depression seems to reach down into the very core of the person's being - their spirit and soul. These patients become incommunicable, and sink rather deeply into their illness. These are the most difficult of all of the elements to treat successfully. These patients appear desperate, paranoid, and out of touch. They fear life and death, and don't have any sense of what their fear means. Usually these people feel that they are beyond help, and no longer seek assistance in their grave dilemma over their life. They also reluctantly fear leaving their homes, and seem to lose their sense of purpose in life. They may appear in a clinic, usually accompanied, and be ungroomed, easily distracted and very scattered. They may have nervous tremors, and seem fearful or totally apathetic. These cases may be misdiagnosed, because it is easy to interpret the patient's signs as arrogance or poor hygiene. Yet, it is important to recognize the desperation of the person's plight because these patients are the ones most prone to suicidal tendencies. Since they feel so lost and don't grasp what is plaguing them on such a pervasive and personal level, they often resort to the ultimate escape from their misery - suicide.

In each of the elements discussed, there are specific clues and hints as to which element is predominant in the given case. It is helpful to ask questions that may evoke the necessary information in order to reach a diagnosis. One must use tact, empathy and a direct approach that is not overly involved, while still maintaining a concerned and caring disposition. The use of the five elements is only a tool in diagnosing and dealing with a case of depression. The elements afford practitioners an added sense of comprehension and clarity in a patient's case. However, it is important to focus on the most comprehensive and effective means of treatment. As alternative health care practitioners, it is also crucial to recognize the importance of dealing with the patient on a psychologically therapeutic level. In most cases of depression, there are unseen, underlying triggers that we as acupuncturists are not trained to deal with. Hence, it requires a delicate balance that always keeps the patients' best interests foremost in mind.

In conclusion, depression must be dealt with on every level of the person's being. The theoretical model of the five elements can be useful in diagnosing and treating a patient suffering from depressive illness. As stated previously, it is vital to assess the severity of a depressive's condition, and tend to their individual needs. In any case, the five element approach can be seen as one perspective in dealing with these conditions.

There is nothing new about diabetes; it has been a medical problem since antiquity. The name which was originated by Aretaeus (30-90 CE) came from the Greek words meaning 'siphon' and 'to run through', signifying the chronic excretion of an excessive volume of urine.

Diabetes mellitus, because of its frequency, is probably the single most important metabolic disease and is widely recognized as one of the leading causes of death and disability in the United States. It affects every cell in the body and the essential biochemical processes that go on there.

Diabetes has been linked to the western lifestyle, as it is uncommon in cultures consuming a more primitive diet. As cultures switch from their native diets to more commercial foods, their rate of diabetes increases, eventually reaching the same proportions seen in western societies.

A great deal of research has been conducted into the possible aetiology of diabetes. Most of the prevalent ideas can be classified under one of the following categories: heredity, endocrine imbalance, dietary indiscretion and obesity, sequelae of infection, and severe and continued psychic stress.

Although genetic factors appear important in determining susceptibility to diabetes, environmental and dietary factors are also important in its development and many have been identified. A diet high in refined fibre-depleted carbohydrate is believed to be the causative factor in many individuals, while a high intake of high-fibre complex carbohydrate foods is protective against diabetes.

Obesity appears to be a significant factor, particularly considering the fact that 90% of Type 2 (see below) sufferers are obese. Even in normal individuals, significant weight gain results in carbohydrate intolerance, higher insulin levels and insulin insensitivity in the fat and muscle tissue. The progressive development of insulin insensitivity is believed to be the main underlying factor in Type 2 diabetes. Weight loss can correct all of these abnormalities in many instances and significantly improves the metabolic disturbance of diabetes in most cases.

What has become apparent through years of research is that the diabetic condition is not simply a matter of one or two things having gone wrong. It is a complex condition with a multitude of metabolic imbalances. Consequently, the conventional medical approach of simply using insulin or oral drugs to treat diabetes is incomplete and the person relying on them to prevent long-term complications remains at risk.

About Blood Sugar

Carbohydrate is the active fuel of the body and is ordinarily the main source of energy of the tissue cell. In the normal digestive process, food sugars and starches (carbohydrates) are changed into sugar glucose. This is stored in the form of glycogen (animal starch) in the liver and muscles for later use as a body fuel, at which time it is reconverted into glucose. Blood sugar rises somewhat after eating, and in healthy individuals returns to normal levels in about an hour or two. The amount of glucose in the blood is controlled mainly by the hormones insulin and glucagon. Too much or too little of these hormones (or if they are somehow ineffective) can cause blood sugar levels to fall too low (hypoglycemia) or rise too high (hyperglycemia). Other hormones that influence blood sugar levels are cortisol, growth hormone and catecholamines (epinephrine and norepinephrine).

The pancreas, a gland in the upper abdomen is responsible for producing insulin and glucagon. The pancreas is dotted with hormone-producing tissue called the islets of Langerhans, which contain alpha and beta cells. When blood sugar rises after a meal, the beta cells release insulin. The insulin helps glucose enter body cells, lowering blood glucose levels to the normal range. When blood sugar drops too low however, the alpha cells secrete glucagon. This signals the liver to release stored glycogen and change it back to glucose, raising blood sugar levels to the normal range. The result of the disturbed metabolism of glucose causes an abnormal accumulation of sugar in the blood stream and the diabetic condition.

Blood Sugar Ranges

The quantity of glucose in the blood seldom exceeds 160 milligrams/decilitre (mg/dl) of blood shortly after food sugar has been absorbed, nor seldom falls below 60 mg/dl during fasting. This increases about 2 mg/dl per decade after age 30. Some mild diabetics will have normal fasting blood sugar values and values in the diabetic range only after meals. Occasionally very mild cases will have values within normal at both times and the diabetic tendency will be evident only when these persons are required to handle more than an ordinary amount of carbohydrate.

In the fasting state, blood sugar can occasionally fall below 60 mg/dl and even to below 50 mg/dl and not indicate a serious abnormality or disease. This can be seen in healthy women, particularly after prolonged fasting. Blood sugar levels below 45 mg/dl in a woman or 55 mg/dl or less in a man indicate a strong possibility of hypoglycaemia.

Higher-than-normal blood sugar levels, for example 140 mg/dl or higher after an overnight fast, can indicate diabetes mellitus. In moderately severe diabetes, after-meal values of 250-350 mg/dl are not unusual. If a person with diabetes develops hyperglycaemia and it is left untreated, the result can lead to coma or death.

Diabetes is characterised by three well-known syndromes, polydipsia (excessive thirst), polyphagia (excessive hunger) and polyuria (excessive urination). Laboratory findings reveal high blood sugar and glucose in the urine and as the metabolic derangement worsens, excessive ketone bodies in the blood and urine. The accumulation of these produces acidosis which, if not counteracted, can result in coma and death.

There are three main types of diabetes:

Type 1 or 'Insulin-Dependent Diabetes Mellitus' (IDDM) also known as 'Juvenile Onset Diabetes'.

Type 2 or 'Noninsulin-Dependent Diabetes Mellitus' (NIDDM) also known as 'Adult Onset Diabetes'.

Gestational diabetes.

Type 1 Diabetes (Insulin-Dependent Diabetes Mellitus/IDDM)

Insulin-dependent diabetes is considered an autoimmune disease in which the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas produces little or no insulin and it is then almost certain that life-long insulin replacement will be necessary. The exact mechanism for the body's immune system attack to the beta cells is unknown but the most likely causes are viral infection, genetic factors and free radicals.

Interest has been generated lately in the strong evidence linking exposure to a protein in cow's milk (bovine albumin peptide) in infancy to the autoimmune response and subsequent Type 1 diabetes. In detailed studies1 it was shown that patients with Type 1 diabetes were more likely to have been breast-fed for less than three months and to have been exposed to cow's milk or solid foods before the age of four months. Since the cow's milk protein can enter the mother's breast milk, in cases of family history of diabetes it is recommended that the mother avoid cow's milk while breast-feeding.

IDDM accounts for about 5 to 10 percent of diagnosed diabetes in the USA and develops most often in children and young adults, but the disorder can appear at any age. Symptoms usually develop over a short period, although beta cell destruction can begin months, even years, earlier.

Over time both Type 1 and Type 2 diabetes are accompanied by many severe complications, such as blindness, renal failure, lower- limb amputations, cardiovascular disease and stroke. For those with Type 1 diabetes the object is not to find a way to get off insulin but rather to prevent the long-term complications. It is encouraging to note that modern research has demonstrated the amount of insulin required could be reduced through appropriate life style modifications and the likelihood of consequent complications significantly lowered.

Type 2 Diabetes (Noninsulin-Dependent Diabetes Mellitus/NIDDM)

The most common form of diabetes is noninsulin-dependent diabetes. About 90 to 95 percent of people with diabetes have Type 2. In the USA more than 16 million people, over 7% of the adult population, have Type 2 with 600,000 new cases diagnosed each year. In many patients, the initial diagnosis of Type 2 diabetes is delayed perhaps by as much as 10 years because symptoms are often absent or very mild during its early stages.

Type 2 diabetes usually develops in adults over the age of 40 and is most common among adults over age 55. It is particularly common among the elderly and in many minority populations, including African Americans, Hispanic Americans, American Indians and Asian and Pacific Islander Americans, in whom it may occur in 10Ç50% of adults.

Type 2 diabetics typically have elevated levels of insulin, often producing two to three times the normal amount. Rather than an insulin deficiency condition it is an "insulin resistance" condition whereby the body loses its ability to properly respond to the signals given by insulin. We now know that excess insulin brought on by insulin resistance is not only associated with elevated blood sugar levels, but also with high blood pressure and increased rates of atherosclerosis.

In the treatment of Type 2 diabetes, dietary modification has been found to be of primary importance and should be diligently followed before using drug intervention since most cases can be controlled by diet alone. For all Type 2 diabetics an effective treatment approach should employ a broad-based therapeutic regimen. Such a regimen would incorporate appropriate diet, prescribed exercise, stress reduction techniques and a substantial amount of specific nutritional supplements. If adequate control of blood sugar levels remains problematic, conventional treatment with insulin and oral agents can be initiated.

Gestational Diabetes

Gestational diabetes develops or is discovered during pregnancy. This type usually disappears when the pregnancy is over, but women who have had gestational diabetes have a greater risk of developing NIDDM later in their lives.

2. Presenting Symptoms

The clinical manifestations of diabetes in the order in which they usually appear are:

frequent, copious urination
excessive thirst
rapid weight loss
excessive hunger
drowsiness, fatigue
itching of the genitals and skin
visual disturbances
skin infections
slow healing
paraesthesia in the hands or feet
Other signs of diabetes include lingering influenza-like symptoms, loss of hair on the legs, increased facial hair, small yellow bumps anywhere on the body (known as xanthomas-cholesterol) and inflammation of the penile skin.

In most juvenile cases the earliest symptoms noted are increased urination, thirst and hunger. Other symptoms include irritability, nausea or vomiting, weakness and fatigue. Physical findings in the adult are mostly attributable to complications, and the first sign of the disease may be some dermatological, circulatory, neurological or visual complications.

3. Laboratory diagnosis

The laboratory diagnosis of diabetes depends on finding glucose in the urine together with an elevated blood sugar. The newest routine diagnostic test for diabetes is a fasting plasma glucose test rather than the previously preferred oral glucose tolerance test. A confirmed fasting plasma glucose value of greater than or equal to 126 mg/dl indicates a diagnosis of diabetes.

In certain clinical circumstances physicians may still choose to perform the more difficult and costly oral glucose tolerance test. When a doctor chooses to perform this test a confirmed glucose value of greater than or equal to 200 mg/dl indicates a diagnosis of diabetes. According to World Health Organisation standards an oral glucose tolerance test is performed by administering 75 grams of anhydrous glucose dissolved in water and then measuring the plasma glucose concentration 2 hours later.

Monitoring the Diabetic Patient

There appears to be a strong relationship between blood sugar levels and the development of the complications of diabetes. Specifically, when blood sugar levels are chronically elevated, the risk of complications is very high. To reduce the risk of developing complications it is important to control elevations in blood sugar by careful monitoring. The availability of home glucose monitoring kits makes this easier now than in the past.

4. Complications or Sequelae of Diabetes

Sometimes a complication of diabetes may give a clue to the presence of the disease. The principle complications or sequelae associated with diabetes are retinopathy, neuropathy, nephropathy and arteriosclerosis. Whether these are the unavoidable consequences of the diabetic state over time or whether they may be influenced by controlling the diabetes through aggressive monitoring, treatment and life-style management, including diet and supplements, remains a central topic.

One of the largest, most comprehensive diabetes studies conducted to date2 showed that keeping blood sugar levels as close to normal as possible through aggressive management slows the onset and progression of eye, kidney and nerve diseases caused by diabetes. In fact it demonstrated that any sustained lowering of blood sugar helps, even if the person has a history of poor control.

Specifically it found that lowering and maintaining more constant blood sugar levels reduced the risk of eye disease by 76%, kidney disease by 50%, nerve disease by 60% and cardiovascular disease by 35%.

Since the discovery of insulin nearly 70 years ago, the patterns of morbidity from diabetes have changed. Where the major causes of death were ketoacidosis and infection, they are now the microvascular and cardiovascular complications of diabetes (renal failure and myocardial infarction). These complications are responsible for a reduction in the life expectancy of a newly diagnosed insulin dependent diabetic by about one-third. The basis of managing diabetes in the 90's is an improvement in the life-style of the diabetic and prevention of complications responsible for morbidity and mortality in diabetes.

Neuropathy (nerve disease)

Diabetic neuropathies are among the most frequent complication of long-term diabetes. It is estimated that 60% to 70% of diabetics have mild to severe forms of nervous system damage. The femoral nerve is commonly involved giving rise to symptoms in the legs and feet. Pain is the chief symptom and tends to worsen at night when the person is at rest. It is usually relieved by activity and aggravated by cold. Paraesthesias are a common accompaniment of the pain. Cramping, tenderness and muscle weakness also occur but atrophy is rare. Advanced femoral nerve disease is a major contributing cause of lower extremity amputations.

Nerves in the arms, abdomen and back may also be affected. Symptoms may include impaired heart function, slowed digestion, reduced or absent perspiration, severe oedema, carpal tunnel syndrome, alternating bouts of diarrhoea and constipation, bladder atony, urinary and faecal incontinence and impotence.

With respect to sexual impotence, diabetes is probably the single most common disease associated with erectile failure (termed neurogenic impotence in the diabetic). Since diabetes is a metabolic disease with vascular and nervous system complications and an erection involves all levels of the nervous system from the brain to the peripheral nerves, lesions anywhere along the path may be responsible for erectile failure. It has been estimated that close to 50% of diabetic males have some degree of erectile dysfunction.

Neuropathies usually improve with the control of the diabetes. Severe or chronic changes may require several weeks or months to show maximum improvement.

Retinopathy (eye disease)

Changes occurring in the eye which are distinctive of diabetes involve the narrowing, hardening, bulging, haemorrhaging or severing of the veins and capillaries of the retina. This is a serious complication known as retinopathy and may lead to loss of vision. Visual changes in the earlier stages may include diminished vision, contraction of the visual field, changes in the size of objects or photophobia. In the more advanced stage, termed 'proliferative retinopathy', haemorrhages, retinal detachment and other serious forms of deterioration are observed. When the disease progresses to this late stage total blindness may occur.

It usually takes between 10-13 years for diabetic retinopathy to develop and it is present in some degree in most diabetics who have had the disease for 20 years. In only about half of the diabetics who develop it however, is vision markedly impaired and blindness occurs in only about 6%. Still, diabetes is the leading cause of blindness in adults 20 to 74 years old and is estimated to cause from 12,000 to 24,000 new cases each year. Two other complications of diabetes, cataracts and glaucoma, can also lead to loss of vision

The development of laser therapy will probably reduce the prevalence of diabetes-induced blindness, however this therapy is not without occasional side effects (haemorrhage, retinal detachment and loss of visual field) and is therefore indicated only for the more serious conditions.

Arteriosclerosis (vessel disease)

The diabetic state is associated with earlier and more severe vascular changes than normally occur at a given age. Cardiovascular-renal disease is the leading cause of death among diabetics. Atherosclerosis can be accurately described as the end stage of Type 1 and Type 2 diabetes, since the vast majority of diabetes patients will die from an atherosclerotic event. Most commonly these events are cardiovascular in nature (an estimated 60% to 65% of diabetics have high blood pressure) although 20-25% of atherosclerotic events may be cerebrovascular or microvascular. The incidence of coronary occlusion in persons with clinical diabetes has been estimated at from 8-17% with diabetic adults having heart disease death rates about 2 to 4 times as high as the general population. The risk of stroke is also found to be 2 to 4 times higher in people with diabetes.

Arteriosclerosis obliterans in the lower extremities, a form of peripheral vascular disease, may produce disturbances in sensation, decrease in muscular endurance, intermittent claudication on effort, absence of peripheral pulses in the lower legs and feet and gangrene, and ultimately lead to amputation of the extremity. Diabetic gangrene usually involves the toes, heels or other prominent parts of the feet and is precipitated by trauma, infection or extremes in temperature. Needless to say, careful attention to proper foot care, avoidance of injury and consistent use of methods to improve peripheral circulation, including withdrawal from tobacco use in any form, are critical for the diabetic.

The aetiology of large vessel disease is multi-factorial in the diabetic as well as the non-diabetic population with lipoprotein metabolism, hypertension, physical activity, obesity, cigarette smoking, stress, personality and genetic and racial factors all playing a part.

Nephropathy (kidney disease)

Nephropathy is a common and important accompaniment of diabetes and one that in young diabetics takes prece-dence over heart disease as a cause of illness and death. As with eye changes, there is a wide variation in the type and degree of renal damage. Nephropathy is less frequent than retinopathy and where it occurs is also a development of long standing diabetes. Nevertheless, diabetes is the leading cause of end-stage renal disease in the US, accounting for about 40% of new cases. In 1995, a total of 98,872 people with diabetes underwent dialysis or kidney transplantation and 27,851 developed end-stage renal disease.

One study3 reported that among 200 juvenile diabetics who survived 20 years after onset, one half had evidence of renal disease. Another study found that the majority of these patients have hypertension and two thirds show significant albuminuria, but the fully developed nephrotic syndrome of hypertension, proteinuria and oedema occurs in less than 10% and renal function is impaired in only one half to three quarters of those patients.

Like other long-term complications, good blood glucose control goes a long way towards reducing the risk of diabetic nephropathy. In addition to monitoring the blood sugar levels, periodic monitoring of a diabetic patient's kidney function (blood urea nitrogen, uric acid, creatinine and creatinine clearance) is important.

Hypoglycaemia

If there is too much insulin in the body compared to the amount of blood sugar, and the blood sugar falls below normal levels, a condition known as hypoglycaemia occurs. This problem of hypoglycaemia due to insulin or oral hypoglycaemic drugs is much more common in Type 1 than Type 2 diabetes since the Type 1 diabetic is directly injecting insulin. If too much insulin is administered, or the person misses a meal or over-exercises, hypoglycaemia may result. In this condition, commonly referred to as insulin shock, the brain is deprived of an essential energy source. The first sign is mild hunger, quickly followed by dizziness, sweating, palpitations, mental confusion and eventual loss of consciousness. Before the condition reaches emergency proportions, most diabetics learn to counteract the symptoms by eating a sweet or drinking a glass of orange juice. In some cases, the only effective measure is an intravenous injection of glucose.

Digestive Disorders

Based on the 1989 US National Health Interview Survey, diabetics are more likely than the general population to report a number of digestive conditions, including ulcers, diverticulitis, symptoms of irritable bowel syndrome, abdominal pain, constipation, diarrhoea and gallstones.

Oral Complications

Periodontal disease, which can lead to tooth loss, occurs with greater frequency and severity among diabetics. Periodontal disease has been reported to occur among 30% of people aged 19 years or older with Type1 diabetes.

Infections

Studies in clinic, community and hospital populations indicate that diabetic subjects have a higher risk of some infections, including asymptomatic bacteriuria, lower extremity infections, re-activation tuberculosis, infections in surgical wounds and group B streptococcal infection. Population-based data suggest a probable higher mortality from influenza and pneumonia.

Complications of Pregnancy

The rate of major congenital malformations in babies born to women with pre-existing diabetes varies from 0% to 5% among women who receive preconception care, to 10% among women who do not receive preconception care. Between 3% to 5% of pregnancies among women with diabetes result in death of the new-born; the rate for women who do not have diabetes is 1.5%4.

Ketoacidosis

Another acute complication more likely to occur in the IDDM is ketoacidosis, a condition caused by a lack of insulin leading to a build-up of ketoacids. Chemical compounds called ketones are one of the natural by-products of fat metabolism. Excessive ketone bodies are formed by the biochemical imbalance in uncontrolled or poorly managed diabetes. The condition known as diabetic ketoacidosis can directly cause an acute life-threatening event, a diabetic coma.

The possibility of ketoacidosis is suggested by:

Confusion or coma, the patient almost always appearing extremely ill.
Air hunger - an attempt to compensate for metabolic acidosis.
Acetone odour (fruity) invariably on the breath.
Nausea and vomiting almost always present.
Abdominal tenderness which may mimic viral gastro-enteritis.
Extreme thirst and dry mucous membranes.
Diabetic history (present in about 90% of cases).
Weight loss.

Before the discovery of proper treatment by insulin and other intravenous injections, acidosis was the chief cause of death among diabetics. Today diabetics can use a simple urine dipstick at home to measure the level of ketones (excreted ketoacids) in the urine.

5. Conventional Medical Treatment

Insulin was the first, and remains the primary means of treatment for Type 1 diabetes and is administered by subcutaneous injection. This method is necessary since insulin is destroyed by gastric stomach secretions when it is taken by mouth. Insulin injections must be balanced with meals and daily activities, and glucose levels must be closely monitored through frequent blood sugar testing. Many diabetics need inject insulin only once a day; others require two or more injections. The usual time for a dose of insulin is before breakfast. The dosage is initially established according to the severity of the condition, but it often has to be reassessed as one or another of the variables in the person's condition changes.

During the past several years a large number of different classes of drug therapies for patients with both Type 1 and Type 2 diabetes have been developed. The concept of genetic re-engineering of insulins to produce insulin analogs (synthetic insulin) with improved properties has enhanced the ability to affect glycaemic control with fewer adverse reactions. For Type 2 patients, the number of orally active antidiabetic agents has increased from one class of agents (the sulfonylureas - sulfa drugs) to the current total of four classes of agents. The three new classes include agents of potentially even greater glycaemic efficacy, such as Biguanide 'Metformin'; agents directly improving the underlying insulin resistance of Type 2 diabetes, specifically thiazolidinediones such as 'Troglitazone'; and finally agents that alter the rate of hydrolysis and absorption of oligosaccharides, such as the alpha-glucosidase inhibitor 'Acarbose'.

The sulfonylureas as a group have proven to be not very effective. After three months of continual treatment at an adequate dosage, only about sixty percent of Type 2 diabetics are able to control blood sugar levels using these drugs. Furthermore these agents generally lose their effectiveness over time. After an initial period of success they fail to produce a positive effect in about thirty- percent of the cases at best.

In addition to being of limited value, there is evidence that the sulfonylureas actually produce harmful long-term effects. Tolbutamide has been reported to be associated with increased cardiovascular mortality. Other major side effects of the sulfonylureas are hypoglycaemia, allergic skin reactions, headache, fatigue, nausea, vomiting and liver damage. Common examples of sulfonylureas include Chlor-propamide (Diabinese), Glipizide (Glucotrol), Tolazamide (Tolinase) and Tolbutamide (Orinase).

Metformin has been used in the management of Type 2 diabetes in more than 90 countries for over 30 years. It was approved for use in diabetes patients in the United States in 1995. Metformin reduces the excessive hepatic glucose production that characterizes Type 2 diabetes. With reduced hyperglycaemia, glucose uptake by peripheral tissues is enhanced while insulin levels remain stable or decline. Metformin also lowers elevated cholesterol and lipids, particularly the serum levels of triglycerides. Frequency of adverse effects is low at the doses needed to obtain the desired metabolic effect.

Troglitazone is a member of a new class of drugs that are 'insulin sensitizers'. It was selected on the basis of its effect to lower glycaemia without increasing insulin levels, its ability to improve lipid levels and absence of significant side effects or adverse events in short-term human studies.

The new generation oral drugs do have a specific and beneficial place particularly for patients who are on an appropriate diet and exercise program, have attained an optimal weight and are still unable to adequately control blood sugar levels. However with the increased number of oral antidiabetic agents soon to increase even further, the medical emphasis upon management of hyperglycaemia in Type 2 diabetes with these agents will likely increase. Realistically this is the easiest and least time-consuming response that can be made by practitioners to the impact of managed care plans. However to prescribe these agents alone and in combination for even minimal degrees of hyperglycaemia without an adequate trial of diet and exercise will only serve to accentuate the problem. For the non-insulin dependent diabetic, dietary and life style changes can often provide adequate remediation.

Medical Cost Attributed To Diabetes

Medical cost for persons with diabetes are higher because they visit physician's offices, hospital outpatient departments and emergency rooms more frequently than their non-diabetic counterparts and are more likely to be admitted to hospitals and nursing homes. One estimate of the total health-care expenditures for diabetes in the USA is approximately $100 billion per year in both direct and indirect costs, or about 12% of all health-care expenditures.

6. Nutritional Therapy

Meal Planning

A non-diabetic produces the constantly varying amounts of insulin necessary for obtaining energy from glucose. A diabetic cannot achieve this balance. Beyond the basic requirements to provide adequate calories and necessary nutrients, there are marked differences in diet strategy for the two major groups of diabetic patients: Type 1 insulin-dependent non-obese patients and Type 2 obese patients who do not require insulin. Patients who are on insulin therapy must schedule their meals to provide regular caloric intake. In overweight patients, special attention must be given to total caloric consumption.

There is no need to disproportionately restrict the intake of carbohydrates in the diet of most diabetic patients. In fact, Dr. H.P. Himsworth demonstrated in 1930 that if carbohydrates were taken out of the diet and replaced by either protein or fats, a person would quickly develop insulin resistance and diabetes5. The key here is in the choice of high-fibre complex carbohydrates.

One of the first dietary rules for all diabetics is to avoid all sugar and foods containing sugar, such as pastry, candy and soft drinks. While these refined sugars and other simple carbohydrates like white flour must be carefully watched, most diabetics are actually encouraged to eat more complex carbohydrates - the same bulky, fibre-rich unprocessed foods that are now recommended for everyone. Vegetables are ideal. For example, a diabetic can eat a large plate of spinach that contains as much carbohydrate as a tablespoonful of sugar, without suffering any ill effects.

Spinach, asparagus, broccoli, cabbage, string beans and celery are among the so-called "Food Exchange Group A" vegetables that the American Diabetes Association (ADA) says can be generously included in the diabetic diet. What makes these complex carbohydrates special is their ability to slow down the body's absorption of carbohydrates by helping to delay the emptying of the stomach and thereby smoothing out the absorption of sugars into the blood. Whole grain cereals also have this ability.

Fully one third of diabetic patients in clinical surveys have hyper-lipidemia, clearly indicating the need for dietary management. The most sensible approach is to limit the amount of fat in their diet and to substitute polyunsaturated fats for the saturated type when possible. Fish and poultry are especially recommended instead of fatty cuts of meat. Greasy, fried foods are strongly discouraged.

Obesity is much more likely in people who eat a high-fat diet, which is often a high calorie diet, since each gram of fat contains nine calories instead of the four calories in each gram of protein or carbohydrate. With obesity comes an increased risk of a variety of problems, not the least of which is adult-onset diabetes.

Overweight diabetics, by carefully calculating the proper daily calorie intake for their body weight and activity level, and never exceeding it, can usually bring their weight down to an optimal level - a level which is actually 10% less than the standard height and weight charts recommend. "The overweight diabetic who successfully brings their weight back to normal usually experiences a dramatic improvement in their condition. Indeed the symptoms often virtually disappear," says Charles Weller M.D. in his book The New Way to Live with Diabetes6. He goes on to state "Weight reduction and control can bring this incurable disease closer to complete remission than any medication."

The need to reduce fat is reflected in the standard diet and food exchange lists prepared by the ADA that restricts the intake of fat to 35% of calories. The reduction of saturated fats to one-third of the fat intake by substituting poultry, veal and fish for red meats, and the reduction of cholesterol to less than 300 mg/day are stressed. The carbohydrate content is 40-50 per cent of total calories, with unrefined carbohydrates recommended to the exclusion of refined and simple carbohydrates.

Currently another diet, known as the 'HCF (high-carbohydrate high plant-fibre) diet' popularised by James Anderson7 has substantial support and validation in the scientific literature as the diet of choice in the treatment of diabetes. It is high in cereal grains, legumes and root vegetables and restricts simple sugar and fats. The calorie intake consists of 70-75 per cent complex carbohydrates, 15-20 per cent protein and only 5-10 per cent fat, and the total fibre content is almost 100 grams/day. The positive metabolic effects of the HCF diet are many: reduced after-mealtime hyperglycaemia and delayed hypoglycaemia; increased tissue sensitivity to insulin; reduced cholesterol and triglyceride levels with increased HDL-cholesterol levels; and progressive weight reduction.

In general the HCF diet is adequate for the treatment of diabetes. However improvements can be made, primarily by substituting more natural (primitive) foods wherever possible. The Modified HCF or MHCF diet recommends a higher intake of legumes, along with restrictions of several foods allowed on the HCF diet, namely processed grains, and excludes fruit juices, low fibre fruits, skimmed milk and margarine. It is noteworthy that if patients resume a conventional ADA diet, their insulin requirements return to prior levels.

Many diabetics have found it beneficial to eat smaller, more frequent meals, rather than the two or three big meals most people consume daily. Researchers have found that multiple frequent feedings tend to keep blood cholesterol levels lower, for the diabetic and non-diabetic alike.

Vitamins and Minerals

Generally a well-balanced diet rich in vitamins and minerals is one of the most important factors in the control of diabetes and prevention of diabetic complications. One reason for stressing the need for proper levels of nutrients is the excessive urination experienced by the diabetic.

Normally the body reabsorbs glucose and other water-soluble nutrients. When glucose rises to levels above 160-170mg/dl, as it does quite frequently in even well controlled diabetic patients, it acts as an osmotic diuretic. This process overwhelms the kidney's ability to reabsorb glucose and other water-soluble nutrients, thus the increased urination, and substantial losses of nutrients such as vitamins B-1, B6 and B-12 and the minerals magnesium, zinc and chromium pass out along with the urine. Consequently diabetes and its complications are as much a result of nutritional wasting as of elevated blood sugar.

In an article in the American Journal of Clinical Nutrition where 247 studies were reviewed8, it was found that Type 1 (IDDM) diabetics generally had deficiencies in zinc, calcium, magnesium and the more active form of vitamin D. Those with Type 2 diabetes (NIDDM) generally were found to be low in zinc and magnesium and often low in vitamins B6 and C.

The physical body needs all these water-soluble nutrients to maintain the integrity of its organ system. Perhaps one of the most important nutrients is magnesium. The medical literature is full of studies showing that diabetic patients invariably have lower blood levels of magnesium than normal, also with higher urinary losses. In a landmark study conducted in 1978 by Dr. P. McNair and titled Hypomagnesemia, a Risk Factor in Diabetic Retinopathy9, it was demonstrated that diabetics with the lowest magnesium levels had the most severe retinopathy, and that low magnesium levels were linked significantly to retinopathy more than any other factor. The article argued that simply elevating the magnesium concentration with supplements would protect the eyes.

Other nutrients are also attracting serious attention. Researchers in London recently reported that vitamin D is essential for the islet cells in the pancreas to be able to secrete insulin properly10. Their studies have shown that individuals with the lowest vitamin D levels experienced the worst blood sugar-handling problems and had a greater risk of developing diabetes. They found that those with greatest risk of developing vitamin D deficiency included the elderly who were either institutionalised or stayed indoors, those living in climates where sunlight is scarce several months a year, and those with indoor sedentary jobs. In an effort to eliminate the widespread vitamin D deficiencies in the institutionalised elderly, over 80% of those individuals are now being given 800 IU/day vitamin D3 supplements.

Other researchers have found that the diabetic is unable to convert carotene into vitamin A. It is advisable therefore for the diabetic to ingest at least the recommended dietary allowance of vitamin A from a non-carotene source such as fish-liver oil. Diabetics and others on low-fat diets often need supplemental amounts of this fat-soluble nutrient. Also recommended is a vitamin E supplement, ranging from 400-1200 IU per day and a vitamin C supplement ranging from 1000-4000 mg per day to help prevent small-vessel disease of the extremities.

Brewer's yeast is another food supplement that is recommended for the diabetic patient. The yeast is a rich source of chromium-containing GTF (glucose tolerance factor) which is able to potentiate the insulin in our bodies. GTF also contains amino acids such as glutamic acid, glycine, and cysteine. Both brewer's yeast (9 gm/day) and trivalent chromium (150-1000 mcg/day) have been shown to significantly improve blood sugar metabolism when taken for several weeks to months. As a side benefit it has also been found that brewer's yeast and chromium supplementation lower elevated total cholesterol and total lipids, and significantly raise the levels of HDL-cholesterol, the beneficial or protective fraction of cholesterol.

Chromium is found in foods as both inorganic and organic salts. Brewer's yeast contains a form of chromium with high bioavailability, chromiumÇdinicotinic acidÇglutathione complex. The bioavailability of chromium in liver, American cheese and wheat germ is also relatively high. Chromium is also available from a variety of sources including whole grains, potatoes and apples with skins, spinach, oysters, carrots, and chicken breast. Recent research has identified certain varieties of barley grown in Mesopotamia to be some of the richest sources of chromium.

A 1996 study of 180 Type 2 diabetics, carried out in China under the guidance of Dr. Richard A. Anderson11, found that 500 mcg of chromium picolinate taken twice daily for four months lowered the fasting glucose level to an average of 129, compared to 160 in those taking a placebo. In addition, glycosylated haemoglobin (a test of longer-term glucose tolerance) averaged an almost normal level of 7.5% in those taking chromium - significantly lower than those on placebo. All of the effects of chromium appear to be due to increased insulin sensitivity.

Another exceptionally useful trace mineral to combat diabetes is vanadium, which lowers blood sugar by mimicking insulin and improving the cells' sensitivity to insulin. A growing body of human research shows that vanadium compounds, most notably vanadyl sulfate, consistently improve fasting glucose and other measures of diabetes. These benefits were often extended for weeks after the mineral supplementation was discontinued.

In addition to taking supplements, diabetics are encouraged to eat the widest possible variety of permitted foods to ensure getting the full range of trace elements and other nutrients. It is interesting to note that certain nutrients like vitamins B1, B2, B12, pantothenic acid, vitamin C, protein and potassium - along with small frequent meals containing some carbohydrate - can actually stimulate production of insulin within the body.

Cautions

1. Fish oil capsules or supplements containing large amounts of para-aminobenzoic acid (PABA) can elevate blood sugar.

2. Supplements containing cysteine interfere with absorption of insulin by cells.

3. Extremely large dosages of vitamins B1 or C may inactivate insulin. Dosages listed above are within normal ranges.

7. Botanical medicines

Since antiquity, diabetes has been treated with plant medicines. The following herbs appear to be the most effective, are relatively non-toxic and have substantial scientific documentation to attest to their efficacy.

European Blueberry (Vaccinium myrtillus)

Traditional herbalism places great value on European Blueberry leaves, a.k.a. Bilberry, as a natural method of controlling or lowering blood sugar levels when they are slightly elevated. Results have shown the leaves have an active ingredient with a remarkable ability to reduce excess sugar in the blood. To use, steep two to three handfuls of leaves in 4 cups hot water for half an hour. Drink three cups a day. Modern research has demonstrated the berries or extract of the berries offer even greater benefit. The standard dose of the extract is 80-160 mg three times per day.

Gymnema sylvestre

Native to the tropical forests of India. Used to lower blood sugar and help repair damage to pancreatic cells. Therapeutic dosage is 400 mg/day. A good source is a preparation by Natrol as a single herb 5:1 extract containing 300 mg.

Bitter melon (Momordica Charantia)

Composed of several compounds with confirmed anti-diabetic properties. 50-60 ml (about 2 oz) of fresh juice per day has shown good results in clinical trials. Charantin, the key ingredient extracted by alcohol, is a hypoglycaemic agent composed of mixed steroids more potent than the drug Tolbutamide that is often used to treat diabetes.

Onion and Garlic

The common bulbs, onion and garlic, have significant blood sugar-lowering action as well as lowering lipids, inhibiting platelet aggregation, and reducing blood pressure.

Fenugreek

Fenugreek seeds have demonstrated anti-diabetic effects in experimental and clinical studies. Administration of the defatted seed (in daily doses of 1.5-2g/kg) reduces fasting and after-meal glucose, glucagon, somatostatin, insulin, total cholesterol and triglycerides, while increasing HDL-cholesterol levels.

Salt Bush (Atriplex halimu)

Rich in fibre, protein, and numerous trace minerals, including chromium. Human studies in Israel have demonstrated improved blood glucose regulation and glucose tolerance in Type 2 diabetes. Dosage used in this study was 3g per day.

Ginkgo biloba

Gingko biloba extract improves blood flow in the peripheral tissues of the arms, legs, fingers and toes and is therefore an important medicine in the treatment of peripheral vascular disease. It has also been shown to prevent diabetic retinopathy. Dosage of the extract standardised to contain 24% ginkgo flavoglycosides is 40-80 mg three times per day.

Ginseng (Panax ginseng)

Ginseng, besides reducing fasting blood sugar levels and body weight, can elevate mood and improve psycho-physiological performance. Therapeutic dosage is 100-200 mg daily.

Many people have small pouches in their colons that bulge outward through weak spots, like an inner tube that pokes through weak places in a tire. Each pouch is called a diverticulum. Pouches (plural) are called diverticula. The condition of having diverticula is called diverticulosis. About 10 percent of Americans over the age of 40 have diverticulosis. The condition becomes more common as people age. About half of all people over the age of 60 have diverticulosis.

When the pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25 percent of people with diverticulosis. Diverticulosis and diverticulitis are also called diverticular disease.

What causes diverticular disease?

Although not proven, the dominant theory is that a low-fiber diet is the main cause of diverticular disease. The disease was first noticed in the United States in the early 1900s. At about the same time, processed foods were introduced into the American diet. Many processed foods contain refined, low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran.

Diverticular disease is common in developed or industrialized countries—particularly the United States, England, and Australia—where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets.

Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on a soft, jelly-like texture in the intestines. Some fiber passes almost unchanged through the intestines (insoluble fiber). Both kinds of fiber help make stools soft and easy to pass. Fiber also prevents constipation.

Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. This excess pressure might cause the weak spots in the colon to bulge out and become diverticula.

Diverticulitis occurs when diverticula become infected or inflamed. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.

What are the symptoms?

Diverticulosis

Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis. You should visit your doctor if you have these troubling symptoms.

Diverticulitis

The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.

What are the complications?

Diverticulitis can lead to bleeding, infections, perforations or tears, or blockages. These complications always require treatment to prevent them from progressing and causing serious illness.

Bleeding

Bleeding from diverticula is a rare complication. When diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can be severe, but it may stop by itself and not require treatment. Doctors believe bleeding diverticula are caused by a small blood vessel in a diverticulum that weakens and finally bursts. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary.

Abscess, Perforation, and Peritonitis

The infection causing diverticulitis often clears up after a few days of treatment with antibiotics. If the condition gets worse, an abscess may form in the colon.

An abscess is an infected area with pus that may cause swelling and destroy tissue. Sometimes the infected diverticula may develop small holes, called perforations. These perforations allow pus to leak out of the colon into the abdominal area. If the abscess is small and remains in the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it.

To drain the abscess, the doctor uses a needle and a small tube called a catheter. The doctor inserts the needle through the skin and drains the fluid through the catheter. This procedure is called percutaneous catheter drainage. Sometimes surgery is needed to clean the abscess and, if necessary, remove part of the colon.

A large abscess can become a serious problem if the infection leaks out and contaminates areas outside the colon. Infection that spreads into the abdominal cavity is called peritonitis. Peritonitis requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without surgery, peritonitis can be fatal.

Fistula

A fistula is an abnormal connection of tissue between two organs or between an organ and the skin. When damaged tissues come into contact with each other during infection, they sometimes stick together. If they heal that way, a fistula forms. When diverticulitis-related infection spreads outside the colon, the colon's tissue may stick to nearby tissues. The organs usually involved are the bladder, small intestine, and skin.

The most common type of fistula occurs between the bladder and the colon. It affects men more than women. This type of fistula can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.

Intestinal Obstruction

The scarring caused by infection may cause partial or total blockage of the large intestine. When this happens, the colon is unable to move bowel contents normally. When the obstruction totally blocks the intestine, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned.

How does the doctor diagnose diverticular disease?

To diagnose diverticular disease, the doctor asks about medical history, does a physical exam, and may perform one or more diagnostic tests. Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment.

When taking a medical history, the doctor may ask about bowel habits, symptoms, pain, diet, and medications. The physical exam usually involves a digital rectal exam. To perform this test, the doctor inserts a gloved, lubricated finger into the rectum to detect tenderness, blockage, or blood. The doctor may check stool for signs of bleeding and test blood for signs of infection. The doctor may also order x rays or other tests.

What is the treatment for diverticular disease?

A high-fiber diet and, occasionally, mild pain medications will help relieve symptoms in most cases. Sometimes an attack of diverticulitis is serious enough to require a hospital stay and possibly surgery.

Diverticulosis

Increasing the amount of fiber in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends 20 to 35 grams of fiber each day. The table below shows the amount of fiber in some foods that you can easily add to your diet.

The doctor may also recommend taking a fiber product such as Citrucel or Metamucil once a day. These products are mixed with water and provide about 2 to 3.5 grams of fiber per tablespoon, mixed with 8 ounces of water.

Until recently, many doctors suggested avoiding foods with small seeds such as tomatoes or strawberries because they believed that particles could lodge in the diverticula and cause inflammation. However, it is now generally accepted that only foods that may irritate or get caught in the diverticula cause problems. Foods such as nuts, popcorn hulls, and sunflower, pumpkin, caraway, and sesame seeds should be avoided. The seeds in tomatoes, zucchini, cucumbers, strawberries, and raspberries, as well as poppy seeds, are generally considered harmless. People differ in the amounts and types of foods they can eat. Decisions about diet should be made based on what works best for each person. Keeping a food diary may help identify individual items in one's diet.

If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, many medications affect emptying of the colon, an undesirable side effect for people with diverticulosis.

Diverticulitis

Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early.

To help the colon rest, the doctor may recommend bed rest and a liquid diet, along with a pain reliever.

An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein. In some cases, however, surgery may be necessary.

When is surgery necessary?

If attacks are severe or frequent, the doctor may advise surgery. The surgeon removes the affected part of the colon and joins the remaining sections. This type of surgery, called colon resection, aims to keep attacks from coming back and to prevent complications. The doctor may also recommend surgery for complications of a fistula or intestinal obstruction.

If antibiotics do not correct an attack, emergency surgery may be required. Other reasons for emergency surgery include a large abscess, perforation, peritonitis, or continued bleeding.

Emergency surgery usually involves two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. Because of infection and sometimes obstruction, it is not safe to rejoin the colon during the first operation. Instead, the surgeon creates a temporary hole, or stoma, in the abdomen. The end of the colon is connected to the hole, a procedure called a colostomy, to allow normal eating and bowel movements. The stool goes into a bag attached to the opening in the abdomen. In the second operation, the surgeon rejoins the ends of the colon.

Points to Remember

• Diverticulosis occurs when small pouches, called diverticula, bulge outward through weak spots in the colon (large intestine).
• The pouches form when pressure inside the colon builds, usually because of constipation.
• Most people with diverticulosis never have any discomfort or symptoms.
• The most likely cause of diverticulosis is a low-fiber diet because it increases constipation and pressure inside the colon.
• For most people with diverticulosis, eating a high-fiber diet is the only treatment needed.
• You can increase your fiber intake by eating these foods: whole grain breads and cereals; fruit like apples and peaches; vegetables like broccoli, cabbage, spinach, carrots, asparagus, and squash; and starchy vegetables like kidney beans and lima beans.

Diverticulitis occurs when the pouches become infected or inflamed and cause pain and tenderness around the left side of the lower abdomen.

References:

National Institutes of Health (NIH)

Nutritional and Herbal Therapy for Diverticular Disease

• Eat a high-fiber diet. This is the most important thing to remember to prevent diverticular disease. Eat more fruits, vegetables, whole grains and less red meat and dairy.
• Regular exercise is important to reduce occurrence of symptoms.
• Omega-3 fatty acids help reduce inflammation.
• Tumeric, ginger and bromelain (in pineapples) reduce inflammation.
• Drink plenty of water to help ease passage through the colon.

The "flu," also called "influenza," is a highly contagious respiratory infection. The flu, compared with the common cold, often causes more severe illness. People with the flu can have a fever, (usually 100 to 103 in adults and often even higher in children), cough, sore throat, extreme fatigue, muscle aches, headaches, runny nose, and watery eyes. Children can also experience vomiting and diarrhea. Some older people might not suffer from fever. Flu-related complications can occur at any age; however, older people or those with chronic health problems, particularly heart or lung disease, are much more likely to develop serious complications and influenza infection than those that are younger and healthier.

The best way to treat a disease is to prevent it.  It is absolutely a bad idea to wait to dig a well until you are thirsty. So, do something to enhance your Qi now, before the influenza virus shoots you down. Chinese herbs such as Huang Qi (Astralagus) and Dang Shen (Codonopsis) are used to strengthen Qi and to boost the immune system. Herbs such as Ban Lan Gen (Isatis) and Da Qing Ye (Daqingye) are commonly used as anti-virus herbs in China.

In China depending on the type of virus, special anti-virus teas are usually given to public schools to help prevent illness during the flu season.

Acupuncture can help rebalance energy, regulate the Qi and stimulate the immune system. Several clinical studies have demonstrated that acupuncture and herbal medicine in particular reduce the incidence of upper respiratory tract infection and shorten the length of time one is ill. When you get sick with the flu, do not wait. Start acupuncture treatments in the early stages. It may help eliminate pathogenic influences.

Regular exercise of sufficient intensity (to warm you up, but not to make you sweat- not overdoing it) has been shown to reduce the incidence of the flu. Exercise such as Qi-gong, Tai-Chi, and Yoga can help reduce emotional and physical stress. It also strengthens the immune system and prevents disease from arising.

Keep a good diet. Make sure to eat a full balanced diet that is rich in vitamins, antioxidants, and minerals. Foods containing beta-carotene are thought to help boost your immune system and keep your mucous membranes and upper respiratory system healthy and harder to infect. Carrots, broccoli, sweet potatoes, garlic and tomatoes are high in beta-carotene. Eating lots of them during the flu season may help you avoid illness, or recover sooner.

Drink water to prevent dehydration. Ample liquids can help your body flush the invaders and the debris from their battle with your immune system. Chicken soup is recommended because it adds extra water and expels mucous to help you get rid of the illness. Try to drink an 8-ounce glass of water every hour. This is very important to help your body recover from the flu.

Extra rest will help you save energy for battling the illness. This is particularly important if you became sick when you were already tired or run down. Get more sleep and take a nap in the afternoon; it will help you recover faster.

Wind in the Gorge we know about, but Wind in the body (other than digestive) sounds like something new! All the various maladies we call the "Cold", the "Flu" and the vague unnamed sense of dilapidation, chills, fever, congestion and sneezing are part of what classical Chinese Medicine would call the Wind syndromes. Yes, as you might guess, wind in the weathery sense is the typical source, or at least provoker, of Wind in the bodily sense.

If you watch an acupuncturist leaving work you'll often notice the presence of a scarf, or at least a high collar, on a windy day, even in warm weather. That is because every day acupuncturists treat people who have been attacked by Wind, or as it is technically called, an "E.P.I." or "external pernicious influence". In fact, in ancient China, Wind was even considered a type of demon, and acupuncture may originally have been conceived of as tiny spears and arrows fighting these demons. Today, you might not think these ancient images were too far off when you look at the pictures of viruses or bacteria and see their strange shapes, projecting spikes, and generally weird and somewhat threatening appearance.

You may often feel this influence when you've been affected by wind walking in from the car or especially out for a stroll on the coast. The shoulders, neck and back of the head are the areas most vulnerable to attack and invasion by Wind. As the wind enters your body and becomes Wind, you start to feel its variations, such as Wind-Heat, Wind-Cold, or, ever-popular in Oregon, Wind-Damp. You might start sneezing, feel chilled and/or feverish, and maybe even achiness in your joints. Sometimes Wind has a tendency to wander or shift; thus our aches move around or we alternate between fevers and chills. If the Cold Wind starts working its way deeper into our body we might even feel so chilly that not even blankets, tea or a warm bath can really comfort and warm us.

If we are in basically good health, eating the right foods, getting some exercise, having fun, and not working too hard, our bodies can often throw off the Wind's invasion. As you intuitively know, there are plenty of times when you've been exposed to something and not become ill - that's when your basic vitality has been intact and the immune system has been able to fend off those nasty EPIs. According to Chinese medicine, the substance responsible for this protective function is "Wei Qi" (pronounced "way chee"). Like all "Qi", Wei Qi is an aspect of the body's vitality, its internal energy system. The word "Wei" shows how this type of Qi acts. Wei was the name given to the soldiers who defended the realm and the Emperor. As these defensive forces of our body fight the invaders we often feel like a battleground. Our neck and shoulders tighten to lock out further invaders and fever and perspiration burn up and cast off the unfriendly forces.

With some rest, hot herbal teas, hydrotherapy and some cleansing perspiration we will usually be on the road to recovery, often aided by taking the break we had been postponing.

 Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

What are the symptoms of GERD?
The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.


GERD in Children
Studies* show that GERD is common and may be overlooked in infants and children. It can cause repeated vomiting, coughing, and other respiratory problems. Children's immature digestive systems are usually to blame, and most infants grow out of GERD by the time they are 1 year old. Still, you should talk to your child's doctor if the problem occurs regularly and causes discomfort. Your doctor may recommend simple strategies for avoiding reflux, like burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, the doctor may recommend avoiding

• sodas that contain caffeine
• chocolate and peppermint
• spicy foods like pizza
• acidic foods like oranges and tomatoes
• fried and fatty foods

Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend that the child sleep with head raised. If these changes do not work, the doctor may prescribe medicine for your child. In rare cases, a child may need surgery.

*Jung AD. Gastroesophageal reflux in infants and children. American Family Physician. 2001;64(11):1853–1860.


What causes GERD?
No one knows why people get GERD. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Other factors that may contribute to GERD include

• alcohol use
• overweight
• pregnancy
• smoking

Also, certain foods can be associated with reflux events, including

• citrus fruits
• chocolate
• drinks with caffeine
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, chili, and pizza

How is GERD treated?
If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

• If you smoke, stop.
• Do not drink alcohol.
• Lose weight if needed.
• Eat small meals.
• Wear loose-fitting clothes.
• Avoid lying down for 3 hours after a meal.
• Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts—just using extra pillows will not help.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time. They are effective for about half of those who have GERD symptoms. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor.

Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD.

Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for GERD.

What if symptoms persist?
If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.

A barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus—called stricture—ulcers, hiatal hernia, and other problems will.


Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor's office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.

The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.


In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

Surgery
Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.

Implant
Recently the FDA approved an implant that may help people with GERD who wish to avoid surgery. Enteryx is a solution that becomes spongy and reinforces the LES to keep stomach acid from flowing into the esophagus. It is injected during endoscopy. The implant is approved for people who have GERD and who require and respond to proton pump inhibitors. The long-term effects of the implant are unknown.

What are the long-term complications of GERD?
Sometimes GERD can cause serious complications. Inflammation of the esophagus from stomach acid causes bleeding or ulcers. In addition, scars from tissue damage can narrow the esophagus and make swallowing difficult. Some people develop Barrett's esophagus, where cells in the esophageal lining take on an abnormal shape and color, which over time can lead to cancer.

Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.

For information about Barrett's esophagus, please see the Barrett's Esophagus fact sheet from the National Institute of Diabetes and Digestive and Kidney Diseases.

Points to Remember

• Heartburn, also called acid indigestion, is the most common symptom of GERD. Anyone experiencing heartburn twice a week or more may have GERD.
• You can have GERD without having heartburn. Your symptoms could be excessive clearing of the throat, problems swallowing, the feeling that food is stuck in your throat, burning in the mouth, or pain in the chest.
• In infants and children, GERD may cause repeated vomiting, coughing, and other respiratory problems. Most babies grow out of GERD by their first birthday.
• If you have been using antacids for more than 2 weeks, it is time to see a doctor. Most doctors can treat GERD. Or you may want to visit an internist—a doctor who specializes in internal medicine—or a gastroenterologist—a doctor who treats diseases of the stomach and intestines.
• Doctors usually recommend lifestyle and dietary changes to relieve heartburn. Many people with GERD also need medication. Surgery may be an option.

Hope Through Research
No one knows why some people who have heartburn develop GERD. Several factors may be involved, and research is under way on many levels. Risk factors—what makes some people get GERD but not others—are being explored, as is GERD's role in other conditions such as asthma and bronchitis.

The role of hiatal hernia in GERD continues to be debated and explored. It is a complex topic because some people have a hiatal hernia without having reflux, while others have reflux without having a hernia.

Much research is needed into the role of the bacterium Helicobacter pylori. Our ability to eliminate H. pylori has been responsible for reduced rates of peptic ulcer disease and some gastric cancers. At the same time, GERD, Barrett's esophagus, and cancers of the esophagus have increased. Researchers wonder whether having H. pylori helps prevent GERD and other diseases. Future treatment will be greatly affected by the results of this research.

References:

National Institutes of Health (NIH)

Nutritional and Herbal Therapy for GERD

• Begin a stress management program: Yoga, Tai Chi, Qigong, Meditation and deep breathing techniques.

• Diet: Avoid carbonated beverages, chocolate, tomato, peppermint, coffee, acidic fruit juices, sour, hot spicy, fatty and fried foods and alcohol.

• Change your eating habits: Eat slowly and chew well. Avoid eating big meals. Eat smaller meals. Don’t over eat, only allow your stomach to be moderately full. Eat 5-6 small meals daily. Eat your dinner at least 3 hours before bedtime. Sit down in an upright chair and rest 20-30 minutes after eating prior to any activity.

• Stop Smoking: Please consult with you practitioner about how acupuncture and Chinese herbs, can help with a smoking cessation program.

• Posture: When sleeping, elevate your upper body by 5 - 6 inches or try sleeping on your left side. Avoid bending from the waist or stooping just after meals.

• Clothing: Avoid tight belts, clothing and bras that increase pressure on your stomach and chest.

• A natural Chinese herbal antacid, Sai Mei An, can help soothe the uncomfortable symptoms of GERD.

There are four types of headache: vascular, muscle contraction (tension), traction, and inflammatory.  The most common type of vascular headache is migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, at times, disturbed vision. Women are more likely than men to have migraine headaches.   

After migraine, the most common type of vascular headache is the toxic headache produced by fever. Other kinds of vascular headaches include "cluster” headaches, which cause repeated episodes of intense pain, and headaches resulting from high blood pressure. Muscle contraction headaches appear to involve the tightening or tensing of facial and neck muscles. Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection. Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.

Is there any treatment?

When headaches occur three or more times a month, preventive treatment is usually recommended. Drug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches. Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches. Drug therapy for migraine is often combined with biofeedback and relaxation training.  One of the most commonly used drugs for the relief of migraine symptoms is sumatriptan. Drugs used to prevent migraine also include methysergide maleate, which counteracts blood vessel constriction; propranolol hydrochloride, which also reduces the frequency and severity of migraine headaches; ergotamine tartrate, a vasoconstrictor that helps counteract the painful dilation stage of the headache; amitriptyline, an antidepressant; valproic acid, an anticonvulsant; and verapamil, a calcium channel blocker.

What is the prognosis?

Not all headaches require medical attention. But some types of headache are signals of more serious disorders and call for prompt medical care. These include: sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person who was previously headache free; and recurring headache in children. Migraine headaches may last a day or more and can strike as often as several times a week or as rarely as once every few years.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts research relating to headaches at its laboratories at the National Institutes of Health (NIH), and supports additional research through grants to major medical institutions across the country. NINDS also supports and conducts studies to improve the diagnosis of headaches and to find ways to prevent them. 

National Institutes of Health (NIH)

Nutritional and Herbal Therapy for Headache

Since there are many types of headaches (migraines, headaches caused by tension, hormonal changes, common cold and eye strain), the nutritional and herbal therapy would be different according to the specific type of headache you have.

According to the Tao of Nutrition, for headaches due to the common cold, you can try the following:

• Make a tea from ginger and green onions, boiling for five minutes. Drink and cover yourself under many blankets to cause a sweat.
• Make a tea from chrysanthemum flowers and and cassia seeds.
• Drink green tea.
• Chinese herbal formula, Chuan Xiong Cha Tiao Wan, is very helpful for headaches due to the common cold.

For headaches due to high blood pressure, menstruation, emotional stress or tension, or migraines, here are some tips:

• Mix lemon juice and 1/2 tablespoon of baking soda in water and drink.
• Make a tea of Chinese prunes, mint and green tea.
• Make a tea of oyster shells and chrysanthemum flowers, slowly boiling the shells for 1 1/2 hours, then adding the flowers for the last 30 minutes.
• Rinse your head with warm water and then gradually increase the temperature to hot.
• Chinese herbal formula, Tian Ma Gou Teng Wan, is excellent for pounding headaches/migraines and headaches due to hypertension.
• For headaches due to menstruation, Xiao Yao Wan, is a popular and effective Chinese herbal formula.

In Chinese medicine, sleep is seen as one's yang energy moving inward to be enfolded by yin. Many different patterns of imbalance can hinder this process. Sleep can be disrupted by pain, hormonal imbalances, digestive or cardiovascular disorders, anxiety and depression, and many medications have the side effect of sleeplessness. The effects of imbalance can be as simple as difficulty quieting the mind when preparing for sleep, or sleep which is easily disturbed by light or sound, to very restless, agitated or dream disturbed sleep.

Our own energy is ruled by the energy of the world around us and the rhythm of our days should naturally reflect the sun's course. As the sun is setting the ruling energy is that of yang (day) transforming into yin (night). This is the appropriate time to start slowing down, quieting the mind and preparing for sleep. This of course is not always possible, but those suffering from sleeplessness should be aware of the influences of universal energy and try to adjust their habits to better reflect this natural pattern. Stimulating food and drink including spicy foods, heavy meats, rich sauces, alcohol and caffeine should be avoided in the evening. Stressful mental work should be avoided if possible in the evenings and vigorous exercise should be scheduled earlier in the day. Activity should be restful, meditation or gentle stretching and breathing exercises can help prepare the body for sleep. Some people find a tea of chamomile or valerian beneficial, for some soaking the feet in warm water helps to draw the energy down from the head and quiet the mind, a gentle foot massage can relax the body and the mind as well. For more serious sleep disturbance a personalized herbal remedy can be prescribed along with acupuncture treatments directed at benefiting sleep and restoring balance.

Children will also benefit from proper sleep. Many parents whose children are poor sleepers, or wake frequently or early, worry that an earlier bedtime would make things worse. Just the opposite can be true. An earlier bedtime can lead to a deeper more restful sleep with fewer interruptions. Chronic or frequent colds, ear infections, extremes of energy (highs and lows) throughout the day, can be brought into balance with good restful sleep.

In our fast paced society sleep can be taken for granted, and many of us develop unhealthy patterns of sleep early in life, but lack of proper sleep does eventually take its toll. Those with chronic sleep disturbance know too well what they are missing. If you feel that you are not getting the rest you should, take steps to change it now; you will be truly grateful for the benefits you receive.

"Premenstrual syndrome” (PMS) is the cyclic recurrence of a group of symptoms that peak 7 to 10 days before menstruation and disappear a few hours after the onset of the menstrual flow. This condition is characterized by multiple and diverse symptoms including, but not limited to: breast tenderness, transient weight gain, bloating, constipation, insomnia, acne, headache, pelvic pain, irritability, depression, mood swings, poor concentration, confusion, social withdrawal, impulsiveness and appetite changes. While many women experience mild symptoms of short duration, other women have more severe symptoms that last for many days and temporarily disturb their normal functioning.

PMS is due to unbalanced hormonal fluctuations. A mixture of correct diet, adequate exercise, and emotional clarity, along with acupuncture and Chinese medicinal herbs can correct imbalances and bring long-term relief.

Balanced nutrition is crucial for overcoming PMS. Certain foods such as alcohol, caffeine, cold temperature foods, sugar, salt, and animal fats exacerbate symptoms of PMS and should be avoided. In addition, commercial red meats and poultry, which have a residue of steroids composed of female animal sex hormones, should be eliminated from the diet. Food necessary for a harmonious menstrual cycle include: plenty of organic vegetables, small amounts of fruit, whole grains, legumes (especially soy), seaweed, small amounts of lean hormone-free meats, and fish (especially salmon, tuna, trout, and mackerel).

Exercise plays an important role in the treatment of PMS. Thirty to forty-five minutes of cardiovascular exercise at least three times per week improves blood circulation and significantly helps reduce symptoms.

In addition to diet and exercise, some form of meditation can be very helpful. Our emotions and hormones influence each other, since they are registered in the same part of our brain. Stress can cause hormonal imbalances and therefore worsen the symptoms of PMS. Some quiet time everyday helps bring emotional and physical equilibrium.

Chinese medicine offers even more tools to address premenstrual syndrome. Acupuncture removes energy blockages and in turn stabilizes hormonal fluctuations. It also provides deep relaxation that helps to calm the mind. Chinese herbs work together with acupuncture to regulate the flow of energy and substances in the body. Together they stimulate the body’s natural functions and encourage it to establish optimum balance.

Women do not have to accept and live with premenstrual syndrome. When the symptoms of PMS are reduced or eliminated, women feel more energetic -- physically, mentally, emotionally and creatively.

 What is a peptic ulcer?

A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of your small intestine. If peptic ulcers are found in the stomach, they're called gastric ulcers. If they're found in the duodenum, they're called duodenal ulcers. You can have more than one ulcer.

Many people have peptic ulcers. Peptic ulcers can be treated successfully. Seeing your doctor is the first step.

What are the symptoms of peptic ulcers?

A burning pain in the gut is the most common symptom. The pain:

• feels like a dull ache
• comes and goes for a few days or weeks
• starts 2 to 3 hours after a meal
• comes in the middle of the night when your stomach is empty
• usually goes away after you eat

Other symptoms are:

• losing weight
• not feeling like eating
• having pain while eating
• feeling sick to your stomach
• vomiting

Some people with peptic ulcers have mild symptoms. If you have any of these symptoms, you may have a peptic ulcer and should see your doctor.

What causes peptic ulcers?

Peptic ulcers are caused by:

• bacteria called Helicobacter pylori, or H. pylori for short
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen
• other diseases

Nonsteroidal anti-inflammatory drugs can cause peptic ulcers.
Your body makes strong acids that digest food. A lining protects the inside of your stomach and duodenum from these acids. If the lining breaks down, the acids can damage the walls. Both H. pylori and NSAIDs weaken the lining so acid can reach the stomach or duodenal wall.

H. pylori causes almost two-thirds of all ulcers. Many people have H. pylori infections. But not everyone who has an infection will develop a peptic ulcer.

Most other ulcers are caused by NSAIDs. Only rarely do other diseases cause ulcers.

Do stress or spicy foods cause peptic ulcers?

No, neither stress nor spicy foods cause ulcers. But they can make ulcers worse. Drinking alcohol or smoking can make ulcers worse, too.

What increases my risk of getting peptic ulcers?

You're more likely to develop a peptic ulcer if you:

• have an H. pylori infection
• use NSAIDs often
• smoke cigarettes
• drink alcohol
• have relatives who have peptic ulcers
• are 50 years old or older

Can peptic ulcers get worse?

Peptic ulcers will get worse if they aren't treated. Call your doctor right away if you have any of these symptoms:

• sudden sharp pain that doesn't go away
• black or bloody stools
• bloody vomit or vomit that looks like coffee grounds

These could be signs that:

• the ulcer has gone through, or perforated, the stomach or duodenal wall
• the ulcer has broken a blood vessel
• the ulcer has stopped food from moving from the stomach into the duodenum

These symptoms must be treated quickly. You may need surgery.

How can I find out whether I have peptic ulcers?

If you have symptoms, see your doctor. Your doctor may

• take x rays of your stomach and duodenum, called an upper GI series. You'll drink a liquid called barium to make your stomach and duodenum show up clearly on the x rays.
• use a thin lighted tube with a tiny camera on the end to look at the inside of your stomach and duodenum. This procedure is called an endoscopy. You'll take some medicine to relax you so your doctor can pass the thin tube through your mouth to your stomach and duodenum. Your doctor may also remove a tiny piece of your stomach to view under a microscope. This procedure is called a biopsy.

If you do have a peptic ulcer, your doctor may test your breath, blood, or tissue to see whether bacteria caused the ulcer.

How are peptic ulcers treated?

Peptic ulcers can be cured. Medicines for peptic ulcers are :

• proton pump inhibitors or histamine receptor blockers to stop your stomach from making acids
• antibiotics to kill the bacteria

Depending on your symptoms, you may take one or more of these medicines for a few weeks. They'll stop the pain and help heal your stomach or duodenum.

Ulcers take time to heal. Take your medicines even if the pain goes away. If these medicines make you feel sick or dizzy, or cause diarrhea or headaches, your doctor can change your medicines.

If NSAIDs caused your peptic ulcer, you'll need to stop taking them. If you smoke, quit. Smoking slows healing of ulcers.

Can I use antacids?

Yes. If you have a peptic ulcer, taking antacids will:

• stop the acids from working and reduce the pain
• help ulcers heal

You can buy antacids at any grocery store or drugstore. But you must take them several times a day. Also, antacids don't kill the bacteria, so your ulcer could come back even if the pain goes away.

Can peptic ulcers come back?

Yes. If you stop taking your antibiotic too soon, not all the bacteria will be gone and not all the sores will be healed. If you still smoke or take NSAIDs, your ulcers may come back.

What happens if peptic ulcers don't heal? Will I need surgery?

In many cases, medicine heals ulcers. You may need surgery if your ulcers:

• don't heal
• keep coming back
• perforate, bleed, or obstruct the stomach or
  duodenum (see Can peptic ulcers get worse?)

Surgery can:

• remove the ulcers
• reduce the amount of acid your stomach makes

What can I do to prevent peptic ulcers?

• Stop using NSAIDs. Talk with your doctor about other pain relievers.

What can I do to lower my risk of getting peptic ulcers?

• Don't smoke.
• Don't drink alcohol.

Glossary
Barium (BAIR-ee-um): A chalky liquid used to coat the inside of organs so that they will show up on an x ray.

Biopsy (BYE-op-see): Removing a small piece of tissue to view under a microscope.

Duodenum (doo-AW-deh-num): The first part of your small intestine, right after your stomach.

Endoscopy (en-DAH-skoh-pee): A test to look inside the stomach and small intestine. The doctor uses a thin, flexible tube that contains a light and a tiny video camera. This device is called an endoscope.

Helicobacter pylori (HELL-ih-koh-BAK-tur py-LOH-ree): A bacterium that can damage stomach and duodenal tissue, causing ulcers. It is known as H. pylori for short.

For More Information
You can get information about peptic ulcers from the

Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Phone: 1–888–MY–ULCER or 404–639–3534
Internet: www.cdc.gov

Acknowledgments
The National Digestive Diseases Information Clearinghouse (NDDIC) would like to thank the following individuals for assisting with scientific and editorial review of this publication.

David A. Peura, M.D., University of Virginia

Steven J. Czinn, M.D., Case Western University

Thanks also to Anne Barker, R.N., B.S.N., at the Health Alliance, Columbia, MD, for facilitating field-testing of this publication.

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Email: nddic@info.niddk.nih.gov

References:

National Institutes of Health (NIH)

Nutritional and Herbal Therapy for Peptic Ulcers

• Some foods can irritate the lining of the intestinal tract. Therefore, it is advised to avoid certain foods:

  • Strong spices such as garlic, coriander, cumin, and chilies.

  • Acidic foods/beverages such as citrus fruits and juices, coffee and strong black teas

  • Alcohol, smoking

  • Fried foods

  • Shellfish

• According to the Tao of Nutrition,
  • Drink warm kale or cabbage juice on an empty stomach to help heal the ulcer.
  • Take 2 teaspoons peanut oil every morning on an empty stomach to help close the wound.
  • Drink potato juice on an empty stomach for at least two weeks.

•  The Chinese herbal remedy, Shu Gan Pian, can help alleviate and heal the digestive tract. It is very helpful when stress is the major factor in the onset of ulcer flare-ups.

Tinnitus is a symptom associated with many forms of hearing loss. It can also be a symptom of other health problems. According to estimates by the American Tinnitus Association, at least 12 million Americans have tinnitus. Of these, at least 1 million experience it so severely that it interferes with their daily activities. People with severe cases of tinnitus may find it difficult to hear, work, or even sleep.

What causes tinnitus?

• Hearing loss. Doctors and scientists have discovered that people with different kinds of hearing loss also have tinnitus.
• Loud noise. Too much exposure to loud noise can cause noise-induced hearing loss and tinnitus.
• Medicine. More than 200 medicines can cause tinnitus. If you have tinnitus and you take medicine, ask your doctor or pharmacist whether your medicine could be involved.
• Other health problems. Allergies, tumors, and problems in the heart and blood vessels, jaws, and neck can cause tinnitus.

What should I do if I have tinnitus?

The most important thing you can do is to go see your doctor. Your doctor can try to determine what is causing your tinnitus. He or she can check to see if it is related to blood pressure, kidney function, diet, or allergies. Your doctor can also determine whether your tinnitus is related to any medicine you are taking.

To learn more about what is causing your tinnitus, your doctor may refer you to an otolaryngologist (oh-toe-lair-in-GAH-luh-jist), an ear, nose, and throat doctor. He or she will examine your ears and your hearing to try to find out why you have tinnitus. Another hearing professional, an audiologist (aw-dee-AH-luh-jist), can measure your hearing. If you need a hearing aid, an audiologist can fit you with one that meets your needs.

How will hearing experts treat my tinnitus?

Although there is no cure for tinnitus, scientists and doctors have discovered several treatments that may give you some relief. Not every treatment works for everyone, so you may need to try several to find the ones that help.

Treatments can include:

• Hearing aids. Many people with tinnitus also have a hearing loss. Wearing a hearing aid makes it easier for some people to hear the sounds they need to hear by making them louder. The better you hear other people talking or the music you like, the less you notice your tinnitus.
• Maskers. Maskers are small electronic devices that use sound to make tinnitus less noticeable. Maskers do not make tinnitus go away, but they make the ringing or roaring seem softer. For some people, maskers hide their tinnitus so well that they can barely hear it. Some people sleep better when they use maskers. Listening to static at a low volume on the radio or using bedside maskers can help. These are devices you can put by your bed instead of behind your ear. They can help you ignore your tinnitus and fall asleep.
• Medicine or drug therapy. Some medicines may ease tinnitus. If your doctor prescribes medicine to treat your tinnitus, he or she can tell you whether the medicine has any side effects.
• Tinnitus retraining therapy. This treatment uses a combination of counseling and maskers. Otolaryngologists and audiologists help you learn how to deal with your tinnitus better. You may also use maskers to make your tinnitus less noticeable. After a while, some people learn how to avoid thinking about their tinnitus. It takes time for this treatment to work, but it can be very helpful.
• Counseling. People with tinnitus may become depressed. Talking with a counselor or people in tinnitus support groups may be helpful.
• Relaxing. Learning how to relax is very helpful if the noise in your ears frustrates you. Stress makes tinnitus seem worse. By relaxing, you have a chance to rest and better deal with the sound.

What can I do to help myself?

Think about things that will help you cope. Many people find listening to music very helpful. Focusing on music might help you forget about your tinnitus for a while. It can also help mask the sound. Other people like to listen to recorded nature sounds, like ocean waves, the wind, or even crickets.

Avoid anything that can make your tinnitus worse. This includes smoking, alcohol, and loud noise. If you are a construction worker, an airport worker, or a hunter, or if you are regularly exposed to loud noise at home or at work, wear ear plugs or special earmuffs to protect your hearing and keep your tinnitus from getting worse.

If it is hard for you to hear over your tinnitus, ask your friends and family to face you when they talk so you can see their faces. Seeing their expressions may help you understand them better. Ask people to speak louder, but not shout. Also, tell them they do not have to talk slowly, just more clearly.

References:

National Institute on Deafness and Other Communication Disorders
National Institutes of Health
31 Center Drive, MSC 2320
Bethesda, MD USA 20892-2320

Nutritional and Herbal Therapy for Tinnitus

According to the Tao of Nutrition, there are some steps you can take to help ease tinnitus. First, you should avoid the following:

• loud noise
• stress & tension
• stimulating foods and drinks (ex. caffeine)
• spicy foods
• smoking
• alcohol

Furthermore, you can try the following simple recipes:

• Drink one cup of juice made with celery and grapes 2-3 times  a day.
• Boil Chinese black dates, walnuts and lotus seeds with rice porridge and eat some daily.
• Rice porridge with black beans and azuki beans once daily.

The Chinese herbal patent formula, Er Long Zuo Ci Wan, can help ease tinnitus: