By Shihan Mary Bolz
Master of Science Oriental Medicine
Doctoral Fellow, FBU
Master Martial Arts Instructor
When you have decided to obtain better health and to be a participant in your own health and well being, it is important for you to seek out a health care practitioner whom you feel you can trust and who is qualified. In the case of using the TCM route, in the state of California, you should seek out a practitioner with L. Ac. (Licensed Acupuncturist) after their name. The California Board of Acupuncture puts out one of the most comprehensive and challenging board exams in the nation and one of the requirement s is that Traditional Chinese Herbology be included. In other states, most acupuncturists will have a Dipl. Ac., following the licensing requirements of the NCCAOM (National Council of Chinese Acupuncture and Oriental Medicine). Those who have this licensure may or may not be qualified in Chinese herbology, as these are separate tests. Any other medical practitioner who has not gone through the actual training lacks the knowledge to help you using acupuncture and herbs. A Certified Acupuncturist goes through a brief overview of acupuncture, which is for use in pain management, but not as a fully licensed acupuncturist with many more hours of training could provide. To help you understand how your practitioner works with you, the following information will give you a little bit of insight into the thinking and basic theory of TCM.
An Oriental medicine doctor uses the four examinations of inquiring, observation, listening/smelling and palpating/touching. The doctor will ask you many questions about yourself and your bodily functions. Not only do your answers tell a lot about yourself, but also your tone of voice, your body language and emotional affect and expressions are very revealing. The practitioner will ask you about your sweat, urination, headaches, bowel and urinary functions, how you sleep, sexual activity, past medical history, exercise, pain, etc.
Observation mainly consists of examination of your tongue, facial color and physiognomy, nails, eyes, and skin and body language. Red, green, yellow, white, and black colors are associated with imbalances of the different internal organs. Red is associated with the heart, green associated with the liver/gallbladder, yellow is associated with the spleen, white is associated with the lung, black is associated with the kidneys. More than one color may be present in different areas of the body, giving a more defined picture of the person’s condition. Of these types of diagnosis, tongue reading is the most important and is a complicated science. Years of practice and study in viewing tongues is required to be able to “see” the person’s condition. The body of the tongue and the coating of the tongue are keenly observed. The body of the tongue will more indicate the long-term and basic condition of the entire system of the person. However, different areas of the tongue are specific to the different internal organs. For example, a very red tongue body color indicates heat in the system. If the tip of the tongue is the most red of all, this indicates excess heat in the heart, since the tip of the tongue is associated with the heart. The coating tells more about the current condition of the digestive system especially, and can change quickly depending on the person’s lifestyle and eating habits. For example, when a patient has been taking the correct herbal formulation for a week, the coating of the tongue can be greatly changed and improved.
Listening/smelling diagnosis: The practitioner will pay attention to the patient’s tone of voice, breathing, any sounds of coughing and what type of cough; all of these provide valuable information. The odor of the patient can also tell the practitioner about the kind of internal disharmonies inside of that person. Palpating, touching: This includes pulse diagnosis, which is the most important one and the most difficult form of diagnostics to learn. Extreme concentration and lots of training and practice are required for this method of diagnosis. When well learned, it is a very accurate science. The body really does tell all. Many times the patient is not very in touch with themselves or with their own illness and really do not answer the questions accurately in the interview process with the doctor. Not to worry. A skilled Oriental medicine doctor will find the truth.
There are twenty-nine different pulse qualifies that an Oriental medicine practitioner will look for. Some of the most used and commonly found are descriptions such as the following: slippery, wiry, hesitant, choppy, floating, tight, slow, rapid, thin, fine, big, excess, deficient, forceful, soft, soggy, and others. Pulses are also rated superficial, at the middle, or deep. There are six different locations on the wrist in the pulse taking process, which will indicate the different pulses and thus manifestations of the different internal body organs.
There is palpation of the entire body when it comes to pain and abdominal palpation for more internal diseases. The body’s response to different palpating pressures in the painful area also carries a very valuable meaning for diagnosis by the practitioner. Pain in a confined area is more due to blood stagnation and pain that moves around is more stagnant Qi (life force energy).
After all of the methods of diagnostic tools are used, the Oriental medicine doctor makes a diagnosis. A diagnosis does not sound anything like an allopathic (Western, conventional in the United States) diagnosis. For the Oriental medicine practitioner, a Western medicine diagnosis sounds like a symptom. For example, the allopathic medicine diagnosis of diabetes, Type II is only a symptom for the Oriental medicine practitioner. It does not tell anything about their individual imbalance or factors that have led to this state. Neither is hepatitis a diagnosis for the practitioner, but just one of their conditions that have resulted from their imbalance.
In Oriental medicine, like allopathic medicine, certain manifestations and conditions will be in common with certain diseases. A person with hepatitis C will probably have as part of their diagnosis “Toxic Heat.” It is an epidemic factor that will manifest in flu-like symptoms and include nausea, fatigue, various skin conditions, even fevers. Toxic Heat can manifest to a greater or lesser degree in the various internal organs, most commonly the liver, spleen, gallbladder, kidney, and heart. If Toxic Heat attacks mostly the liver and spleen, there will be many digestive disturbances with symptomatology of bloating, gas, flatulence, loose and/or fragmented stools and even pain in the abdomen, exceeding tiredness after eating and perhaps the person gets infections easily. When dampness sets in there will be abdominal swelling and fluid retention. There is also Damp Heat, either of the liver/gallbladder system or the spleen system. There can also be Damp Cold of the spleen and not always heat.
Just as there are multiple symptoms affecting the entire system of the person, giving rise to a complicated disease picture, there are many other Oriental medicine diagnoses associated with hepatitis. Each individual will manifest their symptomatology in different ways because each individual has a different predominating factor or cause of the illness. Some of the differential diagnoses follow.
Liver Qi Stagnation: Symptoms include fatigue, pain in the ribcage, and fullness in the abdominal area, flatulence and/or bloating, nausea, swollen liver and spleen. There may be an increase in the liver enzymes. Blood stagnation: Symptoms will include sharp, stabbing pain along the rib cage and the abdomen will be painful upon movement. These symptoms can be relevant to liver cancer.
Blood deficiency: The person will have a pale and dull face, dry skin, and dry mouth. The enzymes will be more normal and the liver will shrink. These symptoms can be relevant to cirrhosis. General Qi deficiency: Symptoms of fatigue, bleeding, purple blotches on the skin, edema and ascites (huge swelling of the abdomen due to water accumulation).
General Yin deficiency: Fatigue, flushed-reddish face color, mainly in the cheeks, night sweats, afternoon fevers, low grade, restlessness, insomnia, restless sleep, maybe even hot flashes.
Specific Liver Yin Deficiency: Dry mouth and throat, dry nails, dry eyes, blurry vision, dizziness, muscle spasms, malar flush of the face, red eyes, numbness in the extremities, and a short, quick temper. Spleen deficiency: Fatigue, nausea, poor appetite, muscle weakness, loose stools, even abdominal tenderness.
Western medication does eliminate the virus from the blood for many people, up to 62 percent with the Hepatitis C virus (HCV) of genotype non-1 on combination therapy, even though there are frequent cases of it not working and sometimes there is even serious side effect of the medications. Those most notably used are Interferon and Ribavirin. It is generally agreed that anyone with antibodies to HCV, HCV RNA (a measurable viral load detected by a PCR test), elevated serum AST and ALT (liver enzymes) levels and evidence of chronic hepatitis on a liver biopsy, with no contraindications, should be offered therapy with the combination of alpha interferon and ribavirin. The liver biopsy is important before making the decision for these therapies. There are certain people who should not be treated with Western therapy. These include clinically decompensate cirrhosis because of the hepatitis C, kidney, liver, heart or other organ transplant, clinical depression that is not controlled in people with a history of attempted suicide, and normal aminotransferase levels. Traditional Oriental Medicine (TCM) can be very good at treating side effects of hepatitis C, as well as improve the liver itself. Unclear thinking and depression can be treated quite effectively with acupuncture and herbs. Even fibrosis and cirrhosis can be improved. TCM can be used in conjunction with Western therapy or by itself. The treatment goals in Traditional Chinese Medicine are not to kill the pathogen, but to help the individual’s own system to become strong enough to contend with the pathogens itself. In the case of Hepatitis C, this is still true and the goal is to alleviate symptoms and prevent further damaged to the system and to even improve the internal organs. Diet, acupuncture, herbal therapy, Qi Gong exercises, meditation, other breathing exercises and a interconnectedness of mind/body/spirit are extremely helpful and do make a great difference in the quality of life for the individual.
When modern TCM practitioners use acupuncture and traditional Chinese herbs to treat HCV, they are used in a combination of the traditional Chinese therapeutic standpoint and their Western known capabilities.
Newly created herbal formulae consist of herbs that have the greatest effect from a Western point of view such as anti-inflammatory, protective for the liver, antiviral properties, and from the traditional point of view of Chinese medicine syndromes and pattern identification of imbalances in the body. Contemporary information on the Chinese herbs is now known for treating hepatitis C. Your TCM herbalist has information on laboratory-based insights into the biochemical actions of certain herbs. Scientific analysis of herbs also helps to avoid toxicities. In addition, TCM herbs taken along with Western drug therapy lessens the negative side effects of the Western drugs. Herbs are wonderful, either used alone or with Western drugs, and can be used to protect the liver, decrease liver inflammation and strengthen the immune system. Strengthening the immune system alone would be a reason to take TCM herbs. Western medication, remember, knocks out everything, not just the virus. There are herbs that can help clear the Toxic Heat in the liver, herbs that strengthen the immune system, herbs that help depression, and all of the other conditions that are possible.
This is largely done based on the aforementioned methods of pattern identification in each patient. Herbs that improve the immune system help fatigue and upset stomach include cordyceps, ganoderma, astragalus, American Ginseng and licorice. However, it is not advised that anyone with Hepatitis C just go out and buy these herbs. It is of vital importance to have yourself diagnosed by a TCM herbalist, because these could be the wrong herbs for you. There is much more to herbal therapy than just treating symptoms. For example, if the herb is too hot in quality, it can increase your heat and thereby the toxin. TCM herbs are always used in well-calculated formulas and very rarely individually. There is a reason for this. One herb does not have all the qualities to get the desired effect.
Acupuncture is completely non-chemical and never adds anything toxic to your body; it gets the body to heal and balance itself. It is understood, the correct acupuncture point combination to be used would depend on the patient’s individual TCM diagnosis. There are no “hepatitis C” points on the body. It is not simplistic symptomatic treatment. There are no “antidepressant points” on the body. It is the combination of the use of certain points, once again, matching the individual’s own pattern of imbalance.
One of the things all people can do for themselves is improve their diet. This is an absolute must for a good recovery from any illness, but mandatory in something as serious as Hepatitis C and other liver diseases. A whole grain and vegetable-based diet is absolutely the very best. Animal food, including fish, but to a lesser degree, contain a lot of toxin and that is just more toxin for the liver to deal with. Beyond just whole grains and vegetables, these should be organically grown and all pesticide and commercially fertilized foods should be greatly reduced or eliminated from the diet. Sugar is another drug, as well as coffee, that is damaging to the spleen and the liver. Miso soup, a traditional Japanese dish with sea vegetables is a very cleansing yet nutritionally complete food. Both the miso and the sea vegetables are effective at clearing excess toxin and radiation from the body. Vegetarian sources of protein such as all forms of beans, seeds, and nuts (nuts used in moderation) are much better than animal sources for the human system. The nutrition is high and the fat and toxin are minimal.
There are also techniques that your practitioner can teach you at home using the acupoints to give yourself acupressure, or have a loved-one do it for you. Moderate exercise is always a good thing. Start slowly and then work your way up to a more rigorous routine, if desired. Do not work to exhaustion. Exercise increases the blood and Qi flow in the body.
Remember, one of the TCM patterns of Hepatitis C is blood stagnation and that is likely a component in all cases, in varying degrees. Positive, positive thinking. Do not think you are doomed; do not think it is the end of your life. Be active, get help and most of all, and help yourself. The first two items, be active and get help are a big step in the process of helping yourself. Remember, life is good!