Knotty problems

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The term " knotty problems " or " knotty diseases " refers to complex cases. I

like the analogy of the ball of string with multiple knots that the author

of the article uses. One also can compare knotty problems to straightening

out a bunched-up string of Christmas tree lights. Often one has to work at

the problem from several directions and sometimes taking turns on areas

until the string is straightened out.

 

An example of a knotty problem is CFIDS (Chronic Fatigue Immune Dysfunction

Syndrome) - especially CFIDS that has gone without proper treatment for a

long while. There will be mulitple system involvement with the Spleen,

Kidneys, Liver, and Heart being the most commonly affected. There often

will be both Heat and Cold present. For example there may be Damp Heat or

Latent Heat in the Liver while the Kidneys and Spleen are Yang Deficient

(Deficiency Cold). This is not a simple case of either warming or cooling

since both Cold and Heat are present.

 

When treating knotty problems, healers often have more success with

completely individualized formulas which they concoct themselves than with

relying on traditional formulas. This enables healers to try to take care

of as many symptoms and Roots as possible with a minimun of side effects.

Completely individualized formulas for complex clinical pictures tend to

contain a lot more herbs than traditional formulas which treat one or two or

three Roots at a time. It's not unusual for knotty problems to require 20

to 30 or more herbs. And, instead of requiring one formula, the client may

need two or three or more formulas with each formula made up of multiple

herbs. (At one time I was on 5 different formulas.)

 

The article points out that in a lot of these cases of complex clinical

pictures that Spleen and Stomach problems will need to be concentrated on

first. This is because if the person's digestion is very poor s/he isn't

going to be able to absorb the healing properties of the herbs for other

problems. Also, allergy and allergy-like problems frequently have a Root of

Spleen disharmony, and the person won't be able to tolerate healing herbs

and food. Poor absorption of food and herbs as well as intolerance to food

and herbs is frequently seen in PWCs (People With CFIDS), though this

problem also arises with other complicated clinical pictures. Concentrating

on Spleen and Stomach problems does not mean that one ignores other problems

in the beginning. As many as possible are treated at the same time, but the

healer pays a little more attention to correcting the Spleen and Stomach

imbalances.

 

Remember the Yin-Yang symbol which shows Yin evolving into Yang and Yang

evolving into Yin? With knotty problems one is the most likely to see

problems becoming their opposite. For example if the Kidneys are Yin

Deficient for a long time without proper treatment, the Kidneys will become

Yang Deficient and Kidney Yang Deficiency will become the primary problem.

(Any chronic condition will result in Kidney Yang Deficiency after a while.)

Another example is Dampness becoming Dryness. A typical scenario in these

cases is the Spleen is Deficient and cannot perform its job of transporting

and transforming fluids. After a while the stagnant fluids congeal into

Phlegm. The Phlegm (in some cases) interferes with fluid transport in the

body, and Dryness results. Cold frequently turns into Heat and then into

destructive Fire. The Cold becomes trapped in the body, under pressure and

containment it becomes first Heat and then Fire. This is what happens when

Wind Chill (the common cold is one manifestation of Wind Chill) becomes

trapped in the Lungs and become Fire (pneumonia).

 

Victoria

 

 

>http://www.itmonline.org/pdf/knotty.pdf

 

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>in this case how do we ensure that the heating herb will not exacerbate the

>heat rather than warm the cold part, and vice versa?

 

There are several ways to do it depending on the individual circumstances.

Sometimes it best to treat the Heat problems first - like in a lot of cases

of very high fever that can damage the brain. Sometimes they're both

treated at once. You take advantage of the fact that specific herbs target

specific meridians, and you keep the overall thermal energy of the formula

neutral. Sometimes there may be one formula taken in the morning and one in

the evening. I'm thinking here of a person who has marked Kidney Yin and

Kidney Yang Deficiency problems. When the Kidneys are affected, there tends

to be both Yang and Yin Deficiency though one will predominate. This is why

whenever a person is Kidney Deficient in one, tonic herb(s) for the other

will be included in the formula. But sometimes this isn't enough. The

person is so Deficient in both Kidney Yang and Kidney Yin that the formula

in the morning needs to go a little heavier on treating one (the Yang

problems) and the formula at night goes a little heavier on treating the

other (the Yin problems).

 

By the way, I have to do this. Even though my Yang Deficiency problem is far

away the worst, there is a Yin Deficiency problem that also need special

attention. When I was the sickest and the most Yang Deficient (and so very

abnormally Cold), I was able to take a formula that did it the usual way of

just including a Yin tonic in with the Yang tonics. But after I improved a

lot, I needed special treatment for the Yin Deficiency and started taking a

Yin tonic herb at night along with a small amount of licorice root (a Qi

tonic).

 

This brings us to some more very fine-tuning of treatment. An excess of

Yang tonic herbs can create Yin Deficiency. In most of these cases just

cutting back on the number of Yang tonic herbs is the correct strategy

because the Yin Deficiency is coming from the Yang Deficient person having

improved to the point where what was proper when the Yang Deficiency problem

was a whole lot worse is now too much. And I did cut back on the Yang tonic

herbs. But in my particular case I also needed the little additional Yin at

night. Part of the reason I knew this was because I'm familiar with my

medical condition and history, and as I improve from the CFIDS, it's been

like backing up through symptoms. CFIDS is not a static condition. The

clinical picture is very varied, and there are phases or stages.

 

The particular Yin tonic herb I use at night was choosen carefully. It's

asparagus root. This one targets the Lungs and the Kidneys which are

exactly where I need the extra Yin the most. If you check Yin tonic herbs,

a lot of them target the Spleen and/or Stomach and these herbs are

contraindicated in cases of Spleen and Stomach Deficiency. Some are

specifically contraindicated in cases of Dampness and Phlegm accumulation

(which frequently are by products of Spleen Deficiency). The Kidney Yang

Deficiency problem was by far the worst problem I have, but there also are

severe Spleen Deficiency problems and Dampness and Phlegm problems. I knew

I needed something that would be the least aggravating to those problems

while supplementing the Kidney Yin.

 

The licorice root (a Qi tonic) does smooth out the effects of other herbs,

but this is not the main reason I combine it with asparagus root.

Alternative healers in the West have discovered that licorice root can be a

treatment for CFIDS. For those wishing more details, check the book Miracle

Cures by Jean Carper. I don't like the title of the book, but it is a very

good book. I don't want to go too far afield with a discussion of CFIDS and

Western medicine here, but researchers at John Hopkins have discovered that

a lot of PWCs have a condition called Neurally Mediated Hypotension. The

blood pressure doesn't maintain or rise when it's supposed to. Licorice

root is an alternative treatment for this condition. So the licorice root

does more than one thing for me that I need - it's a Qi tonic, it smooths

out the effects of other herbs, and it helps the NMH problems. I chew a

very small piece of asparagus root and a very small piece of Chinese

licorice root.

 

Getting back to ways to treat Hot and Cold:

 

Sometimes the time of month in a woman's menstrual cycle will make a

difference on how cooling or heating the overall formula needs to be.

 

Sometimes you can combine acupuncture/ acupressure with the use of herbs.

In some cases you can concentrate on relieving the Cold with the herbs while

using the acupuncture/ acupressure to release the Heat.

 

Sometimes taking care of a Root problem is going to take care of the mixed

Heat and Cold problem. An example of this is Qi Stagnation. Very often,

localized Heat will be a by product of Qi Stagnation. Take care of the Qi

Stagnation, and the Heat problems automatically are taken care of.

 

Another example of times when there may be localized Heat is when energy is

flowing in the wrong direction. I'm thinking specifically of Liver Yang

Rising here. Another example of mixed Heat and Cold symptoms that are taken

care of by taking care of the Root problem is Jue Yin-stage Parasitic Evil.

There will be a thermal pattern of Heat in the upper body, Cold in the lower

body, and cold extremities. The Root is that the person is infected with

parasites. Get rid of the parasites, and the Heat-Cold problems disappear.

The unequal distribution of Heat is coming from a blockage of the flow of

Qi. (BTW, you'll also see the Heat in the upper body, Cold in the lower

thermal distribution in one menopause syndrome, but the Root and treatment

are different in this case.)

 

I hope other readers will respond with techniques for treating mixed Cold

and Heat problems.

 

To be continued.

 

Victoria

 

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>what's the largest amount of herbs you've seen prescribed for a daily

>intake?

 

I don't remember the exact number of different herbs, but I was on a lot of

different herbs at one point. Some of the herbs were in very minute

amounts, but there was a lot of different herbs.

 

There was the main formula that the TCM herbalist concocted from scratch

instead of relying on a traditional formula. I don't remember all the

herbs, but I remember Siberian ginseng for energy, something else for Qi,

cooked rehmannia for its Blood tonic problems and its secondary Yin tonic

properties, dried ginger for warming me up and it's a mild Yang tonic, Fu

Ling for Dampness accumulation problems, cornus fruit for its astringent

properties (yes, it is possible to have both Dampness accumulation problems

and " leaking " problems at the same time) and for cornus helping Kidney

problems, and some other herbs I can't remember. The herbalist did a pulse

examination, a tongue examination, and asked a lot of questions before

coming up with the herbs. The examination took about an hour and 45

minutes.

 

The main formula was decocted into a tea. Then there was a tincture called

Kidney Klenz that contained parsley root, juniper berries, corn silk, uva

ursi, gravel root, and buchu leaves to strengthen my kidneys. (A lot of

these herbs aren't TCM herbs, but he used them in a TCM framework.)

 

There were Fem-O-Pross capsules for female reproductive system health. They

contained Mexican Wild Yam, Vitex, and Tang Qui.

 

There were Clean Sweep capsules for the colonic inertia problem, and they

contained cascara bark, yellow dock, senna, rhubarb, and chaparral.

 

There was a tincture for liver problems, but I can't find the bottle for it

with a list of herbs. (The CFIDS started out for me as mono-induced

hepatitis following gall bladder surgery.)

 

There was a separate tea which was Epimedium (Yin Yang Huo). It's a Yang

tonic, and one that was and is very effective for me.

 

At one point for several months, in addition to all the others, there was

one bag per month of Minor Blue Dragon tea. This is a traditional formula,

and it too worked very well for me.

 

At one point he tried me on osha for the chronic infection problems, but it

didn't work all that well in my case so he switched it to something else. (I

have a history of chronic and recurring mono.)

 

In addition I was brewing up extra cups of ginger tea because I discovered

that they really helped a lot.

 

The herbalist definitely knows his TCM. After being on the herbs for 3

weeks, one day I realized that I had enough energy to start a regular

exercise program that would incorporate some Yoga and other exercises that

would specifically target some health problems - like sit-ups for the

colonic inertia problems, some Yoga exercises for the underactive thyroid

problems, etc. This was a major, major milestone. PWCS are made sicker by

exercise. We have to be brought up to a certain level via other means (like

herbs) before we can do even mild and non-aerobic exercise like Yoga.

Otherwise, we're made sicker by the activity. Body temperature decreases

instead of increases (a big problem when your body temperature is in the 97

and even 96 range to begin with.) Blood flow to the brain decreases instead

of increasing, and it may take several days for it to return to normal. Any

overdoing results in a PWC having to rest up for some time afterwards. I

could have exercised before the herbs, but it would have made me sicker and

it would have been a week or two or longer before I could do it again. And

unlike normal people, exercise does not increase endurance or stamina in

PWCs. It lessens them in PWCs or at best has no effect. So my being able to

start a very modest, *regular* exercise program was very impressive.

 

The herbal tea mixtures weren't brewed daily. I would brew up a batch and

refrigerate it, warming a cup at a time over the next week. The main

formula was taken twice a day. The Minor Blue Dragon was taken one cup once

a day for a week until the next month. (BTW, Minor Blue Dragon contains Ma

Huang - ephedra. This can be a very effective herb when used properly and

when its use really is indicated. This is why I hate seeing it abused so

much in the U.S. and used for things that it's actually contraindicated

for.)

 

The days when I had to take so many different herbs are over. There's been

a lot of improvements. Something else about TCM treatment of CFIDS: I've

had CFIDS for 26 years. In that time I've had 4 major flare-ups of it,

counting the initial appearance of the condition.

Each time I was able to get enough help to go into a partial remission.

Before TCM I never fully regained what was lost with each major flare-up.

It was progressive for me. It was only after starting to use TCM that I was

able to start regaining abilities and levels of functioning that I thought

had been lost forever. I've now regained a lot of what I could do back

during the 2nd partial remission. Improvement continues as long as I use

TCM. BTW, Yang Deficiency problems and Phlegm problems can take a very long

time to resolve. Also, the longer a person has had a problem and the longer

it's gone without proper treatment, the longer it tends to take to resolve.

In some cases it may not be possible to resolve it completely, but

improvement usually is possible.

 

In some PWCs, the Yin Deficiency problems predominate.

>

>in concoting the fomula, do you dispense with providing a balanced for each

>pattern, and just go for an overall balance interms of temperature and

>tastes?

 

You concentrate on treating the Root TCM syndromes and it's the overall

average of the temperature that counts. I remember asking the herbalist very

early in treatment if certain herbs like dandelion root were contraindicated

for me since they were so Cold. (By that time I had bought a copy of Lu's

Chinese Herbal Cures, and was reading and learning all I could. Plus,

asking the herbalist a lot of questions which he answered.) He said it's

the overall thermal energy that matters, and that in the case of a Cold

herb, combine it with enough warming herbs that the overall average was

warming or neutral.

 

A lot of achieving the correct overall thermal energy is a function of the

nature of the herbs used to treat specific TCM syndromes. For example, in

the case of Yin Deficiency, the Yin tonic herbs all tend to have Cold, Cool,

or Neutral thermal energy. In the case of Yang Deficiency, all the Yang

tonic herbs tend to have Warm energy. Tu Si Zi (dodder seed - Semen

Cuscutae) which primarily is a Yang tonic but also has secondary Yin tonic

properties has neutral thermal energy.

 

The Blood tonic herbs are mixed though more tend to be warming or neutral in

thermal energy than cooling. When it comes to Blood Deficiency, this is a

problem that can exist in both too Hot and too Cold people. So the person

being too Hot or too Cold can be a factor in the herbalist choosing one

Blood tonic herb over another.

 

It also can be a problem when there is a pressing need to treat a symptom.

An example is the colonic inertia problems I had (and still have some). The

Root is Yang Deficiency and Internal Cold (also with Qi Stagnation problems)

in my case, but Yang Deficiency problems take a long time to resolve. In

the meanwhile I needed relief of that particular problem in order to help

other problems (like severe intestinal pain, Heat build-up in the Lungs,

etc.). The problem is that most laxative and purging herbs are cooling.

Actually, they're not just cooling but Cold to very Cold. To take them alone

will relieve symptoms temporarily but aggravate the Root so that the problem

get worse and more frequent. The solution is mix these herbs with warming

herbs so the overall thermal average is warming or at least neutral. Or,

find one of the few laxative herbs that have warming energy. Wicke writes in

vol. 2, p. 59, " FRom a TCM perspective, these herbs are appropriate for

Interior-Excess-Heat conditions with abdominal stagnation. Constipation is

the most commonly encountered manifestation of this pattern .... In cases of

Interior-Excess-Cold, the bitter-cold attacking purgatives must be combined

with strong doses of spicy hot herbs such as Rz Zingiberis (fresh ginger) to

counteract the undesirable cold property. There do exist herbs that are

mildly purgative in action yet are also warm, but for some reason these are

not as potent or as common in nature as the bitter cold purgatives. "

 

 

These two posts will only give you some ideas on herbal strategies. The

more you read from a variety of sources, the more actual cases you're

familiar with, the more ideas you'll get.

 

BTW, the treatments for resolving Phlegm problems can differ quite a bit.

There are specific herbs for Cold Phlegm and specific herbs for Hot Phlegm,

but when you really get into a study of Phlegm problems, you find that

treatment also is going to vary quite a bit according to Roots and etiology.

In most of these cases, there is going to be multiple factors, and Spleen

Deficiency is going to be common to many of them. The Spleen is too weak to

perform its function of transporting and transforming fluids, the fluids

congeal into Phlegm. If the underlying Spleen imbalance isn't taken care

of, the body just keeps producing more Phlegm as fast or faster than the

Phlegm relieving herbs can get rid of it. Also, in the case of Cold Phlegm,

some experts like Dr. C.S. Cheung recommends that treatment concentrate not

directly on removing Phlegm with herbs for reducing Cold Phlegm but on

warming the body and correcting the reasons for the person being too Cold

and resolving the Phlegm that way.

 

Victoria

 

 

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This is not a simple case of either warming or cooling

> since both Cold and Heat are present.

 

in this case how do we ensure that the heating herb will not exacerbate the

heat rather than warm the cold part, and vice versa?

 

>

It's not unusual for knotty problems to require 20

> to 30 or more herbs. And, instead of requiring one formula, the client

may

> need two or three or more formulas with each formula made up of multiple

> herbs. (At one time I was on 5 different formulas.)

 

what's the largest amount of herbs you've seen prescribed for a daily

intake?

 

in concoting the fomula, do you dispense with providing a balanced for each

pattern, and just go for an overall balance interms of temperature and

tastes?

 

thanks for intriguing article!

 

Andrew