Long Dan Xie Gan Tang (Gentiana Formula)
– Liver Fire (lesions on chest, upper back and face)

AND/OR
Qing Re An Chuang Wan (Salvia & Scute Formula)

– Lung Heat (lesions on the face)

Protocol A

PLUS

Cases that do not significantly improve with the above protocols.

Course of treatment: 2 weeks
Note: More than one course may be necessary

The main aim of TCM herbal therapy is to unblock the heart's blood vessels by removing obstructions, which may be achieved by using the formulas in the protocols below in a timely manner and at a high enough dosage. This is a better approach than that of Western medical treatment, which only acts to temporarily dilate the blood vessels.

• Soothe the Liver and relieve constraint

• Calm the Spirit
• Nourish the Heart Blood
• Strengthen the Spleen and tonify the Qi

The appropriate principle of treatment should be chosen according to the individual patient.

The main deficiency patterns are Spleen and Kidney Yang deficiency, Lung Qi deficiency with deficiency of the Exterior and insecurity of the defensive Qi. At the deepest level, there is generally a combined deficiency of the Spleen Yang and the Kidney Yang. This is the root cause of the more apparent deficiency of the Lung Qi together with deficiency of the Exterior with insecurity of the defensive Qi.

In planning a treatment protocol, emphasis should be given to clearing away the biao factors, while consolidating the Exterior and strengthening the Lung Qi. Over the long term, treatment during the remission stage should continue for many months, with the aim of warming and tonifying the Spleen and the Kidney Yang. This is essential for most cases.

The main pathodynamic in acute or acute on chronic bronchitis is Phlegm-Heat. Clinically, the treatment protocol should address Heat Toxin as well as the Phlegm-Heat. This is because Heat Toxin may readily develop as a consequence of the Phlegm-Heat, obstructing the Lung Qi.

During the remission stage, the treatment should focus on consolidating the Exterior and tonifying the Qi in children, and also tonifying the Kidney in middle aged and elderly patients

In order to make the treatment suitable for an individual case, the dosages of each formula may be adjusted up or down in accordance with the treatment principle that is being emphasized.

Protocol A

Acute condition: severe case.

• Blood stasis
• Heart Qi deficiency
• Heart Blood deficiency

Therefore, the main treatment principles in treating cardiovascular disease center on tonifying the Qi together with activating the Blood. Specific treatment principle that are applied in treating these patients are as follows:

• Activate the Blood and dispel stasis
• Nourish the Heart and unblock the vessels
• Resolve Phlegm and relieve shock
• Nourish the Blood to calm the Spirit and stabilise the mind

In general patients with side effects from the various Western cancer therapies respond well to the TCM protocols outlined below. It is best to begin treatment promptly as soon as the patient begins to experience any unpleasant symptoms.

Clinically, the main principles of treatment are to strengthen the Spleen and tonify the Qi; clear Heat- Toxin; and warm and tonify the Kidney Yang. Treatments that tonify the Qi and warm and tonify the Kidney Yang or tonify the Qi and enrich the Kidney essence are clinically very effective in long standing cases where the viral infection has burned itself out. These may also be applied to cases of simple fatigue, with relatively severe presentations.

Generally, these cases of CFS represent chronic conditions, which have developed over a long period. Therefore, they require a long-term course of treatment at sufficiently high dosage so that the treatment effects accumulate, leading to a good outcome.

The key to effective treatment of the common cold and 'flu is to use very high dosages of each formula (around 200 - 300 pills per day) and begin treating as early as possible, when the signs and symptoms are only mild. In this way it is possible to fully resolve it within 2 days and avoid developing a fully blown infection.

Please note that Protocol D is specifically for elderly patients or those with a weak constitution, in whom the infection has moved into the lungs.

• Nourish the Heart and calm the Spirit
• Soothe the Liver to relieve constraint
• Activate the Blood and dispel stasis
• Nourish the Blood and the Yin

In menopausal patients with depression it is important to nourish and activate the Blood. This approach has the effect of tonifying the organs of the lower Jiao in order to regulate and balance a woman's physiology and function.

In the earlier TCM texts, diabetes, referred to as 'xiao ke', manifested with signs of Qi deficiency, Yin deficiency and Heat: severe thirst, constant hunger and polyuria. It was discussed according to upper, middle and lower Jiao symptoms.

However, in modern Western clinics, we do not see these types of patients, as they are generally detected and treated with Western medicine before they get to this stage. Therefore, the ancient theories regarding 'xiao ke' are not applicable in clinic today. Clinical experience shows Kidney Yang deficiency and Blood stasis are the main underlying pathodynamic factors. Therefore, the most important thing in treating all patients with type 2 diabetes is to tonify the Kidney. This is the essential principle of treatment for all different types and all different stages of the disease, including those cases with complications.

In cases of insulin resistant diabetes with elevated blood sugar levels and possibly also hypertension, the treatment principles of warming and tonifying the Kidney Yang, enriching the Kidney Essence, activating the Blood to dispel stasis will generally have good clinical results.

It is important to note that treatment should continue over the long term, using the doses specified below.

The basic treatment principles to follow in treating this disease are: tonify the (Lung) Qi and consolidate the Exterior, warm-tonify the Kidney Yang, activate the Blood and dispel stasis, clear Lung Heat and resolve Phlegm.

During the change of seasons, these patients become more susceptible to Exterior attack by Wind-Cold or Wind-Heat, which then invades the Lung, leading to obstruction of the Lung Qi by Phlegm. In these cases, it is important to tonify the Lung Qi while also clearing the pathogenic factors from the Lung.

As emphysema is a chronic condition that has developed over many years, prolonged treatment is required, in order to address both the ben (i.e. the deficiency patterns) as well as the biao (i.e. the excess pathogenic factors) together at the same time. In this way, the effects of the herbal treatment gradually accumulate towards a favourable clinical outcome.

In order to obtain rapid clinical results, strong tonification therapy is required. The best approach is to begin by tonifying the Spleen, the Kidney and the Yang Qi all at the same time. Once there has been a marked improvement in the patient's condition, the treatment should continue in a simplified form, appropriate to the patient's needs (i.e. select one or two of the formulas given below) and continue for several months at a lower dosage.

The main treatment principles for this disorder are to activate the Blood to dispel stasis; drain Damp and promote water metabolism; resolve the bound Phlegm-stasis complex. The main objective of treatment in the initial stage is to provide pain relief, using Huo Luo Xiao Ling Dan, which has a strong effect on relieving pain.

Some cases may present with an additional infection in the sinuses. These require additional treatment to clear Heat Toxin.

Patients with allergies affecting the upper respiratory tract may also present with asthma. In these cases additional treatment is required to resolve Phlegm and disseminate the Lung Qi.

Generally, a prolonged course of treatment is required for the cumulative effects of the prescribed formulas to produce a good clinical outcome. In addition, the formula Xue Fu Zhu Yu Tang is highly effective when taken by elderly patients in maintaining the health of the blood vessels, and has great value in prevention of stroke and heart attack.

In treating patients with both deficiency and Blood stasis, an alternating treatment protocol is often effective. The patient is prescribed either protocol A or B for one week, followed by protocol C for the next week. The patient should be reassessed every month and treatment continued with the appropriate combination of formulas.

As this is a long term, stubborn condition, it is important to give long term treatment, using high doses, as specified below. This is not a modern disease, as the clinical features have been described since ancient times in TCM literature. By taking the traditional approach and treating the root causes (i.e. Kidney Yang and Essence deficiency) over a sufficient period of time, this condition can be resolved.

1. Ovulation disorder – irregular or intermittent ovulation: treatment is to promote ovulation and use herbal formulas to control the cycle.

2. Irregular menstrual cycle, generally due to failure of the corpus luteum to produce sufficient progesterone. Treatment is to use herbal formulas to control the cycle

3. Decline of ovarian function, including polycystic ovarian syndrome (PCOS)

4. Age related decline of hormonal function, leading to failure of ovulation. Treatment is to nourish the Kidney Essence and the Blood to promote female hormone production, promote ovarian function and protect the developing fetus.

5. Cold in the uterus

The formula Tao Hong Si Wu Wan has a direct effect on regulating the female hormones and improving ovarian function so that good quality eggs are produced. This formula has a very important role in every stage of treatment in these women.

Diverticulitis

Heat-Toxin, Blood Stasis and depletion of Yin-fluids

Si Miao Yong An Wan (Lonicera & Scrophularia Formula)

Course of treatment: 1 to 7 days

Protocol B

Colitis, Ulcerative Colitis, Crohn's disease

The auto-immune inflammatory bowel diseases

Zhuang Yang Yi Jing Wan (Epimedium & Ginseng)

Course of treatment: 3 months to 1 or more years

• Liver Qi constraint, Qi stagnation (i.e. emotion - related stagnation of the Qi)
• Phlegm
• Blood stasis

It is important to differentiate these patterns in clinic and apply the appropriate treatment. It should be noted that the main protocols rely primarily on one or more of the above treatment approaches without using a specific Spirit calming (an shen) formula. The common underlying patho-mechanism begins with emotional strain, which affects the Liver. The Liver then begins to fail in maintaining the patency of the Qi, leading to Qi stagnation. The two main consequences of this are Blood stasis and Phlegm, which may lead directly to sleep disturbance. Thus, the basic treatment principles in insomnia center on activating the Blood to dispel stasis, resolving Phlegm and moving or regulating the Qi.

In older patients, who tend to develop Blood stasis, the formula of choice is Tao Hong Si Wu Wan, which, in my experience, is generally more effective than Xue Fu Zhu Yu Tang.

In menopausal women, the common underlying factors are Blood stasis and Phlegm. These are also common underlying factors in depressed patients who are unable to sleep.

Finally, the approach to treatment should be based on the understanding that patients with different body constitutions will require different treatments; while patients with the same body constitution (or even the same patient who presents at a different time) may also require different treatments depending on the various stresses and lifestyle factors involved. Therefore, a flexible approach is required, basing each patient's treatment on a careful assessment of signs and symptoms and TCM pattern. In cases where satisfactory results have not been achieved with Protocols A and B, an additional formula may be select according to the presenting TCM pattern, to be used in combination.

Although individual patients may vary in their presenting symptoms and signs, and one pathodynamic factor may appear to predominate, it is important to treat both, ensuring that the treatment principles include soothing the Liver to relieve constraint, and also strengthening the Spleen to dry Damp.

It should be noted that cases with abdominal cramping pain but no alteration in bowel function (i.e. not true IBS) should be treated with Shao Yao Gan Cao Tang together with Chai Hu Shu Gan Wan to soften the Liver and resolve Qi stagnation.

In cases with severe diarrhoea, treatment should focus on strengthening the Spleen, warm-tonifying the Spleen Yang, drying Damp and astringing the Intestines.

The root causes (ben) of this condition are due to Kidney Yang deficiency, manifesting in an auto-immune response or inappropriate immune response. Protocol D addresses this, and by tonifying the Kidney Yang, assists in regulating and harmonising the immune functions.

Generally, when the Kidney Yang is depleted the Kidney Yin also requires to be nourished. This is especially important in older patients.

In the treatment of cases that present with signs of Blood stasis (i.e. body aches, headaches, purple patches on the tongue), it is important to tonify the Spleen Qi and the Kidney Essence, in addition to activating the Blood to dispel stasis.

Surprisingly good results are obtained by advising male patients to take Zhuang Yang Yi Jing Wan (to warm-tonify the Kidney Yang and replenish the Kidney Essence) about 20 – 30 minutes before intercourse. This formula provides both a physical as well as psychological boost. The equivalent formula for women is Tao Hong Si Wu Wan. However, it is best taken regularly over the medium to long term. This formula provides better results than hormone replacement therapy in post-menopausal women.

• Cases with liver damage (fatty liver, alcohol damage or toxicity due to ingestion of pharmaceutical drugs)

• Gall bladder inflammation (gallstones, cholecystitis)

• Viral hepatitis

The approach to liver damage due to fatty liver, alcohol or drugs is to promote Gallbladder function (li dan) and clear the Liver (qing gan) and thus clear Damp-Heat and regulate the Qi movement of the Liver- Gallbladder.

In cases with inflammation in the gallbladder, the main treatment principles are to promote the Gallbladder, activate the Blood to dispel stasis and also to clear Heat Toxin.

When there has been damage to the liver tissue due to a viral infection, the treatment should aim to clear any residual infection and reduce inflammation in order to assist with liver repair. The main treatment principles in this scenario are to clear the Liver and Gallbladder, promote the Gallbladder and clear the Shao Yang level.

After the 4 weeks' course of treatment, patients should be assessed by Western medicine (i.e. blood test or ultrasound) rather than by signs and symptoms alone.

After normal function has been restored, the patient should take Yu Ping Feng San for several months in order to strengthen the constitution.

The pathodynamic factors underlying this condition are mainly Spleen Qi deficiency and retention of Damp, which underlie the main symptoms of chronic diarrhoea, weight loss, and fatigue.

In chronic cases, the emphasis should be on tonifying the middle Jiao (Spleen-Stomach) to boost the Qi together with strengthening the Spleen to dry Damp.

Although the different stages (i.e. acute, subacute and chronic) have slightly different treatment protocols, the essential principles of treatment remain the same.

Children require an approach that is focused mostly on building up the constitution (by strengthening the health Qi with Yu Ping Feng San), and promoting normal Spleen and Stomach function.

The treatment approach recommended is to treat the underlying causes (ben) by tonifying the Kidney (both the Kidney Yin and the Kidney Yang), nourishing the Yin-fluids and resolving Phlegm. This gives better results than the traditional approach of balancing the Liver and Kidney together with nourishing the Heart and calming the Spirit.

The protocols presented here are no less effective than HRT, without the risk of unwanted adverse effects, such as breast cancer. The main treatment formula for all of the different presentations is Er Xian Tang, which tonifies the Kidney (mainly the Kidney Yang), enriches the Kidney essence and reduces deficiency Fire. This formula is suitable for all the different clinical presentations, and in most cases it is used in combination with formulas to nourish the Kidney Yin and Essence, nourish the Blood, and activate the Blood to dispel stasis.

Although in some cases, the application of a single formula from Protocol A may be effective in the relief of hot flushes and sweating, more lasting results are achieved with the combinations of formulas, as listed in the various protocols below.

In menopausal women who present mainly with mental-emotional symptoms, the additional treatment principles required are to resolve Phlegm and also to stabilise the mind and emotions. An alternative approach is to nourish the Yin (including Blood and Essence), soothe the Liver and relieve constraint.

By applying these protocols, lasting results can be achieved. However, the treatment should be consolidated by continuing the protocol for several months after the symptoms have been relieved, so as to strengthen the constitution by tonifying the Kidney.

• Tonify the Kidney

• Soothe the Liver and relieve constraint

These are the key treatment principles that may be skilfully used to 'manually' regulate a woman's cycle. This is especially important in women with amenorrhea or very irregular cycles. However, the main treatment principle should be to activate the Blood and dispel stasis, using Tao Hong Si Wu Wan. This is the primary treatment, which may be combined secondarily with harmonising the Liver and tonifying the Kidney and/or tonifying the Spleen.

For different types of menstrual disorder, different treatment principles need to be used.
For excessive blood loss: tonify the Kidney Yang
For excessive discharge: strengthen the Spleen and dry Damp
For PMS: Soothe the Liver to relieve constraint (primarily) and activate the Blood and dispel stasis (secondarily)

Treatments should not be prolonged and should stop when the symptoms have been resolved.

• Primary treatment: tonify the Liver and Kidney to strengthen the bones and joints.

• Secondary treatments: activate the Blood and dispel stasis; eliminate Damp to resolve the Bi syndrome

It is important that treatment be given over the long term, as this disorder can be managed very effectively with Chinese herbal medicines. However, complete cure is unlikely and symptoms generally recur once the herbal medicines have been discontinued.

• Blood stasis
• Blood Dryness
• Heat Toxin

If the disease is treated properly, the lesions will resolve and leave no residual scarring. The emphasis of treatment will vary, depending on the stage of the lesions. In general, the following principles of treatment should be followed:

• Expel Wind to relieve itching
• Nourish the Blood and moisten Dryness
• Activate the Blood and dispel stasis
• Clear Heat and resolve Toxin
• Resolve Phlegm nodulation

It is important to continue to nourish the Blood and Yin as this has the effect of expelling Wind as well as moistening Dryness. Therefore, in clinic, the best way to expel Wind in this disease is by treating the Blood. Additionally, as Blood stasis is generally present in all cases, no matter what stage, treatment protocols all call for formulas that activate the Blood and dispels stasis. For these reasons, the main treatment formula is Si Miao Yong An Wan as it covers all of the three main treatment principles: Clears Heat Toxin, nourishes the Blood and Yin, activates the Blood and dispels stasis.

Treatment is necessarily long term and progress is generally quite slow. However, the following approach has yielded considerable success in providing relief from these symptoms and restoring function:

• Activate the Blood and dispel stasis, clear Heat Toxin to resolve swelling and reduce Bi. This is the treatment for biao (the manifest symptoms).

• Warm and tonify the Kidney Yang. This is the treatment for ben (the underlying causes).

Emphasis should be given to the treatment of biao during the initial stages of treatment when symptom relief is most important. Over the long term and for chronic stage conditions it is important to treat the Kidney and also to resolve Phlegm. Following this protocol over a prolonged period gives the best chance of resolving the condition.

• Runny nose
• Blocked nose
• Sneezing

The main treatment formula is Xin Yi San, which has a pronounced action on drying the nasal passages. Cases with nasal blockage require treatment to resolve Phlegm and stasis. In patients with severe and frequent sneezing, it is important to treat the allergic condition.

After recovery, it is important to provide the patient with treatment to strengthen the Exterior and tonify the Qi (with Yu Ping Feng San) and, in some cases, warm-tonify the Kidney Yang (with Zhuang Yang Yi Jing Wan), in order to consolidate the clinical result and prevent recurrence.

Cases of home treatment of basal cell carcinoma have been reported. In a survey of home remedies for skin cancer and solar keratoses, topical treatment with the sap was unanimously considered to be effective by the users. There is a long history of community use with the absence of documented side-effects, except in cases of accidental ocular exposure.

Protocol

In cases where, even though the main symptoms have been resolved, there is still some discomfort remaining after the course of treatment, it is best to clear any residual pathogens with Xiao Chai Hu Wan (Minor Bupleurum Formula), and also strengthen the Exterior and tonify the health Qi.

Generally losing weight is a slow process. However, if the dosage schedule outlined below is followed strictly, then abdominal distention can be reduced quite rapidly. This very noticeable result will give the patient confidence to continue with the treatment protocol over the longer term.