Transcript TCM Kidney Disease

A Short History of Medicine
2000 B.C.
1000 A.D.
1850 A.D.
1940 A.D.
1985 A.D.
2000 A.D.
Here, eat this root
That root is heathen.
Here, say this prayer.
That prayer is superstition.
Here, drink this potion.
That potion is snake oil.
Here, swallow this pill.
That pill is ineffective.
Here, take this antibiotic.
That antibiotic is artificial.
Here, eat this root.
TCM Kidney Disease
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Kidney Physiology
Kidney Jing
Pediatrics
Ear Diseases
Water
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Sound
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
winter
ears
Body Part
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north
Opening
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cold
Season
Direction
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fear
Climate
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groaning
Emotion
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bones
Zang/Fu
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KID/BL
FEAR
According to Plain Questions (Su Wen), fear leads to Qi leakage. Fear allows the
Qi to flow downwards and leak. When this happens, the Kidney Qi is not firm,
thus resulting in incontinence, hind limb weakness, and abortion. The Chinese
word kong refers to Fear which is associated with the Kidney. An animal that
experiences Fear will become scared and run away.
FEAR
Qi goes
downward
& leaks
Kidney Qi
not firm
Urinary incontinence
Hind limb weakness
Premature ejaculation
Abortion
WATER TYPE
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Personal Characteristics:
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Introverted
Terrified or fearful about everything
Quiet, but a good observer
Skilled at planning and scheming
Good advisor or supervisor
Prefers deep thought
Willing to live alone
Very consistent, but slow when doing something
Sinister or insidious if evil
Fear biter
Physical Characteristics:
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Thin, middle sized body
Black hair on the head
Deep, big eyes and big ears
Cold intolerance: Prefers to stay in a warm area
Pulse: Deep
Not a favorable type for a stallion
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Disease Predispositions:
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Edema
Infertility
Back pain
Urinary infections
Diarrhea at dawn
Depression
Life Span:
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Very long
Kidney
The Kidney is the Minister of the Water pathway. The Kidney is the root of prenatal life.
With age, the Kidney essence gradually diminishes. Kidney essence should be always
conserved. If there is a disorder, the Kidney is almost always deficient.
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Storing Jing (Essences)
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Governing Water Metabolism
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Acts as the gate of water
Controlling the Reception of Qi
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Congenital Jing
Acquired Jing
Holds or pulls Qi down from Lung
It is in charge of inhalation
Dominating Bone, Producing Marrow, and Filling up
the Brain

Influences bones and the central nervous system
TCM 24 Hour Clock
LIV
GB
TH
1-3 AM
LU
3-5 AM
LI 5-7
11-1AM
9-11 PM
PC
7-9 PM
KID
BL
ST
7-9 AM
SP
9-11 AM
HT
5-7 PM
3-5 PM
SI
AM
1-3 PM
11-1 PM
Water Balance
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Sheng cycle nourishes it
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Ke cycle restrains it
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Provides the tension
Patterns of Kidney Disharmony
 Lower
back pain
 Frequent urination (bedwetting)
 Ringing in the ear
 Lack of hearing acuity/deafness
 Excessive fear
 Lack of willpower
Kidney Physiology
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Genetics ruled through kidneys (base intelligence)
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Houses & governs the essence, rules the senses (jing)
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Jing of heart rules tongue, speech, consciousness, intelligence
Jing of spleen rules taste, development of flesh
Jing of lung rules smell, acceptance
Jing of kidneys rules hearing (listening), willpower (discipline)
Jing of liver rules vision, creativity, decision making
Rules growth & development
Genetic Control of Life
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Obtain one pair of DNA
from each parent
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Some areas are imprinted
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Suppressed so that only
one gene is active
No back up if something
damages remaining gene
Suspect 200 regions
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Responsible for many later
life diseases
Kidney Physiology
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Storing Jing (Essences)
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Congenital Jing:
•
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Inherited from the parents
Congenital foundation of life (Genetic materials: DNA, genes)
Nourishes the fetus before birth
Regulates development, growth, aging, and reproduction after birth
Deficiency of Kidney Jing Infertility and retarded growth
Controls the 7-year (female) and 8-year (male) cycles of
development and growth
Acquired Jing:
• Also called Essence of Zang-Fu
• Basic substance for maintenance of the vital activities
• Extracted from Food Qi by Spleen
Kidney Essence Impowers
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Kidney provides initial
spark to all other
organs
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During prenatal life of
fetus
Timing & genetics
dictate the resulting
disease
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Which organ is
affected
Spleen for Postnatal Essence
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While kidney is
central for prenatal
life, Spleen is central
for postnatal life
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Maintains vitality of
other organs
Helps protect and
replentish prenatal
essence
The Jing Candle
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Candle bruning at
both ends
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Original Kidney Jing
Acquire Spleen Jing
Candles are different
sizes based upon
Kidney Jing
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Replenished slowly by
spleen
JING
Gu Qi
Telomeres
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Highly repetitive region ofDNA at the
end of a chromosome
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DNA polymerase complex is incapable
of replicating all the way to the end
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Every time a cell with linear
chromosomes divides
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Pretects from loss of vital genetic
information, which is needed for cell's
activities
Lose a small piece of one of its strands
of DNA.
This process has been referred to by
James Watson and Alexei Olovnikov as
the "end replication problem" (1971)
Have a function in the ageing process.
What does this mean?
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Clones are inherently
deficient
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Adult stem cells are
less robust
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Artificial increase in
telemeres leads to
cancer
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When the telemeres
are gone, life ends
Life is Balance

Hope you get the best
Jing
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Protect it with diet
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Live well and enjoy
what you are given

Make lemonade
Yuan Qi
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(Primary Qi, Source Qi, Original Qi)
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Derived from the Kidney Essence or congenital Essence
It is Essence in the form of Qi, rather than fluid.
Requires supplementation and nourishment by the Food
Essence (Gu Qi)
Comprises the Primary Yin (Kidney Yin) and the Primary Yang
(Kidney Yang)
It is the original dynamic motive force of normal activities.
Distributed to the whole body by the Sanjiao
Impels the Zang-Fu organs to bring normal activities into play
Maintains normal growth and development of the body
Pathology: Yuan Qi Deficiency results in decreased disease
resistance
Energy of Life
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Yuan Qi impels the function of the organs
JING PATHOLOGY
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Signs of Jing
Deficiency
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Retarded or poor
growth
Developmental
orthopedic diseases
Loss of vitality
Infertility
Early aging
Jing Pathology
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Can be acquired from
too much strain on
the candle
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One of the problems
of the Chinese
emperors
Pathology of Kidney
Jing Deficiency (original or acquired)
Child
Fear or Stress or Pathogens
Kidney
LU/LI- -asthma & edema
Parent
KID- -nephritis
LIV- -joint disease
Grandchild
HT/PC- -shen
Organ
Grandparent
Channel
SP/ST- -damp
Bone, Marrow, Head
Ears
BL
Incontinence
CAM Use in Kids
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1992-2005, 66 pediatric
utilization studies US,
Canada, UK, Australia,
Turkey, Norway…
 General and subspecialty
populations
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Use increasing
Complementary and Alternative Research and Education Program
Pediatric Epidemiology
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Spiegelblatt ’94 Pediatrics ; 11% used prof. CAM
Ottolini, et al, W, DC, ‘98: 20% of kids in 4 practices
Taylor, et al, Seattle, ‘98: 30% -50% use echinacea or vitamin
C for kids’ colds
Indiana teens ‘98: 20-30% of athletes take supplements
Crow, et al. Ped Res, ’03: 46% w/vitamins; 15% wo/vitamins
in Chicago PPRG
Wilson, et al AmbPeds ’02: 53% of Rochester teens
Lin, et al J Clin Anesth ’04: 30% pediatric pre-op pts use
herbs
Breuner APAM ‘98: 70% homeless teens
Children with other conditions
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Autism: 30%;
 Asthma: 72%-81% of minority (H and Af.A.) families;
 Cancer: 47% of kids at WFUSM in 2003; 73% of kids in
Washington state in 2001;
 CF: 65%, mostly prayer
 Cerebral palsy: 56% of 235 families in Ann Arbor
 ED: 53% used herbs, Atlanta
 IBD: 41% of kids in Boston, Detroit, London
 Rheumatology: 64% of 141 in Toronto, 2003
 Special needs: 24% for kids with correctable condition
vs. 76% for kids with non-correctable condition
Which CAM therapies most
commonly used?
Prayer – most common, least worrisome to MDs
 Herbal therapies, vitamins, minerals and other dietary
supplements – most worrisome to MDs
 Chiropractic – most common professionally provided to
adults; historical competitive threat
 Massage – most common professionally provided to
kids; often taught to parents or provided informally
 Homeopathy – not well enumerated; confusion with
herbs
 Yoga, Tai Chi
 Acupuncture/acupressure
 Biofeedback, hypnosis
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What are pediatricians
most often asked about CAM?
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Herbs, dietary supplements (67%)
Chiropractic (59%)
Nutrition and special diets, vegetarian,
macrobiotic diets (46%)
Homeopathy (36%)
Therapeutic exercise, yoga (34%)
Hypnosis, biofeedback or meditation
(23%)
Massage or other bodywork (17%) ….
Prayer (13%)
Kemper, O’Connor. Amb Peds, 2004
Only 40% tell docs about CAM
“Natural”, not medical; irrelevant , “not
important for the doctor to know” 61%
 Docs not interested; “the doctor never asked”
60%
 “None of the doctor’s business” 31%
 “Doctor would not understand” 20%
 Cultural practice - embarrassing or private,
<20%
 Fear of physician reaction (disapproval,
abandonment, worse medical care) < 15%
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Eisenberg DM, et al. Arch Intern Med, 2001; 135: 344-51
Pediatric AP
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ABDOMINAL PAIN
ANOREXIA
CHILDHOOD DIARRHEA
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COUGH
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OTITIS
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 ICTERUS
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NEONATORUM
CONVULSIONS
PARALYSIS
Pediatric Colic
 Patterns
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Cold in the middlejiao
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Retention of food
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Blood stagnation
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Yang deficiency
Consequences of Jing Deficiency
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Leads to disease of organs
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Severe disease
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Heart
GI tact
Lung
Kidney
Liver
Early affects
Mild disease
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Later effect
Chance
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8 month M Lhasa apso
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Seizures for 1 month
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Tongue: red purple
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Pulse: deep & weak
Di Tan Tang and
Epimedium Powder
Kidney Jing Deficiency
Kidney Jing Deficiency
Blood Deficiency
Kidney Yin Deficiency
Liver Yin Deficiency
Fails to Nourish Jin (sinews)
Internal Wind
Seizures
Kidney Jing Deficiency
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Hz:
Seizures < 1 year of age
Dry nose & mouth
Tongue
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Pale or red
AP
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TCM Herbal
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Pulse
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Weak & thready
Rx Principle
• extinguish the wind and
astringe or nourish the
kidney jing
KID-3, BL-23, SP-6, GV20, ST-36, HT-7, GB-20,
An Shen, Da Feng Men
Di Tan Tang and
Epimedium Powder
Epimedium Powder
Epimedium
Cuscuta
Cistache
Paeonia
Polygonum
Actinolite
Cynomorium
Psoralea
Dipsacus
Lycium
Condonopsis
Astragalus
Rehmannia
Angelica
Ophiopogon
Scrophularia
Citrus
Yin Yang Huo
Tu Si Zi
Rou Cong Rong
Bai Shao Yao
He Shou Wu
Yang Qi Shi
Suo Yang
Bu Gu Zhi
Xu Duan
Gou Qi Zi
Dang Shen
Huang Qi
Shu Di Huang
Dang Gui
Mai Men Dong
Xuan Shen
Chen Pi
Tonify Kid Yang/Jing, Promote Sexual Desire
Tonify Kid Yang, Jing & Yin
Tonify Kid Yang & Yin
Nourish Liver Yin & Blood
Nourish Blood & Jing, Benefit Hair
Tonify Kid Yang
Tonify Kid Yang
Tonify Kid Yang & Strengthen Bones
Tonify Kid Yang & Promote Fracture Healing
Nourish Liver Yin, Benefit Eyes
Tonify Qi
Tonify Qi
Nourish Kid Yin & Jing
Nourish Blood
Moisten & Nourish Yin
Cool Blood & Clear Heat
Move Qi & Relieve Pain
Jocko
Jocko
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Problem List
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Shen Disturbance
Hydrocephalus
Diagnosis
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Jing Deficiency
Yin deficient
• Confirmed ultrasound
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Hepatoencephalopathy
• Confirmed BW
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Overall poor development
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Treatment
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TCVM
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Tongue
• thin-red

Pulses
• Deep, weak fast particularly
on right side
Hydrocephalus formula
Liu Wei Di Huang
Epimedium powder
Ear Disease
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One of most common
complaints for dogs &
cats
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Poor design
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Lack of essence
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Decreased immunity
Failure to support child
• Passes heat to ears
God’s Boo Boo
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Poor design
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No drainage
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Covered with flap
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No air circulation
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Deep, Dark Hole
Infections in Children
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Some feel that the
cause is the use of
antibiotics

Find that CAVM
methods have a more
effective longterm
outcome
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
Chiropractics
Craniosacral
techniques
TCM
How Ears Help in TCM Exam
Otitis Externa
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Itchy
 Red
 Painful
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Damp- -Heat with
Wind
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External pathogen
Liver yin deficiency
Patterns
Channels Near the Ear
SI, TH, GB, BL, GV
AP for Ear Disease
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Local points on SI,
TH, GB, BL, GV
medians
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Influential points
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Points for excess or
deficiency
Excess Patterns
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Damp Heat for Otitis
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Red tongue
Fast, superficial pulse
Otitis Patterns
Pathology of Liver Heat
Liver Blood & Yin Deficiency
Child
Heat & Damp
KID/BL
LIV
Shen Disturbance
Liver Heat
Parent
Grandchild
Organ
Grandparent
LU/LI
Channel
Feet
Eyes
GB
Ears
SP/ST
Ear exam
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Don’t forget to look!
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May find a cause
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Foxtail
Polyp
Tumor
Parasite
Can culture
TCM Herbals
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Clear Damp-Heat
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Treat Topically
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Long Dan Xie Gan
Ear Damp-Heat
TCM Ear Drops
Western Ear Formula
Improve immunity
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Canine Antioxidant Formula
Canine Cancer Formula
Garlic (fresh) orally
Westlab Pharmacy
1-800-4WESTLA
Long Dan Xie Gan Tang
Gentiana
Gardenia
Scutellaria
Plantago
Alisma
Akebia
Angelica
Rehmannia
Bupleurum
Licorice
Long Dan Cao
Zhi Zi
Huang Qin
Che Qian Zi
Ze Xie
Mu Tong
Dang Gui
Sheng Di Huang
Chai Hu
Gan Cao
Clear Liver Heat, Clear Damp-Heat
Clear Damp Heat
Clear Damp-heat
Drain Damp-heat
Drain Damp
Drain Damp-Heat
Nourish Blood
Nourish Yin, clear Heat
Soothe Liver Qi transporter
Harmonize
Ear Damp-Heat
Artemisia
Bupleurum
Scutellaria
Moutan
Prunulla
Lophatherum
Tribulus
Luffa
Stagnation
Melia
Qing Hao
Chai Hu
Huang Qin
Mu Dan Pi
Xia Ku Cao
Dan Zhu Ye
Bai Ji Li
Si Gua Teng
Clear Damp-Heat
Soothe Liver Qi
Clear Damp-Heat
Cool Blood
Clear Heat
Clear Heat
Clear Heat
Transform Phlegm, Resolve
Chuan Lian Zi
Move Qi
TCM Ear Drops
Coptis
Huang Lian
Clear Heat, Detoxify
Alum
Bai Fan
Borneol
Bing Pian
Dry Damp, Transform Phlegm, Stop Bleeding,
Relieve Itching
Clear Heat, Relieve Pain, Open Orifices,
Dissipate Swelling
Glycerol Gan You
Carrier
Western Ear Drops
Detergent Solution:



1 drop of “free” dishwasher soap
8 ounces of water
Vinegar Solution:
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1 ounce apple cider vinegar
3 ounces of water
Vitamin E/garlic oil:
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
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
crush one clove of garlic (use press) into
1 ounce of extra virgin olive oil
let sit overnight at room temperature
pour oil into dropper container
add content of a 1000 IU vitamin E capsule
use 2-3 drops in the ear canals, plus 1-2 on the pinnae
Sheena
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7 yr, FS GSHP
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History of chronic
otitis externa
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Rx Atbs/Tramadol
Neuroexam
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

Mild CP LRL
Mild Babinski LRL
Eye Drop LS
Sheena
Sheena

Pseudomembranous
coating of left ear
canal and mouth
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Dx


Candida Infection
Invasion of DampHeat secondary to Wei
Qi deficiency
Sheena

Treatments

Western
•
•
•
•
Fluconazole
Ear Solutions
Aleo Vera gel
Diet change

Purina JM

Treatments

TCVM
• AP

Shan Gen, LI-4, GV14, ST-4, ST-36, TH5, and ST-44
• Herbal



Long Dan Xie Gan
Ku Shen Si Wu Tang
Wei Qi Booster
Inner Ear Disease

8th Nerve Signs
 7th Nerve Signs
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
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

ear & lip droop
lack of palpebral
reflex
nose turn
nostril flaring
Horner’s Syndrome
Horner’s Syndrome

Small Animals




Ptosis
Myosis
Enophthalmos
Large Animals


Facial sweating
(horse)
Lack of muzzle
sweating (cow)
Inner Ear Disease

Most cases are
secondary to bacterial
infection (otitis media &
interna)



extension from otitis
externa
pharyngitis with extension
up the Eustachian tube
hematogenous spread
Dx of Inner Ear Disease

PE, NE, OE

Schirmer’s tear test

CBC
 UA
 Skull Radiographs
 Other (if indicated)



Chest & Abdominal
Radiographs
Ear Culture
Cardiac Exam
Normal bulla radiograph
Note: sharp bone edges with symmetrical
appearance.
Inner Ear Infection
L
R
R
Right-lateral and DV radiograph of dog with unilateral otitis interna showing
sclerosis of the tympanic bulla on the right side with loss of detail in the region
of the osseous petrous-temporal bone.
Inner Ear Infection

Treat with bacteriocidal
drugs which penetrate
bone and blood-tissue
barriers

Combination therapy
• cephalosporins
• sulfa drugs


Enrofloxacin
Must treat 6-8 weeks
Inner Ear Disease

Treat with antibiotics  Recheck at 6 months
and recheck in 2
 re-examine any
abnormalities (such as
weeks



Recheck in 1 month


abnormal bulla radiographs)
if better, continue
if worse, reassess
if normal, stop
antibiotics
if still residual
problems, continue 2
more weeks

If problems worsens
or persists without
change for 4 weeks,
consider referral.
Inner Ear Disease

Other Neoplasia




neurofibromas
osteosarcomas
FeLV
Prognosis is Poor

Other Infections


Fungal
Prognosis Guarded to
Poor
Inner Ear Disease

Consider Advanced
Imaging Techniques




If owner can not
afford additional tests
or referral, may try
changing antibiotics.

Main reason for
failure is not treating
long enough.
Bone Scan
MRI Scan
Consider Surgical
Drainage of Bulla
Myringotomoy

Chance to look at the
middle ear and get
culture

Personally, I do not
think it is that
necessary

Most ear problems
(like sinusitis) are
from failure of
immunity not infection
Inner Ear Infection
Inner Ear Neoplasia
B.A.E.R. test

Provides indication
of the ability of the
auditory portion of
the 8th nerve to
function and relay
that information
through the
brainstem toward
the cerebral cortex.
Ear Polyps in Cats

Benign growth in the
external ear canal
which causes signs
by extension.
 Can also be
pharyngeal mass
which grows into
middle ear via the
eusthasian tube.
Ear Polyps in Cats

Treatment is surgical
removal.
 Damage can be
permanent, if
pressure necrosis
has destroyed the
inner ear structure.
Bilateral I.E. Disease

No Head Tilt
 No Nystagmus



spontaneous or
physiologic
Wide head
excursions due to
inability to fix eyes on
vertical with
movement.
Open mouth radiograph with
chronic changes in both bullas
Bilateral I.E. Disease

MRI image shows
bilateral disease in
middle and inner
ear.
 May respond to
aggressive antibiotic
therapy.
 Some patients will
also be deaf.
Bilateral Vestibular

Lacks classical signs

Wide head excursions

No physiologic
nystagmus
Inner Ear Disease -- TCM

Invasion of external
pathogen leading to wind,
heat, damp or GB heat
from liver yin deficiency

Heat boils the fluids leading
to the accumulation of
phlegm.

Quiet the wind, reduce
heat, disperse damp and
activate the blood to
dissolve stagnation.
Inner Ear Disease -- TCM

Points


Constitutional points
Clear wind & heat
• GB20, LI4, LI11, GV14

Calm the shen
• PC6, HT7, GV17, GV20, GV21

Eliminate damp
• SP9

Activate Qi & blood
• ST36, ST40, Xin shu (BL17)

Local points
• TH17, TH18, TH21, SI19, GB2,
Er jian, An shen
Hope

Even without Jing, life
can be full

Dogs live in the now

One message they
teach us is that it
does not matter how
long we live, only that
we live well