Specialties and Services

Common Cold/Influenza and Chinese Medicine 

The common cold (cold) and the influenza (flu) are both respiratory illnesses but they are caused by different viruses. Because these two types of illnesses have similar flu-like symptoms, it can be difficult to tell the difference between them based on symptoms alone. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness, or cough are more common and intense. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections, or hospitalizations. 

Causes

Common cold can be caused by a number of different types of viruses. More than 200 different types of viruses are known to cause the common cold. Because so many different viruses can cause cold and new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem.  

Flu, also referred to as seasonal flu, is a highly contagious illness caused by the influenza virus.  Anyone can get the flu as it is spread easily from person to person, usually when an infected person coughs or sneezes.  The virus

may belong to one of three different influenza virus fami¬lies: A, B or C.  In addition to seasonal flu, there are two other flu viruses receiving extra attention around the globe today: Novel 2009 H1N1 Influenza Virus and Avian Flu (H5N1).  

Conventional treatment

Antibiotics are not effective against the viruses that cause the cold and flu. There are no approved antiviral drugs for the common cold.  At this time, two antiviral drugs are available for flu: oseltamivir and zanamivir.  These two drugs have been shown to reduce flu symptoms if started within a day or two of getting sick. Anti-viral medicine is recommended for people with more severe illness and at higher risk for complications.

The treatment is directed at alleviating the symptoms associated with the common cold. Over-the-counter medications such as throat lozenges, throat sprays, cough drops, and cough syrups may help bring relief. Decongestants may be used for nasal symptoms. Acetaminophen (Tylenol and others) and ibuprofen (Advil and others) can help with fever, sore throat, and body aches.  

Chinese medicine

Exogenous pathogenic factors are the main causes of cold/flu. Most common types are wind-cold and wind-heat, in addition, the summer heat, dampness and dryness evils can also joint wind to cause illnesses. However, whether or not those exogenous pathogenic factors cause the diseases depends intimately on the strength or weakness of the body’s defensive system. If body’s defensive system is weak, exogenous pathogenic factors attack the body easily. An improper lifestyle or excessive fatigue can cause laxity of the interstitial spaces and dissipation of defensive ability. In such circumstances an exogenous evil can attach the skin, hair, the lung or the defensive system and result in injury. Furthermore, differences in the body’s constitution are associated with different susceptibilities. For example, wind-cold can easily exploit yang deficiency; wind-heat or dryness heat can easily exploit yin deficiency; and exogenous dampness can easily complicate a body with much phlegm and endogenous dampness. The route of attack from exogenous pathogenic factors is the lung system and exterior defensive system. And the location of the illness is generally also limited to the lung-defensive level. If the defensive yang is constrained by any factor, there may be disharmony between nutritive qi and defensive qi. The struggle between evil qi and genuine qi can generate such symptoms of defensive level or the exterior such as cold-aversion and fever. When an exogenous evil attacks the lung, the air passage becomes blocked. Lung qi can not rise and clarify the body properly, giving rise to cough and nasal mucosal congestion. Flu, because it is a more serious attach by the exogenous evil, has more severe symptoms, and can manifest high fever and delirium. If the patient’s constitution or defensive system is strong, the exogenous pathogenic factors are confined to the lung-defensive level and illness is mild, with mainly symptoms of the exterior. But if the patient is elderly, or has a weak constitution, or weak defensive system, the exogenous pathogenic factors can migrate from the exterior to the interior, which will aggravate the illness and may lead to complications.  

Chinese medicine treatment for cold/flu includes acupuncture, herbal medicine, and some other modalities such as acupressure, moxibustion, Tuina, gwasha.  The choice of treatment modality depends completely on the diagnosis and individual constitution. There are a large number of classical and modern herbal formulas used for the treatment of common cold/flu. It sounds that common colds are easily treated with over-the-counter herbal preparations. However, since there are different types of common cold/flu, the most important aspect is differentiating different types of cold/flu. Therefore, seeking the guidance of an experienced Chinese Medicine practitioner is very important, which will help you to properly diagnose your condition, choose proper treatment modality or proper herbal formula, helping to shorten the duration and severity of the condition, as well as preventing future colds/flu. 

Classification and treatment principle

A. Wind-cold

• Symptoms: An aversion to coldness, shivering, low or no fever, chills predominated over feelings of heat, no sweat, occipital headache, stiff neck, body aches, slight cough, sneezing, and running nose with discharge
• Tongue: Thin white coating or normal
• Pulse: Floating and tight or floating and slow
• Treatment principle:
  • Expel the wind
  • Disperse the cold
  • Restore the lung qi

B. Wind-heat

• Symptoms: Fever and chills with fever predominating, slight sweating, runny nose with yellow discharge, headaches, body aches, cough, sore throat, and slight thirst
• Tongue: Red on the edge
• Pulse: Floating and fast
• Treatment principle:
  • Expel the wind-heat
  • Release the superficial symptoms
  • Restore the descending and dispersing function of the lung qi

C. Wind-dry

• Symptoms: Aversion to cold, fever, slightly sweating, dryness of nose, mouth or throat, and dry cough
• Tongue: Dry, slightly red in the areas of lung and heart
• Pulse: Floating
• Treatment principle:
  • Release the superficial
  • Expel wind
  • Restore the descending and dispersing function of the lung qi
  • Tonify body fluids

D. Summer-dampness

• Symptoms: Fever, anhidrosis, mild chilliness, heavy and painful sensation over the limbs, headache, dizziness, thirst and desire for a little drink, oppressive feeling over the chest, vomiting, and nausea
• Tongue: Yellow and greasy tongue coating
• Pulse: Rapid, soft floating
• Treatment principle:

• Dispel summer-heat evil from the superficial.
• Eliminate dampness with drugs of fragrant

E. Exterior-cold and interior-heat

• Symptoms: Fever, aversion to cold, anhidrosis, general aching, headache, nasal congestion, sore throat, cough, and sticky sputum with yellow or white color
• Tongue: Red on the edge of tongue, thin and white or thin and yellow coating
• Pulse: Floating and rapid
• Treatment principle:
  • Disperse the wind
  • Activate lung
  • Liberate superficial body
  • Eliminate heat

F. qi deficiency

• Symptoms: Fever, anhidrosis, tiredness, cough, and coughing sputum without strength  
• Tongue: Light-white coat
• Pulse: Floating and superficial without strength
• Treatment principle:

• Tonify qi
• Dispel the superficial evil

G. Blood deficiency

• Symptoms: hot body, fever, headache, anhidrosis or slight perspiration, pale complexion, lips and nails, palpation, and dizziness
• Tongue: Light colored tongue with white coat
• Pulse: Thin, superficial without strength, or knot/belt
• Treatment principle:

• Tonify blood
• Dispel the superficial evil

H. yin deficiency

• Symptoms: Hot body, fever, aversion to wind and cold, slight perspiration, dizziness, restless and disquieted, dry month, and dry cough with scanty sputum
• Tongue: Red with scanty coat
• Pulse: Thin and rapid
• Treatment principle:
  • Tonify yin
  • Dispel the superficial evil

I. yang deficiency

• Symptoms: Aversion of coldness from time to time, even chilling with or without fever, anhidrosis or self-sweating, headache, sore and cold bone joints, pale face, low voice, and cold limbs
• Tongue: Corpulent-pale tongue and white coat
• Pulse: Heavy, thin without strength
• Treatment principle:
  • Warm yang
  • Dispel the superficial evil

Clinical studies of Chinese medicine for cold & flu

Complementary and alternative medicine use by otolaryngology patients: a paradigm for practitioners in all surgical specialties. Shakeel M et al. Eur Arch Otorhinolaryngol. 2009 PMID: 19771443.  There is growing interest in complementary and alternative medicine (CAM) amongst the general population. Little information is available on CAM use in otolaryngology patients in the UK. Despite concerns over safety, efficacy and cost-effectiveness, CAM use is common amongst ENT patients. Patients perceive these medications as possible boosters to their immune system. It is becoming increasingly important that health care providers in all specialties ask their patients about CAM use and are aware of the implications it carries. The objective is to study the prevalence and pattern of CAM use among adult and paediatric ENT patients in a UK teaching hospital. A cross-sectional study was done by sending anonymous questionnaire to all outpatient and elective inpatients over a 3-month period. Response rate was 73% (1,789/2,440). Prominent demographics: female, married, over-50 s. Sixty percent had used CAM, 35% in last year. Most common herbs: cod liver oil (n = 481), garlic (n = 255), cranberry (n = 224); non-herbal: massage (n = 287), acupuncture (n = 233), aromatherapy (n = 170). Most commonly cited reasons for using CAM: general health, enhanced immunity and prevention/treatment of common illnesses like the common cold, asthma and bodily aches and pains. 

Clinical observation on effects of acupuncture at Dazhui (GV 14) for abating fever of common cold. Xiao Lei et al. Zhongguo Zhenjiu. 2007;27(3):169-72. OBJECTIVE: To explore the therapeutic effect of acupuncture at Dazhui (GV 14) for abating fever of common cold. METHODS: Two hundred and sixty-one cases were randomly assigned to a treatment group of 133 cases and a control group of 128 cases. The treatment group were treated with electroacupuncture at Dazhui (GV 14) and the control group with antondine injection. The transient effect of abating fever within 24 h was observed. RESULTS: After treatment, the body temperature at all observation time points in the treatment group were lower than those in the control group (P < 0.01). The effect-appearing time (1.42 +/- 1.79) h in the treatment group was shorter than that in the control group (3.44 +/- 5.10) h (P < 0.01). The cured rate and the abating fever rate were 27.8% and 75.9% in the treatment group, and 10.9% and 55.5% in the control group, with significant differences between the two groups, the treatment group being better than the control group (P < 0.01). The abating fever rate for the wind-heat type common cold was 75.3% in the treatment group and 50.0% in the control group, with significant difference between the two groups, the treatment group being better than the control group (P < 0.01). CONCLUSION: The method of acupuncture at Dazhui (GV 14) has a definite therapeutic effect on high fever of common cold, and for wind-heat type common cold, Dazhui (GV 14) first may be chosen to abate high-fever and the treatment should be taken as early as possible. 

Clinical observation on acupuncture for treatment of high fever due to common cold.  Ling D et al. Zhongguo Zhen Jiu. 2006;26(8):554-6. OBJECTIVE: To observe clinical therapeutic effect of acupuncture in abatement of fever. METHODS: Eighty-six cases of high fever were randomly divided into two groups, an acupuncture group (n = 45) treated with acupuncture at Dazhui (GV 14) and a drug group (n = 41) treated with intramuscular injection of Antongding Injectio. Changes of body temperature before and after 24 hours treatment were observed by single blind. RESULTS: In the acupuncture group, 9 cases were cured, and in the drug group, 2 cases were cured, the acupuncture group was better than the drug group in abatement of fever. CONCLUSION: Acupuncture has a reliable therapeutic effect on fever. 

Preventive and curative effects of acupuncture on the common cold: a multicentre randomized controlled trial in Japan. Kawakita K et al. Complementary Therapies in Medicine. 2004;12(4):181-8. OBJECTIVE: To determine the preventive and curative effects of manual acupuncture on the symptoms of the common cold. METHOD: Students and staff in five Japanese acupuncture schools (n=326) were randomly allocated to acupuncture and no-treatment control groups. A specific needling point (Y point) on the neck was used bilaterally. Fine acupuncture needles were gently manipulated for 15 s, evoking de qi sensation. Acupuncture treatments were performed four times during the 2-week experimental period with a 2-week follow-up period. A common cold diary was scored daily for 4 weeks, and a common cold questionnaire was scored before each acupuncture treatment and twice at weekly intervals. A reliability test for the questionnaire was performed on the last day of recording. RESULTS: Five of the 326 subjects who were recruited dropped out. The diary score in the acupuncture group tended to decrease after treatment, but the difference between groups was not significant (Kaplan-Meier survival analysis, log rank test P=0.53, Cox regression analysis, P>0.05). Statistically significantly fewer symptoms were reported in the questionnaire by the acupuncture group than control group (P=0.024, general linear model, repeated measure). Significant inter-centre (P<0.001, general linear model) and sex (P=0.027, general linear model) differences were also detected. Reliability tests indicated that the questionnaire with 15 items was sufficiently reliable. No severe adverse event was reported. CONCLUSION: This is the first report of a multi-centre randomized controlled trial of acupuncture for symptoms of the common cold. A significantly positive effect of acupuncture was demonstrated in the summed questionnaire data, although a highly significant inter-centre difference was observed. Needling on the neck using the Japanese fine needle manipulating technique was shown to be effective and safe. The use of acupuncture for symptoms of the common cold symptoms should be considered, although further evidence from placebo controlled RCTs is required. 

Treatment of fever due to exopathic wind-cold by rapid acupuncture. Tan D. Journal of Traditional Chinese Medicine. 1992;12(4):267-71. 57 cases of common cold, influenza, acute tonsillitis and acute bronchitis were treated by rapid needling with filiform needles at Dazhui (Du 14), Fengchi (GB 13), and Quchi (LI 11). The indices for observation were first determined, and the 19 cases that manifested an axilla temperature drop of over 1 degree C after treatment and a ratio of < 0.3 of the main symptom scores after treatment were regarded as markedly effective; the 27 cases that manifested an axilla temperature drop of 0.5-1.0 degree C and a symptom score ratio of 0.3-0.6 were regarded as effective, and the 11 cases that manifested an axilla temperature drop of < 0.5 degrees C and a symptom score ratio of > 0.7 were regarded as failures. The total effective rate was 80.7%. Analysis of the individual patients indicated that the peripheral blood leucocyte and lymphocyte counts differed insignificantly after needling, while the body temperature, rate of respiration, pulse, blood pressure and acupoint temperature all dropped, with a simultaneous increase in the percentage of T-lymphocytes. The immediate effects were especially marked in fevers due to exogenous wind and cold.  

The effects of nasal massage of the "yingxiang" acupuncture point on nasal airway resistance and sensation of nasal airflow in patients with nasal congestion associated with acute upper respiratory tract infection. Takeuchi H et al. Am J Rhinol. 1999;13(2):77-9. The aim of our study was to determine whether nasal massage of the "yingxiang" acupuncture point in patients with nasal congestion had any effect on nasal airway resistance (NAR) measured by posterior rhinomanometry and sensation of nasal airflow measured on a visual analog scale (VAS). Twenty patients were randomized into two groups; one group self massaged the yingxiang point for 30 seconds, while the other group acted as control group without nasal massage. NAR and VAS were measured at baseline, and at 2 and 10 minutes after massage. At the end of the study, patients were asked to score any change in their nasal congestion. There was no statistically significant difference between the two groups in percentage change in NAR or VAS from baseline at any time during the study, although the massage group showed trends toward decongestion and relief from congestion. At the end of the study, more patients in the massage group than the control group felt their nasal congestion was improved (p < 0.005). It is interesting that all three measures (NAR, VAS, and end question) showed that the nasal massage group had greater relief from nasal congestion than the control group. The results of this study, when taken together, indicate that nasal massage may provide some relief from nasal congestion and that further studies involving a larger patient population are warranted to determine whether nasal massage has a significant effect on NAR. 

Cough and Chinese Medicine 

Coughing is a reflex that keeps your throat and airways clear. Therefore, coughing helps heal your body or protect yourself. However, having a persistent cough can be exhausting. The physical action of coughing depletes your energy reserves and disrupts your sleep. A chronic cough can also cause headache, dizziness, excessive sweating, urinary incontinence, or fractured ribs, especially in women with fragile bones. Coughs can be either acute or chronic. Acute coughs begin suddenly and usually last no more than 2 to 3 weeks and chronic coughs last longer than 2 to 3 weeks.  

Causes

An occasional cough is normal. But a cough that persists for long periods of time may signal an underlying problem. Some causes of coughs include:

• Respiratory infections: cold, influenza, sinusitis, bronchitis, croup, pneumonia or tuberculosis
• Respiratory disorders:  asthma, emphysema, cystic fibrosis, bronchiectasis, cystic fibrosis, interstitial lung diseases, sarcoidosis, chronic obstructive pulmonary disease, or lung tumors
• Argies
• Cardiovascular diseases: heart failure, pulmonary infarction or aortic aneurysm
• Stomach acid backs up into the esophagus: Gastroesophageal reflux disease
• Conditions affecting the lung tissue: mediastinal masses
• Environmental pollutants: smoking, dust or smog
• A foreign body can sometimes be suspect
• Some medications: ACE inhibitors
  

Conventional treatment

The treatment of cough is determined by the cause. However, patients may get symptomatic relief from expectorants which help thin the mucus and make it easier to cough mucus up when you have a productive cough, and from suppressants which control or suppress the cough reflex and work best for a dry, hacking cough that keeps you awake. 

Chinese medicine

In Chinese medicine, cough can be caused by either exogenous pathogenic factors or endogenous origins (the impairment of internal organs).  The exogenous pathogenic factors include wind, cold, heat and dryness; the endogenous factors may originate lung or other related organs such as liver, spleen or kidney, which eventually lead to the dysfunction of lung, causing cough. Exogenous cough arises as a new illness, with abrupt onset flowing exposure to cold, and is accompanied by nasal mucosal congestion and discharge, sneezing, an itchy throat, distending headache, generalized body aches, aversion to wind or cold, and fever. Endogenous cough is generally chronic, with slow onset. There usually are symptoms of other visceral organs, such as fatigue and weakness, chest distention, flank pain, anorexia, diarrhea, or other symptoms. 

Cough can be treated by acupuncture, herbals or some other modalities of Chinese medicine, alone or combination of different modalities, depending on individual situation.  

Clinical classifications and treatment principles

A. Exogenous pathogenic factors

Wind-Cold

• Symptoms and signs: Cough with a heavy sound and thin, white sputum, fever, headache, stuffy and runny nose, anhidrosis
• Tongue:  Thin white coating
• Pulse:  Floating and tight 
• Treatment principle:
  • Disperse the wind
  • Dispel the coldness
  • Clear lung
  • Suppress cough

Wind-Heat

• Symptoms and signs: Cough with a high husky sound and thick white or yellow sputum, fever, chilliness, headache, sore throat, thirst, yellow nasal discharge 
• Tongue:  Thin, yellow coating
• Pulse:  Floating and fast
• Treatment principle:
  • Disperse the wind
  • Eliminate the heat
  • Clear lung
  • Dissolve sputum

Wind-Damp

• Symptoms and signs: Profuse mucus, heavy/loose/thick cough, feelings of heaviness in the body
• Tongue:  Greasy, thick coating
• Pulse:  Floating and slippery
• Treatment principle:
  • Disperse the wind
  • Eliminate Dampness
  • Dissolve sputum

  Wind-Dry

• Symptoms and signs: Dry choking cough with a husky sound and thick or blood-tinged sputum, itching and dryness of throat, sore throat, dryness of nose and lips, headache, stuffy nose, fever, aversion to wind
• Tongue:  Red tip, dry
• Pulse:  Floating
• Treatment principle:
  • Disperse the wind 
  • Moisten the lung
    

B. Impairment of internal organs

Live-fire attacking the lung 

• Symptoms and signs: Coughing possibly blood-tinged, costal pain, irritability
• Tongue:  Red with yellow coating
• Pulse:  Wiry and rapid
• Treatment principle:
  • Eliminate liver fire
  • Smooth qi
  • Suppress ascended qi

Phlegm-dampness accumulating in the lungs

• Symptoms and signs: Cough with a heavy sound and profuse white sputum, fullness and oppressive sensation over the chest and epigastrium, fatigue, poor appetite, nausea, vomiting, diarrhea 
• Tongue:  White and greasy tongue coating
• Pulse:  Soft-floating and smooth
• Treatment principle:
  • Tonify the spleen
  • Dry dampness
  • Eliminate sputum
  • Relieve cough

Phlegm-heat stagnation in the lungs

• Symptoms and signs: Rapid breathing with harsh voice, cough with difficult expectoration of thick yellow sputum, or odorous or bloody sputum, chest pain, dry mouth, constipation
• Tongue: red tongue with yellow or yellow and greasy coating
• Pulse:  rapid and smooth
• Treatment principle:
  • Eliminate the heat
  • Dissolve sputum
  • Peace the lug
  • Relieve cough

Lung-yin deficiency

• Symptoms and signs: Longstanding cough with a little amount of white mucous or blood-streaked sputum, dry throat, hoarseness, flushed cheeks, afternoon fever, feverish sensation over the palms, soles and the chest, insomnia, night sweating, fatigue, emaciation
• Tongue: red tongue with scant coating
• Pulse: Thready and rapid
• Treatment principle:
  • Nourish yin
  • Moisturize the lungs
  • Dissolve sputum
  • Suppress cough

Lung-qi deficiency

• Symptoms and signs: Longstanding cough with very low sound, cough accompanied by asthma, thin, clear and white sputum, poor appetite,  shortness of breath and oppressive sensation over the chest, low spirit, tiredness, spontaneous sweating, aversion to coldness
• Tongue: light color and white coating
• Pulse: weak
• Treatment principle:
  • Nourish qi
  • Warm the lung
  • Dissolve sputum
  • Suppress cough
    

Clinical studies of Chinese medicine for cough 

Evaluation by survival analysis on effect of traditional Chinese medicine in treating children with respiratory syncytial viral pneumonia of phlegm-heat blocking Fei syndrome. Yang Y et al. Chinese Journal of Integrative Medicine. 2009;15(2):95-100. OBJECTIVE: To objectively evaluate the clinical effect of traditional Chinese medicine in treating children's respiratory syncytial viral pneumonia (RSVP) of phlegm-heat blocking Fei syndrome (PHBFS). METHODS: A single-blinded multi-center, blocked, randomized and parallel-controlled method was adopted. The clinical study was carried out on 206 children with RSVP-PHBFS who were assigned to two groups, 108 in the test group treated through intravenous dripping of Qingkailing Injection () in combination of oral intake of Er'tong Qingfei Oral Liquid () and 98 in the control group with intravenous dripping of ribavirin injection in combination with oral intake of potassium guaiacol sulfonate oral liquid, all for 10 days. The clinical efficacy was evaluated and compared at the end of the trial from various aspects by three methods including comprehensive efficacy, post-treatment main symptoms score difference and survival analysis of the main symptoms. RESULTS: After treatment, in the test group, 60 patients were cured, 36 markedly alleviated, and 12 improved. In the control group, 41 were cured, 38 markedly alleviated, 18 improved and 1 unchanged. Comparison on the comprehensive efficacy between the two groups shows a better efficacy in the test group (chi(2)=4.4527, P=0.0348). Scores of the main symptoms were lowered after treatment in both groups, the difference was 22.41+/-4.99 scores in the test group and 17.61+/-6.34 scores in the control group, being more significant in the former (t=-5.99, P<0.01). Survival analysis shows that there was significant difference between the two groups in the effect initiating time on such symptoms as fever, cough, copious sputum, shortness of breath, and rales, which was earlier in the test group (P<0.01 or P<0.05). CONCLUSION: Evaluation of the efficacy of traditional Chinese medicine in treating children with RSVP-PHBFS by using the three methods jointly could better show the objectivity of the evaluation. 

Sixty-eight cases of child chronic cough treated by moxibustion. Cui X, et al. J Tradit Chin Med. 2009;29(1):9-10. OBJECTIVE: To observe the therapeutic effects of moxibustion for chronic cough in children. METHODS: 68 child cases of chronic cough were treated by moxibustion. RESULTS: 54 cases were cured, 13 cases improved, and one case failed. The cure rate was 79.2%, with a total effective rate of 98.5%. CONCLUSION: The moxibustion therapy has definite therapeutic effect for children chronic cough.  

Influence of garlic moxibustion on the therapeutic effect in re-treatment patients of tuberculosis. Zhao XP and Lü HQ. Zhongguo Zhen Jiu. 2009;29(1):10-2. OBJECTIVE: To observe the therapeutic effect of moxibustion in re-treatments patients of tuberculosis. METHODS: Fifty-three cases were randomly divided into an observation group (n = 31) and a control group (n = 22). They were treated with routine chemotherapeutic program of western medicine with garlic moxibustion on main points Feishu (BL 13), Gaohuang (BL 43), Shenzhu (GV 12), etc. added in the observation group. The therapeutic effects were assessed by clinical symptoms and signs, X-ray, CT examination and laboratory indexes. RESULTS: The focus absorbing rate of 87.1% in the observation group was better than 63.6% in the control group (P < 0.05); the rate of bacteria-turned negativity in sputum was 90.5% in the observation group which was better than 56.3% in the control group (P < 0.05); the observation group in improvement of hypodynamia, night sweat and cough was superior to the control group (all P < 0.05). CONCLUSION: Moxibustion can increase the therapeutic effect for the re-treatment patient of tuberculosis.  

Observation on therapeutic effect of low energy He-Ne laser acupoint radiation on infantile cold. Zhou GY et al. Zhongguo Zhen Jiu. 2008;28(9):662-4. OBJECTIVE: To search for an effective therapy for infantile cold. METHODS: Two hundred and fifty-five cases were randomly divided into a laser group (n = 130) and a medication group (n = 125). The laser group were treated with lower energy He-Ne laser radiation at Tiantu (CV 22), Renying (ST 9), Dazhui (CV 14), Fengmen (BL 12), etc. and the medication group were treated mainly with oral administration of Amantadine tablets. The therapeutic effect was assessed after treatment of 5 days. RESULTS: The laser group in alleviation of cough, nasal obstruction, rhinorrhea, sputum sound were significantly better than the medication group (P < 0.001, P < 0.01); the cured rate was 68.5% in the laser group and 42.4% in the medication group, the former being better than the latter (P < 0.001). CONCLUSION: The low energy He-Ne laser acupoint radiation has a significant therapeutic effect on infantile cold. 

Effects of alligator Zhikegao on relieving cough dispelling phlegm and anti-inflammation. Xu DH et al. Journal of Chinese Materia Medica. 2007;32(10):961-5. OBJECTIVE: To research the effects of Alligator Zhikegao on relieving cough, dispelling phlegm and anti-inflammation. METHOD: The coughing tests in mice, the phenol red secreting tests in mice, ear edema tests in mice,and paw edema tests and subcutaneous cotton ball granuloma in rats were adopted for observing the related pharmacological effects of Alligator Zhikegao. RESULT: Alligator Zhikegao could obviously prolong the latent period and decrease the times of mouse coughing, and remarkably inhibit the mouse ear edema (P < 0.001), the rat paw edema and the hyperplasia of subcutaneous cotton ball granuloma in rats. Alligator Zhikegao 11.70 g x kg(-1) could significant improve the carbonic clearances of macrophages (P <0.05) and the hemolysin level in serum (P <0.01). CONCLUSION: Alligator Zhikegao has significant effects on relieving cough, dispelling phlegm, anti-inflammation and immunological regulation. 

Therapeutic effect of Zhuang medicine medicated thread moxibustion on asthma of lung deficiency type. Li G. Zhongguo Zhen Jiu. 2005;25(3):181-3. OBJECTIVE: To observe effects of zhuang medicine medicated thread moxibustion on asthma of lung deficiency type. METHODS: Seventy-two asthma of lung deficiency type were randomly divided into Zhuang medicine medicated thread moxibustion group and an acupuncture-moxibustion control group. They were treated by moxibustion 1-2 times each day, for 21 days. The therapeutic effects, serum immunoglobulin (Ig) and complement-3 (C3) contents, pulmonary function, and symptoms and signs were investigated. RESULTS: There was no significant difference between the two groups in the total therapeutic effect, but the clinical control rate in the treatment group was higher than that in the control group. The Zhuang medicine medicated thread moxibustion could obviously improve cough, dyspnea, and respiratory function, increase levels of IgG and C3, and decrease level of IgE. CONCLUSION: Zhuang medicine medicated thread moxibustion has a better therapeutic effect on asthma of lung deficiency type, with safety. 

Evaluation on clinical efficacy of treatment of children pneumonia by combined internal-external therapy of TCM. OBJECTIVE. Wang XF et al. Chinese Journal of Integrated Traditional & Western Medicine. 2005;25(6):537-9. To evaluate the clinical efficacy of combined internal-external therapy of TCM on children pneumonia. Adopting multi-center, randomized, controlled, double blinded principle, children with pneumonia were divided into 2 groups. Besides the basic treatment of western medicine, to the 406 children in the treated group internal administering of Chinese recipe prescribed according to syndrome differentiation and external applying of Fuxiong plaster were given additionally, while to the 411 children in the control group simulative placeboes were given for instead. The clinical efficacy of treatment on disease and syndrome, improvement of TCM syndrome and physical signs of lung between the two groups were compared after treatment. RESULTS: The cured-markedly effective rate of treatment on disease and syndrome was 97.3%, 95.1% in the treated group and 89.8%, 86.6% in the control group, respectively, the differences of the two indexes between the two groups were significant (P < 0.05). The improvements on physical signs of lung, symptoms as cough, dyspnea and sputum expectorating in the treated group were significantly better than those in the control group (P < 0.05). CONCLUSION: It was showed that the combined internal-external TCM treatment, which could significantly enhance the clinical efficacy, is an effective therapy for children pneumonia.  

Clinical study of wind-warm and pulmonary heat syndrome treated with integrated traditional Chinese and Western medicine.  Zhang CJ et al. Journal of Chinese Integrative Medicine. 2005;3(2):108-10. OBJECTIVE: To investigate the clinical effectiveness of Toubiao Qingfei (expelling exterior evil and clearing lung) Decoction (TBQFD) on wind-warm and pulmonary heat syndrome. METHODS: Forty-six subjects were randomized into treatment group and control group. Patients in the control group were treated with Western medicines, while patients in the treatment group were treated with Western medicines and TBQFD. The therapeutic effects and improvement of symptoms in both groups were observed. RESULTS: The durations of fever, cough and absorption of pulmonary inflammatory focus in the treatment group were 1.52, 3.52 and 6.25 days respectively, which were significantly shorter than those in the control group (P<0.05). CONCLUSION: TBQFD can improve the symptoms, such as fever and cough, and can promote the absorption of infection and shorten the clinical course of wind-warm and pulmonary heat syndrome. 

Clinical study on treatment of severe acute respiratory syndrome with integrative Chinese and Western medicine approach. Li J et al. Chinese Journal of Integrated Traditional & Western Medicine. 2004;24(1):28-31.  OBJECTIVE: To summarize the clinical characteristics of severe acute respiratory syndrome (SARS) and observe the therapeutic effect with integrative Chinese and western medicine (ICWM) approach in treating patients with SARS. METHODS: Forty-eight patients selected from the authors' hospital, whose diagnosis confirmed as SARS were analyzed to sum-up the diagnostic type and basic feature of patients and the chief clinical characteristics. All the patients were randomly divided into the trial group and the control group, 24 in each. The control group was treated with the western medical therapeutic program and the trial group was treated with ICWM therapeutic program. The differences between the two groups were compared in terms of development of illness, time of using corticosteroid and absorption time of pulmonary inflammatory lesion, etc. RESULTS: Most patients were youth and adult aged between 18 to 40 years old, the initial symptom was mainly the high fever, accompanied with general soreness, chest stuffiness and cough, etc. The hospitalization time, body temperature fluctuation sustaining time and time of using corticosteroid in the trial group were shorter than those in the control group, showing significant difference (P < 0.05). ICWM treatment showed a better effect in defervescence and inflammatory lesion absorption time, but with no statistical significance. CONCLUSION: Patients of SARS are mainly youth and adults in the prime of life, fever always appears as the initiation of illness and some accompanying symptoms would appear. As compared with the western treatment, ICWM treatment could evidently shorten the course of illness, prevent the rebounding of fever and reduce the time of using corticosteroid.  

Treatment of cough and dyspnea due to acute bronchitis by plaster for cough and dyspnea--a report of 735 cases. Chen Z et al. J Tradit Chin Med. 2002;22(1):5-8. In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P < 0.01); and that in the treatment group, the cure rate for the wind-cold type of acute bronchitis was significantly higher than that for the wind-heat type of acute bronchitis (P < 0.01). 

Heavy menstruation and Chinese Medicine 

Heavy menstruation is called menorrhagia or hypermenorrhea. Menorrhagia is menstruation at a regular cyclical interval with excessive flow and duration; clinically, blood loss is in excess of 80 ml per cycle; or menses lasts longer than 7 days. Aside from the social distress of dealing with a prolonged and heavy period, over time the blood loss may prove to be greater than the body iron reserves or the rate of blood replenishment, leading to anemia.  

Causes

There are many causes of menorrhagia. The condition should always be diagnosed by a doctor to rule out a variety of potentially serious underlying conditions such as cancer and uterine fibroids. The causes of heavy menstruation are regularly divided into two categories:

• Functional uterine bleeding: A change in hormone levels is a common cause of abnormal menstrual bleeding.
• Organic uterine bleeding (non-functional uterine bleeding):  it is not caused by hormone imbalance but by underlying diseases. The following causes are quite common. 
  • Endometrial hyperplasia
  • Cancer of the uterus
  • Uterine fibroids, uterine polyps or adenomyosis
  • Medical conditions such as thyroid and pituitary disorders, diabetes, cirrhosis of the liver, and systemic lupus erythematosus
  • Pregnancy complications -- such as miscarriage or ectopic pregnancy
  • Changes in birth control pills or estrogens that you take
  • Use of certain drugs such as steroids or blood thinners
  • Use of an intrauterine device (IUD) for birth control
  • Recent trauma, surgery, or other uterine procedure
  • Infection in the uterus (pelvic inflammatory disease)
  • Bleeding disorders such as Von Willebrand disease
  • Polycystic ovary syndrome
    

Conventional treatment

Where an underlying cause can be identified, treatment should be directed at underlying cause. For functional uterine bleeding, hormones are often treatment option, such as progestogen,or oral contraceptive. Non-steroidal anti-inflammatory drugs or tranexamic acid tablets are often used and some surgical procedures such as endometrial ablation, Uterine Artery Embolisation (UAE), or hysterectomy are sometime suggested for severe cases. 

Chinese Medicine

Acupuncture and Chinese medicinal herbals offers a natural alternative to medical intervention in the treatment of menorrhagia. Various studies have been performed and the results show the effectiveness of Chinese medicine. The following are some studies from acupuncture. Study by Liu (1988) diagnosed 5 groups of patients who were treated with the appropriate points formulae and needle techniques. Patients received between 7 and 10 daily treatments, with a follow-up 3 months after treatment. The total effective rate was 90% with 80% of patients experiencing significant benefits.  An interesting secondary feature of the study is the inclusion of blood tests. Post acupuncture tests revealed the blood cell counts had returned to normal levels. 

Another study was performed by Zhang & Wang. They used one acupoint-formula for each along with the appropriate needle technique. Patients in this study received at least 10 treatments, with a follow-up 6 months after treatment. They report “complete cure” in 86% of cases, with 100% “total effective rate”.  

In the third study (1994), patients received individualized treatment according to Chinese medical diagnosis. A course of treatment involved daily acupuncture for 4 to 5 days prior to and after menstruation.  Patients received no more than 3 courses of treatment. This research found that acupuncture was effective in normalizing the menstrual cycle and regulating ovulation (as evidenced by mid-cycle luteinizing hormone and cervical mucus values) in patients who had previously used oral contraceptives. In 84.2% of cases significant benefits were achieved through treatment. There was no follow-up to gauge the long-term benefits. The authors also observed that those who had used oral contraceptive pill for more than 2-3 years, and those with a history of menstrual disorders before using oral contraception, required more treatments.   

Clinical manifestations & treatment principles

There are various causes of heavy menstruation. The common causes of heavy menstruation are heat in the blood, blood stasis, qi deficiency, spleen deficiency, and kidney yin or yang deficiency. The following are the clinical manifestations and treatment principles.

Heat in the blood

• Clinical Manifestations: excessive menstrual flow with bright red or dark red and viscous menses containing clots, restlessness, thirst, yellow urine, constipation, red tongue with yellow coating and smooth, rapid pulse. Sometimes, this category is accompanied with yin-deficiency such as hectic fever, feverish sensation over the palms, soles and the chest, flushed face and profuse bleeding.
• Principle of treatment: clear away heat, cool the blood and stop bleeding.

Blood stasis

• Clinical Manifestations: excessive or prolonged menstrual flow, dark purplish menses with clots, lower abdominal pain and tenderness, dark purplish tongue with petechiae and thready, or unsmooth pulse. Blood stasis may be co-existent with yin deficiency such as red tongue with little coating, dryness of mouth and throat, feverish sensation over palms, soles and the chest, night sweating.
• Principle of treatment: activate blood circulation, eliminate blood stasis and stop bleeding.

qi deficiency

• Clinical Manifestations: excessive menstrual flow with pink and thin menses, pale complexion, shortness of breath, weakness of limbs, empty and bearing-down sensation over the lower abdomen or palpitations, pale tongue and thready, weak pulse.
• Principle of treatment: tonify qi, strengthen the Chong meridian and stop bleeding.

Spleen deficiency

• Clinical Manifestations: Irregular menstrual cycle, manifested as metrorrhagia or metrostaxis, prolonged menstruation, accompanied with shortness of breath, spiritlessness, pale face, poor appetite.
• Principle of treatment: tonify qi, strengthen the spleen, nourish blood and stop bleeding

Kidney yang deficiency

• Clinical Manifestations: prolonged bleeding with a trickle for a long time after the period, late periods, cold feelings, sore back, cold limbs, pale complexion, weak knees and pale urine.
• Principle of treatment: tonify and warm kidney yang, strengthen Chong meridian and stop bleeding.

Kidney yin deficiency

• Clinical Manifestations: trickling of blood after the period. Late cycle, dizziness, tinnitus, weak knees, feelings of heat in the evening, night sweats, hot flashes, mental restlessness.
• Principle of treatment: nourish kidney yin and stop bleeding.

Chinese medicine practitioners treat menorrhagia according to patient’s initial cause, symptoms and signs, presentation of pulse and tongue. Acupuncture, herbal medicine and some other modalities of Chinese medicine can be used alone, or combined, which depend on individual situation. Acupuncture, once or twice a week for 4 weeks, is a common practice. And herbal medicine, twice a day for 10 days, is often used in clinic practice. Individual patient’s response to acupuncture or herbal medicine is different, so treatment course and modalities chosen differ from person to person.

Insomnia and Chinese Medicine 

Insomnia is a symptom that can accompany several sleeping, medical and psychiatric disorders, characterized by persistent difficulty falling asleep and/or staying asleep despite the opportunity. Both organic and non-organic insomnia without other cause constitute a sleep disorder, primary insomnia.

Types of insomnia

• Transient insomnia lasts from days to weeks.
• Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months.
• Chronic insomnia lasts for years at a time. 

Patterns of insomnia

• Onset insomnia: difficulty falling asleep at the beginning of the night.
• Middle insomnia: waking during the middle of the night, difficulty maintaining sleep.
• Terminal (or late) insomnia: early morning waking. Often a characteristic of clinical depression.
• Sallow sleep: easy to wake up.
  

Causes

• Insomnia can be caused by various conditions or disorders.
• Emotional and mental tension: such as fear, stress or anxiety
• Disturbances of the circadian rhythm: such as shift work and jet lag
• Poor sleep hygiene: such as noise
• Physical exercise: exercise-induced insomnia is common in athletes
• Hormone imbalances: such as premenstrual syndrome, perimenopause, during menopause and postmenopause
• Any injury or conditions caused pain
• Medical conditions: digestive or cardiovascular disorders; mental disorders; certain neurological disorders; restless legs syndrome; parasites-induced intestinal disturbances
• Stimulants: caffeine or cocaine
• Certain medication
• Parasomnia
  

Conventional treatment

Sleep disruption is often managed by the use of medications such as benzodiazepines and tricyclic antidepressants. Sedatives and oral hypnotics have high abuse potential and can be addicting. Tricyclic antidepressants may have intolerable adverse effects, including dry mouth, orthostatic hypotension, urinary retention, and cardiac conduction effects. Melatonin is widely available and may be used in an attempt to normalize the sleep-wake cycle. However, there is a paucity of data on the long-term safety of melatonin. Non-pharmacological interventions include "light therapy," a commonly used modality for seasonal affective disorder and sleep disruption. But it has been noted significant adverse effects such as nausea, headache or shakiness.   

Chinese Medicine

Acupuncture studies

Chinese medicine is used for the treatment of insomnia and related conditions for thousands of years in China and is uniquely beneficial for the patients with insomnia. Various acupuncture studies have been done and the evidence show that the effectiveness of acupuncture. In a study by Lee1, all patients reported severe insomnia as a chief complaint; no patient slept more than 3-4 hours per night. Seven auricular points were used in this study: heart, kidney, adrenal, sub-cortex, endocrine, san chiao and shen men. In addition to these standard 7 auricular points, sympathetic, occiput, and gallbladder auricular points were added if reactive or tender. Treatment was 3 times per week with a typical duration of 10-12 initial treatments, followed by a 2- to 4-week observational period; 15 of 16 patients had regimens of 15 treatments or fewer; 1 patient received 28 treatments total. Lee reported that lidocaine injections into exclusively auricular points improved symptoms of sleep disorder in 15 of 16 patients treated. Therapeutic effects were still present 3 months following the conclusion of treatment. In a study of outpatients, Fischer2 reported similarly encouraging results: 100% of patients treated for insomnia obtained benefit without recurrences within 18 months of follow-up. Montakab and Langel3 diagnosed 40 patients using Chinese traditional diagnosis and performed polysomnographic analyses of true acupuncture vs control needled patients. Objective change was noted and found statistically significant in the true acupuncture group.   

Ruan et al4 applied 4 courses of electroacupuncture treatment in 47 patients. Result showed that electroacupuncture considerably improved insomniacs' sleep quality and social function during the daytime. Electroacupuncture had certain repairing effect on the disruption in sleep architecture. At the same time, electroacupuncture prolonged slow wave sleep (SWS) time and relatively rapid eye movement sleep (REM sleep) time. There was no hangover, addiction or decrements in vigilance during the daytime. Electroacupuncture treatment for chronic insomnia is safe. Therefore, electroacupuncture therapy could be a promising avenue of treatment for chronic insomnia. 

Lee et al5   studied the effect of intradermal acupuncture on 52 patients with insomnia after stroke. Hospitalized stroke patients with insomnia were enrolled in the study and were randomly assigned to either a real intradermal acupuncture group (RA group) or a sham acupuncture group (SA group). The effect of acupuncture on insomnia was measured using Insomnia Severity Index (ISI) and Athens Insomnia Scale (AIS) at baseline and three days after treatment. To assess the effect of acupuncture on the autonomic nervous function, the subjects' blood pressure and heart rate variability were monitored. The insomnia-related scales ISI and AIS showed greater improvement of insomnia in the RA group than in the SA group. Moreover, there is a greater reduction of the number of non-dippers and a greater decrease of the LF/HF ratio (heart rate variability) in the RA group than in the SA group. These results indicate that sympathetic hyperactivities were stabilized in the RA group. It can thus be concluded that intradermal acupuncture is a useful therapeutic method for post stroke-onset insomnia as it reduces sympathetic hyperactivities. 

Classification, manifestations and treatments

In Chinese medicine, sleep is seen as one's yang energy moving inward to be enfolded by yin and sleeplessness is a sign of imbalance. 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 restless, agitated or dream disturbed sleep. If your sleep is habitually disturbed it can be very damaging to the vital energy of the body and immune system. If this is the case it is important to determine the cause of the imbalance and treat it appropriately. In Chinese medicine, insomnia is caused by different reasons. The following are the common causes encountered in clinical practice. 

Deficiency of heart and spleen

• Symptoms: hard to fall into sleep, dream a lot and easy to wake up, hard to fall into sleep after waking up, pale complexion, palpation, forgetful, easy to be tired and low energy,  poor appetite, abdominal bloating or loose stool
• Tongue: light-colored with white coat
• Pulse: thin and weak

Disharmony of heart and kidney

• Symptoms: restless, hard to fall into sleep, dream a lot, with dizzy and tinnitus, feel sore and weak in waist and knees, hot flash and night sweating, feeling hot in the body, rashes in month and tongue, spermatorrhoea and irregular menstruation 
• Tongue: red
• Pulse: thin and fast

qi deficiency of heart and gallbladder

• Symptoms: weak, restless, timidity and easy to get startled, fearful all the time, palpation, often sighing, pale complexion,  uncomfortable on lateral chest, and vomit
• Tongue: light-colored and fat
• Pulse: thin and weak

Disturbance by phlegm heat

• Symptoms: restless, dream a lot, easy to wake up, plenty phlegm and feel chest congested, heavy head and tinnitus, bitter month and aversion to food, belch and swallow acid
• Tongue: lightly red and greasy-yellow coat
• Pulse: slippery and fast  

Disharmony of stomach-qi

• Symptoms: can not sleep peacefully with uncomfortable stomach, poor appetite and belch, abdominal bloating and borborygmus, constipation
• Tongue: thick and greasy coat
• Pulse: heavy and slippery 

Liver stagnation-caused fire

• Symptoms: insomnia, anxiety and easy to get angry, red-eyes, bitter month, dark or dark yellow-colored urine and constipation
• Tongue: red, yellow tongue coat
• Pulse: stringy  
  

Principle of treatment

• Deficiency of heart and spleen: tonify heart and spleen, nourish qi and stimulate blood.
• Disharmony of heart and kidney: tonify yin and suppress heat, smooth the route of heart and kidney.
• qi deficiency of heart and gallbladder: tonify qi, suppress fright, peace spirit and sedate heart.
• Disturbance by phlegm heat: clear heart, dissolve phlegm, sedation and peace mind.
• Disharmony of stomach-qi: improve food digest, eliminate constipation, harmonize the stomach qi and peace the mind.
• Liver stagnation-caused fire: Smooth liver and eliminate the heat.
  

Chinese medicine practitioners treat insomnia according to patient’s initial cause, symptoms and signs, presentation of pulse and tongue. Acupuncture, herbal medicine and some other modalities of Chinese medicine can be used alone, or combined, which depend on individual situation.  Acupuncture, twice a week for 4 weeks, is a common practice. And herbal medicine, twice a day for 10 days, is often used in clinic practice.  Responses to acupuncture or herbal medicine are different, so treatment course and modalities used are different.   

References

1. Lee TN. Lidocaine injection of auricular points in the treatment of insomnia. Am J Chin Med. 1977;5:71-77.
2. Fischer MV. Acupuncture therapy in the outpatients-department of the University Clinic Heidelberg [in German]. Anaesthesist. 1982;31:25-32.
3. Montakab H, Langel G. The effect of acupuncture in the treatment of insomnia: clinical study of subjective and objective evaluation [in French]. Schweiz Med Wochenschr Suppl. 1994;62:49-54
4. Ruan JW et al. Electroacupuncture treatment of chronic insomnia. Chin Med J (Engl). 2009;122:2869-73.
5. Lee SY et al. Intradermal acupuncture on shen-men and nei-kuan acupoints improves insomnia in stroke patients by reducing the sympathetic nervous activity: a randomized clinical trial. Am J Chin Med. 2009;37:1013-21.