Friday, June 26, 2009
M. is 52 yo married female who came to me with a toothache, which arose about two weeks after having a dental procedure performed on the lower right teeth. Pain was at the opposite of side of the mouth, flaring up in the early evening, getting progressively worse as the night wore on, making sleep difficult and agitating her person.
M was given four bags of a modified version of the Chinese formula Jade Woman Decoction, which addresses Stomach and Kidney yin deficiency. Here are the ingredients:
- Sheng Di (Rhemania)30 g.
- Shi Gao (Gypsum Fibrosum) 30 g.
- Zhi Mu (Anemarrhena Rhizome) 15 g.
- Huai Niu Xi (Archyanthis bidentatae Radix) 9 g.
- Mai Men Dong (Ophiopogon Tuber) 9 g.
- Huang Lian (Coptis) 1 g.
M noted a decrease in the intensity of pain, but continued experiencing pain in the evening beginning around 7:00 pm. She decided to visit her dentist, whereupon a course of antibiotics were prescribed, which she took for about a week along with three bags of the same formula modified with a higher dose of huang lian, 3g and 3g of clove, the latter primarily for pain.
M visited dentist and had tooth drained, the dentist suspecting an abscess. M noted periodically that pain would migrate from lower jaw to upper jaw. Three days after the draining, M experienced severe pain, but this time it began at 11:00 am.
M was given the above formula modified with following:
- Bai hua she she cao (Herba Hedyotidis Diffusae) 9 g.
- Zhe bei mu (Fritillaria verticillata thunbergii) 9 g.
- San Qi (Notoginseng) 3 g.
Formula was taken for five days. Pain stopped completely after the first day, but on the fifth day M reported feeling a sore throat. The following was prescribed:
- Jin Yin Hua (Lonicera japonica) 6 g.
- Lian Qiao (Forsythia) 6 g.
- Chai Hu (Buplerum) 9 g.
- Chuan Xiong (Ligusticum) 9 g.
- Bai hua she she cao 6 g.
- Tai zi shen 12 g.
According to Chinese medical diagnostics, pain that arises in the evening is the result of two factors, either yin deficiency or deep-level infection. Yin deficiency tends to present with slow onset and infections have a rapid onset. In either case, sheng di, which is the principle herb in Yu Nu Jian is the preferred herb. This is because it penetrates to deep levels of the body, cooling smoldering fires that may give rise to pain while supporting the body's deep-level immunity.
Tooth pain that involves individuals over the age of 30 will likely present with some level of deficiency. This is because a young body is strong and pathogens will have difficulty penetrating deeply. Conversely, the body's immunity becomes less efficient with age and pathogens have an easier time of penetrating deeply.
Chinese medical theory holds that pathogens have a specified order through which they invade the body, essentially from the superficial to deep. Origins of pathogens can also be internal, again usually affecting more superficial organs lung and stomach and penetrating more deeply, spleen and kidney.
The way pathogens are defeated depends upon the level at which the pathogen appears. Superficial pathogens are ejected through aromatic herbs. Those above that fit this bill are jin yin hua and lian qiao. Deeper pathogens are handled with bitter and cold herbs. Still deeper pathogens will be addressed indirectly by nourishing the body with either warming or sticky herbs. As mentioned, sheng di falls into this category, as well as mai men dong.
Bitter and cold herbs are those that fall into the categories of being anti-viral, anti-bacterial, and anti-fungal. These herbs are very effective, but cannot penetrate into deep levels, certainly not without exacting it's toll upon the body's resources. Consequently, great care must be exercised when prescribing these herbs. Of those above that fall into this category, you'll find bai hua she she cao, huang lian, and chai hu.
Upon initiation of treatment, the principle focus was to nourish yin, clear deficiency heat, and secondarily kill the pathogen. Huang lian, which goes to the stomach channel, was selected to perform this function. Although it appears that the formula was not as effective as it could have been, attacking pathogens cannot occur any more than what the body will permit. Permission level is set, in this case, by the time of day the pain flared.
After draining of the tooth, it was assumed that whatever abscess that existed was not resolved, hence the selection of zhe bei mu. It was also assumed that the decoction was performing well because the time at which the pain appeared changed from night to day, meaning that enough support had be lent to the body to allow it to push the pathogen to a more superficial level. According to Chinese meridian theory, the teeth and gums are traversed by the stomach and large intestine channels. Bai hua she she cao was selected because it goes to these channels. Since it is a very strong herb and because the yin of M was somewhat compromised, bai hua she she cao was used only to modify the Jade Woman Decoction. In other words, it was still necessary to support the base levels of the body while administering an attack, so as to prevent the pathogen from going back into the deep level or damaging the body's strength. San qi is a wonder herb that is often used for pain and bleeding and is know to have excellent effects for the body's micro-circulation.
Evidence that the pathogen was indeed being pushed out was further shown by the sore throat, which, within the context of the pathogen moving from deep to superficial, made sense. The subsequent formula sought to move the pathogen out through the expelling action of jin yin hua, lian qiao, and chai hu. Both chai hu and chuan xiong were selected to address any trapped pathogens that may be residing at levels between superficial and deep, the notorious "shao yang" level. Tai zi shen was added to protect immunity and nourish stomach yin.
An obvious question is the role of the antibiotics in the treatment. Chinese herbs are often used as a compliment to Western medical treatments, from cancer to in-vitro fertilization. From the perspective of Chinese medicine, antibiotics fall into the category of cold and bitter herbs. They can be likened to a powerful guided missile. The problem is, as growing antibiotic resistance demonstrates, that bacteria are smarter than the missile, changing their signature in such a way where the missile cannot find its target. Of course, antibiotics aren't so targeted and the side-effects of excess antibiotic use is well chronicled. Since Chinese herbology is comprised of many herbs, bacteria are unable to evade such a wide-spectrum approach. It might be likened to a shot gun.
If switching of metaphors is accepted, then we might contrast Chinese herbology from antibiotics by referencing music. Antibiotics are single spectrum. A single note. The note can be played loudly by striking more vigorously, e.g., taking more medicine, or softly with less medicine, but it's still the same note. Chinese herbology makes use of many notes. A single herb may be considered a symphony in itself from the perspective of chemical assays, but single herbs are rarely if ever prescribed. This is because a single note just doesn't make good music and in Chinese medicine a single herb is a single note. Biomedicine is based upon the theory of "active ingredients." Chinese herbalists assume all of the constituents of a plant are active, seeking to tweak results by selecting the root, the peel/bark, branch, or flower depending on the specifics of each individual. Thus, when a patient presents with a challenge it is not just the condition that's addressed but the patient's age, constitution, and pathogenic progression must be figure into the music. And guess what? In the over 2000 years of using essentially the same herbs, there is no discussion about bacterial immunity to any herb. In fact, pharmacognosists are busily analyzing the Chinese pharmacopoeia for the next great "active ingredient."
Herbal treatment through Chinese medicine is not a one hit wonder. An assessment of the body's overall state must be evaluated in order to devise the right treatment. This case demonstrates the way in which Chinese herbology can be used to assist the body in fighting off a pathogen by first supporting the body before any concerted attact is undertaken. Determining the level at which a pathogen prevails is crucial to an appropriate approach. Getting the body to the place it needs to be is a process that requires time and careful formula modification that is based upon an understanding of pathogenic progression.