TCVM Approach to Megacolon and Megaesophagus

1
TCVM Approach to Megacolon and Megaesophagus
2
Mega- Introduction

• If normal directional motion is inhibited in a
  tubular organ
• A type of Qi Deficiency
• May be a congenital disharmony
• Yang Jing Deficiency if associated with other
  signs of Yang Deficiency
• Yin Jing Deficiency if associated with other
  signs of Yin Deficiency

3
Mega- Introduction

• Directional or propulsive Qi Deficiency
• May be acquired
• Exogenous Pernicious influences
• E.g. distemper virus, trauma, toxins, poor
  quality foods for that species or individual
  constitution
• Endogenous Pernicious influences
• E.g. hypothyroidism, systemic lupus
  erythematosus, hypoadrenocorticism, myasthenia
  gravis
• Remember that sthenia means full or excess
• asthenia means empty or weak or deficient

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Mega- Introduction

• Directional Qi Deficiency
• May be associated with concurrent Blood or Yin
  Deficiency
• Subsequent Dryness fails to lubricate either
  ingesta or feces
• Megaesophagus swallowing inhibited
• Regurgitate dry ingesta
• Megacolon defecation inhibited
• Cannot float the boat in a dry river

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Megaesophagus and Megacolon Types of Wei
Syndromes?

• Wei means withered in Chinese to describe the
  withering of muscles
• Classical Wei or Atrophy Syndrome is a condition
  characterized by a weakness of the four limbs,
  progressively leading to atrophy, a limp state of
  muscles and tendons, an inability to walk
  properly and eventually paralysis
• This weakness generally occurs without pain
• So are these Megas localized Wei?

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Wei Syndrome Pattern Differentiation

• Heat in the Lungs injuring Yin fluids- Excess
• Invasion of Damp-Heat- Excess
• Invasion of Cold-Dampness- Excess
• Stomach and Spleen deficiency- Deficiency
• Spleen and Heart collapse- Deficiency
• Liver and Kidney deficiency- Deficiency
• Blood Stasis in the channels- Combination of
  Excess and Deficiency

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Relationship Between Pattern and Pathoetiology

• Wind-Heat causes only Lung-Heat injuring Yin
  fluids
• External Dampness leads to Damp-Heat or
  Cold-Dampness
• Irregular Diet causes the patterns of Damp-Heat,
  Cold-Dampness and Stomach-Spleen deficiency
• Excessive sex and overwork cause the patterns of
  Kidney-Liver deficiency and Blood stasis in the
  channels
• Trauma causes the pattern of Blood stasis in the
  channels
• Shock leads to the pattern of Heart-Spleen
  collapse

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Mega- Primary treatment principles

• Tonify global and local Qi
• Assist directional Qi Flow
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood
• Invigorate Blood

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Megaesophagus Pattern Differentiation

• Qi Deficiency or Yang Deficiency
• may be seen with hypothyroidism, systemic lupus
  erythematosus, hypoadrenocorticism, myasthenia
  gravis, poor quality foods for that species or
  individual constitution
• Blood Deficiency /- Blood Stagnation
• may be seen with trauma, toxins, poor quality
  foods for that species or individual constitution
• Heat Patterns
• may be seen with distemper infection or other
  febrile diseases

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Megaesophagus Treatment

• Physical assistance with raised feeding station
  and soft, highly digestible foods
• Suggest slow-cooked foods based upon Bian Zheng
  (see following lecture)
• Acupuncture based upon global and local Patterns
• Herbal Formula based upon global and local
  Patterns

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Megaesophagus Qi Deficiency

• Clinical Signs
• Fatigue, weight loss, muscle mass loss,
  decreased/depressed back Shu points
• Tongue
• Pale, moist
• Pulse
• Feeble, especially middle and upper jiao

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Megaesophagus Qi Deficiency

• Acupuncture Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach (esophagus
  belongs to the Stomach)
• BL 13, 14, 15 as local Shu for upper Sea of Qi
• LI 4, LIV 3 to move Qi
• LI 10, ST 36, CV 6 to nourish Qi
• LI 1, LU 11, ST 45 to clear fullness of the chest
  in the region of the Heart

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Megaesophagus Qi Deficiency

• Spleen Qi Deficiency
• Si Jun Zi Tang or Four Gentlemen Decoction
• the chief herb Panax ginseng ren shen is sweet,
  warm and tonifies Spleen Qi
• the deputy herb Atractylodis macrocephalae bai
  zhu is bitter, warm and strengthens Spleen Qi and
  dries Dampness

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Megaesophagus Qi Deficiency

• Spleen Qi Deficiency
• Si Jun Zi Tang
• assistant herb Poria cocos fu ling is sweet,
  bland and leeches out Dampness and mildly
  Tonifies Spleen Qi
• the envoy Glycyrrhiza uralensis gan cao is warm,
  sweet and warms and regulates the middle burner
• modify with Hou Po magnolia bark to promote Qi
  flow, transform Dampness, relieve food
  stagnation, direct rebellious Qi downward for a
  stifling sensation in the chest
• Or modify with Platycodon jie geng resolve phlegm
  and guide other herbs to upper burner

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Megaesophagus Blood Deficiency

• Clinical Signs
• Dry fur, dry pads, firm, dry stools, decreased
  firmness in back Shu points
• Tongue
• Pale, dry, may have slight lavender hue
• Pulse
• Weak, thin, especially middle and upper jiaos

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Megaesophagus Blood Deficiency

• Acupuncture Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach for post-heaven
  Blood
• BL 17, 18 to engender Blood
• LI 4, LIV 3 to move Qi with Blood
• SP 10, ST 36 to engender Blood and benefit Spleen
  and Stomach
• LI 1, LU 11, ST 45 to clear fullness of the chest
  in the region of the Heart

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Megaesophagus Blood Deficiency

• Tao Hong Si Wu Tang Four Substances Decoction
  with Peach Kernel and Safflower
• Shu di huang prepared rehmannia
• Dang gui angelica sinensis
• Bai shao yao white peony
• Chuan xiong ligusticum
• Tao ren peach kernel
• Hong hua safflower
• Nourish Blood, promote Blood circulation, removes
  Blood Stasis

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Megaesophagus Blood Stagnation

• Clinical Signs
• Pain in chest, front Mu and back Shu points,
  uncomfortable lying in ventral recumbency
• Tongue
• Lavender, usually slightly pale and dry
• Pulse
• Wiry, choppy, commonly thin

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Megaesophagus Blood Stagnation

• Acupuncture Use electro-AP!!
• LI 4, LIV 3, LIV 14 to move Blood
• PC 6 master of the chest, reduce stagnation
• CV 17 front Mu of the upper Sea of Qi
• BL 17, 18, SP 10 to engender and circulate
  Stagnant Blood
• CV 12, GB 21, GV 1 to descend Qi
• LI 1, LU 11, ST 45 to clear fullness of the chest
  in the region of the Heart

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Megaesophagus Blood Stagnation

• Xue Fu Zhu Yu Tang Remove Stasis from the Mansion
  of Blood Decoction
• Tao ren peach kernel
• Hong hua safflower
• Dang gui angelica sinensis
• Sheng di huang prepared rehmannia
• Chuan xiong ligusticum
• Chi shao yao red peony
• Chuan niu xi cyathula
• Jie geng platycodon
• Chai hu bupleurum
• Zhi ke bitter orange
• Gan cao licorice
• Promotes the circulation of Blood and Qi, removes
  Blood Stasis, relieves pain

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Megacolon Pattern Differentiation

• Qi Deficiency
• seen with chronic poor quality foods for felids
  in general or individual constitution
• Blood Deficiency /- Blood Stagnation
• seen with trauma, poor quality foods for that
  species or individual constitution
• Heat Patterns
• may be seen with chronic Stagnation of Qi or
  Blood
• Yin Deficiency
• usually a consequence of Chronic Heat
• Mixed Qi and Blood Deficiency
• is very common

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Megacolon Primary treatment principles

• Tonify global and local Qi
• Assist directional Qi Flow
• Tonify Qi of all Bowels (i.e. Stomach System)
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood

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Megacolon Qi Deficiency

• Clinical Signs
• Firm to moderate stools that are difficult to
  expel, thin, small muscles, easily fatigued
• Tongue
• Pale, normal to moist
• Pulse
• Weak, deep

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Megacolon Qi Deficiency

• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish the Spleen
  and Stomach
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for Large
  Intestine
• TH 6, TH 5 empirical points for moving the Qi of
  the intestines for constipation

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Megacolon Qi Deficiency

• Si Jun Zi Tang or Four Gentlemen Decoction
• Panax ginseng ren shen is sweet, warm and
  tonifies Spleen Qi
• Atractylodis macrocephalae bai zhu is bitter,
  warm and strengthens Spleen Qi and dries Dampness
• Poria cocos fu ling is sweet, bland and leeches
  out Dampness and mildly Tonifies Spleen Qi
• Glycyrrhizae uralensis gan cao is warm, sweet and
  warms and regulates the middle burner
• Modify with Rhubarb da huang as a bitter, cold
  herb to move the bowels and dispel stasis

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Megacolon Qi Deficiency

• Fan Xie Ye (I8001)
• Fan Xie Ye senna leaf
• Sweet, bitter, cold
• Enters the Large Intestine Channel
• Drains downward and guides out stagnation
• For constipation due to heat accumulation in the
  Intestines
• Contains anthraquinone glycosides
• Hepatic metabolites stimulate pelvic ganglion
• Purge Large Intestine, resolve food stasis

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Megacolon Blood Deficiency

• Clinical Signs
• Hard, dry stool, dry hair, dry and flakey skin
• Tongue
• Pale and dry
• Pulse
• Thin, weak

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Megacolon Blood Deficiency

• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish post-heaven
  Blood production via SP/ST
• BL 17 and SP 10 to nourish Blood
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for Large
  Intestine
• TH 6, TH 5 empirical points for moving the Qi of
  the intestines for constipation

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Megacolon Blood Deficiency

• Dang Gui Cong Rong (A0250)
• Dang gui angelica sinensis
• Rou cong rong cistanche
• Qu mai dianthus
• Shen qu massa fermentata
• Fan xie ye senna leaf
• Hou po magnolia
• Mu xiang saussurea
• Xiang fu zi cyperus seed
• Zhi ke bitter orange
• Tong cao tetrapanax
• Moisten Large Intestine, resolve impacted Large
  Intestine

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Megacolon Dryness due to Heat

• Clinical Signs
• Constipation with hard stool difficult to expel,
  frequent urination
• Tongue
• Dry, yellow coating
• Pulse
• Deep, rapid or floating and choppy

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Megacolon Dryness due to Heat

• Ma Zi Ren Wan Hemp Seed Pill
• Huo ma ren cannabis seed
• Xing ren apricot seed
• Shao yao peony
• Zhi shi immature bitter orange
• Hou po magnolia cortex
• Da huang rhubarb
• Moisten the Intestines, drains Heat, promotes Qi
  movement, unblocks the bowels

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Megacolon Yin Deficiency

• Clinical Signs
• Constipation, thirst
• Tongue
• Dry, red
• Pulse
• Thin and slightly rapid or weak and feeble
• Consequence of warm-febrile disease in weak or
  Yin Deficient patient

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Megacolon Yin Deficiency

• Acupuncture
• BL 25, ST 25 back Shu and front Mu of Large
  Intestine
• SP 6, KI 3, , CV 4, BL 23 to nourish the Yin
• TH 6, ST 37 to unblock the Large Intestine

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Megacolon Yin Deficiency

• Zeng Ye Tang Increase the Fluids Decoction
• Xuan shen scrophularia
• Mai men dong ophiopogon
• Sheng di huang fresh rehmannia
• Generates fluids, moistens dryness and unblocks
  the bowels

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Megacolon Stagnation with Heat

• Clinical Signs
• Severe constipation and flatulence, focal
  distention and abdominal fullness, abdominal pain
  which increases with pressure, tense and firm
  abdomen
• Tongue
• Dry, yellow or dry and dark coating
• Pulse
• Deep, excessive

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Megacolon Stagnation with Heat

• Acupuncture
• Ren 4 tonifies Yin and fluids
• LI 11 clears Heat in the Large Intestine
• ST 37 lower He Sea for Large Intestine to
  harmonize LI
• ST 44 clears Stomach Heat
• LI 2 clears Large Intestine Heat
• SP 6, KI 6, Ren 12 promote body fluids

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Megacolon Stagnation with Heat

• Da Cheng Qi Tang Major Order the Qi Decoction
• Da huang rhubarb
• Mang xiao mirabilitum
• Zhi shi immature bitter orange
• Hou po magnolia cortex
• Vigorously purges Heat accumulation

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Conclusion

• Megaesophagus and Megacolon are predominantly
  types of localized Qi Deficiency
• Although heritable (Jing) factors may be
  involved, Exogenous Pathogens and poor quality
  foods are root cause
• Blood Deficiency with or without Blood Stagnation
  may be a complicating factor
• Acupuncture and Herbal formula based upon Pattern
  Differentiation may improve quality of life