A Short History of Medicine

1
A Short History of Medicine

• 2000 B.C. Here, eat this root
• 1000 A.D. That root is heathen.
• Here, say this prayer.
• 1850 A.D. That prayer is superstition.
• Here, drink this potion.
• 1940 A.D. That potion is snake oil.
• Here, swallow this pill.
• 1985 A.D. That pill is ineffective.
• Here, take this
  antibiotic.
• 2000 A.D. That antibiotic is artificial.
• Here, eat this root.

2
TCM Kidney Disease

• Kidney Physiology
• Kidney Jing
• Pediatrics
• Ear Diseases

3
Water

• Sound
• groaning
• Emotion
• fear
• Climate
• cold
• Season
• winter

• Direction
• north
• Opening
• ears
• Body Part
• bones
• Zang/Fu
• KID/BL

4
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. Qi goes Kidney
Qi Urinary incontinence FEAR downward not
firm Hind limb weakness leaks Premature
ejaculation Abortion
5
WATER TYPE

• Personal Characteristics
• 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
• 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

• Disease Predispositions
• Edema
• Infertility
• Back pain
• Urinary infections
• Diarrhea at dawn
• Depression
• Life Span
• Very long

6
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.

• Storing Jing (Essences)
• Congenital Jing
• Acquired Jing
• Governing Water Metabolism
• Acts as the gate of water
• Controlling the Reception of Qi
• 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

7
TCM 24 Hour Clock
8
Water Balance

• Sheng cycle nourishes it
• Ke cycle restrains it
• Provides the tension

9
Water
BALANCED
DEFICIENT
EXCESS
10
Water
BALANCED
NO ESSENCE
JING DEFICIENT
11
Patterns of Kidney Disharmony

• Lower back pain
• Frequent urination (bedwetting)
• Ringing in the ear
• Lack of hearing acuity/deafness
• Excessive fear
• Lack of willpower

12
Kidney Physiology

• Genetics ruled through kidneys (base
  intelligence)
• Houses governs the essence, rules the senses
  (jing)
• 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

13
Genetic Control of Life

• Obtain one pair of DNA from each parent
• Some areas are imprinted
• Suppressed so that only one gene is active
• No back up if something damages remaining gene
• Suspect 200 regions
• Responsible for many later life diseases

14
Kidney Physiology

• Storing Jing (Essences)
• Congenital Jing
• 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

15
Kidney Essence Impowers

• Kidney provides initial spark to all other organs
• During prenatal life of fetus
• Timing genetics dictate the resulting disease
• Which organ is affected

16
Spleen for Postnatal Essence

• While kidney is central for prenatal life, Spleen
  is central for postnatal life
• Maintains vitality of other organs
• Helps protect and replentish prenatal essence

17
The Jing Candle

• Candle bruning at both ends
• Original Kidney Jing
• Acquire Spleen Jing
• Candles are different sizes based upon Kidney
  Jing
• Replenished slowly by spleen

18
Telomeres

• Highly repetitive region ofDNA at the end of a
  chromosome
• DNA polymerase complex is incapable of
  replicating all the way to the end
• Pretects from loss of vital genetic information,
  which is needed for cell's activities
• Every time a cell with linear chromosomes divides
• 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.

19
What does this mean?

• Clones are inherently deficient
• Adult stem cells are less robust
• Artificial increase in telemeres leads to cancer
• When the telemeres are gone, life ends

20
Life is Balance

• Hope you get the best Jing
• Protect it with diet
• Live well and enjoy what you are given
• Make lemonade

21
Yuan Qi

• (Primary Qi, Source Qi, Original Qi)
• 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

22
Energy of Life

• Yuan Qi impels the function of the organs

23
JING PATHOLOGY

• Signs of Jing Deficiency
• Retarded or poor growth
• Developmental orthopedic diseases
• Loss of vitality
• Infertility
• Early aging

24
Jing Pathology

• Can be acquired from too much strain on the
  candle
• One of the problems of the Chinese emperors

25
Pathology of Kidney
Jing Deficiency (original or acquired)
LIV- -joint disease
Child
Fear or Stress or Pathogens
Kidney
LU/LI- -asthma edema
HT/PC- -shen
Parent
Grandchild
Organ
KID- -nephritis
Grandparent
Channel
SP/ST- -damp
Bone, Marrow, Head
Ears
BL
Incontinence
26
CAM Use in Kids

• 1992-2005, 66 pediatric utilization studies US,
  Canada, UK, Australia, Turkey, Norway
• General and subspecialty populations
• Use increasing

Complementary and Alternative Research and
Education Program
27
Pediatric Epidemiology

• 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

28
Children with other conditions

• 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

29
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

30
What are pediatricians most often asked about
CAM?

• 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, OConnor. Amb Peds, 2004

31
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 doctors business 31
• Doctor would not understand 20
• Cultural practice - embarrassing or private, lt20
• Fear of physician reaction (disapproval,
  abandonment, worse medical care) lt 15
• Eisenberg DM, et al. Arch Intern Med, 2001 135
  344-51

32
Consequences of Jing Deficiency

• Leads to disease of organs
• Heart
• GI tact
• Lung
• Kidney
• Liver
• Severe disease
• Early affects
• Mild disease
• Later effect

33
Chance

• 8 month M Lhasa apso
• Seizures for 1 month
• Tongue red purple
• Pulse deep weak

Di Tan Tang and Epimedium Powder
34
Kidney Jing Deficiency
35
Kidney Jing Deficiency

• Hz
• Seizures lt 1 year of age
• Dry nose mouth
• Tongue
• Pale or red
• Pulse
• Weak thready
• Rx Principle
• extinguish the wind and astringe or nourish the
  kidney jing

• AP
• KID-3, BL-23, SP-6, GV-20, ST-36, HT-7, GB-20, An
  Shen, Da Feng Men
• TCM Herbal
• Di Tan Tang and Epimedium Powder

36
Epimedium Powder
Epimedium Yin Yang Huo Tonify Kid Yang/Jing,
Promote Sexual Desire Cuscuta Tu Si Zi Tonify
Kid Yang, Jing Yin Cistache Rou Cong
Rong Tonify Kid Yang Yin Paeonia Bai Shao Yao
Nourish Liver Yin Blood Polygonum He Shou Wu
Nourish Blood Jing, Benefit Hair Actinolite
Yang Qi Shi Tonify Kid Yang Cynomorium Suo
Yang Tonify Kid Yang Psoralea Bu Gu Zhi
Tonify Kid Yang Strengthen Bones Dipsacus Xu
Duan Tonify Kid Yang Promote Fracture Healing
Lycium Gou Qi Zi Nourish Liver Yin, Benefit
Eyes Condonopsis Dang Shen Tonify Qi
Astragalus Huang Qi Tonify Qi Rehmannia Shu
Di Huang Nourish Kid Yin Jing Angelica Dang
Gui Nourish Blood Ophiopogon Mai Men Dong
Moisten Nourish Yin Scrophularia Xuan Shen
Cool Blood Clear Heat Citrus Chen Pi Move
Qi Relieve Pain
37
Ear Disease

• One of most common complaints for dogs cats
• Poor design
• Lack of essence
• Decreased immunity
• Failure to support child
• Passes heat to ears

38
Gods Boo Boo

• Poor design
• No drainage
• Covered with flap
• No air circulation
• Deep, Dark Hole

39
Infections in Children

• Some feel that the cause is the use of
  antibiotics
• Find that CAVM methods have a more effective
  longterm outcome
• Chiropractics
• Craniosacral techniques
• TCM

40
How Ears Help in TCM Exam
41
Otitis Externa

• Itchy
• Red
• Painful
• Damp- -Heat with Wind
• External pathogen
• Liver yin deficiency

42
Patterns
43
Channels Near the Ear
SI, TH, GB, BL, GV
44
AP for Ear Disease

• Local points on SI, TH, GB, BL, GV medians
• Influential points
• Points for excess or deficiency

45
Excess Patterns

• Damp Heat for Otitis
• Red tongue
• Fast, superficial pulse

46
Otitis Patterns
47
Pathology of Liver Heat
Liver Blood Yin Deficiency
Shen Disturbance
Child
Heat Damp
Liver Heat
SP/ST
KID/BL
Parent
Grandchild
Organ
LIV
Grandparent
Channel
LU/LI
Feet
Eyes
GB
Ears
48
Ear exam

• Dont forget to look!
• May find a cause
• Foxtail
• Polyp
• Tumor
• Parasite
• Can culture

49
TCM Herbals

• Clear Damp-Heat
• Long Dan Xie Gan
• Ear Damp-Heat
• Treat Topically
• TCM Ear Drops
• Western Ear Formula
• Improve immunity
• Canine Antioxidant Formula
• Canine Cancer Formula
• Garlic (fresh) orally

Westlab Pharmacy 1-800-4WESTLA
50
Long Dan Xie Gan Tang
Gentiana Long Dan Cao Clear Liver Heat, Clear
Damp-Heat Gardenia Zhi Zi Clear Damp Heat
Scutellaria Huang Qin Clear Damp-heat
Plantago Che Qian Zi Drain Damp-heat Alisma
Ze Xie Drain Damp Akebia Mu Tong Drain
Damp-Heat Angelica Dang Gui Nourish Blood
Rehmannia Sheng Di Huang Nourish Yin, clear
Heat Bupleurum Chai Hu Soothe Liver Qi
transporter Licorice Gan Cao Harmonize
51
Ear Damp-Heat
Artemisia Qing Hao Clear Damp-Heat Bupleurum
Chai Hu Soothe Liver Qi Scutellaria Huang Qin
Clear Damp-Heat Moutan Mu Dan Pi Cool Blood
Prunulla Xia Ku Cao Clear Heat Lophatherum
Dan Zhu Ye Clear Heat Tribulus Bai Ji Li
Clear Heat Luffa Si Gua Teng Transform
Phlegm, Resolve Stagnation Melia Chuan Lian Zi
Move Qi
52
TCM Ear Drops
Coptis Huang Lian Clear Heat, Detoxify Alum
Bai Fan Dry Damp, Transform Phlegm, Stop
Bleeding, Relieve Itching Borneol Bing Pian
Clear Heat, Relieve Pain, Open
Orifices, Dissipate Swelling Glycerol Gan
You Carrier
53
Western Ear Drops

• Detergent Solution
• 1 drop of free dishwasher soap
• 8 ounces of water
• Vinegar Solution
• 1 ounce apple cider vinegar
• 3 ounces of water
• Vitamin E/garlic oil
• 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

54
Inner Ear Disease

• 8th Nerve Signs
• 7th Nerve Signs
• ear lip droop
• lack of palpebral reflex
• nose turn
• nostril flaring
• Horners Syndrome

55
Horners Syndrome

• Small Animals
• Ptosis
• Myosis
• Enophthalmos
• Large Animals
• Facial sweating (horse)
• Lack of muzzle sweating (cow)

56
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

57
Dx of Inner Ear Disease

• PE, NE, OE
• Schirmers 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.
58
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.
59
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

60
Inner Ear Disease

• Treat with antibiotics and recheck in 2 weeks
• if better, continue
• if worse, reassess
• Recheck in 1 month
• if normal, stop antibiotics
• if still residual problems, continue 2 more weeks

• Recheck at 6 months
• re-examine any abnormalities (such as abnormal
  bulla radio-graphs)
• If problems worsens or persists without change
  for 4 weeks, consider referral.

61
Inner Ear Disease

• Other Neoplasia
• neurofibromas
• osteosarcomas
• FeLV
• Prognosis is Poor

• Other Infections
• Fungal
• Prognosis Guarded to Poor

62
Inner Ear Disease

• Consider Advanced Imaging Techniques
• Bone Scan
• MRI Scan
• Consider Surgical Drainage of Bulla

• If owner can not afford additional tests or
  referral, may try changing antibiotics.
• Main reason for failure is not treating long
  enough.

63
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

64
Inner Ear Infection
65
Inner Ear Neoplasia
66
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.

67
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.

68
Ear Polyps in Cats

• Treatment is surgical removal.
• Damage can be permanent, if pressure necrosis has
  destroyed the inner ear structure.

69
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
70
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.

71
Bilateral Vestibular

• Lacks classical signs
• Wide head excursions
• No physiologic nystagmus

72
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.

73
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

74
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