Gerontology • General Physiology of the Elderly • General Pathology of the Elderly• Some helpful advice to achieve longevity• Principles of Treatment for Longevity • Administration & Mixing Medications• Infectious Disease• Circulatory System Diseases• Respiratory System Diseases• Digestive System Diseases• Urogenital Systems Diseases• Nervous System Disorders• Metabolic & Endocrine System Disorders• Hemotopoietic (blood) System Disorders• Motor System Disorders• Dermatological Disorders• Ophthalmopathy• Genital Disorders• Senile Psychosis

General Physiology of the Elderly ▲

• Face begins to wrinkle, liver spots appear, hair starts to grey or whiten.• Kidney Qi & Essence becomes deficient – poor memory, silver hair, low back pain, floaters, water retention, tinnitus.• Neck starts to sag & wrinkle.• Excess tearing & nasal discharge or dryness may occur.• Auditory decline – right = Kidney Yang, left = Kidney Yin.• Visual decline, i.e. cataracts• Short term memory becomes dull = heart• Long term memory becomes dull = kidney (heart & kidney need to communicate)• Emotionally become more sad, bitter, angry, irritable.• 4 D’s – debility, depression (Qi stagnation), delerium (Phlegm, Blood Stasis), dementia (Essence).• Appetite & taste decrease.• Calcium absorption declines, i.e. osteoporosis.• Sex drive decreases.• Menopause and andropause. General Pathology of the Elderly

• Deficiency is the overall general pathology.

• All 5 Zang fu Qi becomes deficient – liver becomes deficient first.• The anatomical Spleen begins to decline first from a scientific point of view.• Check birth date & time for organ & element which will help determine what will become deficient with liver, &/or use clinical observation i.e. long term illnesses &/or deficiencies.• Yin usually becomes deficient first, therefore Yang will rise upwards, i.e. high blood pressure.• Although Yang also becomes deficient with the Yin causing coldness, low energy, & water retention, therefore one must judge % of Yin & % of Yang.• Emotional patterns can change drastically.• Sleep may also change, less sleep = more Yin deficiency.• Constipation is very common among the elderly.• Some other common diseases are: diabetes, hypertension, kidney disease. Important notes:1. Mild symptoms on the outside of the elderly very often mean severe disease inside, because the elderly are so deficient they can’t feel the symptoms as intensely (children are the opposite).i.e. shortness of breath may actually be a heartattack.i.e. mild cold (wind/cold) symptoms may actually be pneumonia.Be cautious!2. Elderly always have multiple organ malfunction, not just one (most often 4-6 disease processes).If >65 years old & have bronchitis – suspect cancer, this is especially true if the bronchitis is chronic, the same diet is being taken but the person becomes emaciated, & shortness of breath is present.Principle of treatment for cancer is to tonify, eliminate Phlegm, move blood, & detoxify. The pulse is usually wiry, & rapid. If loose bowel movements appears with this pulse it is not a good sign. 3. The elderly have more Blood Stasis & Phlegm.A tumor is essentially 4 things: deficiency, Blood Stasis, Phlegm, & toxicity. If with a wiry pulse there will be pain, if with a slippery pulse there is Dampness or Phlegm.4. Closed (Jue) & open (Tuo) disorders happen more in the elderly.

Closed (Jue) – can be excess or deficiency, i.e. stroke, with closed hands, syncope with closed eyes, closed teeth, temporary loss of mind. Try acupoints PC 6 & Du 26.Open (Tuo) – The loss of Yin or Yang, quite serious, open bowels, urinary incontinence, eyes mouth & hands wide open, possibly coma. Moxa to return Yin & Yang connection, try acupoints Ren 4, Du 20, & Du 26 gently. Some helpful advice to achieve longevity ▲

Western medicine says:• Diet should be regular, three meals on time.• One must eat breakfast.• Exercise 2-3 times per week – but not overly stressful exercise.• Get 7-8 hours of sleep.• Do not smoke, or if you do quit early in life.• Keep alcohol intake to a minimum.• Maintain a normal healthy weight.• Balance your sex life.• Keep good friends and family around. Traditional Chinese medicine says:• Live to achieve health according to the seasons.• Do not eat too early (before 8am).• Eat soft fruit with grains for breakfast.• Do Qi (energy) exercises in the morning, i.e. Qigong, tai ji, face/gum massage, click teeth for kidneys.• Keep mouth closed when having a bowel movement.• Keep teeth together during urination (helps keep Essence from escaping when orifice is open, i.e. ‘pee shivers’ which are more common in males).• Massage ears when stressed.• Eat more soup made with bone broth & a little vinegar for strong bones when elderly.• Breathing exercises should be a daily occurrence to help detoxify & replenish energy.• Physical exercises should be performed in the afternoon or evening.• The best time for bowel movements is early in the morning (between 5-9am).• Spend more time combing hair to prevent headache & insomnia.• Do large circles with your eyeballs to keep vision.

• Swallow saliva, do not spit it out, this can tonify digestion.• Always keep back warm to protect Yang Qi.• Rub abdomen habitually to regulate stomach Qi (digestion).• When meditating, keep mouth & anal sphincter lightly contracted.• Move & stretch joints regularly to keep mobility.• Use warm hands or dry brush to rub the entire body to keep circulation healthy. Wu Nan – 5 things that shorten life:1. Excess drive towards fame & fortune. 2. Too much anger &/or joy.3. Anything related to reproduction in excess, i.e. sex, births, abortion, miscarriage.4. Poor diet.5. Over-thinking, pensiveness, not taking time to shut your mind off, take breaks. Principles of Treatment for Longevity ▲

Loss of hair – (liver & kidney), Rx- Er Zhi Wan or Qi Bao Mei Yen Dan. Beneficial herbs: He Shou Wu, Sang Seng Zi, Nu Zhen Zi, Gou Qi Zi.

Eye troubles – Beneficial herbs: Gou Qi Zi, He Shou Wu, Nu Zhen Zi.

Ear problems – (kidney), Rx- Liu Wei Di Huang Wan + Chai Hu & Chi Shi, or Qi Ju Di Huang Wan. *When tonifying water (kidney) you must remember to keep earth (spleen) strong.

Teeth, bones, & marrow health – Bu Gu Zi is great for this (also to treat antibiotic side effects on hearing), Rx- Si Shen Wan + Niu Xi & Gu Xue Bu (morning diarrhea, bones, & teeth).

Memory trouble – short term difficulties – tonify heart, long term difficulties – tonify kidney. If Phlegm is present Rx- Di Huang Yin Zi + Tian Nan Xin (gallbladder Phlegm), Long Gu, & Mu Li.Rx- Sang Piao Xiao San + Fu Ling or Fu Shen for heart Phlegm. Rx- Gui Pi Tang + Fu Shen for heart (sleep, & anxiety).

Physical Heart & Lungs – tonify with Rx- Sheng Mai San + modifications for patient, Rx- Mai Wei Di Huang Wan.

Strengthen Spleen, harmonize Stomach – Rx- (spleen) Shen Ling Bai Zhu San, Bu Zhong Yi Qi Tang. Rx- (stomach) Ping Wei San, Ban Xia Hou Po Tang. Try Rx- Xiang Sha Liu Jun Zi Tang between 7-11am to perform both tasks.

Constipation – He Tao Ren (walnuts, also help memory and lung deficiencies), Hei Zhi Ma (black sesame seeds ground in congee form (Hei Zhi Ma Hu Hu) before bed to induce morning bowel movements.

Leakage – (urinary, seminal, vaginal), Rx- Shui Lu E Xian Dan + Jin Ying Zi & Qian Shi.Pain – Rx- Du Huo Ji Sheng Tang + Du Zhong, animal bone, & Xi Xian Cao. General Herbal Tips:• Qi – Wu Jia Pi, Wu Jia Shen (Siberian ginseng)• Blood – E Jiao, dates, He Shou Wu• Body Fluids – Sha Shen, Mai Men Dong, Yu Zhu, Tai Ji Shen, Xi Yang Shen• Essence – seeds (zi)• Marrow – animal (to fill & replenish)• Essence & marrow: Ban Long Wan, Suo Quan Wan. Beneficial herbs: placenta (human), Huang Jing, Jin Ying Zi, Sang Piao Xiao, Yi Zhi Ren, Wu Yao.• Very special: Huang Jing & Shan Yao, both tonify Spleen & Kidney Qi & Yin (perfect for SP yin diabetes) Administration & Mixing Medications ▲

1. Caution should be taken when mixing with chemical drugs – the possibility of increasing or decreasing the effects of the drugs, or creating adverse reactions is possible, monitor patient closely & start with very moderate dosage.2. The same goes for mixing with other complimentary medicines (i.e. homeopathic, vitamins, western herbs, & various other supplements), proceed with caution.3. Do not use too heavy (mineral formulas) or downward moving cold & bitter substances (to guard spleen & stomach) in excessive amounts. If these types of substances are indicated for treatment be sure to add Shan Zha, Ji Nei Jin, & Shan Yao or other herbs which guard & benefit digestion.

4. Processing: consider type of herbal administration, i.e. capsules (easier, convenient, palatable, but tough to digest for some), water pellets (easy, convenient, but also may be difficult for some to digest, i.e. GI cancer patients), powders (poor tasting, very easily absorbed), decoction (the most powerful in strength & easiest absorbed, but generally poor tasting, expensive, & difficult to prepare).5. Dosage: always start small & work your way up to dosage you feel is required ***Always closely observe your elderly patients when administering medication. Infectious Diseases ▲

Pneumonia#1 killer of old peopleAfter 3-4 days of illness be careful – suspect pneumonia1. Fever does not get that high +/- 38 degrees centigrade2. Chest pain/shortness of breath, palpitations & high heart rate (worse than the breathing trouble)3. 1-2 days late can see other organ disease manifestations4. Mental diseases – more common with bedridden patients (poor memory, anger, sadness, crazy) PreventionProtect heart & lungEarly recognition of illness is importantUse of antibiotics imminent with signs in patients around 80 years or more TreatmentIf on antibiotics:• Sheng Mai San• Xiang Sha Liu Jun Zi Tang• Shen Ling Bai Zhu San• Bu Zhong Yi Qi TangIf lots of Phlegm accompanies symptoms:• Dao Tan Tang• San Zi Yang Qing Tang• If Yang deficiency:• Si Ni Tang• Fu Zi Gan Jiang TangIf no antibiotics: treatment needs to tonify and attack.• Cold – Xiao Qing Long Tang

• Heat – Ma Xing Shi Gan Tang If Ma Huang is contraindicated use Zhi Ma Huang or 6-9g Ma Huang with 6g Wu Wei Zi*Sheng Mai San should be used to tonify with either type. Note: When there is Phlegm use blood invigorating herbs also (Tao Ren, Hong Hua, Dan Shen) Cholecystitis ▲

Acute or ChronicMostly GallstonesTypical treatment is to remove Gallbladder completely PreventionLater years it is good to acquire techniques to move gallstones regularlyChai Hu Shu Gan SanXiao Yao San- This is usually due to Liver Qi stagnation i.e. anger, bitterness, resentmentTry including green apples, radishes, olive oils, seaweeds, vinegar, Ji Nei Jin (chicken stomach), Jin Qian Cao, Yin Chen Hao* No spinach with tofu* Limit saturated fat intake* Avoid alcohol Urinary Infections & Prostate problemsFrequent urination with pain, possible backache & feverLin syndrome – usually Lao Lin (deficiency Lin) PreventionSaw Palmetto, cranberry, acupuncture & moxabustion, blueberries, garlic, grapes, dandelion, Uva Ursi, Juniper berries TreatmentUsually antibiotics are administered as normal course of treatmentTCM – tonify Kidney & Spleen• Jin Gui Shen Qi Wan• Liu Wei Di Huang Wan• Zhi Bai Di Huang Wan• add Fu Zi & Gui Zhi to Liu Wei Di Huang Wan for KI Yang deficiency

• Bu Zhong Yi Qi Tang may help urination with Spleen deficiency presentNote:• If no appetite shows this is not a good sign• If appetite is normal but the patient is ematiated this may mean a tumor is present• Basic pattern of a tumor is Spleen & Kidney deficiency Circulatory System Diseases ▲

General - usually chest pain &/or difficult breathing (think Heart first, Lung second)- palpitation &/or ankle Edema = heart- serious fatigue, tired from laying down or just sitting = heart trouble - if these patients move, the lips become purple- dizziness &/or mental symptoms = heart trouble- consider lung cancer comes with heart troubles- generally combines with other systems disease &/or failureAnginaChest pain that radiates to left arm or middle fingerHeart blood vessels spasm (comes & goes)Attacks are usually under 5 minutes, not over 15 minutesIf up to 15 minutes or more = infarctionInfarction = blockageTCM - Basic Pattern is Qi Blood stagnation- which one is more, which one came first, % of each, prescribe a formula that is for Qi & blood stagnation & a formula that treats the root. InfarctionMore heavy & dangerous, especially if pain radiates through to the backThe radiating pain is usually over 15 minutes **Some may happen without pain, or pain in the abdominal regionThe first complaint is usually difficulty breathingTCM basic pattern - blockage patter, too much Yin, no more FireOther signs are perspiration, low blood pressure, pale face, cold hands & feet (Yang collapse) Principle of treatment is to rescue Yang:

Use Fu Zi, Gui Zhi, Hong Hua, Tao Ren to boost Yang & warm King FireRx – Si Ni Tang with Tao Ren, Hong HuaMoxa Du 20, KI 1, Ren 4, 6, 14, 17, ST 36, LI 4Acupuncture PC 6, Du 9, Du 26 1. For 2 weeks the patient must lie in bed & do nothing, within 24-48 hours do not even turn over2. Do not eat for 24 hours, avoid bowel movements (teas, soups, juice)3. After 2 days, a trained person may move the legs of the patient, 3-5 days the patient can move legs & arms, after 10 days the patient may be allowed to walk around the room.Abnormal Heart Rhythms1. too fast >85 – 902. too slow <50 – 553. irregularTCM diagnosis is palpitations (may be anxiety) – slow or fast pulseWM – uses an ECG to diagnoseToo fast = excess Fire or deficiency FireToo slow = deficiency of Yang or Qi stagnation (blood or Phlegm) TCM can treat this well, it also displays fainting, coldness, fatigue, chest distension.*Most abnormal heart beats are deficiencyRx – Gui Pi Tang + modifications - Hei Gui Pi Tang - Gui Pi Tang + Dan ShenRx – Sheng Mai SanSlow Beat try Rx – Ma Huang Fu Zi Xi Xin Tang (Yang deficiency, Wind/Cold with Yang deficiency)Heart FailureSwelling of anklesDifficult breathing (especially at night) -when lie flat breathing is worse (this is an early symptom of heart failure)May have insomnia, irritability, dizzinessWestern medicine says:If left heart fails = difficult breathingIf right heart fails = ankle swellingTCM – basic patterns1. Heart, Kidney, &/or Lung Yang deficiency - water retention or Phlegm-fluids retention -Rx – Zhen Wu Tang + HT LU modifications

- Rx – Jin Gui Shen Qi Wan (KI), Huang Qi can go up to 30-60 g**Don’t promote water circulation too strongly until heart function has been restored - i.e. Rx – Wu Ling San (gentle)Typical to use herbs such as Fu Zi, Gan Jiang2. Blood StasisHypertensionIt is normal for blood pressure to rise after a person reaches +/- 60 years old• 60 – 135/88• 65 – 140/88• 70 – 145/90• 75 – 150/92• 80 – 160/95• 85 – 165/98*Do not try to reduce high blood pressure too much or too quickly, this may lead to embolisms & strokesLook for family & personal history - If the family shows similarities the situation is not as criticalWhat other diseases could be present?TCM – Basic patterns1. Liver rising (most common, 70% of all cases)2. Lung cannot go down (this is most typical for seniors)Make sure bowel movements are normal, this will lower blood pressureConstipation can lead to strokes & high blood pressureMeditation, Tai Ji, Qi gong, breathing exercises are great for high blood pressureDiet – avoid alcohol or use medicated alcohols, lower salt intake Respiratory System Diseases ▲

GeneralShortness of breath, cough with PhlegmWhen there is chest pain, think about heart first – lung secondWhen signs & symptoms show of lung cancer, the cancer has already metastasized to other organs Chronic BronchitisWhen have treated cough for 3 months & there is no alleviation – think lung cancer

-this is usually a dry cough with phlegm that is difficult to cough out, when it is accompanied by chest pain the possibilities of it being a large tumor are goodBronchitis particularly has cough with phlegm, wheezing if the coughing is copious, can also occur with asthmaWhen you have asthma it is easy to get bronchitis, not the other way around Principle of treatment – descend lung Qi – moisten or eliminate phlegm depending on cough, boost immune system, strengthen & protect Lung & SpleenTCM Basic pattern – Lung & Spleen deficiencyMay also get Blood Stasis (if shows purple tongue) – use blood invigoratorsTreatment – Spleen produces Qi, Lung controls Qi, Kidneys receive Qi Rx – Sheng Mai San (LU HT Qi & Yin) - Yu Ping Feng San (LU Qi) - Fu zi Li Zong Tang (SP Yang) - Shen Ling Bai Zhu San (SP Damp) - Bu Zhong Yi Qi Tang (SP LR) - Xiang Sha Liu Jun Zi Tang (SP ST) - Liu Wei Di Huang Wan (KI Yin) *If you have chronic respiratory problems it is bad to Edema &/or diarrhea - if see diarrhea or Edema = Pulmonary Heart Disease - Lung Yang deficiency upper, Kidney Spleen Yang deficiency lower - Rx – Zhen Wu TangLung Yang deficiency - water in upper part of body (tan yin – Phlegm-fluids) - usually with Heart Yang deficiency Rx – Zhen Wu Tang (Fu Zi, Gan Jiang, Bai Zhu) - Si Ni Tang + Ling Gui Zhu Gan TangSpleen Yang deficiency - usually with Kidney or Heart Yang deficiency - King & Minister Fire warms SpleenRx – Fu Zi Li Zhong Tang - with Gui Zhi or Rou Gui = Fu Gui Li Zhong TangLiver Yang deficiency - must be pain along the meridian - usually with Kidney Yang deficiency Rx – Wu Zhu Yu Tang - Dang Gui Si Ni Tang (blood Bi) - Fu Gui Di Huang WanNote: Asthma – early there is usually constipation - late there is usually diarrhea

EmphysemaTCM basic pattern – Yang deficiency with Phlegm-fluids4 types of Phlegm-fluids: whole body, chest, abdomen, hypochondria - this is a more moveable liquid, moves with body positionsWater: usually starts at ankles (yin type) then creeps up (Spleen Kidney) - if this happens when a malignant tumor is present, the end is near EarlyRx – Xiao Qing Long Tang + Jin Gui Shen Qi WanChronicRx – Yang He Tang + Ling Gui Zhu Gan TangModifications: Cold-Phlegm with deficiency - San Zi Yang Qin TangKidney Yang deficiency with Phlegm – Tu Si Zi (heavy low back, turbid urine)Spleen deficiency – use Spleen tonicsPurple tongue – Dang Shen, E Zhu, Tao Ren, Hong Hua, Tian Qi (San Qi)Auto-neumothorax – shortness of breath, pain, slight dry coughRx – 1. Jia Wei Xiang Shu San 2. Ting Li Da Huang Tang -Ting Li Zi 15-30g -Da Huang 10-30g -Sang Bai Pi 10-15g -Hou Po 10-15g -Zi Si 10-15g -Jie Geng 15-18g -Da Zao 5-10 piecesIf Phlegm (white) + Qiu Jie Zi 10-15g “ “ (yellow) + Gua Lou Ren 10-15gIf Chest pain + Gui Zhi 2-6g*Decoct package & drink 4 times/day, every 4 hours -may use more packages in first couple days 3. Bai He Gu Jin Tang20-25% of patients with Emphysema connects with GI ulcersCan also easily acquire bronchitis or pneumoniaConclusion:When patient has chest pain… 1. Heart 2. Lung Cancer 3. Lung Infection(with young people this order is opposite)

Digestive System Diseases ▲

UlcersQuickly may become bleedingCreate dark tarry stoolRx – Chai Hu Shi Gan San - Bu Zhong Yi Qi Tang - modify with stop bleeding herbsPain may not be first complaint in the elderly because of the array of other disease with itWhen ulcer breaks it may infect the intestines (Emergency) - the abdomen gets hard & painful - peristalsis/abdominal sounds are almost non-existent (normally there are 1-2/minute)Pain Rx – Shao Yao Gan Cao Tang - also use Qi blood tonics, stop bleeding, & detoxifying herbs until can be operated onMay not know they have ulcers, figure it out after bloody bowel movementsAdvise to observe stool regularlyToilet bowl will have dark red blood in the toiletTCM – basic patternSpleen Qi deficiency, Stomach Yin deficiency with Liver attack.*Look at big & 2nd toe nails (spleen, stomach, liver)Rx – An Wei San (Ji Dan Ke – egg shell) -bake shells until turn yellow brown -grind until powder -take 3-7 days/day -can stop pain for more than 2 hoursHai Piao Xiao, Tian Qi (single herbs)Acupuncture – back Shu (wei, dan, gan, pi, etc)Chronic GastritisChronic gastrointestinal infectionTCM – basic patterns1. Wood attack Earth – pain with emotions Rx – Xiao Yao San (Liver – Spleen) - Xiao Chai Hu Tang (Gallbladder – Stomach) - Da Chai Hu Tang (Liver Gallbladder troubles)2. Earth insult Wood – can have jaundice, hepatitis, etc. Rx – Yin Chen Hao Tang (Damp/Heat) - Lian Po Yin - San Ren Tang - Yin Chen Si Ni Tang (Damp/Cold)

- either a lot of Damp or weak wood can cause this3. Spleen Stomach disharmony – rebel Qi Rx – Xiang Sha Liu Jun Zi Tang*For Spleen Stomach excess/deficiency, Heat Cold mixed patterns: Rx – …Xie Xin Tang - Ban Xia… - Gan Cao… - Sheng Jiang…It is Quite common to have Blood Stasis when Liver Spleen Stomach are involved Rx – Ge Xia Zhu Yu Tang - Shao Fu Zhu Yu Tang - Xue Fu Zhu Yu Tang - Dan Shen Yin*Long term chronic pain always has Blood Stasis: - Wu /gong (centipede), Tu Bei Chong (cockroach), Quan Xie (scorpion)Treating ulcers can greatly reduce the chances of developing Stomach cancer. Intestinal ObstructionExtremely painful – EmergencyRx – Da Cheng Qi Tang, Xiao Cheng Qi Tang, Da Huang, Fan Xie Ye, Lu Hui - from Cold, Heat, material block, almost anything can cause itConstipationCan lead to strokes & high blood pressureCan be from so many causesSeniors are mostly from deficiencyMake diagnosis differentiation & treat accordingly - flax oil can helpHemorrhoidsInternal or externalIf burning & bleeding – toxicTCM – basic patternsLarge Intestine & Lung Qi deficiency (root)Damp/Heat in Large Intestine (branch)Coordinate with surgery & yoga, Qigong, meditationTry – Huang Qi, Dang Shen, external washes*Quite often are caused from constipationColon Cancer# 2 cancer that kills males in CanadaPeople often think it is hemorrhoids because of pain & bleedingEmaciation for 2-6 months

Pain in chest*Form of stool may change, i.e. line in it from the tumor*Recommend if think have hemorrhoids check for cancerFatty LiverTurbid Phlegm in blood vesselsHave fatigue, abdominal bloating & fullness, numb pain in the hypochondriumRx – Zi Xie 30g He Shou Wu 15g Huang Jing 15g Dan Shen 15g Cao Jue Ming 15g Shan Zha 30g Hu Jiang 15g He Ye 15gTake for 4 months, 1 day – 1 package Rx - Chai Hu 30g Huang Qi 30g Dan Shen 30gYin Chen Hao 30g Dang Gui 15gJi Xue Tan 15gBai Zhu 10gNiu Xi 10gZi Xie 10gShan Zha 10gGou Qi Zi 10gYin Yang Huo (Xian Ling Pi) 10gZi Ke (cao) 10gQing Pi 10gDa Huang 10g (if constipation decoct late, if not it will invigorate blood)Modifications: Quan Lian Zi Yan Hu Suo Yue Jing (phlegm) Zao Qi (phlegm) Lai Fu Zi (phlegm)- take for 4 months – 75% curative effects (+/-) Urogenital Systems Diseases ▲

Glomerular NephritisAcute or Chronic

Western physiological Kidney = TCM Bladder &/or SanJiaoPathology – Basic patternsChronic – western Kidney pathology = TCM Kidney or Spleen Yang deficiency (Yin edema)Acute – western Kidney pathology = TCM bladder &/or San Jiao, Lin Zheng, Yang edema (wind water)Yang Edema – Face (wind water)Yin Edema – start at ankles & works way upwardsMisc.Elderly blood vessels become harder, they show more Kidney hypertension therefore you must restore proper Kidney functioning to treat hypertension. Most drugs have trouble controlling this type.Drugs & herbs effect the Liver & Kidney in the elderly, these organs functions are already low.When Kidney function is low, mineral & electrolyte balances may be lost (Na+, Ca++, K+, Zn, Fe++, Cu++)*Do not use heavy mineral herbs for too long (Huang Qi contains zinc, Dang Gui contains copper, just examples, these are not heavy mineral herbs) Treatment Acute – RxMa Huang Lian QiaoBa Zheng SanWu Ling SanYue Pi TangWu Wei Xiao Du Yin + Yin Qiao SanHerbs – corn silk (Yu Mi Xu), Dan Zhu YeChronic1. Set up group Rx, a) branch – heat, cold, toxicity, smelly urine, etc, b) root – Kidney Spleen Yang deficiency, Lung Yang deficiency, Spleen Qi deficiency, Kidney Essence deficiency, etc, c) Phelgm or Kidney Blood Stasis (leech – Shui Zi, cockroach – Zhe Chong)2. Must coordinate with diet – less salt, no shellfish or strange fish, if eat fish consume Zi Su Ye, avoid parsley, avoid lobster. 3. Exercise – not too physical – Qigong, Yoga etc.*Patients with Kidney troubles usually are on some type of cortisone – this can cause kidney Yin deficiency, or sometimes Spleen Qi deficiency over long periods of use.Renal FailureGeneralLess than 400ml of urine in 24 hours = kidney function failureOver 1000ml in 24 hours may also mean that kidney is failing*Loss not equaling fluid intake (liquid in liquid out should be equal)

Nervous System Disorders ▲

General*All systems are already in declineIs person sick or is system just slowing down? (May be both, pathology follows physiological decline)May be mental or physicalNervous system disorders are serious with rapid onset & developmentWhen the elderly show signs, the disease is already in mid to late stages*Very easily associates with other systems disease StrokeThere are two very serious diseases to prevent in the elderly, heart attacks & strokesThere are 2 types of strokes:1. Blockage – blood stasis, phlegm (embolism), happens more at night2. Hemorrhagic – aneurysm, happens during activity i.e. difficult bowel movements or physical activity, may or may not have a headache, associated with hypertension. Western Medicine uses CT scans or CSF tests to determine stroke type.TCM – basic patternsClosed – blockage (phlegm/stasis) – Huang Qi, Dan ShenOpen – loss/collapse of Yin/Yang – calm Liver herbs*Both may show Heat or Cold*Both may associate with Phlegm*Both may have paralysisNeed to know hot or cold (Yin or Yang deficiency) – treat according to pattern + herbs below…Herbs for stroke (either) – Tao Ren, Hong Hua, Dan Shen, Tian Qi, Dang Gui, Chuan Xiong - move blood & stop bleedingAcupunctureOpen – tonify, do not use Jing-well pointsClosed – use Jing-wellBoth – Du 26, Du 20, moxa Post-stroke – TCM can treat well (sooner the better), acupuncture (scalp with electro), formulas, meditationAfter 1 year it becomes quite difficult to treat..

PreventionKeep regular bowel movements +/- 1/day, treat constipationKeep blood pressure balanced, too high or too low can cause strokeIf at risk, be careful in hot tubs, 45 minutes to 1 hour is too long When over 75, the main complain among the elderly is dizziness (blood deficiency, Wind, Phlegm)These are the same pathogenic influences that can cause stroke -Liver Kidney Yin deficiency creates Wind & causes stroke -External Wind causes stroke -Severe blood deficiency creates Wind & causes stroke Top 3 complaints that may point to the possibility of Stroke 1. Dizziness 2. Headache 3. Numbness***Ask the elderly about these things first during a visit. Also inquire about palpitations, shortness of breath, & chest pain.Middle aged people complain in the reverse order – numbness & headache first. Senile Dimentia2 types:1. trouble with blood vessels in the brain2. Mixed with other disease(s)A third that must be considered is Alzheimer’s.Will see personality changes, & loss of cognitive skills.TCM – basic patternsKidney deficiency (Qi, Yin, Yang, Essence, marrow) + Phlegm (invisible heart, kidney gallbladder) - may also have some Blood StasisCNS – half heart/half kidney PhlegmHerbs• Physical Heart – Gua Lou (heat phlegm), Xie Bai (cold phlegm)• Mental Heart – Shi Chang Pu (heart phlegm), Yuan Zhi (heart phlegm)• Physical & Mental Heart – Seng Long Gu & Mu Li (heart phlegm)• Kidney Phlegm – Tu Si Zi, Yi Zhi Ren, Bu Gu Zhi, Du Zhong, Jin Ying Zi, Fu Pen Zi• Kidney Marrow – Lu Rong, Sea Horse, beef, animal

Rx• Sang Piao Xiao San (heart kidney Essence deficiency & leakage)• Di Huang Yin Zi (marrow, Phlegm, Wind)• Jin Suo Gu Jin Wan (male Essence/sexual tonic)• Wu Zi Yuan Zhong Wan (Kidney Essence tonic)• Ban Long Wan (Kidney Essence tonic)• Tu Si Zi Wan (Kidney Essence tonic)• Quan Lu Wan (Kidney Essence tonic)*All stages of Kidney decline can lead to Phlegm & WindIn order:• Kidney Qi – frequent urination• Kidney Yang – coldness• Kidney Yin – sleep during day, not at night• Kidney Essence – memory• Kidney Marrow – tremors *When Kidney & Liver are deficient, there is not enough water to nourish wood, this may cause the Liver Qi to rise causing Wind.*When tonifying the Kidneys, one should consider the need to keep the Spleen & Stomach strong. Wei Qi Brain Disease -Marrow Bi Zheng Sydenhans DiseaseBi Zheng Parkinsons -Essence, Marrow, Yin deficiency with wind either wind or blood stasis. We must clear wind to treat Dai Zheng Senile Dementia -Kidney deficiency with phlegm Dai Zheng Alzheimers -Kidney deficiency with phlegm Dai Zheng Vascular Dementia -Kidney deficiency with blood stasis Dai Zheng = mental disease (memory)Treatment and Prevention Tonify Kidney move the phlegm and stasis and detoxify *DETOXIFY TOXIC HEAT – Huang Lian Jie Du TangTurbid Phlegm blocking Orifice Wen Dan TangBlood stasis blocking orifice Tong Xiao Hou xie Tang Herbs – Xie Xiang, Chong BaiLiver blood deficiency with Qi stagnation Xiao Yao San with Gan Mai Da Zao Tang

Heart and Spleen deficiency Gui Pi TangLiver and Kidney deficiency Liu Wei Di Huang TangHeadaches – nervous system disease Animal herbs for chronic headaches – top 3 Scorpion – Quan Xie Centipede – Wu Gong Cockroach –Tu Bei Chong Wind Cold Headache -Xi Xin, Man Jing Zi Wind Heat Headache - Gao Ben, Xuan Shen Liver Fire or Wind Headache -Long Dan Xie Gan Tang -Chai Hu Shi Gan Tang Qi or Blood Deficiency - Bu Zhong Yi Qi Tang -Xue Fu Zhu Yu Tang *Brain TUMOR – Tian Nan Xing Metabolic & Endocrine System Disorders▲

GeneralBoth metabolic & endocrine disorders quite often mix with each other, i.e. obesity, diabetes, high cholesterol. It is always associated with weight change (either gain or loss).DiabetesTCM – basic pattern Spleen Yin deficiencyMay also be Liver Kidney Yin deficiency, or Spleen Kidney Qi & Yin deficiencyIn the elderly, the normal excess urine, thirst, and hunger gives way to fatigue being the most prominent symptom.Recommend getting fasting blood sugar tested yearly, cancer may also effect blood sugar levels (tumor feeds off sugar)Lower leg pain & numbness may be present in diabetes & cancerFind out % of mental & physical fatigue*Spleen controls 4 limbs: may show desensitizing *Vision problem may arise*Low Xiao Ke (KI) - Urinary excess or difficulty, constipation *Upper Xiao Ke (LU dryness) – palpitations, can have skin disorders, itchiness - be cautious of itchiness, may also indicate cancer Treatment

Diet – keep blood sugar in acceptable range, try Dong Gua Pi (winter melon), cucumber, bitter melon (Ku Gua), Guava is good for diarrhea, Shan Yao, Huang Jing, Huang Qi, Wu Wei Zi, cranberry, blueberry, mulberry, Xi Yang Shen*Use caution when giving acupuncture, diabetes patients are highly susceptible to infection - remember that Qi & Yin deficiency are hard to treat with acupuncture*Use caution when treating Yin deficiency with Moxa- Acupressure is very beneficial*Use caution when sitting in the sun, do not stay exposed very long, especially feet*Watch sores that do not heal If diabetes runs in the family, check blood sugar regularlyPrevention & treatment- Liu Wei Di Huang Wan w/ Sheng Mai San- Sha Shen Mai Men Dong TangMix with Xue Fu Zhu Yu Tang to promote circulationconstipation – Zeng Ye Tang, Ma Zi Ren Wanloose stools – tonify Spleen*When mixing Rx’s – use mother/son relationships, should be taken at separate times***The obesity associated with diabetes comes from the use of insulin.HyperlipidermaHigh cholesterolPrimary cause is geneticSecondary causes are usually from other diseases & drugs, i.e. birth controlSymptoms – high blood pressure, dizziness, headaches, molesTCM – basic pattern, turbid Phlegm in blood (Liver), or inside blood vessels (Heart)Many factors cause PhlegmGenerally caused by deficiency (Liver Kidney, Spleen Stomach)Phlegm in blood = Stasis (Blood/Phlegm)Tongue Quite often shows purple (stasis)Recommend every 1-2 years that patient checks cholesterol levelsTreatment1. eliminate Phlegm, move Stasis2. tonify deficiency Rx - Xue Fu Zhu Yu TangDao Tan Tang/Wen Dan TangSi Jun Zi Tang

Herbs – Ze Xie, He Shou Wu, Shan Zha (hawthorn), leech, Huang Jing, Pu Huang (cattail pollen), San Qi (tian Qi), Yi Yi Ren, He Ye (lotus leaf)Diet – do not eat too many animal organ, not too much peanut butter, not too may nuts, more mushrooms, sesame, Sang Shen Zi, Hai Zao, Kun Bu (seaweeds) Obesity Do not try to lose weight too fastTCM – basic pattern, deficiency (differentiate)Treatment – tonify + invigorate water metabolismFemale usually is due to Spleen deficiency, hips & low Jiao gain weight - this leaves them quite susceptible to Heart diseaseMale obesity is usually due to Kidney deficiency, beer belly growsWalk, Qigong, Yoga, Meditation, Tai Ji Thyroid DiseaseCan be hyper or hypoIn the elderly there is more HypothyroidismWatch for… 1. mental symptoms include depression & fatigue 2. coldness (out of the ordinary) 3. may show obesity/swelling 4. Vision/auditory reduction*test for this every 2-3 yearsTCM – basic pattern, Spleen Kidney Yang deficiency Western Medicine (prescription) for thyroid in the elderly is easy to effect physical HeartTreatment – treat deficiency, tonify Spleen Kidney Yang Qi Formulas & acupuncture work quite wellDiet – tough to treat through diet, try seaweeds Thyroid patients are easy to depressionDepression patients are easy to get thyroid problems - then they get overweight, this causes depression & the thyroid condition to get worseNote: anything that works in a cycle is related to Liver. Hemotopoietic System Disorders ▲

AnemiaHemoglobin deficiency

TCM – basic pattern, after 65 is normally due to Kidney deficiencyMost common in the elderly:- Blood & Yin deficiency, i.e. Yi Guan Jian, Liu Wei Di Huang Wan, Gou Qi Zi, Ju Hua- Blood/Essence/Marrow deficiency, i.e. Qi Bao Mai Yin Dan, He Shou Wu, Sang Shen Zi, Shu Di Huang, Gou Qi Zi1. Blood deficiency (can happen with Blood Stasis)2. Qi3. Body Fluids – Jin Ye (Heart)4. Yin deficiency (Liver Heart)5. Essence/Marrow (Kidney) - use animal to treat Western Medicine – bone marrow produces blood, 1. blood deficiency 2. body fluid deficiency TreatmentEssence/blood – He Shou Wu, Shi Di Huang, Gou Qi Zi, Sang Shen ZiRx – Qi Bao Mai Yin DanQi/Blood deficiency – Rx – Gui Pi Tang, Ba Zhen Tang, Ren Shen Yang Ying Tang, Si Wu TangBlood/Body Fluid deficiency – Rx – Sha Shen Mai Men Dong Tang, Si Wu TangDiet – red dates, unripe papaya with fish, Gou Qi Zi & red date (papaya is very high in protein, it is good for gynecology uses, headaches, any pain associated with Liver), Shan Yao Platelet deficiencyVery difficult for western medicine to treat, TCM can treat wellTCM – basic pattern, Spleen deficiency (unable to keep blood in vessels), Lung blood deficiency*People that are easy to bruising may have platelet deficiencyTreatmentRx – Gui Pi Tang, Bu Fei E Jiao Tang, Kidney Spleen tonics (add herbs to warm or cool blood, stop bleeding, promote circulation, tonify blood White Blood Cell deficiency• Rx – Bu Zhong Yi Qi Tang (add herbs, never subtract from this formula)• Herbs – Tu Si Zi, Yin Yan Huo, Wu Jia Pi White & Red Blood Cell Deficiency• Ji Xue Tang (chicken blood) 30-60g

• Lu Rong (deer antler) - Essence, Lu Jiao Jiao (deer antler glue), Lu Jiao Xiong (ash) – Bi syndrome• Gui Ban Jiao (turtle shell glue) Motor System Disorders ▲

Separate A & BA: Kidney deficiency (i.e. osteo), also Bi Zheng without pathogenic factorP/T - TonifyB: Bi Zheng (Wind/Cold/Damp – arthritis), pathogenic factors involvedP/T – Expel & Tonify Common syndromes• Retrograde Spondylitis – (A), usually in males, Kidney deficiency• Seniors Arthralgia – (A) &/or (B)• Seniors Osteoporosis – (A)• Hip Arthopathy – (A), Spleen corresponds to hip TreatmentTonify Kidney (Du Zhong, Sang Ji Sheng)*When tonifying Kidney Essence &/or Marrow, one must tonify Qi & bloodPromote blood circulation (Dang Shen, Hong Hua) #1 – hip fractures#2 – ankle fractures Herbs for pain:• Ge Gen – neck/upper back• Sang Zhi – elbow/wrist• Fang Ji – lower leg/knees• Shi Hu – hips• Jiang Huang – shoulders• Niu Xi – ankles• Du Zhong – low back• Gou Ji – mid/low back• Wei Ling Xian – whole body (tendons)• Qin Jiao – whole body (muscles)• Hai Tong Pi – whole body (skin/muscles)• Bu Gu Zhi – whole body (bones)• Gu Sui Bu – whole body (bones)

• Xu Duan – whole body (bones)Chronic pain:• Quan Xie (scorpion) – nerve pain• Wu Gong (centipede) – spinal pain• Di Long (earthworm) – muscle pain• Jiang Can (sick silkworm) – muscle pain• Tu Bei Chong (cockroach) – muscle pain *more pain = more Liver*tablets or capsules are preferred (must take long term) PreventionDry brush painful area dailyDiet 1. slow calcium loss (more vitamin D, Mg, P, Cu, Zn) - consume less coffee, alcohol, sugar2. get more calcium (bone soup, almonds, tofu, soymilk, dairy, sardines, spirulinaExerciseYoga (softball), swim, walk, Tai Ji, Qi gong, dancing, meditation Dermatological Disorders▲

General1. Changes in the functioning of the Endocrine systemTCM – basic pattern – deficiency2. May indicate internal diseases (think cancer first, diabetes second, then others) CausesVital Qi deficiency1. Blood deficiency Rx• Gui Pi Tang• Ba Zhen Tang• Si Wu Tang2. Yin deficiency drynessRx – combo both these & blood deficiency formulas with Qi tonics3. Mixed4. drug toxicity (mostly in blood – Spleen, Liver, Heart)• Zi Cao, Jin Yin Hua, Pu Gong Ying, Mu Dan Pi, Xuan Shen, Lian Qiao (floating minister fire), Lian Zi XinRx

• Si Ni San• Xie Huang San• Xie Bai San• Xiao Chai Hu Tang• Dan Zhi Xiao Yao San• Yu Jue WanWartsTCM basic pattern – Phlegm & blood deficiencyRx – Tao Hong Si Wu Tang - Xiao Feng San 1. Heat in Qi & Xue level – upper Jiao deficient Heat - drugs usually cause heat in the upper Jiao - Rx – Liang Xue Si Wu Tang + Zi Cao, Bai Xian Pi, Tu Fu Ling (detox herbs) + Find root & treat2. Spleen Stomach deficiency3. Liver Kidney deficiency ItchinessRx – Liang Xue Qu Feng Tang• Sheng Di – 30g• Bai Xian Pi – 15g• Xuan Shen – 15g• Ku Shen – 15g• Jin Yin Hua – 15g• Lian Qiao – 15g• Mu Dan Pi – 12g• Chi Shao Yao – 12g• Di Fu Zi – 12g• Zi Cao – 10g• Jing Jie – 10g• Fang Feng – 10g• Sheng Ma – 6g• Bo He – 6g• Gan Cao – 6g• Chan Tui – 3gRx – Ba Zhen Tangexternal – She Chuang Zi Liver SpotsUse the inside of very ripe banana peel (the white part), put on spots every night for a few weeks to a few months, works quite well.Tonify Liver Kidney blood & Yin

Ophthalmopathy ▲

Do eye massage & ocular exercisesHerbs & beneficial foods:Rx – Qi Ju Di Huang Wan, Shi Hu Ye Guang WanJue Ming Zi, Gou Qi Zi, Ju Hua, carrots, fish oils, liver, vitamin A & E, chromium, copper, oyster, clam, mussels Eye InfectionsPu Gong Ying (dandelion) in large dosesAlso try saline solution &/or fresh white grape juice as eye drops Genital Disorders ▲

Rx - Er Xian Tang (andro & menopause) - with You Gui Wan, Zou Gui Wan, Liu Wei Di Huang Wan, Yi Guan Jian according to needs- Yin Yang Huo & Rou Chong Rong (Chinese viagra/sildenafil)*Kidney deficiency (mental symptoms, endocrine/hormonal changes)Males may also show hot flashes, depression, have affairs, change thought patterns, etc. Senile Vaginal DrynessInternal – tonify Liver Kidney (Essence/Marrow)External – creamsDiet – seafood (oysters), beans, dry nuts, walnuts, tofu (estrogen) Senile Psychosis ▲

Mental symptoms: may come from mental &/or physical causes (%?)Symptoms may connect with brain or CNS disordersMental symptoms decline with organ declineTCM basic patterns – Kidney deficiency + Phlegm + Blood Stasis Rx – Wen Dan Tang + tonics - Dao Tan Tang + tonics, Di Tan Tang + tonicsPhlegm herbs: Shi Chang Pu, Yuan Zhi, Tian Zhu Huang, Yu Jin, Fu Shen, Long Gu (all herbs above are for Heart Phlegm)

Gan Song, Pei Lan (Spleen), Bai Jie Zi (Gallbladder), Nu Li, Xia Ku Cao, Tian Tia (liver), Tu Si Zi, Yi Zhi Ren (Kidney)Blood Stasis herbs: in Liver mostly – Dan Shen, Tao Ren, Hong Hua, Shan Zha, Da Huang, Si Wu Wen Dan Tang, Tao Hong Si Wu Tang (+ Xiang Pu, Ru Xiang, Zhi Ke), Xue Fu Zhu Yu Tang TreatmentMania: sedate – Du 14,26, 16, Ren 15, SI 3, PC 8 to LI 4, PC 5 to SJ 6, LR 3 to KI 1Depression: Ren 16, 17, Du 24, PC 7, ST 40, PC 8, KI 1, LR stagnation – Du 26, yintang (electro)Delusion: Ren 12, 17, HT 7, SP 6, PC 6, tonify SP 4Insomnia: self massage, coordinate Heart & Kidney – HT 7, KI 1. - Suan Zao Ren 15-30g + Mai Dong 9g + Wu Wei Zi 5g (Qi & Yin deficiency) - Suan Zao Ren 15-30g + Sheng Di 12g + Wu Wei Zi 5g (HT & KI disharmony) - Suan Zao Ren 15-30g + Ban Xia 9g + Wu Wei Zi 5g (HT Qi deficiency & Phlegm) - Wen Dan Tang + Huang Lian (heat) - Wen Dan Tang + Suan Zao Ren Tang (heat) - Gui Pi Tang + Huang Lian + Suan Zao Ren Tang (heat) - Dan Zhi Xiao Yao San (heat) - Hei Xiao Yao San (heat) - Tian Wang Bu Xin Dan (HT heat) - Xue Fu Zhu Yu Tang - Jiao Tai Wan (HT KI communication, Huang Lian/Rou Gui)Herbs: Bai He, Lian Zi, He Huan Hua, Ye Jiao Teng