TCVM Approach to Megacolon and Megaesophagus

TCVM Approach to TCVM Approach to Megacolon and Megacolon and MegaesophagusMegaesophagus

““ Mega-” IntroductionMega-” Introduction

• If normal directional motion is If normal directional motion is inhibited in a tubular organinhibited in a tubular organ

• A type of Qi DeficiencyA type of Qi Deficiency

• May be a congenital disharmonyMay be a congenital disharmony• Yang Jing Deficiency if associated with Yang Jing Deficiency if associated with

other signs of Yang Deficiencyother signs of Yang Deficiency• Yin Jing Deficiency if associated with Yin Jing Deficiency if associated with

other signs of Yin Deficiencyother signs of Yin Deficiency


• ““Directional” or propulsive Qi DeficiencyDirectional” or propulsive Qi Deficiency• May be acquiredMay be acquired

• Exogenous Pernicious influencesExogenous Pernicious influences• E.g. distemper virus, trauma, toxins, poor quality E.g. distemper virus, trauma, toxins, poor quality

foods for that species or individual constitutionfoods for that species or individual constitution

• Endogenous Pernicious influencesEndogenous Pernicious influences• E.g. hypothyroidism, systemic lupus erythematosus, E.g. hypothyroidism, systemic lupus erythematosus,

hypoadrenocorticism, myasthenia gravishypoadrenocorticism, myasthenia gravis• Remember that “sthenia” means “full” or “excess”Remember that “sthenia” means “full” or “excess”

• ““asthenia” means “empty” or “weak” or “deficient”asthenia” means “empty” or “weak” or “deficient”


• ““Directional” Qi DeficiencyDirectional” Qi Deficiency• May be associated with concurrent May be associated with concurrent

Blood or Yin DeficiencyBlood or Yin Deficiency• Subsequent Dryness fails to lubricate Subsequent Dryness fails to lubricate

either ingesta or feceseither ingesta or feces• Megaesophagus swallowing inhibitedMegaesophagus swallowing inhibited

• Regurgitate dry ingestaRegurgitate dry ingesta

• Megacolon defecation inhibitedMegacolon defecation inhibited• ““Cannot float the boat in a dry river”Cannot float the boat in a dry river”

Megaesophagus and Megacolon: Megaesophagus and Megacolon: Types of Wei Syndromes?Types of Wei Syndromes?

• Wei means “withered” in Chinese to Wei means “withered” in Chinese to describe the withering of musclesdescribe the withering of muscles

• Classical Wei or Atrophy Syndrome is a Classical Wei or Atrophy Syndrome is a condition characterized by a weakness of condition characterized by a weakness of the four limbs, progressively leading to the four limbs, progressively leading to atrophy, a limp state of muscles and atrophy, a limp state of muscles and tendons, an inability to walk properly and tendons, an inability to walk properly and eventually paralysiseventually paralysis

• This weakness generally occurs without This weakness generally occurs without pain pain

• So are these “Megas” localized Wei?So are these “Megas” localized Wei?

Wei Syndrome Pattern Wei Syndrome Pattern DifferentiationDifferentiation

• Heat in the Lungs injuring Yin fluids- Heat in the Lungs injuring Yin fluids- ExcessExcess

• Invasion of Damp-Heat- Excess Invasion of Damp-Heat- Excess • Invasion of Cold-Dampness- ExcessInvasion of Cold-Dampness- Excess• Stomach and Spleen deficiency- DeficiencyStomach and Spleen deficiency- Deficiency• Spleen and Heart collapse- DeficiencySpleen and Heart collapse- Deficiency• Liver and Kidney deficiency- DeficiencyLiver and Kidney deficiency- Deficiency• Blood Stasis in the channels- Combination Blood Stasis in the channels- Combination

of Excess and Deficiencyof Excess and Deficiency

Relationship Between Pattern Relationship Between Pattern and Pathoetiologyand Pathoetiology

• Wind-Heat causes only Lung-Heat injuring Yin Wind-Heat causes only Lung-Heat injuring Yin fluidsfluids

• External Dampness leads to Damp-Heat or Cold-External Dampness leads to Damp-Heat or Cold-DampnessDampness

• Irregular Diet causes the patterns of Damp-Heat, Irregular Diet causes the patterns of Damp-Heat, Cold-Dampness and Stomach-Spleen deficiencyCold-Dampness and Stomach-Spleen deficiency

• Excessive sex and overwork cause the patterns of Excessive sex and overwork cause the patterns of Kidney-Liver deficiency and Blood stasis in the Kidney-Liver deficiency and Blood stasis in the channelschannels

• Trauma causes the pattern of Blood stasis in the Trauma causes the pattern of Blood stasis in the channelschannels

• Shock leads to the pattern of Heart-Spleen Shock leads to the pattern of Heart-Spleen collapsecollapse

““ Mega-” Primary treatment Mega-” Primary treatment principlesprinciples

• Tonify global and local QiTonify global and local Qi• Assist directional Qi FlowAssist directional Qi Flow

• Increase MoistureIncrease Moisture• Tonify YinTonify Yin• Increase Body FluidsIncrease Body Fluids

• Nourish BloodNourish Blood

• Invigorate BloodInvigorate Blood

Megaesophagus: Pattern Megaesophagus: Pattern DifferentiationDifferentiation

• Qi DeficiencyQi Deficiency or or Yang DeficiencyYang Deficiency • may be seen with hypothyroidism, systemic lupus may be seen with hypothyroidism, systemic lupus

erythematosus, hypoadrenocorticism, myasthenia erythematosus, hypoadrenocorticism, myasthenia gravis, poor quality foods for that species or gravis, poor quality foods for that species or individual constitutionindividual constitution

• Blood DeficiencyBlood Deficiency +/- +/- Blood StagnationBlood Stagnation • may be seen with trauma, toxins, poor quality foods may be seen with trauma, toxins, poor quality foods

for that species or individual constitutionfor that species or individual constitution

• Heat PatternsHeat Patterns • may be seen with distemper infection or other febrile may be seen with distemper infection or other febrile

diseasesdiseases

Megaesophagus TreatmentMegaesophagus Treatment

• Physical assistance with raised Physical assistance with raised feeding station and soft, highly feeding station and soft, highly digestible foodsdigestible foods• Suggest slow-cooked foods based upon Suggest slow-cooked foods based upon

Bian Zheng (see following lecture)Bian Zheng (see following lecture)

• Acupuncture based upon global and Acupuncture based upon global and local Patternslocal Patterns

• Herbal Formula based upon global Herbal Formula based upon global and local Patternsand local Patterns

Megaesophagus: Qi DeficiencyMegaesophagus: Qi Deficiency

• Clinical SignsClinical Signs• Fatigue, weight loss, muscle mass loss, Fatigue, weight loss, muscle mass loss,

decreased/depressed back Shu pointsdecreased/depressed back Shu points

• TongueTongue• Pale, moistPale, moist

• PulsePulse• Feeble, especially middle and upper jiaoFeeble, especially middle and upper jiao


• Acupuncture: Use electro-AP!!Acupuncture: Use electro-AP!!• PC 6 master of the chestPC 6 master of the chest• CV 17 front Mu of the upper Sea of QiCV 17 front Mu of the upper Sea of Qi• CV 12 front Mu for the Stomach (esophagus CV 12 front Mu for the Stomach (esophagus

“belongs to” the Stomach)“belongs to” the Stomach)• BL 13, 14, 15 as local Shu for upper Sea of QiBL 13, 14, 15 as local Shu for upper Sea of Qi• LI 4, LIV 3 to move QiLI 4, LIV 3 to move Qi• LI 10, ST 36, CV 6 to nourish QiLI 10, ST 36, CV 6 to nourish Qi• LI 1, LU 11, ST 45 to clear fullness of the chest LI 1, LU 11, ST 45 to clear fullness of the chest

in the region of the Heartin the region of the Heart


• Spleen Qi DeficiencySpleen Qi Deficiency• Si Jun Zi TangSi Jun Zi Tang or Four Gentlemen or Four Gentlemen

DecoctionDecoction• the chief herb Panax ginseng the chief herb Panax ginseng ren shenren shen is is

sweet, warm and tonifies Spleen sweet, warm and tonifies Spleen QiQi• the deputy herb Atractylodis macrocephalae the deputy herb Atractylodis macrocephalae

bai zhubai zhu is bitter, warm and strengthens is bitter, warm and strengthens Spleen Spleen QiQi and dries Dampness and dries Dampness


• Spleen Qi DeficiencySpleen Qi Deficiency• Si Jun Zi TangSi Jun Zi Tang

• assistant herb Poria cocos assistant herb Poria cocos fu lingfu ling is sweet, bland and is sweet, bland and leeches out Dampness and mildly Tonifies Spleen leeches out Dampness and mildly Tonifies Spleen QiQi

• the envoy Glycyrrhiza uralensis the envoy Glycyrrhiza uralensis gan caogan cao is warm, is warm, sweet and warms and regulates the middle burnersweet and warms and regulates the middle burner

• modify with Hou Po magnolia bark to promote Qi flow, modify with Hou Po magnolia bark to promote Qi flow, transform Dampness, relieve food stagnation, direct transform Dampness, relieve food stagnation, direct rebellious Qi downward for a stifling sensation in the rebellious Qi downward for a stifling sensation in the chestchest

• Or modify with Platycodon Or modify with Platycodon jie gengjie geng resolve phlegm resolve phlegm and guide other herbs to upper burnerand guide other herbs to upper burner

Megaesophagus: Blood DeficiencyMegaesophagus: Blood Deficiency

• Clinical SignsClinical Signs• Dry fur, dry pads, firm, dry stools, Dry fur, dry pads, firm, dry stools,

decreased firmness in back Shu pointsdecreased firmness in back Shu points

• TongueTongue• Pale, dry, may have slight lavender huePale, dry, may have slight lavender hue

• PulsePulse• Weak, thin, especially middle and upper Weak, thin, especially middle and upper

jiaosjiaos


• Acupuncture: Use electro-AP!!Acupuncture: Use electro-AP!!• PC 6 master of the chestPC 6 master of the chest• CV 17 front Mu of the upper Sea of QiCV 17 front Mu of the upper Sea of Qi• CV 12 front Mu for the Stomach for post-heaven CV 12 front Mu for the Stomach for post-heaven

BloodBlood• BL 17, 18 to engender BloodBL 17, 18 to engender Blood• LI 4, LIV 3 to move Qi with BloodLI 4, LIV 3 to move Qi with Blood• SP 10, ST 36 to engender Blood and benefit SP 10, ST 36 to engender Blood and benefit

Spleen and StomachSpleen and Stomach• LI 1, LU 11, ST 45 to clear fullness of the chest LI 1, LU 11, ST 45 to clear fullness of the chest

in the region of the Heartin the region of the Heart


• Tao Hong Si Wu TangTao Hong Si Wu Tang Four Substances Four Substances Decoction with Peach Kernel and SafflowerDecoction with Peach Kernel and Safflower• Shu di huangShu di huang prepared rehmannia prepared rehmannia• Dang guiDang gui angelica sinensis angelica sinensis• Bai shao yaoBai shao yao white peony white peony• Chuan xiongChuan xiong ligusticum ligusticum• Tao renTao ren peach kernel peach kernel• Hong huaHong hua safflower safflower

• Nourish Blood, promote Blood circulation, Nourish Blood, promote Blood circulation, removes Blood Stasisremoves Blood Stasis

Megaesophagus: Blood Megaesophagus: Blood StagnationStagnation

• Clinical SignsClinical Signs• Pain in chest, front Mu and back Shu Pain in chest, front Mu and back Shu

points, uncomfortable lying in ventral points, uncomfortable lying in ventral recumbencyrecumbency

• TongueTongue• Lavender, usually slightly pale and dryLavender, usually slightly pale and dry

• PulsePulse• Wiry, choppy, commonly thinWiry, choppy, commonly thin


• Acupuncture: Use electro-AP!!Acupuncture: Use electro-AP!!• LI 4, LIV 3, LIV 14 to move Blood LI 4, LIV 3, LIV 14 to move Blood • PC 6 master of the chest, reduce PC 6 master of the chest, reduce

stagnationstagnation• CV 17 front Mu of the upper Sea of QiCV 17 front Mu of the upper Sea of Qi• BL 17, 18, SP 10 to engender and BL 17, 18, SP 10 to engender and

circulate Stagnant Bloodcirculate Stagnant Blood• CV 12, GB 21, GV 1 to descend QiCV 12, GB 21, GV 1 to descend Qi• LI 1, LU 11, ST 45 to clear fullness of the LI 1, LU 11, ST 45 to clear fullness of the

chest in the region of the Heartchest in the region of the Heart


• Xue Fu Zhu Yu TangXue Fu Zhu Yu Tang Remove Stasis from the Mansion of Remove Stasis from the Mansion of Blood DecoctionBlood Decoction• Tao renTao ren peach kernel peach kernel• Hong huaHong hua safflower safflower• Dang guiDang gui angelica sinensis angelica sinensis• Sheng di huangSheng di huang prepared rehmannia prepared rehmannia• Chuan xiongChuan xiong ligusticum ligusticum• Chi shao yaoChi shao yao red peony red peony• Chuan niu xiChuan niu xi cyathula cyathula• Jie gengJie geng platycodon platycodon• Chai huChai hu bupleurum bupleurum• Zhi keZhi ke bitter orange bitter orange• Gan caoGan cao licorice licorice

• Promotes the circulation of Blood and Qi, removes Blood Promotes the circulation of Blood and Qi, removes Blood Stasis, relieves painStasis, relieves pain

Megacolon: Pattern Megacolon: Pattern DifferentiationDifferentiation

• Qi DeficiencyQi Deficiency • seen with chronic poor quality foods for felids in general seen with chronic poor quality foods for felids in general

or individual constitutionor individual constitution

• Blood DeficiencyBlood Deficiency +/- +/- Blood Stagnation Blood Stagnation • seen with trauma, poor quality foods for that species or seen with trauma, poor quality foods for that species or

individual constitutionindividual constitution

• Heat PatternsHeat Patterns • may be seen with chronic Stagnation of Qi or Bloodmay be seen with chronic Stagnation of Qi or Blood

• Yin DeficiencyYin Deficiency • usually a consequence of Chronic Heatusually a consequence of Chronic Heat

• Mixed Qi and Blood DeficiencyMixed Qi and Blood Deficiency • is very commonis very common

Megacolon: Primary treatment Megacolon: Primary treatment principlesprinciples

• Tonify global and local QiTonify global and local Qi• Assist directional Qi FlowAssist directional Qi Flow• Tonify Qi of all Bowels (i.e. Stomach Tonify Qi of all Bowels (i.e. Stomach

System)System)

• Increase MoistureIncrease Moisture• Tonify YinTonify Yin• Increase Body FluidsIncrease Body Fluids

• Nourish BloodNourish Blood

Megacolon: Qi DeficiencyMegacolon: Qi Deficiency

• Clinical SignsClinical Signs• Firm to moderate stools that are difficult Firm to moderate stools that are difficult

to expel, thin, small muscles, easily to expel, thin, small muscles, easily fatiguedfatigued

• TongueTongue• Pale, normal to moistPale, normal to moist

• PulsePulse• Weak, deepWeak, deep


• AcupunctureAcupuncture• BL 20, 21, ST 36 and CV 12 to nourish the BL 20, 21, ST 36 and CV 12 to nourish the

Spleen and Stomach Spleen and Stomach • ST 37 lower He Sea for Large IntestineST 37 lower He Sea for Large Intestine• BL 25, ST 25 back Shu and front Mu for BL 25, ST 25 back Shu and front Mu for

Large IntestineLarge Intestine• TH 6, TH 5 empirical points for moving TH 6, TH 5 empirical points for moving

the Qi of the intestines for constipationthe Qi of the intestines for constipation


• Si Jun Zi TangSi Jun Zi Tang or Four Gentlemen or Four Gentlemen DecoctionDecoction

• Panax ginseng Panax ginseng ren shenren shen is sweet, warm and tonifies is sweet, warm and tonifies Spleen Spleen QiQi

• Atractylodis macrocephalae Atractylodis macrocephalae bai zhubai zhu is bitter, warm is bitter, warm and strengthens Spleen and strengthens Spleen QiQi and dries Dampness and dries Dampness

• Poria cocos Poria cocos fu lingfu ling is sweet, bland and leeches out is sweet, bland and leeches out Dampness and mildly Tonifies Spleen Dampness and mildly Tonifies Spleen QiQi

• Glycyrrhizae uralensis Glycyrrhizae uralensis gan caogan cao is warm, sweet and is warm, sweet and warms and regulates the middle burnerwarms and regulates the middle burner

• Modify with Rhubarb Modify with Rhubarb da huangda huang as a bitter, cold as a bitter, cold herb to move the bowels and dispel stasisherb to move the bowels and dispel stasis


• Fan Xie YeFan Xie Ye (I8001) (I8001)• Fan Xie YeFan Xie Ye senna leaf senna leaf

• Sweet, bitter, coldSweet, bitter, cold• Enters the Large Intestine ChannelEnters the Large Intestine Channel• Drains downward and guides out stagnationDrains downward and guides out stagnation• For constipation due to heat accumulation in the For constipation due to heat accumulation in the

IntestinesIntestines• Contains anthraquinone glycosidesContains anthraquinone glycosides• Hepatic metabolites stimulate pelvic ganglionHepatic metabolites stimulate pelvic ganglion

• Purge Large Intestine, resolve food stasisPurge Large Intestine, resolve food stasis

Megacolon: Blood DeficiencyMegacolon: Blood Deficiency

• Clinical SignsClinical Signs• Hard, dry stool, dry hair, dry and flakey Hard, dry stool, dry hair, dry and flakey

skinskin

• TongueTongue• Pale and dryPale and dry

• PulsePulse• Thin, weakThin, weak


• AcupunctureAcupuncture• BL 20, 21, ST 36 and CV 12 to nourish BL 20, 21, ST 36 and CV 12 to nourish

post-heaven Blood production via SP/STpost-heaven Blood production via SP/ST• BL 17 and SP 10 to nourish Blood BL 17 and SP 10 to nourish Blood • ST 37 lower He Sea for Large IntestineST 37 lower He Sea for Large Intestine• BL 25, ST 25 back Shu and front Mu for BL 25, ST 25 back Shu and front Mu for

Large IntestineLarge Intestine• TH 6, TH 5 empirical points for moving TH 6, TH 5 empirical points for moving

the Qi of the intestines for constipationthe Qi of the intestines for constipation


• Dang Gui Cong RongDang Gui Cong Rong (A0250) (A0250)• Dang guiDang gui angelica sinensis angelica sinensis• Rou cong rongRou cong rong cistanche cistanche• Qu maiQu mai dianthus dianthus• Shen quShen qu massa fermentata massa fermentata• Fan xie yeFan xie ye senna leaf senna leaf• Hou poHou po magnolia magnolia• Mu xiangMu xiang saussurea saussurea• Xiang fu ziXiang fu zi cyperus seed cyperus seed• Zhi keZhi ke bitter orange bitter orange• Tong caoTong cao tetrapanax tetrapanax

• Moisten Large Intestine, resolve impacted Large Moisten Large Intestine, resolve impacted Large IntestineIntestine

Megacolon: Dryness due to HeatMegacolon: Dryness due to Heat

• Clinical SignsClinical Signs• Constipation with hard stool difficult to Constipation with hard stool difficult to

expel, frequent urinationexpel, frequent urination

• TongueTongue• Dry, yellow coatingDry, yellow coating

• PulsePulse• Deep, rapid or floating and choppyDeep, rapid or floating and choppy

Megacolon: Dryness due to HeatMegacolon: Dryness due to Heat

• Ma Zi Ren WanMa Zi Ren Wan Hemp Seed Pill Hemp Seed Pill• Huo ma renHuo ma ren cannabis seed cannabis seed• Xing renXing ren apricot seed apricot seed• Shao yaoShao yao peony peony• Zhi shiZhi shi immature bitter orange immature bitter orange• Hou poHou po magnolia cortex magnolia cortex• Da huangDa huang rhubarb rhubarb

• Moisten the Intestines, drains Heat, Moisten the Intestines, drains Heat, promotes Qi movement, unblocks the promotes Qi movement, unblocks the bowelsbowels

Megacolon: Yin DeficiencyMegacolon: Yin Deficiency

• Clinical SignsClinical Signs• Constipation, thirstConstipation, thirst

• TongueTongue• Dry, redDry, red

• PulsePulse• Thin and slightly rapid or weak and Thin and slightly rapid or weak and

feeblefeeble

• Consequence of warm-febrile disease Consequence of warm-febrile disease in weak or Yin Deficient patientin weak or Yin Deficient patient


• AcupunctureAcupuncture• BL 25, ST 25 back Shu and front Mu of BL 25, ST 25 back Shu and front Mu of

Large IntestineLarge Intestine• SP 6, KI 3, , CV 4, BL 23 to nourish the SP 6, KI 3, , CV 4, BL 23 to nourish the

YinYin• TH 6, ST 37 to unblock the Large TH 6, ST 37 to unblock the Large

IntestineIntestine


• Zeng Ye TangZeng Ye Tang Increase the Fluids Increase the Fluids DecoctionDecoction• Xuan shenXuan shen scrophularia scrophularia• Mai men dongMai men dong ophiopogon ophiopogon• Sheng di huangSheng di huang fresh rehmannia fresh rehmannia

• Generates fluids, moistens dryness Generates fluids, moistens dryness and unblocks the bowelsand unblocks the bowels

Megacolon: Stagnation with HeatMegacolon: Stagnation with Heat

• Clinical SignsClinical Signs• Severe constipation and flatulence, focal Severe constipation and flatulence, focal

distention and abdominal fullness, distention and abdominal fullness, abdominal pain which increases with abdominal pain which increases with pressure, tense and firm abdomenpressure, tense and firm abdomen

• TongueTongue• Dry, yellow or dry and dark coatingDry, yellow or dry and dark coating

• PulsePulse• Deep, excessiveDeep, excessive


• AcupunctureAcupuncture• Ren 4 tonifies Yin and fluidsRen 4 tonifies Yin and fluids• LI 11 clears Heat in the Large IntestineLI 11 clears Heat in the Large Intestine• ST 37 lower He Sea for Large Intestine to ST 37 lower He Sea for Large Intestine to

harmonize LIharmonize LI• ST 44 clears Stomach HeatST 44 clears Stomach Heat• LI 2 clears Large Intestine HeatLI 2 clears Large Intestine Heat• SP 6, KI 6, Ren 12 promote body fluidsSP 6, KI 6, Ren 12 promote body fluids


• Da Cheng Qi TangDa Cheng Qi Tang Major Order the Qi Major Order the Qi DecoctionDecoction• Da huangDa huang rhubarb rhubarb• Mang xiaoMang xiao mirabilitum mirabilitum• Zhi shiZhi shi immature bitter orange immature bitter orange• Hou poHou po magnolia cortex magnolia cortex

• Vigorously purges Heat accumulationVigorously purges Heat accumulation

ConclusionConclusion

• Megaesophagus and Megacolon are Megaesophagus and Megacolon are predominantly types of localized Qi predominantly types of localized Qi DeficiencyDeficiency

• Although heritable (Jing) factors may be Although heritable (Jing) factors may be involved, Exogenous Pathogens and poor involved, Exogenous Pathogens and poor quality foods are root causequality foods are root cause

• Blood Deficiency with or without Blood Blood Deficiency with or without Blood Stagnation may be a complicating factorStagnation may be a complicating factor

• Acupuncture and Herbal formula based Acupuncture and Herbal formula based upon Pattern Differentiation may improve upon Pattern Differentiation may improve quality of lifequality of life

Documents

TCVM Approach to Megacolon and Megaesophagus