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Townsend Letter for Doctors and Patients, Nov, 2003 by Bob Flaws
Acupuncture & moxibustion: 1. Please see pattern #1 above. 2. Ming Men (GV 4), Guan Yuan (CV 4), Shen Shu (Bl 23). 3. Please see pattern #1 above.
Additions & subtractions: See pattern #1 above.
Remarks
1. In my experience, the single most commonly seen pattern of MS in real-life Western patients is qi and yin dual vacuity, meaning spleen qi and liver-kidney yin vacuity. However, this pattern is always complicated by liver depression, and it is often complicated by any combination of the following: A) damp heat, B) blood stasis, C) internal stirring of wind, D) kidney qi vacuity not securing, and E) kidney yang vacuity. In my experience, it is the rule rather than the exception that there will be five or more concomitant patterns in cases of MS. Whenever there are such complicated patterns, one should first identify all patterns present in order of predominance; two, state the requisite treatment principles for each of those patterns in the same order; and three, compose on an ad hoc basis a treatment plan that addresses all those patterns in the same proportions and with the same priorities.
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2. Because spleen qi vacuity and dampness play a central role in most Western MS patients' disease mechanisms, Chinese dietary therapy must also play a correspondingly central role in any comprehensive treatment plan. This generally means eating a clear, bland, hypoallergenic, yeast-free diet. The more marked spleen qi and dampness or damp heat are in a patient's over-all pattern, the more important is proper diet in the prevention of acute attacks and long-term maintenance.
3. Although Western physicians say that attacks and remissions of MS are spontaneous, my clinical experience as a Chinese doctor suggests that precipitating factors for both acute attacks and remissions can be identified by Chinese medicine. For instance, many female MS patients experience worsening of wind, liver, and/or spleen related symptoms premenstrually. If there is insufficient blood, when the blood descends to the uterus prior to menstruation, this may result in the arising or aggravation of internally stirring wind and/or liver depression. If liver depression is aggravated, then the spleen will tend to become more vacuous due to the liver counterflowing horizontally with wood assailing earth. Other acute attacks can be traced to unusual fatigue, emotional stress, and/or unregulated diet. Therefore, when MS patients experience acute aggravations, it is very important for their Chinese medical care-giver to identify the precipitating factor(s) and to explain these to the patient so that the patient may prevent such exacerbations in the future. For instance, if an MS patient's symptoms worsen on exposure to heat, they should consider moving to a cooler climate in the summer or installing air-conditioning in their home.
4. Chinese sources do not typically list blood stasis as a pattern of MS. However, blood stasis often does complicate MS based on the statement that, "Enduring diseases enter the network vessels." The clinical meaning of this statement is that blood stasis is commonly engendered within the network vessels of chronically ill patients. In such cases, one should add appropriate blood quickening, network vessel freeing medicinals to any other guiding formula, however remembering that blood vacuity may cause or aggravate blood stasis and that blood stasis may cause or aggravate blood vacuity. Therefore, in most cases, blood-quickening medicinals should be combined with blood-nourishing medicinals or medicinals should be chosen which inherently both quicken and nourish the blood, such as Radix Angelicae Sinensis (Dang Gui) and Radix Salviae Miltiorrhizae (Dan Shen). Further, because blood stasis in the network vessels and wind often exist simultaneously, one should not overlook those wind-extinguishing medicinals which also quicken and free the flow of the network vessels, such as Buthus Martensis (Quan Xie) and Scolopendra Subspinipes (Wu Gong).
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