1. ME & Chinese Medicine Treatment
Huijun Shen
Senior lecturer
Acupuncture Programme
University of Lincoln

2. ME: TCM Understanding TCM Name: Xu Lao Xu: Deficiency Lao: Fatigue
Core Etiology & pathogenesis:
Damp retention, and
Qi deficiency

3. What is damp retention
An abnormal accumulation of body fluids, which affect the physical functions of organs (most commonly spleen), tissues (muscles etc) and cells, leading to dysfunction of cellular metabolism.
Damp: intercellular accumulation of body fluids?

4. Where does damp retention come from?
Damp retention leading to Spleen dysfunction
Spleen has the function in transformation and transportation of food essence to produce Qi
Exogenous Damp:
Damp environment, damp weather, etc.
Damp accumulating in Middle Jiao
Spleen
Dysfunction
Xu Lao
Endogenous damp:
Cold food/ unhealthy diet

5. What is Qi Deficiency? Qi: life force, vital energy
Qi deficiency: Qi becomes weaker than normal leading to lessened energy level in the body, manifesting as fatigue/lethargy, weak muscles, poor appetite, weak voice, pale tongue and weak pulse.

6. Where does Qi Deficiency come from?
Typical Qi Deficiency is Spleen Qi Deficiency
Congenital Weakness
Too little production
long term illness
erratic diet
malnutrition
Spleen Qi Deficiency - failing to transform and transport body fluids, leading to Damp retention
Spleen Deficiency
- Failing to produce Qi, Qi becomes weak
Too much consumption
long term illness
overwork

7. Damp Retention vs Spleen Qi Deficiency mutually causative mutually consequent

8. A. Early stage: predominantly excess patterns
Damp accumulated in the interior
1. Damp heat accumulated in the interior
Main symptoms:
feeling slightly hot but no fever, sweating, thirst but no desire for drinking;
distension/fullness in abdomen, with dull pain, poor appetite, erratic bowel movement or diarrhoea, nausea, vomiting;
red tongue with yellow greasy coating, rapid soft pulse.

9. Treatment principles: Clear damp heat
Herbal formulae: San Ren Tang
Herbal prescription: Xing Ren, Sha Ren, Yi Yi Ren, Huan Qin, Zhi Zi, Bai Zhu, Chen Pi, Gan Cao
Point selection: GB34, SP9, ST38, ST25, LI11

10. 2. Damp cold accumulated in the interior
Main symptoms: feeling cold, no or little sweating, no desire for drinking, distension/fullness in abdomen, poor appetite, nausea, erratic bowel movement or diarrhoea, pale tongue with white greasy coating, slow soft (soggy) pulse
Treatment principles: expel cold and remove damp
Point selection: GB34, SP4, SP6, SP9, ST36, ST38, ST25, Ren 12, Ren6, or moxa

11. Treatment principles: expel cold and remove damp
Herbal formulae: Ping Wei San with Huo Zhu Wan
Herbal prescription: Cang Zhu, Hou Po, Chen Pi, Sha Ren, Yi Yi Ren, Huo Xiang, Bai Zhu, Gan Cao, Fu Ling,
Point selection: GB34, SP4, SP6, SP9, ST36, ST38, ST25, Ren 12, Ren6, or moxa

12. 3. Damp /phlegm retention combined with Liver Qi stagnation
Main symptoms:
no feeling cold or hot
distension/fullness in abdomen, or abdominal pain
poor appetite, nausea
or fullness in chest with cough and phlegm
erratic bowel movement or diarrhoea
irregular or painful menstruation
irritability, frequent sighing
pale tongue with white greasy coating, pulse soft in spleen position and wiring in liver position

13. Treatment principles: remove damp/phlegm and spread liver qi
Herbal formulae: Er Chen Tang with Si Ni San
Herbal prescription: Chen Pi, Ban Xia, Fu Ling, Gan Cao; Chai Hu, Bai Shao Yao, Zhi Shi; plus Qing Pi, Yu Jin, Xing Ren.
Point selection: Liv3 (or with LI4), GB34, SP4, SP6, SP9, ST36, ST40, ST25, Ren 12, Ren6, Liv13, Liv14.

14. B. Middle Stage: predominantly deficiency patterns
1. Qi deficiency mingled with damp
Main symptoms: Fatigue, low energy level, poor appetite, loose stools or even diarrhoea, weight loss, pale tongue with teeth marks on the tongue edge, weak pulse.

15. Treatment principles: tonify spleen Qi and remove damp
Herbal formulae:
Herbal prescription:
Point selection: ST36, SP3, SP6, SP9, Ren 6, Ren 12, BL20

16. 2. Qi and blood deficiency
Main symptoms: Fatigue, low energy level, pale complexion, poor appetite, loose stools or even diarrhoea, more obvious weight loss, abnormal menstruation in women, dizziness when feeling tired, numbness in limbs, blurred vision, pale tongue and weak pulse.

17. Treatment principles: Tonify Qi and nourish blood
Herbal formulae: Ba Zhen Tang
Herbal prescription: Dang Sehn, Bai Zhu, Fu Ling, Gan Cao; Dang Gui, Bai Shao Yao, Shu Di Huang, Chuan Xiong; Huang Qi, Shan Yao, He Shou Wu can be added.
Point selection: ST36, SP6, SP10 Ren 6, BL17, BL18, BL20.

18. 3. Yin deficiency
Main symptoms: Feeling hot or hot flushes, night sweats, dry mouth and thirst, “five palm heat”, weight loss, fatigue, red tongue with little coating, weak/thin and rapid pulse.

19. Treatment principles: Nourish Yin
Herbal formulae: Liu Wei Di Huang Wan plus
Herbal prescription: Shu Di Huang, Shan Yao, Shan Zhu Yu, Mu Dan Pi, Ze Xie, Fu Ling; Mai Men Dong, Nu Zhen Zi, Gou Qi Zi, Tai Zi Shen can be added
Point selection: SP6, BL18, BL23, Ren4; KI2, 6 or 7

20. 4. Yang deficiency
Main symptoms: Feeling cold with cold hands and feet, lack of sweats, weight loss, very tired with low energy, obvious general weakness, loose stools or diarrhoea, frequent urination, pale or purple tongue, deep weak pulse.

21. Treatment principles: tonify Yang
Herbal formulae: modified Jing Gui Shen Qi Wan
Herbal prescription: Xian Mao (as substitute of Fu Zi), Rou Gui, Shu Di Huang, Shao Yao, Shan Zhu Yu, Mu Dang Pi, Ze Xie, Fu Ling; Tu Si Zi, Ba Ji Tian can be added.
Point selection: KI3, 6, 7; BL20, 23; Ren4, 6; DU4, ST36

22. C. Later Stage: predominantly multiple deficiency patterns
1. Qi and Yin dual deficiency
Main symptoms: Extreme weakness, feeling hot or hot flushes, night sweats, dry mouth and thirst, “five palm heat”, weight loss, fatigue, poor appetite, erratic bowel movement, red tongue with teeth marks, little tongue coating, weak, thin and rapid pulse.

23. Treatment principles: Tonify Qi and nourish Yin
Herbal formulae: Bao Yuan Jian with Liu Wei Di Huang Wan
Herbal prescription: Dang Shen, Bai Zhu, Huang Qi, Fu Ling, Chen Pi, Gan Cao; Shu Di Huang, Shan Yao, Shan Zhu Yu, Mu Dan Pi, Ze Xie; or Sheng Mai Yin (Ren Shen, Mai Men Dong, Wu Wei Zi) can be added.
Point selection: ST36, SP6, BL18, BL20, BL23, Ren 4 Ren 6; KI 2, 3, 6 or 7

24. 2. Yin and Yang dual deficiency
Main symptoms: Extreme weakness, no hot or cold feeling, or feeling warm/hot in the afternoon but cold at night or in the morning, night sweats and spontaneous sweats, severe weight loss, very poor appetite, deep and very thin/weak pulse.

25. Treatment principles: tonify Yang and nourish Yin
Herbal formulae: Liu Wei Di Huang Wan with Zhen Wu Tang
Herbal prescription: Shu Di Huang, Shan Yao, Shan Zhu Yu, Mu Dan Pi, Ze Xie, Fu Ling; Fu Zi (substituted by Xiao Mao), Gan Jiang, Bai Zhu, Bai Shao Yao; Rou Gui, Ba Ji Tian can be added.
Point selection: SP6, ST36, BL18, BL20, BL23, Ren4; KI2, 3, 6 or 7; Ren4, 6; DU4

26. Lifestyle Modification
Balance Diet
Adequate Rest
Gentle exercise: Tai Ji, Yoga, etc.
Spiritual relaxation: Meditation, enjoy life, have a good relationship
Family support
Social activity

27. Balanced Diet High protein food: red meat, fish
Vegetarian: may not be good for ME sufferers
Eating hot or cold food?

28. Hot/Cold Property of Common Food 常用食物的寒热属性
Warm or Hot Food 温热性食物
(more suitable to people with cold constitution or cold pattern of illness)
Neutral Food
中性食物
(suitable to all)
Cool or Cold Food 寒凉性食物
(more suitable to people with heat constitution or heat pattern of illness)
Meat
Lamb, chicken, goose, prawn,
羊肉, 鸡肉, 鹅肉, 海虾
Pork, beef
猪肉, 牛肉
Crab, most sea food, rabbit, duck, pig liver, donkey
螃蟹, 多数水产品, 兔肉, 鸭, 猪肝, 驴肉
Vegetable
Eggplant, onion, chive, garlic, pepper,
茄子, 洋葱, 韭菜, 大蒜, 辣椒, 姜, 茴香
Potato, Chinese Yam
土豆, 山药
Seaweed, Chinese leaf, cabbage, spinach, carrots, celery, cucumber, wax gourd, gourd, lotus root, tomatoes, green bean
海带, 白菜, 菠菜, 萝卜, 芹菜, 黄瓜, 冬瓜, 葫芦, 莲藕, 西红柿, 绿豆
Fruits
Longan, litchi chinensis, chestnut, walnut, citrus,
龙眼, 荔枝, 栗子, 胡桃, 橘类
Peach, apricot, grape
桃, 杏, 葡萄
Pears, watermelon, melon, persimmon, banana, pineapple梨, 西瓜, 甜瓜, 柿, 香蕉, 菠萝
Others
Brown sugar, syrup, wine, coffee, curry
红糖，饴糖，酒，咖啡，咖喱
Chicken egg 鸡蛋
Sugar, ice sugar, tofu, duck egg
白糖, 冰糖, 豆腐, 鸭蛋

29. Qi Tonic herbs Ginseng (Ren Shen) Other Qi tonic herbs:
Chinese ginseng
Korean ginseng
Siberian ginseng
American ginseng
Other Qi tonic herbs:
Huang Qi
Dang Shen
Bai Zhu
Shan Yao

30. Damp Removing herbs
Cang Zhu
Hou Po
Huo Xiang
Sha Ren