Clinically Effective Formulas for the Treatment of Rheumatoid Arthritis

Transcription

1 Clinically Effective Formulas for the Treatment of Rheumatoid Arthritis Simon A. Becker, Dipl. Ac. &C. H. (NCCAOM) Introduction: Rheumatoid arthritis (RA) affects about 1% of the population. Women are affected 2 to 3 times more often than men, and the age of onset is usually between 25 to 50 years. RA is a chronic disease characterized by symmetric inflammation of the peripheral joints, potentially resulting in progressive destruction of articular and periarticular structures. The etiology is unknown; however, factors such as genetic susceptibility, humoral immunity, cellular immunity, and infectious agents seem to play a role in its pathogenesis. The resulting pathological lesion is a synovial lining which is thrown into numerous villi and frond-like folds that fill the peripheral recesses of the joints 1. Common clinical features are warm, swollen, and painful joints with pain worse upon movement and most severe after periods of disuse. Eventual manifestations of severe flexion and extension deformities terminating in joint ankylosis are common. The treatment of this crippling disease resorts to aggressive drugs such as cortico-steroids and cytotoxic and immunosuppressive drugs (methotrexate). Still, more than 10% of the cases become eventually disabled and the disease has a major impact on the lives of many others 2. In Chinese medicine, this disease falls into the category of impediment pattern (bi zheng). Current internal Chinese medicine textbooks divide it into the two basic patterns of wind damp cold impediment and wind damp heat impediment. The first pattern is further differentiated into moving impediment (xing bi), corresponding to wind, painful impediment (tong bi), corresponding to cold, and fixed impediment (zhuo bi), corresponding to dampness. The commonly proposed disease mechanism is the invasion of either wind, cold, heat, or damp evils because of bodily vacuity weakness with non-density of the interstices. These evils then lodge and stagnate in the channels and network vessels, the flesh, and the joints and obstruct the free flow of qi and blood, thus giving rise to impediment. Longterm stagnation may easily lead to transformative heat, causing cold or wind impediment to change to heat impediment. Although not commonly stated in Chinese sources, I believe that the internal generation of dampness due to faulty diets here in the West is another very important pathogenic factor which needs to be considered in the treatment of RA. Clinical manifestations vary according to pattern; if heat or damp heat is governing, then the joints are red, hot, swollen, and painful, whereas if damp and cold are exuberant, then the pain gets worse in cold weather and there is no redness or heat. If the disease is prolonged, manifestations of qi and blood vacuity or liver and kidney depletion and detriment can often be seen. Rheumatoid arthritis often, but not always, falls into the pattern of wind damp hot impediment. The general formula given in modern day textbooks for this pattern is Bai Hu Jia Gui Zhi Tang (White Tiger Decoction Plus Cinnamon Twig) 3 with additions and subtractions. Below are nine formulas for the treatment of RA translated from the Zhong Guo Zhong Yi Mi Fang Da Quan (Compendium of Chinese Medicine Secret Formulas) 4. Every formula gives a clinical study as a reference to its efficacy. In the conclusion, I have analyzed all nine formulas as to which medicinals were most commonly prescribed in the treatment of impediment in modern day Chinese medicine. This analysis is intended to help English speaking students and practitioners to improve clinical efficacy. All too often, 1 Essential Pathology by E. Rubin and J. Farber, J. B. Lippincott Company, Philadelphia 1995; page The Merck Manual, Sixteenth Edition, Rahway, NJ, 1992; page Ingredients of this formula include Gypsum (Shi Gao), Rhizoma Anemarrhenae Asphodeloidis (Zhi Mu), Semen Oryzae (Geng Mi), honey mix-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao), Ramulus Cinnamomi Cassiae (Gui Zhi). 4 Edited by Hu Xi-ming, 14 th Edition, Literary Collection Publishing and Distributing Company, Shanghai, 1997

2 Western students graduate from Chinese medicine schools with some theoretical foundation but very limited clinical references. The formulas below all have been clinically tested and found to be particularly effective and thus serve the purpose of providing non-chinese reading practitioners with clinically oriented material. Formulas: Shuang Teng Tang (Double Vine Decoction) (Composed by Xiao Jin-sun from the Ji Jing Military Clinic, Xuanhua district, Hebei province) Functions and Indications: Dispels wind, eliminates dampness, quickens the blood, and frees the network vessels. This formula mainly treats wind damp type rheumatoid arthritis. Ingredients: Caulis et Rhizoma Sinomenii seu Sabiae (Qing Feng Teng), 9g, Caulis Piperis Kadsurae (Hai Feng Teng), 9g, Caulis Sargentodoxae (Qian Nian Jian), 9g, Cortex Radicis Schizophragmatis (Zuan Di Feng), 9g, Squama Manitis Pentadactylae (Chuan Shan Jia), 9g, Radix Ledebouriellae (Fang Feng), 9g, Radix Glycyrrhizae Uralensis (Sheng Gan Cao), 9g, Lumbricus (Chuan Di Long), 9g, Rhizoma seu Herba Aristolochiae Mollissimae (Xun Gu Feng), 9g. Put the above in half alcohol, half water; if one cannot take alcohol, just decoct in water and take like that. Additions and Subtractions: If wind evil is predominant, add Radix Gentianae Qinjiao (Qin Jiao), Rhizoma et Radix Notopterygii (Qiang Huo), Ramulus Cinnamomi Cassiae (Gui Zhi), Radix Puerariae (Ge Gen), and Radix Angelicae Sinensis (Dang Gui); if cold evil is predominant, add prepared Radix Ligustici Chuanxiong (Chuan Xiong), Herba Ephedra (Ma Huang), Radix Paeoniae Lactiflorae (Shao Yao), and Radix Astragali Membranacei (Huang Qi); if there is reversal cold of the limbs, add Radix Lateralis Aconiti Carmichaeli (Fu Zi) and Ramulus Cinnamomi Cassiae (Gui Zhi); if dampness evil is predominant, add Herba Ephedra (Ma Huang), Semen Pruni Armeniacae (Xing Ren), Semen Coicis Lachrymajobi (Yi Yi Ren), Rhizoma Atractylodis Macrocephalae (Bai Zhu), and Sclerotium Poriae Cocos (Fu Ling); if heat evil is predominant, add Gypsum (Shi Gao), Rhizoma Anemarrhenae Asphodeloidis (Zhi Mu), and Ramulus Cinnamomi Cassiae (Gui Zhi). In the treatment of 80 cases, 62 recovered fully; this yields a recovery rate of 77.5%. Impediment is [one type] of obstruction. When qi and blood are obstructed by evils, they cannot flow freely and thus impediment pattern arises. In this formula, Qing Feng Teng, Hai Feng Teng, Ma Huang, and Fang Feng dissipate cold and dispel wind; Bai Zhu, Yi Yi Ren, and Fu Ling fortify the spleen and eliminate dampness; Chuan Shan Jia quickens the blood and frees the network vessels; taking [these herbs] in an alcohol/water mixture further increases the herbs effects. When evils are dispelled and qi and blood flow freely, then impediment pain is spontaneously eliminated. This formula s name was created by the editor.

3 Chu Bi Tang (Eliminate Impediment Decoction) (Composed by Gao Er-jin from the Wuhu TCM school, Anhui province) Functions and Indications: Dissipates cold, dispels wind, eliminates impediment, and frees the network vessels. This formula mainly treats damp type rheumatoid arthritis. Ingredients: Ramulus Cinnamomi Cassiae (Gui Zhi), 9g, Rhizoma et Radix Notopterygii (Qiang Huo), 9g, Radix Angelicae Pubescentis (Du Huo), 9g, Radix Ligustici Chuanxiong (Chuan Xiong), 10g, Rhizoma Arisaematis (Hu Zhang), 12g, Rhizoma seu Herba Aristolochiae Mollissimae (Xun Gu Feng), 12g, Fructus Chaenomelis (Mu Gua), 12g, Agkistrodon seu Bungarus (Bai Hua She), 12g, Ping Huo, 12g, Radix Ledebouriella (Fang Feng), 12g. Drink as a decoction; 60 ji equal one treatment course. In the treatment of 416 cases, there was obvious improvement in 284 cases, some improvement in 87 cases, and no improvement in 45 cases. This formula was developed by Mr. Gao and is based on a folk remedy with additions and subtractions. In this formula, Gui Zhi, Qiang Huo, Du Huo, and Fang Feng dispel wind and dissipate cold; Hu Zhang, and Chuan Xiong quicken the blood and free the network vessels; Bai Hua She tracks and picks out wind in the network vessels. Thus [this formula] treats wind cold entering the network vessels type joint impediment pain with good effect. This formula s name was created by the editor. Bi Tong Ling Tang (Impediment Pain Magic Decoction) (Composed by Zhu Si-chun of the Kuazi town hospital, Fengnan district, Hebei province) Functions and Indications: Moves qi, dispels stasis, dissipates wind, eliminates dampness, soothes the sinews, quickens the network vessels, warms yang, and dissipates cold. This formula mainly treats acute and chronic impediment patterns. Ingredients: Semen Coicis Lachryma-jobi (Yi Yi Ren), 30g, Radix Achyranthis Bidentatae (Niu Xi), 10g, Rhizoma Atractylodis (Cang Zhu), 10g, Radix Glycyrrhizae Uralensis (Gan Cao), 3g, Fructus Chaenomelis (Mu Gua), 10g, Rhizoma Cyperi Rotundi (Xiang Fu), 10g, Radix Aristolochiae Fangchi (Fang Ji), 10g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix et Rhizoma Notopterygii (Qiang Huo), 18g, Gummi Olibanum (Ru Xiang), 10g, Myrrha (Mo Yao), 10g, Semen Persicae (Tao Ren), 10g, Flos Carthami Tinctorii (Hong Hua), 10g, Lumbricus (Di Long), 10g, Ramulus Cinnamomi Cassiae (Gui Zhi), 10g, Caulis Perilla Frutescentis (Su Geng), 10g, Radix Linderae Strychnifoliae (Wu Yao), 10g, Radix Gentianae Qinjiao (Qin Jiao), 10g. Take as a decoction. In the treatment of 306 cases, 81.4% fully recovered and 14.4% had good effect, bringing the amelioration rate to 95.8%. The Nei Jing (Internal Classic) says: Wind, cold and dampness are the three most complex qi, causing impediment when

4 they combine. This formula uses Qiang Huo and Gui Zhi to warm yang and unblock the vessels, dissipate cold and diffuse impediment; Qin Jiao and Fang Ji clear heat and dispel wind; Cang Zhu and Yi Yi Ren eliminate dampness and free the network vessels; Dang Gui, Hong Hua, and Su Geng harmonize qi and quicken the blood; thus, [this formula] treats every type of wind cold damp impediment, acute or chronic, with good effect. This formula s name was created by the editor. Tian Ma Tang (Gastrodia Decoction) (Composed by Dong Bai-xuan from the Zhongjing Medical School s first hospital, Sichuan province) Functions and Indications: Dissipates wind, quickens the blood, soothes the sinews, and stops pain. This formula mainly treats wind damp type rheumatoid arthritis. Ingredients: Rhizoma Gastrodiae Elatae (Tian Ma), Radix Angelicae Pubescentis (Du Huo), Radix Rehmanniae Glutinosae (Sheng Di), Cortex Eucommiae Ulmoidis (Du Zhong), Radix Lateralis Aconiti Carmichaeli (Fu Zi), Radix Angelicae Sinensis (Dang Gui), Rhizoma Dioscoreae Hypoglaucae (Bei Xie), Radix et Rhizoma Notopterygii (Qiang Huo), Radix Achyranthes Bidentatae (Niu Xi), Radix Scrophulariae Ningpoensis (Xuan Shen). Prepare as an extract and take 4-10 parts (about equal to 6 to 15 grams) 2 to 4 times per day. 116 cases were treated; 98 had [at the least] some effect; this yields an amelioration rate of 84.5%. This formula uses Tian Ma, Du Huo, Qiang Huo, and Bei Xie to dispel wind and eliminate dampness; Fu Zi warms the channels and dissipates cold; Du Zhong and Niu Xi supplement the kidneys and soothe the sinews. [Therefore,] the root and branch are simultaneously addressed. Thus, there is a definite effect in the treatment of wind cold damp type impediment with aching and pain and swollen limbs. Therefore, one can also treat wind damp type rheumatoid arthritis with outstanding results [with this formula]. Wen Jing Tong Luo Tang (Warm the Channels and Free the Network Vessels Decoction) (Composed by Yao Qing-yun) Functions and Indications: Warms the channels, dissipates cold, quickens the blood, and stops pain. This formula mainly treats chronic rheumatoid arthritis. Ingredients: Ramulus Cinnamomi Cassiae (Gui Zhi), 20g, Radix et Caulis Jixueteng (Ji Xue Teng), 20g, prepared Radix Ligustici Chuanxiong (Chuan Xiong), 15g, Radix Lateralis Aconiti Carmichaeli (Fu Zi), 15g, Radix Paeonia Lactiflorae (Bai Shao), 12g, Radix Angelicae Sinensis (Dang Gui), 12g, Radix Astragali Membranacei (Huang Qi), 12g, Radix Ledebouriella (Fang Feng), 9g, honey mix-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao), 6g; drink as a decoction. Additions and Substractions: If wind is prominent, add Radix Gentianae Qinjiao (Qin Jiao); if dampness is prominent, add Semen Coicis Lachryma-jobi (Yi Yi Ren); if there is pain in the lower limbs, add Fructus Chaenomelis (Mu Gua); if there is pain in the upper limbs, add Rhizomae Curcumae Longae (Jiang Huang); if there is lumbar pain, add Radix Dipsaci Asperi (Xu Duan); for prolonged illness with a vacuous body, add medicinals that supplement qi

5 and blood, enrich the liver and kidney, and harmonize and strengthen the sinews and bone, possibly selecting vine-type medicinals. For traveling pain, add Caulis Piperis Futokadsurae (Hai Feng Teng); for muscle wilting in the four limbs, add Caulis Photiniae (Shi Nan Teng); for sinew and bone tightness, add Caulis Tinosporae Sinensis (Kuan Jin Teng). Also consider adding Nidus Vespae (Lu Feng Fang) and Agkistrodon seu Bungarus (Bai Hua She) in order to track wind and quicken the network vessels. In the treatment of 100 cases, 26 recovered fully, 31 noticed obvious improvement, and 42 cases experienced good effect. In 5 cases, there was no effect. Therefore, the total efficacy rate was 95.2%. This formula uses Chuan Xiong, Fu Zi, and Gui Zhi in order to warm the channels and stop pain; Ji Xue Teng, Dang Gui, and Bai Shao nourish the blood and harmonize the constructive; Fang Feng dispels wind; Huang Qi boosts qi. All medicinals together have the function of warming the channels and dissipating cold, quickening the blood and stopping pain, dispelling wind and drying dampness, boosting qi and harmonizing the constructive. This formula s name was created by the editor. Gui Shao Qu Feng Tang (Cinnamon Twig and Peony Dispel Wind Decoction) (Composed by Jin You and others at the Harbin Medical School s Second Hospital, Heilongjiang province) Functions and Indications: Dispels wind, frees the network vessels, quickens the blood, and stops pain. This formula mainly treats active phase rheumatoid arthritis. Ingredients: Ramulus Cinnamomi Cassiae (Gui Zhi), 15-20g, Radix Albus Paeonia Lactiflorae (Bai Shao), 15g, Radix Paeoniae Rubrae (Chi Shao), 25g, Radix Ledebouriellae Divaricatae (Fang Feng), 15g, Radix Achyranthis Bidentatae (Niu Xi), 30g, Radix et Caulis Jixueteng (Ji Xue Teng), 30g, Radix Gentianae Qinjiao (Qin Jiao), 20g, Radix Angelicae Sinensis (Dang Gui), 20g; take as a decoction. Additions and Subtractions: For pronounced heat, add Gypsum (Shi Gao), Radix Anemarrhenae Asphodeloidis (Zhi Mu), and Cortex Phellodendri (Huang Bai); for pronounced cold, add Radix et Rhizoma Notopterygii (Qiang Huo), Radix Angelicae Pubescentis (Du Huo), Radix Aconiti (Wu Tou), and Radix Lateralis Aconiti Carmichaeli Praeparata (Fu Pian); for pronounced dampness, add Semen Coicis Lachryma-jobi (Yi Yi Ren), Radix Aristolochiae Fangchi (Fang Ji), and Rhizoma Atractylodis (Cang Zhu); For simultaneous blood stasis, add Radix Angelicae Sinensis (Dang Gui), Flos Carthami Tinctorii (Hong Hua), Radix Ligustici Wallichii (Chuan Xiong), and Radix Salviae Miltiorrhizae (Dan Shen); for prolonged illness, add Buthus Martensis (Quan Xie), Zaocys Dhumnades (Wu Shao She), and Eupolyphaga seu Opisthoplatia (Di Bie Chong); for qi vacuity, add Radix Astragali Membranacei (Huang Qi) and honey mix-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao). Thirty cases were treated; 22 (73.3%) recovered fully; 8 (26.7%) experienced good improvement.

6 This formula uses Gui Zhi, Fang Feng, and Qin Jiao to course wind, dissipate cold, and overcome dampness. Distinguishing between pronounced heat, cold, or damp, one can add Shi Gao and Zhi Mu or Wu Tou and Fu Pian or Yi Yi Ren and Cang Zhu. This formula follows the saying in order to treat wind, treat the blood first; when blood moves, wind is extinguished spontaneously. Dang Gui, Niu Xi, and Ji Xue Teng nourish the blood and quicken the blood. In enduring diseases use Wu Shao She, Quan Xie, and Di Bie Chong; all tracking and picking out medicinals. To conclude the entire formula, overall precise medicinals are used and suitable additions and subtractions are made so as to reach good clinical effects. This formula s name was created by the editor. Qiang Gui Fang Ji Di Huang Tang (Notopterygium, Cinnamon Twig, Stephania, and Rehmannia Decoction) (Composed by the department of internal medicine of the Chinese medical hospital in Changpu district, Shanghai) Functions and Indications: Dispels wind, clears heat, transforms dampness, and frees the network vessels. This formula mainly treats active phase rheumatoid arthritis. Ingredients: Radix Aristolochiae Fangchi (Mu Fang Ji), 15g, Radix Rehmanniae Glutinosae (Sheng Di), 15g, Ramulus Cinnamomi Cassiae (Gui Zhi), 9g, Radix Ledebouriellae (Fang Feng), 9g, Radix Glycyrrhizae Uralensis (Gan Cao), 9g, Radix et Rhizoma Notopterygii (Qiang Huo), 30g, Herba Taraxaci Mongolici cum Radice (Pu Gong Ying), 30g; take as a decoction. Take for about 2 to 4 weeks. In the treatment of 34 cases, there was obvious improvement in 13 or 38.2%, some improvement in 19 cases or 55.9%, and no improvement in 2 cases, or 5.9%. Thus, the total amelioration rate was 94.1%. This formula dispels wind, disinhibits dampness, clears heat, and cools the blood; thus, Fang Ji and Sheng Di are the sovereign medicinals; to assist, use Fang Feng, Gui Zhi, and Qiang Huo to dispel wind and free the network vessels; Pu Gong Ying clears heat and resolves toxins; Gan Cao, when used fresh, can also clear heat, drain fire, and disinhibit the throat. Therefore, this formula effectively treats the swelling of rheumatoid arthritis that moves about and does not stay and is accompanied by fever and throat pain, in fact, active phase rheumatoid arthritis. This formula s name was created by the editor. Jiao Tang Xian Teng Tang (Pepper, Paulownia, Clematis, and Millettia Decoction) (Composed by the Liberation Armie s 189 th hospital) Functions and Ingredients: Warms the middle, dissipates cold, dispels wind, quickens blood, soothes the sinews, and frees the network vessels. This formula mainly treat chronic rheumatoid arthritis. Ingredients: Radix Zanthoxyli (Ye Hua Jiao Gen), 60g, Paulownia (Pao Tong), 30g, Radix Camphorae (Zhang Shu Gen), 24g, Alangii (Ba Jiao Feng), 15g, Radix Clematidis (Wei Ling Xian), 24g, Radix et Caulis Jixueteng (Ji Xue Teng), 30g, Caulis Tinosporae Sinensis

7 (Kuan Jin Teng), 30g; stir-fry the first three in rice wine, then add water to all medicinals and cook over low flame until there are 200mL remaining; take one ji per day divided up in 2 doses, or add a little rice wine and take like that. In the treatment of 96 cases, short-term treatment yielded full recovery in 28.1%, obvious improvement in 36.5%, and good effect in 29.2%. 6.2% experienced no effect. Follow-up after months of 67 cases revealed full recovery of 31.3% and some effect in 76.7%. This formula uses Ye Hua Jiao Gen in order to warm the middle and dissipate cold; Zhang Shu Gen dispels wind and dissipates cold; together with Ba Jiao Feng, Wei Ling Xian, and Kuan Jin Teng they dispel wind, free the network vessels, soothe the sinews, and quicken the blood; Ji Xue Teng quickens the blood and frees the network vessels; stir-frying with rice wine helps the entire formula to dissipate cold and quicken the blood. Thus, [this formula] treats chronic cold damp rheumatoid arthritis with good effect. This formula s name was created by the editor. Chang Jiang Fang (Acorus and Ginger Remedy) (Composed by the Chinese medicine pharmacological research center, Linquan district, Anhui province) Functions and Indications: Dispels wind, disinhibits dampness, and frees the network vessels. This formula mainly treats pain from rheumatoid arthritis. Ingredients: Rhizoma Acori Graminei (Shi Chang Pu), 120g, dried Rhizoma Zingiberis Officinalis (Gan Jiang Fen), 12g, Camphora (Zhang Nao), 90g, Resina Pini (Song Xiang), 300g. First melt Song Xiang; then add in Zhang Nao, followed by Shi Chang Pu and eventually Gan Jiang powder. Stir to evenly distribute all ingredients and until there is a thick paste. When the paste is used, bake until it becomes soft, and then stick it to the affected part. Apply hot once every day. In the treatment of 107 patients, 104 (97.2%) experienced results. This formula uses Shi Chang Pu Gen in order to dispel wind and disinhibit dampness, transform phlegm and free the network vessels; Gan Jiang warms and dissipates cold evils; Song Xiang dispels wind and stops pain. Thus this formula treats rheumatoid arthritis pain resulting from wind-cold in the network vessels obstructing and impeding the qi and blood by way of stopping pain and dispersing swellings. This formula s name was created by the editor. Conclusion: An analysis of the above nine formulas reveals the following: the most frequently prescribed medicinals and thus probably the most effective ones in the treatment of rheumatoid arthritis, regardless of the pattern differentiation, are Fang Feng, Qiang Huo, Gui Zhi, and Dang Gui. Medicinals consistently added for pronounced dampness are Yi Yi Ren and Cang Zhu. The best medicinals for heat accompanying impediment are Shi Gao and Zhi Mu; and for cold type impediment, Fu Zi is the preferred medicinal. This short analysis points out some basic herbs which probably should go into any formula for the treatment of rheumatoid arthritis. They could be taken as the core of the formula, with additions and subtractions as

8 needed for the patient s specific TCM pattern. The analysis highlights clinically used medicinals in modern China and thus will help even inexperienced practitioners of Chinese medicine to increase the clinical effectiveness of their herbal formulas. As stated in the introduction, the internal generation of dampness which then potentially transforms into phlegm is an important aspect of impediment. Thus, a healthy diet which stops the continuous production of dampness is of tremendous importance if the treatment ought to be effective. Therefore, the concept of a clear bland diet needs to be explained to the patient and the patient, if at all serious about getting better, absolutely needs to follow such a diet. I have seen several cases of RA in which some patients really conformed to the diet and some did not; differences in their treatment effects are very distinct. A nutshell description of a clear bland diet is a diet free of all sugars (including natural sugars and sweeteners), dairy, and wheat. Furthermore, dampening foods such as potatoes, tomatoes, and citrus fruits should be decreased to a minimum. What one should eat is rice, slightly cooked vegetables (steamed or stir-fried), beans and bean products (such as tofu), fruits, some nuts, and some meats. All liquids should be consumed at room temperature. Basically, such a diet eliminates all dampening products and is a diet which is easily moved and transformed [i.e., digested] by the spleen. For more information about eating healthy according to principles of Chinese medicine, I recommend Bob Flaws The Tao of Healthy Eating: Dietary Wisdom According to traditional Chinese Medicine published by Blue Poppy Press. Again, I cannot stress enough how crucial such a diet is and what kind of dramatic effects it can have on clinical success and patient recovery. Simon Becker holds a diploma in Traditional Chinese Medicine from the Florida Institute of TCM and is a diplomate of acupuncture and herbology in the US. He has studied at the Heilongjiang TCM University Hospital in Harbin, China, and holds a post-graduate certificate in TCM pediatrics from Blue Poppy Seminars. He specializes in pediatrics and hematology and has translated and published a variety of research and articles on these and other subjects of Chinese medicine.