I wish to thank the ICA for giving me this opportunity talk about Chinese Herbal Medicine for the treatment of Interstitial Cystitis.

I.     WHAT IS HERBAL MEDICINE?

What IS Chinese herbal medicine: Like Acupuncture, it is one of the major branches of Chinese medicine. There are more than ten thousand acupuncturists who practice in the USA and acupuncture has been widely accepted by many Americans. But, Chinese herbal medicine is still new to most people in the US. It is worth introducing because it is a powerful and safe  method of treatment. When used correctly, it has almost no side effects. Today, I will talk about what Chinese herbal medicine is, how it works in the body, and the Oriental medicine opinion of IC and how we treat it. I will start with the  basic theory of herbal medicine.

I-1. Classification of Chinese Herbs

There are 365 major herbs and 5,000 minor herbs of which more than 90% are derived from fruit, flowers, bark, seeds, and roots. The remaining 10% are herbs derived from animals.  We call them herbal medicine because it is different from many kinds of other herbs : they have nutritional effects, but the disease treatment purpose is their major. The doctors of traditional Chinese medicine devise herbal prescriptions from over 200 herbs which may take various forms such as tea, pills, capsules, or powders (tea is a traditional form of Chinese herbal medicine). Depending upon the symptoms the patient exhibits, the medically trained doctor chooses 10 to 20 herbs to make up a special formula that best suits the needs of each individual patient.

Chinese herbs are divided into 21 classifications according to their function. To make them better understood, we reclassified them into three major groups. Tonification herbs. Harmful factor elimination herbs, and symptom elimination herbs.

I-2. THREE MAJOR GROUP OF CHINESE HERBS

I-2-1. TONIFICATION HERBS

Also known as strength herbs, mainly support normal body energy and help to build up the body’s natural defense system. This group of herbs has been widely used in treating immune deficient disorders such as cancer patients who are undergoing chemotherapy or radiation and auto-immune disease sufferers. They are also used just to strengthen body energy for general health purposes and to help the body recover form illness.

All of these herbs have shown notable immune system effects. There are about 30 herbs in this groups that have been used very often to improve the immune system.

I-2-2. HARMFUL FACTOR ELIMINATION HERBS

According to Chinese medicine. Disease causes are both internal and external. Internal causes are seven emotions, Exciting, Angry, Worry, Anxious, Sad, Fear, and Shock. External causes are six environmental factors: Wind, Cold, Heat, Dampness, Dryness, and Fire. Food and fatigue are two other causes. This group of herbs acts as a guard. They help our bodies to repel pathogens by promoting body purification and enabling the body to reduce the harms from internal (7 emotion) and external causes ( 6 environmental). Many of the herbs in this category has been shown to have anti-bacterial as well as anti-viral qualities. Some examples of  harmful factor elimination herbs are: Herbs to reduce harmful heat, Herbs to reduce cold, hervs to reduce dampness, herbs for rheumatism, herbs to destroy parasites, herbs for ulcers or tumors, and herbs to induce perspiration.

I-2-3. SYMPTOM ELIMINATION HERBS

Herbs that work directly on specific symptoms are symptom eliminator herbs. Actually, tonification and harmful factor elimination herbs are symptom eliminator herbs as well because they indirectly strengthen the body energy or attack the internal or external harmful factors, Examples of symptom eliminator herbs that work directly on specific symptoms are: Herbs to induce bowel movement, herbs to promote digestion, herbs to suppress cough, herbs to regulate Qi, herbs to regulate blood, herbs to regain consciousness, herbs to reduce anxiety, herbs to stop involuntary movements, and herbs for external applications.

II. HOW DO CHINESE HERBS WORK IN THE BODY?

To understand how Chinese herbal medicine works on our bodies, there are some terms to be introduced.

II-1. INTRODICE SOME TERMS

II-1-1. Qi

Qi is the vital energy which runs through the meridians in the body. Every aspect of movement in the body is a manifestation of the flow of Qi, As the Chinese book says: “When Qi gathers, so the physical body is formed: when Qi disperses, so the body dies.” Qi is constantly ascending, descending, entering, and leaving the body. Good health is dependent on this continuos dynamic activity. The maintenance of normal body temperature is a function of the warming action of Qi. Qi is responsible for protection the body from invasion by external environmental factors such as cold, heat, damp, and internal pathogenic factors such as emotional blockage that may cause illness. The action of Qi in the body is crucial in transforming blood and body fluids into their right place. A healthy and strong Qi is vital in holding the various organs, vessels, and tissues of the body in their correct position, therefore facilitation their correct functioning.

II-1-2. YIN AND YANG

Yin and Yang are two different body energies. Yin energy means cold, quite and negative like water inside. Yang energy means hot, active and positive like fire inside. Yin and Yang have to be balanced, Examples of deficient Yang energy is cold hands and fatigue like many IC patients experience. They are lacking Yang energy to warm them. An example of deficient Yin energy is menopause symptoms such as hot flashes, thirst and anxiety. They lack the water to neutralize the fire.

II-1-3. MERIDIAN OR CHANNEL

Meridians or channels are the complex circulation systems which carry the Qi around the body. Our bodies have 12 meridians. These are:

             Lung             (11)                                        Large Intestine     (20)

            Spleen          (21)                                         Stomach              (45)            

            Heart             (9)                                          Small Intestine      (19)  

            Kidney          (27)                                         Bladder               (67)

           Pericardium     (9)                                          Triple Warmer      (23)

            Liver              (14)                                        Gall Bladder          (44)
 

The meridians are not static lines, but are active currents of Qi which move through the channel system in cyclic routes. The Qi or energy is running through the meridians. Free flow of Qi results in a good immune system. If for any reason the free flow of Qi is out of balance, either sluggish or stuck somewhere, the blockage of Qi will decrease the function of the immune system. Eventually this person will get sick or experience pain.

II-2. HOW DOES CHINESE HERBAL MEDICINE WORK IN THE BODY?

Herbal medicine and acupuncture work though stimulation of the meridians. The effect occurs internally by regulation Qi. They help to remove blockage of the meridians and strengthen the meridians making them less vulnerable to attacks. This helps to red the symptoms from the body.

III. ORIENTAL MEDICINE OPINION OF IC

I became involved in Interstitial Cystitis clinical research in 1994 when Dr. Kristene Whitmore and Dr. David Gorden from the Graduate Hospital of Philadelphia started referring IC patients to my acupuncture office. We divided the patients into three groups: Acupuncture, herbal medicine, and combination of both. Herbal medicine treatment proved to be the most effective.

III-1. INTERSTITIAL CYSTITIS

As we know, IC is a difficult disease to manage. It is said that IC has no cure.

III-2. ANALYSES OF IC WITH CHINESE MEDICAL THEORY

III-2-1. IC IS A TYPICAL KIDNEY DEFICIENT SYNDROME

through case analysis in our research, we found that IC is a typical syndrome of deficient kidney energy. According to Chinese medicine, the patients have extreme pain in their pelvic area. They experience frequency. Low energy, weakness in their lower back area and discomfort in the inner thigh area.  The oriental diagnosis is that IC is deficient kidney energy.

III-2-2. TWO DIFFERENT KINDS OF IC SYNDROMES

We also found that IC patients are not all the same and fall into two different categories. 70 - 80% of them are cold IC patients. Their hands and feet are icy cold. They look pale. They don’t want to drink a lot of water. They may feel relief after urination. Emotionally, they express more feelings of depression than anxiety. This is a group of kidney Yang energy deficient syndrome patients. The sign is their cold hands and feet.

About 20% of the patients are hot IC patients. Instead of icy cold hands, their hands and feet are kind of warm. They are thirsty and drink a lot of water. They may not feel empty or relief after urination. Emotionally they express more feelings of anxiety than depression. This is a group of kidney Yin energy deficient syndrome patients. The sigh is their hands are warm. This group of IC patients seems to have a more sensitive bladder. They are allergic to many things and even the basic nutrients make them flare up.

III-2-3. THE FUNCTION OF KIDNEY SYSTEM

In Oriental medicine, the kidney is a place of storage of the congenital energy known as Qi. Its function is to excrete waste through the urine. The kidney is the original source of energy in the body for growth and function. It is not difficult to understand why IC patients are exhausted. The basic theory is that the kidney and bladder work as a pair in function. The kidney is the controller and the bladder is the executive organ. In Chinese medicine, chronic bladder disorders are due to kidney dysfunction.

III-2-4. THE CHINESE MEDICINE EXPLANATION OF IC SYMPTOMS

The Chinese medicine explanation of IC symptoms is the following: Pain and burning are experienced because of the meridian blockage of both the bladder and kidney and thus the Qi can not flow through the meridian. The frequency is caused by the lack of power in the kidney which causes the bladder to be out of control. The discomfort in the inner thigh area is because this is the pass way of that meridian. The weakness in the lower back is on the location of the blocked meridian. The dizziness and ear ringing is because the ears are the opening of the kidney meridian. 

IV. HOW DO WE TREAT IC PATIENTS?

In these three and one half years of clinic work we have changed and improved the IC herbal formula several times, until it fits the IC problems much better. The basic ingredients of  this IC herbal formula are the following herbs.

IV-1. THE IC HERBAL FORMULA

1.     Shutihuang  (Rehmannia Cooked)

 Meridian and energy Liver and  Kidney. Slightly warm.

Action: Correct deficiencies; nourish kidney; to strengthen blood and Yin energy; stop hair loss.

Indication: Effect on immune system. Good for kidney Yin energy deficiency. To treat dizziness and vertigo. An effective blood tonic. To treat palpitation, heavy menstrual bleeding, blood in urine.

2.     Shanyao ( Dioscorea)

Meridian and Energy:  Spleen, kidney, lung and stomach. Neutral.

Action: Correct deficiencies. To strengthen kidney and lungs. Tone up the spleen and stomach.

Indication: Kidney deficiency with discharge; Frequency or incontinence; Diabetes; Spleen deficiency with diarrhea.

3.     Fuling ( Poria)

Meridian and Energy:  Lung, Spleen, Heart, and Urinary Bladder. Sweet and neutral.

Action: To regulate the water metabolism; resolve dampness; To reinforce the spleen and stomach.

Indication:  High Cholesterol; edema; acute or chronic kidney and bladder problems.

4.     Shanyurou (Cornus)

Meridian and Energy: Liver and kidney. Slightly warm.

Action: Herbs to tone up the liver and kidney; astringent discharge or nocturnal emission.

Indication: To treat heavy menstrual bleeding or discharge; kidney deficiency with excessive urination; to treat insomnia; excessive perspiration; ear ringing.

5.     Zexie ( Alisma)

Meridian Energy: Kidney, Urinary Bladder. Sweet and cold.

Action: To eliminate heat and dampness in the lower burner of the body. To regulate water metabolism and resolve dampness.

Indication:  High cholesterol; edema; acute or chronic kidney and bladder problems.

6.     Xianmao ( Curculigo)

Meridian and Energy: Kidney; spleen and liver.  Warm, pungent.

Action: To warm up the kidney; to reinforce the vital function of sexual organ; to strengthen the sinews and bones; to dispel cold and dampness.

Indication: Impotence; frequency; icy cold body; aching back and knees; abdominal coldness; diarrhea; pain and spasms of the limbs; urorrhea.

Note: Increase function of immune cells.

7.     Bajitian ( Morinda)

Meridian Energy:  Liver;  kidney. Sweet and pungent.

Action: To reinforce the vital function of the kidney; to strengthen the bones and tendons; to dispel wind and dampness.

Indication: Impotence; premature ejaculation; Female infertility; arthritis with difficult walking.

8.     Tusizi ( Cuscuta)

Meridian Energy: Liver and kidney. Sweet, neutral.

Action: To replenish the kidney and essence of life; to nourish the liver and brighten the eyes.

Indication: Impotence, vertigo, threatened abortion, chronic diarrhea. Research shows it increase the immune cells function.

9.     Zhizi ( Gardenia)

Meridian: Heart; lung; liver; Gall blader; stomach and triple-warmer.

Energy:    Bitter and cold.

Action: To clear heat and dampness, to clear pathogenic heat and toxin from the blood, anti-fever and sedative.

Indication: Fever; inflammation;  anxiety; vomit blood or urinate blood.

10. Zhimu ( Anemarrhena)

Meridian and Energy: Lung, Stomach and Kidney. Bitter and cold.

Action: To eliminate the heat; to purge the heat and fire of lung and stomach.

Indication: High fever with thirst in acute infectious disease; low back pain.

11. Dahuang ( Rhubarb)

Meridian and Energy:  Liver; Spleen; Stomach and Large intestine. Bitter and cold.

Action: To eliminate pathogenic heat; to invigorate blood circulation and eliminate stasis; to treat jaundice; detoxification.

Indication: Constipation and abdominal fullness; excessive heat in the blood; dysmennohea; acute appendicitis.

12. Xiyangshen (American ginseng)

Meridian and Energy: Heart, Lung and Kidney. Sweet and slightly bitter.

Action: To tonic (strengthen) Yin energy; to promote the secretion of body fluids; to reduce the internal heat.

Indication: Chronic fatigue; chronic cough due to lung deficiency; low grade fever and night sweating. Slightly anti-pain; anti-anxiety.

IV-2. EXPLANATION OF IC HERBAL FORMULA

The ingredients in numbers 1 through number 5 are the major herbs which based on the master formula of “ Liu-wei-ti-huang-wan”. It is a time proved formula which works on correct deficiency of kidney, especially chronic kidney disorders. We know that in IC patients, the bladder is out of control is due to the fact that kidney has lost its power in this functional pair. The effect of this  master formula is to strengthen the energy of the kidney, especially the Yin energy. The theory is the stronger the kidney is the better the order of the bladder will be.

Number 6 through number 8 are three kidney Yang energy tonic herbs. We use three of them together instead of one which is called multiple tonic method in herbal medicine. They all work on worm up the kidney through strengthen the Yang energy. The result of this multiple tonic method is reinforcement of the kidney and the cold and dampness is dispelled.  This group of kidney Yang tonic herbs make the master formula more specific on the IC symptoms, for instance, these help the icy cold hands and body to warm up. 

Number 9 through 11 are three herbs that work to dispel harmful heat. These are all cold herbs.  We use these three herbs to neutralize the strengthen herbs which are all hot or warm. We also use these cold herbs because IC patients often have burning in the pelvic area which means they have harmful heat in their bodies. They need harmful factor eliminator herbs to repel it. Number 11 Dahuang, especially effective in increasing the movement of gastrointestinal system and eliminating the amassed content if the patient has any. This also helps relieve the pelvic pain.     

Number 12, American ginseng is basically a Yin energy tonic herb it makes the whole formula more effective by  increasing the immune function. It also reduce the internal harmful heat which suits the problems of the IC patient.

Pin most cases this formula works better on the cold style patient than it does on the hot style patient, however in some hot style patients it works well because they all have kidney deficiency. In my practice, the hot style patients tend to be more allergic to a lot of things. I use allergy elimination treatment for this style which desensitizes the bladder. They have good results. We need more research on that.

V. THE RESULTS OF HERBAL MEDICINE TREATMENT

V-1. DESING OF HERBAL MEDICINE TREATMENT SURVEY

After six months of research, we formulated a special herbal formula IC treatment. In May of 1996 the ICA first introduced our research work and the herbal formula to IC patients.  We then initiated a long distance IC treatment program. As of  November 1996  a total of  31 patients provided information for our statistical calculations. 30 (96%) females and 1 male (4%). The duration of their symptoms is from 4.5 months to 20 years with an  average 6.5 years.  Seven of the 31 (23%) patients are on narcotics for their pain. Thirteen of the 31 (42%) have other health problems, i.e. constipation; fibromyalgia; irritable bowel syndrome, or migraine headaches.

I noticed that pain, frequency, urgency, low energy and emotional distress are the major symptoms of IC and they were my major concern when I prescribed the herbal formula. I also noticed that a large number of the patients have gastrointestinal problems, headaches and other disorders. I took this combination of symptoms into my consideration as well.

V-2. RESULTS OF SURVEY

To standardize the results, we use pain, frequency, energy level and emotional level as the 4 factors to evaluate the IC cases (see appendix 1. IC Self Evaluation and appendix 2 Interstitial Cystitis Scores).

·        PAIN

 The majority of IC patients suffer from pain and we used  pain level as the major factor in the evaluation of patients after they received herbal treatment.  During the basic treatment we asked patients to complete an IC pain dairy (see appendix 3 Interstitial Cystitis Patient Pain Diary) which we designed in the initial studies. This is a 10 grade scale with 10 being the most severe pain, 5 being the medium and 1 being the mildest. Each month we calculate the average of the pain points for our study.

25 patients initially have pain in their bladder or pelvic area  ranging from 3 to 10 with an average of 6.96 indicating that the majority of the IC patients had pain and   pain sever enough to interrupt their normal lifestyle.

After the first month of treatment the average pain level decreased from 6.96 to 5.08, which is a 27% decrease and is a significant difference compared to the original data.  After the second month of treatment, the average pain levels were down to 4.18, there is a 39.9% decrease compared to the original data.  After the third month of treatment the average pain level reached is 4.0, a 42.5% decrease.  It is clear that the herbal treatment controls pain well. And the IC patients receive the best results gradually within 3 months (see appendix 4 Average Pain-Point During the Treatment).

·        FREQUENCY

Before the herbal treatment the average frequency time between urination of the 25 patients was between 30 to 60 minutes. We use a word of  “High Frequency” to indicate the patients that urinate at least once every hour.  We use the term “Low Frequency” in reference to patients who indicated a time of at least one hour between urinating. Sixty percent, or 15 of 25 patients, reported high frequency and  40%, 10 of 25 patients, reported low frequency.

These statistics changed as follows (see appendix 5 The Frequency level during 3-Month Treatment):

                                         High Frequency                           Low Frequency

One month treatment:        36 % or 9 of 25 patients              64% or 16 of 25 patients

Two months treatment:      30% or 7 of 23 patients               70% or 16 of  23 patients;

Three months treatment:   20% or 4 of 20 patients                80% or 16 of 20 patients.

After three months treatment, 45% of the patients reported that their urination times are over 2.5 hours which is closer to the average report in healthy people.

We have found a positive correlation between the improvement of frequency and the improvement of pain levels. These results suggest that pain and frequency are the combined symptoms of IC. With herbal treatment, it takes one month to see a decrease in pain, but takes two to three months to see the same decrease in frequency.

·        ENERGY LEVEL

We used “limited” and “good” as two values for energy level. Before the treatment 76%  or 19 of 25 patients reported limited energy. Only 24% or 6 of 25 patients reported that IC had no affected  their energy away (see appendix 6 Percentage of Patients with Limited Energy Condition).

After three months herbal treatment,  the number of limited energy patients decreased to 15%  or 3 of 20 patients. The majority of them experienced normal energy levels.

·        EMOTIONAL DISORDER

Anxiety and/or depression are quite often the result of having IC. We used “yes” and “no” as answers for anxiety or depression . Initially, 75% or 18 of 25  patients answered yes to experiencing anxiety and/or depression because of their IC pain and other symptoms.  After three months of herbal treatment, as long as their physical pain and frequency are under control, the anxiety and depression cases are down to 20%  or 4 of 20 patients ( see appendix 7 Percentage of Patients with Emotional Disorder).

OVERVIEW OF RESULTS 

To make a standardized overview of the results after the basic three months herbal treatment, we applied the term  “ well under control” to patients who met the following criteria:

·        A pain level of  3 or less.

·        A duration of 2.5 hours between urinating.

·        Normal energy and normal emotional level for  a month or more.

The results show that 52% of the patients are well under control. 24% of the patients have significant improvement even though they are not well under control. 4% showed small improvement.  20% of the patients showed no response at all to the herbal treatment.

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