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If you have missed three periods in a row and you are not pregnant or menopausal, this is a matter of serious concern. You should be especially concerned if you are dealing with infertility issues, or are at risk for osteoporosis. Under these circumstances, it would be wise to visit a doctor or consult a women’s health specialist. The absence of menstruation in pre-menopausal women is called amenorrhea. If menstruation has not begun by the age 16, it is called “primary amenorrhea.” If previously normal menstruation stops for more than three months in a woman who is not pregnant or breast feeding and is not nearing menopause, it is called “secondary amenorrhea.”

Amenorrhea in Conventional Medicine
From the viewpoint of conventional Western medicine, normal menstrual cycles are based on a complex feedback system between the hypothalmus, the pituitary gland, and the ovaries, as well as the cyclical reaction of the lining of the uterus (the endometrium) to sex hormones. Primary amenorrhea is considered to be caused by one of the following disorders: hypothalamic disorder, such as deficiency of thyrotropic, adrenocorticotropic or gonadotropin-releasing hormones; pituitary insufficiency; or an ovarian disorder, such as a sex-chromosome problem. Secondary amenorrhea can be caused by any of the following disorders: pituitary dysfunction; ovarian dysfunction; adrenal gland dysfunction; thyroid dysfunction, etc. Quite a few hormones are involved in the absence of menstruation, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estrogen, progesterone, androgen, and gonadotropin-releasing hormone (GnRH).

Because menstrual irregularities are so strongly linked to hormone imbalances, it is natural for doctors to prescribe hormone therapy to regulate menstrual cycles. Progesterone and estrogen are given to start or restart the periods. Estrogen supplements are frequently prescribed to help prevent osteoporosis in women with no underlying disorder if the amenorrhea has lasted for more than six months. Birth control pills are the most popular form of estrogen replacement therapy. If hormone replacement therapy is recommended to you, it is important for you to know about the functions of these hormones, as well as their side-effects and long-range effects. In this article, we will focus on secondary amenorrhea in the framework of Chinese medicine.

Amenorrhea in Chinese Medicine
In traditional Chinese medicine, the most important organs that regulate Blood and menstruation are the Liver, Spleen, and Kidneys; and the key Fundamental Substances are Chi and Blood. The Liver “stores the Blood,” and is responsible for maintaining a smooth and even flow of Blood, Chi, and emotions through the body. Emotions such as anger, irritation, resentment, and anxiety can lead to stagnation of Liver Chi, which in turn can lead to Blood Stasis (especially in the lower body). A main function of the Spleen is to produce Chi and Blood. If the Spleen is weak, there will eventually be a deficiency of Chi and/or Blood, so there will not be enough blood for normal menstruation, or enough Chi to regulate normal cycles. Also, if the Spleen is too weak, it can lead to a condition of Dampness in the body, and Phlegm-Damp can obstruct the uterus. The Kidneys are the organ responsible for conception, reproduction, and aging over time. Kidney-essence is the ultimate origin of menstrual blood.

Amenorrhea can be differentiated into Deficiency patterns or Excess patterns. With Deficiency patterns, the Blood is exhausted or deficient. With Excess patterns, Chi or Blood may be stagnant, retention of Phlegm-Dampness can lead to obstruction of menses, or there is Blood Stasis.

Besides the mechanisms discussed above, some lifestyle factors can cause amenorrhea. Long-term use of contraceptive pills can bring about Blood Deficiency or Kidney Chi Deficiency. Excessive physical exercise or participation in sports, with over-use of the muscles and sinews, can lead to a deficiency condition of the Spleen and Liver. The Spleen fails to produce adequate amounts of Blood, and the Liver fails to store Blood properly, which leads to amenorrhea.

Patterns and Herbal Treatment of Amenorrhea in Chinese Medicine
The following four patterns are very common in cases of secondary amenorrhea. The first two patterns, Kidney Liver Deficiency and Chi Blood Deficiency are Deficiency patterns. To treat these two patterns, the Deficiency must be tonified. The other two patterns, Chi Stagnation with Blood Stasis, and Phlegm Dampness Retention, are Excess patterns. For these two patterns, the Excess should be eliminated through the use of Chinese herbal medicines.

Kidney Liver Deficiency.General weakness, malnourishment of the Kidneys and Liver, or an irregular sex life are the origins of this pattern. Symptoms include: absence of menstruation for a significant period of time; a thin body; dizziness; palpitations; back and knee soreness; insomnia; dream-disturbed sleep; chest congestion; anxiety; hot flashes; excessive perspiration; a red tongue body, absence of tongue coating, or cracks on the tongue; and a wiry-rapid-thin pulse. Rehmannia (Shu Di Huang), dioscorea root (Shan Yao), and angelica (Dang Gui) are the leading herbs that tonify Kidney-essence and Liver Blood. Restoring Kidney Formula (Gui Shen Wan), which includes these herbs, is a wonderful formula for this pattern of amenorrhea.

Chi Blood Deficiency. Chronic illness; excessive bleeding from childbirth, miscarriage, or surgery; or prolonged breast feeding are possible origins of this pattern. Typically, periods become scantier and scantier at the end of the cycle, and eventually cease altogether. Other symptoms include: a pale complexion; dizziness; palpitations; weakness of the limbs; lassitude; loose stools; a pale, thin tongue; and a thin-wiry or thin-weak pulse. Ginseng (Dang Shen) is the top Chi tonic herb. Angelica (Dang Gui) is the leading Blood tonic herb. Chi Blood Tonic (Ba Zhen Tang) is the most widely-used herbal formula for the Chi Blood Deficiency pattern.

Chi Stagnation and Blood Stasis. Emotional stress or trauma is the most common origin of this pattern. Menstruation ceases after intense or prolonged emotional stress or trauma. Symptoms include: absence of menstruation; depression; anxiety; a sensation of fullness in the chest and under the rib cage; swelling or fullness of the abdomen with an aversion to pressure; lack of appetite; thirst; desire to drink cold water; constipation; sides of the tongue are purple, with a yellow-white-sticky tongue coating; and a thin-wiry or deep-choppy pulse. Buplerum (Chai Hu), angelica (Dang Gui), and white peony (Bai Shao) are some popular herbs, and Liver Spleen Harmonizer (Xiao Yao San) is a well-known herbal formula to address this pattern.

Phlegm Dampness Retention. Chronic overweight or a deficient Spleen are a common background for this pattern, as well as the habitual consumption of cold, raw, or greasy foods (especially dairy products). Overweight and Spleen Deficiency contribute to metabolism problems, and retention of Phlegm Dampness leads to absence of menstruation. Other symptoms include: a feeling of fullness and congestion in the chest and lower rib cage; nausea; vomiting; a feeling of sticky phlegm in the mouth; lassitude; large amounts of sticky, mucoid vaginal discharge; a yellow-white-sticky tongue coating; and a thin-slippery pulse. Single herbs such as atractylodes lancea tuber (Cang Zhu), cyperus tuber (Xiang Fu), and tangerine peel (Chen Pi), and an herbal formula, Phlegm Cleansing (Cang Fu Dao Tan Tang) are widely used to address this pattern of amenorrhea.
Acupuncture vs. Medications for Amenorrhea
Besides herbal medicine, acupuncture and moxibustion are two other widely-used healing tools in traditional Chinese medicine. Although both traditional Chinese medicine and conventional Western medicine aim to achieve the same goal — restart the periods and restore the normal cycle, a significant difference exists between these two modalities. Traditional Chinese medicine stimulates the body to regulate its naturally-occurring hormones and restore the normal hormone function, while conventional Western medicine restores the function of the thalamus-pituitary-ovary axis through the use of artificial hormones. The following clinical study shows that they have very different long-lasting effects.

A clinical study was conducted at the Thousand Buddha Mountain Hospital in Jinan, China, to determine the efficacy of acupuncture vs. medication for amenorrhea. There were ninety-five subjects in the study. All the patients amenorrhea has lasted for six months or more, and was attributed to the use of birth control pills. Fifty-seven of the patients were in the Acupuncture Treatment Group, and thirty-eight patients were in the Medication Group. Two patterns of amenorrhea, Spleen Liver deficiency and Liver-Chi stagnation, were differentiated in the Acupuncture Treatment Group. Acupuncture points Ren 3 (Zhong Ji), extra point Zi Gong, Ki 12 (Da He), Sp 6 (San Yin Jiao), and BL 32 (Ci Liao) were used. BL 20 (Pi Shu), BL 23 (Shen Shu), St 36 (Zu San Li), Sp 4 (Gong Sun) and moxibustion on these points were added for the Spleen Liver Deficiency pattern, while BL 18 (Gan Shu), Liv 13 (Qi Men), and Sp 9 (Yin Ling Quan) were added for the Liver Chi Stagnation pattern. A course of treatments consisted of twenty treatments. The whole treatment consisted of six courses, with five-day breaks between the courses. In the Medication Group, patients took Stilbestrol first, then Progesteronum was injected. One month after finishing the treatments, the effective rate (cure, great improvement and improvement) for the Acupuncture Treatment Group was 96.49%, while the effective rate for the Medication Group was 97.36%. Initially, there was no significant difference between these two groups. Six months after finishing the treatments, however, the effective rate was reported at 94.73% for the Acupuncture Treatment Group, while the effective rate dropped to 78.94% for the Medication Group. This is a significant difference between the two groups, suggesting that the long-range effects of acupuncture are very positive.

Many studies in China reveal that acupuncture, moxibustion, and Chinese herbal medicine are superior to conventional medicine in the treatment of menstrual disorders, including amenorrhea.

By Wei Liu, TCMD, MPH, LAC and Changzhen Gong, PhD, MS - The American Academy of Acupuncture and Oriental Medicine (AAAOM)

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Chi

The concept of qi

Similar to the theory of  yin-yang, qi was derived from ancient Chinese philosophy, which believes everything is related. In traditional Chinese medicine, qi is treated as the fundamental substance of the human body, and its movements explain various life processes. Qi in its physiological sense constitutes, replenishes and nourishes the human body. Qi is often called -vital energy, because it is believed to be the motive energy derived from the essential substance for various vital processes.

Qi is often classified according to what it acts on. For example, the heart-qi refers to the force with which the heart works and the blood circulates, so it regulates the cardiac function; the stomach-qi refers to the force with which the stomach functions, so it regulates the gastric function. The qi that maintains normal functioning for resistance against disease is called zheng-qi, which means genuine energy or body resistance. The qi that warms the body and maintains normal body temperature is called yang-qi, which is similar to the heat energy. Metabolism of materials and energy also depends on the action of qi, including metabolism of blood, fluids and other essential materials.

Qi is formed from the inhaled oxygen, the dietary nutrients, and the inborn primordial qi stored in the kidney, which may be genetically related. Qi circulates along meridians and collaterals. A healthy body requires normal circulations of qi. Health problems occur if the flow of qi is stagnated. The circulation of qi is also closely related to mental conditions. Emotional instability may cause the stagnation of qi. For example, anger may lead to dizziness, headache, distress in the hypochondriac regions, or distention in the stomach with impairment of appetite. On the other hand, the exercise of mind can help the circulation of qi, which is the purpose qigong exercise.

General methods of qigong

Qigong is an exercise to regulate the mind and breathing in order to control or promote the flow of qi. Since qi plays such an important role in the vital processes of the human body, the regulation of qi flow is therefore be used to preserve health and treat disease. Medical qigong, the qi exercise practiced to prevent and treat disease, is different from general physical exercise. While physical exercise is aimed at building up health or restoring physical functioning by enhancing strength, medical qigong is focused on the mobilization of functional potentialities by regulating the mind. In other words, physical exercise is purely somatic, while qigong exercise is generally psycho-somatic. Another important difference between physical exercise and qigong is that physical exercise expends energy by tensing the muscles and accelerating the heart beat and respirations, while qigong works to ease, smooth and regulate breathing to store up or accumulate energy in the body.

Medical qigong can be divided into two main categories: internal qigong, which is practiced by the patients themselves to preserve and promote their own health, and external qigong, which is performed by a qigong master on a person with health problems. Practicing internal qigong requires regulation of the mind, body and respiration. There are many kinds of internal qigong, some with motion and others without. Qigong can be practiced while sitting still, standing upright, or lying on the back or side. The basic requirement is to stay comfortable and relaxed.

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The practice of acupuncture and moxibustion is based on the theory of meridians. According to this theory, qi (vital energy) and blood circulate in the body through a system of channels called meridians, connecting internal organs with external organs or tissues. By stimulating certain points of the body surface reached by meridians through needling or moxibustion, the flow of qi and blood can be regulated and diseases are thus treated. These stimulation points are called acupuncture points, or acupoints.

Acupoints reside along more than a dozen of major meridians. There are 12 pairs of regular meridians that are systematically distributed over both sides of the body, and two major extra meridians running along the midlines of the abdomen and back. Along these meridians more than three hundred acupoints are identified, each having its own therapeutic action. For example, the point Hegu (LI 4), located between the first and second metacarpal bones, can reduce pain in the head and mouth. The point Shenmen (HT 7), located on the medial end of the transverse crease of the wrist, can induce tranquilization.

In acupuncture clinics, the practitioner first selects appropriate acupoints along different meridians based on identified health problems. Then very fine and thin needles are inserted into these acupoints. The needles are made of stainless steel and vary in length from half an inch to 3 inches. The choice of needle is usually determined by the location of the acupoint and the effects being sought. If the point is correctly located and the required depth reached, the patient will usually experience a feeling of soreness, heaviness, numbness and distention. The manipulator will simultaneously feel that the needle is tightened.

The needles are usually left in situ for 15-30 minutes. During this time the needles may be manipulated to achieve the effect of tonifying the qi. Needle manipulations are generally involved with lifting, thrusting, twisting and rotating, according to treatment specifications for the health problem. Needling may also be activated by electrical stimulation, a procedure usually called electro-acupuncture, in which manipulations are attained through varying frequencies and voltages.

Treatment protocols, frequency and duration are a matter of professional judgment of the practitioner, in consultation with the patient. A common course of treatment may initially involve between ten and fifteen treatments spaced at approximately weekly intervals, and spread out to monthly later in a program.

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A professional practitioner will always warn the patient of the possibility of exacerbation at the start of a course of treatment. The patients may find that in the short term after treatment, the symptoms may in fact get worse before an improvement sets in. This is a quite common feature of acupuncture treatment.

Patients should inquire about types of needles used prior to treatment. Most practitioners now use pre-packed and sterilized disposable needles that are only once. If re-useable needles are being used patients should ask to see the sterilization procedures that the practitioner adopts.

The effectiveness of an acupuncture treatment is strongly dependent upon an accurate Chinese medical diagnosis. The needling skills and techniques of the practitioner will also influence greatly the effectiveness of the outcome. Acupuncture can be remarkably effective in many conditions, but in the West, patients often use acupuncture as the last option for their long-term chronic problems. Therefore we sometimes see the treatment as slow and in some cases of marginal benefit. With the gradual establishment of acupuncture as the treatment of choice for many people, the effectiveness of the approach with acute as well as with more chronic conditions is being recognized.

Acupuncture is often conducted in combination with Moxibustion. Moxibustion is the process where moxa sticks, made of dry moxa leaves (Artemisia vulgaris) is ignited and held about an inch above the patients’s skin over specific acupuncture points. Moxa is available in a loose form that can be used for making moxa cones. Alternatively, moxa is packed and rolled in a long stick like a large cigar, about 15-20 cm long and about 1-2 cm in diameter. The purpose of this process is to warm the qi and blood in the channels. Moxibustion is most commonly used when there is the requirement to expel cold and damp or to tonify the qi and blood. A single treatment of moxibustion usually lasts 10-15 minutes. Needle-warming moxibustion combines needling and moxibustion by attaching a moxa stub (about 2 cm long) to an inserted needle. This method enhances the effects of needling and is often used to treat chronic rheumatism and rheumatoid arthritis.

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The philosophical origins of Chinese medicine have grown out of the tenets of Daoism (also known as Taoism). Daoism bases much of its thinking on observing the natural world and manner in which it operates, so it is no surprise to find that the Chinese medical system draws extensively on natural metaphors. In Chinese medicine, the metaphoric views of the human body based on observations of nature are fully articulated in the theory of “Yin-Yang” and the system of Five Elements.

The direct meanings of yin and yang in Chinese are bright and dark sides of an object. Chinese philosophy uses yin and yang to represent a wider range of opposite properties in the universe: cold and hot, slow and fast, still and moving, masculine and feminine, lower and upper, etc. In general, anything that is moving, ascending, bright, progressing, hyperactive, including functional disease of the body, pertains to yang. The characteristics of stillness, descending, darkness, degeneration, hypo-activity, including organic disease, pertain to yin.

The function of yin and yang is guided by the law of unity of the opposites. In other words, yin and yang are in conflict but at the same time mutually dependent. The nature of yin and yang is relative, with neither being able to exist in isolation. Without “cold” there would be no “hot”; without “moving” there would be no “still”; without “dark”, there would be no “light”. The most illustrative example of yin-yang interdependence is the interrelationship between substance and function. Only with ample substance can the human body function in a healthy way; and only when the functional processes are in good condition, can the essential substances be appropriately refreshed.

The opposites in all objects and phenomena are in constant motion and change: The gain, growth and advance of the one mean the loss, decline and retreat of the other. For example, day is yang and night is yin, but morning is understood as being yang within yang, afternoon is yin within yang, evening before midnight is yin within yin and the time after midnight is yang within yin. The seed (Yin) grows into the plan (Yang), which itself dies back to the earth (Yin). This takes place within the changes of the seasons. Winter (Yin) transforms through the Spring into Summer (Yang), which in turn transforms through Autumn into Winter again. Because natural phenomena are balanced in the constant flux of alternating yin and yang, the change and transformation of yin-yang has been taken as a universal law.

Traditional Chinese medicine holds that human life is a physiological process in constant motion and change. Under normal conditions, the waxing and waning of yin and yang are kept within certain bounds, reflecting a dynamic equilibrium of the physiological processes. When the balance is broken, disease occurs. Typical cases of disease-related imbalance include excess of yin, excess of yang, deficiency of yin, and deficiency of yang.


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