Geriatric medicine: A TCVM approach (Proceedings)

According to the National Research Council, the term "senior" refers to an animal's functionality, such as decreased activity, weight gain, and other age-related physical and behavioral changes. The term "geriatric" refers to the animal's chronological age which differs according to size and species.

The goals for our geriatric patients include increased life expectancy, enhanced quality of life, decreased rate or cessation of progression of metabolic changes, delayed onset of diseases and dysfunctions, and decreased clinical signs of aging. Some of the inevitable changes that do occur include gastrointestinal dysfunction, decreased rate of intestinal transit time, diminishing enzyme activity, decreased absorption rate, decreased rate of excretion of nutrients, impaired circulation, decreased organ reserves, reduced lean body mass, decreased basal metabolism and decreased physical activity.

General Treatment Recommendations for Geriatric Patients

Traditional Chinese Veterinary Medicine (TCVM) treatment protocols may consist of acupuncture, Chinese herbal medication, Chinese food therapy, Tui-na, and daily exercise. Lifelong herbal medication is often required in geriatric patients due to the chronic nature of most geriatric diseases. As discussed earlier, optimal response to treatment occurs when 2 or more of these methods are utilized due to their synergistic interaction. General treatment recommendations for geriatric patients are:

• Treat as early in the disease process as possible

• Stimulate fewer acupoints and for a shorter duration

• Avoid chronic use of strong herbals; use short courses if these herbals are necessary.

• Administer 1/2 to 2/3 of the standard dosage of acupuncture and Chinese herbal medication

• Lifelong herbal medication may be required due to chronic nature of most geriatric diseases

• Exercise patients daily and combine with Tui-na (Chinese medical massage)

Chinese Food Therapy

The general TCM food therapy tenets for geriatric patients are:

• Support the Middle Jiao

• Support Kidney Essence

• Prevent Qi or Blood vacuity

Easily digestible foods such as well cooked or pureed foods, porridges, master soups, stews, eggs and fish are recommended. Digestive enzymes help support the Spleen and Stomach as they aid these Zang Fu organs (TCM internal organs) in the transformation (digestion) of food. Probiotics, vitamin and mineral supplements and fish oil are also recommended. Avoid overfeeding, feeding late at night, rapid and extreme dietary changes, excessively cooling foods, raw foods and meals that are fatty, oily or roasted meals. In TCM, a high protein diet and heavy meat meals should also be avoided as they weaken geriatric bones and strain the Zang Fu organs of digestion, respiration and circulation.

Tui-na, An-mo

Tui-na, also known as An-mo, is a form of Chinese medical massage that is used for the prevention and treatment of disease. There are over 30 different techniques, most of which are applied to acupuncture points and meridians. Other Tui-na techniques involve stretching and gently shaking the limbs. Tui-na should be used cautiously and in moderation in very old and debilitated animals.

Systemic effects of Tui-na include unblocking and regulating meridians, regulating the circulation of Qi and Blood, balancing Yin and Yang, regulating Zang-fu organs, and strengthening the body's resistance. Local effects seen include removing stagnation, invigorating blood, decreasing/eliminating swelling, relieving spasms, reducing/eliminating tissue adhesions and smoothing joints.

Patterns of Disease in Geriatric Medicine

From a TCM perspective, problems and diseases seen in geriatric patients are primarily caused by Deficiency or a combination or Excess and Deficiency. Qi Deficiency, Blood Deficiency, Yin Deficiency, Stagnation of Qi and Blood, and Phlegm (a secondary Excess), are the most common patterns seen in our older patients. Weakness and Qi and/or Blood deficiency, enable the invasion of pathogens such as Wind, Cold, and Heat which then develop into disease. In Western terms, we can think of invasion of such pathogens as viral, bacterial and fungal invasion with the subsequent development of disease. It is important to note that clinical signs are often subtle even when disease or imbalance(s) is severe, and that multiple concurrent disharmonies are common in our geriatric patients.

Yin Defic

The concept of Yin and Yang are at the root of Chinese medicine. All physiology, pathology and treatment can empirically be reduced to Yin and Yang, so although the terms are seemingly simple and eloquent, they are also extremely profound. In simple terms, Yin can be considered the body's air conditioner. Hence clinical signs of Yin Deficiency are those associated with a malfunctioning or broken air conditioner (i.e., heat): panting, restlessness at night, increased thirst especially at night, seeks cool areas to lie down, dry skin and haircoat, ears/body warm to the touch, constipation.

• Tongue: Red, may have yellow coat

• Pulse: Rapid, weak, thin, may be slippery or choppy

• Acupuncture: Kid-3/6, SP-6/9, BL-23

• Herbal Medication: Liu Wei Di Huang Wan (Kidney and Liver Yin tonic), Da Bu Yin Wan (Great Tonifying Yin Pill. Kidney Yin tonic and reduces deficient heat), Bai He Gu Jin Tang or Lily Combination (Jing Tang) for Lung Yin Deficiency (dry cough, asthma).

• Food Therapy: Bone marrow soup, clam, fish (cod, whitefish, deep ocean fish), turkey, rabbit, barley, brown rice, buckwheat, millet, Coix (Yi Yi Ren, Seed of Job's Tears), barley or wheat grass, barley sprouts, broccoli, celery, Chinese cabbage, cucumber, eggplant, microalgae (chorella, spirulina, blue-green algae), seaweed, spinach, black beans, mung beans, tofu, apple, banana, bitter melon, pear, watermelon, almonds (ground or almond butter), sesame oil, flax seed oil. Warm foods should be used cautiously or avoided

Qi Defic

As Qi can be thought of as energy, bioelectric force, prana or vital force, it is considered to be the fuel that runs the body. Qi is often used to describe the functional activities of the Zang Fu organs. Animals with Qi Deficiency exhibit clinical signs such as general weakness, exercise intolerance, fatigue, poor appetite/anorexia, muscle atrophy, cachexia, loose stool, urinary incontinence, and fecal incontinence. Simply put, Qi deficiency equates to a lack of fuel, which results in decreased function of various systems.

• Tongue: Pale, wet, swollen

• Pulse: Weak, thin

• Acupuncture: ST-36, LI-10, BL-20/24/26. CV-4/6 for Kid/SP Qi Deficiency; CV-17 for LU/HT Qi Deficiency.

• Herbal Medication: Si Jun Zi Tang (Spleen and Stomach Qi Deficiency), Bu Fei Tang (Lung Qi Deficiency with mild Lung Yin Deficiency), Bu Zhong Yi Qi Tang (Severe Deficiency and sinking of Spleen and Stomach Qi; anorexia, fatigue, shortness of breath, chronic diarrhea, uterine/rectal prolapse, fecal incontinence from weakness, limb weakness, asthma). ** Bu Zhong Yi Qi Tang is contraindicated in patients with hypertension.

• Food Therapy: Neutral and warm foods. Beef, chicken, duck, eggs, lamb, mackerel, salmon, trout, corn, brown rice, coix (Yi Yi Ren), glutinous rice, millet, oats, green peas, lentils, potato, pumpkin, soybeans, shiitake mushrooms, string bean, sweet potato, winter squash, yam, date, figs, longan, lychee, coconut, molasses.

Blood Deficiency

TCM Blood is more than Western biomedical blood. In TCM, Blood is a dense, material form of Qi and is inseparable from Qi. It nourishes and moistens the body, is the foundation for mental activities and is the root of the mind. We can think of Blood as the rope and anchor of a sailboat. When the rope and anchor are secure, the boat is safe and stable. When they are not secure, the boat is at the mercy of the wind. Chronic Blood Deficiency may lead to Qi Deficiency and Blood Stagnation. If these conditions are not rectified, pain and serious diseases such as cancer and heart disease may develop. Clinical signs of Blood Deficiency include insomnia, lethargy, fatigue, depression, restlessness, anxiety, poor memory, agitation, dry and flaky skin, dry haircoat, dry and cracked foot pads, dry nails, pruritus, muscle tremors, hyper-pigmentation and thickened skin.

• Tongue: Pale, dry

• Pulse: Choppy or fine

• Acupuncture: SP-6/10, BL-17/18/20/21, ST-36

• Herbal Medication: Si Wu Tang. With Qi Deficiency: Ba Zhen Tang or Eight Treasure Decoction

• Food Therapy: Beef, bone marrow, egg, beef heart, beef liver, salmon, sardine, amaranth, barley, coix (Yi Yi Ren, Job's Tears), oats, short grain rice, beets, carrots, chlorophyll-rich foods (microalgae), dark leafy greens, parsley, seaweed, adzuki bean, black bean, kidney bean, apricot, avocado, date, fig, longan, black sesame seed (ground), sunflower seeds (ground), fatty acids, black strap molasses. Note: Blood tonics can be rich and cloying so diarrhea may result when used in excess.

Phlegm (secondary Excess)

In TCM, anything strange can be thought of as phlegm. Phlegm is the accumulation of pathologic fluids. As it causes obstruction, Phlegm has the potential to cause serious diseases such as cancer. Furthermore, it can give rise to or worsen Blood Stagnation. Clinical signs of Phlegm include nodules, masses, lymphadenopathy, numbness, gall bladder stones, renoliths, bone deformities, coughing, pneumonia, nausea, sluggishness, depression or anxiety.

• Tongue: Purple, swollen, and may have white foam or a sticky coat.

• Pulse: Wiry or slippery.

• Acupuncture: ST-40, BL-20/21, ST-36, SP-6/9

• Herbal Medication: Phelgm-Transforming Formula (Golden Flower), Phlegm Fat Formula (Jing Tang. For Obesity), Max's Formula (Jing Tang. For masses, lipomas, nodules in old or weak animals). Resolve AI (Evergreen Herbs. For nodules, swellings, masses).

• Food Therapy: Digestive enzymes! Beef, chicken, salmon, trout, tuna, barley, rye, adzuki beans, kidney bean, mung bean, soy bean, alfalfa, carrots, celery, corn, radish, mushroom, pumpkin, radish, seaweed, sweet potato, turnip, winter squash, yam, apples, apricots, dates, figs, jujube (Da Zao Chinese dates), ginger, garlic. Avoid: Dairy, banana, very oily and fatty foods, raw foods, cool/cold foods

Stagnation of Qi and Blood – General Pain Management for Bi-Syndrome (Arthritis)

Stagnation refers to the obstruction in normal movement or flow. When Qi and Blood stagnate, this lack of flow produces symptoms such as sleeping longer, decreased activity, stiffness or pain when rising, and behavior changes such as irritability or anxiety. In geriatric patients, this is frequently attributed to "normal aging". However, simple techniques in TCM can often resolve the stagnation and the patient can experience a return to "youthfulness". Stagnation of Qi and/or Blood can manifest in other ways besides arthritis, degenerative joint disease or pain however we will focus on this one aspect of Qi and Blood stagnation.

• Tongue: Purple

• Pulse: Choppy; may be wiry

• Acupuncture: Local points, Ah-shi points (trigger points). Other general points include Bai-hui, Shen-shu, Shen-peng, Shen-jiao, BL-60, Hua-tuo-jia-ji (IVDD, back pain), Jing-jia-ji (cervical stiffness or pain). For Liver Qi Stagnation: GB-20/21/34, Liv-3, BL-18/19.

• Herbal Medication: Body Sore (Jing Tang). Numerous other formulas are available but require further pattern differentiation.

• Food Therapy: Chicken, lamb, venison, crab, shrimp, carrot, mustard greens, parsley, radish, watercress, chestnut, hawthorn berry, orange/tangerine peel, small amounts of the following herbs/spices: Chive, clove, coriander, dill seed, garlic, ginger, turmeric. Small amount of vinegar.

Strengthen Wei Qi/Immune System Enhancement

In TCM, Wei Qi protects the body and is often equated with the Western biomedical immune system. By strengthening Wei Qi, a practitioner can strengthen the immune system to help prevent or to treat viruses, colds and even neoplasia. Wei Qi is also often tonified for adjunctive treatment of various concurrent diseases.

• AP: GV-14, LI-4/10/11, ST-36, Bai-Hui, BL-20/21, LU-1

• Herbal Medication: Wei Qi Booster (Jing Tang), Immune + (Evergreen Herbs)

Western medicine and TCM share the same goals in geriatric case management: prolonged and enhanced quality of life. Acupuncture, Chinese herbal medication, Chinese food therapy and Tui-na provide the practitioner with minimally to non-invasive methods of achieving these goals, especially when used in conjunction with Western diagnostics and select Western treatment protocols.