General Physiology of the Elderly
Face begins to wrinkle, liver spots appear, hair starts to grey or whiten.
Kidney Qi & Essence becomes deficient poor memory, silver hair, low back pain, floaters, water retention, tinnitus.
Neck starts to sag & wrinkle.
Excess tearing & nasal discharge or dryness may occur.
Auditory decline right = Kidney Yang, left = Kidney Yin.
Visual decline, i.e. cataracts
Short term memory becomes dull = heart
Long term memory becomes dull = kidney (heart & kidney need to communicate)
Emotionally become more sad, bitter, angry, irritable.
4 Ds debility, depression (Qi stagnation), delerium (Phlegm, Blood Stasis), dementia (Essence).
Appetite & taste decrease.
Calcium absorption declines, i.e. osteoporosis.
Sex drive decreases.
Menopause (both male & female).
- 1 General Pathology of the Elderly
- 2 Western medicine says:
- 3 Wu Nan 5 things that shorten life:
- 4 General Herbal Tips:
- 5 Administration & Mixing Medications
- 6 Infectious Disease
- 6.1 Pneumonia
- 6.2 Cholecystitis
- 6.3 Urinary Infections & Prostate problems
- 6.4 Angina
- 6.5 Infarction
- 6.6 Abnormal Heart Rhythms
- 6.7 Heart Failure
- 6.8 Hypertension
- 6.9 Chronic Bronchitis
- 6.10 Emphysema
- 6.11 Ulcers
- 6.12 Chronic Gastritis
- 6.13 Intestinal Obstruction
- 6.14 Constipation
- 6.15 Hemorrhoids
- 6.16 Colon Cancer
- 6.17 Fatty Liver
General Pathology of the Elderly
Deficiency is the overall general pathology.
All 5 Zang fu Qi becomes deficient liver becomes deficient first.
The anatomical Spleen begins to decline first from a scientific point of view.
Check birth date & time for organ & element which will help determine what will become deficient with liver, &/or use clinical observation i.e. long term illnesses &/or deficiencies.
Yin usually becomes deficient first, therefore Yang will rise upwards, i.e. high blood pressure.
Although Yang also becomes deficient with the Yin causing coldness, low energy, & water retention, therefore one must judge % of Yin & % of Yang.
Emotional patterns can change drastically.
Sleep may also change, less sleep = more Yin deficiency.
Constipation is very common among the elderly.
Some other common diseases are: diabetes, hypertension, kidney disease.
- Mild symptoms on the outside of the elderly very often mean severe disease inside, because the elderly are so deficient they cant feel the symptoms as intensely (children are the opposite).
i.e. shortness of breath may actually be a heartattack.
i.e. mild cold (wind/cold) symptoms may actually be pneumonia.
- Elderly always have multiple organ malfunction, not just one (most often 4-6 disease processes).
If >65 years old & have bronchitis suspect cancer, this is especially true if the bronchitis is chronic, the same diet is being taken but the person becomes emaciated, & shortness of breath is present.
Principle of treatment for cancer is to tonify, eliminate Phlegm, move blood, & detoxify.
The pulse is usually wiry, & rapid. If loose bowel movements appears with this pulse it is not a good sign.
- The elderly have more Blood Stasis & Phlegm.
A tumor is essentially 4 things: deficiency, Blood Stasis, Phlegm, & toxicity.
If with a wiry pulse there will be pain, if with a slippery pulse there is Dampness or Phlegm.
- Closed (Jue) & open (Tuo) disorders happen more in the elderly.
Closed (Jue) can be excess or deficiency, i.e. stroke, with closed hands, syncope with closed eyes, closed teeth, temporary loss of mind. Try acupoints PC 6 & Du 26.
Open (Tuo) The loss of Yin or Yang, quite serious, open bowels, urinary incontinence, eyes mouth & hands wide open, possibly coma. Moxa to return Yin & Yang connection, try acupoints Ren 4, Du 20, & Du 26 gently.
Some helpful advice to achieve longevity
Must Read: Male Infertility – Men’s Reproductive Health
Western medicine says:
Diet should be regular, three meals on time.
One must eat breakfast.
Exercise 2-3 times per week but not overly stressful exercise.
Get 7-8 hours of sleep.
Do not smoke, or if you do quit early in life.
Keep alcohol intake to a minimum.
Maintain a normal healthy weight.
Balance your sex life.
Keep good friends and family around.
Traditional Chinese medicine says:
Live to achieve health according to the seasons.
Do not eat too early (before 8am).
Eat soft fruit with grains for breakfast.
Do Qi (energy) exercises in the morning, i.e. Qigong, tai ji, face/gum massage, click teeth for kidneys.
Keep mouth closed when having a bowel movement.
Keep teeth together during urination (helps keep Essence from escaping when orifice is open, i.e. pee shivers which are more common in males).
Massage ears when stressed.
Eat more soup made with bone broth & a little vinegar for strong bones when elderly.
Breathing exercises should be a daily occurrence to help detoxify & replenish energy.
Physical exercises should be performed in the afternoon or evening.
The best time for bowel movements is early in the morning (between 5-9am).
Spend more time combing hair to prevent headache & insomnia.
Do large circles with your eyeballs to keep vision.
Swallow saliva, do not spit it out, this can tonify digestion.
Always keep back warm to protect Yang Qi.
Rub abdomen habitually to regulate stomach Qi (digestion).
When meditating, keep mouth & anal sphincter lightly contracted.
Move & stretch joints regularly to keep mobility.
Use warm hands or dry brush to rub the entire body to keep circulation healthy.
Wu Nan 5 things that shorten life:
- Excess drive towards fame & fortune.
- Too much anger &/or joy.
- Anything related to reproduction in excess, i.e. sex, births, abortion, miscarriage.
- Poor diet.
- Over-thinking, pensiveness, not taking time to shut your mind off, take breaks.
Principles of Treatment for Longevity
Loss of hair (liver & kidney), Rx- Er Zhi Wan or Qi Bao Mei Yen Dan. Beneficial herbs: He Shou Wu, Sang Seng Zi, Nu Zhen Zi, Gou Qi Zi.
Eye troubles Beneficial herbs: Gou Qi Zi, He Shou Wu, Nu Zhen Zi.
Ear problems (kidney), Rx- Liu Wei Di Huang Wan + Chai Hu & Chi Shi, or Qi Ju Di Huang Wan. *When tonifying water (kidney) you must remember to keep earth (spleen) strong.
Teeth, bones, & marrow health Bu Gu Zi is great for this (also to treat antibiotic side effects on hearing), Rx- Si Shen Wan + Niu Xi & Gu Xue Bu (morning diarrhea, bones, & teeth).
Memory trouble short term difficulties tonify heart, long term difficulties tonify kidney. If Phlegm is present Rx- Di Huang Yin Zi + Tian Nan Xin (gallbladder Phlegm), Long Gu, & Mu Li.
Rx- Sang Piao Xiao San + Fu Ling or Fu Shen for heart Phlegm. Rx- Gui Pi Tang + Fu Shen for heart (sleep, & anxiety).
Physical Heart & Lungs tonify with Rx- Sheng Mai San + modifications for patient, Rx- Mai Wei Di Huang Wan.
Strengthen Spleen, harmonize Stomach Rx- (spleen) Shen Ling Bai Zhu San, Bu Zhong Yi Qi Tang. Rx- (stomach) Ping Wei San, Ban Xia Hou Po Tang. Try Rx- Xiang Sha Liu Jun Zi Tang between 7-11am to perform both tasks.
Constipation He Tao Ren (walnuts, also help memory and lung deficiencies), Hei Zhi Ma (black sesame seeds ground in congee form (Hei Zhi Ma Hu Hu) before bed to induce morning bowel movements.
Leakage (urinary, seminal, vaginal), Rx- Shui Lu E Xian Dan + Jin Ying Zi & Qian Shi.
Pain Rx- Du Huo Ji Sheng Tang + Du Zhong, animal bone, & Xi Xian Cao.
General Herbal Tips:
Qi Wu Jia Pi, Wu Jia Shen (Siberian ginseng)
Blood E Jiao, dates, He Shou Wu
Body Fluids Sha Shen, Mai Men Dong, Yu Zhu, Tai Ji Shen, Xi Yang Shen
Essence seeds (zi)
Marrow animal (to fill & replenish)
(Essence & marrow)- Rx- Ban Long Wan, Suo Quan Wan. Beneficial herbs: placenta (human), Huang Jing, Jin Ying Zi, Sang Piao Xiao, Yi Zhi Ren, Wu Yao.
Very special: Huang Jing & Shan Yao, both tonify Spleen & Kidney Qi & Yin (perfect for diabetes which is basically a Spleen Yin deficiency pattern).
Administration & Mixing Medications
- Caution should be taken when mixing with chemical drugs the possibility of increasing or decreasing the effects of the drugs, or creating adverse reactions is possible, monitor patient closely & start with very moderate dosage.
- The same goes for mixing with other complimentary medicines (i.e. homeopathic, vitamins, western herbs, & various other supplements), proceed with caution.
- Do not use too heavy (mineral formulas) or downward moving cold & bitter substances (to guard spleen & stomach) in excessive amounts.If these types of substances are indicated for treatment be sure to add Shan Zha, Ji Nei Jin, & Shan Yao or other herbs which guard & benefit digestion.
- Processing: consider type of herbal administration, i.e. capsules (easier, convenient, palatable, but tough to digest for some), water pellets (easy, convenient, but also may be difficult for some to digest, i.e. GI cancer patients), powders (poor tasting, very easily absorbed), decoction (the most powerful in strength & easiest absorbed, but generally poor tasting, expensive, & difficult to prepare).
- Dosage: always start small & work your way up to dosage you feel is required
***Always closely observe your elderly patients when administering medication.
#1 killer of old people
After 3-4 days of illness be careful suspect pneumonia
1. Fever does not get that high +/- 38 degrees centigrade
2. Chest pain/shortness of breath, palpitations & high heart rate (worse than the breathing trouble)
3. 1-2 days late can see other organ disease manifestations
4. Mental diseases more common with bedridden patients (poor memory, anger, sadness, crazy)
Protect heart & lung
Early recognition of illness is important
Use of antibiotics imminent with signs in patients around 80 years or more
If on antibiotics:
Sheng Mai San
Xiang Sha Liu Jun Zi Tang
Shen Ling Bai Zhu San
Bu Zhong Yi Qi Tang
If lots of Phlegm accompanies symptoms:
Dao Tan Tang
San Zi Yang Qing Tang
If Yang deficiency:
Si Ni Tang
Fu Zi Gan Jiang Tang
If no antibiotics: treatment needs to tonify and attack.
Cold Xiao Qing Long Tang
Heat Ma Xing Shi Gan Tang
If Ma Huang is contraindicated use Zhi Ma Huang or 6-9g Ma Huang with 6g Wu Wei Zi
*Sheng Mai San should be used to tonify with either type.
Note: When there is Phlegm use blood invigorating herbs also
(Tao Ren, Hong Hua, Dan Shen)
Acute or Chronic
Typical treatment is to remove Gallbladder completely
Later years it is good to acquire techniques to move gallstones regularly
Chai Hu Shu Gan San
Xiao Yao San
– This is usually due to Liver Qi stagnation i.e. anger, bitterness, resentment
Try including green apples, radishes, olive oils, seaweeds, vinegar, Ji Nei Jin (chicken stomach),
Jin Qian Cao, Yin Chen Hao
* No spinach with tofu
* Limit saturated fat intake
* Avoid alcohol
Urinary Infections & Prostate problems
Frequent urination with pain, possible backache & fever
Lin syndrome usually Lao Lin (deficiency Lin)
Saw Palmetto, cranberry, acupuncture & moxabustion, blueberries, garlic, grapes, dandelion, Uva Ursi, Juniper berries
Usually antibiotics are administered as normal course of treatment
TCM tonify Kidney & Spleen
Jin Gui Shen Qi Wan
Liu Wei Di Huang Wan
Zhi Bai Di Huang Wan
add Fu Zi & Gui Zhi to Liu Wei Di Huang Wan for KI Yang deficiency
Bu Zhong Yi Qi Tang may help urination with Spleen deficiency present
- If no appetite shows this is not a good sign
- If appetite is normal but the patient is ematiated this may mean a tumor is present
- Basic pattern of a tumor is Spleen & Kidney deficiency
Circulatory System Diseases
– usually chest pain &/or difficult breathing (think Heart first, Lung second)
– palpitation &/or ankle Edema = heart
– serious fatigue, tired from laying down or just sitting = heart trouble
– if these patients move, the lips become purple
– dizziness &/or mental symptoms = heart trouble
– consider lung cancer comes with heart troubles
– generally combines with other systems disease &/or failure
Chest pain that radiates to left arm or middle finger
Heart blood vessels spasm (comes & goes)
Attacks are usually under 5 minutes, not over 15 minutes
If up to 15 minutes or more = infarction
Infarction = blockage
TCM – Basic Pattern is Qi Blood stagnation
– which one is more, which one came first, % of each, prescribe a formula that is for Qi & blood stagnation & a formula that treats the root.
More heavy & dangerous, especially if pain radiates through to the back
The radiating pain is usually over 15 minutes
**Some may happen without pain, or pain in the abdominal region
The first complaint is usually difficulty breathing
TCM basic pattern – blockage patter, too much Yin, no more Fire
Other signs are perspiration, low blood pressure, pale face, cold hands & feet (Yang collapse)
Principle of treatment is to rescue Yang:
Use Fu Zi, Gui Zhi, Hong Hua, Tao Ren to boost Yang & warm King Fire
Rx Si Ni Tang with Tao Ren, Hong Hua
Moxa Du 20, KI 1, Ren 4, 6, 14, 17, ST 36, LI 4
Acupuncture PC 6, Du 9, Du 26
- For 2 weeks the patient must lie in bed & do nothing, within 24-48 hours do not even turn over
- Do not eat for 24 hours, avoid bowel movements (teas, soups, juice)
- After 2 days, a trained person may move the legs of the patient, 3-5 days the patient can move legs & arms, after 10 days the patient may be allowed to walk around the room.
Abnormal Heart Rhythms
- too fast >85 90
- too slow <50 55
TCM diagnosis is palpitations (may be anxiety) slow or fast pulse
WM uses an ECG to diagnose
Too fast = excess Fire or deficiency Fire
Too slow = deficiency of Yang or Qi stagnation (blood or Phlegm)
TCM can treat this well, it also displays fainting, coldness, fatigue, chest distension.
*Most abnormal heart beats are deficiency
Rx Gui Pi Tang + modifications
– Hei Gui Pi Tang
– Gui Pi Tang + Dan Shen
Rx Sheng Mai San
Slow Beat try Rx Ma Huang Fu Zi Xi Xin Tang (Yang deficiency, Wind/Cold with Yang deficiency)
Swelling of ankles
Difficult breathing (especially at night)
-when lie flat breathing is worse (this is an early symptom of heart failure)
May have insomnia, irritability, dizziness
Western medicine says:
If left heart fails = difficult breathing
If right heart fails = ankle swelling
TCM basic patterns
- Heart, Kidney, &/or Lung Yang deficiency
– water retention or Phlegm-fluids retention
-Rx Zhen Wu Tang + HT LU modifications
– Rx Jin Gui Shen Qi Wan (KI), Huang Qi can go up to 30-60 g
**Don’t promote water circulation too strongly until heart function has been restored
– i.e. Rx Wu Ling San (gentle)
Typical to use herbs such as Fu Zi, Gan Jiang
- Blood Stasis
It is normal for blood pressure to rise after a person reaches +/- 60 years old
*Do not try to reduce high blood pressure too much or too quickly, this may lead to embolisms & strokes
Look for family & personal history
– If the family shows similarities the situation is not as critical
What other diseases could be present?
TCM Basic patterns
- Liver rising (most common, 70% of all cases)
- Lung cannot go down (this is most typical for seniors)
Make sure bowel movements are normal, this will lower blood pressure
Constipation can lead to strokes & high blood pressure
Meditation, Tai Ji, Qi gong, breathing exercises are great for high blood pressure
Diet avoid alcohol or use medicated alcohols, lower salt intake
Respiratory System Diseases
Shortness of breath, cough with Phlegm
When there is chest pain, think about heart first lung second
When signs & symptoms show of lung cancer, the cancer has already metastasized to other organs
When have treated cough for 3 months & there is no alleviation think lung cancer
-this is usually a dry cough with phlegm that is difficult to cough out, when it is accompanied by chest pain the possibilities of it being a large tumor are good
Bronchitis particularly has cough with phlegm, wheezing if the coughing is copious, can also occur with asthma
When you have asthma it is easy to get bronchitis, not the other way around
Principle of treatment descend lung Qi moisten or eliminate phlegm depending on cough, boost immune system, strengthen & protect Lung & Spleen
TCM Basic pattern Lung & Spleen deficiency
May also get Blood Stasis (if shows purple tongue) use blood invigorators
Treatment Spleen produces Qi, Lung controls Qi, Kidneys receive Qi Rx Sheng Mai San (LU HT Qi & Yin)
– Yu Ping Feng San (LU Qi)
– Fu zi Li Zong Tang (SP Yang)
– Shen Ling Bai Zhu San (SP Damp)
– Bu Zhong Yi Qi Tang (SP LR)
– Xiang Sha Liu Jun Zi Tang (SP ST)
– Liu Wei Di Huang Wan (KI Yin)
*If you have chronic respiratory problems it is bad to Edema &/or diarrhea
– if see diarrhea or Edema = Pulmonary Heart Disease
– Lung Yang deficiency upper, Kidney Spleen Yang deficiency lower
– Rx Zhen Wu Tang
Lung Yang deficiency – water in upper part of body (tan yin Phlegm-fluids)
– usually with Heart Yang deficiency
Rx Zhen Wu Tang (Fu Zi, Gan Jiang, Bai Zhu)
– Si Ni Tang + Ling Gui Zhu Gan Tang
Spleen Yang deficiency – usually with Kidney or Heart Yang deficiency
– King & Minister Fire warms Spleen
Rx Fu Zi Li Zhong Tang
– with Gui Zhi or Rou Gui = Fu Gui Li Zhong Tang
Liver Yang deficiency – must be pain along the meridian
– usually with Kidney Yang deficiency
Rx Wu Zhu Yu Tang
– Dang Gui Si Ni Tang (blood Bi)
– Fu Gui Di Huang Wan
Note: Asthma early there is usually constipation
– late there is usually diarrhea
TCM basic pattern Yang deficiency with Phlegm-fluids
4 types of Phlegm-fluids: whole body, chest, abdomen, hypochondria
– this is a more moveable liquid, moves with body positions
Water: usually starts at ankles (yin type) then creeps up (Spleen Kidney)
– if this happens when a malignant tumor is present, the end is near
Rx Xiao Qing Long Tang + Jin Gui Shen Qi Wan
Rx Yang He Tang + Ling Gui Zhu Gan Tang
Modifications: Cold-Phlegm with deficiency – San Zi Yang Qin Tang
Kidney Yang deficiency with Phlegm Tu Si Zi (heavy low back, turbid urine)
Spleen deficiency use Spleen tonics
Purple tongue Dang Shen, E Zhu, Tao Ren, Hong Hua, Tian Qi (San Qi)
Auto-neumothorax shortness of breath, pain, slight dry cough
Rx Jia Wei Xiang Shu San
- Ting Li Da Huang Tang
-Ting Li Zi 15-30g
-Da Huang 10-30g
-Sang Bai Pi 10-15g
-Hou Po 10-15g
-Zi Si 10-15g
-Jie Geng 15-18g
-Da Zao 5-10 pieces
If Phlegm (white) + Qiu Jie Zi 10-15g
(yellow) + Gua Lou Ren 10-15g
If Chest pain + Gui Zhi 2-6g
*Decoct package & drink 4 times/day, every 4 hours
-may use more packages in first couple days
- Bai He Gu Jin Tang
20-25% of patients with Emphysema connects with GI ulcers
Can also easily acquire bronchitis or pneumonia
When patient has chest pain
- Lung Cancer
- Lung Infection
(with young people this order is opposite)
Digestive System Diseases
Quickly may become bleeding
Create dark tarry stool
Rx Chai Hu Shi Gan San
– Bu Zhong Yi Qi Tang
– modify with stop bleeding herbs
Pain may not be first complaint in the elderly because of the array of other disease with it
When ulcer breaks it may infect the intestines (Emergency)
– the abdomen gets hard & painful
– peristalsis/abdominal sounds are almost non-existent (normally there are 1-2/minute)
Pain Rx Shao Yao Gan Cao Tang
– also use Qi blood tonics, stop bleeding, & detoxifying herbs until can be operated on
May not know they have ulcers, figure it out after bloody bowel movements
Advise to observe stool regularly
Toilet bowl will have dark red blood in the toilet
TCM basic pattern
Spleen Qi deficiency, Stomach Yin deficiency with Liver attack.
*Look at big & 2nd toe nails (spleen, stomach, liver)
Rx An Wei San (Ji Dan Ke egg shell)
-bake shells until turn yellow brown
-grind until powder
-take 3-7 days/day
-can stop pain for more than 2 hours
Hai Piao Xiao, Tian Qi (single herbs)
Acupuncture back Shu (wei, dan, gan, pi, etc)
Chronic gastrointestinal infection
TCM basic patterns
- Wood attack Earth pain with emotions
Rx Xiao Yao San (Liver Spleen)
– Xiao Chai Hu Tang (Gallbladder Stomach)
– Da Chai Hu Tang (Liver Gallbladder troubles)
- Earth insult Wood can have jaundice, hepatitis, etc.
Rx Yin Chen Hao Tang (Damp/Heat)
– Lian Po Yin
– San Ren Tang
– Yin Chen Si Ni Tang (Damp/Cold)
– either a lot of Damp or weak wood can cause this
- Spleen Stomach disharmony rebel Qi
Rx Xiang Sha Liu Jun Zi Tang
*For Spleen Stomach excess/deficiency, Heat Cold mixed patterns:
Rx Xie Xin Tang
– Ban Xia
– Gan Cao
– Sheng Jiang
It is Quite common to have Blood Stasis when Liver Spleen Stomach are involved
Rx Ge Xia Zhu Yu Tang
– Shao Fu Zhu Yu Tang
– Xue Fu Zhu Yu Tang
– Dan Shen Yin
*Long term chronic pain always has Blood Stasis:
– Wu /gong (centipede), Tu Bei Chong (cockroach), Quan Xie (scorpion)
Treating ulcers can greatly reduce the chances of developing Stomach cancer.
Extremely painful Emergency
Rx Da Cheng Qi Tang, Xiao Cheng Qi Tang, Da Huang, Fan Xie Ye, Lu Hui
– from Cold, Heat, material block, almost anything can cause it
Can lead to strokes & high blood pressure
Can be from so many causes
Seniors are mostly from deficiency
Make diagnosis differentiation & treat accordingly
– flax oil can help
Internal or external
If burning & bleeding toxic
TCM basic patterns
Large Intestine & Lung Qi deficiency (root)
Damp/Heat in Large Intestine (branch)
Coordinate with surgery & yoga, Qigong, meditation
Try Huang Qi, Dang Shen, external washes
*Quite often are caused from constipation
# 2 cancer that kills males in Canada
People often think it is hemorrhoids because of pain & bleeding
Emaciation for 2-6 months
Pain in chest
*Form of stool may change, i.e. line in it from the tumor
*Recommend if think have hemorrhoids check for cancer
Turbid Phlegm in blood vessels
Have fatigue, abdominal bloating & fullness, numb pain in the hypochondrium
Rx Zi Xie 30g
He Shou Wu 15g
Huang Jing 15g
Dan Shen 15g
Cao Jue Ming 15g
Shan Zha 30g
Hu Jiang 15g
He Ye 15g
Take for 4 months, 1 day 1 package