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Metabolic / Cardiovascular Disorders

John K. Chen L.Ac., O.M.D., Pharm.D., Ph.D.

Lotus Institute Of Integrative Medicine

Herbalite • Obesity with excess appetite and constant craving for food • Elevated glucose levels from diabetes mellitus • Elevated cholesterol levels from hyperlipidemia

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Herbalite • Chinese Actions – Clears Stomach heat – Cleanses the bowels – Detoxifies residual toxins

Herbalite • Western Actions – Increases energy level and promotes a sense of wellbeing – Speeds up body metabolism to burn off excess fat and body weight – Suppresses appetite to decrease unnecessary food intake – Mild diuretic effect to eliminate water accumulation

• • • • • • • • • • • • •

Bai Shao (Radix Paeoniae Alba) Cha Ye (Folium Camelliae) Chai Hu (Radix Bupleuri) Ci Wu Jia (Radix et Rhizoma seu Caulis Acanthopanacis Senticosi) Da Huang (Radix et Rhizoma Rhei) Da Zao (Fructus Jujubae) He Ye (Folium Nelumbinis) Huang Qi (Radix Astragali) Huang Qin (Radix Scutellariae) Ji Xue Cao (Herba Centellae) Sheng Jiang (Rhizoma Zingiberis Recens) Zao Jiao (Fructus Gleditsiae) Zhi Shi (Fructus Aurantii Immaturus)

Cha Ye (Folium Camelliae)

Cha Ye (Folium Camelliae)

• The mechanism of action to reduce body fat is attributed to the simultaneous reduction fat absorption via the gut inhibition of fat synthesis in the body.[i]

• Administration of a preparation of Cha Ye (Folium Camelliae) shows significant effect to lower plasma fasting glucose, triglycerides, and insulin concentrations. The mechanisms of action are attributed to the beneficial insulin sensitivity and antioxidant effects.[i]

•

[i] Navamayooran Thavanesana. The putative effects of green tea on body fat: an evaluation of the evidence and a review of the potential mechanisms. British Journal of Nutrition. 14 November 2011 106 : pp 1297-1309

•

[i] Hininger-Favier I, Benaraba R, Coves S, Anderson RA, Roussel A-M. 2009. Green tea extract decreases oxidative stress and improves insulin sensitivity in an animal model of insulin resistance, the fructose-fed rat. J Am Coll Nutr 28:355-61.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

1

Cha Ye (Folium Camelliae)

He Ye (Folium Nelumbinis)

• Another randomized, placebo-controlled study in 33 patients with dyslipidemia demonstrated that daily consumption of Cha Ye (Folium Camelliae) for eight weeks was associated with a significant reduction of total cholesterol and LDL-cholesterol levels, but not HDL-cholesterol or triglycerides, when compared to the placebo group.[i]

• He Ye (Folium Nelumbinis) shows numerous mechanisms to suppress obesity, such as impairing digestion, inhibiting absorption of lipids and carbohydrates, accelerating lipid metabolism and up-regulating energy expenditure.[i]

•

[i] Batista Gde A, Cunha CL, Scartezini M, von der Heyde R, Bitencourt MG, Melo SF. Prospective double-blind crossover study of Camellia sinensis (green tea) in dyslipidemias. Universidade Federal do Paraná, PR, Brasil. Arq Bras Cardiol. 2009 Aug;93(2):128-34.

•

[i] Ono Y, Hattori E, Fukaya Y, Imai S, Ohizumi Y. Anti-obesity effect of Nelumbo nucifera leaves extract in mice and rats. Matsuura Yakugyo Co. Ltd., Enjo-cho, Showa-ku, Nagoya 459-8001, Japan. J Ethnopharmacol. 2006 Jun 30;106(2):238-44. Epub 2006 Feb 21

He Ye (Folium Nelumbinis)

He Ye (Folium Nelumbinis)

• For management of hyperglycemia, He Ye (Folium Nelumbinis) and its active constituent catechin significantly and dose-dependently enhance insulin secretion to control hyperglycemia in non-insulin-dependent diabetes mellitus, according to a study in high-fat-dietinduced diabetic mice.[i]

• For treatment of hyperlipidemia, administration of He Ye (Folium Nelumbinis) effectively ameliorates lipid metabolic disorders (hyperlipidemia, hypercholesterolemia, and fatty liver) caused by high fat diet, with efficacy similar to that of silymarin and simvastatin (Zocor).[i]

•

[i] Huang CF, Chen YW, Yang CY, Lin HY, Way TD, Chiang W, Liu SH. Extract of Lotus Leaf ( Nelumbo nucifera) and Its Active Constituent Catechin with Insulin Secretagogue Activity. Graduate Institute of Chinese Medical Science, School of Chinese Medicine, College of Chinese Medicine, China Medical University , Taichung 40402, Taiwan. J Agric Food Chem. 2011 Feb 23;59(4):1087-94. Epub 2011 Jan 14.

Huang Qi (Radix Astragali) Ci Wu Jia (Acanthopanacis Senticosi) • Huang Qi (Radix Astragali) and Ci Wu Jia (Radix et Rhizoma seu Caulis Acanthopanacis Senticosi) both have positive effect on the metabolic rate. Decoction of Huang Qi (Radix Astragali) has been shown to increase the basal metabolic rate and cAMP in laboratory studies.[i] The use of Ci Wu Jia (Radix et Rhizoma seu Caulis Acanthopanacis Senticosi) has been shown to effectively increase human physical working capacity.[ii] • •

[i] Zhong Yao Yao Li Yu Lin Chuang (Pharmacology and Clinical Applications of Chinese Herbs), 1985:193 [ii] Asano, K. et al. Effect of Eleutherococcus Senticosus Extract on Human Physical Working Capacity. Planta Med; 48(3):175. 1986

•

[i] Lin MC, Kao SH, Chung PJ, Chan KC, Yang MY, Wang CJ. Improvement for high fat diet-induced hepatic injuries and oxidative stress by flavonoid-enriched extract from Nelumbo nucifera leaf. Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan. J Agric Food Chem. 2009 Jul 8;57(13):5925-32.

Supplementary Formulas • For high cholesterol levels, add Cholisma. • For high cholesterol levels and fatty liver, add Cholisma (ES). • For edema and water accumulation, add Herbal DRX. • For hypertension, add Gastrodia Complex or Gentiana Complex. • With diabetes, combine with Equilibrium. • For prevention of coronary artery disease, add Circulation.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

2

Clinical Notes

Cautions & Contraindications

• Herbalite is designed to help with weight loss safely and gradually. Individuals who take Herbalite lose an average of one pound per week. • Do not to lose weight drastically. Rapid weight loss may be hazardous and is more likely to lead to rebound weight gain. • It is extremely important to change the dietary and exercise habits to lose weight and avoid rebound weight gain.

• Cha Ye (Folium Camelliae), commonly known as green tea, contains a small amount of caffeine as its natural ingredient. • This formula is contraindicated during pregnancy and nursing. • Discontinue Herbalite once the desired effect is achieved.

Cautions & Contraindications

Case Studies

• The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”

• A 53-year-old female business owner presented with low energy, muscle pain and low back pain. The patient was 45 pounds overweight. Pain was felt in her lumbar area upon palpation. The pulse was slow and the tongue was pale and swollen with a thin white coat. The practitioner diagnosed the condition as Kidney yang deficiency, qi deficiency and Liver yang excess. The practitioner also suspected a possibility of hypothyroidism, which had yet to be confirmed by lab tests. The patient was treated with Herbalite, acupuncture, and diet modification. She then lost 43 pounds in 4 months and her energy level increased dramatically. The pain in her low back has also disappeared. Herbalite appeared to suppress her food cravings, increase her energy and improve her psychological status. The patient became more energetic, radiant, and positive. Submitted by T.S., East Providence, Rhode Island.

Additional Information

Comparative Analysis

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ

• Xenical (orlistat) reduces body weight by blocking absorption of fat in the digestive tract. It causes many gastrointestinal side effects, such as fecal incontinence, fecal urgency, flatulence with discharge, increased defecation, oily evacuation, oily rectal leakage, steatorrhea, and projectile diarrhea. • Meridia (sibutramine) is a stimulant agent that causes weight loss by increasing metabolism and suppressing appetite. It causes anorexia, anxiety, constipation, dizziness, headache, insomnia, irritability, nervousness, rhinitis, xerostomia, hypertension, congestive heart failure, arrhythmias, seizure and stroke.

– – – –

Traditional Points Classic Master Tung Points Balance Method by Dr. Richard Tan Master Tung’s Points by Dr. Brad Whisnant

• Ear Acupuncture – Traditional Points – Auricular Medicine by Dr. Li-Chun Huang

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

3

Cholisma

Cholisma

• Dyslipidemia

• Chinese Actions – Dissolves dampness and eliminates phlegm – Invigorates the circulation of blood

– Hyperlipidemia (high cholesterol and triglycerides levels) – Hypercholesterolemia (high cholesterol levels) – Hypertriglyceridemia (high triglycerides levels)

• Arteriosclerosis and atherosclerosis

• Western Actions – Antihyperlipidemic effect to reduce plasma levels of cholesterol and triglycerides – Reduces absorption of fatty food and enhances breakdown of fatty tissues – Antiatherosclerotic effect to prevent arteriosclerosis and atherosclerosis – Prevents angina through vasodilating, antiplatelet, and anticoagulant effects

Cholisma

Zi Mu Xu (Herba Medicaginis)

• • • • • • • • • • • • •

• Zi Mu Xu (Herba Medicaginis) has been shown to reduce cholesterol absorption and decrease atherosclerotic formation.[i],[ii],[iii] It significantly reduces cholesterol absorption through direct binding in the gastrointestinal tract.[iv]

Cang Zhu (Rhizoma Atractylodis) Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) Ge Gen (Radix Puerariae Lobatae) He Shou Wu (Radix Polygoni Multiflori Praeparata) He Ye (Folium Nelumbinis) Hu Zhang (Rhizoma et Radix Polygoni Cuspidati) Jiao Gu Lan (Rhizoma seu Herba Gynostemmatis) Ju Hua (Flos Chrysanthemi) Jue Ming Zi (Semen Cassiae) Shan Zha (Fructus Crataegi) Yi Yi Ren (Semen Coicis) Ze Xie (Rhizoma Alismatis) Zi Mu Xu (Herba Medicaginis)

Hu Zhang (Rz/Rx Polygoni Cuspidati) Jiao Gu Lan (Rz/Hb Gynostemmatis) • Hu Zhang (Rhizoma et Radix Polygoni Cuspidati) and Jiao Gu Lan (Rhizoma seu Herba Gynostemmatis) have similar effects, as they both lower triglyceride, total cholesterol, and lowdensity lipoprotein levels.[i],[ii],[iii] •

•

•

[i] Xing WW, Wu JZ, Jia M, Du J, Zhang H, Qin LP. Effects of polydatin from Polygonum cuspidatum on lipid profile in hyperlipidemic rabbits. Department of Pharmacognosy, School of Pharmacy, Second Military Medical University, Shanghai 200433, PR China. Biomed Pharmacother. 2009 Aug;63(7):457-62. Epub 2008 Jul 9. [ii] Du J, Sun LN, Xing WW, Huang BK, Jia M, Wu JZ, Zhang H, Qin LP. Lipid-lowering effects of polydatin from Polygonum cuspidatum in hyperlipidemic hamsters. Department of Pharmacognosy, School of Pharmacy, Second Military Medical University, No. 325 Guohe Road, Shanghai 200433, PR China. Phytomedicine. 2009 Jun;16(67):652-8. Epub 2008 Dec 21. [iii] Megalli S, Davies NM, Roufogalis BD. Anti-hyperlipidemic and hypoglycemic effects of Gynostemma pentaphyllum in the Zucker fatty rat. Faculty of Pharmacy and Herbal Medicines Research and Education Centre University of Sydney, Building Al5, Sydney NSW 2006. J Pharm Pharm Sci. 2006;9(3):281-91.

• • • •

[i] Malinow, MR. et al. Effect of alfalfa saponins on intestinal cholesterol absorption in rats. Am J Clin Nutr. 1977; 30:2061 [ii] Malinow, MR. et al. Cholesterol and bile acid balance in macaca fascicularis; effects of alfalfa saponins. J Clin Invest. 1981; 67:156 [iii] Wilcox, MR. et al. Serum and liver cholesterol, total lipids and lipid phosphorus levels of rats under various dietary regimes. Am J Clin Nutr. 1961; 9:236 [iv] Story, JA. et al. Adsorption of bile acids by components of alfalfa and wheat bran in vitro. J Food Sci. 1982; 47:1276

Shan Zha (Fructus Crataegi) • Shan Zha (Fructus Crataegi) also has marked effectiveness for reduction of plasma cholesterol levels. It enhances LDLreceptor activity, increases hepatic breakdown, and decreases synthesis of cholesterol.[i],[ii] • •

[i] Zhong Yi Yao Xue Bao (Report of Chinese Medicine and Herbology), 1989; 2:45 [ii] Rajendran, S. et al. Effect of tincture of crataegus on the LDL-receptor activity of the hepatic plasma membrane of rats fed on atherogenic diet. Atherosclerosis. 123(1-2):235-41, June 1997

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

4

He Shou Wu (Radix Polygoni Multiflori Praeparata) • He Shou Wu (Radix Polygoni Multiflori Praeparata) has antiatherosclerotic benefits and has been shown to prevent development of atherosclerotic lesions.[i] •

[i] Yang P.Y., Almofti M.R., Lu L., Kang H., Zhang J., Li T.J., Rui Y.C., Sun L.N. & Chen W.S. Reduction of atherosclerosis in cholesterol-fed rabbits and decrease of expressions of intracellular adhesion molecule-1 and vascular endothelial growth factor in foam cells by a water-soluble fraction of Polygonum multiflorum. J Pharmacol Sci. 2005, 99(3): 294-300.

Dan Shen, Ge Gen, Shan Zha • Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae), have antiplatelet and anticoagulant activities to prevent formation of blood clots.[i],[ii] • In addition, Ge Gen (Radix Puerariae Lobatae) and Shan Zha (Fructus Crataegi) have vasodilating effect to dilate coronary artery and prevent heart attack.[iii],[iv],[v] • • • • •

[i] Shang Hai Di Yi Xue Yuan Xue Bao (Journal of First Shanghai Medical College), 1979; 6(3):144. [ii] Shang Hai Di Yi Xue Yuan Xue Bao (Journal of First Shanghai Medical College), 1982; 9(1):14 [iii] Yi Xue Yan Jiu Tong Xun (Report of Medical Studies), 1972; (2):14 [iv] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1979; 59(8):479 [v] Guang Xi Zhong Yi Yao (Guangxi Chinese Medicine and Herbology), 1990; 13(3):45

Cholisma

Supplementary Formulas

• • • • • • • • • • • • •

• For obese patients with an excess appetite, add Herbalite. • For fatty liver and obesity, use Cholisma (ES). • For diabetes mellitus and high blood glucose, add Equilibrium. • For hypertension with dizziness or vertigo, combine with Gastrodia Complex. • For hypertension with anger or flushed face, combine with Gentiana Complex. • For edema, add Herbal DRX. • For excess heat in the body, add Gardenia Complex. • For excessive blood stagnation in the body, add Circulation (SJ). • For coronary heart disorders, add Circulation.

Cang Zhu (Rhizoma Atractylodis) Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) Ge Gen (Radix Puerariae Lobatae) He Shou Wu (Radix Polygoni Multiflori Praeparata) He Ye (Folium Nelumbinis) Hu Zhang (Rhizoma et Radix Polygoni Cuspidati) Jiao Gu Lan (Rhizoma seu Herba Gynostemmatis) Ju Hua (Flos Chrysanthemi) Jue Ming Zi (Semen Cassiae) Shan Zha (Fructus Crataegi) Yi Yi Ren (Semen Coicis) Ze Xie (Rhizoma Alismatis) Zi Mu Xu (Herba Medicaginis)

Clinical Notes

Clinical Notes

• Dyslipidemia has many secondary causes (obesity, diabetes, hypothyroidism, and use of drugs such as thiazides, beta-blockers, estrogen and progestins, and glucocorticoids) and multiple complications (atherosclerosis, arteriosclerosis, coronary artery disease, angina pectoris and hypertension). Therefore, optimal treatment must address both the causes and the complications.

• The baseline cholesterol level should be established prior to the initiation of herbal therapy; and the first follow-up test should be done one month after the initiation of herbal therapy. Subsequent follow-ups can be done every 2 to 3 months to determine overall effectiveness. Cholesterol testing kits are available over-the-counter in most pharmacies. Results may vary from patient to patient. Lifestyle and dietary changes are also crucial for satisfactory results. • Cholisma is specifically formulated to reduce blood cholesterol and triglyceride levels. Patients must take this herbal formula on a long-term basis for maximum results.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

5

Cautions & Contraindications

Cautions & Contraindications

• This herbal formula contains herbs that invigorates blood circulation, such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[i]

• Jue Ming Zi (Semen Cassiae), He Shou Wu (Radix Polygoni Multiflori) and Ju Hua (Flos Chrysanthemi) may cause loose stool or diarrhea for those with sensitive gastrointestinal tracts. Should this occur, reduce the dosage to 2 to 3 capsules three times daily.

•

[i] Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-406.

Case Studies

Additional Information

• A 39-year-old male patient presented with a history of loose stools, allergies and poor circulation with high cholesterols. His reports showed 263 mg/dL for total cholesterol levels. The practitioner diagnosed this condition as Spleen qi deficiency with damp and phlegm accumulation. Cholisma was prescribed at 6 grams a day for about five months. After taking the herbs for five months, the patient retested his cholesterol levels and it had dropped to 228 mg/dL. He was very happy with the results, which he attributed mostly to Cholisma. He had also increased his exercise and was eating healthier as well. Submitted by A.Z., Los Angeles, California.

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ

Cholisma (ES)

Cholisma (ES)

• Dyslipidemia • Hyperlipidemia (high cholesterol and triglycerides levels) • Hypercholesterolemia (high cholesterol levels) • Hypertriglyceridemia (high triglycerides levels) • Conditions associated with dyslipidemia: obesity, diabetes mellitus and fatty liver

• Chinese Actions

– – – –

Traditional Points Classic Master Tung Points Balance Method by Dr. Richard Tan Master Tung’s Points by Dr. Brad Whisnant

• Ear Acupuncture – Traditional Points – Auricular Medicine by Dr. Li-Chun Huang

– Dissolves dampness – Eliminates phlegm – Invigorates blood circulation – Clears heat

• Western Actions – Antihyperlipidemic effect to reduce plasma levels of cholesterol and triglycerides – Antiobesity effect to reduce body weight and inhibit lipid accumulation – Hypoglycemic effect to lower blood glucose levels to manage diabetes mellitus – Prevents and treats fatty liver

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

6

Cholisma (ES) • • • • • • • • • •

Da Huang (Radix et Rhizoma Rhei) Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) Ge Gen (Radix Puerariae Lobatae) Hai Zao (Sargassum) Huang Qin (Radix Scutellariae) Jue Ming Zi (Semen Cassiae) Shan Zha (Fructus Crataegi) Yin Chen (Herba Artemisiae Scopariae) Yu Jin (Radix Curcumae) Ze Xie (Rhizoma Alismatis)

Ze Xie (Rhizoma Alismatis) • Ze Xie (Rhizoma Alismatis) has a remarkable antihyperlipidemic effect, and has been shown in various clinical studies to effectively treat dyslipidemia, hypercholesterolemia, arteriosclerosis and fatty liver.[i],[ii] •

•

[i] He, XY. Effects of alisma plantago l. on hyperlipidemia, arteriosclerosis and fatty liver. Chinese Journal of Modern Developments in Traditional Medicine. 1(2):114-7, Oct. 1981 [ii] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1976; 11:693

Jue Ming Zi (Semen Cassiae)

Yu Jin (Radix Curcumae)

• Jue Ming Zi (Semen Cassiae) has multiple therapeutic benefits: it lowers low-density lipoproteins, increases highdensity lipoproteins, and lowers blood pressure, without any serious adverse effects.[i],[ii],[iii]

• Yu Jin (Radix Curcumae) has a potent antioxidant and antihyperlipidemic functions, and demonstrates a comparable effect to lovastatin (Mevacor) to decrease plasma levels of cholesterol, triacylglycerol, and low-density lipoprotein cholesterol.[i]

• • •

[i] Zhong Yao Zhi (Chinese Herbology Journal), 1984:352 [ii] Zhong Cao Yao (Chinese Herbal Medicine), 1991; 22(2):72 [iii] Cho S.H., Kim T.H., Lee N.H., Son H.S., Cho I.J. & Ha T.Y. Effects of Cassia tora fiber supplement on serum lipids in Korean diabetic patients. J Med Food. 2005, 8(3): 311-318.

•

[i] Xu C, Haiyan Z, Hua Z, Jianhong Z, Pin D. Effect of Curcuma kwangsiensis polysaccharides on blood lipid profiles and oxidative stress in high-fat rats. Int J Biol Macromol. 2009 Mar 1;44(2):138-42. Epub 2008 Nov 18.

Yu Jin, Da Huang, Yin Chen Hao

Dan Shen, Ge Gen, Shan Zha

• Yu Jin (Radix Curcumae), Da Huang (Radix et Rhizoma Rhei) and Yin Chen (Herba Artemisiae Scopariae) are all effective in lowering plasma and liver content of cholesterols and triglycerides.[i],[ii],[iii] Clinical applications of these herbs include dyslipidemia, hypercholesterolemia, and coronary artery disease.[iv],[v],[vi]

• Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae), have antiplatelet and anticoagulant activities to prevent formation of blood clots.[i],[ii] • In addition, Ge Gen (Radix Puerariae Lobatae) and Shan Zha (Fructus Crataegi) have vasodilating effect to dilate coronary artery and prevent heart attack.[iii],[iv],[v]

• • • • • •

• • • • •

[i] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1978; (9):540 [ii] Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1986; 12:40 [iii] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1990; 15(6):52 [iv] Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1988; 8:2 [v] Zhong Yi Za Zhi (Journal of Chinese Medicine), 1980; 1:39 [vi] Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1986; 12:40

[i] Shang Hai Di Yi Xue Yuan Xue Bao (Journal of First Shanghai Medical College), 1979; 6(3):144. [ii] Shang Hai Di Yi Xue Yuan Xue Bao (Journal of First Shanghai Medical College), 1982; 9(1):14 [iii] Yi Xue Yan Jiu Tong Xun (Report of Medical Studies), 1972; (2):14 [iv] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1979; 59(8):479 [v] Guang Xi Zhong Yi Yao (Guangxi Chinese Medicine and Herbology), 1990; 13(3):45

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

7

Supplementary Formulas

Clinical Notes

• For high cholesterol and triglyceride levels without fatty liver or obesity, use Cholisma instead. • For obese patients with an excess appetite, add Herbalite. • For patients with diabetes mellitus and high blood glucose, add Equilibrium. • For deficient-type hypertension with dizziness or vertigo, combine with Gastrodia Complex. • For excess-type hypertension with anger or flushed face, combine with Gentiana Complex. • For coronary heart disorders, add Circulation. • For excess heat everywhere in the body, add Gardenia Complex. • For hepatitis or other liver dysfunction, add Liver DTX.

• Dyslipidemia has many secondary causes (obesity, diabetes, hypothyroidism, and use of drugs such as thiazides, beta-blockers, estrogen and progestins, and glucocorticoids) and multiple complications (atherosclerosis, arteriosclerosis, coronary artery disease, angina pectoris and hypertension). Therefore, optimal treatment must address both the causes and the complications. See Supplementary Formulas for more details.

Clinical Notes

Cautions & Contraindications

• The baseline cholesterol levels should be established before the initiation of herbal therapy; the first follow-up test should be done one month after the initiation of herbal therapy. Subsequent follow-ups can be done every two to three months to determine overall effectiveness. Cholesterol testing kits are available over-the-counter in most pharmacies. Results may vary from patient to patient. Lifestyle and dietary changes are also crucial for satisfactory result. • Cholisma (ES) is specifically formulated to reduce blood cholesterol and triglyceride levels in individuals with fatty liver and/or obesity. Patients must take this herbal formula on a long-term basis for maximum results.

• The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”

Cautions & Contraindications

Cautions & Contraindications

• Jue Ming Zi (Semen Cassiae) and Da Huang (Radix et Rhizoma Rhei) may cause loose stool or diarrhea for those with sensitive gastrointestinal tracts. Should this occur, reduce the dosage to 2 to 3 capsules three times daily.

• This herbal formula contains herbs that invigorates blood circulation, such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[i] •

[i] Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-406.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

8

Additional Information

Comparative Analysis

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ

• HMG-CoA reductase inhibitors (“statin” drugs), such as Lipitor (atorvastatin), Zocor (simvastatin), and Pravachol (pravastatin). • These drugs reduce plasma cholesterol and triglyceride levels by reducing their synthesis in the liver. In most cases, these drugs are effective and are well tolerated. • They have been shown to cause serious and potentially life-threatening side effects in a small number of patients, such as rhabdomyolysis with kidney failure (0.5%), liver impairment (2.3%), and increased risk of liver cancer.[i]

– – – –

Traditional Points Classic Master Tung Points Balance Method by Dr. Richard Tan Master Tung’s Points by Dr. Brad Whisnant

• Ear Acupuncture – Traditional Points – Auricular Medicine by Dr. Li-Chun Huang

•

[i] Drug Facts and Comparisons, Updated Monthly. A Wolters Kluwer Company. Page 538. June 2001.

Risk vs. Benefit …

Risk vs. Benefit …

• Statins do not reduce death rates in people without established heart disease. • Statins have no benefit for most people subjected to them.

• In over 2 million patients review

The Journal of the American Medical Association (JAMA)

British Medical Journal, June , 2010

Gastrodia Complex

Gastrodia Complex

• Hypertension (deficient types) with dizziness, blurred vision, headache, and/or generalized weakness • Prevention of seizures, epilepsies and convulsions in hypertensive patients

• Chinese Actions

– For every 1 incident of non-fatal MI prevented, – There are 2 incidents of severe liver or kidney damage, severe muscle pain and damage, and/or cataract

– Extinguishes Liver wind – Calms Liver yang – Clears heat – Nourishes Liver and Kidney yin

• Western Actions – Antihypertensive effect to lower blood pressure – Vasodilating effect to increase blood perfusion and lower blood pressure – Diuretic effect to increase water elimination and lower blood pressure – Antiseizure, antiepileptic and anticonvulsant effects to prevent seizures, epilepsies and convulsions

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

9

Gastrodia Complex

Tian Ma (Rhizoma Gastrodiae)

• • • • • • • • • • • • • •

• Tian Ma (Rhizoma Gastrodiae) increases the volume of blood flow to the cardiac muscle, increases resistance to hypoxia, and therefore reduces the risks of myocardial ischemia and myocardial infarction.[i]

Cha Chi Huang (Herba Stellariae Aquaticae) Chuan Niu Xi (Radix Cyathulae) Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) Di Huang (Radix Rehmanniae) Ge Gen (Radix Puerariae Lobatae) Gou Qi Zi (Fructus Lycii) Gou Teng (Ramulus Uncariae cum Uncis) Jue Ming Zi (Semen Cassiae) Sha Yuan Zi (Semen Astragali Complanati) Shan Zhu Yu (Fructus Corni) Shi Jue Ming (Concha Haliotidis) Tian Ma (Rhizoma Gastrodiae) Xia Ku Cao (Spica Prunellae) Zhen Zhu Mu (Concha Margaritiferae)

Gou Teng (Ramulus Uncariae cum Uncis)

• Administration of Gou Teng (Ramulus Uncariae cum Uncis) has been shown to reduce both systolic and diastolic blood pressure as well as slowing the heart rate.[i],[ii]

• Gou Teng (Ramulus Uncariae cum Uncis) has a potent and prolonged antihypertensive effect. The decrease in blood pressure is attributed to decreased heart rate and a reduced peripheral vascular resistance.[i] Specifically, the vasodilative effect of Gou Teng (Ramulus Uncariae cum Uncis) can be attributed to its αadrenoceptor blocking and calcium channel blocking activities.[ii],[iii]

•

[i] Yano, S. et al. Calcium channel blocking effects of hirsutine and indol alkaloid from uncaria genus in the isolated rat aorta. Planta Med, 57(5):403-5 Oct. 1991 [ii] Mok, SJ. et al. Cardiovascular responses in the normotensive rat produced by intravenous injection of gambirine isolated from uncariae bl. ex korth.

Ge Gen (Radix Puerariae Lobatae) • Ge Gen (Radix Puerariae Lobatae) has shown marked effectiveness in lowering blood pressure by dilating coronary artery and relieving spasms of blood vessels.[i],[ii],[iii] •

[i] Luo, H. et al. Effects of tian-ma injection on myocardial ischemia and lipid peroxidation in rabbits. Journal of West China University of Medical Sciences. 23(1):53-6, Mar. 1992

Gou Teng (Ramulus Uncariae cum Uncis)

•

• •

•

[i] Zhong Yao Xue (Chinese Herbology), 1998; 101:103 [ii] Yi Xue Yan Jiu Tong Xun (Report of Medical Studies), 1972; (2):14 [iii] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1979; 59(8):479

• • •

[i] Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and Pharmacology of Common Chinese Drugs), 1994; 1419:1423 [ii] Ozaki, Y. Vasodilative effects of indole alkaloids obtained from domestic plants uncaria rhynchophylla miq. and amsonia elliptica roem. et schult. Nippon Yakurigaku Zasshi, 95(2):47-54 Feb. 1990 [iii] Horie, S. et al. Effects of hirsutine and antihypertensive indol alkaloid from uncaria rhynchophylla on intracellular calcium in rat thoracic aorta. Life Science, 50(7):491-8 1992

Xia Ku Cao (Spica Prunellae) • Xia Ku Cao (Spica Prunellae) illustrates a rapid onset of antihypertensive effect through vasodilation.[i],[ii] It has been used as a single herb to treat hypertension in 42 patients with good results.[iii] • • •

[i] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983:883 [ii] Zhong Yao Xue (Chinese Herbology), 1998; 128:130 [iii] Fu Jian Zhong Yi Yao (Fujian Chinese Medicine and Herbology), 1959; 4:41

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

10

Supplementary Formulas

Clinical Notes

• For high cholesterol and triglycerides, add Cholisma. • For high cholesterol and triglycerides in individuals with fatty liver and obesity, add Cholisma (ES). • For headache, add Corydalin. • For hypertension with edema and water accumulation, combine with Herbal DRX. • For high blood pressure and fast heart rate due to excess heat, add Gardenia Complex. • For coronary heart disorders, combine with Circulation. • For stress and anxiety, combine with Calm or Calm (ES).

• Western medicine classifies hypertension into two types: “red” and “pale” high blood pressure.

Cautions & Contraindications

Cautions & Contraindications

• This herbal formula contains herbs that invigorates blood circulation, such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[i]

• Herbal treatment is ineffective for malignant hypertension and certain cases of secondary hypertension, such as renal stenosis or pheochromocytoma. Refer the patients to a medical doctor as surgical intervention may be necessary.

•

– “Red” high blood pressure corresponds with TCM diagnosis of “excess,” and generally occurs in energetic and stressed individuals with marked redness and vascularized skin. – “Pale” high blood pressure corresponds with the TCM diagnosis of “deficiency,” and generally occurs in individuals with compromised kidneys, glands, or metabolism.

[i] Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-406.

Cautions & Contraindications

Case Studies

• If untreated, hypertension can lead to various complications such as myocardial infarction, cerebral hemorrhage, renal failure, and premature death from these or other developments. Effective treatment must include both lifestyle changes and herbal therapy.

• M.M., a 53-year-old female patient, presented with high blood pressure. Her blood pressure was 150/80 mmHg. The patient works in a high stress environment and lives a fast paced lifestyle. Her energy is high but her sleep is sometimes restless. Other findings included elevated HDL and LDL levels, yet still favorable. The diagnosis according to traditional Chinese medicine was Liver and Kidney yin deficiencies with Liver yang rising. Gastrodia Complex was prescribed at four spoonfuls twice daily for two months duration. After two months, the patient’s blood pressure was measured at 125/82 mmHg, she was sleeping better and her energy level increased. Submitted by M.M., Alameda, California.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

11

Additional Information

Gentiana Complex

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ

• Hypertension (excess types) with anger, flushed face and throbbing headache • Others:

– – – –

– Viral infection, such as genital herpes and herpes zoster – Bacterial or fungal infections, such as urinary tract infection, vaginal infection, yeast infection, herpes infection, boils, carbuncles, acute cystitis, urethritis, and related discomforts or dysfunctions – Liver and gallbladder disorders, such as acute icteric hepatitis, acute cholecystitis, and more

Traditional Points Classic Master Tung Points Balance Method by Dr. Richard Tan Master Tung’s Points by Dr. Brad Whisnant

• Ear Acupuncture – Traditional Points – Auricular Medicine by Dr. Li-Chun Huang

Gentiana Complex

Gentiana Complex

• Chinese Actions

• • • • • • • • • • • • • •

– Drains fire from the Liver and the Gallbladder channels – Clears damp-heat from the lower jiao – Nourishes yin

• Western Actions – Antihypertensive effect to lower blood pressure – Antibiotic, antibacterial, antiviral and antifungal effects for a variety of infections – Hepatoprotective and cholagogic functions to treat liver and gallbladder disorders – Anti-inflammatory properties to treat inflammation of the internal organs and soft tissue

Ge Gen (Radix Puerariae Lobatae) • Ge Gen (Radix Puerariae Lobatae) has shown marked effectiveness in lowering blood pressure by dilating coronary artery and relieving spasms of blood vessels.[i],[ii],[iii] • • •

[i] Zhong Yao Xue (Chinese Herbology), 1998; 101:103 [ii] Yi Xue Yan Jiu Tong Xun (Report of Medical Studies), 1972; (2):14 [iii] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1979; 59(8):479

Che Qian Zi (Semen Plantaginis) Da Huang (Radix et Rhizoma Rhei) Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) Di Huang (Radix Rehmanniae) Ge Gen (Radix Puerariae Lobatae) Hua Shi (Talcum) Huang Bo (Cortex Phellodendri Chinensis) Huang Qin (Radix Scutellariae) Long Dan (Radix et Rhizoma Gentianae) Niu Xi (Radix Achyranthis Bidentatae) Shi Jue Ming (Concha Haliotidis) Ze Xie (Rhizoma Alismatis) Zhen Zhu Mu (Concha Margaritiferae) Zhi Zi (Fructus Gardeniae)

Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) • Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) dilates blood vessels and increases blood perfusion to peripheral blood vessels.[i] •

[i] Guo Wai Yi Xue Zhong Yi Zhong Yao Fen Ce (Monograph of Chinese Herbology from Foreign Medicine), 1991; 13(3):41

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

12

Long Dan (Radix et Rhizoma Gentianae) Ze Xie (Rhizoma Alismatis) • Long Dan (Radix et Rhizoma Gentianae) and Ze Xie (Rhizoma Alismatis) both have diuretic effect to eliminate water and lower blood pressure.[i],[ii] • •

[i] Sheng Yao Xue Za Zhi (Journal of Raw Herbology), 1982; 36(2):150 [ii] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983: 718

Che Qian Zi (Semen Plantaginis) • Che Qian Zi (Semen Plantaginis) also has significant angiotensinconverting enzyme inhibitory activity to lower blood pressure.[i] •

Da Huang (Radix et Rhizoma Rhei) • Da Huang (Radix et Rhizoma Rhei) has various impacts on the cardiovascular system. It has been shown to lower blood pressure, reduce heart rate, and decrease peripheral vascular resistance.[i],[ii] •

•

[i] Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and Pharmacology of Common Chinese Drugs), 1994; 226:323 [ii] Zhong Guo Zhong Yao Za Zhi (People's Republic of China Journal of Chinese Herbology), 1989; 14(10):46

[i] Geng F, Yang L, Chou G, Wang Z. Bioguided isolation of angiotensin-converting enzyme inhibitors from the seeds of Plantago asiatica L. Phytother Res. 2010 Jul;24(7):1088-94.

Supplementary Formulas • For coronary heart disorders, combine with Circulation. • For severe blood stagnation, add Circulation (SJ). • For high blood pressure and fast heart rate due to excess fire, add Gardenia Complex. • For hypertension with edema and water accumulation, combine with Herbal DRX. • For increased thirst and constipation, combine with Gentle Lax (Excess).

Clinical Notes

Cautions & Contraindications

• Western medicine classifies hypertension into two types: “red” and “pale” high blood pressure.

• Herbal treatment is ineffective for malignant hypertension and some secondary hypertension, such as renal stenosis or pheochromocytoma. Refer the patient to a medical doctor, as surgical intervention may be necessary.

– “Red” high blood pressure corresponds with The TCM diagnosis of “excess,” and generally occurs in energetic and stressed individuals with marked redness and vascularized skin. – “Pale” high blood pressure corresponds with The TCM diagnosis of “deficiency,” and generally occurs in individuals with compromised kidneys, glands, or metabolism.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

13

Cautions & Contraindications

Cautions & Contraindications

• Some patients may experience mild stomach discomfort or loose stool, which may be alleviated by reducing the dosage of herbs or taking the herbs with food. • This formula is contraindicated during pregnancy and nursing.

• The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”

Cautions & Contraindications

Case Studies

• This herbal formula contains herbs that invigorates blood circulation, such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[i] •

[i] Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-406.

• L.L., a 56-year-old female, presented with frustration, anger and sadness over losing her home in the hurricanes. She was unable to move through these emotions. She was also diagnosed with hypertension, high cholesterol, and post-traumatic stress syndrome recently, and refused to take medications. Her blood pressure was 138/78 mmHg and her heart rate was 82 beats per minute. She also suffered from headaches in the temporal region and the vertex. Other symptoms included twitching of the eyes, agitation, red eyes, and a scalloped tongue with thick yellow tongue coating. TCM diagnoses were damp-heat in the Liver and Gallbladder, Kidney yin deficiency, and excess fire and wind rising. She was prescribed the following formulas: Calm (ES) at 1 to 3 capsules, as needed, Cholisma at 4 capsules twice daily, and Gentiana Complex at 5 capsules twice daily. The patient gained control of her emotions immediately after taking Calm (ES). Blood pressure gradually reduced over time to 120/72 mmHg. The practitioner commented that the combination of these formulas are phenomenal. Submitted by M.H., West Palm Beach, Florida.

Additional Information

Comparative Analysis

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ

• Diuretics [Lasix (furosemide) and hydrochlorothiazide] • Beta-blockers [Tenormin (atenolol) and Inderal (propranolol)] • Calcium channel blockers [Procardia (nifedipine) and Calan (verapamil)] • ACE inhibitors [Vasotec (enalapril)] and Capoten (captopril)] • Vasodilators [hydralazine and minoxidil] • Main advantage: potency to suppress blood pressure. • Main disadvantages: do not change the underlying constitution of the patient and must be used continually and cannot be stopped. Discontinuing use of drugs often leads to rebound hypertension.

– – – –

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• Ear Acupuncture – Traditional Points – Auricular Medicine by Dr. Li-Chun Huang

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

14

Circulation

Circulation

• Cardiovascular disorders, such as coronary heart disease, angina pectoris, ischemia, and atherosclerosis • Circulatory disorders, such as poor cerebral and body circulation, numbness of the limbs, peripheral neuropathy and similar problems

• Chinese Actions

Circulation • • • • • • • • • • • • • •

Bai Shao (Radix Paeoniae Alba) Chuan Xiong (Rhizoma Chuanxiong) Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) Dang Gui (Radix Angelicae Sinensis) Ge Gen (Radix Puerariae Lobatae) Gui Zhi (Ramulus Cinnamomi) Hong Hua (Flos Carthami) Hou Po (Cortex Magnoliae Officinalis) Jiang Xiang (Lignum Dalbergiae Odoriferae) Mao Dong Qing (Radix Ilicis Pubescentis) Ren Shen (Radix et Rhizoma Ginseng) Sha Ren (Fructus Amomi) Xie Bai (Bulbus Allii Macrostemonis) Zhi Shi (Fructus Aurantii Immaturus)

Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) • Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) dilates blood vessels and increases blood perfusion to peripheral blood vessels.[i] •

– Invigorates blood circulation in the upper jiao and dispels blood stasis – Unblocks meridians and relieves pain – Warms Heart yang and dispels damp and phlegm

• Western Actions – Vasodilating action to increase blood perfusion and decrease peripheral resistance – Positive cardiotonic property to strengthen cardiac contraction and improve blood circulation – Antiplatelet and anticoagulant effects to reduce the risk of blood clots – Antihyperlipidemic function to lower plasma cholesterols and triglycerides

Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) • Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) has antiplatelet, anticoagulant, and thrombolytic effects, and is also one of the most effective herbs to improve blood circulation.[i],[ii] • •

[i] Shang Hai Di Yi Xue Yuan Xue Bao (Journal of First Shanghai Medical College), 1979; 6(3):144. [ii] Shang Hai Di Yi Xue Yuan Xue Bao (Journal of First Shanghai Medical College), 1982; 9(1):14

Xie Bai (Bulbus Allii Macrostemonis) • Xie Bai (Bulbus Allii Macrostemonis) has been shown to markedly inhibit the aggregation of platelets and prolong clotting time.[i] •

[i] Bai Qiu En Yi Ke Da Xue Xue Bao (Journal of Baiqiuen University of Medicine), 1984; 10(16):609

[i] Guo Wai Yi Xue Zhong Yi Zhong Yao Fen Ce (Monograph of Chinese Herbology from Foreign Medicine), 1991; 13(3):41

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

15

Mao Dong Qing (Radix Ilicis Pubescentis)

Supplementary Formulas

• Mao Dong Qing (Radix Ilicis Pubescentis) has shown marked effectiveness to dilate blood vessels and increase blood perfusion to the coronary arteries.[i] • Mao Dong Qing (Radix Ilicis Pubescentis) has been shown to effectively treat cardiovascular diseases, such as coronary artery disease and ischemic stroke. [ii],[iii]

• For cardiovascular or circulatory disorders affecting the entire body, add Circulation (SJ). • For hypertension with dizziness or vertigo, combine with Gastrodia Complex. • For hypertension with anger or flushed face, combine with Gentiana Complex. • For high cholesterol and triglycerides, add Cholisma. • For high cholesterol and triglycerides with fatty liver and obesity, add Cholisma (ES). • For diabetes mellitus, add Equilibrium. • For obesity, Herbalite may be used to suppress appetite and facilitate weight loss.

• • •

[i] Zhong Yao Xue (Chinese Herbology), 1998; 588:589 [ii] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1979; 11:48 [iii] Guang Dong Yi Xue (Guangdong Medicine), 1983; 4(8):28

Clinical Notes

Cautions & Contraindications

• Maintenance of the herbal treatment is necessary for approximately six months in order to stabilize the condition. One should always address the secondary causes and/or complications of coronary artery disease. • Patients with high risk of cardiovascular disorders may benefit from preventative treatments by taking low doses of Circulation. Risk factors of cardiovascular disorders include family history, obesity, sedentary lifestyle, cigarette smoking, etc.

• Acute myocardial infarction is a medical emergency. Call 911 to send patients to emergency room as soon as possible. Monitor their condition until emergency medical personnel arrive. • Do not use this formula to treat acute myocardial infarction. Circulation is to be used for prevention of coronary artery disease; not for treatment of heart attacks. • Circulation is contraindicated during pregnancy and nursing.

Cautions & Contraindications

Case Studies

• This herbal formula contains herbs that invigorates blood circulation, such as Dang Gui (Radix Angelicae Sinensis) and Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[i],[ii],[iii]

• F.L., a 53-year-old female patient, presented with recent history of TIA (transient ischemic attack). Objective findings included right-sided pulling and numbness of the face with difficulty smiling and closing the right eye, as well as drooping of facial muscles on the right side when smiling, and partial facial flaccidity. Treatment using three capsules of Circulation, three times daily, was successful: no recurring episodes were noted during subsequent follow-up visits. This patient also had constipation with hard, difficult to move stools, abdominal pain, and cramps with bloating. All these gastrointestinal symptoms were resolved with Gentle Lax (Deficient) taken at four capsules, three times daily. Submitted by C.L., Chino Hills, California.

• • •

[i] Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-6. [ii] Pharmacotherapy 1999 July;19(7):870-876. [iii] European Journal of Drug Metabolism and Pharmacokinetics 1995; 20(1):55-60.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

16

Additional Information

Comparative Analysis

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ

• Nitroglycerin • Antiplatelets [aspirin and Ticlid (ticlopidine)] • Anticoagulants [heparin and Coumadin (warfarin)]. • Though these drugs have serious side effects, their use can be justified because they offer major benefits, especially in urgent situations.

– – – –

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Circulation (SJ)

Circulation (SJ)

• Severe blood stasis and stagnant blood circulation in upper, middle and lower jiaos (San Jiao):

• Chinese Actions

– Severe blood stagnation in the upper body: headache, angina pectoris, rheumatic heart disease, thrombosis, embolism, cardiac ischemia, bradyarrhythmia, stroke, concussion, post-concussion syndrome, cerebral atherosclerosis, hyperlipidemia, and physical injury to the chest – Severe blood stagnation in the middle body: pleural adhesion, acute and chronic hepatitis, liver cirrhosis, hepatic hemangioma, cholecystitis, jaundice, and splenomegalia – Severe blood stagnation in the lower body: female infertility, male infertility, amenorrhea, dysmenorrhea, irregular menstruation, uterine bleeding, ectopic pregnancy, hysteromyoma, endometriosis, oophoritic cyst, ovarian cyst, pelvic inflammatory disease, hyperplastic tuberculosis of intestine, ulcerative colitis, and urinary stones

– Invigorates blood and qi circulation in the upper, middle and lower jiaos – Dispels blood stasis and qi stagnation – Unblocks meridians and relieves pain

• Western Actions – Treats cardiovascular and circulatory disorders throughout the entire body – Antiplatelet and anticoagulant effects to reduce the risk of blood clots and decrease blood viscosity – Vasodilating action to lower blood pressure and increase blood perfusion – Positive cardiotonic function to strengthen cardiac contraction and improve blood circulation

Circulation (SJ) • Bai Shao (Radix Paeoniae Alba) • Chai Hu (Radix Bupleuri) • Chi Shao (Radix Paeoniae Rubra) • Chuan Niu Xi (Radix Cyathulae) • Chuan Xiong (Rhizoma Chuanxiong) • Dang Gui (Radix Angelicae Sinensis) • Di Huang (Radix Rehmanniae) • Gan Cao (Radix et Rhizoma Glycyrrhizae) • Hong Hua (Flos Carthami)

• • • • • • • • • •

Jie Geng (Radix Platycodonis) Mo Yao (Myrrha) Mu Dan Pi (Cortex Moutan) Pu Huang (Pollen Typhae) Rou Gui (Cortex Cinnamomi) Shui Zhi (Hirudo) Tao Ren (Semen Persicae) Wu Yao (Radix Linderae) Xiang Fu (Rhizoma Cyperi) Yan Hu Suo (Rhizoma Corydalis) • Zhi Qiao (Fructus Aurantii)

• Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction), 879 • Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction), 885 • Shao Fu Zhu Yu Tang (Drive Out Blood Stasis in the Lower Abdomen Decoction), 889

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

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Supplementary Formulas

Supplementary Formulas

• Cardiovascular disorders:

• Gynecological disorders:

– Angina, atherosclerosis: add Circulation. – High cholesterol: add Cholisma or Cholisma ES. – Hypertension with dizziness or vertigo, combine with Gastrodia Complex. – Hypertension with anger or flushed face, combine with Gentiana Complex.

Supplementary Formulas •

• • • • • • • • • • • • •

For extreme anxiety, stress, emotional or psychological issues, add Shine or Calm ES. If heat is evident from the tongue, use Circulation (SJ) with Gardenia Complex first until heat is purged then follow up with Shine or Calm ES. Insomnia: add Calm (ES), Calm ZZZ, or Schisandra ZZZ. Depression: add Shine or Shine (DS). Post-stroke care: add Neuro +. For nodules or swelling: add Resolve (AI). With excess heat or fever: add Gardenia Complex. Psoriasis or chronic skin condition: add Dermatrol (PS). For weepy skin conditions, add Dermatrol (Damp). For dry skin conditions, add Dermatrol (Dry). For edema or swelling, add Herbal DRX. Varicose veins: add Shan Zha (Fructus Crataegi) For forgetfulness, add Enhance Memory. With cold extremities, add Kidney Tonic (Yang). Hair loss, add Polygonum 14.

– Dysmenorrhea: add Mense-Ease. – Fibrocystic disorder in the breast: add Resolve (Upper). – Endometriosis or fibroids or cysts in the uterus or other mass: add Resolve (Lower).

Clinical Notes • The sedentary lifestyle of modern society is characterized by sitting for long hours and lack of exercise. Most people spend many hours of the day sitting in their cars, office, and home. With lack of movement, blood circulation is impaired and gradually leads to a large number of illnesses. Therefore, this formula is not only an excellent formula to improve blood circulation and treat clot related disorders, it is also a wonderful formula for prevention of chronic illness. In addition, this formula can be combined with many other formulas to improve blood circulation and deliver the herbs to the affected areas that may be hard to reach.

Clinical Notes

Clinical Notes

• Circulation (SJ) has a wide range of therapeutic actions and may be used to treat many different diseases. One common presentation among all these diseases is blood stagnation characterized by either a light or dark purplish tongue. There are also cases where the tongue may appear normal but the sublingual vein are distended and dark in appearance. Patients face may appear dark and lusterless. Lips may be dark or purplish. Axillae, transverse cubital crease and the popliteal fossa may all appear slightly darker than the rest of the skin.

• Circulation (SJ) works similarly like the reset button on the computer. When too many programs are open and running, the computer may freeze. The body works the same way in that it breaks down when there are too many aggravating factors or symptoms. The formula works like the reset button on the computer to clear away stagnation so the body has a chance to start new again. In breaking down the blood clot, it then should become clear what condition needs to be addressed instead of being confused with multiple symptoms that may not point to any clear diagnosis.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

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“Blood-Moving Herbs”

Herb-Drug Interactions

• Thrombolytic herbs: – San Leng (Rhizoma Sparganii) – E Zhu (Rhizoma Curcumae) – Shui Zhi (Hirudo)

• Anticoagulant herbs: – Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) – Chi Shao (Radix Paeoniae Rubra)

• Thrombolytic drugs • Anticoagulant drugs • Antiplatelet drugs

• Antiplatelet herbs: – Chuan Xiong (Rhizoma Chuanxiong) – Hong Hua (Flos Carthami)

• Herbs that activate blood circulation – bleeding and brusing

• Herbs that stop bleeding – clotting

Cautions & Contraindications

Cautions & Contraindications

• This herbal formula contains herbs that invigorates blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[i],[ii],[iii] • Patients on anticoagulant drugs, such as Coumadin (warfarin), should not fluctuate their daily consumption of vitamin K, which is found in alfalfa, cauliflower, liver, and in all dark green vegetables including broccoli and spinach.

• This formula is contraindicated during pregnancy and nursing. It should be used with caution during menstruation as it may cause excessive bleeding. In such cases, discontinue use immediately and resume after menstruation is over. • This formula is contraindicated in patients with bleeding disorders, such as hypermenorrhea, uterine bleeding, and hemophilia. • This formula should be discontinued 1 to 2 weeks before surgery. • This formula should be taken for no more than one month continuously. • Due to its potent effect, this formula is contraindicated in weak and elderly patients.

Cautions & Contraindications

Case Studies

• During the course of treatment with this formula, some patients with chronic “dead blood” might notice pain in places of past injuries. Advise the patient of this possible experience before giving the formula that it is a positive sign as it is clearing away the residual stagnation and bringing in fresh blood supply to the chronically injured place. In some cases where patients cannot tolerate the pain, reduce the dosage of the formula by 20%. After experiencing the initial pain, the patient will later experience a total clearing sensation. This is especially prevalent in those suffering from chronic headaches due to previous head injuries. Failure to advise the patient on the potential experience of pain may result in misunderstanding by the patient, who may think the herbal treatment is causing them more pain in an adverse way.

• After recently attending Dr. Jimmy Chang's seminar in Austin, Texas, I decided to try Circulation SJ with a client I had been working with since March. He is a 25 year old who has been diagnosed with Reflex Sympathetic Dystrophy (RSD) of the right ankle. This is the result of a fall from a cliff 5 years ago in which he sustained extensive crushing injury to the bones of the ankle and fibula. He had three surgeries to attempt to repair the damage that were unsuccessful to the extent that amputation just below the knee was strongly encouraged by his physicians. Most of the time he cannot stand anything touching his right leg so he is in shorts and barefoot, and in a wheelchair. I started working with him with acupuncture only using Dr. Tan's 12 Magic Points since he was reluctant to try herbs since he was using painkillers, even though they were not very effective. We had made some progress: he had been able to reduce his medications and sometimes he could put on a sock and loose shoe. Then two weeks ago I put him on Circulation SJ.

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

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Case Studies • The first week some diminishment of pain occurred, but the second week was the miracle! He came to his appointment with shoes and socks on, and was walking with a slight limp. His face and eyes were clearer then I had ever seen, he was laughing and calm. Later that day the massage therapist who had originally referred him to me called to tell me for the first time in the 2 years she had been working with him she was able to touch his leg without him screaming in pain. She said his entire body was different - the tension and rigidity that was always there in the past was gone. Her statement to me was "it was like massaging a normal person". She stated that she had been contemplating discontinuing working with him because she "felt like all she was doing was grinding bone on bone and causing him pain" My client and I thank you and Dr. Chang for your continuing efforts in the field of Asian medicine. Please do not let Dr. Chang stop teaching. Thanks again!

Case Studies • As an update, this week when I saw this young man, he had continued improvement. While we were talking before his treatment he was sitting there with his legs crossed as only men can do, stroking and playing with his damaged ankle and toes. When I commented on this, he said that it was just so amazing to him to be able to be touched without it causing pain for the first time in years. Submitted by A.G., Austin, Texas.

Additional Information

Comparative Analysis

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ

• Antiplatelets [aspirin and Ticlid (ticlopidine)] • Anticoagulants [heparin and Coumadin (warfarin)]. • Thrombolytic drugs

– – – –

Traditional Points Classic Master Tung Points Balance Method by Dr. Richard Tan Master Tung’s Points by Dr. Brad Whisnant

• Ear Acupuncture – Traditional Points – Auricular Medicine by Dr. Li-Chun Huang

Flex (NP)

Flex (NP)

• Neuropathy: peripheral neuropathy, polyneuropathy, diabetic neuropathy, druginduced neuropathy • Neuralgia: trigeminal neuralgia, postherpetic neuralgia • Wei (atrophy) syndrome • Peripheral vascular disease • General pain, numbness, tingling, swelling, and muscle wasting, especially in the extremities

• Chinese Actions – Invigorates blood circulation – Relieves pain – Opens channels and collaterals

• Western Actions – Analgesic function to relieve pain – Anti-inflammatory function to reduce swelling and inflammation – Circulatory effect to improve peripheral blood circulation to facilitate healing and recovery – Treats causes of peripheral neuropathy, such as trauma, infection, and accumulation of drugs and toxic chemicals

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

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Flex (NP) • • • • • • • • • • • •

Bai Shao (Radix Paeoniae Alba) Chuan Mu Xiang (Radix Vladimiriae) Chuan Niu Xi (Radix Cyathulae) Chuan Xiong (Rhizoma Chuanxiong) Da Huang (Radix et Rhizoma Rhei) Da Zao (Fructus Jujubae) Dang Gui (Radix Angelicae Sinensis) Dang Gui Wei (Extremitas Radix Angelicae Sinensis) Er Cha (Catechu) Fu Ling (Poria) Gan Cao (Radix et Rhizoma Glycyrrhizae) Hong Hua (Flos Carthami)

• • • • • • • • • • • • •

Huang Jin Gui (Caulis Vanieriae) Liu Zhi Huang (Herba Solidaginis) Lu Lu Tong (Fructus Liquidambaris) Mo Gu Xiao (Caulis Hyptis Capitatae) Mo Yao (Myrrha) Mu Dan Pi (Cortex Moutan) Qiang Huo (Rhizoma et Radix Notopterygii) Qin Jiao (Radix Gentianae Macrophyllae) Ru Xiang (Gummi Olibanum) Sheng Ma (Rhizoma Cimicifugae) Tao Ren (Semen Persicae) Xue Jie (Sanguis Draconis) Yan Hu Suo (Rhizoma Corydalis)

• Shen Tong Zhu Yu Tang (Drive Out Blood Stasis from a Painful Body Decoction) • Shu Jing Huo Xue Tang (Relax the Channels and Invigorate the Blood Decoction)

Supplementary Formulas

Clinical Notes

• For neuropathy due to chronic exposure to harmful toxins and chemicals, add Herbal DTX. • For diabetic neuropathy, use with Equilibrium. • To potentiate the effect to relieve pain, add Herbal Analgesic. • For nerve pain in the neck and shoulder area, add Neck & Shoulder (Acute) or Neck & Shoulder (Chronic). • For nerve pain in the lower back, add Back Support (Acute) or Back Support (Chronic). • For nerve pain in the back from herniated disk, add Back Support (HD). • For nerve pain in the arm (shoulder, elbow and wrist), add Arm Support. • For nerve pain in the knees, add Knee & Ankle (Acute) or Knee & Ankle (Chronic).

• It is essential to identify and eliminate the cause(s) of neuropathy, especially if it is induced by drugs or toxic agents. Without elimination of the offending agent, treatment will offer only symptomatic relief. • Neuropathy due to nutritional deficiency must be identified and treated accordingly. Adequate intake of vitamin B complex is beneficial. Though it is uncommon in the developed countries, patients with polyneuropathy due to nutritional deficiency should be put on vitamin B supplementation. • Neuropathy due to metabolic disorders, such as diabetic neuropathy, must be identified, and the root cause treated accordingly. Blood glucose levels must be monitored to ensure that the patient’s levels stay within acceptable range.

Cautions & Contraindications

Cautions & Contraindications

• This formula is contraindicated during pregnancy and nursing.

• The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

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Cautions & Contraindications

Case Studies

• This herbal formula contains herbs that invigorates blood circulation, such as Dang Gui (Radix Angelicae Sinensis) and Dang Gui Wei (Extremitas Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[i],[ii],[iii]

• J.R., a male patient suffered from intolerable neuropathy after receiving chemotherapy and radiation for throat cancer. He conducted an empirical test on himself in which he took Flex (NP) for one week and did not take it for another. He reported that the week without the Flex (NP) was nearly intolerable. But with it, he is “in the zone” and is able to sleep. The Flex (NP) is reduced his neuropathic symptoms a good 50%. Submitted by: C.W., Carpinteria, California

• • •

[i] Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-6. [ii] Pharmacotherapy 1999 July;19(7):870-876. [iii] European Journal of Drug Metabolism and Pharmacokinetics 1995; 20(1):55-60.

Case Studies

Additional Information

• J.B., a 55-year-old female, presented with pain located on the right foot, numbness tingling along the neck, and pain shooting down the back legs. The patient was also complaining about hot flashes and night sweating. Objective findings included pain upon palpation of the joints and red cheeks. TCM diagnosis was qi and blood stagnation with yin deficiency; her Western diagnosis was RSD (reflex sympathetic dystrophy). Flex (NP) was prescribed at 2-3 capsules twice a day. After taking the herbs, the patient experienced less pain in the arm and neck, but pain in the right foot was still present, and she was experiencing slight stomach discomfort. The patient was directed to take a higher dosage if tolerable. Submitted by M.P., Muskego, Wisconsin.

• Nutrition • Lifestyle Instructions • Ａｃｕｐｕｎｃｔｕｒｅ – – – –

Traditional Points Classic Master Tung Points Balance Method by Dr. Richard Tan Master Tung’s Points by Dr. Brad Whisnant

• Ear Acupuncture – Traditional Points – Auricular Medicine by Dr. Li-Chun Huang

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected] Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

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