Health Column November 2018
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What is Dysautonomia? A Brief Introduction
BY  黃冠維, PT
The term "dysautonomia" was originally common in ultra-high stress Japan; it is often considered as "modern lifestyle illness." In recent years, dysautonomia has also been common in Taiwan as the average citizen’s stress levels continue to rise. Dysautonomia may cause dizziness, headaches, sweating, chest discomfort, nausea, muscle tightness, neck and shoulder soreness, difficult breathing, throat blockage, hand tremors or numbness, constipation, diarrhea, insomnia, frequent urination… the list goes on and on!

Why are we talking about dysautonomia today? This blog began as a solution for exercise injuries and all kinds of chronic pain, such as shoulder and back pain. We understand that not all pain arises from musculoskeletal issues; sometimes, nervous system or psychological factors may play a role, and these factors are often related to your lifestyle.
So What is Dysautonomia? 
Your body is controlled by your nervous system, and your nervous system acts like the wires, chips, and memory card in your phone or computer, sending signals and performing calculations. Your nervous system is the boss of your body, controlling everything from organs to individual cells.  The nervous system can be divided into two parts: the central nerves and peripheral nerves.
Central nerves: Includes the brain (cranial nerves) and the spine (spinal nerves)
Peripheral nerves: Divided into somatic nerves (sensory and motor nerves) and autonomic nerves
Although sensory and motor nerves are frequently mentioned, they make up only 10% of peripheral nerves, while the remaining 90%, made up of autonomic nerves, are often overlooked.

What Do Autonomic Nerves Do? 
Autonomic nerves are divided into sympathetic nerves, parasympathetic nerves, and enteric nerves, but more people have probably heard more about the first two. Sympathetic nerves originate in the brain stem, and are divided by the spine into peripheral nerves. Sympathetic nerves excite the body, maintain alertness, increase focus, and prepare the body to react to environmental stressors. Parasympathetic nerves originate directly from the brain stem and don't pass through the spine. Parasympathetic nerves allow the body to relax, rest, conserve energy, promote digestion, and help you sleep. Sympathetic and parasympathetic nerves serve opposite functions, allowing the body to switch between different conditions and maintain balance. Enteric nerves control the gastrointestinal tract, pancreas, gallbladder, and other organs. 

What Are the Effects of Dysautonomia? 
The previous sections taught us that autonomic nerves are located throughout the body and are closely related to tension and relaxation. Thus, it is only to be expected that the symptoms associated with dysautonomia are countless.
Common Problems Caused by Autonomic Nerve Dysfunction Include: 
Dizziness, head heaviness, migraines, concentration difficulties, reduced capacity for thinking and understanding, emotional instability, irritability, nervousness, anxiety, panic disorder, depression, negative thinking, weakness and fatigue, difficulty falling asleep, light sleep, poor sleep quality, snoring, stroke aftereffects, dementia and other neurodegenerative diseases, shaking hands (tremors), facial nerve numbness, dry eye, eye fatigue, worsening farsightedness, chronic rhinitis, allergic rhinitis, chronic laryngitis, chronic cough, dry throat or feeling of blockage, susceptibility to colds, vertigo, tinnitus, heart palpitations, chest discomfort, difficulty breathing, high blood pressure, orthostatic hypotension, burping, abdominal distension, bloating, flatulence, soft stool, diarrhea, heartburn, irritable bowel syndrome, difficulty swallowing, frequent urination, nocturia, Benign Prostatic Hyperplasia (BPH), sexual dysfunction, loss of coordination, night sweats, hyperhidrosis, red face, and more. 

In short, the symptoms are virtually endless, and they include a number of common modern illnesses. Even more interestingly, unlike illnesses such as colds, autonomic nerve symptoms are different for each person. Now you might be wondering, "How do doctors determine if the problem is being caused by dysautonomia or not?" For example, if a person has diarrhea, we generally begin by examining their gastrointestinal tract, because we first suspect that the issue is there. If we cannot find the cause in the gastrointestinal tract, that's when we begin to take a look at autonomic nerves. The reasoning is simple: when performing an examination, doctors usually start from issues that are common and easy to clarify before moving on to check for more complicated or less probable causes.  

How Do You Examine Autonomic Nerves? 
In general, we use the process of elimination in addition to objective testing in order to make a diagnosis, because the symptoms of dysautonomia are so widely varied. Currently, a common autonomic nerve testing method is called Heart Rate Variability. As its name suggests, this test uses the rate of change in a person’s heart rate to detect sympathetic and parasympathetic nerve activity.

Common Causes of Dysautonomia 
Truly identifying the cause of a problem in something as complex as the nervous system is difficult, but common factors include:
1. Natural predisposition
2. Exogenous stress: environmental, psychological, physiological
3. Endogenous stress: related to your personality
4. Poor lifestyle habits
5. Abnormal hormone secretion
6. Age: Parasympathetic nerves rapidly degenerate and may cause dysautonomia for men around the age of 30 and women around the age of 40.
How Can I Reverse Dysautonomia? 
1. Establish a regular work-rest routine to help with insomnia and have better quality sleep
2. Commit to good exercise habits and get more sun exposure.
3. Eat a balanced diet; don’t be picky!
4. Those prone to stress and tension must learn how to release stress and relax. 
About Your Health 
Dysautonomia is actually not a disease; think of it more like a warning being sent out by the body signifying suboptimal health. Suboptimal health means that the body is not completely healthy, but has also not yet reached the point of illness. Many people are caught in this gray area.
Everyday life in today's high-stress society can be overwhelming, and we suggest readers maintain a regular routine, find stress relief methods, and exercise regularly. Doing this can move you further right on the health spectrum, and even if unexpected illness strikes, your body will be able to recover faster. Remember, a tough workout today is an investment in your future health. If you suspect that there is a problem with your autonomic nerves, please turn to family medicine doctors, rehabilitative doctors, mental health professionals, Traditional Chinese medicine practitioners, psychological counselors, and a small number of physical therapists for some help.
Retrieved from: 好痛痛 - 復健科、骨科、物理治療醫療資訊

Herbs for Digestive Complaint
BY Craig Williams, LAC, AHG

One of the most common presentations in the clinical setting is digestive complaints. Almost daily I see patients presenting with a wide array of digestive issues ranging from simple issues such as gas or bloating to complex issues such as IBS or chronic food allergies. The other commonality that I encounter in these clinical issues is the respective patients bringing in bags of digestive supplements. This usually includes basic to complex digestive enzymes and probiotics. The troubling aspect of this presentation is that the majority of these patients are referrals from other acupuncturists. Why would practitioners of Chinese medicine, with all the years of training, resort to prescribing basic digestive supplements over effective TCM formulas based on pattern presentation? Therefore, I will discuss two TCM formulas with specific modifications, that I use extensively in cases of digestive disorders. They also more effectively treat a wide array of digestive challenges versus generic digestive supplements.

Liu Jun Zi Tang
This is one of the most foundational formulas for a wide spectrum of digestive disorders. This formula boosts Spleen Qi, harmonizes the Stomach and transforms Phlegm. The typical tongue presentation for this formula is normal to pale, and swollen with teeth marks. In cases of digestive disorders, heat is often present causing the tongue to be red to scarlet and in these cases, the formula can easily be adapted or combined with another formula to target Spleen Qi Vacuity with 
heat complications.
I often use this formula for patients with a combination of chronic digestive challenges and chronic allergies. Liu Jun Zi Tang is highly effective for resolving chronic low-grade phlegm complications that result in chronic bloating and vague digestive complaints.
This can easily be combined with Chai Hu Shu Gan Wan in such cases, which almost always includes Liver Depression Qi Stagnation.

In cases of digestive issues with chronic phlegm with the patient complaining of a chronic cough or mucus in the throat, combine Liu Jun Zi Tang with Ban Xia Hou Po Tang. In cases of significant phlegm or damp, use the modified Xiang Sha Liu Jun Zi Tang which adds Mu Xiang and Sha Ren with the foundational formula. This will more effectively clear and transform phlegm and dampness, two issues so common in chronic digestive issues and chronic allergies. One of the most effective formulas to combine with Liu Jun Zi Tang is Jia Wei
Xiao Yao Wan. This is an extremely powerful formula combination for any digestive disorder with Spleen/Liver disharmony with concomitant heat. These two formulas often resolve long-standing digestive issues which have been ineffectively treated with the band-aid of generic digestive enzymes or probiotics. If the patient has significant issues with loose stools as a main symptom of the respective digestive complaint, combine Liu Jun Zi Tang with Shen Ling Bai Zhu Tang, a highly effective formula combination which often resolves conditions which probiotics seem unable to effectively resolve.

Bao He Wan
This is perhaps the most important formula in my clinical repertoire when dealing with digestive complaints. I'm constantly shocked at how clinicians seem to ignore this highly effective TCM formula and resort to using generic digestive supplements instead. This formula is essentially a modified Er Chen Tang with the addition of Ban Xia and Fu Ling. This can be used for food stagnation, clears heat, dispels damp, descends the Stomach Qi and promotes digestion. Very few formulas can target so many aspects of the digestive system as well as clear heat. This formula can be highly effective in patent medicines and can be used in a relatively high dose to resolve hard to diagnose or recalcitrant digestive complaints. The tongue presentation is typically a red body with a greasy yellow or 
white coat, often sticky in consistency.  This formula can be combined in with Spleen tonics such as Bu Zhong Yi Qi Tang or Xiao Yao Wan in complex cases of stagnation and heat which often go unresolved when patients are prescribed generic digestive enzymes or probiotics. This formula can be taken with food or on an empty stomach and works fairly quickly to assuage symptoms as well as resolve more complex underlying disease mechanisms. Bao He Wan is a key formula for holiday overeating, as well as for digestive issues which can occur while traveling. This formula can also
of course be combined with the aforementioned Liu Jun Zi Tang in cases of complex and hard to treat digestive presentations.

One wonders why TCM practitioners would ignore the vast array of TCM formulas which target the patterns behind digestive disorders and blindly prescribe generic digestive enzymes or probiotics. While I have no issue with the use of digestive supplements and do occasionally employ them in the clinical setting, the average patient I see in my clinic has already been self-medicating with digestive enzymes/probiotics with poor to average results. 
they may feel slightly better, once they stop the digestive supplements, the symptoms reappear and the digestive complaints remain essentially unresolved. These are the cases in which TCM can excel, and in which TCM clinicians should employ pattern diagnosis to effectively target the root causes instead of seeking to constantly trim the branch symptoms. I hope this information inspires clinicians to put aside generic supplements and strive to use the rich treasure chest of Chinese medicine to help improve the lives of patients suffering from digestive complaints.