The thinking about geriatrics in Chinese medicine has been dominated by Kidney deficiency for centuries. As Kidney-Jing declines as we age, the clinical approach to the treatment of the elderly has been based largely on tonifying the Kidneys.However, modern diseases of the elderly that account for 90% of mortality (cancer, heart disease and stroke) are characterized by Fullness.

Quite simply, we do not die of Kidney deficiency but of Phlegm, Blood stasis and Internal Wind.The most common pathogenic factors (and those leading to serious diseases) are:Phlegm Blood stasis Internal Wind Apart from the major diseases of the elderly such as cancer, stroke and heart disease, very many symptoms and signs that occur in old age are caused by Phlegm and/or Blood stasis. The following is a partial list.

GERIATRIC SYMPTOMS/SIGNS

  • Otosclerosis: Phlegm/Blood stasis
  • Cataract: Phlegm
  • Macular degeneration (vascular, lack of blood nourishment): Blood stasis
  • Dry eyes: may be due to Blood stasis
  • Alzheimer: Phlegm (the neurofibrillary tangles and plaques in the brain are a form of Phlegm)
  • Parkinson: Wind
  • Poor memory: is often due to Phlegm
  • Brain muzziness: Phlegm
  • Dizziness: Phlegm
  • Epiretinal membrane: Phlegm
  • Macules: Blood stasis
  • Dry skin: in the elderly may be due to Blood stasis
  • Itching: Phlegm/Wind
  • Numbness: Phlegm/Wind
  • Hair loss: may be due to Blood stasisThe following three Tables list the major diseases of the elderly with the pathology they are due to:

chart1

chart2

chart3

Many of the symptoms of the elderly are due to Phlegm:Heart: mental confusion, feeling of oppression in the chestGall-Bladder: stones, nausea, inability to digest fatsJoints: bone deformities, pain, rigidityLungs: cough with mucus, feeling of oppression of the chest, asthma, breathlessnessStomach: lack of appetite, digestive problems, hiatus hernia, acid reflux.Skin: greasy skin, sweating, yellow moles.TONGUE DIAGNOSIS IN THE ELDERLYThis has already been discussed in a previous blog (April 2010).

The major pathogenic factors of the elderly manifest on the tongue with the following signs:Phlegm: swollen tongue body, sticky coatingBlood stasis: purple, stiff bodyInternal Wind: stiff, moving deviated.For example, if we see a tongue that is swollen, purple and stiff, it indicates all three pathogenic factors of Phlegm, Blood stasis and internal Wind. When I see a tongue like that in an elderly patient, I actively invigorate Blood and resolve Phlegm for prevention.

tongue

Purple (especially on sides) = Blood stasis. Stiff = internal Wind

tongue2

Purple = Blood stasisSwollen = PhlegmSlightly Deviated = internal Wind

PULSE DIAGNOSIS IN THE ELDERLY

Pulse diagnosis in the elderly also reflects the fact that their clinical picture is dominated by Full conditions. In fact, in the elderly, the pulse is very often Full and Wiry and/or Slippery, not Weak.

TREATMENT PRINCIPLES IN DISEASES OF THE ELDERLY

Considering the above, I believe the most important treatment principles in the elderly are:1) Invigorate Blood and eliminate stasis2) Resolve Phlegm3) Extinguish (internal) WindSome people think that eliminating pathogenic factors (with herbal medicine or acupuncture but especially with herbal medicine) may “weaken” the elderly. I have never found that to be true in practice: if an elderly person has Phlegm and Blood stasis, they will not be “weakened” by resolving Phlegm and invigorating Blood. Of course, one does need to adapt one’s doses to age so that dosages of herbs for the elderly should be lower than those for young people.Invigorating Blood remedies: Red Stirring (Upper Burner), Stir Field of Elixir (Lower Burner), Harmonizing the Moon (Blood stasis in Uterus).

Resolving Phlegm remedies: Clear the Soul, Limpid Sea Extinguishing Wind remedy: Clear Yang Red Stirring = Xue Fu Zhu Yu Tang Stir Field of Elixir = Ge Xia Zhu Yu Tang Harmonizing the Moon = Gui Zhi Fu Ling Wan Clear the Soul = Wen Dan Tang Limpid Sea = Er Chen Tang Clear Yang = Ban Xia Bai Zhu Tian Ma Tang.