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The Protection of Stomach Qi in the Elderly
by Dan Schalm R.Ac, R.TCMP
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In TCM, special attention is always given to the
Stomach, both in the prevention and treatment of
disease.
This organ holds a very important place in the
maintenance of human life, from both a TCM perspective,
and from the viewpoint of modern medical science. In TCM,
it is considered the source of all post-natal Qi while
from a modern physiological standpoint it is one of the
first components of a complicated metabolic process that
serves to nourish the human organism. Because the body
exists as an organic whole, we can say that if the
stomach is weak, it will fail to nourish the body and
can cause an eventual malfunction of other organs and
process's. This, in turn, leads to further weakness.
By the same token, the strength of the rest of the
body may also influence the Stomach, and if the body is
in decline, Stomach function will also be compromised.
In treating the elderly, we are presented with both a
general decline in the body system due to the aging
process (or years of physical neglect and abuse) as well
as specific factors which impede the Stomach itself.
These can include improper diet, unstable emotional
circumstances due to depression or dementia and the
harsh forms of drug therapy common with those of
advanced years.
Therefore, special attention should always be given
to the Stomach in clinical practice, especially in the
field of gerontology. The purpose of this paper is to
discuss the general physiology, pathology and protection
or treatment of the Stomach Qi function with special
emphasis on how this relates to the elderly.
The role of the Stomach within the organic whole
As previously mentioned, the Stomach has a very
special and important role to play in the proper
functioning of the human body. At the time of birth,
much of a humans future health has already been
determined by the strength or deficiency of its prenatal
essence. This essence resides in the Kidneys and governs
the growth and development, as well as the aging and
decline of a human life. Poor congenital essence leads
to weakness and susceptibility to disease throughout
ones life, but if it is strong, the body will flourish
and be strong, healthy and long lived. This is fixed and
cannot be changed, but luckily, the vital essence can
also be strengthened after birth through the
transformation and transportation of refined principle
taken from food.
By eating foods that are healthy and nutritious for
the body, we can contribute in a very important way to
the maintenance of the Kidney essence and primordial Qi.
When processed by the Stomach, this food is called the
"sea of water, cereals, Qi and Blood" because it is the
basis of all the physiological activities of the body.
Food must first enter the Stomach before it is used to
nourish the body. Here it goes through the digestive
process of "rotting and ripening" so that it may be sent
to the Small Intestine. Then, the turbid matter is
separated and sent to the Large Intestine while the
nutritive matter is sent to the Spleen and further
transformed into distilled food essence. It is that
which is sent to nourish all aspects of the body.
Normally, the Stomach Qi has a downward movement and
the Spleen has an upward movement. Both organs, working
in harmony, play a key role in nourishment and the
manufacture of Qi. Sometimes the Spleen and Stomach are
referred to singularly as the Stomach. According to the
Miraculous Pivot, together they make up the entire
Middle Jiao. Therefore, in TCM, the Middle Jiao can also
mean the Stomach.
Stomach Qi and pathology
There are a number of pathological conditions related
to the Stomach. It can be affected by excess,
deficiency, stasis, heat or cold influences. Because of
the strategic importance of the Stomach, all of these
conditions are highly important to address. We will
mainly be concerned with the problems of Stomach Qi for
this paper. This includes both Qi deficiency (with or
without Cold) and Qi stagnation. Because the Stomach is
responsible for transporting and transforming food into
the materials necessary for physiological functioning,
its Qi must be functional and strong. When Stomach Qi is
deficient, the body also becomes deficient.
The factors that can cause Stomach Qi deficiency are
related to diet, emotions, congenital weakness and
depletion of Source Qi from long term illness, over work
or the aging process. In the elderly these are special
considerations. Often, people of advanced years develop
poor eating habits. Because of the deterioration of
their ability to be self-supportive, they may have a
tendency to under eat or to eat foods that are not
nutritionally efficient, but convenient to use. For
instance, instead of cooking their vegetables, they may
eat them raw, thus creating a hardship for the
gastrosplenic function that is adversely affected by
cold. They may also choose to eat canned goods for
convenience, even though the processed nature of such
foods is not nutritionally rich.
Over time, this can seriously harm the Stomach Qi
leading to generalized body weakness, especially if it
is coupled with a general decline of other organs.
Emotionally, the elderly can sometimes be prone to
depression or deterioration of the ability to think and
reason clearly (dementia). This can contribute to poor
eating habits, as mentioned previously, or it can cause
Qi stagnation of the Stomach. If the Stomach Qi is
stagnant, food cannot be processed and ultimately, the
body is not nourished.
Over a lifetime, many conditions can lead to the
depletion of Source Qi. It is a natural process of aging
that a human being suffers decline in their vital
essence. But also, a person who has not taken care of
their health due to improper living, inadequate
nutrition or exercise can suffer the effect of a decline
of Stomach Qi. The likelihood of contracting serious
illness becomes much higher as one ages, and it is
possible for the Qi of the Stomach to suffer greatly
from disease.
To complicate matters, drug therapy can be very hard
on the energy of the Stomach and it is possible for a
decline of Stomach Qi to occur during a course of NSAID
therapy or Antibiotic therapy.
The administration of certain herbal medicine can
also be detrimental to the gastrosplenic function. Herbs
that are too Cold or Hot in nature or are too strong for
a deficient condition can harm the Stomach. For
instance, in treating constipation, special care must be
taken when using purgatives. A decoction such as Da
Cheng Qi Tang would be unsuitable for someone who has a
weak Middle Jiao and something milder should be used.
Also, in the case of herbs which may be administered to
clear Heat from an infection, a practitioner has to keep
in mind that too much Cold will harm the Stomach.
Therefore, it is important to pay special attention in
the clinic when addressing geriatric needs. In the
following section, consideration will be given to
prevention as well as herbal and acupuncture therapy
that can benefit the Stomach Qi and protect it from the
effects of poor diet, harmful substances and general
decline of the bodily functions.
Prevention
It is imperative that healthy eating habits are
maintained in elderly patients. This includes seeing
that they eat sufficient food for proper sustenance and
making sure that what they do eat is nourishing and not
detrimental for the body. Food should be cooked and not
raw. Excess consumption of Cold food should be avoided.
Where possible, foods that harmonize the Stomach and
Spleen and act as tonics for the same should be added to
the diet. Examples of Stomach Qi nourishing foods are
beef, chicken, honey, red and black dates, shiitake
mushrooms, potatoes and squash. In cases of Cold due to
Yang deficiency, the patient can eat more kidney,
lobster, raspberries, shrimp, strawberries and walnuts.
Eating regularly should be encouraged to prevent Stomach
Qi stagnation. The use of medication should be closely
monitored. Even in Western medicine certain drugs can
harm the stomach. Wherever possible, the use of
medication should be limited. Finally, the elderly
patient should have as good an emotional condition as
possible and whenever possible, they should be given
adequate support and counseling in dealing with the
problems particular to the aging process.
Herbal Medicine
An elderly patient may present with various ailments
that require treatment. Usually, a younger person can
stand different therapeutic properties of herbal
medicine, but the aged, due to their deficient
condition, can suffer damage from the same medicine. For
instance, as previously mentioned in the case of
constipation, Da Cheng Qi Tang is not a very good
formula to use on a person with a weak constitution. The
herbs are very cold and drastic and can harm Stomach Qi.
Instead, a milder purgative should be used with
harmonizing and Qi tonifying ability.
If the problem is of a Cold nature, Wen Pi Tang may
be used instead.
If it is due to heat, but with underlying Qi
deficiency, use Tiao Wei Cheng Qi Tang and add some
herbs to tonify Qi.
Other herbs that can harm Stomach Qi, besides very
Cold ones, would be Hot herbs and strong diuretics.
These types of formulas and herbs must be used with
caution, and if they must be used at all, they should be
used concurrently with tonics that invigorate Qi.
Examples of some herbs that nourish Stomach Qi or offer
it protection include Da Zao, Bai Zhu, Gan Cao, Ren Shen,
Huang Qi and Shan Yao.
While taking formulas that are hard on the stomach,
the patient should be extra careful with their diet so
as to not put an extra burden on the Middle Jiao. That
includes not eating greasy or Cold foods.
In the case of Stomach Qi stagnation, the following
are some herbs that can be used to restore the downward
movement of energy: Chen Pi, Cheng Xiang, Chuan Lian Zi,
Da Fu Pi, Ju Hong, Ju Pi, Mu Xiang, Qing Pi, Sha Ren and
Zhi Shi. Digestives such as Bing Lang, Gu Ya, Ji Nei
Jin, Lai Fu Zi, Mai Ya and Shen Qu may also be helpful.
The main things to consider when giving herbal therapy
are that the Stomach may not be able to withstand strong
herbs nor may it be able to properly digest them.
Tonics, regulatory herbs and digestives can be
administered to revive a weak Stomach or to protect it
during treatment with herbs (or Western drugs).
Acupuncture
Acupuncture can also be useful therapy in cases of
Stomach Qi deficiency. It may be used with herbal
remedies or alone, depending on the severity of the
condition. An example of points that may be useful for
treating Stomach Qi deficiency include ST36 Zusanli,
RN12 Zhongwan, BL21 Weishu, BL21 Pishu or REN06 Qihai.
Moxibustion is preferable, especially if there is
Cold or Yang deficiency. According to some literature,
it is thought that the daily warming with moxa of
Zusanli can increase ones life span due to the
strengthening of the Stomach and Spleen function.
Conclusion
The elderly, because of the inevitable decline of the
essence in the body, have a far more delicate
constitution than younger people. This is especially
true for the Stomach Qi. At a time of life, when the
vital fire is declining, a person needs as much acquired
essence as possible. The Stomach function is solely
responsible for the eventual bolstering of acquired Qi
and it is imperative that its function and strength be
preserved. Therefore, there is no doubt that it should
be protected as much as possible.
Bibliography
Yin Huihe & others Fundamentals of Traditional
Chinese Medicine; Foreign Languages Press, Beijing, 1993
ISBN 7-119-01398-X
Giovanni Maciocia The Foundations of Chinese
Medicine; Churchill Livingstone, New York, 1989 ISBN
0-443-03980-1
State Administration of Traditional Chinese Medicine
Advanced textbook on Traditional Chinese Medicine and
Pharmacology: Vol. II; New World Press, Beijing, 1995
ISBN 7-80005-262-1
Chen, Ze-Lin & Mei-Fang; A Comprehensive Guide to
Chinese Herbal Medicine; Castle Books, 1992, USA; ISBN
0-7858-1076-5
Yin, Ganglin; Advanced Modern Chinese Acupuncture
Therapy: A Practical Handbook for Intermediate and
Advanced Study; New World Press, 2000, China; ISBN
7-80005-558-2
Maciocia, Giovanni; The Practice of Chinese Medicine;
Churchill Livingstone, 1994, UK; ISBN 0-443-043051
Nowak, T. & Handford, A.; Essentials of Pathophysiology;
McGraw-Hill, 1999, USA; ISBN 0-697-25205-1
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