Treating Hyper-salivation with TCM Herbal Medicine
Background: In Western medicine, the doctor looks for specific causes of diseases, and focuses on particular body components to treat. Traditional Chinese medicine (TCM) doesn't work in this way. There are fundamental differences in principles, diagnosis and treatment approaches between Western medicine and Chinese medicine. The body is an organic whole, all the component parts are interconnected, they dependent and restrict each other physiologically, influence each other pathologically. Therefore, TCM has strength for treating unknown and difficult diseases because when the body regains it’s normal balance and physiology, itself will treat the disease as long as it happened within the body.
Case Description: This single case reports on a 37-year-old male who presented with a 9-month history of hyper-salivation.
Methods: The patient was treated with only TCM herbal medicine for 8 weeks and applied TEM Classical Formula Selecting Method in order to find a suitable formula.
Results: The patient’s symptom has completely disappeared after 8 weeks of TCM herbal medicine and until 1 year later, the symptom has not come back.
Conclusion: This article may aid in expanding practitioners’ treatment options to include TCM herbal medicine more for unknown and difficult diseases. More research is needed to investigate the role of TCM herbal medicine.
Hypersalivation (also called ptyalism or sialorrhea) is an excessive production of saliva. It has also been defined as an increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva. Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva (dysphagia). Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling of needing to vomit).
Hypersalivation is optimally treated by treating or avoiding the underlying cause. Mouthwash and tooth brushing may have drying effects. In the palliative care setting; anticholinergics and similar drugs that would normally reduce the production of saliva causing a dry mouth could be considered for symptom management: scopolamine, atropine, propantheline, hyoscine, amitriptyline, glycopyrrolate.
Dec 16, 2015, 37-year-old Caucasoid male with a body mass index (BMI) of 23.71 kg/m² (5’11”/170lb) and physically well-developed, presented with a 9-month history of hyper-salivation. The patient claims that this symptom has started since he was on a “bulk up diet (overly eating)”. He went to the family doctor and took anti-acid medication and it got better for 3months. However, this time he was on a “cutting down diet” and the symptom reappeared even worth than the last episode and medication from the doctor did not improve the patient’s condition this time. His symptom aggravated by eating grains and sugar and alleviated by consumes alcohol.
Table 2. All TCM formulas are Sun Tan granules
TEM (Traditional Eastern Medicine) Charting with TEM Herbal & Formula Evidence
1. Patterns of the common cold that patients usually get.
Body Aches Pattern: Tai Yang Disease, Gun Zhi Tang group, Ma Huang Tang group, (Da & Xiao) Qing Long Tang
Fever: Tai Yang, Yang Ming, Shao Yang and rarely Shao Yin
Sore Throat: Ban Xia, Shao Yin sore throat issue
Respiratory (cough, asthma and sinus): Ma Huang, Xi Xin, Ting Li Zi, Ban Xia, Jie Geng, She Gan, Zao Jia etc.
Shao Yang: Sore throat + low-grade fever
2. Patterns of temperature sensitivity.
* Scales of how severally aversion to cold vs aversion to heat (1 - 10)
Aversion to Cold Scale Fu Zi: Mostly above 6 Wu Zhu Yu: Mostly above 5, sometime around 3 Gui Zhi: Around 5
* If patient specifically mentions lower abdomen cold sensation: Wu Zhu Yu, Gan Jiang (prone to get loose stool), Fu Zi + Honey (prone to get constipation), Cong Bai
Aversion to Heat Scale Chai Hu, Gan Sui, Huang Lian: Below 5 Shi Gao, Huang Qin, Zhi Zi, Huang Bai, Ge Gen: Above 5
* Chai Hu patients may feel aversion to heat more, however, they may feel aversion to both heat and cold.
* Hot Flush when a patient has/get (nervous, drinks, menopause, tired): Huang Lian, Zhi Zi + Dan Dou Chi, Gui Zhi
Patients feel good after the sweat: Tai Yang Disease Patients feel warm in general and sweating easily: Yang Ming Patients have a deficient body constitution who get very tired after the sweat Not sweating easily on the lower body but the upper body and has dryer and thicker skin texture: Ma Huang Spontaneous sweating: Gui Zhi and Huang Qi however, Huang Qi patient has obvious deficient body constitution.
4. Thirst and fluid intake
Shi Gao: (Polydipsia) The patient has hyper-metabolism that consumes body fluid fast therefore, the patient has a high energy level.
Gua Luo Gen (Tian Hua Fen) and Man Men Dong: The patient has a deficiency of the body fluid that induces thirst and dryness in the mouth and throat. Chai Hu: Dryness in the mouth with bitter taste due to decreased immunity (eg. Decrease IgA in the saliva may cause the bitter taste and burning sensation in the mouth)
Zhu Ling and Ze Xie: Thirst with urination issues.
5. Appetite and digestion
Indigestion affects epigastrium with poor appetite: Ren Shen Indigestion affects epigastrium with nausea and vomiting: Ban Xia, Sheng Jiang, Cang Zhu Indigestion affects chest with obstructed sensation: Ju Pi, Zhi Shi Eructation: Sheng Jiang Acid regurgitation gets worse with spicy food, alcohol and stress Abdominal Pain: Ren Shen, Gan Jiang, Fu Zi, Bai Shao Yao, Da Zao, Gan Cao, Barley Malt, Huang Lian, Chai Hu, Da Huang, Zhi Shi, Hou Po etc.
6. Bowel Movement
Constipation: Da Huang, Mang Xiao, Ma Zi Ren, Xing Ren Abdominal distention (bloating due to gas retention): Bai Shao Yao, Da Huang, Zhi Shi, Hou Po, Mang Xiao Diarrhea and loose stools (Cold type): Gan Jiang, Fu Zi and sometimes Wu Zhu Yu Diarrhea and loose stools (Heat type): Huang Qin, Huang Lian, Bai Tou Weng, Ge Gen Watery Diarrhea and bleeding (leaky gut): Bai Shao Yao, Chi Shi Zhi, Yu Yu Liang
Urination issues: Can Zhu, Hua Shi, Gan Sui, Long Gu, Mu Li, Zhu Ling, Mu Tong Urinary incontinence: Long Gu and/ or Mu Li (patient usually have Xenophobia or specific fear issues), Cang Zhu Urethritis: Hua Shi and Gan Sui
Palpitation: Huang Lian, Fu Ling, Dan Dou Chi and Gui Zhi + Gan Cao Chest pain and distention: Dan Dou Chi, Gua Lou She, Xie Bai, Ju Pi, Wu Zhu Yu, Hou Po, Zhi Shi, Xing Ren, Huang Qin and Gui Zhi Qu Bai Shao or Xian Xiong Tang group Shortness of breath: Ma Huang, Xing Ren, Hou Po, Fang Ji, Gua Lou Shi, Ting Li Zi, Gui Zhi Qu Bai Shao group Costal and hypochondriac pain: Chai Hu, Da Zao and sometimes Xi Xin
Insomnia: Huang Lian, Fu Ling, Dan Dou Chi, Long Gu, Mu Li, Suan Zao Ren, Xiao Mai Narcolepsy: Ma Huang or Shah Yin group
Blood stagnation: Da Huang, Dang Gui, Chuan Xiong, Dang Gui, Mu Dan Pi, Tao Ren, Hong Hua, Zi Cong, Meng Cong, Shui Di, Tu Gua Gen Bleeding: E Jiao, A Ye, Ce Bai Ye Dry skin and lichenification: Yi Yi Ren Pus: Ban Xia, Da Huang, Jie Geng Spasms: Da Zao, Gan Cao, Barley malt and honey
Details of differentiation of TEM Formula Evidence will not be discussed in this paper.
PROCESS OF SELECTING THE FORMULAS FOR THIS CASE
Major symptoms those considered as a problem other than the chief complaint are thirst, urination and sleeping issues. Since this patient has thirst with high metabolism (high energy level), practitioner’s initially considered to use Shi Gao (gypsum) which helps to clear Yang Ming Heat and Yang Ming Heat could be translated as hyperactives in the interior. Within the formulas listed in Shang Han Jia Bing Lun, there are not many formulas containing She Gao without Ma Huang (patient has hyperactivity, ephedra can not be used since it can stimulates CNS to increase bodily activities), they are Bai Hu Tang, Bai Hu Jia Red Shen Tang, Bai Hu Jia Gui Zhi Tang, Mu Fang Ji Tang, Ju Ye She Gao Tang, Zhu Pi Da Wan. Practitioner rule out Ren Shen (no appetite issue), Gui Zhi (not feeling cold in general), Fang Ji (no shortness of breath) and Ju Pi (no chest area issue) therefore, only Bai Hu Tang was the option for the patient. Patient took Bai Hu Tang for 1week however, there was no improvement. Since reducing the bodily hyperactivities of the patient did not work, this time practitioner’s main focus was on the water metabolism (urination, thirst, diarrhea perspiration, swelling, discharge of body fluid etc) and there are two main formulas that can treat general water metabolism issues in the classical formulas (formulas in Shang Han Jia Bing Lun) and they are Wu Ling San and Zhu Ling Tang. Practitioner choose Wu Ling San first since patient has floating pulse (Tai Yang & Yang Ming), thirst (water metabolism) and prone to feel more cold (Gui Zhi) however, with one week of the prescription, it had been improved the chief complain but, it was disturbing patient’s sleep quality even more than before due to feeling to warm in the night. Practitioner assumed warming effect was due to Gun Zhi in the formulas that make the prescription changed to Zhu Ling Tang. One week of Zhu Ling Tang improved patient’s chef complain up to notice level (one time during whole week) and even his sleep got better. Patient took another 4 weeks of Zhu Ling Tang and until follow up after 1 year later, still patient chief complain did not returned. One interesting part of this case is that there was no intention of the practitioner to treat the patient’s sleep quality, however, with a single formula, it treats several different health issues. This episode does support idea of that “TEM treats the body and the body treats the disease.”
References; 1. thefreedictionary.com > ptyalism Citing: • Dorland's Medical Dictionary for Health Consumers. 2007 • Mosby's Medical Dictionary, 8th edition. 2009 • Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007
2. thefreedictionary.com > sialorrhea Citing: •The American Heritage Dictionary of the English Language, Fourth Edition, Updated in 2009.
3. Medscape > Hypersalivation By Erica Brownfield. Posted: 05/19/2004
4. [Clark], [edited by Parveen Kumar, Michael (2005). Kumar & Clark clinical medicine (6th ed.). Edinburgh: Elsevier Saunders. p. 266. ISBN 0702027634.
5. Medical Care of the Dying, 4th Edition, 2006, Edited by G.Michael Downing MD and Wendy Wainwright, MEd
6. 노의준. 방약병증 차팅선방법 (2015)