GERIATRICS IN CHINESE MEDICINE

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 stasis

The following three Tables list the major diseases of the elderly with the pathology they are due to:
Many of the symptoms of the elderly are due to Phlegm:
Heart: mental confusion, feeling of oppression in the chest
Gall-Bladder: stones, nausea, inability to digest fats
Joints: bone deformities, pain, rigidity
Lungs: cough with mucus, feeling of oppression of the chest, asthma, breathlessness
Stomach: lack of appetite, digestive problems, hiatus hernia, acid reflux.
Skin: greasy skin, sweating, yellow moles.

TONGUE DIAGNOSIS IN THE ELDERLY

This 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 coating

Blood stasis: purple, stiff body
Internal 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.

Purple (especially on sides) = Blood stasis

Stiff = internal Wind
 Purple = Blood stasis
Swollen = Phlegm
Slightly 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 stasis
2) Resolve Phlegm
3) Extinguish (internal) Wind

Some 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