Hemorrhoids That Painful Companionship

Hemorrhoids That Painful Companionship

What is a Hemorrhoid and What Causes it?

A hemorrhoid is simply a swollen vein in the anal canal due to a lack of fiber, exercise, sedentary life, dehydration, chronic diarrhea and/or pregnancy causing an increase pressure on the intestinal walls and weakening the intestines causing the swollen vein normally known as hemorrhoid.

Types of Hemorrhoids

There are two types of hemorrhoids: External and Internal. External hemorrhoids, as the name implies, are those that are out and visible. When an external hemorrhoid is painful to the touch it is called thrombosed hemorrhoid.

The second type of hemorrhoid is the internal which is divided into 4 stages. The first stage still inside and bulges when defecating, second stage hemorrhoid it bulges and comes out of the anal canal during a bowel movement while the third stage it bulges and comes out of the anal canal and has to be "manually" pushed back in. Fourth stage it bulges and stays out all the time. The fourth stage might be confused with an external hemorrhoid but the difference between external and internal hemorrhoids is its origin, if the origin is in the anal canal then it is called internal while a hemorrhoid that originates around or close to the anus it is obviously called external hemorrhoid.

Common Signs and Symptoms

Bleeding, itching, inflammation and pain are the most common complaints of patients that suffer from hemorrhoids. 

Understanding Hemorrhoids, a Chinese Medicine Perspective

Depending on the signs and symptoms plus some other pertinent questions and auscultation (pulse and tongue) the Chinese Medicine practitioner would be able to diagnose and determine the proper herbal treatment.

In Chinese Medicine there are several patterns Intestinal wind, intestinal dryness, damp heat, blood stagnation, spleen qi deficiency and spleen qi sinking.

 Intestinal wind refers to the period when there is bright red blood present without pain or any discomfort. Intestinal dryness is obviously caused by a lack of moisture (yin deficiency or liquid deficiency or even due to what we called heat) and the patient will describe this feeling as of passing "sand paper".

Damp heat is a term used to refer to swelling, pain, burning and inflammation experienced by the patient. Spleen Qi deficiency and Spleen Qi sinking corresponds to third and fourth stage. With spleen qi deficiency or spleen qi sinking the patient will report feeling constantly tired; this kind of patient have a tendency of eating raw food, eat at irregular intervals and/or late at night. The patient with spleen qi deficiency or spleen qi sinking is constantly worrying, excessively thinking or brooding. It is important to mention that a patient with spleen qi deficiency might present with intestinal dryness too, this is so because in Chinese medicine the spleen  is in charge of transporting nutrients and fluids. Another aspect to consider with spleen deficient patients is the possibility of stress, anxiety, depression and resentment which are associated with the liver in this millenarian healing art. When the liver gets affected by several emotional factors it has the tendency of weakening the spleen and/or creating heat that might accumulate in the intestines causing dryness or damp heat. There is another factor to take under consideration: the large intestine. The Large Intestine in Chinese Medicine is related with the Lung (both are metal elements) therefore patients with hemorrhoids might be experiencing some kind of grief, loss or suffering and/or respiratory problems such as sinus, allergies, or skin conditions.

Blood stagnation is simply a thrombosed hemorrhoid.

Damp Heat, What is that? 

Damp heat refers to the end result caused by a chronic illness, an infection, or fat rich diet, sugars (refined sugar, corn syrup) or alcohol. As you can see our diet does have an impact in our intestinal health.

Treating Hemorrhoids Naturally

When we take a closer look to the herbs used in Chinese Medicine we will observe that some have the following properties: hemostatic (astringent), anti-inflammatory, analgesic, antibiotic, diuretic, anti-coagulant or anti-platelet. These properties make herbal remedy an excellent alternative for hemorrhoids. Chemically we can find these compounds: tannins, flavonoids, lipids, enzymes, and saponins among others.

Some Herbs Used in the Treatment of Hemorrhoids 

This is a partial list of herbs used in the treatment of hemorrhoids. It is my advice to consult a professional instead of auto-medicating. Auto medication might worsen your condition and therefore it is advisable to visit a licensed acupuncturist with herbal knowledge or any other health professional that specializes on herbal treatments.

Huai Jiao (Flos Sophorae), Dang Gui (Radix Angelicae Sinensis), Huang Qin (Radix Scutellariae), and Huang Qi (Astragalus) are some examples of herbs used in Chinese Medicine while you can find other herbs like Witch Hazel (Hammamelis Virgiana), Horse Chestnut, Butcher's Broom, Cranesbill Root,Oak bark, Bistor root, and Blackberry leaf.

Horse chestnut and Butcher's broom is excellent for stopping bleeding and relieve inflamed hemorrhoids while witch hazel is excellent for relieving the "sandpaper" feeling. You could also use Varigone from Nature Sunshine which is really good in strengthening capillaries and veins and stopping bleeding, and sometimes relieving inflammation and raising the hemorrhoid. In Chinese medicine we use herbal formulas that match our diagnosis such as:  Huai Jiao Wan, Qin Jiao Bai Zhu Wan, Huai Hua San, Gui Pi Tang, Bu Zhong Yi Qi Tang and Huo Xue San Yu Tang... Quite often these formulas are tailored to patient’s particular needs.

Acupuncture and Hemorrhoids

The treatment of hemorrhoids is tailored to the patient’s needs and the diagnosis hence not everyone will have the same points used. For thrombosed hemorrhoids some acupuncturists use DU 1 which relaxes the pelvic floor and anal sphincter but there are many ways to relieve a thrombose hemorrhoid. I have been able to treat them without going to the local area. If you or anyone that you know is interested in getting treated you can reach me at dr.agujas@gmail.com or 917-907-1915. modifications.

About the Author

Emmanuel Arroyo is a New York State licensed acupuncturist with a Master in Oriental Medicine. A Master in Oriental Medicine means that herbal medicine was part of the curriculum and clinical internship practice was contemplated not only for acupuncture but for herbal medicine.





References:


The Energetics of Western Herbs 4th edition Volume 2 by Peter Holmes. 2006
Clinical Handbook of Internal Medicine First EditionVolume 2 by Will Maclean and Jane Lyttleton. 2002
Chinese Medical Herbology and Pharmacology by John K Chen and Tina T Chen. 2001, 2004
http://www.webmd.com/a-to-z-guides/hemorrhoids-topic-overview     6:45pm May 4th, 2010

90 Percent of Parents Want to Know More About Alternative Medicine, Survey Reveals

90 Percent of Parents Want to Know More About Alternative Medicine, Survey Reveals

Depression: Allopathic Approach and Physiology

On my previous blog I explained how different nutrients elicit changes in the brain structure and neuronal transmission. This blog is intended to explain what is monoamine oxidase (MAO), what are monoamines, from which amino acid(s) the neurotransmitter(s) are synthesized, the functions of those neurotransmitters, the consequences of having deficiency of those neurotransmitters and the allopathic approach for treating depression and an explanation of why we observe certain side effects on certain drugs. It is my intention to give an idea of the physiological alterations created by these medications. Please bear in mind that this information it is limited and its purpose is to educate.
The references used for this blog and others are in the form of links.

Monoamine Oxidase

Monoamine Oxidase is an enzyme that catabolizes monoamines. Monoamines are serotonin, dopamine, epinephrine, norepinephrine, GABA, melatonin, and histamine; yes, the term monoamines refers to neurotransmitters that have one amino acid group hence mono (meaning one) and amine (from the term referring to the origin of the amino acid: ammonia).
There are two types of Monoamine Oxidase: MAO-A and MAO-B.
MAO-A brakes down serotonin, norepinephrine and epinephrine while MAO-B mainly catabolizes phenethylamine. Dopamine is broken down by MAO-A and MAO-B.

Role of Monoamines

Dopamine:  execution on movement, inhibition of prolactin, memory, attention, problem solving and other neuro-cognitive functions, motivation, pleasure, and reward seeking behavior.  
Synthesis: phenylalanine.

Serotonin: regulation of insulin and Insulin like Growth Factor (IGF), serotonin effects appetite, sleep, and general metabolism, and blood vessel constriction. Modulates mood, anger and aggression. Stimulates cells to repair the liver and promotes osteoclasts activity.  
Synthesis: tryptophan.

Epinephrine(adrenaline):  It is involved in the fight-flight response: increases blood perfusion to the brain and skeletal muscles and diminishes blood supply to the GI tract. Suppresses the immune system and elevates blood sugar and breaks down lipids in cells.  
Synthesis: phenylalanine.

Norepinephrine (noreadrenaline):  involved in the fight-flight response. Increases blood pressure and
drops heart rate.  
Synthesis: Dopamine which in turn is made from phenylalanine.

GABA:  Regulates neuronal excitability and muscle tone.  
Synthesis: Glutamate.

Histamine:  Regulates sleep, is involved in inflammation and immune responses, has erectile and sexual functions. Protect against convulsion, stress, and ischemic lesions.  
Synthesis: histidine.

Melatonin:  antioxidant (mainly protects nuclear and mitochondrial DNA), regulates circadian rhythms. Enhances immune functions.  
Synthesis: Tryptophan.

Phenethylamine:  Acts as a releasing agent of dopamine and norepinephrine.  
Synthesis: Phenylalanine.

Amino Acids Deficient in Depression

It is of common knowledge that dopamine and serotonin are the main neurotransmitters affected in people with depression. If we take a closer look to the previous list of monoamines and their functions it will be noticed that phenylalanine and tryptophan are deficient in patients with depression; these amino acids are also essential for the synthesis of other neurotransmitters: Melatonin, Phenethylamine,Norepinephrine, and Epinephrine .
It is not surprising to see a big conglomerate of signs and symptoms in people with depression: insulin resistance, high levels of homocysteine, interlukin and tumor necrosis factor besides the well known signs and symptoms of apathy, sadness, emptiness, guilt, feeling of worthlessness, polyphagia or decreased appetite, insomnia or excessive sleeping, impaired immunity, and decreased libido among others sexual problems.

Allopathic Approach to Depression

The conventional approach to depression is the use of the following medications MAOI (Monoamine Oxidaze Inhibitor) SSRI (Selective Serotonin Reuptake Inhibitor), TAC (Tricyclic Antidepressants), Tetracyclic Antidepressants (Tricyclic and Tetracyclic are known as heterotricyclic),  Serotonin Modulators (5-HT2 Blockers), Norepinephrine-Dopamine Reuptake Inhibitors (NDRI), and SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) and Electroconvulsion Therapy.


List of Medications

Heterocyclic Antidepressants:  amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, 
maprotiline, nortryptiline, protriptyline, and trimipramine.

Selective Serotonin Reuptake Inhibitors:   citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline.

Monoamine Oxidase Inhibitors:  isocarboxazid, phenelzine, selegiline, tranylcypromine.


Serotonin Modulators:  mirtazapine, nefazodone, trazodone.


Serotonin-Norepinephrine Reuptake Inhibitors:  duloxetine, venlafaxine, desvenlafaxine


Norepinephrine-Dopamine Reuptake Inhibitors:  bupropion.




The Logic Behind the Medications

TAC:  This medications inhibit the reuptake of serotonin and norepinephrine by blocking the serotonin and 
norepinephrine transporter (SERT and NET respectively) which in turns increases the levels of serotonin and norepinephrine. The higher the level of serotonin the lower the level of melatonin and viceversa, usually melatonin increases while serotonin decreases: melatonin is metabolized from serotonin. Insulin and serotonin increase accordingly: higher levels of serotonin means higher levels of insulin. Insulin is required in order to increase bio-availability of tryptophan; the downfall is that it might cause insulin resistance which leads to diabetes. An analysis of the functions of melatonin and serotonin will make evident that this medication will cause an imbalance on the circadian rhythms, an increase on blood pressure, GI tract disorders; because norepinephrine activates fight-flight response a reduction on blood flow to the GI tract will be observed leading to slow metabolism and absorption of nutrients from the GI tract leading to poor nutrient assimilation and weight gain. Norepinephrine increases blood flow to the brain which explains why people suffer from blurred vision and dizziness when taking TAC's. Muslce stiffness and twitches are present: remember this medication activates the fight-flight response making  the muscles the primary target.
Cyclics effect every receptor in the CNS which includes Histamine and Muscarinic receptors among others.

              Some TAC's medications are: Anafranil, Adapin, Aventyl, Elavil, Norpramin, Pamelor, Pertofrane, Sinequan, Surmontil, Tofranil, and Vivactil.

MAOI:  There are 3 types known, the one that does not discriminate and inhibits MAO-A and MAO-B and  those that do discriminate and only inhibit MAO-A or MAO-B. MAOIs work by inhibiting the             production of monoamine oxidase which catabolizes serotonin, epinephrine, norepinephrine and dopamine with the aim of increasing blood levels and make them bioavailable. The problem with MAOI is that they increase tyramine levels in the blood. Tyramine is synthesize from Tyrosine. Tyramine acts as a releasing agent of dopamine, epinephrine, and norepinephrine. An increase in tyramine means an increase on dopamine, epinephrine and norepinephrine therefore we will see similar side effects as with TAC's. Consumption of tyrosyne containing food will elicit the "cheese effect" where the person will have high blood pressure, headaches, and racing heart. This medication and the TAC are used as a last results due to the severe side effects.
             Some MAOI medications are: Parnate, Nardil, and Marplan.

SSRI:  This medication selectively inhibits the reuptake of serotonin. The side effects are logic: serotonin is
involved in the appetite, sleep, and general metabolism, and blood vessel constriction. Modulates mood, anger and aggression. Stimulates cells to repair the liver and promotes osteoclasts activity. An increase on serotonin means an effect on any of the functions it regulates.
According to the Journal of Psychopharmacology Jan 1998; vol. 12: pp. 396 - 400: SSRI's cause hyponatremia which is an imbalance
of the sodium electrolyte(calcium, chloride, magnesium and potassium are the most common electrolytes in the human body besides sodium). This sodium imbalance can cause headache, fatigue,  weakness and nausea as first symptoms. More severe cases can result in confusion, seizure, coma and death. This sodium imbalance might explain why patients get headaches, fatigue, weakness or nausea when taking SSRI.  Low sex drive and inability to experience orgasm or retardation of ejaculation are other symptoms which are due to their effect of different type of serotonin receptors (each receptor has effects and affects different physiological aspects of the human body).
           Some SSRI medications are: Celexa, Lexapro, Luvox, Paxil, Prozac and Zoloft.

SNRI:  Increases amount of serotonin and norepinephrine in the synaptic gap. At this point we should have
an idea of the possible side effects of this type of medication based upon the functions of serotonin and  norepinephrine. I must add that the last 2 medications SSRI and SNRI are the most safest of all but that does not mean that side effects are absent. According to WebMD the side effects are the following: weight loss, decreased appetite, restlessness, insomnia, anxiety, constipation, dry mouth, diarrhea, dizziness, drowsiness, blurred vision, light headedness, strange dreams, constipation, fever/chills, headache, increased or decreased appetite, tremor, dry mouth, nausea. Many of these signs and symptoms can be explained to the activation of the fight-flight response while others are related to the close relationship with dopamine and its interaction with other hormones and body processes (ie activation of other serotonin receptors:  S1,S2,etc)
           Some SNRI medications: Effexor, Remeron, and Cymbalta.

DNRI :  Dopamine-Norepinephrine Reuptake Inhibitors functions are obvious: they slow down the reabsorption of dopamine and norepinephrine allowing more concentration of the neurotransmitters. The possible side effects are obvious if we look for the functions of these 2 neurotransmitters. This medication has been linked to seizures (JAOA Vol 7. NO10. October 2007 p 441).
There are different types of DNRI: immediate release (IR), extended release (ER) and sustained release (SR).
           Some DNRI medications:  Bupropion ER, Bupropion IR, Bupropion SR.

 ECT:  Electroconvulsion Therapy is used when everything has fail; occurrence of relapse is possible.
Electroconvulsion as the name implies is the use of electrodes placed on the head to elicit seizures;
anesthesia is provided to the patient due to muscle contractions experienced during the treatment.
Possibility of  memory loss.

OTHER EFFECTS

Other effects that some antidepressant medications exert in the body is the suppression of CYP450. CYP450 is the generic name given to a group of more than 50 enzymes found in the lungs, small intestine, liver and kidneys. These enzymes are involved in the synthesis of several hormones (i.e. estrogen, testosterone), bile acids, cholesterol, thromboxane A2 and metabolism of fatty acids, degradation of vitamin D and the elimination of toxins of the body via the urine and stools. A decrease function of CYP450 can elicit a cascade of effects in our body: high cholesterol, low levels of sex hormones, poor fatty acids metabolism and many others. If we incorporate genetic determination we will notice that some patients have less active CYP450 versus others that have highly active CYP450 then it will be obvious that for some patients the side effects will be more pronounced than others. These patients with a higher CYP450 activity are referred as having "wild" CYP450.

 STATISTICS

According to the newspaper Acupuncture Today December 2001 Volume 2 Issue 12 there are over 28 millions Americans taking antidepressants and anti-anxiety medications but more astonishing is what Merck Manual for Medical Conditions have to say about the efficacy of these medications : "...The chances that any given antidepressant will work for a particular person are about 65%..."
In other words there is a 35% chance that the medication will not work which makes it a big portion of patients that are still affected.
For that reason we are in our right to ask: Is there any alternative for these non-reactive patients?
The answer is yes! and in a next blog I will examine herbal medicine and acupuncture as an alternative.