Eric Chunyi Lee, Haiying Conover, Bing Yang
Abstract: Navel therapy has a long history. It refers to mixing different Chinese herbs into appropriate medicinal forms, such as ointment, paste, powder, pills, etc. and applying the medicine on the umbilicus to produce therapeutic effect. Navel therapy can also refer to physical stimulations, such as acupuncture, moxibustion, heat therapy, and cupping to treat different illnesses. With the rapid development of acupuncture and moxibustion in the United States, Chinese herbal medicine has also received widespread attention. However, herbal medicine is listed as a food supplement rather than medicine in the United States, and has not been popularized for various reasons. After consulting and studying the ancient and modern classics of traditional Chinese medicine, the authors chose to administer Chinese herbs through Shenque (CV8) to achieve a therapeutic effect for patients who are unwilling or unable to take Chinese herbal medicines orally. This article introduces the history and application of navel therapy, along with a clinical case example, in order to arouse interest navel paste therapy.
Key words: Chinese herbal medicine, Shenque (CV8), navel therapy, navel paste, raw herbs
There are many different methods to deliver treatments to patients in traditional Chinese Medicine (TCM). TCM practitioners, after determining the appropriate pattern diagnosis and treatment strategy, can utilize skills and techniques to treat patients externally or internal- ly. Acupuncture, moxibustion, Gua Sha, Tui Na, Cupping, and Qi Gong therapies are more commonly known external treatment options in the U.S. Chinese herbal medicine, in comparison, has not gained as much popularity[1] . However, herbal medicine is, in fact, a major component of TCM. Herbs and formulas have been used under the strict guidance of TCM theories to treat and prevent illnesses through-out the history of TCM. It is versatile and contains more robust TCM theories from different schools of thought than acupuncture. However, unlike acupuncture and moxibustion, herbal medicine has not gained as much recognition by the medical communities of Western society.
According to the World Health Organization, about 80% of the world population uses herbal medicine[2] . By contrast, in the past decade, herbal products including supplements, tea, and herbal medicine, are used by approximately 20% of the U.S. population[3] . However, the safety concerns are still high due to lack of standardized regulations of these products. Physicians, pharmacists, scientists, and the general public have limited training in using natural products as “medicine” in Western biomedical society compared to the cultures of the Middle East, Greece, China, and India[2,3,4,5]. This may be attributed to limited research, education and marketing. In the past 50 years, much research has been done in acupuncture but not much in herbal medicine due to lack of federal support, as well as incentives to drug companies[1,2] .Therefore, the general population of the U.S. lacks knowledge in the field of Chinese herbal medicine. This lack of knowledge can easily lead to misunderstandings and misuse of Chinese herbal medicine. In addition, there are also factors, such as the bitterness of herbal soup as well as negative media coverage, that create public resistance to herbal medicine. These factors create obstacles for practitioners using Chinese herbal medicine in the U.S. and prevents the public from benefiting from the curative effects of Chinese herbal medicine. In order to improve the usage and acceptance of Chinese herbal prescriptions in clini- cal treatment, the authors believe that it is necessary to develop new clinical ideas and experiment with different alternative routes of administration. This article mainly introduces the use of external Chinese medicine prescriptions at Shenque (CV8) as a new alternative route of administration.
The History and theoretical basis of navel therapy
Navel therapy, also known as umbilical therapy, is considered a TCM external treatment, which refers to making herbs into appropriate medicinal forms, such as ointments, pastes, powders, pills, etc. The herbal preparation is then placed on the navel, or used in combination with other physical stimulations, such as acupuncture, moxibustion, heat therapy, and cupping to treat different illnesses[6] .
External treatment of TCM has a long history. It originated from the use of grass leaves and plaster to smear onto wounds when people fought with wild animals during prehistoric times. Ever since its original appearance in TCM literature, external treatment has been valued by doctors of all dynasties[6] . Renowned TCM physician Wu Shi Ji from the Qing Dynasty was an external treatment expert who used pastes and plasters to treat internal and external diseases throughout the history of TCM. In his book, “Li Yue Pian Wen”, he pointed out that “the principle of external treatment is the principle of internal treatment, and the medicine of external treatment is also the medicine of internal treatment. The differences between them are just the techniques”. In the fourth year of Qing Emperor Tongzhi’s reign (1865), Dr. Wu opened a clinic to treat patients with plasters. “Treating one or two hundred peo- ple or three or four hundred people a day” and “curing 50,000 to 60,000 people a year”. The clinical effects were satisfactory. Dr. Wu personally made the medicines to ensure their quality and efficacy, and he especially cared for the poor. In the third year of Emperor Tongzhi (1864), Dr. Wu published his book “Li Yue Pian Wen”, summarizing his life- long experiences in using external treatment methods to treat various difficult internal and surgical diseases[7] . Another famous TCM physician, Li Shi Zhen of the Ming Dynasty, also recorded in his “Ben Cao Gang Mu (Compendium of Materia Medica)” applications of scallion juice to the navel to treat edema[6] . Based on Dr. Wu’s achievements in external treatments, and after referencing different herbal delivery methods of external treatments by physicians of the past, the authors decided to explore the applications and efficacies of applying Chinese herbal medicines at Shenque (CV8).
In TCM, the navel is also known as Shenque (CV8), which is one of the acupoints on the Ren (CV) channel. The Ren (CV) and Du (GV) chan- nels are closely related interiorly and exteriorly, and Shenque (CV8) is on the same level as the Ming Men (GV4) on the back[8] . CV8 has a strong connection to the channels and organs of the body. Nanjing, the Difficult Cannon, clearly points out that the movement of Qi between the two kidneys under the navel is “the foundation of the 5-Yin and 6-Yang Organs, the root of the twelve meridians, the gate of breathing, and the origin of the triple burner”. It “governs the main circulation of the three Qi, which moves through the 5-Yin and 6-Yang Organs”. These historical notes laid the theoretical foundation for navel therapy[6] . Shenque (CV8) is commonly utilized in clinical practice to treat variety of disharmonies, including abdominal pain, borborygmus, flaccid syndrome of apoplexy, prolapse of the rectum, prolonged diarrhea, etc.[9] Though needling Shenque (CV8) is forbidden, physicians often use moxa to stimulate the point. It is a powerful point that can be used in emergencies to rescue Yang Qi and revive collapse[10] . TCM physician Ge Hong in the Jin Dynasty documented the usage of saltmoxa and ginger-moxa in his book “Zhou Hou Fang”[6].
From the perspective of Western medicine, the navel is where the umbilical cord connects before birth. The umbilical cord is responsible for establishing channels for metabolism by connecting the blood circulation between fetus and the mother. There is no subcutaneous tissue be- low the navel, therefore, it is a thin place that directly connects with the peritoneum, making it the optimal place for medicinal absorption. The navel is also proximal to the reproductive and digestive systems, so it is effective in treating diseases of both systems. CV8’s unique anatomical and physiological property makes it an ideal strategic location to admin- ister TCM medicinals [8] .
According to Dr. Wu’s theory, any TCM herbal prescriptions intended for oral administration can be applied topically. Choosing CV8 as the main site of TCM herbal medicine administration has the advantage of easy access, low cost and minimal concerns regarding ingesting herbal compounds [7] . There have been several research papers already published that discuss utilizing Shenque (CV8) to administer TCM herbal formulas. Some examples include randomized controlled trials (RCT) in dysmenorrhea[11], chemotherapy induced gastrointestinal (GI) toxicity in breast cancer [12], GI motility[13], obesity, endocrine disorders, and polycystic ovary syndrome (PCOS)[14] . Though the efficacy of such methods still requires extensive research, it is certainly an alternative option for patients who are not familiar with TCM herbology and/or unable to take TCM herbs orally. As a simple, convenient, effective, and inexpensive medicinal administration method, navel paste therapy has attracted more and more attention from the Chinese medicine community and received praise from patients.
Production and application of navel paste
The exact preparation method of navel paste should be determined according to the patient’s condition. All Chinese medicine treatment must be performed under the strict guidance of TCM theory and diagnosed according to the holistic view of syndrome differentiation. The first step is to grind various medicinal into fine powders and formulate prescriptions according to their different functions. The second step is to add various corresponding binding mediums, such as water, vinegar, egg white, honey, vaseline, lotion, wine, oil, tincture, etc. The herbal powder and the binding medium are then stirred into a paste to make an ointment[15] . The third step is to apply the paste on the navel, cover it with gauze, and then fix it with tape. Generally, the treatment application should stay on for 1-2 hours. If patient’s skin is tolerating the navel therapy, the application time can be extended. If there is itching or oth- er discomfort, which may indicate an allergic reaction, the application should be removed right away, and the navel should be cleaned thoroughly.
In Ming Dynasty, TCM physician Gong Ting Xian recorded treating pediatric night sweats with Wu Bei Zi, (Galla Chinensis) navel paste in his book “Wan Bing Hui Chun”. Wu Bei Zi was ground into fine powder, and mixed with water, and applied on navel[6] . In Dr. Wu’s “Li Yue Pian Wen”, there is also a recipe using Da Zao (Chinese jujube) and Da Ji (Euphorbia pekinensis) powder to form a medicinal paste, which was applied to the navel to treat constipation. In the Tang Dynasty, TCM physician Sun Si Miao’s “Qian Jin Fang” noted that “to treat abdominal pain due to deficient Cold, put Wu Zhu Yu (Evodia rutaecarpa) in the navel”. The powdered Wu Zhu Yu paste on the navel can be used to treat abdominal pain due to deficient Cold and menstrual pain[6] .
Case
A 49-year-old female complains of fatigue and trouble sleeping for more than one year. The patient was diagnosed with right-sided breast cancer one year ago and received surgery, followed by one month of radiation. Ever since, the patient has been taking Tamoxifen for more than eight months. As a common side effect from the medication, the patient has been experiencing general fatigue, trouble falling and staying asleep, and trouble concentrating during the day. She also complains about mood swings and easy agitation. Currently she feels heavy in her body and cold around the waist and lower exterminates. She also reports bitter taste in her mouth, dry mouth, dry eyes, irritation, belching, and halitosis. Patient denies issues with appetite, bowel movements and urination. Her tongue is light purple with a thin white watery coat. Her pulse is thin, with moderate speed, deep in both Chi, wiry in the right Cun and left Guan, and slippery in the left Cun position.
Pattern Differentiation: Yang Deficiency with excess dampness, blocking ascending of clear Yang to the cranium.
Treatment Strategy: Warm the Yang Qi, transform dampness, raise clear Yang and calm the spirit.
Patient expresses unwillingness to take herbs orally, therefore, a modi
fied topical herbal paste is made and applied on her navel.
Formula:
Wu Zhu Yu 5g, Gan Jiang 5g, Gui Zhi 5g, Ai Ye 3g, Wu Yao 5g, Xiang Fu 5g, Yuan Zhi 5g, Shi Chang Pu 5g, Mei Gui Hua 5g
The above raw herbs are ground into powder and mixed with Shi Chang Pu tincture, Hong Jing Tian tincture and Ai Ye tincture. The wet herbal powder is then finished with lotion to form a soft paste.
The patient is instructed to take a small chunk of herbal paste, roughly the size of the tip of her pinky finger, and apply it topical- ly into the navel. A thin gauze is laid over to secure the paste in place and prevent discoloration of clothing. She was recommended to start with a 2-hour application, then gradually increase if there is no adverse reaction. If there were any discomfort or abnormal appearance around the applied skin area, she was to discontinue usage immediately.
After 2 weeks of usage, patient reported no discomfort and mood swings had greatly improved. Her sleep and fatigue also improved. Patient likes the navel paste application and progress continued with subsequent visits.
Discussion
TCM medicinals should be used under the strict guidance of TCM theories and based on holistic pattern differentiation and treatment strategies. Practitioners may sometimes encounter resistance from patients who are not familiar with Chinese herbal medicine and have predetermined misconceptions of TCM herbal compounds. Scarcity of safety standards and scientific studies on Chinese herbal medicine further generates fear and doubt in the general population. Prescribing oral TCM herbal remedies also carries higher risk for malpractice disputes. However, delivering TCM herbal medicine topically via CV8 is an optimal alternative to create a more convenient, affordable, and acceptable TCM herbal service. If navel paste therapy were to be more thoroughly explored, there could be a brighter future of TCM herbal practice for both patients and practitioners in the U.S.
