.
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.
臍貼應用初探
李俊儀，鞠海鷹，楊冰
摘要：臍療歷史悠久，是指將藥物做成適當劑型，如膏、糊、散、丸等敷貼於臍部，或在臍部施以某些物理刺激，如艾灸、針刺、熱熨、拔罐 等，以治療疾病的方法。伴隨針灸在美國的快速 發展，中醫藥亦受到廣泛關注。但中藥製劑在美 國被列入保健食品而非藥品，基於各種原因不能推廣應用。筆者通過查閱研讀中醫藥近現代典籍，對於不願或不能口服中草藥的患者，選擇神闕肚臍作為替代給藥途徑為切入點，以達到治療目的。本文介紹了臍療臍貼的歷史沿革及應用， 並以一則案例詳細介紹臍貼的操作及使用方法， 希望以此起到拋磚引玉之效。
關鍵詞：中藥、神闕穴、臍療、臍貼、原藥飲片中醫有多種不同的治療方法，在辯證論治的基礎上，對病人實施相應的內治或外治法。在美國，針、灸、刮痧、推拿、拔罐、氣功等療法都是常見的外治法，而中藥的使用相對沒那麼普及【1】。中藥是傳統中醫極為重要的一部分，是在中醫基礎理論的嚴格指導下，辯證論治，使用中藥製劑，對於內外婦兒各種疾病起到治療及預防的作用。中藥方劑的使用非常靈活，其理論包含了歷代各家學說的精髓。但相較於針灸，中藥方劑的使用在西方社會及醫療體系中尚未得到普遍接受。
根據世界衛生組織，全球有約80% 的人口使用草藥【2】。在過去十年裡，美國約有20%的人口會使用藥草類製劑包含保健食品、茶飲、藥品【3】。但由於缺乏系統性規範，大眾對於這些藥草類植物產品仍存有較高的安全疑慮。相較於中東、希臘、中國及印度等地區，西方生物醫學的醫師、藥師、科學專家及大眾皆缺乏以天然製劑作為藥物使用的知識【2,3,4,5】。此現象可 歸咎於目前相對匱乏的研究數據、教育科普及社區推廣。過去的五十年內，由於缺乏政府及藥廠的支持，諸多關於中醫的研究都集中在針刺療法，中藥研究相對較少，進一步導緻美國民眾對 於中醫中藥缺乏正確的認知【1,2】。此一知識的缺少易造成對中醫中藥的誤解、誤用，再加上中藥湯汁苦澀難以內服，及負面媒體的報導時有 耳聞，不僅對中醫從業人員在美國使用中醫中藥 形成諸多障礙，也使得廣大民眾無法受益於中醫中藥的非凡療效。為了提升中醫中藥在臨床治療中的使用及接受度，筆者認為有必要在臨床開發新的思路，試驗不同的替代給藥途徑。本文主要介紹利用神闕穴外用中藥製劑作為新的常規替代給藥途徑。
臍療歷史沿革及理論基礎
臍中療法簡稱臍療，作為中醫外治法之一，是將藥物做成適當劑型，如膏、糊、散、丸等敷於臍部，或在臍部施加些物理刺激，如艾灸、針刺、 熱熨、拔罐等，以治療疾病的方法。中醫外治法歷史悠久，自原始社會人類與野獸搏鬥，使用草 葉泥灰等塗抹傷口開始，到中醫文獻有正式記載，外治法均備受歷代醫家重視【6】。清·吳師機是中醫史上擅用膏藥治療一切內外疾病的外治專家，在其著作《理瀹駢文》中指出“外治之理 即內治之理，外治之藥亦即內治之藥，所異者法 耳”。吳氏於同治四年(1865)開診以膏藥施治患者，“日或一二百人或三四百人”，“歲活五六萬人”，頗有成效。吳氏親自製藥保證藥效，並且心系窮苦患者，於同治三年(1864)出版的《理瀹駢文》中，總結其畢生運用外治法，治療各種內外科疑難雜症的心得【7】。另一位醫學家，明·李時珍在其《本草綱目》中記載了蔥汁敷臍治療水腫【8】。筆者根據吳氏在外治法上所創之醫學成就，借鑒歷代醫家運用外治貼敷的給藥方法，探討神闕貼敷給藥的可能性和有效性。
在中醫針灸學中，肚臍又名神闕穴(CV8)，為任脈腧穴之一，任與督脈相表裡，神闕向後與督 脈命門穴(GV4)位於同一水平線，肚臍通五藏 六府，聯絡全身經脈【8】。《難經》明確指出 臍下腎間動氣，為“五藏六府之本，十二經脈之根，呼吸之門，三焦之原”，“主通行三氣，經歷於五藏六府”，為臍療法奠定理論基礎【6】。在臨床上，神闕穴是全身藏府經絡的樞紐，四通八達，可用於治療多種疾病，例如腹痛、腸鳴、陽氣暴脫、脫肛、久痢久瀉等。【9】。神闕通常禁針，但常用於各種艾灸法，甚至可用於回陽救逆【10】。晉代的葛洪在他的《肘後方》中就有記載隔鹽灸和隔姜灸【6】。從西醫的角度，肚臍是人類出生前臍帶連接的地 方，臍帶負責聯結胎兒與母體的血液循環及代謝。肚臍以下沒有皮下組織，是最薄的地方，直接與腹膜相連，藥物的吸收良好。肚臍又和生殖系統，消化系統相關聯，因此用於治療生殖系統消化系統疾病均有佳效。神闕穴特殊的解剖及中醫生理特點，使其成為臨床外用給藥的首選，形成獨特的中醫臍療【8】。
根據吳氏的理論，任何口服的中藥方劑皆可使用外部給藥。運用神闕給藥有操作簡單、價格低廉、減少對口服中藥製劑質疑等特點【7】。近來已有多篇學術文獻發表運用肚臍施治中醫中藥 治療不同的疾病，例如痛經的治療【11】，乳癌 術後化療引起的消化系統疾病【12】，胃腸動力的改善【13】，改善肥胖多囊卵巢綜合徵患者的肥胖指數、內分泌及臨床症狀【14】等。臍療實際臨床的效果還有待更多的實驗證實，但肚臍給藥可適用對於中醫中藥較陌生或無法口服中藥的患者群體，提供另一用藥選項，作為一種具有簡、便、驗、廉、捷特點的給藥方式。神闕穴給藥已經開始引起中醫界的重視和患者的好評。
臍貼的製作及應用舉例
臍貼外用製劑的確切製作方法應視患者情況而定，所有的中醫治療都必須在中醫基礎理論的嚴 格指導之下，根據整體觀及辨證論治而定。第一 步是將各種不同的藥物研成細粉，根據制方規律，按其不同的作用，配伍成方。第二步是加入各種相應的介質，如水、醋、蛋清、蜂蜜、凡士林、乳液、酒、油、酊劑等，攪拌成糊狀，配成藥膏【15】。第三步將藥膏敷貼在肚臍上，然後 用紗布覆蓋，再用膠帶固定。一般敷貼1-2小時，若患者皮膚無不適，敷貼時間也可相對延長。若在過程中有皮膚瘙癢或其他不適，恐為過敏，需及時摘除敷貼並將臍部清理乾淨。明·龔廷賢的《萬病回春》中曾詳細記載了用五倍子臍貼治療小兒盜汗的方法，將五倍子研粉，和水一起攪拌成糊狀，敷於臍部。吳師機的《理瀹駢文》中亦有用大棗、大戟研粉後做 成藥餅，敷於臍部來治療便秘之敘述。唐·孫思邈《千金方》中亦有云，“治虛寒腹痛，以吳茱萸納臍”，即吳茱萸研粉後敷貼在臍，可用於治療虛寒腹痛及痛經【6】。
病案舉例
49歲女性，主訴神疲眠差一年餘。患者於2022 年10月確診右側乳房惡性腫瘤，手術治療後放療一月，繼續口服Tamoxifen激素八月餘。因藥物副作用，一年來患者精神疲乏，夜間難以入睡，淺眠易醒，日間常覺疲憊，情緒煩躁易怒。現下身體自覺沉重，腰腿冷，口苦，口乾，眼乾，心煩，噯氣，口中時有異味，納可，二便調，舌淡紫，苔薄白水滑，脈細緩， 雙尺沉，寸右弦左滑，左關微弦。辨證為陽虛 濕阻，清陽不升，治以溫陽化濕，升清安神。 因患者不願口服中藥，遂用神闕穴外敷給藥。
中藥處方：
吳茱萸 5g 乾薑 5g 桂枝 5g 艾葉 3g 烏藥 5g 香 附 5g 遠志 5g 石菖蒲5g 玫瑰花 5g
上九味原藥飲片打成粉末，用石菖蒲酊、紅景 天酊、艾草酊及乳液調成糊狀。每次使用時拿 一小丸約小指尖大小填入臍中，再用紗布覆蓋固定。建議患者一開始先敷2小時，若無不適再 循序增時，若覺不適或察覺皮膚出現異樣則停止使用。患者使用兩週後匯報無不適，情緒大為好轉，睡眠，體力亦轉佳。繼續治療觀察。
討論
中醫藥方劑是在嚴格的中醫基礎理論指導之下，運用整體觀和辨證論治所實施的治療方 法。醫者在行醫過程中難免會遇到對中醫中藥 較陌生或有誤會偏見的患者，或由於中醫中藥 缺乏系統性的科學及安全性研究，產生對中藥 製劑的畏懼和不信任，降低服用中藥的意願及 配合度。另外處方中醫中藥也有相對較高的訴 訟風險。此時運用神闕外部給藥則可作為一較 好的替代方案，形成方便、價廉、較能被患者 接受的中醫中藥服務。倘若神闕給藥的臨床療 效能被更加研究開拓，一來可以造福於廣大患 者，二來也為在美執業中醫中藥的同業創造更 佳友善的執業環境。
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