Disorders of the Spleen and Stomach - Part Two
by Dian Bang Shi
Translated and edited by
Differentiating yin and yang patterns
n yin and yang theory, zang is yang and fu is yin; spleen is yang earth and stomach is yin earth, although the Spleen and Stomach both have yang and yin. This is very useful in clinical pattern differentiation and when devising a treatment strategy.
Stomach yang deficiency
A deficiency of stomach yang can be due to irregular eating; either too much or too little, internal injuries due to the consumption of cold food, emotional upsets or overwork, all of which result in the impairment of stomach yang, causing deficiency cold in the stomach. Symptoms will include an aversion to cold food, a poor appetite, stomach distention or pain, rebellious stomach qi such as nausea, vomiting, dyspepsia, pale tongue with a white coating and a deep, thin, small pulse. In such cases use Li Zhong Tang (Restore the Middle Decoction) and Liu Jun Zi Tang (Six-Gentlemen Decoction), plus Ding Xiang (Flos Caryophylli), Bai Dou Kou (Fructus Amomi Kravanh) and Sha Ren (Fructus Amomi). If there is severe cold add Bi Ba (Fructus Piperis Longi), Bi Cheng Qie (Fructus Cubebae), Gao Liang Jiang (Rhizoma Alpiniae Officinari) and Rou Gui (Cortex Cassiae Cinnamomi).
Stomach yin deficiency
A deficiency of stomach yin is associated with a deficiency of fluids. Symptoms will include a poor appetite, no feeling of hunger or feels hunger but eats a little, burning stomach pain, a dry mouth, thirst, irritability, dry stools, dark red tongue and a thready, rapid pulse. In these cases, use sweet, cool herbs to generate fluids, whilst sweet and sour herbs can generate yin. Use Yu Zhu Mai Men Tang plus Sheng Di Huang (Radix Rehmanniae Glutinosae), Shi Hu (Herba Dendrobii), Mai Men Dong (Tuber Ophiopogonis Japonici), Bai Shao (Radix Paeoniae Lactiflorae), Wu Mei (Fructus Pruni Mume) and Bai Bian Dou (Semen Dolichoris Lablab). If there is stomach pain, use a modified version of Yi Guan Jian (Linking Decoction).
Spleen yang deficiency
Spleen yang means spleen yang qi which is vital for the functions of transportation and transformation. The stomach depends upon the spleen yang’s warmness to function correctly; the stomach is then able to perform its function of rotting and ripening water and grain.
The main spleen yang deficient symptoms can be seen in the dysfunction of the transformation and transportation actions; severe abdominal distention after eating, qi stagnation in the middle Jiao, epigastric pain or distension, all indicate that the spleen is not able to ascend the clear qi. Instead it descends, with diarrhoea and smaller abdomen or rectal prolapse. The spleen controls the four extremities, if the spleen yang is deficient the symptoms will manifest as four cold extremities, a pale complexion, tiredness, moderate, week or thin and deep pulse and a slightly white tongue coating. Sweet and warm herbs can tonify qi, whilst pungent and sweet herbs can regulate yang. Use the formula Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Li Zhong Tang (Restore the Middle Decoction), Xiang Sha Liu Jun Zi Tang (Six-Gentlemen Decoction with Aucklandia and Amomum), Huang Qi Jian Zhong Tang (AstragalusDecoction to Construct the Middle), Sheng Yang Yi Wei Tang (Raise the Yang and Benefit the Stomach Decoction), etc. For regulating qi add Mu Xiang (Radix Aucklandiae Lappae), Hou Po (Cortex Magnoliae Officinalis), Qing Pi (Pericarpium Citri Reticulatae Viride), Chen Pi (Pericarpium Citri Reticulatae), Zhi Ke (Fructus Citri Aurantii), Zhi Shi (Fructus Immaturus Citri Aurantii), etc. For warming the spleen add Fu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata), Yi Zhi Ren (Fructus Alpiniae Oxyphyllae), Cang Zhu (Rhizoma Atractylodis), Pao Jiang (Quick-fried Rhizoma Zingiberis Officinalis), etc.
In the late Qing dynasty the physician Tang Rong Chuan stated in the text ‘Xue Zheng Lun - Nan Yu Yi Tong Lun’ that “to harmonise and treat the spleen and stomach, the practitioner should differentiate between yin and yang”. After the physician Li Dong Yuan’s teachings, physicians were aware that they should tonify spleen yang in severe stomach and spleen disorders but were unaware they had to tonify spleen yin as well. When spleen yang is deficient, grain and water can absolutely not be transformed. When the spleen yin is deficient, grain and water can also not be transformed. For spleen deficient patterns use warm herbs to reduce the appetite and cold herbs to promote appetite. Tonifying yang herbs include Gan Jiang (Rhizoma Zingiberis Officinalis), Fu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata), etc, which act to generate fluids. Tonifying spleen yin herbs include Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis) and Shi Gao (Gypsum), etc, which act to promote the level of appetite.
Generally, spleen yin deficient symptoms will manifest as dysphasia, constipation, abdominal distention, dry mouth, hot feeling in the hands and feet, irritability, dry skin, yellow complexion and a thin body. The tongue will be red or pale and young with a little or dry coating. The pulse will be soft and thin or thin and rapid. Prof. Shi often uses Zi Yin Jian Pi Wan (see note 1) and sometimes adds Shen Ling Bai Zhu San (Ginseng, Poria and Atracylodes MacrocephalaPowder) to tonify the spleen yin. To treat spleen yin deficient symptoms such as diarrhoea, it is also possible to use Ba Zhen Tang (Eight-Treasure Decoction).
Differentiating hot and cold patterns
There are three types of hot and cold patterns.
Spleen and stomach deficient cold
Most symptoms in this category are associated with a spleen and stomach yang deficiency leading to internal cold. The symptoms include a reduced food intake, stomach and abdominal cold pain, a comfortable feeling after consuming a little amount of food and distention after consuming too much food, indigestion, diarrhoea, pale complexion, tiredness, an aversion to cold, pale tongue with a white coating and a soft, thin pulse. If the spleen and stomach deficient cold is mild use pungent, warm herbs to expel the cold and pungent, sweet herbs to rectify yang. The main formula for this pattern is Liu Jun Zi Tang (Six-Gentleman Decoction). Additionally add Gan Jiang (Rhizoma Zingiberis Officinalis), Cao Dou Kou (Semen Alpiniae Katsumadai) and Yi Zhi Ren (Fructus Alpiniae Oxyphyllae) to warm the spleen and stomach. If this treatment strategy is not effective and the distension and pain become worse, in the Nei Jing (Plain Questions) is states, “when cold pathogen attacks internally use pungent and warm herbs and bitter and sweet herbs to assist”. Prof. Shi often uses the formula Fu Yang Zhu Wei Tang (see note 2) in spleen and stomach deficient cold patterns with abdominal distending pain and loose stools. However, if someone has internal heat this formula can induce stomach fire rising upwards causing a dry mouth and throat, mouth and tongue ulcers and tooth ache. In such cases, replace the formula with Li Yin Jian6, which warms and moistens plus additional herbs to warm the spleen yang. If the main symptom is stomach pain due to spleen and stomach deficient cold and the pain is aggravated by hunger but is relieved by eating with an aversion to cold food, along with distension after excessive eating, use the formula Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) plus Xiao Chai Hu Tang (Minor Bupleurum Decoction). If it is serious use Liang Fu Wan (Galangal and Cyperus Pill).
Spleen and stomach damp heat
This can be caused by a deficiency of spleen and stomach qi as well as internal injury caused by food intake causing damp heat. Other causes include external pathogenic factors such as damp heat. The patient will have an aversion to food, stuffiness of the epigastrium and abdominal regions, epigastric pain, a dry, bitter, sticky mouth, loose stools and ungratifying defecation. The tongue will have a thick, greasy, yellow coating. If damp heat injures yin the tongue will be red. In these cases use herbs to resolve dampness, clear heat and rectify the spleen and stomach dampness or regulate qi to remove stagnation and clear heat. Use the formula Yue Ju Tang (Escape Restraint Decoction), plus Huang Lian (Rhizoma Coptidis), Huang Qin (Radix Scutellariae Baicalensis), Qing Pi (Pericarpium Citri Reticulatae Viride) and Chen Pi (Pericarpium Citri Reticulatae). If there is severe heat add Sheng Shi Gao (Gypsum), Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis) and Zhu Ru (Caulis Bambusae in Taeniis), etc.
Spleen and stomach hot and cold combinations
This pattern is commonly seen in clinical practice. It is caused by the spleen and stomach originally having a deficient cold pattern and if this stagnates for a long period of time it causes heat, therefore this disorder has hot and cold pattern combinations. Symptoms include epigastric distension, a reduced food intake, an aversion to cold food, with the distention and pain becoming worse after consuming cold food, with heart burn and a dry mouth with a bitter taste. Use pungent, warm and bitter cold formulas such as Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium). For severe stomach distension add Zhi Ke (Fructus Citri Aurantii) and Cao Dou Kou (Semen Alpiniae Katsumadai). If there is stomach pain use Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) and Yue Tao San (see note 3), plus Jin Ling Zi San (Melia Toosendan Powder). If there is acid regurgitation use Zuo Jin Wan (Left Metal Pill) plus Duan Wa Leng Zi (Fried Concha Arcae)and Qing Pi (Pericarpium Citri Reticulatae Viride). The physician Zhu Dan Xi stated that “to treat stomach pain use pungent and warm herbs to rectify the stomach and spleen”. Add Shan Zhi Zi (Fructus Gardeniae Jasminoidis) and Huang Lian (Rhizoma Coptidis), etc, which are bitter and cold and clear heat.
Differentiating excess and deficiency patterns
These have already been discussed.
Excessive patterns can include a number of factors such as summer heat damp invading the body or an invasion by pathogenic cold. Symptoms will include a torpid intake, nausea, vomiting, or epigastric pain and loose stools.
Summer heat damp
When summer heat damp invades the body use Huo Xiang Zheng Qi Tang (Wrinkled Gianthyssop Health-Restoring Decoction), plus Huang Lian (Rhizoma Coptidis) and Huang Qin (Radix Scutellariae Baicalensis) to clear heat and resolve dampness.
Exterior pathogenic cold
An invasion by exterior pathogenic cold will include symptoms such as vomiting clear fluids, epigastric pain, abdominal distension and diarrhoea. Use Li Zhong Tang (Regulate the Middle Pill). For severe cold pain add Fu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata). If there is diarrhoea use Wei Ling Tang (Calm the Stomach and PoriaDecoction).
Retention of food
The retention of food can be caused by an improper diet or the existence of a previous spleen and stomach disorder. It can be associated with either an excess or deficiency, but this is mainly a branch, excess pattern. Symptoms will include distension, pain in the epigastrium, nausea, vomiting, foul breath, sour regurgitation or diarrhoea and indigestion. The retention of food can be broken down into a further three patterns:
1. Deficient cold
With spleen and stomach deficient cold and the impairment of the transformation and transportation function due to food intake, use Bao He Wan (Preserve Harmony Pill from the Precious Mirror). Do not use Lian Qiao (Fructus Forsythiae Suspensae) because it is pungent and cool, instead add Bai Zhu (Rhizoma Atractylodis Macrocephalae), Zhi Ke (Fructus Citri Aurantii) and Gan Jiang (Rhizoma Zingiberis Officinalis), etc. Or use Dou Kou Ju Hong San (see note 4) and modify it.
2. Internal heat
With internal heat caused by an improper diet, use Da An Tang (Great Tranquility Decoction), plus Huang Lian (Rhizoma Coptidis) with Huang Qin (Radix Scutellariae Baicalensis).
3. Phlegm damp
When phlegm damp stagnates in the spleen and stomach it causes chest and stomach excess and stuffiness, nausea and the vomiting of phlegm and sometimes stomach pain. Use Er Chen Tang (Two-Cured Decoction) or Fu Ling Yin (see note 5), or use Xiao Ban Xia Jia Fu Ling Tang or He Wei Er Chen Jian (Er Chen Tang plus Gan Jiang (Rhizoma Zingiberis Officinalis) and Sha Ren (Fructus Amomi) to resolve phlegm and harmonise the stomach.
Root deficiency and branch excess
In these cases assist the digestion to reduce the branch (Xiao Bu Fa). The root pattern is a spleen and stomach deficiency. The patient will experience stomach and abdominal distention with reduced food intake or will complain of loose stools and tired extremities. Use a formula such as Zhi Shi Li Zhong Tang (Immature Bitter Orange Decoction to Regulate the Middle) or Jia Wei Zhi Zhu Tang (Modified Immature Bitter Orange and Atractylodes Macrocephala Decoction). If there is excessive distention due to damage caused by food, add Lai Fu Zi (Semen Raphani Sativi) and Ji Nei Jin (EndotheliumCorneum Gigeriae Galli). If the cold is severe add Fu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata) and Gang Jiang (Rhizoma Zingiberis Officinalis). For heat add Huang Lian (Rhizoma Coptidis) and Huang Qin (Radix Scutellariae Baicalensis).
It is necessary to differentiate between excess and deficient patterns in cases of epigastric distension. In protracted diseases due to a spleen and stomach deficiency, if the treatment strategy of regulating qi to dissipate qi or dispersing formula still allows the disorder to be present, then consider that the distention is caused by a deficiency pattern. Excessive distention is caused by qi stagnation, in such cases use pungent and dissipating herbs. Deficiency distention is caused by qi dissipating. The treatment strategy should be to use sour herbs to astringe. If formulas which are sweet and warm are used to invigorate qi and tonify the spleen causing the distention to become severe, it should be considered that the distention is an excessive type. After treatment it is usually possible to differentiate if the pattern is either excessive or deficient after a reaction to the previously prescribed formula. For deficiency distention pattern, if Xiang Sha Liu Jun Zi Tang (Six Gentleman Decoction with Aucklandia and Amomum) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) are not effective then not only can a practitioner use sour herbs to astringe, but also herbs to warm and nourish the kidney fire or warm and tonify the spleen and kidney. Therefore, it can be said, that tonifying the spleen is inferior to tonifying the kidney.
Differentiating Qi and Blood patterns
Spleen and stomach qi deficiency
When the spleen and stomach yang qi is deficient, the transformation and transportation will be dysfunctional with symptoms of abdominal distension, epigastric pain, reduced food intake, diarrhoea, loose stools, weak four extremities, pale complexion and a thin, soft pulse. Use Shen Ling Bai Zhu San (Ginseng, Poria and Atractylodes Macrocephala Powder from the Analytic Collection). If the spleen and stomach is deficient with a deficiency of Yuan Qi and lassitude, use Si Jun Zi Tang (Four Gentleman Decoction), plus Huang Qi (Radix Astragali Membranacei) and Shan Yao (Radix Dioscoreae Oppositae). If there is pain add Rou Gui (Cortex Cinnamomi Cassiae), Bai Shao (Radix Paeoniae Lactiflorae), Xiang Fu (Rhizoma Cyperi Rotundi), Gao Liang Jiang (Rhizoma Alpiniae Officinari) and Wu Yao (Radix Linderae Strychnifoliae), etc. If tonifying the spleen and stomach formula is not effective use a tonifying kidney formula. Use herbs such as Tu Si Zi (Semen Cuscutae Chinensis), Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) and Bu Gu Zhi (Fructus Psoraleae Corylifoliae), etc to warm the lower jiao.
Spleen and stomach qi stagnation
The pathogenic factors that cause spleen and stomach qi stagnation include summer heat damp, wind-cold or internal injury due to the consumption of cold, greasy food along with emotional upset or anger. All these factors will damage the transportation and transformation function of the spleen and stomach, manifesting as abdominal distention, indigestion, foul breath, belching, sour regurgitation or abdominal pain with no desire for food. The bowel movements will be difficult to pass and the tongue will have a thick, greasy coating. Rectify qi and disperse stagnation. Use formulas such as Ping Wei San (Calm the Stomach Powder) and Shen Xiang San (see note 6). If the stangation transforms into heat with symptoms of a dry mouth, yellow tongue coating and hard stools use Huang Lian (Rhizoma Coptidis), Huang Qin (Radix Scutellariae Baicalensis) and Tian Hua Fen (Radix Trichosanthis Kirilowii). If severe add Da Huang (Radix et Rhizoma Rhei).
Spleen and heart blood deficiency
Spleen and heart blood deficiency is a combination of both a deficiency of qi and blood. The commonly seen symptoms include epigastric pain, distention, reduced food intake, tiredness, insomnia, palpitations and a delayed menstruation. When regulating and harmonising the spleen and stomach in blood deficiency patterns do not use pungent and warm herbs as they damage yin and blood causing exuberant stomach fire with depleted spleen yin. The stomach and intestines will become dry with dry and hard stools. The treatment strategy is to nourish and harmonise the heart and spleen. Formulas that can be prescribed include Gui Pi Tang (Restore the Spleen Decoction) or Gui Shao Liu Jun Zi Tang (see note 7), or use Ba Zhen Tang (Eight-Herb Powder for Rectification) or Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction).
Blood stasis causing epigastric pain
In the classics it states that “pain at the beginning is in the meridians, the meridians govern qi, chronic pain moves in the collaterals and the collaterals control blood”. When protracted epigastric pain does not improve, it moves into the blood level within the collaterals. The treatment strategy should use pungent and moist herbs to unblock the collaterals. Clinically, Prof. Shi’s experience is that when the use of qi regulating herbs does not improve the condition, use herbs to quicken the blood and unblock the collaterals and stop the pain. The symptoms of chronic epigastric pain, hypochondriac and back pain tells the practitioner that the disease is in the collaterals. Use herbs such as Dang Gui (Radix Angelicae Sinensis), Tao Ren (Semen Persicae), Bai Zi Ren (Semen Biotae Orientalis), Dan Shen (Radix Salviae Miltiorrhizae), Yu Jin (Tuber Curcumae), Yan Hu Suo (Rhizoma Corydalis Yanhusuo), Wu Ling Zhi (Excrementum Trogopteri seu Pteromi), Hong Hua (Flos Carthami Tinctorri) and Ze Lan (Herba Lycopi Lucidi), etc. If it is a cold pattern add Gui Zhi (Ramulus Cinnamomi Cassiae) and Liang Jiang (Rhizoma Alpiniae Officinari). For heat patterns add Mu Dan Pi (Cortex Moutan Radicis) and Shan Zhi Zi (Fructus Gardeniae Jasminoidis).
For blood stasis patterns as well as using blood quickening herbs, also use qi regulating herbs as qi commands the blood. Include herbs such as Xiang Fu (Rhizoma Cyperi Rotundi), Jiang Xiang (Lignum Dalbergiae Odoriferae), Chen Pi (Pericarpium Citri Reticulatae) and Qing Pi (Pericarpium Citri Reticulatae Viride), etc. Examples of blood quickening formulas include Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansions of Blood Decoction) and Ge Xia Zhu Yu Tang (Drive Out Blood Stasis Below the Diaphragm Decoction). When the stools are black in blood stasis patterns use Da Huang (Radix et Rhizoma Rhei) to remove the blood stasis and produce new blood. When the stools colour turns from black to yellow the treatment has been successful. Clinically, Prof. Shi sometimes sees patients with chronic epigastric pain with unsuccessful treatment and uses Dan Shen Yin (Salvia Decoction) and Dan Shen (Radix Salviae Miltiorrhizae) at 30g each, which he finds very effective.
Clinically, zangfu theory, yin and yang, qi and blood, hot and cold, deficiency and excess have a very close relationship. It is not easy to differentiate and distinguish their mechanisms. A practitioner should understand pattern differentiation from a holistic perspective. Prof. Shi’s understanding is that treatment should have different strategies, for example when treating the stomach and the treatment strategy is not effective, a practitioner should consider that the liver is exploiting the stomach and so treat the liver. With disorders of the spleen, if the treatment strategy of treating the spleen is not responding then treat the kidney. For example, if spleen yang is deficient and warming the spleen yang is not effective then warm the kidney. If the treatment strategy directed at the qi level is not effective then redirect the strategy to the blood level. For blood stasis patterns differentiate between deficiency and excess. For excessive type blood stasis patterns, quicken the blood and dispel blood stasis. For deficient blood stasis patterns, regulate and nourish qi and blood to dispel blood stasis. If when treating an excessive pattern it is not effective consider that the pattern may be one of deficiency. In conclusion, Bian Zheng Lun Zhi should be used with basic Chinese medical theory to differentiate the pathogenic factors, characteristics, mechanisms and disease, disorder location. When using formulas a practitioner should have a set of strategies that are well thought out. With extensive clinical experience and Chinese medicine theory a practitioner can have good clinical results.
1. Zi Yin Jian Pi Wan: Dang Shen (Radix Codonopsitis), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Fu Ling (Sclerotium Poriae Cocos), Gan Cao (Radix Glycyrrhizae Uralensis), Mai Men Dong (Tuber Ophiopogonis Japonici), Wu Wei Zi (Fructus Schisandrae Chinensis), Shan Yao (Radix Dioscoreae Oppositae), Shi Hu (Herba Dendrobii), Chen Pi (Pericarpium Citri Reticulatae) and Shan Zha (Fructus Crataegi).
2. Fu Yang Zhu Wei Tang: Ren Shen (Radix Ginseng), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Gan Jiang (Rhizoma Zingiberis Officinalis), Zhi Gan Cao (Processed Radix Glycyrrhizae Uralensis), Shu Fu Zi (Radix Lateralis Aconiti Carmichaeli Praeparata), Rou Gui (Cortex Cinnamomi Cassiae), Bai Shao (Radix Paeoniae Lactiflorae), Chen Pi (Pericarpium Citri Reticulatae), Yi Zhi Ren (Fructus Alpiniae Oxyphyllae), Wu Zhu Yu (Fructus Evodiae Rutaecarpae) and Cao Dou Kou (Semen Alpiniae Katsumadai).
3. Yue Tao San: Shan Zhi Zi (Fructus Gardeniae Jasminoidis), (cold) and Gao Liang Jiang (Rhizoma Alphiniae Officinari) (hot),
4. Dou Kou Ju Hong San: Ding Xiang (Flos Caryophylli), Mu Xiang (Radix Aucklandiae Lappae), Bai Dou Kou (Fructus Amomi Kravanh), Ren Shen (Radix Ginseng), Hou Po (Cortex Magnoliae Officinalis), Shen Shu, Gan Jiang (Rhizoma Zingiberis Officinalis), Ban Xia (Rhizoma Pinelliae Ternatae), Ju Hong (Pars Rubra Epicarpii Citri Erythrocarpae), Gan Cao (Radix Glycyrrhizae Uralensis), Huo Xiang (Herba Agastaches seu Pogostemi) and Bai Zhu (Rhizoma Atractylodis Macrocephalae).
5. Fu Ling Yin: Ren Shen (Radix Ginseng), Fu Ling (Sclerotium Poriae Cocos), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Zhi Shi (Fructus Immaturus Citri Aurantii), Ju Pi (Pericarpium Citri Reticulatae) and Sheng Jiang (Rhizoma Zingiberis Officinalis Recens).
6. Shen Xiang San: Ding Xiang (Flos Caryophylli), Sha Ren (Fructus Amomi) and Cao Dou Kou (Semen Alpiniae Katsumadai).
7. Gui Shao Liu Jun Zi Tang: Liu Jun Zi Tang (Six-Gentleman Decoction), plus Dang Gui (Radix Angelicae Sinensis) and Shan Yao (Radix Dioscoreae Oppositae)
This article was first published in The Lantern, Sep 2005.
Dian Bang Shi opened his own clinic in 1942,graduated from Beijing University of TCM in1957 and is the retired director of China Academy of TCM. He specialises in spleen and stomach disorders and still practices at the age of 83 in Xi Yuan hospital, Beijing, China.
Attilio D’Alberto graduated from a jointly run program at Middlesex and Beijing Universities in with a BSc (Hons) in Traditional Chinese Medicine (Middlesex University) and a Bachelor of Medicine (Beijing University of TCM). He currently practices in various busy clinics in London. Correspondence: www.attiliodalberto.com/contact.htm
Eunkyung Kim received a BA in Chinese Literature. Later she graduated from a jointly run program at Middlesex and Beijing Universities with an honours degree in Traditional Chinese Medicine (Middlesex University) and a Bachelor of Medicine (Beijing University of TCM). She currently practices at The Earth Health Clinic in London. Correspondence: www.aprilkim.net/contact.htm