Understanding health conditions affecting the elderly
We live in an ageing society. According to the WHO, by 2050 nearly one quarter of the world’s population will be over the age of 60. Heart disease, stroke and chronic pulmonary disorders are the leading killers of the elderly (1) with cardiovascular diseases the main cause of non-communicable disease in any age-group, causing approximately one third of all deaths globally (2).
The leading causes of disability in the elderly are sensory impairments, back and neck pain, chronic obstructive pulmonary disease (COPD), depressive disorders, falls, diabetes, dementia and osteoarthritis and many of these can be postponed or even avoided depending on how we conduct our lives (2).
From soothing aching joints, calming the nerves and supporting restful sleep to treating stroke and angina either alone or as an adjunct to conventional medicine, at the bedside or in a Chinese hospital, traditional Chinese medicine has so much to offer our older citizens and the demand for gentle, natural ways to do so is only increasing.
How do conditions affecting the elderly work in TCM?
“fu jing zhe, sheng zhi ben ye.“
“A person’s essence is the root of life.” (3)
Historically, afflictions of the elderly have been seen in TCM as a decline in jing, our inherited, constitutional essence stored in the kidneys that provides the substance for development and growth. As the years go by, this essence naturally declines – slower if we lead a healthy, balanced life – and with its waning the signs of ageing emerge. Our kidney yin and yang energies also deplete along the journey, becoming less able to cool, moisten, nourish or warm and activate, respectively. Hair whitens, skin dries and wrinkles, organs lose their nourishment and vitality, circulation slows. The ‘marrow’, produced by the kidneys, weakens and is less able to nourish the bones and brain. Senility, frailty and failing senses emerge and once jing is fully consumed, we pass away. This is, of course, the description of a natural process, but one that TCM has slowed and supported for thousands of years.
However, whether as a result of changed environments, diets and lifestyles – with declining physical activity, circulation slows and the development of phlegm and blood stasis increases – or, perhaps, the new light shed on conditions affecting the elderly by modern research, geriatric disorders, particularly those with the greatest rates of morbidity such as heart disease and stroke, are now largely seen as conditions of excess involving one or a combination of the following pathogenic factors: blood stasis, phlegm and internal wind (4,5). These may have deficiency at the root, but the presenting conditions will be predominantly excessive in nature. As such, the modern clinical application of TCM for the elderly, especially in more severe conditions, has shifted from tonifying deficiency towards eliminating excess.
Understanding the root
The natural process of ageing may be accelerated or complicated by factors such as:
- genetics
- a sedentary lifestyle
- smoking
- prolonged chemical/ pollutant exposure
- excessive alcohol consumption
- poor diet
- obesity
- isolation
- poverty
- stress
- injuries
- illness
The following are some of the more common factors impacting health in the elderly from a TCM perspective, with examples of some of their TCM signs and symptoms and associated biomedical conditions. This is a very general overview and there is often an overlap of signs, symptoms and conditions. Likewise, in clinical practice pathological factors are typically combined – for example, internal wind with phlegm is a very common presentation in pathologies affecting the elderly.
Deficient pathologies
yin deficiency: feeling of heat, dizziness, dry throat, hoarse voice, chronic cough that is worse in the evening and dry/ with difficult to expectorate sputum, sore low back and knees, insomnia (trouble staying asleep), atrophy of the limbs, weakness of the knees, restless legs, poor night vision, dry brittle nails, constipation, scanty dark urine, a tongue without coat, lordosis (swayback), myopia (short-sightedness), cataracts, COPD, with deficient heat: depression, anxiety that is worse in the evening, feeling of heat in the head, nightsweats, psoriasis, excessive ear wax, poor memory, chronic light nosebleeds, chronic sore throat, mouth ulcers, loose teeth, bleeding gums, receding gums, dry lips, streaming eyes, red eyes, hot hands, burning sensation in the soles, a red tongue with a dry yellow coat.
yang deficiency: tiredness, dizziness, feeling of cold in legs and back, sore low back and knees that are better for rest, abundant clear urination, urination at night, straining to defecate, day-break diarrhea, a pale wet tongue, with excess fluids: severe breathlessness, oedema – especially of the legs and ankles, palpitations, drooling/ excessive saliva, abdominal distension, a pale, swollen tongue.
jing deficiency: softening of bones, hair loss, poor memory, loose teeth, dizziness, tinnitus, low back ache,kyphosis (rounding of upper back), deafness.
Blood deficiency: dry, cracking nails, dry skin and hair, dizziness, restless legs, insomnia (getting to sleep), constipation, a pale tongue, anaemia.
Excess pathologies
Blood stasis: pain that is fixed and stabbing in nature, chest pain, reddish-purple bridge of the nose, a purple tongue, irregular or taught pulse, macular degeneration, heart disease, angina, arteriosclerosis, cerebrovascular disease, cancer.
Phlegm: dizziness, tics,nodules under the skin, brain fog, numbness, phlegm in the throat, confusion, poor memory, tremor, feeling of oppression of the chest, epigastric pain, stones, nausea, productive cough, shortness of breath , poor appetite and digestion, swollen hands with yellowish thickened nails, a swollen tongue with a sticky coat, cataracts, asthma, reflux, goitre (slow-onset, soft), Alzheimer’s disease, high cholesterol, chronic bronchitis, trigeminal neuralgia, with excess fluids: pale, bluish or pale-yellow and swollen tip of the nose, swollen face, feeling of oppression on the chest especially when lying down, palpitations.
Internal wind: stiff and painful neck, tic, deviation of eye and mouth, unstable gait, tremors, severe dizziness, tinnitus, headache, unilateral numbness of the face, itching, contraction of the upper limbs and fingers, a stiff, deviated, quivering tongue, alopecia, strabismus (squint), nystagmus (quivering eye ball), sudden blindness, Parkinson’s disease, hypertension, stroke, paralysis, vertigo. (4,6)
Signs and symptoms
Major causes of death in the elderly:
- heart disease
- stroke
- chronic lung disease
Major causes of disability in the elderly:
- sensory impairments
- back and neck pain
- chronic obstructive pulmonary disorder (COPD)
- depressive disorders
- falls
- diabetes
- dementia
‘Geriatric syndromes’:
- frailty
- functional limitation
- polypharmacy
- malnutrition
- cognitive impairment
- dementia
- depression
- delirium
- vertigo
- falls
- spontaneous bone fractures
- failure to thrive
- neglect and abuse
- urinary incontinence
- pressure ulcers
Herbal solutions
Chinese herbal medicine tends not to use herbs individually but in synergistic formulae. It is important to consult a qualified TCM practitioner, particularly in cases of serious disease, as they must be carefully prescribed and modified to match the individual’s presenting symptoms, environment and constitution. Depending on the condition and conventional medications the patient is taking, it may also be pertinent to refer to or liaise with and work alongside their primary health care practitioner and herb dosage should always be lowered for the elderly.
Tonics
shu di huang, Rehmannia glutinosa, prepared Rehmannia, nourishes blood, yin and jing to treat conditions such as palpitations, insomnia, loose teeth, incontinence, low back pain, weakness of the legs, dizziness, tinnitus, deafness, poor vision, premature greying of hair and diabetes. Prescribed in most formulas for kidney deficiency, it is the chief herb of the leading formula for kidney yin deficiency, liu wei di huang wan (Six Ingredient Rehmannia Pill).
ren shen, Panax ginseng, Ginseng, used in TCM for millennia to treat conditions of weakness and promote longevity. Strongly tonifies qi and blood and calms the shen. Research has shown it to be beneficial in cases of depression and anxiety where hyperactivation of the HPA axis is present by reducing CRH, ACTH and cortisol (7). Systematic reviews have found it beneficial for hearing loss, hypertension, diabetes and cancer. Clinical studies show it improves congestive heart failure (CHF) alone or with digoxin and is comparable to digoxin and can benefit dry eyes, obesity, cognitive function, ageing skin, stamina and immune function. In a two-year trial, ren shen stabilised cognitive function in Alzheimer’s disease subjects (8). It also features in the formula bu fei yi shen – alongside huang qi, shu di huang and others – a TCM combination frequently employed for COPD. In cases of yin deficiency, ren shen may be substituted with xi yang shen (American Ginseng) which is cold in nature.
ling zhi, Ganoderma lucidum, Reishi, is another classic ‘anti-ageing’ aide with benefits for cancer (especially breast and prostate), liver disease, hypertension, insomnia, anxiety and rheumatoid arthritis. Along with its cardiovascular, neurological and immune benefits, it has glycaemic and lipid controlling abilities, and would appear worthy of the translations, ‘mushroom of immortality’ and ‘spirit mushroom’ (9).
dang gui, Angelica sinensis, Dong quai, is a chief blood tonic and blood invigorator and is also used to moisten the bowels and relieve constipation from dryness. It is an important herb for pain, including rheumatism, injuries and arthritis and is used to treat anaemia, blurred vision, dizziness, numbness in the limbs, palpitations and weakness from blood deficiency. Human research has shown it decreases infarct volume and can improve function in stroke. Further clinical studies showed that alongside huang qi and ren shen it can reduce angina and it was also beneficial for pulmonary hypertension, coronary artery disease, cirrhosis, portal hypertension, stroke, anaemia of chronic disease and cancer (8).
dang shen, Codonopsis pilosula, Codonopsis, is a leading TCM qi tonic and support for fatigue, weakness, poor digestion, chronic cough and shortness of breath. A 2015 systematic review and meta-analysis of 48 randomised control trials found that dang shen formulae showed promise for the treatment of COPD but further investigation is needed (10).
suan zao ren, Zizyphus spinosae, Jujube seeds, is a commonly-used yin and blood tonic and sedative that alleviates irritability, insomnia and anxiety with palpitations in cases of yin or blood deficiency. As an astringent, it is beneficial for spontaneous sweating and nightsweats. It has also been shown to reduce blood pressure. (11) The tonic properties of suan zao ren lend it to safe use in the elderly and it is the primary herb in the classic formula, Suan Zao Ren Tang (Sour Jujube Decoction), used widely in TCM to treat insomnia from yin and blood deficiencies.
gou qi zi, Lycium barbarum, Goji, is another popular blood, yin and, to a lesser extent, yang and jing, tonic used widely to promote longevity and benefit the eyes. Its anti-ageing reputation may be attributed to its antioxidant, immunoregulative, anti-apoptotic properties and ability to reduce DNA damage, thus inhibiting biological aging (12). A systematic review found them beneficial for glycaemic control and, therefore, diabetes. Clinical studies have shown benefits for macular degeneration, dyslipidemia, insomnia, anxiety, cognition, stress, fatigue, immunity and cancer (8).
huang qi, Astragalus membranaceus, Astragalus, is an important qi tonic often used for debility, poor digestion and low immunity. Systematic reviews have displayed benefits for diabetic nephropathy and immune function. Clinical studies found it benefits congestive heart failure, protects against ischemia (restricted blood flow to part of the body) and reperfusion injury (damage caused to tissue when blood flow is restored), as well as asthma, coronary artery disease, cancer and can improve recovery from hemorrhagic stroke (8).
xu duan, Dipsacus asper, Dipsacus, tonifies yang and invigorates blood making it ideal for stiffness and pain, particularly of the lower back and knees, from blood stasis caused by weak yang qi, a frequent presentation in the elderly.It is also a common remedy for bone weakness and injured bones (13).
du zhong, Eucommia ulmoides, Eucommia, tonifies yang, supports yin, strengthens the sinews and bones and is often used for lower back and knee weakness, fatigue and frequent urination. It also lowers blood pressure and stops dizziness from ‘yang rising’ which is common where yin is weak and stress is present.
mai men dong, Ophiopogon japonicas, Ophiopogon, nourishes yin, moistens the lungs and stops cough and is frequently found in TCM formulas for COPD.
Blood invigorators
dan shen, Salvia miltiorrhiza, is a blood invigorator that can also calm the spirit and clear heat. It has demonstrated circulatory, cardiovascular, cerebrovascular and neuroprotective benefits. It is primarily used for cardiovascular disorders and liver fibrosis but is increasingly being applied to all blood stasis syndromes, in particular those associated with ageing, autoimmunity, and progressive diseases (13). fu fang dan shen pian (Compound Dan Shen Dripping Pill (CDDP)) – made up of Salvia (dan shen), Notoginseng (san qi) and Borneol (bing pian) – is used widely in Chinese hospitals to treat angina pectoris and was the first TCM formulation to successfully complete Phase II clinical trial under the US Food and Drug Administration (FDA)’s Investigational New Drug (IND) application.
san qi, Panax notoginseng, Notoginseng, is another important blood invigorator found in formulations for cardiovascular disease and stroke prevention. It has analgesic properties and the unique ability to both invigorate blood and arrest bleeding.
jiang huang, Curcuma longa, Turmeric, is a popular anti-inflammatory and analgesic herb in western herbalism, TCM and Ayurveda. In TCM, it invigorates qi and blood and stops pain, especially in the shoulder, abdomen and chest, and is given for liver congestion, gallstones, hepatitis, arthritis and wounds. Systemic reviews have displayed its ability to help diabetes mellitus, diastolic hypertension, dyslipidemia, anxiety and depression. Clinical studies showed it improved endothelial function and benefitted coronary artery disease, asthma, reflux, rheumatoid arthritis, fatigue, cancer and was hepatoprotective (8).
Phlegm herbs
ban xia, Pinellia ternate, Pinellia, is the primary TCM herb for resolving phlegm and a popular choice for cough with copious sputum, especially from phlegm-cold in the lungs. It also benefits digestion where this has been impacted.
shi chang pu, Acorus gramineus, Acorus, ‘opens the orifices’ by transforming phlegm and thus benefits the mind and spirit (shen), treating seizures, deafness, dizziness, forgetfulness and stupor and is often found in formulas that benefit nervous disorders and cognitive function. Preparations of shi chang pu were found to prolong the effects of barbiturates (11).
Wind herbs
tian ma, Gastrodia elata, Gastrodia, calms wind, descends ascendant qi, hasan analgesic effect and is used for headaches, dizziness, hypertension, stroke with numbness in the extremities and spasms.
gou teng, Unicaria rynchopylla/ sinensis, Gambir, also calms wind but is cool in nature descends yang. It is used for spasms, tremors, seizures, headaches and hypertension.
Herbs that ‘stabilise and bind’
Ginkgo, Ginkgo biloba, Ginkgo, the ginkgo plant is a well-known herbal aide with many applications for the elderly. Bai guo, the ginkgo nut, benefits the kidneys and lungs in TCM and is traditionally used for wheezing and cough with phlegm, as well as frequent urination and incontinence. Yin guo ye, the ginkgo leaf, is the more popular of the pair, has been extensively researched and systematic reviews have found it benefits vertigo, tinnitus, cardiovascular health, dyslipidemia, diabetes, stroke, mild cognitive impairment and dementias. Clinical studies showed benefits for macular degeneration, glaucoma, claudication (pain while walking), depression and ageing skin (8).
wu wei zi, Schisandra chinensis, Schisandra, is an important tonic astringent herb that benefits the heart, kidneys and lungs and treats ‘leakages’ in the form of cough, wheeze, night sweats, diarrhea and frequent urination. It is also a calming herb and benefits nervous conditions. A systematic review showed benefits for congestive heart failure and clinical studies displayed its ability to treat diabetes, non-alcoholic fatty liver disease, cognition, stamina, pneumonia and cancer (8).
Herbs for cough and wheeze
xing ren, Prunus armeniaca, Apricot seed, is an important TCM herb for arresting cough, particularly dry cough, and wheeze and is a primary herb for bronchitis and asthma, both hot and cold in nature. It also moistens the intestines to promote bowel movements, especially useful for the elderly who often suffer from dry intestines. ma zi ren wan (Hemp Seed Pill) in which it is a deputy herb, is a classic formula for this purpose.
Holistic solutions
General principles
- eat a healthy diet
- quit smoking
- maintain a healthy weight
- avoid excessive alcohol consumption
- get regular exercise
- use stress reduction techniques
- study something new
- keep social
Tai chi and qi gong
Tai chi is a hugely popular form of exercise amongst older citizens in China where it is used to encourage circulation, calm the mind, promote strength and balance and has been proven to reduce falls in the elderly (14). Qi gong (‘qi exercises’) is also a common practice for building and preserving energy and strengthening the body and mind.
TCM diet
The elderly, particularly those with yang deficiency or cold, will typically benefit from warm, well-cooked foods due to naturally weakened digestive systems and possible dental issues. Adding warming spices such as fresh ginger can support digestion and may be particularly welcome in the cooler months.
In cases where heat and, or, yin deficiency is present it may be necessary to reduce or avoid warming foods and stimulating substances such as chilli, pepper, garlic, cinnamon and excessive red meat (especially lamb), fried foods, sugar, caffeine and alcohol.
In cases of phlegm avoid damp-forming foods – excessive cold, raw food, greasy, fatty foods, dairy, bananas, peanuts, sugar, flour products, avocados and incorporate foods that cut phlegm such as pear, turnips, radishes and seaweeds.
References
- Centre of Ageing Better. The State of Ageing 2022. Published March 2022. Accessed July 2022. https://ageing-better.org.uk/health-state-ageing-2022.
- Hu YX et al. Proangiogenesis Effects of Compound Danshen Dripping Pills in Zebrafish. BMC Complement Med Ther. 2022; 112. https://doi.org/10.1186/s12906-022-03589-y
- Flaws B. Statements of Fact in Traditional Chinese Medicine. 9th ed. Boulder: Blue Poppy Press; 2010.
- Maciocia G. Chinese Medicine Treatment Principles for Geriatrics. Accessed July 2022. https://giovanni-maciocia.com/geriatrics-in-chinese-medicine/
- Dharmananda S. Salvia and the History of Microcirculation Research in China. Published August 2001. Accessed July 2022. http://www.itmonline.org/arts/salvia.htm
- Maciocia G. Diagnosis in Chinese Medicine: a Comprehensive Guide. Edinburgh: Elsevier; 2004.
- Li C, Huang B, Zhang YW. Chinese Herbal Medicine for the Treatment of Depression: Effects on the Neuroendocrine-Immune Network. Pharmaceuticals (Basel). 2021;14(1):65. Published 2021 Jan 14. doi:10.3390/ph14010065
- Bokelmann J. Medicinal Herbs in Primary Care: An Evidence-Guided Reference for Healthcare Providers. Philadelphia: Elsevier; 2022.
- Powell M. Medicinal Mushrooms: A Clinical Guide. Eastbourne: Mycology Press; 2010.
- Shergis JL et al. Dang Shen [Codonopsis pilosula (Franch.) Nannf] Herbal Formulae for Chronic Obstructive Pulmonary Disease: a Systematic Review and Meta-analysis. Phytother Res. 2015 Feb;29(2):167-86. doi: 10.1002/ptr.5248.
- Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. 2nd ed. Washington: Eastland Press; 1993.
- Gao Y et al. Lycium Barbarum: A Traditional Chinese Herb and A Promising Anti-Aging Agent. Aging Dis. 2017;8(6):778-791. Published 1 Dec 2017. Accessed 1 June 2022. doi:10.14336/AD.2017.0725
- Dharmananda S. Degenerative Diseases: Interpretation and Treatment with Chinese Medicine. Published August 2005. Accessed July 2022. http://www.itmonline.org/arts/degenerative.htm
- Huang Z et al. Systematic Review and Meta-analysis: Tai Chi for Preventing Falls in Older Adults. BMJ Open 2017;7:e013661. doi: 10.1136/bmjopen-2016-013661
