Chinese Medicine Updateabstracted & translated by Bob Flaws, LicAc, Dipt Ac & CH, FNAAOM

Copyright © Blue Poppy Press, 2005. All rights reserved.

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The Treatment of Periodontal Diseasewith Chinese Medicine

Keyworda: Chinese medicine, Chinese herbal medicine, acupuncture, stomatology, dentiatry, periodontal disease

This article is abstracted and condensed from The Treatmentof Modern Western Medical Diseases with Chinese Medicine bymyself and Philippe Sionneau and published by Blue PoppyPress. It is reprinted bere by permission of tbe publisher.

Periodontal disease refers to inflammation or degenerationof the tissues surrounding and supporting the teeth. It mostcommonly begins as gingivitis and progresses to periodontitis.While the greatest single cause of gingivitis is poor oral hygiene,hecause it is commonly noted at puberty and during pregnancy,it is also probably related to endocrine factors. Therefore,gingivitis may be the first sign of a systemic disorder with loweredtissue resistance, such as hypovitaminosis, leukopenic disorders,allergic reactions, or endocrine disorders (e.g., diabetes mellitus).This condition is actually an autoimmune disease. Theinflammation and tissue destruction that follows it is due to theimmune system's attack on bacterial plaque. Therefore, it shouldcome as no surprise that people witb periodontal disease mayhave other systemic conditions. Other factors involved in theoccurrence of this disease include malocclusion, breathingthrough the mouth, nutritional deficiencies, especially folic acidand vitamin B complex, calcium insufficiency (whether due toinsufficient intake or stressor foods that rob it from the system),and a diet low in fiber, and hydrocholoric acid deficiency. Birthcontrol pills tend to increase the body's requirements for folicacid, and, if this is not met, there may be an increased risk ofgingivitis. In addition, smokers are 2-4 times more likely to sufferperiodontal disease than nonsmokers.

The main symptoms of this condition are red, inflamed gumtissue surrounding the bases ofthe teeth, edematous swelling ofthe interdermal papillae, and bleeding on minimal injury, suchas when brushing the teetb. Pain is usuaUy absent. If gingivitisprogresses to the point of periodontitis, there are deepeningpockets between the gingivae and the teeth, enlarged calciumdeposits, loss of attachment ofthe gums to the teeth, and loss ofsupporting bone. This may then lead to bone loss, and, in fact,periodontal disease is the leading cause of tootb loss in adults.

Within Western medicine, the diagnosis and treatment of thiscondition is mainly carried out hy dentists. Its treatment reliesmainly on daily brushing and flossing ofthe teeth combined withdaily massage of the surrounding gum tissue. Wben thiscondition is associated witb another systemic disease, treatmentof that systemic disease is obviously necessary. However, onlytbe gingivitis of diabetes and leukemia are usually given muchconsideration, and patients with less recognizable endrocrinedyscrasias, lowered immunity, and allergies usually are nottreated systemically. If periodontal disease becomes severe,surgery may he necessary to remove the chronically inflamedtissue.

Chinese disease categorization: Periodontal disease ismainly categorized as ya xuan, gaping gums, ya lou, leakinggums, and ya nu, bleeding gums.

Disease causes: External contraction of wind heat toxins,habitual bodily yang exuberance, unregulated eating anddrinking, enduring disease, and bodily weakness due to aging.

Disease mechanisms: If external wind heat toxins invadethe body and enter the yang ming, heat may follow the channelsupward to the mouth, thus causing redness, swelling, pain,ulcerations, and bleeding. However, it is also possible for habitualhodily yang exuberance and over-eating hot, spicy, oily, sweet,thick-flavored foods, and alcohol to engender heat internallywithin the stomach and intestines. This internally engenderedheat may also follow the channels upward causing similarredness, pain, swelling, heat, and bleeding. Enduring heat maydamage and consume yin or yin may simply be consumed byaging. In either case, vacuity heat may likewise flare upward toharass the upper orifices. In this case, there may be redness,swelling, pain, and bleeding, but all less severe tbough moreenduring. If heat not only consumes yin but eats tbe qi, spleenvacuity may eventually reach the kidneys, thus giving rise tokidney yang vacuity. Spleen-kidney yang vacuity may also bedue to the debility and decline of aging. Spleen vacuity may failto contain the blood within its channels, wbile kidney vacuitymay result in loose or falling teeth.

Treatment Based on Pattern Discrimination1. Heat toxins flaming & exuberant pattern

Main symptoms: Commonly seen in those with habitualspleen-stomach accumulation heat who have been invaded bywind heat toxic evils as evidenced by gingival redness, swelling,heat, and pain, spillage of pus and blood, had breath, possiblefever and aversion to cold, oral thirst, a red tongue tip with dry,white fur, and a floating, rapid pulse.

Note: Tbis pattern corresponds to acute attacks of purulent,swollen gingivitis.

Treatment principles: Course wind and clear heat, resolvetoxins and disperse swelling.

Rx: Wu Wei Xiao Du Yin Jia Wei (Five Flavors Disperse "IbxinsDrink with Added Flavors).

Ingredients: Flos Lonicerae Japonicae (Jin Yin Hua), 15g,Flos Chrysanthemi Indici (Ye Ju Hua), Herba Taraxaci MongoliciCumRadice (Pu GongYing), and Herba ViolaeYedoensitis CumRadice (Zi Hua Di Ding),12g each. Radix Semiaquilegiae (TianKui Zi), Radix Scutellariae Baicalensis (Huang Qin), RadixLedebouriellae Divaricatae (Fang Feng), and Fructus ForsythiaeSuspensae (Lian Qiao), 9g each, and Herba Mentbae Haplocalycis(Bo He), 3g.

Additions & subtractions: If tbere is fever or other signsof heat are marked, add six grams of Rhizoma Coptidis Chinensis(Huang Lian).

Acupuncture & moxibustion: Jiao Sun (TB 20), Xiao Hai(SI 8), He Gu (LI 4), Wen Liu (LI 7).

Additions & subtractions: If the upper gums are affected,add Nei Ting (St 44). For frontal headache, add Tbu Wei (St 8).

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For occipital headache, add Feng Chi (GB 20). For severe gingivalredness, swelling, heat, and pain, add Jia Che (St 6) and XiaGuan (St 7). If there is fever, add Guan Chong (TB 1) and ZhongChong (Per 9).

2. Stomach & intestine flre & heat patternMain symptoms: Gingival redness, swelling, heat, and pain,

hleeding gums, fresh red-colored hiood, possihle discharge of pus,hloody secretions, bad breath, oral dryness and thirst with apredilection for chilled drinks, reddish urine, constipation, a redtongue with scanty fluids and thick, yellow fur, and a surging,large or slippery, rapid pulse.

Note: This pattern is commonly seen in those with acutegingivitis or recurrent gingival swelling and purulence.

Treatment principles: Clear the stomach and drain fire.Rx: Qing Wei San Jia Jian (Clear the Stomach Powder with

Additions & Subtractions).Ingredients: Uncooked Gypsum Fibrosum (Shi Gao), 24g,

uncooked Radix Rehmanniae Glutinosae (Sheng Di), 12g, RadixScuteilariae Baicalensis (Huang Qin) and Cortex Radicis Moutan(Dan Pi), 9g each, Rhizoma Coptidis Chinensis (Huang Lian)and Rhizoma Cimicifugae (Sheng Ma), 6g each, and RadixGlycyrrhizae Uralensis (Gan Cao), 3g.

Additions & suhtractions: If there is depressive heat inthe liver and stomach but simultaneous spleen vacuity anddampness, replace Qing Wei San with Xiao Chai Hu Tang JiaWei (Minor Bupleurum Decoction with Added Flavors): RadixScutellariae Baicalensis (Huang Qin), 12g, Radix Bupleuri (ChaiHu), Rhizoma Cimicifugae (Sheng Ma), Radix CodonopsitisPilosulae (Dang Shen), and Rhizoma Pinelliae Tfematae (BanXia), 9g each, mix-fried Radix Glycyrrhizae Uralensis (Gan Cao)and Rhizoma Coptidis Chinensis (Huang Lian), 6g each, FructusZizyphi Jujubae (Da Zao), and uncooked Rhizoma ZingiberisOfficinalis (Sheng Jiang), 2 slices. For bleeding gums, add 12grams of Rhizoma Imperatae Cylindricae (Bai Mao Gen). For abitter taste in the mouth, add six grams of Fructus GardeniaeJasminoidis (Zhi Zi). For dry mouth and oral thirst, add 12 gramsof Tuber Ophiopogonis Japonici (Mai Men Dong). Forsimultaneous internal cold, replace Sheng Jiang with six gramsof dry Rhizoma Zingiberis Officinalis (Gan Jiang).

Acupuncture & moxihustion: He Gu (LI 4), Qu Chi (LI11), Nei Ting (St 44), Jia Che (St 6), Xia Guan (St 7).

Additions & subtractions: For persistent bad breath, addDa Ling (Per 7) or Lao Gong (Per 8). For constipation, add ShangJu Xu (St 37) and Tian Shu (St 25). For a bitter taste in themouth, add Yang Ling Quan (GB 34).

3. Liver-kidney yin vacuity patternMain symptoms: Loose teeth, receding, atrophic gums, lost

teeth, possible gum swelling with slight pain, low hack and kneesoreness and limpness, tinnitus, dizziness, vexatious heat in thefive hearts, a red tongue with scanty fur or flowery peeling, anda fine, rapid or floating, rapid pulse.

Treatment principles: Nourish yin and engender essence,strengthen the bones and harden the teeth.

Rx: Liu Wei Di Huang Wan Jia Wei (Six Flavors RehmanniaPills with Added Flavors).

Ingredients: Cooked Radix Rehmanniae Glutinosae (ShuDi), 18g, Fructus Comi OfTicinaUs (Shan Zhu Yu), 12g, RadixDioscoreae Oppositae (Shan Yao), Sclerotium Poriae Cocos (FuLing), Rhizoma Drynariae (Gu Sui Bu), Radix Dipsaci (Xu Duan),Radix Achyranthis Bidentatae (Niu Xi), and Fructus Lycii

Chinensis (Gou Qi Zi), 9g each, and Rhizoma Alismatis (Ze Xie)and Cortex Radicis Moutan (Dan Pi), 6g each.

Additions & subtractions: For effulgent fire, delete XuDuan and Gou Qi Zi and add nine grams each of RhizomaAnemarrhenae Aspheloidis (Zhi Mu), Cortex Phellodendri(Huang Bai), and Cortex Radicis Lycii Chinensis (Di Gu Pi).

Acupuncture & moxibustion: San Yin Jiao (Sp 6), Tai Xi(Ki 3), Da Ying (St 5), Jia Che (St 6), Xia Guan (St 7).

Additions & subtractions: For seminal emission, add ZhiShi (Bl 52). For sore throat, add Zhao Hai (Ki 6). For constipation,add Zhao Hai (Ki 6) and Zhi Gou (TB 6). For marked vacuityheat, add Fu Liu (Ki 7) and Yin Xi (Ht 6).

4. Mixed vacuity & repletion patternMain symptoms: Loose teeth, gingival swelling and pain,

bleeding and spilling over of pus, bad breath, dizziness, tinnitus,low back pain, seminal emission, vexatious heat in the five hearts,a dry mouth with a liking to drink, clamoring stomach, abdominaldistention afler meals, hiccup, a red tongue with scanty fur, anda fine, rapid pulse.

Note: This pattern describes a combination of kidney vacuityand stomach heat. It is often seen in diabetic, hypertensives,and those suffering from tuberculosis and menstrual irregularity.Diabetes may itself be an autoimmune disease, and ovariandysfunction resulting in endometriosis, infertility, and menstrualirregularities may also be due to an autoimmune ovaritis.

Treatment principles: Nourish yin and clear heat.Rx: Yu Nu Jian Jia Wei (Jade Maiden Decoction with Added

Flavors).Ingredients: Uncooked Gypsum Fibrosum (Shi Gao) and

cooked Radix Rehmanniae Glutinosae (Shu Di), 18g each. TuberOphiopogonis Japonici (Mai Men Dong), 12g, and RhizomaAnemarrhenae Aspheloidis (Zhi Mu), Cortex Phellodendri(Huang Bai), Radix Achyranthis Bidentatae (Niu Xi), and HerbaDendrobii (Shi Hu), 9g each.

Additions & subtractions: For severe loose teeth, add ninegrams of Rhizoma Drynariae (Gu Sui Bu). For severe bleedingand spilling over of pus, add six grams of Rhizoma CoptidisChinensis (Huang Lian) and 12 grams each of Herba ViolaeYedoensitis Cum Radice (Zi Hua Di Ding) and Herba TaraxaciMongolici Cum Radice (Pu GongYing). For bad breath, add ninegrams each of Fructus Gardeniae Jasminoidis (Zhi Zi) and HerbaEupatorei Fortunii (Pei Lan). For dizziness, add nine grams eachof Fructus Tribuli Terrestris (Bai Ji Li) and Rhizoma GastrodiaeElatae (Tian Ma). For tinnitus, add nine grams of Rhizoma AcoriGraminei (Shi Chang Pu). For low back pain, add 12 grams ofCortex Eucommiae Ulmoidis (Du Zhong). For clamoring stomachand abdominal distention after meals, add nine grams each ofRhizoma Acori Graminei (Shi Chang Pu), Radix AuklandiaeLappae (Mu Xiang), and Rhizoma Atractylodis Macrocephalae(Bai Zhu).

Acupuncture & moxibustion: Zhao Hai (Ki 6), San YinJiao (Sp 6), He Gu (LI 4), Nei Ting (St 44), Jia Che (St 6), XiaGuan (St 7).

Additions & subtractions: For bad breath, add Da Ling(Per 7). For dizziness, add Feng Chi (GB 20) and Bai Hui (GV20). For tinnitus, add Ting Hui (GB 2). For low back pain, addGong Sun (Sp 4) and replace Zhao Hai with Fu Liu (Ki 7). Forclamoring stomach and abdominal distention after meals, addZu San Li (St 36) and Zhong Wan (CV 12). For marked vacuityheat with vexatious heat in the five hearts and night sweats,add Yin Xi (Ht 6) and Da Zhui (GV 14).

5. Spleen vacuity not containing tbe blood patternMain symptoms: Bleeding gums on shght stimulation, blood

possibly profuse in amount, bleeding worse when fatigued, palegums, easy bruising, fatigue, lassitude of the spirit, lack of

30 TOWNSEND LETTER for DOCTORS & PATIENTS - JUNE 2005

strength, shortness of breath, disinclination to speak, a weakvoice, a somber white or sallow yellow facial complexion, heartpalpitations, insomnia, a pale, fat tongue with teeth-marks onits edges, and a fine, weak pulse.

IVeatment principles: Fortify the spleen and boost the qi,contain the blood and stop bleeding.

Rx: Gui Pi Tang Jia Jian (Return the Spleen Decoction withAdditions & Subtractions).

Ingredients: RadixAstragaliMembranacei (Huang Qi), 18g,Radix Codonopsitis Pilosulae (Dang Shen), 15g, Semen ZizyphiSpinosae (Suan Zao Ren), 12g, Herba Agrimoniae Pilosae (XianHe Cao), Rhizoma Bletillae Striatae (Bai Ji), Cacumen BiotaeOrientalis (Ce Bai Ye), Rhizoma Atractylodis Macrocephalae (BaiZhu), Radix Angelicae Sinensis (Dang Gui), Arillus EuphoriaeLonganae (Long Yan Rou), and Sclerotium Poriae Cocos (Fu Ling),9g each, and Radix Auklandiae Lappae (Mu Xiang) and mix-fried Radix Glycyrrhizae Uralensis (Gan Cao), 6g each.

Additions & subtractions: For atrophic, pale, recedinggums with less bleeding due to qi and blood dual vacuity, replaceGui Pi Tang Jia Jian with Ba Zhen Tang Jia Wei (Eight PearlsDecoction with Added Flavors): cooked Radix RehmanniaeGlutinosae (Shu Di), 12g, Radix Angelicae Sinensis (Dang Gui),Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix CodonopsitisPilosulae (Dang Shen), Rhizoma Atractylodis Macrocephaiae (BaiZhu), Sclerotium Poriae Cocos (Fu Ling), Radix AchyranthisBidentatae (Niu Xi), and Radix Drynariae (Gu Sui Bu), 9g each,and mix-fried Radix Glycyrrhizae Uralensis (Gan Cao) and RadixLigustici Wallichii (Chuan Xiong), 6g each.

For painful, swollen gums and fissuring which occasionallydischarges pus accompanied by qi and blood vacuity, replace GuiPi Tang Jia Jian with Tuo Li Xiao Du San (Support the Interior& Disperse Toxins Powder): Radix Astragali Membranacei(Huang Qi), 15g, Radix Codonopsitis Pilosulae (Dang Shen),Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix AngelicaeSinensis (Dang Gui), Radix Ligustici Wallichii (Chuan Xiong),and Spina Gleditschiae Chinensis (Zao Jiao Ci), 9g each. RadixAngelicae Dahuricae (Bai Zhi), Squama Manitis Pentadactylis(Chuan Shan Jia), and mix-fried Radix Glycyrrhizae Uralensis(Gan Cao), 6g each, and Rhizoma Cimicifugae (Sheng Ma), 3g.

Acupuncture & moxibustion: Yin Bai (Sp 1), Tai Bai (Sp3), Zu San Li (St 36), Jia Che (St 6), Xia Guan (St 7).

Additions & subtractions: For concomitant blood vacuityadd San Yin Jiao (Sp 6) and Ge Shu (Bl 17). For lassitude ofthespirit, lack of strength, shortness of breath, disinclination tospeak, and a weak voice, add Pi Shu (Bl 20) and Wei Shu (Bl 21).For heart palpitations and insomnia, add Shen Men (Ht 7). Fordampness, add Yin Ling Quan (Sp 9).

6. Spleen-kidney yang vacuity patternMain symptoms: Receding gums, loose teeth, a thin secretion

from cracks in the gums, somber white colored gums, no markedinflammation or hyperemia, listlessness of the essence spirit,scanty qi, lack of strength, chilled limbs, fear of cold, torpidintake, loose stools, a fat, pale tongue with teeth-marks on itsedges and thin, white fur, and a deep, fine, weak pulse.

Treatment principles: Warm and supplement the spleenand kidneys.

Rx: Jin Gui Shen Qi Wan Jia Wei (Golden Cabinet Kidney QiPills with Added Flavors).

Ingredients: RadixAstragaliMembranacei (Huang Qi), 15g,cooked Radix Rehmanniae Glutinosae (Shu Di), 12g, RadixDioscoreae Oppositae (Shan Yao), Fructus Comi Officinalis (ShanZhu Yu), Sclerotium Poriae Cocos (Fu Ling), Radix Drynariae(Gu Sui Bu), Radix Achyranthis Bidentatae (Niu Xi), RamulusCinnamomi Cassiae (Gui Zhi), and Radix Codonopsitis Pilosulae(Dang Shen), 9g each, and Rhizoma Alismatis (Ze Xie), Cortex

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Radicis Moutan (Dan Pi), and mix-fried Radix GlycyrrhizaeUralensis (Gan Cao), 6g each.

Additions & subtractions: For severe spleen qi vacuity,with scanty qi and lack of strength, add 12 grams of RadixCodonopsitis Pilosulae (Dang Shen). For severe yang vacuity withchilled limbs and fear of cold, add three grams of Herba AsariCum Radice (Xi Xin). For torpid intake and loose stools, add ninegrams each of Rhizoma Acori Graminei (Shi Chang Pu) andRhizoma Atractylodis Macrocephalae (Bai Zhu).

Acupuncture & moxibustion: Yin Bai (Sp 1), Tai Bai (Sp3), Guan Yuan (CV 4), Qi Hai (CV 6), Jia Che (St 6), Xia Guan(St7).

Additions & subtractions: For severe spleen qi vacuity withscanty qi and lack of strength, add Zu San Li (St 36). For severeyang vacuity with chilled limbs and fear of cold, add Ming Men(GV 4). For torpid intake and loose stools, add Zhong Wan (CV12) and Yin Ling Quan (Sp 9).

Remarks1. While good oral and dental hygiene are vitally important

to treat the proximal causes of periodontal disease, Chinesemedical treatment seeks to treat the underlying imbalance. Whendentists and oral hygienists are asked why some people are moreprone to this condition than others, they simply say constitutionor genes. In fact, up to 30̂ ^ ofthe population may be geneticallypredisposed to this condition. However, Chinese medicine candiscriminate the internal patterns causing this condition. Byredressing those conditions, one not only treats the root of thiscondition but also helps improve one's total health and well-being.For instance, early internal treatment of gingivitis may helpprevent diabetes. It is also our experience that many patientswith gingivitis and pyorrhea have a history of allergies and/orintestinal dysbiosis. Allergies may lead to both immuneinsufficiency and autoimmune diseases, and this disease isactually a form of autoimmune disease.

2. It is very common to see periodontal disease due to a liver-spleen disharmony plus depressive heat. In that case, there isdepressive heat in the liver and stomach plus spleen qi vacuityfailing to contain the blood.

3. Because middle-aged and older patients with periodontaldisease often have other diseases, such as diabetes andhypertension, they also typically have other patterns or diseasemechanisms as well which do not play a direct part in gingivitisor periodontitis but do play a part in the patient's total,interrelated pattern. In particular, we are thinking of blood stasisand phlegmdampness. Whenthese diseasem e c h a n i s m scomplicate any ofthe abovepatterns, theyshould be takeninto account inthe total treat-ment plan eventhough they maynot directlyresult in theperiodontal signsand symptoms.

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