Periodontal disease

Keywords: Chinese medicine, Chinese herbal medicine, acupuncture, stomatology, dentistry, periodontal disease

**********

This article is abstracted and condensed from The Treatment of Modern Western Medical Diseases with Chinese Medicine by myself and Philippe Sionneau and published by Blue Poppy Press. It is reprinted here by permission of the publisher.

[ILLUSTRATION OMITTED]

Periodontal disease refers to inflammation or degeneration of the tissues surrounding and supporting the teeth. It most commonly begins as gingivitis and progresses to periodontitis. While the greatest single cause of gingivitis is poor oral hygiene, because 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 lowered tissue resistance, such as hypovitaminosis, leukopenic disorders, allergic reactions, or endocrine disorders (e.g., diabetes mellitus). This condition is actually an autoimmune disease. The inflammation and tissue destruction that follows it is due to the immune system's attack on bacterial plaque. Therefore, it should come as no surprise that people with periodontal disease may have other systemic conditions. Other factors involved in the occurrence of this disease include malocclusion, breathing through the mouth, nutritional deficiencies, especially folic acid and vitamin B complex, calcium insufficiency (whether due to insufficient intake or stressor foods that rob it from the system), and a diet low in fiber, and hydrocholoric acid deficiency. Birth control pills tend to increase the body's requirements for folic acid, and, if this is not met, there may be an increased risk of gingivitis. In addition, smokers are 2-4 times more likely to suffer periodontal disease than nonsmokers.

The main symptoms of this condition are red, inflamed gum tissue surrounding the bases of the teeth, edematous swelling of the interdermal papillae, and bleeding on minimal injury, such as when brushing the teeth. Pain is usually absent. If gingivitis progresses to the point of periodontitis, there are deepening pockets between the gingivae and the teeth, enlarged calcium deposits, loss of attachment of the gums to the teeth, and loss of supporting bone. This may then lead to bone loss, and, in fact, periodontal disease is the leading cause of tooth loss in adults.

Within Western medicine, the diagnosis and treatment of this condition is mainly carried out by dentists. Its treatment relies mainly on daily brushing and flossing of the teeth combined with daily massage of the surrounding gum tissue. When this condition is associated with another systemic disease, treatment of that systemic disease is obviously necessary. However, only the gingivitis of diabetes and leukemia are usually given much consideration, and patients with less recognizable endrocrine dyscrasias, lowered immunity, and allergies usually are not treated systemically. If periodontal disease becomes severe, surgery may be necessary to remove the chronically inflamed tissue.

Chinese disease categorization: Periodontal disease is mainly categorized as ya xuan, gaping gums, ya lou, leaking gums, and ya nu, bleeding gums.

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

Disease mechanisms: If external wind heat toxins invade the body and enter the yang ming, heat may follow the channels upward to the mouth, thus causing redness, swelling, pain, ulcerations, and bleeding. However, it is also possible for habitual bodily yang exuberance and over-eating hot, spicy, oily, sweet, thick-flavored foods, and alcohol to engender heat internally within the stomach and intestines. This internally engendered heat may also follow the channels upward causing similar redness, pain, swelling, heat, and bleeding. Enduring heat may damage and consume yin or yin may simply be consumed by aging. In either case, vacuity heat may likewise flare upward to harass the upper orifices. In this case, there may be redness, swelling, pain, and bleeding, but all less severe though more enduring. If heat not only consumes yin but eats the qi, spleen vacuity may eventually reach the kidneys, thus giving rise to kidney yang vacuity. Spleen-kidney yang vacuity may also be due to the debility and decline of aging. Spleen vacuity may fail to contain the blood within its channels, while kidney vacuity may result in loose or falling teeth.

Treatment Based on Pattern Discrimination

1. Heat toxins flaming & exuberant pattern

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

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

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

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

Ingredients: Flos Lonicerae Japonicae (Jin Yin Hua), 15g, Flos Chrysanthemi Indici (Ye Ju Hua), Herba Taraxaci Mongolici Cum Radice (Pu Gong Ying), and Herba Violae Yedoensitis Cum Radice (Zi Hua Di Ding), 12g each, Radix Semiaquilegiae (Tian Kui Zi), Radix Scutellariae Baicalensis (Huang Qin), Radix Ledebouriellae Divaricatae (Fang Feng), and Fructus Forsythiae Suspensae (Lian Qiao), 9g each, and Herba Menthae Haplocalycis (Bo He), 3g.

Additions & subtractions: If there is fever or other signs of 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 Tou Wei (St 8). For occipital headache, add Feng Chi (GB 20). For severe gingival redness, swelling, heat, and pain, add Jia Che (St 6) and Xia Guan (St 7). If there is fever, add Guan Chong (TB 1) and Zhong Chong (Per 9).

2. Stomach & intestine fire & heat pattern

Main symptoms: Gingival redness, swelling, heat, and pain, bleeding gums, fresh red-colored blood, possible discharge of pus, bloody secretions, bad breath, oral dryness and thirst with a predilection for chilled drinks, reddish urine, constipation, a red tongue with scanty fluids and thick, yellow fur, and a surging, large or slippery, rapid pulse.

Note: This pattern is commonly seen in those with acute gingivitis 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, Radix Scutellariae Baicalensis (Huang Qin) and Cortex Radicis Moutan (Dan Pi), 9g each, Rhizoma Coptidis Chinensis (Huang Lian) and Rhizoma Cimicifugae (Sheng Ma), 6g each, and Radix Glycyrrhizae Uralensis (Gan Cao), 3g.

Additions & subtractions: If there is depressive heat in the liver and stomach but simultaneous spleen vacuity and dampness, replace Qing Wei San with Xiao Chai Hu Tang Jia Wei (Minor Bupleurum Decoction with Added Flavors): Radix Scutellariae Baicalensis (Huang Qin), 12g, Radix Bupleuri (Chai Hu), Rhizoma Cimicifugae (Sheng Ma), Radix Codonopsitis Pilosulae (Dang Shen), and Rhizoma Pinelliae Ternatae (Ban Xia), 9g each, mix-fried Radix Glycyrrhizae Uralensis (Gan Cao) and Rhizoma Coptidis Chinensis (Huang Lian), 6g each, Fructus Zizyphi Jujubae (Da Zao), and uncooked Rhizoma Zingiberis Officinalis (Sheng Jiang), 2 slices. For bleeding gums, add 12 grams of Rhizoma Imperatae Cylindricae (Bai Mao Gen). For a bitter taste in the mouth, add six grams of Fructus Gardeniae Jasminoidis (Zhi Zi). For dry mouth and oral thirst, add 12 grams of Tuber Ophiopogonis Japonici (Mai Men Dong). For simultaneous internal cold, replace Sheng Jiang with six grams of dry Rhizoma Zingiberis Officinalis (Gan Jiang).

Acupuncture & moxibustion: He Gu (LI 4), Qu Chi (LI 11), Nei Ting (St 44), Jia Che (St 6), Xia Guan (St 7).

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

3. Liver-kidney yin vacuity pattern

Main symptoms: Loose teeth, receding, atrophic gums, lost teeth, possible gum swelling with slight pain, low back and knee soreness and limpness, tinnitus, dizziness, vexatious heat in the five hearts, a red tongue with scanty fur or flowery peeling, and a 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 Rehmannia Pills with Added Flavors).

Ingredients: Cooked Radix Rehmanniae Glutinosae (Shu Di), 18g, Fructus Corni Officinalis (Shan Zhu Yu), 12g, Radix Dioscoreae Oppositae (Shan Yao), Sclerotium Poriae Cocos (Fu Ling), 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 Xu Duan and Gou Qi Zi and add nine grams each of Rhizoma Anemarrhenae 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 Zhi Shi (Bl 52). For sore throat, add Zhao Hai (Ki 6). For constipation, add Zhao Hai (Ki 6) and Zhi Gou (TB 6). For marked vacuity heat, add Fu Liu (Ki 7) and Yin Xi (Ht 6).

4. Mixed vacuity & repletion pattern

Main 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, abdominal distention after meals, hiccup, a red tongue with scanty fur, and a fine, rapid pulse.

Note: This pattern describes a combination of kidney vacuity and 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 ovarian dysfunction resulting in endometriosis, infertility, and menstrual irregularities 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, Tuber Ophiopogonis Japonici (Mai Men Dong), 12g, and Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), Cortex Phellodendri (Huang Bai), Radix Achyranthis Bidentatae (Niu Xi), and Herba Dendrobii (Shi Hu), 9g each.

Additions & subtractions: For severe loose teeth, add nine grams of Rhizoma Drynariae (Gu Sui Bu). For severe bleeding and spilling over of pus, add six grams of Rhizoma Coptidis Chinensis (Huang Lian) and 12 grams each of Herba Violae Yedoensitis Cum Radice (Zi Hua Di Ding) and Herba Taraxaci Mongolici Cum Radice (Pu Gong Ying). For bad breath, add nine grams each of Fructus Gardeniae Jasminoidis (Zhi Zi) and Herba Eupatorei Fortunii (Pei Lan). For dizziness, add nine grams each of Fructus Tribuli Terrestris (Bai Ji Li) and Rhizoma Gastrodiae Elatae (Tian Ma). For tinnitus, add nine grams of Rhizoma Acori Graminei (Shi Chang Pu). For low back pain, add 12 grams of Cortex Eucommiae Ulmoidis (Du Zhong). For clamoring stomach and abdominal distention after meals, add nine grams each of Rhizoma Acori Graminei (Shi Chang Pu), Radix Auklandiae Lappae (Mu Xiang), and Rhizoma Atractylodis Macrocephalae (Bai Zhu).

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

Additions & subtractions: For bad breath, add Da Ling (Per 7). For dizziness, add Feng Chi (GB 20) and Bai Hui (GV 20). For tinnitus, add Ting Hui (GB 2). For low back pain, add Gong Sun (Sp 4) and replace Zhao Hai with Fu Liu (Ki 7). For clamoring stomach and abdominal distention after meals, add Zu San Li (St 36) and Zhong Wan (CV 12). For marked vacuity heat 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 the blood pattern

Main symptoms: Bleeding gums on slight stimulation, blood possibly profuse in amount, bleeding worse when fatigued, pale gums, easy bruising, fatigue, lassitude of the spirit, lack of strength, shortness of breath, disinclination to speak, a weak voice, a somber white or sallow yellow facial complexion, heart palpitations, insomnia, a pale, fat tongue with teeth-marks on its edges, and a fine, weak pulse.

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

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

Ingredients: Radix Astragali Membranacei (Huang Qi), 18g, Radix Codonopsitis Pilosulae (Dang Shen), 15g, Semen Zizyphi Spinosae (Suan Zao Ren), 12g, Herba Agrimoniae Pilosae (Xian He Cao), Rhizoma Bletillae Striatae (Bai Ji), Cacumen Biotae Orientalis (Ce Bai Ye), Rhizoma Atracty lodis Macrocephalae (Bai Zhu), Radix Angelicae Sinensis (Dang Gui), Arillus Euphoriae Longanae (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, receding gums with less bleeding due to qi and blood dual vacuity, replace Gui Pi Tang Jia Jian with Ba Zhen Tang Jia Wei (Eight Pearls Decoction with Added Flavors): cooked Radix Rehmanniae Glutinosae (Shu Di), 12g, Radix Angelicae Sinensis (Dang Gui), Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Sclerotium Poriae Cocos (Fu Ling), Radix Achyranthis Bidentatae (Niu Xi), and Radix Drynariae (Gu Sui Bu), 9g each, and mix-fried Radix Glycyrrhizae Uralensis (Gan Cao) and Radix Ligustici Wallichii (Chuan Xiong), 6g each.

For painful, swollen gums and fissuring which occasionally discharges pus accompanied by qi and blood vacuity, replace Gui Pi 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 Angelicae Sinensis (Dang Gui), Radix Ligustici Wallichii (Chuan Xiong), and Spina Gleditschiae Chinensis (Zao Jiao Ci), 9g each, Radix Angelicae 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 (Sp 3), Zu San Li (St 36), Jia Che (St 6), Xia Guan (St 7).

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

6. Spleen-kidney yang vacuity pattern

Main symptoms: Receding gums, loose teeth, a thin secretion from cracks in the gums, somber white colored gums, no marked inflammation or hyperemia, listlessness of the essence spirit, scanty qi, lack of strength, chilled limbs, fear of cold, torpid intake, loose stools, a fat, pale tongue with teeth-marks on its edges and thin, white fur, and a deep, fine, weak pulse.

Treatment principles: Warm and supplement the spleen and kidneys.

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

Ingredients: Radix Astragali Membranacei (Huang Qi), 15g, cooked Radix Rehmanniae Glutinosae (Shu Di), 12g, Radix Dioscoreae Oppositae (Shan Yao), Fructus Corni Officinalis (Shan Zhu Yu), Sclerotium Poriae Cocos (Fu Ling), Radix Drynariae (Gu Sui Bu), Radix Achyranthis Bidentatae (Niu Xi), Ramulus Cinnamomi Cassiae (Gui Zhi), and Radix Codonopsitis Pilosulae (Dang Shen), 9g each, and Rhizoma Alismatis (Ze Xie), Cortex Radicis Moutan (Dan Pi), and mix-fried Radix Glycyrrhizae Uralensis (Gan Cao), 6g each.

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

Acupuncture & moxibustion: Yin Bai (Sp 1), Tai Bai (Sp 3), Guan Yuan (CV 4), Qi Hai (CV 6), Jia Che (St 6), Xia Guan (St 7).

Additions & subtractions: For severe spleen qi vacuity with scanty qi and lack of strength, add Zu San Li (St 36). For severe yang vacuity with chilled limbs and fear of cold, add Ming Men (GV 4). For torpid intake and loose stools, add Zhong Wan (CV 12) and Yin Ling Quan (Sp 9).

Remarks

1. While good oral and dental hygiene are vitally important to treat the proximal causes of periodontal disease, Chinese medical treatment seeks to treat the underlying imbalance. When dentists and oral hygienists are asked why some people are more prone to this condition than others, they simply say constitution or genes. In fact, up to 30% of the population may be genetically predisposed to this condition. However, Chinese medicine can discriminate the internal patterns causing this condition. By redressing those conditions, one not only treats the root of this condition but also helps improve one's total health and well-being. For instance, early internal treatment of gingivitis may help prevent diabetes. It is also our experience that many patients with gingivitis and pyorrhea have a history of allergies and/or intestinal dysbiosis. Allergies may lead to both immune insufficiency and autoimmune diseases, and this disease is actually 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 is depressive heat in the liver and stomach plus spleen qi vacuity failing to contain the blood.

3. Because middle-aged and older patients with periodontal disease often have other diseases, such as diabetes and hypertension, they also typically have other patterns or disease mechanisms as well which do not play a direct part in gingivitis or periodontitis but do play a part in the patient's total, interrelated pattern. In particular, we are thinking of blood stasis and phlegm dampness. When these disease mechanisms complicate any of the above patterns, they should be taken into account in the total treatment plan even though they may not directly result in the periodontal signs and symptoms.

abstracted & translated by Bob Flaws, LicAc, Dipl Ac & CH, FNAAOM

Copyright [c] Blue Poppy Press, 2005. All rights reserved.

c/o Blue Poppy Press * 5441 Western Ave. #2 * Boulder, Colorado 80301 USA

www.bluepoppy.com

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group