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Notoginseng 9


CLINICAL APPLICATIONS

* Bleeding

* Internal bleeding (upper gastrointestinal bleeding, stomach bleeding, duodenal bleeding, hemoptysis, hematuria, epistaxis, and excessive or irregular menstrual bleeding)

* External bleeding (from external and traumatic injuries)

 

WESTERN THERAPEUTIC ACTIONS

* Hemostatic effect to stop bleeding

* Facilitates and accelerates wound healing

 

CHINESE THERAPEUTIC ACTIONS

* Cools the blood

* Disperses blood stasis

* Stops bleeding

 

DOSAGE

Take 6 to 8 capsules to stop bleeding. If necessary, the herbs may be repeated three to four times daily until the bleeding stops.

 

INGREDIENTS


Ai Ye (Folium Artemisiae Argyi), charred

Ce Bai Ye (Cacumen Platycladi), charred

Di Yu (Radix Sanguisorbae), charred

He Zi (Fructus Chebulae)

Jing Jie (Herba Schizonepetae), charred

Qian Cao (Radix et Rhizoma Rubiae)

San Qi (Radix et Rhizoma Notoginseng)

Wu Bei Zi (Galla Chinensis)

Xian He Cao (Herba Agrimoniae)


 

BACKGROUND

Bleeding may be caused by external injuries or internal factors. Bleeding from external injuries are simple to diagnose and straight-forward to treat. Bleeding from internal factors, on the other hand, are much more complex and may involve disorders from various organs and systems. Though the body has its own mechanism to stop bleeding, mechanical or medicinal intervention may be required if the bleeding is profuse, prolonged or uncontrolled.

 

FORMULA EXPLANATION

Notoginseng 9 is designed specifically to symptomatically stop bleeding. It contains herbs to cool the blood, disperse blood stasis, and stop bleeding in the upper, middle and lower jiaos.

        San Qi (Radix et Rhizoma Notoginseng) is one of the most important herbs to stop bleeding. It has the dual function to activate blood circulation and stop bleeding, therefore preventing the risk of blood stasis. Charred Ce Bai Ye (Cacumen Platycladi) cools the blood and stops respiratory bleeding. Qian Cao (Radix et Rhizoma Rubiae) moves blood and stops irregular and excessive menstrual bleeding. Charred Di Yu (Radix Sanguisorbae) clears heat and cools the blood to stop bleeding in the gastrointestinal tract. Charred Ai Ye (Folium Artemisiae Argyi) warms the channels and collaterals, relieves pain and treats a variety of bleeding disorders. Xian He Cao (Herba Agrimoniae) has a good restraining function and is commonly used to treat various bleeding disorders. Charred Jing Jie (Herba Schizonepetae) also has an excellent hemostatic effect. Wu Bei Zi (Galla Chinensis) and He Zi (Fructus Chebulae) are astringent herbs to help stabilize and consolidate the effect.

        In summary, Notoginseng 9 is an excellent formula to stop bleeding due to various causes in the upper, middle and lower jiaos.

 

CAUTIONS & CONTRAINDICATIONS

* Patients with profuse bleeding from serious injuries (such as acute trauma or accidents) should be sent to the emergency room immediately.

* This formula is used primarily to stop the “symptom,” not the “cause,” of bleeding. Once bleeding stops, proper measures should be taken to identify and treat the cause of bleeding. This formula should not to be taken long-term. See Supplementary Formulas section for appropriate formulas to use once the cause is determined.

* This formula should not be used in patients who are on anticoagulant or antiplatelet drugs, such as Coumadin (warfarin) and Plavix (clopidogrel), as it may counter the effectiveness of these drugs.

* Some drugs cause bleeding and prolong bleeding, and should be avoided. These drugs include aspirin and non-steroidal anti-inflammatory drugs, such as Motrin (ibuprofen) and Naprosyn (naproxen).

 

SUPPLEMENTARY FORMULAS

* For gastric or duodenal ulcer bleeding, combine with GI Care.

* For colitis or intestinal bleeding with burning diarrhea, combine with GI Care II.

* For bleeding from Crohn’s disease or irritable bowel syndrome (IBS), combine with GI Harmony.

* For bleeding due to ulcerative colitis, add GI Care (UC).

* For external bleeding from injuries and trauma, stop the bleeding first and then use Flex (TMX).

* For cough with blood-streaked sputum, add Respitrol (CF).

* For hemorrhoids, add GI Care (HMR).

* For urinary tract infection, cystitis or abnormal uterine bleeding due to heat, add V-Support.

* For menstrual pain, add Mense-Ease.

* For uterine fibroids or cysts, add Resolve (Lower).

* For bleeding with high fever and excess heat, add Gardenia Complex.

* For blood stagnation, add Circulation (SJ).

* For dryness and thirst, add Nourish (Fluids).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Blood in the urine: Zhongji (CV 3), Xingjian (LR 2), Pangguangshu (BL 28), Yinlingquan (SP 9), Sanyinjiao (SP 6), Xuehai (SP 10), Shenshu (BL 23), Daling (PC 7), Shenmen (HT 7)

* Cough with blood: Xingjian (LR 2), Yuji (LU 10), Laogong (PC 8), Feishu (BL 13), Quze (PC 3), Kongzui (LU 6), Rangu (KI 2), Taixi (KI 3)

* Nosebleed: Shangxing (GV 23), Hegu (LI 4), Shaoshang (LU 11), Fengfu (GV 16), Tianfu (LU 3)

* Vomiting of blood: Shangxing (GV 23), Erjian, Zhongwan (CV 12), Yinbai (SP 1)

* Blood in the stool: Dachangshu (BL 25), Changqiang (GV 1), Pishu (BL 20), Xiajuxu (ST 39), Chengshan (BL 57)

* Bleeding from Spleen deficiency: Needle and moxa Zhongwan (CV 12), Zusanli (ST 36), Shenshu (BL 23), Yinbai (SP 1), Guanyuan (CV 4), and Taibai (SP 3).

 

Classic Master Tung's Points:

* Bleeding (during ovulation): Yunbai (T 44.11), Fuke (T 11.24). Needle everyday except the week of and the week before menstruation.

* Bleeding from trauma: Liuwan (T 66.08)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Bleeding: Liuwan (T 66.08), Huagusi (T 55.05)

 

Balance Method by Dr. Richard Tan:

* Left side: Hegu (LI 4), Yinlingquan (SP 9)

* Right side: Shaofu (HT 8), Laogong (PC 8), Zusanli (ST 36)

* Alternate sides between treatments.

 

Ear Acupuncture:

* Needle the area or organ area corresponding to bleeding, in addition to Adrenal and Subcortex.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Stop bleeding: Pituitary, Diaphragm, Adrenal Gland, Spleen, corresponding point where there is bleeding

* Epistaxis: Internal Nose, Diaphragm, Spleen, Pituitary, Lung, Adrenal Gland

 

NUTRITION

* Consume an adequate amount of calcium and magnesium, which are important for blood clotting.

* Consume an adequate amount of multivitamin, especially vitamin K, as they are essential for blood clotting. Foods rich in vitamin K include alfalfa, broccoli, cauliflower, egg yolks, kale, spinach, and all green leafy vegetables.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Nosebleed and hypertension: Drink lotus root juice daily.

* Vomiting or defecating blood: Cook 1/2 cup of lotus root starch with 1/2 cup rice porridge until jelly-like consistency and consume while lukewarm.

* Blood in the urine: Make tea of lotus root and bamboo leaves.

* Bloody stools: Juice fresh water chestnuts and mix with equal amount of rice wine and drink three times a day on an empty stomach. Results should be seen within three days.

* Excess uterine bleeding: Charcoal the water chestnuts, powder them and take with rice wine.

* Abnormal bleeding, anemia: Boil tea from black fungus and Chinese dates.

 

LIFESTYLE INSTRUCTIONS

* Avoid drinking alcohol, as it irritates the stomach and may cause ulcer and bleeding.

* Patients should find out the cause of bleeding and avoid it accordingly.

 

CASE STUDIES

* K.J., a 33-year-old-female, presented with excess menstrual flow for two days, consisting of red and slightly purple in color. Pain was also present upon palpation of the abdomen. The TCM diagnosis was blood heat, slight blood stagnation, and uterine hemorrhaging. Notoginseng 9 was prescribed at four pills three times a day. The very next day the bleeding had stopped. The patient was able to compete the following night in her sport activity after her recovery from the help of what she described as an amazing herbal formula. Submitted by A.I., Hilo, Hawaii.

* L.B., a 45-year-old female, presented with excessive blood flow from menstruation, not in quantity but duration. The symptoms had been present for six months, bleeding very lightly but constantly. Doctors did not know what to do. The Western diagnosis was metrorrhagia, and the TCM diagnosis was blood heat. After the patient took Notoginseng 9 for 1.5 weeks, the excessive flow completely resolved. She is now a firm believer of Chinese medicine. Since then it has not happened again. Submitted by A.I., Hilo, Hawaii.

* P.I., a 46-year-old female, presented with spotting and uterine bleeding between menstrual cycles, which were irregular short cycles ranging from 15 to 27 days long. She had been experiencing heavy bleeding, no clots during her cycles, night sweats, and chronic anxiety, which was worse before her menses. Her Western diagnosis was perimenopausal syndrome with chronic anxiety; and the TCM diagnosis was Liver and Kidney yin deficiencies with deficiency heat, blood stagnation, Liver qi stagnation, and shen (spirit) disturbance. The practitioner prescribed Calm (ES), two grams three times a day and has been taking this formula for anxiety the past two years. In addition, she was also prescribed Nourish and Notoginseng 9, same dosage as the other formula, for six months to stop the uterine bleeding. Notoginseng 9 successfully stopped the irregular bleeding and night sweats, which had been gradually reduced over the six month period. Her periods have returned to normal with light flow and her anxiety is also much better ever since adding Nourish. The patient had excellent wellness and lifestyle habits, including her diet and exercise, and she was very compliant with taking her herbs. Submitted by E.Z., Portland, Oregon.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Notoginseng 9 is one of the most effective formulas to stop bleeding, as it contains many herbs with a fast onset of hemostatic effect. This formula has been used to treat various types of bleeding disorders, including internal and external bleeding.

        San Qi (Radix et Rhizoma Notoginseng) is one of the most useful and unique herbs to stop bleeding, as it has an excellent effect to stop bleeding with minimal effect of creating blood clots. Pharmacologically, it has shown a marked hemostatic effect to decrease prothrombin time and stop bleeding.[1] Furthermore, the saponins of San Qi (Radix et Rhizoma Notoginseng) have been shown to have mild antiplatelet and anticoagulant effects, thereby minimizing the risks of clotting disorder.[2],[3] Clinically, San Qi (Radix et Rhizoma Notoginseng) has been used to treat various bleeding disorders, including but not limited to, upper gastrointestinal bleeding,[4] stomach bleeding,[5] hemoptysis due to bronchiectasis, pulmonary tuberculosis or pulmonary abscess,[6] and hematuria.[7] In fact, one study reported satisfactory results for treatment of acute perforated stomach ulcer and bleeding using 6 grams of powdered San Qi (Radix et Rhizoma Notoginseng) and 20 grams of powdered Bai Ji (Rhizoma Bletillae) with acupuncture on Tianzhu (BL 10), Zhongwan (CV 12), and Zusanli (ST 36).[8]

        In addition to San Qi (Radix et Rhizoma Notoginseng), Xian He Cao (Herba Agrimoniae) has also demonstrated a remarkable hemostatic effect, with its mechanism of action attributed to an increase in platelets and a reduction in bleeding time.[9] Clinical research has confirmed its effect to treat hemoptysis (coughing of blood), upper gastrointestinal bleeding and menstrual bleeding.[10],[11],[12] Di Yu (Radix Sanguisorbae) also has a good hemostatic effect, and has been shown in animal studies to reduce bleeding time by 31.9 to 45.5%.[13] In humans, Di Yu (Radix Sanguisorbae) is most effective for hemoptysis (coughing of blood),[14] hematochezia (blood in the stools),[15] upper gastrointestinal bleeding, and profuse menstrual bleeding.[16],[17] Ce Bai Ye (Cacumen Platycladi) has demonstrated marked influence to shorten bleeding time,[18] and has been used effectively to treat bleeding ulcers in 100 patients and bleeding hemorrhoids in 8 patients.[19],[20] Administration of Qian Cao (Radix et Rhizoma Rubiae) shows marked effectiveness in reducing bleeding time.[21] According to one study, it effectively stops profuse bleeding after tooth extraction in 41 patients within one to two minutes.[22] Lastly, Jing Jie (Herba Schizonepetae) and Ai Ye (Folium Artemisiae Argyi), in either fresh or charred form, have demonstrated a marked hemostatic effect to stop bleeding.[23],[24]

        While the main priority to treat bleeding disorders is to stop bleeding, it is also important to facilitate wound healing and promote recovery. He Zi (Fructus Chebulae) is a unique herb that has been shown to accelerate dermal wound healing, as indicated by improved rates of contraction and a decreased period of epithelialization. From a biochemical perspective, use of He Zi (Fructus Chebulae) is associated with a significant increase in total protein, DNA, and collagen contents in the granulation tissues of treated wounds.[25]

        In summary, Notoginseng 9 is an excellent formula to treat bleeding disorders as it contains herbs with remarkable hemostatic effects to stop bleeding without creating blood stasis, as well as an herb to facilitate wound healing and promote recovery. It may be used to treat all types of bleeding, including but not limited to upper gastrointestinal bleeding, stomach bleeding, duodenal bleeding, hemoptysis, hematuria, menstrual bleeding, and bleeding due to various external and traumatic injuries.

 

COMPARATIVE ANALYSIS

Bleeding is a very common condition that may be caused by external or internal injuries. Because of the wide variety of etiologies, each condition is managed differently. For example, according to Western medicine, treatments are different for uterine bleeding, gastrointestinal bleeding, bleeding from trauma, and bleeding from overdose of Coumadin (warfarin).

        TCM identifies the causes of bleeding and treat them differently. However, in addition to specific treatments (which requires time to diagnose and prepare treatment), general treatment is also available to immediately stop bleeding. Notoginseng 9 is a formula that is designed to symptomatically stop bleeding. Once bleeding stops, it is then necessary to identify the cause and treat accordingly.

 



[1] Zhong Cao Yao (Chinese Herbal Medicine), 1986; 17(6):34.

[2] Xian Dai Zhong Yao Yao Li Xue (Contemporary Pharmacology of Chinese Herbs), 1997; 282-283, 1997; 807:824.

[3] Lau AJ, Toh DF, Chua TK, Pang YK, Woo SO, Koh HL. Antiplatelet and anticoagulant effects of Panax notoginseng: comparison of raw and steamed Panax notoginseng with Panax ginseng and Panax quinquefolium. Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore 117543, Singapore. J Ethnopharmacol. 2009 Sep 25;125(3):380-6.

[4] Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1983; 9:15.

[5] Yun Nan Zhong Yi Za Zhi (Yunan Journal of Chinese Medicine), 1985; 1:28.

[6] Zhong Yi Za Zhi (Journal of Chinese Medicine), 1965; 11:29.

[7] Ha Yi Da Xue Bao (Journal of Ha Medical University), 1974; 7(2):51.

[8] Zhong Yi Za Zhi (Journal of Chinese Medicine), 1994; (3):135.

[9] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983:323.

[10] Si Chuan Zhong Yi (Sichuan Chinese Medicine), 1995; (8):33.

[11] Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1979; 4:28.

[12] Shan Xi Zhong Yi (Shanxi Chinese Medicine), 1985; 6(7):323.

[13] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983; 406.

[14] Zhong Yao Lin Chuan Xin Yong (New Clinical Applications of Chinese Medicine), 2001; 247.

[15] Zhong Yao Lin Chuan Xin Yong (New Clinical Applications of Chinese Medicine), 2001; 247.

[16] Zhe Jiang Zhong Yi Xue Yuan Xue Bao (Journal of Zhejiang University of Chinese Medicine), 1985; 9(4):26.

[17] Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), 1965; 8(3):4.

[18] Zhong Yi Yao Yan Jiu Zi Liao (Research and Resource of Chinese Medicine and Herbology), 1965; (3):48.

[19] Zhong Hua Nei Ke Xue Za Zhi (Journal of Chinese Internal Medicine), 1960; 8(3):249.

[20] Zhong Guo Gang Chang Bing Za Zhi (Chinese Journal of Proctology), 1985; 4:5.

[21] Zhong Yi Yao Yan Jiu (Research of Chinese Medicine and Herbology), 1991; (3):54.

[22] Yi Xue Wei Sheng Tong Xun (Journal of Medicine and Sanitation), 1974; 1:54.

[23] Zhong Yao Cai (Study of Chinese Herbal Material), 1989; 12(6):37.

[24] Zhong Yao Cai (Study of Chinese Herbal Material), 1992; 15(2):22.

[25] Suguna L, Singh S, Sivakumar P, Sampath P, Chandrakasan G. Influence of Terminalia chebula on dermal wound healing in rats. Department of Biochemistry, Central Leather Research Institute, Adyar, Chennai, India. Phytother Res. 2002 May;16(3):227-31.