61813131 Chapter 17 Internal Diseases
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Chapter 17 INTERNAL DISEASES (CAM) I) Exogenous Pathogenic Factors CONDITION: Signs & Symptoms WIND STROKE falling down in a fit with loss of consciousness, or hemiplegia, slurred speech and deviated mouth. Abrupt onset with pathological changes varying quickly like the wind, hence "wind stroke" Etiology & Pathogenesis Qi and Blood Deficiency Deficiency in lower part of body and excess in the upper part KI Yin due to sexual indulgence Irregular food and drink intake impairing SP T/T fxn leading to phlegm Other factors: Exasperation, agitation, alcohol indulgence, overeating, stress, invasion of wind all leading to upsurge of LV Yang and HT Fire, which makes Qi and Blood go upward together with turbid phlegm, disturbing the mind and resulting in this disease. Mild Cases: Only meridians and collaterals are affected Severe Cases: Zang-Fu organs and meridians and collaterals are affected Differentiation: a) Attack on Zang-Fu Organs: 1) Tense Syndrome: falling down in a fit with loss of consciousness, tightly closed hands and clenched jaws, flushed face, coarse breathing, rattling in the throat, retention of urine, constipation Tongue: Red with thick yellow or dark grey coating Pulse: String-taught, rolling and forceful pulse Analysis: Wind stirred up by upsurge of LV Yang sends Qi and Blood upwards, which together with the accumulated phlegm fire disturb the mind Treatment: Rx: DU20, DU26, ST40, LV3, KI1, 12 jing-well of both hands: LU11, HT9, PC9, LI1, TE1, SI1 Du20 and DU26: Regulate Qi of Du channel and effect resuscitation KI1: Conducts heat downward LV3: Subdues LV Qi &Yang Rising 12 Jing-Well pts: Dispel heat and regain consciousness ST40: Resolve Phlegm Supplementary Pts: Clenched Jaw: ST6 and ST7 Stiff Tongue: Du15, Ren23, HT5 2) Flacid Syndrome: falling down in a fit with loss of consciousness with mouth agape and eyes closed, snoring but feeble breathing, flacid paralysis of limbs, incontinence of urine Tongue: Flacid Pulse: Thready, weak Severe Cases: cold limbs, or flushed face as rouged, fading or floating pulse Analysis: Severe weakness of primary Qi, separation of Yin and Yang and exhaustion of Qi in the Zang organs. Tongue and pulse suggest Blood deficiency and prostration of KI Yang Treatment: Apply Moxa to points on Ren Channel to restore Yang collapse. Rx: Ren 8, Ren 6 (direct Moxa w/salt), Ren 4 (strengthens Primary Qi) (All above mentioned points are primary pts for collapse)
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Transcript of 61813131 Chapter 17 Internal Diseases
Chapter 17 INTERNAL DISEASES (CAM)I) Exogenous Pathogenic Factors
CONDITION: Signs & Symptoms
WIND STROKE falling down in a fit with loss of consciousness, or hemiplegia, slurred speech and deviated mouth. Abrupt onset with pathological changes varying quickly like the wind, hence "wind stroke"
Etiology & Pathogenesis Qi and Blood DeficiencyDeficiency in lower part of body and excess in the upper part KI Yin due to sexual indulgenceIrregular food and drink intake impairing SP T/T fxn leading to phlegm
Other factors:Exasperation, agitation, alcohol indulgence, overeating, stress, invasion of wind all leading to upsurge of LV Yang and HT Fire, which makes Qi and Blood go upward together with turbid phlegm, disturbing the mind and resulting in this disease.
Mild Cases: Only meridians and collaterals are affectedSevere Cases: Zang-Fu organs and meridians and collaterals are affected
Differentiation:
a) Attack on Zang-Fu Organs:
1) Tense Syndrome: falling down in a fit with loss of consciousness, tightly closed hands and clenched jaws, flushed face, coarse breathing, rattling in the throat, retention of urine, constipationTongue: Red with thick yellow or dark grey coatingPulse: String-taught, rolling and forceful pulse
Analysis: Wind stirred up by upsurge of LV Yang sends Qi and Blood upwards, which together with the accumulated phlegm fire disturb the mind
Treatment: Rx: DU20, DU26, ST40, LV3, KI1, 12 jing-well of both hands: LU11, HT9, PC9, LI1, TE1, SI1Du20 and DU26: Regulate Qi of Du channel and effect resuscitationKI1: Conducts heat downwardLV3: Subdues LV Qi &Yang Rising12 Jing-Well pts: Dispel heat and regain consciousnessST40: Resolve Phlegm
Supplementary Pts:Clenched Jaw: ST6 and ST7Stiff Tongue: Du15, Ren23, HT5
2) Flacid Syndrome: falling down in a fit with loss of consciousness with mouth agape and eyes closed, snoring but feeble breathing, flacid paralysis of limbs, incontinence of urineTongue: FlacidPulse: Thready, weakSevere Cases: cold limbs, or flushed face as rouged, fading or floating pulse
Analysis: Severe weakness of primary Qi, separation of Yin and Yang and exhaustion of Qi in the Zang organs. Tongue and pulse suggest Blood deficiency and prostration of KI Yang
Treatment: Apply Moxa to points on Ren Channel to restore Yang collapse.Rx: Ren 8, Ren 6 (direct Moxa w/salt), Ren 4 (strengthens Primary Qi) (All above mentioned points are primary pts for collapse)
b) Attack on Meridians and Collaterals
Meridians and Collaterals/Qi and Blood Stag in Meridians
and Collaterals
Hemiplegia, numbness of the limbs, deviated mouth, slurring speech, accompanied by headache, dizziness, vertigo, twitching of muscles, red eyes and flushed face, thirst, dryness of throat, irritabilityPulse: string-taught and rolling pulse
Analysis:
Wind phlegm enters the meridians and collaterals due to imbalance of yin and yang, or after treatment the fxns of the affected zang-fu organs have been restored, but Wind phlegm still blocks the meridians and collaterals, causing retarded circulation of Qi and Blood. Hence hemiplegia, numbness of the limbs, deviated mouth, slurring speechIf complicated with upsurging LV Yang and upward disturbance of Wind Yang, the symptoms are headache, dizziness, vertigo and twitching of muscles.
Treatment: Points along Du and Yang meridians of the affected side are used to regulateQi and Blood, remove obstruction from meridians and collaterals and dispel wind.Du channel is the Sea of all Yang channelsRx: Du20, UB7, DU16DU20, DU16 combined with UB7 can eliminate wind and remove obstructionsSince the yang meridians dominate the exterior of the body and Qi, points of the Yang meridians are selected to regulate Qi and Blood of the body and promote smooth circulation in the upper and lower portions of the body.
Upper disturbance of LV wind: GB20 & LV3 reduce wind (upper disturbance of LV wind) and pacify the LVKI3 nourishes Yin to reduce the fireSP6 nourishes Yin and pacifies YangFor excessive HT/LV Fire:PC7 & LV2 (reduce) eliminate FireKI3 nourishes Yin to reduce the fire
Deviated Mouth: ST4 & ST6 promote free circulation of Qi in the meridians around the face.
Remarks: a) Wind stroke is referred to as Cerebral Hemorrhage, Thrombosis, Embolism, Subarachnoid hemorrhage, etc. After acute stage there may be sequelae such as hemiplegia, monoplegia, aphasia.
b) Prophylactic measures of Wind Stroke:The old aged w/Qi def and excessive phlegm, or w/manifestations of LV YangRising marked by dizziness and palpitations, may have premonitory symptomssuch as stiff tongue, slurred speech and numbnes of the finger tips.Pay attention to diet, lifestyle and avoid overstraining.Frequent moxa on ST36 and GB39 may prevent an attack of Wind Stroke.
SYNCOPEsudden fainting, pallor, cold limbs and loss of consciousness, which are often resulted from emotional excitement, fright, or debilitation and overstraining.
Etiology & Pathogenesis a) Deficiency: caused by general deficiency of Yuan Qi (primary) and failure to clear Yanf in ascending due to over strain or grief and fright, or by exhaustion of Qi after profuse bleeding.
b) Excess: mainly due to emotional disturbances, such as angerm fear and fright, leading to deranged flow of Qi, which rushes upward to the Heart and Chest, blocking the windpipe and disturbing the mind, or due to rising LV Yang, and upward flow of Qi followed by perversion of blood flow after a fit of anger, leading to disturbance of the mind and resulting in loss of consciousness
Differentiation:
a) Deficiency Type: feeble breathing with mouth agape, spontaneous sweating, pallor, cold limbsPulse: deep and thready
Analysis: Deficiency of Yuan Qi (primary): dizziness, vertigo, loss of consciousness, SOBcomplicated with sinking of SP/ST Qi and failure to clear Yang in ascending.Weak Yuan Qi and disabled Vital Qi: spontaneous sweating (unable to controlthe prores and mouth agape
Treatment: Rx: DU26, DU20, PC6, Ren6, ST36DU26, DU20, PC6 are points for resuscitationRen6 &ST36 are good for reinforcing Qi and invigorating Yang
b) Excess Type: coarse breathing, rigid limbs, clenched jawsPulse: deep and excess-type
Analysis: Perversion of Qi after a fit of anger impairs Qi flow and blood and qi rush upwardto disrurb the mind, resulting in sudden collapse, loss of consciousness, clenched jaws and rigid limbs. Coarse breathing is due to obstruction of LU Qi.
Treatment: Reducing is applied to points of the DU channel and PC to promote resuscitationand regulate flow of Qi.Rx: DU26, LI4, PC9, PC8, LV3, KI1DU26, PC9 promote resuscitationLI4 & LV3 (four gates) regulate Qi and Blood flowPC8 & KI1 promote smooth flow of Qi and clear the mind
SUN STROKEacute case occuring in summer, high fever, irritability, nausea or even collapse and loss of consciousness. Mostly due to prolonged expose to sun or high temp
Etiology & Pathogenesis Summer heat damages Yaun Qi and consumes body fluids, leading to exhaustion of Qi and Yin. It may also penetrate the PC and disturb the mind and impair consciousness.
Differentiation:
a) Mild Type:headache, dizziness, profuse sweating, hot skin, coarse breathing, dry mouth and tongue, dire thirst.Pulse: superficial, large and rapid (indicative of Summer-heat)
Analysis:pathogenic summer heat tends to rise and attack head and give rise to headache and dizziness. Profuse sweating, coarse breathing, dry mouth and tongue, dire thirst are all due to evaporation of body fluids.
Treatment: Rx: DU14, PC6, LI11, UB40Reducing is applied to Du, PC, LI points to eliminate Summer-heatDU14 (mtg pt of DU and all yang chnls prom. qi flow), UB40 and LI11 all eliminate heat (important)PC6 is chosen to reduce fire and protect the Heart
b) Severe Type:headache, dire thirst, SOB at first (beginning stage) and then collapse, loss of consciousness, sweatingPulse: deep and forceless (plus sweating indicate exhaustion of Qi and BF)
Analysis:
Mostly occurs in those doing physical activity in scorching summer sun. Overfatigue plus attack of summer-heat lower body resistance and consume Qi and body fluids. So headache, dire thirst, SOB at first (beginning stage) then the pathogenic heat penetrates the interior and affects the PC by disturbing the mind, hence loss of consc.
Treatment: Rx: DU26, DU20, Shixuan (Extra) PC3, UB40Reducing is applied to DU pts to resuscitate and dispel summer-heatGU26 & DU20 promote resuscitationPC6, UB40 are pricked superficially to remove heat from bloodShixuan (Extra) bleeding reduces heat and primotes resuscitation
Remarks: condition includes thermoplegia, thermospasm, heliosis, etc. Sraping therapy is a popular tx for sunstroke.
COMMON COLD headache, nasal obst., aversion to wind and fever.
Etiology & Pathogenesisoften due to delicate constitution and weakened body resistance which makes the body inadaptable to temperature changes. Wind invades the body through the pores, skin, mouth and nose leading to impairement of descending and dispersing LU fxns.
Differentiation:
a) Wind-Cold chills, fever, no sweat, headache, soreness and pain of limbs nasal obst., runny nose, itchy throat, cough, hoarse voice, profuse thin sputum.Tongue: thin, white coatingPulse: superficial and tense (wind-cold invasion)
Analysis:invasion of cold impairs dispersing fxn of LU and obstructs the nose with discharge. Pathogenic cold is yin and damages Yang. Impaired superficial Yang is manigested by chills, fever, no sweat, headache, body aches.
Treatment:Rx: DU16, UB12, GB20, LU7, LI4Reducing is applied to points of DU, Taiyang and Shaoyang meridians to eliminate W/C and relieve exterior symptoms. Even method w/Moxa is applied to weak constitution patientsDU16 eliminates Wind, relieves exterior and tx headcheUB12 (Taiyang meridian which dominates the surface of whole body, is selected to regulate Qi flow of the meridian, eliminate W/C and relieve chills & feverLU7 Luo-connecting, cough and dispersing LU fxnGB20 crossing pt of Foot Shaoyang and Yang Linking vessel (dominates exterior), which eliminate W/C.LI4 Yuan pt (interior-exterior relationship) eliminates W/C and relieves exterior
b) Wind-Heat fever, sweating, slight aversion to wind, pain and distending sensation of the head, cough with yellow, thick sputum, congested and sore throat, thirstTongue: thin white or yellowish coatingPulse: superficial and rapid
Analysis:
often attacks through nose and mouth. The Lu is involved first. Heat is Yang and is characterized by upwad and outward dispersion. Wind-heat and Wei Qi (body resistence) fight causing fever, slight aversion to wind and sweating. When pathogenic heat stifles the air passage, there is congested sore throat with thirst. Pulse and tongue reflect LU and Wei Qi being attacked by W/H.
Treatment: Rx: DU14, LI11, SJ5, LI4, LI10, LU11Reducing applied to DU, Shaoyang and Yangming pts to eliminate W/HDU14 (pt where all Yang channels meet) eliminates Heat and promotes qi flowLI4 and LI11 (Yuan primary pt and He-Sea pt of Hand Yangming & Taiying
MALARIAparoxysms (sudden attacks) of shivering chills and high fever occuring at regular intervals, mostly in late summer or early autum
Etiology & Pathogenesis Plasmodium falcipadum is the parasite that is transmitted through the female mosquito to humans resulting in Malaria. Bacteria, parasites and viruses are considered pestilential factors.Caused by pestilential factors together with invasion of wind, cold, summer-heat and dampness and a weakened immune system. Invasion of the Shaoyand meridian by path. Factors causes a Ying-Wei hisharmony.Note: Ying qi (nutritive qi) Wei Qi (defensive qi)
Differentiation:
Paroxysms of Shivering Chills and High Fever
hot sensation, preceded by yawning and lassitude, intolerant headache, flushed face and red lips, hypochondriac and chest distention, bitter taste and dry mouth, dire thirst. At end of episode, patient breaks into profuse perspiration and fever subsides.Tongue: sticky, yellow coatingPulse: string-taut and rapid
Analysis:
chills and fever represent the fight b/n the pathogen and ying-wei qi. Yawning, lassitude and chills are caused by the lack of yang qi (nutritive qi). All s/s associated with heat indicate cold turned into heat. Hypochondriac and chest distention, bitter taste suggest pathogen in Shaoyand meridian has impaired qi and blood flow.The tongue and pulse show the presence of both cold and heat.
Treatment: Rx: DU14, DU13, SI3, PC5, SJ2, GB41Reducing is applied to regulate DU and harmonize Shaoyang Tx is done 2 hrs prior to proxysms, if chills are present apply MoxaDU14 (pt where all Yang channels meet) eliminates Heat and promotes qi flowcombined with DU13 can remove obstructions from DU and regulate Yin & YangSJ2 & GB41 (pts on Shaoyang, harmonize qi of channel)SI3 (Hand Taiyang, can activate channel qi and DU qi, expels pathogen) PC5 (Hand Jueyin, empirical pt for Malaria)
High Fever: DU14 & LI11 dispel heatMalaria w/splenomegaly: LV13 (influential pt for zang organs regulates their qi) +
Pigen (extra pt) can be used for mass in hypochondriac region
II) ZANG-FU SYNDROMES
COUGH May be due to impairment of Lu Qi, organ disorders or other organs attacking LU
Etiology & Pathogenesis a) Invasion by pathogenic factorb) Internal Injury
Differentiation:
a) Invasion by pathogenic factor1) WIND-COLD: cough, itching of throat, thin & white sputum, aversion to cold, fever, no sweat, headache, nasal obst and discharge.Tongue: thin, white coatingPulse: superficial (exterior)
Analysis:Pathogenic cold is stagnant in respiratory tract affecting qi flow in Lu and causing coughm itching of throat, thin and white sputum, nasal obst and discharge. When the pathogenic factor stays in the skin and hair, their conflict with the wei qi gives rise to headache, aversion to cold, no sweating and fever.
2) WIND-HEAT: cough w/yellow, thick sputum, choking cough, thirst, sore throat, fever, headache, aversion to wind, sweating.Tongue: thin, yellow coatingPulse: superficial and rapid (exterior, heat)
Analysis:
LU fxn of clearing passage and sending qi down is impaired. Fluids are heated and turned into phlegm, BF are injured resulting in thirst and sore throat. When the pathogenic factor stays in the skin and hair, their conflict with the wei qi gives rise to headache, aversion to wind, sweating and fever.
Treatment:Principle pts chosen from Hand Taiyin and Yangming. Moxa for W/CRx: LU7, LI4, UB13LU7 (Luo) and LI4 (Yuan primary) + UB13 to strengthen LU fxn, elim. Pathogen
Supplementary Pts:LU11 if sore throat w/swellingDU14 & SJ5 for fever w/aversion to cold
b) Internal Injury 1) LU Blocked by Phlegm: cough w/profuse white, sticky sputum, stuffiness and depression of chest, loss of appetite.Tongue: white, sticky coatingPulse: rolling (phlegm)
Analysis:
The SP is considered the source in production of sputum and the LU is the container. If the SP fails in its T/T, dampness will accumulate and congeal into phlegm, which goes upward to the LU, affecting the dispersing and descending fxn of the LU. If dampness stays in Middle Jiao it will cause stuffiness and depression of the chest and loss of appetite.
Treatment: Back-Shu and Foot Yangming, combine w/moxa to strenghten SP fxn and resolve phlegm.Rx: UB13, Ren12, LU5, ST36, ST40UB13, REN12, ST36 strenghten SP fxn and harmnz ST, rem damp/phlegmLU5 (He-sea) reduces pathogenic factor to relieve coughST40 (luo) strengthen smooth qi flow in SP/ST, thus BF will flow freely once phlegm is resolved
2) LU Dryness w/LU Yin def: dry cough w/o sputum or scanty sputum, dryness of nose, throat, sore throat, spitting blood or even coughing blood, afternoon fever, malar flush.Tongue: Red, thin coatingPulse: thready and rapid
Analysis: Dryness injures the LU and consumes BF causing all s/s associated w/dryness. If LU vessels are injured by dryness, there will be blood in sputum (hemoptysis).
Treatment: Rx: UB13, LU1, LU7, KI6UB13 & LU1 (back-shu/Front-Mu) regulate LU passage and descend LU qiLU7 (luo, connected with Ren) & KI6, 8 confluential pt combo to nourish Yin, eliminate dryness, clear the throat and descend LU Qi.
Supplementary Pts:LU6 (Xi-cleft) acute & UB17 (blood) 8 influential pt combo to tx coughing bloodCupping on UB12 & UB13 to tx cough
ASTHMA Repeated attacks of paroxysmal dyspnea with wheezing.
Etiology & Pathogenesis a) Excess type: Wind-Cold, Phlegm-Heatb) Deficiency type:
Differentiation:
a) Excess Type1) WIND-COLD: cough w/thin white sputum, chills & fever, no sweat (at early stage), headache, no thirst.Tongue: thin, white coatingPulse: superficial (exterior) & tense (cold)
Analysis: Invasion of cold impairs smooth flow of Lu Qi, injures skin and hair, closes pores (no sweat). LU Qi fails to descend leading to cough.
Rx: UB13, UB12, DU14, LU7, LI4Treatment: UB13 & UB12 clear LU and eliminate wind.
DU14, LU7 & LI4 eliminate wind/cold, clear LU & soothe asthma. (reduce & moxa)
2) PHLEGM-HEAT: rapid and short breathing, strong and coarse voice, cough w/thick yellow sputum, chest stiffness, fever, restlessness, dry mouth.Tongue: thick, yellow or sticky coatingPulse: rolling (slippery) and rapid (heat)
Analysis:SP fails to T/T resulting in phlegm from accumulated dampness. Long standing accumulation of phlegm turns into heat, or excess fire of the LU evaporates fluids to form phlegm, thus impairing descending and dispersing fxn of LU leading to cough.
Rx: UB13, Dingchuan, Ren22, LU5, ST40Treatment: LU5 (He-Sea) reduces phlegm-heat and soothes asthma
ST40 strenghtens SP fxn and resolves phlegmUB13 clears LU and regules Qi flowRen22 descends Qi and resolves phlegmDingchuan (Extra) is an empirical pt to pacify breathing.
b) Deficiency Type1) LU DEF: short and rapid breathing, feeble voice, weak and low sound of couging, swearing on exertion.Tongue: pale tonguePulse: pulse of deficiency type
Analysis: LU dominates Qi, thus LU Qi deficiency impairs normal LU fxns. When LU Qi and Wei Qi are deficient, even mild exertion will induce sweating (pores are not being controlled).
Rx: UB13, LU9, ST36, SP3Treatment: LU9 (Yuan pt) reinforces LU Qi
UB13 (needle and moxa) strenghtens LU QiST36 (He-Sea) & SP3 (Yuan) strenghten the LU (the LU pertains to Metal and the SP to Earth, which is able to promote Metal) "Reinforces the Mother in case of deficiency"
2) KI DEF: dyspnea on exertion after chronic asthma, severe wheezing, indrawing of soft tissues of the neck, lassitude and weakness, sweating, cold limbs.Tongue: pale tonguePulse: deep and thready (KI Yang def)
Analysis:Chronic asthma affects the KI which is the source of Qi. KI fails to receive Qi, therefore dyspnea on exertion, severe wheezing and shortness of breath occur, as well as lassitude. Exhausted KI Yang may lead to weakening of Wei Qi and hence sweating occurs.
Rx: KI3, UB23, UB13, Ren17, Ren6Treatment: KI3 (Yuan) + UB23 toghether strenghten KI Yuan Qi (primary)
Ren17 (Qi Infl. Pt) and UB13 reinforce Qi and pacify breathingRen6 (Sea of Qi) important pt to regulate Qi in lower burner, reinforce KI, strenghen Yaun Qi, and pacigy breathingDU12 & UB43 moxa on both to relieve chronic athsma DU12 & UB20 moxa on both to strenghten the SP fxn and reinforce Qi.
Remarks: This condition includes bronchial asthma, asthmatic bronchitis, obstructive pulmonary emphysema and dyspnea.
EPIGASTRIC PAIN Repeated attacks of pain in stomach area
Etiology & Pathogenesis a) Food Retentionb) LV Qi invading STc) ST deficiency w/cold stagnation
Differentiation:
a) Food Retention:distending pain in epigastrium, aggravated on pressure (excess)or after meals, belching w/fetid odor.
(Excess condition) Tongue: thick, sticky coatingPulse: deep, forceful or rolling pulse
Analysis: food retention impairs ST qi descending fxn. Stagnant Qi causes pain in epigastrium
Rx: Ren11, PC6,ST36, Inner-Neiting
Treatment: Ren12 (ST Front-Mu), ST36 and PC6 (Confluent pt) used for ST, chest and Heart disorders. Used to pacify the ST and relieve pain.Inner-Neiting (Extra) is an empirical pt for food retention
b) LV Qi invading STparoxysmal pain in epigastrium, radiating to hypochondriac region, freq. belching w/nausea, vomitting, acid regurg, abd distention, anorexia.Tongue: thin, white coatingPulse: deep, string-taut
Analysis: Stagnation of LV Qi impairs LV fxn of controlling free flow of Qi. Pain extends along the path of LV channel in hypondriac region. s/s of Qi stag occur (belching, acid regurg, etc)
Rx: LV14, Ren12, PC6, ST36, LV3
Treatment: LV14 (LV Front-Mu) & LV3 (Yuan) combo used to remove LV Qi Stagnation, regulate Qi flow and relieve painRen12 (ST Front-Mu), ST36 and PC6 (Confluent pt) used for ST, chest and Heart disorders. Used to pacify the ST and relieve pain.
c) ST Def. w/Cold Stag.dull epig pain, relieved by pressure and warmth (def), general lassitude, regurgitation of thin, white fluid,Tongue: thin, white coatingPulse: deep, slow
Analysis: cold impairs t/t fxn of SP leading to pain. SP dominates limbs. SP Yang def leads to lassitude, as well as reurgitation.
Rx: Ren12, Ren6, Ub20, PC6, ST36, SP4
Treatment: Ren12 & ST36 needle and moxa both to warm middle jiao, dispel cold, regulate qi flow and relieve pain.PC6 and SP4 (Confluent pts) indicated for ST disordersUB20 moxa to strengthen the SP, pacify ST, dispel cold and relieve pain.Ren6 Indirect moxa w/Ginger to tx chronic gastric pain due to def. cold. (dispel cold)
VOMITING ST qi fails to descend leading to vomiting.
Etiology & Pathogenesis a) Food Retentionb) LV Qi invading STc) ST/SP Hypofunction (Deficiency)
Differentiation:
a) Food Retention: acid fermented vomitus, epig and abd distention, belching, loose stool or constipation.(Excess condition) Tongue: thick, granular coating
Pulse: forceful & rolling pulse
Analysis:food retention impairs SP's t/t fxn, stagnation in mj causes epig & abd pain, belcing. Retention of food leads to upward flow of turbid qi, so acid fermented (stagnation) vomitus, loose stools or constipation occur.
b) LV Qi invading STvomiting, acid regurg, freq. belching, distenting pain in chest and hypochondriac region, irritability w/oppressed feeling.Tongue: thin, sticky coating
Pulse: string-taut
Analysis: Stagnation of LV Qi impairs LV fxn of controlling free flow of Qi. Pain extends along the path of LV channel in hypondriac region. s/s of Qi stag occur (belching, acid regurg, etc)
c) ST/SP Hypofunctionsallow complexion, vomiting after a big meal, loss of appettite, lassitude, weakness, slightly loose stool.Tongue: thin, white coatingPulse: thready and forceless
Analysis:ST/SP weakness leads to Yang hypofunction in middle jiao (cold) which fails to receive food and water, so vomiting occurs after a big meal. SP's T/T fails and stops nourishing the body leading to lassitude, weakness, loss of appettite and slightly loose stools.
Rx: Ren12, St36, PC6, SP4
General Treatment: Ren12 (ST Front-Mu), ST36 and PC6 (Confluent pt) used for ST, chest and Heart disorders. Used to pacify the ST and relieve pain.
Supplementary Pts:Food Retention Ren10LV Qi invading ST LV3SP/ST weakness UB20Persistent vomiting Jinjing and Yuye (Extra pts) bleed to stop vomiting
HICCUP Involuntary spasm of the glottis and diaphragm, causing the characteristic sound.
Etiology & Pathogenesis a) Food Retentionb) Qi Stagnationc) ST Cold
Differentiation:
a) Food Retention: loud hiccups, epig and abd distention.(Excess condition) Tongue: thick, sticky coating
Pulse: forceful & rolling pulse
Analysis: food retention impairs SP's t/t fxn, stagnation in mj causes epig & abd pain, belcing. Retention of food leads to upward flow of qi causing hiccups.
b) Qi Stagnation: continual hiccups, distending pain and feeling of oppression in chest and hypochond.Tongue: thin, white coating (normal)Pulse: string-taut (wiry) and forceful (sign of LV Qi stag due to depressed LV)
Analysis: stagnant LV qi will invade the ST causing upward perversion of ST Qi leading to hiccup
c) ST Cold:slow and forceful hiccups which may relieved by heat and aggravated by cold, discomfort in epig.Tongue: white, moist coating (cold)Pulse: slow (cold)
Analysis: ST qi fails to descend due to cold, so hiccup is forceful. If warmth is applied, qi circulates and hiccup is subdued, if cold gets worse the hiccups get aggravated.
Rx: UB17, Ren12, PC6, ST36
General Treatment: Ren12 (ST Front-Mu), ST36 and PC6 (Confluent pt) used for ST, chest and Heart disorders. Used to pacify the ST and relieve pain.UB17 able to check the ascension of perverse qi and stop hiccup
Supplementary Pts:Food Retention Ren14 & Inner-Neiting pacify ST and remove stagnationQi Stagnation LV3 (pacify LV qi) & Ren17 relieves depressed feeling in chest and diaphragm relieving hiccups
ST ColdRen13 Moxa may warm the mj to dispel cold, promote smooth distribution of Yang and relieve hiccups
ABDOMINAL PAIN common symptom often accompanied by dystentry, epig pain, appendicitis and GYN diseases.
Etiology & Pathogenesis a) Cold Accumulationb) SP Yang Hypoactivity (Def) c) Food Retention
Differentiation:
a) Cold Accumulationsudden onset of violent abd pain which responds to warmth and gets worse w/cold, loose stools, no thirst, clear and profuse urine, cold limbs.Tongue: thin, white coatingPulse: deep, tense or deep, slow (cold accum)
Analysis:Cold is of Yin nature and causes contraction and stagnation. If cold enters the body, Yang qi will get obstructed, then sudden violent pain and cold limbs appear. Clear and profuse urine and loose stools are due to St/SP failure to t/t.
Rx: Ren12, Ren8, ST36, SP4
Treatment: Ren12 (ST Front-Mu), ST36 and SP4 used to strengthen ST/SP fxn, warm and promote smooth flow of qi in fu organs. Indirect moxa w/salt is applied to warm ST and dispel cold.
c) SP Yang Defintermittent dull pain relieved by warmth or pressure, aggravated by cold, hunger, fatigue and lassitude, aversion to cold.Tongue: thin, white coatingPulse: deep, thready
Analysis: ST/SP weakness leads to Yang hypofunction in middle jiao (cold) which causes pain, loose stools, etc.
Rx: UB20, UB21, Ren12, LV13, Ren6, ST36Treatment: UB20 & LV13, UB21 and Ren12 (Back-Shu/Front-Mu combinations) moxa & needle
Ren6 & ST36 strenghten ST/SP fxn
c) Food Retention epig and adb distending pain aggravated by pressure (excess), anorexia, foul belching and sour regurgitation, or abd pain accompanied by diarrhea and relieved by defecation.Tongue: sticky coatingPulse: rolling (indigestion)
Analysis: anorexia is due to retention of food, foul belching and sour regurg are due to indigestion. Pain is relieved after diarrhea because it leads to movement of qi.
Rx: Ren12, ST25, Ren6, ST36, Inner-NeitingTreatment: Ren12, ST36, ST26 & Ren6 are applied to regulate ST qi flow
Inner-Neiting is empirical pt for indigestion
DIARRHEA refers to abnormal frequency and liquidity of fecal discharge.
Etiology & Pathogenesis 1) Acute: a) Cold-Dampness b) Damp-Heat c) Food Retention2) Chronic: d) SP Def (Chronic) e) KI Def
Differentiation:
1) Acute a) Cold-Damp: watery diarrhea, abd pain and borborygami, chilliness which responds to warmth, no thirst.
Tongue: palePulse: deep, slow
Analysis:
cold-damp attacks ST and intestines impairing SP fxn of sending food escence and water upward and that of ST in sending its' content downward. The food escence and the waste cannot be separated, moving downward together through the LI, hence diarrhea w/borborygami. Pain is due to qi stagnation. Cold-damp can easily damage yang qi which results in chilliness and no thirst.
b) Damp-Heat: diarrhea w/ abd pain, yellow, hot and fetid stools, burning sensation in anus, scanty urine, or accomp by general feverish feeling, thirstTongue: yellow, sticky coatingPulse: rolling & rapid
Analysis:
ST and intestines are attacked by damp-heat in summer or autumn, t/t fxns is impaired and diarrhea occurs. If damp-heat pours down, diarrhea appears as soon as abd pain occurs (damp-heat in ST). If damp-heat stays in intestines, there appears diarrhea w/yellow, hot and fetid stools w/burning sensation in anus.
c) Food Retention: abd pain relieved after bowel movmt, borborygami, diarrhea w/fetid stools, epig and abd fullness and distention, belching, anorexia.Tongue: thick, filthy coating (greasy) (food ret)Pulse: rolling & rapid or deep & string-taut (food ret)
Analysis:food retention impairs ST descending fxn and intestines trasmitting fxn, stagnation in mj causes epig & abd pain, belching. Undigested food turns putrid and leads to diarrhea w/ offensive fetid odor.
Rx: T25, ST36General Treatment: ST25 (LI Front-MU) regulates intestines' transmitting fxn
ST36 (He-Sea pt) regulates ST qi
Supplementary Pts:Cold-Damp Ren12 & Ren6 moxa w.ginger is applied to warm St/SP, dispel cold, rem damp, reg qiDamp-Heat ST44 & SP9 eliminate damp-heat from LIFood Retention Inner-Neiting (Extra) used for food retention & to regulate ST/SP fxns
2) Chronic:d) SP Def: loose stools w/undigested food, anorexia, epig distention after eating, sallow complexion, lassitudeTongue: pale w/white coatingPulse: thready, forceless
Analysis:
weakened SP qi fails to ascend and digestion is impaired, leading to loose stool w/undigested food particles. Impaired t/t fxn leads to epig distress after eating. Persistent diarrhea furhter weakens the ST/SP, affecting the production of essence and formation of qi and blood, thus resultuing in the sallow complexion and lassitude.
Rx: UB20, LV13, SP3, Ren12, ST36UB20 & LV13, (Back-Shu/Front-Mu combination)
Treatment: SP3 (Yuan) & Ren12 (Front-Mu of ST) & ST36 moxa and needle to invig SP yang, strengthen t/t fxn and stop diarrhea
e) KI Def: pain below the umbilicus, borborygami & diarrhea usually occuring at dawn, relieved after bowel movmt, aggravated by cold, abd distention, cold lower extremities.Tongue: pale w/white coating
Pulse: deep, forceless
Analysis:KI Yang hypoactivity & decline of mingmen fire lead to pain below the umbilicus, borborygami & diarrhea usually occuring at dawn. Ki fails to hold its contents due to the decline of Mingmen fire, thus diarrhea occurs.
Rx: UB23, UB20, DU4, Ren4, KI3, ST36 Treatment: UB23 (KI Back-Shu) & KI3 (Yuan) reinforcing needling to warm KI Yang & invig Ki qi
DU4 (Mingmen) & Ren4 to reinforce Mingmen fire and strenghten KI Yang so as to warm the SP & KI to promote digestion. This is known as tx of Root Cause
Remarks:this condition may be involved in acute or chronic enteritis, indigestion, intestinal parasitic diseases, pancreas, LV and biliary tract diseases, endocrine and metabolic disorders and neurotic troubles.
DYSENTERY characterized by abd pain, tensmus & freq bloody and mucusy stools. Common epidemic disease in summer and autumn.
Etiology & Pathogenesis a) Damp-Heat dysenteryb) Cold-Damp dysenteryc) Food-Resistant dysenteryd) Intermittent dysentery
Differentiation:
a) Damp-Heat:abd pain, tenesmus, mucus and blood in stools, burning sensation of the anus, scanty urine, or chills, fever, restlessness, thirstTongue: yellow, sticky coatingPulse: rolling, rapid or soft, rapid
Analysis:
damp-heat stagnates in intestines, qi and blood are blocked leading to disturbance of transmittion causing abd pain and tenesmus. Blood, pus and mucus occur due to heat injuring the blood vessel in intestines. Down-pouring of damp-heat lead to scanty urine and burning sensation of anus.
b) Damp-Cold: diff defecation, white mucus in stools, aversion to cold, epig & chest fullness, lingering abd pain, tastelessness in mouth, no thirstTongue: white, sticky coatingPulse: deep,slow
Analysis:
damp-cold stagnates in intestines, qi and blood are blocked. Cold constricts and stagnates while damp causes turbidity, so there is chest and epig fullness, diff defecation (stagnation) and white (cold) mucus in stool. Cold damages Yang qi. Blocked yang qi fails to disperse (cannot be distributed) leads to aversion to cold and adb pain. Tastelessness and no thirst are due to accumulation of damp.
c) Food Resistent: frequent stools w/blood and pus, total loss of appetite, nausea, vomitingTongue: yellow, sticky coatingPulse: soft, rapid
Analysis:This condition is developed from damp-heat dysentery. Damp-heat stagnates in intestines, qi and blood are blocked, ST is attacked and its descending fxnis impaired. The ST fails to receive food, appetite is lost. ST qi ascends instead of descending, so nausea and vomiting occur.
d) Intermittent dysentery: occuring on and off, difficult to cure, lassitude, aversion to cold, somnolence, anorexiaTongue: pale tongue, sticky coatingPulse: soft (persistent dampness)
Analysis: complicated w/mixed deficiency and excess so the disease lingers and is recurrent. SP Yang qi weakness leads to lassitude, aversion to cold and somnolence.
General Treatment:Internal Classic states: He-Sea pts are applied for fu organ diseasesRx: ST25, ST37ST25 (LI Front-Mu) & ST37 (He-sea of LI) principal pts to remove stagnation of qi in LIDampness will be resolved in case qi is regulated
Damp-Heat Dysentery: LI11 & LI4 may dispel damp-heat from ST & LI
Cold_Damp Dysentery:Ren12 and Ren6 moxa to warm the ST/SP, remove cold and regulate qi flow + SP9 to strenghten the SP fxn and resolve damp
Food Resistant Dysentery: Ren12 and PC6 pacify ST and resolve damp
Intermittent Dysentery:UB20, UB21, ST36, Ren4 (Front-Mu of SI) separates the food essence from the waste, reinforces qi and activates Yang
Supplementary Pts:Fever DU14Tenesmus UB29Rectal Prolapse DU20 w/moxa + DU1
ABD DISTENTIONdistention and fullness is likely to occur in both upper and lower abd. St is in upper abd and intestines are in lower abd, they jointly complete the storage, digestion, and assimilation of food and excretion of waste. Once their fxns are impaired, abd distention and pain, belching, vomiting occur.
Etiology & Pathogenesis a) Excess conditionb) Deficiency Condition
Differentiation:
a) Excess Condition:persistence of distention and fullness in abd, aggravated by pressure, belching, foul breath, dark yellow urine, constipation, sometimes w/fever, vomitingTongue: yellow, thick coatingPulse: rolling, rapid & forceful
Analysis: undigested food in ST causes distention and fullness in epigastrium, foul breath, belching and even vomiting…if retained in intestines it will lead to constipation and abd distention.
b) Deficiency Condition:abd distention relieved by pressure, borborygami, loose stools, loss of appetite, lassitude, listlessness, clear urineTongue: pale tongue w/white coatingPulse: forceless (SP def)
Analysis: ST/SP qi def impairs t/t fxn leading to loss of appetite, borborygami, loose stools. Failure to create qi and blood due to impaired t/t leads to lassitude and listlessness.
Rx: Ren12, ST25, ST36,ST37
General Treatment:Ren12 (ST Front-Mu), ST36 (ST Lower He-Sea), ST25 (LI Front-Mu) & ST37 (LI Lower He-Sea) are used in Front-Mu/Lower He-Sea combo to ST and intestine fxn, regulate qi flow and remove distention
Excess Condition: LI4 & Ren6 are combined to regulate circulation of qi & SP9 eliminates damp-heatDeficiency Condition: SP3 & Ren4 strengthen t/t fxn of SP/ST
JAUNDICE yellow discoloration
Etiology & Pathogenesis a) Yang Jaundiceb) Yin Jaundice
Differentiation:
a) Yang Jaundice:lusterous yellow skin and sclera, fever, thirst, scanty dark yellow urine, heaviness of the body, fullness in abd, stuffiness of the chest, nauseaTongue: yellow,sticky coatingPulse: string-taut, rapid
Analysis:steaming of damp-heat makes bile spread to the skin surface, heat makes the skin discoloration look lusterous. Fever, thirst, scanty dark yellow urine are due to excessive damp-heat which damage body fluids and disturb bladder fxn. When damp accumulates, the pure Yang fails to be distributed and heaviness appears. Siffness and fullness results from qi stagnation.
b) Yin Jaundice:sallow skin, heaviness of the body, weakness, loss of appetite, epig fullness, lassitude, aversion to cold, no thirstTongue: pale tongue, thick, white coatingPulse: deep,slow
Analysis:damp-cold stagnation in SP/ST impedes yang qi distribution, leading to overflow of bile, thus the skin is sallow. When damp accumulates, the pure Yang fails to be distributed and heaviness appears. Siffness and fullness results from qi stagnation.
Rx: SP9, ST36, UB18, UB19, Du9General Treatment: SP9 & ST36 strenghten the SP and resolve damp
UB18, UB19 & DU9 are important pts to tx JaundiceYang Jaundice: GB34 (since damp-heat resides in GB) reduces heat & LV3 is used to regulate LV/GB qi flowYin Jaundice: UB20 & UB48 moxa may resolve cold damp by warmth and tx Jaundice
CONSTIPATION caused by impaired LI transmitting fxn and related to SP,ST & KI fxn
Etiology & Pathogenesis a) Excess Conditionb) Deficiency Condition
Differentiation:
a) Excess Condition:infrequent and difficult defecation from every 3 to 5 days, or even longer. In case of heat accumulation, there are fever, dire thirst, foul breathTongue: thin,sticky coatingPulse: string-taut
Analysis:
heat accumulation in ST & LI consumes body fluids and stagnates qi, impairing the transmitting fx of the LI resulting in constipation. Emotional disturbances lead to qi LV/SP qi stag, thus resulting in abd fullness and hychondriac pain.
b) Deficiency Condition:in case of qi & blood def there is pale and lusterless complexion, lips and nails, dizziness and palpitations, lassitude, shortness of breathTongue: pale tongue, moist, white coatingPulse: deep,slow
Analysis:
constipation can be caused by qi def resulting in failure of LI in transmittion, or by blood def w/shortage of body fluids unable to moisten the LI. Endogenous cold stays in the ST and intestines leading to agglomeration of yin qi, failure of yang qi in transportation and weakned trasmittion of the LI, hence difficult defecation. Palpitations are due to poor nourishment to the Heart from blood def. Dizziness results from poor nourishment to head and eyes. Nails are an expression of LV, there will be lusterless nails when there is LV blood def
Rx: UB25, ST25, SJ6, Ki6
General Treatment:UB25 (LI Back-Shu) & ST25 (LI Front-Mu) promote qi flow in LI, transmittion fxn is regained when there is smooth qi flowSJ6 (promotes qi flow in 3 jiaos) & KI6 are principal pts to tx constipation
Heat Accumulation: LI11 & LI4 remove heat from LIQi Stagnation: Ren12 (Influential pt of fu organs) reduces qi of fu organ + LV3 (reduced to soothe Lvqi)
Qi & Blood Deficiency:
UB20, UB21 & ST36 reinforce SP/ST qi. Once SP/ST qi us vigorous, qi and blood can be produced as a natural consequence, so this is known as treating the root cause of constipation in def conditions
EDEMA subcutaneous retention of fluid which leads to puffiness of the face, eyelids, limbs, abd and even the whole body.
Etiology & Pathogenesis a) Yand Edemab) Yin Edema
Differentiation:
a) Yang Edema: abrupt onset of edema w/puffy face and eyelids and then anasarca (severe generalized edema), lusterous skin, chills, fever, thirst, cough, asthma and reduced urine output.Tongue: thin, white coatingPulse: superficial or rolling, rapid (superficial indicates wind-water invasion)
Analysis:internal accumulation of water and external wind invasion, confrontation b/n them causes sudden onset of edema starting from top portion of body (wind is yang=upper part). When wind water attacks LU there is cough, asthma, chills.
Treatment: Edema above the lumbus s/b tx by diaphoresis (profuse sweating)Rx: LU7, LI4, LI6, SP9, UB39LU7 & LI4 clear the LU and relieve exterior symptoms by diaphoresis.LI6 & SP9 remove damp and promote diuresisUB39 regulates qi of San Jiao and water passages
b) Yin edema:
insidious (sudden onset w/o symptoms) onset of edema, at first on the pedis dorsum or eyelids, and then over the whole body, esp remarkable below the lumbar region, accompanied by sallow complexion, aversion to cold, cold limbs, soreness of back and loins, general weakness, epig fullness, abd distention, loss of appetite, loose stoolsTongue: pale tongue, moist, white coatingPulse: deep, thready
Analysis:
because of SP/KI Yang def, yin is in excess and qi fails to transport water, causing overflow water damp in the lower portion of the body, hence appears pitting edema which is esp remarkable below the lumbar region. SP/KI def make qi unable to nourish the face so the complexion is sallow. Weakened KI Yang w/Mingmen fire decline cannot warm the body resulting in aversion to cold w/cold limbs. The lumbus is the house of the KI, hence pain in back and loins due to excessive water damp.
Treatment:Yin edema is caused by decline of KI yand that fails to control water and by weakness of SP qi that leads to impairment of transportation in the middle jiao.Edema below the lumbus is treated by diuresis, LI6 & SP9 promote diuresis and remoce dampnessRx: UB20, UB23, Ren9, Ren4, KI7, ST36UB20, UB23 & KI7 moxa & needle to warm SP/KI primary yang & remove cold waterRen9 & Ren4 promote water circulation and reinforce primary qi respecivelyST36 promotes SP/ST fxn, restoring normal distribution of fluid
Supplementary Pts:Facial Puffiness: Du26Edema on pedis dorsum: GB41, SP5
NOCTURNAL ENURESIS involuntary discharge of urine occuring at night and during sleep. Mostly seen in kids of over 3 years old and is due to KI qi def w/inability to restrain urine in the bladder
Etiology & Pathogenesis KI qi def w/inability to restrain urine in the bladder
Differentiation:
KI qi def w/inability to restrain urine in the bladder
involuntary micturition during sleep w/dreams, once in several nights is a mild case, several times anight is severe case. Sallow complexion, loss of appetite, weaknessTongue: pale w/white coatingPulse: thready & weak at chi region (def)
Analysis:long duration of disease undermines the KI qi, consequently the SP falls into loss of warming, its t/t fxn is impaired, hence the loss of appetite. SP qi def fails to distribute food essence and therefore fails to nourish the whole body leading to sallow complexion and general weakness.
Rx: UB23, UB28, Ren3, SP6, LV1
Treatment: UB23 (KI Back-shu) & UB28 (UB Back-Shu) & Ren3 (UB Front-Mu) together reinforce the KI qi and its restraining fxnSP6 is added to adjust the qi in 3 Yin meridiansLV1 (Jing-well) moxa to promote circulation of qi in LV meridian and strengthen the therapeutic effect
Supplementary Pts:Enuresis w/dreams: HT7Loss of appetite: UB20 & ST36
Remarks:Chief causative factor is underdevelopment of cerebral micturition center and acupuncture and moxibustion provide satisfactory effect
URINATION DISTURBANCE
manifested by frequency of urination, painful urination and incontinence, resulting mainly from accumulation of heat in the bladder & sometimes from emotional factors or KI deficiency
Etiology & Pathogenesis a) Dysuria caused by calculib) Dysuria caused by qi dysfunctionc) Painful urination w/bloodd) Dysuria w/milky urinee) Dysuria caused by overstrain
Differentiation:
a) Dysuria caused by calculi: occasional presence of calculi in urine, dysuria, dark yellow turbid urine, sudden interuption of urination, pain in lumbus and abdomen, or presence of blood in urineTongue: normal coatingPulse: none stated
Analysis:
when gravel and stones formed by damp-heat fail to be discharged in the urine, dark yellow turbid urine and painful urination occur. Interruption of urination may be due to obstruction by a stone, accompanied by unbearable pain. In case of calculi causing internal injury, there will be blood in the urine
b) Dysuria caused by qi dysfunction: difficult and hesitant urination, fullness and pain of lower abdomen
Tongue: normal coating, thin, whitePulse: deep, string-taut
Analysis: emotional depression leads to qi dysfunction, leading to LV& UB qi stag
c) Painful urination w/blood: hematuria w/pain and urgency, burning sensation and pricking pain in urination.Tongue: thin, yellow whitePulse: rapid & forceful
d) Dysuria w/milky urine: cloudy urine w/milky or creamy appearance, urethral burning pain in urinationTongue: red tongue, sticky coatingPulse: thready & rapid Note: both tongue and pulse are signs of KI Yin def and stagnation of damp-heat
Analysis:condition is due to downward shift of damp-heat, which accumulates in the bladder and affects the qi fxn. The bladder fails to check the downward flow of fatty liquid, so there are cloudy urine w/milky or even creamy appearance (leukorrhea) and urethral burning pain in urination
e) Dysuria caused by overstrain:
difficulty in urination w/dribbling of urine, occurring on and off, exacerbated by overwork and usually refractory to treatmentTongue: not statedPulse: weak
Analysis: overstrain, indulgence in sex and drinking or taking too much drugs are cold in nature which lead to SP/KI deficiency and Yang qi fails to ascend.
Rx: UB28, Ren3, SP9
Treatment:UB28 (UB Back-Shu) & Ren3 (UB Front-Mu) promote bladder activity + SP9 (SP He-Sea pt) to promote diuresis
Supplemental Pts:UB39 (Lower He-Sea of San Jiao) reduces damp-heat from lower jiao and strenghtens fxn of the bladder. Dysuria caused by calculiLV2 (Ying-Spring of LV) used to dispel LV fire & relieve pain. Dysuria caused by qi dysfunctionSP10 & SP6 to stop bleeding. Painful urination w/bloodUB23 & KI6 reinforce KI qi. Dysuria w/milky urineDU20 (Meeting of all yand meridians) & Ren6 (Sea of Qi) & ST36 reinforce SP/Ki qi. Dysuria caused by overstrain
RETENTION OF URINE difficult urination, distending pain in the lower abdomen and even blockage of urine
Etiology & Pathogenesis a) Accumulation of heat in the bladderb) Decline of Mingmen firec) Qi damage
Differentiation:
a) Accumulation of heat in the bladder:
scanty hot urine or retention of urine, distention and fullness of lower abd, thirst but w/no desire to drink, constipationTongue: red tongue w/yellow coatingPulse: rapid
Analysis:when water and heat combined together, impair bladder fxn causing distention and fullness of lower abdomen. Since body fluid fails to be normally distributed there is thirst w/no desire to drink.
Rx: UB28, Ren3, SP6, UB39Treatment: UB28 (UB Back-Shu) & Ren3 (UB Front-Mu) reduce heat from the bladder & adjust fxn
SP6 dispels heat from lower jiaoUB39 (Lower He-Sea of SJ) promotes circulation of waterThese points used together, reduce heat and promote diuresis
b) Decline of Mingmen Fire: dribbling urination, attenuating in force of urine discharge, pallor, listlessness, chilliness below the lumbus, weakness of the loins and kneesTongue: pale tonguePulse: deep, thready pulse weak at chi position (Ki def)
Analysis:dribbling urination, attenuating in force of urine discharge is due to KI Yang deficiency which affects the transmitting fxn, pallor, listlessness, chilliness below the lumbus, weakness of the loins and knees are due to decline of mingmen and failure of qi in reaching the bladder
Rx: DU4, UB23, DU20, Ren4, SJ4Treatment: DU4 & UB23 reinforce KI Yang
DU20 & Ren4 Moxa to invigorate KI qiSJ4 (Yuan primary of SJ) Since KI qi def makes SJ fail to promote water circulation
c) Qi damage in the meridian: dribbling urination or retention of urine, distention and dull pain in the lower abdomenTongue: purplish spots on the tonguePulse: hesitant, rapidBoth pulse and tongue are signs of blood stasis
Analysis:after a traumatic injury or surgical operation on the lower abdomen, the qi of the meridian is damaged and the blood stasis occurs, so dribbling urination appears, as well as distention and pain in the area.
Treatment: a traumatic injury or surgical operation can injure the blood vessels and impede the bladder fxn, thus urodialysis appears.Rx: Ren3, SP6, ST28, KI5
Ren3 (UB Front-Mu) adjusts bladder fxn and promotes urinationSP6 promotes qi and blood circulation in the meridianKI5 (Ki-Cleft) & ST28 promote urination and relieve distention and pain
IMPOTENCE referred to lack of copulative power in males
Etiology & Pathogenesis a) Decline of Mingmen Fireb) Downward flowing of Damp-Heat
Differentiation:
a) Decline of Mingmen Fire: failure to achieve erection or weak erection, palor, cold extremities, dizziness, listlessness, soreness and weakness of loins and knees, frequent urinationTongue: pale tongue w/white coatingPulse: deep, thready Note: If HT/SP are affected, there may be palpitations and insomnia
Analysis:
KI dominates reproduction and opens into the urethra, spermatic ducts and anus. KI Yang deficiency and decline of Mingmen fire wither up the reproductive ability, leading to impotence. Due to Yang deficiency, the body cannot be warmed, resulting in pallor, cold extremitis, dizziness and listlessness.
Rx: Ren4, DU4, UB23, KI3
Treatment: Ren4 is the meeting pt of Ren meridian and the 3 foot Yin meridians. Reinforcing is used to promote primary qi and invigorate KI fxnDU4 (Mingmen), UB23 & KI3 are used to strenghten KI Yang
Supplementary Pts:SP/HT qi damage: UB15, HT7 & SP6 activate SP/HT qi
b) Downward flow of Damp-Heat:
failure to achieve erection, complicated by bitter taste in mouth, thirst, hot and dark red urine, soreness and weakness of the lower extremities.Tongue: yellow, sticky coatingPulse: soft, rapid
Analysis:
The penis consists of two cylindrical bodies. "If damp-heat stagnates in the penis, the major body becomes soft and short, and the small body becomes soft and long." The former is known as contracture, while the latter is known as atrophy and weak. "The downward flowing of damp-heat makes the cylindrical bodies loose and weak, resulting in the inability to obtain an erection. If damp-heat ascends, there will be bitter taste in the mouth and thirst.
Treatment: This condition is caused by the downward flow of damp-heat from the SP.Rx: Ren3, SP6, ST36, SP9Ren3, SP6 and SP9 soothe and regulate SP qi to eliminate damp-heatST36 dispels dampness by improving t/t fxn of the SP. Heat will disappear when dampness is dispelled.
SEMINAL EMISSION generally divided into two categories
Etiology & Pathogenesis a) Nocturnal Emissionb) Spermatorrhea
Differentiation:
a) Nocturnal Emission:mainly due to overcontemplation or excessive sexual activities which lead to disharmony b/n HT/KI.Tongue: red tonguePulse: thready, rapid
Analysis:
If HT fire fails to descend and control the KI water, the KI water cannot ascend and cool the HT fire. When water deficiency and fire excess disturb the essence, nocturnal emission happens in dreams. Moreover, there are dizziness, palpitation, listlessness, lassitude and scanty yellow urine.
Rx: HT7, UB15, KI3, UB52Treatment: HT7 & UB15 lower HT fire and harmonize the HT/KI
KI3 activates KI qiUB52 controls essence
b) Spermatorrhea:
usually due to KI damage after a prolonged illness, sexual indulgence, or chronic nocturnal emission. Clinical manifestations are frequent spermatorrhea at day or night, particularly if there is desire for sex, pallor, lassitude, listlessnessTongue: pale tonguePulse: deep, thready
Analysis: In exhaustion of KI essence, the loss of yin affecst yang. Primary KI qi becomes insufficient, the storage of essence fails and seminal fluid is discharged involuntarily.
Rx: UB23, KI12, SP6, Ren4, Ren6Treatment: UB23 & SP6 reinforce KI qi
Ren4 (meeting pt for Ren and 3 foot Yin meridians) & Ren6 are impt pts for invigoration, moxa applied to these pts can warm and strengthen primary YangKI12 is combined to assist the control of KI essence
INSOMNIA refers to difficulty in falling asleep, early awakening, intermittent waking through the period of sleep, and even inability to sleep at all.
Etiology & Pathogenesis a) HT & SP Qi Deficiencyb) HT/KI Disharmonyc) LV Fire Risingd) ST Dysfunction
Differentiation:
a) HT/SP Qi Deficiency:difficulty in falling asleep, dream-disturbed sleep, palpitations, poor memory, lassitude, listlessness, anorexia, sallow complexionTongue: pale tongue w/thin coatingPulse: thready, weak
Analysis:
HT/SP impairment leads to blood insufficiency to house the mind, so dream-disturbed sleep, poor memory and palpitations occur. Sallow complexion and pale tongue are due to poor blood supply to nourish the upper body. SP/ST dysfunction leads to anorexia. Qi and Blood deficiency leads to qi declining and blood shortage, resulting in lassitude, listlessness, thready and weak pulse.
b) HT/KI Disharmony:restlessness, insomnia, dizziness, tinnitus, dry mouth w/little saliva, burning sensation of the chest, palms and soles, nocturnal emission, poor memory, palpitations, LBPTongue: red tonguePulse: thready and rapid (KI Yin def)
Analysis:
restlessness, poor memory, palpitations, nocturnal emission and LBP are due to KI deficiency and HT fire. Dry mouth w/little saliva, burning sensation of the chest, palms and soles are signs of Yin Deficiency in the lower jiao w/Fire flaring up. Dizziness and tinnitus result from the flaring up of ministerial fire due to KI Yin deficiency.
c) LV Fire Rising:irritability, dream-disturbed sleep, fright and fear accompanied w/headache, distending pain in costal region, bitter taste in mouth Tongue: not statedPulse: string-taut
Analysis:LV Fire flares up to disturb the mind, causing dream-disturbed sleep, fright and fear. When flaring LV fire attacks the head, headache occurs. Long standing LV qi stag turns into fire, leading to irritability. LV fire flares up w/upward flow of bile, producing bitter taste in the mouth.
d) ST Dysfunction:insomnia, suffocating feeling and distending pain in the epig region, belching or difficult defecationTongue: sticky coatingPulse: rolling
Analysis:ST/SP t/t impairment leads to food stagnation in the mj, obstructing the passage and thus giving rise to feelinf of suffocation, distending pain and difficult defecation. Food stag leads to dampness which then turns into phlegm. Sleep is disturbed
Rx: HT7, SP6, Anmian (Extra)HT7 (Yuan Primary) calms and soothes the mind, SP6 (crossing pt of LV,SP, KI) regulates the 3 meridians, and Anmian is the extra pt for insomnia.
General Treatment: a) HT & SP Qi Deficiency: UB20, UB15, SP1UB20 (SP Back-Shu), UB15 (HT Back-Shu) are combined to nourish the HT & reinforce SP, SP1 (Jing-Well - moxa w/small moxa cones) effective for dream-disturbed sleepb) HT/KI Disharmony: UB15, UB23, KI3UB15 (HT Back-Shu) reduces HT Fire, KI3 & UB23 reinforce KI water. The 3 pt combo harmonize HT/KIc) LV Fire Rising: UB18, UB19, GB12UB18, UB19, GB12 subdue LV/GB Fired) ST Dysfunction: UB21, ST36UB21 & ST36 regulate ST and soothe the mind
POOR MEMORY functional decline of the brain, hypomnesia and forgetfulness
Etiology & Pathogenesis
mainly caused by HT/SP def and KI essence def. Essence and will are both stored in the KI. Poor memory appears when the will fails to cooperate w/the HT. The SP dominates recollection and thinking. Since the SP is troubled, the mind is uneasy, so memory is poor. The HT & SP dominate blood. Overthinking injures the HT & SP, consumes blood and leads to poor memory. The KI dominates essence and marrow, which can be consumed or exhausted by indulgence in sexual activity. The brain is therefore, poorly nourished causing forgetfulness.
Treatment: mainly replenish HT blood and reinforce SP/KIRx: Shishencong (Extra pt), UB15, UB20, ST36, UB23 & KI6Shishencong (Extra pt) empirical pt for poor memoryUB15 & UB20 strengthen HT & SPUB23 & KI6 promote KI Essence, produce marrow and replenish the brainST36 reinforces SP/ST t/t and replenish qi and blood
PALPITATION unduly rapid action of the HT which is felt by the patient and accompanied by nervousness and restlesness
Etiology & Pathogenesis a) Disturbance of the Mindb) Qi and Blood Defc) Yin def w/hyperactive Fired) Retention of harmful fluids
Differentiation:
a) Mind Disturbance: palpitation, fear and fright, irritability, restlessness, dream-disturbed sleep, anorexiaTongue: white, thin coatingPulse: a little bit rapidIn case of phlegm heat: T: yellow, sticky coating, P: rolling & rapid
Analysis:
fear makes the qi flow disordered, and fright makes qi descend. A disturned mind is out of self-control, leading to palpitations, fear and fright, dream-disturbed sleep, irritability and restlessness.
b) Qi and Blood Def: palpitations, lusterless complexion, dizziness, blurred vision, shortness of breath, lassitudeTongue: pale w/teeth marksPulse: thready, weak or intermittent
Analysis:
palpitations are due to qi and blood def, which fails to nourish the HT. Dizziness is due to poor nourishment of qi and blood to the brain. The HT dominates the blood and vessels and is manifested in the tongue, hence the teeth marks.
c) Fire Hyperactivity due to Yin Deficiency: palpitations, restlessness, irritability, insomnia, dizziness, blurred vision, tinnitus
Tongue: red w/little coatingPulse: thready, rapid
Analysis:
KI yin def fails to control HT fire, leading to disturbance of the mind, and resulting in palpitations, irritability and insomnia. When Yin def is present in the lower part of the body, Yang hyperactivity is in the upper part, hence the dizziness and tinnitus.
d) Retention of harmful fluid:palpitation, expectoration of mucoid sputum, fullness in the chest and epig region, lassitude, weakness, cold limbs, thirst w/o desire to drinkTongue: white, slippery coating (yang def)Pulse: deep, string-taut or rapid (Yang def SP/KI)
Analysis:
accumulation of dampness forms harmful fluids which depresses HT Yang, hence cold limbs. Unsmooth qi circulation resulting from SP/KI Yang def gives rise to scanty urine and thirst w/o desire to drink.
Rx: UB15, Ren14, HT7, PC6
General Treatment:HT7 (yuan primary) & UB15 w/Ren14 (HT Front-Mu) and PC6 (Luo-connecting of PC) can regulate qi and blood of the HT and calm the mind.
Disturbance of the mind HT5 (Luo-connecting of HT) & GB40 (yuan primary of GB) can calm and regulate GBif accompanied w/phlegm-heat: ST40 (Luo-connecting of ST) & UB19 (GB Back-Shu) disolve phlegm and dispel heat
Qi & Blood def:UB20 & UB21 regulate SP/ST to promote qi and blood production + ST36 is important to reinforce qi and blood
Yin def w/excess Fire UB23 & KI3 can replenish KI Yin + UB14 can clear HT FireRetention of harmful fluids: Ren4 & Ren9 & SP6 can invigorate the HT Yang, strenghten SP and remove harmful fluid
MANIC-DEPRESSIVE DISORDER
mental dejection, reticence or incoherent speech, while manic disorder by shouting, restlessness and violent behavior
Etiology & Pathogenesis a) Depressive Disorderb) Manic Disorder
Differentiation:
a) Depressive Disorder:graudal onset, emotional dejection and mental dullness at the intial stage, followed by incoherent speech, changing moods or muteness, somnolence, anorexiaTongue: thin, sticky coatingPulse: string-taut, thready or string-taut & rolling (Accumulation of phlegm and qi)
Analysis:overcontemplation and emotinal dejection make the LV qi stagnated and the SP qi fails to ascend. Stagnant qi combined with phlegm disturb the mind, leading to mental disorders. The stagnated phlegm in the mj gives rise to anorexia
Treatment: This condition is caused by the stagnation of phlegm and qi, which injures the HT,LV,SPRx: UB15, UB18, UB20, HT7, ST40UB15 is used to clear the HTUB18 removes LV qi stagnationUB20 promotes SP qi circulation
HT7 & ST40
b) Manic Disorder:sudden onset, irritability, easily angered, insomnia, loss of appetite, followed by excessive motor activity w/increased energy and violent behavior.Tongue: yellow, sticky coatingPulse: string-taut, rolling and rapid
Analysis:
anger damages the LV. LV fire flares up and agitates phlegm-heat of Yangming to disturb the mind. Therefore, the patient is irritable, unable to fall asleep and easy to anger. Violent behavior is due to phlegm-heat. The limbs are the foundation of all yang action, therefore preponderant yang makes the limbs move energetically, thus physical strength and motor activity are increased.
LV Fire RisingTreatment: Rx: DU14, DU16, DU26, PC6, ST40
Supplementary pts:Mania w/extreme Heat: 12 Jing-well on hand, LU11, HT9, PC9. LI1, SJ1 bleed to reduce heatDU14 & DU26 reduce heat for clearing the mindDU16 tx mental disorders "The brain is the sea of marrow, its upper part reaches the vertex of the cranium, and its lower part reaches
EPILEPSYoccurs in seizures, manifested by falling down in a fit, loss of consciousness, foam on the lips, or screams with eyes staring upward, convulsions. After some minutes, consciousness returns and patient's condition becomes normal.
Etiology & Pathogenesis a) Fear and FrightFear makes qi disordered and fright makes qi descend, affecting the LV & KI and leading to stirring of the deficiency wind.
b) LV Qi Dysfunction/Irregular Food IntakeLV Qi dysfunction or irregular food intake damaging the SP/ST, makes the dampness of food and drink accumulate as phlegm, which combined with stagnated LV Qi, disturbs the mind and causes epilepsy.
c) Hereditary factors: usually cause epilepsy in early childhood
Differentiation:
a) During Seizure:
preceded by dizziness, headache and suffocating sensation in the chest, immediately followed by falling down w/loss of consciousness, pallor, clenched jaws, upward staring of the eyes, convulsion, foam from the lips, screaming as pigs or sheep, even incontinence of urine and feces. Gradually, the patient regains consciousness. Apart from fatigue and weakness, the patient can live a normal life.Tongue: white, sticky coatingPulse: String-taut, rolling
Analysis:
dizziness, headache and suffocating sensation in the chest are the prodomal (initial) symptoms which show upward perversion of Wind-Phlegm. LV Wind stirs up w/phlegm to disturb the mind. Thus, there is loss of consciousness, convulsions and upward staring of the eyes. The foam on the lips is due to the ascending wind-phlegm. Since wind-phlegm is irregularly accumulated and dispersed, the seizures are paroxysmal (sudden), and the patient behaves normal after the seizure.
Treatment: Points of the DU, Ren & LV channel are selected w/reducing method to dissolve phlegm induce resuscitation, soothe the LV and dispel wind.Rx: DU26, Ren15, PC5, LV3, ST40DU26 & Ren15 used for resuscitationPC5, LV3 & ST40 calm the Heart, ease the mind, dissolve phlegm and dispel wind.
b) After Seizure:listlessness. Lusterless complexion, dizzinesss, palpitations, anorexia, profuse sputum, weakness and soreness of loins and limbs
Tongue: pale w/white coating Pulse: thready, rollingNote: T/P combo indicate qi & blood consumption w/accumulation of phlegm-damp
Analysis:
listlessness is due to damage of vital qi by frequent epileptic fits. With insufficient blood, the complexion is lusterless. Dizziness indicates poor blood supply to the brain and palpitations signal the same to the Heart. Due to the depression of SP Yang, the food cannot be transformed into essence, leading to dampness and phlegm causing anorexia & profuse sputum. Def KI Essence leads to weakness and soreness of loins and limbs.
Treatment: HT/SP/KI pts, to nourish the HT, ease the mind, strenghten the SP & reinforce KIRx: UB15, Yintang, HT7, SP6, KI3, Yaoqi (Extra)UB15, Yintang, HT7 nourish the HT, ease the mindSP6, KI3 strenghten the SP and reinforce the KIYaoqi (Extra) empirical pt for Epilepsy
Supplementary Pts:UB62 used for daytime seizuresKI6 used for night time seizuresRen12 & ST40 regulate ST and dissolve phlegmRen4 & ST36 regulate and replenish qi and blood
DIZZINESS mild case can be relieved by closing one's eyes, while serious cases have an illusion of bodily movement with rotatory sensation, accompanied by nausea, vomiting & sweating
Etiology & Pathogenesis a) Hyperactivity of LV YangLV is analogized as wind and wood, characterized by movement and ascending.Overcontemplation, anxiety, depression or anger can damage the LV Yin, leading to LV Yang hyperactivity. Dizziness indicates LV Yang rising aided by wind. Or KI water, generally deficient, fails to nourish the LV. Dizziness occurs in case the LV lacks nourishment, leading to LV Yang rising (hyperactivity). Both situations show deficiency in the lower part and excess in the upper part.
b) QI & Blood DeficiencyHT/SP are damaged by overwork and overcontemplation in case of weak constitution after an illness. Damaged SP fails to produce Qi & Blood leading to poor nourishment to the brain causing dizziness.
c) Interior Retention of Phlegm-DampnessA person w/generally abundant phlegm-damp, irregular food intake and overwoek damage the SP, impairing t/t fxn leading to production of damp & phlegm. Stagnant phlegm and qi may impede the asceding of clear yang and the descending of turbid yin, thus dizziness occurs.
Differentiation:
a) Hyperactivity of LV Yang:dizziness agravated by anger, irritability, flushed face, red eyes, tinnitus, bitter taste in the mouth, dream-disturbed sleep.Tongue: red w/yellow coating Pulse: string-taut, rapid
Analysis:Anger damages LV Yin leading to LV Yang rising. When Fire flares up, red eyes, flushed face and irritability occur. The Spirit stored in the LV is upset by disorders of the LV leading to dream-disturbed sleep.
Treatment: Nourish Yin and pacify YangRx: GB20, UB18, UB23, KI3, LV2UB23 & KI3 reinforcing method to replenish KI waterUB18, GB20 & LV2 reducing method to pacify LV Yang
b) QI & Blood Deficiency:dizziness w/pallor and lusterless complexion, palpitations, insomnia, pale lips and nails, lassitudeTongue: pale
Pulse: thready and weakNote: t/p indicative of qi & blood def
Analysis:
Dizziness is due to lack of nourishment to the brain. The HT dominates blood and is manifested in the complexion which is pale. The SP dominates t/t to manufacture qi and blood. If Ht/SP are injured, qi and blood wil be insufficient, leading to pale lips, nails, palpitation and insomnia. Def Qi leads to lassitude, anorexia and is agravated by work.
Treatment: Replenish Qi and BloodRx: DU20, UB20, Ren4, ST36, SP6DU20 Moxa, ascends qi & blood to the head and nourish the brain, stop dizzinessRen4 strengthens Primary (Yuan) QiUB20 & SP6 invigorate SP/ST to produce qi and blood
c) Interior Retention of Phlegm-Dampness:
dizziness w/heavy feeling of the head, suffocating sensation of the chest, nausea, profuse sputum, anorexia, somnolenceTongue: white, sticky coatingPulse: soft, rolling
Analysis:dizziness w/heaviness of the head is a sign of pure yang disturbed by phlegm-damp. Chest oppression and nausea are due to qi obstruction in the mj. Anorexia and somnolence are due to SP Yang deficiency.
Treatment: Resolve phlegm and eliminate dampRx: ST8, UB20, Ren12, PC6, ST40UB20 & Ren12 strenghten SP/ST to eliminate dampST40 (luo-connecting of ST) makes qi descend and resolves phlegmST8 is for dizzinessPC6 relaxes the chest, regulates qi and harminizes ST, stops vomiting
MELANCHOLIAgeneral term for disorders resulted from emotional depression and stagnation of qi. Emotional frustration leads to stagnation of qi leading to stagnation of blood, accumulation of phlegm, food retention, fire collection, disharmony of zang-fu organs.
Etiology & Pathogenesis a) Depressed Anger
b) Too much worry
Differentiation:
a) Depression of LV Qi:mental depression, distress of chest, hypochondriac pain, abd distention, belching, anorexia, or abd pain , vomiting, abnormal bowel movementTongue: thin, sticky coating (SP)Pulse: string-taut (LV)
Analysis:
In case of emotional injury, LV fails to be harmonious and flourish, thus mental depression appears. LV qi stag leads to chest distress, hypoch pain and abd distention. If ST qi failst to descend, belching and anorexia occur. When LV qi invades the SP, abd pain, vomiting and abnorman BM result.
Treatment: Soothe LV, strenghten SP, harmonize STRx: UB18, Ren17, Ren12, ST36, SP4, LV3Ren17 (Influential Pt of Qi) regulates qi flowUB18 (LV Back-Shu) and LV3 (Yuan primary) sooth the LV and remove depressionRen12 & ST36 harmonize ST and descend qiSP4 (SP Luo-Connecting) strenghtens SP & harmonizes ST
b) Transformation of depressed Qi into Fire:
headache, dryness, bitter taste, irritability, chest distress, acid regurgitation, constipation, red eyes, tinnitusTongue: red w/yellow coating Pulse: string-taut, rapid
Analysis:
When depressed (stagnant) qi is transformed into Fire, it flares up along the LV meridian, resulting in headache, red eyes, tinnitus. LV fire evaporates body fluids and heat accumulates in ST and intestines leading to bitter taste, constipation, dryness. If LV invades ST, it impairs the ST's descending fx causing chest distress, hyponch distention, acid regurg.
Treatment: Dispel LV Fire and strenghten ST fxnRx: Ren13, SJ6, GB34, LV2, GB43LV2 & GB43 (Ying-Spring of LV/GB) dispel LV/GB FireSJ6 & GB34 tx chest distress, hypochondriac dist, bitter taste, constipationRen13 harmonizes ST, regulates qi flow to tx acid regurgitation
c) Stagnation of Phlegm: feeling of lump in the throat, hard to spit out or swallow itTongue: thin, sticky coating Pulse: string-taut, rolling
Analysis: Stagnant LV qi (depressed) overacts on ST/SP impairing t/t fxn. Dampness from food and water turns into phlegm, which combined w/qi stays in the throat, giving rise to the choking feeling.
Treatment: Soothe the LV, remove depression, regulate qi flow and resolve phlegmRx: Ren22, Ren17, PC6, ST40, LV3LV3 sooths the LV and removes depressionRen22 descends qi and tx throat troublePC6 removes depression from chest and regulates qi flowRen17 (qi Influential pt) & ST40 (ST Luo-Conn) promote qi circulation & resolve phlegm
d) Blood Deficiency: (aka Hysteria)
grief w/o reason, capricious joy or anger, suspicions, liability to get frightened, palpitations, irritability, insomnia, or sudden chest distress, hiccup, sudden aphonia, convulsion, loss of consciousnessTongue: thin, white coating Pulse: string-taut, thready (long-standing Qi Stag damaging blood)
Analysis:due to overcontemplation and emotional frustration, the qi fxn is impaired and the blood is gradually consumed, leading to poor nourishment of the mind. Qi blockage leads to chest distress, hiccup, sudden aphonia and convulsion.
Treatment: Nourish blood, soothe the LV and refresh and tranquilize the mindRx: Ren14, HT7, SP6, LV3LV3 soothes the LV and removes depressionRen14 (HT Front-Mu) & HT7 (Yuan Prim) + SP6 nourish blood, refresh and ease mind
Supplementary Pts:Chest Distress: PC6 & Ren17 remove depression of the chestHiccup: SP4 & Ren22 cause qi to descend and stop hiccupsSudden aphonia: HT5 & Ren23 Convulsion: LI4 (regulates qi flow) & GB34 (Inf. Pt of tendons) relieves painLoss of Consciousness: DU26 & KI1 used for resuscitation
III) Diseases of the Head, Trunk and Lumbar Regions
HEADACHEHeadache is a subjective symptom. It can be induced by various acute and chronic diseases. The head is the place where all the Yang meridians of the foot and hand meet, and qi and blood of the 5 zang organs and the 6 fu organs all flow upward to the head.
Etiology & Pathogenesis a) Invasion of pathogenic wind into the meridians and collaterals:Causes derangement and obstruction of qi and blood. With stagnation in the collaterals, sudden weather change or exposure to wind usually precipitates a headache
b) Upsurge of LV Yang:Patients w/excessive yang of body constitution, H/A may be due to upsurge of LV Yang due to qi stag or LV injury after an anger fit, which damages the Yin.
c) Qi and Blood Deficiency: Qi def prevents clear Yang from ascending and blood def does not nourish the mind, thus leading to H/A
Differentiation:
a) Invasion of pathogenic wind into the meridians and
collaterals:
headache occurs on exposure to wind, pain extends to nape of the neck and back region. Violent, boring & fixed pain
Tongue: thin, white coatingPulse: string-taut
Analysis: Pain comes from qi blockage in the meridians on the head caused by wind. Violent quality of pain is due to wind and the fixed quality is due to blood stasis derived from qi stagnation.
Treatment: Dispel Wind, remove obstruction in the mer. & collaterals, reg qi & blood, stop pain.Rx: Occipital Headache - GB20, UB60, SI3 Frontal Headache - ST8, Yintang, Du23, LI4, ST44 Temporal Headache - Taiyang, GB8, SJ5, GB41 Parietal Headache - DU20, SI3, UB67, LV3
b) Upsurge of LV Yang: headache, blurred vision, severe pain bilaterally, irritability, hot temper, flushed face, bitter tasteTongue: red tongue w/yellow coatingPulse: string-taut & rapid
Analysis:Headache and blurred vision are due to rising of excessive LV Yang attacking the head. Bitter taste is from excess heat in GB due to LV Yang rising. Severe pain bilaterally is due to GB meridian path and excess heat.
Treatment: Pacify LV YangRx: GB20, DU20, GB5, GB43, LV2The Jueyin meridian of foot reaches the parietal region and the Shaoyang meridian runs up bilateral sides of the head.
c) Qi and Blood Deficiency:lingering headache, dizziness, blurred vision, lassitude, lusterless face, pain relieved by warmth and aggravated by cold, overstrain or mental stressTongue: pale tongue w/thin coatingPulse: weak and thready
Analysis:
Lingering headache is due to def qi that fails to make clear Yang ascend and turbid yin descend. Overstrain causes severe pain due to further consumption of qi. Lassitude, pain which is relieved by warmth indicates failure of yang qi distribution. Lusterless face, dizziness, blurred vision indicate poor nourishment of the face and head.
Treatment: Tonify and regulate qi & blood circulation, promote ascension of clean qi and descent of turbid qi by needling DU & Ren channels.Rx: Du20, Ren6, UB18, UB20, UB23, ST36Ren6 tonifies primary qiDU20 lifts up the clean yang
UB18, UB20, UB23 (LV,SP,KI back-shu) LV stores the blood, SP controls blood and KI stores and produces essence and blood, combined they strenghten KI essence and tonify qi and blood.
FACIAL PAIN (Trigeminal Neuralgia)
Facial pain is severe, transient, occuring in one side of the forehead, maxillary region or mandibular region. Onset is abrupt like an electric shock, pain is cutting, burning and intolerable. Frequent recurrences denotes a chronic disease
Etiology & Pathogenesis a) Facial pain due to invasion of pathogenic Wind and Cold:Cold contracts meridians and impairs free flow of qi leading to qi stag causing pain.
b) Facial pain due to LV/ST Fire:ST fire is due to food retention and LV fire is due to LV qi stag.
c) Facial pain due to Yin Def and Excess Fire:Def Yin produces excess fire which rises and attacks the face/head.
Differentiation:
a) Facial pain due to invasion of pathogenic Wind and Cold:
abrupt onset of pain occurs like an electric shock. Pain is cutting, boring, intolerable but transient and paroxysmal. Each attack lasts a few seconds or 1-2 minutes. Ahi pts will be active at supraorbital foramen, infraorbital foramen, angle of mouth, nasolabial groove, lateral sides of ala nasi.Tongue: white, thin coatingPulse: string-taut
Analysis: Pain is due to obtruction of qi and blood in meridians on the face due to invasion of w/c. Burning pain comes from fierce fight b/n pathogenic factor and wei qi.
b) F. pain due to LV/ST Fire: pain as described above accompanied by irritability, hot temper, thirst, constipationTongue: yellow & dry coatingPulse: string-taut, rapidNote: t/p combined indicate LV Fire
Analysis:Irritability and hot temper due to fire caused by prolonged LV qi stag. Burning pain is due to internal heat coming from food retention in ST, which rises to the face through ST meridian, thirst and constipation are the product.
c) Facial pain due to Yin Def and Excess Fire:
insidious (w/no precursor or warning) pain, emaciation, malar flush, soreness in lumbar region, lassitude, pain aggravated by fatigueTongue: redened tongue w/little coatingPulse: thready & rapid (t/p indicative of yin def w/excess fire)
KI stores essence and dominates water. When KI essence is def, lassitude, lumbar pain and emaciation occur. Insufficient KI water fails to control fire, which flares up along the meridians and reaches the face, causing malar flush and facial pain.
Pain in suborbital region: GB14, Taiyang, UB2, SJ5Pain in maxillary region: ST2, SI18, LI20, LI4Pain in mandibular region: ST7, ST6, ST5, Jiachengjiang (extra), LI4
Supplementary PtsW/C Invasion: GB20ST/LV Fire: LV3, ST44Yin Def w/excess Fire: KI6, SP6
EYE & MOUTH DEVIATION derived from Wind-Cold invasion of meridians and collaterals and muscle meridians in the facial region. Most common in patients from 20-40 yrs old, mostly in males.
Etiology & Pathogenesis due to paralysis of facial muscles caused by wind-cold attack on Yangming and Shaoyang meridians, which leads to malnutrition of the muscle regions of said meridians.
Differentiation:
Main Manifestations:
sudden onset, usually right after waking up, incomplete closure of eye in the affected side, drooping of the angle of the mouth, salivation and inability to frown, raise the eyebrow, close eye, blow out cheek, headacheTongue: thin, white coatingPulse: superficial tense or superficial slow
Analysis: paralytic muscles are caused by qi stag in the meridians and malnutrition of the regions of the muscle meridians after the invasion of w/c.
General Treatment: Eliminate wind and remove obstructionRx: SJ17, GB14, Taiyang, SI18, ST7, ST4, ST6, LI4LI4 (LI Yuan Primary) eliminates wind from the head and faceGB12 & GB2 eliminate wind and relieve headacheGB14, Taiyang, UB2, SJ23, GB1, Yuyao, ST3, DU26, ST4, ST6, LI20, SJ17 are local pts that eliminate wind and invigorate circulation of meridians.
Supplementary Pts: Headache: GB20Diff frowning and raising eyebrows: UB2, SJ23Incomplete eye closure: UB2, UB1, GB1, Yuyao, SJ23Diff sniffing: LI20Deviation of philtrum: DU26Inablitiy to show teeth: ST3Tinnitus & deafness: GB2
HYPOCHONDRIAC PAIN a subjective symptom..as the LV supplies the hypochondriac regions, and the LV is related to the GB, the occurrence of hypochondriac pain is mostly concerned w/disorders of the LV/GB.
Etiology & Pathogenesis a) Emotional strain causes LV qi stag.
b) LV qi stag leads to blood stagnation
c) Blood & Essence deficiency
Differentiation:
Excess Type: i) Qi Stagnation:distending pain in costal and hypochondriac region, stifling sensation in the chest, sighing, poor appetite, bitter tasteTongue: white, thin coatingPulse: string-taut
Analysis:
distending pain in costal and hypochondriac region indicates obstruction of collaterals due to LV qi stagnation (impairment of free flow of LV qi). Severity depends on emotional state. Stifling sensation in chest and sighing indicate uneven qi activity. Poor appetite shows LV qi invading SP.
ii) Stagnation of Blood:fixed stabbing pain in hypochondriac region, intensified by pressure and at nightTongue: dark purplish tongue properPulse: deep, hesistant
Analysis: fixed stabbing pain (blood stasis), pain intensified at night suggests blood as yin stagnates at night.
Treatment: Remove stagnation of LV qi and obstruction in collaterals.Rx: LV14, SJ6, GB34SJ6 & GB34 relieve pain by regulating the Shaoyang meridian.LV14 (LV Front-Mu) eases the LV and relieves pain in hypochondrium
Supplementary pts:Qi Stag: LV3, GB40 (regulate LV/GB qi)Blood Stag: UB17, UB18 (activate blood circulation and remove stasis)
b) Deficiency Type:dull pain lingering in costal and hypochondriac region, dry mouth, irritability, dizziness, blurred visionTongue: red tongue w/little coatingPulse: weak or rapid & thready
Analysis:dull pain in the costal and hypoch region indicates essence and blood def which causes poor nourishment of collaterals of LV. Dry mouth and irritability suggest Yin Def with excess heat. Dizziness and blurred vision are due to shortness of essence and blood.
Treatment: Nourish essence and blood, invig circulation of qi, relieve painRx: LV14, UB18, UB23, ST36, SP6, LV3UB18 (LV Back-Shu) & LV14 (LV Front-Mu), LV3 (Yuan prim) combo nourishes Yin & blood, readjusts the LV and relieve painST36, SP6 strengthen SP/ST fxn to produce qi and blood
LOW BACK PAIN closely associated w/disorders of the KI for the lumbus is the seat of the KI
Etiology & Pathogenesis a) Cold-damp Invasion:low back pain (LBP) is due to qi obstruction caused by damp environment
b) Ki Deficiency:generally due to excessive sexual activity that consumes essence and qi, resulting in poor nourishment of the meridians in the lumbar region.
c) Trauma:trauma may injure qi and blood in meridians and collaterals, leading to qi & blood stag
Differentiation:
a) Cold-damp Invasion:
LBP usually occuring after exposure to cold-damp and aggravated by rainy days, heavy senstation and stiffness of muscles in dorsolumbar region, limitation of extension and flexion of the back, pain radiating downwards to the buttocks and lower limbs, cold feeling of the affected areaTongue: white, sticky coatingPulse: deep, weak and slow
Analysis:pathogenic cold-damp stagnates qi & blood and blocks meridians. This produces heaviness, cold sensation and pain in lumbar region and limitation of extension and flexion.
b) Ki Deficiency:insidious (w/o warning) onset of protracted pain and soreness, accompanied by lassitude and weakness of knees and loins, aggravated by fatigue and alleviated by bed rest. KI Yang Def: cramp-like sensation in abdomen, pallor, cold limbsTongue: pale Pulse: deep, slow or deep thready Ki Yin Def: irritability, insomnia, dry mouth and throat, flushed face, feverish sensation in the chest, palms and solesTongue: redened tongue proper w/scanty coating Pulse: thready, weak or thready, rapid (t/p combo indicative of blood stasis)
Analysis:
the lumbar is the "dwelling house of the KI", KI dominates bones, produces marrow, stores essence. When the KI essence is deficient, bones lack marrow, resulting in soreness and pain in lumbar region accompanied by weakness of the knees. Overstrain further consumes qi and blood worstening the pain. KI Yang Def: KI fails to warm the lower abdomen and the limbs. Yang def causes pallor, pale tongue & thready pulse
Ki Yin Def: Ki water is unable to ascend to reduce HT fire, leading to insomnia and irritability. Yin def causes excessive internal heat leading to flushed face, 5 center heat, dry mouth & throat
c) Trauma:history of sprain of lumbar region, rigidity and LBP generally fixed in a certain area, aggravated by pressure and by turning the body.Tongue: pink or dark purplish tongue proper Pulse: string-taut, hesitant
Analysis:muscular strain in lumbar region causes retardation of qi and blood and further leads to stagnation of blood in meridians and collaterals. This results in fixed severe pain which can be aggravated by pressure.
General Treatment: Promote qi and blood circulation, relieve pain, relax muscles & activate circulation in collaterals.Rx: UB23, DU3, UB40UB23 (Ki Back-Shu) tonifies KI Qi. W/Moxa it eliminates cold & dampDU3 (local)UB40 (one of Four Key Pts) important distal pt for LBP
Supplementary Pts:Cold-Damp: UB25, UB26 (dispel w/c, remove obstructions, relieve pain)Ki Yang Def: Du4, Yaoyan (tonidy KI Yang and KI essence)KI Yin Def: UB52, KI3 ( both nourish Ki Yin)Traumatic Injury: DU26 (distal used for rigidity & LBP), Yaotongxue (extra) empirical pt for lumbar sprains + Ashi pts
BI SYNDROMEsyndromes characterized by obstruction of qi and blood due to invasion of wind, cold, damp and manifested by soreness, pain, numbness and heavy sensation of the limbs and joints, and limitation of movement.
Etiology & Pathogenesis a) Wandering Bi: migrating pain caused chiefly by pathogenic wind
b) Painful Bi: severe pain caused chiefly by pathogenic cold
c) Fixed Bi: marked soreness, numbness and heaviness caused by pathogenic damp.d) Heat Bi: heat manifestations and sudden onset
Differentiation:
CHARACTERIZED BY INVASION OF PATHOGENIC FACTOR:
a) Wandering Bi: wandering joint pain, esp wrists, elbows, knees and ankles, limitation of movement, chills & feverTongue: thin & sticky coatingPulse: superficial & tight or superficial & slow
Analysis: wandering pain is due to wind invasion characterized by constant movement and changes. Chills and fever result from the struggle b/n wei qi and pathogenic factor.
b) Painful Bi: severe stabbing pain in joints, alleviated by warmth and aggravated by cold, w/fixed location but no local redness and hotness.Tongue: thin & white coatingPulse: string-taut and tense
Analysis: severe pain due to retarded qi & blood flow caused by cold. Pain is localized because of the congealing effect of cold.
c) Fixed Bi: numbness and heavy sensation of the limbs, soreness and fixed joint pain, aggravated on cloudy and rainy days.Tongue: white, sticky coatingPulse: soft
Analysis:damp is characterized by heaviness, when in excess, it invades the limbs and joints causing retarded qi and blood flow resulting in numbness and heaviness. Pain caused by damp is fixed in location.
d) Heat Bi: arthralgia (joint pain) involving one or several joints, local redness, swelling and excruciating pain w/limited movement, fever, thirstTongue: yellow coatingPulse: rolling & rapid
Analysis: local redness, swelling and joint pain result from the transformation of pathogenic factors into heat.
CHARACTERIZED BY LOCATION:
Skin Bi: numbness of the skin with cold sensation
Muscle Bi: soreness, numbness and muscle pains
Tendon Bi: soreness, pain and stiffness of the tendons and muscles
Vessel Bi: pain due to blockage of vessels
Bone Bi: soreness, heaviness and joint pain which fails to perform their functions of lifting, extension and flexion
General Treatment:
Tx Principle: Reducing method: wandering bi, heat bi, tendon biMoxa: painful bi, vessel biAcup & Moxa: fixed bi, skin bi, muscle bi, bone bi
Remove obstruction from meridians and collaterals, regulate Ying (Nutritive) Qi and Wei (Defensive) Qi for elimination of wind, cold, and damp.
Eight Confluent Points: tx shoulder, back, lumbar, legs, muscles, tendons & bones:
SI3 communicates w/Du Channel UB6 communicates w/Yangqiao meridian SP21 major Luo-connecting of SP which connects qi of the whole body UB17 Influential pt of blood
Shoulder joint pain: Rx: LI15, SJ14, SJ19, SI10Scapula pain: Rx: SI11, SI12, SI14, UB43Elbow pain: Rx: LI11, LU5, SJ10, SJ5, LI4Wrist Pain: SJ4, LI5, SI5, SJ5Finger Stiffness: SI5, LI4, SI3Finger numbness & pain: SI3, LI3, Baxie (Extra)Lumbar pain: Du26, DU12, DU3Hip Joint pain: GB30, GB29, GB39Thigh pain: UB54, UB36, GB34Knee pain: Heding (extra), ST35, Medial Xiyan (extra), GB34, SP9Leg numbness & pain: UB57, UB58Ankle pain: ST41, SP5, GB40, UB60, KI3Toe numbness & pain: SP4, UB65, Bafeng (extra)Back pain: DU26, DU12, DU3General pain: SI3, UB62, SP21, UB17, LI15, LI11, LI4, SJ4, GB30, GB34, GB39, ST41
Supplementary Pts:
Wandering Bi, Vessel Bi:UB17, SP10 (activate & nourish the blood) + GB20 to expel wind (wind will be naturally eliminated if blood circulates)
Painful Bi: UB23, Ren4 (strengthen KI fire and relieve painful bi)Fixed Bi: ST36, SP5 (strengthen SP/ST fxn and eliminate damp to relieve fixed bi)Heat Bi: DU14, LI11Tendon Bi: GB34 (Influential pt for tendons)Bone Bi: UB11 (Influential pt for bone) & GB39 (Influential pt for marrow)
WEI SYNDROMEsyndromes characterized by flaccidity or atrophy of the limbs with motor impairement. Also called "flacid lame" for the leg is usually involved. First described as a syndrome mainly caused by heat in the LU w/lobes scorched.
Etiology & Pathogenesisa) Burning Heat in the Lungs: muscular flaccidity or atrophy of limb results from malnourishment of tendons due to body fluid exhaustion. Caused by exogenous pathogenix heat, or excess heat remaining in LU after illness.
b) Damp-Heat: exogenous damp invades the body, accumulation of damp is turned into heat which damages muscles and tendons, hence becoming flaccid. Greasy food intake which produces internal accumulation of damp-heat, resulting in qi & blood stag in the meridians and collaterals.
c) KI/LV Yin Def: LV stores blood and controls tendons, the KI stores essence and dominates bones. Prolonged illness or excessive sex cause essence and blood loss, resulting in malnutrition of tendons.
d) Trauma: contusion causes injury of the meridian and leads to retarded flow of qi and blood in meridians. Poor nourishment of muscles leads to flaccidity.
Differentiation:
a) Heat in the LU:muscular flaccidity of the lower limbs w/motor impairment, accompanied by fever, cough, irritability, thirst, scanty and brownish urineTongue: redened tongue proper w/yellow coating Pulse: thready & rapid or rolling & rapid
Analysis:Fever and cough are results of pathogenic heat invasion to the LU. Irritability, thirst and scanty, brownish urine indicate body fluid damage by internal heat. Muscular flaccidity and motor impairment due to damaged BF & essence.
b) Damp-Heat:flaccid or slightly swollen legs little hot sensation on touch, heaviness, fullness of chest and epig region, painful urination, hot & brownish urine.Tongue: yellow, sticky coating Pulse: soft & rapid
Analysis: leg flaccidity due to qi & blood stagnation in tendons and muscles caused by prolonged accumulation of damp-heat. Hot and brownish urine indicates downward flow of damp-heat.
c) LV/KI Yin Def:muscular flaccidity of lower limbs w/motor impairment, combined w/soreness and weakness of lumbar region, seminal emission, prospermia, leukorrhea, dizziness, blurred visionTongue: redened tongue proper Pulse: thready & rapid
Analysis:LV/KI yin def leads to poorly nourished muscles, tendons and bones, hence the muscular flaccidity and motor impairment. KI essence def lead to seminal emission, leukorrhea, weakness of lumbar region. Dizziness and blurred vision are due to Yang preponderance.
d) Trauma: history of trauma, flaccid paralytic limbs, may be accompanied w/incontinence of urine and fecesTongue: pink or purplish tongue w/thin Pulse: thready & rapid
Analysis:
flaccid paralytic limbs arise from obstruction of qi and blood at the injured site of trauma. Incontinence of urine and feces is mainly due to Ki disfunction. In case of trauma, the DU channel which dominates all Yang qi is affected, and the qi flow of all fang-fu organs may be impaired, including urination and defecation.
General Treatment:
Tx Principle: Promote qi flow in meridians, nourish tendons and bones.
NOTE: "Only pts of the Yangming meridians are selected to tx paralysis of the limbs"
Upper Limb: LI15, LI11, LI4, SJ5Lower Limb: ST31, GB30, SP10, ST34, ST36, GB34, ST41, GB39
GB34 & GB39 (Inf. Pts of tendons and marrow respectively) nourish tendons and bone
Supplementary Pts:Heat in LU: LU5, UB13 (used to dissipate heat from LU)Damp-Heat: UB20, SP9 (eliminate damp-heat)LV/KI Yin Def: UB18, UB23 (tonify LV/Ki Yin)Trauma: Huatuojiaji pts corresponding to spinal injury (regulate qi in Du channel)Urine Incontinence: Ren3, SP6 (adjust qi in KI/bladder)Fecal Incontinence: UB25, UB32 (improve LI fxn)
