TCM Spleen Disease Spleen PhysiologySpleen Physiology Spleen PathologySpleen Pathology...

TCM Spleen DiseaseTCM Spleen Disease• Spleen PhysiologySpleen Physiology

• Spleen PathologySpleen Pathology

• Gingivitis/StomatitisGingivitis/Stomatitis

• UlcersUlcers

• PancreatitisPancreatitis

• BleedingBleeding

• Muscle WastingMuscle Wasting

• ObesityObesity

• ConstipationConstipation

EarthEarth

•SoundSound•songsong

•EmotionEmotion•sympathysympathy

•ClimateClimate•humidhumid

•SeasonSeason•late summerlate summer

•DirectionDirection•centercenter

•OpeningOpening•lips/gumslips/gums

•Body PartBody Part•musclesmuscles

•Zang/FuZang/Fu•SP/STSP/ST

TCM TCM SPLEENSPLEEN PhysiologyPhysiology

•Governs Transportation & Governs Transportation & TransformationTransformation

•Food & WaterFood & Water

•Controls BloodControls Blood

•Dominates the MusclesDominates the Muscles

•Opens in MouthOpens in Mouth•Lips & Gums (ST)Lips & Gums (ST)

TCM 24 Hour ClockTCM 24 Hour Clock

GB 11- 1AM

TH 9- 11 PM

PC 7- 9 PM

KID 5- 7 PM

BL 3- 5 PM SI 1- 3 PM

HT 11- 1 PM

SP 9- 11 AM

ST 7- 9 AM

LI 5- 7 AM

LU 3- 5 AMLIV 1- 3 AM

Spleen PathologySpleen Pathology


• Damp is the Enemy of the SpleenDamp is the Enemy of the Spleen

• Damp-ColdDamp-Cold• Damp-HeatDamp-Heat• Spleen Qi Deficiency with DampSpleen Qi Deficiency with Damp

Spleen PathologySpleen PathologyUsually combination of excess & deficiencyUsually combination of excess & deficiency

Damp-HeatDamp-Heat Damp-ColdDamp-Cold

Obstructs Spleen Qi FlowObstructs Spleen Qi Flow

Spleen fails to Transform & Transport Gu QiSpleen fails to Transform & Transport Gu Qi

Spleen Qi DeficiencySpleen Qi Deficiency

External or Internal PathogenExternal or Internal Pathogen


Cold Food Cold Food or Drinkor Drink

Cold Cold Environmental Environmental ConditionsConditions

Cold-Damp in SpleenCold-Damp in Spleen

Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow

Spleen Pathology Spleen Pathology

Damp Hot Damp Hot Food or Food or DrinkDrink

Damp Hot Damp Hot Environmental Environmental ConditionsConditions

Damp-Heat in SpleenDamp-Heat in Spleen


Accumulated Accumulated Heat & DampHeat & Damp


OvereatingOvereating

StarvationStarvation


Failure to Transform & TransportFailure to Transform & TransportDisturbed Qi FlowDisturbed Qi Flow

IllnessIllness

OverworkOverwork

Under WorkUnder Work

Spleen Not Controlling BloodSpleen Not Controlling Blood

HemorrhageHemorrhage

Spleen Fails to Hold BloodSpleen Fails to Hold Blood

Chronic HemorrhageChronic HemorrhageGeneral SignsGeneral Signs

Prolonged Spleen Qi DeficiencyProlonged Spleen Qi Deficiency

Spleen Qi SinkingSpleen Qi Sinking

OvereatingOvereating

StarvationStarvation

Chronic Spleen Qi DeficiencyChronic Spleen Qi Deficiency

Failure of HoldingFailure of Holding

Chronic DiarrheaChronic DiarrheaProlapsesProlapsesIncontinenceIncontinence

IllnessIllness

OverworkOverwork

Under WorkUnder Work



Chronic Spleen Chronic Spleen Qi DeficiencyQi Deficiency

Spleen Yang DeficiencySpleen Yang Deficiency


Yang Deficiency SignsYang Deficiency Signs

Stomach PathologyStomach Pathology


Cold Cold Environmental Environmental ConditionsConditions

Cold in StomachCold in Stomach


Inhibition of YangInhibition of Yang

Stomach ColdStomach Cold

Stomach ColdStomach Cold

Cold Food & DrinkCold Food & DrinkCold EnvironmentCold Environment

Receiving &Receiving &DecomposingDecomposing

AnorexiaAnorexia AlteredAlteredQi FlowQi Flow

LassitudeLassitude

Cold SignsCold Signs

Cold Ear/NoseCold Ear/NoseHypersalivationHypersalivationPale-Purple TonguePale-Purple TongueDeep-Slow PulseDeep-Slow Pulse

Stomach Pathology Stomach Pathology

Hot Dry Hot Dry Food or Food or DrinkDrink


Heat in StomachHeat in Stomach

Transform & Transport DisorderTransform & Transport DisorderHeat SignsHeat Signs

Stomach HeatStomach Heat


Pathogenic HeatPathogenic HeatYin DeficiencyYin Deficiency

channelchannel

GumsGums organorgan

UlcerUlcer

childchild

ColitisColitis

grandchildgrandchild

CystitisCystitis

Stomach Food StagnationStomach Food Stagnation

OvereatingOvereating Indigestible FoodIndigestible Food

Retention of Food in StomachRetention of Food in Stomach

Failure to Transform & TransportFailure to Transform & TransportDisturbed Qi FlowDisturbed Qi Flow

Stomach Yin DeficiencyStomach Yin Deficiency

Chronic FebrileChronic FebrileIllnessIllness

Impairment of Body FluidsImpairment of Body Fluids

Stomach Yin DeficiencyStomach Yin Deficiency

StressStress

Liver Qi StagnationLiver Qi Stagnation

TransformationTransformationto Heat/Fireto Heat/Fire

Oral Cavity Disorders: a Oral Cavity Disorders: a TCVM ApproachTCVM Approach

CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA

Oral Cavity Diseases (Western)Oral Cavity Diseases (Western)

•Local damageLocal damage•Electric shockElectric shock•Chemical damageChemical damage•Thermal damageThermal damage•PeriodontitisPeriodontitis

•Tooth tarterTooth tarter

•Systemic diseaseSystemic disease•Metabolic diseaseMetabolic disease•Nutritional diseaseNutritional disease•Immune diseaseImmune disease•Infectious diseaseInfectious disease

•TreatmentTreatment

•Remove offending Remove offending causecause

•SteroidsSteroids•AntibioticsAntibiotics

•Clean teethClean teeth

How to Use Acupuncture for How to Use Acupuncture for Gingivitis in Small Animal Gingivitis in Small Animal

PracticePracticeZang Fu PhysiologyZang Fu Physiology

• Teeth correspond to boneTeeth correspond to bone

• Bone is controlled by the kidneyBone is controlled by the kidney• Malocclusion, oligodontia are examples Malocclusion, oligodontia are examples

of Kidney Jing Deficiencyof Kidney Jing Deficiency

• Gums are influenced by the stomachGums are influenced by the stomach

Meridian TheoryMeridian Theory

• Oral cavity has two main channels Oral cavity has two main channels that influence the teeth and gumsthat influence the teeth and gums

• Large Intestine meridianLarge Intestine meridian

• Stomach meridianStomach meridian

Pattern DiagnosisPattern Diagnosis

• Stomach Heat PatternStomach Heat Pattern• Excess pattern, seen more often in Excess pattern, seen more often in

younger animals (cats)younger animals (cats)

• Stomach Yin Deficiency + Empty HeatStomach Yin Deficiency + Empty Heat• Stomach loves moisture Stomach loves moisture • Moisture balances Yang functionMoisture balances Yang function• Lack of Yin (fluid) allows Yang Fire to Lack of Yin (fluid) allows Yang Fire to

riserise

Stomach Heat PatternStomach Heat Pattern

•FluffyFluffy: 4yr FS DSH: 4yr FS DSH

•Primary complaintPrimary complaint: Bad : Bad breath, eating poorlybreath, eating poorly

•HistoryHistory: Stray, no : Stray, no vetcare, dry food dietvetcare, dry food diet

•ExamExam: Body & coat : Body & coat condition-normal; vital condition-normal; vital signs-WNLsigns-WNL

•Oral ExamOral Exam: Putrid odor, upper and lower : Putrid odor, upper and lower arcade have severely inflamed gingiva, with arcade have severely inflamed gingiva, with spontaneous bleeding, minimal calculus spontaneous bleeding, minimal calculus formationformation

•Lab DataLab Data: Elevated WBC, FELV/FIV=Neg: Elevated WBC, FELV/FIV=Neg

•DiagnosisDiagnosis: Hemorrhagic gingivitis: Hemorrhagic gingivitis

•TreatmentTreatment: Clindamycin 25mg PO BID x 10: Clindamycin 25mg PO BID x 10•Dental prophylaxis followed by Dental prophylaxis followed by Clavamox 62.5 mg BID x 10Clavamox 62.5 mg BID x 10

TCVM Exam & DiagnosisTCVM Exam & Diagnosis

•ConstitutionConstitution: Water/Wood: Water/Wood•TongueTongue: body=reddish purple; no coat: body=reddish purple; no coat•PulsePulse: Bilaterally superficial rapid: Bilaterally superficial rapid•Body ConditionBody Condition: Dry nose; Body Temp : Dry nose; Body Temp NormalNormal•MouthMouth: Stink smell; bloody red gums: Stink smell; bloody red gums

Pattern DXPattern DX: Stomach Heat (excess : Stomach Heat (excess condition)condition)

TCVM Treatment StrategyTCVM Treatment Strategy

•Treatment Principle: Treatment Principle: Clear the Stomach Heat, Cool Clear the Stomach Heat, Cool the Blood, & nourish Stomach Yinthe Blood, & nourish Stomach Yin

•Acupuncture Point SelectionAcupuncture Point Selection::GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10

•Herbal MedicineHerbal Medicine: Yu Nu Jian ( Jade Lady): Yu Nu Jian ( Jade Lady)shi gao, shu di huang, zhi mu, huai niu xishi gao, shu di huang, zhi mu, huai niu xi2 teapills TID or 1/8-1/4 tsp granules TID2 teapills TID or 1/8-1/4 tsp granules TID

•Topical CareTopical Care: Aloe Gel ( Warren Laboratories): Aloe Gel ( Warren Laboratories)

Case Outcome & DiscussionCase Outcome & Discussion

•After 3 weeks of therapy inflammation substantially reduced

•Cervical line lesions which compromised several teeth were removed

•Fluffy is maintained on Aloe oral gel and herbs with only periodic acupuncture therapy

•Long term expectations: depend on owner compliance

•Other herbals: Wei Qi Booster; Slippery Elm

Stomach Yin Deficiency & Stomach Yin Deficiency & Empty Heat PatternEmpty Heat Pattern

• TessTess: 10 yr, FS, Mix Breed: 10 yr, FS, Mix Breed• Primary ComplaintPrimary Complaint: Bad breath, dirty teeth, : Bad breath, dirty teeth,

and periodic vomit/regurgeand periodic vomit/regurge• HistoryHistory: Commercial dry food diet, periodic : Commercial dry food diet, periodic

dental prophylaxis, absent dental dental prophylaxis, absent dental homecare, gums remain inflamed and homecare, gums remain inflamed and plaque builds quicklyplaque builds quickly

• Western Dx / Tx: Western Dx / Tx: Gingivitis with periodontal Gingivitis with periodontal deterioration. Requires 6 month recall for deterioration. Requires 6 month recall for prophylaxisprophylaxis

TCVM ApproachTCVM Approach•Exam:Exam:

•Constitution- WaterConstitution- Water

•Tongue- Violet, dry, no Tongue- Violet, dry, no coatcoat

•Pulse- Deep, thready, and Pulse- Deep, thready, and quickquick

•Gums- dry/breath Gums- dry/breath scorchedscorched

•Coat Quality-DryCoat Quality-Dry

•Treatment Stategy:Treatment Stategy:

•Nourish Stomach Yin and Nourish Stomach Yin and Clear HeatClear Heat

•AP= CV 12 (aqua); SP 3,6; AP= CV 12 (aqua); SP 3,6; ST 36,44; LI 4,11ST 36,44; LI 4,11

•Herbs= Qing Wei SanHerbs= Qing Wei San

•Topical= Aloe GelTopical= Aloe Gel

•Diet: Fresh cooked food/ Diet: Fresh cooked food/ fish-pork-beef-eggs-fish-pork-beef-eggs-veggiesveggies

Ulceration: a TCVM Ulceration: a TCVM ApproachApproach


UlcerUlcer

•SymptomsSymptoms•Periodic painPeriodic pain•Acid regurgitationAcid regurgitation•BelchingBelching•VomitingVomiting

•PatternsPatterns•ExcessExcess

•Stomach ColdStomach Cold

•Food StagnationFood Stagnation

•Liver Qi StagnationLiver Qi Stagnation

•Blood StasisBlood Stasis

•DeficiencyDeficiency•Stomach Yin DeficiencyStomach Yin Deficiency




channelchannel

GumsGums organorgan

UlcerUlcer

childchild

ColitisColitis


CystitisCystitis

Signs of ST HeatSigns of ST Heat• Clinical SignsClinical Signs

• Hot lips & mouthHot lips & mouth• Bad smell from Bad smell from

mouthmouth• ThristThrist• Stomatitis/GingivitisStomatitis/Gingivitis• Loss of or ravenous Loss of or ravenous

appetiteappetite• Dry nose & fecesDry nose & feces

• PulsePulse• Superficial & fastSuperficial & fast

• TongueTongue• Red with yellow Red with yellow

coatingcoating

• Treatment StrategyTreatment Strategy• Clear ST Heat/FireClear ST Heat/Fire• Generate body Generate body

fluidsfluids

Stomach UlcersStomach Ulcers•MildMild

•Moderate to SevereModerate to Severe

AngelicaAngelica Dang Gui Dang Gui Nourish & activate BloodNourish & activate BloodPaeonia Paeonia Bai Shao Yao Bai Shao Yao Nourish Liver Yin & BloodNourish Liver Yin & BloodBupleurum Chai Hu Bupleurum Chai Hu Soothe Liver QiSoothe Liver QiAurantium Zhi Shi Aurantium Zhi Shi Move Qi & relieve painMove Qi & relieve painTrichosanthes Gua Lou Trichosanthes Gua Lou Promote body fluid & transform phlegmPromote body fluid & transform phlegmPinellia Pinellia Ban Xia Ban Xia Dry damp & transform phlegmDry damp & transform phlegmCitrus Citrus Chen Pi Chen Pi Move Qi & relieve painMove Qi & relieve painLicorice Licorice Gan Cao Gan Cao HarmonizeHarmonizeTaraxacum Pu Gong Ying Taraxacum Pu Gong Ying Clear HeatClear Heat

Happy StomachHappy Stomach

Jade LadyJade Lady

Gypsum Gypsum Shi Gao Shi Gao Clear Heat and cool StomachClear Heat and cool StomachAnemarrhena Zhi Mu Anemarrhena Zhi Mu Clear Heat and nourish YinClear Heat and nourish YinRehmannia Shu Di Huang Rehmannia Shu Di Huang Nourish Yin and JingNourish Yin and JingOphiopogon Mai Men Dong Ophiopogon Mai Men Dong Moisten and nourish YinMoisten and nourish YinAchyranthes Niu Xi Achyranthes Niu Xi Bring the Qi flow downBring the Qi flow down

GI Food TherapyGI Food Therapy

•CabbageCabbage•Contains glutamateContains glutamate•Cools stomach & GICools stomach & GI

•SpinachSpinach•Stops hemorrhageStops hemorrhage

Acupuncture of ST HeatAcupuncture of ST Heat

• Clear Stomach FireClear Stomach Fire

• Shan gen, Wei jian, Shan gen, Wei jian, Er jian, Yu Tang, Er jian, Yu Tang, ST44 LI4/11, GV14ST44 LI4/11, GV14

• Body Fluid TonicBody Fluid Tonic

• KID3, SP6, SP9KID3, SP6, SP9

Shan-gen

GV-26Ren zhong

06 Ren-zhong/Shui-gou the center of man/water passage, Xie-07, GV-26

05 Shan-gen Mountain base Xie-05

LO: on the dorsal midline of boundary b/t hairy & non-hairy areas

ME: Perpendicular insertion 0.3 cun

IN: Loss of appetite, sinusitis, coma, shock, wind-cold, wind-heat

LO: At the intersection b/t dorsal and middle 1/3 of the philtrum

ME: Perpendicular insertion for 0.3 cun

IN: Coma, shock, fever, bronchitis, Lung Heat, facial paralysis

23 Lian-quan ridge spring CV-23

LO: At the ventral midline just cranial to throat.

IN: excessive salivation, laryngeal hemiplegia

21 Hua-tuo-jia-ji at cervical region

LO: 0.5 dorsal to cervical vertebrae

IN: cervical stiffness, wobbler’s disease

22 Jian-wei, strengthen stomach

LO: Upper 1/3 of the jugular group, Between vein and cervical vertebra

IN: Anorexia, vomit, stomach disorders

Pancreatitis: a TCVM Pancreatitis: a TCVM ApproachApproach


PancreatitisPancreatitis

•Considered any acute or Considered any acute or chronic change in GI chronic change in GI function usually function usually accompanied by some accompanied by some degree of vomiting, degree of vomiting, diarrhea and abdominal diarrhea and abdominal painpain

•Acute- -MildAcute- -Mild•PancreostasisPancreostasis

•Acute- -SevereAcute- -Severe•Fulminating pancreatitisFulminating pancreatitis

•ChronicChronic•Pancreatic insufficiencyPancreatic insufficiency

•Rx AcuteRx Acute•NPONPO•FluidsFluids•AntiemeticsAntiemetics•Pain reliefPain relief•Low fat/protein foodLow fat/protein food

•Rx ChronicRx Chronic•Enzyme therapyEnzyme therapy

TCVM Acute PancreatitisTCVM Acute Pancreatitis

TCVM Chronic PancreatitisTCVM Chronic Pancreatitis

* Enzyme replacement therapy still good to add* Enzyme replacement therapy still good to add

PerryPerry

3 yr FS Springer3 yr FS Springer

Earth personalityEarth personality

Acute onset of vomiting, Acute onset of vomiting, fever and abdominal painfever and abdominal pain

Increased thirstIncreased thirst

Scant urinationScant urination

Elevated Amylase & LipaseElevated Amylase & Lipase

Increased WBC Increased WBC

Rx: Fluids & RanitidineRx: Fluids & Ranitidine

Tongue: red & dryTongue: red & dry

Pulse: fast & superficialPulse: fast & superficial

West Dx: acute pancreatitisWest Dx: acute pancreatitis

TCM Dx: damp-heat in spleenTCM Dx: damp-heat in spleen

Perry TreatmentPerry Treatment

•APAP•DNDN

•ST-45ST-45

•ST-36ST-36

•LI-4LI-4

•PC-6PC-6

•BL-20BL-20

•CV-12CV-12

•AquaAqua•ST-36ST-36

•BL-20BL-20

•PC-6PC-6

•HerbalHerbal•Great Saussurea CoptisGreat Saussurea Coptis

•Next day was 80% Next day was 80% improvedimproved

•Clinician said, “He is Clinician said, “He is doing absolutely doing absolutely fantastic…better than fantastic…better than any patient in years…any patient in years…NO…it wasn’t the NO…it wasn’t the acupuncture…well…acupuncture…well…maybe we should try it maybe we should try it again!”again!”

Great Saussurea CoptisGreat Saussurea Coptis

Saussurea Saussurea Mu Xiang Mu Xiang Move Qi & relieve painMove Qi & relieve pain

Coptis Coptis Huang Lian Huang Lian Clear Damp-Heat in the intestinesClear Damp-Heat in the intestines

Evodia Evodia Wu Zhu Yu Wu Zhu Yu Warm the middle Jiao & stop vomitingWarm the middle Jiao & stop vomiting

Bleeding: a TCVM Bleeding: a TCVM ApproachApproach


BleedingBleeding•Primary HemostasisPrimary Hemostasis

•Complex chain of events Complex chain of events involving interaction ofinvolving interaction of

•PlateletsPlatelets•Vessel WallVessel Wall•von Willebrand’s factorvon Willebrand’s factor•FibrinogenFibrinogen

•Secondary HemostasisSecondary Hemostasis•Complex interaction of the Complex interaction of the intrinsic and extrinsic intrinsic and extrinsic clotting cascadesclotting cascades

•Stabilize the platelet plugStabilize the platelet plug

Primary HemostasisPrimary Hemostasis

•Evaluated by the Evaluated by the bleeding timebleeding time

•Platelet numberPlatelet number•Amount and Quality of the Amount and Quality of the von WIllebrand’s factor von WIllebrand’s factor VIII:AgVIII:Ag•Fibrinogen concentrationFibrinogen concentration

•Other alterations due to Other alterations due to vessel wall disordersvessel wall disorders

Secondary HemostatisSecondary Hemostatis

•Assessed byAssessed by

•ACT (activated ACT (activated clotting time)clotting time)

•APTT (activated APTT (activated partial thromboplastin partial thromboplastin time)time)

•PT (prothrombin PT (prothrombin time)time)

TCM PathoetiologyTCM Pathoetiology•HeatHeat

•TongueTongue•Red & DryRed & Dry

•PulsePulse•Superficial (forceful) Superficial (forceful) & fast& fast

•Spleen Qi DeficiencySpleen Qi Deficiency•TongueTongue

•Pale & moistPale & moist

•PulsePulse•Deep & weak Deep & weak (particularly on right)(particularly on right)

Spleen Pathology Spleen Pathology

Damp Hot Damp Hot Food or Food or DrinkDrink


Damp-Heat in SpleenDamp-Heat in Spleen


Accumulated Accumulated Heat & DampHeat & Damp

Heat HemorrhageHeat Hemorrhage•Herbal treatment depends Herbal treatment depends upon locationupon location

•BladderBladder•Red Front DoorRed Front Door

•GI tractGI tract•Sophora PowderSophora Powder

•Great Saussurea CoptisGreat Saussurea Coptis

•Red Back DoorRed Back Door

•PulmonaryPulmonary•Red LungRed Lung

•NoseNose•Single ImmortalSingle Immortal

•UterusUterus•Wu Bei SanWu Bei San

Spleen Not Controlling BloodSpleen Not Controlling Blood

HemorrhageHemorrhage

Spleen Fails to Hold BloodSpleen Fails to Hold Blood

Chronic HemorrhageChronic HemorrhageGeneral SignsGeneral Signs

Prolonged Spleen Qi DeficiencyProlonged Spleen Qi Deficiency

DarbyDarby

•SignalmentSignalment•5 yr FS Doberman5 yr FS Doberman

•HistoryHistory•Generalized weaknessGeneralized weakness•EcchymosisEcchymosis•Abdominal bleedingAbdominal bleeding

•TCVM ExamTCVM Exam•Tongue: paleTongue: pale•Pulses: deep & weakPulses: deep & weak

Dx: Spleen Qi Deficiency Dx: Spleen Qi Deficiency (not holding blood in vessels)(not holding blood in vessels)

DarbyDarby

•Western RxWestern Rx

•Compressive Compressive bandagebandage

•Hemorrhage controlHemorrhage control•CryoprecipitateCryoprecipitate•Whole BloodWhole Blood•Thyroid medicationThyroid medication

•TCVM RxTCVM Rx

•APAP•SP Qi TonicSP Qi Tonic

•BL-20/21, SP-6, SP-9 BL-20/21, SP-6, SP-9 & CV-6& CV-6

•Stop HemorrhageStop Hemorrhage•Tian Ping & BL-17Tian Ping & BL-17

•HerbalHerbal•Yunnan Pai YaoYunnan Pai Yao•Huang Tu TangHuang Tu Tang

Huang Tu TangHuang Tu Tang

AtractylodesAtractylodes Bai ZhuBai Zhu Strength Spleen & tonify QiStrength Spleen & tonify Qi

Yellow EarthYellow Earth Zao Xin TuZao Xin Tu Warm Spleen & stop diarrheaWarm Spleen & stop diarrhea

AconiteAconite Fu ZIFu ZI Warm SpleenWarm Spleen

AsinumAsinum Er JiaoEr Jiao Nourish BloodNourish Blood

RehmanniaRehmannia Sheng Di HuangSheng Di Huang Nourish YinNourish Yin

ScutellariaScutellaria Huang QinHuang Qin Stop bleeding & prevent excess heatStop bleeding & prevent excess heat

LicoriceLicorice Gan caoGan cao HarmonizeHarmonize

Muscle Wasting: a TCVM Muscle Wasting: a TCVM ApproachApproach


TCM Muscle ViewTCM Muscle View

•Muscle volume & Muscle volume & strength is under the strength is under the domain of the Spleendomain of the Spleen

•Spleen transforms food Spleen transforms food and transports it to the and transports it to the body to provide energy & body to provide energy & building blocks.building blocks.•Spleen Qi provides Spleen Qi provides muscle strengthmuscle strength

•Liver blood provides Liver blood provides enduranceendurance

•Continued delivery of Continued delivery of Spleen Qi to musclesSpleen Qi to muscles

Western View of Muscle Western View of Muscle WastingWasting

•Generalized WastingGeneralized Wasting

•MalnutritionMalnutrition•Insufficient intake of materials Insufficient intake of materials to support Spleen Qito support Spleen Qi

•Cardiac CachexiaCardiac Cachexia•Heart failure leads to stagnation Heart failure leads to stagnation of bloodof blood•Liver is unable to support Liver is unable to support distribution of blood & Qidistribution of blood & Qi•Leads to accumulation of Damp Leads to accumulation of Damp in Spleenin Spleen•Results in Spleen Qi Deficiency Results in Spleen Qi Deficiency with failure to provide energy with failure to provide energy and building materials to the and building materials to the musclesmuscles

•Cancer CachexiaCancer Cachexia•Tumor Necrosis Factor poisons Tumor Necrosis Factor poisons metabolism leading to Spleen Qi metabolism leading to Spleen Qi DeficiencyDeficiency

•Diminished effective delivery Diminished effective delivery of energy to musclesof energy to muscles

•Localized WastingLocalized Wasting

•TraumaTrauma•Local damage of muscleLocal damage of muscle

•Disuse AtrophyDisuse Atrophy•Local stagnation results in Local stagnation results in Liver failure to support Liver failure to support Spleen/StomachSpleen/Stomach•Accumulation of Damp alters Accumulation of Damp alters Spleen functionSpleen function•Local stagnation decreases Local stagnation decreases delivery of nutrientsdelivery of nutrients

•Neurogenic AtrophyNeurogenic Atrophy•Denervation leads to local liver Denervation leads to local liver stagnationstagnation•Results in failure to support Results in failure to support spleen Qispleen Qi•Leads to decreased delivery of Leads to decreased delivery of local channel energylocal channel energy

Wei SyndromeWei SyndromeDamp HeatDamp Heat •Earth personalityEarth personality

•ObesityObesity•History of damp heat in skin or GIHistory of damp heat in skin or GI•Muscle atrophyMuscle atrophy•WeaknessWeakness•LethargyLethargy•Greasy wet tongueGreasy wet tongue•Fast pulseFast pulse

Si Miao SanSi Miao San

Qi/Yang Qi/Yang DeficiencyDeficiency

•Lethargy, shortness of breath, Lethargy, shortness of breath, weaknessweakness•Too weak to get up to walkToo weak to get up to walk•Loose lipsLoose lips•Loose stoolLoose stool•Anorexia & EmaciationAnorexia & Emaciation•Dry-burnt hairDry-burnt hair•EdemaEdema•Heat seekingHeat seeking•Pale wet tonguePale wet tongue•Thready & weak pulseThready & weak pulse

Bu Yang Huan WuBu Yang Huan Wu

Qi/Yin DeficiencyQi/Yin Deficiency •EmaciationEmaciation•Weakness in lumbar regionWeakness in lumbar region•Heat seekingHeat seeking•Dry skinDry skin•Pale or red & dry tonguePale or red & dry tongue•Weak & thready pulseWeak & thready pulse

Hindquarter Hindquarter formulaformula

JakeJake

•HistoryHistory•Progressive weakness in Progressive weakness in rear legsrear legs•Cool seekingCool seeking•Rear leg muscle atrophyRear leg muscle atrophy•Dry hair & skinDry hair & skin

•TCVM ExamTCVM Exam•Pulses deep & weak (< R)Pulses deep & weak (< R)•Red dry tongueRed dry tongue

DX: Qi/Yin DeficiencyDX: Qi/Yin Deficiency

Jake’s TreatmentJake’s Treatment

• APAP• EAEA

• SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai huiSP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui

• DNDN• BL20, BL23, BL26, KID3BL20, BL23, BL26, KID3

• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26

• HerbalHerbal• Jia Bing FangJia Bing Fang

Jia Bing FangJia Bing Fang

Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify QiCondonopsis Condonopsis Dang Shen Dang Shen Tonify QiTonify QiPolygonum Polygonum He Shou Wu He Shou Wu Nourish Blood and JingNourish Blood and JingRehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Blood, Yin and JingNourish Blood, Yin and JingPaeonia Paeonia Bai Shao Yao Bai Shao Yao Nourish Blood and soothe Liver QiNourish Blood and soothe Liver QiDioscorea Dioscorea Shan Yao Shan Yao Tonify Qi and nourish JingTonify Qi and nourish JingPrunella Prunella Xia Ku Cao Xia Ku Cao Soothe Liver Qi, clear HeatSoothe Liver Qi, clear HeatCyperus Cyperus Xiang Fu Xiang Fu Move Liver Qi and relieve nodulesMove Liver Qi and relieve nodulesBupleurum Bupleurum Chai Hu Chai Hu Soothe Liver QiSoothe Liver QiSargassum Sargassum Hai Zao Hai Zao Transform phlegm, clear Heat, softenTransform phlegm, clear Heat, soften

the hardnessthe hardnessLaminaria Laminaria Kun Bu Kun Bu Transform phlegm, soften theTransform phlegm, soften the

hardness, drain waterhardness, drain water

SamSam

•HistoryHistory•Chronic rear leg Chronic rear leg weakness and muscle weakness and muscle wastingwasting•Dry hairDry hair•Weight lossWeight loss

•TCVM ExamTCVM Exam•Red dry tongueRed dry tongue•Weak thready pulses (< R)Weak thready pulses (< R)

DX: Qi/YinDeficiencyDX: Qi/YinDeficiency

Sam’s TreatmentSam’s Treatment

• APAP• DNDN

• GV20, BL20, BL23, BL26GV20, BL20, BL23, BL26

• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26

• HerbalHerbal• Hindquarter formula (tea pills)Hindquarter formula (tea pills)

Hindquarter FormulaHindquarter Formula

Eucommia Eucommia Du Zhong Du Zhong Tonify Kidney & strengthen backTonify Kidney & strengthen back

AchyranthesAchyranthes Niu Xi Niu Xi Tonify Kidney & strengthen the hind limbsTonify Kidney & strengthen the hind limbs

Lindera Lindera Wu Yao Wu Yao Move Qi and relieve painMove Qi and relieve pain

Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify Qi

Apis Apis Feng Hua Fen Feng Hua Fen Tonify Qi and YinTonify Qi and Yin

Morinda Morinda Ba Ji Tian Ba Ji Tian Warm and strengthen the backWarm and strengthen the back

Angelica Angelica Dang Gui Dang Gui Nourish BloodNourish Blood

Rehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Yin and JingNourish Yin and Jing

Cinnamon Cinnamon Gui Zhi Gui Zhi Warm the Channels and benefit the limbsWarm the Channels and benefit the limbs

DiarrheaDiarrhea

DiarrheaDiarrhea

• Increase in fluidity Increase in fluidity of feces leading to of feces leading to soft to watery fecessoft to watery feces• May contain May contain

mucous & bloodmucous & blood

• Increase frequencyIncrease frequency

• Chronic if greater Chronic if greater than 1 monththan 1 month

DiarrheaDiarrhea

• May include up to May include up to 27% of all patients27% of all patients

• 122 Horses with 122 Horses with acute diarrhea acute diarrhea (TA&M)(TA&M)• 91 recovered91 recovered• 28 euthanatized28 euthanatized• 3 died3 died

DiarrheaDiarrhea• TCVM PatternsTCVM Patterns

• ExcessExcess• Cold DampCold Damp• Damp HeatDamp Heat• Food StagnationFood Stagnation• Disharmony between Disharmony between

SP & LIVSP & LIV

• DeficiencyDeficiency• SP Qi DefSP Qi Def• SP & KID Yang DefSP & KID Yang Def

DiarrheaDiarrhea

Obesity: a TCVM Obesity: a TCVM ApproachApproach


ObesityObesity• Body weight is 20% over idealBody weight is 20% over ideal

• An intake of total dietary energy above that needed for An intake of total dietary energy above that needed for maintenance and production or exercise over a long period of maintenance and production or exercise over a long period of timetime

• Energy in is based uponEnergy in is based upon• Food intakeFood intake• AbsorptionAbsorption

• Energy used isEnergy used is• Basic metabolic rate Basic metabolic rate (thermoneutral condition)(thermoneutral condition)• ExerciseExercise• LactattionLactattion• PregnancyPregnancy• GrowthGrowth

In > > Out

Obesity: TCVM Classical StrategyObesity: TCVM Classical Strategy

(1) Yin Tonic Herbs (Remannia, Lycium etc)

Decrease in appetiteDecrease in food intake

(2) Purgative herbs (Rheum, Cannabis Ma Zi Ren etc)

Passing food faster through SILess time to absorb nutrientsDecrease in absorption

(3) Qi Tonic Herbs (Ginseng, codonopsis etc)

Energy boostingPatient more willing to exerciseBurning down Fat tissue

•Damp-phlegm

•Liver Stagnation

•Blood Stagnation

•Spleen Deficiency

•Kidney Deficiency

Obesity: TCVM Etiology and PatternObesity: TCVM Etiology and Pattern

Excess

Deficiency

Damp-phlegmDamp-phlegm

Etiology

Spleen Qi Deficiency

Water/dampfrom food orenvironment

Other pathogenic factors

Stagnation of Water-damp

Phlegm under the skin

Obesity

Symptoms . Overweight. Swelling neck or belly. fast respiratory rate, or cough or asthma. Pulse: Fast, deep or slippery. Tongue: pale or red with thick coating. In people: obese smoker. Overall: not weak

Treatment Strategy: Transform damp and resolve phlegm Acupuncture treatment

1) needling: ST-36/40, BL-13, SP-6/9or Electro-acupuncture (F=30 Hz) for local swelling area

2) Message: Abdomen and back, twice a day.


Herbal Formula

Citrus Chen Pi 8%Pinellia Ban Xia 8%Poria Fu Ling 10%Coix Yi Yi Ren 20%Atractylodes Cang Zhu 8%Areca Da Fu Pi 10%Benincasa Dong Gua Pi 8%Alisma Ze Xie 10%Plantago Che Qian Cao 10%Cyperus Xiang Fu 8%

Phlegm Fat Formula (Citrus-Pinellia Compound)

Er Chen Tang

Resolve Damp

Liver Qi Master


Fritillaria Zhe Bei Mu Soften hardness and clear nodules

Ostrea Mu Li Soften hardness and clear mass

Prunella Xia Ku Cao Clear Liver Heat and resolve nodules

Scrophularia Xuan Shen Clear Heat and cool Blood

Trichosanthes Tian Hua Fen Clear Heat and promote body fluids

Platycodon Jie Geng Open the Upper Jiao and transform phlegm

Rhubarb Da Huang Clear stagnation/stasis and clear Heat

Angelica Bai Zhi Clear Wind-Cold and relieve pain

Max Formula For lipomas



EtiologyDrug StressEmotional Stress

Liver Qi Stagnation


Obesity

Liver over-control SpleenSpleen fails to transform Damp

Symptoms:

Treatment strategy:

Acupuncture:

. Overweight

. Aggressive, or restlessness

. Hypertension

. irregular estrous cycling

. exercise intolerance, lassitude

. Pulse: Wiry and deep

. Tongue: purple or pale with coating or without coating

Sp-6/9, ST-40Liv-3, GB-20 and GB-34

Regulate liver, clear Fire and transform damp


Herbal formula:

Picrorrhiza Hu Huang Lian 18%Prunella Xia Ku Cao 19%Cassia Jue Ming Zi 18%Rehmannia Sheng Di Huang 15%Rheum Da Huang 15%Cassia Pang Xie Ye 15%

Picrorrhiza Compound*

Clear Liver

Purge LI

Clear LiverNourish Yin/Blood


Blood StagnationBlood Stagnation

Etiology Other factors

Qi stagnation

Stress

Blood Stagnation

Water/Damp retention in the body

Obesity

Qi-blood stagnation

Symptoms:

Treatment strategy:

Acupuncture:

. Overweight

. lump in the body surface

. exercise intolerance, lassitude

. Pulse: slow and deep

. Tongue: purple with coating or without coating

Invigorate Blood and transform damp

BL-17/SP-10LIV-3, GB-34, LI-4ST-40/BL-40


Carthamus Hong Hua 22%Ligusticum Chuang Xiong 22%Olibanum Ru Xiang 19%Typha Pu Huang 1 9%Rheum Da Huang 18%

Stagnation RelieverHerbal Formula:

Move Blood, resolve stasis

Purge LI


Move Qi & Blood


Etiology Water/dampfrom food orenvironment

Chronic illnessOverwork

Spleen Qi Deficiency


Obesity

Symptoms:

Treatment strategy:

• Overweight• Diarrhea, or dry feces• Hyperlipemia• Eexercise intolerance, lassitude • Pulse: Weak and deep • Tongue: pale with coating or without coating

tonify spleen qi and transform damp

Acupuncture: ST-36/40/41, SP-2/3, and BL-20/21


Herbal Formula:

Astragalus Huang Qi 34%Atractylodes Cang Zhu 33%Lycium Gou Qi Zi 33%

Herbal formula:

Astragalus-atractylodes-lycium

Nelumbo He Ye (Lotus) 13%Alisma Ze Xie 13%Poria Fu Ling 13%Coix Yi Yi Ren 13%*Atractylodes Cang Zhu 13%Atractylodes Bai Zhu 12%Citrus Chen Pi 10%Cassia Jue Ming Zi 13%

Nelumbo Compound*

Eliminate Damp, Strengthen SP

Drain Damp

Resolve stagnation, clear Liver


Kidney Qi DeficiencyKidney Qi Deficiency

Etiology Other factorsAgeingChronic illness

Kidney Qi Deficiency

Water retention

Obesity

Phlegm

Symptoms:

Treatment strategy:

Acupuncture:

. Overweight

. Often occurs in the aged patient

. Difficulty in walking or standing, or chronic back pain

. Bone degeneration or osteoporosis

. Pulse: Weak and deep

. Tongue: pale with coating or without coating

tonify Kidney qi and transform damp

Bai-hui, Shen-shu, Shen-peng, Shen-jiaoBl-23/26, SP-6 and Kid-3


Herbal formula: Psoralea Pill

Psoralea Bu Gu Zi 32%Notoginseng Tian Qi 9%Rheum Da Huang 30%Cassia Fan Xie Ye 29%

Purge LI

Move BloodTonify Kid Qi/Yang


9 yr MC Siamese9 yr MC Siamese

Obesity (14 lb)Obesity (14 lb)

Less playful and less activity Less playful and less activity after moving to a new place 3 after moving to a new place 3 weeks agoweeks ago

Warm-seekingWarm-seeking

Tongue: pale & swollenTongue: pale & swollen

Pulse: deep & weakPulse: deep & weak

KobeKobe


Rx: Psoralea PillRx: Psoralea Pill

HenriettaHenrietta

12 yo FS Dachshund12 yo FS Dachshund

OverweightOverweight

Able to get around with Able to get around with supportsupport

Pants a lot with slight Pants a lot with slight coughcough

Pulse: Fast & deepPulse: Fast & deep

Tongue: redTongue: redDamp-PhlegmDamp-Phlegm

Rx: Phlegm Fat Rx: Phlegm Fat FormulaFormula

Constipation: a TCVM Constipation: a TCVM ApproachApproach


Regulation of Colon FunctionRegulation of Colon Function•Colon is like the urinary Colon is like the urinary bladderbladder

•Innervation byInnervation by•Sympathetics from L2-3Sympathetics from L2-3

•Parasympathetics from Parasympathetics from S1-3S1-3

•Filling PhaseFilling Phase•SympatheticsSympathetics

•YinYin

•Emptying PhaseEmptying Phase•ParasympatheticsParasympathetics

•YangYang

Propranolol @ 0.25-0.5 Propranolol @ 0.25-0.5 mg/kg TIDmg/kg TID

ConstipationConstipation•Definition:Definition:

•ConstipationConstipation•Infrequent or Infrequent or incomplete bowel incomplete bowel movementsmovements•Feces are drier or Feces are drier or harderharder

•ObstipationObstipation•Intractable Intractable constipationconstipation•Impossible defecationImpossible defecation

•PatternsPatterns

•HeatHeat•Qi StagnationQi Stagnation•Qi DeficiencyQi Deficiency•Yin/Blood DeficiencyYin/Blood Deficiency




channelchannel

GumsGums organorgan

UlcerUlcer

childchild

ColitisColitisoror

ConstipationConstipation


CystitisCystitis

DifferentiationDifferentiationHEATHEAT Qi StagnationQi Stagnation Qi DeficiencyQi Deficiency Blood/Yin Blood/Yin

DeficiencyDeficiency

OnsetOnset Acute Wood Person. Chronic Chronic

StoolStool Dry On/Off Small/Thin Dry

MucusMucus Yes No No No/Yes

ThirstThirst Yes No No Yes

UrinationUrination Short Normal Long Short

Abdm. PainAbdm. Pain No Flank No No

Mouth odorMouth odor Foul No No Slight

PreferencePreference Cool None Warm Cool

Tongue colorTongue color Red Purple Pale Pale/Red

T. MoistureT. Moisture Dry Normal Wet Dry

T. CoatingT. Coating Yellow Normal No No

PulsePulse Fast/Wiry Wiry Weak Weak/Thready

Constipation/MegacolonConstipation/MegacolonHeatHeat •Acute onset of colicAcute onset of colic

•Hot ear & noseHot ear & nose•Cool seekingCool seeking•ThirstyThirsty•Foul breath Foul breath •Swollen upper palateSwollen upper palate•Red & dry tongueRed & dry tongue•Fast pulseFast pulse

Da Chang Qi TangDa Chang Qi Tang

Qi StagnationQi Stagnation •Sub-acute onset of colicSub-acute onset of colic•Bloat & abdominal fullnessBloat & abdominal fullness•Gaseous bowel movementsGaseous bowel movements•AnorexiaAnorexia•Purple or red tonguePurple or red tongue•Wiry, fast pulseWiry, fast pulse

Xiao Zhang SanXiao Zhang San

Qi DeficiencyQi Deficiency •Chronic constipation or colicChronic constipation or colic•AnorexiaAnorexia•Loss of body massLoss of body mass•WeaknessWeakness•Pale tonguePale tongue•Deep & weak pulseDeep & weak pulse

Fan Xie YeFan Xie Ye

Yin/Blood Yin/Blood DeficiencyDeficiency

•Very chronic megacolon with impactionVery chronic megacolon with impaction•Dry flaky skinDry flaky skin•Weak or geriatric patientWeak or geriatric patient•Pale or red, dry tonguePale or red, dry tongue•Fast, weak & thready pulseFast, weak & thready pulse

Dang Gui Cong Dang Gui Cong RongRong

AcupunctureAcupuncture

HeatHeat Qi Qi StagnationStagnation

Qi Qi DeficiencyDeficiency

Blood/Yin Blood/Yin DeficiencyDeficiency

PointsPoints LI-4

LI-10

GV-1

BL-21

ST-37

LIV-3

GV-1

GB-34

ST-36

SP-6

B-21

BL-15

SP-6

SP-10

GV-1

MethodMethod q d 3d

1-3 times

q wk

2-4 times

q wk

2-5 times

q wk

3-7 times

Kitty LittleKitty Little

15 yr FS Persian15 yr FS Persian

Chronic constipation with Chronic constipation with impactionimpaction

Dry flaky skin with dandruffDry flaky skin with dandruff

General weaknessGeneral weakness

Tongue: Tongue: red & dry red & dry

Pulse: deep, weak & threadyPulse: deep, weak & thready

Yin/Blood DeficiencyYin/Blood Deficiency

Rx: Dang Gui Cong Rx: Dang Gui Cong RongRong

MollyMolly

13 yr FS Maine Coon13 yr FS Maine Coon

Earth personalityEarth personality

Frequent constipation with Frequent constipation with impactionimpaction

Colon cleaning under Colon cleaning under anesthesia 5 times in past 2 anesthesia 5 times in past 2 yearsyears

Recent inappetenceRecent inappetence

Vomits undigested food with Vomits undigested food with impacted impacted

Rx: Lactulose & CisaprideRx: Lactulose & Cisapride

First visit:First visit:

No BM for 5 dayNo BM for 5 dayAbdomen filled with fecal Abdomen filled with fecal ballsballs

Dry haircoatDry haircoatWarm seekingWarm seekingTongue: red & dryTongue: red & dryPulse: weakPulse: weak

Molly DxMolly DxEarth personalityEarth personalityNo BMNo BM

Earth element Earth element (SP/ST)(SP/ST)

DrynessDrynessRed & dry tongueRed & dry tongue

Yin DeficiencyYin Deficiency

Weak pulseWeak pulseAnorexiaAnorexiaDecreased thirstDecreased thirst

Qi DeficiencyQi Deficiency

TCVM Dx: SP/ST (LI) Yin & Qi DeficiencyTCVM Dx: SP/ST (LI) Yin & Qi Deficiency

Molly RxMolly Rx

Acupuncture:Acupuncture:

DN: GV-20, CV-12, ST-25DN: GV-20, CV-12, ST-25EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz)EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz) BL-21, BL-25, ST-36- -ST-37 (bilaterally)BL-21, BL-25, ST-36- -ST-37 (bilaterally)

Owner reported that Molly defecated a long firm stool 10-16 Owner reported that Molly defecated a long firm stool 10-16 hours after acupuncture and continued to have BMs every 2-3 hours after acupuncture and continued to have BMs every 2-3 days. Stool still dry & still warm seeking.days. Stool still dry & still warm seeking.

TCM Herbal:TCM Herbal:

Ma Zi Ren Wan + Fan Xie YeMa Zi Ren Wan + Fan Xie Ye

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