Chapter 17 Internal Diseases

Chapter 17 INTERNAL DISEASES (CAM) I) Exogenous Pathogenic Factors
CONDITION: Signs & Symptoms
WIND STROKE
Etiology & Pathogenesis
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" 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 Wind stirred up by upsurge of LV Yang sends Qi and Blood upwards, which together with the accumulated phlegm fire disturb the mind 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: ST6 and ST7 Du15, Ren23, HT5 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 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 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)
Analysis: Treatment:
Clenched Jaw: Stiff Tongue: 2) Flacid Syndrome:
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, irritability Pulse: string-taught and rolling pulse 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 speech If complicated with upsurging LV Yang and upward disturbance of Wind Yang, the symptoms are headache, dizziness, vertigo and twitching of muscles. Points along Du and Yang meridians of the affected side are used to regulate Qi and Blood, remove obstruction from meridians and collaterals and dispel wind. Du channel is the Sea of all Yang channels Rx: Du20, UB7, DU16 DU20, DU16 combined with UB7 can eliminate wind and remove obstructions
Since 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.
Analysis:
Treatment:
Upper disturbance of LV wind:
Deviated Mouth: Remarks:
GB20 & LV3 reduce wind (upper disturbance of LV wind) and pacify the LV KI3 nourishes Yin to reduce the fire SP6 nourishes Yin and pacifies Yang For excessive HT/LV Fire: PC7 & LV2 (reduce) eliminate Fire KI3 nourishes Yin to reduce the fire ST4 & ST6 promote free circulation of Qi in the meridians around the face. 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 Yang Rising marked by dizziness and palpitations, may have premonitory symptoms such 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.
SYNCOPE
sudden fainting, pallor, cold limbs and loss of consciousness, which are often resulted from emotional excitement, fright, or debilitation and overstraining. 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: Analysis: feeble breathing with mouth agape, spontaneous sweating, pallor, cold limbs Pulse: deep and thready Deficiency of Yuan Qi (primary): dizziness, vertigo, loss of consciousness, SOB complicated with sinking of SP/ST Qi and failure to clear Yang in ascending. Weak Yuan Qi and disabled Vital Qi: spontaneous sweating (unable to control the prores and mouth agape Rx: DU26, DU20, PC6, Ren6, ST36 DU26, DU20, PC6 are points for resuscitation Ren6 &ST36 are good for reinforcing Qi and invigorating Yang coarse breathing, rigid limbs, clenched jaws Pulse: deep and excess-type Perversion of Qi after a fit of anger impairs Qi flow and blood and qi rush upward to disrurb the mind, resulting in sudden collapse, loss of consciousness, clenched jaws and rigid limbs. Coarse breathing is due to obstruction of LU Qi. Reducing is applied to points of the DU channel and PC to promote resuscitation and regulate flow of Qi. Rx: DU26, LI4, PC9, PC8, LV3, KI1 DU26, PC9 promote resuscitation LI4 & LV3 (four gates) regulate Qi and Blood flow PC8 & KI1 promote smooth flow of Qi and clear the mind
Treatment:
b) Excess Type: Analysis:
Treatment:
SUN STROKE
Etiology & Pathogenesis Differentiation: a) Mild Type:
acute 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 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.
headache, dizziness, profuse sweating, hot skin, coarse breathing, dry mouth and tongue, dire thirst. Pulse: superficial, large and rapid (indicative of Summer-heat) 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. Rx: DU14, PC6, LI11, UB40 Reducing is applied to Du, PC, LI points to eliminate Summer-heat DU14 (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, sweating Pulse: deep and forceless (plus sweating indicate exhaustion of Qi and BF) 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. Rx: DU26, DU20, Shixuan (Extra) PC3, UB40 Reducing is applied to DU pts to resuscitate and dispel summer-heat GU26 & DU20 promote resuscitation PC6, UB40 are pricked superficially to remove heat from blood Shixuan (Extra) bleeding reduces heat and primotes resuscitation condition includes thermoplegia, thermospasm, heliosis, etc. Sraping therapy is a popular tx for sunstroke.
Analysis:
Treatment:
Remarks:
COMMON COLD
Etiology & Pathogenesis Differentiation: a) Wind-Cold
headache, nasal obst., aversion to wind and fever. often 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.
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 coating Pulse: superficial and tense (wind-cold invasion) 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. Rx: DU16, UB12, GB20, LU7, LI4 Reducing 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 patients DU16 eliminates Wind, relieves exterior and tx headche UB12 (Taiyang meridian which dominates the surface of whole body, is selected to regulate Qi flow of the meridian, eliminate W/C and relieve chills & fever LU7 Luo-connecting, cough and dispersing LULinking fxn GB20 crossing pt of Foot Shaoyang and Yang 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, thirst Tongue: thin white or yellowish coating Pulse: superficial and rapid 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. Rx: DU14, LI11, SJ5, LI4, LI10, LU11 Reducing applied to DU, Shaoyang and Yangming pts to eliminate W/H DU14 (pt where all Yang channels meet) eliminates Heat and promotes qi flow LI4 and LI11 (Yuan primary pt and He-Sea pt of Hand Yangming & Taiying
Analysis:
Treatment:
MALARIA
paroxysms (sudden attacks) of shivering chills and high fever occuring at regular intervals, mostly in late summer or early autum
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: hot sensation, preceded by yawning and lassitude, intolerant headache, flushed face and red Paroxysms of Shivering Chills lips, hypochondriac and chest distention, bitter taste and dry mouth, dire thirst. At end of and High Fever episode, patient breaks into profuse perspiration and fever subsides. Tongue: sticky, yellow coating Pulse: string-taut and rapid 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. Rx: DU14, DU13, SI3, PC5, SJ2, GB41 Reducing is applied to regulate DU and harmonize Shaoyang Tx is done 2 hrs prior to proxysms, if chills are present apply Moxa DU14 (pt where all Yang channels meet) eliminates Heat and promotes qi flow combined with DU13 can remove obstructions from DU and regulate Yin & Yang SJ2 & 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) DU14 & LI11 dispel heat LV13 (influential pt for zang organs regulates their qi) + Pigen (extra pt) can be used for mass in hypochondriac region
Analysis:
Treatment:
High Fever: Malaria w/splenomegaly:
II) ZANG-FU SYNDROMES

COUGH
Etiology & Pathogenesis Differentiation: 1) WIND-COLD: cough, itching of throat, thin & white sputum, aversion to cold, fever, no sweat, a) Invasion by pathogenic factor headache, nasal obst and discharge. Tongue: thin, white coating Pulse: superficial (exterior) 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 coating Pulse: superficial and rapid (exterior, heat) May be due to impairment of Lu Qi, organ disorders or other organs attacking LU a) Invasion by pathogenic factor b) Internal Injury
Analysis:
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. Principle pts chosen from Hand Taiyin and Yangming. Moxa for W/C Rx: LU7, LI4, UB13 LU7 (Luo) and LI4 (Yuan primary) + UB13 to strengthen LU fxn, elim. Pathogen Supplementary Pts: LU11 if sore throat w/swelling DU14 & SJ5 for fever w/aversion to cold
Treatment:
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 coating Pulse: rolling (phlegm) 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. Back-Shu and Foot Yangming, combine w/moxa to strenghten SP fxn and resolve phlegm. Rx: UB13, Ren12, LU5, ST36, ST40 UB13, REN12, ST36 strenghten SP fxn and harmnz ST, rem damp/phlegm LU5 (He-sea) reduces pathogenic factor to relieve cough ST40 (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 coating Pulse: thready and rapid
Analysis:
Treatment:
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). Rx: UB13, LU1, LU7, KI6 UB13 & LU1 (back-shu/Front-Mu) regulate LU passage and descend LU qi LU7 (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 blood Cupping on UB12 & UB13 to tx cough
ASTHMA
Etiology & Pathogenesis Differentiation: a) Excess Type
Repeated attacks of paroxysmal dyspnea with wheezing. a) Excess type: Wind-Cold, Phlegm-Heat b) Deficiency type:
1) WIND-COLD: cough w/thin white sputum, chills & fever, no sweat (at early stage), headache, no thirst. Tongue: thin, white coating Pulse: superficial (exterior) & tense (cold) 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.
Analysis:
Treatment:
Rx: UB13, UB12, DU14, LU7, LI4 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 coating Pulse: 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, ST40 LU5 (He-Sea) reduces phlegm-heat and soothes asthma ST40 strenghtens SP fxn and resolves phlegm UB13 clears LU and regules Qi flow Ren22 descends Qi and resolves phlegm Dingchuan (Extra) is an empirical pt to pacify breathing. 1) LU DEF: short and rapid breathing, feeble voice, weak and low sound of couging, swearing on exertion. Tongue: pale tongue Pulse: pulse of deficiency type 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, SP3 LU9 (Yuan pt) reinforces LU Qi UB13 (needle and moxa) strenghtens LU Qi ST36 (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 tongue Pulse: deep and thready (KI Yang def)
Treatment:
b) Deficiency Type
Analysis:
Treatment:
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, Ren6 KI3 (Yuan) + UB23 toghether strenghten KI Yuan Qi (primary) Ren17 (Qi Infl. Pt) and UB13 reinforce Qi and pacify breathing Ren6 (Sea of Qi) important pt to regulate Qi in lower burner, reinforce KI, strenghen Yaun Qi, and pacigy breathing DU12 & UB43 moxa on both to relieve chronic athsma DU12 & UB20 moxa on both to strenghten the SP fxn and reinforce Qi. This condition includes bronchial asthma, asthmatic bronchitis, obstructive pulmonary emphysema and dyspnea.
Treatment:
Remarks:
EPIGASTRIC PAIN
Repeated attacks of pain in stomach area a) Food Retention b) LV Qi invading ST c) ST deficiency w/cold stagnation
Differentiation:
a) Food Retention: (Excess condition) Analysis:
distending pain in epigastrium, aggravated on pressure (excess)or after meals, belching w/fetid odor. Tongue: thick, sticky coating Pulse: deep, forceful or rolling pulse food retention impairs ST qi descending fxn. Stagnant Qi causes pain in epigastrium Rx: Ren11, PC6,ST36, Inner-Neiting 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 paroxysmal pain in epigastrium, radiating to hypochondriac region, freq. belching w/nausea, vomitting, acid regurg, abd distention, anorexia. Tongue: thin, white coating Pulse: deep, string-taut 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 LV14 (LV Front-Mu) & LV3 (Yuan) combo used to remove LV Qi Stagnation, regulate Qi flow and relieve pain Ren12 (ST Front-Mu), ST36 and PC6 (Confluent pt) used for ST, chest and Heart disorders. Used to pacify the ST and relieve pain. dull epig pain, relieved by pressure and warmth (def), general lassitude, regurgitation of thin, white fluid, Tongue: thin, white coating Pulse: deep, slow 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 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 disorders UB20 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)
Treatment:
b) LV Qi invading ST
Analysis:
Treatment:
c) ST Def. w/Cold Stag.
Analysis:
Treatment:
VOMITING
ST qi fails to descend leading to vomiting. a) Food Retention b) LV Qi invading ST c) ST/SP Hypofunction (Deficiency)
Differentiation: a) Food Retention: (Excess condition) acid fermented vomitus, epig and abd distention, belching, loose stool or constipation. Tongue: thick, granular coating Pulse: forceful & rolling pulse 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. vomiting, acid regurg, freq. belching, distenting pain in chest and hypochondriac region, irritability w/oppressed feeling. Tongue: thin, sticky coating
Analysis:
b) LV Qi invading ST
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) sallow complexion, vomiting after a big meal, loss of appettite, lassitude, weakness, slightly loose stool. Tongue: thin, white coating Pulse: thready and forceless 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 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: Ren10 LV3 UB20 Jinjing and Yuye (Extra pts) bleed to stop vomiting
c) ST/SP Hypofunction
Analysis:
General Treatment:
Food Retention LV Qi invading ST SP/ST weakness Persistent vomiting
HICCUP
Involuntary spasm of the glottis and diaphragm, causing the characteristic sound. a) Food Retention b) Qi Stagnation c) ST Cold
Differentiation: a) Food Retention: (Excess condition) loud hiccups, epig and abd distention. Tongue: thick, sticky coating Pulse: forceful & rolling pulse 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. 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) stagnant LV qi will invade the ST causing upward perversion of ST Qi leading to hiccup slow and forceful hiccups which may relieved by heat and aggravated by cold, discomfort in epig. Tongue: white, moist coating (cold) Pulse: slow (cold) 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 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: Ren14 & Inner-Neiting pacify ST and remove stagnation LV3 (pacify LV qi) & Ren17 relieves depressed feeling in chest and diaphragm relieving hiccups
Analysis: b) Qi Stagnation:
Analysis: c) ST Cold:
Analysis:
General Treatment:
Food Retention Qi Stagnation
ST Cold
Ren13 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. a) Cold Accumulation b) SP Yang Hypoactivity (Def) c) Food Retention
Differentiation: a) Cold Accumulation sudden 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 coating Pulse: deep, tense or deep, slow (cold accum) 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 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. intermittent dull pain relieved by warmth or pressure, aggravated by cold, hunger, fatigue and lassitude, aversion to cold. Tongue: thin, white coating Pulse: deep, thready ST/SP weakness leads to Yang hypofunction in middle jiao (cold) which causes pain, loose stools, etc. Rx: UB20, UB21, Ren12, LV13, Ren6, ST36 UB20 & LV13, UB21 and Ren12 (Back-Shu/Front-Mu combinations) moxa & needle Ren6 & ST36 strenghten ST/SP fxn 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 coating Pulse: rolling (indigestion) 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-Neiting Ren12, ST36, ST26 & Ren6 are applied to regulate ST qi flow Inner-Neiting is empirical pt for indigestion
Analysis:
Treatment:
c) SP Yang Def
Analysis:
Treatment:
c) Food Retention
Analysis:
Treatment:
DIARRHEA
refers to abnormal frequency and liquidity of fecal discharge. 1) Acute: a) Cold-Dampness b) Damp-Heat c) Food Retention 2) 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: pale Pulse: deep, slow 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, thirst Tongue: yellow, sticky coating Pulse: rolling & rapid 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 (dampheat 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, ST36 ST25 (LI Front-MU) regulates intestines' transmitting fxn ST36 (He-Sea pt) regulates ST qi Supplementary Pts: Ren12 & Ren6 moxa w.ginger is applied to warm St/SP, dispel cold, rem damp, reg qi ST44 & SP9 eliminate damp-heat from LI Inner-Neiting (Extra) used for food retention & to regulate ST/SP fxns d) SP Def: loose stools w/undigested food, anorexia, epig distention after eating, sallow complexion, lassitude Tongue: pale w/white coating Pulse: thready, forceless 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, ST36 UB20 & LV13, (Back-Shu/Front-Mu combination) 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 UB23 (KI Back-Shu) & KI3 (Yuan) reinforcing needling to warm KI Yang & invig Ki qi
Analysis:
Analysis:
General Treatment:
Cold-Damp Damp-Heat Food Retention 2) Chronic:
Analysis:
Treatment:
Treatment:
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. a) Damp-Heat dysentery b) Cold-Damp dysentery c) Food-Resistant dysentery d) 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, thirst Tongue: yellow, sticky coating Pulse: rolling, rapid or soft, rapid 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. diff defecation, white mucus in stools, aversion to cold, epig & chest fullness, lingering abd pain, tastelessness in mouth, no thirst Tongue: white, sticky coating Pulse: deep,slow 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. frequent stools w/blood and pus, total loss of appetite, nausea, vomiting Tongue: yellow, sticky coating Pulse: soft, rapid 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. occuring on and off, difficult to cure, lassitude, aversion to cold, somnolence, anorexia Tongue: pale tongue, sticky coating Pulse: soft (persistent dampness) 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.
Analysis:
b) Damp-Cold:
Analysis:
c) Food Resistent:
Analysis: d) Intermittent dysentery:
Analysis:
General Treatment:
Damp-Heat Dysentery: Cold_Damp Dysentery: Food Resistant Dysentery:
Internal Classic states: He-Sea pts are applied for fu organ diseases Rx: ST25, ST37 ST25 (LI Front-Mu) & ST37 (He-sea of LI) principal pts to remove stagnation of qi in LI Dampness will be resolved in case qi is regulated LI11 & LI4 may dispel damp-heat from ST & LI Ren12 and Ren6 moxa to warm the ST/SP, remove cold and regulate qi flow + SP9 to strenghten the SP fxn and resolve damp Ren12 and PC6 pacify ST and resolve damp
Intermittent Dysentery: Fever Tenesmus Rectal Prolapse
UB20, UB21, ST36, Ren4 (Front-Mu of SI) separates the food essence from the waste, reinforces qi and activates Yang Supplementary Pts: DU14 UB29 DU20 w/moxa + DU1
ABD DISTENTION
distention 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. a) Excess condition b) Deficiency Condition
Etiology & Pathogenesis Differentiation: a) Excess Condition:
persistence of distention and fullness in abd, aggravated by pressure, belching, foul breath, dark yellow urine, constipation, sometimes w/fever, vomiting Tongue: yellow, thick coating Pulse: rolling, rapid & forceful 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. abd distention relieved by pressure, borborygami, loose stools, loss of appetite, lassitude, listlessness, clear urine Tongue: pale tongue w/white coating Pulse: forceless (SP def) 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 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 LI4 & Ren6 are combined to regulate circulation of qi & SP9 eliminates damp-heat SP3 & Ren4 strengthen t/t fxn of SP/ST
Analysis:
b) Deficiency Condition:
Analysis:
General Treatment: Excess Condition: Deficiency Condition:
JAUNDICE
Etiology & Pathogenesis Differentiation: a) Yang Jaundice:
yellow discoloration a) Yang Jaundice b) Yin Jaundice
lusterous yellow skin and sclera, fever, thirst, scanty dark yellow urine, heaviness of the body, fullness in abd, stuffiness of the chest, nausea Tongue: yellow,sticky coating Pulse: string-taut, rapid 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.
Analysis:
b) Yin Jaundice:
sallow skin, heaviness of the body, weakness, loss of appetite, epig fullness, lassitude, aversion to cold, no thirst Tongue: pale tongue, thick, white coating Pulse: deep,slow 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, Du9 SP9 & ST36 strenghten the SP and resolve damp UB18, UB19 & DU9 are important pts to tx Jaundice GB34 (since damp-heat resides in GB) reduces heat & LV3 is used to regulate LV/GB qi flow UB20 & UB48 moxa may resolve cold damp by warmth and tx Jaundice
Analysis:
General Treatment: Yang Jaundice: Yin Jaundice:
CONSTIPATION
Etiology & Pathogenesis Differentiation: a) Excess Condition:
caused by impaired LI transmitting fxn and related to SP,ST & KI fxn a) Excess Condition b) Deficiency 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 breath Tongue: thin,sticky coating Pulse: string-taut 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. in case of qi & blood def there is pale and lusterless complexion, lips and nails, dizziness and palpitations, lassitude, shortness of breath Tongue: pale tongue, moist, white coating Pulse: deep,slow 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 UB25 (LI Back-Shu) & ST25 (LI Front-Mu) promote qi flow in LI, transmittion fxn is regained when there is smooth qi flow SJ6 (promotes qi flow in 3 jiaos) & KI6 are principal pts to tx constipation LI11 & LI4 remove heat from LI Ren12 (Influential pt of fu organs) reduces qi of fu organ + LV3 (reduced to soothe Lvqi) 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
Analysis: b) Deficiency Condition:
Analysis:
General Treatment: Heat Accumulation: Qi Stagnation: Qi & Blood Deficiency:
EDEMA
Etiology & Pathogenesis Differentiation:
subcutaneous retention of fluid which leads to puffiness of the face, eyelids, limbs, abd and even the whole body. a) Yand Edema b) Yin Edema
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 coating Pulse: superficial or rolling, rapid (superficial indicates wind-water invasion) 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.
Analysis:
Treatment:
Edema above the lumbus s/b tx by diaphoresis (profuse sweating) Rx: LU7, LI4, LI6, SP9, UB39 LU7 & LI4 clear the LU and relieve exterior symptoms by diaphoresis. LI6 & SP9 remove damp and promote diuresis UB39 regulates qi of San Jiao and water passages 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 stools Tongue: pale tongue, moist, white coating Pulse: deep, thready 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. 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 dampness Rx: UB20, UB23, Ren9, Ren4, KI7, ST36 UB20, UB23 & KI7 moxa & needle to warm SP/KI primary yang & remove cold water Ren9 & Ren4 promote water circulation and reinforce primary qi respecively ST36 promotes SP/ST fxn, restoring normal distribution of fluid Supplementary Pts: Du26 GB41, SP5
b) Yin edema:
Analysis:
Treatment:
Facial Puffiness: Edema on pedis dorsum:
NOCTURNAL ENURESIS years old and is due to KI qi def w/inability to restrain urine in the bladder
Etiology & Pathogenesis Differentiation: KI qi def w/inability to restrain urine in the bladder
involuntary discharge of urine occuring at night and during sleep. Mostly seen in kids of over 3
KI qi def w/inability to restrain involuntary micturition during sleep w/dreams, once in several nights is a mild case, several urine in the bladder times anight is severe case. Sallow complexion, loss of appetite, weakness Tongue: pale w/white coating Pulse: 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 fxn SP6 is added to adjust the qi in 3 Yin meridians LV1 (Jing-well) moxa to promote circulation of qi in LV meridian and strengthen the therapeutic effect Supplementary Pts: HT7 UB20 & ST36 Chief causative factor is underdevelopment of cerebral micturition center and acupuncture and moxibustion provide satisfactory effect
Enuresis w/dreams: Loss of appetite: Remarks:
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 a) Dysuria caused by calculi b) Dysuria caused by qi dysfunction c) Painful urination w/blood d) Dysuria w/milky urine e) 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 urine Tongue: normal coating Pulse: none stated 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 difficult and hesitant urination, fullness and pain of lower abdomen Tongue: normal coating, thin, white Pulse: deep, string-taut Analysis: c) Painful urination w/blood: emotional depression leads to qi dysfunction, leading to LV& UB qi stag hematuria w/pain and urgency, burning sensation and pricking pain in urination. Tongue: thin, yellow white Pulse: rapid & forceful cloudy urine w/milky or creamy appearance, urethral burning pain in urination Tongue: red tongue, sticky coating Pulse: thready & rapid Note: both tongue and pulse are signs of KI Yin def and stagnation of damp-heat 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 difficulty in urination w/dribbling of urine, occurring on and off, exacerbated by overwork and usually refractory to treatment Tongue: not stated Pulse: weak 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.
Analysis:
b) Dysuria caused by qi dysfunction:
d) Dysuria w/milky urine:
Analysis: e) Dysuria caused by overstrain:
Analysis:
Treatment:
Rx: UB28, Ren3, SP9 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 calculi LV2 (Ying-Spring of LV) used to dispel LV fire & relieve pain. Dysuria caused by qi dysfunction SP10 & SP6 to stop bleeding. Painful urination w/blood UB23 & KI6 reinforce KI qi. Dysuria w/milky urine DU20 (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 a) Accumulation of heat in the bladder b) Decline of Mingmen fire c) Qi damage
Differentiation: a) Accumulation of heat in the scanty hot urine or retention of urine, distention and fullness of lower abd, thirst but w/no desire bladder: to drink, constipation Tongue: red tongue w/yellow coating Pulse: 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, UB39 UB28 (UB Back-Shu) & Ren3 (UB Front-Mu) reduce heat from the bladder & adjust fxn SP6 dispels heat from lower jiao UB39 (Lower He-Sea of SJ) promotes circulation of water These points used together, reduce heat and promote diuresis dribbling urination, attenuating in force of urine discharge, pallor, listlessness, chilliness below the lumbus, weakness of the loins and knees Tongue: pale tongue Pulse: deep, thready pulse weak at chi position (Ki def) 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, SJ4 DU4 & UB23 reinforce KI Yang DU20 & Ren4 Moxa to invigorate KI qi SJ4 (Yuan primary of SJ) Since KI qi def makes SJ fail to promote water circulation
Treatment:
b) Decline of Mingmen Fire:
Analysis:
Treatment:
c) Qi damage in the meridian: dribbling urination or retention of urine, distention and dull pain in the lower abdomen Tongue: purplish spots on the tongue Pulse: hesitant, rapid Both 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. a traumatic injury or surgical operation can injure the blood vessels and impede the bladder fxn, thus urodialysis appears. Rx: Ren3, SP6, ST28, KI5
Treatment:
Ren3 (UB Front-Mu) adjusts bladder fxn and promotes urination SP6 promotes qi and blood circulation in the meridian KI5 (Ki-Cleft) & ST28 promote urination and relieve distention and pain
IMPOTENCE
Etiology & Pathogenesis Differentiation: a) Decline of Mingmen Fire:
referred to lack of copulative power in males a) Decline of Mingmen Fire b) Downward flowing of Damp-Heat
failure to achieve erection or weak erection, palor, cold extremities, dizziness, listlessness, soreness and weakness of loins and knees, frequent urination Tongue: pale tongue w/white coating Pulse: deep, thready Note: If HT/SP are affected, there may be palpitations and insomnia 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 Ren4 is the meeting pt of Ren meridian and the 3 foot Yin meridians. Reinforcing is used to promote primary qi and invigorate KI fxn DU4 (Mingmen), UB23 & KI3 are used to strenghten KI Yang Supplementary Pts: UB15, HT7 & SP6 activate SP/HT qi 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 coating Pulse: soft, rapid 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 dampheat 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. This condition is caused by the downward flow of damp-heat from the SP. Rx: Ren3, SP6, ST36, SP9 Ren3, SP6 and SP9 soothe and regulate SP qi to eliminate damp-heat ST36 dispels dampness by improving t/t fxn of the SP. Heat will disappear when dampness is dispelled.
Analysis:
Treatment:
SP/HT qi damage: b) Downward flow of Damp-Heat:
SEMINAL EMISSION
Etiology & Pathogenesis Differentiation: a) Nocturnal Emission:
generally divided into two categories a) Nocturnal Emission b) Spermatorrhea
mainly due to overcontemplation or excessive sexual activities which lead to disharmony b/n HT/KI. Tongue: red tongue Pulse: 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, UB52 HT7 & UB15 lower HT fire and harmonize the HT/KI KI3 activates KI qi UB52 controls essence 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, listlessness Tongue: pale tongue Pulse: deep, thready 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, Ren6 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 Yang KI12 is combined to assist the control of KI essence
Treatment:
b) Spermatorrhea:
Analysis:
Treatment:
INSOMNIA
refers to difficulty in falling asleep, early awakening, intermittent waking through the period of sleep, and even inability to sleep at all. a) HT & SP Qi Deficiency b) HT/KI Disharmony c) LV Fire Rising d) ST Dysfunction
Differentiation: a) HT/SP Qi Deficiency: difficulty in falling asleep, dream-disturbed sleep, palpitations, poor memory, lassitude, listlessness, anorexia, sallow complexion Tongue: pale tongue w/thin coating Pulse: thready, weak 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. restlessness, insomnia, dizziness, tinnitus, dry mouth w/little saliva, burning sensation of the chest, palms and soles, nocturnal emission, poor memory, palpitations, LBP Tongue: red tongue Pulse: thready and rapid (KI Yin def) 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. irritability, dream-disturbed sleep, fright and fear accompanied w/headache, distending pain in costal region, bitter taste in mouth Tongue: not stated Pulse: string-taut
Analysis:
b) HT/KI Disharmony:
Analysis: c) LV Fire Rising:
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. insomnia, suffocating feeling and distending pain in the epig region, belching or difficult defecation Tongue: sticky coating Pulse: rolling 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. a) HT & SP Qi Deficiency: UB20, UB15, SP1 UB20 (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 sleep b) HT/KI Disharmony: UB15, UB23, KI3 UB15 (HT Back-Shu) reduces HT Fire, KI3 & UB23 reinforce KI water. The 3 pt combo harmonize HT/KI c) LV Fire Rising: UB18, UB19, GB12 UB18, UB19, GB12 subdue LV/GB Fire d) ST Dysfunction: UB21, ST36 UB21 & ST36 regulate ST and soothe the mind
d) ST Dysfunction:
Analysis:
General Treatment:
POOR MEMORY
functional decline of the brain, hypomnesia and forgetfulness 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. mainly replenish HT blood and reinforce SP/KI Rx: Shishencong (Extra pt), UB15, UB20, ST36, UB23 & KI6 Shishencong (Extra pt) empirical pt for poor memory UB15 & UB20 strengthen HT & SP UB23 & KI6 promote KI Essence, produce marrow and replenish the brain ST36 reinforces SP/ST t/t and replenish qi and blood
Treatment:
PALPITATION
unduly rapid action of the HT which is felt by the patient and accompanied by nervousness and restlesness a) Disturbance of the Mind b) Qi and Blood Def c) Yin def w/hyperactive Fire d) Retention of harmful fluids
Differentiation: a) Mind Disturbance: palpitation, fear and fright, irritability, restlessness, dream-disturbed sleep, anorexia Tongue: white, thin coating Pulse: a little bit rapid In case of phlegm heat: T: yellow, sticky coating, P: rolling & rapid
Analysis: b) Qi and Blood Def:
fear makes the qi flow disordered, and fright makes qi descend. A disturned mind is out of selfcontrol, leading to palpitations, fear and fright, dream-disturbed sleep, irritability and restlessness. palpitations, lusterless complexion, dizziness, blurred vision, shortness of breath, lassitude Tongue: pale w/teeth marks Pulse: thready, weak or intermittent 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.
Analysis:
c) Fire Hyperactivity due to Yin Deficiency: palpitations, restlessness, irritability, insomnia, dizziness, blurred vision, tinnitus Tongue: red w/little coating Pulse: thready, rapid 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. palpitation, expectoration of mucoid sputum, fullness in the chest and epig region, lassitude, weakness, cold limbs, thirst w/o desire to drink Tongue: white, slippery coating (yang def) Pulse: deep, string-taut or rapid (Yang def SP/KI) 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 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. HT5 (Luo-connecting of HT) & GB40 (yuan primary of GB) can calm and regulate GB ST40 (Luo-connecting of ST) & UB19 (GB Back-Shu) disolve phlegm and dispel heat UB20 & UB21 regulate SP/ST to promote qi and blood production + ST36 is important to reinforce qi and blood UB23 & KI3 can replenish KI Yin + UB14 can clear HT Fire Ren4 & Ren9 & SP6 can invigorate the HT Yang, strenghten SP and remove harmful fluid
Analysis: d) Retention of harmful fluid:
Analysis:
General Treatment: Disturbance of the mind if accompanied w/phlegm-heat: Qi & Blood def: Yin def w/excess Fire Retention of harmful fluids:
MANIC-DEPRESSIVE DISORDER
Etiology & Pathogenesis Differentiation: a) Depressive Disorder:
mental dejection, reticence or incoherent speech, while manic disorder by shouting, restlessness and violent behavior a) Depressive Disorder b) Manic Disorder
graudal onset, emotional dejection and mental dullness at the intial stage, followed by incoherent speech, changing moods or muteness, somnolence, anorexia Tongue: thin, sticky coating Pulse: string-taut, thready or string-taut & rolling (Accumulation of phlegm and qi) 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 This condition is caused by the stagnation of phlegm and qi, which injures the HT,LV,SP Rx: UB15, UB18, UB20, HT7, ST40 UB15 is used to clear the HT UB18 removes LV qi stagnation UB20 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 coating Pulse: string-taut, rolling and rapid 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 Rising 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 heat DU14 & DU26 reduce heat for clearing the mind DU16 tx mental disorders "The brain is the sea of marrow, its upper part reaches the vertex of the cranium, and its lower part reaches
Analysis:
Treatment:
EPILEPSY
occurs 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. a) Fear and Fright Fear 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 Intake LV 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: 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 coating Pulse: String-taut, rolling 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. 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, ST40 DU26 & Ren15 used for resuscitation PC5, LV3 & ST40 calm the Heart, ease the mind, dissolve phlegm and dispel wind. listlessness. Lusterless complexion, dizzinesss, palpitations, anorexia, profuse sputum, weakness and soreness of loins and limbs
a) During Seizure:
Analysis:
Treatment:
b) After Seizure:
Tongue: pale w/white coating Pulse: thready, rolling Note: T/P combo indicate qi & blood consumption w/accumulation of phlegm-damp 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. HT/SP/KI pts, to nourish the HT, ease the mind, strenghten the SP & reinforce KI Rx: UB15, Yintang, HT7, SP6, KI3, Yaoqi (Extra) UB15, Yintang, HT7 nourish the HT, ease the mind SP6, KI3 strenghten the SP and reinforce the KI Yaoqi (Extra) empirical pt for Epilepsy Supplementary Pts: UB62 used for daytime seizures KI6 used for night time seizures Ren12 & ST40 regulate ST and dissolve phlegm Ren4 & ST36 regulate and replenish qi and blood
Analysis:
Treatment:
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 a) Hyperactivity of LV Yang LV 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 Deficiency HT/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-Dampness A 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 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 dreamdisturbed sleep. Nourish Yin and pacify Yang Rx: GB20, UB18, UB23, KI3, LV2 UB23 & KI3 reinforcing method to replenish KI water UB18, GB20 & LV2 reducing method to pacify LV Yang dizziness w/pallor and lusterless complexion, palpitations, insomnia, pale lips and nails, lassitude Tongue: pale
b) QI & Blood Deficiency:
Pulse: thready and weak Note: t/p indicative of qi & blood def 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. Replenish Qi and Blood Rx: DU20, UB20, Ren4, ST36, SP6 DU20 Moxa, ascends qi & blood to the head and nourish the brain, stop dizziness Ren4 strengthens Primary (Yuan) Qi UB20 & SP6 invigorate SP/ST to produce qi and blood
Analysis:
Treatment:
c) Interior Retention of Phlegm- dizziness w/heavy feeling of the head, suffocating sensation of the chest, nausea, profuse Dampness: sputum, anorexia, somnolence Tongue: white, sticky coating Pulse: soft, rolling Analysis: Treatment: 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. Resolve phlegm and eliminate damp Rx: ST8, UB20, Ren12, PC6, ST40 UB20 & Ren12 strenghten SP/ST to eliminate damp ST40 (luo-connecting of ST) makes qi descend and resolves phlegm ST8 is for dizziness PC6 relaxes the chest, regulates qi and harminizes ST, stops vomiting
MELANCHOLIA
general 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. 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 movement Tongue: thin, sticky coating (SP) Pulse: string-taut (LV) 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. Soothe LV, strenghten SP, harmonize ST Rx: UB18, Ren17, Ren12, ST36, SP4, LV3 Ren17 (Influential Pt of Qi) regulates qi flow UB18 (LV Back-Shu) and LV3 (Yuan primary) sooth the LV and remove depression Ren12 & ST36 harmonize ST and descend qi SP4 (SP Luo-Connecting) strenghtens SP & harmonizes ST
Analysis:
Treatment:
b) Transformation of depressed headache, dryness, bitter taste, irritability, chest distress, acid regurgitation, constipation, red Qi into Fire: eyes, tinnitus Tongue: 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. Dispel LV Fire and strenghten ST fxn Rx: Ren13, SJ6, GB34, LV2, GB43 LV2 & GB43 (Ying-Spring of LV/GB) dispel LV/GB Fire SJ6 & GB34 tx chest distress, hypochondriac dist, bitter taste, constipation Ren13 harmonizes ST, regulates qi flow to tx acid regurgitation feeling of lump in the throat, hard to spit out or swallow it Tongue: thin, sticky coating Pulse: string-taut, rolling 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. Soothe the LV, remove depression, regulate qi flow and resolve phlegm Rx: Ren22, Ren17, PC6, ST40, LV3 LV3 sooths the LV and removes depression Ren22 descends qi and tx throat trouble PC6 removes depression from chest and regulates qi flow Ren17 (qi Influential pt) & ST40 (ST Luo-Conn) promote qi circulation & resolve phlegm 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 consciousness Tongue: thin, white coating Pulse: string-taut, thready (long-standing Qi Stag damaging blood) 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. Nourish blood, soothe the LV and refresh and tranquilize the mind Rx: Ren14, HT7, SP6, LV3 LV3 soothes the LV and removes depression Ren14 (HT Front-Mu) & HT7 (Yuan Prim) + SP6 nourish blood, refresh and ease mind Supplementary Pts: Chest Distress: PC6 & Ren17 remove depression of the chest Hiccup: SP4 & Ren22 cause qi to descend and stop hiccups Sudden aphonia: HT5 & Ren23 Convulsion: LI4 (regulates qi flow) & GB34 (Inf. Pt of tendons) relieves pain Loss of Consciousness: DU26 & KI1 used for resuscitation
Treatment:
c) Stagnation of Phlegm:
d) Blood Deficiency: (aka Hysteria)
Analysis:
Treatment:
III) Diseases of the Head, Trunk and Lumbar Regions
HEADACHE
Headache 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. 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 headache occurs on exposure to wind, pain extends to nape of the neck and back region. into the meridians and Violent, boring & fixed pain collaterals: Tongue: thin, white coating Pulse: 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 headache, blurred vision, severe pain bilaterally, irritability, hot temper, flushed face, bitter taste Tongue: red tongue w/yellow coating Pulse: string-taut & rapid 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. Pacify LV Yang Rx: GB20, DU20, GB5, GB43, LV2 The Jueyin meridian of foot reaches the parietal region and the Shaoyang meridian runs up bilateral sides of the head. lingering headache, dizziness, blurred vision, lassitude, lusterless face, pain relieved by warmth and aggravated by cold, overstrain or mental stress Tongue: pale tongue w/thin coating Pulse: weak and thready 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. 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, ST36 Ren6 tonifies primary qi DU20 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.
b) Upsurge of LV Yang:
c) Qi and Blood Deficiency:
Analysis:
Treatment:
FACIAL PAIN (Trigeminal 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. Neuralgia) 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: 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 a) Facial pain due to invasion of supraorbital foramen, infraorbital foramen, angle of mouth, nasolabial groove, lateral sides of ala pathogenic Wind and Cold: nasi. Tongue: white, thin coating Pulse: string-taut Analysis: b) F. pain due to LV/ST Fire: 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. pain as described above accompanied by irritability, hot temper, thirst, constipation Tongue: yellow & dry coating Pulse: string-taut, rapid Note: t/p combined indicate LV Fire 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.
Analysis:
c) Facial pain due to Yin Def and insidious (w/no precursor or warning) pain, emaciation, malar flush, soreness in lumbar region, Excess Fire: lassitude, pain aggravated by fatigue Tongue: redened tongue w/little coating Pulse: 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, SJ5 Pain in maxillary region: ST2, SI18, LI20, LI4 Pain in mandibular region: ST7, ST6, ST5, Jiachengjiang (extra), LI4 Supplementary Pts W/C Invasion: GB20 ST/LV Fire: LV3, ST44 Yin Def w/excess Fire: KI6, SP6
EYE & MOUTH DEVIATION region. Most common in patients from 20-40 yrs old, mostly in males.
Etiology & Pathogenesis Differentiation:
derived from Wind-Cold invasion of meridians and collaterals and muscle meridians in the facial
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.
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, headache Tongue: thin, white coating Pulse: superficial tense or superficial slow 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.
Analysis:
General Treatment:
Eliminate wind and remove obstruction Rx: SJ17, GB14, Taiyang, SI18, ST7, ST4, ST6, LI4 LI4 (LI Yuan Primary) eliminates wind from the head and face GB12 & GB2 eliminate wind and relieve headache GB14, 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: GB20 Diff frowning and raising eyebrows: UB2, SJ23 Incomplete eye closure: UB2, UB1, GB1, Yuyao, SJ23 Diff sniffing: LI20 Deviation of philtrum: DU26 Inablitiy to show teeth: ST3 Tinnitus & deafness: GB2
HYPOCHONDRIAC PAIN 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 taste Tongue: white, thin coating Pulse: string-taut 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 night Tongue: dark purplish tongue proper Pulse: deep, hesistant Analysis: Treatment: fixed stabbing pain (blood stasis), pain intensified at night suggests blood as yin stagnates at night. Remove stagnation of LV qi and obstruction in collaterals. Rx: LV14, SJ6, GB34 SJ6 & 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 vision Tongue: red tongue w/little coating Pulse: weak or rapid & thready
a subjective symptom..as the LV supplies the hypochondriac regions, and the LV is related to
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. Nourish essence and blood, invig circulation of qi, relieve pain Rx: LV14, UB18, UB23, ST36, SP6, LV3 UB18 (LV Back-Shu) & LV14 (LV Front-Mu), LV3 (Yuan prim) combo nourishes Yin & blood, readjusts the LV and relieve pain ST36, 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 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: 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 area Tongue: white, sticky coating Pulse: deep, weak and slow 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. 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 limbs Tongue: 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 soles Tongue: redened tongue proper w/scanty coating Pulse: thready, weak or thready, rapid (t/p combo indicative of blood stasis) 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 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.
a) Cold-damp Invasion:
Analysis:
b) Ki Deficiency:
Analysis:
Analysis:
General Treatment:
Promote qi and blood circulation, relieve pain, relax muscles & activate circulation in collaterals. Rx: UB23, DU3, UB40 UB23 (Ki Back-Shu) tonifies KI Qi. W/Moxa it eliminates cold & damp DU3 (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 SYNDROME
syndromes 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. 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 & fever Tongue: thin & sticky coating Pulse: superficial & tight or superficial & slow 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. severe stabbing pain in joints, alleviated by warmth and aggravated by cold, w/fixed location but no local redness and hotness. Tongue: thin & white coating Pulse: string-taut and tense severe pain due to retarded qi & blood flow caused by cold. Pain is localized because of the congealing effect of cold. numbness and heavy sensation of the limbs, soreness and fixed joint pain, aggravated on cloudy and rainy days. Tongue: white, sticky coating Pulse: soft 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. arthralgia (joint pain) involving one or several joints, local redness, swelling and excruciating pain w/limited movement, fever, thirst Tongue: yellow coating Pulse: rolling & rapid local redness, swelling and joint pain result from the transformation of pathogenic factors into heat.
Analysis:
b) Painful Bi:
Analysis:
c) Fixed Bi:
Analysis:
d) Heat Bi:
Analysis:
CHARACTERIZED BY LOCATION:
Skin Bi: Muscle Bi: Tendon Bi: Vessel Bi: Bone Bi: General Treatment: Tx Principle: Reducing method: wandering bi, heat bi, tendon bi Moxa: painful bi, vessel bi Acup & 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. SI3 communicates w/Du Channel Eight Confluent Points: tx communicates w/Yangqiao meridian shoulder, back, lumbar, legs, SP21 major Luo-connecting of SP which connects qi of the whole body muscles, tendons & bones: UB17 Influential pt of blood Shoulder joint pain: Scapula pain: Elbow pain: Wrist Pain: Finger Stiffness: Finger numbness & pain: Lumbar pain: Hip Joint pain: Thigh pain: Knee pain: Leg numbness & pain: Ankle pain: Toe numbness & pain: Back pain: General pain: Rx: LI15, SJ14, SJ19, SI10 Rx: SI11, SI12, SI14, UB43 Rx: LI11, LU5, SJ10, SJ5, LI4 SJ4, LI5, SI5, SJ5 SI5, LI4, SI3 SI3, LI3, Baxie (Extra) Du26, DU12, DU3 GB30, GB29, GB39 UB54, UB36, GB34 Heding (extra), ST35, Medial Xiyan (extra), GB34, SP9 UB57, UB58 ST41, SP5, GB40, UB60, KI3 SP4, UB65, Bafeng (extra) DU26, DU12, DU3 SI3, UB62, SP21, UB17, LI15, LI11, LI4, SJ4, GB30, GB34, GB39, ST41 Supplementary Pts: Wandering Bi, Vessel Bi: Painful Bi: Fixed Bi: Heat Bi: Tendon Bi: Bone Bi: UB17, SP10 (activate & nourish the blood) + GB20 to expel wind (wind will be naturally eliminated if blood circulates) UB23, Ren4 (strengthen KI fire and relieve painful bi) ST36, SP5 (strengthen SP/ST fxn and eliminate damp to relieve fixed bi) DU14, LI11 GB34 (Influential pt for tendons) UB11 (Influential pt for bone) & GB39 (Influential pt for marrow) UB6 numbness of the skin with cold sensation soreness, numbness and muscle pains soreness, pain and stiffness of the tendons and muscles pain due to blockage of vessels soreness, heaviness and joint pain which fails to perform their functions of lifting, extension and flexion
WEI SYNDROME
syndromes 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. a) 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 urine Tongue: redened tongue proper w/yellow coating Pulse: thready & rapid or rolling & rapid 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. 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 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. muscular flaccidity of lower limbs w/motor impairment, combined w/soreness and weakness of lumbar region, seminal emission, prospermia, leukorrhea, dizziness, blurred vision Tongue: redened tongue proper Pulse: thready & rapid 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. history of trauma, flaccid paralytic limbs, may be accompanied w/incontinence of urine and feces Tongue: pink or purplish tongue w/thin Pulse: thready & rapid 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.
Analysis:
b) Damp-Heat:
Analysis:
c) LV/KI Yin Def:
Analysis:
d) Trauma:
Analysis:
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: Lower Limb: LI15, LI11, LI4, SJ5 ST31, GB30, SP10, ST34, ST36, GB34, ST41, GB39 GB34 & GB39 (Inf. Pts of tendons and marrow respectively) nourish tendons and bone Supplementary Pts: LU5, UB13 (used to dissipate heat from LU) UB20, SP9 (eliminate damp-heat) UB18, UB23 (tonify LV/Ki Yin) Huatuojiaji pts corresponding to spinal injury (regulate qi in Du channel) Ren3, SP6 (adjust qi in KI/bladder) UB25, UB32 (improve LI fxn)
Heat in LU: Damp-Heat: LV/KI Yin Def: Trauma: Urine Incontinence: Fecal Incontinence:

Chapter 17 Internal Diseases

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Chapter 17 Internal Diseases

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Chapter 17 INTERNAL DISEASES (CAM) I) Exogenous Pathogenic Factors

CONDITION: Signs & Symptoms

Clenched Jaw: Stiff Tongue: 2) Flacid Syndrome:

Upper disturbance of LV wind:

Deviated Mouth: Remarks:

b) Excess Type: Analysis:

High Fever: Malaria w/splenomegaly:

II) ZANG-FU SYNDROMES

a) Food Retention: (Excess condition) Analysis:

c) ST Def. w/Cold Stag.

Food Retention LV Qi invading ST SP/ST weakness Persistent vomiting

Food Retention Qi Stagnation

Cold-Damp Damp-Heat Food Retention 2) Chronic:

Analysis: d) Intermittent dysentery:

Damp-Heat Dysentery: Cold_Damp Dysentery: Food Resistant Dysentery:

Intermittent Dysentery: Fever Tenesmus Rectal Prolapse

Etiology & Pathogenesis Differentiation: a) Excess Condition:

General Treatment: Excess Condition: Deficiency Condition:

yellow discoloration a) Yang Jaundice b) Yin Jaundice

General Treatment: Yang Jaundice: Yin Jaundice:

Analysis: b) Deficiency Condition:

General Treatment: Heat Accumulation: Qi Stagnation: Qi & Blood Deficiency:

Facial Puffiness: Edema on pedis dorsum:

Enuresis w/dreams: Loss of appetite: Remarks:

b) Dysuria caused by qi dysfunction:

d) Dysuria w/milky urine:

Analysis: e) Dysuria caused by overstrain:

b) Decline of Mingmen Fire:

SP/HT qi damage: b) Downward flow of Damp-Heat:

generally divided into two categories a) Nocturnal Emission b) Spermatorrhea

Analysis: c) LV Fire Rising:

Etiology & Pathogenesis

Analysis: b) Qi and Blood Def:

Analysis: d) Retention of harmful fluid:

b) QI & Blood Deficiency:

d) Blood Deficiency: (aka Hysteria)

III) Diseases of the Head, Trunk and Lumbar Regions

c) Qi and Blood Deficiency:

LOW BACK PAIN

CHARACTERIZED BY INVASION OF PATHOGENIC FACTOR:

Etiology & Pathogenesis

c) LV/KI Yin Def:

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