Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Strong aversion to cold, slight fever, no sweating, headache, aching joints/limbs, stuffy/runny nose, scratchy throat, no thirst, can have cough with clear or thin white phlegm. T- normal P- floating, tight Slight aversion to cold, sore swollen throat, sweating, fever, headache, thirst, nasal congestion with yellow phlegm, can have cough with thick yellow phlegm. T- thin yellow coat P- floating, rapid Tx Principle expel wind scatter cold release the exterior ventilate the lung Drain, moxa Acupuncture Points / Techniques he gu LI4 / lieque LU7 - yuan/luo (host/guest), command pts (face & mouth, head & nape) feng chi GB20 - expel wind, meets w/yang wei mai so resolves exterior feng men BL12 - local, wind entry site, add moxa, ventilate lung, dispel wind, release exterior zhi zheng SI7 - combine w/feng men to clear wind, clear heat, release exterior ying xiang LI20 - nasal problems w/cough or upper backache - fei shu BL13; walking cup along upper thoracic w/local sinus pain and/or headache - yin tang (for deep-seated nasal congestion), tai yang yu ji LU10 - xing-spring: clears heat; eases throat pain due to heat chi ze LU5 - he-water: douses fire; earth point: drains child he gu LI4 - command; releases exterior; clears heat (tui re) qu chi LI11 - clears heat (tui re); earth drains fire; regulates ying & xue levels feng chi GB20 - expel wind, meets w/yang wei mai feng men BL12 - resolve exterior, release wind fei shu BL13 - discharge heat; ventilate lungs w/high fever - da zhui DU14: let blood with cupping; or shi xuan (fingertips): let blood w/swollen painful throat - shao shang LU11: let blood **DO NOT needle below ge shu BL17 or on yin meridians to avoid pulling pathogen deep in to body.** he gu LI4 - command; releases exterior; clears heat (tui re) kong zui LU6 - xi-cleft, induces sweating, clears heat, descend & regulate lung qi zhi gou TB6 - move qi, resolve dampness zhong wan REN12 / zu san li ST36 - mu/he of stomach w/heat prominent - da zhui DU14 w/dampness prominent - yin ling quan SP9 w/abdominal distension & diarrhea/loose stools - tian shu ST25 (mu of large intestine) he gu LI4 / lieque LU7 - yuan/luo, command pts feng men BL12 - local, wind entry site, add moxa fei shu BL13 - ventilate lungs, stop cough; can apply cupping w/severe cough - tian tu REN22 (ventilate lungs, transform phlegm, disinhibit throat) w/taiyang headache - feng chi GB20 (dispel wind, resolve exterior) w/nasal congestion - shang xing DU23 and/or ying xiang LI20 he gu LI4 / lieque LU7 - yuan/luo, command pts fei shu BL13 - ventilate lungs, stop cough, discharge heat; can apply cupping da zhui DU14, qu chi LI11, yu ji LU10 - clear heat, yu ji also increases vital capacity of lung chi ze LU5 - water on metal meridian, drains child w/severe cough - tian tu REN22 (ventilate lungs, transform phlegm, disinhibit throat) w/severe throat pain - shao shang LU11: let blood; tian rong SI17 (local) fei shu BL13 - ventilate lungs, stop cough, discharge heat he gu LI4 / lieque LU7 - yuan/luo, command pts chi ze LU5 - tonify; rectify lung qi, regulate water passages w/heat - qu chi LI11, yu ji LU10 w/high fever - da zhui DU14 w/coughing blood - kong zui LU6 w/excess sweating - yin xi HT6 (helps contain fluids)

Syndrome Gan Mao Common cold Invasion of Wind-cold

Etiology / Pathomechanism External wind invasion: wind-cold in autumn & winter; wind-heat in spring & summer; wind with summer-heat-dampness in late summer. Chronic or temporary deficiency of zheng qi, can be due to psychoemotional factors. With deficiency of yang one is more susceptible to wind-heat invasion (add moxa to zu san li ST36 or gao huang shu BL43). With deficiency of yin one is more susceptible to wind-cold invasion (tonify fei shu BL13). Ear acupuncture: lung, nose, trachea, occiput, internal nose, ear apex. For prevention: 1) Acupressure on yin tang, he gu LI4 and ying xiang LI20; stimulate 3-5 minutes, 3X/day, until skin is red & aching. 2) zu san li ST36, moxa with 3-5 cones daily (if over 30). 3) Needle/moxa LI4 & ST36 regularly.

Gan Mao Common cold Invasion of Wind-heat

expel wind clear heat clear and rectify lung release the exterior Drain Can let blood.

Gan Mao Common cold Invasion of Summerheat -dampness

Unsurfaced fever, slight aversion to cold, bound/heavy headache, heavy limbs/joints, fatigue, lethargy, irritability, no thirst or thirst with preference for hot drinks, nausea, dark scanty urine, chest oppression, abdominal/epigastric distension and fullness, loose stools, can have cough with sticky phlegm. T- yellow, greasy coat P- floating, rapid, slippery Acute cough, sudden onset, forceful, frequent; itchy throat, fever & chills, white/clear copious thin watery phlegm, easily expectorated, no sweating, runny/stuffy nose, occipital headache, muscle/neck stiffness/pain. T- normal P- floating, tight Severe frequent cough, yellow (or white) thick phlegm, difficult to expectorate, coarse heavy breathing, chest pain, fever, sweating, aversion to wind, headache, thirst. T- normal with red tip, can have thin yellow coat P- floating, rapid Dry cough, scanty or no mucus, sticky and/or blood streaked mucus, non-productive cough, dry/scratchy/ sore mouth/throat/nose, can come w/cold or heat signs. T- dry, red tip w/heat P- floating, rapid w/heat, or tight w/cold

clear summer-heat transform dampness course and dredge biao (resolve exterior) harmonize interior Drain expel wind scatter cold ventilate the lung stop cough Drain, moxa expel wind clear heat stop cough down-bear lung qi transform phlegm Drain moisten lung stop cough expel wind-dryness Drain. Tonify to moisten.

Ke Sou Cough Invasion of Lung by Wind-cold (external) Ke Sou Cough Invasion of Lung by Wind-heat (external) Ke Sou Cough Invasion of Lung by Wind-dry (external)

Acute cough d/t exogenous pathogen; constriction of lung by cold entering pores/mouth/nose, lung cant diffuse/ ventilate/down-bear.

Acute cough d/t exogenous pathogen; fire/heat flaming upward, wind-cold transformed to heat, lung descending function is impaired.

Acute cough d/t exogenous pathogen; dryness damages lung fluids, prevents ability of lung to descend. Occurs in autumn or dry weather/dry indoors.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Dry hacking cough, sticky blood streaked mucus, fever w or w/o sweat, heat in chest, SOB, wheezing, dry mouth, thirst, red complexion. T- red tip, yellow coat P- rapid (not floating) Severe choking spasmodic cough, irritation that cant be coughed out, worse with stress/emotions, intermittent, can follow a cold, scanty sticky phlegm, bitter taste, red complexion, red eyes, dizziness, headache, dry scratchy throat, bloody sputum, irascibility. T- red sides & tip, dry yellow coat P- wiry, rapid Cough worse in morning and after eating (especially between 9-11 AM), copious thick white/clear phlegm, phlegmy sounding cough, also SP & LU qi deficiency Sx. T- pale, swollen, tooth marks, greasy wet white coat P- slippery, soggy Tx Principle clear heat downbear qi stop cough Drain drain liver fire clear lung heat stop cough Drain Acupuncture Points / Techniques fei shu BL13 - ventilate lungs, stop cough, discharge heat he gu LI4, da zhui DU14, yu ji LU10 - clear heat w/blood - kong zui LU6 (xi-cleft, stop bleeding), tan zhong REN17, chi ze LU5, ge shu BL17 fei shu BL13 - ventilate lungs, stop cough, discharge heat yu ji LU10, xing jian LR2- xing-spring, clear heat Yang ling quan GB34 - down-bear qi ni gan shu BL18 - course liver, clear heat, move qi jing qu LU8 - clear lung fire, treat shortness of breath w/dry scratchy throat - zhao hai KI6 (brings up moisture) w/coughing blood -kong zui LU6 (xi-cleft, stop bleeding) fei shu BL13& tai yuan LU9, tai bai SP 3 & pi shu BL20 - shu-stream earth points on tai yin (metal) meridians, together will strengthen zheng qi, moxa pi shu to tonify feng long ST40 - main point for phlegm he gu LI4 - with feng long will harmonize stomach, mobilize turbidity downward, get qi moving xia wan REN10, zhong wan REN12, shang wan REN13 - 3 stomach chambers (stomach is root) tian shu ST25, qi hai REN6, liang men ST20, zu san li ST36 w/thoracic oppression/abdominal distension - nei guan PC6 (rectify qi harmonize stomach) w/pre-existing heat/more heat symptoms - clear heat first: chi ze LU5, yu ji LU10, tan zhong REN17 chi ze LU5 - he-water zhao hai KI6 (if more heat), or tai xi KI3 (if less heat) fei shu BL13, shen shu BL23 - tonify gao huang shu BL43 - 100 taxations, use moxa if less heat w/severe heat - yu ji LU10 w/dry throat - lie que LU7 w/coughing blood - kong zui LU6, ge shu BL17 fei shu BL13, tai yuan LU9 - shu/yuan for tonification, can moxa on fei shu qao huang shu BL43, da zhui REN14 - use moxa, both will tonify lie que LU7 - release exterior, stimulate descent & dispersal of lung qi zu san li ST36 - tonify earth (he-earth) which is mother to lung metal w/spleen deficiency - zhong wan REN12 & pi shu BL20 w/spontaneous sweating - he gu LI4 (drain) & fu liu KI7 (tonify) - classic treat sweating combination

Syndrome Ke Sou Cough Lung Heat (external) Ke Sou Cough Liver Fire (internal)

Etiology / Pathomechanism Any of the 3 exogenous can transform to lung heat. Acute can transform to chronic, can both be present together. Liver fire tortures the lung (wood insults metal). Can be acute or chronic. Most often involves psycho-emotional stimuli causing qi profusion, fire rising violates decent of lung qi. Can chronically wax and wane over weeks/months. Turbid phlegm obstructing the lung. Chronic cough d/t internal injury. Underlaying deficiency in spleen and lung causing accumulation of dampness which turns to phlegm. Can also be caused by poor diet.

Ke Sou Cough Phlegm-dampness (internal)

strengthen spleen transform phlegm dry dampness stop cough ventilate lung Even tonify even drain. Can use moxa. moisten/enrich yin down-bear fire stop cough Tonify, clear if needed.

Ke Sou Cough Lung & Kidney Yin Deficiency (internal)

Lung & kidney yin deficiency cough Chronic cough d/t interaction between kidney and lung being deficient. Lung yin damaged by chronic disease, dry weather, smoking, febrile conditions.

Dry chronic cough, scanty sticky phlegm, can be blood tinged, difficult to expectorate, also yin deficiency Sx; thirst, night sweats, tidal fever, emaciation, insomnia, low back pain, weak knees, dryness all over. T- red, scanty/no coat, peeled, cracked P- floating, rapid, thready Chronic weak cough, coughing tires patient out, worse with exertion, worse with exposure to wind, mucus is thin white clear watery frothy, plus lung qi def. Sx: SOB, spontaneous sweating, aversion to cold, frequent catching colds, weak voice, reluctance to speak, fatigue. T- pale P- weak

Ke Sou Cough Lung Qi Deficiency (internal)

Lung qi is weak, lung down-bearing function is weak, causing chronic cough. Can be due to pre-existing lung deficiency or it can follow an exogenously caused cough that depletes lung qi and develops in to chronic lung deficiency cough.

tonify lung qi transform phlegm stop cough Tonify, moxa

Alternate therapeutic methods for treating cough: Dietary: eliminate hot spicy foods, they cause sweating, sweating causes loss of qi, thus aggravating qi deficiency. Emotional: avoid irritable situations, try to facilitate acceptance (the emotion of the lungs). Stop, or at least moderate, smoking. Keep warm, especially protect the back of the neck from cold and wind. Ear acupuncture: main points - liver, shen men, lung, trachea. Needle both ears, retain 10-20 minutes, every other day. 10 treatments make one course. Ear seeds can be applied to points after treatment. Blistering therapy: Apply rice grain size lumps of ban mao, mylabris, to points fei shu BL13, gan shu BL18, pi shu BL20. Remove after 12-20 hours. Cover blisters with gauze and allow them to naturally reabsorb.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Sweating, pale face, weak voice, prone to catching colds, sneezing, runny nose, shortness of breath, attacks elicited by pollen or dust, allergic rhinitis. P- empty Attacks of asthma at night, chest tightness, wheezing, dry cough, dry throat, weak voice, night sweating, tiredness, prone to catch colds, pale face, palpitations. T- dry, slightly red in lung area P- floating, empty Attacks of asthma worse at night, chest tightness, chilliness, facial edema, tiredness, back ache, depression, husky voice, daytime sweating, frequent pale urination, attack elicited by cold exposure, chilliness. T- pale P- weak, deep, slow Mild attacks of asthma, breathlessness on exertion, dry cough, dry throat, slight night sweating. T- red, no coat at front P- floating, empty at LU Chronic asthma with infrequent nighttime attacks, wheezing, breathlessness on exertion, dry throat, night sweating, backache, tinnitus, dry cough, five heart fever. T- red, no coat in front P- floating, empty Attacks elicited by emotional stress, chest and hypochondrium oppression and distension. T- normal or red sides P-wiry Soothe the liver Regulate qi Restore descending of lung qi Calm the mind Clear liver fire Subdue rebellious qi Restore descending of lung qi Calm the mind Nourish liver yin Move liver qi Restore descending of lung qi Calm the mind gong sun SP4 & nei guan PC6 - relieve fullness in chest, subdue rebellious qi, calm mind, move liver qi qi men LR14 & gan shu BL18 - move liver qi tan zhong REN17 - move qi in the chest, restore descending of lung qi Tx Principle Tonify lung and kidney wei qi systems Restore descending of lung qi Calm the mind If needed, or in late-onset asthma, tonify the spleen Acupuncture Points / Techniques To tonify lung and kidney wei qi systems: fei shu BL13, shen shu BL23, zhi shi BL52 huang shu KI16, guan yuan REN4, tai yuan LU9 shen que REN8 - with moxa on salt To restore descending of lung qi: fei shu BL13 lie que LU7, chi ze LU5, tan zhong REN17 To calm the mind: shen ting DU24, hou ding DU19, shen men HT7, jiu wei REN15 To tonify the spleen: pi shu BL20, wei shu BL21 zhong wan REN12, zu san li ST36, feng long ST40

Syndrome Asthma Allergic, Atopic, Early-onset Asthma Lung Qi Deficiency Asthma Early-onset Asthma Lung Qi & Lung Yin Deficiency Asthma Early-onset Asthma Lung Qi & Kidney Yang Deficiency Asthma Early-onset Asthma Lung Yin Deficiency Asthma Early-onset Asthma Lung & Kidney Yin Deficiency Asthma Early-onset Asthma Liver Qi Stagnation Insulting the Lungs Asthma Early-onset Asthma Liver Fire Insulting the Lungs Asthma Early-onset Asthma Liver Yin Deficiency

Etiology / Pathomechanism Treatment Between Attacks This refers to periods of time when asthma attacks are very infrequent, or when asthma is controlled by the occasional use of inhalers. The priority of treatment in between attacks is to treat the root by tonifying the lung and kidneys wei qi (defensive qi) systems.

Loud wheezing, attacks elicited by emotional stress, irritability, easily angered, chest and hypochondrium fullness and distension, bitter taste, thirst. T- red sides P-wiry, rapid Infrequent asthma attacks at night, dry throat, dry cough, blurred vision, dry eyes, hypochondriac and chest distension. T- red, no coat P- floating, empty

xing jian LR2 - clear heat from liver and drain fire, spread liver qi qi men LR14 & gan shu BL18 - clear liver fire and move liver qi nei guan PC6 - relieve fullness in chest, subdue rebellious qi, calm mind, move liver qi, ease breathing lie que LU7 - restore descending of lung qi qu quan LR8 & guan yuan REN4 - nourish liver yin san yin jiao SP6 & tai xi KI3 - nourish kidney yin to nourish liver yin gong sun SP4 & nei guan PC6 - relieve fullness in chest, subdue rebellious qi, calm mind, move liver qi

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Sudden wheezing and breathlessness with difficulty exhaling, no sweating, chest tightness, pale face, feeling cold, sneezing, cough, no thirst, attack elicited by cold weather, stiffness of shoulders & neck. P- tight Tx Principle Release exterior Expel wind-cold Calm asthma Calm the mind Drain Use cupping. Acupuncture Points / Techniques ding chuan extra - asthma point (calm/level wheezing), .5 cun bilateral to da zhui DU14 fei shu BL13 and/or feng men BL12 - release exterior, scatter cold (cupping) feng chi GB20 - regulate exterior, clear wind, relax the neck & shoulders jian jing GB21 - treat stiffness and pain of neck & shoulders, makes qi descend tain tu REN22 - ventilate lungs, treat cough, labored breathing, asthma, chest pain lie que LU7 - ventilate lung, release exterior, restore descending of lung qi kong zui LU6 - xi-cleft, treat acute asthma attack shen men HT7 & jiu wei REN15 - calm the mind, relieve fullness in the chest ding chuan extra - asthma point (calm/level wheezing), .5 cun bilateral to da zhui DU14 fei shu BL13 and/or feng men BL12 - release exterior, scatter cold (cupping) tain tu REN22 - ventilate lungs, treat cough, labored breathing, asthma, chest pain lie que LU7 - ventilate lung, release exterior, restore descending of lung qi kong zui LU6 - xi-cleft, treat acute asthma attack shen men HT7 & jiu wei REN15 - calm the mind, relieve fullness in the chest zu san li ST36 & san yin jiao SP6 - even method, harmonize ying and wei levels

Syndrome Asthma Allergic, Atopic, Early-onset Asthma Wind-cold (without sweating)

Etiology / Pathomechanism Treatment During Attacks Early-onset asthma characteristics: Starts in early childhood. Appears to run in families. Often associated with eczema from birth. Have whealing skin reactions to common allergens. Have antibodies in their serum which could be transferred to the skin of nonsensitized people and cause the same whealing reactions. Levels of IgE immunoglobulins up to six times higher than levels found in patients with non-atopic asthma. Common allergens include; dust mites, pollen, fungal spores, feathers, animal dander, cats saliva.

Asthma Early-onset Asthma Wind-cold (with sweating)

Slight sweating, attack with breathlessness and wheezing, less noisy than above, not much chilliness, tightness of chest, pale face. P- tight, slow

Release exterior Harmonize ying and wei levels Calm asthma Calm the mind Drain Release exterior Descend lung qi Expel wind-heat Calm asthma Calm the mind Drain

Asthma Early-onset Asthma Wind-heat

Fever and aversion to cold or feeling of heat, headache, chest tightness, loud wheezing, barking cough, mental restlessness, slight thirst. T- red sides and towards front P- rapid

ding chuan extra - asthma point (calm/level wheezing), .5 cun bilateral to da zhui DU14 fei shu BL13 - release exterior, restore descending of lung qi chi ze LU5 - he-sea point (downbear qi ni), ventilate & drain & moisten lung, treat all lung-heat illnesses zhong fu LU1 & lie que LU7 - ventilate lung, release exterior, restore descending of lung qi kong zui LU6 - xi-cleft, treat acute asthma attack, descend lung qi shao shang LU11 - expel wind-heat, soothe the throat, stop cough & labored breathing, treat anxiety shen men HT7 & jiu wei REN15 - calm the mind, relieve fullness in the chest

Xiao Chuan Wheezing and Breathlessness General Information

Main influence is tan yin (phlegm and clear fluids), lack of proper water metabolism. Tan is laying dormant in lung until factors activate it. Bronchitis, emphysema, TB, cancer, pneumothorax, acid reflux, high altitude, anxiety, anemia, poor fitness level, obesity, heart disease. Often congenital due to allergies. Blockage of descending function of lung due to constriction by cold, accumulation of fluids and qi, constriction of bronchii.

Shortness of breath (SOB) is main symptom. Wheezing, rapid, coarse labored breathing, thoracic oppression, inability to lay flat, depression/concavity of superclavicular fossa, can have cold sweats, more prevalent in cold weather, comes and goes. Can be brought on or aggravated by allergies (foods, environmental dust, pollens, dander, chemicals). SOB, phlegm (clear, thin, white, foamy), + wind-cold: itchy throat, fever & chills, no sweating, runny/stuffy nose, occipital headache, muscle/neck stiffness/pain. T- normal (can have white greasy coating) P- floating, tight SOB, wheezing, worsened or initiated by emotions and/ or stress, fullness in chest, not much mucus usually, frequent sighing, plum pit qi. T- normal P- wiry

Differentiating between excess and deficiency is the key factor in the treatment of asthma. Always calm/level wheezing and transform phlegm. For excess: expel evils from lung and promote respiration. For deficiency: support upright qi (bank up root) (supplement the lung and supporting organ deficiency during remission), treat acute symptoms of wheezing/SOB during attacks (branch).

Xiao Chuan Wheezing and Breathlessness Exogenous Wind-cold

Calm/level wheezing Dispel wind & scatter cold Ventilate lung Transform phlegm Drain Use moxa, cupping. Course liver Rectify qi Down-bear lung Calm/level wheezing Drain Can harmonize/regulate.

lie que LU7 - ventilate lung, release exterior chi ze LU5 - he-sea point (downbear qi ni), ventilate lung, water point- child of metal so drains lung fei shu BL13 or feng men BL12 - drain qi through tai yang, release exterior, scatter cold (moxa or cup) ding chuan extra - asthma point (calm/level wheezing), .5 cun bilateral to da zhui DU14 feng chi GB20 - regulate exterior (intersects w/yang wei mai), clear wind w/nasal congestion - shang xing DU23 & ju liao ST3 w/headache - wen liu LI7 (xi-cleft, stops pain) nei guan PC6 - rectifies qi (especially in jue yin) qi men LR14 - mu of liver, treats excess in liver tai chong LR3 - regulate, rectify and spread liver qi (or xing jian LR2 if excess is severe) tan zhong REN17 - meeting point of Qi so mobilizes qi in chest, down-bears qi ni fei shu BL13 - drain qi through tai yang, release exterior ding chuan extra - asthma point (calm/level wheezing)

Xiao Chuan Wheezing and Breathlessness Liver Qi stagnation

Liver qi stagnation violates the lung (wood insults metal). Most often involves psycho-emotional stimuli causing qi profusion, fire rising violates decent of lung qi. Can have lung qi deficiency underneath.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms SOB (rapid, labored breathing), phlegm (yellow, sticky, thick, hard to expectorate), + wind-heat: slight aversion to cold, sore swollen throat, sweating, fever, headache, thirst, nasal congestion with yellow phlegm. T- red tip, yellow greasy coat P- floating, rapid, slippery Tx Principle Expel wind & clear heat Down-bear lung Calm/level wheezing Transform phlegm Drain Acupuncture Points / Techniques

Syndrome Xiao Chuan Wheezing and Breathlessness Exogenous Wind-heat

Etiology / Pathomechanism Wind-cold transformed to heat, or heat invades the lung and blocks descent by rising/dispersing.

he gu LI4 - release exterior, clear heat da zhui DU14 - clear heat, stop cough & asthma ding chuan extra - asthma point feng long ST40 - transform phlegm, lou point (nets throat, treats sore throat) zhong fu LU1 - mu of LU, helps descent of lung qi, intersects with spleen so treats damp/phlegm kong zui LU6 - clear heat, disseminate and descend lung qi, regulate lung qi (for acute asthma attack) tan zhong REN17 - meeting point of Qi so mobilizes qi in chest, down-bears qi ni chi ze LU5 - he-sea point (down-bear qi ni), ventilate lung, water point- child of metal so drains lung w/severe labored breathing - cupping at fei shu BL13, needle yu ji LU10 to increase vital capacity of lung tai yuan LU9 & fei shu BL13 - shu/yuan tonify, bolster lung qi, benefit zheng qi, drain damp gao huang shu BL43 - tonify deficiency (100 taxations) zu san li ST36 - tonify deficiency, tonify earth tan zhong REN17 - widen chest, disinhibit diaphragm, transform phlegm ding quan (asthma point) - ventilate lung, calm asthma tai yuan LU9 & fei shu BL13 - shu/yuan tonify, bolster lung qi, benefit zheng qi, drain damp pi shu BL20 & gao huang shu BL43 - moxa; tonify deficiency (100 taxations) zu san li ST36 - tonify deficiency, tonify earth tan zhong REN17 - widen chest, disinhibit diaphragm, transform phlegm ding quan (asthma point) - ventilate lung, calm asthma san yin jian SP6 - drain damp, fortify spleen, regulate and harmonize ying & xue levels tai yuan LU9 & fei shu BL13 - yuan/shu combo (tonify, bolster lung qi), benefit zheng qi, drain damp gao huang shu BL43 - tonify deficiency (100 taxations) zu san li ST36 - tonify deficiency, tonify earth tan zhong REN17 - widen chest, disinhibit diaphragm, transform phlegm ding quan (asthma point) - ventilate lung, calm asthma shen shu BL23 & tai xi KI3 - yuan/shu combo (tonify kidney qi), moxa shen shu plus guan yuan REN4 w/excess fluids (edema, ascites) - fu liu KI7 (regulate fluids) and yin ling quan SP9 (transform damp) lie que LU7 (on right) and zhao hai KI6 (on left) - tonify kidney and restore descending of lung qi tai yuan LU9 & fei shu BL13 - yuan/shu combo (tonify, bolster lung qi), benefit zheng qi, drain damp zu san li ST36 & gao huang shu BL43 - tonify deficiency (100 taxations) tan zhong REN17 - widen chest, disinhibit diaphragm, transform phlegm ding quan (asthma point) - ventilate lung, calm asthma w/heart yang deficiency - nei guan PC6 and shen men HT7 (strengthen heart) w/loss of consciousness - ren zhong DU26 to prevent loss of consciousness: moxa at qi hai REN6, guan yuan REN4 and ming men DU4

Xiao Chuan Wheezing and Breathlessness Lung Deficiency

Qi deficiency in lung, can also be lung yin deficiency. Slow onset and progression, extended length, breathing is weak/faint/feeble, rhythm often irregular, pulse is weak. Weak post-heaven, congestion by damp-phlegm. Slow onset and progression, extended length, breathing is weak/faint/feeble, rhythm often irregular, pulse is weak. Kidney grasping function (na qi) is weak, kidney yang deficiency. Kidney is basis for wei (defensive) qi and zheng (upright) qi so more susceptible to colds, fluid metabolism is affected. Slow onset and progression, extended length, breathing is weak/faint/feeble, rhythm often irregular, pulse is weak. Severe condition. Excess fluids afflict heart (CHF). Slow onset and progression, extended length, breathing is weak/faint/feeble, rhythm often irregular, pulse is weak.

SOB, bright white complexion, spontaneous sweating, aversion to wind, weak cough, quiet voice, no desire to speak, frequent colds (due to weak wei qi), nasal congestion, sneezing, fatigue, lack of strength. If yin is also deficient: dry mouth, sore dry throat, malar flush. T- pale P-weak Lung deficiency symptoms above, plus Spleen deficiency symptoms: loose stools, lackluster complexion, fatigue, poor appetite, abdominal distension, copious mucus. T- pale, may have thick coating P- thready, weak Lung deficiency symptoms above, plus Kidney def: breathing worse with exertion/fatigue/cold/sexual activity, more difficult to inhale than exhale, rapid breathing, feel fear or trepidation, chest fluttering with anxiety, dark complexion, facial puffiness, tinnitus, dizziness, low back pain, cold lower limbs, lethargy, frequent urination. P- slow, thready, deep T- swollen, pale, perhaps purplish (stasis) blue (cold) Lung deficiency symptoms above, plus: Palpitations, cyanosis, cold limbs, can be loss of consciousness, heart pain. T- purple spots P- faint, weak, irregular

Support upright qi Strengthen lung Transform phlegm Calm/level wheezing Tonify, moxa Drain phlegm Support upright qi Strengthen spleen & lung Transform phlegm Calm/level wheezing Tonify, moxa Drain phlegm Support upright qi Strengthen kidney & lung Transform phlegm Calm/level wheezing Tonify, moxa Drain phlegm

Xiao Chuan Wheezing and Breathlessness Spleen & Lung Deficiency Xiao Chuan Wheezing and Breathlessness Kidney & Lung Deficiency

Xiao Chuan Wheezing and Breathlessness Heart Yang Qi & Lung Deficiency

Support upright qi Strengthen heart & lung Transform phlegm Calm/level wheezing Tonify, moxa Drain phlegm.

Alternate therapeutic methods for treating asthma: Dietary: eliminate foods that cause allergies. Emotional: avoid irritable situations, try to facilitate acceptance (the emotion of the lungs). Stop smoking and avoid environmental allergens. Keep warm, especially protect the back of the neck from cold and wind. Ear acupuncture: main points -asthma, trachea, bronchi, lung, kidney, sympathetic, shen men, adrenal, subcortex. Needle both ears, retain 10-20 minutes, every day. 10 treatments make one course. Ear seeds can be applied to points after treatment. Plum blossom needling: Treat over yu ji LU10 and along lung meridian on forearm, over fei shu BL13, ding chuan, tian tu REN22. 10-15 minutes until skin is slightly red. Useful during attach to decrease severity. Cupping: on bei shu thoracic area, multiple cups or walking cup. Heavenly moxa: 3 days on hottest days of year (around summer solstice). Blister beetle (ban mao) plaster on fei shu BL13, pi shu BL20, gan shu BL 18. Used for frequent, long-term conditions.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Sudden onset of hoarse husky voice or loss of voice, plus wind-cold symptoms: strong aversion to cold, slight fever, no sweating, headache, aching joints/limbs, stuffy/runny nose, scratchy throat, no thirst, can have cough with clear or thin white phlegm. T- normal P- floating, tight Sudden onset of hoarse husky voice or loss of voice, severe throat pain, plus wind-heat symptoms: sweating, fever, headache, thirst, nasal congestion with yellow phlegm, can have cough with thick yellow phlegm. T- normal or red tip, thin yellow coat P- floating, rapid Sudden onset of hoarse husky voice or loss of voice, worse with emotional stress, plum pit qi without inflammation, irascibility, irritability, dizziness, tinnitus, hiccupping, burping, bitter taste, red eyes & complexion. T- normal or with red sides and tip P- wiry, rapid with heat Prolonged loss of voice where tremendous effort is required to speak, there are actual structural changes such as tumors or growths (nodules or polyps), sensation of foreign object lodged in throat, severe hoarseness and raspiness, frequent throat clearing, spitting phlegm, chest oppression. T- dark, dull, purple, stasis spots, greasy coat P- rough/choppy, may be slippery Gradual onset of hoarseness or loss of voice, aggravated by stress / over-taxation / long periods of speaking, weak voice - worse in evening, easily become hoarse, dry non-productive cough, dry mouth/throat, sore throat, loss of weight, night sweats, 5-heart fever, malar flush, low back pain, tinnitus, palpitations. T- red, scanty or no coat, may be dry P- thready, rapid Prolonged husky voice, worsened by fatigue / taxation / exertion, worse in morning, voice faint and weak, speaking is taxing, when severe cant speak, also lung and spleen qi deficiency symptoms: SOB, fatigue, slow speech, poor appetite, loose stools, etc. Tx Principle Dispel wind Scatter cold Ventilate/diffuse lungs Open the voice (kai yin) Drain Dispel wind Clear heat Open the voice (kai yin) Transform phlegm Rectify the throat Drain Course liver Rectify qi Open the voice Drain fire (with heat) Drain Branch: Move qi Invigorate blood Open the voice Transform phlegm Drain Root: Tonify root deficiency Nourish yin Downbear fire Open the voice Rectify the throat Tonify and drain. Also even tonify even drain. Acupuncture Points / Techniques he gu LI4 & lie que LU7 - yuan/luo (host/guest, cold in LI moving to LU), also to release exterior fu tu LI18 - local point to mobilize qi xue, on yang metal jing mai for treating exterior illness tong li HT5 - main point for sudden loss of voice (luo- deficiency)

Syndrome Shi Yin Loss of Voice Wind-cold

Etiology / Pathomechanism Invasion of external wind-cold enters, binds and constricts lungs, doesnt allow ventilating/diffusing function.

Shi Yin Loss of Voice Wind-heat

Invasion of external wind-heat enters, or wind-cold transforms to heat, binds and constricts lungs, doesnt allow ventilating/diffusing function.

he gu LI4, yu ji LI10 - clear heat, release exterior, regulate lung fu tu LI18 - local point to mobilize qi xue, on yang metal jing mai for treating exterior illness tong li HT5 - main point for sudden loss of voice chi ze LU5 - water point so drains fire w/excessive throat pain - shao shang LU11 (let blood), tian rong SI17 (local, open orifaces) w/damp-heat or phlegm-heat - feng long ST40, qu chi LI11 (eliminate dampness, clear damp-heat) he qu LI4 & tai chong LR4 - 4 gates, will strongly rectify qi, clear heat tong li HT5 - main point for sudden loss of voice lian quan REN23 or shang lian quan (extra) - local, descend qi & alleviate cough, treat loss of voice w/significant liver qi stagnation - nei guan PC6, jue yin pair for strongly rectifying qi w/fire - xing jian LR2 add or relpace tai chong with this he qu LI4 & tai chong LR4 - 4 gates, will strongly rectify qi, invigorate blood lian quan REN23 or shang lian quan (extra) - local, descend qi & alleviate cough, treat loss of voice nei guan PC6 - jue yin pair for strongly rectifying qi, release thoracic oppression, mobilize blood feng long ST40 - transform phlegm, luo point- nets throat Also tonify the underlying deficiency pattern. If polyps are small, acupuncture can get rid of them. If large, surgery required, then acupuncture for prevention of reoccurrence. tai xi KI3 (tonify) or zhao hai KI6 (even) if more fire- will also moisten throat yu ji LI10 - clear heat from throat, regulate lung lian quan REN23 or shang lian quan (extra) - local, descend qi & alleviate cough, treat loss of voice lie que LU7 - combined with zhao hai will target the throat (even) fei shu BL13, shen shu BL23 - tonify lung and kidney

Shi Yin Loss of Voice Liver Qi Stagnation

Depression/upset/anger/lack of attainment causing liver qi stagnation, disrupting dredging/discharging function and causing local gi stagnation in throat. Usually caused by one of the deficiency syndromes developing into this, or any of the excess syndromes can progress into this. Can also be caused by trauma or injury.

Shi Yin Loss of Voice Qi Stagnation, Blood Stasis, Phlegm Blockage

Shi Yin Loss of Voice Lung and Kidney Yin Deficiency

Weakening of lung and kidney yin causes taxation of vocal cords. Can also be caused by smoking, recurrent infection or inflammation, local injury or trauma.

Shi Yin Loss of Voice Lung and Spleen Qi Deficiency

Weakening of lung and spleen qi causes insufficiency of zong qi and taxation of vocal cords. Can also be caused by smoking, recurrent infection or inflammation, local injury or trauma.

Tonify spleen & lung qi Open the voice Rectify the throat Tonify, moxa

tai yuan LU9 & fei shu BL13, tai bai SP3 & pi shu BL20 - yuan/shu combination for tonification san yin jiao SP6 - tonify spleen, 3 yin of foot connect to throat lian quan REN23 or shang lian quan (extra) - local, descend qi & alleviate cough, treat loss of voice zu san li ST36 - tonify blood, qi and post-heaven

Alternate therapeutic methods for treating loss of voice: Shi yin syndrome DOES NOT include loss of voice due to stroke. Does include laryngitis, injury or overuse of vocal cords, hysterical loss of voice, thyroid problems, smoking, polyps or tumors. NOTE: Loss of voice is a main sign for throat cancer. Consider recommending western diagnosis where suspected. Ear acupuncture: lung, throat, neck, trachea, plus specific syndrome points. Needle both ears, retain 15-20 minutes. 5 treatments make one course. Ear seeds can be applied to points after treatment.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Sudden onset, severe stomach pain, worse with pressure, better with heat, pain is twisting / torquing / wringing / spasmodic / violent, when targeted by cold have wind-cold symptoms, when from cold food have vomiting of clear fluids, decreased appetite. T- normal or pale with white coat P- wiry, tight Sudden onset distending full pain in epigastrium, worse with pressure or eating, better after vomiting / passing gas / bowel movement, burping, sour rotten smelling regurgitation, stools are sluggish foul muddy, diarrhea or constipation, nausea, vomiting of undigested food, bad breath, lower bowel gas. T- thick greasy coating, can be curdy, yellow with heat P- slippery Sudden onset distending, full, spasmodic pain, can be roving, worse with pressure (massage can move qi and make it better), worse with emotional upset or stress, better with exercise & relaxation, there can be qi ni of stomach, will also have liver qi stagnation symptoms. T- normal (or red with heat present) P- wiry (rapid if heat present) Sudden acute, severe, burning pain, worse with pressure and/or heat. LR stag/LR fire Sx: irritability, bitter taste. ST heat/fire Sx: restlessness, irritability, acid reflux, hot constipation, high appetite, bad breath, bleeding gums, mouth sores, dry bitter taste, high thirst. T- red, yellow coat P- strong, surging, rapid, wiry Sharp, stabbing pain, fixed location, worse with pressure or eating and also at night, pain can refer to back, poor appetite, may have vomiting of dark blood, cyanosis, black tarry stools. T- dark, dull, purple, stasis spots P- rough/choppy, wiry Tx Principle Warm center Scatter cold Stop pain Drain Acupuncture Points / Techniques

Syndrome Wei Tong Stomach Pain Cold Pathogen Violating Stomach

Etiology / Pathomechanism Caused by direct exogenous targeting by cold, or by eating too much cold raw food. Causes constricting and contracting of stomach qi leading to lack of qi movement.

zhong wan REN12 - moxa, meeting of fu, mu of stomach, harmonizes digestion, rectifies middle jiao qi zu san li ST36 - moxa, promotes down-bearing of stomach qi, (mu-he combination for excess in fu) nei guan PC6 - strongly rectifies qi, harmonizes interior (opens to yin wei mai), treats nausea liang qiu ST34 - xi-cleft of stomach, stop pain, harmonize stomach, rectify qi Also choose local a shi points. he gu LI4 - resolves exterior gong sun SP4 - luo of spleen (excess- treats cutting intestinal pain) zhong wan REN12 - meeting of fu, mu of stomach, harmonizes digestion, rectifies middle jiao qi zu san li ST36 - promotes down-bearing of stomach qi, (mu-he combination for excess in fu) nei guan PC6 - strongly rectifies qi, harmonizes interior (opens to yin wei mai), treats nausea liang qiu ST34 - xi-cleft of stomach, stop pain, harmonize stomach, rectify qi Also choose local a shi points. li nei ting extra - transforms food stasis xia guan REN10 or jian li REN11 - transform stasis, dissolve accumulation, strengthen transport/ transform function of SP/ST zhong wan REN12 - meeting of fu, mu of stomach, harmonizes digestion, rectifies middle jiao qi zu san li ST36 - promotes down-bearing of stomach qi, (mu-he combination for excess in fu) nei guan PC6 - strongly rectifies qi, harmonizes interior (opens to yin wei mai), treats nausea liang qiu ST34 - xi-cleft of stomach, stop pain, harmonize stomach, rectify qi Also choose local a shi points. tai chong LR3 and he gu LI4 - 4 gates, course liver and rectify qi qi men LR14 (mu of LR-course LR and rectify qi) or zhong men LR13 (mu of SP-harmonize wood/earth) yang ling quan GB34 - for hypochondrial pain, clear damp heat of LR/GB, smooth flow of liver qi zhong wan REN12 - meeting of fu, mu of stomach, harmonizes digestion, rectifies middle jiao qi zu san li ST36 - promotes down-bearing of stomach qi, (mu-he combination for excess in fu) nei guan PC6 - strongly rectifies qi, harmonizes interior (opens to yin wei mai), treats nausea liang qiu ST34 - xi-cleft of stomach, stop pain, harmonize stomach, rectify qi Also choose local a shi points. nei ting ST44 and xing jian LR2 - xing-spring, clear heat w/acid regurgitation add: xia wan REN10 or jian li REN11 zhong wan REN12 - meeting of fu, mu of stomach, harmonizes digestion, rectifies middle jiao qi zu san li ST36 - promotes down-bearing of stomach qi, (mu-he combination for excess in fu) nei guan PC6 - strongly rectifies qi, harmonizes interior (opens to yin wei mai), treats nausea liang qiu ST34 - xi-cleft of stomach, stop pain, harmonize stomach, rectify qi Also choose local a shi points. san yin jiao SP6, ge shu BL17, he gu LI4, tai chong LR3 - move qi, invigorate blood, transform stasis w/vomiting blood or bloody stools: add xi men PC4 (xi-cleft) and yin bai SP1 (help spleen control blood)

Wei Tong Stomach Pain Obstruction by Food Stasis

Food and drink collect and stagnate, cause lack of movement of stomach qi. Due to overeating or poor eating habits. Often comes with spleen and stomach deficiency.

Resolve stasis Drain heat (if needed) Stop pain Drain

Wei Tong Stomach Pain Liver Qi Invades Stomach

Emotions cause liver qi stagnation, liver profusion then invades stomach (wood over-controlling earth). This disturbs the descent of stomach qi.

Course liver, rectify qi Drain heat (if needed) Stop pain Drain

Wei Tong Stomach Pain Heat in Stomach (and Liver)

Can be just stomach heat. Accumulation of heat blocking stomach qi due to excess hot foods, alcohol, hot herbs/drugs, or emotions causing liver qi stagnation which transforms to heat and overacts on stomach. Severe situation. Blocking of stomach qi by static blood due to trauma, injury, surgery, or chronic liver Qi stagnation, chronic stomach cold or stomach heat.

Drain heat in LR & ST Stop pain Drain

Wei Tong Stomach Pain Blood Stasis

Invigorate blood Move qi Transform stasis Stop pain Stop bleeding (if needed) Drain

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Chronic long-term pain, comes on over time, dull, indistinct, continuous, better with small amounts of food, poor appetite, lethargy, fatigue worse after eating, physical fatigue, vomiting clear fluid. With yang deficiency will have cold extremities, intolerance to cold, borborygmus, loose watery stools, abdominal distension. T- pale, swollen (teeth marks, thick greasy coat w/yang deficiency) P- deep, weak (slow w/yang deficiency) Chronic pain, vague, dull, indistinct, may be slightly burning pain, worse with empty stomach, better with pressure, dryness (mouth, mucus membranes, skin, throat, tongue), indeterminate gnawing hunger but no desire to eat, poor appetite, thirst for small amounts, dry retching, hard dry stools, can have ulcer formations. T- red, scanty or no coat, center peeled/mirror P- thready, rapid Tx Principle Fortify spleen Boost stomach Tonify With yang deficiency also: Warm center Add moxa. Fortify spleen Boost stomach Nourish yin Tonify Acupuncture Points / Techniques pi shu BL20 & wei shu BL21 - fortify spleen, boost stomach zhong wan REN12 - meeting of fu, mu of stomach, strengthen ST, fortify SP, rectifies middle jiao qi zu san li ST36 - harmonize ST, strengthen SP, tonify qi nei guan PC6 - strongly rectifies qi, harmonizes interior (opens to yin wei mai), treats nausea gong sun SP4 - fortify spleen, luo of spleen (deficiency- treats abdominal distension) w/yang deficiency add moxa to pi shu, wei shu, zhong wan & zu san li if due to KI yang deficiency: qi hai REN6- benefit spleen qi, tonify kidneys and fortify yuan qi pi shu BL20 & wei shu BL21 - fortify spleen, boost stomach zhong wan REN12 - meeting of fu, mu of stomach, strengthen ST, fortify SP, rectifies middle jiao qi zu san li ST36 - harmonize ST, strengthen SP, tonify qi nei guan PC6 - strongly rectifies qi, harmonizes interior (opens to yin wei mai), treats nausea tai xi KI3 - boost kidney yin, clear deficiency heat, treat constipation san yin jiao SP6 - nourish yin, fortify spleen

Syndrome Wei Tong Stomach Pain Spleen/Stomach Qi Deficiency (Yang Deficiency)

Etiology / Pathomechanism Poor dietary habits, mental and/or physical taxation, invasion of exogenous cold or damp, long-term kidney yang deficiency, extended illness. All can lead to SP/ST qi or yang deficiency. Spleen and stomach are undernourished leading to pain. Acute when due to febrile illness damaging fluid. Can progress from excess syndromes. Chronic stomach fire, hot diet, alcohol, drugs, eating disorders.

Wei Tong Stomach Pain Stomach Yin

Alternate therapeutic methods for treating stomach pain: Ear acupuncture: spleen, stomach, liver, shen men, sympathetic, subcortex. Stomach chamber 5 needles (wan wu zhen): shang wan REN13, zhong wan REN12, xia wan REN10 or jian li REN11, liang men ST21 For hiatal hernia pain - zu san li ST36 on ashi side (Dr. Tan) Fu Tong Abdominal Pain Cold Coagulation Caused by direct exogenous targeting by cold, or by eating too much cold raw food. Causes constricting and contracting of stomach qi leading to lack of qi movement. Sudden onset, severe stomach pain, worse with cold & pressure, better with heat, pain is twisting / torquing / wringing / spasmodic / violent, aversion to cold, cold limbs, clear copious urine, loose stools w/ undigested food, can have constipation. T- normal or pale with white coat P- wiry, tight Sudden onset distending full pain in abdomen & epigastrium, worse with pressure or eating, better after vomiting / passing gas / bowel movement, burping, sour rotten smelling regurgitation, stools are sluggish foul muddy, diarrhea or constipation, nausea, vomiting of undigested food, bad breath, lower bowel gas. T- thick greasy coating, can be curdy, yellow with heat P- slippery, wiry Sudden onset distending, full, spasmodic pain, can be roving, worse with pressure (massage can move qi and make it better), worse with emotional upset or stress, better with exercise & relaxation, will also have liver qi stagnation symptoms. T- normal (or red with heat present) P- wiry (rapid if heat present) Warm center Scatter cold Rectify qi Stop pain Drain, moxa zu san li ST36 - moxa, (lower uniting - for problems in fu), promotes down-bearing of stomach qi tian shu ST25 - mu of LI, rectify qi, aid movement thru fu, regulate chong wei mai, diarrhea/constipation he gu LI4 - resolves exterior, move qi shen que REN8 or guan yuan REN4 - moxa, warm center, disperse cold add lower uniting point which treats specific area of pain: epigastric area - zu san li ST36, costal area - yang ling quan GB34, umbilical area - xia ju zu ST-39, peri-umbilical - shang ju zu ST37, lower abdomen - wei zhong BL40, roving pain - wei yang BL39 zu san li ST36 - (lower uniting - for problems in fu), promotes down-bearing of stomach qi jian li REN11 or xia wan REN10 - transform stasis, dissolve accumulation, move qi thru lower burner he gu LI4 - resolves exterior, move qi li nei ting extra - transforms food stasis add lower uniting point which treats specific area of pain: epigastric area - zu san li ST36, costal area - yang ling quan GB34, umbilical area - xia ju zu ST-39, around navel - shang ju zu ST37, lower abdomen - wei zhong BL40, roving pain - wei yang BL39 zu san li ST36 - (lower uniting - for problems in fu), promotes down-bearing of stomach qi he gu LI4 and tai chong LR3 - 4 gates, course liver, rectify qi, calm emotions, stop pain nei guan PC6 - regulate interior (opens to yin wei mai), rectify qi, treat nausea, treat pain in middle jiao tian shu ST25 - mu of LI, rectify qi, aid movement thru fu, regulate chong wei mai, diarrhea/constipation qi men LR14 - mu of liver, local point for relieving pain wei yang BL39 - for roving pain and/or yang ling quan GB34 - for hypochondrial pain w/epigastric pain - shang wan REN13

Fu Tong Abdominal Pain Food Stasis

Food and drink collect and stagnate, cause lack of movement of stomach qi. Due to overeating or poor eating habits. Often comes with spleen and stomach deficiency.

Transform food Guide out stasis Stop pain Drain

Fu Tong Abdominal Pain Liver Profusion Qi Stagnation

Emotions cause liver qi stagnation, liver profusion then invades stomach (wood over-controlling earth). This disturbs the descent of stomach qi.

Course liver, rectify qi Drain heat (if needed) Stop pain Drain

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Sudden acute, full & distending, burning pain, worse with pressure and/or heat (can sometimes palpate and feel heat), irritability, bitter taste, restlessness, irritability, constipation, difficult to defecate, thirst, dry mouth, fever possible, scanty dark urine. T- red, yellow greasy coat P- slippery, rapid, strong Sharp, stabbing pain, fixed location, worse with pressure or eating and also at night, better with heat, dark dull purplish or ashen complexion. May be palpable mass. T- dark, dull, purple, stasis spots P- rough/choppy, wiry Chronic long-term pain, comes on over time, dull, indistinct, continuous, better with small amounts of food, poor appetite, lethargy, fatigue worse after eating, physical fatigue, vomiting clear fluid. With yang deficiency will have cold extremities, intolerance to cold, borborygmus, loose watery stools, abdominal distension. T- pale, swollen (teeth marks, thick greasy coat w/yang deficiency) P- deep, weak (slow w/yang deficiency) Tx Principle Free the stool Clear heat Transform damp Stop pain Drain Acupuncture Points / Techniques

Syndrome Fu Tong Abdominal Pain Obstruction by Damp-heat (in intestines)

Etiology / Pathomechanism Accumulation of damp heat blocking intestines due to excess hot foods, alcohol, hot herbs/drugs, or emotions causing liver qi stagnation which transforms to heat and overacts on stomach, causing blockage in intestines. Severe situation. Blocking of stomach qi by static blood due to trauma, injury, surgery, or chronic liver Qi stagnation, chronic stomach cold or stomach heat. Poor dietary habits, mental and/or physical taxation, invasion of exogenous cold or damp, long-term kidney yang deficiency, extended illness. All can lead to SP/ST qi or yang deficiency. Spleen and stomach are undernourished leading to pain. Kidney yang deficiency causing deficiency cold & constriction/blockage.

xia wan REN10 - transform stasis, dissolve accumulation, move qi thru lower burner liang men ST21 - harmonize stomach, transform stasis, rectify qi, stop pain qu chi LI11 - clear heat, eliminate dampness, clear damp-heat (add tui re points for high fever) tian shu ST25 - mu of LI, rectify qi, aid movement thru fu, regulate chong wei mai, diarrhea/constipation shang ju xu ST39 - mu-he combination for problems in fu, treats excess in stomach yin ling quan SP9 - primary point to transform and drain dampness from lower burner w/excessive thirst and stomach heat - add nei ting ST44 Use local a shi points. he gu LI4 and tai chong LR3 - 4 gates, course liver, rectify qi, move blood, calm emotions, stop pain tan zhong REN17 - meeting of qi, moves qi, transforms stasis, opens chest ge shu BL17 - invigorate blood, dispel stasis, drains static blood san yin jiao SP6 and xue hai SP10 - invigorate blood zu san li ST36 - harmonize stomach, strengthen post-heaven, can add moxa pi shu BL20, wei shu BL21, shen shu BL23, da chong shu BL25 - add moxa to pi shu & shen shu w/kidney yang deficiency (cold weak aching low back, SOB) - tai xi KI3, guan yuan REN4 - add moxa

Fu Tong Abdominal Pain Blood Stasis

Invigorate blood Transform stasis Warm meridian Stop pain Drain Tonify spleen Warm kidney Tonify With yang deficiency also: Warm center Add moxa.

Fu Tong Abdominal Pain Spleen Qi and Kidney Yang Deficiency

Alternate therapeutic methods for treating abdominal pain: Point for lower abdominal pain: yang ling quan GB34 on same side as pain. Global Balancing Treatment for Abdominal Pain Sick Meridian 1- Same Name / Opposite side Kidney Ashi from shaohai HT3 to shenmen HT7 Stomach Ashi from hegu LI4 to quchi LI11 Spleen Ashi from chize LU5 to taiyuan LU9 Ren Points on the Du meridian level with area of pain. 2-Jing Bie (branching) / Either side Ashi from waiguan TB5 to tianjingTB10 Ashi from quze PC3 to neiguan PC6 Ashi from wangu SI4 to xiaohai SI8 3- Biao Li (int/ext) / Opposite side Ashi from weizhong BL40 to chengshanBL57 Ashi from diji SP8 to yinlingquan SP9 Ashi from zusanli ST36 to jiexi ST41 4- Clock Opposite / Either side Ashi from xialian LI8 to quchi LI11 Ashi from quze PC3 to neiguan PC6 Ashi from waiguan TB5 to tianjingTB10 5- Clock Neighbor / Opposite side Ashi from quze PC3 to neiguan PC6 Ashi from hegu LI4 to quchi LI11 Ashi from shaohai HT3 to shenmen HT7

Extra point Ling Ku (about .5 cun proximal to hegu LI4) can enhance the treatment for abdominal pain, particularly in lower abdomen. For lower abdominal pain, yanglingquan GB34 on same side. Global balance for any digestive disorder, for roving or difficult to pinpoint pains: Left side- waiguan TB5, hegu LI4, ququan LR8, yinlingquan SP9. Right side- neiguan PC6, lieque LU7, zusanli ST36, yanglingquan GB34

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Roving, distending hypochondrial pain, worse/initiated by emotions/stress, irritability, frustration, frequent sighing, belching, chest/thoracic oppression, insomnia. T- normal P- wiry Tx Principle Course liver Rectify qi Resolve binding Stop pain Drain Acupuncture Points / Techniques

10

Syndrome Xie Tong Hypochondrial Pain Liver Qi Binding and Stagnant

Etiology / Pathomechanism Lack of regulation of emotions, lack of attainment, dredging/discharging impairment prevents clear flow of qi, which causes pain. bu tong zi tong - where there is no clear passage, there is pain

he qu LI4 & tai chong LR4 - 4 gates, will strongly rectify qi, course liver yang ling quan GB34 - lower uniting of GB, down-bears liver qi, treats costal area pain zhi gou TB6 - rectify qi, activate channel, stop pain zui lin qi GB41 & wai guan TB5 - 8 vessel meeting pair for hypochondrial pain (instead of GB34 & TB6) qi men LR14 or ri yue GB24 - local, mu points, palpate to choose which point to use w/GI symptoms - zu san li ST36, strengthen earth against attack by wood w/regurgitation - wei shu BL21, descend rebellion of stomach qi w/insomnia - shen men HT7, calm the shen tai chong LR3 - regulate & rectify qi & blood, nourish liver blood, spread liver qi yang ling quan GB34 - promote smooth flow of liver qi, activate channel, stop pain ge shu BL17 & san yin jiao SP6 - invigorate blood, transform stasis qi men LR14 or ri yue GB24 - local, mu points, palpate to choose which point to use w/palpable mass below rib cage - zhong men LR13 (meeting of zang, mu of spleen), treats costal pain w/external injury as cause - select local injury points and a shi points, can let blood, cup, surround needle (needle around and under injury), moxa, or electro-acupuncture to dispel mass yang ling quan GB34 - promote smooth flow of liver qi, clear damp-heat of LR/GB, rectify gallbladder, activate channel, stop pain zhi gou TB6 - rectify qi, drain san jiao heat, treat alternating chills/fever, activate channel, stop pain qi men LR14 or ri yue GB24 - local, mu points, palpate to choose which point to use yin ling quan SP9 - drain dampness san yin jiao SP6 - draining SP6 will naturalize damp w/severe heat - da zhui DU14 w/nausea, vomiting, abdominal distension - nei guan PC6, zhong wan REN12 & zu san li ST36 (mu-he) w/heart vexation - xi men PC4, quiet the shen, treat fear, melancholy & fright tai chong LR3 & gan shu BL18 - shu/yuan, nourish liver blood, spread liver qi yang ling quan GB34 - rectify qi to stop pain ge shu BL17 - tonify qi & blood san yin jiao SP6 - nourish blood qi men LR14 or ri yue GB24 - local, mu points, palpate to choose which point to use w/yin deficiency heat - yin xi HT6 & xin shu BL15, treat deficiency heat, nourish yin, astringe sweat w/tidal fever - gao huang shu BL43, nourish yin and clear heat, tonify deficiency taxation w/dizziness - bai hui DU20, return yang

Xie Tong Hypochondrial Pain Qi Stagnation and Blood Stasis

Liver qi stagnation can cause lack of blood circulation leading to blood stasis. External injury (sprain, strain, contusion) locally blood becomes static causing qi stagnation and pain.

Stabbing, sharp, fixed costal pain, worse w/pressure and at night, may be chronic, can be from previous injury or trauma, can have palpable masses in hypochondrium, can be from late-stage hepatitis. T- dull, dark, purplish black stasis spots P- wiry, choppy or rough Burning, stabbing pain, especially on right side, can be gallstones or gallbladder inflammation, worse w/spicy foods, plus shao yang illness Sx: alternating chills/fever, fullness & pain in chest & hypochondrium, vexation & dry heaves, depression and no desire to eat, bitter taste, dry throat, dizziness. T- red sides, thick greasy yellow coat P- wiry, rapid Hypochondrial pain is dull, faint, indistinct, intermittent, general location, worse w/taxation. Pale complexion, palpitations, insomnia, dizziness. If it progresses to yin deficiency: malar flush, low-grade fever, spontaneous sweating, night sweats, dryness. T- pale, dry (red, scanty or no coat w/yin deficiency) P- thready, rapid w/heat

Rectify qi Invigorate blood Transform stasis Stop pain Drain

Xie Tong Hypochondrial Pain Damp-heat Accumulating and Binding

Too much alcohol, hot-damp food, damp-heat shifts to liver from middle burner. Exogenous induction of excess heat amassing half in/half out (shao yang) causing blockage and pain.

Clear heat Naturalize damp Course liver Naturalize gallbladder Drain

Xie Tong Hypochondrial Pain Blood Deficiency and Loss of Nourishment

Extended illness, aging, taxation, which depletes blood and eventually yin, leading to blood/yin deficiency in liver and undernourishment of liver, which is unable to dredge/discharge, causing blockage and pain.

Nourish blood Stop pain With yin deficiency also: Nourish yin Clear heat Tonify

Alternate therapeutic methods for treating hypochondrial pain: Ear acupuncture: LR, GB, shen men, thorax. Select points on affected side. Retain 30 minutes or embed. Plum blossom needle: Lightly tap site of pain and bei shu points on back that are level with the pain. Follow with cupping therapy for deficiency syndromes.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Sudden/acute onset, vomiting of clear fluids, may contain food matter, aversion to cold, fever, headache, body ache. T- white slippery coat P- floating, tight Frequent vomiting, may contain bile, may be projectile, fever, headache, thirst, desire for cold drinks. T- red P- floating, rapid (Check for stiffness in back of neck, if extremely painful to touch chin to chest can signify meningitis, send to ER.) Vomiting of undigested food, better after vomiting, worse after eating, foul belching, no appetite, epigastric and abdominal distension/fullness, constipation, flatulence. T- thick greasy coat P- slippery Tx Principle Scatter cold Down-bear qi ni Stop vomiting Drain, moxa Clear heat Down-bear qi ni Stop vomiting Drain No needle retention. Disperse food stasis Guide out stagnation Down-bear qi ni Stop vomiting Drain Acupuncture Points / Techniques

11

Syndrome Ou Tu Vomiting Cold Evil Attacks Stomach Ou Tu Vomiting Heat Evil Attacks Stomach

Etiology / Pathomechanism Cold or epidemic toxin enters through mouth and attacks stomach causing qi ni of stomach.

zhong wan REN-12 - add moxa, mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - add moxa, harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - treats nausea, rectify qi & harmonize stomach he gu LI4 - regulate qi, expel wind, scatter cold w/phlegm - tan zhong REN17 & feng long ST40 zhong wan REN-12 - mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - treats nausea, rectify qi & harmonize stomach da zhui DU14 - clear heat, treat external pathogens qu chi LI1 - clear heat, regulate stomach & intestines w/toxic heat - let blood at jin jin yu ye zhong wan REN-12 - mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - treats nausea, rectify qi & harmonize stomach li nei ting extra - disperse food stasis, guide out stagnation xia wan REN 10, jian li REN11 - harmonize middle burner & regulate qi, transform stasis wei shu BL21 - descend rebellion of stomach qi, guide out food stagnation xuan ji REN21 - descend stomach qi zhong wan REN-12 - mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - treats nausea, rectify qi & harmonize stomach tai chong LR3 - spread liver qi, subdue liver yang and extinguish wind gan shu BL18 - course liver, main point for stagnant liver qi yang ling quan GB34 - promote smooth flow of liver qi, clear damp-heat of liver/gallbladder w/roving pain - wei yang BL39 (lower uniting of san jiao) zhong wan REN-12 - mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - treats nausea, rectify qi & harmonize stomach pi shu BL20, wei shu BL21 - fortify spleen, strengthen stomach, descend rebellion of stomach qi zhang men LR13 - mu of spleen, meeting of zang, benefit spleen & stomach, regulate middle/lower jiao gong sun SP4 - luo (deficiency- drum distension), fortify spleen, rectify qi w/phlegm - feng long ST40 - transform phlegm, harmonize stomach, down-bear counterflow

Heat or epidemic toxin enters through mouth and attacks stomach causing qi ni of stomach.

Ou Tu Vomiting Food Stagnation

Improper dietary habits, overeating, too much sweet and/or fatty foods, food poisoning causing qi ni of stomach.

Ou Tu Vomiting Liver Qi Invades Stomach

Emotions cause liver qi stagnation, liver profusion then invades stomach (wood over-controlling earth). This disturbs the descent of stomach qi causing qi ni of stomach.

Anger, depression, irritability, distension & pain of hypochondrium, roving pain, nausea, vomiting, acid regurgitation. T- normal P- wiry

Calm liver Harmonize stomach Down-bear qi ni Stop vomiting Drain

Ou Tu Vomiting Spleen and Stomach Qi Deficiency

Poor dietary habits, mental and/or physical taxation, invasion of exogenous cold or damp, long-term kidney yang deficiency, extended illness. All can weaken stomach causing qi ni.

Weak digestion, easily vomit if not careful about what is eaten, worry a lot, lusterless complexion, thoracic/ epigastric fullness/oppression, phlegm in vomit, like warm drinks, habitual borborygmus, dizziness, palpitations. T- swollen, thin whit coat P- slippery, soggy

Fortify spleen Harmonize stomach Down-bear qi ni Stop vomiting Tonify

Alternate therapeutic methods for treating vomiting: Ear acupuncture: stomach, liver, shen men, sympathetic, subcortex, tip of inferior antihelix crus. 2-3 points, strong stimulation, 20-30 minutes retention, daily or every other day. Stomach chamber 5 needles (wan wu zhen): shang wan REN13, zhong wan REN12, xia wan REN10 or jian li REN11, liang men ST21 Fan Wei Stomach Reflux Spleen and Stomach Deficiency Cold with Stomach Counterflow Distension and fullness of epigastrium and abdomen after eating, vomiting in evening of food eaten in morning and vomiting in moring of food eaten the evening before, vomitus contains undigested food. Tiredness, fatigue, lusterless complexion. T- pale, thin white coat P- thready, tardy, forceless Warm and strengthen spleen and stomach Downbear qi Tonify, moxa pi shu BL20, wei shu BL21, zhong wan REN12 & zu san li ST36 - moxa; warm & strengthen SP & ST zhang men LR13 - mu of spleen; course liver, guide out food stagnation, benefit spleen & stomach nei guan PC6 - rectify qi and harmonize stomach, treat nausea, decrease stomach acid qi hai REN6 - benefit spleen qi, regulate qi futu ST32 on painful side w/severe vomiting - gu shu BL17 & zhong kui (dorsal middle finger, midpoint of proximal phalange joint) w/kidney yang deficiency - shen shu BL23 w/qi & yin deficiency - guan yuan REN4 & san yin jiao SP6

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Deep, slow, forceful hiccup, prefer warm drinks, epigastric pain & distension, decreased appetite, cold hands & feet, clear copious urine, no thirst, diarrhea. T- white coat P-slow Tx Principle Warm stomach Dispel cold Stop hiccup Drain, moxa Acupuncture Points / Techniques

12

Syndrome E Ni Hiccupping Stomach Cold

Etiology / Pathomechanism Overeating cold and raw food, resulting in stomach cold, causing qi ni of stomach.

zhong wan REN12 - add moxa, mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - add moxa, harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - open the chest, rectify qi & harmonize stomach ge shu BL17 - diaphragm transport point, open the chest, rectify qi, descend qi ni tan zhong REN17 - disinhibit diaphragm, widen chest liang men ST21 - add moxa, harmonize stomach, rectify qi shang wan REN13 - add moxa, harmonize stomach, regulate qi, descend rebellion zhong wan REN12 - mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - open the chest, rectify qi & harmonize stomach ge shu BL17 - diaphragm transport point, open the chest, rectify qi, descend qi ni tan zhong REN17 - disinhibit diaphragm, widen chest nei ting ST44 - xing-spring, clear stomach heat, harmonize stomach zhong wan REN12 - mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - open the chest, rectify qi & harmonize stomach ge shu BL17 - diaphragm transport point, open the chest, rectify qi, descend qi ni tan zhong REN17 - disinhibit diaphragm, widen chest tai chong LR3 - spread liver qi, subdue liver yang and extinguish wind qi men LR14 - mu of liver, course liver, rectify qi, benefit stomach zhong wan REN12 - add moxa, mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - add moxa, harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - open the chest, rectify qi & harmonize stomach ge shu BL17 - diaphragm transport point, open the chest, rectify qi, descend qi ni qi hai REN6 - add moxa, benefit spleen qi, rescue collapse of yang, regulate qi

E Ni Hiccupping Stomach Fire

Overeating hot spicy food, resulting in stomach fire, causing qi ni of stomach.

Forceful, continuous, loud, resonant hiccup, prefer cool drinks, bad breath, thirst, red complexion, constipation, dark yellow scanty urine. T- yellow coat P- rapid, slippery Hiccupping brought on by anger/emotional stress, stops when sleeping, chest/hypochondrial pain & distension, irritability, depression, belching. T- normal P- wiry, forceful

Drain fire Down-bear stomach qi Stop hiccup Drain

E Ni Hiccupping Liver Qi Stagnation

Emotions cause liver qi stagnation, liver profusion then invades stomach (wood over-controlling earth). This disturbs the descent of stomach qi causing qi ni of stomach.

Soothe liver Harmonize stomach Stop hiccup Drain

E Ni Hiccupping Spleen and Stomach Yang

Poor dietary habits, mental and/or physical taxation, invasion of exogenous cold or damp, long-term kidney yang deficiency, extended illness. All can lead to SP/ST qi or yang deficiency.

Weak sounding hiccup, often seen in elderly, emaciation, lusterless complexion, cold hands & feet, poor food intake, feeling of heaviness, fatigue, abdominal distension after eating, regurgitation of phlegm. T- pale, swollen, white coat P- deep, thready, weak Intermittent rapid sequence hiccups, less forceful, not loud, often follows febrile illness, dry mouth/throat, thirst, restlessness, malar flush, night sweats. T- red, no coat, can have cracked surface P- thready, rapid

Warm & supplement spleen & stomach Harmonize middle jiao Down-bear qi ni Stop hiccup Tonify, moxa Tonify yin Engender fluids Stop hiccup Tonify

E Ni Hiccupping Stomach Yin Deficiency Fire

Acute when due to febrile illness damaging fluid. Can progress from excess syndromes; chronic stomach fire, hot diet, alcohol, drugs, eating disorders. Deficiency fire moving upwards.

zhong wan REN12 - add moxa, mu of ST, meeting of fu, harmonize digestion & rectify middle jiao qi zu san li ST36 - add moxa, harmonize stomach, (mu-he combination for excess in fu) nei guan PC6 - open the chest, rectify qi & harmonize stomach ge shu BL17 - diaphragm transport point, open the chest, rectify qi, descend qi ni tai xi KI3 - boost kidney yin, clear deficiency heat, anchor qi san yin jiao SP6 - nourish yin, fortify spleen, boost kidney

Alternate therapeutic methods for treating hiccupping: Ear acupuncture: diaphragm, stomach, liver, spleen, sympathetic. Can embed needles for stubborn hiccups. Cupping: ge shu BL17, ge guan BL46 (diaphragm gate), gan shu BL18, zhong wan REN12, ru gen ST18. Cup each point for 10-15 minutes. Needling method for hiccupping syndromes: First needle; ge shu BL17, gan shu BL18, pi shu BL21, wei shu BL21, san yin jiao SP6; retain for 30 minutes. Then flip over and needle 3 gates of stomach, shang wan REN13, zhong wan REN12, xia wan REN10 (can add any of following; tian shu ST25, liang men ST21, qi hai REN6, nei guan PC6, tan zhong REN17 or zu san li ST36), retain for 30 minutes. Insert perpendicularly for excess, flat for deficiency. Most effective for excess syndromes.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Difficulty swallowing, worse with stress or emotional disharmony, better when relaxed, thoracic oppression, hardness/fullness of epigastrium, tight constricted throat, coughing/spitting phlegm, decreased appetite, acid reflux, fatigue, boredom, lack of strength, heavy limbs, sluggish stools, weight loss. (Can have heat with hot, yang constitutions.) T- normal or greasy coat P- wiry, slippery Difficulty swallowing, dry throat, burning behind sternum, acid reflux,. When severe swallowing is painful, can only swallow fluids. When yin becomes deficient, constipation, dry throat/mouth/skin, thirst, gradual weight loss, hoarse voice, night sweats, tidal fever, emaciation, insomnia, low back pain, weak knees. T- red, dry, scanty or no coat P- rapid, thready Severe difficulty swallowing (even liquids), fixed stabbing pain behind sternum, vomiting of dark blood, dark tarry blood in stools, gagging, choking, dull dark or sallow dull complexion. T- purplish, dull P- choppy/rough Tx Principle Harmonize stomach Down-bear counter flow Disinhibit throat Fortify spleen Transform phlegm Move qi Even tonify even drain. Acupuncture Points / Techniques

13

Syndrome Ye Ge Difficulty Swallowing Blockage by Qi and Phlegm

Etiology / Pathomechanism Emotional disharmony causing binding of qi, failure to move fluids locally, damp phlegm accumulates. Rich fatty foods causing damp phlegm accumulation. Results in stagnation blocking esophagus. Local blockage of qi & phlegm.

zu san li ST36 - down-bear qi, transform phlegm, harmonize stomach tian tu REN22 - disinhibit throat, transform phlegm, clear the voice tan zhong REN17 - meeting of qi, mobilize and smooth qi , widen chest, transform phlegm ge shu BL17 - rectify qi, descend qi ni, dispel stasis, invigorate blood, tonify qi & blood san yin jiao SP6 - fortify spleen, drain damp, transform stasis, promote smooth flow of liver qi shang wan REN13 or zhong wan REN12 - fortify spleen, transform phlegm,down-bear counter flow, harmonize stomach, strengthen middle jiao nei guan PC6 - rectify qi of chest, harmonize stomach, down-bear counter flow feng long ST40 - transform phlegm, luo vessel - nets the throat (treats pain, swelling, phlegm in throat) pi shu BL20 & wei shu BL21 - tonify middle burner (can add moxa if no heat evident) zu san li ST36 - down-bear qi, transform phlegm, harmonize stomach tian tu REN22 - disinhibit throat, transform phlegm, clear the voice tan zhong REN17 - meeting of qi, mobilize and smooth qi , widen chest, transform phlegm ge shu BL17 - rectify qi, descend qi ni, dispel stasis, invigorate blood, tonify qi & blood san yin jiao SP6 - fortify spleen, drain damp, transform stasis, promote smooth flow of liver qi shang wan REN13 or zhong wan REN12 - fortify spleen, transform phlegm, down-bear counter flow, harmonize stomach, strengthen middle jiao nei guan PC6 - rectify qi of chest, harmonize stomach, down-bear counter flow zhao hai KI6 - nets back of tongue, promotes fluids, treats yin deficiency heat & constipation zu san li ST36 - down-bear qi, transform phlegm, harmonize stomach tian tu REN22 - disinhibit throat, transform phlegm, clear the voice tan zhong REN17 - meeting of qi, mobilize and smooth qi , widen chest, transform phlegm ge shu BL17 - rectify qi, descend qi ni, dispel stasis, invigorate blood, tonify qi & blood - add moxa san yin jiao SP6 - fortify spleen, drain damp, transform stasis, promote smooth flow of liver qi shang wan REN13 or zhong wan REN12 - fortify spleen, transform phlegm, down-bear counter flow, harmonize stomach, strengthen middle jiao - add moxa nei guan PC6 - rectify qi of chest, harmonize stomach, down-bear counter flow he gu LI4 - move qi, invigorate blood zu san li ST36 - down-bear qi, transform phlegm, harmonize stomach tian tu REN22 - disinhibit throat, transform phlegm, clear the voice tan zhong REN17 - meeting of qi, mobilize and smooth qi , widen chest, transform phlegm ge shu BL17 - rectify qi, descend qi ni, dispel stasis, invigorate blood, tonify qi & blood san yin jiao SP6 - fortify spleen, drain damp, transform stasis, promote smooth flow of liver qi shang wan REN13 or zhong wan REN12 - fortify spleen, transform phlegm, down-bear counter flow, harmonize stomach, strengthen middle jiao nei guan PC6 - rectify qi of chest, harmonize stomach, down-bear counter flow shen shu BL23 - tonify qi, fortify yang - add moxa pi shu BL20 & wei shu BL21 - tonify middle burner, support post-heaven w/shortness of breath - moxa at qi hai REN6 or guan yaun REN4 w/cold limbs, faint pulse, sweating - moxa at ming men DU4

Ye Ge Difficulty Swallowing Depletion of Fluids (Jin) with Accumulation of Heat

Hot dry foods, smoking, alcohol causing local accumulation of heat which injures jin fluids. This leads to accumulation of excess heat and damage to yin fluids. Results in stagnation blocking esophagus.

Nourish yin Generate fluids Harmonize stomach Down-bear counter flow Disinhibit throat Clear heat Tonify

Ye Ge Difficulty Swallowing Blood Stasis and Qi Stagnation (with actual physical blockage)

More severe case due to binding depression of qi and phlegm causing stagnant blood and actual physical blockage such as polyps and tumors. Can also be due to long-term yin deficiency which decreases fluids.

Invigorate blood Transform stasis Harmonize stomach Down-bear counter flow Disinhibit throat Even tonify even drain.

Ye Ge Difficulty Swallowing Degeneration and Exhaustion of Yang Qi

If stomach yin is severely depleted, kidney yin will be injured. Injury to yin leads to injury to yang, thus dysfunction of both the spleen and kidney. Exhaustion of yin, degradation of yang. Can be cancer with tumor blocking esophagus.

Blood stasis symptoms above, but worse. Cant swallow at all, emaciation, vomit if eat or drink, pale sallow withered complexion, extreme weakness, cold body, intolerant to cold, abdominal distension, SOB, edema. T- pale, swollen P- weak, thready, imperceptible

Tonify spleen qi Warm kidney yang Harmonize stomach Down-bear counter flow Disinhibit throat Tonify

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Diarrhea, acute onset, clear, watery, loose, can be continuous, w/food particles. Severe, twisting, abdominal pain, worse w/pressure, may double-over to retain warmth, borborygmus, nausea, poor appetite, heaviness, clear copious urine, no thirst, feel cold, like warm drinks. T- white, greasy coat P- slow, soggy, slippery Sudden acute onset diarrhea, urgent, frequent, thin, yellow, pasty, mucus in stool, foul smell. Abdominal pain w/cramping, worse w/pressure, anal burning/itching, irritability, bitter taste, restlessness, irritability, thirst, dry mouth, fever possible, scanty dark urine. Stools can be difficult to pass due to heat & burning. T- red, yellow greasy coat P- rapid, slippery, soggy Diarrhea, stomach/abdominal pain, worse with pressure or eating, better after vomiting / passing gas / bowel movement, burping, sour rotten smelling regurgitation, stools are sluggish foul muddy, diarrhea or constipation, nausea, vomiting of undigested food, bad breath, lower bowel gas, no desire to eat or drink. T- thick greasy dark or yellow coating P- strong, slippery, wiry Recurrent (comes & goes), urgent diarrhea, often related to stress/emotions, abdominal pain before/with bowel movement, flatulence relieves pain, can have alternating diarrhea/constipation (LR either stuck or over-coursing), irritability, hypochondrial pain, breast distension, irreg. menses, belching, acid regurgitation, heart burn, nausea. T- unremarkable, or red tip/sides P- wiry, rapid w/heat Frequent loose stools, thin, muddy, undigested food, worse w/oily, greasy food, tired after eating, heavy limbs, abdominal fullness/distension, nausea, poor appetite, fatigue, mental lassitude, sallow complexion, borborygmus. T- pale, tooth marked P- weak, thready, slippery/soggy w/dampness Cocks crow diarrhea, urgent, watery, undigested food, borborygmus, dull/distending/cold abdominal pain, better w/heat & pressure, +yang deficiency: intolerance to cold, cold body/extremities, weak/aching low back & knees, fatigue, emaciation. T- pale, swollen, tooth marked, wet P- deep, thready, weak Tx Principle Regulate qi of stomach & intestines Stop diarrhea Warm lower burner Scatter cold Tonify, moxa Regulate qi of stomach & intestines Stop diarrhea Clear heat Transform damp Drain Acupuncture Points / Techniques

14

Syndrome Xie Xie Diarrhea Cold Damp

Etiology / Pathomechanism Caused by direct exogenous targeting by cold damp, or by eating too much cold raw food. Enter thru LU/ST, invade middle burner and disturb ST, SP & intestines. Also caused by antibiotics. External invasion of summerheat-dampness in late summer, or accumulation of damp heat blocking intestines due to excess hot foods, alcohol, hot herbs/drugs, or emotions causing liver qi stagnation which transforms to heat and overacts on stomach, causing blockage in intestines. Food and drink collect and stagnate, cause lack of movement of stomach qi. Due to overeating or poor eating habits. Disruption of transform/transport function of SP/ST. Can be acute or acutely chronic (often comes with spleen and stomach deficiency). Deficiency in spleen/stomach with excess/profusion in liver. Can start as liver excess and cause spleen deficiency or start as spleen/stomach deficiency and cause liver profusion. Emotions cause LR excess, LR over-controls SP, blockage of transform/transport function. Mental over-activity, worry, anxiety causing taxation of SP. Poor diet, chronic illness or dampness causing taxation of SP/ST. Resulting in deficiency of transport/transform function. Poor diet, cold food or GI surgery can damage yang of spleen. Kidney yang deficiency caused by old age, chronic illness, cold environment or hereditary, can also cause spleen yang deficiency.

tian shu ST25 & shang ju xu ST37 - mu-he combination for LI (can replace ST 37 with zu san li ST36) he gu LI4 - move qi, resolve exterior, regulate the intestines yin ling quan SP9 - regulate spleen & transform damp, drains dampness from lower burner zhong wan REN12 - mu of stomach, meeting point of fu, transform damp rectify middle burner shen que REN8 & guan yuan REN4 (and/or qi hai REN6) - add moxa to warm lower burner & scatter cold, harmonize stomach, regulate SI, benefit SP qi tian shu ST25 & shang ju xu ST37 - mu-he combination for LI (can replace ST 37 with zu san li ST36) he gu LI4 - move qi, resolve exterior, regulate the intestines yin ling quan SP9 - regulate spleen & transform damp, clears damp heat zhong wan REN12 - mu of stomach, meeting point of fu, transform damp rectify middle burner nei ting ST44 - clear damp-heat, harmonize stomach feng long ST40 - harmonize stomach, transform phlegm, rectify qi, clear heat qu chi LI11 - regulate stomach & intestines, eliminate dampness, clear damp-heat w/significant heat - let blood at shang yang LI1 tian shu ST25 & shang ju xu ST37 - mu-he combination for LI (can replace ST 37 with zu san li ST36) he gu LI4 - move qi, resolve exterior, regulate the intestines yin ling quan SP9 - regulate spleen & transform damp, clears damp heat zhong wan REN12 - mu of stomach, meeting point of fu, transform damp rectify middle burner li nei ting extra - transforms food stasis xia guan REN10 or jian li REN11 - transform stasis, dissolve accumulation, strengthen transport/ transform function of SP/ST (lower stomach chamber points) tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain zhong wan REN12 & zu san li ST36 - mu-he combination for ST, regulate SP/ST, stop diarrhea, stop pain gan shu BL18 - course liver, resolve stasis tai chong LR3 - course liver, resolve stasis pi shu BL20 - tonify spleen, boost stomach yang ling quan GB34 - clear damp-heat in liver, smooth liver qi tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain zhong wan REN12 & zu san li ST36 - mu-he combination for ST, regulate SP/ST, stop diarrhea, stop pain pi shu BL20 & tai bai SP3 - yuan/shu combination, tonify spleen wei shu BL21 - boost stomach guan yuan shu BL26 - regulate lower jiao tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain zhong wan REN12 & zu san li ST36 - mu-he combination for ST, regulate SP/ST, stop diarrhea, stop pain pi shu BL20, guan yuan REN4 & ming men DU4 - add moxa to warm yang, regulate stomach/intestines tai xi KI3 & shen shu BL23 - yuan/shu combination, tonify kidney, fortify yang Ear acupuncture for all syndromes: shen men, SI, LI, ST, SP, LR, KI, sympathetic. 3-5 points per treatment, for acute treat 1-2 times daily and retain 5-10 minutes, for chronic once daily retain 10-20 minutes.

Xie Xie Diarrhea Damp Heat

Xie Xie Diarrhea Food Stasis

Regulate qi of stomach & intestines Stop diarrhea Disperse food Guide out stagnation Drain

Xie Xie Diarrhea Liver Profusion over-controlling Spleen

Regulate qi of stomach & intestines Stop diarrhea Course liver, resolve stasis Drain

Xie Xie Diarrhea Spleen and Stomach Deficient and Weak

Regulate qi of stomach & intestines Stop diarrhea Fortify spleen Boost stomach Tonify Regulate qi of stomach & intestines Stop diarrhea Warm yang Tonify

Xie Xie Diarrhea Spleen and Kidney Yang Deficiency

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms General for all dysenstery: Increased frequency of bowel movements, contain pus, blood, mucus, cramping lower abdominal pain, tenesmus (straining). Plus: Heat more prevalent than damp, burning at anus, more blood than pus/mucus, fever/chills, high thirst, irritability. T- red, yellow, greasy coat P- rapid, slippery General plus: Sticky stools, more pus/mucus less blood, chills/fever, cold body, prefer warmth, low-grade thirst, loss of appetite, heavy head & limbs, chest oppression. T- pale, greasy white coat P- soggy, soft, slow General plus: Acute, severe, sudden onset of high frequency bowel movements, ample blood/mucus/pus in stool, pain & tenesmus is severe, high fever/thirst, severe headache, restlessness, vexation, can progress to delirium, convulsions, loss of consciousness (due to heat in jue yin-PC). T- dark crimson red, dry yellow coat P- rapid, slippery Tx Principle Clear heat Resolve/release toxins Transform damp Regulate qi Harmonize blood Can use zhi xie (extrastop diarrhea) located 2.5 cun below navel on anterior midline. Acupuncture Points / Techniques

15

Syndrome Li Ji Dysentery Damp-heat

Etiology / Pathomechanism Dysentery is differentiated from diarrhea by it having more blood, pus and mucus in the stool. It is caused by attack of epidemic heat and dampness or by the intake of raw or contaminated food or water which causes an obstruction in the intestines by the xie qi. This stagnation causes injury to the luo which causes bleeding, leading to infection which causes pus. Dampness accumulates causing mucus.

Needle with draining: tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain he gu LI4 - move qi, invigorate blood, resolve the exterior, retreat fever, regulate the intestines qu chi LI11 - clear damp-heat, retreat fever, regulate & harmonize the ying & xue levels, regulate stomach and intestines yin ling quan SP9 - transform dampness, regulate spleen & drain damp from lower burner, clear heat nei guan PC6 - rectify qi, treat nausea, clear heat, rectify qi & harmonize stomach w/fever - add da zhui DU14 w/tenesmus - add zhong lu shu BL29 and chang qiang DU1 w/inability to eat or drink- add zhong wan REN12 Needle with tonifying, add moxibustion: tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain he gu LI4 - move qi, invigorate blood, resolve the exterior, retreat fever, regulate the intestines zhong wan REN12- transform damp, rectify middle burner, strengthen stomach, fortify spleen yin ling quan SP9 - transform dampness, regulate spleen & drain damp from lower burner Needle with draining: tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain he gu LI4 - move qi, invigorate blood, resolve the exterior, retreat fever, regulate the intestines let blood at jing-well points or shi xuan (tips of fingers) points wei zhong BL40 - xi point of blood, will drain heat in blood, resolve toxins, cool blood, stop diarrhea da zhui DU14 - clear heat, retreat fever, treat half interior/half exterior pathogens qu chi LI11 - clear damp-heat, retreat fever, regulate & harmonize the ying & xue levels yin ling quan SP9 - transform dampness, regulate spleen & drain damp from lower burner w/loss of consciousness - needle ren zhong DU26 and yong quan KI1 Needle with draining: tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain he gu LI4 - move qi, invigorate blood, resolve the exterior, retreat fever, regulate the intestines zhong wan REN12- transform damp, rectify middle burner, strengthen stomach, fortify spleen, clear heat Needle with even tonifying even draining: tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, regulate LI, stop diarrhea, stop pain he gu LI4 - move qi, invigorate blood, resolve the exterior, retreat fever, regulate the intestines Plus: tonify spleen and stomach between relapses; pi shu BL20, wei shu BL21, zu san li ST36, tai bai SP3, zhong wan REN12, qi hai REN6

Li Ji Dysentery Cold-damp

Li Ji Dysentery Epidemic Toxins

Li Ji Dysentery Food-denying

Food-denying dysentery is an advanced stage which develops from the dampheat or toxin stage where there is damage to the middle burner. Recurrent-intermittent dysentery starts with recovery from a previous stage which stays latent in the body becoming a chronic lingering pathogen. When the zheng qi is deficient it recurs.

General plus: Vomiting right after eating, nausea, dry retching, no desire to eat. T- dark red, crimson red, dry yellow coat P- rapid, slippery

Li Ji Dysentery Recurrent-intermittent

General plus: Recurring symptoms, systemic weakness of spleen & stomach, abdominal distension, fatigue, lethargy, loss of appetite.

Alternate therapeutic methods for treating dysentery: Ear acupuncture: shen men, LI, SI, ST, SP, KI, lower portion of rectum. 3-5 point per session, for acute elicit strong sensation and retain 20-30 minutes daily, for chronic elicit mild sensation and retain 5-10 minutes every other day.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Hard, dry, burning, difficult to pass stools, at several day intervals, abdominal fullness, may be palpable masses, frequent flatulence, the 4 bigs (fever, thirst, sweat, pulse), red complexion, halitosis, vexation, irritability, increased hunger, mouth ulcers, bleeding gums. T- red, dry yellow coat P-strong, rapid Difficulty passing stool, bound, sluggish, chronic, sense of lack of completion, stool are not hard/dry unless there is heat, abdominal pain & distension thru to hypochondrium, pebble-like stools, irritability, moodiness, hypochondrial pain, bitter taste, burping/ belching, hiccupping, worse w/stress & emotions. T- normal, red tip/sides w/heat P- wiry, rapid w/heat Stools are usually normal but there is lack of strength to eliminate them, feel unfinished, take a long time to pass, desire to defecate but must strain, after BM have SOB, spontaneous sweating, fatigue, indistinct lower abdominal pain, lusterless complexion. T- pale, can be tooth marked P- weak, thready Similar to qi deficiency above, but stools are dryer, more pellet-like, plus blood deficiency Sx: paleness, palpitations, dizziness, poor memory, blurry vision, insomnia, weakness. T- pale, dry P- thready, weak Hard stools, decreased motility, stools may or may not be dry, difficult to eliminate, fatigue after BM, anal prolapse, coldness, cold limbs, prefer warmth, abdominal pain & coldness, cold aching low back & knees, pale waxy complexion, long/clear/copious urine or scanty urination with edema. T- large, swollen, scalloped, pale, wet P- deep, weak, slow, can be soggy or slippery Dry, hard, impacted stools, can be pelleted, plus yin deficiency Sx: insomnia, night sweats, tidal fever, 5 heart fever, thirst, gnawing hunger with no desire to eat. T- red, scanty or no coat, center can be red, peeled P- thready, rapid Tx Principle Safeguard/preserve jin fluids Clear heat Free the stool Drain Course liver Rectify qi Free the stool Clear heat if needed Drain Acupuncture Points / Techniques

16

Syndrome Bian Bi Constipation Yang Ming Heat (ST/LI)

Etiology / Pathomechanism Exogenous pathogen transforming to internal heat. Too much hot greasy foods. Stagnation of internal heat and dryness resulting in lack of fluids

tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, open clear passage and regulate LI zhi gou TB6 - open lower orifaces, move the stool, drain san jiao heat (if you want to gozhi gou) nei ting ST44, qu chi LI11, he gu LI4 - clear heat and move qi w/abdominal pain - da heng SP15 (can electro w/tian shu), regulate LI & spleen qi, stop pain and also gui lai ST29 (on left side), local to descending colon tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, open clear passage and regulate LI zhi gou TB6 - open lower orifaces, move the stool, drain san jiao heat (if you want to gozhi gou) he qu LI4 & tai chong LR4 - 4 gates, will strongly rectify qi, course liver qi hai REN6 - regulate and mobilize qi w/heat - replace tai chong with xing jian LR2 to clear heat, yang ling quan GB34 to clear heat and promote smooth flow of liver qi tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, open clear passage and regulate LI zhi gou TB6 - open lower orifaces, move the stool zu san li ST36 - tonify qi, strengthen spleen, harmonize stomach, nourish blood (5 taxations & 7 injuries) qi hai REN6 - benefit spleen qi, regulate qi, tonify kidneys pi shu BL20 - fortify spleen, boost stomach, regulate and harmonize qi & blood da chang shu BL25 - regulate intestines, tonify LI function of clear passage zhong wan REN12 - harmonize digestion, rectify qi of middle jiao, strengthen stomach, fortify spleen tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, open clear passage and regulate LI zhi gou TB6 - open lower orifaces, move the stool ge shu BL17 & san yin jiao SP6 - nourish blood zu san li ST36 - tonify qi, strengthen spleen, harmonize stomach, nourish blood (5 taxations & 7 injuries) pi shu BL20 - fortify spleen, boost stomach, regulate and harmonize qi & blood da heng SP15 - local, tonify spleen, regulate LI, stop pain w/qi deficiency - da chang shu BL25 - regulate intestines, tonify LI function of clear passage tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, open clear passage and regulate LI zhi gou TB6 - open lower orifaces, move the stool guan yuan REN4, ming men DU4 & shen shu BL22 with moxa, can also moxa tian shu ST25 For all syndromes: wai guan TB5, zhi gou TB6, hui zong TB7 - test for ashi point to determine side to treat

Bian Bi Constipation Qi Stagnation

Stagnation of the flow of qi from emotional upset. Disruption of the dredging-discharging-coursing function of the liver, which disrupts the motility of yang ming organs. Habitual constipation. Deficiency of qi from internal injury from strain, stress or a lack of physical exercise, chronic or extended illness, weak zheng qi. There is a lack of power to move the stools.

Bian Bi Constipation Qi Deficiency

Tonify qi Free the stool Tonify

Bian Bi Constipation Blood Deficiency

Deficiency of blood from internal injury from strain, stress, or a lack of physical exercise, chronic or extended illness. Leads to a decrease of fluids but without heat. Commonly follows childbirth.

Nourish blood Free the stool Tonify

Bian Bi Constipation Yang Deficiency Cold

Deficiency of yang causing lack of warming/mobilizing, leading to collection and binding of cold in LI. Seen in seniors, chronic illness, poor constitutions.

Assist the yang Free the stool Tonify, moxa

Bian Bi Constipation Yin Deficiency

Seen in seniors, chronic illness, dehydrated, taxation, extended drug users. Fluids are consumed by deficiency heat/fire and lack of moistening, lubricating properties of yin.

Nourish yin Clear deficiency heat Free the stool Tonify

tian shu ST25 & shang ju xu ST37 - mu-he combination for LI, open clear passage and regulate LI zhi gou TB6 - open lower orifaces, move the stool, drain san jiao heat (if you want to gozhi gou) san yin jiao SP6 - moisten & supplement yin zhao hai KI6 - nourish yin, clear deficiency heat

Alternate therapeutic methods for treating constipation: Massage: rub abdomen in clockwise direction (following course of LI). Acupressure: at da heng SP15, tian shu ST25, gui lai ST29 on left side. Diet/lifestyle: increase exercise, eat fruits and exercise, eat proper temperature foods. Trunk twisting exercise.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Gradual onset. Heavy distended feeling at anus during bowel movement (or all the time), mild protrusion of rectum thru anus after BM, usually spontaneously retracts, can progress to needing manual retraction, worsens over time, if untreated can become irretractable and ischemic, lack of strength, fatigue, dizziness, mental laziness, palpitations, sallow withered complexion. T- pale P- thready, weak Anal prolapse concomitant with dysentery, straining, activity and pressure on anus, can come with hemorrhoids. Distending, heavy sensation prior to BM, urgency, frequency, local redness, swelling, itching, burning, pain, (plus dysentery symptoms). T- red, yellow greasy coat, especially at root P- rapid, slippery Usually there is right lower quadrant (RLQ) abdominal pain, but initially, pain can be anywhere on abdomen. Initial stage: Abdominal pain around navel or at epigastrium, pain then shifts to RLQ, there is extreme pressure pain upon palpation. (McBurneys point; located at lateral 1/3 on line between ASIS & navel.) Purulent stage: Steady increase in pain with rebound pain in RLQ, involuntary muscle guarding, nausea, vomiting, constipation. Right leg is often contracted, extending right leg is extremely painful. 60-80% show tenderness at lan wei xue. Ulcerative stage: Appendix bursts, sudden extreme pain, high fever, sweating, aversion to cold. Palpable mass in RLQ. T- coat becomes thicker, more yellow & greasy. P- surging & rapid. Tx Principle Benefit qi Cause raising & lifting Tonify Acupuncture Points / Techniques bai hui DU20 - raise the clear chang qiang DU1 - local, assist with binding & stitching of anus da chang shu BL25 - retension and cinching of large intestine, clear damp-heat from large intestine cheng shan BL57 or wei zhong BL40 - treat rectal prolapse, hemorrhoids (bladder has jing bie connection to anus) qi hai REN6 - tonify spleen and qi and spleens ability to raise the clear pi shu BL20 - tonify zheng qi zu san li ST36 - strengthen spleen/stomach, help spleen raise the clear bai hui DU20 - raise the clear chang qiang DU1 - local, assist with binding & stitching of anus da chang shu BL25 - retension and cinching of large intestine, clear damp-heat from large intestine cheng shan BL57 or wei zhong BL40 - treat rectal prolapse, hemorrhoids (bladder has jing bie connection to anus) qu chi LI11 - clear damp-heat from fu yin ling quan SP9 - clear damp-heat from lower burner lan wei xue - point of positive response on right leg, 1-2 cun distal to zusanli ST36, appendix point zhong wan REN12 - clear heat, dissolve food accumulation, transform stasis, transform damp tian shu ST25 - open clear passage thru fu, guide out stasis, resolve damp-heat rectify qi in ST & LI di ji SP8 - stop pain, rectify qi, harmonize spleen & stomach w/fever - qu chi LI11 & nei ting ST44 w/vomiting - nei guan PC6 & shang wan REN13 w/abdominal distension - qi hai REN6 w/constipation - fu jie SP14 (1.3 cun below daheng) & yang ling quan GB34 Ear acupuncture: appendix, sympathetic, shen men

17

Syndrome Tuo Gang Prolapse of Rectum Deficiency

Etiology / Pathomechanism Weak constitution, multiple pregnancies, long difficult labor, aging, taxation, spleen qi deficiency, digestive insult. Gradual onset with mild protrusion of rectum thru anus during defecation.

Tuo Gang Prolapse of Rectum Excess (damp-heat)

Severe diarrhea, dysentery, or hemorrhoid flare-up, excess force required to push out stool, damp-heat collecting locally due to rich diet, damp producing and hot foods, or external damp-heat that invades the intestines. Swelling and suppuration in the intestinal tract. Western - appendicitis; it is an acute abdominal condition often treated with surgery. Caused by gorging or sudden bouts of drinking & eating or excess physical activity following a large meal causing blood & food stasis and injury to intestinal wall. Accumulation and binding of dampness & heat due to too much rich food. Exogenous cold collecting in abdomen and transforming to heat. Exposure to cold or too much cold foods. In all cases, qi & blood are blocked, stagnant qi turns to heat, dampness & heat cause tissue necrosis in bowels.

Clear and drain dampheat Cause raising & lifting Drain

Chang Yong Appendicitis (Intestinal Abscess)

Clear heat Guide out food stagnation Invigorate blood Disperse binding & masses Drain NOTB: treatment is for initial stage, advanced stages require emergency treatment at hospital.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Tx Principle Acupuncture Points / Techniques

18

Syndrome Tong Zheng Pain Complexes

Etiology / Pathomechanism

Internal organ problems that cause severe pain. Includes angina, gallbladder attack or inflammation, acute gastritis, pancreatitis, abdominal pain with appendix or intestinal obstruction, parintenitis, kidney stones, kidney pain. Invasion by cold pathogen entering zang fu causing qi & blood stasis. Emotions disrupting flow of qi and stagnating qi & blood, blocking meridians and organ function. Damp & heat combine causing formation of calculi. Qi stagnation and blood stasis or cold invasion. Chest pain radiating from heart or center of upper back. Pain may start in upper back and penetrate chest. Pain can radiate into shoulder and neck or down left arm. When severe pain is stabbing, fixed, sharp. Chest oppression, SOB, palpitations, spontaneous sweating. When severe, panting, labored breathing, inability to lay flat, cold limbs. T- dark, dull purple P- choppy or hidden Severe pain, colicky spasm, intermittent, worse with pressure, may have constant pain, nausea, vomiting, poor appetite, alternating chills & fever, bitter taste. Right hypochondrium pain or right upper abdominal pain, may radiate into shoulder. Jaundice, vomiting sour bile-like fluid. T- normal or yellow greasy coat (with damp-heat) P- wiry, may be rapid & slippery (with damp-heat) Move qi Clear yang Open and allow clear passage of yang Invigorate blood Stop pain Drain tan zhong REN17 - rectify qi in upper burner, transform stasis nei guan PC6 - regulate yin wei mai and interior connection, regulate qi in chest, heart & stomach, invigorate blood xin shu BL15 - awaken heart, calm shen zu san li ST36 - regulate qi, move yang tian tu REN22 - chest pain w/stabbing sharp pain with blood stasis - ge shu BL17 & jue yin shu BL14 w/white complexion, cold limbs, SOB, profuse sweating - moxa at guan yuan REN4 or qi hai REN6 qi men LR14 and/or ri yue GB24 & yang ling quan GB34 and/or dan nang xue - mu-he of GB, rectify gallbladder, clear damp-heat from LR/GB, course liver, move qi, stop pain; (can apply electrical stim to these two points) tai chong LR3 - course liver, rectify gallbladder zhong wan REN12 & zu san li ST36 - mu-he of stomach, clear & naturalize damp-heat, open fu wai qui GB36 - xi-cleft, activate channel, stop pain, clear heat & detoxify poison w/nausea & vomiting - nei guan PC6 w/alternating chills & fever - zhi gou TB6, wai guan TB5 & zu lin qi GB41 w/severe abdominal pain - zhong wan REN12 & liang men ST21 w/damp-heat - bu rong ST19, zhi yang DU9 Ear acupuncture - shen men, LR, GB, sympathetic zhong wan REN12 & zu san li ST36 - mu-he of stomach, strengthen & harmonize stomach, transform stasis, rectify qi. Moxa at zhong wan to warm the middle. w/food stagnation - li nei ting, jian li REN11 & xia wan REN10 w/pain radiating to hypochondrium - yang ling quan GB34 w/sharp stabbing pain - ge shu BL17 w/nausea & vomiting - nei guan PC6 Ear acupuncture - shen men, LR, ST shen shu BL23 & zhi shi BL52 - can add electro for 5-10 minutes san yin jiao SP6 - can add electro for 5-10 minutes tai xi KI3 jing men GB25 yin ling quan SP9

Tong Zheng Heart Pain (angina/heart attack)

Tong Zheng Gallbladder Pain (branch)

Qi stagnation and damp heat. Acupuncture can facilitate the expulsion of gallbladder stones under 1 cm in diameter and cystic duct stones under 1.5 cm. Obtain de qi and drain strongly, retain for over 40 minutes (important), manipulate at intervals or apply electro (high frequency dense-sparse wave), connecting a local & distal point. Treat every day for 10 days. Entry of cold pathogen causing stasis of qi & blood.

Course liver Rectify gallbladder Move qi Stop pain Drain

Tong Zheng Epigastric or Gastric (acute gastritis, pancreatitis)

Sudden onset of severe, twisting, wringing stomach pain, distending lower abdominal pain, better with warmth, worse with pressure, regurgitation, burping, qi ni, vomiting, nausea, fullness or distension of epigastrium or hypochondrium. With blood stasis there is fixed pain that is stabbing or sharp. T- normal or dull purple P- wiry or tight ot choppy Sudden onset of colic-type pain which radiates from kidney area in lower back to the abdomen and scrotum and medial aspect of thigh on the same side,. Cold sweating, nausea and vomiting, percussive pain in renal reqion.

Harmonize stomach Downbear counterflow Rectify qi Stop pain Warm center Drain, moxa

Tong Zheng Renal Colic

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Distension, fullness and protrusion of abdomen, as though inflated, round & swollen, with pressure feels soft but springs back when pressure removed, skin color is normal, worse w/emotions, better w/burping or flatulence, when percussing abdomen it feels hollow and drum-like, scanty yellow urine, incomplete stools, bound or constipated. Plus LR profusion Sx: hypochondrial pain, chest fullness, burping/flatulence. T- normal P- wiry, can be thready Large, distended, round abdomen, laying on back water pockets at sides, skin bright & shiny, pressure causes temporary pitting/depression, edema of lower body, epigastric fullness & distension, dull yellow complexion. With cold will have aversion to cold, loose muddy stools, lack of free flow of urine, fatigue. T- white greasy coat, P- slow, soggy. With heat will have vexation, feverishness, dark yellow urine, bitter taste, constipation or sticky stool, jaundice. T- greasy yellow coat, P- slippery, rapid Large, hard abdomen and epigastrium, tight and hard to the touch, vericosities or protruding vessels around navel or purple/blue/greenish color, might palpate solid masses at spleen/liver area, stabbing fixed pain, skin can be dark scaly hard or dry & smooth over stasis area, skin can crack, dull dark blackish yellow complexion, small spider veins on chest/head/face, can have subcutaneous blood macules, stool may be black (due to stomach or esophagus luo vessel hemorrhage). T- dull, dark, purple, stasis spots P- rough, thready, wiry Tx Principle Harmonize middle Disperse swelling or distension Course liver Rectify qi Drain Acupuncture Points / Techniques

19

Syndrome Gu Zhang Drum Distension of Abdomen Qi Distension

Etiology / Pathomechanism Emotions cause LR qi profusion, impairing dredge/discharge function, leading to distension. Too much alcohol injures the spleen, damp turbidity collects, injuring liver. Water toxins, liver flukes or other parasites block lymph vessels causing ascites.

tan zhong REN17 - rectify qi in upper & middle burner zhong wan REN12 - dredge middle burner qi hai REN6 - regulate qi in lower burner zu san li ST36 - strengthen earth to prevent injury to earth by wood tai chong LR3 - course liver, rectify qi w/constipation - fu jie SP14 (1.3 below & 4 bilateral to navel), resolve abdominal qi stagnation w/hypochondrial pain - yang ling quan GB34 & zhi gou TB6 (hand & foot shao yang), rectify qi w/damp-heat & dark yellow urine - yin ling quan SP9 - clear heat, regulate spleen and transform damp (clears damp-heat) pi shu BL20 & gong sun SP4 - fortify spleen, rectify qi to move water shui fen REN9 - moxa to mobilize water, disperse abdominal swelling and reduce water retention zhong wan REN12 - regulate middle burner w/cold-damp - yin ling quan SP9 - regulate spleen and transform damp w/fear of cold - moxa guan yuan REN4 and ming men DU4 to warm yang w/damp-heat - yang ling quan GB34 & nei ting ST44 - clear damp-heat from LR/GB, rectify GB w/damp-heat causing constipation - zhi gou TB6, will moisten stools w/kidney yang deficiency - shen shu BL23 & fu liu KI7 - moxa shen shu, fu liu is metal point on water, tonify metal to strengthen kidney yang qi men LR14 & zhong men LR13 - mu of LR & SP, course & open clear passage of LR & SP san yin jiao SP6 - move & invigorate blood shi men REN5* - mu of san jiao, invigorate blood, transform stasis, open vessels, disperse masses w/severe epigastric distension - liang men ST21, harmonize ST, transform stasis, rectify qi, stop pain w/ deficiency of LR & KI yin - tonify tai xi KI3 & gao huang shu BL43 (100 taxations) w/jaundice - wan gu SI4 - clears damp-heat, treats jaundice

Gu Zhang Drum Distension of Abdomen Water Distension

Water and damp collect over time, due to qi stagnation (above), which affects the transport/transform function of the spleen, impeding water metabolism, so water and damp collect in the abdomen.

Regulate qi Move water Fortify spleen Boost kidney Disperse swelling or distension Drain Moxa at bei shu of SP/KI.

Gu Zhang Drum Distension of Abdomen Blood Distension

Qi stagnation (above) leads to blood stasis, leading to distension.

Course and allow passage of liver & spleen Invigorate blood Transform stasis Drain Caution: palpate abdomen before needling to avoid enlarged liver or spleen.

Alternate therapeutic methods for treating drum distension of the abdomen: Ear acupuncture: LR, GB, KI, Pancreas, LI, SP IMPORTANT: This syndrome can be life threatening (liver cirrhosis, severe ascites). Use dietary treatments and herbs. Clinical point selection (from Warren Fischer): Alternate these two point groupings every other treatment: GROUP 1 - gan shu BL18, zhi yang REN9, zu san li ST36 GROUP 2 - zhang men LR13, pi shu BL20, san yin jiao SP6 Follow with moxa at shen que REN8, zhong wan REN12, guan yuan REN4, da hang SP16 for 30 minutes (use two points per treatment). Once each day. 10 days = 1 course. 10 courses = treatment. Take 4-7 day break between courses.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Damp-heat in middle jiao. Eyes & skin bright yellow, or orange yellow. Fever, bitter taste, desire cold drinks but is difficult to drink, abdominal distension & fullness, scanty yellow urine, stools are bound or constipated. T- red, greasy yellow coat P- wiry, rapid With epidemic toxins above symptoms are more severe, heat sinks deeply into blood of jue yin, can cause loss of consciousness, patchy, red skin rashes, can have bleeding. With more dampness than heat the skin color is less vivid, less fever, more GI symptoms, muddy loose stools, T- less yellow, more greasy P- slippery, soft/soggy Damp-cold in middle jiao. Eyes & skin are dull, dim, lifeless, smoky yellow. May be dark grey or blackish. Mental fatigue, aversion to cold, poor appetite, epigastric hardness/fullness, unformed loose stools, no thirst, bland tasteless sticky mouth, heaviness. T- pale, thick greasy coat P- slow, soggy Can progress to blood stasis: formation of masses below the ribs (cirrhosis or enlarged SP/LR), sharp stabbing rib pain, abdomen may be distended (ascites), rest of body emaciated, sharp decline in appetite. T- purple with stasis patches, peeled coat P- thready, rough Note: this can signify malignancy. Tx Principle Clear heat Naturalize damp Dispel jaundice Drain Acupuncture Points / Techniques

20

Syndrome Huang Dan Jaundice Yang Jaundice

Etiology / Pathomechanism Bile flows outside its proper channels into the skin, eyes and urine. Usually exogenous damp hot weather, contaminated food or water, or epidemic toxins (hep. A). Can also be endogenous caused from overconsumption of alcohol or hot greasy food. Dampheat accumulates in LR/GB, impairing dredge/discharge function. Bile leaks out into meridians and tissues.

yin ling quan SP9 - clear heat, regulate spleen and transform damp (clears damp-heat) yang ling quan GB34 - clear damp-heat from LR/GB, rectify GB san yin jiao SP6 - drain damp, cool the blood zhi gou TB6 - drain san jiao heat, on shao yang (same as GB) will help clear damp-heat from GB dan shu BL19 - rectify GB, clear heat, remove dampness zhi yang DU9 - drain dampness, regulate middle burner, treats jaundice (below T7) wan gu SI4 - clears damp-heat, treats jaundice w/strong heat - da zhui DU14 & he gu LI4 w/fainting & loss of consciousness - ren zhong DU26, can also let blood at HT or PC jing-well points or at shi xuan extra points w/hypochondrial or costal pain - qi men LR14, mu of liver, invigorate blood, course liver, rectify qi w/epigastric hardness, loose stools - zu san li ST26 w/nausea, chest oppression - nei guan PC6 & gong sun SP 4, rectify qi, resolve damp yin ling quan SP9 - drain to transform damp pi shu BL20 & wei shu BL21 - tonify and use moxa, tonify spleen & stomach zu san li ST36 - tonify post-heaven to relieve damp san yin jiao SP6 - drain to treat static blood and masses below ribs ge shu BL17 - drain to treat static blood and masses below ribs, invigorate blood qi hai REN6 - drain to move qi & invigorate blood w/mental fatigue and fear of cold - moxa guan yuan REN4 and ming men DU4 to warm yang w/loose stools - tian shu ST25 & da chang shu BL25, mu-shu of LI Reduce intake of alcohol and greasy, hot foods. Get lots of rest, avoid overwork. Once branch is under control, treat root.

Huang Dan Jaundice Yin Jaundice

Chronic, can develop from yang jaundice. Internal injury: endogenous due to overconsumption of damp, cold, raw foods, starve & binge eating, alcohol in excess, accumulation of cold-damp. Taxation pattern: caused by fixation, obsession, anxiety, excess emotions, mental taxation which attack the spleen, lead to SP qi deficiency with internal accumulation of cold-damp. This causes impaired transform/transport function and blocked dredge/discharge function of liver and impeded secretion of bile.

Fortify spleen Naturalize damp Dispel jaundice Even tonify, even drain. w/blood stasis: Invigorate blood Transform stasis Moxa for cold & stasis.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Very rapid onset, non-pitting edema, around eyes, especially lower lids, aversion to wind, fever, swollen painful throat. T- red P- rapid, floating Tx Principle Course wind Clear heat Ventilate lungs Disperse swelling Drain Acupuncture Points / Techniques

21

Syndrome Yang Shui Zhong Yang Edema Wind-heat or Wind-water

Etiology / Pathomechanism Exogenous pathogen (wind-heat, damp wet, exposure to wind after bathing) enters and affects lungs, accumulates in upper body as lungs fail to down-bear fluids, water collects in yang areas.

lei que LU7 - resolve exterior, disperse wind-heat and damp, regulate water pathways by promoting down-bearing & dispersing of lung, most exterior acting LU point (luo, biao-li connection) yin ling quan SP9 - drain damp he gu LI4 - regulate exterior, activate sweat, move qi, clear heat zu san li ST36 - down-bear qi from upper body, help SP transform/transport function fei shu BL13 (for wind-heat), pi shu BL20 (for damp), san jiao shu BL22 (move water, transform qi) wai guan TB5 & feng men BL12 - open/release exterior w/severe edema in face & head - ren zhong DU26, clears wind from head lei que LU7 - resolve exterior, disperse wind-heat and damp, regulate water pathways yin ling quan SP9 - drain damp he gu LI4 - regulate exterior, activate sweat, move qi, clear heat zu san li ST36 - down-bear qi from upper body, help SP transform/transport function fei shu BL13 (for wind-heat), pi shu BL20 (for damp), san jiao shu BL22 (move water, transform qi) zhong wan REN12 & shui fen REN9 - transform damp, separate & facilitate water metabolism w/severe edema in arms - zhong zhu TB3, shu-stream for dampness, drain dampness from arms lei que LU7 - resolve exterior, disperse wind-heat and damp, regulate water pathways yin ling quan SP9 - drain damp he gu LI4 - regulate exterior, activate sweat, move qi, clear heat zu san li ST36 - down-bear qi from upper body, help SP transform/transport function fei shu BL13 (for wind-heat), pi shu BL20 (for damp), san jiao shu BL22 (move water, transform qi) da zhui DU14 & qu chi LI11 - clear heat, can also let blood at shi xuan extra w/severe edema in legs - san yin jiao SP6, drain damp & water, boost spleen, regulate kidney pi shu BL20 & shen shu BL23 - moxa, tonify & warm yang qi shui fen REN9 - moxa, strongly disperses water, tonify spleen & kidney functions guan yuan REN4 or qi hai REN6 - moxa, promote qi transformation of fluids in lower burner, tonify yang fu liu KI7 - metal point on water meridian, will tonify water, regulate water & yang of kidney yin ling quan SP9 - drain to disinhibit damp, fortify spleen function zu san li ST36 - fortify spleen, transform damp san yin jiao SP6 - drain damp pi shu BL20 & shen shu BL23 - moxa, tonify & warm yang qi shui fen REN9 - moxa, strongly disperses water, tonify spleen & kidney functions guan yuan REN4 or qi hai REN6 - moxa, promote qi transformation of fluids in lower burner, tonify yang fu liu KI7 - metal point on water meridian, will tonify water, regulate water & yang of kidney yin ling quan SP9 - drain to disinhibit damp, fortify spleen function ming men DU4 - moxa, tonify yang qi w/fullness/hardness of epigastrium - zhong wan REN12, transform damp, rectify middle burner w/muddy stools - tian shu ST25, resolve dampness, open clear passage thru fu (mu of LI) ren zhong DU26 & shi xuan extra - awaken the brain nei guan PC6 - opens to yin wei mai so regulates internal organs, especially the heart bai hui DU20 - moxa, regulate the shen, return yang (DU is the sea of yang) shui fen REN9 - moxa, strongly disperses water, mobilize urination zu san li ST36 - moxa, down-bear fluids, move qi in chest, bring fluid away from heart

Yang Shui Zhong Yang Edema Damp Burdens the Spleen

Exogenous damp targets the spleen (rather than the lungs), burdening the spleen and interfering with the transform/transport function, resulting in water swelling.

Rapid onset non- or mildly pitting edema, scanty urine, poor appetite, nausea, thoracic oppression. T- wet white greasy coat P- deep, slippery

Fortify spleen Transform damp Disperse swelling Drain

Yang Shui Zhong Yang Edema Toxic Heat

Local accumulation of toxic heat which moves into interior, affecting lung down-bearing and opening water pathways.

Swelling first on head & face, then moving to limbs, then trunk. Very high fever, thirst, irritability, dark scanty urine, constipation, can have lesions, boils, can be an extreme insect bite reaction. If it moves into liver jue yin there can be spasms & convulsions. T- red, yellow greasy coat P- rapid, slippery or soggy Distension & fullness of stomach & abdomen, edema is particularly severe below the waist, edema is pitting. Decreased appetite, loose muddy stools, sallow yellow withered complexion, fatigue, tired heavy body, cold limbs, scanty urine. T- pale, white coat P- deep, weak or deep, slow Often comes with SP yang deficiency, edema below the waist is more severe. Low back pain, palpitations (KI water douses HT fire), SOB (lack of naqi KI function), cold limbs & body (especially feet), knees & low back are aching heavy & cold, general heaviness, scanty urination, mental lassitude/boredom. T- pale, swollen, wet P- deep, slow, forceless Severe edema, enlarged, distended, full abdomen, little or no urine, SOB, labored breathing, coughing, palpitations, chest oppression, nausea/vomiting, foul breath, loss of consciousness, delirium, convulsions.

Clear heat Resolve toxins Disperse swelling Drain

Yin Shui Zhong Yin Edema Spleen Yang Deficiency

Improper eating habits disrupt transform transport function, causing poor transformation of fluids which accumulate as water and dampness in lower limbs. This is deficiency of spleen at root with excess water as branch. Taxation, age, chronic illness, sexual over-activity cause decrease in jing and yang qi of kidney, qi transformation and fluid metabolism lack power, weakening of open-close of urethra, retention of murky water in lower burner.

Warm & tonify spleen yang Transform damp Disinhibit water Disperse swelling Even tonify, even drain. Warm with moxa. Warm kidney yang Disinhibit water Disperse swelling Even tonify, even drain. Warm with moxa.

Yin Shui Zhong Yin Edema Kidney Yang Deficiency

Shui Zhong Edema Toxic Water

Yin edema progresses to life-threatening stage, water toxin overwhelms the heart, later stages of uremia (urine in blood), rise to and poisons the heart. Heart failure, kidney failure.

Rescue the yang Emergency situation, keep yin & yang integrated long enough to get to hospital.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Excess thirst, high fluid intake, dry mouth, excess hunger, frequent urination, dry skin/lips/tongue, + Heart fire Sx: vexation, irritability, insomnia. T- red, esp. front half, thin scanty coat (can be yellow) P- rapid, surging (thready w/yin deficiency) Tx Principle Clear lung heat Engender fluids Nourish the yin Even tonify, even drain. Acupuncture Points / Techniques

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Syndrome Xiao Ke Wasting-thirst (diabetes) Shang Xiao Upper burner wasting, Lung/Stomach

Etiology / Pathomechanism Dry heat injures fluids causing injury to yin of the lung. Root yin deficiency causes branch dry heat. Upper wasting is caused by excess emotions or taxation of the mind leading to heart fire which injures yin of the lung. The heart fire can also lead to stomach heat/fire, resulting in excessive thirst. Dietary factors (rich/fatty/sweet/spicy foods or alcohol overconsumption) lead to accumulation of heat in middle burner. The heat transforms to dryness which injure fluids causing excessive hunger & thirst. Commonly Type 1, constitutional type. Can also come from over-consumption of jing (age, taxation, over-indulgence in sex, chronic illness). Kidney yin (jing) is deficient, eventual depletion of KI yang. Eventually manifests in all 3 burners. Deficiency of yang can also lead to blood stasis and can cause gangrene (of feet).

yu ji LU10 & nei ting ST44 - drain, xing-spring, clear heat yi shu extra (pancreas shu) - tonify, help insulin secretion, treat diabetes fei shu BL13 & tai yuan LU9 - tonify, shu/yuan, treat deficiency of, and prevent injury to, fluids and yin

Xiao Ke Wasting-thirst (diabetes) Zhong Xiao Middle burner wasting, Spleen/Stomach Xiao Ke Wasting-thirst (diabetes) Xia Xiao Lower burner wasting, Kidney

Excess hunger, excess thirst, irritability, weight loss, emaciation, vague stomach discomfort or pain, constipation, dry hard stools. T- red, dry yellow coat (no coat w/yin damage) P- rapid, forceful (thready w/yin damage)

Clear stomach heat Engender fluids Nourish the yin Even tonify, even drain. Or drain first, followed with tonifying treatment. Nourish the yin Clear heat With yang deficiency add: Assist/fortify yang With blood stasis add: Invigorate blood Transform stasis

nei ting ST44 - drain, xing-spring, clear heat yi shu extra (pancreas shu) - tonify, help insulin secretion, treat diabetes zu san li ST36 - tonify the stomach, down-bear stomach qi ni pi shu BL20 & wei shu BL21 - tonify the middle burner, wei shu also will increase fluids (ST is origin of) san yin jiao SP6 - tonify to nourish yin, preserve jin fluids w/frequent hunger & stomach discomfort - tonify zhong wan REN12 & nei guan PC6 w/constipation - da chang shu BL25 & shang ju xu ST37 - drain heat from LI yi shu extra (pancreas shu) - tonify, help insulin secretion, treat diabetes pang guang shu BL28 - regulate urine/bladder, tonify kidney, clear damp-heat from lower burner shen shu BL23 - facilitate qi transformation, nourish kidney yin tai xi KI3 & guan yuan REN4 - fortify kidney, facilitate qi transformation, nourish kidney yin w/blurry vision - guang ming GB37, benefit eyes w/dizziness - shang xing DU23 & bai hui DU20, clear heat, scatter wind, return yang, calm shen w/yang deficiency - moxa at guan yuan REN4 and ming men DU4 w/blood stasis - ge shu BL17 & san yin jiao SP6, mobilize blood

Excess urination due to loss of kidney sealing/storage function not sealing urethra, malar flush, restlessness, vexation, dizziness, vertigo, dry mouth/lips/tongue, high thirst and hunger, blurry vision, weak aching low back and knees, turbid milky urine. T- red, scanty or absent coat P- rapid, thready With extended illness yang is also injured and can come with blood stasis: cold limbs, fear of cold, dull dark blackish complexion, increased urine volume, impotence, amenorrhea, with blood stasis will have numb tingling fingers and toes, can lead to gangrene. T- pale, dull, purple, blackish P- deep, thready

Alternate therapeutic methods for treating diabetes: Ear acupuncture: Pancreas, endocrine, shen men, KI, LU, ST Plum blossom at jia ji from T7 - T12, every second day. If there is severe heat can let blood with plum blossom.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Burning pain on urination. Frequent, urgent, difficult, dark scanty urine. Sharp pain in urethra, lower abdominal distension & pain, constipation. If due to exogenous induction; fever, headache, thirst, bitter taste. T- red body, yellow, slimy coat P- rapid, soggy Tx Principle Clear heat Disinhibit damp Free the urine Stop pain Drain Acupuncture Points / Techniques Core points for all lin zheng syndromes: yin ling quan SP9 - clear damp from lower burner zhong ji REN3 - mu of bladder, clear heat from lower burner pang guang shu BL28 - (mu-shu combination), regulate bladder qi, move urine (Clinical note: wei zhong BL40 & ci liao BL32 are also effective points.) san yin jiao SP6 - drain damp w/exogenous induction - he gu LI4 & wai guan TB5, release exterior CLINICAL PEARL: xing jian LR2 or tai chong LR3 - LR jing mai wraps genitals and moves qi accumulation tai xi KI3 - drain to benefit water and qi transformation of kidney & bladder Strong pain, can be excruciating. Can be unilateral lower back pain, pain is severe, cramping, colicky. Pubic pain, pain can radiate down inner thigh, blood in urine, difficult urination, can be blocked, postural shift can sometimes free urination, small particles in urine. T- red, yellow greasy coat P- rapid, slippery, wiry Pain with bleeding. Frequent, urgent, sharp, burning pain, urethral pain, blood in urine, dark red color, can be clotted, or can just change color of urine. T- red, yellow coat P- rapid, slippery, forceful Pain with cloudy or milky urine. Turbid, cloudy, milky, creamy, cottony, murky, oily, swill like urine, can have blood in urine, burning urethral pain, nausea, poor appetite. T- red, yellow greasy coat P- soggy, rapid Pain due to qi stagnation. Difficult urination, can feel rough, dribbling, fullness & pain of lower lateral abdomen, chest oppression, pain and distension of hypochondrium. T- normal P- wiry Dull pain, sense of hanging, dragging, or distension of lower abdomen, weak urination, interrupted flow, dribbling & dripping, shortness of breath, pale complexion, low back ache. T- pale, light white coat P- weak Clear heat Disinhibit damp Expel stones Free the urine Stop pain Drain Clear heat Cool the blood Stop bleeding Free the urine Stop pain Drain Clear heat Disinhibit damp Free the urine Stop pain Drain Course liver, rectify qi Free the urine Stop pain Drain Boost qi Fortify spleen Tonify

23

Syndrome Re Lin Zheng Heat Painful Urination (Urinary Stranguary) Damp-Heat

Etiology / Pathomechanism Damp-heat accumulates and disturbs the qi transformation (qi hua) of the urinary bladder. External induction; poor genital hygiene, external pathogens spread from bowel movement, infection acquired during sexual congress. Internal induction; dietary due to too much hot, spicy, rich, sweet foods or too much alcohol. Damp-heat accumulates and forms stones. External or internal causes (see above).

Shi Lin Zheng Stones Painful Urination Stones

Core points above plus: ran gu KI2 - xing-spring point, clear heat wei yang BL39 - lower uniting of TB, harmonize TB and regulate urine, treat painful & difficult urination wei zhong BL40 - he point of BL, move qi, stop pain (can alternate with BL39) w/bloody urine - san yin jiao SP6 (drain damp, cool the blood) & xue hai SP10 (cool the blood, facilitate urination) Core points above plus: ran gu KI2 - xing-spring point, clear heat xue hai SP10 - cool the blood, regulate blood in lower burner, facilitate urination san yin jiao SP6 - regulate bleeding, cool the blood

Xue Lin Zheng Bleeding Painful Urination Bleeding

Damp-heat injures the blood vessels (the local luo mai). External or internal causes (see above).

Gao Lin Zheng Unctuous Painful Urination Milky-cloudy

Damp-heat pours into the lower burner and interferes with the qi transformation of clear and turbid, allowing escape of lipid fluids. External or internal causes (see above). Emotional disturbance causes the liver to become profuse and the qi to stagnate, which prevents normal function of the bladder and results in painful urination. Deficiency of kidney and spleen qi injures the zheng (upright) qi and causes the inability of the clear qi to rise. Qi sinks downward.

Core points above plus: san yin jiao SP6 - drain damp shui dao ST28 - move water stagnation in lower burner, open water passages, benefit bladder

Qi Lin Zheng Qi Painful Urination Liver Qi Stagnation

Core points above plus: tai chong LR3 - course liver, rectify qi san yin jiao SP6 - tonify liver, promote smooth flow of liver qi (even tonify, even drain)

Qi Lin Zheng Qi Painful Urination Deficiency of Spleen and/or Kidney

Core points above plus: qi hai REN6 - benefit qi (especially spleen qi), tonify kidneys and fortify yuan qi zu san li ST36 - moxa to strongly tonify zheng qi

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Bloody urine, lighter red, mild pain, mild discomfort when urinating, five heart fever, night sweats, weak aching low back and knees. T- red, scanty coat P- rapid, thready Prolonged dribbling of milky, cloudy urine. Sediment, greasy film, copious urine, moderate urethral pain or discomfort, worse with fatigue or rich food, dragging sinking sensation in lower abdomen, weight loss, fatigue, tinnitus, dizziness, weak aching low back & knees. T- pale, grease coat P- weak, thready Pain worse with taxation. Chronic inflammation, pale urine, periodic involuntary dribbling after taxation or strain, dull vague abdominal pain, lassitude, fatigue, weak aching low back and knees, may have history of qi prolapse, poor appetite, loose stools. T- pale P- weak Long bi syndrome is diminished volume of urine, if severe, there is complete blockage of urine. Forceless dribbling, soreness of lumbar, weakness of 4 limbs, pallor, listlessness. T- pale P- deep, thready Tx Principle Nourish the yin Clear heat Stop pain Even tonify, even drain. Tonify kidney Secure the essence Tonify Acupuncture Points / Techniques Core points above plus: ran gu KI2 - xing-spring point, clear heat xue hai SP10 - cool the blood, regulate blood in lower burner, facilitate urination san yin jiao SP6 - regulate bleeding, cool the blood Core points above plus: shen shu BL23 & tai xi KI3 - shu/yuan combination, tonify kidney pi shu BL20 - tonify spleen & stomach zu san li ST36 - help separation of clear & turbid, tonify spleen & stomach From core formula points - drain both yin ling quan SP9 & zhong ji REN3 Core points above plus: qi hai REN6 - benefit qi (especially spleen qi), tonify kidneys and fortify yuan qi zu san li ST36 - help separation of clear & turbid, tonify spleen & stomach

24

Syndrome Xue Lin Zheng Bleeding Painful Urination Kidney Yin Deficiency Fire Gao Lin Zheng Unctuous Painful Urination Deficiency of Kidney and Spleen Qi Lin Zheng Painful Urination Deficiency Taxation

Etiology / Pathomechanism Kidney yin deficiency causes deficiency fire which causes damage to local blood vessels (luo) and causes bleeding. Caused by overindulgence in sex, weak constitution, taxation, aging. Deficiency of spleen qi prevents the proper separation of clear & turbid, and deficiency of kidney causes an inability to reabsorb essence (jing). Caused by aging, chronic illness, weak constitution. Deficiency of kidney and spleen qi injures the zheng (upright) qi and causes the inability of the clear qi to rise. Qi sinks downward.

Fortify spleen Tonify kidney Tonify

Long Bi Urinary Blockage Kidney Yang Qi Deficiency

Aging, poor constitution, chronic illness, cause a decline of the ming men fire of the kidney. This results in a dysfunction of the bladder in controlling urine, the qi transformation of the bladder is not working and thus the free passage of urine is obstructed. Damp heat accumulates in lower burner and blocks and impedes urination (blocks the qi transformation function of the bladder).

Warm & tonify yang qi Reinforce kidney Free the urine Tonify

shen shu BL23 - moxa, reinforce kidney, tonify yuan qi san jiao shu BL22 - move water, regulate san jiao, promote urination yin gu KI10 - he-sea water point, rectify qi, boost kidney, treat frequent painful urination wei yang BL39 - lower uniting of TB, harmonize TB and regulate urine, treat painful & difficult urination san yin jiao SP6 - strengthen spleen, kidney & liver, promote urination zhong ji REN3 or guan yuan REN4 or qi hai REN6 - moxa, or can connect REN3REN4 or REN4REN6 w/spleen deficiency - pi shu BL20 & zu san li ST36, use moxa w/low back pain - moxa ming men DU4 or yao yang guan DU3 ci liao BL32 or pang guan shu BL28 - regulate lower jiao, treat blocked or urinary retention, bladder infections zhong ji REN 3 (mu point of BL) or qu gu REN2 (connects to urethra oriface) - free the urine yin ling quan SP9 & san yin jiao SP6- drain damp shui dao ST28 - move water stagnation in lower burner, open water passages, benefit bladder yin gu KI10 - he-sea water point, rectify qi, boost kidney, treat frequent painful urination ci liao BL32 or pang guan shu BL28 - regulate lower jiao, treat blocked or urinary retention zhong ji REN3 - mu of bladder, important point for urinary disorders, especially excess patterns san yin jiao SP6 - invigorate blood shui quan KI5 - xi-cleft of kidney, stop pain shui dao ST28 - move water stagnation in lower burner, open water passages, benefit bladder w/external injury - xing jian LR2 or tai chong LR3

Long Bi Urinary Blockage Damp-heat in Bladder

Obstructed discharge of scanty amounts of urine, lower abdominal distension, burning urination, thirst but no desire to drink, restlessness, vexation, sticky bitter taste. T- red, yellow slimy coat P- rapid, soggy History of trauma or surgery, dripping urine or full obstruction of urine, frequent urge but cant get urine started, pain & distension in lower abdomen. T- purple, dull, stasis spots P- rough

Clear heat Disinhibit damp Free the urine Drain

Long Bi Urinary Blockage Stagnant Blood (trauma)

Injury from childbirth trauma, surgical injury or other injury/trauma causing static blood which obstructs the channels & collaterals of the local area, causing obstruction of the urethra obstructed passage of urine.

Invigorate blood Transform stasis Free the urine Drain

In severe cases, this syndrome can progress to the accumulation of water toxins which violate and obstruct the upper burner (can lead to uremia with labored breathing, palpitations, vexation, loss of consciousness): w/total obstruction of urine - chi ze LU5 (drains water from metal) & da zhu BL11 [Medical emergency - get to hospital.] w/loss of consciousness - ren zhong DU26 & let blood at shao shang LU11 [Medical emergency - get to hospital.] Biomedical perspective: urinary tract infections, tumors (bladder, kidney, prostate), urethral scarring, urinary calculi obstruction, multiple sclerosis, alcohol syndrome, fecal impaction causing obstruction.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Difficulty falling asleep, over-thinking, frequent dreaming, sleep is light, + heart blood deficiency Sx: palpitations, forgetfulness, lackluster complexion, + SP qi def. Sx: lassitude, hard epigastruim, loose stools, poor appetite, excess menstrual bleeding, bloody stools, lower body bruising. Emotionally everything has a presumed negative future/outcome attached to it. T- pale, dry P- thready, weak Difficulty falling asleep, or fall asleep but wake easily for no apparent reason, restless sleep, 5 heart fever, mild palpitations, dry mouth/throat, thirst, night sweats, dizziness, tinnitus, forgetfulness, low back pain & weakness, seminal emission. T- red, scanty or no coat P- rapid, thready. Lack of peaceful sleep, fitful, not sound sleep, annoyance at not sleeping, hard full epigastrium, burping, hiccupping, if severe can have vomiting of saliva or phlegm, dizziness. T- yellow greasy coat P- slippery, can be wiry Most severe - no sleep all night, dizziness, headaches, frequent irascibility, anger, dry red gritty eyes, tinnitus, hypochondrial pain, bitter taste. T- red, yellow coat P- wiry, rapid Tx Principle Tonify qi Nourish blood Calm the shen Tonify, moxa Acupuncture Points / Techniques

25

Syndrome Bu Mei Insomnia Heart and Spleen Deficiency

Etiology / Pathomechanism Deficiency of both heart blood and spleen qi caused by over-thinking and stress. This disrupts the harmony of yin-yang, yang qi fails to enter or be anchored by yin, the heart shen is not anchored in heart blood.

xin shu BL15 & pi shu BL20 - tonify heart & spleen, calm shen shen men HT7 - strongly calm the shen, stop palpitations, yuan/shu combination- tonify heart blood san yin jiao SP6 - fortify spleen, increase qi, nourish blood w/frequent dreaming - po hu BL42, fortify po (corporeal soul, the structive body) w/forgetfulness - bai hui DU20 (moxa to raise clear yang), zhi shi BL52 (help kidney to consolidate memory, seal & store) Clinical pearl: yin tang extra, tai chong LR3 & bai hui DU20 - to soften liver; tonify zhao hai KI6 (bring darkness to the eyes) and drain shen mai BL62 (awaken the shen), they are the yin/yang qiao vessel pts. da ling PC7 - drain, cool & descend deficiency heart fire tai xi KI3 - moisten kidney yin; or zhao hai KI6 if there is more fire shen men HT7 - calm shen and heart tai chong LR3 - calm liver, tonify liver blood, allow retention of yang (shen) xin shu BL15 & shen shu BL23 (or jia ji at T5 & L2) - regulate heart/kidney interaction w/dizziness or vertigo - feng chi GB20, extinguish and lead out internal wind w/tinitus - ting gong SI19 (biao of heart) w/seminal emission - zhi shi BL52, consolidate kidney seal & store function zhong wan REN12 & feng long ST40 - harmonize stomach, transform phlegm li dui ST45 - strongly calm the shen especially w/frequent dreams/nightmares (jing-well) yin bai SP1 - help bring about deep sleep phase (jing-well) w/annoyance or nausea/vomiting - nei guan PC6, rectify qi, stop nausea w/dizziness - yin tang extra xing jian LR2 - descend liver fire zu qiao yin GB44 - metal controls wood, regulate yin/yang yang ling quan GB34 - drain fire from liver/gallbladder feng chi GB20 - clear head of excess, clear interior wind da ling PC7 - calm shen, clear heart fire shen men HT7 - clear excess heart fire w/tinnitus - yi feng TB17, upper shao yang meets w/GB, benefits ear w/red eyes - tai yang extra or shang yang LI1, can let blood xin shu BL15 & shen men HT7 - shu/yuan, tonify heart blood, calm shen dan shu BL19 & qiu xu GB40 - shu/yuan, tonify gallbladder qi, strong effect on resolve & rectitude (mental aspect of GB) da ling PC7 - calm shen san yin jiao SP6 - tonify qi and blood

Bu Mei Insomnia Heart and Kidney not Interacting

Taxation, age, chronic illness, sexual over-activity, menopause, injures kidney yin, resultant deficiency fire affects HT/KI ferrying function. Fire rises to heart, lack of yin fails to cool heart fire so mind is active at night. (Basically KI yin def. fire disrupting ferrying function.) Dietary habits & factors (rich/fatty/ sweet/spicy foods or excess alcohol) lead to accumulation of damp & phlegm with heat in SP/ST which rises to disturb the heart & shen causing insomnia. Fury, depression, anger, emotions cause liver fire to harass upwards and disturb upper burner, causing lack of calm in heart and shen.

Moisten yin Down-bear fire Calm the shen Drain & tonify.

Bu Mei Insomnia Stomach and Bowels not Harmonized

Transform phlegm Harmonize stomach Calm the shen Drain

Bu Mei Insomnia Liver Fire Harassing Upward

Smooth/calm liver Down-bear fire Calm the shen Drain

Bu Mei Insomnia Heart and Gallbladder Qi Deficiency

Constitutional GB qi deficiency , lack of GB rectitude & courage combined with Heart qi deficiency, create timidity of spirit and lack of resolve. Results in shyness, prone to fright and fear, and person is easily startled. Hun & shen are not properly anchored.

Frequent dreaming, tendency to wake with a startle, timidity, fearfulness, prone to fright, especially upon retiring, palpitations, SOB, fatigue. T- pale P- thready, weak

Tonify qi Suppress fright Calm the shen Drain

Alternate therapeutic methods for treating insomnia: Acupuncture has good effect on treating insomnia. It is best to treat later in the day. Ear acupuncture: sympathetic, shen men, HT, SP, LR, ST Diagnosis notes: With difficulty falling asleep, but once asleep, stay asleep - blood deficiency. Wake frequently, often feeling hot - yin deficiency. Repeated waking around 2-4 AM, worse with stress - liver qi stagnation, stagnant heat or fire. Lots of wild dreaming, talking during sleep, sleepwalking - possible involvement of the Hun. Recurrent nightmares that cause waking - heart & gallbladder deficiency. Waking with palpitations and panic attacks - heart & kidney yin deficiency. Chronic insomnia with feverishness at night but no sweating - blood stagnation.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Emotional depression, despondence, restlessness, chest fullness, hypochondrial or abdominal distension, belching, poor appetite, abdominal pain, nausea, vomiting. T- thin greasy coat P- wiry Tx Principle Soothe the liver Rectify qi Draining or even technique. Acupuncture Points / Techniques

26

Syndrome Yu Zheng Depression Liver Qi Stagnation

Etiology / Pathomechanism Emotional disturbances that are characterized by stagnation and obstruction of the flow of qi. Internalized anger, anxiety, overthinking or grief can lead to disharmony of qi in the zang fu, which can affect the livers function of maintaining the free flow of qi. Anxiety, stress or overwork can cause dysfunction of the spleens transport/transform function. These can lead to accumulation of damp or phlegm and disturbance of the heart spirit because the shen lacks nourishment. Anxiety or fear can injure the kidney, which can also cause disturbance of the heart mind. Heart mind disturbance can cause depression. This syndrome can also manifest as anxiety; with restlessness, insomnia, chest fullness, hypochondrial distension, irritability & plum pit qi.

Treat liver jing mai and ren mai. tan zhong REN17 - drain, widen chest, disinhibit diaphragm, treat emotional constraint d/t LR qi stag. gan shu BL18 - even; course liver (main point for stagnant liver qi) tai chong LR3 - drain; spread liver qi, regulate & rectify qi & blood zhong wan REN12 (drain) & zu san li ST36 (even) - mu-he of ST; for stomach complaints gong sun SP4 - even; rectify qi and treat heart vexation & insomnia Retain needles for 15-20 minutes and manipulate 2-3 times. Or electro at taichong LR3 gongsun SP4 & tanzhong REN17 (zhigou TB6, or quchi LI11, or lieque LU7, or pressure pain point on chest). Treat liver, triple burner, gallbladder & stomach jing mai. xing jian LR2 - clear heat from liver & drain fire, spread liver qi xia xi GB43 - clear heat, treat red painful eyes zhigou TB6 - treat constipation, soothe liver yang ling quan GB34 - clear heat, promote smooth flow of liver qi shang wan REN13 & zu san li ST36 - harmonize ST & regulate qi, descend rebellion of acid regurgitation Retain needles for 15-20 minutes and manipulate 2-3 times. Treat liver jing mai and ren mai. tian tu REN22 - even; open throat, descend qi, transform phlegm nei guan PC6 - even; open chest, move qi & blood in chest tai chong LR3 - even; spread liver qi, regulate & rectify qi & blood tan zhong REN17 - drain, widen chest, disinhibit diaphragm, treat emotional constraint d/t LR qi stag. feng long ST40, drain; transform phlegm Retain needles for 15-20 minutes and manipulate 2-3 times. Treat liver & heart jing mai. tai chong LR3 - tonify; nourish liver blood xin shu BL15 & ju que REN14 - beishu/mu of heart; calm the shen, treat palpitations and chest pain shen men HT7 - calm the shen, regulate and nourish heart san yin jiao SP6 - calm the shen, treat insomnia, irritability, anxiety, tonify & soothe liver nei guan PC6 - pacify the heart, calm the shen, open the chest w/hoarseness or loss of voice - tong li HT5, lian quan REN23 w/hiccups - tian tu REN22, zhong wan REN12 w/syncope - he gu LI4, yang ling quan GB34, ren zhong DU26, yong quan KI1

Yu Zheng Depression Qi Stagnation Transforming to Fire

Extreme irritability, vexation, fullness of chest & hypochondrium, dryness or bitter taste in the mouth, headache, congested red eyes, tinnitus, severe insomnia, acid regurgitation, constipation. T- red P- rapid, wiry Depression, chest fullness, plum pit qi, bound/tight headache, mucus, congestion. T- greasy P- wiry, slippery

Eliminate liver fire Soothe the liver Rectify qi Calm the mind Drain

Yu Zheng Depression Liver Qi Stagnation with Phlegm

Soothe the liver Rectify qi Transform phlegm Draining or even technique.

Yu Zheng Depression Blood Deficiency (of Liver and Heart)

Frequent sorrow without known cause, abnormal joy or rage, unreasonable suspicion or fear, palpitations (from heart blood deficiency), irritability, insomnia. This is a common menopausal syndrome. Symptoms that can come & go: chest fullness, loss of voice. When severe there can be convulsions or syncope. T- pale & thin, thin white coat P- thready

Nourish blood Nourish heart Calm the shen Soothe the liver Tonifying or even technique.

Alternate therapeutic methods for depression: Ear acupuncture: shen men, subcortex, occiput, brain, endocrine, sympathetic, LR, HT, stomach, throat. Needle to elicit strong sensation, retain 20-30 minutes, every other day. 5 - 10 session = one course. Can follow with ear seeds. Balancing Du Mai & Ren Mai combinations from Maciocia: Anxiety with chest oppression: hou ding DU19 & jiu wei REN15 (has powerful calming effect) Mental depression with anxiety: bai hui DU20 & jiu wei REN15 (calm mind & lift mood) Depression with spleen/stomach deficiency: bai hui DU20 & zhong wan REN12 Depression due to collapse of qi: bai hui DU20 & qi hai REN6 (has powerful mood-lifting effect) Depression and anxiety with kidney yin deficiency: bai hui DU20 & guan yuan REN4 Severe anxiety with kidney yin deficiency: shen ting DU24 & guan yuan REN4 For anxiety & worrying: shen ting DU24 & jiu wei REN15 (calm mind, lift mood, boost memory & concentration) For insomnia with anxiety & worrying: yin tang & guan yuan REN4 For treating minor psychological disturbances - treat controlling element point on channel related to emotional problem. Anger - zhong feng LR4 (liver, wood controlled by metal) Excess joy - shao hai HT3 (heart, fire controlled by water) Anxiety/worry - yin bai SP1 (spleen, earth controlled by wood) sadness/complaining - yu ji LU10 (lung, metal controlled by fire) fear/tears - tai xi KI3 (water controlled by earth)

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms This is not mental illness, but there are mental signs of depression and physical signs of depression in body function. There are a vast array of clinical symptoms, but depression must be the main condition present. This condition also includes plum pit qi and hysterical disorder (zang zao). Symptoms can manifest in terms of the heart spirit (shen), motor function and/or sensory impairment. Main zang fu associated with depression patterns are the heart (shen), spleen (stores yi, controls thought), liver (stores the hun, controls dredging/ discharging) & kidney (the sea of marrow, often accompanies menopause). Excited Type: This is qi stagnation due to emotional factors which transform to fire & hyperactivity. Restlessness, overly active emotions, hallucinations, excessive talking, motor hyperactivity, rash & reckless behavior, agitation, irritability, hypochondrial distension, bitter taste, bloodshot eyes, headache, tinnitus. Inhibited Type: This is blockage by static qi or phlegm. Patient is silent & withdrawn, symptoms seem more voluntary (by choice) than in excited type, may just want to sleep, cloister themselves off, dont want to see or talk to anyone. Tx Principle Acupuncture Points / Techniques Characteristics of diagnosis: Psycho-emotional stimulus. Often sudden onset of symptoms. History of symptoms (has happened before). Symptoms are very changeable. All symptoms are richly endowed with all types of insights and feeling. Person is suggestible and easily influenced (this can be beneficial therapeutically). No pathological reflexes or signs (no motor or sensory dysfunction). Signs & symptoms dont correspond in a predictable pattern. There is no time correspondence, there is no cyclical patterning. There are no nerve, organ or neurological symptoms that correspond. Patient does not negate having a history of the problem, they are not deceitful. Symptoms are variable from person to person and within one person. At the root, heart orifaces become clouded & blocked which causes a disturbance of the heart and shen by phlegm & qi stagnation. At the branch, there are symptoms of reckless behavior, haziness, a sense of feeling stuck. Work systematically to move everything, use fast and thorough release of qi. With liver profusion or qi stagnation: Course the liver Rectify qi With transformation to fire: Clear the liver Drain fire With obstruction by static qi or phlegm: Rectify qi Transform phlegm With yin deficiency: Nourish the yin Calm the shen The needling technique must be heavy and strong, up to tolerance, qi must arrive at site of illness. Couple with suggestion. Crying will allow the depression an exit, helping to resolve the condition. First treatment effect will help to bring patient back for full course of treatment.

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Syndrome Yu Zheng Depression General Information

Etiology / Pathomechanism This condition stems from an emotional disturbance characterized by stagnation and obstruction of the flow of qi. The main cause is psycho-emotional (worry, anxiety, anger, frustration, planning, plotting, scheming, deliberation, fixation, sadness, grief). These result in the qi mechanism not flowing (qi ji bu chang). There is a disruption in the dredging/discharging function of the liver, an inability to achieve and obtain. This especially affects the LR, SP, & HT. Dysfunction & poor regulation in the conscious mind, intellect & emotions. May realize they are not acting like themselves but emotionally they are not controlled. Often a humdrum state of mind, unresponsive, reaction to outside stimulus is slow. Hallucinations, faulty sensations and body feelings, emotions may be mixed up and they dont trust what they feel, may see things that arent there (mild paranoia). There may be excessive emotional response (a travelling shen), excessive outburst without a known cause. Definite effects on physical movement. These symptoms are often seen after an emotional stimulus, either excited or depressed motor functions.

Yu Zheng Depression Shen Heart Spirit

Yu Zheng Depression Motor Function

Excited Type: Facial or tongue spasms, restless, chaotic movement of the limbs, or stiff limbs, external stimulus will bring on symptoms, there are no pathological reflexes of the nervous system. Inhibited Type: Paralysis/laxness/flaccidity of body, can be whole side of body, no abnormal reflexes, no pupil dilation, no suicide or mutilation attempts, suggestion by others can relieve symptoms.

Yu Zheng Depression Sensory Impairment

Excited Type: Pain or hypersensitivity, sensory impairment is changeable and does not follow nerve distribution patterns, moveable pain, abdominal or stomach pain, IBS, palpitations. Inhibited Type: Numbness or loss of sensation.

Core point formula: ren zhong DU26 - open the orifaces, move qi (twist needle in one direction until stuck, then lift & thrust until tearing appears in patients eyes), facial nerve nei guan PC6 - move qi, clear the heart (elicit strong de qi), medial nerve da ling PC7 - use where heart fire is strong, medial nerve yong quan KI1 - causes strong descent of qi and fire, medial plantar nerve branches With excited type add: da zhui DU14 - clear heat, open Du Mai to treat problems with heart spirit, 8th cervical nerve xue hai SP10 - activate movement, especially for tendency to blood stasis, femoral nerve branch feng shi GB31 - for external wind or for wind in general, femoral nerve With inhibited type add: da dun LR1 - wood point on wood meridian, dredges, strongly effects the shen (heart spirit) wei zhong BL40 - over the tibial nerve, can actually touch nerve, can lift patients leg to elicit twitch san yin jiao SP6 - over tibial nerve With limb sensations add: ji quan HT1 - arm should twitch, brachial nerves chi ze LU5 - elicit strong twitch, tibial nerve wei zhong BL40 - over the tibial nerve, can actually touch nerve, can lift patients leg to elicit twitch With loss of voice add: lian quan REN24, tong li HT5 & tian tu REN23 - patient should cry out (tongue & voice are sprout of HT) he gu LI4 - to move qi tai xi KI3 & yong quan KI1 - elicit a sound from the patient With plum pit qi add: tai chong LR3 - course liver, rectify qi tan zhong REN17 - strongly moves qi of chest feng long ST40 - luo connection to throat, transform phlegm yu ji LU10 - naturalize the throat nei guan PC6 - to rectify qi, for excitability shen men HT7 - affects the heart and the shen w/insomnia add: li dui ST45 - to harmonize stomach & treat nightmares w/sore throat add: shang yang LI1 (distal) and tian ding LI17 (local) w/chest oppression add: tan zhong REN17 - to move qi w/ yin deficiency add: xinshu BL15, geshu BL17, pishu BL20, shenshu BL23, neiguan PC6 & sanyinjiao SP6

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Qi stagnation & binding of phlegm. Gradual onset, low spirit, emotional depression, dull senses, turned inward, withdrawn, silent, indifferent, dull eyes (no shen brightness in eyes), may ask useless question which have no basis. When severe, thinking strays from normal lines of thought, irrational, non-sequential, illogical speech, may feel unengaged in their body (like they have left their body), emotional abnormalities, excessive crying/ sadness, visual or auditory hallucinations, muttering, dont practice cleanliness because cant distinguish between clean & dirty. T- greasy coat P- slippery, wiry When depression is prolonged, it can lead to consumption of Spleen qi & Heart blood. Symptoms can then include palpitation, insomnia, mental confusion, a blank flat expression, poor appetite, lusterless complexion, difficulty comprehending even simple things. T- pale P- thready, wiry Excess of phlegm-fire. Abrupt onset, red grimy/oily complexion, large pores or blackheads, will cause disturbance, often noisy, unsettled. When severe can be physically violent and destructive to people & objects, strong irascibility, agitated, angry, rude, argumentative, will argue for no reason, headaches, can be arrogant and make grandiose claims that have no basis in truth (but they believe are true), desire to be bare bodied, unrestrained. T- yellow greasy coat P- slippery, rapid This phase usually burns out quickly, but if prolonged the fire will injure the yin. They will then be easily startled or frightened, restless, have insomnia, emaciation. T- red, scanty coat P- thready, rapid Tx Principle Regulate qi Transform phlegm Clear the heart Calm the shen Drain Acupuncture Points / Techniques

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Syndrome Dian Kuang Depression & Mania (Bipolar) Depression Phase

Etiology / Pathomechanism Yin manifestation of this illness. Comes on slowly due to psychoemotional disharmony (worrying, obsessing, plotting & scheming, lack of attainment), consumes heart blood which fails to nourish the spirit. This clouding of the shen eventually leads to faulty, chaotic thinking. Can also be due to phlegm blocking the clear orifaces of the heart, and therefore the shen. This is caused by dietary factors injuring spleen qi, which causes an internal accumulation of phlegm which blocks or clouds the spirit.

Above Tx plus: Fortify spleen Nourish blood Even tonify even drain.

shen men HT7 - calm shen, tonify heart blood (treats wooden idiot - not responsive to the world) da ling PC7 - ghost point, calm shen, treat fright & fear yin tang extra - awaken the brain, illuminate the shen tan zhong REN17 - mu of PC, rectify qi of chest, move stagnation in heart, awaken the brain feng long ST40 - transform phlegm (both physical & formless), harmonize stomach san yin jiao SP6 - strengthen spleen, prevent damp accumulation zhong wan REN12 & zu san li ST36 - mu-he of stomach, transform phlegm, harmonize stomach tai chong LR3 - course liver, rectify qi w/deficiency of qi & blood & some heat - tonify shen men HT7, zu san li ST36 & san yin jiao SP 6 w/deficiency of qi & blood & no heat symptoms - add moxa to xin shu BL15, gan shu BL18 & pi shu BL20 w/visual hallucinations - jing ming BL1 (intersection of BL, yin qiao & yang qiao) w/auditory hallucinations - ting gong SI19, treats ears, biao of heart w/crying & sadness - tai yuan LU9, will bolster lung qi

Dian Kuang Depression & Mania (Bipolar) Mania Phase

Yang manifestation of this illness. Comes on rapidly. Accumulation of phlegm due to dietary factors overburdening the spleen, then emotional disharmony and outbursts, especially sudden anger, frustration or excitement, violence causes fire. Yang carries this phlegm-fire upwards to disturb the shen ming (the clarity/brilliance of the mindspirit), affecting its ability to understand, resulting in chaotic thoughts, speech and actions.

Level/calm liver Clear fire Transform phlegm Clear the heart Calm the shen Drain

zhong wan REN12 or shang wan REN13 - harmonize stomach, down-bear turbidity ren zhong DU26 - clear mind & head, descend turbid from head, clear fire, awaken the brain (by cutting through phlegm), regulate yang ming and harmonize stomach feng long ST40 - transform phlegm and illuminate the mind lao gong PC8 - ghost cave/ghost road, xing point, drain heart fire and calm the shen da zhong KI4 - luo point, has direct connection to brain (via bladder meridian), treats heart and regulates psychological functions, helps moisten kidney yin and descend fire w/excess fire having injured yin - tonify these points: shen men HT7, san yin jiao SP6, da ling PC7, xin shu BL15 & shen shu BL23 w/excess heat - add da zhui DU14, or let blood at hand jing-well points w/raging anger - tai chong LR3 & zhi gou TB6, rectify qi

Alternate therapeutic methods for treating mania/depression: Ear acupuncture: HT, KI, subcortex, occipital, forehead, shen men Electro acupuncture: For depression (dian) - connect bai hui DU20 and ren zhong DU26, intermittent wave, strong stimulation, 15 minutes. For mania (kuang) - connect tong li HT5 and feng long ST40, continuous pulse, strong stimulation, 30 minutes. Frequent treatment are most effective, every day or every other day. When patient is in mania phase forcefulness may be required in dealing with them. Treat root illness also.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Manifests in earlier stages of the disease. Sudden falling down, loss of consciousness, fainting, clenching spasms of jaw, epistitonis (arching of spine), strong limb spasms, rapid forceful convulsions, loss of postural control, frothing at mouth, spitting of phlegm, biting of tongue, bleating/screaming sound, constricted breathing due to contracted respiratory muscles, urinary or fecal incontinence. There is sudden onset of spasms, which fade quickly, followed by aching limbs and fatigue, but no other residual effects. T- red (if there is fire), yellow thick greasy coat P- rapid (with heat), slippery & wiry (with phlegm) Tx Principle Extinguish wind Transform phlegm Down-bear fire Awaken heart & shen Drain Acupuncture Points / Techniques

29

Syndrome Xian Zheng Seizure Patterns Excess: Obstruction by Wind and Phlegm, and Profusion of Phlegm and Fire

Etiology / Pathomechanism Psycho-emotional factors, especially fear, fright, frustration and anger cause profusion of qi and subsequent transformation into fire, the fire evaporates fluids, causing phlegm, which is carried upwards by fire & wind. Phlegm obstructs the channels and obscures the clear orifaces of the heart spirit (the shen). There is chaos of yin-yang and subsequent seizures.

zhou wei REN15 - down-bear qi, resolve stasis feng long ST40 - transform phlegm, harmonize stomach tai chong LR3 - level liver, extinguish wind yao qi extra - treats epilepsy (on Du Mai, 2 cun superior to tip of coccyx) CLINICAL PEARL: shen zhu DU12 - resolve epistitonis (below T3) zhou wei REN15 - down-bear qi, resolve stasis (DU12 & REN15 used together will regulate yin/yang) ben shen GB13 - eliminate wind from head, resolve phlegm, awaken brain & shen (shen foundation) feng long ST40 - transform phlegm, harmonize stomach tai chong LR3 - level liver, extinguish wind jin suo DU8 - (at T9), release contractile aspect (jin), open and clear Du Mai, forcefully quiet During seizure - ren zhong DU26 (awaken brain, regulate yin/yang), jia che ST6 (relax jaw), hou xi SI3 (meeting point of Du Mai, awaken the shen, relax contractile tissue, clear heat & wind) w/nighttime seizures - zhao hai KI6 - opens to yin qiao mai, brings darkness to eyes w/daytime seizures - shen mai BL62- opens to yang qiao mai, awaken the shen xin shu BL15 - nourish heart, calm the shen yin tang extra - calm the mind, treat convulsions shen men HT7 - calm the shen, tonify heart blood san yin jiao SP6 - tonify spleen & kidney, prevent the upward movement by tonifying yin tai xi KI3 - tonify kidney yin, prevent the upward movement by tonifying yin yao qi extra - treats epilepsy w/extended seizures - yong quan KI1 (reconnect yin/yang) & moxa at qi hai REN6 (tonify) w/deficiency treat between seizures - ST mu-he, zhong wan REN12 & zu san li ST36, & bai hui DU20 w/liver & kidney yin deficiency - shen shu BL23 & tai xi KI3 (shu-yuan) and gan shu BL18 w/secondary type (developed in adulthood) - feng chi GB20, bai hui DU20, yao qi extra CLINICAL PEARL: tong li HT5 - nourish heart, calm mind & shen, benefit intellect feng long ST40 - transform phlegm, harmonize stomach shen shu BL23 - tonify kidney, nourish kidney yin, extinguish internal wind (deficiency wind) san yin jiao SP6 - level the liver yu zhen BL9 - tonify kidney, treat dizziness jian li REN11 - fortify spleen, tonify yin, yang ling quan GB34 - release spasms, stop convulsions jin suo DU8 - (at T9), release contractile aspect (jin), open and clear Du Mai, forcefully quiet

Xian Zheng Seizure Patterns Deficiency: Kidney, Heart and Spleen Deficiency

Injury or weakness of the spleen due to dietary factors causes retention of damp and phlegm, this transforms to fire and rises, obstructing the channels and clouding the clear orifaces of the heart spirit. Liver & kidney yin is deficient (often due to fear) which causes hyperactivity of liver yang and ultimate transformation to fire and internal wind. There is chaos of yin-yang and subsequent seizures.

Seizures are less severe than excess syndrome seizures, but are more frequent, have less forceful spasms. Cold sweat, difficulty breathing, snoring sounds. Following seizures will have listlessness, dizziness, palpitations, fatigue, flat expression, decreased appetite, weak aching low back & knees, lusterless complexion, decreased mental capacity. T- pale purple, no coat if severe P- thready, may be wiry

Tonify and boost heart and spleen Tonify kidney Calm the shen Tonify, moxa

Alternate therapeutic methods for treating seizure patterns: Ear acupuncture: shen men, HT, occiput, brain. Requires treatment every other day for several months to get effective results. Flat needling and connecting needling: best for non-inherited epilepsy. Needle with barly hair needle or thread down with 2 cun needles, along Du Mai, from top to bottom with one of the following: shen dao DU11 (below T5) to yao yang guan DU3 (below L4) yao yang guan DU3 (below L4) to yao qi extra (2 cun above tip of coccyx) xin hui DU 22 to bai hui DU20 Connecting needle from jian shi PC5 to zhi gou TB6, can apply electro acupuncture. Connecting needle from shen mai BL62 to zhao hai KI6, can apply electro acupuncture. Water needling: 1/mL of B1 (100 mg dose) or B12 (0.5 mg dose). Use following points, one or two per treatment, alternating points, every day for 5-6 days, take day off, then repeat as required. Points: zu san li ST36, nei guan PC6, da zhui DU14, feng chi GB20

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms This is blockage/impediment, and therefore pain and discomfort, in the chest. Absence of clear passage is the main patho-mechanism. For excess type: bu tong ze tong where there is no free flow, there is pain. For deficiency type: bu rong ze tong where there is no nourishment, there is pain. Tx Principle Acupuncture Points / Techniques

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Syndrome Xiong Bi Chest Blockage General Information

Etiology / Pathomechanism In all cases there is deficiency at the root and excess at the branch. In all cases there is decreased yang of the chest (due to blockage from phlegm, cold, damp, static blood) which causes further blockage of the chest yang, which impairs the creation of new chest yang.

Biomedical perspective: Cardiac origin - angina, myocardial infarction, ischemic heart disease, pain located retro-sternal or upper abdominal, upper thoracic, may radiate to jaw/throat/teeth/arms, worse or initiated by exertion, relieved by rest, pain is squeezing, crushing, aching, heavy or vague discomfort, can feel like indigestion, other Sx: SOB, palpitations, cyanosis, pallor, sweating, syncope, impending sense of doom. Stomach origin - hiatal hernia which causes retro-sternal pain which may be burning and worse with laying flat and eating, peptic ulcer causing gnawing retro-sternal pain worse 30 minutes to 3 hours after eating and better with antacids, esophageal pain or spasm due to eating or certain positions or stress and relieved by antacids. Gallbladder origin - colicky, deep, aching pain which can radiate from right hypochondrium to scapula or right shoulder, pain is worse with fatty foods. Pulmonary origin - pleurisy (varies with breathing, associated with fever and cough, worse with breathing and coughing), bronchitis or pneumonia (with fever, cough, colored sputum, worse with cough). Musculo-skeletal origin - intercostal muscle spasms. Open and allow clear passage of yang Transform phlegm Drain feng long ST40 - transform phlegm tai yuan LU9 - shu-stream, treats dampness, transform phlegm, stop cough, stop pain, restore the pulse tan zhong REN17 - regulate and invigorate qi of chest xi men PC4 & ju que REN15 - activate heart yang, transform phlegm or stasis w/pain radiating to upper back - cup at xin shu BL15 & jue yin shu BL14 w/shortness of breath - moxa qi hai REN6 or guan yuan REN4 and also shen shu BL23, benefit yang

Xiong Bi Chest Blockage Turbid Phlegm

The nourishment of heat and lung qi and blood become deficient due to advancing age, coupled with too much sweet, fatty, raw, cold food, and/or anxiety, fixation, over-thinking. These cause spleen deficiency and a subsequent production of damp and phlegm. This turbidity collects internally and interferes with the yang of the chest, blocking the qi ji and chest yang and causing pain. Invasion of cold pathogen causes congealing/contracting with turbid phlegm, phlegm blocks meridians and vessels and leads to severe chest pain.

This is a mild type and is common in seniors. Thoracic oppression and pain as though suffocating, pain can penetrate to back, difficulty breathing, SOB, rapid breathing, coughing, copious white, sticky phlegm. T- white greasy coat P- slow, soggy, slippery, (wiry with pain)

Xiong Bi Chest Blockage Deficiency Cold (includes excess cold)

Chest pain which penetrates thru to back, plus yang deficiency Sx: SOB, chest oppression, palpitations, plus cold Sx: aversion to cold, cold limbs, worse with exposure to cold. T- white, slimy coat (purple with severe yang deficiency) P- deep, slow Heart of chest pain that is stabbing, piercing, sharp, twisting, there is sharp penetration of pain thru chest to back, SOB, thoracic oppression, palpitations, purple lips, cyanosis. T- dull dark purple P- thready, rough

Assist the yang Scatter cold Stop pain Tonify, moxa

xin shu BL15 & jue yin shu BL14 - moxa, assist heart yang, disperse cold nei guan PC6 & tong li HT5 - luo points, invigorate blood, open and allow clear passage, stop pain w/severe yang deficiency - moxa shen shu BL23 & guan yuan REN4, fortify yang, tonify kidney w/aversion to cold - moxa feng men BL12 & fei shu BL13

Xiong Bi Chest Blockage Static Blood

Over time, if turbid phlegm and cold remain in the chest, the meridians and vessels become severely blocked, leading to qi stagnation and blood stasis, and a decline of the chest yang (because the yin pathogen damages the heart yang). Most severe type of xiong bi.

Invigorate blood Transform stasis Stop pain Drain

tan zhong REN17 - regulate and invigorate qi of chest ju que REN15 - mu of HT, activate heart yang, transform phlegm/stasis, treat heart pain & palpitations yin xi HT6 - xi-cleft point of heart, stop pain ge shu BL17 - meeting point of blood, invigorate blood, dispel stasis, treat heart pain that radiates to upper back xin shu BL15- activate heart yang w/cyanosis - let blood at shao chong HT9 & shao shang LU11

Alternate therapeutic methods for treating chest blockage: To lower cholesterol and increase vessel elasticity, alternate between the following two point groupings. Daily treatments for 10 days then one week break = one course. After 2-3 courses measure cholesterol to verify that you are getting results. Continue as needed. 1) nei guan PC6 (even), zu san li ST36 (tonify or even), san yin jiao SP6 (even). 2) yang ling quan GB34 (drain), feng long ST40 (drain), tai bai SP3 (even). Ear acupuncture: HT, SI, sympathetic, brain, LU, LI, hypertension line at back of auricle. 2-3 points per session, retain for 60 minutes. Treat every other day. Chest pain, heartburn: fu tu ST32 on ashi side.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Tx Principle Acupuncture Points / Techniques

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Syndrome Xin Ji Palpitations

Etiology / Pathomechanism

Irregular or accelerated heart rate that patient is aware of, with accompanying nervousness, anxiety, fear or terror. Mild: fright palpitations (jing ji) - brought on by sudden fright or by exertion. Racing heart (zheng chong) - irregular or accelerated heart rate that occurs without fright or exertion. Western: neurosis, tachycardia, arrhythmia. Usually apply heart monitor for 24 hours. Deficiency of gallbladder qi and heart qi. Can be constitutional. Palpitations, timidity, easily frightened, live in state of fear, insomnia, lots of dreams. T- thin, white coat P- weak in heart position Palpitations, lack of mental clarity, poor memory, lusterless complexion, dizziness, fatigue, insomnia. T- pale, thin P- weak, thready Palpitations, irascibility, irritability, insomnia, malar flush, dull low back pain, tinnitus, dizziness. Common in menopausal women. T- red, scant coat P- rapid, thready Cold exposure, cold raw food cause yang deficiency leading to heart yang deficiency and causing decreased circulation in heart. Palpitations, chest oppression or pain, SOB, pale white complexion, cold extremities, feel physically cold. T- pale, swollen P- deep thready Palpitations, dizziness, expectoration of phlegm and mucus, chest and epigastric fullness & distension, cold extremities, scant urine, edema in lower limbs. T- white greasy coat P- deep, wiry Qi stagnation & blood stasis in heart. Palpitations, chest oppression, chest pain, purplish lips & nails. T- purple, may have stasis macules P- rough, choppy or intermittent Tonify heart qi and gallbladder qi Calm shen Tonify. Boost qi Tonify blood Nourish heart Calm shen Tonify, moxa. Tonify yin Quell fire Nourish heart Calm shen Even tonify & drain. Warm & tonify heart yang Calm shen Tonify, moxa. Warm yang Transform phlegm Calm shen Even tonify & drain.

Core point formula: xin shu BL15 - calm the shen, nourish the heart, treat vexation, palpitations, insomnia, anxiety ju que REN14 - downbear qi ni, transform phlegm, treat heart vexation, fright palpitations & pain shen men HT7 - regulate and tonify heart, calm the shen, treat fright palpitations, pounding of heart nei guan PC6 - pacify the heart, calm the shen, even heart rhythm, treat heart pain, open the chest Core points above plus: tong li HT5 - calm the shen, regulate heart rhythm, treat chest fullness & distension qiu xu GB40 - regulate and strengthen gallbladder and strengthen resolve, treat hypochondriac pain bai hui DU20, hou ding DU19, shen ting DU24, tong tian BL7, shao chong HT9 Core points above plus: ge shu BL17 - tonify qi & blood, invigorate blood, open the chest pi shu BL20 - fortify spleen, regulate and harmonize qi & blood zu san li ST36 - nourish blood, boost qi, harmonize spleen & stomach w/poor appetite and digestion - wei shu BL21 Core points above plus: jue yin shu BL14 - regulate the heart, treat tachycardia, chest pain, chest oppression, angina shen shu BL23 - tonify kidney yin, strengthen lower back, treat tinnitus tai xi KI3 - boost kidney yin, strengthen lower back, clear deficiency heat, strengthen lumbar spine w/tinnitus - zhong zhu TB3 (open orifaces, benefit hearing) Core points above plus: guan yuan REN4 - moxa; tonify kidneys and fortify yuan qi shen shu BL23 - moxa; warm & tonify kidney yang Core points above plus: shui fen REN9 - separate & facilitate water metabolism, treat edema, regulate qi yin ling quan SP9 - transform damp, treat edema guan yuan REN4 - tonify kidneys and fortify yuan qi w/chest and epigastric fullness & distension - zhong wan REN12 w/loose stools - tian shu ST25 & pi shu BL20 Core points above plus: tan zhong REN17 - transform phlegm, open chest, treat heart pain, vexation, palpitations xue hai SP10 - invigorate blood, harmonize ying and blood levels qi hai REN6 - regulate & move qi, harmonize blood san yin jiao SP6 - invigorate blood, transform stasis, harmonize ying and blood levels, calm the shen

Xin Ji Palpitations Heart and Gallbladder Qi Deficiency Xin Ji Palpitations Heart Blood Deficiency

Too much worry or overthinking, or excessive blood loss.

Xin Ji Palpitations Yin Deficiency Fire

Xin Ji Palpitations Heart Yang Deficiency Xin Ji Palpitations Invasion of Heart by Phlegm-fluid

Xin Ji Palpitations Heart Blood Stasis

Invigorate blood Transform stasis Rectify qi Open the luo Calm shen Even tonify & drain.

Alternate therapeutic methods for palpitations: Ear acupuncture: HT, SI, shenmen, sympathetic, subcortex. Mild stimulation, manipulate 2-3 times during retention. Treat daily for 10 days for one course.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Tx Principle Acupuncture Points / Techniques Location of pain: Tai yang: occiput, neck, back - high BP, epilepsy, sphenoid sinusitis. Yang ming: forehead, eyebrows, face, teeth - myopia, glaucoma, sinusitis. Shao yang: lateral (often one-sided) - middle ear infection, migraine Jue yin: vertex, behind eyes - high BP. Liver yang rising, liver blood deficiency. Whole head - incomplete closure of aortic valve, nervous breakdown, carbon monoxide poisoning, cerebral TB. Can be caused by wind-heat or kidney deficiency.

32

Syndrome Tou Tong Headache General Information

Etiology / Pathomechanism Generally speaking, headaches are caused by stagnation of qi & blood. Recent onset & short duration indicate external invasion of wind. Gradual onset with long duration indicates headache from internal causes.

Points for specific location: tai yang - feng chi GB20, feng fu DU16, hou xi SI3, da zhu BL11, kun lun BL60, for one sided tai yang headache: feng shi GB31 on ashi side & hou xi SI3 on side of headache yang ming - shang xing DU23, yin tang, tou wei ST8, yang bai GB14, nei ting ST44, he gu LI4, cuan zhu BL2, yin ling quan on ashi side shao yang - shuai gu GB8, tai yang, zu lin qi GB41, lie que LU7, xia xi GB43, wan gu GB12, wai guan TB5, nei guan PC6 & yang chi TB4 (especially in women), yang chi TB4 & qiu xu GB40 (harmonize shao yang) jue yin - bai hui DU20, tong tian BL7, xing jian LR2, tai chong LR3, hou xi SI3, zhi yin BL67 Tai yin headache causes heavy feeling head, shao yin headache radiates to brain & teeth. feng chi GB20, feng fu DU16, tian zhu BL10, feng men BL12 - local, dispel wind he gu LI4 & lie que LU7 - relieve exterior, stop pain, command points for head & neck hou xi SI3 & shen mai BL62 - treat occipital headache and back of neck w/occipital headache - tong gu BL66 & zhi yin BL67 w/neck & shoulder pain - kun lun BL60 & jin suo DU8 feng chi GB20, da zhui DU14, wai guan TB5, tian you TB6 - dispel wind-heat yang bai GB14 - local to sinuses he gu LI4 - relieve exterior, stop pain qu chi LI11 - clear heat feng chi GB20 & feng fu DU16 - dispel wind he gu LI4 - relieve exterior, stop pain hou xi SI3 - targets back of head zhong wan REN12, feng long ST40, san yin jiao SP6 - drain damp point connection from si zhu kong TB23 to shuai gu GB8 tou wei ST8 - resolve dampness affecting head lie que LU7 & pian li LI6 - release exterior and stimulate lung dispersal & descend function han yan GB4, xuan lu GB5 - local, stop pain (can connect points with thru needling) tai chong LR3 - course liver, subdue yang tai xi KI3 - tonify kidney yin to anchor liver yang qu quan LR8 - tonify liver blood and liver yin san yin jiao SP6 - tonify to calm mind and nourish liver Optional point prescription: bai hui DU20, feng chi GB20, tai chong LR3 or xing jian LR2, yang ling quan GB34, zu lin qi GB41 (treat branch during headache; root during remission) w/ red eyes - let blood at guan chong TB1 w/flushed & hot complexion - nei ting ST44 Ancient formula from Great Compendium - bai hui DU20, qian ding DU21, shang xing DU23 ,shen ting DU24, si zhu kong TB23, feng chi GB20, he gu LI4, cuan zhu BL2, tou wei ST8 feng chi GB20, xing jian LR2, yang fu GB38 - clear liver fire, expel wind, subdue fire wai guan TB5 - subdue liver yang, treat shao yang channel san yin jiao SP6 - tonify to nourish yin to prevent injury to yin from liver fire w/one sided headache around eye - xia xi GB43 w/ headache on side of head - qiao yin GB44 w/ lots of heat - qu chi LI11

Tou Tong Headache Wind-cold

External: acute onset, severe, continuous pain. Headaches from external attack are of the excess type; short in duration, caused by wind evil (cold, dampness or heat), with wind as most prevalent factor.

Tai yang pattern headache, occiput and extending through neck & upper back. Worse with cold. Often accompanied by common cold symptoms. T- thin white coat P- floating, tight Splitting or distending headache with accompanying wind-heat invasion Sx: aversion to wind, flushed complexion, thirst, red eyes, stuffy sinus. T- yellow coat P- floating, rapid Tightly bound headache, squeezing feeling, heavy limbs, thoracic oppression, poor appetite, scanty urine, loose or muddy stools. T- white slippery coat P- floating, soggy or slippery

Dispel wind Scatter cold Stop pain Drain Dispel wind Clear heat Stop pain Drain Dispel wind Dispel damp Stop pain Drain

Tou Tong Headache Wind-heat Tou Tong Headache Wind-damp

Tou Tong Headache Liver Yang Rising

Internal: Gradual onset, usually pain is less severe, intermittent pain. Emotions cause liver yang to rise, which disturbs flow of qi & blood to head. Liver yang rising is usually branch, root is usually liver yin deficiency, kidney yin deficiency or blood deficiency.

Distending headache, dizziness, vertigo, headache is often unilateral (frequently on left side), spasmodic pain, flushed complexion, irritability, red eyes, bitter taste. T- thin yellow coat P- wiry, forceful

Course liver Subdue yang Stop pain Even tonify, even drain.

Tou Tong Headache Liver Fire

Liver yang rising symptoms above plus: Thirst, bitter taste, scanty dark urine, constipation, dry stools, red eyes. Headache more intense, fixed in one place, accompanied by nausea and vomiting. T- red, yellow coat

Pacify liver Clear fire Stop pain Drain

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Dull headache, feels like head is wrapped in cloth or full of cotton wool, heaviness of head, difficulty thinking, worse in morning, affects whole head or forehead only, can affect temples if in GB channel. Persistent catarrh, sinusitis, nausea, poor appetite, fullness in chest or epigastrium. T- thick sticky coat P- slippery, can be weak & floating if chronic Tx Principle Transform dampness Stimulate ascent of clear yang Tonify SP/ST Stop pain Drain, except tonify SP/ST Acupuncture Points / Techniques tai bai SP3, san yin jiao SP6 & yin ling quan SP9 - transform and drain dampness he gu LI4 - command point of face lie que LU7 - ascend clear yang, treat headache zhong wan REN12, pi shu BL20 & wei shu BL21 - tonify spleen & stomach to eliminate dampness tou wei ST8 - local, eliminate dampness from head bai hui DU20 - raise clear yang shen ting DU24 - drain damp from forehead yin tang - treat headache on forehead feng chi GB20, bai hui DU20, yin tang - local points zhong wan REN12 - drain damp, transform phlegm, tonify spleen feng long ST40 - transform phlegm zu san li ST36 - drain damp w/spleen deficiency & loose stools - tian shu ST25, shen que REN8 (moxa) w/mucus, nausea, vomiting - nei guan PC6 Select a shi points on head (check Du mai and gallbladder meridian). he gu LI4 & san yin jiao SP6 - move qi & blood (contra-indicated in pregnancy) tai chong LR3 - benefit dredging/discharging to resolve stasis and invigorate qi & blood tai yang extra - let blood at engorged vein and cup feng chi GB20 - open orifaces

33

Syndrome Tou Tong Headache Dampness

Etiology / Pathomechanism

Tou Tong Headache Turbid Phlegm

Excess consumption of sweet, rich, fatty foods cause accumulation of dampness which leads to phlegm blocking the jing luo & flow of qi and blood to head.

Squeezing headache, heaviness of head, dizziness, fogginess, blocked consciousness, chest & epigastrium congestion, mucus in GI tract, nausea, vomiting, loose stools. T- white greasy coat P- slippery Persistent, stabbing headache in a fixed location. Long history of headaches, may be history of head trauma, flowery/blurred/unclear vision. T- dark & purplish P- choppy Dull headache, dizziness, vertigo, lack of mental clarity, lusterless complexion, blurred vision, palpitations, difficulty falling asleep, fatigue, heavy periods, blood loss, better with rest, worse in afternoon & evening. T- pale P- weak, thready Constant dull headache, worse with overwork, poor appetite, lack of strength, fatigue. Better with rest and laying down, worse in morning. T- pale, thin white coat P- weak Headache with feeling of emptiness in head, dizziness, vertigo, weak aching low back, fatigue, seminal emission, tinnitus, insomnia, night sweats. T- red, scanty coat P- thready, forceless

Drain dampness Transform phlegm Stop pain Drain

Tou Tong Headache Blood Stasis

Long history of headaches or trauma can cause blood stasis, which causes pain.

Invigorate qi & blood Resolve stasis Stop pain Drain Nourish blood Stop pain Tonify

Tou Tong Headache Blood Deficiency

Prolonged illnes or trauma causing blood deficiency, lack of blood causes lack of nourishment to head & brain.

choose bei shu points based on sensitivity - xin shu BL15, ge shu BL17, gan shu BL18, pi shu BL20 bai hui DU20 - raise clear yang to head, raise spleen qi he gu LI4 - move qi, stop pain zu san li ST36 & san yin jiao SP6 - tonify qi & blood during remission of headaches strive to increase blood production - qi hai REN6 & zusanli ST36, + beishu bai hui DU20 - raise clear yang to head, raise spleen qi shang xing DU23 - local point for stopping pain qi hai REN6, pi shu BL20 & zu san li ST36 - moxa, nourish qi and blood he gu LI4 - move qi, stop pain shen shu BL23 - tonify kidney yin gan shu BL18 - drain to prevent liver yang rising bai hui DU20 - raise clear yang to head shang xing DU23 - local point for stopping pain tai xi KI3 & san yin jiao SP6 - nourish kidney yin nao kong GB19 - benefit the head and alleviate pain, fill marrow, draws essence to brain w/insomnia (frequent waking & night sweats) - yin xi HT6 (calm shen, clear def. heat, stop sweating) w/tinnitus - ting gong SI19 w/jing (essence) deficiency - xuan zhong (jue gu) GB39, meeting point of marrow w/fire symptoms - ran gu KI2, xing-spring, clear heat, & shao hai HT3, he-sea water point Ancient formula from Great Compendium - shang xing DU23, feng chi GB20, nao kong GB19, tian zhu BL10, shao hai HT3

Tou Tong Headache Qi Deficiency Tou Tong Headache Kidney Yin Deficiency

Qi deficiency can lead to qi stagnation in the head, causing pain.

Tonify (boost) qi Stop pain Tonify Tonify kidney yin Stop pain Tonify

Deficiency of kidney yin causes liver yang to rise, which disturbs flow of qi & blood to head, causing headache.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Less severe headache, intolerance to cold, pale white complexion, cold limbs, aching low back, fatigue. T- pale, swollen P- deep, slow Tx Principle Tonify & warm KI yang Stop pain Tonify, moxa Acupuncture Points / Techniques bai hui DU20 - raise clear yang to head shang xing DU23 - local point for stopping pain ming men DU4 & shen shu BL23 - moxa, tonify & warm kidney yang guan yuan REN4 - moxa, tonify kidneys and fortify yuan qi tai xi KI3 - nourish kidney yin fu liu KI7 - metal point on water will tonify kidney, consolidate/secure the kidney nao kong GB19 - benefit the head and alleviate pain, fill marrow, draws essence to brain Ancient formula from Great Compendium - shang xing DU23, feng chi GB20, nao kong GB19, tian zhu BL10, shao hai HT3

34

Syndrome

Etiology / Pathomechanism

Tou Tong Deficiency of kidney yang causes liver Headache yang to rise, which disturbs flow of qi & Kidney Yang Deficiency blood to head, causing headache.

Alternate therapeutic methods for headache: Ear acupuncture: Occiput, subcortex, shen men, frontal. Needle unilateral or bilateral to elicit a strong sensation. Retain 20-30 minutes, manipulate every 5 minutes. Can apply embedding needles for 3-7 days. Can let blood at veins on ear posterior. Plum blossom: Tap over head, temples, back of neck and hua tuo jia ji points. In excess & blood stasis patterns tap forcefully to let blood. Daily for ten days = one course. Blood letting: For liver yang rising and blood stasis patterns. Look for excess in luo (engorged veins). Look for engorged vessels at back of ear. Acupoint injection: Solution of dang gui zhu shu ye. Inject at gan shu BL18, dan shu BL19, wai guan TB5, tai chong LR3 and a shi points. Scalp acupuncture: Treat upper 1/5 of sensory band Migraine type headache: needle shao fu HT8 on contralateral side. Vertex headache: bring water to head, disperse bai hui DU20, then strongly stimplate xing jian LR2. Occipital headache: tian zhu BL10, bai hui DU 20, local ashi points, hou xi SI3 & shen mai BL62, wai guan TB5. Temporal headache: local ashi points, shuai gu GB8 (2 cun above ear tip where 3 sutures meet), wai guan TB5, zu lin qi GB41, let blood at tai yang. Meridian acupuncture diagnosis for headache. FRONTAL HEADACHE Possible Meridian effected. Stomach - under the eyes, corner of mouth, mandible area Large Intestine - under the eyes, corner of mouth Gallbladder - above the eyebrows San Jiao - corner of eyebrows Small Intestine - in front of the ear, outer corner of eyes Bladder - above the eyebrows, medial end of the eyebrows Du - between the eyebrows Bladder, Gallbladder or Du Gallbladder, Small Intestibe or San Jiao (rare) Bladder or Du Gallbladder or Stomach All yang meridians Left- shao shang LU11, zhong chong PC9 and shao chong HT9; zu san li ST36, yang ling quan GB34 and wei zhong BL40 Right- san jian LI3, hou xi SI3 and zhong zhu TB3; shang qiu SP5, zhong feng LR4 and tai xi KI3 Left- zhong zhu TB3 and tian jing SJ10; qu quan LR8 (or Dr. Tans liver point), tai chong LR3 and yin ling quan SP9 Right- nei guan PC6 and qu zu PC3; yang ling quan GB34 (or Dr. Tans gallbladder point) and zu san li ST36

OCCIPITAL HEADACHE TEMPORAL HEADACHE VERTEX HEADACHE HEADACHE BEHIND THE EYES EVERYWHERE

Migraine heaqdache with vomiting spells

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Dizziness, postural dizziness, mild vertigo, lightheadedness, blurred vision, worse with exertion or overstrain, there is no spinning or flipping of objects, pale face / lips / nails, palpitations, insomnia, mental lassitude, no desire to speak, weak limbs, poor appetite, can have fainting when more severe. Common after recovering from prolonged illness or a hard labor/ delivery. T- pale P- weak, thready Dizziness & vertigo, listlessness, insomnia, poor memory, forgetfulness, dream-troubled sleep, weak aching low back & knees, tinnitus, seminal emission, five heart fever, night sweats, seeing black. T- red, scanty coat P- thready, rapid, wiry Tx Principle Tonify qi & blood Fortify spleen & stomach Tonify, moxa . Acupuncture Points / Techniques

35

Syndrome Xuan Yun Dizziness / Vertigo Qi and Blood Deficiency

Etiology / Pathomechanism Dizziness & vertigo are usually due to either deficiency patterns, or to patterns with a root deficiency and branch excess. All cases involve wind, this wind may be combined with fire, phlegm and/or deficiency. Extended illness, stress, anxiety, worry or weak heart and spleen can cause qi & blood deficiency. Qi & blood cannot rise to nourish the brain. Chronic illness, aging, congenital deficiency or excessive sexual activity can lead to kidney deficiency. The sea of marrow becomes deficient and the brain is not nourished.

ge shu BL17, gan shu BL18, pi shu BL20 - moxa, tonify qi & blood, gan shu helps extinguish wind bai hui DU20 - raise clear yang, strengthen brain, extinguish wind qi hai REN6 - moxa, benefit & regulate qi & blood, rescue collapse of yang zu san li ST36 - treat dizziness due to deficiency, strengthen spleen & stomach, nourish blood san yin jiao SP6 & zhong wan REN12 - strengthen spleen & stomach, nourish blood xin shu BL15 - nourish heart blood w/palpitations and/or insomnia - nei guan PC6 (pacify the heart, calm shen), shen men HT7 (regulate & tonify heart, calm shen) shen shu BL23 & zhi shi BL52 - tonify kidney, nourish yin, enrich the marrow, benefit essence, strengthen low back gan shu BL18 - extinguish wind bai hui DU20, feng fu DU16 - raise clear yang, strengthen brain, extinguish wind xuan zhong (jue gu) GB39, nao hu DU17 - increase or benefit marrow, nourish brain guan yuan REN4 - tonify kidney, restore collapse san yin jiao SP6 - boost kidney, calm shen, regulate blood pressure tai xi KI3 or zhao hai KI6 - boost kidney, anchor qi w/tinnitus - ting gong SI19 or er men TB21 w/kidney yang deficiency - hou xi SI3 & shen mai BL62 shen shu BL23 - tonify, treats the root; tonify kidney, nourish yin, enrich the marrow, benefit essence, gan shu BL18 - drain, extinguish wind, course liver, clear heat tai chong LR3 - drain, subdue liver yang and extinguish wind, spread liver qi, clear head & eyes feng chi GB20 - dispel wind, tonify marrow, nourish brain yang fu GB38 - jing-river fire; clear heat, subdue liver yang shui quan KI5 - xi-cleft; moisten water & nourish yin, help blurred or cloudy vision Look for pressure point near right lower rib cage, needle sensitive spot. w/ chest & hypochondrial oppression - yang ling quan GB34 - promote smooth flow of liver qi w/tinnitus - ting gong SI19 or er men TB21 bai hui DU20 - raise clear yang, strengthen brain, extinguish wind tou wei ST89 - dispel wind, treat dizziness & vertigo feng long ST40 - transform phlegm, harmonize stomach, open the luo zu san li ST36 - drain damp, strengthen & harmonize SP/ST, open & allow clear passage through luo zhong wan REN12, tai bai SP3, pi shu BL20, wei shu BL21 - strengthenSP/ST, transform damp yin ling quan SP9, shui fen REN9, jie xi ST41 - regulate spleen, transform damp w/nausea & vomiting - nei guan PC6 w/heat - jie xi ST41 (jing-river fire, clear heat from stomach & face), xing jain LR2 w/severe dizziness & vertigo - feng chi GB20

Xuan Yun Dizziness / Vertigo Kidney Yin, Qi and Essence Deficiency

Tonify the kidney and nourish yin Tonify

Xuan Yun Dizziness / Vertigo Liver Yang Rising

Emotional depression or anger can damage liver yin causing liver yang to rise to head and stirring of liver wind, causing dizziness.

Dizziness & vertigo, objects spinning & flipping in visual field, worse with troubled emotions or anger, tunnel vision, distending headache, chest & hypochondrial oppression, irritability, insomnia with dream disturbed sleep, bitter taste. T- red P- wiry, rapid

Flatten the liver Extinguish wind Nourish & tonify the liver & kidney Strengthen spleen Even tonify even drain.

Xuan Yun Dizziness / Vertigo Phlegm Turbidity

Improper diet, stress & taxation can damage the spleen & stomach, causing obstruction of the middle burner by phlegm -dampness or phlegm-fire. Wind carries phlegm to the head which blocks the clear yang.

Dizziness & vertigo, head feels heavy and as if tightly bound or filled with cotton wool, difficulty thinking and concentrating (especially in morning), chest oppression, sticky mouth, no thirst, nausea, vomiting, loss of appetite, fatigue. T- thick greasy coat P- soggy or slippery, rapid with heat

Transform phlegm Drain dampness Extinguish wind Strengthen spleen & harmonize stomach Open & allow clear passage through luo Drain

Alternate therapeutic methods for headache: Ear acupuncture: shen men, kidney, occiput, inner ear, subcortex; 2-3 points/session, 20-30 minute retention, manipulate at intervals, once/day for 5-7 sessions = one course. Scalp acupuncture: bilateral auditory and dizziness/vertigo band, 2 mm depth, periodically apply 2-3 high-speed twirling manipulations. Once daily for 10 days. Allow 3 day interval before beginning another course. Acupoint injection: .5% glucose or B12 (for blood deficiency) solution at he gu LI4, tai chong LR3, feng chi GB20, zu san li ST36 Plum blossom: jia ji from C1 to C4, lumbo-sacral bands on bladder meridian, bai hui DU20, yin tang, tai yang, and on ear; moderate sensation, once or twice daily, for 5-10 sessions.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Prodromal (warning) signs: Fatigue, tiredness, tingling of limbs, dizziness, stiffness of tongue, agitation. Generally there is wind and phlegm involved, and sometimes static blood. No loss of consciousness. Dizziness, vertigo, headache (temporal or apex), tinnitus, pressure behind eyes, blurred vision, sudden vision loss in one eye, irritability, restlessness, insomnia, lower back ache, hypertension. Zhong luo; mild, blockage of luo, targeting of superficial vessels. Numbness of skin, deviation of eyes & mouth. Zhong jing; blockage of meridians. Deviation of facial features, progressive hemiplegia, difficulty speaking. T- red, scanty coat P- thready, wiry, rapid No loss of consciousness. Dizziness, overwhelming desire to sleep, unable to focus, headache, constipation, chest oppression, phlegm in throat, sudden heaviness, numbness or paralysis of extremities on one side, facial paralysis, or dysphasia. T- stiff, quivering or deviated, greasy yellow coat P- slippery, wiry Lost consciousness, clenched fists, rigid limbs, eyes are open, clenched teeth, no loss of bowel or bladder control. With accompanying heat signs: fever, convulsions, red face & lips, heavy breathing, halitosis. T- greasy yellow coat P- rapid, slippery, wiry Lost consciousness, clenched fists, rigid limbs, eyes are open, clenched teeth, no loss of bowel or bladder control. With accompanying yin signs: damp & phlegm with wind, grey lips, pale/white face, cold limbs, rough raspy breath, copious sputum. T- greasy white coat P- deep, slow, slippery Lost consciousness, hands open & relaxed, copious sweating, flaccid extremities, mouth is open, SOB, red cheeks, cold limbs, loss of bowel or bladder control. T- flaccid, pale P- floating, large, without root Tx Principle There are two aspects to treatment; prevention (before a stroke) and treatment of the sequelae. Flatten liver yang Extinguish wind Moisten and nourish liver & kidney (nourish root yin deficiency to anchor yang) Drain & tonify. Acupuncture Points / Techniques

36

Syndrome Zhong Feng Wind Stroke General Information Zhong Jing Luo Channel Stroke Internal Stirring of Liver Wind

Etiology / Pathomechanism Western: cerebro-vascular accident (RENA), transient ischemic attack (TIA), burst aneurism, thrombosis, embolism, spasm of cerebral blood vessels. Liver wind moving internally, carrying static blood and turbid phlegm, which blocks the jing luo. This is root liver yin deficiency with branch liver yang rising. Swiftly applied treatment may subdue wind and avert catastrophe. If wind is not constrained, it can wreak havoc in the channels causing loss of motor control and paralysis. This can correspond to hypertension, TIAs and RENAs. Obesity, poor dietary habits (excess sweet, greasy foods) cause accumulation of dampness, causing production of phlegm. Phlegm profusion causes excess heat which rises to the head.

Acupuncture is not given (other than for resuscitation) to acute stroke victims as a bleeding aneurysm may continue to bleed with acupuncture treatment. For the first 2 weeks following a stroke only herbal treatment is used until the patient is stable, then acupuncture is phased in. Prompt treatment is important, within first 3 months provides good effect, after 6 months effectiveness is lower. Strokes of this type are easier to prevent than to treat. Lifestyle changes from overworking, poor dietary habits and excess stress are very helpful. feng chi GB20, tai chong LR3 & wai guan TB5 - drain tai xi KI3 - tonify Other points that may be helpful depending on the symptom picture: he gu LI4, qu chi LI11, feng long ST40, yang ling quan GB34, zu san li ST36, xing jian LR2, an mian, nei guan PC6, xuan zhong GB39, zu lin qi GB41, feng shi GB31, jian jing GB21 Do not overstimulate patients with very high blood pressure. Ear acupuncture: let blood at ear apex and lower blood pressure groove

Zhong Jing Luo Channel Stroke Phlegm-heat with Wind

Transform phlegm Extinguish wind Open & allow clear passage thru jing luo Drain

si shen cong; with flat needle toward bai hui DU20 he gu LI4 & qu chi LI11 - clear heat, clear wind from 4 limbs, treat constipation yang ling quan GB34 - clear heat, downbear wind xing jian LR2 - clear heat, extinguish wind feng long ST40 - transform phlegm, open the luo da zhui DU14 - clear heat, treat deficiency taxation w/constipation - zhi gou TB6 (open lower orifaces, drain san jiao heat, move the stool), tian shu ST25 & shang ju xu ST37 (mu-he of LI) or zu san li ST36 ren zhong DU26 - awaken brain, open orifaces he gu LI11 - clear heat (w/high fever add qu chi LI11) zhong chong PC9 & lao gong PC8 - let blood to clear heat xing jian LR2 - clear heat, extinguish wind zu lin qi GB41 - treat hemiplegia, downbear qi & blood xia guan ST7 & jia che ST6 - relax clenched jaw Use strong stimulation unless patient has high blood pressure. ren zhong DU26 - awaken brain, open orifaces he gu LI11 - clear heat zhong wan REN12 & zu san li ST36 - even needling then moxa feng long ST40 - transform phlegm, open the luo tai chong LR3 To restore consciousness: shi xuan, lao gong PC8, retain needles until consciousness is restored. guan yuan REN4, shen que REN8 - strong moxa, restore consciousness, return yang, treat diarrhea ren zhong DU26, su liao DU26 - raise BP, strengthen heart, restore consciousness yong quan KI1, zu san li ST26 -moxa to anchor yang, downbear counterflow ming men DU4 & qi hai shu BL24 - moxa to return yang zhong ji REN3, san yin jiao SP6 - for incontinence of bladder & bowel w/copious sweating - yin xi HT5 w/difficult to wake - shen mai BL62

Bi Zhong Zang Fu Organ Stroke Yang Closed Type

These are more severe manifestations of wind stroke. There is always loss of consciousness. Zhong fu; site of illness is deeper, hemiplegia, facial paralysis, aphasia, consciousness comes & goes, muddled thinking, lack of mental clarity. Zhong zang; most severe, complete loss of consciousness, difficult to revive, with revival there is numbness, facial deviation. After regaining consciousness, the prognosis is favorable if the mind becomes progressively clearer and thinking becomes normal.

Clear heat Extinguish wind Awaken brain Open orifaces Drain Bloodletting. Open orifaces Transform phlegm Extinguish wind Warm meridian Drain, moxa Return yang Restore consciousness Tonify, moxa

Bi Zhong Zang Fu Organ Stroke Yin Closed Type

Tuo Zhong Zang Fu Organ Stroke Open Type

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Tx Principle Acupuncture Points / Techniques

37

Syndrome

Etiology / Pathomechanism

zhong feng Wind Stroke Recovery stage following acute attack Liver and Kidney Yin Deficiency with Floating Yang & Wind There are still signs of kidney and liver yin deficiency, with wind. This causes upper excess and lower deficiency.

This is the recovery stage, just following the acute stage of wind stroke. The first two weeks following the stroke. Patient is still usually hospitalized. Wind and yang are still present. The object is to prevent further attack by wind and stabilize the patient. If impending sign of stroke is observed, moxa or needle feng shi GB31 & zu san li ST36. Add tuina, massage, PT exercises, lifestyle changes. Red flushed face, vexation, paralysis of limbs (usually legs). Tonify liver & kidney yin Extinguish wind Clear floating yang Even tonify, even drain. Regulate & tonify spleen & stomach Transform phlegm Even tonify, even drain. gan shu BL18 & shen shu BL23 - tonify liver & kidney yin yin xi HT6 - nourish heart yin, regulate heart blood tai xi KI3 - tonify yin, anchor qi xing jian LR2 - drain, expel interior wind, spread liver qi w/agitation - shen men HT7 (regulate & tonify heart) zu san li ST26 & zhong wan REN12 - tonify or moxa; tonify spleen & stomach pi shu BL20 - tonify; fortify spleen, transform damp, boost stomach, regulate & harmonize qi & blood yin ling quan SP9 - even; regulate spleen & transform damp, nourishes earth so life may thrive san yin jiao SP6 - drain damp w/sleepiness - yin tang extra, ren zhong DU26 (return yang) w/muddy stools - moxa at tian shu ST25 (mu of large intestine) xin shu BL15, ge shu BL17, pi shu BL20 - nourish blood, regulate & tonify heart & spleen, can moxa qi hai REN6 - moxa; benefit and regulate qi, rescue collapse of yang zu san li ST26 & san yin jiao - benetit qi and blood w/fluttering of heart - nei guan PC6 w/abdominal distension - zhong wan REN12 w/insomnia - shen men HT7 Upper limb paralysis: he gu LI4, yang xi LI5 , shou san li LI10, qu chi LI11, san jian LI3, bi nao LI14 , jian yu LI15, da zhu BL12, wai guan TB5, with twitching add nei guan PC6 or da ling PC7 Lower limb paralysis: huan tiao GB30, wei zhong BL40 & cheng shan BL57 (elicit leg twitching with these 3 points), yang ling quan GB34, zu san li ST36, jie xi ST41, kun lun BL60, chong yang ST42, feng shi GB31, fu tu ST32, xuan zhong GB39, to treat root: san yin jiao SP6, tai chong LR3 & feng long ST40 w/swelling or coldness in hands or feet - ba xia or ba feng extra points yin bai SP1 - needle to try to get leg to jerk to demonstrate that movement is possible lian quan REN23 (attain deqi, then short lift & thrust from side to side) feng chi GB20 - aim needle toward tip of nose fu tu ST32, he gu LI4, feng long ST40 (luo, connects to throat), lie que LU7 jin jin / yu ye - needle toward root of tongue, no manipulation, or can let blood ya men DU15 - (gate of muteness) opens the voice tong li HT5 - luo, connects to throat (deficiency-unable to speak); heart meridian connects to tongue tai xi KI3 - restore yin, kidney meridian connects to throat san yin jiao SP6, shang lian quan extra

Spleen and Stomach Deficiency Weakness

Comes with turbid phlegm not transformed.

Fatigue, wooden expression, limb paralysis, loose muddy stools.

Qi and Blood Deficiency

Spleen qi and heart qi are both deficient.

Pale, lusterless complexion, paralysis and numbness of limbs, wooden expression, fatigue.

Nourish blood Benefit qi Regulate & tonify HT & SP Tonify

Wind Stroke Sequelae Hemiplegia

Varies from complete to partial paralysis. Tends to locate in upper limbs. Lower limb paralysis is easier to cure than upper limb. Flaccid or tonic hemiplegia are both treated the same. Treat 6 days per week, twice per day. Have patient try to move limbs during treatment. Improvement starts proximally and progresses distally. Special single points for hemiplegia; Upper limbs - .5 cun proximal to midpoint of anterior edge of ulna, on palmar side of arm. Lower limbs - 2.5 cun superior to head of fibula on anterior tendon of biceps femoris. Lay on unaffected side, hands crossed over chest, needle to depth = 1/3 of diameter of limb, gentle rotation, retain 30-90 minutes, go deeper of needed to obtain deqi. There may be excessive phlegm with difficulty coughing the phlegm out.

Open & allow clear passage thru jing luo Regulate and harmonize qi and blood

Wind Stroke Sequelae Difficulty Swallowing Wind Stroke Sequelae Aphasia Dysphasia

Open & allow clear passage thru jing luo Regulate qi and blood Empower the throat Extinguish wind Eliminate phlegm Open orifaces

Loss of ability to speak, tongue has limited dexterity, unable to form sounds, tongue can be stiff.

Alternate therapeutic methods for wind stroke sequelae: Ear acupuncture: adrenal, shen men, brain, HT, LR, SP, KI. For high blood pressure - let blood at ear apex or hypertensive groove at back of ear. Scalp acupuncture: treat motor bands; for lower limbs - treat middle 2/5 of bands, for upper limbs - treat upper 1/5 of bands. Also treat speech and motor sensory bands. Eye acupuncture: Upper limb paralysis - select shang jiao. Lower limb paralysis - select xia jiao. Tonify good side, drain affected side. Look for contorted vessels or dew drops.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Tx Principle Acupuncture Points / Techniques

38

Syndrome Xue Zheng Bleeding Patterns

Etiology / Pathomechanism

Bleeding patterns include any bleeding outside the proper courses, whether it runs from the nose or mouth, is passed in feces or urine or extravasates into the skin. The etiology of bleeding patterns can involve either external or internal factors. The basic pathogenic mechanisms are either fire evil or deficient qi that cannot contain the blood. The zangfu organ involved is based on the site of the bleeding. Patterns involving blood stasis are generally complicated by both excess and deficiency. Whatever the etiology, both excess & deficiency can result in depletion of qi and degeneration of yang due to excessive blood loss. Thus, excess patterns have a good chance of transforming to deficiency patterns. In addition, blood that has escaped the vessels but not left the body adds to the static blood factor, further complicating treatment and slowing recovery. Emotional upset or over-consumption of alcohol or rich spicy foods result in liver fire, which in excess then invades the lung (injury to luo vessel by heat, wood violates metal). Chronic or extended illness cause depletion of yin, leading to deficiency fire. Recurrent cough, blood-streaked phlegm, pulling pain in chest and hypochondrium when coughing, when severe spitting copoius amounts of bright red or purplish blood. Irritability, bitter teste, dry stools, dark urine. T- red sides and tip, thin yellow coat P- rapid, wiry Coughing with expectoration of small amounts of bloodstreaked phlegm or recurrent coughing of bright red blood. Tidal fever, night sweats, five heart fever, flushed cheeks, dry mouth & throat, emaciation. T- red, scant coating P-thready, rapid Itchy throat, coughing, difficult expectoration, dry mouth & nose, fever, blood streaked phlegm. T- red, dry with thin yellow coat P- rapid, floating Vomiting of bright red or purplish blood which is often mixed with food matter, epigastric distension and/or pain, halitosis, constipation, black stools, bleeding gums, mouth ulcers, thirst, high appetite. T- red, yellow coat P- rapid, slippery, strong Emotional upset or over-consumption of alcohol or rich spicy foods result in liver fire, which in excess then invades the stomach. Improper diet and eating habits, physical or mental exertion, indulgent sexual activity cause injury to spleen & stomach qi, resulting in lack of qi to contain blood. Vomiting of bright red or dark purple blood, bitter taste, costal pain, irritability, dizziness, headache, insomnia, dream-disturbed sleep, red face, dark scanty urine. T- deep red P- rapid, wiry Vomiting of pale blood, of varying severity over prolonged time, sometimes copious amounts. Epigastric pain alleviated by heat or pressure, loss of appitite, SOB, fatigue, palpitations, pale complexion. T- pale, white coat P- thready & weak or thready & deep Drain liver, downbear fire Clear lung Harmonize luo vessel Stop bleeding Drain Nourish yin Drain deficiency fire Tonify & moisten lung Stop bleeding Even tonify/drain. Clear heat Moisten lung Stop bleeding Drain Clear heat Drain fire Downbear counterflow Stop bleeding Drain Clear liver Downbear fire Harmonize stomach Stop bleeding Drain Tonify qi Contain blood Tonify, moxa. fei shu BL13 - discharge heat, ventilate lungs, stop cough yu ji LU10 - discharge heat, descend rebellious qi xing jian LR2 - drain liver fire, clear heat and stop bleeding lao gong PC8 - cool the blood, will stop reckless bleeding w/excessive bleeding - kong zui LU6 - xi-cleft; clear heat, stop bleeding chi ze LU5 - clear lung heat and descend rebellious qi, drain and moisten lungs yu ji LU10 - discharge heat, descend rebellious qi, treat coughing blood kong zui LU6 - xi-cleft; clear heat, stop bleeding ran gu KI2 - clear deficiency heat zhao hai KI6 - nourish yin, clear deficiency heat fei shu BL13 - discharge heat, ventilate lungs, stop cough chi ze LU5 - clear lung heat and descend rebellious qi, drain and moisten lungs kong zui LU6 - xi-cleft; clear heat, stop bleeding he gu LI4 - clear heat, release the exterior, retreat fever, expel wind, stop pain nei ting ST44 - clear stomach heat, clear damp heat, stop pain xi men PC4 - stop bleeding, stop pain in acute conditions shang wan REN13 - descend rebellion, harmonize stomach

Ke Xue Coughing Blood Liver Fire invading Lung

Ke Xue Coughing Blood Yin Deficiency Fire

Ke Xue Coughing Blood Wind-heat-dry Tu Xue Vomiting Blood Stomach Fire

External wind, heat or dryness damages the lungs.

Tu Xue Vomiting Blood Liver Fire invading Stomach Tu Xue Vomiting Blood Spleen and Stomach Qi Deficiency

xing jian LR2 or tai chong LR3 - clear heat from liver and drain fire, subdue liver yang liang qiu ST34 - harmonize stomach and stop pain, treat acute stomach pain bu rong ST19 - harmonize middle jiao and descend rebellion lao gong PC8 - cool the blood, harmonize the stomach, treat mouth sores and ulcerations di wu hui GB42 - spread liver qi, clear gallbladder heat pi shu BL20 - tonify spleen qi, raise spleen qi and contain the blood zhong wan REN12 - mu of stomach; strengthen stomach, fortify spleen, treat qi ni of stomach zu san li ST36 - tonify qi, nourish blood, strengthen spleen, harmonize stomach yin bai SP1 - moxa to stop bleeding, benefit spleen & stomach

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Bloody stools or bleeding prior to passage of stool, difficult bowel movement or loose muddy stools, burning pain of anus, intermittent abdominal pain, bitter taste in mouth. T- yellow greasy coating P- slippery, rapid Tx Principle Clear heat Disinhibit dampness Stop bleeding Drain Tonify spleen Warm middle jiao Contain blood Tonify, moxa. Acupuncture Points / Techniques

39

Syndrome Da Bian Xue Blood in Stool Damp-heat in Large Intestine Da Bian Xue Blood in Stool Spleen and Stomach Deficiency Cold

Etiology / Pathomechanism

da chang shu BL25 - regulate intestines ci liao BL32 - regulate lower jiao, treat difficult defecation chang qiang DU1 - treat hemorrhoids, constipation and anal bleeding cheng shan BL57 - stop pain, cure hemorrhoids shang ju xu ST37 - lower uniting of LI; clear damp heat, regulate intestines, regulate spleen & stomach guan yuan REN4 - benefit qi and restore collapse of yang, fortify yuan qi zu san li ST36 - tonify qi, nourish blood, strengthen spleen, harmonize stomach tai bai SP3 - fortify spleen, rectify qi, harmonize spleen & stomach, stop pain bai hui DU20 - raise yang hui yang BL35 - clear damp-heat in lower burner yin bai SP1 - moxa to stop bleeding, benefit spleen & stomach guan yuan REN4 - benefit qi and restore collapse of yang, fortify yuan qi tai xi KI3 - clear deficiency heat, boost kidney, strengthen lumbar yin gu KI10 - clear damp-heat from lower jiao, boost kidney da dun LR1 - clear damp-heat, regulate lower jiao, strengthen liver blood storage function guan yuan REN4 - mu of SI; regulate lower burner and benefit bladder lao gong PC8 - drain heart fire, clear heat from middle jiao, clear ying & xue levels ran gu KI2 - clear deficiency heat, regulate kidneys & lower jiao san yin jiao SP6 - cool the blood, regulate ying & xue levels pi shu BL20 & shen shu BL23 - tonify spleen & kidney tai bai SP3 - fortify spleen, rectify qi, harmonize spleen & stomach, stop pain guan yuan REN4 - benefit qi and restore collapse of yang, fortify yuan qi zu san li ST36 - tonify qi, nourish blood, strengthen spleen, harmonize stomach zhi shi BL52 - tonify kidney, regulate urination, strengthen lumbar da zhui DU14 & qu chi LI11 - clear heat san yin jiao SP6 - cool the blood, regulate ying & xue levels ge shu BL17 - meeting point of blood; clear heat from blood and help stop bleeding xue hai SP10 - sea of blood; harmonize & cool the blood, treat blood heat skin problems wei zhong BL40 - cool the blood, resolve toxins ran gu KI2 - xing-spring; clear deficiency heat tai xi KI3 or zhao hai KI6 - , boost kidney, nourish yin, clear deficiency heat san yin jiao SP6 - cool the blood, regulate ying & xue levels, help spleen contain blood, liver store blood and kidney to seal & store blood shen shu BL23 - nourish yin, enrich the marrow san yin jiao SP6 - help spleen contain blood, liver store blood and kidney to seal & store blood pi shu BL20, wei shu BL21 - fortify spleen and strengthen stomach, raise qi and contain the blood guan yuan REN4 or qi hai REN6 - benefit qi and restore collapse of yang, fortify yuan qi zu san li ST36 - tonify qi, nourish blood, strengthen spleen, harmonize stomach ge shu BL17 - tonify qi & blood ba liao BL31 thru 34 & yao yang guan DU3 - ginger partition moxa (no needle)

Improper diet and eating habits, physical or mental exertion, indulgent sexual activity cause injury to spleen qi, resulting in lack of qi to contain blood.

Passage of dark purplish or black colored blood with or without stools. Dull abdominal pain, prefer warm drinks, loose stools, tiredness, mental boredom, lusterless complexion, no desire to speak. T- pale, white coat P- weak, thready Dark scanty urine containing small amounts of blood, no urethral pain. Dizziness, tinnitus, night sweats, tidal fever, flushed face, weak aching low back and knees. T- red, scant coat P- rapid, thready Dark yellow urine containing bright red blood, usually not accompanied by pain or may be slight burning pain. Irritability, thirst, mouth sores, restless sleep. T- red tip P- rapid

Niao Xue Blood in Urine Yin Deficiency Fire Niao Xue Blood in Urine Heart Fire Niao Xue Blood in Urine Spleen and Kidney Qi Defieicncy Xue Zheng Subcutaneous Bleeding Blood Heat Xue Zheng Subcutaneous Bleeding Yin Deficiency Fire Xue Zheng Subcutaneous Bleeding Spleen Qi Deficiency

Chronic or extended illness cause depletion of yin, leading to deficiency fire.

Nourish yin, clear heat Drain deficiency fire Cool blood, stop bleeding Even tonify/drain. Drain fire Clear ying & xue levels Stop bleeding Drain Tonify spleen & kidney Astringe & constrain Stop bleeding Tonify, moxa. Clear heat Resolve toxins Cool blood Stop bleeding Drain Nourish yin Drain deficiency fire Cool blood Stop bleeding Even tonify/drain.

Improper diet and eating habits, physical or mental exertion, indulgent sexual activity cause injury to spleen & kidney qi, resulting in lack of qi to contain, seal & store blood. External wind, heat or dryness, emotional upset or over-consumption of alcohol or rich spicy foods result in heat causing the blood to move recklessly. Chronic or extended illness cause depletion of yin, leading to deficiency fire.

Frequent painless pale red urination. Loss of appetite, tiredness, sallow complexion, dizziness, tinnitus, lower backache. T- pale P- weak, forceless Small dark purplish patches or spots or points on skin. May also have other bleeding also such as excessive menses, blood in urine, nose or gum bleeds, blood in stool. Fever, thirst, constipation, vexation, irritability. T- red, yellow coat P- rapid, wiry Intermittent subcutaneous bleeding with other bleeding (see above). Night sweats, malar flush, five-heart fever. T- red, scant or no coating P- rapid or thready

Improper diet and eating habits, physical or mental exertion, indulgent sexual activity cause injury to spleen qi, resulting in lack of qi to contain blood.

History of blood loss, slow onset, recurrent subcutaneous Tonify qi bleeding, easy bruising, especially in lower body. Contain blood Excessive menses, blood in stool, boredom, listlessness, Tonify, moxa. fatigue, lassitude, weariness, melancholy, depression, loss of appitite, pale complexion. No heat symptoms. T- pale P- weak, thready

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Symptoms are intermittent tonic spasms of voluntary muscles. Spasm of the masseters accounts for the name lockjaw. Early symptoms: lockjaw, clenched teeth, convulsion of limbs, opisthotonos (arching of spine), tightening of neck, unable to touch chin to sternum, tightening of facial muscles. P- deep, rapid or wiry, rapid Later stage symptoms: if untreated, xie qi enters deeply into body, zheng qi becomes deficient; loss of consciousness, rapid breathing, difficulty speaking, sweating. P- deep, weak Death occurs from spasm of muscles of respiration. Progression of disease: neck becomes thicker and enlarged, masses may be palpated, skin is loose. The only initial symptom is swelling of the neck. As disease advances there will be dry throat & mouth, agitation, irascibility, palpitations, copious sweating, 5 heart fever. Tx Principle Clear toxin Eradicate wind Drain Acupuncture Points / Techniques

40

Syndrome Po Shang Feng Tetanus

Etiology / Pathomechanism An acute poisoning from a neurotoxin produced by Clostridium tetani. Tetanus bacilli form durable spores that can be found in soil and animal feces and remain viable for years. Puncture injury by metal, wood or glass that has been underground. Wind toxin enters, moves thru jing luo causing spasms & twitching. Without treatment, wind toxin overcomes zheng qi, invades deep into interior and causes death. Incubation period is variable and is affected by the strength of the zheng qi, along with the severity of the symptoms.

hou xi SI3 & wei zhong BL40 - dredge tai yang of wind & toxin san jian LI3 - release spasms in jaw, dispel exterior wind, benmefit throat & teeth feng long ST40 - open yang ming luo mai and release the jaw Retain needles for 2 hours or up to 3 days. Use heavier guage needles for longer retention, insert flatly and tape them down. w/zheng qi deficiency (sweating & difficulty breathing) - zu san li ST36 & qi hai REN6 w/convulsions - feng chi GB20, qu chi LI11 & tai chong LR3 Classical point formula: xuan shu DU5, ji zhong DU6, zhi yang DU9, shen zhu DU12, hou ding DU19, qian ding DU21, cheng qiang REN24 Emperical point formula: feng chi GB20, fei shu BL13, gan shu BL18, shen mai BL62, nei guan PC6, da ying ST6 Locally use surround needle around goiter, 6-8 needles, insert at margin of thyroid gland at 45 angle into center of the mass, use strong manipulation, twirling and lifting & thrusting. Acumoxa therapy is definitely effective in treating goiter. For best results however, oral dosages of iodine should be taken. Ear acupuncture: endocrine, shenmen, subcortex, neck, w/hyperthyroidism add HT, SP & brain For hyperthyroidism (high fever, vomiting, delerium, thready rapid pulse) - shui tu ST10, nei guan PC6, jian shi PC5, zu san li ST36, san yin jiao SP6. Retain for 30 minutes daily for 50 days. For thyroid hyperplasia (enlargement or cyst) - use surround technique described above, retain 20 min. Or use flat needling with no retention qu gu REN2, tian zhu BL10, da zhu BL11 & nei guan PC6. For thyroiditis (Hashimotos disease) - use moxa to rectify autoimmune disorder (patient is usually yin deficient). Alternate between these 2 point groupings, 5 cones at each point, rest 5 days, repeat with alternate group. Group 1: da zhui DU14, shen shu BL23 & ming men DU4. Group 2: tan zhong REN17, zhong wan REN12 & guan yuan REN4. In addition, indirect moxa can be applied at feng chi GB20, fei shu BL13 & nei guan PC6. qi she ST11 - drain; benefit throat & neck, descend qi nao hui TB13 - drain; regulate qi & transform phlegm, treat goiter jian shi PC5 - drain; clear heat from shen, calm agitation & palpitations, transform phlegm tai chong LR3 - tonify; nourish liver blood tai xi KI3 - tonify; nourish yin w/bulging eyeballs - feng chi GB20 & tian zhu BL10 w/insomnia - dan shu BL19 & xin shu BL15 w/tidal fever - da zhui DU14 & lao gong PC8 w/night sweats - yin xi HT6 & hou xi SI3 w/excessive hunger & weight loss - zu san li ST36 & san yin jiao SP6 tian ding LI17 & shui tu ST10 - local; benefit throat & neck guan yuan REN4 - tonify & increase yuan qi, nourish yin he gu LI4 - regulate qi zhao hai KI6 & lie que LU7 - benefit the throat, nourish yin w/palpitations - shen men HT7 & nei guan PC6 w/muddy stools - pi shu BL20, tian shu ST25 & gong sun SP4

Ying Qi Goiter General Information

Western: goiter, hyperthyroidism, thyroid tumors. Swelling or lumps on anterior of neck, bilateral to Adams apple. No change in skin color over lump. This is a prolonged illness with gradual increase in lump size. Three types; 1) qi ying - qi goiter Sx: extensive swelling and enlargement of anterior neck, tissue is soft to the touch and may increase or decrease in size based on emotional status of patient. 2) rou ying - fleshy goiter Sx: unilateral or bilateral presentation of one or several soft but tough round lumps, move up and down with movement of the throat. 3) shi ying - stone goiter Sx: hard lumps resembling stones appearing bilaterally in a random fashion on anterior neck, unaffected by swallowing movement. Masses in general are caused by qi stagnation combined with emotional factors with phlegm collecting. There is no place on the body where phlegm cannot collect, but it is common on the throat, as stasis forms, they become hard.

Ying Qi Goiter Yin Deficiency with Fire

Emotional depression causes binding of qi, which impairs proper movement of fluids. Fluids congeal forming phlegm & static blood in neck. Exogenous invasion of mountain vapor & sandy water which is a geographical description of areas with lack of iodine in diet.

Yin deficiency with profusion of fire. Weight loss or emaciation, frequent hunger, large appetite, insomnia, tidal fever, frequent sweating, dry skin & hair, palpitations, 5 heart fever, trembling tongue & hands. T- red, scant coat P- thready, rapid

Nourish yin Drain fire Drain & tonify Use local surround needling described above.

Ying Qi Goiter Yin and Qi Deficiency

NOTB: extra point qi ying (cervical lump of qi) is located near shuitu ST10, on the lateral superior side of the swelling associated with goiter.

SOB, loss of strength, muddy stools, loss of appetite, sallow yellow complexion, + yin deficiency signs. T- pale, dry P- thready, weak

Increase and tonify qi Nourish yin Tonify Use local surround needling described above.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Tx Principle Acupuncture Points / Techniques Meridians that travel thru anus: Jing bie of large intestine and kidney. Jing mai of stomach Du, ren, chong, yin wei & yin qiao. Use neiguan PC6 or zhu bin KI9 (xi-cleft) to access yin wei. Use gong sun SP4 to access chong. Use lie que LU7 to access Ren. Use zhao hai KI6 to access yin qiao. Yin qiao mai will treat intestinal wind with bleeding; combine zhao hai KI6 & jing ming BL1. Nei zhi - internal, within anus, vericosity with pain with bowel movement, may require manual retraction, sometimes a flap of connective tissue forms. Can be embolytic. Wei zhi - external, outside anus, passage of stool can cause vericosity to break & bleed, tend to be itchy. Hun he zhi - combined inside & outside, have characteristics of both. Initial stage: small, soft, non-protruding hemorrhoids, color is bright red to purple, may be bleeding from friction of bowel movement (BM). Advanced stage: larger hemorrhoids which cause difficult painful BM. May have signs of damp-heat; difficult urination, thirst, red tongue, rapid pulse. May see qi sinking with excessive loss of blood, sallow yellow complexion, sense of pressure at anus, SOB, lazy speech, poor appetite, loss of strength, prolapse of hemorrhoid (sagging down), difficult to reduce. Prolapse causes danger of blood circulation being cut off which causes severe pain and ulceration. More acute, usually has signs of qi stagnation and blood stasis. Hemorrhoids, anal bleeding, blood dark red in color, swelling, distension, pain and itching of the anus, dry mouth, thirst, dark scanty urine, constipation. T- red, yellow coat, may be greasy P- rapid, slippery Clear heat Drain dampness Transform stasis Drain

41

Syndrome Zhi Chuang Hemorrhoids General Information

Etiology / Pathomechanism Vericosities of the hemorrhoidal veins. They are thought to be due to increased pressure in the venous plexus that drains the rectum & anus, in association with or independent of, weakness or loss of tone in the venous walls. Zhi - small fleshy protuberances in or around the anus. Generally occur in adults and present with pain, itching and bleeding of the anus.

Zhi Chuang Hemorrhoids Damp-heat

Extended sitting or standing, or carrying heavy weight for long distances, causes disruption in movement of qi & blood, which leads to qi stagnation & blood stasis. The lack of free flow of blood in the luo mai leads to accumulation of damp-heat. Too much hot, spicy, sweet, fatty foods also lead to damp-heat. Prolonged diarrhea, dysentery, or constipation affect the large intestine causing accumulation of heat with constipation, straining and then prolapse. Over-taxation from childbirth disrupts the flow of qi & blood, causing prolapse of anus during delivery.

chang qiang DU1 - luo of Du, important point for stagnant blood hemorrhoids hui yang BL35 - clears damp-heat, regulates lower jiao, treats hemorrhoids ci liao BL32 - clear heat & blood stagnation from lower jiao and rectal area cheng shan BL57 - special point for hemorrhoids, especially combined with chang qiang DU1, regulates lower intestine and rectum, dispels wind & stops bleeding er bai - (4 cun proximal from palmar wrist, either side of tendon), treats bleeding hemorrhoids w/swelling & pain of anus - zhu bin KI9 (xi-cleft, stops pain) & zan zhu BL2 (treats hemorrhoid pain) w/bleeding - xue hai SP10 (cools the blood) & qi hai shu BL24 (treats bleeding hemorrhoids) w/constipation - da chang shu BL25 & shang ju xu ST37 (clear damp-heat & regulate intestines) bai hui DU20 - moxa; raises yang qi when strongly moxaed shen que REN8 - partition moxa w/ginger or salt; quan yuan shu BL26 - treats deficiency with injury to blood ge guan BL46 - harmonize diaphragm and resolve qi stagnation cheng shan Bl57 - 7 moxa cones; special point for hemorrhoids, especially combined with chang qiang, regulates lower intestine and rectum, dispels wind & stops bleeding chang qiang DU1 - luo of Du, important point for stagnant blood hemorrhoids w/swelling & pain of anus - cheng shan BL57, fei yang BL58 (treats hemorrhoids) & wei yang BL59 w/hot pain of anus - lao gong PC8 (clears heat from middle jiao and cools the blood)

Zhi Chuang Hemorrhoids Qi Deficiency with Prolapse

More chronic. Hemorrhoids, anal bleeding, blood that is abundant and pale in color, protrusion of hemorrhoids from anus, heavy sensation of anus, tiredness, fatigue, SOB, no desire to speak, poor appetite, lusterless complexion. T- pale P- weak

Tonify spleen qi Tonify, moxa

Alternate therapeutic methods for hemorrhoids: Ear acupuncture: shenmen, brain, spleen, large intestine, lower portion of rectum. Select 2-3 points per session, retain 20-30 minutes, treat once daily. Pricking therapy: Locate hemorrhoid points (one or several small red papules that appear along the sides of the spine from the level of the T7 to the lumbar sacral region. Using a thick filiform needle, prick open the papule(s) and squeeze out a drop of blood or fluid. Treat once every 7 days. Patients with hemorrhoids should avoid hot spicy foods, maintain softness of stools and keep their bowel movements regular. In severe cases, surgery may be required.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms High fever, sweating, headache, yellow sticky phlegm. T- thin yellow coat P- rapid, floating Tx Principle Clear heat Ventilate lung Drain Acupuncture Points / Techniques Tui re - four heat retreating points: da zhui DU14 - clear heat & retreat fever he gu LI4 - clear heat, retreat fever, expel wind qu chi LI11 - clear heat, retreat fever, expel wind, clear the head wai guan TB5 - lear heat, retreat fever, expel wind, release exterior yu ji LU10 - clear heat from luns and lung channel da zhui DU14 - clear heat & retreat fever qu chi LI11 - clear heat, retreat fever, expel wind, clear the head nei ting ST44 - clear stomach heat, calm the spirit shang yang LI1 - clear excess fire guan chong TB1 - clear heat from qi level w/abdominal pain - he gu LI4, tian shu ST25 & shang ju xu ST37 w/coughing & chest pain - chi ze LU5 w/high fever that wont break - shi xuan (tips of fingers) zhong chong PC9 - open oriface, clear heat from ying & xue levels qu ze PC3 - clear heat from qi, ying & xue levels shao chong HT9 - cleat heat from xue level wei zhong BL40 - let blood; cool the blood, resolve toxins w/rash - xue hai SP10 (sea of blood, cool blood, harmonixe ying & xue levels) w/delerium - ren zhong DU26 & shi xuan (tips of fingers)

42

Syndrome Gao Re High Fever Wind-heat Disturbing Lung

Etiology / Pathomechanism Wind-heat enters through nose, mouth and skin into the wei level.

Gao Re High Fever Warm Pathogen Sinking Internally

Warm pathogen moves deeper into qi level.

The four bigs: high fever, copious sweating, high thirst, large pulse. Aversion to heat but not to wind, red etes, desire copious amounts of cold drinks, constipation, chest pain, coughing, abdominal distension or pain which is worse with pressure. T- yellow P- surging, rapid High fever, aggitation, restlessness, vexation, irritability. When severe there may be loss of consciousness, delerium, thirst severe dryness, rash, bleeding from any oriface. Can advance to pericardium and liver and cause loss of consciousness, convulsions and spasms. T- deep crimson red and dry P- rapid, thready High fever, restlessness, mental agitation, thirst, body feels hot, desire copious amounts of cold drinks, dry lips & mouth, gastrointestinal symptoms. Can progress to delerium, convulsions, loss of consciousness. T- deep red, dry P- surging, rapid High sustained fever, swollen painful throat, pain can move to jaw, ear, head & face and become red, hot swollen. Aggitation, restlessness. May develop cinnebar toxin or scarlet fever from strep bacteria.

Clear heat Dispel pathogen Drain

Warm pathogen moves even deeper into ying or xue level.

Clear heat Drain ying & xue levels Drain, bloodletting

Gao Re High Fever Summer Heat Blocks Heart

Summer heat enters through yang ming and then enters blood level.

Clear and drain summer heat Drain

da zhui DU14 - clear heat & retreat fever qu chi LI11 - clear heat, retreat fever, expel wind, clear the head qu ze PC3 - clear heat from qi, ying & xue levels To prevent loss of consciousness - zhi zheng SI7 (to regulate yin/yang), ren zhong DU26 & bai hui DU20 w/thirst - bloodlet at jin jin / yu ye (large veins at underside of tongue) Tui re (see above), da zhui DU14, hegu LI4, qu chi LI11 & wai guan TB5 xian gu ST43 - clear heat from yang ming wei zhong BL40 - let blood; cool the blood, resolve toxins w/severe swelling of throat - tian rong SI17 & let blood at shao shang LU11 w/rash - xue hai SP10 (sea of blood, cool blood, harmonixe ying & xue levels) w/restlessness - qu ze PC3 (clear heat from qi, ying & xue levels)

Gao Re High Fever Epidemic Toxins

Bacterial toxins enter through skin, muscle, mouth and sink internally into the zangfu. Examples are strep throat and scarlet fever.

Clear heat Resolve toxins Drain

Alternate therapeutic methods for high fever: Ear acupuncture: shen men, er jian Gua sha: Coat skin along spine & between the ribs with oil then scrape skin surface with qua sha tool. If there is sore throat also scrape along sides of neck, over shoulder and down the arm. NOTB: In emergency situations, antibiotics may be required.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Internal Medicine (nei ke)
Symptoms Tx Principle Acupuncture Points / Techniques

43

Syndrome Nue Zheng Malaria

Etiology / Pathomechanism

Infectious disease with alternating chills and high fever, most common in summer and high autumn. Three categories based on length of cycle; 24 hour, 48 hour & 72 hour. Most common is 48 hour. 1) zheng nue, typical malaria; most common, alternating chills & fever. 2) wen nue, warm malaria; heat and fever are predominant 3) han nue, cold malaria; cold & chills are predominant 4) lao nue, taxation malaria; signs of taxation, prolonged course of illness, qi & blood are depleted Invasion of malarial evils, may have simultaneous invasion of wind, cold, summer-heat, dampness, especially if zheng qi is weakened, and if there is strain, stress or poor sleep. Shao yang is targeted (half exterior - half interior), when in interior there are chills, when in exterior there is fever. Alternating chills & fever which are cyclical (24, 48 or 72 hour cycles), fatigue before onset followed by chills followed by fever, headache, thirst, then perspiration as fever remits. T- red, thin white or yellow coat P- wiry Chronic malaria, fatigue, SOB, no desire to speak, spontaneous sweating, weight loss, sallow complexion, symptoms recur with stress, overwork, strain. T- pale P- thready Fainting can cause loss of consciousness or loss of life. Can also refer to shock or heart failure. Oily sweat (pearl natured), sticky hot skin, hot hands & feet, desire large amounts of cold drink, loss of consciousness. P- rapid, thready, rootless Clear, copious sweating, cool skin, cold hands & feet, no thirst or desire for hot drinks, clouded unclear mind, curling up position, loss of consciousness. P- faint, broken, stops & starts

Western: Malaria is infection with any of 4 species of Plasmodium. Symptoms are fever, which may be periodic, chills, sweating, hemolytic anemia, and splenomegaly. Diagnosis is by seeing Plasmodium in a peripheral blood smear. Treatment and prophylaxis depend on the species and drug sensitivity and include chloroquine, quinine, atovaquone and proguanil, mefloquine, doxycycline, and artemisinin derivatives. Patients infected with P. vivax and P. ovale also receive primaquine. Malaria is endemic in Africa, much of South and Southeast Asia, Central America, and northern South America. Treat 2 hours before onset of attack. Harmonize shao yang Dispel evils Drain, use moxa with cold. jian shi PC5, ye men TB2, da zhu BL11, hou xi SI3, da zhui GB14 & wai guan TB6 w/heat predominant (wen nue) - qu chi LI11 w/cold predominant (han nue) - hegu LI4 w/damp or phlegm - yin ling quan SP9 or feng long ST40 w/loss of consciousness - ren zhong DU26 w/restlessness - nei guan PC6 Once symptoms begin - bleed all hand jing-well points jian shi PC5, ye men TB2 (these two are emperical malaria points) da zhu BL11, hou xi SI3, pi shu BL20, zu san li ST36 w/sub-hypochondrial lumps and masses - pigan (M-BW-16), zhang men LR13, gan shu BL18 Ear acupuncture: adrenal, endocrine, subcortex, SP, LR. Retain 1 hour, treat daily for 3 days.

Nue Zheng Typical Malaria

Lao Nue Taxation Malaria

Tonify qi and blood Dispel evils Tonify, can add moxa.

Tuo Zheng Fainting Tuo Zheng Fainting Collapse of Yin Tuo Zheng Fainting Collapse of Yang

Fainting is a sudden separation of yin & yang, or a collapse of yin & yang. Similar to sunstroke but jin fluids are lost.

Bao Tuo (excessive type) - Excessive sweating and/or fever, severe hemorrhaging, separation of yin/yang, death comes rapidly. Xu Tuo (deficient type) - Later stage of chronic illness, loss of yin is not easily replenished. Gradual loss of yuan qi, jing, yang. Blood loss. Stop desertion Return yang Regulate yin yang Tonify, moxa nei guan PC6 - raise blood pressure and improve cardiac function su liao DU25 & ren zhong DU26 - stimulate qi and awaken brain guan yuan REN4 & shen que REN8 (moxa) - return yang, stop desertion yong quan KI1 (drain) - revive from fainting (bring superficial yang back to yin) zu san li ST36 & he gu LI4 - assist yang to stop desertion zhong chong PC1 - regulate qi of yin and yang meridians After restoration of consciousness add tai xi KI3 & qi hai REN6. w/heart failure - nei guan PC6 w/cold limbs - moxa bai hui DU20 & qi hai REN6 w/cold limbs and fading pulse - moxa bai hui DU20, shen que REN8 & quan yuan REN4 w/coma - ren zhong DU26, zhong chong PC9 & yong quan KI1

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Wind evil with roving pain. Pain moving through muscles, joints and limbs, no fixed location, tingling, radiating pain, can have signs of heat or cold, pain can come & go, more common in upper body. T- thin white or yellow coat P- floating, wiry Accumulation of cold with severe pain. Fixed location, limitation of movement, usually unilateral, may be alleviated by heat, aggravated by cold, patient may like to rub, press or pat painful area. T- white coat P- tight, wiry Tx Principle Dispel wind Clear the connections Dissipate cold or heat Dispel dampness Dissipate cold Clear the connections Dispel wind Dispel dampness Acupuncture Points / Techniques

44

Syndrome Xing/Feng Bi Moving/Wind Painful Obstruction

Etiology / Pathomechanism Bi Zheng - Painful Obstruction All bi patterns involve obstruction of the channels and connections inhibiting the flow of qi and blood. The invasion of wind, cold and damp obstruct the flow, this affects the muscles, bones, tendons and joints causing aching, pain, heaviness, numbness, difficulty of movement or redness and swelling. There is often a pre-existing deficiency pattern causing the pores to be flaccid and empty which allows the evil pathogen to move inward. When this pain becomes chronic, zheng qi is weakened and the pathogen moves further in to the body. Exposure to wind, damp, cold, heat penetrates and blocks movement of qi and blood causing pain.

ge shu BL17, gan shu BL18, san yin jiao SP6 & xuehai SP10 - tonify to nourish blood to expel wind feng men BL12, feng shi GB31, xuan zhong GB39, da zhui DU14, feng chi GB20, zhi gou TB6, yang ling quan GB34, tai chong LR3 & he gu LI4 - drain to dispel wind From Compendium of Acupuncture: chi ze LU5 & yang fu GB38 Plus see local point prescriptions on next page. Use warm needle moxa to dissipate cold, nourish & move blood. shen shu BL23, ming men DU4, guan yuan REN4 , shen que REN8 zu san li ST36, qi hai REN6, yang gu SI5, tian zhu BL10, da zhui DU14, yao yang guan DU3 From Compendium of Acupuncture: qu chi LI11, lie que LU7, huan tiao GB30, feng shi GB31, wei zhong BL40, shang qiu SP5, zhong feng LR4, zu lin qi GB41 With severe general internal coldness - ming men DU4 (add moxa) & shen que REN8 With cold affecting joints - yang chi TB4 & chong yang ST42 (add moxa) Plus see local point prescriptions on next page. pi shu BL20 - tonify to nourish blood yin ling quan SP9, san yin jiao SP6, yang ling quan GB34 & zu san li ST36 - drain to drain dampness From Compendium of Acupuncture: ge shu BL17, shang qiu SP5 Plus see local point prescriptions on next page. da zhui DU14, qu chi LI11, feng chi GB20, he gu LI4, xian gu ST43 - drain to clear heat With heat in blood - qu chi LI11 & xue hai SP10 With damp-heat - qu chi LI11, yin ling quan SP9, yang ling quan GB34 & wai guan TB5 or zhi gou TB6 Plus see local point prescriptions on next page. For all above bi types: w/qi & blood deficiency - tonify zu san li ST36, san yin jiao SP6, guan yuan REN4, qu quan LR8, pi shu BL20, shen shu BL23 w/phlegm in joints - clear feng long ST40, yin ling quan SP9, san yin jiao SP6, shui fen REN9; tonify pi shu BL20 & zhong wan REN12 w/blood stasis - clear or even; xue hai SP10, ge shu BL17, nei guan P6, san yin jiao SP6, qu qhi LI11 w/liver & kidney deficiency - tonify da zhu BL11, gan shu BL18, shen shu BL23, guan yuan REN4, qu quan LR3, yang ling quan GB34, zu san li ST36, san yin jiao SP6, xuan zhong GB39, tai xi KI3

Tong/Han Bi Painful/Cold Painful Obstruction

Zhao/Shi Bi Fixed/Damp Painful Obstruction Re Bi Heat Painful Obstruction Gu Bi Bone Painful Obstruction

Accumulation of damp with numbness of muscles & joints, distending, aching pain with fixed location, heaviness, mild swelling without redness, worse w/damp or cold. T- white greasy coat P- soggy Red, swollen, painful joints. Dont want affected joint to be touched, sweating, limited movement, sore throat or fever common, scanty urine, constipation, red complexion. T- thick yellow greasy coat P- rapid, soggy

Dispel dampness Clear the connections Dispel wind Dissipate cold Drain heat Clear the connections Dispel wind Dispel dampness da zhu BL11, xuan zhong GB39 - even method.

Only occurs in chronic cases and develops from any of the above four types. Persistent obstruction of joints leads to retention of body fluids which transform to phlegm, further obstructing joints and channels. This can then lead to muscular atrophy and swelling and deformity of joint bones.

Painful joints with swelling and bone deformities, numbness and heaviness of the body and limbs, heavy sensation in affected parts, stiff joints which are difficult to move. Prolonged bone bi can develop into kidney bi: curved back & waist, difficult to straighten after bending, anchylosis, impaired flexion/extension, weak lower limbs, difficult walking, loss of hair.

Needling Techniques

Successive needling (bao ci) - For non-localized traveling pain (wind-bi). Insert a needle into an ashi sensitive point, manipulate needle and retain needle for a few minutes. Meanwhile, find a second ashi point in area, then remove first needle and needle second point with the same method. Restorative needling (hui ci) - For relaxing muscles and tendons, relieve spasms. Insert needle in ashi point, apply lift and thrust manipulation perpendicularly, then reinsert obliquely and lift and thrust again in each of the four directions. Uniform needling (qi ci) - For cold-fixed bi on a small deep spot. Insert needle in center of painful spot, then two other needles are inserted very near on each side of first needle. Add moxa to needles. Superficial needling (yang ci) - For superficial cold bi on larger area of skin and muscle. Insert one needle perpendicular in center of painful spot, then add four needles around it inserted flat and superficially, pointing toward first needle. Short thrust needling (duan ci) - For treating bone bi. Insert needle at ashi point or nearest acupuncture point in center of painful area. Obtain de qi, then insert needle until tip gently touches bone underneath, twist it and lightly lift and thrust, gently contacting bone with each thrust. Use a light touch to avoid damaging periosteum and bone. Shallow or floating needling (fu ci) - For tendon, muscle or cold bi with muscular spasms. Insert two needles obliquely and slightly lateral on either side of affected muscle. Muscle needling (he gu ci) - Treats cramping and pain in muscles. For wind, damp and cold bi. Insert needle perpendicularly in most painful spot of affected muscle, lift and thrust perpendicularly and obliquely. Then insert two more needles obliquely, pointed away from first needle, parallel to tendon attachments of muscle to bone and gently manipulate.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Tx Principle Acupuncture Points / Techniques

45

Syndrome Local Area

Etiology / Pathomechanism

ASHI points: In myofacial pain and joint pain, treating ashi points may sometimes produce better results than treating traditional points. Local points: use jing-well & xing-spring for superficial pain; jing-river & he-sea for deeper pain. Yuan / Lou point combination: use in cases of the pain affecting both interior-exterior related channels (i.e. anterior shoulder pain along both lung & large intestine channels, use lie que LU7 & he gu LI4 as first combination and pian li LI6 & tai yuan LU9 as second combination). The yuan points open the channels and the luo points unblock the collaterals and eliminate stagnation. This can provide quicker results and greater long-term therapeutic effectiveness. Adding jing-well points: adding the jing-well points of the associated channels to the above yuan / luo technique may improve therapeutic results even more, especially on pain relief and muscular spasm along meridian. [Also refer to Facial Pain syndrome.] Distal points - he gu LI4, nei ting ST44 Local points - si bai ST2, ju liao ST3, jia che ST6, xia guan ST7, quan liao SI18 Ear acupuncture - Group A: cheek, mandible, maxilla. Group B: shen men, sympathetic; add to body points if results are insufficient. Use 1-2 points from each group. Acute due to invasion of wind-cold or to sprain. Chronic due to repeated attacks which are nor treated properly. Commonly has underlying liver pattern (liver blood deficiency in women, liver qi stagnation or liver yang rising in men, liver fire or liver wind in elderly). [Also refer to Crick in the Neck syndrome.] Combination 1 - tian zhu BL10, feng chi GB20 & da zhui DU14 Combination 2 - hou xi SI3, lie que LU7 & luo zhen extra (if neck pain is unilateral, stimulate the contralateral lou zhen first) 3-needle technique - da zhui DU14 & an mian, this prescription is especially useful in the case of sleeplessness with neck pain. In acute cases, use stronger manipulation with reducing method. Distal points are more important in acute cases. Always treat underlying condition in chronic cases. Acute case distal points - hou xi SI3 (occiput & back of neck pain), wai guan TB5 (pain on side of neck, use on affected side), xuan zhong GB39 (for restricted movement, reduce this point while patient slowly moves neck from side to side) Acute case local points - tian zhu BL10 (with bilateral occiput pain), feng chi GB20 (pain at base of neck & top of shoulder), feng fu DU16 (expel wind), jian jing GB21 (tension in trapezius) Chronic case distal points - kun lun BL60 (neck, shoulder, upper back), wai guan TB5 (pain on side of neck, use on affected side), san yang luo TB8 (pain involving multiple arm yang channels), nei guan PC6 (effective for nervous tension in women), da zhong KI4 (kidney deficiency), febg long ST40 (luo, goes to throat) Chronic case local points - see acute local points above and check for tenderness at jian zhen SI9, nao shu SI10, tian zong SI11, bing feng SI12, qu yuan SI13, jian wai shu SI14, jian zhong shu SI15 and tian liao TB15. Warming needle or cupping stop pain and relax the muscles.

Head & Face

Neck

Chest & Ribs Spine

qi men LR14, nei guan PC6, jian shi PC5, yang ling quan GB34, wai guan TB5 on most ashi side or zhi gou TB6, hui zong TB7, yang ling quan GB34 on contralateral side [Also refer to Lower Back Pain or Sprain syndromes.] Thoracic spine: ren zhong DU26, + jia ji or bei shu pressure pain points with electro-acupuncture; huo xi SI3 (for acute conditions), combine with shen mai BL62 for entire spine Upper back: cheng shan BL57, needle or bleed contralateral to pain Lower thoracic or upper lumbar: kong zui LU6, needle or bleed contralateral to pain Lower spine: jia ji or bei shu pressure pain points with electro-acupuncture; niu shang xue extra (for acute lumbar sprain, 3 cun distal to qu chi LI11 on meridian line, manipulate while moving painful part), shen shu BL23, zhi shi BL52 (moxa to resolve cold & dampness), yin men BL37, wei zhong BL40 (for blood stasis, acute pain) Sacroiliac joint area: tai xi KI3, contralateral to pain [Refer to Shoulder Pain syndrome.] Distal points - he gu LI4, shang yang LI1, wai guan TB5, san yang luo TB8 (if pain covers both LI & TB channels), xi yang guan GB33 (on contralateral side) Local points - qu chi LI11 (pain & inflammation, tennis elbow), qu yang wei extra (warming needle, adjacent to epicondyle when elbow is bent on dorsal aspect), zhou liao LI12 when pain radiates upward along channel), tian jing TB10 olecranon pain & bursitis), xiao hai SI18 (pain at medial condyle of humerus), chi ze LU5 (elbow stiffness), shao hai HT3 (numbness & inflammation or contracture of elbow) Other combinations - qu chi + shou san li LI10 or he gu LI4; tian jing TB10 + wai guan TB5; chi ze LU5 + lie que LU7 Cortisone injections slow down the effects of acupuncture; it can help to needle the luo point of the affected channel on the opposite side in these cases. Needle distal point first, then use local points. Distal points - zu san li ST36 (with dampness); the following points correspond to using the corresponding channel of the same polarity on opposite end: jie xi ST41 on same side (pain in LI channel), qiu xu GB40 (pain in TB channel), kun lun BL60 (pain in SI channel), shang qiu SP5 (pain in LU channel), zhong feng LR4 (pain in pericardium channel), tai xi KI3 (pain in heart channel) Local points - yang chi TB4, wai guan TB5, wan gu GB12, yang gu SI5, yang xi LI5, da ling PC7 (can surround entire wrist) Use moxa if cold is involved. If wrist is swollen, tap with plum blossom needle to elicit slight bleeding and then apply indirect moxa stick over area. [Also refer to Sprain syndrome for fall on heel of hand with nerve pain or for wrist sprain.]

Shoulder Elbow

Wrist

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Tx Principle Acupuncture Points / Techniques

46

Syndrome Fingers

Etiology / Pathomechanism

For acute cases use local points only - ba xie extra, san jian LI3 (needle deeply, .5-1 cun), zhong zhu TB3, hou xi SI3 (needle deeply, .5-1 cun) For chronic cases use local points above combined with adjacent points - wai guan TB5 (obtain deqi radiating towards fingers), lie que LU7 (for pain at base of thumb, needle obliquely distally, needle sensation should radiate towards the thumb), yang gu SI5 (when fingers are swollen, transforms dampness) Distal points - zu lin qi GB41 (main point), qiu xu GB40 (yuan of GB), shen mai BL62 (good for hip stiffness), tai bai SP3 (if pain radiates to groin), wei zhong BL40, yang ling quan GB34, xuan zhong GB39 Main local hip pain point: huan tiao GB30 (with warm needle) Anterior hip: jul iao GB29, chong men SP12 (when pain extends to groin) Thigh: cheng fu BL36, yin men BL37, fu tu ST32 or feng shi GB31 For sciatic pain extending down lateral thigh/leg - huan tiao GB30, feng shi GB31, yang ling quan GB34 & kun lun BL60 [Also refer to Sprain syndrome for hip sprain.] Distal points - shang qiu SP5 (main distal point), qiu xu GB40 (with pain along gallbladder channel), jie xi ST41 (with pain along stomach channel), xue hai SP10 (to circulate and nourish the blood, cool blood, reduce stasis) Local points for pain above the knee - lian qiu ST34 with warming needle (unless there is heat) Local points for pain at lateral knee - zu san li ST36 (expels dampness from knee), yang ling quan GB34 (influential point for sinews, treats stiffness in knee), xi yang guan GB33 (relaxes the tendons) Local points for pain at medial knee - yin ling quan SP9 (always use if knee is swollen), xi guan LR7 (relax tendons, expel damp and cold), qu quan LR8 (especially with underlying liver and kidney deficiency, strengthens the knee) Local points for pain inside knee joint - xi yan extra (use warming needle unless there is heat), zu san li ST36 Local points for pain at back of knee - wei zhong BL40 Three needle technique - he ding, lateral & medial xi yan (if cold type arthritic pain, add warming needle technique to all three points) Electro therapy: nei xian xue hai SP10 and wai xian liang qiu ST34; + needle yang ling quan GB34, yin ling quan SP9 and xi yang guan GB33 [Also refer to Sprain syndrome for knee sprain.] Main points: qiu xu GB40 (needle deeply, often used with warming needle), shang qiu SP5, jie xi ST41 (expel dampness, good for pain at instep, needle at least .5 cun) zhao hai KI6, tai xi KI3, kun lun BL60 (treat ankle & heel pain, edema, pain in sole of foot), yang xi LI5 on contralateral side, LU2a on contralateral side (ashi slightly lateral to yun men LU2, on deltoid muscle) With swelling of ankle due to rheumatic disorder or sprain - san yin jiao SP6 & yin ling quan SP9 Lateral ankle sprain - electro therapy: qiu xu GB40 shen mai BL62 [Also refer to Sprain syndrome for ankle sprain.] ba feng extra plus either chong yang ST42 or jie xi ST41 - for numbness, pain and/or inflammation, regional arthritic pain, spasm or contracture Distal points - jie xi ST41, tai xi KI3 & kun lun BL60 -or- jie xi ST41, qiu xu GB40 & shang qiu SP5 With dampness - tai bai SP3 With swelling - san yin jiao SP6 & yin ling quan SP9 With yin deficiency (feeling of heat in feet, especially at night) - tai xi KI3 & san yin jiao SP6; needle sensation should radiate to toes

Hip & Thigh

Knee

Ankle

Toes

Alternate therapeutic methods for painful obstruction: Ear acupuncture: shen men, sympathetic, corresponding site of pain Acupuncture injection: .5 - 1 ml in local points of dang gui, fang feng, wei ling xian Plum blossom: for heat syndrome tap around swollen joint to elicit bleeding, tap along jia ji points corresponding to area of pain. Tinctures for cold bi: wu jia pi, ji xue teng, sang ji sheng Prevention: Apply 5 direct moxa cones in summertime to point for area that pain occurs; for upper limbs- qu chi LI11, for lower limbs - zu san li ST36, for upper back - gao huang shi BL43, for lower back - shen shu BL23 Grand Master Technique for Pain Disperse the painful points, then tonify the principle channels. Insert needles in painful points, subcutaneously for superficial pain, deeply for deep pain. Apply electro stim to disperse for 15-20 minutes. Join with trigger point, ashi point, jia ji enervation point, etc. Tonify the mother point and yuan-source point on the affected channels.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Cold-damp exposure, heaviness, aching, numbness in lower back, spasms, contractions which radiate into thigh, buttock or popliteal fossa, severe pain, aggravated by cold-damp weather, pain can come and go, worse with cold raw food, better with warmth. T- white greasy coat P- deep, weak; or weak, slow Sharp pain of fixed location, usually there is qi and/or blood stagnation, there may be history of trauma/injury, where less severe there is stiffness & aching. Aggravated by tiredness or physical exertion. Have difficulty twisting waist. Often have static blood at wei zhong BL40. T- normal P- normal or wiry Tx Principle Scatter cold Transform damp Warm the channels Stop pain Drain Tonify & moxa kidney. Acupuncture Points / Techniques

47

Syndrome Yao Tong Lower Back Pain Cold-damp

Etiology / Pathomechanism Exposure to cold-damp after sweating, laying on damp cold ground for extended periods, exposure to wind & rain, swimming in cold water, causes cold to enter the meridians and blocks qi & blood circulation in lumbar region. Pain at one or both sides of lumbar spine. Trauma from twisting of lower back due to a heavy load, a fall, a compression injury, working bent over for extended periods. Causes blockage of qi & blood circulation in lumbar region. Pain at one or both sides of lumbar spine. Can include spine pathology or pathology of soft tissue around spine.

Yao Tong Lower Back Pain Trauma (blood stasis)

Invigorate blood Transform stasis Rectify qi Stop pain Drain

shen shu BL23 - tonify, strengthen lower back wei zhong BL40 - drain damp, command point for lower back & legs, relax the sinews, treat lumbar pain & difficulty flexing & extending hip joint (can let blood and cup) yao yang guan DU3 - benefit lumbar region & legs, treat combined lower back & leg disorders with pain & motor impairment a shi points of low back & legs ge shu BL17 - invigorate blood, dispel stasis, rectify qi jin suo DU8 - relax sinews, relieve stiffness and contraction shi qi zhu xia extra - (below L5) - for back pain and aching in the center of lower back ci liao BL31 - for pain over sacrum, needle sensation should radiate outwards For cold-damp - ming men DU4 & yin ling quan SP9; add moxa to scatter cold, drain damp For acute sprain of spine - ren zhong DU26 - manipulate strongly, then have patient gently bend & flex For bilateral acute low back pain - tian zhi BL10 or yao tong xue extra (all 4 on both hands, medial oblique at least .5 cun); with patient standing needle first with reducing method, have patient gently bend and twist lower back, manipulate needle again, repeat until pain is reduced, then have patient lay down for complementary treatment. Distal points - hou xi SI3 (unilateral pain near L2), yao tong xue (unilateral pain above L2), fei yang BL58 (with leg pain in GB & BL channels), shen mai BL62 (unilateral pain radiating down leg), fu yang BL59 (if walking is difficult, needle sensation should radiate upward along channel) shen shu BL23 - tonify kidney, fortify yang, nourish kidney yin, strengthen lower back wei zhong BL40, yao yang guan DU3, a shi points of low back & legs ming men DU4 - assist yang, strengthen yuan qi, strengthen lower back, tonify kidneys zhi shi BL52 - tonify kidney, benefit jing, strengthen lumbar region fei yang BL58 - treat pain of upper & lower back, atrophy of leg, lower back pain & sciatica tai xi KI3 - boost kidney yin & yang, strengthen lower back & lumbar spine If pain stems from midline - Men: SI3 on L, BL62 on R. Women: SI3 & KI6 on R & BL62 & LU7 on L If pain radiates out toward hip - Men: BL62 on R (1st), SI3 on R (2nd), use opposite sides for women w/yang deficiency - moxa at ming men DU4 & shen shu BL23

Yao Tong Lower Back Pain Kidney Deficiency

Prolonged or chronic illness, advanced age, or fever can deplete yin. Advanced age or excessive sexual activity can deplete jing. Depletion of yin and/or jing cause a lack of nourishment of contractile tissue and bones.

Aching & weakness of lower back, dull, indistinct, gradual onset, may have accompanying discomfort in legs & knees. With yang deficiency: fatigue, cold limbs. T- pale, swollen P- deep, weak With yin deficiency: irritable, restless, dark scanty urine. T- red, thin or no coat P- rapid, thready

Tonify kidney yang and/or kidney yin Stop pain Tonify

Pain originating from the lumbar spine or musculature is a common complaint, affecting an estimated 80% of people at some time in their lives. Lower back pain is commonly undiagnosed in western medicine, but can be due to disc herniation, sciatica, arthritis, degenerative spinal disorders, facet joint syndrome, soft tissue injury, prolapsed intervertebral discs, kidney disease, kidney stones, polycystic kidneys, tumors, intestinal and gynecological diseases. Acute pain is from invasion of pathogens or blood stagnation. Chronic pain is from kidney deficiency, combined kidney deficiency and pathogenic invasion, or spleen deficiency with damp.

For tight/contracted psoas (major and minor) muscle - needle and apply electro acupuncture to these two point pairs; wu shu GB27 qi chong ST30 and bi guan ST31 fu tu ST32 For one sided pain that restricts mobility - yao tong (hand low back points) - needle with patient sitting or standing while gently flexing and extending as far as they can manage, select most tender point on affected side and needle strongly. w/pain extending down leg - huan tiao GB30 -(main point for sciatica and pain in lower limbs), yang ling quan GB34, kun lun BL60 w/injury to spine - hou xi SI3 (opens to Du Mai) & ren zhong DU26 w/injury to side of spine (BL meridian) - kun lun BL60, cheng fu BL36, yin men BL37 w/pain at lateral lower abdomen (GB & LR meridian) - yang ling quan GB34, xing jain LR2, dai mai GB26, feng shi GB31, jue gu GB39 yao yan extra - (eyes of lower back) for low back pain [in depression 3.5-4 cun bilateral to L4]

Alternate therapeutic methods for lower back pain: Ear acupuncture: shen men, subcortex, KI, leg, lumbar, sacral, look for engorged or purple veins in low back area). Elicit strong sensation. Select points on affected side. Rapidly twist needles. Have patient try to move limbs and bend at waist. Hand acupuncture: Low back & leg points. Good for acute sprains & strains. Cupping: Apply to local area after needling. Prick veins at wei zhong BL40 and then cup. Plum blossom: Tap over the jia ji points, emphasizing the lumbar area, especially near shen shu BL23. Electro-acupuncture: jia ji at pressure point from L1 to L5 and connect two of the points on each side of spine, ci liao BL32 bao huang BL53; or bao huang BL53 zhi bian BL54; pressure point slightly medial to jia ji ci liao BL32 Massage and physical therapy can be used to increase results.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Stiffness and pain in the neck with inability to move/turn the head. Aching or pressure pain upon movement, may radiate into shoulder, upper back or arm of affected side. May have headache. Pain usually responds well to heat. Western: neck strain, inflammatory condition of neck muscles, arthritis of neck, cervical bone spurs. Stiffness & pain of neck, aversion to wind or cold, fever, headache. T- thin white coat P- floating, tight Dispel wind Scatter cold Soothe soft tissues Harmonize luo Drain Apply moxa or cupping. Warm needle therapy. Tx Principle Acupuncture Points / Techniques

48

Syndrome Lao Zhen Crick in the Neck General Information

Etiology / Pathomechanism Improper sleeping posture causing excessive extension and contraction of neck muscles. Caused from too high or too low pillow or excessive rotation or crooking of the neck. The majority of cases affect adults. Invasion of wind-cold obstructs flow of qi and blood causing pain and restriction of movement.

Auxiliary points: w/pain in upper limb - jian yu LI15, fu yang BL59 w/pain in upper back - tian jing TB10, pressure pain points on small intestine meridian in shoulder/neck w/pain in spine - ren zhong DU26 (distal point for acute sprain of spine) w/restricted forward/backward movement of head - kun lun BL60, lie que LU7 (command for nape) w/restricted left/right movement of head - zhi zheng SI7 w/bone spurs of cervical spine - da zhu BL11, ge shu BL17, san yin jiao SP6, shen shu BL23 luo zhen extra - on dorsum of hand, .5 cun proximal to and midway between the 2nd & 3rd metacarpophalangeal joints. Needle this point, along with houxi SI3 & xuanzhong GB39, while asking patient to move head in a circular fashion. Follow with needling local points with needle warming moxa and cupping on shoulders & back. hou xi SI3 - relax contractile tissue, benefit occiput, neck & back (meeting point of Du Mai) xuan zhong GB39 - meeting of marrow, benefit sinews, bones & neck, dispel wind-damp (needle upward and elicit strong upward sensation) feng chi GB20 or tian zhu BL10 - dispel wind, resolve exterior, tonify marrow, treat headache he gu LI4 - resolve exterior, expel wind, stop pain, move/invigorate blood w/fever - da zhui DU14 (retreat fever) a shi points luo zhen extra - on dorsum of hand, .5 cun proximal to and midway between the 2nd & 3rd metacarpophalangeal joints. Needle this point, along with houxi SI3 & xuanzhong GB39, while asking patient to move head in a circular fashion. Follow with needling local points with needle warming moxa and cupping on shoulders & back. hou xi SI3 - relax contractile tissue, benefit occiput, neck & back (meeting point of Du Mai) xuan zhong GB39 - meeting of marrow, benefit sinews, bones & neck (needle upward and elicit strong upward sensation) tian zhu BL10 - treats muscular/skeletal stiffness in neck, shoulder & upper back, treats diseases of cervical vertebrae, treats occipital headache ge shu BL17 - invigorate blood

Lao Zhen Crick in the Neck Invasion by Wind-cold

Lao Zhen Crick in the Neck Qi and Blood Stagnation

Qi and blood stagnation due to trauma or prolonged presence of wind-cold.

Stiffness & pain of neck, limited movement of head, may be history of trauma, may have masses or hard lumps in neck area. T- normal or purplish P- normal or choppy

Invigorate blood Move qi Soothe soft tissues Harmonize luo Drain Apply moxa or cupping.

Alternate therapeutic methods for stiff neck: Ear acupuncture: shen men, neck, shoulder, cervical vertebrae (threading), a shi points. Elicit strong sensation. Have patient move neck slowly while manipulating needles for 2-3 minutes. Retain needles for 30 minutes. Daily until pain is alleviated. Plum blossom: Tap over painful and stiff areas of neck, shoulder & upper back until skin is slightly red. Moxibustion treatment for wind-cold syndrome: ginger partition moxa at da zhui DU14 and feng men BL12 with 3-5 cones. Follow with indirect moxa at pressure pain points of neck & shoulder. For tai yang type pain (pain aggravated by flexion and extension): hou xi SI3 on most ashi side

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Tx Principle Acupuncture Points / Techniques

49

Syndrome Lou Jian Feng Leaky Shoulder Wind Shoulder Pain Frozen Shoulder 50s Shoulder

Etiology / Pathomechanism

This is a bi zheng syndrome, common in middle-aged women due to functional decline of yin and blood. There is limited range of movement accompanied by pain. Biomedical: scapulohumeral periarthritis, peripheral shoulder arthritis. Habitual poor sleeping position (side sleeping) weakens circulation in rotator cuff muscles causing qi and blood stagnation and weakening of shoulder muscles. A functional decline of yin & blood causes decline of ying & wei qi and lack of protection from exogenous pathogens and poor nourishment arriving at shoulder area, there is susceptibility to wind-cold invasion which causes contraction, blockage & pain. Overtaxation/overuse of shoulder causing stagnation of qi & blood. Invasion of, or pre-existing dampheat causing blockage and limited movement. There are 3 types of lou jian feng: 1) Wind type - Contractile tissue attack, related to tendons. Pain radiates to neck & upper back and tends to move around. 2) Cold type - Could be injury to bone. Pain is deep, severe and responds well to heat. 3) Damp type - Injures the flesh. Heavy, fixed shoulder pain, aggravated by pressure, local swelling either with or without redness. Determine the following: Is pain unilateral or bilateral? Where does pain radiate to (neck, arm, hand, fingers)? Is pain worse at night? Is pain aggravated by wind & cold? What is the range of motion? Muscles affected with dysfunction of: abduction - deltoid, supraspinatus adduction - teres major, pectoralis major, latissimus dorsi forward flexion - pectoralis major, coracobrachialis forward extension - posterior deltiod, teres major, latissimus major lateral rotation - infraspinatus, teres minor, posterior deltoid medial rotation - subscapularis, latissimus dorsi, anterior deltoid, teser major, pectoralis major elevation of scapula - upper trapezius, levator scapulae, rhomboid, lower serratus anterior Dr. Tan: Pain between shoulder & scapula or scapula pain yang lao SI6 on same side Lateral deltoid (shao yang area) - SP9a (1-2 cun below yinling quan SP9) on contralateral side Frontal shoulder (yang ming area)- jie xi ST41 on same side Trapezius area - huan tiao GB30 on contralateral side Dredge, open and allow clear passage thru jing luo Depending on type: Dispel wind Scatter cold Transform dampness Drain Moxa for cold type. For acute shoulder pain the main distal point is tiao kou ST38, needle on same side and manipulate strongly while patient gently rotates shoulder joint, provide assistance if needed. If main area of pain is along SI channel, use fei yang BL58 instead with same technique. Follow with local points and use warming needle for cold type. Core points: jian yu LI15 - local (upper deltoid) jian zhen SI9 - local (teres major) bi nao LI14 - local (lower deltoid) qu chi LI11 - treat elbow to treat shoulder wai guan TB5 - opens shao yang hou xi SI3 - opens tai yang jian qian extra - local, for anterior shoulder pain (midway between jian yu LI15 and superior end of anterior axillary crease) jian hou extra - local, for posterior shoulder pain (1.5 cun superior to posterior axillary crease) For wind type add - feng chi GB20, yang ling quan GB34 For cold type add - moxa at local ashi points For damp type add - yin ling quan SP9 If tai yin (LU meridian) is involved there is limited forward flexion (difficulty adducting arm), pain may radiate to thumb, muscles involved include anterior deltoid, pectoralis major & coracobrachialis - add tai yuan LU9, chi zi LU5, jian nei shu (midway between high point of clavical and coracoid process, anterior to clavical). Local point: yun men LU2. If yang ming (LI meridian) is involved there is difficulty abducting arm, muscle atrophy, pain at superior aspect of glenohumeral joint which radiates to index finger - add shou san li LI10, tiao kou ST38 (needle towards shoulder and have patient move shoulder joint). Local points: jian yu LI15 & bi nao LI14 If shao yang (TB meridian) is involved there is numbness & tingling in 3rd, 4th & 5th finger, limited abduction, pain behind acromion extending to back of neck or ear, pain can radiate to posterior elbow, muscles include posterior deltoid and latissimus dorsi - add yang ling quan GB34. Local points: nao hui TB13, jian liao TB14, tain liao TB15 If tai yang (SI meridian) is involved there is difficult extension backward, limited adduction forward, muscles involved include posterior deltoid, levator scapulae, trapezius & rhomboid - Local points: jian zhen SI9, nao shu SI10, tian zong SI11, bing feng SI12. qu yuan SI13, jain wai shu SI14, jian zhong shu SI15, nao hui TB13, (can let blood & cup). If shao yin (HT meridian) is involved there is pain in armpit radiating down inner arm - ji quan HT1, qing ling HT2, shao hai HT3 For chronic pain use local points above and distal points based on the channel involved - large intestine: shang yang LI1 or he gu LI5 plus lie que LU7, lung: lie que LU7, small intestine: hou xi SI3 or shao ze SI1, triple burner: guan chong TB1 or wai guan TB5 Three needle technique: jian yu LI15, jian qian (1 cun anterior to jian yu LI15) and jian hou (1 cun posterior to jian yu LI15). Direct needle to center of shoulder, 1-1.5 deep. Add cupping and moxibustion.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Tx Principle Move qi Invigorate blood Open and allow clear passage through jing luo Acute cases - drain. Prolonged cases - tonify and add moxibustion or needle-warming moxa. Always treat injury ASAP. If injured area is too tender to treat locally, needle distal or opposite side points. Have patient try to move injured area while manipulating needles. Acupuncture Points / Techniques

50

Syndrome Niu Shang Sprain

Etiology / Pathomechanism

Twisting injury of soft tissues of body or joints (muscles, tendons & vessels). Excludes fractures, joint dislocation and conditions where skin is broken. Forceful movement, improper lifting, twisting at the waist, falls, traction injuries with overstretching, can all injure the contractile tissue or joints. There is profusion of qi locally with blood stasis. Local swelling and pain, may have bruising. Acute, mild injury has mild swelling, pressure pain over local area. Severe acute injury has inflammation and redness locally with impaired movement of joint. If ligament is torn, surgery may be required. In long-term injury, swelling is usually not significant, instead there may be invasion of wind, cold and/or damp. Over a long period this becomes bi zheng, painful obstruction. Emperical therapies: Lower back sprain - plucking or pulling technique at kun lun BL60, pluck inward and upward to produce electrical sensation moving thru calf; select ashi points on Du Mai and Tai Yang; needle jin men BL63 (xi-cleft); injection therapy of 5-10% dong gui along spine; w/twisting pain, needle zhi gou TB6 & yang ling quan GB34 and have patient move back while manipulating needles. Fall on heel of hand with nerve pain - yang lao SI6, ju quan HT1. Also apply disperse blood stasis free passage in luo technique (san yu tong luo fa); insert needles 10mm distal or proximal to local ashi points, use multiple needles, about 3-5, or 3-5 pricks with 3-edge needle, at the superficial level and let blood, then apply cup and leave for 20 minutes, follow with indirect roll moxa for 30-50 minutes. If prompt treatment is applied to new injury, the effective rate is 78%. Hip sprain - This is often injury to the piriformis muscle. Needle or apply acupressure for 10 minutes to each of the following points; cheng fu BL36, yin men BL37, fu xi BL38, he yang BL55, huan zhong (midway between huan tiao GB30 & yao shu DU2), yang jiao GB35, jue gu GB39, feng shi GB31, and xue hai SP10. Laser therapy is also effective. Knee sprain - Select point of greatest pressure pain, needle superficially and let blood. Empirical points: ren ying ST9 & zhou jian (extra at elbow tip). Local points: liang qiu ST34, xue hai SP10, xi yan, yang ling quan GB34 & yin ling quanSP9, he ding; electro liang qiu ST34 to xi yan or yang ling quan GB34, and xue hai SP10 to xi yan or yin ling quan SP9. External invasion only. Most common between ages 20-40, but can occur at any age. Usually no concomitant wind stroke symptoms. Wind-cold or wind-heat invading yang ming, causing blockage of qi and blood. Wind-cold follows injury due to cold, sleeping in wind or draft or being near fan for long periods. Wind-heat follows a cold with fever, middle-ear infection, infection of gums. Abrupt onset, usually upon waking, side of face feels heavy & numb, deviation of mouth & eye, unable to expose teeth or puff out cheeks, drooling, dribbling, food collects, eyelid wont completely close, tearing, can have pain posterior or inferior to ear. Anterior 2/3 of tongue is affected for movement and taste. May have sensitivity to noise. This is a stomach pathology, sudden deviation of mouth, one side eye wont open, other side eye wont close.

Use ashi points locally, plus blood moving distal points: he gu LI4, san yin jiao SP6, tai chong LR3, and ge shu BL17 or gan shu BL18. Local area point prescriptions: Shoulder - jian yu LI15, jian liao TB14, jian zhen SI9 & jian qian (anterior aspect of shoulder joint, midway between anterior axillary crease & jain yu LI15). Elbow - qu chi LI11, xiao hai SI8, tain jing TB10 (electro LI11 to TB10) & he gu LI4 Wrist - yang chi TB4, yang xi LI5, yang gu SI5 & wai guan TB5 Lower back - da chang shu BL25, yao yang guan DU3 & wei zhong BL40 Hip - huan tiao GB30, zhi bian BL54, cheng fu BL36 & yang ling quan GB34 Groin strain - Local points on liver meridian with electro, nei guan & extra point 1.5 cun proximal to elbow on heart meridian on opposite side plus li gou LR5 on same side. Knee - du bi ST35, nei xi yan & liang qiu ST34 Ankle - jie xi ST41, kun lun BL60 & qiu xu GB40 Lateral ankle sprain - electro shen mai BL62 and qui xu GB40 Neck - feng chi GB20, tian zhu BL10, da zhu BL11 & hou xi SI3 Alternate therapeutic methods: Ear acupuncture: sensitive points corresponding to site of injury, subcortex, shenmen, adrenal. Retain for 10-30 minutes daily or every other day. Bloodletting & cupping: Use plum blossom needle and tap heavily over painful areas until blood droplets appear, follow with fire cupping. This method is appropriate in cases of recent injury where hematoma is marked, as well as in prolonged cases where static blood is evident and cold has invaded the area.

Mian Tan Facial Paralysis Wind-cold

Dispel wind Disperse cold Regulate & harmonize qi & blood Drain. Follow with tonifying. Dispel wind Clear heat Regulate & harmonize qi & blood Drain. Follow with tonifying.

Mian Tan Facial Paralysis Wind-heat

feng chi GB20 - open luo, dispel wind, stop pain yi feng TB17 - open orifaces, dispel wind, clear heat, treat pain at ear posterior wai guan TB5- expel wind, release exterior, clear heat, release the muscles, benefit head & ears connect di cang ST4 to jia che ST6 - local points for mouth & cheek, oblique or flat needling yang bai GB14 & si bai ST2 - local points for eyes he gu LI4 - command point for face & mouth, distal yang ming crossover point xia ju xu ST39 - lower point of the sea of blood, regulate & harmonize qi & blood w/heat - nei ting ST44 (clear stomach heat), xian gu ST43 (clear heat from face & eyes) w/drooling - cheng jiang REN24 Point connection (tou fa) formulas (Manipulate lightly to avoid causing muscle spasms.) jie che ST6 di cang ST4; di cang ST4 ying xiang LI20; ying xiang LI20 si bai ST2; si bai ST2 quan liao SI18; then add distal points; he gu LI4 or nei ting ST44; tai chong LR3 or xing jian LR2

Alternate therapeutic methods for facial paralysis: Ear acupuncture: shen men, face, subcortex. Fresh ginger paste at yi feng TB17, yin tang, quan liao SI18. Prick with 3-edge needle, apply paste for 10 minutes. Cupping - Use small cup on affected areas of face. May cause bruising. Moxa: For 10-15 minutes at jia che ST6 & yi feng TB17 Plum blossom: On affected side of face, over yang bai GB14, si bai ST2, tai yang, quan liao SI18, di cang ST4, jia che ST6, yi feng TB17, wan gu SI4 Electro acupuncture: connect the most appropriate of the following point pairs, face muscles should twitch slightly; di cang ST4 jie che ST6; yang bai GB14 xia guan ST7; he gu LI4 wai guan TB5 Plaster: ma qian zi (seed), soak seed, slice, grind, mix into paste with water, apply to di cang ST4 & xia guan ST7, leave for 30 minutes. Daily for 3 days = one course. Will dispel wind, stop pain, relax contractile tissue, invigorate luo.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Tx Principle Acupuncture Points / Techniques

51

Syndrome mian tong Facial Pain General Info

Etiology / Pathomechanism

Spasmodic pain of cheeks & face. Usually unilateral and commonly on left side. Most common between ages 40-60. Pain is short lived initially, but gradually comes more frequently and is more severe. Western medicine: trigeminal neuralgia. Pain is generally intermittent, scorching, stabbing, lasts several seconds to minutes, or can last several hours or days. Spontaneously decreases and fades. Will come & go. Can disappear for months. Usually affects the inferior and medial branch of the trigeminal nerve (the lower & upper jaw). Pain will start at a particular location and is worsened by a breeze on that spot, by speaking, eating, tooth brushing & face washing. Upper branch will have pressure pain at zan zhu BL2, middle at si bai ST2, lower at da ying ST5.

Obtain deqi, apply doufa (shaking), retain needles for 30 - 40 minutes with no further manipulation. w/pain over or around eye - yang bai GB14, tai yang extra, si bai ST2, tai chong LR3 w/pain at upper jaw - feng chi GB20, yi feng TB17, xia guan ST7, he gu LI4 Threading (tou fa) formulas; needle every other day for 5 treatments, rest several weeks, repeat: Upper branch - yu yao, needle obliquely outward and downward, 1 - 1.5 cun, apply strong twirling Medial branch - si bai ST2, obliquely upward toward outer canthus, twirl or shake, sensation should radiate over cheek and even under tongue Lower branch - xia guan ST7, needle 1/3 depth of facial tissue, downward anterior to ear to jia che ST6 Lower branch - jia cheng jiang extra, obliquely toward tip of chin, obtain sensation in lower lip, doufa Point groupings that can be alternated: Upper: xia guan ST7, yang bai GB14, tou wei ST8, ben shen GB13, yin tang, zan zhu BL2, si zhu kong TB23 Medial: xia guan ST7, ying xiang LI20, tong zi liao GB1, jiao sun TB20, si bai ST2 Lower: xia guan ST7, ting hui GB2, jia che ST6, yi feng TB17, tain rong SI17 wai guan TB5 - resolves exterior, sensation should travel up to head feng chi GB20, yi feng TB17 - expel wind feng long ST40 - transform phlegm, open luo, treat exterior zu san li ST36 - moxa shao zi SI1, shang yang LI1, guan chong TB1 - jing-well of 3 yang of head, let blood to clear wind-heat qu chi LI11 - clear heat xian gu ST43 - shu-stream, treats pain in yang ming feng long ST40 - transfom phlegm ye men TB2, xing jian LR2 & xia xi GB43 - xing-spring, drain; clear heat & fire, clear liver qu quan LR8 - he-sea water, drain then tonify; tonify water to dampen fire

mian tong Facial Pain Wind-cold mian tong Facial Pain Wind-heat mian tong Facial Pain Liver wind & fire mian tong Facial Pain Qi & blood deficiency with blood stasis

History of exposure to cold. Cold will trigger symptoms and heat will alleviate symptoms. There may be clear nasal discharge. T- thin white coat P- floating, tight Usually follows after a cold with fever. Burning or feeling of heat at pain site. Drooling, red eyes, tearing of eyes. T- greasy yellow coat P- floating, rapid Irritability, breast distension, hypochondrial pain, sighing, red eyes, flushed complexion, flaring up of emotions. T- red, yellow coating P- rapid, wiry Pale complexion, fatigue, insomnia, dizziness, palpitations, sharp stabbing pain, pain in fixed location, may have purple stasis spots on face. T- pale purplish P- choppy

Disperse wind-cold Transform phlegm Open the luo Needle with draining. Dispel wind, clear heat Transform phlegm Open the luo Needle with draining. Clear the liver Drain fire Needle with draining. Tonify qi Nourish blood Invigorate blood Resolve stasis Open the luo Needle with tonifying.

ge shu BL17 - build & move blood gan shu BL18 - move blood, tonify liver blood and liver yin guan yuan REN4 - tonify & move blood (via its access to yuan yang qi) san yin jiao SP6 - tonify spleen & qi, nourish blood, move blood zu san li ST36 - tonify qi & blood w/aversion to wind - da zhui DU14 w/spontaneous sweating - tonify fu liu KI7 (consolidate the kidney, regulate water passages)

Alternate therapeutic methods for facial pain: Ear acupuncture: cheek, maxilla, mandible, forehead, shen men. Elicit strong sensation, retain for 20-30 minutes, manipulate every 5 minutes. Can use needle embedding therapy. Acupuncture injection: At pain point on face inject .5 ml of B12 or .1 ml of water. Electro: disperse the following points on good side of face to move qi & blood to bad side - quan liao SI18, ting gong SI19, ying xiang LI20, yang bai GB14; then tonify blood - he gu LI4, wai guan TB5, yi feng TB17, zu san li ST36 & san yin jiao SP 6 bilateral. For TMJ pain: zhong du GB32 on most ashi side

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Musculoskeletal Disorders

Symptoms Tx Principle Acupuncture Points / Techniques

52

Syndrome Wei Zhong Atrophy Syndrome

Etiology / Pathomechanism

Withering of tendons and muscles from lack of nourishment. General Symptoms: slackness or loss of tone in any of the 4 limbs, loss of strength, inability to move easily, when severe can have complete paralysis, most common in legs, can be unilateral or bilateral. When treating atrophy, select yang ming. It has ample qi and blood, it moistens & nourishes all of the contractile tissue, It meets the chong mai at qi chong ST30 and chong mai is the reservoir of the 12 meridians and is the sea of blood. As the sea of food & grain it provides the post-heaven constitution.

Core points for upper limbs - bi nao LI14 & jian yu LI15 (tonify qi & blood); qu chi LI11 (benefit sinews); he gu LI4 & hou xi SI3 (affect hand & fingers); yang xi LI5; shou san li LI10 (for forearm); wai guan TB5 (remove obstruction & expel wind/spasms) Core points for lower limbs - bi guan ST31 (facilitate raising of leg), fu tu ST32, lian qiu ST34, zu san li ST36, jie xi ST41 & qiu xu GB40 (when foot is dragging), san yin jiao SP6, huan tiao GB30 (treat with patient on side, get needle sensation down to foot), feng shi GB31, yang ling quan GB34 Other core points - ci liao BL32, yao yang guan DU3, shen zhu DU12 & da zhui DU14 with corresponding jia ji points (affect spinal nerves), qi chong ST30 (promote circulation of nutrients from stomach upwards to tendons & ligaments along spine and downwards to legs). Clear lung heat Moisten dryness Nourish the lung Generate fluids Clear heat Transform damp Drain Acute condition, treat daily. Core points above plus: fei shu BL13 - discharge lung heat, nourish lungs chi ze LU5 - clear lung heat, regulate water passages da zhui DU14 & zhong fu LU1 - clear heat and lung heat zu san li ST36, san yin jiao SP6 & tai xi KI3 - nourish yin and promote fluids Core points above plus: yin ling quan SP9, san yin jiao SP6, san jiao shu BL22- clear heat, regulate spleen & transform dampness pi shu BL20 - transform dampness da zhui DU14, qu chi LI11 - clear heat zu san li ST36 - tomify to strengthen spleen and resolve dampness Core points above plus: feng long ST40, yin ling quan SP9, san yin jiao SP6 - drain dampness tou wei ST8 - even zhong wan REN12, pi shu BL20, zu san li ST36, ming men DU4 - moxa; strengthen SP/ST Core points above plus: gan shu BL18, shen shu BL23, tai xi KI3, qu quan LR8 - tonify liver & kidney yin xuan zhong GB39 - increase or benefit marrow, benefit sinews and bones, dispel wind-damp yang ling quan GB34 - benefit sinews & joints, treat hemiplegia and paralysis of lower limbs yao yang guan DU3 - tonify kidneys and circulate qi and blood to legs guan yuan REN4 - tonify kidney yin w/blood stasis - ge shu BL17, da shu BL11, xue hai SP10, zhi yang DU9, jin suo DU8, ST36 & SP6 Core points above plus: zhong wan REN12 & zu san li ST36 - even technique, strengthen spleen & stomach, transform damp san yin jiao SP6 - drain to drain dampness pi shu BL20, wei shu BL21 - even technique, fortify spleen, boost stomach, transform damp, boost qi w/ heat - nei ting ST44, drain heat

Wei Zhong Atrophy Syndrome Lung-heat (with injury to body fluids) Wei Zhong Atrophy Syndrome Damp-heat

Profusion of heat in lungs (from exogenous invasion of toxic heat or from febrile illness) damages jin and ye fluids and weakens lungs, lungs cant nourish skin, muscles and flesh causing atrophy. Exposure to dampness which collects to form heat. Damp-heat affects yang ming channels causing slackness & atrophy.

General symptoms above plus: rapid development, fever, cough, irritability, thirst, dark scanty urine. T- red, yellow coat P- surging, rapid General symptoms above plus: rapid development, heavy aching limbs, fever with sweating, chest oppression, aversion to heat in affected limbs, relieved by cold, turbid urine. T- yellow greasy coat P- slippery, rapid General symptoms above plus: dizziness, feeling of heaviness, blurred vision, pain in back and shoulders, numbness of back, weakness, flaccidity and coldness of limbs. General symptoms above plus yin deficiency symptoms: slow onset, gradual weakening, no fever or exogenous attack, aching, weak lower back, dizziness, seeing black, palpitations, spontaneous sweating. T- red, scanty coat P- rapid, thready Can develop to blood stasis pattern with purple tongue. General symptoms above plus SP/ST deficiency & dampness symptoms: slow onset, sallow complexion, spontaneous sweating, decreased appetite, muddy stools, edema in affected limbs. T- pale, white coat (can be greasy) P- slippery, thready, weak, tardy

Wei Zhong Atrophy Syndrome Cold-damp Wei Zhong Atrophy Syndrome Liver and Kidney Yin Deficiency

External invasion of cold-damp.

Transform damp Expel cold

Prolonged or chronic illness, advanced age, or fever can deplete yin. Advanced age or excessive sexual activity can deplete jing. Depletion of yin and/or jing cause a lack of nourishment of contractile tissue causing atrophy. Overconsumption of spicy, hot, sweet, fatty foods cause heat in stomach & spleen, this affects the transform/ transport function of middle burner making it unable to nourish skin, muscles and flesh causing atrophy.

Tonify liver & kidney yin Clear deficiency heat Tonify

Wei Zhong Atrophy Syndrome Spleen and Stomach Deficiency with Dampness

Tonify spleen & stomach Boost qi Transform dampness

Auxiliary points: For polio sequelae - Upper limb: shou san li LI10, lao gong PC8, he gu LI4. Lower limb: zu san li ST36, yang ling quan GB34, wei zhong BL40, cheng shan BL57. w/incontinence of urine - zhong ji REN3 & san yin jiao SP6 w/incontinence of stools - da chang shu BL25 & ci liao BL32 w/fever - da zhui DU14 Alternate therapeutic methods for atrophy syndrome: Ear acupuncture: shen men, LU, SP, ST, LI, LR, KI and points corresponding to affected parts. 3-5 points/session, strong sensation, retain 10 minutes, every other day. 10 sessions = one course. Plum blossom: Tap lightly over lung, spleen, stomach, liver & kidney bei shu points, as well as along the course of the hand & foot yang ming channels. Treat every other day. 10 sessions = one course.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Male Disorders

Symptoms Inability or difficulty to achieve an erection, may have seminal emission, semen is thin, clear & cold, aching low back & knees, fear of cold, cold limbs, dizziness, vertigo, tinnitus, frequent urination. With qi & blood deficiency there will be fatigue & lassitude, palpitations, pale lusterless complexion. T- pale P-weak, thready Inability to achieve or sustain an erection, premature ejaculation, sweaty sticky scrotum, sharp urine-like smell, heavy aching lower limbs, dark yellow urine, thirst or bitter taste, excess bodily secretions. T- red, greasy yellow coat P- soggy, rapid Tx Principle Tonify kidney yang Warm & support yang Tonify, moxa. Acupuncture Points / Techniques shen shu BL23 - tonify kidney, fortify yang, nourish yin, benefit essence guan yuan REN4 - angle needle inferiorly to direct needle sensation to tip of penis, tonify kidney san yin jiao SP6 - boost kidneys Moxa above 3 points with stick for 15 minutes, with needle warming moxa, or with indirect ginger partition moxa. w/qi deficiency - ming men DU4, strengthen yuan qi, assist yang w/blood deficiency - ge shu BL17, tonify qi & blood w/dizziness - feng chi GB20 w/cold semen - yao yang guan DU3, regulate lower jiao, treats seminal emission & impotence ci liao BL32 (or other ba liao points with pressure pain) - drain, yin ling quan SP9 - drain, clear heat & transform damp zu san li ST36 - transform phlegm li gou LR5 - drain, clear damp & heat from lower jiao, benefit genitals da he KI12 & yin gu KI10 - even, together will clear damp-heat from lower jiao zhong ji REN3 - open & regulate chong mai, consolidate the root w/kidney yin deficiency - tai xi KI3, boost kidney yin & yang, clear deficiency heat, regulate sexual function

53

Syndrome Yang Wei Impotence Kidney Deficiency

Etiology / Pathomechanism Overindulgent sexual activity, habitual masturbation or emotional disturbances such as anxiety, worry, fear, or fright. These weaken the mingmen fire, depleting kidney qi and resulting in loss of sexual capacity. Excessive deliberation, plotting, scheming, overtaxation of the shen cause depletion of qi & blood. Descent of damp-heat into lower burner can result in flaccidity of the penis.

Yang Wei Impotence Damp-heat

Clear heat Disinhibit dampness Even tonify even drain.

Alternate therapeutic methods for impotence: Ear acupuncture: shen men, testicles, endocrine, external genitalia, kidney. Plum blossom: Tap lightly over lower back and sacral region as well as along the inner legs down to san yin jiao SP6. Tap until skin is slightly red. Daily or every other day. Electro-acupuncture: One of the ba liao (ci liao BL32 is common) ran gu KI2 or guan yuan REN4 san yin jiao SP6, 3-5 minutes of stimulation. Needle embedding: At shen shu BL23, san yin jiao SP g & zhong ji REN3 or guan yuan REN4. Point injection: Vitamin B1 or testosterone at guan yuan REN4 or zhong ji REN3 & shen shu BL23, every other day for 10 days. Counseling can assist in alleviation of worry or obsessive thoughts, physical exercise and good lifestyle and eating habits will also help. Note from Julie: The Clinical Handbook of Internal Medicine, Volume 1 includes the following additional syndromes for impotence; Liver Qi Stagnation, Heart Blood and Spleen Qi Deficiency, Heart and Gallbladder Qi Deficiency; and it has separate syndromes for Kidney Yin Deficiency and Kidney Yang Deficiency. Since this is a likely syndrome to see in the clinic, this is good information to review.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Male Disorders

Symptoms Mengyi: Frequent nocturnal seminal emission that comes with dreams. Huajing: Frequent nocturnal seminal emission that comes even without dreams. Can also happen spontaneously in the daytime. With damp-heat: poor appetite, nausea, bitter taste, thirst with no desire to drink, irritability, restlessness, constipation or loose sluggish stools, dark scanty urine, heavy aching lower limbs, lethargy. T- greasy yellow coat P- deep, slippery (can be rapid) With kidney yin deficiency: frequent seminal discharge, prolific dreaming, weak aching lower back & knees, dry mouth & throat, insomnia, malar flush, night sweats, dizziness, tinnitus, dry stools or constipation, dark urine. T- red, dry, scant or no coat P- thready, rapid With kidney yang deficiency: backache, cold extremities, aversion to cold, bright white facial complexion, fatigue, urinary frequency or nocturia, impotence. T- pale, wet, swollen P- deep, thready or slow, weak Tx Principle tonify & increase kidney qi consolidate the gate of semen Acupuncture Points / Techniques

54

Syndrome Yi Jing Seminal Emission meng yi (wet dreams) Yi Jing Seminal Emission hua jing (without dreaming)

Etiology / Pathomechanism Seminal emission as a pathology is excessive spontaneous ejaculation of semen in the absence of tactile or sensual stimulation. The milder version occurs with dreams, and the more serious version (which usually develops from the dreaming version) occurs without dreams. In severe cases spontaneous emissions may occur while awake. In adolescent boys, spontaneous emission 1-2 times per month is considered normal. Most commonly caused by excess heart fire stimulating a pseudo-arousal (pornography, frequent masturbation, fixated admiration or unbridled desire can cause this). The heart fire consumes the kidney yin causing the ming men fire to disturb the chamber of semen. The kidney is unable to hold the semen. Stress & frustration can also lead to yin deficiency. Or, poor diet can lead to accumulation of damp-heat which descends and agitates the semen chamber.

zhishi BL52 - strengthen the will (treats addiction), tonify kidney, benefit jing tai xi KI3 - boost kidney yin & yang, clear deficiency heat, regulate sexual function zhong ji REN3 or guan yuan REN4 - (sensation should travel to genitals), tonify KI qi, consolidate the root See auxiliary points below: zhishi BL52 - strengthen the will (treats addiction), tonify kidney, benefit jing tai xi KI3 - boost kidney yin & yang, clear deficiency heat, regulate sexual function zhong ji REN3 or guan yuan REN4 - (sensation should travel to genitals), tonify KI qi, consolidate the root da he KI12 - tonify kidneys and astringe essence Auxiliary points: w/yang deficiency - moxa ming men DU4, moxa REN3 or REN4 w/heat & insomnia - li dui ST45, shen men HT7, xin shu BL15 w/shortness of breath - fei shu BL13 w/spontaneous sweating - yin xi HT6 w/spleen deficiency - tonify: pi shu BL20, zu san li ST36, san yin jiao SP6 w/heart fire - xin shu BL15, PC6 nei guan w/damp-heat - xia liao BL34, yin ling quan SP9, san yin jiao SP6, tai chong LR3, neiguan PC6

Clear heat out of heart Downbear fire Tonify yin Astringe the semen

Alternate therapeutic methods for seminal emission: Ear acupuncture: shen men, testicles, endocrine, HT, KI Plum blossom: Tap lightly over lower back and sacral region as well as along the inner legs down to san yin jiao SP6. Tap until skin is slightly red. Daily or every other day. Needle embedding: At shen shu BL23, san yin jiao SP6 & zhong ji REN3 or guan yuan REN4. Point injection: Vitamin B1 or dong gui zhu she ye at zhong ji REN3 or guan yuan REN4.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Male Disorders

Symptoms Pulling, penetrating, twisting pain in lower lateral abdomen and testes, generalized feeling of cold, contraction of penis, cold scrotum, cold hands & feet, pale white complexion. When severe pain can extend upward into chest & hypochondrium and can cause loss of consciousness. T- pale, white coat P- wiry or tight (excess), deep & hidden (yang deficiency) Distending pain of testes, scrotum is red, hot and swollen, pain aggravated by pressure, aversion to cold, fever, headache, tender limbs, scant urine, red-tinged urine, sticky greasy mouth. T- swollen; thick, yellow, curdy, greasy coating P- soggy, rapid If heat retreats but damp remains, fluid collects in scrotum which may hang lower on one side. Tx Principle Warm & transform cold-damp Dredge & open meridians Drain, moxa. Acupuncture Points / Techniques Needle affected side: da dun LR1 - main point for hernia disorders, course liver, benefit genitals qi men LR14 - (mu of liver), course liver, rectify qi, invigorate blood, disperse masses, stop pain qi hai REN6 or shen que REN8 - moxa, warm yang, treat abdominal pain zu san li ST36 - moxa, treat abdominal pain, open clear passage qi xue KI13 - moxa, regulate Ren mai and lower jiao san yin jiao SP6 - moxa, treat hernia, penile pain, contracted testes, promote smooth flow of liver qi Needle affected side: da dun LR1 - main point for hernia disorders, clear damp-heat, course liver, benefit genitals zhao hai KI6 - regulate, open & allow clear passage of urine, clear deficiency heat yin ling quan SP9 - drain dampness from lower burner, clear heat qi chong ST30 - clear heat, treat pain & swelling of genitals, stop pain zhong ji REN3 - treat hernia, open & regulate Chong Mai, consolidate the root san yin jiao SP6 - moxa, treat hernia, penile pain, contracted testes, promote smooth flow of liver qi w/fever & aversion to cold - he gu LI4, wai guan TB5 Needle affected side: gui lai ST29 - benefit genital region, treat penile pain, qi shan guan yuan REN4 - regulate lower jiao san jiao jiu extra - moxa, tonify qi, raise prolapse, treat shan disorder zu san li ST36 - treat abdominal pain, open clear passage ti tuo extra - treat prolapse, hernia (4 cun bilateral to and 3 cun below navel) bai hui DU20 - counter prolapse, calm the liver da dun LR1 - main point for hernia disorders, course liver, benefit genitals ji mai LR12 or qi chong ST30 - lower abdominal pain, hernia, groin pain w/reduced appetite, lassitude & fatigue - zhong wan REN12 The vulnerable area (point of weakness in abdominal wall) can be surrounded by needles inserted obliquely and shallowly, pointing towards center of weakness.

55

Syndrome Shan Qi Hernia Disorders Han Shan Cold Type

Etiology / Pathomechanism Sitting or laying on damp ground, exposure to wind, rain and/or cold. Colddamp enters liver and Ren meridians causing blood to coagulate in lower abdomen, testes and scrotum.

Shan Qi Hernia Disorders Re Shan Heat Type

Cold & damp collect in lower jiao and eventually transform to heat, this combines with pre-existing heat in the liver & spleen causing swelling and fluid collection in scrotum.

Clear heat Transform dampness Reduce swelling Free the connections Drain

Shan Qi Hernia Disorders Hu Shan Fox Type

Use of excessive force in lifting, carrying heavy weight, acute or long-term physical strain puts strain on lower abdominal & inguinal area causing small intestine to slip into scrotum. Or can be due to over-taxation causing qi deficiency which can cause prolapse.

Pressure and distending, pulling pain between scrotum and inguinal area, when severe can involve testes, aggravated when standing, disappears when laying down (gravitational prolapse of small intestine into scrotum). When severe it wont retract back into abdomen without external pressure or manipulation. When chronic will cause qi deficiency with poor appetite, SOB, lassitude, fatigue. T- normal or pale with qi deficiency P- normal or weak & thin with qi deficiency

Tonify qi Raise prolapse Stop pain Tonify Note: If blood supply is pinched off, surgery is necessary to prevent gangrene.

Alternate therapeutic methods for hernia: Ear acupuncture: shen men, external genitalia, LR, KI, SI, SP, ST For infants with congenital hernia: apply plaster of she xian (musk) at shen que REN8, blood let at da dun LR1.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Menstrual flow tends to be heavy, deep red or purplish, sticky & thick. Troubled mind, vexation, thirst, red complexion, yellow urine, dry stools. May also have dampness. T- red, yellow coat P- wiry or slippery, rapid Menstrual flow tends to be scanty, red, sticky & thick. Tidal fever, night sweats, 5 heart fever, low backache. T- red, scant coating P- rapid, thin or thready Menstrual flow can be heavy or scant, dull red or purplish, clotted, interrupted (start & stop). Chest & hypochondrial distension, premenstrual breast distension, inguinal pain, irritability, bitter taste, dry throat. T- red sides & tip P- wiry rapid Menstrual flow is heavy, pale color, watery. Fatigue, aching limbs, SOB, palpitations, muddy stools, hanging pressure in lower abdomen. T- pale P- weak, thin or thready Menstrual flow is scanty, dull color, with small purple or black clots. Severe lower abdominal pain that is better with heat, aggravated by pressure, feeling of cold in body, cold limbs, pale white complexion. T- white coat P- deep, tight or slow, deep Menstrual flow is scanty, pale color, thin, runny or watery. Fear of cold, cold limbs, dull or mild lower abdominal pain, likes heat and pressure, clear copious urine, muddy stools. T- pale, swollen P- deep, slow or weak, thready Menstrual flow is scanty, dull or dark color, clots. Chest or hypochondrial distension, premenstrual breast distension, lower abdominal distension & pain, irritability, easily angered, mental depression. T- normal P- wiry Menstrual flow is scanty, pale color, watery. Pale complexion, dizziness, palpitations, blurred vision, insomnia, dry skin. T- pale, thin, dry P- weak, thready Tx Principle Regulate menstruation Harmonize blood Clear heat (& damp) Drain Regulate menstruation Harmonize blood Clear heat, nourish yin Tonify Regulate menstruation Harmonize blood Soothe the liver Clear liver heat Drain Acupuncture Points / Techniques

56

Syndrome Yue Jing Xian Qi Early Periods Excess Heat

Etiology / Pathomechanism Menstruation arrives 7 or more days early for at least 3 consecutive cycles. Heat in blood injures Chong and Ren Mai causing blood to move recklessly and periods come early. (Hot diet; yang constitution with internal heat; emotions transforming to fire; liver profusion turning into heat.) Over-taxation, overwork, excessive worry, frequent dieting, vegetarian diet, excessive sexual activity all can lead to qi deficiency, weakening spleen function of containing blood, causing periods to come early.

qi hai REN6 - harmonize blood, regulate qi guan yuan REN4 - meets with & regulates LR / SP / KI, benefit uterus xue hai SP10 - regulate menses, cool blood, harmonize ying xue (nutritive & blood aspect), move blood w/excessive heat - tai chong LR 3 & qu chi LI11 (earth points will drain fire) w/excessive bleeding - shui quan KI5 & moxa at yin bai SP1 qi hai REN6, guan yuan REN4 & xue hai SP10 - see notes above ran gu KI2 - clear deficiency heat, regulate kidneys, regulate lower jiao w/night sweating - yin xi HT6 & hou xi SI3 (stop profuse night sweating, clear deficiency heat) w/lower backache - shen shu BL23 & yao yan extra qi hai REN6, guan yuan REN4 & xue hai SP10 - see notes above qu chi LI11 - regulate & harmonize ying & xue levels (nutritive & blood aspect) di ji SP8 - harmonize the womb, regulate menstruation, rectify qi, stop bleeding, stop pain w/chest or hypochondrium pain or distension - nei guan PC6 & qi men LR14 w/distension or pain of lower abdomen - qi xue KI13 (regulate Du & Ren, regulate menses) w/ irritability & vexation - jain shi PC5 (regulate menstruation, rectify qi, calm shen, pacify heart) w/liver profusion heat - xing jian LR2 (clear heat from liver, spread liver qi, stop bleeding) qi hai REN6, guan yuan REN4 & xue hai SP10 - see notes above zu san li ST36 & zhong wan REN12 - mu-he, strengthen digestion and tonify qi & blood pi shu BL20, wei shu BL21 - raise spleen qi & hold the blood, rectify qi & blood, boost qi w/kidney deficiency - shen shu BL23 qi hai REN6 - harmonize blood, regulate qi, treat abdominal pain, irregular menses and amenorrhea qi xue KI13 - regulate Du & Ren, regulate menses san yin jiao SP6 - tonify & invigorate blood, regulate & harmonize ying & xue levels gui lai ST29 & tian shu ST25 - moxa, regulate menses, invigorate blood, transform stasis, warm lower jiao w/clots - zhong ji REN3 & si man KI14 - regulate qi & move blood stasis, open & regulate chong mai qi hai REN6, qi xue KI13 & san yin jiao SP6 - see notes above fu liu KI7 - reduce edema, metal point will tonify water ming men DU4 - moxa to warm kidney yang w/weak aching low back - shen shu BL23 qi hai REN6, qi xue KI13 & san yin jiao SP6 - see notes above tai chong LR3 - tonify liver blood, soothe liver, recitify qi li gou LR5 - lou point of LR & enters genitals, course liver, regulate menses, benefit genitals di ji SP8 - harmonize the womb, regulate menstruation, rectify qi, stop bleeding, stop pain w/ breast or hypochondrial distension - zhong feng LR4 w/chest oppression - nei guan PC6 qi hai REN6, qi xue KI13 & san yin jiao SP6 - see notes above zu san li ST36 & zhong wan REN12 - mu-he, strengthen digestion and tonify qi & blood pi shu BL20, wei shu BL21 - raise spleen qi & hold the blood, rectify qi & blood, boost qi ge shu BL17 - needle if tender, nourish blood w/palpitations - shen men HT7 (regulate & tonify heart) w/dizziness, vertigo, blurred vision - bai hui DU20 (extinguish wind, bring clear yang to head)

Yue Jing Xian Qi Early Periods Deficiency Heat Yue Jing Xian Qi Early Periods Liver Qi Stagnation with Fire

Yue Jing Xian Qi Early Periods Qi Deficiency Yue Jing Hou Qi Menstruation arrives 7 or more days late Late Periods for at least 3 consecutive cycles. Excess Cold Blood cold congeals & contracts blood, slows filling of the sea of blood, causes late periods. (Constitutional yang Yue Jing Hou Qi deficiency causing internal cold; invasion Late Periods of exterior cold just before, during or just Deficiency Cold after period; excess raw or cold food.) Qi stagnation due to dysfunction of liver dredge & discharge function causes late Yue Jing Hou Qi periods because of lack of free flow of qi Late Periods (and blood). Liver Qi Stagnation Blood deficiency causes insufficient storage of blood by liver, this causes Yue Jing Hou Qi Chong Mai to be empty or deficient and periods to be late and scanty. (Extended Late Periods illness; too frequent childbirths or Blood Deficiency miscarriages; excessive hemorrhaging; GI tract ucler; Chrons Disease; injury to SP/ST from poor diet or excessive worry.)

Regulate menstruation Harmonize blood Boost qi Tonify Regulate menstruation Harmonize blood Scatter cold Warm the menses Drain, moxa. Regulate menstruation Harmonize blood Reinforce yang Dispel cold Tonify, moxa. Regulate menstruation Harmonize blood Soothe the liver Rectify qi Drain Regulate menstruation Harmonize blood Nourish blood Tonify, moxa..

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Menstrual flow can be heavy or scant, dull purplish, clotted, interrupted (start & stop). Chest & hypochondrial distension, premenstrual breast distension, frequent sighing, belching, loss of appetite, mental depression. T- normal P- wiry Menstrual flow is scanty, pale color, thin, runny or watery. Weak aching low back & knees, dizziness. T- pale P- deep, weak Cold pain in lower abdomen, before or during menses, decreased flow, dark or dull color, clots, worse with pressure or cold exposure, better with heat. T- white, slippery coat P- deep, tight Distending pain in lower abdomen, before or during menses, decreased flow, dull purplish color, clots, interrupted flow, better with clot expulsion. T- normal or dark dull w/stasis spots P- deep, wiry Pain in lower abdomen, before menses, worse with pressure, thick flow, purplish or blackish red color, large clots, burning or distending pain in lower back & sacrum, yellow sticky vaginal discharge, scanty urine, mild fever. T- red, yellow slimy coat P- rapid, wiry or slippery Dull pain in lower abdomen, before or after menses, scant pale watery menses, dull lower back pain, better w/pressure, dizziness, fatigue, tinnitus. T- pale or slightly red P- deep, thready Tx Principle Regulate menstruation Harmonize blood Soothe the liver Rectify qi Drain Regulate menstruation Harmonize blood Tonify kidney Tonify, moxa. Scatter cold, warm vessels Disinhibit damp Transform stasis Stop pain Soothe liver, rectify qi Regulate menses Transform stasis Stop pain Clear heat Disinhibit damp Invigorate blood Transform stasis Stop pain Tonify liver & kidney Regulate Chong & Ren Stop pain Tonify Acupuncture Points / Techniques guan yuan REN4 - meets with & regulates LR / SP / KI, benefit uterus san yin jiao SP6 - tonify & invigorate blood, regulate & harmonize ying & xue levels qi men LR14 - course liver, rectify qi, invigorate blood, disperse masses tai chong LR3 - tonify liver blood, soothe liver, recitify qi w/interrupted flow - li gou LR5 (luo point; course liver, regulate menses, benefit genitals) w/chest/hypochondrium/breast distension - tai chong LR3 (course liver), zhi gou TB6 (move qi) guan yuan REN4 - meets with & regulates LR / SP / KI, benefit uterus san yin jiao SP6 - tonify & invigorate blood, regulate & harmonize ying & xue levels shen shu BL23 & tai xi KI3 - tonify & regulate kidney shui quan KI5 - xi-cleft, stop bleeding; benefit menstruation, regulate Du & Ren Mai w/low back & knee pain - qu quan LR8, yin gu KI10, yao yan extra zhong ji REN3, ming men DU4 & shen shu BL23 - moxa; scatter cold, warm vessels shui dao ST28 - moxa; benefit uterus, scatter cold, warm vessels, disinhibit damp di ji SP8 - xi-cleft; harmonize the womb, regulate menstruation, rectify qi, stop pain w/severe pain - ci liao BL32 & gui lai ST29 (regulate menses, transform stasis, invigorate blood) qi hai REN6 - harmonize blood, regulate qi san yin jiao SP6 - invigorate blood, regulate & harmonize ying & xue levels tai chong LR3 - tonify liver blood, soothe liver, recitify qi w/chest/hypochondrial/breast distension - yang ling quan GB34 & guang ming GB37 w/ abdominal distension & fullness - tian shu ST25, qi xue KI13, di ji SP8

57

Syndrome Yue Jing Bu Ding Qi Irregular Periods Liver Qi Stagnation

Etiology / Pathomechanism Menstruation arrives at irregular (early & late) intervals. Liver qi stagnation disrupts the dredge & discharge function of the liver and can cause chaotic menstrual flow. Chaotic menses can also result from disruption of the sealing & storing aspect of the kidneys. When weak it comes early, when too strong it comes late.

Yue Jing Bu Ding Qi Irregular Periods Kidney Deficiency Tong Jing Dysmenorrhea Coagulation of Cold and Damp Tong Jing Dysmenorrhea Liver Qi Profusion

Invasion of exogenous cold (wet cold weather, laying on cold ground, swimming in cold) obstructs free flow of Chong & Ren Mai. Depression, anger cause stagnation of liver qi, disrupting free flow of Chong & Ren Mai.

Tong Jing Dysmenorrhea Descent of Damp-heat

External invasion of damp-heat or rich diet cause accumulation of damp-heat in lower jiao.

zhong ji REN3 - open & regulate Chong Mai, treat dysmenorrhea ci liao BL32 - regulate menses, transform stasis, invigorate blood, regulate lower jiao, stop leukorrhea he gu LI4, tai chong LR3 & gui lai ST29 - invigorate blood, transform stasis di ji SP8 - harmonize the womb, regulate menstruation, rectify qi, stop pain guan yuan REN4 - benefit uterus, tonify kidney & fortify yuan qi gan shu BL18 & shen shu BL23 - tonify liver & kidney zhao hai KI6 - nourish yin, regulate menses zu san li ST36 - nourish blood, tonify qi w/dizziness & tinnitus - xuan zhong GB39 & tai xi KI3 w/more severe abdominal pain - da he KI12 & qi xue KI13 (local, tonify kidneys, regulate Du & Ren) shen shu BL23, guan yuan REN4 & zu san li ST36 - moxa; warm uterus, tonify & warm yang san yin jiao SP6 - tonify liver & kidney, move blood, transform stasis, regulate ying & xue levels zhong ji REN3 - open & regulate Chong Mai, treat dysmenorrhea di ji SP8 - harmonize the womb, regulate menstruation, rectify qi, stop pain ge shu BL17, gan shu BL18, pi shu BL20 & shen shu BL23 - boost qi & nourish blood, move blood guan yuan REN4 - benefit uterus, tonify kidney & fortify yuan qi zu san li ST36 & san yin jiao SP6 - nourish blood, tonify qi w/insomnia - shen men HT7

Tong Jing Dysmenorrhea Liver and Kidney Deficiency

Constitutional weakness of liver and kidney, extended illness, excess sex, frequent childbirth/miscarriage cause lack of nourishment of Chong & Ren Mai.

Tong Jing Dysmenorrhea Yang Deficiency Cold Tong Jing Dysmenorrhea Qi and Blood Deficiency

Yang deficiency with internal cold, too much col/raw food, exterior cold invasion injures yang, disrupting free flow of Chong & Ren Mai. Qi & blood deficiency from extended illness, improper diet, overwork, loss of blood; leads to failure to nourish blood, failure to fill Chong Mai.

Cold pain in lower abdomen, during or after menses, small volume of dark blood, better w/warmth & pressure, weak aching cold low back & knees, copious urination. T- swollen, moist white coat P- deep Indistinct pain in lower abdomen, during or after menses, scant light & thin flow, feeling of bearing down, better w/pressure, dull complexion, fatigue, loss of appetite. T- pale, thin P- thready, thin

Warm uterus Tonify & warm yang Stop pain Tonify, moxa. Boost qi Nourish blood Stop pain Tonify, moxa.

Ear acupuncture: Uterus, endocrine, ovary, LR, KI, sympathetic. Elicite moderate sensation, retain 15-20 minutes, every 1-2 days. Needle embedding therapy may also be used.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Tx Principle Acupuncture Points / Techniques Core points for deficiency: guan yuan REN4 - tonify & consolidate kidney, meets with chong, ren, kidney, spleen & liver san yin jiao SP6 - tonify liver & kidney, meets with kidney, spleen & liver Core points for excess: zhong ji REN3 - open & regulate chong mai san yin jiao SP6 - move blood, transform stasis, drain damp

58

Syndrome Jing Bi Amenorrhea General Information

Etiology / Pathomechanism

Primary amenorrhea - when no period has occurred by 18 years of age. Western: no uterus, no vagina, ovarian disorders, sex chromosomal disorder, congenital absence of ovaries, hypothalamus or pituitary disorder, low or absent LH or FH hormones. Secondary amenorrhea - when there is absence of menstruation for at least 3 cycles. Western: pregnancy, postpartum non-return of menstruation, menopause, hypothalamus or pituitary disorder, ovarian or pituitary tumor, ovarian failure, severe PID, adrenal or thyroid disorder, nutritional disorder, chronic debilitating illness. Early marriage with many children, constitutional qi deficiency, extended illness; cause insufficiency of kidney qi, qi is not consolidated, jing and blood are injured. Poor diet or eating habits, over-taxation, excessive blood loss; cause spleen & stomach deficiency and weakness, the source of transformation of blood is not sufficient and chong and ren vessels are empty and no blood can be discharged as menses. Often manifests as primary amenorrhea. Low back pain, tinnitus, five-heart fever, dry mouth and throat. T-red P- thready, wiry Cycles gradually lengthen, amount of blood gradually decreases, eventually there is complete closure, no periods. Poor appetite, diarrhea, muddy stools, tiredness, palpitations or pounding of heart, SOB, laziness of speech. T- pale P- thready, weak Period gradually stops. Pale complexion, dry skin, weight loss, fatigue. T- pale P- thready Sudden onset of no periods, there is a background of liver profusion. Mental/emotional depression, may follow sudden bout of anger, hypochondrial fullness, irritability, distending pain of lower abdomen, aggravated by pressure. T- darkish or purplish, stasis spots P- wiry Closure of periods for 3 months or more, history of cold invasion, cold body, cold limbs, cold pain in lower abdomen that is better with warmth. T- pale, white coat P- slow, deep Phlegm & dampness blocking a stagnating, causing closure. Often seen in obese patients. Fullness & oppression of chest & hypochondrium, copious leukorrhea, fatigue. T- greasy coat P- slippery Tonify and benefit liver & kidney Tonify, moxa

Jing Bi Amenorrhea Liver and Kidney not Consolidated Jing Bi Amenorrhea Spleen and Stomach Deficient and Weak

guan yuan REN4 & san yin jiao SP6 (see above) gan shu BL18 - tonify liver blood shen shu BL23 & tai xi KI3 - tonify & regulate kidney w/weak low back & knees - ming men DU4, yao yan, yin gu KI10 w/tidal fever & night sweats - gao huang shu BL43 (100 taxations) , ran gu KI2 (clear deficiency heat) guan yuan REN4 & san yin jiao SP6 (see above) pi shu BL20, wei shu BL21 & zu san li ST36 - tonify spleen & stomach, tonify qi zhong men LR13 - mu of spleen, meeting of zang, tonify spleen & liver w/decreased appetite & diarrhea - zhong wan REN12, tian shu ST25, yin ling quan SP9 w/palpitations - nei guan PC6 guan yuan REN4 & san yin jiao SP6 (see above) ge shu BL17 - boost qi & nourish blood gan shu BL18, pi shu BL20 & shen shu BL23 - boost qi & nourish blood zhong ji REN3 & san yin jiao SP6 (see above) tai chong LR 3 & he gu LI4 - 4-gates, sooth liver & rectify qi, invigorate blood & transform stasis xue hai SP10 - invigorate blood, dispel stasis, harmonize menstruation di ji SP8 - regulate menstruation, invigorate blood w/lower abdominal distension & pain with internal mass - qi hai REN6 & si man KI14 w/chest & hypochondrial fullness & distension - qi men LR14 & zhi gou TB6 zhong ji REN3 & san yin jiao SP6 (see above) guan yuan REN4 - moxa to warm uterus & scatter cold moxa core points also zhong ji REN3 & san yin jiao SP6 (see above) feng long ST40 - transform phlegm di ji SP8, zu san li ST36, he gu LI4 w/excessive vaginal discharge - ci liao BL32

Tonify spleen & stomach Tonify qi Nourish blood Tonify, moxa

Jing Bi Amenorrhea Blood Deficiency Jing Bi Amenorrhea Blood Stagnation

Tonify qi Nourish blood Tonify, moxa Soothe liver, rectify qi Invigorate blood Transform stasis Drain

Liver qi profusion and binding cause lack of free flow of qi and blood, causing blood stagnation & pain.

Jing Bi Amenorrhea Accumulation of Cold Jing Bi Amenorrhea Phlegm and Dampness

Exogenous cold enters into lower jiao, or eating to much cold/raw food, causing blood to congeal & coagulate. Loss of transport/transform function of spleen from collection of dampness causes blockage of flow of blood to chong and ren vessels.

Warm the uterus Scatter cold Drain, moxa Fortify spleen Transform phlegm Drain

Alternate therapeutic methods for amenorrhea: Ear acupuncture: For regulating menstruation; pituitary, endocrine, ovary, uterus, KI, LR. For hypomenorrhea and amenorrhea add; sympathetic, gonadotropin, coronary vascular subcortex. For menorrhagia (heavy bleeding) or metrorrhagia (irregular bleeding) add; diaphragm, SP, adrenal gland. For dysmenorrhea, endometritis or endometriosis add; lower jiao, sympathetic, adrenal gland. Select 3-4 points per session, elicit moderate sensation, retain 15-20 minutes, every 1-2 days. Needle embedding therapy may also be used. Plum blossom: Tap with light or moderate force over Du Mai and lumbar & sacral portions of bladder meridian, once every two days.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Tx Principle Acupuncture Points / Techniques

59

Syndrome Beng Lou Flooding & Trickling (Metrorrhagia) General Information

Etiology / Pathomechanism

Beng - A period that starts suddenly with a flood, often early. Luo - A period that starts with a trickle, often late. There is injury to the Chong & Ren Mai causing irregularity of the cycle. (This is not heavy periods, which are heavy blood loss during the normal cycle time. Western: Dysfunctional uterine bleeding is abnormal uterine bleeding in the absence of clinical or ultrasonographic evidence of structural abnormalities, inflammation, or pregnancy. Treatment is usually with oral contraceptives. When severe, causes may be cervical or uterine cancer, endometrial polyps, myomas, endometriosis and hysterectomy may be required. Spleen deficiency (diet, worry, taxation) causing injury to spleen qi so spleen cant hold blood in vessels and Chong & Ren cant consolidate blood. Large amounts of pale, watery blood and excessive spotting. Pale complexion, fatigue, SOB, lazy speech, poor appetite, loose stools, can be edema of face/limbs. T- pale P- thready Flooding & trickling of pale, dilute blood. Cold pain in lower abdomen, better with warmth & pressure, cold limbs/body, frequent copious urination, muddy stools. T- pale P- deep, thready Flooding & trickling of scant, bright red blood. Low back ache, dizziness, tinnitus, five-heart fever, tidal fever, insomnia, night sweating. T- red, scant coat P- thready, rapid Flooding of deep red, thick blood, blood can smell rotten (due to tissue necrosis from heat). Dry mouth, thirst, flushed complexion, irritability, constipation, dark urine. T- red, yellow coat P- slippery, rapid Flooding & trickling of bright red or dark red blood, may have clots. Chest & costal pain & distension, frequent sighing, irritability. T- normal, or red edges P- wiry, rapid Flooding & trickling of dull red blood. Heavy milky or green foul smelling vaginal discharge, vaginal itching, lower abdominal pain & distension. T- yellow greasy coat P- soggy, rapid Flooding & trickling of blackish-purple blood with clots. Lower abdominal pain that is worse with pressure, better after clot expulsion. T- dull or dark, can have stasis spots/macules P- deep, rough Tonify middle burner qi Secure the blood Tonify Warm needle moxa. Warm and tonify kidney yang, relieve bleeding Tonify, moxa Regulate and tonify kidney yin Relieve bleeding Tonify Clear heat Cool the blood Relieve bleeding Drain Soothe/dredge liver Rectify qi Clear heat Drain

Core points for deficiency: guan yuan REN4 & san yin jiao SP6 - tonify kidney (seal & store), spleen (contain blood) & liver (store blood) shen shu BL23 - tonify kidney sealing and storing function jiao xin KI8 - xi-cleft of yin qiao so will stop uterine bleeding, help kidney seal & store function, regulate Du & Ren, adjust menstruation, clear heat & damp from lower jiao Core points for excess: yin bai SP1 - direct moxa to stop bleeding qi hai REN6 & san yin jiao SP6 - drain to cool blood, transform stasis guan yuan REN4 (or qi hai REN4), san yin jiao SP6, shen shu BL23 & jiao xin KI8 (see above) gao huang shu BL43 - tonify deficiency taxation pi shu BL23 & zu san li ST36 - tonify spleen & stomach, tonify qi w/loose stools - tian shu ST25 (mu point of LI) guan yuan REN4, san yin jiao SP6, shen shu BL23 & jiao xin KI8 (see above) ming men DU4 & qi hai REN4 - tonify kidneys, benefit & regulate qi fu liu KI7 - metal point will tonify water, consolidate & secure the kidneys w/ weak aching low back & legs - yao yan guan yuan REN4, san yin jiao SP6, shen shu BL23 & jiao xin KI8 (see above) ran gu KI2 - clear deficiency heat, regulate the kidneys and lower jiao yin gu KI10 - tonify kidney, treat flooding & spotting w/ night sweating - yin xi HT6 w/insomnia - shen men HT7 yin bai SP1, qi hai REN6 & san yin jiao SP6 (see above) xue hai SP10 - cool the blood, regulate menses, harmonize ying & xue levels shui quan KI5 - xi-cleft; stop bleeding, benefit menstruation w/severe heat - da zhui DU14 & qu chi LI11 yin bai SP1, qi hai REN6 & san yin jiao SP6 (see above) tai chong LR3 & zhi gou TB6 - strongly move qi, rectify qi da dun LR1 - promotes proper storage of blood by liver, course liver, regulate menses w/ heart vexation or irritability - jian shi PC5 or da ling PC7 w/distension & pain of chest & hypochondrium - yang ling quan GB34, qi men LR14 & tan zhong REN17 (thrust tanzhong needle laterally inferior in both directions to open chest) yin bai SP1, qi hai REN6 & san yin jiao SP6 (see above) zhong ji REN3 - consolidate the root, open & regulate chong mai, treat irregular menstruation yin ling quan SP9 - drain damp, clear heat w/excessive vaginal discharge - xia liao BL34 w/genital itching - li gou LR 5 & xue hai SP10 yin bai SP1, qi hai REN6 & san yin jiao SP6 (see above) di ji SP8 - xi-cleft; harmonize the womb, regulate menstruation, rectify qi, stop pain qi chong ST30 - regulate chong mai, regulate menses, stop pain chong men SP12 - invigorate blood, regulate qi, stop pain w/abdominal pain worse with pressure - he gu LI4, zhong ji REN3 & si man KI14

Beng Lou Flooding & Trickling Spleen Qi Deficiency

Beng Lou Long term illness, excessive sex cause Flooding & Trickling kidney yang deficiency resulting in loss Kidney Yang Deficiency of seal & store function and causing excessive bleeding. Beng Lou Flooding & Trickling Kidney Yin Deficiency Beng Lou Flooding & Trickling Blood Heat Beng Lou Flooding & Trickling Liver Qi Stagnation Transforming to Heat Kidney yin deficiency causing deficiency fire and resulting in restless movement of blood, forcing blood from normal pathway. Yang profuse constitution with internal heat, exogenous induction of heat, hot spicy diet; cause internal heat and injury to Chong & Ren, blood leaves pathway. Liver fire disrupts livers storage of blood, affecting the Chong & Ren vessels and causing reckless movement of blood in the uterus, blood leaves normal course. Damp-heat collects in the lower jiao, affecting the movement of blood in the uterus, blood leaves normal course.

Beng Lou Flooding & Trickling Damp-heat

Clear heat Disinhibit damp Drain

Beng Lou Flooding & Trickling Blood Stasis

Static blood, due to cold or profusion of qi, blocks normal movement of blood in the uterus, blood leaves normal course.

Regulate blood Invigorate blood Drive out stasis Drain

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Tx Principle Acupuncture Points / Techniques Core point formula: qi hai REN6 - regulate & tonify qi, transform damp dai mai GB26 - local; regulates dai mai, sensation should travel to genitals, drain damp, stop vaginal discharge san yin jiao SP6 - drain dampness from lower burner bai huan shu BL30 - sensation should travel to genitals, stop leukorrhea IMPORTANT NOTB: Toxic damp syndrome in women over 40, especially with blood present, should be checked for cancer. Bloody discharge with pus occurring after the menopause often indicates the presence of uterine carcinoma.

60

Syndrome Dai Xia Bing Disease Below the Girdle Vessel (Leukorrhea) [Change in the amount, color, consistency or smell of vaginal discharge.]

Etiology / Pathomechanism

Leukorrhea is vaginal discharge that becomes excessive, thick, becomes cloudy or yellow, or has an offensive smell. Spleen qi deficiency, descent of damp heat to the lower burner or kidney deficiency can all lead to dysfunction of the Ren & Dai vessels, allowing the development of vaginal discharge. Western: Vaginal discharge varies according to cycles and pregnancy, it should have no odor nor cause itching or burning. Causes include infection, inflammation, neoplasm (causes dark discharge), vaginitis. The lower and upper female genital tracts are separated by the cervix. Vaginitis is inflammation of the lower tract: the vagina and vulva. Pelvic inflammatory disease (PID) is infection of the upper tract: the cervix, uterus, fallopian tubes, and, if infection is severe, ovaries (one or both). PID results from microorganisms ascending from the vagina and cervix into the endometrium, fallopian tubes, and peritoneum. Infection of the cervix (cervicitis) causes mucopurulent discharge. Infection of the fallopian tubes (salpingitis), uterus (endometritis), and ovaries (oophoritis) tends to occur together. IUDs can cause upper track infections. Sudden onset suggests infection, which is common after childbirth or when discontinuing the contraceptive pill, after a course of antibiotics, at the start of a new sexual relationship. Neisseria gonorrhoeae and Chlamydia trachomatis are common causes of PID; they are transmitted sexually. PID commonly occurs in women < 35. It is rare before menarche, after menopause, and during pregnancy. Risk factors include previous PID and presence of bacterial vaginosis or any sexually transmitted infection. Improper diet & eating habits, excess worry, over-taxation can injure spleen qi causing transport/transform dysfunction. Damp accumulates in lower burner, can become damp-heat. Poor hygiene during menses, or following childbirth when chong & ren are empty and zheng qi is weakened, turbid filth can enter into lower burner. Copious white or pale yellow discharge which can be sticky or thick, but has no odor. Pale complexion, fatigue, loose stools, abdominal distension. T- pale, white coat P- tardy Copious yellow-green pus-like thick sticky discharge, can have clots or streaks of blood, foul or putrid odor, can cause local itching. Bitter taste, dry throat, lower abdominal pain, damp dark urine. T- red, yellow coat P- slippery, rapid Copious white thin watery discharge with no odor. Cold lower abdominal pain, aching lower back, frequent copious urination, nocturia, loose stools, diarrhea. T- pale P- deep, slow Reddish white discharge, slightly sticky, no odor. Burning sensation in vagina, dizziness, malar flush, five heart fever, insomnia, frequent dreaming, constipation. T- red, scant coat P- thready, rapid Fortify spleen Boost qi Regulate Ren, Chong and Dai Mai Tonify Clear heat Disinhibit dampness Resolve toxins Drain

Dai Xia Bing Leukorrhea Spleen Qi Deficiency

Core points above plus: pi shu BL20, wei shu BL21 - tonify spleen, boost stomach, promote transformation of fluids in lower jiao zu sanli ST36 - (warming needle can be applied), tonify qi, drain damp w/continuous discharge - chong men SP12, zhong ji REN3 w/poor appetite & muddy stools - zhong wan REN12, tian shu ST25 Core points above plus: zhong ji REN3 - disinhibit dampness yin ling quan SP9 - drain dampness from lower burner w/vaginal itching - li gou LR5 , tai chong LR3, du yin extra (under 2nd toe) w/red discharge - jian shi PC5 (regulate menstruation, treat leukorrhea, clear heat) w/excessive heat - qu chi LI11 (clear heat & resolve toxins) Core points above plus: shen shu BL23 - moxa, tonify kidney yang quan yuan REN4 - moxa, tonify kidney yang & yuan qi, consolidate Chong Mai ci liao BL32 - resolve dampness from lower jiao & genitals w/heavy discharge - da he KI12, qi xue KI13 (moxa) w/lower back pain - yao yan, xiao chang shu BL27 Core points above plus: shen shu BL23 - tonify kidneys, consolidate essense zhao hai KI6 - nourish kidney yin ci liao BL32 - resolve dampness from lower jiao & genitals w/irritability - jian shi PC5 (pacify heart, calm shen, clear heat, treat leukorrhea) w/insomnia - shen men HT7 (calm shen, treat insomnia)

Dai Xia Bing Leukorrhea Damp Toxins

Dai Xia Bing Extended illness, too many children too Leukorrhea close together, excessive sex can injure Kidney Yang Deficiency kidney qi causing dysfunction of sealing & storing.

Warm & tonify kidney yang Regulate Ren, Chong and Dai Mai Tonify, moxa Tonify & boost kidney yin Clear deficiency heat Regulate Ren, Chong and Dai Mai Tonify

Dai Xia Bing Leukorrhea Kidney Yin Deficiency

Alternate therapeutic methods for leukorrhea: Ear acupuncture: shen men, uterus, endocrine, SP, LR, KI, TB. Three to five points per session, elicit moderate sensation, retain 15-20 minutes. Daily or every other day. Plum blossom: tap over Du, Ren and Dai Mai.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Tx Principle Eat a diet that is easy on the spleen Use tonics that build blood & qi Limit excesses that weaken the kidney Lessen stress Flatten liver Down-bear liver yang Nourish yin Even technique. Acupuncture Points / Techniques Before age 35 women have strong digestion, abundant production of qi & blood, abundant postnatal acquired essence, thus normal body functions use prenatal essence sparingly.

61

Syndrome Jue Jing Menopause (Period is changing or stopped.)

Etiology / Pathomechanism

More accurately called climateric syndrome, this is the phase in a womans life during which she makes the transition from reproductive to non-reproductive stage, a period of declining ovarian function which usually spans 2-5 years around the menopause. Kidney yin deficiency is natural with aging. When there is less blood, there is less body fluid and less yin. As less blood is produced, qi and yang become excessive in relation to yin and blood. This imbalance causes menopausal problems. There is a drying up at this time. The kidney is becoming progressively weaker, there is less qi & blood and a lack of nourishment to the Chong & Ren vessels. With kidney yin deficiency, yang is no longer contained or hidden, liver yang begins to rise as heat symptoms. Vertigo, dizziness, blurry vision, vexation, irritability, hot flashes with sweating, aching low back & knees. There may be flooding & spotting or heavier periods. T- red P- wiry, rapid or thready, rapid Palpitations or pounding heart, insomnia with frequent dreams, five heart fever, emotional instability ( or craziness). T- red, scant coat P- thready rapid Pale white complexion, lassitude, fatigue, poor appetite, muddy stools, abdominal distension, edema of face and limbs. T- pale P- thready, forceless

Over age 35-40 women have weaker digestion, lower production of qi & blood, less abundant postnatal acquired essence, thus normal body functions use more prenatal essence. By lessening the amount of blood required, menopause slows the aging process by preserving qi, blood & jing. bai hui DU20 & feng chi GB20 - drain, subdue wind and down-bear yang tai xi KI3 - tonify, nourish kidney yin tai chong LR3 - even, down-bear yang, flatten liver, nourish liver blood w/irritability - da ling PC7, calm shen, cool blood, clear heart heat, unbind chest w/hot flashes - yong quan KI1 & zhao hai KI6 w/low back ache - shen shu BL23 & yao yang guan DU3 xin shu BL15, pi shu BL20, shen shu BL23 - nourish yin, nourish heart, rectify qi & blood san yin jiao SP6 - tonify liver/spleen/kidney, regulate & harmonize ying & xue levels w/palpitations - tong li HT5, calm shen, regulate heart rhythm w/five heart fever - lao gong PC8, drain heart fire, cool the blood w/psycho-emotional problems - ren zhong DU26 (ghost palace) & da ling PC7 (ghost heart) pi shu BL20 & wei shu BL21 - tonify spleen & stomach zhong wan REN12 - strengthen stomach, fortify spleen, transform damp, rectify middle burner zhang men LR13 - mu of spleen, meeting of zang, benefit SP & ST, regulate middle & lower burner zu san li ST36 - tonify qi, drain damp, harmonize stomach, strengthen spleen w/abdominal distension - xia wan REN10, qi hai REN6 w/muddy stools - tian shu ST25, yin ling quan SP9 w/edema - shui fen REN9, guan yuan REN4 tan zhong REN17 - move qi & eliminate stagnation, transform phlegm, widen chest zhong wan REN12 - strengthen stomach, fortify spleen, transform damp, rectify middle burner qi hai REN6 - move qi in lower burner, tonify kidney, benefit qi, harmonize blood zhi gou TB6 - move qi & eliminate stagnation feng long ST40 - transform phlegm, rectify qi, harmonize stomach, invigorate blood san yin jiao SP6 - resolve dampness, tonify liver/spleen/kidney, regulate & harmonize ying & xue levels

Jue Jing Menopause Hyperactivity of Liver Yang

Jue Jing Menopause Injury to Heart Blood Jue Jing Menopause Spleen and Stomach Deficiency

Over-taxation of the heart due to injury to ying and blood levels. Can be caused by overconcern for others (excess worry).

Tonify yin Tonify heart blood Reconnect heart & kidney Tonify Tonify spleen qi Supplement stomach Tonify, moxa

Kidney yang weakness with lack of warming causes spleen yang & stomach deficiency. Also affects kidney qi.

Jue Jing Menopause Phlegm Accumulation

Impaired transform/transport function of spleen with accumulation of dampness which turns to tan which causes binding and stagnation of qi & blood stagnation.

Often occurs in obese patients, chest oppression, nausea, costal pain, clotting of menstrual blood. T- normal or purplish body, white greasy coat P- slippery

Rectify qi Transform phlegm Drain

Alternate therapeutic methods for menopause: Ear acupuncture: shen men, ovaries, endocrine, sympathetic, subcortex, HT, LR, SP, KI. Three to four points per session, elicit moderate sensation, retain 15-20 minutes. Every other day. Needle embedding therapy may also be used. Extra point for treating hot flashes (curious point of Master Tong): 2.5 cun above yin tang Menopause point: lou gu SP7 on most ashi side

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Tx Principle Acupuncture Points / Techniques Ear acupuncture: shenmen, ovary, external genitalia, SP, LR, KI. Retain 15-30 minutes, daily. Laser therapy: threat points heng gu KI11 & hui yin REN1 and locally on white thickened areas. Injection: Inject dang gui zhu she ye. For damp-heat; at shen shu BL23 & yin lianLR11. For LR & KI yin deficiency; at pi shu BL23 and ashi points on foot yin meridians.

62

Syndrome Yin Yang Genital Itch

Etiology / Pathomechanism

Western: Vaginitis is infectious or noninfectious inflammation of the vaginal mucosa and sometimes the vulva. Symptoms include vaginal discharge, irritation, pruritus, and erythema. Types include inflammatory, bacterial, candidal, and trichomonal (pinworms, flagellated protozoa). It may also involve itching of the anus. Senile vaginitis is more chronic and causes white thickening of skin at vagina and anus. Liver qi profusion causes heat and overcomes spleen, resulting in accumulation of internal dampness which causes damp-heat in liver channel (which goes through genitals). Poor hygiene results in infection of toxic dampness entering vagina. Liver and kidney yin and blood deficiency cause production of wind dryness and lack of nourishment to genital area. More common around menopause. Bearing down too much early in labor, prolonged constipation, prolonged coughing, heavy physical labor too soon after childbirth. These can all cause spleen qi and kidney qi deficiency and prolapse due to weakened uterine vessel and inability to hold uterus and vagina in place. Excess sex or too many children too close together cause dysfunction of chong, ren and dai vessels leading to prolapse. Unable to sit or lay peacefully due to severe itching, there can also be painful itching, yellow thick leukorrhea, the itching can be unbearable. T- greasy P- slippery, rapid Clear heat Drain dampness Relieve itching Course liver if needed Drain

Yin Yang Genital Itch Damp-heat Invades Liver

Yin Yang Genital Itch Liver and Kidney Yin and Blood Deficiency Yin Ting Genital Prolapse Spleen Qi Deficiency

Vagina is dry, rough and itchy, may be accompanied by heat or burning sensation, thickening of vaginal epithelium, white patches on vaginal wall or labia, scratching makes it worse. + yin & blood deficiency Sx. T- red, scant coat P- rapid, thready, forceless Protrusion of red mass into vagina, goose egg in size and shape, severe, hangs down outside of vagina, bearing down sensation in lower abdomen. Worse with overtaxation, weak limbs, sallow complexion, copious thin white vaginal discharge, fatigue. T- pale, thin white coat P- weak, thready Protrusion of red mass into vagina, goose egg in size and shape, severe, hangs down outside of vagina, bearing down sensation in lower abdomen. Backache, weak knees, lack of vaginal secretions, nocturia, dizziness, tinnitis. T- pale red P- weak, deep

Tonify liver & kidney yin Nourish blood Relieve itching Tonify Tonify and raise spleen qi Tonify, moxa

zhong ji REN3 - (mu of bladder, meets with SP, LR & KI) clear damp heat xue hai SP10 - nourish blood and clear wind from blood san yin jiao SP6 - nourish blood, tonify spleen, drain damp w/damp-heat - xia liao BL34, yin ling quan SP9 & li gou LR5 (stops itching in genitals) w/yin & blood deficiency - gan shu BL18, shen shu BL23 & zhao hai KI6 w/severe itching - qu gu REN2 & da dun LR1 (dredge liver & clear wind) w/parasites - replace xue hai SP10 with bai chong wo and also use external application of decoctions of she chuang zi or san huang hua herbal formulas. w/damp-heat syndrome with heart vexation & insomnia - da lingPC7 (clear fire from jue yin) w/LR & KI yin deficiency syndrome with heart vexation & insomnia - tai chong LR3

qi hai REN6 - benefit spleen qi dai mai GB26 - regulate dai vessel, treat hernia and groin pain zu san li ST36 & san yin jiao SP6 - tonify spleen w/ bearing down sensation in lower abdomen - zhong wan REN12, pi shu BL20 & ti tuo Ear acupuncture: external genitalia, shenmen, zigong, SP, KI

Yin Ting Genital Prolapse Kidney Deficiency

Tonify kidney Raise qi Tonify, moxa

guan yuan REN4 - tonify kidneys, fortify spleen, benefit uterus zi gong (infants palace) - treat uterine prolapse (3 cun bilateral & 4cun below navel) da he KI12 & zhao hai KI6 - tonify kidney w/low back & knee pain - shen shu BL23 & qu quan LR8 w/dizziness & tinnitus - shen shu BL23 & bai hui DU20

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Gynecology

Symptoms Tx Principle Acupuncture Points / Techniques

63

Syndrome Ru Pi Breast Lumps General Information

Etiology / Pathomechanism

Fibrocystic changes (previously, fibrocystic disease) is a catchall term that refers to mastalgia, breast cysts, and nondescript lumpiness, which may occur in isolation or together; breasts have a nodular and dense texture and are frequently tender when palpated. Masses are bilateral, irregular in shape, sometimes are spherical or flat, have indistinct borders, are freely mobile. 3-4 days before menses they increase in size and become painful, after menses pain dissapates and they shrink. May have yellow-green or bloody brown nipple discharge. Fibrocystic changes cause the most commonly reported breast symptoms and have many causes. Most causes are not associated with increased risk of cancer; they include adenosis, ductal ectasia, simple fibroadenoma, fibrosis, mastitis, mild hyperplasia, cysts, and apocrine or squamous metaplasia. Other causes, particularly if fibrocystic changes require biopsy, may slightly increase risk of breast cancer. Fibrocystic changes are more common among women who had early menarche, who had their 1st live birth at age > 30, or who are nulliparous. Generally occurs between age 30-40. Fibroadenomas are typically painless lumps that feel like small, slippery marbles. They usually develop in young women (common between age 20-25), often in teenagers, and may be mistaken for cancer although they are benign and tend to be more circumscribed and mobile. Commonly appear in upper outer quadrant of breast, are spherical with well-defined edges. Skin color is normal, generally occur alone, or one in each breast. Simple fibroadenoma does not appear to increase risk of breast cancer; complex fibroadenoma may increase risk slightly. NOTB: Only a small fraction of fibroadenomas or breast cysts become malignant, if there is discharge have patient see western doctor for diagnosis. Anxiety or worry cause liver qi profusion and binding, disrupting free flow of qi & blood. If there is weakness in the spleen, phlegm can accumulate and combine with the liver qi stagnation & form masses. Qi stagnation can also come from the heart and/or lung due to sadness or grief and cause qi stagnation in the chest. Loss or separation can specifically affect the qi of the breast (which is a womans connection with her loved ones). Long-term illness or excessive sex can injure the liver & kidney causing yin & blood deficiency, which leads to lack of nourishment to the tissues and lack of blood, blood deficiency & blood stasis. Disharmony of the Chong & Ren, which are in decline after menopause, causes imbalance between top and bottom of body. Lower burner is deficient in blood & jing, qi of Chong vessel may reverse and stagnate above, it may also dredge up phlegm and carry it up to breast where it stagnates. There may be stagnation of heart or lung qi behind this. Thoracic oppression, dizziness, burping, belching, lower abdominal distension & pain, lack of free flow of menses. T- normal P- wiry Dredge the liver Rectify qi Drain wu yi ST15 - descend rebellious qi, unbind chest, benefit breasts, treat mammary abcess tan zhong REN17 - widen chest, allow clear passage thru luo, transform phlegm, treat breast pain xing jian LR2 - clear heat from liver & drain fire, spread liver qi nei guan PC6 - clear heat, invigorate blood, rectify qi, open the chest w/lack of free flow of menses - guan yuan REN4 & san yin jiao SP6

Ru Pi Breast Lumps Liver Qi Stagnation

Ru Pi Breast Lumps Phlegm Congealing or Binding

Thoracic oppression, dizziness, nausea, epigastric hardness and fullness, vomiting of phlegm or clear fluid, poor appetite, muddy stools. T- greasy coat P- slippery

Transform phlegm Open and allow free passage through luo vessels Drain

ying chuang ST16 - benefit breasts, treat mammary carbuncles tan zhong REN17 - widen chest, allow clear passage thru luo, transform phlegm, treat breast pain pi shu BL20 - transform dampness, regulate & harmonize qi & blood zhong wan REN12 - transform damp, clear heat, transform stasis feng long ST40 - transform phlegm, open the luo, clear heat, invigorate blood, rectify qi w/dizziness - yin tang & si shen cong

Ru Pi Breast Lumps Liver and Kidney Yin Deficiency

Tidal fever, dull complexion, malar flush, dizziness, tinnitus, low back ache, fatigue, scant pale menses. T- red with scant coat or pale with white coat P- thready, rapid

Tonify and increase liver & kidney yin Tonify

ru gen ST18 - benefit breasts, reduce swelling, treat mammary carbuncles & breast pain shen shu BL23 - tonify kidney, nourish kidney yin li gou LR5 - course the liver, open the luo, clear damp heat, regulate menses shui quan KI5 - regulate Du & Ren vessels, benefit menstruation w/tidal fever - bai lao (1 cun lateral 2 superior to dazhui, treat yin deficiency, transform phlegm & dissipate nodules) & gao huang shu BL43 (treat deficiency of all types) Ear acupuncture: endocrine, mammary gland

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Obstetrics

Symptoms Period is delayed, scant amount of pale blood, can have amenorrhea when severe. Kidney yang deficiency: Lower backache, dizziness, feeling cold, depression, frequent urination. T- pale, swollen, wet P- deep, thready or slow, deep Kidney yin deficiency: Five heart fever, night sweating, dizziness, tinnitus. T- red, scant coat P- rapid, thready Tx Principle Regulate & rectify the Chong & Ren Vessels Nourish the blood Warm kidney yang ---and/or-- Nourish kidney yin Tonify Add moxa for yang deficiency. Acupuncture Points / Techniques

64

Syndrome Bu Yun Female Infertility Kidney Deficiency

Etiology / Pathomechanism Infecundity, or female infertility, is defined as the failure to conceive after 3 years of normal sexual activity. 40% due to ovarian problems or menstrual irregularities. 30-40% due to blockage of fallopian tube. Rest due to unclear causes. With kidney deficiency the pre-heaven is not consolidated causing kidney qi or jing deficiency which results in lack of nourishment to uterine vessel.

Core points for female infertility: zhong ji REN3 - warm kidneys, strengthen yang, consolidate the root, open & regulate Chong Mai guan yuan REN4 - tonify kidney & fortify yuan qi, fortify spleen, benefit uterus, regulate lower burner san yin jiao SP6 - boost kidney, tonify liver, fortify spleen, move blood, transform stasis, drain damp, smooth liver, regulate & harmonize ying & xue levels Joannes core formula - zhong ji REN3, yin jiao REN7 & zi gong xue (uterus point, 3 cun lateral to REN3) Kidney deficiency points: shen shu BL23 & ming men DU4 - nourish kidney yin & yang, benefit essense, strengthen lower back qi xue KI13 - regulate Du & Ren Mai, regulate lower jiao, treat infertility ran gu KI2 - clear deficiency heat, regulate kidneys & lower burner, treat irregular menses w/dizziness or tinnitus - bai hui DU20 & tai xi KI3 w/prolonged menstrual cycle - tian shu ST25 & gui lai ST29 w/palpitations & insomnia - shen men HT7 Core points above plus: pi shu BL20, wei shu BL21 & zu san li ST36 - increase and tonify qi & blood w/dizziness & palpitations from heat - bai hui DU20 & shen men HT7

Bu Yun Female Infertility Blood Deficiency

Blood deficiency leads to decline in function of the Chong & Ren Mai which results in lack of nourishment to uterine vessel.

Period is delayed, scant amount of pale blood, can have amenorrhea when severe. General weakness, loss of weight, insomnia, sallow yellow complexion, palpitations, tiredness, blurred vision. T- pale and thin P- choppy or fine Irregular periods which are generally late, darker colored blood with purplish or black clots. Cold pain in lower abdomen which is better with heat, feel cold in general. T- pale, swollen P- deep, tight Irregular periods which may be early or late, lack of free flow of menses, blood clots. Chest & hypochondrium pain and distension, engorged breasts, menstrual cramps, emotional depression, irritability. T- normal, may have stasis spots P- wiry Irregular periods which may be early or late, lack of free flow of menses. Overweight, excessive sticky thick leukorrhea, dizziness, palpitations, thoracic oppression. T- greasy coat P- slippery

Regulate & rectify the Chong & Ren Vessels Nourish the blood Tonify

Bu Yun Female Infertility Cold in the Uterus

A decline in the ming men fire allows cold to enter and settle in the lower jiao, which becomes cold in the uterus.

Regulate & rectify the Chong & Ren Vessels Warm the uterus Scatter cold Tonify Regulate & rectify the Chong & Ren Vessels Move qi Soothe the liver Invigorate blood Drain Regulate & rectify the Chong & Ren Vessels Transform phlegm Transform stasis Invigorate blood Drain

Core points above plus: shen shu BL23 & ming men DU4 - moxa to warm the uterus & scatter cold moxa core points also

Bu Yun Female Infertility Liver Qi Profusion

Psycho-emotional problems cause liver qi stagnation and binding, which leads to blood stasis, blocking free flow in the uterine vessel.

Core points above plus: qi men LR14 - mu point, course liver, rectify qi, invigorate blood & disperse masses tai chong LR3 - regulate & rectify qi & blood, spread liver qi, nourish liver blood, regulate menstruation qi chong ST30 - regulate Chong Mai, regulate menses, rectify qi of lower burner, stop pain w/thoracic fullness - nei guan PC6 w/abdominal pain causing nausea or epigastric fullness - shi guan KI18 (regulates Chong vessel) Core points above plus: zhong wan REN12 - transform stasis, transform damp & rectify middle burner feng long ST40 - transform phlegm, invigorate the blood, rectify qi w/excessive leukorrhea - zhong liao BL33

Bu Yun Female Infertility Phlegm-damp

Spleen qi deficiency leads to production of dampness, dampness can turn to phlegm and block the uterine vessel.

Alternate therapeutic methods for female infertility: Ear acupuncture: ovaries, endocrine, uterus, subcortex, KI. Two to three points per session, elicit moderate sensation, retain 15-20 minutes. Every day, 10 days = one course. Needle embedding therapy may also be used. Select Dai Vessel points: dai mai GB26, wu shu GB27 & wei dai GB28 From Jia Yi Jing: Moxa shen que REN8 or needle yong quan KI1.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Obstetrics

Symptoms General Symptoms: Nausea and vomiting during the first trimester of pregnancy, especially during the morning hours. Symptoms usually subside in the third month. Pathological syndromes are listed below. Tx Principle General Tx: Descend qi ni Harmonize stomach Use mild manipulation. Use as few points as possible as pregnancy may not be consolidated yet. Use extreme caution if there is a previous history of miscarriage and encourage bed rest. Recommend small frequent meals, and to avoid cold, raw or greasy foods. Nausea & vomiting, vomiting after eating, epigastric & abdominal fullness & distension, tired, drowsy. T- pale P- slippery, forceless Nausea & vomiting, vomiting of phlegm, frequent spitting of saliva, epigastric and abdominal fullness & distension, dizziness. T- swollen, white slippery coat P- slippery, weak Nausea & vomiting, vomiting of acid or bitter fluid, hypochondriac & chest distension, belching, sighing, moodiness, irritability. T- red sides, slight yellow coat P- slippery, wiry The yin of the kidney nourishes and dominates development and growth of the fetus through pregnancy. As birth date approaches and yin reaches its zenith, yang must begin to grow in order to turn the fetus and prepare for the intense activity of birth. Fetal position is monitored after 28 weeks of pregnancy. Any position other than left occiput anterior (LOA) or right occiput anterior (ROA) is considered abnormal. This is head down with the babys spine facing outwards towards the mothers abdomen. Descend qi ni Tonify spleen Strengthen & harmonize stomach Transform phlegm Descend qi ni Harmonize stomach Acupuncture Points / Techniques zhong wan REN12 - treats nausea & vomiting (caution: uterus lies under this point by 32 weeks) zu san li ST36 - harmonize stomach, descend qi ni gong sun SP4 - opens to Chong Mai - regulates, luo of spleen - treats nausea & vomiting

65

Syndrome Ren Shen E Zu Morning Sickness General Information

Etiology / Pathomechanism The major factor is the failure of stomach qi to descend. Blood jing & kidney qi are being diverted to nourish fetus, this strains blood reserves of Chong vessel causing a relative imbalance of qi and blood in the Chong vessel, blood is diminished causing qi ni of Chong which causes nausea & vomiting (by causing qi ni of the stomach).

FYI from Debra Betts Acupuncture in Pregnancy & Childbirth: I have observed a womans nausea diminish instantaneously on needling only shu fu KI27, while other women have reported that as soon as zhao hai KI6 was needled, the vomit rising up to their throat immediately resolved. As these points are also useful pressure points, with women usually reporting a preference to using them compared with nei guan PC6, they have over the years become my favorite points. To maintain the effect of this treatment and to enhance their use as pressure points, ear press needles can be inserted at shu fu & zhao hai bilaterally. Using this method as a baseline treatment, additional points can be included to deal with any presenting disharmonies, taking care to keep the number of points chosen to a minimum. Nei guan PC6 is a well-known point for relieving nausea during pregnancy. Combining neiguan PC6 with you men KI21 can be a useful combination, especially for anxious women with patterns of heart disharmony. Commercial seasickness bands can be used to apply pressure to nei guan PC6 between visits. Main points above plus: nei guan PC6 - harmonizes stomach and alleviates nausea & vomiting pi shu BL20 or wei shu BL21 - tonify spleen, harmonize stomach Main points above plus: feng long ST40 - transform phlegm nei guan PC6 - harmonizes stomach and alleviates nausea & vomiting wei shu BL21 - harmonize stomach Main points above plus: nei guan PC6 - harmonizes stomach and alleviates nausea & vomiting tai chong LR3 - promotes smooth flow of liver qi w/vomiting bile - yang ling quan GB34 w/thoracic oppression - tan zhong REN17 w/distending headache - bai hui DU20, yin tang Point zhi yin BL67 is where qi changes polarity from the kidney to the bladder meridian. Moxa at zhi yin will increase yang. Make patient comfortable in lounge chair or propped up in bed with knees up and supported. Apply a moxa stick to zhi yin BL67 bilaterally for 20 minutes, once a day for 10 days. The 10 day treatment should be continued even if the baby turns early in the procedure, but can be reduced to 10 minutes bilaterally. Optimum time for turning a breech baby is proven to be most efficient at week 34, before the baby has grown too large. Since many babies will have turned spontaneously by 36 weeks, many midwives and doctors wait until 36 weeks to begin treatment. Treatment can be effective as late as 38-39 weeks. Needles and then electro-acupuncture can be added if the moxibustion treatment alone doesnt work.

Ren Shen E Zu Morning Sickness Spleen and Stomach Deficiency Ren Shen E Zu Morning Sickness Spleen Deficiency with Phlegm

Pre-existing spleen qi deficiency which worsens during pregnancy.

Pre-existing spleen qi deficiency with phlegm and accumulation of fluids in stomach cause of blockage and prevent stomach qi from descending properly.

Ren Shen E Zu Liver blood depletion during pregnancy, Morning Sickness because blood is being diverted to Liver Invading Stomach Chong vessel to nourish fetus, causes liver blood deficiency, which leads to liver qi stagnation & profusion and liver attacks stomach horizontally. Tai Wei Bu Zheng Abnormal Fetal Position The root cause of malposition and malpresentation results from a deficiency in kidney energy which, due to the kidneys relationship to the uterus and its role in nourishing the fetus, may lead to either deficiency or stagnation of uterine qi and fetal qi and blood.

Smooth the liver Descend qi ni Harmonize stomach

If, towards the time of delivery, there is insufficient yang activity of the uterus, due either to deficiency or stagnation, then yang must be stimulated.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Obstetrics

Symptoms Tx Principle Acupuncture Points / Techniques Alternate methods: Injection of dang gui or pitocyn at he gu LI4 & san yin jiao SP6. Ear acupuncture: uterus, subcortex, endocrine, KI

66

Syndrome Zhi Chan Difficult Delivery Zhi Chan Difficult Delivery Qi and Blood Deficiency

Etiology / Pathomechanism

Childbirth doesnt occur within 24 hours after start of labor. Uterus may not be contracting strongly enough due to weak abdominal & pelvic floor muscles. Birth canal may be too small for size of babys skull. Malposition of fetus may make vaginal birth impossible. Deficiency of zheng qi can cause difficult labor due to weakened constitution. Contractions and premature force occur before cervix is adequately dilated. Premature breaking of water can cause dryness and impede labor. Fear or strong emotions accompanying labor can cause stagnation of qi & blood which can cause lower abdominal muscles to tighten. Lack of exercise during pregnancy can lead to qi stagnation prior to labor, affecting progression of labor. Cold invasion can block movement and interfer with progression of labor. Constitutional qi deficiency or over taxation during labor can cause lack of strength to push placenta out. Weakness, contractions are intermittent and weak, contractions dont become more frequent or more painful, perineal pressure is not severe. May discharge large amount of pale blood. Pale complexion, fatigue, palpitations, SOB. T- pale, thin coat P- large & empty or deep, thready & weak Severe abdominal and low back pain, scant discharge of blood, blood is dull or dark red, mental tension, depressed emotional state, strong contractions at irregular intervals, slow progression of labor, blue green complexion, chest & hypochondrium distension and fullness, intermittent nausea. T- dark red, normal or slimy coat P- deep & forceful or rapid & uneven (if more stasis) Mild distending pain in lower abdomen, may be soft lower abdominal masses, large amount of pale discharge, pale complexion, SOB, lassitude, fatigue. T- pale, thin P- weak, thin Lower abdominal pain, coldness in lower abdomen, pain can be severe, worse with pressure, can have hard masses in lower abdomen, scant dark red discharge. T- normal or purplish P- deep, wiry, rough Induce labor Tonify qi Nourish blood Tonify, moxa

Zhi Chan Difficult Delivery Qi Stagnation and Blood Stasis

Induce labor Regulate qi Invigorate blood Dissolve stasis Drain

he gu LI4 - used to enhance the efficiency of contractions, provide pain relief, promote an efficient second stage, promote delivery of placenta and reduce blood loss in third stage san yin jiao SP6 - promote labor and aid cervical dilation zhi yin BL67 - effective to use in labor when baby is in posterior position (spine facing mothers spine), can be treated bilaterally with ear press needles to maintain stimulation du yin - promotes labor when baby has a poor or high presentation, non-descent of placenta, expel dead fetus (located at underside of 2nd toe, at midpoint of distal interphalangeal joint crease) for deficiency type add: zu san li ST36 for excess type add: tai chong LR3 (aid cervical dilation and move liver qi (needle in direction of KI1) w/listlessness & lassitude - moxa guan yuan REN4 & qi hai REN6 w/palpitations & SOB - nei guan PC6 & tai xi KI3 w/ chest & hypochondrium fullness - nei guan PC6 & jian jing GB21 (jian jing can provide pain relief, help baby to descend and promote efficient delivery of the placenta) ci liao BL32 - promote efficient labor, aid cervical dilation, provide pain relief during labor

Bao Yi Bu Xia Non-descent of Placenta Qi and Blood Deficiency Bao Yi Bu Xia Non-descent of Placenta Blood Stasis

Tonify qi Nourish blood Tonify, moxa

guan yuan REN4 - tonify kidneys and fortify yuan qi, fortify spleen, benefit uterus san yin jiao SP6 - promote efficient delivery of placenta du yin - promote contractions w/fatigue or coldness - moxa shen que REN8 (warm yang, down-bear qi) w/excess bleeding during labor - moxa yin bai SP1 zhong ji REN3 & qi hai REN6 - moxa to regulate qi, invigorate blood, regulate Chong vessel he gu LI4 & san yin jiao SP6 - to enhance efficiency of contractions du yin - promote contractions jian jing GB21 - can provide pain relief, promote efficient delivery of the placenta w/cold pain - use heavy moxa on zhong ji & qi hai w/static blood in uterus - tian shu ST25 (guide out stasis, regulate blood) Electro-acupuncture at he gu LI4 & san yin jiao SP6 for 30 minutes for strong effect in promoting contractions and promoting delivery of placenta. tan zhong REN17 - regulate qi in the chest (meeting point of qi) ru gen ST18 - local shao zi SI1 - (metal engenders water) for illness in arena of ye fluids, frees the breast milk w/heat - xing jian LR2 w/muddy stools - tain shu ST25 w/heavy blood loss - ge shu BL17 & gan shu BL18 w/distension of chest & hypochondrium - qi men LR14 Ear acupuncture: chest, thorax, endocrine, LR, KI To stop lactation: draining technique followed by moxa at zu lin qi GB41 & guang ming GB37

Exposure to cold during or right after labor can cause blockage of qi and blood and blood stasis.

Regulate qi Invigorate blood Drive out stasis Warm meridians (w/cold) Drain Moxa (with cold).

Ru Shao Insufficient Breast Milk Qi and Blood Deficiency Ru Shao Insufficient Breast Milk Liver Profusion

Poor diet or excessive loss of blood during labor lead to spleen & stomach deficiency which leads to insufficient qi & blood; there is not enough blood to produce milk. Emotional depression after childbirth can lead to the livers failue to attain & achieve which can lead to impairment of the free flow of qi, blood & breast milk.

Scant or no breast milk, milk is clear or thin, no distension of breasts, breasts feel soft. Lusterless complexion, fatigue, loose stools.

Free the breast milk Tonify qi & blood Tonify

Scant breast milk, milk flow shuts off suddenly, breasts are distended and painful, distension and fullness of chest & hypochondrium, irritability, vertigo, loss of appetite.

Free the breast milk Dredge the liver Rectify qi Drain

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Obstetrics

Symptoms Postnatal lochia discharge exceeding 3 weeks. Large amount of lochia, pale color, thin consistency, no smell. Downward pressure in lower abdomen, fatigue. T- pale P- weak Tx Principle Tonify qi Contain blood Tonify, moxa Acupuncture Points / Techniques guan yuan REN4 - tonify kidneys and fortify yuan qi, fortify spleen, benefit uterus zu san li ST36 - tonify qi, nourish blood san yin jiao SP6 - tonify spleen, liver & kidney w/large amount of lochia - qi hai REN6 & pi shu BL20 w/abdominal pressure - bai hui DU20 & zhong wan REN12

67

Syndrome E Lu Bu Jue Incessant Lochia Qi and Blood Deficiency

Etiology / Pathomechanism Weak constitution, large blood loss or long hard labor cause qi deficiency. Chong & Ren are not consolidated due to failure of qi to contain blood. Prolapse due to starting work too soon after childbirth causes collapse of spleen qi and its inability to contain blood. Yin deficiency constitution exacerbated by childbirth. Too much warm dry foods or herbs produces heat and injures blood. Blood is forced out of its pathway. Liver profusion turning to liver fire causing blood to move recklessly.

E Lu Bu Jue Incessant Lochia Blood Heat

Postnatal lochia discharge exceeding 3 weeks. Large amount of bright red lochia, thick consistency, foul odor. Flushed complexion, dry mouth. T- red, scant coat (yin deficiency) or yellow coat (LR fire) P- rapid, (thready with yin deficiency)

Clear blood heat Tonify yin (if needed) Even technique.

For yin deficiency heat: zhong ji REN3 - treat uterine bleeding ge shu BL17 - cool the blood, stop bleeding tai xi KI3 & ran gu KI2 - clear deficiency heat For liver fire: zhong ji REN3 - treat uterine bleeding xue hai SP10 - cool the blood, regulate menses zhong du LR6 - xi-cleft, stop bleeding, treat incessant lochia after birth w/aggitation - xing jian LR2 (clear heat & stop bleeding, drain liver fire, spread liver qi) w/dry mouth - zhao hai KI6 (clear deficiency heat, benefit the throat) zhong ji REN3 - treat uterine bleeding, warm kidneys, regulate Chong vessel di ji SP8 - stop bleeding, regulate uterus & menstruation w/abdominal pain - gui lai ST29 & qi hai REN6 (invigorate blood, transform stasis, move qi) w/cold periumbilical pain - moxa at shen que REN8 & warm needle at yin jiao REN7 (warm yang)

E Lu Bu Jue Incessant Lochia Blood Stasis

Blood stasis due to cold entering or cold raw food. Retention of placental fragments.

Postnatal lochia discharge exceeding 3 weeks. Scant amount of dark, dull, purplish, clotted lochia. Flow increases after passing clot. Lower abdominal pain, worse with pressure. T- dull or dark purple with stasis spots P- deep, rough, wiry

Move qi invigorate blood Drain Moxa if there is cold.

Alternate therapeutic methods for incessant lochia: Ear acupuncture: uterus, sympathetic, endocrine, shen men, subcortex, SP, LR, KI During postpartum period avoid exposure to cold, avoid cold raw foods, avoid taxation or physical exhertion. After a C-section treat blood stasis: yin mu cao (Chinese motherwort) as tea. E Lu Bu Xia Absence of Lochia Cold Congealing with Blood Stasis Exogenous invasion of cold or too much cold food cause cold to congeal and block the flow of blood & qi. Lochia should last 2-3 weeks, going from bloody to white and fluid-like, then clear. If it is scant, it is pathological. Scant discharge of purplish, dark or clear lochia. Lower abdominal pain, worse with pressure, better with heat, may have palpable lower abdominal masses, + cold symptoms. T- purple P- rough, choppy Scant or absent lochia, distension and fullness of chest, hypochondrium and lower abdominal areas. T- normal P- wiry Invigorate blood Resolve stasis Drain, moxa zhong ji REN3 & qi chong ST30 - invigorate blood di ji SP8 - invigorate blood, stop pain w/severe lower abdominal pain - si man KI14, shi guan KI18 & yin jiao REN7 w/cold limbs - moxa at guan yuan REN4 [Ear acupuncture: LR, KI, shen men, uterus, adrenal] Regulate qi Release profusion Harmonize qi & blood Drain guan yuan REN4 & qi hai REN6 - regulate qi, harmonize qi & blood tai chong LR3 & jian shi PC5 - dredge liver and release profusion w/strong descending pain of lower abdomen - qi chong ST30 w/distension of chest and hypochondrium - qi men LR14

E Lu Bu Xia Absence of Lochia Qi Stagnation and Blood Stasis

Liver qi profusion and binding prevent the free flow of blood & qi.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Obstetrics

Symptoms Dull lower abdominal pain, better with pressure, abdomen feels soft, lochia is scant & pale. Dizziness, dry hard stools. T- pale P- weak, thready Tx Principle Tonify and increase qi & blood Regulate Chong & Ren Tonify, moxa Acupuncture Points / Techniques guan yuan REN4 - tonify kidneys and fortify yuan qi, fortify spleen, benefit uterus zu san li ST36 - tonify qi, nourish blood san yin jiao SP6 - tonify spleen, liver & kidney ge shu BL17 - tonify qi & blood w/dizziness - bai hui DU20 & si shen cong w/hard dry stools - zhi gou TB6, da heng SP15 & zhao hai KI6 guan yuan REN4 - moxa; tonify kidneys and fortify yuan qi, fortify spleen, benefit uterus shen shu BL23 - moxa; tonify kidneys and fortify yang san yin jiao SP6 - invigorate blood w/cold limbs - moxa at shen que REN8 & yin jiao REN7 w/severe abdominal pain - moxa ming men DU4 & ci liao BL32 zhong ji REN3 & gui lai ST29 - resolve stasis & move blood ge shu BL17 - move blood, dispel stasis xue hai SP10 - move blood, dispel stasis, regulate the uterus tai chong LR3 - soothe liver, move qi w/pain in chest & hypochondrium - qi men LR14 & tan zhong REN17 w/scant lochia - qi hai REN6 & yin jiaoREN7 Ear acupuncture: LR, KI, shen men, subcortex, occiput

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Syndrome Chan Hou Fu Tong Postpartum Abdominal Pain Blood Deficiency

Etiology / Pathomechanism Excessive bleeding during labor causes injury to Chong & Ren (due to lack of nourishment). Excessive strain during labor or difficult long labor injures qi & blood causing blood deficiency and insufficient blood to nourish uterus. These cause pain in the lower abdomen. Cold invading during labor/delivery causes blood to congeal, causing stasis & pain.

Chan Hou Fu Tong Postpartum Abdominal Pain Cold Congealing Chan Hou Fu Tong Postpartum Abdominal Pain Liver Qi Stagnation and Blood Stasis Ren Chen Xian Zheng Eclampsia (convulsions during pregnancy) Ren Chen Xian Zheng Eclampsia Liver Wind

Cold lower abdominal pain, better with heat, worse with pressure, cold limbs, greenish white complexion. T- dull, dark P- deep, tight

Assist yang Disperse cold Warm, open & allow free passage through uterine vessel. Drain, moxa Move qi Transform stasis Open & allow free passage thru luo vessels Stop pain Drain

Liver qi profusion and binding of liver qi causes qi and blood stagnation which blocks vessels and causes pain.

Distending pain in lower abdomen, chest & hypochondrium, masses in lower abdomen, masses can be thick & hard, scant lochia that is not free-flowing (comes & goes) which is dull dark red color with clots. T- purple P- wiry, rough

Eclampsia usually occurs after 36 weeks (8 months), during labor, or within 24 hours of delivery.

Sudden loss of consciousness with convulsions. Western: toxemia or hypertension; edema & swelling Mild: swelling of feet & ankles which does not resolve after rest. Moderate: swelling reaches the knee, hypertension. Severe: swelling reaches top of thigh, hypertension, dizziness, upper abdominal discomfort, albumin in urine. Between 36 weeks to 24 hours postpartum. Dizziness & vertigo, flushed complexion, bitter taste, lower limb edema, dry mouth. If severe there may be sudden loss of consciousness, limb convulsions, clenched jaw, eyes rolled back but open. T- red or deep red P- wiry Between 36 weeks to 24 hours postpartum. Same symptoms as liver wind above plus; course respiration from throat, consciousness comes & goes. T- deep red body, yellow slimy coat P- wiry, slippery Nourish yin Conceal yang Level the liver Eradicate internal wind

Blood collects to nourish fetus, as fetus grows it uses more of mothers blood. If there is pre-existing liver & kidney deficiency or liver blood deficiency, this diversion of blood to the fetus can cause strong rising of liver yang & wind. Heart yin deficiency caused by blood being diverted to the fetus causes heat to collect and heart fire. The fire causes formation of phlegm which combines with heat and causes wind.

bai hui DU20 - calm mind, stop internal wind (stop convulsions) feng chi GB20 - eradicate internal wind nei guan PC6 - calm shen, level liver, drain wind tai chong LR3 - nourish liver blood, down-bear yang, level liver san yin jiao SP6 & tai xi KI3 - nourish yin w/ clenched jaw - jie che ST6 & xia guan ST7 (local) w/dizziness & vertigo - si shen cong & yin tang bai hui DU20 - calm mind, stop internal wind (stop convulsions) feng chi GB20 - eradicate internal wind da zhui DU14 & lao gong PC8 - clear heat and open orifices ren zhong DU26 - open orifices, awaken brain feng long ST40 - transform phlegm tai chong LR3 - level liver, drive out wind w/incessant convulsions - yang ling quan GB34 & qu quan LR8 (he-sea, down-bear qi of LR & GB)

Ren Chen Xian Zheng Eclampsia Phlegm-fire

Clear heat Drive out phlegm

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Obstetrics

Symptoms Tx Principle Acupuncture Points / Techniques Acute purulent condition of the breast. Stage 1 - Redness pain and swelling of breast, masses form in breast, lumps, thickened tissue, local swelling & pain, blockage of free-flow of breast milk, malaise, alternating chills & fever. Stage 2 - More severe swelling & distension, breast may become flaming red and extremely painful, pus begins to form. Stage 3 - Center of mass begins to grow soft, pus ripens, there is tissue necrosis, pus moves to surface, there is ulceration and pus comes out. After discharge of pus there is gradual healing of lesions and mass disappears. Thirst with desire to drink, halitosis, nausea & vomiting, constipation. T- yellow greasy coat P- slippery, rapid Thoracic oppression, hypochondrium pain, nausea, vomiting, dry heaves, anger, worry, resentment, belching, poor appetite. T- normal P- wiry Cracking of breast tissue around nipple. Drain fire Disperse accumulation Drain

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Syndrome Ru Yong Mammary Carbuncle (Acute Mastitis)

Etiology / Pathomechanism Western: Acute mastitis caused by staphylococcal bacteria. Inner type: occurs during pregnancy. External type: exposure to pathogens while nursing. Neither internal nor external: can happen anytime during pregnancy and breast feeding, most common during first month postpartum, and after first child. Dietary; excess rich food causes heat in stomach channel, stomach channel goes thru breast.

Tip from Diana: Apply fresh cabbage leaves to breast to draw toxin out. Tip from Diane: Lymphatic drainage, push lightly in small circles from breast toward armpit. Have patient lay on side with arm over head, then apply hot packs to breast. Mash garlic or white onion, apply to tender area and use as moxa partition, or add indirect moxa for 10-20 minutes, once per day. Blood let - If there are small, flat, red, blood macules/papules presenting along T1 thru T12, squeeze or needle them to release blood. (Treat yang to treat yin.) Try to get breast milk flowing, hot packs, massage, infant suckling or breast pump. Local points if tender - ru gen ST18, tian xi SP18, zhou rong SP20, wu yi ST15, massage at ru zhong ST17 ying chuang ST16 - benefit breasts, treat mastitis xia ju xu ST39 & feng long ST40 - clear damp-heat, transform stagnation wen liu LI7 - clear heat, detoxify poisons, moderate acute conditions, clear yang ming fire & calm spirit w/poor flow of milk - shao ze SI1 & tan zhong REN17 & he gu LI4 (to increase breast milk) w/headache & fever - hegu LI4 & feng chi GB20 qi men LR14 - mu of liver; course liver, rectify qi, invigorate blood, disperse masses, cool blood tian chi PC1 - unbind chest, transform phlegm, regulate qi, dissipate nodules, benefit breasts jian jing GB21 - strongly course liver, disperse accumulation, reduce swelling nei guan PC6 & xing jian LR2 - open chest & clear heat in jue yin qu chi LI11, he gu LI4, feng chi BG20, wai guan TB5 & da zhui DU14 - clear heat & release exterior NOTB: Acumoxa is VERY effective PRIOR to stage 3, pus formation. If there is pus, refer to western doctor.

Ru Yong Mammary Carbuncle Stomach Fire

Ru Yong Mammary Carbuncle Liver Qi Profusion

Emotional; anxiety, worry, anger, cause liver qi profusion and binding, which causes heat or fire. Leads to blockage of free-flow of breast milk. Dry cracked nipple or poor hygiene during breast feeding allows heat & toxins to enter breast and block milk.

Course the liver Rectify qi Disperse accumulation Drain Clear heat Disperse accumulation Drain

Ru Yong Mammary Carbuncle External Invasion

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Dermatology Diseases

Symptoms Tx Principle Acupuncture Points / Techniques

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Syndrome

Etiology / Pathomechanism

Diseases of the skin and subcutaneous tissues. The wei qi moves in the superficial layers and is associated with pores and body hair. The lungs have a strong influence on the wei qi. The bladder channel also regulates the exterior. The ying qi travels with the blood in the vessels and is associated with the spleen which stores the ying qi and keeps the blood in the vessels. The tissue extension of the spleen is the flesh, the subcutaneous tissues. Loose flesh signifies poor storage function of the spleen. If the flesh is soft and weak, so is the spleen qi. Fire is an important pathomechanism in wei ke. Painful red and itching lesions are associated with heart fire or fire heat. Ban Tu Alopecia Areata (patch balding) Blood Deficiency Kidney & liver deficiency (yin deficiency) makes blood unable to adequately nourish skin, pores become slack allowing wind to enter the skin and blood causing dryness & lack of nourishment to hair. Liver qi profusion and binding hinders harmonious flow of qi causing localized stagnation of qi & blood which leads to blood stasis and lack of nourishment to hair. Eruption of small red blisters occurring in a band across the skin. Resembles a red snake, following dermatomes. Most common on lower back & costal areas. Can also occur on chest, across breast, face, limbs, hands & feet. Accumulation of wind-fire. Excess fire turns to internal wind. Associated with liver & gallbladder meridians. Psychoemotional, dietary, alcohol, smoking. Damp-heat invading from outside of the body targets the spleen & stomach and blocks ying & wei qi, preventing the smooth flow of qi & blood. General symptoms: Sudden loss of small patches of hair, irregular in size, usually larger than a coin, variable in number, scattered, skin of patch is smooth & shiny (not flaky & dry), when severe all hair can be lost. Dizziness, insomnia, pale complexion. T- pale, thin P- thready, weak General symptoms above. This is a long-standing condition. Dull or dark complexion. Commonly seen in high stress individuals. T- stasis spots along edges P- rough Nourish blood Drive out wind Rub juice of fresh ginger slice on bald skin patches, then tap with plum blossom needle with enough force to release small droplets of blood. This will release wind and stasis. Treat daily for 7 - 10 days. As hair starts to grow back in tap gently and carefully so not to damage delicate new hair growth. bai hui DU20 & feng chi GB20 - dredge wind & calm mind ge shu BL17 - nourish & invigorate blood zu san li ST36 & san yin jiao SP6 - increase qi, nourish & invigorate blood w/dizziness - shang xing DU23 (1 cun posterior to hairline) w/insomnia - nei guan PC6 & shen men HT7 Moxa can be applied to patch areas until they are slightly red. For general balding: zhong fu LU1, he gu LI4 & tai chong LR3 (to lower stress by engendering acceptance) Western: Acute infectious viral disease marked by inflammation of the posterior root ganglia of only a few segments of the spinal or cranial peripheral nerve. This painful vesicular eruption occurs along the course of the nerve and is almost always unilateral. Herpes zoster virus, the chicken pox virus, which has remained dormant since recovery, is triggered by psychological stress or reduced immune function.

Ban Tu Alopecia Areata (patch balding) Blood Stasis She Dan Shingles (Snake Cinnabar) (Herpes Zoster)

Invigorate blood Transform stasis

Local changes in skin, burning pain locally is the first sign, followed by the eruption of blisters. Small groups of fluid-filled blisters form over a particular area in a band-like formation. Skin between blisters is normal. There may be petachiae or blood blisters which indicates there is more fire. The local area presents with severe pain. Usually unilateral. If on the face it is extremely painful. Pain or oppression of costal areas, bitter taste in mouth, dizziness, headache, irascibility, scant dark urine, flushed complexion, red eyes. T- yellow greasy or dry coat P- wiry, rapid Affected areas are more often on chest & face, there is more exudation of fluid, fatigue, loss of strength, poor appetite, epigastric fullness & hardness. T- yellow greasy coat P- soggy, rapid Clear and discharge wind and fire Drain

She Dan Shingles Wind-fire

She Dan Shingles Damp-heat

Clear heat Transform dampness Drain

Local treatment of lesions: Use surround needle technique, needling superficially and flatly underneath the outer edge of lesion, needling toward center of lesion. Place needles 1-2 cun apart around entire lesion. Needle directly into lesion to release blood, then apply cupping. This is a more painful treatment. For wind-heat: qi men LR14 & qu quan LR8 - clear fire from jue yin zu qiao yin GB44 & zhong zhu TB3 - dredge & disperse shao yang zhi gou TB6 & feng shi GB31 - effects sides of body, harmonize shao yang, expel wind, eliminate stagnation and regulate qi w/extreme fire - xi men PC4 & shen men HT7 w/bitter taste - yang ling quan GB34 & zhi gou TB6 For damp-heat: gong sun SP4 & nei ting ST44 - clear damp-heat from spleen & stomach wai guan TB5 - dredge biao w/profuse heat - he gu LI4 & da zhui DU16 w/weak zheng qi - moxa at ming men DU4 (unless there are extreme fire signs) After rash clears, if there is lingering pain: nei guan PC6 & yang fu GB38

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Dermatology Diseases

Symptoms General: Erythema (red) papules or patches, vesicles, pustules, scales, scabs, alone or in combination. Very changeable. Allergic constitution is common. Acute or chronic cutaneous inflammation, may be dry or produce water, commonly itching & burning, recurrent, chronic, variable in form, different from patient to patient. Acute stage, skin is flaming red, itchy, rapid onset of small bumps, blisters, papules, which may crack open due to scratching, may weep fluid. Abdominal pain, constipation or diarrhea, scant dark urine, fever, headache. T- yellow greasy coat P- rapid, slippery General above plus: Chronic stage, recurrent symptoms, no blisters, darkened pigmentation at lesions, skin rough & thick, may be purplish, itchiness, flaking skin. T- pale P- thready, wiry Tx Principle Clear heat Drain damp Drain Acupuncture Points / Techniques

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Syndrome Shi Zhen Eczema Damp-heat

Etiology / Pathomechanism Invasion of exogenous wind, heat, damp, lodges in jing luo and manifests in skin. Damp-heat over time damages the blood, interferes with circulation, heats & drys the blood, causing internal wind & redness & itching of skin. Can also be caused by food allergies; corn, dairy, wheat, seafood & eggs are common.

tao dao DU13 - clear heat from heart (at T1) fei shu BL13 - discharge heat, treat skin disorders qu chi LI11 - clear heat, harmonize ying & blood levels yin ling quan SP9 - clear damp-heat w/severe itching - shen men HT7 w/copious fluid exudation - shui fen REN9 w/diarrhea - zu san li ST36 Local treatment at site: prick surface with 3-edge needle, create redness & small drops of blood, then apply cupping to draw blood & fluid. Moxa lesion until it becomes red. Ear acupuncture: LU, shen men, adrenal, cortex zu san li ST36 & san yin jiao SP6- nourish blood, fortify spleen & stomach xue hai SP10 (or bai chong wo) & da zhu BL11 - invigorate & nourish blood, stop itching xi men PC4 & da du SP2 - clear heat from ying level, drain damp, drain blood heat, stop itching Local at site, moxa & ear acupuncture above also apply here. Can become chronic and recurrent and is often treated with antibiotics. When it occurs on the head & face, or is spread over a large body area, it has the potential to affect the mind. It may block lymph vessels and cause swelling. Ear acupuncture: shen men, adrenal, subcortex, occiput. qu chi LI11 - let blood; clear yang ming heat, drain fire jie xi ST41 - clear heat from stomach, head & face feng men BL12 - dispel wind & release the exterior, strengthen defensive qi & consolidate the exterior wei zhong BL40 - let blood; resolve toxins, clear heat from blood, xi-cleft of blood Use surround needling technique around skin lesions, can apply cupping afterwards. w/severe heat - tao dao DU13 (clear heat from heart) w/agitation - nei guan PC6 (clear heat, pacify heart, calm shen) he gu LI4 & jie xi ST41 - clear heat from stomach, head & face yin ling quan SP9 - clear damp-heat xue hai SP10 - cool the blood Use surround needling technique around skin lesions, can apply cupping afterwards. w/with sustained fever, delirium & convulsions - let blood at shi xuan (tips of 10 fingers) w/vomiting - nei guan PC6 & zhong wan REN12

Shi Zhen Eczema Blood Deficiency

Untreated or poorly treated extended illness causes blood deficiency which, over time, causes wind dryness and lack of nourishment to the skin. Erysipelas; invasion of hemolytic streptocaucas. Acute, contact contagious rash with abrupt reddening of the skin.

Nourish blood Moisten dryness Drain

Dan Du Cinnebar Toxin

Rapid onset, flaming red color skin, local heat & pain, worse with touch, slightly raised skin rash with distinct borders, spreads rapidly in all directions. As skin heals it recedes back to normal skin level and becomes dull in color. After several days, skin flakes off as it heals. Where severe, there is blistering, itching, pain & heat. If toxin enters internal organs there is high fever, chest oppression and vomiting. Can ultimately cause loss of consciousness and convulsions. Appears mostly on head & face, fever, aversion to cold, achy joints, constipation, concentrated urine, poor appetite. T- red, thin yellow coat P- surging, rapid Expel wind Clear heat Resolve toxins Drain Bloodletting

Dan Du Cinnebar Toxin Wind-heat

Fire invading blood level causing heat to become profuse in superficial tissues, giving rise to rash.

Dan Du Cinnebar Toxin Damp-heat

Appears mostly on lower limbs, fever, agitation, thirst, chest oppression, swollen painful joints. T- yellow greasy coat P- soggy, rapid

Clear heat Drain damp Resolve toxins Drain Bloodletting

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Dermatology Diseases

Symptoms Size varies from grain of rice to soybean; surface is smooth, color light brown or same as skin. Common on face and backs of hands, can appear singly or in clusters. Generally painless but occasionally are itchy. Most prevalent in teenage years, often in girls. Tx Principle Clear heat Moisten dryness Disperse warts Nourish blood Drain Moxa locally at warts. Dredge wind Clear heat Disinhibit dampness Drain Acupuncture Points / Techniques

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Syndrome Bian Ping You Flat Warts

Etiology / Pathomechanism Small benign growth in the skin of the type verruca plana. Develop in superficial layers of the skin. Due to wind & heat in the skin, or liver fire, causing blood dryness. Also seen in deficiency of small intestine luo vessel. Western: neurodermatitis, psoriasis. Combination of wind, damp & heat collecting and blocking skin & vessels. Damp blocks flow of qi & blood, wind causes lack of nourishment. Difficult to treat, persistent, recurrent.

Locally, select mother wart (first wart to appear) and apply surround needle technique, leave for 1520 minutes, remove, then needle into center of wart and rotate needle around center of wart (around the ditch), masticating flesh of wart until bleeding occurs. Remove needle and apply iodine. w/wind-heat - qu chi LI11 & yu ji LU10 (could also add feng chi GB20 & shang yang LI1) w/liver qi profusion - zhong zhu TB3 & qiu xu GB40 (could also add xing jian LR2 & xia xi GB43) Moxa applied directly (3 small cones) or indirectly (10-15 minutes) to wart. Thuja homeopathic remedy (external pellets & tincture) can also be effective. feng chi GB20 - dispel wind, clear heat, resolve exterior tai yuan LU9 - clear heat, disperse wind, transform phlegm xue hai SP10 - cool & invigorate the blood, harmonize ying & xue levels yin ling quan SP9 - clear heat, drain damp qu chi LI11 - clear heat, expel wind, eliminate dampness, regulate & harmonize ying & xue levels Use surround needling technique around and under skin lesions. w/lesions on back of neck - lei que LU7 (head/neck command) & wei zhong BL40 (clear heat) w/lesions at elbow crease - xi men PC4 & lao gong PC8 w/lesions at knee crease - yin men BL37 & kun lun BL60 w/lesions at medial thigh - san yin jiao SP6 w/lesions on upper eyelid - tou wei ST8 & bai hui DU20 xue hai SP10 & san yin jiao SP6 - cool & invigorate the blood, harmonize ying & xue levels ge shu BL17 - cool & nourish the blood Use surround needling technique around and under skin lesions, or plum blossom over lesion followed by cupping. w/severe itching - let blood at qu chi LI11, cup at da zhui DU14 w/severe itching at night - zhao hai KI6 & shen men HT7

Niu Pi Xuan Ox Hide Tinea Wind-damp with Heat

General: Skin lesions that are thickened like the skin on oxs neck. Tends to occur at back of neck, inside of thigh, elbow & knees crease, upper eyelids, point of elbow. Characterized by extreme itching, worse at night or with emotional upset. Looks like lichen with irregular borders, skin darkens. Sloughing off with itching. Acute, more short-term condition. Itching red skin that weeps with scratching, skin appears lubricated, and has little scabs. T- thin yellow coat or yellow greasy coat P- soggy, rapid General symptoms above. More long-term condition. Skin is dry, thickened, scaly. T- thin coat P- thready

Niu Pi Xuan Ox Hide Tinea Blood Deficiency and Wind-dryness

If long-term, heat will cause blood deficiency, with wind & dryness. Consider liver qi profusion if condition follows an emotional upset.

Nourish blood Lubricate dryness Even technique.

Alternate therapeutic methods for ox hide tinea: Ear acupuncture: shenmen, adrenal, subcortex, LR, LU Advise patient to avoid scratching lesion, avoid hot water on lesion as it increases itching, avoid yeast, avoid stimulating topical ointments. Ding Chuang Clove Sores Spleen and Stomach Fire Toxin Internal accumulation of heat toxin due to diet or rich food or alcohol, fire accumulates, toxins build up internally and sores arise. Lack of hygiene allows external invasion of toxin which enters yang ming, heat toxin accumulates and may invade deeply along jing luo and eventually attack zang fu. Hard, deep rooted lesion resembling a clove. Western: staphylococcal bacteria infection. Common around nose, mouth, hands & feet. When severe there may be red bands running toward heart from sores which represents septicemia. Initial stage: lesion is small (millet grain), may be yellow or purple, small blister at top, lesion has hard deep root, local numbness, itching & mild pain. Intermediate stage: lesion becomes red, swollen and hot, local swelling & severe pain, fever, aversion to cold, yellow tongue coat. Late stage: pus is released from lesion and symptoms subside. If sore does not resolve, toxins can invade deeply, attack zang fu and cause septicemia; fever, agitation, dizziness, vomiting, convulsions, red bands. Clear heat Resolve toxins Stop pain Drain, blood let. shen zhu DU12 - clear heat from heart, pacify wind, treat faruncles & carbuncles, dredge yang meridians ling tai DU10 - clear heat, detoxify poison, treat boils & carbuncles, dredge & discharge yang meridians w/sores on front of face (yang ming) - qu chi LI11 & shang yang LI1 w/sores on sides of face (shao yang) - yang ling quan GB34 & zu qiao yin GB44 w/sores on index finger - qu chi LI11 & ying xiang LI20 w/sores on 4th toe - yang ling quan GB34 & ting hui GB2 w/red lines radiating from sore towards heart - let blood along red line with 3-edge needle or pifuzhen Pricking therapy: look for small, round, hard, slightly raised bumps along thoracic vertebrae, slit skin over bumps with needle, lift up white fibers and pinch and snap them. Using heat to treat heat: extra point ding shu (4 cun proximal to shen men HT7) - apply direct moxa, only on side with lesion, 50 zhuang, burn until too hot then flick off. Repeat in 2-3 days.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Dermatology Diseases

Symptoms Arises following exposure to cold or wind, aggravated by wind or cold, rash is more white in color, may be better with application of heat, more common in winter. T- thin white coat P- tight, floating Appears or worsens with exposure to heat, more common in summer, red patchy rash, may feel hot to the touch, better with cold application. T- thin yellow coat P- rapid, floating Red patchy rash, epigastric and abdominal pain & distension, constipation or diarrhea, nausea, vomiting, poor appetite. T- yellow greasy coat P- rapid, slippery Chronic, recurring wind rash, can reoccur over several months or years, brought on or exacerbated by overwork, strain ot fatigue. T- pale, thin, thin white coat P- thin, thready Rash occurs a few days prior to menstruation, disappears when menstruation ends. There may also be dysmenorrhea or irregular periods. T- pale P- weak, thready Tx Principle Dispel wind & scatter cold Regulate & harmonize ying and wei levels Drain, moxa. Acupuncture Points / Techniques lie que LU7 - circulate wei qi & release the exterior, expel wind & scatter cold feng chi GB20 - resolve exterior, expel wind & scatter cold he gu LI4 & qu chi LI11 - scatter cold from superficial level, dispel wind, stop itching zu san li ST36 - support the immune system xue hai SP10 - regulate & harmonize ying and wei levels, invigorate the blood w/cough or asthma - chi ze LU5 & tan zhong REN17

73

Syndrome Feng Zhen Wind Rash Wind-cold

Etiology / Pathomechanism Known as hives or urticaria. Can be acute or chronic. Comes & goes, moves around on body, appears in patches, bright red or pale white color, itchy, rapid onset, rapid resolution. Wei qi deficiency causes skin pores to be slack and allows for invasion of windcold or wind-heat.

Feng Zhen Wind Rash Wind-heat

Dispel wind & clear heat Regulate & harmonize ying and wei levels Drain Clear damp-heat Dispel wind Free the stool (if needed) Drain Tonify qi & blood Dispel wind Harmonize ying & wei Tonify, moxa if needed. Regulate chong & ren Dispel wind Harmonize ying & wei Tonify

he gu LI4 & da zhui DU14 - resolve exterior, clear heat, expel wind, stop itching qu chi LI11 - regulate & harmonize ying and wei levels, clear heat, expel wind xue hai SP10 & san yin jiao SP6 - regulate & harmonize ying and wei levels, cool & invigorate the blood wei zhong BL40 - can let blood; resolve toxins, cool the blood, stop itching w/sore throat or red eyes - let blood at shao shang LU11 qu chi LI11, xue hai SP10, san yin jiao SP6, zu san li ST36, yin ling quan SP9 - clear damp-heat tian shu ST25 - clear damp heat & regulate the intestines (mu point of LI) w/intestinal parasites - bai chong wo (1 cun proximal to xue hai SP10) treats intestinal parasites, itching w/excessive heat - nei ting ST44 (clear stomach heat, clear damp-heat, calm the shen) qu chi LI11, xue hai SP10 & san yin jiao - tonify qi & blood, harmonize ying & wei zu san li ST36 - moxa if needed, tonify qi & blood ge shu BL17 & pi shu BL20 - tonify qi & blood qu chi LI11, xue hai SP10 & san yin jiao - tonify qi & blood, harmonize ying & wei zhong ji REN3 - regulate chong & ren vessels gong sun SP4 - regulate chong vessel lie que LU7 - regulate ren vessel w/dysmenorrhea - he gu LI4 & di ji SP8 Ear acupuncture: LU, shen men, occiput, endocrine, adrenal

Feng Zhen Wind Rash Damp-heat in Stomach and Intestines Feng Zhen Wind Rash Qi and Blood Deficiency Feng Zhen Wind Rash Dysfunction of Chong and Ren Vessels

Allergic reaction to seafood or intestinal parasites can cause damp-heat in the stomach or intestines, which can stagnate in the superficial tissues. Blood deficiency can give rise to internal wind or external evil can take advantage of qi depletion. Deficiency of liver and kidney and dysfunction of the Chong & Ren can lead to poor blood nourishment of skin, allowing development of wind rash.

Alternate therapeutic methods for wind rash: Ear acupuncture: shenmen, adrenal, LU, occiput, endocrine. Elicit moderate sensation, retain 20 minutes, daily.

Pediatrics Children have a pure yang constitution, their organs are not completely developed and are delicate. They progress quickly through illness and recover quickly because their qi is very clear and transformation progresses very quickly. This means that conditions can rapidly worsen and rapidly heal. Acupressure is used most commonly with children. When needles are used they are inserted quickly and removed immediately. The tongue usually has no coating, this is normal. Pulse tends to be rapid and is not reliable for diagnosis. Diagnosis is instead done using the 3 gates of the index finger. The 5 slows are used to represent lack of proper growth and development: 1) Fontanelle closure 4) Growth of body 2) Hair & teeth growth 5) Age of walking 3) Speech development

Copyright 2008 Julie Casper

Index finger vein diagnosis (hu kou san guan zhi mai): Location: wind gate (feng guan) - proximal phalange segment; less serious qi gate (qi guan) - middle phalange segment; more serious life gate (ming guan) - distal phalange segment; serious illness Color: pale purple or reddish brown - normal bluish purple - blood stasis, spasms, tremors light red - qi & blood deficiency, deficiency cold red - heat dark purplish red - accumulation of heat

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Depth: mildly visible - normal easily viewed - exterior syndrome deeper - interior syndrome Size: thick vein - excess thin vein - deficiency

Therapeutics: Syndromes and Acumoxa Treatment for Pediatric Diseases

Syndrome Etiology / Pathomechanism Symptoms Involuntary passage of urine during sleep in a child over 3 years of age (bed wetting). Frequent bed wetting which occurs several times per night, sleep is very deep, child is unaware of wet bed until morning. Pale white complexion, clear copious frequent urination during the day, cold limbs, feel cold. T- pale P- deep, slow, forceless Commonly seen following illness, weakened constitution, bed wetting is frequent but with small amounts. Pale white complexion, fatigue, muddy stools, loss of appetite, SOB. T- pale, white coat P- tardy or deep & thready Small amount or dark yellow enuresis, stronger smell, agitation and restlessness during sleep, talking during sleep, grinding of teeth during sleep, red lips. T- yellow slimy coat P- slippery, rapid Tx Principle Warm and tonify kidney yang Secure and astringe the urine Tonify, moxa. Acupuncture Points / Techniques To tonify with friendly needle, press in multiples of 9, to drain press in multiples of 6. zhong ji REN3 - warm kidney, strengthen yang, consolidate the root (mu of bladder) guan yuan REN4 - tonify kidney, regulate lower burner, benefit bladder (mu of small intestine) shen shu BL23 - tonify kidney, fortify yang, regulate water passages and benefit urination pang guang shu BL28 - tonify kidney, regulate bladder w/very deep sleep - bai hui DU20 & shen men HT7 w/several bed wettings per night - moxa at da dun LR1 (benefit genitals, regulate urination & lower jiao) w/kidney yin deficiency - tai xi KI3 qi hai REN6 - benefit spleen qi, regulate qi, treat bed wetting tai yuan LU9 - tonify lung qi, treat spleen & lung deficiency zu san li ST36 - strengthen spleen, boost qi, harmonize stomach san yin jiao SP6 - fortify spleen, drain damp, treat urinary disorders and bed wetting w/muddy stools - pi shu BL20 & shen shu BL23 w/frequent urination - bai hui DU20 & ci liao BL32 pang guang shu BL28 - tonify kidney, regulate bladder, clear damp-heat from lower jiao zhong ji REN3 - warm kidney, strengthen yang, consolidate the root (mu of bladder) yin ling quan SP9 - clear heat, regulate spleen and transform damp, clear passage thru triple burner san yin jiao SP6 - fortify spleen, drain damp, treat urinary disorders and bed wetting xing jian LR2 - clear heat from liver channel, benefit lower burner w/frequent dreaming - shen men HT7 Xiao Er Yi Niao Kidney dysfunction, inability to seal & Enuresis store, kidney qi hua dysfunction. Loss of Kidney Yang Deficiency lower jiao qi can turn in to kidney yang deficiency causing bladders inability to hold urine.

Xiao Er Yi Niao Enuresis Lung and Spleen Qi Deficiency

Lungs ventilate and disperse fluid & qi and send fluid down to kidney/bladder. Spleen is responsible for transformation transportation of water and dampness and sends turbid to bladder via the small intestine. With SP & LU qi deficiency, upper cant control lower, bed wetting. Damp-heat in liver causes hyperactivity of dredging discharging function and bed wetting.

Tonify spleen & lung qi Boost qi Tonify, moxa.

Xiao Er Yi Niao Enuresis Damp-heat in Liver Channel

Clear heat Drain dampness Drain

Alternate therapeutic methods for enuresis: Ear acupuncture: KI, BL, subcortex, urethra, brain and ashi points. 2-3 points/session, elicit moderate sensation, retain 20 minutes. Once daily. Scalp acupuncture: foot motor sensory line, reproductive line. Intradermal needle at guan yuan REN4 or zhong ji REN3 or san yin jiao SP6. Press in before sleep. Hand acupuncture: yi nao (bed wetting point) at midpoint of distal interphalangeal joint of small finger, palmar side. Reduce fluid intake before bed time, urinate befor going to sleep, establish confidence to eliminate problem in child.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Pediatric Diseases

Symptoms Invasion of summer-heat pathogen. Liquid stools, thin consistency, yellow color, foul smelling. Abdominal pain, tenesmus, fever, thirst, scant dark urine. T- yellow slimy coat P- slippery, rapid Tx Principle Clear heat Disinhibit dampness Drain Acupuncture Points / Techniques NOTB: Insert and immediately remove needles, no retention. This applies to all cases. zhong wan REN12 & zu san li ST36 - (mu-he of ST) treat excess in fu tian shu ST25 - (mu of LI) resolve damp-heat, rectify ST & LI qi, regulate SP & ST qu chi LI11 & nei ting ST44 - clear damp-heat from stomach & intestines w/high fever - he gu LI4 & da zhui DU14 w/severe dampness - yin ling quan SP9 tian shu ST25 & shang ju xu ST37 - (mu-he of LI) treat excess in fu bai hui DU20 - moxa to drive out wind-cold he gu LI4 - expel wind-cold, resolve the exterior w/watery stools - zhong wan REN12 & yin ling quan SP9

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Syndrome Xiao Er Fu Xie Infantile Diarrhea Damp-heat Invasion

Etiology / Pathomechanism For children under 2 years old. Increase in frequency of bowel movements or loose, runny watery consistency of stools. More common in summer and autumn. Infants zangfu are tender and immature, spleen & stomach are frail, transform/ transport function is frail. This allows easier entry of exogenous pathogens such as wind, cold, summer-heat and dampness. Children commonly eat unclean food which affects transform/transport function and can also cause parasitic infection, resulting in diarrhea. Excessive nursing (over-eating) can cause stagnation of food as there is too much for frail SP/ST to process. Extended illness can injure SP/ST or KI resulting in lack of warmth necessary to transform water & grain, clear & turbid are not properly separated.

Xiao Er Fu Xie Infantile Diarrhea Wind-cold Invasion Xiao Er Fu Xie Infantile Diarrhea Food Stagnation

Watery diarrhea, foamy, borborygmus, no foul odor. Abdominal pain, aversion to cold, fever. T- white slimy coat P- slippery, floating or tight Abdominal distension, intermittent pain followed by passage of runny foul-smelling stools, alleviation of pain after passage of stool. Foul belching, vomiting of undigested food, restlessness. Parasite invasion would look similar to this. T- thick slimy coat P- slippery Longer-term diarrhea, pale colored liquid stools, no foul odor, bowel movement directly following meal. Sallow yellow complexion, poor appetite, weight loss, fatigue. T- pale, thin white coat P- slow, thready

Dispel wind Disperse cold Drain, moxa. Drive out stasis Drain

tian shu ST25, zhong wan REN12 & zu san li ST36 (mu-he of ST) - regulate ST & LI, assist digestion jian li REN11 - special point for food stagnation qi hai REN6 - normalize qi, guide out stagnation li nei ting - treat poor digestion with food accumulation si feng - palmar aspect of 4 fingers, midpoint of proximal phalange joint, prick & squeeze out yellow fluid w/vomiting - nei guan PC6 & shang wan REN13 w/abdominal distension & pain - xia wan REN10 & he gu LI4 zhong wan REN12 - moxa; strengthen spleen & stomach, transform damp, rectify middle jiao zu san li ST36 - moxa; strengthen spleen, treat diarrhea pi shi BL20 - moxa; fortify spleen, transform damp, raise spleen qi guan yuan shu BL26 - moxa; regulate lower jiao, treat diarrhea zhang men LR13 - benefit spleen & stomach, regulate middle & lower jiao w/abdominal distension and pain - qi hai REN6 & gong sun SP4 shen que REN8 - moxa w/salt partition; warm yang, especially good for diarrhea in children shang ju xu ST37 - regulate spleen, stomach & intestines, treat diarrhea ming men DU4 & shen shu BL23 - needle, then moxa; tonify kidneys, assist yang w/cold extremities - moxa at guan yuan REN4 (tonify kidneys and fortify yuan qi) Classical points for diarrhea: ming men DU4 - with needle warming moxa to treat diarrhea chi ze LU5 - needle 0.5 cun deep, retain for 5 minutes For all types of diarrhea - tian shu ST25, zu san li ST36 & shen que REN8. For diarrhea with anal prolapse - chang qiang DU1, da chang shu BL25, bai hui DU20 (with moxa) & cheng shan BL57.

Xiao Er Fu Xie Infantile Diarrhea Spleen Qi Deficiency

Fortify the spleen Boost qi Tonify, moxa.

Xiao Er Fu Xie Infantile Diarrhea Kidney Yang Deficiency

Prolonged diarrhea, bowel movement directly following meal, thin clear stools, undigested food in stools. General coldness of body, pale white complexion, listlessness, may have anal prolapse. T- pale P- thready, weak

Tonify & warm kidney Tonify, moxa.

Alternate therapeutic methods for infantile diarrhea: Acupoint injection: vitamin B12 at zu san li ST36 & da chang shu BL25. Cupping therapy: at da chang shu BL25, apply bilaterally for 5-10 minutes, daily. Moxibustion: At the border of the red and white flesh directly inferior to tip of lateral malleolus apply indirect moxa with moxa roll for 10-15 minutes, two to three times daily. This will activate yang qi and treats all types of diarrhea. Tuina: Apply oil made of following recipe at shen que REN8 & zu san li ST36, then tuifa and roufa. Oil recipe: 200 g vegetable oil, 30g spring onion, 50g fresh ginger (or 15g dry ginger), 30g mugwart, 30g fresh peach tree bark. Saute ginger & onion in oil, add human hair, remove from heat, add remaining ingredients, let sit several hours, then strain through cheese cloth.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Pediatric Diseases

Symptoms Exogenous pathogen affects wei qi, symptoms are similar to common cold. Sneezing, runny nose, cough, expectoration of thin, white, foamy phlegm. T- thin white coat P- floating Finger vessel - pale red at wind gate Tx Principle Release exterior Expel wind Ventilate lung Stop cough Drain - no needle retention Acupuncture Points / Techniques feng men BL12 - moxa; ventilate lungs, dispel wind, release exterior, stop cough he gu LI4 - resolve exterior, expel wind lie que LU7 -regulate descent & dispersal of lung qi, circulate wei qi & release exterior, expel wind w/aversion to cold - da zhui DU14 w/itchy painful throat - let blood at shao shang LU11 w/severe cough - tian tu REN22 w/copious phlegm - feng long ST40 w/fever - wai guan TB5 kong zui LU6 -clear heat, regulate lung qi, disseminate & descend lung qi chi zi LU5 - clear heat, descend lung qi ni, rectify lung qi, drain & moisten lungs feng men BL12 & fei shu BL13 - drain lungs and resolve exterior, ventilate lungs, stop cough feng long ST40 - transform phlegm, downbear counterflow, treat coughing with copious phlegm w/fever - qu chi LI11 w/nose bleed or coughing of blood - tian fu LU3 & shang xing DU23 Cupping at da zhui DU14 & fei shu BL13. Single point formula: si feng (4 seams) Strengthen spleen Tonify lungs Tonify - no needle retention

76

Syndrome Dun Ke Whooping Cough External - Stage 1

Etiology / Pathomechanism The 100 day cough. Pertussis. Pediatric infectious respiratory disease. Recurrent, spasmodic cough with inhalation sounding like a roosters crow. Common in winter/spring. Children under 5 most susceptible. Invasion of pathogenic, seasonal, xie qi, evils enter lungs and create turbid phlegm which affects ability of lung to ventilate and lung qi to move downward, also disrupts fluid metabolism in lungs causing lung qi ni and spasmodic coughing due to phlegm. If left untreated, heat enters the luo mai of the lung causing coughing of blood.

Dun Ke Whooping Cough Spasmodic Coughing - Stage 2

More severe cough, seasonal evils accumulate and transform into phlegm-heat. Continuous spasmodic cough, intermittent bouts of coughing, deep sounding inhalation, vomiting of food matter, expectoration of phlegm which may be blood-streaked, vomiting or phlegm expectoration provides relief. During bouts, face may swell, veins in neck bulge, face becomes red, hands clenched, tongue hangs out. Cough is worse at night, fever, dry mouth, constipation, concentrated urine, weight loss. T- yellow coat P- slippery, rapid Finger vessel - purplish red Cough decreases, less frequent bouts, vomiting is rare, cough has less force, phlegm is thin and scant, SOB, weak voice, spontaneous sweating, general lack of strength, pale lips. Qi is still depleted and can stay depleted for 2-3 months after cough has stopped. T- scant coat P- rapid, thready Finger vessel - pale greenish

Clear heat Transform phlegm Stop cough Drain - no needle retention

Dun Ke Whooping Cough Recovery - Stage 3

fei shu BL13 - ventilate lungs, stop cough pi shu BL20 - fortify spleen, transform dampness tai yuan LU9 - tonify lung qi, downbear qi ni, clear heat, disperse wind, stop cough, transform phlegm zu san li ST36 - strengthen spleen, transform phlegm, treat coughing with copious phlegm w/severe deficiency - qao huang shu BL43 (tonify deficiency taxation, especially deficiency cough) w/poor appetite & muddy stools - zhong wan REN12, tian shu ST25 & qi hai REN6 w/cold hands & feet - moxa at guan yuan REN4 w/yin deficiency - san yin jiao SP6 & tai xi KI3

Alternate therapeutic methods for whooping cough: Ear acupuncture: LU, bronchi, shenmen, sympathetic Plum blossom: Tap along cervical and thoracic jia ji line, zhong wan REN12, nei guan PC6, tai yuan LU9 & feng long ST40. Moxa: Alternate the following formulas, treating once per week; 1) needle shang qiu SP5 and direct moxa fei shu BL13 with 3-5 zhuang, 2) needle he gu LI4 and direct moxa gao huang shu BL43 with 3-5 zhuang, 3) direct moxa que pen ST12 with 3-5 zhuang. For recovery stage; moxa at gan shu BL18 & wei shu BL21 with 3-5 zhuang. Developmental Problems The 5 Slows Liver and Kidney Yin Deficiency Developmental Problems The 5 Slows Heart Blood and Spleen Qi Deficiency Slower than normal; 1) Standing 2) Movement 3) Hair growth 4) Growth of teeth 5) Speaking Muscles are weak, development is slow in sitting up and standing, lassitude, pale complexion, pale and thin finger vessel. Supplement kidney Tonify liver Tonify. tai xi KI3 & xin shu BL15 - moxa with 3 cones daily for 3 days w/liver & kidney yin deficiency - shen shu BL23 & guan yuan (needle or moxa) w/heart & spleen deficiency - pi shu BL20, shen men HT7 & qi hai REN6 (needle or moxa)

Slow in speaking, seem to lack intelligence, listless, can be no speaking even after several years, speech is unclear & unintelligible, skin is white & withered, hair is dry with slow growth, poor appetite. T- glossy, no coat

Tonify heart blood Nourish spleen qi Tonify.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Pediatric Diseases

Symptoms Tx Principle Acupuncture Points / Techniques Acute wind fright: sudden onset, high fever, convulsions, external pathogenic invasion. Use draining technique.

77

Syndrome Xiao Er Jing Feng Wind Fright (Infantile Convulsions) Ji Jing Feng Acute Wind Fright External Attack

Etiology / Pathomechanism

Loss of consciousness or clouded consciousness, muscular spasms of limbs, tetany of jaw. Most common under 5 years of age. Frequency of attacks decreases with age. Western: high fever, acute infectious CNS disease such as epidemic cerebral spinal meningitis, encephalitis B, toxic pneumonia and dysentery. External pathogen enters pores due to weakness of wei qi, there is rapid transformation to fire as children are pure yang, fire transforms to wind, which targets jue yin, fire enters blood, heart orifaces are blocked and loss of consciousness occurs. Prodromal signs: High sustained fever, red complexion, agitation & restlessness, rocking of head, active tongue, clenching jaw, grinding teeth, sudden jerking, sitting up while sleeping or deeply sleeping and difficult to wake. Onset of wind fright: rapid loss of consciousness, eyes roll back in head, stiffness of neck, opisthotonos, convulsions of limbs, greenish purple finger vessel. External attack: above signs plus - fever & headache, inflamed throat, cough, nausea, vomiting, thirst. Prodromal and onset signs above plus: Fever, abdominal distension and pain, vomiting, phlegm in throat, wheezing respiration, constipation, foul smelling stool which may contain pus or blood, loss of appetite. Prodromal and onset signs above plus: No fever, cold limbs, restlessness at night, nightmares, deep sleep, difficult to wake from sleep, frequent crying during day, easily frightened.

Chronic wind fright: slow onset, no fever, intermittent episodes, mild spasms, exposed eyeballs with convulsions, no external pathogenic invasion, signs of internal deficiency. Tonify. Open orifices Eradicate wind Settle convulsions Clear heat Draining - no needle retention. Core points for acute fright wind: Let blood at 12 jing-well points to clear heat. ren zhong DU26 - open orifices, awaken brain da zhui DU14 - clear heat, expel external pathogens; can let blood and cup tai chong LR3 & he gu LI4 - 4 gates; normalize qi, clear heat & wind, clear the mind, resuscitate shi xuan (finger tips) - let blood to treat coma, fainting, fever yang ling quan GB34 - relax tendons and stop convulsions w/eyes rolled back in head - shen ting DU24 w/clenched jaw - jie che ST6 For external attack add - qu chi LI11 - clear heat Core points for acute fright wind above plus: feng long ST40 & zhong wan REN12 - remove stagnant qi & resolve phlegm da ling PC7 - clear heat from heart & calm mind

Ji Jing Feng Acute Wind Fright Phlegm-heat

Excess eating causes accumulation and stagnation of food in stomach & large intestine, phlegm & turbidity blocks movement of qi, qi stagnates and turns to fire which transforms to internal wind causing convulsions. Weak Yuan qi causing susceptibility to environmental oddities, feel insecure, sounds & shadows cause sudden fright or fear disrupting flow of qi & blood, qi scatters and shen has nothing to hold onto. Excess yang transforms to wind. Long-standing weakness of spleen & stomach, vomiting & diarrhea lead to insufficient ability to transform/ transport, causing lack of blood and lack of nourishment to tissue, which gives rise to wind.

Open orifices Eradicate wind Settle convulsions Clear heat Transform phlegm Draining - no retention. Open orifices Eradicate wind Settle convulsions Calm the mind Draining - no needle retention. Tonify & increase spleen yang Level the liver Eradicate wind Tonify & drain - no needle retention.

Ji Jing Feng Acute Wind Fright Fear & Fright

Core points for acute fright wind above plus: shen men HT7 - calm the mind, treat fear & fright yong quan KI1 - open orifices, strengthen heart, calm the mind, treat wind fright yin tang - calm mind, eliminate wind, treat infantile convulsions

Man Jing Feng Chronic Wind Fright Spleen Yang Deficiency

General chronic wind fright symptoms: Yellowish complexion, emaciation, fatigue, mental lassitude, cold limbs, weak respiration, sunken fontanelles in babies, fall into deep sleep with eyeballs exposed, intermittent weak longer lasting convulsions. With spleen yang deficiency will also see: Loose stools, diarrhea, edema in face & feet. T- pale, white coat P- deep, slow, forceless General chronic wind fright symptoms plus: Restlessness, mental lassitude, vexation, flushed cheeks, hard dry stools. T- shiny, scant coat P- deep, thready, rapid

pi shu BL20, wei shu BL21, gan shu BL18 & shen shu BL23 - tonify jin suo DU8 (sinew contraction) - drain; soothe jin, extinguish wind, soothe liver zu san li ST36 & qi hai REN6 - tonify bai hui DU20, yin tang & tai chong LR3 - drain to treat convulsions

Man Jing Feng Chronic Wind Fright Liver and Kidney Yin Deficiency

Febrile illness affects liver & kidney yin causing liver yin deficiency and a relative excess of liver yang, which leads to liver yang rising and wind.

Tonify & increase liver & kidney yin Tonify - no needle retention.

gan shu BL18, shen shu BL23 & tai xi KI3 - tonify liver & kidney yin yao yang guan DU3 - regulate lower jiao, treat constipation yang ling quan GB34 & jue gu GB39 - benefit sinews & joints, treat infantile convulsions qu chi LI11 & zu san li ST36 - move qi & blood to limbs

Alternate therapeutic methods for acute wind fright: Ear acupuncture: sympathetic, shenmen, subcortex, heart, brain. Blood letting: shi xuan, ren zhong DU26, he gu LI4, tai chong LR3 Moxa: at zhong kui (dorsal aspect of proximal interphalangeal joint of middle finger).

Alternate therapeutic methods for chronic wind fright: Ear acupuncture: LR, SP, shenmen, subcortex, thoracic, cervical and lumbosacral spine. Plum blossom: along bladder back shu line or jie ji line along spine. NOTB: Acumoxa is effective in treating acute stage and to restore consciousness. It is also important to treat the root.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Pediatric Diseases

Symptoms Fever, aversion to cold, swelling & tenderness of parotid glands, unclear swelling boundary, difficulty chewing, red painful throat, general malaise and body ache. T- red, yellow coat P- floating, rapid Tx Principle Dispel wind Release exterior Clear heat Resolve toxins Drain Acupuncture Points / Techniques jie che ST6 - dispel wind, clear heat, benefit jaw & cheek, treat mumps yi feng TB17 - dispel wind, clear heat, benefit ears he gu LI4 - dispel wind, clear heat, retreat fever wai guan TB5 - dispel wind, release exterior, clear heat, benefit head & ears Needle obliquely downward toward swelling along shao yang on side of head. w/high fever - da zhui DU14 & let blood at shao shang LU11 w/red painful throat - let blood at shang yang LI1 & shao shang LU11

78

Syndrome Zha Sai Mumps Mild Type

Etiology / Pathomechanism External epidemic warm toxins invade through nose & mouth causing fire & phlegm to collect in shao yang and obstruct flow of qi & blood causing swelling & pain at parotid gland area. Most common in ages 5-11. Severe seasonal heat toxin can spread from shao yang to jue yin. In liver channel it causes red, swollen testes. In pericardium channel it causes convulsions & loss of consciousness. Dangerous in older children & adults as it can lead to sterility.

Zha Sai Mumps Severe Type

Heat, pain, redness & swelling of area over the parotid glands, may be flamming red, high fever, headache, agitation, restlessness, thirst, painful swollen throat, constipation, vomiting. When severe; swelling & pain in testes, convulsions, loss of consciousness. T- red, yellow coat P- slippery, rapid

Clear heat Resolve toxins Soften hardness Open and allow clear passage thru luo vessel Drain

er he liao TB22 - expel wind, alleviate pain, treat swelling of jaw wai guan TB5, he gu LI4 & qu chi LI11 - dispel wind, release exterior, clear heat, benefit head & ears guan chong TB1 - treat exterior invasion of wind-heat, disinhibit throat, benefit ears feng long ST40 - clear heat, transform phlegm, luo vessel connects to throat; opens the luo and treats pain, swelling & phlegm in throat w/high fever - let blood at the 12 jing-well points w/pain and swelling of testes - qu quan LR8 & tai chong LR3 w/headache - feng chi GB20 & xie xi GB43

Alternate therapeutic methods for mumps: Ear acupuncture: helix 4, 5 & 6, parotid gland, face, cheek, shenmen. Select 2-3 points, elicit strong sensation. Treat daily for 3 days for one course. Deng xin cao (lampwick grass): dip wick in sesame oil, light it, apply to extinguish wick to point jiao sun TB20 on affected side. Repeat 2-3 times. Treat 1-2 times per day for 3 days. Single point formula: qian gu SI2 (clear wind-heat and reduce swelling; benefit eyes, ears & throat, treat swollen painful throat & cheeks). Plum blossom: tap at er jian (extra - ear tip). Or moxa until it becomes red. Xiao Er Gan Ji Infantile Malnutrition gan = sweet (which injures spleen) or pole-like (extreme thinness). Deficiency of qi, blood and fluids. General Sx: Emaciation, stick-like appearance, mental exhaustion, sallow yellow complexion, fine sparse hair, scaly skin. Effects children under 5 and slows development if not treated properly. General symptoms above plus muddy stools with undigested food, cold limbs, hollow looking belly, sleep is unsettled, exposed eyeballs during sleep, pale lips, when severe there is retarded development. T- pale P- thready, forceless Feed fixed portions at regular intervals. Avoid rich oily foods. Protect SP & ST. Regulate and normalize spleen & stomach Guide out food stagnation Tonify & drain. Alternate therapeutic methods: Plum blossom: Tap lightly along jia ji from T1 to L5 and on following points, zu san li ST36, pi shu BL20, wei shu BL21, san jiao shu BL22 & si feng. Treat once every other day. Herbal formula: ganjisan, xiangfuzi, jineijin, huhuanglian, cangzhu, shenqu, roudoukou, sharen, maiya. 3g, 3x per day. zhang men LR13 & pi shu BL20 - mu-shu; regulate and normalize spleen (even) zhong wanREN12 & wei shu BL21 - mu-shu; regulate and normalize stomach (even) zu san li ST36 - regulate & tonify spleen & stomach, guide out food stagnation (even) gong sun SP4 - luo; treat abdominal distension and pain shang qiu SP5 & xia wan REN10 - drain to remove stagnation si feng - prick to release drop of yellow fluid w/muddy stools & abdominal distension - tian shu ST25 & qi hai REN6 w/cold limbs - qi hai REN6 w/restless sleep - jian shi PC5 ju que REN14 - drain; move qi downward, transform phlegm, treat epigastric pain zhong wan REN12 & tian shu ST25 - drain; guide out stasis, resolve dampness bai chong wo - drain; for parasitic infection zu san li ST36 - afterward tonify with moxa here w/abdominal distension - zhang men LR13 & qi hai REN6 w/cloudy growth on eye (nebulae) - xing jian LR2 & yang ling quan GB34

Xiao Er Gan Ji Infantile Malnutrition Spleen and Stomach Deficiency

Improper care, poor diet, poor eating habits, low quality foods, overeating of fat sweet rich or cold foods, will all harm SP & ST compromising the transform/ transport function. Over time nutrients are not properly absorbed, or food stasis prevents proper absorption, further injuring qi & yang causing malnutrition. Consumption of unclean food leading to parasitic infection. Worms consume qi & blood causing lack of nourishment to flesh & muscles and malnutrition.

Xiao Er Gan Ji Infantile Malnutrition Parasitic Infestation

General symptoms above plus abnormal appetite (never full, want to eat dirt and bugs), epigastric and abdominal distension, frequent abdominal pain, grinding of teeth during sleep. Inside of cheeks may have white spots. T- pale P- thready, wiry

Kill and expel worms Guide out food stagnation Drain, then tonify spleen, stomach, qi & blood.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Common symptoms: Red, swollen, painful eyes, often associated with aversion and sensitivity to light and brightness, tearing, excess mucus or purulent discharge, crusted eyelid, gritty eyes, difficult to open. Can start in one eye, spread to other eye and other people. Plus LR/GB Sx: vertex or temporal headache or behind eyes, tinnitus, dizziness, bitter taste, irritability, flushed complexion, feel hot. T- red tip & sides P- wiry, rapid Common symptoms above plus: headache, fever, aversion to wind, stuffy nose. T- thin yellow coat P- floating, rapid Tx Principle Drain liver gallbladder fire Disperse swelling Stop pain Drain Acupuncture Points / Techniques Core points: he gu LI4 - command for head & face; clear heat, release exterior jing mingBL1 - local point for eye disorders, expel wind, clear heat, benefit eyes tai yang - clear heat, disperse swelling, stop pain (can let blood for pink eye or enlarged vein in eye) feng chi GB20 - dispel wind, clear heat, brighten eyes, resolve exterior, treat headache yang lao SI6 & tong gu BL6 - harmonize rising and descending of qi, expel wind from tai yang Core points above plus: xing jian LR2 or tai chong LR3 - alternate; clear liver, clear heat xia xi GB43 - clear damp-heat from channel, benefit eyes, ears & head, clear heat, treat headache & tinnitus Core points above plus: qu chi LI11 - clear heat, retreat fever, expel wind, clear the head wai guan TB5 - lear heat, retreat fever, expel wind, release exterior shao shang LU11 - clear wind-heat shang xing DU23 - let blood; clear heat and scatter wind, open orifaces, brighten eyes w/headache - yin tang w/irritability - guan chong TB1

79

Syndrome Mu Chi Zhong Tong Sore, Red and/or Swollen Eyes Liver Gallbladder Fire

Etiology / Pathomechanism Internal liver/gallbladder fire heating blood and blocking meridian.

Mu Chi Zhong Tong Sore, Red and/or Swollen Eyes Wind-heat

Exogenous wind heat moving in and causing profusion of heat and fire in the eyes.

Clear pathogen Clear wind-heat Disperse swelling Stop pain Drain

Alternate therapeutic methods for sore, red and swollen eyes: Ear acupuncture: eye, eye 1, eye 2, LR, elicit strong sensation, retain 30 minutes. Bloodletting: er jian; treats conjunctivitis. Plum blossom: heavy tapping at jia ji, light tapping at temple and around eye. Moxa: du gu kong and xia gu kong. Water needle: use saline, B vitamins, antibiotics at he gu LI4, qu chi LI11, si zhu cong TB23. tong zi liao GB1 and cuan zhu BL2. Advise patient to wash hands frequently, aviod hot spices, get plenty of sleep, avoid eye strain, avoid anger and taxation. CAUTION: Wear gloves and wash hands carefully when treatiing contagious disease. Zhen Yan Stye Wind-heat Exogenous wind heat moving in and causing stasis in the eyes. Inflammation of sebaceous gland of eyelid, bacterial infection. Common symptoms: Hard bump or swelling on edge of eyelid, size of wheat grain. Itchy, painful, swelling at root of eyelash on rim, gradual swelling, bump can become hard, swollen, red, immobile. Progresses to increasing redness & swelling, fever, stye painful to touch, worse when hed is put down, pus and yellow discharge. Plus: fever, aversion to cold, headache, malaise, fatigue. T- thin yellow coat P- floating, rapid Zhen Yan Stye Spleen and Stomach Damp-heat Overconsumption of hot, greasy, spicy foods creating damp in yang ming which rises up. Common symptoms above plus: high thirst, halitosis, vexation, constipation, dark urine, more pus and discharge. Clear heat Disinhibit damp Disperse swelling Drain Clear heat Dispel wind Drain he gu LI4 - command for head & face; clear heat, release exterior tai yang - clear heat, disperse swelling, stop pain feng long ST40 - clear damp heat xing jian LR2 -clear liver, clear heat wai guan TB5 - lear heat, retreat fever, expel wind, release exterior Points based on location: Lateral stye - tong zi liao GB1 & si zhu kong TB23 Medial stye - jing ming BL1 and/or cuan zhu BL2 Upper eyelid - yang bai GB14 & yu yao Lower eyelid - si bai ST2 & cheng qi ST1 he gu LI4 - command for head & face; clear heat, release exterior tai yang - clear heat, disperse swelling, stop pain yin ling quan SP9 - disinhibit damp nei ting ST44 - clear heat w/constipation - qu chi LI11 & shang ju xu ST37 w/halitosis - cheng jiang REN24

Alternate therapeutic methods for sore, red and swollen eyes: Ear acupuncture: eye, ear apex, LR, SP, ST, elicit strong sensation, retain 30 minutes. Bloodletting: let blood at da zhui DU14 and cup. Let blood at er jian or veins at back of ear.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Congenital eyelid ptosis; inability to raise upper eyelid. T- pale P- deep, weak Tx Principle Warm kidney yang boost spleen yang Tonify, moxa Acupuncture Points / Techniques cuan zhu BL2 through needle to jing ming BL1 yu yao through needle to si zhu kong TB23 tai yang through needle to tong zi liao GB1 guan yuan REN4 - add moxa; warm kidney yang zu san li ST36 - add moxa; boost spleen pi shu BL20 & shen shu BL23 - add moxa; tonify spleen & kidney cuan zhu BL2 through needle to jing ming BL1 yu yao through needle to si zhu kong TB23 tai yang through needle to tong zi liao GB1 san yin jiao SP6 - add moxa; tonify spleen zu san li ST36 - add moxa; boost spleen qi hai REN6 - add moxa; sea of qi, boost qi pi shu BL20 - add moxa; tonify spleen & kidney cuan zhu BL2 through needle to jing ming BL1 yu yao through needle to si zhu kong TB23 tai yang through needle to tong zi liao GB1 san yin jiao SP6 - tonify spleen feng chi GB20 - dispel wind he gu LI4 - command point for head & face, clear heat, release exterior gan shu BL18 - nourish liver

80

Syndrome Shang Bao Xia Chui Upper Eyelid Droop Kidney Yang Deficiency

Etiology / Pathomechanism Eyelid ptosis, drooping upper eyelid which blocks vision. Congenital kidney yang deficiency leading to qi deficiency and failure to nourish muscles. Spleen qi fails to nourish muscles.

Shang Bao Xia Chui Upper Eyelid Droop Spleen Qi Deficiency

Slow onset of eyelid droop, better in morning or with rest, worse later in day or following exertion, tiredness, fatigue, dizziness, poor appetite, numbness in eyelid. T- pale, thin white coat P- weak, forceless

Boost spleen qi Tonify, moxa

Shang Bao Xia Chui Upper Eyelid Droop Liver Blood Deficiency

Depletion of liver blood with wind evil lodging in the eyelid, causing obstruction of channels and flow of qi and blood.

Abrupt onset of onesided eyelid ptosis, frequently with outward deviation of the eyeball and double vision. Lusterless complexion, dizziness, tinnitus. Can have external patterns of aversion to cold, fever, headache. T- pale P- thready, wiry

Nourish liver blood Dispel wind evil Even tonify, even drain.

Alternate therapeutic methods for upper eyelid droop: Plum blossom: Tap on affected side over course of gallbladder and bladder channels, as well as over the orbicularis oculi muscle. Work from top down, and proximal to distal. Liu Lei Zheng Tearing Patterns Liver and Kidney Deficiency Weakened liver and kidney function allows external wind to evoke tearing. Frequent clear cool tears that are thin in consistency, increase on exposure to wind but without apparent redness, pain or swelling of eyes. Dizziness, tinnitus, blurred vision, weak aching low back and knees. T- red, scant coat P- weak, thready Nourish liver blood Tonify kidney Tonify, moxa jing mingBL1 - local point for eye disorders, expel wind, benefit eyes cuan zhu BL2 - dispel wind, clear heat, benefit eyes feng chi GB20 - dispel wind, brighten eyes gan shu BL18 & shen shu BL23 - add moxa; tonify liver & kidney w/blurred vision - yang lao SI6 & cheng qi ST1 w/excessive tearing from wind exposure - he gu LI4

Alternate therapeutic methods for tearing patterns: Ear acupuncture: eye 1, eye 2, LR, KI,, elicit strong sensation, retain 30 minutes Jin Shi Nearsightedness Liver Blood and Kidney Jing Deficiency Constitutional deficiency, or depletion of liver blood or kidney essence due to poor working habits such as poor lighting, poor posture, excessive periods of writing, reading or close work. Cant focus on distant object, see near objects clearly. Common during teenage years. Weakening of vision, close objects clear, distant objects blurry, headache, rapid eye fatigue. Sometimes dizziness, tinnitus, weak aching low back & knees, insomnia, poor memory. P- weak, thready Tonify liver blood Nourish kidney jing Brighten eyes Tonify jing ming BL1, cuan zhu BL2 & cheng qi ST1 - local points for eye disorders feng chi GB20 - dispel wind, brighten eyes (sensation should reach forehead/eye area) gan shu BL18 & shen shu BL23 - add moxa; tonify liver & kidney guang ming GB37 - brighten eyes he gu LI4 - command point for face & eyes yi ming - treat eye disorders (sensation should reach forehead/eye area) w/spleen & stomach qi deficiency - zu san li ST36, san yin jiao SP6 & si bai ST2

Alternate therapeutic methods for tearing patterns: Ear acupuncture: eye, LR, KI,, elicit moderate sensation, retain 30 minutes, every other day for 10 sessions. Plum blossom: Tap around eyes, feng chi GB20 and bei shu points, treat daily, 10-15 session per course

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Unclear vision, dizziness, tinnitus, weak aching low back & knees. T- red, scant coat P- thready Tx Principle Nourish liver blood Boost kidney essence Moisten kidney & liver Brighten eyes Tonify, moxa Tonify the spleen Boost qi Brighten eyes Tonify, moxa Acupuncture Points / Techniques jing ming BL1, cuan zhu BL2 & qui hou - local points for eye disorders feng chi GB20 - dispel wind, brighten eyes gan shu BL18 & shen shu BL23 - add moxa; tonify liver & kidney fu liu KI7 - boost kidney, consolidate essence, moisten kidney & liver guang ming GB37 - brighten eyes w/kidney yang deficiency - guan yuan REN4 & ming men DU4, add moxa jing ming BL1, cuan zhu BL2 & qui hou - local points for eye disorders si bai ST2 - benefit eyes he gu LI4 - command point for face & eyes san yin jiao SP6 - add moxa; tonify spleen zu san li ST36 - add moxa; boost qi pi shu BL20 - add moxa; tonify spleen jing ming BL1, cuan zhu BL2 & qui hou - local points for eye disorders feng chi GB20 - dispel wind, brighten eyes guang ming GB37 - brighten eyes xing jian LR2 or tai chong LR3 - alternate; course liver, clear heat xia xi GB43 - clear damp-heat from channel, benefit eyes, ears & head, clear heat, treat headache jing ming BL1, cuan zhu BL2 & qui hou - local points for eye disorders he gu LI4 - command point for face & eyes guang ming GB37 - brighten eyes tai xi KI3 - nourish yin, boost kidney, clear deficiency heat yin ling quan SP9 - transform dampness, clear heat san yin jiao SP6 - drain damp, tonify liver, kidney & spleen

81

Syndrome Yuan Yi Nei Zhang Cataract Liver and Kidney Deficiency Yuan Yi Nei Zhang Cataract Spleen Qi Deficiency

Etiology / Pathomechanism Advancing years and the resulting insufficiency of essence and blood.

Weakened spleen unable to transport qi & essence to nourish eyes.

Blurred vision, tiredness, fatigue, sallow complexion, poor appetite, loose stools. T- pale, white coat P- weak thready

Yuan Yi Nei Zhang Cataract Upper Burner Liver Heat Yuan Yi Nei Zhang Cataract Yin Deficiency and Damp-heat

Stagnant heat in liver channel causing the ascent of damp-heat.

Headache, discomfort of eyes, blurred vision, excessive secretion of mucus and tears from the eyes, bitter taste, dry throat. P- rapid, wiry Constitutional yin deficiency, dry eyes, blurred vision, irritability, halitosis, difficult bowel movements. T- red, slimy yellow coat P- soft, rapid

Course the liver Brighten eyes Drain

Depletion of yin causing the ascent of damp-heat.

Nourish yin Clear heat Transform dampness Brighten eyes Even tonify, even drain

Alternate therapeutic methods for cataract: Ear acupuncture: eye, eye 1, eye 2, LR, KI, elicit mild to moderate sensation, retain 15-30 minutes, every other day. Treating jing qi of 5 zang: Treat outer bladder line point of affected organ: Difficulty smelling - Lung - po hu BL42 Difficulty speaking - Heart - shen tang BL44 Diagnosis notes: Liver blood deficiency - blurred vision, floaters, myopia, dry gritty eyes. Liver yin deficiency - dry gritty eyes. Liver blood stasis - painful eyeball. Liver yang rising - watery eyes. Liver fire - dry bloodshot eyes, may be red, swollen, painful. Liver wind - eyeball moving, turning upwards, moving involuntarily. Decline of kidney jing - chronic eye diseases. Kidney yin deficiency - failing eyesight and dryness of the eyes. Heart fire - pain and redness of the eye.

Difficulty tasting - Spleen - yi she BL49

Difficulty seeing - Liver - hun men BL47

Difficulty hearing - Kidney - zhi shi BL52

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Sudden onset of deafness or tinnitus (ocean waves or claps of thunder), anger or frustration causes onset or increase in severity, blockage or pressure in ear which is unchanged by applying pressure. Red complexion, dry mouth, bitter taste, agitation, restless sleep, irritability, chest & hypochondrium distension & pain, constipation, dark urine. T- red, yellow coat P- rapid, wiry Common cold symptoms which also include distension and obstruction in the ears, tinnitus, decreased hearing. Headache, fever, dry mouth, aversion to wind. T- normal or thin yellow coat P- rapid, floating Tinnitus and deafness with dizzy spells, chest oppression, heavy head, phlegm, bitter taste, irregular urine and bowel movements. T- red, yellow slimy coat P- slippery, rapid Long-term, intermittent tinnitus resembling buzzing of cicadas, worse at night, gradual loss of hearing. Dizziness, low back & knee pain, seminal emission. T- red, scant coat P- thready, fine Tinnitus & deafness aggravated by overwork, sensation of emptiness and coolness within ears. Tiredness, fatigue, poor appetite, loose stools, epigastric distension after eating, sallow complexion. T- pale P- weak Tx Principle Clear LR/GB fire Drain Acupuncture Points / Techniques

82

Syndrome Er Ming Er Long Tinnitus and Deafness Liver and Gallbladder Fire

Etiology / Pathomechanism Er ming; ringing in the ears. Er long; decrease or complete loss of hearing. Anger, fright or fear cause LR/GB hyperactivity, leading to blockage of shao yang meridian or qi blockage at ear. Severe emotions can transform to fire. Invasion of ear by external wind-heat.

yi feng TB17 - open orifices, dispel wind, clear heat, benefit ears (deafness, tinnitus, clogged eustachian tubes, ear infections) ting hui GB2 - open orifices, dispel wind, clear heat, benefit hearing (deafness, tinnitus, ear infections auditory hallucinations) zhong zhu TB3 - open orifices, clear heat, benefit hearing, stop pain, move dampness out of ear xia xi GB43 - clear heat, reduce damp-heat swelling in channel, benefit head, ears & eyes xing jian LR2 - clear heat & drain fire from liver, spread liver qi, expel interior wind, stop bleeding qiu xu GB40 - course liver, rectify gallbladder, open clear passage thru luo yi feng TB17, ting hui GB2, zhong zhu TB3 & xia xi GB43 - see above he gu LI4 - resolve exterior, retreat fever, clear heat, expel wind, regulate face, ears, eyes, nose, mouth feng chi GB20 - dispel wind, clear heat, resolve exterior, treat illness of sense organs wai guan TB5 - clear heat, retreat fever, expel wind, release exterior, benefit head & ears yi feng TB17, ting hui GB2, zhong zhu TB3 & xia xi GB43 - see above feng long ST40 - transform phlegm, downbear counterflow lao gong PC8 - drain heart fire, clear heat from middle jiao, harmonize stomach, clear nutritive level and cool the blood yi feng TB17 - open orifices, benefit ears, activate channel & stop pain ting hui GB2 - open orifices, benefit acuity of hearing and intelligence, activate channel & stop pain tai xi KI3 - boost kidney, clear deficiency heat, strengthen lower back & lumbar spine shen shu BL23 - tonify kidneys, enrich the marrow, benefit essence, benefit ears & hearing guan yuan REN4 - tonify kidneys & fortify yuan qi yi feng TB17 & ting hui GB2 - see KI deficiency above pi shu BL20 and/or wei shu BL21 - fortify spleen, strengthen stomach zu san li ST36 - strengthen spleen, harmonize stomach, transform phlegm, tonify qi, open orifices qi hai REN6 - benefit spleen qi, regulate qi, tonify kidneys & fortify yuan qi

Er Ming Er Long Tinnitus and Deafness Wind-heat Er Ming Er Long Tinnitus and Deafness Phlegm-heat Er Ming Er Long Tinnitus and Deafness Kidney Jing Deficiency Er Ming Er Long Tinnitus and Deafness Spleen Qi Deficiency

Course wind Clear heat Drain Clear heat Transform phlegm Open orifices Drain Tonify kidney Secure the essence Tonify

Excessive consumption of alcohol and rich foods, or external damp-heat cause damp-heat stagnation in ear. Depletion of KI jing due to poor constitution, extended illness, excess sexual activity, cause lack of nourishment to ears. Inability of spleen qi to rise and nourish ears due to poor diet or over working.

Tonify spleen Harmonize stomach Boost qi Tonify

Alternate therapeutic methods for tinnitus and deafness: Ear acupuncture: LR, KI, inner ear, endocrine, subcortex, shenmen. Needle daily or every other day, elicit moderate sensation, retain 30 minutes. 15-20 sessions per course. Scalp acupuncture: Vertigo & hearing region (yun ting qu). Retain needles for 20 minutes, manipulate periodically. Daily or every other day. Tuina self-massage: 1- Palms over ears and beat occiput & mastoid with fingers. 2- Rhythmically lift/press palms over ears, opening and closing orifice. Maintain rhythm for several minutes. Repeat morning & night. Regulate diet, emotions and sleeping schedule. Avoid tea, coffee, chocolate, alcohol and other stimulants. Long Fa Deaf Muteness Deafness in children which causes inability to learn to speak. Pre-heaven insufficiency. Dampness and fire toxins or warm toxins. Trauma, fall or injury to ear. Child may be born deaf or there may be a history of pathogenic toxins affecting the ears which were improperly treated, or history of trauma to the ears or head. Open and allow clear passage to luo mai. Treat deafness first, then treat muteness. Point selection for deafness: er men TB21, ting gong SI19 & ting hui GB2 - ear 3 needles yi feng TB17, zhong zhu TB3 & wai guan TB5 - see above Point selection for muteness: ya men DU15 - gate of muteness; benefits tongue & treats muteness lian quan REN23 & shang lian quan - local; benefit tongue, descend qi tong li HT5 - benefit the tongue bai hui DU20 - benefit head & sense organs, nourish marrow, raise the clear xin shu BL15 & shen shu BL23 - tonify & nourish heart, regulate heart qi; benefit essence, benefit ears zu san li ST36 & qi hai REN6 - tonify qi, regulate qi, tonify kidneys & fortify yuan qi, open orifices

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Pain, blockage, distension in the ear, gradual increase in severity, tinnitus and decreased hearing, perforated eardrum with drainage of pus into the ear, after which, the pain recedes. Fever, aversion to cold, headache, sweating, stuffy nose. T- red, thin yellow coat P- rapid, floating Abrupt onset, pain, blockage, distension in the ear, tinnitus and decreased hearing, perforated eardrum with drainage of thick yellow bloody pus into the ear, after which, the pain recedes. Bitter taste, dry mouth, constipation, irritability. T- red, yellow coat P- rapid, wiry Drainage of clear thin pus into the ear in varying quantities, treatment response may be poor. Loose stools, dizziness, vertigo, heavy head, fatigue, sallow complexion, poor appetite. T- swollen, pale, wet P- weak, slippery, soggy Discharge of small amount of thin pus into external ear, extended course of illness, significant hearing impairment. Dizziness, vertigo, tinnitus, tiredness, fatigue, weak aching low back & knees. P- weak, thready, rapid Tx Principle Course wind-heat Resolve toxins Promote suppuration (release of pus) Drain Drain liver/gallbladder fire Resolve toxins Promote suppuration (release of pus) Drain Tonify spleen Transform dampness Promote suppuration (release of pus) Tonify Tonify kidney yin Clear deficiency heat Resolve toxins Promote suppuration Tonify Acupuncture Points / Techniques

83

Syndrome Ting Er Purulent Ear Wind-heat

Etiology / Pathomechanism Otitis media: Chronic or acute infection, inflammation of internal ear. Perforation or rupture of tympanic membrane with drainage of purulent pus to external ear. Most often seen in children. External wind-heat enters the ear. Disharmony from emotional causes exuberant liver & gallbladder fire which penetrates the channel and disturbs the ears.

yi feng TB17 & ting hui GB2 - benefit ears, eliminate wind, clear heat, activate channel & alleviate pain feng chi GB20 - eliminate wind, clear sense organs, benefit head & eyes he gu LI4 - expel wind & release exterior, regulate face, eyes, nose, mouth & ears wai guan TB5 - expel wind & release exterior, benefit head & ears, clear heat w/severe heat - da zhui DU14 & qu chi LI11 w/headache - tai yang & shang xing DU23 yi feng TB17 & ting hui GB2 - benefit ears, eliminate wind, clear heat, activate channel & alleviate pain feng chi GB20 - eliminate wind, clear sense organs, benefit head & eyes zu lin qi GB41 - spread liver qi, transform phlegm, clear the head, treat deafness & tinnitus xing jian LR2 - clear liver fire, spread liver qi, clear heat & stop bleeding w/severe heat - da zhui DU14 & qu chi LI11 w/headache - tai yang & shang xing DU23 yi feng TB17 & ting hui GB2 - benefit ears, activate channel & alleviate pain zu san li ST36 - fortify spleen and resolve dampness, harmonize stomach yin ling quan SP9 - regulate spleen & resolve dampness, open & move water passages pi shu BL20 - tonify spleen qi and yang, resolve dampness tai bai SP3 - tonify spleen and resolve dampness, harmonize spleen & stomach yi feng TB17 & ting hui GB2 - benefit ears, eliminate wind, clear heat, activate channel & alleviate pain shen shu BL23 - nourish kidney yin, , benefit ears & eyes, strengthen lumbar region tai xi KI3 - nourish kidney yin & clear deficiency heat, tonify kidney yang yin ling quan SP9 - resolve dampness, benefit lower jiao, open & move water passages w/kidney yang deficiency - needle & moxa at guan yuan REN4 & ming men DU4

Ting Er Purulent Ear Liver and Gallbladder Fire

Ting Er Purulent Ear Spleen Qi Deficiency

Weakened spleen function causing dampness, which rises to the ears.

Ting Er Purulent Ear Kidney Yin Deficiency with Heat

Depletion of kidney yin with accumulation of toxic heat.

Alternate therapeutic methods for purulent ear: Ear acupuncture: KI, inner ear, endocrine, occiput, external ear. Needle daily, elicit moderate sensation, retain 20-30 minutes. Can let blood at small veins at back of ear. Patients should minimize consumption of eggs, seafood & legumes during treatment. Refrain from swimming.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Nosebleed with moderate amount of bright red blood. Dryness and heat in nasal cavity, fever, cough with little phlegm, dry mouth. T- red tip, thin white dry coat P- rapid, may be floating Nosebleed with large amount of deep or bright red blood. Dry nasal cavity, dry mouth, halitosis, excessive thirst, hard dry stools and dark scanty urine. T- red, dry yellow coat P- rapid, surging Nosebleed with large amount of dark red blood. Headache, dizziness, bitter taste, dry throat, irritability, flushed complexion, bloodshot eyes, chest and hypochondrium distension and fullness. T- red, yellow coat P- rapid, wiry Intermittent nosebleed with small amount of pale red blood. Dry mouth, tidal fever, night sweats, dizziness and vertigo, blurred vision, palpitations, insomnia, tinnitus, five heart fever. T- red, scant coat P- rapid, thready Nosebleed with varying amounts of light red blood. Lusterless complexion, poor appetite, tiredness, fatigue, no desire to speak. T- pale P- weak Tx Principle Course wind, Clear heat Cool blood Stop bleeding Drain Clear stomach Drain fire Cool blood Stop bleeding Drain Clear liver Drain fire Cool blood Stop bleeding Drain Nourish yin Drain deficiency fire Cool blood Stop bleeding Even tonify, even drain Tonify spleen Boost qi Secure the blood Stop bleeding Tonify, moxa Acupuncture Points / Techniques feng chi GB20 - course wind, clear heat he gu LI4 - clear heat, release exterior qu chi LI11 - clear heat, expel wind ying xiang LI20 - clear wind-heat from yang ming, open nasal passages shao shang LU11 - extinguish wind, clear heat from lungs w/severe fever - wai guan TB5 and let blood at shang yang LI1 nei ting ST44 - clear stomach heat, harmonize stomach wei zhong BL40 - xi-cleft of blood; cool blood shang xing DU23 - local; clear heat and scatter wind, open orifices cheng jiang REN24 - extinguish wind & benefit face, meeting of REN, DU, ST & LI channels w/hard dry stools - er jian LI2 during acute bleeding stage - moxa at yin bai SP1 to stop bleeding xing jian LR2 - clear liver fire, spread liver qi, clear heat & stop bleeding wei zhong BL40 - xi-cleft of blood; cool blood qu quan LR8 - water point; cool the blood, course the liver xia xi GB43 - clear damp-heat from channel, benefit eyes, ears & head, clear heat, treat headache w/dry throat, irritability & restlessness - dui duan DU27 (calm spirit, clear heat, generate fluids) yi xi BL45 - empirical point for nosebleed with dizziness shen shu BL23 & gan shu BL18 - nourish kidney & liver yin tai xi KI3 or zhao hai KI6 - nourish yin, drain deficiency heat tai chong LR3 - nourish liver blood, clear head & eyes tong tian BL7 - benefit and regulate nose, clear the head yong quan KI1 - moxa; drain fire, downbear counterflow of liver qi, treat dizziness zhong wan REN12 - fortify spleen, strengthen stomach pi shu BL20 - tonify spleen to secure the blood zu san li ST36 - boost qi, tonify spleen, harmonize stomach yin bai SP1 - moxa to stop bleeding

84

Syndrome Bi Nu Nosebleed/Epistaxis Lung Heat

Etiology / Pathomechanism Excess heat invading lung, cold transforming to heat in lung, winddryness-heat causing blood heat and creating reckless movement of blood.

Bi Nu Nosebleed/Epistaxis Stomach Fire

Overeating of rich, hot, spicy, greasy or sweet foods, too much alcohol, cause upward movement of stomach fire which heats blood.

Bi Nu Nosebleed/Epistaxis Liver Fire

Liver fire from anger or frustration moves upward, blood follows and results in reckless movement of blood outside vessels.

Bi Nu Nosebleed/Epistaxis Liver and Kidney Yin Deficiency

Deficient fire flares upward, blood follows and results in reckless movement of blood outside vessels.

Bi Nu Nosebleed/Epistaxis Spleen Qi Deficiency

Poor diet, worry, anxiety deplete spleen qi causing weakness in spleens ability to contain blood.

Alternate therapeutic methods for nosebleed: Ear acupuncture: Inner nose, LU, adrenal, forehead. Needle daily, elicit moderate sensation, retain 20-30 minutes.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Putrid, fishy smelling copious nasal discharge, can become thick and scanty with white, green, yellow or red coloring. Frontal or eye area headache which is relieved with discharge of mucus, aversion to cold, fever, cough with phlegm. T- red tip, thin yellow coat P- floating, rapid Turbid, foul thick nasal discharge, bay contain blood. Severe pain behind eyes and in sinus which is worse with pressure, bitter taste, irritability, dry throat, fever, dizziness, tinnitus, insomnia. T- red, yellow coat P- rapid, wiry Tx Principle Course wind Ventilate lung Scatter cold or clear heat Open orifices Drain Acupuncture Points / Techniques lie que LU7 & he gu LI4 - biao/li, yuan/luo pair; ying xiang LI20 - clear wind-heat from yang ming, open nasal passages feng chi GB20 - dispel wind, clear heat, treat headache bi tong (shang ying xiang) - treat nasal problems w/frontal or eyebrow headache - yin tang or cuan zhu BL2

85

Syndrome Bi Yuan Deep Source Nasal Congestion Lung Wind-heat

Etiology / Pathomechanism Excess wind-heat invading lung or wind-cold invasion transforming to heat in lung, interferes with ventilation of lung causing nasal blockage.

Bi Yuan Deep Source Nasal Congestion Liver Gallbladder Fire

Anger or frustration cause accumulation of heat in liver & gallbladder which moves upward disturbing and blocking nose.

Drain heat from liver and gallbladder Dispel turbidity Open orifices Drain

feng chi GB20 - dispel wind, clear heat, treat headache yin tang - local point for headache, dizziness and nasal problems shang xing DU23 - local; clear heat and scatter wind, open orifices ying xiang LI20 - clear wind-heat from yang ming, open nasal passages bi tong (shang ying xiang) - treat nasal problems tou lin qi GB15 - local, benefit nose & eyes, benefit head and stop pain xing jian LR2 - clear liver fire, spread liver qi, clear heat & stop bleeding xia xi GB43 - clear damp-heat from channel, benefit eyes, ears & head, clear heat, treat headache w/headache and dizziness - bai hui DU20 & tai yang shang xing DU23 - local; clear heat and scatter wind, open orifices ying xiang LI20 - clear wind-heat from yang ming, open nasal passages feng chi GB20 - dispel wind, clear heat, treat headache yin ling quan SP 9 and san yin jiao SP6 - drain dampness zu san li ST36 - harmonize stomach, boost qi, transform phlegm nei ting ST44 - drain stomach heat, clear damp-heat, harmonize stomach bi tong (shang ying xiang) - treat nasal problems w/headache - he gu LI4 & yin tang fei shu BL13 & qi hai REN6 - add moxa; tonify lung qi zu san li ST36 - harmonize stomach, boost qi, transform phlegm bau hui Du20 - add moxa; scatter wind-cold he gu LI4 - release exterior feng chi GB20 - dispel wind, treat headache shang xing DU23 - local; clear heat and scatter wind, open orifices ying xiang LI20 - clear wind-heat from yang ming, open nasal passages shang xing DU23 - local; clear heat and scatter wind, open orifices ying xiang LI20 - clear wind-heat from yang ming, open nasal passages bi tong (shang ying xiang) - treat nasal problems bau hui Du20 - add moxa; scatter wind-cold zu san li ST36 - harmonize stomach, boost qi, transform phlegm pi shu BL20 and guan yuan REN4 - add moxa; tonify spleen qi yin ling quan SP 9 - drain dampness

Bi Yuan Deep Source Nasal Congestion Damp-heat

Spleen and stomach damp-heat from poor diet and eating habits. Damp-heat moves upward and blocks nose.

Yellow, heavy, turbid, thick discharge, continuous discharge and congestion. Red, swollen, distended, painful nasal cavity, decreased smell, heavy, aching head, epigastric distension & fullness, fatigue, poor appetite, dark yellow urine, bitter taste. T- red, greasy yellow coat P- rapid, slippery or soggy Intermittent clear slightly stick nasal discharge. Worse with cold exposure, decreased smell, SOB, spontaneous sweating, weak voice, loss of strength. T- pale, thin white coat P- weak

Clear heat Drain dampness Dispel turbidity Open orifices Drain

Bi Yuan Deep Source Nasal Congestion Lung Deficiency Cold

Deficient lung is sensitive to cold invasion, interferes with ventilation of lung causing nasal blockage.

Warm and tonify lung qi Scatter cold Open orifices Tonify, moxa

Bi Yuan Deep Source Nasal Congestion Spleen Qi Deficiency

Spleen qi deficiency with retained dampness causing lack of clear to rise, dampness rises instead.

Heavy, thick, milky nasal discharge with no foul smell. severe nasal congestion with loss of sense of smell, heavy limbs, loss of strength, poor appetite, loose stools, sallow complexion, heavy head with dizziness and vertigo. T- pale, white coat P- weak

Tonify spleen qi Transform dampness Open orifices Tonify, but drain damp, Add moxa

Alternate therapeutic methods for deep source nasal congestion: Ear acupuncture: Inner nose, adrenal, LU, forehead; with allergic rhinitis add anti-asthma & endocrine. Elicit strong sensation, retain 20-30 minutes, daily. Can use needle embedding for 5-7 days.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Moderate to severe throat pain, acute onset, increased pain upon swallowing or coughing, dry burning throat. Fever, aversion to cold, cough with sticky phlegm that may be yellow. T- red tip, thin yellow coat P- rapid, floating Severe pain with redness & swelling of throat, pain radiates to base of ear and beneath the jaw, acute onset, difficulty swallowing, sensation of throat obstruction with hoarseness in some cases. High fever, excessive thirst, headache, hailtosis, thick sticky yellow phlegm, constipation, dark scanty urine. T- red, thick yellow coat P- rapid, surging Slow onset or extended course of illness, slight redness swelling and pain of throat with dryness, itching or burning sensation, more severe in afternoon and night. Dry cough with scanty stick phlegm or no phlegm. Dizziness, vertigo, blurred vision, weak aching low back & knees, irritability, insomnia, five heart fever. T- red, scant coat P- rapid, thready Tx Principle Course wind Clear heat Disinhibit throat Stop pain Drain Acupuncture Points / Techniques

86

Syndrome Yan Hou Zhong Tong Sore Swollen Throat Wind-heat

Etiology / Pathomechanism Wind-heat invading lungs and moving up to throat.

shao shang LU11 - blood let to clear lung heat, disinhibit throat, extinguish wind chi ze LU5 - clear lung heat and descend rebellious qi, treat all lung heat illnesses (water drains metal) he gu LI4 - clear heat, expel wind, retreat fever, resolve the exterior, stop pain qu chi LI11 - clear heat, expel wind, retreat fever, clear the head guan chong TB1 - prick to bleed to clear heat from lung & stomach w/hoarseness - lie que LU7 & fu tu LI18 sore throat during summer - ye men TB2 on either side or on same side if one-sided pain shao shang LU11 - blood let to clear lung heat, disinhibit throat, extinguish wind nei ting ST44 - drain stomach heat, clear damp-heat, harmonize stomach, stop pain tian tu REN 22 - ventilate lungs, transform phlegm, disinhibit throat, clear the voice feng long ST40 - transform phlegm, clear heat xian gu ST43 - clear heat from yang ming guan chong TB1 - prick to bleed to clear heat from lung & stomach w/high fever - da zhui Du14 & qu chi LI11 w/constipation - shang ju xu ST37 zhao hai KI6 - nourish yin, clear deficiency heat, benefit and moisten throat lie que LU7 - combine with KI6 to treat dry sore throat tai xi KI3 - nourish yin, clear deficiency heat yu ji LU10 - discharge heat, benefit throat lian quan REN23 - local, treat throat pain w/five heart fever - shao fu HT8 w/qi & yin deficiency - qi hai REN6 & zu san li ST36

Yan Hou Zhong Tong Sore Swollen Throat Stomach Fire

Stomach fire rises to steam fluids and affect throat.

Clear heat Resolve toxins Disinhibit throat Stop pain Drain

Yan Hou Zhong Tong Sore Swollen Throat Kidney and Lung Yin Deficiency

Kidney & lung yin deficiency causing insufficient yin fluids, fluids dont rise to lubricate throat.

Nourish yin Downbear fire Disinhibit throat Stop pain Drain

Alternate therapeutic methods for sore swollen throat: Ear acupuncture: throat, tonsils, LU, helix 1-6. Elicit moderate to strong sensation, retain 30 - 60 minutes, daily. With severe redness, swelling and pain of throat one to five drops of blood can be let at helix 1-6 or at small veins at back of ear.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Sudden hoarseness of voice, sore throat, dry nose, fever, thirst, coughing with expectoration of yellow phlegm. T- thin yellow coat P- rapid, floating Tx Principle Course wind Clear heat Ease the throat Open the voice Drain Course wind Scatter cold Ventilate the lung Open the voice Drain, moxa Course the liver Regulate qi Open the voice Drain Nourish lung & kidney yin Downbear fire Ease the throat Open the voice Even tonify, even drain Acupuncture Points / Techniques

87

Syndrome Shi Yin Loss of Voice Wind-heat

Etiology / Pathomechanism Mild- hoarseness of voice. Severeaphonia. Laryngitis, strain or nodulation of vocal cords or loss of voice from hysteria. Acute - from external invasion of windheat or wind-cold, or emotional upset; sudden onset and short course of illness.

chi ze LU5 - clear lung heat and descend rebellious qi, treat all lung heat illnesses (water drains metal) he gu LI4 - clear heat, expel wind, retreat fever, resolve the exterior, stop pain lian quan REN23 - local, treat throat pain tian ding LI17 - benefit throat & voice tong li HT5 - main point for sudden loss of voice (luo deficiency; unable to speak) w/severe sore throat - er jian LI2 he gu LI4 - expel wind, resolve the exterior, stop pain wai guan TB5 - expel wind, release the exterior, activate channel and stop pain lian quan REN23 - local, treat throat pain tian ding LI17 - benefit throat & voice tong li HT5 - main point for sudden loss of voice (luo deficiency; unable to speak) w/coughing with copious phlegm - lie que LU7 he gu LI4 - regulate qi, move blood, clear heat tai chong LR3 - course the liver, regulate and rectify qi lian quan REN23 - local, treat throat pain tian ding LI17 - benefit throat & voice tong li HT5 - main point for sudden loss of voice (luo deficiency; unable to speak) yu ji LU10 - discharge heat, benefit throat tai xi KI3 - nourish yin, clear deficiency heat lian quan REN23 - local, treat throat pain tian ding LI17 - benefit throat & voice zhao hai KI6 - nourish yin, clear deficiency heat, benefit and moisten throat lie que LU7 - combine with KI6 to treat dry sore throat tai yuan LU9 - tonify lung qi zu san li ST36 - tonify spleen, harmonize stomach, boost qi san yin jiao SP6 - tonify spleen, drain damp lian quan REN23 - local, treat throat pain tian ding LI17 - benefit throat & voice he gu LI4 - regulate qi, move blood tai chong LR3 - course the liver, regulate and rectify qi nei guan PC6 - invigorate blood lian quan REN23 - local, treat throat pain tian ding LI17 - benefit throat & voice w/lung & kidney yin deficiency - tai xi KI3 w/lung & spleen qi deficiency - zu san li ST36 & san yin jiao SP6 w/copious phlegm - feng long ST40

Shi Yin Loss of Voice Wind-cold

Sudden hoarseness of voice, aversion to cold, fever, stuffy nose, thin clear nasal mucus, itchy throat, coughing with expectoration of thin phlegm, no apparent thirst. T- thin white coat P- tight, floating Sudden hoarseness of voice or aphonia, irritability, dizziness, tinnitus, fullness & distension of chest & hypochondrium, frequent sighing. T- thin, white or slimy coat P- wiry

Shi Yin Loss of Voice Liver Qi Stagnation

Shi Yin Loss of Voice Lung and Kidney Yin Deficiency

Chronic- from weakening of lung, spleen or kidney; slow onset, longer duration.

Progressive hoarseness of voice, aggravated by stress or overstrain of voice, dry throat & mouth, dry cough with little phlegm, weak aching low back & knees, tidal fever, night sweating, dizziness, tinnitus. T- red, scant coat P- rapid, thready Prolonged hoarseness of voice, worse with overwork, worse in morning, faint voice, speaking requires great effort and cannot be sustained, SOB, slow speech, tiredness, fatigue, poor appetite, loose stools. T- pale, white coat P- weak, forceless Prolonged loss of voice where tremendous effort is required to speak, plum pit qi, chest oppression, phlegm, laryngoscopic examination often reveals nodules or polyps of the vocal cords. T- dark, purplish P- rough

Shi Yin Loss of Voice Spleen and Lung Qi Deficiency

Tonify lung & spleen Boost qi Open the voice Tonify, moxa

Shi Yin Loss of Voice Qi Stagnation, Blood Stasis and Congealed Phlegm

Move qi Invigorate blood Transform phlegm Open the voice Even tonify, even drain

Alternate therapeutic methods for loss of voice: Ear acupuncture: LU, HT, KI, throat, neck, trachea. Elicit strong sensation when acute, mild sensation when chronic.

 Copyright 2008 Julie Casper

Therapeutics: Syndromes and Acumoxa Treatment for Eye, Ear, Nose & Throat Diseases
Symptoms Mouth sores that are yellowish-white with surrounding bright red slightly swollen mucus membranes. When severe sores merge into patches and localized burning and pain is aggravated when speaking and eating. Fever, thirst, halitosis, constipation, dark urine. T- red, yellow coat P-rapid Smaller number of mouth sores that are greyish-white with pale or unchanged surrounding mucus membranes, no fusion of sores into patches, local pain aggravated during eating, frequent recurrence of sores. Weak aching low back and knees, dry throat. T- dry, little coat P- rapid, thready Tx Principle Clear heat Resolve toxins Disperse swelling Relieve pain Drain Acupuncture Points / Techniques cheng chiang REN24 - extinguish wind and benefit face, treat mouth & tongue ulcers jie che ST6 - clear heat, dispel wind, benefit jaw & cheek, stop pain lao gong PC8 - drain heart fire, cool the blood, harmonize stomach he gu LI4 - clear heat, expel wind, retreat fever, resolve the exterior, stop pain qu chi LI11 - clear heat, expel wind, retreat fever, clear the head zu san li ST36 - harmonize stomach dui duan DU27 - clear heat, generate fluids and benefit the mouth, treat mouth ulcerations cheng chiang REN24 - extinguish wind and benefit face, treat mouth & tongue ulcers jie che ST6 - clear heat, dispel wind, benefit jaw & cheek, stop pain lao gong PC8 - drain heart fire, cool the blood, harmonize stomach tai xi KI3 - nourish yin, clear deficiency heat xing jian LR2 - clear heat from liver and drain fire, expel interior wind, clear heat to stop bleeding lian quan REN23 - local, treat tongue & mouth pain, tongue ulcers, treat throat zu san li ST36 - harmonize stomach, nourish spleen, boost qi san yin jiao SP6 - tonify kidney, spleen and liver

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Syndrome Kou Chuang Mouth Sores (Canker) Heart and Spleen Excess Heat

Etiology / Pathomechanism Overconsumption of alcohol or spicy foods or invasion of external wind fire or dryness causing heart & spleen heat. This heat moves through channels to the mouth.

Kou Chuang Mouth Sores (Canker) Deficiency Fire

Yin deficiency constitution, prolonged illness or overwork causing heart or kidney yin deficiency. Deficiency fire rises to mouth.

Nourish yin Downbear fire Relieve pain Even tonify, even drain

Alternate therapeutic methods for mouth sores: Ear acupuncture: shen men, HT, SP, KI, mouth, tongue, endocrine. Choose two to four points, elicit moderate sensation, retain 20-30 minutes, daily. Ya Tong Toothache Wind-fire Tooth pain involves yang ming; stomach for upper teeth, large intestine for lower. Excess wind heat enters yang ming. Moderate to severe pain, acute onset of red swollen gums. Aversion to cold, fever, dry mouth, thirst. T- thin yellow coat P- rapid, floating Excruciating toothache pain, acute onset, sustained duration, severe swelling of gums, may have pus and bleeding, swelling at side of cheek and under jaw. Headache, fever, thirst, halitosis, constipation. T- thick yellow coat P- rapid, surging Dull intermittent toothache, chronic, worse in evening, atrophy of gums with loosening of teeth, loss of biting force, no halitosis. Weak aching low back and knees, dry throat & mouth but no desire for drink, dizziness, blurred vision. T- red, tender, scant coat P- rapid, thready Course wind Clear heat Disperse swelling Relieve pain Drain Cool blood Drain stomach heat Disperse swelling Relieve pain Drain Tonify kidney yin Drain deficiency fire Relieve pain Even tonify, even drain xia guan ST7 (for upper teeth) or jie che ST6 (for lower teeth) - have patient clench jaw until pain lessens, then retain needle for 10 minutes more; clear heat, dispel wind, benefit jaw & cheek, stop pain he gu LI4 - clear heat, expel wind, retreat fever, resolve the exterior, stop pain feng chi GB20 - expel wind, resolve exterior, clear heat wai guan TB5 - clear heat, retreat fever, expel wind, release exterior, stop pain xia guan ST7 (for upper teeth) or jie che ST6 (for lower teeth) - have patient clench jaw until pain lessens, then retain needle for 10 minutes more; clear heat, dispel wind, benefit jaw & cheek, stop pain he gu LI4 - clear heat, expel wind, retreat fever, resolve the exterior, stop pain nei ting ST44 - drain stomach heat, clear damp-heat, harmonize stomach, stop pain lao gong PC8 - drain fire, cool the blood, harmonize stomach xia guan ST7 (for upper teeth) or jie che ST6 (for lower teeth) - have patient clench jaw until pain lessens, then retain needle for 10 minutes more; clear heat, dispel wind, benefit jaw & cheek, stop pain he gu LI4 - clear heat, expel wind, retreat fever, resolve the exterior, stop pain tai xi KI3 - nourish yin, clear deficiency heat xing jian LR2 - clear heat from liver and drain fire, expel interior wind, clear heat to stop bleeding Auxiliary points for all syndromes: w/cavities causing pain - er jian LI2 & yang gu SI5 w/swelling of gums - jiao sun TB20, xiao hai SI8, shang yang LI1 w/headache - tai yang Alternate therapeutic methods for toothache: Ear acupuncture: shen men, maxilla, mandibula, tragic apex, adrenal. Elicit strong sensation, retain 20-30 minutes. Can embed needles for 2-3 days.

ya tong Toothache Stomach Fire

Heat from stomach or large intestine enters into teeth.

ya tong Toothache Deficiency Fire

Deficiency of kidney yin or jing weakens kidney ability to control the bones, deficiency fire rises to teeth.

INDEX Therapeutics Syndromes and Acumoxa Treatment

Internal Medicine (nei ke) Common Cold (gan mao) ....................................................................... 1 Cough (ke sou).................................................................................... 1-2 Asthma (early-onset) .........................................................................3-4 Wheezing & Breathlessness (xiao chuan)............................................ 4-5 Loss of Voice (shi yin) ............................................................................. 6 Stomach Pain (wei tong) .................................................................... 7-8 Abdominal Pain (fu tong) ................................................................... 8-9 Hypochondrial Pain (xie tong) ..............................................................10 Vomiting (ou tu) ...................................................................................11 Stomach Reflux (fan wei)......................................................................11 Hiccupping (e ni) ..................................................................................12 Difficulty Swallowing (ye ge) ................................................................13 Diarrhea (xie xie) ..................................................................................14 Dysentery (li ji) .....................................................................................15 Constipation (bian bi) ...........................................................................16 Prolapse of Rectum (tuo gang) .............................................................17 Appendicitis (chang yong) ....................................................................17 Pain Complexes (tong zheng) ...............................................................18 Drum Distension of Abdomen (gu zhang) .............................................19 Jaundice (huang dan) .......................................................................... 20 Edema (shui zhong) ..............................................................................21 Diabetes - Wasting Thirst (xiao ke) ...................................................... 22 5 Urinary Syndromes (wu lin zheng) ................................................23-24 Urinary Blockage (long bi) ....................................................................24 ISeizure Patterns (xian zheng) ............................................................. 29 Chest Blockage (xiong bi) .....................................................................30 Palpitations (xin ji) ...............................................................................31 Headache (tou tong)....................................................................... 32-34 Dizziness & Vertigo (xuan yun) .............................................................35 Wind Stroke & Sequelae (zhong feng) ............................................ 36-37 Bleeding Patterns ((xue zheng) ...................................................... 38-39 Tetnaus (po shang feng) ...................................................................... 40 Goiter (ying qi) .................................................................................... 40 Hemorrhoids (zhi chuang) ....................................................................41 High Fever (gao re) ...............................................................................42 Malaria (nue zheng) .............................................................................43 Fainting (tuo zheng) .............................................................................43 Mental/Emotional Insomnia (bu mei) ............................................................................... 25 Depression (yu zheng) .................................................................... 26-27 Bipolar or Mania & Depression (dian kuang) ........................................ 28 Musculoskeletal Disorders Painful Obstruction (bi zheng) .......................................................44-46 Lower Back Pain (yao tong) ..................................................................47 Neck Pain - Crick in the Neck (lao zhen) ............................................... 48 Shoulder Pain - Frozen Shoulder (lou jian feng) ....................................49 Sprain (niu shang) ............................................................................... 50 Facial Paralysis (mian tan) ................................................................... 50 Facial Pain - Trigeminal Neuralgia (mian tong) .....................................51 Atrophy Syndrome (wei zhong) ............................................................52 Gynecology Irregular Periods (yue jing) ............................................................. 56-57 Dysmenorrhea (tong jing) ....................................................................57 Amenorrhea (jing bi) ........................................................................... 58 Metrorrhagia - Flooding & Trickling (beng lou) .....................................59 Leukorrhea (dai xia bing) ..................................................................... 60 Menopause (jue jing) ...........................................................................61 Genital Itch - Vaginitis (yin yang) .........................................................62 Genital Prolapse (yin ting) ....................................................................62 Breast Lumps (ru pi) .............................................................................63 Obstetrics Female Infertility (bu yun) .................................................................. 64 Morning Sickness (ren shen e zu) ......................................................... 65 Abnormal Fetal Position (tai wei bu zheng) ......................................... 65 Difficult Delivery (zhi chan) ................................................................. 66 Non-descent of Placenta (bao yi bu xia)............................................... 66 Insufficient Breast Milk (ru shao) ......................................................... 66 Incessant Lochia (e lu bu jue) ................................................................67 Absence of Lochia (e lu bu xia) ..............................................................67 Post-partum Abdominal Pain (chan hou fu tong) ................................ 68 Eclampsia (ren chen xian zheng).......................................................... 68 Mammary Carbuncle - Acute Mastitis (ru yong) ................................... 69 Male Disorders Impotence (yang wei) ..........................................................................53 Seminal Emission (yi jing) ................................................................... 54 Hernia Disorders (shan qi) ....................................................................55 Dermatology Patch Balding - Alopecia Areata (ban tu) ..............................................70 Shingles - Herpes Zoster (she dan) ........................................................70 Eczema (shi zhen) .................................................................................71 Cinnebar Toxin - Erysipelas (dan du) .....................................................71 Flat Warts (bian ping you) ................................................................... 72 Psoriasis - Neurodermatitis - Ox Hide Tinnea (niu pi xuan)................... 72 Clove Sores (ding chuang) ................................................................... 72 Hives - Urticaria - Wind Rash (feng zhen) ........................................... 73 Pediatrics Enuresis (xiao er yi niao) .......................................................................74 Infantile Diarrhea (xiao er fu xia) ..........................................................75 Whooping Cough (dan ke) ....................................................................76 Developmental Problems (the 5 slows).................................................76 Wind Fright - Infantile Convulsions (xiao er jing feng) ......................... 77 Mumps (zha sai) ...................................................................................78 Infantile Malnutrition (xiao er gan ji .....................................................78 Deaf Muteness (long fa) ...................................................................... 82 Eye, Ear, Nose & Throat Diseases Sore, Red, Swollen Eyes (mu chi zhong tong) / Stye (zhen yan) .............79 Upper Eyelid Droop (shang bao xia chui).............................................. 80 Tearing Patterns (liu lei zheng) ............................................................ 80 Nearsightedness - Myopia (jin shi) ...................................................... 80 Cataract (yuan yi nei zhang) .................................................................81 Tinnitus and Deafness (er min er long) ................................................ 82 Purulent Ear - Otitis Media (ting er) ..................................................... 83 Nosebleed - Epitaxis (bi nu) ................................................................. 84 Sinusitis - Deep Source Nasal Congestion (bi yuan) .............................. 85 Sore Swollen Throat (yan hou zhong tog) ............................................ 86 Loss of Voice (shi yin) ............................................................................87 Mouth Sores - Canker (kou chuang) ..................................................... 88 Toothache (ya tong) ............................................................................ 88