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Circle the Dragon Chinese Herbal Medicine and Medical Acupuncture in Family Practice. Tom Archie , MD , DABFM, DABMA St. Luke’s Wood River Medical Center Integrative Therapies Service www.drtomsalchemy.com. Objectives. Pattern Recognition Chinese Medicine Physiology

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circle the dragon chinese herbal medicine and medical acupuncture in family practice

Circle the DragonChinese Herbal Medicine and Medical Acupuncture in Family Practice

Tom Archie, MD, DABFM, DABMA

St. Luke’s Wood River Medical Center

Integrative Therapies Service

www.drtomsalchemy.com

objectives
Objectives
  • Pattern Recognition
  • Chinese Medicine Physiology
    • Three Treasures – Jing, Shen, Qi
    • Physiology of Qi and Blood
    • Five Elements
    • Eight Principles
    • External Pathogenic Factors
    • Psyche-Soma: The Five Parts of the Soul
  • Diagnostics: Tongue and Pulse
  • Cases Discussed
pattern recognition diagnoses
Western Medicine

Premenstrual Syndrome

Hypertension

Depression

Migraine

Congestive Heart Failure

Pneumonia

Diabetes

Chronic Fatigue Syndrome

Eczema

Asthma

Angina

Pleurisy

Dysmenorrhea

Chinese Medicine

Liver Qi Stagnation

Liver Blood Deficiency

Liver Blood Stagnation

Kidney Yin Deficiency

Kidney Yang Deficiency

Lung Qi Deficiency

Spleen Qi Deficiency

Phlegm Heat misting the

Heart and Mind’s Orifices

Wind Cold (or Heat) Invasion

Latent Wind HeatHeart Yin Deficiency

Heart Qi Deficiency

Pattern Recognition - Diagnoses
slide5
Physiology

Of

Chinese Medicine

the three treasures
The Three Treasures
  • Jing (Essence) - derived from the Kidney
    • Shen and Qi are derived from Jing
    • Inherited from parents - Genetics/Constitution
    • Determines growth, sexual maturation, conception, pregnancy, brain/cognitive function
  • Qi – derived from Spleen (food) and Lung (air)
    • Replenished day-to-day
    • Nutrition and air quality important
  • Shen (Mind) – housed in the Heart
    • Creativity, Drive, Vision, and Intelligence
slide7
Qi

Vapor

Qi

Rice

lost in translation
Lost in Translation?
  • Qi (Character with vapor rising above cooking rice)
    • Early 1900s - Soulie de Mourant- Qi = “energy” and Jing = “meridian”
    • Simplified translation of complicated terms
    • “Life Force” made up of air and food transformed by body into blood and body fluids
  • Nei Jing written during 3rd – 1st Century BCE
    • Chinese physicians & cadaver dissections
    • Using needles of glass, metal and bone to influence neurovascular system
tcm qi physiology
TCM Qi Physiology
  • Stomach separates pure from impure Qi of food
    • Pure Qi to Spleen
    • Impure to Small Intestine (process repeats again)
  • Spleen sends Food Qi to Lung
    • Lung combines it with pure Qi extracted from air
    • Food/Air Qi “heated” by Yuan Qi (ancestral pilot light) provided by Kidney to make “Nutritive Qi”
      • In Heart to make Blood
      • In Meridians
blood deficiency
Blood Deficiency
  • Causes:
    • Hemorrhage, low dietary protein, constitution
    • Deficiency or stagnation of Qi
  • Fatigue, brain fog, dizziness, dry skin, dry hair, brittle nails, pale tongue, irregular and very light menses, pale complexion, trouble falling asleep, anemia, headache, anxiety
blood stagnation
Blood Stagnation
  • Caused by Blood Deficiency or Qi Stagnation
  • Dark/dusky tongue, purple sublingual veins
  • Chronic stabbing pain
  • Musculoskeletal
    • Pleurisy, Angina
    • Degenerative disc disease, spinal stenosis
    • Blood moving herbs are anti-inflammatory
  • Gynecological
    • Painful and heavy menstrual periods
    • Large dark clots
meridians
Meridians
  • Acupuncture points linked together in lines called “meridians”
  • Qi circulates through meridians
  • Meridians named for associated Organ
    • Kidney, Heart, Small Intestine, Bladder
    • Liver, Pericardium, Triple Energizer, Gallbladder
    • Spleen, Lung, Large Intestine, Stomach
fmri study
fMRI Study
  • Needle placed in foot Acupuncture point associated vision
  • fMRI shows stimulation of visual cortex
fmri study1
fMRI Study
  • Auditory Complex stimulated by needle placed in AP point on the leg associated with hearing
acupuncture models
Acupuncture Models
  • Meridian-based: Japanese, Vietnamese, French Energetics
  • Traditional Chinese Medicine (“TCM”)
    • Eight Principles (Yin/Yang, Damp/Dry, Cold/Heat, Interior/Exterior)
    • Zhang-Fu organ pairings blends Yin-Yang and 5 Element
  • Five Element (Korean)
    • Wood, Fire, Earth, Metal and Water
  • Different schools of thought regarding etiology of disease (Kidney versus Spleen/Stomach)
  • Neuroanatomical - CraigPENS, osteopuncture
meridian based acupuncture
Meridian-Based Acupuncture
  • Blockage in meridian flow produces disease
  • Therapeutic action of “unblocking” meridian flow (Relieving Stagnation)
    • Pain
    • Asthma
    • Heavy, Painful, or Irregular Menstrual Periods
french energetics acupuncture principal meridian treatment
French Energetics AcupuncturePrincipal Meridian Treatment

Yin Tonification

Chronic Symptoms (or cold, deficient)

Balance needles so that more are on Yin meridians

Tonify Yin Meridian by twirling, applying heat via Moxibustion, or low frequency electrical stimulation

Yang Dispersal

Acute Symptoms (or heat, excess, spasm)

Balance needles so that more are on Yang meridians

Disperse Yang Meridian by leaving needles alone, cooling with alcohol pads, or medium to high frequency electrical stimulation

principal meridians
Shao Yin

Kidney, Heart

Jue Yin

Liver, Pericardium

Tai Yin

Spleen, Lung

Tai Yang

Small Intestine, Bladder

Shao Yang

Triple Heater, Gallbladder

Yang Ming

Large Intestine, Stomach

Principal Meridians
french energetics acupuncture principal meridian treatment1
French Energetics AcupuncturePrincipal Meridian Treatment
  • How do you chose the Principal Meridian?
    • Location of clinical problem (ex: pain)
    • Meridian associated with function of problematic organ system (ex: diarrhea)
    • Constitution of the patient
      • Central low back pain in patient with Wood-Fire as principal meridian system
        • Anger/frustration/irritability
        • Consider Jue Yin – Shao Yang (LR-PC-TH-GB) instead of Shao Yin – Tai Yang (KI-HT-SI-BL)
pattern recognition1
Pattern Recognition

Five Elements

Interconnections between

Patterns and

Systems

TCM Eight

Principles

eight principles polarities
Yang

Light

Sun

Activity

Energy

Expansion

Hot

Fire

Hard

Excitement

Qi

Yin

Darkness

Moon

Rest

Matter

Contraction

Cold

Water

Soft

Inhibition

Blood

Eight Principles - Polarities
yin yang deficiency and excess
Yin & Yang Deficiency and Excess

Yin Deficiency

Yang will appear in excess with heat, dryness, thirst, back pain, stiffness insomnia, loss of willpower to follow through with action. This is Empty Heat compared to Full Heat (tonify rather than disperse).

Yang Deficiency

Yin will appear in excess with cold, fluid retention, chills, back pain, daytime fatigue, low libido, loss of willpower to initiate action. This is Empty Cold (tonify rather than disperse).

Yang Excess

Yang appears in excess with Full Heat – migraines, pressure, bloating, mania, hypertension, anger, insomnia, fever. Full Heat (disperse rather than tonify).

Yin Excess

Yin appears in excess with Full Cold – usually due to Wind Cold invasion. Stiffness, contraction of tendons, chilliness, severe menstrual or abdominal pain, fluid retention and watery-loose discharges including stools.

external pathogenic factors
External Pathogenic Factors
  • Wind
  • Cold
  • Summer Heat
  • Damp
  • Dryness
  • Fire
external pathogenic factors wind
Rapid onset

Wind Cold to Wind Heat

Symptoms & signs change rapidly and move from place to place in body

Enters neck to respiratory tract

Circulates between skin and muscles

Warms muscles

Aversion to cold or to wind

Chills/myalgias

Further warmed by body

Fever, rigors, rash/hives

Wind in the Skin

Eczema, dermatitis, itching

Chronic allergic rhinitis

Dry/Wind plus Yin Def

Upper respiratory infection signs

Chills, cold intolerance, sore throat, clear nasal drainage that warms to yellow/thick

Internal Wind (neurologic)

Stroke, seizures, tremor, headaches, hypertension, paresthesias/neuropathy

External Pathogenic FactorsWind
external pathogenic factors cold
Usually enters via Wind Cold invasion

Direct channel invasion

Bi Syndrome

Painful Obstruction Syndrome

Arthritis without hot/red joints

Wind-Damp-Cold

Contracts muscles/tendons

Chronic, dull pain (abdomen, pelvis, joints) better with heat

Internal Cold(from Yang Def)

Consumes Spleen Yang

Chilliness, dull pain, prefer warm liquids, cold limbs, no thirst, fatigue

Heart Yang Deficiency

Stuffy pain in chest, palpitations

Lung Qi Deficiency

Catch every cold, sweats, cough with thin white mucus

Spleen Yang Deficiency

Diarrhea/loose stools, low appetite

Kidney Yang Deficiency

Frequent pale profuse urination, low back pain, cold feet/knees, erectile dysfunction, white vaginal discharge

External Pathogenic FactorsCold
external pathogenic factors summer heat
External Pathogenic FactorsSummer Heat
  • Specific to hot weather
  • Aversion to heat, sweating, headache, dark scant urine, dry lips, thirst, rapid pulse
  • Severe Summer Heat
    • Invades Pericardium
      • Delirium, slurred speech, loss of consciousness
      • “Heat Exhaustion” or “Heat Stroke” in western med
external pathogenic factors damp
Damp weather

Wearing damp clothing

Sitting on damp ground

Consuming damp diet

Refined sugars, dairy

Excessive raw veg/fruit

Ascends legs

Symptoms depend on where damp settles

Pelvis – vaginal discharge

GI – loose stools

Bladder – urinary frequency or burning

Heaviness of limbs/head

Tired, fullness of chest or abdomen, muscles sore/weak

Dirtiness/clouded color

Clouded urine, thick discharge (vaginal or skin)

Stickiness

Sticky tongue coating, sticky taste, Slippery/wet pulse

With Heat

Fever, sticky yellow tongue coat

Phlegm

Chronic Damp (with Fire)

External Pathogenic FactorsDamp
external pathogenic factors dryness
External Pathogenic FactorsDryness
  • Very dry weather
  • Artificially dry, centrally heated buildings
  • Dry skin/mouth, throat, lips, tongue, stools, and scanty urination
  • Injures Yang
    • Lung Qi Deficiency as Allergic Rhinitis
    • Specific to Dry/Wind exposure in Idaho
    • Chronic Dry/Wind exposure in population with Yin Deficiency (due to overwork/hectic lifestyles)
external pathogenic factors fire
External Pathogenic FactorsFire
  • Extreme form of Heat
  • Quickly becomes Internal pathogenic factor
  • Fever, thirst, bitter taste, sweating, constipation (dry), ulcers, bleeding gums, canker sores, delirium, scanty dark urine, headache, dizziness, irritability, red face,
  • Tongue red with dry yellow coat
slide35

Fire

Five Elements

System of

Correspondences

Earth

Wood

Water

Metal

homeostasis sheng ke cycle
HomeostasisSheng – Ke Cycle

Supporting or Augmenting Influence

Controlling or Dampening Influence

System Self-Correction (in the short term)

five element acupuncture
Five Element Acupuncture
  • Imbalance between Elements causes Disease
  • Example
    • Chronic overwork/abuse/disease leads to deficiency of Water (fatigue, chronic UTI/stones/incontinence, joint pains, low back pain, fear, low self-esteem)
    • Water controls Fire (Water Def – Fire Excess)
    • Excess Fire symptoms result (anxiety, hot flashes, palpitations, insomnia, inflammation)
treatment
Treatment
  • Treat by “Tonifying” deficiencies and “Dispersing” excesses
    • Release excess Fire
    • Tonify deficient Water
    • Use Acupuncture and Chinese Herbs in combination
five element correspondences
Five Element Correspondences
  • Wood (Liver, Gallbladder)
    • Driven, multiple projects, movement, CEO, anger/anxiety, tight traps/lateral neck/IT band, TMJ, migraines, caffeine sensitivity, fibromyalgia, blue/green, sour/citrus, Spring, expansion, insomnia (esp. sleep maintenance 11pm-3am), east
    • Augments Fire, controls Earth, augmented by Water and controlled by Metal
    • Coupled with Fire
five element correspondences1
Five Element Correspondences
  • Fire (Heart, Small Intestine, Pericardium, Triple Energizer)
    • Creative, CEO, joy, awareness, love/attachment, mania, palpitations, insomnia (esp. sleep initiation), hot flashes, night sweats, cardiac disease, dysrhythmias, red/orange, bitter/roasted, summer, south
    • Augments Earth, Controls Metal, Augmented by Wood, Controlled by Water
    • Coupled with Wood and Water
five element correspondences2
Five Element Correspondences
  • Earth (Spleen, Stomach)
    • Nurturing, worry/obsession, GI issues (loose stools, gastritis, bloating, abd pain), sinusitis, cysts, tumors, lumps, dampness, obesity, chronic fatigue(multifactorial), sweet, dampness (cysts, edema), yellow/brown, transitions of seasons, center of compass positions
    • Nurtures Metal, Controls Water, Controlled by Wood
    • Coupled with Metal
five element correspondences3
Five Element Correspondences
  • Metal (Lung, Large Intestine)
    • Respiratory, skin disorders (“3rd lung”), constipation, dryness, sense of duty, grief, loss, depression (multifactorial), flavorful/spicy, white/grey/colorless, autumn, west
    • Nurtures Water, Controls Wood, Controlled by Fire
    • Coupled with Earth
five element correspondences4
Five Element Correspondences
  • Water (Kidney, Bladder)
    • UTI, Kidney stones, incontinence, joint pain, low back pain, inner chill, abuse, philosopher, music, hearing problems, throat, winter, black, north, salty, motivation/willpower
    • Nurtures Wood, Controls Fire, Controlled by Earth
    • Coupled with Fire
slide44

Five Elements of the Soul

Fire

Shen : Mind

Clarity of Thought Consciousness Insight Creative Thinking Mental Get Up & Go Joy - Mania

Earth

Wood

Yi : Intellect

Applied Thinking Studying, Memorization Concentration/Focus Gathering Ideas Nurturing – Co-dependent

Hun : Ethereal Soul

Link Shen to Universal Mind Dreams, Daydream, Ambition Opens with Meditation or Dreams Irritability, Frustration, Anger, Grudge, Rage, Anxiety

Po : Corporeal Soul

Activity of Thinking Monkey Mind Sensations (Touch, Smell, etc.) Quiets with Meditation (as Hun opens) Sadness, Grief, Loss, Melancholy

Zhi : Willpower

Old Memory Drive/Determination Pilot Light Self-Esteem, Guilt Fear, Phobias

Metal

Water

excessive attachment to emotions anger
Excessive Attachment to Emotions- Anger -
  • Bottled up
    • Liver Qi Stagnation (irritable, “short fuse,” if chronic, then depression)
  • Liver Qi Stagnation –> Lung and Spleen Qi Stag. (see Worry)
  • Liver Qi Stagnation –> Liver Blood Stagnation (chronic pain)
  • If with Kidney Yin Deficiency (overwork or excessive sex), then Liver Yin Deficiency leads to LiverYang Rising
    • Deficient Water fails to nourish Wood through Sheng cycle
    • Rage/outbursts, headache, thirst, dry mouth, bitter taste, tinnitus, dizziness
  • Liver Qi invading Stomach
    • Upper abdominal pain, bloating, gas, nausea, alternating diarrhea/constipation
excessive attachment to emotions worry
Excessive Attachment to Emotions- Worry -
  • Knots the Qi (smooth flow of Qi is the domain of the Liver, but the effect is most prominent at LU and SP)
  • Affects the Lung and Spleen
  • Lung Qi Stagnation: breathing shallow, chest discomfort, shoulder tension, anxiety
    • Chest/lungs reduce expansion with shallow breaths
    • Lung Qi stagnates – Heart Qi stagnation can follow, as can Heart Blood Deficiency (due to lack of Lu Qi)
  • Spleen Qi Stagnation: Disordered thinking, brain fog, decreased concentration/memorization, forgetfulness
excessive attachment to emotions
Excessive Attachment to Emotions
  • Hatred – Liver, Heart – Wood/Fire
  • Sadness, Grief, Regret – Lung - Metal
  • Fear – Kidney - Water
  • Shock – Kidney, Heart - Water/Fire
  • Love – Heart - Fire
  • Craving – Heart - Fire
  • Guilt – Kidney, Heart - Water/Fire
insomnia
Insomnia
  • Blood Deficiency – Can’t Fall Asleep
  • Yin Deficiency (KI, HT, LR, LU) with Shen Ungrounded - Can’t Stay Asleep
    • KI Yin Def: Exhausted, low willpower, start projects but don’t finish them, thirst, dry mouth
    • HT Yin Def: Palpitations, anxiety, sweats
    • LR Yin Def: Chronic depression, anger
    • LU Yin Def: Sweat, itchy skin, lonely, breathless
  • Hun Ungrounded – Dream-disturbed sleep, Sleep walking/talking, Restlessness
  • Heart-Gallbladder Deficiency – Wake up too early
depression many patterns
Depression – Many Patterns
  • Mind Obstructed
    • Liver Qi Stagnation
    • Heart and Lung Qi Stagnation
    • Heart or Liver Blood Stagnation
    • Phlegm Misting the Mind’s Orifices
    • Phlegm Heat obstructed the Mind/Heart
  • Mind Unsettled
    • Heart or Liver Fire blazing
    • Heart Blood or Yin Deficiency
    • Liver Blood Deficiency
    • Kidney Yin Deficiency (+/- Empty Heat)
  • Mind Weakened
    • Blood, Qi, and/or Yang Deficiency
chinese diagnostics
Chinese Diagnostics
  • Tongue
    • Color, size, wetness/“scalloping”, coating, cracks
    • Geographic representations of organs
    • Clinical changes occur slowly (weeks)
  • Pulses
    • Radial artery
    • Organ assessment at certain positions/depths
    • Clinical changes occur quickly (during treatment)
  • Body Type/Morphology
  • Skin/Complexion Color/Lesions
  • Palpation – heat/cold, lumps/knots
tongue diagnosis
Tongue Diagnosis

Normal to Pale Tongue. Normal clear thin coat. No “scalloping”, No Cracks

slide52

KI Yang Deficiency

Swollen, pale, scalloped, thin clear coat

Kidney Yin Deficiency

Excess Heat in Heart

Invasion of Wind

Long, thin, dry, red body with lateral deviation

Dry yellow coat

Heart Yin and Blood Deficiency

Tongue body pale and

tip red and pointed

No coat

Severe Yin Deficiency

Long-standing heat

or fire (LR or ST)

Red tongue body with black, dry central coat

jiao scalp acupuncture
Jiao Scalp Acupuncture

Indications (Neurologic)

Pain, Weakness, Tremor, Stroke recovery, Vertigo, and problems of Balance, Vision, or Speech

modular herbal formulae hierarchy
Modular Herbal Formulae Hierarchy
  • Emperor
    • Relieves the principal symptom
  • Ministers
    • Increase the effect of the Emperor
  • Assistants
    • Relieves potential side effects of Emperor
      • Small dose of warm herb in an overall cool formula to prevent diarrhea
      • Small dose of Spleen tonic in overall Kidney Yin tonic
  • Guides/Conductors
    • Directs the formula to a specific part of the body
      • Blood Stagnation in Pelvis (Painful Periods or Endometriosis) versus in the Chest (Angina, Pleurisy, or Rib Contusions/Fractures)
chronic tonsillitis
Chronic Tonsillitis
  • 10 yr old girl
  • Frequently upper respiratory illnesses
  • Enlarged Tonsils – Tonsillectomy Advised
    • Voice husky, tonsils nearly touching
  • Herbal Formula: Phlogisticlean (Beinfield, Korngold)
    • Purge Phlegm, Heat, and Toxins for Blood and lymph system
  • Acupuncture
    • LU/LI Distinct Meridian
    • SP-LU-LI-ST movement (Tai Yin – Yang Ming)
menopausal sweats insomnia mood swings abdominal bloating
Menopausal Sweats, Insomnia, Mood Swings, Abdominal Bloating
  • 49 yo female – insomnia, hot flashes with sweats, thirst, dry mouth, irritable mood, gas, upper abdominal bloating/pain, borborygmus (gurgling)
  • Tongue – Dry red body, red tip, dry coat white on sides, yellow centrally
  • Pulse – rapid, floating, choppy, KI position deep
  • Kidney Yin Deficiency with Empty Heat
  • Liver Qi Stagnation - Food Qi Stagnation and Stomach Heat
menopausal sweats insomnia mood swings abdominal bloating1
Menopausal Sweats, Insomnia, Mood Swings, Abdominal Bloating
  • Herbs:
    • Ease the Journey-Yin (Maciocia)
      • Kidney Yin Def with Empty Heat
    • Meal Mover (Beinfield, Korngold)
      • Food Qi Stagnation
  • Acupuncture: Operator 5 Phase
    • Tonify Kidney and Spleen
    • Disperse heat
    • Move Liver Qi
phlegm heat
PhlegmHeat
  • 52 yo male with a 3 year history of progressively severe headaches, anxiety, palpitations, heat, and brain fog.
    • Evaluated at the Mayo Clinic in Rochester, MN with a large metabolic and neurologic workup
    • Brain biopsy ruled out Pick’s Disease.
    • Declared psychiatric illness
  • Dietary history included
    • 2-3 regular sodas per day
    • “Processed foods diet” (foods that are boxed, canned, or otherwise packaged with generally high glycemic indices and artificial preservatives).
phlegm heat1
Tongue

Swollen, red, sticky thick damp yellow coating extending to tip

Pulse

Wet/slippery at right middle position (SP)

Phlegm Heat
phlegm heat2
Phlegm Heat
  • Herbal Formula: Clear the Soul(Maciocia)
    • Clear Phlegm and Heat, Open the Mind and Heart’s Orifices, relax the chest
  • Acupuncture
    • Spleen Qi tonification and movement, Heart points
    • Phlegm clearing points
    • Heat clearing points
  • Dietary change – cessation of refined sugar/dairy
  • Symptoms and pulses improved within 3 weeks
  • Tongue improved after 6-10 weeks
fatigue and diarrhea
Fatigue and Diarrhea
  • 39 yo female with fatigue, chilled, low libido, irritable bowel syndrome with intermittent diarrhea worse with irritability/anger
  • History of childhood emotional trauma
  • Loose stool upon awakening
    • “Cock-crow diarrhea”
    • Kidney Yang Deficiency
fatigue and diarrhea1
Pulses: wiry, sharp at LR, deep KI, and wet at SP

Tongue: Pale, wide, 1+ scalloped, raw edges, wet clear coat

Kidney Yang Deficiency

Water fails to nourish Wood

LR Qi Stagnates and invades ST/SP

Wood invades Earth

SP Qi Deficiency

LR Yin fails, LR Qi Stagnates, LR Yang rises

Fatigue and Diarrhea
peeling the onion
Peeling the Onion

Start at the Outside (Manifestation) and work your way Inward (Root)

slide69

Metaphor of the Tree

Branches – Manifestation

Roots – Underlying Cause

what is the root etiology
What is the Root Etiology?
  • Spleen versus Kidney (Age-old TCM Debate)
  • Qi(from Environment plus Life Experience)

Versus

  • Jing (from Constitution/Genetics plus Life Experience) - Jing as source of KI Yin/Yang and, ultimately, of Qi
  • Childhood emotional trauma likely trumps all and injures Water (Kidney)
  • Presume that Kidney Yang Deficiency is Root
  • But start with Spleen/Liver treatment to improve digestion and mood
    • Therefore improve ability to generate Qi
slide71

Herbs: Strengthen the Root(Maciocia) Kidney Yang tonic Irritease (Kaptchuk) Move Liver Qi, Tonify Spleen Qi, Clear Damp Heat in the Middle Burner (upper abdomen)

Tonify Tai Yin (SP) with movement onto Yang Ming (ST), disperse Liver

spleen yang deficiency liver blood qi stagnation
Spleen Yang DeficiencyLiver Blood/Qi Stagnation
  • 35 yo female - generally colder than others, cold hands/feet, intermittent abdominal pain with loose stools, mild fatigue, feels best with exercise, missing menstrual periods, uterine fibroids
  • Herbs
    • Arouse Vigor(Kaptchuk)
      • Tonify Yuan Qi, Tonify Spleen/Stomach Qi, and Raise Yang
    • Women’s Chamber(Kaptchuk)
      • Invigorate Blood, transform Blood Stasis, reduce Abd Masses
  • Acupuncture: SP-ST tonification, LR movement
palpitations
Palpitations
  • 55 yo male - palpitations, dizziness, chronic insomnia, generally hot with hot flashes 1-2 per night, mild anxiety, low back ache, knee soreness, hair/nails are dry/brittle
  • Overwork, divorced age 48
  • Tongue: long, thin, dry, body with mild pallor, pointed/red tip
  • Pulse: Floating, deep at KI and HT
palpitations1
Palpitations
  • Heart Yin and Blood Deficiency
    • Yin (hot, dry, insomnia, red/dry/thin tongue)
    • Blood (tongue with pallor, hair/nails dry/brittle, dizziness)
  • Kidney Yin Deficiency
    • Back/joint pain
    • Yin Deficient symptoms above
    • Co-exists with HT Yin Deficiency
    • Overwork, stressful divorce as risk factors
palpitations2
Palpitations
  • Herb: Celestial Emperor’s Blend (Kaptchuk)
    • Heart and Kidney Yin Deficiency, Shen ungrounded, Blood Deficiency
  • Acupuncture
    • Shao Yin – Tai Yang Principal Meridian
      • KI-HT-SI-BL
        • Focus on HT primarily at first, then shift to KI later
        • Relieve Fire first, then tonify Water
    • Settle Shen
      • Upper Burner/Heater points (CV17, GV20)
      • Ground Water with KI1
  • Palpitations reduced 80% after 5 treatments, insomnia improved, no longer thirsty/dry mouth
osteoarthritis of the knee
Osteoarthritis of the Knee

Principal Meridian plus Knee SP9-ST34, SP10-ST36, Eyes of Knee

Bi Syndrome Formula (Depends on Pattern) Blood Stagnation Blood Deficiency Wind-Cold-Damp Phlegm Heat more typical of RA

Vitamin D 5000iu EPA-DHA 3000-4000mg

Cardinal Points

Start 20Hz - Move to 4Hz after initial improvement or if no change after 2-3 treatments

pleurisy
Pleurisy
  • 41 yo female with 2 weeks bronchitis followed by sudden onset severe chest pain with breathing. ER visit reveals normal cardiac evaluation and normal chest xray. Seen in clinic 5 days later with severe pain failing NSAIDS and narcotics. No DVT.
  • History of anxiety, insomnia, hysterectomy for menorrhagia
  • Tongue: red, dry, dusky purple color yellow coat just medial to purple edges 1-2+ scalloping
  • Pulse: choppy

Photo taken 4 days after 1st treatment

pleurisy1
Pleurisy
  • Herbs: Red Stirring (Maciocia)
    • Move Blood Stagnation in Chest
  • Acupuncture: Jue Yin –Shao Yang
    • LR-PC-TH-GB (needle balance for Yang Dispersal, 20Hz)
    • Regional chest points, Ear and Scalp points
    • No Moxa
  • At time of first treatment, “agonizing” pain
  • Next day “woke up with no pain”
  • 2 days 40% pain reduction
  • 4 days 20% pain reduction
  • Retreated on Day 4
fatigue
Fatigue
  • 71 yo male with 4-5 years of fatigue following treatment for prostate cancer, low libido, mild memory loss (names), markedly ridged nails
    • Low testosterone “Andropause”
      • Testosterone controversial with history Prostate CA
    • Prolonged personal conflict/anger increases cortisol transiently – burns out over time
fatigue1
Fatigue
  • High blood pressure – Meditation too time consuming
  • Renal insufficiency (proteinuria, CrCl 61ml/min)
  • Thyroid labs normal except elevated RT3
  • Low AM Cortisol
    • Adrenal Fatigue ~ Kidney Yin or Yang Deficiency
  • Tongue – red, thin damp yellow coat, deep wide SP/ST crack
  • Pulse – deep diffusely
fatigue2
Fatigue
  • Kidney Yin Deficiency, Qi Deficiency, Blood Deficiency
  • Acupuncture:
    • Tonify Kidney, Back Shu points, Ming Men
    • Extra Points: SP/ST points added (damp, ST crack)
  • Herbs: Nourish the Root(Maciocia)
    • Kidney Yin Tonic
  • Other: Adrenal support protocol
    • High dose B5/B6, hydrolyzed collagen, adrenal adaptogenic herbs, adrenal glandular, pregnenolone, GI mucosal support, GI probiotic
    • Rest
ki tonification plus sp6
KI Tonification plus SP6

After 6 weekly treatments, 95% improved – similar level of energy as experienced 2 years ago

fatigue3
Fatigue

Future Consideration: Tonify Blood (pale tongue, ridged nails), Qi (fatigue, central crack)

After 4 weeks of Kidney Yin tonic for dry red tongue with yellow coating

slide88
What about Blood Deficiency?markedly ridged nails, tongue pallor uncovered with Yin tonification, fatigue

Blood Physiology – (Dense, material form of Qi)

degenerative disc disease spinal stenosis
Degenerative Disc DiseaseSpinal Stenosis
  • 62 yo male – chronic back pain worse over the last year
    • Intermittent sciatica into leg
    • MRI: degenerative disc disease, lumbar spinal stenosis
  • Neurosurgeon recommends PT, epidural steroid injections, conservative treatment
    • Come back if genitourinary problems or severe pain failing all other treatments
slide90
PENS
  • Percutaneous Electrical Nerve Stimulation
  • A form of “Neuroanatomical Acupuncture”
    • Dr. Bill Craig
  • Electrically stimulate spinal segments responsible to the area of pain
    • Dermatome, Myotome, Sclerotome, Sympathetics
slide93
PENS

Degenerative Disk Disease Shingles Spinal Stenosis Low Back or Neck Pain failing other types of acupuncture

Start Single 4Hz Module Then Split into 4Hz/15Hz Then 4Hz/30Hz, 4Hz/80Hz, and up to 4Hz/150Hz

Can Use 3-4 Modules (4/15/30/80Hz)

T10

T12

L2

L4

L5

S1

4Hz

30Hz

upper back pain
Upper Back Pain
  • 58 yo female with 3-4 months of upper back pain at trapezius
    • Shoots into lower shoulder blade, upper arm, and onto dorsal forearm
    • Recent headaches
    • Hot, dry mouth, thirst, prefers dark chocolate and salty flavors, emotional stress – irritability, neck/shoulder tightness
    • History of endometriosis leading to hysterectomy
upper back pain1
Upper Back Pain
  • Tight knots in right trapezius, levator scapulae, rhomboids
  • Palpation reproduces pain
  • Tongue – red, dry, red tip, dry yellow coat
  • Pulse – deep, wiry, slight floating quality
  • Liver Qi Stagnation, LR Blood Stagnation
  • Liver Yin Deficiency
myofascial upper back pain
Myofascial Upper Back Pain

JueYin – ShaoYang: LR2,LR3,GB21-34@20Hz and upper back regional points

100% better for 3 days and 80% better at 1 week after 3 treatments

jiao scalp acupuncture1
Jiao Scalp Acupuncture

Indications (Neurologic)

Pain, Weakness, Tremor, Stroke recovery, Vertigo, and problems of Balance, Vision, or Speech

circle the dragon soft tissue masses ganglion cysts shingles rash
Circle the DragonSoft Tissue Masses, Ganglion Cysts, Shingles Rash

KI3, HT3, HT6 – SI3 @20Hz, SI8

SP6-SP9@2Hz, ST40

Herb: Cluster Dissolving (Beinfield, Korngold)

Move Liver Qi/Blood, dissolve masses, dispel Phlegm/Damp, purge Heat/Toxins, tonify Liver and Spleen

Expect 50% reduction by 5-8 treatments

applications
Applications
  • Studies of various standards
  • Value of RDBPCT design for interactive modalities dubious
  • Internal Medicine
    • Asthma, nausea, IBS, Crohn’s/UC, anxiety, depression, epilepsy, chronic UTI, eczema, sinusitis, allergies, headache, TMJ, Bell’s Palsy, neuropathy, stroke (scalp acupuncture)
  • Substance abuse - smoking, chewing, opiates, alcohol, craving
applications1
Applications
  • OB/GYN
    • Premenstrual syndrome, (peri)menopausal symptoms, dysmenorrhea, menorrhagia, oligomenorrhea, infertility, labor pain, breech presentation
  • Pain
    • Epicondylitis, plantar fasciitis, arthritis, low back pain, neck pain, pelvic pain, zoster
applications2
Applications
  • Essentially, any medical problem should be accessible with AP
    • Issues are practicality and density of disease
    • Acupuncturist training and experience
  • Role in Cancer
    • Helpful for decreasing side effects of chemo/radiation
    • Especially with herbal therapy
    • Facilitating spiritual transition to interaction with mortality
slide104

Veterinary AcupunctureHeidi Woog, DVM

East Meets West Wellness CareAtSun Valley Animal Center

complications and precautions
Complications and Precautions
  • Retained Needle
  • Pneumothorax (any organ puncture)
  • Auricular infections
  • Other skin infections
  • Temporary (24hr) clinical worsening
  • Pregnancy
    • Not a contraindication
    • Theoretical concern of causing contractions
  • Anticoagulation - not a contraindication
recommended readings
Recommended Readings
  • Between Heaven and Earth
    • Harriet Beinfield, LAc & Efrem Korngold, LAc, OMD
  • The Web That Has No Weaver
    • Ted Kaptchuk, OMD
  • Getting to Know You
    • Joseph Helms, MD
other sources several figures in this lecture reproduced from these sources
Other Sources (several figures in this lecture reproduced from these sources)
  • The Foundations of Chinese Medicine
    • Giovanni Maciocia
    • Several other texts authored (Practice, Diagnosis, Tongue Diagnosis, OB/GYN)
  • Atlas of Chinese Tongue Diagnosis
    • Barbara Kirschbaum
  • Acupuncture Energetics: A Clinical Approach for Physicians
    • Joseph Helms, MD
circle the dragon chinese herbal medicine and medical acupuncture in family practice1

Circle the DragonChinese Herbal Medicine and Medical Acupuncture in Family Practice

Tom Archie, MD, DABFM, DABMA

St. Luke’s Wood River Medical Center

Integrative Therapies Service

www.drtomsalchemy.com