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Oral Cavity Disorders: a TCVM Approach. CAPT R.M. Clemmons, DVM, PhD, CVA. Local damage Electric shock Chemical damage Thermal damage Periodontitis Tooth tarter Systemic disease Metabolic disease Nutritional disease Immune disease Infectious disease. Treatment Remove offending cause

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Oral Cavity Disorders: a TCVM Approach


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    1. Oral Cavity Disorders: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

    2. Local damage Electric shock Chemical damage Thermal damage Periodontitis Tooth tarter Systemic disease Metabolic disease Nutritional disease Immune disease Infectious disease Treatment Remove offending cause Steroids Antibiotics Clean teeth Oral Cavity Diseases (Western)

    3. TCM Spleen Disease Spleen Physiology Spleen Pathology Gingivitis/Stomatitis

    4. Sound song Emotion sympathy Climate humid Season late summer Direction center Opening lips/gums Body Part muscles Zang/Fu SP/ST Earth

    5. Governs Transportation & Transformation Food & Water Controls Blood Dominates the Muscles Opens in Mouth Lips & Gums (ST) TCM SPLEENPhysiology

    6. TCM 24 Hour Clock

    7. Earth BALANCED DEFICIENT EXCESS

    8. Spleen Pathology

    9. Spleen Pathology • Damp is the Enemy of the Spleen • Damp-Cold • Damp-Heat • Spleen Qi Deficiency with Damp

    10. Spleen Pathology Usually combination of excess & deficiency External or Internal Pathogen Damp-Heat Damp-Cold Obstructs Spleen Qi Flow Spleen fails to Transform & Transport Gu Qi Spleen Qi Deficiency

    11. Spleen Pathology Cold Environmental Conditions Cold Food or Drink Cold-Damp in Spleen Disharmony of Qi Flow Transform & Transport Disorder

    12. Spleen Pathology Accumulated Heat & Damp Damp Hot Environmental Conditions Damp Hot Food or Drink Damp-Heat in Spleen Disharmony of Qi Flow Transform & Transport Disorder

    13. Spleen Qi Deficiency Illness Overeating Overwork Starvation Under Work Spleen Qi Deficiency Disturbed Qi Flow Failure to Transform & Transport

    14. Spleen Not Controlling Blood Prolonged Spleen Qi Deficiency Spleen Fails to Hold Blood Hemorrhage General Signs Chronic Hemorrhage

    15. Spleen Qi Sinking Illness Overeating Overwork Starvation Under Work Chronic Spleen Qi Deficiency Failure of Holding Chronic Diarrhea Prolapses Incontinence

    16. Spleen Pathology Cold Food or Drink Chronic Spleen Qi Deficiency Spleen Yang Deficiency Disharmony of Qi Flow Transform & Transport Disorder Yang Deficiency Signs

    17. Stomach Pathology Cold Environmental Conditions Cold Food or Drink Cold in Stomach Disharmony of Qi Flow Transform & Transport Disorder Inhibition of Yang

    18. Stomach Cold Cold Food & Drink Cold Environment Stomach Cold Receiving & Decomposing Cold Signs Anorexia Altered Qi Flow Cold Ear/Nose Hypersalivation Pale-Purple Tongue Deep-Slow Pulse Lassitude

    19. Stomach Pathology Damp Hot Environmental Conditions Hot Dry Food or Drink Heat in Stomach Heat Signs Transform & Transport Disorder

    20. Pathogenic Heat Yin Deficiency Stomach Heat channel grandchild Gums organ child Cystitis Ulcer Colitis Stomach Heat

    21. Stomach Food Stagnation Indigestible Food Overeating Retention of Food in Stomach Disturbed Qi Flow Failure to Transform & Transport

    22. Stomach Yin Deficiency Stress Liver Qi Stagnation Chronic Febrile Illness Transformation to Heat/Fire Impairment of Body Fluids Stomach Yin Deficiency

    23. How to Use Acupuncture for Gingivitis in Small Animal Practice Zang Fu Physiology • Teeth correspond to bone • Bone is controlled by the kidney • Malocclusion, oligodontia are examples of Kidney Jing Deficiency • Gums are influenced by the stomach

    24. Meridian Theory • Oral cavity has two main channels that influence the teeth and gums • Large Intestine meridian • Stomach meridian

    25. Pattern Diagnosis • Stomach Heat Pattern • Excess pattern, seen more often in younger animals (cats) • Stomach Yin Deficiency + Empty Heat • Stomach loves moisture • Moisture balances Yang function • Lack of Yin (fluid) allows Yang Fire to rise

    26. Stomach Heat Pattern • Fluffy: 4yr FS DSH • Primary complaint: Bad breath, eating poorly • History: Stray, no vetcare, dry food diet • Exam: Body & coat condition-normal; vital signs-WNL

    27. Oral Exam: Putrid odor, upper and lower arcade have severely inflamed gingiva, with spontaneous bleeding, minimal calculus formation • Lab Data: Elevated WBC, FELV/FIV=Neg • Diagnosis: Hemorrhagic gingivitis • Treatment: Clindamycin 25mg PO BID x 10 • Dental prophylaxis followed by Clavamox 62.5 mg BID x 10

    28. TCVM Exam & Diagnosis • Constitution: Water/Wood • Tongue: body=reddish purple; no coat • Pulse: Bilaterally superficial rapid • Body Condition: Dry nose; Body Temp Normal • Mouth: Stink smell; bloody red gums Pattern DX: Stomach Heat (excess condition)

    29. TCVM Treatment Strategy • Clear the Stomach Heat, Cool the Blood, & nourish Stomach Yin • Acupuncture Point Selection: GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10 • Herbal Medicine: Yu Nu Jian ( Jade Lady) shi gao, shu di huang, zhi mu, huai niu xi 2 teapills TID or 1/8-1/4 tsp granules TID • Topical Care: Aloe Gel ( Warren Laboratories)

    30. Case Outcome & Discussion • After 3 weeks of therapy inflammation substantially reduced • Cervical line lesions which compromised several teeth were removed • Fluffy is maintained on Aloe oral gel and herbs with only periodic acupuncture therapy • Long term expectations: depend on owner compliance • Other herbals: Wei Qi Booster; Slippery Elm

    31. Stomach Yin Deficiency & Empty Heat Pattern • Tess: 10 yr, FS, Mix Breed • Primary Complaint: Bad breath, dirty teeth, and periodic vomit/regurge • History: Commercial dry food diet, periodic dental prophylaxis, absent dental homecare, gums remain inflamed and plaque builds quickly • Western Dx / Tx: Gingivitis with periodontal deterioration. Requires 6 month recall for prophylaxis

    32. Exam: Constitution- Water Tongue- Violet, dry, no coat Pulse- Deep, thready, and quick Gums- dry/breath scorched Coat Quality-Dry Treatment Stategy: Nourish Stomach Yin and Clear Heat AP= CV 12 (aqua); SP 3,6; ST 36,44; LI 4,11 Herbs= Qing Wei San Topical= Aloe Gel Diet: Fresh cooked food/ fish-pork-beef-eggs-veggies TCVM Approach

    33. Ulceration: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

    34. Ulcer • Symptoms • Periodic pain • Acid regurgitation • Belching • Vomiting • Patterns • Excess • Stomach Cold • Food Stagnation • Liver Qi Stagnation • Blood Stasis • Deficiency • Stomach Yin Deficiency

    35. Pathogenic Heat Yin Deficiency Stomach Heat channel grandchild Gums organ child Cystitis Ulcer Colitis Stomach Heat

    36. Mild Moderate to Severe Stomach Ulcers Happy Stomach Angelica Dang Gui Nourish & activate Blood Paeonia Bai Shao Yao Nourish Liver Yin & Blood Bupleurum Chai Hu Soothe Liver Qi Aurantium Zhi Shi Move Qi & relieve pain Trichosanthes Gua Lou Promote body fluid & transform phlegm Pinellia Ban Xia Dry damp & transform phlegm Citrus Chen Pi Move Qi & relieve pain Licorice Gan Cao Harmonize Taraxacum Pu Gong Ying Clear Heat Jade Lady Gypsum Shi Gao Clear Heat and cool Stomach Anemarrhena Zhi Mu Clear Heat and nourish Yin Rehmannia Shu Di Huang Nourish Yin and Jing Ophiopogon Mai Men Dong Moisten and nourish Yin Achyranthes Niu Xi Bring the Qi flow down

    37. GI Food Therapy • Cabbage • Contains glutamate • Cools stomach & GI • Spinach • Stops hemorrhage

    38. 05 Shan-gen Mountain base Xie-05 LO: on the dorsal midline of boundary b/t hairy & non-hairy areas ME: Perpendicular insertion 0.3 cun IN: Loss of appetite, sinusitis, coma, shock, wind-cold, wind-heat Shan-gen GV-26 Ren zhong 06 Ren-zhong/Shui-gou the center of man/water passage, Xie-07, GV-26 LO: At the intersection b/t dorsal and middle 1/3 of the philtrum ME: Perpendicular insertion for 0.3 cun IN: Coma, shock, fever, bronchitis, Lung Heat, facial paralysis

    39. 21 Hua-tuo-jia-ji at cervical region LO: 0.5 dorsal to cervical vertebrae IN: cervical stiffness, wobbler’s disease 22 Jian-wei, strengthen stomach LO: Upper 1/3 of the jugular group, Between vein and cervical vertebra IN: Anorexia, vomit, stomach disorders LO: At the ventral midline just cranial to throat. IN: excessive salivation, laryngeal hemiplegia 23 Lian-quan ridge spring CV-23

    40. Pancreatitis: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

    41. Considered any acute or chronic change in GI function usually accompanied by some degree of vomiting, diarrhea and abdominal pain Acute- -Mild Pancreostasis Acute- -Severe Fulminating pancreatitis Chronic Pancreatic insufficiency Rx Acute NPO Fluids Antiemetics Pain relief Low fat/protein food Rx Chronic Enzyme therapy Pancreatitis

    42. TCVM Acute Pancreatitis

    43. TCVM Chronic Pancreatitis * Enzyme replacement therapy still good to add

    44. Perry 3 yr FS Springer Earth personality Acute onset of vomiting, fever and abdominal pain Increased thirst Scant urination Elevated Amylase & Lipase Increased WBC Rx: Fluids & Ranitidine Tongue: red & dry Pulse: fast & superficial West Dx: acute pancreatitis TCM Dx: damp-heat in spleen

    45. AP DN ST-45 ST-36 LI-4 PC-6 BL-20 CV-12 Aqua ST-36 BL-20 PC-6 Herbal Great Saussurea Coptis Next day was 80% improved Clinician said, “He is doing absolutely fantastic…better than any patient in years…NO…it wasn’t the acupuncture…well…maybe we should try it again!” Perry Treatment

    46. Great Saussurea Coptis Saussurea Mu Xiang Move Qi & relieve pain Coptis Huang Lian Clear Damp-Heat in the intestines Evodia Wu Zhu Yu Warm the middle Jiao & stop vomiting

    47. Bleeding: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

    48. Bleeding • Primary Hemostasis • Complex chain of events involving interaction of • Platelets • Vessel Wall • von Willebrand’s factor • Fibrinogen • Secondary Hemostasis • Complex interaction of the intrinsic and extrinsic clotting cascades • Stabilize the platelet plug

    49. Primary Hemostasis • Evaluated by the bleeding time • Platelet number • Amount and Quality of the von WIllebrand’s factor VIII:Ag • Fibrinogen concentration • Other alterations due to vessel wall disorders

    50. Secondary Hemostatis • Assessed by • ACT (activated clotting time) • APTT (activated partial thromboplastin time) • PT (prothrombin time)