Chinese Herbal Medicine and Medical Acupuncture in Family Practice

Chinese Herbal Medicine and Medical Acupuncture in Family Practice

اسلاید 1: www.tabaye.ir

اسلاید 2: Circle the Dragon Chinese Herbal Medicine and Medical Acupuncture in Family Practice Tom Archie, MD, DABFM, DABMASt. Luke’s Wood River Medical CenterIntegrative Therapies Servicewww.drtomsalchemy.com

اسلاید 3: ObjectivesPattern RecognitionChinese Medicine PhysiologyThree Treasures – Jing, Shen, QiPhysiology of Qi and BloodFive ElementsEight PrinciplesExternal Pathogenic FactorsPsyche-Soma: The Five Parts of the SoulDiagnostics: Tongue and PulseCases Discussed

اسلاید 4: Pattern Recognition

اسلاید 5: Pattern Recognition - DiagnosesWestern MedicinePremenstrual SyndromeHypertensionDepressionMigraineCongestive Heart FailurePneumoniaDiabetesChronic Fatigue SyndromeEczemaAsthmaAnginaPleurisyDysmenorrheaChinese MedicineLiver Qi StagnationLiver Blood DeficiencyLiver Blood StagnationKidney Yin DeficiencyKidney Yang DeficiencyLung Qi DeficiencySpleen Qi DeficiencyPhlegm Heat misting theHeart and Mind’s OrificesWind Cold (or Heat) InvasionLatent Wind Heat Heart Yin DeficiencyHeart Qi Deficiency

اسلاید 6: Physiology Of Chinese Medicine

اسلاید 7: The Three TreasuresJing (Essence) - derived from the KidneyShen and Qi are derived from JingInherited from parents - Genetics/Constitution Determines growth, sexual maturation, conception, pregnancy, brain/cognitive functionQi – derived from Spleen (food) and Lung (air)Replenished day-to-dayNutrition and air quality importantShen (Mind) – housed in the HeartCreativity, Drive, Vision, and Intelligence

اسلاید 8: QiRiceVaporQi

اسلاید 9: 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 fluidsNei Jing written during 3rd – 1st Century BCEChinese physicians & cadaver dissectionsUsing needles of glass, metal and bone to influence neurovascular system

اسلاید 10: TCM Qi PhysiologyStomach separates pure from impure Qi of foodPure Qi to SpleenImpure to Small Intestine (process repeats again)Spleen sends Food Qi to LungLung combines it with pure Qi extracted from airFood/Air Qi “heated” by Yuan Qi (ancestral pilot light) provided by Kidney to make “Nutritive Qi”In Heart to make BloodIn Meridians

اسلاید 11: TCM Qi Physiology

اسلاید 12: Blood Physiology (Dense, material form of Qi)

اسلاید 13: Blood DeficiencyCauses: Hemorrhage, low dietary protein, constitutionDeficiency or stagnation of QiFatigue, brain fog, dizziness, dry skin, dry hair, brittle nails, pale tongue, irregular and very light menses, pale complexion, trouble falling asleep, anemia, headache, anxiety

اسلاید 14: Blood StagnationCaused by Blood Deficiency or Qi StagnationDark/dusky tongue, purple sublingual veinsChronic stabbing painMusculoskeletalPleurisy, AnginaDegenerative disc disease, spinal stenosisBlood moving herbs are anti-inflammatoryGynecologicalPainful and heavy menstrual periodsLarge dark clots

اسلاید 15: MeridiansAcupuncture points linked together in lines called “meridians”Qi circulates through meridiansMeridians named for associated OrganKidney, Heart, Small Intestine, BladderLiver, Pericardium, Triple Energizer, GallbladderSpleen, Lung, Large Intestine, Stomach

اسلاید 16: Meridians

اسلاید 17: 91% of Acupuncture Points share this Histology

اسلاید 18: fMRI StudyNeedle placed in foot Acupuncture point associated visionfMRI shows stimulation of visual cortex

اسلاید 19: fMRI StudyAuditory Complex stimulated by needle placed in AP point on the leg associated with hearing

اسلاید 20: Acupuncture ModelsMeridian-based: Japanese, Vietnamese, French EnergeticsTraditional Chinese Medicine (“TCM”)Eight Principles (Yin/Yang, Damp/Dry, Cold/Heat, Interior/Exterior)Zhang-Fu organ pairings blends Yin-Yang and 5 ElementFive Element (Korean) Wood, Fire, Earth, Metal and WaterDifferent schools of thought regarding etiology of disease (Kidney versus Spleen/Stomach)Neuroanatomical - CraigPENS, osteopuncture

اسلاید 21: Meridian-Based AcupunctureBlockage in meridian flow produces diseaseTherapeutic action of “unblocking” meridian flow (Relieving Stagnation)PainAsthmaHeavy, Painful, or Irregular Menstrual Periods

اسلاید 22: French Energetics Acupuncture Principal Meridian TreatmentYin TonificationChronic Symptoms (or cold, deficient) Balance needles so that more are on Yin meridiansTonify Yin Meridian by twirling, applying heat via Moxibustion, or low frequency electrical stimulationYang DispersalAcute Symptoms (or heat, excess, spasm)Balance needles so that more are on Yang meridiansDisperse Yang Meridian by leaving needles alone, cooling with alcohol pads, or medium to high frequency electrical stimulation

اسلاید 23: Principal MeridiansShao YinKidney, Heart Jue YinLiver, PericardiumTai YinSpleen, Lung Tai YangSmall Intestine, BladderShao YangTriple Heater, GallbladderYang MingLarge Intestine, Stomach

اسلاید 24: French Energetics Acupuncture Principal Meridian TreatmentHow 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 patientCentral low back pain in patient with Wood-Fire as principal meridian systemAnger/frustration/irritabilityConsider Jue Yin – Shao Yang (LR-PC-TH-GB) instead of Shao Yin – Tai Yang (KI-HT-SI-BL)

اسلاید 25: Pattern RecognitionFive ElementsInterconnections between Patterns and SystemsTCM Eight Principles

اسلاید 26: Eight Principles

اسلاید 27: Eight Principles - PolaritiesYangLightSunActivityEnergyExpansionHotFireHardExcitementQiYinDarknessMoon RestMatterContractionColdWaterSoftInhibition Blood

اسلاید 28: Yin & Yang Deficiency and ExcessYin DeficiencyYang 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 DeficiencyYin 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 ExcessYang appears in excess with Full Heat – migraines, pressure, bloating, mania, hypertension, anger, insomnia, fever. Full Heat (disperse rather than tonify).Yin ExcessYin 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.

اسلاید 29: External Pathogenic FactorsWindColdSummer HeatDampDrynessFire

اسلاید 30: External Pathogenic Factors WindRapid onsetWind Cold to Wind HeatSymptoms & signs change rapidly and move from place to place in bodyEnters neck to respiratory tractCirculates between skin and musclesWarms musclesAversion to cold or to windChills/myalgiasFurther warmed by bodyFever, rigors, rash/hivesWind in the SkinEczema, dermatitis, itchingChronic allergic rhinitisDry/Wind plus Yin DefUpper respiratory infection signsChills, cold intolerance, sore throat, clear nasal drainage that warms to yellow/thickInternal Wind (neurologic)Stroke, seizures, tremor, headaches, hypertension, paresthesias/neuropathy

اسلاید 31: External Pathogenic Factors ColdUsually enters via Wind Cold invasionDirect channel invasionBi SyndromePainful Obstruction SyndromeArthritis without hot/red jointsWind-Damp-ColdContracts muscles/tendonsChronic, dull pain (abdomen, pelvis, joints) better with heatInternal Cold (from Yang Def)Consumes Spleen YangChilliness, dull pain, prefer warm liquids, cold limbs, no thirst, fatigueHeart Yang DeficiencyStuffy pain in chest, palpitationsLung Qi DeficiencyCatch every cold, sweats, cough with thin white mucusSpleen Yang DeficiencyDiarrhea/loose stools, low appetiteKidney Yang DeficiencyFrequent pale profuse urination, low back pain, cold feet/knees, erectile dysfunction, white vaginal discharge

اسلاید 32: External Pathogenic Factors Summer HeatSpecific to hot weatherAversion to heat, sweating, headache, dark scant urine, dry lips, thirst, rapid pulseSevere Summer HeatInvades PericardiumDelirium, slurred speech, loss of consciousness“Heat Exhaustion” or “Heat Stroke” in western med

اسلاید 33: External Pathogenic Factors DampDamp weatherWearing damp clothingSitting on damp groundConsuming damp dietRefined sugars, dairyExcessive raw veg/fruitAscends legsSymptoms depend on where damp settlesPelvis – vaginal dischargeGI – loose stoolsBladder – urinary frequency or burningHeaviness of limbs/headTired, fullness of chest or abdomen, muscles sore/weakDirtiness/clouded colorClouded urine, thick discharge (vaginal or skin)StickinessSticky tongue coating, sticky taste, Slippery/wet pulseWith HeatFever, sticky yellow tongue coatPhlegm Chronic Damp (with Fire)

اسلاید 34: External Pathogenic Factors DrynessVery dry weatherArtificially dry, centrally heated buildingsDry skin/mouth, throat, lips, tongue, stools, and scanty urinationInjures YangLung Qi Deficiency as Allergic RhinitisSpecific to Dry/Wind exposure in IdahoChronic Dry/Wind exposure in population with Yin Deficiency (due to overwork/hectic lifestyles)

اسلاید 35: External Pathogenic Factors FireExtreme form of HeatQuickly becomes Internal pathogenic factorFever, 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

اسلاید 36: Five ElementsSystem of Correspondences Fire WoodWaterMetalEarth

اسلاید 37: Homeostasis Sheng – Ke CycleControlling or Dampening InfluenceSupporting or Augmenting InfluenceSystem Self-Correction (in the short term)

اسلاید 38: Five Element AcupunctureImbalance between Elements causes DiseaseExampleChronic 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)

اسلاید 39: TreatmentTreat by “Tonifying” deficiencies and “Dispersing” excessesRelease excess FireTonify deficient WaterUse Acupuncture and Chinese Herbs in combination

اسلاید 40: Five Element CorrespondencesWood (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), eastAugments Fire, controls Earth, augmented by Water and controlled by MetalCoupled with Fire

اسلاید 41: Five Element CorrespondencesFire (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, southAugments Earth, Controls Metal, Augmented by Wood, Controlled by WaterCoupled with Wood and Water

اسلاید 42: Five Element CorrespondencesEarth (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 positionsNurtures Metal, Controls Water, Controlled by WoodCoupled with Metal

اسلاید 43: Five Element CorrespondencesMetal (Lung, Large Intestine)Respiratory, skin disorders (“3rd lung”), constipation, dryness, sense of duty, grief, loss, depression (multifactorial), flavorful/spicy, white/grey/colorless, autumn, westNurtures Water, Controls Wood, Controlled by FireCoupled with Earth

اسلاید 44: Five Element CorrespondencesWater (Kidney, Bladder)UTI, Kidney stones, incontinence, joint pain, low back pain, inner chill, abuse, philosopher, music, hearing problems, throat, winter, black, north, salty, motivation/willpowerNurtures Wood, Controls Fire, Controlled by EarthCoupled with Fire

اسلاید 45: Fire WoodWaterMetalEarthShen : MindClarity of Thought Consciousness Insight Creative Thinking Mental Get Up & Go Joy - ManiaYi : IntellectApplied Thinking Studying, Memorization Concentration/Focus Gathering Ideas Nurturing – Co-dependentPo : Corporeal SoulActivity of Thinking Monkey Mind Sensations (Touch, Smell, etc.) Quiets with Meditation (as Hun opens) Sadness, Grief, Loss, MelancholyZhi : WillpowerOld Memory Drive/Determination Pilot Light Self-Esteem, Guilt Fear, PhobiasHun : Ethereal SoulLink Shen to Universal Mind Dreams, Daydream, Ambition Opens with Meditation or Dreams Irritability, Frustration, Anger, Grudge, Rage, Anxiety Five Elements of the Soul

اسلاید 46: Excessive Attachment to Emotions - Anger - Bottled upLiver 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 RisingDeficient Water fails to nourish Wood through Sheng cycleRage/outbursts, headache, thirst, dry mouth, bitter taste, tinnitus, dizzinessLiver Qi invading StomachUpper abdominal pain, bloating, gas, nausea, alternating diarrhea/constipation

اسلاید 47: 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 SpleenLung Qi Stagnation: breathing shallow, chest discomfort, shoulder tension, anxietyChest/lungs reduce expansion with shallow breathsLung 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

اسلاید 48: Excessive Attachment to EmotionsHatred – Liver, Heart – Wood/FireSadness, Grief, Regret – Lung - MetalFear – Kidney - WaterShock – Kidney, Heart - Water/FireLove – Heart - FireCraving – Heart - FireGuilt – Kidney, Heart - Water/Fire

اسلاید 49: InsomniaBlood Deficiency – Can’t Fall AsleepYin Deficiency (KI, HT, LR, LU) with Shen Ungrounded - Can’t Stay AsleepKI Yin Def: Exhausted, low willpower, start projects but don’t finish them, thirst, dry mouthHT Yin Def: Palpitations, anxiety, sweatsLR Yin Def: Chronic depression, angerLU Yin Def: Sweat, itchy skin, lonely, breathlessHun Ungrounded – Dream-disturbed sleep, Sleep walking/talking, RestlessnessHeart-Gallbladder Deficiency – Wake up too early

اسلاید 50: Depression – Many PatternsMind ObstructedLiver Qi StagnationHeart and Lung Qi StagnationHeart or Liver Blood StagnationPhlegm Misting the Mind’s OrificesPhlegm Heat obstructed the Mind/HeartMind UnsettledHeart or Liver Fire blazingHeart Blood or Yin DeficiencyLiver Blood DeficiencyKidney Yin Deficiency (+/- Empty Heat)Mind WeakenedBlood, Qi, and/or Yang Deficiency

اسلاید 51: Chinese DiagnosticsTongueColor, size, wetness/“scalloping”, coating, cracksGeographic representations of organsClinical changes occur slowly (weeks)PulsesRadial arteryOrgan assessment at certain positions/depthsClinical changes occur quickly (during treatment)Body Type/MorphologySkin/Complexion Color/LesionsPalpation – heat/cold, lumps/knots

اسلاید 52: Tongue DiagnosisNormal to Pale Tongue. Normal clear thin coat. No “scalloping”, No Cracks

اسلاید 53: Heart Yin and Blood DeficiencyTongue body pale and tip red and pointedNo coatSevere Yin DeficiencyLong-standing heat or fire (LR or ST)Red tongue body with black, dry central coatKI Yang Deficiency Swollen, pale, scalloped, thin clear coatKidney Yin DeficiencyExcess Heat in HeartInvasion of WindLong, thin, dry, red body with lateral deviationDry yellow coat

اسلاید 54: Pulse Diagnosis

اسلاید 55:

اسلاید 56: Jiao Scalp AcupunctureIndications (Neurologic)Pain, Weakness, Tremor, Stroke recovery, Vertigo, and problems of Balance, Vision, or Speech

اسلاید 57: Herbs

اسلاید 58: Modular Herbal Formulae HierarchyEmperorRelieves the principal symptom MinistersIncrease the effect of the EmperorAssistantsRelieves potential side effects of EmperorSmall dose of warm herb in an overall cool formula to prevent diarrhea Small dose of Spleen tonic in overall Kidney Yin tonicGuides/ConductorsDirects the formula to a specific part of the bodyBlood Stagnation in Pelvis (Painful Periods or Endometriosis) versus in the Chest (Angina, Pleurisy, or Rib Contusions/Fractures)

اسلاید 59: Cases

اسلاید 60: Chronic Tonsillitis10 yr old girlFrequently upper respiratory illnessesEnlarged Tonsils – Tonsillectomy AdvisedVoice husky, tonsils nearly touchingHerbal Formula: Phlogisticlean (Beinfield, Korngold)Purge Phlegm, Heat, and Toxins for Blood and lymph systemAcupunctureLU/LI Distinct MeridianSP-LU-LI-ST movement (Tai Yin – Yang Ming)

اسلاید 61: Menopausal Sweats, Insomnia, Mood Swings, Abdominal Bloating49 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 centrallyPulse – rapid, floating, choppy, KI position deepKidney Yin Deficiency with Empty Heat Liver Qi Stagnation - Food Qi Stagnation and Stomach Heat

اسلاید 62: Menopausal Sweats, Insomnia, Mood Swings, Abdominal BloatingHerbs:Ease the Journey-Yin (Maciocia) Kidney Yin Def with Empty HeatMeal Mover (Beinfield, Korngold)Food Qi Stagnation Acupuncture: Operator 5 Phase Tonify Kidney and SpleenDisperse heat Move Liver Qi

اسلاید 63: Phlegm Heat52 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 workupBrain 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).

اسلاید 64: Phlegm HeatTongueSwollen, red, sticky thick damp yellow coating extending to tipPulseWet/slippery at right middle position (SP)

اسلاید 65: Phlegm HeatHerbal Formula: Clear the Soul (Maciocia)Clear Phlegm and Heat, Open the Mind and Heart’s Orifices, relax the chestAcupunctureSpleen Qi tonification and movement, Heart pointsPhlegm clearing pointsHeat clearing pointsDietary change – cessation of refined sugar/dairySymptoms and pulses improved within 3 weeksTongue improved after 6-10 weeks

اسلاید 66: Fatigue and Diarrhea39 yo female with fatigue, chilled, low libido, irritable bowel syndrome with intermittent diarrhea worse with irritability/angerHistory of childhood emotional traumaLoose stool upon awakening“Cock-crow diarrhea”Kidney Yang Deficiency

اسلاید 67: Fatigue and Diarrhea 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 WoodLR Qi Stagnates and invades ST/SP Wood invades Earth SP Qi Deficiency LR Yin fails, LR Qi Stagnates, LR Yang rises

اسلاید 68: Peeling the OnionStart at the Outside (Manifestation) and work your way Inward (Root)

اسلاید 69: Metaphor of the TreeBranches – Manifestation Roots – Underlying Cause

اسلاید 70: What is the Root Etiology?Spleen versus Kidney (Age-old TCM Debate)Qi (from Environment plus Life Experience) VersusJing (from Constitution/Genetics plus Life Experience) - Jing as source of KI Yin/Yang and, ultimately, of QiChildhood emotional trauma likely trumps all and injures Water (Kidney)Presume that Kidney Yang Deficiency is RootBut start with Spleen/Liver treatment to improve digestion and mood Therefore improve ability to generate Qi

اسلاید 71: 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

اسلاید 72: Macroglossia – “My Tongue is Huge”

اسلاید 73: Spleen Yang Deficiency Liver 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 fibroidsHerbsArouse Vigor (Kaptchuk)Tonify Yuan Qi, Tonify Spleen/Stomach Qi, and Raise YangWomen’s Chamber (Kaptchuk)Invigorate Blood, transform Blood Stasis, reduce Abd MassesAcupuncture: SP-ST tonification, LR movement

اسلاید 74: Palpitations55 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 tipPulse: Floating, deep at KI and HT

اسلاید 75: PalpitationsHeart Yin and Blood DeficiencyYin (hot, dry, insomnia, red/dry/thin tongue)Blood (tongue with pallor, hair/nails dry/brittle, dizziness)Kidney Yin DeficiencyBack/joint painYin Deficient symptoms aboveCo-exists with HT Yin DeficiencyOverwork, stressful divorce as risk factors

اسلاید 76: PalpitationsHerb: Celestial Emperor’s Blend (Kaptchuk)Heart and Kidney Yin Deficiency, Shen ungrounded, Blood DeficiencyAcupunctureShao Yin – Tai Yang Principal MeridianKI-HT-SI-BL Focus on HT primarily at first, then shift to KI laterRelieve Fire first, then tonify WaterSettle ShenUpper Burner/Heater points (CV17, GV20)Ground Water with KI1Palpitations reduced 80% after 5 treatments, insomnia improved, no longer thirsty/dry mouth

اسلاید 77: Osteoarthritis of the KneePrincipal Meridian plus Knee SP9-ST34, SP10-ST36, Eyes of KneeBi Syndrome Formula (Depends on Pattern) Blood Stagnation Blood Deficiency Wind-Cold-Damp Phlegm Heat more typical of RAVitamin D 5000iu EPA-DHA 3000-4000mgCardinal PointsStart 20Hz - Move to 4Hz after initial improvement or if no change after 2-3 treatments

اسلاید 78: Scalp Acupuncture added for Pain Reduction in Legs

اسلاید 79: Pleurisy41 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 menorrhagiaTongue: red, dry, dusky purple color yellow coat just medial to purple edges 1-2+ scallopingPulse: choppyPhoto taken 4 days after 1st treatment

اسلاید 80: PleurisyHerbs: Red Stirring (Maciocia) Move Blood Stagnation in ChestAcupuncture: Jue Yin –Shao Yang LR-PC-TH-GB (needle balance for Yang Dispersal, 20Hz)Regional chest points, Ear and Scalp pointsNo MoxaAt time of first treatment, “agonizing” painNext day “woke up with no pain” 2 days 40% pain reduction4 days 20% pain reductionRetreated on Day 4

اسلاید 81: Fatigue71 yo male with 4-5 years of fatigue following treatment for prostate cancer, low libido, mild memory loss (names), markedly ridged nailsLow testosterone “Andropause”Testosterone controversial with history Prostate CA Prolonged personal conflict/anger increases cortisol transiently – burns out over time

اسلاید 82: FatigueHigh blood pressure – Meditation too time consumingRenal insufficiency (proteinuria, CrCl 61ml/min)Thyroid labs normal except elevated RT3Low AM Cortisol Adrenal Fatigue ~ Kidney Yin or Yang DeficiencyTongue – red, thin damp yellow coat, deep wide SP/ST crackPulse – deep diffusely

اسلاید 83: FatigueKidney Yin Deficiency, Qi Deficiency, Blood DeficiencyAcupuncture: Tonify Kidney, Back Shu points, Ming MenExtra Points: SP/ST points added (damp, ST crack)Herbs: Nourish the Root (Maciocia)Kidney Yin TonicOther: Adrenal support protocolHigh dose B5/B6, hydrolyzed collagen, adrenal adaptogenic herbs, adrenal glandular, pregnenolone, GI mucosal support, GI probioticRest

اسلاید 84: Ming Men and Back Shu Points

اسلاید 85: KI Tonification plus SP6After 6 weekly treatments, 95% improved – similar level of energy as experienced 2 years ago

اسلاید 86: FatigueAfter 4 weeks of Kidney Yin tonic for dry red tongue with yellow coatingFuture Consideration: Tonify Blood (pale tongue, ridged nails), Qi (fatigue, central crack)

اسلاید 87: What about Blood Deficiency? markedly ridged nails, tongue pallor uncovered with Yin tonification, fatigueBlood Physiology – (Dense, material form of Qi)

اسلاید 88: Degenerative Disc Disease Spinal Stenosis62 yo male – chronic back pain worse over the last yearIntermittent sciatica into legMRI: degenerative disc disease, lumbar spinal stenosisNeurosurgeon recommends PT, epidural steroid injections, conservative treatmentCome back if genitourinary problems or severe pain failing all other treatments

اسلاید 89: PENSPercutaneous Electrical Nerve StimulationA form of “Neuroanatomical Acupuncture”Dr. Bill CraigElectrically stimulate spinal segments responsible to the area of painDermatome, Myotome, Sclerotome, Sympathetics

اسلاید 90: PENS

اسلاید 91: PENS Sympathetic NS Spinal Segments

اسلاید 92: PENST10T12 L2L4L5S14Hz30HzDegenerative 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/150HzCan Use 3-4 Modules (4/15/30/80Hz)

اسلاید 93: Upper Back Pain58 yo female with 3-4 months of upper back pain at trapeziusShoots into lower shoulder blade, upper arm, and onto dorsal forearmRecent headaches Hot, dry mouth, thirst, prefers dark chocolate and salty flavors, emotional stress – irritability, neck/shoulder tightnessHistory of endometriosis leading to hysterectomy

اسلاید 94: Upper Back PainTight knots in right trapezius, levator scapulae, rhomboidsPalpation reproduces painTongue – red, dry, red tip, dry yellow coatPulse – deep, wiry, slight floating qualityLiver Qi Stagnation, LR Blood StagnationLiver Yin Deficiency

اسلاید 95: Myofascial Upper Back PainJueYin – 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

اسلاید 96: Jiao Scalp AcupunctureIndications (Neurologic)Pain, Weakness, Tremor, Stroke recovery, Vertigo, and problems of Balance, Vision, or Speech

اسلاید 97: Circle the Dragon Soft Tissue Masses, Ganglion Cysts, Shingles RashKI3, HT3, HT6 – SI3 @20Hz, SI8SP6-SP9@2Hz, ST40Herb: Cluster Dissolving (Beinfield, Korngold)Move Liver Qi/Blood, dissolve masses, dispel Phlegm/Damp, purge Heat/Toxins, tonify Liver and SpleenExpect 50% reduction by 5-8 treatments

اسلاید 98: Circle the Dragon

اسلاید 99: So What Is It Good For?

اسلاید 100: ApplicationsStudies of various standardsValue of RDBPCT design for interactive modalities dubiousInternal MedicineAsthma, 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

اسلاید 101: ApplicationsOB/GYNPremenstrual syndrome, (peri)menopausal symptoms, dysmenorrhea, menorrhagia, oligomenorrhea, infertility, labor pain, breech presentationPainEpicondylitis, plantar fasciitis, arthritis, low back pain, neck pain, pelvic pain, zoster

اسلاید 102: ApplicationsEssentially, any medical problem should be accessible with AP Issues are practicality and density of diseaseAcupuncturist training and experienceRole in CancerHelpful for decreasing side effects of chemo/radiationEspecially with herbal therapyFacilitating spiritual transition to interaction with mortality

اسلاید 103: Veterinary Acupuncture Heidi Woog, DVMEast Meets West Wellness Care At Sun Valley Animal Center

اسلاید 104: Veterinary Acupuncture

اسلاید 105: Complications and PrecautionsRetained NeedlePneumothorax (any organ puncture)Auricular infectionsOther skin infectionsTemporary (24hr) clinical worseningPregnancyNot a contraindicationTheoretical concern of causing contractionsAnticoagulation - not a contraindication

اسلاید 106: Recommended ReadingsBetween Heaven and EarthHarriet Beinfield, LAc & Efrem Korngold, LAc, OMDThe Web That Has No WeaverTed Kaptchuk, OMDGetting to Know YouJoseph Helms, MD

اسلاید 107: Other Sources (several figures in this lecture reproduced from these sources)The Foundations of Chinese MedicineGiovanni MaciociaSeveral other texts authored (Practice, Diagnosis, Tongue Diagnosis, OB/GYN)Atlas of Chinese Tongue DiagnosisBarbara KirschbaumAcupuncture Energetics: A Clinical Approach for PhysiciansJoseph Helms, MD