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Circle the Dragon Chinese Herbal Medicine and
Medical Acupuncture in Family Practice
Tom Archie, MD, DABFM, DABMASt. Luke’s Wood River Medical Center
Integrative Therapies Service
www.drtomsalchemy.com
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
Pattern Recognition - Diagnoses
Western MedicinePremenstrual Syndrome
HypertensionDepressionMigraine
Congestive Heart FailurePneumonia
DiabetesChronic Fatigue Syndrome
EczemaAsthmaAnginaPleurisy
Dysmenorrhea
Chinese MedicineLiver Qi Stagnation
Liver Blood DeficiencyLiver Blood StagnationKidney Yin Deficiency
Kidney Yang DeficiencyLung Qi Deficiency
Spleen Qi DeficiencyPhlegm Heat misting the
Heart and Mind’s OrificesWind Cold (or Heat) Invasion
Latent Wind HeatHeart Yin Deficiency
Heart Qi Deficiency
Physiology
Of
Chinese Medicine
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
Qi
Rice
Vapor
Qi
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
• 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
TCM Qi Physiology
Blood Physiology(Dense, material form of Qi)
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
• 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
• 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
Meridians
91% of Acupuncture Points share this Histology
fMRI Study• Needle placed in foot Acupuncture point
associated vision
• fMRI shows stimulation of visual cortex
fMRI Study
• Auditory Complex stimulated by needle placed in AP point on the leg associated with hearing
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
• Blockage in meridian flow produces disease
• Therapeutic action of “unblocking” meridian flow (Relieving Stagnation)– Pain– Asthma– Heavy, Painful, or Irregular Menstrual Periods
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
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 Recognition
Five Elements
Interconnections between Patterns and Systems
TCM Eight Principles
Eight Principles
Eight Principles - Polarities
YangLightSun
ActivityEnergy
ExpansionHotFireHard
ExcitementQi
YinDarkness
Moon Rest
MatterContraction
ColdWaterSoft
Inhibition Blood
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
• Wind
• Cold
• Summer Heat
• Damp
• Dryness
• Fire
External Pathogenic FactorsWind
• 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 FactorsCold
• 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 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 FactorsDamp
• 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 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 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
Five ElementsSystem of
Correspondences
Fire
Wood
Water Metal
Earth
HomeostasisSheng – Ke Cycle
Controlling or Dampening Influence
Supporting or Augmenting Influence
System Self-Correction (in the short term)
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
• Treat by “Tonifying” deficiencies and “Dispersing” excesses– Release excess Fire– Tonify deficient Water– Use Acupuncture and Chinese Herbs in
combination
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 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 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 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 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
Fire
Wood
Water Metal
EarthShen : MindClarity of Thought
Consciousness Insight Creative Thinking
Mental Get Up & Go Joy - Mania
Yi : IntellectApplied Thinking
Studying, Memorization Concentration/Focus Gathering Ideas
Nurturing – Co-dependent
Po : Corporeal SoulActivity of Thinking Monkey Mind
Sensations (Touch, Smell, etc.) Quiets with Meditation (as Hun opens)
Sadness, Grief, Loss, Melancholy
Zhi : WillpowerOld Memory
Drive/Determination Pilot Light Self-Esteem, Guilt
Fear, Phobias
Hun : 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
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 -
• 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
– 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
• 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• 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• 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
Normal to Pale Tongue. Normal clear thin coat. No “scalloping”, No Cracks
Heart Yin and Blood Deficiency
Tongue body pale and tip red and pointed
No coat
Severe Yin DeficiencyLong-standing heat or fire (LR or ST)
Red tongue body with black, dry central coat
KI Yang Deficiency
Swollen, pale, scalloped, thin clear coat
Kidney Yin DeficiencyExcess Heat in Heart
Invasion of Wind
Long, thin, dry, red body with lateral deviationDry yellow coat
Pulse Diagnosis
Jiao Scalp AcupunctureIndications (Neurologic)
Pain, Weakness, Tremor, Stroke recovery, Vertigo, and problems of Balance, Vision, or Speech
Herbs
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)
Cases
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)
Lung/Large Intestine Distinct Meridian
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 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
• 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 Heat
• Tongue– Swollen, red, sticky
thick damp yellow coating extending to tip
• Pulse– Wet/slippery at right
middle position (SP)
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
• 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 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 Wood
• LR Qi Stagnates and invades ST/SP – Wood invades Earth
• SP Qi Deficiency – LR Yin fails, LR Qi Stagnates, LR Yang
rises
Peeling the Onion
Start at the Outside (Manifestation) and work your way Inward (Root)
Metaphor of the Tree
Branches – Manifestation
Roots – Underlying Cause
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
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
Abdominal CV points, ST25, Mu Points for Liver/Gallbladder
Macroglossia – “My Tongue is Huge”
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
• 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
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
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
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
Scalp Acupuncture added for Pain Reduction in Legs
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
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
• 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
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
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
Ming Men and Back Shu Points
KI Tonification plus SP6
After 6 weekly treatments, 95% improved – similar level of energy as experienced 2 years ago
Fatigue
After 4 weeks of Kidney Yin tonic for dry red tongue
with yellow coating
Future Consideration: Tonify Blood (pale tongue, ridged nails), Qi (fatigue, central crack)
What about Blood Deficiency?markedly ridged nails, tongue pallor
uncovered with Yin tonification, fatigue
Blood Physiology – (Dense, material form of Qi)
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
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
PENS
PENSSympathetic NS Spinal Segments
PENS
T10
T12
L2
L4
L5
S1
4Hz
30Hz
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)
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 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
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 AcupunctureIndications (Neurologic)
Pain, Weakness, Tremor, Stroke recovery, Vertigo, and problems of Balance, Vision, or Speech
Circle the DragonSoft Tissue Masses, Ganglion Cysts, Shingles Rash
KI3, HT3, HT6 – SI3 @20Hz, SI8SP6-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
Circle the Dragon
So What Is It Good For?
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
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
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
Veterinary AcupunctureHeidi Woog, DVM
East Meets West Wellness CareAt
Sun Valley Animal Center
Veterinary Acupuncture
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
• 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)
• 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 Practice
Tom Archie, MD, DABFM, DABMASt. Luke’s Wood River Medical Center
Integrative Therapies Service
www.drtomsalchemy.com
www.drtomsalchemy.com
