Clinical Studies Study Guide 1

Acupuncture Treatment Strategy
and Herbal Internal Medicine

. Study Guide
Volum'e I
Jinhua Xie BMed., PhD [I .
-
Midwest College of Oriental Medicine
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Copyright ©2009 Midwest College of Oriental Medicine

All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means electronic, mechanical,
photocopying, recording, or otherwise, without the prior permission of the publisher.
11
Table of Contents
Volume One
Preface 1
Introduction to Acupuncture Treatment Strategy 3
Part J Internal Medicine 8
Introduction to Herbal I nternal Medicine 8
1 Common Cold ·13
2 Cough 17
3 Asthma 24
4 Stomach Pain 30
5 Pl1tcoagl i ii
6 Vomiting 39
7 Esophageal Constriction 44
8 Abdominal Pain 47
. 54
9 Diarrhea
10 Dysentery 59
11 Constipation 63
12 lateral Costal Pain 68
13 Jaundice 72
14 Drum Distension 77
15 Edema 81
16 Thoracic Bi 85
17 Palpitation 91
18 Insomnia 95
19 Headache 99
20 Dizziness and Vertigo 107
21 Low Back Pain 112
22 Seminal Emission 117
23 Impotence 120
24 Wasting-Thirst 124
25 Urinary Strangury 131
26 Dribbling Urinary Block 136
27 Depression Patterns 140
28 Mania and Withdrawal 145
29 EpilepsyP atterns 149
30 Bi Patterns 154
31 Atony Patterns 162
32 Internal Damage Fever 167
33 Parasitic Worm Patterns 173
34 Pulmonary consumption 177
iii
35 Facial Pain 180
36 Malaria Patterns 184
Part II Surgery 186
37 Scrofula 186
38 Goiter 188
39 Intestinal Abscess 195
40 Hemorrhoid 197
41 Gangrene 199
42 Sprain 202
43 Crick in the Neck 204
IV
According to the curriculum there are three courses of acupuncture treatm.ent strategy (1
to 3). The contents for each course are provided. Students are advised to check with
their instructors for the detailed teaching arrangement of each quarter. .
In herbal internal medicine there are two courses e.g., internal medicine 1 and 2. The
internal medicine 1 covers the contents in the volume one of this study guide, while
internal medicine 2 covers the contents in the volume two ofthe study guide.
Table of Contents of Acupuncture Treatment Strategy
Treatment Strategy 1
COWmOD Cold; flu 2nd COBSQ
Asthma and Consumptive Diseases
Headache and Dizziness
Sore throat and Loss of Voice
Nosebleed and Bi Yuan
Wei Patterns
BiPattems
Low back pain, Facial pain and Crick in the Neck
Tinnitus, Deafness and Purulent ear
Ophthalmology
Abdominal Pain
Abnormalities of ingestion and defecation
Urology Part
Gynecology
Obstetrics
Chest and Neck Symptoms
Water Accumulation Patterns'
Diabetes and Internal Damage Fever
Psychiatric Disorders
Tremor and Seizure Disorders
Dermatology and Hemorrhoids
Cancer
Aids and HIV illness
Chronic Fatigue Syndrome
Emergency Medicine
v
Preface
Acupuncture treatment strategy and herbal internal medicines, are two of the most
important clinical subjects in the training of oriental medicine students. Based on the
current textbook used in Midwest College, this guide is compiled to facilitate the study
of students and make the classroom teaching more relevant to clinical situation.
In the textbook Practical Therapeutics of Traditional Chinese Medicine (Yan Wu, 1997)
99 disorders in 10 categories are discussed. For the convenience of readers this study
guide follows the same sequence. The guide is in two volumes, with volume 1 covering
4.3 disorders in internal medicine and surgery, and volume 2 covering 56 disorders in
dermatolo necolo, obstetrics, pediatrics, ophthalmology, stomatology and
emergentology. In the monograph of a condition, the following 6 sections are inc u e .
• Biomedical Reviews: Itis not the intention of author to give a through review of
medical knowledge related to the condition studied. The review of the
biomedical theory for the symptoms and conditions studied will help
acupuncturists understand major biomedical pathology, medical diagnoses, and
a brief introduction of current medical treatments related to the condition are
included, especially when the condition or disorder is a symptom or a syndrome
according to biomedical theory. Often a TCM disorder or condition may be
related to many possible medical diagnoses. Symptoms and signs indicative of
emergency will be reviewed thus aiding the practitioner the ability to discern
when western medical evaluations, interventions or referrals are required of
deemed mandatory.
• Summary ofTCM Etiolgy and Pathogenesis of Common Cold: This summary in
chart form is made by following the information in the textbook; however some
changes for certain conditions are made based on the current TCM
understanding for that condition. ~~.
• Clinical Reasoning: This practical section is based on the experience on author's
teaching and clinlcal practice in Chinese universities and hospitals. This assists
students during their internship to make a better assessment of their patients'
condition and a suitable acupuncture treatment, and appropriate TCM
treatment plan for the particular condition. Teachers should adjust in their
teachings according to their own experience.
• Acupuncture Treatment: When available, acupuncture prescriptions from three
different textbooks are presented. These include Practical Therapeutics of
Traditional Chinese Medicine (WU, 1997), Chinese Acupuncture and
Moxibustion (CAM, Chen, 1997) and a standard Chinese textbook (CT) used in
TCM universities in China (ZhenJiu Xue Acupuncture and Moxibustion, Maoliang
Qiu, eds, Shanghai Science and Technology Press, 1985). This part is used only
for students in the study of acupuncture treatment strategy 1, 2 and 3.
• Herbal Treatment: This is a summary of patterns and formulas in the textbook
(WU 1997) and practical options. Sometimes practical options are provided
when a formula recommended in the textbook is not covered in the herbal
formula syllabus of Midwest College or is not commonly available in Midwest
College teaching clinics. Based on TeM theory and author's experience most
options provides are acceptable substitute for the formula recommended in the
1
textbook; although sometimes these options may include slightly different
ingredients compared with textbook-recommended formulas. It is advised for
the teachers to give recommendations according to their teaching and practical
experience. In order to make the guide more concise} the author does not
include single herbal modifications in this guide. They will be reviewed in the
classroom based on textbook information. This part is used only for students in
the study of herbal internal medicine 1 and 2.
• Prognosis and Development of Patterns: This section reviews general
prognosis related to the condition studied. TCM pattern development will be
reviewed to help the students understand the clinical development of a
condition. As one TCM condition is often associated with several medical
conditions" it is very hard to include prognosis related to all possible medical
conditions. Students are encouraged to relate the study of this course to
western pathology and to use other medical reference.
Jinhua Xie, BMed., BS. MM} MSOM" PhD

Racine, Wisconsin} March 2009
2
Introduction of Acupuncture Treatment Strategy
Treatment Strategy 1} 2 and 3 are three consecutive courses presenting the Chinese
differential diagnosis and treatment of important symptoms and biomedical conditions
with acupuncture therapy. Treatment Strategy is a comprehensive subject related to the
knowledge of almost every course taught previously in the program.
The acupuncture treatment strategy provides the students the knowledge of treating
common diseases with acupuncture therapies by integrating modern technologies and
traditional Chinese medical theories on a scientific basis.The theory of acupuncture
treatment strategy has been deeply influenced by herbal medicine theory especially
after acupuncture became a subject ofTCM university curriculum 1950s in China which
now is predominantly a program for integrating biomedicine and herbal medicine. A
condition is normally classified into different patterns; and acupuncture and
moxibustion treatments are given based upon differentiation of patterns (Bian Zhen Shi
Zhi). The general principles of acupuncture treatment strategy are very similar to those
in internal herbal medicine.
1. The general principles of acupuncture treatment

The three features of traditional Chinese medicine (TeM) include holistic view (Zheng Ti
Guan Lian), treating diseases according to the pattern (Bian Zhen Lun Zhi), and
synchronization between human and universe (Tian Ren Xiang Ying). The fundamental
ofTCM pathology is the imbalance of yin and yang. When these theories are applied in
acupuncture treatment strategy it is translated into the following general principles.
1.1 -Regulatlng yin and yang

Under this principle all acupuncture treatments aim to restore the balance of yin and
yang in a body. By reducing the excess and replenishing the deficiency of yin or yang}
the new balance is achieved after treatment.
1.2 Strengthening the vital qi and eliminating pathogenic factors

Strengthening vital qi is a therapeutic principle using replenishing methods for
deficiency syndromes; eliminating pathogenic factors is a therapeutic principle using
reducing or removing methods for excess syndromes. The development of a disease is
the conflict between the vital qi and pathogenic factors. The disease progresses when
pathogenic factors overcome the vital qi, and it subsides when vital qi defeats the
pathogenic factors. The treatment of strengthening vital qi and eliminating pathogenic
factors will restore the vital qi and remove pathogenic factors to facilitate the recovery
. of diseases.
The methods of strengthening vital qi include replenishing qi, nourishing blood,

nourishing yin and invigorating yang. The methods of eliminating pathogenic factors
include dispelling superficial pathogens, purgation, eliminating dampness, promoting
diuresis, promoting digestion, and resolving blood stasis. Mutually supportive,
strengthening vital qi will facilitate resisting pathogenic factors, while eliminating
pathogenic factors from the body will help protect and restore vital qi.
In acupuncture treatment the effect of strengthening the vital qi is achieved by

activating the body's vital qi through selecting the "replenishing" points, performing
replenishing needling-manipulations, applying tuina or moxibustion and etc. This differs
from herbal treatment in which effective components of tonic herbs are absorbed into
the human body to replenish the yin, yang, qi, blood and essence. Likewise the
acupuncture treatments for eliminating pathogenic factors are achieved by regulating
the function of internal organs, meridian and channel through selecting the "draining"
points, performing reducing needling-manipulations, applying tuina and etc. In addition
to the point-selectiOnS and mOda!jtY-SelectjOQ the wsw that acypgiots are stimulated is
very critical. Therefore acupuncture treatment emphasizes more interaction between
practitioners and patients.
The common ways of replenishing and eliminating include:
• Replenishing the mother-organ for deficiency syndrome and reducing the child-
organ for excess syndrome
• Replenishing water to inhibit pathogenic yang and invigorating fire to eliminate

pathogenic yin
• Treating the exterior fu organ to relieve the problem in corresponding interior

zang organ or treating the interior zang organ to relieve the problem in
corresponding exterior fu organ
1.3 Distinguishing the root and branch
The root and branch of a disease changes constantly during the process of illness.
However the root of a disease usually refers to the status of vita I qi, causative factors,
internal condition, and the original illness. The branch usually refers to the pathogenic
factors, external condition, and complications of an illness. When formulating an
acupuncture treatment practitioner should take account the root and the branch of a
disease.
1.4 Treating diseases according to climatic, seasonal condition, geographical location

and individual condition
This principle applies in both acupuncture and herbal medicine, but more in herbal
medicine.
1.4.1 Individuality-concerned treatment
This means that the principles of treatment should be decided according to the
individual factors, such as sex, age, constitution, etc.
1.4.2 Climate-concerned treatment"
Seasonal and climatic conditions exert certain influence on physiological function and
pathological response of the human body. The principles of treatment should be
decided in accordance with the climate in the season involved.
1.4.3 Environment-concerned treatment
This means that the principles of treatment should be decided in accordance with the
environmental factors involved.
4
2. Acupuncture therapeutic methods
These therapeutic methods are very similar to those 8 traditional therapeutic methods
discussed in herbal medicine, e.g., diaphoretic therapy (Han), emetic therapy (Tu),
purgative therapy (Xia), regulating (harmonizing) therapy (He), warming therapy (Wen),
heat-clearing therapy (Qing), resolving therapy (Xiao), and replenishing therapy (Bu).
The diaphoretic therapy, emetic therapy, purgative therapy, and resolving therapy (Xiao)
belong to the scope of reducing / eliminating therapy. Harmonizing therapy is actually a
com prehensive use of all other therapies.
2.1 Reinforcing I Replenishing

2.2 Reducing I Eliminating
2.3 Warming
2.4 Clearing (heat)
2.5 Ascending
2.6 Descending
3. The principle of acupuncture point selection
In a typical acupuncture prescription three categories of points are included:
Nearby points: local points, adjacent points, or A-Shi points
Empirical points for symptoms:
Distant points: This is the most important way of point selection. The applications of
specific points are basically the applications of distant points, e.g., five-Shu points,
lower He-sea points of six fu organs, 12 Yuan-source points, 15 Luo-connecting points,
16 Xi-cleft points, B confluent points ofB extra meridians, B influential points of eight
tissues, 12 front-Mu points and 12 back-Shu points, and crossing points among all the
meridians. Of course those specific points, especially back-shu and front-mu points may
sometimes be used as local points or empirical points. Commanded points such as ST36,
L14, LU7, UB40, and PC6 may be considered as specific type of distant empirical points.
The theory of specific acupuncture points has been discussed in the courses point
location 1 and 2, courses needling techniques 1,2, and 3, and course of B Principle /5
PhaseTreatment Strategy. During the teaching of the acupuncture treatment strategy
teachers may review these theories again. For a student it will be a more rewarding
experience if he or she can try going behind all points in an acupuncture prescription of
a particular pattern for the rationale of point selection, rather than just simply
memorizing the points, going to the midterm and final exams, and copying the points to
the medical files of patients when working in the clinic as an intern. The acupuncture
prescriptions in this guide include those in the textbook (WU), those in Chinese
Acupuncture and Moxbustion (CAM) and those in a standard Chinese textbook (CT). In
most cases, prescriptions from different books are very similar and comparable.
However discrepancy does exist. If students can analyze the prescriptions by using the
theory mentioned above, they may find the difference among those prescriptions is
merely a different option based on a similar or the same principle.
5
For the details please refer to Chapter of Point Categories in A Manual of Acupuncture
(Peter Deadman).
4 The Procedure of Diagnosing and Treating Patients with Acupuncture
The procedure includes the following four steps.
• Recognize the disease based on the information obtained from TCM four
diagnostic methods, medical exams, identification of the location and nature of
a disease, infer the cause of a disease from its manifestations,
• Design the therapeutic principle and method,
• Choose the acupuncture points and formulate a prescription, and
• Perform the acupuncture treatment
4.1 Diagnosis based on the information obtained 'from TCM four diagnostic methods
The complete information about a disease is traditionally collected with four diagnostic
methods. In modern TCM practice, practitioners also review results of medical exams to
he Ip pattern differentiation.
Whether the information collected by applying the four diagnostic methods is accurate
or not greatly influences the accuracy of pattern differentiation. So the four diagnostic
" methods should be performed from all angles to avoid one-sided views. Sometimes on
pa rticular diagnostic method may be performed predominantly to the understand the
major aspects of a disease.
Medical information provided by the patients and medical diagnosis provided by the
physician are very important too. That information may help make a TCM diagnosis and
evaluate the suitability of oriental medical treatment for the patient.
The systems used to analyze the information are called methods of pattern
differentiation, including B-prtnclpal-pattems differentiation, pattern differentiation
based on etiology, pattern differentiation based on qi and blood theory, pattern
differentiation of six channels (Shan Han Lun), wei, qi , ying (nutritive) and blood level
pattern differentiation, San.liao pattern differentiation, and Zang-fu organ patterns
differentiations. For acupuncture treatment, the commonly used systems include 8-
principal-patterns differentiation, pattern differentiation based on etiology, pattern
differentiation based on qi and blood theory, and Zang-fu organ patterns
differentiations. The selection of appropriate method for pattern differentiation
depends on the nature of illness. Usually a pattern for a patient's condition-is the result
of comprehensive use of more than one methods of pattern differentiation.
4.2 The therapeutic principle and method
The therapeutic principle and method are designed according to the result ofsyndrome
differentiation. For example, the therapeutic principle of clearing away liver fire and
lowering the adverse rising lung qi is designed for a cough categorized as syndrome of
liver fire invading the lung.
4.3 Acupuncture points selection and acupuncture prescriptions
Acupuncture points are selected according to the principles discussed above, including
nearby points, empirical points for symptoms, and distant points with more complicated
theory. The application of specific techniques are indicated in an acupuncture
prescription, e.g., reducing, reinforcing, or even manipulation, electric stimulation,
6
tuina, moxibustion, heating lamp, etc. Sometimes the point sequence of needle
inserting or withdrawing is specified.
4.4 Perform the acupuncture treatment
Treatment is performed in the points selected. In addition to the proper needling
techniques} the points should be located precisely.
7
Part I Internal Medicine
Introduction
1 Classification and Characteristics of Herbal Internal Medicine
1.1 Classification of Internal Disease in Traditional Chinese Medicine
The Internal diseases of TeM include two categories: externally contacted diseases and
diseases due to internal injury.
The externally contacted diseases refer to febrile diseases that are mainly caused by
the invasion of exogenous cold, wind heat, summer heat, damp heat, etc., and can be
differentiated and treated according to the theory of six meridians, theory of wei, qi,
ving aDd blgOd and thegry gfSag Jjag. These are discussed in Midwest College course
Herbal Classics (Shan Han Lun and Warm Disease Theory)
The diseases due to internal injury include diseases of internal organs and the meridian
system that are mainly caused by endogenous pathogenic factors. They can be
differentiated and treated according to the theory of zang-fu organs, theory of qi, blood
and body fluid, and meridian theory. Some diseases such as cough, diarrhea, and urinary
disturbance may be caused by exogenous pathogenic factors, but are conventionally
discussed under the category of diseases due to internal injury since their
manifestations are similar to those of diseases caused by endogenous pathogenic
factors.
1.2 Characteristics of Internal Diseases in TeM
1.2.1 Endogenous pathogenic factors are the major causes of internal diseases
Most internal diseases are caused by endogenous pathogenic factors.
Among the causes of internal diseases, there are some endogenous pathogenic factors
secondary to the dysfunction of internal organs, l.e., endogenous wind, endogenous
cold,
Also phlegm and blood stasis are two common endogenous pathogenic factors of
internal diseases. They are pathological products due to the dysfunction of zang-fu
organs and become secondary pathogenic factors to human body. Many disorders are
associated with these two secondary pathogenic factors. For example, the accumulation
of phlegm in the lungs may lead to cough and asthma, and blood stasis may give rise to
chest Bi syndrome, abdominal mass, palpitation, stomachache and abdominal pain, etc.
1.2 .2 Concurrence of cold} heat} deficiency and excess in internal diseases
In most cases, the course of an internal disease is relatively long and its pathogenesis is
complicated with concurrence of excessive cold and heat and deficiency of qi, blood, yin
and yang in zang-fu organs. Generally the pathogenesis of internal diseases can be
classified into two categories: excess and deficiency, Deficiency of qi, of blood, of yin
and of yang, or deficiency of both qi and blood, deficiency of both yin and yang are in
the category of deficiency, while qi stagnation, blood stasis, fluid retention, damp heat
and phlegm accumulation are ascribed to the category of excess.
8·
MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by.lH Xie
2 The Clinical Procedure in TCM Internal Medicine

2.1 The Procedure of Diagnosis and Treatment
The procedure of the diagnosis and treatment for internal diseases includes the
following 3 steps:
2.1.1 Making a TCM diagnosis and differentiating the pattern
The diagnosis in TCM is not limited to a disease. They could be symptoms or syndromes.
Traditionally TCM diagnosis is made based on clinical manifestations. As practitioners in
TCM hospitals in China both biomedicineand TCM, information from biomedical exams
are often taken into account even when making a TCM diagnosis, e.g., wasting-thirst
pa tEd liS (did"@Ees) and palniOiidi y Lonsali i plio" paltd II (tabu calusb). reM t: LatH :Cllt
is given usually based on a pattern. Patterns are usually classified by using one or two of
these methods of pattern differentiation, including 8-principal-patterns differentiation,
pattern differentiation based on etiology, pattern differentiation based on qi and blood
theory! pattern differentiation based on six channels (Shang Han Lun), 4-level patterns
differentiation and San Jiao patterns differentiation (warm diseases)! pattern
differentiation based on channels theory, and Zang Fu organs pattern differentiation. In
herbal internal medicine the most commonly used methods are differentiation of 8-
principal patterns! qi and blood patterns and Zang Fu organ patterns.
2.1.2 Designing therapeutic principle and method
The therapeutic principle and method are designed according to the result of syndrome
differentiation. For example, the therapeutic principle of clearing away liver fire and
lowering the adverse rising lung qi is designed for a cough categorized as syndrome of
liver fire invading the lung.
2.1.3 Prescription: a traditional formula vs custom formula
Traditional formula: Traditional formulas are the summary of clinical experience over
thousands of years. They reflected the treatment strategy and philosophy created by
practitioners from generation to generation for certain diseases under the guidance of
TCM theory. It is encouraged to study, apply and develop these formulas in clinical
practice. Young practitioners usually start with a traditional formula for a specific
syndrome or disease. It is better for them to follow a traditional prescription and modify
it as required in an actual situation. Simply piecing together the herbs according to
symptoms of a pattern should be avoided. Meanwhile when clinical manifestations are
complicated and variable, it is hard to get a traditional formula that completely fits the
clinical situation. Modification to a traditional prescription is often required. Usually
herbs are added to or deleted from a traditional prescription to make the modified one
suitable for both the major problem and complications of a disease, so as to meet the
diverse needs of their patients.
Custom formula: Sometimes a custom formula may be formulated by selecting herbs
simply based on individual conditions, rather than by following any traditional formula.
If this is necessary the therapeutic strategy and philosophy must be well demonstrated
in the prescription. Through clinical practice this skill can be gradually gained.
The above five-step procedure is followed in the process of syndrome differentiation
and treatment for a disease. Actually it includes the four aspects: Li (theory)! Fa
[principle], Fang (prescription) and Yao (herb).
9
MCOMAcupuncture TreatmentStrategyand Herbal Internal MedicineStudyGuide2009 by JHXie
• Li refers to the etiology and pathogenesis of the disease;

• Fa, the therapeutic principle and method;
• Fanq, the traditional prescription; and
• .Yao, the herbs in a prescription.
Consistency in these four aspects for a specific disease is the premise for good
therapeutic effect. Meanwhile, this 3-step procedure can be divided into two stages, i.e.
stage of syndrome differentiation and stage of treatment. Of the 3 steps, the first one is
for syndrome differentlatlon, while the rest two at the stage of treatment. It is for the
convenience of Iearning that the procedure in making syndrome differentiation and
treatment is divided 3 steps or two stages, but clinically it is not necessary to follow it
rigidly step by step. When working on a specific disease, a practitioner may follow the
Pi oeedm e Iii a ffexible YOU ,.
3 Therapeutic Principles and Methods of Internal Diseases in TCM
3.1 Therapeutic Principles
The therapeutic principles are formulated according to the basic theory ofTCM and
syndrome differentiation. These principles should be followed throughout the process
of designing therapeutic methods, selecting prescrlptlons, and administering herbs.
3.1.1 Routine treatment and treatment contrary to the routine
Routine treatment refers to a therapeutic principle of treating a disease with the
method and herbs contrary to its nature, i.e., treating heat syndrome with herbs of cold
nature, treating cold syndrome with herbs of warm or hot nature, treating deficiency
syndrome with replenishing method, and treating excess syndrome with reducing
method. This is the most commonly used method.
Treatment contrary to the routine refers to a therapeutic principle applied for a specific
condltion, in which there exist false phenomena against the essential nature of disease.
In this case a treatment aiming at the false phenomena is given, Le'l treating the false
cold phenomena (in a real heat syndrome) with herbs of cold nature, treating the false
heat phenomena (in a real cold syndrome) with herbs of warm or hot nature, treating
the false phenomena of stagnation (in a real deficiency syndrome) with replenishing
method, and treating diarrhea (in a real excessive heat syndrome) with purging method.
These treatments seemingly aim at the false phenomenal e.g., cold method for cold
manifestatlons, and warming method for heat manifestations, but are directly against
the essential pathogenesis of a disease. Some scholars termed it a special type of
routine treatment. For example, Dacengqi Tang (Potent Purgative Decoction) is used to
treat the patient with false phenomena such as diarrhea and delirium with accumulated
excessive heat in large intestines.
3.1.2 Strengthening vital qi and eliminating pathogenic factors
Strengthening vital qi is a therapeutic principle using replenishing methods for
deficiency syndromes; eliminating pathogenic factors is a therapeutic principle using
reducing or removing methods for excess syndromes. The development of a disease is
the conflict between the vital qi and pathogenic factors. The disease progresses when
pathogenic factors overcome the vital ql, and it subsides when vital qi defeats the
pathogenic factors. The treatment of strengthening vital qi and eliminating pathogenic
factors will restore the vital qi and remove pathogenic factors to facilitate the recovery
of diseases.
The methods of s.trengthening vital qi include replenishing ql, nourishing blood,
10
MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by JH Xie
nourishing yin and tonifying yang. The methods of eliminating pathogenic factors
include dispelling superficial pathogens} purgation, eliminating dampness, promoting
diuresis, promoting digestion, and resolving blood stasis. Strengthening vital qi will
facilitate the elimination of pathogenic factors, while eliminating pathogenic factors
from the body will help protect and restore vital qi.
Generally, methods of strengthening vital gi are used for deficiency syndromes with
indistinct pathogenic factors, while methods of eliminating pathogenic factors are used
for excess syndromes with indistinct deficiency of vital qi.
A complicated syndrome with vital qi deficiency and pathogenic factors accumulation
will require a method of both strengthening vital qi and eliminating pathogenic factors.
In clinical ractice the need to differentiate which is dominant, excess or deficient, in a
cornp reate syn rome, IS necessary.
3.1.3 Replenishing and eliminating method for zang-fu organs
As previously discussed, TCM holistic view postulates that the human body is an organic
whole, and that zang-fu organs are interrelated physiologically and are affected one
another pathologically. Disease of a given organ will affect other organs; and, in turn}
disorder of an affected organ may affect the original organ. The replenishing and
eliminating methods are given according to interrelation defined by five-element theory
among zang-fu organs, e.g., inter-generation, inter-restriction, and exterior-interior
relation. The principles include replenishing the mother-organ for deficiency syndrome
and reducing the child-organ for excess syndrome; replenishing water to inhibit
pathogenic yang and invigorating fire to eliminate pathogenic yin; and treating the
exterior fu organ to relieve the problem in corresponding interior zang organ or treating
the interior zang organ to relieve the problem in corresponding exterior fu organ.
• Replenishing the mother-organ for deficiency syndrome and reducing the child-
organ for excess syndrome
• Replenishing water to inhibit pathogenic yang and invigorating fire to eliminate
pathogenic yin
• Treating the exterior fu organ to relieve the problem in corresponding interior
zang organ or treating the interior zang organ to relieve the problem in
corresponding exterior fu organ
3.1.4 Different principles for different cases
This means that the principles of treatment should vary with individual cases} climatic
conditions, environmental factors, etc. It is especially important when practicing TCM in
this country. To consider that the traditional concepts about season and climate,
environment and individual difference are very much based on situations in China and
Chinese people and culture, the adjustments should be made to ensure the treatment is
suitable to the situations in this country.
3.1.4.1 Individuality-concerned treatment
This means that the principles of treatment should be decided according to the
individual factors, such as sex, age, constitution, etc. When a female patient is treated,
her conditions of menstruation, pregnancy and postpartum period must be taken into
account. In general, dosage for young children should be less than that for adults;
replenishing methods should be recommended for the elderly; invigorating method with
warm herbs should be avoided for the patient with a heat constitution; and cold herbs
should be used with caution for the patient with a yin cold constitution.
3.1.4.2 Climate-concerned treatment
Seasonal and climatic conditions exert certain influence on physiological function and
11
MCOM AcupunctureTreatment Strategy and Herbal Internal MedicineStudy Guide2009 by JH Xie
pathological response of the human body. So the principles of treatment should be

decided in accordance with the climate in the season involved. In summer and spring
seasons} yang qi dominates in nature; the surface pores on the body are open or loose.
Warm and pungent herbs in large dosage should be used cautiously to avoid the
damage of qi and yin. While in winter} yin qi dominatesin nature} cold and bitter herbs
in large dosage should be used cautiously to avoid the consumption of yang qi.
3.1.4.3 Environment-concerned treatment
This means that the principles of treatment should be decided in accordance with the
environmental factors involved. In northwestern China} a higher altitude region with a
cold and dry climate} people are easily affected by pathogenic cold-dryness} and their
conditions should be treated with warming method to moisturize the dryness. In
SaUd/EaSle", eliliio} 01000 lyiJ.g ;egioH "ill, a :Uiil p h~Ii:iM BAi 'iFIiM iliJii3tQ; peQple
tend to have disorders with damp-heat and their conditions should be treated with
methods of dearing away heat and resolving dampness. The examples iHustrate that
spectrums of disease are different in different regions} and different therapeutic
principles should be adopted accordingly. Furthermore even if the people suffer from.
the same disease} the treatments and herb administration should differ for different
people in different region. For example} in cold northwestern China} a larger dose of
warm pungent herbs should be used to treat exterior wind cold syndrome while a
smaller dose will do in warm southeastern China.
3.2 Commonly Used Treatments in Internal Medicine
• Diaphoretic therapy
• Emetic therapy
• Purgative therapy
• Regulating therapy
• Warming therapy
• Heat-clearing therapy
• Resolving therapy
• Invigorating therapy
12
1. Common Cold
Practical Therapeutics ofTCM Page 9
1.1 Biomedical Review

Common cold is upper respiratory infection of virus. The flu is a contagious infection
of the nose, throat, and lungs caused by the influenza virus. In most individuals who
are otherwise healthy, a common cold or the flu goes away within 7 to 10 days. The
possible complications of common cold or flu include:
• Bronchitis
•. Pneumonra
• Ear infection
• Sinusitis
• Worsening of asthma
Medical Evaluations and Emergency Symptoms
Medical evaluations may be required if:
• The symptoms worsen or do not improve after 7 to' 10 days
• When breathing difficulty develops, the complications such as bronchitis,
pneumonia and worsening of asthma are suspected.
1.2 rCM Etiology and Pathogenesis
Table 1.1 Summary of rCM Etiology and Pathogenesis of Common Cold

Sudden change Wind cord Chills
of climate Wind heat Fever
Wind invades into body Wind cold with Headache
and causes disharmony
Poor internal heat Obstruction of
of ying (nutritive) and
adjustment to Summer heat nose
wei (defensive) and
the weather dampness Sneezing
dysfunction of lung qi in
change Wind dryness with Runny nose
dispersing and
underlying deficiency
descending
Individuals with of yin, yang, ql, and
underlying blood
deficiency
1.3 Clinical Reasoning

1.3.1 Verify medical diagnosis
1.3.2 The differentiation between a regular common cold and a seasonal epidemical
cold (the flu) should be made when making TCM diagnosis.
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MCOMAcupuncture Treatment Strategyand HerbalInternal MedicineStudy Guide2009 by JHXie
Table 1.2 Differentiation between Common Cold and the Flu

Common Cold The Flu
Contagiosity low high
Severity of
Mild and self-limited Serious
symptoms
especially in patients with other
Complications Rare
underlying conditions
1.32 The patients may have underlying deficiency of qi and blood, or yin and yang.
1.3.3 Wind cold and wind heat are two most important patterns of common cold.
Te!lhB 1 iI 9iifs,sAtiiiiisi'R bct"mcn Hlind Ge'd 2nd 'Mind Heat Patterps

Wind Cold Wind Heat
Symptoms Chills and fever, more serious Fever, slight aversion to cold or wind,
chills, obstruction of nose, runny nose with yellow and thick
runny nose with, cough with discharge, thirsty, sore throat
white and clear phlegm
Tongue Thin white coating, pink body Thin white dry or slightly yellow coating,
with pink or slightly red body
Pulse Floating and tight Floating and rapid
1.4 Acupuncture Treatment for Common Cold

1.4.1 Invasion of Wind Cold .;)
WU CAM CT
LU7 LU7 LU7
L120 DU16 L120
UB12 UB12 UB12
GB20 GB20 GB20
L14 L14 L14
51 7 517
Auxiliary Points:
For Headache:
Yin Tang Yin Tang
TaiYang TaiYang
Along with upper backache:

Cupping UB 13
1.4.3 Invasion of Wind Heat

WU CAM CT
LI 5 LU10 LUS
L1l1 L111 L111
SJ 5 SJ 5 SJ 5
DU14 DU14 DU14
LI4 LI4 LU10
G820 LUll
Auxiliary Points:
. 14
MCOMAcupuncture Treatment Strategyand HerbalInternal MedicineStudyGuide2009 by JH Xie
For swollen throat, add:

Bleed LU 11 LUll
For severe cough add: eV22
1.4.4 Invasion of Summer heat-Dampness

WU CAM CT
LU6 LU6
Ll4 L14
eV12 eV12
Si35 513b
SJ 6 SJ 6
Auxiliary Points:
With Nausea and vomiting:
PC6
If heat is prominent:
DU 14
If dampness is prominent:
5P 9
Abdominal distention and loose stool:
ST?5
1.4.5 In cases of Qi Vacuity

WU ~M cr
. LU 7
L120
517
UB 12
GB 20
L14
ST 36
UB 13
1.4.6 Cords in Casesof Yin Vacuity

WU CAM CT
LU 5
GB 20
L111
L14
DU14
SJ 5
UB43
KD7
Auxiliary Points:
For Swollen throat:
Bleed LU 11
15
1.5 Herbal Treatments for Common Cold
Patterns Classic Formula Practical Options

Invasion of Wind Cong Chi Tang Jian Fan Sai Du San in different
Cold Jing Fan Bai Du San dosage
Ma Huang Tang
Invasion of Wind Yin Qiao San Yin Qiao San
Heat Gan Mao Ling
Zhong Gan Ling
Invasion of Xin Jia Xiang Ru Yin Yin Qiao San + Huo Xiang Zheng
-'UIIIIII\:;1 II\:;C~
-
\ " ... 'w"- .... rr -
-.I ........ ('"
Dampness Elsholtzia Beverage)

Cold In casesof Shen Su Yin Jing Fan Bal Du San +SiJun Zi
qi vacuity Tang
Cold in cases of Jia Jian Wei Rui Tang Yin Qiao San or Sang Ju Yin +
yin deficiency mild yin nourishing herbs such
as YU Zhu, Bai We;, Sha Shen
1.6 Prognosis and Development of Patterns

1.6.1 A wind cold pattern often transforms into a pattern of wind cold exterior with
internal heat pattern, or a pattern of wind heat
1.6.2 A patient with common cold repeatedly may develop a deficient pattern.
1.6.3 Prognosis of common cold is usually good, but those with complication may
develop serious conditions.
16
2. Cough
Practical Therapeutics of TCM Page 17

Coughing may be initiated either voluntarily or reflexively. As a defensive reflex it has
both afferent and efferent pathways. The afferent limb includes receptors within the
sensory distribution of the trigeminal, glossopharyngeal, superior laryngeal, and vagus
nerves. The efferent limb includes the recurrent laryngeal nerve and the spinal nerves.
The cough starts with a deep inspiration followed by glottic closure, relaxation of the
diaphragm, and muscle contraction against a closed glottis. The resulting markedly
positive intrathoraCIC pressure causes narrowing ofthe trachea. oilte me giUttiS OPel IS,
the large pressure differential between the airways and the atmosphere coupled with
tracheal narrowing produces rapid flow rates through the trachea. The shearing forces
that develop aid in the elimination of mucus and foreign materials.
Cough can be initiated by a variety of irritant triggers either from an exogenous source
(smoke, dust, fumes, foreign bodies) or from an endogenous origin (upper airway
secretions, gastric contents). These stimuli may affect receptors in the upper airway
(especially the pharynx and larynx) or in the lower respiratory tract, following access to
the tracheobronchial tree by inhalation or by aspiration. Any disorder resulting in
inflammation, constriction, infiltration, or compression of airways can be associated
with cough.
2.1.1 Common causes of cough
• Upper respiratory infections such as common cold and flu
• Lung infections such as pneumonia or acute bronchitis
• Lung disease such as bronchiectasis, interstitial lung disease, or tumors
• Chronic obstructive pulmonary disease
• Cigarette smoking
• Exposure to secondhand smoke
• Exposure to air pollutants
• Allergies and asthma
• Sinusitis leading to postnasal drip
• Gastroesophageal reflux disease (GERD)
• Side effect of ACE inhibitors
2.1.2 Causes of coughing up blood (blood-streaking of mucopurulent or purulent
sputum)
• Blood clot in the lung
• Bronchiectasis
• Bronchitis
• Cancer
• Cystic fibrosis
• Goodpasture's syndrome
• Inflammation of the blood vessels in the lung (vasculitis)
• Inhaling blood into the lungs (pulmonary aspiration)
• Irritation of the throat from violent coughing
• Nosebleed that drips blood down into the lungs
• Laryngitis
17
• Pneumonia
• Pulmonary edema
• Systemic lupus erythematosus
• Tuberculosis
2.1.3 Medical Evaluations and Emergency Symptoms
Medical Evaluations may be required if the patient has
• Violent cough that begins suddenly
• High-pitched sound when inhaling
• Cough that produces blood
• Suspected serious bacterial infections are, e.g, high fever or cough with thick,
Foul 31.. e1lili~, Jl!lIs :lilR SFiilR ~Ali8JA
• A history of heart disease} edema} or a cough that worsens when you lie down
(may indicate heart failure)
• Suspected pulmon-ary tuberculosis
Emergency symptoms related to cough:
• Serious difficulty breathing
• Hives or swollen face or throat with difficulty swallowing
• Serious bleeding when coughing
2.2 TeM Etiology and Pathogenesis
Table 2.1 Summary of TCM Etiology and Pathogenesis of Cough

Cough due
Wind cold to external
Wind heat factors
External
Cool dryness (more An external
Factors
Warm dryness excessive cough after
patterns) being
Liver fire due to mistreated}
emotional Lung ql or delayed
factors, dysfunction Cough due in
Attacking
Dampness and in dispersing to internal treatment
Lungs
phlegm in spleen or factors may
due to alcohol descending (more transform
Internal
and phlegm and complicate into an
Factors
dampness- d patterns internal
producing food} with cough
Lung and Kidney excess and
deficiency due deficiency)
to chronic illness
and over strain
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2.009 by JH Xie

According to World Health Organization (WHO) 2002 Acupuncture Review and Analysis
of Reports on Controlled Clinical Trials} chronic pulmonary could be treated with
acupuncture if the practitioner has special modern medical knowledge and adequate
monitoring equipment. Chronic pulmonary is often classified as cough or wheezing in
TCM.
2.3.1 Verify the medical diagnosis

2.3.2 Make TCM diagnosis according to the chief complain of the patient. When cough is
only a less significant symptoms during the process of an illness} a TCM diagnosis other
fhan cough should be made} e.g.} cornman Ediu} lUng MBLess} 61 ShidSILls.
2.3.3 Differentiate the internal cough and external cough
Table 2.2 External and Internal Differentiation in Cough

External Cough Internal Cough
History Short Long'
Pattern of Onset Acute Chronic
Dysfunction of lung system and
Accompanying Dysfunction of internal organs
wei defensive together with
Symptoms (lung} spleen} liver and kidney)
exterior patterns
Dispersing / descending lung ql, Regulate and tonify the internal
Treatment not astringent treatment at initial organs} not over-dispersing with
stage pungent herbs
2.3.3 Differentiate the location of the illness} the internal organs involved: Lung is
always involved. In addition} symptoms related to liver} spleen or kidney
dysfunctions may present. In complicated casestwo or more organs are often
involved.
2.3.4 Differentiate the excess and deficiency aspect of the condition: More excessive
patterns are seen in external cough and complicated patterns with excess and
deficiency are often seen in internal cough.
2.3.5 Differentiate the cold and heat aspect of the condition: The differentiation should
be focused on the color} quality} quantity of the phlegm and the tongue and
pulse
Table 2.3 Cold and Heat Differentiation in Cough

Cold Heat
Phlegm White} clear} thin Yellow} thick} sticky
Tongue White} moist coating with pink Yellow coating with red
or pale tongue tongue
Pulse Slow Rapid
Accompanying Not thirst} or thirst prefer to a Thirst
Symptoms warm drink
2.3.6 Important Points of Clinical Decision-Making in TCM Practice
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MCOMAcupuncture Treatment Strategy and HerbalInternal Medicine Study Guide2009 byJH Xie
• The case with a complicated pattern of excess and deficiency is more difficult to
treat.
• The balance between resolving phlegm and tonifying organs should be handled
carefully.
• When treating external-cough] it is very important to prevent the external cough
from transforming into an internal cough.
• When treating internal cough} it is very important to prevent the relapse of the
condition.
2.4 Acupuncture Treatment

2 4 1 'P',?siop of'Mjpd Cgld
WU CAM CT
LU 7 LU7 LU 7
L14 L14 L14
UB13 UB 13 VB 13
SJ 5 SJ 5 SJ5
Auxiliary Points:
For Headache:
GB20 GB 20
DU23 DU23
For Aching Limbs:
UB 60 UB 60
L17 L17
1.2.5.2. Invasion of Lung by Wind-Heat

WU CAM CT
UB13 UB 13 UB 13
LU 5 L17 LU 5
Ll 11 L14 L111
DU 14 DU 14 DU 14
Auxiliary Points:
For sore] dry throat bleed:
L111
For excessive perspiration without relinquishment of fever:
ST43
KD7
1.2.5.3 Jnvasion of Lung by Wind-Dryness

WU CAM CT
UB13 UB 13
LU 5 LU 7
L111 KD3
KD 6
Auxiliary Points:
For aversion to cold without perspiration:
LU 7
L14
For coughing blood] add:
LU 6 LU 6
SP10
20
1.2.5. 4. Phlegm-Dampness Cough

wu CAM CT
LU 9 LU 9
UB13 UB13 US13
ST40 ST40 ST40
SP 3 CV12 SP 3
UB20 ST36 UB20
L14 LU 5
Auxiliary Points:
For coughing with asthma:
WAI DING CHUAN· DING CHUAN
For oppression in the chest and epigastric fullness and distention:
ST36 5136
PC 6 PC 6
CV12
1.2.5.5. Liver-Fire Cough

WU CAM CT
UB13 UB13
UB18 GB34
L1V 3 L1V 3
LU 8 LU 5
Auxiliary Points:
WU CAM CT
For dry scratchy throat:
KD6 KD 6
For coughing bJood:
LU 6 LU 6
2.4.6. Yin Vacuity Cough

wu CAM CT
UB13 US 13 US 13
LU 5 lU 1 lU 1
lU 7 lU 7 lU 9
KD 6 KD 6 KD3
lU 8
Auxiliary Points:
For coughing blood:
LU 6 lU6
UB17
For night sweating:
UB43
For irritability and insomnia:
HT7
21
2.5 Herbal Treatment for Cough
Table 2.4 Herbal Treatment Based on Patterns

Patterns Formulas Recommended in Practical Options
Textbook
Wind cold SanAa Tang + Zhi Suo San Zhi Suo San + .ling Fang Bai
Du San
Wind heat Sang Ju Yin
\I\/i nrl (""::I rrn] rI rvnpc;c; Sanz.Xlna Tang:
Cool dryness Xing Su San
Phlegm and dampness Er Chen Tang + Sang Zi Yang Qi Guan Van Wan
QingTang
Liver fire attacking Xie Bai San + Dai Ge San 1.Xie Bai San plus Xia Ku
lungs Dai Ge San: Cao, Da Qing Ye, Ban Lan
• Qing Dai (Indigo) Gen, Huang Qin, Xing Ren
• Hai Ge Ke (Clamshell) 2. Harmonize Lung & Liver
(Kan)
Lung yin deficiency Sha Shen Mai Men Dong
Tang
Patterns that are not included in textbook
Lung qi deficiency Bu Fei Tang Er Chen Tang + Zhi Suo San +
I
Liu Jun Zi Tang

Cold phlegm in lungs Xiao Qing Long Tang
Phlegm heat in lungs Wei Jing Tang or Qing Qi Hua
Tang Wan
Table 2.5 Commonly Used Herbs for Cough

Wind cold Bai Qian, M a Huang, Sheng Jing, Xing Ren, Zi Su Ye
Wind Heat Jie Geng, Ju Hua, Lu Gen, Sang Ye, Niu Ban Zi, Qian Hu, Xing Ren
Dryness in lung Bai Bu, Chuan Bei Mu, Kuan Dong Huan, Zi Wan , Sha Shen, Yu Zhu,
BaiHe
Cold or Damp Bai Jie Zi, Gan Jian, Lai Fu Zi, Su Zi, Xan Yuan, Chen Pi, Xuan Fu Hua
Phlegm
Lung Heat or Ce Bai 'i.e, Chuan Bei M u, Dan Nan Xing, Di Gu Pi, Gua Lou Shi, QiDg
Heat phlegm Dai, Sang Bai Pi, Pi Pa Ye, She Gan, Tian Zhu Huang, Zhe Bei Mu , Zhu
Ru
Huang Qin, Di Gu Pi, Lu Gen, Yu Xing Cao
2.6 Prognosis
• The prognosis depends on the underlying medical diagnosis and TCM
patterns.
• External Cough: Most patients with wind cold/wind heat patterns will be
cured with appropriate treatments. Patients complicated with damp will be
more intractable. Wind cold pattern may transform into heat pattern. Wind
cold or wind heat pattern may transform into external dry pattern. All
22
MCOM Acupuncture Treatment Strategy and HerbalInternal MedicineStudy Guide 2009 by JHXie
external cough patterns may transform into internal cough patterns if

treatment is not given appropriately or promptly.
• The patterns due to wind (cool/warm) dryness are intractable. Body fluid is
often consumed in these patients. It takes longer course of treatment to
improve the symptoms. If they are not treated properly internal cough
patterns may develop.
• Phlegm damp pattern in internal cough may transform into a phlegm cold or
phlegm heat pattern. Phlegm damp pattern may result in a lung qi and
kidney yang qi deficiency pattern if the condition exists for a long period of
time.
• Phlegm heat and liver fire attacking lung pattern may cured If treated
properly with heat clearing methods. A complicated pattern with heat,
phlegm and body fluid (yin) deficiency may develop, which is intractable.
• Lung yin deficiency pattern is usually chronic. It is often resulted from heat-
related patterns. Proper treatment will prevent the relapse of the condition
and may cure the condition.
• Lung qi and cold phlegm in lungs patterns are usually chronic. They are often
the result of the cold-related patterns. They are the most intractable of all
cough patterns. Very often, spleen, lung and kidney are all deficient. External
pathogenic factors often attack due to the deficiency body. A pattern
involved heart yang and qi deficiency, and heart blood stagnation may
develop from this pattern, which is very serious.
23
MCOM Acupuncture Treatment Strategyand HerbalInternal MedicineStudy Guide 2009 by JHXie
3. Asthma
The "asthma" discussed in this chapter includes asthma arising from allergies and
difficulty breathing arising from other conditions such as chronic asthmatic bronchitis,
obstructive pulmonary emphysema and other illnesses accompanied by the symptom of
dyspnea. It differs from asthma defined in biomedicine which is a condition arising from
allergies.
3.115101i1edltal fteuleua
Asthma arises from allergies. Asthma symptoms are triggered by allergens or triggers.
Triggers include pet dander, dust mites, cockroach allergens, molds, or pollens. Asthma
symptoms can also be triggered by respiratory infections, exercise, cold air, tobacco
smoke and other pollutants, stress, food, or drug allergies. Aspirin and other non-
steroidal anti-inflammatory medications (NSAIDS) provoke asthma in some patients.
Difficulty breathing may arise from lung disease, heart diseases, gastric intestinal
diseases, and psychiatric conditions. They should be differentiated from asthma arising
from alIergies. These may include:
• Emphysema
• Interstitial lung disease
• Pneumonia
• Pulmonary hypertension
• Inhalation of a foreign object
• Coronary artery disease
• Heart attack
• Congestive heart failure (CHF)
• Heart arrhythmias
• Deconditioning (lack of exercise)
• Obesity
• Compression of the chest wall
• Panic attacks
• Hiatial hernia
• Gastroesophageal reflux disease (GERD)

• Extreme difficulty breathing (shortness of breath at rest, peak flow less than
50% of personal best)
• Cyanosis in the lips and face
• Severe anxiety due to shortness of breath
• Difficulty breathing with very rapid pulse
• Difficulty breathing with profuse sweating
• Decreased level of alertness, such as severe drowsiness, confusion, or chest pain
during an asthma attack
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MCOM Acupuncture Treatment Strategy and Herballntemal Medicine Study Guide 2009 by JHXie
3.2 TCM Etiology and Pathogenesis

This summary of TCM pathogenesis is more appropriate for asthma arising from
allergies.
Table 3.1 Summary of TCM Etiology and Pathogenesis of Asthma
Lungs attacked by Trigged by Asthma or
exogenous factors. exogenous dyspnea due
Spleen damaged by factors} to phlegm Excess in
inappropriate food emotional obstruction upper jiao
Internal phlegm
Liver damaged by factors} and lung qi and
accumulation
abnormal emotions inappropriate dysfunction deficiency in
eOiigeiiltal deficiency of FadaiS} /6:: 81 jiB6
kidney or kidney damage overstrains
by chronic illness

of Reports ~n Controlled Clinical Trials, bronchial asthma is listed as a condition for
which the therapeutic effect of acupuncture has been shown but further proof is
needed.

3.3.2 Differentiate the location of illness according to TCM theory. In addition to lungs
the condition often involves other organs.
• Spleen: Poor appetite} abdominal fullness and loose stool
• Liver: Asthma attack after emotional stress (anger and anxletv), or related to
menstruation
• Kidney: Repeated attack of asthma} weakness and soreness of lower back,
dyspnea even with very light exertion
3.3.3 Differentiate the excess and deficiency} cold and heat patterns. The condition is
usually class, "sd as patterns of excess complicated with deficiency.
Table 3.2 Excess and Deficiency Differentiation in Asthma

Excess Deficiency
Pattern of Onset Acute Chronic or less acute
Symptoms Wheezing with more exhaling} Wheezing with more inhaling} shallow
loud husky voice} forceful pulse} inspiration and feeble voice} weak pulse}
in acute and young patients in elderly and chronic patients.
Table 3.3 Cold and Heat Differentiation in Asthma

Cold Heat
Manifestations Thin} clear} white} foamy phlegm} Thick} sticky} yellow or white and yellow
greenish and gray complexion} cold phlegm} dark yellow urine} constlpatlon
limbs} not thirst or thirst preference
warm drink
3.3.4 Important Points of Clinical Decision-Making in TCM Practice
25
MCOM AcupunctureTreatment Strategyand Herbal Internal Medicine Study Guide2009 by JH Xie
• During the attack of asthma treatment should be aimed at dispelling pathogenic

factors} resolving phlegm and regulating rung qi to stop wheezing.
• During remissions from asthma} treatment should be aimed at the root of the
disease} e.g., regulating the function of spleen} liver} lungs and kidney to
strengthen the organs and prevent the production of phlegm.
• For serious cases with Emergency Symptoms} collapse of yin and yang may
occur and medical referral is required.
3.4 Acupuncture Treatment for Asthma

3.4.1 Invasion of Lung by Wind-Cold
VOO {Art' iT
LU 7 LU 7 LU 7
UB12 US 12 UB 12
UB13 US 13 UB 13
LU 5 DU14 LU 5
L14 CV22
Auxiliary Points:
For stuffy nose and runny nose:
- 5T3
For headache and aching shoulders and back:
L17 L17
For fever and aversion to cord:
517 SJ 5
DU14
L14
3.4.2 Accumulation of Phlegm-Heat in lung

WU CAM CT
CV22 CV22 CV22
LU 5 LUS LU 6
UB13 UB13-m<_ DU14
ST40 ST40 ST40
L14 LU 1
DINGCHUAN DINGCHUAN L14
Auxiliary Points:
For high fever: CV17
L111
L12
3.4.3a. Vacuity of lung
WU CAM CT
DING CHUAN DING CHUAN DING CHUAN
UB13 UB13 UB13
LU 9 LU 9 LU 9
UB43 ST36 UB43
SP 9
Auxiliary Points:
26
For vacuity of lung and spleen qi:

5T36 5T36
UB20 UB20
5P3
UB40
3.4.3b. Vacuity of lung
WU CAM CT
DING CHUAN DING CHUAN DING CHUAN
UB13 UB13 UB13
LU 9 LU 9 LU 9
0843 3T3~ eJ843
5P 9
Auxiliary Points:
For vacuity of lung and spleen qi:
5T36 5T36
UB20 UB 20
5P3
UB40
3.4.4 Vacuity of Kidney
WU CAM CT
DING CHUAN DING CHAN
CV17 CV17 UB43
UB13 UB13 UB13
UB23 UB23 UB23
KD3 KD 3 KD3
CV6 CV6 CV6
LU 9
Auxiliary Points
For persistent asthma, add:
DU12 DU 12
For vacuity of lung qi and heart yang, with symptoms of desertion add:
PC6
HT7
For spleen vacuity, add:
CV12 CV 12
UB20 UB20
Appry moxibustion to:
CV6
CV4
DU4
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MCOMAcupuncture TreatmentStrategy and Herbal Internal MedicineStudy Guide2009 by JH Xie
3.5 Herbal Treatment for Asthma

Patterns Formulas Recommended in Textbook Practical Options
Wind Cold Ma Huang Tang

Gui Zhi Jia Hou Po Xing Zi Tang
She Gan Ma Huang Tang
• She Gan, Ma Huang, Xi Xin, Zi
Wan, Kuan Dong Huan, Fa Ban
Xia, Wu Wei Zi, Sheng Jiang,
Da Zao
Xiao Qing Long Tang (exterior cote ana
interior cold rheum)
Phlegm Heat Sang Bai Pi Tang Qing Qi Hua Tang Wan + Ma
in Lung Xing Shi Gan Tang
Lung Vacuity Sheng Mai San + Bu Fei Tang (Lung- For lung qi deficiency: Liu Jun Zi
(qi or qi and Supplementing Deoction) Tang + Xiao Qing Long Tang
yin)
Kidney Jin Gui Shen Qi Wan Ren Shen Ge Jie San
Vacuity Su Zi Jiang Qi Tang (excess in lungs
with phlegm and qi stagnation and
kidney deficiency)
Zheng Wu Tang (yang deficiency, cold
turbid fluid affected lung and heart)
3.6 Prognosis
• During the attack of asthma excess patterns or excess patterns complicate..d with
deficiency are identified. During the remission from asthma deficiency patterns
are usually identified. An excess pattern may transform into a deficiency pattern
or deficiency complicated with excess pattern after repeated attacks of asthma.
Asthma classified as a deficiency pattern may transform a excess pattern when
the attack is triggered by pathogenic factors.
• A pattern of cold phlegm rheum in rungs may be controlled with herbal and
acupuncture treatment very well. It may transform into a pattern of phlegm,
heat in lungs if it is over-treated with warming methods (especially herbs). It
may also transform into a pattern of upper excess and lower deficiency in
chronic cases.
• A pattern of phlegm heat in lungs usually response to herbal and acupuncture
treatment well. It may transform into a pattern of cold phlegm and rheum in
lungs if it is over-treated with cold herbs or patient's spleen and kidney yang is
damaged. It may also transform into a pattern of yin deficiency complicated
with phlegm heat in chronic cases.
• A pattern of phlegm and' blood stasis is usually seen at the late stage of the
asthma. The treatment aiming at resolving phlegm and promoting blood
circulation will help control the condition. If a patient has this pattern frequently,
a yin or yang collapse pattern may occur.
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MCOM Acupuncture Treatment Strategyand Herbal Internal MedicineStudy Guide 2009 byJHXie
• Asthma attack with collapse of yin or yang is very serious. Medical intervention
is required.
• During the remission from asthma, treatments aiming at regulating and
strengthening spleen] liver] lungs and kidney will reduce the frequency and
severity of asthma attack] or prevent the asthma attack.
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MCOM Acupuncture Treatment Strategy and Herballntemal Medicine Study Guide 2009 by JH Xie
4. Stomach Pain

Stomach pain is often discussed with abdominal pain in symptom differentiation. Major
causes ofstomach pain (pain in epigastrium) include:
• Excessive gas
• Food allergy
• Food poisoning (salmonella, shigella)
• Gastroesophageal reflux
• near Lbdi II or II/dlgestloii
• Ulcers
• Vira I gastroenteritis (stomach flu)
• Chronic gastritis
• Cancer
• Stomach pain accompanied with vomiting and being unable to pass stool
• Stomach pain accompanied with vomiting blood or blood in stool (tarry black
stool)
• Stomach pain accompanied with chest pain, severe should pain
• Acute and very sharp stomach pain
• Stomach pain accompanied with fever, jaundice, nausea and pain in shoulder
blades
• Stomach pain accompanied with rigid abdomen, abdominal tenderness and
rebound tenderness
Table 4.1 Summary of TeM Pathogenesis of Stomach Pain

Emotiona I factors Live qi stagnation liver
attacking stomach
Overstrain or chronic Spleen deficiency and
illness phlegm damp
accumulation
Inappropriate diet or Indigestion of food in
overeating stomach
Stomach qi
External cold or Cod accumulation in
stagnation and
eating cold and raw stomach
dysfunction of Stomachache
food
stomach qi in
Sweet and greasy Damp heat accumulation
lowering
food, alcohol and
spicy food
Constitutional yin Stoma yin deficiency and
deficiency or yin fail to nourish stomach
damaged by heat
Chro nic pain Qi and blood stagnation in
involving collaterals 'stomach
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MCOMAcupuncture Treatment Strategyand Herbal Internal Medicine Study Guide 2009 by JHXie

of Reports on Controlled Clinical Trials, acute epigastralgia in peptic ulcer, acute or
chronic gastritis, and gastrospasm is listed as a symptom for which acupuncture has
proved, through controHed trials, to be effective treatment.
4.3.1 Verify the medical diagnosis and make TCM diagnosis based on the symptoms.
4.3.2 Differentiate the diseased organs.
• Stomachache due to liver and stomach disharmony: It is often related to
emotional factors and stress. Stomachache often radiates to hypochondriac
region.
• Spleen and stomach: Distending pain, decreased appetite, fatigue and loose
stool.
• Liver, spleen and stomach: It is often related to emotional factors and stress,
frequent attack, fatigue and loose stool, and decreased appetite.
4.3.3 Differentiate the different types of pain (sudden and cold pain, burning pain,
distending pain, pricking pain and dull pain) to identify the pattern of cold, heat, qi
stagnation, blood stasis, and deficiency.
4.3.4 Important points of clinical decision-making in TCM practice
• Chronic stomach pain accompanied with nausea, vomiting blood and pale
complexion is a medical emergency.
• Chronic and intractable stomach pain in elderly patient should be medically
evaluated to exclude the malignancy.

4.4.1 Settling of Cold Evil in the Stomach
WU CAM CT
CV 12 CV 12 CV 12
ST36 ST36 ST36
PC 6 PC 6 PC 6
SP 6 SP 4 SP 6
US 20
CV6
Auxiliary Points:
For severe epigastric pain, add:
ST34
4.4.2 Obstruction by Food Stagnation

WU CAM CT
cv n CVll CV 11
ST 36 ST36 ST36
PC6 PC 6 PC 6
Li Nei Tlng Li Nei Ting Li Nei Ting
ST25
31
MCOM AcupunctureTreatment Strategyand. Herbal Internal MedicineStudy Guide2009 by JHXie
4.4.3 Disruption of the Stomach by Liver Qi

wu CAM CT
ST 36 ST36 ST36
CV12 CV12 CV 12
LlV 3 L1V 3 L1V 3
L1V 14 L1V 14 L1V 14
PC 6 PC 6
GB 34
4.4.4 Accumulation of Heat in the Liver and Stomach

ovtJ &if
CV 12 CV13
ST34 ST34
L1V 2 L1V 2
ST44 ST44
ST36 L14
PC 6
Auxiliary Points:
For cases of add regurgitation and clamoring stomach, add:
CV 10
CV 11
S. Obstruction of the Stomach by Static Blood

wu cr
CV 12 CV 12
ST36 ST36
PC 6 PC 6
SP 4 SP 4
ST21 SP 6
Auxlllary Points:
For cases of vomiting blood or bloody stools, add:
US 17 SP 10
PC4
SP 11
6. Depletion of Stomach Yin

WU CT
. UB 20 US 20
US 21 US 21
CV 12 CV 12
ST36 ST36
SP 6 SP 6
KD 3 SP 10
LIV 13
PC 6
32
MCOMAcupunctureTreatment Strategy and HerbalInternal Medicine Study Guide 2009 by JH Xie
7. Vacuity-Cold of the Spleen and Stomach

wu cr
UB20 UB20
UB 21 UB 21
CV 12 CV 12
PC 6 PC 6
SP 4 SP 4
CV 6 CV4·
ST 36 L1V13
Auxiliary Points:
For vornltlng or bloody stools add:
UB 17
SP 3
4.5 Herbal Treatment for Stomach Pain
Cold in Stomach Liang Fu Wan Purge the Cold (Kan)
• Gao Liang Jian (Lesser Galangal
Root), Xiang Fu
Xiang Su San
Food Stagnation Baa He Wan Baa He Wan
Xiao Cheng Qi Tang Zhi Shi Dao Zhi Wan
Da Cheng Qi Tang Ma ZiRen Wan
Liver Qi Attacking Chai Hu Shu Gan San
Stomach
Heat in the Liver and Hua Gan Jian (Lfver-rransforrnlng Brew) Jia Wei Xiao Yao San +
Stomach • Mu Dan Pi, Zhi Zi, Bai Shao Yao, Qing Wei San
(a specific type of Qing Qi, Chen Pi, Ze Xie, Chuan
liver and stomach Bei Mu
disharmony) Zuo Jin Wan
Blood Stasis in Shi Xiao San Dan Shen Yin
Stomach Dan Shen Yin Ge XlaZhu Yu Tang
Huang Tu Tang (vomiting blood or black
stool due to bleeding)
Gui Pi Tang
Stomach Yin Shao Yao Gan Cao Tang Yu Nu Jian
Deficiency Zuo Jin Wan Shao Yao Gan Cao
Tang
Deficient Cold in Xiao Jiang Zhong Tang
Spleen and Stomach Huang Qi Jiang Zhong Tang
Da Jiang Zhong Tang
u
Fu Zi Zhong Tang
Liang Fu Wan (acute attack)
Huang Tu Tang (bleeding)
Xiang Sha Liu Jun Zi Tang (long term
maintaining or preventive use)
33
MCOMAcupunctureTreatment Strategy and HerbalInternal MedicineStudyGuide 2009 by JH Xie
4.6 Prognosis
• Prognosis depends on the underlying medical diagnosis and reM patterns.
• Prognosis of patients with excessive patterns is usually better than those with
deficient patterns.
• Initially stomach pain is often classified as a pattern of excess (qi stagnation,
cold invasion, indigestion) and most patients will be cured with proper
treatments. An excessive pattern may transform into a deficient pattern if not
treated promptly.
• Within the excessive patterns, a qi stagnation pattern may transform into a heat
pattern. Acold pattern may transform into a heat pattern or damp heat pattern.
• All patteiid 11169 ccciltually tlslig,elli: iMll!l8 pliiiiFM iflalQod rtasis ?odpb1esm
accumulation.
34
5. Hiccough

A hiccup is an unintentional movement (spasm) of the diaphragm. The spasm is
followed by quick closure of the vocal cords, which produces a distinctive sound.
Hiccupsoften start for no apparent reason and usually disappear after a few minutes.
Rarely, hiccups persist for days, weeks, or months. Hiccups are common and normal in
newborns and infants.
Common causes of hiccough
• Gastric neurosis
• Post-abdominal surgery
• Hot and spicy foods or liquids
• Chemical irritants
• Hiccough due to unknown causes
Some less common causes of hlccough
• Gastritis
• Gastrectasis
• Late stage of hepatocirrhosis
• Uremia
• Stroke or tumor affecting the "hiccup center" in the brain
• Pleurisy or pneumonia irritating the nerves that control the diaphragm
Table 5.1 Summary ofTCM Etiology and Pathogenesis of Hiccough

Accumulation of Stomach cold
indigested food Stomach heat
complicated with Indigestion food in
Excess cold or heat stomach
Emotional factors Liver attacking stomach
Hiccough
Phlegm and blood Phlegm obstruction
stasis in stomach Blood stasis obstruction
Spleen and stomach Stomach qi deficiency
Deficiency qi or yin deficiency Stomach yin deficiency
due to chronic illness
35
MCOM AcupunctureTreatment Strategyand Herballntemal Medicine Study Guide2009 by JH Xie

5.3.2 Differentiation based on the characteristics of hiccough
Table 5.2 TCM Differentiation of Hiccough

Stomach cold Deep slow forceful hlccough, milder with warmth, severe
with cold, no thirst
Food stagnation Forceful hiccough with sour reflex, taste of undigested food
Stomach fire Loud clear hiccough, halitosis, irritability, thirsty and
constipation
phlegm obstruct,on H,ccoOgh witti di€Sl IOlliies;, t1lzzliiess dild pliclgiii
Blood stasis Hiccough immediate after drinking, pricking pain in chest or
epigastrium, dark purplish tongue
Liver attacking stomach Hiccough triggered by emotional factors, distention & pain
in chest, flatulence
Stomach yang deficiency Low weak hiccough, lack of warmth in limbs, poor appetite,
fatigue
Stomach yin deficiency Fast & abrupt hlccough, irritability, uneasiness and dry
mouth
5.3.3 Determine the diseased organs

In addition to spleen and stomach, the hiccough may involve kidney and liver.
5.3.4 Evaluate the severity and prognosis of the hiccough
Most patients with hiccough are mild and have good prognosis. Low and forceless
hlccough seen in patients of terminal illness, or very deficient elderly patients
accompanied with inability to take food and a very deep and weak pulse indicates the
exhaustion of yuan (origin, resource) qi and stomach qi. Their prognosis is very poor.
5.4.1 Stomach Cold

WU
CV12
Ll4
PC6
5T36
US 17
Auxiliary Points:
For severe cold, moxa:
CV 13
5T21
For obstruction of food:
CV 11
Li Nei Ting
36
MCOM AcupunctureTreatment Strategy and Herbal Internal MedicineStudyGuide 2009 byJH Xie
5.4.2 Effulgent Stomach Fire

WU
UB 17
CV12
ST36
PC6
ST44
5.4.3 Liver Qi Stagnation

WU
CV12
UB 17
PC6
ST36
CV17
LV3
LV 14
5.4. 4 Spleen and Stomach Yang Vacuity

WU
CV12
PC6
ST36
US 17
CV6
5.4.5 Stomach Yin Vacuity
WU
CV12
PC6
ST36
UB 17
KD 3
SP 6
37
MCOMAcupunctureTreatment Strategyand Herbal Internal Medicine StudyGuide 2009 by JH Xie
. ".
5.5 Herbal Treatment for Hiccough

Textbook
Stomach Cold Ding Xiang Shi Di Tang Xiang Sha Liu Jun Zi Tang
plus Shi Di, 0 ing Xiang
Stomach Fire Zhu Ye Shi Gao Tang QingWeiSan
Xiao Cheng Qi Tang Ma ZiRen Wan
Liver Qi Stagnation Wo Mo Yin Zi (Five Milled Chai Hu Shu Gan San +
Ingredients Drink) Xuang Sha Liu Jun Zi Tang
Xuan Fu Dai Zhi Tang (qi ascent
wrtn pruegrm
Spleen and Stomach Li Zhong Tang Purge Cold
Yang Deficiency Maintaining or preventive use:
Xuan Fu Dai Zhi Tang
Bu Zhong Yi Qi Tang plus Dao
Dou, Wu Zhu Yu and Ding Xiang
Stomach Yin Yi Wei Tang (Stomach-Boosting Yu Nu Jian plus Pi Pa Ye, Shi
Deficiency Decoction) Di and Shi Hu
•
Sha Shen, Sheng Di
Huang, Mai Men Dong,
Yu Zhu and rock candy
Commonly used herbs for hiccups include:
Bi Cheng Qie (Fructus Litsae), Chen Xiang, Dao Dou (Semen Canavaliae), Ding Xiang, Shi
Di
These herbs may be added into the formulas for all types of hiccough.
5.6 Prognosis
• Most patients with hiccough are mild and have good prognosis. Occasional
hiccough may disappear without treatment. Hiccough with excess patterns has
a better prognosis. Hiccough with deficiency is more difficult to manage.
Chronic deficient hiccough may cause kidney deficiency and become very
intractable.
• Hiccough with a complex pattern (qi stagnation and phlegm accumulation, liver
qi stagnation and spleen deficiency, phlegm and heat complex, phlegm
accumulation and blood stasis) is more intractable than that with simple pattern.
The improvement of a complex pattern comes slowly.
• Low and forceless hiccough seen in patients of terminal illness, orvery deficient
elderly patients accompanied with inability to take food and a very deep and
weak pulse indicates the exhaustion of yuan qi and stomach qi. Their prognosis
is very poor.
38
MCOM Acupuncture Treatment Strategy and HerballnternaJ Medicine Study Guide 2009 by JH Xie
6. Vomiting
Causes of vomiting
• Disorders in digestive system
• Gastrointestinal viral and bacterial infection
• Acute Appendicitis
• Acute Pancreatitis
• Acute Gastritis
• Acute Cholecystitis
• Gall-stope
• Incomplete pylorus obstruction
• Gastric ulcers
• Gastric neurosis
• Intestinal obstruction
• Gastrointestinal tumors
• Food poisoning
• Food allergies
• Other disorders
• Uremia
• Meniere's disease
• Side effect of some medications (such as antibiotics and chemotherapy
drugs)
• Seasickness or motion sickness
• Migraine headaches
• Morning sickness
• Brain tumors
• Bulimia
• Alcoholism
• Sunstroke
• Vomiting due to poisoning or a child has taken aspirin
• Vomiting with blood or bile in the vomit
• Vomiting with severe abdominal pain
• Vomiting with headache, high fever, stiff neck or unconsciousness
• Vomiting with serious dehydration
39
MCOM Acupuncture TreatmentStrategy and HerbalInternal M.edicine StudyGuide2009 b~!H Xie
Table 6.1 Summary of TCM Etiology and Pathogenesis of Vomiting

Exogenous wind cold, summer Exogenous factors
heat and dampness invasion attacking stomach
lnapproprlate diets causing food
Food stagnation
stagnation
Emotional factors causing liver qi
Liver attacking
stagnation and attacking stomach Failure of
stomach
stomach qi
PI i1egii i and IIlEU",
Over-thinking cause spleen in Vomiting
accumulation Spleen
deficiency and phlegm descending
and stomach yang qi
accumulation
deficiency
stomach yin deficiency as a
constitution or caused by chronic Stomach yin
illness, over use of hot food or deficiency
herbs

of Reports on Controlled Clinical Trials, nausea and vomiting are symptoms for which
acupuncture has been proved, through controlled trials, to be an effective treatment.
6.3.2 The first step is to differentiate the deficiency and excess. Within excess patterns a
differentiation of cold and heat should be made. The stomach is the most important
organ in the development of vomiting, but the condition may involve the other organs
such as spleen and liver.
Table 6.2 Pattern Differentiation of Vomiting

Patterns Symptoms'
Fast and acute vomiting accompanied with
Exterior Evil
manifestations of exterior wind cold and interior
Invading ST
dampness
Food Vomiting acid fluid with indigestion contents of stomach
Excess Stagnation and other symptoms of food stagnation
Vomiting of clear liquid and mucus, epigastric fullness,
Phlegm Damp
loss of appetite, dizziness, and palpitation
Liver Qi Vomiting acid regurgitation, frequent eructation,
Invading St oppression in the chest, and hypochondriac pain
SP and ST Chronic vomiting brought on by a slight increase in food
Deficiency intake, other symptoms of yang and qi deficiency in SP &
Deficiency Cold ST
STYin Repeating vomiting with spells of retching, thirst, dry
Deficiency throat, hunger without desire for food
40
MCDMAcupuncture Treatment Strategy and HerbalInternal MedicineStudy Guide2009 by JH Xie
6.3.3 The vomiting discussed in this chapter should be differentiated with hlccough,
stomach reflux(wei fan) and esophageal constriction.
Table 6.3 Differentiation of Hiccough, Stomach Reflux and Esophageal Constriction
Hiccough Stomach reflux Esophageal constriction
Symptoms Hiccough, maybe Vomiting in the Difficulty in swallowing
nausea evening of flood eaten orvomiting immediately
in the morning and after the eating and
vomiting in the drinking
evening of flood eaten
in the morning
Related Diseases that Pylorus obstruction Cardiac sphincter
biomedical irritate the and spasm spasm, hiatal hernia,
conditions diaphragm nerve esophagitis, esophageal
diverticulosis and
cancer

6.4.1 Exterior Evil Invading the Stomach
WU CAM CT
CV12 CV 12
ST 36 ST36
PC6 PC 6
L14 L14
GB 20 GB 20
Auxiliary Points:
For retention food, add:
CV11
For dry retching, add:
PC 5
For accumulation of internal phlegm, add:
St 40
6.4.2 Food Accumulation and Stagnation

WU CAM CT
CV 11 CV 10 CV 11
CV12 CV12 CV21
ST 36 ST 36 ST36
SP 14 SP 4 SP 14
PC 5 PC 6 PC 6
CV21 ST44
Auxiliary Points:
For abdominal distention, add:
CV6 CV6
41
MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine ~tudy Guide 2009 by JH Xie
6.4.3 Obstruction and Stagnation of Phlegm-Dampness

wu CAM CT
CV 12 CV 12
SP 4 SP 4
~~ ~~
PC 6 PC 6
ST 36 L1V 13
SP 9
Auxiliary Points:
For borborygmus, add:
ST 25 US 20
US 25
For palpitation, add:
HT7
4. Liver Qi Invading Stomach
wu CAM CT
CV 12 CV 12 CV 13
ST 36 ST 36 ST34
LlV 3 L1V 3 L1V 3
GB 34 PC 6 GB34
PC 6 SP 4 HT7
Auxiliary Points:
For acid regurgitation and dry retching, add:
pe6
SP4
s. Spleen and Stomach Vacuity Cold
wu CAM CT
ev 12 CV 12 eV12
ST 36 ST 36 ST36
PC 6 PV 6 PC6
SP 4 SP 4 LlV 13
US 20 US 20 US 20
US 21 US 21
eV4
6. Stomach Yin Vacuity
wu CAM CT
ST36 ST36
PC6 PC6
SP 6 SP 6
CV12 US 20
SP4 US 21
KD3 SP 10
Auxiliary Points:
For burning sensation in the stomach, add:
KD 3
For dry retching, add:
SP4
42
MCOMAcupunctureTreatmentStrategyand HerbalInternal Medicine Study Guide2009 byJHXie
6 5 Herbal Treatment
Patterns Formulas Recommended Practical Options
in Textbook
Exterior Evil Invading Huo Xiang Zheng Qi San -
Stomach
Bao He Wan Zhi Shi Dao Zhi Wan
Food Stagnation -
Xiao Cheng Qi Tang
Xiao Ban Xia Tang (Minor Xiang Sha Liu Jun Zi Tang
Pinellia Decociton)
-
• Zhi Ban Xia•.
Sheng Jiang
Phlegm Damp Ling Gui Zhu Gan Tang
-
Obstruction • Fu Ling, Gui Zhi,
Bai Zhu, Zhi Gan
Cao -
Wen Dan Tang
liver Qi Invading Ban Xia Huo Pu Tang Chai Hu Shu Gan Tang ~
Stomach Zuo Jin Wan QingWei San

Spleen and Stomach Li Zhong Tang
Deficiency Cold -
Stomach Yin Mai Men Dong Tang

Deficiency
6.6 Prognosis
• Prognosis depends on the underlying medical conditions and the level of vital qi.
• Vomiting classified as a pattern of exterior wind cold, wind heat and summer
heat are usually improved as the exterior-releasing treatment is applied.
Pattern of food stagnation is usually cured with a method of promoting
digestion and resolving stagnation.
• Vomiting classified as a pattern of liver attacking stomach may recur, but it has a
favorable prognosis. Repeated vomiting in this pattern may result in pattern of
liver and spleen disharmony, spleen and stomach yang qi deficiency, phlegm
and rheum accumulation and stomach yin deficiency.
• Vomiting classified as a pattern of phlegm and rheum accumulation is often
seen in the patient with a biomedical diagnosis of incomplete pylorus
obstruction or Meniere's disease. The prognosis for this pattern is usually good
unless the vomiting is due to pylorus obstruction. In that case medical
evaluation is required. In case of tumor, stomach reflux may develop.
• The prognosis is good for vomiting classified as a pattern of stomach and spleen
yang qi deficiency and cold. The prognosis for vomiting classified as a pattern of
stomach yin deficiency depends on the severity of yin deficiency. Medical
evaluation (endoscopy) may provide information on the prognosis of this
pattern.
43
MCOM AcupunctureTreatmentStrategyand HerbalInternal Medicine Study Guide2009 by.lH Xie
7. Esophageal Constriction

Painful or difficulty swallowing may be caused by esophagus diseases, infections, mouth
and throat diseases. Traditional the esophageal constriction discussed in this chapter
includes difficult and painful swallowing due to esophagus diseases and some stomach
cancer.
Causes of painful or difficulty swallowing (esophageal constriction)

• DiSeaSeS 61 tile esophagus alid stOlIIdCIi
• Inflammation of the esophagus
• Achalasia
• Esophageal spasms
• Nutcracker esophagus
• Esophagus cancer
• Cardiac cancer
• Gastric cancer
• Benign esophagus stenosis
• Esophagus diverticulitis
• Esophagus neurosis
• Tumors or enlargement of organs surrounding the esophagus (mediastinum,
aorta, heart),
• infection
• Cytomegalovirus
• Gum disease
• Herpes simplex
• Human immunodeficiency virus (HIV)
• Pharyngitis
• Thrush (a fungal infection caused by candida)
• Tooth infection or abscess
• Mouth orthroat ulcers
All patients with continuous painful or difficult swallowing should be medically
evaluated.
44

Table 7.1 Summary ofTCM Etiology and Pathogenesis of Esophageal Constriction
Emotional Liver ql Phlegm and qi Yin and blood
factors stagnation congestion, deficiency,
Phlegm Stagnant heat dryness in
Spleen
dampness and yin fluid esophagus
deficiency Esophagus
accumulation damage and ql and yang
-----------------=---- constriction
deficiency may
Phlegm and Phlegm and
Sweet, greasy develop at the
ililMPJ Aiil blood stasis
and alcohol late stage 61
accumulation accumulation
illness

7.3.2 Differentiate excess and deficiency patterns
Table 7.2 Differentiation of Excess and Deficiency in Esophagus Constriction

Patterns Symptoms
Sensation of obstruction Ithe throat when swallowing,
Congestion of
fullness and oppression in the chest and diaphragm, minor
qi and phlegm
relief of symptoms when in a favorable emotional state
Excess Spasmodic pain of fixed location in the chest, inability to
swallow solid foods and difficulty in swallowing liquids,
Blood stasis
hard stools, vomiting of dark red liquids, dull graysish
complexion, emaciation, and dry skin
Spleen and
Chronic inabilityto swallow food or liquids, emaciation,
Stoma Yang Qi
pale complexion, regurgitation of clear fluids, and edema
Vacuity
Deficiency Depletion of Difficulty swallowing accompanied by sensation of
fluids with obstruction and pain, liquids ingest easily but solids with
accumulation difficulty, emaciation, dry mouth, and vexing heat in the
of heat five hearts
7.3.3 The condition is usually classified as pattern of primary deficiency with secondary
excess. Superficially patterns show qi stagnation, blood stasis, and phlegm obstruction.
The primary deficiency progresses through stages of mild body fluid damage, moderate
consumption of blood and yin, and eventua lIy serious deficiency of qi, yang, yin and
blood. Duringthe early stages, excess is predominant, with the primary deficiency
becoming predominant at the later stage of illness.
7.3.4 The condition should be distinguished from stomach reflux and plum-pit qi
patterns.
45
MCOM Acupuncture TreatmentStrategyand Herballntemal MedicineStudy Gulde2009 byJH Xie

Patterns Acupuncture Prescriptions
Congestion of qi and phlegm CV22, CV17, CV13, ST36,PC6, BL2i
Yin Deficiency and Accumulation CV22,CV17,CV13,ST36, PC6, BL17
of Heat
Blood Stasis Accumulation BL17, CV22, CV17, PC6, CV13, ST36,
Vacuity of Qi and Devitalization BL23, BL20, BL2i,BL17,CV22,CV17,CV13,PC6,
of Yang ST36
7.S Herbal Treatment

Patterns Formulas Recommenaea In I eX'[OOOK tTdLLlLdl 'r
Congestion of qi and Qi Ge San (Diaphragm-Arousing Chai Hu Shu Gan Tang

phlegm Powder) Liu Jun Zi Tang
• Bai Sha Shen, Dan Shen, Fu Dan Shen Yin
Ling, Yu Iin, Chuan Bei Mu,
Sha Ren, He Ye, rice bran
Yin Deficiency and Sha Shen Mai Men Dong Tang Shan Shen Mai Men
Accumulation of Heat Dong Tang + Dan
Shen Yin
Blood Stasis Qi Ge San and Xue Fu Zhu Yu Tang
Accumulation Tao Hong Yin (Perch Kernel and Xiang Sha Liu Jun Zi
Carthamus Beverage) Tang
• Rao Ren, Huang Hua, Chuan
Xiong, Dang Gui Wei, Wei Ling
Xian
Vacuity of Qi and Bu Qi Yun Pi Tang (Qi-Supplementing Bu Zhong Yi Tang +
Devitalization of Yang Spleen-Moving Decoction) You Gui Wan
• Ren Shen, Bai Zhu, Fu Ling,
Huang Qi, Jiang Ban Xia, Chen
Pi, Sha Ren, Gan Cao, Sheng
Jiang, Da Zao
and You Gui Wan

• During the early stages, excess is predominant and patients vital qi is still strong.
Acupuncture and herbal medicine may be used as a supplement to drugs,
surgeries and radiotherapies.
• At the later stage of illness primary deficiency becomes predominant and
phlegm and blood stasis obstruction becomes deeply complicated. The
condition has a poor prognosis and becomes very intractable.
46
MCOM Acupuncture Treatment Strategyand Herbal Internal MedicineStudyGuide2009 by lH Xie
8. Abdominal Pain
Many conditions can cause abdominal pain. For TCM practitioners the key is to
understand the common causes and emergency symptoms of patients with abdominal
pain.
Table 8.1 Classification of abdominal pain
Pain Originating in the Abdomen
Parietal peritoneal • Bacterial contamination, e.g., perforated appendix, pelvic
1IJ1ldlllllldLUlyr <;:p~<;:p
• Chemical irritation, e.g., perforated ulcer, pancreatitis

Mechanical • Obstruction of the small or large intestine
obstruction of • Obstruction of the biliary tree
hollow viscera • Obstruction of the ureter
Vascular • Embolism or thrombosis
disturbances • Vascular rupture
• Pressure or torsional occlusion
• Sickle cell anemia
Abdominal wall • Distortion or traction of mesentery
• Trauma or infection of muscles
Distention of hepatic or renal capsules
visceral surfaces
Pain Referred from Extra-abdominal Source
Disorders of • Thorax, e.g., pneumonia, referred pain from coronary
adjacent organs occlusion
• Spine, e.g., radiculitis from arthritis, herpes zoster
• Genitalia, e.g., torsion of the testicle
Metabolic causes Exogenous
• Black widow spider Bite
.• Lead poisoning and others
Endogenous
• Uremia
• Diabetic ketoacidosis
• Porphyria
• Allergic factors
Neurogenic causes Organic
• Tabes dorsalis
• Herpes zoster
• Causalgia and others
Functional
Major causes of abdominal pain

• Viral gastroenteritis (stomach flu)
• Appendicitis
47
MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study G~ide 2009 ~y.lH Xie
• Intestinal obstruction
• Chronic constipation
• Diverticular disease, including diverticulitis
• Excessive gas
• Food allergy
• Lactose intolerance
• Food poisoning (salmonella, shigella)
• Heartburn or indigestion
• Gastric ulcers
• Gastroesophageal reflux
• Hernia
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Irritable bowel syndrome
• Intussusception (infants)
• Pancreatitis (inflammation of the pancreas)
• Parasitic infections
• Cholecystitis and gallstone
Other less common causes
• Early-stage shingles
• Infectious mononucleosis
• Sickle cell crisis
• Spinal fracture
• Urinary tract infections
• Kidney stones
• Dissecting abdominal aortic aneurysm
• Tumors of organs in abdominal cavity
Abdominal pain accompanied with
• Vomiting and being unable to pass stool
• Vomiting blood or blood in stool(maroon or dark, tarry black)
• Chest, neck} or shoulder pain
o Any sudden and sharp abdominal pain
• Jaundice, nausea and pain in shoulder blades
• Rigid abdomen, abdominal tenderness and rebound tenderness
• Fever
48
MCOM AcupunctureTreatmentStrategyand Herbal Internal Medicine Study Guide2009 by JH Xie
Table 8.2 Summary of TCM Etiology and Pathogenesis of Abdominal Pain

Emotional Liver qi stagnation Cold accumulation, food Abdominal pain
factors stagnation, heat (excess)
Exogenous Cold strike or accumulation, or damp
factors Coldtransforming heat accumulation cause
into heat qi and blood stagnation
Inappropriate Food stagnation or and obstruction
diets Damp heat
accumulation from
spicy and greasy food
Constitutiona I Deficient cold Malnourishment of Abdominal pain
deficiency of organs and meridian due (deficiency)
yang to yang qi and blood
deficiency

According to WHO 2002 Acupuncture Reviewand Analysis of Reports on Controlled
Clinical Trials, abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
is listed as a symptom for which the therapeutic effect of acupuncture has been shown,
but further proof is needed.
8.3.1 Verifythe medical diagnosis

8.3.2 Make TCM diagnosis based on the chief complain of the patient
8.3.3 Determine the diseased organs
In TCM theorgans related to abdominal pain include spleen, stomach, liver, gallbladder,
';\lii'""
kidney, large and small intestine. The diagnostic should be made based on the TCM
organ physiology and patfiologv. Biomedicalorgan anatomy is helpful but practitioners
should not confuse biomedical anatomy and TCM organ descriptions.
8.3.4 Differentiation based ~n eight-principle patterns and qi and blood patterns
Excess:
• Abdominal pain due to cold: Excess, acute & sudden pain, decreased with
warmth, increased by cold
• Abdominal pain due to excess heat: Abdominal full & distention, increased with
pressure, constipation, irritability, thirst, scanty dark urine
• Abdominal pain due to food stagnation: Abdominal fullness and pain, distentlon
increase with.pressure, acid regurgitation, pain relieved by emptying bowels
Deficiency:
•. Abdominal pain due to deficiency: Dull abdominal pain, relieve by warmth and
pressure, increased when hungry, fatigue
Differentiation of Qi Stagnation and Blood Stagnation
• Predominant Qi stagnation: Distention, fullness & pain, increase with anger,
indeterminate location, relief following belching or gas
• Predominant Blood Stagnation: Severe pain, stationary pain with purple or
spotted purple
49

8.4.1 Obstruction by Cold Evil
WU CAM
eV12 eV12
5T 36 5T 36
5P 4 5P4
5P 15 eV8
L14
Auxiliary Points:
For severe abdominal pain accompanied by diarrhea and cold limbs, Add salt moxa to:
(V8
8.4.2 Obstruction by Damp-Heat

WU
cvio
5T 21
L111
5T 25
5P 9
Auxiliary Points:
For thirst, add:
5T 44
8.4.3. Vacuity of Spleen Vacuity

WU CAM
5T 36 5T 36
5P 6 ev 6
UB 20
UB21
ev 12
L1V 13
Auxiliary Points:
For loose stool and diarrhea, add:
UB20
UB 23
eV4
L1V 3
8.4.4. Obstruction by Food Stasis
WU CAM
ev 12 ev 12
5T 25 5T 25
5T 21 5T 21
5T 36 5T 36
LI NEI TING LI NEI TING
50
MCOMAcupuncture Treatment Strategy and Herbal Internal Medicine Study Guide2009 by JHXie
~.4.5a. Qi Stagnation and Blood Stasis-Pre~ominant Qi Stagnation

WU
CV 17
L1V 3
PC6
GB43
Auxiliary Points:
For costal pain, add:
L1V 14
for UDDer abdominal pain, add:
CVl2
For pain in the umbilical region, add:
CV6
CVlO
. 8.4.5b. Qi Stagnation and Blood Stasis-Predominant Blood Stasis

wu CAM CT
CV 17
L1V 3
US 17
SP6
Auxiliary Points:
For costal pain:
LV 14
For upper abdominal pain:
eV12
For pain in the umbilical area:
eV6
eV10
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MCOMAcupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by JHXie
8.5 Herbal Treatment for adominal pain
Table 8.3 Herbal Treatments Based on Patterns

Cold Obstruction Liang Fu Wan + Purge Cold (Kan)
Zheng Qi Tian Xiang San (Qi-Righting Ma Zi Ren Wan
Lindera and CvperusPowder) Xiao Huo Luo Dan
• Wu Yao, Gan Jian, Xiang Fu, Zi Su
Zit Chen Pi
Trine M::Ii Si Ni Tanz
Damp Heat Da Cheng Qi Tang Purge Qi
Obstruction
Spleen Yang Xiao Jian Zhong Tang Purge Cold
Deficiency Da Jian Zhong Tang
Fu Zi Li Zhong Tang
Food Stagnation Bao He Wan
Zhi Shi Dao Zhi Wan
Qi Stagnation Chai Hu Shu Gan Tang
and Blood Stasis:
Qi stagnation
predominant
Blood stasis Shao Fu Zhu Yu Tang Purge Blood
predominant
Table 8.4 Commonly Used Herbs for Abdominal Pain
Qi Stagnation Fu Shou, Hou Po, M u Xiang, Qing Pi, Sha Ren, Tang xiang, Wu Yao,
Xiang F~, Zhi Shi and Zhi Ke
Blood Stagnation Dan Shen, Ru Xiang, Mo Yao, Hong Hua, Van Hu SUO/ Chuan Xiong,
San Leng, and EZhu
Heat accumulation Chuan Lian Zi ~,
Blood Deficiency Bai Shao Yao, Dang Gui, Ji Xue Teng

Excessive and Gao Liang Jiang, Ai Ye, Wu Zhu Yu
Deficient Cold
8.6 Prognosis
• Cold pattern and heat pattern: Abdominal pain of cold pattern may transform
into a heat pattern due to cold stagnation generating heat, or over-treated with
warm or hot herbs. A heat pattern may transform into a cold pattern due to
over-treated with heat-clearing herbs with cold property. When not treated
appropriately, a cold pattern abdominal pain may cause heart yang and kidney
yang deficiency and collapse and heat pattern abdominal pain may cause yin
fluid damage.
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MCOMAcupuncture Treatment Strategyand HerbalInternal Medicine Study Guide2009 by.lH Xie
• Qi stagnation pattern and blood stasis pattern: Qi stagnation and blood stasis
are often seen together. For abdominal pain with the pattern of blood stasis,
abdominal masses may develop. Herbs that resolve hardness may be used in
combination with blood-moving herbs.
• Food stagnation pattern: Abdominal pain due to simple food stagnation is
usually cured within 2-3 days. However if not treated promptly food stagnation
may damage the function of spleen and stomach, and stomach pain or clumping
may be resulted. Some patient may develop diarrhea.
• Complicated pattern: For the convenience of teaching and learning different
types of abdominal pain are discussed. Clinically patients often present a
complicated pattern that includes the charactensbcs or several tYpes or
abdominal pain discussed in textbook.
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MCOM AcupunctureTreatment Strategyand HerbalInternal Medicine Study Guide 2009by JH Xie
9. Diarrhea
Practical Therapeutics ofTCM Page76

Table 9.1 Classification of Diarrhea
Acute • Infections
Diarrhea • Side effects of medications
• Toxic ingestions
• Ischemia
Secretary Causes
Chronic • Exogenousstimulant laxatives
8:61 : Lea 'RF8Rii i.RiRSI iRBQftio9
• Drugs and toxins
• Endogenous laxatives (dihydroxy bile adds)
• Idiopathic secretary diarrhea
• Certain bacterial lnfections
• Bowel resectlon.dlsease, or fistula
• Partial bowel obstruction or fecal impaction
• Hormone-producing
• Addison's disease
• Congenital electrolyte absorption defects
Osmotic causes
• Osmotic laxatives
• Lactase and other disaccharide deficiencies
• Non-absorbable carbohydrates (sorbitol, lactulose,polyethylene
glycol)
~.
Steatorrhealcauses
• Intraluminal mal-dlgestion (pancreatic exocrine insufficiency,
bacterial overgrowth, liver disease)
• Mucosal mal-absorption (celiac sprue, Whipple's
disease,infections, betalipoproteinemia, ischemia)
• Postmucosal obstruction (lymphatic obstruction)
Inflammatory causes
• Idiopathic inflammatory bowel disease [Crohn's chronic
ulcerative colitis) i/o><. '
• Microscopic and collagenous colitis

• Immune-related mucosal disease (immune deficiencies, food
allergy, eosinophilic gastroenteritis, graft-vs-host disease)
• Infections (bacteria, viruses, and parasites)
II Radiation injury
• Gastrointestinal malignancies
Dysmotile causes
• Visceral neuromyopathies
• Hyperthyroidism
• Drugs (prokinetic agents)
Factitial causes
• Munchausen
• Bulimia ~--' -
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MCOMAcupunctureTreatment Strategy and HerbalInternal Medicine Study Guide 2009 byJH Xie
Major causes of diarrhea

• Viral and bacterial gastroenteritis
• Food poisoning
• Traveler's diarrhea
• Side effects of Medications( antibiotics, laxatives, magnesium, and drugs in
chemotherapy)
• Malabsorption syndromes (Celiac diseasesuch and lactose intolerance)
• Inflammatory bowel diseases (Crohn's disease and ulcerative colitis)
• Irritable bowel syndrome (IBS)
Other less common causes of diarrhea
• Zollinger-Ellison syndrome
• Neutopathy (autonomic neuropathy or diabetic neuropathy)
• Carcinoid syndrome
• Gastrectomy
• High dose radiation therapy
Diarrhea with
• High fever, blood or pus in stool
• Severe abdominal pain that is not relieved by a bowel movement
• serious symptoms of dehydration
Table 9.1 Summary ofTCM Etiology and Pathogenesis of Diarrhea

Cold dampness in spleen
Exogenous
Summer heat dampness
factors
Damp heat in large intestine
Emotional Liver qi stagnation due to anger, worry
factors and stress, attacking spleen
Contaminated food, sweet and greasy
Improper Diarrhea
food, over-eating causing dysfunction of
diets
spleen and stomach
Spleen deficiency or
Deficiency Kidney yang deficiency due to aging,
of organs chronic illness, weak constitution, kidney
yang failing to warming spleen yang

Acupuncture and herbal treatment has a good effect for diarrhea due to viral and
bacterial gastroenteritis, food poisoning and traveler's diarrhea. According to WHO 2002
Acupuncture Review and Analysis of Reports on Controlled Clinical Trials,
Chronic ulcerative colitis is listed as a condition for which the therapeutic effect of
acupuncture has been shown but further proof is needed.
9.3.1 Verify medical diagnosis and make a TCM diagnosis based on the symptoms.
9.3.2 Differentiate acute and chronic diarrhea.
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MCOM Acupuncture Treatment Strategyand Herbal Internal Medicine StudyGuide 2009 by JH Xie
Differentiation of chronic and acute diarrhea is not induded in regular pattern

differentiation; however it is routine in TCM management of diarrhea. Acute diarrhea
usually includes excessive patterns while chronic diarrhea includes deficient patterns or
complicated patterns of excess and deficiency.
9.3.3 Differentiate cold, heat, excessive and deficient aspect in diarrhea.
Table 9.2 Differentiation of Cold, Heat, Excess and Deficiency in Diarrhea

Patterns Symptoms
Excess Acute onset, swift transmission, abdominal fullness and pain worsened on
pressure and relieved after bowel movement
Deficiency Chronic illness, mild abdominal pain relieved with pressure, and not thirst
Cold Diarrhea with clear and watery stool and indigested food, abdominal pain
relieved with warmth, and cold limbs
Heat Diarrhea with yellow and foul- smelling stool, burning sensation around
anus, cramping and urgent feeling, scanty and dark urine, and thirst
9.3.3 Differentiate the location of illness.

Diarrhea is usually the result of dysfunction of spleen, stomach and large intestine.
However in complicated patterns often other organs such as liver and kidney may be
involved.
9.3.4 Important points in clinical decision-making.
• The balance between expelling pathogenic factors and regulating the organs'
functions: For acute diarrhea expelling pathogenic factors are the priority of
treatment. For chronic diarrhea a method of combining replenishing organs and
expelling pathogenic factors is used.
• The balance between expelling pathogenic factors and stopping diarrhea with
astringent herbs: Astringent herbs should be used with cautions. For acute
diarrhea not astringent herbs should be used unless the diarrhea is very serious
and there is a concern of body fluid exhaustion, and ql, yin and yang collapse.
Astringent herbs may be used with cautions for chronic deficient patterns .of
diarrhea.
9.4 Acupuncture Treatment"
9.4. 1 Attack by External Cold and Dampness
WU CAM CT
5T25 ST25 ST25
CV 12 CV 12 CV 12
5T 36 ST 36 5T37
LI 4 CV 6 L/4
SP 9
Auxiliary Points:
For severe abdominal pain
CV 8
9.4. 2 Attack by External Damp-Heat
WU CAM CT
56
MCOM AcupunctureTreatment Strategyand HerbalInternal MedicineStudy Guide 2009 by JH Xie
5T25 5T25 5T25

5T44 5T44 5T44
5T36 5T36 5T36
5P 9 5P 9 UB40
L111 L14
CV 12, Jin Jie Yu Ye
9.4.3 Retention of Food in the Stomach and Intestines

wu CAM CT
U NEI TING LI NEJ riNG LI NEITING
CV 12 5T 25 CV 12
57
36 STaG
5T25 5T25 UB20
UB 21
L1V 13
CV21
CVl1
Auxiliary Points:
For vomiting, add:
PC6
5P 4
9.4. 4 Disharmony of liver and Spleen

WU CAM CT
5T25 5T25
5T36 5T36
UB 18 US 18
L1V 3 L1V 3
GB34 GB34
CV 12 CV12
UB 20
L1V 14
9.4. 5 Vacuity of the Spleen and Stomach
WU CAM CT
US 20 US20 US 20
CV 12 CV 12 C\l12
5T 36 5T 36 5T 36
5P 3 5P 3 5P 6
5T 25 L1V 13 5T 25
UB 25 UB 25
UB 26 CV9
UB 21
9.4. 6Vacuity of Kidney and SpleenYang
WU CAM CT
UB 23 UB 23 UB 23
CV4 CV4 CV4
UB20 UB20 UB 20
5T 36 5T 36 5T36
DU 4 DU4 CV12
KD 3 KD 3 L1V 13
5T25
Auxiliary Points:
For severe abdominal pain, add:
CV4,CV8
57
9.5 Herbal Treatment for Diarrhea

External Cold Huo Xiang Zheng Qi San
Dampness Wei Ling Tang (Wu Ling San + Ping Wei
San)
External Damp Heat Ge Gen Huang Qin Huang Lian Tang Huang Lian Jie Du
Ping Wei San Tang+
Ping Wei San
CI"'\f"'\r1 ... ~ L' ,n RriO He Wrin
Zhi Shi Dao Zhi Wan
Disharmony of Spleen Tong Xie Yao Fan Harmonize Liver &
and Liver Spleen (Kan)
Irritease (Kan)
Spleen and Stomach Fu Zi Li Zhong Tang
Deficiency Bu Zhong Yi Qi Tang for preventive and
maintaining treatment
Kidney and Spleen Si Shen Wan Purge Cold (Kan) +
Yang Deficiency Tao Hua Tang Consolidate Qi (Kan)
• Chi Shi Zi (haloysite), Gan Jiang
and non-glutinous rice
9.6 Prognosis
The prognosis of patients with diarrhea depends very much on the underlying
medical diagnosis, the severity of pathogenic factors and the strength of vital qi.
Most patients of acute diarrhea classified as the pattern of exterior pathogenic
factor invasion (cold dampness and damp heat), and pattern of food stagnation
will be cured with proper treatments,
Diarrhea classified as the pattern q.f liver attacking spleen or yang deficiency of
spleen and kidney is usually chronic. These patterns should be treated primarily
with a method of replenishing. Maintaining treatment is necessary even after
the diarrhea is stopped.
Some patients with acute diarrhea may develop into chronic. Dangerous pattern
may develop in elderly or weak patients with sudden serious diarrhea 'or chronic
intractable diarrhea.
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MCOM Acupuncture Treatment Strategy and Herbal1nternal Medicine Study Guide 2009 by JH Xie
10. Dysentery
10..1 Biomedical Review

Dysentery usually refers to bacterial and amoebic dysentery. The symptoms and signs of
dysentery disorder discussed in this chapter may be also associated with other
inflammatory diseases of bowels such as inflammatory bowel disease (IBD), Crohn's
disease, ulcerative colitis, anorectal abscess, infectious colitis (infection of the colon),
colorectal cancer or tumors and radiation proctitis or colitis (inflammation of the colon
or rectum from radiation) although these conditions are not diagnosed as dysentery in
bibi "edreal Pi dcUce.
Tenesmus is the constant feeling of the need to empty the bowels, accompanied by pain,
cramping; and involuntary straining efforts.
Dysentery accompanied with high fever, chills, blood in the stool, nausea, or
vomiting, restlessness, convulsion, unconsciousness, profuse sweating and
shortness of breath.
• Children may have above symptoms even before the dysentery symptoms.
Table 10.1 Summary of reM Etiology and Pathogenesis

Cold Dampness
Dysentery cold
Damp Heat Dampness accumulation
dampness type or
Contaminated Qi and blood stagnation
damp heat type
Food
Toxin accumulation, qi
and blood stagnation, Epidemic toxic
Pestilent toxin
toxin transmitting into dysentery
ying and blood levels
chronic intermittent .
Vital qi deficiency
Yang and qi deficiency of Spleen and dysentery with
with lingering
stomach deficient and excess
pathogenic factors
complications

According to WHO 2002 Acupuncture Review and Analysis of Reports on Controlled
Clinical Trials, acute bacillary dysentery is listed as a condition for which acupuncture
has been proved, through controlled trials, to be an effective treatment.
10.3.1 All patients with dysentery should be medically evaluated.
10.3.2 Verify medical diagnosis and make.a TCMdiagnosis based on typical symptoms.
10.3.3 Dysentery disorder should be differentiated with regular diarrhea pattern.
10.3.4 Differentiate cold dampness pattern and damp heat pattern and exclude the
epidemic toxic dysentery pattern in acute dysentery condition.
10.3.5 Differentiate yin deficiency dysentery, yang deficiency dysentery and chronic
intermittent dysentery in chronic patients.
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MCOMAcupunctureTreatment Strategyand Herbal Internal Medicine Study Guide2009 by JH Xie
10.3.6 Herbs that promote sweating and promote urination should been used with great
cautions. When necessary mild promoting-sweating herbs should be used and
discontinued immediately after the exterior pattern is resolved. Promoting-urination
herbs may be used for short periods in case of serious dampness. Inadequate use of
these two types of herbs may damage yin, disturb blood, and cause yin deficiency
dysentery. In the initial stage of dysentery disorder, warming-astringent herbs should
be avoided; otherwise toxin pathogenic factors may stay and cause an intractable
condition.
Table 10.2 Differentiation between Dysentery Disorder and Diarrhea

"jiB.1SP; Diarrhea
Both conditions may be caused by exogenous pathogenic factors and
improper (contaminated) food. Both conditions may have symptoms
such as abdominal pain and increased frequency of bowel movement
Pathogenesis Accumulation of pathogenic Dysfunction of spleen and
factors and stagnation of qi and stomach and failure of separating
blood turbid and clear fluid causing
dampness accumulation
Symptoms Stool mixed with pus and blood, Watery stool or indigested
tenesmus, and difficult bowel food in stool, or incontinence
movement
Contagious Most cases are contagious Some cases are contagious
Principle of Expelling pathogenic factors, Expelling pathogenic factors,

Treatment removing accumulation, regulating functions of spleen
regulating qi and blood and stomach, resolving
dampness
Table 10.3 Differentiation among Cold Dampness,

Damp Heat and Epidemic Toxic Dysentery
Damp Heat Cold Dampness Epidemic Toxic
Dysentery Dysentery disorder, Dysentery disorder, St,9ol mixed with pus
symptoms stool mixed with both stool mixed pus and and blood
pus and blood, bright blood (pus being more
blood, dark yellow and predominant)
Q. foul-smelling,
Accompanie Burning sensation in Not apparent thirst, Sudden onset of illness.

d sYmptorT!s the anus, thirst, fever, heaviness of the head Serious symptoms such
and signs yellow and slimy and limbs, white slimy as high fever,
tongue coating coating of the tongue headache, restlessness,
loss of consciousness
with convulsions may
develop very quick
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by.l H Xie

Damp Heat L14, 5T25, 5T37, L11l, 5P9
For fever add: DU14 -
For tenesmus add: BL29, DUl
For inability to take food or drink, add:CV12, PC6
Epidemic Toxic L14, 5T25, 5T37,DU14, 5hi Xuan (bleed) -
Heat For loss of consciousness with convulsions, to open the orifice and
return consciousness, needle: DU26, Kil
For drain heat and extinguish wind: LR3, BL40 -
Cold Dampness L14, 5T25, 5T37, 5P9, CV12
Yin Deficiency L14, 5T25, 5T37, K16, 5P6
-
Dysentery
Deficient Cold L14, 5T25, 5T37, BL20, BL23
Dysentery For anal prolapsed, add: DUi,.D U20
Chronic '-14, 5T25, 5T37, CV4, 5T36
-
Inte rrnitte nt
Dysentery ~ -
10.5 Herbal Treatment
Textbook
Damp Heat 5hao Yao Tang Huang Lian Jla Ou Tang + Bai
• Bai 5hao Yao, Huang Ilan, Jiang CaD, Bai Tou Weng
Huang Qin, Dang Gui, Da Coptis ExtractTablets (Kan or
Huang, Bing Lang, Mu Xiang, Mayway)
Gan Cao, Rou Gui Xiang Lian Wan (Aucklandia &
Ge Gen Huang Qin Huang Lian Tang Coptis Teapills, Mayway)
Bai Tou WengTang
Epidemic Toxic Bai Tou Weng Tang plus heat-toxins-
Heat c1ea ring herbs
5hen Fu Tang (Ginseng and Aconite
Decoction) for collapse patterns
Cold Dampness Wei Ling Tang Wu Ling San + Ping Wei San +
Delete: Ze Xie and Fu Ling Xiang Lian Wan
Add: Bal5hao Yao and Dang Gui
Yin Deficiency Zhu Che Wan (Carriage-Halting Pill) 5i WuTang+
Dysentery • Huang Lian, Dang Gui, E Jiao, Xiang Lian Wan (Aucklandia
PaD .lian & Coptis Teapills, M ayway)
Deficient Cold Zhen Ren Yang Zang Tang Purge Cold (Kan) plus Wu Wei
Dysentery Bu Zhong Yi Qi Tang Zi, He Zi, Huang Lian
Chronic Huang Lian Li ZhongTang (Lian Li Li Zhong Tang +
lnte rm ittent Tang) Xiang Lian Wan (Aucklandia &
Dysentery Coptis Teapills, Mayway)
61
10.6 Prognosis
Most patients with dysentery, except those with epidemic toxic dysentery, have
favorable prognosis.
Patients should be treated thoroughly in order to prevent the development of
chronic dysentery.
62
11. Constipation

Constipation refers to infrequent or hard stools, or difficulty passing stools. Constipation
may involve pain during the passage of a bowel movement, inability to pass a bowel
movement after straining or pushing for more than 10 minutes, or no bowel movements
after more than 3 days. Infants who are exclusively breastfed may go 7 days without a
stool.
COiiiiiiOii causes of cOiiSLIpatlUii
A low-fiber diet,
Lack of physical activity,
Not drinking enough water,
Delay in going to the bathroom when you have the urge to defecate
Stress and travel
Pregnant women
Side effects of some medications
Diseases of the bowel (such as irritable bowel syndrome),
Other less common causes of constipation
Hypothyroidism
Cystic fibrosis
Metal health problems
Neurological diseases (such as neuropathy)
Colon cancer
Constipation accompanied with
• Sudden constipation with abdominal cramps and an inability to pass gas or stool
• Sharp or severe abdominal pain
Medical evaluation may be required when the patient has constipation accompanied
with
• Thin, pencil-like stools
• Rectal pain
• Unexplained weight loss
63
Table 11.1 Summary of TCM Etiology and Pathogenesis of Constipation

Heat or yang excess constitution/ over Dry and
indulgence in alcohol/ spicy and hot food/ Excessive heat unsmooth
or warming or hot herbs/ lingering heat in stomach and intestine
from febrile disease/ lung heat intestine
transmitting into large intestine
Spleen qi stagnation due to over-thinking/
Qi stagnation
liver qi stagnation due to anger/ lung qi
Qi stagnation in intestines
stagnatigp sedeptary ute and DRrasites
accumulation
Yin deficiency constitution/ yin deficiency
Dryness in
due to giving child-birth/ blood loss/ over Yin and blood
intestines Constipations
use of diaphoretics or hot/ warming deficiency
drying herbs/ and overstrain
Cold
Cold accumulation
Cold invasion/ over use of cold herbs
accumulation and qi
stagnation
Weakness in
Deficient constitution/ elderly patient/ Yang and. qi transportation
over-treated with cold and purging herbs deficiency and cold
congealed in
intestines

11.3.1 Verify the medical diagnosis and make rCM diagnosis based on symptoms
11.3.2 Differentiate excess and deficiency/ cold and heat/ qi stagnation and blood yin
deficiency in constipation.
Table 11.2 Differentiating Diagnosis of Constipation

Patterns Symptoms
Heat accumulation Dry and hard stool/ hot feeling around the anus/ thick yellow
tongue coating
Cold accumulation Difficulty bowel movement/ pale tongue and white slippery
coating
Qi stagnation Unsmooth bowel movement
Qi deficiency Difficulty bowel movement due to lake of strength/ pale tongue
and scanty coating
Deficiency of Dry stool/ red tongue with scanty coating
yin/blood
11.3.3 Identify other organs involved in addition to large intestine.
64
11.3.4 Constipation is often caused by life style problems (diets] water intake an
exercise). Life style modifications should always be tried before or together with
acupuncture and herbal treatments. Drastic bitter and cold purgatives (herbs) should be
used with cautions in patients with chronic constipation. A comprehensive treatment
including method of regulating internal organs' functions will be better to those patients.

11.4.1 Heat Constipation
WU CAM CT
ll11 Llll Ll11
11 4 1/4 11 4
ST25 ST25 ST 36
UB25 UB 25 SP 15
SJ 6 SJ 6
KD 6 KD 6
Auxiliary Points:
For irritability, fever and thirst, add:
HT8 HT8
CV23 CV23
For headache] add:
Yin tang
For halitosis] add:
CV24 CV24
HT8
11.4.2 Qi Stagnation Constipation

WU CAM CT
ST25 ST25 ST25
UB 25 UB 25 GB 34
CV 12 CV 12 CV 12
L1V 3 L1V 3 L1V 2
SJ 6 SJ 6 CV6
CV 6 KD 6
Auxiliary Points:
For severe costal pain, add:
LlV 14 L1V 14
GB 24 SJ 6
11.4.3 Qi Vacuity Constipation

WU CAM CT
ST25 ST25 ST25
US 25 UB 25 US 25
US 20 UB 20 UB 20
ST36 ST36 ST36
CV4 UB21 CV4
SP 6 KD 6 US 21
SJ 6 SP 6
Auxiliary Points:
For persplratlon, add:
KD 7
65
11.4.4 Blood Vacuity Constipation

WU CAM CT
ST 25 ST 25
UB 25 UB 25
ST36 ST36
SP 14 UB 21
CV 4 UB 20
SP 6 SJ 6
Auxiliary Points:
For palpitation, add:
PC 6
For yin vacuity with internal heat, add:
KP 5
11.4.5 Cold Constipation

WU CAM CT
ST 25 ST25 ST25
UB 25 UB 25 CV 5
CV6 CV6 CV6
KD6 ko 6 KD 6
CV4 SJ 6 CV4
UB 23 UB 23 UB 20
Auxiliary Points:
For severe yang vacuity, add moxibustion of:
CV8 CV8
For anal prolapse, add:
DU 1 DU 1
DU 20 OU 20
11.5 Herbal Treatment for Constipations

Heat Ma Zl Ren Wan Ma Zi Ren Wan
Accumulation
.Qi Stagnation Liu Mo Yin [Slx-Milled Ingredients Chai Hu Shu Gan Tang +
Beverage) Ma Zi Ren Wan
Qi Deficiency Huang Qi Tang Bu Zhong Yi Qi Tang +
• Huang Qi, Chen Pi, Huo Ma Ren, Feng Mi Run Chang Wan
Blood Deficiency Run Chang Wan Run Chang Wan, or
Wu Ren Wan
Cold Ji Chuan Jian You Gui Wan + Run -
Accumulation Chang Wan
Table 12.4 Commonly Used Herbs for Constipations

Excessive Heat Oa Huang} Fan Xie Ye} Hou Po} Lu Hui
Dryness or Dang Gui} Gua Lou Ren} He Shou Wu} He Zi M a} Hu Tao Ren} Huo Ma
Deficiency Ren, Hu Ma Ren} JueMing Zl, Rou Cong Rang} Sheng Di Huang} Tao
Ren, Xing Ren, Yu Li Ren
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MCOMAcupunctureTreatment Strategy and Herbal Internal Medicine StudyGuide2009 by JH Xie
11.6 Prognosis
• The prognosis of the patients with constipation depends on their constitution.
hlstorv, involved organs and the strength of vital qi.
• Acupuncture or herbs are helpful for constipation due to common causes.
• Most uncomplicated patients with a short history may have relief within 1-2 weeks.
• Chronic patients with vital qi deficiency and a history of inappropriate treatment may
become very intractable.
• Constipation is often a trigger of hemorrhoid, dizziness and angina pectoris.
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MCOMAcupuncture TreatmentStrategyand HerbalInternal MedicineStudyGuide 2009byJH Xie
12. Lateral Costal Pain


Lateral costal region is not a well-defined anatomical term. Lateral costal pain usually
refers to side chest pain resulted from the disorders of liver, gall bladder, pleura, nerves
and muscle, such as
• Hepatitis
• Fatty liver diseases
• Hepatomegaly (liver abscess, cirrhosis, cancer, and etc.)
• Cholecystitis
• tholeHthlasls
• Traumatic injury
• Costal chondritis
• Intercostal neuralgia
• Muscle spasm
Lateral costal pain may occasionally be caused by spinal arthritis and vertebral disk
disease.
Flank pain may be described as lateral costal pain by some patients. Flank pain refers to
pain in one side of the body between the upper abdomen and the back. Ifflank pain is
accompanied by fever, chills, blood in the urine, or frequent or urgent urination, then a
kidney problem is the likely cause. That is not discussed in the chapter of lateral costal
pain in TCM therapeutics.
Emergency symptoms may include:
• Severe tenderness over the liver area with or without jaundice may be caused
by gall bladder disease, liver abscess, and severe venoocclusive disease or an
occasional accompaniment of acute hepatitis
• Severe lateral costal pain due to traumatic injury (fracture, pneumothorax and
internal bleeding)
• Lateral costal pain accompanied with dyspnea and palpitation (pneumothorax)
12.2 rCM Etiology and Pathology
Table 12.1 Summary of TCM Etiology and Pathology
Liver qi stagnation
Lateral costal
Blood stasis pain
(excessive
patterns)
Chronic illness,
Malnourishment
overstrain, blood lose, Lateral costal
of collaterals in
overindu Igent sexual Liver yin deficiency lateral costal pain (deficient
activity causing essence patterns)
region
deficiency
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MCOMAcupunctureTreatment Strategy and HerbalInternal Medicine
Study Guide 2009 by JH Xie
Auxiliary Points:
For vomiti ng, and nausea , add;
CV12
For acid regurg ltatlon , add:
UB21
12.4.2 Stasis of Liver Blood

WU CT
L1V 14 L1V 4
L1V 3 L1V 3
US 17 US 17
SP 6 SP 6
GB25
SP 21 ST36
'-'4 SJ 6
12.4.3 Liver and Gallbl adder Damp- Heat

wu CT
L1V 14 L1V 14
L1V 3 L1V 3
SJ 6 SJ 6
GB34 GB34
SP9 ST36
GB 24 PC 6
Auxiliary Points:
For severe heat, add:
GB 14
For irritability, add:
PC4
For nausea and abdom inal distent ion, add
ST36 .
CV 12
For jaundic e, add:
DU 9
12.4.4 Vacuity of Liver Yin

WU CT
L1V 14 L1V 14
UB 18 US 18
US 23 US 23
SP 6 SP 6
SP 10 ST 36
KD 3
Auxiliary Points:
For dizziness, add:
DU 20
For tidal fever, add:
UB 43
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MCOMAcupunctureTreatment Strategy and Herbal Internal MedicineStudy Guide 2009 by JHXie

Clinical Trials, cholelithiasis and chronic cholecystitis with acute exacerbation are two
conditions for which the therapeutic effect of acupuncture has been shown but for
further proof is needed.

12.3.2 Lateral costal pain should be differentiated with stomach pain, abdominal pain
and thoracic Bi (angina pectoris).
12.3.3 In TCM practice, lateral costal pain is usually classified as two types: excessive
and defiCient type. ExcesSive lateral costal pam ifltlddt!S pattE; Ii or 41 SldgilstlOii, blood
stagnation and damp heat. Deficient lateral costal pain includes pattern of liveryin
blood deficiency. The pattern differentiation is based primarily on the nature of pain
and the accompanied symptoms.
12.3.4 General principles for excessive patterns of lateral costal pain include regulating
ql, promoting blood circulation, clearing away heat and resolving dampness. The general
principles for deficient patterns of lateral costal pain include nourishing yin and blood,
soothing liver and very gently regulating qi and harmonizing collaterals. High doses or
long term use of pungent and dry herbs for regulating qi should be avoided.
Table 12.2 Excess and Deficiency Differentiation of Lateral Costal Pain in TeM
Excessive Patterns Deficient Patterns
Pattern of Onset Acute, with short history Chronic with long history
Severity of pain Severe pain Dull pain
tenderness Tenderness on pressing Relieved with pressing
constitution Strong Weak
Pulse Full and forceful weak
Table 12.3 Pattern Differentiation of lateral Costal Pain in TCIYI

Qi stagnation Distending pain, wandering pain, pain on and off, pain due to
emotional disturbance
Blood stasis Pricking pain, with fixed location, constant pain, pain worsened by
pressing, pain worse during the night
Damp heat Pain with heaviness, fixed pain, periodical pain
Yindeficiency Dull pain, lingering pain, pain relieved by massage, pain worsened by
exertion

12.4.1 Stagnation of liver Qi
WU CT
L1V 14 LlV 14
5J 6 5J 6
L1V 3 L1V 3
GB 34 GB34
UB 18 5T36
69
MCOM Acupuncture Treatment Str~tegy and Herballnternal Medicine Study Guide 2009 by JHXie
13. Jaundice
The bilirubin present in serum represents a balance between input from production and
hepatic / biliary removal of bilirubin. Hyperbilirubinemia may result from (1)
overproduction of bilirubin; (2) impaired uptake, conjugation, or excretion of bilirubin;
or (3) regurgitation of unconjugated or conjugated bilirubin from damaged hepatocytes
or bile ducts. An increase in unconjugated bilirubin in serum results from
overproduction, impairment of uptake, or conjugation of bilirubin. "An increase in
conjugated bilirubin is due to decreased excretion in to the bile ductules or backward
liiltiS8 &if tRG "iBTOP+
In evaluating the patient with jaundice it is important to determine (1) whether the
hyperbilirubinemia is predominantly conjugated or unconjugated in nature, and (2)
whether other biochemical liver tests are abnormal.
Common causes of jaundice
• Hepatitis
• Hepatic Cirrhosis
• Side effect of medications (drug-induced cholestasls, drug-induced hepatitis)
• Biliary atresia
• Blockage of the bile ducts (by infection, tumor, biliary stricture or gallstones)
• Congenital disorders of bilirubin meta bolism
• Hemolytic jaundice
• Malaria
• Pancreatic carcinoma
Causes of jaundice in children
• Newborn jaundice (physiologic jaundice)
• Breastfeeding jaundice
• Breast milkjaundice
• Viral hepatitis (hepatitis AI hepatitis B I hepatitis C, hepatitis D, and hepatitis E)
• Hemolytic anemia
• Disorders present since birth that cause problems processing bilirubin (Gilbert's
syndrome, Dubin-Johnson syndrome, Rotor's syndrome, or Crigler-Najjar
syndromes)
• Biliary atresia
• Autoimmune hepatitis
• Malaria
All patients with jaundice should be medically evaluated.
72
12.5 Herbal Treatment of Lateral Costal Pain

Patterns Formulas Recommended Practical Options
in Textbook
Liver Oi Stagnation Chai Hu Shu Gan Tang
Liver Blood Stasis Ge Xia Zhu Yu Tang
Fu Yuan Huo Xue Tang
Liver an 'Gallbladder Long Dan Xie Gan Tang Li Dan Support (especially for
Damp Heat Idu=rdl LU~Ldl J.ldlll UUI:: LU
cholelithiasis and chronic

-
ch 0 Iecystitis)
Liver Yin Deficiency Vi Guan Jian
Table 12.5 Commonly Used Herbs for Lateral Costal Pain

Oi stagnation Bo He, Chai Hu, Chuan Lian Zi, Fo Shou, Oing Pi, Xiang Fu, Zhi Ke
Blood stagnation Chuan Xiong, Jiang xlang, Pu Huan r Van Hu Suo, Yu Jin
12.6 Prognosis
Prognosis depends on the underlying medical diagnosis and TCM patterns.
The pattern of live qi stagnation is usually curable. This pattern may transform
into a pattern of qi stagnation with liver fire, then a pattern of liver yin
deficiency. A pattern of liver qi stagnation may also cause the pattern
disharmony of liver and spleen in which lateral costal pain is seen together with
symptoms of spleen dysfunction. This pattern may also transform into a pattern
of blood stasis which is very intractable.
A pattern of blood stasis may develop into a pattern of hard mass.
A pattern of damp heat is usually curable, although some patients with this
pattern may develop a pattern of lingering damp heat in which lateral costal
pain becomes chronic.
In patients with lateral costal pain due to gall bladder stones the symptoms of
liver and gall bladder fire may be improved soon after treatment, but the
removal of stones takes a longer period of treatment. Surgery may be necessary
in some cases.
Lateral costal pain classified as liver yin blood deficiency is usually chronic.
Maintaining treatment is needed even after the pain is relieved.
71
Table 13.3 Differentiation of Yin and Yang Jaundice in TeM

Patterns Symptoms
yellow discoloration eyes/skin! unsurfaced
fever
feeling of heaviness! fullness & discomfort
chest
Yang Damp Predominant
loss of appetite, nausea, vomiting! thirst with
Jaundice Heat Predominant
little liquid intake
bright yellow discoloration eyes/skin, fever
& thirst! dark yellow scanty urine and
co I iJti ~B,i8 iii
dull yellow eyes/skin, feelings of heaviness &
Cold dampness in
Yin Jaundice fatigue, oppression of epigastrium,
spleen
reduced food intake! no apparent thirst
sudden onset jaundice, high fever/ vexing
thirst
Acute Yang Toxic heat causing
coastal pain/ abdominal pain, loss
Jaundice jaundice
co nscio usness
epltaslxls, dermal maculae stasis

13.4.1a. Heat-Predominant Yang Jaundice
WU ~M cr
DU9 DU9 514
UB19 UB19 UB19
GB34 GB34 GB34
L1V3 L1V3 L1V3
UB18 UB18
DU14 SP9
ST36
Auxiliary Points:
For abdominal distention and constipation! add:
ST25
UB25 UB25
L1V14
5J6
For fever, add:
DU14
13.4.1b. Dampness-PredominantYang Jaundice

WU ~M cr
DU9 DU9 DUg
UB19 UB19 UB19
UB18 UB18 UB20
GB34 GB34 CV12
SP9 SP9 SP6
L1V3 LlV3 ST36
ST36
74
Table 13.1 Summary of TCM Etiology and Pathogenesis of Jaundice

Dysfunction of spleen and
Invasion of epidemic stomach causing damp heat
pestilent qi obstruction in liver and gall
bladder
Internally generated damp
Improper diet and over
heat obstructing in liver and"
ind ulgence in alcohol
gall bladder
Spleen yang and gj
deficiency or
Cold dampness obstruction in Jaundice
spleen yang damaged by
liver and gall bladder
dampness in yang
jaundice

Patients with cholelithiasis and chronic cholecystitis with acute exacerbation may have
jaundice. According to WHO 2002 Acupuncture Review and Analysis of Reports on
Controlled Clinical Trlals, for these two conditions therapeutic effect of acupuncture has
been shown but proof is need.
13.3.1 Verify medical diagnosis and make TeM diagnosis based on symptoms.
13.3.2 In TCM theory, jaundice is caused by dampness. It involves spleen, stomach, liver
and gall bladder. The jaundice is usually classified into three categories, yang type, yin
type and acute yang jaundice. The differentiation of yin type jaundice and yang type
jaundice is primarily based on the color of jaundice and accompanied symptoms.
According to the textbook yang jaundice is further divided into heat Predominant Yang
jaundice and damp Predominant Yang jaundice. This classification is helpful, but
clinically yang jaundice is often classified into three patterns, e.g., yang jaundice due to
spleen and stomach damp heat, damp heat in liver and gall bladder and heat and stone
stagnation in gall bladder, whIle yin jaundice could be further classified into pattern of
cold dampness in spleen and pattern of blood stasis in liver and gall bladder. Acute yang
jaundice could be further classified as a pattern of toxic heat causing jaundice and a
pattern of toxic heat sinking into pericardium.
Table 13.2 TCM Clinical Classification of Jaundice

Current Chinese Textbook Textbook (Wu)
Damp heat in spleen and stomach
Yang
Damp heat in liver and gallbladder
Jaundice
Damp heat and stone in gallbladder
Cold dampness in spleen
Yin Jaundice
Blood stasis in gallbladder
Toxic heat causing jaundice
Acute Yang Toxic heat causing jaundice and
Toxic heat causing jaundice
Jaundice sinking into pericardium and ying
(nutritive) or blood level
73

Damp Predominant Yin Chao Hao Tang Li Dan Support (Kan)
Yang Jaundice Da Chai Hu Tang (gallstone obstruction) + Ping Wei San
Wu Mei Wan (Mume Pill)
• Wu Mei, Wu Mei Wan (round
• Fu Zi, Gang Jiang, Huang Jiao, worm obstruction)
Gui Zhi, Xi Xin
• Huang Lian, Huang Bal
• Ren Shen, Dang Gui,
.. _. . J i n":ln 'rlnnnrt..j..
1. __ . . . . . . . . . . . . . "",. "'" rIO
·v
Yang Jaundice Gan Lu Xiao Du Dan (damp and heat Huang Lian Jie Du
equally serious) Tang
Acute Yang Jaundice Xi Jiao San (Rhinocceros Horn Powder)
• Xi Jlao, Huang Llan, Sheng Ma,
Zhi Zl, Yin Chen Hao
Yin Jaundice: Yin Chen Zhu Fu Tang Li Dan Support +
Cold dampness in Xiao Yao San (disharmony of liver and Li Zhong Tang or Fu
spleen spleen) Zi Ling Zhong Tang

According to rCM theory yang jaundice dassified as pattern of damp heat in
liver and gall bladder and pattern of damp heat in spleen and stomach can be
resolved. shortly after treatment. Yang jaundice classified as pattern of heat and
stone in gall bladder is more intractable. Acute yang jaundice ls very serious
pattern. Yin jaundice classified a pattern of cold dampness in spleen and
stomach is mild and can be resolved with proper treatment, while yin jaundice
with blood stasis is intractable.
Yang jaundice may transform into the pattern of acute yang jaundice. Yang
jaundice may also transform into yin ja undice if the pattern is over treated with
cold and bitter herbs.
Yin jaundice may transform into "abdominal mass" or "drum distension" pattern.
76
MCOM AcupunctureTreatment Strategyand Herbal Internal Medicine Study Guide 2009 by JH Xie
Auxiliary Points:
For fever, add:
Ll4
For nausea and oppression in the chest, add:
pe6
5P4
For fullness of the epigastrium and loose stools, add:
5T36
13.4.1c. Acute Yang Jaundice

WU CAM CT
0,,9 PU26
DU14 GY14
GB34 6834
UB19 UB19
UB18 UB18
L1V3 L1V3
L14
Auxiliary Points:
For loss of consciousness, let blood at:
DU26
pe6
HT9
For epistaxis and hemafecia, add:
UB40
KDl
13.4.2 Yin Jaundice
WU CAM CT
UB20 UB20 UB20
5T36 5T36 5T36
UB19 UB19 L1V13
5P9 5P9 514
5P6 UB48 SP6
eV12 DU9 CV12
UB18
Auxiliary Points:
For lassitude and chills, add:
DU4 DU4
eV6 CV4
For loose stools, add:
eV4
5T25
75
MCOM Acupuncture Treatment Strategyand Herbal Internal Medicine Study Guide2009by JH Xie
" ' .
14.3.3 The condition usually involves the dysfunction of liver, spleen and kidney. The
predominantly involved organ should be identified.
14.3.4 The condition is usually classified as a pattern of primary deficiency with
secondary excess (qi and blood stagnation with pathological water accumulation). Two
things need to be further clarified after the primary diagnosis. The first is to evaluate the
predominance of deficiency and excess. Some patients' condition will predominantly be
primary deficient with only mild excess, while some will predominantly be excessive and
have no much deficient signs. The second is to evaluate the predominant excessive
factors, e.g., qi stagnation, blood stagnation and dampness water accumulation.
..L"'t'."'t' .,. ,- .. -.- . . ~ l"\ ...... .,
Patterns Acupuncture Prescription-

Qi Stagnation and CV6, LR3, CV9, cviz, STZS, SP9
Obstruction of Dampness
Cold Dampness in Spleen eV9, LR13, BLZo., SP4, eV12, SP9
Damp Heat eV9,GB34,LR2,ST44,ST2S,ST37
Spleen Qi Stagnation and LR14,LR13,CVS,SP6,ST36,CV9
Liver Blood Stasis
Ya ng Deficiency of Spleen BL20, BL23, CV9, K17, eV4, ST 36
and Kidney
Liver and Kidney Yin BL18, BL23, CVS, CV9, SP6, K/7
Deflciencv
78
14. Drum Distension


Drum distension is similar to ascites in modern medicine. Ascites is excess fluid in the
peritoneal cavity.
Ascites is often caused by:
• Cirrhosis
• Hepatitis
• Portal vein thrombosis (clots in the veins of the liver)
• Peritonitis
• Schistosomiasis
• Constrictive pericarditis
• Congestive heart fai1ure
• Liver cancer
• Ovarian cancer
• Protein-losing enteropathy
• Nephrotic syndrome
• Pancreatitis
According to the textbook drum distension is described as a condition resemblance of a
swollen and distended abdomen to askin stretched over a drum with enlargement and
distention of the abdomen , greenish-yellow discoloration of the skin and a protrusion of
superficial abdominal blood vessels. These features are more commonly seen at the
later stages of ascites due to cirrhosis, peritonitis (peritoneal tuberculosis), and tumors
in peritoneal cavity.
Emergency and Medical Evaluation
Medical evaluation is required for all patients with suspected ascites. Patients with a
diagnosed ascites who develop new abdominal pain and fever need immediate medical
intervention.
14.2 rCM Etio(ogy and Pathogenesis
Table 14.1 Summary of rCM Etiology and Pathogenesis of Drum Distension

Qi and blood
Emotional factors
stagnation Qi, and blood stagnation
Inappropriate diets Dysfunction of
Dampness complicated with
Internal damage Liver,
accumulation pathological water in
Parasite infection Spleen and
and dysfunction abdominal cavity drum
Externa lIy contracted Kidney
of Qi hua (qi distention
factors Overstrain
transforming)

14.3.2 A TCM diagnosis of drum distension was made solely based on clinical features
before the modern medicine was introduced to China. Currently practitioners will make
the diagnosis drum distension based on the clinical features and medical exams.
77
MCOM AcupunctureTreatment Strategyand HerballnternaJMedicineStudy Guide 2009by.lH Xie
The pattern of spleen qi and liver blood stagnation may transform into a pattern
of liver and kidney yin deficiency. If it is treated very aggressively with blood-
moving herbs, the bleeding (vomiting blood or bleeding in stool) may occur.
The condition of the patient classified as the pattern of kidney and spleen yang
deficiency is often improved greatly with herbal treatment. Their life quality will
be improved accordingly although the disease is not cured. Occasionally
warming and replenishing herbs mav cause yin fluid damage and the patient
may develop a pattern of liver and kidney yin deficiency.
• The prognosis of the patient classified as a pattern of liver and kidney yin
deficiency is usually poor. This pattern is often seen at the later stage of drum
elistCII!lioli. TM! ~~rPJeii lif tFiii!3tFRSlAt is to ;mprO"A symptom aDd Hfe cwaHbr
80
45 Herbal Treatment for Drum Distention

Patterns Formulas Recommended in Textbook Practical Options -
Qi Stagnation Chai Hu Shu Gan Tang
and Obstruction Wei Ling Tang
of Dampness -
Cold Dampness Shi Pi Yin LiZhong Tang + Ping
in Spleen Wei San or Purge
Moisture -
uamp Heal: znong Man t-en xrao lang \L.enler runness LI Udn ouppo L T nual/5
Separating and Dispersing Decoction) Lian Jie Du Tang + Wu
-
• Hou Po, Zhi Shi, Huang Lian, Huang Qin, Zhi Ling San+ Er Chen Tang
Mu, Zhi Ban Xia, Chen Pi, Fu Ling, Zhu Ling,
Ze Xle, Sha Ren, Gan Jiang, Jiang Huang, Bai
-
Zhu, Zhi Gan CaD, Ren Shen
and Yin Chen Hao Tang
Spleen Qi Tiao Ying Yin (Construction-Regulating Xiao Yao San
-
Stagnation and Beverage) Zhi Shi Dao Zhi Wan
Liver Blood • E Zhu, Chuang Xiong, Dang GUi, Van Hu Suo, Dan Shen Yin
Stasis Chi shao Yao, Qu Mai, Da Huang, BingLang,
-
Chen Pi, Da Fu Pi, Ting Li zt, ru Ling, San Bai
Pi, Xi Xin, Bai Zhi, Rou Gui, Zhi Gan CaD
Yang Deficiency Fu Zi Li Zhong Tang -
of Spleen and Wu Ling San
Kidney Ji Sheng Shen Qi Wan
Liver and Liu Wei Di Huang Wan and -
Kidney Yin Ge Xia Zhu Yu Tang

Deficiency

• Prognosis of patients of drum distension with a short history and relatively
stronger vital qi is favorable. Based on the TeM patterns the prognosis of
patient with pattern of stagnation of qi and obstruction by dampness,cold
dampness in spleen, and pattern of spleen and kidney yang deficiency is better
than that of other patterns, e.g., pattern of damp heat, stagnation of spleen qi
and blood, and liver and kidney yin deficiency.
An excessive pattern may transform into a deficlent pattern if it is over treated
with draining method. A deficient pattern may transform into an excessive
pattern if it is over treated with replenishing herbs.
The pattern of cold dampness in spleen may transform into a pattern of kidney
and spleen yang deficiency, or a pattern of damp heat accumulation.
The pattern of damp heat accumulation may transform into a pattern of spleen
qi and liver blood stagnation, or a pattern of fiver and kidney yin deficiency.
Both are unfavorable.
79
MCOM AcupunctureTreatment Strategyand HerbalInternal MedicineStudy Guide 2009 by JH~ie
Table 15.1 Summary of TCM Etiology and Pathogenesis of Edema

Wind cold and wind heat invading lungs
Exogenous water and dampness invading
spleen
Pathological
Wind damp toxin infecting skin and attacking
water
lung and spleen
accumulation
Inappropriate diets and overstrain injuring
causing edema
spleen and stomach
[ltl!@9Si: e !H.m~81 iUiii 'i¥{; !!t1b1liiji'3!iS'I£;
overstrain, chronic 'illness injuring kidney qi opening and closing

15,3,1 An importa nt first question is whether the edema is localized or generalized. The
discussion of this chapter is limited in generalized edema.
15,3,2 Verify medical diagnosis
15.3.3 Drum distension is a condition often related to edema, but should be
differentiated from the edema discussed in this chapter.
15.3.4 Differentiation between yin edema and yang edema
• Yang edema: abrupt onset beginning on face, more severe edema in upper part
of the body with bright shiny skin, pitting edema in that dent will fill back in
more quickly.
• Yin edema: chronic onset, beginning on legs, more severe under the waist,
sallow or dark complexion, general pitting edema in which dent will fill back in
very slowly.
15.3.5 Identify the diseases organ
15.4 Acupuncture Treatment for Edema

15.4. 1 Attack by Wind-Heat
WU CAM CT
UB 13 LU 7 UB 13
UB12 UB 39 LU 5
SJ5 LI6 SJ 5
L14 L14 L14
LI 6 SP 9 US 22
LU 7
Auxiliary Points:
For severe edema of the face, add:
DU26 DU26 DU26
For edema on the pedis dorsum:
GB41
For sore throat, add bloodlettng at:
LUll
82
15. Edema

Edema is described as pitting or non-pitting.
• Pitting edema leaves a dent in the skin after pressing on area with a finger for
about 5 seconds. The dent will slowly fill back in.
• Non-pitting edema does not leave dent when pressing on the swollen area.
Edema is classified into localized and generalized edema. TCM theory related to the
generauzed edema IS discussed ih this Ehapter.
Cause of localized edema (TCM treatment is not discussed in this chapter)
• Localized edema is often caused by obstruction of venous and lymphatic
drainage of a limb thrombophlebitis, chronic lymphangitis, resection of regional
lymph nodes, Filariasis, thrombophlebitis, or lymphedema
Causes of generalized edema
• Increased intake of sodium
• Hypoalbuminemia
• Poor nutrition
• Pregnancy
• Drug-induced edema
• Androgenic and anabolic steroids
• Certain blood pressure medicines
• Corticosteroids such as prednisone
• Estrogen
• Nonsteroidal anti-inflammatory drugs
• Calcium channel blockers
• Thiazolidinediones
• Kidney diseases (Nephrotic syndrome, Acute and chronic glomerulonephritis)
• Heart failure
• Cirrhosis
• Thyroid disease
• For edema patient with a diagnosis of heart failure: severe crushing chest pain,
difficult breath, fainting, or rapid and irregular heartbeat.
• For edema patient with a diagnosis of renal failure: nausea orvomiting
persisting for more than 2 weeks, decreased urine output or not urine (oliguria
or anuria).
81
15 5 Herbal Treatment for Edema

Wind Heat Yue Bi Jia Zhu Tang (Spleen-Effusing Ma Xiang Gan Shi Tang
Edema Decoction plus Bai Zhu) Wu Ling San
• Ma Huang, Shi Gao, Sheng Jiang, Gan Cao,
Da Zao, Bai Zhu
Water Wu Pi San + Wu Ling San
Dampness
Damp Heat Shu Zao Yin Zi (Coursing and Piercing 0 rink) Huang Lian .lie Du Tang
• Ze Xie, Chi Xiao Dou, Shang Lu (phytolacca), Wu Ling San
Qiang Huo, Da Fu Pi, Jiao Mu (zanthoxylum Purge Moisture
seed), Mu Tong, Qin Jlao, Bing Lang, Fu Lin
PI, sneng Jiang
Ji Jiao Li Huang Wan (Fangji, Zanthoxylum,
Tang Li and Rhubarb Pill)
I
• FangJi, Jiao Mu, Ting Li Zi, Da Huang

Decline of Shi Pi Yin Zhen Wu Tang
Spleen Yang Li Zhong Tang
Kidney Yang Zhen Wu Tang
Deficiency Ji Sheng Shen Qi Tang

Prognosis of edema patient depends very much on the underlying medical
diagnosis. Generally in TCM practice patients with yang edema have a better
prognosis than those with yin edema. Yang edema is usually resolved within 3-7
days. After that treatment focused on regulating the internal organs will be
followed. The condition may be cured. If Yang edema is not treated promptly
and adequately, the condition may transform into a more difficult Yin edema.
Yin edema is usually chronic. The principle of treatment and formula selected
should not be changed frequently. The purpose of treatment is to maintain
patient in a long term stable condition.
Pattern of attack by wind heat is usually controlled well with herbal treatment.
If patient has a deficiency of lung and wei qi and repeated attack of wind, the
condition may transform into a pattern of inundation of water dampness or
accumulation of damp heat.
Pattern of inundation of water dampness may transform into a pattern of
accumulation of damp heat.
Pattern of accumulation of damp heat is serious excessive pattern. Formulas
and herbs selected for this pattern are very potent. The herbs should be
discontinued when the majority of edema is resolved and gentle replenishing
treatment may be followed. This pattern may transform into a Yin edema
pattern.
Pattern of spleen yang deficiency and kidney yang deficiency are both classified
as Yin edema. Kidney yang deficiency is a more serious pattern and often
complicated with spleen yang deficiency.
In the treatment of edema, especially those with nephrotic syndrome, acute
and chronic glomerulonephritis as underlying disorders, blood-invigorating and
blood stasis-dissolving herbs are often added (See textbook page 137-138).
84
15.4.2 Inundation by Water-Dampness

WU CAM CT
US20 UBZa
US23 UB22
eV9 CV9
5T36 5T36
5P9 5P6
eV12 CV6
Auxiliary Points:
For severe edema accompanied by difficult breathing, add:
UB13
LU7
15.4.3 Accumuration of Damp-Heat

WU CAM CT
5P9
eV9
UB39
L14
L111
UB22
Auxiliary Points:
For hematuria, add:
SP10
SP6
15.4.4 Decline of Spleen Yang
WU CAM CT
UB23 UB20 UB20
ST36 5T36 5T36
eV9 CV9 CV9
CV6 CV4 CV4
5P9 UB23 UB23
5P6 KD7 UB22
Auxiliary Points:
For epigastric fullness and discomfort, add:
eV12
5T25 5T25
5T37
15.4. 5 Vacuity of Kidney Yang

WU· CAM CT
UB23 UB23 UB23
UB20 UB20 UB20
CV4 CV4 eV4
CV9 CV9 CV9
KD7 KD7 UB22
CV6 ST36 5T36
Auxiliary Points:
For swelling of the foot, add:
GB4
SPS
83

All patients with new, unexplained chest pain or pressure should be medically evaluated.
According to the description in the textbook, thoracic Bi pattern in rCM may include the
symptoms of stable anginal unstable angina and heart attack. Clinical studies in China
showed that Acupuncture and herbal treatment when used together with drugs was
beneficial to the patients of coronary heart disease. However unstable anginal heart
attack, and serious arrhythmias in coronary heart disease are a very dangerous medical
emergency. Their symptoms may include:
• Sudden crushlng, squeezing, tlghtenlng, or pressure in chest.
• Pain radiating to jaw, left arm, or between shoulder blades.
, NapSA? djnipAss sweatip'l palpitation or shgrtgess pf breath
• Chest discomfort that is suddenly moore intense and brought on by lighter
activity or lasts longer than usual.
• Chest pain occurring at rest.
• Sudden sharp chest pain with shortness of breath.
• Chest pain with arrhythmias
Table 16.2 Summary of TCM Etiology and Pathogenesis of Thoracic Bi

Heart yin deficiency
Aging or Kidney yin deficiency and deficient heat
weak causing phlegm
co nstitutio n Kidney yang Heart qi and yang
deficiency deficiency
Dietary Phlegm due to spleen Phlegm obstructing
factors dysfunction collateral in chest Chest
Over thinking injuring pain
Phlegm and blood
spleen and causing
Emotional stasis in chest
phlegm
factors
Anger causing Liver Qi stagnation and
qi stagnation phlegm accumulation
Cold Cold accumulation
Chest yang inhibited
invasion and qi stagnation

16.3.2 Make rCM diagnosis of thoracic bi pattern based on symptoms and medical
exams. Exclude the congestion and pain in the chest caused by disorders of diaphragm,
stomach, esophagus, and etc.
16.3.3 Differentiate deficient and excess patterns
• Deficient patterns: heart and kidney yin deficlency, qi and yin deftclencv, yang qi
deficiency and debilitation (
Excessive patterns: heart static blood obstruction, congestion by phlegm
turbidity and congealed yin cold
86
16. Thoracic Bi

Thoracic Bi refers to patterns characterized by oppression in the chest with chest pain.
Its clinical features are similar to angina pectoris that is most commonly caused by
coronary heart disease.
Other less common causes of angina include:
• Arrhythmia
• AnemIa
• Coronary artery spasm
• Heart failure
• Heart valve disease
• Hyperthyroidism
Angina could be further divided into stable angina and unstable angina.
Table 16.1 Symptoms of Stable Angina} Unstable Angina and Heart Attack
Stable Stable angina is chest pain that typically occurs with activity or stress. The
angina pain usually lasts 1 to 15 minutes and is usually relieved with rest or
nitroglycerin. Stable angina is also called chronic angina.
Occurs without cause (for example! it wakes you up from sleep)
Unstable Lasts longer than 15 - 20 minutes
angina Responds poorly to a medicine called nitroglycerine
May occur along with a drop in blood pressure or significant
shortness of breath
Symptoms of unstable angina may also include:
Sudden chest pain that may also be felt in the shoulder! arm! jaw!
neck! back! or other area
Pain that feels like tightness} squeezing! crushing! burning! choking!
or aching
Pain that occurs at rest and does not easily go away when using
medicine
In the patient with stable angina, if his chest pain starts to feel different!
lasts longer thal115 - 20 minutes} or occurs at different times! the patient
may be developing unstable angina.
The pain can be severe or mild. It can feel like squeezing or heavy
Heart pressure! a tight band around the chest! something heavy sitting
Attack on the chest! or bad indigestion.
Pain usually lasts longer than 20 minutes. Rest and a medicine
called nitroglycerine do not completely relieve the pain of a heart
attack.
Other symptoms of a heart attack include shortness of breath! nausea or
vomiting! anxiety! fainting! dizziness} palpitations! and profuse sweating.
85
For phlegm producing heat, add:

L14
5T44
5P9
16.4.3 Congealed Yin Cold
WU CAM CT
UB15 UB15
UB14 UB14
PC6 PCG
HT5 HT5
CV6
CV4
AllyiliaN pgints'
For cold extremities, add moxibustion to:
CV6
CV4
16.4.4 Heart and Kidney Yin Vacuity

WU CAM CT
UB15 UB15
UB23 UB23
HT6 HT7
KD3 KD3
CV17 PC6
UB17 SP6
Auxiliary Points:
For insomnia, add:
HT7
For constipation, add:
5T25
KD6
16.4.5 Qi and Yin Vacuity
WU CAM CT
UB15
PCG
. CV17
5T36
UB17
Auxiliary Points:
For shortness of breath, add moxibustion to:
UB24
UB23
16.4.6 Yang Ql Vacuity and Debilitation

WU CAM CT
UB 23
CV4
CV17
PC 6
HT5
UB 15
Auxiliary Points:
For cold extremities, moxa:
CV6
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MCOM Acupuncture Treatment Strategy and Herbai Internal Medicine Study Guide 2009 by JH Xie
16.3,4 The pattern differentiation is primarily based on the nature of chest pain and"
accompanied symptoms.
Table 16.3 Differentiation of Chest Pain in Thoracic Bi Pattern

Qi stagnation Chest stiffness] mild chest pain] hypochondriac distending] sighing
Phlegm obstruction congestion/pain in chest] worsened in humid and overcast
weather
rapid respiration] heaviness in limbs] overweight excessive
phlegm
Blood stasis stabbing fixed pain, pain severe at night] palpations periodically]
obstruction purple tongue with purplish spots
Cold accumulation Chest pain triggered by cold weather, cold limbs
Heart yin deficiency Chest pain with burning sensation, palpitation, dizziness, restless,
shortness of breath] thirst and night sweating
Hart qi deficiency Dull pain and stiffness in chest, pain trigger by exertion, shortness
of breath, palpitation
16.3.5 The general therapeutic principles

During the attack of a ngina: primarily activating blood a nd dredging the
collaterals
During the recovery stage: primarily replenishing heart qi
16.4 Acupuncture Treatment for Thoracic Bi

16.4.1 Heart Static Blood Obstruction
WU CAM CT
eV17 CV17
CV14 CV14
UB 15 US 15
UB 17 US 17
HT6 HT6
PC4
Auxiliary Points:
For purple tongue & cyanotic lips, bleed:
LU 11
HT9
PC 9
16.4.2 Congestion by Phlegm-Turbidity

WU CAM CT
CV14 CV14
CV17 CV17
PC4 PC4
LUg LU9
ST40 ST40
Auxiliary Points:
For pain radiating through to the back, add cupping to the following points:
UB13
UB15
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MCOM Acupuncture TreatmentStrategyand Herba I Internal Medicine StudyGuide 2009 by JH Xie
Pattern of congealed yin cold' is usually seen in patient with more severe chest pain.
If it is not treated promptly and properly it may transform into a pattern of yang qi
deficiency and debilitation.
Pattern of heart static blood obstruction is the basic pattern of thoracic bi. The
blood stasis may be caused by qi stagnation, cold congestion, and phlegm
obstruction, or by deficiency of ql, yin and yang. Treatment of quickening the blood
and dissolving stasis is often used in combination with method of moving ql,
expelling cold and resolving phlegm, and replenishing ql, yin and yang. The pattern
may transform into a pattern of heart qi deficiency or heart and kidney yin
deficiency.
Of three deficient patterns, e.g., heart and kidney yin deficiency, qi and yin
deficiency, and yang qi deficiency and debilitation, pattern of qi and yin deficiency
IS j datloel y iiiild GilE diid patte,,: of ,ail6 @ii l!h!lfil!!i@liuy .RliI Q9i1iWatjgp is the most
serious. Some patients may only present a pattern of heart qi deficiency. All these
deficient patterns may be complicated with blood stasis, phlegm obstruction and
cold congestion.
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MCOM Acupuncture TreatmentStrategyand Herbal Internal MedicineStudyGuide2009 byJH Xie
16.5 Herbal Treatment for Thoracic Bi

Patterns Formulas Recommended in Practical Options -
Textbook
Heart Blood Xue Fu Zhu Yu Tang Dan Shen Yin +
-
Stasis Da Huang Jiang Zhi Wan
(Mayway Rhubarb Teapills)
Phlegm Turbidity Gua Lou Xie Bai Ban Xia Tang Er Chen Tang + Dan Shen Yin +
-
rnncroctif")n Da Huang Jiang Zhi Wan
(Mayway Rhubarb TeapilIs)
Congealed Yin Gua Lou Xie Bai Bai Jiu Tang Er Chen Tang + Dan Shen Yin
-
Cold Purge Cold (Kan)
Heart and Kidney Zuo Gui Yin Zuo Gui Yin + Dan Shen Yin
Yin Deficiency -
Qi and Yin Sheng Mai Yin + Sheng Mai San+Shi Quan Da Bu
Deficiency Ren Shen Yang Rong Tang Tang + Suan Zao Ren Tang
{Shi Quan Da Bu Tang + Wu Wei -
Zi, Yuan Zhl, etc.}
Zhi Gan Cao Tang (palpitation)
YangQi Shen Fu Tang -
Deficiency and
Debilitation
Table 16.5 Commonly Used Herbs for Thoracic Bi

Qi Deficiency Ren Shen, Huang Qi} Dang Shen, Tai Zi Shen, Xi Vang Shen, Huang Qi
Qi Stagnation Mu Xiang, Tan Xiang, Wu Yao, Zhi Ke} Zhi Shi, Chai Hu, Qing Pl,
Chuan Xiong
Blood Stagnation Chuan Xiong, Dan Shen, Hong Hua, Jiang Huang, Shan Zha, Wu Ling
Zhi, Van Hu Suo} Vu Jin, Ru Xiang, Mu Yao, Sang Qi
Deficient or Fu Zl, Gui Zhi, Xie Bai, Ying Vao Huo, Ba Ji Tlan, Lu Jiao Shuang
Excessive CoId
Phlegm Bai Jie Zl, Ban Xia} Gua lou, Hou Po} Xie Bai, Zhi Shi, Shi Chan Pu
accumulation
According to pharmacological studies} following herbs may improve the chest pain of
coronary heart disease: Chen Xlang, Chuan Xiong, Dan Shen, Ge Gen, Gua Lou Shl, Gui
Zhi, Hong Hua, San Qi, Shan Zha, She xlang, Su He Xlang, Tan Xiang, Xiw Bai, Van Hu Suo,
and Zhi Shi.
General speaking, the prognosis of patients with excessive patterns are better than
that deficient patterns.
Five patterns are discussed in textbook. Clinically it is rare to see a patient with only
a simple excessive pattern or simple deficient pattern. Most patients will have a
pattern of excess and deficiency complex. It is believed that thoracic bi is a
condition of primary deficiency and secondary excess.
Pattern of congestion of phlegm and turbidity is usually seen at the initial stage of
thoracic bi. If it is not treated promptly and properly it may transform into a pattern
of phlegm and blood stasis obstruction.
89
highest in patients with coronary artery disease, congestive heart failure, or other
structural cardiac abnormalities.
1?3.2 TCM diagnosis of palpitation is made based on symptoms and medical history.
1?.3.3 TCM evaluation is focused on differentiating excessive and deficient patterns.
1?3.4 Differentiate the severity of the condition by distinguishing Jing Ji (fright
palpitation) from Zheng Zhong (fearful throbbing).
17.4 Acupuncture Treatment for Palpitation

17.4.1 Heart and Gallbladder Qi Vacuity
WU CAM CT
I JR15 UB15 UB15
CV14 CV14 eVia
HT? HT? HT7
PC6 PC6 pes
HTS HTS UB19
GB40 GB40
Auxiliary Points:
For susceptibility to fright, add: .
PC? PC?
For phlegm-heat, add:
5T40
UB19
17.4.2 Heart Blood Vacuity

WU CAM CT
UB1S UB15 UB15
CV14 CV14 CV14
UB20 UB20 UB20
5T36 5T36 5T36
PC6 PC6 UBi?
HT? HT?
UBi? UB21
Auxiliary Points:
For loss of appetite, add:
UB21
17.4.3 Yin Vacuity with Effulgent Fire

WU CAM CT
UB23 UB23 UB23
CV14 CV14 HT6
HT7 HT7 HT?
KD3 KD3 KD3
UB15 UB15
UB14 UB14
PC? PC?
Auxiliary Points:
For tinnitus, add:
5J3
For irritability, add:
PCB
For vexing heat in the hands and foot, add:
PCB, KDl
92
17. Palpitation
Palpitations are characterized by an awareness of the beating of the heart. Patients
commonly describe "pounding" or fluttering}' heart beats or report a sensation that the
heart is stopping or skipping beats. These symptoms may be caused by a change in the
heart's rhythm or rate or by an increase in the force of its contractions.
Common causes of palpitation
• Psychiatric conditions: anxiety, depressive and panic disorders
• Fever
• Card,acd,sorders (tachycardia and arrhYthmIas, coronary aHery dIsease,
congestive heart failure, or other structural cardiac abnormalities)
• Any condition associated with increased catecholamine levels
• Increased intake of caffeine, nicotine, cocaine
• Hyperthyroidism
• Anemia
o Hyperventilation
• Hypoxemia
• Side effects of medications
.. Palpitation with unconsciousness.
• Palpitation with shortness of breath, chest pain, unusual sweating, or dizziness
• Palpitation with a heart rate of 100 beats per minute
Table 17.1 Summary ofTCM Etiologyand Pathogenesis of Palpitation

Constitutional
deficiency
Poor diets and
- - - - - - - - - - - - - - - - - - - o bstructio n of
-overstrain
Disturbance of qi heart vessels
Emotional disturbance Palpitations
movement Disturbance of
- - - - - - - - - - - - - - - - - - - - heart spirit (Shen)
Exogenousfactor?
invasion Phlegm accumulation
Side effect of herbs and and blood stasis
medications

Patients with cardiac neurosis may have palpitation. Cardiac neurosis is listed as a
condition for which the therapeutic effect of acupuncture has been shown but further
proof is needed according to WHO 2002 Acupuncture Review and Analysis of Reports on
Controlled Clinical Trials.
In medical practice the first goal in the evaluation of patients with palpitations is to
exclude the possibility of life-threatening arrhythmias. The riskfor such arrhythmias is
91
17.s Herbal Treatment for Palpitation

Heart and An Shen Ding Zhi Wan Fu Ling/ Fu Sheri, Yuan Suan Zao Ren Tang
Gallbladder Qi Zhi/ Ren Shen, Shi Chang Pu/ Long Shi (Long + Gui Pi Tang
Deficiency GU)
Phlegm Heat Huang Lian Wen Dan Tang Ease the Stra in
(Kan)
U'"""'l"+ Rlnnrl ~lli Oi Taric
Deficiency Zhi Gan Cao Tang

Sheng Mai San
Yin Deficiency with Tian Wang Su Xin Dan
Deficient Fire Zhi Sai Di Huang Tang
Heart Yang Gui Zhi Gan Cao Long Gu Mu Li Tang Zhi Gan Cao Tang +
Deficiency (Cinnamon/ Licorice/ Dragon Bon and Oyster Chai Hu Long Gu Mu Li
Shell Decociton) plus Ren Shen and Fu Zi Wan
Oppression of Ling Gui Zhu Gan Tang
Heart by Wate r Zhen Wu Tang
and Phlegm-Fluid
Heart Blood Stasis Tao Ren Hong Hua Jian (Peach Kernel and Xue Fu Zhu Yu
Carthamus Brew) + Gui Zhi Gao Cao Long Gu Tang + Chai Hu Long
Mu Li Tang Gu Mu Li Wan
• Tao Re,n/ Hong Hua, Dan Shen, Chi Shao

Yao, Xiang Fu, Yan Hu Suo/ Dang Gui/
Sheng Di Huang/ Qing Pi/ Chuan Xiong
Table 17.3 Commonly Used Herbs for Palpitation
Heart Fire Zhu Sha, Huang Lian, Lian Zi Xin,

Liver Fire and Ci Shi, Long Gu/ Mu Li, Zhe Zhu Mu, Xia Ku Cao, Long Dan Cao, Ju
Liver Yang Hua, Zhi Zi, He Huan Pi/ He H uan Hua, Mei Gui Hua (rose)
Phlegm fire Yuan Zhi, Zhu Ru/ Tian Zhu Huang/ Tian Hua Fen
Deficient fire Tian Men Dong/ Mai Men Dong/ Bai He/ Sheng Di Huang/ Sha Shen, Xi
Yang Shen
Blood deficiency Bai Zi Ren, Suan Zao Ren, Lian Zl, Long Van Rou,

The prognosis of a patient with palpitation depends on the underlying medical
diagnosis.
• According to TCM theory the favorable prognosis is seen in patients who have
only mild deficiency of ql, blood/ yin and yang and have no complications of
phlegm/ blood stasis or substantial damage of internal organs.
The patient with serious deficiency/ accumulation of phlegm/ blood stasis/ very
slow or rapid pulses/ and irregular pulses has a poor prognosis.
94
17.4.4 Heart Yang Vacuity

WU CAM C1
UB15 UB15
PC6 PC6
HT7 HT7
CV14 UB14
CV4 CV4
CV6
Auxiliary Points:
For severe physical cold and cold extremities, apply moxibustion to:
UB23
17.4.17.4.5 oppression of the Heart by Water and phlegm-FlUId

WU CAM C1
UB15 UB15 UB23
PC6 PC6 PC6
HTI HTI HTI
CV4 CV4 CV4
SP9 SP9 SP9
CV14 CV14
CV9 CV9
Auxiliary Points:
For epigastric and discomfort, add:
CV12
ST25
UB20
6 Obstruction of the Heart by Blood Stasis

WU CAM CT
UB15 UB15
CV17 CV17
SPiO SPiO
HT7 PC6
CV6 CV6
CV14 UB17
SP6
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MCOM Acupuncture Treatment Strategy and Herbal Internal MedicineStudy Guide2009 by JH Xie
Table 18.2 Summary of TCM Etiology and Pathogenesis of Insomnia

Improper diet or deficiency of Qi and blood deficiency and
spleen and stomach malnourishment of heart shen
Yin deficiency and deficient
Chronic illness or overstrain
heat disturbing heart shen
Deficiency of heart and gall
Constitutional deficiency or Insomnia
bladder
chronic illness,
Uneasy heart shen
II' tlegi Ii I lEd t due to I.e: bs,
Heart shen disturbance due to
food, exogenous fire and
phlegm heat
dampness

Clinical Trials, insomnia is listed as a symptom for which the therapeutic effect of
acupuncture has been shown but further proof is needed.

18.3.2 Differentiation between excessive and deficient patterns
After TeM diagnosis of insomnia is made, the next most important step is to
differentiate deficient patterns and excessive patterns.
Excessive patterns: greasy tongue coating, and wiry, slippery, or rapid and
forceful pulse
Deficient patterns: thin coating of tongue, and thready, fragile or weak and
rapid pulse.
18.3.3 Identify the diseases organs
According to TCM theory, insomnia is always associated with heart-spirit (shen)
dysfunction. However dysfunction of other organs such as liver, gall bladder.spleen,
kidney and stomach also contributes to insomnia.
Table 18.3 Involved Organs and Symptoms in Insomnia

Liver blood Insomnia without obvious restless, accompanied with hypochondriac
deficiency pain or distention, dizziness and blurred vision
Gall bladder Insomnia accompanied with easily being frightened, and timidity
deficiency
Spleen Insomnia accompanied with abdominal fullness, increased intestinal
dysfunction . sound, diarrhea and constipation
Stomach Insomnia accompanied with abdominal fullness, hiccup and belching
dysfunction
Kidney Insomnia accompanied with dizziness, tinnitus, low back pain,
soreness and weakness of knees, sperm emission in the male, or
irregular menstruation in the female
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MCOM AcupunctureTreatment Strategyand Herbal Internal Medicine StudyGuide2009 by JH Xie
18. Insomnia
Table 18.1 Classification and Causes of Insomnia

Primary Insomnia without identifiable cause or without a clear underlying single
Insomnia cause
Transient Situational Insomnia
· isr i))'3Wp'e lot 'as
Insom nia Associated with Mental Disorders
• Anxiety
• "Depression or major depression
• Exhilaration or excitement
• Grief
• Stress and worrying
Psychophysiologic insomnia
• Bed or bedroom that does not promote sleep
• Too much stimulation at bedtime
Insom nia Associated with Neurologic Disorders
A variety of neurologic diseases result in sleep disruption
through both indirect} nonspecific mechanisms (e.g., pain in
cervical spondylosis or low back pain)
Medlcatlon-, Drug-, or Alcohol- Associated Insomnia
• Alcoholism or abruptly stopping alcohol after long-term use
Secondary • Illicit street drugs} such as amphetamines and cocaine
Insomnia • Medications} such as too much thyroid medicine} ephedrine}
henylpropanolam lne, theophylline derivatives} and others
• Stimulants taken in the evening} including nicotine} alcohol}
caffeine} or food
II Suddenly stopping a medication (such as sleeping pills or
sedatives)
Insomnia Associated with Other Medical Disorders
• Asthma} cardiac ischemia} chronic obstructive pulmonary
disease} cystic fibrosis} menopause} hyperthyroidism}
gastroesophageal reflux} chronic renal failure} and liver failure}
enlarged prostate} cystitis} arthritis} heart or lung problems}
restless leg syndrome} etc.
Others
• Aging
• Lackof exposure to bright light or sunlight
• Shift work
• Sleeping too much during the day
• Wake-sleep pattern disturbances
Medical evaluation and intervention are required for insomnia associated with serious
medical conditions.
95
Fire may transform into a pattern of Phlegm Fire Harassing Interior. Within
deficient patterns, both patterns of heart and spleen vacuity and patterns of
heart and gall bladder qi vacuity may transform into a pattern of yin vacuity
with effulgent fire (also termed disharmony of heart and kidney).
Patients with insomnia patterns may develop more serious conditions such as
palpitation, dizziness and consumptive disorders.
98
18.4 Acupuncture Treatment for Insomnia

Liver Depression Transforming into Fire HT7,SP6, LR3, Bl18,PCS,An Mian
Phlegm Fire CV12,ST40,BL2i,ST36,HT7,SP6
Yin Deficiency and Deficient Fire HT7, SP6, Bl15, Bl23, KI3,PC6
Heart and Spleen Deficiency HT7,SP6, Bl20,BLiS,ST36
Heart and Gallbladder Qi Deficiency HT7,SP6,Bl15,Bl19/PC7,GB40
18.5 Herbal Treatment for Insomnia

Textbook
liver Depression. long Dan Xie Gan Tang plus Jia Wei Xiao Yao San
Transforming into Fire Shen-calming herbs Suan Zao Ren Tang
Phlegm Fire Huang Lian Wen Dan Tang plus Ease the Strain (Kan)
Shen-calming herbs
Yin Deficiency and Huang lian Er Jiao Tang Zhi Bai Di Huang Wan alone
Deficient Fire or with
Tian Wan Bu Xin Dan
Heart and Spleen Gui Pi Tang
Deficiency
Heart and Gallbladder An Shen Ding Zhi Wan Suan Zao Ren Tang + Gui Pi
Qi Deficiency • Fu ling, Fu Shen, Yuan Zhi, Tang
Ren Shen, Shi Chang Pu,
Long Shi (long GU)
Table 18.3 Commonly Used Herbs for Insomnia
Heart Fire Zhu Sha, Huang lian, Lian Zi Xin,

live r Fire and Ci Shi, Long Gu, Mu Li, Zhe Zhu MU, Xia Ku Cao, Long Dan CaD, Ju
Liver Yang Hua, Zhi Zi, He Huan Pi, He Huan Hua, Mei Gui Hua (rose)
Phlegm fire Yuan Zhi, Zhu Ru, Tian Zhu Huang, Tian Hua Fen
Deficient fire Tian Men Dong, Mai Men Dong, Bai He, Sheng Di Huang, Sha Shen, Xi
YangShen
Blood deficiency Bai Zi Ren, Suan Zao Ren, Lian Zi, Long Yan Rou,

The prognosis of insomnia patients depends on the underlying disorders. Most
patients have a favorable prognosis. .
The excessive patterns (liver Depression Transforming into Fire and Phlegm Fire
Harassing Interior) may transform into deficient patterns (Yin Vacuity with
Effulgent Fire, Heart and Spleen Vacuity, Heart and GB Qi Vacuity) and vice versa.
Within excessive patterns, the pattern of Liver Depression Transforming into
97
• Sudden, explosive or violent headache

II Headache accompanied with slurred speech, change in vision, numbness or
paralysis of limbs, loss of balance, confusion, or memory loss
• Headache progressively worse over a 24-hour period
• Headache accompanied by fever, stiff neck, nausea, and vomiting
• Any headache due to a head injury
• Headache that is severe and localized to one eye with redness in that eye
o Newly onset headache in a patient over age 50, especially with impaired vision
and pain while chewing (Arteritis)
19.2 i CivJ Eti6iOgy aild Pdthogenesls
Table 19.2 Summary of TCM Etiology and Pathogenesis of Headache

Externally-
Obstruction of channel and collaterals by contracted
Exogenous
wind cold, wind heat, wind dampness,
pathogenic factors headache patterns
invasion Deteriorating the pre-exiting internal
headache
Liver qi stagnation, liver Internal
heat, or damage of yin headache
Emotional factors
blood and stirring up of due to
internal wind
Overstrain, Qi and blood deficiency
Constitutional
Kidney essence
deficiency, aging,
deficiency, empty of the
excessive sex activity Internal headache
sea of rnarrow
chronic illness patterns
Pathogenic factors
Traumatic injuries or
entering the collaterals
chronic illness
and causing blood stasis
Phlegm dampness
produced internally
Qi and blood deficiency
Improper diet
due to insufficient
resource from spleen and
stomach

Clinical Trials, headache is listed as a symptom for which acupuncture has been proved,
through controlled trials, to be effective treatment.
19.3.1 Verify medical diagnosis.

The quality, location, duration, and time course of the headache and the conditions that
produce, exacerbate, or relieve it should be carefully reviewed.
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by JHXie
19. Headache

Headache can occur as the result of (1) distention, traction, or dilation of intracranial or
extracranial arteries; (2) traction or displacement of large intracranial veins or their
dural envelope; (3) compression, traction, or inflammation of cranial and spinal nerves;
(4) spasm, inflammation, or trauma to cranial and cervical muscles; (5) meningeal
irritatign and raised intracranial pressure; or (6) other possible mechanisms such as
activation of brainstem structures. According to the International Headache Society,
headache is classified into following 14 categories.
Table 19.1 International Classification of Headache Disorder

Part I: The Primary Headaches
1. Migraine
2. Tension-type headache
3. Cluster headache and other trigeminal autonomic cephalalgias
4. Other primary headaches
Part II:The Secondary Headaches
5. Headache attributed to head and/or neck trauma
6. Headache attributed to cranial or cervical vascular disorder
7. Headache attributed to non-vascular intracranial disorder
8. Headache attributed to a substance or its withdrawal
9. Headache attributed to infection
10. Headache attributed to disorder of homoeostasis
11. Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose,
sinuses, teeth, mouth or other facial or cranial structures
12. Headache attributed to psychiatric disorder
Part III: Cranial Neuralgias Central and Primary Facial Pain and Other Headaches
13. Cranial neuralgias and central causes of facial pain
14~ Other headache, cranial neuralgia, central or primary facial pain
Sourc~: International Classification of Headache Disorder, 2 Edition 2003 Cephalalgia
nd
24 (Suppll) 2003.
Clinically the most commonly seen types of headaches are:

• Tension headaches
o Migraine headaches
• Cluster headaches
• Headaches due to cold, the flu, fever, sinusitis or premenstrua! syndrome
• Headache induced by substance use or exposure
e Headache due to side effects of medications
• Headache due to hypertension
• New headache that interferes with daily activities
99
19.3.2 Make a TCM diagnosis based on the symptoms

19.3.3 Initial differentiation is focused on the external and internal headache.
Table 19.3 Externally contracted headache and Internal Headache Differentiation

Externally Contracted Internal
Onset Pattern Acute and a short history Chronic and longer history, repeated
attack of headache
Severity severe various
Deficient and More excessive patterns Deficient patterns or excessive

Excessive quaiJty paltCi liS COli iJ5li@fttel:::itk Qefideoq'
Accompanied Exterior patterns of wind cold, Symptoms due to deficiency of qi,
Symptoms wind dampness or wind heat blood, kidney
Symptoms due to turbid phlegm and
blood stasis
-
19.3.4 Differentiation of involved channels and quality of headache
Table 19.4 Differentiation of Involved Channels in Headache

Channel Features of Headache
Tai Yang (urinary bladder) Headache alone occiput or neck
Yang Ming (L1 and ST) Headache along the forehead and eyebrow
Shao Yang (GB and San Jiao) Headache along the lateral side of the head above
the ears
Jue Yin (liver) Headache along the apex of the ear
Note: This differentiation is used primarily for the externally contracted headache. The location
of headache in one specific channel indicates the obstruction or invasion of pathogenic factors in
that channel. It is not much related to the dysfunction in the corresponding organs. However
channel-guiding herbs or local acupuncture points are often used when internal headache due to
deficiency or excess is localized in one channel.
19.3.5 The principle of expelling wind, moving blood and stopping pain is very
commonly used in the treatment of headache. However when treating chronic
headache, this principle should be used with cautions due to the concern of vital qi
consumption by the treatment.
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study
Guide 2009 by JHXie
19.4.2. Wind-Heat Heada che

WU CAM CT
L14
GB 20
L111
GB 14
19.4.3 Wind- Dampn ess Heada che

wu CAM CT
LU 7
GB 20
SJ 8
L14
19.4.4 Liver Yang Heada che

wu CAM CT
GB 20 GB 20 GB 20
GBS GBS GBS
GB4 DU20 GB4
L1V 3 L1V 2 L1V 3
GB 43 GB 43 GB40
KD 3 ASHIXUE
Auxiliary Points:
For bloods hot eyes, add:
SJ 1
For sensat ion of scorching heat in the face, add:
ST44
For dizziness, add:
Si Shen Cong
19.4.5 Kidney Yin Vacuity Heada che

WU CAM CT
DU 20 DU 20
UB 23 UB23
UB 18 UB 18
KD 3 LlV 3
SP 6 KI3
DU 23 SP 6
Auxiliary Points:
For insomn ia, add:
HT7
For tinnitu s, add:
SI 19
For vexing heat in the five hearts
PC8
KD 1
103
Table 19.5 Differentiation of Quality of Headache

Patterns Features of Headache
Wind Cold Headache alone the neck and back aggravated by drafts,
aversion to cold
Wind Heat Distending, splitting headache, fever, sensitive to drafts,
Liver Yang Distending headache with dlzzlness, vertigo, irritability
Hyperactive
Phlegm Dampness Tightly bound headache (dampness) or headache with the
feeling of heaviness (phlegm and dampness), dizziness or
numbness over the head
Blood Stasis Hxed and iocallzed 1 pnckihg1 dlstendiilg1 6i POiSdtlilg lieat:latlie
Oi and Blood Dull headache triggered by exertion or fatigue, lassitude
Deficiency
Kidney Deficiency Emptiness headache, dizziness and tinnitus
19.4 Acupuncture Treatment for Headache

19.4.1 Wind-Cold Headache
WU CAM CT
GB 2.0
UBl2.
L14
LU 7
Auxiliary Points: Those modifications are suitable for all types of externally contracted
headache.
For occipital headache, add:
UB60 UB 60
SI 3 513
UB10 GB 2.0
DU19
For frontal headache, add:
ST 8 5T8
DU 2.3 DU 23
ST44 5T44
GS14 L14
YIN TANG
For lateral headache, add:
TAl YANG TAl YANG
GSB GB8
SJ 5 5J 5
GB41 GB41
For headache at the apex, add:
DU 2.0 DU 20
SI 3 513
UB67 UB 67
L1V 3 lIV 3
UB7 UB 7
102
Auxiliary Points:
For pain of the supraorbital ridge, add:
UB 2 UB 2
For lateral headache} add:
TaiYang TaiYang
For occipital headache} add:
SJ 18 UB 10
GB 20
For headache atthe apex, add:
Si Shen Cong Si Shen Cong
19.5 Herbal Treatment for Headache

Textbook
Wind Cold Chuan Xiong Chai Tiao San Purge External Wind (Kan)
Wu Zhu Yu Tang (headache in Jue Yin
Channel)
Wind Heat Ju Hua Chao Tiao San Purge External Wind +
Xiong Zhi Shi Gao Tang Chuan Xin Lian Pian
Wind Dampness Quo Huo Sheng Shi Tang
Huang Lian Xiang Ru Yin + Huo Xiang,
Pei Lan, He Ye
(summerheat and dampness)
• Huang Llan, Xiang RU I Sian
Dou, Hou PU I Huo Xiang, Pei
Lan, He Ye
Liver Yang Tian Ma Gou TengYin Purge Internal Wind (Kan)
Kidney Yin Da Bu Yuan Jian Qu Ju Di Huang Wan
Deficiency
Kidney Yang You Gui Wan
Deficiency -
Qi Deficiency Bu Zhong Yi Qi Tang
Blood Deficiency Jia Wei Si Wu Tang (Supplemented Bend the Bamboo (Kan)
Four Agents Decoction)
Phlegm Turbidity Ban Xia Bai Zhu Tian Ma Tang Tian Ma Gou Teng Yin
Purging the Phlegm
Clear Yang (Kan)
Blood Stasis Tong Qiao Huo Xue Tang Tong Qiao Huo XueTang
Yuan Hu Suo Zhi Tong San
105
19.4.6 Kidney Yang Vacuity Headache

wu CAM CT
DU 20
UB23
CV4
KD3
DU4
DU23
19.4.7 Qi Vacuity Headache

WU CAM CT
QI12Q OU 20
CV6 US 18
UB20 US 23
UB20 5T36
L14 CV6
5T 36
19.4.8 Blood Vacuity Headache

WU ~M cr
DU 23 DU 23
UB18 DU20
UB17 5Pl0
5T36 5T36
UB20 5P 6
5P 6
Auxiliary Points for Qi and Blood Vacuity Headache
For insomnia and palpltatlons, add:
HT7
PC6
19.4.9 Phlegm-Turbidity Headache

wu CAM CT
OU20 DU 20
CV12 CV12
5T40 5T40
YIN TANG YIN TANG
5T36 A-5HI
'-14
Auxiliary Points:
For vomiting, add:
PC6 PC 6
ST25 5T25
19.4.10 Blood Stasis Headache

WU CAM CT
L14 Ll4
SP 6 SP 6
L1V 3 UB 17
5P 10 UB40
ASHI A-5HI
5T36
104
20. Dizziness and Vertigo


Dizziness is a common symptom. Patients with gait disorders caused by peripheral
neuropathy, myelopathy, spasticity, parkinsonism, or cerebellar ataxia complain of
dizziness despite the absence of vertigo or other abnormal cephalic sensations. Clinically
the term dizziness is usually used to describe disturbed ambulation. After eliminating
the gait disorder, dizzinessis usually classified into three categories: (1) faintness, (2)
. ce I neous Ii htheadedness.
Faintness: Priorto an actual faint (syncope), there are 0 en pro roma
presyncopal symptoms faintness reflecting lschernla to a degree insufficient to
impair consciousness. The causes includes not enough blood getting to the
brain due to low blood pressure, sudden drop in blood pressure, dehydration
from vomiting, diarrhea, or fever, and getting up too quickly from a lying or
seated position. Faintness or dizziness may accompany other medical disorders
such as the flu, hypoglycemia, common cold, or allergies. Dizziness is also seen
in some serious medical conditions such as serious arrhythmias, heart attack,
stroke, and shock
Vertigo: Vertigo is usually due to a disturbance in the vestibular system (benign
positional vertigo and labyrinthitis). The vestibular system is one of three
sensory systems subserving spatial orientation and posture; the other two are
the visual system (retina to occipital cortex) and the somatosensory system. The
three stabilizing systems overlap sufficiently to compensate (partially or
completely) for each other's deficiencies. Vertigo may represent either
physiologic stimulation or pathologic dysfunction in any of the three systems.
Some lesscommon causes of vertigo include stroke, multiple sclerosis, seizures,
brain tumor and bleeding in brain.

• Dizziness due to head injury
• Dizziness with fever over 101°F, headache, or very stiff neck
• Dizziness with convulsions or ongoing vomiting
• Dizziness with weakness of limbs and slurred speech, unconsciousness
Dizziness
107
Table 19.6 Commonly Used Herbs for Headache

Wind cold Bai Zhi, Cang Er Zi, Chuan Xiong, Du Huo, Gao Ben, Xin Xin, Xin Vi Hua
Wind heat Bo He, Sang Ve, Ju Hua, Man Jing Zi, Chan Tui, Jiang Can, Niu Bang Zi
Wind dampness Bai Zhi, Cang Zhu, Gao Ben} Qiang Huo
Liver yang or fire Bai Ji Li, Gou Teng, Tian Ma, Ju Hua, Long Gu, M u Li, Shi Jue Ming,
Zhen Zhu Mu
Deficiency Guo Qi Zi, Man Ji Zi, Bai Shao Vao
Qi and blood Van Hu SUQ, Chuan Xiong, Niu Xi
stagnation
Stubborn '
_. ~ .,-
~
Wu Gong, Quan Xie, Oi Long, -

The prognosis of headache depends on the underlyingmedical diagnosis and TCM
patterns.
Usually externally contracted headache has a favorable prognosis.
Internal headache is often chronic and classified as patterns of complication of
excess and deficiency. With proper treatment the severity, frequency and
accompanied symptoms of internal headache may be improved significantly.
Some patients may be cured. Inappropriate use of herbs that expel wind and
move blood may cause side effects such as sore throat} fatigue, and increased
menstrual flow in the female.
Externally contracted headache may transform into internal headache if not
treated properly.
Internal headache initially classified as the patterns of complication of excess and
deficiency may transform into patterns of sim pie deficiency as the condition
progresses and the vital qi is gradually consumed.
Internal headache is often triggered by invasion of exogenous factors and
disturbance of emotional factors.
106
20.3.4 Differentiate the excess and deficiency

Dizziness will more likely be classified as patterns of deficiency or patterns of deficiency
complicated with excess. In a deficiency-excess complicated pattern; wind, fire, phlegm
and blood stasis are usually the secondary pathogenic factors while yin deficiency of
liver and kidney and deficiency of qi and blood are usually the primary pathogenic
factors.
20.3.5 Identify the diseases organs according to the symptoms of dizziness patterns
e 2.0.2. Differentiation of Diseased Organs in Dizziness

Patterns Features of Dizziness
Live Wind Dizziness/ vertigo with distending headache and flushed face
Qi and Blood Dizziness/ vertigo with poor appetite, pale complexion and fatigue
deficiency
Phlegm and Dizziness/ vertigo with poor appetite, nausea, heaviness of head, tinnitus
Dampness
Kidney Essence/ Dizziness / vertigo with soreness and weakness of low back and knees,
Yin Deficiency tinnitus of high pitch
20.4 Acupuncture Treatment for Dizziness and Vertigo
20.4.1 Ascendant Hyperactivity of Liver Yang

WU CAM CT
US 18 UB 18 UB 18
GB 20 GB 20 GB 20
LlV 2 L1V 2 L1V 2
KD 3 KD 3 GB 43
US 23 UB 23
Auxiliary Points:
For distention of the costal regions, add:
GB 34
For tinnitus, add:
5119
For lnsomnla, add: HT7
SP 6
20.4.2 Vacuity of Qi and Blood

WU CAM CT
DU 20 DU 20 DU 20
ST36 ST36 ST36
CV6 CV4 CV6
SP 6 SP 6 SP 6
US 17 UB20 UB 17
UB 18 SP 10
109
MCQM Acupunc ture Treatmen t Strategy and Herbal Internal Medicine
Study Guide 2009 by JH Xie .
Auxilia ry Points :
For palpita tions" add:
PC 6
For insomn ia" add:
HT7
For shortn ess breath and sponta neous sweati ng" add:
CV 17
KD7
20.4.3 Vacuit y of Kidney Essenc e and Yin

WU CAM CT
LIB 23 US 23
LIB 18 US 18
KD3 KD3
DU 20 L1V 3
SP 6 KD 6
ST 36 HT7
20.4.4 Vacuit y of Kidney Essenc e and Yang

WU CAM CT
DU20
LIB 20
ST36
UB 18
UB 23
CV4
20.4.5 Obstru ction of the Middle Burner by Phlegm -Damp ness

WU ~M cr
~~ ~@
~8 ~8
CV 12 CV 12
PC 6 PC 6
US 20 SP 9
ST36
Auxilia ry Points:
For severe dizzine ss and vertigo" add:
GS 20
For abdom inal distent ion and poor appeti te, add:
ST36
ST25
20.4.6 Obstru ction of the Middle Burner by Phlegm -Fire

WU ~M cr
ST8
ST40
CV 12
PC 6
L1V 2
GB 20
110
20 5 Herbal Treatment for Dizziness and Vertigo

Liver Yang Tian Ma Gou Teng Yin Purge Internal Wind
Hyperactivity Da Ding Fen Zhu
• Bai Shao Yao, EJlao, Gui Ban, Sheng Di
Huang, Huo Ma Ren, Wu Wei zt, Mu Li,
Mai Men Dong, Bie Jia, Zhi Gan Xao, egg
yolk
Qi Ju Di Huang Wan (maintaining or
,
IJI ~V~II ... v,", .......... /
Qi and Blood Gui Pi Tang

Deficiency
Kidney Yin Essence Zuo Gui Wan
Deficiency
Kidney Essence You Gui Wan
and Yang
Deficiency
Phlegm and Ban Xia Sai Zhu Tian Ma Tang Purge Internal Wind
Dampness Er Chen Tang
Obstructing in
Middle Jiao
Phlegm-Fire Huang Lian Wen Dan Tang
Obstructing in
Middle Jiao
According to the pharmacological these herbs may be improve the blood pressure of
hypertensive patients: Che Qian Zi, Da Ji, Di Gu Pi, Di ong, Du Zhong, Fen Fang Ji, Gou
Teng, Huai Hua, Huang Lian, Ju Hua, Jue Ming Zi, Jue Ming Zi, Shan Zha, Xi Xian Cao, Xia
Ku Cao, Xuan Shen, Yin Yang Huo, and Ze Xie.

• Prognosis depends on the underlying medical diagnosis and TCM patterns.
• In term ofTCM patterns, a patient's pattern may change from excessive to
deficient, vice versa. In chronic patients with dizziness their patterns are often a
complex of excess and deficiency, such as liver yang hyperactivity with yin
deficiency, qi deficiency with phlegm and dampness obstruction.
111
MCOMAcupuncture TreatmentStrategyand Herbal Internal MedicineStudyGuide2009 by JH Xie
21. Low Back Pain

Table 21.1 Causes of Lower Back Pain

Congenital/developmental
Spondylolysis and spondylolisthesis
Kyphoscoliosis
Spina bifida occulta
Tethered spinal cord
Minor trauma
Strain or sprain
Fractures
Traumatic-falls} motor vehicle accidents
Atraumatlc-e-osteoporosls, neoplastic infiltration/ exogenous steroids
Intervertebral disk herniation
Degenerative
Disk-osteophyte complex
Internal disk disruption
Spinal stenosis with neurogenic c1audicationa
Atlantoaxial joint disease (e.g., rheumatoid arthritis)
Arthritis
Spondylosis
Facet or sacroiliac arthropathy
Autoimmune (e.g., anklyosing spondylitis/ Reiter's syndrome)
Neoplasms
Metastatic
Hematologic
Primary bone tumors
Infection/inflammation
Vertebral osteomyelitis
Spinal epidural abscess
Septic disk
Meningitis
Lumbar arachnoiditisa
Metabolic
Osteoporosis- postmenopausal/ hyperparathyroidism and immobility
Osteosclerosis [e.g., Paget's disease)
Other
Referred pain from visceral disease
Postural
Psychiatric/ malingering/ chronic
112
Common Causes of low Back Pain

• Fibromyalgia
• Herniated disk
• Obesity
• Osteoarthritis
• Osteoporosis (Compression fractures)
• Poor posture
• Pregnancy
• Sciatica
• Scoliosis
• Spinal fractures due to trauma
• Spinal stenosis
o Spondylolisthesis
• Sprains and strains
• Tension or stress
• Unexplained fever with back pain.
• Lower back pain after a severe trauma.
• Hot sensation, redness or swelling on the back or spine.
• Low back pain traveling down the legs below the knee with weakness or
numbness in hip, thigh and leg.
• Burning sensation with urination or blood in urine.
• Very sharp pain.
• Low back pain with incontinence.
21.2 reM Etiology and Pathogenesis
Table 21.2 Summary of TeM Etiology and Pathogenesis in low Back Pain
Exogenous factors} especially wind Obstruction of channel
Excess patterns of
cold and dampness
_ _ _ _ _---.l.... and collaterals in low back low back pain
Qi and blood stagnation in
Traumatic injuries
low back region
Kldney deficiency due to
Deficiency
constitutional factors} prolonged Malnourishment of
patterns of low
staying in cold place, overindulgent channel and collaterals in
back pain
sexual activity, chronic illness} aging} low back
multiple child birth
Note: Patients with underlying kidney deficiency are more vulnerable tothe invasion of exogenous factors,
and patients with prolonged excess patterns of low back pain often develop kidney deficiency. Therefore low
back pain classified as a pattern of complication of excess and deficiency isvery common.
113

Low back pain is listed as a symptom for which acupuncture has been proved, through
controlled trails to be an effective treatment according to Acupuncture: Review and
Analysis of Reports on Controlled Clinical Trials by World Health Organization 2002.

21.3.2 Make TCM diagnosis according to the chief complain
21.3.3 Evaluate the deficiency and excess, interior and exterior in low back pain patient :
• Deficient patterns of low back pain are primarily kidney deficiency
or
EXCeSsloe palte:, 13 18: ·!i.sl, pain are patterns Of external pathogenic factors
invasion and traumatic injuries.
Complicated patterns with deficiency and excess are seen in chronic deficient
patterns with new external pathogenic factors invasion. Pathogenic factors
which Iiger and damage kidney qi.
Low back pain classified as exterior patterns: acute onset, history of external
pathogenic factors invasion, severe pain and symptoms of exterior patterns
Low back pain classified as internal patterns: chronic low back pain, remarkable
soreness, and symptoms of liver, kidney, qi and blood deficiency.
21.3.4 Differentiate the patterns based on the quality of low back pain
Table 21.2 Differentiation of low Back Pain Based on the Quality of Pain
Patterns Quality of low Back Pain
Cold Dampness Cold pain and heaviness of the lower back, difficulty turning
the waist, pain alleviated by applications of heat but not
diminished by lying quietly and an increase in pain during
cold or rainy weather
Damp Heat Low back pain accompanied by a sensation of heat at the
location of the pain, increase in pain during hot or rainy
weather,
Kidney Deficiency Slow onset with extended duration, aching of lower back
diminished by pressing and rubbing, fatigue, weakness of
knees] increase in pain after exertion] decrease in pain while
lying quietly, frequent recurrence of symptoms
Trauma and Injuries Stabbing low back pain of fixed location] aggravation of pain
with external pressure] increase in the severity of pain at
night, discomfort bending forward and straightening in mild
cases and, in severe cases, an inability to twist sideways
114
MCOMAcupunctureTreatment Strategy and Herbal Internal Medicine Study Guide2009 byJHXie
21.4 Acupuncture Treatment for Low Back Pain
21.4.1 Cold-Dampness
WU CAM CT
US 23 UB 23 UB 23
UB40 UB40 UB 40
DU 3 DU 3 DU 3
UB 25 UB 25 DU 16
UB 32 UB 26 ASHIXUE
GB 34
EV q
21.4.2 Damp-Heat
WU CAM CT
UB 23
DU 3
UB 40 (54)
GB34
UB 32
SP 6
21.4.3 Blood Stasis

WU CAM CT
UB 23 UB 23 US 32
DU 3 DU 3 US 17
UB40 UB40 UB40
DU 26 DU 26 DU 26
ASHIXUE ASHI XUE ASHIXUE
YAOTONG XUE YAOTONGXUE GB34
HUA TUG JIA JI
Auxiliary Points:
LBP extending down the legs add:
GB 30
GB 34
UB 60
21.4.4 Kidney Yang Vacuity

wu CAM CT
UB"23 UB 23 UB 23
DU 3 DU 3 US 52
UB 40 UB40 US40
UB 32 DU 4 KD3
YAO VAN YAO YAN CV4
DU4 CV6
21.4.5 Kidney Yin Vacuity

WU CAM CT
UB 23 UB 23 UB 23
UB 40 UB40 UB40
DU 3 DU 3 UB52
US 32 UB 52 KD 3
UB 52 KD 6 KD 6
115
KD 3
21.5 Herbal Treatment for tow Back Pain
Textbook
Cold Dampness Gan Cao Gan Jiang Ling Zhu Tang Xiao Huo Luo Wan
• Gan Cao, Gan Jiang, Fu (not for long term use)
Ling, Bai Zhu
Du Hou Ji Sheng Tang
n"'mn I-IQ::tT Si Miao Tang
Blood Stasis Shen Tong Zhu Yu Tang Yao Tong Plan +
Yan Huo Suo Zhi Tong Pian
~
Kidney Yang Kidney Essence Defi-: Qing E Wa n You Gui Wan+

Deficiency (Young Maid Pill) Yao Tong Pian
• Bu Gu Zhi, Du Zhong, Hu -
Tao Ren, Da Suan (garlic
bulb)
You GuiWan
-
Kidney Yin Zuo Gui Wan Zuo GuiWan +
Deficiency Da Bu Yin Wan (for deficient fire) Yao Tong Pian
The following herbs are commonly used for low back pain due to general kidney
deficiency: Bu Gu Zhi, Du Zhong, Gou Jl, Su Sui Bu, Hu Tao Ren, Sang.li Sheng, Sha Yuan
z, Tu Si Zi, and Xu Duan.
The prognosis depends on the underlying medical diagnosis and patterns.
Low back pain classified as deficient patterns (kidney yin or yang deficiency)
may transform into excessive patterns due to the invasion of external
pathogenic factors such as damp heat.
Low back pain due to chronic trauma is usually classified as a pattern of kidney
deficiency complicated with blood stasis.
116
MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by 1H Xie
22. Seminal Emission

Nocturnal emission may be seen in healthy individuals or some medical conditions while
spontaneous seminal discharge (seminal efflux) may be caused by medical conditions
such as neurosis, prostatitis, spermatocystitis, and orchitis.
Table 22.1 Major Causes of Seminal Emission

Acute Acute prostatitis is usually caused by a bacterial infection of ihe
prostatitis prostate gland.
Some sexually transmitted diseases (STDs) can cause acute prostatitis,
typically seen in men you nger than 35. These include gonorrhea,
chlamydia, urealyticum, and trichomonas. Prostatitis from an STD
typically closely follows sexual contact with an infected partner.
Acute prostatitis may also develop as a result of procedures involving
the urethral such as catheterization or cystoscope, trauma, bladder
outlet obstruction.
Chronic Chronic prostatitis is usually caused by a bacterial infection. It may be
prostatitis associated with or follow urinary tract infection, urethritis, epididymitis,
or acute prostatitis.
Certain factors may predispose a man to develop chronic prostatitis,
such as excessive alcohol intake, perineal injury, and certain sexual
practices (particularly anal sex without a condom). These factors may
cause congestion of the prostate gland, which produces an excellent
breeding ground for various bacteria.
Nonbacterial There are many theories about the cause of nonbacterial prostatitis:
prostatitis fungi, viruses, trichomonads, and obligate anaerobic bacteria have been
suspected. Irritation caused by a reflux of urine flowing into the
prostate may also be a cause.
Orchitis Orchitis may be caused by number of different types of bacteria and
viruses. It is usually a result of epididymitis. The most common viral
cause of orchitis is mumps. Orchitis may also occur along with infections
of the prostate or epididymis and may occur as a result of sexually-
transmitted diseases (STD) such as gonorrhea or chlamydia.
Neurosis Mental imbalance such as stress and anxiety

• Seminal emission with testicular pain
• Seminal emission with fever and painful urination
117
MCOM Acupuncture Treatment Strategy and Herbal Internal MedicIne Study Guide 2009 by JH Xie
Table 22.1 Summary of rCM Etiology and Pathogenesis of Seminal Emission

Deficient fire due to kidney yin
Disharmony between heart and kidney
deficiency disturbing the
due to emotional stress/ over-thinking
chamber of the essence
Overstrain/ chronic illness/
masturbation/ and overindulgent Failure of kidney in securing
sexual activity injuring kidney qi and the essence
Yepg
Heart spirit disturbance and Seminal
Stress/ over-thinking injuring the
failure of qi in securing the Emission
spleen and heart
essence
Exogenous damp heat invasion or Downpour of damp heat
internally generated damp heat due to disturbing the chamber of the
poor diets essence
Unsatisfied desire Excessive heart fire
disturbing the chamber of
the essence

22.3.1 Seminal emission is not medical problem unless it is caused by disorders such as
prostatitis/ sperrnatocvstltls, and orchitis. However seminal emission is often a concern
of health in TCM partially due to the influence of Taoism. It is often related to the
dysfunction of kidney and heart according to TCM theory.
22.3.2 Excess and Deficiency Pattern Differentiation
Excessive patterns include patterns of heart fire and damp heat downpour.
Deficiency patterns include patterns of kidney yang {qi) and kidney yin
deficiency.
Patterns Acupunctu re Prescriptio ns

Kidney Yin Deficiency with Deficient Fire BL15/ BL23/ HT7/ K13/ BL52/ PC6
Kidney Yang Deficiency with Failure to Secure the BL23/ CV4/ SP6/ BL52/ xuz, CV6/
Essence CV4
Qi Deficiency with Failure to Secure the Essence BL20/ BL23/CV6/ST36/BLS2/SP6
Damp Heat Descent CV3/ BL34/ SP9/ SP6/ LR3/ PC6
118

Pattern Formulas Recommended in Textbook Practical Options
KidneyYin Zhi Bai Di Huang Wan
Deficiency with San Cai Feng Sui Dan (Heaven} Human} and
Deficient Fire Earth Marrow-retaining Elixir)
• Shu Di Huang} Tia Men Dong} Ren
Shen, Huang Ba], Sha Ren} Gan Cao
• Usually Huang Qi} Shan Yao and Shan
Zhu Yu is added
Kidney yang I uu UUI vva
Deficiency with Jin Suo Gu Jing Wan

Failure to Secure Shui Lu Er Xian Dan (Land and Water Two
the Essence Immortals Elixir)
• Jin Ying Zi, Qian Shi
Qi Deficiency with Bu Zhong Yi Qi Tang
Failure to Secure
the Essence
Damp Heat Cheng Shi Bi Xie Feng Qing Yin Clear the Root
Descent (Kan)

The prognosis depends on the underlying medical conditions and patterns.
Seminal emission not caused by a medical condition may not need treatment.
Seminal emission due to neurosis is relatively easy to cure.
Excessive patterns seen at the early stage of the condition have favorable
prognosis. Chronic patients with the patterns of deficiency or deficiency
complicated with excess are more difficult to treat.
Most patients have excessive patterns initially and gradually develop patterns of
deficiency or deficiency complicated with excess.
A pattern of heart fire may transform into a pattern of disharmony between
heart and kidney.
A pattern of damp heat downpour may transform into a pattern of damp heat in
lower burner complicated with liver and kidney yin deficiency.
Kidney deficiency is seen in most chronic patients.
It is believed in TCM that patients with repeated seminal emission may develop
premature ejaculation and impotence.
119
MCOM Acupuncture Treatment Strategy and Herba Iinterna I Medicine Study Guide 2009 by JH Xie
KD/LU xu
Ge Jie Bu S 23. Impotence

Erectile Dysfunction (ED) may result from three basic mechanisms: (1) failure to initiate
(psychogenic, endocrinologic, or neurogenic); (2) failure to fill (arteriogenic); or (3)
failure to store (venoocclusive dysfunction) adequate blood volume within the lacunar
network. These categories are not mutually exclusive, and multiple factors contribute to
ED 1111/18119 paLitiib. j2gp!!nI!lSiRis factos frecp rept'\, cORxist with gther etiologic factors
and should be considered in all cases. Diabetic, atherosclerotic, and drug-related causes
account for >80% of casesof ED in older men.
Table 23.1 Causes of Erectile Dysfunction

Vasculogenic ED
Atherosclerotic
Traumatic arterial disease
ED due to Neurogenic Disorders
Spinal cord injury
Multiple sclerosis
Peripheral neuropathy
Endocrinologic ED
Hypogonadism
Hyperprolactinemia
Diabetic ED
Primarily related to diabetes-associated vascular and neurologic complications
Psychogenic ED
These include performance anxiety, depression relationship conflict, loss of
attraction, sexual inhibition, conflicts over sexual preference, sexual abuse in
childhood, and fear of pregnancy or sexually transmitted disease.
Almost all patients with ED, even when it has a clear-cut organic basis, develop
a psychogenic component as a reaction to ED.
Medication-Related
o Refer to table 23.2 drugs associated with ED
120
Table 23.2 Drugs Associated with Erectile Dysfunction

Categories Drugs
Diuretics Thiazldes Spironolactone
Antihypertensives Calcium channel blockers Reserpine
Methyldopa beta-Blockers
Clonidine Guanethidine
Cardiac/ Digoxin Clofibrate
antlhvperllpldernlcs Gemfibrozil
Antidepressants Selective serotonin reuptake Lithium
J;.I:ilsilol9 Mopoamipe gxidaSe
Tricyclic antidepressants inhibitors
Tranquilizers Butyrophenones Phenothiazines
H2 antagonists Ranitidine Cimetidine
Hormones Progesterone GnRH agonists
Estrogens 5_-Reductase lnhlbltors
Corticosteroids Cyproterone acetate
Cytotoxic agents Cyclophosphamide Roferon-A
Methotrexate
Anticholinergics Disopyramide Anticonvulsants
Recreational Ethanol Marijuan
Cocaine
23.2 TCM Etiology and Pathogenesis of Impotence
Table 23.3 Summary of TCM Etiology and Pathogenesis of Impotence

Excessive sex or Debilitation of
Exhaustion of kidney qi
masturbation Life Gate Fire
Stress or Kidney qi
Damage of kidney qi
being frightened deficiency
Damage of heart and Essence and
Stress or over-thinking Impotence
spleen blood deficiency
Stress or anger Liver qi stagnation
Failure of
Fatty or sweet food, principal tendons
Damp heat in liver channel
alcohol

Non-organic male sexual dysfunction is listed as a condition for which the therapeutic
effect of acupuncture has been shown but for which further proof is needed according
to Acupuncture: Review and Analysis of Reports on Controlled Clinical Trails by World
Health Organization 2002.
23.3.1 Verify the medical diagnosis and review the history of medications
. 23.3.2 Make TCM diagnosis according to the symptoms
23.3.3 Differentiate excess and deficiency
121
The initial step of pattern differentiation is to differentiate. excess and deficiency. Two
patterns are discussed in the textbook} e.g.} pattern of debilitation of life gate and the
pattern of downpour of damp hat into lower burner. Clinical patterns may be more
complicated. According to the TeM theory most patients with impotence are classified
as the deficient patterns or patterns of deficiency complicated with excess. Deficient
patterns include debilitation of Life Gate Fire, deficiencyof heart and spleen, and
damage of kidney qi by fright. Excessive patterns include liver qi stagnation and
downpour of damp heat into lower burner.
23.3.4 The role of liverand heart in the development of impotence is not addressed in
[j dC1itlbi lal dlscussioil. I:: t: aelitio I 1I11ioiliRiR8 kid po',' defirjepr\' is emphasized most in
the pathogenesis of the impotence. Many current TCM clinical studies emphasized the
role of liver qi stagnation and heart spirit damage due to stress, anger and over-thinking.
23.4 Acupuncture Treatment for Impotence

23.4.1 Debilitation of life-Gate Fire
WU CAM CT
CV4 CV4 CV4
DU4 DU4 DU4
UB23 UB23 UB23
KD3 KD3 5P6
DU20 0/3
UB31/32/33/34 5P36
Auxiliary Points:
Poor appetite:
GB20
Cold seminal discharge:
UB2
Damage of the heart and spleen Qi deficiency:
UB15
HT7
5P6
23.4.2 Downpour of Damp-Heat into the lower Burner
WU CAM C1
CV3 CV3 CV3
5P6 5P6 5P6
5P9 5P9 GB43
5T36 5T36 KDI0
LVS
Auxiliary Points:
Vacuity of Kidney Yin:
KD3
Sweatiness of scrotum:
5P9
122
23.5 Herbal Treatment for Impotence

Patterns Formulas Recommended in Textbook Practical
Options
Debilitation of Wu Zi Van Zong Wan Replenish
life-Gate Fire • Guo Qi Zi/ Fu Pen Zi/ Tu Si Zi/ Wu Wei Zi/ Che Essence (Kan)
Qian Zi (This is a
Zan Yu Dan slightly warm
• Shu Di Huang/ Shan Zhu Yu, Gou Qi Zl, Bal Ji formula. It is
Tian/ Rou Cong Rong, Du Zhong/ She Chuang Zi not suitable
I~_·.J;II""'" ,,"...,run Ybn I\II:::ln lcurculleol Yin Yang fo r patients
Hue, Dang Gui/ Bai Zhu, Zhi Fu Zl, Rou Gul, Jiu -with kidney
Cai Zi (Chinese leek seed) yin essence
Gui Pi Tang deficiency)
Downpour of Long Dan Xie Gan Tang Clear the Root
Damp Heat Zhi BaiDi Huang Wan
into Lower
Jiao

The prognosis depends on the underlying medical diagnosis and patterns.
The patients with excessive patterns have more favorable prognosis. However if
these patterns are not treated adequately the complication of liver and kidney
yin deficiency may develop and the condition becomes intractable.
123
24. Wasting-Thirst
PracticaI Therapeutics of TCM Page 207
The clinical manifestations described in rCM Wasting-Thirst patterns are similar to those
of diabetes mellitus and diabetes insipidus.
Diabetes insipidus is caused by decreased secretion or action of arginine vasopressin
(AVP). It is a syndrome characterized by the production of abnormally large volumes 'of
dilute urine. The polyuria produces symptoms of urinary frequency, enuresis, and/or
nocturia, which may disturb sleep and cause mild daytime fatigue or sornnclence.It is
ensurate increase in fluid intake (polydipsia).
Deficient secretion of AVP can be primary or secondary. It is mentioned in tete 00
thatTCM treatment for both diabetes mellitus and diabetes insipidus can be made
according to the discussion in wasting-thirst chapter. However diabetes insipidus is not
commonly treated by following the principles discussed in this chapter. The diabetes
insipidus is more complicated in diagnosis and evidence from clinical studies is very
limited. Therefore the discussion in this chapter is primarily on the treatment of
diabetes mellitus.
TABLE 24.1 Etiologic Classification of Diabetes Mellitus
I. Type 1 diabetes (fs-cell destruction, usually leading to absolute insulin deficiency)
A. Immune mediated
B. Idiopathic
II. Type 2 diabetes (may range from predominantly insulin resistance with relative
insulin deficiency to a predominantly secretory defect with insulin resistance)
III. Other specific types
A. Genetic defects of B-cell function
1. Chromosome 12, HNF-lcr (MODY3)
2. Chromosome 7, glucokinase (MODY2)
3. Chromosome 20, HNF-40' (MODY1)
4. Chromosome 13, insulin promoter factor-1 (IPF-l; MODY4)
5. Chromosome 17, HNF-lfS (MODY5)
6. Chromosome 2,NeuroDl (MODY6)
7. Mitochondrial DNA
8. Others
B. Genetic defects in insulin action
1. Type A insulin resistance
2. Leprechaunism
3. Rabson-Mendenhall syndrome
4. Lipoatrophic diabetes
5. Others
C. Diseasesof the exocrine pancreas
1. Pa ncreatitis
2. Trauma/pancreatectomy
3. Neoplasia
4. Cystic fibrosis
5. Hemochromatosis
6. Fibrocalculous pancreatopathy
7. Others (to be continued)
124
D. Endocrinopathies
1. Acromegaly
2. Cushing's syndrome
3. Glucagonoma
4. Pheochromocytoma
5. Hyperthyroidism
6. Somatostatlnorna
7. Aldosteronoma
8. Others
E. Drug- or chemical-induced
1. 'o'a081
2. Pentamidine
3. Nicotinic acid
4. Glucocorticoids
5. Thyroid hormone
6. Diazoxide
7. B-adrenergic agonists
8. Thiazides
9. Dilantin
10. a-Interferon
11. Others
F. Infections
1. Congenital rubella
2. Cytomegalovirus
3. Others
G. Uncommon forms of immune-mediated diabetes
1. "Stiff-man" syndrome
2. Anti-insulin receptor antibodies
3. Others
H. Other genetic syndromes sometimes associated with diabetes
1. Down's syndrome
2. Klinefelter's syndrome
3. Turner's syndrome
4. Wolfram's syndrome
5. Friedreich's ataxia
6. Huntington's chorea
7. Laurence-Mcon-Biedl syndrome
8. Myotonic dystrophy
9. Porphyria
10. Prader-Willi syndrome
11. Others
IV. Gestational diabetes mellitus (GDM)
Abbreviations: FPG, fasting plasma glucose; GAD, glutamic acid decarboxylase
GCT,glucose challenge test; GDM, gestational diabetes rnellltus.Htl}, hepatocyte
nuclear factor; IFG, impaired fasting glucose; IGT, impaired glucose tolerance
MODY, maturity-onset diabetes of the young; WHO, World Health Organization
Source: American Diabetes Association" 2004. Diabetes Care 27:55-510, 2004 © 2004 by
the American Diabetes Association, Inc.
http://care.diabetesjournals.org/cgijcontent/fulIj27/suppl_l/s5
125
MCOMAcupunctureTreatment Strategy and Herbal Internal MedicineStudy Guide 2009 by JHXie
Table 24.2 Major Types of Diabetes

Type 1 diabetes. According to American Diabetes Association 5-10% of Americans who
are diagnosed with diabetes have type ldiabetes.
Type 2 diabetes. Most Americans who are diagnosed with diabetes have type 2
diabetes
Gestational diabetes Immediately after pregnancy, 5% to 10% of women with gestational
diabetes are found to have diabetes, usually, type 2.
Pre-diabetes Pre-diabetes is a condition that occurs when a person's blood glucose
levels are higher than normal but not high enough for a diagnosis of
type 2 diabetes. There are 57 million Americans who have pre-
diabetes, Ii i addItlOi i to tIIE [:5.8 "Iillio:: ,cit!: @lifdH:r~ii illi1i9!id i p S to
American Diabetes Association.
Table 24.3 Exams and Tests for Diabetes Mellitus

Fasting blood Diabetes is diagnosed if higher than 126 mg/dL (milligrams per deciliter)
glucose level on two occasions. Levelsbetween 100 and 126 mg/dL are referred to as
impaired fasting glucose or pre-diabetes. These levels are considered to be
risk factors for type 2 diabetes and its complications.
Oral glucose Diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2
tolerance test hours.
Normal blood values for a 75-gram oral glucose tolerance test used to
check for type 2 diabetes:
o Fasting: 60 -100 mg/dL
• 1 hour: less than 200 mg/dL
• 2 hours: less than 140 mg/dL. Between 140-200 mg/dL is
considered impaired glucose tolerance or pre-diabetes. This group
is at increased risk for developing diabetes. Greater than 200
mg/dL is a sign of diabetes mellitus.
screen for gestational diabetes:
• .1 hour: less than 140 mg/dL
screen for gestational diabetes:
• Fasting: less than 95 mg/dL
• hour: less than 155 mg/dL
Random (non- Diabetes is suspected if higher than 200 mg/dL and accompanied by the
fasting) blood classic diabetes symptoms of increased thirst, urination, and fatigue. (This
glucose level test must be confirmed with a fasting blood glucose test.)
126
Table 24.4 Summary of TCM Etiology and Pathogenesis of Wasting Thirst Patterns
Overindulgence in sweet, fatty,
hot, spicy food and alcohol
damaging spleen and stomach
Qi stagnation due to emotional
- Wasting-thirst
disturbance causing stagnant fire
patterns
Overstrain or excessive sexual
activities damaging kidney essence u@litibil
Deficient constitution and kidney fire/heat
yin essence deficiency
Note: This summary describes the traditional understandinq ofpathogenesis inwasting thirst patterns.
However many clinical studies pointed out that qi deficiency and blood stasis pray an important role in the
development of the condition. Also atthe latter stage ofwasting-thirst pattern deficiency ofyin and yang is
seen in many patients.

According to Acupuncture: review and analysis of reports on controlled clinical trials by
World Health Organization 2002, non-insulin-dependent diabetes mellitus (NIDDM) is
listed as a condition for which the therapeutic effect of acupuncture has been shown
but for which further proof is needed.
24.3.2 TCM diagnosis is made based on symptoms and more importantly on medical
exams.
24.3.3 Pattern differentiations
Differentiate the locations: upper (lung), middle (stomach) and lower (kidney)
Differentiate the predominance of yin deficiency and dry heat
Differentiate the diabetic complications
24.3.4 Traditional patterns introduced in the textbook (Wu, 1997) include lung heat with
injury to fluids, profusion of stomach fire and depletion of kidney yin. Clinically wasting-
thirst is often classified as pattern of yin deficiency, deficient fire due to yin deficiency,
deficiency of qi and yin, deficiency of yin and yang, and blood stasis. This method of
pattern classification is more practical especially when treating asymptomatic diabetic
patients as many pre-diabetic or mild diabetic patients do not have classic symptoms of
yin deficiency and dry heat, e.g., excessive thirst, hunger and urination.
127
24.4 Acupuncture Treatment for Wasting~Thirst Patterns

24.4.1 lung Heat with Injury to Fluids
WU CAM CT
HT8 HT8
UB15 UB15
LUg LUg
UB13 UB13
YI5HU YI SHU
LU10
Auxiliary Points:
For dry mouth and tongue, add:
'''3.
eV24
For excessive thirst:
CV23
5T44
24.4.2 Profusion of Stomach Fire

WU CAM CT
5T44 5T44
UB20 UB20
UB2i UB21
VI SHU YI SHU
5P6 5P6
5T36
Auxiliary Points:
For constipation, add:
5T25
5T37
For Excessive hunger, add: eV12
PCG
24.4.3 Depletion of Kidney Yin

WU CAM CT
UB23 UB23
UB18 UB18
KD3 KD3
L1V3 L1V3
VI5HU VI SHU
Auxiliary Points:
For dizziness and vertigo, add:
DU23 DU23
For blurred vision, add:
6B37 -GB37
For vacuity of kidney yang, add moxibustion to:
CV4
DU4
For blood stasis, add:
UB17
128
24.5 Herbal Treatment for Wasting-Thirst Patterns

Patterns : Formulas Recommended in Textbook Practical
Options
Lung Heat Xiao Ke Fang (Wasting Thirst Formula) Xiao Ke Wan *
With Injury to • Tian Huo Feng, Huang Lian, Sheng Di Huang,
Sheng Jiang, fresh lotus juice, hone, human
Fluid
milk
Er Dong Tang (Ophiopogon and Asparagus
Decoction)
• Tian Men Dong, Mai Men Dong, Tian Hua
Fen, Huang Qin.. Zhi Mu, He Ye, Gan Cao,
Ken snen
Bai Hu Tang plus Ren Shen
Profusion of Yu Nu Jian Yu Nu Jian
Stomach Fire Zeng YeCheng Qi Tang Qiang Wei San
Depletion of Liu Wei Di Huang Wan
Kidney Yin
*Xiao Ke Wan is a patent product including herbs clearing heat, nourishing yin, moving
blood, replenishing qi. It is different from traditional Xiao Ke Fangformula that is only
for nourishing yin and clearing dry heat.
Table 24.6 TCM Treatment for Diabetic Complications

Complications TeM Patterns Formulas
Thoracic Bi Qi and blood stagnation. Sheng Mai San + Xue Fu
(coronary heart disease) Blood stagnation due to qi Zhu Yu Tang
deficiency
Dizziness or Vertigo Internal wind due to liver Tian Ma Guo Teng Yin
(higher cholesterol level, and kidney deficiency
hypertension, cerebral
arteriosclerosis)
Wind stroke Blood stagnation due to qi Bu Yang Huan Wu Tang
(stroke) deficiency
Blood stagnation and liver Sheng Mai San +
and kidney deficiency Bu Yang Huan Wu Tang
Edema Deficiency of Spleen and Wu Ling San +
(diabetic nephropathy) Kidney Shen Qr Wan
Deficiency of yin and yang Ji Sheng Shen Qi Wan
Blurred vision Blood stasis and deficiency Qi.lu Di Huang Tang
( diabetic retinopathy) of liver and kidney Shi Hu Ye Guang Wan
Gangrene Cold accumulation and Yang He Tang
obstruction of meridian
Yin deficiency, dry heat and Wu Wei Xiao Du Yin
toxins
Numbness of limbs Qi and yin deficiency Sheng Mai San + Si Wu
(diabetic neuropathy) Malnourishment of Tang + Herbs for dredging
meridians the meridians and
collaterals
129
Pharmacologica studies suggest that the following herbs may be beneficial to the blood
sugar in diabetic patients: Huang Jlng, Huang Llan, Jian Can, Nu Zhen Zi, Huang Qi} Dan
Shen, Gou Qi Zl, Sheng Di Huang, Yu Mi Xu, Zhi Mu, Ci Shao Yao, Dang Gui} Ge Gen,
Others: Huang Llan, Shan Yao, Yu Zhu, Mai Men Dong, Tu Ling, Tu Si Zl, Shi Gao, Wu Mei,
Cang zhu, Xuan Shen, Xian He Cao, Di Gu Pi,Ze Xie, Huang Jing Jie Gen, Yin Yang Hou
24.6 Prognosis ·and Development of Patterns

The prognosis depends on the types of diabetes and patterns.
Initially most patients are classified as patterns of yin deficiency and dry heat. As
the condition progresses pattern of qi and yin deficiency and blood stasis may
develop. At the later stage pattern 61 yiii dilt1 yallg liid y dcoelop. TI:@
complications such as thoracic bl, stroke, bi patterns (neuropathy) due to
deficiency of qi and yin and blood stagnation may develop. Edema may develop
in patients at the later stage with the pattern of yin and yang deficiency. Skin
ulcer, boils, and gangrene may develop in patients with the pattern of qi
deficiency, blood stasis and toxic heat accumulation. Dizziness may develop due
to the yin deficiency of liver and kidney and internal wind stirring-up.
130
25. Urinary Strangury

Frequent urination means needing to urinate more often than usual. Urgent urination is
a sudden, compelling urge to urinate, along with discomfort in bladder.
Major causes of frequent, urgent and painful urination include:
• Acute or chronic urinary tract infection
• Urinary stones
j'.lUfl8 iFUiJ oh:gpic pmsbtiVs
• Chyluria
Other causes include:
• Interstitial cystitis
• Overactive bladder syndrome
• Stroke and other neurological diseases
• Urinary incontinence
• Bladder cancer
• Bladder dysfunction
• Side effects of radiation therapy
Medical evaluation may be required if:
Frequent, urgent and painful urination seen in a patient with increased thirst or
appetite, fatigue, or sudden weight loss (suspected diabetes)
• Frequent, urgent and painful urination with bloody or cloudy urine
• Frequent, urgent and painful urination with discharge from the genitals
Emergency Symptoms:
• Frequent, urgent and painful urination with fever, back or flank pain, vomiting,
or shaking chills
• Frequent, urgent and painful urination with incontinence
• Any patients with urine retention
131
Table 25.1 Summary of TCM Etiology and Pathogenesis of Urinary Strangury

Damp heat caused by spleen Heat in US and Kidney:
and stomach dysfunction Heat strangury
Exogenousturbid toxic Heat damaging blood
pathogenic factors invading vessels:
into lower burner Blood strangury
Dysfunction of Damp heat condensing fluid
Heart fire transferring into
urina bladder and causing stone: Excessive
sma
in qi hua (qi Stone strangury a erns
----------- transforming) Damp heat obstructing the
Stagnant fire due to qi collatera Is and lipids
stagnation causing qi and exfluxing:
fire complication in urinary Unctuous strangury
bladder Qi stagnatio n:
Qi strangury
Sinking of spleen qi: Qi
strangury
Yin deficiency in lingering
Spleen qi falling to Blood
strangury patterns due to
strangury
damp heat
Constitutional deficiency of
Deficiency of
spleen and kidney
spleen and
Aging
kidney
Chronic illness
Overindulgence in sexual
activity
Condition triggered by
Overstrain
exertion: Lao Lin Taxation
Strangury
Note: The pathogenesis ofthis condition is often simplified as the dysfunction of UBincontrolling water
passage and qihua due todamp heat in UB, liver qistaqnallon and deficiency ofkidney and spleen.

World Health Organization 2002 female urethral syndrome} chronic prostatitis}
recurrent lower urinary-tract infection} urolithiasis are conditions for which the
therapeutic effect of acupuncture has been shown but for which further proof is needed.
Patients with these conditions may present with symptoms of urinary strangury.
2~.3.1 VerIfy the medical diagnosis

25.3.2 Make TCM diagnosis according to the symptoms and differentiate with dribbling
urinary block in TCM
The clinical features of strangury include frequent scanty or difficult urination] dribbling
urination} sharp pain in the urethra and lower abdominal spasms or pain radiating to the
132
lower back during urination. The most important feature for strangury is pain (in the
urethra and lower abdominal spasms or radlating pain) during urination.
25.3.3 Differentiate the types of strangury according to clinical features
Table 25.2 Features of Different Types of Urinary Strangury

Patterns Features of Strangury
Heat strangury Burning and painful urination
Blood strangury Bleeding and painful urination
Qi Strangury Distention in lower abdomen, dribbling, difficult and
WiSllie!,'" plliRfwl kl5iR2tisn
Stone strangury Excretion of stone in urine, decreased urine stream, or
interrupted urination, renal colicky pain
Unctuous strangury Urine like rice-washing water or unctuous urination
Taxation Strangury Chronic strangury often triggered by overstrain
25.3.4 Differentiate the deficiency and excess

Excessive Patterns:
Acute cases with theaccumulatlon of dampness, heat, stones or qi stagnation
Deficient Patterns:
Chronic cases with deficiency of spleen, kidney, qi, blood, yin and yang
25.4 Acupuncture Treatment for Urinary Strangury

25.4.1 Heat Strangury
WU CAM CT
UB28 UB28 UB 28
CV3 CV3 CV 3
SP9 SP 9 SP 9
SP6 LV2
SJ5
Auxiliary Points:
For aversion to cold and fever add:
L14 L14
For more constipation:
SJ6 SJ 6
25.4.2 Stone Strangury

WU CAM CT
UB28 UB 28 UB28
CV3 CV3 CV3
SP9 SP9 UB54 thru ST28
UB39 UB39 UB39
KD2 KD2
Auxiliary Points:
For hematuria:
SP6 SP6
In prolonged cases of urinary stones with depletion of qi and blood:
ST36 CV6 SP6
Where injury has been done to kidney yin:
UB23 KD3
133
MCOM Acupuncture Treatmen t Strategy and Herballn temal Medicine
25.4.3a. Qi Strangury-Repletion Patterns

wu CAM CT
UB28 UB 28 UB28
CV3 CV3 CV3
Spg SP9 UB54 thru ST28
L1V3 LV2 PC6
SP6 LV14
UB18
25.4.3 b. Qi Strangury-Vacuity Patterns

WU CAM CT
UB28 0828 ~HU8
CV3 CV 3 CV3
srs SP 9 UB54 thru ST28
CV6 CV 6 CV4
ST36 ST 36 ST36
DU20 UB20
25.4.4a. Blood Strangury-Repletion Patterns

WU CAM CT
UB28 UB28 UB28
CV3 CV3 CV3
Spg Spg HT8
SPi0 SP10 SPi0
SP6 SP6 SP6
PC8
25.4.4 b. Blood Strangury-Vacuity Patterns
WU CAM CT
UB28 UB28 UB28
CV3 CV3 CV3
Spg Spg ST36
SP6 SP6 SP6
SP10 SP10 SP10
KD7
KD3
25.4.5a. Unctuous Strangury-Repletion Patterns

WU ~M cr
UB28 UB28 UB28
CV3 CV3 CV3
Spg SP9 Spg
SP6 KD6 SP6
ST28 UB23 UB23
DU4
2S.4.Sb. Blood Strangury-Vacuity Pattern s

WU CAM C1
UB28 UB28 UB23
CV3 CV3 UB20
ses SP9 UB21
ST36 ST36 ST36
CV6 CV6 DU4
CV3
CV4
134
25.5 Herbal Treatment for Urinary Strangury

Heat strangury Sa Zheng San Ba Zheng San + Chuan
Xiao Chai Hu Tang Xin Lian Pian or Huang
Lian Jie Du Tang
Stone stra.ngury ShiWeiSan Ba Zheng San plus Hai Jin

• Shi Wei, Qu Mai, Che Qian Zi, Sha, Jin Qian Cao, Ji Nei
Dong Kui Zi, Hua Shi Jin
~nr r:hrnnic with deficiency: Ba Zhen Jie Shi Ling (Mayway Stone
Tang or Liu Wei Di Huang Wan rorrnurai
Qi Strangury: Chen Xiang San Chai Hu Shu Gan Tang +
Excessive (Aquilaria Powder) Wu Ling San
• Chen Xiang, Shi Wei, Hua Shi, Dang
Gui, Bai Shao Yao, Chen Pi, Dong Kui
Zi, Wang Bu Liu Xing Zi, Gan Cao
Qi Strangury: Bu Zhong Vi Qi Tang
Deficient Ba Zhen Tang
Blood strangury: Xiao Ji Yin Zi Ba Zheng San +
Excessive Heat Consolidate Blood (Kan)
Unlocking the Gate (Kan)
Blood strangury: Zhi Bai Di Huang Wan Clear Root
Deficient Heat
Unctuous Cheng Shi Bie Xie Fen Qing Yin Clear the Root
strangury Gao Lin Tang (Unctuous Strangury
Decoction)
• Shan Yao, Qian Shi, Duan Long
Gu, Duan Mu Li, Sheng Di
Huang, Sang Shen, Bai Shao Yao
• Often add: Jin Ying Zi, Tu Si Zi
Taxation Wu Bi Shan Yao Wan (Matchless Replenish Essence
Strangury Dioscorea Pill)
• Huang Qi, Ren Shen, Bai Zhu,
Dang Gui, Chen Pi, Sheng Ma,
Chai Hu, Zhi Gan Cao
Bu Zhong Vi Qi Tang, Qi Wei Du Qi Wan

• Prognosis depends on the underlying medical diagnosis and TCM patterns
Prognosis of excessive patterns is usually favorable. If excessive patterns last for
a long period of time, they may transform into deficient patterns or taxation
strangury.
Deficient patterns of strangury may develop into patterns of spleen and kidney
exhaustion or patterns of liver and kidney yin deficient and internal wlnd.
Excessive heat strangury pattern due to toxic heat may develop a pattern of
toxic heat in Sanjiao or toxic heat invading nutritive or blood level. Excessive
heat strangury pattern may also damage blood vessels and cause a blood
strangury pattern.
Stone strangury pattern is often complicated with blood strangury and heat
strangury.
135
MCOM Acupuncture Treatment Strategy and Herballntemal Medicine Study Guide 2009 by JHXie
26. Dribbling Urinary Brock


TCM pattern of dribbling urinary block refers to symptoms such as difficult in urination]
retention of urine and oliguria. Difficulty starting or maintaining a urinary stream is
called urinary hesitancy. According to the textbook description dribbling urinary block is
urinary hesitancy and retention of urine without painful urination.
Oliguria is often caused by dehydration, decreased circulatory volume (shock) and renal
. different from the urine retention (in bladder). Oliguria
may also caused by the obstruction of ureter. According to the text 00 0 .guria ue 0
renal diseases such as renal failure is also discussed in this chapter however the
treatment for oliguria due to renal failure is very different from those due to obstruction.
Urinary hesitancy accompanied with frequent] urgent and painful urination is diagnosed
as TCM urinary strangury.
Causes of urinary hesitancy and retention of urine without painful urination
• Benign prostatic hyperplasia (enlarged prostate)
• Side effects of medicaions (some cold remedies, some nasal decongestants,
tricyclic antidepressants, and anticholinergics)
• Shy or bashful bladder syndrome in younger people
• Neurologic disorders
• Postoperative urine retention
Urinary hesitancy with fever, vomiting, side or back pain, shaking chills, or
passing little urine for 1-2 days
Any patients with urine retention
Table 26.1 Summary of TCM Etiology and Pathogenesis of Dribbling Urinary Block
Damp heat accumulation Dysfunction of qi hua of UB
Lung qi stagnation due to Dysfunction of water passage due to
heat lung qi stagnation
Liver qi stagnation Dysfunction of qi hua and dispersing
Obstruction of ureter or
Obstruction of urination
urethra
Spleen qi failure of in rising Turbid yin fluid failing to descend
Kidney ql deficiency Dysfunction of qi hua

World Health Organization 2002 retention of urine due to traumatic injury is listed as a
condition for which the therapeutic effect of acupuncture has been shown but for which
'further proof is needed.
Neuropathic bladder in spinal cord injury is listed as a condition for which there are only
individual controlled trials reporting some therapeutic effects, but for which
136
acupuncture isworth trying because treatment by conventional and other therapies is

difficult.
Clinical studies showed that acupuncture are effective for postoperative urine retention.

26.3.2 Differentiate with urinary strangury pattern when making a rCM diagnosis
Table 26.2 Differentiation between Urinary Strangury and Dribbling Urinary Block
Urinary Strangury Dribbling Urinary Block
IQidjOi SYiilplOiilJ. FI cett!U!Iili; Major symptoms· Diffjclll! ipurination, retention of
urgent and painful urination. urine and oliguria. The daily output of urine is
The patient may have decreased usually decreased in case of oliguria. Patients with
urine output in each urination, urine retention due to urethral obstruction may
but usually have normal daily have abdominal pain and distention. However
urine output. some patients may have both painful urination and
urine retention in that case a diagnosis of urinary
strangury and dribbling urinary block may be
made.
26.3.3 Differentiation of cold, heat, deficient and excessive patterns in dribbling

urinary blockage
Table 26.3 Patterns Differentiation of Dribbling. Urinary Blockage

Pattern Clinical Features
Heat pattern Dark and scanty urine, thirst, red tongue
Cold pattern Clear urine, not thirst, pale tongue
Excess patterns Including patterns of damp heat, lung heat with qi stagnation,
liver qi stagnation, obstruction in urinary system
Deficient patterns Including pattern of spleen qi deficiency and kidney deficiency
26.4 Acupuncture Treatment for Dribbling Urinary Blockage

26.4.1 Bladder Damp-Heat
WU CAM CT
UB 28 UB 28 UB 28
CV3 CV3 CV3
SP 6 SP 6 SP 6
SP 9 UB 39 SP 9
Auxiliary Points:
For mental confusion add:
DU 26 DU26
PC-9 PC9
137
MCOM Acupuncture Treatme nt Strategy and Herbal Internal Medicine
Study Guide 2009 by JH Xie .
26.4.2 Exube rant Lung Heat Conge stion

WU CAM CT
LU 5 LU 5
CV 3 CV3
US 28 US 28
L14 LU 11
SP 9
SP 6
Auxilia ry Points:
For irritabi lity, add:
PC 6 PC 6
26.4.3 Liver Qi Stagna tion

WU CAM CT
CV 3 CV 3
UB 28 ST29
L1V 3 L1V 3
UB 39 L14
26.4.4 Interna l Obstru cti·on by Stagna nt Blood

WU CAM CT
CV 3 CV3 CV3
ST 28· ST 28 UB 28
SP 6 SP 6 SP 10
KD 5 KD 5 CV4
Auxiliary Points:
For the prolon ged illness with vacuity qi and blood, add:
0/4
ST36
26.4-.5 Spleen Qi Vacuit y

WU CAM CT
CV3
UB 20
ST36·
SP 9
US 22
Auxilia ry Points:
For anal prolap se, add:
UB 32
26.4.6 Exhaus tion of Kidney Yang

WU CAM CT
US 23 UB 23 UB 23
CV4 CV4 CV4
KD 10 DU 4 DU4
CV 6 DU 20 UB 28
US 22 SJ 4
Auxilia ry Points:
For elderly patien ts with weak constit utions where both the spleen
and kidney are
deplet ed, apply moxib ustion to:
DU 20
ST36
138
26.5 Herbal Treatment for Dribbling Urinary Blockage
- Patterns Formulas Recommended in Textbook Practical Options

Bladder Damp Sa Zheng San JieShiLing(Mayway Stone
Heat Dao Chi San Formula)
-
Zi Sheng Tong Guan Wan (Kidney Zhi Bal Di HuangWan plus .
Enriching Gate-opening Pill) Niu Xi, Che Qian Zi
-
• Zhi Mu, Huang Bai, Rou Gui
- ("'\4+"" ....... 1r e e- C::hona r1i 1-111::1 ric Nill
Xi, Che Qian Zi

-
Huang Lian Wen Dan Tang Clear the Soul (Kan,
modified Wen Dan Tang) +
~
Wu LingSan
Lung Heat Qing-Fei Yin (Lung Clearing Beverage) Qing FeiClearing Formula (Kan)
• Fu ling, Huang Qin, Sang Bai Pi, +Wu UngSan
Mai Men Dong, Che Qian Zi,
Shan Zhi Zi, Mu Tong
LiverQi Chen Xiang San (Aquilaria Powder) Chai Hu Shu Gan Tang +
Stagnation • Chen Xiang, Shi Wei, Hua Shi, Wu Ling San
Dang Gui, Bai Shao Yao, Chen
Pi, Dong Kui Zl, Wang Bu Liu
Xing Zi, GanCao
Internal Dai Di Dan Wan (Substitute Dead-On Purge Blood + Wu Ling
Obstruction of Pill) San, or
Bload Stasis • Shu Da Huang, Dang Gui Wei, Unlocking the Gate (Kan)
~
Sheng Di Huang, Chuan Shan

Jia, Tao Ren, Mang Xiao, Rou
Gui
Spleen Qi Bu Zhong Yi Qi Tang
Deficiency
Kidney Yang Ji Sheng Shen Qi Wan
Deficiency

Prognosis depends on the underlying medical conditions and TCM patterns.
139
27. Depression
Pattern Practical Therapeutics ofTCM Page 234
According to the TcM theory the clinical features of depression patterns may include
symptoms of psychiatric disorders such as somatoform disorder (hysteria), anxiety
disorders, and sometimes bipolar disorder (manic-depression) or non-psychiatric
conditions such as menopausal pattern. Ther'efore the concept of depression in TCM is
broader than and different from the depressive disorders (depression) in biomedicine
which is classified as a type of mood disorders.

There are two main psychiatric classifications in current use: the American Psychiatric
th
Association's Diagnostic and Statistical Manual (4 edition), or DSM-IV, and the World
th
Health Organization's International Classification of Disease (10 edition), ICD-l0. The
two systems are very similar, but ICD-10 is more widely used outside the United States.
The following is a review some psychiatric disorders related to TCM depression patterns.
27.1.1 Mood Disorders

Depression is a type of mood disorders according to classification of psychiatric
disorders. Mood disorders are characterized by a disturbance in the regulation of mood,
behavior, and affect. Mood disorders are subdivided into (1) depressive disorders, (2)
bipolar disorders, and (3) depression in association with medical illness or alcohol and
substance abuse.
Depressive disorders are differentiated from bipolar disorders by the absence of a manic
or hypomanic episode. The relationship between pure depressive syndromes and
bipolar disorders is not well understood; depression is more frequent in families of
bipolar individuals, but the reverse is not true.
Depressive Disorders
Major depression is defined as depressed mood on a daily basis for a minimum
duration of 2 weeks. An episode may be characterized by sadness, indifference,
apathy, or irritability and is usually associated with: changes in sleep patterns,
appetite, and weight; motor agitation or retardation; fatigue; impaired
concentration and decision-making; feelings of shame or guilt; and thoughts of
death or dying. Patients with depression have a profound loss of pleasure in all
enjoyable activities, exhibit early morning awakening, feel that the dysphoric.
mood state is qualitatively different from sadness, and often notice a diurnal
variation in mood (worse in morning hours).
Dysthymic disorder consists of a pattern of chronic (at least 2 years), ongoing,
mild depressive symptoms that are less severe and less disabling than those
found in major depression; the two conditions are sometimes difficult to
separate, however, and can occur together ("double depression"). Many
patients who exhibit a profile of pessimism, disinterest, and low self-esteem
respond to antidepressant treatment.
Other common forms of depression include:
• Postpartum depression
140
• Premenstrual dysphoric disorder (PMDD)

• Seasonal affective disorder (SAD)
Depression in Association with Medical Illness, Sides Effects of Medications and
Substance Abuse
Depression occurring in the context of medical illness is difficult to evaluate.
Depressive mood may be associated with psychological, social, biological and
pharmacological factors. Depression may reflect the psychological stress of
coping with the disease, may be caused by the disease process itself or by the
medications used to treat it, or may simply coexist in time with the medical
diagnosis.
Drugs that may induce depressive mood Include anbnypeHenslVe drugs,
anticholesterolemic agents, and antiarrhythmic agents, glucocorticoids,
antimicrobials, systemic analgesics, anti-parkinsonian medications, and
anticonvulsants. To decide whether a causal relationship exists between
pharmacologic therapy and a patient's change in mood, it may sometimes be
necessary to undertake an empirical trial of an alternative medication.
Depression may be related to substance abuse (alcohol and certain drugs).
Depressive mood was reported in the process of many medical conditions
including:
• Cardiac conditions: unstable angina, myocardial infarction, or
heart transplant impair rehabilitation
• Neurologic disorders: cerebrovascular disorders, Parkinson's
disease, dementia, multiple sclerosis, and traumatic brain injury
• Endocrinopathy: Diabetes mellitus and hypothyroidism
• HIV-positive individuals
• Others chronic fatigue syndrome and fibromyalgia
Bipolar Disorders (Maniac-Depression)
Bipolar disorder not otherwise specified.
Bipolar I disorder, most recent episode depressed
Bipolar /I disorder
Cyclothymic disorder
27.1.2 Anxiety disorder

• Generalized anxiety disorder
Panic disorder
Agoraphobia
• Phobias
Social anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
Separation anxiety
Medical Evaluations and Medical Evaluations and Emergency Symptoms

All patients with symptoms mood disorders, anxiety disorder or bipolar disorders should
be evaluated by qualified mental health specialists.
141
Call 911, a suicide hotllne, or get safely to a nearby emergency room if the patient has
thoughts of suicide, a suicidal plan, or thoughts of harming himself or others.
Medical Evaluations and Emergency Symptoms may also include:
Hallucination
Frequent crying spells with little or no provocation
Depression that disrupt work, school, or family life for longer than 2 weeks
Table 27.1 Summary of TCM Etiology and Pathogenesis of Depression

Anger damages liver and
causes liver qi stagnation;
Over-thinking damages
Qi stagnatio nand
spleen and causing
dysfunction of multiple Depression patterns
dysfunctio n of
internal organs
transportation;
All emotional factors will
da mage heart shen (spirit);

According to Acupuncture: review and analysis of reports on controlled cllnlcal trials by
World Health Organization in 2002 the depression is listed as a condition for which
acupuncture has been proved, through controlled trials, to be an effective treatment.

27.3.2 Be aware of the difference between biomedical term depression and the term
depression in TCM
27.3.3 Differentiate this condition with other TeM patterns such as plum-pit qi and
esophageal constriction.
27.3.4 The primary pathology ofTCM depression pattern includes liver qi stagnation,
dysfunction of spleen in transportation and malnourishment of heart. Generally
speaking qi stagnation, blood stagnation and fire stagnation are associated with liver
disorder; food stagnation, phlegm stagnation and dampness stagnation are associated
with spleen disorder} and depression classified as deficient patterns are associated with
heart disorder.
27.4 Acupuncture Treatment for Depression Patterns

27.4.1 Stagnation of liver Qi
WU CAM CT
UB18 LlV14
L1V3 LlV3
CV17 PC6
5T36 5T36
CV12 GB34
SJ6
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MCOM Acupunc ture Treatmen t Strategy and Herbal Internal Medicine
Auxiliary Points:
For oppres sion in the chest and vomiting, add:
PC6
SP4
For signs of blood stasis, add
UB17
SP6
27.4.2 Transf ormati on of Static Qi into Fire
WU CAM CT
L1V2 L1V2
61334 6831
GB43 ST44
eV13 L1V14
SJ6
Auxiliary Points:
For constip ation, add:
SJ6
27.4.3 Obstru ction by Static Qi and Phlegm

wu CAM CT
eV17
PCG
L1V3
ST40
eV22
eV12
Auxiliary Points:
L1V14
27.4.4 Vacuity of Yinand Blood
WU CAM CT
eV14
HT7
SP6
ST36
Ll4
143
27.5 Herbal Treatment for Depression Patterns

Textbook -
Stagnation of Liver Qi Chai Hu Shu Gan Tang Chai Hu Jia Long gu Mi Li
Tang
-
Transformation of Jia Wei Xiao Vao San
Static Qi into Fire
Obstruction by Static Qi Ban Xia Hou Po Tang Chai Hu Jia Long gu Mi Li
..,. ... ~ Dhl",O'rn Wpn n~:m Tanz
-
Tang + Er Chen Tang
Vacuity ofVin and Gan Mai Da Zao Tang plus Bai Gan mai Da Zao Tang +
Blood Zi Ren, Suan Zao Ren, Fu Shen, Suan Zao Ren Tang
-
He Huan Hua

Excessive patterns may develop into deficient patterns. In a patient of liver fire
pattern symptoms such as restlessness and anger, hypochondriac distention,
feeling of foreign body in throat may disappear, while symptoms of spleen and
heart deficlencv such as over-thinking, worrying too much, fatigue and
palpitation may develop. Patient's tongue body changes from dark purplish to
pale. Tongue coating changes from slimy coating to scanty coating. Pulse change
from wiry rapid to weak pulse or thready and wiry pulse. When deficient
patterns develop into excessive patterns the clinical features may change in a
reverse way.
144
28. Mania and Withdrawal

Mania and withdrawal in rCM include symptomsof psychiatric disorders such as bipolar
disorder (manic-depression) and schizophrenia.
According to the American Psychiatric Association's Diagnostic and Statistical Manual
th
(4 edition), or DSM-(V, there are 5 types of schizophrenia:
• Catatonic
, I5lSOI gSiiized
• Paranoid
• Residual
• Undifferentiated
As the illness continues, psychotic symptoms develop:
• An appearance or mood that shows no emotion (flat affect)
• catatonic behavior in which there is less reaction to the environment
• Delusions
• Hallucinations
• Disordered thinking
Symptoms can be different depending on the type of schizophrenia.
Catatonic type:
• Agitation
• Decreased sensitivity to pain
o Inability to take care of personal needs
• Negative feelings
o Motor disturbances
• Rigid muscles
• Stupor
Paranoid type:
• Anger
• Anxiety
o Argumentativeness
o Delusions of persecution or grandeur
• Violence
Disorganized type:
• Child-like (regressive) behavior
• Delusions
• Flat affect
• Hallucinations
o Inappropriate laughter
• Not understandable (incoherence) ,
• Repetitive behaviors
• Social withdrawal
Undifferentiated type may include symptoms of more than one type of schizophrenia.
Residual type -- symptoms of the illness have gone away, but some features, such as
hallucinations and flat affect may remain.

All patients with psychotic symptoms or being suspected to have bipolar disorders or
schizophrenia should be evaluated by qualified mental health specialists.
Call 911, a suicide hotllne, or get safely to a nearby emergency room if the patient has
thoughts of suicide, a suicidal plan, or thoughts of harming himself or others.
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by lH Xie
Table 28.1 Summary of TCM Etiology and Pathogenesis of Mania and Withdrawal
Heredity Deficiency of heart and
depressive psychotic
Emotional factors: spleen
unsatisfied desire, over-
---=------------
Stagnation of qi and phlegm
disturbance (Dian)
thinking, excessive Phlegm fire disturbing shen manic psychotic

emotions including anger, Yin deficiency and deficient disturbance
sadness, joy, fright fire disturbing shen (Kuan)
2&.3 C1inlEal ReasbHifig

Schizophrenia is listed as a condition for which the thera peutic effect of acupuncture
has been shown but further proof is needed according to Acupuncture: Review and
Analysis of Reports on Controlled Clinical Trials by WHO 2002.

28.3.2 TCM diagnosis is made after differentiating with other disorders associated with
emotional factors such as depression patterns.
28.3.3 Differentiate the depressive psychotic disturbance and manic psychotic
disturbance based on clinical features.
28.4.1a. Binding Depression of Qi and Phlegm

WU CAM CT
HT7 HT7 HT7
PC7 UB15 UB15
UB18 UB18 UB18
ST40 ST40 ST40
SP6 UB20 UB20
L1V3 L1V3
YIN TANG
Auxiliary Points:
For unprovoked bouts of sadness and crying, add:
LUg
28.4.1b. Heart and Spleen Vacuity

WU CAM CT
UB15 UB15
SP6 SP6
UB20 UB20
HT7 HT7
ST36 ST36
UB18
Auxiliary Points:
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 byJH Xie
For tendency towards being easily frightened, add:

PC7
28.4.2a. Phlegm-Fire Harassing the Interior

wu CAM CT
DU26 DU26 DU26
ST40 ST40 ST40
PC6 PC6 PC8
DU14 DU14 LlV3
DU16 DU16 CV13
Auxiliary Points:
For acute exuberant heat with manic behavior, bleed the twelve essence-well points.
For mania with constipation, add:
L1V3 5T25
5J6 5J6
28.4.2b. Exuberant Fire with Injury to Yin

WU CAM CT
HT7 HT7
KD4 KD4
PC7 PC7
5P6 5P6
UB15
UB23
147
28 5 Herbal Treatment
Depressive Psychotic Patterns'
Binding Shun Qi Dao Tan Tang (Qi- Normalizing Phlegm- Ease the Strai n
Depression Abducting Decoction) (Kan)
of Qi and • Ban Xia, Chen Pi, Fu Ling, Dan Nan Xing, Zhi
Phlegm Shi, Mu Xiang, Xiang Gu, Sheng Jiang, Zhi
Gan Cao
Huang Lian Wen Dan Tang
Bai Jin Wan (Alum and Curcuma Pill)
• Bai Fan (Alumen), Yu Jin (Curcuma)
Heart and Yang Xin Tang (Heart Nourishing Decoction) Gui Pi Tang +
Spleen • Huang Qi, Ren Shen, Fu Ling, Fu Shen, Dan Suan Zao Ren
Vacuity Gui, Chuan Xiong, Zhi Ban Xia, Bai Zi Ren, Tang
Yuan Zhi, Suan Zao Ren, Wu Wei Zl, Rou Gui,
Zhi Gan Cao
Gan Mai Da Zao Tang
Manic Psychotic Patterns
Phlegm Fire Shen Tie Luo Yin (Iron Flakes Beverage) Huang Lian Wen
Harassing • Tie Luo (iron flakes), Tian Men Dong, Mai Dan Tang
the Interior Men Dong, Zhe Bei Mu, Dan Nan Xing, Ju
Hong, Yuan Zhi, Shi Chang Pu, Lian Qiao, Fu
Ling, Fu Shen, Xuan Shen, Dan Shen, Gou -
Teng
Jia Jian Cheng Qi Tang
Wen Dan Tang
Exuberant Er Yin .lian (Tow Yin Brew) Tian Wang Bu Xin
Fire with • Sheng Di Huang, Mai men Dong, Xuan Shen, Wan
Injury to Yin Huang Lian, Mu tong, Zhu Ye, Fu Shen, Deng
Xin Cao, Suan Zao Ren, Gan Cao
-
• Prognosis depends on the medical diagnosis and TCM patterns.
• Patients with depressive psychotic disturbance (Dian pattern) are usually
classified with patterns of primary deficiency and secondary excess. Initially
most patients are classified with excessive patterns such as live qi stagnation
or/and phlegm misting orifice. Gradually complicated patterns of deficiency and
-
excess will be seen. Many patients will develop a pattern of spleen and heart
deficiency.
• Patients with manic psychotic disturbance (Kuan) most patients will be classified
-
with patterns of liver and heart fire, yang ming fu heat, or phlegm fire disturbing
upwards. When the condition becomes chronic, patient's heart and kidney yin
. may be damaged. When that occurs the patient's condition may change into a
depressive psychotic disturbance (Dian).
148
29. Epilepsy Patterns
29.1.1 Seizures and Epilepsy

Seizures: A seizure is a paroxysmal event due to abnormal, excessive, hypersynchronous
discharges from an aggregate of central nervous system (CNS) neurons. Depending on
t1:e 8igfFiib!~iQR of discharies this abpormal kNS activity can have various
manifestations, ranging from dramatic convulsive activity to experiential phenomena
not readily discernible by an observer.
Epilepsy: Epilepsy describes a condition in which a person has recurrent seizures due to
a chronic, underlying process. This definition implies that a person with a single seizure,
or recurrent seizures due to correctable or avoidable circumstances, does not
necessarily have epilepsy. Epilepsy refers to a clinical phenomenon rather than a single
disease entity, since there are many forms and causes of epilepsy.
29.1.2 Classification of Seizures and Epilepsy Syndrome

Types of Seizure
Based on the clinical features of seizures and associated electroencephalographic
findings (without considering other potentially distinctive features such as etiology or
cellular substrate) seizures could be classified as:
• Partial seizures
• Simple partial seizures (With motor, sensory, autonomic, or psychic signs) .
• Complex partial seizures
• Partial seizures with secondary generalization
• Primarily generalized seizures
• Absence (petit mal)
• Tonic-clonic (grand mal)
• Tonic
a Atonic
• Myoclonic
• Unclassified seizures
• Neonatal seizures
• Infantile spasms
Types of Epilepsy Syndromes
Juvenile myoclonic epilepsy
Lennox-Gastaut syndrome
Mesial temporal lobe epilepsy (MTLE)
Medical Evaluations and Emergency Symptoms and Medical Evaluation

All patientswith seizure should be medically evaluated. Emergency situations in
epilepsy and seizure include:
The first time a person has had a seizure Of a seizure is occurring in someone
without a medicallD bracelet
149
The patient with a diagnosed seizures or epilepsy has a longer seizure than the
patient normally has, or an unusual number of seizur~s
Repeated seizures over a few minutes
Repeated seizures where consciousness or normal behavior is not regained
between them (status epilepticus)
Seizure First Aid
• When a seizure occurs, the main goal is to protect the person from injury.
• Cushion the person's head.
• Loosen tight clothing, especially around the person's neck.
• lUi Jill IE pc: SOl: 6,. Aii iF ReF dd e If \tgmjtip'l PCG! Irs this helps make sure that
the vomit is not inhaled into the lungs.
• Look for a medical J.D. bracelet with seizure instructions.
• Stay with the person until he or she recovers, or until you have professional
medical help. Meanwhile, monitor the person's vital signs
Table 29.1 Summary of rCM Etiology and Pathogenesis of Epilepsy
Liver wind and

Heredity
phlegm turbidity
Emotional factors causing liver
Liver fire and phlegm
and heart qi stagnation
heat
Constitutional deficiency
Blood stasis
causing dysfunction of organs
Dietary factors damaging Heart blood
spleen and causing phlegm deficiency
Trauma injuries or trauma Liver and kidney yin
during the delivery causing deficiency
blood stasis in the vessels of Spleen deficiency and
brain phlegm

29.3.2 TCM diagnosis is made according to typical symptoms and signs.
29.3.3 If acupuncture or herbal treatment is applicable the pattern differentiation will
first be focused on the differentiation between excessive patterns and deficient patterns.
29.3.4 The excessive patterns are often classified in the period of frequent seizures.
They include pattern of obstruction of wind phlegm and pattern of internal profusion of
phlegm fire. The quality of phlegm, tongue and pulse will help the differehtiation. When
epilepsy is associated with brain injury, blood stasis is often considered asthe causative
factor.
29.3.5 The deficient patterns are often classified as being in a stable period. They
include patterns of liver and kidney yin deficiency and patterns of spleen and stomach qi
deficiency.
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MCOMAcupunctureTreatment Strategyand Herbal Internal Medicine Study Guide2009 by JH Xie
29.4 Acupuncture Treatment "for Epilepsy

29.4.1 Obstruction by Wind-Phlegm
WU CAM CT
CV 15
Yao qi
PC 5
LV 3
5T40
Auxiliary Points:
During seizures:
DU 26
5T6
HT7
Prolonged epilepsy with vacuity of qi moxa:
CV4
5T 36
29.4.2 Internal Profusion of Phlegm-Fire

wu CAM CT
CV 15
Yao qi
LV 3
GB13
5T40
DU 14
Auxiliary Points:
During seizures:
DU 26
5T6
51 3
Constipation:
5J 6
29.4.3 Vacuity of Liver and Kidney Yin

wu CAM CT
UB23
UB 18
KD 3
5P 6
" YaoQi
CV 15
Auxiliary Points:
During nighttime seizures:
KD 1
KD 6
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MCOM AcupunctureTreatment Strategy and Herbal Internal Medicine Study Guide 2009 by JH Xie
Daytime seizures:
US 62
Trance-like state:
US 15
HT7
Ying tang
29.4.4 Vacuity of Spleen and Stomach Qi

WU CAM CT
YaoQi
CV1S
US 20
CV12
SP 6
ST36
Auxiliary Points:
Where seizures manifest as prolonged periods of unconsciousness:
KO 1
Moxa:
CV6
Dizziness and vertigo:
DU 20
29.5 Herbal Treatment for Epilepsy

Options
_.
Wind Phlegm Ding Xian Wan (Epilepsy Stabilizing Pill) Tian Ma Gou
Obstruction • Tian Ma, Chuan Bei Mu, Fa Ban Xia, Fu Ling, Teng Yin +
Fu Shen, Dan Nan Xing, Shi Chang PU I Quan Purge Phlegm
Xie, Bai Jiang Can, Hu Po, Deng Xin cao, Chen (Kan)
Pi, Yuan Zhi, Dan Shen, Mai Men Dong, Zhu
Sha, Gan Cao, Zhu Li, Sheng Jiang Uuice)
Internal Long Dan Xie Gan Tang + Long Dan Xie
Profusion of Oi Tan Tang (Phlegm-Flushing Decoction) Gan Tang +
Phlegm-Fire • Fan Ban Xla, Tian Nan Xing, Che Pil Zhi Shi, Purge Phlegm
Fu Ling, Ren Shen, Shi Chang PU I Zhu RU I (Kan)
Sheng Jiang, Gan Cao
Vacuity of Liver Zuo Gui Yin
and Kidney Yin Gan Mai Da Zao Tang
Vacuity of Liu Jun Zi Tang plus herbs for resolving phlegm and
Spleen and settling spirit: Shi Chang PU I Yua Zhi, Dan Xing Bai
Stomach Qi Jiang Can
152
Epilepsy may be a chronic life long condition controlled with medications. The
medications may be reduced or eliminated over time in some patients. Certain
types of childhood epilepsy resolve or improve with age. A seizure-free period
of 4 years may indicate that reduction or elimination of medications is possible.
Death or permanent brain damage from seizures is rare, but can occur if the
seizure is prolonged or status epilepticus.
According to TeM theory, p~olonged excessive patterns with internal liver wind,
phlegm and blood stasis may cause complicated patterns of deficiency of heart
blood, spleen qi, liver yin or kidney yin. The symptoms of deficiency will usually .
pi (SCI it e1t!1l it,~ iki itil?lo period
153
30. Bi Pattern
The clinical manifestations of TCM Bi patterns include muscle pain, joint pain and
numbness of the body (fingers, hands, feet, arms, or legs).
30.1.1 Muscle ache
The most common causes are:
• ihjdfy 6f LJadiiid Iiicladiilg sp:ail,9 OItS ittiaiRs
• Overuse: using a muscle too much, too soon, too often
• Tension or stress
M usc\e pain may also be due to:
• Certain drugs, including:
• ACE inhibitors for lowering blood pressure
• Cocaine
• Statins for lowering cholesterol
• permat~myositis
• Electrolyte imbalances like too little potassium or calcium
• Fibromyalgia
• Infections, including:
• Influenza (the flu)
• Lyme disease
• Malaria
• Muscle abscess
• Polio
• Rocky Mountain spotted fever
• Trichinosis (roundworm)
• Systemic lupus erythematosus (SLE)
• Polymyalgia rheumatica
• PoIymyositis
• Rhabdomyolysis
30.1.2 Arthritis
Arthritis is caused by injuries, Infection (bacteria or viruses), autoimmune diseases and
degenerative diseases
Types of arthritis:
• Osteoarthritis
• Osteomyelitis
• Septic arthritis
• Tendonitis
o Rheumatoid arthritis (in adults)
• Juvenile rheumatoid arthritis (in children)
• Systemic lupus erythematosus (SLE)
.. Gout
• Scleroderma
• Psoriatic arthritis
154
• Ankylosing spondylitis
• Reiter's syndrome (reactive arthritis)
• Adult Still's disease
• Viral arthritis
• Gonococcal arthritis
• Other bacterial infections (non-gonococcal bacterial arthritis)
• Tertiary Lyme disease (the late stage)
• Tuberculosis arthritis
• Fungal infections such as blastomycosis
30.1.3 Numbness of body
Causes of numbness of body
• Aortic aneurysm
• Acoustic neuroma
• Alcoholism
• Brachial plexus injury
• Brain aneurysm
• Brain tumo.r
• Carpal tunnel syndrome
• Guillain-Barre syndrome
• Herniated disk
• Lyme disease
• Multiple sclerosis
• Paraneoplastic syndromes of the nervous system
• Peripheral neuropathy
• Raynaud's disease
• Side effects of chemotherapy or anti-HIV drugs
• Sjogren's syndrome
• Spinal cord injury
• Spinal tumor
•Stroke
•Syphilis
•Transient ischemic attack
•Type 2 diabetes
•Vasculitis (blood vessel inflammation)
·e Vitamin B-12 deficiency
Numbness can have a variety of causes. Emergency situation related to numbness
includes numbness that:
• Begins suddenly
• Follows a recent head injury
• Involves a whole arm or leg
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MCOMAcupuncture Treatment Strategy and Herbal Internal lV1edicine Study Guide 2009 by JHXie
Table 30.1 Summary of TCM Etiology and Pathogenesis
Internal or pre-exiting deficient of qi,

blood, yin and yang
Obstruction Bi
Invasion of external pathogenic factors:
patterns
Wind, Cold, Dampness and Heat
Three major categories of pathological changes at the chronIc cases:

Obstruction of blood stasis and phlegm turbidity
Deficiency of qi and blood
Progress of pathogenic factors from channels and
connections into the internal organs

Bi-pattern is one of the most commonly seen conditions in acupuncture practice.
Keen pain} periarthritis of shoulder} rheumatoid arthritis} sciatica and tennis elbow are
conditions for which acupuncture has been proved, through controlled trials, to be an
effective treatment according to Acupuncture: Review and Analysis of Reports on
Controlled Trials by WHO 2002.
Fibromyalgia and fasciitis, gouty arthritis, osteoarthritis, primary raynaud syndrome,
acute spin pain, and reflex sympathetic dystrophy are conditions for which the
therapeutic effect of acupuncture has been shown but further proof is needed
according to the same review.
Patients with these conditions may develop symptoms of pain and numbness. In TCM
practice} they are usually treated with acupuncture or herbs according to the theory
discussed in this chapter.

30.3.2 TCM diagnosis of painful bi patters are made according to the chief complains.
30.3.3 Differentiate deficiency and excess (acute or chronic)
30.3.4 Although wind bl, damp bi and heat bi are normally differentiated} clinically wind
and dampness often invade bi-pattern patients together. Wind cold dampness bi
pattern and wind dampness heat pattern often classified for externally contracted bi
patterns.
• Wind cold dampness: joint pain worsened by cold, not fever
• Wind heat dampness: joint pains with redness and swollen} pain slightly relieved
with cool compression, severe pain, and fever
30.3.5 Differentiate predominance of wind} cold, dampness and heat
• Wind bi: pain roving through various location
• Cold bi: cold pain severe
• Damp bi: numbness, aching, heaviness, swelling and pain of fixed location
o Heat bi: Fever and red swollen painful joints
30.3.6Differentiate the involvement of phlegm and blood stasis
156
30.4 Acupuncture Treatm ent for Bi Patterns
30.4.1 Wind-D omina nt Bi

WU CAM CT
UB12 GB20
UB17 UB17 UB17
SP10 SP10 SPiO
DU14
30.4.2 Cold-Dominant Bi
\Oil , CAM CT
UB 23 UB 23 UB 23
CV4 CV4 CV4
DU 14
UB 12
30.4 .3 Dampness-Dominant Bi
WU CAM CT
ST 36 ST36' ST36
SP 9 SP 5 SP 9
US 20 US 20
DU 14
US 17
-30.4. 4 Heat-D omina nt Bi

WU ~M CT
DU 14 DU 14 DU 14
LI 11 II 11 L111
L14
30.4.5 Bi with Blo,od Stasis and Phlegm -Turbid ity

Use points that moving blood and resolving phlegm togeth er with auxillai
ry points
based on location of bi pattern.
30.4 .6. Bi with Deplet ion of Qi and Blood, Kidney and Liver Vacuit
y
Use points that nourish qi, blood, kidney and liver with auxillairy points
based on
location of bi pattern.
30.4 .7. Bi with Heart Vacuity

Use polnts for tonifying qi and blood and calming heart shen.
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MCOM AcupunctureTreatmentStrategyand Herbal Internal Medicine Study Guide2009 by JH Xie
Auxiliary points based on the locations of the bi patterns:

WU ~M cr
For pain of the shoulder joint, add:
L115 U1S U1S
~14 ~14 SJ14
5110 5110 5[10
519
For pain of the scapular region, add:
5111 5111
sl12 Si12
5114 5114
UB43 US43
For pain of the elbow, add:
L111 Ull L111
L14 L14 Ll3
SJi0 SJ10 SJ10
SJS SJ 5 SJS
LUS LUS LUS
For pain of the wrist, add:
SJ4 SJ 4 SJ 4
LIS LIS LIS
SIS SIS 5/5
~5 ~S SJ 5
For stiffness of the fingers, add:
SIS SIS
L14 L14
513 513
For numbness and pain of the fingers, add:
513 513
L13 U3
BAXIE BAXIE
For pain of the hip joint, add:
GB 30 GB 30 GB30
GB29 GB 29 GB 29
GB39 GB 39 GB 39
For pain of the thigh, add:
UBS4 US 54 UB 54
UB36 US 38 UB 36
GB34 GB 34 GB34
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Study Guide 2009 by JHXie
For pain of the knee joint, add:

5T 35 5T 35 5T35
GB 34 GB 34 GB 34
5T 34 NEI XI YAN 5T34
GB33 5P9 GB 33
5P 9 HE DING
NEI XI VAN
Pain of the ankle, add:
5T 41 5T 41 5T41
UB 60 06 eo
!!\jl EO
GB40 GB40 GB40
5P 5 5P 5 UB 62
UB 62 KD3 KD6
KD 6
For numbn ess and pain of the calf, add:
UB57 US57
US 58 US 58
For numbn ess and pain of the toes, add:
5P 4 5P 4
UB 65 US 65
SA FENG BA FENG
For genera l pain over the entire body, add:
513 513
UB 62 UB 62
5P 21 5P 21
LI 15 LI 15
LI 11 LI 11
L14 L14
5J4 5J4
GB 30 GB 30
GB 34 GS 34
GB 39 GB 39
ST 41 5T 41
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MCOM Acupuncture Treatment Strategy and Herbal lnternal Medicine Study Guide 2009 by JHXie
30.5 Herbal Treatment for Bi Patterns

Wind Fang Feng Tang (Ledebouriella Decoction) Qiang Huo Shen Shi
Dominant Bi • Fang Feng, Dang Gui, Fu Ling, Xing Tang
Ren, Qin Jiao, Ma Huang, Ge Gen,
Huang Qin, Rou Gui, Sheng Jiang, Gan
Cao, Da Zao
Cold Wu Tou Tang (Aconite Main Tube Decoction) Xiao Huo Luo Dan
uomrnant /jl · \..IIuoII vv .... \ ...........
Huang, Bai Shao Yao, Huang Qi, Zhl

' .. ~
.L .\
I
1\ /I
Gan Cao
Dampness Vi Vi Ren Tang (Coix Decoction) Qiang Huo Shen Shi

Dominant Bi • Vi Vi Ren, Chuan Xiong, Dang Gui, Qian Tan,
Huo, Du Huo, Ma Huang, Gui Zhi, Fang Juan Bi Tan
Feng, Cang Zhu, Sheng Jian, Zhi Chuan
Wu Tau (aconite Main tuber) -
Juan Bi Tang
Heat Bai Hu Tang plus Gui Zhi Clear Channels (Gui
Dominant Bi Xi Jiao San (Rhinoceros Horn Powder) Zhi Shao Vao Zhi Mu -
• Xi Jiao, Huang Lian, Sheng Ma, Zhi Zi Tang} or
San Miao Wan Bai Hu Tang + Juan Bi
Tang -
Bi with Blood Tao Hong Vin (Peach Kernel and Carthamus Shen Tong Zhu Vu
Stasis and Beverage) Tang+
Phlegm 0 Tao Ren, Hong Hua, Chuan Xiong, Lucid Channel (a -
Turbidity Dang Gui Wei, Wei Ling Xian modified Er Chen
Tang)
-
Bi with Duo Huo Ji Sheng Tang Duo Huo Ji Sheng
Deficiency of San Bi Tang Tang
Qi, Blood, Vao Tong Pian
-
Liver and
Kidney
Bi with Heart Zhi Gan Cao Tang Refer to chapter
-
Vacuity palpitation
Table 30.3 Commonly Used Herbs for Bi Pattern

Wind Bi Fang Feng, Gao Ben, Hai FengTeng, Luo Shi Teng, Qiang Huo, Du
Huo, Quan Xie, She Tui Tian Ma, Wu Gong,
Cold Bi Cao Wu Tau, Chuan Wu Tau, Fu Zi, Gao Ben, Gui Zhi, Ma Huang, Xi
Xin, Vin Vang Huo
Damp Bi Cang Zhu, Du Huo, Mu Gua, Qing Huo, Vi Vi Ren
Heat or Damp Heat Di Long, Huang Bai, Hai Tong Pi, Qin Jiao, Ren Dong Teng, San Zhi
Bi
Bi with Deficiency Du Zhong, Xu Duan, Sang Ji Sheng, Niu Xi, Bu Gu Zhi, Vin Vang Hue,
Xian Mao,
160

• Prognosis depends on underlying medical diagnosis and TCM patterns.
• Patients may be cured when the condition is at its initial stage with relative
stronger vital qi. Ifthe patient has underlying deficiency of yin/ yang/ ql and
blood/ or severe pathogenic factor invasion/ the condition may become
intractable.
• In terms ofTCM patterns/ wind dampness and cold dampness patterns are
usuallyseen at the initial stage of illness.They are relatively easier to control.
Inappropriate or delayed treatment will cause these two patterns transform
mto pattern of damp neat of told-neat EorfiPIiCdt@tj PdLEeJ Ii 01 a panEl Ii ovilli
phlegm and blood stasis obstruction.
• Patterns of damp heat or toxic heat are usually due to direct invasion of
pathogenic factors. They are usually more serious and require prompt
treatment. They often result in complicated pattern of phlegm and blood stasis
with qi and yin deficiency if not treated properly.
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MCOM Acupuncture Treatme'nt Strategy and Herbal Internal Medicine Study Guide 2009 by JH Xie
31. Atony Patterns

The condition is similar to neurogenic atrophy which occurs when there is injury or
disease to a nerve.
• Acute Myelitis
• Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease)
• 861113
• Diabetic neuropathy
• Guillain-Barre syndrome
• Injury
• Long-term corticosteroid therapy
• Long-term immobilization
• Muscular dystrophy
• Myasthenia Gravis
• Peripheral neuropathy
• Polio
• Spinal cord injury
• Stroke
Disused muscular atrophy due to immobilization of limbs may be treated according to
the principles discussed in this chapter! but is not normally diagnosed as atrophy
patterns in TCM. Muscular atrophy due to arthritis such as osteoarthritis and
rheumatoid arthritis is normally classified as a Bi-pattern in traditional Chinese medicine.
All patients with muscular atrophy should be medically evaluated.
Emergency symptoms related to atony patterns may include:
• Difficulty with speaking! chewing or swallowing
• Incontinence
• Very slow heart rate or low blood pressure
• Difficulty breathing

Table 31.1 Summary of TeM Etiology and Pathogenesis of Atony Patterns
yin fluid damage and
Invasion of toxic damp
Lung heat malnourishment of tendons!
heat to lungs
muscles and meridians
Exogenous damp heat or
dampness heat Damp heat damaging tendons! Atony
damp heat produced due
accumulation muscles and meridians patterns
to inappropriate diets
Deficiency of Malnourishment of tendons!
Overstrain! chronic illness
spleen! stomach! muscles and meridians due to
and poor constitution
liver and kidney blood and essence
162

Progressive bulbar and pseudobulbar paralysis are conditions for which acupuncture
treatment maybe tried provided the practitioner has special modern medical
knowledge and adequate monitoring equipment according to Acupuncture: Review and
Analysis of Reports on Controlled Trials by WHO 2002.

31.3.2 Differentiate with painful bi patterns and wind stroke patterns when making a
TCM diagnosis
31.3.5 And 1eM eHag: 10gbis lifitieg tbg first step Of differeptiation is to differentiate the
excess and deficiency
Table 31.2 Differentiation of Excess and Deficiency in Atrophy Patterns

Excess Deficiency
Acute onset, swift progress, short history, Long history, chronic onset, evident muscle
not obvious numbness and spasm or atrophy and weakness.
muscle atrophy. Often classified as patterns of deficiency of
Often classified as damp heat and lung spleen, stomach, liver and kidney
heat with yin fluid damage
31.3.4 Differentiate the diseased organs according to the clinical features

Lung: Fever, sore and dry throat, cough or atrophy seen after a febrile disease
Spleen and stomach: Muscle atrophy and weakness in arms and legs, poor appetite,
loose stool, abdominal distention,
Liver and kidney: Muscle atrophy and weakness in lower limbs, weakness and soreness
in low back and knees, tinnitus and dizziness, irregularity of menstruation in female
patients
31.3.5 When treating muscle atrophy herbs that expel wind and dredging meridian
should be used with cautions due to their side effects of drying and heat-generating.

31.4.1 Lung Heat with (njury to Body Fluids
WU CAM CT
UB13 UB13 HUA TUO .IIA.l1
LU 5 LU 5 LU 9
L111
ST39
Auxiliary Points:
For flaccidity and motor impairment of the upper limbs, add:
LI 15 LI 15
Ll11 Ll11
SJ 5 SJ 5
LI4 LI4
For flaccidity and motor impairment of the lower limbs, add:
ST31 ST31
GB 30 GB 30
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Study Guide.2009 by JH Xie
5T34 5T34
5T36 5T36
5T41 5T41
GB 39 GB39
5P 10
GS 34
For inconti nence of urine, add:
CV3 CV3
5P 6 5P 6
For ipcont inence of st091s add;
UB 25 UB 25
US 32 UB 32
For fever, add:
DU14 DU 14
31.4~2 Invasion by Damp-Heat Evils
wu CAM CT
US 20 US 20 HUA TUO JIA JI
5P 9 5P 9 5P 9
L111
L14
5T31-5T 41
For flaccid ity and motor impair ment of the upper limbs, add:
LI 15 LI 15
LI 11 LI 11
5J 5 5J 5
LI4 LI4
For flaccid ity and motor impair ment of the lower limbs, add:
5T 31 5T 31
GB30 GB30
5T 34 5T 34
5T 36 5T 36
5T 41 5T 41
GS 39 GB 39
GB 34
5P 10
For inconti nence of urine, add:
CV3 CV3
5P 6 SP 6
For inconti nence of stools, add:

UB25 US 25
US 32 US32
164
31.4.3 Spleen and Stoma ch Qi Vacuit y

wu CAM CT
CV 12 HUA TUG JIA JI
SP 6 CV6
US 2.0 5P 9
5T 31-5T 41
For flaccid ity and motor impair ment of the upper limbs, add:
L115
L111
L14
For flaccidity and motor impair ment of the lower limbs, add:
5T 31
GS 30
5T34
5T 36
5T41
GB 39
For incont inence of stools, add:
UB 25
UB 32
For fever, add:
DU 14
For incont inence of urine, add:
CV3
5P 6
31.4.4 Deplet ion of Liver and Kidney Yin

WU CAM CT
UB 18 UB 18 HUA TUO JIA JI
UB 23 UB 23 UB 23
GB 34 5P 6
GB 39 CV4
'-.115- L14
5T 31--5T 41
Flaccidity and motor impair ment of upper limbs:
L115
L1ll
5J5
L14
Flaccid ity and motor impair ment of the lower limbs:
5T31
GB30
ST34
5T 36
5T41
165
GB 39
For incontinence of urine add:
CV3
SP 6
For fever add:
DU 14
31.5 Herbal Treatment Atony Patterns

-
Lung Heat with Qing Zao .Iiu Fei Tang Qing Zao Jiu Fei Tang
IlIJUI Y lU DUUy T. VVCI 10115 l--'LUIIIOl..1 I-UUU.;)LII 15 'II/ --'110 .....,,'- VI'" IV''-'
Fluid • Sha Shen, Sheng Di Huang, Mai Dong Tang

-
Men Dong, Yu Zhu, rock candy
Invasion by Jia Wei Er Miao San Clear Channels (Gui Zhi

-
Damp Heat • Huang Bai, Cang Zhu, Niu Xi, Dang Shao Yao Zhi Mu Tang
Gui, Gui Ban
Spleen and Shen Ling Bai Zhu San -
Stomach Qi
Deficiency
Deficiency of Hu Qian Wan (Hidden Tiger Pill) -
Liver and • Shu Di Huang, Zhi Mu, Gui Ban,
Kidney Huang Bai, Bai Shao Yao, H u Gu
(tiger bone, substituted with pig -
bone or dog bone), Chen Pi, Suo
Yang, Gan .liang
Zhi Bai Di Huang Wan -

• Prognosis depends on the medical diagnosis and TCM patterns.
• According to TCM theory muscle atrophy due to external factor invasion has a
favorable prognosis. Chronic patients with deficiency of qi, blood, yin and yang,
serious muscle atrophy are poor in prognosis.
166
32. Internal Damage Fever
Internal damage fevers are those conditions in which the fever results from internal
etiological factors and their pathogenic mechanisms. In traditional Chinese medicine
internal damage fever is clearly distinguishable from external contraction fever including,
cold damage diseases, warm diseases, and common cold. Externally contracted fever is
often caused by infections while internal damage fever is more complicated and its
causes liidy 'iielude iilkc!isli!) tl!lHifil6; GaRrO'S, a"tgjmm"pe diseases and fevers of
undetermined origin in bio-medicine. The patients usually have fever and symptoms due
to the dysfunctions of qi, blood, body fluid, yin, yang and zang-fu organs.

The discussion in this review may include the pathophysiology of fever that may be
classified as externally contracted fever in TCM.
Fever is an elevation of body temperature that exceeds the normal daily variation and
occurs in conjunctionwith an increase in the hypothalamic set point.
Hyperthermia is characterized byan unchanged (normothermic) setting of the
thermoregulatory center in conjunction with an uncontrolled increase in body
temperature that exceeds the body's ability to lose heat. Exogenous heat exposure and
endogenous heat production are two mechanisms by which hyperthermia can result in
dangerously high internal temperatures. Excessive heat production can easily cause
hyperthermia despite physiologic and behavioral control of body temperature. For
example, work or exercise in hot environments can produce heat faster than peripheral
mechanisms can lose it.
Most patients with elevated body temperature have fever, but there are a few
circumstances in which elevated temperature represents not fever but hyperthermia.
Heat stroke, caused by thermoregulatory failure in association with a warm
environment, may be categorized as exertional or nonexertional. Exertional heat stroke
typically occurs in younger individuals exercising at ambient temperatures and/or
humidities that are higher than normal. Nonexertional or classic heat stroke typically
occurs in either very young or elderly individuals, particularly during heat waves.
It is important to distinguish between fever and hyperthermia since hyperthermia can
be rapidly fatal and characteristically does not respond to antipyretics.
Causes of fever
Infections
Noninfectious inflammatory diseases such as collagen vascular disease, and
autoimmune disorders
Neoplasm
Side effects of medications (antibiotics, antihistamines, barbiturates,
hypotensors, anticholinergic or antiparkinsonian drugs or diuretics)
Unknown causes
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MCOM Acupuncture Treatment Strategyand HerbalInternal Medicine Studv Guide 20~9 by JHXie
Fever due to unknown origin (FUQ)

oF)
FUO definition in 1961 (Petersdorf and Beeson): (i) temperatures of >38.3 DC (>101
on several occasions; (2) a duration of fever of>3 weeks; and (3) failure to reach a
diagnosis despite 1 week of inpatient investigation.
New system for classification of FUO (Durack and Street): (i) classic FUO; (2) nosocomial
FUO; (3) neutropenic FUO; and (4) FUO associated with HIV infection
According to Harrison's Principles of Internal Medicine} 16th ed. New York} McGraw-Hili}
1991 the causes of FUO in adults in the United States include:
Infections
s
Habitual Hyperthermia {Exaggerated circadian rhythm
Collagen Vascular/ Hypersensitivity Diseases
Granulomatous Diseases
Miscellaneous Conditions {aortic dissection} drug fever} gout} hematomas}
hemoglobinopathies} laennec's cirrhosis} periodic fever} adenitis} pharyngitis}
postmyocardial infarction syndrome} recurrent pulmonary emboli} subacute
thyroiditis andtissue infa rction/necrosis
Inherited ad Metabolic Diseases
Thermo Regulatory Disorder {brain tumor} cerebrovascular
accident} encephalitis} hypothalamic dysfunction}
hyperthyroidism} pheochromocytoma)
Factitious Fever
Afebrile FUO(>38.3°C)
Medical evaluation and intervention is required immediately for:
All adult patients with a fever that lasts longer than 48 to 72}
Anyone has a fever over 105°F (40.5°C)} unless it comes down readily with
treatment and the person is comfortable} and
Adult patients with fever accompanied by the symptoms such as} confusion}
difficulty breathing} stiff neck} inability to move an arm or leg} or first-time
seizure.
The underlying conditions should be treated actively. For patients with fever due to
unknown origins medical evaluation is required. TCM treatment based on patterns may
be given after that.
168

Table 32.1 Summary of rCM Etiology and Pathogenesis of Internal Damage Fever
Emotional factors causing liver qi
stagnation Internal heat due to
Stagnant liver qi causing liver heat or stagnant heat or fire
fire
Qi stagnation} overstrain} emotional Internal heat due to blood
factors} traumatic injuries stasis accumulation
Internal heat due to
EifiOtiOildl rnttOis (ODd tl:j"ltili~) lAS
accumulabon oT
inappropriate diets causing dysfunction
dampness
of spleen and stomach
Ina ppropriate diets} overstrains} and Yin-fire due to damage of

chronic illness causing middle jiao qi spleen and stomach (qi
deficiency deficiency)
Brood deficiency in liver and heart due
to chronic illness} spleen deficiency and
Deficient
chronic bleeding
Deficient heat due to yin Patterns of
Yin deficiency due to overstrains} febrile
and blood deficiency Internal Damage
diseases, excessive sexual activities}
Fever
constitutional deficiency} over use of
warm tonics
Spleen and kidney yang deficiency due Deficient yang floating out
to constitutional deficiency} chronic cold and causing heat
illness and chronic qi deficiency phenomena

32.3.1 For patients without an established medical diagnosis evaluation should be made
to exclude emergency symptoms and serious situations that require immediate medical
intervention.
32.3.3 TCM diagnosis of internal damage fever is made after the externally contracted
fever is excluded.
32.3.4 TCM patterns are differentiated based on the characteristics of the fever.
32.3.5 The severity of condition, complications and the status of stomach qi should be
evaluated.
169
Table 32.2 Differentiation between

Internal Damage Fever and Externally Contracted Fever
Internal Damage Fever Externally Contracted Fever
Etiology Internal damages External factors
Pathogenesis Obstruction of qi and blood Struggle between vital qi and
Imbalance of yin and yang pathogenic factors
Deficiency Often deficient patterns Often excessive patterns
Pattern of Onset chronic acute
Course [61 ,gel LDOiSE of ill "css .. ;L1, iMQ rat
repeated fever
Feature of Fever Often low grade fever or feeling Often high fever
hot without increased temperature
Chills and other Not chills, or feeling chilly but Chills together with fever.
accompanying relieved with warmth or bundling Accompanying symptoms
symptoms with clothes. Other accompanying include headache,' runny nose,
symptoms include dizziness, cough, floating pulse.
fatigue, night sweating or weak
pulse
Table 32.3 Differentiation of Internal Damage Fever Based on Clinical Features

Patterns Features of Fever
Qi stagnation Low grade fever or afternoon tidal fever that may be fluctuated
with emotional status
Bload Stasis tidal fever in afternoon or night, or hot feeling in a local region of '
the body
Damp accumulation Low grade fever worsened in afternoon, unsurfaced fever
Qi' deficiency Low grade or high fever severe with overwork
Blood deficiency Low grade fever all day around
Yin deficiency tidal fever in afternoon or night, vexing heat, bone fever
Yang deficiency Fever with cold limbs'
32.4 Acupuncture Treatment for Internal Damage Fever
32.4.1 Qi Stagnation Fever

WU CAM CT
DU14
L/4
L1V3
GB34
SJ5
Auxiliary Points:
For pain and distention of the chest and costal regions, add:
L/V14
CV17
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MCOM Acupuncture Treatme nt Strategy and Herbal Internal Medicine
32.4.2 Blood Stasis Fever

WU CAM CT
DU14
uri
UB17
SPiO
SP6
Auxiliary Points:
For accompanyiiJg vacuity of qi, add.
CV4
ST36
32.4.3 Qi Vacuity Fever

WU CAM CT
CV4
UB20
ST36
5P6
CV6
Auxiliary Points:
For decrea se in appeti te with loose stools, add:
CV12
5125
32.4.4 Blood Vacuity Fever

WU CAM CT
UB17
UB18
CV4
5136
5P6
Auxiliary Points:
For palpita tions and insomn ia, add:
PC6
HT7
32.4.5 Yin Vacuity Fever

WU CAM CT
UB23
UB43
KD3
SP6
KDl
Auxiliary Points:
171
..
In cases of insomnia and might sweating, add:

HT7
HT6
32.5 Herbal Treatment for Internal Damage Fever

Pattern Formulas Recommended in Textbook Practical Options
Qi Stagnation Jia Wei Xiao Yao San/ Dan Zhi Xiao Yao San Jia Wei Xiao Yao
7~ C'h. ·n:....... f:""n Vin (\AI::It~r-F! • . 1.' L.iver- San +
Clearing Beverage) Liu Wei Di Huan
• Sheng Di Huang, Sha Zhu Yu, Shan Yao, Fu Wan +some
Ling, Mu Dan Pi, Ze Xie, Chai Hu, Bai Shao spirit-calming
Yao, Dang Gui, Zhi Zi, Suan Zao Ren herbs
Blood Stasis Xue Fu Zhu Yu Tang -
Qi Deficiency Bu Zhong Yi Qi Tang
Sheng Yang Yi Wei Tang (Yang-Upbearing Bu Zhong Yi Qi

Stomach-Boosting Decoction) Tang+ -
• Huang Qi, Ren Shen, Bi Ban Xia, Fu Ling, Cheng's Qing Shu
Chen Pi, Zhi Gan Cao, Qiang Huo, Du Huo, Yi Qi Tang (Kan
-
Fang Geng, Bai Shao Yao, Bai Zhu, Ze Xie, Qing Shu
Chai Hu, Huang Lian, Sheng Jlan, Da Zao Formula)
Blood Gui Pi Tang
-
Deficiency
Yin Deficiency Qing Gu San
Table 32.5 Commonly Used Herbs for Internal Damage Fever

Yin deficiency Bai Wei, Bie Jia, Di Gu Pi, Hu Huang Lian, Qin Jlao, Qing Hao, Yin Chai
Hu] Zhi Mu
Qi deficiency Huang Qi, Ren Shen, Dang Shen
Live qi Bo He, Mu 0 an Pi] Zhi Zl, Xia Ku Cao
stagnation
Heat in blood Chi Shao Yao, Bai Shao Yao, Mu Dan Pi] Sheng Di Huang

The prognosis depends on underlying medical diagnosis and TCM patterns.
Generally speaking excessive patterns that are often seen at the initial stage of
illness may transform into deficient patterns or complicated patterns of
deficiency and excess. Simple deficient patterns may develop into more
complicated deficient patterns, e.g., pattern of qi and blood deficiency or
pattern of yin and yang deficiency.
According to traditional theory great caution should be taken when a patient
with internal damage fever presents with symptoms such as diarrhea, poor
appetite, shortness of breath, feeble voice, and poor responses to regular
tonifying or nourishing herbs. These symptoms are indicative to the exhaustion
of stomach qi.
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33. Parasitic Worm Patterns
This chapter addresses patterns resulting from infection by intestinal parasitic worms.
All patients with suspected parasitic infections should be medically evaluated.
33.1.1 Roundworm
Epidemiology: AsEdfis Jl1fflbflEblbes is Widely CliSLi loa teeth i [j apiCal di id sabti opical
regions as well as in other humid areas, including the rural southeastern United States.
Transmission typically occurs through fecally contaminated soil.
Life Cycle Adult worms live in the lumen of the small intestine. Mature female
roundworms produce eggs, which pass with the feces. Ascarid eggs become infective
after several weeks of maturation in the soil and can remain infective for years. After
infective eggs are swallowed, larvae hatched in the intestine invade the mucosa,
migrate through the circulation to the lungs, break into the alveoli, ascend the bronchial
tree, and return via swallowing to the small intestine, where they develop into adult
worms. Between 2 and 3 months elapse between initial infection and egg production.
The adult worms live for 1 to 2 years.
Clinical Features: Most infected individuais have low worm burdens and are
asymptomatic. Clinical disease arises from larval migration in the lungs or effects of the
adult worms in the intestines.
During the lung phase of larval migration, about 9 to 12 days after egg ingestion,
patients may develop an irritating nonproductive cough and burning substernal
discomfort that is aggravated by coughing or deep inspiration. Patients may have fever
and develope eosinophilic pneumonitis.
In established infections, adult worms in the small intestine usually·cause no symptoms.
In heavy infections, particularly in children, a large bolus of entangled worms can cause
pain and intestinal obstruction, sometimes complicated by perforation, intussusception,
or volvulus. Single worms may cause disease when they migrate into aberrant sites. A
large worm can enter and occlude the biliary tree, causing biliary colic, cholecystitis,
cholangitis, pancreatitis, or intrahepatic abscesses. Migration of an adult worm up the
esophagus can provoke coughing and oral expulsion of the worm. In highly endemic
areas, intestinal and biliary ascariasis can rival acute appendicitis and gallstones as
causes of surgical acute abdomen. Other complications include partial or complete
intestinal obstruction.
Prevention: Practice good hygiene and care when traveling
33.1.2 Pinworm
Epidemiology: Enterobius vermicularis is more common in temperate countries than in
the tropics.
Life Cycle: Enterobius adult worms are about 1 em long and dwell in the bowel lumen.
The gravid female worm migrates nocturnally out into the perianal region and releases
up to 10,000 immature eggs. The eggs become infective within hours and are
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transmitted by hand-to-mouth passage. The larvae hatch and mature entirely within the
intestine. This life cycletakes _1 month, and adult worms survivefor about 2 months.
Self-infection results from perianal scratching and transport of infective eggs on the
ha nds or under the nailsto the mouth. Because of the ease of person-to-person spread,
pinworm infections are common among family members and institutionalized
populations.
Clinical Features: Most pinworm infections are asymptomatic. Perianal pruritus is the
major symptom. The itching, which is often worse at night is a result of the nocturnal
migration of the female worms. On rare occasions, pinworms invade the female genital
tract, causing vulvovaginitis and pelvic or peritoneal granulomas.
Prevention: Practice good hygiene and keep tRe household Clean.
33.1.3 Tapeworm
Tapeworms are segmented worms. The adults reside in the gastrointestinal tract, but
the larvae can be found in almost any organ. Human tapeworm infections can be
divided into two major clinical groups. In one group, humans are the definitive hosts,
with the adult tapeworms living in the gastrointestinal tract (Taenia saginata,
, Diphyllobothrium, Hymenolepis, and Dipylidium caninum). In the other, humans are
intermediate hosts, with larval-stage parasites present in the tissues. Diseases in this
category include echinococcosis, sparganosis, and coenurosis. For Taenia solium, the
human may be either the definitive or the intermediate host.
Taneiasis Saginata
Epidemiology: The beef tapeworm T. saginata occurs in all countries where raw or
undercooked beef is eaten. It is most prevalent in sub-Saharan African and Middle
Eastern countries. T. saginata asiatica is a variant of T. saginata that is found in Asia and
for which pigs are the intermediate host.
Clinical Features: Patients become aware of the infection most commonly by noting
passage of proglottids in their feces. The proglottids are often motile, and patients may
experience perianal discomfort when proglottids are discharged. Mild abdominal pain or
discomfort, nausea, change in appetite, weakness, and weight loss can occur with T.
saginata infection.
TanelaslsSollum and Cysticercosis
Epidemiology: The pork tapeworm T. solium can cause two distinct forms of infection.
The form that develops depends on whether humans are infected with adult tapeworms
in the intestine or with larval forms in the tissues (cysticercosis). Humans are the only
definitive hosts for T. solium; pigs are the usual intermediate hosts, although other
animals may harborthe larval forms. T. solium exists worldwide but is most prevalent in
Latin America, sub-Saharan Africa, China, southern and Southeast Asia, and Eastern
Europe. Cysticercosis occurs in industrialized nations largely as a result of the
immigration of infected persons from endemic areas.
Clinical Features: Intestinal infections with T. solium may be asymptomatic. Fecal
passage of proglottids may be noted by patients. In cysticercosis, the clinical
manifestations are variable. Cysticerci can be found anywhere in the body but are most
commonly detected in the brain, skeletal muscle, subcutaneous tissue, or eye.
The clinical presentation of cysticercosis depends on the number and location of
cysticerci as well as the extent of associated inflammatory responses or scarring.
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 20~9 by JH Xie
Neurological manifestations are the most common. Seizures are associated with
inflammation surrounding cysticerci in the brain parenchyma. These seizures may be,
generalized, focal! or Jacksonian. Hydrocephalus results from obstruction of
cerebrospinal fluid (CSF) flow by cysticerci and accompanying inflammation or by CSF
outflow obstruction from arachnoiditis. Signs of increased intracranial pressure,
including headache, nausea, vomiting, changes in vision, dizziness, ataxia, or confusion
are often evident. Patients with hydrocephalus may develop papilledema or display
altered mental status. When cysticerci develop at the base of the brain or in the
subarachnoid space, they may cause chronic meningitis or arachnoiditis, communicating
hydrocephalus, or strokes.
Prevenbon:
• Practice good hygiene; wash hands with soap and water before eating
or handling food and after using the toilet.
• Use care when traveling in areas where tapeworm is found; wash and
cook all fruits and vegetables with safe water before eating.
• Eliminate livestock exposure to tapeworm eggs by properly disposing of
animal and human feces.
• Thoroughly cook meat at temperatures of at least 150° F (66°C)to kill
tapeworm eggs or larvae.
• Freeze meat for at least 12 hours and fish for at least 24 hours to kill
tapeworm eggs and larvae.
• Avoid eating raw or undercooked pork, beef and fish.
Table ~3~1 Summary of TCM Etiology and Pathogenesis of Parasitic Worm Patterns
Spleen and stomach qi
Infection of parasitic
stagnation
worms due to poor hygiene
Damp heat accumulation
and intake of contaminated
Food stagnation
foods
Consumption of qi and blood

33.3.2 Make the TCM diagnosis according to the symptoms and related laboratory
exams
33.3.3 Although herbs or acupuncture may be beneficial to the treatment of parasitic
worms chemical drugs are often required. Acupuncture and herbs may be used to
regulate spleen and stomach and promote the recovery after the worms are expelled.
33.4 Acupuncture Treatment for Parasitic Worm Patterns
Roundworm Infection Si Feng, SP15, CV6, ST36, Bai Chong Wo, BL18, BL2D,
Pinworm Infection SP6
Tapeworm Infection
Biliary Roundworm CV12, CV13, GB34, ST36, GB24, ST2, L120
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medlclne-Studv Guide 2009 by JH Xie
33.5 Herbal Treatment for Parasitic Worm Patterns

Roundworm Wu Mei Wan (Mume Pill) Raw herbs:
Infection • Wu Mei, Fu Zl, Gang Jiang, Huang Shi Jun Zi (Quisqualis
Jlao, Gui Zhl, Xi Xln, Huang tlan, seed)
Huang Bai, Ren Shen, Dang Gul, Ku Lian Pi (Radicis
Shi Jun Zi San(Quisqualis Powder) Cortes Meliae)
• Shi Jun Zi (quisequalis fruit), Wu Vi
1...1....... ,... ... 1,.... \ rhJl~ I i::In 7i (.;::In r::ln -
,
Xiang Sha Uu Jun Zi Tang
Pinworm Shi Jun Zi Da Huang Tang (Quisqualis and Raw herbs:
-
Infection Rhubarb Powder) Fei Zi (Torreya seed)
He Shi (Fructus
Carpesii) -
Tapeworm Qu Di Tang (Flushing Expulsion Decoction) Raw herbs:
Infection Xiang Sha Liu Jun Zi Tang Nan Gua Zi (pumpkin
seeds) ~
Bing Lang (Semen

Arecae)
Biliary Wu MeiWan "-
Roundworm Dan Dao Qu Hui Tang (Biliary Roundworm-

Expelling Decoction)
• Bing Lang, Shi Jun Zi, Van Hu Suo, Ku -
Lian Gen Pi (china berry root bark),
Mu Xiang, Hou Pu
Note: Wu Mei Wan is better for quiting the roundworm, not for expelling round worm.
Table 33.3 Commonly Used Herbs for Parasite Infection

Roundworms Bing Lang, Chuan Lian Zl, Fei Zl, He Shl, Hua Jlao, Lu Hui (aloe), Nan
Gua Zi (Semen Pharbitidis), Shi Jun Zi (Fructus Quisqualis), Wu Vi
(Fructus Ulmi Praeparatus)
Pinworms Bai Bu, Bing Lang, Fei Zi, Guan Zhong (Rhizoma Dryopteridis), Ku Lian
Gen Pi
Tapeworms Nan Gua Zi (Semen Pharbitidis) Bing Lang, Fei Zi, Guan Zhong
(Rhizoma Dryopteridis), Ku Lian Gen Pi

Most patients will be cured with adequate treatments.
Prevention should be emphasized.
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34. Pulmonary Consumption

This chapter discusses TCM treatment of pulmonary tuberculosis. Pulmonary
tuberculosis (TB) is a contagious bacterial infection. It is not easily diagnosed by
symptoms. All suspected patients should be medically evaluated. It is required to report
TB case to the local health department. Treatment regimens recommended by
organizations such as the United States Public Health Service (USPHS) and the Infectious
Qisii686 ii'6ist','Qf AWQrisa (IPSA) shg,,'d he followed oc"P"Qct"re and berba'
medicine may be used as supplementary treatment.
For further information and state TB control offices please visit the website of National
Center of HIV/AIDS} Viral Hepatitis} STO and TB Prevention} Division of Tuberculosis
Elimination: http://www.cdc.gov/tb/default.htm
Table 34.1 Summary of rCM Etiology and Pathogenesis Pulmonary Consumption

Invasion of Tuberculosis in lung
Contacting the patient with SJ consumption manifested as pattern of
parasite Kidney yin deficiency
---------------"'--------
Constitutional deficiency Lung yin deficiency
Deficiency of Spleen qi deficiency
-Emotional
- - - -disturbance
---------- vital qi complicated with phlegm
Excessive alcohol or sexual activities
and blood stasis

34.3.2 TCM diagnosis is made based on the medical diagnosis and clinical manifestations.
34.3.3 If acupuncture and herbs are applicable} the first step of pattern differentiation is
to determine the excess and deficiency. Deficiency in this condition includes deficiency
of ql, yin and yang; Excess in this condition. includes phlegm and blood stasis.
34.3.4 In addition to lungs} pulmonary consumption often involves the pathology of
spleen} kidney} heart and liver.
34.4 Acupuncture Treatment for Pulmonary consumption.

34.4.1 lung Yin Vacuity
WU CAM CT
LU 9 LU 9
UB13 UB 13
UB43 UB 43
LU 5 LU 1
ST36
SP 6
KO 3
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MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2009 by JH-Xie
Auxiliary Points:
For severe coughing, add:
LU 7
For blood expectoration, add:
LU 6 LU 6
UB17
For night sweating, add:
HT6
KD7

WU CAM (I
UB13 UB13
LU 1 LU 1
LU10 LU 10
UB43 LU 9
UB23 LU 6
KD3 KD 3
L1V 2 HT6
Auxiliary Points:
For tidal fever:
DU14
For nocturnal emissions:
UB 52 (47)
5P 6
34.4.3 Qi and Yin Vacuity

WU CAM CT
UB13 UB13
UB43 UB43
UB20 LU 9
5P 6 5P 6
5T36 5T36
eV17
Auxiliary Points:
For loss of appetite and abdominal distention:
UB21 UB 21
eV12 UB 20
34.4.4 Dual Vacuity of Yin and Yang

WU CAM CT
UB13 UB 13
UB43 UB43
UB20 LU 9
UB23 UB 23
eV4 eV4
5T36 5T36
KD 3
34.S Herbal Treatment for Pulmonary consumption

Ling Yin Bai He Gu Jin Tang
178
Deficiency
Yin Deficiency Qin .liao Bie Jia San (Large Gentian And Trubel ZhiBaiDiHuang
with Deficient Shell Powder) Tang
Fire • Qin Jiao, Ble Jia, Zhi Mu, Di Gu Pi, Chai + Qin Jiao, Sa Bu
Hu, Dang Gui, Qing Hao, Wu Mei
Qi and Yin Bao Zhen Tang (True Safeguarding Decoction) Bu Fei Tang
Deficiency • Dang Shen, Huang Qi, Bai Zhu, Fu Ling, Ci Shi Quan Da Bu
Fu Ling, Shu Di Huang, Sheng Di Huang, Wan
Dang Gui, Sai Shao Yao, Chi Shao Yao, Wu
Wei Zl, Tian Men Dong, Mai Men Dong,
...
\...1101 I I .... r ' 'v ..... u~ .... '5.... , ..... 1.11 ,y, ...., ........ '0
Bai, Chen Pi, Lian Zi Xin, Sheng Jlang, Gan
Cao and Da Zao
Deficiency of Bu Tian Da Zao Wan (Heaven-Supplementing Shi Quan Da Bu
Both Yin and Great Creation Pill) Wan
Yang • Ren Shen, Huang Qi, Bai Zhu, Fu Ling, Zuo Gui Wan
Shan Yao, Dang Gui, Bai Shao Yao, Gou Qi You Gui Wan
Zi, Shu Di Huang, Gui Ban, Lu Jiao Jiao, Zi
He Che (human placenta), Suan Zao Ren,
Yuan Zhi

Prognosis depends on the constitutional status of the patient, severity of
condition and the treatment.
A pattern of lung yin deficiency is usually seen at the early stage of condition.
The symptoms of this pattern can be controlled well with acupuncture and
herbs. This pattern may develop into pattern internal heat, qi deficiency and
yang deficiency if it is not treated appropriately.
A pattern of yin deficiency with deficient fire flaring up is often the cause of
cough with blood. The pattern may develop into a pattern of qi (spleen) and yin
deficiency, or pattern of spleen and kidney yang deficiency.
The prognosis of pattern of yin and yang deficiency is poor and is usually seen in
the later stage of pulmonary consumption.
The pattern of blood stasis in lungs may cause yin and yang deficiency.
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35. Facial Pain
Facial pain discussed in this chapter includes primarily the trigeminal neuralgia. Facial
pain due to other causes such as: abscessed tooth, cluster headache, herpes zoster or
herpes simplex infection, injury to the face, mlgraine, myofascial pain syndrome,
sinusitis, and temporomandibular joint dysfunction syndrome are not discussed in this
chapter. The treatments for those conditions can be found in other chapters of this
guide or the textbook (Wu 1997).

The three major sensory divisions of the trigeminal nerve consist of the ophthalmic,
maxlllarv, and mandibular nerves.
Clinical Manifestations: Trigeminalneuralgia is characterized by excruciating paroxysms,
of pain in the lips, gums, cheek, or chin and, very rarely, in the distribution of the
ophthalmic division of the fifth nerve. The pain seldom lasts more than a few seconds .or
a minute or two but maybe very intense. The paroxysms, experienced as single jabs or
clusters, tend to recur frequently, both day and night, for several weeks at a time. They
may occur spontaneously or with movements of affected areas evoked by speaking,
chewing, or smiling. Another characteristic feature is the presence of trigger zones,
typically on the face, lips, or tongue, that provoke attacks; patients may report that
tactile stimuli-e.g. washing the face, brushing the teeth, or exposure to a draft of air-
generate excruciating pain. An essential feature of trigeminal neuralgia is that objective
signs of sensory loss cannot be demonstrated on examination.
Onset is typically sudden, and pains tend to persist for weeks or months before
remitting spontaneously. Remissions may be long lasting, but in most patients the
disorder ultimately recurs.
Pathophysiology: Symptoms result from ectopic generation of action potentials in pain
sensitive afferent fibers of the fifth cranial nerve root just before it enters the lateral
surface of the pons. Compression or other pathology in the nerve leads to
demyelination of large myelinated fibers that do not themselves carry pain sensation
but become hyperexcitable and electrically coupled with smaller unmyelinated or poorly
myelinated pain fibers in close proximity.
Compression of the trigeminal nerve root by a blood vessel, most often the superior
cerebellar artery or on occasion a tortuous veln, is the source of trigeminal neuralgia in
a substantial proportion of patients. In cases ofvascular cornpresslon, age-related brain
sagging and increased vascular thickness and tortuosity may explain the prevalence of
trigeminal neuralgia in later life.
Current Medical Treatment: Current treatment for the condition includes drugs and
surgical procedures. Drugs for trigeminal neuralgia include carbamazepine and
phenytoin. If drug treatment falls, surgica I therapy may be offered. Surgical procedure
produces short-term relief in most patients treated however; long-term studies indicate
that pain recurs in a substantial percentage of treated patients.
180
Table 35.1 Summary of TCM Etiology and Pathogenesis of Facial Pain

Invasion of wind cold into yang Obstruction of the channels
ming channel along the yang ming course
Live qi stagnation Liver fire flaring up
Overindulgent in spice, hot food Stomach fire flaring up

Facial pain is listed as a condition for which acupuncture has been proved-through
controlled trials-to be an effectIve treatment accordmg to Acupuncture: review and
analysis of reports on controlled clinical trials by World Health Organization 2002.

35.3.2 TCM diagnosis is usually made according to typical symptoms.
35.3.3 The differentiation between excessive patterns and deficient patterns is primarily
based on the pattern of onset, history of illness, and quality of pain. The differentiation
between cold and heat pattern is primarily based on quality of pain and accompanying
symptoms.
35.3.4 The differentiation between liver fire pattern and stomach fire pattern is
primarily based on the location of facial pain.
35.4 Acupuncture Treatment for Facial Pain

35.4.1 External Wind-Cold
WU CAM CT
GB20 GB 20 GB20
ST7
SJ 5
Auxiliary Points
For supraorbital pain, add:
UB2 UB 2 UB2
GB 14 GB 14 GB 14
TAl YANG YAI YANG ST8
YUYAO SJ 5 GB8
L14
ST41
For supramaxillary pain, add:
ST2 ST2 ST2
SI18 SI18 SI 18
LJ 20 LJ 20 LI 20
GB3 LJ4 GB 3
LI4
For mandibular pain, add:
ST6 ST6 ST6
ST5 STS ST7
SJ 17 ST7 SJ 17
181
JIACHENGJ IAN JIACHENGJIANG CV24

JIA CHENG .lIANG
5T44
35.4.2 Liver and Stomach Fire

WU CAM CT
LtV 3 L1V 3
5T 44 5T44
L14
51 )
Auxiliary Points:
For supraorbital pain, add
UB 2 UB 2
GB 14 GB 14
TAl YANG TAIYANG
YUYAO 5J 5
For supramaxillary, add:
5T 2 5T2
5118 5118
L120 Ll20
GB3 L14
For mandible pain, add:
5T6 5T6
5T 5 .5T5
5J 17 5T7
JIA CHENG JIANG JIA CHENG JIANG
L14
35.5 Herbal Treatment for Facial Pain

Textbook
External Wind Cold Chuan Xiong Cha Tiao 5an Purge External Wind (Kan)
Liver and Stomach Xiong Zhi Shi Gao Tang Ju Hua Cha Tiao San
Fire (Ligusticum, Dahurica Angelica Qing Wei San
and Gypsum Decoction) plus . Long Dan Xie Gan Tang
liver and stomach fire-draining
herbs

• Facial pain due to trigeminal neuralgia may be a chronic and life long condition.
During active period pains tend to persist for weeks or months before remitting
spontaneously. Remissions may be long lasting, but in most patients the
disorder ultimately recurs. Acupuncture and herbal treatment aim to control or
reduce pain, prolong the remission and improve the patients overall condition.
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MCOM Acupuncture Treatmen t Strategy and Herbal Internal Medicine
Newly onset facial pain with a short history of illness is often classified
as
pattern s of phlegm, wind and fire. Ifthese patterns are not treated proper
ly
they may transform into pattern s of liver and kidney yin defidency or qi
and
blood deficiency.
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36. Malarial Patterns
PracticalTherapeutics ofTCM Page 298
36.1 Biomedical Reviews

Malaria is a protozoan disease transmitted by the bite of infected Anopheles mosquitoes.
Malaria has now been eliminated from North America, Europe, and Russia but, despite
enormous control efforts, has resurged in many parts of the tropics. Added to this
resurgence are the increasing problems of drug resistance of the parasite and
liiSEdkide iCsistdiiee cftl:@ eSl1ilIiJPiiQiiiiiiitiiHp! Icc?' transmissiOQ fO"owiPR: impgrtation
of malaria has occurred recently in several southern and eastern areas of the United
States and in Europe, indicating the continual danger to nonmalarious countries.
Malaria remains today, as it has been for centuries, a heavy burden on tropical
communities, a threat to non-endemic countries, and a danger to travelers.
For details information please refer to: http://www.cdc.gov/malaria/
Acupuncture or herbal medicines are not normally used in the management of malaria,
except that products derived from Qing Hao have been successful used to control some
types of malaria.
Table 36.1 Summary of TeM Etiology and Pathogenesis of Malaria Patterns

Invasion of malaria Pathogen staying in
pathogens intermediate level
Improper diets
Overstrains
- - - - - - - - - - - Deficiency of vital qi
Improper life styles

36.3.1 Acupuncture or herbal medicines are not normally used in the management of
malaria although there is rich traditional theory in treating malaria with herbs and
acupuncture. The theory discussed in this chapter is for academic purpose. Some
practitioners may apply the theory to the treatment of externally contracted conditions
with malaria-like symptoms.
36.3.2 Malaria must be recognized promptly in order to treat the patient in time and to
prevent further spread of infection in the community. When a patient who traveled to
countries with malaria riskpresents the symptoms such as fever, chills, sweats,
headaches, nausea and vomiting, body aches or general malaise, malaria should be
suspected. The patient should be referred to appropriate physician. For more
information about severe malaria please check http://www.cdc.gov/malaria/.
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36.4 Acupuncture Treatment for Malaria Patterns

Typical Malaria BL11} DU13, 513, PCS, SJ2,
PC6
Taxation Malaria BL11, DU13, S13, PCS, SJ2,
PC6, BL20,ST36
36.5 Herbal Treatment for Malaria Patterns

Options
. Typical Xiao Chai Hu Tang +Chang Shan, Cao Guo, Qing Hao
Malaria Gui Zhi Bai Hu Tang plus Chai Hu, Qing Hao
Taxation He Ren Yin (Flowery Knotweed and Ginseng Beverage) +
Malaria Chang Shan, Cao Guo
• He Shou Wu, Ren Shena Dang Gui, Chen Pi, Sheng
Jiang

• Prognosis depends on the types of malaria and patients' general health.
Symptoms of uncomplicated malaria are usually controlled within 48 hours after
treatment. Severe malaria is very complicated and may be very dangerous.
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MCOM Acupuncture Treatment Strategy and HerballJiternal Medicine Study Guide 2009 by JH Xie
II. Surgery
37. Scrofula

Please refer to Chapter 34 for biomedical review.
Scrofula is a tuberculosis infection of the lymph nodes in the neck. If left untreated, the
191 iil!l: 'UtS8i ~ii';' bosoTa lI!ce eat ed
pmdl'cjpg drajniog sores. The possible
complications of scrofula include scarring and formation of a draining fistula in the neck.

37.1 Summary ofrCM Etiologyand Pathogenesis of Scrofula
Spleen attacked by liver
Emotional factors causing
and phlegm due to
liver qi stagnation
dysfunction of spleen
Liver heat or fire due to
Liver heat or fire
liver qi stagnation
Long last liver fire Deficient fire and phlegm
Deficient fire due to liver
accumulation causing liver obstruction in channels and
and kidney yin deficiency
and kidney yin deficiency collaterals --- scrofula

37.3.2 TeM diagnosis may be made based on the symptoms and signs. However medical
examinations are usually needed. Scrofula in adults is most often caused by the bacteria
. Mycobacterium tuberculosis. In children, it is usually caused by Mycobacterium
scrofulaceum or Mycobacterium avium. Medical treatment usually includes 9-12
months of antibiotics for tuberculosis.
37.3.3 When acupuncture or herbs are applicable the first step of differentiation is to
differentiate excessive fire and deficient fire.
Liver qi stagnation Main Points: LR 13, 5J10, GB41

Pain and distention of chest and hypochorndrium: GB34, PC6
Epigastic fullness and discomfort, poor appetite: CV12, 5T36
Kidney yin deficiency Main Points: 5JI0, HT3, Bai Lao, BL23, BL20
Night sweating: HT6, BL43
Coughing: LU7, BL13
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MCOMAcupunctureTreatmentStrategyand Herbal Internal MedicineStudy Guide2009 byJH Xie
Liver qi Xiao Vao San + Er Chen Tang plus herbs that Xiao Yao San +
stagnation resolving phlegm and dispersing lump, Cluster Dissolving (Kan)
softening the hardness:
Xuan Shen, Mu Li, Zhe Bei Mu, Xia Ku Cao
and Kun Bu
I'~ J
.I I
71-.· D ... : ....: U',~nl'T \A/~n
- rrh horhc rh:::lt
rc 7hi Bai Oi Huang Wan +
deficiency clearing heat and softening hardness: Cluster Dissolving (Kan)
Xia Ku Cao, Mu Li, Xuan Shen and Tian Hua
Feng

• With medical treatment, patients usually make a complete recovery.
.. In term ofTCM, the patient often has a pattern of liver qi stagnation or liver fire
with phlegm initially and a pattern of deficient fire with phlegm may develop in
chronic condition.
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38. Goiter
In TCM Ying is defined as swelling or lumps on the front of the neck bilateral to Adam's
apple. TCM Ying is currently translated as goiter. It can be further divided into qi goiter,
fleshy goiter and stone goiter.
The features of qi goiter are similar to that of diffuse nontoxic goiter in biomedicine. The
features of fleshy goiter are similar to that of toxic or nontoxic multinodular goiter and
benign thyroid neoplasm. The features of stone goiter are similar to that of thyroid
cancers.

According to the TCM description the goiter may include goiter and thyroid neoplasm.
Thyrotoxicosis is the state of thyroid hormone excess and hyperthyroidism is the result
of excessive thyroid function. Hypothyroidism is the result of decreased thyroid function.
Because many conditions that cause thvrotoxlcosls, hvperthvroldlsrn, or hypothyroidism
present enlargement of thyroid (golter], e.g., Graves' disease, toxic multinodular goiter,
toxic adenomas, and Hashimoto's thyroldltls, a brief review of thyrotoxlcosls,
hyperthyroidism and hypothyroidism is provided for reference.
38.1.1 Goiter
Goiter refers to an enlarged thyroid gland. Biosynthetic defects, iodine deflclencv,
autoimmune disease, and nodular diseases can each lead to golter, though by different
mechanisms.
Biosynthetic defects and iodine deficiency are associated with reduced efficiency of
thyroid hormone svnthesls, leading to increased thyroid-stimulating hormone (TSHL
which stimulates thyroid growth as a compensatory mechanism to overcome the block
in hormone synthesis.
Graves' disease and Hashimoto's thyroiditis are also associated with goiter. In Graves'
disease, the goiter results mainly from the TSH-receptor-mediated effects of thyroid-
stimulating immunoglobulins (TSI). The goitrous form of Hashimoto's thyroiditis occurs
because of acquired defects in hormone svnthesls, leading to elevated levels ofTSH and
its consequent growth effects. Lymphocytic infiltration and immune system-induced
growth factors also contribute to thyroid enlargement in Hashimoto's thyroiditis.
Nodular disease is characterized by the disordered growth of thyroid cells, often
combined with the gradual development of fibrosis. Thyroid nodules may be solitary or
multlple, and they may be functional or nonfunctional.
38.1.1.1Diffuse Nontoxic (simple) Goiter

When diffuse enlargement of the thyroid occurs in the absence of nodules and
hyperthvroldlsrn, it is referred to as a diffuse nontoxic goiter. Most diffuse nontoxic
goiter is due to Iodine deficiency (endemic goiter). Sporadic goiter may be seen and its
cause is usually unknown.
Clinical Features: Most goiters are asymptomatic and euthyroid. Spontaneous
hemorrhage into a cyst or nodule may cause the sudden onset of localized pain and
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MCOM Acupuncture Treatment Strategy and Herbal Internal MedicineStudy Guide 2009 byJHXie
swelling. Examination of a diffuse goiter reveals a symmetrically enlarged, non tender,

generally soft gland without palpable nodules. Goiter is defined, somewhat arbitrarily,
as a lateral lobe with a volume greater than the thumb of the individual being examined.
If the thyroid is marked Iy enlarged, it can cause tracheal or esophageal compression.
38.1.1.2 Nontoxic Multinodular Goiter (MNG)

There is typically wide variation in nodule size. Histology reveals a spectrum of
morphologies ranging from hypercellular regions to cystic areas filled with colloid.
Fibrosis is often extensive, and areas of hemorrhage or lymphocytic infiltration may be
seen.
clinical Features:-Most pailents with nontoxic lyiNG are aSyiiipWii Idde diid, by defiliitioai,
euthyroid. MNG typically deveiops over many years and is detected on routine physical
examination or when an individual notices an enlargement in the neck. If the goiter is
large enough, it can ultimately lead to compressive symptoms including difficulty
swallowing, respiratory distress (tracheal compression), or plethora (venous congestion),
but these symptoms are uncommon. Symptomatic MNGs are usually extraordinarily
large and/or develop fibrotic areas that cause compression. Sudden pain in a MNG is
usually caused by hemorrhage into a nodule but should raise the possibility of invasive
malignancy. Hoarseness, reflecting laryngeal nerve involvement, also suggests
malignancy.
38.1.1.3 Toxic Multinodular Goiter (MNG)

The pathogenesis of toxic MNG appears to be similar to that of nontoxic MNG; the
major difference is the presence of functional autonomy in toxic MNG. In addition to
features of goiter, the clinical presentation of toxic MNG includes sub-clinical
hyperthyroidism or mild thyrotoxicosis.
The patient is usually elderly and may present with atrial fibrillation or palpitations,
tachycardia, nervousness, tremor, or weight loss. Recent exposure to iodine, from
contrast dyes or other sources, may precipitate or exacerbate thyrotoxicosis. The TSH
level is low. The T4 level may be normal or minimally increased. T 3 is often elevated to
a greater degree than T4. Thyroid scan shows heterogeneous uptake with multiple
. regions of increased and decreased uptake; 24-h uptake of radioiodine may not be
increased.
38.1.1.4 Hyperfunctioning Solitary Nodule

A solitary, autonomously functioning thyroid nodule is referred to as toxic adenoma.
The pathogenesis of this disorder has been unraveled by demonstrating the functional
effects of mutations that stimulate the TSH-R signaling pathway.Most patients with
solitary hyperfunctioning nodules have acquired somatic, activating mutations in the
TSH-R.
Thyrotoxicosis is usually mild. The disorder is suggested by the presence of the thyroid
nodule, which is generally large enough to be palpable, and by the absence of clinical
features suggestive of Graves' disease or other causes of thyrotoxicosis. A thyroid scan
provides a definitive diagnostic test, demonstrating focal uptake in the hyperfunctioning
nodule and diminished uptake in the remainder of the gland, as activity of the normal
thyroid is suppressed.
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MCOM AcupunctureTreatmentStrategyand Herbal.lnterna~ Medicine StudyGuide2009 byJHXie
38.1.2 Thyroid Neoplasm
38.1.2.1Benign Thyroid Tumors

• Follicular epithelial cell adenomas
• Macrofollicular (colloid)
• Normofollicular (simple)
• Microfollicular (fetal)
• Trabecular (embryonal)
• Hurtle cell variant [oncocytlc}
About one-third ot palpable nodules are thyrQtG cysts. inese may De recoghiieubyutt:m
ultrasound appearance or based on aspiration of large amounts of pink or straw-colored
fluid (colloid). Many are mixed cystic/solid lesions, in which case it is desirable to
aspirate cellular components under ultrasound or harvest cells after cytospin of cyst
fluid. Cysts frequently recur, even after repeated aspiration, and may require surgical
excision if they are large or if the cytology is suspicious. Sclerosis has been used with
variable success but is often painful and may be complicated by infiltration of the
sclerosing agent.
38.1.2.2Thyroid Cancers
Thyroid neoplasms can arise in each of the cell types that populate the gland, including
thyroid follicular cells, calcitonin producing C cells, lymphocytes, and stromal and
vascular elements, as well as metastases from other sites. The American Joint
Committee on Cancer (AJCC) has designated a staging system using the TNM
classification.
38.1.3 Thyrotoxicosis and Hyperthyroidism

Thyrotoxicosis is defined as the state of thyroid hormone excess and is not synonymous
with hyperthyroidism, which is the result of excessive thyroid function. However, the
major etiologies of thyrotoxicosis are hyperthyroidism caused by Graves' disease, toxic
multinodular goiter, and toxic adenomas.
The symptoms of thyrotoxicosis and hyperthyroidism include hyperactivity, irritability,
dysphoria, heat intolerance and sweating, palpitations, fatigue and weakness, weight
loss with increased appetite, diarrhea, polyuria, oligomenorrhea, and loss of libido. Its
signs include tachycardia; atrial fibrillation in the elderly tremor, goiter, warm, moist
skin, muscle weakness, and proximal myopathy. Ophthalmopathy and dermopathy are
specific for Graves' disease.
38.1.4 Hypothyroidism
Symptoms of hypothyroidism include tiredness, weakness, dry skin, feeling cold, hair
lossr difficulty concentrating and poor memory, constipation, weight gain with poor
appetite, dyspnea, hoarse voice,menorrhagia (later oligomenorrhea or amenorrhea),
paresthesia and impaired hearing. The signs of hypothyroidism include dry coarse skin,
cool peripheral extremities, puffy face, hands, and feet (myxedema), diffuse alopecia,
bradycardia, peripheral edema} delayed tendon reflex relaxation} carpal tunnel
syndrome} and serous cavity effusions.
190
Table 38.1 Classification of Hyperthyroidism

Primary Graves' disease
hyperthyroidism Toxic multinodular goiter
Toxic adenoma
Functioning thyroid carcinoma metastases
Activating mutation of the TSH receptor
Activating mutation of Gs_ (McCune-Albright syndrome)
Struma ovarii
Drugs: iodine excess (Jod-Basedow phenomenon)
Tbvrgtgxjcpsis S!Jbacute thyroiditis
without Silent thyroiditis
hyperthyroid ism Other causes of thyroid destruction: amiodarone, radiation,
infarction of adenoma
Ingestion of excess thyroid hormone (thyrotoxicosis factitia) or
thyroid tissue
Secondary TSH-secreting pituitary adenoma

hyperthyroidism Thyroid hormone resistance syndrome: occasional patients may have
features of thyrotoxicosis
,Chorionic gonadotropin-secreting tumors
(Circulating TSH levels are low in these forms of secondary
hyperthyro idism.)
Gestational thyrotoxicosis
Table 38.2 The Classification of Hypothyroidism

Primary Autoimmune hypothyroidism: Hashimoto's thyroiditis, atrophic
thyroiditis
Iatrogenic: 1311 treatment, subtotal or total thyroidectomy, external
irradiation of neck for
lymphoma or cancer
Drug-induced
Congenital hypothyroidism
Iodine deficiency
Infiltrative disorders
Overexpression of type 3 deoiodinase in infantile hemangioma
Transient Silent thyroiditis, including postpartum thyroiditis
Subacute thyroiditis
Withdrawal of thyroxine treatment in individuals with an intact thyroid
After 1311 treatment or subtotal thyroidectomy for Graves' disease
Secondary Hypopituitarism: tumors, pituitary surgery or irradiation, infiltrative
disorders, Sheehan'ssyndrome, trauma, genetic forms of combined
pituitary hormone deficiencies
Isolated TSH deficiency or inactivity
Bexarotene treatment
Hypothalamic disease: tumors, trauma, infiltrative disorders, idiopathic
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38.1.5 Thyroiditis
The patients may have a painful and enlarged thyroid, sometimes accompanied by fever.
Table 38.3 The Classification of Thyroiditis Based on the Onset and Duration
Acute (rare) Bacterial infection
Fungal infection
Radiation thyroiditis after 1311 treatment
Amiodarone (may also be subacute or chronic)
Subacute Viral (or granulomatous) thyroiditis
Silent thyroiditis (including postpartum thyroiditis)
M)ccobactfcifll iofectioD
Chronic Autoimmunity
Riedel's thyroiditis
Parasitic thyroiditis.
Traumatic: after palpation
38.1.6 Medical Evaluations and Emergency Symptoms

All patients with swelling in the front of the neck or symptoms of goiter should be
medically evaluated. Because the management of goiter depends on the etiology, the
detection of thyroid enlargement on physical examination should prompt further
evaluation to identify its cause.
• Thyroid crisis or storm is an acute worsening of the symptoms of
hyperthyroidism that may occur with infection or stress. Its symptoms may
include fever, decreased mental alertness, and abdominal pain.
• Myxedema coma is a medical emergency that occurs when the body's level of
thyroid hormones becomes extremely low. Its symptoms and sings may include
below normal body temperature, decreased breathing, low blood pressure,
unresponsiveness, unconsciousness or coma.
Table 38.4 Summary of TCM Etiology and Pathogenesis of Goiter

Emotional disturbance causing liver qi stagnation
Lack of dietary iodine
Improper diet causing phlegm produced internally
Phlegm and
Blood stasis due to qi stagnation in chronic
blood stasis
patients
complex
Phlegm, blood
Internal fire due to liver qi stagnation, phlegm and
stasis and fire
blood stasis accumulation
complex
Phlegm, blood
Constitutional yin deficiency of yin deficiency due stasis and
. to the fire damaging the yin fluid deficient fire
complex
192

38.3.2 When acupuncture is applicable treatment may aim to decreases the size of
masses or symptoms related to goiter.
38.3.3 Medical diagnosis and laboratory exams should be taken into consideration
carefully when trying to treat goiter patient with herbs, espetially when iodine-
containing herbs are used.
38.4 Acupuncture Treatment for Goiter

38.4.1 Liver Qi Stagnation, Static Blood, Congealing Phlegm
000 CAlVI 8
SJ 13 SJ 13 5J 13
CV22 CV22 CV22
L14 L14 L14
L1V 3 L1V 3 L1V 3
51 17 51 17 ST36
L117 L117
Auxiliary Points:
For oppression in the chest, add:
CV 17
193
WU CAM CT
5J13 5J13
ST11 LOCAL MASS
PCS PCS
LlV3 L1V3
KD3 KD3
SP6 SP6
Auxiliary Points:
For palpitations, add:
pe6
HT7
For protrusion of the eyes, add:
UB10 UB10
GB20 GB20
UBi
UB2
5J23
For night sweating, add:
HT6 HT6
5/3 KD7
For loose stool and fatigue, add:
CV4
5T36 5T36
193
MCOM Acupuncture Treatment Strategy and l:ierba/lnternal Medicine Study Guide 2009 by.lH Xie
38.5 Herbal Treatment for Goiter
Pattern Classic Formula Pattern Product

Liver Qi Stagnation/ static Hao Zao Yu Hu Tang Purge Phlegm (Kan)
Blood / Congealing Phlegm Cluster Dissolving (Kan)
Yin Deficiency with Zhi Sai Di Huang Tang Zhi Sai Di Huang Tang
Deficient Fire Purge Phlegm (Kan)

• H erth roidism ·caused b Graves disease is usually progressive and has many
associated complications/ some of which are severe and a ect qua ity 0 I e.
However/ hyperthyroidism is generally treatable and rarely fatal. Prognosis of
Hypothyroidism depends on the specific medial diagnosis. With medical
treatment/ most people will return to normal. The hormone replacement is
usually life long. Herbs and acupuncture may be used as supplementary
treatment.
• If the size of the masses in nontoxic multinodula r goiter does not decrease after
three months of acupuncture or herbal treatment discontinue the treatment.
194
MCOM Acupuncture Treatment Strategy and Herbal Internal Medicine Study Guide 2.009 by JH Xie "
39. Intestinal Abscess
Practical Therapeutics of Tf'M Page 313
This chapter discussesthe reM theory of intestinal abscess which includes acute
appendicitis (acute simple, mild suppurative and periappendicular abscess), chronic
appendicitis and perforated appendicitis with abscess. "

Appendicitis is one of the most common causes of emergency abdominal surgery.
The symptoms or appendiCItis vary.
It tan tJe lia. d [0 dfagiiO;)E apptlidiciHs it i , e~R~
children, the elderly, and women of reproductive age. The history and sequence of
symptoms are important diagnostic features of appendicitis. The initial symptom is
usually abdominal pain of the visceral type. It is usually poorly localized in the
periumbilical or epigastric region with an accompanying urge to defecate or passflatus,
neither of which relieves the distress. This visceral pain is mild, often cramping, usually
lasting 4 to 6 hour, but it may not be noted by stoic individuals or by some patients
during sleep. As inflammation spreads to the parietal peritoneal surfaces, the pain
becomes somatic, steady, and more severe, aggravated by motion or cough, and usually
located in the right lower quadrant. Nausea and vomiting occur in more than half of
cases, but vomiting is usually self-limited.
The most important sign is tenderness. Percussion, rebound tenderness, and referred
rebound tenderness are often present; they are most likely to be absent early in the
illness. Flexion of the right hip and guarded movement by the patientare due to parietal
peritoneal involvement. Hyperesthesia of the skin of the right lower-quadrant and a
positive psoas or obturator sign are often late findings and are rarely of diagnostic value.
When the inflamed appendix is in close proximity to the anterior parietal peritoneum,
muscular rigidity is present yet is often minimal early.
Emergency Symptoms and Medical Evaluations

Although benefit of acupuncture and herbal medicines in the management of
appendicitis was showed in many clinical studies in China, it is not advised for
acupuncturists and herbalists in this country to treat symptoms of appendicitis.
Emergency symptoms related to the condition include:
• Abdominal pain is severe, sudden and sharp
• Rigid and hard abdomen that is tender to touch
• Abdominal fullness, pain, vomiting and unable to pass stool
Table 39.1 Summary ofTCM Etiology and Pathogenesis of Intestinal Abscess

Inappropriate diet and life Stagnation of qi and blood
style Accumulation of dampness
Intestinal Abscess
Emotional disturbance and heat
Exogenous heat invasion Erosion of blood and flesh
195
MCOM Acupuncture Treatment Strategy arid Herballntemal Medicine Study Guide 2009 by JHXie

39.3.1 Although there are many successful experiences in China on using herbal
medicine and acupuncture to treat appendicitis, it is not recommended for
acupuncturists in this country to treat any symptoms related to appendicitis. When
appendicitis is suspected immediate referral is required.
39.3.2 According to TCM theory the condition often involves blood stasis and damp heat
or damp cold, When in pyogenic stage the condition involves blood stasis and toxic heat,
while cold pattern is less common.
-
~q4 Acununcture Treatment for Intestinal Abscess
Initial Stage: ST37, ST25, L111, Lan Wei Xue
Qi Stagnation and Blood Stasis with Damp (Appendix Point)
-
Heat For fever add: DU14, ST44; for
Qi Stagnation and Blood Stasis with Cold vomiting add: PC6 and CV12; for
Dampness constipation add SP14, GS34, for
-
Pyogenic Stage Heat Toxin abdominal distention add CV6
Rupture Stage: Heat Toxin
Blood Stasis with Cold Dampness -
39.5 Herbal Treatment for Intestinal Abscess

Options
Initial Stage: Da Huang Mu Dan Pi Tang
Qj Stagnation and Blood
Stasis with Damp Heat
Initial Stage: Huo Xiang Zheng Qi San + Hong Teng Jian Ji
Qj Stagnation and Blood (Sargentodoxa Brewed Formula)
Stasis with Cold • Hong Teng (sargentodoxa], Zi Hua Di
Dampness Ding, Ru xiang Mo Yao, Jin Yin Hua,
Lia Qiao, Da Huang, Mu Dan Pi, Van
Hu Suo, Gan Cao
Pyogenic Stage Hong Teng Jian Ji
Rupture Stage: Da Huang Mu Dan Pi Tang + Zeng Ye Tang
Heat Toxin
Rupture Stage: Yi Yi Fu Zi Bal Jiang San (Coix, Aconite and
Blood Stasis with Cold Baijiang Powder)
Dampness • YI Yi Ren, Zhi Fu Zi, Sai Jiang Cao

• If surgery is performed before the perforation the prognosis is usually good. If
appendix ruptures before surgery, the patient will probably recover more slowly,
and are more likely to develop an abscess or other complications.
196
40. Hemorrhoid

Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.
They result from increased pressure in the veins of the anus. The pressure causes the
veins to bulge and expand, making them palnful, particularly when sitting.
The most common cause is straining during bowel movements. Hemorrhoids may result
11 611i eel'!I'1!i~6tieM, gi!tilil~ Mr IslitS liiriliH~i @fti~i, iRS iRil iRisctiORf 'p some Gases
they may be caused by other diseases, such as liver cirrhosis.
Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External
hernorrholds occur at the anal opening and may hang outside the anus.
Symptoms of hemorrhoids include anal itching, anal ache or pain, especially while sitting,
bleeding and pain during or after bowel movement, hard tender lumps near the anus.
The blood in the enlarged veins may form clots, and the tissue surrounding the
hemorrhoids can die. Hemorrhoids with clots generally require surgical removal. Severe
bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood.

Significant bleeding from hemorrhoids is unusual; however if blood loss is significant or
if patient feels dizzy or faint due to the bleeding call 911.
Table 40.1 Summary of TCM Etiology and Pathogenesis of Hemorrhoids

Ina ppropriate life style:
Prolonged sitting, standing, or overstraining
during bowel movement
Inappropriate diets:
Hemorrhoids
Spice or food producing dryness and heat
Medical conditions:
Chronic dysentery or constipation,
pregnancy and liver cirrhosis

40.3.1 Verify medical diagnosis. A doctor can often diagnose hemorrhoids simply by
examining the rectal area.
40.3.2 Make a TCM diagnosis based on the medical diagnosis and examinations.
40.3.3 TCM pattern differentiation is focused on the deficiency and excess of the
patterns.
197
MCOM Acupuncture Treatment Strategy and Herballnterna/ Medicine Study Guide 2009 by JH Xie
40.4 Acupuncture Treatment for Hemorrhoid

-
Stagnation of Blood Main points:
with Damp Heat BL32, SP6, DU1, BL35, BL57, Er Bai
For pain and swelling of the anus: BL54, BL2
-
For anal bleeding: SP10, BL24
For constipation: BL25, ST37
Oi Vacuity with Main- points: -
Prolapse Du20, CV8, BL20, ST36, bl26, BL46
For pain and swelling of the anus: BL58
For anal prolapsed: CV6, BL32 -
40.5 Herbal Treatment for Hemorrhoids

Patterns Formulas in Textbooks Practical Options
Stagnation Zhi Tong Ru Shen Tang (Divine Pain- Herbal Times Product:
of Blood Relief Decoction) Zhi Bao (Damp Heat or
with Damp 0 Cang Zhu, Huang Bai, ZeXie, Repletion Heat Hemorrhoid,
Heat Bing Lang, Qin Jiao, Fang Feng, including Huang Jiao, Huang Qi,
Tao Ren, Zao Jiao Ci, Dang Gui Mu Li, Jin Yin Hua, Pu Gong Ying,
Wei, Shu Da Huang Dang Gui, Di Yu, Da Huang, and
Liang Xue Di Huang Tang (Blood- Zhi Ke)
Cooling Rehmannia Decoction) Mayway Product:
0 Sheng Di Huang, Di Yu, Huai Huai Jiao Wan (Sophora Japonica
Jiao, Tian Hua Fen, Huang Teapills including Huai jiao zi, Di
Lian, Sheng Ma, Huang Qin, . yu, Huang qin, Zhi ke, Fang feng,
Chi Shao Yao, Dang Gui Wei, Dang gui) for hemorrhoid
Zhi Ke, Jing Jie Tang, Gan Cao bleeding.
Fargelin Pills (Hua Zhi Ling Pill
Qi Vacuity Bu Zhong Yi Qi Tang including Shi Iiu pi, Hai ge ke,
with Use Gui Pi Tang when blood is Tian san ql, Huang lian, Hu po,
Prolapse deficient too Zhu dan zhi) for hemorrhoid pain
and bleeding.
40.6 Prognosis
• Most treatments are effective, but to prevent the hemorrhoids from coming
back, to maintain a high-fiber diet and drink plenty offluids will prevent
recurrence of the condition.
• Prevention: Avoid straining during bowel movements. Prevent hemorrhoids by
preventing constipation. Drink plenty of fluids. Eat a high-fiber diet of fruits,
vegetables, whole grains. Consider fiber supplements.
198
41. Gangrene
Practical Therapeutics ofTCM Page323
Gangrene is death and decay of body tissue, often occurring in a limb, caused by
insufficient blood supply. It may happen from injury, an infection, or other causes. Some
of risk factors for gangrene include:
• A serious injury
•. Blood vessel disease (such as arteriosclerosis in arms or legs)
Bieeeteg
• Suppressed immune system
• Surgery
The TCM theory discussed in this chapter is limited to that caused by thromboangiitis
obliterans (Buerger's disease).

Thromboangiitis obliterans (Buerger's disease) is an inflammatory occlusive vascular
disorder involving small and medium-sized arteries and veins in the distal upper and
lower extremities. Cerebral, visceral, and coronary vessels may also be affected. This
disorder develops most frequently in men under age 40. The prevalence is higher in
Asians and individuals of eastern European descent. While the cause of thromboangiitis
obliterans is not known, there is a definite relationship to cigarette smoking in patients
with this disorder.
The clinical features of thromboangiitis obliterans often include a triad of claudication of
the affected extremity, Raynaud's phenomenon and migratory superficial vein
thrombophlebitis. Claudication is usually confined to the calves and feet orthe forearms
and hands, because this disorder primarily affects distal vessels. In the presence of
severe digital ischemia, trophic nail changes, painful ulcerations, and gangrene may
develop at the tips of the fingers or toes. '
The physical examination shows normal brachial and popliteal pulses but reduced or
absent radial, ulnar, and/or tibial 'pulses. Arteriography is helpful in making the diagnosis.
Smooth, tapering segmental lesions in the distal vessels are characteristic, as are
collateral vessels at sites of vascular occlusion. Proximal atherosclerotic disease is
usually absent. The diagnosis can be confirmed by excisional biopsy and pathologic
examination of an involved vessel.
There is no specific treatment except abstention from tobacco. The prognosis is worse
in individuals who continue to smoke, but results are discouraging even in those who do
stop smoking. Arterial bypass of the larger vessels may be used in selected instances, as
well as local debridement, depending on the symptoms and severity of ischemia.
Antibiotics may be useful; anticoagulantsand glucocorticoids are not helpful. If these
measures fail, amputation may be required.

All patients with any sign or symptom such as claudication and Raynaud's phenomenon
should be medically evaluated.
199
MCOM Acupuncture Treatment Strat~gy and Herbal Internal Me~icine Study Guide 2009 by.lH Xie
Table 41.1 Summary of TCM Etiology and Pathogenesis of Gangrene

Spleen and kidney Qi and blood stagnation
Symptoms and signs of
yang deficiency Obstruction of channels and
initia I and intermediate
Invasion of cold and connections
stages
dampness Malnourishment of extremities
Damp heat due to
Symptoms and signs of
stagnation of qi and Toxic heat/ blood stagnation
heat
blood/ dampness
QI and blodd detiti@t1Cy
Serious symptoms and
Chronic cases with qi Obstruction of channels and
signs of th romboangiitis
and blood deficiency connections
or gangrene
Malnourishment of extremities

Gangrene is a seriouscondltlon that usually requires amputation of the affected finger
or toe. There is not cure for thromboangiitis obliterans currently. Various treatment
approaches may be applied to reduce any signs and symptoms. Some clinical studies
from China showed acupuncture and herbal formulas may reduce the symptoms and
decreases the rate of amputation. Not systematic review or meta-analysis provides
further evidence of effectiveness.
World Health Organization 2002/ pain in thromboangiitis obliterans is listed as a
symptom for which the therapeutic effect of acupuncture has been shown but further
proof is needed.
41.3.2 Make TCM diagnosis according to the symptoms and sings
41.3.3 Differentiation the excessive patterns and deficient patterns. The obstruction of
channels and collaterals is the primary pathogenesis. Excessive patterns may be blood
stasis complicated with wind cold} wind dampness/ damp heat/ phlegm turbidity and qi
stagnation. Deficient patterns may be blood stasis complicated with deficiency of yin/
yang/ qi or blood.
41.4 Acupuncture Treatment for Gangrene

Qi Stagnation and Blood Main Points: BL17/ CV6/ BL26/ 5T36/ 5P6
Stasis For gangrene of the fingers: Ll4.. pe6/ Lll1 and Ba Xie
'For gangrene of the toes: 5P5/ GB40}KI6 and Ba Feng
Qi and Blood Vacuity Main Points: CV4/ BL17/ 5T36/ LU9/ SP10/ BL20
200
41.5 Herbal Treatment for Gangrene

Qi Stagnation and Blood Yang He Tang + Tao Hong Si Wu Tang
Stasis For dampness complication: add Er Miao San
For toxic heat: Si M iao Yong An Tang
Qi and Blood Vacuity Shi Quan Da Bu Tang/ or Ren Shen Yang Rong Tang

Prognosis is often poor in Buerger's disease. Acupuncture and herbs may be beneficial
to the control of pain and circulation in the affected area.
201
MCOM Acupuncture Treatment Strategy and..Herballnternal Medicine Study Guide 2009 by JH .Xie..
42. Sprain

A sprain is an injury to the ligaments around a joint. Sprains are caused when a joint is
forced to move into an unnatural position.
Symptoms
• Joint pain or muscle pain
• Swelling
• Joint stiffness
• Discoloration of the skin} especially bruising
Emergency Symptoms
II Suspected fracture
II Deformed joint or joint dislocation
e Serious injury or the severe pain
.. Serious hematoma
Medical evaluations are required for patients with:
• Swelling does not go down within 2 days
• Symptoms of infection in the affected area e.g., redder, more painful} hot feeing
and swelling
Table 42.1 TCM Etiology and Pathogenesis of Sprain

Strenuous exercise,
external blows or collision}
Local qi and blood Symptoms and signs of
falls} forceful stretching}
stagnation sprain
overburdening or twisting
of joints
Invasion of external factors} e.g., wind} cold and dampness due to local vacuity following
sprains will add to the severity of the injury and prolonging the illness. That is a situation
similar to painful-bi patterns.

World Health Organization 2002 the sprain is listed as a condition for which acupuncture
has been proved-through controlled trials-to be an effective treatment.
42.3.1 Verify medical diagnosis and exclude medical emergency

42.3.2 TCM diagnosis is made according to the symptoms and signs.
42.3.3 Treatments often include moving qi and blood} stopping pain} stopping bleeding}
promoting the subsidence of swelling} and promoting recovery.
42.3.4 When use TCM modalities always try first aid at the same time:
.. Apply ice immediately to help reduce swelling. Wrap the ice in cloth and do not
place ice directly on the skin.
202
• Try not to move the affected area. Bandage the affected area firmly, but not
tightly. Use a splint if necessary.
• Keep the swollen joint elevated above the level of the heart, even while
sleeping.
• Rest the affected joint for several days.
42.4 Acupuncture Treatment for Sprain

In acute casesneedle with draining methods; in prolonged cases, needle with
reinforcing methods, add moxibustion or employ needle-warming moxibustion. A- Shi
Points are normally selected together with some location-specific points.
42.5 Herbal Treatment for Sprain

Shu Jin Huo Xue Tang
Bu Zhen Zhuang Jin Tang

• With proper treatment pain and swelling due to sprain usually subsides within
7-10 days for mild sprains and 3-5 weeks for severe sprains.
.• If not treated appropriately the affected area may become vulnerable to the
invasion of wind, cold and dampness. And a Bi-obstruction pattern may occur.
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MCOM Acupuncture Treatment Strategv and Herbal Internal MedlclneStudy Guide 2009 by.lH Xie
43. Crick in the Neck

Crick in the neck is called Lao Zhen in Chinese! that literally means "fallen from the
pillow." However the TCM theory discussed in this chapter covers more than the
stiffness and pain due to sleeping in an uncomfortable position.
Neck pain may result from the disorders of cervical muscles! nerves! spinal vertebrae
and the disks. Neck pain may also be the result of problem of the shoulder! jaw! head!
and upper arms.
Major causes of neck pain
• Cervical muscle strain
• Osteoarthritis
• Fibromyalgia
Cervical fibrositis
Cervical vertebral fractures
Herniated cervical disk
Torticollis
Nuchal rigidity! fever and headache are the classic clinical triad of meningitis. The
diagnosis and treatment of meningitis is not discussed in this chapter.

Medical evaluations are necessaryfor the investigation of causes of neck pain.
Emergency symptoms include:
• Neck stiffness seen together with a fever and headache
Neck pain with dizziness! numbness! tingling! or weakness in arm or hand
Neck pain and numbness and weakness of arm or hand after a traumatic injuries
Table 43.1 rCM Etiology and Pathogenesis of Crick in the Neck

Excessive stretching and tightening of
Pain and
cervical muscle due to improper sleeping
Local qi and blood restriction of
posture! inadequate or excessive rotation or
stagnation movement in the
crooking of the neck;
neck
Invasion of wind cold

World Health Organization 2002 the neck pain is listed as a condition for which
acupuncture has been proved-through controlled trials-to be an effective treatment.
204
43.4 Acupuncture Treatment for Crick in the Neck

1 Qi Stagnation and Blood Stasis
WU ~M cr
Ashi Points
Luo Zhen
UB 10
51 3
GB 39
2 Invasion by Wind-Cold Evils

000 cAM tT
Luo zhen
L14
Ashi points
SJ 5
UB 10
513
GB 39
Auxiliary Points:
For shoulder pain add:
51 13
L115
For back pain add:
UB 11
51 14
For restriction in forward-back movement of the head add:
UB 60
LU 7
Restriction in left-right movement of the head add:
517
43.5 Herbal Treatment for Crick in the Neck

Qi and Blood Shu .lin Huo Xue tang (Sinew-Soothing Blood- Shen Tong Zhu Vi
Stagnation Quickening Decoction) Tang
• Du Huo, Qiang Huo, Fang Feng, Jing Jle,
Dang Gui, Xu Duan, Qing Pi, Niu Xi, Wu
Jia Pi, D u Zhong, Hong Hua, Zhi Ke
Wind Cold Ge Gen Tang
Invasion

The prognosis is favorable. Acupuncture has been proved effective for this condition by
clinical studies.
205

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Acupuncture Treatment Strategy

and Herbal Internal Medicine

Jinhua Xie BMed., PhD [I .

Copyright ©2009 Midwest College of Oriental Medicine

Table of Contents of Acupuncture Treatment Strategy

Jinhua Xie, BMed., BS. MM} MSOM" PhD

1. The general principles of acupuncture treatment

1.1 -Regulatlng yin and yang

1.2 Strengthening the vital qi and eliminating pathogenic factors

The methods of strengthening vital qi include replenishing qi, nourishing blood,

In acupuncture treatment the effect of strengthening the vital qi is achieved by

• Replenishing water to inhibit pathogenic yang and invigorating fire to eliminate

• Treating the exterior fu organ to relieve the problem in corresponding interior

1.3 Distinguishing the root and branch

1.4 Treating diseases according to climatic, seasonal condition, geographical location

2.1 Reinforcing I Replenishing

In a typical acupuncture prescription three categories of points are included:

Nearby points: local points, adjacent points, or A-Shi points

Empirical points for symptoms:

2 The Clinical Procedure in TCM Internal Medicine

• Li refers to the etiology and pathogenesis of the disease;

pathological response of the human body. So the principles of treatment should be

Practical Therapeutics ofTCM Page 9

1.1 Biomedical Review

1.2 rCM Etiology and Pathogenesis

Table 1.1 Summary of rCM Etiology and Pathogenesis of Common Cold

1.3 Clinical Reasoning

Table 1.2 Differentiation between Common Cold and the Flu

Te!lhB 1 iI 9iifs,sAtiiiiisi'R bct"mcn Hlind Ge'd 2nd 'Mind Heat Patterps

1.4 Acupuncture Treatment for Common Cold

Along with upper backache:

1.4.3 Invasion of Wind Heat

For swollen throat, add:

1.4.4 Invasion of Summer heat-Dampness

1.4.5 In cases of Qi Vacuity

1.4.6 Cords in Casesof Yin Vacuity

1.5 Herbal Treatments for Common Cold

Patterns Classic Formula Practical Options

Dampness Elsholtzia Beverage)

1.6 Prognosis and Development of Patterns

2.1 Biomedical Review

2.2 TeM Etiology and Pathogenesis

Table 2.1 Summary of TCM Etiology and Pathogenesis of Cough

2.3 Clinical Reasoning

2.3.1 Verify the medical diagnosis

Table 2.2 External and Internal Differentiation in Cough

Table 2.3 Cold and Heat Differentiation in Cough

2.3.6 Important Points of Clinical Decision-Making in TCM Practice

2.4 Acupuncture Treatment

1.2.5.2. Invasion of Lung by Wind-Heat

1.2.5.3 Jnvasion of Lung by Wind-Dryness

1.2.5. 4. Phlegm-Dampness Cough

1.2.5.5. Liver-Fire Cough

2.4.6. Yin Vacuity Cough

2.5 Herbal Treatment for Cough

Table 2.4 Herbal Treatment Based on Patterns

Liu Jun Zi Tang

Table 2.5 Commonly Used Herbs for Cough

external cough patterns may transform into internal cough patterns if

Practical Therapeutics ofTCM Page 28

Medical Evaluations and Emergency Symptoms

3.2 TCM Etiology and Pathogenesis

3.3 Clinical Reasoning

3.3.1 Verify the medical diagnosis