Acupressure Diseases 1

Course: Acupuncture Treatment of Disease I Date: September 22, 2008
Class #: 1 FAROOQ BIN MAHFOOZ

Syllabus chat:
1. All info you need comes from the handouts and classes. However, many questions on the
board are now coming from Maciocias book. Wording, paragraphs, case studies may come
from that book. His symptom descriptions especially. Some exam questions for this class as
well.
2. Final exam is in the 11th week this term.
3. Focus:
a. Mechanism for disease. Example appendicitis is due to what reason? What meridians is
blocked and by what?
b. Basic points to use for disease treatment and why those pts chosen.
c. Different patterns appendicitis for example is D/H retention in the large intestine.
First 3 classes introduction. Afterward, specific diseases.
Acupuncture Treatment of Disease 1

www.CatsTCMNotes.com
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General Introduction
We will cover all of the following diseases in this class.
System Biomed says: TCM calls it:

Respiratory Allergic Rhinitis Bi Qiu
Asthma Xiao Chuan
Common Cold Gan Mao
Epistaxis (nose bleed) Bi Ru
Pharyngitis and tonsillitis (both Hou Bi
acute and chronic)
Tinnitus Er Ming
Deafness Er Long
Cardiac Congestive Heart Failure Xin Li Shuai Jie
Heart failure/palpitations Xin Ji
Hypertension Gao Xue Ya
Endocrine Diabetes Xiao Ke
Hypothyroidism Jia Di Zheng
Reproductive Amenorrhea Bi Jing or Jing Bi
Dysmenorrhea Tong Jing
Female infertility Bu Yun Zheng
Impotence Yang Wei

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Principles of Treatment
There are four basic principles of treatment:
1) Regulating Yin and Yang
2) Tonifying body resistance and eliminating pathogens
3) Distinguishing root from symptoms
4) Treat: climactic, geographic, conditions, individual conditions.
Regulating Yin and Yang

This is in chapter 5 of Maciocia. Regulation of Yin and Yang is the underlying principle of acupuncture
treatment of disease.
Basic understanding of Yin and Yang

The belt-line is the Dai channel, dividing the body into top and bottom. The higher you get the more
Yang there is. The lower you get the more Yin there is.
i. Yin: The front (anterior) aspect as well as the bottom half of the body.
1. Kid 1 is the strongest Yin
This is a very sensitive point, energetically. You can use it to treat poor memory with
poor concentration, urination problems such as incontinence, as well as high blood
pressure as it will lower blood pressure by drawing Qi downwards, pulling
abnormally rising Qi back down. But because it is an energetically sensitive point,
when over stimulated it will not tonify Yin, but instead will stimulate Yang Qi
possibly causing more problems. This is especially true in cases of hypertension and
cardiac disease.
2. UB 52 is Yin within Yang

This point is used to nourish Yin and to tonify the Kidney. UB 52 is on the same
horizontal level as UB 23 and Du 4. It is 3 cun lateral to Du 4. Du 4 is very Yang, as
the whole Du channel is considered to be Yang. UB 23 is considered to be Yang
within Yin because of its position in relation to the others.
Why is UB 52 this point Yin within Yang when UB 23 is Yang within Yin? Because
Du 4 is very very Yang and the further the points are from Du 4 the less Yang they
become. As a result, UB 52 on the 2nd Bladder line is the most Yin of the set and is
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thus Yin within Yang.
ii. Yang: The back (posterior) aspect as well as the top half of the body.
1. Du 20 is the strongest Yang
As this point is at the topmost part of the body, it is the strongest Yang point in the
body. It can be used to treat hypertension due to too much Yang Qi rising to the head.
You can use Du 20 to reduce Yang using needling with reducing techniques or by
bleeding techniques.
2. Du 4 is the purest Yang

Du 4 is located on the posterior aspect of the body, which is Yang and is also at the
horizontal midline of the body. Du 4 is very closely related to Kidney function. Use
this point to tonify Kidney Yang. A moxa box is often used for this purpose at Du 4.
Du 4 can be used to treat infertility and urination issues such as incontinence. It can
also be used to tonify any deficiency of Kidney Yang.
3. UB 23 is Yang within Yin.

This point is used to nourish Yang and to tonify this aspect of the Kidney. This point,
as discussed in the Yin text above, is on the same horizontal level as Du 4 and UB 52.
Because it is closer to Du 4 than UB 52 is, this point is considered more Yang than
UB 52 which is closer to the lateral aspect of the body.
iii. Pivot of Yin and Yang is Shaoyang/Shaoyin.
iv. Borders of Yin and Yang

What is the yin/yang border? The vertical aspect at which Yin turns into Yang and Yang
turns into Yin. This border is useful to regulate each other.
1. Du 28/Du 26
Why is this a border? Because Du and Ren communicate with each other at this point
this is where one shifts to the other.
2. UB 35 and Ren 1
UB 35 is called Hui Yang, the influential or meeting point of Yang. It is located 0.5
cun lateral to the tip of the coccyx. Ren 1 is the Hui Yin, the influential or meeting
point of Yin and is located at the perineum between the anus and the scrotum or labial
commisure. This is the area in which one shifts to the other.

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3. Shixuan or 10 spreading points at the tips of the fingers and toes.
Correction of Imbalances
There are 4 basic dysfunctions in the balance of Yin and Yang. We learned all of these in Foundations 2
as well as in Diagnostics II so theres nothing earth shatteringly new here. Click on the links if youd
like to review them.
1) Excessive Yang with excess or full heat
2) Excessive Yin with excess or full cold
3) Deficient Yang with empty cold
4) Deficient Yin with empty heat
Excessive Yang
Excessive Yang is an overload of Yang where there really is absolutely too much Yang in the
body. This leads to excessive Heat and Fire symptoms. You will definitely be tested on this!
The etiologies (origin) of Excessive Yang is thus:
1) Invasion of External Yang Pathogens
Wind, heat, fire, and summer heat can all invade, causing an excess of Yang.
2) Hyperactivity of Internal Organs

An organ can have 3 different states in regard to the amount of Qi the organ has.
a. Normal: It is normal for an organ to have Qi. This is a good thing!
b. Too much Qi: This comes from hyperactivity of the internal organ and leads to Fire,
which is pathological. Generally speaking, it is the Heart or Liver which are most
likely to have the condition of too much Qi and Fire.
c. Too little Qi: this is Qi deficiency.
3) Emotional disorders
Emotional disorders, especially anger and irritation, can cause a condition of excessive
Yang. Heart and Liver are the organs most likely to be affected by emotional disorder,
leading to Heart or Liver Fire.
4) Irregular diet or overtaking of Yang herbs.

An irregular diet which is not balanced can cause an excess of Yang. Excessive
consumption of coffee for example can generate too much Yang. Over consumption of
Yang herbs such as ginseng can also cause a Yang excess.
Sidebar: White part of the scallion plus brown sugar can be used dietarily to warm
cold. Scallion has the warming function with its pungent flavor; brown sugar
sweetness combined with this slowly generates Yang Qi.
Symptoms of Excessive Yang:

1) The Four Greats, though not necessarily all at once:
i. High fever
ii. Great thirst with desire for cold drinks.
(This is not a sipping thirst like empty heat produces either)
iii. Profuse sweating all over the body
(not spontaneous sweating or night sweating only
iv. Great pulse: fast, full, forceful, and/or slippery pulse.
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2) Red face all over the face, not just the cheekbones
3) Constipation
4) Dark yellow urine
5) Menieres syndrome perhaps
6) Irritation/agitation
7) Pulse: see above in item 1.
8) Tongue: red with a yellow coating.
Treatment for this condition is to sedate/clear the heat. The most effective way to clear
fire or a great heat is to do blood letting either with a 3 edged needle for deep points or a
lancet for shallower points. The following acupoints can be used for blood letting:
1) Du 20
2) Du 14
Add cupping here to increase blood flow and heat clearing. You could also use a
plum blossom needle at Du 14 and then follow up with cupping.
3) Shixuan or the spreading points at the tips of the fingers and toes.
Pick the ones appropriate to condition. Lung heat, for example, use Lu 11.
4) UB 40
Since this is a deep point, use a 3 edged needle. Add cupping for greater blood
flow and heat sedation.
5) Also, perhaps Erjian at the tip of the ear. Especially useful for high blood
pressure.
Excessive Yin
This condition occurs in the body when there is absolutely too much Yin in the body which is
expressed by excessive or full Cold symptoms. The possible etiologies of Excessive Yin are:
1) Invasion of External Yin pathogens such as Cold, Damp, Dryness
Note that these pathogens can invade as Cold/Damp or Cold/Dry or singly.
2) Unbalanced or irregular diet and/or over consumption of Yin herbs/medicines

Over consumption of Yin substances such as cold foods and drinks (yogurt, dairy, ice
cream), excessive sweet flavors and excessive sour flavors. Sour and sweet will
transform into Yin per the Neijing. Yin herbs and Yin medicines such as antibiotics
can also generate excessive cold.
3) Retention of internal Yin pathogens

a. Damp - tends to be more generalized.
b. Phlegm - tends to be more localized.
c. Water retention or edema a deeper form of Dampness.
d. Blood stasis
Discussion: Conditions of damp, phlegm and edema are due to internal organ
dysfunction. The Spleen transforms fluids and the Lung disperses moisture.
Dysfunction and Qi deficiency in either organ can result in dampness, phlegm, and
edema. Spleen dysfunction leading to dampness can either be
Heated by Lung or Stomach dysfunction which transforms to Phlegm which is
then stored in the Lung.

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Cooled by an insufficiency of Spleen Yang or Kidney Yang which results in
edema/water retention in the lower body.
(Edema in the face or upper body is due to Wind/Water retention caused by Qi
congestion in the Lung and is treated by promoting sweating.)
Symptoms
1) Aversion to cold
2) Chills and shivering
3) Edema
4) Obesity
5) Cold extremities
Warming does not help and cannot be alleviated with more clothing.
(Deficient conditions can be relieved this way)
6) Cold pain anywhere in the body with an aversion to touch or pressure
7) Tongue: body can be normal or can be pale, swollen with teeth marks.
Coat will be white, greasy or wet, moist.
8) Pulse: can be superficial and tight or deep, slow and powerful.
Treatment principle for full or excessive Cold is to sedate the Cold. There are 2 primary
ways to do this:
Moxibustion
Use moxa on the upper extremities, upper back and head, which is a sedation
method for using moxa. (By contrast, moxa on the lower body is a tonification
technique.) Specific points to use are LI 4, LU 7, GB 20, UB 12 and UB 13. You
can use direct moxa or you can use a moxa stick and layers of paper to shelter the
skin, sliding the layers and the stick up and down over the points.
Example: when one has a cold or congestion due to Wind/Cold you can slide
between Du 14 and 16. There are 6 extra points here which affect the sensory
organs and this method affects all of them.
You could also use a ma huang/cinnamon topical application of herbs at GB 20

and warm it with a hairdryer to counter Wind/Cold.
Herbal therapy, which may be better than acupuncture for this particular
dysfunction. Examples: Sheng Jiang which is pungent and dynamic and opens the
meridians. Gan Jiang can also be used as it tonifies the Yang and tonifies.
Yang Xu (Deficiency)
Yang Xu occurs when there is too little Yang in the body, causing a condition of relatively too
much Yin, manifesting as symptoms of deficient or empty Cold. The four possible etiologies of
Yang Xu are as follows.

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1) Chronic stage of invasion of Yin pathogens which damages the Yang of the body,
causing Yang Xu.
2) Severe hypo function of internal organs.

A normal hypo function of an internal organ is a simple Qi Deficiency/Xu. Severe Qi
deficiency on the other hand leads to Yang deficiency. By way of example, a Spleen
Yang Deficiency is always a Spleen Qi Deficiency plus Cold. One might cause this
by having a Spleen Qi Xu and then consuming too much Cold substances.
3) Excessive sexual activity.
4) Irregular diet or long-term consumption of cold herbs or medications.

i. Irregular diet causing Yang Xu is a chronic phase of bad diet.
It begins as a diet which causes Yin invasion which then damages the Yang over
time. The most common form of Yang Xu caused this way is either Spleen or
Kidney Yang Xus.
ii. Long-term consumption of cold herbs or medications
Antibiotics and chemo-therapy are both cold therapies. One always has a thick,
greasy tongue coating after a 10 day course of antibiotics.
Symptoms:
1) Pale face
2) Chills which can be alleviated by warmth
3) Cold pain anywhere in the body
4) Desire for pressure or touching or warmth
5) Aversion to cold
6) Cold extremities
7) No thirst
8) Pulse: deep (internal), weak (deficient), slow (cold)
9) Tongue: pale, swollen body with wet or moist coating.
Note that cold plus sweating is indicative of a Yang Xu. Sweating indicates deficiency, as
the pores are opened up and cannot close. An excess will close off the sweating pores and
block sweating.
Treatment:
Treat a Yang Xu by tonifying and warming the Yang! Use moxibustion on the lower
extremities, lower back or abdomen. You can also use the warm needle technique, moxa
with paper layers, or salt in the navel, etc.
Yin Xu (Deficiency)
Yin Xu occurs in the body when there is too little Yin causing a condition of relatively too much
Yang, manifesting as symptoms of deficient or empty Heat. There are four possible etiologies of
Yin Xu as follows.
1) Chronic condition of excessive Yang disease such as heat disease, febrile disease, etc.
This type of heat damages the Yin. Example: a Yang disease causes sweating leading
to loss of fluids and therefore loss of Yin.

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2) Overwork, especially at night.
Yin is regenerated at night when you sleep and Yang is regenerated while you work
or study during the day. If you work through the Yin regenerative period you damage
overall Yin.
3) Excessive sexual activity, mostly due to loss of sexual fluids.
4) Long term consumption of Yang herbs or Yang meds.

Radiation therapy is considered a Yang treatment, consuming body fluids, causing
dry skin, thirst, hair loss.
Symptoms:
All of these symptoms are worse at night or after work/exertion
1) Night sweating
2) Malar flush
3) Hot sweats
4) Tidal fever
Low grade occurring regularly in the late afternoons or evenings.
5) Five palm heat
This is a hot sensation in the palms of the hands and soles of the feet
6) Thirsty and drinking water at night
7) Steaming bone heat
8) Tongue: small red body with cracks. Coating is scanty, thin, peeled, or mirror
(none at all)
9) Pulse: thin, weak, fast can be deep or superficial.
Treatment:
Nourish or tonify the Yin. Use Chinese herbal and food therapies or acupuncture for this
purpose. General acupoints include: KI 3, KI 6, KI 1. SP 6. UB 52, UB 43.
Note that KI 1 treats deficient heat (needle here) while Du 20 treats excess heat (use
blood letting). Hmmm!
In the clinic, be clear on whether a disease is yin or yang, excess or deficient.

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Strengthening Body Resistance and Eliminating Pathogens
The bodys ability to resist disease and eliminate pathogens is dependent upon Zhen Qi or Upright Qi.
Zhen Qi is a combination of:
Wei Qi
Blood
Body constitution
Body Fluids
Body tissues
Essence
The term pathogen above is relative. Something only becomes a pathogen when it negatively impacts
the body and causes disease. Pathogens arise from one of three sources:
1) External
This refers to the Six Evils. Need a refresher course on that? Click here for the Foundations
notes where we learned that. The Six Evils are Wind, Cold, Damp, Summer Heat, Fire/Heat,
and Dryness.
Important to know: External pathogens have an incubation period. Not an instant effect.
2) Internal
This refers to the Seven Emotions. Heres the link back to the Foundations information on
the Seven Emotions. The Seven Emotions are joy, anger, fear, grief, worry, pensiveness, and
shock. While the Seven Emotions are normal they can become pathogenic when they are
unexpected, strong, or chronically stimulated. When pathological, they affect the body this
way:
a. Attack the internal organs directly and without an incubation period.
b. Long-lasting emotional disorders can also generate heat then fire.
c. They affect the normal pattern of an organs Qi.
i. Anger causes Qi to rise, affects Liver most strongly
ii. Joy causes Qi to slow, affects Heart most strongly, causing Heart Qi and Shen
to scatter.
iii. Worry and Pensiveness affects the Spleen, causing Qi to stagnate or knot.
iv. Sadness and Grief dissolves Qi and affects the Lungs
v. Fear makes Qi descend, affecting the Kidney
vi. Shock scatters Qi, affecting Heart and Kidney
3) Non-internal and non-external

These can be poor diet, over-work, insect bites or animal bites, accidents, sports injuries,
inadequate sleep or too much sleep, chemical and/or radiation exposure, etc.
Disease, then, is a fight which occurs between the Zhen Qi and the pathogenic influence. The strength of
the fight and thus the strength of the symptoms is an expression of 1) the strength of the Zhen Qi and 2)
the strength of the pathogen. Many disease start as an excess and become a deficiency type disease as
time progresses and the disease gets to the chronic stage.

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Remember that you tonify deficiencies and sedate/reduce excesses. In the presence of a disease, how
then do you decide whether to reduce or to tonify? It might be helpful for you at this point to review
some Foundations notes again. Click here to check out Dr. Wus extremely awesome lecture on this
topic. If you want to cut to the chase, jump to page 5.
Here are some guidelines on deciding whether to tonify or to sedate/reduce.
Excess type individuals (including teens and kids)

Zhen/Upright Qi is strong in excess type individuals, so there is strong resistance to a
pathogen. If the pathogen happens to also be strong the fight can be most spectacular
like a violent game of rugby between two very good teams.
Basically, the disease will last a shorter time, but the reaction will be strong. Symptoms
might include a high fever, loud voice, constipation. The pathogen will likely stay in the
Yangming stage.
Treatment:
Because both sides are strong, you must pay more attention to the strong evil and sedate
or eliminate the pathogen. Do this only for the short term to avoid weakening or
depressing the bodily constitution by long term sedation. Once the pathogen is gone, stop
with the sedation!
Deficient type individuals (elderly, weak constitutions)

Individuals who are deficient or have weak constitutions have poor Zhen/Upright Qi.
Resistance to pathogens is weak and the body doesnt put up much of a fight when
pathogens attack.
Be very aware of the dangers here! A weak or deficient person may have a very strong
pathogen attacking them, but dont have the Upright Qi to marshal a defense so the
symptoms will not be strong. If you took Dr. Pughs Pathophys I class (see slide 26 if you
are interested) she talked about how elderly people tend to have little or no symptoms to a
disease and a decrease in normal immune responses while a younger person will have
severe symptoms. This is exactly what she was talking about. Sometimes the first
symptom you see in an elderly person is delirium which indicates theyve just gone
from bad to Omigod!
Treatment:
Tonify the body and the Wei Qi. There is weaker body resistance to a pathogen, whether
that pathogen is weak or strong. The reaction to pathogens in a weak/deficient body will
be milder again, the pathogen may be quite severe though the body shows few or no
symptoms/signs. Pathogenic attack will also last longer in a weak/deficient person. The
pathogen moves into the Taiyin stage more readily.
Yes, the evil qi will also be tonified when you tonify the body and the Wei Qi, but it is
more important to tonify the already-weak body in this case. Sedation of the pathogen
would also weaken the body and make it more deficient.

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Further Guidelines to help you decide:
Again, you might wish to refer to Dr. Wus final Foundations lecture.
Stage Treatment principle Who this applies to:

Single Excess Initial stage of acute Sedate only Yang individuals such
disease as children and teens
Single Deficiency End of a chronic Tonify only Older people, anyone
disease with poor constitution
(Xu type)
Combinations Middle stage of disease Treat both
More Beginning to middle Sedate, then tonify Pathogen is still strong
excess, less stage of disease and resistance is injured
deficient
More Middle to the end of a Tonify, then sedate Poor body constitution,
deficient, disease individuals who catch
less excess cold easily.
50/50 Middle stage of disease Sedate and/or tonify
only
Distinguishing the Root (Ben) from the Symptom (Biao)
Ben is the root of a problem. Biao is the symptom set and is the less important factor. Chinese medicine
is designed to treat the root of a problem rather than just band-aid fixing symptoms. With that in mind, it
is important for us to be able to distinguish the root cause (ben) from the symptoms and signs of disease
(biao).
Keep 3 principles in mind as you determine treatment for a disease:

1. When a disease is at an acute or emergency stage, treat the symptom (biao).
Thats right out of the Neijing. No matter why there is a symptom generating the emergency,
stop this first and work out the etiology later.
Example 1:
A patient comes in with the flu who also has hypertension. Treat the flu first (unless were
talking malignant send-em-to-the-ER-right-now hypertension).
Example 2:
Patient with both a Yin deficiency (xu) and a Yang xu. Treat the Yang xu first. Yang
responds more quickly giving faster results.
Example 3: If your patient is having an acute asthma attack, alleviate the symptoms of this
first by treating the Lung and respiratory system.
2. When a disease is chronic, treat the root (ben)/cause.

When there is no emergency and no risk to the patients health treat the root to give the
patient long-term relief (and return business for you!).

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Example:
Using asthma again, when your patient is between attacks, this is the chronic phase. Treat the
root of the cause, the Kidney (usuallysome practitioners, Maciocia included, identify a
couple of kinds of asthma with different root problems). The Neijing says: In the summer
treat the root (kidney); in the winter, treat the branch (lung). Winter is the more likely time
for patients to suffer from acute asthma while it is often quiescent in the summer.
i. Seasonal treatment per the Neijing:

In summer protect the Yang; in winter protect the Yin.
1. Summertime: protect the Yang.
Summer is the peak of Yang during the year. If the bodys Yang is damaged
in summer it will really suffer in the fall and winter.
2. Wintertime: protect the Yin.

Winter is the quintessential time for Yin during the year. If the bodys Yin is
damaged in the winter (like by excess use of heat sources) then it will be far
more likely to suffer from Yin disorders in the following seasons
A traditional dish on Winter Solstice is Yang Rou (mutton) with dang gui
and sheng jiang in a soup.
3. Treat both root and symptoms

While this is sort of restating the 1st and 2nd principle, it also applies to conditions which are a
little of both: not really acute, not really chronic.
Ben root and most important Biao symptom and least important
Cause, etiology and course of disease Symptoms of disease
Body constitution Pathogen
Root Superficial
Chronic disease Acute disease
Patient Practitioner
Shen/mind/spirit Physical body

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Treatment according to Climactic/Weather/Geographic/Individual Constitution
Climactic conditions
You can also think of this as principles according to season.
1. Spring
Energy tends to go upward. If it ascends too much it causes headaches. There is more heart
heat and dermatitis in the spring and summer (especially in the summer).
Balance the upward energy with downward energy in the form of Qigong and/or
acupuncture.
Needle more shallowly in the spring and summer. Shy away from moxa, ma huang too.
Substitute xiang ru for ma huang if needed.
2. Summer
Energy goes outwards. Wei Qi stays superficial. As we sweat in the summer the Yang can go
out of balance, exiting the body too much.
If the climate is humid however, the pores are closed and the Yang cannot come out causing
dermatitis.
Heart heat is a stronger possibility in Summer as well.
Dont use moxa in the summer, especially for high blood pressure or Liver Yang Rising!
Also, no gui zhi or ma huang. If your patient needs ma huang, substitute xiang ru.
Use only superficial acupuncture, puncturing more shallowly so as not to push pathogens
deeper where the Wei Qi will be weaker.
3. Autumn
Energy goes downward. When it goes downward too much it can cause diarrhea and/or
depression. People also tend to lose more hair in the autumn. Balance this with upward
moving energy, again using acupuncture or Qigong.
You can needle more deeply in the autumn and use a little more moxa.
4. Winter
Energy is drawn inward, causing more asthma/wheezing (especially when the Lungs are
exposed to outside cold air) and depression. The pulse is deeper in the winter and there is
decreased immunity at the superficial layers of the body.
Needle more deeply and use moxa in the winter time. Dont do blood letting in the winter as
a rule, as this will disturb the Yang Qi.
Geographic Conditions
You must allow for geographic consideration when treating your patients. If you set up shop in the
Pacific Northwest, for example, youd see a lot more cold/damp than you will in Texas.

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Individual Considerations
1. Age
a. Children and teens
This age group is more likely to have pure yang/yin, good body constitution, fewer
emotional disorders, single and simple diseases. Illnesses are generally of the excess type,
often typical external heat syndromes.
b. Adults
Adults often have combinations of excess and xu with more xu, more complicated
diseases.
c. Elderly
Often have weak constitutions and are more subject to xu than to excess. They have little
resistance and therefore little fight when a pathogen attacks. Lack of symptoms for
elderly people is not necessarily a good sign!
2. Sex
a. Male
The Kidney is the most important organ for males.
Males tend to have:
i. more heat problems
ii. less tolerance to pain (ha! I knew it!)
iii. Qi and Yang xus, often showing as impotence or premature ejaculation
iv. Prostate problems (prostate is considered part of the internal Kidney organ).
Often this is Kidney Qi Xu, manifesting as enlarged prostate, dribbling, urinary
incontinence, and frequency of urination.
b. Female
The Liver is the most important organ for females.
Women tend to have:
i. More cold problems
ii. Better pain tolerance than men (and wouldnt we have to for childbirth?)
iii. Menopause which is typically expressed with Yin xu symptoms, Blood xu, and
Essence xu (which is Yin xu + osteoarthritis)
iv. Frozen shoulder or 50s shoulder which is a hormonal imbalance.
v. Menstrual disorders and stress/emotional problems which is related to Liver as the
congenital organ for females.
3. Body Constitution
Body type is determined by Yin/Yang aspects as well as by the Five Elements. This is
defined in the Spiritual Pivot. We also talked about this in Diagnostics (see page 3). Also
refer to the last 7 chapters of the Maciocia book for a discussion on Yun Qi Theory.
4. Lifestyle/Cultural Backgrounds
a. Lifestyle
Per Dr. Wu, many diseases from which adults suffer are due to lifestyle imbalances
which then generate emotional and stress reactions (i.e., high blood pressure, high blood
sugar, high cholesterol, etc.). Additionally, people who work night shifts or just tend to
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be night owls suffer from Yin deficiency.
b. East versus West

i. West
Diets in western cultures tend to be high in meat, dairy, and fried foods causing
damp and phlegm in the body. There is more obesity/overweight, diabetes, cardio-
vascular disease, emotional stress, Liver Qi Yu (stagnation).
People from a western culture tend to be more extroverted.
Westerners are generally less tolerant to needle sensation.
ii. East
Suffer from more digestive disorders, poor hygiene, poor nutrition.
Tend to be more introverted.
More tolerant of needle sensation.
c. Three most common diseases of the 21st century in the West

(assuming we can sustain energy expenditure to generate artificial atmospheric conditions
such as air conditioning and heating)
i. Nervous system disease (due to air conditioning/heating)
ii. Autoimmune disease (such as allergies, lupus, some forms of arthritis)
iii. Viral infections

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Case 1
25yo female.
Irregular diet. Epigastric distention. Burning pain. Aversion to touch. Belching with sour odor. Aversion
to cold. Tongue: curdy thick coating. Whats the best treatment?
1) Heart 7, Pericardium 7, Du 26, Du 20
2) Ren 17, LU 7, KI 6, SI 3
3) GB 34/40, SP 4
4) St 36, Ren 12, P 6, ST 25
This is food retention with stomach heat.
Case 2
79yo male patient with lower back pain, frequent urination x 10 years, tired and poor appetite. 2 days
ago he got common cold and slight aversion to wind and cold. Pulse: superficial, weak.
Whats the diagnosis? External wind/cold invasion with Kidney deficiency and Spleen deficiency.
What do you do?
1) Ht 7, LU 9, SP 6, UB 15, UB 13, GB 20
2) LU 9, KI 3, UB 23, LU 7, LI 4, UB12, SJ17
3) ST 36, LI 10, UB12, GB 20, UB 20, UB 23
4) REN 4, REN 6, DU 4, UB 23
Case 3
9 yo keed. Had fever, common cold, taking white tiger decoction for 4 weeks. Fever is gone, but
patient has low voice, spontaneous sweat, poor app, diarrhea, fatigue, pale swollen tongue with teeth
marks. Pulse is large, weak.
Kids correct Qi is damaged. White Tiger is very cold, took too long, now resistance is gone.
Case 4
39yo male. Irritable for 2 weeks, bitter taste, thirsty. At night, tosses and turns and sleeps poorly.
Templar headache, hypochondriac pain, constipation. Urine is yellow and hot. Tongue is red, especially
on sides, pulse is wiry.
1) Stomach excessive heat
2) LI excess heat
3) Heart excess fire
4) Hyperactivity or Liver.
What to do? Clear Liver heat with LV 2, HT 8, LI 11, 4 gates (but use LV 2 instead of LV 3)

Page 17 of 17
BASIC PRINCIPLES
Principles of Treatment
There are four basic priciples of treatment:
1- Regulating Yin & Yang
2- Tonifying / Strengthening body resistance and eliminating pathogens
3- Distinguish root from the symptom
4- Treatment of disease in accordance w/ climatic or geographic conditions, as well as individual conditions
(age, gender, etc.)
1- Regulating Yin & Yang

Basic: front = Yin, back = Yang; top = Yang, bottom = yin
Yang is strongest at DU-20 (top of head, closer to sky) -- Yin is strongest at KID-1 (lowest point)
@ L2: DU-4 at midline = purest/strongest Yang
UB-23 at 1.5 cun lateral = Yang w/in Yin (good to nourish Yang)
UB-52 @ 3 cun = Yin w/in Yang (good to nourish Yin)
Shaoyang / Shaoyin = pivot of Yin and Yang
Border of Yin and Yang:
o Shixuan 10 fingertip points and 10 tips of toes = Border of Yin and Yang as the Yin meridians meet
Yang Meridians and vice versa at these points
o Betw/ UB-35 = Mtg of Yang and REN-1 = Mtg of Yin
* Borders of Yin and Yang are useful to regulate each other
A. Correction of Excessive Yang = Yang Excess Yang Excess causes Excessive Heat symptoms
(i) Concept Bodys Yang is absolutely too much (above average)
a. Invasion of Yang pathogens: Wind, Heat, Fire, Summer Heat
b. Hyperactivity of Internal Organs
(ii) Etiology - Normal int organ f(x) = Qi [i.e. LU Qi = LU f(x)]
- If too much (hyper) Fire (pathological and abnormal)
:: usually HT or LIV Fire
- If too little (hypo) Qi Xu
c. Emotional disorders: esp. anger, irritation (usually HT or LIV Fire)
d. Irregular diet or overtaking of Yang herbs
- Excessive Heat:
4 Greats (Bigs): not all are necessary at once
Fever: high
(iii) Symptoms Thirst: desire for cold drinks, not sipping
Sweat: not spontaneous, not night only, all over body
Pulse: Full, forceful, fast, slippery
- Red face - Constipation
- Dark yellow urination - Menieres, Irritation
- Forceful, fast Pulse, may be slippery - Red tongue body w/ yellow coat
(iv) Treatment Sedation (and Clear Heat)
Blood letting w/ 3 edge needle (to clear Heat):
Tx techniques: 1-3 drops of blood: on pts of upper extremities, face, head.
DU-20, DU-14, UB-40, Shixuan (tips of fingers: use one according to
affected
system i.e. thumb for LU)
1
B. Correction of Excessive Yin = Yin Excess Yin Excess causes Excess Cold symptoms
(i) Concept Bodys Yin is absolutely too much (above average)
a. Invasion of External Yin pathogens: Cold, Damp, Dryness
b. Diet: eating too much Yin foods: cold (yogurt, ice cream, etc.),
(ii) Etiology or over-consumption of Yin Herbs or Yin medicines (antibiotics)
c. Retention of Internal Yin pathogens: Damp, water retention, Xue stasis,
Phlegm (d/t internal organ dysfunction: SP transforms fluids, LU retains
Dampness) [Retention of Yin pathogen in initial stage b/c long-term retention
becomes excess Yang]
SP (dysfunction) Dampness [therefore, here, more general & superficial]
[phlegm is deeper

Heat [from LU or ST] Cooled [by SP or KID Yang Xu]
& more localized
than Dampness;
Phlegm Retention of water / Edema in the lower body
Water retention is
even deeper] (sticky and visible) [Edema of the face and upper body = Wind-
and retained in LU water retention (LU Qi congestion). Tx thru
promoting sweating]
- Aversion to Cold - Chills / Shivering

- Edema - Obesity
- Cold extremities (which is not released by adding warmth)
(iii) Symptoms * Excess cold symptoms cannot be alleviated with more clothing
[[* Xu Yang cold can be alleviated with more clothing.]]
- Cold pain (anywhere in body) w/ aversion to touch/pressure
- Tongue Body: normal or pale swollen w/ teeth marks; Coat: white greasy, or
wet, moist
- Pulse: superficial, tight; or deep, slow, but powerful (deep, slow, weak = Yang
Xu)
(iv) Treatment Sedation (b/c Excess)

Moxibustion -- on upper extremities, upper back, head = sedation
[Moxa on lower extremities, abdomen, lower back = tonification/warming]
LI-4, LU-7, GB-20, UB-12, UB-13

Tx techniques:
* Moxa stick directly on layers of paper over point and slide paper/stick up
and down:
i.e. DU-14 DU-16 when one has a cold or congestion d/t Wind-Cold
(there are 6 extra pts betw/ DU-14 and 16 that affect the sensory organs).
One can also use the heat from a hair dryer (cinnamon/ma huang pkg
against GB-20 w/ hair dryer)
Herbal therapy (may be better than acupuncture in treating this type of

individual):
- Sheng jiang: pungent, more dynamic, opens the meridians: mainly for Yin Shi
- Gan Jiang: Warms the Yang and tonifies
2
C. Correction of Deficient Yang / Yang Xu Yang Xu causes Xu Cold symptoms
> Yang Xu = mechanism that causes the Sx of Xu Cold
(i) Concept Bodys Yang is Deficient / lower than average and as a result, the bodys Yin is
relatively Excess
a. Chronic stage of invasion d/t Yin pathogens
b. Severe hypo-function of internal organs [severe Qi Xu = Yang Xu
(ii) Etiology (normal hypo-function = Qi Xu)]
- SP Yang Xu = SP Qi Xu + Cold
c. Irregular diet chronic stage [acute irregular diet = invasion of Yin diet]
SP and/or KID Yang Xu
or Long-term taking of cold herbs / medications [including chemotherapy
& antibiotics (always thick greasy coat after 10 days of antibiotics)]
d. Excessive sexual activity
- Pale face - Aversion to cold

(iii) Symptoms - Chills which are release by warmth - Cold extremities
of Xu Cold - Cold pain anywhere in the body - No thirst This is the deficiency
- Desire for pressure/touch or warmth - Pulse: Deep, weak, and slow
- Tongue: Pale, swollen body w/ wet or moist coat
(iv) Treatment Tonifying and Warming

Moxibustion
Tx techniques: on points on lower extremities, lower back, or abdomen
* Warm needle technique, moxa w/ paper layers, salt on navel, etc.
D. Correction of Deficient Yin / Yin Xu Yin Xu causes Xu Heat symptoms

(i) Concept Bodys Yin is lower than average, and as a result, the Yang is relatively Excess
a. Chronic condition of Excessive Yang diseases (heat dz, febrile dz, etc.)
i.e. Yang Dz sweating loss of fluids Yin Xu
b. Overworking, esp. at night
(ii) Etiology - Sleep at night to produce Yin and work during day to produce Yang. If
work thru Yin production time, injure Yin
c. Excessive sexual activity
d. Long-term taking of Yang herbs or Yang meds (including radiation
therapy consumes body fluids: dry skin, thirst, hair loss)
- Night sweats
- Malar flush
- Hot sweats
- Tidal fever (low-grade fever occurring in the late afternoon or evenings,
(iii) Symptoms occurring on a regular basis)
- 5 Palm Heat
- Symptoms worse at night or after work/exertion
- Thirsty drinks more water at night
- Steaming bone heat
- Small tongue body, red in color w/ cracks; Coat: less tongue coating, peeled, or
mirror coat (no coat)
- Pulse: thin, weak, fast that is deep or superficial
(iv) Treatment Tonify and Nourish Yin

#1- Chinese Herbs or food therapy
Tx techniques: #2- Acupuncture: general pts: KID-3, 6, 1; SP-6; UB-52, 43

[compare: excess heat blood let DU-20; Xu Heat needle KID-1]
3
2- Strengthening body resistance and eliminate pathogens
Bodys resistance = Wei Qi Constitution Body tissue = Zhen /
Blood Body fluids Essence Upright Qi
Pathogens = (1) External pathogens = 6 Evils

(2) Internal = 7 Emotions -- b/c affect internal organs (Qi) directly w/o an incubation
period
(occurs immediately)
(3) Non-external, Non-internal pathogens = irregular diet
accident
animal / insect biteschemical contact,
etc.
* Any disease is a fight betw/ the pathogens and the bodys Zhen Qi and will cause either a Xu or Shi
* Any disease can begin as an excess and move to a deficient type
Zhen / Upright Qi is: Evil Qi is:

Upright Qi is strong Evil Qi is very strong
Excess Strong resistance w/ strong pathogen - Because both sides are strong, need to pay more
Type lasts shorter duration w/ a stronger attention to these strong evils and sedate [eliminate
Individual reaction: pathogens] - for short term only b/c do not want to
(teens, children)
high fever, loud voice, constipation, weaken / depress bodys constitution once the
(pathogen stays in Yangming) pathogen is removed
Upright Qi is weak (& cant fight) Evil Qi is either weak or strong

Deficiency Pay more attention to constitution and
If tonify, will the Evil Qi also be tonified?
Type tonify.
Possibly, but it is more important to tonify the
Individual Weaker body resistance w/ pathogen
(elderly, weak
already weak body before this weakness becomes
(strong or weak) leads to milder reaction
constitutions) worse.
and lasts longer [pathogen moves into
Pay attention to body resistance;
taiyin] illness doesnt look as strong, but
give tonification to body, wei qi, etc.
pathogen could still be very severe. Pay
attention!
Stage of Dz Tx principle Typical population affected

A. Single Excess Initial stage of Acute Dz Sedate only Yang individuals: i.e. children,
teens
Older people or anyone w/ poor
B. Single Deficiency End of Chronic Dz Tonify only constitution Xu type
C. Combination: Middle stage of a Treat both
disease
* More excess, Sedation followed by - Pathogen is still strong,
Beginning to middle tonification resistance is injured
less
deficiency
* More Tonfication followed by - Poor body constitution
Middle to end sedation individuals who catch colds
deficiency,
less excess easily
* Half / Half Middle stage only Sedate and/or tonify
For teens, tonify w/ gui zhi tang, ma huang, -- NOT for older PTs!
For older people w/ cold - cook an herbal rice porridge/congee with the following:
100 gms rice + 3 pieces of scallion (white part & root) + 5 pieces of fresh ginger + 10 Chinese dates (da zao)
+ 2 cups water. Cook in crock pot/slow cooker until porridge consistency. Drink the soup; it is not
necessary to eat the ginger, scallions or dates. Very strong for poor constitution tonify & sedates.
4
In Clinic need to distinguish yin/yang and excess/xu
3- Distinguish Ben/Root from Biao/Symptoms (relative to each other)

Ben/Root (most important factor) Biao/ Symptom (least important factor)
Cause / etiology / course of disease Symptoms
Body constitution Pathogen
Root Superficial
Chronic disease Acute disease
Patient Practitioner
Shen / Mind / Spirit Physical body
Psycho-puncture (Jamie Wu terminology!)

Nei Jing: 3 types of doctors: Best works on shen; good works on qi; so-so works on physical
A. In emergency situations, treat the symptom(s) first:

No matter why there is a symptom stop the symptom 1st: i.e. Stop the Bleeding!
Work out etiology later
Ex: Flu vs hypertension: treat the flu
Ex: yang xu vs yin xu: treat the yang xu 1st: yang xu easier to treat faster results
B. In a chronic situation, treat the cause / root:

No emergency no risk; plenty of time to determine the real root
Asthma: during attack treat the acute (the LU); when not in asthmatic attack, treat the root (KID as
root of breath: in the summer, treat root; in the winter, treat the branch: bai jie zi therapy)
Nei Jing says: In the summer, protect the yang; in the winter, protect the yin [if in the summer, the
yang is weakened, the yang will be weak in the following fall/winter. In the winter, if the yin is
injured (excess use of heat sources) then much easier to suffer from yin disorders in the following
seasons].
> Traditionally, on winter solstice day, eat yang rou (mutton) w/ dang gui and sheng jiang as a soup
[dang gui root move xue (only use if have xue stasis)]
C. Treat both symptoms & root

Initially, relieve the symptoms first then treat root: this way, the patient finds immediate relief and
will return for treatments. Chronic root will take longer to treat.
Most diseases are treated this way, esp. in western countries
One or more diseases not really acute or chronic a little of both
4- Treatment of Diseases According to Climatic / Weather, Geographic, or Individual Conditions

A. Climatic
Spring: energy is upwards easy for peoples energy to go upward too much headaches,
> Balance up w/ down: w/ qigong, acupuncture
Summer: energy is outwards as humans, our Wei Qi stays superficial. As we sweat, our yang
comes out to balance, on the other hand, wind/humidity closes pores and then yang cannot come out
dermatitis
> No moxa; no gui zhi, ma huang; superficial acupuncture only! (deep acupuncture will not yield
good results and/or may push pathogen deeper where the wei Qi is weaker)
Autumn: energy is downward people tend to lose more hair, energy can go downward too much
diarrhea
> Move energy upwards to balance
Winter: energy is inward deeper pulse, decreased immune system in the superficial area and LU
are exposed to the outside asthma, wheezing,
> Good to use moxa; deeper needling
External evils for diagnosis needling layers:

Conditions for treatment (summer/spring needle superficial; heaven Wei Qi
winter/fall needle deeper)
Moxa not good for summer esp. for high bp or LIV yang ^ human Ying Qi
No ma huang in the summer use xiang ru instead
No blood letting in the winter do not want to disturb yang qi earth Yuan Qi
Winter/fall see more depression
5
Spring/summer see skin problems; dermatitis; HT heat
B. Geographic
In China: acupuncture in east; tuina in center; moxa in south (damp, need to dry it)
Must allow for various geographic changes when treating patients.
C.
Individual
1. Age Kids change very fast...ok to critical quickly.
Children, teens: pure yang (pure yin) in nature; good body constitution; illness is usually
excess type (typical external heat syndrome); less emotional disorders; single & simple diseases
Remember for old patients Adults: combinations of excess & xu; emotional distress; more xu; more complicated

they have little resistance - If Yin Xu, Jin Ye Xu, typically older people, do NOT take ma huang! Will cause red
sweating nasal bleeding,
so there is little 2. Sex
Male usually more heat problems; less tolerance to pain; qi & yang xu (impotence, premature
fight. Lack of fight KI most imp
ejaculation); prostate problems (enlarged, dribbling; incontinence; frequency = KID Qi Xu)
is not necessarily a good Female more cold problems; better pain tolerance (pain threshold decreases at menses); 51 is
average age of menopause; typical yin xu; blood xu; essence xu (yin xu + osteoarthritis). 50s LV is most imp
thing! shoulder = frozen shoulder from hormones
- Nei Jing: Liver is congenital organ for females menstrual disorders, stress/emotions
Kidney is congenital organ for males: prostate is part of internal kidney
- It is said that females have higher pain tolerance than males.
3. Body Constitution
Body type; five elements from Spiritual Pivot
Yun qi theory includes birth date (last 7 chapters)
4. Life style / Cultural background
Night work = yin xu
Diet is very different betw/ East and West! more Dampness/Phlegm d/t more consumption of
dairy in West [diet = dampness: fried foods, alcohol, etc.]
Eastern = more digestive disorders; poor hygiene; poor nutrition; more introvert; more tolerant
to needling sensation
Western = more damp retention (food); overweight; diabetes; cardio-vascular; more emotional
stress; more LIV Qi Yu; more extrovert; less tolerant to needle stimulation
3 common diseases of the 21st century (mostly d/t artificial internal conditions: ac, heating, )

i. Artificial cooling/heating more nervous sys diseases,
ii. More autoimmune disorders (allergies, lupus)
iii. Viral infections
Basic principles of Acu-prescription & Selection

I. Composition of acu-formula
A. List of acu-points: Order & sequence routine way to avoid disturbing normal flow of Qi
this not only helps to systematically put needles in, but to also systematically take needles out.

Follow pattern from:

Yang to Yin,

Head to feet,

Back to front
Primary to secondary points
* Exceptions: special needs (i.e. hypertension, or opening of extra meridians)
which are typically addressed first
B. Techniques & methods: Use standard symbols to note what exactly was done
+ or T Tonify
- or Sedate
or | Even / Regulating ( tonify sedate)
Moxa w/ cone
X Moxa w/ stick
6
Warming needle technique
Blood letting
Examples: LI-4 = sedate LI4
+
DU-4 = tonify & moxa DU-4
C. Duration & frequency:

Duration:
Tonify (according to Dr. Wu)
- Leave needle in for more than 40 minutes (Keep in to gather/collect Qi), stimulate

regularly, close hole
Sedate (excess)
- Leave needle in for only short time (dont want to accumulate Qi in local area and make
stagnation/stasis
worse); strong sensation right away, leave hole open
- Blood letting is strongest release of Excess
* Note: NCCAOM claims that leaving the needle in for >40 minutes is a sedation technique [d/t
this
controversy, this will not longer be tested]

Frequency:

Acute more frequent initially: 2-3 times per week for 1-2 weeks
Chronic treatments over longer period of time: 2 times per month or once a week over time

D. Number of points selected: (acupoints & herbal formulations)

Odd # of needles: Excess, External more yang in nature (dynamic, good for sedation)

Even # of needles: Chronic, Zangfu, more tonifying more yin in nature, more balanced

Acute: more needles (esp. if strong constitution)
Chronic: fewer needles

E. Styles

Japanese style uses fewer needles: 3-5

Chinese: many points

Korean: 4 needle technique
Traditional Chinese uses fewer needles
II. Point Selection

A. According to Meridian Theories
1. Go to specific / affected meridian or organ
2. Go to related meridians:

a. Superficial internal/external related: i.e. LU LI (host-guest, etc.)
b. Mother-Son related meridians: i.e. LU: SP (mother of LU) if LU deficiency, KID = son of LU
and therefore, sedate the son (KID) for LU Excess
c. Same name related meridians: LU Hand Taiyin SP Foot Taiyin
B. According to Point Theories
1. Local points as basic points (i.e. toothache: SI-19, ST)
2. Distal points (i.e. toothache: LI-4, ST-44)
- Using only local points will cause congestion add distal point to open whole meridian
- To tx head and extremities: combine local and distal
- To tx trunk & internal organ dysfx: combine Front Mu and Back Shu
3. Symptomatic points: extra points for specific diseases
i.e. Insomnia An Mian; AsthmaDing chuan
C. According to Special Point Theories

1. Lower He-Sea
2. Bio-clock theory
3. 4 Needle Technique:
Five-shu and 5-elemental theory
Used as a secondary choice, if routine treatment isnt successful
For organ disorder, not meridian disorder
7
Yin yang checks yin Yang

Five shu
jing-well wood metal

generating
generating
ying-spring fire water
shu-stream earth wood
jing-river metal
fire

he-sea water earth
1st: Diagnosis - determine location (organ) and propery (excess or deficiency)

2nd: Principle of tx
> If Excess ex: if LIV excess (wood)

Sedate son sedate fire
Tonify controller (GM/grandmother) tonify metal
> If Deficiency ex: if LIV Xu (wood)
Tonify mother tonify water
Sedate controller (GM/grandmother) sedate metal
3rd: Select Points
> For Excess ex: if LIV excess (wood)
1. Sedate its son point on its meridian LIV2-
AND its son point on the sons meridian HT-8-
2. Tonify its controlling point on its meridian LIV-4+
AND its controlling point on controlling meridian LU-8+
> For Deficiency ex: if LIV Xu (wood)
1. Tonify its mother point on its meridian LIV-8+
AND its mother point on the mothers meridian KID-10+
2. Sedate its controlling point on its meridian LIV-4-
AND its controlling point on controlling meridian LU-8-
To summarize:
1- Son point from affected meridian
4 Sedate
2- Son point from son meridian
needles
for Shi 3- Controlling (grandmother) point from the affected meridian
Tonify
4- Controlling (grandmother) point from the controlling meridian
1- Mother point from the affected meridian

4 Tonify
2- Mother point from mother meridian
needles 3- Controlling point (grandmother) from affected meridian
for Xu Sedate
4- Controlling point (grandmother) from controlling meridian
4. Balancing techniques (related to taiyin, )

i.e. LI-4, LIV-3 mirror each other in location on hand & foot
5. Specific empirical points
i.e. SI-11 = dot com point; ST-38 = shoulder point;
8
Divergent & Tendino-Muscular Meridians (T-M m)
I. Divergent Meridians
A. Characteristics (of the pathways)
1. 12 Divergent will diverge & converge from certain regular meridians; enter and exit certain body
tissues: from
chest, abdomen, neck, face, & head.
a. Each diverge m. diverges from its regular (primary) meridian at a big joint area - knee / popliteal
fossa; shoulder; arm pit; hip; elbow.
b. Each Divergent m. enters abdomen or chest (6 foot into abdomen; 6 hand into chest) & connects
w/ its internal organ
c. Each divergent m. exits at neck, face, head or cheek (i.e. neck an above)
d. Each divergent m. converges at its related Yang meridian.
Yang divergents converge at their yang regular meridian
Yin divergents converge at its yang (superficial-internal related) primary meridian
2. Divergents will pass through HT organ (10 of them directly)
- HT is most important organ from the Nei Jing (this theory of divergent meridians is from Nei
Jing)
- KID is most important organ during the 11th c
- SP is most important organ during Ming dynasty (15th c)
3. Divergents supplement the distribution of the regular meridians - the areas that the 12 regular meridians
do not reach
4. Divergents emerge at neck regions; near or overlap at sky-window points
5. There are no points on divergent meridians divergent run deeper than regular
[i.e. ST-13 ST-30 is a branch of the ST meridian that runs deeper = Qi street]
B. Functions
1. Strengthen the connection between the pairs of yin and yang regular meridians (because yin divergent
connect with yang regular meridians).
2. The divergent pass through the HT organs so that the HT controls the whole body [HT is the storehouse of
the Mind] (from extremities inward) thru the flow of Ying & Wei Qi.
* Ying and Wei Qi are spiritual parts of Qi & Xue, while Qi & Xue
are substantial parts of Ying & Wei Qi.
* Ying and Wei Qi are carriers of Shen.
* Wei Qi syndromes will lead to dysfunction of the extremities (bu yong); while Ying Qi Xu will
cause
numbness/muscle weakness (bu ren)
3. 12 Divergents distribute wei qi to head & face (yang area) & protect body.
Allergies, wind invasions, etc: wei qi is congested: fighting of wei qi against pathogen

strong reaction (strong symptoms) shows strong fight!
4. Divergent integrate body tissues as a whole. joints HT face/sensory
C. Distribution (memorize points for test!) - Many books will have different descriptions -
Meridians Diverge Enter Exit Converge
(endpoint)
Foot Taiyang (UB) Popliteal fossa abdomen; KID & UB
UB-10
UB-40 organs; thru diaphragm & neck
(sky window)
Foot Shaoyin (KID) KID-10 enter HT organ
Foot Shaoyang (GB) Hip GB-30 abdomen; LIV & GB
Foot Jueyin (LIV) Inner leg LIV-5 organs; thru diaphragm & outer canthus GB-1
enter HT organ
Foot Yangming (ST) Lower abdomen ST-30 abdomen; SP & ST organs; UB-1 (ST)
Foot Taiyin (SP) Groin SP-12 thru diaphragm & enter HT mouth Tongue (#SP-
organ (indirectly) no point)
Hand Taiyang (SI) Shoulder SI-10 chest; HT & SI
face UB-1
Hand Shaoyin (HT) Armpit HT-1
Hand Shaoyang (SJ) Head DU-20 chest: PC & SJ
Retro-auricular SJ-16
Hand Jueyin (PC) Hypochondriac region (HT via PC)
region (sky window)
GB-22 or PC-1
Hand Yangming (LI) Shoulder LI-15 chest; LU & LI supraclavicular LI-18
Hand Taiyin (LU) Chest LU-1 not HT fossa ST-12 (sky window)
9

Use even method at the convergent points (end points) to regulate.
#
Exception! B/c the ST divergent doesnt converge on the ST meridian (BL instead), the SP divergent
doesnt/cannot converge w/ ST & stays on the SP meridian pathway instead (tongue).
Notes:
Divergents & wei qi connect HT/Shen with rest of body (smelling; sensation; vision; hearing
shen related)
Divergent meridians are pathway for Wei Qi; Wei Qi is carrier of shen
Windstroke; paraplegia; MS, etc. = blockage of Wei Qi
Sky-window points promote circulation of Wei Qi & help w/ stress; numbness; tingling of upper
extremities (brachio-plexus syndrome: cervical jia ji + sky window)
Wei Qi comes to surface in a.m. when you wake up and open eyes
(Yin qiao delivers to UB-1; Yang qiao, UB & SI primary + ST & HT divergents at UB-1)
Right side is digestive/respiratory; left side is emotional
II. Tendino-Muscular Meridians (T-M m.)

A. Characteristics
1. Pathways of the 12 T-M m. on the extremities are similar to the pathways of their related primary
meridians
2. The 12 T-M m. will start, bundle, distribute, and unite at certain places
a. They start from the terminals of extremities toes, fingers (mostly jing well points = toes/fingers;
exception is KID-1 on the sole of the foot)
b. Bundle (attach) at big joints (wrist/elbow/shoulder; ankle/knee/hip)
c. Distribute to superficial areas: never connect to internal organs
d. There are NO points on T-M m. (use acupressure, tuina, shiatsu, rolfing no acupuncture)
windstroke; flaccidity etc. best is physical work + massage
e. Unite at face/head & trunk
* All move in one direction towards the trunk (b/c of the heart)
* T-M m Theory is older than the 12 Regular Meridian Theory
B. Functions
1. To nourish muscle, tendon, & joints [pathways for energy flow to muscles; distributes nutrients to
soft tissues,
muscle, skin, ligaments] F(x) of Wei Qi:
1- Defense from epf
* Wei Qi flows betw/ the skin and muscles = Zhou
2- Warms body (Yang in nature)
Li 3- Opens/closes pores to maintain
2. To form first defensive layer of body (skin is actual first, then body temp.
T-M) 4- Fill in & nourish muscles
3. To extend & flex joints & to be in charge of movement of
extremities
* T-M m = external source of energy for the muscles
- Fibromyalgia: internal organs are fine, but T-M m are weak
Internal External
Jing: Essence Jing: ligament
Qi Gu: bone
Shen: Spirit Pi: skin
C. Symptoms & Treatment

1. Symptoms: Joint pain; arthritis; spasm; numbness of extremities; limitation of movement;
flaccidity; fibromyalgia, skin problems (herpes zoster/shingles, eczema,
psoriasis), etc.
Note: fibromyalgia (chronic fatigue) latent pathogen in T-M m area (zhou
li);
between muscle & skin shaoyang pivot
2. Treatment: Acupressure & Massage
D. Distribution (memorize!) 4 groups by hand/foot; yin/yang

T-M Meridians Start Bundle Distribute Unite
3 foot yang toes jing big joints: ankle; lateral aspect of lower cheek
ST, GB, UB well points knee; hip extremities; superficial area ST-3; SI-18
3 foot yin toes big joints: ankle; medial aspect of lower
SP, LIV, KID REN-3
knee; hip extremities; superficial area
fingers big joints: wrist; lateral aspect of upper
10
3 hand yang elbow; shoulder extremities; superficial area GB-13
LI, SI, SJ (lateral extensor of humeral temporal area
epicondyle: tennis elbow)
fingers big joints: wrist; medial aspect of upper
3 hand Yin elbow; shoulder extremities; superficial area GB-22
LU, HT, PC (medial flexor of humeral
epicondyle: miners elbow)
Note: to palpate abdomen, patient must have both hip & knee flexed: or abdomen T-M m will be too tight
11
Song Luo
Farooq Bin Mahfooz
Powerpoint by Dr. Luo 1

Basic principles of Acu-prescription & Selection
II. Point Selection

According to Meridian Theories
According to Point Theories
According to Special Point Theories

List of acu-points

Techniques & methods
+ or T Tonify
- or Sedate
or | Even / Regulating ( tonify sedate)
Moxa w/ cone
X Moxa w/ stick
Warming needle technique
Blood letting
Duration & frequency

Number of points selected
Odd # of needles:
Even # of needles:
Acute:
Chronic:
Styles
Japanese style uses fewer needles: 3-5
Chinese: many points
Korean: 4 needle technique
Traditional Chinese uses fewer needles

II. Point Selection
A. According to Meridian Theories
Go to specific / affected meridian or organ
Go to related meridians:
Internal/external
Mother-Son
Same name

B. According to Point Theories
Points selection principle local; distal; symptomatic points
Points association principle---local meridian; ext./int.(?);
---front/back; local/distal;
---left/right; upper/lower

C. According to Special Point Theories
Lower He-Sea
Bio-clock theory
Balance technique
Four Needle Technique

Lower He Sea Points of the 6 Fu (Yang) Organs
ST 36
Large Intestine SST37 -Yang Ming- Stomach ST36
UB 39 GB 34
Triple Heater UB39 -Shao Yang- Gall Bladder GB34
UB 40
Small Intestine ST39
ST 39 -Tai Yang- Urinary UB40
Bladder

Four Needle Technique:
Select Points
For Excess--LIV excess (wood)
1. Sedate its son point on its meridian LIV2-
AND its son point on the sons meridian HT-8-
2. Tonify its controlling point on its meridian LIV-4+
AND its controlling point on controlling meridian LU-8+
For Deficiency--LIV Xu (wood)

1. Tonify its mother point on its meridian LIV-8+
AND its mother point on the mothers meridian KID-10+
2. Sedate its controlling point on its meridian LIV-4-
AND its controlling point on controlling meridian LU-8-

Summarization
1- Son point from affected meridian
Sedate
2- Son point from son meridian
Four
needles
for Shi 3- Controlling (grandmother) point from the affected
meridian
Tonify
4- Controlling (grandmother) point from the controlling
meridian
1- Mother point from the affected meridian
Tonify
Four 2- Mother point from mother meridian
needles
for Xu 3- Controlling point (grandmother) from affected
meridian
Sedate
4- Controlling point (grandmother) from controlling
meridian
Course: Acupuncture Treatment of Disease 1 Date: September 29, 2008
Class #: 2
Today: four needle technique and how to select points with this theory. This is on the boards, in exit
exams, etc.
Basic principles of acu-prescription and selection
Composition of acu-formulas
In general, you acupoints should be inserted from Yang to Yin, so top to bottom, back first then front.
Some authors will vary.
Techniques and Methods

Notations on the right upper corner of the point on your charts.
+ or T Tonify Tonify deficiencies. Lift/thrust method, more force

and intent on the thrust. Inhale/exhale, more intent on
the inhale. Close the hole. Follow the meridian
Reduce/sedate Reducing or sedation is the opposite of tonification
methods
Even/regulate
Moxa w/ cone Moxa most related to Spleen and Liver. Dont use
with full heat, but can with deficient. Check the tongue
to makes sure the tongue doesnt show deficient body
fluids. Good for immunological disease. Can treat
hyperthyroid per Dr. Luo 6 points around Du 14.
Moxa w/ stick
Warm needle
Blood letting
(looks like a E-stim Know it before you treat with it! Never use with
lightning bolt) pacemaker patients or any other electro implants.
* Plum blossom
O Cupping Air, fire, bamboo, water cupping
|m| Point injection Allowed in some states, not all. Syringe used to inject
herbal into a prescribed point. Dan shen or huang qi
for instance. Not legal in Texas. Excellent result,
however and very strong. Side effects are severe
however hurts lots. Have to be sure you dont get an
artery or vein.

Page 1 of 10
Duration of point retention
Decided based on the patients condition. The longer the needles are retained the more it actually
weakens the patient. If you have a very weak patient, then you dont want to retain too long and
further deplete them. If on the other hand your patient comes in with an excess and you want to
sedate it you would leave the needles in longer to drain away more of the excess.
Other factors can affect the decision about how long to retain needles. For instance, if you
regularly practice medical qigong, bring that Qi into your treatment and channel it to your
patient, then you are slowing the rate at which Qi is depleted in the patient and can therefore
keep the needles in longer.
As a rule of thumb:
To reduce or sedate an excess keep the needles for a longer time.
To tonify, retain the needles a relatively shorter period of time.
How often should a patient visit?

This too is dependent upon the patients condition. You cannot needle too frequently or this too
will deplete the patient. (And dont needle someone 2ce in one day for sure!) As a general rule:
Acute conditions:
If patient has an acute problem, 2-3 times per week until the condition resolves.
Chronic conditions:
As a rule, 1 treatment every 2 weeks for a longer amount of time than for an acute
problem.
Number of needles
Hmmm. Thats a weird thing to talk about. Odd or even numbers of needles have meaning in
Chinese medicine. This is true in herbs too: formulas for acute conditions often have an odd
number of herbs while formulas for chronic conditions often contain even numbers.
Odd number of needles

Acute and Yang problems.
This is a habit in China. Odd numbers are thought to have a Yang nature.
The emperor is indicated by 9 dragons, the utmost Yang.
Example: acute loss of consciousness, can use just Du 26 and thats enough.
Even number of needles

Chronic conditions, to treat Yin and Blood. Deeper insertion too.
Example case-let:
16yo female patient comes in with an acute excessive disorder. What would you
choose?
1 odd number of needles, reducing, twice per week
2 odd number of needles, tonify, twice per week
3 even number of needles, reducing, twice per week
4 even number of needles, tonifying, twice per month.
Page 2 of 10
Examples of different acupuncture styles
Japanese style acupuncture uses fewer needles 3 to 5
Chinese uses more needles and tends towards balancing techniques
Korean techniques use a 4 needle technique
Tradition Chinese method uses as few needles as possible.
Point Selection
According to Meridian Theories

There are different principles for this.
1. Go to the specific or affected meridian or organ
Go directly to the affected problem.
Example: insomnia with heart fire, use the heart channel points, esp heart 8. To tonify heart,
use HT 7. Stomach defic or excess, use ST 36. Diarrhea/digestive, use ST 25
2. Go to the related meridians

Chosen by
i. Internal/external relationship
Example: Strong cough, chest pain, yellow sputum, red face, rough breathing.
Using internal/external selection, use LU 10 (strongest to clear heat), LI 11 (to clear
heat). This is an interior (LU 10) with exterior (LI 11) combination.
ii. Mother/son relationship

Use the same example above. This is a Lung meridian problem. This is an excess
problem, so you reduce the Son, thus youd reduce the Kidney/Water channel. Use
Kidney 10 to reduce or UB 66 to reduce the Kidney.
What if this was a deficient problem? Then youd tonify the Mother, the
Spleen/Stomach or Earth channel. That would be SP 3 or ST 36. This would reduce
the phlegm/damp in the body. This would treat the root.
Asthma example:
This is a winter disease, flaring up more regularly in the winter. Treat the root in the
summer by tonifying the Spleen. Could also reduce the Kidney in the Winter.
Kidney, Spleen, and Lung are all part of the asthma equation. Kidney is the root of
the breath and is the son in this relationship. The Lung is the organ affected. The
Spleen is the mother.
iii. Same name/channel

Example of asthma again: Lung is the affected organ. Thus you use the Lung Hand
Taiyin or the Spleen Foot Taiyin.
Example of insomnia: often is a Heart-Kidney disharmony. Both are Shaoyin

channels.

Page 3 of 10
According to Point Theories
Point Selection Principle
1. Local
Easy as pie choose points in the area local to the problem.
I have a toothache choose ST 6 or 7.
2. Distal
Use distal points to treat problems elsewhere.
Examples: Vertex headache associated with Liver heat is often treated with Liver 2 to reduce
the fire. Another example is appendicitis which is treated with dan nang xue, an extra point
below ST 36 in the distal area.
You can also combine them with local points. In the toothache example above in the Local
point selection principle, ST 6 is associated with LI 4, the command point of face and mouth.
Combinations of distal with local is common in clinic.
Yaotong on the wrist can be used for lumbar pain.
3. Symptomatic
Treat the symptom. Yaotong for the lumbar pain for example. Or Dan nang xue for
appendicitis.
Points association principle

1. Local meridian.
Choose points on the meridian associated with the organ having problems. Stomach channel
for stomach problems for example.
a. External/internal associated meridians.
Refers to the host-guest or Yuan/Luo connection.
Cough for example is a lung problem. The external meridian associated with this is the
Large Intestine. The internal is the Lung.
Lung channel has LU 9 for the Yuan and LU 7 as the Luo. LI channel has LI 4 for the
Yuan and LI 6 for the Luo.
Lets say the patient starts with a cough and later has constipation. Youd choose the
Yuan for the first affected organ (Lung) and thus would choose LU 9. Then couple that
with the Luo on the 2nd affected organ/channel, LI 6. Why would this happen? Because
Lung Qi cannot perform dispersing of water function, causing water deficiency in the LI
and thus constipation.
Another person has constipation as the primary complaint. Theyve had it a long time.
Now they develop a cough. Use the Yuan point on the LI (LI4) and the Luo on the Lung
(LU7). You do something similar with herbs: you can promote bowel activity to stop a
cough or tonify the Lung to promote bowel activity!

Page 4 of 10
2. Front/Back
Front Mu points and Back Shu points to treat problems. You can treat problems from both
perspectives. Example: gallbladder pain, some diarrhea, could use GB 24 (front mu of GB),
UB 19 (back shu of GB) to treat. Very simple and effective treatment.
a. Distal and local is part of the front/back association. Just talked about that. Swollen and
red eye problem for instance, could be treated locally with UB 1 or 2 (if UB 1 is too
scary!) while distally using Liver 2.
3. Left/right
Bells Palsy and paralysis for instance, you treat from opposite/contralateral side. Neijing
calls this ju ci or contralateral treatment. Often used with distal points.
a. Upper and lower.
Four gates is a common example. Treating both upper and lower at the same time.
According to Special Point Theories
Lower He-Sea Points

The Six Yang organs have special He Sea points on the lower limbs.
Organ LHS Channel Organ LHS

LI ST 37 Yang Ming ST ST 36
SJ UB 39 Shao Yang GB GB 34
SI ST39 Taiyang UB UB 40
Bioclock Theory
Can be very complex or very simple, depending on how you approach it. The theory says
different organs have different times of day:
GB = 23 1am
LV = 1 3 am
LU = 3 5 am
LI = 5 7am
ST = 7am 9am
SP = 9am 11am
Ht = 11am 1pm
SI = 1pm 3pm
UB = 3pm 5pm
Ki = 5pm 7pm
Pc = 7pm 9pm
SJ = 9pm 11pm
You can treat according to time Liver excess for example you could reduce during the hours
which affect the Son or Heart. If you combine this with the other flavors of treatment covered
the result is powerful. Of course, you probably wont be treating this way unless you happen to
be in a hospital settingand in the US, thats going to require a major culture shift!
Balance Technique
Very similar to left/right balance. Most of the time you use bilateral treatment (both sides).
Page 5 of 10
Four needle Technique
You would use this technique if the routine treatment just isnt fixing the problem. This
treatment type is for organ disorders, not for meridian disorders.
Use the 5 element chart to determine your points.

Remember that Yang meridian controls the yin meridian.
Diagnosis: determine the location or organ and the property deficient or excess.
Principle of treatment is as follows:
Excesses
Sedate or reduce the son element and tonify the controlling element
Example: reduce the son (fire or Heart) for a Liver or Wood excess. If that doesnt work
you can add in tonification on the control or Metal/Lung element.
Deficiencies
Tonify the mother element or sedate/reduce the controlling element
Example: Liver deficiency would call for tonifying mother/water/Kidney or sedating the
control element of metal. (The control element is also referred to as Ko or Grandmother)

Page 6 of 10
How you select the points
Excesses:
The principle is sedate/reduce excesses.
1. Sedate
a. Sedate son on its own meridian
b. Sedate the son point on the son meridian
2. Tonify
a. Tonify the controlling point on its own meridian
b. Tonify controlling point on the controlling meridian
Deficiencies:
The principle is tonify deficiencies.
1. Tonify
a. Tonify the mother point on its own meridian
b. Tonify the mother point on the mother meridian
2. Sedate
a. Sedate the control point on its own meridian
b. Sedate the control point on the controlling meridian
Case Study-ette 1
Spleen Deficiency/earth:
Tonify the mother on its own meridian: earth is SP 3, so mother is SP 2

Tonify the mother point on the mother meridian: mother of earth is fire. Earth point on the fire
meridian is heart 7, so mother is HT 8
Sedate control point on its own meridian: SP 1
Control point on control meridian: LV 1
Case Study-ette 2
LI excess heat
Sedate the son on its own meridian: LI 2

Sedate the son point on the son meridian: UB 66
Tonify controlling point on its own meridian: LI 5
Tonify the controlling point on the control meridian: SI 5
Homework: 4 needle technique for KI Xu

Page 7 of 10
HOMEWORK
Kidney Xu 4 needle technique:
Deficiencies:
The principle is tonify deficiencies.
1. Tonify
a. Tonify the mother point on its own meridian
b. Tonify the mother point on the mother meridian
2. Sedate
a. Sedate the control point on its own meridian
b. Sedate the control point on the controlling meridian
1. Tonify the KI 7 point and the LU 8 point

2. Sedate the KI 3 point and the SP 3 point

Page 8 of 10
Case Study 1
Zhang, female, age 60
Chief Complaint: Lower back pain for 1 year

Pertinent history:
Fatigue, ringing in the ears, hot flashes, night sweating and palm heat. Digestive disorder with gas and
bloating, poor appetite and aversion to meat. She feels full in the abdomen and has a greasy taste in her
mouth.
Tongue: Her tongue is pale and swollen and the coating is thick and greasy.
Pulse: thin and fast, weak in rear positions
Shed prefer an herbal treatment
1. What is your differential diagnosis for this case?

a. Spleen and Kidney Qi xu with damp retention
b. Kidney yang xu with Spleen Qi xu
c. Kidney yin xu with dampness in spleen
d. Middle Jiao disorder with Kidney essence xu
2. What is the therapeutic principle?

a. Warm Kidney yang and tonify the Spleen Qi
b. Nourish Kidney Yin and remove dampness
c. Regulate middle jiao and strengthen Kidney essence
d. Tonify Kidney and Spleen Qi and remove dampness
3. What is the strategic plan for this case?

a. Apply Kidney yin tonics and ignore the dampness
b. Tonify Spleen and Kidney Qi and warm Kidney yang
c. Nourish Kidney essence and regulate middle jiao
d. Strengthen Spleen and remove dampness first then nourish Kidney yin secondarily
What points might you choose?
Answers: 1 = c, 2 = b, 3 = d
Points: KI 3 (tonify KI), GB 34 (stimulate GB and help with digestion of fats/meats, relax sinews to help
with lower back pain), GB 39 (boost marrow), ST 36 (tonify spleen/digestion), SP 6 (both kidney and
spleen tonification), Ren 12 (help digestion). You could also use UB 23, yaoyin and jaiji points for the
lower back pain.

Page 9 of 10
Case Study 2
Wang, 30yo male.
Chief complaint: Stomach ache
Pertinent history:
Patient has an irregular diet. Distention in epigastric area, burning pain and aversion to touch. Belching
with a sour odor. Constipation, aversion to food.
Tongue: red with a thick and curdy coating
Pulse: slippery, wiry, forceful.
1. What is the pattern differentiation for this case?

a. Retention of heat and phlegm in the middle warmer
b. Food stagnation with accumulation of stomach heat
c. Spleen deficiency with empty heat in stomach
d. Stomach excessive heat and fire with yin xu
2. Which of the following groups of points would be appropriate to this patient?

a. HT 7 (shenmen), P 7 (dahling), Du 26 (renzhong), Du 20 (Baihui)
b. Ren 17 (tanzhong), Lu 7 (lieque), Kid 6 (zaohai), SI 3 (houxi)
c. ST 36 (zusanli), Ren 12 (zhongwan), P 6 (neiguan), ST 25 (tianshu)
d. GB 34 (yanglingquan), GB 40 (qiuxu), SP 4 (gongsun)
Answers: 1 = B, 2 = C

Page 10 of 10
Course: Acupuncture Treatment of Disease 1 Date: Oct 6, 2008
Class #: 3
Quiz 1 next week

Case discussions + dx/tx/point selection
Re 4 needle: mother point on the mother meridian would be something like metal point on the metal
meridian.
For this lecture, see the first class handout starting at page 9.
Divergent and Tendino-Muscular Meridians (T-M m)

Divergent Meridians
There are 12 divergent meridians which diverge and converge from the main channels. They enter and
exit certain body tissues.
Characteristics of the pathways

1) Diverge, enter, exit and converge are the key words in divergent channels. They diverge and
converge to the regular/primary meridians whether they are yin or yang. They also finally combine
with a primary channel, specifically, the Yang channel of the pair. (I.e., Lung will converge with LI
primary, LI converges with LI primary)
(i) They diverge from large joints such as hips, knees, popliteal fossas, shoulders, armpits,
elbows.
(ii) They enter abdomen or chest and connects with its internal organs.
(iii)They exit at the neck, face, head or cheek.
(iv) They converge with related Yang meridians.

Yangs diverge from and converge with the primary Yang meridian.
Yins diverge from the Yin primary and converge with the paired Yang primary.
2) Divergents pass through the Heart Organ. Ten of them do this directly.
Divergents transform Ying and Wei Qi to nourish other organs.
i) Go through directly
This is true of the St, Heart, SI, UB, GB meridians.
ii) Go through heart indirectly

This is true of Kidney, which meets heart at the root of tongue, and also of LV/GB, and SP
iii) Indirectly through the PC/SJ channels in the chest
Note: Different dynasties and time periods have emphasized different organs as the most
important for the divergent meridians.
Acupuncture Treatment of Disease 1 Fall 2008
Page 1 of 9
(1) Heart was deemed the most important from the Nei Jings theory of divergent meridians.
(2) Spleen was the emphasized organ during the Mind dynasty (15th century)
(3) Kidney got the highest importantce in the 11th century
3) Divergents supplement distribution of the regular meridians and reach areas that the 12 primaries do
not reach.
4) Divergents emerge at neck regions, near or overlapping with the window of sky points.
There are 10 window of sky points, 8 of which are on the neck. One is on the arm, one on the trunk,
two on the back of the head. Allergies are related to wei qi and the outside world, so you can use
window of sky points for this. Because the divergent channels flow thru here it helps the wei qi to
transform.
5) No points on the divergent meridians because they run deeper than the regular meridians because
they reach the internal organs. (I remember Dr. Wu talking about the Qi street during our Wild
Goose Qigong class and describing it running down from ST 12 to ST 30, but more deeply than
that.)
Functions
1) Strengthen the connection between the pairs of Yin and Yang primary meridians because the yin
divergents connect with the yang primaries.
2) The divergents are closely related to Ying (nutritive) and Wei (protective) qi.
Because divergent pathways are connected to and pass through the Heart organ, they control the
whole body through the flow of Ying and Wei Qi. Divergent meridians are the carriers of Wei Qi.
Wei Qi is the carrier of Shen, connecting the whole body including the senses of smell, tactile
sensation, vision and hearing, all of which are Shen related.
Windstroke, paraplegia, MS, etc, all of which affect the senses and motor functions are a result of
the blockage of Wei Qi. Window of sky points promote the circulation of Wei Qi and help alleviate
stress, treat numbness and tingling of the upper extremities. (Note: numbness/tingling of the upper
limbs is called brachio-plexus syndrome and can be treated with the cervical jiaji points + window of
sky points.)
A couple of bullet points to emphasize the above:
a) Ying and Wei Qi are the spiritual parts of Qi (Energy) and Xue (Blood) while Qi and Xue are the
substantial parts of Ying and Wei Qi.
b) Ying and Wei Qi are the carriers of Shen. Because all of these divergents are closely in contact
with the Heart, and the Heart is the storehouse of the Mind, they are then the carriers of Shen.
c) Wei Qi syndromes will lead to the dysfunction of the extremities. Why? Because the divergents
flow from the extremities to the heart. This is called bu yong. Ying Qi deficiency will cause
numbness and muscle weakness for the same reason. This called bu ren.

Page 2 of 9
Ying and Wei should be balanced for there to be health, both mental and physical. The inside of
the body has more blood accumulated, so there is more Ying and less Wei. On the superficial
areas, divergent is very shallow, so there is less Ying, but more Wei. Qi gets stronger at the
superficial areas and thinner areas of skin. On the head where the skin is thin and there is less
deep tissue, for instance, there is more Wei than Ying.
If the Wei Qi is strong, Qi in general is strong. If the The function of Wei Qi is to:
Wei Qi is strong you dont have to stimulate with 1. Form a defensive layer
acupuncture very deeply at all. Bells Palsy for 2. Warm the body, as it is
instance, needle just deep enough to stand up. This is Yang in nature
enough stimulate Wei Qi. Same for treatment of 3. Open and close the pores
common cold and allergies. to maintain body
temperature
Shallow stimulation in shallow areas, deeper in 4. Fill in and nourish the
deeper areas. muscles
d) Wei qi comes to the surface in the morning when you

wake and open your eyes.
e) The right side of the bodys divergent meridians are digestive/respiratory in nature while the left
side are emotional.
3) The 12 divergent meridians distribute wei qi to the head and face, yang areas. They also protect the
body from allergies, wind invasions and the like. If one suffers from allergies or wind invasions, this
is an indication that the wei qi is blocked or congested.
By similar token, if there is a strong reaction to a pathogen, this shows that the wei qi is healthy
enough and flowing freely enough to put up a very respectable fight!
4) Divergent meridians integrate the body tissues as a whole, flowing from the joints to the Heart and to
the face and sensory organs.
Example of all of the above:

Lung Divergent Channel
Diverges from the Lung primary channel at axilla and passes anterior to the Heart channel in the
chst. It connects with the Lung organ and disperses in the LI. A branch ascends from the Lung,
emerging at the supraclavicular fossa, ascending across the throat and converges with the LI
primary channel.
LI Divergent Channel separates from the LI primary channel on the hand and ascends the arm to
the shoulder at the LI 15. It travels medially to the spinal column then crosses to the
supraclavicular fossa and descends to the thorax, breast, Lung and Large Intestine. A branch
ascends to the supraclav fossa along the throat and unites with the LI primary channel.
Review the divergent in the Deadman material.

Page 3 of 9
Distribution
Know this chart! Know the process for divergents too. All of this is board-focused and will be on our
tests both for this class and the boards!
Meridians Divergent Enters Exit Converge/end1
** Popliteal fossa Abkid and UB Neck UB 10
Foot Taiyan UB UB 40 organsthru window of sky2
Foot Shaoyin KI Ki 10 diaphragm and
enter heart organ
Foot Shaoyang GB Hip GB 30 Abdomenliver Outer GB 1
Foot Jueyin LV Inner leg - LV 5 and gb organs canthus
thru diaphragm and
enter HT organ
Foot Yangming ST Lower ab ST 30 Abdomensp and Mouth Stomach: UB 1
Foot Taiyin - SP Groin SP 12 st organsthru Tongue: SP( no
diaphragmenter point associated
heart organ with this one)3
indirectly
Hang Taiyang SI Shoulder SI 10 Chest: HT and SI Face UB 1
Hand Shaoyin - HT Armpit HT 1
Hand Shaoyang SJ Head Du 20 Chest: PC and SJ. Retro- SJ 16
Hand Jueyin - PC Hypochondriac Connects to heart auricular window of sky
region - GB 22 or via PC region
PC1
** Chest: Supraclav LI 18
Hand Yangming LI Shoulder LI 15 LU and LI, not fossa window of sky
Hand Taiyin - LU Chest LU 1 Heart ST 12
1
Use even methods at the convergent/end points of the divergent channels in order to regulate them.
2
Window of Sky points promote circulation of Wei Qi and help with stress, numbness, tingling of upper
extremities (brachio-plexus syndrome: cervical jia ji and window of sky points).
3
Exception: Because the stomach divergent doesnt converge on the Stomach meridian, but converges at
the Bladder meridian, the Spleen divergent does not and cannot converge with the Stomach and stays on
the Spleen meridian pathway instead, ending at the tongue.

Page 4 of 9
TendinoMuscular Meridians
Sinew channel distribution, using the Lung sinew channel as an example:
Originates the thumb at LU 11 and ascends to bind at the thenar eminence. Follows the radial pulse and
ascends to the flexor aspect of the forearm and binds again at the center of the elbow. Continues along
anter-lateral aspect of the upper arm to enter chest below axilla, emerges in the region of ST 12 and
laterally to shoulder, anterior to LI 15. To supraclav region and descends into the chest. Spreads over the
diaphragm and converges around the floating rib.
Generally, begins distally then concentrates to the trunk. During this process combines with the joints.
Can thus use this theory to treat Bi syndrome, which often affects the joints.
Characteristics
Start, bundle, distribute and unite are the key words for Tendino-muscular theory.
All T-M m meridians start at the terminals of the extremities and move toward the trunk of the body
(because of the heart). The theory of the Tendino-Muscular meridians is far older than the theory
outlining the 12 primary meridians.
1) Pathways of the 12 meridians are similar to the primary meridians
2) They start, bundle, distribute and unite at certain places.

a) Start at the terminus of the extremities
All of them, except for Kidney 1 on the sole of the foot, start at jing well points.
b) They bundle or attach at the big joints

Wrist, elbows, shoulders on the upper body and ankle, knee, and hip on the lower extremities.
c) They distribute to superficial organs, never connecting to internal organs.

Even if they go to the chest, they are still superficial, not deep.
d) There are no points on the sinew channels.

You use acupressure, tuina, shiatsu, rolfing, etc, but no acupuncture. Windstroke, flaccidity, etc
respond best to physical work and massage.
e) Unite at the face, head and trunk.
Functions
1) Nourish the muscles, tendons and joints.
These are pathways for energy flow to the muscles, distribute nutrients to the soft tissues, skin and
ligaments.
Remember that Wei Qi flows between the skin and muscles (Zhou Li). This is the theory in use
when we hold the arms out and pull in the energy from the universe in Medical Qigong.
The function of Wei Qi is to 1) form a defense, 2) warm the body as it is Yang in nature, 3) open and

Page 5 of 9
close the pores to maintain body temperature, and the 4) fill in and nourish the muscles.
2) The T-M m form the second defensive layer of the bodythe skin is the first layer.
3) Extends and flexes the joints to be in control of muscle movement of extremities.

The T-M m is the external source of energy for the muscles
Fibromyalgia is a disease in which the Internal External

internal organs are fine, but the Jing: Essence Jing: ligament
tendino-muscular structures are Qi Gu: bone
affected. Fibromyalgia + chronic Shen: spirit Pi: skin
fatigue is a latent pathogen in the T-M
m area (zhou li) between the muscle and skin layers. Shaoyang pivot.
Symptoms and Treatment

1) Symptoms
Joint pain, arthritis, spasms, numbness of extremities, limitation of movement, flaccidity,
fibromyalgia (see note above), skin problems such as herpes zoster, eczema, or psoriasis, and so
forth.
2) Treatment: acupressure and massage.
3) Other treatment recommends by Dr. Luo:
i) In cases of excess: reduce high frequency e-stim, bleeding, needle with reducing
techniques.
ii) If is a case of deficiency: tonify either with mild e-stim, needling with tonification.
Note: to palpate abdomen during physical exam, patient may need to flex both hip and knee or the
abdominal tendino-muscular meridian may be too tight.
Might ask areas or points that are tender GB 22 is in the 4th intercostal space.
Distribution
Notes say to memorize this too.

Page 6 of 9
Key point to all of this is keep it superficial.
Depths of the body from most superficial to deepest (well, the physical stuff anyhow. Some theories of
existence say that we have several energetic bodies before they get concentrated enough to be detected
by our senses):
Skin area is the most superficial areas of the body. This belongs to the collateral/Luo channels.
Minute luo/collateral channels. There are countless numbers of these. And thats the first time
Ive ever heard of that!
Sinew
Jing main channels
Divergent channels
Fu organs
Zang organs
Extraordinary channels/vessels overlay the main channels. Some theories say that they are deeper than
the main meridians, however.
How many countable meridians in the body?

Grand total of 71. See the Foundations II lecture, class 6. Pages 4-5.
Case Discussions
Zhang, a 42yo male comes in with the chief complaint of irritability

He has been suffering from irritability for about 2 weeks and has a bitter taste in his mouth, thirst with
desire for drink, tossing and turning. He has severe headache in the temple area with burning pain in the
hypochondriac region, constipation, hot and yellow urine which burns. His tongue is red, redder on the
sides. His pulse is very wiry on both sides.
1) Diagnosis?
a) Excessive heat in stomach organ
b) Yang excess if the large intestine
c) Hyperactivity in liver organ.
d) Heart excessive fire.
2) What are the points you would use if you chose 4 needle technique?
a) Tonify LV 4 and LU 8; sedate LV 2 and HT 8
b) Tonify LV 3 and SP 4; sedate LV 5 and HT 7
c) Sedate SP 3 and LV 2; tonify Ht 8 and LU 9
d) Sedate LV 4 and HT 8; tonify K 10 and LV 8
Zhao, a 76 yo male suffers from lower back pain for over 5 years. He has frequent urination for the same
period of time. He often feels tired and has a poor appetite. He has had a common cold for 2 days with
less sweating, slight aversion to wind and cold. His pulse is superficial but weak.
1) What is the diagnosis?

a) Heart and LU Yin xu with W/C invasion

Page 7 of 9
b) Ki and LU Qi xu with cold invasion
c) SP and KI Qi xu with wind/cold invasion
d) Kidney Yang xu with cold invasion
2) What is the treatment principle?

a) Nourish heat and Lung yin and remove wind-cold pathogens
3) What group of points?

a) HT 7, LU 9, SP 6, BL 15, BL 13, GB 20, BL 12
b) LU 9, KI 3, BL23, LU 7, LI 4, BL 12, SJ 17
c) ST 36, LI 10, BL 12, GB 20, BL 20, BL 23
d) Ren 4, Ren 6, BL 23, DU 4, BL 12, GB 20

Page 8 of 9
Quiz 1 exam:
40 questions. 6 cases in it. Must be able to analyze, just like the case studies he gave in the
lectures thus far. Be able to rule out what doesnt fit if you dont know the answer right away.
Know 4 needle techniqueknow the chart on your own!!!
Know yin/yang and symptoms
Know stages of disease beginning and end especially.
Know front mu/back shu know em! Review them all. Know lower he sea, too. Basically, if its
in the lecture, cover it.
Know the charts in this lecture. Know origination, convergence especially. Know the nature of
the two theories. Which has points/not, which is superficial/deep, what are the distribution chars
Know all of the cases and discussions so far!!! He emphasized this.

Page 9 of 9
Course: Acupuncture Treatment of Disease I Date: October 13, 2008
Class #: 4
Quiz this afternoon, missed 2 out of 40.
Today on the hit parade: Farooq Bin Mahfooz

Allergic Rhinitis, asthma, common cold, Epistaxis, pharyngitis, tonsillitis, tinnitus and deafness all fall
into this category.
Respiratory System Overview
Intro and Biomedicine Overview

In western diagnosis these are predominantly problems of the lungs. It is helpful to understand heart and
lung circulation from a biomedical standpoint in order to understand how this works together. Lung and
heart problems are often linked. Cardiopulmonary diseases are predominant in America. Smoking, for
example, will cause small vessels in the lung to harden, increasing pulmonary circulatory pressure. The
right side of the heart then gets larger and larger with the fluid/blood backup causing right sided heart
failure.
TCMs Take on the Respiratory System

In TCM the understanding is very different. The Neijing calls it the highest organ or the coach roof.
When an external evil attacks, this is generally the first organ attacked. From foundations we learned
that the most important function of Lung is to govern the Qi, including the Wei/protective Qi. Another
important function is ascending and dispersing. This too relates to the Wei qi being dispersed. When the
Lung cannot descend the Qi the result is cough.
Sidebar: when you wake up do you inhale first or exhale first? This is sort of Chinese what
came first the chicken or the egg but in this case there is an answer. The answer is inhale. Thats
why often you start w/ a yawn!
The Lung includes the organ as well as the whole system (nose to bronchioles) and the Lung meridian.
Fun facts about Lung Qi and the Lung meridian:
Originates at the Middle Jiao in the neighborhood of Ren 12. The energy of the Lung (or Lung
Qi) comes from the Spleen and Stomach, with the Spleen being the Mother of the Lung.
The meridian runs through the cardiac orifice through the diaphragm, down the arm to the corner
of the thumbnail.
Lung Qi ascends when you exhale and descends when you inhale
The descending function of Lung Qi is more important than the ascending and dispersing. Why?
Here are some reasons:
o Bronchitis occurs when the Lung Qi cannot descend properly
o Coughing is the result of rebellious Lung Qi.
But back to that dispersing thing. Lung Qi does disperse, which is still important, and travels to
the sides of the chest.
Lung is in the upper jiao (though it originates in the middle) and relative to the other organs it is
situated at the highest position. This is why, as stated above, it is exposed first whether directly
or indirectly and is the first affected by external pathogenic factors.
Page 1 of 10
Lung disperses moisture to the skin and opens to the nose. Dry skin and nasal congestion or
stuffiness are a lung problem.
Autumn is the season associated with the Lung and with metal. Note that autumn is a dry season
and the Lung is susceptible to attacks by dryness.
The 3 stages of Lung Disease

The whole shebang in a nutshell. Know this!!!
1. Rebellious Qi acute
Examples are asthma, bronchitis, and cough. Qi cannot descend and instead ascends
manifesting in cough and wheeze. This is an early stage of Lung disease.
2. Distention of the Lung Qi

This is a stagnation of Qi in the Lung.
An example is emphysema with a barrel chest which causes shallow breathing. In Chinese
this is called fei zhang and is a common Chinese diagnosis. Youll need to know this for
herbal treatments later on. This is of concern in acupuncture the lung is expanded and
pneumothorax is a higher likely. St 12, Liv 14, all the thoracic points are more dangerous
now.
3. Xue level
The previous 2 levels were Qi related. Not this one. Weve now progressed to edema, purple
or dark face, purple finger nails, purple swollen tongue late stage pulmonary heart disease
in which blood stasis is blocking the heart. The oxygen cannot be exchanged and causes
those purple symptoms. Relate this to pulmonary hypertension the lung cant the get the
blood thru the circulation and causes right sided heart failure due to blood backflow from
lung to heart.
Generally speaking Lung disease begins at the Qi level and progresses to the Blood level when it affects
the heart. You can equate this with the progression from Lung disease to Heart disease.

Page 2 of 10
Bi Qiu Allergic Rhinitis
Bi Qiu sounds like a sneezewhich is kind of what it is! Bi translates to nose while qiu is the
sound of sneezing in the Chinese language.
Pointless information bonus box!
This translation of sound into word is called onomatopoeia.
Bi qiu not only sounds like a sneeze, but also sounds like
Bijou as in The Bijou Theater which is where I saw 5th rate
movies such as The Legend of Boggy Creek when I was growing
up in Podunk Nowhere, Texas.
Things to know about Allergic Rhinitis for Acupuncture Treatment of Disease:

Where does wind invade the body
Mechanism for bi qiu
Basic points
Differential diagnosis/treatment
Ben or biao superficial symptom or the root
Biomedical overview of Allergic Rhinitis

In biomedicine you will find that there are an awful lot of people about 27 million in the US that
suffer from allergic rhinitis in the US. Allergic rhinitis is inflammation and swelling of the mucous
membranes of the nasal passages caused by exposure to airborne substances.
Environmental triggers including dust, mold, pollen, grasses, trees and animal dander/hair can cause it.
There is initial contact with an allergen such as pollen which sensitizes the immune system and
antibodies (IgE) which binds to the surface of the mast cells. When re-exposed the allergen binds and
cross links with IgE molecules on the surface of the mast cells under the mucosal surface. This causes
release of mediators including histamine which turns on the water works to flush out the bad guysand
then the snot and wateriness begin. Yippee. The symptoms that result are sneezing, runny nose,
stuffiness, itchiness of the throat, nose, eyes, etc, and watery eyes.
Diagnosis is made by having a family history and review of symptoms. Treatment includes
recommending avoidance, corticosteroid spray and antihistamines.
Note that there can be 2 types: 1) seasonal, 2) perennial. Seasonal types may be preventable, but
perennial are more difficult. This is pertinent in clinic so you treat superficial sx or the root? Treat em
both at the same timehmmm. Lets move on to the lecture to find out.

Page 3 of 10
TCM Etiology and Mechanism for Allergic Rhinitis
KNOW THIS DEFINITION!
Definition of allergies in TCM:
The fighting of Wei Qi with external pathogenic Wind
The upshot of this is that the fighting between the Wei Qi and the external pathogenic Wind causes the
local Wei Qi to get congested or stuck resulting in the allergies.
So why is this a Wind thing?

Heres some justification about that.
Seasonal allergies are usually at their worst in the Spring when wind is predominant.
o Wind-cold is generally the first sign of cedar allegies.
o Wind-heat is generally indicative of an oak allergy and often occurs in March or April
(when the live oak trees pollenate in Central Texas).
Location of wind allergies in the body: head and face.

Remember that anything from the chest up is a wind area.
They attack at the wind orifices

More on this in the Where does wind invade the body section below.
Symptoms have wind-like qualities:

o Sudden onset like wind
o Itching which is also wind-like:
Itchy eyes
Itchy nose
Itchy throat
Itchy ears
Itchy skin i.e. allergic dermatitis
In western medicine wind is the carrier of pathogensthey just call it air-borne pathogens.
Where does wind invade the body?
At the Wind points/orifices, which are open to the outside and are therefore susceptible to
Wind
o GB 20, a major point to treat windand for wind to invade.
o BL 12, the wind gate
o BL 13, the back shu of the Lung
o SJ 17, treating ear/facial problems and expelling wind.
Page 4 of 10
o DU 16, expelling wind and opening the mind.
At the skin.
The pores of the skin open to the deeper tissues of the body
At the Five Sense Organs and Orifices

o Nose
Opens to the Lungs and is a direct connect to the world.
o Eyes
Open to the Liver which itself is a wind related and wind affected organ.
o Ears
Open to the Kidneys and are also affected by wind.
o Mouth
This one not only allows pathogens in from the air (especially for you mouth
breathersyou know who you are!), but also in the form of food allergies.
Food allergies are also considered to be wind related because the symptoms are
similar to airborne allergies.
Fun things to know about food allergies:

The best formula for food allergies is Tong Xie Yao Feng. The main
ingredient in this formula is Fang Feng, an herb with not one, not two, but
four wind expelling functions. Hmmm!
When a person has a food allergy they will also often have a hot ear auricle.
(Not always true allow for anatomical variation offer not valid in Hawaii
void where prohibited)
Food allergy symptoms often include skin itching, swelling, diarrhea, upset
stomach.
Spleen, Lung and Kidney are still the organs related to food allergies.
What organs and energies are related to Allergic Rhinitis and Wind?
Lung.
Lung is the center for allergies either affecting the Lung organ or the Lung system.
o Allergic Rhinitis affects the Lung Channel and the Nose
o Allergic Dermatitis affects the Lung Channel and therefore the Skin.
o Food allergies affect the Large Intestine which is the paired organ for the what? The
Lung! Exactly.
Wei Qi.
Local Wei Qi congestion with general Wei Qi Deficiency.
o WTF? Yeah thats a little confusing. OK, the pathogens and the Wei Qi are fighting
in a local area Wei Qi congestion. But overall deficiency. Its kinda like waging a
war and then sending all of your fighting forces to one area leaving yourself wide
open for attack. Hmmm. I may have just described our current involvement in the
Middle East.
Page 5 of 10
o This is considered to be a Wei Qi disorder. You treat it by regulating and harmonizing
the Wei Qi, not just tonifying it. Why? You do want to build up the forces, but you
also have to readjust the troops to be sure all of your borders have good defenses. Got
it? Good. Enough with the army chat.
Disorder of the Wei Qi System is a disorder of the Lung, Spleen, and Kidney!
o Spleen
Food Qi comes from the Spleen and feeds the Wei Qi and Ying Qi. The Spleen is thus
the basis of Lung Qi since it generates Qi and provides it to the Lung first. In turn the
Lung passes Qi to the Kidney.
Remember the Generation Cycle diagram from Foundations? Spleen, the earth
element, is the Mother of the Lung (metal element), which is then the Mother of the
Kidney. And so goes the world.
The upshot of this is that if you wish to regulate and harmonize the Wei Qi, you do it
through the Lung, the Spleen and the Kidney. A terrific formula for this is Si Jun Zi
Tang.
o Kidney
This roots the Wei Qi system
Allergies versus a Common Cold

Common cold has more generalized symptoms
o Headaches
o Body aches
o Chills and fever
o More Wei and Ying Qi disorder
If Wei Qi is less than Ying Qi symptoms will include sweating spontaneously and
chills because the Wei Qi is insufficient to warm the body.
If Ying Qi is less than Wei Qi the Yin will be damaged and you might see dry
skin and other Yin deficiency symptoms.
Allergies have more localized symptoms in the area of the 5 sense organs where the Wei qi is
stuck or congested. There is a notable absence of the chills and fever that comes with a common
cold.
Both have symptoms in the head and face, and in both Wei qi is affected.
Etiology and Mechanism

Allergies are due to invasion of external pathogens
This causes congestion of Qi in the area affected as discussed above.
o Wind:
This includes dust mites, animal dander and food allergies. Basically, airborne pathogens.
Wind is of neutral temperature, neither hot nor cold.

Page 6 of 10
Symptoms: sneezing, runny nose, etc.
o Wind/Cold:
This is Cedar Fever, occurring in November and December when the plant pollinates.
o Wind/Heat:
Oak allergies occurring in March and April during pollination. Spring is a Yang season.
Symptoms include nasal bleeding and other wind/heat signs.
o Wind/Damp
Triggers are mold accompanying humidity and rain.
Allergies can also result from an irregular diet.

This causes a Wei Qi deficiency.
o Excess consumption of dairy leads to a weakened Spleen. Weak Spleen then cannot
supply the Lung with enough Qi to generate a respectable amount of Wei Qi and thus
compromised ability to fight off pathogens.
o Food allergies also fall into this category. As previously stated, if food allergies are
affecting a patient they can have a hot and red ear auricle.
Overworking and Emotions

This causes a Wei Qi deficiency as the resources are depleted. Emotions cause the disruption of
the flow of Wei Qi leading to allergies. For more information on how the 7 emotions affect the
body and the Qi, see Dr. Wus lecture from Foundations 2, Class 7. Start at page 4 at the
Disorders of Seven Emotions heading.
Congenital Causes
If both the mother or father is affected by allergies, there is a 65% chance kids will be too. If
both parents have allergies the chance for the offspring jumps to 85%.
Mechanism of Allergies
Know this!
Local Wei Qi congestion with general Wei Qi deficiency
We touched on this on page 5 near the bottom of the page. Theres a certain amount of Wei Qi in your
body at any given time. When allergens attack you the Wei Qi goes to fend off the attack and congests
during the battle. Theres your local Wei Qi congestion.
This leaves other areas un-defended and theres your general Wei Qi deficiency.

Page 7 of 10
TCM Treatment Principles and Differential Diagnosis for Allergic Rhinitis
There are general principles to bear in mind.

1. Treat the symptoms when the condition is acute.
The symptoms are considered the excess: the Shi/excess. Alleviate congestion by regulating
the Wei Qi during the acute phase.
2. Treat the root when the condition is not acute.

The underlying cause or root is a deficiency of Wei Qi: the Xu/deficiency.
Tonify the Wei Qi when during the quiescent or non-acute phase.
Yu Ping Feng San is a common formula to use to prevent common cold. Add cang er zi to it
to treat congestion and allergies.
3. In the case of perennial allergies which persist year round you treat both of the above at the
same time.
Basic treatments
There are specific diagnoses following this section, but for allergies you begin with these basic
treatments.
Points for Local Congestion

o LI 20
o Bitong extra point
Both LI 20 and Bitong relieve nasal congestion
o Yintang extra point

Opens the sinuses
o UB 7
Common scalp acu-point for nasal congestion
Other basic points

o GB 20
Primarily to expel wind, but also treat sense organ problems of eye and throat.
o UB 12
The Wind Gate point located lateral to T2. This point is used to expel exterior wind and
for respiratory problems.
o UB 13
This is the Back Shu of the Lung, used for respiratory and nasal problems as well as to
expel exterior wind.
o LI 4
Not only is this the command point for the face and mouth, it is also used in combination
with LU 7 (next point) to expel pathogenic heat, wind/heat, and wind/cold. As the entry
point for the LI channel, it also dispels exterior wind and moves qi and blood to
Page 8 of 10
uncongest Wei Qi.
o LU 7
Used in combination with LI 4 to expel pathogens, used for nasal and respiratory
problems and to expel wind (mostly wind-cold)
o Moxibustion only appropriate for winter allergies. Be sure your patient isnt allergic to
moxa!
Invasion of Wind-Cold
This is mostly a Winter allergy invasion. This refers to an acute bout of allergies. Note that the
symptoms listed in the 2nd column are excess symptoms.
Treatment principle: Remove Wind-Cold and Regulate Wei Qi.
If you patient has these symptoms, treat them by combining Local Congestion and other basic points
above with the points listed in the 3rd column. When they recede, more on to treating the Cause/Root,
the 3rd Differential Diagnosis for Allergic Rhinitis discussed below.
The root of a wind-cold invasion is a deficiency of Lung, Kidney, and Spleen, the 3 water metabolism
organs. When you cant control water metabolism you get all these watery symptoms.
If you want the Lung to work better, strengthen the Spleen Qi. Remember the generation sequence?
Spleen/Earth generates the Lung/Metal element. Also, the Spleen is the generator of Qi and the origin of
the Lungs ability to generate Wei Qi.
You also need to strengthen the Kidneys which root the Qi. The Lungs draw Qi in, but the Kidney
grasps it and holds it so that it can feed the body. If the Kidneys are too weak, the Qi will not stay long
enough to do a lot of good. Strengthen the Kidney too.

Page 9 of 10
Invasion of Wind-Heat
This is mostly a Spring problem occurring Austin when the oak trees pollinate (March-April). As with a
Wind-Cold invasion, treat the symptoms when the problem is acute and the root when the symptoms
recede to prevent further attacks in the following allergy season.
Symptoms are again those of excess. Combine basic and local congestion points with the specific points
listed in the 3rd column.
Root/Cause differentiation and treatment

The cause/root of seasonal allergies is an underlying Lung, Spleen, and/or Kidney Qi deficiency. You
treat the underlying causes before the allergy season to prevent attack.
Perennial Allergic Rhinitis

This is a year-round gift that keeps on giving allergy symptoms. You must treat both the cause/root and
the symptoms equally. It is imperative that you do address the cause!

Page 10 of 10
Allergic Rhinitis (bi qiu)
Congested Wei Qi in local area w/General Wei Qi Deficiency
Allergy vs. the common cold
1. Common cold - more generalized with HA; body aches; chills & fever, more Wei and Ying Qi
Disorder
2. Allergy - more localized into 5 sense organs; wei qi stuck/congested
3. Symptoms of head and face in both
4. Wei Qi affected in both
Local Congestion Pts LI-20, Bitong, Yintang (opens sinuses), UB-7
Other Basic Points GB-20, UB-12, UB-13, LI-4, LU-7, Moxa
Seasonal Tx of Symptoms: - Acute stage/onset Remove Wind-Cold,
- Runny nose with loose, watery, white discharge, Regulate Wei Qi
Invasion of - Nasal congestion; itchy nose and eyes --------------------
Wind-Cold - Sneezing (esp. in a.m. when wake up) Local Congestion Points +
- NO: thirst, redness of eyes, or chills
LI-4; LU-7; GB-20;
T: Normal C: Thin white coat UB-12; UB-13
Mostly in the Winter P: Superficial, Tight (or Soft) Wind Invasion or Moxa ok
(i.e. Cedar allergies in Wind-Cold invasion with Wei Qi Xu
Austin)
Seasonal Tx of Symptoms: - Acute onset Remove Wind-Heat,
- More congestion Regulate Wei Qi
Invasion of - Sneezing; red watery eyes --------------------
Wind-Heat - Runny nose with sticky, yellow discharge
- Sore or scratchy throat with thirst or slight thirst Local Congestion Points +
(sore throat is always heat)
- "Hay Fever" LI-4; LI-11; SJ-5, DU-14;
Mostly in the Spring UB-12, 13;
- Dry lips with burning sensation
(i.e. Oak allergies) GB-20
T: Red or red tip C: Thin, yellow
P: Superficial, fast
- When not in acute stage Tonify SP; LU; KID

Seasonal Treatment of: - SP, LU & KID: Wei Qi System Disorder: Wei Qi System (R axis pulses - LU,
* LU Qi Xu * SP Qi Xu SP/ST, KID yang)
Cause / Root * KID Qi Xu: chronic sob, weak back/knees, --------------------
frequent urination, pale face, fatigue, weak &
deep pulse (esp. in rear positions) LU Qi Xu: UB-13; REN-17; LU-9; ST-36
LU Qi Xu - Wei qi source from Gu Qi (SP);
SP Qi Xu SP Qi Xu: UB-20, 21; ST-36; SP-6;
- Wei qi is spread by LU;
KID Qi Xu REN-12, 8
- KID is root of Wei Qi
- SP is mother of LU; LU is mother of KID KID Qi Xu: UB-23; KID-3; REN-4, 6
- SP (earth) controls KID (water) Also: LI-10; UB-52; DU-4
Before the allergy season
- Be sure to tonify SP!
ST-36 + LI-10 = immune system
KID-3 - do not needle during acute stage
Tx Xu and Shi at the same time:
Perennial Allergic Year-round allergies combination of Xu and 50% : 50%
Shi Sx
Rhinitis Pick 50% from symptomatic Tx and 50%
> Yu Ping Feng San: Huang Qi, Bai Zhu, Fang from cause/root Tx (its very important to tx
Feng, Cang Er Zi the root!)
Asthma (xiao chuan) Wheezing & Dyspnea

UB-13 (Back Shu of LU)
Basic REN-17 (Needle downwards to regulate Qi & phlegm) For chronic asthma: 4 needles towards REN-17
Points: REN-22 (Needle downwards to descend Qi; can stop wheezing; especially for lasting-state asthma)
1
Ding Chuan [0.5 cun lateral to DU-14]
*May include DU-14 (for all types of asthma: acute or chronic)
- Intercostal spaces may be enlarged in asthma patients: avoid deep needling! (Esp. BL-12 & 13)
CC: - LIV-3 is contraindicated in acute asthma! (Generally, avoid all Liver points for asthma PTs)
- Acute onset.
Eliminate Wind-Cold,
Due to Invasion of Regulate (descend) LU Qi
Wind-Cold - Dyspnea, wheezing
- Cough w/ chest tightness, rapid and short breathing --------------------------
W-C Sx: Basic points plus:
Excess condition; - Chills/aversion to cold, slight fever, headaches, LI-4; LU-7; UB-12
Will cause acute attack of general aching; no thirst, no sweating; cough with GB-20 (to dispel wind)
chronic condition white thin sputum
May use moxa use smokeless so
T: Normal body C: Thin white, or greasy white coat that the smoke/smell will not
Also, d/t W-H, W-Dryness,
P: Floating/Superficial and tight affect the asthma!
W-Dampness
- Acute onset - Dyspnea, wheezing Resolve Phlegm, Clear Heat,
Due to Accumulation - Cough with profuse, sticky, thick, yellow sputum Soothe Asthma,
of Phlegm Heat - Sensation of chest stuffiness; tightness (oppression); Descend Lung Qi
rough breath; strong and coarse voice
Excess condition; - Thirst with desire for cold drinks; dry mouth, bitter --------------------------
Most common asthma taste, bad mouth odor
- May have fever; nausea and vomiting Basic points +
pattern;
Usually refers to acute - Dark yellow urine; constipation LI-4, LI-11; SJ-5; P-6
attack ST-40 (clear heat, resolve phlegm)
T: Red, or dark red (scarlet) or no change
SP-9 (resolve phlegm, clear heat)
- Smokers & alcohol drinkers C: Thick, greasy yellow coating,
REN-12 (for any d.o. caused by phlegm)
- May derive from W-C from P: Rapid and slippery, wiry
DU-14 (removes heat)
above turning into heat * If severe may have purple lips or tongue
- Chronic onset
Tonify LU Qi to
Due to LU Qi Xu - SOB and rapid breathing strengthen Wei Qi
- Difficulty inhaling, more exhale than inhale --------------------------
- Wheezing, dyspnea Basic points +
Deficiency condition; - Soft or weak voice; low/weak sound of coughing
LU-9 (yuan),
Usually seen with - Pale face; fatigue
UB-43 (for Xu cough, asthma)
prolonged and protracted - Spontaneous sweating; easily catches colds
ST-36; SP-6; UB-20, 21
cough that causes (If LU Qi Xu, SP is mother of LU use
T: Pale to tonify MJ to tonify LU Qi)
LU Qi Xu. C: Thin white, or greasy white (if phlegm)
Chronic LI-10 (= ST-36 of the arm Tonify can
P: Deep and weak, weaker on right 1st (cun) position combine LI-10 + ST-36 for any kind of
Xu. LI is int/ext paired w/ LU)
- Chronic onset (or newborns; young childrens Tonify KID Qi to

asthma) hold (grasp) breath
Due to KID Qi Xu - Severe wheezing and dyspnea
- Difficulty inhaling inhaling w/ help of chest
--------------------------
muscle: upon inhalation, obvious depression above
Deficiency condition; KID Basic points +
clavicle, shrugs shoulders (more exhale than inhale)
failing to grasp Qi - SOB; soft voice; fatigue REN-4, 6 (both root breath);
(KID = root of breath) - Pale face; cold limbs; DU-4;
- Weakness/lassitude, esp. of lower back and knee UB-23, 52; KID-3, 7
More Xu than LU Xu; joint.
Symptoms of asthma are - Incontinence of urine and stool; Profuse, frequent If patient has manifestation of KID
more severe. urination; enuresis (in children) Yang Xu, use Moxa on REN-8,
Chronic T: Pale, swollen, w/ teeth marks DU-4, REN-4, REN-6, UB-23
C: Thin white, or white greasy
P: Deep and weak especially 3rd positions
2
3 Stages of LU Dz
1) Rebellious Qi (Acute)
e.g.Asthma, Bronchitis, Cough
2) Distention of LU Qi
e.g. Emphysema (barrel chested) = Fei zhang
3) Xue level
e.g. Pulmonary heart dz Xue stasis blocking heart
From Qi Blood level;

From LU HT
By Dr.Luo 1
Biomedicine
TCM
Differential Diagnosis & Treatment
By Dr.Luo 2
Our Focuses for Allergic Rhinitis
Where does wind invade body?

Mechanism for Bi Qiu ?
Basic points ?
Differential Diagnosis/treatment?
Superficial or Root ?
By Dr.Luo 3
TCM
ALLERGY-- Fighting of Wei Qi + External Pathogenic Wind
Wind? (Season-spring /location- wind orifices /symptoms- Sudden onset + itchy )

Where attack?(Wind pointsGB-20/BL-12/BL-13/SJ-17/DU-16/Skin/Five sense organs)
Related organ Sp------Lung(center)-----KD
Allergy Vs. Common cold?
Etiology--External pathogens (congestion)

Emotions
Irregular Diet(deficiency)
Overworking
Congenital( 65%/ 85%)
Mechanism--Local Wei Qi congestion w/ general Wei Qi Deficiency
By Dr.Luo 4
Differential Diagnosis
Seasonal treatment:
Symptoms---Invasion of Wind-Cold/ Invasion of Wind-Heat
Root---LU/Sp/KD Qi Xu
Perennial: Treat Xu and Shi at the same time
Treatment
Basic Points LI-20, Bitong, Yintang, UB-7---local congestion/

GB-20, UB-12, UB-13, LI-4, LU-7, Moxa
Differential Points
By Dr.Luo 5
Asthma (xiao chuan)
Biomedicine
TCM
By Dr.Luo 6
Our Focuses for Asthma
Xiao ? Chuan ?
Mechanism for Asthma ?
Three stages of Lung disease?
Basic points ?
By Dr.Luo 7
Asthma (xiao chuan)
TCM
Characteristics
Asthma is a Qi disease
Repeated attacks of paroxysmal wheezing & dyspnea.
Xiao = wheezing sound in throat
Chuan = dyspnea = rapid/short breathing/ suffocating sensation
Most will be chronic illness with acute attacks
Relationship of Xiao & Chuan

Xiao must have Chuan as accompanied symptom (such as asthma )
Chuan may not have Xiao (e.g. cough, bronchitis)
Relationship of Asthma & other LU dz

Asthma--presence of wheezing Asthma -- root of retention of phlegm
Where is the noise from?

Rebellious energy passing thru the retention of water/dampness/phlegm
By Dr.Luo 8
Etiology
Shi types
Disability of dispersing/ascending-- External pathogen

Disability of descending-- Irregular Diet
-- Emotional disorders
-- Exercise
Xu types
Congenital Kidney Xu
Overwork
Chronic dz-LU/Sp/KD xu
Mechanism Rebellious LU Qi w/ retention of phlegm
Root Retention of phlegm
By Dr.Luo 9
Deficiency: LU Qi Xu/ KID Qi Xu
Excess:Wind-Cold/W-Heat/W-Dryness/ W-Dampness/ Phlegm Heat
Treatment
Basic points UB-13/ REN-17/ REN-22/ Ding Chuan/ DU-14
LIV-3 Contraindicated in acute asthma! (Liver points)
Differential points
By Dr.Luo 10
Course: Acupuncture Treatment of Disease I Date: October 20, 2008
Class #: 5 Asthma, Common Cold, Epistaxis
Farooq Bin Mahfooz
Disclaimer:
Dr. Luo was in rare and confusing form today. I have re-written these notes based
on the non-western logic used to deliver the lecture, the Fuyip book and on Dr.
Luos slides. Good luck to us all.
Asthma
Xiao Chuan
Biomedical View
Incidence is something like 17million, about 5 million of which are kids 6+% of patients you will see.
Asthma is defined as a condition in which the airways narrow in rsvp to certain stimuli causing
difficulty in breathing. Causes/etiologies include pollens, dust mites, body secretions, feathers, animal
dander and smoke. Patients often have sudden recurrent attacks of labored breathing, chest constriction,
cough. Most commonly patients suffer from this in the winter, most often having attacks at night and
early morning.
Asthma patients will often open the mouth and show the 3 hollows just above sternum, at about ST 12
and I forget the 3rd. Syx include wheezing, Dyspnea, shortness of breath, chest stuffiness and coughing.
(The coughing causes more inflammation responses and further narrowing of the bronchioles. Mast
cells, eosinophils and T-lymphocytes involve in the process.
Common treatments in biomed include bronchodilators (theophyllines), and corticosteroids.
TCM View
The Chinese way to say asthma is xiao chuan. Xiao translates to wheezing and chuan translates to
dyspnea. Wheezing by definition must be accompanied by dyspnea because wheezing is caused by
constriction of the bronchi in some way (either by an obstruction or by tightening of the tissues).
Dyspnea, however, may not always have wheezing that goes along with it. Also, dyspnea may
accompany coughing and bronchitis but there will probably not be wheezing that goes along with it.
As a general rule, wheezing is closely linked to asthma, thus the Chinese expression Xiao Chuan is used
to indicate wheezing + dyspnea which equals asthma.
Why are we making such a federal case out of this? Because were very likely to come across these
terms later on in Chinese medicine. Know what the two terms mean and that combined together they =
asthma.
(And to further muddy the waters, youll study stuff in Physical Assessment that declares that
indeed wheezing may accompany other lung diseases.)

Page 1 of 18
Characteristics of Asthma
Asthma is a Qi disease! Know this!
The root of asthma is the deep and long lasting retention of phlegm (in Chinese it is called xiu
tan or old phlegm). Because it is deeply rooted and concentrated it is difficult to get rid of.
When Qi crosses this phlegm the result is the wheezing sound. You may hear the wheezing in the
throat or in the bronchi of the chest if you listen with a stethoscope.
Wheezing is the hallmark symptom identifying Xiao Chuan/Asthma.
Again, asthmas root is retention of phlegm. As a result asthma treatments always need to
address/pay attention to phlegm. Other lung diseases have other roots.
Repeat attacks of paroxysmal (intermittent, sudden and recurrent) wheezing and dyspnea.
Most of the time this is a chronic illness with acute attacks.
In lung diseases one can have dyspnea but perhaps not wheezing that accompanies it. This is true
of emphysema, bronchitis (ok, sometimes that does have a wheeze), pneumonia or just plain
cough. But as previously stated, if a patient has wheezing they are having dyspnea.
May also have cough
May also have:

o Rebellious Qi causing noisy symptoms (like wheezing) due to rebellious energy passing
through water, dampness, or phlegm.
This can be rebellious Qi of LU, ST, SI, LI or Wei Qi which, when passing through
retention of dampness/phlegm/water, can cause wheezing, vomiting, or borborygmous.
On occasion this can cause that screaming like a pig or sheep thing Dr. Wu mentioned in
Foundations. (As an aside, Ive at various times in my life lived in the presence of sheep
and have never heard one scream. Pigs on the other hand can squeal like mo fos!)
Early sign of asthma before an actual attack can include chest tightness
Symptoms of asthma can last 6+ hours.

The 2 main symptoms are:
o Xiao or wheezing sound in the throat
o Chuan or dyspnea. If youve never seen or experienced it, dyspnea is rapid short
breathing and a suffocating sensation. It sucksliterally and figuratively.
To reiterate: you can have Chuan/dyspnea without Xiao/wheezing, but you cant have Xiao/wheezing
without Chuan/dyspnea.

Page 2 of 18
Etiology
There are 2 basic etiological categories for Asthma (xiao chuan): excess (or shi) types and deficient
(or xu) types.
Excess/Shi type etiologies for Asthma/xiao chuan
Disability of the dispersing, ascending and descending Lung functions
o Invasion of external pathogens are an excess in the Lung which cause a disability
of the Lungs dispersing and ascending function. Allergic factors such as
environmental and airborne pathogens cause the Lung Qi to stay inside. The Qi
then becomes rebellious. Since the Lung is the upper source of water, when water
does not disperse the result is generally phlegm in the Lung.
Pathogens can be wind, cold, heat, dampness or dryness, but is usually wind-cold
or wind-heat.
Wind-Cold.
This is a major reason for asthma attacks. The usual suspect in this part of
the country is the winter time pollination of the juniper/cedar trees which
triggers allergic reaction. See the allergic rhinitis lecture for more.
Wind-Heat.
Another major reason, this one is usually due to oak pollens in the Spring
in Central Texas.
o Irregular diet, emotional disorders and exercise cause a disability of the

descending Lung function.
Irregular diet causes digestive disorder which then affect the Lungs
descending function. This includes a diet high in greasy foods and dairy
which result in dampness and phlegm and quite possibly phlegm heat in
the Lung. Allergies to seafood and other foods may add a further
challenge to the lung and exacerbate asthma/dyspnea.
Remember that the Spleen is the source of phlegm, but the Lung is the
place in which phlegm is stored!
Emotional disorders which are the result of Liver hyperactivity prevent

Lung Qi from descending. This would be a Wood insulting Metal
problem. Liver related emotional disorders include anger and irritability
from either Liver Qi stagnation or from Yang rising.
In children the onset of asthma can be due to strong emotions such as

those generated when Liver Qi over rises or when Liver Qi is stagnant.
This influences the Lung Qis movement and prevents it from descending
normally.
When the Lung Qis descending function is affected without phlegm the
Page 3 of 18
result is cough and/or Epistaxis. When the function is affected with
phlegm the result is asthma.
Exercise produces Yang which is upward moving. This creates a faster

and more superficial breath that is not rooted which in turn affects the
Lung Qis ability to properly descend.
Encourage asthma patients to exercise mildly or qi will stir too much

causing an asthma attack.
Deficiency/Xu type etiologies for Asthma/Xiao Chuan
Congenital Factors
This refers to Congenital Kidney Deficiency/Xu.
All genetic disease are related to Kidney, as the Kidney is the storage house for
congenital essence. For all inherited diseases, treat the Kidney. Remember that the
Kidney roots the breath in the lower dan tian. Without sufficient Kidney essence the
breath is not held. This is one of the deficient etiologies for Asthma.
Overwork
Overworking can also deplete the Kidney and resulting in a failure of Kidney to root the
breath.
Chronic diseases of the Lung, Kidney, and Spleen

o Deficiency of Lung Qi results in a long-term protracted cough
o Kidney Qi Xu can be due to overwork as stated above, overindulgence in sexual
activities or in congenital problems. Again, deficient Kidney Qi causes a lack of
rooting in breath and subsequent asthma.
o Spleen Qi Xu Spleen cannot supply Lung with sufficient Qi. Spleen/earth is the
mother of the Lung/metal. Without sufficient Spleen Qi the Lung suffers also.
Mechanism of Asthma/Xiao Chuan
The Mechanism of Asthma in TCM is:
Rebellious Lung Qi with retention of Phlegm.
This can result from a latent pathogen and/or from retention of phlegm.
Rebellious Qi is due to one of two reasons:

1) Disorder of the descending function which is internally related to asthma.
There are several factors to consider:
a. Emotional reasons resulting in an overactive upwards movement of Liver Qi
which keeps the Lung Qi from descending properly.
b. Dietary reasons as discussed earlier
c. Exercise also discussed previously.

Page 4 of 18
2) Disorder of the dispersing function which is externally related to asthma. This results
from the invasion of pathogenic factors. See the discussion above under the excess
etiology section for more detail.
The three stages of Lung Disease.

As discussed in the last lecture (Class 4, page 2), Lung diseases of all varieties progress from Qi
level Blood level, or from Lung Heart. Therefore, when you are treating the Lung, also
treat the Heart and the Blood.
The three stages progress as follows:
1) Acute phase of Lung disease

This includes not only asthma but bronchitis and cough.
2) Emphysema (fei zhang) is the 2nd progression of Lung disease. Emphysema is characterized
by a barrel chest which forms as the Lung Qi distends.
3) Pulmonary heart disease is the 3rd stage of a Lung disease.

This is a progression from the Qi level to the Xue level. Xue or blood contains Qi and Qi is
the carrier of the blood. There is blood stasis at this progression leading to Heart disease.
Symptoms will include palpitations, fatigue, shortness of breath, spontaneous sweating and
dyspnea upon lying down.
Differential Diagnosis and Treatment for Asthma/Xiao Chuan
Basic points and Cautions
Cautions: This is a reiteration from Point Locations, Energetics, Techniques and just about every other
class youve had from a TCM perspective, but remember that needling over the intercostal spaces carries
a significant risk of pneumothorax. Additionally, intercostal spaces may be enlarged in asthma patients.
Avoid deep needling!
One final bit about cautions:

Though Dr. Luo disagrees, some books say Liver 3 is contraindicated for asthma patients. (note that he
didnt say he disagreed on the slideprobably need to know this for the test Im guessing.)
Basic Points UB 13 Back Shu of Lung

Ren 17 Needle downwards to regulate Qi and Phlegm.
For chronic asthma you can also use 4 needles pointing inward
transversely to Ren 17.
Ren 22 Needle downwards to descend Qi. This can stop wheezing,
especially for lasting-state asthma.
Ding Chuan Extra point cun lateral to Du 14. You may include Du 14 for
either acute or chronic asthma.
Note: if you see a point prescription for asthma listed on the test and it doesnt include Ding Chuan,
then its not the right one!!!
Page 5 of 18
Differential Diagnoses for Asthma/Xiao Chuan
Combinations of patterns may be seen in this disease. Pay attention to the symptoms and the points
below!
Excess Diagnoses
Asthma due to Invasion of Wind-Cold
This is an excess condition generally resulting from a change in the weather. Can also
result from an invasion of wind-heat, wind-dryness or wind-dampness. Dont tonify too
much with these wind points. Excess conditions result in acute attacks. When the attack
and acute conditions are done determine the root cause, which will very very likely be a
deficiency condition defined in the next section, and treat accordingly.
Asthma due to an accumulation of Phlegm Heat
Deficient Diagnoses
These are chronic problems unlike excess conditions/diagnoses which are acute. Fro Qi
deficiencies you also need to tonify the middle jiao which you will see in the treatment
prescriptions below.
Asthma due to Lung Qi Deficiency
Long term smoking is one reason for Lung Qi xu.

Page 6 of 18
Asthma due to Kidney Qi Deficiency
Alternative treatments for Asthma

1) Mid summer moxibustion preventative for Autumn Asthma
BL 12 or BL 13, BL 20, BL 23, BL 43
a. Use moxa during the hottest part of the summer or year
b. Use moxa on a ginger cone, burning 3-7 cones until the skin reddens but does not cause
blisters!
c. Do this once per week until Autumn
2) Plum Blossom needle during acute attack
a. Usually use points along the UB channel above T7 to neck or on Jia Ji points
b. Use mild stimulation until skin is warm, but not bleeding.
3) Dietary supplementation
a. To descend rebellious Lung qi: juice of asian turnip + asian pear. Drink cup
during attack
4) Zeng Zhen recommended scarring moxa on ST 36 at the height of summer to build immunity for
the coming autumn/winter season.
Precautions for Asthma:

1) Stay warm and avoid catching cold
2) Avoid foods you are allergic to
3) Avoid environmental allergens

Page 7 of 18
Common Cold
Gan Mao or Catch Hat
Biomedical View
The incidence is about 62 million in the US on the average. But thats a pretty variable number. About 1
per second!
By definition is a viral infection (rhinovirusthis is the etiology) of the lining of the nose, sinuses,
throat and large airways. Resulting symptoms are discomfort in the nose and throat, sneezing and runny
nose, fever and cough lasting 4 10 days. Usually improves in a week or so, so often not treated in
biomedicine. Unfortunately, complications can include otitis media, pneumonia, asthma, and
myocarditis.
Treatment is to stay warm, take antivirals, take antihistamines. Will antibiotics help? Depends on the
etiology! If its a virus, no! Should you take a cough suppressant? Not at first moves the Qi to expels
pathogens.
TCM Etiology
There are 2 basic etiologies for a common cold in TCM: 1) Invasion of external pathogenic factors and
2) Deficiency of Zheng Qi which leads to invasion by external pathogenic factors.
Invasion of External Pathogenic Factors

Related to temperature
o Heat
o Cold
Related to pressure
o Wind, which is a guide for other pathogens
Related to humidity
o Dryness
o Dampness
o Summer Heat which is a combination of temperature and humidity.
Deficiency of Zheng Qi
This can be a deficiency of Qi, Xue, Yin, Yang. All are related to the immune system.
Qi Xu
Tendency to catch cold, damp. Can be all pathogens.
Blood deficiency
More prone to invasion by heat or dryness, but could be all pathogens.
Yin Xu
Prone to dryness and heat invasions
Yang Xu
Prone most to cold and damp invasions

Page 8 of 18
People with Blood and Yin deficiencies tend to get wind-heat invasions more frequently. Yang
pathogens, such as wind-heat (and summer heat), will attack the damage the Yin. The upper part of the
body is attacked first with the heat following the wind into the body through the wind points. The
meridians of the body bottle neck at the body neck where they narrow and concentrate. Thats why
exterior heat invasions often express as neck stiffness and pain.
This also true on the heat where the meridians curve around a lot. This slows the Qi flow and where
anything in the body slows it becomes more prone to problems. That is true for blood, qi, fluids, etc.
Evil grabs on more easily when the flow is slow.
People with Qi and Yang deficiencies are more susceptible to wind-cold invasions. Yin pathogens such
as wind-cold attack and damage the Yang.
Mechanism
The mechanism of Common Cold/Gan Mao in TCM is:
Disorder of General Wei Qi and Ying Qi
Another way to say this is disharmony of Ying and Wei Qi. When they are not balanced and are in
disharmony the body is more vulnerable. Why is this?
If Ying is stronger/more than Wei:

If Ying is more than Wei, then Wei Qi is weak and cannot protect the body. The result is that the
sweating pores of the body are open and vulnerable to attack.
If Wei is stronger/more than Ying:

If Wei Qi is more than Ying Qi, then Ying is too weak to regulate the heat of the body which is
generated by the Wei Qi. The result is the heat of the body will push the sweating pores (the
doors of the body) open with the same result as above: the body is left open to attacking evils.
How can you tell the difference between a common cold and allergies?
This is a reiteration from the Class 4 lecture (page 6).
Common cold has more generalized symptoms and is a disorder of both Ying and Wei.
o Headaches
o Body aches
o Chills and fever
o More Wei and Ying Qi disorder
If Wei Qi is less than Ying Qi symptoms will include sweating spontaneously and
chills because the Wei Qi is insufficient to warm the body.
If Ying Qi is less than Wei Qi the Yin will be damaged and you might see dry
skin and other Yin deficiency symptoms.

Page 9 of 18
Allergies have more localized symptoms in the area of the 5 sense organs. This disorder is of the
Wei Qi only. Wei qi becomes stuck or congested where the evil attacks. There is a notable
absence of the chills and fever that comes with a common cold.
Why do the symptoms of a common cold manifest mostly on the head?

(This is true for allergies as well)
Divergent meridians send Wei Qi to the head and face for defense.
Meridians have a lot of curves on the head and face as discussed above. Its easier to have
blockages where the meridian curves are than where they run straight. You might think about RR
2222 very curvy and winding and nearly impossible to drive fast. You have to slow down or
risk smashing into something hard, vertical and cliff-like.or driving over said cliff and
smashing into something hard, horizontal and rock-like at the bottom of the drop.
Wind points are mainly located on the head, face, and upper back. This is where the wind enters
the body.
This is where the 5 sense organs open to the world.
When there is a Yang pathogen it tends to attack the Yang parts of the body, aka, the upper body
and head.
Characteristics of Wind, Heat and Cold
Wind Heat Cold

Attacks the upper part of Enters thru the nose and Enters thru the skin, face,
the body mouth upper body
Consumes Jin Ye or body
fluids
Opens pores. Contracts the pores.
Tends to move outward and Induces sweating. Comes No sweating. Chills. Body
causes slight sweating with the gift of fever. aches.
Guides pathogens inward
Yang in nature Yang in nature Yin in nature
Pulse: floating or soft Pulse: floating, rapid Pulse: floating, tight.

Page 10 of 18
Differential Diagnoses and Treatment
Differential diagnoses for common cold are mostly of excess types, though there is also some deficiency
involved as noted in the sections below.
Basic points
Wind Cold Invasion (Excess)

Note that chills will be more than fever.
Wind-Heat Invasion (Excess)

Fever more than chills in this one. You can use blood letting at LU 10 and 11 as well as at LI 1. and
cupping/bleeding to clear Lung heat (Du 14 for example)

Page 11 of 18
Wind-Damp Invasion
Weather changes can produce chills/fever, heaviness due to the damp, tightness (damp tightens and
grabs), nausea and vomiting (blockage of water/phlegm), loss of appetite, diarrhea and loose stool
(water/damp problems).
Summer Heat Invasion

Summer heat, which is damp + heat in the humid summer time weather occurring after June 21 and
before September 21 or 22.
Note that summer heat attacks the Heart and Pericardium directly. Thats why symptoms look all shen-
disturby-like. Also, there is more dampness in summer heat than in plain old heat. This heat is damp and
wraps the body which intensifies the heat and blocks the release of excess body heat. This is why
summer heat can cause loss of consciousness faster than regular heat.
Sunstroke falls into the summer heat category.

Page 12 of 18
Deficiency patterns
This is a combination of external pathogens and a deficiency of the body.

Page 13 of 18
Epistaxis
Bi Ru
Bi ru nose bleeding. Incidence is about 16% in the US. This is various amounts of blood coming out of
the nose with or without an itchy nose. What causes it? Nose picking or injury, cold and dry air, blood
disease, anticoagulation drugs/substances, and tumors. Bleeding can occur either at the front or back of
the nose.
Treatment includes local anesthetic for examination of minor bleeding. With severe bleeding you use an
absorbent sponge and/or cauterizing bleeding spots.
TCM Etiology
Lots or reasons for nose bleeding in TCM.
The nose related entities are:

Meridians:
o Lung
o Liver (in the post nasal area)
o Large Intestine channel
o Stomach channel
o Du channel
o Bladder channel
Organ
o Lung
Lung, Stomach and Liver Qi rebellion can also cause nose bleeds.
Epistaxis is excess-related 80-90 % of the time, usually excessive Yang and Heat syndromes.
Four Etiologies
Epistaxis and pharyngitis have similar etiologies (due to heat). Epistaxis comes down to excess,
heat and fire. Youll note in the etiologies below the culprit is heat regardless of the way the
heat came to be. Heat causes blood to flow more quickly which breaks the small vessels.
All of these etiologies are excesses, but underlying deficiencies can exacerbate the problems. For
example, a deficiency of Spleen Qi results in an inability of the Spleen to hold the blood in the
vessels. Lung qi deficiency results in an inability of the Lung to control the strength of the
hundred vessels which are damaged by the heat in the blood and the blood beating harder and
faster against the vessel walls.
1) Invasion of External Pathogens

a. Wind heat
Bladder Related
b. Summer heat
Du channel related
Page 14 of 18
You can use blood letting at Du 14 and 16 (wind dryness). Little boys are pure yang if
you add summer heat to this combination they are prone to nose bleeds. A good remedy
to stop bleeding for anyone, but especially for kids:
Put ice on HT 1, LU 5 and P3. You can also put ice on the forehead and on Du 16 which
has a direct connect to the nose. (The nose, by the way, is called the King of the Face.
I did not know my face was not a democracy, but there ya go.)
An alternative remedy, should you have it lying about, is Qinghao paste place it in the
nostrils instead of cotton to stop bleeding.
2) Emotional Disorders
a. Liver Fire counter-checking Lung and the nose is the opening to the Lung.
b. Liver meridian distribution through the post nasal area. When fire passes through the
post nasal area the heat damages the vessels.
Long Dan Xie Gan Tang removes GB and LV heat.
3) Irregular diet
Causing an accumulation of heat in the Yangming channels
a. Over-consumption of Yang and spicy foods
b. Food stagnation which can lead to heat
c. Taking too much Yang or hot herbs. This can happen after taking Ma Huang Tang or
Pe Min Kan Wan. Causes red sweating also called hong han.
4) Overworking
a. Causes fire to rise to the head
Pregnancy can lead to a propensity for nosebleeds. Why? Yin and Xue distribution is focused on
the uterus to nourish the fetus. As a result, there is a deficiency of Yin, Essence and Blood in the
upper body or head area which leads to dryness which can cause bleeding. It may also be due to
a blockage of energy flow leading to gas/bloating Spleen Qi failing to hold blood and causing
bleeding. May also be due to a relative deficiency of Qi per Dr. Luo.
As a final etiological tidbit, remember that diseases and symptoms above the waist are more excess,
heat and Yang in nature while diseases and symptoms below the waist are more deficient, cold,
and Yin in nature. Zhang Zhongjing reminds us that edema above the waist is due to wind and water
and that as practitioners we should promote sweating. Edema below the waist, however, is due to
Kidney Yang deficiency and we should promote urination.

Page 15 of 18
Differential Diagnoses and Treatment
There are 3 excesses diagnoses and 1 deficient diagnosis included in this section along with treatment
principles and point prescriptions. If you dont remember what the following points do, Id encourage
you to refer to Agnes Nowakowskis most excellent point reference chart for this class. Click here to
check it out.
Basic points for Epistaxis are combined with specific differential diagnoses and treatments. The basic
points for Epistaxis are:
Now on to the differential diagnoses.
Wind Heat or Summer Heat in the Lung

This is an acute condition more predominant in Spring, Summer and the beginning of Autumn
(which brings dryness, but is still relatively warm in Texas). This most often affects children and
teens.
Symptoms are in the left column and principles/points are on the right.
The difference between summer heat and heat:

1) Summer Heat attacks the Heart and Pericardium directly so there are more emotional/mental
symptoms than with plain old heat.
2) There is dampness associated with Summer Heat
3) Any heat occurring between Summer Solstice (June 21 or 22) and the Vernal Equinox
(September 21 or 22 ) is considered to be Summer Heat per the Neijing.

Page 16 of 18
Accumulation of Heat in the Yangming
This is an acute condition with severe/violent bleeding and large amounts of blood. It may arise
from Wind-Heat, Summer-Heat or from Heat due to an irregular diet. Remember that the
Yangming is rich in Qi and Blood.
Symptoms are in the left column and principles/points are on the right. Note that symptoms
include bleeding primarily from the right nostril.
Liver Fire Flaring Up

Hyperactivity of the Liver (left nostril) or Liver counterchecking Lung (right nostril). This is an
acute condition.

Page 17 of 18
Liver/Kidney Yin Xu or Lung Yin Xu with deficient Heat/Fire
This includes excess symptoms above with a deficient/chronic root below. There may be a
component of Lung Yin Xu which may involve Lung TB. Please note that all of this can include
bleeding during menopause.

Page 18 of 18
By Dr.Luo 1
Case Discussion
CASE 1 CASE 2
Pulse: superficial and soggy Pulse: wiry and fast on the left side
weak on the second position of right
By Dr.Luo 2
Common Cold
Epistaxis
By Dr.Luo 3
Our Focuses for Common Cold
Mechanism for Common Cold ?

Basic points ?
Difference between Heat and Summer-heat?
By Dr.Luo 4
Common Cold (gan mao)
TCM Etiology
Due to invasion of external pathogenic factor -----Temperature/Pressure/Humidity
Due to Zheng Qi Xu-------Qi, Xue, Yin, Yang
People with Xue and Yin Xu Get Wind-Heat Invasions more
People with Qi and Yang Xu Get Wind-Cold invasions more
By Dr.Luo 5
Mechanism
Disorder of general Wei Qi & Ying Qi
Common Cold -------Allergy
Why head ?
Divergent
Curve
Wind points
Direct open
Yang pathogen ?
Characteristics of Wind, Heat and Cold
Attack pathway
Moving tendence
Nature
Pulse
By Dr.Luo 6
Excess Pattern
Wind-Cold
Wind-Heat
Wind-Dam
Summer Heat
Deficiency Pattern
Qi Xu
Xue Xu
Yin Xu
Yang Xu
Treatment
Basic Points---Wind(UB12,SJ17)
Lung(LU7,UB13)
LI(LI-4)
Local point(Taiyang)
By Dr.Luo 7
Ma Huang ----- Xiang Ru
Elderly/ Deficiencies/ Summer

Yin Xu/ Xue Xu / Jin Ye Xu
Difference between H and S-H
Summer-heat attacks HT and PC directly(mentally/emotionally)
By Dr.Luo 8
Epistaxis
Nose Bleeding(bi ru)
TCM Etiology & Mechanism
Nose-related meridian/organs---LU,ST,LI,Liv,DU.BL
Invasion of External Pathogen Wind-Heat (BL related); Summer heat (DU related)
Emotional Disorders (Liv Fire countercheck LU/Liv meridian distribution)
Irregular diet (Spicy food/Yang herb)
Overworking
Pregnancy---Nose Bleeding ?
Yin and Xue distribution
Blockage of energy flow
Relative deficiency of Qi (Dr. Luo)
Any dz and Sx above waist----more Excess, Heat, Yang in nature

Any dz and Sx below waist----more Xu, Cold, and Yin in nature
Zhang Zhong Jing---- Edema above waist---Wind-Water (promote sweat);

below waist --- KID Yang Xu (promote urination)
By Dr.Luo 9
Excess:
Wind-Heat or Summer-Heat in LU
Accumulation of Heat in Yang Ming
LIV Fire Flaring Up
Dediciency:
LIV & KID Yin Xu,

LU Yin Xu
Treatment
Basic PointsLU6?,LI4,11,20, SJ5

Ice remedy
Differential acupoint selection
By Dr.Luo 10
Common Cold (gan mao)
[gan= catch; mao = hat]
Basic points for Common Cold: LI-4; LU-7; GB-20; UB-12, 13; SJ-17; Taiyang
- Acute onset Remove External pathogenic Wind-
- Chills or severe chills; aversion to cold; slight fever; Cold, Regulate Wei & Ying Qi
no sweating, no thirst --------------------------------
- Stiff neck; general body aches Basic points +
Wind-Cold - Headaches: Taiyang headache Add: Moxa and /or Cupping
Invasion - Sneezing w/ watery, white nasal discharge and
drainage; cough w/ profuse, loose, white mucous DU-14 to DU-16 Gua Sha
- Constipation Folk therapy: use scrapping "gua sha" - along
Bladder lines 1 & 2 from C7 to L5 until color is
T: Normal C: Thin white coat fresh or dark red
P: Superficial; Tight Also scrape from 2nd line obliquely outward along
Excess condition ribs
Acute ---------------------------------------------------------
Wind-Cold Excess
[There is a line of points between LI and SJ to
- No sweat, Cold predominates
Wind-Cold Xu tonify the immune system]
- Sweating but no improvement
> Gui Zhi Tang
- Imbalance between Ying Qi and Wei Qi
Take formula, then eat warm soup. Following,
- Floating and soft pulse possible, not tight, perhaps not
take a hot bath/shower and wrap warmly and take
even floating
a nap. Upon waking, the Sx should be much
- Not enough Qi. Above pts + ST-36; BL-20, 21; LI-10
better.
- Acute onset Wei level

Remove Wind-Heat
- High fever (fever more pronounced); slight aversion Regulate Wei & Ying Qi
to cold -------------------------------
Wind-Heat
- Sore throat; cough w/ yellow mucous;
Invasion - Thirst or slight thirst; Basic points +
- Skin rash; red congestion of eyes & throat SJ-5; LI-11; DU-14 (removes H)
- May have headache (whole head)
Excess condition High fever:
- Slight aversion to heat and wind; slight sweat
Acute Prick LU-11 & LI-1; LU-10 for sore throat
T: Normal and/or with red tip Formulas:

C: Thin, Yellow > Yin Qiao San (1 tube every hr or 5-6 scoops
May be W-C every hr + Echinacea)
turning into Heat P: Superficial; Rapid
> Sang Ju Yin (w/ prominent cough)
> Gan Mao Ling (more severe heat)
- Acute onset Remove Wind-Damp
- Chills, aversion to cold & slight fever (one not more Regulate Middle Jiao
than the other) [like W-C] --------------------------------
Wind-Damp - General heaviness of whole body; joint pain Pts from Yin meridians are okay to use b/c
Invasion - Heaviness of the head (as if wrapped in towel); Damp has origins in SP and the pathogen is
foggy sensation already inside (diarrhea). It will not drive
- Decreased appetite; nausea, vomit; fullness, epf in deeper.
- Distending sensation of epigastrium, abdomen
Excess condition
- Loose stool or diarrhea LI-4; P-6; REN-12;
Acute ST-25, 36, 40;
T: Normal (D-C) or Red tip (D-H), or Swollen
SP-9, 6
Stomach Flu C: Greasy; Thin or Thick; White or Yellow
UB-12, 20, 21
P: Soft (floating, big w/o strength); or superficial &
Yintang; ST-8 (D-headaches)
slippery
1
- Fever or high fever; slight chills or aversion to cold Remove Summer-Heat, Calm Shen,
- Great, profuse sweating; rough breath; distending Regulate Middle Jiao
Summer Heat sensation in chest --------------------------------
Invasion - Nausea, vomit; esp. in a.m.; decreased appetite;
- Great thirst; desire for cold drink or no desire DU-20, 14
Excess condition. - Restlessness; irritable; tossing and turning HT-1, 8; P-6
- BM is normal, constipated, or loose UB-40; (P-3)
- Urine is scanty, yellow Prick Shi Xuan pts.
*See below for LI-4, 11; SJ-5; GB-20
difference betw/ H & T: Red or scarlet C: Thick or greasy; yellow UB-12, 14, 15, 20, 21
S-H P: Forceful/full (or slippery) & rapid; overflowing in REN-12, 17
the HT position SP-6, 9
Wind-Heat; Wind-Cold; Wind-Damp plus one or more of: Qi; Blood; Yin; Yang Xu
Combination of Remove external pathogen as specified above; plus:
External Qi Xu: REN-17; LU-9; UB-13, 20, 23; ST-36; LI-10 (> Yu Ping Feng San - Jade screen)
Pathogens & [primarily W-D + pale face, sob, easy to catch cold, sweats easily, etc]
Body Xue Xu: LIV-8; ST-36; UB-17; SP-10, 6; UB-20, 23 (> Zhai Zao San)
Deficiencies [+ pale face, poor mem / conc, dd sleep, scanty menses, pale nails, floaters, anemia, weak P, thin & pale T body]
Yin Xu: Yin tonifying - UB-43; KID-3, 7; SP-6; UB-52 (> Jia Jian Wei Rei Tang)
[W-H or W-Dry w/ Yin Xu Sx: night sweat, hot flash, low-grade fever, 5 palm heat, dry throat, dry cough, fever
It is ok to use lower w/ sl. aversion to W or C; T: Red, cracks, peeled coat; P: thin, rapid]
points - pathogen is
already inside Yang Xu: Warm Yang, Remove epf - UB-23; DU-4; REN-4, 6 - with moxa {if W-C, moxa on all pts}
(> Tang Bai Qi Wei Yin)
[W-C or W-D + cold extremities, chronic diarrhea, morning diarrhea (5am), premature ejaculation, edema, etc.;
T: pale, swollen, teeth marks, white coat; P: deep, weak, slow]
* Difference between H and S-H:

1- Summer Heat attacks the HT and PC directly as a result, there are more emotional/mental Sx
2- There is more Dampness w/ S-H
3- According to the Nei Jing, any heat after the Summer solstice day (in summer season) is considered S-H
Epistaxis (bi ru)

Nose Bleeding
LI-4; LI-11; SJ-5; LU-6 (Xi-cleft); LI-20

Basic Points
Use sedation or mild stimulation.
- Fresh red color; often in right nostril Remove W-H, S-H;

Wind-Heat or - Cough or dry-cough; yellow sticky mucous Cool blood,
Summer-Heat in LU - Thirsty with desire for drinks Stop Bleeding
- Constipation, dark yellow urine ------------------------------
Acute W-H / S-H Sx: Basic +
More predominant in: - Sl. fever, desire for cold drinks,
- S-H restlessness, tossing and turning, irritability DU-15, GB-20, UB-12, UB-13,
the Spring, Summer,
beginning of Autumn - History of common cold (due to dryness + heat) S-H: HT-8, P-8
(dryness + heat); - Burning sensation in chest
children/teens T: Red, redder tip, C: Thin yellow [[ Look for red spots between
P: Floating, fast ((or slippery, stronger in right front)) scapsprick to bleed ]]
2
- Acute onset; related to irregular diet (spicy hotpot!) Remove Heat from YM,
Accumulation of Heat - Fresh red, or dark red blood; primarily from right Cool Blood,
nostril Stop Bleeding
in Yang Ming - W/ other YM H Sx: high fever, thirst, desire for cold
------------------------------
drinks, bad mouth odor, toothache, gum bleeding,
Acute constipation, dark, yellow urination, burning pain in Basic points +
Severe/violent bleeding stomach, much acid regurgitation. Add pts from foot YM:
w/ large amts of blood ST-44, 45; SJ-6;
-- Sudden nasal bleeding with fresh red, sticky blood;
-- Both nostrils and hot sensation UB-40; SP-10
May arise from: -- Acne on forehead, cheeks or mouth, red face SP-6;
W-H / S-H, or -- Burning pain in stomach, acid regurgitation; SP-1 (blood let)
Hx of irregular diet. -- Dark yellow urine with hot sensation
* ST-44 is more for internal heat, not W-H
Yangming = T: Red or scarlet (according to Dr. Wu)
more Qi and Xue C: Thick, yellow/brown, Dry rough coat
P: Rapid, forceful, slippery, ((maybe floating))
- Acute onset; closely related to hx of emotional Remove LIV Fire, Cool Blood,
disorder Stop Bleeding
LIV Fire - May not have other general physical Sx ------------------------------
- Sticky, fresh red nasal bleeding esp. left nostril
Flaring Up - Anger, irritability Basic +
(hyperactivity of LIV, - Bitter taste, thirst, desire for cold drinks LIV-2, 3, 5
LIV counterchecking LU) - Red eyes, burning hypochondriac pain SJ-5
- Constipation, dark yellow urine GB-41, 43
Acute ((sedate UB-18, 19))
-- Dizziness; tinnitus (thundering, loud)
-- Insomnia, tossing and turning; severe headache > Long Dan Xie Gan Tang
Left Nostril = Liver
Right Nostril = Lung T: Red, redder on sides C: Yellow
P: Wiry, fast
Nourish Yin
LIV & KID Yin Xu, - Chronic onset; related to overworking, occurs esp. Remove Empty-Heat,
or LU Yin Xu, at night; or too much sex Stop Bleeding
- Off/on bleeding; small amount, fresh red, watery ------------------------------
with Xu Heat/Fire blood
- Usually left nostril (If LU Yin Xu: right nostril) Basic +
Excess Symptoms - Yin Xu Sx: hot flashes, malar flush, 5 palm heat, LU-7
with Xu root: low grade fever, tinnitus, dizziness, vertigo, KID-1 (Moxa or soak in hot water)
Excess above; Xu below. weakness of lower back and knees, night vision KID-6 (start of Yin Qiao which ends at
Chronic problems; nocturnal emissions nose)
- Insomnia; bleed worse at night or after working; dry KID-3; SP-6
* May have a component of cough; steaming bone symptoms KID-7 (metal/LU)
LU Yin Xu w/ above UB-52, 43 (Yin tonifying)
- This can involve Lung TB T: Red or scarlet; or thin and small with cracks
C: Yellow, less, or mapped KID-1 is very good to stop epistaxis d/t
LIV/KID Yin Xu
> Can include bleeding P: Thin, fast and weak (can be floating)
during menopause
3
Course: Acupuncture Treatment of Disease 1 Date: October 27, 2008
Class #: 6
Cats Disclaimer:
Dr. Luo was in wild form today and bounced around like crazy. That which
follows is my attempt to make some freakin sense out of the lecture. If you see
something wrong, mis-interpreted, or just plain whack, please contact me. My
goal is to make this a good learning experience for everyone. As such, Im open
to suggested changes/additions and welcome corrections.
catwommn@yahoo.com
Two diseases for today:

Hou bi (laryngitis or pharyngitis).
Er ming (tinnitus) and Er long (deafness)
Hou Bi
Introduction
Hou translates to pharynx and Bi translates to blockage.
The pharynx is divided into

1) nasal area-nasopharynx
2) back of the mouth oropharynx
3) larynx in the throat
Pharyngitis/laryngitis can manifest as either acute with pain, swelling, redness or as chronic which is
more often itching and/or dryness of the throat, some redness, some swelling.
Tonsillitis manifests as swollen tonsils which inflame, get red and are then visible in the throat in
various degrees of swelling
The Biomedical Perspective

Biomedicine defines this as a sore throat or acute pharyngitis, acute inflammation and infection
of the throat and/or tonsils. Symptoms include soreness or discomfort in the throat perhaps with
scratchiness, often with pain upon swallowing. It is most commonly a local infection either viral
(like EBV) or bacterial (like streptococcus), but can also be irritation of the pharynx by post-
nasal drip caused by allergies, sinusitis, etc. While everyone is susceptible, frequent recurrence
or chronic pharyngitis can signal underlying disorder such as diabetes, malnutrition or immune
disorder. Chronic pharyngitis can result from overexposure to environmental or occupational
irritants such as pollution, toxic chemicals, etc.
Approximately 30 million people per year suffer from some form of this each year. Thats about
10.7% of the population.
Symptoms and notes:

Acute infection, manifesting as redness, swelling in the throat with heat and pain.

Page 1 of 15
Chronic infection feels itchy, dry, and/or blocked. It is rarely painful and generally has no
swelling. It might very well fall into the category of plum pit Qi in TCM
Viral pharyngitis is often accompanied by cold, flu, nasal symptoms or cough + body
aches.
Can also be accompanied by EBV or Epstein Barr virus.
Note: EBV is frequently implicated in nasal cancers in Asia.
Streptococcal bacterial infection may also be present.
Note: kids most often have the strep type of throat infection. If left unchecked this will
eventually lead to kidney failure.
Lymph nodes in the back part of the throat may be involved. Look in the recesses by the
uvula.
Fever may be 101 or below.
Treatment is generally drug therapy, most often penicillin or erythromycin to treat bacterial
pharyngitis.
Tonsillitis is also redness,

swelling, and pain in the throat,
but with swollen tonsils. The
progression from uncomfortable
to really nasty goes like this:
1st swollen tonsils but

still in pharyngeal recess.
Swelling is minor.
2nd swelling out of

pharyngeal recess.
3rd swollen so much out

of recess that it covers the uvula. Crosses the midline of the throat. Chinese herbs Da qing
ye and Ban lan gen can treat these well. We grow these in the Chinese garden that
AOMA has.
Incidentally, in the image above the tonsil on the left side of the picture was labeled as a
bacterially infected tonsil. The one on the right was labeled as a non-bacterial or viral. And gray
furry tongue coat? Thats western med talking. Im betting its more yellow unless this person
has had this a really long time and has enough heat that the tongue coat is starting to look black
and burned.

Page 2 of 15
The TCM Perspective
Etiology
Invasion of External Pathogens
Yang Evils such as Wind, Heat, Dryness. Can also be an attack from cold which starts it.
Invasion of these external pathogens will directly attack the throat because they are the opening
from the body to the world. Remember that Lung is always attacked first it is the carriage
roof, the highest organ in the body. The lung opens to the external world through the nose and
throat.
Irregular diet
Spicy foods, Yang herbs
This introduces too much heat into the body. Irregular diet is related to Spleen and Stomach
meridians both of which cross the throatmore on that in a moment.
Overworking
This refers to over-use of the throat (musicians, teachers, speakers.my yakky aunts).
Overworking also impacts the Liver and Kidney. These too are connected to the throat with
Liver going to the back of the throat while the Kidney is further forward (anterior).
Mechanism
The mechanism is, generally speaking, either excess (including fire) or deficient heat.
Why heat causes blockage in the throat

Pain results from these blockages
Heat blocks the flow of Qi.

This refers to the way that heat causes the body tissues to swell which in turn blocks
the flow of Qi, causing the Qi to stagnate.
Heat causes the blood to stagnate

This is a thickening of the body fluids leading to thickening of the blood, slowing of
the flow and blood stasis.
Heat causes phlegm

This is a thickening of the body fluids due to heat too. In this case it becomes phlegm.
Note that pus is a special type of phlegm.
Im into cooking. There are recipes for sauces I use that start with a pretty watery
mixture which I then reduce or simmer until they get thick. This is what happens to
body fluids when they are reduced by heat down to phlegm.
Anything sticky like phlegm can cause a blockage as well.
Channels and Organs that are related to the throat which are affected by the heat.
While the Lung is the prime organ related to the throat, Liver, Kidney, Stomach,
Spleen and Kidney also cross through here and influence the area.

Page 3 of 15
Check this out again: the neck is a very narrow area. All of these channels coming
through here is like blocking lanes on Mopac prime place for a traffic jam!
Now lets add one other organ into the mix: San Jiao. San jiao is related to the
lymphatic system. If you have swollen lymph nodes in the throat, use SJ points to
drain the pus.
Other factors to consider when thinking about the Mechanism of Hou Bi

1) Pain occurs in Hou Bi due to one of the blockages listed above, but can also be a result of
malnutrition.
2) Cold may also cause blockage in the throat by contracting the area.
3) Stomach and Spleen deficiency (remember the ST and SP channels pass through this
area) can also cause blockage and pain here as can Wei Qi deficiency.
Acute
o Wind/heat invasion
External invasion of pathogens as discussed above.
o Symptoms for wind/heat invasion
Slight chills, high fever, sweating
Thirst with a desire for cold drinks
Hoarseness of voice with dry throat
Sensation of burning heat and throat soreness
Congestion of the retropharyngeal wall
Tongue: Red with red tip and thin yellow coat
Pulse: floating/superficial and rapid.
o Treatment:
Principle: Remove Wind-Heat and Benefit the Throat
Basic Treatment points listed below plus
UB 12, UB 13, Du 14 (possibly with bleeding/cupping), GB 20, SJ 5
Gua sha between Ren 22 and 23 with light stimulation downwards or back
and forththough Dr. Qiu says not to do that.
o Accumulation of Heat in LU and ST

This is internal heat causing blockage in the throat.
o Symptoms for accumulation of Heat in Lu and St
Thirst with desire for cold drink
Distinct sore throat with difficulty swallowing and thick sputum
If accumulation of heat is in Lung:
High fever
If from Stomach:
Bad mouth odor, toothache, bleeding gums
Constipation
Dark yellow urination
Tongue: red with thick yellow or brownish coat, could also be dry.
Pulse: fast, slippery.
Could be forceful if heat is from Stomach.

Page 4 of 15
o Treatment:
Principle is to remove heat from Lung or Stomach and benefit the throat.
Basic Treatment points listed below, especially LU 11, LI 1, LI 4, and P3
Blood letting at LU 11 and LI 1
Stomach heat. Use lower extremity points:
ST 44, ST 45, SJ 6 (for constipation)
Lung heat. Use upper extremity points:
LU 5, LU 7, LI 6 (luo pt which also connects w/the LI channel), LI 7 (xi
cleft to treat heat in Yangming)
o Basic Acute Treatment:

These are basic points for Acute treatment only
Needle:
Lung and LI points:
LU 5 (he sea), LU 10 (ying spring to clear heat), LU 11 (clear heat), LI 4
(external expel wind/heat), LI 11 (best to clear heat).
San Jiao points:

San Jiao points are good to remove heat because Shaoyang is the pivot
between interior/exterior. San Jiao is also good to remove swelling in the
lymph nodes and tonsils as San Jiao has a connection to the lymphatic
system.
Use: SJ-1 and SJ 3. Locally, use SJ 16 for the ears
Locally, use Ren 23, SJ 16 (which helps water metabolism and is around
the ears), SI 16 and 17 (for the tonsils window of sky points also clear
the heat and treat acute/sudden onset conditions)
Blood letting:
LU 10, LU 11 (release heat), SJ 1 (for emergency situations)
Both acute and chronic treatment points

Window of heaven points: Ren 22, ST 9, LI 18, SJ 16, SI16 and 17, UB 10
These promote circulation of Wei Qi. Also, window of sky points treat sudden
onset problems.
Chronic
o Chronic pharyngitis due to Yin Xu
More common form. This is a chronic inflammation of the pharyngeal mucosa and
submucosal lymphoid tissues, often due to ongoing treatment of acute pharyngitis, repeat
occurrence of upper respiratory infection (URT). Can also be related to a highly dusty
environment.
Symptoms:
Dry throat, on/off sore throat, itching of throat.
Cough, feeling of a foreign body in the throat
Thirst, preferring to sip water at night (yin xu symptom)
Hoarseness of voice
Page 5 of 15
Symptoms are worse after overworking or at night
Yin deficiency symptoms are included here:
hot flashes, low grade fever, 5 palm heat, restlessness, etc.
Tongue: red, thin, small, with cracks. Very little coat, thin yellow coat, or
mapped coating.
Pulse: Thin and rapid
Treatment:
Principle is to Nourish Yin, Remove Empty Heat and Benefit the throat.
Use Basic Chronic points below, plus
KID 3, SP 6 to nourish the Kidney yin
KID 1 (very good point with Moxa to bring Empty heat downward and
return it to its origin)
UB 43 and UB 53
LU 7 and KID 6
o Chronic pharyngitis due to Yang Xu

This is often the last stage of disease. Yang Xu retention of water in the throat. If water
fills in the throat, throat problems such as hoarseness and loss of voice. There will be
pain, but the pain will be less and deficient like. There may be lower body edema as well.
Symptoms:
Hoarseness, slight sore throat or dull pain that is off and on rather than
constant.
May be a total loss of voice
Yang Xu symptoms will accompany this:
Cold limbs, cold pain in the lower back and knees (but not too severe
because this is of deficient type), pale face, impotence, edema on the
lower limbs.
Might be slightly overweight
Tongue: pale, swollen with teethmarks; wet moist coat, perhaps white.
Pulse: deep, weak, slow.
Treatment:
Principle is to Warm the Kidney Yang, promote urination and remove
swelling.
Use basic chronic points, plus
KID 3, Ren 4, Du 4, Ren 6, UB 23 with moxa. You can also moxa Ren 4
and Du 4 with good result.
If swelling/edema is severe, use Ren 3, ST 28, UB 28
o Basic Chronic Treatment:

LU 7 + KI 6
This is to treat throat, Lung, and chest problems. This combination is the
confluential point of Ren and Yin Qiao channels respectively.
Both acute and chronic treatment points

Window of heaven points: Ren 22, ST 9, LI 18, SJ 16, SI16 and 17, UB 10
These promote circulation of Wei Qi. Also, this would count as a local
Page 6 of 15
treatment as well in many cases.
Tinnitus and Deafness
Introduction and Biomedical Perspective

Tinnitus and deafness can be due to conduction problems in the ear canal or drum or it can be due to
sensorineural reasons.
Conduction problems refer to blockages in the ear canal (cerumen, bugs no Im not kidding,
scar tissue, etc) or impairment of the ear drum.
Sensorineural deafness or tinnitus refers to a cranial nerve dysfunction (CN VIII, Auditory or
Vestibulocochlear nerve). This is very difficult to treat. Acute conditions are easier to treat than
chronic conditions of the ear. Remember all of the hearing tests from PA 2.
Fewer people suffer from tinnitus and deafness than from other diseases weve studied so far: 4.5%
tinnitus and 10% deafness.
Tinnitus is noise originating in the ear rather than in the environment. Deafness, by contrast, is a
profound hearing loss. Etiology can include external source such as noise or explosion or internal
reasons such as infection, blockage, Menieres disease, drug complications and tumors.
Symptoms include buzzing, ringing, roaring, whistling, or hissing in the ear. Treatment depends upon
the cause and may include drugs, surgery, hearing aids.
The TCM Perspective

From a TCM perspective, tinnitus is hyperactivity of ear function while deafness is hypoactivity of ear
function.
Etiology
Emotional disorder
o Anger
Anger either is due to hyperactive Liver function or causes hyperactive Liver function.
This leads eventually to Liver fire and the generation of inner wind which can manifest
as anger, vertigo, dizziness, wind stroke, Hemiplegia, anxiety, shaking/tremors,
Parkinsons, numbness of extremities, twitching, and more. Of course, the road map to all
of these is slightly different, but the upshot to it is that hyperactive liver function can lead
to impact upon the ears.
o Absolutely too much Yang.
This is anger leading to Liver fire and causing it directly. If Liver fire is
absolutely too much the result is Liver Yang Rising and inner wind.
o Yang is relatively too much
In this case the result is Liver Yin Deficiency, then causing Liver Yang to rise
which leads to inner wind.
o Stress and Depression
This is a hypofunction of the Liver, but the result is much the same. This hypofunction
leads to Liver Qi Stagnation, then to Liver fire which can take one of 2 paths: 1) Liver
Yin Xu Liver Yang Rising Inner wind or 2) Liver Yang Rising Inner wind.

Page 7 of 15
Finally, please note that Liver Blood Deficiency can result in the same thing. It either
jumps directly to Inner Wind or takes the path to Liver Yin Xu Liver Yang Rising
Inner wind.
Aging
Aging results in deficiency of the Spleen, Kidney Essence Xu (kidney opens to the ears), and
Zong Qi Xu.
Zong Qi is the Qi of the chest which collects and circulates Qi outwards. It is a combination of
clear Qi and Gu Qi. Gu Qi or Food Qi makes up Wei and Ying Qi as well. Wei and Ying qi are
the carriers of the Spirit/Shen and the Five Senses. When these become deficient, the hearing
suffers as well. This may be accompanied by deficiency in vision and sensations overall.
Overworking
Directly impact the Liver and Kidney and causes temporary Yin deficiency.
Irregular diet
Produces Heat and Phlegm Heat. If phlegm combines with Yang Qi flowing upwards rapidly
there can be a sudden blockage and very quick impact upon the ears.
Exposure to loud noises

o This could be considered an invasion of Yang pathogens. The five sense organs are
pathways for external pathogenic factors to enter the body, so Yang pathogens may enter
and stay to lodge in the ear.
o Excessive Liver Yang/Wind can lead to a blockage of the meridians.
o Allergies may also impact the hearing external Yang pathogenic influence.
Traumatic accident
Results in blood stasis and a blockage of meridians.
Mechanism
Ear
Because almost all Yang channels enter the ears, ear disorders are often Yang in nature. These
channels enter the ears.
o Gallbladder.
Gallbladder 2 point is directly anterior to the ear and is used to treat it as a local point.It
treats tinnitus and deafness. One branch of the GB channel enters the ear at SJ 17.
o San Jiao
One branch directly enters the ear. San Jiao points encircle the ear. SJ 3 is considered the
most important distal point to treat ear pathologies. SJ 17-21 are also points to treat ear
problems.
o Small Intestine
One branch of the SI channel enters the ear at SI19. SI 2 and 3 in conjunction with LI 6
are used to treat deafness/ear problems. SI 19 also is used to treat ear problems of any
kindtreats Shen problems too interestingly, in light of the emotion connection to ear
disorder.
o Bladder
A branch of the Bladder channel descends to the temples around the ears from Du 20, the
Page 8 of 15
vertex.
o Kidney
The Kidney organ opens to the ears through its association with the Du channel. Kidney
connects with the Du channel at the perineum, ascends the spinal column and goes to the
ears. Deficiency of Kidney Essence results in diminished hearing and tinnitus.
KI 1, 3 directly treat ear problems.
Qi that is related
Zong Qi is the Qi of the chest which collects and circulates Qi outwards. It is a combination of
clear Qi and Gu Qi. Gu Qi or Food Qi makes up Wei and Ying Qi as well. Wei and Ying qi are
the carriers of the Spirit/Shen and the Five Senses. When these become deficient, the hearing
suffers as well. This may be accompanied by deficiency in vision and sensations overall.
o UJ: Zong Qi
If deficient Qi cannot go upwards, cant think clearly, cant ascend Qi to ear and feels
blocked/rings.
o MJ: Clear Qi and Gu qi
o Wei and Ying Qi
Excess type: blockage of meridians around ears

Blockage comes from
o External noise
o Internal phlegm d/t improper diet
o Liver Yang rising which is an excess blocking the hearing
o Stasis d/t trauma or other
Deficient type: malnutrition of the ears.

o KI xu
o Zong qi xu or other Qi xu
o SP/ST xu.

Page 9 of 15
Differential Diagnosis and Treatment
There are 3 excess types of deafness/tinnitus and 3 deficient types.
The basic points to treat all tinnitus and deafness are as follows. Use these in addition to specific
treatments listed for the different differential types discussed afterwards.
Local Points SI 19, GB 2, SJ 21, SJ 17

Distal Points SJ 3, SJ 5, GB 41
Qigong can also be used for treatment: use the palms to create suction in the ears, then pull away
quickly. You can also use your palms to cover your ears with the fingers pointing at the nape of the
neck. Tap on the occiput to generate vibrations that can clear blockages.
Excess types
Excess types are more easily cured and get better results than chronic/deficient and age related types.
Liver and Gallbladder fire flaring up (which includes Liver Yang Rising)
This is an acute and excess heat seen often in teenagers and in military personnel (hmmm).
Dont overlook the fact that this includes both Fire and Yang Rising. Superficially the Liver Fire
type looks worse, but Liver Yang rising is worse and is more internal.
o Symptoms of the Liver Fire subtype:
This is general and superficial. This is heat in the Qi stage.
Acute onset
Clearly related to emotional disorder
Loud thundering noise or high pitch in ears
Liver fire symptoms such as
Anger
Irritability
Bitter taste in the mouth
Thirst
Hypochondriac pain
Tongue: red, redder on the sides with a yellow coating.
Coating is likely to be dry as heat of this nature dries the body fluids.
Pulse: wiry and fast
o Symptoms of Liver Yang Uprising subtype:

This is internalized, deeper, and localized. The heat here is in the Xue stage, one level
lower than the Liver Fire subtype. There may be no symptoms of thirst, dark yellow
urine, or constipation. There may not even be fast pulse. If the Liver Yang uprising came
from or is an intensifying of Liver Fire then you will see more fire signs but they will be
more severe than for the previous subtype.
Wind stroke cerebral bleeding
Blood/Xue is involved, leading to Shen disturbances
Throbbing headache, worse when lying down.
Dizziness, hypertension, vertibo
Irritability, anger, tossing and turning, restlessness, insomnia
Tongue is deeper red than Liver fire type, is even scarlet.

Page 10 of 15
Pulse is wiry and slippery
o Treatment:
Principle: Remove Liver/Gallbladder Fire, Subdue the Liver Yang and Benefit the ears.
Basic points under Differential Diagnosis and Treatment
Additional points:
GB 40, GB 43, GB 20
LIV 2, LIV 3, LIV 5
UB 18/19 (with sedation)
Phlegm fire flaring up

This too is an acute and excessive type of problem. Look at all of the phlegm related symptoms
below! Remember that phlegm is an advanced form of dampness, cooked down by heat. Pay
attention to the discharge symptoms, which helps you identify this type.
o Symptoms
Acute onset
Loud and noisy ringing in the ears
Like crickets or cicadas
Pressure or sharp pain in and around the ears combined with an ear ache or ear
infection.
Look for discharge yellow, sticky might be ear infection or allergic reaction
with turbid fluid. Could also be swimmers ear.
Heaviness of head and a foggy sensation (due to the phlegm affecting the head)
Tightness of chest and profuse mucous (again a phlegm sign)
Nausea and vomiting (that darned phlegm again!)
Cough with yellow sputum
Profuse vaginal discharge.
Constipation
Dark yellow urine
Tongue: red with yellow greasy coating that may be either thick or thin
Pulse: slippery, wiry, and fast.
o Treatment
Principle: Remove Phlegm Fire, Benefit ears.
Basic points at the beginning of the section
Additionally, add these points. The highlighted points are the key ones.
Ren 17, Ren 12 (helps ST/SP resolve phlegm)
ST 39, ST 40 (best point on the body to relieve phlegm)
SP 9 (resolve dampness)
LI 4, 11
GB 43
Traumatic accidents and Blood stagnation

This is the final type of acute and excess differentiation for tinnitus/deafness. This causes a
blockage of the channels around the ears.
o Symptoms:
Acute onset

Page 11 of 15
Clear history of traumatic accident
Concussion followed by ringing in the ears or deafness
Dizziness, fixed headache
Ringing in the ears is worse at night
Other symptoms present such as masses or a bruise
Tongue: purple or has purple spots
Pulse: hesitant/choppy.
o Treatment
Principle is to promote circulation, remove the Blood stasis, open the channels to benefit
the ears.
Basic points, plus
Additional points:
UB 17 (upper body and upper jiao/head nourishing in nature), UB 40
(excess conditions)
SP 10 (lower body and middle jiao)
SI 3 (opens to Du to melt the stasis)
UB 62 (opens the Du/Yang and moves Qi)
UB 40 SP 10 UB 17 are 3 key points for blood stasis.
Deficiency Types
Kidney Deficiency yin, yang, essence
This is a chronic and deficient differential diagnosis for tinnitus/deafness from Yin, Yang, (and)
or Essence deficiencies. Focus on the Yin xu type here with Liver Yang Rising. While liver yang
rising can be due to sudden excess liver hyperactivity such as anger, it can also follow Yin
deficiency which then flows to Yang rising. This is the more chronic pattern. Look at the
diagram below. Liver fire can also come from Liver Qi stagnation, a form of excess. Working
too hard for too long is another way to abnormally cause Yang to rise.
o General Symptoms for Kidney deficiency causing tinnitus/deafness

These are the basic symptoms. Add the following (essence, yin xu, yang xu) for a
complete picture.
Chronic onset, intermittent occurrence.

Page 12 of 15
Intermittent ringing that is high pitched like a whistle, not loud or like water
flowing.
Gradually leads to deafness.
o Kidney Essence Deficiency symptoms

General symptoms, plus
Dizziness
Vertigo
Weakness of lower back and knee joints
Hair loss
o Kidney Yin Deficiency symptoms
Hot flashes
Night sweating
Palm heat
Low grade fever
Steaming bone heat
Night emissions
Tongue: red body, small and thin in size with cracks and less coating
Pulse: thin and fast
o Kidney Yang Deficiency symptoms
Edema from lower extremities
Cold extremities
Pale face
Fatigue
Cold pain in the lower back
Water retention in the ears (?)
Tongue: swollen, pale, teethmarks with moist wet coat
Pulse: deep, weak, slow
Tinnitus and deafness from either age or overwork goes one of 2 ways:
1) Kidney Yin Xu Liver Yang Rising Tinnitus

2) Kidney essence Xu Deafness
Zong Qi Deficiency or Upper Jiao Deficiency

This is chronic and deficient. It is also the late stage of disease in which pectoral qi cannot
lift/warm. This is a combination of Lung, Heart, and Upper Jiao Qi and is thus a Qi deficiency.
This is rare to see since it happens so late. UB 20 and 21 are the source of Zong Qi.
o Symptoms:
Page 13 of 15
Chronic onset
May or may not have ringing in the ears
Decreased hearing which progresses to deafness
Zong Qi Xu:
Pale face
Fatigue, tired
Soft voice
Palpitations
Spontaneous sweating
Poor appetite
Shortness of breath
Numbness of extremities
Tongue: pale, swollen with thin white coat
Pulse: deep and weak, esp on the right side in LU and SP positions
o Treatment:
Principle is to Tonify Zong Qi, benefit the ears, and sharpen the five sense organs
Use the basic points plus
Additional points:
Ren 17
UB 13
UB 20 and 21 which are the source of Zong Qi
ST 36
LU 9
Heart Blood Deficiency

This is chronic and deficient. The heart houses the Shen. In the narrow definition, this includes
memory and concentration which is why heavy duty studying can negatively impact heart blood.
Lovely. In the broader view, this includes facial complexion, speech, tongue movement, eye
movement and the five sense organs. Brain is related to the shen as well, therefore memory is
related to Heart Blood and Kidney essence. Heart blood determines short term memory while
Kidney essence determines long term memory.
o Symptoms
Chronic type
Ringing is high pitched, not loud and is off and on. It is worse after over-working
Deafness
Floaters and blurred vision
Dizziness
Poor memory and concentration
Palpitations
Scanty and light menses
Fatigue
Pale nails
Tongue: pale, thin and small with a white coat
Pulse: thin and weak
o Treatment
Principle: Nourish the Heart Blood, benefit the ears and the Shen.
Page 14 of 15
Basic points for deafness/tinnitus
Additional points:
LIV 8 (nourish the blood)
UB 15 (back shu of the heart)
UB 17 (hui of blood)
Ren 14 (front mu of heart)
ST 36, SP 6 (nourish and generate Qi and Blood)
Final notes:
Most important is to know the different types of ear ringing causes.
Temporary situations can also cause tinnitus/deafness
o Deficient type can occur when a plane takes off causing energy and blood to go to the
feet.
o Excess type occurs when a plane lands and more pressure is in the head, causing energy
to quickly rise here.
Paper due Last Class!!!
HA: etiology/mechanism of diff headaches from BIO and TCM standpoints. Differentiation, dx, points.
About 4 pages.

Page 15 of 15
Pharyngitis & Tonsillitis (hou bi)
Throat blockage
LU-5; LU-10; LU-11; LI-4, LI-11; REN-23

Basic Points SJ-1; SJ-3 (SJ is good to remove heat b/c Shaoyang is pivot; also good to remove swelling
- Acute only- of lymph nodes/tonsils)
SJ-16 (ears); SI-16; SI-17 (tonsils)
Blood let LU-10; LU-11; SJ-1 (for emergency situations)
Chronic pharyngitis LU-7 + KID-6 (throat, LU, chest problems)
Window of heaven: REN-22; ST-9; LI-18, SJ-16; SI-16, 17; UB-10
Acute and Chronic (Promote circulation / Wei Qi)
> Super Sore Throat Spray (Shuan Liao Hou Feng San)
Patents > Liu Shen Wan *Caution: has a lot of very strong herbs & heavy metals (better to
crush & dissolve & apply drops to ulcers)
- Sl. chills, high fever, sweating Remove W-H, Benefit the throat
- Thirst, desire for cold drinks ---------------------------
Wind-Heat Invasion - Hoarseness of voice, dryness Basic points +
- Sensation of burning heat & soreness
of the throat UB-12, 13; DU-14; GB-20; SJ-5
- Congestion of the retropharyngeal wall Gua sha betw/ REN-22 & 23
(light stimulation: downwards, or back & forth)
T: Red w/ red tip
Acute > Si Ji Qin Pian
C: Thin yellow coat
P: Floating/superficial; rapid > Liu Shen Wan (be very careful in usage - very
strong & has heavy metals)
- Thirst, desire for cold drinks Remove Heat from Lung
- Distinct sore throat; difficulty in or Stomach organ,
swallowing; thick sputum Benefit throat
Accumulation of - If from LU: high fever
Heat in ---------------------------
- If from ST: bad mouth odor, toothache,
Basic points esp. LU-11; LI-1, 4; P-3
LU & ST gum bleeding
Blood letting: LU-11; LI-1
- Constipation; dark, yellow urination
Acute For ST-H [if H from ST, use lower pts]:
T: Red ST-44, 45; SJ-6 (constipation)
C: Thick yellow (brownish) coat, or dry
Can arise from: For LU-H [if H from LU, use upper extremity pts]:
P: Fast, slippery; could be forceful (ST
W-H type, or Heat) LU-5, 7; LI-6 (luo), LI-7 (xi-cleft) heat in YM
irregular diet.
> Zhu Huang San - external Tx
- Dry throat, sore throat off/on, itching Nourish Yin; Remove Empty Heat;
Chronic Pharyngitis of throat Benefit throat
- Cough, feeling of foreign body ---------------------------
due to obstruction in the throat
Yin Deficiency - Thirst; prefers to sip water at night Basic chronic points +
- Hoarseness of voice KID-3; SP-6
Chronic inflammation of - Sx are worse after overworking or at KID-1 (very good pt! Moxa to bring
pharyngeal mucous night Empty-Heat back to its origin)
membrane & submucosal
- Yin Xu Sx: hot flash, low grade fever, UB-43, 53
lymphoid tissues often d/t on-
going Tx of acute pharyngitis 5 palm heat, restlessness, LU-7; KID-6
or repeated occurrence of T: Red, thin, small w/ cracks
URT infection; related to high > Liu Wei Di Huang Wan
C: Less coat, or thin, yellow; or mapped
dust environment
P: Thin & rapid
- Hoarseness, sl. sore throat or dull pain Warm KID Yang; Promote
Late stage of dx Chronic Pharyngitis off/on
due to urination; Remove swelling
- May lose voice
Yang Deficiency - Yang Xu Sx: cold limbs, pale face,
--------------------------- Best to moxa:
Basic chronic points +
cold pain in low back/knees, Du 4, Ren 4
Yang Xu retention of
impotence, edema on low extremities KID-3; REN-4, 6; DU-4; UB-23
water; if fills in throat, Ren 17 maybe ok
w/ moxa
throat problems:T: Pale, swollen, teeth marks
slightly overweight often. Cold pain but not so severe due to xu.
1
hoarseness & loss of C: Wet, moist perhaps white If swelling/edema are severe: REN-3;
voice, less pain. P: Deep, weak, slow ST-28; UB-28
May also have edema of
> Jin Gui Shen Qi Wan
lower body.
Tinnitus (er ming) & Deafness (er long)

Tinnitus indicates hyperactivity of ear f(x) Deafness is hypoactivity of ear f(x)
Liver fire and Liver yang rising
Absolutely too
much yang LIV Yang Rising Inner Wind
HYPER
Anger LIV FIRE
LIV Yin Xu
Yang is relatively
too much
HYPO
Stress, LIV QI Yu LIV Xue Xu
Depression
1) HYPER = Anger LIV fire (anger causes liver fire directly)

2) HYPO = Stress, depression LIV Qi Yu long-term LIV Qi Yu LIV fire
3) In turn, LIV Fire: LIV Yang Rising (excess/absolutely too much LIV Yang), or
LIV Yin Xu (which can lead to LIV Yang rising Yang is relatively too much: Xu)
* LIV Yang rising d/t Excess or LIV Yang rising d/t LIV Yin Xu (combination)
4) LIV Fire may cause inner wind (quarrels/anger/personality triggers leading to dizziness/vertigotemporary
= functional d.o.)
5) LIV Yang rising from LIV fire Inner wind (wind stroke, hemiplegia)
6) LIV Yang rising from LIV Yin Xu Inner Wind (menopause: anxiety, shaking, )
7) LIV Yin Xu (no Yang relation) Inner wind (Parkinsons)
8) LIV Xue Xu may cause inner wind (mild, older people, numbness of extremities, twitching of skin, spasms
of legs)
LIVER FIRE LIVER YANG UPRISING

Internal (deeper),
General, Heat in the Qi stage Heat in the Xue
localized
superficial stage
- Thirst, desire for cold drinks, bitter taste, - Wind stroke = cerebral bleeding
red eyes, burning pain on - Xue is involved Shen disturbances
hypochondrium, constipation, dark - Throbbing headaches, worse when lying
Sx: yellow urine down, hypertension / high bp, dizziness,
vertigo, irritability, anger, tossing & turning,
T: Red body w/ red spots on sides restlessness, insomnia
C: Yellow T: Red or scarlet
P: Wiry, slippery, fast P: Wiry & slippery
* May not be any thirst, or dark yellow urine, or
* More on head, 5 sense organs, trunk, and constipation, or fast pulse
LJ
Superficially, LIV Fire looks worse, but If comes from LIV Fire or if comes from LIV
LIV Yang rising is, in fact, more internal Yin Xu, will see Sx of respective
and worse differentiations
Basic points for all Local: SI-19; GB-2; SJ-21; SJ-17

Tinnitus & Deafness Distal: SJ-3; SJ-5; GB-41
2
- Acute onset Remove LIV/GB Fire,
- Clearly related to emotional disorder Subdue LIV Yang,
LIV & GB Fire Flaring - Loud "thundering" noise in ears or high pitch Benefit ears GB 2
LIV Yang Rising (is - LIV fire symptoms (anger, irritability, bitter taste,
---------------------
included) thirsty, hypochondriac pain, etc)
- Or LIV Yang Rising Sx Basic +
- Pressure around ears GB-40, 43, 20
Acute, Excess
T: Red, redder on sides LIV-2, 3, 5
Seen often in: C: Yellow UB-18, 19 (sedate)
teenagers & military P: Wiry & fast
- Acute onset Remove Phlegm Fire,
- Loud & noisy ringing, like crickets or cicadas Benefit Ears
- Pressure or sharp pain in/around ears combined ---------------------
w/ ear ache or ear infection (yellow, sticky
Phlegm Fire discharge): ear infection or allergy related; turbid Basic +
Flaring Up fluid inside; swimmer's ear
- Heaviness of head; foggy sensation REN-17, 12;
- Tightness of chest & profuse mucous ST-39, 40
- Nausea, vomiting; cough w/ yellow sputum SP-9
Acute, Excess LI-4, 11
- Profuse vaginal discharge
- Constipation; dark yellow urine GB-43
T: Red C: Yellow, greasy: thin or thick
P: Slippery, wiry, fast
- Acute
Promote circulation,
- Clear hx of traumatic accident Remove Xue Stasis; Open
Traumatic accidents w/ - Concussion, followed by ringing or deafness Channels to benefit ears
Xue Stagnation - Dizziness, fixed headache -----------------
(blockage of channels - Ringing worse at night Basic +
around the ears) - Other Sx: bruise, masses,
UB-17, 40; SP-10
SI-3; UB-62 (open DU/Yang to move
T: Purple or w/ purple spots Qi)
Acute, Excess P: Hesitant (se mai: same as choppy in some texts)
> 3 pts for Xue Stasis:
UB-40 SP-10 UB-17
- Chronic onset; intermittent Strengthen lower back; Tonify
- Intermittent ringing: high pitch (like whistle), not KID; Benefit Ear
loud or like water flowing ---------------------
- Gradually leading to deafness
KID Xu: + KID Essence Xu: dizziness, vertigo, weakness Basic Pts +
Yin, Essence, or Yang of lower back and knee joints, hair loss
+ KID Yin Xu: hot flash, night sweating, palm KID Essence Xu: KID-3; SP-6;
heat, low grade fever, steaming bone, night GB-39; DU-15, 16 (sea of marrow)
emissions, red tongue body, small and thin in
size, cracks, less coating; thin & fast P KID Yin Xu: basic + Essence
Chronic, Deficiency + KID Yang Xu: edema from lower extremities, pts + KID-6, 1; UB-43, 52
cold extremities, pale face, fatigue, cold pain on
the lower back, water retention in the ears; T: KID Yang Xu: basic + Essence
swollen, pale, teeth marks, moist & wet coat; P: pts + UB-23; DU-4; REN-4, 6
deep, weak, slow
- Old age / overwork related
KID Yin Xu LIV Yang ^ tinnitus
KID essence Xu deafness
3
Zong Qi Xu or - Chronic onset Tonify Zong Qi,
Upper Jiao Xu - May or may not have ringing in ears Benefit ears / Sharpen 5 sense
- Decreased hearing, until it progresses to deafness organs
- Zong Qi Xu: Pale face; fatigue/tired; soft voice; ----------------------
Chronic, Deficiency
palpitations; spontaneous sweating; poor Basic pts +
> Zong Qi in charge of skin appetite; SOB; numbness of extremities
sensations and f(x) of 5 sense REN-17; UB-13; UB-20; UB-21
organs T: Pale, swollen C: Thin, white ST-36; LU-9
> = Da, Wei, and Ying Qi P: Deep & weak esp. on R side (in LU & SP)
HT Xue Xu
- Chronic Nourish HT Xue;
- Ringing: high pitch, not loud, off/on; worse after Benefit ears and Shen
Chronic, Deficiency
over-working ----------------------
Heart houses Shen: - Deafness
Narrow definition: memory - Floaters, blurred vision Basic +
& concentration - Dizziness, poor memory & concentration,
Broad: includes facial palpitations LIV-8; UB-15, 17;
complexion, speech, tongue - Scanty, light menses REN-14; ST-36; SP-6
movement, eye movement, - Fatigue
and 5 sense organ f(x) - Pale nails
Brain houses Shen: T: pale, thin, small C: white

therefore memory related to P: Thin, weak
HT Xue and KID Essence:
HT Xue (short term), KID
Essence (long term)
4
1
Hou Bi (Pharyngitis & Tonsillitis )
Er Ming (Tinnitus ) & Er Long (Deafness)
2
TCM
Etiology
Invasion of external pathogens Yang evils-W/H/Dryness

Irregular diet spicy /Yang herb
Overworking
Mechanism
Excessive /Deficient Heat
Why heat blockage occurs in the throat ?
Blocks flow of Qi
Blood stagnation
Body fluids ( phlegm )
Channel &Organs: LU + LIV, LI, ST, KID, SP
San Jiao related to lymph system
3
LI Channel ST Channel
4
Sp Channel Liv Channel
5
6
Acute Wind-Heat Invasion
Accumulation of Heat in LU & ST
Chronic Chronic Pharyngitis due to Yin Deficiency
Chronic Pharyngitis due to Yang Deficiency
Treatment
Basic points
Acute Filiform LU&LI(LU-5; LU-10; LU-11; LI-4, LI-11);

Topical(REN-23/SJ-16/SI-16/SI-17)
Blood let LU-10; LU-11; SJ-1
Chronic LU-7 + KID-6 ?
Combination REN-22; ST-9; LI-18, SJ-16; SI-16, 17; UB-10

7
TCM
Etiology
Emotional disorder
Aging
Overworking
Irregular diet
Exposure to loud noises
Traumatic accident
Mechanism
Ear: Channels GB, SJ, SI, BL (at DU-20 branches to ear) Organ KID
Zong Qi/ Clear qi &Gu qi /Wei & Ying qi
Blockage of meridians around the ears Excess type

Malnutrition of the ears Deficient type
8
Excess: LIV & GB Fire Flaring
Phlegm Fire Flaring Up
Traumatic Accidents +Blood Stagnation
Deficiency: KID Xu (Yin/Yang/Essence)
Zong Qi Xu
Heart Xue Xu
Treatment
Basic points-- Local (SI-19; GB-2; SJ-21; SJ-17)
Distal (SJ-3; SJ-5; GB-41 )
Differential Treatment
Note
More excess = more yang = more blockage related----good result
More excess tends to be tinnitus--------------------------- good result
More xu tends to be deafness--------------------------------bad result
9
Course: Acupuncture Treatment of Disease 1 Date: November 3, 2008
Class #: 7
Quiz 2 next week. Look at all of the cases he has given us in class. Pretty complex.
Gao Xue Ya Hypertension

Palpitations Xinji and Congestive Heart Failure.
Hypertension Gao Xue Ya
Biomed and Introduction

About 20% of Americans suffer from hypertension. By definition this is a systemic circulation problem,
often due to arterial constriction or hardening. Normal and abnormal readings are shown below.
Bear in mind that blood pressure fluctuates during the day. 90-130 is better for systolic than shown
above and 60-80 is better for the diastolic pressure. As a rule the highest pressures for people are midday
and the lowest pressures between 3 and 4 in the morning.
There is another class of folks myself included whose highest pressures will be recorded 6 9 am.
Mine was lowest in the evenings around 8pm.
Etiology Primary 85 90%, Secondary 10-15%. Symptoms are mostly unrecognized for what they
area. Headaches are a sign of hypertension. The hypertension itself isnt so bad, but the organs it impacts
take a large hit over time. Click here for a good article on the complications of long term hypertension.
Heart works very hard and left ventricle enlarges. On an X-ray the heart starts looking like a
ski boot shape. Left sided heart failure is possible as a result. Also arterio- and atherosclerosis,
aneurysms, coronary artery disease.
Brain brain vessels get thick and large and cause aneurisms, strokes, TIAs, dementia, mild
cognitive impairment.
Page 1 of 8
Eyes high pressure in the vessels breaks them causing blindness in varying degrees
retinopathy, fluid build up under the retina, and nerve damage.
Kidney long term hypertension affects vessels here too causing bleeding out in the kidney,
kidney failure, scarring and kidney arterial aneurysm.
Treatments include diuretics, ACEI, calcium channel blockers.
To take blood pressure, have patient rest about 5 minutes, be sure they havent smoked for 15 minutes
(Mandyam says 1 hour. See the Physical Assessment 1 information on blood pressure for best info.)
TCM How to understand this
Etiology
Emotional disorder
Liver Yang or Fire rising up. Can also be caused by Liver and Kidney Yin deficiency
which allows the Yang to rise abnormally.
Irregular Diet
Fat, greasy and spicy food diet. Irregular diet will cause phlegm and water buildup in the
Lung, Spleen and Kidney, the water related organs.
Too much water and phlegm is the equivalent too much fluid in a hydraulic system. Too
much pressure in the system causes hypertension.
Cut back on salty, greasy foods, even raw foods which will weaken the Spleen and
depress its ability to make the water metabolism work correctly.
If the Kidney is Yin deficient will cause Liver Yin to be deficient as well. This is yin xu
in the Lower Jiao causing the Yang to rise. Encourage patients in this state to sleep
regularly and at night, not staying up too late or the Kidney Yin will be further depleted.
And also, quit the night shift!
Lung is affected as well it is the dispersal organ. If it cannot disperse fluid metabolism
is all messed up also.
Liver is also related to hypertension Liver Qi yu or Liver Yin xu will cause the vessels
to lose flexibility which drives blood pressure up as well.
Overwork
Impacts the Kidney, Liver, Heart and Spleen.
Weve talked about Kidney, Liver and Spleen. Heart Qi or Zong Qi/pectoral Qi pushing
too much or not enough will also cause hypertension. Heart fire pushes the blood forward
too much and too fast which can also cause hypertension.
Have you noticed that all 5 Zang organs have been involved now? Aint that a bummer?

Page 2 of 8
Age
Medication
Mechanism
Excess in the upper part of the body with deficiency on the lower part of the body. This imbalance is the
basic mechanism for hypertension.
Deficiency
Mostly due to Liver Yang rising Liver/kidney Yin xu (the most common reason for
hypertension) causing the Yang to rise. Yin is getting less and cannot anchor the Yang which
then goes to the highest part of the body. Thats the deficiency in the lower part.
Excess
Liver Yang rising up becomes an excess in the upper body. Also, if patient is overweight theres
a retention of damp and phlegm which is also excess.
The Dai channel is the dividing line between upper and lower. As a result, you choose Dai channel
points, especially GB 41+SJ5 to balance the upper and lower.
Differential diagnosis
Excess:
o Liver fire
o Excessive Liver Yang Rising
o Wind-Phlegm
Deficiency
o Liver and Kidney Yin Xu with Liver Yang Rising
o Kidney Yang Xu
Kidney Yang deficiency results in an inability of the Kidney to warm the water. It will be
unable to nourish Wood which dries Wood out and makes it deficient. Liver and Kidney
have the same source per the Nei Jing closely related. If Liver has a problem then the
Liver Yang rises.
Treatment
Note the Yangming points regulates Qi and blood. Sanjiao and foot shaoyang points help water
metabolism related to hypertension. P6 is used to regulate Heart Qi . GB 20 is about wind. Mostly use
reducing in the upper body and more tonification in the lower body.
Treatment for different syndromes below use special points per syndrome plus the Basic points above.

Page 3 of 8
Liver Fire
Heat signs. We discussed this last week. Look at the differences between Liver Fire and Liver
Yang below. See that Liver Yang Rising is the same, but more severe.
Liver 2 is a ying spring point and is key for this syndrome. Note UB 18 for Liver fire, not liver
yang. Bleeding is a choice as is Gua sha at Liver 2.
Liver Yang
More severe and advanced than Liver Fire. Headache is throbbing, dizziness/vertigo is more
severe, more shen disturbance than Liver Fire.
Liver 3 instead of Liver 2 nourishes Liver Yin more. This is the special point.
Du 20 is good for wind and vertigo. Use a reducing method here. Du 16 is wind residence point,
so this is for wind too, as is GB 20.
Upward Disturbance of Wind-Phlegm
Notice the nausea/vomit middle jiao damp, water and phlegm retention. Mucous too.
ST 40 and UB 20 are good points to make the Spleen Qi stronger and resolve phlegm. SP 2 and 3
nourish the spleen to reduce water.

Page 4 of 8
Liver and Kidney Yin Deficiency with Liver Yang Rising
Not only Liver fire can cause Liver Yang to rise more heat signs there but also Liver/Kidney
Yin Xu can cause Liver Yang to rise because theres not enough Yin to balance/control.
Liver 3 is a key point for this condition. Kidney 3 is another. Kidney 7 is for night sweating,
Kidney 10 is He Sea. UB 18 is the back shu of Liver and nourishes.
Kidney Yang Deficiency

Look for the cold signs plus the knee and waist symptoms. Also, pulse is different. Du 4 and Ren
4 are the key points. Promote urination points to reduce water excess. ST 28 is the water
passage point. UB 22 for SJ back shu application. UB 28 is the back shu of the Bladder. Again,
use the basic points, plus these points.
Treatment
Basic points, plus points for specific syndrome.
Auricular acupuncture: shenmen, liver area, kidney, sympathetic, liver yang point (excess
condition), and tip of ear on the front of the ear and lower pressure groove on the back of the ear.
Herbs: tian ma gou teng yin formula. This is a liquid used to extinguish wind/control phlegm,
cool the blood. Zhen gan xi teng tang decoction to calm liver and extinguish the wind
Control the diet.
Qigong
In emergency condition, refer to western doc right away.

Page 5 of 8
Palpitations Xinji / Congestive Heart Failure Xin Li Shuai Jie
Biomedical View and Intro to Congestive Heart Failure

Heart and Lung circulation is closely related. The disfunctionality of one affects the other. Remember
that hypertension causes left sided heart enlargement and eventually left sided heart failure. Blood will
eventually back up here. Pulmonary hypertension causes right sided heart failure as the heart cannot
push blood to the lungs. Pulmonary hypertension follows cardio-hypertension. This causes wide-spread
water circulation problems.
Know that left side heart failure = wake up in the middle of the night, shortness of breath to get more
oxygen to the lungs.
Right sided heart failure = lower legs swollen with pitting edema because heart cannot push blood to the
lungs.
The incidence of CHF increases with age. 2% for 40-59 yo, 5% for 60-69 yo, and 10% over 70 yo. CHF
is often due to smoking and is the 3rd stage of Lung/Heart disease. CHF occurs due to aninability of the
heart to pump sufficient blood to the bodys other organs. This can result from
Narrowed arteries
Past heart attack or MI causing scar tissues on the heart.
High blood pressure
Heart valve disease due to past rheumatic fever or other cause
Primary disease of the heart muscle - cardiomyopathy
Heart defects at birth
Infection of the heart valve or heart muscle endocarditis or myocarditis.
Any part of the heart having problems can cause heart failure.
Smoking is a high risk activity causing cardio-pulmonary complications. Other diseases can cause lung,
heart and blood vessel damage leading to CHF.
Symptoms are both pulmonary and systemic.

Pulmonary (left heart failure SOB, sudden dyspnea at night, phlegm which may be pink) is
lung
Systemic (right heart failure fatigue, pitting edema) is whole body.
Treatment depends upon cause hypertension, MI, valve dysfunction, etc which is treated first. Then
perhaps diuretics, ACEI (ace inhibitors), Beta blockers, digoxin, and aocoafulants.
Prognosis is very poor indeed.
TCM View of Congestive Heart Failure

Etiology
Invasion of external pathogens
Over-working
Congenital factors

Page 6 of 8
Mechanism
Combination of Excess and Deficiency of the Heart
o Deficiency
Heart Qi xu easily fatigued and SOB
Heart and Kidney Yang Xu
Lung/spleen/kidney deficiency - Edema
Lung - Cough
o Excess
Blood Stasis: Purple lips, etc
Water/damp/phlegm
Treatment
Basic points:
The following 2 syndromes are examples. There are more reasons than this
Heart Qi Deficiency with Retention of Blood Stasis
Fatigue above is pretty severe. Heart sweat = heart Qi too weak to control the fluids of the
body. Heart Qi xu causes blood not to push forward in the body, so causes stasis. Cyanosis =
purplish due to lack of oxygen. Pulse will be very weak.
Use heart back shu/front mu + Heart 7 to nourish heart yin. UB 17, SP 10 to address blood stasis.
Blood stasis is Yin in nature blood becomes cold and stagnant open the Du channel (SI 3,
UB62) to warm the blood and melt the stasis.

Page 7 of 8
Heart and Kidney Yang Xu with Retention of Water
Dont confuse with Ht/KI disharmony, which is a Yin Xu! Look at all of the cold stuff below.
You might find edema in the upper body in this syndrome as Yang gets weak and cannot move
the water around. Edema is the hallmark symptom.
Ren 4, Du 4 are primary points. Ren 6 is the ocean of the Qi. UB 28 and ST 28 will control water
in the body. This is for severe edema. As is Ren 9, the water division point, which refers to
Herbs: ginseng 10g, huang qi 30g, ren shen 10g (tonify qi), dan shen 10g (for blood yu), chuan
xiong to move blood, Wu Wei zi.
Moxa box on the heart back shu points for Yang xu. Moxa at Ren 17 to warm the chest.
Bear in mind that for heart patients with weakness cannot use strong stimulation.
Quiz 2:
40 MC. Cover everything after Quiz 1. Review all case discussions very carefully. Know diff
between Ht/KI disharmony (yin xu), and Kidney yang xu.
A whole bunch of freakin case studies.

Page 8 of 8
1
Hypertension
Biomedicine
Definition Systemic Circulation/Artery/140/90mmHg(18.6/12Kpa)
Systolic Pressure Diastolic Pressure
Classification (mmHg) (mmHg)
Normal 90-140 60-90
1st grade 140-159 90-99

(mild)
2nd grade 160-179 100-109
(medium)
3rd grade >=180 >= 110
(severe)
1mmHg=0.133 Kpa 2
Hypertension
TCM
Etiology
Emotional disorder--Liver
Irregular diet--Fat/Greasy/Spicy food
Overworking-- KID, LIV, HT, SP
Age
Medication
Mechanism
Factors involved in maintaining blood pressure-- KID /HT /LIV
Excess on the upper part of the body, Deficiency on the lower part of the body
Hypertension is a blood disorder involving the HT, LIV, & KID
Discussion
3
Excess: LIV Fire /Excessive LIV Yang Rising/ Wind-Phlegm
Deficiency: LIV & KID Yin Xu LIV Yang Rising/KID Yang Xu
Treatment
Basic Points LI-4; LI-11; ST-36; ST-9;

GB-41 1st + SJ-5
P-6
GB-20
Kidney ?
Food Therapy
Qigong
Auricular acupuncture
4
Congestive Heart Failure
TCM
Etiology
Invasion of external pathogen

Over-working
Congenital factors
Mechanism
Combination of Excess and Deficiency of the heart
5
Deficiency: Heart Qi Xu /Heart and Kidney Yang Xu
Excess: Blood Stasis/ Retention of Water
Treatment
Basic points REN-14, UB15
REN-17; UB-14
P-6
SJ-5
6
Case Discussion
CASE 1 CASE 2
Pulse thin and fast. The rear Pulse deep, choppy,weak
position on both sides were deep. and slow
7
CARDIOVASCULAR SYSTEM
Congestive Heart Failure (CHF) / Palpitations (xin li shuai jie / xin ji)
Basic points REN-14, 17; UB-14, 15; P-6; SJ-5 (luo) [P-6 SJ-5]
- Chronic: off/on symptoms Tonify Heart (& LU) Qi / Zong
- Fatigue, exhaustion; SOB; soft voice; Qi, Promote Xue Circulation,
spontaneous sweating Remove Xue Stasis
Heart Qi Xu with - All Sx worse w/ exertion
Retention of Xue - Pale face; palpitations ----------------------------
- Cyanosis Basic +
Stasis UB-17, 40; SP-10; HT-7 (yuan)
- Chest tightness or suffocating feeling or dull
pain in chest
Also:
Deficiency + Excess, T: Purple, or pale & purple (may have dark blue REN-14, 17; P-6; UB-14, 15, 17, 40
Chronic and swollen veins ) LIV-8
C: Thin, white coat SI-3, UB-62 (Circulate Qi, open DU)
LU-7, KID-6 (Open REN)
P: Weak, deep, or hesitant
- Chronic onset worse than and can arise from Warm Heart and KID Yang,
first type Promote Urination,
- Palpitations (bradycardia - slow rate) Remove Edema
Heart and Kidney - Cold extremities, cold sensation in knees, low
Yang Xu with back and betw/ scapulas (Heart Yang Xu)
---------------------------
Retention of Basic +
- Impotence, scanty and difficult urination, or
Water profuse and frequent urination REN-4, 6; DU-4; UB-23; DU-9 w/
- Retention of urine or incontinence of urine moxa
- Edema in whole body especially in lower
extremities If edema is severe: REN-3; UB-28;
Deficiency + Excess, ST-28; REN-9; KID-2; UB-63 to
T: Pale, swollen body w/ teeth marks
Chronic promote urination
C: White, wet, moist coat (d/t phlegm)
P: Very deep, weak and slow or deep, slippery,
w/o strength [Hidden (fu mai)]
Hypertension (gao xue ya)

[gao = high; xue = blood; ya = pressure]
1. San Jiaos 2 Systems (based on theory by Dr. Lin Yaoxin)
mother
LU son son HT Left
Xue & yin axis
Right - Endocrine d.o.
Qi & Yang axis - Mental &
- Immune system SP mother mother LIV emotional sys.
- Metabolism son son - Autoimmune d.o.
KID mother KID
* Hypertension is a blood disorder involving the HT, LIV, & KID

Discussion
A. HT, LIV, KID blood disorder axis of blood, yin, essence
B. Excess (yang) on upper part; deficiency (yin) on lower part of body (rebellious qi & blood go upwards)
C. Mother son disorder (water wood fire)
D. Extra meridians: Dai meridian regulates upper & lower
> Thus, GB-41 + SJ-5 used to soothe, open, and dredge Dai Vessel (which controls all vertical meridians) to
adjust imbalance of the upper and lower parts of the body
1
Definition Hypertension (as defined by WHO) = presents w/ the following bp: systolic > 140; diastolic <
90
Could be high systolic & diastolic (i.e. 130/95); or high systolic only (i.e. 150/85) or high
diastolic only
BP should be taken 3 times (at various times of the day in different places w/ different
machines) to confirm high bp
2. Differential Diagnosis and Treatment

Basic Points LI-4; LI-11; ST-36; ST-9; GB-20; P-6
Also: GB-41 1st + SJ-5 (Dai meridian)
- Hypertension Purge LIV Fire
- Severe headaches; red eyes; red face ----------------------
LIV Fire - Dry mouth; bitter taste in mouth; vertigo
- Constipation DU-20; LIV-2; UB-18; KID-3
> More superficial, more heat
than LIV Yang Rising T: Red w/ yellow dry coat > Long Dan Xie Gan Wan
P: Wiry, rapid
- Hypertension Strengthen SP;
- Headaches; dizziness; severe vertigo; Dispel Phlegm; Extinguish
- Vomiting; nausea; turbid mucous disturbs Wind
Upward Disturbance head; thoracic oppression ----------------------
of Wind-Phlegm
T: White, greasy coat P-5; REN-17; SP-2, 3; ST-40
P: Wiry slippery UB-20
> Ban Xia Bai Zhu Tian Ma Tang
- Hypertension Subdue LIV Yang
Excessive LIV Yang - Throbbing headache; dizziness; vertigo ----------------------
Rising (absolute) - Irritability; restlessness
DU-20, 16; GB-20
From LIV Fire (total excess) T: Scarlet or dark red LIV-3 + SJ-5
C: Yellow or with some cracks SP-6
> More spirit related, deeper P: Wiry or slippery
than LIV Fire
Nourish LIV & KID Yin;
LIV & KID Yin Xu w/ - Hypertension Calm LIV Yang
- Dizziness; vertigo; dry eyes; blurred ----------------------
LIV Yang rising vision
= Hyperactivity of LIV - Night sweats; numbness of limbs; LIV-3, 14
Yang d/t LIV & trembling hands; tinnitus KID-3, 7, 10
KID Yin Xu Taiyang; UB-18
T: Red w/ thin yellow coat
P: Thready, rapid > Zhen Gan Xi Feng Tang
(Relatively too much Yang) > Qi Ju Di Huang Wan
- Hypertension Warm KID Yang;

- Cold limbs; cold sensation or aversion to Promote urination
cold; sore/ weak low back, knees; ----------------------
KID Yang Xu impotence
- Dizziness; vertigo; w/ edema in the face REN-3; UB-28; ST-28
Failure to promote & lower extremities; retention of Moxa REN-4, 6; UB-23; DU-4
urination edema urination; pale & lustrous face (water UB-22, 40, 60
blood volume retention)
increases
T: Pale, swollen w/ teeth marks
C: Moist
P: Deep, weak, slow, esp. right rear
position
2
Absolutely too
much yang LIV Yang Rising Inner Wind
HYPER
Anger LIV FIRE
LIV Yin Xu
Yang is relatively
too much
HYPO
Stress, LIV QI Yu LIV Xue Xu
Depression
1) HYPER = Anger LIV fire (anger causes liver fire directly)

2) HYPO = Stress, depression LIV Qi Yu long-term LIV Qi Yu LIV fire
3) In turn, LIV Fire: LIV Yang Rising (excess/absolutely too much LIV Yang), or
LIV Yin Xu (which can lead to LIV Yang rising Yang is relatively too much: Xu)
* LIV Yang rising d/t Excess or LIV Yang rising d/t LIV Yin Xu (combination)
4) LIV Fire may cause inner wind (quarrels/anger/personality triggers leading to dizziness/vertigotemporary
= functional d.o.)
5) LIV Yang rising from LIV fire Inner wind (wind stroke, hemiplegia)
6) LIV Yang rising from LIV Yin Xu Inner Wind (menopause: anxiety, shaking, )
7) LIV Yin Xu (no Yang relation) Inner wind (Parkinsons)
8) LIV Xue Xu may cause inner wind (mild, older people, numbness of extremities, twitching of skin, spasms
of legs)
LIVER FIRE LIVER YANG UPRISING

Internal (deeper),
General, Heat in the Qi stage Heat in the Xue
localized
superficial stage
- Thirst, desire for cold drinks, bitter taste, - Wind stroke = cerebral bleeding
red eyes, burning pain on - Xue is involved Shen disturbances
hypochondrium, constipation, dark - Throbbing headaches, worse when lying
Sx: yellow urine down, hypertension / high bp, dizziness,
vertigo, irritability, anger, tossing & turning,
T: Red body w/ red spots on sides restlessness, insomnia
C: Yellow T: Red or scarlet
P: Wiry, slippery, fast P: Wiry & slippery
* May not be any thirst, or dark yellow urine, or
* More on head, 5 sense organs, trunk, and constipation, or fast pulse
LJ
Superficially, LIV Fire looks worse, but If comes from LIV Fire or if comes from LIV
LIV Yang rising is, in fact, more internal Yin Xu, will see Sx of respective
and worse differentiations
Class #: 8 Diabetes and Hyperthyroid
Diabetes
Xiao Ke
Xiao Ke is wasting/emaciation and thirsting. The Chinese translation is tang liao bing which equals
diabetes. The term diabetes is actually of Greek and Roman origin and means sweet urine. In China
one of the tests for diabetes was to put urine on a rock in the sunshine to dry. If ants or bees were
attracted to it this was considered to be a positive diagnosis for sugar in the urine.
Biomedicine acknowledges 2 types of diabetes (though I remember some chat in Pathophys about a new
type that some doc had defined).
1) Type I or Type A Diabetes.
Patients with this type are dependent upon insulin. This is an auto-immune disease in which beta
cells in the pancreas are destroyed and cant secrete insulin. Insulin helps the cells absorb blood
sugar which is the fuel for cell-produced energy. Because no insulin is produced there is a need
for regular external sources of insulin. This type of diabetes is usually diagnosed before the age
of 20 yrs. The prognosis for this type is very poor and usually results in kidney failure.
2) Type II or Type B Diabetes

In this disease the pancreas can still produce insulin, but not enough to support the body. This is
generally diagnosed over the age of 50 (though the incidence of this is rising due to the crappy
ass American diet). 90% of diabetes diagnosed is Type II. This type of diabetes is mostly
controlled through regulation of the diet rather than on insulin injections or oral doses.
Acupuncture helps a lot too.
Page 1 of 13
Biomedical mechanism
Biomedically speaking, energy of the body comes from sugar which is carried by insulin into the cells.
Insulin insufficiency results in glucose being retained in the blood which is a great breeding ground for
bacteria. This can manifest in dermatitis, carbuncles, furuncles, rashes. If you test the urine there will
also be sugar here. Insulin also assists the body in the use of fats and proteins. Without insulin fat and
protein are not used properly. This factor plus the inability to use sugars can result in a bad apple
smell.
When sugar in the blood is too high for too long the heart suffers by damaging the vessels and tissues.
Brain suffers from stroke due to damage to the vessels. Kidney loses ability to function due to the same
problem vessel damage. Bacteria feed on the sugary environment causing infection and gangrene in
the distal areas of the body. This can be a very significant thing to know for acupuncturists! You can
actually introduce bacteria into this sugar-rich environment if you clean needle technique is not so good!
Eyesight is lost because vessels in the eye bleed out. (Remember that in TCM the eyes are associated
with the Liver.)
What is normal?
Blood sugar should be 126 mg/dl when fasting and 200mg /dl 2 hours after a meal.
Symptoms:
Polydipsia excessive thirst. Polyuria excessive urination. Polyphagia excessive appetite. When the
cells arent getting sugar due to lack of insulin, they signal the need for more food and so the patient eats
a lot. Sugar molecules are really big and are floating around in the blood stream, which the Kidney
filters. It takes a lot of fluid to flush those sugar molecules through the Kidneys filters, hence the high
thirst and urination.
A person need the thyroid hormones T3 and T4 in order to use insulin. When sugar is not used properly
the body begins to burn fat for energy resulting in emaciation. When patients take insulin they no longer
exhibit the typical symptoms of diabetes (polydipsia, polyphagia, polyuria + emaciation).
You may also see patients who are overweight but have diabetes. This could be due to Qi and Yin xu or
blood stasis.
Miscellaneous statistics on diabetes in the US:

Its on the rise. About a third is not diagnosed. This makes the complications harsher and more
expensive both to individuals and to the society. The death rate is twice as high with diabetes as it
contributes to other diseases. Native Americans and Eskimo populations suffer a 3x higher incidence of
diabetes than other ethnic groups. Mexican Americans clock in around 10.6%, African Americans at
10% and Caucasians at 7%.
Magnesium, sugar, and other nutrients all depend upon insulin to get into the cells.
There are 2 classes of drugs for diabetes: one type causes the pancreas to produce more insulin while the
other type is insulin itself.
It is important to find out how long ago your patient was diagnosed and whether they are insulin
dependent or not.
Page 2 of 13
For the NCCAOM boards, you should know this synopsis:
Shang Xiao or Upper Jiao

Impairment of body fluids in the Lung
Excessive thirst, sweating, urination
Dont confuse this with epidemic febrile disease!
Xiao Ke Fang
Zhong Xiao or Middle Jiao

Excess blazing heat in the Stomach: over-eating/polyphagia with increased
appetite
Dont confuse this with hyperthyroidism!
Yu Nu Jian is chronic
Zeng Ye Cheng Qi Tang for acute with dry-constipation
Xia Xiao or Lower Jiao

Kidney Yin Xu
Frequent, oily/greasy film on urine with sweet smell
Dont confuse this with other urinary disorders
Deficiency of Yin and Yang
Liu Wei Di Huang Wan
Yu Quan Wan or Jade Spring Pills are typically prescribed for this condition.
TCM Etiology
Diagnosis with Eight Principles

You can diagnose this disease with Eight Principles: heat and deficiency. Heat for this disease is
either yin deficient or excessive. Diabetes 1 presents with emaciation classic deficiency.
Diabetes 2 often manifests due to overweight and diet, hence the excessive. Yin deficiency with
empty heat is nonetheless the most frequent diagnosis for diabetes.
Diagnosis with Zangfu Theory

You can also diagnose this disease with Zangfu theory, which is more practical and useful in
TCM.
There are 3 different jiaos in TCM: upper (lung), middle (stomach) and lower (kidney). All 3 of
these organs are related to water metabolism. Key symptoms for each of these jiao will look
familiar:
1) Upper jiao/Lung thirst, maybe because of heat in the Lung.
Polydipsia. Skin problems, also common to diarrhea are related to this xiao. Could also
be related to resulting heart problems due to the Zheng Qi relationship.
2) Middle jiao/Stomach hunger.

Polyphagia. Because Heart is the mother of Spleen/Stomach could be son rebelling
against mother.
Page 3 of 13
3) Lower jiao/Kidney urination.
Polyuria. Cataracts and bleeding in the eye causing blindness are also related to Kidney.
Heart/Kidney Disharmony could also explain the heart problems. Remember too that
Kidney is related to the Brain and can contribute to brain damage/strokes associated with
Diabetes.
TCM Etiology
1) Emotional Disorder
Refers to Liver Fire and Heat.
2) Irregular Diet
Over-consumption of spicy, greasy foods and alcohol. This generates damp heat and fire. Over-
consumption of sugar leads to phlegm heat which can also result in diabetes.
3) Overworking
Overworking leads to Yin deficiency and then to empty heat. Specifically, Liver/Kidney Yin Xu.
4) Age
Exhaustion of Kidney essence.
5) Congenital Causes
Kidney involvement. A congenital involvement will usually show in younger patients, often
Type I Diabetes. In aging patients it is often Type II Diabetes. As with in all congenital disease,
nourish the Kidney Yin!
TCM Mechanism
Mechanism of Diabetes/Xiao Ke in TCM:

Excessive heat with deficient heat
The combination of these heats causes the symptoms. Excessive heat consumes Yin leading to
deficiency, to deficient heat, and finally to excessive heat. Heats consumption of Yin and body fluids
leads to emaciation. This causes excessive heat in the Lung, Stomach and Kidney.
This in turn consumes Yin leading the yin deficiency. This makes the excessive heat symptoms worse as
it is adding deficient heat to it. What a vicious cycle!
Yin deficiency complications due to this excessive heat lead to the following:
Cataracts.
The black of the pupil turns grey as is it obstructed. This is due to Liver and Kidney deficiency.
Remember the Five Wheel Theory (see page 5 of this link) from the first Diagnostics class? The
pupil represents water and the health of the Kidney. The iris represents the Liver in this theory.
Cataracts cover both of these parts of the eye.
Page 4 of 13
Peripheral nerve disorders or neuropathy.
This includes numbness and tingling of the extremities. This is due to Yin, Blood/Xue and
Essence deficiencies.
Skin rashes, carbuncles and infections

Bacteria loves the excess sugar floating in the blood when there is not enough insulin to escort
those sugars into the cells. This bacterial infection leads to further heat in the body.
To avoid infections and infectious problems in diabetic patients in the

clinic, use strict CN procedures, keep the area well cleaned and explain
possible complications to your patient due to their condition!
TCM Differential Diagnoses and Treatment
There are 3 differential diagnoses and some basic points for Xiao Ke. Note that each of the 3 Jiaos are
represented here.
Basic point:
Insulin point, 1.5 cun lateral to the lower border of the spinous process of T8.
Upper Jiao Diabetes: Excessive heat in the Lung with Lung Yin Xu
This is diabetes in the initial stage.
Symptoms are on the left, principles and points are on the left.
Middle Jiao Diabetes: Excessive heat in Stomach with Stomach Yin Xu

This is the middle stage of diabetes.
Page 5 of 13
Lower Jiao Diabetes: Kidney Yin Xu with Empty Heat
Patients may have upper or middle jiao diabetes for many years which progress into this stage.
This is the last stage of diabetes. Note that acupuncture is not strong enough by itself and this
requires herbal therapy.
Page 6 of 13
May also have burning toes
and feet as a symptoms.
UB 52 more for Yin xu more away from the Du channel. UB 23 tonifies the Qi. UB 43 is for
chronic long term Kidney deficiency with some heat. In Chinese this point is Gao huang means
the disease is severe and stubborn going to areas you cant touch. Frequent urination: KI 5
because it is the water spring.
Some patents to use for Xiao Ke: Yu quan wan. Good for frequent urination, Qi and yin xu with
typical 3 more and 1 less symptoms (i.e., polyuria, -dipsia, -phagia + emaciation)
Page 7 of 13
Other Treatments:
1) Exercise! (He was very excited about this!) Increases the bodys ability to use sugars and also
boosts the immunity.
2) Diet: generally, control food strictly. Needs a low glycemic diet and 3 regular meals. Dont eat
until full, but stay a little hungry. Ive also heard you should eat 5 small meals to keep the blood
sugar at a constant level.
The Sugarbusters diet was defined for this purpose as a low glycemic diet to specifically treat
Type 2 diabetes. Click here to check it out. Youll see a lot of high fiber, lots of greens. Lipids
and salts are low too. That said, this diet is actually pretty tasty.
3) Ear points very important for Xiao Ke.

a. Pancreas
b. Endocrine
Page 8 of 13
Hypothyroidism
Jia Di Zheng
Disclaimer:
This was not covered in Class 8, so I suspect he probably did it at the start of Class 9,
which I could not attend. Im building this text from Dr. Luos class handouts and the
Fuyiu Yip study guide. Should you have any class notes or words of wisdom to share,
Im all ears.or all eyes in the event you want to e-mail it to me at
catwommn@yahoo.com.
TCM doesnt have a diagnosis of hypothyroidism. Instead, it is classified as depression, fatigue,

weakness and edema. If you read Maciocias book, you will see it called xu lao. Please note that the
esteemed and highly trusted Dr. Jamie Wu disagrees. See the HIV notes in the study guide!
By definition, hypothyroidism is under activity of the thyroid gland that leads to inadequate production
of thyroid hormone and slowing of the vital body functions.
There are approximately 10 million people in the US diagnosed with thyroid disorder. Another 13
million have thyroid disorders but have not been diagnosed.
Biomedical Perspective
The thyroid is a butterfly shaped gland below the Adams apple and in front of the trachea about Ren
22-23. It is connected to hair growth, intestinal activity, stomach activity and legs. The T3 hormone is
about 20% of what the thyroid produces and the T4 hormone is about 80%. Of these two, T3 is the more
active hormone. T3 and T4 travel in the bloodstream and convert oxygen and claories into energy. Cells
need assistance from both. If there is a decrease in either fatigue is felt in the body.
Hashimotos disease is an autoimmune disease in which the body attacks the thyroid gland which then
cannot produce T3 and 4. Swelling of the thyroid is a symptom of this disease. Typically, however in
hypothyroidism the thyroid is atrophied. Hashimotos is the exception to this rule.
Symptoms of hypothyroid include:

Cold
Depression
Stress
Drooping eyelids
Alzheimers disease
Myxedema
Puffy eyes and face
Weight gain
Constipation
Fatigue
Palpitations
Page 9 of 13
TCM Perspective
Xu Zhen or deficiency syndrome, Shui Zhong or water swelling, and Yu Zhen or depression are how
TCM classified it. These syndromes are marked by fatigue, depression, stress, weakness, and edema.
Hair loss is typical. Hair is a surplus of Blood and is related to Kidney essence.
Both hypo and hyperthyroidism are both a yin and yang disorder. Hyperthyroid tends to move towards
hypothyroidism at later stages.
Hypothyroidism is Qi + Yang deficiency
This falls into the Yang axis with Kidney, Spleen, and Lung implicated in the disease.
Hypothyroid is both a Qi and water metabolism problem.
Hyperthyroidism is characterized by a thin body, heat signs, quick weight loss, a swift pulse of
130-150 bpm, tremors, irritability, irregular menses or amenorrhea. This all points to a Yin
deficiency with empty fire rising up. The Zangfu implicated are Kidney, Liver, and heart.
Any endocrine disorder:

If it is deficiency type, it is Kidney related.
If it is of excess type, it is Liver related.
o If the Liver is too strong, there is a hyperactivity of functioning with Liver overchecking
the Spleen because the Liver is absolutely too strong. You can use something like da chai
hu tang for this if you want to think about herbal treatment.
o If the Liver is normal or hypofunctioning but the Spleen is nevertheless deficient, the
Liver is still overchecking the Spleen because the Liver is relatively too much for the
weak spleen. Use Xiao yao san for this to soothe the liver and tonify the spleen.
TCM Etiology
1) Emotional Disorder
This refers to and can cause Liver overacting on Spleen leading to Spleen Qi xu and damp
retention.
2) Irregular Diet
This leads to dampness, phlegm and water retention.
3) Congenital Cause
I.e., Kidney deficiency.
TCM Mechanism
Hypothyroidism involves the Lung, Spleen, Kidney Qi (or Yang) Deficiency.
Because the Spleen is involved, the Liver is involved. Again, if the Liver is too strong it overacts on the
Spleen. If the Spleen is weak, the Liver is overacting on it anyhow because by comparison the Liver is
relatively too much to balance the Spleen.
Because the Spleen is deficient this can lead to Heart Blood deficiency and its subsequent symptoms of
hair loss, palpitations, and Shen disturbance.
Page 10 of 13
The Spleen controls metabolism, thus the Liver and Heart are too with Spleen at the center.
TCM Differential Diagnosis and Treatment
The possible diagnoses can be that of excess or of deficiency. Excesses include Liver Qi Stagnation,
retention of Dampness and of Water. Deficiencies are chronic conditions consisting of Spleen Qi Xu,
Heart Blood/Xue Xu, and Kidney Yang Xu.
First there is Qi and Yang Xu. This is followed by Liver Qi stagnation and then Yin deficiency. If a
patient is suffering from a depression that seems very resilient and wont subside, fatigue, and edema
recommend they have their thyroid checked.
Basic points to treat Hypothyroid conditions:

Combine the basic points with points listed in this section for specific differential diagnoses applying to
your patient.
Points to tonify Yuan Qi and support Lung and Kidney:
o Ren 4
Ren 4 is a meeting point of all 3 leg yin channels. It is also called the Gate of Origin, the
lower Dantian. Click here and scroll to the bottom of page 2 to read Zheng Zengs
discussion of it in full.
o Ren 6
Ren 6 is the lower Sea of Qi. Use this point for Qi deficiencies to rescue Yang Qi. You
can also use this point for Qi stagnation, but Ren 17 is more often used for this.
o Ren 12
This helps resolve phlegm and damp. Click here and scroll to the bottom of page 4 for
Zheng Zengs input.
o Stomach 36
Click for the Zheng Zeng chat. Scroll to page 3.
o Du 4
This is the Mingmen or Gate of Life, located at L2. Click here for the scoop, page 5.
o Kidney 8
Yes, Zheng Zeng has a discussion about it, but it doesnt really address why to use it in
this case. Its the Xi Cleft of the Yin Motility/Qiao vessel. Deadman says one of its
actions is to clear heat and drain damp from the Lower Jiao. Dr. Wu says it supports the
Kidney.
Local points:
o Ren 22
o Stomach 9
o Large Intestine 18
o Ren 23
To open the throat
o Lung 7 plus Kidney 6
Moxa is appropriate, especially on the Kidney channel for edema.
Page 11 of 13
Liver Qi Stagnation or Liver overacting on Spleen
This is an excess condition. The symptoms are listed in the column on the right while the
treatment principles and prescribed points and methods are in the left column below.
Spleen Qi Xu with Heart Blood/Xue Xu

This is a Qi and Blood deficiency and is a chronic condition leading to the western condition
called hypothyroidism. The symptoms are listed in the column on the right while the treatment
principles and prescribed points and methods are in the left column below.
Page 12 of 13
Spleen Qi Xu with Retention of Dampness
Deficiency condition with some excess, the retention of damp. The symptoms are listed in the
column on the right while the treatment principles and prescribed points and methods are in the
left column below.
Kidney Yang Xu with Retention of Water

Deficiency condition with some excess, retention of water. The symptoms are listed in the
column on the right while the treatment principles and prescribed points and methods are in the
left column below.
Page 13 of 13
Xiao Ke Differential Diagnosis & Treatment
1) Great thirst; 2) Great Hunger; 3) Profuse Urination; 4) Emaciation
Basic / Special Point Insulin Point 1.5 cun lateral to T8 (below spinous process)
*In China point injection technique (Vit B12) at this point w/ qi sensation first this halves the normal insulin
needed
- Acute Remove excess LU heat;

Upper-Jiao - Great thirst; cough, yellow mucous; dry throat, Nourish LU Yin
mouth; sweating ----------------------
Diabetes: (-) sedate
- Desire for drinks (+) tonify
- Dry stool (constipation); Fatigue Insulin point + or even
If more Yin Xu:
- Dry skin, nose; dry cough, blood tinged sputum; (+) LU-7, 9; REN-17
Excessive heat in UB-14; ST-36; SP-6 (w/ xu)
LU w/ LU Yin palm heat; night sweating
(-) UB-13; LU-5 (he sea);
*be careful to not misdiagnose w/Yangming or Qi level LI-4, 11 (w/ heat)
(Initial stage) heat
T: Red spots on the tip; thin yellow
P: Thin, fast or (rapid, full)
- Could be acute Clear excess ST heat;
Middle-Jiao Diabetes - Great hunger Nourish ST Yin
- Burning pain in ST; thirsty; constipation; dark -----------------------
yellow urine
- Feeling of heat Insulin point +
Excessive heat in - Yin Xu Sx: palm heat, night sweating
ST w/ ST Yin Xu - More severe: gum bleeding, toothache; or acne (-) LI-4, 11; UB-21
becomes worse Severe: ST-44, 36
(+) SP-6; UB-20,
(Middle stage) T: Red or scarlet, w/cracks; Even: REN-12
C: Thick yellow, or yellow greasy, or mirror coat
(ST Yin Xu) or no coat Dietary therapy is very important!
P: Fast, slippery, forceful; or thin, and fast [maybe
floating (Yin cannot hold Yang)]
- Chronic
Lower-Jiao Diabetes - May have UJ or MJ Diabetes for many years Nourish KID Yin
already
- Polyuria = Profuse urination &/or emaciation
-----------------------
- Frequent urination: daytime 6-10x; night 2-3x Insulin point +
KID Yin Xu with (may complain of insomnia s/t night time urination)
Empty-Heat - Fatigue, lower back pain, weakness of (+) KID-3, 6, 1; SP-6
knees/ankles UB-23, 52, 43
- Tinnitus, deafness; palm heat, night sweat, low-
May have UJ or MJ
grade fever If Yang Xu: DU-4, REN-4, 6 w/
Diabetes for many years
- May still have hunger & thirst. Also: dizzy, moxa
already that progressed
vertigo, tinnitus, low back pain; fatigue; n.
into this stage.
sweat; low grade fever; 5 palm
(Last stage) - May progress to KID Yang Xu type w/ water Acupuncture is not strong enough;
retention near the end serious Px is very must include herbal therapy
poor > Yu Quan Wan (Jade spring pills)
[for all types]
T: Red, small, (thin) w/ cracks
C: Yellow coat, dry (no coat), less coat, or
mapped
P: Weak, thin, fast (deep)
KID is root of body Yin, therefore, affects all Yin

LIV (nerve), HT (shen)
Xu heat disorders: Yin axis (left pulse: HT, LIV, KID)
affects all three organs: Yin/Xue.
> With LIV & KID Yin Xu: may see burning toes as a symptom
1
Hypothyroidism Differential Diagnosis & Treatment
st
1 Qi & Yang Xu 2nd LIV Qi Yu 3rd Yin Xu
Tonify Yuan Qi to support LU and KID: REN-4; REN-6; REN-12; ST-36; DU-4; KID-8
Basic Local: REN-22; ST-9; LI-18; REN-23 (meeting of Yin Wei)
Points To open throat (REN goes to thyroid): LU-7 + KID-6
A lot of moxa is appropriate on KID channel for edema
* Stubborn depression; fatigue; edema recommend having thyroid checked!
- Stress, depression Soothe LIV Qi; Strengthen

- Mood/emotional swings SP
- Sighing from time to time
- Distending feeling in chest, or distention of
----------------------
hypochondriac region Basic +
LIV Qi Yu - Poor appetite; alternating constipation and
or LIV SP LI-4, LIV-3
diarrhea; gas/bloating
GB-34; LIV-14
UB-18, 47
T: Normal or pale (if SP Qi Xu)
C: thin white DU-24, Yintang (for stress &
Excess P: Wiry depression)
> Needle DU-24 and Yintang towards
each other w/ e-stim (better to even
add O2 if allowed!)
- Chronic Tonify SP Qi,
- Hair loss Nourish HT Xue
- Poor memory and concentration
SP Qi Xu w/ HT - Poor spirit (lack of initiative), fatigue,
-----------------------------
Xue Xu sleepiness Basic +
(Qi and Xue Xu) - Poor appetite; scanty, pale red menses
- Palpitations, dream-disturbed sleep REN-14; UB-15, 17, 20
ST-36; SP-6
T: Pale P-6
Chronic C: Thin white
P: Thin and weak
- Chronic Tonify SP Qi,

- Gas/bloating Remove Dampness
- Poor appetite, cravings for sweets
SP Qi Xu w/ - Overweight; profuse vaginal discharge
------------------------
Retention of - Coughing out mucous
Basic +
Dampness - Nausea, vomiting; general heaviness
ST-36; SP-6
Chronic T: Pale, swollen, teeth marks
SP-9; ST-40; SJ-5
C: Thick, greasy, white
UB-20, 21
P: Deep, slippery, w/o strength
2
- Chronic Warm KID Yang,
- Cold extremities
- Fatigue Promote urination,
- Lower back weakness, edema (whole
Remove water retention
body:
KID Yang Xu puffy face, esp. lower body) -----------------------
with - Difficult urination; or profuse, frequent,
Water retention clear Basic +
urination
- Impotence, or aversion to sexual KID-3,
intercourse; male or female infertility KID-2, UB-63: paired to promote
Chronic urination
T: Pale, swollen, teeth marks REN-3; ST-28; UB-28, 22
C: White or moist SJ-5
P: Deep, slow, weak, esp. in both 3rd Can use moxa
positions
3
1
Diabetes
Normal Impaired Diabetes
Glucose Glucose Mellitus
Tolerance Tolerance
Fasting plasma 70-110 110-125 >=126

glucose(mg/dl)
2 hours after
glucose < 140 140--200 >=200
load(mg/dl)
Random plasma glucose >= 200mg/dl

Plasma glucose after overnight fast>= 126 mg/dl
1mmol/L = 0.0557mg/dL 1mg/dL=17.95mmol/L
2
Xiao Ke
TCM
Etiology
Emotional disorder
Irregular diet
Overworking
Age
Congenital
Mechanism
Excessive Heat + Deficient Heat
Three Jiao Differentiation
3
Excess: Excessive heat in LU / Excessive heat in ST
Deficiency: LU Yin /ST Yin /KID Yin Xu
Treatment
Exercise
Diet
Basic Points Insulin point
Differential Points (pictures)
Auricular points
4
Hypothyroidism (Jia Di Zheng)
Definitionunderactivity of the thyroid gland

that leads to inadequate production of thyroid
hormone and slowing of vital body functions.
5
Symptoms
Intolerance to cold, depression, stress, eyelids

droop, Alzheimers disease, myxedema, puffy
eyes and face, gain weight, constipation,
fatigue, palpitation
Biomedicine:N.S/endocrine/digestive/immun
ological/circulation
6
Jia Di Zheng
TCM
Etiology
Emotional disorder
Irregular diet
Congenital
Mechanism
Nature ?
Organ ?
7
Deficiency: SP Qi Xu / HT Xue Xu /KID Yang Xu
Excess: LIV Qi Yu/ Retention of Dampness/Water retention

Treatment
Basic points Ren4, 6,12; Du4, ST36, KD8

Ren 22, Ren 23; ST 9, LI-18
LU7+KD6
Differential points!!
8
Case Discussion
CASE 1 CASE 2
Pulse:weak,thin and fast Pulse: soggy and weak

9
Class #: 9 Morning Sickness and Nausea Not actual class date
Note from goofy webgeek running this show:
I did not attend this class. I am writing the notes from the class handouts posted on the
student portal and from the Fuyiu Yip book. Anything you would like to contribute that
I left out, got wrong, etc. would be greatly appreciated. Thanks, man.
Morning Sickness
A womans body requires GnRH (gonadotropin-releasing hormone) in order to begin the ovulation
cycle. The pituitary gland releases lutenizing hormone or LH as well as FSH (follicle stimulating
hormone) which promotes the development of the ovarian follicle that contains an egg (which we shall
assume is viable since this is a discussion about morning sickness in pregnancy).
FSH acts upon the ovary to continue the growth and development of the follicle. Within this follicle
FSH promotes the production of estrogen which in turn causes a mid-cycle surge of LH (lutenizing
hormone), stimulating ovulation. The follicle ruptures during ovulation and releases and egg (or oocyte)
which, in a perfect world, is picked up by the fallopian tubes.
If the egg is then fertilized while it is in the fallopian tube, it begins cellular division and migrates down
the fallopian tube to the uterus within the first 4 days or so after fertilization has occurred. The fertilized
egg which now is classified as an embryo, dividing and growing like mad, then implants into the wall of
the uterus to continue its development into a fetus. This implantation process also stimulates the growth
of the placenta.
Within the first month or so of this processbadda boom, badda bing.morning sickness for about
of all pregnant women. The symptoms of morning sickness are nausea and vomiting mostly in the
morning, though a lucky few do experience it all day long. This is often the earliest sign of pregnancy.
(The Virgin Mary probably thought she had the flu. What a shocker!) The term is of ancient Egyptian
origin first noted around 2000 BC. About of pregnant women will suffer from morning sickness
especially if the following happen to be true:
First time pregnancy
Women under 20 years old
Obese pregnant women (over 170lbs)
Pregnant with twins
Non-smoking pregnant womenand shouldnt they all be?
The intensity and duration of morning sickness is related to pre-existent digestive dysfunction. Morning
sickness may begin as early as the 1st month and generally subsides by the end of the 12th week.
According to western medicine there are 3 hypotheses regarding the mechanism causing morning
sickness:
1) Elevated levels of human chorionic gonadotropin (HCG)
Page 1 of 11
2) Ration between HCG and estrogen
3) Corpus luteum in ovary elevated corpus luteum in the right ovary.
Another source I read suggests the culprit may be progesterone production from the
corpus luteum, which is the follicle from which the egg was expelled. Progesterone
maintains the lining of the uterus and signals the ovaries to stop releasing eggs, thus
stopping the monthly periods.
Another possible cause for morning sickness is an enhanced sensitivity to smell which
can trigger the gag reflex.
Treatment from a biomedical perspective includes avoiding medications, eating small meals before
feeling the hunger and eating a balanced diet, avoiding excessively spicy or pungent foods. Another
currently popular bit of advice encourages women to eat a couple of dry crackers before getting up from
bed.
Traditional Chinese Medicine Perspective

Morning sickness in Chinese is called Ren shen e zu
Etiology
Well. Pregnancy! But technically, its pregnancy with Qi disturbance and Blood nourishment.
You should be aware of the physiological changes associated with pregnancy which will quickly clue
you in to an assessment that your patient may well have morning sickness:
Cessation of menses a type of physiological amenorrhea
Your patients periods may have stopped or she may have missed a period.
Food cravings often for specific foods, sour, sweet, salty, etc.
(My sister craved onions and lemons. Go figure.)
Fatigue, palpitations, dizziness
An increase in urination frequency.
Temporary sciatic pain
Breast tenderness and nipples getting darker
A heavy sensation
Low back pain or weakness
Mechanism
The mechanism of morning sickness in TCM is
Middle Jiao disorder + Blood Deficiency

leading to rebellious Stomach Qi and Chong Qi
While Qi rebellion is an excess, morning is primarily a problem of more deficiency and the excess in
this syndrome is relative.

Page 2 of 11
Lets look at why this happensand note that it all comes down to (from really) Blood Deficiency:
There are 3 chambers of blood in the female

body: Liver, Uterus and the Chong
Channel. The Spleen/Stomach (at ST 30),
Liver and Uterus are all connected by the
Chong Channel.
A fetus is itself pure Yin in nature and full

of blood, continuing to need more blood as
it grows. As a result:
1) When a woman is first pregnant

there is a temporary Blood xu in the
uterus. Women are either anemic or
borderline anemic. The menses and
bleeding stops in order to nourish the
fetus. Fatigue can be very evident at
this stage.
2) Blood from the cessation of menses

is not enough as the fetus continues
to grow. More blood is transferred
from Liver to Uterus and can lead to
general blood deficiency signs such
as:
a. Pale nails
b. Dizziness
c. Blurred vision
Cravings for sour foods, which astringe the Liver to hold Blood, or for sweet foods to tonify the
Spleen which is the source for Blood will manifest at this stage. Any sweet/sour foods will
nourish the bloodwhich Im guessing is probably why my sister, after a lifetime of hating it,
began to crave lemonade when she got pregnant.
3) As the fetus continues to grow even more blood is needed. This takes more blood away from the
Chong Channel, the Sea of Blood. In an optimal world, Qi and Blood should be balanced.
Now, however, Qi and blood are out of balance. Blood from the Chong goes to the Uterus to
nourish the baby resulting and a relative excess of Qi, or Qi that is not rooted, in the Chong.
And heres the key:

Qi rebels upward through the connection of the Chong to the Stomach channel (ST 30). This
causes a rebellion of Stomach Qi leading to the nausea and vomiting symptoms!
Recall, please that one of the indications we learned in Energetics for the Chong channel was the
adverse flow of Qi in the abdomen and chest.

Page 3 of 11
Additionally, per the Chinese clock, the 7 9 am hours are those times when the Stomach Qi is
relatively strong. When the stomach Qi is rebellious in these hours due to the rebellious Chong Qi, the
symptoms can thus be worse in the morning.
To reduce morning sickness symptoms, a pregnant woman can avoid pungent and spicy foods. These
foods as well as burning incense can cause the fetus to be restless within the body exacerbating the
symptoms. From a treatment perspective, dont move Qi or blood and avoid descending too much
during pregnancy to keep the fetus calm and stable.
The treatment for morning sickness is to

Avoid medication
Watch the diet no spicy, greasy, pungent foods
Use the basic and differential points below.
Basic Points for Morning Sickness (Ren shen e zu)

Puncture and stimulate using an even method with no sedation. Use 34 or 36 gauge needles only.
Please note that these points are good for all stomach disorders including gastritis and so forth.
Know and love them!
P-6
You can also check out Zheng Zengs notes here. Go to page 4-5 for the Pericardium 6
discussion.
Ren 12
Note that this only applies for the first 3 months of pregnancy. As a rule of thumb, do not
puncture Ren 12 after the 5th month of pregnancy. The fundus (see page 16 of site link) has
moved upward past this point and you do not want to puncture now. Check out Zheng Zengs
notes for Ren 12. See page 4.
ST 36
Oh, how Zheng Zeng loves this point! See pages 3 6 of this link to read all about it again.
Forbidden Points for Pregnancy

Points on the lower abdomen and lower back, below the level of the umbilicus and 1st Lumbar
vertebra are forbidden for pregnancy. Do not use Jing Well points after the 3rd month.
LI 4
You can use LI 4 alone on occasion for wind invasions, however, this point moves a lot
of qi and can cause the uterus to contract, really pissing off the fetus. It also moves blood
really well and this is not good for retention of a fetus either.
As a matter of fact, LI 4 and SP6 in combination are often used to help expel the placenta
after childbirth (tonify on LI 4 and reduce on SP 6). Some sources say it is used to induce
abortion.
Click here to read Zheng Zengs notes on this subject. Go to page 7 for the discussion.

Page 4 of 11
SP 6
The same info found in the LI 4 bullet point applies regarding the LI 4 + SP 6
combination. SP 6 causes the uterus to contract and is said to induce labor. Read the full
Zheng Zeng discussion here. Pages 6-7.
GB 21
See the top of page 7 for the GB 21 link above. This point has a function for descending
the Qi which is not good in the event you want to retain the fetus during pregnancy. This
point is also used to expel a placenta that is retained abnormally after delivery of a baby,
but the LI 4 + SP 6 combination is used more frequently.
Liver Qi Stagnation
This is an excess reason for morning sickness. Aka, Liver overacting on Spleen. This is also expressed
as disharmony between the Liver and the Middle Jiao/Warmer. Basically, this is a temporary Liver Qi
stagnation with gas and bloating caused by the resultant Spleen Qi Deficiency as the Liver is overacting
on the Spleen.
Symptoms are found in the first column below and treatment principles and points are found in the right
column.
(see next page)

Page 5 of 11
Spleen and Stomach Deficiency/Middle Jiao Disorder
This is a reason of deficiency for morning sickness. Specifically, this is SP/ST Xu with a Chong Xu.
This is caused by the baby blocking the flow of qi which causes the deficiency.
Symptoms are found in the column on the left while treatment principles and points are found on the
right.
Notes on Miscarriage
If there is a severe sinking sensation in the lower abdomen, this may be an indication of miscarriage.
Any bleeding or spotting with lower back pain is a Kidney deficiency and is an even worse sign. If you
see early signs, raise the Spleen Qi (Spleen Qi xu) and tonify the Kidney Qi.
You can use Tai Shan Pan Shi Jian during the 1st trimester of pregnancy to strengthen Kidney Qi in the
event of deficiency. If there is an organ prolapse due to Spleen Qi Xu use Bu Zhong Yi Qi Tang formula.
If you suspect your patient has had a miscarriage, check the pulses. The pulse will often be very very
deep and weak on one side, but still slippery on the other. This indicates miscarriage, but with some
retention of fetal tissues.

Page 6 of 11
Nausea and Vomiting (ou tu)
By definition nausea is an unpleasant feeling that may include dizziness, vague discomfort in the
stomach/abdomen, and unwillingness to eat and a feeling that one needs to vomit. Vomiting is the
forceful contraction of the stomach which propels the contents upwards into the esophagus and out
through the mouth.
Pregnant women and those who suffer easily from motion sickness are the most susceptible to nausea
and vomiting. This of course does not take into account alcohol and drug induced vomiting, nor
vomiting as a symptom of disease, heat stroke, cardiac infarction, etc. There is a vomiting center in the
brain, CTZ, a chemoreceptor trigger zone, which is activated and results in vomiting.
Symptoms include, in this order:

1) Retching
This begins from deep inspiration: the glottis is closed, the esophagus distended and intra-
thoracic pressure falls. Simultaneous to this, strong abdominal contracts occur leading to spasms
of the duodenum and antrum of the stomach as well as reverse/retrograde peristalsis forcing the
chyme in the stomach upwards. Due to the spasms, however, the upper esophageal sphincter
remains closed and the chyme falls back down into the stomach. With subsequent spasms the
chyme moves upward and downward repeatedly until the stomach is full.
(Chyme is a thick liquid made up of partially digested food and stomach juices which has been
processed by the stomach. Under normal circumstances the chyme passes through the stomachs
pyloric valve at the bottom of the stomach and into the duodenum, the upper portion of the
small intestineits not supposed to go back into the stomach!)
2) Vomiting
When the stomach is full after step 1, it forces the diaphragm upward into the thoracic cavity.
This pressure from the upward pushing energy eventually forces the upper esophageal sphincter
to open and some of the stomach contents to be released. Vomiting repeats until all stomach
contents are released. Sometimes even bile is expelled. This does not taste pretty!
3) Sympathetic nerve discharge causes the following symptoms:

a. Tachycardia
b. Tachypnea
c. Sweating
Treatment
Recognize that this is a protective function of the body! This expels bacteria and toxins such as in the
cases of Stomach flu and food poisoning. If this is whats going on, let the vomiting happen rather than
trying to quell it. That said, ensure the patient has sufficient fluid intake. If vomiting is really severe
western medicine will sometimes use tranquilizers to calm the activity causing vomiting in the brain.

Page 7 of 11
Relatively pointless little sidebar
Once upon a time I was an ER tech, low enough on the totem pole that I had to
work holidays. Regularly on Thanksgiving and Christmas afternoons whole
families would come in having given themselves food poisoning by cooking the
turkey at an insufficient temperature in an effort to get it just a little moister.
Theyd show up all dehydrated and looking like hell. Wed give them a shot of
Compazine to reduce their nausea for a couple of hours, pat em on their sweaty
little heads, and give them fluids to drink. (This was in the dark ages folks, we
didnt do drip IVs just for the sheer hell of it then.) Wed encourage them to get
themselves home before the Compazine wore off, drink plenty of liquids in spite
of the vomiting and continue throw up the toxins theyd just enjoyed at the
holiday table.
Moral to the tale: If youre cooking a bird for the holidays, make sure the internal
temperature the turkey is 180 Fsome sources say 165 , but having seen these
poor self-poisoned folks, Id recommend the higher number!
Now isnt that a festive little story?
Traditional Chinese Medicine Perspective

Etiology
1) Irregular diet
This includes bad food and unclean food. See the relatively pointless little sidebar above!
2) Medication and antibiotics

You hear this on TV when the pharmaceutical commercials give the blazing fast side effect
disclaimers, i.e., side effects may include nausea, vomiting, bleeding from the ears, crack
addiction, and suicide.
3) Emotional disorder
This includes Liver Qi stagnation and anxiety. Reverse Qi disorder can occur in the Stomach
(acid regurgitation, vomiting), Lung (includes wheezing and coughing), and Liver (comes with
headache, irritation, etc.)
4) External pathogens
Damp cold, damp heat and just plain old dampness as in the case of Stomach flu. The three basic
methods for removing dampness are sweating, vomiting and purging. You can actually remove a
pathogen through diarrhea, especially if the pathogen is damp cold. Damp heat is often expelled
by vomiting.

Page 8 of 11
Mechanism
The mechanism of nausea and vomiting, per TCM is:
Middle jiao disorder resulting in rebellious Stomach Qi
Note that morning sickness, by contrast, will also have a rebellion of Chong Qi. . . and of course, comes
coupled with pregnancy. So if your patient is a dude, you can instantly weed that option out of the
possible mechanisms!
There are a couple of types of vomiting to be aware of which are found in the Fuyiu Yip book.
1) Ou or vomiting with sound and with expulsion of food.
This is an excess. This is rebellious Stomach Qi or Qi disorder with Food Stagnation. Any sound
is a rebellion of Qi in this case. This is a disharmony between the Liver and the Stomach.
2) Tu or vomiting with food, but without sound.

This is more food stagnation, but less rebellious Stomach Qi, as there is no sound. This too is an
excess.
3) Gan ou or vomiting with sound, but without food expulsion.

This is more rebellious Stomach or Liver Qi + Stomach Yin Xu, but without food stagnation.
You will see this with the dry vomiting or dry heaves and with projectile vomiting in which there
is no retching, just immediate severe vomiting. This is an excess and a deficiency at the same
time. This usually occurs in chronic diseases such as late stage of stomach cancer.
(OK, yeah, it also happens after you drink too much then do a technicolor yawn and then have
nothing left in your stomach to expel. )
Basic Points
Use these points for any kind of stomach disorder.
ST 36
See this discussion for the full Zheng Zeng download (page 3)
Ren 12
P6
Add one of the following. Avoid SP 6 if the patient is pregnant. See discussion in the previous
section of this document. :
SP 6
See this discussion for the full Zheng Zeng scoop. (page 6)
SP 4
See this discussion for the full Zheng Zeng scoop. (page 4-5)

Page 9 of 11
To descend the Stomach Qiu use the following. Remember that points below the umbilicus are more
descending and above are more lifting. ST 25 will do both. Remember the cautions about pregnancy
regarding SP 6 and all points in the lower abdomen!
ST 30
Useful for rebellious stomach Qi, helps descend.
SP 6
See this discussion for the full Zheng Zeng scoop. (page 6)
Invasion of External Pathogens

This is an excess type of diagnosis for nausea and vomiting. This can be due to damp cold, damp heat,
and dampness alone (i.e., stomach flu).
The symptoms are to the left while the treatment principles and points are on the left.
Food Stagnation
This is also an excess type of nausea/vomiting. In this case there will probably be food stagnation
vomiting but perhaps no sound.

Page 10 of 11
Liver overacting upon Stomach
Also called Liver Qi Stagnation or Disharmony of Liver and Stomach. This too is an excess type. This
includes motion sickness.
Spleen/Stomach Qi and Yin Xu

This is the only deficiency type. This may very well be the gan ou type with vomiting sans food dry
heaves. In chronic diseases, this is really not a good sign. This may arise from the 1st 3 types above
because of loss of fluids or due to chronic disease. This can show you the prognosis of a disease.

Page 11 of 11
1
Morning Sickness (ren shen e zu)
Nausea & Vomiting (ou tu)
2
HYPOTHALAMUS--Gonadotropin-releasing
hormone (GnRH) which is needed to begin
the ovulatory cycle.
PITUITARY-- luteinizing hormone (LH)/
follicle stimulating hormone (FSH) which
promote the development of the ovarian
follicle that contains an egg.
OVARY: FSH acts on the ovary to continue
growth and development of the follicle.
Within the follicle, FSH promotes the
production of estrogen. Estrogen causes a
mid-cycle surge in LH, which stimulates
ovulation. The follicle ruptures and the
oocyte (egg) is released.
FALLOPIAN TUBES: pick up the released
egg from the ovary. Fertilization occurs in
the Fallopian tube. The fertilized egg then
develops into an early embryo and is
slowly transported into the uterus (within
about four days).
UTERUS: the embryo implants into the
wall of the uterus and development of
the placenta and fetus begin.
Development continues until birth.
3
TCM
Etiology
pregnancy (Qi disturbance/Blood nourishment)
Physiological changes
Cessation of menses/food cravings
Fatigue/ palpitations/ dizziness
Increase urination /sciatic pain
Breast tenderness/nipples get darker/heavy sensation/low back pain or weakness
Mechanism
Middle Jiao disorder + Xue Xu Rebellious ST Qi + Chong Qi
More deficiency; the excess is relative
3 blood chambers: LIV, Uterus, Chong:
Why nausea&vomiting ?
Blood Xu
Menses stop
Cravings for sour / sweet foods
Chong (Sea of Blood) -----ST30------ST Qi
4
Excess: LV Stagnation
Deficiency: SP/ST Xu/Chong Xu
Treatment
Avoid medication/food
Diet
Basic Points P-6; REN-12; ST-36
Miscarriage -SP Qi Xu -- Bu Zhong Yi Qi Tang

KID Qi Xu-- Tai Shan Pan Shi Jian
After miscarriageslippery +weak pulse
5
TCM
Etiology
Irregular diet/medication
Emotional disorder
External pathogens: D-C / D-H / Dampness
Mechanism
Middle jiao disorder ---- rebellious ST Qi
6
Deficiency: SP /ST Qi and Yin Xu
Excess: External Pathogen /Food Stagnation/ LIV Qi Stagnation
Treatment
Basic points ST-36/REN-12/P-6 + SP-6 / SP-4
Differential points
7
Case Discussion
CASE 1 CASE 2
8
P-6; REN-12; ST-36 (even method no sedation; 34 or 36 gauge only)
Basic
* Do not puncture REN-12 after 5 months of pregnancy typically recommended that during the
Points first 3 months are okay evaluate on a per PT basis.
LI-4; SP-6; GB-21
Forbidden Points on lower abdomen & low back (below umbilicus and L1; these low points are ok in 1st trimester);
Points Jing Well points (do not use after the 3rd month)
Using LI-4 alone (off/on) for W-invasion is okay
LI-4 + SP-6 together induces abortion!
* The basic pts are effective for ALL ST disorders, including gastritis, etc. (know these pts well!)
- Nausea & vomiting, worse in the morning, off/on Tonify SP Qi; Descend Rebellious
- Fatigue; decreased or poor appetite ST Qi; Regulate MJ; Stop Nausea
- Drowsy/sleepy; pale face & Vomiting
- Gas and bloating; vomiting out stomach contents
or sour fluid (vomiting of undigested food right -----------------------
SP and ST Xu / after eating when severe) Basic points +
MJ Disorder - Loose stool or diarrhea
- May have prolapsed sensation in lower abdomen UB-20, 21
- Typical Blood Xu Sx: pale face, poor memory, SP-9, 3, (4)
palpitations, dizziness, bad concentration, dream- > Su Ye Huang Lian Tang (zi su ye 6g:
disturbed sleep huang lian 3g) 10 bags: 1 bag/day; take 5-
8x/day stops vomiting/awaken SP & ST
Baby blocks qi flow T: Pale, may be thin
C: Thin white; or Thin, White, Greasy > Xiang Sha Liu Jin Zi Tang (Si Jun Zi
P: Deep, Thin, weak; or slippery w/o strength. Tang + chen pi + ban xia = Liu Jin Zi Tang +
[especially in right middle position] sha ren, mu xiang)
Soothe Liver Qi;

- Emotional swings, irritability, easy to anger, Strengthen MJ;
stress, depression Regulate Spleen & Stomach
LIV SP / - Breast tenderness; hypochondriac pain
Disharmony between
- Morning vomiting; acid regurgitation; belching ------------------------
Liver & Middle
Warmer - Gas/bloating; hiccup; vomiting sour fluids Basic points +
- Decreased appetite; fatigue
- Crave sour and sweet GB-34; LIV-13; UB-18, 20, 21
- (Blurred vision, floaters) Do not use 4 gates!
Temporary LIV Qi
T: Normal [or pale body, or red tip, red spots on sides] May add:
Yu w/ gas &
C: Thin, white LIV-3, 8; UB-17, 18, 20, 21 only in 1st 3
bloating (SP Qi Xu) months
P: Wiry [without strength: or (SlipperyPregnancy)]
> Su Ye Huang Lian Tang (zi su ye 6g:
huang lian 3g) 10 bags: 1 bag/day; take 5-
8x/day stops vomiting/awaken SP & ST
- If severe sinking sensation in lower abdomen, may be indication of miscarriage. Any bleeding/spotting with any lower
back pain is even worse KID xu. For early signs of miscarriage, should: raise SP Qi and Tonify KID Qi.
- Can use Tai Shan Pan Shi Jian to prevent miscarriage can use in 1st trimester of pregnancy strengthen SP and K
function.
- Also, lift prolapse due to SP Qi Xu, use Bu Zhong Yi Qi Tang.
- Case study example: following a miscarriage, a PTs pulse was very, very weak & deep on one side, but still slippery on
the other side. This was an indication that a miscarriage had occurred, but there was still a retention of some fetal tissue
in the uterus.
Basic Points: ST-36, REN-12, P-6; add: SP-6 or SP-4
For any kind of ST disorder, use ST-36, REN-12, P-6 - remember to not use SP-6 if patient is pregnant
To descend ST Qi, use: ST-30, SP-6 (points below umbilicus more descending; above umbilicus more lifting; ST-25
for both)
- Acute onset Remove Dampness (external
Invasion of Damp Sx: pathogen), Regulate Middle
- N & v with or without food; decreased appetite Jiao
External Pathogen Typical Sx of ext invasion:
Damp-Cold - Fever, chills, aversion to wind or cold, w/ or w/o ------------------
sweating, general achy or heaviness Basic points +
Damp-Heat
Dampness GB-20; UB-12, 13
T: Normal, or red tip C: Thin, white yellow
(ex. ST flu) SJ-5, LI-4, LU-7, SP-9
P: Superficial, tight or fast
- Acute onset with history of irregular diet Remove Food Yu;
- Vomiting with undigested food; sour odor; Sedate Rebellious Stomach
- Severe pain or fullness in the abdomen w/ aversion to Qi; Regulate Middle Jiao
Food Stagnation touch
- Bm alleviates pain/fullness --------------------
- Decreased appetite or aversion to food Basic points +
Tu type:
- Constipation, or stinky diarrhea with undigested food
Food Yu vomit, ST-21, 34; REN-10, 11
no sound T: Normal or swollen UB-20, 21; ST-25, SP-15
C: Bean curd coating; or greasy thick, rough w/o root All with sedation
P: Slippery, forceful
- Acute onset with history of emotional disorder Regulate LIV & ST by
LIVST / - Nausea or vomiting; acid regurgitation; belching; Soothing LIV Qi and
hiccup Removing LIV Heat
Disharmony of - Vomiting of undigested food or even bile
Liver and Stomach - Distending sensation in abdomen & hypochondriac ----------------------
- Irritability, anger, bitter taste in mouth, breast
tenderness Basic points +
Includes motion sickness
4 gates, GB-41; LIV-13, 2
T: Normal, or red tip or red sides
UB-18, 20, 21
C: Thin, white
P: Wiry, or wiry & fast
- Chronic onset; seen in many chronic disease (@ end Nourish ST yin and
ST Yin Xu of stomach cancer) Descend rebellious ST Qi
- ST Yin is exhausted, no food to vomit, no acid
(Only Xu type)
regurgitation
--------------------
Basic points +
- Dry vomiting off/on, n & v worse at night
- Burning pain or dull pain in gastric area SP-4, 6, 9 (more SP pts as Yin ch to
Gan Ou: Vomiting without - Thirsty and dry mouth; constipation; decreased nourish Yin)
food (dry heaves); in UB-20, 21, 43; KID-6; ST-44
appetite; emaciation
chronic disease not good Sx.
- Yin Xu: palm heat; night sweats; low grade fever
Food therapy or herbs is better than
May arise from 1st 3 types T: Red or scarlet, small and thin, w/ cracks acupuncture (pear, watermelon -
(b/c loss of fluids or d/t not OJ)
C: Mirror or mapped coat; or chicken heart tongue (no
chronic dz).
Can also show prognosis of coat in ST area but coat everywhere else)
> Wu Zhi Yin
disease. P: Thin, fast, w/o strength (deep)
> Sha Shen Mai Men Dong Tang
Course: Acupuncture Treatment of Disease 1 Date: December 1, 2008
Class #: 10 Amenorrhea and Dysmenorrhea
Final next week, week 11, NOT week 12! Review ALL case studies and m/c options for final !
I need the past case studies I missed.
Paper due end of 12th week.
Amenorrhea
(bi jing or jing bi)
Biomedical perspective
The definition of amenorrhea is The absence of menstrual periods. This refers to an absence of
periods after the age of puberty, and not during pregnancy, breastfeeding or post-menopause.
Amenorrhea can be classified 2 ways:

1. Primary Amenorrhea
This is a woman at least 16 years old or older who have never had a 1st period.
Actually, the Nei Jing defines menstruation as typically beginning around the age of 14. Kind of
makes sense womens cycles are counted in 7 year increments, so 7x2 = 14 years of age. It
should be noted that today, likely because of diet and hormones in the food the average onset of
menstruation is 12 13 years of age.
That said, for the purposes of the test, its 16 years of age, which is why I highlighted it above.
Dr. Luo said this could be a true/false on the final!
The Kidney, it should be noted, is in charge of bringing the first period even though the Liver is
then the most important organ on the block in this respect thereafter.
2. Secondary Amenorrhea
Secondary amenorrhea applies to women who have had periods already, but the period has
stopped for over 3 months. This cessation of the period is a secondary cause due to another
disease or special reason.
a. Physiological Amenorrhea
This encompasses pregnancy and menopause
b. Pathological Amenorrhea
Always check to see if a woman is pregnant in cases of amenorrhea!
i. Accident (Blood stasis in TCM) can cause secondary pathological amenorrhea.
ii. Excess weight can also cause this type of amenorrhea
iii. An extreme deficiency of body fat/weight (i.e., anorexia nervosa and anorexia
athletica), can also result in secondary pathological amenorrhea.
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Other biomedical etiologies for secondary pathological amenorrhea
Hypothalamus
Pituitary The highlighted ones are the most likely suspects. Hypothalamus
Ovaries produces GnRH (gonadotropin-releasing hormone) which is
Fallopian tubes needed to begin ovulation cycle.
Uterus
Thyroid Pituaitary Releases lutenizing hormong and follicle stimulating
Adrenal hormone to promote the development of ovarian follicle
Pancreas containing an egg.
Stress
Anorexia nervosa Ovaries: Promotes production of estrogen, causing a midcycle
Environmental change surge in LH, stimulating ovulation. Follicle ruptures and an egg is
released.
Thyroid organ affects menstrual cycle due to the hypothalamus, pituitary connection feedback loop
with these glands. Stress can affect glandular production.
Treatment depends upon the cause tumor, thyroid, diabetes, etc. Treated with progestin and estrogen.
Always rule out preggers first!
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TCM Perspective
Menstruation is the monthly accumulation and release of energy. Amenorrhea then is the disruption of
the regularity of this bioclock.
This bioclock cycle works like this:

Period
A period is typically 5 7 days long. Blood is lost due to the Qi which builds up between
cycles.
Heavy bleeding on the other hand is due to 1) Excess Qi causing fire or 2) a Qi xu which
then cannot hold the blood and thus heavy bleeding.
Bioclock Therapy/Regulation
Regulate Qi and Blood
Post Period
For approximately 7 days after the period you will see signs of blood deficiency.
Nourish Blood
Between Cycle
7 to 10 days after Post Period or 14-17 days after end of period.
This is considered to be the between cycle phase in which there is accumulation of blood,
yin, and essence. This is a period of conservation and includes ovulation.
Nourish essence and Yin to support accumulation of Essence and Yin at this time of the
month.
Before Period
One week or so before the start of the next period.
The Qi rises as does the Yang.
If there is an excess of Qi and Yang one will experience PMS symptoms (Liver). Yang
rising may also be tied to migraines at this time in the monthly cycle.
Soothe the Liver Qi, Protect the Yang, Balance Yin and Yang.
Though blood is the most obvious and visible aspect of the monthly period, Qi is the most important
component. Work on the Qi before menses, Blood and Qi during menses, and Blood after menses.
There are 3 blood chambers involved in menstruation:
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Liver
This is the primary congenital organ for women (kidney is primary for men). The Liver stores
and holds blood and is in charge of voulation, separation, and discharge of eggs. The Liver also
regulates energy and adjusts the endocrine system and the bioclock. Thus, if there is a stagnation
of Liver Qi a woman is prone to cysts, fibroids, and blockage of the fallopian tubes.
Hormone disorders can be in 3 exciting flavors:

o Shi/Excess type
Manifests in acne and migraines
o Xu/Deficient type
Address the Kidney in cases of deficiency
o A combination of excess/shi and deficiency/xu
Treat both the Liver and Kidney in this case.
In western medicine it is also the Liver which helps to regulate the hormone levels. You thus
regulate the Liver in order to have a healthy harmonized flow of hormones and thus of the
monthly cycle.
Chong
The Chong Channel is the Sea of the Blood. It originates from uterus just as the Du and Ren
channels do.
Uterus
The uterus is the extraordinary organ from which Chong, Du and Ren emerges.
Etiologies:
Congenital essence xu
This is an essence deficiency, a disorder of the kidney. This is the etiology for primary or
secondary amenorrhea. This might be a genetic disorder, absolute lack of uterus, etc.
Tian gui is the Chinese phrase meaning hormone system. The Tian gui is in charge of
o Growth and maturation of the reproductive system
o First menstruation, which per the Nei jing occurs at age 14 (but, again for the test, say
16). Menopause and the cessation of menstruation occurs 2 years after the tian gui stops,
which the Nei Jing says is age 49. Thus menstruation stops at around age 51.
Emotional disorder
This is causes secondary amenorrhea and is the result of stress and/or Liver Qi Stagnation/Yu
leading to Liver Fire. This is a Qi level functional disorder further resulting in Blood stasis, a
blood level organic disorder.
To treat any endocrine disorder:

o Excess disorder: Use Liver points plus the basic points detailed in the Differential
Diagnosis and Treatment section of this document or of Dr. Luos handout.
o Deficiency disorder: Use Kidney points plus the aforementioned basic points.
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Irregular diet
This too causes secondary amenorrhea. An irregular diet leads to dampness then to phlegm
retention which blocks the Chong meridian so that Blood cannot move. This causes Blood Xu or
Damp-Phlegm.
Likewise, malnutrition can cause secondary amenorrhea due to deficiency.
Accident
Trauma which may damage the Chong meridian causing secondary ameorrhea.
Overwork
Overwork leads to Qi and Blood deficiency and organ Xu and Yin xu, mostly Kidney.
Invasion of cold
Cold contracts the meridians and blocks the channels and causes 2ndary amenorrhea. Women
should be exposed to wind or cold during menstruation. Wind and cold will directly attack the
Kidney and Uterus (Shaoyin channel).
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Differential Diagnoses and Treatments
Differentials can be either of excess or due to deficiency. Excess reasons: qi stagnation and blood stasis,
cold accumulation, damp/phlegm retention. Deficient reasons can be Qi/blood xu and Kidney xu.
Ill say it again, because its emphasized over and over:

Always remember to verify that any patient who comes to you is not pregnant! Heres a fun chart,
courtesy of Dr. Wu and Fuyiu Yip detailing the difference between amenorrhea and pregnancy.
Amenorrhea Pregnancy
Symptoms Chronic and gradual onset. Irregular Sudden onset. Periods just stop suddenly and
cycles occur for a long time and with there may be early signs of pregnancy:
disorder. Symptoms might be similar to o Fatigue
menopause. Dysfuncitons may include: o Nausea, vomiting, morning sickness
o Scanty flow o Craving for sweet/sour foods, etc.
o Heavy flow History of regular menstruation
o Dysmenorrhea followed by Gynecological changes such as darkened
amenorrhea nipples.
No obvious gynecological changes No cramping
Abdominal cramping
Pulse Wiry Liver Qi Stagnation/Yu Slippery

Hesitant/Choppy Liver Blood Yu Note: after 5 months you may be able to tell if
Deep, weak, thin Blood Xu it s a boy or girl. A strong floating pulse on the
right is a girl, strong on the left is a boy. Best
felt at 5-7am. Also good to know the history of
your patients pulses and whether they are
usually stronger on one side than other.
Gynec Exam No changes Obvious changes:

Shows: o Darker nipple color
o Breast distention
o Darker lips
Pregnancy Test Negative Positive. You must confirm this with multiple tests!
Dont promote Blood circulation nor move stasis if
you even think your patient is pregnant!
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Basic points
Notes on points listed above:
Kidney 8
Very important (maybe most important) point for amenorrhea. This point is especially for
menses as well as endocrine diseases. Also used for infertility. Note, not KI 10. This is the He
Sea point and nourishes Ki and Ki yin. If you see a question re KI 10 or KI 8 for amenorrhea,
pick KI 8!
Ren 5
Can induce menses and do not needle this point during menses!
Also note that deep needling Ren 5 may damage the Chong channel and create a state of
secondary amenorrhea! Needle 0.5 1 cun for Ren 5, though you can needle Ren 4 and 6 to a
depth of between - 2 cun.
Ren 6
Sea of Qi. Good for Qi stagnation and Qi deficiencies.
Zigong
Uterus point or Fetal Palace. 3 cun lateral to Ren 3.
ST 28
Treats water passage problems and promotes Qi flow. It is also called the Gate of the Uterus
on the left side and Childrens door on the right. Use it for reproductive problems.
Sp 6
Nourishes the 3 yin channels of the legs, treating Yin, Blood, dampness and reproductive
problems. Never use it with LI-4 during pregnancy, as it is said to cause abortion of the fetus.
Lots more stuff than this in Zheng Zengs notes. Click here and scroll to page 6 if you care to
read about it.
You may also need to use some of the 8 Confluent Points (also referred to as Completion Points).
Ren channel is opened by LU 7, for instance, while SP 4 is used to open the Chong channel. For
deficiencies, use these points alone to tonify Ren and Chong.
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For excesses, however, combine them:
LU 7 + KI 6.
KI 6 opens the Yin Qiao channelcombine the 2 together for throat, lung, chest and for
excess type amenorrhea.
SP 4 and PC 6.
PC 6 opens the Yin Wei vessel and treats Heart, Chest, and Stomach disorders. The
combination of the two opens the Chong and the Yin Wei, treating excess type amenorrhea.
Note the #s on the Basic Points chart in the Xu and Excess sections. This refers to a cross insertion
technique. You begin on the right side since as Dr. Wu says, Women are always right.
1st Right 2nd Left 3rd Right 4th Left

Open Ren LU 7 KI 6 LU 7 KI 6
Open Chong SP 4 PC 6 SP 4 PC 6
(To open the Ren or Chong for men you can also use the cross insertion technique, just begin on the left
instead of on the right.)
Kidney deficiency
Symptoms in patients over 16 or 18 years old will be amenorrhea plus primarily Ki Xu symptoms. Look
for lower back and knee weakness and pain, heel pain, mental and intelligence deficiencies, tinnitus, etc.
In the case of KI yin xu, look for the yin xu signs. If Qi xu, look for the back/knee problems, weakness.
Very special for Kidney essence: GB 30, 39. GB 39 is the confluent of marrow. Open the Ren channel to
tonify. Can also use Sp 4 to nourish. This is a deficiency type, so use the Ren and Chong opening points
without their combinations.
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Qi and Blood Deficiency
Note the differences in Qi and Blood xu above. Tonify the Qi and Blood points in this case. Ren 6, ST
36, SP 6. Again, be sure you have ruled out preggers! UB 20/21 = nourish middle jiao so more qi/blood
generated.
Qi Stagnation, Blood Stasis
Blood stasis question on the final! If stasis affecting skin, will be darker and scaly. Look for T/F
questions on the final. Scaly skin and dark = blood stasis/stagnation. Might also be scaly dry.
Patient might also have pain in lower ab (most likely) and will be fixed, worse at night. Pulse should be
choppy/hesitant/uneven.
SP 10 and UB 17 are the key points.
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Accumulation of Cold in the Uterus
This pain will be alleveiated by warmth. If excess cold, wont like touch. If deficient will want it. Moxa
is a key treatment here!
Phlegm/Damp Retention
How would you know this? Slippery pulse, greasy coating, nausea/vomiting, poor appetite especially in
really humid weather. SP 9 and ST 40 are very important.
Look for T/F question on amenorrhea indicating you should rule out preggers first!
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Dysmenorrhea
This is, per biomedical angle, dysmenorrhea is pelvic pain during the period. Etiology is of 2 flavors:
Primary
Related to a Prostaglandin level that is too high. This causes uterine contraction, less blood
supply and more sensitivity to pain. Usually happens prior to the age of 20.
Secondary
Generally happens in women over the age of 20 and is related to organic problems such as:
o Endometriosis
o Fibroids
o Pelvic infection
o Pelvic congestion syndrome
Pain occurs a few days prior to menstruation and within a day of the period pain may be more
severe.
Typical symptoms of dysmenorrhea can include lower abdominal pain, lower back and leg pain,
headache, nausea, constipation, diarrhea, urinary changes and irritability. Treatment depends upon cause
and consists of non-steroidal anti-inflammatory drugs such as NSAIDs like ibuprofen and aspirin,
antiemetics, rest, sleep, exercise.
You need to be able to tell the difference between this and say appendicitis, cholitis, etc.
TCM perspective
Tong jing is the Chinese term for dysmenorrhea. Tong = pain, jing = menses. In concept this is 2 fold:
1. Pain and blockage syndrome resulting from a blocked release of monthly accumulations of
energy. Refer to the previous discussion of the bioclock on page 3 of this document.
2. Pain and blockage due to a large mass or tumor. If less than 1 cm in size acupuncture can help to
shrink the mass. If larger, surgery may be necessary.
Mechanism
Pain is due to only 2 reasons:
Blockage blood stasis, qi stagnation for instance. Cold will also contract the meridian. Phlegm
and damp will also cause blockage. Bu tong ze tong
This is blockage of the Ren and Chong due to Qi Stagnation (yu), damp, Blood (xue) Stasis
Symptoms can include pain that comes at the beginning of the period when the Qi rises and is in
excess. This is a sharp excruciating pain with aversion to touch.
Malnutrition qi and blood xu or liver/ki xu. Bu rong ze tong not nourished then pain.
This is malnutrition of the Ren and Chong from overwork. Symptoms include dull generalized
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pain coming at the end of the period with a desire for touch. This is due to an existing deficiency
of Blood exacerbated by the blood xu that comes at the end of the period.
Same as amenorrhea, but different expression!
Etiology
There are 5 possible etiologies for Dysmenorrhea
Emotional disorder
This stems from Qi Stagnation. Qi stagnation is a process leading to Blood stagnation and finally
to Blood stasis.
o Blood Stagnation (Xue Yu)
This is a process showing the bodys condition at that moment and is not visible.
o Blood Stasis (Yu Xue)

Visible dead blood in the form of menstrual clots, bruise with mass, etc. This is a
pathogenic factor and the result of Blood stagnation.
Irregular diet
Irregular diet leads to dampness and then to phlegm. Turbid phlegm blocks the meridians.
Fibroids, for example, are a combination of phlegm with Qi and Blood Stagnation.
Trauma/Accident
This can directly cause blood stasis
Wind-Cold invasion
Can occur before or during menses when resistance is decreased. Wind cold can directly attack
to the Shaoyin level.
Blockage of meridians
Refers to blockage in the Ren, Chong and Du, all of which originate from the uterus. Liver and
Kidney are also affected.
Overwork
Affects the Liver, Kidney, and can cause Spleen Qi Xu leading to malnutrition of the Ren and
Chong.
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Differential Diagnoses and Treatments
Can be reasons of deficiency (usually at the end and after periods) or excess (prior to period and during
period).
Deficient reasons: Qi and Blood Xu, Liver and Kidney Xu.

Excess reasons: Qi Yu and Blood stasis and accumulation of Cold.
Some of these points are the same as for amenorrhea. Why ST 29 rather than ST 28 as in amenorrhea?
ST 28 is water passage and will dredge blockage. ST 29 is more for qi and phlegm blockage as well as
for malnutrition.
Some points are local around the umbilicus. Can open ren/du/chong channels as in the previous section.
Qi Yu and Blood Stasis

Qi stasis will move more than blood stasis.
Pulse will be wiry, choppy, uneven, hesitant. 4 Gates are primary, UB 17 and SP 10 are important
points. Can also open the Ren and Chong.
Opening the Chong will help more with blood related problems.
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Retention of Turbid Phlegm
Can also use back shus for spleen/stomach.
Accumulation of Cold in the Uterus

Especially cold in the lower ab, get cold and then problems get worse, touch cold water and gets worse.
Menstruation will be less because cold contracts. Moxa at Ren and Du 4 are the first choice. Baliao
UB 32 for moxa is excellent.
Also the San Jiao Ju the triangle on the belly would be a good choice for moxa.
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Qi and Xue Xu
Tired, not sleeping well, etc tells the Qi xu. With blood xu will be less blood. Qi xu more likely to be
more blood because body cannot hold it.
BL 17 very helpful. Use Liv 8 to nourish the blood of the Liver.
Liver and Kidney Xu

Lower back and knees will hurt a lot. Tinnitus. Long term concentration will suffer. Look for yin xu
signs night sweat, hot flashes, etc.
Kidney 8 again. Ki 3 will nourish the KI.
Timing of Treatments
Excess types:
Treat before and during menses.
Deficiency types:
Treat at end or after menses.
Before menses focus on the Qi.

Afterward focus on Blood
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During, harmonize and regulate both Qi and Blood
Always pay attention to eight extra meridians

o Chong sea of blood
o Ren - Sea of Qi and Yin
o Du Sea of Yang
Treat every week for a while then go to 1ce per month about 2-3 days before period for excess and at
end for deficiency.
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1. Amenorrhea Differential Diagnosis and Treatment
REN-5 (Shi Men = Stone Gate) can induce menses [see note below]
REN-6 (Qihai Sea of Qi)
Basic points for ALL types of Zigong (fetus palace uterus point)
Amenorrhea ST-28 (water tract promote Qi flow)
SP-6 (Yin, Xue, Dampness, reproductive pt; 3 yin mtg) [see note below]
KID-8 (Jiao Xin communicate menses endocrine point)
If Xu type LU-7 or SP-4 to tonify REN and Chong [use 1 or both points] #
If Excess type: LU-7 + KID-6 and / or SP-4 + P-6
Do not open either if there is an epf to regulate/open Chong and REN [use 2 or 4 points]#
- Over 18 y.o. and has not had 1st period Strengthen/Tonify KID;
W/ other KID Yin Xu Sx: Regulate Chong & REN
KID Xu - Hair loss or dry thin hair (withered), dry nails -------------------------
- Weakness of low back & knee joints, heels
- Retarded growth, etc. Basic points +
[[Endocrine Disorder Type:
KID & LIV Yin Xu]] - Tinnitus, deafness; dizziness LU-7 and/or SP-4
- Yin Xu: Severe cases: night sweats, 5 palm heat
low grade fever KID-3; UB-23, 52; GB-39
Primary Amenorrhea - Qi Xu: Fatigue; tiredness; SOB UB-18; LIV-3, 8
T: Pale (small) C: Thin, white

P: Deep, thin, weak; weaker on both KID
positions (esp L)
- Recovery from chronic diseases Tonify Qi & Nourish Blood;
- Hasnt ever had period, or Regulate Chong & REN
History of irregular cycle for long time w/ scanty; -------------------------
Qi / Blood Xu pink menses; retarded menses followed by
amenorrhea Basic points +
[[Anemia]] - Qi Xu (fatigue; poor appetite; soft voice, weak knee; LU-7 and/or SP-4
SOB)
- Blood Xu (poor memory; bad concentration; pale ST-36; LIV-8; SP-10; UB-17;
Primary or secondary face; palpitations; blurred vision; dream disturbed REN-4
sleep, etc.) UB-18, 20, 21
T: Pale; (thin, small size)
C: Thin, white > Gui Pi Tang
P: Thin, weak or thready
- Irregular cycle (dark color with dark red clots) Soothe LIV; Move Qi &
with severe PMS [hx of dysmenorrhea w/ cramps Blood; Remove Xue Stasis;
Qi Yu and Blood & clots] amenorrhea Regulate Chong & REN
Stasis - History of emotional disorder, sighing -------------------------
- Breast distension; hypochondriac pain; distending
pain in the abdomen; emotional swings; Basic points +
Excess depression, stress, irritability, anger LU-7 + KID-6 and/or SP-4 + P-6
Secondary related
T: Normal or purple w/ spots SP-10; UB-17; UB-40 to remove xue
C: Thin, white stasis
Related to emotions, P: Wiry or hesitant, Choppy 4 gates; GB-34
trauma, surgery May add: UB-18, 19 to soothe Qi
May add: LIV-13, 14 if chest/
hypochondriac distension
- Retarded menses w/ cramps in the abdomen; Warm Uterus; Regulate

Accumulation of black/dark red w/ lots of clots severe pain Chong & REN; Remove
Cold in Uterus followed by amenorrhea Cold
- Cold sensation warmth releases pain -------------------------
- Cold extremities or aversion to cold and touch
Secondary - May have chills, fever; - Pale face Basic points +
1
Golden Chamber of Nei Jing states T: Pale or normal LU-7, K 6 and/or SP-4 plus P 6
that if a woman catches a cold
before a pd, the Cold can run into
C: Thin (or thick) white
Moxa: REN-4, 8; san jiao jiu
and penetrate the uterus. P: Deep, slow; or weak [or superficial, tight if
triangle; DU-4, 3; BL-23
invasion]
(also on basic points REN-5, 6)
- May have had period before (w/ profuse vaginal Remove Damp Phlegm;
discharge) Regulate Chong & REN
Retention of Damp - Abdominal distension; gas & bloating; -------------------------
Phlegm - Nausea, vomiting in early a.m.
- Cough w/ profuse mucous; phlegm Basic points +
- Heaviness, overweight; Chest distension LU-7 + K 6 and/or SP-4 + P 6
Secondary sensation
w/ overweight - Craves sweets SP-9; ST-40;
SJ-5 (outer gate promote water
T: Pale, normal (or swollen) metabolism/urination)
C: Thick, greasy REN-9, 12 (for phlegm)
P: Slippery or slippery w/o strength (deep) REN-17; P-6
When treating women with amonorrhea during reproductive age, make sure that they are
not PREGNANT!
2. Dysmenorrhea Differential Diagnosis & Treatment

REN-6; ST-29; Zigong;
SP-6, 9, 8 (= Ladys pts Before or during menses, these pts are very tender
Basic Points Palpate: these SP pts are corresponding pts to the reproductive system.)
Also: ST-25, SP-15, LU-7 & KID-6; SP-4 + P-6
- Acute onset Promote Qi & Xue

- Related to emotions, stress, depression; sighing time Circulation;
to time Remove Xue Stasis;
- Menses: dark red, w/ a lot of dark clots (pain Regulate REN and Chong;
Qi Yu & released w/ expulsion of clots); severe pain before
Alleviate pain
Blood Stasis and during
- Cramps in low abdomen; not fixed location; -----------------------
distending sensation in lower abdomen (severe Basic +
spasms) SP-10, UB-40, UB-17 (for xue stasis)
Emotional disorder - May radiate to groin area (LIV-10, 11,12)
or trauma 4 gates, GB-34
- Severe PMS (distended breasts, etc.); distention in
hypochondriac region LIV-14 (if hypochondriac pain)
- Fixed & worse at night if more Xue related LU-7 + K-6 if more Qi Yu
T: Normal or w/ purple spots C: Normal SP-4 + P-6 if more Xue Yu
P: Wiry or hesitant/choppy
2
- Distending low abdomen with or without mass Remove Damp Phlegm
inside Regulate REN and Chong
- Spasm and pain in the lower abdomen before -----------------------
period, irregular cycle, mostly late
- Profuse vaginal discharge; Basic +
Retention of - Overweight; irregular diet; chest distention
ST-40; ST-36, P-6; REN-17
sensation
Turbid Phlegm REN-12 (good to remove phlegm)
- Cough with profuse mucous; nausea; vomit,
REN-9; SJ-5
Heaviness sensation, decreased appetite
T: Normal or pale swollen w/tm; LU-7, K 6 and/or SP-4 plus P 6
C: Thick greasy white coat, or wet
P: Deep, slippery
- Severe cramps or spasm with cold pain in low Remove Pathogenic Cold;
Accumulation of abdomen Regulate REN and Chong
Cold in Uterus - Curled in body shape curled forward over -----------------------
abdomen
Could be internal or - Cold extremities Basic +
external cold - Heat therapy can alleviate pain; prefers touch and
REN-4; UB-23; ST-28
warmth
Baliao (esp. UB-32); san jiao jiu
Shaoyin & uterus - Aversion to cold with chills
triangle
attacked directly - Other typical Cold Sx: pale face, cold extremities,
by Cold. profuse, clear urination, loose stool Moxa (ai ye is the 1 herb that enters
- Slight fever if cold invasion uterus directly)
- Delayed menstruation Massage also good
Traditional remedy: eat
fermented congee w/ brown
- Lots of clotsdark red color
sugar for warmth [brown - May faint If Wind-Cold invasion:
sugar = warming; white GB-20, UB-12, 13
sugar = cooling] T: Normal or Pale C: White coat, wet/moist
P: Deep, slow w/o strength (weak of Qi Xu) LU-7, K 6 and/or SP-4 plus P 6
- Chronic onset w/ hx of menorrhagia Nourish Xue; Tonify Qi;

- Off and on dysmenorrhea Alleviate Pain;
- Dull pain; prefers pressure Regulate REN and Chong
Dull pain in lower abdomen with gas and bloating -----------------------
- Pain comes at end of menses
- Scanty light menses & other Xue Xu Sx (fatigue; Basic +
Qi & Xue Xu palpitations; blurred vision; poor memory; bad
LIV-8; UB-17, 18, 20, 21;
concentration; floaters)
SP-10; ST-36; SP-6
- Qi Xu: Fatigue, pale face, soft voice; decreased
appetite
LU-7 and/or SP-4
T: Pale, small C: Thin white coat
P: Weak & thready
- Chronic onset Average age: 46+ Tonify KID & LIV
- Irregular, or heavy bleeding, followed by Regulate Chong and REN
menopause Strengthen Low Back
- Dull pain in lower abdomen that radiates to lower Regulate Menses
back; mostly at end of menses; prefers pressure
-----------------------
- Worse w/ overwork
LIV & KID Xu - W/ KID Xu Sx: tinnitus, weak low back; fatigue, KID-3; KID-8 (endocrine pt)
dream disturbed sleep; night sweats; hot flashes; LIV-3, 8; UB-23, 18, GB-39 (for
palm heat; low grade fever essence)
T: Red, small w/ cracks; or Pale, may be small
LU-7 and/or SP-4
C: Less coat w/ cracks; or Thin, white
P: Thin, weak; or thin, fast; weaker in rear Massage is good for most types
3
By Dr.Luo 1
Amenorrhea (bi jing / jing bi)
Dysmenorrhea (tong jing)
By Dr.Luo 2
Amenorrhea (bi jing / jing bi)
TCM
Discussion
Menstruation is monthly accumulation and release of energy
Three Blood chambers in menstruation: LIV; Chong; Uterus
LIV- congenital organ for women / KID-men
Qi before menses; Blood & Qi during menses; Blood after menses
Shi-type of hormone disorders-Liver /Xu-type Kidney
Concept
Primary - 16 years old/ 1st period
Secondary - stopped for over 3 months (Physiological/Pathological)
Must check if woman is pregnant!
Etiology
Congenital Essence Xu
Emotional Disorder
Irregular Diet
Accident
Overwork
Invasion of Cold
By Dr.Luo 3
Amenorrhea /pregnancy
Excess: Qi Yu&Blood Stasis / Cold Accumulation / Damp Phlegm Retention
Deficiency: Qi/Blood Xu / KID Xu
Treatment
Basic Points REN -5/REN-6/Zigong/ST-28/SP-6/KID-8
By Dr.Luo 4
Dysmenorrhea (tong jing)
TCM
Concept
Etiology
Emotional disorder
Irregular diet
Trauma/Accident
Overwork
Invasion of W-C
Blockage of meridians
Mechanism
Blockage (Bu Tong Ze Tong)
Malnutrition (Bu Rong Ze Tong)
By Dr.Luo 5
Deficiency: Qi & Xue Xu /LIV & KID Xu
Excess: Qi Yu & Blood Stasis/ Phlegm/Accumulation of Cold
Treatment
Basic points REN-6; Zigong ; ST-29;
SP-6, 9, 8
+ ST-25, SP-15,
+ LU-7+KID-6; SP-4 + P-6
Differential points
By Dr.Luo 6
Course: Acupuncture Treatment of Disease 2 Date: Dec something 08
Class #: 12 from Treatment 1, but material is for 2 .
Topic: Female Infertility, Male Impotence
Female Infertility
Biomedicine
Infertility is the term applied to a females inability to produce children while impotence is the term
applied to men who are unable to produce sperm which will fertilize an egg. In western medicine there
are 2 types of female infertility:
1. Primary infertility
Per biomedicine, if a woman who has never been pregnant before and has been trying
unsuccessfully to conceive (unprotected intercourse) for more than a year she has a diagnosis of
primary infertility. Compare this to TCM which says that a woman is infertile (primary) if she
has been trying for 2 years unsuccessfully to conceive. This is usually the result of Kidney xu of
either yin, yang, or essence.
2. Secondary infertility:
Per biomedicine, if a woman has been pregnant in the past, but has been trying to conceive for 1-
2 years unsuccessfully, then she is infertile for secondary reasons. This can also be the result of
reasons such as fibroids (blood stasis and/or blockage of the Ren/Chong), artificial abortion,
miscarriage.
Note that sterility is the inability to produce offspring, which would include inability to conceive (female
sterility) or inability to induce conception (male sterility).
The etiology is said to be one of the following:

Hormone disorder 41%
This will show in irregular menses. One must have at least 3 months of regular menstrual cycles
in order to get pregnant.
Fallopian tube disorder (blockage) 32%
Cervical and vaginal disorder 8%
Uterine disorder 15%
Other disorders/reasons 4%
Acupuncture Treatment of Disease 2 Winter 2009 Dr. Luo

Page 1 of 18
Traditional Chinese Medicine
Etiology of Female Infertility
Female infertility can be the result of the following etiologies:
1. Congenital Essence Deficiency

The term Tian Gui is heavenly water, the material substance of both menstrual blood and
sperm. The Kidney essence is the origin of the formation of Tian Gui. Tian Gui is in charge of
growth of reproductive organs. A deficiency of congenital essence leads to a deficiency of Tian
Gui. This refers especially to primary infertility.
2. Emotional Disorder
The Liver is one of the blood chambers of the body and is charge of separation and discharge of
the female reproductive egg. If the Liver is affected by emotional disorder the result is Liver Qi
Stagnation, leading to blood stasis and thus dysfunction of this blood chamber and the
separation/discharge of the egg.
3. Diet
Two possibilities resulting from poor diet:
a. Blood deficiency
b. Damp-phlegm retention. This is Yin pathogen blocking Chong or Ren, especially if the
patient is overweight.
4. Other
Other factors can lead to miscarriage and artificial abortion. Consider these possibilities:
a. Overworking leading to Kidney and other deficiencies
b. Strong smells
Pregnant women should stay away from strong smells, especially pungent incenses.
These can contain blood moving herbs which stir both the Blood and Qi which can cause
fetal instability. Inhalation of herbs is much stronger and faster than taking them orally!
c. Constitutional weakness
d. Cold invasion
e. Physical trauma
As a side note, winter time is the best time to conceive, as the Kidneys essence is supposed to be
strongest at this time, rendering the babys essence much stronger if conceived at this time. This is a Yin
time of rest and accumulation of Essence.
Mechanism of Female Infertility
Deficiency or Excess of Chong and Ren Channels.

Page 2 of 18
Discussion
Tian Gui, as previously mentioned, is reliant upon congenital Kidney Essence. Kidney Essence
stimulates the production of Kidney Qi which in turn stimulates the production Kidney Yang. Kidney
Essence also stimulates the creation of Kidney Yin. Note the following symptom generalizations about
deficiency of these:
If one has a Kidney essence or Qi deficiency, there will be a lack of heat or cold signs/symptoms
If one has a Kidney yin deficiency there will be empty heat signs
If one has Kidney yang deficiency, there will be empty cold signs
The Liver and Kidney are in charge of the hormonal system. Remember that the Kidney is the
congenital organ of importance for men while the Liver is the most important organ for women.
The extra meridians, Du, Chong, and Ren, all originate from the uterus. Du is primarily for male
infertility while Ren and Chong are used for female infertility. Because of this:
For an essence or yin deficiency, treat the Ren meridian

For Blood disorders, either excess or deficient, treat the Chong meridian
For deficiency types, needle the single master point, which is for tonifying that meridian.
For excesses, open the extra points (coupling points for needling), which is a regulating
treatment.
There is an herbal prescription for female infertility developed by Dr. Wu:

Ze he che or tai pan (placenta) take this as a powder daily one week to 10 days before
ovulation and up to ovulation. The dose is 2 scoops BID early morning or late at night. You can
also encapsulate it and take 4 BID or add it to other herbs in a formula.
Excesses causing female infertility include cold in the uterus, phlegm damp obstruction, Liver Qi
stagnation, and Blood stasis. Deficient reasons include Kidney deficiencies, and Heart/Spleen
deficiencies. The latter is a Heart Blood deficiency coupled with a Spleen Qi deficiency.
Bear in mind that this is always a disorder of Ren and Chong, so be sure to regulate them.
Basic Points:
Ren 4 This is also called the Lower Dantian, the sea of Qi in the lower body. As
such, it is a very important point to tonify the Kidney. Use it to:
Promote and foster original Qi
Benefit the Essence
Fortify Kidney Yang
Nourish Kidney Yin
Ren 6 This too is referred to as the Lower Sea of Qi and treats Qi deficiencies as
well as reproductive problems.

Page 3 of 18
Zigong Zigong is the Palace of the Child. It is used to treat infertility and irregular
menstruation.
SP 4 SP 4 is the confluent point of the Chong channel, which addressed infertility
and irregular menstruation.
SP 6 SP 6 is the meeting point of all 3 lower Yin channels. It treats blood
disorders as well as female and male reproductive disorders and tonifies Yin.
Be sure your patient is not preggers because this can cause restless fetus.
SP 9 SP 9 is excellent for damp issues, but also for reproductive issues.
SP 10 SP 10 is the Sea of Blood. Ok, yes, there are several sea of bloods in the
body, but this is a great point to treat all kinds of blood issues heat, stasis
and deficiency -- that might be causing infertility.
Kidney Deficiencies
This can be deficiency of Kidney Yin, Yang, Qi or Essence causing infertility. Symptoms are
outlined in the column to the left while treatment principles and points are in column on the left.
Yang Xu Strengthen Kidney

Cold extremities Strengthen Chong and Ren Channels
Aversion to intercourse
Qi Xu Basic points plus
Weakness of the lower back or knees
Fatigue KI 3, GB 39, UB 23, UB 52, DU 4
Yin Xu
Prolonged or shortened menstrual Also:
cycle with pale, scanty menstrual ST 36, ST 29 for prolonged cycles
KID 13 to nourish Chong, tonify Kidney,
discharge strengthen uterus
Urination: UB 52 to tonify Kidney and nourish essence
Frequent, copious, often nighttime LU 7 to regulate Ren, strengthen uterus and
urination. Kidney
Dizziness
Herbal formula is yu lin zhu, Unicorn Rearing Pill
Tinnitus
Tongue: Pale, swollen, wet

Pulse: Weaker, deeper in 3rd position
Discussion:
Kidney 3 is the principle point to tonify the kidney and to nourish the Chong and Ren
since they have their root in (note, I did not say originate from) and are nourished by
the Kidney.
GB 39 is the meeting point of marrow. One reason to use this is that it helps smoothe the
Liver qi, but its not a strong enough indication for that reallyI believe Dr. Luo said to
use it to nourish Kidney essence, but you might want to ask him about that before taking
my word for it.
UB 23 is the back shu of the Kidney and treats all of the deficiencies (yin, yang, essence,
qi).
UB 52 is on the same level as 23 and also tonifies the Kidney.

Page 4 of 18
DU 4 is the Mingmen or Gate of Life and again is on the same level as UB 23 and UB 52.
It tonifies the Kidney, treats reproductive problems and Yang deficiency.
Heart and Spleen Deficiency
This is Heart Blood Xu plus Spleen Qi Xu. Symptoms are outlined in the column to the left
while treatment principles and points are in column on the left.
Symptoms Treatment Principles and Points

Infertility lasting for a long time Treatment principles:
Inability to conceive Tonify Spleen Qi
Heart symptoms: Nourish Heart Blood
o Palpitations Strengthen Chong and Ren
o Insomnia channels
o Poor memory
o Bad concentration Points:
Blood symptoms: Basic points, plus
o Scanty light menses
o Dizziness ST 28, UB 20, UB 21, UB 17, UB 15,
o Pale complexion Ren 14
o Blurred vision
Spleen Qi deficiency symptoms: ST 36, KID 13, UB 23, Ren 12
o Poor appetite
o Fatigue Herbal Formula: Ba Zhen Tang or Eight Precious
o Shortness of breath Decoction
o Depression
Tongue: Pale and thin with a thin white coat
Pulse: Weak and thin or fine and choppy
Discussion
ST 28 activates the lower jiao and dispels stagnation. It is also local to the uterus, treating
dysmenorrhea, infertility, cold congealing the uterus.
UB 15 is the Back Shu of the Heart. It tonifies and nourishes the heart, regulates the
Heart Qi, calms the spirit and unbinds the chest. It is indicated for palpitations, shortness
of breath, poor memory, anxiety, insomnia and dream disturbed sleep and depression. UB
15 also tonifies deficiencies
UB 17 is the Hui Meeting Point of Blood. This point invigorates blood and dispels stasis,
cools the blood, nourishes and harmonizes the Blood. This point is used for chest
oppression, depression (as well as mania), deficiency of Blood,
UB 20 is the Back Shu of the Spleen. This point tonifies Spleen Qi, regulates and
harmonizes the Qi of the Middle Jiao, raises Spleen Qi and hold the blood. The Spleen
provides the post-natal Qi. Without proper Spleen Qi this function is impaired. Without
proper post-natal Qi to support the congenital Qi and without the ability to hold the
blood, the body is unable to support a fetus.

Page 5 of 18
UB 21 is the Back Shu of the Stomach. This point regulates the functions of the Stomach
and harmonizes the Middle Jiao. The Stomach itself is the Sea of water and grain and is
coupled with the Spleen in the provision of post natal Qi to the body.
Ren 14 is the Front Mu Point of the Heart, the complement to UB 15, with many of the
functions and actions overlapping. Ren 14 can also assist in treating the shortness of
breath symptom above.
ST 36 is a primary point for the treatment of Spleen Qi Xu. It is indicated for all types of
problems related to Spleen Qi xu including Spleen Qi and Blood deficiency. It also helps
to calm Shen disturbance causing poor memory, sleep disorders, and depression.
KI 13 is one of the meeting points of the Kidney channel with the Chong channel. The
application for this point is the treatment of reproductive disorders. It is used to regulate
the Ren and Chong vessels and to regulate the Lower Jiao. It is indicated for infertility
and irregular menstruation.
UB 23 is the back shu of the Kidney and treats all of the deficiencies (yin, yang, essence,
qi).
Ren 12 is the Front Mu of the Stomach as well as the Hui Meeting Point of Fu. It
harmonizes the Middle Jiao and tonifies the Spleen and Stomach.
Cold in the Uterus
Symptoms are outlined in the column to the left while treatment principles and points are in
column on the left.

Typically, external cold pathogen causing Treatment principles:
severe dysmenorrhea with cold Warm Uterus
sensations, severe pain, retarded or late Expel external Cold pathogen
menses, and dark red clots. Regulate Chong and Ren
Inability to conceive Channels
Pain relieved by heat, worse with cold
Cold extremities Points:
If still has the external cold will have Basic points, plus
shivering and chills.
Pale face DU 4, REN 4 with Moxa
UB 12 and UB 13 with Moxa
Tongue: Normal or pale and swollen with a
thin white coat. Ren 2 with Moxa to scatter cold
Pulse: slow and deep. If more Yang, then KI 7 and UB 23 to tonify Kidney
slow and weak. Yang
Ren 7 to nourish Kidney and
strengthen uterus.
Discussion
Du 4, the Mingmen or Gate of Life, tonifies the Kidney and treats reproductive problems.
It also has a strong effect upon Yang Qi and ministerial fire, tonifying and warming the
fire, especially with the addition of Moxa. The Mingmen also connects with the uterus.
Ren 4 is also called the Lower Dantian, one of the seas of Qi in the body. In addition to
the Kidney tonifying benefits mentioned in the Basic Point, it is also the meeting point of
Page 6 of 18
the Conception/Ren channel with the Spleen, Liver and Kidney channels, benefiting the
uterus and assisting in conception. Adding moxa to the treatment of this point is effective
in alleviating cold in the uterus. Kidney deficiency can lead to coldness in the Uterus, or
Palace of the Child, resulting in the infertility under discussion in this section.
Moxibustion here will not only assist in nourishing and tonifying the Kidneys, but will
also warm the uterus and Spleen.
As a fun aside, Ren 7 through Ren 4 are considered to be the residence of the deepest
energies of the body, touching the energies that move between the Kidneys the Gate of
Life. This is the basis of human life, the source of the Zangfu, the door of respiration and
the origin of the San Jiao.
As another fun aside, did you know that Dantian has been translated as Cinnabar Field?
That may not seem interesting unless you know that cinnabar is another word for mercury
and that mercury when purified properly by a master alchemist is said to give incredible
longevity and health. It has been called the Sorcerers Stone by alchemists. Sun Simiao,
the dude we studied in Foundations long ago, was not only the Herb King, but an
alchemist who is said to have lived well over 100 years, having successfully purified and
ingested mercury. Legend has it that when he died his body did not decay. Read In
Search of the Medicine Buddha on your next break if this sparks your interest. I should be
done with it and will have returned it to the library by then.
UB 12 is the Wind Gate, used to expel pathogenic factors from the body. External
pathogenic factors can obstruct the bodys defensive Qi, impairing its warming function.
Moxibustion is the best solution for Wind Cold invasions at this point.
UB 13 is the Back Shu of the Lung. This point is also used to expel external pathogens
from the body. Use it with Moxa like UB 12.
Ren 2 warms and invigorates the Kidneys. It is used to treat a wide array of genital and
urinary disorders and gynecological diseases.
KI 7 is the Jing Well of the Kidney Channel, controlling the flow of fluids and blood as
well as the flow of defensive Qi which is part of original Qi and emanates from the lower
jiao. OK, Ill admit Im shaky on this, so Id ask Dr. Luo for sure, but Deadman says that
KI 7 has wide applications in regulating the opening and closing of sweating pores which
also helps regulate heat. Could this help regulate and alleviate the cold affecting the
uterus?
UB 23 is the Back Shu of the Kidney. It tonifies the Kidneys, fortifies Yang, benefits
essence, nourishes Kidney yin and Kidney qi, and warms/benefits the Uterus. It is
indicated for accumulation of Cold in women and chronic cold of the Uterus.
Ren 7 is a point at which the Ren and Chong channels meet together with the Kidney
channel. It treats cold disorders in the uterus as well as deficiency, excess, heat, exterior
pathogens and interior disharmony.

Page 7 of 18
Obstruction by Phlegm-Damp
This is typically true in overweight patients or patients with high cholesterol. Symptoms are
outlined in the column to the left while treatment principles and points are in column on the left.

Profuse vaginal discharge Treatment principles:
Blockage of fallopian tubes Remove Damp Phlegm
Inability to conceive Open the Chong and Ren channels
Prolonged menstrual cycle and in some
severe cases, amenorrhea Points:
May be overweight Basic points, plus
Chest distention with profuse mucous and ST 40, Ren 12, Ren 17, PC 6
phlegm
Heavy sensation Ren 3 to strengthen the uterus and
Nausea/vomiting resolve dampness
Dizziness and vertigo ST 28, SP 9, SP 6, and Ren 9 to
resolve dampness
Tongue: normal or pale and swollen with a LU7 + KI 6 to regulate Ren and
thick white or yellow greasy coating strengthen the uterus
Pulse: slippery ST 30 to regulate Chong, also
invigorates Blood to transform water
UB 32 drains damp from the genital
system
Herbal formula: Qi Gong Wan or Uterus

Opening Pill
Discussion
ST 40 is the most important point in the body to resolve phlegm. Phlegm occurs when the
Spleens transportation and transformation function is impaired, allowing body fluids to
collect and over time change to phlegm. The Spleen should be regulated in any phlegm
condition. Because this point is the Luo connecting point, it also connects with the Spleen
channel.
Ren 12 is the Front Mu of the Stomach as well as the Hui Meeting Point of Fu. It
harmonizes the Middle Jiao and tonifies the Spleen and Stomach. Proper function of the
Spleen and Stomach are imperative when resolving phlegm as stated above. This also
treats the symptoms of nausea and vomiting.
Ren 17 is the Front Mu of the Pericardium and the Hui Meeting Point of Qi. In this case,
Ren 17 regulates the proper flow of Qi, assisting the Qi of the middle jiao in descending
properly. This in turn benefits the harmony of the Stomach which again assists in the
resolution of phlegm. This point will also help treat nausea and vomiting by assisting in
the descent of Qi.
PC 6 has a powerful effect upon the middle jiao and is important to harmonize the
Stomach and alleviate nausea and vomiting.
Ren 3 is the Front Mu of the Bladder and is another of the meeting points of the Ren
channel with the Spleen, Liver and Kidney channels. It drains dampness, assisting the
Page 8 of 18
resolution of phlegm, dispels stagnation and benefits the lower jiao, predominantly in
excess patterns
ST 28, also called Water Passage, has an action of regulating the lower jiao and
dispelling stagnation. Sun Simiao, our own personal Herb Saint, referred to the left ST 28
as the Gate of the Uterus and to the right ST 28 as the Childs Door. Combine that
together and there is an implication that this point could get rid of
accumulation/stagnation affecting the uterus. Hmmm. It also drains off dampness which
could exacerbate the condition of phlegm blocking the uterus.
SP 9 is the He Sea and Water point of the Spleen channel. It is essential in the treatment
of dampness and Spleen disorder, especially in the lower jiao.
SP 6
Ren 9
LU 7 and KI 6
ST 30
UB 32
Liver Qi Stagnation
column on the left.

Clearly related to an emotional disorder Treatment principles:
Infertility with PMS and irritability Soothe Liver
Irregular, late or absent periods Promote circulation
Premenstrual depression and tension Regulate Chong and Ren Channels
Painful periods
Sighing a lot Points:
Depression in general Basic points, plus
Breast tenderness
Four gates: LI 4 + LV 3
Tongue: normal GB 34, LV 14, UB 18
Pulse: wiry
Herbal formulas:
Jia Wei Xiao Yao San
Kai Yu Zhong Yu Tang or
Depression Opening Jade Plant
Decoction
Discussion
Four gates (LI 4 + LV 3)
GB 34
LV 14
UB 18

Page 9 of 18
Blood Stasis
column on the left.

Inability to conceive Treatment principles:
Irregular or delayed menses Invigorate Blood
Painful periods Remove stasis
Lower abdominal pain, worse with Soothe Liver
pressure Regulate menses
Dark blood (purplish black) with dark
clots Points:
Irritability Basic points, plus
Mental restlessness or manic behavior
UB 17, ST 20, LU 7 + KI 6
Tongue: dark purple with spots or patches LV 3, GB 34, KI 14
Pulse: wiry or choppy
Herbal fomula: Shao Fu Zhu Yu Tang or
Lesser Abdomen Stasis Expelling Decoction
Discussion
UB 17
ST 20
LU 7 and KI 6
LV 3
GB 34
KI 14
Regarding Treatment Principles:

There are four phases of the menstrual cycle. Adjust your treatments to the phase your patient is in
when she comes to see you.
1. Period phase:
Regulate menstruation. Stop the period if it is heavy or invigorate Blood if the period is
scanty.
2. Post-menstrual phase:
Nourish Blood and tonify the Kidney
3. Inter-menstrual phase:
Tonify the Kidney and consolidate Ren and Chong
4. Pre-menstrual phase:
Tonify Yang and move the Liver Qi

Page 10 of 18
Li, Female Age 25
She suffered from infertility for 4 years. She had profuse, white, watery vaginal discharge. She had pale
complexion, fatigue, profuse clear and frequent urination, chronic loose stools, edema in the lower
extremities, lower back pain, pale and swollen tongue with sticky white coating. Her pulse was
slow and weak.
1. The differential diagnosis for this case is:

a. Liver overacting on Spleen with lower pouring of dampness
b. Spleen and Kidney Yang xu with dampness
c. Spleen and Kidney Qi xu with damp retention
d. Liver and Kidney Yin xu with damp phlegm retention.
2. Which group of points for this case?

a. LI 4, LI 11, SJ 5, ST 44, GB 41, GB 34, LV 2, BL 26
b. SP 6, BL 23, DU 4, ST 36, SP 9, GB 26, BL 32
c. GB 26, ST 34, GB 37, LV 5, H7, P6, SI 3, LI 10
d. GB 26, BL 17, BL 13, DU 14, GB 20, LI 15, GB 34

Page 11 of 18
Male Impotence
In TCM this is called Yang Wei. Hmmm. That rings a bell, doesnt it? Ah yes. Theres a whole channel
called Yang Wei too. In this case it means Yang Flacidity Syndrome.
Definition
By definition, impotence is the inability of a man to sustain an erection sufficient for sexual
intercourse and/or the inability to achieve ejaculation. Levels of these dysfunctions can vary:
there may be a total inability, inconsistent ability, or a tendency to sustain only very brief
erections. While there is no total agreement on this issue, generally, if one has this problem for 3
months or more, then the dude has a problem.
Discussion
While Yin and Blood are triggers for female infertility, it is Yang and Qi which are the triggers
for male impotence. The most important organ for men is the Kidney.
Externally the Kidney controls the scrotum, testicles and penis.
Internally the kidneys control the Kidneys themselves as well as the prostate.
Note that the penis and scrotum are also related to the Liver. The penis, or yang instrument as
described in the Nei Jing is the place of convergence for sinews and ligaments. The term penis in
Chinese is called the Zong Jing or the convergence (zong) of ligaments (jing). About 15% of
all cases of impotence have an organic cause; emotional causes springing from a Liver
disharmony (or causing a Liver disharmony) are the more common cause.
Infertility in males includes but is not exclusively impotence. Be sure you can differentiate
between infertility and impotence. Men need both Yin and Yang in order to have fertility. Yin
provides essence and thus sperm while Yang gives this sperm motility. When a male is infertile
this includes deficiencies of Yin, Blood, and Essence (or quantity, quality, and function) of
sperm. Impotence however is more related to Qi and Yang deficiencies.
Left Axis
On the left side of the body or left axis you find the Heart, Liver, and Kidney Yin. Also on the
left are the endocrine system, nerve system and emotion.
Right Axis
On the right side of the body or right axis, you find the Lung, Spleen, and Kidney Yang. Also on
the right are the reproductive system, urinary system and immune systems .
TCM Etiology
Emotional Disorders
About 85% of impotence cases are functional rather than organic. The emotions of anxiety, guilt,
sadness, depression, stress, fright, and frustration all contribute as causes of impotence. This
causes a Liver Qi stagnation which blocks the channel and results in failure to have or sustain an
erection.

Page 12 of 18
Overwork
Too much work taxes the Kidneys, the most important organ for men. This includes excessive
sexual intercourse or masturbation (damn!).
Western medications
Medications for stress, high blood pressure and anti-depressants are know to cause sexual
dysfunction in men.
Mechanism of Impotence
Liver Qi Stagnation
This results in failure to support the movements of sinews and ligaments. Refer back to the
discussion at the beginning of this section for more specific info on this.
Kidney Qi and Yang deficiencies failing to support function of external kidneys.

Externally the Kidney controls the scrotum, testicles and penis.
Lower pouring of damp heat blocks the channels
Differential Diagnosis and Treatment of Impotence
Differentiations of both deficiency and excess can be cited in impotence. Deficiencies can include
Spleen and Kidney Qi xu as well as Spleen and Kidney Yang xu. Excesses can include Liver Qi Yu and
Lower pouring of damp heat.
As with all disease studied so far, there are a basic set of points you use in addition to the points
specified below for the differential diagnoses.
Basic Points
Discussion
Ren 4 Ren 4 is the Guan Yuan or gate of origin. It is also one of the points in the area
of the dantian. This point promotes and fosters the original Qi, benefits essence,
fortifies KI yang, nourishes KI yin, and is an extremely important to tonify the
Kidneys.
Ren 6 Ren 6 is the lower Sea of Qi and is good to use for general Qi deficiencies and
for Qi stagnations.
Jing Frankly, Im not sure if this is what Dr. Luo was referring to, but Jinggong is
gong another name in Chinese for BL 52. This name has to do with this points ability
to fortify Kidney Qi and Yang, control sexual function and discharge of semen,
so it is used to treat impotence.
BL 23 Back Shu of the Kidney.
Page 13 of 18
Classic point used to tonify kidneys including kidney yang xu, yin xu, Qi xu, and
essence xu. BL 23 is also used for all kinds of reproductive problems.
Du 4 This is the Mingmen or gate of life point. The Mingmen is where Kidney
essence and Qi are stored. Use this point to tonify kidneys for both impotence
and male infertility. Also tonifies the Kidney Yang.
Ba liao Ba liao points are almost local points and are used to treat reproductive
problems.
Spleen and Kidney Qi Deficiency

This is one of the chronic problems which cause impotence. Symptoms are listed in the left
column while treatment principles and points are listed on the right.
Discussion of Points
KI 3 Yuan source of the KI channel, best and most common clinical application point
to tonify and treat disharmony of the Kidney Zang.
Just for giggles, note that some works says that KI 3 is best related to Kidney Qi,
KI 6 to Kidney Yin, and KI7 (and/or Du 4) to Kidney Yang.
SP 6 This is the meeting point of Spleen (the source of Qi and Blood), Kidney (which
stores Essence) and Liver (which stores Blood and moves Qi). It treats male
infertility, impotence and nocturnal emissions by treating Kidney deficiency,
Liver Qi stagnation and damp heat.
ST 36 Treats Spleen deficiencies, which weve all heard about a million times at this
point.
UB 20 Back Shu of the Spleen. Dont need to go over that one either, eh.
UB 21 Back Shu of the Stomach.
UB 52 Complementary point to BL 23, thus tonifying the Kidney. Jinggong is another
name in Chinese for BL 52. This name has to do with this points ability to
fortify Kidney Qi and Yang, control sexual function and discharge of semen, so
it is used to treat impotence.
Ren 17 As the Sea of Qi, this point regulates Qi flow in the body.

Page 14 of 18
Spleen and Kidney Yang Xu
This is a problem of deficiency causing impotence. Symptoms are listed in the left column while
treatment principles and points are listed on the right.
KI 3 Yuan source of the KI channel, best and most common clinical application point
to tonify and treat disharmony of the Kidney Zang.
Just for giggles, note that some works says that KI 3 is best related to Kidney Qi,
KI 6 to Kidney Yin, and KI7 (and/or Du 4) to Kidney Yang.
SP 6 This is the meeting point of Spleen (the source of Qi and Blood), Kidney (which
stores Essence) and Liver (which stores Blood and moves Qi). It treats male
infertility, impotence and nocturnal emissions by treating Kidney deficiency,
Liver Qi stagnation and damp heat.
ST 36 Treats Spleen deficiencies, which weve all heard about a million times at this
point.
UB 20 Back Shu of the Spleen. Dont need to go over that one either, eh.
UB 21 Back Shu of the Stomach.
UB 52 Complementary point to BL 23, thus tonifying the Kidney. Jinggong is another
name in Chinese for BL 52. This name has to do with this points ability to
fortify Kidney Qi and Yang, control sexual function and discharge of semen, so
it is used to treat impotence.
Ren 17 As the Sea of Qi, this point regulates Qi flow in the body.
SI 3 + SI 3 is the confluent point of the Du channelcant remember how it connects
UB 63 to UB 63 and all the sources I have available right now are silent on the issue.
Hmmm. Got any input? Send it to cat@catstcmnotes.com and thank you in
advance.

Page 15 of 18
Liver Qi Stagnation
This is an excess causing impotence. Symptoms are listed in the left column while treatment
principles and points are listed on the right.
Four LI 4 + LV 3
Gates
GB 34 Hui of Sinews. Main point to influence sinews. Soothes Liver.
UB 18 Back Shu of the Liver
UB 19 Back Shu of the Gallbladder
Lower Pouring of Damp Heat

This is the acute stage of prostatis and is another excess causing impotence. Symptoms are listed
in the left column while treatment principles and points are listed on the right.

Page 16 of 18
Ren 3 Front Mu of the Bladder. Dispels stagnation and benefits the Lower Jiao, drains
dampness and damp heat. Also fortifies the Kidneys. You can aim toward UB 18
and ST 28 when you treat.
UB 28 Back Shu of the Bladder. You can aim toward Ren 3 when you needle for better
effect. Regulates the Bladder and clears damp heat from the Lower Jiao.
UB 22 Back Shu of the San Jiao. Regulates water passage and promotes urination by
regulating the San Jiao, thus regulating dampness.
UB 39 Lower He Sea of the San Jiao. Nuf said already.
ST 28 This is the water passage point, assisting with damp drainage.
SP 9 He Sea point of the Spleen Channel. Best point in the body for damp retention
and damp heat. All of the Yin He Sea points strongly drain damp (SP 9, KI 10,
LV8)
SJ 5 Luo of San Jiao and Confluent with Yang Linking. Drains heat, Dr. Luo
indicates it for Damp and Heat.
LI 11 He Sea of the LI channel. One of the best points to clear heat in the whole body.
Cools the blood and helps to drain damp.
Impotence can be treated herbally by tonifying Yang:

Kings Therapy or Spring Therapy. Spring is a very active and upward moving season. You can
warm Yang temporarily, but bear in mind that longer term this can damage Yin. Would you
believe animal penises soaked in alcohol for 6 months? Ew.
Dong chong xia tiao formula
Silk work cocoon soaked in alcoholwhich sounds better than animal penises!
You can also treat with Qigong therapy called Tie dan gong which is Qigong and massage to treat
infertility.

Page 17 of 18
Wang, Male, Age 20
He suffers from erectile dysfunction, complicated with bitter taste in mouth, thirst, hot and dark red
urine, soreness and weakness of lower extremities, wetness in the scrotum, burning and painful
urination, slippery and rapid pulse.
1. Which kind of tongue would be inspected for this patient?

a. Pale and swollen body with teethmarks, thin and moist coat
b. Normal body with red spots in the tip and sides
c. Small thin body with map coating
d. Red tongue body with yellow, sticky coating
2. What is your diagnosis to this case:

a. Impotence due to Kidney Yang xu
b. Impotence due to Spleen Qi xu
c. Disharmony between Heart and Kidney
d. Impotence due to lower pouring of damp heat
3. Which group of the points is for this case?

a. BL 23, DU 4, BL 52, RN 4, RN 6
b. SP 6, ST 36, BL 20, BL 21
c. KI 3, KI 6, BL 25, LV 3, LI 8, UB 62
d. LI 11, SJ 5, GB 34, RN 3, BL 28, BL 31-34

Page 18 of 18
By Dr. Luo 1
Female Infertility (bu yun zheng)
Impotence (yang wei)
By Dr. Luo 2
Biomedicine
Definition Infertility-inability to conceive a child after

1 year of continuous unprotected intercourse.
Sterility-inability to produce offspring, i.e.,

the inability to conceive (female sterility) or
to induce conception (male sterility).
By Dr. Luo 3
TCM
Etiology
Congenital Essence Xu: Tian gui--primary infertility
Emotional disorder
Diet
Overworking
Cold invasion
Trauma (Miscarriage, Artificial abortion )
Mechanism
Xu or Shi of Chong and REN Channels
Discussion
Tian kui
KID (Essence / Qi / Yang / Yin)
KID & LIV -- hormone system
Extra meridians DU - male infertility
Chong & REN - female infertility
Notes:
Essence or Yin Xu - REN meridian
Blood disorder (excess or xu) -Chong meridian
Xu types- master point By Dr. Luo 4
Excess: Cold in Uterus/Phlegm-Dampness Obstruction/LIV Qi Yu/Blood Stasis
Deficiency: KID Xu /HT & SP Xu
Treatment
Time(Year--Before Winter;Month4 menstrual phases principles)
Causes
Basic Points REN-4, 6; Zigong; SP-4, 6, 9, 10
Herb Zi He Che/ Da Bu Yin Wan/ Ba Zheng San
By Dr. Luo 5
Biomedicine
TCM
By Dr. Luo 6
A common problem among men characterized by the
consistent inability to sustain an erection sufficient for
sexual intercourse or the inability to achieve ejaculation, or
both.
Impotence can vary. It can involve a total inability to

achieve an erection or ejaculation, an inconsistent ability to
do so, or a tendency to sustain only very brief erections.
There is no universally agreed upon criteria for how

consistent the problem has to be and for what duration it
needs to be present to fulfill the definition, although three
months is often used as a guideline.
By Dr. Luo 7
TCM
Description Kidney/Penis
Etiology
Medication
Emotional disorder-- >85% not organic but functional disorder
Overwork: Sexual intercourse or masturbation
Mechanism
LIV Qi Yu
KID Qi & Yang Xu
Lower pouring of D-H blocks channels
By Dr. Luo 8
Deficiency: SP & KID Qi Xu /SP & KID Yang Xu
Excess: LIV Qi Yu /Lower Pouring of Damp Heat
Treatment
Basic points REN-4, 6, Jing gong ,BL-23, DU-4, Ba liao
Differential points
By Dr. Luo 9
Case Discussion
CASE 1 CASE 2
Pulse: slow and weak Pulse: slippery and fast

By Dr. Luo 10
Differential Disgnosis & Treatment
always a disorder of RN & Chong (Regulate REN & Chong)
Basic Points REN-4, 6; Zigong; SP-4, 6, 9, 10
- Yang Xu: cant conceive = functional d.o. Strengthen KID,

- Cold extremities, aversion to intercourse Strengthen Chong & REN Channels
- Qi Xu: weakness of lower back or knees, ------------------------------------
fatigue Basic +
KID Xu - Yin Xu Sx
(Yin, Yang, Qi, - Prolonged or shortened menstrual cycle; KID-3; GB-39; UB-23, 52; DU-4
or Essence) scanty pale menstrual discharge Also:
- Frequent, copious urination; nighttime ST-36; ST-29 (for prolonged cycles)
urination; dizzy; tinnitus KID-13 (nourish Chong; tonify KID; strengthens uterus)
UB-52 (tonifies KID; nourishes Essence)
T: Pale, swollen, wet LU-7 (regulates REN; strengthen uterus & KID)
P: Weaker, deeper in rear positions >Yu Lin Zhu (Unicorn Rearing Pill)
- Infertility lasting for long time Tonify SP Qi, Nourish HT Blood,
- Inability to conceive Strengthen Chong and REN
- Palpitations, insomnia, poor memory, bad ---------------------------
HT & SP Xu concentration, scanty light menses, Basic +
dizziness, pale complexion, blurred vision
(HT Xue Xu & ST-28; UB-20, 21
- Poor app, fatigue, SOB, depression
SP Qi Xu) UB-17, 15; REN-14
T: Pale, thin C: Thin white --
P: Weak, thin [fine, choppy] ST-36; KID-13; UB-23; REN-12
> Ba Zhen Tang (Eight Precious Decoction)
- Typically, caught cold and severe Warm Uterus, Expel Cold epf,
dysmenorrhea: cold sensation, severe pain, Regulate Chong and REN
retarded/late menses, dark red clots --------------------------
- Inability to conceive Basic +
- Pain relieved by heat, worse w/ cold
DU-4; REN-4 w/ moxa
Cold in Uterus - Cold extremities
UB-12, 13 w/ moxa
- If still has ext. cold pathogen: shivering,
chills Moxa: REN-2 (scatters cold),
- Pale face KID-7; UB-23 (tonify KID Yang)
REN-7 (nourishes KID, strengthens uterus)
T: Normal, or pale, swollen
C: Thin, white coat > Ai Fu Nuan Gong Wan (Artemisia-Cyperus
P: Slow, deep (if more Yang: slow, weak) Warming The Uterus)
1
Remove Damp-Phlegm,
- Profuse vaginal discharge Open Chong & REN
- Blockage of fallopian tubes -----------------------
Obstruction - Inability to conceive
by Phlegm- Basic+
- Prolonged menstrual cycle; amenorrhea in
Dampness severe cases ST-40; REN-12, 17; P-6
- May be overweight
- Chest distention w/ profuse mucous, phlegm REN-3 (strengthen uterus; resolve damp)
- Heaviness sensation; n, v ST-28; SP-9; SP-6; REN-9 (resolve damp)
overweight, - Dizziness & vertigo LU-7 + KID-6 (regulate REN; strengthen uterus)
high cholesterol ST-30 (reg. chong; invigorate Blood to transform
T: Normal or Pale, swollen water)
C: Thick, white or yellow, greasy coat UB-32 (drains damp from genital system)
P: Slippery
> Qi Gong Wan (Uterus Opening Pill)
- Clearly related to emotional disorder Soothe LIV; Promote circulation;
- Infertility w/ PMS, irritability Regulate Chong and REN
- Irregular, late or absent periods; premenstrual -------------------------------
depression/ tension; painful periods Basic +
LIV Qi Yu - Sighing, depression
- Breast tenderness, 4 gates, GB-34; LIV-14; UB-18
> Jia Wei Xiao Yao San
T: Normal > Kai Yu Zhong Yu Tang (Depression
P: Wiry Opening Jade-Plant Decoction)
- Inability to conceive; irregular or delayed Invigorate Blood; Remove Stasis;
menses; painful periods; lower abdominal pain Soothe LIV; Regulate menses
worse with pressure; dark blood (purplish- -------------------------
black) with clots
Blood Stasis - Irritability; mental restlessness or manic Basic +
behavior UB-17; ST-29; LU-7 + KID-6
LIV-3; GB-34; KID-14
T: Dark purple w/ spots or patches
> Shao Fu Zhu Yu Tang (Lesser Abdomen
P: Wiry or choppy
Stasis-Expelling Decoction)
Treatment 1. Period phase: regulate menstruation: stop period if heavy or invigorate Blood if
Principles: scanty
4 phases of 2. Post-menstrual phase: nourish Blood & tonify KID
3. Inter-menstrual phase: tonify KID & consolidate REN & Chong
Menstrual Cycle 4. Pre-menstrual phase: tonify yang and move LIV Qi
Herbal Therapy:
Placenta powder (from sheep or goat)
Take 3-5 d before ovulation
> Ba Zhen San / 8 Treasure Decoction (sometimes called Nu Zhe Ba Zhen San)
2
[Yang Wei = Yang Flaccidity Syndrome]
Differiential Diagnosis & Treatment
REN-4, 6
Basic Points Jing gong (sperm palace = same as zi gong! [3 cun lateral to REN-3])
BL-23, DU-4, Ba liao (BL-31 to 34: esp. BL-31, 32 on both sides)
Qi Xu w/ SP & KID Qi Xu signs: Tonify SP & KID Qi;

- Impotence, infertility Benefit/Strengthen External Kidneys
- Fatigue; tiredness; poor appetite; loose stool ---------------------
or diarrhea; gas & bloating in the abdomen Basic +
SP & KID - Incontinence or profuse, frequent urination;
Qi Xu low back pain; worse after orgasm KID-3; SP-6; ST-36; UB-20, 21
- Sinking sensation in the lower abdomen If impotence is predominant Sx:
- Pale face; may have SOB Use moxa for preventative tx
Chronic - Palace therapy qigong to prevent loss of Qi [not for long term: if begin to feel: 1) thirsty,
2) have insomnia/poor sleep, 3) dark, yellow
urination or constipation stop moxa! B/c the
T: Pale, swollen w/ tm C: Thin, white
PT is not Yang Xu yet!]
P: Deep, weak
UB-52; REN-17
- Worse than Qi Xu Warm SP & KID Yang;

- Impotence, failure to achieve erection Benefit the external kidneys
- Premature ejaculation ------------------------
- All of the above Qi Xu Sx, plus: Basic +
- Cold extremities, cold pain in the lower back or
abdominal, desire for warm drinks Same points as above
SP & KID - Profuse, clear, frequent urination Add moxa (moxa box is very good on the
Yang Xu - Morning diarrhea lower back over DU-4, UB-23 area, or
- Incontinence (more severe) over the Baliao pts)
- No desire or aversion to sexual intercourse SI-3 + UB-63 for the DU
- May have edema
T: Pale swollen tongue body May add:
C: Wet/moist SP-6; ST-36; REN-17; DU-20; REN-8
P: Deep, weak, slow
- Hx of relationship or emotional disorder, or Soothe LIV Qi;
personality (introverted, scared) Promote circulation;
- Impotence, failure of erection Benefit the external kidneys
- Stress & depression; prefers to be alone --------------------
- Sighing time to time
- Distention of the hypochondriac region or
Basic +
breast
LIV Qi Yu - Distending sensation or pain (esp. after 4 gates; GB-34 (hui of sinews)
intercourse) at root of penis or scrotum & UB-18, 19
radiates to perineum, groin or hypochondriac
region
T: Normal
P: Wiry
3
- Related to UTI-type Sx: burning, urgent, Remove D-H from LJ;
frequent and/or painful urination; itchiness Benefit the external kidneys
- Impotence, failure of erection -------------------
- Dark yellow/brown tea/may even be pink urine
Lower Pouring (if bleeding) Basic +
of Damp Heat - Wetness of the scrotum w/ itching or skin rash
REN-3; UB-28, 22, 39
- Bitter taste
ST-28; SP-9; SJ-5
- If more H: thirsty; If more D: no desire to drink
Acute stage of - May have temporal headaches; restlessness If more Heat: LI-11
prostatitis
T: Red, w/ red spots, tm
C: Yellow greasy, may be thick
P: Slippery, wiry, fast
Herbal therapy Yang tonifying:

- Kings Therapy or Spring Therapy [Spring is a very active and upgoing season]
Can warm Yang temporarily, but can lead to Yin damage
Animal penises soaked in alcohol for 6 months
- Dong Chung Xiao Tiao formula
- Silk worm cocoon soaked in alcohol
Qigong therapy
Tie Dan gong (sp?): Qi gong & massage to tx male infertility
4
Course: Acupuncture Treatment of Disease 1 Date: Oct 8, 2008
Doc: Test 1 Review
This test consists of

1. 40 questions. 6 case studies in it. Must be able to analyze, just like the case studies he gave in
the lectures thus far. Be able to rule out what doesnt fit if you dont know the answer right
away.
2. Know 4 needle techniqueknow the chart on your own!!!
3. Know yin/yang and symptoms
4. Know stages of disease beginning and end especially.
5. Know front mu/back shu know em! Review them all. Know lower he sea, too. Basically, if
its in the lecture, cover it.
6. Know the charts in lecture 3. Know origination, convergence especially. Know the nature of
the two theories. Which has points/not, which is superficial/deep, what are the distribution
chars
7. Know all of the cases and discussions so far!!! He emphasized this.
Page 1 of 14
Case Studies
Answers are provided at the end of this section.
Study 1
Betty Boop, a 25yo female.
Irregular diet. Epigastric distention. Burning pain. Aversion to touch. Belching with sour
odor. Aversion to cold. Tongue: curdy thick coating.
What is your assessment of the condition? Whats she got?
Whats the best treatment?

1) Heart 7, Pericardium 7, Du 26, Du 20
2) Ren 17, LU 7, KI 6, SI 3
3) GB 34/40, SP 4
4) St 36, Ren 12, P 6, ST 25
Study 2
Ralph, a 79yo male patient is complaining of lower back pain with frequent urination for
the past 10 years. He is tired and has a poor appetite. 2 days ago he got common cold and
slight aversion to wind and cold. Pulse: superficial, weak.
Whats the diagnosis?
What do you do?

1) Ht 7, LU 9, SP 6, UB 15, UB 13, GB 20
2) LU 9, KI 3, UB 23, LU 7, LI 4, UB12, SJ17
3) ST 36, LI 10, UB12, GB 20, UB 20, UB 23
4) REN 4, REN 6, DU 4, UB 23
Study 3
Bubba, a 9 yo kid.
Had fever, common cold, and was taking White Tiger decoction, a very cold herbal
script, for 4 weeks. The fever is gone now, but patient has low voice, spontaneous sweat,
poor app, diarrhea, fatigue, pale swollen tongue with teeth marks. Pulse is large, weak.
What happened?
Study 4
Greg, a 39yo male.
Irritable for 2 weeks, bitter taste, thirsty. At night, tosses and turns and sleeps poorly.
Templar headache, hypochondriac pain, constipation. Urine is yellow and hot. Tongue is
red, especially on sides, pulse is wiry.
What is your diagnosis for Greg?

1) Stomach excessive heat
2) LI excess heat
3) Heart excess fire
Page 2 of 14
4) Hyperactivity of Liver.
What do you do for Greg?
Study 5
Zhang, female, age 60
Chief Complaint: Lower back pain for 1 year
Pertinent history:
Fatigue, ringing in the ears, hot flashes, night sweating and palm heat. Digestive
disorder with gas and bloating, poor appetite and aversion to meat. She feels full
in the abdomen and has a greasy taste in her mouth.
Tongue: Her tongue is pale and swollen and the coating is thick and greasy.
Pulse: thin and fast, weak in rear positions
Shed prefer an herbal treatment
1. What is your differential diagnosis for this case?

a. Spleen and Kidney Qi xu with damp retention
c. Kidney yin xu with dampness in spleen
d. Middle Jiao disorder with Kidney essence xu
2. What is the therapeutic principle?

a. Warm Kidney yang and tonify the Spleen Qi
3. What is the strategic plan for this case?

a. Apply Kidney yin tonics and ignore the dampness
b. Tonify Spleen and Kidney Qi and warm Kidney yang
d. Strengthen Spleen and remove dampness first then nourish Kidney yin
secondarily
What points might you choose?
Study 6
Wang, 30yo male.
Chief complaint: Stomach ache
Pertinent history:
Patient has an irregular diet. Distention in epigastric area, burning pain and aversion to
touch. Belching with a sour odor. Constipation, aversion to food.
Tongue: red with a thick and curdy coating
Pulse: slippery, wiry, forceful.
1. What is the pattern differentiation for this case?

a. Retention of heat and phlegm in the middle warmer
Page 3 of 14
b. Food stagnation with accumulation of stomach heat
c. Spleen deficiency with empty heat in stomach
d. Stomach excessive heat and fire with yin xu
2. Which of the following groups of points would be appropriate to this patient?

a. HT 7 (shenmen), P 7 (dahling), Du 26 (renzhong), Du 20 (Baihui)
b. Ren 17 (tanzhong), Lu 7 (lieque), Kid 6 (zaohai), SI 3 (houxi)
c. ST 36 (zusanli), Ren 12 (zhongwan), P 6 (neiguan), ST 25 (tianshu)
d. GB 34 (yanglingquan), GB 40 (qiuxu), SP 4 (gongsun)
Study 7
Sam, a 42yo male comes in with the chief complaint of irritability.
He has been suffering from irritability for about 2 weeks and has a bitter taste in his
mouth, thirst with desire for drink, tossing and turning. He has severe headache in the
temple area with burning pain in the hypochondriac region, constipation, hot and yellow
urine which burns. His tongue is red, redder on the sides. His pulse is very wiry on both
sides.
1) Diagnosis?
a) Excessive heat in stomach organ
b) Yang excess if the large intestine
c) Hyperactivity in liver organ.
d) Heart excessive fire.
2) What are the points you would use if you chose 4 needle technique?
a) Tonify LV 4 and LU 8; sedate LV 2 and HT 8
b) Tonify LV 3 and SP 4; sedate LV 5 and HT 7
c) Sedate SP 3 and LV 2; tonify Ht 8 and LU 9
d) Sedate LV 4 and HT 8; tonify K 10 and LV 8
Study 8
Ira, a 76 yo male suffers from lower back pain for over 5 years. He has frequent urination for
the same period of time. He often feels tired and has a poor appetite. He has had a common
cold for 2 days with less sweating, slight aversion to wind and cold. His pulse is superficial
but weak.
1) What is the diagnosis?

a) Heart and LU Yin xu with W/C invasion
b) Ki and LU Qi xu with cold invasion
c) SP and KI Qi xu with wind/cold invasion
d) Kidney Yang xu with cold invasion
2) What is the treatment principle?

a) Nourish heat and Lung yin and remove wind-cold pathogens
b) Tonify kidney and lung Qi and remove the cold pathogens
c) Strengthen the Spleen and Kidney functions and eliminate the wind-cold pathogens
Page 4 of 14
d) Warm the kidney yang and dispel the cold pathogen
3) What group of points?

a) HT 7, LU 9, SP 6, BL 15, BL 13, GB 20, BL 12
b) LU 9, KI 3, BL23, LU 7, LI 4, BL 12, SJ 17
c) ST 36, LI 10, BL 12, GB 20, BL 20, BL 23
d) Ren 4, Ren 6, BL 23, DU 4, BL 12, GB 20
Answers to Case Studies
Study 1
This is food retention with stomach heat.
The best treatment is #4: St 36, Ren 12, P 6, ST 25.
Study 2
The diagnosis:
External wind/cold invasion with Kidney deficiency and Spleen deficiency.
What do you do?
Option 3: ST 36, LI 10, UB12, GB 20, UB 20, UB 23
Study 3
What happened?
Bubbas correct Qi is damaged. White Tiger is very cold, took too long, now
resistance is gone.
Study 4
Whats wrong with Greg?
Answer 4: Hyperactivity or Liver.
What do you do for Greg?
Clear Liver heat with LV 2, HT 8, LI 11, 4 gates (but use LV 2 instead of LV 3)
Study 5
Answers: 1 = c, 2 = b, 3 = c
Points: KI 3 (tonify KI), GB 34 (stimulate GB and help with digestion of fats/meats, relax
sinews to help with lower back pain), GB 39 (boost marrow), ST 36 (tonify
spleen/digestion), SP 6 (both kidney and spleen tonification), Ren 12 (help digestion).
You could also use UB 23, yaoyin and jaiji points for the lower back pain.
Study 6
Answers: 1 = B, 2 = C
Study 7
Answers: 1 = c, 2 = a
Study 8
Answers: 1 = C, 2 = C, 3 = C
Page 5 of 14
Four Needle Technique
What is the most appropriate application for four needle technique?
Four needle is used as a secondary choice if routine treatment fails. It is used for treating organ
disorders, not for meridian problems.
What is the four needle principle of treatment for excesses?
Sedate the son element

(1) sedating the son element on the affected organs meridian
(2) sedate the son element on the son meridian.
Tonify the controlling or grandmother or ko element
(1) tonify the controlling point on the affected organs meridian
(2) tonify the controlling point on the control meridian
What is the four needle principle of treatment for deficiencies?
Tonify the mother element

(1) tonify the mother point on the affected organs meridian
(2) tonify the mother point on the mother meridian
Sedate the control element
(1) Sedate the controlling point on the affected organs meridian
(2) sedate the control point on the control meridian
Fill in the following five element chart. Know this well for the test and be able to use it for the four
element needling technique. Ill give you a several of these so you can practice if you wish to print these
out.
Yin Jing Ying Shu Jing He Yang Jing Ying Shu Jing He
well spring stream river sea well spring stream river sea
Wood Fire Earth Metal Water Metal Water Wood Fire Earth
LU LI
SP ST
HT SI
KI UB
PC SJ
LV GB
Page 6 of 14
LU LI
SP ST
HT SI
KI UB
PC SJ
LV GB
LU LI
SP ST
HT SI
KI UB
PC SJ
LV GB
LU LI
SP ST
HT SI
KI UB
PC SJ
LV GB
Page 7 of 14
Heres a completed one for your comparison. The bigger blue numbers are the horary points (i.e., metal
point on the metal channel.)
LU 11 10 9 8 5 LI 1 2 3 5 11
SP 1 2 3 5 9 ST 45 44 43 41 36
HT 9 8 7 4 3 SI 1 2 3 5 8
KI 1 2 3 7 10 UB 67 66 65 60 40
PC 9 8 7 5 3 SJ 1 2 3 6 10
LV 1 2 3 4 8 GB 44 43 41 38 34
Using this chart, how would you use the four needle technique to treat a Liver excess?
-LV 2
-HT 8
+LV 4
+LU 8
Using the five element chart (preferably the one you jot down from your own brain), how do you treat a
Liver deficiency?
+LV 8
+KI 10
-LV 4
-LU 8
Using a five element chart, how would you use 4 needle technique to treat a Spleen deficiency?
Tonify the mother (fire) on the Spleen (earth) channel: +SP 2

Tonify the mother (fire) on the mother (fire) channel: +HT8
Sedate the control element (wood) on the Spleen channel: -SP 1
Sedate the control element (wood) on the control (wood) channel: -LV 1
Page 8 of 14
Let the torture continue: How would you treat a LI excess using the 4 needle theory?
Sedate the son element (water) on the LI channel (metal): -LI 2

Sedate the son element (water) on the son channel (water): -UB 66
Tonify the control element (fire) on the LI channel (metal): +LI 5
Tonify the control element (fire) on the control (fire) channel: +SI5
Just one more. Give it to me for a Kidney deficiency.
Tonify the mother (metal) element on the Kidney (water) channel: +KI 7
Tonify the mother element (metal) on the mother channel (metal): +LU8
Sedate the controlling (earth) element on the Kidney (water) channel: -KI 3
Sedate the control (earth) element on the control (earth) channel: -SP 3
Yin Yang
Yang Excess
What is excessive Yang and what are the symptoms?
An absolute too much Yang producing excessive or Full Heat and Fire symptoms.
1. The four greats
a. High fever
b. Great thirst
c. Profuse sweating
d. Full fast pulse
2. Red face
All over, not just cheekbones like you will see in a Yin deficiency with empty heat.
3. Constipation
4. Dark yellow urine
5. Menieres disorder dizziness, tinnitus, hearing loss or deafness
6. Irritation and/or agitation
7. Pulse: full and fast (see 4 greats)
8. Tongue:
a. Body: red
b. Coating: yellow coat
What is the etiology of Yang Excess? (5)

1. Invasion of Yang pathogens (wind, heat, fire, summer heat)
2. Hyperactivity of internal organs
3. Emotional disorder, esp anger and irritation
4. Irregular diet
5. Overtaking of Yang herbs
What is the treatment principle for Yang Excesses and what methods would you use?
Sedate/clear heat.
1. Blood letting with 3 edged needle at Du 20, Du 14, UB 40, Shixuan
(spreading points)
2. Plum blossom needle at Du 14 + cupping
Page 9 of 14
3. Needle at LI 11 and/or LIV 2, etc.
Yang Deficiency
What is deficient Yang and what are the symptoms?
A syndrome in which there is too little Yang to balance out Yin. The result is relatively
too much Yin and thus too much cold. Because this cold results from deficiency,
however, the signs are characterized by less. This is often called empty cold.
Symptoms of deficient Yang

1. Pale face
2. Chills which can be alleviated with warming therapies
3. Cold pain anywhere in the body
4. Desire for pressure, touch, warming
5. Aversion to cold
6. Cold extremities
7. No thirst
8. Pulse: deep, weak, slow
9. Tongue:
a. Body: pale and swollen
b. Coating: wet/moist
What is the etiology of a Yang deficiency?

1. Chronic stage of invasion due to Yin pathogens
2. Severe hypofunction of internal organs
3. Irregular diet
4. Long term consumption of cold herbs or meds (i.e., antibiotics, chemo)
This would damage the Yang long term.
5. Excessive sexual activity
What is the treatment principle for Yang deficiency and what methods would you use?
Tonify and warm using moxibustion on lower extremity, lower back or abdomen points.
You could also use warm needle technique, moxa with paper layers, salt cone in the navel
and moxa on top at Ren 8, etc.
Yin Excess
What is a Yin excess and what are the symptoms that charactize it?
An excess of Yin is absolutely too much Yin in the body. As a result, the Yang is
overwhelmed resulting in full cold symptoms.
1. Aversion to cold
2. Chills and shivering
3. Edema
4. Obesity
5. Cold extremities
Warming therapies dont help, neither does more clothing
6. Cold pain (anywhere) with aversion to touch or pressure
7. Tongue:
Page 10 of 14
a. Body is normal or pale/swollen/teethmarks.
b. Coating is white/greasy or wet/moist.
8. Pulse either:
a. superficial and tight
b. deep, slow, powerful
What is the etiology of a Yin excess?

1. Invasion of external Yin pathogens such as Cold, Damp, and Dryness
2. Eating too much Yin food (cold dairy) or overconsumption of Yin herbs or meds (like
antibiotics.
3. Retention of internal Yin pathogens such as Damp, water retention, blood stasis,
phlegm due to organ dysfunction (spleen or lung)
Example: Spleen xu dampness.
a. If this is combined with heat from LU or ST the result is sticky visible phlegm
retained in the Lung.
b. If this is combined with cool from Spleen or Kidney Yang Xu, the result is
retention of water/edema in the lower body.
What is the treatment principle for Yin excesses and what methods could you use to treat them?
Sedation of the Yin excess.
Moxibustion on the upper extremities, upper back and head is the key here. Use a moxa
stick or the stick-on moxa. Herbal therapy such as shen g jiang or gan jiang.
Yin Deficiency
What is a Yin Xu and what are the symptoms?
This is a condition of too little Yin in the body resulting in relatively too much Yang and
thus empty heat. Possible symptoms are:
1. Night sweats
2. Malar (zygomatic/cheekbone) flush
3. Tidal fevers
Low grade fevers in the late afternoons or evenings
4. Five palm heat
Heat in the soles of the feet and palms of the hands
5. Thirsty and/or dry mouth especially at night
Often the patient will want to sip water for dry mouth rather than have full thirst.
6. Steaming bone heat
7. Tongue:
a. Body: small red body with cracks
b. Coating: scanty, thin, peeled, mirror (no coating at all)
8. Pulse: thin, fast, weak. Might be deep, might be superficial.
What is the etiology of a yin deficiency?

1. Chronic condition of Excessive Yang such as heat disease or febrile disease.
(ex: Yang disease with sweating leads to loss of fluids and therefore loss of Yin)
2. Overworking, esp at night
3. Excessive sexual activity
Page 11 of 14
4. Long term consumption of Yang herbs or Yang meds
This includes radiation therapy which consumes body fluid, leading to dry skin, hair
loss, thirst.
What is the treatment principle for a yin deficiency and what are some treatment methods?
Tonify and nourish the Yin.
1. Chinese herbs and/or food therapy
2. acupuncture
a. KI 3, 6, 1
b. SP 6
c. UB 52, 43
(compare the two:
for excess heat you blood let at Du 20 while you needle Ki 1 for xu heat)
Stages of Disease
This doesnt refer so much to the six stages or four levels in the context of what weve covered so far,
but to this progression and treatment for disease:
Stage of Disease Treatment principle Typical pop affected

Single Excess Initial stage of acute Sedate only Yang individuals such
disease as children and teens1
Single Deficiency End of a chronic disease Tonify only Older people2, anyone
with poor constitution
or Xu type
Combination Middle stage of disease Sedate and tonify
More excess, Beginning to middle Sedate first then tonify Pathogen is strong,
less xu resistance is injured
More xu, less Middle to end Tonify first, then sedate Poor body constitution
excess and individs who catch
cold easily
Half/half Middle stage only Sedate and/or tonify
Sidebar bonus info, not needed for test:

1
For teens, tonify with gui zhi tang, ma huang, but not older people!
2
For older people with cold, cook herbal rice congee with:
100g rice + 3 pieces scallion (cong baibulb and root) + 5 pieces fresh ginger + 10
chinese dates (da zao) and 2 C water. Cook in slow cooker until porridgy mush. Dont
have to eat the dates/cong bai/ginger, but consume the rest. Great for a poor constitution
tonifies and sedates
Page 12 of 14
Front Mu Points
Zang organs Front Mu Fu organs Front Mu

Lung LU-1 Large Intestine ST-25
Spleen LV-13 Stomach Ren-12
Heart Ren-14 Small Intestine Ren-4
Kidney GB-25 Urinary Bladder Ren-3
Pericardium Ren-17 San Jiao Ren-5
Liver LV-14 GallBladder GB-24
Back Shu Points
Bladder Point Category Vertebral

Level
BL 11 Hui of Bone T1
BL 12 Wind Gate T2
BL 13 Back Shu of Lung T3
BL 14 Back Shu of Pericardium T4
BL 15 Back Shu of Heart T5
BL 16 Du Shu T6
BL 17 Hui of Blood T7
Also called Back Shu of
Diaphragm
T8
BL 18 Back Shu of Liver T9
BL 19 Back Shu of Gallbladder T10
BL 20 Back Shu of Spleen T11
BL 21 Back Shu of Stomach T 12
BL 22 Back Shu of San Jiao L1
BL 23 Back Shu of Kidney L2
BL 24 L3
BL 25 Back Shu of Large Intestine L4
L5
BL 26 S1
BL 27 Back Shu of Small Intestine S2
BL 28 Back Shu of Bladder S3
Page 13 of 14
Divergent and Tendinomuscular meridians
Meridians Divergent Enters Exit Converge/end1

** Popliteal fossa Abkid and UB Neck UB 10
Foot Taiyan UB UB 40 organsthru window of sky2
Foot Shaoyin KI Ki 10 diaphragm and
enter heart organ
Foot Shaoyang GB Hip GB 30 Abdomenliver Outer GB 1
Foot Jueyin LV Inner leg - LV 5 and gb organs canthus
thru diaphragm and
enter HT organ
Foot Yangming ST Lower ab ST 30 Abdomensp and Mouth Stomach: UB 1
Foot Taiyin - SP Groin SP 12 st organsthru Tongue: SP( no
diaphragmenter point associated
heart organ with this one)3
indirectly
Hang Taiyang SI Shoulder SI 10 Chest: HT and SI Face UB 1
Hand Shaoyin - HT Armpit HT 1
Hand Shaoyang SJ Head Du 20 Chest: PC and SJ. Retro- SJ 16
Hand Jueyin - PC Hypochondriac Connects to heart auricular window of sky
region - GB 22 or via PC region
PC1
** Chest: Supraclav LI 18
Hand Yangming LI Shoulder LI 15 LU and LI, not fossa window of sky
Hand Taiyin - LU Chest LU 1 Heart ST 12
Page 14 of 14
Doc: Case Discussions
The cases are worded in Dr. Luo speak. Good luck with that.
Zhao, Male, 63 years old
Chronic pharyngitis xu heatKI can

Patient has had an itching throat for more than 15 years. Sometimes he also has had a slightly sore and
cause throat pain
dry throat, especially when he spoke too much. All of the above symptoms were developed during the
deficient heat
last month. He felt thirst in the afternoon and prefer for drinking frequently. However, he didnt want to
deficiency pharyngitis
drink too much for each time. He also had hoarseness of voice and said it was due to his long period of
yin xu w/ deficient heat
teaching experience before retirement. Sometimes he felt hot on his palms at night especially during the
recent three weeks while he was preparing some lectures for community education. He felt soreness in
KI Yin Xu no Yang Xu, though
his waist and legs after returning from the supermarket every day. However, he didnt have cold
sensation in his waist.

Xu Liver Yang rising
His figure is thin and his blood pressure was 156/110. He has had hypertension for more than 10 years.
Heat Yin xu damaged body fluids deficiency
The tongue is red, no coat, dry and shiny. The pulse is thin and deep.
Whats up with this guy?
Pattern differentiation: Kidney Yin Xu. The hypertension also indicates this has caused Liver
Yang Rising. The diagnosis would be chronic pharyngitis. You might write this on a chart as
Chronic pharyngitis due to Kidney Yin Xu with Empty Heat; Hypertension due to Liver Yang
Rising.
If he was a little bit fat with poor appetite and a cold sensation in his knees? What would his
tongue look like then?
Kidney Yang Deficiency
If the patient had a low voice and purple lips?
Blood stagnation
Points: UB 43, KI 3, SP 6, K1 w/ moxa, LU7 + KI 6
Page 1 of 15
Li, Female, 56 years old
This is an in-patient who was admitted for having had knee joints pain for more than 3 months and
diabetes can be due to KI yin xu, LU yin xu, St yin xu (see p 35 study guide)
deteriorated for 1 day. The pain reduced after warm application. She also has had diabetes for 2 years.
One hour ago, before the lunch, she felt joints pain again after legs exposure without being properly
strong stimulation of ST causing ST Qi to rebel
covered. She took some pills for stopping the pain. Half an hour ago she took some spicy chicken. 15
minutes ago she felt upset in stomach and vomited forcefully. All the chicken was vomited out without
Vomiting and nausea plus the acute onset of total deafness = Phlegm Fire flaring up
good digestion. Five minutes ago she could hear nothing any more on both sides. She sweated a lot
during the vomit and felt vertigo and dizzy after vomiting the food. She usually had poor appetite and
felt cold in the epigastrum.
Her tongue was light red and thin white coating. Her pulse was large and superficial without root. Her
blood pressure was 178/100. She had no history of hypertension.
This is tricky one. Phlegm fire flaring up causes sudden onset and is considered to be an acute excess.
The strong stimulation of the stomach by the pain killers plus the spicy chicken (what freakin hospital
is she in? who would feed recovering people spicy chicken?!) caused Stomach Qi to rebel and the
vomiting. This caused the phlegm fire to flare up and cause the sudden total deafness. From page 26 of
the study guide. Note that the patient doesnt have most of these symptoms. Also know that food
poisoning and sudden stomach trouble fall into this category.
Phlegm Fire Acute onset Principle:

Flaring Up Loud and noisy ringing like crickets or cicadas remove phlegm fire, benefit ears
Acute, Excess Pressure or sharp pain in and around the ears
combined with ear ache or infection (yellow, Basic points for deafness/tinnitus
sticky discharge): ear infection or allergy (SI 19, GB 2, SJ 21, SJ17; SJ 3,
related. Turbid fluid. Swimmers ear. SJ 5, GB 41)
Heaviness in the head; foggy sensation
Tightness of chest and profuse mucous And
Nausea, vomiting. Perhaps cough with yellow REN 17/12, ST 39/40, SP 9, LI 4
sputum and 11, GB 43.
Profuse vaginal discharge
Constipation and dark yellow urine.
Tongue red with greasy thick or thin coat
Pulse: slippery/wiry/fast
Theres a small artery in the ear that gets blocked that can also contribute to this.
Page 2 of 15
Li, male this time60 years old.
Three days ago, the patient had a headache after trying to carry something to the 2nd floor. During these
Cold or damp invasion not localized and also = dampness or phlegm
3 days he had a slight fever, aversion to cold, general body heaviness, especially on the head. He
deficiency type Sp xu
sweated a lot without exercising too much. He usually had poor appetite and decreased in these days.
Also, he had nausea, distending sensation of epigastrum and loose stool.
His blood pressure was 149/90 mmHg.

Exterior syndrome dampness excess..cold
Pulse is superficial and soggy. Tongue has a thick white coating.
Patient has a couple of things going on, not just one. First, hes got a Middle Jiao deficiency thats
causing dampness. That same deficiency seems to have weakened his defensive Qi too. Hes got
symptoms of an exterior invasion, wind cold. Since the symptoms are generalized and not localized you
know its not an allergy. If you look at page 12 of the study guide you see that common cold has
generalized symptoms with headache, chills/fever where allergies do not have these symptoms.
Ergo: Hes got Gan Mao/Common Cold with a Wind-Damp-Cold invasion. The treatment principle
would be to remove the external Wind-Cold and to regulate the Wei and Ying Qi.
Study guide outlines Wind-damp as presenting with stomach flu: chills/fever in equal measure, general
body heaviness and joint pain, heaviness of the head, decreased appetite with nausea/vomit/fullness,
distention of epigastrum or ab, loose stool or diarrhea. Tongue is normal (damp cold) or red tip (damp
heat) or swollen. The coat will be greasy , thick or thin, white or yellow. Pulse will be soft or superficial
and slippery.
Points to use: LI 4, LU 7, GB 20, UB 12, SP 9 for damp and Taiyang for headache. Study guide adds P
6, Ren 12, ST 25/36/40, SP 6, UB 20/21 and ST 8 for damp headaches.
Page 3 of 15
Cao, A 39 Year Old Female:
Why study is bad for you
Excess heat causing reckless bleeding

The patient had fresh red nasal bleeding last night when she was preparing for test at home. She had kept
Go have some fun, girl. Youre angering your liver. Liver qi stagnation or liver yang/fire flaring + stress
preparing the test for 15 days. She also found she was irritated easily recently during the study. Whats
Qi stagnation of the Liver which rules the tendons/sinews Liver heat
more, she felt better after extending her extremities. She also had red eyes, burning hypochondriac pain
Liver heat continued Liver overacting on Spleen
and bitter taste, thirst, desire for cold drinks. She had poor appetite for more than 10 days.
Liver fire
Her blood pressure is 135/85. Her tongue has a yellow coat. Her pulse is wiry and fast on the left, weak
on the 2nd on the right.
So whaddup? Liver Fire flaring upward with Liver overacting on Spleen. Treatment principle is to
remove Liver fire, cool blood, and stop bleeding.
Per the study guide, treatment for this is:

Use the basic Epistaxis points: LI 4, LI 11, SJ 5, LU 6 (xi cleft) , and LI 20 using sedation or mild stim.
Add Liver Fire flaring up points: Liv 2/3/5, GB 41/43 and sedate UB 18/19.
Page 4 of 15
Wang, female 30 years old
Chief complaint: wheezing and dyspnea

Chronic w/ current acute attacks
She has suffered from asthma since she was 4 years old. She had to apply inhaler every day recently.
Invasion of airborne pathogens
Her asthma attacks were elicited by exposure to dogs, cats, and house-dust mites. She also suffered
mildly eczema and the symptoms get worse when exposed to inhaled or ingested allergens. She usually
deficiency of qi and lung kidney defic. Liver involvement Qi yu.
felt tired with soft voice and lower back ached. Her periods lasted 7 8 days with severe cramps and she
Kidney xu
suffered from pre-menstrual tension. Her pulse was slightly weak in the left rear position and slightly
Liver This does seem like Spleen Qi, but in the answers
wiry in the left middle position. Her tongue was pale, swollen with teeth marks, and coating was greasy
below you need to pick the most involved organs based on the case discussion.no other spleen signs
here.
white.
1) Which organs were involved in this case?

a. Kidney, Liver, Lungs
b. Lungs, Kidney, Heart
c. Liver, Heart, Kidneys
d. Spleen, Heart, Kidneys
2) The excessive parts for this patient include the follows, EXCEPT:
a. Liver Qi stagnation
b. Blood stagnation
c. Damp-phlegm retention
d. Invasion of wind pathogens
3) What are the deficient parts in this case?
a. Heart and Liver Blood Xu
b. Spleen and Kidney Qi Xu
c. Lung and Kidney Qi Xu
d. Liver and Kidney Yin xu
4) What is the principle of treatment of this patient?
a. Promote blood circulation, soothe liver and nourish heart and liver blood.
b. Tonify spleen and kidney Qi, nourish heart and liver blood, remove pathogens
c. Descend lung Qi, nourish liver and kidney yin, promote circulation
d. Tonify lung and kidney Qi, soothe liver, dispel wind pathogens and remove phlegm
5) Which group of points is good for this case?
a. Ren 17, Ren 22, BL 13, BL 12, GB 20, ST 40, ST 36, LU 9, BL 23, Dingchuan(extra)
b. ST 36, SP 6, BL 20, SP 21, ST 25, H 7, LV 8, BL 18, BL 17, DU 20
c. BL 17, BL 40, SP 10, 4 Gates (LI 4, LV 3), LV 8, PC 6, HT 7, Dingchuan (extra)
d. Dingchuan, LU 9, BL 12, BL 13, BL 15, Ren 14, GB 20, LU 10, LI 11
Page 5 of 15
Mao, female 36 years old
Chief complaint: Sneezing and nasal discharge

Wind invasion
Shes suffered from allergic rhinitis since the age of 14. She sneezed and her nose ran (white watery
discharge) when exposed to dust, cats, dogs. She also sneezed while drinking tea, coffee, wine or eating
wind invasions = airborne allergies and induce sneezing, runny nose
certain foods such as cheese, butter, chocolate, fats and spices. She suffered from frequent urination and
Kidney deficiency of Qicant hold the urine
sometimes she had urgent, even incontinent, urination. She described it as cystitis but there was no
burning and the urine was pale. This symptom had started only a few months previously. She also had
Kidney Qi xu
been suffering from backache for the previous 6 years.
Deficiency Kidney positions cold or defic of blood, qi, yang
Pulse was weak and deep and weaker in both rear positions. Her tongue was pale with a white coat.
1) In this case the pathogenic factors are

a. Emotional disorder and/or congenital factors
b. Overworking and/or again
c. Wind-cold and or wind-dryness invasion
d. Invasion of external pathogens and/or irregular diet
2) The deficiency part of this case is
a. Kidney essence xu
b. Kidney Qi xu
c. Kidney Yin xu
d. Kidney Yang xu
3) In this case, her urinary disorder is mainly due to:
a. Lower pouring of dampness
b. Retention of damp-heat in the lower jiao
c. Kidney deficiency failing to hold urine
d. Spleen xu with damp retention
4) What is the differential diagnosis for this case?
a. Spleen and Kidney xu with wind-heat invasion
b. Dampness in the lower jiao with Lung Qi xu and wind invasion
c. Kidney Qi xu with external pathogenic wind invasion
d. Lung, Spleen, Kidney Qi xu with wind-dampness invasion
5) Which group of points is good for this case?
a. LU 9, BL 13, BL 12, GB 20, RN 17, ST 36, KID 3, SP 6, Yintang, Bitong, BL 7
b. ST 40, KID 3, BL 23, BL 52, BL 12, BL 13, GB 20, Yintang, Bitong with moxa
c. SJ 5, GB 41, SJ 3, BL 28, GB 3, SP 9, ST 40, ST 36, KID 3, SP 6, LI 20, Bitong,
Yintang, GB 20, BL 7
d. GB 20, BL 12, BL 13, LI 20, Yintang, Bitong, BL 23, BL 28, Ren 3, Ren 4, Ren 6
Note: BL 52 = KI Yin Xu
DU 4 + Ren 4 = KI Yang
Xu
Page 6 of 15
Li, male 30 years old
Chief complaint: wheezing and dyspnea

Heat + phlegm
Has been suffering from asthma recently. He coughed out large amounts of yellow sticky phlegm. He
Heat phlegm heat
also had a high fever, chest fullness, and scanty/short dark urine. When diagnosing, you note he had a
Heat + lung qi rebelling and qi moving across phlegm heat/phlegm
flushed face, wheeze, cough, thirst, and a body temperature of 101F. He had sticky, profuse, yellow
heat excess heat phlegm or damp
phlegm. His tongue was red with a thick yellow coating. His pulse was slippery.
1) The TCM diagnosis indicates

a. Excess type asthma due to wind-cold affecting the lungs
b. Deficiency type asthma due to Lung Qi xu
c. Asthma due to external pathogenic wind-heat invasion
d. Excess type asthma due to heat phlegm accumulated in the Lungs.
2) What acupuncture points would you use for this case?
a. DU 4, REN 4, REN 6, ST 36, KID 3, SP 6
b. ST 40, REN 17, DU 14, LI 4, LI 11, LU 5
c. LU 9, ST 36, BL 13, BL 20, BL 21
d. BL 17, SP 10, ST 41, BL 40, REN 3, ST 25
3) Which point can increase the effect of the treatment
a. A point cun lateral to BL 52
b. A point 3 cun lateral to the posterior spinous process of L 1
c. A point cun lateral to Du 14
d. A point 3 cun lateral to Ren 3
4) What are the typical symptoms of asthma?
a. Cough, chest distention and spontaneous sweating
b. Rash on skin, acne, thirst
c. Pale face, short of breath
d. Dyspnea and wheezing
Page 7 of 15
Zhang, female 60 years old
Chief complaint: lower back pain for 1 year

Yin deficiency, probably KI because of ears.
She has fatigue, ringing in the ears, hot flash, night sweating and palm heat. She also has digestive
Spleen Qi xu ?? probably Gallbladder which isnt sufficient to digest meats.
disorder with gas, bloating, poor appetite and aversion to meat. She feels full in the abdomen and has
Gallbladder again excess + damp/phlegm
greasy taste in her mouth. Her tongue is pale and swollen and the coating is thick and greasy. Her pulse
xu + heat Kidney xu
is thin and fast, weak in the rear positions. She prefers herbal treatment.
1) Whats your differential diagnosis for this case?

a. Spleen and kidney Qi xu with damp retention
c. Kidney yin xu with dampness in the Spleen
d. Middle jiao disorder with Kidney essence xu
2) Whats the therapeutic principle?
a. Warm Kidney Yang and tonify Spleen Qi
3) Whats the strategic plan for this case?
a. Go ahead and apply Kidney Yin tonics and ignore the dampness
b. Tonify Spleen and Kidney Qi and warm Kidney Yang
d. Strengthen Spleen and remove dampness first then nourish Kidney yin secondly.
Points could include KID 3, GB 39, SP 9, ST 36, REN 12, BL 23.
Page 8 of 15
Wang, male 30 years old
Chief complaint is stomach ache.
Suffers from irregular diet. The main symptoms included distention in the epigastric region, burning
Excess heat Food stagnation heat damaging fluidsaversion to food is stag too heat
pain and aversion to touch, belching with a sour odor, constipation, aversion to food. His tongue was red
food stagnation damp or food stag excess..why wiry, I dont knowLiver?
with a curdy thick coating. The pulse was slippery, wiry, and forceful.
1) What is the differentiation of this case?

a. Retention of heat phlegm in the middle warmer
b. Food stagnation with accumulated heat in the stomach
c. Spleen deficiency with empty heat in the stomach
d. Stomach excessive heat and fire with yin deficiency
2) Which of the following group of points is appropriate to him?
a. HT 7, PC 7, DU 26, DU 20
b. REN 17, LU 7, KID 6, SI 3
c. ST 36, REN 12, PC 6, ST 25
d. GB 34, GB 40, SP 4
Page 9 of 15
Li, female 49 years old
Chief Complaint: Headache for two years

Liver heat
She has been suffering from hypertension and irritability for about 2 years. Two years ago she started to
Wind yin xu liver/heat shaoyang area
have dizziness, vertigo and night sweating and she was very irritable. She often has headache on the side
kidneyyin? Xu kidney yin xu
of the head as well as tinnitus (mainly left ear). She is very tired with weakness of the lower back and
?? yin xu
knee joints. She feels hot inside the chest and her palms are always warm and wet. She has lots of
heart involvement blood / heart
dreams and wakes up time to time. Her memory and concentration are poor. She has still menses, but it
damp
is always late and scanty. She is over-weighted and tries to lose weight. She occasionally gets
heart xu heart heat thick = excess, damp/phlegm
palpitations. Her tongue body is pale and small with a red tip and the coating is thick, greasy, and white.
Deficiency dampness/phlegm kidney
Her pulses are thin and weak on the left side, slippery on the right side middle position and weaker on
both rear positions.
1) Her hypertension is mainly due to

a. Liver fire flaring up due to emotional disorders and phlegm retention
b. Liver yang up-rising due to emotional disorders
c. Liver heat and fire induced by Liver Qi stagnation
d. Liver Yang rising due to Liver and Kidney Yin deficiency with damp-phlegm.
2) What is the excess part of her case?
a. Liver fire flaring up
b. Liver Qi stagnation
c. Blood stagnation
d. Damp-phlegm retention
3) The differential diagnosis includes the follows, EXCEPT:
a. Liver yang rising due to Liver and Kidney Yin xu
b. Heart Blood xu
c. Damp-phlegm retention
d. Liver fire flaring up with excessive Liver Yang rising up.
4) Which point grouping is appropriate to this case?
a. SP 9, ST 40, ST 25, LI 10, SJ 6, LU 7, REN 17, P 6, LI 18, BL 18, BL 20, HT 5
b. LV 3, LI 4, GB 34, BL 18, BL 19, LV 14, GB 24, ST 9, ST 36
c. DU 4, DU 9, DU 20, RN 4, RN 6, K 3, K 6, BL 23, LI 4, LI 11, SJ 5, GB 20
d. GB 20, P 6, HT 7, LV 8, K 3, BL 23, SJ 5, LV 3, LI 4, ST 40, ST 36, SP 9
Page 10 of 15
Wang, male 41 years old
Chief complaint: headache for 2 months

Liver / heat wind
He has been suffering from hypertension and irritability for over 2 months with dizziness, vertigo, and
Shaoyang headache throbbing = liver yang rising
tinnitus. He had also severe throbbing headache on his temple areas and lying posture made the pain
liver heat/Qi yu big heat heat + damp/phlegm
worse. He was very emotional and with short temper. His tongue was scarlet w/ yellow greasy coating.
1) What could be the pulse?

a. Fast/wiry on both sides
b. Thin and wiry pulses
c. Slippery and wiry on both sides
d. Hesitant wiry pulses
2) The differential diagnosis for this case is
a. Liver fire flaring up
b. Liver qi stagnation
c. Liver yang rising up
Throbbing headache gives this away as does irritability/restlessness.
d. Liver wind harassing the head
3) Acu points for this case are:
a. 4 gates, SJ 5, GB 34, ST 36, SP 6, ST 40, SP 9, LU 7, LI 18
b. LV 2, GB 41, SJ 6, LI 4, SJ 17, GB 34, BL 18, SP 6, GB 43
c. LV 3, GB 41, SJ 5, GB 20, BL 18, DU 20, LI 11
d. K 3, SP 6, K 6, BL 23, BL 52, BL 43, P 6, HT 7, DU 4, GB 20
Page 11 of 15
Wang, male 65 years old. Retired teacher.
Deficiency chronic deficiency

He had intermittent headaches for more than 10 years. He felt better after resting for a while. Sometimes
Wind and liver blood x
he also had vertigo, tinnitus, blurred vision and vomit while turning his head. He accepted the physical
Kidney bone overgrowth
exam in a hospital and found the proliferation of C5 C7 (Dr. Luo speak for bone overgrowth) and mild
hmmm. Yin xu liver wind
cataracts. During the last year, he had obvious night sweating and found it was difficult to pick food up
smoothly (Dr. Luo for tremors). However, he could point and touch his nose accurately. He also felt
Kidney yin xu spleen qi xureally need to know where distention is.
back pain and soreness of knees and waist. He also had abdominal distention and poor appetite.
Kidney qi xu
Sometimes he had diarrhea early in the morning. He said that was due to eating cold. He spat out white
Damp/phlegm damp LV yang rising not fire because headaches dont throb
phlegm in the mornings. He was overweight. His blood pressure was 165/110.
He had taken medicine for years.
Differentiation: Liver and Kidney Yin deficiency with Liver Yang rising.
Treatment: Nourish Liver and Kidney Yin and calm Liver Yang.
Points: DU 20, DU 16, GB 20, LIVER 3 + SJ 5, SP 6
Page 12 of 15
Hu, female 50 years old
Lung qi xu, chronic

She had chronic cough and shortness of breath for more than 12 years. 10 yrs ago according to diagnosis
Phlegm or Qi congestion
from a hospital, she got chronic bronchitis. During recent 1 year she felt stuffiness in the chest and had
cardiopulmonary failure acute pulmonary edema ht/KI yang xu
to sit up to hold deep breath. Early in the morning she spat out pink sputum. She found edema in the
w/ retention of water stagnation of some kin heart xu qi?
distal part of her legs. Sometimes she also felt abdominal distention. She had palpitations and cold
HT yang xu also heart yang xu
sensation in the lower back as well as the cold sensation at the central part of her back. She went to the
sign of ht/KI yang xu stasis/cyanosis
toilet at night 4-5 times. Her lips were purple.
Qi xu with damp
She has a history of smoking for 20+ years. Her tongue is pale and swollen with teeth marks and a white
coat. Her BP was 168/100 mmHg. Her pulse was deep, weak and slow.
Heart and Kidney Yang Xu with Retention of Water. Also, Heart Qi xu, Lung Qi xu, damp and phlegm
retention.
Points: Ren 4/6, Du 4, UB 23/15/13, ST 28, BL 28. Moxa at the Du and ren 4 points.
Page 13 of 15
Zhang, male 42 years old (oy vey! Come up with a different name already! Mark, Rick, Steve, anything!
Chief complaint: Irritability (his wife probably sent him in!)
He has been suffering from irritability for over 2 weeks with a bitter taste in his mouth, thirst, and desire
for drinks. Hes been tossing and turning at night. He also has had a severe headache on the temple area
with a burning pain on the hypochondriac region, constipation, hot and yellow urine and a burning
feeling. His tongue is red, redder on the sides. His pulse is very wiry on both sides.
1) What is the differential diagnosis?

a. Excessive heat in the stomach
b. Yang excess of the large intestine
c. Hyperactivity of liver organ
d. Heart excessive fire
2) What are the points for 4 needle technique

a. Tonify LV 4, LU 8 and sedate LV 2 and HT 8
b. Tonify LV 3, SP 4 and sedate LV 5, HT 7
c. Sedate SP 3 and LV 2 while tonifying HT 8 and LU 9
d. Sedate LV 4 and HT 8 while tonifying KI 10 and LV 8
Zhao, whom I shall now call Andre, male 76 years old
Chief Complaint: Lower back pain for over 5 years
He has been suffering from lower back pain and frequent urination for over 5 years. He often feels tired
and has a poor appetite. He has been suffering from common cold for 2 days with less sweating, slight
aversion to wind and cold. His pulse is superficial but weak.
1) What is the differential diagnosis?

a. Heart and Lung Yin xu with wind-cold invasion
b. Kidney and Lung Qi xu with cold invasion
c. Spleen and Kidney Qi xu with wind-cold invasion
d. Kidney Yang xu with cold invasion
2) Whats the treatment principle?
a. Nourish HT and LU yin and remove wind-cold pathogen
b. Tonify KI and LU Qi and remove cold pathogen
c. Strengthen SP and KI functions an eliminate wind-cold pathogens
d. Warm KI yang and dispel cold pathogen
3) Which group of points for this case if you decide to treat both chronic and acute symptoms?
a. HT 7, LU 9, SP 6, BL 15, BL 13, GB 20, BL 12
b. LU 9, K 3, BL 23, BL 13, LU 7, LI 4, BL 12, SJ 17
c. ST 36, LI 10, BL 12, GB 20, BL 20, BL 23
d. Ren 4, Ren 6, BL 23, DU 4, BL 12, GB 20
Page 14 of 15
Li, whom we shall name Bart
Mr. Bart Li suffered from tinnitus with a sudden onset which was clearly related to emotional
disorder. In addition, he also had headache, bitter taste, red face, and constipation. His tongue was red
with spots on both sides and yellow coating. His pulse was wiry and rapid. Whats the differential
diagnosis?
1) Rising of Liver Yang

2) Invasion of wind-heat
3) Kidney yin deficiency
4) Flaring up of Liver fire
Zhang, nicknamed Annabelle
Ms. Zhang, aka Annabelle, suffered from pharyngitis 2 days ago. Which of the following groups of
points for pharyngitis due to heat in both Lung and Stomach would you pick for her?
1) LU 11, LI 1, GB 20, ST 36, GB 41, SI 9, SJ 17

2) LI 4, ST 44, LU 10, ST 9, LU 11, SJ 6, Ren 23
3) ST 25, ST 36, ST 40, BL 40, LU 6, LU 7, Ren 22
4) KI 6, KI 3, LI 4, PC 6, HT 7, SI 3, LV 8, SP 10
Mr. Wang, whose friends call him Mike
Mike has some emotional disorders lately. Which group of the following symptoms belong to Liver
Fire?
1) Throbbing headache, tinnitus, irritation, insomnia, wiry pulse

2) Thirst, dry throat, constipation, yellow urine, bitter taste in mouth, fast/wiry pulse, burning pain
in hypochondriac region, red spots on the tip and sides of his tongue.
3) Chest distention, epigastric pain, diarrhea, crying from time to time, thin pulse
4) Chills, fever, sore throat, palpitations, hypochondriac pain, edema
Page 15 of 15

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Course: Acupuncture Treatment of Disease I Date: September 22, 2008

Class #: 1 FAROOQ BIN MAHFOOZ

2. Final exam is in the 11th week this term.

First 3 classes introduction. Afterward, specific diseases.

Acupuncture Treatment of Disease 1

System Biomed says: TCM calls it:

Acupuncture Treatment of Disease 1

Regulating Yin and Yang

Basic understanding of Yin and Yang

2. UB 52 is Yin within Yang

2. Du 4 is the purest Yang

3. UB 23 is Yang within Yin.

iii. Pivot of Yin and Yang is Shaoyang/Shaoyin.

iv. Borders of Yin and Yang

Acupuncture Treatment of Disease 1

2) Hyperactivity of Internal Organs

4) Irregular diet or overtaking of Yang herbs.

Symptoms of Excessive Yang:

2) Unbalanced or irregular diet and/or over consumption of Yin herbs/medicines

3) Retention of internal Yin pathogens

Acupuncture Treatment of Disease 1

You could also use a ma huang/cinnamon topical application of herbs at GB 20

Acupuncture Treatment of Disease 1

2) Severe hypo function of internal organs.

3) Excessive sexual activity.

4) Irregular diet or long-term consumption of cold herbs or medications.

Acupuncture Treatment of Disease 1

3) Excessive sexual activity, mostly due to loss of sexual fluids.

4) Long term consumption of Yang herbs or Yang meds.

In the clinic, be clear on whether a disease is yin or yang, excess or deficient.

Acupuncture Treatment of Disease 1

3) Non-internal and non-external

Acupuncture Treatment of Disease 1

Here are some guidelines on deciding whether to tonify or to sedate/reduce.

Excess type individuals (including teens and kids)

Deficient type individuals (elderly, weak constitutions)

Acupuncture Treatment of Disease 1

Stage Treatment principle Who this applies to:

Distinguishing the Root (Ben) from the Symptom (Biao)

Keep 3 principles in mind as you determine treatment for a disease:

2. When a disease is chronic, treat the root (ben)/cause.

Acupuncture Treatment of Disease 1

i. Seasonal treatment per the Neijing:

2. Wintertime: protect the Yin.

3. Treat both root and symptoms

Acupuncture Treatment of Disease 1

Acupuncture Treatment of Disease 1

b. East versus West

c. Three most common diseases of the 21st century in the West

Acupuncture Treatment of Disease 1

Acupuncture Treatment of Disease 1

1- Regulating Yin & Yang

SP (dysfunction) Dampness [therefore, here, more general & superficial]

- Aversion to Cold - Chills / Shivering

(iv) Treatment Sedation (b/c Excess)

LI-4, LU-7, GB-20, UB-12, UB-13

Herbal therapy (may be better than acupuncture in treating this type of

- Pale face - Aversion to cold

(iv) Treatment Tonifying and Warming

D. Correction of Deficient Yin / Yin Xu Yin Xu causes Xu Heat symptoms

(iv) Treatment Tonify and Nourish Yin

Tx techniques: #2- Acupuncture: general pts: KID-3, 6, 1; SP-6; UB-52, 43

Pathogens = (1) External pathogens = 6 Evils

Zhen / Upright Qi is: Evil Qi is: