Course: Class #:

Acupuncture Treatment of Disease 3 2

Date:

April 20, 2009

Mechanism, basic points, different differentiations, what meridian points are most often chosen. Point selection principles.

Wei Syndrome Flaccidity Syndrome Wei is muscular atrophy without pain. Different from Bi syndrome. Examples include: ☯ ☯ ☯ ☯ ☯ ☯ ☯ ☯ ☯ ☯ ☯

Multiple Sclerosis, often seen in clinic ALS Myasthenia Gravis Paralysis leading to muscular wasting Myelitis Progressive muscular dystrophy Acute infectious multiple neuritis Progressive myodystrophy Progressive myodystrophia Hysterical paralysis Periodical paralyis (due to deficiency of potassium…mineral xu’s are a form of Yin xu in TCM) ☯ Facial paralysis ☯ Guillain-Barre Syndrome ☯ Stroke leading to paralysis Etiology Many Wei syndromes occur in humid and hot regions (summer heat) more often than in cooler climates. These are weather/climate related exogenous causes. External causes have a better prognosis than do the internal types. Internal (endogenous) causes are often congenital or acquired through lifestyle and are more difficult to rectify, thus having a poorer prognosis. Exogenous etiologies include: ☯ Damp heat ☯ Wind cold Endogenous causes include: ☯ Spleen/stomach deficiencies, especially of Qi. ☯ Improper food intake ☯ Overstrain/overwork Resulting in Liver/Kidney deficiency ☯ Congenital insufficiency I.e., Kidney essence deficiency. ☯ Longstanding illness Acupuncture Treatment of Disease 3 www.CatsTCMNotes.com Page 1 of 9

☯ Over-sexual indulgence may damage the Lv and Ki leading to insufficiency of blood/body fluids and thus malnutrition of tendons, muscles and meridians. Qi, blood, and body fluid deficiency is the result of all of the above. “Five Wei Syndrome” per Neijing affects all five Zang: Liver, Heart, Spleen, Lung and Kidney. 1. Liver – affects tendons 2. Heart – vessels 3. Spleen – muscles 4. Lung – skin 5. Kidney – bone All is encompassed even though it is the muscle atrophy that is the most obvious. Mechanism Qi and Blood deficiency due to internal and external causes Last semester we learned that Wei Qi is responsible for movement, Ying Qi is responsible for sensation. This involves both. Differentiation and Treatment When you treat Wei syndromes you must 1) differentiate between excess and deficiencies as well as 2) identify complications. Exogenous types are classified as excesses while the internal types are more often deficiencies. The initial attack, such as with Guillain-barre are excesses which then become chronic and are then deficiencies. Kidney, Liver, Spleen/Stomach are the salient organs/channels to treat in cases of Wei Syndrome. Although the spleen/stomach, liver and kidneys are the organs chiefly involved, complications frequently develop, such as phlegm damp, damp heat, and food retention/stagnation. Take this into account when you develop your treatment plan. The Neijing says you should select points predominantly from the Yangming channels. This both expels the pathogen from the Yangming (which is rich in Qi and Blood) and also tonifies the deficiency Yangming. General acupuncture treatment Points Wei Syndrome of upper extremities This is a door/hinge type treatment – points are at the joints. ☯ LI 15 ☯ LI 11 ☯ LI 4 Acupuncture Treatment of Disease 3 www.CatsTCMNotes.com Page 2 of 9

Wei Syndrome of lower extremities You might use the Spleen channel instead of the Stomach points below if there is more Spleen deficiency signs. Stomach channel is more for 1st/early stage. ☯ ST 31 ☯ ST 34 – Xi cleft ☯ ST 36 ☯ ST 41 Modifications ☯ For lung heat: o LU 5 o UB 13 ☯ For damp heat o SP 9 o UB 20 ☯ For LV and KI xu: o UB 18 o UB 23 o GB 34 o GB 39

Consumption of Body Fluids by Lung-heat Symptoms Lots of heat signs ☯ ☯ ☯ ☯ ☯ ☯ ☯ ☯ ☯ ☯

Treatment Principles Clear heat and nourish body fluids, nourish lung.

High fever Cough Thirst Disturbed shen Flaccidity of limbs and muscular atrophy Constipation Very yellow urination Dyspnea T: red with yellow coating P: thready, rapid

Most points used are from the Yangming and the Hand Taiyin channel. Points: ☯ Hua tou Jiaji points, determined by what spinal nerves are involved. ☯ LU 9 – nourish the Lung ☯ LI 11 – clear the heat ☯ ST 37 – lower he sea of LI. Clears the heat from the LI. Constipation

May have other symptoms before has LU heat. ☯ Modifications for lung dryness o LU 7 o KI 6 o Ren 23

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Retention of Damp Heat Acute stage – beginning Wei Syndrome. Not as dangerous as Lung heat. Symptoms Fever Heaviness Numbness of extremities Inability to move Edema of limbs (especially lower limbs) Deep colored burning urination T: yellow/greasy coating P: slippery and fast.

Treatment Principles Clear the heat and dry the dampness

Most points are on Foot Taiyin and Yangming Points: ☯ Hua tuo Jiaji points on the appropriate and/or damaged spinal nerves. ☯ SP 9 ☯ LI 11 ☯ ST 40 ☯ LI 4 ☯ Pai Ci Stomach 31-41 along the Yangming. Needle at every one cun. Reduce for acute cases.* ☯ Modification for digestive affectation: o Ren 12 o ST 44 o Nei Ting *There was some discussion in class about how to reduce. Originally Dr. Luo said point the needles obliquely downward…but that’s with the channel which is a tonification principle. He then reversed tack and said no, you point the needles upward against the channel. Look it up if you’re confused, because so are we. Deficiency of Spleen/Stomach Symptoms Weakness of limbs aggravated by movement Fatigue Spontaneous sweating Poor appetite Loose stool T: pale tongue with thin white coating P: thready, weak

Treatment Principles Tonify spleen, strengthen Qi Points chosen are from foot Yangming and Pai Ci ☯ Hua tou Jiaji ☯ Ren 6 ☯ SP 6 ☯ SP 9 ☯ Pai Ci ☯ Modification for Vertigo: o GB 20 o DU 20

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Deficiency of Liver/Kidney Chronic stage. Symptoms Insidious onset Flaccidity of lower limbs Lumbago Dizziness Tinnitus Nocturnal emissions Fecal/urinary incontinence Muscular twitching Irregular menstruation T: red with little coating P: thready, rapid

Treatment Principles Tonify Liver and Kidneys, Nourish Yin, Clear Heat. Points are predominatly chosen from the Foot Shaoyin and from Yangming ☯ Hua Tuo Jiaji points ☯ Pai Ci (upper and lower limbs) Sometimes use Liver channel points from LV he sea downward with deep insertion or with tonify/reduce pointing up or down the channel ☯ Wei Ci (circle around the troubled area) ☯ Ren 4 ☯ SP 6 ☯ KI 3 ☯ BL 23 ☯ LV 3 ☯ LV 8 – nourishes Yin and Blood

Blockage of collaterals by Blood stasis Late stage Symptoms Weakness/numbness of limbs Dry and scaled/fishlike skin Muscular spasm (chronic yin xu) T: Dusky/purple tongue P: Choppy/uneven, thready

Treatment Principles Promote Qi/Blood circulation (remove stasis), Dredge the collaterals Points are from the Taiyin and Taiyang channels. ☯ Hua Tuo Jiaji points ☯ Local points ☯ REN 6 ☯ SP 6 ☯ SP 10 ☯ UB 17 ☯ BL 40 – for bleeding

Alternative Treatment Methods ☯ Electrical stimulation Use intermittent or alternating frequency. You must see the muscle twitch! Use for 10-30 minutes.

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☯ Seven Star needle technique on Bladder meridian Back-shu points. Can also use this along the legs at the Stomach/Spleen channel depending on what symptoms are expressing the most. ☯ Point injections 2ce per week at the most. o Huang Qi – qi xu o Dan shen zhu she ye – blood stasis at late stage o Dang gui zhu she ye – tonifies the blood o Vitamin B1 and B12

Syringomyelia This is a cyst or cavity which forms in the spinal cord. The cyst itself is called a “syrinx.” The syrinx expands and elongates over time, causing damage to the spinal cord. You can see the cyst in the pic below on the left side.

Damage results in weakness/stiffness in the back, shoulders, arms or legs. Paralysis can also result. Other symptoms can include headaches, insensitivity to hot/cold especially in the hands. This often leads to increased and progressive weakness in the arms, legs and hands. This is considered in western medicine to be a congenital condition involving the cerebellum which occurs in fetal development.

TCM Mechanism Deficiency of SP, LV, KI

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In TCM this is considered a marrow problem and the prognosis is bad. Spinal cord is marrow in TCM and is part of the Kidney. The cyst is liquid filled so this is also considered to be a water retention abnormality. Kidney is also involved here as is the Lung and Spleen, the 3 water metabolism organs. Spleen is also involved in the muscular atrophy. Liver could be related – this is related to how hard the wall of the cyst is and whether the sinew of the muscle is also affected.

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Pattern Differentiation and Treatment Basic points Points ☯ ☯ ☯ ☯

GB 20 - wind Du 16 - wind KI 3 – tonify kidney Jia Ji xue – cervical jia ji points

Modifications: Spleen Xu: ☯ Ren 12 ☯ ST 36 ☯ UB 20 Kidney Xu: Use moxa, but with care since patient has possible lost sensations ☯ UB 23 ☯ Ren 4 LV and KI Xu: ☯ UB 23 ☯ UB 18 ☯ SP 6 ☯ GB 34 ☯ GB 39 Use moxibustion with Ren 4, Ren 6, ST 36

Spleen and Stomach Deficiency Symptoms Numbness of hands/fingers Loss of pain/feeling sensation Atrophy of small muscles of the hands Weakness Poor appetite Loose stool T: Pale with thin white coat P: deep and weak

Treatment Principles Tonify Spleen and Stomach, Strengthen Qi ☯ ☯ ☯ ☯

Basic points plus Ren 12 ST 36 UB 20

Bu Zhong Yi Qi Tang

Lower Jiao Yang Deficiency Symptoms Numbness of hands/fingers Loss of pain/feeling sensation

Treatment Principles Tonify Yang

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Abnormally curved spine Cold limbs Slow response T: Pale, swollen with TM and white coating P: Deep, slow, weak Liver and Kidney Xu Symptoms Obvious muscular atrophy/shriveling Limb spasms Dry skin Loose nails Distal necrosis of extremities Dizziness Night sweating Tinnitus T: red with less coating P: thin and fast

Di huang yin zi

Treatment Principles Tonify Liver and Kidney Kidney Xu: Use moxa, but with care since patient has possible lost sensations ☯ UB 23 ☯ Ren 4 LV and KI Xu: ☯ UB 23 ☯ UB 18 ☯ SP 6 ☯ GB 34 ☯ GB 39

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