Circle the Dragon Chinese Herbal Medicine and Medical Acupuncture in Family Practice

1. Circle the DragonChinese Herbal Medicine and Medical Acupuncture in Family Practice Tom Archie, MD, DABFM, DABMA St. Luke’s Wood River Medical Center Integrative Therapies Service www.drtomsalchemy.com

2. Objectives • Pattern Recognition • Chinese Medicine Physiology • Three Treasures – Jing, Shen, Qi • Physiology of Qi and Blood • Five Elements • Eight Principles • External Pathogenic Factors • Psyche-Soma: The Five Parts of the Soul • Diagnostics: Tongue and Pulse • Cases Discussed

3. Pattern Recognition

4. Western Medicine Premenstrual Syndrome Hypertension Depression Migraine Congestive Heart Failure Pneumonia Diabetes Chronic Fatigue Syndrome Eczema Asthma Angina Pleurisy Dysmenorrhea Chinese Medicine Liver Qi Stagnation Liver Blood Deficiency Liver Blood Stagnation Kidney Yin Deficiency Kidney Yang Deficiency Lung Qi Deficiency Spleen Qi Deficiency Phlegm Heat misting the Heart and Mind’s Orifices Wind Cold (or Heat) Invasion Latent Wind HeatHeart Yin Deficiency Heart Qi Deficiency Pattern Recognition - Diagnoses

5. Physiology Of Chinese Medicine

6. The Three Treasures • Jing (Essence) - derived from the Kidney • Shen and Qi are derived from Jing • Inherited from parents - Genetics/Constitution • Determines growth, sexual maturation, conception, pregnancy, brain/cognitive function • Qi – derived from Spleen (food) and Lung (air) • Replenished day-to-day • Nutrition and air quality important • Shen (Mind) – housed in the Heart • Creativity, Drive, Vision, and Intelligence

7. Qi Vapor Qi Rice

8. Lost in Translation? • Qi (Character with vapor rising above cooking rice) • Early 1900s - Soulie de Mourant- Qi = “energy” and Jing = “meridian” • Simplified translation of complicated terms • “Life Force” made up of air and food transformed by body into blood and body fluids • Nei Jing written during 3rd – 1st Century BCE • Chinese physicians & cadaver dissections • Using needles of glass, metal and bone to influence neurovascular system

9. TCM Qi Physiology • Stomach separates pure from impure Qi of food • Pure Qi to Spleen • Impure to Small Intestine (process repeats again) • Spleen sends Food Qi to Lung • Lung combines it with pure Qi extracted from air • Food/Air Qi “heated” by Yuan Qi (ancestral pilot light) provided by Kidney to make “Nutritive Qi” • In Heart to make Blood • In Meridians

10. TCM Qi Physiology

11. Blood Physiology(Dense, material form of Qi)

12. Blood Deficiency • Causes: • Hemorrhage, low dietary protein, constitution • Deficiency or stagnation of Qi • Fatigue, brain fog, dizziness, dry skin, dry hair, brittle nails, pale tongue, irregular and very light menses, pale complexion, trouble falling asleep, anemia, headache, anxiety

13. Blood Stagnation • Caused by Blood Deficiency or Qi Stagnation • Dark/dusky tongue, purple sublingual veins • Chronic stabbing pain • Musculoskeletal • Pleurisy, Angina • Degenerative disc disease, spinal stenosis • Blood moving herbs are anti-inflammatory • Gynecological • Painful and heavy menstrual periods • Large dark clots

14. Meridians • Acupuncture points linked together in lines called “meridians” • Qi circulates through meridians • Meridians named for associated Organ • Kidney, Heart, Small Intestine, Bladder • Liver, Pericardium, Triple Energizer, Gallbladder • Spleen, Lung, Large Intestine, Stomach

15. Meridians

16. 91% of Acupuncture Points share this Histology

17. fMRI Study • Needle placed in foot Acupuncture point associated vision • fMRI shows stimulation of visual cortex

18. fMRI Study • Auditory Complex stimulated by needle placed in AP point on the leg associated with hearing

19. Acupuncture Models • Meridian-based: Japanese, Vietnamese, French Energetics • Traditional Chinese Medicine (“TCM”) • Eight Principles (Yin/Yang, Damp/Dry, Cold/Heat, Interior/Exterior) • Zhang-Fu organ pairings blends Yin-Yang and 5 Element • Five Element (Korean) • Wood, Fire, Earth, Metal and Water • Different schools of thought regarding etiology of disease (Kidney versus Spleen/Stomach) • Neuroanatomical - CraigPENS, osteopuncture

20. Meridian-Based Acupuncture • Blockage in meridian flow produces disease • Therapeutic action of “unblocking” meridian flow (Relieving Stagnation) • Pain • Asthma • Heavy, Painful, or Irregular Menstrual Periods

21. French Energetics AcupuncturePrincipal Meridian Treatment Yin Tonification Chronic Symptoms (or cold, deficient) Balance needles so that more are on Yin meridians Tonify Yin Meridian by twirling, applying heat via Moxibustion, or low frequency electrical stimulation Yang Dispersal Acute Symptoms (or heat, excess, spasm) Balance needles so that more are on Yang meridians Disperse Yang Meridian by leaving needles alone, cooling with alcohol pads, or medium to high frequency electrical stimulation

22. Shao Yin Kidney, Heart Jue Yin Liver, Pericardium Tai Yin Spleen, Lung Tai Yang Small Intestine, Bladder Shao Yang Triple Heater, Gallbladder Yang Ming Large Intestine, Stomach Principal Meridians

23. French Energetics AcupuncturePrincipal Meridian Treatment • How do you chose the Principal Meridian? • Location of clinical problem (ex: pain) • Meridian associated with function of problematic organ system (ex: diarrhea) • Constitution of the patient • Central low back pain in patient with Wood-Fire as principal meridian system • Anger/frustration/irritability • Consider Jue Yin – Shao Yang (LR-PC-TH-GB) instead of Shao Yin – Tai Yang (KI-HT-SI-BL)

24. Pattern Recognition Five Elements Interconnections between Patterns and Systems TCM Eight Principles

25. Eight Principles

26. Yang Light Sun Activity Energy Expansion Hot Fire Hard Excitement Qi Yin Darkness Moon Rest Matter Contraction Cold Water Soft Inhibition Blood Eight Principles - Polarities

27. Yin & Yang Deficiency and Excess Yin Deficiency Yang will appear in excess with heat, dryness, thirst, back pain, stiffness insomnia, loss of willpower to follow through with action. This is Empty Heat compared to Full Heat (tonify rather than disperse). Yang Deficiency Yin will appear in excess with cold, fluid retention, chills, back pain, daytime fatigue, low libido, loss of willpower to initiate action. This is Empty Cold (tonify rather than disperse). Yang Excess Yang appears in excess with Full Heat – migraines, pressure, bloating, mania, hypertension, anger, insomnia, fever. Full Heat (disperse rather than tonify). Yin Excess Yin appears in excess with Full Cold – usually due to Wind Cold invasion. Stiffness, contraction of tendons, chilliness, severe menstrual or abdominal pain, fluid retention and watery-loose discharges including stools.

28. External Pathogenic Factors • Wind • Cold • Summer Heat • Damp • Dryness • Fire

29. Rapid onset Wind Cold to Wind Heat Symptoms & signs change rapidly and move from place to place in body Enters neck to respiratory tract Circulates between skin and muscles Warms muscles Aversion to cold or to wind Chills/myalgias Further warmed by body Fever, rigors, rash/hives Wind in the Skin Eczema, dermatitis, itching Chronic allergic rhinitis Dry/Wind plus Yin Def Upper respiratory infection signs Chills, cold intolerance, sore throat, clear nasal drainage that warms to yellow/thick Internal Wind (neurologic) Stroke, seizures, tremor, headaches, hypertension, paresthesias/neuropathy External Pathogenic FactorsWind

30. Usually enters via Wind Cold invasion Direct channel invasion Bi Syndrome Painful Obstruction Syndrome Arthritis without hot/red joints Wind-Damp-Cold Contracts muscles/tendons Chronic, dull pain (abdomen, pelvis, joints) better with heat Internal Cold(from Yang Def) Consumes Spleen Yang Chilliness, dull pain, prefer warm liquids, cold limbs, no thirst, fatigue Heart Yang Deficiency Stuffy pain in chest, palpitations Lung Qi Deficiency Catch every cold, sweats, cough with thin white mucus Spleen Yang Deficiency Diarrhea/loose stools, low appetite Kidney Yang Deficiency Frequent pale profuse urination, low back pain, cold feet/knees, erectile dysfunction, white vaginal discharge External Pathogenic FactorsCold

31. External Pathogenic FactorsSummer Heat • Specific to hot weather • Aversion to heat, sweating, headache, dark scant urine, dry lips, thirst, rapid pulse • Severe Summer Heat • Invades Pericardium • Delirium, slurred speech, loss of consciousness • “Heat Exhaustion” or “Heat Stroke” in western med

32. Damp weather Wearing damp clothing Sitting on damp ground Consuming damp diet Refined sugars, dairy Excessive raw veg/fruit Ascends legs Symptoms depend on where damp settles Pelvis – vaginal discharge GI – loose stools Bladder – urinary frequency or burning Heaviness of limbs/head Tired, fullness of chest or abdomen, muscles sore/weak Dirtiness/clouded color Clouded urine, thick discharge (vaginal or skin) Stickiness Sticky tongue coating, sticky taste, Slippery/wet pulse With Heat Fever, sticky yellow tongue coat Phlegm Chronic Damp (with Fire) External Pathogenic FactorsDamp

33. External Pathogenic FactorsDryness • Very dry weather • Artificially dry, centrally heated buildings • Dry skin/mouth, throat, lips, tongue, stools, and scanty urination • Injures Yang • Lung Qi Deficiency as Allergic Rhinitis • Specific to Dry/Wind exposure in Idaho • Chronic Dry/Wind exposure in population with Yin Deficiency (due to overwork/hectic lifestyles)

34. External Pathogenic FactorsFire • Extreme form of Heat • Quickly becomes Internal pathogenic factor • Fever, thirst, bitter taste, sweating, constipation (dry), ulcers, bleeding gums, canker sores, delirium, scanty dark urine, headache, dizziness, irritability, red face, • Tongue red with dry yellow coat

35. Fire Five Elements System of Correspondences Earth Wood Water Metal

36. HomeostasisSheng – Ke Cycle Supporting or Augmenting Influence Controlling or Dampening Influence System Self-Correction (in the short term)

37. Five Element Acupuncture • Imbalance between Elements causes Disease • Example • Chronic overwork/abuse/disease leads to deficiency of Water (fatigue, chronic UTI/stones/incontinence, joint pains, low back pain, fear, low self-esteem) • Water controls Fire (Water Def – Fire Excess) • Excess Fire symptoms result (anxiety, hot flashes, palpitations, insomnia, inflammation)

38. Treatment • Treat by “Tonifying” deficiencies and “Dispersing” excesses • Release excess Fire • Tonify deficient Water • Use Acupuncture and Chinese Herbs in combination

39. Five Element Correspondences • Wood (Liver, Gallbladder) • Driven, multiple projects, movement, CEO, anger/anxiety, tight traps/lateral neck/IT band, TMJ, migraines, caffeine sensitivity, fibromyalgia, blue/green, sour/citrus, Spring, expansion, insomnia (esp. sleep maintenance 11pm-3am), east • Augments Fire, controls Earth, augmented by Water and controlled by Metal • Coupled with Fire

40. Five Element Correspondences • Fire (Heart, Small Intestine, Pericardium, Triple Energizer) • Creative, CEO, joy, awareness, love/attachment, mania, palpitations, insomnia (esp. sleep initiation), hot flashes, night sweats, cardiac disease, dysrhythmias, red/orange, bitter/roasted, summer, south • Augments Earth, Controls Metal, Augmented by Wood, Controlled by Water • Coupled with Wood and Water

41. Five Element Correspondences • Earth (Spleen, Stomach) • Nurturing, worry/obsession, GI issues (loose stools, gastritis, bloating, abd pain), sinusitis, cysts, tumors, lumps, dampness, obesity, chronic fatigue(multifactorial), sweet, dampness (cysts, edema), yellow/brown, transitions of seasons, center of compass positions • Nurtures Metal, Controls Water, Controlled by Wood • Coupled with Metal

42. Five Element Correspondences • Metal (Lung, Large Intestine) • Respiratory, skin disorders (“3rd lung”), constipation, dryness, sense of duty, grief, loss, depression (multifactorial), flavorful/spicy, white/grey/colorless, autumn, west • Nurtures Water, Controls Wood, Controlled by Fire • Coupled with Earth

43. Five Element Correspondences • Water (Kidney, Bladder) • UTI, Kidney stones, incontinence, joint pain, low back pain, inner chill, abuse, philosopher, music, hearing problems, throat, winter, black, north, salty, motivation/willpower • Nurtures Wood, Controls Fire, Controlled by Earth • Coupled with Fire

44. Five Elements of the Soul Fire Shen : Mind Clarity of Thought Consciousness Insight Creative Thinking Mental Get Up & Go Joy - Mania Earth Wood Yi : Intellect Applied Thinking Studying, Memorization Concentration/Focus Gathering Ideas Nurturing – Co-dependent Hun : Ethereal Soul Link Shen to Universal Mind Dreams, Daydream, Ambition Opens with Meditation or Dreams Irritability, Frustration, Anger, Grudge, Rage, Anxiety Po : Corporeal Soul Activity of Thinking Monkey Mind Sensations (Touch, Smell, etc.) Quiets with Meditation (as Hun opens) Sadness, Grief, Loss, Melancholy Zhi : Willpower Old Memory Drive/Determination Pilot Light Self-Esteem, Guilt Fear, Phobias Metal Water

45. Excessive Attachment to Emotions- Anger - • Bottled up • Liver Qi Stagnation (irritable, “short fuse,” if chronic, then depression) • Liver Qi Stagnation –> Lung and Spleen Qi Stag. (see Worry) • Liver Qi Stagnation –> Liver Blood Stagnation (chronic pain) • If with Kidney Yin Deficiency (overwork or excessive sex), then Liver Yin Deficiency leads to LiverYang Rising • Deficient Water fails to nourish Wood through Sheng cycle • Rage/outbursts, headache, thirst, dry mouth, bitter taste, tinnitus, dizziness • Liver Qi invading Stomach • Upper abdominal pain, bloating, gas, nausea, alternating diarrhea/constipation

46. Excessive Attachment to Emotions- Worry - • Knots the Qi (smooth flow of Qi is the domain of the Liver, but the effect is most prominent at LU and SP) • Affects the Lung and Spleen • Lung Qi Stagnation: breathing shallow, chest discomfort, shoulder tension, anxiety • Chest/lungs reduce expansion with shallow breaths • Lung Qi stagnates – Heart Qi stagnation can follow, as can Heart Blood Deficiency (due to lack of Lu Qi) • Spleen Qi Stagnation: Disordered thinking, brain fog, decreased concentration/memorization, forgetfulness

47. Excessive Attachment to Emotions • Hatred – Liver, Heart – Wood/Fire • Sadness, Grief, Regret – Lung - Metal • Fear – Kidney - Water • Shock – Kidney, Heart - Water/Fire • Love – Heart - Fire • Craving – Heart - Fire • Guilt – Kidney, Heart - Water/Fire

48. Insomnia • Blood Deficiency – Can’t Fall Asleep • Yin Deficiency (KI, HT, LR, LU) with Shen Ungrounded - Can’t Stay Asleep • KI Yin Def: Exhausted, low willpower, start projects but don’t finish them, thirst, dry mouth • HT Yin Def: Palpitations, anxiety, sweats • LR Yin Def: Chronic depression, anger • LU Yin Def: Sweat, itchy skin, lonely, breathless • Hun Ungrounded – Dream-disturbed sleep, Sleep walking/talking, Restlessness • Heart-Gallbladder Deficiency – Wake up too early

49. Depression – Many Patterns • Mind Obstructed • Liver Qi Stagnation • Heart and Lung Qi Stagnation • Heart or Liver Blood Stagnation • Phlegm Misting the Mind’s Orifices • Phlegm Heat obstructed the Mind/Heart • Mind Unsettled • Heart or Liver Fire blazing • Heart Blood or Yin Deficiency • Liver Blood Deficiency • Kidney Yin Deficiency (+/- Empty Heat) • Mind Weakened • Blood, Qi, and/or Yang Deficiency

50. Chinese Diagnostics • Tongue • Color, size, wetness/“scalloping”, coating, cracks • Geographic representations of organs • Clinical changes occur slowly (weeks) • Pulses • Radial artery • Organ assessment at certain positions/depths • Clinical changes occur quickly (during treatment) • Body Type/Morphology • Skin/Complexion Color/Lesions • Palpation – heat/cold, lumps/knots