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NMT 200: NATUROPATHIC THERAPEUTICS II TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 10 LIVER AND GALL BLADDER FUNCTIONS Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand the functions of the Liver Learn the interactions between the Liver and other organs Learn t...

NMT 200: NATUROPATHIC THERAPEUTICS II TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 10 LIVER AND GALL BLADDER FUNCTIONS Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand the functions of the Liver Learn the interactions between the Liver and other organs Learn the key actions for treating the Liver Learn the key acupuncture points for treating the Liver Understand the functions of the Gall Bladder LIVER FUNCTIONS Stores Blood Ensures the smooth flow of Qi Controls the Sinews Manifests in the nails Opens into the eyes House the Hun (Ethereal Soul) STORES BLOOD Regulates Blood volume Blood flows to muscles and sinews during activity Blood flows back to the Liver at rest Influences resistance to external pathogens Moistens eyes and sinews Deficiency: Dry eyes or blurred vision Excess heat: Red and burning Poor nourishment of sinews may lead to muscle cramps and poor tendon functioning Internal Wind may cause muscle tremors STORES BLOOD Regulates menstruation Deficiency can lead to amenorrhea or light bleeding Excess heat can lead to heavier bleeding Stagnation can lead to pain, cramping, and PMS Influences the Conception (Ren Mai) and Penetrating vessels (Chong Mai), which are connected to the uterus ENSURES THE SMOOTH FLOW OF QI Relates to emotions Essential to balanced emotions Reduced flow → Obstructed Qi → Irritability/frustration/anger Repressed emotion → Obstructed Qi ENSURES THE SMOOTH FLOW OF QI Aids in digestion Assists in the normal movement of Qi for each organ Descending for Stomach, ascending for Spleen Obstructed Qi → blocked movement of Qi → symptoms Liver directs Qi traffic in the middle burner Regulates secretion of bile Obstructed Qi → poor bile secretion → poor digestion CONTROLS THE SINEWS Nourishes the tendons, ligaments, and cartilage An extension of the Liver Related to Liver Blood levels Muscles are under control of the Spleen GB 34 is the Influential point for tendons and sinews MANIFEST IN THE NAILS Nails are a byproduct of sinews in TCM Related to Liver Blood Deficient = dry, brittle, cracked Stagnation = dark or purple OPENS INTO THE EYES Related to Liver Blood Proper vision requires adequate Liver Blood Blood Deficient = blurred vision, myopia, floaters Yin Deficient = dry, gritty eyes Excess Heat = burning, painful, redness Stagnation = painful eyeball (or behind the eye) Liver Wind = moving eyeball Kidney Essence and Heart Qi/Blood required for vision CONTROLS TEARS Tears are the fluid related to the Liver Mainly for moistening and clearing of foreign bodies Not linked to emotional tears Necessary for proper functioning of the eyes Deficiency of Blood or Yin can lead to dry eyes Liver Yang Rising may cause watery eyes HOUSE THE HUN (ETHEREAL SOUL) Linked to “Spirits” and “Demons” Yang in nature Planning life and giving life a sense of direction Affected by Liver function Linked to the Corporeal Soul (Po) of the Lung The Po closes with death The Hun continues to the next life CONTROLS PLANNING Gives life direction and meaning Organizes functions to ensure smooth flow of Liver Qi  Liver Blood Stasis Liver Fire Excess Stagnation of Cold Liver Qi stagnation Internal Wind Deficiency Liver Blood Liver Yin Liver Yang Deficiency Deficiency Rising KEY ACTIONS Promotes the smooth flow of Liver Qi Subdues Liver Yang Moves stagnation Benefits the genitals Benefits the breasts KEY ACUPUNCTURE POINTS POINT USES Liver 3 Source point, moves Qi, regulates emotions, nourishes Blood/Yin LI 4 Regulates ascending and descending of Qi, subdues Liver Yang CV 6 Moves Qi, moves stagnation GB 34 Promotes the smooth flow of Liver Qi UB 18 Back Shu point; good for deficiency conditions Liver 14 Front-Mu point, moves Blood; good for excess conditions Liver 2 Clears Liver Fire, subdues Liver Yang, stops bleeding GV 20 Subdues Liver Yang Pc 6 Moves Liver Qi, subdues Qi in upper and middle burners GB 21 Promotes the smooth flow of Liver Qi Sp 6 Regulates the Liver, promotes the smooth flow of Liver Qi, nourishes Blood GALL BLADDER FUNCTIONS Stores and excretes bile Controls Decisions Controls the Sinews STORES AND EXCRETES BILE Aids the digestive functions of the spleen and stomach Affected by Liver’s circulation of Qi Only Yang organ to store a “pure” substance Depends on flow of Liver Qi CONTROLS DECISIONS Works with Liver’s control of planning Other organs depend on Gall Bladder’s decision-making capabilities Seen as a motivator for others Courage and initiative (“Drive”) CONTROLS THE SINEWS Like the Liver but less nourishing and more qi distribution to the sinews REFERENCES Liangyue, Deng et al. Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1996. Maciocia, Giovanni. The Foundations of Chinese Medicine. 3ed. Philadelphia, PA: Elsevier Ltd, 2015. Tyme. Student Manual on the Fundamentals of Traditional Oriental Medicine. San Diego, CA: Living Earth Enterprises, 1997. Kaptchuk, Ted. The Web That Has No Weaver. Chicago, IL: Congdon & Weed, Inc, 1983. NMT 200: NATUROPATHIC THERAPEUTICS II TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING WEEK 2 S P L E E N A N D S TO M A C H F U N C T I O N S Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand the functions of the Spleen Understand the interactions between the Spleen and other organs Understand the functions of the Stomach EARTH ELEMENT Spleen & Stomach Meridians Emotional sound is Singing Saliva is the secretion Illness sound is Swallowing Sense is Taste Pensiveness and worry are the emotions Season is Late summer or the last 2 weeks of every season Fragrant is the odor Climate is Moist and Sweet is the flavor Thunderous Stomach: 7 - 9am, Spleen: 9 – 11am SPLEEN ORGAN FUNCTIONS Governs Transformation and Transportation Controls the blood Controls the muscles and the 4 limbs Opens into the mouth, and manifests in the lips Controls the ‘raising of Qi’ House the Yi (Intellect) GOVERNS TRANSFORMATION AND TRANSPORTATION Receives Food Qi from the Stomach and converts it into Food Essence Important for digestion and production of Qi and Blood Send `Clear` fluids to the Lungs, and `Turbid` fluids to the Small Intestine Dysfunction can lead to dampness/phlegm accumulation CONTROLS THE BLOOD Keeps Blood within the vessels Uses ‘raising of Qi’ function to accomplish this task “Control” also refers to Spleen’s assistance in making Blood Uses ‘transformation and transportation’ function to accomplish this task CONTROLS THE MUSCLES AND THE 4 LIMBS Qi extracted from the food gets sent to the muscles of the limbs to assist their functioning Weak Food-Qi extraction leads to poor muscle functioning, which can lead to weak muscles and/or atrophy OPENS INTO THE MOUTH, AND MANIFESTS IN THE LIPS Chewing of food to prepare it for transformation Saliva is also controlled by the Spleen and is important in aiding digestion Taste is also controlled by Spleen and assists in digestion Changes in the lip color and texture resemble the state of the Spleen Dry, red, pale, or swollen lips may be a sign of Spleen dysfunction CONTROLS THE ‘RAISING OF QI’ Sending refined Qi upwards to the Lung and Heart Also sends Yang fluids upwards to be used by sense organs and be released from nose and mouth Works closely with Stomach’s function of ‘descending Qi’ “Raising” also implies keeping organs in their place to prevent prolapse or herniation HOUSE THE YI (INTELLECT) Thinking, studying, focusing, memorizing, concentrating, and generating ideas. Closely connected to Shen (Ht) and Zhi (Kd) Pensiveness or brooding negatively affects the Yi  Sple en Small Intestine  SPLEEN QI DEFICIENCY Spleen Spleen Qi Spleen Failing Yang Sinking to control Deficiency Blood STOMACH ORGAN FUNCTIONS Controls ‘receiving’ Responsible for “Rotting” and “Ripening” Controls transportation of Food Essences Controls descending of Qi Origin of Fluids CONTROLS ‘RECEIVING’ Related to food and drink arriving and staying in the stomach for processing “Sea of Qi and Blood and of Food Drink” Dysfunction may lead to poor appetite and/or rebellious Qi RESPONSIBLE FOR “ROTTING” AND “RIPENING” Prepares the food for extraction by breaking it down, which makes it easier for the Spleen to transform and transport Similar to a cauldron “If there is Stomach-Qi there is life, if there is no Stomach-Qi, there is death” CONTROLS TRANSPORTATION OF FOOD ESSENCES Identical to Spleen’s function of transportation to the 4 limbs A difference is that Stomach’s function will have an affect on the pulse quality Stomach Qi can also affect tongue coating CONTROLS DESCENDING OF QI Sends down to Small Intestine for further separation Also works with Spleen’s ‘ascending’ function Assisted by Liver Qi Dysfunction may lead to stagnation of Qi in the Stomach ORIGIN OF FLUIDS Fluids are required for rotting and ripening Stomach ensures that fluids which are not used to produce food essences are used to produce body fluids The Stomach likes wet and dislikes dry REFERENCES Liangyue, Deng et al. Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1996. Maciocia, Giovanni. The Foundations of Chinese Medicine. 2ed. Philadephia, PA: Churchill Livingstone, 2005. Tyme. Student Manual on the Fundamentals of Traditional Oriental Medicine. San Diego, CA: Living Earth Enterprises, 1997. Kaptchuk, Ted. The Web That Has No Weaver. Chicago, IL: Congdon & Weed, Inc, 1983. NMT200: NATUROPATHIC THERAPEUTICS II TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING WEEK 1 REVIEW G E N E R A L PAT H O LO G I E S O F D E F I C I E N C I E S A N D E XC E S S E S POINT PRESCRIPTIONS Author: Dr. Neemez Kassam, MSc, ND LECTURE OBJECTIVES Review general deficiency conditions: Qi, Blood, Yin and Yang Review general excess conditions: Cold, Heat, Dampness, Stagnation Applying treatment principles to diagnosis Applying acupuncture points to diagnoses for treatment DEFICIENCY Characterized by Emptiness of the Upright Qi and the absence of a pathogenic factor Empty Qi: Pale face, weak voice, slight sweating, slight shortness of breath, fatigue, loose stools, poor appetite Empty Yang: Bright pale face, cold limbs, absence of thirst, desire for hot drinks, frequent pale urination Empty Yin: Heat in the afternoon, dry throat at night, night sweats Empty Blood: Dull-pale face, pale lips, dry hair, blurred vision, tiredness, poor memory, insomnia, scanty periods YIN DEFICIENCY Decrease in Yin produces heat symptoms Red cheeks Dry stools Anxiety at night Night sweats Hot flushes 5 Centre Heat Thirst for cold drinks in sips Yin Yang YIN EXCESS Excess Yin produces cold symptoms Abdominal pain better with warmth Dysmenorrhea better with warmth Local pain better with heat Chills Yin Yang YANG DEFICIENCY Decrease of Yang produces cold symptoms Tired after bowel movement Low libido Edema Fatigue Yin Yang YANG EXCESS Excess Yang produces heat symptoms Feeling hot all day Red face Thirst for cold drinks (gulps) Yin Yang QI 氣 “Qi is the root of the human body; the stem & leaves would dry up without a root” - Eight Problems of Classics on Medical Problems QI FUNCTIONS Promoting: Growth & development Warming: Warmth is maintained by readjusting Qi Defence: Wei Qi Protects the body from exterior attacks Checking: Maintains homeostasis Nourishing: Ying Qi or Nutritive Qi Qi Hua: Function of the organs e.g. Lung Qi = Lung function QI DEFICIENCY Fatigue Insomnia Poor digestion Cold hands and feet Shortness of breath Little to no appetite Frequent infections, weak immune system STAGNATION If the Qi stagnates in the meridians, the main symptoms are stiffness, heaviness, numbness or tingling of the limbs in the affected regions, or migrating pain in the limbs. BLOOD Formed from mainly Food Qi Food Qi from the Spleen and Stomach rises to the chest where it is acted upon by Yuan Qi At this point it is known as blood But blood is not complete (Blood) until it is sent to the Heart where Heart turns Blood red "Heart Governs Blood" BLOOD FUNCTIONS Nourishment & moisture: Movement of the eyes & 4 limbs Nourishes hair, sinews, bones & bowels Foundation of mental activities; houses the mind Circulates with Ying Qi Determines Menstruation BLOOD DEFICIENCY Long cycles, Short luteal phase Scanty menstrual blood, Amenorrhea Fatigue, anxiety, insomnia, poor memory Cold hands and feet, abdomen, low back Floaters in eyes, slow recovery Pale BLOOD STASIS Oppression or pain in the chest Coughing up dark, clotted blood Purple Deep, stabbing pain EXCESS Characterized by the presence of a pathogenic factor while Upright Qi is relatively intact and actively fighting against the pathogenic factor Pain worse with pressure Pain that is acute in onset Irritability, restlessness Strong voice YIN EXCESS Excess Yin produces cold symptoms Abdominal pain better with warmth Dysmenorrhea better with warmth Local pain better with heat Chills YANG EXCESS Excess Yang produces heat symptoms Feeling hot all day Red face Thirst for cold drinks (gulps) COLD Feeling of cold Cold limbs Absence of thirst Full- or Empty-Cold? This time depends on Yin, if it is in Excess or Relative Excess of Yang  Comparison between Full-Cold and Empty-Cold Full-Cold Empty-Cold FULL- VS. Face Bright-white Dull-white EMPTY-COLD Pain Sharp, worse on pressure Dull, worse on pressure Better after bowel Worse after bowel Bowels movement movement Pulse Full-Tight-Deep Weak-Slow-Deep Tongue Thick white coating Thin white coating HEAT Feeling hot; fever Sweating Thirst Empty- vs. Full-Heat? All dependent on if it is a manifestation of Excess of Yang or if Yang is relatively in Excess  Comparison between Full-Heat and Empty-Heat Full-Heat Empty-Heat Face Whole face red Malar flush Thirst Desire to drink cold water Desire to drink in small sips Eyelid Red all over inside eyelid Thin red line inside eyelid Taste Bitter taste No bitter taste FULL-VS. Feeling of heat Fever All day High fever In the afternoon or evening Low-grade fever in the afternoon EMPTY-HEAT Mind Very restless and agitated Vague anxiety, fidgeting Bowels Constipation, abdominal pain Dry stools, no abdominal pain Bleeding Profuse Slight Waking frequently during the Sleep Dream-disturbed, very restless night or early morning Scarlet-red, not raised, painless Skin eruptions Red hot painful skin skin eruptions Pulse Full-Rapid-Overflowing Floating-Empty-Rapid Tongue Red with yellow coating Red and peeled Treatment Clear heat Nourish Yin, clear empty-heat method DAMPNESS Excess of Yin From damp environments: clothes, living, wading, diet, lack of movement Sticky and difficult to get rid of HEAVY & SLOW DAMPNESS Feeling of heaviness, pain or anything worse with damp, Anything swollen and/or oozing No appetite, bloating, made worse with food Cloudiness of discharges Pulses: Slippery Tongue: Sticky coat and/or fat, swollen tongue TREATMENT PRINCIPLE Based on diagnosis(es) Primary approach Should have a treatment principle for each diagnosis Secondary approach Creating a treatment principle for symptom management TREATMENT PRINCIPLE Example Weak cough that is worse on exertion, difficult breathing, fatigue, weakness, and spontaneous sweating Dx: Lung Qi Deficiency 1o Tx Principle: Tonify Lung, tonify Qi 2o Tx principle: relieves coughing (good), or descends Lung Qi (better) Lung deficiency + Qi deficiency Tonify Lung + tonify Qi Cough Caused by Lung Qi rebelling, or moving in the wrong direction Using ‘descends Lung Qi’ treats the cause of coughing vs ‘relieves coughing’ which tries to push the cough down Can use both principles together when sxs are acute POINT PRESCRIPTIONS Tonifies Lung Qi Lung 1, Lung 9, UB 13, GV 12 Tonifies Qi LI 4, LI 10, Ht 5, St 36, UB 17, UB 43, CV 6, CV 17 POINT PRESCRIPTIONS Descends Lung Qi Lu 1, Lu 2, Lu 5, Lu 7, Lu 8, Lu 11, LI 16, SI 15, SP, 19, SP 20, St 10, St 12, St 40, Kd 24, Kd 25, UB 11, UB 12, UB 13, UB 42, UB 45, GB 18, GB 21, GB 22, CV 14, CV 15, CV 17, CV 21, CV 22, Bailao Relieves coughing Lu 1, Lu 2, Lu 9, Lu 10, LI 13, LI 16, LI 18, SP 18, SP 19, SP 20, St 16, St 18, St 19, St 40, Kd 19, Kd 22, Kd 23, Kd 25, Kd 26, Kd 27, UB 11, UB 13, UB 42, UB 43, UB 44, CV 19, CV 20, CV 21, CV 22, CV 23, GV 10, Bailao, Dingchuan REFERENCES Kaptchuk, Ted. The Web That Has No Weaver. Chicago, IL: Congdon & Weed, Inc, 1983. Kassam, N. Fundamentals of Clinical Acupuncture. Toronto, ON: CCNM Press, 2009. Maciocia, G. (2015). Foundations of Chinese Medicine. Third Edition. Maciocia, Giovanni. The Foundations of Chinese Medicine. 2ed. New York, NY: Churchill Livingstone, 2005. pp. 427 Maciocia, Giovanni. The Foundations of Chinese Medicine. 2ed. New York, NY: Churchill Livingstone, 2005. pp. 255-266.