NMT 200: Naturopathic Therapeutics II PDF

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) SYNCHRONOUS LECTURE WEEK 3 Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Review Liver and Gall Bladder functions Review Liver and Gall Bladder pathologies Diagnose cases using Zang-Fu diagnoses Apply treatment principles to Zang-Fu diagnoses Create an acupuncture treatment plan TIME ACTION 10 mins Discussion on E-Learning and previously learned topics 30 mins Small group case diagnosis Week 3, Case 1 (W3C1) 15 mins Discussion of case conclusions for W3C1 5 mins Break 30 mins Small group case diagnosis Week 3, Case 2 (W3C2) 15 mins Discussion of case conclusions for W3C2 5 mins Summary and findings WEEK 3, CASE 1 (W3C1) CC: Heartburn 45 y.o. male, accountant Symptoms began 5 years ago with a feeling of burning in the chest after eating pepperoni pizza, pasta with tomato sauce, red wine, coffee, or pineapples. Now the burning sensation is present when lying down at bedtime, exercising, and soon after waking in the morning. Uses Pantoprazole (40mg bid) which helps the symptoms, but he has been on the medication for 2 years and wants a change. His appetite was high but has decreased since starting the medication. He informs you that he also has belching (after meals), hiccups (1-2x/wk), infrequent bowel movements (1 q3-4d), and a distending pain in the epigastrium. His job is stressful at times with tax deadlines, RRSP deadlines, and corporate year-end. During these times he feels irritable, has low libido (some erectile dysfunction), headaches (distending pressure behind both eyes), difficulty sleeping, and dry eyes. He admits to drinking more alcohol when he feels stressed (2-4 oz per night of scotch, whiskey, or bourbon). He denies chest pain, palpitations, hearing loss, anger, low back pain, urination concerns, or feelings of heaviness. Pulse: Strong, wiry, rapid. Tongue: Red body with light purple edges, and med purple in the center of the tongue. Moderately thick, dry, yellow coating W3C1 OUTCOMES Differential diagnoses with rule-in/rule-out criteria Working diagnosis using Zang-Fu pathology(ies) Severity of condition: mild, moderate, severe Treatment principle(s) Acupuncture points to use for treatment principle(s) WEEK 3, CASE 2 (W3C2) CC: Hot flashes 51 y.o. female, Firefighter She experiences 4-5 hot flashes everyday but are more common in the afternoon and early evening. Her hot flashes are described as feeling hot in the distal extremities, and centrally around the chest, then radiates up toward the head. Her cheeks get red and needs to fan herself or remove layers of clothing until the episode ends after 30-60 seconds. The hot flashes are also triggered by coffee, red wine, nervous situations, and spicy food. She has night sweats every 2-3 nights that wake her up from sleep and needs to change the sheets and her pyjamas. She has not a menstrual cycle for 1 year. Associated intermittent symptoms are tinnitus (low pitch), dry eyes, insomnia, dry mouth/throat, vaginal dryness, increased libido, thinning hair, low back and knee pain, and dull headaches behind the eyes. In the past 2 weeks she has had mutiple episodes of vertigo, her face is turning red with hot flashes, she has more random bouts of anger, more difficulty falling and staying asleep, high- pitched tinnitus, and a vertex headache. Pulse: Rapid, thready overall. Weak left Chi pulse. Tongue: Red body with peeled areas on the sides and root. Dry coating. W3C2 OUTCOMES Differential diagnoses with rule-in/rule-out criteria Working diagnosis using Zang-Fu pathology(ies) Severity of condition: mild, moderate, severe Treatment principle(s) Acupuncture points to use for treatment principle(s)