TCM exam.pdf

NMT 150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 12 POINT ACTIONS 2 Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand TCM action terms of: Releases the Exterior Expels (exterior) wind Calms the mind Resolves phle...

NMT 150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 12 POINT ACTIONS 2 Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand TCM action terms of: Releases the Exterior Expels (exterior) wind Calms the mind Resolves phlegm Removes obstructions Dissipates masses POINT ACTIONS Releases the exterior: Forces out from the layer between skin and muscle Works as a diaphoretic (Causes sweating/perspiration) Good for external pathogens: wind, heat, cold, dampness, dryness Most effective when used with first symptoms  PATHOGENS SKIN WEI QI MUSCLE FUNCTIONAL DEFENCE SYSTEM RELEASING THESYSTEM COMPROMISED EXTERIOR POINT ACTIONS Expels (exterior) wind: Similar action to releases the exterior but specifically for wind Believed to open gates to allow wind to escape Can use the “wind gate” to expel wind Mainly for exterior wind that is caught in the Wei Qi layer POINT ACTIONS Calms the mind: Works in many ways depending on the condition Can slow an overactive mind or can quicken a slower mind Can help with sleep difficulties due to an overactive mind Works for emotional concerns like depression, anxiety, and stress Treats the branch over the root cause Best if used with point actions that manage the root cause POINT ACTIONS Resolves phlegm (damp): Converts phlegm into a less viscous or more mobile substance Does not affect the cause of phlegm/damp accumulation Best if used with other actions to treat the root POINT ACTIONS Removes obstructions: Obstructions usually manifest as pain or lack of flow Treats obstructions of any type Self-regulating with respect to what and how it removes the obstructions Can be used for stagnation (Qi or Blood), phlegm/damp, cold Treats the branch over the root Best if used with point actions that manage the root cause POINT ACTIONS Dissipates masses: Masses are generally caused by either Qi stagnation, Blood stagnation, or phlegm-damp accumulation Reduces the size and impact of the mass of meridian flow Treats the branch over the root Best if used with point actions that manage the root cause REFERENCES Kassam, Neemez et al. Fundamentals of Clinical Acupuncture. Toronto, Canada: CCNM Press, 2009. 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. NMT150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) LECTURE 11 P U L S E C H A R T I N G A N D TO N G U E D I A G N O S I S POINT SELECTION CASES Author: Neemez Kassam, M.Sc., N.D., R.Ac. PULSE PALPATION 1. Locate the styloid process of the radius using the opposite hand from the one you are palpating. 2. This marks the spot for your middle finger. 3. Your index and ring finger should fall on the first and third positions, respectively. 4. Be sure to leave enough room between fingers based on the size of the patient. More room for taller and less room for shorter patients. PULSE PALPATION 5. Once you have located the 3 positions, arch your fingers as though you are playing a guitar or violin. The tips of your fingers are more sensitive than the pads. You can feel subtle changes in the pulse with this technique. 6. The 1st position is known as the cun, the 2nd as the guan and the 3rd as the chi 7. After arching your fingers onto the radial artery of both hands, compare the two sides. With all three fingers staying on the same level, begin palpating the superficial level than middle followed by deep. PALPATION You are looking for pulses that stand out for being different from the others at that level. Now you can palpate the cun pulse at all 3 levels. Remember that if one of these pulses stood out from earlier, you may want to palpate another pulse at the same time to use as a reference. Follow the same procedure for the guan and chi pulses. PALPATION Normal Variations of Pulses Seasonal Changes Athletes tend to slower Spring – Wood Element – Wiry Women tend to softer & faster Summer – Fire Element – Children tend to faster Flooding Heavier set individual will be Late summer – Earth Element deep & slow – Slippery Autumn – Metal Element – Thin set individual will be Floating superficial Winter – Water Element – Fasting individuals will have a Sinking deficient/weak pulse INITIAL VARIABLES Speed Fast: >90 bpm = Heat Slow: 90 bpm or > 5 beats per breath. < 60 bpm or < 4 beats per Rapid & Forceful = Heat breath. Excess Slow & Forceful = Cold excess Rapid & Weak = Heat Deficiency Slow & Weak = Cold deficiency Swift Extreme heat and yin exhaustion. Nearing Qi collapse. 140 -180 bpm or 7-8 beats per breath. TYPES OF PULSES Empty Deficiency syndrome. Can be Qi, Blood, Yang or Yin. Check with the symptoms Weak at all three levels. Strong Excess syndrome. Can be cold, heat, phlegm Qi, blood or food stagnation. Forceful at all three levels. TYPES OF PULSES Minute Deficiency syndrome. Barely palpable at any level. Frail Qi and Blood Deficiency. Only palpable at the deep level. TYPES OF PULSES Hidden Thready feeble and hardly palpable Pathogens in the interior Jue Syndrome (syncope, cold limbs) Severe pain Felt only a the very deep level TYPES OF PULSES Hollow / Onion stalk Loss of blood or impairment of yin. The yin is not able to root the yang and you have a break or absent middle level pulse. With loss of blood, there is not enough substance to travel in the artery. Felt at the superficial and deep levels only. TYPES OF PULSES Moving / Spinning bean Has a round shape like a bean, feeling short, slippery, rapid and forceful Pain Fright TYPES OF PULSES Slippery / Rolling Phlegm and fluid retention, excess heat, food stagnation, pregnancy. Analogy: Trying to trap a beach ball in a pool of water by placing pressure on one side. The ball squirts out from under your hands and flies forward. TYPES OF PULSES Soggy / Soft Deficiency syndrome or Damp accumulation. Felt at the superficial level. Flooding / Tidal Excess heat. Waves come on strong and powerful then fade away like a tidal wave. TYPES OF PULSES Thready / Thin Deficiency syndrome or damp. Can be of Qi, blood or yin. Feels like a fine thread under your fingers. Wiry Liver and GB disease, pain, malaria or phlegm and damp retention. Feels like the string of an instrument. Wiry vs. Thready: A wiry pulse will have a distinct edge when you roll over it. A thready pulse does not have this edge. TYPES OF PULSES Choppy / Rough / Hesitant Rough, uneven and “unsmooth” Qi and blood stagnation Food stagnation Forceful and choppy Phlegm retention Essence impairment Blood Deficiency Weak and choppy TYPES OF PULSES Tympanic / Leather Large, hollow and taut like “ the surface of a drum” Loss of Blood Impairment of essence Felt at the superficial level TYPES OF PULSES Confined / Fixed / Prison Long, taut and forceful Cold accumulation Qi or Blood Stagnation Felt at the deep level TYPES OF PULSES Scattered Scattered and uneven Qi exhaustion Felt at the superficial level Tight / Tense Tight and forceful like a stretched rope Cold Syndrome Pain Food Stagnation TYPES OF PULSES Long Long and straight Normal pulse – long and gentle Liver Yang hyperactive Excess Heat syndrome – morbid long pulse (long & wiry) Short Feels short as though it does not span the width of your fingertip Qi stagnation Qi Deficiency Only felt distinctly at Guan location TYPES OF PULSES Hurried / Abrupt Knotted Rapid with irregularly Slow with irregularly missed beats missed beats Excess Heat Excessive Yin (Cold excess) Qi and Blood stagnation Qi stagnation Phlegm retention Cold phlegm retention Food stagnation Blood stagnation Prostration – Abrupt and weak TYPES OF PULSES Intermittent / Regularly intermittent pulse Missed beats at regular intervals Zang Qi deficiency Wind syndrome Pain Emotional fear and fright Injury or trauma GROUP WORK: POINT SELECTION 1. Lung Qi Deficiency 2. Lung Heat 3. Phlegm-Heat in the Lung 4. Heart Blood Deficiency 5. Heart Yin Deficiency POINT SELECTION GUIDELINE Choose 6 points from Lung, LI, Ht, SI, Pc, and TW to treat each of the pathologies 1-5 from previous slide Be able to explain your rationale for use 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 150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 11 A C U P U N C T U R E T R E AT M E N T P L A N S POINT ACTIONS 1 Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Learn how to put together an acupuncture treatment plan Understand points actions and their use in treatment plans Understand TCM action terms of: Tonifies/Nourishes Harmonizes/Regulates Descends/Subdues Clears Opens/Benefits Learn about the various Point Classifications DIAGNOSIS Written as a Zang-Fu Diagnosis E.g. Lung Qi Deficiency or Heart Fire Multiple organ diagnoses are also possible Liver Qi Stagnation with Spleen Qi Deficiency Heart and Kidney Yin Deficiency Objective is to treat the underlying dysfunction(s) TREATMENT PRINCIPLE Based on the Zang-Fu diagnosis Dx: Lung Qi Deficiency Tx Principle: Tonify Lung and Tonify Qi (or tonify Lung Qi) Based on signs or symptoms Sx: Productive cough, chest pain, nasal congestion Tx principle: Relieves coughing, resolves phlegm, opens the chest, opens the nose TREATMENT PRINCIPLE Based on dysfunctions Cough (descending function of Lung) Tx: Descends Lung Qi (or descends Qi for Lung meridian points) Cough (rebellious Qi in Lung) Tx: Subdues rebellious Lung Qi (or subdues rebellious Qi for Lung meridian points) SOB (dispersing function of Lung) Tx: Disperses Lung Qi Chest pain (stagnant Lung Qi) Tx: Moves stagnant Lung Qi TREATMENT PRINCIPLE Based on Indications Look for sx/signs under the “Indications” section for each point E.g. Cough treats cough, asthma treats asthma, chest pain treats chest pain, etc. Treats the branch (symptoms) over the root (diagnosis) Good for symptomatic relief over long-term benefit POINT ACTIONS Tonifies: Increase or build Used for conditions that are far away from optimal levels Nourishes: Strengthen or build Used for conditions that are far away from optimal levels Harmonizes: Bring into balance or return to “normal” levels Used for conditions that are close to optimal levels Regulates: Bring movements into balance (ie. Qi circulation) Used for conditions that are close to optimal levels POINT ACTIONS Descends: Forces down Sometimes uses the natural activity of the organ Lung and Stomach naturally descend Subdues: Prevents ascending by holding down Used for rebellious Qi and Yang, which tend to ascend Clears: Removes from the body through appropriate areas Mainly for heat Uses emunctories of perspiration, defecation, urination, respiration Choice of emunctory is based on function of the organ/channel DESCENDS SUBDUES POINT ACTIONS Opens: Increases movement in an area Causes of obstruction can be anything Stagnation, dampness/phlegm, cold, etc. Benefits: Directs Qi and Blood to a certain area Does not specify action once it arrives to the area E.g. Lung 10 A: Benefits the throat I: Sore throat, loss of voice POINT CLASSIFICATIONS 5 Transporting Points Well-Spring-Stream-River-Sea Source Points 12 regular meridians Influential Points Qi, Blood, Zang, Fu, Bone, Marrow, Sinews, Vessels Command Points Face/mouth, Posterior neck, Abdomen, Back POINT CLASSIFICATIONS Back Shu 12 Primary meridians Mainly for physical concerns and less emotional/spiritual Outer Back Shu Next to Back Shu points but more for emotional/spiritual and less for physical concerns Front Mu 12 Primary meridians Work for both physical and emotional concerns REFERENCES Kassam, Neemez et al. Fundamentals of Clinical Acupuncture. Toronto, Canada: CCNM Press, 2009. 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. NMT150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) WEEK 9 T C M H E A R T, S M A L L I N T E S T I N E , P E R I C A R D I U M , T R I P L E WA R M E R D IF F E R E N T IA L S Author: Dr. Neemez Kassam, M.Sc, ND, R.Ac FIRE ELEMENT Heart & Small Intestine, Emotional sound is Laughter Pericardium & Triple Warmer and Talkative Sweat is the secretion Illness sound is Belching Sense is Taste and Speech Joy is the emotion Season is Summer Scorched (burnt) is the odor Climate is Hot Bitter and sharp are the flavors Heart: 11am – 1pm, SI: 1 – 3pm HEART FUNCTIONS Governs Blood Pumping of blood through the body Controls the blood vessels Depends on Heart Qi and blood Manifests in the Complexion Control of blood and vessels Thin skin in face allows for true color to show through HEART FUNCTIONS House the Shen (Mind) Incorporates all 5 of the mental-spiritual aspects Hun, Po, Zhi, Yi, Shen Opens into the tongue Speech difficulties and taste problems Controls Sweat Questionable function of the Heart since the Lungs control this area  en Sple HEART QI DEFICIENCY Causes Dizziness Poor constitution Prolonged illnesses or severe diseases Pale face Congenital deficiency or senility Watery or thin/clear sputum Palpitations Catches colds easily SOB, worse on exertion Tongue Low and/or hoarse voice Pale tongue with a thin, white coating Fatigue Pulses Spontaneous sweating Weak or empty pulses HEART YANG DEFICIENCY Causes Tongue Same as for Qi deficiency Pale, swollen with a white, smooth or wet coating Heart Qi Deficiency plus Pulses Chills Weak and deep, often slow Cold limbs Heart Yang Collapse occurs in Chest pain severe cases of Yang Deficiency and the key sxs are cyanosis of Bright-pale face the lips and a hidden pulse HEART BLOOD DEFICIENCY Causes Anxiety Prolonged illness Hemorrhage Easily startled Poor production of blood Emotional issues disturbing the mind Dull-pale complexion Palpitations Pale lips Insomnia Tongue Excessive dreams Pale and thin with a thin, white coat Poor memory Pulses Dizziness Weak and thready HEART YIN DEFICIENCY Causes Tongue Same as Heart Blood Deficiency Red body with little or no coat Heart Blood Deficiency plus Red tip with red papules Malar flush Deep midline crack extending to Low-grade or afternoon fever tip maybe bifurcating the tip Dry mouth and throat Pulse 5 centre heat sensation Rapid and thready Night sweats Insomnia HEART FIRE Causes Insomnia Mental Depression Red face External pathogens turning to heat inside the body Dark urine or blood in urine Interior heat excess Bitter taste in the mouth only in Palpitations the morning Thirst Tongue Mouth and tongue ulcers Red with a redder tip Mental restlessness Pulses Full and rapid pulse Agitated PHLEGM-FIRE HARASSING THE HEART Causes Mental confusion or depression Mental depression Phlegm accumulation in the body Irrational behavior Mental restlessness Tendency to hit or scold people Palpitations Uncontrolled laughter, crying, Bitter taste in the morning shouting Dream-disturbed sleep Tongue Easily startled Red with a yellow sticky coat Incoherent speech or Aphasia Pulses Muttering to oneself Wiry and slippery PHLEGM MISTING THE MIND Causes Staring at walls Congenital in children Phlegm accumulation in the body Muttering to oneself Mental confusion Introverted manner Unconsciousness Depression Lethargic stupor Tongue Vomiting Thick, sticky coat maybe with a swollen body Rattling sound in throat Pulses Aphasia Slippery often slow HEART QI STAGNATION Causes Poor appetite Emotions Weak and cold limbs Worry, stress, anxiety Suppressed or excessive Pale complexion Palpitations Slightly purple lips Distention or heaviness in chest Tongue Slightly purple on the sides in the Lump in throat anterior 1/3 Slight SOB Pulses Sighing Empty but overflowing in left cun HEART VESSEL OBSTRUCTED Causes Heaviness in chest Emotions Sharp stabbing pain in chest that may radiate to shoulder Excessive dairy & greasy foods Excess physical work Worse cold, better heat Feeling of heaviness Palpitations Dislike of speaking SOB with inability to lay down Tongue Depression Purple sides, swollen with sticky coat Pulses Mental restlessness Wiry, choppy, knotted HEART BLOOD STAGNATION Causes Feeling of constriction in the Insufficiency of Heart blood and yang chest Mental irritation Cyanosis of the lips and nails Exposure to cold Tongue Palpitations Dark purple or dark purple spots Stabbing pain in the heart region on the tongue May radiate to the left arm or Pulses shoulder Thready and hesitant or with missed-beats  LUNG HEART Cough Asthma Breathing Palpitations Insomnia Memory Weak, during Qi Def Weak Weak Weak None Weak activity Weak, during Blood Def - - - Mild Weak rest Moderate, Yin Def Dry Dry Weak Moderate Weak during rest Rapid, all the Over Heat/Fire Yellow Yellow Rapid Severe time active SMALL INTESTINE FUNCTIONS Separates “pure” from “turbid” Communicates with the stomach, spleen, bladder and large intestine FULL-HEAT IN THE SI Causes Scanty and dark urine Excessive anxiety Painful urination Mental restlessness Tongue ulcers Blood in the urine Pain in the throat Tongue Deafness Red with a redder tip and a yellow coat Uncomfortable feeling in the chest Pulses Abdominal pain Rapid and full Thirst SI QI PAIN Causes Borborygmi Excessive consumption of cold and Flatulence raw foods Abdominal pain relieved by Factors which cause Liver Qi passing wind stagnation Pain in the testis Lower abdominal twisting pain Tongue which may extend to the back White coating Abdominal distention Pulses Dislikes pressure on abdomen Deep and wiry SI DEFICIENT & COLD Causes Tongue Excessive consumption of cold and raw foods Pale body with white coating Abdominal pain Pulses Desire for hot drinks Deep, slow and weak Likes pressure on abdomen Borborygmi Diarrhea Pale and copious urine REFERENCES Liangyue, Deng et al. Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1996. Maciocia, Giovanni. The Foundations of Chinese Medicine. 2ed. Philadelphia, 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. NMT 150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 9 T C M P E R I C A R D I U M A N D T R I P L E WA R M E R FUNCTIONS AND THEORY Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand the functions of the TCM Pericardium and Triple Warmer PERICARDIUM FUNCTIONS Organ Protects the Heart Governs Blood Houses the Shen Channel Influences the centre of the thorax PROTECTS THE HEART Acts as a covering to protect the Heart from external pathogens Xin Zhu: “Master of the Heart” Xin Bao: “Envelope of the Heart” Xin Bao Luo: “Connecting Channel of the Envelope of the Heart” 6th Yin organ but some believe it is an extension of the Heart and not a standalone organ GOVERNS BLOOD Very similar to the Heart Can help move Blood and clear heat from Blood Heart is better with Blood deficiency HOUSES THE SHEN Mainly a Heart function but assisted by Pericardium Pericardium points can stimulate the mind and manage emotions May present as depression with slight anxiety CENTRE OF THE THORAX The channel runs internally to the centre of the chest (Shan Zhong), and is known as “the palace of the Pericardium” (Xin Zhu) Influences Gathering Qi (Zong Qi), along with the Heart and Lungs CONNECTION TO UTERUS Connected to Liver since both are Terminal Yin (Jue Yin) channels Uterus is connected to Heart/Pericardium via Uterus Vessel (Bao Mai) Issues relating to menstrual function and emotions can be treated using Pericardium channel points TRIPLE WARMER FUNCTIONS Mobilizes Original Qi Controls Transportation and Penetration of Qi Controls Water Passages and excretion of fluids MOBILIZES ORIGINAL QI Original Qi (Yuan Qi) is the yang component of Essence Differentiates Original Qi into different forms to carry out specific tasks within the body: Provides heat to the Spleen for Transformation and Transportation Facilitates production of True Qi (Zhen Qi) from Gathering Qi (Zong Qi) in the chest Aids in the production of Blood in the Heart from Food Qi (Gu Qi) CONTROLS TRANSPORTATION AND PENETRATION OF QI Controls the “Qi Mechanism” which is the movement of Qi to carry out its various functions Movement up/down, entering/exiting Triple Warmer is considered to have free passage (tong) Applies to the Three Qi: Upper: Gathering Qi (Zong Qi) Middle: Nutritive Qi (Ying Qi) Lower: Defensive Qi (Wei Qi) CONTROLS WATER PASSAGES AND EXCRETION OF FLUIDS Official in charge of irrigation Transports fluids for use in each burner system: Upper: Sweat; released from between skin and muscles Middle: Stomach fluids; used to moisten the body and move Blood Lower: Urine; for excretion with some fluid for stools 6 TH YANG ORGAN? Considered to be the 6th Yang organ because it has “function” but no “form” Connected to the Gall Bladder since both are Greater Yang (Shao Yang) channels Connected to the chest which makes it a Fire element organ Without the Triple Warmer, other organs would be unable to function REFERENCES Liangyue, Deng et al. Chinese Acupuncture and Moxibustion. Beijing, China: Foreign Languages Press, 1996. Maciocia, Giovanni. The Foundations of Chinese Medicine. 3ed. Philadephia, 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 150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 10 TCM LIVER AND GALL BLADDER FUNCTIONS AND THEORY Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand the functions of the TCM Liver Understand the functions of the TCM 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 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 150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 13 CONNECTING (LUO) POINTS BACK (SHU) POINTS FRONT (MU) POINTS Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Understand the function and uses for: Connecting (Luo) Points Back Shu Points Front Mu Points CONNECTING (LUO) POINTS 15 connecting points throughout the body 12 regular meridians 1 Governing vessel 1 Conception vessel 1 Great Spleen CONNECTING CHANNELS Refers to the areas governed by the Connecting point Each point has 2 areas to govern: 1. Along a path to a defined area for each meridian See table 1 for areas governed 2. Between the main meridian and the skin Works like a mesh or network stretching horizontally between the skin and muscles The main meridians run deeper in the body Connecting channels are unable to pass through large joints  Organ Connecting Channel Lung Lu 7 to the thenar eminence Large Intestine LI 6 to the teeth and ears TA B L E 1 Stomach St 40 to the neck Spleen Sp 4 to the stomach and intestines Heart Ht 5 to the tongue and eye Small Intestine SI 7 to the shoulder Urinary Bladder UB 58 to the Kidney channel on the leg Kidney Kd 4 to the pericardium Pericardium Pc 7 to the heart Triple Warmer TW 5 to the chest Gall Bladder GB 37 to the dorsum of foot Liver Lr 5 to the external genitalia Governing Vessel GV 1 to the spine and occiput Conception Vessel CV 15 to the abdomen Great Connecting Sp 21 to the chest and ribs Maciocia p.848-849 CONNECTING (LUO) POINTS 3 main uses: In conjunction with Source Point of the paired organ On their own based on Full-Empty symptoms To affect the area(s) governed by the respective Connecting channel WITH SOURCE POINT Paired with Yin-Yang organ in the same element Ie. Lung-LI, ST-Spleen, Heart-SI, etc. Movement is generally from Connecting → Source Using the Connecting point with the Source point increases effect of the Source point Ie. Lung 9 (Source) with LI 6 (Connecting) for treating Lung Qi deficiency ON THEIR OWN Based on Full or Empty symptoms of Connecting Channels See Table 51.1 (p852) in Maciocia More frequently used from the table are listed in Table 2  Point Symptomatology St 40 Insanity (Full) TA B L E 2 Sp 4 Abdominal pain (Full), abdominal distenstion (Empty) Ht 5 Aphasia (Empty) Kd 4 Backache (Empty) Pc 6 Chest pain (Full) Lr 5 Genitalia concerns (Full), itching genitals (Empty) Maciocia p851 BASED ON CONNECTING CHANNELS As per Table 1, the Connecting point can be used to affect the area of the Connecting Channels for that meridian Ie. Lung 7 for thenar eminence or Ht 5 for the tongue and eye Can be used in conjunction with other points of the same action, or affecting the same area BACK SHU POINTS Have a direct connection to their respective organ Transport Qi directly to the organ Western correlation is the sympathetic chain ganglia and their associated organ systems Energetically, they resemble areas governed by major energy centres or Chakras BACK SHU POINTS Used mainly for chronic conditions Treat diseases of the Yin organs better than the Yang organs Located on the back (Yang area), they are effective in treating conditions of feeling cold or Yang deficiency Can also treat excess conditions, Yin concerns, and Yang organs. BACK SHU Organ Shu Point Organ Shu Point POINTS Lu UB 13 LI UB 25 Pc UB 14 TW UB 22 Ht UB 15 SI UB 27 Lr UB 18 GB UB 19 Sp UB 20 St UB 21 Kd UB 23 UB UB 28 OUTER BACK SHU POINTS The outer line (3 cun lateral to the midline) More for psychological and emotional concerns Mainly for the Yin organs Organ Outer Shu Emotion Lung UB 42 Corporeal Soul Heart UB 44 Shen or Mind Liver UB 47 Ethereal Soul Spleen UB 49 Intellect Kidney UB 52 Will Power FRONT MU POINTS Mu is equivalent to “Alarm” or “Collecting” Located on the anterior torso of the body Usually located directly over the organ itself Located on the front of the body (Yin area), they have a cooling effect. FRONT MU POINTS Used to treat conditions of mainly Yang organs. Used in both acute and chronic conditions but mainly for acute excess conditions. Some say the points are beneficial when treating intrinsic disorders of the organ I.e. Liver Mu for hepatitis or cirrhosis, Lung Mu for emphysema or pneumonia. FRONT MU Organ Mu Point Organ Mu Point POINTS Lu Lu 1 LI St 25 Pc CV 17 TW CV 5 Ht CV 14 SI CV 4 Lr Lr 14 GB GB 24 Sp Lr 13 St CV 12 Kd GB 25 UB CV 3 BACK SHU AND FRONT MU POINTS Can be used together to enhance a treatment if the patient is in a position that allows access to both points. E.g. Lung 1 and UB 13, CV 14 and UB 15 If treatments are not frequent (every 2 weeks), then both groups of points are encouraged in one treatment. Best to use either Back Shu or Front Mu, if treatments are occurring more frequently Can be used for treatment and diagnosis Tenderness in the area of the point can carry with it a lot of information E.g. Sharp or excess type pain in a point indicates sedation is required. E.g. Dull or empty type pain indicated tonification is required. REFERENCES Kassam, Neemez et al. Fundamentals of Clinical Acupuncture. Toronto, Canada: CCNM Press, 2009. 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. NMT 150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) E-LEARNING LECTURE 14 POINT SELECTION Author: Neemez Kassam, M.Sc., N.D., R.Ac. LEARNING OBJECTIVES Learn how to select points for treatment based on treatment principles and patient presentation Understand how to put together an acupuncture treatment plan TREATMENT PRINCIPLES Use point actions that match the treatment principle Lung Yin deficiency Tonify Lung Nourish Yin Nourishes Lung Yin Heart Fire Sedate Heart Clear heat Clears Heart Fire PATIENT PRESENTATION Use point actions that match the patient presentation Coughing Descends Lung Qi Relieves coughing Insomnia Calms the mind Roots the ethereal soul (Hun) Promotes the smooth flow of Liver Qi POINT SELECTION Use major classes of points where possible: Deficiency Source Back Shu Connecting (Luo) Excess Front Mu Well points Connecting (Luo) POINT SELECTION Move Qi Xi-Cleft Clears Heat Spring points Sea points (Arm) Specific Tissue or fluid Influential Specific body area Command POINT SELECTION Use point actions that match as many treatment principles and symptoms as possible Start with classes, then treatment principle(s), then symptom-based actions POINT SELECTION Lung Yin Deficiency Lung 9: Source, relieves coughing, tonifies Lung Yin Urinary Bladder 13: Back Shu, Disperses and descends Lung Qi, nourishes Lung Yin, relieves coughing. Urinary Bladder 43: Outer Back Shu, nourishes Lung Yin, relieves coughing. Lung 5: Sea point, descends Lung Qi, tonifies Lung Yin POINT SELECTION Heart Fire Conception Vessel 14: Front Mu, calms the mind Heart 8: Spring point, clears Heart Fire, calms the mind Heart 3: Sea point, clears heat, calms the mind Heart 5: Connecting (Luo) point, calms the mind Pericardium 8: Clears Heart Fire, calms the mind BALANCED TREATMENT Consider using points from all over the body to create a balanced approach Focusing on one area is acceptable but too many points in one area may lead to stagnation E.g. selecting a few points in the chest for chest pain with others chosen on the arms, legs, and back REFERENCES Kassam, Neemez et al. Fundamentals of Clinical Acupuncture. Toronto, Canada: CCNM Press, 2009. 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. NMT150: NATUROPATHIC THERAPEUTICS I TRADITIONAL CHINESE MEDICINE (TCM) LECTURE 10 T C M P E R I C A R D I U M A N D T R I P L E WA R M E R D I F F E R E N T I A L S P U L S E C H A R T I N G A N D TO N G U E D I A G N O S I S Author: Neemez Kassam, M.Sc., N.D., R.Ac. FIRE ELEMENT Heart & Small Intestine, Emotional sound is Laughter Pericardium & Triple Warmer and Talkative Sweat is the secretion Illness sound is Belching Sense is Taste and Speech Joy is the emotion Season is Summer Scorched (burnt) is the odor Climate is Hot Bitter and sharp are the flavors Heart: 11am – 1pm, SI: 1 – 3pm PERICARDIUM FUNCTIONS Protects the Heart Especially from external pathogens Governs Blood and houses the Shen Like the Heart Stimulate or Calm the Mind PERICARDIUM HEAT Causes Tongue Wind-heat invasion Red and dry without coating Goes into Nutritive Qi level Pulses Fever at night Thready and rapid Mental confusion Incoherent speech or aphasia Delerium Hot body with cold hands and feet Macules PERICARDIUM BLOOD DEFICIENCY Causes Poor memory Emotional strain Easily startled Sadness and grief Dull-pain complexion Feeling of stuffiness and discomfort in chest Pale lips Cold hands Dull-ache in chest Scanty periods Mild SOB Amenorrhea Palpitations Anxiety Tongue Pale, thin, slightly dry Insomnia Pulses Dizziness Choppy or thready Left cun position Dream-disturbed sleep PERICARDIUM FIRE Causes Feeling of heat Emotional strain Insomnia Excess intake of hot foods Dream-disturbed sleep Palpitations Red face Tightness and heat in the chest Bitter taste Mild chest ache Heavy periods Rapid breathing Thirst Tongue Red with redder and swollen tip Mouth and tongue ulcers May have red dots and yellow coat Mental restlessness Pulses Full, rapid Agitated May overflow PHLEGM-FIRE HARASSING PERICARDIUM Causes Insomnia Emotional strain Dream-disturbed sleep Excess intake of hot foods Agitation Palpitations Incoherent speech Feeling of oppression and heat in the chest Mental confusion Chest Pain Irrational behaviour Tachypnea Uncontrolled laughter or crying Thirst Red face Tongue Bitter taste Red, swollen with yellow, dry sticky coat Phlegm production in throat Deep crack in Heart Rattling sound in throat Pulses Mental restlessness Full, rapid, slippery or Rapid, full, wiry PERICARDIUM QI STAGNATION Causes Irritability Emotional strain Poor appetite Weak and cold limbs Feeling of distention and pain in the chest Slightly purple lips Tightness of chest Pale complexion Mild SOB Sighing Tongue Mildly pale-purple on sides at front Feeling of lump in throat Pulses Palpitations Empty Depression May overflow in left cun position BLOOD STASIS IN PERICARDIUM Causes Cyanosis of the lips and nails Emotional strain Cold hands Painful periods with dark clots Palpitations Stabbing or pricking pain in the chest Tongue May radiate to inner aspect of left Purple everywhere arm or shoulder Or only on sides at front Feeling of oppression or constriction Pulses of the chest Choppy, wiry or knotted SOB TRIPLE WARMER FUNCTIONS Mobilizes Original Qi Controls Transportation and Penetration of Qi Moves Qi in its desired direction Controls Water Passages and excretion of fluids Transforms, transports, and excretes fluids PULSE CHARTING Intensity Can use scales with ranges from 0-10 Best practice is 0-3 (or 0-5 scales) As you gain more experience, larger scales are more common 0 = no pulse felt 1 = weak 2 = moderate 3 = strong PULSE CHARTING You should note any characteristics palpated for each location Wiry in Liver or Thready in Heart Can me more precise: Thready in mid level of Heart PULSE CHARTING Sup Mid Deep Deep Mid Sup Thready Heart 2 1 1 2 2 2 Lung Wiry Slippery Liver 2 2 1 1 1 1 Spleen Kidney 1 1 1 1 1 1 Kidney Yin Yang Rate: 72 bpm TONGUE CHARTING Always chart what you see Use natural light whenever possible Change angles to get different views Clothing around the neck and upper chest can affect tongue colour If taking pictures, have patient sign a release TONGUE CHARTING No universally accepted charted method Should be clear if another practitioner reads your chart Include as much detail as possible NORMAL 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.