Tcm Patho Midterm Fall '11

Front 1

Jian Tong
(Shoulder Pain)
Key Symptoms

Back 1

-Stiffness
-Loss of motion (ROM testing)
-Pain with movement (throwing)
-Deformity, asymmetry, atrophy
-Swelling

Front 2

Jian Tong
(Shoulder Pain)
Etiology

Back 2

1. Trauma
2. Overuse
3. Lack of Nourishment
4. Invasion of exogenous pathogens
5. Stress

Front 3

Jian Tong
(Shoulder Pain)
Pathology

Back 3

1. Repletion-damage to sinews resulting in Qi Stagnation & blood stasis, susceptible to W-C-D invasion
2. Vacuity: chronic injury, aging, long-term stasis from chronic injury & decline of Qi & Xue/LR & KI Qi due to aging results in lack of nourishment to sinews

Front 4

Jian Tong
Treatment Principles

Back 4

Immediate Pain Relief!
-ID distal, local, and adjacent points
-Treat pattern
*Acute cases: start with distal points to clear channel first
* chronic cases: combine distal, local and adjacent points

Front 5

Jian Tong
Acupuncture Treatment
Distal Points Used
Large Intestine

Back 5

-LI channel: LI 11 (benefits sinews/joints), LI 4 (pain point, unblock channel)

Front 6

Jian Tong
Acupuncture Treatment
Distal Points
Triple Burner

Back 6

-TB Channel: TB 9 (Stops pain, unblocks channel), TB 10 (relaxes tendon), TB 4 Relaxes sinews), TB 5 (painful obstruction)

Front 7

Jian Tong
Acupuncture Treatment
Distal Points
Small Intestine

Back 7

-SI Channel: SI 8 (Painful obstruction), SI 3 (Shu Stream point for joint disorder)

Front 8

Jian Tong
Acupuncture Treatment
Distal Point
Lung

Back 8

-Lu Channel: Lu 5 (relaxes tendons), Lu 9 (Shu stream pt for joint disorder)

Front 9

Jian Tong
Acupuncture Treatment
Local Points
Large Intestine (anterior)

Back 9

-LI 15 (glenohumeral joint and supraspinatus tendon), LI 16 (AC joint and supra tendon)

Front 10

Jian Tong
Acupuncture Treatment
Local Points
Triple Burner (lateral)

Back 10

-TB 14 (Supra and infra tendons)

Front 11

Jian Tong
Acupuncture Treatment
Local Points
Small Intestine (posterior)

Back 11

-SI 9 (deltoid and teres major), SI 10 (deltoid and infra)

Front 12

Jian Tong
Acupuncture Treatment
Local Points
Lung, Heart, and extra
(Anterior shoulder, chest, and coracoid process)

Back 12

-Lu 1, 2 (pec major/minor)
-Ht 1 (subscapularis)
-Jian Nei Ling (Anterior deltoid, short head of biceps)

Front 13

Jian Tong
Acupuncture
Adjacent Points

Back 13

-LI 14 (Insertion of deltoid)
-TB 15 (Triceps)
-TB 15 (Trapezius)
-SI 11 (Infraspinatus)
-SI 12 (supraspinatus)
-SI 13-14 (Levator scapula)
-SI 15 (splenius cervicis)

Front 14

Jian Tong
Acupuncture
Commonly Used Points

Back 14

BL 62 with SI 3
LI 15, TB 14, & SI 10 (9) together if entire shoulder is in pain

Front 15

Jian Tong

Empirical Points

Back 15

-ST 38 (for anterior pain- stimulated while pt mobilizes shoulder)
-GB 34 (Lateral shoulder)
-BL 58 (posterior shoulder)

Front 16

Jian Tong

Other points to use

Back 16

Jia ji, GB, TB, & BL channels to treat trapezius, levator scapula & rhomboids

Front 17

Single Herbs for Jian Tong
Shoulder Pain

Back 17

Gui Zhi Wei Ling Xian
Qiang Huo Jiang Huang
Bai Zhi Chuan Xiong
Gao Ben
Ge Gen
Sang Zhi

Front 18

Shoulder Pain Manifesting as Qi Stagnation/Blood Stasis Symptoms

Back 18

Severe pain that is fixed in location and sharp or stabbing in quality, pain may be exacerbated by movement and is worse at night
Tongue: normal color & coat, if chronic may be dark purple
Pulse: wiry, choppy

Front 19

Shoulder Pain Manifesting as Qi stagnation/Blood Stasis
Treatment Principles

Back 19

Move Qì, Quicken Xuè, Eliminate Stasis, Relieve Pain

Front 20

Shoulder Pain Manifesting as Qi Stagnation/Blood Stasis
Points Used

Back 20

• SP-10: removes stasis
• BL-17: tonifies Qi and Blood
• LR-3: moves Qi and Blood
• LI-4: unblocks channel

Front 21

Shoulder Pain Manifesting as Wind-Cold-Damp WIND Predominant
Symptoms

Back 21

Main Symptoms: sore, aching pain that is intermittent or moves around
Tongue: possibly moist, white coating
Pulse: floating, tight, slippery, or slow are possible, most common is wiry & tight

Front 22

Shoulder Pain Manifesting as Wind-Cold-Damp WIND Predominant
Treatment Principles

Back 22

Expel Wind, Scatter Cold, Eliminate Dampness, Open the Channels & Collaterals, Relieve Pain

Front 23

Shoulder pain Manifesting as wind-cold-damp WIND
predominant
Points Used

Back 23

• SP-10: removes stasis
• BL-12: For beginning stage of exterior invasion of wind-cold or wind-heat
• BL-17: tonifies Qi and Blood
• TB-5: Releases exterior, expels wind-heat
• LI-4: Releases exterior, stimulates dispersing and descending, consolidates exterior

Front 24

Shoulder Pain Manifesting as wind-cold-damp
COLD predominant
Symptoms

Back 24

Main Symptoms: severe, fixed pain that is aggravated by cold & relieved by warmth
Tongue: pale w/ white coat
Pulse: floating, tight, slippery, or slow are possible, most common is wiry & tight

Front 25

Shoulder Pain Manifesting as wind-cold-damp
COLD predominant
Treatment Principles

Back 25

Scatter Cold, Expel Wind, Eliminate Dampness, Warm & Open the Channels & Collaterals, Relieve Pain

Front 26

Shoulder Pain Manifesting as wind-cold-damp
COLD predominant
Points Used

Back 26

• CV-4: Strengthens Yang
• BL-23: Tonifies Kidney
• GV 4: Tonifies Kidney Yang

Front 27

Shoulder Pain Manifesting as wind-cold-damp DAMP predominant
Symptoms

Back 27

Main Symptoms: heavy, sore, fixed, aching pain that is aggravated by dampness, swelling & numbness in the affected area may be present
Tongue: greasy, white coat
Pulse: floating, tight, slippery, or slow are possible, most common is wiry & tight

Front 28

Shoulder Pain Manifesting as wind-cold-damp DAMP predominant
Treatment Principles

Back 28

Eliminate Dampness, Expel Wind, Scatter Cold, Open the Channels & Collaterals, Relieve Pain

Front 29

Shoulder Pain Manifesting as wind-cold-damp DAMP predominant
Points Used

Back 29

• SP-9: Resolves dampness in lower burner
• ST-36: Tonifies Qi and Blood for St and Sp xu
• BL-20: Tonifies Spleen Qi and Yang, resolves dampness

Front 30

Shoulder Pain Manifesting as Qi and Blood Xu
Symptoms

Back 30

Main Symptoms: sore aching pain exacerbated by exertion, possible muscle wasting or weakness
Secondary Symptoms: fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations possible
Tongue: pale & possibly scalloped
Pulse: thin, weak, deep

Front 31

Shoulder Pain Manifesting as Qi and Blood Xu
Treatment Principles

Back 31

Boost Qì, Nourish Blood, Open the Channels & Collaterals, Relieve Pain

Front 32

Shoulder Pain Manifesting as Qi and Blood Xu
Points Used

Back 32

• CV-6: Strengthens source Qi
• SP-6: Supplements Qi and Blood
• ST-36: Tonifies Qi and Blood
• BL-17: Moves Blood

Front 33

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Shang Jin (Damaged Sinews)
Key Symptoms

Back 33

• Soreness & pain on the lateral aspect of the elbow near the lateral epicondyle
• Pain may radiate distally along the extensor muscles of the forearm, into the hand, upper arm, or shoulder
• Pain is worse with grasping and pronation of the forearm
• Patient may exhibit weakness in the affected arm doing simple tasks such as opening a door handle or shaking hands • Pain on lateral aspect of elbow when wrist is extended against resistance
• Pain on lateral aspect of elbow when extending fingers against resistance
• Patient when palpating distal to the lateral epicondyle

Front 34

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Shang Jin (Damaged Sinews)
Etiology

Back 34

1) Trauma
2) Overuse
3) Lack of nourishment to the sinews.
4) Invasion of exogenous pathogens.
5) Stress can play into chronic musculoskeletal problems

Front 35

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Shang Jin (Damaged Sinews)
Pathology

Back 35

1) Repletion - damage to sinews resulting in Qì stagnation & blood stasis; creates susceptibility to invasion i.e. Wind-Cold-Damp
2) Vacuity: chronic injury, aging; long-term stasis & decline of Qì & Xuè/LR & KD Qì due to aging results in lack of nourishment to the sinews

Front 36

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Shang Jin (Damaged Sinews)
Overall Treatment Principles

Back 36

Immediate Pain Relief!!

-Identify distal and local points (including ashi), adjacent (including ashi), according to pattern, empirical, microsystems, trigger points
-Treat pattern
-Involves LI, TB, SI and LU channels

Front 37

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Shang Jin (Damaged Sinews)
Local Acupuncture Points

Back 37

• Local Points: LI-10 - removes channel obstruction; LI-11 - benefits sinews and joints; LI-12 - unblocks channel, stops pain, benefits joint; LI-13 - unblocks channel, stops pain;
LU 5 - relaxes tendons along channel; TB 9 - unblocks channel, stops pain; TB 10 - relaxes tendons; Ashi points

Front 38

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Shang Jin (Damaged Sinews)
Distal Points

Back 38

• Distal Points: LI-1 – removes obstruction; LI-2 – clears heat; LI-3 – joint pain (shu stream); LI-4 - unblocks channel; TB 3 - unblocks channel; TB 5 - unblocks channel;
SI 3 - benefits sinews, tendons and is good for acute conditions; SI 4 - unblocks channel

Front 39

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Manifesting as Qi Stagnation/
Blood Stasis
Symptoms

Back 39

Main Symptoms: severe pain that is fixed in location & sharp or stabbing in quality, pain may be exacerbated by movement & is usually worse at night
Tongue: normal color & coat, if chronic may be dark/purplish
Pulse: wiry or choppy

Front 40

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Manifesting as Qi Stagnation/
Blood Stasis
Treatment Principles

Back 40

Move Qì, Quicken Xuè, Eliminate Stasis, Relieve Pain

Front 41

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain)
Manifesting as Qi Stagnation/
Blood Stasis
Points Used

Back 41

• SP-10: removes stasis
• BL-17: tonifies Qi and Blood
• LR-3: moves Qi and Blood
• LI-4: unblocks channel

Front 42

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain) Manifesting as wind-cold-damp
COLD predominant
Symptoms

Back 42

Main Symptoms: severe, fixed pain that is aggravated by cold & relieved by warmth
Tongue: pale w/ white coat
Pulse: floating, tight, slippery, or slow are possible, most common is wiry & tight

Front 43

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain) Manifesting as wind-cold-damp
COLD predominant
Treatment Principles

Back 43

Scatter Cold, Expel Wind, Eliminate Dampness, Warm & Open the Channels & Collaterals, Relieve Pain

Front 44

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain) Manifesting as wind-cold-damp
COLD predominant
Points Used

Back 44

Same as Shoulder Pain, add Moxa

Front 45

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain) Manifesting as wind-cold-damp
DAMP predominant
Symptoms

Back 45

Main Symptoms: heavy, sore, fixed, aching pain that is aggravated by dampness, swelling & numbness in the affected area may be present
Tongue: greasy, white coat
Pulse: floating, tight, slippery, or slow are possible, most common is wiry & tight

Front 46

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain) Manifesting as wind-cold-damp
DAMP predominant
Treatment Principles

Back 46

Eliminate Dampness, Expel Wind, Scatter Cold, Open the Channels & Collaterals, Relieve Pain

Front 47

Elbow Pain
Lateral Epicondylitis
Zhou Teng (Elbow Pain) Manifesting as wind-cold-damp
DAMP predominant
Points Used

Back 47

• Moxa • CV-4: strengthen Yang
• GV-4: expels cold
• SP-9: Resolves dampness in lower burner
• ST-36: Tonifies Qi and Blood for St and Sp deficiency
• BL-20: Tonifies Spleen Qi and Yang, resolves dampness

Front 48

Elbow Pain
Lateral Epicondylitis
Manifesting as Qi and
Blood Xu
Symptoms

Back 48

Main Symptoms: sore aching pain exacerbated by exertion, possible muscle wasting or weakness
Secondary Symptoms: fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations possible
Tongue: pale & possibly scalloped
Pulse: thin, weak, deep

Front 49

Elbow Pain
Lateral Epicondylitis
Manifesting as Qi and
Blood Xu
Treatment Principles

Back 49

Boost Qì, Nourish Blood, Open the Channels & Collaterals, Relieve Pain

Front 50

Elbow Pain
Lateral Epicondylitis
Manifesting as Qi and
Blood Xu
Points Used

Back 50

• CV-6: Strengthens source Qi
• SP-6: Supplments Qi and Blood
• ST-36: Tonifies Qi and Blood
• BL-17: Moves Blood

Front 51

Carpal Tunnel Syndrome
Shou Zhi Ma (Hand and finger tingling)
Wan Tong (Wrist Pain)
Wan Bi Zheng (Wrist Painful Obstruction)
Etiology

Back 51

1) Repetitive overuse/sprain/traumatic injury > Qi/Blood stasis 2) Lack of nourishment to the sinews. 3) Invasion of exogenous pathogens due to local vacuity. Other possible causes: Diabetes millitus, rheumatoid arthritis, thyroid disorders, pregnancy, menopause

Front 52

Carpal Tunnel Syndrome
Shou Zhi Ma (Hand and finger tingling)
Wan Tong (Wrist Pain)
Wan Bi Zheng (Wrist Painful Obstruction)
Pathology

Back 52

1) Repletion - damage to sinews resulting in Qì stagnation & blood stasis; creates susceptibility to invasion 2) Vacuity: chronic injury, aging> stasis from chronic injury and decline of Qì & Xuè/LR & KD Qì due to aging results in lack of nourishment to the sinews

Front 53

Carpal Tunnel Syndrome
Shou Zhi Ma (Hand and finger tingling)
Wan Tong (Wrist Pain)
Wan Bi Zheng (Wrist Painful Obstruction)
Early Stage Symptoms

Back 53

pain, burning, & tingling along the palmar surface of the thumb, index, & middle fingers; symptoms are worse at night. As symptoms progress,parathesia becomes more frequent; pain may radiate proximally into the forearm and occasionally into shoulder, chest, or neck

Front 54

Carpal Tunnel Syndrome
Shou Zhi Ma (Hand and finger tingling)
Wan Tong (Wrist Pain)
Wan Bi Zheng (Wrist Painful Obstruction)
Late Stage Symptoms

Back 54

tingling eventually gives way to numbness, loss of strength, & lack of coordination; if severe, inability to oppose thumb to other fingers with visible wasting of thenar eminence

Front 55

Carpal Tunnel Syndrome
Shou Zhi Ma (Hand and finger tingling)
Wan Tong (Wrist Pain)
Wan Bi Zheng (Wrist Painful Obstruction)
Treatment Principles

Back 55

Immediate Pain Relief!! Identify the involved channel Identify local and distal points
Treat pattern
-Involves LU, PC, HT channels
-Repetitive movement should cease for healing to occur.
Patient should be treated 2x/week for 3 weeks, then reassessed.
-Biomedical treatment = rest, wrist splint, NSAIDs, corticosteroid injections, stretching/strengthening exercises, surgical treatment

Front 56

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Acupuncture Treatment

Back 56

Basic points:

PC-6
PC-7 – disperses heat
PC-8 – disperses heat
Bā Xié

Front 57

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as Qi Stagnation/
Blood Stasis
Symptoms

Back 57

Main Symptoms: severe pain that is fixed in location & sharp or stabbing in quality, pain may be exacerbated by movement & is usually worse at night
Secondary Symptoms: none
Tongue: normal color & coat, if chronic may be dark/purplish
Pulse: wiry or choppy

Front 58

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as Qi Stagnation/
Blood Stasis
Treatment Principles

Back 58

Move Qì, Quicken Xuè, Eliminate Stasis, Relieve Pain

Front 59

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as Qi Stagnation/
Blood Stasis
Points Used

Back 59

• SP-10: removes stasis
• BL-17: tonifies Qi and Blood
• LR-3: moves Qi and Blood
• LI-4: unblocks channel

Front 60

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as wind-cold-damp
WIND predominant
Symptoms

Back 60

Main Symptoms: sore, aching pain that is intermittent or moves around
Tongue: possibly moist, white coating
Pulse: floating, tight, slippery, or slow are possible, most common is wiry & tight

Front 61

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as wind-cold-damp
WIND predominant
Treatment Principles

Back 61

Expel Wind, Scatter Cold, Eliminate Dampness, Open the Channels & Collaterals, Relieve Pain

Front 62

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as wind-cold-damp
Points Used for all exogenous symptoms

Back 62

• TB-5: unblocks channel
• LI-11: benefits sinews and joints
• LI-4: unblocks channel
• SI-3: benefits sinews, tendons; is good for acute conditions
CV-6: strengthens source Qi
CV-4: strengthens Yang
GV-4: expels cold
Moxa

Front 63

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as wind-cold-damp
COLD predominant
Treatment Principles

Back 63

Scatter Cold, Expel Wind, Eliminate Dampness, Warm & Open the Channels & Collaterals, Relieve Pain

Front 64

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as wind-cold-damp
DAMP predominant
Symptoms

Back 64

Main Symptoms: heavy, sore, fixed, aching pain that is aggravated by dampness, swelling & numbness in the affected area may be present
Tongue: greasy, white coat
Pulse: floating, tight, slippery, or slow are possible, most common is wiry & tight

Front 65

Carpal Tunnel Syndrome
Shou Zhi Ma (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction)
Manifesting as wind-cold-damp
DAMP predominant
Treatment Principles

Back 65

Eliminate Dampness, Expel Wind, Scatter Cold, Open the Channels & Collaterals, Relieve Pain

Front 66

Carpal Tunnel Syndrome
Shou Zhi Ma Mu (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction) Manifesting as Qi and Blood Xu
Symptoms

Back 66

Main Symptoms: sore aching pain exacerbated by exertion, possible muscle wasting or weakness
Secondary Symptoms: fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations possible
Tongue: pale & possibly scalloped
Pulse: thin, weak, deep

Front 67

Carpal Tunnel Syndrome
Shou Zhi Ma Mu (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction) Manifesting as Qi and Blood Xu
Treatment Principles

Back 67

Boost Qì, Nourish Blood, Open the Channels & Collaterals, Relieve Pain

Front 68

Carpal Tunnel Syndrome
Shou Zhi Ma Mu (hand and finger tingling)
Wan Tong (Wrist pain)
Wan Bi Zheng (Wrist painful obstruction) Manifesting as Qi and Blood Xu
Points Used

Back 68

• CV-6: Strengthens source Qi
• SP-6: Supplments Qi and Blood
• ST-36: Tonifies Qi and Blood
• BL-17: Moves Blood

Front 69

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Key Symptoms

Back 69

Pain of one or more branches of the trigeminal nerve (ophthalmic, maxillary, mandibular). Arising from unknown causes. Unilateral pain is brief and paroxysmal, stabbing and shock-like and is severe.

Problems that could exacerbate the symptoms: MS, TMD, compression of trigeminal roots from tumors or blood vessels, dental problems.

Front 70

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Etiology/Pathology for Excess

Back 70

1) Exogenous Pathogens: Wind-Cold or Wind-Heat pathogens invade the Yáng channels of the hand or feet & attack the facial region. They may combine with Phlegm and obstruct the channels and collaterals causing Qì stagnation & Xuè stasis that results in pain
2) Diet: excessive intake of spicy, greasy, or sweet foods leads to Heat accumulation in the ST and LI which transforms into Fire flaring up along the channels of the face causing facial pain. Can also lead to phlegm accumulation which can obstruct channels of face.
3) Emotional Stress: frustration, anger, irritability causes Liver Qì stagnation that transforms into Liver Fire which flares up along the Shàoyáng channel in the face causing facial pain

Front 71

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Etiology/Pathology for Deficiency

Back 71

1) Poor diet: improper food choices over time weaken the SP/ST resulting in decreased production of Qì & Xuè. This causes lack of nourishment to the face with Qì stagnation & Xuè stasis from vacuity
2) Aging, excessive sexual activity, chronic disease: can weaken the KD Yīn & Jīng resulting in upward flaring of vacuity Fire causing facial pain

Front 72

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Treatment Principles

Back 72

Immediate Pain Relief!! -Identify the involved channel -Identify local and distal points
-Treat pattern
Involves LI, ST, TB channels
Biomedical treatment = anticonvulsant drugs, tricyclic antidepressants, surgery

Front 73

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Acupuncture Points

Back 73

1st Branch: BL 2, ST 8, GB 14, TB 23, Yu Yao; TB 3, LI 4, Tai Yang
2nd Branch: ST 2, ST 3, SI 18, LI 19, LI 20, Tai Yang; TB 2, LI 4
3rd Branch: ST 5-7, TB 17, CV 24, Jia Cheng Jiang; LI 4, ST 44
*Use 2-3 points per branch treatment and alternate points
**Palpate the following points to determine which branch is involved:
Pain on Bl 2 = 1st branch
Pain on ST 2 = 2nd branch
Pain on ST 5 = 3rd branch
***ST 7 can be used to treat pain along all 3 branches
-Always treat the Shen in pain conditions > Ear Shen Men, GV 24

Front 74

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Herbs

Back 74

• Bái Zhĭ (Angelica root)
• Chuān Xiōng (Ligusticum root)
• Xì Xīn (Asarum herb)
• Găo Bĕn (Ligusticum rhizome)
• Màn Jīng Zĭ (Vitex Fruit)
• Shí Gāo (Gypsum)
• Tiān Má (Gastrodia rhizome)
• Quán Xiē (Scorpion)
• Wú Gōng (Centipede)
• Bái Fù Zĭ (Typhonium rhizome)
• Bài Jiāng Cán (Stiff Silkworm)
• Dì Lóng (Earthworm)
• Bīng Piàn (Borneol)
• Sān Qī (Notoginseng root)
• Yán Hú Suŏ (Corydalis rhizome)

Front 75

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as
Wind-Cold Invasion w/
Phlegm Obstruction
Symptoms

Back 75

Main Symptoms: recurrent episodes of severe, unilateral cramping or spastic facial pain that is aggravated by cold & relieved by heat; somber white facial complexion
Secondary Symptoms: possible fever/chills
Tongue: pale w/ thin white coat; thick greasy white coat (Phlegm)
Pulse: floating & tight, most often tight or wiry

Front 76

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as
Wind-Cold Invasion w/
Phlegm Obstruction
Treatment Principles

Back 76

Expel Wind, Scatter Cold, Resolve Phlegm, Open the Channels & Collaterals, Relieve Pain

Front 77

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as
Wind-Cold Invasion w/
Phlegm Obstruction
Points Used

Back 77

• TB-5: unblocks channel
• GB-20: expels wind
• ST-40: resolves phlegm-damp
• ST-36: expels wind-damp in painful obstruction syndrome

Front 78

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as
Wind-Heat Invasion w/
Phlegm Obstruction
Symptoms

Back 78

Main Symptoms: recurrent episodes of severe, unilateral facial pain that is aggravated by heat & relieved by cold; red facial complexion, red eyes, sweating during episodes of pain
Secondary Symptoms: possible fever/chills, thirst, dark urine, dizziness, chest oppression, numbness of limbs w/ Phlegm
Tongue: red w/ thin yellow coat; thick greasy yellow coat (Phlegm)
Pulse: floating & rapid, most often wiry or slippery & wiry

Front 79

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as
Wind-Heat Invasion w/
Phlegm Obstruction
Treatment Principles

Back 79

Expel Wind, Clear Heat, Resolve Phlegm, Open the Channels & Collaterals, Relieve Pain

Front 80

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as
Wind-Heat Invasion w/
Phlegm Obstruction
Points Used

Back 80

• TB-5: unblocks channel
• GB-20: expels wind
• LI-1: removes obstruction
• LI-11: expels exterior wind-heat and interior wind
• TB-1: clears heat, expels wind
• SI-1: expels wind-heat
• ST-44: clears ST heat
• ST-40: resolves phlegm and damp

Front 81

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as ST Fire
Symptoms

Back 81

Main Symptoms: recurrent episodes of severe, unilateral, burning facial pain that is aggravated by heat & relieved by cold; possible gingival redness, swelling, & bleeding
Secondary Symptoms: halitosis, thirst, constipation, dark urine, headache
Tongue: red w/ thick yellow coat
Pulse: forceful & rapid

Front 82

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as ST Fire
Treatment Principles

Back 82

Drain Stomach Fire, Open the Channels & Collaterals, Relieve Pain

Front 83

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as ST Fire
Points Used

Back 83

• ST-44: clears heat from ST
• LI-11: expels exterior wind-heat and interior wind
• LI-2: clears heat

Front 84

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as LV Fire
Symptoms

Back 84

Main Symptoms: recurrent episodes of mild to severe, unilateral, burning facial pain that is aggravated by heat & emotional upset & relieved by cold; patient tends towards irritability, impatience, & anger, & sighs often; red face & eyes
Secondary Symptoms: bitter taste in the mouth, dry throat, oppression or pain the chest & rib cage, constipation w/ dry stools, dark urine
Tongue: red w/ dry yellow coat
Pulse: wiry & rapid

Front 85

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as LV Fire
Treatment Principles

Back 85

Clear the Liver, Drain Fire, Open the Channels & Collaterals, Relieve Pain

Front 86

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as LV Fire
Points Used

Back 86

• TB-2: clears heat, expels wind
• LV-2: clears Liver Fire
• LV-8: nourishes Liver Blood
• GB-43: Subdues Liver Yang

Front 87

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as Phlegm Obstruction with Blood Stasis
Symptoms

Back 87

Main Symptoms: recurrent episodes of severe, unilateral, sharp facial pain accompanied by heaviness or lack of sensation on the skin; pain worse at night; facial complexion appears dark or sooty
Secondary Symptoms: possible vomiting during episodes of pain
Tongue: pale, purplish w/ white greasy coat
Pulse: wiry or slippery

Front 88

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as Phlegm Obstruction with Blood Stasis
Treatment Principles

Back 88

Quicken Xuè, Resolve Phlegm, Open the Channels & Collaterals, Relieve Pain

Front 89

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as Phlegm Obstruction with Blood Stasis
Points Used

Back 89

• ST-36: expels wind-damp in painful obstruction syndrome
• ST-40: resolves phlegm damp
• SP-10: removes blood stasis
• BL-17: moves Blood

Front 90

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as ST Fire > KI Yin Xu with Xu Fire
Symptoms

Back 90

Main Symptoms: recurrent episodes of severe, unilateral facial pain that is aggravated by heat & relieved by cold; possible gingival redness & swelling, loose teeth
Secondary Symptoms: thirst, constipation, frontal headache
Tongue: dry red w/ yellow coat
Pulse: floating, large, slippery, deficient

Front 91

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as ST Fire > KI Yin Xu with Xu Fire
Treatment Principles

Back 91

Clear Heat, Drain Stomach Fire, Nourish Yīn, Relieve Pain

Front 92

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as ST Fire > KI Yin Xu with Xu Fire
Points Used

Back 92

• ST-44: clears heat from ST
• KI-2: clears deficiency heat
• KI-3: Back-Shū – ST
• KI-6: nourishes Yin
• BL-21: regulates and tonifies ST
• BL-23: tonifies KI

Front 93

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as KI Yin Vacuity with Vacuity Fire
Symptoms

Back 93

Main Symptoms: recurrent episodes of chronic, unilateral, mild to severe burning facial pain that is worse in the afternoon & night
Secondary Symptoms: sore, weak low back & knees, hot flashes, dry throat, thirst, night sweats, insomnia, dizziness, tinnitus
Tongue: red w/ little coat
Pulse: thin, rapid

Front 94

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as KI Yin Vacuity with Vacuity Fire
Treatment Principles

Back 94

Supplement KD Yīn, Drain Fire, Relieve Pain

Front 95

Face Pain (aka Trigeminal Neuralgia)
Mian tong (Face Pain)
Bian Tou Tong (side head pain)
Tou Tong (headache)
Tou Feng (head wind)
Jue Ni Tou Tong (reverse flow headache)
Manifesting as KI Yin Vacuity with Vacuity Fire
Points Used

Back 95

• KD-2: clears deficiency heat
• KD-3: tonifies KI, benefits essence
• KD-6: nourishes Yin
• BL-23: Tonifies KI

Front 96

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Key Symptoms

Back 96

• The most common symptoms are: unilateral facial weakness or paralysis; inability to blink or close the eye, frown, raise the eyebrow, puff out the cheek, whistle, or show the teeth; tearing & dry eyes; dry mouth
• Other symptoms include: impaired speaking, drooling; difficulty eating; facial twitching; impaired sense of taste (hypogeusia or ageusia); hypersensitivity to sound; dizziness
• The severity of symptoms depends on the extent of facial nerve damage and varies from mild weakness to complete paralysis. Bell's palsy usually affects both the upper and lower parts on one side of the face. Both sides of the face are affected in less than 1% of cases.

Front 97

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Etiology/pathology

Back 97

Exogenous pathogenic factors: Wind-Cold (or Wind-Heat) invade the Yáng channels and collaterals of the face, obstructing the flow of Qì & Blood. Wind in the channels can also stir up latent Phlegm, which can further obstruct Qì & Blood. Lack of nourishment from Qì stagnation & Blood stasis due to Wind invasion causing facial paralysis. Underlying Qì & Blood deficiency (due to illness or poor diet) allows for invasion of exogenous pathogenic factors.

Other causes of nerve palsy that must be distinguished from Bells Palsey: Guillain Barre syndrome, Lyme disease, Otitis media, Ramsay Hunt syndrome, Sarcoidosis, some influenza vaccines

Front 98

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Treatment Principles

Back 98

Symptoms come on suddenly and progress within 48 hours.

Frequent treatments will help patient respond quickly – every other day is ideal within the first couple of weeks.


Biomedical treatment = antiviral drugs; eye lubricants for irritation; analgesics for pain

Front 99

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Acupuncture Points Used

Back 99

GB 1, BL 2, ST 2, ST 4, ST 6, GB 14, GB 20, TB 23, Yu Yao, Qian Zheng; LV 3, LI 4
Inability to frown: GB 1, BL 2, Yu Yao
Shallow Nasolabial Groove: LI 20, Bi Tong
Pain at corner of jaw: TB 17
Deviation of philtrum: GV 26
Deviation of mentolabial groove: GV 24, Jia Chen Jiang
Hypogeusia or ageusia: CV 23
Cupping
Indirect moxa
Electrostim (after first/second week of treatment)

Front 100

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Herbs

Back 100

Qiān Zhèng Săn
(Pull Aright Powder)

Front 101

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Wind-Cold
Treatment Principles

Back 101

Expel Wind, Scatter Cold, Warm & Open the Channels & Collaterals, Relieve Pain

Front 102

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Wind-Cold
Points Used

Back 102

• Du-14: clears heat, releases exterior, expels wind
• Du 13: clears heat, releases exterior
• Du 16: expels wind
• GB 20: expels wind

Front 103

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Wind-Cold
Herbs for all Wind Invasion (Facial)

Back 103

• Jīng Jiè (Schizonepetae herb) 10g
• Fáng Fēng (Saposhnikoviae root) 10g
• Bái Zhĭ (Angelica root) 10g
• Jú Huā (Chrysanthemum flower) 12g
• Màn Jīng Zĭ (Vitex Fruit) 10g

Front 104

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Wind-Heat
Treatment Principles

Back 104

Expel Wind, Clear Heat, Open the Channels & Collaterals, Relieve Pain

Front 105

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Wind-Heat
Points Used

Back 105

• TB-5: unblocks channel
• LI-11: expels exterior wind-heat and interior wind
• Du-14: clears heat, releases exterior, expels wind
• LI 4: pain point, unblocks channel

Front 106

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Wind-Phlegm
Treatment Principles

Back 106

Expel Wind, Clear Heat, Resolve Phlegm, Open the Channels & Collaterals, Relieve Pain

Front 107

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Wind-Phlegm
Points Used

Back 107

• ST-40: resoles phlegm damp
• ST-36: expels wind-damp in painful obstruction syndrome

Front 108

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Qi and Blood Deficiency
Treatment Principles

Back 108

Boost Qì, Nourish Xuè, Open the Channels & Collaterals, Relieve Pain

Front 109

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Qi and Blood Deficiency
Points Used

Back 109

• CV-6: Tonifies Qi
• SP-6: tonifies SP/ST, harmonizes LV, moves blood
• ST-36: Tonifies Qi and Blood
• BL-17: Moves Blood
• Bl 20: Tonifies SP Qi and Yang

Front 110

Facial Paralysis
Bells Palsy
Kou Yan Wai (Kuai) Xie
(deviated eyes and mouth, facial paralysis)
Manifesting as Qi and Blood Deficiency
Herbs

Back 110

Bā Zhēn Tāng
(Eight Treasure Decoction)