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204 Cards in this Set

  • Front
  • Back
10 diagnostic systems of pattern differentiation
1.Eight Principle Pattern Identification
(ba gang bian zheng)
2.Five Phase Pattern Identification
(wu xing bian zheng)
3.Viscera and Bowel Pattern Identification
(zang fu bian zheng)
4.Channel and Collateral Pattern Identification
(jing luo bian zheng)
5.Qi and Blood Pattern Identification
(qi xue bian zheng)
 6.Body Fluid Pattern Identification
(jin ye bian zheng)
7.Disease Cause Pattern Identification
(bing yin bian zheng)
8.Six Stages Pattern Identification
(liu jing bian zheng)
9.Four Levels Pattern Identification
(si fen bian zheng)
10.Three Burner Pattern Identification
(san jiao bian zheng)
Acupuncture treatment methods
1.Reinforcing/supplementing/tonifying
2.Reducing/draining
3.Warming
4.Clearing
5.Ascending
6.Descending
Herbal treatment methods
1.Resolving/releasing the exterior
2.Clearing (Heat)
3.Precipitation/purgation
4.Harmonization
5.Eliminating Dampness
6.Moistening Dryness
7.Warming
8.Rectifying Qi
9.Abductive dispersion and transforming accumulations (for Food stagnation, Phlegm nodules, Qi & Blood masses)
10.Expelling worms
11.Rectifying the Blood
12.Transforming Phlegm
13.Calming the Spirit
14.Eliminating Wind
15.Opening the orifices
16.Supplementation/tonification
17.Securing and astringing
18.Ejection/emesis
Causes of qi stagnation
1.Emotional strain
2.Irregular diet
3.Taxation fatigue (overwork)
4.Lack of exercise
5.W/C/D
Cause of Blood stasis
1.Trauma
2.Qi stagnation
3.Qi deficiency
4.Cold
5.W/C/D
5.Heat
6.Blood deficiency
7.Aging
SOAP
Subjective: history, px observations, inquiry
Objective: Physical exam, doc observations, Looking/palpation/listening/smelling etc
Assessment: Diagnosis/prognosis
Main yin/yang imbalances
Shi yang - full/shi heat
Xu yang - empty/xu cold
Shi yin - full/excess cold
Xu yin - empty/xu heat

Shi heat --- lead to xu heat
Shi cold --- lead to xu cold
Clear xu heat herb combo
Zhi mu + huang bai
Xie qi
6 ext evils
5 int. gen evils
+ phlegm, qi stag, xue stasis
Zheng qi
Right qi, anti pathogenic qi
- all physiologic qi of zang/Fu, blood
Most common shoulder pain classification
Rotator cuff tendonitis -esp supraspinatus muscle
Stiffness + loss of motion is Major sx for...
adhesive capsulitis ( frozen shoulder), dislocation, glenohumeral joint arthritis
Pain with throwing is major sx that suggests...
Anterior glenohumeral instability
Chronic pain + loss of passive range of motion =
Frozen shoulder, possible tears of rotator cuff
Acute trauma with arm abducted and ext. rotated =
Shoulder sublexation, dislocation, possible glenoid labral injury
Neck pain/pain radiating below elbow are subtle signs of -
Cervical spine disorder (excludes an actual shoulder problem) - this is cause of pain
Referred pain from where + which channels also could exclude actual shoulder problem-
Elbow, HT, GB - could cause shoulder pain
Complete shoulder exam includes -
Shoulder inspection/observation
Shoulder palpation
Shoulder range of motion
Shoulder provocative testing
Inspection of shoulder -
Swelling, asymmetry, muscle atrophy, scars, ecchymosis, venous distention
-deformity (ant dislocation -squaring of the shoulder)
-scapular winging (shoulder instability/ serratus ant. or trapezius)
-atrophy of supraspinatus or infraspinatus (rotator cuff tear, suprascapular nerve entrapment or neuropathy)
Palpation of shoulder -
*acromioclavicular + sternoclavicular joints
*cervical spine + biceps tendon
*ant glenohumeral joint
*coracoid process, Afro ion + scapula palp. for tenderness + deformity
(palpate any affected channels, local + distal to pain // trigger pts considered + palpated)
Apleys scratch test
Px reach behind head to touch opposite scapula (measures abduction + external rotation)

Px reach behind back to touch inf. aspect of opposite scapula (extension + internal rotation)
Active range of motion test -
Px fully abducted arms without supinating palms - pain btwn 45* + 120* = possible tendinitis of rotator cuff muscles, subacromial bursitis, calcium deposits
- muscle prob usu.
Passive ROM -
If painful - most likely joint itself: tendon/ligament/cartilage/bone etc.
You move their arm for them
Empty can test - shoulder provacative testing ---
For supraspinatus (most commonly implicated for shoulder pain)
* abduct to 90 degrees thumbs down + internal rotation
(partial tear of muscle or tendon - pain/weakness) complete disruption of muscle will prevent any foreward flexion - will shrug up using deltoids to compensate.
Cervical compression test-
IVF encroachment, radiculopathy (nerve root compressed) if radiation occurring
* local pain in cervical spine (doesn't radiate) not related to shoulder
Valsalvas maneuver -
Strain to poo
Cervical disorders OR
*lumbar radiculopathy
Adsons test -
Abduct and ext. Rotate, bring back -- palpate pulse
Take breath, hold it, turn in direction of extended hand
(compression of scalenes on brachial plexus)
Jian tong
Shoulder pain d/t overuse + trauma
Bi zheng
Painful obstruction syndrome (W C D)
4 etiologies for shoulder pain -
Trauma
Overuse
Lack of nourishment
Invasion of exogenous pathogens
Shi shoulder pain issues -
*Overuse, sprain/trauma / damage to sinews - qi and blood stag in ch./coll - leads to lack of nourishment to sinews
*WCD invasion / local xu of Wei qi + xue allows pathogenic factors to invade
Xu shoulder pain issues -
Chronic injury / aging
Long term stasis from chronic injury or overuse + decline of qi + xue /LV + KD qi due to aging results in lack of nourishment to sinews
Basic approach for selecting acu pts
-always identify involved channel(s)
Local
Adjacent
Distal
Pts for pattern
-according to pt category
-empirical
-microsystems
Methods of pt selection
-channel qi dynamic "the further the farther the nearer the closer"
-point correspondence to joints (imaging)
-acute cases - start with distal pts to clear ch; possible local pts after
-chronic cases - combine distal, local + adjacent pts
-balance upper/lower, left/right, yin/yang, front/back
-consider moxa /esp w/cold
-electro/plum blossom/ cupping/ gua sha
Channels transversing the shoulder
3 yang ch. most important
LI, SJ, SI
LU / HT + PC (less imp. though HT 1 into subscap sometimes imp - frozen shoulder)
Important shoulder pain points
St38 - empirical for ant. shoulder pain (ipsilateral w/ stimulation while px moves shoulder) acute best
Gb34 - tendons / distal empirical pt for lateral shoulder pain (any kind)
Bl58 - distal empirical pt for posterior shoulder pain (ipsilateral while px moves shoulder) acute
Bl62 - master yang qiao; combine with SI3
Other imp shoulder pain needling techniques
-3 needle tech/ if pain deep + involves whole shoulder ( li15' SJ14 + si10 or si9) estem often applied li15 + SI 10)
- always include tx of paraspinal muscles (trap/levator scap/ rhomboids)
Gb 21 + SI 13 halfway = tb15)
Hua tou jia Ji, gb, tb, bl channels)
Shoulder pain - as qi stag + blood stasis
Sx: severe pain, fixed location, sharp + stabbing, worse w/ movement, usu. worse @ night
T: normal color + coat (if chronic possible drk/purplish)
P: poss. Wiry or choppy
Tx principle- move qi + quicken xue, eliminate stasis, relieve pain
* best represented by trauma s/s
Pts/prescription for shoulder pain w/ qi stag + xue stasis
Based on affected ch. using local, adjacent, distal pts
+ SP10, BL17, LV 3, LI4
-use draining technique
- also ear: shoulder, Shen men, subcortex, adrenal ///moxa, e-stim, cupping, plum blossom
Lock + chain method
Free up qi/xue @ joints specifically
Herbs for shoulder pain d/t qi + xue stasis
Shen tong zhu yu tang
Tao ren, hong hua, dang gui, chuan xiong, mo Yao, wu ling zhi, niu xi, di long, Qin jiao, qiang huo, Xiang Fu, gan cao
Shoulder pain - W/C/D
Wind predominant- sore aching pain intermittent/moves around
Cold predominant - severe, fixed, aggravated by cold, better warmth
Damp predominant - aka fixed bi - heavy sore fixed aggrav. By damp, swelling/numbness in affected area
T: possibly moist, white coat with wind predominant or greasy, white coat with damp predominant
P: floating/tight, slippery, slow all possible / wiry + tight most common
Tx: expel wind, scatter cold, eliminate damp, open channels + collaterals, relieve pain
- put predominant factor first in order of tx strategy
Pts/prescription for shoulder pain d/t W/C/D bi
Local / adjacent / distal PLuS
Wind dominate - BL12, BL17, SP10
Cold dominate - BL23, CV4, GV4
Damp dominate - SP9, CV9, ST28 (BL20, ST36)
Needle with draining technique; moxa
Ear: shoulder, shen men, subcortex, adrenal) /// moxa, cupping, e-stem, plum blossom)
Xue hai
Sp10 - move blood strongly (clear heat)
BL 17 similar in moving blood
Tx of shoulder should always include ---
Tx of paraspinal muscle (trapezius, levator scap, rhomboids) + neck + upper back (hua tui jia jia, Gb, TB, BL channels)
Disperse wind - pts often used --
LI4 + TB5 most important for wind in the body
Herb /prescription for shoulder pain dt bi syndrome
W/C/D, wind predominant
Juan bi tang
Cold predominant
Wu tou tang
Damp predominant
Yi yi ren tang
* may need to add guiding herbs
Shoulder pain d/t qi + xue xu
Sx: sore aching pain exacerbated by exertion; possible muscle wasting or weakness
T: pale + possibly scalloped
P: thin, weak, deep
Tx: boost qi, nourish blood, open ch + collat, stop pain
Pts/prescription for shoulder pain d/t qi + xue xu
Local/adjacent/distal
BL17, ST36, CV6(boost qi/warm yang), SP6
- needle with supplementing technique
Herbal formula for shoulder pain due to qi and blood xu
Huang qi gui zhi wu wu tang
-huang qi, bay shao Yao, gui zhi, sheng jiang, da zao
Guiding herbs for shoulder pain
Gui zhi (HT LU BL acrid sweet warm), qiang huo (BL KD acrid bitter aromatic warm), bai zhi( LU SP ST acrid warm), gao ben (GV BL acrid warm), ge gen (SP ST acrid sweet cool), sang zhi (LV, bitter neutral), Wei ling Xian (BL salty warm), jiang huang (SP ST LV acrid bitter warm) chuan xiong
Assessment of shoulder pain includes...
Determine iteology + pathogenesis /assess root + branch, Zheng qi/ xie qi, shi/xu etc
*diagnose TcM disease
*differentiate pattern
*determine prognosis
Plan- devise tx methods, formulate plan (referral?/duration + frequency of tx, lifestyle, diet)
Formulate prescription based on tx methods (acu + herbs)
Lateral Epicondylitis/Tennis Elbow
Definition:
Lateral epicondylitis, popularly termed tennis elbow, is sprain or strain of the insertions of the extensor muscles of the forearm caused by overuse or trauma.
Sx of lateral epicondylitis
•Soreness and pain on the lateral aspect of the elbow near the lateral epicondyle
•Pain may radiate distally along the extensor muscles of the forearm (the extensor muscles originate at the lateral epicondyle), into the hand, upper arm and shoulder
•Pain is worse with grasping and pronation of forearm
•Patient may exhibit weakness in affected arm doing simple tasks such as opening a door handle or shaking hands with someone.
•Onset often insidious.
Examination/test for lateral epicondylitis
•Pain on lateral aspect of the elbow when the wrist is extended/dorsiflexed against resistance (Cozen’s Test)
•Pain when palpating on and distal to the lateral epicondyle along course of extensor tendons/muscles (proximal pain also possible).
Biomedical tx tennis elbow
•R.I.C.E. method (rest, ice, compression and elevation) in acute phase
•Discontinuation of activities that cause the pain is recommended.  
•NSAIDs
•Cortisone injection in chronic or severe cases
•Ultrasound
•Wrist splint or brace
•PT; flexibility and strengthening exercises
Tcm tennis elbow categorization
•Zhŏu Tòng: “elbow pain”
•Shāng Jīn: “damaged sinews”
•Zhŏu Láo: “elbow taxation”
•Zhŏu Bì Zhèng: “elbow painful obstruction syndrome”
Elbow Pain:
TCM Etiology and Pathogenesis
Excess:
1.Overuse, sprain/traumatic injury: causes damage to the sinews resulting in Qi stagnation and Blood stasis in the channels and collaterals; this, in turn, leads to lack of nourishment (Blood and Qi) to the sinews
2.Wind-Cold-Damp invasion: local deficiency of Defensive Qi and Blood allows pathogenic factors to invade resulting in Qi stagnation and Blood stasis in the channels and collaterals
Deficiency:
3.Chronic injury, aging: long-term stasis from chronic injury and decline of Qi and Blood/Liver and Kidney Qi due to aging results in lack of nourishment to the sinews
Elbow pain - qi stag + blood stasis
Symptoms: severe pain that is fixed in location and sharp or stabbing in quality; pain may be exacerbated by movement and is usually worse at night
Tongue: normal color and coat (if chronic, may be dark/purplish)
Pulse: wiry or choppy
Tx:Move Qi and quicken the Blood, eliminate stasis and relieve pain
Acu tx for elbow pain/qi stag + blood stasis
1.Basic points:
a)Local points: LI 10, LI 11, LI 12, LI 13, Ashi
    Distal points: LI 4, LI1 (also TB1)
b)Local points: SI8, HT3
    Distal points: SI6, SI3
2.Modification based on the pattern:
 SP10, BL17, 4 Gates
c)Herbal liniments and heat therapy
•Imaging, auricular
Herbal formula for elbow pain/qi stag + blood stasis
Sheng Tong Zhu Yu Tang
Tao Ren (Peach kernel) 9g
Hong Hua (Carthamus flower) 9g
Dang Gui (Angelica root) 9g
Chuan Xiong (Ligusticum root) 6g
Mo Yao (Myrrh) 6g
Wu Ling Zhi (Flying squirrel feces) 6g
Niu Xi (Achyranthes root) 9g
Elbow Pain Manifesting as
Cold-Damp Invasion
Symptoms:
   Cold predominant: severe, fixed pain that is aggravated by cold and relieved by warmth
   Damp predominant (a.k.a. Fixed Bi): heavy, sore, fixed aching pain that is aggravated by dampness; numbness in the affected area may be present
Tongue: possibly moist or greasy, white coating with Damp predominant
Pulse: tight, slippery, slow are theoretically possible; wiry or tight are most common
Tx:
1.Scatter Cold, expel Wind, eliminate Dampness, warm and open the channels and collaterals, relieve pain
2.Eliminate Dampness, expel Wind, scatter Cold, open the channels and collaterals, relieve pain
Acupuncture Treatment for
Elbow Pain Manifesting as
Cold-Damp Invasion
1.Basic points:
a)Local points: LI 10, LI 11, LI 12, LI 13, Ashi
    Distal points: LI 4, LI1 (also TB1)
b)Local points: SI8, HT3
    Distal points: SI6, SI3
2.Modification based on the pattern:
 ST36, SP9, Moxa
3.Herbal liniments and heat therapy
4.Imaging, auricular
Herbs for elbow pain d/t w/c/d with cold Predominant
Wu Tou Tang
(Aconite Decoction)
 
Zhi Chuan Wu Tou (Processed Aconite root) 6g
Ma Huang (Ephedra stem) 6g
Huang Qi (Astragalus root) 12g
Bai Shao Yao (White Peony root) 9g
Gan Cao (Licorice root) 6g
Feng Mi (honey)
Herbs for elbow pain d/t w/c/d with damp Predominant
Yi Yi Ren Tang
Yi Yi Ren (Coix seed) 30g
Cang Zhu (Atractylodes root) 6g
Qiang Huo (Notopterygium root) 9g
Du Huo (Angelica tuhuo root) 9g
Fang Feng (Saposhnikoviae root) 6g
Zhi Chuan Wu Tou  3g (Processed Aconite root)
Ma Huang (Ephedra stem) 6g
Gui Zhi (Cinnamon twig) 6g
Dang Gui (Angelica root) 9g
Chuan Xiong (Ligusticum root) 9g
Sheng Jiang (Fresh ginger root) 6g
Gan Cao (Licorice root) 6g
Elbow Pain Manifesting as Qi and Blood Deficiency
Symptoms: sore, aching pain exacerbated by exertion; possible muscle wasting or weakness; fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations possible
Tongue: pale and possibly scalloped
Pulse: thin, weak, deep

 
Treatment Method
Boost Qi, nourish Blood, open the channels and collaterals, stop pain
Acupuncture Treatment for
Elbow Pain Manifesting as Qi and Blood Deficiency
Acupuncture:
1.Basic points:
a)Local points: LI 10, LI 11, LI 12, LI 13, Ashi
    Distal points: LI 4, LI1 (also TB1)
b)Local points: SI8, HT3
    Distal points: SI6, SI3
2.Modification based on the pattern:
 BL 17, ST 36, CV 6
3.Herbal liniments and heat therapy
4.Imaging, auricular
Herbs for elbow pain d/t qi + xue xu
Huang Qi Gui Zhi Wu Wu Tang
(Five Ingredient Astragalus and Cinnamon Twig Decoction)
 
Huang Qi (Astragalus) 12g
Bai Shao Yao (White Peony) 9g
Gui Zhi (Cinnamon Twig) 9g
Sheng Jiang (Fresh Ginger) 12g
Da Zao (Jujube) 12 pcs.
Prognosis and Tx Plan for
Tennis Elbow
•Tennis Elbow can be challenging to treat; chronic cases and associated weakness in the forearm have a more guarded prognosis.
•It is imperative for healing that patient refrain from offending activities.
•2x/week for 3 weeks minimum then reassess; may continue at 1x/week interval for another 6 visits if you see improvement; if no improvement, refer out
Carpal tunnel syndrome =
   Carpal tunnel syndrome occurs when the median nerve becomes compressed within the carpal tunnel, usually resulting from swelling of adjacent tendon sheaths due to inflammation.
Carpal tunnel etiology
Repetitive motion
•Other risk factors: diabetes mellitus, RA, thyroid disorders, pregnancy, and menopause
Carpal tunnel sx
•Early-stage: pain, burning, and tingling along the palmar surface of the thumb, index, and middle fingers; symptoms are worse at night
•As symptoms progress, paresthesia becomes more frequent; pain may radiate proximally into the forearm and occasionally to shoulder, chest, or neck.
Late stage: tingling eventually gives way to numbness, loss of strength and lack of coordination; if severe, inability to oppose thumb to other fingers with visible wasting of the thenar eminence
Carpal tunnel tests For diagnosis
•+ Tinel’s sign = tingling or shock-like pain on percussion of the transverse carpal ligament
•+  Phalen’s sign = reproduction of symptoms after 60-90 seconds with the patient flexing wrists at 90º by pressing dorsal aspect of both hands together
•EMG = “gold standard;”
 
•Differential diagnosis: CTS paresthesia often confused with paresthesia of brachial plexus in thoracic outlet syndrome or other cervicobrachial pain syndromes; hx cervical injury and Adson’s test may help in differentiating
Wrist pain tcm diffentiations
•Shŏu Zhĭ Má Mù: “hand and finger tingling and numbness”
•Wàn Tòng: “wrist pain”
•Wàn Bì Zhèng: “wrist painful obstruction syndrome”
Wrist pain etiology/pathogenesis
Excess:
1.Overuse, sprain/traumatic injury: causes damage to the sinews resulting in Qi stagnation and Blood stasis in the channels and collaterals; this, in turn, leads to lack of nourishment (Blood and Qi) to the sinews
2.Wind-Cold-Damp invasion: local deficiency of Defensive Qi and Blood allows pathogenic factors to invade
Deficiency:
3.Chronic injury, aging: long-term stasis from chronic injury and decline of Qi and Blood/Liver and Kidney Qi due to aging results in lack of nourishment to the sinews
Wrist pain qi stag + blood stasis
1.Local/Adjacent points: PC7, PC6, PC8, Ba Xie  
–TB4, TB5
–SI5, SI4, SI6, SI3
–LI5, LI4, LI3, LI7
2.Modification based on the pattern:
 SP10, BL 17, 4 Gates
3.Herbal liniments and heat therapy
4.Imaging, auricular
 *Shen tong zhu yu tang
Wrist pain d/t W/C/D
1.Local/Adjacent points: PC7, PC6, PC8, Ba Xie  
–TB4, TB5
–SI5, SI4, SI6, SI3
–LI5, LI4, LI3, LI7
2.Modification based on the pattern: TB 5, LI 4, SI3, ST36, SP9, Moxa
3.Herbal liniments and heat therapy
4.Imaging, auricular
Cold predominant - wu tou tang
Dmp predominant - yi yi ren tang
Wrist pain d/t qi + blood xu
1.Local/Adjacent points: PC7, PC6, PC8, Ba Xie  
–TB4, TB5
–SI5, SI4, SI6, SI3
–LI5, LI4, LI3, LI7
2.Modification based on the pattern:
 BL 17, ST 36, CV 6
3.Herbal liniments and heat therapy
4.Imaging, auricular
Huang qi gui zhi wu wu tang
Carpal tunnel prognosis + tx plan
•Carpal Tunnel Syndrome that has been symptomatic for less than one year usually responds reasonably well to treatment.  If symptoms have lasted more than one year, the prognosis should be guarded.
•It is imperative for healing that patient limit offending activities. Ergonomic setup of computer station and regular breaks from typing essential if computer work is part of etiology.
2x/week for 3 weeks minimum then reassess; may continue at 1x/week interval for another 6 visits if you see improvement; if no improvement, refer out
TMD =
Temporomandibular disorders (TMD) refers to pain and soreness in the temporomandibular joint region
TMD etiology
•Injury to the jaw, temporomandibular joint, or muscles of the head and neck - such as from a heavy blow or whiplash
•Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
•Presence of osteoarthritis or rheumatoid arthritis in the TMJ
Types of TMD
•Myofascial pain: discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles; most common form of TMD
•Internal derangement of the joint: a dislocated jaw or displaced disc, or injury to the condyle
•Degenerative joint disease: osteoarthritis or rheumatoid arthritis in the jaw joint
TMD s/s:
•Pain, particularly in the chewing muscles and/or jaw joint, is the most common symptom. Other likely symptoms include:
–limited movement or locking of the jaw.
–radiating pain in the face, neck or shoulders.
–painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth.
–a sudden, major change in the way the upper and lower teeth fit together.
–possible swelling
Related sx:
Additional associated symptoms include:
•Headaches
•Earaches
•Dizziness
•Hearing problems
 
Important note about angina:
According to Richard N. Fogoros M.D., "Jaw pain is a fairly common manifestation of TMD"
Jaw pain/ tcm categorization
•Miàn Tòng: “facial/jaw pain”
•Ĕr Tòng: “earache”
•Miàn Fu: “facial swelling”
•Nie Chi: “gnashing of teeth”
•Nie He: “clenching of teeth”
TMD diagnosis
•Palpation of the TMJs and chewing muscles for pain or tenderness
•Listening for clicking, popping or grating sounds during jaw movement
•Examining for limited motion or locking of the jaw while opening or closing the mouth
NSAIDs, tricyclics, muscle relaxants, corticosteroids, botulism toxin, bite guard, cognitive behavioral therapy, arthrocentisis, surgery
–arthrography (joint x-rays w/ dye)
–MRI
–CT
Jaw pain etiology
1.Physical strain or traumatic injury: results in Qi stagnation and Blood stasis in the channels and collaterals of the Shaoyang and Yangming; this, in turn, can lead to lack of nourishment (Blood and Qi) to the sinews over time.
2.Exogenous pathogenic factors: local deficiency of Defensive Qi and Blood allows invasion of Wind-Cold-Damp, causing obstruction of Qi and Blood in the channels and collaterals.
3.Emotional stress: Excessive rumination (Spleen) or prolonged anger/frustration (Liver) can cause bruxism or jaw clenching, leading to Qi stagnation and Blood stasis.

Deficiency:
1.Poor diet: poor food choices and irregular eating habits can damage the Spleen and Stomach, leading to Qi and Blood deficiency.  This leads to malnourishment of the muscle channels of the Shaoyang and Yangming in the face.
2.Chronic disease, aging: long-term stasis from chronic injury, decline of Qi and Blood/Liver and Kidney Qi due to aging, and certain chronic diseases (arthritis, ankylosis, neoplasms, SLE) results in lack of nourishment to the sinews and muscle channels of the Shaoyang and Yangming in the face.
Jaw pain d/t qi stag + xue stasis
1.Basic points:
a)Local/Adjacent points: ST7, ST5, ST6, Taiyang, SI19, Ashi, TB17; GB20
b)Distal points: LI 4
2.Modification based on the pattern:
Qi stagnation and Blood stasis: SP10, LI 4, LV 3
3.Herbal liniments and heat therapy
4.Imaging, auricular
Tong Qiao Huo Xue Tang
Jaw pain d/t W/C/D
1.Basic points:
a)Local/Adjacent points: ST7, ST5, ST6, Taiyang, SI19, Ashi, TB17; GB20
b)Distal points: LI 4
2.Modification based on the pattern:
Wind-Cold-Damp: TB 5, Moxa
3.Herbal liniments and heat therapy
4.Imaging, auricular
Juan bi tang, wu tou tang, yi yi ren tang
Jaw pain d/t qi + xue xu
1.Basic points:
a)Local/Adjacent points: ST7, ST5, ST6, Taiyang, SI19, Ashi, TB17; GB20
b)Distal points: LI 4
2.Modification based on the pattern:
Qi and Blood deficiency: BL 17, BL 18, BL 20, ST 36, SP 6, GB 39
3.Herbal liniments and heat therapy
4.Imaging, auricular
Ba Zhen Tang
Jaw pain d/t liver + kidney xu
1.Basic points:
a)Local/Adjacent points: ST7, ST5, ST6, Taiyang, SI19, Ashi, TB17; GB20
b)Distal points: LI 4
2.Modification based on the pattern:
LV & KI deficiency: BL 18, BL 23, KI 3, KI 6, SP 6,  LV 3, LV 8
3.Herbal liniments and heat therapy
4.Imaging, auricular

Da Bu Yin Wan Jia Jian
Prognosis + tx plan for TMD
•Some cases may respond quickly, in some cases in less than a month. Other cases, such as those involving arthritis or people with long-standing or severe bruxism, have a more guarded prognosis.
 
•2x/week for 3 weeks minimum then reassess; may continue at 1x/week interval for another 6 visits if you see improvement; if no improvement, refer out.
Jaw pain sx d/t LV + KD xu
Symptoms: soreness and weakness of the low back and knee joints, insomnia, dream-disturbed sleep, blurred vision, dizziness, tinnitus, loose teeth
Tongue: read with little coating
Pulse: thin and rapid
Tx principle:
Jaw pain d/t qi + blood xu
Symptoms: fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations
Tongue: pale with scallops
Pulse: thin and weak
Tx principle- Boost Qi and nourish Blood, nourish the sinews, stop pain
Herbs for jaw pain
•Bai Zhi (Angelica root)-acrid, warm; LU, ST, SP
•Chuan Xiong (Ligusticum root)-acrid, warm; LV, GB, PC
•Xi Xin (Asarum herb)-acrid, warm; LU, KI
•Gao Ben (Ligusticum rhizome)-acrid, warm; BL, GV
•Man Jing Zi (Vitex fruit)-acrid, bitter, cool; BL, LV, ST
Bells palsy =
•Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to the seventh cranial nerve, one of the two facial nerves.
•The paralysis causes distortion of facial features and interferes with normal facial function.
The onset of Bell's palsy usually is sudden
Bells palsy etiology
•Classically, Bell’s palsy has been defined as idiopathic, and the cause of the inflammatory process in the facial nerve remains uncertain.
•Recently, attention has focused on infection with herpes simplex virus type 1 (HSV-1) as a possible cause, though this is by no means certain.
Bells palsy s/s:
•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 and dry eyes
•Dry mouth
 
Other symptoms include the following:
•Impaired speaking
•Drooling
•Difficulty eating
•Facial twitching
•Impaired sense of taste (hypogeusia or ageusia)

•In about 60% of cases, patients are recovering from a recent upper respiratory infection or other viral infection.
•Bell's palsy is self-limiting. Symptoms do not spread beyond the face and do not worsen once they "peak.“
Bells palsy diagnosis + differential
1.Ask the patient to raise her eyebrows. Assess whether the wrinkles on the forehead have become shallower or disappeared .
2.Ask the patient to close her eyes while you attempt to open them. This helps you gauge the strength of the orbicularis oculi muscle.
3.Visually examine the nasolabial and mentolabial folds on the affected side to determine whether they have become shallower or disappeared altogether.
4. Ask the patient to a) purse her lips, b) puff up her cheeks and blow out, and c) then smile widely and show her teeth.  If the patient is unable to perform a & b and if the number of teeth revealed on one side is less than the other, the results are positive for a dysfunction of the orbicularis oris muscle.
5. Check whether there is tenderness on or below the mastoid process.
If only the third and fourth tests are positive, then the facial paralysis is a result of central nervous dysfunction
Bells palsy differentials-
Conditions that can produce isolated
facial nerve palsy identical to Bell’s palsy:
•Structural lesions in the ear or parotid gland
(e.g., cholesteatoma, salivary tumors)

Other causes of peripheral nerve palsies usually have additional features that distinguish them from Bell’s palsy:
•Guillain-Barré syndrome
•Lyme disease
•Otitis media
•Ramsay Hunt syndrome (an outbreak of herpes zoster in the facial nerve distribution)
•Sarcoidosis
•Some influenza vaccines
Bells palsy tcm categorization
•Kōu Yān Wāi (Kuāi) Xié: “deviated eyes and mouth;” “facial paralysis”
•Zhòng Fēng: “wind stroke”
Midterm covers
Tx principles etc, Shoulder elbow wrist facial paralysis + face pain
Facial paralysis etiology
•Underlying Qi and Blood deficiency (due to illness or poor diet) allows for invasion of exogenous pathogenic factors into face.
•Exogenous pathogenic factors: Wind (Wind-Cold or Wind-Heat) invades the Yang channels and collaterals of the face obstructing the flow of Qi and Blood.  Wind in the channels can also stir up latent Phlegm, which can further obstruct Qi and Blood.  
Trigeminal neuralgia=
•Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that affects the sensory nucleus of the trigeminal - or 5th - cranial nerve.
3 branches of trigeminal neuralgia
Opthalmic, maxillary, mandibular branch
Trigeminal neuralgia etiology
•Most cases (85%) are idiopathic; these are termed “classic trigeminal neuralgia.”
•An abnormal vascular course of the superior cerebellar artery is often cited as the cause.
•Aneurysms, tumors, chronic meningeal inflammation, or other lesions may irritate trigeminal nerve roots along the pons causing symptomatic trigeminal neuralgia.
•Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. Lesions of the entry zone of the trigeminal roots within the pons may cause a similar pain syndrome.
•Infrequently, adjacent dental fillings composed of dissimilar metals may trigger attacks, and an atypical case has been reported following tongue piercing.
Tigeminal neuralgia s/s:
Nature of pain:
•Pain is brief and paroxysmal, but it may occur in volleys of multiple attacks.
•Pain is stabbing or shock-like and is typically severe.
Distribution of pain:
•One or more branches of the trigeminal nerve (usually maxillary or mandibular) are involved.
•Pain is unilateral (rarely bilateral).

•Duration of pain is typically from a few seconds to 1-2 minutes.
 
•Pain may occur several times a day; patients typically experience no pain between episodes.

Pain triggers:
•Light touch or vibration is the most provocative.
•Activities such as shaving, face washing, or chewing often trigger an episode.
•Stimuli as mild as a light breeze may provoke pain in some
Pain provokes brief muscle spasm of the facial muscles, thus producing the tic.
Trigeminal neuralgia diagnosis
•Diagnosis is generally based on the patient’s medical history and description of symptoms, a physical exam, and a thorough neurological examination by a physician. 
•Contrast MRI is often conducted to exclude a mass lesion or vascular compression on the nerve roots.
Trigeminal neuralgia differential diagnosis...
•Multiple sclerosis: development of trigeminal neuralgia in the young suggest the possibility of MS
•TMD

•Atypical facial pain
•Glossopharyngeal neuralgia
•Compression of trigeminal roots from tumors or aberrant vessels
•Dental problems
Trigemnial neuralgia biomedical tx
•Carbamazepine: tx of choice; anti-convulsant; side-effects
•Other anticonvulsants: oxcarbazepine, topiramate, clonazepam, phenytoin, lamotrigin, and valproic acid. 
Tricyclics, rhizotomy ( cut nerve fibers ), microvascular decompression (most sure way sx will be relieved, neurectomy
Mst of tx cause some degree of facial numbness
Trigeminal neuralgia tcm classifications
•Miàn Tòng: “face pain”
•Biān Tóu Tòng: “side head pain”
•Tóu Tòng : “headache”
•Tóu Fēng: “head wind”
•Jué Nì Tóu Tòng: “reverse flow headache”
Face pain etiology
Excess:
1.Exogenous Pathogens: Wind-Cold or Wind-Heat pathogens invade the Yang channels of the hand or feet and attack the facial region. They may combine with Phlegm and obstruct the channels and collaterals causing Qi stagnation and Blood stasis that results in pain
2.Diet: excessive intake of spicy, greasy, or sweet foods leads to Heat accumulation in the Stomach and Large Intestine.  This Heat transforms into Fire which then flares up along the Yang Ming channels of the face causing facial pain.  Also, excessive intake of greasy, sweet foods may, over time, result in Phlegm accumulation which can combine with exogenous pathogens to obstruct the channels and collaterals of the face.
1.Emotional Stress: frustration, anger, irritability causes Liver Qi stagnation that transforms into Liver Fire which flares up along the Shaoyang channel in the face causing facial pain.

Deficiency:
1.Poor diet: improper food choices over time weaken the Spleen/Stomach resulting in decreased production of Qi and Blood.  This causes lack of nourishment to the face with Qi stagnation and Blood stasis from deficiency.
2.Aging, excessive sexual activity, chronic disease: these can weaken the Kidney Yin resulting in upward flaring of deficiency Fire causing facial pain.
Face pain, wind cold invasion, phlegm obstruction
Main Symptoms: recurrent episodes of severe, unilateral cramping or spastic facial pain that is aggravated by cold and relieved by heat; a somber, white facial complexion
Additional Symptoms: theoretically chills and fever
Tongue: pale with thin, white coat; thick, greasy white coat with Phlegm
Pulse: theoretically floating and tight; usually tight or wiry

 
Treatment Method:
Expel Wind and scatter Cold, (resolve Phlegm), open the channels and collaterals, stop pain
Face pain, wind cold invasion w/phlegm obstruction pts:
Basic points:
a)1st branch: BL2, Yu Yao, TB23, GBI4, ST8, Tai Yang; TB3, L14
b)2nd branch: LI20, ST2, ST3, ST7, SI18, LI19, TB20; LI4
c)3rd branch: ST5, ST6, ST7, TBI7, CV24, Jia Cheng Jiang; ST44, LI4
*Use 2-3 points per branch per treatment and alternate points.

Modification based on the pattern:
GB20, TB5, (ST40, ST36)
Herbs for face pain, W/C invasion + phlegm obstruction
Chuan Xiong Cha Tiao San Jia Wei
(Ligusticum Powder to Be Taken with Green Tea with Additional Flavors)
Chuan Xiong (Ligusticum root) 12g
Qiang Huo (Notopterygium root and rhizome) 6g
Bai Zhi (Angelica Dahuricae root) 6g
Xi Xin (Asarum herb and root) 3g

Bo He (Mint) 24g
Jing Jie (Schizonepetae herb) 12g
Fang Feng (Saposhnikoviae root) 6g
Gan Cao (Licorice root) 6g
Green Tea
+Quan Xie (Scorpion) 6g
Wu Gong (Centipede) 6g
Tian Nan Xing (Arisaematis rhizome) 6g
Face pain, W/H + phlegm obstruction s/s:
Main Symptoms: recurrent episodes of severe, unilateral facial pain that is aggravated by heat and relieved by cold; a red facial complexion, red eyes; sweating during episodes of pain
Additional Symptoms: theoretically chills and fever, thirst, dark urine; dizziness, chest oppression, numbness of the limbs with Phlegm
Tongue: red with thin, yellow coat; greasy, yellow coat with Phlegm
Pulse: theoretically floating and rapid; usually wiry; slippery and wiry with Phlegm
Tx-Expel Wind, clear Heat, (resolve Phlegm), open the channels and collaterals, stop pain
Face pain, W/H + phlegm obstruction Tx:
Basic points:
a)1st branch: BL2, Yu Yao, TB23, GBI4, ST8, Tai Yang; TB3, L14
b)2nd branch: LI20, ST2, ST3, ST7, SI18, LI19, TB20; LI4
c)3rd branch: ST5, ST6, ST7, TBI7, CV24, Jia Cheng Jiang; ST44, LI4
*Use 2-3 points per branch per treatment and alternate points.

Modification based on the pattern:
TB5, GB20, LI1, TB1, SI1, LI11, ST44, (ST40, ST 36)
Herbs for - Face pain, W/H + phlegm obstruction
Ju Hua Cha Tiao San Jia Wei
(Chrysanthemum Flower Powder to Be Taken with Green Tea with Additional Flavors)
Chuan Xiong Cha Tiao San +
Bai Jiang Can (Stiff Silkworm) 6g
Ju Hua (Chrysanthemum flower) 12g
 
If Wind-Heat and pain is severe: + Shi Gao (Gypsum) 15g
Face Pain Manifesting as Stomach Fire
Main Symptoms: recurrent episodes of severe, unilateral, burning facial pain that is aggravated by heat and relieved by cold; possible gingival redness, swelling, and bleeding
Additional Symptoms: halitosis, thirst, constipation, dark urine, headache
Tongue: red with thick, yellow coat
Pulse:forceful + rapid
Tx: Drain Stomach Fire, open the channels and collaterals, stop pain
Face pain manifesting as ST fire pts:
Basic points:
a)1st branch: BL2, Yu Yao, TB23, GBI4, ST8, Tai Yang; TB3, L14
b)2nd branch: LI20, ST2, ST3, ST7, SI18, LI19, TB20; LI4
c)3rd branch: ST5, ST6, ST7, TBI7, CV24, Jia Cheng Jiang; ST44, LI4
*Use 2-3 points per branch per treatment and alternate points.

Modification based on the pattern:
ST44, LI11, LI2
Herbs 4 face pain d/t ST fire
Qing Wei San
(Clear the Stomach Powder)
Huang Lian (Coptis rhizome) 6g
Sheng Ma (Cimicifugae rhizome) 3g
Mu Dan Pi (Moutan root bark) 9g
Sheng Di Huang (Rehmannia root) 12g
Dang Gui (Angelica root) 9g
 
If Stomach Fire is severe: + Shi Gao (Gypsum) 15g = Qing Wei Tang
+ Chuan Xiong (Ligusticum root) 12g
Face pain d/t LV fire sx
Main Symptoms: recurrent episodes of mild to severe unilateral, burning facial pain that is aggravated by heat and emotional upset and relieved by cold; patient tends toward irritability, impatience and anger and sighs often; red face and eyes
Additional Symptoms: bitter taste in the mouth, dry throat, oppression or pain in the chest and rib cage, constipation with dry stools, dark yellow urine
Tongue: red with dry, yellow coating
Pulse: wiry + rapid
Tx:Clear the Liver, drain Fire, open the channels and collaterals, stop pain
Face pain d/t LV fire pts:
Basic points:
a)1st branch: BL2, Yu Yao, TB23, GBI4, ST8, Tai Yang; TB3, L14
b)2nd branch: LI20, ST2, ST3, ST7, SI18, LI19, TB20; LI4
c)3rd branch: ST5, ST6, ST7, TBI7, CV24, Jia Cheng Jiang; ST44, LI4
*Use 2-3 points per branch per treatment and alternate points.

Modification based on the pattern:
TB2, LV2, GB43, LV8
Face pain d/t LV fire Herbs
Dan Zhi Xiao Yao San
 
Chai Hu (Bupleurum root) 9g
Dang Gui (Angelica root) 9g
Bai Shao Yao (White Peony root) 9g
Fu Ling (Poria) 9g
Bai Zhu (Atractylodes rhizome) 9g
Gan Cao (Licorice root) 6g
Sheng Jiang (Fresh Ginger root) 3g
Bo He (Mint) 3g
Mu Dan Pi (Moutan root bark) 9g
Zhi Zi (Gardenia fruit) 9g
If LV Fire is severe:
+ Shi Gao (Gypsum) 15g
Chuan Xiong (Ligusticum root) 12g
Face Pain
Manifesting As Phlegm Obstruction with Blood Stasis s/s
Main Symptoms: recurrent episodes of severe, unilateral, sharp facial pain accompanied by heaviness or lack of sensation on the skin; pain may be worse at night; facial complexion appears dark or sooty
Additional Symptoms: possible vomiting during episodes of pain
Tongue: pale, purplish tongue with white, greasy coat
Pulse: wiry or slippery
*Note: This is not a common stand-alone pattern, but rather one that complicates other patterns.
Tx: Quicken the Blood, resolve Phlegm, open the channels and collaterals, stop pain
Acupuncture Tx for Face Pain
Manifesting As Phlegm Obstruction
with Blood Stasis
Basic points:
a)1st branch: BL2, Yu Yao, TB23, GBI4, ST8, Tai Yang; TB3, L14
b)2nd branch: LI20, ST2, ST3, ST7, SI18, LI19, TB20; LI4
c)3rd branch: ST5, ST6, ST7, TBI7, CV24, Jia Cheng Jiang; ST44, LI4
*Use 2-3 points per branch per treatment and alternate points.

Modification based on the pattern:
ST36, ST40, SP10, BL17
Herbs 4 Face Pain Manifesting As Phlegm Obstruction with
Blood Stasis
Ban Xia Bai Zhu Tian Ma Tang
(Pinellia, Atractylodes, Gastrodia Decoction)
Ban Xia (Pinellia rhizome) 9g
Tian Ma (Gastrodia rhizome) 6g
Chen Pi (Tangerine peel) 6g
Bai Zhu (Atractylodes rhizome) 9g
Fu Ling (Poria) 6g
Gan Cao (Licorice root) 3g
Sheng Jiang (Fresh Ginger root) 2 slices
Da Zao  (Jujube) 4 pcs.

+ Tong Qiao Huo Xue Tang
(Unblock the Orifices and Quicken the Blood Decoction)
Tao Ren (Peach kernel) 9g
Hong Hua (Safflower, Carthamus) 9g
Chi Shao Yao (Red Peony root) 3g
Chuan Xiong (Ligusticum root) 3g
She Xiang (Deer musk) 0.15g
Sheng Jiang (Fresh ginger root) 9g
Da Zao (Jujube) 7 pieces
Cong Bai (Scallion) 3g
Face Pain Manifesting As Stomach Fire causing Kidney Yin Deficiency with Deficiency Fire
Main Symptoms: recurrent episodes of severe, unilateral, burning facial pain that is aggravated by heat and relieved by cold; possible gingival redness and swelling; loose teeth
Additional Symptoms: thirst, constipation, frontal headache
Tongue: dry red with yellow coat
Pulse: floating, large, slippery, deficient
Tx:Clear Heat, drain Stomach Fire,
nourish Yin, stop pain
Face Pain Manifesting As Stomach Fire causing Kidney Yin Deficiency with Deficiency Fire pts:
Basic points:
a)1st branch: BL2, Yu Yao, TB23, GBI4, ST8, Tai Yang; TB3, L14
b)2nd branch: LI20, ST2, ST3, ST7, SI18, LI19, TB20; LI4
c)3rd branch: ST5, ST6, ST7, TBI7, CV24, Jia Cheng Jiang; ST44, LI4
*Use 2-3 points per branch per treatment and alternate points.
Modification based on the pattern:
KI2, KI3, KI6, ST44, BL21, BL23
Herbs 4 face pain Manifesting As Stomach Fire causing Kidney Yin Deficiency with Deficiency Fire
Yu Nu Jian
(Jaded Woman Decoction)
Shi Gao (Gypsum) 15-30g
Shu Di Huang (Prepared Rehmannia root) 9-30g
Zhi Mu (Anemarrhenae root) 6g
Mai Men Dong (Ophiopogonis tuber) 6-9g
Chuan Niu Xi (Cyathulae root) 3-6g
Face Pain Manifesting As Kidney Yin Deficiency with the Deficiency Fire sx:
Main Symptoms: recurrent episodes of chronic, unilateral, mild to severe burning facial pain that is worse in the afternoon or nighttime
Additional Symptoms: soreness and weakness in the low back and knees, hot flashes, dry throat, first, night sweating, insomnia, dizziness, tinnitus
Tongue: red with little coat
Pulse: thin and rapid

Treatment Method:
Supplement the Kidneys, nourish Yin, clear deficiency Fire, stop pain
Face Pain Manifesting As Kidney Yin Deficiency with the Deficiency Fire pts:
Basic points:
a)1st branch: BL2, Yu Yao, TB23, GBI4, ST8, Tai Yang; TB3, L14
b)2nd branch: LI20, ST2, ST3, ST7, SI18, LI19, TB20; LI4
c)3rd branch: ST5, ST6, ST7, TBI7, CV24, Jia Cheng Jiang; ST44, LI4
*Use 2-3 points per branch per treatment and alternate points.

Modification based on the pattern:
KI2, KI3, KI6, BL23
Herbs for face pain manifesting as KD yin xu with xu fire
Zhi Bai Di Huang Wan
(Anemarrhena, Phellodendron, and Rehmannia Pill)
 
Shu di huang (Cooked Rehmannia root) 24g
Shan zhu yu (Cornus fruit) 12g
Shan yao (Dioscorea root) 12g
Ze xie (Alisma tuber) 9g
Mu dan pi (Moutan root bark) 9g
Fu ling (Poria) 9g
Zhi mu (Anemarrhena root) 9g
Huang bai (Phellodendron bark) 9g
Acupuncture tchniq for facial pain
•In addition to the patient’s description, one may palpate the following points to determine which branch the trigeminal nerve is affected:
–Pain when pressing BL2 = 1st branch
–Pain when pressing ST2 = 2nd branch
–Pain when pressing ST5 = 3rd branch
Acu tx for trigeminal neuralgia
•Most Chinese practitioners look for strong needle sensation when treating this condition, especially at ST7, ST6, ST2, and BL2, and then retain the needles for one hour.
•ST7 can, in fact, be used to treat pain along all three branches of the trigeminal nerve
•Remember always to treat the Shen in pain conditions: Ear Shen Men, GV24
•Many Chinese acupuncturists use electroacupuncture for all patterns of this disease.
Prognosis + tx plan for face pain
•Although it is a long-term condition, the course of trigeminal neuralgia is characterized by remissions. In most individuals, sudden attacks of pain are present for several weeks or months and then may stop spontaneously.
•The remission periods may be short, or the pain may be absent for months or years. Attack-free intervals may become shorter as the individual ages, but permanent disappearance of symptoms is rare.
•Trigeminal neuralgia is not fatal, but frequent paroxysms may incapacitate an individual. Just the fear of an attack may limit activity. Individuals with frequent and ongoing attacks may be significantly disabled by the condition. Excruciating pain may lead some individuals to contemplate suicide.
•Factors influencing duration may depend on the type of trigeminal neuralgia, the frequency and severity of attacks, the individual's underlying condition, response to therapies, and presence of complications.
•If one only uses acupuncture to treat this condition, 2x/ week should be considered the minimum, with three or more being ideal, at least for the first 2-3 weeks; if pain is decreasing, may continue at 1x/week interval for another 6 visits; if no improvement, refer out.
Herbs for facial pain
•Shi Gao (Gypsum) –acrid, sweet, very cold; LU, ST
•Chuan Xiong (Ligusticum root)-acrid, warm; LV, GB, PC
•Bai Zhi (Angelica root)-acrid, warm; LU, ST, SP
•Xi Xin (Asarum herb)-acrid, warm; LU, KI
•Tian Ma (Gastrodia rhizome)-sweet, neutral; LV
•Quan Xie (Scorpion)-acrid, neutral, toxic; LV
•Wu Gong (Centipede)-acrid, warm, toxic; LV
•Bai Fu Zi (Typhonium rhizome)-acrid, sweet, warm, toxic; SP, ST
•Bai Jiang Can (Stiff Silkworm)-salty, acrid, neutral; LV, LU
•Di Long (Earthworm)-salty, cold; LV, SP, BL, LU
•Bing Pian (Borneol)-acrid, bitter, cool; HT, SP, LU
•Gao Ben (Ligusticum rhizome)-acrid, warm; BL, GV
•Man Jing Zi (Vitex fruit)-acrid, bitter, cool; BL, LV, ST
•San Qi (Notoginseng root)-sweet, bitter, warm; LV, ST
•Yan Hu Suo (Corydalis rhizome)-acrid, bitter, warm; HT, LV, SP
Many Chinese formulas for treatment of pain from trigeminal neuralgia call for the use of She Xiang (Musk), which is very expensive and difficult to obtain. Bing Pian (Borneol) and Xi Xin (Asarum herb and root) are considered acceptable, although less potent, substitutes
Prescription for Bì Zhèng
manifesting as Wind-Cold-Damp, Wind Predominant
Juan Bi Tang
Qiang Huo (Notopterygium root) 9g
Du Huo (Angelica Duhuo root) 9g
Qin Jiao (Large Gentian root) 9g
Hai Feng Teng (Kadsura Pepper stem) 9g
Sang Zhi (Mulberry twig) 15g
Dang Gui (Angelica root) 9g
Chuan Xiong (Ligusticum root) 9g

- wind predominant bi Zheng
Wu Tou Tang
(Aconite Decoction
Wu Tou Tang
(Aconite Decoction)
Zhi Chuan Wu Tou (Processed Aconite root) 6g
Ma Huang (Ephedra stem) 6g
Huang Qi (Astragalus root) 12g
Bai Shao Yao (White Peony root) 9g
Zhi Gan Cao (Licorice root) 6g
Feng Mi (honey)

- cold predominant bi Zheng
Prescription for Bì Zhèng manifesting as Wind-Cold-Damp, Damp Predominant
Yi Yi Ren Tang
Yi Yi Ren (Coix seed) 30g
Cang Zhu (Atractylodes root) 6g
Qiang Huo (Notopterygium root) 9g
Du Huo (Angelica tuhuo root) 9g
Fang Feng (Saposhnikoviae root) 6g
Zhi Chuan Wu Tou  3g (Processed Aconite root)
Bi Zheng- damp predominant
Cause of xue stag
Qi xu
Qi stag
Blood xu
Cold
Aging
Trauma
WCD
Heat
Cause of qi stag
Emotional strain
Irregular diet
Taxation fatigue
Overwork
WCD
Gui zhi shao Yao zhi mu tang
Gui zhi, ma huang, Fu zi, zhi mu, bai zhu, bai shao, sheng jiang, fang feng, gan cao
-gui zhi shao Yao zhi mu tang
-Cold bi Zheng generally, hot bi locally
Bai Hu jia gui zhi tang
Shi gao, jing mi, zhi mu, gui zhi, zhi gan cao
- hot bi Zheng - yang Ming ch heat (four bigs)
Phlegm accum + blood stasis
Usu. Chronic bi Zheng, incessant pain, swollen, stiff joints, poss. deformity + subcutaneous nodules
T: dark or purple w white greasy c
P: thin, choppy, slippery, deep
Shen tong zhu yu tang
Tao ren, hong hua, dang gui, chuan xiong, mo Yao, wu ling zhi, niu xi, di long, Qin jiao, qiang huo, Xiang Fu, gan cao
For phlegm + Dan nan xing, + bai jie zi
- phlegm accum + blood stasis bi zheng
Huang qi gui zhi wu wu tang
Huang qi, bai shao Yao, gui zhi, sheng jiang, da zao
- bi Zheng dt qi + blood xu
Du huo Ji sheng tang
Du huo, xi xin, fang feng, Qin jiao, rou gui, dang Shen, Fu ling, gan cao, dang gui, chuan xiong, shu di huang, bai shao Yao, du Zhong, huai niu xi, sang Ji sheng
-bi Zheng dt qi + xue xu + LV + KD xu
SI jun zi tang + SI wu tang
SP 21
Blood stasis in collaterals
Bi Zheng differentiation
•Wind/Wandering Bì: characterized by pain that migrates from joint to joint; pain tends to be sore and aching
•Cold/Painful Bì : characterized by severe, excruciating pain in the affected joints with limited ROM
•Damp/Fixed Bì : characterized by heavy aching with possible swelling and numbness in the joints and limbs
•Heat Bì: characterized by red, swollen, painful joints that are warm to the touch

•According to which of the 5 Tissues are affected: Skin Bi, Muscle Bi, Vessel Bi, Sinew Bi, Bone Bi
•According to which of the 5 Zang are affected: Lung Bi, Spleen Bi, Heart Bi, Liver Bi, Kidney Bi
•According to the Fu affected: Intestine Bi, Bladder Bi
Skin, muscle, vessel, sinew, bone bi
•Skin Bi: local or generalized swelling, thickness of the skin with reduced sensation or numbness or sensation of cold
•Muscle Bi: muscle soreness, aching, stiffness, numbness, and weakness; heaviness of the limbs, body, and/or head; fatigue, spontaneous sweating, poor digestion
•Vessel Bi: fixed, stabbing pain that may be worse at night; also, soreness, pain, numbness that may involve an entire channel or limb; absence of pulse; purplish, dark areas under the skin (gangrene in severe cases)

•Sinew Bi: joint pain with stiffness, inflexibility, and spasm of the tendons
•Bone Bi: stiff, painful, swollen and even deformed joints
General tx methods for bi zheng
•Wind Bì: Expel Wind while nourishing Blood.  “Treat the Blood prior to expelling Wind.  As Blood circulation is restored, Wind is inevitably arrested.”
•Cold Bì : Scatter Cold while fortifying Yang.  “Warmth can unblock congealed Cold.”
•Damp Bì : Drying and draining Dampness are the primary strategies, along with tonifying the Spleen. “Bank up Earth to check Water.”
•Heat Bì: Clear Heat and employ other strategies according to the pathogens that are present.
WCD bi acupuncture
1.Wind-Cold-Damp Bi
A.Differentiation of Syndrome:
1)Wind: BL12, BL17, SP10, GB31, LI4, TB5
2)Cold: GV4, CV4, BL23 + moxa
3)Damp: SP9, CV9, ST28, (ST36, BL20)
B.Local points (based on the location of pain):
1)Shoulder: LI15, TB14, SI10, SI9, Jian Qian
2)Elbow: LI11, LU5, PC3, HT3, LI10, TB10, SI8
3)Wrist: LI5, TB4, PC7, LI4, TB5
4)Fingers: Ba Xie, LI4, LI3, TB3, Si Feng
5)Hip: GB30, GB29, GB34, ST31, Huan Zhong
Local points (cont’d.):
1)Sacrum: BL32, BL27, BL28
2)Low back: BL23, BL27, BL28
3)Knee: ST35, Nei Xi Yan, ST34, BL40, GB33, LV8, GB34, SP9, KI10, SP10, He Ding
4)Ankle: BL60, KI3, ST41, GB40, SP5, KI6
5)Toes : Ba Feng, ST44, SP3
6)Spine: GV14, GV12, GV3, Jia Ji
7)Neck: GB20, BL10, BL11, Jia Ji
WDH bi Zheng Pts
2. Wind-Damp-Heat Bi
A.General points: GV14, LI11, BL12, BL17, SP10, GB31, LI4, SP9, CV9, ST28, SP6, ST36, BL20
B.Local points: same as Wind-Cold-Damp
Phlegm + xue stag - bi Zheng pts
3. Stagnation of Phlegm and Blood
A.General for Phlegm: ST40, SP9, SP6, CV12, CV9, BL20
B.General for Blood stasis: SP10, BL17, BL11, SP6, (GB39)
C.Local points: same as Wind-Cold-Damp
Zheng qi xu cause bi Zheng acu pts
4. Zheng Qi Deficiency
A.General points for Qi and Blood Xu: CV4, CV6, SP6, ST36, BL20, BL17
B.General points for LV and KI Xu: BL18, BL23, GV4, CV4, K13, LV3, SP6
C.Local points: same as Wind-Cold-Damp
Guiding herbs Bi Zheng
•Upper Extremities: Qiang Huo, Bai Zhi, Jiang Huang, Wei Ling Xian, Chuan Xiong, Gao Ben
•Lower Extremities: Du Huo, Niu Xi, Mu Gua, Fang Ji
•Low Back or Spine: Du Zhong, Sang Ji Sheng, Yin Yang Huo, Ba Ji Tian, Xu Duan
•Red, swollen, painful, warm joints: Shi Gao, Zhi Mu, Lian Qiao, Qin Jiao, Ren Dong Teng
•Chronic Bi with spasmodic pain and spastic contracture of the limbs: Quan Xie, Wu Gong
Soft tissue structure grading scale
0   No tenderness
 I   Tenderness to palpation WITHOUT grimace or flinch
II   Tenderness WITH grimace &/or flinch to palpation
  III  Tenderness with WITHDRAWAL (+  "Jump Sign")
  IV  Withdrawal (+ "Jump Sign") to non– noxious stimuli (ie. superficial palpation,           pin prick, gentle percussion)
Neck pain tcm diff
Luò Zhěn: “crick in the neck;” “stiff neck;” literally means “fallen from the pillow,” and includes the following biomedical disorders: torticollis, cervical muscle strain, cervical fibrositis, grades I and II whiplash, and cervical rheumatism
Neck pain etiology + pathogenesis
1.Improper posture while sleeping: this restricts the flow of Qi and Blood locally in the channels and collaterals of the neck causing pain and stiffness.
2.Trauma: hyperextension, flexion or rotation damages the channels and collaterals in the neck, restricting Qi and Blood flow and resulting in pain.

1.Emotional stress: intense or prolonged stressful emotional states can stagnate Qi and Blood, causing stiffness and pain and the neck.
2.Exogenous Pathogens: invasion of exogenous Wind-Cold into the channels and collaterals of the neck restrict the flow of Qi and Blood, causing stiffness and pain.
Neck pain dt qi stag + blood stasis
1.Local points: Ashi, GV14, GV15, GV16, Jia Ji, BL10, GB20, GB21, SI16
2.Distal points: SI3, BL60, BL62, GB39, Luo Zhen, LU7, TB5
3.Modification based on the pattern:
a)Qi stag., Blood stasis: BL17, SP10, 4 Gates
Neck pain tx dt qi stag + xue stasis
Move Qi, quicken the Blood, soothe soft tissues, harmonize and open the channels and collaterals, stop pain
Neck pain, qi stag + xue stasis herbal formula
Sheng Tong Zhu Yu Tang
Tao Ren (Peach kernel) 9g
Hong Hua (Carthamus flower) 9g
Dang Gui (Angelica root) 9g
Chuan Xiong (Ligusticum root) 6g
Mo Yao (Myrrh) 6g
Wu Ling Zhi (Flying squirrel feces) 6g
Niu Xi (Achyranthes root) 9g
Di Long (Earthworm) 6g
Qin Jiao (Large Gentian root) 3g
Qiang Huo (Notopterygium root) 3g
Xiang Fu (Cyperus rhizome) 3g
Gan Cao (Licorice root) 6g
Neck pain dt wind cold invasion acu pts
1.Local points: Ashi, GV14, GV15, GV16, Jia Ji, BL10, GB20, GB21, SI16
2.Distal points: SI3, BL60, BL62, GB39, Luo Zhen, LU7, TB5
3.Modification based on the pattern:
a)Wind-Cold Invasion: GV14, BL12, GB20, LI4, TB5 + moxa
Neck pain dt wind cold invasion herbal formula
Ge Gen Tang
Ge Gen (Pueraria root) 15g
Ma Huang (Ephedra) 6g
Gui Zhi (Cinnamon twig) 9g
Bai Shao Yao (White Peony root) 9g
Sheng Jiang (Fresh Ginger root) 6g
Da Zao (Jujube) 3pcs.
Zhi Gan Cao (Honey-fried Licorice root) 6g
Neck Pain Manifesting as Stagnation of Liver Qi
Main Symptoms: stiffness, muscle spasm, or tension and aching pain on one or both sides of the neck as well as the occipital and/or temporal regions of the head; pain mild to moderate in intensity; pain is related to emotional situation (e.g., anger, frustration, irritability, depression) and stress
Additional Symptoms: feeling of tightness or stuffiness in the chest, tendency to sigh, headache, bitter taste in the mouth, insomnia
Tongue: normal or slightly purplish in color with thin, white coat
Pulse: wiry
Tx method: Course the Liver, rectify the Qi, soothe and nourish soft tissues, open the channels and collaterals, stop pain
Acupuncture for Neck Pain Manifesting as Stagnation of Liver Qi
1.Local points: Ashi, GV14, GV15, GV16, Jia Ji, BL10, GB20, GB21, SI16
2.Distal points: SI3, BL60, BL62, GB39, Luo Zhen, LU7, TB5
3.Modification based on the pattern:
a)LV Qi stagnation: LV3, GB20, PC6, BL18, GB41
Rx for Neck Pain Manifesting as Stagnation of Liver Qi
Xiao Yao San Jia Wei
(Free Wanderer Powder with Additional Flavors)
 
Chai Hu (Bupleurum root) 10g
Dang Gui (Angelica root) 10g
Bai Shao Yao (White Peony root) 20g
Fu Ling (Poria) 15g
Bai Zhu (Atractylodes rhizome) 10g
Gan Cao (Licorice root) 6g
Sheng Jiang (Fresh Ginger root) 3g
Bo He (Mint) 3g
Ge Gen (Pueraria root) 15g
Yan Hu Suo (Corydalis rhizome) 12g
Whiplash classifications
The Quebec Task Force Classification of Whiplash-Associated Disorders identifies 4 categories of injury:
1.Grade I: comprises general, nonspecific complaints regarding the neck, such as pain, stiffness, or soreness without objective physical findings
2.Grade II: comprises neck complaints plus decreased range of motion and point tenderness in the neck.
3.Grade III: comprises neck complaints plus neurologic signs such as decreased deep tendon reflexes, weakness and sensory deficits.
4.Grade IV: comprises neck pain plus fracture or dislocation, or injury to the
General acupuncture for neck pain
4.One method for treatment of Neck Pain is to needle Luo Zhen, GB39, or SI3 and have the patient rotate the neck while stimulating the needle.  A few minutes of this can dramatically reduce pain and stiffness.  This can be followed up with more extensive treatment including local and distal points, moxibustion, cupping and/or massage.
Sx for neck pain dt qi stag + blood stasis
Symptoms: recent onset of stiffness and fixed pain of the neck; pain mild to severe in intensity and possibly sharp or stabbing and worse at night; heat provides temporary relief; possible twisting or tilting of head toward affected side; local tender spots that may have palpable cord-like masses
Tongue: normal color with thin, white coat
Pulse: wiry
Heat bi etiology + pathogenesis
1.Exogenous Heat invades,in combination with Wind and Dampness, causing Wind-Damp-Heat Bì.
 
Heat Bì can also form when Wind-Cold-Damp invade a body that has pre-existing Heat, either through Yang excess or Yin Deficiency. Qi stagnation itself can potentially generate Heat, and in individuals with pre-existing Heat this process is greatly facilitated.
B zheng 3 stage
1.Superficial stage/Channel stage: acute, relatively mild symptoms
2.Intermediate stage/Tissue stage: chronic/recurrent, relatively severe symptoms
3.Deep stage/Internal organs stage: very severe, chronic symptoms
Wei Zheng Definition
•Wĕi Zhèng refers to a group of disorders in which the limbs have become atonic – weak, flaccid, and unresponsive to voluntary motor control.
•The condition may be localized or systemic. The lower limbs are most often affected, resulting in weakness and difficulty ambulating.
•In chronic cases, muscular atrophy and complete paralysis of the affected limbs can develop.
Wei Zheng pathogenesis
The main pathomechanism of Atrophy Syndrome/Wĕi Zhèng is lack of nourishment and moistening of the sinews (muscles, tendons, and vessels). External and internal evils can both cause this condition and can mutually affect each other.
Wei Zheng etiology
*External Heat evil or prolonged febrile disease: this can cause Lung Heat, which injures fluids and impairs d + d fx of the Lung.  Moisture and nourishment are not disseminated to the sinews and muscles; the extremities are affected, becoming weak and flaccid with decreased motor control.
*Exposure to Dampness or irregular diet: these result in accumulation of Dampness in the sinews and muscles that transforms into Damp-Heat, obstructing the flow of Qi and Blood and consuming body fluids.  The sinews and muscles lose nourishment, become weak and flaccid, lose mass and atrophy.
*1.Weak constitution, chronic disease, unhealthy lifestyle, aging, excessive sexual activity result in:
A.Spleen/Stomach Deficiency: inefficient rotting and ripening and t + t results in Qi, Blood, Body Fluid, and Essence Deficiency. Qi Xu causes impaired circulation of Xue + Jin ye; deficient xue and Jin ye fail to nourish and moisten the sinews, muscles, and bones causing atrophy.
*Liver and Kidney Xu: the Liver governs the sinews and stores the Blood to nourish sinews, while the Kidney governs the Bones and stores the Essence that produces Marrow to nourish the Bones.  If the Liver and Kidney are deficient, they are unable to support their related tissues and there will be flaccidity and weakness of the sinews and Bones.
SJ 5 + gb 41 can treat
Occipital region.. .good distal pts for neck pain
Low libido in men
Usu KD yang xu
Erectile disfx could be damp heat
Herbal formula for KD yang xu
You gui wan (right restoring pill)
Shu di huang, Shan Yao, shan zhu yu, qou qi zi, tu si zi, Lu jiao jiao, du Zhong, dang guy, zhi Fu zi, rou gui
Low back pain etiology + pathogenesis
1.Constitutional deficiency, aging, chronic illness, or excessive sexual activity: these factors lead to Kidney deficiency with failure to nourish the low back, sinews, and bones.
Herbal formula for KD yin xu
Zuo gui wan (restore left pill)
Shu di, Shan Yao, shan zhu yu, gou qi zi, tu si zi, gui ban jiao, Lu jiao jiao, huai niu xi
Shi or xu back pain
•Excess patterns generally have a more acute onset and are associated with obstruction by exogenous pathogenic factors or trauma, overuse, or sprain/strain.
•Deficiency patterns generally have a gradual onset and are associated with Kidney deficiency.
•Mixed excess/deficiency patterns are possible.
* consider Lin syndrome if urination problems present
Acupuncture (general) for low back pain
1.Local points:
A.Main points: BL23, GV3, Hua Tuo Jia Ji,   BL 25, BL26, BL28, BL30, BL32, BL54, GV4, Shiqizhuixia, Yaoyan
B.Secondary points: other BL points, GB25, GB30
2.Distal points: BL40, BL60, BL57, BL58, SI3, BL62, KI3, Yaotongxue, GB34
Acupuncture for back pain based on patterns
1.According to pattern:
A.Cold-Dampness: BL40, GV3, SP9, CV9 + moxa
B.Damp-Heat: BL40, SP9, BL28, LI11
C.Qi & Blood stagnation: BL40, SP10, SP6, BL17, BL32; acute sprain: GV26
D.Kidney deficiency: KI3, BL23, GV3, GV4, CV4, CV6, BL52 + moxa
2.Ear Acupuncture: Lumbar Vertebrae, Sacral Vertebrae, Kidney, Shen Men
3.Cupping
4.Electroacupuncture
Sciatic etiology
Sciatica: Etiology
Common causes of sciatica include:
•Piriformis syndrome (a pain disorder involving the narrow piriformis muscle in the buttocks)
•Herniated disk
•Degenerative disk disease
•Spinal stenosis
•Pelvic injury or fracture
•Tumors
•Vascular problems due to abnormalities of blood vessels in and around the spinal canal.
•Other causes such as trauma, infection, and inflammation can affect nervous tissue.
Sciatica definition
•In TCM terms, sciatica may be categorized as Painful Obstruction Syndrome/Bì Zhèng or Low Back Pain/Yāo Tòng.
•Sciatica refers to pain, weakness, numbness, or tingling in the leg. It is caused by injury to or compression of the sciatic nerve.
•It may be sudden in onset and can persist for days or weeks.
•Sciatica is a symptom of another medical problem, not a medical condition on its own.
Gv 26 can be used for
Acute lumbar sprain
Sciatica sx
•Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or a burning sensation. In some cases, the pain is severe enough to make a person unable to move.
•The pain most often occurs on one side. Some people have sharp pain in one part of the leg or hip and numbness in other parts. The sensations may also be felt on the back of the calf or on the sole of the foot. The affected leg may feel weak.

•The pain often starts slowly. Sciatica pain may get worse:
–After standing or sitting
–At night
–When sneezing, coughing, or laughing
–When bending backwards or walking more than a few yards, especially if caused by spinal stenosis
Sciatica red flags
Additionally:
1.Unintentional weight loss
2.History of steroid or intravenous drug use
3.History of previous back pain but this episode is different and feels worse
4.Back pain that has lasted longer than 4 weeks
If any of these symptoms are present, your patient needs to be checked for any sign of infection (such as meningitis, abscess, or urinary tract infection), ruptured disk, spinal stenosis, hernia, cancer, kidney stone, twisted testicle, or other serious problem.
SLR
Straight leg test for sciatica
•+ Radicular leg pain = nerve root compression, intervertebral disc herniation, piriformis entrapmnent
•+ Low back pain = SI/lumbar sprain/strain
•Degree of Flexion and Tissue Involved:
–0 to 35 degrees indicates extradural involvement (hip).
–between 30 and 70 degrees indicates nerve root compression.
–beyond 70 degrees points to lumbosacral joint conditions.
If SLR is positive do...Other orthopedic tests for sciatica
•Bragard's Sign: If the SLR is positive, lower the leg on the affected side to just below the point of pain and quickly dorsiflex the foot. If the pain is duplicated or increased, this suggests sciatic neuritis.
•Lindner’s Test/Lift the Head: Once the leg is raised to the point at which symptoms are reproduced, instruct the patient to lift his or her head, bringing the chin to the chest. If this movement is limited or increases the pain in the lower back or leg, it suggests inflammation of the nerve root.
Well leg raise
•Well Leg Raise: The SLR is performed on the unaffected leg. If pain is referred back to the symptomatic side, this indicates nerve root compromise by an extruded disc.
Acupuncture pts for sciatica
1.Local points: BL23, BL24, Hua Tuo Jia Ji (L-3 to L-5 primarily), BL32, BL54, GB30, Huan Zhong, Ashi
2.Distal points:
A.BL Channel: BL36, BL40, BL60, BL57, BL58
B.GB Channel: GB34, GB35, GB39
C.Extraordinary Vessels: SI3, BL62
Qi + xue, LV + KD xu herbal formula
Du Huo Ji Sheng Tang
Du Huo (Pubescent Angelica root) 9g
Xi Xin (Asarum herb) 3g
Fang Feng (Saposhnikoviae root) 6g
Qin Jiao (Large Gentian root) 6g
Rou Gui (Cinnamon bark) 6g
Dang Shen (Codonopsis root) 12g
Fu Ling (Poria) 6g
Gan Cao (Licorice root) 6g
Dang Gui (Angelica root) 6g
Chuan Xiong (Ligusticum root) 6g
Shu Di Huang (Cooked Rehmannia root) 6g
Bai Shao Yao (Peony root) 6g
Du Zhong (Eucommia bark) 6g
Huai Niu Xi (Achyranthes root) 6g
Sang Ji Sheng (Taxillus) 6g
Tx principle for bi Zheng d/t Qi + xue, LV + KD xu
Treatment Method:
Supplement Qi and Blood, nourish the Liver and Kidney, expel Wind, scatter Cold, eliminate Dampness
Bi Zheng sx d/t Qi + xue, LV + KD xu
 
Symptoms: chronic, aching pain in joints, particularly the low back and knees; difficult movement with limited ROM, possible aversion to cold with symptoms relieved by warmth, possible numbness or decreased sensation in affected areas; fatigue, shortness of breath
Tongue: pale with white coat
Pulse: weak, thin
Back pain d/t KD yin xu sx + tx principle
Main Symptoms: gradual onset and long history of dull, aching pain in the low back that is aggravated by exertion and relieved by rest and pressure
Additional Symptoms: insomnia, malar flush, 5 center Heat, dry throat, sore/weak knees
Tongue: red with scanty coat
Pulse: thin, rapid

Treatment Method:
Nourish Kidney Yin, relieve pain
Back pain d/t KD yang xu sx + tx principle
Main Symptoms: gradual onset and long history of dull, aching pain in the low back that is aggravated by exertion and relieved by rest and pressure; possible cold sensation in low back
Additional Symptoms: cold extremities, pale complexion, nocturia, low libido, sore/weak knees, possible lower body edema; may also see incontinence, frequent urination, infertility, and loose stool with undigested food
Tongue: pale with thin, white coat
Pulse: deep, thin, weak

Treatment Method:
Warm and supplement Kidney Yang, relieve pain
Back pain d/t Damp heat herbal formula
Si Miao Wan Jia Wei
(Mysterious Four Pill with Additional Flavors)
Huang Bai (Phellodendron bark) 9g
Cang Zhu (Atractylodes root) 9g
Huai/Chuan Niu Xi (Achyranthes/Cyathulae root) 9g
Yi Yi Ren (Coix seed) 15g
 
+ Mu Gua (Chaenomeles fruit) 9g
Luo Shi Teng (Star Jasmine stem) 12g
Back pain d/t Damp heat sx + tx method
Main Symptoms: mild to severe low back pain with sensation of heat in the area; possible sensation of heaviness; pain aggravated in damp, hot weather
Secondary Symptoms: bitter taste in the mouth, dark, scanty urine
Tongue: red (possibly) with yellow, greasy coat
Pulse: soft or slippery and rapid

Treatment Method:
Clear Heat, eliminate Dampness, open the channels and collaterals, relieve pain
Back pain d/t Cold damp herbal formula
Gan Jiang Ling Zhu Tang Jia Wei
Fu Ling (Poria) 12g
Gan Jiang (Dried Ginger root) 12g
Bai Zhu (White Atractylodes root) 6g
Gan Cao (Licorice root) 6g
+ Gui Zhi (Cinnamon twig) 9g
Chuan Niu Xi (Cyathulae root) 9g
Du Zhong (Eucommia bark) 12g
Sang Ji Sheng (Taxillus) 12g
Xu Duan (Dipascus root) 9g
Low back pain d/t cold damp
Main Symptoms: mild to severe cold pain with heaviness in the low back with decreased range of motion; pain is better with light exercise and heat, worse with rest and exposure to cold and dampness; one cold predominates, pain is more severe and muscles are stiffer and were contracted; when damp predominates, swelling and numbness are possible
Tongue: white, greasy coat
Pulse: deep, tight or deep, slow

Treatment Method:
Dispel Cold, eliminate Dampness, warm and open the channels and collaterals, relieve pain
Low back pain d/t qi stag + blood stasis herbs
Shen Tong Zhu Yu Tang
Tao Ren (Peach kernel) 9g
Hong Hua (Carthamus flower) 9g
Dang Gui (Angelica root) 9g
Chuan Xiong (Ligusticum root) 6g
Mo Yao (Myrrh) 6g
Wu Ling Zhi (Flying squirrel feces) 6g
Niu Xi (Achyranthes root) 9g
Di Long (Earthworm) 6g
Qin Jiao (Large Gentian root) 3g
Qiang Huo (Notopterygium root) 3g
Xiang Fu (Cyperus rhizome) 3g
Gan Cao (Licorice root) 6g
Low back pain d/t qi stag + blood stasis sx + tx principle
Main Symptoms: severe, fixed, stabbing pain that may be better with light movement; pain aggravated by rest, pressure, and at night; decreased range of motion; noticeable muscle spasm; possible history of recent injury
Tongue: dark, purplish; may have stasis macules
Pulse: choppy

Treatment Method:
Quicken the Blood, transform stasis, move Qi, relieve pain
Low back pain general tx method
•Early-stage of exogenous invasion: expel pathogenic factors, open the channels and collaterals, relieve pain.
•Chronic low back pain: supplement the Kidney, relieve pain.
•Mixed excess and deficiency: treat Root and Branch simultaneously with both tonification and elimination of pathogenic factors.