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79 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
sheng mai san
Fx: augment qi, generate fluids, preserve yin, stop shi sweating
I: chronic cough, scanty sputum diff. to expect. s.o.b, spont. sweat, dry mouth/tongue, red T w/ dry thin coat, xu/rapid or xu/thin
ren shen, mai men dong, wu wei zi
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
liu wei di huang wan
Fx: enrich yin, nourish KD essence
I: sore, weak low back, light headed, vertigo, tinnitis, night sweat, spont/noct. emissions red T w/little coat, rapid thin pulse (five palm heat, sore throat, kiao ke)
shu di huang- tonify xue, kd yin/essence
shan zhu yu + shan yao: nourish LV blood/bind essence + tonify SP/+kd essence
fu ling - disperse damp, +turbidy w/ze xie + mu dan pi: clear lv fire d/t yin xu
ze xie: clear kd fire, turbid water of kd
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)
qi ju di huang wan
gou qi zi + ju hua
fx: enrich yin, nourish KD/eyes
*dry eyes w/dimin. visual acuity, photophbia, tearing when exposed to drafs, painful eyes, kd/lv xin xu w/LV xu predominant
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
zhi bai di huang wan
zhi mu + huang bai - clear xu heat + nourish yin
I: steaming bone/night sweat, dry mouth/tongue, large pulse in rear positiion, urinary diff. w/low back pain from D/H in LJ
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
jin kui shen qi wan
fx: warm/tonify KD yang
I: low back pain, weak lower extrem, cold in lower 1/2 body, tenseness in lower abd. pale swollen T w/thin white moist coat, empty frail pulse, suberged faint @ prox. position
Fu Zi
Rou Gui (or gui zhi)
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
shao yao gan cao tang
fx: nourish blood, augment yin, moderate painful spasms, alleviate pain
I: irritable, sl. chills, spasms of calf muscles, no coat on T, abd. pain better w/pressure, thin/wiry P
shao yao, zhi gan cao
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.
jin ling zi san
Fx: spread lv qi, drain heat, regulate qi, alleviate pain
I: intermitt epigastric/hypochondriac pain, hernial pain/mensrual pain, red T w/yellow coat, wiry/rapid p
chuan lian zi, yan hu suo
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
bu yang huan wu tang
fx: tonify qi, invigorate xue, unblock ch.
I: sequelae of wind-stroke
*qi nourishing, xue stag after stroke
huang qi, dang gui, chuan xiong, chi shao, tao ren, hong hua, di long
shi xiao san
fx: invigor. blood, dispel xue stasis, disperse accum.
I: irreg. menstruation, dysmenorr, retention lochia, post partum abd. pain
*painful menses
wu ling zi, pu huang
xue fu zhu yu tang
fx: invig. xue, dispel xue stasis, spread qi of LV, unblock ch.
I: pain in chest/hypochond. stubborn h.a.,
*stasis/heat in UJ (long term)
chuan xiong, tao ren, hong hua, dang gui, chi sao, niu xi, sheng di huang, chai hu, jie geng, zhi ke