Ty: Tcmpatho 1

Front 1

10 diagnostic systems of pattern differentiation

Back 1

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)

Front 2

Acupuncture treatment methods

Back 2

1.Reinforcing/supplementing/tonifying
2.Reducing/draining
3.Warming
4.Clearing
5.Ascending
6.Descending

Front 3

Herbal treatment methods

Back 3

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

Front 4

Causes of qi stagnation

Back 4

1.Emotional strain
2.Irregular diet
3.Taxation fatigue (overwork)
4.Lack of exercise
5.W/C/D

Front 5

Cause of Blood stasis

Back 5

1.Trauma
2.Qi stagnation
3.Qi deficiency
4.Cold
5.W/C/D
5.Heat
6.Blood deficiency
7.Aging

Front 6

SOAP

Back 6

Subjective: history, px observations, inquiry
Objective: Physical exam, doc observations, Looking/palpation/listening/smelling etc
Assessment: Diagnosis/prognosis

Front 7

Main yin/yang imbalances

Back 7

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

Front 8

Clear xu heat herb combo

Back 8

Zhi mu + huang bai

Front 9

Xie qi

Back 9

6 ext evils
5 int. gen evils
+ phlegm, qi stag, xue stasis

Front 10

Zheng qi

Back 10

Right qi, anti pathogenic qi
- all physiologic qi of zang/Fu, blood

Front 11

Most common shoulder pain classification

Back 11

Rotator cuff tendonitis -esp supraspinatus muscle

Front 12

Stiffness + loss of motion is Major sx for...

Back 12

adhesive capsulitis ( frozen shoulder), dislocation, glenohumeral joint arthritis

Front 13

Pain with throwing is major sx that suggests...

Back 13

Anterior glenohumeral instability

Front 14

Chronic pain + loss of passive range of motion =

Back 14

Frozen shoulder, possible tears of rotator cuff

Front 15

Acute trauma with arm abducted and ext. rotated =

Back 15

Shoulder sublexation, dislocation, possible glenoid labral injury

Front 16

Neck pain/pain radiating below elbow are subtle signs of -

Back 16

Cervical spine disorder (excludes an actual shoulder problem) - this is cause of pain

Front 17

Referred pain from where + which channels also could exclude actual shoulder problem-

Back 17

Elbow, HT, GB - could cause shoulder pain

Front 18

Complete shoulder exam includes -

Back 18

Shoulder inspection/observation
Shoulder palpation
Shoulder range of motion
Shoulder provocative testing

Front 19

Inspection of shoulder -

Back 19

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)

Front 20

Palpation of shoulder -

Back 20

*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)

Front 21

Apleys scratch test

Back 21

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)

Front 22

Active range of motion test -

Back 22

Px fully abducted arms without supinating palms - pain btwn 45* + 120* = possible tendinitis of rotator cuff muscles, subacromial bursitis, calcium deposits
- muscle prob usu.

Front 23

Passive ROM -

Back 23

If painful - most likely joint itself: tendon/ligament/cartilage/bone etc.
You move their arm for them

Front 24

Empty can test - shoulder provacative testing ---

Back 24

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.

Front 25

Cervical compression test-

Back 25

IVF encroachment, radiculopathy (nerve root compressed) if radiation occurring
* local pain in cervical spine (doesn't radiate) not related to shoulder

Front 26

Valsalvas maneuver -

Back 26

Strain to poo
Cervical disorders OR
*lumbar radiculopathy

Front 27

Adsons test -

Back 27

Abduct and ext. Rotate, bring back -- palpate pulse
Take breath, hold it, turn in direction of extended hand
(compression of scalenes on brachial plexus)

Front 28

Jian tong

Back 28

Shoulder pain d/t overuse + trauma

Front 29

Bi zheng

Back 29

Painful obstruction syndrome (W C D)

Front 30

4 etiologies for shoulder pain -

Back 30

Trauma
Overuse
Lack of nourishment
Invasion of exogenous pathogens

Front 31

Shi shoulder pain issues -

Back 31

*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

Front 32

Xu shoulder pain issues -

Back 32

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

Front 33

Basic approach for selecting acu pts

Back 33

-always identify involved channel(s)
Local
Adjacent
Distal
Pts for pattern
-according to pt category
-empirical
-microsystems

Front 34

Methods of pt selection

Back 34

-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

Front 35

Channels transversing the shoulder

Back 35

3 yang ch. most important
LI, SJ, SI
LU / HT + PC (less imp. though HT 1 into subscap sometimes imp - frozen shoulder)

Front 36

Important shoulder pain points

Back 36

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

Front 37

Other imp shoulder pain needling techniques

Back 37

-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)

Front 38

Shoulder pain - as qi stag + blood stasis

Back 38

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

Front 39

Pts/prescription for shoulder pain w/ qi stag + xue stasis

Back 39

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

Front 40

Lock + chain method

Back 40

Free up qi/xue @ joints specifically

Front 41

Herbs for shoulder pain d/t qi + xue stasis

Back 41

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

Front 42

Shoulder pain - W/C/D

Back 42

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

Front 43

Pts/prescription for shoulder pain d/t W/C/D bi

Back 43

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)

Front 44

Xue hai

Back 44

Sp10 - move blood strongly (clear heat)
BL 17 similar in moving blood

Front 45

Tx of shoulder should always include ---

Back 45

Tx of paraspinal muscle (trapezius, levator scap, rhomboids) + neck + upper back (hua tui jia jia, Gb, TB, BL channels)

Front 46

Disperse wind - pts often used --

Back 46

LI4 + TB5 most important for wind in the body

Front 47

Herb /prescription for shoulder pain dt bi syndrome

Back 47

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

Front 48

Shoulder pain d/t qi + xue xu

Back 48

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

Front 49

Pts/prescription for shoulder pain d/t qi + xue xu

Back 49

Local/adjacent/distal
BL17, ST36, CV6(boost qi/warm yang), SP6
- needle with supplementing technique

Front 50

Herbal formula for shoulder pain due to qi and blood xu

Back 50

Huang qi gui zhi wu wu tang
-huang qi, bay shao Yao, gui zhi, sheng jiang, da zao

Front 51

Guiding herbs for shoulder pain

Back 51

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

Front 52

Assessment of shoulder pain includes...

Back 52

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)

Front 53

Lateral Epicondylitis/Tennis Elbow

Back 53

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.

Front 54

Sx of lateral epicondylitis

Back 54

•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.

Front 55

Examination/test for lateral epicondylitis

Back 55

•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).

Front 56

Biomedical tx tennis elbow

Back 56

•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

Front 57

Tcm tennis elbow categorization

Back 57

•Zhŏu Tòng: “elbow pain”
•Shāng Jīn: “damaged sinews”
•Zhŏu Láo: “elbow taxation”
•Zhŏu Bì Zhèng: “elbow painful obstruction syndrome”

Front 58

Elbow Pain:
TCM Etiology and Pathogenesis

Back 58

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

Front 59

Elbow pain - qi stag + blood stasis

Back 59

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

Front 60

Acu tx for elbow pain/qi stag + blood stasis

Back 60

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

Front 61

Herbal formula for elbow pain/qi stag + blood stasis

Back 61

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

Front 62

Elbow Pain Manifesting as
Cold-Damp Invasion

Back 62

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

Front 63

sheng mai san

Back 63

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

Front 64

Acupuncture Treatment for
Elbow Pain Manifesting as
Cold-Damp Invasion

Back 64

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

Front 65

liu wei di huang wan

Back 65

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

Front 66

Herbs for elbow pain d/t w/c/d with cold Predominant

Back 66

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)

Front 67

qi ju di huang wan

Back 67

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

Front 68

Herbs for elbow pain d/t w/c/d with damp Predominant

Back 68

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

Front 69

zhi bai di huang wan

Back 69

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

Front 70

Elbow Pain Manifesting as Qi and Blood Deficiency

Back 70

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

Front 71

jin kui shen qi wan

Back 71

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)

Front 72

Acupuncture Treatment for
Elbow Pain Manifesting as Qi and Blood Deficiency

Back 72

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

Front 73

shao yao gan cao tang

Back 73

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

Front 74

Herbs for elbow pain d/t qi + xue xu

Back 74

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.

Front 75

jin ling zi san

Back 75

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

Front 76

Prognosis and Tx Plan for
Tennis Elbow

Back 76

•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

Front 77

bu yang huan wu tang

Back 77

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

Front 78

shi xiao san

Back 78

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

Front 79

xue fu zhu yu tang

Back 79

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