Oral Cavity Disorders: a Oral Cavity Disorders: a TCVM ApproachTCVM Approach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
Oral Cavity Diseases (Western)Oral Cavity Diseases (Western)
•Local damageLocal damage•Electric shockElectric shock•Chemical damageChemical damage•Thermal damageThermal damage•PeriodontitisPeriodontitis
•Tooth tarterTooth tarter
•Systemic diseaseSystemic disease•Metabolic diseaseMetabolic disease•Nutritional diseaseNutritional disease•Immune diseaseImmune disease•Infectious diseaseInfectious disease
•TreatmentTreatment
•Remove offending Remove offending causecause
•SteroidsSteroids•AntibioticsAntibiotics
•Clean teethClean teeth
TCM Spleen DiseaseTCM Spleen Disease
• Spleen PhysiologySpleen Physiology
• Spleen PathologySpleen Pathology
• Gingivitis/StomatitisGingivitis/Stomatitis
EarthEarth
•SoundSound•songsong
•EmotionEmotion•sympathysympathy
•ClimateClimate•humidhumid
•SeasonSeason•late summerlate summer
•DirectionDirection•centercenter
•OpeningOpening•lips/gumslips/gums
•Body PartBody Part•musclesmuscles
•Zang/FuZang/Fu•SP/STSP/ST
TCM TCM SPLEENSPLEEN PhysiologyPhysiology
•Governs Transportation & Governs Transportation & TransformationTransformation
•Food & WaterFood & Water
•Controls BloodControls Blood
•Dominates the MusclesDominates the Muscles
•Opens in MouthOpens in Mouth•Lips & Gums (ST)Lips & Gums (ST)
TCM 24 Hour ClockTCM 24 Hour Clock
GB 11- 1AM
TH 9- 11 PM
PC 7- 9 PM
KID 5- 7 PM
BL 3- 5 PM SI 1- 3 PM
HT 11- 1 PM
SP 9- 11 AM
ST 7- 9 AM
LI 5- 7 AM
LU 3- 5 AMLIV 1- 3 AM
Spleen PathologySpleen Pathology
Spleen PathologySpleen Pathology
• Damp is the Enemy of the SpleenDamp is the Enemy of the Spleen
• Damp-ColdDamp-Cold• Damp-HeatDamp-Heat• Spleen Qi Deficiency with DampSpleen Qi Deficiency with Damp
Spleen PathologySpleen PathologyUsually combination of excess & deficiencyUsually combination of excess & deficiency
Damp-HeatDamp-Heat Damp-ColdDamp-Cold
Obstructs Spleen Qi FlowObstructs Spleen Qi Flow
Spleen fails to Transform & Transport Gu QiSpleen fails to Transform & Transport Gu Qi
Spleen Qi DeficiencySpleen Qi Deficiency
External or Internal PathogenExternal or Internal Pathogen
Spleen PathologySpleen Pathology
Cold Food Cold Food or Drinkor Drink
Cold Cold Environmental Environmental ConditionsConditions
Cold-Damp in SpleenCold-Damp in Spleen
Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow
Spleen Pathology Spleen Pathology
Damp Hot Damp Hot Food or Food or DrinkDrink
Damp Hot Damp Hot Environmental Environmental ConditionsConditions
Damp-Heat in SpleenDamp-Heat in Spleen
Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow
Accumulated Accumulated Heat & DampHeat & Damp
Spleen Qi DeficiencySpleen Qi Deficiency
OvereatingOvereating
StarvationStarvation
Spleen Qi DeficiencySpleen Qi Deficiency
Failure to Transform & TransportFailure to Transform & TransportDisturbed Qi FlowDisturbed Qi Flow
IllnessIllness
OverworkOverwork
Under WorkUnder Work
Spleen Not Controlling BloodSpleen Not Controlling Blood
HemorrhageHemorrhage
Spleen Fails to Hold BloodSpleen Fails to Hold Blood
Chronic HemorrhageChronic HemorrhageGeneral SignsGeneral Signs
Prolonged Spleen Qi DeficiencyProlonged Spleen Qi Deficiency
Spleen Qi SinkingSpleen Qi Sinking
OvereatingOvereating
StarvationStarvation
Chronic Spleen Qi DeficiencyChronic Spleen Qi Deficiency
Failure of HoldingFailure of Holding
Chronic DiarrheaChronic DiarrheaProlapsesProlapsesIncontinenceIncontinence
IllnessIllness
OverworkOverwork
Under WorkUnder Work
Spleen PathologySpleen Pathology
Cold Food Cold Food or Drinkor Drink
Chronic Spleen Chronic Spleen Qi DeficiencyQi Deficiency
Spleen Yang DeficiencySpleen Yang Deficiency
Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow
Yang Deficiency SignsYang Deficiency Signs
Stomach PathologyStomach Pathology
Cold Food Cold Food or Drinkor Drink
Cold Cold Environmental Environmental ConditionsConditions
Cold in StomachCold in Stomach
Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow
Inhibition of YangInhibition of Yang
Stomach ColdStomach Cold
Stomach ColdStomach Cold
Cold Food & DrinkCold Food & DrinkCold EnvironmentCold Environment
Receiving &Receiving &DecomposingDecomposing
AnorexiaAnorexia AlteredAlteredQi FlowQi Flow
LassitudeLassitude
Cold SignsCold Signs
Cold Ear/NoseCold Ear/NoseHypersalivationHypersalivationPale-Purple TonguePale-Purple TongueDeep-Slow PulseDeep-Slow Pulse
Stomach Pathology Stomach Pathology
Hot Dry Hot Dry Food or Food or DrinkDrink
Damp Hot Damp Hot Environmental Environmental ConditionsConditions
Heat in StomachHeat in Stomach
Transform & Transport DisorderTransform & Transport DisorderHeat SignsHeat Signs
Stomach HeatStomach Heat
Stomach HeatStomach Heat
Pathogenic HeatPathogenic HeatYin DeficiencyYin Deficiency
channelchannel
GumsGums organorgan
UlcerUlcer
childchild
ColitisColitis
grandchildgrandchild
CystitisCystitis
Stomach Food StagnationStomach Food Stagnation
OvereatingOvereating Indigestible FoodIndigestible Food
Retention of Food in StomachRetention of Food in Stomach
Failure to Transform & TransportFailure to Transform & TransportDisturbed Qi FlowDisturbed Qi Flow
Stomach Yin DeficiencyStomach Yin Deficiency
Chronic FebrileChronic FebrileIllnessIllness
Impairment of Body FluidsImpairment of Body Fluids
Stomach Yin DeficiencyStomach Yin Deficiency
StressStress
Liver Qi StagnationLiver Qi Stagnation
TransformationTransformationto Heat/Fireto Heat/Fire
How to Use Acupuncture for How to Use Acupuncture for Gingivitis in Small Animal Gingivitis in Small Animal
PracticePracticeZang Fu PhysiologyZang Fu Physiology
• Teeth correspond to boneTeeth correspond to bone
• Bone is controlled by the kidneyBone is controlled by the kidney• Malocclusion, oligodontia are examples Malocclusion, oligodontia are examples
of Kidney Jing Deficiencyof Kidney Jing Deficiency
• Gums are influenced by the stomachGums are influenced by the stomach
Meridian TheoryMeridian Theory
• Oral cavity has two main channels Oral cavity has two main channels that influence the teeth and gumsthat influence the teeth and gums
• Large Intestine meridianLarge Intestine meridian
• Stomach meridianStomach meridian
Pattern DiagnosisPattern Diagnosis
• Stomach Heat PatternStomach Heat Pattern• Excess pattern, seen more often in Excess pattern, seen more often in
younger animals (cats)younger animals (cats)
• Stomach Yin Deficiency + Empty HeatStomach Yin Deficiency + Empty Heat• Stomach loves moisture Stomach loves moisture • Moisture balances Yang functionMoisture balances Yang function• Lack of Yin (fluid) allows Yang Fire to Lack of Yin (fluid) allows Yang Fire to
riserise
Stomach Heat PatternStomach Heat Pattern
•FluffyFluffy: 4yr FS DSH: 4yr FS DSH
•Primary complaintPrimary complaint: Bad : Bad breath, eating poorlybreath, eating poorly
•HistoryHistory: Stray, no : Stray, no vetcare, dry food dietvetcare, dry food diet
•ExamExam: Body & coat : Body & coat condition-normal; vital condition-normal; vital signs-WNLsigns-WNL
•Oral ExamOral Exam: Putrid odor, upper and lower : Putrid odor, upper and lower arcade have severely inflamed gingiva, with arcade have severely inflamed gingiva, with spontaneous bleeding, minimal calculus spontaneous bleeding, minimal calculus formationformation
•Lab DataLab Data: Elevated WBC, FELV/FIV=Neg: Elevated WBC, FELV/FIV=Neg
•DiagnosisDiagnosis: Hemorrhagic gingivitis: Hemorrhagic gingivitis
•TreatmentTreatment: Clindamycin 25mg PO BID x 10: Clindamycin 25mg PO BID x 10•Dental prophylaxis followed by Dental prophylaxis followed by Clavamox 62.5 mg BID x 10Clavamox 62.5 mg BID x 10
TCVM Exam & DiagnosisTCVM Exam & Diagnosis
•ConstitutionConstitution: Water/Wood: Water/Wood•TongueTongue: body=reddish purple; no coat: body=reddish purple; no coat•PulsePulse: Bilaterally superficial rapid: Bilaterally superficial rapid•Body ConditionBody Condition: Dry nose; Body Temp : Dry nose; Body Temp NormalNormal•MouthMouth: Stink smell; bloody red gums: Stink smell; bloody red gums
Pattern DXPattern DX: Stomach Heat (excess : Stomach Heat (excess condition)condition)
TCVM Treatment StrategyTCVM Treatment Strategy
•Clear the Stomach HeatClear the Stomach Heat, Cool the Blood, & nourish , Cool the Blood, & nourish Stomach YinStomach Yin
•Acupuncture Point SelectionAcupuncture Point Selection::GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10
•Herbal MedicineHerbal Medicine: Yu Nu Jian ( Jade Lady): Yu Nu Jian ( Jade Lady)shi gao, shu di huang, zhi mu, huai niu xishi gao, shu di huang, zhi mu, huai niu xi2 teapills TID or 1/8-1/4 tsp granules TID2 teapills TID or 1/8-1/4 tsp granules TID
•Topical CareTopical Care: Aloe Gel ( Warren Laboratories): Aloe Gel ( Warren Laboratories)
Case Outcome & DiscussionCase Outcome & Discussion
•After 3 weeks of therapy inflammation substantially reduced
•Cervical line lesions which compromised several teeth were removed
•Fluffy is maintained on Aloe oral gel and herbs with only periodic acupuncture therapy
•Long term expectations: depend on owner compliance
•Other herbals: Wei Qi Booster; Slippery Elm
Stomach Yin Deficiency & Stomach Yin Deficiency & Empty Heat PatternEmpty Heat Pattern
• TessTess: 10 yr, FS, Mix Breed: 10 yr, FS, Mix Breed• Primary ComplaintPrimary Complaint: Bad breath, dirty teeth, : Bad breath, dirty teeth,
and periodic vomit/regurgeand periodic vomit/regurge• HistoryHistory: Commercial dry food diet, periodic : Commercial dry food diet, periodic
dental prophylaxis, absent dental dental prophylaxis, absent dental homecare, gums remain inflamed and homecare, gums remain inflamed and plaque builds quicklyplaque builds quickly
• Western Dx / Tx: Western Dx / Tx: Gingivitis with periodontal Gingivitis with periodontal deterioration. Requires 6 month recall for deterioration. Requires 6 month recall for prophylaxisprophylaxis
TCVM ApproachTCVM Approach•Exam:Exam:
•Constitution- WaterConstitution- Water
•Tongue- Violet, dry, no Tongue- Violet, dry, no coatcoat
•Pulse- Deep, thready, and Pulse- Deep, thready, and quickquick
•Gums- dry/breath Gums- dry/breath scorchedscorched
•Coat Quality-DryCoat Quality-Dry
•Treatment Stategy:Treatment Stategy:
•Nourish Stomach Yin and Nourish Stomach Yin and Clear HeatClear Heat
•AP= CV 12 (aqua); SP 3,6; AP= CV 12 (aqua); SP 3,6; ST 36,44; LI 4,11ST 36,44; LI 4,11
•Herbs= Qing Wei SanHerbs= Qing Wei San
•Topical= Aloe GelTopical= Aloe Gel
•Diet: Fresh cooked food/ Diet: Fresh cooked food/ fish-pork-beef-eggs-fish-pork-beef-eggs-veggiesveggies
Ulceration: a TCVM Ulceration: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
UlcerUlcer
•SymptomsSymptoms•Periodic painPeriodic pain•Acid regurgitationAcid regurgitation•BelchingBelching•VomitingVomiting
•PatternsPatterns•ExcessExcess
•Stomach ColdStomach Cold
•Food StagnationFood Stagnation
•Liver Qi StagnationLiver Qi Stagnation
•Blood StasisBlood Stasis
•DeficiencyDeficiency•Stomach Yin DeficiencyStomach Yin Deficiency
Stomach HeatStomach Heat
Stomach HeatStomach Heat
Pathogenic HeatPathogenic HeatYin DeficiencyYin Deficiency
channelchannel
GumsGums organorgan
UlcerUlcer
childchild
ColitisColitis
grandchildgrandchild
CystitisCystitis
Stomach UlcersStomach Ulcers•MildMild
•Moderate to SevereModerate to Severe
AngelicaAngelica Dang Gui Dang Gui Nourish & activate BloodNourish & activate BloodPaeonia Paeonia Bai Shao Yao Bai Shao Yao Nourish Liver Yin & BloodNourish Liver Yin & BloodBupleurum Chai Hu Bupleurum Chai Hu Soothe Liver QiSoothe Liver QiAurantium Zhi Shi Aurantium Zhi Shi Move Qi & relieve painMove Qi & relieve painTrichosanthes Gua Lou Trichosanthes Gua Lou Promote body fluid & transform phlegmPromote body fluid & transform phlegmPinellia Pinellia Ban Xia Ban Xia Dry damp & transform phlegmDry damp & transform phlegmCitrus Citrus Chen Pi Chen Pi Move Qi & relieve painMove Qi & relieve painLicorice Licorice Gan Cao Gan Cao HarmonizeHarmonizeTaraxacum Pu Gong Ying Taraxacum Pu Gong Ying Clear HeatClear Heat
Happy StomachHappy Stomach
Jade LadyJade Lady
Gypsum Gypsum Shi Gao Shi Gao Clear Heat and cool StomachClear Heat and cool StomachAnemarrhena Zhi Mu Anemarrhena Zhi Mu Clear Heat and nourish YinClear Heat and nourish YinRehmannia Shu Di Huang Rehmannia Shu Di Huang Nourish Yin and JingNourish Yin and JingOphiopogon Mai Men Dong Ophiopogon Mai Men Dong Moisten and nourish YinMoisten and nourish YinAchyranthes Niu Xi Achyranthes Niu Xi Bring the Qi flow downBring the Qi flow down
GI Food TherapyGI Food Therapy
•CabbageCabbage•Contains glutamateContains glutamate•Cools stomach & GICools stomach & GI
•SpinachSpinach•Stops hemorrhageStops hemorrhage
Shan-gen
GV-26Ren zhong
06 Ren-zhong/Shui-gou the center of man/water passage, Xie-07, GV-26
05 Shan-gen Mountain base Xie-05
LO: on the dorsal midline of boundary b/t hairy & non-hairy areas
ME: Perpendicular insertion 0.3 cun
IN: Loss of appetite, sinusitis, coma, shock, wind-cold, wind-heat
LO: At the intersection b/t dorsal and middle 1/3 of the philtrum
ME: Perpendicular insertion for 0.3 cun
IN: Coma, shock, fever, bronchitis, Lung Heat, facial paralysis
23 Lian-quan ridge spring CV-23
LO: At the ventral midline just cranial to throat.
IN: excessive salivation, laryngeal hemiplegia
21 Hua-tuo-jia-ji at cervical region
LO: 0.5 dorsal to cervical vertebrae
IN: cervical stiffness, wobbler’s disease
22 Jian-wei, strengthen stomach
LO: Upper 1/3 of the jugular group, Between vein and cervical vertebra
IN: Anorexia, vomit, stomach disorders
Pancreatitis: a TCVM Pancreatitis: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
PancreatitisPancreatitis
•Considered any acute or Considered any acute or chronic change in GI chronic change in GI function usually function usually accompanied by some accompanied by some degree of vomiting, degree of vomiting, diarrhea and abdominal diarrhea and abdominal painpain
•Acute- -MildAcute- -Mild•PancreostasisPancreostasis
•Acute- -SevereAcute- -Severe•Fulminating pancreatitisFulminating pancreatitis
•ChronicChronic•Pancreatic insufficiencyPancreatic insufficiency
•Rx AcuteRx Acute•NPONPO•FluidsFluids•AntiemeticsAntiemetics•Pain reliefPain relief•Low fat/protein foodLow fat/protein food
•Rx ChronicRx Chronic•Enzyme therapyEnzyme therapy
TCVM Acute PancreatitisTCVM Acute Pancreatitis
TCVM Chronic PancreatitisTCVM Chronic Pancreatitis
* Enzyme replacement therapy still good to add* Enzyme replacement therapy still good to add
PerryPerry
3 yr FS Springer3 yr FS Springer
Earth personalityEarth personality
Acute onset of vomiting, Acute onset of vomiting, fever and abdominal painfever and abdominal pain
Increased thirstIncreased thirst
Scant urinationScant urination
Elevated Amylase & LipaseElevated Amylase & Lipase
Increased WBC Increased WBC
Rx: Fluids & RanitidineRx: Fluids & Ranitidine
Tongue: red & dryTongue: red & dry
Pulse: fast & superficialPulse: fast & superficial
West Dx: acute pancreatitisWest Dx: acute pancreatitis
TCM Dx: damp-heat in spleenTCM Dx: damp-heat in spleen
Perry TreatmentPerry Treatment
•APAP•DNDN
•ST-45ST-45
•ST-36ST-36
•LI-4LI-4
•PC-6PC-6
•BL-20BL-20
•CV-12CV-12
•AquaAqua•ST-36ST-36
•BL-20BL-20
•PC-6PC-6
•HerbalHerbal•Great Saussurea CoptisGreat Saussurea Coptis
•Next day was 80% Next day was 80% improvedimproved
•Clinician said, “He is Clinician said, “He is doing absolutely doing absolutely fantastic…better than fantastic…better than any patient in years…any patient in years…NO…it wasn’t the NO…it wasn’t the acupuncture…well…acupuncture…well…maybe we should try it maybe we should try it again!”again!”
Great Saussurea CoptisGreat Saussurea Coptis
Saussurea Saussurea Mu Xiang Mu Xiang Move Qi & relieve painMove Qi & relieve pain
Coptis Coptis Huang Lian Huang Lian Clear Damp-Heat in the intestinesClear Damp-Heat in the intestines
Evodia Evodia Wu Zhu Yu Wu Zhu Yu Warm the middle Jiao & stop vomitingWarm the middle Jiao & stop vomiting
Bleeding: a TCVM Bleeding: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
BleedingBleeding•Primary HemostasisPrimary Hemostasis
•Complex chain of events Complex chain of events involving interaction ofinvolving interaction of
•PlateletsPlatelets•Vessel WallVessel Wall•von Willebrand’s factorvon Willebrand’s factor•FibrinogenFibrinogen
•Secondary HemostasisSecondary Hemostasis•Complex interaction of the Complex interaction of the intrinsic and extrinsic intrinsic and extrinsic clotting cascadesclotting cascades
•Stabilize the platelet plugStabilize the platelet plug
Primary HemostasisPrimary Hemostasis
•Evaluated by the Evaluated by the bleeding timebleeding time
•Platelet numberPlatelet number•Amount and Quality of the Amount and Quality of the von WIllebrand’s factor von WIllebrand’s factor VIII:AgVIII:Ag•Fibrinogen concentrationFibrinogen concentration
•Other alterations due to Other alterations due to vessel wall disordersvessel wall disorders
Secondary HemostatisSecondary Hemostatis
•Assessed byAssessed by
•ACT (activated ACT (activated clotting time)clotting time)
•APTT (activated APTT (activated partial thromboplastin partial thromboplastin time)time)
•PT (prothrombin PT (prothrombin time)time)
TCM PathoetiologyTCM Pathoetiology•HeatHeat
•TongueTongue•Red & DryRed & Dry
•PulsePulse•Superficial (forceful) Superficial (forceful) & fast& fast
•Spleen Qi DeficiencySpleen Qi Deficiency•TongueTongue
•Pale & moistPale & moist
•PulsePulse•Deep & weak Deep & weak (particularly on right)(particularly on right)
Spleen Pathology Spleen Pathology
Damp Hot Damp Hot Food or Food or DrinkDrink
Damp Hot Damp Hot Environmental Environmental ConditionsConditions
Damp-Heat in SpleenDamp-Heat in Spleen
Transform & Transport DisorderTransform & Transport DisorderDisharmony of Qi FlowDisharmony of Qi Flow
Accumulated Accumulated Heat & DampHeat & Damp
Heat HemorrhageHeat Hemorrhage•Herbal treatment depends Herbal treatment depends upon locationupon location
•BladderBladder•Red Front DoorRed Front Door
•GI tractGI tract•Sophora PowderSophora Powder
•Great Saussurea CoptisGreat Saussurea Coptis
•Red Back DoorRed Back Door
•PulmonaryPulmonary•Red LungRed Lung
•NoseNose•Single ImmortalSingle Immortal
•UterusUterus•Wu Bei SanWu Bei San
Spleen Not Controlling BloodSpleen Not Controlling Blood
HemorrhageHemorrhage
Spleen Fails to Hold BloodSpleen Fails to Hold Blood
Chronic HemorrhageChronic HemorrhageGeneral SignsGeneral Signs
Prolonged Spleen Qi DeficiencyProlonged Spleen Qi Deficiency
DarbyDarby
•SignalmentSignalment•5 yr FS Doberman5 yr FS Doberman
•HistoryHistory•Generalized weaknessGeneralized weakness•EcchymosisEcchymosis•Abdominal bleedingAbdominal bleeding
•TCVM ExamTCVM Exam•Tongue: paleTongue: pale•Pulses: deep & weakPulses: deep & weak
Dx: Spleen Qi Deficiency Dx: Spleen Qi Deficiency (not holding blood in vessels)(not holding blood in vessels)
DarbyDarby
•Western RxWestern Rx
•Compressive Compressive bandagebandage
•Hemorrhage controlHemorrhage control•CryoprecipitateCryoprecipitate•Whole BloodWhole Blood•Thyroid medicationThyroid medication
•TCVM RxTCVM Rx
•APAP•SP Qi TonicSP Qi Tonic
•BL-20/21, SP-6, SP-9 BL-20/21, SP-6, SP-9 & CV-6& CV-6
•Stop HemorrhageStop Hemorrhage•Tian Ping & BL-17Tian Ping & BL-17
•HerbalHerbal•Yunnan Pai YaoYunnan Pai Yao•Huang Tu TangHuang Tu Tang
Huang Tu TangHuang Tu Tang
AtractylodesAtractylodes Bai ZhuBai Zhu Strength Spleen & tonify QiStrength Spleen & tonify Qi
Yellow EarthYellow Earth Zao Xin TuZao Xin Tu Warm Spleen & stop diarrheaWarm Spleen & stop diarrhea
AconiteAconite Fu ZIFu ZI Warm SpleenWarm Spleen
AsinumAsinum Er JiaoEr Jiao Nourish BloodNourish Blood
RehmanniaRehmannia Sheng Di HuangSheng Di Huang Nourish YinNourish Yin
ScutellariaScutellaria Huang QinHuang Qin Stop bleeding & prevent excess heatStop bleeding & prevent excess heat
LicoriceLicorice Gan caoGan cao HarmonizeHarmonize
Muscle Wasting: a TCVM Muscle Wasting: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
TCM Muscle ViewTCM Muscle View
•Muscle volume & Muscle volume & strength is under the strength is under the domain of the Spleendomain of the Spleen
•Spleen transforms food Spleen transforms food and transports it to the and transports it to the body to provide energy & body to provide energy & building blocks.building blocks.•Spleen Qi provides Spleen Qi provides muscle strengthmuscle strength
•Liver blood provides Liver blood provides enduranceendurance
•Continued delivery of Continued delivery of Spleen Qi to musclesSpleen Qi to muscles
Western View of Muscle Western View of Muscle WastingWasting
•Generalized WastingGeneralized Wasting
•MalnutritionMalnutrition•Insufficient intake of materials Insufficient intake of materials to support Spleen Qito support Spleen Qi
•Cardiac CachexiaCardiac Cachexia•Heart failure leads to stagnation Heart failure leads to stagnation of bloodof blood•Liver is unable to support Liver is unable to support distribution of blood & Qidistribution of blood & Qi•Leads to accumulation of Damp Leads to accumulation of Damp in Spleenin Spleen•Results in Spleen Qi Deficiency Results in Spleen Qi Deficiency with failure to provide energy with failure to provide energy and building materials to the and building materials to the musclesmuscles
•Cancer CachexiaCancer Cachexia•Tumor Necrosis Factor poisons Tumor Necrosis Factor poisons metabolism leading to Spleen Qi metabolism leading to Spleen Qi DeficiencyDeficiency
•Diminished effective delivery Diminished effective delivery of energy to musclesof energy to muscles
•Localized WastingLocalized Wasting
•TraumaTrauma•Local damage of muscleLocal damage of muscle
•Disuse AtrophyDisuse Atrophy•Local stagnation results in Local stagnation results in Liver failure to support Liver failure to support Spleen/StomachSpleen/Stomach•Accumulation of Damp alters Accumulation of Damp alters Spleen functionSpleen function•Local stagnation decreases Local stagnation decreases delivery of nutrientsdelivery of nutrients
•Neurogenic AtrophyNeurogenic Atrophy•Denervation leads to local liver Denervation leads to local liver stagnationstagnation•Results in failure to support Results in failure to support spleen Qispleen Qi•Leads to decreased delivery of Leads to decreased delivery of local channel energylocal channel energy
Wei SyndromeWei SyndromeDamp HeatDamp Heat •Earth personalityEarth personality
•ObesityObesity•History of damp heat in skin or GIHistory of damp heat in skin or GI•Muscle atrophyMuscle atrophy•WeaknessWeakness•LethargyLethargy•Greasy wet tongueGreasy wet tongue•Fast pulseFast pulse
Si Miao SanSi Miao San
Qi/Yang Qi/Yang DeficiencyDeficiency
•Lethargy, shortness of breath, Lethargy, shortness of breath, weaknessweakness•Too weak to get up to walkToo weak to get up to walk•Loose lipsLoose lips•Loose stoolLoose stool•Anorexia & EmaciationAnorexia & Emaciation•Dry-burnt hairDry-burnt hair•EdemaEdema•Heat seekingHeat seeking•Pale wet tonguePale wet tongue•Thready & weak pulseThready & weak pulse
Bu Yang Huan WuBu Yang Huan Wu
Qi/Yin DeficiencyQi/Yin Deficiency •EmaciationEmaciation•Weakness in lumbar regionWeakness in lumbar region•Heat seekingHeat seeking•Dry skinDry skin•Pale or red & dry tonguePale or red & dry tongue•Weak & thready pulseWeak & thready pulse
Hindquarter Hindquarter formulaformula
JakeJake
•HistoryHistory•Progressive weakness in Progressive weakness in rear legsrear legs•Cool seekingCool seeking•Rear leg muscle atrophyRear leg muscle atrophy•Dry hair & skinDry hair & skin
•TCVM ExamTCVM Exam•Pulses deep & weak (< R)Pulses deep & weak (< R)•Red dry tongueRed dry tongue
DX: Qi/Yin DeficiencyDX: Qi/Yin Deficiency
Jake’s TreatmentJake’s Treatment
• APAP• EAEA
• SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai huiSP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui
• DNDN• BL20, BL23, BL26, KID3BL20, BL23, BL26, KID3
• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26
• HerbalHerbal• Jia Bing FangJia Bing Fang
Jia Bing FangJia Bing Fang
Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify QiCondonopsis Condonopsis Dang Shen Dang Shen Tonify QiTonify QiPolygonum Polygonum He Shou Wu He Shou Wu Nourish Blood and JingNourish Blood and JingRehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Blood, Yin and JingNourish Blood, Yin and JingPaeonia Paeonia Bai Shao Yao Bai Shao Yao Nourish Blood and soothe Liver QiNourish Blood and soothe Liver QiDioscorea Dioscorea Shan Yao Shan Yao Tonify Qi and nourish JingTonify Qi and nourish JingPrunella Prunella Xia Ku Cao Xia Ku Cao Soothe Liver Qi, clear HeatSoothe Liver Qi, clear HeatCyperus Cyperus Xiang Fu Xiang Fu Move Liver Qi and relieve nodulesMove Liver Qi and relieve nodulesBupleurum Bupleurum Chai Hu Chai Hu Soothe Liver QiSoothe Liver QiSargassum Sargassum Hai Zao Hai Zao Transform phlegm, clear Heat, softenTransform phlegm, clear Heat, soften
the hardnessthe hardnessLaminaria Laminaria Kun Bu Kun Bu Transform phlegm, soften theTransform phlegm, soften the
hardness, drain waterhardness, drain water
SamSam
•HistoryHistory•Chronic rear leg Chronic rear leg weakness and muscle weakness and muscle wastingwasting•Dry hairDry hair•Weight lossWeight loss
•TCVM ExamTCVM Exam•Red dry tongueRed dry tongue•Weak thready pulses (< R)Weak thready pulses (< R)
DX: Qi/YinDeficiencyDX: Qi/YinDeficiency
Sam’s TreatmentSam’s Treatment
• APAP• DNDN
• GV20, BL20, BL23, BL26GV20, BL20, BL23, BL26
• AquaAqua• SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26
• HerbalHerbal• Hindquarter formula (tea pills)Hindquarter formula (tea pills)
Hindquarter FormulaHindquarter Formula
Eucommia Eucommia Du Zhong Du Zhong Tonify Kidney & strengthen backTonify Kidney & strengthen back
AchyranthesAchyranthes Niu Xi Niu Xi Tonify Kidney & strengthen the hind limbsTonify Kidney & strengthen the hind limbs
Lindera Lindera Wu Yao Wu Yao Move Qi and relieve painMove Qi and relieve pain
Astragalus Astragalus Huang Qi Huang Qi Tonify QiTonify Qi
Apis Apis Feng Hua Fen Feng Hua Fen Tonify Qi and YinTonify Qi and Yin
Morinda Morinda Ba Ji Tian Ba Ji Tian Warm and strengthen the backWarm and strengthen the back
Angelica Angelica Dang Gui Dang Gui Nourish BloodNourish Blood
Rehmannia Rehmannia Shu Di Huang Shu Di Huang Nourish Yin and JingNourish Yin and Jing
Cinnamon Cinnamon Gui Zhi Gui Zhi Warm the Channels and benefit the limbsWarm the Channels and benefit the limbs
Obesity: a TCVM Obesity: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
ObesityObesity• Body weight is 20% over idealBody weight is 20% over ideal
• An intake of total dietary energy above that needed for An intake of total dietary energy above that needed for maintenance and production or exercise over a long period of maintenance and production or exercise over a long period of timetime
• Energy in is based uponEnergy in is based upon• Food intakeFood intake• AbsorptionAbsorption
• Energy used isEnergy used is• Basic metabolic rate Basic metabolic rate (thermoneutral condition)(thermoneutral condition)• ExerciseExercise• LactattionLactattion• PregnancyPregnancy• GrowthGrowth
In > > Out
Obesity: TCVM Classical StrategyObesity: TCVM Classical Strategy
(1) Yin Tonic Herbs (Remannia, Lycium etc)
Decrease in appetiteDecrease in food intake
(2) Purgative herbs (Rheum, Cannabis Ma Zi Ren etc)
Passing food faster through SILess time to absorb nutrientsDecrease in absorption
(3) Qi Tonic Herbs (Ginseng, codonopsis etc)
Energy boostingPatient more willing to exerciseBurning down Fat tissue
•Damp-phlegm
•Liver Stagnation
•Blood Stagnation
•Spleen Deficiency
•Kidney Deficiency
Obesity: TCVM Etiology and PatternObesity: TCVM Etiology and Pattern
Excess
Deficiency
Damp-phlegmDamp-phlegm
Etiology
Spleen Qi Deficiency
Water/dampfrom food orenvironment
Other pathogenic factors
Stagnation of Water-damp
Phlegm under the skin
Obesity
Symptoms . Overweight. Swelling neck or belly. fast respiratory rate, or cough or asthma. Pulse: Fast, deep or slippery. Tongue: pale or red with thick coating. In people: obese smoker. Overall: not weak
Treatment Strategy: Transform damp and resolve phlegm Acupuncture treatment
1) needling: ST-36/40, BL-13, SP-6/9or Electro-acupuncture (F=30 Hz) for local swelling area
2) Message: Abdomen and back, twice a day.
Damp-phlegmDamp-phlegm
Herbal Formula
Citrus Chen Pi 8%Pinellia Ban Xia 8%Poria Fu Ling 10%Coix Yi Yi Ren 20%Atractylodes Cang Zhu 8%Areca Da Fu Pi 10%Benincasa Dong Gua Pi 8%Alisma Ze Xie 10%Plantago Che Qian Cao 10%Cyperus Xiang Fu 8%
Phlegm Fat Formula (Citrus-Pinellia Compound)
Er Chen Tang
Resolve Damp
Liver Qi Master
Damp-phlegmDamp-phlegm
Fritillaria Zhe Bei Mu Soften hardness and clear nodules
Ostrea Mu Li Soften hardness and clear mass
Prunella Xia Ku Cao Clear Liver Heat and resolve nodules
Scrophularia Xuan Shen Clear Heat and cool Blood
Trichosanthes Tian Hua Fen Clear Heat and promote body fluids
Platycodon Jie Geng Open the Upper Jiao and transform phlegm
Rhubarb Da Huang Clear stagnation/stasis and clear Heat
Angelica Bai Zhi Clear Wind-Cold and relieve pain
Max Formula For lipomas
Damp-phlegmDamp-phlegm
Liver Qi StagnationLiver Qi Stagnation
EtiologyDrug StressEmotional Stress
Liver Qi Stagnation
Phlegm under the skin
Obesity
Liver over-control SpleenSpleen fails to transform Damp
Symptoms:
Treatment strategy:
Acupuncture:
. Overweight
. Aggressive, or restlessness
. Hypertension
. irregular estrous cycling
. exercise intolerance, lassitude
. Pulse: Wiry and deep
. Tongue: purple or pale with coating or without coating
Sp-6/9, ST-40Liv-3, GB-20 and GB-34
Regulate liver, clear Fire and transform damp
Liver Qi StagnationLiver Qi Stagnation
Herbal formula:
Picrorrhiza Hu Huang Lian 18%Prunella Xia Ku Cao 19%Cassia Jue Ming Zi 18%Rehmannia Sheng Di Huang 15%Rheum Da Huang 15%Cassia Pang Xie Ye 15%
Picrorrhiza Compound*
Clear Liver
Purge LI
Clear LiverNourish Yin/Blood
Liver Qi StagnationLiver Qi Stagnation
Blood StagnationBlood Stagnation
Etiology Other factors
Qi stagnation
Stress
Blood Stagnation
Water/Damp retention in the body
Obesity
Qi-blood stagnation
Symptoms:
Treatment strategy:
Acupuncture:
. Overweight
. lump in the body surface
. exercise intolerance, lassitude
. Pulse: slow and deep
. Tongue: purple with coating or without coating
Invigorate Blood and transform damp
BL-17/SP-10LIV-3, GB-34, LI-4ST-40/BL-40
Blood StagnationBlood Stagnation
Carthamus Hong Hua 22%Ligusticum Chuang Xiong 22%Olibanum Ru Xiang 19%Typha Pu Huang 1 9%Rheum Da Huang 18%
Stagnation RelieverHerbal Formula:
Move Blood, resolve stasis
Purge LI
Blood StagnationBlood Stagnation
Move Qi & Blood
Spleen Qi DeficiencySpleen Qi Deficiency
Etiology Water/dampfrom food orenvironment
Chronic illnessOverwork
Spleen Qi Deficiency
Phlegm under the skin
Obesity
Symptoms:
Treatment strategy:
• Overweight• Diarrhea, or dry feces• Hyperlipemia• Eexercise intolerance, lassitude • Pulse: Weak and deep • Tongue: pale with coating or without coating
tonify spleen qi and transform damp
Acupuncture: ST-36/40/41, SP-2/3, and BL-20/21
Spleen Qi DeficiencySpleen Qi Deficiency
Herbal Formula:
Astragalus Huang Qi 34%Atractylodes Cang Zhu 33%Lycium Gou Qi Zi 33%
Herbal formula:
Astragalus-atractylodes-lycium
Nelumbo He Ye (Lotus) 13%Alisma Ze Xie 13%Poria Fu Ling 13%Coix Yi Yi Ren 13%*Atractylodes Cang Zhu 13%Atractylodes Bai Zhu 12%Citrus Chen Pi 10%Cassia Jue Ming Zi 13%
Nelumbo Compound*
Eliminate Damp, Strengthen SP
Drain Damp
Resolve stagnation, clear Liver
Spleen Qi DeficiencySpleen Qi Deficiency
Kidney Qi DeficiencyKidney Qi Deficiency
Etiology Other factorsAgeingChronic illness
Kidney Qi Deficiency
Water retention
Obesity
Phlegm
Symptoms:
Treatment strategy:
Acupuncture:
. Overweight
. Often occurs in the aged patient
. Difficulty in walking or standing, or chronic back pain
. Bone degeneration or osteoporosis
. Pulse: Weak and deep
. Tongue: pale with coating or without coating
tonify Kidney qi and transform damp
Bai-hui, Shen-shu, Shen-peng, Shen-jiaoBl-23/26, SP-6 and Kid-3
Kidney Qi DeficiencyKidney Qi Deficiency
Herbal formula: Psoralea Pill
Psoralea Bu Gu Zi 32%Notoginseng Tian Qi 9%Rheum Da Huang 30%Cassia Fan Xie Ye 29%
Purge LI
Move BloodTonify Kid Qi/Yang
Kidney Qi DeficiencyKidney Qi Deficiency
9 yr MC Siamese9 yr MC Siamese
Obesity (14 lb)Obesity (14 lb)
Less playful and less activity Less playful and less activity after moving to a new place 3 after moving to a new place 3 weeks agoweeks ago
Warm-seekingWarm-seeking
Tongue: pale & swollenTongue: pale & swollen
Pulse: deep & weakPulse: deep & weak
KobeKobe
Kidney Qi DeficiencyKidney Qi Deficiency
Rx: Psoralea PillRx: Psoralea Pill
HenriettaHenrietta
12 yo FS Dachshund12 yo FS Dachshund
OverweightOverweight
Able to get around with Able to get around with supportsupport
Pants a lot with slight Pants a lot with slight coughcough
Pulse: Fast & deepPulse: Fast & deep
Tongue: redTongue: redDamp-PhlegmDamp-Phlegm
Rx: Phlegm Fat Rx: Phlegm Fat FormulaFormula
Constipation: a TCVM Constipation: a TCVM ApproachApproach
CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA
Regulation of Colon FunctionRegulation of Colon Function•Colon is like the urinary Colon is like the urinary bladderbladder
•Innervation byInnervation by•Sympathetics from L2-3Sympathetics from L2-3
•Parasympathetics from Parasympathetics from S1-3S1-3
•Filling PhaseFilling Phase•SympatheticsSympathetics
•YinYin
•Emptying PhaseEmptying Phase•ParasympatheticsParasympathetics
•YangYang
Propranolol @ 0.25-0.5 Propranolol @ 0.25-0.5 mg/kg TIDmg/kg TID
ConstipationConstipation•Definition:Definition:
•ConstipationConstipation•Infrequent or Infrequent or incomplete bowel incomplete bowel movementsmovements•Feces are drier or Feces are drier or harderharder
•ObstipationObstipation•Intractable Intractable constipationconstipation•Impossible defecationImpossible defecation
•PatternsPatterns
•HeatHeat•Qi StagnationQi Stagnation•Qi DeficiencyQi Deficiency•Yin/Blood DeficiencyYin/Blood Deficiency
Stomach HeatStomach Heat
Stomach HeatStomach Heat
Pathogenic HeatPathogenic HeatYin DeficiencyYin Deficiency
channelchannel
GumsGums organorgan
UlcerUlcer
childchild
ColitisColitisoror
ConstipationConstipation
grandchildgrandchild
CystitisCystitis
DifferentiationDifferentiationHEATHEAT Qi StagnationQi Stagnation Qi DeficiencyQi Deficiency Blood/Yin Blood/Yin
DeficiencyDeficiency
OnsetOnset Acute Wood Person. Chronic Chronic
StoolStool Dry On/Off Small/Thin Dry
MucusMucus Yes No No No/Yes
ThirstThirst Yes No No Yes
UrinationUrination Short Normal Long Short
Abdm. PainAbdm. Pain No Flank No No
Mouth odorMouth odor Foul No No Slight
PreferencePreference Cool None Warm Cool
Tongue colorTongue color Red Purple Pale Pale/Red
T. MoistureT. Moisture Dry Normal Wet Dry
T. CoatingT. Coating Yellow Normal No No
PulsePulse Fast/Wiry Wiry Weak Weak/Thready
Constipation/MegacolonConstipation/MegacolonHeatHeat •Acute onset of colicAcute onset of colic
•Hot ear & noseHot ear & nose•Cool seekingCool seeking•ThirstyThirsty•Foul breath Foul breath •Swollen upper palateSwollen upper palate•Red & dry tongueRed & dry tongue•Fast pulseFast pulse
Da Chang Qi TangDa Chang Qi Tang
Qi StagnationQi Stagnation •Sub-acute onset of colicSub-acute onset of colic•Bloat & abdominal fullnessBloat & abdominal fullness•Gaseous bowel movementsGaseous bowel movements•AnorexiaAnorexia•Purple or red tonguePurple or red tongue•Wiry, fast pulseWiry, fast pulse
Xiao Zhang SanXiao Zhang San
Qi DeficiencyQi Deficiency •Chronic constipation or colicChronic constipation or colic•AnorexiaAnorexia•Loss of body massLoss of body mass•WeaknessWeakness•Pale tonguePale tongue•Deep & weak pulseDeep & weak pulse
Fan Xie YeFan Xie Ye
Yin/Blood Yin/Blood DeficiencyDeficiency
•Very chronic megacolon with impactionVery chronic megacolon with impaction•Dry flaky skinDry flaky skin•Weak or geriatric patientWeak or geriatric patient•Pale or red, dry tonguePale or red, dry tongue•Fast, weak & thready pulseFast, weak & thready pulse
Dang Gui Cong Dang Gui Cong RongRong
AcupunctureAcupuncture
HeatHeat Qi Qi StagnationStagnation
Qi Qi DeficiencyDeficiency
Blood/Yin Blood/Yin DeficiencyDeficiency
PointsPoints LI-4
LI-10
GV-1
BL-21
ST-37
LIV-3
GV-1
GB-34
ST-36
SP-6
B-21
BL-15
SP-6
SP-10
GV-1
MethodMethod q d 3d
1-3 times
q wk
2-4 times
q wk
2-5 times
q wk
3-7 times
Kitty LittleKitty Little
15 yr FS Persian15 yr FS Persian
Chronic constipation with Chronic constipation with impactionimpaction
Dry flaky skin with dandruffDry flaky skin with dandruff
General weaknessGeneral weakness
Tongue: Tongue: red & dry red & dry
Pulse: deep, weak & threadyPulse: deep, weak & thready
Yin/Blood DeficiencyYin/Blood Deficiency
Rx: Dang Gui Cong Rx: Dang Gui Cong RongRong
MollyMolly
13 yr FS Maine Coon13 yr FS Maine Coon
Earth personalityEarth personality
Frequent constipation with Frequent constipation with impactionimpaction
Colon cleaning under Colon cleaning under anesthesia 5 times in past 2 anesthesia 5 times in past 2 yearsyears
Recent inappetenceRecent inappetence
Vomits undigested food with Vomits undigested food with impacted impacted
Rx: Lactulose & CisaprideRx: Lactulose & Cisapride
First visit:First visit:
No BM for 5 dayNo BM for 5 dayAbdomen filled with fecal Abdomen filled with fecal ballsballs
Dry haircoatDry haircoatWarm seekingWarm seekingTongue: red & dryTongue: red & dryPulse: weakPulse: weak
Molly DxMolly DxEarth personalityEarth personalityNo BMNo BM
Earth element Earth element (SP/ST)(SP/ST)
DrynessDrynessRed & dry tongueRed & dry tongue
Yin DeficiencyYin Deficiency
Weak pulseWeak pulseAnorexiaAnorexiaDecreased thirstDecreased thirst
Qi DeficiencyQi Deficiency
TCVM Dx: SP/ST (LI) Yin & Qi DeficiencyTCVM Dx: SP/ST (LI) Yin & Qi Deficiency
Molly RxMolly Rx
Acupuncture:Acupuncture:
DN: GV-20, CV-12, ST-25DN: GV-20, CV-12, ST-25EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz)EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz) BL-21, BL-25, ST-36- -ST-37 (bilaterally)BL-21, BL-25, ST-36- -ST-37 (bilaterally)
Owner reported that Molly defecated a long firm stool 10-16 Owner reported that Molly defecated a long firm stool 10-16 hours after acupuncture and continued to have BMs every 2-3 hours after acupuncture and continued to have BMs every 2-3 days. Stool still dry & still warm seeking.days. Stool still dry & still warm seeking.
TCM Herbal:TCM Herbal:
Ma Zi Ren Wan + Fan Xie YeMa Zi Ren Wan + Fan Xie Ye