CIRCLE THE

DRAGON
INTERNAL MEDICINE
AND MEDICAL
ACUPUNCTURE IN
FAMILY PRACTICE

BY
MK SASTRY
Objectives • Pattern Recognition
• Chinese Medicine
Physiology
– Three Treasures – Jing, Shen,
Qi
– Physiology of Qi and Blood
– Five Elements
– Eight Principles
– External Pathogenic Factors
– Psyche-Soma: The Five Parts
of the Soul
• Diagnostics: Tongue and
Pulse
• Cases Discussed
Pattern Recognition
 Pattern Recognition - Diagnoses

Western Medicine Chinese Medicine

Premenstrual Syndrome Liver Qi Stagnation
Hypertension Liver Blood Deficiency
Depression Liver Blood Stagnation
Migraine Kidney Yin Deficiency
Congestive Heart Failure Kidney Yang Deficiency
Pneumonia Lung Qi Deficiency
Diabetes Spleen Qi Deficiency
Chronic Fatigue Syndrome Phlegm Heat misting the
Eczema Heart and Mind’s Orifices
Asthma Wind Cold (or Heat) Invasion
Angina Latent Wind Heat
Pleurisy Heart Yin Deficiency
Dysmenorrhea Heart Qi Deficiency
 Physiology
Of
Chinese Medicine
 The Three
Treasures
• Jing (Essence) - derived from the Kidney
– Shen and Qi are derived from Jing
– Inherited from parents - Genetics/Constitution
– Determines growth, sexual maturation, conception, pregnancy, brain/cognitive
function
• Qi – derived from Spleen (food) and Lung (air)
– Replenished day-to-day
– Nutrition and air quality important
• Shen (Mind) – housed in the Heart
– Creativity, Drive, Vision, and Intelligence
 Qi

Vapor

Qi
Rice
 Lost in • Qi (Character with vapor rising above
cooking rice)
Translation – Early 1900s - Soulie de Mourant-
Qi = “energy” and Jing =
? “meridian”
– Simplified translation of
complicated terms
– “Life Force” made up of air and
food transformed by body into
blood and body fluids
• Nei Jing written during 3rd –
1st Century BCE
– Chinese physicians & cadaver
dissections
– Using needles of glass, metal
and bone to influence
neurovascular system
 TCM Qi • Stomach separates pure from
Physiology impure Qi of food
– Pure Qi to Spleen
– Impure to Small Intestine
(process repeats again)
• Spleen sends Food Qi to Lung
– Lung combines it with pure Qi
extracted from air
– Food/Air Qi “heated” by Yuan Qi
(ancestral pilot light) provided by
Kidney to make “Nutritive Qi”
• In Heart to make Blood
• In Meridians
 TCM Qi
Physiology
 Blood
Physiology
(Dense,
material
form of Qi)
 Blood • Causes:

Deficiency
– Hemorrhage, low dietary protein,
constitution
– Deficiency or stagnation of Qi
• Fatigue, brain fog, dizziness, dry skin,
dry hair, brittle nails, pale tongue,
irregular and very light menses, pale
complexion, trouble falling asleep,
anemia, headache, anxiety
 • Caused by Blood Deficiency
Blood or Qi Stagnation
Stagnation • Dark/dusky tongue, purple
sublingual veins
• Chronic stabbing pain
• Musculoskeletal
– Pleurisy, Angina
– Degenerative disc disease,
spinal stenosis
– Blood moving herbs are anti-
inflammatory
• Gynecological
– Painful and heavy menstrual
periods
– Large dark clots
Meridians • Acupuncture points linked together in
lines called “meridians”
• Qi circulates through meridians
• Meridians named for associated Organ
– Kidney, Heart, Small Intestine, Bladder
– Liver, Pericardium, Triple Energizer,
Gallbladder
– Spleen, Lung, Large Intestine, Stomach
Meridians
 91% of
Acupunctu
re Points
share this
Histology
fMRI Study
• Needle placed in foot Acupuncture point associated vision
• fMRI shows stimulation of visual cortex
fMRI Study

• Auditory Complex stimulated by needle placed in AP point on the leg

associated with hearing
 Acupuncture Models

– Meridian-based: Japanese, Vietnamese, French Energetics

– Traditional Chinese Medicine (“TCM”)
• Eight Principles (Yin/Yang, Damp/Dry, Cold/Heat,
Interior/Exterior)
• Zhang-Fu organ pairings blends Yin-Yang and 5 Element
– Five Element (Korean)
• Wood, Fire, Earth, Metal and Water
– Different schools of thought regarding etiology of disease
(Kidney versus Spleen/Stomach)
– Neuroanatomical - CraigPENS, osteopuncture
 Meridian- • Blockage in meridian flow produces
disease
Based • Therapeutic action of “unblocking”
Acupunctur meridian flow (Relieving Stagnation)

e – Pain
– Asthma
– Heavy, Painful, or Irregular Menstrual
Periods
 French Energetics Acupuncture
Principal Meridian Treatment
Yin Tonification Yang Dispersal
Chronic Symptoms Acute Symptoms
(or cold, deficient) (or heat, excess,
spasm)
Balance needles so
Balance needles so
that more are on
that more are on Yin
Yang meridians
meridians
Disperse Yang
Tonify Yin Meridian
Meridian by leaving
by twirling, applying
needles alone,
heat via Moxibustion,
cooling with alcohol
or low frequency
pads, or medium to
electrical stimulation
high frequency
electrical stimulation
Principal
Meridians
• Shao Yin • Tai Yang
– Kidney, Heart – Small Intestine, Bladder
• Jue Yin • Shao Yang
– Liver, Pericardium – Triple Heater, Gallbladder
• Tai Yin • Yang Ming
– Spleen, Lung – Large Intestine, Stomach
 French
Energetics
Acupunctu
• How do you chose the Principal Meridian?
reproblem (ex: pain)
– Location of clinical

Principal
– Meridian associated with function of problematic organ system (ex:
diarrhea)
Meridian
– Constitution of the patient

Treatment
• Central low back pain in patient with Wood-Fire as principal meridian system
– Anger/frustration/irritability
– Consider Jue Yin – Shao Yang (LR-PC-TH-GB) instead of Shao Yin – Tai Yang
(KI-HT-SI-BL)
Pattern Recognition
Five Elements

Interconnections between
Patterns and
Systems

TCM Eight
Principles
 Eight
Principles
 Eight Principles - Polarities

Yin Yang
Darkness Light
Moon Sun
Rest Activity
Matter Energy
Contraction Expansion
Cold Hot
Water Fire
Soft Hard
Inhibition Excitement
Blood Qi
 Yin & Yang Deficiency and Excess

Yin Deficiency Yang Deficiency Yang Excess Yin Excess

Yang will appear in Yin will appear in Yang appears Yin appears in
excess with heat, excess with cold, in excess with excess with Full
dryness, thirst, fluid retention, Full Heat – Cold – usually due
back pain, stiffness chills, back pain, migraines, to Wind Cold
insomnia, loss of daytime fatigue, pressure, invasion. Stiffness,
willpower to follow low libido, loss of bloating, mania, contraction of
through with willpower to hypertension, tendons, chilliness,
action. This is initiate action. anger, severe menstrual or
Empty Heat This is Empty insomnia, fever. abdominal pain,
compared to Full Cold (tonify Full Heat fluid retention and
Heat (tonify rather rather than (disperse rather watery-loose
than disperse). disperse). than tonify). discharges
including stools.
 External • Wind

Pathogenic • Cold
• Summer Heat
Factors • Damp
• Dryness
• Fire
 External Pathogenic Factors
• Rapid onset
– Wind Cold to Wind Heat
• Symptoms & signs change
rapidly and move from
place to place in body
• Enters neck to respiratory
tract
• Circulates between skin
and muscles
• Warms muscles
– Aversion to cold or to wind
– Chills/myalgias
• Further warmed by body
– Fever, rigors, rash/hives
Wind
• Wind in the Skin
– Eczema, dermatitis, itching
• Chronic allergic rhinitis
– Dry/Wind plus Yin Def
• Upper respiratory
infection signs
– Chills, cold intolerance, sore
throat, clear nasal drainage
that warms to yellow/thick
• Internal Wind (neurologic)
– Stroke, seizures, tremor,
headaches, hypertension,
paresthesias/neuropathy
 External Pathogenic Factors
• Usually enters via Wind Cold
invasion
• Direct channel invasion
• Bi Syndrome
– Painful Obstruction Syndrome
– Arthritis without hot/red joints
– Wind-Damp-Cold
• Contracts muscles/tendons
• Chronic, dull pain (abdomen,
pelvis, joints) better with heat
Cold
• Internal Cold (from Yang Def)
• Consumes Spleen Yang
– Chilliness, dull pain, prefer warm liquids,
cold limbs, no thirst, fatigue
• Heart Yang Deficiency
– Stuffy pain in chest, palpitations
• Lung Qi Deficiency
– Catch every cold, sweats, cough with
thin white mucus
• Spleen Yang Deficiency
– Diarrhea/loose stools, low appetite
• Kidney Yang Deficiency
– Frequent pale profuse urination, low
back pain, cold feet/knees, erectile
dysfunction, white vaginal discharge
External Pathogenic
• Specific to hot weather Factors
• Aversion toSummer Heat
heat, sweating, headache,
dark scant urine, dry lips, thirst, rapid
pulse
• Severe Summer Heat
– Invades Pericardium
• Delirium, slurred speech, loss of
consciousness
• “Heat Exhaustion” or “Heat Stroke” in
western med
 External Pathogenic Factors
Damp
• Damp weather
• Wearing damp clothing
• Sitting on damp ground
• Consuming damp diet
– Refined sugars, dairy
– Excessive raw veg/fruit
• Ascends legs
• Symptoms depend on
where damp settles
– Pelvis – vaginal discharge
– GI – loose stools
– Bladder – urinary frequency or
burning
• Heaviness of limbs/head
– Tired, fullness of chest or
abdomen, muscles
sore/weak
• Dirtiness/clouded color
– Clouded urine, thick
discharge (vaginal or skin)
• Stickiness
– Sticky tongue coating, sticky
taste, Slippery/wet pulse
– With Heat
• Fever, sticky yellow tongue
coat
• Phlegm
– Chronic Damp (with Fire)
 External • Very dry weather
• Artificially dry, centrally
Pathogenic heated buildings
Factors • Dry skin/mouth, throat, lips,
tongue, stools, and scanty
Dryness urination
• Injures Yang
– Lung Qi Deficiency as Allergic
Rhinitis
– Specific to Dry/Wind exposure in
Idaho
– Chronic Dry/Wind exposure in
population with Yin Deficiency
(due to overwork/hectic
lifestyles)
 External • Extreme form of Heat

Pathogenic
• Quickly becomes Internal pathogenic
factor
Factors • Fever, thirst, bitter taste, sweating,

Fire constipation (dry), ulcers, bleeding

gums, canker sores, delirium, scanty
dark urine, headache, dizziness,
irritability, red face,
• Tongue red with dry yellow coat
 Fire
Wood Earth
Five Elements
System of
Correspondences

Water Metal
 Homeostasis
Sheng – Ke Cycle

Supporting or
Controlling or Augmenting Influence
Dampening Influence

System Self-Correction
(in the short term)
 Five Element Acupuncture
• Imbalance between Elements causes Disease
• Example
– Chronic overwork/abuse/disease leads to deficiency of
Water (fatigue, chronic UTI/stones/incontinence, joint
pains, low back pain, fear, low self-esteem)
– Water controls Fire (Water Def – Fire Excess)
– Excess Fire symptoms result (anxiety, hot flashes,
palpitations, insomnia, inflammation)
Treatment • Treat by “Tonifying” deficiencies and
“Dispersing” excesses
– Release excess Fire
– Tonify deficient Water
– Use Acupuncture and Chinese Herbs in
combination
 Five • Wood (Liver, Gallbladder)

Element
– Driven, multiple projects, movement,
CEO, anger/anxiety, tight traps/lateral
Correspond neck/IT band, TMJ, migraines, caffeine
sensitivity, fibromyalgia, blue/green,
ences sour/citrus, Spring, expansion, insomnia
(esp. sleep maintenance 11pm-3am),
east
– Augments Fire, controls Earth,
augmented by Water and controlled by
Metal
– Coupled with Fire
 Five
Element
•
Correspond
Fire (Heart, Small Intestine, Pericardium, Triple Energizer)
ences
– Creative, CEO, joy, awareness, love/attachment, mania, palpitations,
insomnia (esp. sleep initiation), hot flashes, night sweats, cardiac disease,
dysrhythmias, red/orange, bitter/roasted, summer, south
– Augments Earth, Controls Metal, Augmented by Wood, Controlled by Water
– Coupled with Wood and Water
 Five
Element
Correspond
• Earth (Spleen, Stomach)
– Nurturing, worry/obsession, GI issues (loose stools, gastritis, bloating,
ences
abd pain), sinusitis, cysts, tumors, lumps, dampness, obesity, chronic
fatigue(multifactorial), sweet, dampness (cysts, edema), yellow/brown,
transitions of seasons, center of compass positions
– Nurtures Metal, Controls Water, Controlled by Wood
– Coupled with Metal
 Five • Metal (Lung, Large Intestine)

Element
– Respiratory, skin disorders (“3rd lung”),
constipation, dryness, sense of duty,
Correspond grief, loss, depression (multifactorial),
flavorful/spicy, white/grey/colorless,
ences autumn, west
– Nurtures Water, Controls Wood,
Controlled by Fire
– Coupled with Earth
 Five • Water (Kidney, Bladder)

Element
– UTI, Kidney stones, incontinence, joint
pain, low back pain, inner chill, abuse,
Correspond philosopher, music, hearing problems,
throat, winter, black, north, salty,
ences motivation/willpower
– Nurtures Wood, Controls Fire,
Controlled by Earth
– Coupled with Fire
 Five Elements Fire
of the Soul
Shen : Mind
Wood Clarity of Thought
Earth
Consciousness Yi : Intellect
Hun : Ethereal Soul Insight
Applied Thinking
Creative Thinking
Link Shen to Universal Mind Mental Get Up & Go Studying, Memorization
Dreams, Daydream, Ambition Joy - Mania Concentration/Focus
Opens with Meditation or Dreams Gathering Ideas
Irritability, Frustration, Anger, Nurturing – Co-dependent
Grudge, Rage, Anxiety
Po : Corporeal Soul
Zhi : Willpower
Activity of Thinking Monkey
Old Memory Mind Sensations (Touch,
Drive/Determination Smell, etc.) Quiets with Meditation
Pilot Light (as Hun opens) Sadness, Grief, Loss,
Self-Esteem, Guilt Melancholy
Fear, Phobias

Water Metal
 Excessive Attachment to Emotions
- Anger -
• Bottled up
– Liver Qi Stagnation (irritable, “short fuse,” if chronic, then depression)
• Liver Qi Stagnation –> Lung and Spleen Qi Stag. (see Worry)
• Liver Qi Stagnation –> Liver Blood Stagnation (chronic pain)
• If with Kidney Yin Deficiency (overwork or excessive sex), then
Liver Yin Deficiency leads to LiverYang Rising
– Deficient Water fails to nourish Wood through Sheng cycle
– Rage/outbursts, headache, thirst, dry mouth, bitter taste, tinnitus,
dizziness
• Liver Qi invading Stomach
– Upper abdominal pain, bloating, gas, nausea, alternating
diarrhea/constipation
 Excessive Attachment to Emotions
- Worry -
• Knots the Qi (smooth flow of Qi is the domain of the
Liver, but the effect is most prominent at LU and SP)
• Affects the Lung and Spleen
• Lung Qi Stagnation: breathing shallow, chest
discomfort, shoulder tension, anxiety
– Chest/lungs reduce expansion with shallow breaths
– Lung Qi stagnates – Heart Qi stagnation can follow, as can
Heart Blood Deficiency (due to lack of Lu Qi)
• Spleen Qi Stagnation: Disordered thinking, brain fog,
decreased concentration/memorization, forgetfulness
 Excessive Attachment to Emotions
– Hatred – Liver, Heart – Wood/Fire
– Sadness, Grief, Regret – Lung - Metal
– Fear – Kidney - Water
– Shock – Kidney, Heart - Water/Fire
– Love – Heart - Fire
– Craving – Heart - Fire
– Guilt – Kidney, Heart - Water/Fire
 Insomnia

• Blood Deficiency – Can’t Fall Asleep

• Yin Deficiency (KI, HT, LR, LU) with Shen
Ungrounded - Can’t Stay Asleep
– KI Yin Def: Exhausted, low willpower, start projects but don’t finish
them, thirst, dry mouth
– HT Yin Def: Palpitations, anxiety, sweats
– LR Yin Def: Chronic depression, anger
– LU Yin Def: Sweat, itchy skin, lonely, breathless
• Hun Ungrounded – Dream-disturbed sleep, Sleep
walking/talking, Restlessness
• Heart-Gallbladder Deficiency – Wake up too early
 Depression – Many Patterns

• Mind Obstructed
– Liver Qi Stagnation
– Heart and Lung Qi Stagnation
– Heart or Liver Blood Stagnation
– Phlegm Misting the Mind’s Orifices
– Phlegm Heat obstructed the Mind/Heart
• Mind Unsettled
– Heart or Liver Fire blazing
– Heart Blood or Yin Deficiency
– Liver Blood Deficiency
– Kidney Yin Deficiency (+/- Empty Heat)
• Mind Weakened
– Blood, Qi, and/or Yang Deficiency
 Chinese
Diagnostics
• Tongue
– Color, size, wetness/“scalloping”, coating, cracks
– Geographic representations of organs
– Clinical changes occur slowly (weeks)
• Pulses
– Radial artery
– Organ assessment at certain positions/depths
– Clinical changes occur quickly (during treatment)
• Body Type/Morphology
• Skin/Complexion Color/Lesions
• Palpation – heat/cold, lumps/knots
 Tongue
Diagnosis

Normal to Pale Tongue. Normal clear

thin coat. No “scalloping”, No Cracks
 KI Yang Deficiency

Swollen, pale, scalloped,

thin clear coat

Kidney Yin Deficiency

Heart Yin and Blood Excess Heat in Heart
Deficiency Severe Yin Deficiency Invasion of Wind
Tongue body pale and Long-standing heat
or fire (LR or ST) Long, thin, dry, red body with
tip red and pointed lateral deviation
No coat Red tongue body with black, dry Dry yellow coat
central coat
Pulse Diagnosis
Jiao Scalp Acupuncture
Indications (Neurologic)
Pain, Weakness, Tremor,
Stroke recovery, Vertigo,
and problems of Balance,
Vision, or Speech
Herbs
Modular Herbal Formulae Hierarchy
• Emperor
– Relieves the principal symptom
• Ministers
– Increase the effect of the Emperor
• Assistants
– Relieves potential side effects of Emperor
• Small dose of warm herb in an overall cool formula to prevent
diarrhea
• Small dose of Spleen tonic in overall Kidney Yin tonic
• Guides/Conductors
– Directs the formula to a specific part of the body
• Blood Stagnation in Pelvis (Painful Periods or Endometriosis) versus
in the Chest (Angina, Pleurisy, or Rib Contusions/Fractures)
Cases
 Chronic • 10 yr old girl
• Frequently upper respiratory
Tonsillitis illnesses
• Enlarged Tonsils –
Tonsillectomy Advised
– Voice husky, tonsils nearly
touching
• Herbal Formula: Phlogisticlean
(Beinfield, Korngold)
– Purge Phlegm, Heat, and Toxins for Blood
and lymph system
• Acupuncture
– LU/LI Distinct Meridian
– SP-LU-LI-ST movement (Tai Yin
–Yang Ming)
Lung/Large Intestine
Distinct Meridian
Menopausa
l Sweats,
• Insomnia,
49 yo female – insomnia, hot flashes with sweats, thirst, dry mouth,
(gurgling)Mood
irritable mood, gas, upper abdominal bloating/pain, borborygmus

Swings,
• Tongue – Dry red body, red tip, dry coat
Abdominal
on sides, yellow centrally
white

Bloating
• Pulse – rapid, floating, choppy,
position deep
KI

• Kidney Yin Deficiency with Empty Heat

• Liver Qi Stagnation - Food Qi Stagnation and
Stomach Heat
Menopausa • Herbs:
l Sweats, – Ease the Journey-Yin
(Maciocia)
Insomnia, • Kidney Yin Def with Empty Heat
Mood – Meal Mover (Beinfield,
Swings, Korngold)
• Food Qi Stagnation
Abdominal • Acupuncture: Operator 5
Bloating Phase
– Tonify Kidney and Spleen
– Disperse heat
– Move Liver Qi
 Phlegm
Heat
• 52 yo male with a 3 year history of progressively
severe headaches, anxiety, palpitations, heat, and
brain fog.
– Evaluated at the Mayo Clinic in Rochester, MN with a
large metabolic and neurologic workup
– Brain biopsy ruled out Pick’s Disease.
– Declared psychiatric illness
• Dietary history included
– 2-3 regular sodas per day
– “Processed foods diet” (foods that are boxed, canned,
or otherwise packaged with generally high glycemic
indices and artificial preservatives).
 Phlegm
Heat

• Tongue
– Swollen, red, sticky
thick damp yellow
coating extending to
tip
• Pulse
– Wet/slippery at right
middle position (SP)
 • Herbal Formula: Clear the Soul
Phlegm (Maciocia)
Heat – Clear Phlegm and Heat, Open
the Mind and Heart’s Orifices,
relax the chest
• Acupuncture
– Spleen Qi tonification and
movement, Heart points
– Phlegm clearing points
– Heat clearing points
• Dietary change – cessation of
refined sugar/dairy
• Symptoms and pulses
improved within 3 weeks
• Tongue improved after 6-10
weeks
 Fatigue and Diarrhea

• 39 yo female with fatigue, chilled, low libido, irritable bowel syndrome

with intermittent diarrhea worse with irritability/anger

• History of childhood emotional trauma

• Loose stool upon awakening
– “Cock-crow diarrhea”
– Kidney Yang Deficiency
 Fatigue and Diarrhea

• Pulses: wiry, sharp at LR, deep KI, and

wet at SP
• Tongue: Pale, wide, 1+ scalloped, raw
edges, wet clear coat

• Kidney Yang Deficiency

– Water fails to nourish Wood
• LR Qi Stagnates and invades ST/SP
– Wood invades Earth
• SP Qi Deficiency
– LR Yin fails, LR Qi Stagnates, LR Yang rises
 Peeling the Onion

Start at the Outside (Manifestation)

and work your way Inward (Root)
 Metaphor of the Tree
Branches – Manifestation

Roots – Underlying Cause

 What is the Root Etiology?
• Spleen versus Kidney (Age-old TCM Debate)
• Qi (from Environment plus Life Experience)
Versus
• Jing (from Constitution/Genetics plus Life Experience) -
Jing as source of KI Yin/Yang and, ultimately, of Qi

• Childhood emotional trauma likely trumps all and injures

Water (Kidney)
• Presume that Kidney Yang Deficiency is Root
• But start with Spleen/Liver treatment to improve digestion
and mood
– Therefore improve ability to generate Qi
Herbs: Strengthen the Root (Maciocia) Kidney Yang tonic
Irritease (Kaptchuk) Move Liver Qi, Tonify Spleen Qi,
Clear Damp Heat in the Middle Burner (upper abdomen)

Tonify Tai Yin (SP) with movement onto

Yang Ming (ST), disperse Liver
 Abdominal CV points, ST25,
Mu Points for Liver/Gallbladder
Macroglossia – “My Tongue is Huge”
 Spleen
Yang
• Deficiency
35 yo female - generally colder than others, cold
hands/feet, intermittent abdominal pain with loose
Liver
stools, mild fatigue, feels best with exercise, missing
Blood/Qi
menstrual periods, uterine fibroids
Stagnation
• Herbs
– Arouse Vigor (Kaptchuk)
• Tonify Yuan Qi, Tonify Spleen/Stomach Qi, and Raise Yang
– Women’s Chamber (Kaptchuk)
• Invigorate Blood, transform Blood Stasis, reduce Abd Masses

• Acupuncture: SP-ST tonification, LR movement

 Palpitation
s
• 55 yo male - palpitations, dizziness, chronic insomnia, generally hot with
hot flashes 1-2 per night, mild anxiety, low back ache, knee soreness,
hair/nails are dry/brittle
• Overwork, divorced age 48
• Tongue: long, thin, dry, body with mild pallor, pointed/red
tip
• Pulse: Floating, deep at KI and HT
Palpitation • Heart Yin and Blood Deficiency
s – Yin (hot, dry, insomnia,
red/dry/thin tongue)
– Blood (tongue with pallor,
hair/nails dry/brittle, dizziness)
• Kidney Yin Deficiency
– Back/joint pain
– Yin Deficient symptoms above
– Co-exists with HT Yin Deficiency
– Overwork, stressful divorce as
risk factors
 Palpitations
• Herb: Celestial Emperor’s Blend (Kaptchuk)
– Heart and Kidney Yin Deficiency, Shen ungrounded,
Blood Deficiency
• Acupuncture
– Shao Yin – Tai Yang Principal Meridian
• KI-HT-SI-BL
– Focus on HT primarily at first, then shift to KI later
– Relieve Fire first, then tonify Water
– Settle Shen
• Upper Burner/Heater points (CV17, GV20)
• Ground Water with KI1
• Palpitations reduced 80% after 5 treatments,
insomnia improved, no longer thirsty/dry mouth
 Osteoarthritis of the Knee

Principal Meridian plus Knee

SP9-ST34, SP10-ST36, Eyes of Knee

Bi Syndrome Formula
(Depends on Pattern) Cardinal
Blood Stagnation
Points
Blood Deficiency
Wind-Cold-Damp
Phlegm
Heat more typical of RA
Vitamin D 5000iu Start 20Hz - Move to 4Hz after
EPA-DHA 3000-4000mg initial improvement or if no
change after 2-3 treatments
 Scalp
Acupunctu
re added
for
Pain
Reduction
in Legs
 Pleurisy
• 41 yo female with 2 weeks bronchitis followed by
sudden onset severe chest pain with breathing.
ER visit reveals normal cardiac evaluation and
normal chest xray. Seen in clinic 5 days later with
severe pain failing NSAIDS and narcotics. No
DVT.
• History of anxiety, insomnia, hysterectomy for
menorrhagia
• Tongue: red, dry, dusky purple color
yellow coat just medial to purple edges
1-2+ scalloping
• Pulse: choppy

Photo taken 4 days

after 1st treatment
 Pleurisy

• Herbs: Red Stirring (Maciocia)

– Move Blood Stagnation in Chest
• Acupuncture: Jue Yin –Shao Yang
– LR-PC-TH-GB (needle balance for Yang Dispersal, 20Hz)
– Regional chest points, Ear and Scalp points
– No Moxa
• At time of first treatment, “agonizing” pain
• Next day “woke up with no pain”
• 2 days 40% pain reduction
• 4 days 20% pain reduction
• Retreated on Day 4
 Fatigue

• 71 yo male with 4-5 years of fatigue following treatment for prostate

cancer, low libido, mild memory loss (names), markedly ridged nails
– Low testosterone “Andropause”
• Testosterone controversial with history Prostate CA

– Prolonged personal conflict/anger increases cortisol transiently – burns

out over time
Fatigue • High blood pressure – Meditation
too time consuming
• Renal insufficiency
(proteinuria, CrCl 61ml/min)
• Thyroid labs normal except
elevated RT3
• Low AM Cortisol
– Adrenal Fatigue ~ Kidney Yin or
Yang Deficiency
• Tongue – red, thin damp
yellow coat, deep wide SP/ST
crack
• Pulse – deep diffusely
 Fatigue

• Kidney Yin Deficiency, Qi Deficiency, Blood

Deficiency
• Acupuncture:
– Tonify Kidney, Back Shu points, Ming Men
– Extra Points: SP/ST points added (damp, ST crack)
• Herbs: Nourish the Root (Maciocia)
– Kidney Yin Tonic
• Other: Adrenal support protocol
– High dose B5/B6, hydrolyzed collagen, adrenal
adaptogenic herbs, adrenal glandular, pregnenolone,
GI mucosal support, GI probiotic
– Rest
Ming Men and Back Shu Points
 KI Tonification plus SP6

After 6 weekly treatments, 95% improved –

similar level of energy as experienced 2 years ago
 Fatigue

After 4 weeks of Kidney Yin Future Consideration: Tonify

tonic for dry red tongue Blood (pale tongue, ridged
with yellow coating nails), Qi (fatigue, central crack)
What about
Blood
Deficiency?
markedly
ridged nails,
tongue pallor
uncovered with
Yin
tonification,
fatigue

Blood Physiology – (Dense, material form of Qi)

 Degenerati
ve Disc
• 62 yoDisease
male – chronic back pain worse over the last year
Spinal
– Intermittent sciatica into leg

Stenosis
– MRI: degenerative disc disease, lumbar spinal stenosis
• Neurosurgeon recommends PT, epidural steroid injections,
conservative treatment
– Come back if genitourinary problems or severe pain failing all other
treatments
 PENS

• Percutaneous Electrical Nerve Stimulation

• A form of “Neuroanatomical Acupuncture”
– Dr. Bill Craig
• Electrically stimulate spinal segments responsible to the area of pain
– Dermatome, Myotome, Sclerotome, Sympathetics
PENS
 PENS
Sympathetic NS Spinal Segments
 PENS

Degenerative Disk Disease

Shingles
T10 Spinal Stenosis
T12 4Hz Low Back or Neck Pain failing
other types of acupuncture
L2 Start Single 4Hz Module
Then Split into 4Hz/15Hz
L4 Then 4Hz/30Hz, 4Hz/80Hz,
L5
and up to 4Hz/150Hz
30Hz
S1 Can Use 3-4 Modules
(4/15/30/80Hz)
Upper Back • 58 yo female with 3-4 months
Pain of upper back pain at trapezius
– Shoots into lower shoulder
blade, upper arm, and onto
dorsal forearm
– Recent headaches
– Hot, dry mouth, thirst, prefers
dark chocolate and salty flavors,
emotional stress – irritability,
neck/shoulder tightness
– History of endometriosis leading
to hysterectomy
Upper Back
Pain
• Tight knots in right trapezius, levator scapulae, rhomboids
• Palpation reproduces pain
• Tongue – red, dry, red tip, dry yellow coat
• Pulse – deep, wiry, slight floating quality
• Liver Qi Stagnation, LR Blood Stagnation
• Liver Yin Deficiency
Myofascial Upper Back Pain

JueYin – ShaoYang: LR2,LR3,GB21-34@20Hz

and upper back regional points
100% better for 3 days
and 80% better at 1 week after 3 treatments
Jiao Scalp Acupuncture
Indications (Neurologic)
Pain, Weakness, Tremor,
Stroke recovery, Vertigo,
and problems of Balance,
Vision, or Speech
 Circle the Dragon
Soft Tissue Masses, Ganglion Cysts, Shingles Rash

KI3, HT3, HT6 – SI3 @20Hz, SI8

SP6-SP9@2Hz, ST40
Herb: Cluster Dissolving (Beinfield, Korngold)
Move Liver Qi/Blood, dissolve masses, dispel Phlegm/Damp,
purge Heat/Toxins, tonify Liver and Spleen
Expect 50% reduction by 5-8 treatments
Circle the
Dragon
SO WHAT IS IT GOOD FOR?
 Applications

• Studies of various standards

• Value of RDBPCT design for interactive modalities dubious
• Internal Medicine
– Asthma, nausea, IBS, Crohn’s/UC, anxiety, depression, epilepsy, chronic
UTI, eczema, sinusitis, allergies, headache, TMJ, Bell’s Palsy, neuropathy,
stroke (scalp acupuncture)

• Substance abuse - smoking, chewing, opiates, alcohol,

craving
Application • OB/GYN

s
– Premenstrual syndrome,
(peri)menopausal symptoms,
dysmenorrhea, menorrhagia,
oligomenorrhea, infertility, labor pain,
breech presentation
• Pain
– Epicondylitis, plantar fasciitis, arthritis,
low back pain, neck pain, pelvic pain,
zoster
Application • Essentially, any medical
s problem should be accessible
with AP
– Issues are practicality and density
of disease
– Acupuncturist training and
experience
• Role in Cancer
– Helpful for decreasing side
effects of chemo/radiation
– Especially with herbal therapy
– Facilitating spiritual transition to
interaction with mortality
Veterinary Acupuncture
Heidi Woog, DVM
East Meets West Wellness Care
At
Sun Valley Animal Center
 Veterinary
Acupunctur
e
Complicatio
ns and
Precautions
• Retained Needle
• Pneumothorax (any organ puncture)
• Auricular infections
• Other skin infections
• Temporary (24hr) clinical worsening
• Pregnancy
– Not a contraindication
– Theoretical concern of causing contractions
• Anticoagulation - not a contraindication
 Recommend
ed
•
Readings
Between Heaven and Earth
– Harriet Beinfield, LAc & Efrem Korngold, LAc, OMD
• The Web That Has No Weaver
– Ted Kaptchuk, OMD
• Getting to Know You
– Joseph Helms, MD
 Other • The Foundations of Chinese
Sources Medicine
(several figures in – Giovanni Maciocia
this lecture – Several other texts authored
reproduced from (Practice, Diagnosis, Tongue
these sources)
Diagnosis, OB/GYN)
• Atlas of Chinese Tongue
Diagnosis
– Barbara Kirschbaum
• Acupuncture Energetics: A
Clinical Approach for Physicians
– Joseph Helms, MD
 CIRCLE THE
DRAGON
CHINESE HERBAL
MEDICINE AND MEDICAL
ACUPUNCTURE IN
FAMILY PRACTICE
Tom Archie, MD, DABFM, DABMA
St. Luke’s Wood River Medical Center
Integrative Therapies Service

www.drtomsalchemy.com
www.drtomsalchemy.com