TCM Spleen Disease Spleen Physiology Spleen Pathology Gingivitis/Stomatitis Ulcers Pancreatitis Bleeding Muscle Wasting Obesity Constipation

Earth Sound Emotion Climate Season Direction Opening Body Part Zang/Fu song Emotion sympathy Climate humid Season late summer Direction center Opening lips/gums Body Part muscles Zang/Fu SP/ST

TCM SPLEEN Physiology Governs Transportation & Transformation Food & Water Controls Blood Dominates the Muscles Opens in Mouth Lips & Gums (ST)

TCM 24 Hour Clock

Earth BALANCED DEFICIENT EXCESS

Spleen Pathology

Spleen Pathology Damp is the Enemy of the Spleen Damp-Cold Damp-Heat Spleen Qi Deficiency with Damp

Spleen Pathology Usually combination of excess & deficiency External or Internal Pathogen Damp-Heat Damp-Cold Obstructs Spleen Qi Flow Spleen fails to Transform & Transport Gu Qi Spleen Qi Deficiency

Spleen Pathology Cold Environmental Conditions Cold Food or Drink Cold-Damp in Spleen Disharmony of Qi Flow Transform & Transport Disorder

Spleen Pathology Accumulated Heat & Damp Damp Hot Environmental Conditions Damp Hot Food or Drink Damp-Heat in Spleen Disharmony of Qi Flow Transform & Transport Disorder

Spleen Qi Deficiency Illness Overeating Overwork Starvation Under Work Disturbed Qi Flow Failure to Transform & Transport

Spleen Not Controlling Blood Prolonged Spleen Qi Deficiency Spleen Fails to Hold Blood Hemorrhage General Signs Chronic Hemorrhage

Spleen Qi Sinking Illness Overeating Overwork Starvation Under Work Chronic Spleen Qi Deficiency Failure of Holding Chronic Diarrhea Prolapses Incontinence

Spleen Pathology Cold Food or Drink Chronic Spleen Qi Deficiency Spleen Yang Deficiency Disharmony of Qi Flow Transform & Transport Disorder Yang Deficiency Signs

Stomach Pathology Cold Environmental Conditions Cold Food or Drink Cold in Stomach Disharmony of Qi Flow Transform & Transport Disorder Inhibition of Yang

Stomach Cold Cold Food & Drink Cold Environment Stomach Cold Anorexia Receiving & Decomposing Cold Signs Anorexia Altered Qi Flow Cold Ear/Nose Hypersalivation Pale-Purple Tongue Deep-Slow Pulse Lassitude

Stomach Pathology Damp Hot Environmental Conditions Hot Dry Food or Drink Heat in Stomach Heat Signs Transform & Transport Disorder

Stomach Heat Stomach Heat Pathogenic Heat Yin Deficiency Gums Ulcer channel Gums organ Ulcer child Colitis grandchild Cystitis

Stomach Food Stagnation Overeating Indigestible Food Retention of Food in Stomach Disturbed Qi Flow Failure to Transform & Transport

Stomach Yin Deficiency Stress Liver Qi Stagnation Chronic Febrile Illness Transformation to Heat/Fire Impairment of Body Fluids Stomach Yin Deficiency

Oral Cavity Disorders: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

Oral Cavity Diseases (Western) Local damage Electric shock Chemical damage Thermal damage Periodontitis Tooth tarter Systemic disease Metabolic disease Nutritional disease Immune disease Infectious disease Treatment Remove offending cause Steroids Antibiotics Clean teeth

How to Use Acupuncture for Gingivitis in Small Animal Practice Zang Fu Physiology Teeth correspond to bone Bone is controlled by the kidney Malocclusion, oligodontia are examples of Kidney Jing Deficiency Gums are influenced by the stomach Add picture of Dog with dragon breath!

Meridian Theory Oral cavity has two main channels that influence the teeth and gums Large Intestine meridian Stomach meridian

Pattern Diagnosis Stomach Heat Pattern Excess pattern, seen more often in younger animals (cats) Stomach Yin Deficiency + Empty Heat Stomach loves moisture Moisture balances Yang function Lack of Yin (fluid) allows Yang Fire to rise

Stomach Heat Pattern Fluffy: 4yr FS DSH Primary complaint: Bad breath, eating poorly History: Stray, no vetcare, dry food diet Exam: Body & coat condition-normal; vital signs-WNL

Oral Exam: Putrid odor, upper and lower arcade have severely inflamed gingiva, with spontaneous bleeding, minimal calculus formation Lab Data: Elevated WBC, FELV/FIV=Neg Diagnosis: Hemorrhagic gingivitis Treatment: Clindamycin 25mg PO BID x 10 Dental prophylaxis followed by Clavamox 62.5 mg BID x 10

TCVM Exam & Diagnosis Constitution: Water/Wood Tongue: body=reddish purple; no coat Pulse: Bilaterally superficial rapid Body Condition: Dry nose; Body Temp Normal Mouth: Stink smell; bloody red gums Pattern DX: Stomach Heat (excess condition)

TCVM Treatment Strategy Clear the Stomach Heat, Cool the Blood, & nourish Stomach Yin Acupuncture Point Selection: GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10 Herbal Medicine: Yu Nu Jian ( Jade Lady) shi gao, shu di huang, zhi mu, huai niu xi 2 teapills TID or 1/8-1/4 tsp granules TID Topical Care: Aloe Gel ( Warren Laboratories)

Case 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 & Empty Heat Pattern Tess: 10 yr, FS, Mix Breed Primary Complaint: Bad breath, dirty teeth, and periodic vomit/regurge History: Commercial dry food diet, periodic dental prophylaxis, absent dental homecare, gums remain inflamed and plaque builds quickly Western Dx / Tx: Gingivitis with periodontal deterioration. Requires 6 month recall for prophylaxis

TCVM Approach Exam: Treatment Stategy: Constitution- Water Tongue- Violet, dry, no coat Pulse- Deep, thready, and quick Gums- dry/breath scorched Coat Quality-Dry Treatment Stategy: Nourish Stomach Yin and Clear Heat AP= CV 12 (aqua); SP 3,6; ST 36,44; LI 4,11 Herbs= Qing Wei San Topical= Aloe Gel Diet: Fresh cooked food/ fish-pork-beef-eggs-veggies

Ulceration: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

Ulcer Symptoms Patterns Periodic pain Acid regurgitation Belching Vomiting Patterns Excess Stomach Cold Food Stagnation Liver Qi Stagnation Blood Stasis Deficiency Stomach Yin Deficiency

Stomach Heat Stomach Heat Pathogenic Heat Yin Deficiency Gums Ulcer channel Gums organ Ulcer child Colitis grandchild Cystitis

Signs of ST Heat Clinical Signs Pulse Tongue Treatment Strategy Hot lips & mouth Bad smell from mouth Thrist Stomatitis/Gingivitis Loss of or ravenous appetite Dry nose & feces Pulse Superficial & fast Tongue Red with yellow coating Treatment Strategy Clear ST Heat/Fire Generate body fluids

Stomach Ulcers Mild Moderate to Severe Happy Stomach Jade Lady Angelica Dang Gui Nourish & activate Blood Paeonia Bai Shao Yao Nourish Liver Yin & Blood Bupleurum Chai Hu Soothe Liver Qi Aurantium Zhi Shi Move Qi & relieve pain Trichosanthes Gua Lou Promote body fluid & transform phlegm Pinellia Ban Xia Dry damp & transform phlegm Citrus Chen Pi Move Qi & relieve pain Licorice Gan Cao Harmonize Taraxacum Pu Gong Ying Clear Heat Moderate to Severe Jade Lady Gypsum Shi Gao Clear Heat and cool Stomach Anemarrhena Zhi Mu Clear Heat and nourish Yin Rehmannia Shu Di Huang Nourish Yin and Jing Ophiopogon Mai Men Dong Moisten and nourish Yin Achyranthes Niu Xi Bring the Qi flow down

GI Food Therapy Cabbage Spinach Contains glutamate Cools stomach & GI Stops hemorrhage

Acupuncture of ST Heat Clear Stomach Fire Body Fluid Tonic Shan gen, Wei jian, Er jian, Yu Tang, ST44 LI4/11, GV14 Body Fluid Tonic KID3, SP6, SP9

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 Shan-gen GV-26 Ren zhong 06 Ren-zhong/Shui-gou the center of man/water passage, Xie-07, GV-26 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

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 LO: At the ventral midline just cranial to throat. IN: excessive salivation, laryngeal hemiplegia 23 Lian-quan ridge spring CV-23

Pancreatitis: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

Pancreatitis Considered any acute or chronic change in GI function usually accompanied by some degree of vomiting, diarrhea and abdominal pain Acute- -Mild Pancreostasis Acute- -Severe Fulminating pancreatitis Chronic Pancreatic insufficiency Rx Acute NPO Fluids Antiemetics Pain relief Low fat/protein food Rx Chronic Enzyme therapy

TCVM Acute Pancreatitis

TCVM Chronic Pancreatitis * Enzyme replacement therapy still good to add

Perry 3 yr FS Springer Earth personality Acute onset of vomiting, fever and abdominal pain Increased thirst Scant urination Elevated Amylase & Lipase Increased WBC Rx: Fluids & Ranitidine Tongue: red & dry Pulse: fast & superficial West Dx: acute pancreatitis TCM Dx: damp-heat in spleen

Perry Treatment AP Herbal Next day was 80% improved DN ST-45 ST-36 LI-4 PC-6 BL-20 CV-12 Aqua Herbal Great Saussurea Coptis Next day was 80% improved Clinician said, “He is doing absolutely fantastic…better than any patient in years…NO…it wasn’t the acupuncture…well…maybe we should try it again!”

Great Saussurea Coptis Saussurea Mu Xiang Move Qi & relieve pain Coptis Huang Lian Clear Damp-Heat in the intestines Evodia Wu Zhu Yu Warm the middle Jiao & stop vomiting

Bleeding: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

Bleeding Primary Hemostasis Secondary Hemostasis Complex chain of events involving interaction of Platelets Vessel Wall von Willebrand’s factor Fibrinogen Secondary Hemostasis Complex interaction of the intrinsic and extrinsic clotting cascades Stabilize the platelet plug

Primary Hemostasis Evaluated by the bleeding time Platelet number Amount and Quality of the von WIllebrand’s factor VIII:Ag Fibrinogen concentration Other alterations due to vessel wall disorders

Secondary Hemostatis Assessed by ACT (activated clotting time) APTT (activated partial thromboplastin time) PT (prothrombin time)

TCM Pathoetiology Heat Spleen Qi Deficiency Tongue Pulse Red & Dry Superficial (forceful) & fast Spleen Qi Deficiency Pale & moist Deep & weak (particularly on right)

Spleen Pathology Accumulated Heat & Damp Damp Hot Environmental Conditions Damp Hot Food or Drink Damp-Heat in Spleen Disharmony of Qi Flow Transform & Transport Disorder

Heat Hemorrhage Herbal treatment depends upon location Bladder Red Front Door GI tract Sophora Powder Great Saussurea Coptis Red Back Door Pulmonary Red Lung Nose Single Immortal Uterus Wu Bei San

Spleen Not Controlling Blood Prolonged Spleen Qi Deficiency Spleen Fails to Hold Blood Hemorrhage General Signs Chronic Hemorrhage

Darby Signalment History TCVM Exam 5 yr FS Doberman Generalized weakness Ecchymosis Abdominal bleeding TCVM Exam Tongue: pale Pulses: deep & weak Dx: Spleen Qi Deficiency (not holding blood in vessels)

Darby Western Rx TCVM Rx Compressive bandage Hemorrhage control AP Cryoprecipitate Whole Blood Thyroid medication TCVM Rx AP SP Qi Tonic BL-20/21, SP-6, SP-9 & CV-6 Stop Hemorrhage Tian Ping & BL-17 Herbal Yunnan Pai Yao Huang Tu Tang

Huang Tu Tang Atractylodes Bai Zhu Strength Spleen & tonify Qi Yellow Earth Zao Xin Tu Warm Spleen & stop diarrhea Aconite Fu ZI Warm Spleen Asinum Er Jiao Nourish Blood Rehmannia Sheng Di Huang Nourish Yin Scutellaria Huang Qin Stop bleeding & prevent excess heat Licorice Gan cao Harmonize

Muscle Wasting: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

TCM Muscle View Muscle volume & strength is under the domain of the Spleen Spleen transforms food and transports it to the body to provide energy & building blocks. Spleen Qi provides muscle strength Liver blood provides endurance Continued delivery of Spleen Qi to muscles

Western View of Muscle Wasting Generalized Wasting Malnutrition Insufficient intake of materials to support Spleen Qi Cardiac Cachexia Heart failure leads to stagnation of blood Liver is unable to support distribution of blood & Qi Leads to accumulation of Damp in Spleen Results in Spleen Qi Deficiency with failure to provide energy and building materials to the muscles Cancer Cachexia Tumor Necrosis Factor poisons metabolism leading to Spleen Qi Deficiency Diminished effective delivery of energy to muscles Localized Wasting Trauma Local damage of muscle Disuse Atrophy Local stagnation results in Liver failure to support Spleen/Stomach Accumulation of Damp alters Spleen function Local stagnation decreases delivery of nutrients Neurogenic Atrophy Denervation leads to local liver stagnation Results in failure to support spleen Qi Leads to decreased delivery of local channel energy

Wei Syndrome Damp Heat Si Miao San Qi/Yang Deficiency Bu Yang Huan Wu Earth personality Obesity History of damp heat in skin or GI Muscle atrophy Weakness Lethargy Greasy wet tongue Fast pulse Si Miao San Qi/Yang Deficiency Lethargy, shortness of breath, weakness Too weak to get up to walk Loose lips Loose stool Anorexia & Emaciation Dry-burnt hair Edema Heat seeking Pale wet tongue Thready & weak pulse Bu Yang Huan Wu Qi/Yin Deficiency Emaciation Weakness in lumbar region Dry skin Pale or red & dry tongue Weak & thready pulse Hindquarter formula

Jake History TCVM Exam Progressive weakness in rear legs Cool seeking Rear leg muscle atrophy Dry hair & skin TCVM Exam Pulses deep & weak (< R) Red dry tongue DX: Qi/Yin Deficiency

Jake’s Treatment AP Herbal EA DN Aqua Jia Bing Fang SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui DN BL20, BL23, BL26, KID3 Aqua SP6, ST36, BL23, BL26 Herbal Jia Bing Fang

Jia Bing Fang Astragalus Huang Qi Tonify Qi Condonopsis Dang Shen Tonify Qi Polygonum He Shou Wu Nourish Blood and Jing Rehmannia Shu Di Huang Nourish Blood, Yin and Jing Paeonia Bai Shao Yao Nourish Blood and soothe Liver Qi Dioscorea Shan Yao Tonify Qi and nourish Jing Prunella Xia Ku Cao Soothe Liver Qi, clear Heat Cyperus Xiang Fu Move Liver Qi and relieve nodules Bupleurum Chai Hu Soothe Liver Qi Sargassum Hai Zao Transform phlegm, clear Heat, soften the hardness Laminaria Kun Bu Transform phlegm, soften the hardness, drain water

Sam History TCVM Exam Chronic rear leg weakness and muscle wasting Dry hair Weight loss TCVM Exam Red dry tongue Weak thready pulses (< R) DX: Qi/YinDeficiency

Sam’s Treatment AP Herbal DN Aqua Hindquarter formula (tea pills) GV20, BL20, BL23, BL26 Aqua SP6, ST36, BL23, BL26 Herbal Hindquarter formula (tea pills)

Hindquarter Formula Eucommia Du Zhong Tonify Kidney & strengthen back Achyranthes Niu Xi Tonify Kidney & strengthen the hind limbs Lindera Wu Yao Move Qi and relieve pain Astragalus Huang Qi Tonify Qi Apis Feng Hua Fen Tonify Qi and Yin Morinda Ba Ji Tian Warm and strengthen the back Angelica Dang Gui Nourish Blood Rehmannia Shu Di Huang Nourish Yin and Jing Cinnamon Gui Zhi Warm the Channels and benefit the limbs

Diarrhea

Diarrhea Increase in fluidity of feces leading to soft to watery feces May contain mucous & blood Increase frequency Chronic if greater than 1 month

Diarrhea May include up to 27% of all patients 122 Horses with acute diarrhea (TA&M) 91 recovered 28 euthanatized 3 died

Diarrhea TCVM Patterns Excess Deficiency Cold Damp Damp Heat Food Stagnation Disharmony between SP & LIV Deficiency SP Qi Def SP & KID Yang Def

Diarrhea

Diarrhea

Obesity: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

Obesity In > > Out Body weight is 20% over ideal An intake of total dietary energy above that needed for maintenance and production or exercise over a long period of time Energy in is based upon Food intake Absorption Energy used is Basic metabolic rate (thermoneutral condition) Exercise Lactattion Pregnancy Growth In > > Out

Obesity: TCVM Classical Strategy (1) Yin Tonic Herbs (Remannia, Lycium etc) Decrease in appetite Decrease in food intake (2) Purgative herbs (Rheum, Cannabis Ma Zi Ren etc) Passing food faster through SI Less time to absorb nutrients Decrease in absorption (3) Qi Tonic Herbs (Ginseng, codonopsis etc) Energy boosting Patient more willing to exercise Burning down Fat tissue

Obesity: TCVM Etiology and Pattern Damp-phlegm Liver Stagnation Blood Stagnation Spleen Deficiency Kidney Deficiency Excess Deficiency

Damp-phlegm Etiology Spleen Qi Deficiency Water/damp from food or environment Other pathogenic factors Stagnation of Water-damp Phlegm under the skin Obesity

Damp-phlegm 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-6/9 or Electro-acupuncture (F=30 Hz) for local swelling area 2) Message: Abdomen and back, twice a day.

Damp-phlegm Herbal Formula Phlegm Fat Formula (Citrus-Pinellia Compound) 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% Er Chen Tang Resolve Damp Liver Qi Master

Damp-phlegm Max Formula For lipomas 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

Liver Qi Stagnation Etiology Emotional Stress Drug Stress Liver over-control Spleen Spleen fails to transform Damp Phlegm under the skin Obesity

Liver Qi Stagnation 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 Symptoms: Treatment strategy: Regulate liver, clear Fire and transform damp Acupuncture: Sp-6/9, ST-40 Liv-3, GB-20 and GB-34

Liver Qi Stagnation Herbal formula: Picrorrhiza Compound* 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% Clear Liver Clear Liver Nourish Yin/Blood Purge LI

Blood Stagnation Etiology Other factors Stress Qi stagnation Qi-blood stagnation Water/Damp retention in the body Obesity

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 Treatment strategy: Invigorate Blood and transform damp Acupuncture: BL-17/SP-10 LIV-3, GB-34, LI-4 ST-40/BL-40

Blood Stagnation Herbal Formula: Stagnation Reliever Carthamus Hong Hua 22% Ligusticum Chuang Xiong 22% Olibanum Ru Xiang 19% Typha Pu Huang 1 9% Rheum Da Huang 18% Move Blood, resolve stasis Move Qi & Blood Purge LI

Spleen Qi Deficiency Etiology Water/damp Overwork from food or environment Overwork Chronic illness Spleen Qi Deficiency Phlegm under the skin Obesity

Spleen Qi Deficiency Symptoms: Treatment strategy: Acupuncture: Overweight Diarrhea, or dry feces Hyperlipemia Eexercise intolerance, lassitude Pulse: Weak and deep Tongue: pale with coating or without coating Treatment strategy: tonify spleen qi and transform damp Acupuncture: ST-36/40/41, SP-2/3, and BL-20/21

Spleen Qi Deficiency Herbal formula: Nelumbo Compound* Herbal Formula: 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% Eliminate Damp, Strengthen SP Drain Damp Resolve stagnation, clear Liver Herbal Formula: Astragalus-atractylodes-lycium Astragalus Huang Qi 34% Atractylodes Cang Zhu 33% Lycium Gou Qi Zi 33%

Kidney Qi Deficiency Etiology Other factors Chronic illness Ageing Water retention Phlegm Obesity

Kidney Qi Deficiency 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 Treatment strategy: tonify Kidney qi and transform damp Acupuncture: Bai-hui, Shen-shu, Shen-peng, Shen-jiao Bl-23/26, SP-6 and Kid-3

Kidney Qi Deficiency Psoralea Pill Herbal formula: Psoralea Bu Gu Zi 32% Notoginseng Tian Qi 9% Rheum Da Huang 30% Cassia Fan Xie Ye 29% Tonify Kid Qi/Yang Move Blood Purge LI

Kobe 9 yr MC Siamese Obesity (14 lb) Less playful and less activity after moving to a new place 3 weeks ago Warm-seeking Tongue: pale & swollen Pulse: deep & weak Kidney Qi Deficiency Rx: Psoralea Pill

Henrietta 12 yo FS Dachshund Overweight Able to get around with support Pants a lot with slight cough Pulse: Fast & deep Tongue: red Damp-Phlegm Rx: Phlegm Fat Formula

Constipation: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

Regulation of Colon Function Colon is like the urinary bladder Innervation by Sympathetics from L2-3 Parasympathetics from S1-3 Filling Phase Sympathetics Yin Emptying Phase Parasympathetics Yang Propranolol @ 0.25-0.5 mg/kg TID

Constipation Definition: Patterns Constipation Obstipation Heat Infrequent or incomplete bowel movements Feces are drier or harder Obstipation Intractable constipation Impossible defecation Patterns Heat Qi Stagnation Qi Deficiency Yin/Blood Deficiency

Stomach Heat Pathogenic Heat Yin Deficiency Stomach Heat Gums Cystitis channel Gums organ Ulcer child Colitis or Constipation grandchild Cystitis

Differentiation Onset Stool Mucus Thirst Urination Abdm. Pain HEAT Qi Stagnation Qi Deficiency Blood/Yin Deficiency Onset Acute Wood Person. Chronic Stool Dry On/Off Small/Thin Mucus Yes No No/Yes Thirst Urination Short Normal Long Abdm. Pain Flank Mouth odor Foul Slight Preference Cool None Warm Tongue color Red Purple Pale Pale/Red T. Moisture Wet T. Coating Yellow Pulse Fast/Wiry Wiry Weak Weak/Thready

Constipation/Megacolon Heat Acute onset of colic Hot ear & nose Cool seeking Thirsty Foul breath Swollen upper palate Red & dry tongue Fast pulse Da Chang Qi Tang Qi Stagnation Sub-acute onset of colic Bloat & abdominal fullness Gaseous bowel movements Anorexia Purple or red tongue Wiry, fast pulse Xiao Zhang San Qi Deficiency Chronic constipation or colic Loss of body mass Weakness Pale tongue Deep & weak pulse Fan Xie Ye Yin/Blood Deficiency Very chronic megacolon with impaction Dry flaky skin Weak or geriatric patient Pale or red, dry tongue Fast, weak & thready pulse Dang Gui Cong Rong

Acupuncture Points Method Heat Qi Stagnation Qi Deficiency Blood/Yin Deficiency Points LI-4 LI-10 GV-1 BL-21 ST-37 LIV-3 GB-34 ST-36 SP-6 B-21 BL-15 SP-10 Method q d 3d 1-3 times q wk 2-4 times 2-5 times 3-7 times

Kitty Little 15 yr FS Persian Chronic constipation with impaction Dry flaky skin with dandruff General weakness Tongue: red & dry Pulse: deep, weak & thready Yin/Blood Deficiency Rx: Dang Gui Cong Rong

Molly 13 yr FS Maine Coon Earth personality Frequent constipation with impaction Colon cleaning under anesthesia 5 times in past 2 years Recent inappetence Vomits undigested food with impacted Rx: Lactulose & Cisapride First visit: No BM for 5 day Abdomen filled with fecal balls Dry haircoat Warm seeking Tongue: red & dry Pulse: weak

Molly Dx Earth personality No BM Dryness Weak pulse Red & dry tongue Anorexia Decreased thirst Earth element (SP/ST) Yin Deficiency Qi Deficiency TCVM Dx: SP/ST (LI) Yin & Qi Deficiency

Molly Rx Acupuncture: DN: GV-20, CV-12, ST-25 EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz) BL-21, BL-25, ST-36- -ST-37 (bilaterally) Owner reported that Molly defecated a long firm stool 10-16 hours after acupuncture and continued to have BMs every 2-3 days. Stool still dry & still warm seeking. TCM Herbal: Ma Zi Ren Wan + Fan Xie Ye