Class 7: Diseases of eye, ear, nose and throat Xianhui Li

Deep-source Nasal congestion (Bi Yuan) The main clinical manifestations usually mentioned in connection with Bi Yuan are a purulent nasal discharge with a foul smell, a stuffed nose, a runny nose, headache and sneezing.

Etiology and Pathology Repeated invasion of wind cold and wind heat results in Lung Heat Liver and Gall-bladder heat Improper diet results in spleen deficiency with damp heat

Patterns Accumulation of lung-heat Liver and Gall-Bladder fire Stomach and spleen Damp-heat

Accumulation of lung-heat Clinical manifestations –Sticky-yellow or purulent nasal discharge, flushed face, feeling of heat, thirst, sore throat, itchy-red eyes, headache, constipation. Red tongue with sticky yellow coating. Slippery pulse especially on the right front position Treatment principle –Restore the dispersing and descending of Lung-qi, clear lung heat Acupuncture: LI11, LI4, LI20, Bitong, Yintang, LU10, LU7, DU14, –LU7 smoothes the flow of the lung qi and eliminates the pathogenic wind –LI4, LI11 and LI20: LI is exterior-interiorly related to LU and travels by the sides of nose. LI4, LI11 and LI20 are selected to regulate the qi circulation in the LI and to clear away the heat from the lung –LU10, ying point of the lung, clear heat in the lung –DU14 clear heat –Bitong is located at sides of the noses and yin tang is close to the nose. Both have the action of removing the obstruction and eliminating heat from the nose Herbal treatment: cang er zi san

Liver and Gall-Bladder fire Clinical manifestations –Sticky-yellow or purulent nasal discharge, flushed face, headache, dizziness, a bitter taste, dry stools, irritability, hot temper, distention at the hypochondrium region, red tongue with redder sides, sticky yellow coating, wiry and rapid pulse. Treatment principle –Clear liver and Gall bladder fire, restore the descending of lung qi Acupuncture: LI4, LI20, Bitong, Yintang, LI11, LIV2, GB43 xia xi, GB15 tou lin qi, GB20, –LI4, LI11 and LI20: LI is exterior-interiorly related to LU and travels by the sides of nose. LI4, LI11 and LI20 are selected to regulate the qi circulation in the LI and to clear away the heat from the lung –Bitong is located at sides of the noses and yin tang is close to the nose. Both have the action of removing the obstruction and eliminating heat from the nose –LV2 and GB43, ying points of the liver and GB, clear heat from the liver and GB –GB15 drain the liver and GB fire, it is adjacent point to treat nose problem –GB20 expels the wind and clears heat Herbal treatment: long dan xie gan tang

Stomach and spleen Damp-heat Clinical manifestations –Sticky yellow nasal discharge, red cheeks, thirst, impaired sense of smell, a feeling of heaviness and dizziness of the head, a sticky taste, a feeling of oppression of the chest and epigastrium, sticky stool, poor appetite, sticky-yellow tongue coating in the centre. Slippery pulse Treatment principle –Clear heat, resolve dampness, harmonize the stomach, tonify the spleen Acupuncture: LI4, LI20, Bitong, LI11, Yintang, Ren12, BL20, Ren9, SP9, BL22, –LI4, LI and LI20: LI is exterior-interiorly related to LU and travels by the sides of nose. LI4, LI11 and LI20 are selected to regulate the qi circulation in the LI and to clear away the heat from the lung –Bitong is located at sides of the noses and yin tang is close to the nose. Both have the action of removing the obstruction and eliminating heat from the nose –Ren12 and BL20 tonify the spleen to resolve dampness –Ren9 and BL22 promote the transformation of fluids and resolve dampness –SP9 resolves dampness Herbal treatment: huang qin hua shi tang

Allergic rhinitis: nasal congestion, a watery nasal discharge and sneezing. In a few cases it affects the eyes and conjunctiva may become red and itchy. Sometimes related to asthma Antigen-antibody reaction in the nasal mucosa. Antigens: pollen particles seasonal allergic rhinitis (hay fever). If the antigens are dust, animal dander, cigarette smoke, petrol fumes, perfumes, moxa smoke perennial rhinitis,

Sinusitis: sinuses are mucosa-lined cavities in the skull communicating with the nasal cavities. The frontal and maxillary sinuses are more prone to infection and inflammation. Brain discharge Gall-bladder channel flows through the brain The main symptoms of sinusitis are a purulent, yellow nasal discharge from the front and the back of nose, a stuffed nose, a frontal headache, facial pain and a feeling of muzziness and heaviness of the head. There may be local tenderness over the maxillary or frontal sinuses.

Epistaxis A dysfunction of the viscera and bowels and not include traumatic injury

Etiology and pathogenesis Nosebleeds is close linked to the functioning of the lung, stomach, liver and spleen –Exuberance of lung heat Invasion of external wind-heat or dryness-heat –Exuberance of stomach heat Consumption of strong alcoholic beverages or spicy foods –Effulgent liver fire Anger or frustration –Vacuity of liver and kidney yin Prolonged illness, overindulgent sexual activity –Spleen failing to manage the blood Anxiety and worry, overwork or poor dietary habits

Patterns Extreme heat in the lung and stomach Deficiency of Yin with empty fire

Extreme heat in the lung and stomach Clinical manifestations –Epistaxis, fever, cough, thirst with preference for cold drink, constipation, foul breath, red tongue, yellow coating, forceful and rapid pulse Treatment principle –Clear heat and stop bleeding Acupuncture: LI20, LI4, DU23, LU11, LU6, LU10, ST44 –Hand yangming and hand tai yin are exteriorly and interiorly related, the hand yangming connects with foot yangming meridians. LI20 and LI4 are selected to clear heat and stop bleeding –DU is the sea of all the yang meridians, excess yang forces blood to rush out, so DU23 is used to reduce heat from Du –LU10 and LU11, ying and jing well point of the LU, clear heat from the lung –LU6 xi cleft point of the lung, clear heat from the lung and stop bleeding –ST44 ying point, clear heat from ST Herbal treatment: sang ju yin or xi jiao di huang tang

Deficiency of Yin with empty fire Clinical manifestations –Epistaxis, night sweat, malar flush, dry mouth, 5 palms heat, thin and rapid pulse Treatment principle –Nourish Yin, Clear heat and stop bleeding Acupuncture: LI20, LI4, DU23, KI1, KI2, KI5 shuiquan, KI6 –Hand yangming and hand tai yin are exteriorly and interiorly related, the hand yangming connects with foot yangming meridians. LI20 and LI4 are selected to clear heat and stop bleeding –DU is the sea of all the yang meridians, excess yang forces blood to rush out, so DU23 is used to reduce heat from Du –KI1 and KI2, jing well and ying point of KI, clear vacuity heat and cool the blood –KI5, Xi cleft point of KI, clear empty heat –KI6 eight confluential point linking to yin qiao, has the function of nourishing yin and reducing fire Herbal treatment: zhi bai di huang wan

Toothache ya tong Tooth pain: aggravate by heat, cold or consumption of acid or sweet foods Includes: –Acute and chronic pulpitis, dental caries and periodontitis

Etiology and pathogenesis Repletion: involved in in the hand and foot yang ming channels, which pass the lower and upper gums respectively –Wind-fire toothache –Stomach fire toothache Vacuity –Vacuity fire toothache

Patterns Accumulation of heat in the stomach Invasion of wind fire Deficiency of kidney Yin with empty fire

Accumulation of heat in the stomach Clinical manifestations –Severe toothache, thirst with preference for cold drink, constipation, foul breath, red tongue, yellow coating, forceful and rapid pulse Treatment principle –Clear heat and relieve pain Acupuncture: ST6, ST7, LI4, LI11, ST44 –ST6 and ST7 are local points to stop pain and regulate qi circulation in the foot-yangming meridian –LI4 and LI11 is used to disperse pathogenic heat from the hand- yangming meridian –ST44, the ying point of the ST, is used to reduce the fire in the ST Herbal treatment: qing wei san

Invasion of wind fire Clinical manifestations –Acute toothache with gingival swelling accompanied by chills and fever, superficial and rapid pulse. Treatment principle –Clear heat, expel wind and relieve pain Acupuncture: ST6, ST7, LI4, TE5, GB20 –ST6 and ST7 are local points to stop pain and regulate qi circulation in the foot-yangming meridian –LI4 is used to disperse pathogenic heat from the hand-yangming meridian and to relieve the pain. –GB20 is used to dispel wind and clear off fire –TB5 expels wind heat and relieves pain Herbal treatment: bo he lian qiao fang

Deficiency of kidney Yin with empty fire Clinical manifestations –Dull pain off and on, loose teeth, hot flushes, night fever, night sweat, 5 palms heat, red tongue little coat, thin rapid pulse. Treatment principle –Clear heat, nourish Yin and relieve pain Acupuncture: ST6, ST7, LI4, KI3, KID2, KID1, KID5 –ST6 and ST7 are local points to stop pain and regulate qi circulation in the foot-yangming meridian –LI4 is used to disperse pathogenic heat from the hand-yangming meridian and to relieve the pain. –KI1 and KI2, jing well and ying point of KI, clear vacuity heat and cool the blood –KI5, Xi cleft point of KI, clear empty heat –KI3 nourishes yin and reduces fire Herbal treatment: zhi bai di huang tang

Sore throat Sore throat is commonly seen, it is related to stomach, lung, and kidney It can be divided into excess and deficiency –Excessive heat (ST and LU) –Yin deficiency (KI)

Etiology and pathology emotional strain excessive sexual activity and overwork old age diet exposure to loud sounds

Etiology and pathology Repletion patterns: –Lung wind-heat Wind heat invasion –Exuberant lung and stomach heat Overconsumption of spicy foods Vacuity patterns –Depletion of lung and kidney yin

Patterns Excess of heat Deficiency of yin

Excess of heat Clinical manifestations –Abrupt onset with chills, fever, headache, congested and sore throat, thirst, dysphagia, constipation, reddened tongue with thin yellow coating, superificial and rapid pulse. Treatment principle –Disperse wind and eliminate heat Acupuncture: LU11 shao shang, LI4 He gu, ST44 nei ting, SI17 tian rong –LU11, pricking to let a few drops of blood out is used to clear off the heat fro the lung and relieve pain –LI4 disperses exterior pathogenic factors from LU and yang ming meridian –ST44, Ying point of ST, clear heat –SI17, local point for pain Herbal treatment: Yin qiao san

Deficiency of yin Clinical manifestations –Gradual onset without fever or with low fever, slightly congested throat with intermittent pain or pain during swallowing, dryness of the thraot, mored marked at night, feverish sensation in the palms and soles, reddened and furless tongue, thready and rapid pulse. Treatment principle –Nourish yin and descend fire Acupuncture: KI3 tai xi, LU10 yu ji, Ren23 lian quan, KI6 zhao hai, LU7 lie que, LI18 fu tu –KI3, yuan point of KI, tonify KI yin –LU10, Ying point of LU, reduces fire –KI6 and LU7, a pair point of the eight confluent points, relieve sore throat by leading the deficiency fire downward –LI18 and Ren23 are local points for relieving pain Herbal treatment: Zhi bai di huang wan

Tinnitus and deafness Tinnitus indicates the subjective sensation experienced on hearing a noise in one or both ears. The noise may be constant or coming in bouts and vary in intensity and character. It may sound like a high-pitched whistle, like bells, like an engine running, or like rushing water. Or low- pitched sound. Deafness and tinnitus are similarly in etiology and treatment, they are discussed together

Etiology and pathology emotional strain excessive sexual activity and overwork old age diet exposure to loud sounds

Patterns Rising of liver and gall-bladder fire phlegm fire flaring upwards kidney essence deficiency

Rising of liver and gall-bladder fire Clinical manifestations –Tinnitus and deafness with a sudden onset and loud sound and clearly related to emotional strain, headache, irritability, a bitter taste, thirst, red face, dizziness, constipation. Red tongue with redder sides, yellow coating. Wiry and rapid pulse. Treatment principle –Drain liver fire, calm the mind and ease the ears Acupuncture: TB17 yifeng, TB21 erment, SI19 tinggong, GB2 tinghui, LIV2, TB5, TB3 zhong zhu, GB43, GB20 –The shao yang meridians of hand and foot travel to the ear region. So points of shaoyang meridians are used –GB2, TB21, SI19 and TB17 are local points for tinnitus, especially that related to the gall bladder channel –TB3 subdues liver yang and eases the ears –LV2 clear liver fire –TB5 and GB43 are major distal points to subdue liver yang and drain liver fire in the ear region –GB20 subdue liver yang and ease the ear Herbal treatment: long dan xie gan tang

Phlegm fire flaring upwards Clinical manifestations –Tinnitus sound like cicadas or crickets, deafness, a feeling of oppression at the chest, thirst, a feeling of muzziness in the head and dizziness. Red swollen tongue, sticky yellow tongue coating. Slippery and rapid pulse Treatment principle –Clear fire, drain dampness and ease the ears Acupuncture: TB17 yi feng, TB21, SI19, GB2, TB5, TB3, GB43, GB20, Ren9, ST40, SP9, Ren12 –The shao yang meridians of hand and foot travel to the ear region. So points of shaoyang meridians are used –GB2, TB21, SI19 and TB17 are local points for tinnitus, especially that related to the gall bladder channel –TB3 subdues liver yang and eases the ears –TB5 and GB43 are major distal points to subdue liver yang and drain liver fire in the ear region –GB20 subdue liver yang and ease the ear –Ren12, Ren9, SP9 and ST40 tonify the spleen and drain dampness and phlegm Herbal treatment: jia wei er chen tang

kidney essence deficiency Clinical manifestations –Tinnitus with gradual onset and low sound sometimes like rushing water and coming in bouts, deafness, slight dizziness, a feeling of emptiness of the head, poor memory, blurred vision, sore back and knees, diminished sexual desire. –Pale swollen tongue with thin white coating or red tongue without coanting –Deep weak pulse or thin rapid pulse Treatment principle –Tonify kidney and benefit the sea of marrow Acupuncture: TB17, TB21, SI19, GB2, KI3, Ren 4, BL23, KI7fu liu, SP6, DU4, Ren6, HT6, LIV3 –The shao yang meridians of hand and foot travel to the ear region. So points of shaoyang meridians are used –GB2, TB21, SI19 and TB17 are local points for tinnitus, especially that related to the gall bladder channel –Ren4, KI7, KI3, BL23 Du4 tonify the kidney and essence –SP6 helps to tonify kidneys, Ren6 tonify kidney qi –HT6, in combination with KI3, harmonizes heart and kidneys –LV3 subdues liver yang Herbal treatment: er long zuo ci wan

Congestion, swelling and pain of the eye A acute eye condition in various external eye disorders.

Etiology and pathology External wind heat –Obstructions of qi circulation in the meridians Liver and gallbladder fire –Qi and blood stagnation in the meridians

Patterns Wind heat Liver and gallbladder fire

Wind heat Clinical manifestations –Congestion, swelling and pain of the eye, photophobia, lacrimation and sticky discharge. Fever, slightly chills, headache, sore throat, superficial and rapid pulse Treatment principle –Disperse wind heat Acupuncture: GB20 feng chi, UB1 jing min, taiyang, (extra) LI4 he gu, LV2 xing jian, SJ5 wai guan –Use points in liver, yangming and tai yang meridian, GB20, LI4, regulate qi circulation in the yangming and shao yao –UB1 is where yangming and taiyang meridians meet, disperse local heat –LV2 conduct liver meridian qi downward and remove heat –Qiuhou, effective for eye diseases –SJ5, relive exterior wind heat, also clear heat from head and eye Herbal treatment: yin qiao san

Liver and gallbladder fire Clinical manifestations –Congestion, swelling and pain of the eye, photophobia, lacrimation and sticky discharge. Bitter taste in the mouth, irritability with feverish sensation, constipation and wiry pulse Treatment principle –Drain the liver and gallbladder fire Acupuncture: GB20 feng chi, UB1 jing min, taiyang, (extra) LI4 he gu, LV2 xing jian, LV3 tai chong –Use points in liver, yangming and tai yang meridian, GB20, LI4, regulate qi circulation in the yangming and shao yao –UB1 is where yangming and taiyang meridians meet, disperse local heat –LV2 conduct liver meridian qi downward and remove heat –Qiuhou, effective for eye diseases –LV3 yuan point of the liver, clear heat and soothe liver Herbal treatment: long dan xie gan tang

Optic Atrophy A chronic eye disorder marked by gradual degeneration of the vision acuity. Early stage: blurring vision Late stage: loss of eyesight

Etiology and pathology Deficiency of the kidney and liver yin –Consumption of essence and blood that nourish the eyes Dysfunction of spleen –Qi and blood deficiency, lack of essential nutrients for the eyes Liver qi stagnation and blood stasis –Failure of essential qi to flow upwards to nourish the eyes

Patterns Deficiency of the kidney and liver yin Deficiency of qi and blood Liver qi stagnation and blood stasis

Deficiency of the kidney and liver yin Clinical manifestations –Dryness of the eyes, blurred vision, dizziness, tinnitus, nocturnal emission, aching of the lower back, thready and weak pulse, reddened tongue with scanty coating. Treatment principle –Tonify liver and kidney yin Acupuncture: GB20 feng chi, UB1 jing min, Qiuhou (extra) GB37 guang ming LV3, KI3, UB18, UB23 –Use foot shaoyao and tai yang meridian, GB20, GB37, UB1, regulate qi in the meridian to improve vision –Qiuhou, effective for eye diseases –LV3, KI3, UB18, UB23, combination of yuan and shu points, tonify kidney and liver Herbal treatment: qi ju di huang wan

Deficiency of qi and blood Clinical manifestations –Blurred vision, weakness of breath, disinclination to talk, lassitude, poor appetite, loose stools, thready and weak pulse, pale tongue with thin white coating. Treatment principle –Tonify qi and blood Acupuncture: GB20 feng chi, UB1 jing min, Qiuhou (extra) GB37 guang ming, ST36, SP6 –Use foot shaoyao and tai yang meridian, GB20, GB37, UB1, regulate qi in the meridian to improve vision –Qiuhou, effective for eye diseases –ST36 and SP6 tonify qi and blood Herbal treatment: gui pi tang

Liver qi stagnation and blood stasis Clinical manifestations –Blurred vision, emotional depression, dizziness, vertigo, hypochondriac pain, bitter taste in the mouth, dry throat and wiry pulse. Treatment principle –Soothe the liver, remove stagnation Acupuncture: GB20 feng chi, UB1 jing min, Qiuhou (extra) GB37 guang ming, LV3, LV14, GB34 –Use foot shaoyao and tai yang meridian, GB20, GB37, UB1, regulate qi in the meridian to improve vision –Qiuhou, effective for eye diseases –LV3, LV14 and GB34 remove qi stagnation from the liver Herbal treatment: chai hu shu gan san