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

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 Treatment Remove offending cause Steroids Antibiotics Clean teeth

TCM Spleen Disease Spleen PhysiologySpleen Physiology Spleen PathologySpleen Pathology Gingivitis/StomatitisGingivitis/Stomatitis

Earth SoundSound songsong EmotionEmotion sympathysympathy ClimateClimate humidhumid SeasonSeason late summerlate summer Direction center Opening lips/gums Body Part muscles Zang/Fu SP/ST

TCM SPLEEN Physiology Governs Transportation & TransformationGoverns Transportation & Transformation 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 Clock

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

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

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

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

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

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

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

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

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

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

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

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

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

How to Use Acupuncture for Gingivitis in Small Animal Practice Zang Fu Physiology Teeth correspond to boneTeeth correspond to bone Bone is controlled by the kidneyBone is controlled by the kidney Malocclusion, oligodontia are examples of Kidney Jing DeficiencyMalocclusion, oligodontia are examples of Kidney Jing Deficiency Gums are influenced by the stomachGums are influenced by the stomach

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

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

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

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

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

TCVM Treatment Strategy Clear the Stomach Heat, Cool the Blood, & nourish Stomach YinClear the Stomach Heat, Cool the Blood, & nourish Stomach Yin Acupuncture Point Selection:Acupuncture Point Selection: GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10 Herbal Medicine: Yu Nu Jian ( Jade Lady)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)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 BreedTess: 10 yr, FS, Mix Breed Primary Complaint: Bad breath, dirty teeth, and periodic vomit/regurgePrimary 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 quicklyHistory: 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 prophylaxisWestern Dx / Tx: Gingivitis with periodontal deterioration. Requires 6 month recall for prophylaxis

TCVM Approach Exam:Exam: Constitution- WaterConstitution- Water Tongue- Violet, dry, no coatTongue- Violet, dry, no coat Pulse- Deep, thready, and quickPulse- Deep, thready, and quick Gums- dry/breath scorchedGums- dry/breath scorched Coat Quality-DryCoat 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 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 Heat Pathogenic Heat Yin Deficiency channel Gums organ Ulcer child Colitis grandchild Cystitis

Stomach Ulcers MildMild Moderate to Severe Angelica Dang Gui Nourish & activate Blood Paeonia Bai Shao YaoNourish 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 Happy Stomach 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 CabbageCabbage Contains glutamateContains glutamate Cools stomach & GICools stomach & GI SpinachSpinach Stops hemorrhageStops hemorrhage

Shan-gen GV-26 Ren zhong 06 Ren-zhong/Shui-gou the center of man/water passage, Xie-07, GV 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 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 painConsidered any acute or chronic change in GI function usually accompanied by some degree of vomiting, diarrhea and abdominal pain Acute- -MildAcute- -Mild PancreostasisPancreostasis Acute- -SevereAcute- -Severe Fulminating pancreatitisFulminating pancreatitis ChronicChronic Pancreatic insufficiencyPancreatic 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 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% improved Clinician said, “He is doing absolutely fantastic…better than any patient in years…NO…it wasn’t the acupuncture…well…may be 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 HemostasisPrimary Hemostasis Complex chain of events involving interaction ofComplex chain of events involving interaction of PlateletsPlatelets Vessel WallVessel Wall von Willebrand’s factorvon Willebrand’s factor FibrinogenFibrinogen Secondary HemostasisSecondary Hemostasis Complex interaction of the intrinsic and extrinsic clotting cascadesComplex interaction of the intrinsic and extrinsic clotting cascades Stabilize the platelet plugStabilize the platelet plug

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

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

TCM Pathoetiology HeatHeat TongueTongue Red & DryRed & Dry PulsePulse Superficial (forceful) & fastSuperficial (forceful) & fast Spleen Qi DeficiencySpleen Qi Deficiency TongueTongue Pale & moistPale & moist PulsePulse Deep & weak (particularly on right)Deep & weak (particularly on right)

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

Heat Hemorrhage Herbal treatment depends upon locationHerbal treatment depends upon 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 Blood Hemorrhage Spleen Fails to Hold Blood Chronic Hemorrhage General Signs Prolonged Spleen Qi Deficiency

Darby 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 (not holding blood in vessels)

Darby Western RxWestern Rx Compressive bandageCompressive bandage Hemorrhage controlHemorrhage control CryoprecipitateCryoprecipitate Whole BloodWhole Blood Thyroid medicationThyroid 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

AtractylodesBai ZhuStrength Spleen & tonify Qi Yellow EarthZao Xin TuWarm Spleen & stop diarrhea AconiteFu ZIWarm Spleen AsinumEr JiaoNourish Blood RehmanniaSheng Di HuangNourish Yin ScutellariaHuang QinStop bleeding & prevent excess heat LicoriceGan caoHarmonize

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

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

Western View of Muscle Wasting Generalized WastingGeneralized Wasting MalnutritionMalnutrition Insufficient intake of materials to support Spleen QiInsufficient intake of materials to support Spleen Qi Cardiac CachexiaCardiac Cachexia Heart failure leads to stagnation of bloodHeart failure leads to stagnation of blood Liver is unable to support distribution of blood & QiLiver is unable to support distribution of blood & Qi Leads to accumulation of Damp in SpleenLeads to accumulation of Damp in Spleen Results in Spleen Qi Deficiency with failure to provide energy and building materials to the musclesResults in Spleen Qi Deficiency with failure to provide energy and building materials to the muscles Cancer CachexiaCancer Cachexia Tumor Necrosis Factor poisons metabolism leading to Spleen Qi DeficiencyTumor Necrosis Factor poisons metabolism leading to Spleen Qi Deficiency Diminished effective delivery of energy to musclesDiminished 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 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 San Qi/Yang Deficiency Lethargy, shortness of breath, weaknessLethargy, shortness of breath, weakness 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 Wu Qi/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 formula

Jake HistoryHistory Progressive weakness in rear legsProgressive weakness in rear 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 Deficiency

Jake’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 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 the hardness Laminaria Kun Bu Transform phlegm, soften the hardness, drain water hardness, drain water

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

Sam’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 Formula Eucommia Du Zhong Tonify Kidney & strengthen back AchyranthesNiu 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

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

Obesity Body weight is 20% over idealBody 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 timeAn intake of total dietary energy above that needed for maintenance and production or exercise over a long period of time Energy in is based uponEnergy in is based upon Food intakeFood intake AbsorptionAbsorption Energy used isEnergy used is Basic metabolic rate (thermoneutral condition)Basic metabolic rate (thermoneutral condition) ExerciseExercise LactattionLactattion PregnancyPregnancy GrowthGrowth 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

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

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 Citrus Chen Pi8% Pinellia Ban Xia8% Poria Fu Ling10% Coix Yi Yi Ren20% Atractylodes Cang Zhu8% Areca Da Fu Pi10% Benincasa Dong Gua Pi8% Alisma Ze Xie10% Plantago Che Qian Cao10% Cyperus Xiang Fu8% Phlegm Fat Formula (Citrus-Pinellia Compound) Er Chen Tang Resolve Damp Liver Qi Master Damp-phlegm

FritillariaZhe Bei MuSoften hardness and clear nodules OstreaMu LiSoften hardness and clear mass PrunellaXia Ku CaoClear Liver Heat and resolve nodules ScrophulariaXuan ShenClear Heat and cool Blood TrichosanthesTian Hua FenClear Heat and promote body fluids PlatycodonJie GengOpen the Upper Jiao and transform phlegm RhubarbDa HuangClear stagnation/stasis and clear Heat AngelicaBai ZhiClear Wind-Cold and relieve pain Max FormulaFor lipomas Damp-phlegm

Liver Qi Stagnation Etiology Drug Stress Emotional Stress Liver Qi Stagnation Phlegm under the skin Obesity Liver over-control Spleen Spleen 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-40 Liv-3, GB-20 and GB-34 Regulate liver, clear Fire and transform damp Liver Qi Stagnation

Herbal formula: Picrorrhiza Hu Huang Lian18% Prunella Xia Ku Cao19% Cassia Jue Ming Zi18% Rehmannia Sheng Di Huang15% Rheum Da Huang15% Cassia Pang Xie Ye15% Picrorrhiza Compound* Clear Liver Purge LI Clear Liver Nourish Yin/Blood Liver Qi Stagnation

Blood Stagnation EtiologyOther 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-10 LIV-3, GB-34, LI-4 ST-40/BL-40 Blood Stagnation

Carthamus Hong Hua 22% Ligusticum Chuang Xiong22% Olibanum Ru Xiang19% Typha Pu Huang1 9% Rheum Da Huang18% Stagnation Reliever Herbal Formula: Move Blood, resolve stasis Purge LI Blood Stagnation Move Qi & Blood

Spleen Qi Deficiency Etiology Water/damp from food or environment Chronic illness Overwork 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 Deficiency

Herbal Formula: Astragalus Huang Qi 34% Atractylodes Cang Zhu33% Lycium Gou Qi Zi33% Herbal formula: Astragalus-atractylodes-lycium Nelumbo He Ye (Lotus)13% Alisma Ze Xie13% Poria Fu Ling13% Coix Yi Yi Ren13% *Atractylodes Cang Zhu 13% Atractylodes Bai Zhu12% Citrus Chen Pi10% Cassia Jue Ming Zi13% Nelumbo Compound* Eliminate Damp, Strengthen SP Drain Damp Resolve stagnation, clear Liver Spleen Qi Deficiency

Kidney Qi Deficiency EtiologyOther factors Ageing Chronic 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-jiao Bl-23/26, SP-6 and Kid-3 Kidney Qi Deficiency

Herbal formula: Psoralea Pill Psoralea Bu Gu Zi32% Notoginseng Tian Qi9% Rheum Da Huang30% Cassia Fan Xie Ye29% Purge LI Move Blood Tonify Kid Qi/Yang Kidney Qi Deficiency

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 Kobe 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 bladderColon is like the urinary bladder Innervation byInnervation by Sympathetics from L2-3Sympathetics from L2-3 Parasympathetics from S1-3Parasympathetics from S1-3 Filling PhaseFilling Phase SympatheticsSympathetics YinYin Emptying PhaseEmptying Phase ParasympatheticsParasympathetics YangYang mg/kg TID

Constipation Definition:Definition: ConstipationConstipation Infrequent or incomplete bowel movementsInfrequent or incomplete bowel movements Feces are drier or harderFeces are drier or harder ObstipationObstipation Intractable constipationIntractable constipation Impossible defecationImpossible defecation Patterns Heat Qi Stagnation Qi Deficiency Yin/Blood Deficiency

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

Differentiation HEAT Qi Stagnation Qi Deficiency Blood/Yin Deficiency Onset AcuteWood Person.Chronic Stool DryOn/OffSmall/ThinDry Mucus YesNo No/Yes Thirst YesNo Yes Urination ShortNormalLongShort Abdm. Pain NoFlankNo Mouth odor FoulNo Slight Preference CoolNoneWarmCool Tongue color RedPurplePalePale/Red T. Moisture DryNormalWetDry T. Coating YellowNormalNo Pulse Fast/WiryWiryWeakWeak/Thready

Constipation/Megacolon Heat Acute onset of colicAcute onset of colic Hot ear & noseHot ear & nose Cool seekingCool seeking ThirstyThirsty Foul breathFoul breath Swollen upper palateSwollen upper palate Red & dry tongueRed & dry tongue Fast pulseFast pulse Da Chang Qi Tang Qi 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 San Qi 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 Ye Yin/Blood Deficiency 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 Rong

Acupuncture Heat Qi Stagnation Qi Deficiency Blood/Yin Deficiency Points 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 Method q d 3d 1-3 times q wk 2-4 times q wk 2-5 times q wk 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 Earth element (SP/ST) Dryness Red & dry tongue Yin Deficiency Weak pulse Anorexia Decreased thirst Qi Deficiency TCVM Dx: SP/ST (LI) Yin & Qi Deficiency

Molly Rx Acupuncture: DN: GV-20, CV-12, ST-25 EA: (10 20 Hz & 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 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