1. Asian Bodywork III Class 6
Timur Lokshin LMT, CPS, LAc.

2. Rebellious Qi Rebellious qi is AKA Counterflow qi.
Occurs when the normal function of the flow is impaired or obstructed, causing a reversed movement of flow.
e.g. ST qi downbears to the LI. When obstructed by late night eating (fullness) or impaired by spicy foods (heat) it rebels and gives symptoms of GURD

3. Cough
Coughing is one of the more predominant patterns in cases of respiratory illness. In Chinese, coughing is called Ke Sou. Ke is characterized coughing with sound but without phlegm, and Sou is characterized coughing with phlegm but without sound. Sing majority of coughing patterns have the characteristics of both sound and phlegm, Ke and Sou are usually used as a compound word

4. Impaired Lu Qi
Lung qi depuration and downbearing can be impaired by heat arising through transformation of exogenous pathogens or by brewing phlegm damp. It is often characterized by and is most common cause of, persistent cough or qi counterflow.

5. Etiology
Patterns of coughing are divided into two categories: External Cough and Internal Cough.
External is developed following the invasion of one or more of the six external evils.
Wind Cold
Wind Heat
Wind Dryness
Most Commonly Observed Clinically

6. Internal Cough
Internal cough are mainly caused by internal evils resulting from the dysfunction of the viscera and bowels. Three most common type:
Phlegm Damp
Liver Fire
Yin Vacuity

7. Invasion of LU by Wind Cold
Sx: Choking cough, accelerated respiration, scratchy throat and expectoration of thin white phlegm, aversion to cold, headache and stuffy runny nose.
Tongue: Thin White Coating
Pulse: Floating, Taut
Tx: UB13, LU7, SJ5, LI4

8. Invasion of LU by Wind Heat
Sx: Frequent coughing, heavy breathing, sore throat, dry mouth and difficult expectoration of thick sticky yellow phlegm, accompanied by fever, perspiration, aversion to wind, headache, thirst.
Tongue: Thing Yellow Coating
Pulse: Floating Rapid Pulse
Tx: UB 13, LI11, LU5

9. Invasion of LU by Wind Dryness
Dry cough without phlegm or with scanty sticky phlegm that is difficult to expectorate, or with phlegm containing streaks of blood, scratchy or sore dry throat, dry nose and mouth, exterior symptoms such as stuffy nose, headache, slight aversion to cold or fever in early stages.
Tongue: Dry Red, Thing White or Yellow Coat
Pulse: Floating, possibly Rapid
Tx: UB13, LI11, LU5, SP6, KD6

10. LU and SP
Lungs downbearing qi, meets with Spleens upbearing qi to creat nutrient qi. When LU qi is impaired by obstruction, invasion or vacuity, the SP can not transform and transport. Building up dampness and phlegm in the body.

11. Phlegm Dampness Cough
Frequently recurring cough particularly marked on rising in the morning with expectoration of abundant dilute white phlegm, accompanied by oppression in the chest, epigastric fullness and distention, nausea, fatigue, poor appetite, loose stools.
Tongue: White Slimy Coating
Pulse: Soggy or SLippery
Tx:UB13, SP9, LU5, ST40 (strong stim at LU5)

12. LU and LV
Liver is the unyielding organ and governs the upbearing of qi. The lung is the body’s uppermost organ and governs downbearing of qi. These complimentary movements represent a major factor in the upward and downward bearing of qi in the body. Pathologically, if the hepatic upbearing is stronger than pulmonary downbearing, liver fire may invade the lungs. Provoking such symptoms as irritability, pain in the chest and lateral costal region, counterflow of qi (cough) or expectoration of blood.

13. Liver Fire Cough
Sx: Hacking cough, scanty sticky phlegm, full distended sensation and pain throughout the chest and costal region during coughing, flushed complexion, bitter taste in mouth, dry scratchy throat, variation in severity of symptoms with emotional state.
Tongue: Red with Thin Yellow Coating
Pulse: Rapid, Wiry
TX: UB 13, LV2, PC6

14. Yin Vacuity Cough
Sx: Dry hacking cough without phlegm, or with scanty sticky white or blood-tinged phlegm, gradual hoarseness, dry throat and mouth, afternoon tidal fever, vexing heat in the five hearts, night sweating, listlessness, emaciation.
Tongue: Red with little coating
Pulse: Rapid, threading
Tx: UB13, LU5, KD6, SP6

15. Gua Sha
Gua Sha in Chinese direct translation, “ (Gua)” means “scrape” and “ (Sha)” means “sand”. Originally, Sha is written as which means sand that we see on the beach, but as the Chinese language developed to describe it as a medical condition. So, what is sand or Sha as a medical condition? It is the red small dots that appears on the skin after scrapping. In Western Medicine, it is called petechiae. Some people translate it as the blockage in our body, and Gua Sha is just the way to get the blockage out from hiding.

16. Gua Sha Cont.
Gua Sha is one of the most ancient way of making people feel better. No medicine is required, and the tools that can be used for Gua Sha can be as easy as our hands, fingers, a tread of string, or any object with smooth surface. It is also not invasive, so it is wildly used at home by many families in China. There are many with their own special ways of doing Gua Sha or similar technique. However, just to note that about more than half of those special ways are not safe or healthy, and many of them actually injure the body more.

17. Gua Sha Cont.
When there is a blockage/tension/stress stored in certain part of our body, we feel tight, sore, pain and all soft of discomfort. The circulation in that area would be slower and we can usually feel a knot when we rub the tense area. What Gua Sha does is to scrape those blockage/tension and bring whatever that cause blockage to the surface of our skin where our capillaries will slowly take those away. It is a similar idea as to use a broom to bring dusts out from under our beds or the corners.

18. Gua Sha Cont.
There are lots of different kind of Gua Sha tools out there. When you search online, you see various shapes and sizes. In addition, they are all made out of different materials. Water buffalo horns  are said to be the best material, because it is all natural and contains no chemical products and cause no allergy to most people, and water buffalo horns are herbal medicine that can help with movement of Qi (energy), reducing blood stasis, and nourishing the skin. However, I have use tools that are made out of wood, plastic, ceramic, jade, water buffalo horns, and different kind of stones and crystals, and they all works very well. In my opinion, just use anything that is easy to clean and solid with a smooth edge. Some of my patients use coins to Gua Sha, and it is not recommended. Coins are usually not clean and without smooth edge, so it breaks skin even with application of oil or other lubricants, and it might cause infections.

19. Gua Sha Cont.
Gua Sha tools usually comes with two different kinds of edges. One would be more narrow and one would be wider. The narrow edge is more commonly use in our daily practice as has the function of “disperse”. It means that it is used as we described earlier to scoop out the dust in our body and help clean them out. The wlder/rounder edge is used for “tonification”. It means that it provides a more gentle scrape that focus on boosting our circulation and Qi.

20. Gua Sha Cont.
Since Gua Sha involve using something to rub on the skin repeatedly, oil or your favorite lubricant is a must have. The pores on our skin will open up during this process, so you want to pick something that your patient is not allergy to and something that is safe for the skin. In my clinic, I sometimes mix in herbal oil that I specially made to speed up the healing. For example, I use different oils for weight lose patients in compare to back pain patients. And it is always important that you clean the hands, skin surface, and sterilize Gua Sha tools before start doing anything and after the treatment.

21. Gua Sha Cont.
There are various different way to perform Gua Sha. Here I will just give a general rule about how it should be done. First, no excess pain should be involved. The force that is applied should be enough to scrape the Gua Sha tool again the skin steadily, but without causing unbearable pain. Too much force will just injury the subcutaneous tissues or capillaries. For more tense area, the speed of scraping can be faster, and to boost energy and reduce stress, slower and softer scraping is more appropriated. It should be a comfortable experience. Second, the direction should be from up to down and from center to outward. Avoid scraping over open wound or on the bone, especially the spine, unless instructed by a licensed acupuncturist. Third, if there is no “Sha” appears, it is okay. There is no need to increase strength or to spend more time at the area. Normally 3 to 5 minutes at an area is enough, and spending more than 20 minutes at a spot is not recommended. Forth, prior to the next Gua Sha session, you should wait until that all Sha (red dots) disappeared. Usually it takes about 3 to 5 days for all the Sha to disappear.