Oral Cavity Disorders: a TCVM Approach

1
Oral Cavity Disorders a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

2
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

3
TCM Spleen Disease

• Spleen Physiology
• Spleen Pathology
• Gingivitis/Stomatitis

4
Earth

• Sound
• song
• Emotion
• sympathy
• Climate
• humid
• Season
• late summer

• Direction
• center
• Opening
• lips/gums
• Body Part
• muscles
• Zang/Fu
• SP/ST

5
TCM SPLEEN Physiology

• Governs Transportation Transformation
• Food Water
• Controls Blood
• Dominates the Muscles
• Opens in Mouth
• Lips Gums (ST)

6
TCM 24 Hour Clock
7
Earth
BALANCED
DEFICIENT
EXCESS
8
Spleen Pathology
9
Spleen Pathology

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

10
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
11
Spleen Pathology
Cold Environmental Conditions
Cold Food or Drink
Cold-Damp in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
12
Spleen Pathology

Accumulated Heat Damp
Damp Hot Environmental Conditions
Damp Hot Food or Drink
Damp-Heat in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
13
Spleen Qi Deficiency
Illness
Overeating
Overwork
Starvation
Under Work
Spleen Qi Deficiency
Disturbed Qi Flow
Failure to Transform Transport
14
Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
Chronic Hemorrhage
General Signs
15
Spleen Qi Sinking
Illness
Overeating
Overwork
Starvation
Under Work
Chronic Spleen Qi Deficiency
Failure of Holding
Chronic Diarrhea Prolapses Incontinence
16
Spleen Pathology
Cold Food or Drink
Chronic Spleen Qi Deficiency
Spleen Yang Deficiency
Transform Transport Disorder
Disharmony of Qi Flow
Yang Deficiency Signs
17
Stomach Pathology
Cold Environmental Conditions
Cold Food or Drink
Cold in Stomach
Transform Transport Disorder
Disharmony of Qi Flow
Inhibition of Yang
18
Stomach Cold
Cold Food Drink
Cold Environment
Stomach Cold
Receiving Decomposing
Cold Signs
Anorexia
Altered Qi Flow
Cold Ear/Nose Hypersalivation Pale-Purple
Tongue Deep-Slow Pulse
Lassitude
19
Stomach Pathology

Damp Hot Environmental Conditions
Hot Dry Food or Drink
Heat in Stomach
Heat Signs
Transform Transport Disorder
20
Stomach Heat
21
Stomach Food Stagnation
Indigestible Food
Overeating
Retention of Food in Stomach
Disturbed Qi Flow
Failure to Transform Transport
22
Stomach Yin Deficiency
Stress
Liver Qi Stagnation
Chronic Febrile Illness
Transformation to Heat/Fire
Impairment of Body Fluids
Stomach Yin Deficiency
23
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

24
Meridian Theory

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

25
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

26
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

27

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

28
TCVM Exam Diagnosis

• Constitution Water/Wood
• Tongue bodyreddish 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)

29
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)

30
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

31
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

32
TCVM Approach

• Exam
• 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-veggi
  es

33
Ulceration a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

34
Ulcer

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

35
Stomach Heat
36
Stomach Ulcers

• Mild

Happy Stomach
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
37
GI Food Therapy

• Cabbage
• Contains glutamate
• Cools stomach GI
• Spinach
• Stops hemorrhage

38
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
39
21 Hua-tuo-jia-ji at cervical region
LO 0.5 dorsal to cervical vertebrae IN
cervical stiffness, wobblers 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
40
Pancreatitis a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

41
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

42
TCVM Acute Pancreatitis
43
TCVM Chronic Pancreatitis
Enzyme replacement therapy still good to add
44
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
45
Perry Treatment

• AP
• DN
• ST-45
• ST-36
• LI-4
• PC-6
• BL-20
• CV-12
• Aqua
• ST-36
• BL-20
• PC-6
• Herbal
• Great Saussurea Coptis

• Next day was 80 improved
• Clinician said, He is doing absolutely
  fantasticbetter than any patient in yearsNOit
  wasnt the acupuncturewellmaybe we should try
  it again!

46
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
47
Bleeding a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

48
Bleeding

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

49
Primary Hemostasis

• Evaluated by the bleeding time
• Platelet number
• Amount and Quality of the von WIllebrands factor
  VIIIAg
• Fibrinogen concentration
• Other alterations due to vessel wall disorders

50
Secondary Hemostatis

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

51
TCM Pathoetiology

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

52
Spleen Pathology

Accumulated Heat Damp
Damp Hot Environmental Conditions
Damp Hot Food or Drink
Damp-Heat in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
53
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

54
Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
Chronic Hemorrhage
General Signs
55
Darby

• Signalment
• 5 yr FS Doberman
• History
• Generalized weakness
• Ecchymosis
• Abdominal bleeding
• TCVM Exam
• Tongue pale
• Pulses deep weak

Dx Spleen Qi Deficiency (not holding blood in
vessels)
56
Darby

• Western Rx
• Compressive bandage
• Hemorrhage control
• 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

57
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
58
Muscle Wasting a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

59
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

60
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

61
Wei Syndrome
62
Jake

• History
• Progressive weakness in rear legs
• Cool seeking
• Rear leg muscle atrophy
• Dry hair skin
• TCVM Exam
• Pulses deep weak (lt R)
• Red dry tongue

DX Qi/Yin Deficiency
63
Jakes Treatment

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

64
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
65
Sam

• History
• Chronic rear leg weakness and muscle wasting
• Dry hair
• Weight loss
• TCVM Exam
• Red dry tongue
• Weak thready pulses (lt R)

DX Qi/YinDeficiency
66
Sams Treatment

• AP
• DN
• GV20, BL20, BL23, BL26
• Aqua
• SP6, ST36, BL23, BL26
• Herbal
• Hindquarter formula (tea pills)

67
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
68
Obesity a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

69
Obesity

• 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

70
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
71
Obesity TCVM Etiology and Pattern

• Damp-phlegm
• Liver Stagnation
• Blood Stagnation
• Spleen Deficiency
• Kidney Deficiency

Excess
Deficiency
72
Damp-phlegm
Etiology
73
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 (F30 Hz) for local
swelling area 2) Message Abdomen and back,
twice a day.
74
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
75
Damp-phlegm
Max Formula
For lipomas
76
Liver Qi Stagnation
Etiology
Emotional Stress
Drug Stress
Liver Qi Stagnation
Liver over-control Spleen Spleen fails to
transform Damp
Phlegm under the skin
Obesity
77
Liver Qi Stagnation
. 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
78
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
79
Blood Stagnation
Etiology
Other factors
Stress
Qi stagnation
Blood Stagnation
Qi-blood stagnation
Water/Damp retention in the body
Obesity
80
Blood Stagnation
Symptoms
. 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
81
Blood Stagnation
Herbal Formula
Stagnation Reliever
Move Blood, resolve stasis
Carthamus Hong Hua 22 Ligusticum Chuang
Xiong 22 Olibanum Ru Xiang 19 Typha Pu
Huang 1 9 Rheum Da Huang 18
Move Qi Blood
Purge LI
82
Spleen Qi Deficiency
Water/damp from food or environment
Etiology
Overwork
Chronic illness
Spleen Qi Deficiency
Phlegm under the skin
Obesity
83
Spleen Qi Deficiency
Symptoms

• 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
84
Spleen Qi Deficiency
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
85
Kidney Qi Deficiency
Etiology
Other factors
Chronic illness
Ageing
Kidney Qi Deficiency
Water retention
Phlegm
Obesity
86
Kidney Qi Deficiency
Symptoms
. 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
87
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
88
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
89
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
90
Constipation a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

91
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 _at_ 0.25-0.5 mg/kg TID
92
Constipation

• Definition
• Constipation
• Infrequent or incomplete bowel movements
• Feces are drier or harder
• Obstipation
• Intractable constipation
• Impossible defecation

• Patterns
• Heat
• Qi Stagnation
• Qi Deficiency
• Yin/Blood Deficiency

93
Stomach Heat
94
Differentiation
95
Constipation/Megacolon
96
Acupuncture
97
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
98
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
99
Molly Dx
Earth personality No BM
Weak pulse Anorexia Decreased thirst
Dryness Red dry tongue
Earth element (SP/ST)
Yin Deficiency
Qi Deficiency
TCVM Dx SP/ST (LI) Yin Qi Deficiency
100
Molly Rx
Acupuncture DN GV-20, CV-12, ST-25 EA (10
minutes _at_ 20 Hz 10 minutes _at_ 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
101
TCVM Approach to Megacolon and Megaesophagus
102
Mega- Introduction

• If normal directional motion is inhibited in a
  tubular organ
• A type of Qi Deficiency
• May be a congenital disharmony
• Yang Jing Deficiency if associated with other
  signs of Yang Deficiency
• Yin Jing Deficiency if associated with other
  signs of Yin Deficiency

103
Mega- Introduction

• Directional or propulsive Qi Deficiency
• May be acquired
• Exogenous Pernicious influences
• E.g. distemper virus, trauma, toxins, poor
  quality foods for that species or individual
  constitution
• Endogenous Pernicious influences
• E.g. hypothyroidism, systemic lupus
  erythematosus, hypoadrenocorticism, myasthenia
  gravis
• Remember that sthenia means full or excess
• asthenia means empty or weak or deficient

104
Mega- Introduction

• Directional Qi Deficiency
• May be associated with concurrent Blood or Yin
  Deficiency
• Subsequent Dryness fails to lubricate either
  ingesta or feces
• Megaesophagus swallowing inhibited
• Regurgitate dry ingesta
• Megacolon defecation inhibited
• Cannot float the boat in a dry river

105
Megaesophagus and Megacolon Types of Wei
Syndromes?

• Wei means withered in Chinese to describe the
  withering of muscles
• Classical Wei or Atrophy Syndrome is a condition
  characterized by a weakness of the four limbs,
  progressively leading to atrophy, a limp state of
  muscles and tendons, an inability to walk
  properly and eventually paralysis
• This weakness generally occurs without pain
• So are these Megas localized Wei?

106
Wei Syndrome Pattern Differentiation

• Heat in the Lungs injuring Yin fluids- Excess
• Invasion of Damp-Heat- Excess
• Invasion of Cold-Dampness- Excess
• Stomach and Spleen deficiency- Deficiency
• Spleen and Heart collapse- Deficiency
• Liver and Kidney deficiency- Deficiency
• Blood Stasis in the channels- Combination of
  Excess and Deficiency

107
Relationship Between Pattern and Pathoetiology

• Wind-Heat causes only Lung-Heat injuring Yin
  fluids
• External Dampness leads to Damp-Heat or
  Cold-Dampness
• Irregular Diet causes the patterns of Damp-Heat,
  Cold-Dampness and Stomach-Spleen deficiency
• Excessive sex and overwork cause the patterns of
  Kidney-Liver deficiency and Blood stasis in the
  channels
• Trauma causes the pattern of Blood stasis in the
  channels
• Shock leads to the pattern of Heart-Spleen
  collapse

108
Mega- Primary treatment principles

• Tonify global and local Qi
• Assist directional Qi Flow
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood
• Invigorate Blood

109
Megaesophagus Pattern Differentiation

• Qi Deficiency or Yang Deficiency
• may be seen with hypothyroidism, systemic lupus
  erythematosus, hypoadrenocorticism, myasthenia
  gravis, poor quality foods for that species or
  individual constitution
• Blood Deficiency /- Blood Stagnation
• may be seen with trauma, toxins, poor quality
  foods for that species or individual constitution
• Heat Patterns
• may be seen with distemper infection or other
  febrile diseases

110
Megaesophagus Treatment

• Physical assistance with raised feeding station
  and soft, highly digestible foods
• Suggest slow-cooked foods based upon Bian Zheng
  (see following lecture)
• Acupuncture based upon global and local Patterns
• Herbal Formula based upon global and local
  Patterns

111
Megaesophagus Qi Deficiency

• Clinical Signs
• Fatigue, weight loss, muscle mass loss,
  decreased/depressed back Shu points
• Tongue
• Pale, moist
• Pulse
• Feeble, especially middle and upper jiao

112
Megaesophagus Qi Deficiency

• Acupuncture Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach (esophagus
  belongs to the Stomach)
• BL 13, 14, 15 as local Shu for upper Sea of Qi
• LI 4, LIV 3 to move Qi
• LI 10, ST 36, CV 6 to nourish Qi
• LI 1, LU 11, ST 45 to clear fullness of the chest
  in the region of the Heart

113
Megaesophagus Qi Deficiency

• Spleen Qi Deficiency
• Si Jun Zi Tang or Four Gentlemen Decoction
• the chief herb Panax ginseng ren shen is sweet,
  warm and tonifies Spleen Qi
• the deputy herb Atractylodis macrocephalae bai
  zhu is bitter, warm and strengthens Spleen Qi and
  dries Dampness

114
Megaesophagus Qi Deficiency

• Spleen Qi Deficiency
• Si Jun Zi Tang
• assistant herb Poria cocos fu ling is sweet,
  bland and leeches out Dampness and mildly
  Tonifies Spleen Qi
• the envoy Glycyrrhiza uralensis gan cao is warm,
  sweet and warms and regulates the middle burner
• modify with Hou Po magnolia bark to promote Qi
  flow, transform Dampness, relieve food
  stagnation, direct rebellious Qi downward for a
  stifling sensation in the chest
• Or modify with Platycodon jie geng resolve phlegm
  and guide other herbs to upper burner

115
Megaesophagus Blood Deficiency

• Clinical Signs
• Dry fur, dry pads, firm, dry stools, decreased
  firmness in back Shu points
• Tongue
• Pale, dry, may have slight lavender hue
• Pulse
• Weak, thin, especially middle and upper jiaos

116
Megaesophagus Blood Deficiency

• Acupuncture Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach for post-heaven
  Blood
• BL 17, 18 to engender Blood
• LI 4, LIV 3 to move Qi with Blood
• SP 10, ST 36 to engender Blood and benefit Spleen
  and Stomach
• LI 1, LU 11, ST 45 to clear fullness of the chest
  in the region of the Heart

117
Megaesophagus Blood Deficiency

• Tao Hong Si Wu Tang Four Substances Decoction
  with Peach Kernel and Safflower
• Shu di huang prepared rehmannia
• Dang gui angelica sinensis
• Bai shao yao white peony
• Chuan xiong ligusticum
• Tao ren peach kernel
• Hong hua safflower
• Nourish Blood, promote Blood circulation, removes
  Blood Stasis

118
Megaesophagus Blood Stagnation

• Clinical Signs
• Pain in chest, front Mu and back Shu points,
  uncomfortable lying in ventral recumbency
• Tongue
• Lavender, usually slightly pale and dry
• Pulse
• Wiry, choppy, commonly thin

119
Megaesophagus Blood Stagnation

• Acupuncture Use electro-AP!!
• LI 4, LIV 3, LIV 14 to move Blood
• PC 6 master of the chest, reduce stagnation
• CV 17 front Mu of the upper Sea of Qi
• BL 17, 18, SP 10 to engender and circulate
  Stagnant Blood
• CV 12, GB 21, GV 1 to descend Qi
• LI 1, LU 11, ST 45 to clear fullness of the chest
  in the region of the Heart

120
Megaesophagus Blood Stagnation

• Xue Fu Zhu Yu Tang Remove Stasis from the Mansion
  of Blood Decoction
• Tao ren peach kernel
• Hong hua safflower
• Dang gui angelica sinensis
• Sheng di huang prepared rehmannia
• Chuan xiong ligusticum
• Chi shao yao red peony
• Chuan niu xi cyathula
• Jie geng platycodon
• Chai hu bupleurum
• Zhi ke bitter orange
• Gan cao licorice
• Promotes the circulation of Blood and Qi, removes
  Blood Stasis, relieves pain

121
Megacolon Pattern Differentiation

• Qi Deficiency
• seen with chronic poor quality foods for felids
  in general or individual constitution
• Blood Deficiency /- Blood Stagnation
• seen with trauma, poor quality foods for that
  species or individual constitution
• Heat Patterns
• may be seen with chronic Stagnation of Qi or
  Blood
• Yin Deficiency
• usually a consequence of Chronic Heat
• Mixed Qi and Blood Deficiency
• is very common

122
Megacolon Primary treatment principles

• Tonify global and local Qi
• Assist directional Qi Flow
• Tonify Qi of all Bowels (i.e. Stomach System)
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood

123
Megacolon Qi Deficiency

• Clinical Signs
• Firm to moderate stools that are difficult to
  expel, thin, small muscles, easily fatigued
• Tongue
• Pale, normal to moist
• Pulse
• Weak, deep

124
Megacolon Qi Deficiency

• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish the Spleen
  and Stomach
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for Large
  Intestine
• TH 6, TH 5 empirical points for moving the Qi of
  the intestines for constipation

125
Megacolon Qi Deficiency

• Si Jun Zi Tang or Four Gentlemen Decoction
• Panax ginseng ren shen is sweet, warm and
  tonifies Spleen Qi
• Atractylodis macrocephalae bai zhu is bitter,
  warm and strengthens Spleen Qi and dries Dampness
• Poria cocos fu ling is sweet, bland and leeches
  out Dampness and mildly Tonifies Spleen Qi
• Glycyrrhizae uralensis gan cao is warm, sweet and
  warms and regulates the middle burner
• Modify with Rhubarb da huang as a bitter, cold
  herb to move the bowels and dispel stasis

126
Megacolon Qi Deficiency

• Fan Xie Ye (I8001)
• Fan Xie Ye senna leaf
• Sweet, bitter, cold
• Enters the Large Intestine Channel
• Drains downward and guides out stagnation
• For constipation due to heat accumulation in the
  Intestines
• Contains anthraquinone glycosides
• Hepatic metabolites stimulate pelvic ganglion
• Purge Large Intestine, resolve food stasis

127
Megacolon Blood Deficiency

• Clinical Signs
• Hard, dry stool, dry hair, dry and flakey skin
• Tongue
• Pale and dry
• Pulse
• Thin, weak

128
Megacolon Blood Deficiency

• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish post-heaven
  Blood production via SP/ST
• BL 17 and SP 10 to nourish Blood
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for Large
  Intestine
• TH 6, TH 5 empirical points for moving the Qi of
  the intestines for constipation

129
Megacolon Blood Deficiency

• Dang Gui Cong Rong (A0250)
• Dang gui angelica sinensis
• Rou cong rong cistanche
• Qu mai dianthus
• Shen qu massa fermentata
• Fan xie ye senna leaf
• Hou po magnolia
• Mu xiang saussurea
• Xiang fu zi cyperus seed
• Zhi ke bitter orange
• Tong cao tetrapanax
• Moisten Large Intestine, resolve impacted Large
  Intestine

130
Megacolon Dryness due to Heat

• Clinical Signs
• Constipation with hard stool difficult to expel,
  frequent urination
• Tongue
• Dry, yellow coating
• Pulse
• Deep, rapid or floating and choppy

131
Megacolon Dryness due to Heat

• Ma Zi Ren Wan Hemp Seed Pill
• Huo ma ren cannabis seed
• Xing ren apricot seed
• Shao yao peony
• Zhi shi immature bitter orange
• Hou po magnolia cortex
• Da huang rhubarb
• Moisten the Intestines, drains Heat, promotes Qi
  movement, unblocks the bowels

132
Megacolon Yin Deficiency

• Clinical Signs
• Constipation, thirst
• Tongue
• Dry, red
• Pulse
• Thin and slightly rapid or weak and feeble
• Consequence of warm-febrile disease in weak or
  Yin Deficient patient

133
Megacolon Yin Deficiency

• Acupuncture
• BL 25, ST 25 back Shu and front Mu of Large
  Intestine
• SP 6, KI 3, , CV 4, BL 23 to nourish the Yin
• TH 6, ST 37 to unblock the Large Intestine

134
Megacolon Yin Deficiency

• Zeng Ye Tang Increase the Fluids Decoction
• Xuan shen scrophularia
• Mai men dong ophiopogon
• Sheng di huang fresh rehmannia
• Generates fluids, moistens dryness and unblocks
  the bowels

135
Megacolon Stagnation with Heat

• Clinical Signs
• Severe constipation and flatulence, focal
  distention and abdominal fullness, abdominal pain
  which increases with pressure, tense and firm
  abdomen
• Tongue
• Dry, yellow or dry and dark coating
• Pulse
• Deep, excessive

136
Megacolon Stagnation with Heat

• Acupuncture
• Ren 4 tonifies Yin and fluids
• LI 11 clears Heat in the Large Intestine
• ST 37 lower He Sea for Large Intestine to
  harmonize LI
• ST 44 clears Stomach Heat
• LI 2 clears Large Intestine Heat
• SP 6, KI 6, Ren 12 promote body fluids

137
Megacolon Stagnation with Heat

• Da Cheng Qi Tang Major Order the Qi Decoction
• Da huang rhubarb
• Mang xiao mirabilitum
• Zhi shi immature bitter orange
• Hou po magnolia cortex
• Vigorously purges Heat accumulation

138
Conclusion

• Megaesophagus and Megacolon are predominantly
  types of localized Qi Deficiency
• Although heritable (Jing) factors may be
  involved, Exogenous Pathogens and poor quality
  foods are root cause
• Blood Deficiency with or without Blood Stagnation
  may be a complicating factor
• Acupuncture and Herbal formula based upon Pattern
  Differentiation may improve quality of life

139
TCVM Food Therapy for Gastrointestinal Disorders
140
Introduction

• TCVM Cooking Pot analogy of gastrointestinal
  function
• Used to emphasize Warm Transformation
• Cold Damage
• Moisture and Dampness

141
Cooking Pot and Science

• Western Biomedicine and Digestion
• Mechanical and Biochemical
• Biochemical Digestion
• Based upon Enzyme (Protein) Function
• Enzymes have Temperature Specificity
• Cold Temperatures interfere with Function
• Cold Foods thus need to be Warmed by the Body

142
Cooking Pot and Science

• Biochemical Digestion
• Enzymes have Temperature Specificity
• Cold Temperatures interfere with Function
• Cold Food is Poorly Enzymatically Transformed
• Lower rate of digestion and absorption
• Cold Food Challenges the Body to Warm it
• Challenge to all, especially Geriatrics
• Eventually depletes the bodys Yang Qi

143
Cooking Pot

• Species specificity
• Damp-engendering foods for one may be adequate
  for another
• Age and vigor
• Middle burner has more Yang Qi in younger animals
  than older so both environmental temperature and
  Xing of foods should be warmer in geriatric
  animals

144
Introduction to Food Therapy

• Food therapy in Traditional Chinese Veterinary
  Medicine (TCVM) is based upon two fundamental
  principles
• The first principle is of Food Energetics
• This refers to the effect of a food on digestive,
  metabolic, and physiological processes of the
  body
• Xing or Thermal Nature is essentially the
  post-ingestive effect on the body

145
Food and Herb Properties

• Xing or Thermal Nature or Temperature
• Cold such as Seaweed
• Cool such as Rabbit
• Neutral such as Rice
• Warm such as Chicken
• Hot such as Lamb

146
Food and Herb Properties

• Flavor
• Sweet benefits SP/ST and strengthens, moistens
  and tonifies deficiency
• Pungent benefits LU/LI and disperses stagnation
  and promotes flow
• Salty benefits KI/BL and moistens, softens and
  detoxifies
• Sour benefits LIV/GB and stimulates absorption
  and contraction
• Bitter benefits HT/SI and drains and counteracts
  Dampness
• Bland is the 6th Flavor that drains dampness

147
TCVM Food Therapy A Note on the Sweet Flavor

• Sweet enters the Spleen and Stomach and
  engenders Qi and Blood
• TCVM Sweet is a property of many foods
• This should be obvious since we eat to make Qi
  and Blood
• But modern Sweet is an historical anomaly of
  refinement and excess availability of simple
  carbohydrates

148
TCVM Food Therapy A Note on the Sweet Flavor

• Modern Sweet is an historical anomaly of
  refinement and excess availability of simple
  carbohydrates
• In fruits this is called empty sweet
• Natural sweet or full sweet is found in almost
  all whole grains, all nuts and seeds, most
  vegetables, and almost all fish and meats

149
Basic Food Properties Introduction

• Deficiency conditions are treated
  heteropathically with tonifying foods
• Tonifying foods strengthen a bodily substance or
  function and are especially useful for chronic
  disharmonies
• Qi tonics
• Blood tonics
• Yin Tonics
• Yang tonics

150
Basic Food Properties Qi Tonics

• Qi tonics maintain and improve the quantity and
  quality of available energy in the body
• Palatable Qi Tonifying foods for carnivores
  include
• Beef, Chicken, Date, Fig, Lentil, Mackerel,
  Microalgae, Molasses, Oats, Sweet Potato, Pumpkin
  and Squash

151
Advanced Food Properties Introduction to
Regulation

• Whereas Tonifying foods strengthen a bodily
  function or substance Regulating Foods help
  remove Excess conditions or Stagnation
• Qi Circulating
• Blood Circulating
• Cooling foods
• Warming foods
• Foods which counteract Dampness
• Water-draining foods
• Phlegm-resolving foods

152
Advanced Food Properties Qi Circulation

• Qi Circulation is stimulated by the sweet and
  pungent flavors
• Palatable Qi Circulating foods for carnivores
  include
• Basil, Cardamom, Carrot, Cayenne, Clove,
  Coriander, Garlic, Hawthorn Berry and Turmeric

153
Advanced Food Properties Damp

• Dampness is a result of poor transformation
  and/or transportation of fluids
• Dampness is treated by avoiding dampening foods
  (e.g. dairy products, pork and rich meat,
  concentrated juices, sugar and saturated fats),
  by strengthening the Spleen and Stomach and by
  using bitter foods
• Foods which counteract Dampness which are
  palatable to carnivores include
• Alfalfa, Barley, Garlic, Green Tea, Jobs tears,
  Kidney Bean, Mackerel, Mushroom, Parsley,
  Pumpkin, Rutabaga, Rye and Turnip

154
Bian Zheng or Pattern Differentiation

• Second Principle
• TCVM is based upon Pattern Differentiation
• Diagnostic systems include
• Yin/Yang
• Eight Principles
• Zang-Fu Organs
• Four Levels
• Six Stages
• San Jiao
• Pathogenic Factors

155
Bian Zheng or Pattern Differentiation Basic

• Treatment is based upon the inverse of Pattern of
  Disharmony (Heteropathy)
• Not sure of Herbal Formula?
• Use cardinal signs to choose Food Therapy
• For example, a dog with loose stools, weakness,
  shortness of breath, pale moist tongue and a weak
  pulse might be diagnosed as Spleen Qi Deficient
• The treatment principle is then to Tonify
  (Deficient) Spleen Qi

156
Bian Zheng or Pattern Differentiation Basic

• For the Spleen Qi deficient dog the weakness,
  pale tongue and the weak pulse suggest Deficiency
• Use Tonifying foods such as Chicken, Oats,
  Quinoa, Yam and many of the culinary herbs to
  either add to the current diet or create a Food
  Therapy Formula for this dog

157
Bian Zheng or Pattern Differentiation Advanced

• Treatment is based upon the inverse of Pattern of
  Disharmony (Heteropathy)
• A diagnosis of Spleen Qi Deficiency?
• Treated by Tonifying (Deficient) Spleen Qi
• Classical Herbal Formulae
• Already designed to treat Patterns
• Elegant Food Therapy
• May formulate based upon detailed analysis of
  classical Herbal Formula

158
Spleen Qi Deficiency Introduction

• General signs of Qi Deficiency include lethargy
  and fatigue
• Qi Deficiency signs are exacerbated by activity
  and improved with rest
• Primary signs of Spleen Qi Deficiency include
• Loose stools
• Fatigue
• Shortness of breath
• Reduced appetite
• Pale moist tongue
• Weak pulse

159
Bian Zheng and Herbal Formula

• Spleen Qi Deficiency
• Tonify Spleen Qi with the herbal formula Si Jun
  Zi Tang or Four Gentlemen Decoction
• the chief herb Panax ginseng ren shen is sweet,
  warm and tonifies Spleen Qi
• the deputy herb Atractylodis macrocephalae bai
  zhu is bitter, warm and strengthens Spleen Qi and
  dries Dampness
• the assistant herb Poria cocos fu ling is sweet,
  bland and leeches out Dampness and mildly
  Tonifies Spleen Qi
• the envoy Glycyrrhizae uralensis gan cao is warm,
  sweet and warms and regulates the middle burner

160
Si Jun Zi Tang and Food Therapy

• A Food Combination that would have similar
  actions to Si Jun Zi Tang could include
• Warm, sweet Chicken which enters the Spleen and
  Stomach to Tonify Qi
• Warm, sweet Oats to strengthen the Spleen and dry
  Dampness
• Or neutral, bitter Rye to drain Dampness and
  Water from the Spleen

161
Si Jun Zi Tang and Food Therapy

• A Food Combination that would have similar
  actions to Si Jun Zi Tang
• Cool, sweet Mushroom to leech Dampness and mildly
  tonify Spleen Qi
• Neutral, sweet and sour Coriander to direct the
  actions to the middle burner and mildly warm the
  Spleen and Stomach
• Use acrid, warm, aromatic Cardamom (Sha Ren) if
  there is also Phlegm or vomiting

162
Spleen Qi Deficiency with Damp

• Shen Ling Bai Zhu San Ginseng, Poria, and
  Atractylodes Powder
• Ren shen ginseng
• Bai zhu white atractylodes
• Fu ling poria
• Zhi gan cao honey-fried licorice
• Shan yao dioscorea
• Bai bian dou dolichoris lablab
• Lian zi nelumbinis
• Yi yi ren coix
• Sha ren amomum
• Jie geng platycodon
• Augments the Qi, strengthens the Spleen, leaches
  out Dampness and stops diarrhea

163
Shen Ling Bai Zhu San Ginseng, Poria, and
Atractylodes Powder

• Ren shen ginseng, Bai zhu white atractylodes, Fu
  ling poria, and Zhi gan cao honey-fried licorice
  are Si Jun Zi Tang
• Shan yao dioscorea tonifies the Spleen and
  supports the chief herbs
• Bai bian dou dolichoris lablab and Lian zi
  nelumbinis strengthen the Spleen and stop
  diarrhea
• Yi yi ren coix strengthens the Spleen and leaches
  out Dampness
• Sha ren amomum transforms Dampness and promotes
  Qi movement
• Jie geng platycodon unblocks the flow of Lung Qi

164
Shen Ling Bai Zhu San Food Therapy

• Ren shen ginseng, Bai zhu white atractylodes, Fu
  ling poria, and Zhi gan cao honey-fried licorice
  are Si Jun Zi Tang
• Warm, sweet Chicken which enters the Spleen and
  Stomach to Tonify Qi
• Warm, sweet Oats to strengthen the Spleen and dry
  Dampness
• Cool, sweet Mushroom to leech Dampness and mildly
  tonify Spleen Qi
• Neutral, sweet and sour Coriander to direct the
  actions to the middle burner and mildly warm the
  Spleen and Stomach
• Yam and/or Sweet potato are neutral, sweet and
  tonify the SP
• Pumpkin is sweet, neutral and dries Damp in the
  GI tract
• Rutabaga is sweet, bitter, tonifies SP,
  circulates Qi, dries Damp
• Aduki bean is neutral, sweet, sour and dries Damp
  and Water
• Black pepper is sweet, pungent and hot, and
  transforms Damp and Phlegm

165
Spleen Yang Deficiency Introduction

• Cold from Deficiency in the Middle Burner
• Disrupts Qi Mechanism
• Principle signs
• Epigastric and abdominal distention and pain
• Fatigue
• Cold extremities
• White, slippery tongue coating
• Slow, deep pulse

166
Spleen Yang Deficiency Herbal Formula

• Li zhong wan or Regulate the Middle Pill
• Actions Warms the middle burner and strengthens
  the Spleen and Stomach

167
Spleen Yang Deficiency Li zhong wan

• Indications diarrhea with watery stool, nausea
  and vomiting, little thirst, loss of appetite,
  abdominal pain
• Tongue pale with white coat
• Pulse thin, deep

168
Spleen Yang Deficiency Li zhong wan

• Zingiberis officinalis gan jiang warms the Spleen
  and Stomach Yang and dispels interior Cold
• Radix ginseng ren shen strongly tonifies the Yuan
  Qi and reinforces the Yang
• Atractylodis macrocephalae bai zhu tonifies SP/ST
  and dries damp
• One warming, one tonifying, one drying
• Glycyrrhizae uralensis zhi gan cao augments the
  middle burner Qi

169
Spleen Yang Deficiency Food Therapy

• Lamb is sweet, hot, enters the Spleen and Kidney
  and tonifies Yang
• Sweet potato is sweet, warm, enters the Kidney
  and Spleen and tonifies Yin and Qi and dispels
  Cold
• Corn is sweet, neutral, enters the KI, LI and ST,
  tonifies Qi and dries damp
• Fenugreek seed is warm, bitter, circulates Qi and
  tonifies Yang
• Or Ginger as in Li zhong wan

170
Stomach Heat

• Bai Hu Tang White Tiger Decoction
• Shi gao gypsum
• Zhi mu anemarrhena
• Zhi gan cao honey fried licorice
• Geng mi nonglutinous rice
• Clears Qi-level Heat, drains Stomach Fire,
  generate fluids, and alleviates thirst

171
Bai Hu Tang White Tiger Decoction

• Shi gao gypsum is sweet, acrid and extremely cold
  to Clear Heat and Drain Fire
• Zhi mu anemarrhena is bitter, cold and
  moistening, Clears Heat and enriches Yin
• Zhi gan cao honey fried licorice and Geng mi
  nonglutinous rice benefit the Stomach and protect
  the fluids, and protect the middle Jiao from the
  first two cold ingredients

172
Bai Hu Tang Food Therapy

• Crab is cold, salty, enters the Liver and
  Stomach, nourishes Yin and Clears Heat
• Millet is cool, sweet, salty, enters the Kidney,
  Spleen and Stomach and Clears Heat
• Squash is warm, sweet, enters the Spleen and
  Stomach, tonifies Qi and protects from Cold
• Coriander is neutral, sweet, bitter, enters the
  Stomach and protects from the Cold

173
Food and Qi Stagnation

• Yue Ju Wan Escape Restraint Pill
• Cang zhu red/grey atractylodes
• Chuan xiong ligusticum
• Xiang fu cyperus
• Shan zhi zi gardenia
• Shen qu massa fermentata
• Promotes the movement of Qi and releases
  constraint Five Stagnation (Qi, blood, food,
  phlegm and heat)

174
Yue Ju Wan Escape Restraint Pill

• Cang zhu red/grey atractylodes dries Dampness and
  resolves Phlegm
• Chuan xiong ligusticum releases constrained Blood
  to resolve fixed pain
• Xiang fu cyperus releases constraint and
  disperses Qi Stagnation
• Shan zhi zi gardenia clears Heat from Sanjiao,
  resolves Fire from constraint and acid reflux
• Shen qu massa fer