Acupuncture (AP) in Traditional Chinese Medicine (TCM)
GENERAL CONCEPTS (5/7)
Stone_A1 (1996) Western and Eastern Med compared. Adapted from WWW (Acupuncture.com).
Ever seen that drawing of 2 silhouettes looking at each other? One moment you see 2 faces, the next moment, its a vase. Which is it? Obviously it is just a matter of your perception or the way your brain links together visual clues.
That's the difference between WM and TCM. Diagnosing the same patient with a lump in her breast, the doctor of WM will see a cyst, lesion, fibroid or cancer whereas the doctor of TCM will see a Stasis of Qi, Xue, or Phlegm. The doctor of WM will seek to prove the diagnosis with a biopsy of the hardened tissue. The doctor of TCM will feel the unique quality of the Pulses at the radial artery which may feel "wiry" or hard, like a guitar string bouncing up and down beneath the fingers (as opposed to other pulses that can feel softer and more flowing), observe the colour and shape of the tongue (looking for purple in particular, with possibly a thick yellow coating). For diagnostic purposes, he/she will also use seemingly unrelated symptoms such as sensations of constriction in the chest, abdominal bloating, heightened emotional sensitivity, a tendency to be angered easily, and frequent headaches at the top or the sides of the head. This allows the doctor of TCM to diagnose a Syndrome of "Qi, Xue or Phlegm Stasis." That example shows that there are very different ways of organizing the information from the same symptoms, the same signs and the same patient.
Both WM and TCM have their place. Within each discipline, a huge amount of time-tested information has its own logic and usefulness. Some believe that the greatest strength of WM is in it's trauma care and therapies for acute problems, while TCM excels in the areas of chronic problems and preventive Med.
Qi is an internal substance, a central concept in TCM that the scientific world is still struggling to accept. In the West we could describe this as bio-electric energy. You can't look at it under a microscope, you can't detect it with any scientific instruments, you can't isolate it from a substrate. This isn't to say that one cannot feel it, or see it, but these are intuitive human qualities that practitioners of TCM develop over years of practice. Many westerners can also perceive this Qi (energy). Martial artists sometimes feel it as heat in the palms of their hands, or warm liquid moving through the body. It is the invisible substance in mountain air that clears the mind with just one deep breath. A young mother witnesses it in the form of light coming from her baby's eyes.
AP seeks to treat health by balancing the levels of Qi. Qi flows in specific conduits in the body, the Channels, collaterals and Vessels. Needles inserted along the Channels influence the Qi that flows to the Zang-Fu (internal solid organs and hollow bowels). It can treat Internal diseases which affect both the structure and function of the Zang-Fu. AP can work also on in External diseases, such colds, 'flu, chills and on specific areas of pain (Ahshi points, TPs) that may be associated with External or superficial or local problems (for example, pulled muscles, sport-injuries). A needle inserted near the area of a pulled tendon or overstrained muscle will increase the flow of Qi to that area which removes pain and quickens the healing process.
Another difference between TCM and WM is that TCM treats the Yang and WM treats the Yin.
Everything in the universe can be described in terms of Yin or Yang. This is one of the underlying philosophies of TCM. The TCM characters for Yin-Yang mean, literally, the shady side of the hill and sunny side of the hill respectively.
Stone_Ac1 (1996) Symptomatic Diagnosis: Part 1.Adapted from WWW (Acupuncture.com).
These are notes from a class in which we organized information by the symptoms themselves but not by Zang-Fu differentiation, Eight Principles (Yin-Yang, Hot-Cold, Shi-Xu, Internal-External), Six Channels, or Four Levels. The class moved rapidly, and I haven't had the chance to organize this information or check the spelling on these formulas as well as I'd like. This page is an interesting way to organize information, but it should be cross-checked against other sources for more reliable accuracy.
Multiple Sclerosis doesn't exist in TCM, nor does epilepsy, or ulcerative colitis. These are all Western differentiations. TCM would treat these Syndromes as perhaps Channel Qi-Xue-Stasis, LV-Wind or Damp-Heat in the Lower Jiao. These treatments are based on the perspective of TCM, not on WM. This page was uploaded to show the different way in which practitioners of TCM might approach a Syndrome.
1. Aversion to Wind and Cold along with chills
Note: Difference between Chills and Aversion to Cold is this: Chills will not be relieved by warm clothing. Aversion to Cold is.
External Syndrome (99% of cases): Wind-induced fever and chills, though it can be combined with other factors: Muscle aches, headache; Wind with Cold; Chills and aches. Formula: Ma Huang Tang (Pungent and warm). Wind with Heat: Fever and sore throat. Formula: Yin Qiao San (Pungent and cool). Wind with Damp: stuffiness, aching in joints. Formula: Qian Wei Qiang Hua Yin (Warm and Dry).
Yang-Collapse (KI and HT most effected): Feeble or faint pulse; Very low energy; Confusion and disorientation; Cold sweat, Cold body, Cold extremities; Low blood pressure; Patient prefers fetal position; Diarrhoea with undigested food; Clear copious urine. Treatment principle: Restore Yang from Collapse. Formula: Shen Fu Tang.
Yang-Xu (not as severe as collapse) (HT, SP, KI): Aversion to Cold; Fatigue. Qi-Xu Sx + Cold Sx. HT-Yang-Xu (Palpitations, SOB, fatigue, cyanosis). Formula: Gui Zhi Tang with more Zhi Gan Cao. SP-Yang-Xu: add Li Zhong Tang. KI-Yang-Xu: add Jin Gui Shen Qi Tang AKA Ba Wei Di Huang Wan.
True Heat, Pseudo Cold: A Shi Syndrome due to many etiologies which pushes the Yin from the Interior to the Exterior: Cold Sx externally; Aversion to Cold; Cold skin (which warms upon prolonged touch); Warm Sx internally; Doesn't desire warm clothes; Bad breath, constipation. T: Red with yellow coat. P: Forceful and Rapid. Formula: Bai Hu Tang.
Phlegm-Stasis: A Syndrome in which a Yin Evil blocks the flow of Yangqi (Yangqi-Stasis), leading to aversion to Cold. Thirst, with no desire to drink; Aversion to Cold. T: Thick greasy white coat. P: Slippery. Formula: Er Chen Tang.
2. Shivers or "Severe Chills"
External Syndrome: Severe Stasis caused by External factors, skin pores close, Weiqi pushes up against the closed pores in an attempt to expel the pathogen. This creates shivering. Formula: Ma Huang is the king herb, Ma Xing Shi Gan Tang.
Febrile Disease is due to attack of pathogenic Heat (usually the Wei-Heat and Qi-Heat according to Wen Bing theory).
3. Alternating fever and chills
Shaoyang disease: Bitter taste in mouth; Dry mouth; Chest and hypochondriac discomfort; Irritability. T: Red tip with thin yellow coat. P: Wiry. Treatment Principle: "Harmonize Interior and Exterior" which means Disperse the Exterior and Clear the Interior. Formula: Xiao Chai Hu Tang.
Malaria: Very regular cycle between fever and chills; Patient is very weak and needs to sleep after each cycle. Formula: Qing Hao and Zhong San are king herbs.
4. Aversion to Heat without chills: An Internal-Shi Syndrome of LU and ST
Hot Phlegm in LU (Bronchitis): Fever; Cough; Chest pain; Sputum is thick and yellow, brown, or green; Thirst; Constipation. T: Red with thick greasy yellow coat. P: Rapid and slippery. Treatment Principle: One can Clear Heat from LU by purging constipation. Formula: Ma Xing Shi Gan Tang.
Yangming Jing (ST-Channel); No chills because the pathogen is too far Interior: "4 Big Symptoms": Big thirst, Big fever, Big sweats, Big pulse. Formula: Bai Hu Tang (Bitter and Cold).
Yangming Fu (LI-organ): Heat leads to Fever, Constipation, Bloating; Palpable hardnesses in abdomen (dry stool). P: Deep, strong, slow (slow due to Stasis). Formula: Da Cheng Qi Tang.
Ying- or Xue- Syndromes (PC): High fever (104 degrees F. and above); Mental manifestations (confusion, delirium, etc); T: Red tongue with scanty, or no coat (Yin Xu). Formula: King herbs include: Xi Jiao, Ling Yang Jiao and Shui Niu Jiao (Herbs must go to the PC).
5. Tidal fever (Low grade fever which comes and goes like the tide)
Yin-Xu: Low grade fever in the afternoon or evening; Five Centre Heat. Formula: Liu Wei Di Huang Wan.
Qi-Xu (Qi-Xu of SP-ST): Low grade fever at no regular time; Fever + Qi-Xu symptoms. Formula: Bu Zhong Yi Qi Tang.
Xue-Stasis (Late stage Stasis leads to Xue-Xu, as in late stage cancer): Low grade fever in evening; Aches; Dry skin; Dark circles under eyes; Tumour formation. T: Purple. P: Choppy and thready. Treatment Principle: Clear Xue-Stasis.
Yangming Fu Syndrome (LI-organ): Low fever possible, due to Stasis; Fever; Constipation. Formula: Da Ching Qi Tang, or any of the related "Ching Qi Tang" formulas.
6. Five Centre Heat
Yin-Xu with Heat-Xu: Five Centre Heat, which is Heat manifesting on the Yin surfaces of the body, such as the palms, bottom of the feet, and the chest; Night sweats, Hot flashes. T: Red, narrow, scanty coat. P: Thin and rapid. Treatment Principle: Nourish Yin, Clear Heat. Formula: Liu Wei Di Huang Wan (Tonifies Yin), Zhi Bai Di Huang Wan (Clears Heat-Xu). Important herbs: Huang Bai, Zhi Mu. Bitter and Cold, they cool both Heat-Xu and Heat-Shi.
Xue-Xu leading to Heat-Xu (Think LV-SP): Five Centre Heat especially in the afternoon and evening; Fatigue, poor appetite, palpitations, dizziness, vertigo, pale complexion. T: Pale. P: Thready, soft, or choppy. Treatment Principle: Nourish Xue. Formula: Si Wu Tang.
7. Night Sweats (Think HT, since sweat is the Jin-Fluid of HT)
HT-Xue-Xu: Night sweats, palpitations, insomnia, pale complexion fatigue; T: Pale; P: Weak. Treatment Principle: Tonify HT-Xue, astringe sweat. Formula: Si Wu Tang, plus an astringent such as Wu Wei Zi, Long Gu, My Li, Fu Xiao Mai, Gui Pi Tang.
Yin-Xu with Heat-Xu: Night sweats, palpitations, insomnia, pale complexion fatigue; T: Pale; P: Weak. Treatment Principle: Tonify Yin. Formula: Liu Wei Di Huang Wan + astringent such as Fu Xiao Mai.
8. Obesity
Phlegm-Damp Stasis (Excess Syndrome): Obesity, excessive appetite, likes sweet and fatty, greasy food; heavy sensations in body, foggy thinking; Aversion to Heat; T: Flabby; thick, greasy coat; P: Wiry/slippery (Wiry can suggest Phlegm, Heat, or food Stasis). Left untreated, the Phlegm can lead to Heat, leading to Yin Xu, leading to Wind, leading to stroke. Treatment Principle: Remove Damp and Phlegm. Formula: Wen Dan Tang + Ping Wei San. These formulas are combined to lose weight, more gentle and safe than Ma Huang based formulas.
Qi-Xu (Xu Syndrome): Fatigue, weak voice, shortness of breath, Phlegm-Damp Stasis; Aversion to Cold, edema, puffy face, poor digestion, sleepy, hypofunctions. Not necessarily an overeating problem. T: Pale with white coating. P: Thready and weak. Treatment Principle: Tonify Yang, raise metabolism.
Stone_Ac2 (1996) Symptomatic Diagnosis: Part 2.
9. Emaciation
Xu of SP-ST (Stressed digestive problems): Anaemia, malnutrition, indigestion, thin constitution with indigestion. Poor appetite, chronic loose stool, fatigue, shortness of breath, weak voice; Sallow or pale complexion. T: Pale. P: Weak. Treatment Principle: Tonify SP. Formula: Si Jun Zi Tang, Ba Zhen Tang, Stress carminative herbs.
Qi-Xue-Xu (Digestive problems less stressed): Anaemia, malnutrition. Pale face, nails, tongue, lips, fatigue, dizziness, vertigo. Yangqi-Xue unable to rise to nourish head. T: Pale. P: Thready/Weak. Formula: Ba Zhen Tang; tonic herbs for stress, such as He Shou Wu, E Jiao, Ji Xue Teng.
LU-Yin-Xu (Any Yin Xu leads to a certain amount of emaciation): Thin, emaciated body, Chronic dry cough, e.g. allergies; Lung TB, AIDS, both lead to this sort of emaciation. Cough with blood-streaked sputum, Haematemesis, Dry mouth, tidal fever, night sweats, Five Centre Heat. T: Red with scanty coat. P: Thready, rapid. Treatment Principle: Tonify Yin. Formula: Bai He Gu Jin Tang for LU-Yin-Xu; Liu Wei Di Huang Wan for any Yin-Xu.
ST-Heat (genetic, or acquired, usually chronic): Excessive appetite, hypermetabolism, bad breath, thin constitution; Craves Cold drinks; Irritability; Scanty urine; tends to be constipated. T: Red with dry coat. P: Thready, rapid, forceful. Formula: Jing Wei Tang for ST-Heat; Yu Niu Jiao for ST-Yin Xu due to ST-Heat.
LV-Fire (Excess Heat): Easily angered; Chest and hypochondriac pain or burning; Bitter taste, dry mouth; Insomnia, restlessness; Dark yellow urine, constipation. T: Red with yellow coat. P: Wiry, rapid, forceful. Formula: Long Dong Xie Gan Tang.
10. Fatigue
Summer Heat, often associated with Damp, because the Heat causes SP-Xu, leading to production of Damp: Symptoms follow excessive sweats, sun stroke; they always involved exposure to climatic Heat; fatigue and weakness in extremities; Dehydration, shortness of breath; fever; Weak voice, thirst; Dusky face colour if Damp is involved; Possible loose stool. T: Possible greasy coat. P: Weak and rapid, may be soft. Formula: Qing Su Yi Qi Tang.
Damp-Stasis, maybe associated with SP-Xu if the symptoms stress it: Sluggish and heavy sensations. Cloudy, foggy head. SP-Qi-Xu: indigestion, loose stool, bloating, low appetite. T: Greasy coat. P: Soft and slippery. Treatment Principle: Dry Damp, stimulate digestion. Formula: Ping Wei San; then later, tonify SP.
Qi-Xue-Xu: Fatigue and Pale colour; Pale skin, face, lips, nails etc; Dizziness, palpitations. T: Pale. P: Deep thready, weak. Formula: Ba Zheng Tang.
11. Flaccidity of Neck and Head due to weak muscles; a serious condition, wherein the patient is unable to raise the head.
Zhong Qi-Xu: More often effects children with severe malnutrition, Jing-Xu, Down's Syndrome: severe emaciation; Pale or sallow complexion; disorientation, confusion, extreme fatigue; indigestion, loose stool; Middle Jiao Xu leads to Zhong-Xu.
Bone Marrow Xu (a critical Xu Syndrome): Comes due to old age, sexual hyperactivity, associated with tinnitus, low back pain, difficulty in walking or straightening back. T: Pale with scanty coating. P: Deep, very weak, or feeble. Treatment Principle: Tonify KI-Jing. Formulas: Herbs made of animal products to quickly tonify.
12. Involuntary Twitching of Head Muscles
LV-Wind, LV-Fire (Acute Shi Syndrome): Twitching, acute, dizziness, bodily twitches in extremities especially. Red face, eyes, bitter taste in mouth. T: Red with yellow coat. P: Rapid and wiry. Treatment Principle: Dispel Wind, Clear Heat. Formula: Ling Jiao Gou Teng Tang.
LV-Wind (Chronic Xu Syndrome) e.g. Parkinson's: Tidal Fever, Night sweats, insomnia, fatigue. T: Red with scanty coat. P: Thready and rapid. Treatment Principle: Tonify Yin, Calm LV, Dispel Wind. Formula: Da Ding Feng Zhu.
13. Tinnitus Cranii (Noise in the head)
Bone marrow Xu: Tinnitus; Weakness/soreness in the lower back and/or knees; Vertigo/Dizziness possibly associated with ear tinnitus. T: Pale with scanty coat. P: Deep, thready, weak. Etiology: Constitution, age, oversexed, Jing-Xu fails to produce Jing. Treatment Principle: Tonify Jing. Formula: Zhou Gui Wan,
He Che Da Zao Wan. Animal products are good for Jing Xu.
Damp-Heat Stasis: Tinnitus; Headache, heavy sensation in head; Naseau/Vomiting; Low appetite; Dizziness; Quan Yang (carbuncles on head). T: Red with greasy yellow coat. P: Slippery, rapid. Etiology: Shi Syndromes due to diet of sweet, greasy, alcohol, or over indulgence creates Damp-Heat in Channels which obstructs the flow of (causes Stasis of) Yangqi. Upper Jiao Stasis effects the head Channels. Treatment Principle; Clear Heat, Dry Damp. Formula: Huang Lian Jie Tu Tang plus blood activators for sharp fixed pain.
LV-Qi-Stasis: Tinnitus triggered by anger or emotion; distention or pain in the hypochondrium, chest tightness; bitter taste in mouth; irritability, restlessness. T: Normal. P: Wiry and rapid. Etiology: Anger leads to disturbance in flow of Qi and leads to Qi-Stasis in the head. Treatment Principle: Soothe LV-Qi. Formula: Xiao Yao Wan; Long Dan Xie Gan Tang if Fire is present.
14. Sore Gums
KI-Xu and SP-Xu (teeth and gums): Sore gums aggravated mostly by Cold drinks and weather, sometimes Hot drinks as well. Teeth feel weak while chewing. T: Pale. P: Deep and Weak. Etiology: Old age, chronic Syndromes. Treatment Principle: Tonify SP and KI. Formula: Zuo Gui Yin, Ruo Gui Yin, Liu Wei Di Huang Wan, Ba Wei Di Huang Wan, Chew and eat walnuts (Hu Tao Ren).
Wind-Cold: Sore gums, prefer warm drinks and food to Cold. T: White slippery coat (slightly greasy). P: Floating and Tense. Formula: Xi Xin (individual herb) can be chewed raw, or decocted as a tea; Ma Huang Xi Xin Fu Zi Tang.
15. Bleeding Gums (ulcerative gingivitis)
Yangming Heat & Fire (acute Shi Syndrome in ST-LI): Swollen, red aching bleeding gums; Fresh, bright red blood; Bad breath, prefers Cold drinks, constipation. T: Red body, thick yellow coat. P: Forceful and rapid. Formula: Qing Wei Tang + Yu Niu Jiao + herbs to cool and activate Xue.
ST-Yin-Xu (Xu Syndrome, chronic): Swollen gums with pale blood, gums not bright red, sometimes painful, sometimes not. T: Red with scanty coat. P: Slippery, rapid, thready. Formula: Yu Niu Jiao + herbs to cool and activate Xue.
KI-Yin-Xu with Heat-Shi (a chronic Syndrome in old age): Slightly sore gums combined with loose teeth; Dizziness, tinnitus; Sore back and weak knees; T: Red body with scanty coat. P: Thready and rapid. Formula: (with Heat): Zhi Bei Di Huang + Gu Sui Bu and/or Xu Duan; (without Heat): Rou Gui Yin or Zuo Gui Yin + Gu Sui Bu and/or Xu Duan.
SP-Qi-Xu (SP unable to govern Xue, chronic Xu-Syndrome): Pale gums, lips, and nails due to Xue Xu; Easily bruised. T: Pale with white coat. P: Soft, weak. Formula: Gui Pi Tang (#1 Formula: for purpura-bruising).
16. Dark Black Teeth (Black from inside of teeth, not a stain due to coffee etc)
Xue-Heat in the Lower Jiao: High fever, delirium, semi-conscious, coma, convulsions; Irritability; Shrivelling and dry lips. T: Red with very dry coat, shrunken. P: Extremely rapid. Etiology: Heat has damaged Yin and Jin/Ye, ST-Qi damaged (shrunken mouth). KI unable to nourish teeth, turning them black, the colour of KI. Formula: Salty, Cold, sweet and moist herbs, Fu Mai Tang, Pa Ting Fen Zhu Tang.
Stone_Ac3 (1996) Symptomatic Diagnosis: Part 3.
17. Stiffness of Neck
Wind-Cold: More chills than fever, etc. T: White slippery coat (slightly greasy). P: Floating and Tense. Formula: Ge Gen Tang.
Wind-Cold-Damp (a Bi-Syndrome such as arthritis): Heavy sensation in the head, head ache, aching joints, fever/chills sometimes. T: Greasy coat. P: Floating and slippery. Formula: Ge Gen Tang + Qiang Huo, Jian Huang and/or Sang Zhi.
Xue-Heat: High fever, stiffness of head; irritability, delirium; Possibly associated with convulsions, muscle spasms. "Extreme Heat leads to LV-Wind". Formula: Ling Yang Ge Gen Tang.
18. Goitre (Thyroid gland Enlargement)
Phlegm-Stasis and Qi-Stasis: Swelling of thyroid, which is soft without pain; Sense of obstruction in throat; Chest constriction and hypochondriac distending pain; Irritability. T: Greasy white coat. P: Wiry and slippery. Etiology: Stress -> Qi-Stasis -> impaired metabolism of Jin-Ye -> Phlegm-Stasis in throat. Formula: Ban Xia Huo Po Tang + Hai Zao and Kun Bu.
Qi-Xue-Stasis: Tumours or cancer of the thyroid gland developing from Phlegm-Stasis and Qi-Stasis (see above); Swelling is harder than simple Phlegm and Qi-Stasis; More defined pain and sense of obstruction effecting ability to breath and/or swallow; Chest constriction and hypochondriac distending pain; Irritability. T: Dark purple. P: Deep and choppy. Etiology: Prolonged Qi-Stasis with Phlegm leads to hardening of the Phlegm leading to tumour formation. Formula: Ban Xia Huo Po Tang + Blood activators such as E Zhu, San Lin, Dan Shen, Ru Xiang, Mo Ya and anti-cancer herbs.
Yin-Xu of HT and LV: Typical hyperthyroidism, swollen thyroid, though not hard; Palpitations, insomnia, nervous, trembling; Easily sweats, shortness of breath, irritability, dizziness/vertigo; Dry eyes, hot flashes, night sweats; Nocturnal emissions, premature ejaculation; irregular menstruation. T: Red with scanty coat. P: Wiry and rapid, or thready and rapid. Treatment Principle: Tonify Yin and Clear Fire. Formula: Suan Zao Ren Tang, Zhi Bai Di Huang, Tian Wang Bu Xing Tang, Yi Guan Jiang.
19. Edema of the extremities
Heat-Damp-Stasis ("Heat Bi-Syndrome"): Edema in small joints; Acute achy swollen arthritis; Combined with fever, thirst and irritability; T: Red body with yellow greasy coat. P: Slippery and rapid. Formula: Bai Hu Tang + Gui Zhi and Cang Zhu.
Cold-Damp-Stasis ("Cold Bi-Syndrome"): Cold, achy arthritis with edema. T: Greasy white coat. P: Slow. Formula: Wu Tou Tang.
Qi-Stasis: Pitting edema; Chest constriction and hypochondriac distending pain. T: Pale with white coating. P: Wiry. Etiology: Because this a Channel pathology, the etiology is often External Wind. Treatment Principle: Harmonize Ying and Weiqi. Formula: Xiang Su San (Xiang Fu activates Qi; Su Ye Dispels Wind).
Qi-Xue-Stasis (Post-stroke sequelae, paralysis, hemiplegia): Edema (mostly lower extremities), weakness, numbness; Colour of the skin at affected site is purple. T: Pale with purple spots. P: Wiry, choppy. Etiology: Phlegm remaining in Channels after stroke. Formula: Huang Qi Gui Zhi Tang.