09/08/2010
Wednesday, September 08, 2010
8:03 PM
09082010 - 2
Audio recording started: 8:29 PM Wednesday, September 08, 2010
Sore Throat
Common symptom in clinic - most often seen in those associated with cold or flu
In TCM, if we see sore throat that includes pharyngitis, laryngitis, tonsilitis
- The most important cause is HEAT
 Excess heat
□ LU (throat belongs to LU channel) or ST (ST channel passes through throat)
 Deficiency heat
□ LU or KD yin deficiency => deficiency heat can damage water and lodge heat in
throat/lack of nourishment in throat
□ SP Qi deficiency => overuse of antibiotic drugs (bitter and cold, which easily damages
SP yang QI -> SP cannot transport/transform dampness -> dampness congeals into
phlegm and lodges in the throat)
 External pathogen
□ Wind Heat: easily damages LU - heat can be lodged in throat
 Improper diet
 Emotions
Key Diagnostic points:
- Red, swollen/swollen glands: heat mostly due to wind heat
- Red, swollen, with pus on surface: LU & ST excess heat, heat toxicity
- Pale red: deficiency heat
- Aggravation of sore throat
 With fatigue: yin deficiency or SP Qi deficiency
 With spicy food: ST heat, excess heat
Acupuncture treats acute sore throats well - almost better immediately
- Wind heat pathogen/LU ST excess heat:
 LU10, LU11 - needle or bleed
 LI1
 Ashi points beneath the chin, along side throat
 Ren23
- Signs/Symptoms of Wind Heat Pathogen causing sore throat:
 Fever, chills (fever more than chills)
□ Tidal fevers
 Thirst
 Headaches
 Common cold/flu symptoms
 Yellow phlegm
 Red, swollen glands, sore throat - swollen nodules under chin
 Tongue: red tip, thin white/yellow coating
 Pulse: floating, rapid or floating, slippery
 Treatment principle: clear heat, expel wind
□ SJ5, LI11, LI4, LU10, LU11, LI1
□ High fever: DU14
□ Local points: LI8
BL12, BL13
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□ BL12, BL13
□ Ear points: ear-throat, ear-tonsils
□ Yan (throat)San (3) Zhen (needle)
- Signs/Symptoms of LU/ST heat causing sore throat:
 Usually severe
 Pain radiates to lower jaw and even ears
 Red, swollen tonsils (sometimes so swollen throat closes up)
 Yellow on surface
 Pain when swallowing
 Nodules beneath chin
 High fever
 Very thirsty with strong desire to drink
 Constipation
 Concentrated, dark yellow urination
 Cough with yellow, sticky phlegm
 Hoarse voice
 Tongue: deep red, yellow, thick greasy coating
 Pulse: flooding pulse - fast & strong
 Treatment principle: clear heat, drain fire, benefits throat
□ Clear heat from LU: LU3, LU5, LU10, LU11
□ Clear heat from ST: ST44, ST43, LI11
□ Benefits throat: Yan San Zhen, LI18, Ren22 (be careful - 0.2cun, then change
direction)
□ Ear points: ear-throat, ear-tonsils
- Signs/Symptoms of LU/KD deficiency causing sore throat:
 Chronic sore throat
 Comes and goes
 Worse in afternoons, evenings, or when fatigued
 Dryness, dry mouth, sore throat
 Itching sensation in throat
 Afternoon fever
 Heat sensation in palms and soles
 Dry stools, constipated
 Sometimes hoarse voice
 Tongue: pale red, possibly swollen, maybe normal, dry, mirrored tongue (no coating)
 Pulse: thin, rapid
 Treatment principle: nourish LU and KD yin, clear deficiency heat, moisten the throat
□ Nourish LU yin: LU7, LU9
□ Nourish KD yin: KD6, KD3, SP6
□ BL13, BL23
- Signs/Symptoms of SP Qi Deficiency causing sore throat:
 Direct result of overuse of antibiotics
 Acute sore throat often treated with antibiotics in biomedicine
□ Antibiotics are cold and bitter - can clear ST heat, but it can damage SP
 Throat is slight red, or even just pale in color
 Possibly swollen (phlegm lodged in throat)
 Frequent cold, or URI
 Loose stools, diarrhea
 Picky eating
 Abdominal distention
 Puffiness or mild edema
 Puffiness of upper eyelid
 Tongue: pale, possibly swollen, white coating
 Pulse: thin, weak
Treatment Principle: Tonify Sp, eliminate dampness, Transform Phlegm
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Pulse: thin, weak
 Treatment Principle: Tonify Sp, eliminate dampness, Transform Phlegm
□ Acupuncture + Moxa (help SP & dry dampness)
□ Ren12, ST36, ST40, SP9, SP3, LU9
□ BL13, BL20
Wheezing or Asthma (Xiao Chuan)
Tightness, congestion, breathlessness, or constriction in chest
In TCM, wheezing or asthma is due to failure or LU Qi to descend -> LU Qi rebellious
In some cases, acute episode occurs in background of disease
Sometimes patients can collapse and die in severe situations
Etiology:
- External pathogens: wind cold (cold may cause constriction that can narrow the air passages)
- With wheezing, there is often preexisting phlegm in the LU (often due to SP Qi deficiency)
- Dairy, sugar, or rich/sticky foods can produce phlegm
- Can be triggered by stress/emotions
 Stagnant LV Qi
- LU Qi, LU yin deficiency
- KD deficiency - particularly in chronic cases
- Treatments:
- Treat from roots between acute episodes
- Treat manifestations during episodes
- Ren17, Ren22 (quick point to descend Qi), LU1, LU2, GB21
- Ding Chuan (0.5 cun lateral to DU14)
-
- Wheezing/Asthma due to Wind Cold - initiated or aggravated by wind cold
- Acute onset
- Tightness around chest & throat
- Cough with a lot of phlegm/mucus
 White, clear mucus
- Simultaneous fever & chills (chills more than fever)
- Headache, muscle ache, body aches
- Nasal congestion
- Tongue: normal, thin white coating
- Pulse: floating tight, or floating wiry
- Treatment Principles: Dispel wind, expel cold, descend LU Qi
 Descend LU Qi: Ren17, Ren22, LU1, LU2, GB21
 Dispel wind & expel cold: LI4, LU7
 BL12, BL13
 Perfuse clear white phlegm: ST40, SP3, SP9
 Moxa is applicable - BL12, BL13, Ding Chuan
- Wheezing/Asthma due to Wind Heat
- Acute with sticky, scanty yellow phlegm
- Phlegm hard to expectorate
- Fullness/tightness in chest
- Mild fever with little chills
- Thirst
- Dry, sore throat
- Nasal congestion/discharge
- Tongue: red tip, thin yellow coating
Pulse: floating rapid or floating slippery
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Tongue: red tip, thin yellow coating
- Pulse: floating rapid or floating slippery
- Treatment Principles: Expel wind, clear heat from the LU, descend LU Qi
 SJ5, LI11, LI4
 Clear heat from LU: LU3, LU5
 BL12, BL13
 NO moxa - cupping and guasha is ok
- Wheezing/Asthma due to Damp Phlegm
- Phlegm blocks LU so Qi cannot descend
- Chronic
- Usually associated with improper diet or recurrent respiratory tract infections
- Wheezing/asthma with copious phlegm
 White, thick, sticky phlegm
- Worse in the morning and after eating
- Epigastric distention
- Poor appetite
- Fullness in chest
- Nausea/vomiting
- Loose stools
- Sticky/bland taste in mouth
- Tongue: Pale, puffy, thick white greasy coating
- Pulse: soft, slippery
- Treatment Principles: Strengthen SP, Transform phlegm, Dry dampness, Descend LU Qi
 Eliminate damp phlegm: Ren12, ST36, SP6, SP9, SP3, ST40, LU7
 Descend LU Qi: Ren17, Ren22, LU1, LU2, GB21
 BL20, BL21
 Moxa on Bl20, Bl21, SP9, ST40
 Damp phlegm transform into heat: thirst, dry mouth, red tongue with yellow coating
□ Clear heat: LI11, LU5, LU3
- Wheezing/Asthma due to LV Qi Stagnation
- Often from stress
- Tightness in the chest
- Wheezing or asthma with difficulty breathing
- With little or no mucus
- Muscle tightness
- Clearly related to emotions: feels better when relaxed, attack with stressed/nervous
- During episode, patient often panics
- Plum pit Qi
- Palpitations
- Hypochondriac pain
- PMS, irregular menstruation
- Tongue: unremarkable, can be normal or dark tongue, thin white coating
- Pulse: wiry
- Treatment Principle: Move LV Qi
 LV13, LV14, 4 gates, PC6
 Ear points: Ear-shen men, Ear-liver
 Yin Tang
 Ren17, GB21
 BL13, BL15, BL18
 Cupping on chest, back shu - 100% improvement in about 3 or 4 sessions
 Gua sha
 Electric stimulation
Wheezing/Asthma due to LU Qi/Yin deficiency
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- Wheezing/Asthma due to LU Qi/Yin deficiency
- Chronic
- History of using steroids
- Worse with exertion
- Soft/weak voice
- Spontaneous sweating
- Aversion to wind/drafts
- Dry mouth, dry throat
- Thirsty
- Constipation
- Tongue: pale red, pink, sometimes with cracks, little coating
- Pulse: weak, soft, deep
- Treatment Principles: Tonify LU Qi, nourish LU yin, redirect LU Qi downward
 Tonify LU Qi & Lu Yin: LU9, LU7, BL13, BL43 (tonifying point for LU & HT)
 Strengthen SP: ST36, SP6
 Nourish KD yin: KD3, KD6
- Wheezing/Asthma due to SP Qi deficiency & LU Qi deficiency
- Wheezing/asthma with SOB
- Worse with exercise and exertion
- Worse during colds and flu
- White, clear phlegm
- Easily fatigued, tired
- Pale complexion
- Frequent colds
- Spontaneous sweating
- Indigestion, poor appetite, gas, bloating
- Loose stools, diarrhea
- In children: picky eaters
- Tongue: pale, swollen, white coating from thin to thick
- Pulse: thin, deep, weak
- Treatment Principles: Strengthen SP, tonify LU Qi, redirect LU Qi downward
 Tonify LU Qi: Lu7, LU9, BL13, Bl43
 Tonify SP Qi: Ren12, Ren6, ST36, SP6, SP9, BL20
 Moxa is applied
- Wheezing/Asthma due to KD Yang deficiency
- Chronic wheezing/asthma
- When KD deficiency -> affects water metabolism
 Water retention
- Difficulty inhalation vs less difficult exhalation
- Worse during physical exertion, fatigued, with cold
- Wheezing/asthma following sex
- Spontaneous sweating
- Frequent urination or water retention
- Edema
- Lower back soreness, lower back weakness
- Pale complexion, or pale purple complexion
- Dark green under the eyes
- Facial puffiness or edema
- Tongue: pale, swollen, possibly purplish or with purple spots, white coating, thin/thick or greasy
- Pulse: deep, thin, slow
- Treatment Principles: Tonify KD, warm KD yang
 Ren4, Ren6, KD3, DU4, BL23
Moxa is often used - Ren4, DU4 (best combination for warm KD yang, tonify KD Qi)
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 Moxa is often used - Ren4, DU4 (best combination for warm KD yang, tonify KD Qi)
 Descend LU Qi: BL13
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