Cautions & Precautions

Question 1

• pregnancy under 3 months (CLUE: belly not very big yet)
• pregnancy over 3 months (CLUE: belly is bigger)
• pregnancy

Answer 1

C.I. in low abdomen or in lumbosacral area
C.I. in upper abdomen or in lumbosacral area
C.I. to puncture LI4, SP6, BL60, BL67 (strong sensation)

Question 2

• for infants, when fontanel is not closed

- infants: unable to cooperate w/ the practitioner

Answer 2

C.I. on vertex

Retaining of needles is forbidden in infants

Question 3

In 4 needle technique, what is the tx principle for deficiency?

Answer 3

TONIFY MOTHER, SEDATE NANA

Question 4

In Korean 4 needle technique, what do you do in cases of excess?

Answer 4

SEDATE THE SON, TONIFY NANA

Question 5

In Korean 4 needle technique, how do you find the other two points?

Answer 5

They match the first two points by element and manipulation. The are the horary points of the elements of the first two points.

Question 6

Fainting: Causes? Manifestations? Management? Prevention?

Answer 6

Causes: nervous tension, delicate constitution, hunger, fatigue, improper position or too forceful manipulation
Manifestations: dizziness, vertigo, SOB, nausea, pallor, etc. if severe, cold limbs drop of blood pressure, loss of consciousness
Management: Fainting aura-> withdraw all the needles-> help the patient to lie down, off warm or sweet water
-if severe, press or needle DU26, PC9, DU25, PC6, ST36 or moxa DU20, RN6, RN4
-if no response call 911

Question 7

Stuck Needle: Causes? Manifestations? Management? Prevention?

Answer 7

Causes: nervousness, strong spasm of local mm after insertion, excessive rotation, changing position
Manifestations: needle is difficult to rotate, lift or thrust
Management: d/t excessive rotation: twirl needle in opposite direction, d/t mm tension: leave needle in place for a while, massage skin nearby, insert another needle nearby, d/t changing position: resume original posture
Prevention: real tension before insertion, do not twirl w/ large amplitude or in one direction, keep original posture

Question 8

Bent needle: Causes? Manifestations? Management? Prevention?

Answer 8

Cause: unskillful manipulation, hard tissue, sudden change in posture, improper management of stuck needle
Manifestations: difficult to lift and thrust, rotate and withdraw needle an pt. feels pain
Management: do not lift, thrust or rotate, remove slowly and withdraw by following the course of the bend, d/t changing posture: resume original position, relax local mm, remove needle, NEVER withdraw w/ force!
Prevention: perfect insertion and gentle manipulation, proper and comfortable position, do not change position, do not impact or press needle area

Question 9

Broken needle: Causes? Manifestations? Management? Prevention?

Answer 9

Cause:
Manifestation:
Management:
Prevention:

Question 10

Hematoma:

Answer 10

Cause:
Manifestations:
Management:
Prevention:

Question 11

After-effect:

Answer 11

Cause: unskilled manipulation and forceful stimulation
Manifestation: after withdrawal of needle, there is an uncomfortable sensation of soreness and pain which may persist for a long amount of time
Management: mild: press local area, severe: in addition to pressing moxa is applied to local area
Prevention: too forceful manipulation shall in no case be applied.

Question 12

Internal bleeding: signs

Answer 12

Penetrating trauma. This happens when a foreign object penetrates the body, tearing a hole in one or more blood vessels. Examples are gunshot wounds, stabbings, or falling onto a sharp object.

Most serious:
Head trauma with internal bleeding (intracranial hemorrhage)
Bleeding around the lungs (hemothorax)
Bleeding around the heart (hemopericardium and cardiac tamponade)
Tears in the large blood vessels near the center of the body (aorta, superior and inferior vena cava, and their major branches)
Damage caused by trauma to the abdomen such as liver or spleen lacerations or perforation of other soft organs

Question 13

Internal bleeding: symptoms

Answer 13

Abdominal pain and/or swelling can be caused by Internal bleeding from trauma in the liver or spleen. These symptoms get worse as the bleeding continues.
Light-headedness, dizziness, or fainting can result from any source of internal bleeding once enough blood is lost.
A large area of deeply purple skin (called ecchymosis) can result from bleeding into the skin and soft tissues.
Swelling, tightness, and pain in the leg can result from internal bleeding in the thigh. Most often, this is caused by a fracture of the thighbone.
Headache and loss of consciousness could be the result of Internal bleeding in the brain.

Question 14

Moxibustion: GINGER

Answer 14

Weakness of ST/SP such as diarrhea, abdominal pain, painful joints, and symptoms d/t Yang xu

Question 15

Moxibustion: GARLIC

Answer 15

scrofula, tuberculosis, the early stage of skin ulcers w/ boils, poisonous insect bite, etc.

Question 16

Moxibustion: SALT

Answer 16

• abdominal pain, vomiting, diarrhea, pain around umbilicus, pain cause by HERNIA, prolonged DYSENTERY, etc.
• RESTORE YANG COLLAPSE! (e.g. excessive sweating, cold limbs, and minute pulse)

Question 17

Moxibustion: FU ZI

Answer 17

Fu Zi warms Yang, expels cold, for persistent yin-cold syndromes (such as impotence and premature ejaculation cause by Mingmen Fire decline)

Question 18

C. I. Moxibustion:

Answer 18

• Excess syndrome, hot or fever
• caution in diabetes or other conditions(difficult to sense)
• not on face
• patients w/ HBP (internal heat)
• Pregnancy: not on abdomen or low back
• no scarring moxa: face, head, large blood vessels
• points prohibiting moxa (i.e. LU3)

Question 19

Bloodletting: C.I.

Answer 19

no hemophiliacs, pts. on blood thinners, no weak pts./anemia, no vascular tumors, no jingwells on pregnant women and caution for postpartum

Question 20

Cutaneous needling: plum blossom, 7 star, etc.

Answer 20

no on traumatic injury, wet, weeping skin, inflammation, ulceratiion, or acute abdominal disorders (no abdominal tapping)

Question 21

C.I.: electro-acupuncture

Answer 21

Do not cross heart, spine, midline, important organs (i.e. eyes, not on BL1)
do not use on pregnant or weak pts. (not in 1st trimester at all, later on extremities but not on abdomen on low back)
no use with pacemakers or metal body parts in area
do not use where insertion is less than 0.5cm (eyes, fingertips)

Question 22

Moxa burn

Answer 22

small blister: heals by itself
large blister: should be punctured and drained. if pus is formed, the blister should be dressed to prevent further infection

Question 23

Famished, eating to excess, intoxicated, overfatigues, very weak

Answer 23

apple few needles or delay acupuncture tx

Question 24

Cupping C.I.

Answer 24

• skin ulcer, edema, large blood vessel, high fever and convulsion
• abdominal and sacral regions of pregnant women
• if pt. is susceptible to spontaneous bleeding or endless bleeding after trauma

Question 25

Management of cupping bruise

Answer 25

bruise or small blister: will disappear after several days

severe blister: draw out the liquid, apply gentian violet and cover w/ gauze