External Therapeutics Flashcards
Tennis Elbow
Main Merridian
LI
Tennis Elbow Sn/Sx
Pain: fluctuates, Close to LI 11 (bent elbow, halfway b/w lateral epichondyle and end of crease), increases with pressure or rotation
No swelling, often older patients/manual labourers/sports players
It’s really a bone thing
Tennis Elbow
Differential Dx
vs Golf Elbow/Student Elbow (Medial Epichondyle)
Tennis Elbow
Tx
LI 10, 11, 12 (3 needle technique), 1.5c needle or 1.2c perp
LI 4
Lu 5 (if tender near there, or pain referring downwards from shoulder), LI 15, SJ 14
Huatojiaji - Cervical, esp C4-C6 (golf elbow is C7-T1)
Yangming
Electro with 3 needle technique (hook up any two, or use one clip on two needles, and the other gets it’s own clip, stim 20 minutes till you can see needle jump, works especially well on Shi)
Warming Needle or Moxa until local turns red
Dr. Dong’s extra points technique - uses points close to bone, lines up 3 or 4 needles
Bone issue, so sometimes insert two needles just right on bone so 3 needle technique becomes 5 needles in a circle
Ashi Points
Bleeding:
Shi only, if really clear Ashi pts, 3-5 dots, can cup after pricking)
Auricular:
elbow, ear shenmen, liver
Herbal Plaster:
People with allergic constitutions may get skin changes, itching, burning, cooling, etc. Take it off after a couple hours if itching too much.
**Must tonify Qi and Blood - St 36, 25, Ren 4,6. **
Tennis Elbow
Education
Keep area warm (no ice)
Prevent EPF
Minimize movement of forearm
Need to continue Tx for at least 8x, even if pain is gone
Reynoad’s Disease
What is it
Vasospasm of small cutanious arteries
(nose, hands, feet)
Results in cyanotic, cold state of the skin
eg: hands turn pale/red/purple when they touch something cold, and then later they flush to warm.
Autoimmune disorder - often accompanied by Lupus (SLE), Rheumatoid Arthritis, etc.
Triggers - stress, cold
Target- Young women
Reynoad’s
Triggers
Cold, Stress
Reynoad’s
Target
Young Women (often)
Reynoad’s
Sx
Attacks last minutes to 7 hours (fluctuating spasm)
Area blanches, then gets colour again but it’s red and throbs v.painfully
(blanch —>cyanotic (purple/blue) —> red)
Longstanding cases - skin becomes thin, shiny, smooth, tight, and may develop small painful ulcers
Often accompanied by Rheumatoid Arthritis, piano fingers (long, thin, flexible),
Reynoad’s
Complications
Recurrent attacks —> infection, gang green (very rare)
Reynoad’s Test
No test —> clinical Sx
Reynoad’s
TCM Dx
Yang Xu
Mingmen Fire Decline (plus invasion of cold blocks the circulation)
Reynoad’s
POT
Warm the meridian
Dispel Cold
Tonify Kidney Yang
Reynoad’s
Education
Keep warm!!!
Regulate Emotions - can be stress triggered (even just too happy)
Avoid overstrain
Quit smoking (nicotine can make the small blood vessels spasm)
Treat in summer since it’s a winter disease, and in summer the Yang comes back to superficial, so we can treat more effectively. Can even just rub pepper on hands often in summer). Tx in hottest time of summer (very, very hottest days).
Self moxa on SJ 4, St 36 20 to 30 minutes before bed for the patient. Warn them not to burn themselves, and to put out moxa stick in water, not just assume it’s done burning.
Inquiry
6 questions
O-onset
P - palliation (what makes it worse or better)
Q - quality (dull/burning/etc)
R - radiation
S - severity
T - timing
also - location, inducing factors, history, nature, severity, time, accompanying Sx
Diagnostic Steps
Inquiry
Observation
Palpation
Olfaction/ Listening (Aufaction?)
Observation
parts
Shen Bearing Skin Colour Collaterals Tongue
Palpation
parts
*start in pain-free area and move towards pain Skin Chest and Hypochondrium Hand and Foot Acupoints Auricular points Abdomen Pulse
Olfaction and Listening
parts
Chief Complaints Acute vs Chronic Natuer of pain progression and change of symptoms and such modalities to stop pain quickly
Modalities for Pain
Herbal Acup Moxa Auricular Cupping Guasha Heat and Cold complex Tuina Food
Prevention of Pain/Education
Regulate Emotions Health Education Avoid overstrain Exercise regularly Preventative herbs/acup
Bi Syndrome
Definition
Disease
“Closed, Blockage”
Obstruction of Qi and blood in the meridians and collaterals from EPF
Pain, mumbness, heavy sensation of body, limbs and joints, muscles, limitation of movement
Bi Syndrome
Manifestations
Pain
Numbness
Limitation of Movement (spleen-muscle/ kidney-bone/ liver-sinews)
Swelling and Deformity
Xu Qi
signs
Water retention (phlegm, blood stasis)
7 Needling Techniques
Successive Needling
Restorative Needling (relaxes muscles and tendons)
Uniform Needling (small circumference deep pain)
Superficial Needling
Short Thrust Needling
Shallow Needling
Muscle Needling
Successive Needling
how
why
Successively needle and remove ashi points along a line
Wandering Bi
Restorative Needling
how
why
Needle Perpendicularly, then remove and change direction to all four directions
Relaxes muscles and tendons
Uniform Needling
First needle into centre of pain, retain it. Then a needle on each side-within 2c, angled slightly towards centre needle
Small circumference, deep pain
Superficial Needling
One needle perp in centre, four shallow oblique around
Wide, shallow pain, Cold Bi
Short Thrust Needling
how
why
Insert at ashi, GENTLY hit bone repeatedly
Bone Bi
Shallow Needling
How
Why
Two needles superficially pointed towards pain
Atrophy, numbness, spasms from muscle or tendon Cold Bi
Muscle Needling
how
why
Needle Ashi, Origin, Insertion
Muscle Bi from Wind-Cold-Damp, spasms, cramps
Why are steroids bad for arthritis?
They harm the bone
Factors Influencing Osteo-Arthritis
Weigh bearing joint
use of steroids
age
Factors of Rheumatoid Arthritis
Female 8-15 y/o or 25-55 y/o Recurring infections (esp. tonsillitis) Family history small joints, bilaterally morning stiffness swelling or tingling of hands or feek, nodules or cyst around affected joints deformed joints, feeling of malaise blood test! (RF factor >20) may show anemia Sx ESR (Erythrocyte Sedimentation Rate)
Goals for Arthritis Tx
Relieve Pain
Minimize Joint Destruction
Maintain Range of Motion of Joint
Increase Strength of Joint
Frozen Shoulder Syndrome
how people get it
During pregnancy (bones open) - can either make better or worse Something gets in there and stays
Frozen Shoulder
Differential Dx
- Supraspinatu Tendinitis (painful arch 60degrees to 120 degrees, but otherwise no pain)
- Adhesive capsulitis bursitis (acute=red and swollen)
- Bicipital Tendinitis (long head) (tender at Pc2, so press on it then get patient to move arm at elbow and pain will go away)
- Rotator Cuff injury (degeneration, etc, will start with 1 or 2 tendons having partial tears, then more tendons tear later or sometimes tendons tear all the way and need surgery)
Pain Management
Pathologies
- Stagnation of Qi and Blood
- Imbalance of Yin and Yang
- Imbalance of Ascending and Descending
Reasons for Stagnation of Qi and Blood
Cold Damp Heat Frustration Trauma Phlegm/fluids Qi and Blood Xu Lingering Dx go to Collaterals
Pain - Etiology
Emotional EPF Internal Injury Trauma Phlegm/retained Fluids Blood Stasis
Pain Classification Methods
Etiology
Location
Nature
Pain
Nature of it
Cold
Heat
Xu
Shi
Pain
POT
- Stop pain
- Tx Ben and Biao
* change plan when Sx change, Tx organ and Channel differently
Pain
Modalities
Herbal (internal and external) Acup/Moxa Auricular Cupping Guasha Heat/Cold Tuina
Skin Lesion Types
Local and Severe (few general Sx, focus on local)
Chronic, Flat, Deep lesions (more general stuff - pale face and lips, SOB, weak pulse)
If pain precedes swelling…
Blood issue at tendon and bone level
If swelling precedes pain
Qi issue
If injury is red then …..
have strong Qi and Blood
If injury is pale but sore and swoolen
Qi and Blood Xu
What are the three levels of Qi and Blood Stasis?
Muscle
Tendon
Bone
What are the Pathologies of Pain
- Stagnation of Qi and Blood
- Imbalance of Yin and Yang
- Imbalance of Ascending and Descending
How to Classify Pain
Etiology
Location
Nature
Etiology of Pain
Emo EPF Internal Injury Trauma Phlegm / retained Fluids Blood Stasis
Sources of Internal Injury
Emo
Diet
Overstrain (physical/mental/sexual)
Location of Pain
- Zang Fu organs and Channels/Collaterals
2. Qi, Blood, Body Fluids
Nature of Pain
Cold
Heat
Xu
Shi
What is Bi Syndrom
Obstruction of Meridians (Qi, Blood) Painful (muscles, joints), limits movement Weather All over body = Arthritis (osteo/rheumatoid)
Western names for Bi
Neuralgia
Peripheral Vascular Disease
Sequelae of Trauma
Rheumatic Disease
Bi
Differential Dx
Wei - (“MS”) wei is Xu, has Atrophy, Not related to weather changes, mainly lower limbs, and bi/unilateral, No Pain
Windstroke (Wind Fire, Blood Stasis, Phlegm attack head and block clear orifice) -disorder of Qi, Blood, Yin and Yang, Zang and Fu. Is an actual stroke with stroke Sx
Bi is obstruction from EPF, no atrophy, lots of pain, limited but not loss of movement.
Bi Types
W-C-D W-D-H Blood Phlegm Stagnation Liv Kid Xu
Shi: Wind Cold Damp Heat
Which Disease?
Wandering or fixed pain in joints and or muscles that is aggravated in damp cold or alleviated by warmth, sensitive to weather changes, pain changes in severity, painful area might be cold feeling, aversion ot wind, swelling but not red, joints or muscles may feel weak but mobility is OK. May hae liver and kidney xu, qi and blood xu Sx, Tongue normal with thin or thick white sticky coat, pulse wiry, tight or soggy.
Wind Cold Damp Bi
General Bi Tx
Ashi GB 39 (influential of Marrow) GB 34 (influential of Tendons) UB 11 (sea of Bone)
Which Dx?
Acute onset, wandering or fixed, severe burning pain in the joints with limited movement, wihci will be gone after swelling disappears. Joints are red, swollen and warm to the touch.May have fever, thirst, restlessness, dark yellow urine, red macule. Tongue red at tip with thick or thin yellow sticky coat. Pulse slippery and rapid.
Wind Damp Heat Bi
Wind
Tx
Disperse Wind
*GB20 ("reserves the wind")
GB 31 ("wind market")
UB 12 ("wind gate")
Du 16 ("House of Wind")
*SJ 5 (wind, blood, channel)
Sp 10 ("Sea of Blood")Disperse Cold
Tx
UB 23 (Kidney)
Du 3, 4 (Kidney, wind, yang)
Ren 4, 6 (Yang)
Remove Damp
Tx
St 28 - “Water Passage”
St 36 - He-Sea
Sp 6, 9
Ren 9 (water)
Clear Heat
Tx
LI 11
LI 4
Du 14
Tonify Qi and Blood
Tx
St 36 Ub 17, 18 (Four Flowers) Ub 20 Sp 6 Sp 10
Tonify Liver and Kidney
Tx
K 3, 6, 7 Ub 18 (Liver) Ub 23 (Kidney) Sp 6 GB 39 Du 4 Ren 4
Dx?
Wandering pain in the joints, limitation of movement, chilliness and fever, thin and white tongue coat, superficial tight or superficial moderate pulse.
Wind Bi
Dx?
Severe pain in the joints, alleviated by warmth and agravated by cold, fixed localization but no redness, no hotness, limitation of movement. Coldness of limbs, lack of perspiration. Thin and white tongue coating and a pale tongue. Pulse wiry and tight.
Cold Bi
Dx?
Numbness and heavy sensation of the limbs, soreness and fixed pain or swelling of the joints, aggravated on cloudy and rainy days. White, thick, sticky and wet tongue coating. Soft or slippery pulse.
Damp Bi
Dx?
Swelling, rigidity, deformity and restricted movement of the joints, permanently. Pain in the fixed joints is intermittent or changes from time to time. It is worse in the early morning at night, and cloudy, rainy days. It could be better after movement. Purple tongue, white coat, thready, choppy pulse.
Stagnation of Phlegm and Blood Bi
Dx?
Wandering or fixed pain in the joints and or muscles that is aggravated by overstrain or stress, and alleviated by rest. The severity of the pain changes from time to time. Sore and weak lumbar and knees, lower fever, emaciation or listlessness, shortness of breath, pale or sallow complexion. Red or pink tongue, with scanty or thin white coat. Pulse is thready, rapid or slow.
Liver and Kidney Xu Bi
Could combine with other types of Bi Syndrome
Temporomandibular Joint Syndrome
Types
Wind-Cold-Damp Invasion
Qi and Blood Stagnation
Liver and Kidney Xu
Qi and Blood Xu
Shi types of TMJ
(Qi and Blood Stagnation in the Shoayang and Yangming Meridians)
W-C-D
Qi and Blood Stagnation
Xu types of TMJ
(Malnourishment of the muscular region of Shaoyang and Yanming)
Liver and Kidney Xu
Qi and Blood Xu
Shaoyang
San Jiao
Gall Bladder
Yangming
Large Intestine
Stomach
Qi and Blood Stagnation
Tx?
Liv 3
GB 41
Frozen Shoulder
Types
Wind-Cold-Damp
Qi and Blood Stagnation
Qi and Blood Xu
Dx?
Wandering pain in shoulder, which is aggravated by wind-cold, and alleviated by warmth. Slight restriction of joint mobility may be present. Aversion to wind and cold, Stiffness of neck. Tongue pale, coating thin and white. Pulse superficial or wiry.
Frozen Shoulder,
Wind Cold Damp
Dx?
Fixed sharp or stabbing pain which becomes worse during the night. May have swelling of the shoulder. Limited movement of the shoulder. Purple tongue, with thin white or yellow coating. Pulse is wiry or thready and choppy.
Frozen Shoulder Syndrome
Qi and Blood Stagnation
Dx?
Soreness and pain in the shoulder which is aggravated by overstrain, limited movement of shoulder. May have macular atrophy. Shortness of breath, lassitude, dizziness, blurred vision, palpitations, tinnitus. Tongue pale with thin white coat. Pulse thready or deep and choppy.
Frozen Shoulder
Qi and Blood Xu
Frozen Shoulder Tx
Add Lu 7 to whatever it is, or prick to bled and cup.
Stiff Neck
Types
Qi and Blood Stasis
Wind Cold
Dx?
Distending pain on one side of the neck, oblique haed to the diseased side, lower jaw turning to the healthy side and limited movement, pain may radiate to the upper back and upper limb. May have a history of injury. No obvious general symptoms. Thin and white coating on tongue, tongue itself is normal or slightly purple. Pulse is wiry.
Stiff Neck
Qi and Blood Stagnation
Dx?
Distending pain on one side of the neck, oblique head to the diseased side, lower jaw turing to the healthy side and limited movement. Pain may radiate to upper back and the upper limb. Chills, fever, general aching, heavy sensation of the head. Tongue is normal but with a thin and white or white and sticky coating. Pulse is superficial and tight or superficial and moderate.
Stiff Neck
Invasion of Wind Cold
Cervical Spondylosis
Types
Nerve Root Pattern Spinal Cord Pattern Vertebral Artery Pattern Sympathetic Nerve Pattern Mixed Pattern
Cervical Spondylosis
Nerve Root Pattern
Sx?
Stiffness, Pain in neck
Shoots
Worse at Night
Maybe Limited Movement
Cervical Spondylosis
Spinal Cord Pattern
Sx?
Neck discomfort/Pain
Can’t stretch
Heavy, Numb Limbs
Possible Spasmodic Paralysis and Incontinence/Impotance
Squeezes behind nerve root but hits spinal cord and pushes discs together.
Cervical Spondylosis
Vertebral Artery Pattern
Sx?
Dizzy Headache Tinnitus Numb extremities Possible Sudden Collapse
Cervical Spondylosis
Sympathetic Nerve Pattern
Sx?
Distended feeling eyes, impaired vision
Tinnitus (deafness)
Nose/Throat/Dreams involved
Numb hands
Cervical Spondylosis
Dx
Qi and Blood Stagnation in Du and Taiyang (SI, UB)
Taiyang
Small Intestine (hand Taiyang) Urinary Bladder (foot Taiyang)
Tennis Elbow
Types
Qi and Blood Obstruction (Early Stage, Shi)
Qi and Blood Xu (Later Stage, mixed)
Tennis Elbow
Sx
Active, older patient, dominant arm Pain on Lateral Elbow Non bacterial Inflammation, but no visible swelling Pain increases with pressure Pain fluctuates Tender spots right on the bone
Tennis Elbow
Differential Dx
Golf Elbow/Student Elbow
-medial (rather than lateral) elbow
Tennis Elbow
Tx
Ashi
LI 4, 5, 10, 11, 12
Lu 5,7
Wei Syndrome
Main Meridian to Tx
Which text says it
Yangming (LI, SI)
Yellow Emperor Internal Classic
Wei Syndrome
Western Disease Names
Nervous System Disease Disorder
(Atrophy, nerve Sx)
Motor Vehicle Accidents
Paraplegia
Cordiaplegia
MS ….multiple Lesions in brain, atrophy, weakness.
ALS (Lou Gherig’s Disease)
Poly neuritis …. Feels like they are wearing gloves when they aren’t.
Progressive Myotrophy
Myelitis
Muscular Distrophy
Miacenia Gravis… Droopy eyelid is starting Sx, eventually diaphragm stops working too. Tx with spleen b/c Sp controls muscle
Periodic Paralysis …. Related to blood Potassium levels
Histerial Paralysis… Emo/shock
Meningitis after effects
Wei Syndrome
Meaning of name
Wasting/ Withering Disease
Wei Syndrome
Types
Lung Heat Consuming Body Fluids Damp Heat Affecting Channels Sp and St Wi Xu Liv & K Xu Qi and Blood Stagnation
Wei Syndrome
Major Organs Involved
Lung ... Distributes nutrition Stomach.... Sea of Grain, Yangming Liver.. Kidney.... Spleen...... All 3 control muscles
Strain vs Sprain
Strain = tendon Sprain = ligament! bruises, swelling, pain, limited movement, history of injury, esp lateral ankle GB40, X-ray shows no break
Sprain Dx
bruises, swelling, pain, limited movement, history of injury, esp lateral ankle GB40, X-ray shows no break, elastic fixation (limited ROM)
Sprain Etiology
Acute
Chronic
Acute: Obstruction of Qi &Blood locally (pain, swelling)
Chronic: Qi Xu (can lead to W-C-D invasion)
Sprain/Strain Differential Dx
vs Bone Fracture
(History, tapping pain, severe swelling/bruising, loss of Fx,deformity)
vs Dislocated Joint
(History, pain, swelling, loss of Fx, elastic fixation, X-ray, and socket is empty upon Palpation)
vs Deformity
(History, lack of pain)
How to put dislocation back
- Pull opposite direction b/c muscles will then pull it back into place (same as TMJ)
- Bend elbow and gently push back into place
Severe fixed pain aggravated by pressure, movement, obvious swelling. Red or purple skin (ecchymosis), insomnia, thin white tongue coating, tight and wiry pulse
Early stage sprain
Mild or moderate fixed pain of joint, or soreness and heaviness, recurrent swelling, limited movement, aggravated by cold. Skin is cool and has numbness, pale puffy around area or overall complexion, lassitude, chills. Ecchymosis tongue with white sticky coating. Pulse thready and choppy
Sprain-later stage
Sprain Tx
Xxxxxxxx
Strain vs Sprain
Strain = tendon Sprain = ligament! bruises, swelling, pain, limited movement, history of injury, esp lateral ankle GB40, X-ray shows no break
Sprain Dx
bruises, swelling, pain, limited movement, history of injury, esp lateral ankle GB40, X-ray shows no break, elastic fixation (limited ROM)
Sprain Etiology
Acute
Chronic
Acute: Obstruction of Qi &Blood locally (pain, swelling)
Chronic: Qi Xu (can lead to W-C-D invasion)
Sprain/Strain Differential Dx
vs Bone Fracture
(History, tapping pain, severe swelling/bruising, loss of Fx,deformity)
vs Dislocated Joint
(History, pain, swelling, loss of Fx, elastic fixation, X-ray, and socket is empty upon Palpation)
vs Deformity
(History, lack of pain)
How to put dislocation back
- Pull opposite direction b/c muscles will then pull it back into place (same as TMJ)
- Bend elbow and gently push back into place
Severe fixed pain aggravated by pressure, movement, obvious swelling. Red or purple skin (ecchymosis), insomnia, thin white tongue coating, tight and wiry pulse
Early stage sprain
Mild or moderate fixed pain of joint, or soreness and heaviness, recurrent swelling, limited movement, aggravated by cold. Skin is cool and has numbness, pale puffy around area or overall complexion, lassitude, chills. Ecchymosis tongue with white sticky coating. Pulse thready and choppy
Sprain-later stage
Strain vs Sprain
Strain = tendon Sprain = ligament! bruises, swelling, pain, limited movement, history of injury, esp lateral ankle GB40, X-ray shows no break
Sprain Dx
bruises, swelling, pain, limited movement, history of injury, esp lateral ankle GB40, X-ray shows no break, elastic fixation (limited ROM)
Sprain Etiology
Acute
Chronic
Acute: Obstruction of Qi &Blood locally (pain, swelling)
Chronic: Qi Xu (can lead to W-C-D invasion)
Sprain/Strain Differential Dx
vs Bone Fracture
(History, tapping pain, severe swelling/bruising, loss of Fx,deformity)
vs Dislocated Joint
(History, pain, swelling, loss of Fx, elastic fixation, X-ray, and socket is empty upon Palpation)
vs Deformity
(History, lack of pain)
How to put dislocation back
- Pull opposite direction b/c muscles will then pull it back into place (same as TMJ)
- Bend elbow and gently push back into place
Severe fixed pain aggravated by pressure, movement, obvious swelling. Red or purple skin (ecchymosis), insomnia, thin white tongue coating, tight and wiry pulse
Early stage sprain
Mild or moderate fixed pain of joint, or soreness and heaviness, recurrent swelling, limited movement, aggravated by cold. Skin is cool and has numbness, pale puffy around area or overall complexion, lassitude, chills. Ecchymosis tongue with white sticky coating. Pulse thready and choppy
Sprain-later stage
Carpal tunnel is felt in which 3.5 fingers?
Lateral
Contra lateral points method…
opposite side, opposite limb
Which zone to Tx low back pain?
Wrist/ankle 6
Thready pulse indicates….
Deficiency
Ring and small finger numbness…. Which vertebrae?
C7-T1
Swelling and pain from sprain… Hot or cold in first 24hrs?
Cold
51 y/o F, numbness of r hand for 1 month. Possible Dx?
Wei Syndrome
Carpal Tunel (lateral 3.5 fingers)
Reynoad’s
Cervical Spondylosis
