Final Review Flashcards
Case 12 to 20 plus cautions and contraindications
A 39 year old female has been diagnosed with clinical depression. Symptoms include mental depression, chest distress, hypochondriac distention, bleching, poor appetite, and irregular bowel movements. The tongue has a thin-sticky coating. The pulse is string-taut. The acupuncture prescription is UB-18, RN-17, RN-12, ST-36, and LR-3. After several treatments, the patient returns and now reports depression, h/a, chest distress, hypochondriac distention, acid regurgitation, dry mouth, constipation. Her eyes are blood shot. The tongue has a yellow coating. The pulse is string-taut and sl. fast. What is your prescription?
A) ST-44, LI-11, DU-14, ST-25
B) UB-18, GB-20, RN-12, ST-36, KD-6
C) LR-2, GB-43, RN-13, SJ-6, GB-34
D) RN-17, PC-6, LR-3, ST-40 GB-20,
C) LR-2, GB-43, RN-13, SJ-6, GB-34
LR-2 (YS LR)
GB-43 (YS GB, water point, D-H, descend LR yang)
RN-13 (subdue reb ST qi)
SJ-6 (open intestines, cl-H, reg qi, remove obst ch)
GB-34 (prom flow LR qi, subdue reb qi, relax sinew/muscle)
DX:
Original= LR qi OA ST
Now= LR-F causing Reb ST qi
FX:
Long dan xie gan tang (LR-F)
Explanation:
Melancholia pg 450 CAM
d/t Transformation of depressed qi into fire
Main manifestations:
H/a, dryness and bitter taste in mouth, irritability, distress of chest, hypochondriac distention, acid regurgitation, constipation, red eyes, tinnitus, red tongue w/ yellow coating, string-taut rapid pulse
A patient has tongue ulcers, thirst, palpitations and a red tongue. What is the treatment plan?
A) Clear HT-F, resolve P, pacify mind
B) Clear HT, Drain F, pacify mind
C) Open HT, Resolve P
D) Tonify and nourish HT yin, pacify mind
B) Clear HT, Drain F, pacify mind
DX:
HT-F blazing
FX:
Xie xin tang
Prescription:
HT-8, HT-9, RN-15, LI-11, DU-24, SP-6, KD-6 (promote yin to cool F)
A patient has sudden unconsciousness, convulsions, deviation of eye and mouth. What is the treatment plan?
A) Clear heat, disper LR, subdue wind
B) nourish LR yin, subdue LR yang and wind
C) sedate LR, clear fire
D) disperse LR, regulate xue
B) nourish LR yin, subdue LR yang and wind
DX:
LR yin xu –> LR yang rising –> INT LR W
FX:
Shen gan xi feng tang
Prescription:
LR-3 (subdue yang, W)
GB-20 (Int W, subdue yang, clear H, CL brain)
LI-4 (subdue yang)
SJ-5 (subdue LR yang)
DU-19 (int W)
SP-6, LR-8, KD-3 (Tn LR Yin)
Shi xuan (resuscitation)
DU-20 (“”)
DU-16 (expel W, cl mind, benefit brain)
Explanation:
FCM pg 525 LR Wind
CAM pg 401 Windstroke
No F s/s
No sallow complexion therefore no xue xu
No KD yin xu s/s
A) Clear heat, disper LR, subdue wind
LR F–> LR W
B) nourish LR yin, subdue LR yang and wind
LR Yin Xu–> LR yang –> LR W
C) sedate LR, clear fire
LR-F
D) disperse LR, regulate xue
INT W d/t LR Xue xu
Numbness in the extremities, burning pain in the lower limbs, skin feels hot to touch, and yellow greasy tongue coating can indicate:
A) Phlegm-damp obstruction
B) Damp-phlegm stagnation
C) Damp-heat
D) wind-phlegm blocking channels
C) Damp-heat
DX:
D-H in Lower Jiao
FX:
Mod Long dan xie gan tang
Explanation:
numbness d/t D or nonsubstantial P
skin hot to touch= D-H
A) Phlegm-damp obstruction
white greasy tongue coat, er chen tang
B) Damp-phlegm stagnation
er chen tang
C) Damp-heat
long dan xie gan tang
D) wind-phlegm blocking channels
causes convulsions, ban xia bai zhu tian ma tang
A 33 year old woman’s main complaint is constipation, a problem she has had for six years. She has 2-3 BM’s per week. The stools are small and dry. Her breath has a foul odor. The tongue has a normal color w/ a dry yellow coating which is thicker at the root. The pulse is normal. What is the treatment?
A) RN-10, GB-34, LR-3, SP-15, SJ-6
B) ST-25, SP-15, RN-10, ST-44, LI-11, ST-36
C) UB-25, ST-25, ST-36, SP-6, RN-6, UB-13
D) ST-36, SP-6, RN-4, UB-20, UB-23, SP-15
B) ST-25, SP-15, RN-10, ST-44, LI-11, ST-36
ST-25 (FM LI) w/ SP-15 (prom fx LI, Tn SP, reg qi) (combo constipation)
RN-10 (Tn SP, descend ST qi, rel food stag)
ST-44 (YS ST, cl H, reg qi, elim fullness, prom digestion)
LI-11 (cl H)
ST-36 (Tn SP/ST qi, xue, reg intestines, gen fluid)
DX:
Dry heat in LI
FX:
Zhen ye chen qi tang
(mod zhen ye tang + xiao cheng qi tang)
(zyt= gen fluid for constipation d/t yin xu/shi dry)
“boat can’t move w/o water”
Explanation:
CAM pg 429 patient is between xu (yin xu) and shi dry heat therefore pulse is normal yellow coat=dry heat (if yin xu would be scanty/no coat, red body) foul odor- d/t ST food retention/fall descend (ST-44 + RN-10 descend ST)
When concluding the acupuncture needle technique “Setting the Mountain on Fire” you:
A) slowly withdraw the needle and rotate to the left
B) withdraw needle when patient exhales
C) quickly withdraw the needle and press the hole
D) rotate needle fast w/ large amplitude
C) quickly withdraw the needle and press the hole
Explanation:
CAM pg 349
KIM pg 291
In electroacupuncture, pulses which alternate with quick and slow periods are preferable for treating:
A) Pain
B) Paralysis and numbness
C) Spasm
D) Muscle contractions
B) Paralysis and numbness
Explanation:
PG 309 KIM
Regular Frequencies:
- Best for treating pain and spasm
- Drain Shi
Alternate Quick & Slow:
- Tx paralysis
- Strengthen Xu
Chronic and stubborn numbness in the fingers and toes with sensations that are distinguishable between the fingers and toes indicates:
A) Blood xu
B) Wind-phlegm blocking channels
C) Damp-heat blocking channels
D) Damp-phlegm obstruction
D) Damp-phlegm obstruction
Explanation:
A) Blood xu
Sallow complexion, xue xu s/s
B) Wind-phlegm blocking channels
Pulse floating/slippery (d/t Ext W), foamy, white or clear sputum
C) Damp-heat blocking channels
Heat s/s, pulse soggy/rapid/forceful, tongue red w/ yellow greasy coating, thick yellow sputum
D) Damp-phlegm obstruction
nonsubstantial phlegm, may not have any other phlegm s/s
“Strange diseases are due to phlegm”
The needle techniques of “Setting the Mountain on Fire” and “Penetrating Heaven-Coolness” are derived form all of the following techniques EXCEPT:
A) slow and rapid insertion of needle
B) the relation of need tip to flow of qi
C) lifting and thrusting of needle
D) keeping the hole open or closed
B) the relation of need tip to flow of qi
Explanation:
Setting the Mountain on Fire
Tonification
Superficial-Medium-Deep (9x3)
Insertion: slow
Thrust (slow)/Lift(quick): 9x at each level
Withdrawal: Rapid + close hole
Penetrating Heaven Coolness:
Sedation
Superficial-Medium-Deep (6x3)
Insertion: Rapid
Thrust (quick)/Lift (slow): 6x at each level
Withdrawal: Slow + open hole
Kim pg 291
The thumbtack intradermal needle is usually applied to the:
A) Thighs
B) Arms
C) Back
D) Ear
D) Ear
Kim pg 293
The most widely performed bloodletting technique is:
A) Clumping
B) Spot Pricking
C) Dispersing
D) Pecking
B) Spot Pricking
CAM pg 354
Kim pg 293
The dispersing method of bloodletting is done by inducing superficial bleeding in a wide area of the skin. It is primarily used for:
A) Skin diseases such as nerodermatitis
B) Heat stroke
C) Apoplexy
D) Gastronintestinal inflammation
A) Skin diseases such as nerodermatitis
Dr. Cao: bloodletting is for strange diseases such as mental disorders. Can bleed the heal. Also bleed da zhui for skin diseases.
A patient has hypertension with dizziness, flushed face, red eyes, stiff neck, constipation, dry mouth, yellow tongue coating, and strong-wiry pulse. You choose GB-20, LI-11, ST-36, LR-3. What other points would you add to the prescription?
A) PC-6, ST-40
B) KD-3, HT-7
C) LR-2, GB-34
D) RN-6, RN-4
C) LR-2, GB-34
LR-2 (Ying spring, cl LR F)
GB-34 (HS, Sinews, smooth LR qi, subdue reb qi)
DX:
Liver Fire Blazing
FX:
Long dan xie gan tang
The points RN-22, LI-18, LI-4 symptomatically treat:
A) Asthma
B) Coughing
C) Congested throat
D) Lateral neck pain
C) Congested throat
Explanation:
Asthma or cough involves LU xu + would include LU points @ distal, not LI-4 as in the prescription.
RN-22 doesn’t match lateral neck pain
RN-22: location key, plum pit, sore throat, cough
LI-18: cough, sore throat, neck pain
LI-4: Face/head, neck pain, throat
The points UB-15, HT-7, LR-3 symptomatically treat:
A) Breast distention
B) Sensation of plum pit in the throat
C) Vertex headache
D) Excessive dreaming
D) Excessive dreaming
LR-3 is distal point for shi dreaming
Explanation:
A) Breast distention
Use more LU pts
B) Sensation of plum pit in the throat
Qi stag or phlegm, not tx by HT pts
C) Vertex headache
LR qi stag or LR xue xu- would use LR pts
D) Excessive dreaming
Dream from HT
Which host-guest combination opens and regulates the water passages when pathogenic wind causes symptoms of upper body edema, no sweating, and difficult urination?
A) LI-4, LU-7
B) LU-7, LI-6
C) LU-9, LI-6
D) SP-3, ST-40
C) LU-9, LI-6
Explanation:
Disease location= LU therefore source LU + Luo LI
CAM pg 387
Deadman pg 41-2
SOURCE: LUO:
9 7 7 7 5 6
4 4 4 6 7 5
3 3 3 4 4 5
42 64 40 40 58 37
According to the Yuan-Luo/Host-Guest points which of the following treats Spleen disorders?
A) PC-4, ST-42
B) SP-3, ST-40
C) SP-3, ST-42
D) SP-4, ST-40
B) SP-3, ST-40
A patient has fixed stabbing pain in the hypochondriac area, and pain worse at night. The tongue is purplish. The pulse is choppy. What is the prescription?
A) LR-14, LR-13, GB-26, SJ-6, GB-34
B) UB-18, LR-14, SJ-6, GB-34, UB-17
C) RN-14, LR-3, UB-18, SP-6, ST-36
D) LR-3, LR-14, GB-34, SJ-6, GB-40
B) UB-18, LR-14, SJ-6, GB-34, UB-17
UB-18 (Sooth LR, Tn Xue)
LR-14 (Local pain, move qi)
SJ-6 (reg qi, alleviate pain)
GB-34 (all kinds pain)
UB-17 (all xue disorders)
DX:
LR Xue Stagnation
FX:
Xue Fu Zhu Yu Tang
or
Ge Xia Zhu Yu Tang
Explanation:
pg 458 CAM Pain in Hypochondriac
C= Xue xu
D= LR qi stag
A 32 year old woman has painful periods. She has a short cycle with periods every 21-23 days. She has severe menstrual pain with red blood with small dark clots. She feels cold during her period and has dizziness, and tinnitus. The tongue is pale and swollen. The pulse is slow, choppy, and especially weak in the left rear position. What is the diagnosis?
A) Liver Stagnant Blood
B) Liver Yang Rising
C) Deficient Kidney Yang w/ Empty Cold
D) Deficient Liver Blood
C) Deficient Kidney Yang w/ Empty Cold
FX:
You gui wan
Prescription:
RN-8 (w/ moxa- Tx cold pain during period)
KD-3 (Tn KD yin/yang)
DU-4 (Tn yang)
RN-4,6 (Local points)
Zi Gong Xue (local points)
LR-3 (move qi, ch connect uterus)
SP-6 (VIP pain)
Explanation:
Dizziness + tinnitus = yang xu
W/ yang xu, KD yin pulse also still xu- look at tongue
CAM pg 475 Dysmenorrhea
A 35 year old female patient has had migraines for ten years. The location of the headaches is on top of the head and behind the eyes. They start with a dull pain and proceed to become severe with nausea, vomiting, and diarrhea. The headaches improve with the patient lying down. The headaches occur every day. The tongue is thin and pale and the pulse is weak on the right side and wiry on the left side. What is the treatment?
A) LR-3, DU-20
B) PC-6, SJ-4, ST-36, LR-8, SP-6, LR-3
C) LI-4, LR-3
D) GB-20, SJ-5, LI-4, ST-44, SP-6, KD-3
B) PC-6, SJ-4, ST-36, LR-8, SP-6, LR-3
PC-6 (nausea, reg Jueyin)
SJ-4 (H/A)
ST-36 (Tn qi + xue, ST Dx)
LR-8 (LR xue xu + yin)
SP-6 (Tn yin, xue, reg qi, soothe LR)
LR-3 (Anchor yang, Tn LR xue)
DX:
LR Yang Rising d/t LR Xue Xu (W/ SP Qi Xu)
FX:
Mod Xiao yao san
+Mu li, Gou teng
Explanation:
Jueyin H/A
If H/A d/t LR-F + LR-2
A patient has flooding at the beginning of her period which then stops. It continues trickling for a longer time after the period proper. The blood is pale and watery. She has a pale face, tiredness, slight dizziness, no appetite. The tongue is pale with teeth-marks. The pulse is weak. What is the pattern?
A) Spleen qi xu
B) KD yang xu
C) Spleen not holding xue
D) Xu qi and xue
C) Spleen not holding xue
FX:
Gui pi tang
Prescription:
RN-12, UB-20, UB-21, UB-17 (Tn xue, stop bleeding), ST-36, SP-3 (source), SP-6 (Tn qi, xue, yin, sooth LR), SP-10, SP-1 (stop bleeding)
Explanation:
CAM pg 479 Metorrhagia
An 82 year old man has pain in both knees which are swollen and respond with pain to cold weather. He is in general good health. His only other problem is occasional insomnia. The tongue is red without coating and with cracks. The pulse is normal and only a little fine. What is the diagnosis?
A) Deficient channel qi
B) Deficient HT yang
C) Cold and damp bi syndrome
D) WInd-cold invades LU
C) Cold and damp bi syndrome
Prescription:
Moxa SP-6 + ST-36 (Tn qi, xue, yin, yang)
GB-34 (Tn sinew, bone)
Local: Xi yan, he ding, ST-35, ST-34 (XC, move qi/xue), UB-40, SP-9
KD-3 (Tn KD, Tn sinew/bone)
FX:
Du huo ji sheng tang
(chronic C + D Bi d/t LR/KD yin xu)
Explanation:
swollen= damp
pain w/ C weather= cold
Main s/s= C-D bi
Rest s/s= d/t age
Which of the following acupuncture points can be needled with one hand stretching the skin with the thumb and index finger of one hand and using the other hand to insert the needle?
A) ST-4
B) RN-4
C) Yin tang
D) UB-2
B) RN-4
CAM pg 342-4 Insertion
RN-4 stretching skin
ST-4, Yin tang, UB-2 insert by pinching skin
In applying gua sha to the sternum, in which direction should it be applied?
A) bottom up to the sternal notch
B) transverse from left to right going up
C) top down to the xyphoid process
D) transverse from right to left going down
C) top down to the xyphoid process
A patient has pain and numbness in the right leg. Which scalp acupuncture area would you treat?
A) left upper fifth of the sensory line
B) bilateral upper fifth of the sensory line
C) right second and third fifths of the sensory line
D) left second and third fifths of the sensory line
A) left upper fifth of the sensory line
Upper 1/5= lower limb + trunk
2nd/3rd 1/5s= upper limb
Lower 2/5= facial
Left to treat right
Yellow discharge with pus in the blood in a woman after menopause indicates:
A) Stagnation of LR qi
B) Damp heat in lower burner
C) Damp heat in LR channel
D) Toxic damp heat in uterus
D) Toxic damp heat in uterus
Pus + Blood= Toxic damp heat
Post meopause probably cancer- must have biopsy
If pain generally not cancer unless stage 4
For which conditions is moxibustion with garlic best used?
A) Scrofula, TB, and early stages of skin ulcer with boils
B) Asthma, chronic diarrhea and indigestion
C) Abdominal pain, vomiting, and prolonged dysentery
D) Impotence, KD yang xu, and premature ejaculation
A) Scrofula, TB, and early stages of skin ulcer with boils
Explanation:
CAM pg 364- Moxibustion
KIM pg 296 Moxa
A) Scrofula, TB, and early stages of skin ulcer with boils
Moxa w/ Garlic
B) Asthma, chronic diarrhea and indigestion
C) Abdominal pain, vomiting, and prolonged dysentery
Moxa w/ salt
D) Impotence, KD yang xu, and premature ejaculation
Moxa w/ Fu zi (monkshood) cake
A patient has stabbing pain in the epigastrium, vomiting dark blood. What is the treatment?
A) LR-14, ST-36, RN-13, UB-21, GB-34
B) RN-13, ST-21, SP-4, PC-6, ST-44
C) ST-36, RN-12, UB-20, UB-21, RN-6
D) SJ-6, ST-21, ST-34, SP-10, UB-17
D) SJ-6, ST-21, ST-34, SP-10, UB-17
SJ-6 (Distal tx ST, Subdue Reb ST qi, promote BM)
ST-21 (Local Tx ST, Reg ST, stop vomit, subdue Reb ST qi, stop pain)
ST-34 (XC Acute Dx ST, Subdue Reb ST qi)
SP-10 (All xue Dx)
UB-17 (Stop bleeding, Tn Xue)
DX:
ST xue stasis
FX:
Yunnan baiyao
(best stop bleeding; San Qi enter LR, ST; esp any kind ST bleeding)
Explanation:
Stabbing pain= xue stasis
Wandering pain is d/t qi stagnation
Which point combination helps in the treatment of fixed bi syndrome?
A) UB-17, SP-10
B) UB-23, RN-4
C) DU-14, LI-11
D) ST-36, SP-5
D) ST-36, SP-5
Explanation:
CAM pg 464 Bi Syndrome
A) UB-17, SP-10 wandering bi
B) UB-23, RN-4 painful bi
C) DU-14, LI-11heat bi
D) ST-36, SP-5 fixed bi
Which point combination helps in the treatment of heat bi syndrome?
A) UB-17, SP-10
B) UB-23, RN-4
C) ST-36, SP-5
D) DU-14, LI-11
D) DU-14, LI-11
FX:
Mod Xue fu zhu yu tang
+ Mu dan pi, dan shen, shi gao, da huang
Explanation:
CAM pg 464 Bi Syndrome
A) UB-17, SP-10 wandering bi
B) UB-23, RN-4 painful bi
C) ST-36, SP-5fixed bi
D) DU-14, LI-11 heat bi
A patient has irregular menstruation with a shortened cycle, profuse, thin and light red blood, shortness of breath, and fatigue. The tongue is pale with thin coating. The pulse is thin and weak. What is the pattern?
A) Deficient blood
B) Stagnant qi
C) Deficient qi
D) Cold uterus
C) Deficient qi
FX:
Mod Si jun zi tang
Prescription:
DU-14, RN-17, RN-4, RN-6, ST-36 + SP-6, LR-3 + LI-4
Explanation:
CAM pg 472 Irregular menstruation
Causes Irregular Menstruation:
Xue xu vs. Qi xu
- Xue xu:* Sallow complexion, dizziness, numbness
- Qi xu:* fatigue, SOB
A patient has amenorrhea with delayed menstrual cycle and gradual decrease of menses, poor appetite, loose stools, dizziness, and sallow complexion. The tongue is pale with little coating. The pulse is weak. What is the pattern?
A) Deficient SP qi w/ damp obstruction
B) Deficient SP + ST qi
C) Deficient blood
D) Deficient LR blood
C) Deficient blood
FX:
Tao hong si wu tang
Tao ren + hong hua + si wu tang (shu di, dang gui, bai shao, chuan xiong)
Prescription:
SP-6 + ST-36, RN-4 (TN qi to TN xue), ST-29 (abundant qi/xue, local), Zi gong xue (zi=fetus, gong=home), LR-3 (move qi, TN xue)
Explanation:
CAM pg 477 Amenorrhea
- 2 Causes:*
1) Xue stagnation
2) Xue xu
Local tx + estim is VIP for gynecology
A patient has abnormal uterine bleeding which is continuous and scanty, light red and thin blood, lassitude, and shortness of breath, and poor appetite. The tongue is pale. The pulse is thin and weak. What is the pattern?
A) Deficient blood
B) Deficient qi
C) Deficient yin
D) Internal, deficient, hot
B) Deficient qi
Explanation:
key: SOB, poor appetite, continuous + scanty light red and thin blood
CAM pg 479 Uterine Bleeding
2 Causes: 1) Shi H, 2) Qi xu
A pregnant woman has prolonged labor with malposition of the fetus, shap pain in the abdomen, scanty dark and red bleeding, dark complexion. The tongue is dark. The pulse is deep and forceful. What is the pattern?
A) Hot blood and stagnant qi
B) Deficient qi and stagnant qi
C) Deficient blood and stagnant qi
D) Stagnant qi and blood
D) Stagnant qi and blood
Prescription:
LI-4 + SP-6 (prolonged labor) + moxa on belly to help fetus change position
KEY: Sharp pain, dark tongue, deep + forceful pulse, scanty dark + red bleeding
FX:
Chai hu shu gan san (move qi)
Explanation:
CAM pg 484 Prolonged labor
Causes: 1) Qi + xue stag, 2) QI + xue xu
A pregnant woman patient has morning sickness with nausea + vomiting of undigested food right after eating, sleepiness, and lassitude. The tongue is pale with white coating. The pulse is slippery and weak. What is the pattern?
A) Stagnant LR qi invading ST
B) Rebellious ST qi
C) Deficient qi of SP + ST
D) Deficient qi + xue
C) Deficient qi of SP + ST
FX:
SI jun zi tang + Sheng jiang (subdue reb ST qi, stop nausea + vomit)
Prescription:
PC-6, RN-17, RN-12
Explanation:
CAM pg 483 Morning Sickness
2 Causes: 1) XU SP + ST, 2) Disharmony SP + ST
Slippery pulse d/t pregnancy, weak d/t xu
For which of the following conditions can the plum blossom needle be used?
A) Edementous swellings
B) Intercostal neuralgia
C) Infectious disease
D) Acute abdominal disorders
B) Intercostal neuralgia
Which of the following points can be used for a woman in the second month of pregnancy with morning sickness?
A) SP-6
B) RN-12
C) GB-21
D) UB-60
B) RN-12
After 3 mo, can’t use RN-12
SP-6, GB-21, UB-60 all induce labor, are contraindicated
LI-4, UB-67 also for induce labor
Below umbilicus and lumbar region
The dispersing method of bloodletting is done by inducing superficial bleeding in a wide area of the skin. It is primarily used for:
A) Skin diseases such as neurodermatitis
B) Heat stroke
C) Apoplexy
D) Gastrointestinal inflammation
A) Skin diseases such as neurodermatitis
When should you test for giving Gua Sha?
A) When the skin feels cold to the touch
B) When there is pain anywhere
C) When the patient asks for it
D) When there is a dark spot on the skin
B) When there is pain anywhere
As a general guideline, the classics write that during the winter time needling recommendation is to:
A) not needle too deep
B) hav shallow needling
C) needle deep
D) not needle during this time
C) needle deep
A patient has difficulty falling asleep, dreams, palpitations, poor memory, anorexia, and sallow complexion. The tongue is pale with thin white coating. The pulse is thin and weak. What is the prescription?
A) UB-18, UB-19, GB-12, HT-7, SP-6, An mian
B) HT-7, SP-6, An mian, UB-20, UB-15, SP-1
C) ST-36, HT-7, SP-6, An mian, UB-21
D) An mian, UB-15, UB-23, HT-7, SP-6, KD-3
B) HT-7, SP-6, An mian, UB-20, UB-15, SP-1
HT-7 (SS, Source, Tn HT Xue)
SP-6 (San yin jiao, Tn SP, Nourish Xue)
An mian (insomnia, palpitations)
UB-20 (BS SP)
UB-15 (BS HT)
SP-1 (Insomnia)
DX:
Palpitations d/t HT blood and SP Qi xu
FX:
Gui pi tang
A patient has edema more pronounced in the legs and ankles, cold feelings, fullness and distention in abdomen, sore lower back, and scanty and clear urination. What pulse is expected?
A) deep, weak and slow pulse
B) Floating, empty and rapid pulse
C) Floating and empty pulse or choppy pulse
D) Floating and empty pulse or leather pulse
A) deep, weak and slow pulse
DX:
KD yang xu causing edema
PTS:
ST-36 (all xu)
UB-28 (BS UB, prom urine to drain edema)
UB-23 + DU-4 (moxa, Tn KD yang-root)
KD-7 (Tn KD yang, drain pathogenic h2o)
KD-3 (source)
SP-9 (water metab)
RN3 (prom urine)
UB-39 (LHS SJ, prom urine, for edema)
FX:
Wu ling san (tx edema)
You gui wan (tx root KD yang xu)
A patient has urgent and frequent urination, buring urine, difficult urination which stops midstream, dark colored urine, blood and sand in the urine, feverish sensations, and thirst. What tongue is expected?
A) White-greasy coating on root
B) Pale and wet tongue
C) Red tongue without coating
D) Thick, sticky, yellow coating on the root w/ red spots
D) Thick, sticky, yellow coating on the root w/ red spots
DX:
Damp-Heat in Lower Jiao/UB
FX:
Ba zheng san
PTS:
RN-3 (FM UB), SP-9 (h2o metab), UB-22 (BS SJ), UB-28 (BS UB), LI-11 (better then UB-63 in practice), SP-6 (benefit urination, cool blood)
A patient has abdominal pain, diarrhea with mucous and blood, foul smelling stools, burning anus, fever, sweating does not abate fever, and thirst with no desire to drink. What tongue is expected?
A) Thick-yellow and dry coating
B) Pale or red dry tongue without coating
C) Red tongue, greasy-yellow coating
D) Pale tongue
C) Red tongue, greasy-yellow coating
DX:
Damp heat in LI
FX:
Bai tou weng tang
severe diarrhea w/ xue/mucous in stools
PTS:
ST-25 (FM LI)
ST-37 (LHS LI)
SP-9 (D-H)
SP-6 (D-H)
UB-25 (BS LI)
LI-11 (All H)
ST-44 (YS, Shi H, CL H, Drain D)
RN-3 + RN-9 (drain water to solidify stool)
Explanation:
Thirst=shi H
Thirst w/o desire drink= D-H
Greasy= D, Red= H
Mucous/Xue stool= D-H
Fowl smelling stool= D-H
Promote urination to solidify stool (esp w/ scanty urination w/ diarrhea)
A 32 year-old overweight woman was diagnosed with viral meningitis two years ago. At that time she had a high fever, rigid neck, and vomiting. After the meningitis was resolved she experienced tiredness, feelings of achiness and heaviness in the limbs, night sweats, and poor concentration. She felt a low-grade fever throughout the day. She had leucorrhea which was a bright yellow color. The tongue body is swollen with sticky-yellow coating. The pulse is slippery. What is the diagnosis?
A) Deficient SP qi w/ accumulation of dampness
B) LR and GB damp-heat
C) Damp-heat invading SP
D) ST heat, xu yin
C) Damp-heat invading SP
FX:
Mod. Wu ling san (best)
Bai zhu, Fu ling, zhu ling, ze xie
Add:
Huang lian (C, drain D-H mid jiao)
Pu gong yin (cl-H, drain D, prom urine)
Hou po (dry D mid jiao, descend qi, sticky taste)
Huo xiang (Drain D midj, descend qi, prom sw)
A 37 year-old woman has PMS. It started after she got depressed from giving birth. She gets irritable and cries alot. She has breast distention. Other symptoms include constipation, headaches, insmonia, excess dreaming, and palpitations. The tongue is pale, thin, and red on the sides. The pulse is thin, wiry on the left middle position, and weak on the left front position. What is the treatment plan?
A) Nourish LR and HT Xue, Smooth LR Qi
B) Disperse LR, Smooth Qi, Regulate Xue
C) Disperse LR, Smooth Qi, Nourish HT yin
D) Nourish LR and KD Yin
A) Nourish LR and HT Xue, Smooth LR Qi
DX:
LR + HT Xue xu w/ LR qi stagnation
FX:
Mod Xiao yao san
- Herbs Tn HT*:
- or*
Ba zhen san
+ Herbs sooth LR
(Chai hu, bo he, chen pi, xiang fu)
PTS:
UB-15, UB-17, UB-18, UB-20
LR-3, LR-14 (Qi stag/sooth LR)
SP-10 (All Dx xue)
SJ-6 (Prom BM, Tx constipation)
SP-6, RN-17, HT-7
In a patient with chest pain which would prompt you to make an immediate emergency referral?
A) Chest pain that burns and is worse lying down
B) Chest pain not worse w/ exertion but worse swallowing very hot or cold substances
C) Chest pain longer than 4 minutes w/ sweating and feeling of dread
D) Chest pain from the breastbone increases w/ deep breaths, movement and touch
C) Chest pain longer than 4 minutes w/ sweating and feeling of dread
If a patient has an enlarged heart, which of the following needled points can damage the heart muscle?
A) ST-12 + ST-21
B) RN-14 + ST-19
C) RN-15 + RN-16
D) KD-22 + ST-21
B) RN-14 + ST-19
- RN-14: 6 cun above umbilicus*
- ST-19: “”, 2 lateral RN-14*
ST-12=LU
ST-21= LR, peritoneal cavity
RN-15= contra moxa
RN-16= none
KD-22= HT, LU, LR
The pulse can be felt with a gentle touch of the fingers and, on further pressure to the deep level, the pulse becomes forceless and soft. What treatment principle is applicable?
A) nourish the yin
B) tonify the qi
C) tonify the yang
D) drain damp
A) nourish the yin
To anchor floating pulse
Not being able to fall asleep, but sleeping well after falling asleep indicates:
A) Deficiency of KD-Yin
B) Deficiency of LU Qi
C) Deficiency of HT-Xue
D) Deficiency of GB
C) Deficiency of HT-Xue
KIM Pg 48 Sleep
FX:
Gui pi tang
PTS:
Yintang
HT-7 (Tn HT xue) + Du-20
An mian (insomnia)
SP-6 + ST-36
KD-6 + UB-62 (Tx severe insomnia)
KIM pg 252
The beginning stages of difficulty walking form limb atrophy is often due to:
A) Xu of LR yin
B) Xu of SP + KD yang
C) Xu of LR + KD yin
D) ST-SP qi Xu
D) ST-SP qi Xu
- CAM pg 465 Wei Syndrome*
- Def: Wei syndrome= faccidity or atrophy of limbs w/ motor impairment*
LEG (yangming exuberant qi and blood)
ST-34 (xc ST), ST-36, ST-38
ARM (“”)
LI-4, LI-11, LI-10
A patient has erectile dysfunction, soreness weakness of the legs and hot-dark urination. The tongue is a yellow greasy coating. The pulse is fast. What is the pattern?
A) accumulation of damp-heat in UB
B) decline of mingmen fire
C) damage of the qi of the meridian
D) Xu KD w/ accumulation of dampness
A) accumulation of damp-heat in UB
- CAM p438*
- Impotence d/t downward flowing of Damp Heat*
FX:
Ba zheng san
PTs:
UTI: SP-9, UB-28, RN-3
LI-11 (D-H), ST-28 (prom urine, local pain)
focus tongue and pulse
A patient has chronic epigastric pain. The pain radiates from the epigastrium to right area. The pain is worse at night and improves after eating. He often belches. The stool is dry. He is tired. The tongue is red on the sides, stiff w/ Sl. rootless coating. The pulse is fine and empty at the deep level on the right mid position, the pulse is empty-floating and sl. wiry. What is your treatment strategy?
A) Each root must eventually be treated
B) first stop pain and move LR qi and then tonify ST yin
B) first stop pain and move LR qi and then tonify ST yin
Urgent case treat branch then treat root
Branch= pain, qi stagnation
Root= ST Yin
Wiry=qi stag
Fine/Empty @ Deep= xu
Empty/Floating = Yin xu @ Mid= ST
In measuring electrical resistance to find ear points which of the following is not true?
A) Repeated probing will make the electrical resistance decline
B) Patient with higher electrical resistance are selected for therapy
C) Cold weather increases electrical resistance in the ear.
D) Some patients (Uterus, UB, Endocrine) normally have lower electrical resistance
B) Patient with higher electrical resistance are selected for therapy
- CAM pg 524*
- Detecting electrical changes:*
- Observing changes in electrical resistance, capacity, and potential at auricular points. The most commonly used method is to determine the conductant point of skin resistance by instrument**. Those auricular points w/ low electrical resistance can be displayed on a screen, or by an indicator, or by sound, through the apparatus. This is used for clinical diagnosis.*
A patient has SP Qi xu w/ chronic edema, menstrual blood when a patient has one root (ben) which gives rise to different biao. What courses of action should be taken?
A) Simultaneously treat root and biao
B) treat the root
C) Treat the biao
B) treat the root
KIM pg 30
BEN Only: When clinical manifestation of BIAO are few and mild
BEN & BIAO: When BIAO produces severe s/s
BIAO 1st, BEN after: When BIAO s/s are urgent/ acute cases
MULTIPLE BEN & BIAO:
1) TX each BEN: Multiple BEN giving rise to different BIAO
2) TX BEN: One BENgiving rise to different BIAO
3) TX BEN/BIAO: BEN coincides w/ BIAO (trauma)
A patient has bronchial asthma with an upper respiratory tract infection. The selected prescription is extra point ding chuan, RN-22, RN-21, combined w/:
A) DU-14, LI-4
B) ST-40
C) ST-36, RN-4
D) LI-4, ST-36
A) DU-14, LI-4
Cl H + Detoxify, +Rel Ext first, then resolve phlegm
DU-14
(Expel W, Cl-H, Rel ext, Reg ying/wei, cl mind, Tn qi)
LI-4
(Dispel W, Rel ext, stim descension/dispersion LU)
FX:
Mod Qing qi hua tan wan
(LU PH-H causing cough pg 287 Kim mini)
w/
Ding chuan tang
Besides the Nutritive-Qi level (ying) which level has delirium, fainting, and a confused mind?
A) Qi level (qi)
B) Only Nutritive-Qi level (ying)
C) Defensive-Qi level (wei)
D) Blood level (xue)
D) Blood level (xue)
Ying Level key s/s:
fever worse at night, restlessness, delirium, bright red tongue, insomnia
Xue Level key s/s: (ying ++)
skin eruptions, rashes, bleeding, dark tongue
(Jean’s DOS pg 81-2)
Which scalp area is located on the front of the scalp, and begins at the hairline directly above the pupil of the eyes, parallel wit hthe mid line of the head, is 2cm in length and extends posteriorly?
A) reproduction area
B) thoracic cavity
C) speech #2 area
D) stomach area
D) stomach area
The pulse can be felt with a gentle touch of the fingers and, on further pressure to the deep level, the pulse becomes forceless and soft. What treatment principle is applicable?
A) Tonify the qi
B) Nourish the yin
C) Drain damp
D) Tonify the yang
B) Nourish the yin
Floating pulse
- FCM Pg 331*
- 3 Causes Floating Pulse:*
- 1) Exterior Invasion*
- 2) Yin xu causing yang to rise or be unachored*
- 3) Severe qi xu (cancer/anemia)*
A patient has abdominal pain, tongue ulcers, and dark-scanty and painful urination. What is the treatment plan?
A) Move Qi in the Lower Jiao, Harmonize the LR
B) Remove Lower Jiao Obstruction, Move SI qi
C) Drain UB Heat, Transform Dampness
D) Drain HT & SI Fire
D) Drain HT & SI Fire
FX:
Dao chi san
PTS:
ST-39 (LHS SI, Cl-H)
HT-8 (HT-F)
LI-11 (H whole body, any)
RN-3 (local UTI, FM UB, prom urine)
ST-28 (local UTI, prom urine, alleviate pain)
Er jian
SP-6 (San yin jiao)
A patient has poor appetitie, weak limbs, and tiredness. Two weeks later he also reports symptoms of edema in the legs and leg pain which is worse in basements. What is the root (ben)?
A) Spleen Dampness
B) poor appetite, weak limbs, and tiredness
C) Spleen Qi Xu
D) Leg edema and leg pain
C) Spleen Qi Xu
ROOT= SP Qi Xu S/S
Weak d/t SP control muscles
FX:
Si Jun Zi Tang (Tn Qi SP/LU)
+
Ze xie, gui zhi, zhu ling (from Wu Ling San)
If nausea/vomit then Liu Jun Zi Tang (Ph + Qi Xu)
A 35 year old female has had depression and anxiety for 12 years. She is on antidepressants. She had an unhappy childhood and to this day has resentment toward her mother. Her sleep is restless. Other symptoms include headaches w/ stabbing pain on the forehead. She tends to have nasal discharge w/ thick, yellow phlegm. She has a burning sensation in the epigastrium w/ thirst. The tongue is red w/ a purplish tinge and a crack in the center. The coating is greasy and yellow. The pulse is slippery, wiry, and full. What is the treatment plan?
A) Regulate LR, Smooth Qi, Move Blood
B) Disperse LR + GB, Resolve Phlegm, Clear Heat
C) Clear ST- Heat, Descend ST Qi, Resolve Phlegm
D) Resolve Phlegm, Drain Fire, Move Blood, Calm Mind
D) Resolve Phlegm, Drain Fire, Move Blood, Calm Mind
tongue purplish, stabbing pain= xue stag
DX:
Phlegm Fire Misting the Mind w/ Blood Stasis
FX:
Gun tan wan (+herbs cool/reg xue)
PTS:
RN-12 (Local burning epigastrium)
SP-6 (qi stag, b.s.)
PC-5 (ph/f)
LI-11 (F)
SP-10 (b.s.)
ST-40 (ph)
LR-2 (F)
- If more H: + ST-44*
- Any ST-Dx + ST-36*
E-STIM:
- Connect to Pt TX main S/S*
- Ex: ST-Pain: RN-12 + ST-36*
A patient has abdominal pain, desire for hot drinks, desire for abdominal pressure and massage, diarrhea, and clear and profuse urination, pale tongue with white coating, and deep and slow and weak pulse. What is the Small Intestine Zang-fu pattern?
A) SI Qi pain
B) SI Xu + Cold
C) SI Heat
D) SI Qi Tied
B) SI Xu + Cold
- PG 52 KIM Mini:*
- SI XU Cold: Dull abdominal pain alleviated by pressure, a desire for hot drinks, borborygmus, diarrhea, pale and abundant urination, cold limbs, T: pale w/ white coat, P: deep, weak, slow*
FX:
Li Zhong Wan
PTS:
RN-6, 4 (moxa)
ST-25
ST-39 (LHS SI)
ST-36
UB-27 (BS SI)
UB-20 (BS SP)
DU-4 (moxa= yang xu)
Which of the following points are prohibited in infants with unclosed fontanelles?
A) DU-20, Si shen cong
B) DU-15, DU-16
C) Si Feng
D) DU-22, DU-23
D) DU-22, DU-23
- KIM pg 241: DU-20-23*
- CAM: DU-21, 22, 23*
Which point regulates the intestines and transforms stagnation; clears damp heat and alleviates diarrhea and dysenteric disorder; regulates the spleen and stomach; and activates the channel and alleviates pain?
A) LI-11
B) ST-37
C) ST-38
D) ST-39
B) ST-37 (LHS LI)
A patient has palpitations, dizziness, insomnia, sleep disturbed by dreams, anxiety, poor memory, startles easily, a dull and pale face, and pale lips. What tongue is expected?
A) Bluish-purple tongue
B) Pale, thin and slightly dry tongue
C) Pale, wet and swollen tongue
D) Pale tongue
B) Pale, thin and slightly dry tongue
A) Bluish-purple tongue=xue stag
B) Pale, thin and slightly dry tongue=xue xu
C) Pale, wet and swollen tongue=yang xu
D) Pale tongue=qi xu
DX:
HT Xue Xu
FX:
Gui pi tang
PTS:
HT-7, PC-6, RN-14, UB-17, RN-15, SP-6, RN-17 (palps), SP-10 (all xue dx)
Which point combination stops lactation?
A) GB-21, SI-1
B) GB-41, GB-37
C) PC-6, RN-17
D) LR-14, PC-6
B) GB-41, GB-37
- CAM PG 487*
- Promote lactation: GB-21, RN-17, LR-14, SI-1*
- Inhibit lactation: GB-47, GB-37*
FX:
Decoction Mai ya 200g w/ vinegar 5tbsp
(no vinegar if reflux) (3x/day)
Stops in 2 days
A patient has a Greater-Yang (tai yang) organ pattern with accumulation of blood. What is the treatment?
A) RN-9, RN-3, ST-28, LU-7
B) RN-3, KD-14, ST-28, SP-10 SP-6
C) RN-4, KD-3, KD-6, SP-6
D) SJ-5, SJ-6, GB-41, DU-13
B) RN-3, KD-14, ST-28, SP-10 SP-6
RN-3 (FM UB)
KD-14 (Local invig xue)
ST-28 (Invig xue, prom urine)
SP-10 (All xue dx)
SP-6 (Benefit urine, invig xue)
DX:
Blood stasis in Lower jiao or UB
FX:
Xue fu zhu yu tang
(cool prop, xue stag anywhere body)
If UTI + Ba Zheng Tang
A patient has burning urination, difficult urination, and dark urine. What is the treatment plan?
A) Resolve dampness, expel cold, remove obstruction from lower jiao water passages
B) Tonify and warm UB and KD yang
C) Resolves dampness, clear heat, open lower jiao water passages
D) Clear heat, open lower jiao water passages
C) Resolves dampness, clear heat, open lower jiao water passages
DX:
Damp-Heat in UB/Lower Jiao
FX:
Ba zheng san
PTS:
RN-3, ST-28, SP-9, LI-11, RN-5
A patient has dribbling after urination, back pain, and chronic vaginal discharge or nocturnal emissions without dreams. What is the diagnosis?
A) KD fail to receive qi
B) KD Jing Xu
C) KD qi not firm
D) KD yang xu
C) KD qi not firm
FX:
Jin suo gu jing wan
- jin suo= golden rock*
- gu jing= stabilize essence*
PTS:
KD-3, RN-4, RN-6, UB-23, UB-52, DU-4
A patient has chronic diarrhea which tends to occur in the early morning, pain below the navel, and cold extremities. The tongue is pale with white coating. The pulse is deep and weak. What is the pattern?
A) Earth not controlling water
B) Cold-damp
C) Xu KD yang
D) Xu SP yang
C) Xu KD yang
FX:
BEST: Zhen ren yang zhang tang
(SP/KD yang xu)
(chronic diarrhea d/t kd yang xu)
PTS:
KD-7 (prom urine to solidify stools)
ST-37 + ST-25 (LHS LI + FM LI to stop diarrhea)
SP-9 + SP-6 (drain D)
UB-23, Du-4, RN-4, RN-6, KD-3, UB-52
MOXA: RN-8 + ST-25
A patient has palpitations, shortness of breath on exertion, sweating, paleness, fatigue, listlessness, pale tongue, and an empty pulse. What is the treatment?
A) HT-5, PC-6, UB-15, RN-17, RN-6, UB-21
B) HT-7, PC-6, RN-15, UB-17, RN-4, UB-20
C) HT-7, PC-6, RN-15, RN-4, HT-6, KD-6, KD-7
D) HT-5, PC-6, UB-15, RN-17, RN-6, DU-14
D) HT-5, PC-6, UB-15, RN-17, RN-6, DU-14
DX:
HT Qi xu
FX:
Bao yuan tang
or
Huang qi sheng mai san
(Best HT qi causing palpitations)
Which moxa technique treats Tuberculosis?
A) moxa w/ garlic
B) moxa w/ ginger
C) moxa w/ salt
D) moxa w/ monkshood/fu zi
A) moxa w/ garlic
KIM pg 296
A patient has a sore and weak back, clear and frequent urination, weak urinary stream, dribbling after urination, incontinence, urination at night, nocturnal emission without dreams, and premature ejaculation, pale tongue, and deep and weak pulse in the rear position. What is the KD zang-fu pattern?
A) KD yang xu
B) KD fail to receive qi
C) KD qi not firm
D) KD jing xu
C) KD qi not firm
FX:
Jin suo gu jing wan
PTS:
UB-23, DU-4, RN-4, RN-6, KD-3, KD-7, UB-52
- All discharge= KD qi, therefore not firm*
- Can have deep + xu pulse*
A 35 year-old woman has had abdominal distention for the past four years. It started during a break up with her boyfriend. She complains of depression and frequently sighs. She has a sallow complexion. She is irritable and quick to get angry. Her appetite is poor and is frequently tired. She has loose stools. The abdominal distention is improved with flatulence. periods are irregular w/ dark red flow. Breasts are distended during menstruation. The tongue is pale. The pulse is thin and wiry. What is the treatment?
A) RN-12, ST-36, ST-25, SP-9, SP-6, LI-4
B) ST-36, RN-4, RN-12, ST-25, UB-25, UB-20
C) ST-25, UB-25, LI-11, SP-9, SJ-6
D) SP-4, PC-6, LR-3, RN-12, RN-6, ST-36
D) SP-4, PC-6, LR-3, RN-12, RN-6, ST-36
SP-4 (luo)
PC-6 (reg qi/xue, harmonize ST, reg jueyin)
(remove stag for distention)
LR-3 (VIP qi stag)
RN-12 (FM ST, W/ ST-36 Tn SP qi)
RN-6 (tn qi, local tx)
DX:
LR overacting on SP
FX:
Xiao yao san
+
Tong xie yao feng
(painful diarrhea d/t qi stag)
Explanation:
A) RN-12, ST-36, ST-25, SP-9, SP-6, LI-4
Diarrhea rel ST dx
B) ST-36, RN-4, RN-12, ST-25, UB-25, UB-20
SP/ST Xu–> diarrhea
C) ST-25, UB-25, LI-11, SP-9, SJ-6
D-H LI–> diarrhea
D) SP-4, PC-6, LR-3, RN-12, RN-6, ST-36
LR qi stag–>Sp/ST dx
Needling caution KD-11, 12, 13
Caution deep insertion with full bladder
KD-11 0.5 cun lateral RN-2
KD-12 0.5 cun lateral RN-3
KD-13 0.5 cun lateral RN-4
Caution pneumothorax which UB points on the back?
UB-12 to 21
Needling caution SI-13
Too medial/deep medial puncture lung
Needling caution HT-7
Caution ulnary artery and nerve
Needling caution ST-20
penetrate enlarged liver
Needling caution KD-24, 25, 26?
Deep perpendicular or oblique needling
pneumothorax
Needling caution PC-3
Avoid brachial artery and vein
Needling caution GB pneumothorax
GB-21-24
GB-21: midway btn Du-14 & acromion
GB-22: Mid-axillary line, 3 cun below axilla
GB-23: 1 cun anterior GB-22 (lvl nipple)
GB-24: One rib below LR-14 (6th intercostal space), directly below nipple, 7th intercostal space
Needling caution GB-25 + 26
Peritoneal cavity
Which UB points caution penetrate KD
UB-22-23, UB 51-52
Caution deep needle ST-23
Peritoneal cavity
Needling caution ST-19
Deep needle penetrate enlarged
HT- Left, LR-Right
Needling caution full bladder Ren channel
RN-2,3,4
Needling caution SP-12
Femoral artery, femoral nerve
Needling caution LR-12
Femoral vein
Needling caution LR-13
enlarged LR or SP
