TCM Painful Obstructions (BI) Syndrome and Difficult Points 3rd year 2nd Semester Final Flashcards
Which of the following is a characteristic symptom of Wind (Wandering) Bi syndrome?
a) Fixed pain and swelling of the joints
b) Severe, unilateral joint pain
c) Soreness and pain of muscles and joints with limited movement, and pain moving from joint to joint
d) Heaviness and numbness in the affected area
Correct answer: c) Soreness and pain of muscles and joints with limited movement, and pain moving from joint to joint. Also a floating and rapid pulse in acute cases
Explanation:
a) This describes Damp Bi syndrome, not Wind Bi.
DAMP (FIXED) BI exhibits- Pain, soreness, and swelling of muscles and joints
* Feeling of heaviness and numbness
* Fixed location of pain
* Worse in damp environments
* Slow and slippery pulse in acute cases
b) Severe, unilateral pain is characteristic of Cold Bi syndrome or Cold (Painful) Bi.
* Severely painful in a muscle or joint
* Limited movement
* Usually unilateral
* Tight pulse in acute cases
c) Wind Bi or Wind (Wandering) Bi is characterized by pain that moves from joint to joint, with soreness, pain of muscles and joints, and limited movement.
Floating and rapid pulse in acute cases
d) feeling of Heaviness and numbness are more typical of Damp Bi syndrome. Pain, soreness, and swelling of muscles and joints * Fixed location of pain
* Worse in damp environments
* Slow and slippery pulse in acute cases
Differentiation from Other Types of Bi Syndrome
Wind Bi (Moving pain, migratory joint discomfort)
Cold Bi (Severe, sharp pain that worsens in cold weather)
Damp Bi (Heavy, swollen joints with a feeling of sluggishness)
Heat Bi (Redness, swelling, burning pain)
Which acupuncture point is most appropriate for resolving Dampness in Damp (Fixed) Bi syndrome?
a) SP 9
b) ST 36
c) UB 17
d) LI 11
**Correct answer: a) SP 9 is used to resolve Dampness and is indicated for Damp Bi syndrome. It is a key point for clearing Dampness from the body, particularly from the lower burner, and is often used for conditions like Damp Bi, where Dampness obstructs the joints.
Explanation:
b) ST 36: While ST 36 is great for tonifying Qi and treating general weakness or deficiency, it is not specifically indicated for resolving Dampness.
c) UB 17: UB 17 is used to nourish and move Blood, not to resolve Dampness. It’s more for Blood-related stagnation or deficiencies.
d) LI 11: LI 11 is used to clear Heat, which is not directly related to Damp Bi syndrome. It does not specifically resolve Dampness.
Which of the following is the most appropriate treatment for Cold (Painful) Bi syndrome?
a) Tonify Yang with points like ST 36 and GV 14
b) Expel Wind using points like UB 12 and GB 39
c) Resolve Dampness using points like SP 6 and GB 34
d) Clear Heat with points like LI 4 and ST 43
a) Tonify Yang with points like ST 36 and GV 14
Correct for Cold Bi syndrome.
ST 36 is a very important point to tonify Qi, strengthen the body, and promote Yang in general. It helps to improve circulation and counteract Cold, which is a hallmark of Cold Bi syndrome.
GV 14 is the “sea of yang” point, and it helps to tonify Yang and expel Cold. It is often used for warming and dispelling Cold from the body.
Conclusion: This is correct for Cold Bi syndrome. The goal of warming the body and tonifying Yang helps to dispel Cold and alleviate the painful obstruction caused by Cold.
b) Expel Wind using points like UB 12 and GB 39
Correct for Wind Bi syndrome, but not Cold Bi syndrome.
UB 12 is a key point for expelling Wind, especially Wind-Heat or Wind-Cold, from the body. It helps to strengthen the defensive Qi (Wei Qi) and prevent further invasion of Wind.
GB 39 is often used for Wind in the body, particularly for Wind-Damp or Wind-Cold affecting the joints or muscles.
Conclusion: This is not correct for Cold Bi syndrome. This treatment is aimed at Wind Bi syndrome (also known as Wandering Bi syndrome), which is caused by Wind invading the body and causing pain and discomfort, typically with a wandering, moving pain.
c) Resolve Dampness using points like SP 6 and GB 34
Correct for Damp Bi syndrome, but not Cold Bi syndrome.
SP 6 is a key point for resolving Dampness, strengthening the Spleen, and promoting the movement of fluids. It is especially useful when Dampness obstructs the joints or muscles.
GB 34 is another important point for resolving Dampness and promoting the free flow of Qi and Blood in the body, especially for joint pain.
Conclusion: This is not correct for Cold Bi syndrome. This treatment is more appropriate for Damp Bi syndrome, where the symptoms are characterized by a sensation of heaviness and obstruction due to Dampness.
d) Clear Heat with points like LI 4 and ST 43
Correct for Heat Bi syndrome, but not Cold Bi syndrome.
LI 4 is a general point for clearing Heat and can be used for both Wind-Heat and Heat-related conditions. It is often used for conditions involving inflammation, redness, or fever.
ST 43 helps to clear Heat from the Stomach and is specifically useful for clearing Heat from the body, especially in the case of excessive heat-related pain.
What is a potential safety risk associated with needling the point GB 20?
a) Pneumothorax
b) Damage to the radial nerve
c) Overpenetration can injure the spinal cord
d) Risk of damage to the carotid artery
Correct answer: c) Overpenetration can injure the spinal cord
Explanation:
a) Pneumothorax is a risk with points near the lung, such as LU 1, not GB 20.
b) The radial nerve is located near the wrist, not near GB 20.
c) GB 20 is located near the cervical spine, so over-needling can cause injury to the spinal cord.
d) The carotid artery is near the neck, but the risk is more directly associated with points like ST 9/10, not GB 20.
Which of the following acupuncture treatments is indicated for chronic cases of Bi syndrome with Blood Stasis?
a) ST 36, SP 6, CV 4, LR 8, UB 20, UB 23
b) ST 40, SP 9, SP 6, CV 12, CV 9, UB 20
c) SP 10, UB 17, PC 6, SP 6, LI 11
d) LR 8, KD 3, SP 6, GB 39, UB 18, UB 23, CV 4, UB 11, GB 34, ST 36
Correct answer: c) SP 10, UB 17, PC 6, SP 6, LI 11
- SP 10: Moves Blood, resolves Blood stagnation, and is commonly used for Blood-related conditions like skin problems or menstrual issues.
- UB 17: Moves Blood, nourishes the Blood, and is a key point for conditions involving Blood stagnation or deficiency.
- PC 6: Opens the chest, moves Qi, and calms the Heart. It’s often used for emotional or Qi stagnation-related issues.
- SP 6: Tonifies the Spleen, Kidney, and Liver, nourishes Yin, and is used for a wide range of gynecological and digestive issues.
- LI 11: Clears Heat, cools the Blood, and can be used for heat-related conditions, including fever and inflammation.
Explanation:
a) ST 36, SP 6, CV 4, LR 8, UB 20, UB 23
- ST 36: Tonifies Qi and Blood, strengthens the Spleen, and is a major point for general energy and vitality.
- SP 6: Tonifies the Spleen and Kidney, nourishes Yin, and moves Blood and Dampness.
- CV 4: Strengthens the Kidney and supports Yuan Qi, often used for chronic deficiency or to tonify the essence.
- LR 8: Nourishes Liver Yin, moves Blood, and is often used in cases of Liver and Kidney deficiency.
- UB 20: Tonifies the Spleen, strengthens Qi, and is often used for digestive issues and Qi deficiency.
- UB 23: Tonifies the Kidney, strengthens Yang, and is used for cases of Kidney deficiency, particularly in chronic conditions.
b) ST 40, SP 9, SP 6, CV 12, CV 9, UB 20
- ST 40: Resolves Phlegm, transforms Dampness, and is good for conditions involving accumulation or obstruction.
- SP 9: Resolves Dampness, clears heat, and is effective for transforming Damp and promoting urination.
- SP 6: Tonifies Spleen, Kidney, and Liver, nourishes Yin, and can move Blood.
- CV 12: Tonifies the Spleen, harmonizes the Stomach, and is used for digestive issues.
- CV 9: Resolves Dampness and edema, especially in the lower burner.
- UB 20: Tonifies the Spleen, strengthens Qi, and helps in digestive issues, especially when there is weakness.
d) LR 8, KD 3, SP 6, GB 39, UB 18, UB 23, CV 4, UB 11, GB 34, ST 36
- LR 8: Nourishes Liver Yin, moves Blood, and is used for Liver and Kidney deficiency.
- KD 3: Tonifies Kidney Yin and Yang, nourishes Essence, and is often used for general Kidney deficiency.
- SP 6: Tonifies Spleen, Kidney, and Liver, nourishes Yin, and is used for a wide range of conditions.
- GB 39: Benefits the bones and marrow, used for joint issues and to strengthen the sinews and tendons.
- UB 18: Tonifies Liver Blood and Yin, and helps with conditions like Liver deficiency.
- UB 23: Tonifies the Kidney, especially for Kidney Yang and Essence deficiency.
- CV 4: Tonifies the Kidney and supports Yuan Qi, often used for chronic deficiency.
- UB 11: Benefits the bones and promotes Bone Qi, often used for bone issues.
- GB 34: Moves Liver Qi and Blood, and is used for joint pain, especially in the lower limbs.
- ST 36: Tonifies Qi and Blood, boosts energy, and is one of the most commonly used points for general tonification.
Which of the following acupuncture points should be avoided in the treatment of Heat Bi syndrome?
a) LI 11
b) SP 6
c) ST 43
d) GV 14
Explanation:
a) LI 11 is used to clear Heat in the body and is appropriate for Heat Bi syndrome.
b) SP 6 is contraindicated in Heat Bi because it nourishes Yin, and Yin nourishing treatments are not suitable when there’s Heat.
c) ST 43 is used to clear Heat and is suitable for Heat Bi.
d) GV 14 is useful to expel Heat, making it appropriate for Heat Bi.
For Wind Bi syndrome, which acupuncture points should be used to expel Wind?
a) UB 12, GB 31, GB 39, GV 14, TW 6
b) ST 36, UB 23, CV 6
c) SP 9, SP 6, GB 34
d) ST 40, SP 9, SP 6, CV 12
Correct answer: a) UB 12, GB 31, GB 39, GV 14, TW 6
Explanation:
a) These points expel Wind and are specifically used for Wind Bi syndrome.
b) These points tonify Yang and Qi, which are appropriate for Cold Bi syndrome, not Wind Bi.
c) These points resolve Dampness, not Wind.
d) These points resolve Phlegm in the joints, not Wind.
Which of the following acupuncture points is treated with 5 direct moxa cones in the summertime?
a) ST 36
b) LI 11
c) UB 23
d) UB 43
Correct answer: b) LI 11 is treated with 5 direct moxa cones in the summertime. It is commonly used for clearing heat and resolving excess conditions.
Explanation:
a) ST 36: This point is commonly used for tonifying the body and is not part of the group to be treated with 5 direct moxa cones in the summer.
c) UB 23: While UB 23 is an important point for tonifying the Kidney and treating lower back pain, it is not specified for moxa use in the summer.
d) UB 43: This point is used for chronic conditions and respiratory issues, but it’s not included in the direct moxa treatment list for the summer.
When needling Urinary Bladder 1 (UB 1), what should you instruct the patient to do before needle insertion?
a) Close their eyes and relax
b) Close their eyes and gently push the eyeball laterally and inferiorly
c) Close their eyes and look down
d) Look up while keeping their eyes open
Correct answer: b) Close their eyes and gently push the eyeball laterally and inferiorly. This is correct. Before needling UB 1, the patient should close their eyes, and the practitioner should gently push the eyeball laterally and inferiorly during the insertion.
Explanation:
a) Close their eyes and relax: While closing the eyes is part of the procedure, it is not enough to ensure the safety of needle insertion near the eye.
c) Close their eyes and look down: This is the correct instruction for ST 1, not UB 1.
b) Close their eyes and gently push the eyeball laterally and inferiorly:
d) Look up while keeping their eyes open: Incorrect; this is not the correct procedure for UB 1 or any of the points in the eye area.
Which of the following acupuncture points should be needled perpendicularly to a depth of 0.5-1.0 inch along the infraorbital ridge?
a) ST 1
b) ST 2
c) ST 9
d) ST 36
Correct answer: a) ST 1: Correct. ST 1 is located directly below the pupil, between the eyeball and the infraorbital ridge, and the needle should be inserted perpendicularly to a depth of 0.5-1.0 inch along the infraorbital ridge.
Explanation:
b) ST 2: While ST 2 is located below ST 1, the depth and technique for insertion are different. The needle should be inserted into the infraorbital foramen at a shallower depth.
c) ST 9: This point is located on the anterior border of the sternocleidomastoid muscle, so it does not follow the same needling technique as ST 1.
d) ST 36: This point is on the lower leg and involves a different needling technique, so it is not applicable to this question.
Which of the following points is contraindicated in pregnancy until the late third trimester?
a) LU 1
b) GB 21
c) CV 22
d) GB 39
Correct answer: b) GB 21 is contraindicated in pregnancy until the late third trimester, as needling it may induce labor.
GB 21 Location
* Midway between GV 14 or the spinous process of C7 and the acromion, at the highest point of the shoulder.
Needling GB 21
* Puncture perpendicularly 0.3-0.5 inch or obliquely
0.5 – 0.8 inch. Moxibustion is applicable. Contraindicated in pregnancy until late 3rd trimester.
Explanation:
a) LU 1: This point is used for respiratory issues and does not have any specific contraindication in pregnancy.
Lu 1 is Location
* 6 cun lateral to the anterior midline in the 1st intercostal space, one cun below Lu 2, in the delto-pectoral groove
Needling Lu 1
* Puncture oblique along the intercostal space 0.5-0.8 inch towards the lateral aspect of the chest.
c) CV 22: While this point is located near the throat. In the center of the suprasternal fossa and should be used with caution, there is no specific contraindication for pregnancy listed here.
To Needle
* First puncture perpendicularly 0.2 inch and then insert the needle tip downward along the posterior aspect of the sternum 0.5 - 1.0 inch. Moxibustion is applicable.
d) GB 39: This point is used for strengthening the bones and sinews and does not have a contraindication in pregnancy.
Which of the following acupuncture points requires the needle to be inserted perpendicularly to a depth of 0.3 - 0.5 inch on the anterior border of the sternocleidomastoid muscle?
a) ST 9
b) ST 10
c) GB 20
d) LU 1
Correct answer: a) ST 9: is located on the anterior border of the sternocleidomastoid muscle, and the needle is inserted perpendicularly to a depth of 0.3 - 0.5 inch.
St 9 Location
* Level with the tip of Adam’s apple, just on the course of the common carotid artery, on the anterior border of sternocleidomastoid muscle.
St 9 Needling
* Palpate for the common carotid artery. Place your fingers on the artery prior to and during insertion. It may be necessary to needle on the medial side of the artery in some individuals. After insertion, move needle to the appropriate depth (perpendicularly 0.3-0.5 inch) and allow the needle to stay in the point without manipulation for the duration of the treatment. When removing, ensure closure of the site by placing cotton over the area with firm pressure to avoid bruising.
Explanation:
a)
b) ST 10: Incorrect. ST 10 is located along the same muscle, but the needling technique is similar to ST 9, though it is located differently.
St 10 Location
* At the midpoint of the line joining St 9 and St 11, on the anterior border of the sternocleidomastoid muscle.
ST 10 Needling
* Palpate for the common carotid artery. Place your fingers on the artery prior to and during insertion. It may be necessary to needle on the medial side of the artery in some individuals. After insertion, move needle to the appropriate depth (perpendicularly 0.3-0.5 inch) and allow the needle to stay in the point without manipulation for the duration of the treatment. When removing, ensure closure of the site by placing cotton over the area with firm pressure to avoid bruising.
c) GB 20: Incorrect. GB 20 is located between the sternocleidomastoid muscle and trapezius muscle, and requires a different angle.
GB 20Location
* In the depression between the upper portion of the sternocleidomastoid muscle and trapezius muscle, on the same level with GV 16.
GB 20Needling
* The correct angulation of this point is towards the tip of the nose. Be sure you are using the correct angulation as a medial angulation runs the risk of penetrating the brain stem. If you have trouble with determining the angle, place a finger in front
d) LU 1: Incorrect. LU 1 is located in the delto-pectoral groove, not on the anterior border of the sternocleidomastoid muscle.
- What is the primary concern when needling in challenging anatomical areas, such as near vital structures like the common carotid artery?
a) Incorrect depth of needling
b) Incorrect needle angulation
c) Not applying pressure after needle removal
d) Not using moxibustion
Correct answer: b) Incorrect needle angulation: Correct. The main concern in challenging anatomical areas, especially near vital structures like the common carotid artery, is ensuring the correct needle angulation to avoid injury.
Explanation:
a) Incorrect depth of needling: While depth is important, angulation is the more crucial factor in preventing complications when needling near sensitive areas.
c) Not applying pressure after needle removal: Although important for avoiding bruising, the most critical issue when needling in these areas is ensuring correct angulation and depth.
d) Not using moxibustion: Moxibustion is not the primary concern when needling near vital structures. The main focus is on correct technique and angulation.
- Which acupuncture point is located in the depression between the upper portion of the sternocleidomastoid muscle and the trapezius muscle and requires careful angulation to avoid penetrating the brainstem?
a) GB 20
b) GB 21
c) LU 1
d) TW 17
Correct answer: A) GB 20: is located between the sternocleidomastoid muscle and the trapezius muscle, and the needle must be angled towards the tip of the nose to avoid penetrating the brainstem.
Explanation:
b) GB 21: Incorrect. GB 21 is located on the shoulder and does not have the same angulation concerns as GB 20.
c) LU 1: Incorrect. LU 1 is located in the delto-pectoral groove and does not require the same care regarding brainstem penetration.
d) TW 17: Incorrect. TW 17 is located behind the ear and does not have the same anatomical concerns as GB 20.
- Which acupuncture point is located 6 cun lateral to the anterior midline, in the first intercostal space, and requires an oblique needling technique?
a) LU 1
b) ST 36
c) UB 23
d) GB 21
Correct answer: a) LU 1
a) LU 1: Correct. LU 1 is located in the first intercostal space, 6 cun lateral to the anterior midline, and requires an oblique needling technique.
Explanation:
b) ST 36: Incorrect. ST 36 is located on the lower leg, and its needling technique is different from LU 1.
c) UB 23: Incorrect. UB 23 is located on the lower back and is not needled with the same technique as LU 1.
d) GB 21: Incorrect. GB 21 is located on the shoulder and requires a perpendicular or oblique needling technique, but not in the first intercostal space.
