Transcript Providing Animal Safety and Control in Emergency

Oral Cavity Disorders: a TCVM
Approach
CAPT R.M. Clemmons, DVM, PhD, CVA
Oral Cavity Diseases (Western)
•Local damage
•Electric shock
•Chemical damage
•Thermal damage
•Periodontitis
•Tooth tarter
•Systemic disease
•Metabolic disease
•Nutritional disease
•Immune disease
•Infectious disease
•Treatment
•Remove offending
cause
•Steroids
•Antibiotics
•Clean teeth
TCM Spleen Disease
•
•
•
Spleen Physiology
Spleen Pathology
Gingivitis/Stomatitis
Earth
•Sound
•song
•Emotion
•sympathy
•Direction
•center
•Opening
•lips/gums
•Climate
•Body Part
•humid
•muscles
•Season
•late summer
•Zang/Fu
•SP/ST
TCM SPLEEN Physiology
•Governs Transportation &
Transformation
•Food & Water
•Controls Blood
•Dominates the Muscles
•Opens in Mouth
•Lips & Gums (ST)
TCM 24 Hour Clock
LIV
GB
TH
1-3 AM
LU
3-5 AM
LI 5-7
11-1AM
9-11 PM
PC
7-9 PM
KID
BL
ST
7-9 AM
SP
9-11 AM
HT
5-7 PM
3-5 PM
SI
AM
1-3 PM
11-1 PM
Spleen Pathology
Spleen Pathology
• Damp is the Enemy of the Spleen
• Damp-Cold
• Damp-Heat
• Spleen Qi Deficiency with Damp
Spleen Pathology
Usually combination of excess & deficiency
External or Internal Pathogen
Damp-Heat
Damp-Cold
Obstructs Spleen Qi Flow
Spleen fails to Transform & Transport Gu Qi
Spleen Qi Deficiency
Spleen Pathology
Cold Food
or Drink
Cold
Environmental
Conditions
Cold-Damp in Spleen
Disharmony of Qi Flow
Transform & Transport Disorder
Spleen Pathology
Damp Hot
Food or
Drink
Accumulated
Heat & Damp
Damp Hot
Environmental
Conditions
Damp-Heat in Spleen
Disharmony of Qi Flow
Transform & Transport Disorder
Spleen Qi Deficiency
Illness
Overeating
Overwork
Starvation
Under Work
Spleen Qi Deficiency
Disturbed Qi Flow
Failure to Transform & Transport
Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
General Signs
Chronic Hemorrhage
Spleen Qi Sinking
Illness
Overeating
Overwork
Starvation
Under Work
Chronic Spleen Qi Deficiency
Failure of Holding
Chronic Diarrhea
Prolapses
Incontinence
Spleen Pathology
Cold Food
or Drink
Chronic Spleen
Qi Deficiency
Spleen Yang Deficiency
Disharmony of Qi Flow
Transform & Transport Disorder
Yang Deficiency Signs
Stomach Pathology
Cold
Environmental
Conditions
Cold Food
or Drink
Cold in Stomach
Disharmony of Qi Flow
Transform & Transport Disorder
Inhibition of Yang
Stomach Cold
Cold Food & Drink
Cold Environment
Stomach Cold
Receiving &
Decomposing
Anorexia
Cold Signs
Altered
Qi Flow
Lassitude
Cold Ear/Nose
Hypersalivation
Pale-Purple Tongue
Deep-Slow Pulse
Stomach Pathology
Damp Hot
Environmental
Conditions
Hot Dry
Food or
Drink
Heat in Stomach
Heat Signs
Transform & Transport Disorder
Stomach Heat
Pathogenic Heat
Yin Deficiency
Stomach Heat
channel
Gums
organ
grandchild
child
Cystitis
Ulcer
Colitis
Stomach Food Stagnation
Overeating
Indigestible Food
Retention of Food in Stomach
Disturbed Qi Flow
Failure to Transform & Transport
Stomach Yin Deficiency
Stress
Liver Qi Stagnation
Chronic Febrile
Illness
Transformation
to Heat/Fire
Impairment of Body Fluids
Stomach Yin Deficiency
How to Use Acupuncture for Gingivitis in
Small Animal Practice
Zang Fu Physiology
• Teeth correspond to bone
• Bone is controlled by the kidney
• Malocclusion, oligodontia are examples
of Kidney Jing Deficiency
• Gums are influenced by the stomach
Meridian Theory
• Oral cavity has two main channels
that influence the teeth and gums
• Large Intestine meridian
• Stomach meridian
Pattern Diagnosis
• Stomach Heat Pattern
• Excess pattern, seen more often in
younger animals (cats)
• Stomach Yin Deficiency + Empty Heat
• Stomach loves moisture
• Moisture balances Yang function
• Lack of Yin (fluid) allows Yang Fire to
rise
Stomach Heat Pattern
•Fluffy: 4yr FS DSH
•Primary complaint: Bad
breath, eating poorly
•History: Stray, no
vetcare, dry food diet
•Exam: Body & coat
condition-normal; vital
signs-WNL
•Oral Exam: Putrid odor, upper and lower
arcade have severely inflamed gingiva, with
spontaneous bleeding, minimal calculus
formation
•Lab Data: Elevated WBC, FELV/FIV=Neg
•Diagnosis: Hemorrhagic gingivitis
•Treatment: Clindamycin 25mg PO BID x 10
•Dental prophylaxis followed by
Clavamox 62.5 mg BID x 10
TCVM Exam & Diagnosis
•Constitution: Water/Wood
•Tongue: body=reddish purple; no coat
•Pulse: Bilaterally superficial rapid
•Body Condition: Dry nose; Body Temp
Normal
•Mouth: Stink smell; bloody red gums
Pattern DX: Stomach Heat (excess
condition)
TCVM Treatment Strategy
•Clear the Stomach Heat, Cool the Blood, & nourish
Stomach Yin
•Acupuncture Point Selection:
GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10
•Herbal Medicine: Yu Nu Jian ( Jade Lady)
shi gao, shu di huang, zhi mu, huai niu xi
2 teapills TID or 1/8-1/4 tsp granules TID
•Topical Care: Aloe Gel ( Warren Laboratories)
Case Outcome & Discussion
•After 3 weeks of therapy inflammation
substantially reduced
•Cervical line lesions which compromised several
teeth were removed
•Fluffy is maintained on Aloe oral gel and herbs
with only periodic acupuncture therapy
•Long term expectations: depend on owner
compliance
•Other herbals: Wei Qi Booster; Slippery Elm
Stomach Yin Deficiency & Empty Heat
Pattern
• Tess: 10 yr, FS, Mix Breed
• Primary Complaint: Bad breath, dirty teeth,
and periodic vomit/regurge
• History: Commercial dry food diet, periodic
dental prophylaxis, absent dental
homecare, gums remain inflamed and
plaque builds quickly
• Western Dx / Tx: Gingivitis with periodontal
deterioration. Requires 6 month recall for
prophylaxis
TCVM Approach
•Exam:
•Treatment Stategy:
•Constitution- Water
•Tongue- Violet, dry, no
coat
•Pulse- Deep, thready, and
quick
•Nourish Stomach Yin and
Clear Heat
•AP= CV 12 (aqua); SP 3,6;
ST 36,44; LI 4,11
•Herbs= Qing Wei San
•Gums- dry/breath
scorched
•Topical= Aloe Gel
•Coat Quality-Dry
•Diet: Fresh cooked food/
fish-pork-beef-eggsveggies
Ulceration: a TCVM Approach
CAPT R.M. Clemmons, DVM, PhD, CVA
Ulcer
•Symptoms
•Periodic pain
•Acid regurgitation
•Belching
•Vomiting
•Patterns
•Excess
•Stomach Cold
•Food Stagnation
•Liver Qi Stagnation
•Blood Stasis
•Deficiency
•Stomach Yin Deficiency
Stomach Heat
Pathogenic Heat
Yin Deficiency
Stomach Heat
channel
Gums
organ
grandchild
child
Cystitis
Ulcer
Colitis
Stomach Ulcers
•Mild
Happy Stomach
Angelica
Paeonia
Bupleurum
Aurantium
Trichosanthes
Pinellia
Citrus
Licorice
Taraxacum
Dang Gui
Bai Shao Yao
Chai Hu
Zhi Shi
Gua Lou
Ban Xia
Chen Pi
Gan Cao
Pu Gong Ying
Nourish & activate Blood
Nourish Liver Yin & Blood
Soothe Liver Qi
Move Qi & relieve pain
Promote body fluid & transform phlegm
Dry damp & transform phlegm
Move Qi & relieve pain
Harmonize
Clear Heat
•Moderate to Severe
Jade Lady
Gypsum
Anemarrhena
Rehmannia
Ophiopogon
Achyranthes
Shi Gao
Zhi Mu
Shu Di Huang
Mai Men Dong
Niu Xi
Clear Heat and cool Stomach
Clear Heat and nourish Yin
Nourish Yin and Jing
Moisten and nourish Yin
Bring the Qi flow down
GI Food Therapy
•Cabbage
•Contains glutamate
•Cools stomach & GI
•Spinach
•Stops hemorrhage
05 Shan-gen Mountain base Xie-05
Shan-gen
GV-26
Ren
zhong
LO: on the dorsal midline of
boundary b/t hairy & non-hairy
areas
ME: Perpendicular insertion 0.3
cun
IN: Loss of appetite, sinusitis,
coma, shock, wind-cold, wind-heat
06 Ren-zhong/Shui-gou the center of man/water passage, Xie-07, GV-26
LO: At the intersection b/t dorsal and middle 1/3 of the philtrum
ME: Perpendicular insertion for 0.3 cun
IN: Coma, shock, fever, bronchitis, Lung Heat, facial paralysis
21 Hua-tuo-jia-ji at cervical region
LO: 0.5 dorsal to cervical vertebrae
IN: cervical stiffness, wobbler’s disease
22 Jian-wei, strengthen stomach
LO: Upper 1/3 of the jugular group,
Between vein and cervical vertebra
IN: Anorexia, vomit, stomach disorders
23 Lian-quan ridge spring
LO: At the ventral midline just cranial to throat.
CV-23
IN: excessive salivation, laryngeal hemiplegia
Pancreatitis: a TCVM Approach
CAPT R.M. Clemmons, DVM, PhD, CVA
Pancreatitis
•Considered any acute or
chronic change in GI
function usually
accompanied by some
degree of vomiting,
diarrhea and abdominal
pain
•Acute- -Mild
•Pancreostasis
•Acute- -Severe
•Fulminating pancreatitis
•Chronic
•Pancreatic insufficiency
•Rx Acute
•NPO
•Fluids
•Antiemetics
•Pain relief
•Low fat/protein food
•Rx Chronic
•Enzyme therapy
TCVM Acute Pancreatitis
TCVM Chronic Pancreatitis
* Enzyme replacement therapy still good to add
Perry
3 yr FS Springer
Earth personality
Acute onset of vomiting,
fever and abdominal pain
Increased thirst
Scant urination
Elevated Amylase & Lipase
Increased WBC
Rx: Fluids & Ranitidine
Tongue: red & dry
Pulse: fast & superficial
West Dx: acute pancreatitis
TCM Dx: damp-heat in spleen
Perry Treatment
•AP
•Next day was 80%
improved
•DN
•ST-45
•ST-36
•LI-4
•PC-6
•BL-20
•CV-12
•Aqua
•ST-36
•BL-20
•PC-6
•Herbal
•Great Saussurea Coptis
•Clinician said, “He is
doing absolutely
fantastic…better than
any patient in
years…NO…it wasn’t the
acupuncture…well…may
be we should try it
again!”
Great Saussurea Coptis
Saussurea
Mu Xiang
Move Qi & relieve pain
Coptis
Huang Lian
Clear Damp-Heat in the intestines
Evodia
Wu Zhu Yu
Warm the middle Jiao & stop vomiting
Bleeding: a TCVM Approach
CAPT R.M. Clemmons, DVM, PhD, CVA
Bleeding
•Primary Hemostasis
•Complex chain of events
involving interaction of
•Platelets
•Vessel Wall
•von Willebrand’s factor
•Fibrinogen
•Secondary Hemostasis
•Complex interaction of the
intrinsic and extrinsic
clotting cascades
•Stabilize the platelet plug
Primary Hemostasis
•Evaluated by the
bleeding time
•Platelet number
•Amount and Quality of the
von WIllebrand’s factor
VIII:Ag
•Fibrinogen concentration
•Other alterations due to
vessel wall disorders
Secondary Hemostatis
•Assessed by
•ACT (activated
clotting time)
•APTT (activated
partial thromboplastin
time)
•PT (prothrombin
time)
TCM Pathoetiology
•Heat
•Tongue
•Red & Dry
•Pulse
•Superficial (forceful)
& fast
•Spleen Qi Deficiency
•Tongue
•Pale & moist
•Pulse
•Deep & weak
(particularly on right)
Spleen Pathology
Damp Hot
Food or
Drink
Accumulated
Heat & Damp
Damp Hot
Environmental
Conditions
Damp-Heat in Spleen
Disharmony of Qi Flow
Transform & Transport Disorder
Heat Hemorrhage
•Herbal treatment depends
upon location
•Bladder
•Red Front Door
•GI tract
•Sophora Powder
•Great Saussurea Coptis
•Red Back Door
•Pulmonary
•Red Lung
•Nose
•Single Immortal
•Uterus
•Wu Bei San
Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
General Signs
Chronic Hemorrhage
Darby
•Signalment
•5 yr FS Doberman
•History
•Generalized weakness
•Ecchymosis
•Abdominal bleeding
•TCVM Exam
•Tongue: pale
•Pulses: deep & weak
Dx: Spleen Qi Deficiency
(not holding blood in vessels)
Darby
•Western Rx
•Compressive
bandage
•Hemorrhage control
•Cryoprecipitate
•Whole Blood
•Thyroid medication
•TCVM Rx
•AP
•SP Qi Tonic
•BL-20/21, SP-6, SP-9
& CV-6
•Stop Hemorrhage
•Tian Ping & BL-17
•Herbal
•Yunnan Pai Yao
•Huang Tu Tang
Huang Tu Tang
Atractylodes
Bai Zhu
Strength Spleen & tonify Qi
Yellow Earth
Zao Xin Tu
Warm Spleen & stop diarrhea
Aconite
Fu ZI
Warm Spleen
Asinum
Er Jiao
Nourish Blood
Rehmannia
Sheng Di Huang Nourish Yin
Scutellaria
Huang Qin
Stop bleeding & prevent excess heat
Licorice
Gan cao
Harmonize
Muscle Wasting: a TCVM Approach
CAPT R.M. Clemmons, DVM, PhD, CVA
TCM Muscle View
•Muscle volume &
strength is under the
domain of the Spleen
•Spleen transforms food
and transports it to the
body to provide energy &
building blocks.
•Spleen Qi provides
muscle strength
•Liver blood provides
endurance
•Continued delivery of
Spleen Qi to muscles
Western View of Muscle Wasting
•Generalized Wasting
•Malnutrition
•Insufficient intake of materials
to support Spleen Qi
•Cardiac Cachexia
•Heart failure leads to stagnation
of blood
•Liver is unable to support
distribution of blood & Qi
•Leads to accumulation of Damp
in Spleen
•Results in Spleen Qi Deficiency
with failure to provide energy
and building materials to the
muscles
•Cancer Cachexia
•Tumor Necrosis Factor poisons
metabolism leading to Spleen Qi
Deficiency
•Diminished effective delivery
of energy to muscles
•Localized Wasting
•Trauma
•Local damage of muscle
•Disuse Atrophy
•Local stagnation results in Liver
failure to support
Spleen/Stomach
•Accumulation of Damp alters
Spleen function
•Local stagnation decreases
delivery of nutrients
•Neurogenic Atrophy
•Denervation leads to local liver
stagnation
•Results in failure to support
spleen Qi
•Leads to decreased delivery of
local channel energy
Wei Syndrome
Damp Heat
•Earth personality
•Obesity
•History of damp heat in skin or GI
•Muscle atrophy
•Weakness
•Lethargy
•Greasy wet tongue
•Fast pulse
Si Miao San
Qi/Yang
Deficiency
•Lethargy, shortness of breath,
weakness
•Too weak to get up to walk
•Loose lips
•Loose stool
•Anorexia & Emaciation
•Dry-burnt hair
•Edema
•Heat seeking
•Pale wet tongue
•Thready & weak pulse
Bu Yang Huan Wu
Qi/Yin Deficiency
•Emaciation
•Weakness in lumbar region
•Heat seeking
•Dry skin
•Pale or red & dry tongue
•Weak & thready pulse
Hindquarter
formula
Jake
•History
•Progressive weakness in
rear legs
•Cool seeking
•Rear leg muscle atrophy
•Dry hair & skin
•TCVM Exam
•Pulses deep & weak (< R)
•Red dry tongue
DX: Qi/Yin Deficiency
Jake’s Treatment
• AP
• EA
• SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui
• DN
• BL20, BL23, BL26, KID3
• Aqua
• SP6, ST36, BL23, BL26
• Herbal
• Jia Bing Fang
Jia Bing Fang
Astragalus
Condonopsis
Polygonum
Rehmannia
Paeonia
Dioscorea
Prunella
Cyperus
Bupleurum
Sargassum
Huang Qi
Dang Shen
He Shou Wu
Shu Di Huang
Bai Shao Yao
Shan Yao
Xia Ku Cao
Xiang Fu
Chai Hu
Hai Zao
Laminaria
Kun Bu
Tonify Qi
Tonify Qi
Nourish Blood and Jing
Nourish Blood, Yin and Jing
Nourish Blood and soothe Liver Qi
Tonify Qi and nourish Jing
Soothe Liver Qi, clear Heat
Move Liver Qi and relieve nodules
Soothe Liver Qi
Transform phlegm, clear Heat, soften
the hardness
Transform phlegm, soften the
hardness, drain water
Sam
•History
•Chronic rear leg
weakness and muscle
wasting
•Dry hair
•Weight loss
•TCVM Exam
•Red dry tongue
•Weak thready pulses (< R)
DX: Qi/YinDeficiency
Sam’s Treatment
• AP
• DN
• GV20, BL20, BL23, BL26
• Aqua
• SP6, ST36, BL23, BL26
• Herbal
• Hindquarter formula (tea pills)
Hindquarter Formula
Eucommia
Du Zhong
Tonify Kidney & strengthen back
Achyranthes
Niu Xi
Tonify Kidney & strengthen the hind limbs
Lindera
Wu Yao
Move Qi and relieve pain
Astragalus
Huang Qi
Tonify Qi
Apis
Feng Hua Fen
Tonify Qi and Yin
Morinda
Ba Ji Tian
Warm and strengthen the back
Angelica
Dang Gui
Nourish Blood
Rehmannia
Shu Di Huang
Nourish Yin and Jing
Cinnamon
Gui Zhi
Warm the Channels and benefit the limbs
Obesity: a TCVM Approach
CAPT R.M. Clemmons, DVM, PhD, CVA
Obesity
• Body weight is 20% over ideal
• An intake of total dietary energy above that needed for
maintenance and production or exercise over a long period of
time
• Energy in is based upon
• Food intake
• Absorption
• Energy used is
•
•
•
•
•
Basic metabolic rate (thermoneutral condition)
Exercise
Lactattion
Pregnancy
Growth
In
>>
Out
Obesity: TCVM Classical Strategy
(1)
Yin Tonic Herbs (Remannia, Lycium etc)
Decrease in appetite
Decrease in food intake
(2)
Purgative herbs (Rheum, Cannabis Ma Zi Ren etc)
Passing food faster through SI
Less time to absorb nutrients
Decrease in absorption
(3)
Qi Tonic Herbs (Ginseng, codonopsis etc)
Energy boosting
Patient more willing to exercise
Burning down Fat tissue
Obesity: TCVM Etiology and Pattern
•Damp-phlegm
•Liver Stagnation
Excess
•Blood Stagnation
•Spleen Deficiency
Deficiency
•Kidney Deficiency
Damp-phlegm
Etiology
Water/damp
from food or
environment
Other pathogenic factors
Stagnation of
Water-damp
Spleen Qi Deficiency
Phlegm under the skin
Obesity
Damp-phlegm
Symptoms
. Overweight
. Swelling neck or belly
. fast respiratory rate, or cough or asthma
. Pulse: Fast, deep or slippery
. Tongue: pale or red with thick coating
. In people: obese smoker
. Overall: not weak
Treatment Strategy: Transform damp and resolve phlegm
Acupuncture treatment
1) needling: ST-36/40, BL-13, SP-6/9
or Electro-acupuncture (F=30 Hz) for local
swelling area
2) Message: Abdomen and back, twice a day.
Damp-phlegm
Herbal Formula
Citrus
Pinellia
Poria
Coix
Atractylodes
Areca
Benincasa
Alisma
Plantago
Cyperus
Phlegm Fat Formula (Citrus-Pinellia Compound)
Chen Pi
Ban Xia
Fu Ling
Yi Yi Ren
Cang Zhu
Da Fu Pi
Dong Gua Pi
Ze Xie
Che Qian Cao
Xiang Fu
8%
8%
10%
20%
8%
10%
8%
10%
10%
8%
Er Chen Tang
Resolve Damp
Liver Qi Master
Damp-phlegm
Max Formula
For lipomas
Fritillaria
Zhe Bei Mu
Soften hardness and clear nodules
Ostrea
Mu Li
Soften hardness and clear mass
Prunella
Xia Ku Cao
Clear Liver Heat and resolve nodules
Scrophularia
Xuan Shen
Clear Heat and cool Blood
Trichosanthes Tian Hua Fen
Clear Heat and promote body fluids
Platycodon
Jie Geng
Open the Upper Jiao and transform
phlegm
Rhubarb
Da Huang
Clear stagnation/stasis and clear Heat
Angelica
Bai Zhi
Clear Wind-Cold and relieve pain
Liver Qi Stagnation
Etiology
Emotional Stress
Drug Stress
Liver Qi Stagnation
Liver over-control Spleen
Spleen fails to transform Damp
Phlegm under the skin
Obesity
Liver Qi Stagnation
Symptoms: . Overweight
. Aggressive, or restlessness
. Hypertension
. irregular estrous cycling
. exercise intolerance, lassitude
. Pulse: Wiry and deep
. Tongue: purple or pale with coating or without coating
Treatment strategy:
Acupuncture:
Regulate liver, clear Fire and transform damp
Sp-6/9, ST-40
Liv-3, GB-20 and GB-34
Liver Qi Stagnation
Herbal formula:
Picrorrhiza
Prunella
Cassia
Rehmannia
Rheum
Cassia
Picrorrhiza Compound*
Hu Huang Lian
Xia Ku Cao
Jue Ming Zi
Sheng Di Huang
Da Huang
Pang Xie Ye
18%
19%
18%
15%
15%
15%
Clear Liver
Clear Liver
Nourish Yin/Blood
Purge LI
Blood Stagnation
Etiology
Stress
Other factors
Qi stagnation
Blood Stagnation
Qi-blood stagnation
Water/Damp retention in the body
Obesity
Blood Stagnation
Symptoms:
. Overweight
. lump in the body surface
. exercise intolerance, lassitude
. Pulse: slow and deep
. Tongue: purple with coating or without coating
Treatment strategy:
Acupuncture:
Invigorate Blood and transform damp
BL-17/SP-10
LIV-3, GB-34, LI-4
ST-40/BL-40
Blood Stagnation
Herbal Formula:
Carthamus
Ligusticum
Olibanum
Typha
Rheum
Stagnation Reliever
Hong Hua
Chuang Xiong
Ru Xiang
Pu Huang
Da Huang
22%
22%
19%
1 9%
18%
Move Blood, resolve stasis
Move Qi & Blood
Purge LI
Spleen Qi Deficiency
Etiology
Overwork
Water/damp
from food or
environment
Chronic illness
Spleen Qi Deficiency
Phlegm under the skin
Obesity
Spleen Qi Deficiency
Symptoms: • Overweight
• Diarrhea, or dry feces
• Hyperlipemia
• Eexercise intolerance, lassitude
• Pulse: Weak and deep
• Tongue: pale with coating or without coating
Treatment strategy:
Acupuncture:
tonify spleen qi and transform damp
ST-36/40/41, SP-2/3, and BL-20/21
Spleen Qi Deficiency
Herbal formula:
Nelumbo
Alisma
Poria
Coix
*Atractylodes
Atractylodes
Citrus
Cassia
Nelumbo Compound*
He Ye (Lotus)
Ze Xie
Fu Ling
Yi Yi Ren13%
Cang Zhu
Bai Zhu
Chen Pi
Jue Ming Zi
13%
13%
13%
13%
12%
10%
13%
Eliminate Damp, Strengthen SP
Drain Damp
Resolve stagnation, clear Liver
Herbal Formula: Astragalus-atractylodes-lycium
Astragalus
Atractylodes
Lycium
Huang Qi
Cang Zhu
Gou Qi Zi
34%
33%
33%
Kidney Qi Deficiency
Etiology
Chronic illness
Other factors
Kidney Qi Deficiency
Water retention
Phlegm
Obesity
Ageing
Kidney Qi Deficiency
Symptoms:
. Overweight
. Often occurs in the aged patient
. Difficulty in walking or standing, or chronic back pain
. Bone degeneration or osteoporosis
. Pulse: Weak and deep
. Tongue: pale with coating or without coating
Treatment strategy:
Acupuncture:
tonify Kidney qi and transform damp
Bai-hui, Shen-shu, Shen-peng, Shen-jiao
Bl-23/26, SP-6 and Kid-3
Kidney Qi Deficiency
Herbal formula:
Psoralea
Notoginseng
Rheum
Cassia
Psoralea Pill
Bu Gu Zi
Tian Qi
Da Huang
Fan Xie Ye
32%
9%
30%
29%
Tonify Kid Qi/Yang
Move Blood
Purge LI
Kobe
9 yr MC Siamese
Obesity (14 lb)
Less playful and less activity
after moving to a new place 3
weeks ago
Warm-seeking
Tongue: pale & swollen
Pulse: deep & weak
Kidney Qi Deficiency
Rx: Psoralea Pill
Henrietta
12 yo FS Dachshund
Overweight
Able to get around with
support
Pants a lot with slight
cough
Pulse: Fast & deep
Damp-Phlegm
Tongue: red
Rx: Phlegm Fat
Formula
Constipation: a TCVM Approach
CAPT R.M. Clemmons, DVM, PhD, CVA
Regulation of Colon Function
•Colon is like the urinary
bladder
•Innervation by
•Sympathetics from L2-3
•Parasympathetics from
S1-3
•Filling Phase
•Sympathetics
•Yin
•Emptying Phase
•Parasympathetics
•Yang
Propranolol @ 0.25-0.5
mg/kg TID
Constipation
•Definition:
•Constipation
•Infrequent or
incomplete bowel
movements
•Feces are drier or
harder
•Obstipation
•Intractable
constipation
•Impossible defecation
•Patterns
•Heat
•Qi Stagnation
•Qi Deficiency
•Yin/Blood Deficiency
Stomach Heat
Pathogenic Heat
Yin Deficiency
Stomach Heat
channel
Gums
organ
grandchild
child
Cystitis
Ulcer
Colitis
or
Constipation
Differentiation
HEAT
Qi Stagnation
Qi Deficiency
Blood/Yin
Deficiency
Onset
Acute
Wood Person.
Chronic
Chronic
Stool
Dry
On/Off
Small/Thin
Dry
Mucus
Yes
No
No
No/Yes
Thirst
Yes
No
No
Yes
Urination
Short
Normal
Long
Short
Abdm. Pain
No
Flank
No
No
Mouth odor
Foul
No
No
Slight
Preference
Cool
None
Warm
Cool
Purple
Pale
Pale/Red
Tongue color Red
T. Moisture
Dry
Normal
Wet
Dry
T. Coating
Yellow
Normal
No
No
Pulse
Fast/Wiry
Wiry
Weak
Weak/Thready
Constipation/Megacolon
Heat
•Acute onset of colic
•Hot ear & nose
•Cool seeking
•Thirsty
•Foul breath
•Swollen upper palate
•Red & dry tongue
•Fast pulse
Da Chang Qi Tang
Qi Stagnation
•Sub-acute onset of colic
•Bloat & abdominal fullness
•Gaseous bowel movements
•Anorexia
•Purple or red tongue
•Wiry, fast pulse
Xiao Zhang San
Qi Deficiency
•Chronic constipation or colic
•Anorexia
•Loss of body mass
•Weakness
•Pale tongue
•Deep & weak pulse
Fan Xie Ye
Yin/Blood
Deficiency
•Very chronic megacolon with impaction
•Dry flaky skin
•Weak or geriatric patient
•Pale or red, dry tongue
•Fast, weak & thready pulse
Dang Gui Cong
Rong
Acupuncture
Heat
Qi
Stagnation
Qi
Deficiency
Blood/Yin
Deficiency
Points
LI-4
LI-10
GV-1
BL-21
ST-37
LIV-3
GV-1
GB-34
ST-36
SP-6
B-21
BL-15
SP-6
SP-10
GV-1
Method
q d 3d
1-3 times
q wk
2-4 times
q wk
2-5 times
q wk
3-7 times
Kitty Little
15 yr FS Persian
Chronic constipation with
impaction
Dry flaky skin with dandruff
General weakness
Tongue: red & dry
Pulse: deep, weak & thready
Yin/Blood Deficiency
Rx: Dang Gui Cong
Rong
Molly
13 yr FS Maine Coon
Earth personality
Frequent constipation with
impaction
Colon cleaning under
anesthesia 5 times in past 2
years
Recent inappetence
Vomits undigested food with
impacted
Rx: Lactulose & Cisapride
First visit:
No BM for 5 day
Abdomen filled with fecal
balls
Dry haircoat
Warm seeking
Tongue: red & dry
Pulse: weak
Molly Dx
Earth personality
No BM
Dryness
Red & dry tongue
Earth element
(SP/ST)
Yin Deficiency
Weak pulse
Anorexia
Decreased thirst
Qi Deficiency
TCVM Dx: SP/ST (LI) Yin & Qi Deficiency
Molly Rx
Acupuncture:
DN: GV-20, CV-12, ST-25
EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz)
BL-21, BL-25, ST-36- -ST-37 (bilaterally)
Owner reported that Molly defecated a long firm stool 10-16
hours after acupuncture and continued to have BMs every 2-3
days. Stool still dry & still warm seeking.
TCM Herbal:
Ma Zi Ren Wan + Fan Xie Ye
TCVM Approach to Megacolon and
Megaesophagus
“Mega-” Introduction
• If normal directional motion is
inhibited in a tubular organ
• A type of Qi Deficiency
• May be a congenital disharmony
• Yang Jing Deficiency if associated with
other signs of Yang Deficiency
• Yin Jing Deficiency if associated with
other signs of Yin Deficiency
“Mega-” Introduction
• “Directional” or propulsive Qi Deficiency
• May be acquired
• Exogenous Pernicious influences
• E.g. distemper virus, trauma, toxins, poor quality
foods for that species or individual constitution
• Endogenous Pernicious influences
• E.g. hypothyroidism, systemic lupus erythematosus,
hypoadrenocorticism, myasthenia gravis
• Remember that “sthenia” means “full” or “excess”
• “asthenia” means “empty” or “weak” or “deficient”
“Mega-” Introduction
• “Directional” Qi Deficiency
• May be associated with concurrent
Blood or Yin Deficiency
• Subsequent Dryness fails to lubricate
either ingesta or feces
• Megaesophagus swallowing inhibited
• Regurgitate dry ingesta
• Megacolon defecation inhibited
• “Cannot float the boat in a dry river”
Megaesophagus and Megacolon: Types of Wei
Syndromes?
• Wei means “withered” in Chinese to
describe the withering of muscles
• Classical Wei or Atrophy Syndrome is a
condition characterized by a weakness of
the four limbs, progressively leading to
atrophy, a limp state of muscles and
tendons, an inability to walk properly and
eventually paralysis
• This weakness generally occurs without
pain
• So are these “Megas” localized Wei?
Wei Syndrome Pattern Differentiation
• Heat in the Lungs injuring Yin fluidsExcess
• Invasion of Damp-Heat- Excess
• Invasion of Cold-Dampness- Excess
• Stomach and Spleen deficiency- Deficiency
• Spleen and Heart collapse- Deficiency
• Liver and Kidney deficiency- Deficiency
• Blood Stasis in the channels- Combination
of Excess and Deficiency
Relationship Between Pattern
and Pathoetiology
• Wind-Heat causes only Lung-Heat injuring Yin
fluids
• External Dampness leads to Damp-Heat or ColdDampness
• Irregular Diet causes the patterns of Damp-Heat,
Cold-Dampness and Stomach-Spleen deficiency
• Excessive sex and overwork cause the patterns of
Kidney-Liver deficiency and Blood stasis in the
channels
• Trauma causes the pattern of Blood stasis in the
channels
• Shock leads to the pattern of Heart-Spleen
collapse
“Mega-” Primary treatment principles
• Tonify global and local Qi
• Assist directional Qi Flow
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood
• Invigorate Blood
Megaesophagus: Pattern Differentiation
• Qi Deficiency or Yang Deficiency
• may be seen with hypothyroidism, systemic lupus
erythematosus, hypoadrenocorticism, myasthenia
gravis, poor quality foods for that species or
individual constitution
• Blood Deficiency +/- Blood Stagnation
• may be seen with trauma, toxins, poor quality foods
for that species or individual constitution
• Heat Patterns
• may be seen with distemper infection or other febrile
diseases
Megaesophagus Treatment
• Physical assistance with raised
feeding station and soft, highly
digestible foods
• Suggest slow-cooked foods based upon
Bian Zheng (see following lecture)
• Acupuncture based upon global and
local Patterns
• Herbal Formula based upon global
and local Patterns
Megaesophagus: Qi Deficiency
• Clinical Signs
• Fatigue, weight loss, muscle mass loss,
decreased/depressed back Shu points
• Tongue
• Pale, moist
• Pulse
• Feeble, especially middle and upper jiao
Megaesophagus: Qi Deficiency
• Acupuncture: Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach (esophagus
“belongs to” the Stomach)
• BL 13, 14, 15 as local Shu for upper Sea of Qi
• LI 4, LIV 3 to move Qi
• LI 10, ST 36, CV 6 to nourish Qi
• LI 1, LU 11, ST 45 to clear fullness of the chest
in the region of the Heart
Megaesophagus: Qi Deficiency
• Spleen Qi Deficiency
• Si Jun Zi Tang or Four Gentlemen
Decoction
• the chief herb Panax ginseng ren shen is
sweet, warm and tonifies Spleen Qi
• the deputy herb Atractylodis macrocephalae
bai zhu is bitter, warm and strengthens
Spleen Qi and dries Dampness
Megaesophagus: Qi Deficiency
• Spleen Qi Deficiency
• Si Jun Zi Tang
• assistant herb Poria cocos fu ling is sweet, bland and
leeches out Dampness and mildly Tonifies Spleen Qi
• the envoy Glycyrrhiza uralensis gan cao is warm,
sweet and warms and regulates the middle burner
• modify with Hou Po magnolia bark to promote Qi flow,
transform Dampness, relieve food stagnation, direct
rebellious Qi downward for a stifling sensation in the
chest
• Or modify with Platycodon jie geng resolve phlegm
and guide other herbs to upper burner
Megaesophagus: Blood Deficiency
• Clinical Signs
• Dry fur, dry pads, firm, dry stools,
decreased firmness in back Shu points
• Tongue
• Pale, dry, may have slight lavender hue
• Pulse
• Weak, thin, especially middle and upper
jiaos
Megaesophagus: Blood Deficiency
• Acupuncture: Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach for post-heaven
Blood
• BL 17, 18 to engender Blood
• LI 4, LIV 3 to move Qi with Blood
• SP 10, ST 36 to engender Blood and benefit
Spleen and Stomach
• LI 1, LU 11, ST 45 to clear fullness of the chest
in the region of the Heart
Megaesophagus: Blood Deficiency
• Tao Hong Si Wu Tang Four Substances
Decoction with Peach Kernel and Safflower
•
•
•
•
•
•
Shu di huang prepared rehmannia
Dang gui angelica sinensis
Bai shao yao white peony
Chuan xiong ligusticum
Tao ren peach kernel
Hong hua safflower
• Nourish Blood, promote Blood circulation,
removes Blood Stasis
Megaesophagus: Blood Stagnation
• Clinical Signs
• Pain in chest, front Mu and back Shu
points, uncomfortable lying in ventral
recumbency
• Tongue
• Lavender, usually slightly pale and dry
• Pulse
• Wiry, choppy, commonly thin
Megaesophagus: Blood Stagnation
• Acupuncture: Use electro-AP!!
• LI 4, LIV 3, LIV 14 to move Blood
• PC 6 master of the chest, reduce
stagnation
• CV 17 front Mu of the upper Sea of Qi
• BL 17, 18, SP 10 to engender and
circulate Stagnant Blood
• CV 12, GB 21, GV 1 to descend Qi
• LI 1, LU 11, ST 45 to clear fullness of the
chest in the region of the Heart
Megaesophagus: Blood Stagnation
• Xue Fu Zhu Yu Tang Remove Stasis from the Mansion of
Blood Decoction
•
•
•
•
•
•
•
•
•
•
•
Tao ren peach kernel
Hong hua safflower
Dang gui angelica sinensis
Sheng di huang prepared rehmannia
Chuan xiong ligusticum
Chi shao yao red peony
Chuan niu xi cyathula
Jie geng platycodon
Chai hu bupleurum
Zhi ke bitter orange
Gan cao licorice
• Promotes the circulation of Blood and Qi, removes Blood
Stasis, relieves pain
Megacolon: Pattern Differentiation
• Qi Deficiency
• seen with chronic poor quality foods for felids in general
or individual constitution
• Blood Deficiency +/- Blood Stagnation
• seen with trauma, poor quality foods for that species or
individual constitution
• Heat Patterns
• may be seen with chronic Stagnation of Qi or Blood
• Yin Deficiency
• usually a consequence of Chronic Heat
• Mixed Qi and Blood Deficiency
• is very common
Megacolon: Primary treatment principles
• Tonify global and local Qi
• Assist directional Qi Flow
• Tonify Qi of all Bowels (i.e. Stomach
System)
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood
Megacolon: Qi Deficiency
• Clinical Signs
• Firm to moderate stools that are difficult
to expel, thin, small muscles, easily
fatigued
• Tongue
• Pale, normal to moist
• Pulse
• Weak, deep
Megacolon: Qi Deficiency
• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish the
Spleen and Stomach
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for
Large Intestine
• TH 6, TH 5 empirical points for moving
the Qi of the intestines for constipation
Megacolon: Qi Deficiency
• Si Jun Zi Tang or Four Gentlemen
Decoction
• Panax ginseng ren shen is sweet, warm and tonifies
Spleen Qi
• Atractylodis macrocephalae bai zhu is bitter, warm
and strengthens Spleen Qi and dries Dampness
• Poria cocos fu ling is sweet, bland and leeches out
Dampness and mildly Tonifies Spleen Qi
• Glycyrrhizae uralensis gan cao is warm, sweet and
warms and regulates the middle burner
• Modify with Rhubarb da huang as a bitter, cold
herb to move the bowels and dispel stasis
Megacolon: Qi Deficiency
• Fan Xie Ye (I8001)
• Fan Xie Ye senna leaf
•
•
•
•
Sweet, bitter, cold
Enters the Large Intestine Channel
Drains downward and guides out stagnation
For constipation due to heat accumulation in the
Intestines
• Contains anthraquinone glycosides
• Hepatic metabolites stimulate pelvic ganglion
• Purge Large Intestine, resolve food stasis
Megacolon: Blood Deficiency
• Clinical Signs
• Hard, dry stool, dry hair, dry and flakey
skin
• Tongue
• Pale and dry
• Pulse
• Thin, weak
Megacolon: Blood Deficiency
• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish
post-heaven Blood production via SP/ST
• BL 17 and SP 10 to nourish Blood
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for
Large Intestine
• TH 6, TH 5 empirical points for moving
the Qi of the intestines for constipation
Megacolon: Blood Deficiency
• Dang Gui Cong Rong (A0250)
•
•
•
•
•
•
•
•
•
•
Dang gui angelica sinensis
Rou cong rong cistanche
Qu mai dianthus
Shen qu massa fermentata
Fan xie ye senna leaf
Hou po magnolia
Mu xiang saussurea
Xiang fu zi cyperus seed
Zhi ke bitter orange
Tong cao tetrapanax
• Moisten Large Intestine, resolve impacted Large
Intestine
Megacolon: Dryness due to Heat
• Clinical Signs
• Constipation with hard stool difficult to
expel, frequent urination
• Tongue
• Dry, yellow coating
• Pulse
• Deep, rapid or floating and choppy
Megacolon: Dryness due to Heat
• Ma Zi Ren Wan Hemp Seed Pill
•
•
•
•
•
•
Huo ma ren cannabis seed
Xing ren apricot seed
Shao yao peony
Zhi shi immature bitter orange
Hou po magnolia cortex
Da huang rhubarb
• Moisten the Intestines, drains Heat,
promotes Qi movement, unblocks the
bowels
Megacolon: Yin Deficiency
• Clinical Signs
• Constipation, thirst
• Tongue
• Dry, red
• Pulse
• Thin and slightly rapid or weak and
feeble
• Consequence of warm-febrile disease
in weak or Yin Deficient patient
Megacolon: Yin Deficiency
• Acupuncture
• BL 25, ST 25 back Shu and front Mu of
Large Intestine
• SP 6, KI 3, , CV 4, BL 23 to nourish the
Yin
• TH 6, ST 37 to unblock the Large
Intestine
Megacolon: Yin Deficiency
• Zeng Ye Tang Increase the Fluids
Decoction
• Xuan shen scrophularia
• Mai men dong ophiopogon
• Sheng di huang fresh rehmannia
• Generates fluids, moistens dryness
and unblocks the bowels
Megacolon: Stagnation with Heat
• Clinical Signs
• Severe constipation and flatulence, focal
distention and abdominal fullness,
abdominal pain which increases with
pressure, tense and firm abdomen
• Tongue
• Dry, yellow or dry and dark coating
• Pulse
• Deep, excessive
Megacolon: Stagnation with Heat
• Acupuncture
• Ren 4 tonifies Yin and fluids
• LI 11 clears Heat in the Large Intestine
• ST 37 lower He Sea for Large Intestine to
harmonize LI
• ST 44 clears Stomach Heat
• LI 2 clears Large Intestine Heat
• SP 6, KI 6, Ren 12 promote body fluids
Megacolon: Stagnation with Heat
• Da Cheng Qi Tang Major Order the Qi
Decoction
•
•
•
•
Da huang rhubarb
Mang xiao mirabilitum
Zhi shi immature bitter orange
Hou po magnolia cortex
• Vigorously purges Heat accumulation
Conclusion
• Megaesophagus and Megacolon are
predominantly types of localized Qi
Deficiency
• Although heritable (Jing) factors may be
involved, Exogenous Pathogens and poor
quality foods are root cause
• Blood Deficiency with or without Blood
Stagnation may be a complicating factor
• Acupuncture and Herbal formula based
upon Pattern Differentiation may improve
quality of life
TCVM Food Therapy for
Gastrointestinal Disorders
Introduction
•TCVM Cooking Pot
analogy of
gastrointestinal
function
•Used to emphasize
Warm Transformation
•Cold Damage
•Moisture and
Dampness
Cooking Pot and Science
• Western Biomedicine and Digestion
• Mechanical and Biochemical
• Biochemical Digestion
• Based upon Enzyme (Protein) Function
• Enzymes have Temperature Specificity
• Cold Temperatures interfere with
Function
• Cold Foods thus need to be Warmed
by the Body
Cooking Pot and Science
• Biochemical Digestion
• Enzymes have Temperature Specificity
• Cold Temperatures interfere with
Function
• Cold Food is Poorly Enzymatically
Transformed
• Lower rate of digestion and absorption
• Cold Food Challenges the Body to
Warm it
• Challenge to all, especially Geriatrics
• Eventually depletes the body’s Yang Qi
Cooking Pot
•Species specificity
•Damp-engendering foods for one may be
adequate for another
•Age and vigor
•Middle burner has more Yang Qi in younger
animals than older so both environmental
temperature and Xing of foods should be
warmer in geriatric animals
Introduction to Food Therapy
• Food therapy in Traditional Chinese
Veterinary Medicine (TCVM) is based
upon two fundamental principles
• The first principle is of Food
Energetics
• This refers to the effect of a food on
digestive, metabolic, and physiological
processes of the body
• Xing or Thermal Nature is essentially the
post-ingestive effect on the body
Food and Herb Properties
• Xing or Thermal Nature or
Temperature
•
•
•
•
•
Cold such as Seaweed
Cool such as Rabbit
Neutral such as Rice
Warm such as Chicken
Hot such as Lamb
Food and Herb Properties
• Flavor
• Sweet benefits SP/ST and strengthens,
moistens and tonifies deficiency
• Pungent benefits LU/LI and disperses
stagnation and promotes flow
• Salty benefits KI/BL and moistens, softens and
detoxifies
• Sour benefits LIV/GB and stimulates absorption
and contraction
• Bitter benefits HT/SI and drains and counteracts
Dampness
• Bland is the 6th Flavor that drains dampness
TCVM Food Therapy: A Note on the Sweet Flavor
• “Sweet” enters the Spleen and
Stomach and engenders Qi and Blood
• TCVM “Sweet” is a property of many
foods
• This should be obvious since we eat to
make Qi and Blood
• But modern “Sweet” is an historical
anomaly of refinement and excess
availability of simple carbohydrates
TCVM Food Therapy: A Note on the Sweet Flavor
• Modern “Sweet” is an historical
anomaly of refinement and excess
availability of simple carbohydrates
• In fruits this is called “empty sweet”
• Natural sweet or “full sweet” is found
in almost all whole grains, all nuts
and seeds, most vegetables, and
almost all fish and meats
Basic Food Properties: Introduction
• Deficiency conditions are treated
heteropathically with tonifying foods
• Tonifying foods strengthen a bodily
substance or function and are
especially useful for chronic
disharmonies
•
•
•
•
Qi tonics
Blood tonics
Yin Tonics
Yang tonics
Basic Food Properties: Qi Tonics
• Qi tonics maintain and improve the
quantity and quality of available
energy in the body
• Palatable Qi Tonifying foods for
carnivores include
• Beef, Chicken, Date, Fig, Lentil, Mackerel,
Microalgae, Molasses, Oats, Sweet
Potato, Pumpkin and Squash
Advanced Food Properties: Introduction to
Regulation
• Whereas Tonifying foods strengthen a
bodily function or substance Regulating
Foods help remove Excess conditions or
Stagnation
•
•
•
•
•
•
•
Qi Circulating
Blood Circulating
Cooling foods
Warming foods
Foods which counteract Dampness
Water-draining foods
Phlegm-resolving foods
Advanced Food Properties: Qi Circulation
• Qi Circulation is stimulated by the
sweet and pungent flavors
• Palatable Qi Circulating foods for
carnivores include:
• Basil, Cardamom, Carrot, Cayenne,
Clove, Coriander, Garlic, Hawthorn Berry
and Turmeric
Advanced Food Properties: Damp
• Dampness is a result of poor
transformation and/or transportation of
fluids
• Dampness is treated by avoiding dampening
foods (e.g. dairy products, pork and rich meat,
concentrated juices, sugar and saturated fats),
by strengthening the Spleen and Stomach and
by using bitter foods
• Foods which counteract Dampness which
are palatable to carnivores include:
• Alfalfa, Barley, Garlic, Green Tea, Job’s tears,
Kidney Bean, Mackerel, Mushroom, Parsley,
Pumpkin, Rutabaga, Rye and Turnip
Bian Zheng or Pattern Differentiation
• Second Principle
• TCVM is based upon Pattern Differentiation
• Diagnostic systems include
•
•
•
•
•
•
•
Yin/Yang
Eight Principles
Zang-Fu Organs
Four Levels
Six Stages
San Jiao
Pathogenic Factors
Bian Zheng or Pattern Differentiation: Basic
• Treatment is based upon the inverse of
Pattern of Disharmony (Heteropathy)
• Not sure of Herbal Formula?
• Use cardinal signs to choose Food Therapy
• For example, a dog with loose stools,
weakness, shortness of breath, pale moist
tongue and a weak pulse might be
diagnosed as Spleen Qi Deficient
• The treatment principle is then to Tonify
(Deficient) Spleen Qi
Bian Zheng or Pattern Differentiation: Basic
• For the Spleen Qi deficient dog the
weakness, pale tongue and the weak
pulse suggest Deficiency
• Use Tonifying foods such as Chicken,
Oats, Quinoa, Yam and many of the
culinary herbs to either add to the
current diet or create a Food Therapy
Formula for this dog
Bian Zheng or Pattern Differentiation: Advanced
• Treatment is based upon the inverse
of Pattern of Disharmony
(Heteropathy)
• A diagnosis of Spleen Qi Deficiency?
• Treated by Tonifying (Deficient) Spleen
Qi
• Classical Herbal Formulae
• Already designed to treat Patterns
• “Elegant” Food Therapy
• May formulate based upon detailed
analysis of classical Herbal Formula
Spleen Qi Deficiency: Introduction
• General signs of Qi Deficiency include
lethargy and fatigue
• Qi Deficiency signs are exacerbated by
activity and improved with rest
• Primary signs of Spleen Qi Deficiency
include
•
•
•
•
•
•
Loose stools
Fatigue
Shortness of breath
Reduced appetite
Pale moist tongue
Weak pulse
Bian Zheng and Herbal Formula
• Spleen Qi Deficiency
• Tonify Spleen Qi with the herbal formula Si Jun Zi
Tang or Four Gentlemen Decoction
• the chief herb Panax ginseng ren shen is sweet, warm
and tonifies Spleen Qi
• the deputy herb Atractylodis macrocephalae bai zhu is
bitter, warm and strengthens Spleen Qi and dries
Dampness
• the assistant herb Poria cocos fu ling is sweet, bland
and leeches out Dampness and mildly Tonifies Spleen Qi
• the envoy Glycyrrhizae uralensis gan cao is warm, sweet
and warms and regulates the middle burner
Si Jun Zi Tang and Food Therapy
• A Food Combination that would have
similar actions to Si Jun Zi Tang
could include
• Warm, sweet Chicken which enters the
Spleen and Stomach to Tonify Qi
• Warm, sweet Oats to strengthen the
Spleen and dry Dampness
• Or neutral, bitter Rye to drain Dampness
and Water from the Spleen
Si Jun Zi Tang and Food Therapy
• A Food Combination that would have
similar actions to Si Jun Zi Tang
• Cool, sweet Mushroom to leech
Dampness and mildly tonify Spleen Qi
• Neutral, sweet and sour Coriander to
direct the actions to the middle burner
and mildly warm the Spleen and
Stomach
• Use acrid, warm, aromatic Cardamom
(Sha Ren) if there is also Phlegm or
vomiting
Spleen Qi Deficiency with Damp
• Shen Ling Bai Zhu San Ginseng, Poria, and
Atractylodes Powder
•
•
•
•
•
•
•
•
•
•
Ren shen ginseng
Bai zhu white atractylodes
Fu ling poria
Zhi gan cao honey-fried licorice
Shan yao dioscorea
Bai bian dou dolichoris lablab
Lian zi nelumbinis
Yi yi ren coix
Sha ren amomum
Jie geng platycodon
• Augments the Qi, strengthens the Spleen, leaches
out Dampness and stops diarrhea
Shen Ling Bai Zhu San Ginseng, Poria, and
Atractylodes Powder
• Ren shen ginseng, Bai zhu white atractylodes, Fu
ling poria, and Zhi gan cao honey-fried licorice are
Si Jun Zi Tang
• Shan yao dioscorea tonifies the Spleen and
supports the chief herbs
• Bai bian dou dolichoris lablab and Lian zi
nelumbinis strengthen the Spleen and stop
diarrhea
• Yi yi ren coix strengthens the Spleen and leaches
out Dampness
• Sha ren amomum transforms Dampness and
promotes Qi movement
• Jie geng platycodon unblocks the flow of Lung Qi
Shen Ling Bai Zhu San
Food Therapy
• Ren shen ginseng, Bai zhu white atractylodes, Fu ling poria,
and Zhi gan cao honey-fried licorice are Si Jun Zi Tang
• Warm, sweet Chicken which enters the Spleen and Stomach to
Tonify Qi
• Warm, sweet Oats to strengthen the Spleen and dry Dampness
• Cool, sweet Mushroom to leech Dampness and mildly tonify
Spleen Qi
• Neutral, sweet and sour Coriander to direct the actions to the
middle burner and mildly warm the Spleen and Stomach
• Yam and/or Sweet potato are neutral, sweet and tonify the SP
• Pumpkin is sweet, neutral and dries Damp in the GI tract
• Rutabaga is sweet, bitter, tonifies SP, circulates Qi, dries
Damp
• Aduki bean is neutral, sweet, sour and dries Damp and Water
• Black pepper is sweet, pungent and hot, and transforms
Damp and Phlegm
Spleen Yang Deficiency: Introduction
• Cold from Deficiency in the Middle
Burner
• Disrupts Qi Mechanism
• Principle signs
• Epigastric and abdominal distention and
pain
• Fatigue
• Cold extremities
• White, slippery tongue coating
• Slow, deep pulse
Spleen Yang Deficiency: Herbal Formula
•Li zhong wan or Regulate the
Middle Pill
•Actions: Warms the middle
burner and strengthens the
Spleen and Stomach
Spleen Yang Deficiency:
Li zhong wan
•Indications: diarrhea with watery
stool, nausea and vomiting, little
thirst, loss of appetite, abdominal
pain
•Tongue: pale with white coat
•Pulse: thin, deep
Spleen Yang Deficiency:
Li zhong wan
• Zingiberis officinalis gan jiang warms the
Spleen and Stomach Yang and dispels
interior Cold
• Radix ginseng ren shen strongly tonifies
the Yuan Qi and reinforces the Yang
• Atractylodis macrocephalae bai zhu
tonifies SP/ST and dries damp
• One warming, one tonifying, one drying
• Glycyrrhizae uralensis zhi gan cao
augments the middle burner Qi
Spleen Yang Deficiency
Food Therapy
• Lamb is sweet, hot, enters the Spleen
and Kidney and tonifies Yang
• Sweet potato is sweet, warm, enters
the Kidney and Spleen and tonifies
Yin and Qi and dispels Cold
• Corn is sweet, neutral, enters the KI,
LI and ST, tonifies Qi and dries damp
• Fenugreek seed is warm, bitter,
circulates Qi and tonifies Yang
• Or Ginger as in Li zhong wan
Stomach Heat
• Bai Hu Tang White Tiger Decoction
•
•
•
•
Shi gao gypsum
Zhi mu anemarrhena
Zhi gan cao honey fried licorice
Geng mi nonglutinous rice
• Clears Qi-level Heat, drains Stomach
Fire, generate fluids, and alleviates
thirst
Bai Hu Tang White Tiger Decoction
• Shi gao gypsum is sweet, acrid and
extremely cold to Clear Heat and Drain Fire
• Zhi mu anemarrhena is bitter, cold and
moistening, Clears Heat and enriches Yin
• Zhi gan cao honey fried licorice and Geng
mi nonglutinous rice benefit the Stomach
and protect the fluids, and protect the
middle Jiao from the first two cold
ingredients
Bai Hu Tang Food Therapy
• Crab is cold, salty, enters the Liver and
Stomach, nourishes Yin and Clears Heat
• Millet is cool, sweet, salty, enters the
Kidney, Spleen and Stomach and Clears
Heat
• Squash is warm, sweet, enters the Spleen
and Stomach, tonifies Qi and protects from
Cold
• Coriander is neutral, sweet, bitter, enters
the Stomach and protects from the Cold
Food and Qi Stagnation
• Yue Ju Wan Escape Restraint Pill
•
•
•
•
•
Cang zhu red/grey atractylodes
Chuan xiong ligusticum
Xiang fu cyperus
Shan zhi zi gardenia
Shen qu massa fermentata
• Promotes the movement of Qi and
releases constraint; “Five Stagnation”
(Qi, blood, food, phlegm and heat)
Yue Ju Wan Escape Restraint Pill
• Cang zhu red/grey atractylodes dries
Dampness and resolves Phlegm
• Chuan xiong ligusticum releases
constrained Blood to resolve fixed pain
• Xiang fu cyperus releases constraint and
disperses Qi Stagnation
• Shan zhi zi gardenia clears Heat from
Sanjiao, resolves Fire from constraint and
acid reflux
• Shen qu massa fermentata relieves
constraint caused by food stagnation
Yue Ju Wan Food Therapy
• Crab is cold, salty, enters the Kidney and
Stomach and circulates Blood
• If crab is unavailable, Chicken is warm,
sweet, enters the SP/ST and circulates
Blood
• Carrot is neutral, sweet, enters the Liver,
Lung, and Spleen and circulates Qi
• Wheat germ is cold, sweet, enters the Heart
and Stomach and circulates Blood
• Garlic is hot, sweet, pungent, enters the
Heart, Liver, Lung and Stomach, resolves
Damp, Phlegm and circulates Qi
Megacolon: Dryness due to Heat
• Ma Zi Ren Wan Hemp Seed Pill
•
•
•
•
•
•
Huo ma ren cannabis seed
Xing ren apricot seed
Shao yao peony
Zhi shi immature bitter orange
Hou po magnolia cortex
Da huang rhubarb
• Moisten the Intestines, drains Heat,
promotes Qi movement, unblocks the
bowels
Ma Zi Ren Wan
Hemp Seed Pill
• Huo ma ren cannabis seed moistens the
intestines and unblocks the bowels
• Xing ren apricot seed directs Qi downward
and moistens the intestines
• Bai Shao yao peony nourishes the Yin and
harmonizes the interior
• Zhi shi immature bitter orange breaks up
accumulation, especially in the intestines
• Hou po magnolia cortex removes fullness
and distension
• Da huang rhubarb is a purgative
Ma Zi Ren Wan Food Therapy
• Rabbit is cool, sweet, nourishes Qi and Yin and
enters the Large Intestine and Liver channels
• If Rabbit is unavailable, Beef is neutral, sweet,
nourishes Yin, Qi and Blood and enters the SP, ST
and LI
• Alfalfa sprouts are neutral, salty and bitter, nourish
Yin and Blood and enter the LI
• Cabbage is neutral sweet and pungent, enters the
ST and LI and dispels Heat
• Tofu is cool, sweet, nourishes Yin and enters the
Spleen, Stomach and Large Intestine
• Honey is neutral, sweet, enters the Lung, ST and LI
and moistens the bowel
• Saffron is neutral, sweet and circulates Qi
Historical TCM Example of “Food as Medicine”
• Dang gui sheng jiang yang rou tang
or Mutton stew with Angelica and
Fresh Ginger Decoction
• Angelica sinensis dang gui
• Zingiberis officinalis recens sheng jiang
• Mutton yang rou
• Actions: Warms the interior,
nourishes Blood and alleviates pain
Geriatrics and Food Therapy
• The astute veterinarian can already
see that Raw Foods, although
commonly healthful for young, active,
warm animals, may be too cooling
and stagnating for geriatric, inactive,
cool animals
• This is compounded when there is a
concurrent Spleen Qi or Yang
deficiency
Geriatrics, Processing and Xing
•Important!
•Cooking generally adds “warmth”
to foods
•Because Warm Transformation is
decreased with age
•Warming and moving foods more
important
Conclusion
• TCVM Food Therapy is as important
as Acupuncture and Herbal Medicine
to facilitate complete healing
• Classical Herbal Formula strategies
may be used to construct TCVM Food
Therapy formulas
• Knowledge of Food Energetics is
necessary to understand and develop
food therapy formulas
Another Way for TCVM Feeding
•Use a balanced base
food
•Supplement for
constitution,
disorders or
deficiencies
•Add additional
therapy as needed
Base TCVM Diet for Dogs
•3 oz chicken heart
•2 oz turkey breast
•3 oz ground beef
•3 oz beef kidney
•2 oz beef liver
•3 oz white fish
•4 oz tofu
•2 sardines in olive oil
•1 T olive oil
•1/2 c broccoli
•1/2 c carrots
•2 oz mushrooms
•1/2 c spinach
•1/4 c red peppers
•1/4 c green peppers
•1 T vinegar
•1 clove garlic
•1500 mg calcium
Contains 1250 calories with a 48/11/42 percent
protein/carbohydrate/fat content.
Deficient Fire Food
•4 oz chicken heart
•4 oz chicken
•4 oz lamb
•1/8 t cayenne
•750 mg calcium
Contains 800 calories with a 47/1/52 percent
protein/carbohydrate/fat content.
Deficient Earth Food
•1 T fresh ginger
•4 oz ground beef
•4 oz sweat bread
•750 mg calcium
Contains 665 calories with a 34/1/65 percent
protein/carbohydrate/fat content.
Deficient Metal Food
•8 oz rice
•4 chicken egg
•4 oz egg plant
•600 mg calcium
Contains 650 calories with a 20/36/44 percent
protein/carbohydrate/fat content.
Deficient Water Food
•2 oz bamboo shoots
•4 oz pork
•4 oz duck
•600 mg calcium
Contains 572 calories with a 42/1/57 percent
protein/carbohydrate/fat content.
Deficient Wood Food
•3 oz chicken liver
•1/2 c asparagus
•4 oz chicken
•600 mg calcium
Contains 356 calories with a 61/6/33 percent
protein/carbohydrate/fat content.
Qi Tonic Food
•4 oz ground beef
•1/4 cup spinach
•4 oz beef liver
•3 oz string beans
•1 T olive oil
•1000 mg calcium
Contains 704 calories with a 37/10/53 percent
protein/carbohydrate/fat content.
Yang Tonic Food
•4 oz lamb kidney
•1/2 t fennel
•1 T olive oil
•1/4 cup red pepper
•1/4 t cinnamon
•400 mg calcium
Contains 290 calories with a 38/6/56 percent
protein/carbohydrate/fat content.
Yin Tonic Food
•4 eggs
•4 oz cheddar cheese
•2 oz chicken liver
•4 oz firm tofu
•1 T olive oil
•500 mg calcium
Contains 1225 calories with a 27/3/70 percent
protein/carbohydrate/fat content.
Blood Tonic Food
•4 oz ground beef
•2 oz seaweed
•4 eggs
•500 mg calcium
•1 T olive oil
Contains 958 calories with a 25/20/55 percent
protein/carbohydrate/fat content.
To Use TCVM Food
•Use 50% of diet as base
food
•Add 25% for any
deficiency
•Fire
•Earth
•Metal
•Water
•Wood
•Add 25% of Grandparent
for excess
•Add 25 % of Grandchild if
balanced
•Add 25% tonic
•Qi
•Yang
•Yin
•Blood