CASE STUDIES EXAM 1 Flashcards
(109 cards)
1
Q
INFLUENTIAL POINTS -
Hui Meeting Points ZANG FU QI BLOOD
A
ZANG: LV-13
FU: REN-12
QI: REN-17
BLOOD: BL-17
2
Q
INFLUENTIAL POINTS / HUI MTG POINTS - SINEW VESSELS BONE MARROW
A
SINEW: GB-34
VESSELS: LU-9
BONE: BL-11
MARROW: GB-39 (benefits sinews & bones, like weakness/contraction & pain of limbs)
3
Q
COMMAND POINTS - Disorders of... Head & Nape Face & Mouth Chest & Lateral Costal Region Abdomen Back & Lumbar Region Resuscitation
A
LU-7: Head & Nape LI-4: Face & Mouth PC-6: Chest & Lateral Costal Region ST-36: Abdomen BL-40: Back & Lumbar Region DU-26: Resuscitation
4
Q
FX of REN-12
A
- Transforming & Distributing the Essence of Food & Drink throughout the Body
- Tonify ST Qi, ST Yin & SP Qi to Resolve Phlegm
5
Q
CHANNELS / REGIONS
A
12 Primary Ch, 12 Divergent Ch
Luo-Conn Ch, 12 Sinew/Muscle Ch
8 Extraordinary Channels
12 Cutaneous Regions
6
Q
8 EXTRAORDINARY CHANNELS
A
CHONG Mai, DAI Mai, DU Mai, REN Mai
YANG QIAO Mai, YIN QIAO Mai
YANG WEI Mai, YIN WEI Mai
7
Q
8 EXTRAORDINARY CHANNELS
CHONG MAI - PENETRATING Vessel
A
Sea of BLOOD
Influence Abdomen, Uterus, Chest, Heart
Counterflow of Qi, Ab Urgency, Gynecological Disorders, Atrophy of Leg
8
Q
8 EXTRAORDINARY CHANNELS
DAI MAI - GIRDLING Vessel
A
Vertical Path to 12 PRIMARY Channels
Influence the Genitals, Waist, Hips,
Treats Ab fullness, waist & lumbar spine, Leucorrhea, DH in lower burner, mensus, infertility, weakness of legs
9
Q
8 EXTRAORDINARY CHANNELS
DU MAI - Governing Vessel
A
Governs all YANG Channels
Provides Heat (Yang Qi) to warm all Organs & Ch
Influences Fx of Brain, Head & Sense Organs
Strengthens Constitution & Immunity
Regs Fx of Uterus, KD, HT, Brain & Channels
Influences all Channels d/t conn w/Ren & Chong
10
Q
8 EXTRAORDINARY CHANNELS
YANG QIAO MAI - Yang Motility Vessel
A
Dominates ACTIVITY
Influences Lat Aspect of Leg, Back, Neck, Head & Eyes
Treats Daytime Epilepsy, Insomnia, tight muscles on side of leg, eversion of foot
11
Q
8 EXTRAORDINARY CHANNELS
YIN QIAO MAI - Yin Motility Vessel
A
Dominates QUIETNESS
Influences Inner side of legs, Abdomen & Eyes
Treats Night time Epilepsy, Genital pain, Inversion of Foot
12
Q
8 EXTRAORDINARY CHANNELS
YANG WEI MAI
A
Dominates EXTERIOR - Tai Yang, Shao Yang
Balances YANG QI
Treats Bi-Polar, OCD, excessive Anger, Vertigo, Alt Fever & Chills
13
Q
8 EXTRAORDINARY CHANNELS
YIN WEI MAI
A
Dominates INTERIOR - Qi in YIN Ch & Organs (esp. HT, LU, ST, SP)
Treats chest pain, cardiac/epigastric pain, ab pain & ext. genitalia, mental instability, low self esteem, lack of will power
14
Q
8 EXTRAORDINARY CHANNELS
REN MAI - Conception/Directing Vessel
A
Sea of YIN Channels - helps reg Qi of all YIN Ch
Influences Ab, thorax, LU, throat, face
Important in Reproductive system - esp. women
Treats issues w/ fertility, conception, pregnancy, childbirth, menopause
15
Q
4 STAGES OF PENETRATION (WEN BING)
A
Wei
Qi
Ying or Nutritive
Blood
16
Q
QI LEVEL - 4 BIGS
A
Fever
Thirst
Sweating
Pulse
17
Q
EFP at YING LEVEL
A
Chronic conditions at this level
People start to waste away, disease consumes weight and Body Fluids
Low-grade fever, Yin has contained Heat a little so that it isn’t as exuberant
Fever usually comes and goes
Herbs must be used
18
Q
EFP at BLOOD LEVEL
A
General fever, Reckless Blood Extreme restlessness; irritability Insomnia, Stuttering Very dark skin eruptions Tremors; convulsions; seizures Less fluids allow Wind to enter vessels
19
Q
IDENTIFICATION OF PATTERNS ACCORDING TO 4 LEVELS - DEFENSIVE QI or WEI LEVEL
A
Wind Heat
Summer Heat
Dry Heat
Damp Heat
20
Q
IDENTIFICATION OF PATTERNS ACCORDING TO 4 LEVELS - QI LEVEL
A
Lung Heat (Heat in Chest and Diaphragm) Stomach Heat Intestines Dry Heat Gall Bladder Heat Damp Heat in Stomach and Spleen
21
Q
IDENTIFICATION OF PATTERNS ACCORDING TO 4 LEVELS - NUTRITIVE or YING LEVEL
A
Heat in the Nutritive Qi Level
Heat in the Pericardium
22
Q
IDENTIFICATION OF PATTERNS ACCORDING TO 4 LEVELS - BLOOD LEVEL
A
Heat victorious moving Blood Heat victorious stirring Wind Empty Wind agitating in the Interior Collapse of Yin Collapse of Yang
23
Q
SOAP - O,P,Q,R,S,T for Pain
A
O = Onset, P = Provocation &/or Alleviation Q = Quality of Pain, R = Region & Radiation S = Severity, T = Time (history)
24
Q
Fx of Xi Cleft Points
A
Where Qi & Blood gather & plunge more deeply.
Mainly used to treat acute conditions and pain.
Yin channels (Lu, Sp, Ht, Ki, Pc, Liv) have add’l action of treating disorders of blood.
25
Fx of YUAN SOURCE Points
Points where the ORIGINAL QI surfaces & lingers.
Mostly use to TONIFY YIN organs.
However the YANG Source Points are mostly used in EXCESS patterns to expel pathogenic factors.
26
Fx of LUO CONNECTING Points treat
Disorders of their INT/EXT related Ch or Zangfu.
Disorders in REGIONS reached by Luo-Conn Ch.
PSYCHO-EMOTIONAL disorders.
Can be used in FULL and EMPTY conditions.
27
Fx JING-WELL Points
Clear HEAT, Restore CONSCIOUSNESS and Rescue COLLAPSE.
| Has strong action for CLEARING EXCESS PATHOGENIC factors
28
Fx SHU STREAM Points treat
Disorders of the ZANG.
Feeling of HEAVINESS in the body & JOINT PAIN
Shu-stream points on the Yin channels are the primary points for tonifying & harmonizing their respective zang.
29
Fx of CUTANEOUS REGIONS
CIRCULATE QI & BLOOD (especially the Wei Qi to the body’s surface)
REG FX of SKIN & PORES
STRENGTHEN body's IMMUNITY
Directly related to LU Qi
30
Fx of DIVERGENT CHANNELS
Dist QI & BLOOD to HEAD & FACE.
Integrate areas not conn. by Primary Ch
Strengthen the YIN-YANG Relationship btw INT/EXT paired CH & Zangfu.
Branch out from the 12 primary and have no specific points of their own.
31
HEADACHE by Dx - TOP OF HEAD
Usually LV
Most often LV Bld def- dull, improves w/lying down
LV Yang Rising - Sharp
Could also be Qi and Blood def or Ht Blood def
32
HEADACHE by DX - SIDES OF HEAD
Usually GB
Liv Yang Rising, Liv Fire, Liv Wind
Mainly sharp, throbbing
33
HEADACHE by DX - ONE SIDED
GB channel
Liv Yang Rising, Liv Fire
It is said that L side def and R side excess but this is not always true.
34
HEADACHE by Dx - TEMPLES
GB channel
Liv Fire, Liv Yang Rising, Liver Wind
Throbbing
35
HEADACHE by Dx - BEHIND THE EYES
LV channel
LV Blood def if dull
LV Yang Rising if sharp/severe
36
HEADACHE by Dx - BACK OF HEAD
KD Def manifesting on the BL channel
| If acute, it is due to external Wind, usually accompanied by stiffness of neck and back
37
HEADACHE by Dx - FOREHEAD
ST channel: ST def-dull, ST heat-sharp
Sometimes due to Dampness/Phlegm- in this case, heavy sensation in the head, fuzziness, dizziness, blurred vision.
If after Wind Cold/Heat, it cold be from Wind not being expelled.
38
HEADACHE by Dx - WHOLE HEAD
If CHRONIC, it is due to KD YIN or KD Essence DEF, they will be dull accompanied by FEELING of EMPTINESS.
If ACUTE, due to invasion of EXT WIND, they will be SHARP & SEVERE.
39
Dx by TYPE OF HA PAIN - DULL
Generally indicates Empty conditions
| Qi def, Blood def, Liv Blood def, Ki def
40
Dx by TYPE OF HA PAIN - FEELING OF HEAVINESS
Dampness/Phlegm preventing clear Yang from ascending to head and turbid Yin from descending.
Phlegm is more obstructive to the “orifices” and sense organs causing dizziness and blurred vision.
41
Dx by TYPE OF HA PAIN - DISTENDING (THROBBING)
Typically LV Yang or LV Fire and will present on sides of head.
Also due to Exterior Wind Heat which will affect whole head.
42
Dx by TYPE OF HA PAIN - STIFF
Usually invasion of Wind Cold
| If Chronic and accompanied by stiff shoulders and neck, it indicates Liv Yang Rising.
43
Dx by TYPE OF HA PAIN - PULLING
Internal Liv Wind
44
Dx by TYPE OF HA PAIN - STABBING, BORING
Fixed in one place, intense, and chronic, indicates Blood Stasis
45
Dx by TYPE OF HA PAIN - FEELING OF EMPTINESS
Def of Ki Yin or Yang
46
DX According to Amelioration and Aggravation
| WEATHER
Worse with heat -Liv Yang Rising or Liv Fire
Worse with cold -Yang def
Worse with damp weather -Dampness or Phlegm
Better with app of cold -LV Yang Rising or LV Fire
47
DX According to Amelioration and Aggravation
| TIME OF DAY
Chronic HA worse during day-indicate def of Qi/Yang, or Dampness.
Chronic HA worse at during evening- indicate def of Blood or Yin (could cause Yang Rising)
48
DX According to Amelioration and Aggravation
| ACTIVITY / REST
Worse w/activity- Def Qi or Blood
Better w/activity-LV Yang Rising or Phlegm
Better w/rest or lying down- Def Qi or Blood
Worse lying down- Dampness or Phlegm
49
Western Differential Dx
| INTRACRANIAL - INFLAMMATORY
Meningitis: inflammation of the meninges occurring during a febrile disease, often starts during a viral infection such as influenza or bacterial infection such as respiratory or ear infection, occur mainly in children before the age of 5.
Symptoms: severe HA, fever, vomiting, neck rigidity and if severe, mental confusion.
Test: Brudzinski’s, positive if with patient lying supine and chest held firmly to bed, try to flex the neck, in meningitis this will cause involuntary flexion of hips.
50
Western Differential Dx
| NON INFLAMMATORY - VASCULAR
Migraine: most frequent cause of recurrent HA, consists of initial constriction of head arteries followed by vasodilatation of vessels causing throbbing. Attacks are precipitated by stress, consumption of cheese, chocolate, red wine, contraceptive pill.
Symptoms: mainly unilateral and usually around the eye, severe, throbbing, photophobia, nausea, vomiting.
51
Western Differential Dx
| CEREBRAL HEMORRHAGE
More frequent in men over 40, intense head pain, neck rigidity, vomiting followed by loss of consciousness.
52
Western Differential Dx
| NEOPLASTIC - CEREBRAL TUMOR
Uncommon cause of HA, but if HA become progressively worse in terms of frequency, duration, intensity and are accompanied by vomiting, intellectual impairment, tumor may be suspected.
53
Western Differential Dx
| HYPERTENSIVE - ESSENTIAL HYPERTENSION
Persistent HBP without apparent cause. HA manifests usually on vertex or occipital, also neck muscles stiffness, tinnitus, irritability, and of course HBP.
54
Western Differential Dx
| HYPERTENSIVE - SECONDARY HYPERTENSION
HBP secondary to other factors like Ki disease, other manifestations are tiredness, edema, high albumin (protein) in the blood.
55
Western Differential Dx
| CRANIAL - SINUSITIS
Inflammation of the sinuses, HA is clearly located on the face (frontal, ethmoidal, maxilary), other symptoms include nasal congestion, feeling of muzziness of the face.
56
Western Differential Dx
| CRANIAL - OTITIS MEDIA
Common in small children confusing earache with HA, sometimes accompany by fever.
57
Western Differential Dx
| EXTRA CRANIAL - GLAUCOMA
Raised intraocular fluid pressure, rare before middle age, pain is around of behind the eyes, easily mistaken for migraine, worse in the evening, accompanied by haloes ad blurred vision.
58
Western Differential Dx
| CERVICAL SPONDYLOSIS
Includes arthritis and disc degeneration of the cervical area, causes occipital HA extending to the neck and upper shoulder area, X-rays will show narrowing of the intervertebral spaces and/or osteophyte formation.
59
Western Differential Dx
| TRIGEMINAL NEURALGIA
Inflammation of one or more of the 3 trigeminal nerves (part of the cranial nerves), usually seen in elderly, pain is unilateral, very intense, pain can occur on the forehead, eye, cheek, temple, and/or jaw depending on the affected nerve.
60
HA - LV Yang Rising vs. LV Fire
LV FIRE: There IS an actual PATHO FACTOR- HEAT.
LV YANG RISING: An IMBALANCE btw YIN/YANG but NO PATHO FACTOR.
Same symptoms as Liv Yang but Liv Fire also has thirst, scanty dark urine, constipation, red eyes, red tongue/yellow coating. Same type of HA as Liv Yang but more intense, tends to be more fixed location and more often presents with nausea/vomiting.
61
HA BEFORE MENSES
HA Worse - LV Yang Rising or LV Qi Stagnation
62
CHANNELS - FROM MOST SUPERFICIAL TO DEEPEST
```
Cutaneous regions
Minute collateral
Sinew/Muscle channels
Lou-connecting channels
Primary channels
Divergent channels
Extraordinary channels
```
63
```
FRONT MU POINTS
PC
HT
LV
GB
```
PC: REN-17
HT: REN-14
LV: LV-14
GB: GB-24
64
```
FRONT MU POINTS
SP
SI
SJ
ST
```
SP: LV-13
SI: REN-4
SJ: REN-5
ST: REN-12
65
```
FRONT MU POINTS
BL
KD
LI
LU
```
BL: REN-3
KD: GB-25
LI: ST-25
LU: LU-1
66
ETIOLOGY OF BACK PAIN
```
Excessive Physical Work
Excessive sexual activity
Pregnancy and Childbirth
Invasion of External Cold and Dampness
Overwork
Inadequate Exercise
```
67
MOST COMMON PATHOLOGIES - BACK PAIN
| Retention of Damp
- When cold predominates
- When Damp predominates
- When cold and damp are the cause, the lower back ache is a form of Bi Syndrome
68
MOST COMMON PATHOLOGIES - BACK PAIN
| Stagnation of Qi & Blood
- Characterized by a severe, stabbing pain
- Pain becomes worse and better with light exercise (worse with overexertion)
- Tender to touch
- Does not respond to weather changes
- Much worse with standing or sitting. It is also
- Unaffected by the application of heat.
- Marked rigidity and stiffness of the back muscles and inability to flex, extend or turn the waist
69
MOST COMMON PATHOLOGIES - BACK PAIN
| Kidney Deficiency
- Pain is dull and comes in bouts
- Better w/rest & worse when pt is overtired
- Aggravated by sexual activity.
- If from Def of KD Yang, may be a cold sensation
- Might be slight improvement with heat
- KD deficiency is more common in the middle-aged and elderly. It happens in children when it is hereditary or from over-exertion from work or sports.
70
MOST COMMON PATHOLOGIES - BACK PAIN
| LV Qi Stagnation
- Can cause acute or chronic backache
- LV is involved in 2 ways: (1) It affects the sinews of the spine & (2) it has a sphere of influence on the lower jiao that, when stagnant, causes contraction, spasm and stiffness.
- Etiology is emotional stress such as anger, resentment, frustration, guilt
- Frequently occurs against a background of Kidney deficiency.
71
LBP: There is considerable interaction between the pathologies
Repeated invasion of Cold Dampness leads to permanent retention of Cold Dampness in the back muscles. This weakens the KD as Cold Damp interferes with KD’s transformation of Water and leads to Kidney Def, and on the other hand, it obstructs the circulation of Qi and Blood in the area and gives rise to stagnation of Qi and Blood.
72
ACUPUNCTURE - TAI YANG / GR YANG STAGE
Invasion of WC with Cold Predominance
Invasion of WC with Wind predominance
UB 12 with cupping, Lu 7, LI 4. Moxa
UB 12 with cupping, Lu 7, LI 4, GB 20, St 36
73
ACUPUNCTURE - TAI YANG / GR YANG STAGE
| Invasion of WH (also mentioned in SHL)
LI 4, LI 11, Lu 7, UB 12, SJ 5
74
ACUPUNCTURE - TAI YANG / GR YANG STAGE
Accumulation of Blood
Accumulation of Water
UB 62, SI 3 (in combo), UB 39, SI 5, UB 22, Sp 10, Liv 1
Ren 9 (Water Separation), Ren 3, Lu 7, UB 22 (SJ), UB 39 (lower He Sea SJ)
75
ACUPUNCTURE - YANG MING / BR YANG STAGE
Channel Pattern
Organ Pattern
LI 11, Du 14, P3, St 44, St 43
LI 11, Du 14, P 3, St 44, St 43, St 25 (Front Mu Li), Sp 15, St 37(Lower He Sea Li), Sp 6
76
ACUPUNCTURE - SHAO YANG / LESSER YANG
SJ5, SJ 6, GB 41, Du 13
77
ACUPUNCTURE - TAI YIN / GREATER YIN STAGE
Ren 12, UB 20, St 36, Sp 9, Moxa
78
ACUPUNCTURE - SHAO YIN / LESSER YIN
Cold Transformation
Hot Transformation
UB 23, Ren 4, Ren 6, Ren 8, K 7, K 3. Moxa
Ren 4, Ren 6, K 3, K 6, Sp 6.
79
ACUPUNCTURE - JUE YIN / TERMINAL YIN
Liv 3, LI 4, Sp 4, and P 6
80
POINT - ACUTE LBP
Lower Part of Back
(whether unilateral or bilateral)
UB-40
81
POINT - ACUTE LBP
| If the pain is unilateral and slightly higher, level with the navel
SI-3
82
POINT - ACUTE LBP
| If there is a pain in the leg between the UB and GB line
UB-58
83
POINT - ACUTE LBP
If the pain is unilateral and radiates down one leg. It is also selected when the pain radiation down the leg affects more than one channel.
UB-62
84
POINT - ACUTE LBP
| If walking is difficult. From this point one should obtain a needling sensation that radiates up the UB channel.
UB-59
85
LBP ACUTE conditions usually due to
Cold Dampness or
| Qi & Blood Stagnation
86
NEEDLING for Acute LBP
1st - Needle Distal point, manipulate vigorously while pt. gently flexes and turns waist (while standing) - needles retained for 15 mins.
2nd - Distal needles are removed. Pt lays down for Local points to be needled.
87
CHRONIC LBP conditions are ALWAYS due to KD DEF that can be combined with retention of Cold Damp or Qi and/or blood stagnation...T/F?
TRUE
88
LOCAL Points for Acute LBP are selected based on
Tenderness upon Palpation
89
CHRONIC LBP - DISTAL POINTS
| Men vs. Women
In MEN, needle SI-3 on LEFT and UB-62 on right.
In WOMEN, needle SI-3 on the RIGHT and UB-62 on the left and the REN channel points: Lu-7 on the left and K-6 on the right.
Remove needles in reverse order.
90
SCIATICA - DISTAL POINTS USED
```
UB-40
UB-57
UB-58
UB-62
GB-40 or GB-41 (if down GB Ch)
KD-4
```
91
SCIATICA - LOCAL POINTS USED
```
Tunzhong, UB 36 and 37 (pain from buttocks)
GB 30 & 31 (pain along GB Ch)
GB 34 (pain only to knee)
GB 34 (pain in lower leg)
```
92
Unless there is damp heat in the UB or GB channel, noxa is extremely beneficial for sciatica. This is best done with moxa pole and heating the area around the needle, especially UB 36 and UB 37...T/F?
TRUE
93
The Most Common Pathogenesis of Back Pain
Chronic lower lumbar ligamentous strain (ligaments)
Spondylosis (synovial joints of vertebrae)
Spinal osteoarthritis (vertebrae)
Prolapsed lumbar disc (disc)
94
Most common cause of nerve root compression
Prolapsed Lumbar Disc
95
The most common disc to prolapse are those at
L4/L5 and L5/S1
96
Area of pain small =
sprain and stagnation of Qi and Blood
97
WHY USE SP-3 FOR CHRONIC LBP?
Spleen 3- Influences the spine and is good to select in chronic backache with obvious scoliosis of the spine.
98
DIAGNOSIS - LBP
INVASION OF COLD: Worse in the morning on waking up and getting gradually better thru day
DEF OF KD: Better in the morning on waking up and gradually getting worse during the day
INVASION OF EXT COLD & DAMPNESS: Worse when the weather is cold and damp
SPRAIN OR KD DEF: Unrelated to weather
99
Liver Qi stagnation can cause acute and chronic LBP...T/F?
TRUE. It frequently occurs against a background of Kidney deficiency.
100
Additional Causes of Illness
Phlegm & Static Blood
101
Six Exogenous Causes
```
Wind
Cold
Damp
Summer-Heat
Fire
Dryness
```
102
Seven Endogenous Causes
Joy, Anger, Worry (Anxiety), Over Thinking (Pensiveness/ Melancholy), Grief (Sadness), Fear, and Fright(Shock)
103
Five Independent Causes
```
Dietary Irregularity
Excessive Sexual activity
Taxation/ Fatigue
Trauma
Parasites
```
104
WEI LEVEL & PULSE
Wind Heat: Floating & Rapid
Summer Heat: Soggy & Rapid
Damp Heat: Soggy & Slow
Dry Heat: Floating & Rapid
105
PULSE - BACKACHE DX
1. Left Rear - Wiry and Floating:
2. Left Rear - Fine and Deep, but also slightly Wiry:
3. Left Rear position Tight:
1. Acute backache or an acute exacerbation of a chronic back problem
2. Chronic backache on a background of KD Def
3. Invasion of Cold Dampness in the UB Channel
106
TX (Points) for Wind Cold
LU-7, LU-6, UB-12
107
TX (Points) for Wind Heat
LI-4, LI-11, SJ-5
108
WC enters via...
| WH enters via...
WC - Skin
| WH - Mouth &/or Nose
109
```
PULSES by LEVEL
Wei
Qi
Ying
Blood
```
Wei = floating, Rapid
Qi = Rapid, Full
Ying = Thin, Rapid
Blood (Heat) = Wiry, Rapid
Blood (Collapse of Yin/Empty Wind) = Rapid, Thready
Blood (Collapse of Yang) = Hidden, Slow, Scattered
