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Flashcards in External Therapeutics Deck (134)
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Tennis Elbow Sn/Sx

Pain: fluctuates, Close to LI 11 (bent elbow, halfway b/w lateral epichondyle and end of crease), increases with pressure or rotation
No swelling, often older patients/manual labourers/sports players
It's really a bone thing

1

Tennis Elbow
Main Merridian

LI

2

Tennis Elbow
Differential Dx

vs Golf Elbow/Student Elbow (Medial Epichondyle)

3

Tennis Elbow
Tx

**LI 10, 11, 12 (3 needle technique)**, 1.5c needle or 1.2c perp
LI 4
Lu 5 (if tender near there, or pain referring downwards from shoulder), LI 15, SJ 14
Huatojiaji - Cervical, esp C4-C6 (golf elbow is C7-T1)
Yangming
Electro with 3 needle technique (hook up any two, or use one clip on two needles, and the other gets it's own clip, stim 20 minutes till you can see needle jump, works especially well on Shi)
Warming Needle or Moxa until local turns red
Dr. Dong's extra points technique - uses points close to bone, lines up 3 or 4 needles
Bone issue, so sometimes insert two needles just right on bone so 3 needle technique becomes 5 needles in a circle
Ashi Points
Bleeding:
Shi only, if really clear Ashi pts, 3-5 dots, can cup after pricking)
Auricular:
elbow, ear shenmen, liver
Herbal Plaster:
People with allergic constitutions may get skin changes, itching, burning, cooling, etc. Take it off after a couple hours if itching too much.
**Must tonify Qi and Blood - St 36, 25, Ren 4,6. **

4

Tennis Elbow
Education

Keep area warm (no ice)
Prevent EPF
Minimize movement of forearm
Need to continue Tx for at least 8x, even if pain is gone

5

Reynoad's Disease
What is it

Vasospasm of small cutanious arteries
(nose, hands, feet)
Results in cyanotic, cold state of the skin
eg: hands turn pale/red/purple when they touch something cold, and then later they flush to warm.
Autoimmune disorder - often accompanied by Lupus (SLE), Rheumatoid Arthritis, etc.
Triggers - stress, cold
Target- Young women

6

Reynoad's
Triggers

Cold, Stress

7

Reynoad's
Target

Young Women (often)

8

Reynoad's
Sx

Attacks last minutes to 7 hours (fluctuating spasm)
Area blanches, then gets colour again but it's red and throbs v.painfully
(blanch --->cyanotic (purple/blue) ---> red)
Longstanding cases - skin becomes thin, shiny, smooth, tight, and may develop small painful ulcers
Often accompanied by Rheumatoid Arthritis, piano fingers (long, thin, flexible),

9

Reynoad's
Complications

Recurrent attacks ---> infection, gang green (very rare)

10

Reynoad's Test

No test ---> clinical Sx

11

Reynoad's
TCM Dx

Yang Xu
**Mingmen Fire Decline** (plus invasion of cold blocks the circulation)

12

Reynoad's
POT

Warm the meridian
Dispel Cold
Tonify Kidney Yang

13

Reynoad's
Education

Keep warm!!!
Regulate Emotions - can be stress triggered (even just too happy)
Avoid overstrain
Quit smoking (nicotine can make the small blood vessels spasm)
Treat in summer since it's a winter disease, and in summer the Yang comes back to superficial, so we can treat more effectively. Can even just rub pepper on hands often in summer). Tx in hottest time of summer (very, very hottest days).
Self moxa on SJ 4, St 36 20 to 30 minutes before bed for the patient. Warn them not to burn themselves, and to put out moxa stick in water, not just assume it's done burning.

14

Inquiry
6 questions

O-onset
P - palliation (what makes it worse or better)
Q - quality (dull/burning/etc)
R - radiation
S - severity
T - timing
also - location, inducing factors, history, nature, severity, time, accompanying Sx

15

Diagnostic Steps

Inquiry
Observation
Palpation
Olfaction/ Listening (Aufaction?)

16

Observation
parts

Shen
Bearing
Skin Colour
Collaterals
Tongue

17

Palpation
parts

*start in pain-free area and move towards pain
Skin
Chest and Hypochondrium
Hand and Foot
Acupoints
Auricular points
Abdomen
Pulse

18

Olfaction and Listening
parts

Chief Complaints
Acute vs Chronic
Natuer of pain
progression and change of symptoms and such
modalities to stop pain quickly

19

Modalities for Pain

Herbal
Acup
Moxa
Auricular
Cupping
Guasha
Heat and Cold complex
Tuina
Food

20

Prevention of Pain/Education

Regulate Emotions
Health Education
Avoid overstrain
Exercise regularly
Preventative herbs/acup

21

Bi Syndrome
Definition

Disease
"Closed, Blockage"
Obstruction of Qi and blood in the meridians and collaterals from EPF
Pain, mumbness, heavy sensation of body, limbs and joints, muscles, limitation of movement

22

Bi Syndrome
Manifestations

Pain
Numbness
Limitation of Movement (spleen-muscle/ kidney-bone/ liver-sinews)
Swelling and Deformity

23

Xu Qi
signs

Water retention (phlegm, blood stasis)

24

7 Needling Techniques

Successive Needling
Restorative Needling (relaxes muscles and tendons)
Uniform Needling (small circumference deep pain)
Superficial Needling
Short Thrust Needling
Shallow Needling
Muscle Needling

25

Successive Needling
how
why

Successively needle and remove ashi points along a line
Wandering Bi

26

Restorative Needling
how
why

Needle Perpendicularly, then remove and change direction to all four directions
Relaxes muscles and tendons

27

Uniform Needling

First needle into centre of pain, retain it. Then a needle on each side-within 2c, angled slightly towards centre needle
Small circumference, deep pain

28

Superficial Needling

One needle perp in centre, four shallow oblique around

Wide, shallow pain, Cold Bi

29

Short Thrust Needling
how
why

Insert at ashi, GENTLY hit bone repeatedly
Bone Bi