REPETITIVE STRESS INJURY

Question 1

REPETITIVE STRESS INJURY

Answer 1

Multiple, tiny strains from repetitive motions
Occurs in muscles, tendons, attachments
Occupational etiology: generally, pain in shoulder, elbow, forearm, wrist and hand
Sports etiology: knee and ankle
Pain: dull, sharp exacerbations; use worsens
_At first with prolonged use; later, any use at all
_May have swelling, numbness, tingling, heaviness, fatigue
TCM: external accumulation of Qi and Blood
Rest is essential
Acupuncture: local, distal, trigger points; regular Tx’s

Question 2

ELBOW

Answer 2

INVASION OF EXTERNAL FACTORS
_Wind
_Damp
_Heat
_Generally acute onset, external Sx
STAGNATION OF BLOOD
_Overwork, sports or overuse, physical trauma
_Acute onset with Hx of trauma; Chronic onset

Question 3

ELBOW-INVASION OF EXTERNAL FACTORS
SX
T & P
TX: principle & pts

Answer 3

Acute elbow pain, aversion to Cold or Wind, varying with weather, limitation of movement
T: Thin white coat P: Floating, superficial
TX: Dispel Wind and eliminate External factors

LI 4, LI 10, TW 5, GB 20, Ashi points

Question 4

ELBOW-STAGNATION OF BLOOD
SX
T & P
TX: principle & pts

Answer 4

Traumatic Hx or Hx of elbow strain, elbow pain of long duration, stabbing pain in elbow, aggravated at night or by immobility, limitation of elbow movement, dislike of pressure and massage
T: Purplish P: Wiry
TX: Promote circulation of Blood, eliminate Blood stasis, relieve pain
LI 3, LI 4, LI 6, LI 10, TW 5, TW 10, LIV 3, SP 6

Question 5

ELBOW-JOINT FX

Answer 5

Hinge joint
Flexion of elbow enables us to eat
Enables supination & pronation of wrist

Question 6

ELBOW-YIN & YANG PTS

Answer 6

YIN: LU5, H3, PC3
YANG: LI10, LI11,LI12, TW10

Question 7

FOREARM, WRIST & HAND
FX:
PTS ON HAND

Answer 7

Junction of forearm and hand
Upper forearm muscles move wrist, fingers and thumb
Wrist: six meridians
Hand: meridian polarity
Points on hand treat acute problems and emotional issues

Question 8

WRIST
PATHOLOGY: AX OF P-D, S OF QI & BLD,
DEF OF BLD

SX: EXT & INT

Answer 8

INVASION OF WIND COLD
ACCUMULATION OF PHLEGM DAMP
STAGNATION OF QI AND BLOOD
DEFICIENCY OF BLOOD

External: acute onset, short duration, external symptoms; invasion of pathogenic factors

Internal: chronic onset, long duration, Sx of internal disorder; disorder of Internal organs

Question 9

WRIST-INVASION OF WIND COLD	
_SX
_T
_P
_TX: principle & pts

Answer 9

Acute wrist pain, swelling and pain of wrist with cold sensation, difficulty in relaxing or extending the wrist, worsening of pain in cold weather; alleviation of symptoms with movement, spasm in fingers or arms aversion to cold, prefers warmth
T: Purplish, white coat
P: Wiry, or tight
TX: Dispel Cold, regulate Qi, alleviate Pain
LI 3, LI 4, LU 7, SI 4, TW 5, Ba Xie, Ashi

Question 10

WRIST-ACCUMULATION OF PHLEGM DAMP
_SX
_T
_P
_TX: principle & pts

Answer 10

Swelling and pain of wrist, limitation of movement, heavy sensation in wrist and fingers, formation of soft nodules around wrist, poor appetite, loose stools
T: Pale, white and greasy coat
P: Deep, slippery
TX: Promote Qi circulation, eliminate Phlegm, alleviate pain
LI 4, LI 5, LU 7, TW 4, SI 6, SP 6, ST 40, Ashi

Question 11

WRIST-STAGNATION OF Qi and BLOOD
_SX
_T
_P
_TX: principle & pts

Answer 11

Chronic wrist pain with numbness, Hx of traumatic injury to wrist, or wrist operation, pain worse at night or with emotional upset, alleviation of pain with movement, cold or purplish hands, preference for warmth
T: Purplish
P: Wiry
TX: Regulate Qi and Blood, eliminate Blood stasis, alleviate pain
LI 4, PC 7, LU 9, HT 7, SI 4, SI 5, SP 6, LIV 3, Extra Ba Xie

Question 12

WRIST-BLOOD DEFICIENCY
_SX
_T
_P
_TX: principle & pts

Answer 12

Slight wrist pain, numbness and slight stiffness of wrist, weakness of wrist and hands, pale complexion, pale lips, dizziness, palpitations, dry stools
T: Pale, thin white coat
P: Thready and weak
TX: Tonify Qi, nourish Blood and alleviate Pain
PC 7, HT 7, ST 36, SP 6, LU 9, A shi

Question 13

Points of the Wrist and Hands

Answer 13

Local:
LU 9, 10
LI 3, 4, 5
SI 3, 4, 5
TW 3, 4, 5
HT 5, 7, 8
PC 6, 7
Shang Ba Xie, Ba Xie, Sifeng

Distal:
LI 6, 10
LU 7

Question 14

HAND: Palmar Pain; ETIOLOGY 
_INV OF EXT C-D
_INV OF EXT D-H
_S OF LIV-QI W YANG DEF
_INV OF T-F
_S OF BLD

Answer 14

INVASION OF EXTERNAL COLD DAMP
INVASION OF EXTERNAL DAMP HEAT
STAGNATION OF LIVER Qi with YANG DEF.
INVASION OF TOXIC FIRE
STAGNATION OF BLOOD

Question 15

HAND: Palmar Pain-INVASION OF EXTERNAL COLD DAMP
_SX
_T
_P
_TX: principle & pts

Answer 15

Palm pain with a cold, heavy sensation, worse with exposure to cold and humid weather or by contact with water, alleviated by warmth, swelling of joints; pale skin of hands, slight fever, aversion to cold, numb or frigid fingers, cold limbs, poor appetite, absence of thirst, clear urine
T: Pale, white moist coat
P: Floating, tense
TX: Dispel Cold-Damp, promote Blood circulation
LI 4, LI 5, TW 5, LU 7, SI 3, LIV 3

Question 16

HAND:Palmar Pain-INVASION OF EXTERNAL DAMP-HEAT
_SX
_T
_P
_TX: principle & pts

Answer 16

Palmar pain with a hot and heavy sensation, accompanied by redness, swelling and a burning feeling in the finger joints or all the limb joints, preference for cold, fever, thirst, yellow urine, restlessness
T: Red, yellow coat
P: Rapid, slippery
TX: Clear Damp-Heat, promote Blood circulation
LI 3, LI 11, TW 5, PC 6, SP 6, SP 9

Question 17

HAND:Palmar Pain-INVASION OF TOXIC FIRE 
_SX
_T
_P
_TX: principle & pts

Answer 17

Formation of ulcers and oedema in the palm, reddish skin on the palm with a hot feeling, aggravation of pain with pressure, itching and a wet palm, thirst with cold drinks, bitter taste in mouth, fever, an aversion to cold, constipation, scanty and yellow urine
T:  Red, yellow and dry coat
P:  Rapid
TX:  Clear FIRE,   tonify QI & Blood 
LI 4, LI 11, PC 8, TW 2, SP 6, ST 40

Question 18

HAND:Palmar Pain-LIVER QI STAGNATION with YANG DEFICIENCY
_SX
_T
_P
_TX: principle & pts

Answer 18

Palmar pain with a distending and cold sensation, aggravated by emotional upset or exposure to cold especially during menstrual period, pale color of skin of the hand, hypochondriac pain, fatigue, poor appetite, dull feeling in Stomach, irritability
T: Pale, white coat
P: Deep, wiry
TX: Regulate Liver Qi, warm Liver channel, dispel Cold
LI 4, ST 36, PC 6, LIV 3, BL 18, GB 20

Question 19

HAND:Palmar Pain-BLOOD STAGNATION
_SX
_T
_P
_TX: principle & pts

Answer 19

Traumatic injury to or operation on wrists, palm and fingers; long-standing pain in palm, stabbing pain with a fixed location, worse at night, alleviated by movement, rigidity of palm or fingers, swelling of joints and hands
T: Purplish, thin coat
P: Wiry and choppy
TX: LI 3, TW 5, LU 7, PC 6, GB 34, ST 36, BL 17

Question 20

HAND: Finger Pain/Etiology
AC OF C-D IN CHANNELS
S O QI &BLD
LIV+K ESS DEF

Answer 20

ACCUMULATION of COLD DAMP IN CHANNELS
STAGNATION OF Qi and BLOOD
BLOOD DEFICIENCY
LIVER and KIDNEY ESSENCE DEFICIENCY

Question 21

HAND: Finger Pain-ACCUMULATION OF COLD-DAMP
_SX
_T
_P
_TX: principle & pts

Answer 21

Swelling and pain in fingers, heaviness and numbness of fingers with a cold sensation, worse in damp cold weather, limitation of joint , movement, spasms of fingers, difficulty grasping; heaviness of body, aversion to cold, poor appetite, loose stools
T: pale, white, greasy coating
P: Deep, slow and slippery, or tight
TX: Dispel Cold, remove Damp, regulate Qi
TW 5, CV 12, SP 6, SP 9, LI 4, Extra Ba Xie, Ashi

Question 22

HAND: Finger Pain-ACCUMULATION OF DAMP-HEAT
_SX
_T
_P
_TX: principle & pts

Answer 22

Swelling, redness and pain in fingers, worse in damp, warm weather; heaviness and numbness in fingers, difficulty grasping, limitation of joint movement, spasm of fingers; heaviness of body, poor appetite, loose stools
T: Red, yellow, greasy coat
P: Deep, slippery and rapid, or tight and rapid
TX: Dry Damp, clear Heat, regulate Qi, alleviate pain
TW 6, CV 12, LI 2, LI 3, LI 4, ST 40, ST 44, SP 9, Extra Ba Xie, Ashi

Question 23

HAND: Finger Pain-STAGNATION OF Qi and BLOOD
_SX
_T
_P
_TX: principle & pts

Answer 23

Chronic Hx of finger pain or Hx of trauma or operation, pain and numbness in fingers, worse at night, better with movement, cold or purplish fingers and hands, preference for warmth
T: Purplish
P: Deep, wiry
TX: Regulate Qi and Blood, alleviate Pain
LI 4, LI 11, PC 6, LU 7, SP 6, Extra Ba Xie, Ashi

Question 24

HAND: Finger Pain-BLOOD DEFICIENCY
_SX
_T
_P
_TX: principle & pts

Answer 24

Slight finger pain, numbness of fingers with stiffness, weakness in hands, pale complexion, pale lips, dizziness, palpitations, dry stools
T: Pale, thin white coat
P: Thready, weak
TX: Tonify Qi, nourish Blood, alleviate Pain
LI 4, PC 6, HT 7, SP 6, ST 36, KD 3, Ashi

Question 25

``` HAND: Finger Pain-LIVER and KIDNEY ESSENCE DEFICIENCY _SX _T _P _TX: principle & pts ```

Answer 25

Slight finger pain with spasm, gradual deformity of fingers, weakness of the fingers, wrists, arms and legs; tiredness, lower back pain, tinnitus, poor memory, hair loss T: Thin coat P: Weak, especially in KD TX: Tonify KD and LIV, nourish Essence, strengthen tendons and bones, alleviate pain LI 4, PC 6, KD 3, LIV 3, SP 6, Ashi

Question 26

DX PTS

Answer 26

FORARM | HIP, BUTTOCK, GROIN & THIGH

Question 27

LOWER EXTREMITIES-PATHOLOGY INV OF W-C-D SX-T-P

Answer 27

INVASION OF WIND-COLD-DAMP WIND: wandering pain, worse in windy weather, limited movement, chills and fever; T: thin white greasy P: superficial COLD: severe pain, cold feeling, better with warmth, cold limbs. T: White coat P: Tight, superficial DAMP: Pain and swelling, limited joint movement, worse in cloudy and rainy weather, numbness of the skin and muscles, heavy sensation in buttocks and lower limbs, limping; T: White, greasy coat P: Soft, slow

Question 28

LOWER EXTREMITIES-DOWNWARD FLOW OF DAMP HEAT _SX _T _P

Answer 28

Swelling, pain, limited movement, burning sensation with redness; irritability, restlessness, poor appetite, bitter taste, scanty, yellow urination, occasional fever T: Yellow and greasy coat P: Rapid pulse

Question 29

LOWER EXTREMITIES-STAGNATION OF QI AND BLOOD _SX _T _P

Answer 29

Fixed, stabbing pain, swelling of joints, Hx of trauma, limited movement, worse on rest and at night, alleviated by movement; red or hard nodules under the skin around joints T: Purplish, purple spots P: Choppy or thready

Question 30

LOWER EXTREMITIES-QI AND BLOOD DEFICIENCY _SX _T _P

Answer 30

Intermittent pain, alleviated with rest or pressure, aggravated by overwork, numbness and weakness of the lower limbs; tiredness, pale complexion, poor appetite, loose stools, SOB, aversion to cold T: Pale, thin white coat P: Thready, weak

Question 31

LOWER EXTREMITIES-LIVER AND KIDNEY DEFICIENCY _SX _T _P

Answer 31

Chronic pain, difficult movement, aggravated by overstrain, weakness of lower back, knees, rigidity in morning, joint deformity, muscular atrophy; fatigue, lower back pain, aversion to cold T: Thin, white coat P: Deep, wiry; weak on KD

Question 32

``` HIP-ETIOLOGY INV OF EPF D-H-FD S-O QI & BLD DEF O QI & BLD LIV & K DEF ```

Answer 32

``` INVASION of EXTERNAL PATHOGENIC FACTORS DAMP HEAT FLOWING DOWNWARD STAGNATION OF QI AND BLOOD DEFICIENCY OF QI AND BLOOD LIVER AND KIDNEY DEFICIENCY ```

Question 33

HIP-INVASION OF WIND-COLD-DAMP | _TX

Answer 33

WIND: Dispel Wind, resolve Damp, eliminate Cold TW 5, LI 4, BL 12, GB 30, GB 31, GB 35, SP 10, SP 6 COLD: Warm, dispel Cold, dispel Damp TW 5, LI 4, GB 30, GB 31, GB 41, ASHI DAMP: Eliminate Damp, dispel Cold, Wind TW 5, LI 4, ST 31, ST 40, SP 9, GB 29, GB 30, BL 12, BL 54, BL 58, ASHI

Question 34

HIP TX _STAGNATION OF QI AND BLOOD _DEFICIENCY OF QI AND BLOOD _LIVER AND KIDNEY DEFICIENCY

Answer 34

STAGNATION OF QI AND BLOOD LI 4, SP 6, SP 10, BL 17, LIV 3, GB 29, GB 30, ST 31, ASHI QI AND BLOOD DEFICIENCY GB 30, GB 34, GB 39, ST 31, LIV 3, KD 3, ST 36, SP 6 ASHI LIVER AND KIDNEY DEFICIENCY GB 29, GB 30, GB 34, ST 31, ASHI, KD 3, BL 23, BL 18, SP 6, Hua Tou Jia Ji

Question 35

KNEE-PTS

Answer 35

PTS

Question 36

KNEE-INVASION OF WIND COLD DAMP | TX

Answer 36

WIND: TW 5, LI 4, GB 31, GB 35, SP 6, ASHI COLD: TW 5, LI 4, GB 34, GB 35, ST 36, Xi Yan, Ashi, SP 6 DAMP: TW 5, LI 4, GB 34, Xi Yan, ST 40, SP 6, SP 9. ASHI

Question 37

KNEE-TX _DOWNWARD FLOW OF DAMP HEAT _QI AND BLOOD STAGNATION _LIVER AND KIDNEY DEFICIENCY _QI AND BLOOD DEFICIENCY

Answer 37

DOWNWARD FLOW OF DAMP HEAT ST 40, SP 6, SP 9, BL 64, GB 34, GB 43, ST 44, Ashi QI AND BLOOD STAGNATION LI 4, SP 6, SP 10, BL 17, LIV 3, GB 35, Ashi LIVER AND KIDNEY DEFICIENCY GB 34, GB 39, ST 34, KD 3, KD 10, SP 6, LIV 3, LIV 8 QI AND BLOOD DEFICIENCY GB 34, GB 39, LIV 3, KD 3, ST 36, SP 6, Ashi

Question 38

LEG, ANKLE & FOOT

Answer 38

PTS

Question 39

LEG, ANKLE & FOOT

Answer 39

INVASION OF WIND-COLD-DAMP TW 5, LI 4, BL 12, GB 30, GB 31, GB 35, SP 6, ASHI QI AND BLOOD STAGNATION LI 4, SP 6, BL 17, LIV 3, GB 30, ASHI QI AND BLOOD DEFICIENCY GB 34, GB 39, LIV 3, KD 3, ST 36, SP 6, AHSI DOWNWARD FLOW OF DAMP-HEAT TW 6, LI 4, ST 40, SP 6, SP 9, GB 34, ST 44, ASHI ACCUMULATION OF PHELGM-DAMP TW 6, LI 4, SP 3, SP 6, SP 9, ST 36, ST 40, GB 30, BL 40, ASHI KIDNEY ESSENCE DEFICIENCY GB 34, GB 39, KD 3, BL 23, BL 18, SP 6, ASHI

Question 40

ANKLE-TX | _INVASION OF WIND COLD DAMP

Answer 40

WIND: TW 5, LI 4, BL 12, GB 40, GB 41, SP 10, SP 6, ASHI COLD: TW 5, LI 4, ST 36, SP 6, BL 12, BL 60, BL 63, GB 40, ASHI DAMP: TW 5, LI 4, ST 40, SP 9, BL 12, BL 63, BL 64, GB 40, ASHI

Question 41

ANKLE-TX DOWNWARD FLOW OF DAMP HEAT QI AND BLOOD STAGNATION LIVER AND KIDNEY DEFICIENCY

Answer 41

DOWNWARD FLOW OF DAMP HEAT TW 5, LI 4, SP 6, BL 60, GB 34, GB 40, GB 41, ST 44, ASHI QI AND BLOOD STAGNATION LI 4, SP 6, SP 10, BL 17, LIV 3, GB 34, ASHI LIVER AND KIDNEY DEFICIENCY GB 39, GB 34, LIV 3, KD 3, ST 36, SP 6,

Question 42

FOOD

Answer 42

PTS

Question 43

HEEL-TX INVASION OF WIND-COLD-DAMP INVASION OF TOXIC FIRE QI AND BLOOD STAGNATION DOWNWARD FLOW OF DAMP-HEAT QI AND BLOOD DEFICIENCY LIVER AND KIDNEY DEFICIENCY

Answer 43

INVASION OF WIND-COLD-DAMP TW 5, LI 4, SI 4, BL 58, BL 60, BL 63, BL 64, KD 3, SP 6 INVASION OF TOXIC FIRE TW 6, LI 4, LI 11, ST 44, SP 6, SP 10, BL 60, BL 63, SI 4, KD 2 QI AND BLOOD STAGNATION LI 4, SP 6, LIV 3, SI 3, GB 34, SI 4, BL 60 DOWNWARD FLOW OF DAMP-HEAT TW 6, SI 3, SI 4, BL 63, BL 64, KD 2, SP 6, SP 9, GB 34 QI AND BLOOD DEFICIENCY SI 3, SI 4, BL 63, BL 64, SP 6, ST 36, GB 39, GB 34 LIVER AND KIDNEY DEFICIENCY GB 39, GB 34, LIV 3, KD 3, SI 3, BL 63, ST 36, SP 6

Question 44

SOLE-TX INVASION OF WIND-COLD-DAMP INVASION OF TOXIC HEAT DOWNWARD FLOW OF DAMP-HEAT QI AND BLOOD STAGNATION QI DEFICIENCY BLOOD DEFICIENCY KIDNEY ESSENCE DEFICIENCY

Answer 44

INVASION OF WIND-COLD-DAMP TW 5, LI 4, SI 3, SI 4, BL 63, BL 64, LIV 3, SP 6 INVASION OF TOXIC HEAT TW 6, LI 4, LI 11, SST 44, SP 6, SP 10, KD 2 DOWNWARD FLOW OF DAMP-HEAT TW 6, SI 3, SI 4, BL 63, BL 64, KD 2, SP 6, SP 9, GB 34 QI AND BLOOD STAGNATION LI 4, SP 6, LIV 3, GB 34, SI 3, SI 4, BL 60 QI DEFICIENCY SI 3, SI 4, SP 6, ST 36, KD 3, GB 34, BL 60, BL 64, LIV 3 BLOOD DEFICIENCY SI 3, SI 4, SP 6, ST 36, KD 3, GB 34, GB 39, CV 6, LIV 3 KIDNEY ESSENCE DEFICENCY LIV 3, LIV 8, SP 6, KD 3, KD 4, KD 5, KD 10 BL 64

Question 45

TOE-TX WIND: COLD DAMP DOWNWARD FLOW OF DAMP-HEAT LIVER AND KIDNEY DEFICIENCY QI AND BLOOD STAGNATION

Answer 45

INVASION OF WIND-C0LD-DAMP WIND: TW 5, LI 4, BL 12, BL 60, GB 40, SP 6, Bafeng COLD TW 5, LI 4, SP 6, BL 12, BL 60, BL 63, GB 40, Bafeng DAMP TW 6, LI 4, ST 40, SP 9, BL 12, BL 63, BL 64, GB 40, Bafeng DOWNWARD FLOW OF DAMP-HEAT TW 6, LI 4, SP 6, SP 9, BL 60, GB 34, GB 40, GB 41, ST 44 LIVER AND KIDNEY DEFICIENCY GB 39, GB 34, LIV 3, KD 3, ST 36, SP 6, Bafeng QI AND BLOOD STAGNATION LI 4, SP 6, SP 10, BL 17, LIV 3, GB 34 Bafeng