Oral Cavity Disorders: a TCVM Approach

1
Oral Cavity Disorders a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

2
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

3
TCM Spleen Disease

• Spleen Physiology
• Spleen Pathology
• Gingivitis/Stomatitis

4
Earth

• Sound
• song
• Emotion
• sympathy
• Climate
• humid
• Season
• late summer

• Direction
• center
• Opening
• lips/gums
• Body Part
• muscles
• Zang/Fu
• SP/ST

5
TCM SPLEEN Physiology

• Governs Transportation Transformation
• Food Water
• Controls Blood
• Dominates the Muscles
• Opens in Mouth
• Lips Gums (ST)

6
TCM 24 Hour Clock
7
Earth
BALANCED
DEFICIENT
EXCESS
8
Spleen Pathology
9
Spleen Pathology

• Damp is the Enemy of the Spleen
• Damp-Cold
• Damp-Heat
• Spleen Qi Deficiency with Damp

10
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
11
Spleen Pathology
Cold Environmental Conditions
Cold Food or Drink
Cold-Damp in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
12
Spleen Pathology

Accumulated Heat Damp
Damp Hot Environmental Conditions
Damp Hot Food or Drink
Damp-Heat in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
13
Spleen Qi Deficiency
Illness
Overeating
Overwork
Starvation
Under Work
Spleen Qi Deficiency
Disturbed Qi Flow
Failure to Transform Transport
14
Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
Chronic Hemorrhage
General Signs
15
Spleen Qi Sinking
Illness
Overeating
Overwork
Starvation
Under Work
Chronic Spleen Qi Deficiency
Failure of Holding
Chronic Diarrhea Prolapses Incontinence
16
Spleen Pathology
Cold Food or Drink
Chronic Spleen Qi Deficiency
Spleen Yang Deficiency
Transform Transport Disorder
Disharmony of Qi Flow
Yang Deficiency Signs
17
Stomach Pathology
Cold Environmental Conditions
Cold Food or Drink
Cold in Stomach
Transform Transport Disorder
Disharmony of Qi Flow
Inhibition of Yang
18
Stomach Cold
Cold Food Drink
Cold Environment
Stomach Cold
Receiving Decomposing
Cold Signs
Anorexia
Altered Qi Flow
Cold Ear/Nose Hypersalivation Pale-Purple
Tongue Deep-Slow Pulse
Lassitude
19
Stomach Pathology

Damp Hot Environmental Conditions
Hot Dry Food or Drink
Heat in Stomach
Heat Signs
Transform Transport Disorder
20
Stomach Heat
21
Stomach Food Stagnation
Indigestible Food
Overeating
Retention of Food in Stomach
Disturbed Qi Flow
Failure to Transform Transport
22
Stomach Yin Deficiency
Stress
Liver Qi Stagnation
Chronic Febrile Illness
Transformation to Heat/Fire
Impairment of Body Fluids
Stomach Yin Deficiency
23
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

24
Meridian Theory

• Oral cavity has two main channels that influence
  the teeth and gums
• Large Intestine meridian
• Stomach meridian

25
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

26
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

27

• Oral Exam Putrid odor, upper and lower arcade
  have severely inflamed gingiva, with spontaneous
  bleeding, minimal calculus formation
• Lab Data Elevated WBC, FELV/FIVNeg
• Diagnosis Hemorrhagic gingivitis
• Treatment Clindamycin 25mg PO BID x 10
• Dental prophylaxis followed by Clavamox 62.5 mg
  BID x 10

28
TCVM Exam Diagnosis

• Constitution Water/Wood
• Tongue bodyreddish 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)

29
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)

30
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

31
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

32
TCVM Approach

• Exam
• Constitution- Water
• Tongue- Violet, dry, no coat
• Pulse- Deep, thready, and quick
• Gums- dry/breath scorched
• Coat Quality-Dry

• Treatment Stategy
• Nourish Stomach Yin and Clear Heat
• AP CV 12 (aqua) SP 3,6 ST 36,44 LI 4,11
• Herbs Qing Wei San
• Topical Aloe Gel
• Diet Fresh cooked food/ fish-pork-beef-eggs-veggi
  es

33
Ulceration a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

34
Ulcer

• Symptoms
• Periodic pain
• Acid regurgitation
• Belching
• Vomiting
• Patterns
• Excess
• Stomach Cold
• Food Stagnation
• Liver Qi Stagnation
• Blood Stasis
• Deficiency
• Stomach Yin Deficiency

35
Stomach Heat
36
Stomach Ulcers

• Mild

Happy Stomach
Angelica Dang Gui Nourish activate
Blood Paeonia Bai Shao Yao Nourish Liver
Yin Blood Bupleurum Chai Hu Soothe
Liver Qi Aurantium Zhi Shi Move Qi
relieve pain Trichosanthes Gua Lou Promote body
fluid transform phlegm Pinellia Ban
Xia Dry damp transform phlegm Citrus
Chen Pi Move Qi relieve pain Licorice
Gan Cao Harmonize Taraxacum Pu Gong
Ying Clear Heat

• Moderate to Severe

Jade Lady
Gypsum Shi Gao Clear Heat and cool
Stomach Anemarrhena Zhi Mu Clear Heat and
nourish Yin Rehmannia Shu Di Huang Nourish
Yin and Jing Ophiopogon Mai Men Dong Moisten
and nourish Yin Achyranthes Niu Xi Bring the
Qi flow down
37
GI Food Therapy

• Cabbage
• Contains glutamate
• Cools stomach GI
• Spinach
• Stops hemorrhage

38
05 Shan-gen Mountain base Xie-05
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
Shan-gen
GV-26 Ren zhong
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
39
21 Hua-tuo-jia-ji at cervical region
LO 0.5 dorsal to cervical vertebrae IN
cervical stiffness, wobblers disease
22 Jian-wei, strengthen stomach
LO Upper 1/3 of the jugular group, Between vein
and cervical vertebra IN Anorexia, vomit,
stomach disorders
LO At the ventral midline just cranial to
throat. IN excessive salivation, laryngeal
hemiplegia
23 Lian-quan ridge spring CV-23
40
Pancreatitis a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

41
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

42
TCVM Acute Pancreatitis
43
TCVM Chronic Pancreatitis
Enzyme replacement therapy still good to add
44
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
45
Perry Treatment

• AP
• DN
• ST-45
• ST-36
• LI-4
• PC-6
• BL-20
• CV-12
• Aqua
• ST-36
• BL-20
• PC-6
• Herbal
• Great Saussurea Coptis

• Next day was 80 improved
• Clinician said, He is doing absolutely
  fantasticbetter than any patient in yearsNOit
  wasnt the acupuncturewellmaybe we should try
  it again!

46
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
47
Bleeding a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

48
Bleeding

• Primary Hemostasis
• Complex chain of events involving interaction of
• Platelets
• Vessel Wall
• von Willebrands factor
• Fibrinogen
• Secondary Hemostasis
• Complex interaction of the intrinsic and
  extrinsic clotting cascades
• Stabilize the platelet plug

49
Primary Hemostasis

• Evaluated by the bleeding time
• Platelet number
• Amount and Quality of the von WIllebrands factor
  VIIIAg
• Fibrinogen concentration
• Other alterations due to vessel wall disorders

50
Secondary Hemostatis

• Assessed by
• ACT (activated clotting time)
• APTT (activated partial thromboplastin time)
• PT (prothrombin time)

51
TCM Pathoetiology

• Heat
• Tongue
• Red Dry
• Pulse
• Superficial (forceful) fast
• Spleen Qi Deficiency
• Tongue
• Pale moist
• Pulse
• Deep weak (particularly on right)

52
Spleen Pathology

Accumulated Heat Damp
Damp Hot Environmental Conditions
Damp Hot Food or Drink
Damp-Heat in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
53
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

54
Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
Chronic Hemorrhage
General Signs
55
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)
56
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

57
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
58
Muscle Wasting a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

59
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

60
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

61
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
62
Jake

• History
• Progressive weakness in rear legs
• Cool seeking
• Rear leg muscle atrophy
• Dry hair skin
• TCVM Exam
• Pulses deep weak (lt R)
• Red dry tongue

DX Qi/Yin Deficiency
63
Jakes 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

64
Jia Bing Fang
Astragalus Huang Qi Tonify Qi Condonopsis Dang
Shen Tonify Qi Polygonum He Shou Wu Nourish
Blood and Jing Rehmannia Shu Di Huang Nourish
Blood, Yin and Jing Paeonia Bai Shao Yao
Nourish Blood and soothe Liver Qi Dioscorea
Shan Yao Tonify Qi and nourish Jing Prunella
Xia Ku Cao Soothe Liver Qi, clear Heat Cyperus
Xiang Fu Move Liver Qi and relieve
nodules Bupleurum Chai Hu Soothe Liver
Qi Sargassum Hai Zao Transform phlegm, clear
Heat, soften the hardness Laminaria Kun Bu
Transform phlegm, soften the hardness,
drain water
65
Sam

• History
• Chronic rear leg weakness and muscle wasting
• Dry hair
• Weight loss
• TCVM Exam
• Red dry tongue
• Weak thready pulses (lt R)

DX Qi/YinDeficiency
66
Sams Treatment

• AP
• DN
• GV20, BL20, BL23, BL26
• Aqua
• SP6, ST36, BL23, BL26
• Herbal
• Hindquarter formula (tea pills)

67
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
68
Obesity a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

69
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

70
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
71
Obesity TCVM Etiology and Pattern

• Damp-phlegm
• Liver Stagnation
• Blood Stagnation
• Spleen Deficiency
• Kidney Deficiency

Excess
Deficiency
72
Damp-phlegm
Etiology
73
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 (F30 Hz) for local
swelling area 2) Message Abdomen and back,
twice a day.
74
Damp-phlegm
Herbal Formula
Phlegm Fat Formula (Citrus-Pinellia Compound)
Citrus Chen Pi 8 Pinellia Ban Xia 8 Poria
Fu Ling 10 Coix Yi Yi Ren 20 Atractylodes
Cang Zhu 8 Areca Da Fu Pi 10 Benincasa
Dong Gua Pi 8 Alisma Ze Xie 10 Plantago
Che Qian Cao 10 Cyperus Xiang Fu 8
Er Chen Tang
Resolve Damp
Liver Qi Master
75
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
76
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
77
Liver Qi Stagnation
. Overweight . Aggressive, or restlessness .
Hypertension . irregular estrous cycling .
exercise intolerance, lassitude . Pulse Wiry
and deep . Tongue purple or pale with coating
or without coating
Symptoms
Treatment strategy
Regulate liver, clear Fire and transform damp
Acupuncture
Sp-6/9, ST-40 Liv-3, GB-20 and GB-34
78
Liver Qi Stagnation
Herbal formula
Picrorrhiza Compound
Picrorrhiza Hu Huang Lian 18 Prunella Xia Ku
Cao 19 Cassia Jue Ming Zi 18 Rehmannia
Sheng Di Huang 15 Rheum Da Huang 15 Cassia
Pang Xie Ye 15
Clear Liver
Clear Liver Nourish Yin/Blood
Purge LI
79
Blood Stagnation
Etiology
Other factors
Stress
Qi stagnation
Blood Stagnation
Qi-blood stagnation
Water/Damp retention in the body
Obesity
80
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
Invigorate Blood and transform damp
Acupuncture
BL-17/SP-10 LIV-3, GB-34, LI-4 ST-40/BL-40
81
Blood Stagnation
Herbal Formula
Stagnation Reliever
Move Blood, resolve stasis
Carthamus Hong Hua 22 Ligusticum Chuang
Xiong 22 Olibanum Ru Xiang 19 Typha Pu
Huang 1 9 Rheum Da Huang 18
Move Qi Blood
Purge LI
82
Spleen Qi Deficiency
Water/damp from food or environment
Etiology
Overwork
Chronic illness
Spleen Qi Deficiency
Phlegm under the skin
Obesity
83
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
tonify spleen qi and transform damp
Acupuncture
ST-36/40/41, SP-2/3, and BL-20/21
84
Spleen Qi Deficiency
Nelumbo Compound
Herbal formula
Nelumbo He Ye (Lotus) 13 Alisma Ze
Xie 13 Poria Fu Ling 13 Coix Yi Yi
Ren 13 Atractylodes Cang Zhu 13 Atractylodes
Bai Zhu 12 Citrus Chen Pi 10 Cassia Jue
Ming Zi 13
Eliminate Damp, Strengthen SP
Drain Damp
Resolve stagnation, clear Liver
Herbal Formula
Astragalus-atractylodes-lycium
Astragalus Huang Qi 34 Atractylodes Cang
Zhu 33 Lycium Gou Qi Zi 33
85
Kidney Qi Deficiency
Etiology
Other factors
Chronic illness
Ageing
Kidney Qi Deficiency
Water retention
Phlegm
Obesity
86
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
tonify Kidney qi and transform damp
Acupuncture
Bai-hui, Shen-shu, Shen-peng, Shen-jiao Bl-23/26,
SP-6 and Kid-3
87
Kidney Qi Deficiency
Psoralea Pill
Herbal formula
Psoralea Bu Gu Zi 32 Notoginseng Tian
Qi 9 Rheum Da Huang 30 Cassia Fan Xie Ye 29
Tonify Kid Qi/Yang
Move Blood
Purge LI
88
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
89
Henrietta
12 yo FS Dachshund Overweight Able to get
around with support Pants a lot with slight
cough Pulse Fast deep Tongue red
Damp-Phlegm Rx Phlegm Fat Formula
90
Constipation a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

91
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 _at_ 0.25-0.5 mg/kg TID
92
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

93
Stomach Heat
94
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
Tongue color Red Purple Pale Pale/Red
T. Moisture Dry Normal Wet Dry
T. Coating Yellow Normal No No
Pulse Fast/Wiry Wiry Weak Weak/Thready
95
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
96
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
97
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
98
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
99
Molly Dx
Earth personality No BM
Weak pulse Anorexia Decreased thirst
Dryness Red dry tongue
Earth element (SP/ST)
Yin Deficiency
Qi Deficiency
TCVM Dx SP/ST (LI) Yin Qi Deficiency
100
Molly Rx
Acupuncture DN GV-20, CV-12, ST-25 EA (10
minutes _at_ 20 Hz 10 minutes _at_ 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