Course:

Class #:

Acupuncture Treatment of Disease 1

7

Date:

November 3, 2008

Quiz 2 next week. Look at all of the cases he has given us in class. Pretty complex.
Gao Xue Ya Hypertension
Palpitations Xinji and Congestive Heart Failure.

Hypertension Gao Xue Ya

Biomed and Introduction

About 20% of Americans suffer from hypertension. By definition this is a systemic circulation problem,
often due to arterial constriction or hardening. Normal and abnormal readings are shown below.

Bear in mind that blood pressure fluctuates during the day. 90-130 is better for systolic than shown
above and 60-80 is better for the diastolic pressure. As a rule the highest pressures for people are midday
and the lowest pressures between 3 and 4 in the morning.
There is another class of folks myself included whose highest pressures will be recorded 6 9 am.
Mine was lowest in the evenings around 8pm.
Etiology Primary 85 90%, Secondary 10-15%. Symptoms are mostly unrecognized for what they
area. Headaches are a sign of hypertension. The hypertension itself isnt so bad, but the organs it impacts
take a large hit over time. Click here for a good article on the complications of long term hypertension.
Heart works very hard and left ventricle enlarges. On an X-ray the heart starts looking like a
ski boot shape. Left sided heart failure is possible as a result. Also arterio- and atherosclerosis,
aneurysms, coronary artery disease.
Brain brain vessels get thick and large and cause aneurisms, strokes, TIAs, dementia, mild
cognitive impairment.
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 Eyes high pressure in the vessels breaks them causing blindness in varying degrees
retinopathy, fluid build up under the retina, and nerve damage.
Kidney long term hypertension affects vessels here too causing bleeding out in the kidney,
kidney failure, scarring and kidney arterial aneurysm.
Treatments include diuretics, ACEI, calcium channel blockers.
To take blood pressure, have patient rest about 5 minutes, be sure they havent smoked for 15 minutes
(Mandyam says 1 hour. See the Physical Assessment 1 information on blood pressure for best info.)

TCM How to understand this

Etiology
Emotional disorder
Liver Yang or Fire rising up. Can also be caused by Liver and Kidney Yin deficiency
which allows the Yang to rise abnormally.
Irregular Diet
Fat, greasy and spicy food diet. Irregular diet will cause phlegm and water buildup in the
Lung, Spleen and Kidney, the water related organs.
Too much water and phlegm is the equivalent too much fluid in a hydraulic system. Too
much pressure in the system causes hypertension.
Cut back on salty, greasy foods, even raw foods which will weaken the Spleen and
depress its ability to make the water metabolism work correctly.
If the Kidney is Yin deficient will cause Liver Yin to be deficient as well. This is yin xu
in the Lower Jiao causing the Yang to rise. Encourage patients in this state to sleep
regularly and at night, not staying up too late or the Kidney Yin will be further depleted.
And also, quit the night shift!
Lung is affected as well it is the dispersal organ. If it cannot disperse fluid metabolism
is all messed up also.
Liver is also related to hypertension Liver Qi yu or Liver Yin xu will cause the vessels
to lose flexibility which drives blood pressure up as well.
Overwork
Impacts the Kidney, Liver, Heart and Spleen.
Weve talked about Kidney, Liver and Spleen. Heart Qi or Zong Qi/pectoral Qi pushing
too much or not enough will also cause hypertension. Heart fire pushes the blood forward
too much and too fast which can also cause hypertension.
Have you noticed that all 5 Zang organs have been involved now? Aint that a bummer?
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 Age
Medication
Mechanism
Excess in the upper part of the body with deficiency on the lower part of the body. This imbalance is the
basic mechanism for hypertension.
Deficiency
Mostly due to Liver Yang rising Liver/kidney Yin xu (the most common reason for
hypertension) causing the Yang to rise. Yin is getting less and cannot anchor the Yang which
then goes to the highest part of the body. Thats the deficiency in the lower part.
Excess
Liver Yang rising up becomes an excess in the upper body. Also, if patient is overweight theres
a retention of damp and phlegm which is also excess.
The Dai channel is the dividing line between upper and lower. As a result, you choose Dai channel
points, especially GB 41+SJ5 to balance the upper and lower.
Differential diagnosis
Excess:
o Liver fire
o Excessive Liver Yang Rising
o Wind-Phlegm
Deficiency
o Liver and Kidney Yin Xu with Liver Yang Rising
o Kidney Yang Xu
Kidney Yang deficiency results in an inability of the Kidney to warm the water. It will be
unable to nourish Wood which dries Wood out and makes it deficient. Liver and Kidney
have the same source per the Nei Jing closely related. If Liver has a problem then the
Liver Yang rises.
Treatment

Note the Yangming points regulates Qi and blood. Sanjiao and foot shaoyang points help water
metabolism related to hypertension. P6 is used to regulate Heart Qi . GB 20 is about wind. Mostly use
reducing in the upper body and more tonification in the lower body.
Treatment for different syndromes below use special points per syndrome plus the Basic points above.

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Liver Fire
Heat signs. We discussed this last week. Look at the differences between Liver Fire and Liver
Yang below. See that Liver Yang Rising is the same, but more severe.
Liver 2 is a ying spring point and is key for this syndrome. Note UB 18 for Liver fire, not liver
yang. Bleeding is a choice as is Gua sha at Liver 2.

Liver Yang
More severe and advanced than Liver Fire. Headache is throbbing, dizziness/vertigo is more
severe, more shen disturbance than Liver Fire.
Liver 3 instead of Liver 2 nourishes Liver Yin more. This is the special point.
Du 20 is good for wind and vertigo. Use a reducing method here. Du 16 is wind residence point,
so this is for wind too, as is GB 20.

Upward Disturbance of Wind-Phlegm

Notice the nausea/vomit middle jiao damp, water and phlegm retention. Mucous too.
ST 40 and UB 20 are good points to make the Spleen Qi stronger and resolve phlegm. SP 2 and 3
nourish the spleen to reduce water.

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Liver and Kidney Yin Deficiency with Liver Yang Rising

Not only Liver fire can cause Liver Yang to rise more heat signs there but also Liver/Kidney
Yin Xu can cause Liver Yang to rise because theres not enough Yin to balance/control.
Liver 3 is a key point for this condition. Kidney 3 is another. Kidney 7 is for night sweating,
Kidney 10 is He Sea. UB 18 is the back shu of Liver and nourishes.

Kidney Yang Deficiency

Look for the cold signs plus the knee and waist symptoms. Also, pulse is different. Du 4 and Ren
4 are the key points. Promote urination points to reduce water excess. ST 28 is the water
passage point. UB 22 for SJ back shu application. UB 28 is the back shu of the Bladder. Again,
use the basic points, plus these points.

Treatment
Basic points, plus points for specific syndrome.
Auricular acupuncture: shenmen, liver area, kidney, sympathetic, liver yang point (excess
condition), and tip of ear on the front of the ear and lower pressure groove on the back of the ear.
Herbs: tian ma gou teng yin formula. This is a liquid used to extinguish wind/control phlegm,
cool the blood. Zhen gan xi teng tang decoction to calm liver and extinguish the wind
Control the diet.
Qigong
In emergency condition, refer to western doc right away.
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Palpitations Xinji / Congestive Heart Failure Xin Li Shuai Jie

Biomedical View and Intro to Congestive Heart Failure

Heart and Lung circulation is closely related. The disfunctionality of one affects the other. Remember
that hypertension causes left sided heart enlargement and eventually left sided heart failure. Blood will
eventually back up here. Pulmonary hypertension causes right sided heart failure as the heart cannot
push blood to the lungs. Pulmonary hypertension follows cardio-hypertension. This causes wide-spread
water circulation problems.
Know that left side heart failure = wake up in the middle of the night, shortness of breath to get more
oxygen to the lungs.
Right sided heart failure = lower legs swollen with pitting edema because heart cannot push blood to the
lungs.
The incidence of CHF increases with age. 2% for 40-59 yo, 5% for 60-69 yo, and 10% over 70 yo. CHF
is often due to smoking and is the 3rd stage of Lung/Heart disease. CHF occurs due to aninability of the
heart to pump sufficient blood to the bodys other organs. This can result from
Narrowed arteries
Past heart attack or MI causing scar tissues on the heart.
High blood pressure
Heart valve disease due to past rheumatic fever or other cause
Primary disease of the heart muscle - cardiomyopathy
Heart defects at birth
Infection of the heart valve or heart muscle endocarditis or myocarditis.
Any part of the heart having problems can cause heart failure.
Smoking is a high risk activity causing cardio-pulmonary complications. Other diseases can cause lung,
heart and blood vessel damage leading to CHF.
Symptoms are both pulmonary and systemic.
Pulmonary (left heart failure SOB, sudden dyspnea at night, phlegm which may be pink) is
lung
Systemic (right heart failure fatigue, pitting edema) is whole body.
Treatment depends upon cause hypertension, MI, valve dysfunction, etc which is treated first. Then
perhaps diuretics, ACEI (ace inhibitors), Beta blockers, digoxin, and aocoafulants.
Prognosis is very poor indeed.

TCM View of Congestive Heart Failure

Etiology
Invasion of external pathogens
Over-working
Congenital factors

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Mechanism
Combination of Excess and Deficiency of the Heart
o Deficiency
Heart Qi xu easily fatigued and SOB
Heart and Kidney Yang Xu
Lung/spleen/kidney deficiency - Edema
Lung - Cough
o Excess
Blood Stasis: Purple lips, etc
Water/damp/phlegm

Treatment
Basic points:

The following 2 syndromes are examples. There are more reasons than this
Heart Qi Deficiency with Retention of Blood Stasis

Fatigue above is pretty severe. Heart sweat = heart Qi too weak to control the fluids of the
body. Heart Qi xu causes blood not to push forward in the body, so causes stasis. Cyanosis =
purplish due to lack of oxygen. Pulse will be very weak.
Use heart back shu/front mu + Heart 7 to nourish heart yin. UB 17, SP 10 to address blood stasis.
Blood stasis is Yin in nature blood becomes cold and stagnant open the Du channel (SI 3,
UB62) to warm the blood and melt the stasis.

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Heart and Kidney Yang Xu with Retention of Water

Dont confuse with Ht/KI disharmony, which is a Yin Xu! Look at all of the cold stuff below.
You might find edema in the upper body in this syndrome as Yang gets weak and cannot move
the water around. Edema is the hallmark symptom.
Ren 4, Du 4 are primary points. Ren 6 is the ocean of the Qi. UB 28 and ST 28 will control water
in the body. This is for severe edema. As is Ren 9, the water division point, which refers to
Herbs: ginseng 10g, huang qi 30g, ren shen 10g (tonify qi), dan shen 10g (for blood yu), chuan
xiong to move blood, Wu Wei zi.
Moxa box on the heart back shu points for Yang xu. Moxa at Ren 17 to warm the chest.
Bear in mind that for heart patients with weakness cannot use strong stimulation.

Quiz 2:
40 MC. Cover everything after Quiz 1. Review all case discussions very carefully. Know diff
between Ht/KI disharmony (yin xu), and Kidney yang xu.
A whole bunch of freakin case studies.

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