Most Common Conditions Treated in Bob Doane’s Clinic · Most Common Conditions Treated in Bob...

Most Common Conditions Treated in Bob Doane’s Clinic

Robert Doane EAMP, L.Ac., Dipl, C.H.

Owner of the Acupuncture & Wellness Center, P.S.

Lotus Institute Of Integrative Medicine Tel: (626) 780-7182 Fax: (626) 609-2929

Website: wwww.doane.us/lotus Email: [email protected]

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715 Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine

Conditions To Be Discussed

•  Weak Heart/Congestive Heart Failure •  Mitral Valve Prolapses •  Aortic Stenosis and Regurgitation •  Coronary Ischemia •  Sinus Congestion/Allergies •  Fatty Livers •  Fatigue, Anxiety, and Depression

Heart Conditions Most Commonly Seen in ClinicWeak Heart/Congestive Heart Failure

•  Heart failure affects nearly 6 million Americans.

•  Roughly 670,000 Americans are diagnosed each year.

•  Leading cause of hospitalization of people over 65

Heart Conditions Most Commonly Seen in Clinic Weak Heart/Congestive Heart Failure

• Heart’s pumping power is weaker than normal. • Blood moves through the heart and body at a slower rate. • Not enough oxygen and nourishment to meet body and heart’s needs.

Heart Conditions Most Commonly Seen in Clinic Weak Heart/Congestive Heart Failure

•  The walls of the heart weaken and are unable to pump efficiently.

•  The kidneys respond causing retention of fluid and salt.

•  The body swells with excess fluid.

What Causes Heart Failure?

•  Coronary artery disease. – Heart is robbed of oxygen and nutrients.

•  Heart Attack. – This damages the heart muscle and the heart

loses function.

What causes Heart Failure?

•  Cardiomyopathy – Damage to the muscle from infection or other

causes.

•  Conditions that overwork the heart. – Hypertension, valve disease, thyroid disease,

heart defects, diabetes, excessive aerobic exercise.

Symptoms of Heart Failure

•  Congested Lungs. SOB, wheezing, coughing.

•  Fluid and water retention.

•  Dizziness, fatigue and weakness.

•  Rapid or irregular heartbeats

Type of Heart Failure

•  Systolic Dysfunction – Heart contractions are weak causing less blood

flow.

•  Diastolic Dysfunction – Heart contracts normally but the ventricles do

not relax or are too stiff so less blood enters the heart. EF is weak.

Diagnosis Of Heart Weakness or Failure •  Blood Tests

– B-type Natriuretic Peptide (BNP) blood test. Substance secreted from the heart in response to an increase in heart failure.

•  Chest X-Ray – Shows if the heart is enlarged and if there is

fluid build up around the heart and lungs.

Diagnosis of Heart Weakness or Failure •  Echocardiogram

– Shows the heart’s movement, structure and function.

•  Electrocardiogram – Will show if you have already had a heart

attack by showing a disturbance in the electrical impulses traveling through the heart.

Diagnosis of Heart Weakness or Failure •  Cardiac Catheterization

– Helps to determine whether coronary artery disease is a cause of the heart failure.

•  Stress Test, Treadmill stress test, Adenosine stress test, Stress echocardiogram, nuclear stress test.

Treatment of Heart Disease

•  Beta-blockers

•  Ace inhibitors

•  Life style changes

•  Surgery

•  Pace Makers

Stages of Heart Failure

•  Stage A – Mostly people at risk with no adverse

symptoms yet.

•  Stage B – People with systolic left ventricular dysfunction.

EF is less than 40%.

Stages of Heart Failure

•  Stage C – Known systolic dysfunction with SOB, fatigue

and reduced ability to exercise.

•  Stage D – Advanced symptoms of systolic heart failure.

Left Cun Heart: Pulse Types for Heart Failure/Weak Heart/Congestive Heart

1. Small Pulse/Thin and Weak •  Can be deep indicating Yang Qi deficiency with

damp retention. Can be too high indicating a weakness of Qi and Blood. Possible Mitral valve murmur.

•  Symptoms: Chronic issues such as, Fatigue, anxiety, patient is overly sensitive, insomnia, patient cries easily, ADD or inability to concentrate, poor memory, palpitations.


2. Scattered Pulse/Dead Fish • Scattered feeling, no borders, like lots of thin pulses strung together. This indicates blockage in the small vessels of the heart. If the Dead Fish is in the middle depth there is not to much water retention yet around the heart and lungs. If the Dead Fish is deep then there is chest congestion in the Heart and Lungs. The pulse is to indicative of blocked blood flow through the heart or a bundle branch block. Basically, inefficient blood flow through the heart.


2. Scattered Pulse/Dead Fish

•  Symptoms: Tightness in chest, insomnia, shortness of breath on exertion, palpitations.


3. Constricted Pulse/Pulse Within Pulse •  This is a scattered pulse/dead fish that has

a thin line, fine pulse in the middle or on the side of the scattered feeling.

•  Symptoms: This is a more serious coronary constriction and often the patient will complain of tightness in the chest.


5. Gu pulse •  Pulse has high amplitude, is usually strong, and

can be felt over 3 positions, distal to proximal. Indicates Aortic valve stenosis. If the Gu pulse also collapses under the finger pads then the valve also does not close entirely on diastole

•  Symptoms: Chest pain or pressure (angina). Feeling dizzy or faint. Feeling tired and being short of breath.

Left cun – Heart / Small Intestine Small pulse •  Pulse sign: Small pulse

–  Small pulse is thin and weak –  Upon pressure, it disappears

•  Indications –  Heart blood def. – poor memory, poor concentration –  ADD, overactive, can’t concentrate

•  Herbal Rx –  Ren Shen Yang Ying Tang, Shi Quan Da Bu Tang, Tian Wang Bu

Xin Dan –  Check Left Guan – if it is too high or overactive, then 1/3 to ½ of

formula should be Chai Hu Jia Long Mu Tang

Left cun – Heart / Small Intestine Small pulse •  ADD, overactive, can’t concentrate

–  Tian Wang Bu Xin Dan is not strong enough –  Use Shi Chang Pu, Yuan Zhi, Suan Zao Ren,

Lian Zi Xin –  Add Tian Zhu Huang if you find a slippery pulse

(brain damage pulse according to Jimmy) –  Pay attention to the Left Guan. You have to treat he

liver if it is overactive, which it usually is. Can use Liver Detox or Zhi Zi

–  Can combine with Tian Wang Bu Xin Dan with Zhi Gan Cao Tang if heart palpitations

Left cun – Heart / Small Intestine Deep and weak pulse •  Pulse sign: Deep and weak •  Indications

– Congestive heart failure (pre-clinical) – Fluid in the lungs – Edema in the ankles (systemic edema)

Left cun – Heart / Small Intestine Deep and weak pulse •  Herbal Rx:

– Fang Ji Huang Qi Tang: 20-80 % – Vitality/ Stress1: 80-20%

Left cun – Heart / Small Intestine Scattered/ Dead Fish •  Pulse sign: Scattered pulse

–  Shapeless pulse where its border is difficult to perceive

–  Thick (wide), soft or firm, slow and deep –  Dead fish pulse

•  Indication: –  Vessel blockage, either large or small –  Bundle branch block –  Systolic murmur

Left cun – Heart / Small Intestine Scattered/ Dead Fish •  Herbal Rx

–  Mao Dong Qing 25% –  Dan Shen 25% –  Gua Lou Xie Bai Ban Xia Tang 25% –  Stress 1 25% –  Add Ye Jiao Teng, if there is anxienty

-  Other possibilities: -  San Qi -  Shan Zha -  Yan Hu Suo

Left cun – Heart / Small Intestine Constricting/Pulse within a pulse •  Pulse sign: Constricting/

Pulse within a Pulse – Straight pulse that feels

like there is a bundle of electric wires (that are thin, straight, tight) within the artery

•  Indications – Severe coldness in the heart –angina pectoris,

myocardial infarction, coronary heart conditions

Left cun – Heart / Small Intestine Constricting/Pulse within a pulse •  Herbal Rx

– Si Ni Tang 20%, Stress 1 20%, Dan Shen 20, Gua Luo Xie Bai Ban Xia Tang 20, plus Openers: Dang Gui 10% Chuan Xiong 10% (or Sheng Ma 10%).

– What herbs are good to clear the plaque on the vessel wall? Shan Zha, Jue Ming Zi, He Ye, Xia Ku Cao, San Qi, Dan Shen

Left cun – Heart / Small Intestine Gu pulse •  Pulse sign: Gu pulse

–  Refers to when both the upward (systolic) and downward (diastolic) beat of the pulse are felt –  Can be felt on all pulse positions

•  Indications –  Heart valve problems – aortic valve regurgitation,

stenosis; shortness of breath, chest pain, fainting, dizziness

–  MSG, soda, or coffee intake

Left cun – Heart / Small Intestine Gu pulse •  Herbal Rx

–  Mao Dong Qing 50% •  Excellent for water retention in the chest/heart •  Edema caused by heart dysfunction (i.e. congestive

heart failure) – Can use Mao Dong Qing 100%

–  Tian Wang Bu Xin Dan 25% –  Yang Xin Tang 25%

Acupuncture Tx for Deficient Heart

Target: Heart Tx: Ren 14 HT 8 K1 SI 2 or 3

Leave needles in no longer that 10 minutes and re-stimulate at time of extraction

Acupuncture Tx for Coronary Constriction Target: Heart

Tx: Moxa Ren 17, 14

Acupuncture Tx for Heart Valve Dysfunction •  Weak Murmur: Mitral Valve

–  Target: Heart –  Tx: Ren 14

HT 8 K 1 SI 2, 3

–  Take needles out between 8 – 10 minutes •  Strong Murmur: Aortic

–  Target: Heart –  Tx: Ren 14

Ear Shen Men K 1 P6 HT 8 K7

–  Leave needles in for at least 40 minutes

Allergies and Chronic Sinus Congestion •  Rhinitis and Common Cold •  Sinusitis •  Sinus Infection

Non Allergic Rhinitis (No identified allergic reaction is involved)

•  Symptoms (can be acute or chronic): – Stuffy Nose – Runny Nose – Sneezing – Mucus (phlegm) in the throat (postnasal drip).

(Does not cause itchy eyes, nose and throat) Swollen sinus membranes.

Causes of Non-Allergic Rhinitis

•  Environmental irritants •  Weather changes •  Viral infections •  Medications

– Beta blocker, antidepressents, oral contraceptives, Viagra, Advil, Motrin, overuse of nasal sprays, high blood pressure medications.

•  Stress

Allergic Rhinitis

•  Symptoms: –  Itchy nose, mouth, eyes, throat, skin or any

area. – Problems with smell, runny nose, coughing,

sneezing, watery eyes. •  Chronic Symptoms:

– Stuffy nose, coughing, clogged ears, sore throat, dark circles under eyes, fatigue, irritability and headaches.

Causes of Allergic Rhinitis

•  Allergens, both air-born and/or food born. •  When the cause is pollen Allergic Rhinitis is

called Hay Fever.

Treatment of Rhinitis in General

•  Antihistamines •  Corticosteroid Sprays •  Decongestants •  Allergy Shots

Sinusitis: Chronic and Acute

•  Acute is a temporary infection of the sinus cavities due to cold.

•  Chronic has to have at least two of the following. –  Drainage of a thick, yellow or greenish discharge from

the nose or down the back of the throat. –  Nasal obstruction or congestion causing difficulty

breathing through the nose. –  Pain, tenderness and swelling around your eyes. –  Reduced sense of smell

Sinusitis: Chronic

•  Other Signs and Symptoms: – Ear pain – Aching in the upper jaw – Cough, possibly worse at night – Sore throat – Bad breath – Fatigue or irritability – Nausea

Sinusitis: Chronic and Acute

•  The signs and symptoms of chronic sinusitis are similar to acute sinusitis, except they last longer and often cause more significant fatigue. Fever can go along with acute sinusitis but not chronic.

Sinusitis: Causes

1.  Nasal polyps that block the nasal passages 2.  Allergies such as Hay Fever causing

inflammation blocking the sinuses 3.  Allergic triggers including fungal infections 4.  Deviated septum 5.  Trauma to face causing boney obstructions to

the sinuses 6.  Respiratory tract infections, which inflame sinus

membranes blocking mucus drainage

Sinusitis: Treatment

1.  Saline nasal irrigation 2.  Nasal corticosteroids (Flonase, etc.) 3.  Decongestants (Sudafed, Afrin Spray) 4.  OTC painkillers 5.  Antibiotics. These often do not work

because chronic sinusitis is usually not a bacterial infection.

Chinese Medicine Approach to Sinus Problems •  First of all we treat a Chinese Diagnosis of

the problem

•  This is best done by analyzing the flow of blood through the radial artery.

The Most Common Pulses Associated With Sinus Conditions 1.  Superficial, Forceful and Jumpy 2.  Deep and Weak 3.  Superficial and Weak 4.  Wiry and Thin or Not Thin 5.  Constricting/Pulse Within a Pulse 6.  Scattered Pulse/Dead Fish

Right cun – Lung / Large Intestine Normal pulse •  Normal pulse: Buoyant

–  Buoyant pulse is soft and strong –  Stronger at the superficial and weaker as the depth

increases. –  Pushes up against the fingers throughout the

superficial, mid, and deep levels, but softer at mid and deep levels

•  Lung should be balanced of dryness & dampness –  Dry = Slightly floating –  Moist = Slightly deep

RIGHT CUN: Lung / Large Intestine Normal Pulse

Right cun – Lung / Large Intestine Superficial and Forceful or Jumpy •  Pulse sign: Superficial and

Forceful or Jumpy –  Jumpy = forceful pulse, Impetuous –  If the pulse is high in amplitude, use colder heat

clearing herbs. –  If lower in amplitude, but still forceful, that means there

is also stagnation involved.

Right cun: Lung / Large Intestine Superficial and Forceful or Jumpy Indications

•  Upper respiratory infection (bacterial or viral)

•  Sinusitis (Acute or Chronic)

Right cun – Lung / Large Intestine

•  If the pulse is convex with no wiriness then use:

Astringent Formula 15 ABX Formula 15 Huang Lian Shang Gin Wan 15 Gardenia Complex 15 Resolve Lower 40

Right cun – Lung / Large Intestine

•  Or: Ge Qiao 13 Fu Hai Shi 13 Di Long 13 Lian Qiao 15 Niu Bang Zi 15 Astringent Formula 20 Huang Qin 10

Right cun – Lung / Large Intestine Deep, Thin and Weak •  Pulse sign: Deep and weak with

accompanying signs of a cold •  Indications

– Upper respiratory infection (Viral) – Flu – Wei Qi Deficiency

Right cun – Lung / Large Intestine Deep, thin and Weak •  Herbal Rx

– Pu Ji Xiao Du Yin 20% BEST for viral infection. (Yin Qiao San is for bacterial infection.)

– Yu Ping Feng San 20% – Qing Fei Tang 20% – Astringent Complex 20% – Ge Gen Tang 20%

Right cun – Lung / Large Intestine Superficial and Weak pulse •  Pulse sign: Tent pulse

– Convex-shaped pulse that collapses upon pressure

– Wiry shaped that collapses upon pressure •  Indications: Lung qi deficiency •  Weak immune system •  Common cold •  Allergies

Tent pulse

Right cun – Lung / Large Intestine Superficial and Weak pulse •  If Allergies (Wind) plus Fatigue: •  Yu Ping Fen San or Huang Qi Jian

Zhong Tang, 30 •  Chan Tui 10 •  Xin Yi Hua 10 •  Jie Geng 5 •  Dang Shen 5 •  Bai Zhi 10 •  Wu Mei 5 •  Gan Cao 5 •  He Zi 10 •  Wu Bei Zi 10

•  If wheezing add: •  Di Long 6 •  Ku Shen 6

•  If loose stools add: •  Ge Gen 15

•  If blood stasis add: •  Mu Dan Pi 8 •  Dang Gui 5 •  Lu Lu Tong 6 • 

Right cun – Lung / Large Intestine Wiry (Superficial, thin or not thin) •  Acute Wind Cold or Wind Heat •  Acute Allergies •  Chronic Allergies with Lung Qi Deficiency •  Wiry is always indicative of wind. Thinness refers

to whether the pattern is Heat or Cold. With chronic or acute allergies the wiry pulse is indicative of an itching problem. If no itching and the problem just began the patient has a common cold.

Right cun – Lung / Large Intestine Wiry (Superficial, thin and tight) •  Wind Cold Allergy or Common Cold:

– Wiry pulse that is thin and light •  Wind Heat Allergy or Common Cold:

– Wiry pulse that has a stronger jump and a little faster and thicker (can be slightly convex if more heat than wind)

Right cun – Lung / Large Intestine Wiry (Superficial, thin or not thin) •  Diagnosis: Wind Cold / Common Cold

•  Symptoms: Pulse is thin and tight. Can be also weak due to Lung Qi Deficiency. Nose and/or cheeks should be cool. Thin phlegmy discharge.

Right cun – Lung / Large Intestine Wiry (Superficial, thin or not thin) Herbal Rx: Wind Cold •  Ge Gen Tang 20 to 40 •  Yin Qiao San 20 •  Pu Ji Xiao Du Yin 20 •  Astringent Formula (if more than 3 days) 20 •  Lung: Xiao Ging Long Tang 20 •  Thin Pulse: Yang Wei 20 •  Weak Pulse: Yu Ping Feng San 20

Right cun – Lung / Large Intestine Wiry ( Superficial, not thin with a jump (can be a fast pulse)) •  Symptoms: Pulse is thin, wiry, fast and has

jump. Almost always superficial unless a lot of Dampness or Blood Stasis. Phlegm is thicker. Can have a sore throat. Cheeks and nose are warm and hot.

Right cun – Lung / Large Intestine Wiry ( Superficial, not thin with a jump (can be a fast pulse)) Herbal Rx: Wind Heat • Yin Qiao San 20 to 40 • Pu Ji Xiao Du Yin 20 • ABX 20 • Ning Sou San (if patients colds end up in chest 20 • Astringent Formula (if more than 3 days) 20 • Yu Ping Feng San (if noticeable Qi deficiency) 20 • Resolve Lower (if patient’s colds end up in sinus infections) 20 • Huang Lian Shang Qin Wan (if patients colds end up in chest 20 history of lung infections)

Right cun – Lung / Large Intestine Wiry (Superficial and thin) •  Symptoms: Runny nose, itchy eyes or nose

or throat. Chronic or acute. Swollen face and sinus passages.

•  Diagnosis: Airborne allergy. Wind Cold type

Right cun – Lung / Large Intestine Wiry (Superficial and thin) Herbal Rx: Wind Cold •  Cang Er San 30 •  Jing Jie 10 •  Fang Feng 10 •  Sin Ni San 10 •  Gan Cao 5 •  Bai Zhi (for runny nose) 10 •  Astringent Formula 10 •  Chan Tui 5

Right cun – Lung / Large Intestine Wiry (Superficial and thin, with a jump) •  Symptoms: Clogged sinuses, swollen sinus

tissue, warm nose, head and cheeks, itchy sensations, chronic or acute.

•  Diagnosis: Airborne Allergy, Wind Heat type

Right cun – Lung / Large Intestine Wiry (Superficial and thin, with a jump) Herbal Rx: Wind Heat •  Mu Dan Pi 15 •  Shen Ma 10 •  Xin Yi Hua 10 •  Lu Lu Tong 10 •  Cang Er Zi 10 •  Chan Tui 5 •  Lian Qiao 10

•  Bai Zhi 5 (increase to 15 if runny nose) •  Chuan Xiong 5 •  E Bu Shi Cao 5 •  Gan Cao 5 •  Huang Qin 10

If eyes are affected add Ju Hua, Sang Ye, Bai Ji Li, Bo He

Right cun – Lung / Large Intestine Constricting/Pulse within a pulse •  Pulse sign: Constricting/

Pulse within a Pulse –  Straight pulse that feels like

there is a bundle of electric wires (that are thin, straight, tight) within the artery

•  Indications –  Wind-cold (if superficial) or Lung-cold with phlegm (if

deeper) –  White sputum / post nasal drip / nasal discharge

Right cun – Lung / Large Intestine Constricting/Pulse within a pulse •  Herbal Rx

–  Xiao Qing Long Tang 20% –  Si Ni Tang (in winter or cold climate area) 20% –  Openers: Dang Gui 15% and Sheng Ma 15% (or Dang Gui

15% and Chuan Xiong 15%). Either pair would be fine. •  Opens up and promotes circulation in the capillaries, small

vessels. Transport the WBC, RBC, etc to the area.

–  Astringent Complex 30% for inflammation (to bring all the wiry pulses inside together)

–  With headache, add Chuan Xiong Cha Tiao San –  If drippy nose, add E Bu Shi Cao and Bai Zhi

Right cun – Lung / Large Intestine Scattered pulse

•  Pulse sign: Scattered pulse – Shapeless pulse where its

border is difficult to perceive – Thick (wide), soft or firm, slow and deep – Dead fish pulse

Right cun – Lung / Large Intestine Scattered pulse •  Indications

–  Sinus infection –  Vertigo or dizziness –  Polyps in Large Intestine –  Head pain due to micro-capillary bleeding leading to dead blood in

the sinus and head area

•  Causes include: •  Traumatic injury to the head •  Drinking cold/ice water on a hot day or after exercise •  Holding breath for too long •  Lifting heavy objects/weights, Weight lifters

Right cun – Lung / Large Intestine Scattered pulse •  Herbal Rx

–  If trauma to the head use Stress 1 40% ( Circulation San Jiao - See Robert’s list of proprietary formulas for explanation) plus Tong Qiao Huo Xue Tang 20% and Seattle 1 40%

–  If sinus infection, i.e. cheeks are very hot and scattered pulse will feel firm, use

Resolve Lower – 40 Herbal ABX – 15 Astringent Complex – 15 Huang Lian Shang Qin Wan – 15 Seattle 1 – 15 (Gardenia Complex)

Right cun – Lung / Large Intestine Scattered pulse

•  Dizziness/Vertigo from phlegm in the eustachian tubes.

Bai Zhu – 20% Ban Xia – 20% Tian Ma – 20% Fu Ling – 20% Ze Xie – 20%

Acupuncture Tx for Exterior Conditions

Target: Nose, lung, and all sinus cavities Stomach dysfunction (if present) ST 36,37,41 (bi-lateral)

Nose: LI 1, 2, 3, 4, 11 (bi-lateral) Lung: LU 5 (bi-lateral) SP 9 (bi-lateral) Stomach: ST 36 / GB 34

LI 4, 11 SP 9 / LV 8 SJ 5 / P 6 / LU 9

Acupuncture Tx for Weak Immune System Target: Thyroid and Lung

Tx: LU 1 (front mu) ST 36, 37, 41 SP 8, 9 LU 9 LI 5 SJ 4 or All yin points at wrist & ankle

Important: Pull needles after 8 – 10 minutes to stimulate sympathetic system.

Acupuncture Tx for Asthma, Bronchitis, Cough Target: Diaphragm and Lungs

Tx: LU 5 x3 SP 9 x3 ST 36 x3 All bi-lateral LI 10, 11 P 6, 7 LU 1 (front mu)

Fatty Liver

Two Main Types: 1. Alcoholic Liver Disease (ALD) 2. Non Alcoholic Liver Disease (NAFLD)

Fatty Liver Alcoholic Liver Disease •  Can occur after drinking moderate or large

amounts of alcohol over a long or short period.

•  Genetics plays a part. It can influence how much you consume and you susceptibility to the disease. It can influence your levels of liver enzymes required to alcohol.

Fatty Liver Alcoholic Liver Disease •  Other contributing risk factors are:

– Hepatitis C –  Iron Overload – Obesity – Diet

Fatty Liver Non-Alcoholic Liver •  Most common cause of liver disease in the

USA •  It can be benign or more serious •  Benign NAFLD is simply to much fat in the

liver. If the liver is not inflamed or damaged Western Medicine considers the condition benign

Fatty Liver Non-Alcoholic Liver •  More serious NAFLD is called non-alcoholic

steatohepatitis (NASH). This is similar to ALD but these patients do not drink that much. NASH can lead to permanent liver damage. The liver may enlarge over time, liver cells may be replaced by scar tissue. This is now liver cirrhosis. The liver doesn’t work right and you develop liver failure or liver cancer. NASH is one of the leading causes of cirrhosis.

Fatty Liver Disease

•  Up to 20% of adults have fatty liver NASH. •  More than 6 million children have one of

these conditions, which are more commin in Asian and Hispanic children.

•  Recent research shows that NAFLD increase the risk of heart disease in children who are overweight or obese.

Fatty Liver Disease Causes •  Medications •  Viral Hepatitis •  Inherited liver Disease •  Autoimmune Disease •  Rapid Weight Loss •  Genetic Risks (it runs in families) •  Affects mostly the middle aged who have high

cholesterol or triglycerides, and diabetes or pre-diabetes •  Obesity

Fatty Liver Disease Symptoms •  Fatigue •  Weakness •  Nausea •  Confusion with trouble concentrating •  Pain in center or right upper abdomen •  Enlarged liver •  Patchy, dark skin discoloration, usually on the

neck or underarm areas

Liver Cirrhosis Symptoms •  Fluid retention •  Muscle wasting •  Internal bleeding •  Jaundice •  Liver failure

Fatty Liver Disease Diagnosis 1.  Blood tests with elevated ALT or AST 2.  Enlarged liver on physical exam 3.  Liver biopsy which shows signs of fat,

inflammation and damaged liver cells. If no damage then benign fatty liver.

Fatty Liver Disease Treatment •  No specific treatment in Western Medicine

other than losing weight, exercise and stop drinking alcohol.

•  Patients are advised to not take NSAIDs.

Fatty Liver Disease and Chinese Medicine Diagnosis

•  Pulse diagnosis will reveal a fatty liver

•  On the Left Guan the pulse will be: – Deep, Scattered and Concave – Deep and Forceful

Left guan – Liver / Gallbladder Normal Pulse

Left guan – Liver / Gallbladder Normal pulse •  Normal pulse: Slightly wiry

– Wiry pulse is a pulse that is straight – When normal is not too thin or thick or

too strong or too weak – Locate at the middle depth

Left guan – Liver / Gallbladder Concave and Deep •  Pulse sign: Concave and Deep

–  Concave = pulse curved downward –  Can feel the curvature along the

sides and bottom •  Indications

–  Fatty Liver –  Emotional conditions – anxiety, depression, irritability –  Damp in the Liver and GB channel –  If forceful, damp-heat

Left guan – Liver / Gallbladder Concave and Deep Herbal Rx: Fatty Liver •  Ge Xia Zhu Yu Tang 20 •  Yin Chen Hao Tang 25 •  Huang Shui Qie 15 •  Hu Zhang 15 •  Xia Ku Cao 15 •  Zhi Zi 15

Liver Damage and Chinese Medicine - Left guan Liver / Gallbladder: Wiry, Forceful, and Deep

•  Pulse sign: Wiry, Forceful, and Deep •  Indications

– Actual Liver organ function disorders – hepatitis, elevated Liver enzymes

– Very thin at middle or deep depths is usually due to having mono in the past

Left guan – Liver / Gallbladder Wiry, Forceful, and Deep •  Herbal Rx

– Actual Liver disorder •  Liver DTX 30% •  Ge Xia Zhu Yu Tang 20%

– High Liver enzyme •  Add Chai Hu Qing Gan Tang 20% and Wu Wei Zi

15% and Shan Zhu Yu 15%

Acupuncture Tx for Excess Liver Conditions Target: Liver

Tx: LV 14 ST 36, 37, 38 GB 34 LV 8 SP 9, 8, 7 P 6 LU 9 LI 4 SJ 5

If gallbladder involvement add: GB 24

Fatigue, Anxiety and Depression Most Common Pulse Signs 1.  Overall Deep Pulse in all left arm positions 2.  Liver pulse is too high and Heart Pulse too

low 3.  Heart pulse is weak 4.  Overall pulse is deep and the Heart Pulse

is weak 5.  Liver pulse is too high and pounding

Fatigue, Anxiety and Depression

Symptom: – Deep pulse in all left arm positions

Diagnosis: – Systemic Blood Stasis

Fatigue Anxiety and Depression

Herbal Rx: •  Chai Hu Jia Long Mu Tang 20 •  Mu Li 20 •  Xia Ku Cao 15 •  He Huan Pi 15 •  Tian Wang Bu Xin Dan 15 •  Ren Shen Yang Yin Tang 15


Symptom: – Heart pulse is weak and other pulses

also weak.

Diagnosis: –  Heart Qi and probably Blood Deficiency.

Likely Mitral valve leakage.


Herbal Rx: •  Sheng Mai San 20 •  Tian Wang Bu Xin Dan 20 •  If warm hands: Zhi Bai Di Huang Wan 20 •  If cold hands: Ba Wei Di Huang Wan 20 •  Jia Wei Xia Yao San 20 •  Gan Mai Da Zao Tang 20


Symptom: – Overall pulse is deep and Heart Pulse is

weak Diagnosis:

– Weak heart with Congestion, Congestive Heart


Herbal Rx: •  Fang Ji Huang Qi Tang 20 •  Vitality Formula 80

If Liver is inflamed i.e. Liver Pulse is deep and strong, then add Yin Chen Hao Tang 20


Symptom: –  Liver pulse is too high and pounding

Diagnosis:

– Inflamed liver, Liver Fire


Herbal Rx: •  Zhen Zhu Mu 13 •  Ci Shi 13 •  Mu Li 13 •  Xia Ku Cao 15 •  Yin Chen Hao 15 •  Astringent Formula 20 •  Long Dan Cao 10


Alternative Herbal Rx: •  Huang Shui Qie 15 •  Cha Chi Huang 15 •  Hu Zhang 15 •  Xia Ku Cao 15 •  Yin Chen Hao Tang 20 •  Long Dan Xie Gan Tang 20

Fight or Flight / Chronic Stress Causes •  Childhood trauma (rape, physical abuse,

car accidents, alcoholic parents, history of drowning, divorce of parents when child was young)

•  Abuse •  Military Combat •  Financial Pressure (busy businessman

syndrome)

Fighty or Flight / Chronic Stress Signs and Symptoms •  Increased levels of Cortisol, Norepinephrine,

and Adrenaline in the blood. •  Always agitated, cannot stop doing things,

work till they drop. •  Existential angst •  Subliminal Fearfulness •  Always waiting for the other shoe to drop

feeling.

Fight or Flight / Chronic Stress Diagnosis Diagnosis Blood test for elevated stress hormones Chinese Medicine: Reverse Hook pulse

Fight or Flight / Chronic Stress

Herbal Rx if hands are warm: •  Zhi Bai Di Huang Wan 20 •  Shen Mai San 40 •  Tian Wang Bu Xin Dan 40 Herbal Rx if hands are cold: •  Ba Wei Di Huang Wan 50 •  Long Dan Xie Gan Tang 50 If the liver is really agitated i.e. Liver Pulse is too high and pounding then use the above formulas for Liver Fire.

Fight or Flight / Chronic Stress

If Liver Pulse is high and pounding but not too strong then the diagnosis is Liver Heat. Herbal Rx: •  Zhen Zhu Mu 13 •  Ci Shi 13 •  Mu Li 13 •  Sheng Di Huang 15 •  Xuan Shen 15 •  Astringent Formula 20 •  Zhi Zi 10

Acupuncture Tx for Anxiety, Fight or Flight, Heart / Kidney Imbalances Target: Heart, Diaphragm, & Kidney

Tx: GB 25 Ren 14 P 3, 6 GB 34, 41 LV 3, 8 SJ 3, 8 Ear Shen Men

Acupuncture Tx for Deficient Heart

Target: Heart Tx: Ren 14 HT 8 K1 SI 2 or 3

Leave needles in no longer that 10 minutes and re-stimulate at time of extraction

Acupuncture Tx for Coronary Constriction Target: Heart

Tx: Moxa Ren 17, 14

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Acupuncture & Wellness Center, P.S. 18870 8th Ave NE, Suite 108

Poulsbo, WA 98370

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Most Common Conditions Treated in Bob Doane’s Clinic · Most Common Conditions Treated in Bob...

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