Pulling it all together – working in code
3. Deficiency of Liver Blood.
Treatment of all three syndromes aims to subdue the Liver Wind, which can be very dangerous. Otherwise, the Liver energies need controlling or tonify- ing according to whether the underlying symptoms exhibit Excess or Defi- ciency. The prevention of stroke depends on getting this balance correct.
Liver Blood Xu Western diagnoses: hypertension, chronic eye problems, chronic menstrual
problems, anaemia.
Symptoms: dizziness, blurring of vision, dryness of the eyes, seeing spots
before the eyes, muscle spasms and tics, limb numbness, pale face, irreg- ular and meagre menstrual flow.
Tongue: pale. Pulse: thin and wiry.
Liv 2 Xingjian Fire point, disperses Fire in the Liver
Liv 3 Taichong Liver Source point; balances Liver, moves Qi
GB 20 Fengchi expels Wind
UB 18 Ganshu Back Shu point for the Liver
LI 4 Hegu expels Wind; used for face and neck
Du 20 Baihui used to calm the Liver and expel Wind
Kid 3 Taixi tonifies Kidney Yin and Yang
Kid 7 Fuliu tonifies both Kidney and Liver
Treatment
Tonify Liver Yin and tonify the Spleen:
Explanation
This syndrome may be caused by extreme or repeated blood loss, leading to a deficiency of stored Liver Blood. Poor constitution or Kidney Yin and Spleen Qi Xu will also contribute to the overall problem. There will be poor nourishment of the tissues and poor Liver function.
Liver Yang rising Western diagnoses: hypertension, migraine, nervous disorders.
Symptoms: anger, depression, throbbing unilateral headaches, visual prob-
lems, heart palpitations, dizziness, tinnitus.
Tongue: red body. Pulse: wiry.
Treatment
Disperse Liver Yang, tonify Liver Yin:
Explanation
The Liver loses control over the smooth flow of body Qi due to stress, anger or frustration, so the Qi accumulates and stagnates. As it is essentially Yang, it tends to rise.
Liver–Gall Bladder Western diagnoses: infectious hepatitis, cholecystitis.
invaded by Damp Heat Symptoms: jaundice, bitter taste in the mouth, fullness and pain in the
chest and hypochondrium, nausea, fever with thirst and dark urine, loss of appetite, vaginal discharge and itching, pain and swelling of the scrotum.
Tongue: red with yellow greasy coating.
pulling it all together 189
Liv 2 Xingjian disperses Liver Heat
GB 34 Yanglingquan calms the Liver and Gall Bladder
UB 18 Ganshu Back Shu point for the Liver
GB 20 Fengchi used for headache, expels Wind
Sp 6 Sanyinjiao tonifies Spleen, Liver and Kidney Yin
Kid 3 Taixi tonifies Kidney Yin and Yang.
Sp 6 Sanyinjiao tonifies Spleen, balances Liver and regulates Blood
UB 23 Shenshu Back Shu point for the Kidneys
UB 20 Pishu Back Shu point for the Spleen
UB 18 Ganshu Back Shu point for the Liver
UB 15 Xinshu Back Shu point for the Heart
St 36 Zusanli tonifies and regulates the Stomach and Spleen
Ren 4 Guanyuan builds up the Kidney and Yuan Qi
Pulse: wiry, slippery and rapid.
Treatment
Clear and disperse the Damp Heat:
Explanation
The bitter taste in the mouth is said to be due to Heat forcing the bile out of the Gall Bladder. This syndrome is caused by a diet containing too many rich, greasy, spicy foods and alcohol. This tends to cause Heat in the Liver and Damp in the Spleen, which combine to become Liver–Gall Bladder Damp Heat.
NB: Although there are acupuncture points recommended for this condi-
tion, medical help should be sought immediately. Cholycystectomy may prove necessary and any type of hepatitis needs to be treated with great care.
As long as the situation is monitored, carefully reviewing all the usual laboratory test results, it has been shown in an interesting case study that this condition responds to a mixture of acupuncture and Chinese herbal medicine (Williams 1992).
Cold stagnation in the Western diagnoses: pelvic inflammatory disease, hernia.
Liver channel Symptoms: pain in the lower abdomen, pain improved by warmth and
made worse by cold, pain sometimes described as being on the sides of the body, swelling and painful distension in the scrotum.
Tongue: damp with white glossy coating. Pulse: wiry, deep and slow.
Treatment
Move the stagnation, disperse Cold:
GB 34 Yanglingquan disperses Damp Heat
Liv 2 Xingjian disperses Liver Heat
Sp 9 Yinlingquan transforms Damp
UB 48 Yanggang point used for jaundice
GB 24 Riyue regulates Liver Qi, soothes Damp
St 36 Zusanli regulates the Stomach and Spleen
UB 19 Danshu Back Shu point for the Gall Bladder
UB 18 Ganshu Back Shu point for the Liver
LI 11 Quchi resolves Damp, clears Heat.
Liv 3 Taichong move the Qi in the channel
Liv 5 Ligou clears the channel
Liv 8 Ququan Water point, tonifies the Liver
Sp 6 Sanyinjiao benefits the Liver
Ren 4 Guanyuan disperses Cold from the lower Jiao
Explanation
This is an essentially painful condition. The Pathogen Cold is always asso- ciated with a deep, penetrating type of pain. Cold congeals or ‘freezes’ the flow of Qi and Blood.
Liver invades Spleen Western diagnoses: stress due to overwork or emotional problems.
Symptoms: Possible combinations between the two lists in Box 8.14.
Tongue: pale with red sides.
Pulse: weak on the right, wiry on the left.
Treatment
Move stagnating Liver Qi and tonify Spleen Qi:
Explanation
This is a somewhat modern interpretation of TCM syndromes and described by Maciocia as a combined pattern. It implies that indigestion has occurred due to the secretion of large amounts of acidic digestive juice (produced by the Liver) in comparison to alkaline digestive juice (produced by the Spleen). The symptoms can present either as a deficiency, when the Spleen permits the ‘invasion’, or as an excess, when Liver symptoms pre- dominate. Either way, it is linked to long-term emotional stresses, poor eating habits or overworking (Maciocia 1989).
Collapse of Yin and Yang These two patterns tend to stand alone and they both require urgent treat- ment if recognized.
Collapse of Yang Western diagnoses: total exhaustion, severe shock.
Symptoms: chills, cold clammy skin, cold extremities, cold sweat, feeble
breathing, lack of spirit, exhaustion, desire for hot drinks.
pulling it all together 191
Liv 14 Qimen smooth flow of Liver Qi
Liv 13 Zhangmen harmonizes the Liver and Spleen
GB 34 Yanglingquan promotes smooth flow of Liver Qi, calms pain
Liv 3 Taichong promotes smooth flow of Liver Qi, calms pain
St 36 Zusanli tonifies the Spleen
Sp 6 Sanyinjiao tonifies the Spleen, regulates the Liver.
Excess (Liver) Deficiency (Spleen)
Constipation Diarrhoea
Abdominal distension Abdominal distension
Marked pain Little pain
Tongue, red sides Tongue, pale
Irritability Tiredness
Box 8.14 Symptom list
Tongue: swollen, pale, wet. Pulse: deep and weak.
Treatment
Rescue Yang, prevent further loss:
Explanation
Collapse of Yang is due to continuous, extreme vomiting or diarrhoea. Excessive bleeding or perspiration in the case of heat stroke can also cause it. The patient needs to be kept warm. If associated with shock, the feet should also be elevated. The specific Yang organs should be treated on their respective Fire points to guard against further collapse. Medical help is
advisable.
Collapse of Yin Western diagnoses: mental overwork, high stress, emotional collapse.
Symptoms: restless, insomniac, dull spirit, inability to focus or make
decisions; often linked with the overuse of stimulants or tranquillizers.
Tongue: red, peeled, dry. Pulse: floating, empty, rapid.
Treatment
Tonify Qi and Yin. Calm the spirit, disperse Fire:
Explanation
Changes in lifestyle are required or this will become a chronic state, even- tually leading to collapse of Yang as Yang rages out of control. Relaxation techniques should be taught. Some form of meditation or Qi Gong will also be helpful.
Using syndrome The preceding syndromes are very basic and, in reality, most patients tend differentation to show more than one during the course of any lengthy disease. More
complex diseases such as multiple sclerosis actually progress quite clearly from one syndrome to another. Blackwell & MacPherson (1993) described a staging for multiple sclerosis in terms of syndromes (Table 8.1). The first
Sp 6 Sanyinjiao tonifies Yin
Kid 6 Xaohai tonifies Yin
St 36 Zusanli tonifies Qi and Blood
Yintang for restlessness
Anmian for insomnia
Ren 17 Shanzhong Yin Xu with anxiety.
Ren 4 Guanyuan tonifies Yang
Du 20 Baihui tonifies Yang
Ren 8 Shenque rescues Yang
stage, or remission, shows no symptoms and the aim of acupuncture treat- ment is to return patients to that situation.
Acupoints are selected as appropriate for each stage, but treatment of the superficial meridian symptoms continues throughout (Blackwell & MacPherson 1993).
No rigorous research has been done in the field of multiple sclerosis; achieving a homogeneous group of patients would be almost impossible, and any study would require very large numbers to power it adequately. However, anecdotal clinical findings seem to indicate that this type of treat- ment may be useful in delaying the progression of the disease. It is cer- tainly worthwhile suggesting this type of treatment early in the course of the disease (Case study 8.1).
Evolving TCM Physiotherapy is a profession closely associated with the treatment of neu- rological disease, but the TCM textbooks often do not give the information we require. The following is an exercise undertaken with a group of neu- rological physiotherapists, reasoning from basic TCM principles but apply- ing these to physiotherapy as it is generally practised.
Acupuncture and The following is a list of problems observed in a patient with Parkinson’s
Parkinson’s disease disease; the most important TCM link is given in parentheses:
1. slow and limited movement (stagnation of Qi, Blood and Body fluids)