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ARTHRITIS Major types of Bi Syndrome Pattern A.

Cold Bi (Bi due to cold obstruction) S/S: Severs stabbing pain relieved by hot compress, and aggravated by cold weather, local pain with no swelling, no redness or warmth in the area T/P: White moss, slow pulse P: Bl 23, Kd 7,band local Ashi points B. Damp Bi (Bi due to damp obstruction), usually combined with Heat BI S/S: Fixed pain with heaviness and numbness of the hands and/or feet, aggravated by exposure to rain or wet swelling of the involved area T/P: Thick greasy moss, slippery pulse P: Sp3, St 40< Ashi and local points C. Heat Bi (due to heat obstruction) S/S: Pain on the joints (arthralgia) with redness and warmth on the area, painful joints, with or without fever T/P: Yellow moss, fast pulse P: Li 4, Li 11, Ashi and local points D. Wind Bi (due to wind obstruction) S/S: Wandering joint pain, changes in location, difficulty of movement, with or without chills and fever T/P: Thin moss, superficial pulse P: Lr 3, GB 34, Ashi and local points Notes 1. The pathogenic factor of Bi syndrome may combine with each other to form a more complex pattern. For ex. Damp with Heat to produce Damp-Heat 2. When treating Bi syndrome, select local and distal points 3. Be sure not to puncture swollen areas

HEADACHE PATTERNS 1. Wind-Cold S/S: Acute headache reaching to the head, neck, nape and back, fear of wind, chills more than fever, fear of cold, no thirst T/P: White tongue coating; Superficial slow pulse P: Li 4, Li 11, GV 14, Lu 7, Yintang, Taiyang, moxa Bl 12 and 13 2. Wind-Heat S/S: Acute headache reaching to the neck, nape up to the back, fear of wind, fever more than chills, sweats a lot, and increased thirst, red face, and sore throat T/P: Yellow and thin tongue coating, superficial and fast pulse P: Li 4, Li 11, TW 5, GV 14, Yintang, Taiyang INTERNAL PATTERNS 1. Liver Yang Rising S/S: Headache, throbbing and distended esp. in the temple and vertex usually precipitated by tension or stress, blurring vision, dryness of the eyes, irritability, redness of the face, bitter taste in the mouth, restlessness T/P: Tongue is red with or without a purplish tongue; fast and wiry pulse P: Lr 3, Li 20, GV 20, Yintang, Taiyang 2. Deficiency of Qi and Blood S/S: Chronic, on and off headache with dizziness or light-headedness, lingering accompanied by blurring of vision, lethargy, weakness, general body malaise T/P: Pale and dry tongue, Weak pulse P: CV 6, BL 18, BL 20, St 36 PAIN Pain is the derangement in the production and circulation of Qiand Blood due to the presence of pathogenic factors in the body, emotional excesses and miscellaneous To be pain-free: 1. Qi and Blood levels should be adequate 2. The circulation of Blood and Qi should be smooth and free-flowing

CLASSIFICATION OF PAIN

1. Based on the strength of the Pathogenic and anti-pathogenic factors: Excess (Shi) refers to those types of disharmonies, where there is hyperactivity of the pathogenic and anti-pathogenic factors Deficiency (Xu)- refers to those patterns where the bodys resistance has been diminished EXCESS AND DEFICIENCY ECXESS A. Excess-stagnation of Qi and/or Blood due to trauma and/or scars b. Stagnation of Qi and/or Blood due to an invasion of external Perverse Qi, esp. cold and damp c. Stagnation of Qi and/or Blood due to stuck Liver Qi d. Erratic flow of Qi and Blood due to an attack of Heart and/or Wind DEFICIENCY Blood deficiency Qi deficiency Yin and Yang Deficiency will not be discussed in this level

2. The location of actual pain is an essential step in the diagnosis -> it helps us to define the areas of malfunction which lead to the derangement in the production and/or circulation of Qi and/or Blood Exterior -skin -sbucutaneous tissues -muscles -joints Interior

The exterior us connected with the by Interior by the Jing-Lou system so that: A. An internal derangement in Qi and Blood production and/or circulation may not only lead to pain internally but also externally; and B. An external disturbance in Qi and Blood circulation may also keas to pain in the deeper level. C. 1. Classification of pain based the strength of he pathogenic and antipathogenic factors

Types a.duration b. onset c. severity d. responds to massage and/or pressure

excess acute Sudden More severe, pricking, stabbing, distending and/or throbbing Aggravated by massage and/or pressure, or initially aggravated than relieved by pressure and/or massage aggravated

Deficiency Chronic gradual Mild, dull and lingering Relieved by massage and /or pressure

e. relation to : i. food intake

C. 2. Based on the pathogenic Qi and/or Disharmony c.2.a. Excess i. Hold s/s -Involved area is cold to touch and/or pale -Severe pain -Pain aggravated by cold and relieved by heat -No swelling or inflammation -With swelling or inflammation -Diminished mobility -Heaviness -Pain becomes more severe at the onset of and during humid and/or rainy conditions -Numbness is more announced than pain -The involved area is hot to touch and/or pale -Pain is aggravated by heat -pain is relieved by cold -mau be associated with inflammation (Damp-Heat); and -may be accompanied with fever -on and off pain and -migratory pain -pain may be adjacent to the affected area -associated with emotion -migratory pain

ii. Damp

iii. Heat

iv. Wind v. Stagnation if Qi and/or Congealed blood due to trauma or scar vi. Stuck liver Qi and congealed blood

Xue (means blood) C.2.b deficiency i. Qi Xu s/s - Gradual onset -Chronic -Dull and lingering pain -Relieved by massage and /or pressure, -May be relieved by food intake and/or aggravated bowel movement., and -Pain may occur after the menstrual period -PLUS: PALENESS+WEAKNESS+MOISTNESS -S/S of Qi Xu -PLUS: PALENESS Essentials of Diagnosis 1. Location of actual pain 2. Location of the root of pain 3. Types of pain Excess Deficiency ASHI POINTS Literally translated as that is it These are areas of body which are tender to touch It regulates the flow of qi and Blood, from and to the painful area.

ii. Xue Xu

Treatment Guidelines: 1. treat location of pain through Ashi use of Ashi points needle regular acupuncture point surrounding the painful area w/needles strengthen St & Sp Qi -> tonify Qi & Blood 2. Treat the root of pain regulate the function of the Lr & GB- maintaining the function of free-flow of Qi expel heat from the St expel cold from the Kd expel the pathogenic factors

VENTOSA method of treating diseases, promoting health and preventing illness

Indications: arthritis gas pain, abdominal distention and/or diarrhea due to damp-cold paralysis muscle cramps myalgia, pain in the joints and other signs referable to stuck Qi retention of food in stomach and spleen external attack of wind-cold

Contraindications: unconsciousness

Sites to be avoided: areas overlying bony structures, lymph nodes and primary blood vessels skin diseases, including wounds, cysts, ulcers, etc.

Techniques: use of cotton dipped in alcohol use a paper cone use ginger placed under the wick done with acupuncture

To remember: in removing cup: press skin in one side and let the cup be detached treatment could last for 10-15 minutes

Caution: