Pulses And Herbs DPD Pulse-Workshop - Doane Online Education · 2018. 9. 28. · Robert Doane EAMP, L.Ac., Dipl. C.H. Owner of the Acupuncture & Wellness Center, P.S. Websites: doane.us

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© 2014 Doane US/Doane EU, 18870 8th Ave NE, Poulsbo, WA 98370 Shall not be copied, duplicated or distributed in any form or to be used for teaching without prior written consent of Doane US and/or Doane EU.

Pulses And Herbs DPD

Pulse-Workshop Sydney 2015

Robert Doane

EAMP, L.Ac., Dipl. C.H. Owner of the

Acupuncture & Wellness Center, P.S.

Websites: doane.us doane.eu

Email: [email protected]


Course Outline 1.  Chinese Medicine and its basis in bio-physiology: Examples From

the Classics

2.  Hand Positions 3.  General Principles – Jump, Shape and Depth

4.  Right Hand Pulses: 5.  Right cun – Lung (Specifically Upper Respiratory Area/ Sinuses

and Head / Large Intestine) -Normal pulse -Deviations

6.  Right guan – Digestive Function -Normal pulse -Deviations

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Course Outline (con’t)

7.  Right chi – Kidney (Urinary Bladder functions) -Normal pulse -Deviations

8.  Left Hand Pulses: 9.  Left cun – Heart / Small Intestine

-Normal pulse -Deviations

10.  Left guan – Liver / Gallbladder -Normal pulse -Deviations

11.  Left chi – Kidney (Reproductive functions) -Normal pulse -Deviations

12.  Extra Meridian pulses distal to the cun position


Chinese Medicine and its basis in bio-physiology:

Examples From the Classics

Researched and compiled by: Professor Zhang Shi Ping, School Of Chinese Medicine, Hong Kong Baptist University 2014

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《難經、一難》：“十二經皆有動脈。 ”

Nan Jing, Lun Mai, First Chapter, (206 B.C.–9 A.D.):

“The twelve channels all have pulses.”

What is an acupuncture meridian? Example 1

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《靈樞、經水》：“夫八尺之士,皮肉在此,外可度量切循而得之,其死可解剖

而視之。其臟之堅脆，腑之大小，穀之多少，脈之長短，血之清濁，氣之多少……皆有大數。

Huang Di Nei Jing, Ling Shu, Chapter 12 (206 BC–220 AD) : Rivers and Channels: For man who is on the average eight chi, the skin and flesh, and the external boundaries and limits may

be measured, and the pulse taken. Upon death, examination can reveal and disclose. There are great standard measures to the

existence of the viscera being: strong or weak; the bowels being large or small; the valleys (the amount of grain inside the hollow

organs) being plentiful or sparse; the vessels being long or short; the blood being clear or turbid; the qi (oxygen) being

plentiful or sparse.

Example 2

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《靈樞、經脈》“經脈十二者，伏行分肉之間，深而不見，其常見者，足太陰過於外踝之上，無所隱故也。”’

Huang Di Nei Jing, Ling Shu, Chapter 10, (206 BC–

220 AD) : The Major Channels: The twelve major channels lie hidden while travelling between the divisions of the

flesh. They are deep and invisible, except for the Leg Tai Yin, which passes through the upper part of the

lateral malleolus (transliteration mistake: since it mentioned Tai Yin it should read medial malleolus) and

may be frequently seen because it has no place to hide.

Example 3

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《漢書、王莽傳》“翟義黨王孫捕得，莽使太醫尚方与巧屠共刳剝之，量度五臟，以竹筳度其脈，知

其終始，云可以治病。

The Book of Han (Han Shu), Volume 99 (111 AD):

”…Measure the Five Zang, Use bamboo stick to measure the beginning and end of his vessel...

Example 4

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《銅人腧穴鍼灸圖經》

Illustrated Manual of Acupuncture Points of the Bronze Figure (1027 AD):

Summary

The acupoints at the trunk were arranged by sections (somewhat similar to dermatomes), whereas those at the limbs were arranged

according to a vessel system.

Example 5

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《素問、舉痛論》 Huang Di Nei Jing, Su Wen, Chapter 39 (206 BC–220 AD) :

經脈流行不止，環周不休，寒氣入經而稽遲。泣而不行，

客於脈外，則血少，客於脈中則氣不通，故卒然而痛。

The vessels/ channels run ceaselessly and circle incessantly. Cold evil aggresses on the vessels, the blood will be made scanty there. If it resides inside the vessels, the qi will be

obstructed. So, pains ensue suddenly.

Example 6

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寒氣客於脈外則脈寒，脈寒則縮踡，縮踡則脈絀急，則外引小絡，故卒然而痛，得炅則痛立止；因重中於寒，則痛久矣。

If the cold reside outside the vessels, then the vessels become cold.

When the vessels become cold, they shrink. The shrinkage makes the vessels spasmodic, and the spasms radiate to the little blood vessels outside, so the pain occurs abruptly while it ends quickly when being

given heat. If the patient is hit by cold repeatedly, the pain will be protracted.

Example 7

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寒氣客於背俞之脈，則脈泣，脈泣則血虛，血虛則痛。

The cold settles in the foot greater-yang bladder vessel and obstructs it. The obstructed vessel causes the blood to be

deficient. The blood deficiency produces pain.

Example 8

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寒氣客於經脈之中，與炅氣相薄，則脈滿，滿則痛　而不可按也。寒氣稽留，炅氣從上，則脈充大而血氣亂，故痛甚不可

按也。 The cold resides in the vessel/channel and wrestles with the hot qi,

so the vessel becomes full, and the fullness makes the pain resistant to pressure (fullness causes pain that is aversion to pressure). The

cold lingers and the hot qi fights against it, so the vessels are dilated and the blood and qi become disordered. Therefore, the pain is

severe and cannot bear pressure.

Example 9

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Huang Di Nei Jing Su Wen, Vol. 1 An Annotated Translation 2011

Prolegomena, p.20, Unschuld and Tessenow:

“...qi 氣 is one of the very few Chinese terms we have chosen to transliterate rather than to

translate. It should be noted that the interpretation of qi 氣 as “energy”, so widespread in TCM literature today, lacks any historical basis.”

Example 10

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The term “meridian” refers to real visible vessels at ancient times.

In modern anatomical terms, it would be a synthesis of the vascular and the nervous

system.

The energy concept of qi 氣 has no historical basis.

Conclusion:

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•  Locations: cun, guan, chi •  Your index finger should be distal to the highest point, which is the

styloid process. The styloid process is therefore between your index and middle fingers. If you are half a finger away, you are not going to feel the pulse correctly.

•  Traditionally, in the textbook, the guan position is right over the styloid process.

Hand Positions

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correct

correct

Hand Positions

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Hand Positions

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Hand Positions

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Right Hand:

-  Cun: Lung (Upper Respiratory and LI) -  Guan: Spleen/Stomach (Digestive Function) -  Chi: Kidney (Urinary Function) This side reflects conditions like UTI,

nephritis, kidney stones, etc. This pulse is also reflective of the neck, shoulder and upper back area. The pulse can start from the chi and extend proximally 1 to 3 cm. up the arm. Acute and chronic neck and upper back pain, soft tissue damage, fallen pillow syndrome, arthritis, bone spur, etc. can all be diagnosed here. Each of the above will show a different type of pulse but they are all from the chi and proximal to it.

General Principles Normal Pulse

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Left Hand

-  Cun: Heart/Small Intestines -  Cardiovascular: Issues such as valve problems, coronary blockages, congestive heart, etc. -  Small Intestine: Diseases such as ulcerative colitis and Crohn’s Disease, IBS, etc.

-  Guan: Liver/GB (Hepatic Function) Cirrhosis, fatty liver, etc. -  Chi: Kidney (Reproductive Function) Hormone, uterus, menses, Chinese

Kidney, low libido, infertility, etc. Also reflective of the low back and lower body (hip, knees, ankles). Same thing as the right chi in that the pulses will extend proximal to the chi if you feel the pulse.


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1.  In general, a normal pulse should not feel excessively thick or thin, fast or

slow, deep or superficial; in other words nothing extreme is normal.

2. A normal pulse is relative to each person’s constitution. Depending on the

size, age, sex of a person, a normal pulse for one may be abnormal for another.

Example: It is normal to feel a wiry pulse on a growing teenager. But a wiry

pulse on a postpartum patient is abnormal. Therefore, what you should look for is what is “abnormal” within what should be “normal” for that patient.


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•  Cun Position: Should be at superficial depth.

•  Guan Position: Should be at middle depth.

•  Chi Position: Should be at deep depth.


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3 criteria that make up a pulse. •  1. Shape (L, r) •  2. Jump (F, P, R, v) •  3. Depth

What makes up for a pulse from a western medical perspective. •  F = Blood Flow •  P = Pressure •  R = Resistance •  v = Fluid Viscosity •  L = Length of Tube •  r = Radius of Tube

General Principles 3 Criteria of a Normal Pulse

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• Structural aspects of what makes up a pulse, shape of the vessel.

-  Straight Pulses: Thick, thin, wiry, roof, (constricted blade),

guitar string, long, short, etc.

-  Curved Pulses: Convex, concave, bean, turtle, rainbow, etc.

-  Others: Hard, soft, shapeless, etc.

General Principles 3 Criteria of a Normal Pulse: Shape

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Significance •  Vascular change in the radial vessel reflects:

•  1. Vascular change of respective organs. -  Example: Constricted pulse in the left cun position due to cold

indicates the constriction of blood vessels in the heart.

•  2. Structural characteristic or change of the respective organs. -  Example: Weak and shrinking pulse in the left cun position

indicates a weakness of the heart or the decline of the heart’s function.

Diagnostic impression is inconclusive if only the shape of a pulse is felt. Shape MUST be combined with jump.


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•  Thick or Thin pulse refers to the diameter of the artery.

•  Normal diameter is relative to the patient’s size, but in general it is about the size of an acupuncture guide tube or a tube inside a ballpoint pen.

Normal Thick Thin


Discussion of Thick and Thin

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Thick Pulse •  Definition: Thick pulse refers to artery enlargement. The entire artery is

wider in diameter. •  Thickness of a pulse does not refer to the thickness of the arterial wall or

thickness of the blood.

Normal

Thick

Not Thick

Not Thick



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What makes a pulse thick? •  Normally for a big and strong guy, a thick pulse is like the size of a straw.

A thick pulse in a woman is approximately the size of a small earth worm. •  Heat, inflammation, and increasing pressure expands the diameter of the

lumen.

•  Sympathetic excitement

•  Qi deficiency makes the vessel wall become flaccid and it loses its elasticity.



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Thin Pulse •  Definition: Thin pulse refers to the constriction of the artery. The entire

artery is narrower in diameter.

•  A thin pulse has a diameter of a sewing needle and can be as thin as an acupuncture needle or paper edge.

•  Thinness of a pulse does not refer to the thinness of the arterial wall.

Thin Normal



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What makes a pulse thin? •  Sudden temporary narrowing (like spasm) from exposure to cold.

•  Chronic stagnation, causing poor blood flow.

-  Blockage deprives tissues of its normal blood flow and oxygen. -  Results in damage, degeneration and narrowing of arteries.



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General Principles 3 Criteria of a Pulse: Jump

Jump

-  Pulsation aspects of pulse -  Sensation of the force against your finger

4 Aspects of Jump

1.  Velocity (Rate) 2.  Strength (forceful or weak), Excess/Deficiency 3.  Resistance/Impedance (Arteriosclerosis) 4.  Amplitude (Magnitude at which the blood vessel expands)

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General Principles 3 Criteria of a Pulse: Jump / Velocity

Velocity -  Fast or Slow Significance -  Thyroid Level -  Nervous Tension Level -  Determine if there is an infection -  MSG, Caffeine -  Questions: Patients on western meds, will it affect their pulse?

If they are on synthroid, they may have a fast heart rate as a side effect.

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General Principles 3 Criteria of a Pulse: Jump / Velocity

What’s fast? What’s slow?

-  Normal is 72 beats per minute. Anywhere from 70-80 bpm is okay.

-  A heart rate over 80 bpm is considered a bit fast. -  A heart rate below 60 bpm or above 120 bpm is definitely a

problem.

-  If a heart rate is 120 or above with a fever, there is an abscess for sure. If they are on beta blockers the pulse will usually be slow.

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General Principles 3 Criteria of a Pulse: Jump / Strength

Completely Strong Jump

-  Definition: A strong pulse (to the extreme) can be felt on the superficial, middle and deep levels.

-  A completely strong pulse does NOT disappear with pressure.

-  Diagnosis: True/Total excess.

Totally Weak Jump

-  Definition: A weak pulse (to the extreme) means the pulse disapears with even the slightest pressure.

-  Diagnosis: True/Total deficiency.

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General Principles 3 Criteria of a Pulse: Jump / Strength

Importance of Brachial Pulse

If a strong looking person has a weak pulse it might not be

weak. Check the brachial pulse. It may be pounding. The radial

pulse is weak because of renal hypertension constriction.

These patients have high blood pressure.

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General Principles 3 Criteria of a Pulse: Jump / Resistance

Resistance

-  Impedance of blood flow within the blood vessels.

-  Hard to explain how this feels. -  Sluggish -  Choppy -  High viscosity feeling -  Flow is NOT smooth.

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General Principles 3 Criteria of a Pulse: Jump / Amplitude

Amplitude

-  Magnitude at which the blood vessel expands -  Height of the pulse wave

Significance

-  High amplitude = more heat -  Low amplitude

1.  Stagnation: Low amplitude and forceful •  Vessel wall has plaque •  Viscosity of blood is high

2.  Deficiency: Low amplitude and weak

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General Principles 3 Criteria of a Pulse: Level

Level

-  The depth at which the pulse is felt. -  Superficial pulse

-  Dx: Heat causing dryness -  Mid level pulse -  Deep pulse

-  Dx: Dampness/Blood Stasis

From the Yellow Emperor’s Classic, Su Wen Chapter 74 -  Superficial pulse is caused by heat/dryness -  Deep pulse is caused by dampness

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Dispel the textbook myth of Superficial Pulse=Exterior Condition and Deep Pulse = Interior Condition -  In school, we learned that exterior condition is manifested as

a superficial pulse while interior condition is a deep pulse.

-  If that is so, then have you ever wondered why a patient who has hypertension, and may be about to have a stroke, would have a superficial and forceful pulse? There is no exterior condition at all in this case.

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Significance of Level -  Normally, cun is the most superficial (right below the skin, not on the skin),

guan in the mid level, and chi is the deepest (but not deep to the bone). -  Evaluating the relative level gives you an idea of which organ is out of

balance.

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General Principles 3 Criteria of a Pulse: Basic Inspection

1.  Feel the diameter (Shape) -  For beginners, start with just thick or thin. -  Thick Expanding -  Thin Constriction

2.  Feel the strength of the pulse (Jump) -  Strong (Forceful) Excess -  Weak Deficiency

3.  Feel the Level (Level) -  Superficial Dryness -  Deep Dampness, damp heat? Damp cold will be determined by

the jump. Deep also means blood stasis.

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General Principles 3 Criteria of a Pulse:

Why Classic Pulse Taking is Limiting

1.  Many classical pulses described only shape or jump and therefore it is difficult to gather a complete picture of the diagnosis.

2.  Classical pulses rarely discus specific pulses in specific positions. It usually describes pulses as a whole to determine a TCM diagnosis.

3.  Most important factors are the shape, jump and depth.

Diagnosis is inconclusive when one is missing.

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General Principles Summary: Exterior Syndrome

(Rt) cun: Fine, Weak, Soft (Shrinking Pulse) (Rt) cun: Fine, Forceful, Hard (Constricting Pulse) (Rt) cun: Soft, Weak, Disperses upon pressure (Can be a scattered Pulse) (Rt) cun: Thick, Forceful, Abundant (Expanding Pulse)

Deficiency

Excess

Deficiency

Excess

Exterior

Hot

Cold

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General Principles Summary: Interior Syndrome

Fine, Weak, Soft, Deep (Shrinking Pulse) Fine, Forceful, Hard (Constricting Pulse) Soft, Weak, Disperses upon pressure (Can be a scattered Pulse) Thick, Forceful, Abundant (Expanding Pulse)

Deficiency

Excess

Deficiency

Excess

Interior

Hot

Cold

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Review of normal right cun – Respiratory/LI Pulse 6 deviations of the right cun

1.  Superficial and forceful or jumpy 2.  Deep and weak 3.  Superficial and wiry (and/or weak upon pressure) 4.  Constricting/ Pulse within a pulse 5.  Scattered/ Dead Fish 6.  Short

Right Cun Lung / Large Intestine

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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 a balance of dryness & dampness –  Dry = Slightly floating –  Moist = Slightly deep

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RIGHT CUN Lung / Large Intestine

Normal Pulse

M

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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.

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

–  Upper respiratory infection (bacterial or viral) –  If you have a wind, exterior pattern then the pulse will

be more wiry. If the pulse is convex and pounding then the patient probably has a sinus infection

–  For all wind invasions (wiry pulse), at least the first week, exterior releasing herbs MUST be used.

•  Ge Gen Tang 20% of the formula (If the nose and cheeks are cool or cold)

•  Yin Qiao San 20% of the formula (If the nose and cheeks are warm or hot)

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Right cun – Lung / Large Intestine Superficial and Forceful or Jumpy •  Indications (con’t)

–  If there is cough or to prevent coughing, add either Qing Fei Tang, or Lung PH, or Dun Sou San 20% to the formula.

– How to differentiate dry vs. productive cough? •  Dry = (R) cun very floating and jumpy

–  The more floating, the more dry the condition – use Qing Fei Tang

•  Productive with phlegm = (R) cun is deep, use Dun Sou San or Ding Chuan Tang

•  Strong at all levels with cough use Lung PH

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Right cun – Lung / Large Intestine Superficial and Forceful or Jumpy

•  If the pulse is mostly wiry with heat signs: Yin Qiao San 40, ABX 20, Pu Ji Xiao Du Yin 20. (Add Lung PH if there is some cough 20 grams more)

•  If the pulse is convex and strong: Resolve EM 40, ABX 15, Astringent 15, Gardenia or Seattle complex 15, Huang Lian Shang Qin Wan 15. (this is for a sinus infection)

•  If the pulse is wiry with no amplitude and tight: Ge Gen Tang or Gui Zhi Tang 35, Yin Qiao San 20, ABX 15, Astringent to stop nasal drip 15,a long with Er Chen Tang 15

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Right cun – Lung / Large Intestine Superficial and Forceful or Jumpy •  Herbal Rx if there is mostly coughing with

yellow-green-sticky phlegm (Lung Ph) – Jin Yin Hua – 15g Yi Yi Ren – 15g –  Shi Gao – 15g Lian Qiao – 10g –  Lu Gen – 15g Tao Ren – 5g –  Gan Cao – 5g Dong Gua Zi – 10g –  Astringent Complex– 5g Xing Ren – 5g

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Right cun – Lung / Large Intestine Superficial and Forceful or Jumpy •  Dry cough usually combined with ST-fire •  Need to moisten dry and clear ST-fire add:

–  Qing Zao Jiu Fei Tang •  Which taste moistens dryness?

–  Acrid, cold (for dry fire) and salty (for fire) –  Salty and cold (pulse is strong at all depths): Fu Hai

Shi, Hai Ge Fen, Di Long –  Acrid and cold (pulse is strong mostly at the higher

depth): Da Qing Ye, Niu Bang Zi

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Formulas for Exterior Conditions Summary

•  Use 30% to 40% of formula to release exterior –  Yin Qiao San and Ge Gen Tang

•  If Nose and/or cheeks are cold, use Ge Gen Tang. If they are extremely cold use Xiao Qing Long Tang

•  If the nose and cheeks are hot, use Yin Qiao San

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Formulas to Exterior Conditions Summary

•  Stomach Fire often is associated with exterior heat or wind heat.

•  ST 8 hot = Stomach Fire

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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

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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

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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%

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Herbs for Loss of Voice

•  Loss of voice: Add He Zi 15% and Jie Geng Tang 20% (contains Jie Geng 10% and Gan Cao 10%)

•  Can also use Shi Wei – 6%, She Gan – 6%, Jie Geng – 6%

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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)

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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.

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Right cun – Lung / Large Intestine Superficial and Weak pulse

•  Pulse sign – Convex-shaped pulse

that collapses upon pressure – Wiry shaped that collapses upon pressure

•  Indications: Lung qi deficiency •  Weak immune system •  Allergies •  (Common cold)

Tent pulse

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•  Allergies: 3 Types –  Acute Wind Cold or Wind Heat –  Chronic allergies with Lung Qi Deficiency

-‐Wind Cold Allergy: Wiry pulse that is thin and Cght

-‐Wind Heat Allergy: Wiry pulse that has a stronger jump and

a liGle faster and thicker (can be slightly convex)

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Right cun – Lung / Large Intestine Superficial and weak pulse

Herbal Rx: Wind Cold Cang Er San – 30 Gan Cao – 5 Jing Jie – 10 Bai Zhi – 10 (for runny nose) Jie Geng – 10 Astringent Complex – 10 Fang Feng –10 Chan Tui – 5 Si Ni San – 10

Wind Heat: (or more severe sx’s) Mu Dan Pi – 15 Lian Qiao – 10 Sheng Ma – 10 Bai Zhi – 5 (increase to 15 if runny nose)

Xin Yi Hua – 10 Chuan Xiong – 5 Lu Lu Tong – 10 E Bu Shi Cao – 5 Cang Er Zi – 10 Gan Cao – 5 Chan Tui – 5 Huang Qin – 10

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

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•  Herbal Rx: Chronic allergies with Lung Qi Deficiency. Use any one of the following 2 formulas as 20% of your allergy formula. –  Huang Qi Jian Zhong Tang or –  Yu Ping Feng San

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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 – 6g, Ku Shen – 6g

If loose stools, add Ge Gen – 15g

If blood stasis, add Mu Dan Pi – 8g, Dang Gui – 5g, Lu Lu Tong – 6g

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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

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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

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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

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•  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

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•  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)

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•  Dizziness/Vertigo from phlegm in the eustachian tubes.

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

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Right cun – Lung / Large Intestine Short pulse

•  Pulse sign: Short pulse –  Convex-shaped pulse

that is shorter than the width of one pulse position, Approximately 0.5cm in length

•  Indications –  Jumpy + superficial = Fire in LI (Constipation w/ dryness)

•  The more floating à more dryness and fire in body –  Diverticulosis / Enteritis –  Polyps in the Large Intestine –  Hemorrhoids (if the short pulse is very small)

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•  Indications (con’t) –  Amplitude high à inflammation = Colitis with or

without diarrhea •  Use fire clearing herbs and Astringent Complex

–  Wherever the short pulse is found, indicates blockage in that area

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•  Herbal Treatments for Large Intestine Problems:

1. Diverticulosis/ Large or small polyps (Large Turtle Pulse): •  Herbs: Zhen Ren Hou Ming Yin 20, Astringents 20, Cold Breakers (if no

jump)/ Warm Breakers (if there is a jump/amplitude) 20, Ge Xie Zhu Yu Tang 20, Cha Chi Huang 20 (or Huang Qin).

2.  IBS: •  Ge Gen Huang Lian Tang 30, Jia Wei Xiao Yao San 20, Xian Sha Liu

Jun Zi Tang 20, Shan Zha 15, Mai Ya 15. If the stomach pulse is very wiry and strong: He Zi 15, Wu Bei Zi 15, Bai Wei 15, Tian Hua Fen 15, Huang Lian Jie Du Tansg 20, Jia Wei Xiao Yao San 20.

3.  Constipation:

•  Add Da Huang 8g, Mang Xiao 8g.

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•  Herbal Rx – Short pulse means blockage

•  Determine hardness of pulse –  Soft, empty, and can be pushed away – mild condition

such as a soft polyp or hemorrhoid – Hard – severe condition, may be a stronger obstruction in

the large intestine •  Can be a phlegm block in the lung, especially if you

find it in the Yang Wei pulse on the right arm –  This will be Asthma

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Right cun – Lung / Large Intestine Short pulse / Yang Wei Pulse

•  Acute Asthma – Cold condition with runny, white, clear phlegm

and a cool Ren 22 •  Xiao Qing Long Tang 50, Astringents 30, Zi Wan 10,

Bai Bu 10 - Hot condition with thick, yellow, sticky phlegm and a warm Ren 22

•  Ding Chuan Tang 50, Di Long 10, Lung Ph 20, Qian Hu 20

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•  Short Pulse – Asthma cont’d With a weak and short pulse and with a weak stomach pulse, use:

Zhi Huang Qi – 15 Zhi Gan Cao – 5 Chan Tui – 5 Bai Zhu – 5 Ling Zhi – 15 Dang Gui – 5 Dan Shen – 10 Fang Feng – 5 Astringent Cplx – 10 Chen Pi – 15 Ban Xia – 5 Ku Shen – 5


Late onset Asthma with lower back problems, use: Zhi Huang Qi – 15 Ling Zhi – 10 Shan Zhu Yu – 5 Tu Si Zi – 5 (Zi) Su Zi – 5 Chen Pi – 5 Astringent Cplx – 10 Zhi Gan Cao – 5 Shu Di Huang – 10 Ge Jie – 5 Dong Chong Xia Cao – 5 Bu Gu Zhi – 5 Ku Shen – 5 Fu Ling – 5 Dan Shen – 5

If cold, add: Fu Zi, Gan Jiang, Rou Gui

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Acupuncture Tx for IBS Target: Entire abdomen above & below navel

All organs of digestion Tx: LU 9 / LI 5 ST 36 / GB 34 LI 4 / SJ 5 P 6 CV 12 (stomach) LV 14 (liver) CV 4 (sm. int.) ST 25 (lg. int.)

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RIGHT GUAN – Digestive Function

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RIGHT GUAN – Digestive Function

Review of normal right guan – Spleen pulse 5 deviations of the right guan

1.  Convex, Forceful, and Superficial 2.  Wiry, Forceful, and Superficial 3.  Wiry, Forceful, and Deep 4.  Deep and Concave (Scattered or Pounding) 5.  Weak pulse

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RIGHT GUAN – Digestive Function Normal Pulse

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Right guan – Digestive Function Convex, Forceful, and Superficial

•  Pulse sign: Convex, Forceful, and Superficial –  Convex = bulging pulse

that has a rounded feeling •  Indications

–  Acid reflux, H. pylori, bacterial infection •  s/s: stomach pain, burning sensation in the abdominal area,

nausea, frequent belching –  If LI-10 feels cold and there is a forceful, convex pulse in

the Rt. Guan then a constitutionally cold stomach has been invaded by a heat pathogen. For your formula to be most effective 20% of it will have to be a warm tonic for the stomach.

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•  Herbal Rx –  Astringent Complex 40% (anti-inflammatory formula

for acute and chronic inflammation) –  Herbal ABX 20% –  Huang Lian Jie Du Tang 20% –  Jia Wei Xiao Yao San 20% –  (add An Zhong San if LI area is cold)

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•  Check temperature of LI-10 and palm –  If different à Parasites

•  Chronic fatigue •  Poor digestion •  Sleeping disorders •  Might need anti-parasitic drugs •  Can add Wu Mei Wan to other formulas if you

suspect parasites (worms) •  Experience shows anti-parasitic drugs work best for

Giardia or Entameba Histolytica

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•  For acid reflux and bloating –  Add Chai Hu Jia Long Mu Tang

•  Good if acid reflux is severe •  Protects ST lining damage •  Also good for acid reflux is Wa Leng Zi and Mu Li in

combination

•  If LI-10 is cold à constitutionally deficient-cold in stomach, but now has ST-fire –  Add An Zhong San

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Right guan – Digestive Function Wiry, Forceful, and Superficial

•  Pulse sign: Wiry, Forceful, and Expanding (can be felt on Superficial level) –  Wiry = Tight, straight pulse –  If strong à inflammation w/o bleeding –  If hollow, tight tubeà bleeding

•  Indications –  Duodenal ulcer – from nervousness –  Stomach pain –  Acid reflux –  Emotional stress ulcer. LR overacting on SP/ ST

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•  Herbal Rx –  Feng Wei Cao 15% for inflammation of the stomach only –  Zhen Ren Huo Ming Yin 20% to stop pain –  Chai Hu Jia Long Mu Tang 20% –  Astringent Complex 15% –  Zhe Chong Yin 15% to stop pain –  Huang Lian Jie Du Tang 15% –  Add Jia Wei Xiao Yao San if too emotional

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If that previous formula does not work then use: Hu Zhang – 15 Xia Ku Cao – 15 Cha Chi Huang – 15 Huang Shui Qie – 15 Jia Wei Xiao Yao San – 20 Huang Lian Jie Du Tang - 20

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•  Jia Wei Xiao Yao San and Yi Gan San are –  For emotional aspects of Liver problem. –  Both spread Liver qi stagnation and calm the shen –  Do not help with the stomach pain.

•  Yi Gan San is better than Jia Wei Xiao Yao San if the patient also has fast heart rate or trembling.

•  Jia Wei Xiao Yao San is safe for long term use.

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Right guan – Digestive Function Wiry, Forceful, and Deep

•  Pulse sign: Wiry, Forceful, and Deep – Wiry = Tight, straight pulse

•  Indications – Too much sugar or carbohydrates in diet – Pre-diabetic – May have Type II diabetes

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Right guan – Digestive Function Wiry, Forceful, and Deep

•  Herbal Rx – M3 (Xie Huang San, Gan Lu Yin, Huang Lian

Jie Du Tang-all equal amounts ) 40% for stomach fire

– Hu Zhang 15% – Huang Shui Qie 15% – Cha Chi Hunag 15% or Zhi Zi 15% – Xia Ku Cao 15%

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Acupuncture Tx for Digestive Problems involving the Liver &

Stomach Target: Stomach, Liver, Intestines

Tx: ST 25, LV 14, Ren 4, Ren 12 ST 36, 37 LV 8 GB 34 SP 9 P 6 LU 9 SJ 5 LI 4

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Right guan – Digestive Function Deep and Concave (Scattered or Pounding)

•  Pulse sign: Deep and Concave

– Concave = a pulse that is curved downward

– Can feel the curvature along the sides and bottom

•  Indications – Poor digestion– gas, bloating, belching – Chronic superficial gastritis (if pulse is forceful)

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Right guan – Digestive Function Deep and Concave (Scattered or Pounding)

•  Herbal Rx for Superficial Gastritis

•  Astringent Complex 40% •  Herbal ABX 20% •  Chai Hu Jia Long Mu Tang 20% •  Huan Lian Jie Du Tang 20%

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Right guan – Digestive Function Weak pulse

•  Pulse sign: Weak pulse –  Weak pulse is thin and weak –  Upon pressure, it disappears

•  Indications –  Middle jiao deficiency – deficient-cold in Stomach –  Usually found in very weak people, post surgical,

lupus, etc. –  Weak digestion, trouble digesting raw food (“LI10”

area is cold)

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Right guan – Digestive Function Weak pulse

•  Herbal Rx –  An Zhong San for cold stomach –  Gui Pi Tang for weak stomach. Can add Jia Wei Xiao Yao

San to build the middle Jiao and replenish an exhausted mind—good for students who have a cold, weak digestive system

–  Fu Zi Li Zhong Tang for a very cold stomach –  Best way to tonify the middle jiao is to change the diet –  Herbal formula: An Zhong San 50%, Jia Wei Xiao San

20%, Gui Pi Tang 30%. (Substitute An Zhong San with Fu Zi Li Zhong Tang if the pulse is very thin like the edge of a piece of paper and disappears with any pressure.

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Acupuncture Tx for Weak Digestion

Target: Stomach, Intestines, Pancreas, Liver Tx: Ren 12, Ren 4 ST 25, LV 4 ST 36, GB 34 SP 9, LV 8 P 6, LU 9 SJ 5, LI 4

Important: Pull needles after 10 minutes and stimulate as you pull.

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RIGHT CHI – Kidney / Urinary Bladder

(Neck & Shoulder area)

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RIGHT CHI Kidney / Urinary Bladder

Review of normal right chi – Kidney pulse 6 deviations of the right chi

1.  Bird’s beak/Pen tip pulse 2.  Turtle pulse 3.  Scattered pulse 4.  Taiyang pulse 5.  Du pulse

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RIGHT CHI – Kidney / Urinary Bladder

(Neck & Shoulder area) Normal Pulse

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Right chi – Kidney / Urinary Bladder Normal pulse

•  Normal pulse: Deep – Deep pulse can only be felt upon pressure – Deeper in level than the cun and guan

positions – Should still have a jump. Should not be weak

or small

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Right chi – Kidney / Urinary Bladder Bird’s beak/Pen tip pulse

•  Pulse sign: Bird’s beak/Pen tip pulse – Convex-shaped pulse that

is approx. 0.1cm in length – Feels pointy like a pen's tip – Usually hard and cannot be pushed away

with pressure •  Indication

– Kidney stones in right ureter

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Right chi – Kidney / Urinary Bladder Bird’s beak/Pen tip pulse

•  Herbal Rx – Dissolve (KS)

•  Can also be used for severe high BP due to kidney problem

**Side note: if BP fluctuates drastically, it’s not

arteriosclerosis, it’s caused by the kidneys

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Formulas for Kidney Type of High Blood Pressure

•  1. Kidney stones –  Dissolve (KS) –  Add Hot or Cold Breaker if there is a cyst in the

kidney •  Hot Breaker – Huai Hua, Xuan Shen, Xia Ku Cao, Zhe Bei Mu •  Cold Breaker – San Leng, E Zhu, Wang Bu Liu Xing

–  Pulse for cyst – feels bigger than a pen tip •  2. Water metabolism kidney problem with high

blood pressure; Blockage in ureter Shui Ding Xian - 20 Dan Shen - 20 Xian Feng Cao - 20 Di Long - 20 Li Zhi He - 20

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Formulas for Kidney Type of High Blood Pressure

•  3. Kidney yang deficiency (weak kidney and bladder function) – cold condition –  EGFR – filtration rate of kidney is low. –  Use Yin Yang Huo 55% + Xian Mao 25% + Si Ni Tang

20%

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Acupuncture Tx for Kidney Diseases

Excess Diseases: Target: Kidneys Tx: GB 25 (Ren for Kidney Disease) K 10, 9 SJ 8, 7 HT 3, P 3 LI 11, 10, 9, 8 UB 58, 57

Deficient Diseases: Same points as above but stimulate & remove in 10 minutes

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Acupuncture Tx for Bladder Diseases

Excess Diseases: Target: Bladder & Ureters Tx: Ren 3 SI 5, 6, 7 LU 6, 7, 8, 9 UB 59, 60, 40, 58 K 3, 4, 5, 6, 7, 10

Deficient Diseases: Same points as above but stimulate and remove in 10 minutes

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Right chi – Kidney / Urinary Bladder Turtle pulse

•  Pulse sign: Turtle pulse with or without Tail – Convex-shaped pulse that

is 3-D, but flat on the bottom – Tail = thin forceful pulse

extending from the Turtle that is proximal to the chi position

•  Indications – 1. NO Tail = Shoulder pain, stiffness from soft

tissue damage

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•  Indications (con’t) –  2. With Tail (means thin straight pulse proximal to chi)

= Bone spurs, disk problems in the neck and shoulders, neck pain

–  3. Both chi = Prostate enlargement, varicocele –  4. More forceful = more inflammation and pain; more

recent the injury; more acute the condition

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•  Indications (con’t) –  5. Low amplitude = less inflammation; pain may be dull

and intermittent; more chronic and stagnant the condition (more blood stagnation)

•  Use more blood movers •  Other than Circulation SJ what else can be used?

–  Shen Tong Zhu Yu Tang (frozen shoulder with blood stasis

–  Shu Jing Huo Xue Tang (bloodd stasis and damp) –  Bu Yuan Huan Wu Tang (frozen shoulder with Qi

deficiency and blood stasis) –  Er Zhu Tang if frozen shoulder with damp

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•  Herbal Rx – Soft tissue damage (strong Turtle with no tail)

Astringent Complex 60%, Zhen Ren Huo Ming Yin 25%, Ge Gen Tang 15% (channel guiding formula)

– Bone spurs or disk problems (Turtle pulse with tail) •  Flex Spur (see Robert’s list of special formulas)

– Prostate enlargement (Turtle pulse on both chi) •  Resolve (Lower) 50% •  Astringent Complex 50%

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•  Pulse sign: Turtle pulse with significant tail--Headache (migraine) due to neck pain Chuan Xiong Cha Tiao San – 30% Seattle 1 Complex – 30% Ge Gen Tang – 20% Flex Spur – 20%


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Right chi – Kidney / Urinary Bladder Scattered pulse

•  Pulse sign: Scattered pulse (dead fish) –  Pulse in which its border

is difficult to perceive –  Thick (wide), soft, slow,

and deep •  Indications

–  Frozen shoulder –  Past traumatic injuries with dead blood –  Might also have numbness of the fingers or arm

because shoulder blocked

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•  Herbal Rx – Frozen shoulder, dead blood causing upper

body pain •  Circulation SJ 30% •  Ge Gen Tang 20% •  Er Zhu Tang 50% If no hypertension can use Bu Yang Huan Wu Tang – 80% Ru Xiang – 10% Mo Yao – 10%

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•  Herbal Rx – Traumatic injuries

•  Circulation SJ 40% •  Ge Gen Tang 30% •  Flex (Spur) 30%

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Right chi – Kidney / Urinary Bladder Taiyang pulse

•  Pulse sign: Taiyang pulse – Big and long pulse – Straight, thick, expanding,

and forceful in all three levels

– Extends proximally to the chi position – Cun and guan are soft and normal

chi is big and thick – Usually thicker, but definitely higher than a Du

Mai

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•  Indications –  If found on left chi and the patient is female with very

hot hands then a hormonal imbalance—excess estrogen.

–  If found on right chi a urinary dysfunction – UTI, burning urination, KD infection.

–  If found on both chi positions chemical poisoning, environmental toxins, heavy metal poisons, multi-chemical sensitivities. Exposure to chemical fumes, agent orange, glue, gasoline, paint, gun powder, etc.

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•  Herbal Rx –  Chemical poisoning or sensitivities

•  Ba Zheng San 40% •  Long Dan Xie Gan Tang 20% •  Herbal ABX 40%

–  Urinary dysfunctions due to heat •  Ba Zheng San 40% •  Herbal ABX 60%

–  Hormonal imbalance/conditions with heat s/s •  Shan Yao 30% •  Zhi Bai Di Huang Wan 20% •  Seattle 1 Complex 50%

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•  Herbal Rx – Hormonal imbalance/conditions with cold s/s

•  Shan Yao 50% •  You Gui Wan 20% •  Bu Gu Zhi 15% •  Jiu Cai Zi 15%

•  Salty warm and bitter warm herbs are good to tonify hormones i.e., Bu Gu Zhi, Jui Cai Zi

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Right chi – Kidney / Urinary Bladder Du pulse

•  Pulse sign: Du pulse – Forceful, thick or thin, straight pulse that extends proximal to the chi position, -  approximately up 1/2 of the forearm -  Usually thicker but definetely higher than a Du Mai

•  Indications – Neck pain, stiffness – Upper body aches and pain

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Right chi – Kidney / Urinary Bladder Du pulse

•  Herbal Rx: •  Neck pain

•  Seattle 1 30% for the inflammation, Astringent Complex 30% for inflammation, Ge Gen Tang 20% to guide, Flex Spur for pain 20%

•  Upper body pain/joint pain from flu (wind-cold)

•  Ji Xiang Teng 50% Dao Di Wu Gong 50%

•  Migraine/Chronic Headaches •  Chuan Xiong Cha Tiao San – 30% •  Gardenia Complex – 30% •  Ge Gen Tang – 20% •  Flex Spur - 20%

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LEFT CUN – Heart / Small Intestine

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LEFT CUN Heart / Small Intestine

Review of normal left cun – Heart pulse 7 deviations of the left cun

1.  Reverse hook pulse 2.  Small pulse 3.  Constricting/Pulse within a pulse 4.  Gu pulse 5.  Rainbow pulse 6.  Scattered pulse/ Dead fish 7.  Deep and weak pulse

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LEFT CUN – Heart / Small Intestine Normal Pulse

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Left cun – Heart / Small Intestine Normal pulse

•  Normal pulse: Hook – Hook pulse is a pulse where the cun position

is higher (more superficial) than the guan and chi positions

•  The guan position is mid-level; the chi position is deepest

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Left cun – Heart / Small Intestine Reverse hook pulse

•  Pulse sign: Reverse hook pulse –  Pulse where the chi position

is higher (more superficial) than guan and cun positions

•  Indications –  Long-term emotional imbalance – nervousness, scared,

easily frightened, under constant anxious, frightened state, an existential uneasiness, subliminal fearfulness

•  Adrenalines are too active or exhausted from past frightening situations, Chronic Stage 3 Stress (Fight or Flight)

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Left cun – Heart / Small Intestine Reverse hook pulse

•  Herbal Rx (if hands are warm) – Tian Wang Bu Xin Dan 40 – Sheng Mai San 40% – Zhi Bai Di Huang Wan 20% – Patient also needs calcium in this condition –  If hands are cold

•  Long Dan Xie Gan Tang – 50 •  Ba Wei Di Huang Wan – 50

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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

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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

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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

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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

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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

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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

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Acupuncture Tx for Coronary Constriction

Target: Heart Tx: Moxa Ren 17, 14

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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

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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%

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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

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Left cun – Heart / Small Intestine Rainbow pulse

•  Pulse sign: Rainbow pulse –  Convex-shaped pulse that

extends distally beyond the cun position. Slightly hard to the touch.

–  Relates to SI

•  Indications –  Gas, bloating, enteritis –  Food poisoning or colitis

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Left cun – Heart / Small Intestine Rainbow pulse

•  Herbal Rx –  Gas, bloating, enteritis

•  Ge Gen Huang Qin Huang Lian Tang 25% •  Shao Yao Tang 35% •  Astringent Complex or Herbal ABX 40%

–  Food poisoning or colitis •  Add Herbal ABX, all equal percentage (25%)

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Acupuncture Tx for Intestinal Diseases

(Excess in Nature) Target: Whole Abdomen

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

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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

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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

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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)

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Left cun – Heart / Small Intestine Deep and weak pulse

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

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LEFT GUAN Liver / Gallbladder

Review of normal left guan – Liver pulse 6 deviations of the left guan

1.  Convex and Forceful 2.  Wiry, Forceful, and Deep 3.  Deep (and concave) 4.  Bird’s beak/Pen tip pulse 5.  Rooftop pulse

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LEFT GUAN – Liver / Gallbladder Normal Pulse

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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

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Left guan – Liver / Gallbladder Convex and Forceful

•  Pulse sign: Convex and Forceful –  Convex = bulging pulse

that has a rounded feeling •  Indications

–  Emotional aspect of Liver involved – stress, irritability, excessive thinking, nervousness, mood swings, insomnia

–  Positive type of emotional condition – patient does not hold feelings inside. Most likely would like to argue or fight with others.

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Left guan – Liver / Gallbladder Convex and Forceful

•  Herbal Rx Jia Wei Xiao Yao San 33% Chai Hu Jia Long Mu Tang 33% Yi Gan San 33% for fast heart rate If that does not work, use

Zhi Zi – 15% Hu Zhang – 15 Huang Shui Qie – 15 Xia Ku Cao – 15 Long Dan Xie Gan Tang – 20 Astringent Complex – 20

•  If no emotional conditions, just fatigue/tired Chai Hu Qing Gan Tang or Liver DTX 50% Wu Wei Zi 25% Shan Zhu Yu 25%

151


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

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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%

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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

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Left guan – Liver / Gallbladder Deep (Scattered or Pounding)

•  Pulse sign: Concave and Deep –  Concave = pulse curved downward –  Can feel the curvature along the

sides and bottom –  Can be scattered or pounding

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

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Left guan – Liver / Gallbladder Concave and Deep

•  Herbal Rx –  Fatty Liver

Ge Xia Zhu Yu Tang - 20 Hu Zhang - 15 Yin Chen Hao Tang - 25 Xia Ku Cao - 15 Huang Shui Qie - 15 Zhi Zi - 15

–  Meniere’s , vertigo • Ban Xia Bai Zhu Tian Ma Tang - 33 • Tian Ma Gou Teng Yin - 33 • Long Dan Xie Gan Tang - 33

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Left guan – Liver / Gallbladder Bird’s beak/Pen tip pulse

•  Pulse sign: Bird’s beak/Pen tip pulse – Convex-shaped pulse that

is approximately 0.1cm in length

– Feels pointy like a pen's tip – Usually hard and cannot be pushed away with

pressure – Usually appears with concave and deep pulse

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Left guan – Liver / Gallbladder Bird’s beak/Pen tip pulse

•  Indications – Gallstones; Sludge in the Gallbladder – Hepatic Cyst

•  Herbal Rx – For Gallstones use:

•  Dissolve (GS) – For Hepatic Cyst use:

•  Dissolve (GS) 80% •  Fu Yuan Huo Xue Tang 20%

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Left guan – Liver / Gallbladder Rooftop pulse

•  Pulse sign: Rooftop pulse –  Mild blade= a pulse that is pinched

on top forming a thin, straight pulse on the superficial level, with an increase in diameter as it moves down to the deeper level

•  Indications –  Liver stagnation, liver damage, history of mono, excess use

of drugs, tylenol, etc. –  Severe constriction – Liver cirrhosis, Liver cancer

•  Thinner and tighter the pulse, more severe the condition, both physically and emotionally

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Left guan – Liver / Gallbladder Rooftop pulse

•  Herbal Rx – Liver damage (previous mono or hepatitis) – Liver cirrhosis (many times from drinking, drugs,

overdose of medication) •  Resolve (EM) 40% •  Yin Chen Hao Tang 30% opens GB •  Openers: Dang Gui 15%

Sheng Ma or Chuan Xiong 15% •  If constriction is due to cold: Add Si Ni Tang 20% and

reduce each of the previous herbs by 5%

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LEFT CHI – Kidney / Reproductive Fx

(Lower back area)

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LEFT CHI Kidney / Reproductive Fx

Review of normal left chi – Kidney pulse 8 deviations of the left chi

1.  Deep and Small pulse 2.  Bird’s beak/Pen tip pulse 3.  Turtle pulse 4.  Scattered pulse 5.  Taiyang pulse 6.  Du pulse 7.  Ren pulse

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LEFT CHI – Kidney / Reproductive Fx (Lower back area)

Normal Pulse

M

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Left chi – Kidney / Reproductive Fx Deep and Small pulse

•  Pulse sign: Deep and Small pulse – Small = a pulse that is thin and weak – Upon pressure, it disappears

•  Indications –  Infertility – Low libido –  Impotence

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Left chi – Kidney / Reproductive Fx Deep and Small pulse

•  Herbal Rx –  You Gui Wan 20% –  Ba Wei Di Huang Wan 20% –  Ba Ji Tian 15% –  She Chuang Zi 15% –  Jiu Cai Zi 15% –  Yin Yang Huo 15%

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Acupuncture Tx for Reproductive Diseases

Deficiencies: Target: Entire female reproductive area; ovaries, uterus, vagina

Tx: K11, 12, 13, 14, 15 (Chong Mai) St 30 Ren 1, 7

(All these points are intersecting points between Ren and Chong Mai vessels)

P 61 GB 34 ST 36 SJ 5 LV 8 SP 9 LI 4 LU 9

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Left chi – Kidney / Reproductive Fx Bird’s beak/Pen tip pulse

•  Pulse sign: Bird’s beak/Pen tip pulse •  Indications

–  Kidney stones in the left ureter: Use Dissolve KS 100 % –  Scar tissue from an abortion, hysterectomy,

C-section, IUD, tied tubes, any lower abdominal surgeries.

If no jump to pulse use: Cold Breakers 20%, Shao Fu Zhu Yu Tang 40%, Zhe Chong Yin 20%, Ge Xie Zhu Yu Tang 20%.

If a jump to the pulse then use: Warm Breakers 20%, Da Ding Huang 10%, Zhen Ren Huo Ming Yin 30%,

Resolve EM 40%.

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Left chi – Kidney / Reproductive Fx Turtle pulse

•  Pulse sign: Turtle pulse with or without Tail •  Indications

–  1. NO Tail = Back and lower body pain, stiffness, and soft tissue damage; overuse or repetitive movements – must use Astringent Complex

–  2. With Tail = Bone spurs, disk problems of lower back. Po Bu Zi Ye for bone spur, key ingredient for Flex Spur

–  3. Both chi = Prostate enlargement, varicocele

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Left chi – Kidney / Reproductive Fx Turtle pulse

•  Herbal Rx –  Soft tissue damage (Turtle pulse with no tail)

•  Astringent Complex 60% •  Zhen Ren Huo Ming Yin 25% •  Dang Gui Nian Tong Tang 15% for lower body

(for upper body, use Er Zhu Tang + Flex (Spur)) –  Bone spurs or disk problems (Turtle pulse with tail)

•  Flex (Spur) –  Prostate enlargement or soft tissue damage in knee

(Turtle pulse on both chi) •  Resolve (Lower) 50% •  Astringent Complex 50%

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Left chi – Kidney / Reproductive Fx Scattered pulse (Dead Fish)

•  Pulse sign: Scattered pulse –  Pulse in which its border

is difficult to perceive –  This pulse is thick (wide),

soft, slow, and deep •  Indications

–  Blood stasis from old injuries – low back pain –  Lower abdominal surgery, abortion, C-section, IUD,

hysterectomy

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Vasectomy **side notes: a bump between guan and chi in men

may indicate vasectomy or something swollen in the genital area – Hot condition – swollen, inflammation

•  Hot Breaker (Xia Ku Cao, Xuan Shen, Huai Hua)

– Cold condition – blockage with no heat •  Cold Breaker (Wang Bu Liu Xing, San Leng, E

Zhu)

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Left chi – Kidney / Reproductive Fx Scattered pulse (Dead Fish)

•  Herbal Rx – Circulation SJ 50% – Resolve (Lower) 50%

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Left chi – Kidney / Reproductive Fx Overview Taiyang, Du and Ren

Superficial, thick, extending proximally

Deep, thin, tight, extending proximally

Middle depth to slightly lower, extending proximally

Taiyang

Ren

Du

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Left chi – Kidney / Reproductive Fx Taiyang pulse

•  Pulse sign: Taiyang pulse •  Indications

– Reproductive dysfunctions – Chemical sensitivities/heavy metal poisoning –  Inflammation in lower abdomen – On both chi positions (in women)

•  If palms are hot à ask if taking hormones à If yes, possible high risk of breast cancer, too much estrogen

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Left chi –kidney / Reproductive Fx Taiyang pulse

•  Herbal Rx – Seattle 1 Complex 60% – Astringent Complex 20% – Ba Zheng San 20%

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Left chi – Kidney / Reproductive Fx Du pulse

•  Indications: Back pain, stiffness, strain, or sprain

•  Herbal Rx: If the pulse has a jump then there is heat

and inflammation use: Gardenia Complex 33%, Astringent Complex 33%, Dang Gui Nian Tong Tang 33%

•  Herbal Rx: If the pulse has no jump then there is a cold condition use: Cold breakers 20%, Flex Spur 30%, Shu Jing Huo Xue Tang 20%, Ru Xiang 15%, Mo Yao 15%.

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Left chi – Kidney / Reproductive Fx Ren pulse

•  Pulse sign: Ren pulse •  Indications

– Endometriosis, adhesions, ovarian cysts, small fibroids, uterine prolapse

•  Herbal Rx •  Resolve EM 40, Cold Breakers 20, Shao Fu Zhu Yu

Tang 20, Zhe Chong Yin 20

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•  Uterine bleeding •  If the palm is hot then uterine bleeding is probably related

to hormonal imbalance especially if taking HRT •  Ren pulse; Dark colored blood; Pelvic area on the

ear is dark – Black combo 50%, Zhi Bai Di Huang Wan 25%, Astringent Complex 25%

•  If the palm is not hot then probably a functional bleeding problem unrelated to hormonal inbalance. Same formula as above but replace Zhi Bai with Shao Fu Zhu Yu Tang.

Left chi – Kidney / Reproductive Fx Ren pulse

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Left chi – Kidney / Reproductive Fx Ren pulse overview

Women: Abortion scar, tubes tied, C-section Men: Vasectomy

Dead fish – back surgery, hysterectomy, blood stasis

PCOS/ Endometriosis

Women: PCOS

Endometriosis, painful periods

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Extra Meridian Pulses Distal to the Cun Position

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Extra Meridian Pulses Distal to the Cun Position

2 extra meridian pulses distal to the cun position 1.  Yangwei pulse 2.  Yinwei pulse

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Extra meridian pulses Yangwei pulse

•  Pulse sign: Yangwei pulse –  Distal to the cun position

pointing towards the thumb •  Indications

–  On right side: Lower respiratory conditions – bronchitis, deep cough, phlegm congestion in Lung

•  Ren 22 feels hot – heat condition •  Ren 22 feels cold – cold condition

–  On left side: Arthritis. If pounding Heat Bi pain, if thin and tight Cold Bi Pain

Yangwei

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•  Herbal Rx – Yang Wei is convex and strong—Phlegm Heat

in Lung, Ren 22 warm •  Lung PH 50% •  Astringents 20% •  Hai Ge Fen 15% •  Di Long 15%

– Yang Wei is thin and tight, Ren 22 cold--Phlegm Cold in Lung

•  Dun Sou San 60%, Astringents 20%, Xiao Qing Long Tang 20%

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•  Herbal Rx –  Joint arthritis and Yangwei is wiry and tight—cold condition

•  Shu Jing Huo Xue Tang 50% •  Shen Tong Zhu Yu Tang 20% •  Ru Xiang 15% •  Mo Yao 2%

Joint arthritis and Yangwei is convex and strong—heat condition

•  Dang Gui Nian Tong Tang 50% •  Astringent Complex 50%

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Extra meridian pulses Yinwei pulse

•  Pulse sign: Yinwei pulse – Distal to the cun position

pointing towards the little finger

•  Indications – Heart conditions – shortness of breath, chest

stuffiness and pressure, palpitation, high low-density lipoprotein high LDL

Yinwei

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Extra meridian pulses Yinwei pulse

•  Herbal Rx – Si Ni Tang 20% – Circulation 80%

– To tonify the heart by releasing the water, use Mao Dong Qing.

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Documents

Pulses And Herbs DPD Pulse-Workshop - Doane Online Education · 2018. 9. 28. · Robert Doane EAMP, L.Ac., Dipl. C.H. Owner of the Acupuncture & Wellness Center, P.S. Websites: doane.us