CMPR122 > Liver & GB patterns > Flashcards

Liver & GB patterns Flashcards

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1
Q

What are the 8 main functions of the Liver?

A

Ensure smooth flow of qi
Store blood
Control sinews
Manifests in the nails
Opens to the eyes
Fluid is tears
Houses ethereal soul (hun)
Affected by anger (frustration/irritation/stress)

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2
Q

What are 7 common Liver channel symptoms?

A

Lower back pain
Unable to bend back forwards or backwards
Swelling of scrotum in men
Swelling of lower abdomen in women
Dry throat
Grey or pale complexion
Cold, numbness or pain along channel pathway

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3
Q

What are 5 common Liver signs & symptoms?

A

Irritability
fluctuations of emotions, moods & energy level
eye problems
hypochondriac pain/distension
Menstrual disorders

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4
Q

What are the main functions of the Gallbladder?

A

Stores and excretes bile
Controls ‘decisiveness’
Controls sinews with Liver

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5
Q

What are 3 common Gallbladder S&S?

A

Hypochondriac pain and distension
Digestive issues
Indecisiveness

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6
Q

What are 12 common gallbladder channel symptoms?

A

Bitter taste in the mouth
Deep sighing
Chest and hypochondriac pain
Cannot turn side to side
Grey and dull complexion
Hot feet
Headache
Pain and swelling in the supraclavicular fossa
Swelling in the armpits
Swollen neck
Malaria
Pain and numbness along the channel pathway

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7
Q

What is the main aetiology of Gallbladder issues?

What is the GB easily effect by?

A

External pathogen
emotional strain
diet

  • easily effected by dampness deriving from impairment of the spleen function of T&T
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8
Q

What are 6 common symptoms of Liver pathology?

A

rapid changes eg in skin diseases
up & down fluctuation eg level of energy/mood/emotionally
moodiness, irritability
eye problems
feeling of ‘distension’
gynaecological problems

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9
Q

What is the common aetiology of Liver disorders?

A

External pathogen - wind & dampness
- exterior wind can aggravate interior liver disharmony - eg liver-yang rising or liver-wind
->may also affect liver-blood -> resulting in skin issues
Emotional strain
Diet
Blood loss

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10
Q

What are 5 of the main clinical manifestations of Liver qi Stagnation?

A
  • feeling of distension of hypochondrium, chest, epigastrium or abdo (distension is the subjective bloating feeling, which can also be seen & palpated)
  • sighing (spontaneous way to release stagnant Qi in chest)
  • melancholy, depression, moodiness, fluctuation of mental state, ‘feeling wound up’ (the stagnation impedes the ‘coming & going’ of the Hun)
  • feeling of lump in throat (as the internal pathway of the primary channel goes via the throat)
  • IRR periods, distension of breasts pre period, PMS (impairs the movement of Blood & Qi in the Ren Mai & Chong Mai (CV & thoroughfare))

Tongue: body may be normal - in severe cases, mildly red on the sides
Pulse: String-like (wiry) - esp. left side (if not wiry, than not liver-qi stagnation

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11
Q

What are the differences in liver qi stagnation S&S in women deriving from/associated with liver-blood Xu?

Consider that liver-qi and liver-blood are the yin/yang aspect of the liver

Herbal formulas indicated?

A
  • slightly different S&S, generally the Xu type
  • depression rather than irritability
    pulse - generally fine & only slightly wiry on the left

Xiao Yao San - good for liver-qi stagnation deriving from/associated with liver-blood Xu
Yue Ju Wan - ‘pure’ liver-qi stagnation

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12
Q

6 acupuncture points to smooth the liver and move qi?

A

GB34 - moves liver-qi & particularly influences the hypochondrial region
LIV3 - moves liver-qi & particularly affects throat & head
LIV13 - regulates liver qi in middle jiao, particularly when it invades spleen
LIV14 - regulates liver-qi in middle jiao - particularly when it affects stomach
SJ6 - moves liver-qi & particularly affects sides of the body
PC6 - moves liver-qi (by being part of Jueyin), indicated when stagnation is caused by emotional problems

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13
Q

What are 5 S&S of stagnant Liver-qi turning into heat?

What can this pattern develop into?

consider, emotionally, Liver-qi stagnation tends to make a person repress anger more & become moody whereas heat makes one more….

A

Think liver-qi stagnation S&S plus
- feeling of heat
- red face
- thirst
- propensity to outbursts of anger
- heavy periods

Tongue: red sides
Pulse: slightly rapid, wiry esp. on L) side

this pattern can develop into liver-fire

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14
Q

7 acupuncture points to smooth the Liver, move qi & lightly clear heat?

A

Same as Liver-qi stagnation
- GB34, LIV3, LIV13, LIV14, SJ6, PC6
Plus LIV2 if the symptoms of heat are pronounced

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15
Q

What are 7 S&S of Liver Yang Xu?

(I find this pattern odd, as it isn’t in maciocia, and when looking online, doesn’t seem to be an entirely real pattern. It appears true yang Xu belongs more to Spleen/kidney - however, this pattern is in the modules, so I add it here)

A

depression
distension in hypochondriac region
Susceptible to fright
Aversion to cold
Cold limbs
Dizziness
Blurred vision

Tongue: Pale with white coat
Pulse: Sunken slow weak

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16
Q

What are 5 S&S of Rebellious Liver-qi?

A
  • hypochondrial distension
  • hiccup, belching, N&V (impairment of ST qi descending - as Liver-qi is rebelling horizontally, accentuating the movement, hence emotional symptoms are fewer)
    -sighing
    -irritability
  • breast distension

Tongue: in severe cases - sides will be red
Pulse: wiry - particularly liver and stomach positions

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17
Q

What is the difference b/w liver-qi stagnation and rebellious liver-qi?
five elements
pathology
pulse
treatment
hun

A

5 elements
- wood underactive vs overactive
Pathology
- lack of free flow vs liver qi is overactive, flowing in wrong direction
pulse
- wiry & reluctant vs wiry esp. both middle positions
Treatment
- move qi, eliminate stagnation with pungent herbs vs subdue rebellious liver-qi with sweet herbs
Hun
- stimulate it’s coming & going vs restrain its coming & going

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18
Q

8 acupuncture points to smooth the liver & subdue liver-qi?

A

LIV14 - main point to subdue liver-qi when it invades stomach
PC6 - subdues rebellious liver-qi, makes stomach qi descend & calms the mind
GB34 - smoothes the liver and moves qi
LIV3 - smooths the liver, moves qi, calms the mind and settles the hun
SJ6
LI4 - regulates descending and ascending of qi
ST21 & ST19 - make stomach qi descend

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19
Q

What are 9 shared S&S of Liver yin deficiency & Liver blood deficiency?

A
  • dizziness
  • numbness/tingling of limbs
  • Blurred vision/floaters in eyes/diminished night vision (as liver opens into the eyes -> meaning they lack nourishment & moisture)
  • scanty periods/amenorrhoea (as the Ren & Chong are dependent on LR for their blood supply)
  • cramps/muscular weakness (as Liver controls the sinews)
  • Brittle nails (as the liver manifests in the nails, so they lose nourishment)
  • Insomnia
  • Fine pulse
  • depression/aimlessness
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20
Q

What are 4 S&S of Liver yin deficiency differentiating from Liver Blood Xu?

A

basically the same as liver-blood Xu but the main differences are

  • Dry eyes
  • VERY dry skin and hair
  • Dry throat
  • dull-pale complexion without lustre BUT red cheekbones (due to empty-heat)

Tongue: Scanty/rootless coat (without coating is a key difference b/w the 2)
Pulse: floating-empty

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21
Q

What are 4 S&S of Liver blood deficiency differentiating it from Liver Yin Xu?

much more common in women than men

A
  • dull-pale complexion without lustre (sign of blood Xu)
  • Muscle tension
  • Pale lips (sign of Blood Xu)
  • dry skin and hair

Tongue: pale body esp. sides - which in extreme cases may be orangey in colour. thin and slightly dry
Pulse: Fine, choppy

blurred vision, pale, tongue, choppy pulse is enough to diagnose

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22
Q

What is the aetiology of Blood Xu?

A

emotional stress
overexercise
diet

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23
Q

9 acupuncture points to tonify liver and nourish blood?

A

LR8 - nourishes liver-blood
ST36 & SP6 - tonify post-heaven qi to produce blood (this with LR8 is excellent to nourish blood)
CV4 - moxa to nourish blood esp menstrual blood
BL18, BL20,
BL23 - tonifies kidneys to produce blood
BL17 - direct moxa to nourish blood
Yuyao - good for dull headaches or blurred vision from liver-blood Xu

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24
Q

7 acupuncture points to tonify the liver, nourish yin & clear empty-heat if necessary?

A

LR8, ST36, SP6 & CV4
KI3 & KI6 - nourish kidney & liver yin
LR2 - if empty heat

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25
What are 6 S&S of liver blood stasis? the liver is particularly affected by blood stagnation as it stores blood and derives from stagnated Liver-Qi
- hypochondrial pain, abdo pain - vomiting of blood, epistaxis (due to blood stasis in LR channel) - painful periods/ IRR / dark & clotted (Ren & Chong mai are affected, and blood will stagnate in them -> menstrual issues) - purple lips/nails/complexion - dry skin (severe cases) (as it's obstructing the circulation of fluids) - Petechiae (bleeding under the skin) Tongue: purple especially/only on sides (purple spots if severe) Pulse: wiry or firm (firm is typical of blood stasis)
26
12 acupuncture points to smooth the liver, move qi & blood, and eliminate stasis?
GB34 LIV3 - moves Qi & blood BL18 - liver back shu point BL17 - Hui point for blood - can move blood (when needled only, no moxa) SP10 (when combined with BL17, moves blood in upper and lower jiao) CV6 SP4 & PC6 - open the penetrating vessel - which is the vessel of the sea of blood and very good at moving blood in blood stasis ST29 - moves blood in lower jiao and uterus KI14 - the point of penetrating vessel that moves blood LIV5 & LIV6 move liver qi and blood
27
What are 8 S&S of damp-heat in liver?
- Fullness of hypochondrium/abdo/hypogastrium - sticky taste (damp) - bitter taste - poor appetite, nausea (dampn obstructing middle Jiao) - yellow vaginal discharge, vaginal itching, sores (dampness infusing downwards -> hence manifests often as sores/eczema in genital region) - mid cycle bleeding/pain - pain/redness/swelling of scrotum - urinary difficulty/burning/dark (damp obstructing the urinary passages Pulse: slippery-wiry-rapid Tongue: Red (redder on sides) with yellow slimy/sticky coat ?STIs
28
8 acupuncture points to resolve dampness, clear the liver and clear heat?
LR14 - regulates liver-qi in hypochondrium & epigastrium GB34 - resolves dampness in LR & GB BL18 - resolves dampness from Liver CV12 - tonifies spleen to resolve dampness SP9 & SP6 - resolve dampness - particularly in lower jiao LI11, LR2
29
What are 8 S&S of liver-yang rising? this is a mixed Xu/excess pattern deriving from Liver-yin Xu and/or Kidney-yin xu or liver-blood causing rising of liver-yang
- headache (either temple/eyes/lateral sides of head), throbbing in nature - dizziness - tinnitus, deafness (both sudden onset) - blurred vision - dry mouth & throat - insomnia - irritability - propensity to outbursts of anger Pulse: wiry (if background of liver-yin/liver-blood xu, may be wiry only one side or also fine) Tongue: may vary depending on the underlying pathology causing liver-yang rising. - pale if liver-blood Xu - without coating - if liver-yin Xu - rebellious liver-qi - normal or slightly red on the sides
30
17 acupuncture points to subdue liver-yang, nourish yin or blood?
LR3 - main distal point SJ5 - subdues liver-yang -> particularly indicated for headaches along GB channel PC6 - subdue liver-yang and calm the mind LI4 GB43 - main distal point fro headaches around the eyes/temple GB38 - distal point to subdue liver-yang -> often used in chronic/stubborn headaches GB20 - important adjacent point to subdue liver-yang BL2, Taiyang, GB9, GB8, GB6 - all important local points for liver-yang rising SP6, LR8, ST36 - nourish liver-blood & yin KI3 & KI6 used if there if a kidney-yin Xu
31
What is the common characteristic between Liver-yang rising & liver-fire?
excessive ascending of Liver-qi
32
What are 12 S&S of Liver-fire blazing?
- irritability - propensity to outbursts of anger - tinnitus, deafness (sudden onset, high-pitched whistle) - temporal headache - dizziness - red face & eyes - thirst - bitter taste (will be there all day, as opposed to heart-fire just mornings post bad sleep) - dream-disturbed sleep - constipation with dry stools - dark-yellow urine - expistaxis, haematemesis (vomit), haemoptysis (cough) (rarer cases heat causing the blood to extravasate) Tongue: red body, redder on sides, dry yellow coating (dry yellow coat confirms full-heat) Pulse: full-wiry-rapid
33
12 acupuncture points to clear the liver, drain fire?
LR2 - main point LR3 GB20 - subdues the ascending of Liver-qi Taiyang - clears liver-fire GB13 - subdues the ascending Liver-yang LI11 GB1, GB9, GB8, GB6 SP6 LR1
34
What is the comparison b/w liver-yang rising and Liver-fire? Aetiology Pathology Ba Gang Symptoms treatment principle
A. - emotional stress vs. emotional stress & diet P. - imbalance b/w yin & yang, excessive ascending of liver-qi - no real heat vs. full heat B. - ... - full heat S. - headaches vs headaches & eye problems Treatment - subdue liver-yang vs. drain fire
35
What are 5 S&S of liver-wind agitating within?
convulsion or paralysis *shaking of the sinews* tremor spasms numbness tic
36
What are the 4 distinct types of liver-wind?
Extreme heat generating wind liver-yang rising generating wind - liver-yang rising deriving from Liver-yin Xu - Liver-yang rising deriving from liver & kidney-yin Xu - Liver-yang rising deriving from liver-blood Xu Liver-fire generating wind Liver-blood Xu generating wind
37
What are 5 differentiating S&S of extreme heat generating wind? consider when heat reaches blood level in febrile diseases
high temp convulsions rigidity of neck tremor of limbs opisthotonos - uncontrolled flexing of muscles in back and neck Tongue: deep-red, stiff, dry yellow coating Pulse: wiry-rapid seen in meningitis - heat has reached the blood level
38
7 acupuncture points to cool blood, nourish yin and extinguish wind?
LR3 - extinguishes liver-wind Shixuan - extinguishes wind and cool blood (prick to bleed) GV20, GV16, GB20 - extinguish wind GV8 - relieves spasms to stop convulsions GV14 - pricked to bleed to cool blood
39
What are 8 common S&S of Liver yang transforming into wind? b/w liver-yang rising deriving from liver-yin Xu deriving from liver and kidney-yin Xu deriving from liver-blood Xu
Tremor Dizziness headache tinnitus dry throat blurred vision numbness/tingling of limbs poor memory Pulse: wiry-fine
40
What are the shared & differentiating S&S of liver-yang rising deriving from Liver-yin Xu vs Liver & kidney-yin Xu? 3 shared 1 for liver-yin xu 4 for liver & kidney-yin xu
both have: extreme dizziness facial tic dry eyes Tongue: normal-coloured without coating Liver-yin Xu - hypertension Liver & Kidney-yin Xu - backache - scanty urination - night sweating - possibly HTN
41
What are the differentiating S&S of Liver-yang rising deriving from blood-Xu?
HTN insomnia
42
8 aupuncture points to subdue liver-yang, extinguish wind and nourish liver-yin?
LR3 - subdues liver-yang & extinguishes wind GB20 - extinguishes wind & subdues yang LI4 - helps to subdue yang TE5 - subdues liver-yang GV19 - extinguishes wind SP6, LR8 & KI3 - nourish liver-yin
43
10 acupuncture points to subdue liver-yang, extinguish wind and nourish liver & kidney-yin?
Same as points to subdue liver-yang, extinguish wind and nourish liver-yin - LR3, GB20, LI4, TE5, GV19, SP6, KI3, LR8 plus - KI6 & CV4 to nourish kidney-yin
44
10 acupuncture points to subdue liver-yang, extinguish wind and nourish liver-blood?
LR3, GB20, LI4, TE5, GV19, SP6, KI3, LR8 plus - BL17 & CV4 - nourishes blood
45
What is 7 S&S of & Cold stagnating in the liver channel? think invasion of the Liver channel by cold. Consider the pathway of the liver channel
- fullness & distension of the hypogastrium with pain which refers downwards towards scrotum, testis & upwards to the hypochondrium - pain alleviated by warmth - Spasm in the liver channel - straining of testis/contraction of scrotum - Jueyin headache - feeling of cold, hands & feet - vomiting of clear watery fluid/dry vomiting Tongue: pale & wet with white coating Pulse: deep-wiry-slow
46
What are 10 S&S of liver-fire generating wind? most likely to occur in elderly may occur when liver-fire persists for quite some time
tremor irritability propensity to outbursts of anger sudden onset of deafness/tinnitus temporal headache red eyes & face thirst bitter taste constipation with dry stools epistaxis/haematemesis/haemoptysis Tongue: red with redder sides & dry yellow coating Pulse: wiry-rapid
47
8 acupuncture points to clear the liver, drain fire and extinguish wind?
LR2 - drains liver-fire LR3 - extinguishes liver-wind GB20 - extinguishes wind LI11 - drains fire GB1 - extinguishes liver-wind SP6 LR1 - extinguishes liver-wind GV8 - relieves spasms and tremors
48
What are the 5 differentiating S&S of Liver-blood Xu generating wind? plus 3 symptoms which differentiate it from liver-yang rising deriving from liver-blood xu
scanty periods, facial tic and fine tremor are the symptoms that differentiates this pattern from liver-yang rising deriving from liver-blood Xu dizziness blurred vision numbness/tingling of limbs poor memory insomnia Tongue: pale & thin Pulse: wiry-fine
49
12 acupuncture points to nourish liver-blood and extinguish wind?
LR8, KI3, SP6 - nourish liver-blood LR3 & GB20 - extinguish wind LI4 TE5 & GV19 - extinguish liver-wind CV4 & BL17 - nourish blood
50
4 acupuncture points to clear the liver & expel the cold?
CV3 - with moxa to dispel cold from lower burner LR5 - luo connecting - which flows around genitals and disperses cold LR1 - clears liver channel & removes obstruction of cold from lower jiao LR3 - resolves spasms & helps to relieve contraction
51
What are 3 shared S&S b/w Liver-gallbladder dampness-heat & depressed gallbladder with harassing phlegm?
Hypochondriac pain and distention Nausea Bitter taste
52
What are 11 differentiating S&S of damp-heat in Liver & GB? Enough to diagnose - 5 what is the sign of liver involvement - 2
- hypochondrial fullness, bitter taste, sticky yellow coating on right side, genital skin rashes & itching are enough to diagnose liver involvement - urinary & genital symptoms, liver channel causes swelling of feet - N&V - inability to digest fats - yellow complexion - scanty & dark yellow urine - dizziness - bitter taste - yellow sclera - swelling of feet - difficulty/burning urination - excessive yellow vaginal discharge - swelling/heat of scrotum Tongue: thick sticky yellow coating (bilateral or unilateral) Pulse: slippery-wiry-rapid
53
14 acupuncture points to resolve dampness, clear heat, clear the liver & GB and promote the smooth flow of liver-qi?
GB24, GB34, Dannangxue, GV9, BL19 - resolve dampness and clear heat from GB LR14 & BL18 - resolves dampness and clear heat form liver CV12, BL20, LI11, TE6, ST19, LR3, LR5 - promotes smooth flow of qi, as the luo connecting point it resolves dampness in urinary & genital areas
54
What are 9 S&S of Gallbladder dampness-heat which differentiate it from from dampness in GB? Western pattern? Enough to diagnose?
- Scanty & dark yellow urine, bitter taste, fever, thirst without desire to drink (signs of heat, no desire to drink because damp) - dizziness - tinnitus - irritability - swelling of feet - loose stools/constipation - alternation of hot & cold feeling - feeling of heat - N&V (dampness obstructing the middle Jiao, preventing ST qi from descending? Tongue: Thick sticky yellow coat (either bilateral or unilateral Pulse: Rapid-wiry-slippery Think gallstones (cholethiasis) enough to diagnose - hypochondrial fullness, bitter taste & thick sticky yellow coat on right side of tongue
55
What are 9 differentiating S&S of depressed gallbladder with harassing phlegm?
Timidity Easily frightened Insomnia Dreamful sleep Chest oppression Frequent sighing Dizziness Vomiting Vexation Tongue: White slimy coat Pulse: String-like (wiry)
56
11 acupuncture points to resolves dampness, clear heat in GB and stimulate the smooth flow of liver-qi?
GB24 & BL19 - clear heat in GB LR14 - promote smooth flow of liver-qi CV12 & BL20 GB34 - stimulates the smooth the flow of liver-qi, resolves dampness & clears heat Dannangxue - same functions as GB34 and use if tender on pressure (only on the R) leg) GV9 - clears heat in GB, stimulates smooth flow of liver-qi & resolves damp LI11 TE6 - clears heat in shaoyang channels ST19
57
What are 2 shared S&S b/w Gallbladder heat & gallbladder qi deficiency?
Irritability Insomnia
58
What are the 5 differentiating S&S of Gallbladder heat?
Irascibility (easy to anger, short temper) Hypochondriac distension Bitter taste Ear pain Tinnitus Red tongue with yellow coat
59
What are 9 differentiating S&S of gallbladder qi deficiency?
- Panic - Suspicion/timidity - Sighing - Nervousness - easily startled - lack of courage/initiative - Lassitude - Dizziness - waking up early in the morning & restless dreams Tongue: pale/normal pulse: weak
60
7 acupuncture points to tonify & warm the GB and tonify liver-qi?
GB40 - yuan source point - has a great effect on the mental aspect of the GB LR8, SP6, ST36 - tonify liver-blood & qi CV4 - tonifies the liver BL18 BL47 - influences the mental aspect of the liver & regulates the ethereal soul - stimulates it's coming & going in this case
61
What are 6 shared S&S b/w Liver fire flaming upward & ascendant hyperactivity of liver yang?
Dizziness Headache Flushed face Bitter taste Tinnitus String-like pulse
62
What are 2 differentiating S&S of Liver fire flaming upward?
Vertex headache Blurred vision
63
What are 6 differentiating S&S of ascendant hyperactivity of liver yang?
Hearing impairment Blood-shot eyes Hematuria, hemopysis or epistaxis when severe Mental irritability Yellow tongue coat Rapid pulse
64
What are 10 S&S of liver-fire blazing?
irritability propensity to outbursts of anger tinnitus & deafness bitterness temporal headache dizziness red face & eyes constipation with dry stools dark-yellow urine vomiting/coughing of blood Tongue: red body, redder on sides, dry yellow coat Pulse: full-wiry-rapid
65
12 acupuncture points to clear the liver, drain fire?
LR2 - main point - specific to drain liver-fire LR3 - drains the liver GB20 - drains liver-fire & subdues ascending of liver-qi. (very important point to use in case of eye problems/headaches caused by liver-fire) Taiyang - clears liver-fire & for temporal headaches GB13 - subdues ascending liver-yang & calms the mind LI11 GB1, GB9, GB8, GB6 - important local points for liver-fire ascending to the head - only if there are headaches SP6 - nourish yin LR1 - clears the liver and subdues rising liver-yang & liver-fire
66
What are 11 signs & symptoms of the full-pattern of dampness in the GB?
- jaundice - dull-yellow eyes & skin - N & V - due to dampness obstruction in middle jiao and ST qi being unable to descend - inability to digest fats - dull-yellow sclera - turbid urine - no thirst - sticky taste - dull headache ( dampness lodging in head) - feeling of heaviness in body Tongue: thick sticky white coating, either bilateral in 2 strips or unilateral Pulse: slippey-wiry
67
9 acupuncture points to resolve dampness, clear the gallbladder & promote the smooth flow of liver-qi?
GB24, GB34, GV9, BL19 - resolve dampness from the GB LR14 - harmonises GB & liver CV12 - resolve damp BL20 - tonifies spleen to resolve dampness TE6 - promotes the smooth flow of liver-qi in the hypochondrium ST19 - promotes the descending of ST-qi to relieve obstruction in the middle jiao - treats N&V
68
Channel Disorder of the GB
Head, face and sense organs: headache, pain in the eyes, side of the head, cheek, ear, jaw, deafness and tinnitus Shao Yang Syndrome: alternating chills and fever, bitter taste in the mouth, hypochondriac pain and distension, malaria Channel obstruction: pain swelling of the neck and glands, swollen axilla, pain and inability to turn waist, spasm and pulling sensation along the sides of the body including the hip, leg, knee, fibula, ankle and foot
69
Organ Disorder of GB
Gall Bladder and Liver, hypochondria pain, vomiting, nausea, belching, bitter taste in the mouth, poor appetite, abnormal bowel movements, dusty and dark complexion Urogenital: swelling and pain of the genitals, hernia, leukorrhea, genital itching, difficult urination Emotional and mental: deep sighing, depression, mood swings, frequent anger, poor judgement, indecision, insomnia
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