CIRRHOSIS OF THE LIVER

GENERAL

Clinical Manifestations	Cirrhosis is a late stage of scarring (fibrosis) of the Liver caused by many forms of Liver diseases and conditions, such as hepatitis and chronic alcoholism. Each time the Liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the Liver to function (decompensated cirrhosis). Advanced cirrhosis is life-threatening. Symptoms: Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include: Fatigue Easily bleeding or bruising Loss of appetite Nausea Swelling in the legs, feet or ankles (edema) Weight loss Itchy skin Yellow discoloration in the skin and eyes (jaundice) Fluid accumulation in the abdomen (ascites) Spiderlike blood vessels on the skin Redness in the palms of the hands For women, absent or loss of periods not related to menopause For men, loss of sex drive, breast enlargement (gynecomastia) or testicular atrophy Confusion, drowsiness and slurred speech (hepatic encephalopathy
Treatment Principle
Herb Formulas	With gynecomastia: Ge Gen Tang
Points

TAI YANG - SHAO YANG

Clinical Manifestations	Joint pain with a crackling sensation Epigastric pain Fatigue Gastrointestinal weakness Headache Heaviness in the head Fever Moderately severe chills Distension beneath the Heart Periumbilical or lower abdominal pain Tenseness around the pubic bone Subcostal pain Epigastric fullness Nausea Mild vomiting Mild thoraco-costal discomfort Costal distress Tension in the rectus abdominus Chest distension Abdominal pain Abdominal distension Constipation Irritability Insomnia Repeated loss of spinal alignment due to muscular tension P: Floating and weak
Treatment Principle	Release the Exterior and muscle layer Harmonize and release the Shao Yang Harmonize the Liver, Spleen and Intestines Dispel Water Accumulation
Herb Formulas	Chai Hu Gui Zhi Tang
Points

YANG MING JING

Clinical Manifestations	High fever Profuse perspiration Great thirst with a desire to drink Abdominal pain Dryness Irritability Restlessness Feverish body parts Red face Dry stools No constipation No aversion to Cold T: Red, dry C: Dry yellow P: Rolling and rapid (gigantic)
Treatment Principle	Clear Heat Reduce fever Moisten and replenish fluids
Herb Formulas	Zhu Ling Tang
Points	DU-14, KI-3, KI-6, LI-4, LI-11, SP-6, ST-44 With Qi and Body Fluid Deficiency: DU-14, LI-11, REN-6, REN-12, SP-3, ST-36, ST-44, UB-20 With diarrhea: To Expel Wind Cold: Sedate DU-16, GB-20, LI-4, SJ-5, UB-12 To Disperse the Lungs: LU-7, UB-13 To stop diarrhea: Moxa REN-8, REN-12, ST-25, ST-36 With vomiting but no diarrhea: To Expel Wind Cold: Sedate DU-16, GB-20, LI-4, SJ-5, UB-12 To Disperse the Lungs: LU-7, UB-13 To stop vomiting: PC-6, SP-4

SHAO YANG FU WITH CONGESTIED FLUID

Clinical Manifestations	Alternating chills and fever (chills predominate) or Chills without fever Sensation of irritability in the chest Sweating from the head Fatigue Gastrointestinal weakness Heavy head Neuralgia Epigastric distension Lower abdominal pain Tension around pubic bone Periumbilical pain Urinary difficulty T: Moist C: White and slippery P: Superficial and wiry
Treatment Principle	Disperse Clumping Harmonize the Shao Yang Warm the Interior Dispel Cold
Herb Formulas	Chai Hu Gui Zhi Gan Jiang Tang
Points	GB-41, SJ-5, moxa or moxa needle REN-4, REN-6, REN-8, REN-12, SJ-6, ST-25, ST-36

SHAO YANG FU WITH UNDERLYING LIVER QI STAGNATION

Clinical Manifestations	Fullness and distention in the chest Irritability Occasional fright palpitations Urinary difficulty Constipation Delirious speech Insomnia Subcardiac distention Palpitations at the abdomen Melancholia Fear Agitation Unsteadiness Tends toward mania and convulsions Tends toward fatigue and clumsiness of limbs Dysuria Excitability Dizziness Anxiety Depression Tinnitus Deafness Profuse expectoration of Phlegm Bitter taste in the mouth Palpitations Pale face Oliguria A sensation of extreme heaviness of the body Fatigue Inability to rotate the trunk Difficulty moving the body T: Red C: Slippery P: Wiry and rapid
Treatment Principle	Harmonize the Shao Yang Unblock the three Yang Stages Sedate and calms the Spirit Relieve the chest and subcardiac regions Alleviate spasms
Herb Formulas	Chai Hu Jia Long Gu Mu Li Tang
Points

SHAO YIN HEAT

Clinical Manifestations	Dry throat and/or mouth Chronic sore throat (not acute) Restlessness Malar flush Insomnia Disturbed speech Low grade fever, worse in afternoon Yellow urine Irritability with a sensation of Heat in the chest Palpitations with anxiety Sores in the mouth or on the tongue More Heat than in Yin Deficiency (chronic low grade fever) T: Red, deep red C: None P: Deep, thready and rapid
Treatment Principle	Nourish Yin Reduce Heat
Herb Formulas	Si Ni San
Points	DU-14, HT-5, HT-7, KI-3, KI-6, KI-7, LIV-3, SP-6, UB-10, UB-15, UB-23

JUE YIN HEAT

Clinical Manifestations	Cold extremities Body hot and feverish due to lack of harmony of Liver Qi Thirst Abdominal distention Fever Dark yellow urine T: Red C: Yellow P: Rapid and slippery
Treatment Principle	Clear Heat Reverse reversals
Herb Formulas	Si Ni San
Points	DU-14, LI-4, LI-11, LIV-2, LIV-3, LIV-14, PC-6, REN-12, P-6

FLUID RETENTION IN THE INTESTINES

Clinical Manifestations	Clear, watery, frothy diarrhea More water than diarrhea Borborygmus with the sound of water sloshing in the abdomen on palpation Emaciation Nausea and/or Vomiting of clear fluids Abdominal distention Scanty urination A dry mouth Dizziness T: Pale C: Greasy and white P: Slippery or Soggy
Treatment Principle	Warm and strengthen the Spleen Warm and strengthen Fluid metabolism Drain Dampness through the urine or bowel
Herb Formulas	Ling Gui Zhu Gan Tang + Ji Jiao Li Huang Tang With more severe Spleen Deficiency and pitting edema: Shi Pi Yin Chinese Patent Medicines: Fu Zi Li Zhong Wan Jin Gui Shen Qi Wan
Points	KI-7, REN-4, REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-23, UB-28, UB-39 Ear: Kidney, Spleen, Lung, Stomach, Large Intestine, Sanjiao, Shenmen, Adrenal

COLD-DAMP DISTRESSES THE SPLEEN

Clinical Manifestations	Distention and fullness of epigastrium and abdomen Nausea Vomiting Anorexia Loose stools Diarrhea Reduced sensation of taste No thirst or preference for hot drinks Sticky sensation in mouth Borborygmus Lassitude Yin jaundice Heavy head Maybe edema Maybe copious white vaginal discharge Maybe cold limbs, fear of Cold or feeling chilled T: Pink C: Thick, white and greasy or sticky P: Deep and slow
Treatment Principle	Warm Cold Transform Dampness Harmonize the Stomach Strengthen the Spleen
Herb Formulas	Wei Ling Tang Yin Chen Si Ni Tang Yin Chen Zhu Fu Tang modified
Points	Moxa or moxa needle REN-6, REN-12, SP-6, SP-9, ST-36, UB-20 Cold-Damp Dysentery: Moxa or moxa needle LI-4, REN-6, REN-12, SP-6, ST-25, ST-37 Cold-Damp Diarrhea: Moxa or moxa needle REN-6, REN-12, ST-25, ST-36, ST-37, UB-25 Cold-Damp Vaginal Discharge: Moxa or moxa needle GB-26, REN-4, REN-6, SP-6, ST-36, UB-30 Cold-Damp Jaundice (Yin Jaundice): Moxa or moxa needle DU-9, GB-24, LIV-13, SP-9, ST-36, UB-19, UB-20 , UB-48

DAMP-HEAT INJURES THE SPLEEN

Clinical Manifestations	Anorexia Emaciated Limbs Abdominal distention and discomfort Suffocating sensation in the chest Epigastric mass Maybe abdominal pain on palpation Yang jaundice (sclera and skin are bright yellow) Dislike of oily foods Hematemesis Nausea Vomiting Lassitude Insomnia Eyes sunken and moist with tears Scanty, dark urine Maybe thirst or thirst with no desire to drink Diarrhea with foul smell or Constipation Hemafecia Fever Sweet sticky taste or bitter taste in mouth T: Pink C: Thick, yellow and greasy (maybe sticky) P: Soft and rapid
Treatment Principle	Clear Heat Benefit Dampness
Herb Formulas	Yin Chen Wu Ling San
Points	DU-9, GB-24, GB-34, LIV-14, REN-11, SI-4, SP-9, ST-44, UB-18, UB-19, UB-48 Alternate, moxa needle: 1. LIV-14, SP-10, ST-36, UB-18, UB-20 2. LIV-13, SP-6, SP-9, UB-23, UB-25 3. Dannangxue, GB-24, GB-26, GB-34, LIV-5, PC-6, REN-3, REN-6, SP-6, SP-9, ST-36 LIV-9, LIV-14, SP-9, UB-16, UB-18, UB-20, UB-23 LIV-13, SP-6, SP-10, UB-17, UB-19, UB-22, UB-24 LIV-4, SP-6, SP-10, UB-16, UB-18, UB-30 KI-7, KI-9, REN-9, ST-36, Yiming LI-11, REN-12, SP-9, ST-36, ST-44, UB-20

SPLEEN QI DEFICIENCY WITH BLOOD DEFICIENCY

Clinical Manifestations	Yin jaundice The face, eye and skin are a dull, lusterless yellow or very pale or sallow Fatigue Lethargy Weakness in the extremities Poor muscle tone Loose stools or Diarrhea Poor appetite Dizziness Pale face Weak voice Reluctance to speak Sweating with little or no exertion Palpitations Insomnia Shortness of breath Dry skin Dry hair Poor memory Paleness Scanty periods T: Pale and swollen or Pale, thin and dry C: Thin and white P: Weak or Thin and choppy or Soft and thin
Treatment Principle	Strengthen the Spleen Warm the Middle Jiao Tonify Qi Nourish the Blood
Herb Formulas	Huang Qi Jian Zhong Tang Chinese patent medicines: Wu Ji Bai Feng Wan Shi Chuan Da Bu Wan Bu Zhong Yi Qi Wan
Points	DU-4, DU-9, REN-4, REN-6, REN-12, ST-36, UB-19 KI-3, LIV-3, LU-9, SP-6, ST-36, UB-11, UB-17

SPLEEN QI DEFICIENCY WITH DAMPNESS

Clinical Manifestations	Edema Tympanitis which is firm and full when pressed Loose stools or watery diarrhea Epigastric distress Hepatosplenomegaly Weak extremities Weight loss Distention and a stifling sensation in chest and epigastrium Pale, wan complexion Abdominal distention Indigestion Vomiting Fatigue Chills Maybe vomiting Leukorrhea Reduced appetite Borborygmus Diarrhea with onset of menstrual flow Cough with copious sputum Leukorrhea in obese women Scanty urine T: Pale or Pale red C: White - maybe greasy P: Thready and even or Even and Deficient or Thready and tight
Treatment Principle	Augment Qi Strengthen the Spleen Resolve Dampness Stop diarrhea
Herb Formulas	Shen Ling Bai Zhu San Xiang Sha Liu Jun Zi Tang Fen Xiao Tang Si Ling San With Qi Stagnation: Wu Pi San Wu Pi Yin With Blood Stagnation: Cirrhosis #3 With Liver and Kidney Yin Deficiency: Cirrhosis #4
Points

SPLEEN QI DEFICIENCY WITH FOOD STAGNATION

Clinical Manifestations	Reduced appetite Difficulty digesting Abdominal and epigastric bloating Watery diarrhea Loose stools T: Normal C: Slightly yellow, greasy P: Deficient and frail
Treatment Principle	Strengthen the Spleen Harmonize the Stomach Reduce Food Stagnation Stop diarrhea
Herb Formulas	Jian Pi Wan
Points

SPLEEN YANG DEFICIENCY

Clinical Manifestations	Sallow complexion Anorexia (maybe with vomiting) Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools or watery stools containing undigested food Shortness of breath Pain in the epigastrium with cold sensations (pain is relieved by warmth) Cold limbs Feeling chilled Frequent, clear urination Mental fatigue Maybe scanty urine with edema Maybe clear, watery vaginal discharge T: Pale C: Thin and white P: Deep and weak
Treatment Principle	Warm the Center Dispel Cold
Herb Formulas	Li Zhong Tang Fu Zi Li Zhong Wan
Points	Moxa or moxa needle LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

SPLEEN AND STOMACH DEFICIENCY COLD

Clinical Manifestations	Mild constant epigastric pain; relieved by warmth and pressure Anorexia Abdominal pain and fullness after meals Nausea Vomiting Loose, unformed stools Excessive salivation Cold limbs Lassitude Weakness Sallow or pale, dull complexion Maybe edema Maybe scanty urination Maybe clear, watery, copious vaginal discharge T: Pale C: White and greasy P: Deep, thready and forceless
Treatment Principle	Strengthen the Spleen Warm Yang Warm the Center Dispel Cold
Herb Formulas	Fu Zi Li Zhong Wan Xiao Jian Zhong Tang Gan Jiang Ren Shen Ban Xia Wan Wen Wei Yin
Points	Moxa or moxa needle LIV-13, REN-12, SP-3, SP-6, ST-36, UB-20, UB-21

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Abdominal distention Ductal glomus Fatigue Anorexia Body cold Weakness of the limbs Limbs icy Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria Severe: Abdominal ascites T: Pale, moist and swollen with teethmarks C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce the Spleen and Kidneys
Herb Formulas	Fu Zi Li Zhong Wan + Wu Ling San Ji Sheng Shen Qi Wan
Points	Moxa or moxa needle REN-4, REN-12, SP-6, SP-9, ST-36, UB-20, UB-23 SP-6, SP-9, moxa or moxa needle REN-4, REN-6, REN-9, ST-36, UB-20, UB-21, UB-23 Moxa or moxa needle DU-4, REN-4, REN-6, ST-36 With severe Spleen Deficiency: + UB-20 With severe Kidney Deficiency: + UB-23 With diarrhea: + ST-25 With low back and knee weakness and pain: + KI-7, SP-4

SPLEEN AND KIDNEY YANG DEFICIENCY WITH WATER FLOODING

Clinical Manifestations	Body cold Limbs icy Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria Severe: Abdominal ascites T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce the Spleen and Kidneys
Herb Formulas	Zhen Wu Tang Shi Pi Yin
Points	Moxa or moxa needle REN-4, REN-12, SP-6, SP-9, ST-36, UB-20, UB-23

FOOD STAGNATION IN THE STOMACH WITH DAMP-HEAT OBSTRUCTING THE INTESTINES

Clinical Manifestations	Abdominal pain (worse with pressure) Abdominal and epigastric distention Dysentery Scanty dark urine Constipation T: Red C: Yellow and greasy or slippery P: Deep and forceful
Treatment Principle	Reduce and guide out Stagnation and Accumulation Clear Heat Dispel Dampness
Herb Formulas	Zhi Shi Dao Zhi Wan- Mu Xiang Bing Lang Wan
Points

STOMACH QI DEFICIENCY WITH INTERIOR COLD AND HEAT

Clinical Manifestations	Epigastric distention, fullness and hardness Dry heaves Nausea/Vomiting Irritability Borborygmus Diarrhea with undigested food Hysteria Fatigue Erosions of the throat Insomnia with difficulty falling asleep Frequent waking Talking in one's sleep Sleepwalking Dream disturbed sleep T: Pink C: Yellowish P: Wiry and rapid
Treatment Principle	Benefit Qi Harmonize the Stomach Relieve epigastric distention Disperse lumps and hardness Stop diarrhea
Herb Formulas	Gan Cao Xie Xin Tang
Points

DISHARMONY BETWEEN THE STOMACH AND INTESTINES

Clinical Manifestations	Epigastric focal distention Fullness and tightness with very slight or no pain Dry heaves Vomiting Borborygmus Diarrhea Anorexia Stomach pain Abdominal pain Subcardiac distention Heartburn Resistance below the Heart Soft epigastrium Nausea Ascites Gurgling sounds T: Normal or with a red tip C: Thin, yellow and greasy P: Wiry and rapid or Wiry, tight and rapid
Treatment Principle	Harmonize the Stomach Descend Rebellious Qi Disperse clumping Eliminate focal distention due to Cold and Heat factors
Herb Formulas	Ban Xia Xie Xin Tang
Points

LIVER QI STAGNATION INVADES THE SPLEEN

Clinical Manifestations	Abdominal distention and pain Vague hypochondriac pain Anorexia Gas Borborygmus Diarrhea Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Lassitude Women: Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: White and greasy P: Slippery and wiry
Treatment Principle	Nourish Liver Blood Soften the Liver Spread Liver Qi Strengthen the Spleen Resolve Dampness
Herb Formulas	Dang Gui Shao Yao San With Spleen Deficiency: Xiao Yao San modified
Points

LIVER QI STAGNATION INVADES THE STOMACH

Clinical Manifestations	Epigastric pain (worse when emotionally upset) Belching with acid regurgitation Nausea Vomiting Anorexia Epigastric distention Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Harmonize the Stomach
Herb Formulas	Chai Hu Shu Gan Tang Zuo Jin Wan Xiao Yao San Hei Xiao Yao San With Heat: Jia Wei Xiao Yao San With costal or abdominal pain and menstrual complaints: Si Ni San With Food Stagnation: Mu Xiang Shun Qi Wan
Points	LIV-3, LIV-14, PC-6, REN-12

LIVER QI STAGNATION WITH BVLOOD DEFICIENCY AND HEAT

Clinical Manifestations	Irritability Short temper Restlessness Fever or tidal fever Red eyes Dry mouth and throat Palpitations Lower abdominal pain Difficult urination Painful urination Increased menstrual flow Uterine bleeding Early menstruation Aching in limbs Dizziness Mental instability Red face Thirst Turbid urine Alternating chills and fever Red cheeks Wheezing Nervousness Headache Red eyes Dry mouth Anorexia Infertility Spontaneous sweating or night sweats with fever Anxiety Dry eyes Hypochondriac pain Somnolence Insomnia Aching shoulders Five Sole Heat Earache Premenstrual tension Hot flashes Fatigue Lassitude Depression Constipation with flushing up Pale complexion Bitter taste in mouth Vertigo Abdominal distention near the umbilicus Epistaxis Irregular menstruation Heaviness in the lower abdomen T: Red or Red edges C: Thin and yellow P: Thready, rapid and wiry or Wiry and tight and rapid
Treatment Principle	Nourish the Blood Soothe the Liver Clear Heat Disperse Stagnation
Herb Formulas	Ping Gan Liu Qi Yin
Points

LIVER QI AND BLOOD STAGNATION

Clinical Manifestations	Facial color dark and dull Emaciation Sides and ribs distended on both sides (maybe with sharp pain) Enlargement of the Liver and Spleen Suffocating sensation in chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Dark purple (maybe purple spots on edge of tongue) P: Wiry, choppy and slow
Treatment Principle	Activate Blood circulation Soften hardness
Herb Formulas	Ge Xia Zhu Yu Tang Shi Xiao San
Points	LIV-3, LIV-13, LIV-14, SP-6, UB-17

STAGNATION OF QI IN THE LIVER CHANNEL

Clinical Manifestations	A sensation of fullness, distention and pain in the chest which is improved with massage Cough Prefers warm drinks P: Wiry and large
Treatment Principle	Unblock Yang Expand the chest Dredge Stasis Transform clumps
Herb Formulas	Xuan Fu Hua Tang
Points

LIVER BLOOD STAGNATION

Clinical Manifestations	Hepatosplenomegaly A dark complexion Piercing pain, oppression and distention in the lateral costal area A feeling of hardness, conglomeration, accumulation or a lump on palpation of the abdomen Twinges or distress in the hypochondrium Abdominal distention Anorexia Distended and engorged vessels on the abdominal wall Scaly skin Spider naevi T: Static purple C: Thin and white P: Deep and wiry or Wiry and choppy
Treatment Principle	Invigorate the Blood Transform Stasis Soften hardness Unblock the channels
Herb Formulas	Chronic Hepatitis #3 Cirrhosis #2
Points

DAMP-HEAT IN THE LIVER AND GALLBLADDER

Clinical Manifestations	Yang jaundice (sclera and skin bright yellow) Pain and fullness in ribs on both sides Maybe pain in the right hypochondrium Bitter taste in mouth Nausea Vomiting sour and bitter fluids Anorexia Maybe alternating chills and fever Concentrated, dark urine Abdominal distention Women: Yellow vaginal discharge with foul smell Pruritis vulvae Men: Pain, swelling and burning sensations of testicles T: Pink C: Yellow and greasy or sticky P: Wiry and rapid or Slippery and rapid
Treatment Principle	Clear Dampness Purge Heat from Liver and Gall Bladder
Herb Formulas	Long Dan Xie Gan Tang With Dampness greater than Heat: Yin Chen Hao Tang
Points	DU-9, GB-34, LIV-3, REN-12, SP-9, ST-36, UB-19, UB-39 With nausea: + PC-6 With hypochondriac pain: + LIV-13, LIV-14, SJ-6 Dannangxue, DU-9, GB-24, GB-34, LIV-14, SI-4, SP-9, UB-18, UB-19, UB-48

LIVER YIN DEFICIENCY

Clinical Manifestations	Dizziness Blurred vision Impaired vision Dry eyes Night blindness Tinnitus Headache Nervousness Insomnia with much dreaming Dry throat Thirst Five sole Heat Night sweats Light menses or Late menses or Amenorrhea T: Red C: Little P: Thready, wiry and rapid
Treatment Principle	Nourish Yin Nourish the Liver
Herb Formulas	Yi Guan Jian
Points	KI-3, LIV-3, UB-18, UB-23

LIVER AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Facial complexion pale and sallow Both cheeks slightly red Dizziness Dry eyes Blurred vision Spots before the eyes Numbness of limbs Flaccid paralysis (Wei syndrome), weakness Tinnitus Deafness Forgetfulness Low back and knees sore and painful Throat dry and painful Five Sole Heat Low-grade fever Night sweats Irritability Insomnia Stools difficult to pass Constipation Men: Spermatorrhea Women: Irregular menses or Scanty menses or Amenorrhea Vaginal discharge T: Red C: None P: Thready and rapid
Treatment Principle	Nourish and Reinforce the Liver and Kidneys
Herb Formulas	Yi Guan Jian Yi Guan Jian + Xiao Yu Tang
Points	KI-3, LIV-3, SP-6, UB-18, UB-23

KIDNEY YANG DEFICIENCY WITH INTERNAL COLD

Clinical Manifestations	Severe breathlessness Rapid breathing Extremely cold extremities Aversion to Cold Sleeping with knees drawn up Lethargy with a constant desire to sleep Vomiting Abdominal pain and Cold Lack of thirst Coma Diarrhea Indigestion Edema Pale face Superficial fever Red face Cyanosis of the lips and nails T: Pale or Dark purple C: White and slippery P: Deep and thready or Deep and slow or Deep and faint
Treatment Principle	Rescue Yang Warm the Middle Jiao Disperse Internal Cold Stop diarrhea
Herb Formulas	Si Ni Jia Ren Shen Tang Si Ni Tang
Points

YANG DEFICIENCY WITH INTERNAL COLD-DAMP

Clinical Manifestations	Aching bones and joints Muscle ache Whole body pain Aversion to Cold, especially at the back Cold limbs Lower abdominal pain and Cold Abdomen feels chilled Maybe fever No thirst T: Normal C: White and slippery P: Deep and faint or Forceless or Choppy and slow or Wiry
Treatment Principle	Dispel Cold Warm the channels Assist Yang Dispel Dampness Relieve pain
Herb Formulas	Fu Zi Tang
Points

YIN DEFICIENCY WITH BLOOD STAGNATION

Clinical Manifestations	A dark, blackish, lusterless facial complexion Scaly, dry skin Five-Sole-Heat Tachycardia Very little sleep Insidious burning pain in the chest, flanks, epigastrium and abdomen T: Purplish red C: Peeled P: Thready and rapid
Treatment Principle	Nourish Yin Invigorate the Blood Soften hardness Dispel Stasis Unblock the channels
Herb Formulas	Cirrhosis #1 If the disease is located in the channels and collaterals: Si Miao Yong An Tang If the disease is located in the viscera and bowels: Da Bu Yin Wan + Tao Hong Si Wu Tang Yi Guan Jian + Xia Yu Xue Tang
Points

QI DEFICIENCY LEADING TO BLOOD STAGNATION

Clinical Manifestations	Insidious, lingering pain in the chest, flank, epigastric and abdominal areas Pain worse with exertion Shortness of breath Weakness Possible hemiplegia T: Purplish pale C:Thin and white P: Forceless and choppy
Treatment Principle	Tonify Qi Transform Stasis
Herb Formulas	Qi Xu Xue Yu Tang Bu Yang Huan Wu Tang Yi Xin Tang
Points

QI, BLOOD AND PHLEGM STAGNATION

Clinical Manifestations	Immobile masses below the hypochondrium or in the abdomen Abdominal pain Emaciation Poor appetite Alternating chills and fever Amenorrhea Hard abdominal masses that produce pain Aggravated by pressure Hypochondriac distention T: Purple with echymoses P: Choppy
Treatment Principle	Invigorate the Blood Remove Stasis Circulate Qi Resolve Phlegm Eliminate accumulations Soften and resolve hard masses
Herb Formulas	Bie Jia Jian Wan
Points

QI AND DAMP STAGNATION

Clinical Manifestations	Ascites Anorexia Fullness, distention and pain in the hypochondrium Epigastric and abdominal distention which is worse after eating Belching Flatulence Irritability Scanty urine Sluggish stools T: Pink C: Greasy and white P: Wiry
Treatment Principle	Soothe the Liver Regulate Qi Drain Dampness Reduce Fluid Accumulation
Herb Formulas	Chai Hu Shu Gan Tang + Ping Wei San modified Chinese Patent Medicines: Ma Xing Shun Qi Wan Wu Ling San Wu Pi Wan
Points	GB-34, LIV-3, LIV-13, LIV-14, PC-6, REN-6, REN-9, ST-36

QI BLOOD AND YIN DEFICIENCY

Clinical Manifestations	Palpitations Fatigue Anxiety Irritability Insomnia Emaciation Shortness of breath Constipation Dry mouth and throat Numbness Dry cough Cough with little or no sputum Cough with blood streaked sputum Spontaneous perspiration Night sweats Five sole Heat due to stress Early menses Restlessness Dry tongue Pale copious menstrual flow Weakness Memory loss Excess dreams Fright Tired body Dry, hard stool Coarse skin Dry throat A skinny appearance T: Pale and shiny or Red C: Thin and white or None P: Knotted or Intermittent or Minute, forceless and Deficient or Thready and rapid
Treatment Principle	Augment Qi Nourish Blood Enrich Yin Restore the Pulse
Herb Formulas	Zhi Gan Cao Tang
Points

BLOOD STAGNATION

Clinical Manifestations	Sharp, stabbing costal and hypochondria pain which is worse at night Abdomen hurts with movement Hypochondriac lumps A dark, stagnant facial complexion Dark, purplish lips, head chest and neck region with spots and red threads Maybe spider naevi and/or palmar erythema T: Purple or Purple edges or Static macules or Spots C: White P: Choppy or Wiry (with pain) or Wiry and choppy
Treatment Principle	Activate the Blood Transform Stasis Unblock the Channels Disperse Accumulation
Herb Formulas	Ge Xia Zhu Yu Tang modified Da Huang Zhe Chong Wan Xue Fu Zhu Yu Tang modified Hua Yu Tang For Qi and Blood Deficiency: Ba Zhen Tang + Hua Ji Wan modified For severe distention with scanty urination: Zhou Che Wan Shi Zao Tang With Heat: Da Huang Huang Qin Xie Xin Tang With Deficiency Cold: Huang Tu Tang Chinese patent medicines: Mu Xiang Shen Qi Wan Chen Xiang Hua Qi Wan Fu Zi Li Zhong Wan
Points	Special points .75 cun from the DU channel at the level of T-10, T-11 and T-12, UB-18, UB-19, UB-20, LIV-3, LI-4, SP-10, LI-11 Moxa or moxa needle DU-9, REN-12, SP-6, SP-9, ST-36, UB-19, UB-20 LIV-2, Pigen, REN-3, SP-10, UB-20, UB-21, moxa or moxa needle LIV-13, LIV-14 For hematemesis: Ahshi points, PC-4, PC-6, REN-12, SP-4, SP-10, ST-21, UB-17, UB-21 With severe pain: LI-4, LIV-5 With irritability or depression: + LIV-1, Yintang or LIV-3 Ear: Stomach, Duodenum, Large Intestine, Small Intestine, Liver, Adrenal, +, Shenmen

BLOOD STAGNATION WITH BLOOD DEFICIENCY

Clinical Manifestations	Emaciation Abdominal fullness Anorexia Rough, dry and scaly skin May be localized abdominal pain and tenderness Amenorrhea A dull, dark appearance of the eyes Tidal fever May be dry stools T: Petechiae or Purplish or Reddish P: Wiry and choppy or Wiry, small and smooth
Treatment Principle	Invigorate the Blood Strongly break up Stasis Generate new Blood
Herb Formulas	Da Huang Zhe Chong Wan
Points

DAMPNESS CAUSING BLOOD STAGNATION

Clinical Manifestations	Bilateral, insidious pain in the lateral costal region, made worse with pressure Epigastric and abdominal distention and oppression Poor appetite Loose stools Short, scanty urination T: Pale purple C: Greasy P: Wiry and choppy
Treatment Principle	Strengthen the Spleen Dispel Dampness Invigorate the Blood Transform Stasis
Herb Formulas	Chronic Hepatitis #1
Points

COLD ACCUMULATION DUE TO COLD FOOD STAGNATED IN THE STOMACH AND INTESTINES

Clinical Manifestations	Sudden epigastric and abdominal pain and distention The pain is so intense that it feels like an awl is piercing the abdomen Rough, uneven breathing Stabbing pain in the chest Lockjaw A cyanotic complexion Asthma Dyspnea Oliguria A pale face No bowel movements Rapid breathing Constipation Cold limbs Possible loss of consciousness (severe cases) T: Bluish-purple C: White or White and slippery P: Deep and tight or Deep and slow
Treatment Principle	Harshly Purge Cold Accumulation Alleviate pain
Herb Formulas	San Wu Bei Ji Wan
Points

COLD-DAMP

Clinical Manifestations	Ascites Heaviness in the body and head Aversion to Cold Warming the abdomen makes it better Edema of the extremities (usually not pitting) Scanty urination Loose stools or Diarrhea T: Normal C: Greasy and white P: Soft and moderate or Wiry and slow
Treatment Principle	Transform Dampness Drain Fluids Warm Yang Disperse Cold
Herb Formulas	Shi Pi Yin modified Chinese Patent Medicines: Fu Zi Li Zhong Wan
Points	Moxa or moxa needle REN-9, SP-6, SP-9, UB-20, UB-22, UB-23, UB-39

DAMP-HEAT WITH BLOOD STAGNATION

Clinical Manifestations	Burning Heat, aching and pain in the lateral costal area Chest and epigastric bitterness and fullness Enlarged, distended abdomen Vexatious heat Thirst with no desire to drink Red, astringent urination Constipation or Loose stools like rotten soy sauce T: Purple-red C: Grayish yellow P: Wiry and rapid
Treatment Principle	Clear Heat Disperse Dampness Cool and invigorate the Blood
Herb Formulas	Chronic Hepatitis #2
Points

TAN YIN

Clinical Manifestations	Anorexia Edema Abdominal distention Chest and hypochondriac distention Dizziness Nausea Vomiting Vertigo Thirst with no desire to drink Maybe no thirst Palpitations Shortness of Breath T: Normal C: Thick and slippery P: Slippery, full and maybe wiry
Treatment Principle	Warm and Dissolve Tan Yin
Herb Formulas	Wu Ling San With jaundice and dysuria: Yin Chen Wu Ling San
Points	PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23

XUAN YIN

Clinical Manifestations	Cough with sharp pain in the chest and hypochondrium Hypochondriac distention and pain Hard focal distention in the epigastrium Dry heaves Shortness of breath Headache Abdominal distention Wheezing Fullness in the chest Dyspnea caused by extreme chest and back pain Dizziness Vertigo Asthma Rapid breathing Generalized edema which is worse in the lower body Difficult urination and defecation T: Normal or Dark C: Thick, greasy and white P: Deep and wiry
Treatment Principle	Attack and Dispel water
Herb Formulas	Shi Zao Tang
Points	KI-3, LI-4, LI-11, PC-6, REN-11, REN-12, ST-36, UB-13, UB-20, UB-23

BLOOD STAGNATION IN THE LOWER JIAO

Clinical Manifestations	Palpable masses that may or may not be painful Lower abdominal pain without palpable masses Lower abdominal distention Lower back pain Lower abdominal distention during menstruation Frequent menstruation (3-5 timer per month) Spotting Dark purple menstrual Blood (usually with clots) Abnormal uterine bleeding with abdominal soreness and pain Aversion to Cold Depression Cold extremities White vaginal discharge T: Pale C: White P: Choppy
Treatment Principle	Invigorate the Blood Promote the movement of Qi Dispel Blood Stasis Alleviate pain
Herb Formulas	Shao Fu Zhu Yu Tang
Points

YANG EDEMA

Clinical Manifestations	Generalized edema Wheezing Dyspnea Restlessness Anuria Irritability Thirst Constipation Urinary obstruction
Treatment Principle	Drain downward Drive out water Expel Wind Release the Exterior
Herb Formulas	Shu Zao Yin Zi
Points

ALCOHOL INDUCED (DAMPNESS AND HEAT)

Clinical Manifestations	Alternating chills and fever Thirst A bitter taste in the mouth Anorexia Edema Vomiting and diarrhea with water intake Dysuria Fullness and oppression in the chest and hypochondrium Diarrhea T: Pink C: White P: Superficial and wiry
Treatment Principle	Harmonizes the Exterior and the Interior Relieves the Shao Yang Dispels Water Accumulation Resolves Phlegm Accumulation
Herb Formulas	Chai Ling Tang Zhong Man Fen Xiao Wan modified With very scanty urine or anuria, severe ascites and distention: Zhou Che Wan In severe cases with bleeding: Xi Jiao San modified
Points	GB-34, GB-40, LI-11, LIV-3, LIV-13, LIV-14, Pigen, UB-18, UB-19, UB-20, UB-21, UB-40 With impaired consciousness: + DU-26, Shixuan

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