Zang Fu Diagnosis

“…caused by Wind entering the Liver and the Qi of the channels rebelling upwards, this causes tics of the face and tremors of the limbs…. (Chan Zheng, The Principles of Medicine, 1565)

“Tremors may be caused by: deficient Qi unable to attract fluids & Blood towards the sinews & channels to nourish them, deficient fluids & Blood not nourishing the sinews, Phlegm-Fire obstructing the channels & sinews so that fluids & Blood cannot nourish them, deficient Yuan Qi facilitating the invasion of pathogenic factors in the channels so that Blood cannot nourish sinews & channels. Although there are many different causes, in all of them there is a deficiency of fluids & Blood not nourishing sinews & Channels…”
(The Original Theory of Medicine, Ming Dynasty)

MAIN CAUSES OF INTERNAL WIND

• LV Blood Xu
• LV Yin Xu
• LV Yang Rising
• LV Fire
• Extreme Heat

MAIN SX OF INTERNAL WIND

• Tremors
• Dyskinesia
• Seizures/Convulsions
• Facial Tic
• Numbness
• Tingling
• Paralysis

ZANG FU

• Liver: Always Involved
• Heart
• Stomach

MAIN ACUPUNCTURE PTS

• Tremor: GB20, LI11, GB34, LI4, SJ5, DU16, xtra; Xiao Chan Xue
• Lower Limb Pts: ST41, SP10, SP6, KD3, GB31, ST31, ST36, GB40, LV8, LV3
• Upper Limb Pts: LI10, LI11, SJ5, LI4, HT7, LU7
• Ear: Point Zero, Shen Men, Adrenal Gland, LV pt, ACTH pt, Striatum

Extra Pt: Xiao Chan Xue (Stopping Tremor Point) on the Heart channel, 1.5” below Ht 3

Chorea Line:
Thread down the chorea line located1cm ant. to mid point, 1.5cm ant. to motor line. Use Bilaterally or opposite side as affected limb.

Electro Acu: low frequency only, between 2 needles on the same side of head using Chorea line and GB20, DU16, DU20
Only Try if Comfortable With Electro Stim.

TCM DIFFERENTIAL DX

• Liver Blood Xu generating Wind
• Liver Fire generating Wind
• Phlegm Heat agitating Wind
• Liver Yang rising generating Wind
• Liver and Kidney Yin deficiency
• Blood Stasis

LV BLOOD XU GENERATING WIND

• Chronic one sided/one limbed tremor, decreased facial expressions, pale, inhibited speaking/swallowing, unbalanced, choppy &/or slowed movements, dizziness, vision degeneration, increased sweating, symptoms worse with too much activity/stress. Tongue: Pale, Thin and Quivering Pulse: Fine or Choppy

LV BLOOD XU GENERATING WIND

• Tx Principle: Nourish Blood, Invigorate Lou channels and Clear Wind
• Points: LV3, GB20, LI4, SJ5, DU19 SP6, ST36, LV8, KD3, UB17, RN4
• Formula: Ba Zhen Tang (8 Precious Decoction) to nourish blood with Tian Ma Gou Teng Yin (Gastrodia-Uncaria Decoction) to clear Wind

Liver Yang Rising Generating Wind:

Most commonly occurs in the elderly after many years of chronic LV yang rising. Usually begins with Liver Yin Xu, Liver & Kidney Yin Xu or Liver Blood Xu and ends with generating wind.

LV YANG RISING GENERATING WIND

• Resting Tremor, Facial tic, Dizziness, Tinnitus, Headache (vertex), HBP, Dry throat & eyes, Vision degeneration, Peripheral neuropathy: numbness or tingling of limbs, brain fog, intermittent memory problems Wiry and Fine Pulse

LV YANG RISING GENERATING WIND POINTS

• GB20, TB5, LV3, GB34, LI4, DU19
• SP6, LV8, KD3
• KD6, R4 + UB17

LV YANG RISING GENERATING WIND FORMULAS

• San Jia Fu Mai Tang: 3-Shell Decoction to Restore The Pulse
• E Jiao Zi Huang Tang: Ass-Hide Gelatin and Egg Yolk Decoction

LIVER FIRE GENERATING WIND

• Resting Tremor, Irritability, Easily Angered, Tinnitus and/or Hearing loss, Temporal HA, Dizziness, Red face and eyes, Thirst & dry mouth, Bitter taste, Dream disturbed sleep (sitting up kicking, screaming or punching), Chronic Constipation with dry stools, dark yellow urine, Epistaxis, hemoptysis

LIVER FIRE GENERATING WIND

• Tx Principle: Clear LV, drain Fire, extinguish Wind
• DU8: Relive Spasms & Tremors
• SP6: Nourish Wind
• LV1, 2 & 3, GB20, LI11, GB1: Clear LV Wind

LIVER FIRE GENERATING WIND FORMULA

• Ling Jiao Gou Teng Tang (antelope horn uncaria decoction) Originally for Jue Yin stage of febrile disease where heat in the Liver channel generates internal Wind
• Make sure patient does not have deficiency that would make this formula too strong.

Phlegm Heat Agitating Wind

Liver Fire Generating Wind

• Tongue: Red with redder sides and dry yellow coat
• Pulse: Wiry, Rapid

Phlegm Heat Agitating Wind: Points

• ST40, SP6, SP9, LV3: needle with even method
• RN12, UB20: tonfiy

Phlegm Heat Agitating Wind

• Resting tremors, obesity, staring look/mask face, dislike of exercise, chest oppression, dry mouth, sweating, dizziness, spits yellow phlegm, stiff neck and back
• Tongue: Red with sticky coat
• Pulse: wiry, fine, rapid

Phlegm Heat Agitating Wind: Herbs

• Dao Tan Tang: Tian Ma Gou Teng Yin + Er Chen Tang + Zhi Shi +Dan Nan Xing + Sheng Jiang
• Wen Dan Tang + Tian Ma & Gou Teng

Qi & Blood Stag (blood connecting channels)

• Resting tremors, agitation, insomnia (trouble staying asleep), Rigidity/cog wheel movement, staring look/mask face, numbness of the limbs (neuropathy), slurred speech, headache, darkened nails (often from neuropathy)
• Tongue: Purple
• Pulse: wiry, choppy, firm

Qi & blood stag (Blood Connecting Channel)

• Points: LV3, SP10, UB17, PC6 & SP4

Qi & blood stag (Blood Connecting Channel)

• Herbs: Modified Tong Qiao Huo Xue Tang (opening the orifices & invigorating the blood decoction)
• + Chai Hu 6, Tian Ma 6, Di Long 6, Wu Gong 6

LV & KD Yin Deficiency

• Weight loss, dizziness, tinnitus high pitch, insomnia, dream disturbed sleep, headache, night sweating, mental restlessness esp. at night, sore low back & knees, numb limbs/neuropathy, Curia of the head, Clenched jaws, Resting tremor w/ high amplitude, Cramping esp. calfs & toes, Difficulty & clumsiness of walking, Staring look/mask face, Poor memory
• Tongue: Thin, No coat, Quivering Pulse: Fine, Rapid, or Floating

LV & KD Yin Deficiency

• Tx Principle: Nourish Yin, Exstinguish Wind, Invigorate connecting channels
• Points: RN4, UB23, KD3, SP6, UB18, LV8, LV3, GB20

LV & KD Yin Deficiency

• Zuo Gui Wan
• + Gou Teng & Ling Yang Jiao: to eliminate wind
• + Dan Shen & Chi Shao Yao: to move blood, pattern more common in elderly so blood stasis is likely

LV & KD Yin Def: PD Empirical Prescription

• Sheng Di Huang: 12
• Shu Di Huang: 12
• Shou Wu: 9
• Xuan Shen: 6
• Gou Teng: 6
• Ba Ji Li: 6
• Ling Yang Jiao: 4.5
• Mu Li: 15
• Dan Shen: 4.5
• Chi Shao: 4.5
• Du Zhong: 6

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