AC501: Special
Topics in
Acupuncture
Spring 2020
Week 1

Agenda for today
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Personal introduction
Learning objectives
Syllabus
Introduction to the course
Urinary Syndrome
Q&A

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Online
Learning
Addendum

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This is new for all of us
Lectures are being recorded
Your presence and attention is
being monitored
Quizzes and exams through
Populi

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Yaron Cohen
MATCM, L.Ac., Dipl.OM.
ycohen18@vuim.edu

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Learning Objectives and
Syllabus

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Learning
Objectives
Develop necessary critical
thinking and analytic skills

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Demonstrate understanding of
and articulate basic theory,
principles and techniques of
TCM
Demonstrate knowledge of how
to treat and prevent common
internal disease with TCM
Communicate the etiology,
pathology, and treatment of
diseases subject to this course

6

Syllabus
1.
2.

Urinary Syndrome
Enuresis/Incontinence/Urinary
Retention/Interstitial Cystitis
a.

3.
4.
5.

Quiz

BPH/Prostatitis/Prostatodynia
Edema
a.

6.
7.

a.

8.
9.

Quiz

Lower Backache/Sciatica
a.

Mid-Term Exam

Painful Obstruction Syndrome
Fibromyalgia/Chronic Fatigue/
Erectile Dysfunction
Parkinson’s Disease/Stroke
Atrophy Syndrome/Multiple
Sclerosis
a.

10.

Quiz

Quiz

Final Exam

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Format of the class

This is how we do it

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Lecture
4 Quizzes
2 Exams
Quiz review
Case studies
Q&A

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Introduction to this course

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Introduction
1.

Definition of Symptom, Syndrome & Disease in TCM Internal
Medicine
a.
b.
c.

2.

Symptom - 4 diagnostic methods
Syndrome - Pattern differentiation. The essence of TCM
Disease - Western medical diagnosis. “Headline”

Etiology & Pathology
a.

Etiology
i. 6 Exogenous (Climactic) Factors: Heat, Cold, Fire, Wind, Dampness, Dryness
ii. 7 Endogenous (Emotional) Factors: Joy, Anger, Worry, Sadness, Fear, Grief,
Fright
iii. Diet (Post-Heaven Qi)
iv. Work & Rest (Lifestyle Balance)
v. Phlegm retention & Blood stasis
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b.

Pathology
i. Basic Pathogenesis
1. Excess & Deficiency of Evil & Vital Qi
2. Imbalance of Yin & Yang
3. Abnormal movement of Qi
a. Ascending & Descending
b. Entering & Exiting
ii. Qi & Blood Pathogenesis
1. Qi: Qi-deficiency, Qi-collapse, Qi-stagnation, Qi-reversed flow
2. Blood: Bleeding, Blood-stasis, Blood-deficiency
iii. Internal Wind, Cold, Dryness & Fire
1. Internal Wind - Liver-Yang transforms into Liver-Wind, Fire courses
Wind, Yin/Blood Deficiency leading to Wind
2. Internal Cold - Excess Internal Yin-Cold, Spleen & Kidney Yang
Deficiency Cold
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1.

iv.

v.

Internal Dryness - Lung & Stomach Fluid Deficiency, Liver & Kidney Yin
Deficiency
2. Internal Fire - Excess Fire (Heart, Liver), Deficiency Fire (Kidney, Lung)
Dampness, Phlegm & Fluid retention
1. Dampness - Cold Damp disturbing Spleen, Damp Heat in Middle Jiao,
Damp retention due to Spleen Deficiency
2. Phlegm - Phlegm blocking the Lungs, Turbid-Phlegm blocking the
Heart-orifice, Phlegm accumulation in Spleen & Stomach, Phlegm
stagnation in meridians & joints
3. Fluid retention - physiological fluids
Zang-Fu Pathogenesis

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3.

Principles of Treatment
a.
b.
c.
d.
e.

4.

Routine Treatment method
Treatment contrary to routine method, ie tonify for bloating, astringing diarrhea
Branch and root, insidious and acute
Strengthen the body resistance to eliminate pathogenic factor
Tonify and eliminate according to Zang-Fu organs

Procedure of differentiation & treatment
a.
b.
c.
d.
e.
f.
g.

Four diagnostic methods
Differentiating the nature of disease
Differentiating the location of disease
Identification of etiology according to differentiation of signs & symptoms
Selecting therapy
Choose the formula
Modification

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Urinary Syndrome
Lin Zheng

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Definition: Lin Syndrome
Urinary Syndrome, called Lin Zheng in TCM, is a condition of
urinary dysfunction characterized by:
Frequency, scanty or excessive, painful, difficult, urgent,
burning and/or incomplete urination.
Associated with hypogastric or lower back cramps. The pain
may also radiate down to the legs.
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Western Medical Diseases
❖ Urinary tract infections - cystitis, urethritis, prostatitis,
pyelonephritis, renal tuberculosis, etc.
❖ Urinary tract obstructions:
➢
➢
➢

Urinary calculus (kidney stone, bladder stone, ureter stone, etc.)
Urinary tumor (tumor of renal pelvis, bladder cancer, etc.)
Tumor of prostate

❖ Chylous urine - cloudy (fat, lymph)

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Organ Involvement: Lin Syndrome
1. Urinary Bladder - Stores/excretes urine. Qi transformation
2. Spleen - transform/transport fluid. Formation of Dampness
3. Kidneys - Yin/Yang regulate amount of urine excreted. Qi controls
lower orifice
4. Lungs - Qi provides strength for urination, propulsion of Qi
5. Liver - Regulate the smooth flow of Qi
6. San Jiao - Regulate water passages
7. Small Intestine - Separate clear from turbid. Transfers Heart Fire

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Etiology
1.
2.
3.
4.
5.
6.
7.
8.

External Dampness - Damp accumulation
Poor Diet - Damp and/or Heat accumulation
Emotional Stress - Liver Qi Stagnation
Excessive lifting or standing - Qi Stagnation
Poor hygiene or sexual contact - Damp and/or Heat accumulation
Excessive sexual activity - Kidney Deficiency
Constitutional Deficiency, chronic illness, old age - Kidney Deficiency
Overthink / overwork - Heart Yin Deficiency

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Pathology
1. Dampness and Damp Heat
a. Difficult urination, pain, cloudy urination
2. Qi Stagnation
a. Hypogastric distention, pain before micturition
3. Qi Deficiency
a. Frequency, slight incontinence
4. Kidney Deficiency
a. Frequency, slight incontinence
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Diagnostic Differentiation
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Color
â—‹
â—‹
â—‹
â—‹

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Dark, concentrated: Heat, Damp Heat, Yin Deficiency
Pale: Kidney Yang Deficiency, Spleen Qi Deficiency, Qi Stagnation
Cloudy, turbid: Dampness, Damp Heat
Pale pink to bright red or purple: bleeding due to Fire, Damp Heat, Blood stasis,
Kidney Yin Deficiency or stones

Pain
â—‹
â—‹
â—‹

Burning: Severe - Heat, Damp Heat. Mild - Yin Deficiency
Stabbing or localised: Blood stasis, Stones
Mild or dragging, empty discomfort following urination: Qi Deficiency

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Diagnostic Differentiation
●

Frequency
â—‹ Frequent, urgent, concentrated: Heat, Damp Heat
○ Frequent, pale: Kidney Yang or Qi Deficiency
○ Frequent, pale with weak or broken stream: Kidney Yang Deficiency

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Timing of the pain
â—‹ During urination: excess condition
â—‹ Before urination: Qi Stagnation
○ After urination: deficient condition
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6 Lin Patterns
All Lin: difficulty and pain, dribbling, frequency, sacral/hypogastric ache.
1.
2.
3.
4.
5.
6.

Heat Lin: painful, burning, urgent urination. Excess or Deficient
Stone Lin: stones or sand in urine. Excess only
Qi Lin: hypogastric bloating & distention, incomplete urination. Excess or
Deficient
Blood Lin: blood in urine. Excess or Deficient
Gao Lin: cloudy or turbid urine. Excess or Deficient
Lao Lin: sxn induced by exertion, chronic, exhaustion. Deficient only

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Heat Lin
Symptoms: Frequent, scanty, burning & difficult
urination. Dark-yellow urine with strong foul
odor. Lower back and/or hypogastric pain,
aversion to pressure. Bitter taste, thirst,
constipation. Fever & chills.

●

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Tongue: yellow greasy coat at root, possible red
spots.
Pulse: slippery, rapid
Treatment principle: Clear Heat, Drain
Dampness, Open water passages.

Acupuncture: Ren3, UB28, UB22, ST28,
SP9, UB66, UB63, LI11.
â—‹ Liver Fire: LV2, SP6
â—‹ Heart Fire: HT8, SI2
â—‹ Exterior: LI4, LU7, SJ5
Formulas:
â—‹ Ba Zheng San - Classic
â—‹ Long Dan Xie Gan San - Liver Fire
â—‹ Huang Lian Jie Du Tang - Toxic Heat
â—‹ Dao Chi San - Heart Fire
â—‹ Zhu Ling Tang - Damp>Heat
â—‹ Wu Lin San - Blood stasis

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Stone Lin
Symptoms: Stone/sand in urine. Severe stabbing
painful, difficult urination that may stop suddenly.
Lower back / hypogastric pain, cramps that may
radiate down leg. Blood in urine.

●

Acupuncture: UB22, ST28, SP9, Ren6,
Ren3, UB28, UB63, UB39, K2

Tongue: Red with yellow coat

●

Formulas:
â—‹ Shi Wei San - Damp Heat
â—‹ San Jin Pai Shi Tang - Dampness,
stones
â—‹ Niao Lu Pai Shi Tang - Moves Qi
â—‹ Zhi Shi Lin Fang - Tonify Kidney
Yang

Pulse: wiry, rapid
Treatment principle: Clear Heat, Drain
Dampness, Open the Water passages, Expel
stone.

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Qi Lin
Symptoms: Excess - Difficult, painful, incomplete
urination. Hypogastric pain and distention.
Irritability. Deficiency - Difficult urination, weak
stream. Slight hypogastric distention, fatigue.

●

Acupuncture: Ren3, Ren5, UB28,
LV3, LV5, LV8, UB64, SP6, ST36,
Ren6, Du20, LU7, K6, SI3

●

Formulas:
â—‹ Chen Xiang San - Excess
○ Bu Zhong Yi Qi Tang Deficiency

Tongue: Excess - no change or sl red. Deficiency Pale
Pulse: Excess - deep, wiry. Deficiency - weak,
thready
Treatment principle: Excess - Smooth Qi, Eliminate
stagnation, open Water passages. Deficiency - Tonify
& raise Qi, open Water passage

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Blood Lin
Symptoms: Excess - painful, urgent, burning
urination. Blood in urine or small clots. Hypogastric
fullness and pain. Irritability. Deficiency - Pale blood
in urine, sl discomfort on urination. Soreness &
weakness of lower back & knees. Fatigue. 5 heart
heat at night.
Tongue: Red. Less coat with deficiency
Pulse: Rapid. Thready with deficiency
Treatment principle: Excess - Clear Heat, Cool Blood,
Stop Bleeding, Open Water passages. Deficiency Clear Empty Heat, Cool Blood, Nourish Yin, Stop
Bleeding, Open Water passages

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Acupuncture: LV3, KD2, Ren3,
UB28, UB63, SP10, UB17, SP6,
Ren4, K6

●

Formulas:
â—‹ Xiao Ji Yin Zi - Excess
○ Zhi Bai Ba Wei Wan Deficiency

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Gao Lin
Symptoms: Excess - Turbid or cloudy urine like rice soup.
Painful, burning, urgent urination. Deficiency - Cloudy or
turbid urine. Sl difficulty. Fatigue, dizziness, sore lower
back & knees.
Tongue: Excess - red, yellow greasy coat. Deficiency pale, sticky greasy coat
Pulse: Excess - slippery, rapid. Deficiency - soft, thin,
weak
Treatment principle: Excess - Drain Dampness, Clear
Heat, Separate clear from turbid, Open the Water
passages. Deficiency - Tonify Qi, Strengthen Kidneys,
Separate clear from turbid, Drain Dampness, Open the
Water passages.

●
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Acupuncture: Ren3, UB22, UB28, UB23,
K7, Ren6, Ren9, ST28, SP9, SP6.
Formulas:
â—‹ Excess
â–  Cheng Shi Bi Xie Yin - Damp
Heat
â–  Bi Xie Fen Qing Yin - Cold
Damp
○ Deficiency
â–  Gao Lin Tang - Qi Xu w/
Dampness
â–  Bu Zhong Yi Qi Tang + Qi Wei
Du Qi Tang - Qi Sinking with Yin
Xu
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Lao Lin
Symptoms: Sl difficult urination, no burning,
frequency, dribbling urination. Dragging feeling in
hypogastrium, exhaustion, depression, feeling
cold. Weakness of lower back & knees. Induced
by exertion & overwork
Tongue: pale
Pulse: weak
Treatment principle: Tonify and Raise Qi,
Strengthen Kidneys, Open the Water passages

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●

Acupuncture: UB23, Ren4, UB28, Du20,
ST36, SP6, SP9, Ren6, K3, Du4
Formulas:
â—‹ Wu Bi Shan Yao Wan - Kidney Yang
Xu Dampness
â—‹ Bu Zhong Yi Qi Tang - Spleen Qi Xu
Sinking
â—‹ Zhi Bai Di Huang Wan - Kidney Yin
Xu Heat
â—‹ You Gui Wan - pronounced Kidney
Yang Xu
â—‹ Qing Xin Lian Zi Yin - Heart Qi Xu

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Remarks
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Acupuncture and herbs are quite effective at treating most Lin syndromes
Stone tends to be more complicated
Prevention includes avoiding those triggers which exacerbate the root cause
â—‹

â—‹

Deficient
â–  Avoiding overindulgence in sex (men)
â–  Avoiding overwork and lifting heavy objects
â–  Avoid standing too long
Excess
â–  Avoid sex with a full bladder
â–  Avoid hot spicy food, alcohol
â–  Avoid overindulgence in sex (women)
â–  Urinating after sex
â–  Maintaining personal hygiene
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Appendix:
Urinary Calculi
Characterization

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Stones or sand precipitated by
Heat in Dampness
Characterized by deficiency of
Spleen and Kidneys, and Heat
Acute vs Chronic stages

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Etiology
●

Excessive Sexual activity
â—‹

●

Diet
â—‹
â—‹
â—‹
â—‹
â—‹

●

Consumption of stone forming foods or Damp forming foods
Calcium - cheese, milk
Oxalate - spinach, rhubarb
Uric acid - liver, kidney, fish roe, sardines
Phosphate - many foods

Lack of exercise
â—‹

●

Weakening Kidney Yin creating Heat that concentrates urine

Stagnation in Lower Jiao

Loss of fluids
â—‹

Concentrating urine
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Pathology
● Deficient Spleen and Kidney fail to transform leading to
accumulation of Dampness
● Heat evaporates fluids and condenses the Dampness
● Acute stage - colicky pain, stone moving
● Chronic stage - recurring stones, or stone not moving

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Treatment - Acute Stage
Symptoms: Intense colicky pain that comes in
waves located where the stone is. Restlessness,
sweating, shock. Burning urination, interrupted
flow, frequency, urgency, blood. Shivering, fever,
thirst, lumbago, lassitude.
Tongue: Thick yellow coat with red papules at the
root
Pulse: Rapid and Wiry in the Chi position
Treatment principle: Expel Stone, Stop Pain

Acupuncture: UB23, ST25, Ren6, SP9, LV3, K3.
●

Local Points:
â—‹
â—‹
â—‹
â—‹

●

Kidney: UB23, UB22, GB25, UB52
Upper ureter: ST25, SP15, UB23, UB24
Mid-lower ureter: ST27, ST28, ST29, UB26
Bladder: Ren3, Ren2, UB32, UB28

According to channel:
â—‹
â—‹
â—‹

Liver - LV3, LV8
Stomach - ST36
Kidney - K10, SP9, UB39

Formula: Shi Wei San - Clear Damp Heat, Open
water passages, Relieve urinary dysfunction

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Treatment - Chronic Stage Damp Heat
Symptoms: Burning urination,
difficult urination, dark urine
Tongue: Yellow greasy coat at the
root
Pulse: Rapid Slippery
Treatment principle: Clear Damp
Heat

●

Acupuncture: UB22, ST28, SP9,
ST26, Ren6

●

Formula
â—‹ Zhi Bo Ba Wei Wan
â– 

Nourish Kidney Yin, Resolve
Damp Heat

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Treatment - Chronic Stage Kidney Xu
Symptoms: Repeated attacks of colicky pain, dull
backache. Yin Xu - dark urine, prickly pain with
urination, insomnia, dry mouth, night sweats.
Yang Xu - chilliness, exhaustion, depression

●

Acupuncture: UB23, Ren6, Ren4,
SP6, K3. Moxa for Yang Xu

●

Formula

Tongue: Yin Xu - Red, coatless. Yang Xu - Pale
Pulse: Yin Xu - Floating, Empty. Yang Xu - Deep,
Weak

â—‹

Treatment principle: Tonify Kidney

â—‹

Zhi Bo Ba Wei Wan
â–  Nourish Kidney Yin, Resolve
Damp Heat
Jin Gui Shen Qi Wan and Wu Ling
San
â–  Tonify Kidney Yang, drain
Dampness
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Prognosis
● Prognosis primarily depends on multiple factors:
â—‹
â—‹
â—‹
â—‹

Location: the higher the stone the more difficult
Shape and size: the rounder the easier, the larger the more difficult
Time of tx: acupuncture works best when pain is present. Pain after
needling indicates the stone is being expelled
Body condition: the weaker the patient the more difficult

● Stay hydrated, stay active

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Acupoint Review

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UB / Water
Metabolism
Dysfunction
Point Review

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Ren3
UB28
ST28
UB22
UB63
SP9
Ren9
K7

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Heat Clearing
Point Review

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LI11
UB66
LV2
HT8
SI2

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52

Release
Exterior

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LI4
LU7
SJ5

Point Review

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56

Stone

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UB39
K2

Point Review

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Regulate Qi
Point Review

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Ren5
Ren6
LV3
LV5
LV8
SP6
Du20

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62

63

64

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66

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Regulate Blood

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SP10
UB17

Point Review

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Tonify
Deficiency
Point Review

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ST36
K3
Du4
Ren4
UB23
UB64
LU7/K6
SI3/UB62

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