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ANKYLOSING SPONDILITIS

GENERAL

Clinical Manifestations	Pelvic Syndrome affecting: Sacroiliac joints Pain in buttocks Occurs in A.M. Better with warmth Spinal Syndrome: (precedes deformation stage) Stiffness which progresses upward with night or morning pain Better after warming up Articular Syndrome: a. Peripheral arthritis mostly affecting lower limbs b. Arthritis affecting hips and shoulders Inflammation at insertion of the ligaments, tendons and bone capsules (enthesitis) a. most commonly affects heel, spinous process and great trochanter Extra-Articular complications: Iridocyclitis (inflammation of the iris and ciliary body) Anterior uveitis Cardiac condition characterized by: Aortic insufficiency Uremia from amyloidosis (wax-like starch) which may form in any organ near the end of a disease upper like fibrosis of the lungs Targets young men between ages 20-30 (hereditary predisposition) With Yuan Qi Problem: (Yuan Qi promotes proper function in: the pelvis, the Du Channel and the Yin Qiao and Yang Qiao vessels.) R rigidity and stiffness Morning pain Mostly hips, heels, shoulders and eyes Yang Deficiency (Yin type stagnation): Worse at night or in the morning Progressive stiffness- moves toward kyphosis Better with warmth, massage and movement Cold and Dampness: Triggering factors Must use prolonged moxa and deep massage (Tuina or Shiatsu)
Treatment Principle
Herb Formulas	For severe pain: Gan Cao Fu Zi Tang
Points	Pelvic: DU-4, REN-4, UB-23 moxa REN-8 With DU Channel involvement: DU-1, UB-11 With involvement of the Yin Qiao and Yang Qiao Channels: GB-29, KI-6, KI-8, UB-31, UB-59, UB-61, UB-62

WIND-COLD

Clinical Manifestations	Aversion to Cold Headache Nasal congestion Sacroiliac joints Pain in buttocks Occurs in A.M. Better with warmth Stiffness which progresses upward with night or morning pain Peripheral arthritis mostly affecting lower limbs Arthritis affecting hips and shoulders Inflammation at insertion of the ligaments, tendons and bone capsules Most commonly affects heel, spinous process and great trochanter T: Pale C: White P: Floating and tight
Treatment Principle	Scatter the Wind Warm Cold Regulate the throat
Herb Formulas	Ma Huang Tang With Dampness: Ma Huang Jia Zhu Tang
Points

WIND-DAMPNESS

Clinical Manifestations	Pelvic Syndrome affecting: Sacroiliac joints Pain in buttocks Occurs in A.M. Better with warmth Spinal Syndrome: (precedes deformation stage) Stiffness which progresses upward with night or morning pain Better after warming up Articular Syndrome: a. Peripheral arthritis mostly affecting lower limbs b. Arthritis affecting hips and shoulders Inflammation at insertion of the ligaments, tendons and bone capsules (enthesitis) a. most commonly affects heel, spinous process and great trochanter Extra-Articular complications: Iridocyclitis (inflammation of the iris and ciliary body) Anterior uveitis Cardiac condition characterized by: Aortic insufficiency Uremia from amyloidosis (wax-like starch) which may form in any organ near the end of a disease upper like fibrosis of the lungs Targets young men between ages 20-30 (hereditary predisposition) With Yuan Qi Problem: (Yuan Qi promotes proper function in: the pelvis, the Du Channel and the Yin Qiao and Yang Qiao vessels.) R rigidity and stiffness Morning pain Mostly hips, heels, shoulders and eyes Yang Deficiency (Yin type stagnation): Worse at night or in the morning Progressive stiffness- moves toward kyphosis Better with warmth, massage and movement Cold and Dampness: Triggering factors Must use prolonged moxa and deep massage (Tuina or Shiatsu)
Treatment Principle	Disperse Wind-Dampness Stop Bi pain Tonify the Kidneys Nourish Jing and Blood
Herb Formulas	Du Huo Ji Sheng Tang
Points	For pelvic problems: DU-4, REN-8, REN-4, UB-23, UB-31 (promotes pelvic Qi) For Du Channel problems (spine): DU-1, UB-11 For Yin Qiao and Yang Qiao Problems: needle confluent and Xi-cleft points UB-62 (Yang Qiao confluent), UB-59 (Xi-cleft Yang Qiao), KI-6 (confluent Yin Qiao), KI-8 (Xi-cleft Yin Qiao), UB-61 (Command barrier point of ankles), GB-29 (Command barrier point of hips)

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Chronic lumbago: low back feels cold, weak and aching The symptoms are improved by massage and rest Frequent recurrences The pain is aggravated by exertion, prolonged standing, sexual activity and fatigue Weak, sore legs and knees Knees feel cold and aching Feeling chilled Aversion to Cold Cold limbs General debility Pale face Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Lassitude Withdrawn, subdued behavior Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang
Herb Formulas	Jin Gui Shen Qi Wan (Ba Wei Di Huang Wan) You Gui Wan modified Chinese Patent Medicines: Shen Rong Hu Gu Wan Jia Kui Shen Qi Wan Ren Shen Lu Rong Wan Ge Jie Bu Shen Wan
Points	Moxa or moxa needle DU-4, Huatuojiaji when tender, KI-3, REN-4, REN-6, UB-23, UB-25, UB-52, UB-60 Moxa or moxa needle DU-4, KI-3, REN-4, UB-23 For chronic diarrhea, rectal prolapse and Vanquished Yang: + moxa DU-20, REN-8 For Kidney Yang Deficiency impotence: moxa or moxa needle DU-4, DU-20, KI-3, REN-4, UB-23 For Kidney Yang Deficiency (Cock Crow) Diarrhea: moxa or moxa needle DU-20, KI-3, REN-4, UB-23

KIDNEY YIN DEFICIENCY

Clinical Manifestations	Chronic lumbago: low back feels weak and aching The symptoms are improved by massage and rest Frequent recurrences The pain is aggravated by exertion, prolonged standing, sexual activity and fatigue Weak, sore legs and knees Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of low back Spermatorrhea or premature ejaculation Aching in bones Aching in leg and heel T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Reinforce the Kidneys
Herb Formulas	Liu Wei Di Huang Wan Zuo Gui Wan modified Chinese Patent Medicines: Jian Bu Hu Qian Wan Liu Wei Di Huang Wan Zhi Bai Di Huang Wan Da Bu Yin Wan
Points	DU-4, Huatuojiaji when tender, KI-3, REN-4, REN-6, UB-23, UB-25, UB-52, UB-60 KI-1, KI-3, KI-6, REN-4, SP-6, UB-23

YANG DEFICIENCY WITH INTERNAL COLD-DAMP

Clinical Manifestations	Lower abdominal pain and Cold Abdomen feels chilled Aching bones and joints Muscle ache Whole body pain Aversion to Cold, especially at the back Cold limbs No Thirst 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

DAMP-HEAT IN THE LOWER JIAO

Clinical Manifestations	Lower Jiao pain Constipation or Diarrhea Heaviness Headache Dull Spirit Abdominal distention Mental fuzziness T: Normal C: Yellowish white and greasy P: Soft or maybe Slippery and rapid
Treatment Principle	Clear Damp-Heat from the Lower Jiao
Herb Formulas	Er Miao San
Points	LI-11, SP-6, SP-9, ST-25, UB-25