GOUT

GENERAL

Clinical Manifestations	Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable. Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares. The signs and symptoms of gout: almost always occur suddenly, and often at night. They include: Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins. Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints. Inflammation and redness. The affected joint or joints become swollen, tender, warm and red. Limited range of motion. As gout progresses, you may not be able to move your joints normally.
Treatment Principle
Herb Formulas
Points	Moving pain: Split into two groups and alternate GB-31, GB-39, KI-3, SI-3, SJ-3, SJ-8, ST-36, bleed LI-11 Fixed pain: 1. Upper extremities: Humerus: LI-11, SJ-8, SJ-10, moxa or moxa needle UB-27 Forearm: HT-3, LI-10, LI-15, LU-5, SJ-5 Elbow: HT-3, LI-11 Spastic elbow: LU-5, contralateral GB-34 Cannot extend arm due to pain: PC-7, SI-10, SI-11, SJ-4 Cold pain in the arm: LI-11, LU-5, SI-14, UB-62 Red, swollen arm: LI-10, SJ-2, SJ-3 Spastic, extended elbow: LI-10, PC-3 Trauma of the wrist and arm: SJ-4, SJ-5 Sore, spastic fingers: SI-3, SJ-3, SJ-5 All fingers painful: LI-4, LU-6, SI-3, SJ-4, SJ-5 Stiff index finger: SI-11, SJ-10, UB-22 Pain in the middle and ring fingers: LI-11, LI-15, SJ-3, SJ-6 Thumb pain: UB-25 Numbness of the fingers: Baxie, LI-4, LI-11, LU-5, SJ-5 Numbness in the middle finger: GB-21, GB-39, LI-11, ST-36 Spastic hand: PC-7 Writer's cramp: HT-3, LI-4, LI-11, LU-9, PC-3, PC-5 Weak wrist:LU-9 Thumbs, hands and feet: LI-15 Shoulder and upper back: Bafeng, SI-10, SJ-3, SJ-5, tender point below UB-42 Stuck shoulder joint with pain: contralateral SI-9 2. Lower extremities: Knee joint pain: Heding, LIV-2, contralateral LI-11 Pain inside the knee: ST-35 Swollen, painful knee: LIV-2, moxa needle ST-36, contralateral LI-11 Medial aspect of the knee: moxa needle LIV-3, LIV-4 Cold knee: Xiyan, moxa or moxa needle UB-36 Lateral aspect of the knee: GB-34, KI-3 Cold tibia:LIV-3 Difficult leg extension: SJ-6 Legs weak and limp: moxa or moxa needle GB-39, ST-36, UB-11 Ankle pain: GB-40, KI-3, LIV-3, ST-41, UB-60, UB-62 Heel pain: KI-3, UB-57, UB-60 Red, swollen dorsum of the foot: GB-40, KI-6, UB-60 Cold feet: moxa or moxa needle GB-31, Shiqizhuixia, UB-23 Toe pain: KI-1 Toe numbness: Bafeng, SP-4, ST-41 Painful sole of the foot:UB-60 REN-4, SP-6, UB-19, UB-23, UB-24 + local points To tonify the Spleen and eliminate Damp-Heat: moxa or moxa needle KI-17, UB-20 To assist the Spleen's transformative and transportive functions: SP-17 To cause the Fluids to descend and become clear: LU-1 To tonify Yang: REN-6 To promote the circulation of Fluids in the joints: SP-21 To transform Phlegm: ST-40 To regulate the opening and closing functions of the Kidneys: KI-3, KI-6, UB-23 To alleviate an acute crisis of the big toe: LIV-3, ST-40, UB-40 For shoulder pain: also see Shoulder Pain For toe pain: also see Toe Pain For pain in the palms of the hands: also see Wrist and Hand Pain For heel pain: also see Heel Pain

TAI YANG ZHONG FENG WITH MUSCLE PAIN

Clinical Manifestations	Aversion to Wind Mild or severe chills Fever which may be persistent Uneasiness from fever Spontaneous perspiration Headache Muscle aches and pain Stiff neck and shoulders Nausea Nasal irritation Nasal obstruction Tendency to snore Itchy throat T: Normal C: Thin and white P: Superficial and slow or Moderate and maybe weak
Treatment Principle	Create sweat to relieve the Exterior and expel Wind Harmonize Ying and Wei to protect digestion and nourish Wei Qi
Herb Formulas	Gui Zhi Qu Shao Yao Jia Fu Zi Tang Xiao Xu Ming Tang
Points	Bitong, DU-16, GB-20, KI-7, LI-4, LI-20, LU-7, SJ-5, UB-12, UB-13, Yintang With stiff neck and shoulders: + GB-21 With Dampness: + SP-6, SP-9

WIND-COLD WITH INTERNAL INJURY DUE TO COLD

Clinical Manifestations	Fever and chills without sweat Headache Body aches Stiff neck and back Abdominal pain and Cold Diarrhea with borborygmus A sensation of fullness in the chest and abdomen May be Cold in the lower body with Heat in the upper body Aching at the waist Anhidrosis Loose stools Sciatica Nausea Abdominal distention Borborygmus An aversion to food Vomiting Women: Cold-type epigastric and abdominal pain Menstrual irregularity Dysmenorrhea T: Normal C: White and greasy P: Deep and wiry or Superficial and slow
Treatment Principle	Release the Exterior Warm the Interior Smooth the flow of Qi Transform Phlegm Invigorate the Blood Reduce Accumulations Regulate Qi and Blood
Herb Formulas	Wu Ji San
Points

WIND BI

Clinical Manifestations	Wandering joint pain, especially the wrists, elbows, knees and ankles Chills and fever Atrophy above and below the knees Limited movement Paralysis of knees One or both knees swollen, enlarged and painful Stiffness of knees Legs so weak and sore after dysentery that it is difficult to walk Generalized pain and numbness in the legs Hemiplegia Dizziness Neuralgia Paralysis, stiffness, swelling and pain of feet Atrophy of the leg muscles Chest oppression Lumbago Tinnitus T: Pink or Pale and swollen or Red C: Thin white or Greasy white P: Superficial and tense or tight or Deep and thin or Deep and weak or Deep, slow and weak
Treatment Principle	Dispel Wind Activate Qi and Blood Tonify Qi and Blood Eliminate Cold-Dampness Tonifies Yang Strengthens the muscles, tendons and bones
Herb Formulas	Da Fang Feng Tang
Points

WIND-DAMP BI

Clinical Manifestations	Joint pain, especially in the wrist, ankle, knee and elbow Muscle pain There may be numbness and heaviness in the limbs The pain is worse with Cold and better with warmth The pain is aggravated by Wind The pain aggravated by Dampness The pain is stabbing Muscle weakness Difficult movement Numbness of the muscles and skin Hemiplegia, especially of the upper limbs The pain alleviated by movement Slight muscle edema Heaviness of the joints Cold joints Aversion to Cold The pain worse at night Local inflammation Migratory pain Deviation of the eyes and mouth Spasm of the limbs T: Slightly purple or purple spots C: Thick and white P: Slippery or Slightly superficial or slightly rough or Slow and Soft or Wiry and tight or Floating and wiry
Treatment Principle	Remove Wind-Dampness Eliminate Painful Obstruction Circulate Qi and Blood Stop pain
Herb Formulas	Juan Bi Tang
Points

WIND DAMP BI WITH BLOOD DEFICIENCY AND STAGNATION

Clinical Manifestations	Painful joint flare ups at night Joints are red, hot, swollen and extremely painful =Damp-Heat caused by Excess Dampness in diet or yang Deficiency caused by over exertion, recurrent infections, trauma or surgeries Predominant location is in the Spleen channel at level of big toe (Damp-Heat or Phlegm-Heat) with frequent relapses at end of spring and fall “Tophi” (chalk stone deposits) form on joints =Phlegm-Cold (governed by the lungs) Uremic Arthropathies= Spleen dysfunction (governs the circulation of fluids in the joints) Uremic Nephropathies= Kidney dysfunction
Treatment Principle
Herb Formulas
Points	To tonify the Spleen: UB-20, KI-17 To aid transformation and transportation: SP-17 To descend fluids: LU-1 To tonify Yang: REN-6 To circulate Fluids: SP-21 To transform Phlegm: ST-40 To regulate the Kidneys: UB-23, KI-3 or KI-6 For an acute crisis: ST-40, UB-40, LIV-3 *Avoid all Damp-Heat generating foods

WIND-COLD-DAMP

Clinical Manifestations	Joint pain, especially in the wrist, ankle, knee and elbow Muscle pain There may be numbness and heaviness in the limbs The pain is worse with Cold and better with warmth The pain is aggravated by Wind The pain aggravated by Dampness The pain is stabbing Muscle weakness Difficult movement Numbness of the muscles and skin Hemiplegia, especially of the upper limbs The pain alleviated by movement Slight muscle edema Heaviness of the joints Cold joints Aversion to Cold The pain worse at night Local inflammation Migratory pain Deviation of the eyes and mouth Spasm of the limbs T: Slightly purple or purple spots C: Thick and white P: Slippery or Slightly superficial or slightly rough or Slow and Soft or Wiry and tight or Floating and wiry
Treatment Principle	Remove Wind-Dampness Disperse Cold Eliminate Painful Obstruction Circulate Qi and Blood Stop pain
Herb Formulas	Juan Bi Tang For pain in the palms of the hands and heel pain: Juan Bi Tang Er Hao modified Chinese Patent Medicines: Feng Shi Pian Jing Fang Bai Du Pian Tian Ma Fu Qu Feng Bu Pian
Points

WIND-COLD-DAMP BI WITH WIND PREDOMINANT

Clinical Manifestations	Migrating pain in the joints especially the : Shoulders Elbows Knees Wrists Fingers Upper back and neck Multiple joints Pain quality changes May move from soreness to numbness to aching Sensitivity varies Pain often appears abruptly, acutely or paroxysmal and then disappears Limited range of motion Chills and fever Aversion to Wind Symptoms are worse in windy weather Sore throat General body aches Maybe perspiration T: Pink C: Thin and white or Sticky and yellow P: Superficial and moderate
Treatment Principle	Eliminate Wind Warm Cold Expel Damp Clear the Channels
Herb Formulas	Qu Feng Tang Fang Feng Tang Recurrent with Heat: Gui Zhi Shao Yao Zhi Mu Tang
Points	To disperse Qi and relieve external symptoms: LI-4, UB-12, SJ-5, GB-31 GB-20 or GB-41, DU-1, LI-11, ST-36, UB-40 or UB-17, SI-12, DU-16, GB-20, UB-12, SJ-17, SP-10, GB-31 or DU-20, GB-20, GB-30 + General points

WIND-COLD-DAMP BI WITH DAMP PREDOMINANT

Clinical Manifestations	Numbness and heaviness of the extremities Soreness and fixed pain of joints Stiffness or numbness of the muscles or skin Pain worse on cloudy or rainy days Maybe peripheral or systemic edema Pain is alleviated by pressure and warmth Pain lingers and is recalcitrant to treatment Worse during cloudy or wet weather Limited movement Edema Maybe stifling sensation in chest Maybe anorexia or indigestion Maybe abdominal distention Maybe loose or semi-liquid stools T: Pink or Pale C: Greasy and white P: Slow, moderate and soft
Treatment Principle	Expel Damp Clear the channels
Herb Formulas	Qu Feng Tang Han Shi Bi Tang Recurrent with Heat: Gui Zhi Shao Yao Zhi Mu Tang
Points	To eliminate Dampness and ease sinews: 1. SJ-6, GB-34, SP-5, SP-6, SP-9, LI-10, ST-36, ST-40 2. UB-20, SP-9 When affected by weather changes: 1. SJ-5, UB-35, ST-36, SP-5 2. SP-5, ST-38, ST-36 3. LI-13, ST-32, UB-38, GB-30, GB-34, SJ-8, DU-1 Lower back pain: moxa DU-2 Legs: GB-29, GB-30, UB-40 + General points

WIND-COLD-DAMP-BI WITH COLD PREDOMINANT

Clinical Manifestations	Excruciating sharp, stabbing joint pain Pain alleviated by warmth and aggravated by Cold Pain with fixed location Few joints are involved The joints cannot be flexed or extended No local redness or Heat Painful area often feels cold to the touch Pain worse at night and better during the day Pain mostly affects low back and lower extremities Pain intense but short lived Pain changes over days or weeks Ankylosis (stiffness) of joint Aversion to Cold Maybe chills with a slight fever Anhidrosis Frequent nocturnal urination T: Pink or Pale C: Thin and white (thicker than for Wind-Bi) P: Superficial and tight or Wiry and tight - maybe slow
Treatment Principle	Warm the channels Activate Qi and Blood.
Herb Formulas	Qu Han Bi Tang For toe pain: Wu Fu Ma Xin Gui Jiang Tang Chinese Patent Medicines: For toe pain: Han Shi Bi Cheng Ji
Points	To warm and circulate channels and collaterals: LIV-3, moxa LI-4, ST-36, GB-34, GB-31, SJ-5, SJ-4, UB-23, REN-4 or Moxa UB-23, REN-4, GB-39 Arm pain: moxa needle GB-21, LI-8, LI-9, LI-10, LI-11, LI-13, LU-9

WIND-COLD-DAMP BI WITH BLOOD STASIS

Clinical Manifestations	Attacks of severe acute joint pain which is fixed in location, worse with Cold and better with warmth Aversion to Wind, Cold and Dampness Stiff and painful muscles and joints Limited movement Pain aggravated by Wind Sensitive to climatic changes Numbness of muscles Pain aggravated by Dampness Cold joints Possible deformation and hardening of the joint with restricted movement Maybe joint swelling without redness or Heat Pain worse at night Low back pain or soreness Lumbago Fatigue Heaviness of the body Heaviness of the muscles Preference for warmth Weak joints Palpitations Pale face Shortness of breath Preference for dry weather T: Pale or Purplish C: Thin, white and greasy P: Thready and weak or Thready and slippery or Deep, slippery and wiry or Soft, moderate and wiry
Treatment Principle	Dispel Wind-Cold-Damp Tonify Qi Warm the channels Strengthen the tendons Nourish and Invigorate the Blood Break up Blood Stasis Eliminate Damp Stop pain
Herb Formulas	San Bi Wan Jia Jian Ji Xue Fu Zi Nian Tong Tang With Qi, Blood and Yang Deficiency: Qing Hai Feng Teng Tang With Qi, Blood and Yin Deficiency: Du Huo Ji Sheng Tang modified
Points	LI-4, SP-6 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For metacarpal and finger impediment: + Baxie, SI-3 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, UB-60, UB-62 For metatarsal and toe impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

WIND-COLD-DAMP WITH LIVER AND KIDNEY DEFICIENCY

Clinical Manifestations	Painful joints Heavy and painful sensations at fixed locations in lower back and extremities with weakness and stiffness or hypertonicity and immobility Aversion to Cold Attraction to warmth Palpitations Pain in the midline and back during pregnancy Pain worse at night General coldness Sallow complexion Wandering pain Pale complexion Shortness of breath May be paresthesia and numbness Cold pain in the low back and knees Limited movement Soreness, weakness and numbness of the joints Tinnitus Muscle spasms Dizziness T: Pale C: Thin and white or White and moist P: Thin, weak and slow or Deep, thready and weak or slippery
Treatment Principle	Disperse Wind-Dampness Scatter Cold Stop Bi pain Tonify the Kidneys and Liver Tonify Qi Nourish the Blood
Herb Formulas	Du Huo Ji Sheng Tang
Points

WIND-COLD-DAMP BI WITH QI DEFICIENCY

Clinical Manifestations	High fever accompanied by severe chills and shivering Aversion to Cold Pain worse at night Difficult movement Local inflammation Migratory pain Soreness and pain of the extremities Nasal congestion with sonorous breathing Anhidrosis Pain and stiffness of the head and neck Focal distention and fullness of the chest and diaphragm A productive cough May have numbness and heaviness in the limbs Body aches Nasal obstruction Cough with sputum Stuffy nose Joint pain Pain worse with Cold and better with warmth Pain aggravated by Wind Pain aggravated by Dampness Pain is stabbing Muscle weakness Pain alleviated by movement Slight muscle edema Heaviness of the joints Cold joints Headache Dizziness T: Pale or Slightly purple or Purple spots C: White or thin, white, greasy P: Slippery or Slightly superficial or Superficial and soft or Slightly rough or Slow and Soft or Wiry and tight or Superficial and rapid that is forceless under pressure
Treatment Principle	Release the Exterior Augment Qi Remove Wind-Cold-Damp Eliminate Painful Obstruction Circulate Qi and Blood Stop pain
Herb Formulas	Ren Shen Bai Du San
Points	To warm and circulate channels and collaterals: LIV-3, moxa LI-4, ST-36, GB-34, GB-31, SJ-5, SJ-4, UB-23, REN-4 or Moxa UB-23, REN-4, GB-39

WIND-COLD-DAMP BI WITH QI AND BLOOD DEFICIENCY

Clinical Manifestations	A generalized sensation of heaviness Neck, shoulder, elbow and upper back stiffness Numbness of the extremities Difficulty moving Wandering joint pain, especially in the neck, shoulder, upper back and elbow Upper back spasms Immobility of the joints Wandering joint pain T: Normal C: White P: Moderate or Floating and slow or Slippery or Slow or Superficial and wiry or tight
Treatment Principle	Tonify Qi Nourish Blood Dispel Wind Eliminate Dampness
Herb Formulas	Juan Bi Tang #1
Points

WIND-COLD-DAMP BI WITH LIVER AND KIDNEY DEFICIENCY

Clinical Manifestations	A constant but not severe pain in one or more toes Pain worse when walking Rigidity of the toe in the morning Hyperosteogeny (excessive bone growth) Muscular atrophy Low back and knee pain and weakness Fatigue T: Pale C: thin and white P: Thready and weak
Treatment Principle	Replenish Qi and Blood Strengthen the Liver and Kidneys Dispel Wind, Cold and Damp Unblock the channels and collaterals
Herb Formulas	Du Huo Ji Sheng Tang Chinese Patent Medicines: Hai Ma Bu Shen Pian Du Huo Ji Sheng Wan Kang Gu Zheng Sheng Pian
Points	Bafeng, GB-34, GB-39, KI-3, LIV-3, SJ-6, ST-36 With swollen toes and feet: + SP-9 With swelling and possible deformity of the toes due to Qi and Blood Stagnation: + SP-10 With severe aversion to Cold and a cold sensation in the joints: + moxa the toes With restlessness and insomnia: + HT-3, PC-6

WIND-DAMP-HEAT

Clinical Manifestations	Generalized body aches and pains Irritability Heavy sensation in the shoulder and back Discomfort or a constricted sensation in the area of the chest and diaphragm Multiple sores, carbuncles furuncles or abscesses Redness Itching Persistent swelling Chest pain Fever Thirst Aching and painful extremities Aching and painful joints Eczema in the genital area Unbearable swelling and pain of the lower extremities Shoulder stiffness T: Normal C: Greasy and slightly yellow P: Wiry and rapid or Soft and moderate or Soft, superficial and slow or Slippery and rapid or Deep and tight
Treatment Principle	Resolve Dampness Clear Heat Disperse Wind Stop pain Activate the Blood Tonify Qi and Blood
Herb Formulas	Dang Gui Nian Tong Tang San Miao Wan Shi Re Bi Tang Xuan Bi Tang Sang Zhi Shi Gao Zhi Mu Tang Bai Hu Jia Gui Zhi Tang Gui Zhi Shao Yao Zhi Mu Tang
Points

WIND-DAMP-HEAT WITH BLOOD STASIS

Clinical Manifestations	Severe, acute joint aching and pain The pain is in a fixed location The pain is accompanied by redness, swelling and Heat Irritability Heavy sensation in the shoulder and back Discomfort or a constricted sensation in the area of the chest and diaphragm Multiple sores, carbuncles furuncles or abscesses Itching Persistent swelling Chest pain Fever Thirst Aching and painful extremities Aching and painful joints Eczema in the genital area Unbearable swelling and pain of the lower extremities Shoulder stiffness Constipation Reddish, yellow urine T: Red C: Greasy and yellow P: Slippery, wiry and rapid
Treatment Principle	Resolve Dampness Clear Heat Disperse Wind Stop pain Activate the Blood
Herb Formulas	Ren Dong Pu Gong Er Miao San Shang Zhong Xia Tang Yong Tong Feng Wan
Points	DU-14, LI-4, LI-11 For elbow impediment: + LI-10, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For metacarpal and finger impediment: + Baxie, SI-3 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, UB-60, UB-62 For metatarsal and toe impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

SPLEEN AND KIDNEY QI DEFICIENCY

Clinical Manifestations	Protracted, incessant cough Expectoration of copious, clear, watery or white Phlegm Short, weak, breathing Asthma Spontaneous sweating Weak voice Reluctance to speak A general air of sadness or melancholy A waxy, pale complexion Rounded or hunched shoulders Four limbs tired Anorexia General lassitude Distention and pain of the epigastrium and abdomen Loose stools Severe cases: Frightens easily T: Pale with a thin crack C: White or White and greasy P: Thready and weak or Floating and weak
Treatment Principle	Reinforce the Spleen Benefit the Lungs Descend Lung Qi Disperse accumulation
Herb Formulas	Wu Ji San Chinese Patent Medicines: Su Zi Jiang Qi Wan Jiu Fei Su He Wan
Points	LU-9, REN-17, SP-3, ST-36, UB-13, UB-20, UB-43 DU-12, DU-14, LU-5, LU-7, LU-9, PC-6, REN-6, ST-25, ST-36, UB-13, UB-20 Ear: Lung, Spleen, Stomach Intestines, Abdomen

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Continuous cramping pain in the abdomen Pain is not severe Pain is relieved by pressure Edema of the feet Urinary difficulty Slight edema (primarily of the lower limbs) Symptoms generally occur during pregnancy Pale face Fatigue Heaviness of head Lassitude Lower abdominal pain Dizziness Tinnitus Lumbago Edema Abdominal pain with edema during pregnancy due to Blood Deficiency and abnormal water circulation Oliguria	Palpitations Cold feet Extreme coldness of the hands and feet Vertigo Weakness and numbness of lower back and legs during pregnancy or postpartum Mal position of the fetus Dysmenorrhea Irregular menstruation Right upper quadrant pain Hepatomegaly Anemia Lack of energy Sore back Thirst with no desire to drink T: Pale or pink maybe petechiae on margin C: Thin or Greasy white P: Deep and weak or Soft, floating, small and slow or Wiry and small or Wiry and rough
Treatment Principle	Strengthen the Spleen and Kidneys Resolve Dampness
Herb Formulas	Dang Gui Shao Yao San
Points

LIVER YIN AND BLOOD DEFICIENCY WITH DEFICIENCY HEAT RISING AND PHLEGM-HEAT

Clinical Manifestations	Irritability Anxiety Palpitations Night sweats Dizziness Vertigo Dry throat and mouth no thirst Fidgeting Insomnia Insomnia due to stress Excessive dreams Lack of energy Weakness and fatigue Weak abdomen Restlessness Sleepiness Light-headedness Impatience T: Pale or Red and dry P: Wiry and rapid or Thready and rapid or Thready and weak or Thready and tight
Treatment Principle	Nourish Liver Blood Calm the Shen Clears Heat in Liver Eliminate irritability
Herb Formulas	Yi Gan San Jia Chen Pi Ban Xia
Points	DU-20, GB-20, GB-34, GB-43, KI-3, LIV-2, LIV-3, REN-4, SP-6, ST-36, UB-17, UB-18, UB-20, UB-23

LIVER AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Enduring joint pain Symptoms worsen after exertion Lack of joint flexibility 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 Strengthen and reinforce sinews and bones
Herb Formulas	Liu Wei Di Huang Wan modified
Points	KI-3, KI-7 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For metacarpal and finger impediment: + Baxie, SI-3 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, UB-60, UB-62 For metatarsal and toe impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

YANG DEFICIENCY WITH YIN EXCESS

Clinical Manifestations	Painful joint flare ups at night Joints are red, hot, swollen and extremely painful =Damp-Heat caused by Excess Dampness in diet or yang Deficiency caused by over exertion, recurrent infections, trauma or surgeries Predominant location is in the Spleen channel at level of big toe (Damp-Heat or Phlegm-Heat) with frequent relapses at end of spring and fall “Tophi” (chalk stone deposits) form on joints = Phlegm-Cold (governed by the lungs) Uremic Arthropathies = Spleen dysfunction (governs the circulation of fluids in the joints) Uremic Nephropathies = Kidney dysfunction
Treatment Principle
Herb Formulas
Points	To tonify the Spleen: UB-20, KI-17 To aid transformation and transportation: SP-17 To descend fluids: LU-1 To tonify Yang: REN-6 To circulate Fluids: SP-21 To transform Phlegm: ST-40 To regulate the Kidneys: UB-23, KI-3 or KI-6 For an acute crisis: ST-40, UB-40, LIV-3 *Avoid all Damp-Heat generating foods

YANG DEFICIENCY WITH LIVER QI STAGNATION

Clinical Manifestations	Palmar pain with a distending Cold sensation Pain worse with emotional upset or exposure to Cold Pain worse during menstruation Pale skin on the hand Fatigue Hypochondriac pain Poor appetite A dull feeling in the Stomach Irritability T: Pale C: White P: Deep and wiry
Treatment Principle	Regulate Liver Qi Warm the Liver channel Dispel Cold
Herb Formulas	Dang Gui Si Ni Tang
Points

QI AND BLOOD STAGNATION

Clinical Manifestations	Pain that is severe, fixed and stabbing or Pains that move around Distention Depression Irritability Pan is worse with pressure Dark complexion Fixed, palpable masses Bleeding with clots Purple lips Purple nails Dry skin Blue, dark or purplish discoloration of skin in small or large areas, Varicose and spider veins Cold hands and feet Tendency to hemorrhage dark blood or clots T: Purple, possible purple or red spots Red purple if there is Heat Blue purple if there is Cold C: White P: Choppy or Wiry and choppy Note: This pattern often accompanies and complicates other patterns.
Treatment Principle	Invigorate the Blood Break up Stagnation Unblock the channels Stop pain
Herb Formulas	Wu Ling Di Long Tang Fu Yuan Huo Xue Tang Without Qi Stagnation: Fu Yuan Huo Xue Tang Tao Hong Si Wu Tang modified Middle and restoration stages: Ba Xian Xiao Yao Tang Chinese Patent Medicines: Jin Gu Die Shang Wan Xiao Huo Luo Dan
Points	LI-4, SP-6 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For metacarpal and finger impediment: + Baxie, SI-3 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, UB-60, UB-62 For metatarsal and toe impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41 GB-40, GB-41, LIV-3, LIV-14, PC-6, SJ-6, SP-6, SP-10, ST-36, UB-17, UB-18, UB-40

QI AND BLOOD DEFICIENCY

Clinical Manifestations	Joint pain with a dull sensation Symptoms worse with fatigue and exertion and alleviated with rest A slight, diffused tenderness on the heel Lower back pain Fatigue Lassitude Loose stools Poor appetite Dizziness Pale face Weak voice Shortness of breath Reluctance to speak Sweating with little or no exertion Palpitations Insomnia Dry skin Dry hair Poor memory Paleness Scanty periods Nycturia T: Pale or Pale, thin and dry C: Thin and white P: Weak or Thin and choppy
Treatment Principle	Tonify Qi Nourish the Blood Nourish the muscles Alleviate pain
Herb Formulas	Ba Zhen Tang modified Chinese Patent Medicines: Shi Quan Da Bu Wan
Points

DEFICIENT QI, BLOOD AND KIDNEY JING BI WITH DAMP-HEAT

Clinical Manifestations	Weakness of the knees Soreness of the lower back Lumbago Atrophy of the leg muscles Lower back weakness Knee pain Difficulty walking Emaciation Impotence Poor memory Dizziness Night sweats Five-sole Heat Aggravation of the pain by Damp weather Pale complexion Profuse urination at night Tinnitus Hair loss Sensation of warmth Thirst Dry skin T: Red or Pale and flabby with teethmarks C: Little or Thin and white P: Thready and weak, especially in the Kidney positions
Treatment Principle	Tonify the Liver and Kidneys Strengthen the tendons and bones Eliminate Damp-Heat Tonify Kidney Jing Relieve rheumatic pain
Herb Formulas	Deficient Bi #3
Points	ST-25, Xiyan, Heding, SP-6, SP-9, GB-34, KI-3

DAMP-HEAT IN THE LOWER JIAO

Clinical Manifestations	Distension and pain before or during menses Burning abdominal pain which precedes or follows the menstrual flow with guarding Soreness and distention of the lower back Pressure makes the pain worse There may be constant lower abdominal pain that worsens with menstruation Hot sensations A feeling of Heat in the abdomen Aversion to Heat Yellow smelly vaginal discharge between periods Dark-red or purple thick Blood with clots Maybe heavy bleeding Maybe dark, scanty, concentrated urine May be a mild fever T: Red C: Yellow and greasy P: Wiry and rapid or slippery and rapid or soft and rapid
Treatment Principle	Resolve Dampness Clear Heat
Herb Formulas	Ba Zheng San Jia Wei Er Miao San Er Miao San modified Si Miao Wan Niao Lu Pai Shi Tang Er Hao San Jin Tang Bai Hu Jia Gui Zhi Tang modified With Yin Deficiency: Zhi Bai Di Huang Wan Chinese Patent Medicines: Qian Jin Zhi Dai Wan Yu Dai Wan Shi Lin Tong Pian
Points	General points + GB-34, KI-7, SP-9

TURBID DAMPNESS POURING DOWWARD WITH BLOOD STASIS

Clinical Manifestations	Severe, acute joint aching and pain The pain is fixed in location The pain is marked by pronounced swelling and distention of the affected joints
Treatment Principle	Eliminate Dampness Discharge turbidity Invigorate the Blood Transform Stasis
Herb Formulas	Er Ze Tang For Turbid Dampness Pouring Downward due to marked Spleen Qi Deficiency: Shen Ling Bai Zhu San modified
Points	SP-9, ST-36 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For metacarpal and finger impediment: + Baxie, LI-4, SI-3 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, UB-60, UB-62 For metatarsal and toe impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

TOXIC HEAT

Clinical Manifestations	Ulcerated sores that do not heal on a limb that is dark red Slightly swollen and warm to the touch There may me a rotten smell to the lesion Gangrene of the extremities, especially the fingers and toes with purulent abscess Extreme pain Local inflammation and swelling There may be copious discharge of pus from the ulcers A burning sensation Fever Thirst T: Red C: Normal P: Rapid
Treatment Principle	Clear Heat Resolve toxicity Nourish Yin Activate the Blood Alleviate pain
Herb Formulas	Si Miao Yong An Tang Wu Wei Xiao Du Yin Pu Ji Xiao Du Yin modified Chinese Patent Medicines: Feng Shi Xiao Tong Wan Niu Huang Jie Du Pian
Points

DAMP-HEAT AFFECTING THE CHANNELS

Clinical Manifestations	Heat and pain in the joints and muscles Severe limitation of movement Fever and shaking chills Lusterless yellow complexion Scanty, dark urine Pain worse on cloudy or rainy days Arthralgia involving one or several joints Local redness and Heat of the extremities Swelling with excruciating pain Pain better during the day and worse at night Numbness of the muscles Thirst Dryness of the mouth Irritability Muscular atrophy Restlessness Anorexia Desire for Cold drinks Loose stools Aversion to Heat Fullness of the chest Pain improved with Cold and worse with Heat Muscular swelling Muscle redness General heaviness T:Red, maybe flabby C: Yellow and greasy P: Slippery and rapid
Treatment Principle	Clear Heat Eliminate Dampness Invigorate the collaterals Stop pain
Herb Formulas	Jia Wei Xuan Bi Tang Si Miao Wan modified Chinese Patent Medicine: Si Miao Wan
Points

PHLEGM OBSTRUCTING THE CHANNELS

Clinical Manifestations	Enduring joint pain which is sometimes mild and sometimes stronger The joint pain does not heal Recurrent attacks of joint swelling Restricted movement Maybe dark, purple skin in the affected area Stiffness, hardening and deformation of the joints Tophi (painless uric acid crystals) under the skin, mainly on the face, ears and joints T: Dark or Purple with possible static spots C: White P: Thready and choppy and/or wiry
Treatment Principle	Transform Phlegm Dispel Stasis Unblock the channels Stop pain
Herb Formulas	Gout #1 If this pattern manifests mainly as tophi, and hyperuricemia without swelling, pain or joint deformation: Xiao Tan Tang Jia Jian
Points	REN-12, ST-36, ST-40 For elbow impediment: + LI-10, LI-11, LI-12, SI-8 For wrist impediment: + SI-4, SJ-4, SJ-5 For metacarpal and finger impediment: + Baxie, SI-3 For knee impediment: + LIV-8, ST-35, UB-40, Xiyan For ankle impediment: + GB-40, KI-3, KI-6, SP-5, UB-60, UB-62 For metatarsal and toe impediment: + Bafeng, GB-41, LIV-3, SP-4, ST-41

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