Oral Cavity Disorders: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

Oral Cavity Diseases (Western) Local damageLocal damage Electric shockElectric shock Chemical damageChemical damage Thermal damageThermal damage PeriodontitisPeriodontitis Tooth tarterTooth tarter Systemic diseaseSystemic disease Metabolic diseaseMetabolic disease Nutritional diseaseNutritional disease Immune diseaseImmune disease Infectious diseaseInfectious disease Treatment Remove offending cause Steroids Antibiotics Clean teeth

TCM Spleen Disease Spleen PhysiologySpleen Physiology Spleen PathologySpleen Pathology Gingivitis/StomatitisGingivitis/Stomatitis

Earth SoundSound songsong EmotionEmotion sympathysympathy ClimateClimate humidhumid SeasonSeason late summerlate summer Direction center Opening lips/gums Body Part muscles Zang/Fu SP/ST

TCM SPLEEN Physiology Governs Transportation & TransformationGoverns Transportation & Transformation Food & WaterFood & Water Controls BloodControls Blood Dominates the MusclesDominates the Muscles Opens in MouthOpens in Mouth Lips & Gums (ST)Lips & Gums (ST)

TCM 24 Hour Clock

Spleen Pathology

Damp is the Enemy of the SpleenDamp is the Enemy of the Spleen Damp-ColdDamp-Cold Damp-HeatDamp-Heat Spleen Qi Deficiency with DampSpleen Qi Deficiency with Damp

Spleen Pathology Usually combination of excess & deficiency Damp-Heat Damp-Cold Obstructs Spleen Qi Flow Spleen fails to Transform & Transport Gu Qi Spleen Qi Deficiency External or Internal Pathogen

Spleen Pathology Cold Food or Drink Cold Environmental Conditions Cold-Damp in Spleen Transform & Transport Disorder Disharmony of Qi Flow

Spleen Pathology Damp Hot Food or Drink Damp Hot Environmental Conditions Damp-Heat in Spleen Transform & Transport Disorder Disharmony of Qi Flow Accumulated Heat & Damp

Spleen Qi Deficiency Overeating Starvation Failure to Transform & Transport Disturbed Qi Flow Illness Overwork Under Work

Spleen Not Controlling Blood Hemorrhage Spleen Fails to Hold Blood Chronic Hemorrhage General Signs Prolonged Spleen Qi Deficiency

Spleen Qi Sinking Overeating Starvation Chronic Spleen Qi Deficiency Failure of Holding Chronic Diarrhea ProlapsesIncontinence Illness Overwork Under Work

Spleen Pathology Cold Food or Drink Chronic Spleen Qi Deficiency Spleen Yang Deficiency Transform & Transport Disorder Disharmony of Qi Flow Yang Deficiency Signs

Stomach Pathology Cold Food or Drink Cold Environmental Conditions Cold in Stomach Transform & Transport Disorder Disharmony of Qi Flow Inhibition of Yang

Stomach Cold Cold Food & Drink Cold Environment Receiving & Decomposing Anorexia Altered Qi Flow Lassitude Cold Signs Cold Ear/Nose Hypersalivation Pale-Purple Tongue Deep-Slow Pulse

Stomach Pathology Hot Dry Food or Drink Damp Hot Environmental Conditions Heat in Stomach Transform & Transport Disorder Heat Signs

Stomach Heat Pathogenic Heat Yin Deficiency channel Gums organ Ulcer child Colitis grandchild Cystitis

Stomach Food Stagnation Overeating Indigestible Food Retention of Food in Stomach Failure to Transform & Transport Disturbed Qi Flow

Stomach Yin Deficiency Chronic Febrile Illness Impairment of Body Fluids Stomach Yin Deficiency Stress Liver Qi Stagnation Transformation to Heat/Fire

How to Use Acupuncture for Gingivitis in Small Animal Practice Zang Fu Physiology Teeth correspond to boneTeeth correspond to bone Bone is controlled by the kidneyBone is controlled by the kidney Malocclusion, oligodontia are examples of Kidney Jing DeficiencyMalocclusion, oligodontia are examples of Kidney Jing Deficiency Gums are influenced by the stomachGums are influenced by the stomach

Meridian Theory Oral cavity has two main channels that influence the teeth and gumsOral cavity has two main channels that influence the teeth and gums Large Intestine meridianLarge Intestine meridian Stomach meridianStomach meridian

Pattern Diagnosis Stomach Heat PatternStomach Heat Pattern Excess pattern, seen more often in younger animals (cats)Excess pattern, seen more often in younger animals (cats) Stomach Yin Deficiency + Empty HeatStomach Yin Deficiency + Empty Heat Stomach loves moistureStomach loves moisture Moisture balances Yang functionMoisture balances Yang function Lack of Yin (fluid) allows Yang Fire to riseLack of Yin (fluid) allows Yang Fire to rise

Stomach Heat Pattern Fluffy: 4yr FS DSHFluffy: 4yr FS DSH Primary complaint: Bad breath, eating poorlyPrimary complaint: Bad breath, eating poorly History: Stray, no vetcare, dry food dietHistory: Stray, no vetcare, dry food diet Exam: Body & coat condition-normal; vital signs-WNLExam: Body & coat condition-normal; vital signs-WNL

Oral Exam: Putrid odor, upper and lower arcade have severely inflamed gingiva, with spontaneous bleeding, minimal calculus formationOral Exam: Putrid odor, upper and lower arcade have severely inflamed gingiva, with spontaneous bleeding, minimal calculus formation Lab Data: Elevated WBC, FELV/FIV=NegLab Data: Elevated WBC, FELV/FIV=Neg Diagnosis: Hemorrhagic gingivitisDiagnosis: Hemorrhagic gingivitis Treatment: Clindamycin 25mg PO BID x 10Treatment: Clindamycin 25mg PO BID x 10 Dental prophylaxis followed by Clavamox 62.5 mg BID x 10Dental prophylaxis followed by Clavamox 62.5 mg BID x 10

TCVM Exam & Diagnosis Constitution: Water/WoodConstitution: Water/Wood Tongue: body=reddish purple; no coatTongue: body=reddish purple; no coat Pulse: Bilaterally superficial rapidPulse: Bilaterally superficial rapid Body Condition: Dry nose; Body Temp NormalBody Condition: Dry nose; Body Temp Normal Mouth: Stink smell; bloody red gumsMouth: Stink smell; bloody red gums Pattern DX: Stomach Heat (excess condition)

TCVM Treatment Strategy Clear the Stomach Heat, Cool the Blood, & nourish Stomach YinClear the Stomach Heat, Cool the Blood, & nourish Stomach Yin Acupuncture Point Selection:Acupuncture Point Selection: GV 14; Tian Ping; ST 4,6,34,44; LI 4,11; SP 10 Herbal Medicine: Yu Nu Jian ( Jade Lady)Herbal Medicine: Yu Nu Jian ( Jade Lady) shi gao, shu di huang, zhi mu, huai niu xi 2 teapills TID or 1/8-1/4 tsp granules TID Topical Care: Aloe Gel ( Warren Laboratories)Topical Care: Aloe Gel ( Warren Laboratories)

Case Outcome & Discussion After 3 weeks of therapy inflammation substantially reduced Cervical line lesions which compromised several teeth were removed Fluffy is maintained on Aloe oral gel and herbs with only periodic acupuncture therapy Long term expectations: depend on owner compliance Other herbals: Wei Qi Booster; Slippery Elm

Stomach Yin Deficiency & Empty Heat Pattern Tess: 10 yr, FS, Mix BreedTess: 10 yr, FS, Mix Breed Primary Complaint: Bad breath, dirty teeth, and periodic vomit/regurgePrimary Complaint: Bad breath, dirty teeth, and periodic vomit/regurge History: Commercial dry food diet, periodic dental prophylaxis, absent dental homecare, gums remain inflamed and plaque builds quicklyHistory: Commercial dry food diet, periodic dental prophylaxis, absent dental homecare, gums remain inflamed and plaque builds quickly Western Dx / Tx: Gingivitis with periodontal deterioration. Requires 6 month recall for prophylaxisWestern Dx / Tx: Gingivitis with periodontal deterioration. Requires 6 month recall for prophylaxis

TCVM Approach Exam:Exam: Constitution- WaterConstitution- Water Tongue- Violet, dry, no coatTongue- Violet, dry, no coat Pulse- Deep, thready, and quickPulse- Deep, thready, and quick Gums- dry/breath scorchedGums- dry/breath scorched Coat Quality-DryCoat Quality-Dry Treatment Stategy: Nourish Stomach Yin and Clear Heat AP= CV 12 (aqua); SP 3,6; ST 36,44; LI 4,11 Herbs= Qing Wei San Topical= Aloe Gel Diet: Fresh cooked food/ fish-pork-beef-eggs- veggies