1. Acupuncture Techniques in Treating Acute Diseases
Cao Min
Department of Emergency, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine

2. Doctor Bian Que Treated Syncope
Doctor Bian Que told his student Zi Yang to sharpen the needle and acupoint Baihui. In a moment the prince revived.
Doctor Bian Que ordered his student Zi Bao to prepare drugs ironing. Then the prince was able to sit up.
Then regulated the balance of Yin and Yang and told the prince to take the herbal decoction for days. Finally the prince fully recovered.
—— From “The Historical Records of Bian Que Cang Gong Biography”

3. How about the application of acupuncture in your own country ?
Especially in Treating Acute Diseases !

4. 【Objectives】
Understand how acupuncture treatment works in critical patients.
Make a good command of some practical acupuncture techniques in treating acute patients.

5. 【Acute diseases】 Syncope Palpitation Chest-Bi syndrome
Acute Lumbar Sprain ……

6. Syncope

7. How could you help if you were there?

8. 【Definition of syncope】
JUE ZHENG 厥证
a sudden unexpected fall to the ground with transient loss of consciousness and cold limbs.
In mild cases, patients may rapidly and spontaneously recover without any sequelae.
However, a severe syncope can be life-threatening.

9. 【Etiology and pathogenesis】
1. Internal injuries caused by seven emotions
Mental irritation is the main cause for syncope. When sudden mental irritation surpasses the range of self-regulating abilities, functional disorders of zangfu-organs and syncope will occur. Anger makes qi go upwards, which will cause rebellion of qi or inability of yang to ascend, affecting the clear orifices, resulting in sudden collapse and syncope.
2. Body constitution
A constitution with unsmooth circulation of qi and blood
or yin deficiency and yang hyperactivity
or retention of phlegm due to deficiency of spleen,
if attacked by great mental irritation, will result in sudden derangement of qi and blood, developing into syncope.

10. 【Etiology and pathogenesis】
3. Great loss of blood and essence
Deficient blood and essence fails to nourish the clear orifices, leading to the syncope.
4. Improper diet
An improper diet such as overdrinking and overeating the greasy and sweet food may damage the spleen, leading dysfunction of transporting and transforming, which will cause phlegm-dampness. An improper diet may obstruct the flow of qi and then result in syncope.
5.summer heat
Hot invades body,disturb the spirit
The disease mainly locates in heart, liver, spleen and kidney. The main pathogenesis of syncope is sudden derangement of qi activities, abnormal ascendance and descendance and abnormal circulation of qi and blood.

11. key points for diagnosis
1.Sudden fall down with no consciousness, sometimes accompanied with cold limbs.
2.Before attack,there were premonitory signs：dizziness, blurred vision, pale, sweating,nausea.After waking up , there would be no sequelae like aphasia or paralysis.
There was a similar history of attack. Usually, there could be some risk factors, such as emotional changes, or loss of blood, or overeating, or phlegm stagnation in the body.

12. 【Differential Diagnosis】
Diseases
Differentiation
syncope
stroke
epilepsy
consciousness
Loss of consciousness
Coma
Accompanied symptoms
Suddenly fainted, cold limbs
eye-mouth distortion
,paralyzed
Foam on the lips, staring upwards, twitching limbs or screaming
State after regaining consciousness
No eye-mouth distortion or hemiplegia
Usually with sequelae
Just act like a normal person without any sequelae

13. Treatment according to syndrome differentiation
excessive qi syncope
deficient qi syncope
excessive blood syncope
deficient blood syncope
phlegm syncope
food syncope
summer-heat syncope
major manifestations
lockjaw, clenched fists, coarse breath.
Dizziness, palpitation and shortness of breath, .
lockjaw, flushed face, purple lips.
Palpitation and dizziness.Pale
Dizziness, or gurgling in the throat or coarse breathing.
Overeating, falling down all of a sudden.
Fever, sweating, thirst, flushed face,
accompanied manifestations
mental irritation before onset.
pale , sweating with cold limbs, or urinary incontinence.
Vertigo or headache , easy to be angry, bitter taste,
sinking of the eyes, opened mouth, spontaneous sweating, feeble breathing.
Chest tightness, poor appetite, vomiting , sputum and saliva.
Abdominal distention, nausea and vomiting with a foul smell.
dizziness and headache, chest tightness, fatigue.
tongue
A thin and white tongue coating.
A pale tongue with white coating.
Red tongue with thin yellow coating.
Pale tongue with a thin and white coating.
A white and greasy tongue coating.
A thick and greasy tongue coating.
A red and dry tongue.
pulse
A hidden or a deep and taut pulse.
A deep, thready and feeble pulse.
A taut pulse.
A rapid, weak or a hollow pulse.
A deep and slippery pulse.
Slippery.
A strong and rapid pulse.

14. 【Acupuncture Treatment】
Basic Method: Opening the orifice and inducing resuscitation (开窍醒神)
Main points：DU 26 (水沟), DU 20 (百会), PC 6 (内关)

15. Summary chart on syndrome differentiation
and acupuncture treatment for syncope
Patterns
method
Acupuncture points
Excessive qi syncope
regulating the circulation of qi to relive stagnation.
DU 26 (水沟), DU 20 (百会), PC 6 (内关),
LR 2 (行间), LR 3 (太冲), DU 16 (风府), and PC 9 (中冲)
Deficient qi syncope
Invigorating qi and restoring yang to awake mind.
ST 36 (足三里), RN 6 (气海), and KI 2 (然谷)
Excess blood syncope
Promoting qi and activating blood circulation.
DU 26 (水沟), DU 20 (百会),
PC 6 (内关), LR 3 (太冲), and LI 4 (合谷)
Deficient blood syncope
Invigorating qi and blood.
RN 4 (关元), BL 17 (膈俞), and ST 36 (足三里)
Phlegm syncope
Circulating qi to resolve phlegm.
RN 4 (关元), ST 40 (丰隆), and ST 36 (足三里)
Food syncope
Promoting digestion and harmonizing the stomach.
ST 36 (足三里), ST 24 (滑肉门), and SP 17 (食窦)
summer-heat syncope
Clearing away the summer-heat
EX-UE11（十宣）、DU 26 (水沟)、PC 6 (内关),
DU 20(百会), PC3（曲泽）、 LI 4 (合谷)

16. 【Case Study】
A 52-year-old female received treatment due to chest fullness and tightness, difficulty breathing and 3 times of sudden syncope coupled with convulsions of the four extremities and cyanosis.
Case history: hypertension with 300mg/dl of total cholesterol
Presenting signs and symptoms: dizziness, chest tightness, insomnia
Tongue: thin
Pulse: wiry

17. Palpitations

18. Definition
Patients have palpitation which ascribed to being frightened, and sometimes can’t be controlled by themselves. They may feel chest distress, breath hard, dyspnea, amnesia, dizziness, tinnitus and so on.

19. 【Etiology and pathogenesis】
A weak constitution
Deficiency of qi, blood, yin and yang may deprive the nourishment of the heart.
Improper diet and overstrain
Lack of resource may cause heart blood deficiency, which deprive nourishment of the heart; Overeating rich and fried food may either store heat, produce fire and phlegm or damage the spleen to produce phlegm turbidity, thus causing the disturbance of the heart by fire. Palpitation then occurs.
Emotional trauma
Stagnation of qi movement.
Attack by the external pathogenic factors
Wind, cold and dampness will pass into the heart, obstructing the heart channels and damaging heart qi and yin, which finally cause palpitation.

20. 【Etiology and pathogenesis】
The pathological changes are divided into deficiency and excess.
Insufficiency of qi, blood, yin and yang results in the disnourishment of the heart.
phlegm-fire, invasion of the heart by water and fluid retention , stagnant blood block heart channels.
Excess and deficiency are mutually complicated and transformed. A prolonged case may be combined with deficiency of qi, blood, yin and yang while a deficiency case is usually involved with phlegm-heat, retention of water and fluid and blood stasis.

21. key points for diagnosis
1. The patient may have palpitation, violent heart beats, nervous looking, which are not able to be self-controlled. The heart beats are either too fast or too slow. Over-strong heart beats and intermittent heart beats can also be seen. Palpitation can either be occasional or persistent.
2. The accompanying symptoms include discomfort in the chest, irritability, vexation, insomnia, tiredness, dizziness. chest pain, cold limbs and sweating or syncope can be combined.
3. The following pulse changes can be seen: a rapid pulse, a deep pulse,a slow pulse,a swift /slow pulse with irregular/regular intermittence, a slow pulse with irregular /regular intervals.
4. Be triggered by emotional stimuli, fear and fright, stress,drinking alcohol and overeating.

22. Differential Diagnosis
Palpitation 心悸
Jing Ji惊悸
Zheng Chong怔忡

23. Distinguish JING JI from ZHENG CHONG
Conditon
JING JI
ZHENG CHONG
Inducing factors
Fear or fright, anger,
sad or stress
Chronic deficiency or dysfunction of the five-zang organs
Duration
Short and momentary
Long, persistent and uncotrollable
Frequency
Infrequency
Nature
Excessive
Deficient or combined deficiency and excess

24. Treatment according to syndrome differentiation
Timidity due to heart deficiency
Deficiency of the heart and spleen
Deficiency of the heart yang
Attack of heart
by retention of water
Deficiency of yin and hyperactivity of fire
Heart Blood Stasis
major manifestations
fear and fright, restlessness.
shortness of breath, dizziness,pale.
chilly sensation,
shortness of breath worsened on the exertion.
dizziness, fullness in the chest and epigastrium, thirst with no desire for drinks, scanty urine.
easiness to be angry, insomnia, all the symptoms can be worsened by overthinking.
cyanosis ,
chest pain which is like being punctured by needles.
accompanied manifestations
Insomnia, dream-disturbed sleep, a poor appetite, dislike of sound.
A poor appetite.
stuffiness in the chest,
restlessness,
Nausea, vomiting.
dizziness, blurred vision
stuffiness in the chest
tongue
A thin and white tongue coating.
A pale tongue.
A pale tongue with a white coating.
A pale tongue with a slippery coating.
A red tongue with scanty or no coating.
A dark purple tongue or a tongue with petechiae.
pulse
A thready and rapid pulse or a thready and taut pulse.
A thready and weak pulse.
A weak or a deep and thready pulse.
A deep, thready and smooth pulse or a taut and smooth pulse.　
a thready and rapid pulse.　　
A slow pulse with irregular intervals or an unsmooth pulse or a slow pulse with regular intervals.

25. 【Acupuncture Treatment】
Basic Method: harmonizing the heart-qi and calming the mind
(调理心气，安神定悸)
Main points：PC 6 (内关), RN 17 (膻中), BL 15 (心俞), BL 14 (厥阴俞), HT 7 (神门)

26. Summary chart on syndrome differentiation
and acupuncture treatment for palpitations
Syndromes
method
Acupuncture points
Timidity due to heart deficiency
tranquilize and sedate mind
PC 6 (内关), RN 17 (膻中), BL 15 (心俞), BL 14 (厥阴俞), HT 7 (神门)BL 19 (胆俞), PC 7 (大陵), PC 5 (间使)
Deficiency of the heart and spleen
enrich blood to nourish heart, benefit qi and calm mind.
PC 6 (内关), RN 17 (膻中), BL 15 (心俞), BL 14 (厥阴俞), HT 7 (神门)BL 17 (膈俞),
BL 20 (脾俞), ST 36 (足三里)
Deficiency of yin and hyperactivity of fire
Replenish yin to clear away fire, nourish heart to calm the mind.
PC 6 (内关), RN 17 (膻中), BL 15 (心俞), BL 14 (厥阴俞), HT 7 (神门)，BL 23 (肾俞), KI 3 (太溪), HT 6 (阴郄), PC 7 (大陵)
Deficiency of the heart yang
Warm heart yang
PC 6 (内关), RN 17 (膻中), BL 15 (心俞), BL 14 (厥阴俞), HT 7 (神门)
RN 14 (巨阙), BL 23 (肾俞)，RN 4 (关元)
Attack of heart
by retention of water
Invigorate the heart yang, produce qi and resolve fluid retention
PC 6 (内关), RN 17 (膻中), BL 15 (心俞), BL 14 (厥阴俞), HT 7 (神门)，BL 23 (肾俞),
KI 5 (水泉), RN 4 (关元)
Heart Blood Stasis
Activate circulation of blood to remove blood stasis
PC 6 (内关), RN 17 (膻中), BL 15 (心俞), BL 14 (厥阴俞), HT 7 (神门)，RN 6 (气海), ST 36 (足三里), BL 17 (膈俞)

27. 【Case Study】
A 33-year-old female patient received treatment for palpitation for 3 days. Three days ago, she experienced a great deal of stress due to artificial abortion. After that, she started to suffer from dizziness, palpitations and precordial discomfort. She was diagnosed with paroxysmal tachycardia. The patient has a weak constitution and occasionally experienced palpitations upon physical exertion. She had normal bowel movements and bladder function as well as a normal appetite. She had alternating good and poor sleep quality.
PE: a thin build, good spirit and quick reaction. BP: 96/60 mmHg, HR: 128 beats/min. The patient presented with a pale complexion.
Tongue: pale with thin, white coating.
Pulse: thready, rapid.

28. Chest-Bi Syndrome

29. 【Definition of Chest-Bi Syndrome】
A chest-bi is characterized by a sensation of oppression, squeezing and tight pain in the chest.
The pain may radiate to the upper back, neck, jaw, shoulders, or arms.
Associated with dyspnea, sweating, anxiety or fear.

30. 【Etiology and pathogenesis】
（1）Cold invasion
External cold directly invades the chest. It may contracts the heart vessels and obstructs the circulation of yang qi and blood, causes heart blood stasis, inadequate blood flow to nourish the heart, resulting in chest-bi.
（2）Improper diet
Overeating greasy, sweet food, alcohol or smoking may damage the spleen and stomach and impair their function of transportation and transformation, thus producing dampness and phlegm. The phlegm may upward attack the chest, hinder the clear yang and qi dynamic and finally causing the blockage of the heart channels and the occurrence of the disease.

31. 【Etiology and pathogenesis】
（3）Emotional disturbance
Emotional disturbance such as worry and overthinking may impair the spleen and cause internal phlegm. Anger may impair the liver and cause stagnation of qi. Over time, qi stagnation may transform into fire, and the fire then scorches the body fluid into phlegm. Qi stagnation and phlegm retention in the heart vessels may cause blood stasis and block chest-yang, leading to chest-bi.
（4）Overstrain and internal injury
Overstrain may damage the spleen and impair the transportation and transformation of qi and blood, causing disnourishment of the beart channels, leading to chest-bi; Overstrain may also damage heart and kidney yang, then cold will invade the body, causing the obstruction of blood circulation, leading to chest-bi.

32. 【Etiology and pathogenesis】
（5）A weak constitution due to an old age
Aging debility or overexertion may cause hypofunction and deficiency of the kidney. The kidney dominates the vital fire and store primary yin and yang. When kidney yang fails to warm heart yang, the insufficient heart yang fails to facilitate the circulation of blood, heart blood stasis and subsequent chest-bi may result. When kidney yin fails to nourish heart yin, insufficient yin-fluids result in sluggish circulation of heart blood flow, leading to chest-bi.
The main pathogenesis of the disease is the blockage of the heart vessels. The main affected organ is the heart but its occurrence is mostly related to the dysfunction of the liver, spleen, kidney and lung. Its root belongs to deficiency while its branch belongs to excess. The former includes deficiency of qi, blood, yin and yang. The latter includes qi stagnation, blood stasis, cold coagulation and phlegm-dampness.

33. key points for diagnosis
1. The disease is mainly marked by a sudden pain in the left chest, which often travels to the shoulder, forearm, throat,teeth. The pain can be recurrent or intermittent, which is commonly accompanied with palpitation, shortness of breath, spontaneous sweating, even inability to lie down.
2. It usually lasts for a short time from a few seconds to a few minutes. In severe cases, there may be intermittent pain, sweating, cold limbs, a pale complexion, purple nails and lips, tachycardia, arrhythmia, even leading to sudden death.
3. The disease is more common in the middle-age and aged persons. It is usually induced by emotional upsets, the changes of weather, overeating and overstrain.

34. Differential Diagnosis
Stomach ache
Stomach ache is related to food. It happens in the upper abdomen. It may have pressure pain on a certain location of the body surface and it is mainly marked by distending pain and may last for a longer time. Its accompanying symptoms include a poor appetite, nausea and vomiting, acid reflux, belching. The pain of an untypical type of chest-Bi syndrome can be located at gastro area. Chest-Bi is marked by fullness and suffocation in the chest and heart. It can often be relived by rest and medicine.
True heart pain
True cardiac pain is an advanced progression of chest-bi. Patients may present with persistent intense cardiac pain that lasts from half an hour to a couple of days, along with interrupted breathing, profuse sweating, breathing with an open mouth, raised shoulders or fainting, and a feeble or knotted pulse.

35. Treatment according to syndrome differentiation
Obstruction by blood stasis
Qi stagnation in the chest and heart
Obstruction by phlegm -turbidity
Cold stagnation in the heart vessels
Deficiency of heart qi and yin
Deficiency of heart and kidney yin
Deficiency of heart yang
major manifestations
Severe stabbing or gripping pain in the chest and heart with a fixed location.
Fullness and suffocation in the chest and heart, frequent sighing.
More severe chest suffocation than heart pain, obesity, a heavy sensation in the whole body.
A sudden onset of heart pain, or pain in the chest radiating to the back , shortness of breath.
Paroxysmal vague pain in the chest and heart, distress in the chest.
Pain and distress in the heart and chest.
pain and distress in the chest, a pale complexion, cold limbs,
accompanied manifestations
heart pain radiating to the back ,shoulder .　　
fullness and distention in the epigastrium.　
Profuse phlegm, shortness of breath, a poor appetite, loose stools.
Chest stuffiness, palpitation, pale complexion.
Lassitude, dislike of speaking, pale complexion, proneness to sweating. 　　
A hot sensation in the palms and soles, night sweating, tidal fever in the face.
shortness of breath,tiredness,
tongue
A dark-red or dark and purple tongue with stasis macules, phlebectasia under tongue.
A thin or a thin and greasy tongue coating.
A white and sticky tongue coating.
A thin and white tongue coating.
A pale, enlarged tongue with tooth prints on the margins, a thin and white tongue coating.
A red tongue with scanty moisture, a thin or exfoliative tongue coating.
A pale and enlarged tongue and a white or greasy tongue coating.
pulse
A taut and unsmooth pulse, or a slow or rapid pulse with irregular intervals, or a slow pulse with regular intervals.
A thready and taut pulse.
A smooth pulse.
A deep and tense pulse or a rapid pulse with irregular intervals.
A weak, thready and moderate pulse or a slow pulse with irregular intervals or a slow pulse with regular intervals.
A thready and rapid pulse, or a slow pulse with intervals.
A deep, thready and slow pulse.

36. 【Acupuncture Treatment】
Basic Method: circulating qi and invigorating blood and alleviating pain.
(行气活血止痛)
Main points：PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)

37. Summary chart on syndrome differentiation
and acupuncture treatment for Chest-Bi
Syndromes
Acupuncture points
Obstruction of heart-blood
Activate the circulation of blood to remove blood stasis in the vessels and relieve pain.
PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)，BL 15 (心俞), BL 17 (膈俞)
Qi stagnation in the chest and heart
regulate qi dynamic, harmonize the blood and relax the vessels.
PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)，LR 3 (太冲),合谷
Internal obstruction of phlegm-turbidity
Freeing yang, discharging the turbidity, sweeping phlegm
PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)，RN 12 (中脘), ST 40 (丰隆), ST 36 (足三里)
Cold stagnation in the heart vessels
Dispell cold, quicken blood, remove obstructiont.
PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)，BL 15 (心俞), RN 6 (气海), RN 4 (关元)
Deficiency of heart and kidney yin
Nourish yin, clear heat fire, activate the blood circulation .
PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)，BL 15 (心俞), BL 23 (肾俞), KI 3 (太溪)
Deficiency of qi and yin
Supplement the cardiac qi and yin to activate the heart vessels.
PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)，BL 15 (心俞), RN 6 (气海), SP 6 (三阴交)，ST 36 (足三里)
Insufficinecy of heart-yang
warm up the heart yang.
PC 6 (内关), RN 17 (膻中), RN 14 (巨阙), HT 6 (阴郄)，BL 15 (心俞), BL 23 (肾俞), RN 4 (关元)

38. 【Case Study】
A 61-year-old male patient received treatment due to sudden, intermittent paroxysmal precordial choking pain for 2 weeks. Each attack would last seconds to minutes, causing a sense of heavy oppression in the precordial region, palpitation and lassitude as well as occasional sweating. He was diagnosed with coronary artery disease. A few days prior to treatment, he experienced poor appetite and loose stools.
PE: a thin build, sallow complexion with clear consciousness. BP: 150/95mmHg, HR: 88 beats/min. EKG showed ST segment depression. He also presented with tenderness in the precordial region and on the back involving the heart, pericardium and BL 17 (geshu) on the left side.
Tongue: pale with a white, greasy coating.
Pulse: weak, wiry, choppy and slightly rapid.

39. Acute Lumbar Sprain

40. 【Definition of acute lumbar sprain】
Acute lumbar sprain refers to acute waist muscle, fascia and ligament injury caused by strenuous exercise, or burden, improper posture, or accidentally tumble, traction, or excessive torsion, etc. lumbar pain, activity limitation, without fracture and dislocation, skin damage and other symptoms.

41. 【Syndrome Differentiation】
Identify the Disease
1）acute lumbar muscular sprain
2）acute ligament sprain
3）acute joint sprain
Identify the Meridian
1）bilateral to the lumbosacral vertebrae and lumbar muscles or at the region of sacroiliac joint —— foot Taiyang meridian syndrome
2）the midline of the lumbosacral vertebrae —— Du meridian syndrome

42. 【Acupuncture Treatment】
Basic Method: circulating qi and alleviating pain, relaxing tendons and invigorating collaterals (导气止痛，舒筋活络)
Main points：ashi-point, yaotongdian (EX-UE 7)

43. Thanks for your attention！43 43