Course: Acupuncture Treatment of Disease 3 Date: June 22, 2009 Class #: 10 Psoriasis, Fibromyalgia/CFS. Psoriasis

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1 Course: Acupuncture Treatment of Disease 3 Date: June 22, 2009 Class #: 10 Psoriasis, Fibromyalgia/CFS (bai bi which translates to skin diseases) Fibromyalgia/CFS Psoriasis 2.02 % of the US population (5.5 million) suffer from psoriasis. By definition it is a chronic recurrent disease causing raised, red patches that have silvery white scale and distinct borders between patches and normal skin. Compare this to eczema which is far less distinct. If you scrape off the silver scale you will see that each patch has multiple layers and beneath there will be pin-head sized bleeding spots. This is called Auspitz sign. Often seen at the posterior hairline. Itches like a mo fo. Triggers: Stress Allergies Lack of sleep Diet Medications Etc Etiology: Skin injury and irritation Sun exposure Moderate exposure to UV is good, but stronger exposure and sunburn exacerbates. Diet Stress and anxiety Medications i.e., Bipolar meds, esp lithium. Also, meds for tumor necrosis Infection Often psoriasis occurs around the elbows and knees because these are the most common sites of skin injury and irritation. Types of psoriasis: Plaque psoriasis Nail psoriasis Pustular psoriasis Damp heat here. Erythrodermic psoriasis Scalp psoriasis Guttate psoriasis Inverse psoriasis Psoriatic arthritis Long term psoriasis leading to joint deformity. Often related to repeat scratching. Psoriasis is described in degrees of severity. Mild: less than 5% of the body skin Moderate: 5 30% Severe: greater than 30% of body is affected. Page 1 of 8

2 To diagnoses skin problems: Color o Fresh red is heat o Light red is possibly deficient or mild heat Location o Eczema for instance has inner side bilateral itching and manifestations o Shingles usually one sided and usually around trunk, sometimes face/genitals o Psoriasis is elbow, knee, posterior hairline. o If location is more yang, yang evil: wind, heat o If more yin, yin evil: damp, cold. Boundaries o Clear or unclear? Secretions o Determines dampness or not. o Observe for blisters Scale o Not all disease have scale. Eczema does not, but psoriasis does. All that white tells you lung could be involved. Scale is dry and silvery. This is lung yin xu. Can also be due to excessive lung heat, but more likely a deficient heat. Symptoms of psoriasis are rather simple: White, silvery scales with multiple layers. Under the scale is a fat-like lustrous film (called film phenomenon). This is the base of the psoriasis. Pin head sized bleeding spots when scale scraped away Auspitz sign. Page 2 of 8

3 Look at these by comparison: Urticaria Eczema Psoriasis This is a damp rash and is more chronic. Seen as many small blisters with fluid and is found mainly in Yin areas. Usually deep red in color and rather dark. It s also bilateral. Acute, easiest type to treat, and typically in the upper regions of the body (head, face, upper extremities). Generally goes away on it s own. No set boundaries. This is usually a wind rash comes and goes quickly. This is the most difficult to treat. Look for white silvery scales with multiple layers, film phenomenon and Auspitz sign along with distinctive border. Due to heat in the blood, blood stasis, and blood dryness (and more, but these are the biggies). Can scar with black colorations. El Senor just indicated there is likely to be a comparison question on the final about these like which is the easiest to treat, what is the characteristic of distribution for eczema, what are the 3 main signs of psoriasis, what is most likely to be on the Yin areas, etc. Western treatment includes steroids, UV-B treatments, sunlight. Calcipotriene is a form of Vitamin D3 in cream or ointment that helps a lot. One Chinese herb for this is Pi Yan Ping formula. TCM Mechanism Blood Disorder: Heat in Blood Blood Stasis Blood Xu with Inner Wind All of these conditions will generate wind which causes the itching. Common to see asthma with combination of psoriasis TCM Differentiation and Treatment Know the 3 types and stages of Psoriasis! Page 3 of 8

4 Basic Points GB 31 is the wind market Du 10 is level of T6, will dispel wind. SP 10 for blood heat and thus the wind. PC 6 not only to calm shen and digestion, but can also cleanse blood Cup/bleed at Du 14 to clear the heat and indirectly kill off the damn wind. Blood heat by contrast will have a fresher color, won t move around as much, might have more bleeding symptoms and will itch like mad. Shen will also be more disturbed (and that itching? That doesn t help!). Bleed at UB 40. May have some scarring from the itching. Lots of itching = lots of scale. Itching is more localized in blood stasis too. Can generally move the blood could use SP 10 and then use points to nourish the Yin. At this stage skin disease is slightly different from other blood stasis treatments don t open the Du channel in this case! UB 17 and 40 for stasis PC 6 for blood heat Page 4 of 8

5 Skin and scale is very dry, somewhat dark. Even normal skin will be dry. Will also have numbness and will want to sip water not swallow. This is a chronic condition and is likely to be late stage. Nourish the Yin and don t move the blood too much. LV 8 could be most important. LV back shu UB 43 is for chronic and intermittent disease Other treatments: Plum blossom needling either around the boundary in the acute stage. You can also use plum blossom in the middle of the rashes. (Sometimes the lesion is very hard and needle won t go through, which is why you use the boundary sometimes. ) If excess heat, use an odd number of needles; if deficiency, tonify with even number. Use bleeding directly on the rashes at BL 40 and DU 14. Ear points: LV, Shenmen, LU to address skin problems, HT. Washes: Chinese herbal wash for external treatment. Xiao Feng San for instance would clear the heat and cool the blood make a wash from the raw herb and wash the affected area. Page 5 of 8

6 Fibromyalgia/Chronic Fatigue Syndrome Fibromyalgia tests pretty much negative in the Biomed world. They aren t completely healthy, but they aren t considered diseased either. Dr. Luo calls it sub-healthy. Fibromyalgia is increasingly recognized as a chronic pain syndrome. It is characterized by widespread/body-wide musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. Symptoms and Diagnosis Fatigue It is persistent and does not improve with bed rest. Average daily activity is reduced by at least 50% for at least 6 months. There is no previous history of this. Additionally, four or more of the following which must have persisted or recurred during 6 months or more consecutive months and predating the fatigue o Short term memory or concentration problems o Sore throat o Multiple joint pains without redness or swelling o Muscle pain o Headaches of a new type, pattern, severity o Non-refreshing sleep o Post-exertional malaise lasting more than 24 hours Liver and Spleen are related to all of these things. So is Wei qi which is transported into the sinews via the divergent channels. Treatment includes exercise (which just seems wrong, but works!), improving the quality of sleep and applications of heat (especially good for cold and phlegm sx). TCM Etiology Residual pathogen often in diaphragm. Retention of latent pathogen dampness is generally what glues it in place. Look for slight overweight. Retention occurs between skin and muscular layers. TCM Mechanism Blockage of Wei Qi in the 12 regular of tendino-muscular regions Again, dampness can cause both the blockage and the retention of latent pathogens which can cause this disease. Blockage of tendon and muscular channels causes the pain. If pain is very deep upon palpation could be blockage of the regular channels which run more deeply than the TM channels. Page 6 of 8

7 Diagnosing Fibromyalgia While no lab tests are available, you can diagnose via body aches and sleep disturbance. Also, 11 of 18 bilateral trigger points will be reactive per some doctors. UB 40 might also be tender. This is a relative diagnosis, not such a strict one. Pain comes from blockage (Qi stagnation or damp) or from malnutrition (Qi xu perhaps or Blood xu). TCM Differential and Treatment Actually massage is the best tx quick relief. Acupuncture, cupping is good too. Combination is the best. Basic points: Jiaji points (1 cun insertion at a 45 degree angle) 4 gates are excellent points to use GB 20. GB 21 SI 11 SP 9 ST 40 Page 7 of 8

8 Often happens in the upper back Lung area. If all over = Spleen. If lower back = kidney. LI 10 and ST 36 good for this. Point injection is a great treatment but you can only do it in 4 different states. Page 8 of 8