Acupuncture Continuing Education

Sample from Hiccups, Digestion & Stomach Pain

Acupuncture CEUs Online 

GI Tract

 

Download the course, complete the online quiz and receive immediate acupuncture license credit! Learn herbal formulas for the treatment of hiccups, constipation, stomach pain and vomiting. Enjoy interesting case studies highlighting the material. This course is approved for 12 California acupuncture CEUs (category 1), 12 NCCAOM Diplomate recertification PDAs, 12 Texas acupuncture CAEs, 5 Florida CEs, and 12 CTCMA & CAAA acupuncture CEs. Also approved for 12 California nursing contact hours.
 

About the Author
Professor Liao, L.Ac. has served as professor of herbology and acupuncture theory at the Academy of Chinese Culture & Health Sciences in Oakland, California. Prof. Liao has also served as faculty at Five Branches University in Santa Cruz, California. His many years of teaching experience bring the highest quality of interesting and useful courses to HealthCMi continuing education online. Prof. Liao has published many works of Traditional Chinese Medicine including original translations of Chinese Medicine classic texts. In addition, Prof. Liao has a private acupuncture practice in Walnut Creek, California and travels to China frequently with his students for advanced Qi Gong and meditation practices.  

 

 

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Introduction

This course takes a close look at digestive dysfunction and its relationship to blood stasis. Here, we take a close look at how the blood invigorating formula Xue Fu Zhu Yu Tang is helpful across many diagnostic patterns when blood stasis is involved. Vomiting, hiccups, chronic constipation and stomachache are the main focus of this course material.

Xue Fu Zhu Yu Tang is a Qing dynasty formula introduced by Dr. Wang Qing Ren in his book Yi Lin Gai Cuo (Correcting of Errors in the Medical Field). Xue Fu Zhu Yu Tang is based on Tao Hong Si Wu Tang and is modified with Qi regulating herbs. Translated as Drive Out Stasis in the Mansion of Blood Decoction, this formula invigorates the blood circulation and dispels blood stasis.

 

Xue Fu Zhu Yu Tang Overview

Xue Fu Zhu Yu Tang is appropriate for conditions with underlying Qi and blood stasis. Various conditions such as Liver yang uprising, damp-heat, etc… may combine with Qi and blood stasis. In all cases, the correct circumstances for the application of Xue Fu Zhu Yu Tang is when the root condition is Qi and blood stasis.

Treatment Principles of Xue Fu Zhu Yu Tang
The formula vitalizes blood to remove stasis and regulates Qi to stop pain. Xu Fu Zhu Yu Tang moves the blood and Liver Qi. It opens the channels to relieve pain.

Traditional Usage
Classical use of Xue Fu Zhu Yu Tang includes the treatment of head and chest pain due to blood stasis in the chest region or impeded blood circulation. The pain is associated with blood stasis and is therefore fixed, stabbing and piercing. Chronic hiccups, insomnia, irritability, pain of the hypochondrium, a heat sensation in the chest, palpitations, a choking sensation upon drinking, emotional turbulence and tidal fevers in the late afternoon or evening may result from the chest blood stasis or diminished blood circulation. Poor circulation or blood stasis related pain may affect the heart and lead to insomnia and mental restlessness.

Blood Mansion
The Xue Fu area is the Blood Mansion. Qi and blood stagnation in this area may cause headaches or chest & costal pain. The headaches are characterized by sharp pain. The headaches may last for many years. The chest and costal region pain comes and goes, which is consistent with the insidiousness of Qi stagnation related pain. The character of pain is sharp, fixed and may be accompanied by nausea or vomiting. The pulses are often small, wiry and choppy for these conditions. The tongue and lips are deep red or purple.

Blood stasis in the Blood Mansion may cause heat. This leads to insomnia, palpitations and the patient may be easily angered. The insomnia may last for years and may be accompanied by darkening of the skin, numbness of the lower limbs and dizziness. When the tongue and pulse match the conditions for Xue Fu Zhu Yu Tang, it may resolve this syndrome. This condition may also be accompanied by menstrual cramping and irregular menstruation. Herbs such as Xiang Fu, Ze Lan and Yi Mu Cao are often added to the formula Xue Fu Zhu Yu Tang for these gynecological concerns.

Stomach Blood Stasis
Blood stasis affecting the Stomach may cause Qi to rebel upwards thereby resulting in constant hiccups, choking when drinking, and dry heaves. One circumstance when blood stasis affects the Stomach is when chronic blood stasis impedes the normal flow of Liver Qi. In a five element relationship of wood overacting on earth, the consequent Liver Qi stagnation overacts upon the Spleen and Stomach Qi thereby causing rebellious Qi. More in course materials... 

 

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Sample 2, excerpt from course material:

 

Digestion and Blood Stasis

Using Xue Fu Zhu Yu Tang for the treatment of digestive complaints is often helpful when Spleen Qi deficiency, Qi stagnation, food stagnation, etc... combine with blood stasis. This course explores how other formulas including Sheng Ling Bai Zhu San, Ding Xiang Shi Di Tang, Ma Zi Ren Wan and Wu Zi Ren Wan may be combined with Xue Fu Zhu Yu Tang to achieve positive patient outcomes. Herbal formulas and differential diagnostics are presented. Next, case studies illustrate real life clinical applications and formula modifications.

Symptoms and Signs
Bloating, acid reflux, gas, diarrhea, constipation, fatigue

Tongue:   dark, deep red, purple, or teethmarks

Pulses:    weak, small, slippery, wiry or choppy

Diagnosis
Qi and blood stasis
Spleen Qi deficiency

Treatment Strategy
Promote Qi and blood circulation
Strengthen the Spleen Qi and drain dampness

Base Formulas
Xue Fu Zhu Yu Tang modified with Sheng Ling Bai Zhu San
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Sample 3, excerpt from course material:

 

Hiccups

Symptoms
Hiccups, abdominal bloating, fullness in the chest, slightly purple or red on sides of tongue, wiry and floating pulse

Diagnosis
Liver Qi Stagnation, rebellious Stomach Qi, Food stagnation

Treatment Strategy
Regulate the Stomach, Spleen and Liver Qi and blood and descend the Stomach Qi

Base Formula
Xue Fu Zhu Yu Tang modified with Ding Xiang Shi Di Tang and Bao He Wan

 

Ding Xiang Shi Di Tang

This simple formula is important for its elegant simplicity in descending and supporting Stomach Qi.

Ingredients:
Ding Xiang        Flos Caryophylii, 3 g
Shi Di                 Kaki Calyx,12 g
Sheng Jiang     Zingiberis Officinalis Recens, Rhizoma12 g

All of the above herbs descend Stomach Qi. Ding Xiang is acrid and warm and therefore penetrates through cold stagnation. Shi Di is lightweight and flows to the surface. Shi Di (calyx of the persimmon) is especially helpful in relieving hiccups, belching and vomiting. Sheng Jiang warms the Stomach and Spleen.

Dang Shen       Radix Codonopsitis Pilosulae, 12 g

Dang Shen strengthens the Spleen Qi.  Dang Shen benefits the Middle Jiao.

 

Bao He Wan

Bao He Wan is a great classic and lends its invigorating properties and its ability to dissolve phlegm and clear heat toxins to the treatment of hiccups.

Ingredients:
Shan Zha          Fructus Crateigi, 15 – 30 g
Shen Qu            Massa Fermenatata15 – 30 g
Lai Fu Zi            Semen Raphani Sativi, 15 – 30 g

Shan Zha, Shen Qu and Lai Fu Zi reduce food stagnation. Shan Zha promotes blood circulation and reduces meat stagnation. Shen Qu regulates Qi for cases of chronic food stagnation. Lai Fu Zi descends the Stomach Qi.

Lian Qiao          Fructus Forsythiae Suspensae, 12 g
Ban Xia             Pinelliae Rhizoma Preparatum, 9 g
Fu Ling              Sclerotium Poriae Cocos, 15 – 30 g

The preceding three herbs assist the chief food stagnation herbs. Lian Qiao dissolves food stagnation nodules and clears heat stagnation. Ban Xia dissolves food stagnation nodules and descends Stomach Qi. Fu Ling drains dampness from the Middle Jiao.
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Sample 4, excerpt from course material:

 

Case Studies

Case Study 1

A male, age 38, experienced problems since he argued with his neighbor a few months ago. Since the argument, he had a poor appetite, belching, and fullness in the hypochondriac region. More recently, he developed fatigue and at night severe vomiting. Although he did not have a stomachache, he did not like having his abdomen touched. His M.D. did not found anything wrong in his abdominal region (or with his stomach). He was thirsty but did not desire to drink. His tongue was a dark red color with purple dots along the sides. His pulse was wiry, small and rapid.

Diagnosis:  Liver Qi and blood stagnation; Stomach Qi rebelling upwards

Treatment Strategy: Regulate Liver Qi and blood, descend Stomach Qi, and cool the heat in the blood.

Formula: Xue Fu Zhu Yu Tang modification

Chai Hu             Radix Bupleauri,6 g
Zhi Ke                Fructus Citri Aurantii, 12 g
Qing Pi              Pericarpium Citri Reticaulatae Veride, 12 g
Yu Jin                Tuber Curcumae, 12 g

All of the above herbs regulate Qi. Chai Hu spreads the Liver Qi to the sides and upwards. Zhi Ke opens the chest. Qing Pi breaks Liver Qi stagnation associated with pain. Yu Jin cools the heat in the blood, promotes Qi and blood circulation and reduces irritability.

Hong Hua          Flos Carthami Tinctorii, 9 g
Tao Ren             Semen Persicae, 12 g

Hong Hua and Tao Ren break congealed blood. Hong Hua acts faster, flows to surface and flow to the upper body. Tao Ren moistens the dryness and remains in the bloodstream longer.

Chi Shao           Radix Paeoniae Rubrae, 12 g
Mu Dan Pi         Cortex Moutan Radicis, 12 g

Chi Shao and Mu Dan Pi cool the blood and promote blood circulation. Chi Shao more effectively promotes blood circulation while Mu Dan Pi more effectively cools heat in the blood.

Ban Xia             Pinelliae Rhizoma Preparatum, 9 g
Chen Pi             Pericarpium Citri Reticulatae, 9 g

Ban Xia and Chen Pi regulate Stomach Qi, dry dampness and descend Stomach Qi. Ban Xia strongly dries dampness and descends Stomach Qi. Chen Pi regulates the Stomach and Spleen.

Sheng Di Huang       Radix Rehmanniae Glutinosae, 30 g
Mai Men Dong           Tuber Ophiopogonis Japonici, 12 g

Sheng Di Huang and Mai Men Dong lubricate Yin and cool the heat. Sheng Di Huang nourishes the blood and Jing. Mai Men Dong calms the Heart.

Gan Cao           Radix Glycyrrhizae Uralensis, 6 g

Gan Cao has a sweet character or taste. As already mentioned, its job is to harmonize the other ingredients in this formula.

Result of Treatment
After he took 5 bags for 5 days, his appetite improved and he began eating more soft food. The vomiting reduced to 1 - 2 times instead of 5 – 6 times per night. His stomach region softened to the touch and the dark coloration of his tongue reduced by 60%. However, he still had purple dots on the sides of his tongue, and his pulse was still wiry and small.

After he continued to take 5 bags for 5 more days, he only vomited occasionally at night. The purple dots on the sides of his tongue reduced 80% and his wiry pulse softened. The herbal formula was further modified by adding:

  • Bai Shao    (Paeoniae Radix Alba)
  • Bo He         (Mentha Ahaplocalyx)
  • Dang Shen (Radix Codonopsitis Pilosulae)
  • Huang Qi    (Radix Astragali Membranaceus)

This was added to smooth and strengthen his Qi. He continued taking the modified formula in the dosage of 10 bags for 10 days. After 10 days, he reported no more vomiting. He was given Xiao Yao Wan for further care.
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Sample 5, excerpt from course material:

 

Stomachache

Symptoms
Stomachache, bloating, nausea, irritability, bad breath, poor appetite, acidity

Tongue
Dark red with a thick, white or yellow coating

Pulse
Full and wiry

Diagnosis
Liver Qi, blood and phlegm stagnation
Disharmony between the Liver and Stomach

Treatment Strategy
Regulate the Qi
Move the blood
Eliminate food stagnation and promote digestion
Descend the Stomach Qi

Base Formula
Xue Fu Zhu Yu Tang modified with Bao He Wan

Bao He Wan

Once again appearing in this course, Bao He Wan proves to be an indispensable formula in the treatment of digestive disturbances.

Ingredients

Shan Zha          Fructus Crateigi, 15 g
Shen Qu            Massa Fermenatata, 30 g
Lai Fu Zi            Semen Raphani Sativi, 30 g

All of the herbs reduce food stagnation. Sha Zha promotes blood circulation. Sheng Qu penetrates through chronic food stagnation. Lai Fu Zi descends the Stomach Qi and eliminates food stagnatin.

Ban Xia             Pinelliae Rhizoma Preparatum, 9 g
Fu Ling              Sclerotium Poriae cocoa, 15 g
Lian Qiao          Fructus Forsythiae Suspensae, 12 g

The above herbs treat dampness and work as team. Ban Xia dries the dampness and descends the Stomach Qi. Fu Ling drains the dampness and benefits the Spleen and Stomach Qi. Lian Qiao clears heat toxins, dissolves nodules and is especially helpful when Qi stagnation and food stagnation turn into heat.

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