CONGESTIVE HEART FAILURE

GENERAL

Clinical Manifestations	Congestive Heart failure (CHF) is a condition in which the Heart's function as a pump is inadequate to meet the body's needs. Many disease processes can impair the pumping efficiency of the heart to cause congestive Heart failure. The symptoms of congestive Heart failure vary, but can include: Fatigue Diminished exercise capacity Shortness of breath S swelling (edema)
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SEVERE WIND-COLD ATTACKS THE LUNGS

Clinical Manifestations	Fever and chills (chills predominant) Irritability Anhidrosis Cough Wheezing (asthma) Copious, white, stringy, difficult to expectorate sputum Stifling sensation in the chest Lacrimation General heaviness (especially upper body) General body aches No thirst Floating edema (severe) Considerable difficulty breathing while lying down (severe) Intolerance of Cold Periorbital edema Dyspnea Vomiting of frothy saliva during pregnancy Edema Chest and abdominal distention Dry heaves Decreased urine Subcardiac edema Stridor Occasional chills on the back Hiccups Retching Dysphagia Diarrhea Dysuria Flushed face Dizziness Headache Inflammation of the tear ducts Lacrimation T: Pink C: Moist or White and greasy or Yellow and greasy P: Superficial, tight and rapid
Treatment Principle	Release the Exterior Transform congested Fluids (Thin Mucus) Transform Phlegm Warm the Lungs Descend Qi Relieve wheezing and coughing Clear Heat
Herb Formulas	Xiao Qing Long Jia Shi Gao Tang
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TAI YANG BIAO FU

Clinical Manifestations	Chills and fever or Fever with no thirst Swollen eyes, limbs abdomen or genitals Achiness Stiff neck and shoulders Anhidrosis Headache Stabbing joint pain Itchy throat Cough Asthma Aversion to Cold Maybe frozen shoulder Dyspnea Vomiting, if the condition is tonified before the Wind is expelled Urinary retention if the condition is reduced before the Wind is expelled Shortness of breath Mild or severe gasping Hiccups Fullness in chest Vomiting Heaviness of the body Edema Dysuria Maybe thirst Maybe diarrhea Maybe scanty urine Maybe lower abdominal fullness T: Normal C: Greasy and white P: Floating and slippery or tight
Treatment Principle	Relieve the Exterior Expel Cold Disperse the Lungs Stop asthma Expel water or Phlegm
Herb Formulas	Xiao Qing Long Tang With Internal Heat and irritability: Xiao Qing Long Jia Shi Gao Tang With indigestion leading to diarrhea: Si Ling San Severe:Wu Pi Yin modified
Points	Moxa Dingchuan, DU-4, REN-4, REN-6, needle DU-16, GB-20, LI-4, LU-7, REN-17, REN-22, SP-6, SP-9, SJ-5, ST-40, UB-12, UB-13 With Internal Heat and irritability: - moxa + LI-11, ST-44 With Qi Deficiency: KI-7, REN-8, REN-9, SP-6, SP-9, ST-28 With Excess type swelling (severe swelling, oliguria, constipation): DU-2, DU-6, LI-4, LU-7, REN-9, SP-6, SP-9, ST-28, ST-36, ST-43, UB-27

TAI YANG SHANG HAN WITH FLIUID RETENTION IN THE LUNGS

Clinical Manifestations	Anorexia Abdominal distention and discomfort Suffocating sensation in the chest Epigastric mass Maybe abdominal pain on palpation Yang jaundice (sclera and skin are bright yellow) Dislike of oily foods Nausea Vomiting Lassitude Scanty, dark urine Maybe thirst or thirst with no desire to drink Diarrhea with foul smell or Constipation Fever Sweet sticky taste or bitter taste in mouth T: Pink C: Thick, yellow and greasy (maybe sticky) P: Soft and rapid
Treatment Principle	Clear Heat Benefit Dampness
Herb Formulas	Yin Chen Wu Ling San
Points	LI-11, REN-12, SP-9, ST-36, ST-44, UB-20 For Damp-Heat Diarrhea: LI-4, SP-9, ST-25, ST-36, ST-44, UB-25 For Damp-Heat Dysentery: LI-4, LI-11, SP-9, ST-25, ST-37, ST-44

SHAO YIN COLD

Clinical Manifestations	Aversion to Cold Curls up a lot Doesn't like to talk Tired (disoriented) Fatigue Constant somnolence Sleeping with the knees drawn up to the chest Generalized edema No spirit Dull Shen Cold extremities Aching and heaviness in the extremities Diarrhea or loose stools or undigested food Clear, frequent urine Nocturia Oliguria Lower back pain Maybe nausea (wants to vomit but can't) Abdominal pain which is relieved by warmth and pressure No thirst Cough with thin, watery mucus Likes warm drinks Severe edema in chest Palpitations Dizziness T: Pale, swollen and moist C: White and greasy P: Deep and weak or Slow, deep and weak
Treatment Principle	Restore Yang Reverse inward energy Expel Cold
Herb Formulas	Si Ni Tang Zhen Wu Tang Jin Gui Shen Qi Wan If Cold is less severe: Wu Zhu Yu Tang Chinese Patent Medicines: Jin Gui Shen Qi Wan
Points	Moxa DU-4, DU-20, KI-3, KI-7, LI-4, REN-4, REN-6, REN-8, SP-6, ST-36. UB-15, UB23 For loss of consciousness or shock: DU-26, KI-1 KI-3, KI-7, SP-6, SP-9, moxa or moxa needle REN-6, REN-9, ST-36, UB-20, B23

LUNG AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Unproductive cough or Scanty, sticky phlegm or Sometimes blood-streaked sputum Dry mouth Dry throat Low back and knees sore and weak "Steaming Bone" tidal fever Night sweats Malar flush Maybe hoarse voice Maybe pain in shin, foot, and heel Sterility Spermatorrhea T: Red and dry C: None P: Thready and rapid
Treatment Principle	Nourish Yin Moisten the Lungs Reinforce the Kidneys
Herb Formulas	Yang Yin Qing Fei Tang + Da Bu Yin Wan
Points	HT-6, KI-3, KI-6, LU-6, LU-9, UB-13, UB-23

DAMP-HEAT INJURES THE SPLEEN

Clinical Manifestations	Anorexia Abdominal distention and discomfort Suffocating sensation in the chest Epigastric mass Maybe abdominal pain on palpation Yang jaundice (sclera and skin are bright yellow) Dislike of oily foods Nausea Vomiting Lassitude Scanty, dark urine Maybe thirst or thirst with no desire to drink Diarrhea with foul smell or Constipation Fever Sweet sticky taste or bitter taste in mouth T: Pink C: Thick, yellow and greasy (maybe sticky) P: Soft and rapid
Treatment Principle	Clear Heat Benefit Dampness
Herb Formulas	Yin Chen Wu Ling San
Points	LI-11, REN-12, SP-9, ST-36, ST-44, UB-20 For Damp-Heat Diarrhea: LI-4, SP-9, ST-25, ST-36, ST-44, UB-25 For Damp-Heat Dysentery: LI-4, LI-11, SP-9, ST-25, ST-37, ST-44

SPLEEN QI DEFICIENCY WITH DAMPNESS AND QI STAGNATION

Clinical Manifestations	Generalized edema Sensation of heaviness, distention and fullness in the epigastrium and abdomen Labored, heavy breathing Urinary difficulty Asthma Chest distention General edema in summer Gasping Rapid breathing T: Normal C: White and slippery P: Thready and moderate or slipper
Treatment Principle	Resolve Dampness Reduce edema Regulate Qi Strengthen the Kidneys Reduce swelling
Herb Formulas	Wu Pi Yin Wu Pi San
Points

SPLEEN DEFICIENCY EDEMA

Clinical Manifestations	Edema in limbs, especially lower limbs Maybe anasarca Maybe abdominal distention Loose stools Physical and mental fatigue T: Pale C: White and moist P: Soft and even
Treatment Principle	Warm Yang Strengthen the Spleen Benefit Qi Move water
Herb Formulas	Shi Pi Yin Wu Ling San
Points	REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Body cold Limbs icy Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria Severe: Abdominal ascites T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce the Spleen and Kidneys
Herb Formulas	Zhen Wu Tang With water flooding: Shi Pi Yin
Points	Moxa or moxa needle REN-4, REN-12, SP-6, SP-9, ST-36, UB-20, UB-23

PHLEGM OBSTRUCTS THE HEART ORIFICE: EXHAUSTION SYNDROME

Clinical Manifestations	Sudden collapse with loss of consciousness Mouth open and hands relaxed Eyes closed Limbs cold Snoring Perspiration ("flows like oil") Incontinence of urine and feces T: Not described P: Minute and thready - about to collapse or Superficial and big but with no root (with a red face)
Treatment Principle	Support Zheng Qi Consolidate Exhaustion Strengthen Qi Return Yang
Herb Formulas	Shen Fu Tang Di Huang Yin Zi Du Shen Tang
Points	Moxa REN-4, REN-6, REN-8, ST-36

HEART QI DEFICIENCY

Clinical Manifestations	Palpitations Shortness of breath (especially on exertion) Excessive perspiration (in daytime) Symptoms worse after exertion or when tired Facial pallor Fatigue Weakness Suffocating sensation in chest T: Pale and swollen C: White P: Weak or Big and weak or Intermittent
Treatment Principle	Reinforce and Strengthen Heart Qi
Herb Formulas	Si Jun Zi Tang Bao Yuan Tang Zhi Gan Cao Tang
Points	HT-7, PC-6, REN-6, REN-14, REN-17, ST-36, UB-15

HEART YANG DEFICIENCY

Clinical Manifestations	Palpitations Shortness of breath Excessive perspiration (daytime) Above symptoms worse after exertion or when tired Cold limbs Fatigue Weakness Maybe chills Cyanosis Suffocating sensation in chest Depression Facial pallor T: Pale and swollen C: White P: Thready and weak or Knotted or Intermittent
Treatment Principle	Warm and Clear Heart Yang
Herb Formulas	Bao Yuan Tang Gui Zhi Gan Cao Long Gu Mu Li Tan Gua Lou Xie Bai Bai Jiu Tang
Points	Moxa or moxa needle DU-25, HT-5, HT-7, HT-8, PC-3, PC-4, PC-5, PC-6, PC-7, REN-14, REN-17, SP-6, ST-36, UB-15

HEART YANG EXHAUSTION: FAINTING WITH COLD LIMBS

Clinical Manifestations	Palpitations Shortness of breath Excessive perspiration (daytime) Above symptoms worse after exertion or when tired Fatigue Weakness Maybe chills Cyanosis Suffocating sensation in chest Depression Facial pallor All four limbs cold Watery stools with undigested food Maybe loss of consciousness T: Pale and swollen C: White P: Thready and weak or Knotted or Intermittent
Treatment Principle	Return Yang Relieve contravection
Herb Formulas	Si Ni Tang
Points	Moxa or moxa needle DU-25, DU-26, KI-1, PC-6, PC-9, REN-4, REN-6, REN-8, ST-36

HEART YANG EXHAUSTION: YIN FLOURISHING MASKED BY YANG

Clinical Manifestations	Body hot but desires warm bedclothes Feeling of thirst with no desire to drink Vomiting immediately after drinking Agitation Face and cheeks flushed Watery stools with undigested food P: Minute (on the point of collapse)
Treatment Principle	Warm Cold Return Yang Clear Communication between the Inside and Outside
Herb Formulas	Tong Mai Si Ni Tang
Points	Moxa or moxa needle DU-25, DU-26, KI-1, PC-6, PC-9, REN-4, REN-6, REN-8, ST-36

HEART YANG EXHAUSTION: VANQUISHED YANG

Clinical Manifestations	Palpitations Shortness of breath Drenched with perspiration Above symptoms worse on exertion or when tired Four limbs cold Cyanosis of mouth and lips Faint, weak respiration P: Minute (on the point of collapse)
Treatment Principle	Return Yang Consolidate Exhaustion
Herb Formulas	Shen Fu Tang
Points	Moxa or moxa needle DU-25, DU-26, KI-1, PC-6, PC-9, REN-4, REN-6, REN-8, ST-36

HEART YANG NOT VIGOROUS: WATER QI INSULTS THE HEART WITH KIDNEY YANG DEFICIENCY

Clinical Manifestations	Edema of whole body particularly at and below the waist Pitting edema Low back pain, aching and heaviness Abdominal distention with full sensations Oliguria Cold limbs Face gray and congested or pale Feeling nervous and cold with mental weariness In severe cases: Ascites Edema of scrotum T: Pale and swollen C: Thin, white or Thick, white and sticky P: Deep and thready With Water Flooding the Lungs: Cough with copious, thin watery phlegm Asthma with phlegmy sound (wheezing) Dyspnea Facial edema Edema of limbs Dysuria T: Pale and swollen C: White and moist or White and greasy P: Superficial and tight
Treatment Principle	Warm Kidneys Promote diuresis
Herb Formulas	Zhen Wu Tang
Points	KI-7, REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23, UB-39 DU-4, KI-3, KI-7, PC-5, PC-6, REN-4, REN-6, REN-9, REN-17, SP-6, SP-9, UB-15, UB-23

HEART BLOOD DEFICIENCY

Clinical Manifestations	Palpitations Irritability Anxiety Easily startled Insomnia Much dreaming Poor memory Dizziness Pale face and lips T: Pale P: Thready and weak
Treatment Principle	Nourish Heart Blood Calm the Heart and Shen
Herb Formulas	Dang Gui Bu Xue Tang Gui Pi Tang Suan Zao Ren Tang
Points	HT-7, PC-6, REN-4, REN-14, SP-6, ST-36, UB-15, UB-17, UB-20, Rice-grain moxa SP-1

HEART BLOOD AND SPLEEN QI DEFICIENCY

Clinical Manifestations	Palpitations Insomnia Much dreaming Easily startled Poor memory Four limbs tired and lethargic Loss of appetite Distention and fullness of the epigastrium and abdomen Loose stools Sallow complexion Copious, pale menses Uterine bleeding or Light menstrual flow or Amenorrhea T: Pale P: Thready and weak
Treatment Principle	Reinforce and Benefit the Heart and Spleen
Herb Formulas	Gui Pi Tang
Points	HT-7, REN-4, SP-1, SP-6, ST-36, UB-15, UB-20

HEART AND LUNG QI DEFICIENCY

Clinical Manifestations	Palpitations Shortness of breath Asthma Soft weak cough Prolonged bouts of coughing with dyspnea Expectoration of clear, watery Phlegm Suffocating sensation in the chest Spontaneous, weak perspiration All of the above manifestations are exacerbated by exertion Shiny white complexion Weak voice Catches colds easily T: Pale C: Thin and white P: Weak or Thready and weak
Treatment Principle	Reinforce and Benefit Heart and Lung Qi
Herb Formulas	Bao Yuan Tang Si Jun Zi Tang Sheng Mai San With Blood and Phlegm Stagnation: Sheng Yu Tang + Xiao Xian Xiong Tang
Points	HT-7, LU-9, REN-17, UB-13, UB-15

HEART AND KIDNEY YANG DEFICIENCY WITH PHLEGM ACCUMULATION

Clinical Manifestations	Cold extremities Spontaneous perspiration Weak breathing Shortness of breath Dizziness An extremely pale face Intolerance of Cold Cold abdominal pain Loose stools Upset stomach Lung abscess Coughing Wheezing Fullness and distention in the chest Profuse Phlegm and saliva Dysuria Edema Nasal congestion Clear, watery rhinorrhea Oliguria Loss of taste and smell Dyspnea Edema of the face and eyes Insomnia T: Pale and Swollen C: White and greasy P: Slippery or Minute (almost imperceptible)
Treatment Principle	Restore Yang Strongly tonify Yuan Qi Rescue Qi from collapse due to Vanquished Yang Drain the Lungs Move s Fluids Drive out Phlegm Stop cough Calm wheezing
Herb Formulas	Shen Fu Tang + Ting Li Da Zao Xie Fei Tang With Water Accumulation: Zhen Wu Tang + Wu Ling San
Points

HEART AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Insomnia with much dreaming Spermatorrhea with erotic dreams Premature ejaculation Irritability Easily startled Palpitations Poor memory Dizziness Tinnitus Low back soreness Legs weak Tidal fever Night sweats Dry mouth Red cheeks Urine short and red T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Reduce Fire Make Heart and Kidney communicate
Herb Formulas	Jiao Tai Wan Tian Wang Bu Xin Dan Liu Wei Di Huang Wan With Fire Rising: Dao Chi San
Points	HT-7, KI-3, PC-6, PC-7, UB-15, UB-23

LIVER AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	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
Herb Formulas	Qi Ju Di Huang Wan Da Bu Yin Wan Liu Wei Di Huang Wan With Fire Flaring: Zhi Bai Di Huang Wan
Points	KI-3, LIV-3, SP-6, UB-18, UB-23

KIDNEY YANG DEFICIENY WITH WATER FLOODING

Clinical Manifestations	Cardiac edema Generalized edema Sensation of heaviness, distention and fullness in the epigastrium and abdomen Labored, heavy breathing Urinary difficulty Asthma Chest distention General edema in summer Gasping Rapid breathing T: Normal C: White and slippery P: Thready and moderate or slipper
Treatment Principle	Resolve Dampness Reduce edema Regulate Qi Strengthen the Kidneys Reduce swelling
Herb Formulas	Wu Pi Yin Zhen Wu Tang
Points	KI-7, REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23, UB-39

KIDNEY YIN DEFICIENCY WITH FIRE FLARING

Clinical Manifestations	Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of the low back Spermatorrhea or Premature ejaculation Aching in the bones Aching in the leg and heel Dry mouth Thirst Night sweats Five Sole Heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and/or Constipation Urine short and red Heightened libido If Heart Fire also Flares: Insomnia Frequent dreams Palpitations If Liver Yang also Rises: Dizziness Blurred vision T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Subdue Fire
Herb Formulas	Zhi Bai Di Huang Wan
Points	KI-1, KI-2, KI-3, KI-6, KI-9, KI-10, REN-4, SP-6, UB-23 If Heart Fire also Flares: HT-7, PC-7, UB-15 If Liver Yang also Rises: LIV-3, UB-18

YANG DEFICIENCY WITH INTERNAL COLD-DAMP

Clinical Manifestations	Lower abdominal pain and Cold Abdomen feels chilled Aching bones and joints Muscle ache Whole body pain Aversion to Cold, especially at the back Cold limbs No Thirst Lower abdominal pain and Cold Abdomen feels chilled Maybe fever No thirst T: Normal C: White and slippery P: Deep and faint or Forceless or Choppy and slow or Wiry
Treatment Principle	Dispel Cold Warm the channels Assist Yang Dispel Dampness Relieve pain
Herb Formulas	Fu Zi Tang
Points

QI AND BLOOD STAGNATION WITH WATER ACCUMULATION IN THE LEGS

Clinical Manifestations	Pitting edema Numbness Fatigue Weakness in the legs Palpitations Distention beneath the Heart Constipation Dyspnea T: Blue purple maybe with purple or red spots C: White P: Choppy or Wiry and choppy
Treatment Principle	Dispel water accumulation Disperse Qi and Blood Stagnation Relieve constipation
Herb Formulas	Jiu Wei Bing Lang Jia Wu Fu Tang
Points

TURBID DAMPNESS IN THE SAN JIAO

Clinical Manifestations	General edema of the body and extremities Dysuria Oliguria Orthopnea Pitting edema Dyspnea Gasping Anorexia Abdominal fullness and pain T: Thick C: White and thick P: Slow or Wiry
Treatment Principle	Dispel Stagnant Water Dry Dampness Eliminate water from the Lungs Harmonizes the Spleen Relieve edema Move Qi
Herb Formulas	Dao Shui Fu Ling Tang
Points

WATER ACCUMULATION IN THE UPPER JIAO

Clinical Manifestations	Shortness of breath Increased dyspnea when lying down Asthma Abdominal pain Chest and epigastric fullness and distention A dark facial complexion Scanty urination Edema P: Deep and tight
Treatment Principle	Activate Water circulation to eliminate Stagnation Descend Qi
Herb Formulas	Mu Fang Ji Tang
Points

TAN YIN

Clinical Manifestations	Anorexia Edema Abdominal distention Chest and hypochondriac distention Dizziness Nausea Vomiting Vertigo Thirst with no desire to drink Maybe no thirst Palpitations Shortness of Breath T: Normal C: Thick and slippery P: Slippery, full and maybe wiry
Treatment Principle	Warm and Dissolve Tan Yin
Herb Formulas	Ling Gui Zhu Gan Tang Wu Ling San With indigestion, diarrhea and decreased urination: Si Ling San With jaundice and dysuria: Yin Chen Wu Ling San
Points	PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23

YI YIN

Clinical Manifestations	Heaviness Swollen extremities Pain in the extremities Sluggish urination Aversion to Cold Fever Anhidrosis Cough Asthma with Phlegm T: Swollen C: Greasy and white P: Tight and wiry
Treatment Principle	Warm Yang Benefit water Dispel exogenous pathogens
Herb Formulas	Wu Ling San With indigestion, diarrhea and decreased urination: Si Ling San With jaundice and dysuria: Yin Chen Wu Ling San
Points	Moxa only PC-6, SJ-6, SP-6, SP-9, ST-40, UB-13, UB-20, UB-23

ZHI YIN

Clinical Manifestations	Cough Asthma Shortness of breath which is worse when lying down Abdominal distention with water retention Edema in the lower extremities Facial edema T: White bubbles C: Thick, greasy and white P: Thready
Treatment Principle	Regulate the Lungs Purge Yin
Herb Formulas	Wu Ling San Xiao Qing Long Tang
Points	LU-7, SP-6, SP-9, UB-13

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