Oral Cavity Disorders: a TCVM Approach

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Oral Cavity Disorders a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

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Oral Cavity Diseases (Western)

• Local damage
• Electric shock
• Chemical damage
• Thermal damage
• Periodontitis
• Tooth tarter
• Systemic disease
• Metabolic disease
• Nutritional disease
• Immune disease
• Infectious disease

• Treatment
• Remove offending cause
• Steroids
• Antibiotics
• Clean teeth

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TCM Spleen Disease

• Spleen Physiology
• Spleen Pathology
• Gingivitis/Stomatitis

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Earth

• Sound
• song
• Emotion
• sympathy
• Climate
• humid
• Season
• late summer

• Direction
• center
• Opening
• lips/gums
• Body Part
• muscles
• Zang/Fu
• SP/ST

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TCM SPLEEN Physiology

• Governs Transportation Transformation
• Food Water
• Controls Blood
• Dominates the Muscles
• Opens in Mouth
• Lips Gums (ST)

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TCM 24 Hour Clock
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Earth
BALANCED
DEFICIENT
EXCESS
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Spleen Pathology
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Spleen Pathology

• Damp is the Enemy of the Spleen
• Damp-Cold
• Damp-Heat
• Spleen Qi Deficiency with Damp

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Spleen Pathology
Usually combination of excess deficiency
External or Internal Pathogen
Damp-Heat
Damp-Cold
Obstructs Spleen Qi Flow
Spleen fails to Transform Transport Gu Qi
Spleen Qi Deficiency
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Spleen Pathology
Cold Environmental Conditions
Cold Food or Drink
Cold-Damp in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
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Spleen Pathology

Accumulated Heat Damp
Damp Hot Environmental Conditions
Damp Hot Food or Drink
Damp-Heat in Spleen
Transform Transport Disorder
Disharmony of Qi Flow
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Spleen Qi Deficiency
Illness
Overeating
Overwork
Starvation
Under Work
Spleen Qi Deficiency
Disturbed Qi Flow
Failure to Transform Transport
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Spleen Not Controlling Blood
Prolonged Spleen Qi Deficiency
Spleen Fails to Hold Blood
Hemorrhage
Chronic Hemorrhage
General Signs
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Spleen Qi Sinking
Illness
Overeating
Overwork
Starvation
Under Work
Chronic Spleen Qi Deficiency
Failure of Holding
Chronic Diarrhea Prolapses Incontinence
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Spleen Pathology
Cold Food or Drink
Chronic Spleen Qi Deficiency
Spleen Yang Deficiency
Transform Transport Disorder
Disharmony of Qi Flow
Yang Deficiency Signs
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Stomach Pathology
Cold Environmental Conditions
Cold Food or Drink
Cold in Stomach
Transform Transport Disorder
Disharmony of Qi Flow
Inhibition of Yang
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Stomach Cold
Cold Food Drink
Cold Environment
Stomach Cold
Receiving Decomposing
Cold Signs
Anorexia
Altered Qi Flow
Cold Ear/Nose Hypersalivation Pale-Purple
Tongue Deep-Slow Pulse
Lassitude
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Stomach Pathology

Damp Hot Environmental Conditions
Hot Dry Food or Drink
Heat in Stomach
Heat Signs
Transform Transport Disorder
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Stomach Heat
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Stomach Food Stagnation
Indigestible Food
Overeating
Retention of Food in Stomach
Disturbed Qi Flow
Failure to Transform Transport
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Stomach Yin Deficiency
Stress
Liver Qi Stagnation
Chronic Febrile Illness
Transformation to Heat/Fire
Impairment of Body Fluids
Stomach Yin Deficiency
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How to Use Acupuncture for Gingivitis in Small
Animal Practice
Zang Fu Physiology

• Teeth correspond to bone
• Bone is controlled by the kidney
• Malocclusion, oligodontia are examples of Kidney
  Jing Deficiency
• Gums are influenced by the stomach

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Meridian Theory

• Oral cavity has two main channels that influence
  the teeth and gums
• Large Intestine meridian
• Stomach meridian

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Pattern Diagnosis

• Stomach Heat Pattern
• Excess pattern, seen more often in younger
  animals (cats)
• Stomach Yin Deficiency Empty Heat
• Stomach loves moisture
• Moisture balances Yang function
• Lack of Yin (fluid) allows Yang Fire to rise

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Stomach Heat Pattern

• Fluffy 4yr FS DSH
• Primary complaint Bad breath, eating poorly
• History Stray, no vetcare, dry food diet
• Exam Body coat condition-normal vital
  signs-WNL

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

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TCVM Exam Diagnosis

• Constitution Water/Wood
• Tongue bodyreddish purple no coat
• Pulse Bilaterally superficial rapid
• Body Condition Dry nose Body Temp Normal
• Mouth Stink smell bloody red gums
• Pattern DX Stomach Heat (excess condition)

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TCVM Treatment Strategy

• Clear the Stomach Heat, Cool the Blood, nourish
  Stomach Yin
• Acupuncture Point Selection
• GV 14 Tian Ping ST 4,6,34,44 LI 4,11 SP 10
• 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)

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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

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Stomach Yin Deficiency Empty Heat Pattern

• Tess 10 yr, FS, Mix Breed
• Primary 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 quickly
• Western Dx / Tx Gingivitis with periodontal
  deterioration. Requires 6 month recall for
  prophylaxis

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TCVM Approach

• Exam
• Constitution- Water
• Tongue- Violet, dry, no coat
• Pulse- Deep, thready, and quick
• Gums- dry/breath scorched
• Coat 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-veggi
  es