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Oral Cavity Disorders: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA 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 TCM Spleen Disease • • • Spleen Physiology Spleen Pathology Gingivitis/Stomatitis Earth •Sound •song •Emotion •sympathy •Direction •center •Opening •lips/gums •Climate •Body Part •humid •muscles •Season •late summer •Zang/Fu •SP/ST TCM SPLEEN Physiology •Governs Transportation & Transformation •Food & Water •Controls Blood •Dominates the Muscles •Opens in Mouth •Lips & Gums (ST) TCM 24 Hour Clock LIV GB TH 1-3 AM LU 3-5 AM LI 5-7 11-1AM 9-11 PM PC 7-9 PM KID BL ST 7-9 AM SP 9-11 AM HT 5-7 PM 3-5 PM SI AM 1-3 PM 11-1 PM Spleen Pathology Spleen Pathology • Damp is the Enemy of the Spleen • Damp-Cold • Damp-Heat • Spleen Qi Deficiency with Damp 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 Spleen Pathology Cold Food or Drink Cold Environmental Conditions Cold-Damp in Spleen Disharmony of Qi Flow Transform & Transport Disorder Spleen Pathology Damp Hot Food or Drink Accumulated Heat & Damp Damp Hot Environmental Conditions Damp-Heat in Spleen Disharmony of Qi Flow Transform & Transport Disorder Spleen Qi Deficiency Illness Overeating Overwork Starvation Under Work Spleen Qi Deficiency Disturbed Qi Flow Failure to Transform & Transport Spleen Not Controlling Blood Prolonged Spleen Qi Deficiency Spleen Fails to Hold Blood Hemorrhage General Signs Chronic Hemorrhage Spleen Qi Sinking Illness Overeating Overwork Starvation Under Work Chronic Spleen Qi Deficiency Failure of Holding Chronic Diarrhea Prolapses Incontinence Spleen Pathology Cold Food or Drink Chronic Spleen Qi Deficiency Spleen Yang Deficiency Disharmony of Qi Flow Transform & Transport Disorder Yang Deficiency Signs Stomach Pathology Cold Environmental Conditions Cold Food or Drink Cold in Stomach Disharmony of Qi Flow Transform & Transport Disorder Inhibition of Yang Stomach Cold Cold Food & Drink Cold Environment Stomach Cold Receiving & Decomposing Anorexia Cold Signs Altered Qi Flow Lassitude Cold Ear/Nose Hypersalivation Pale-Purple Tongue Deep-Slow Pulse Stomach Pathology Damp Hot Environmental Conditions Hot Dry Food or Drink Heat in Stomach Heat Signs Transform & Transport Disorder Stomach Heat Pathogenic Heat Yin Deficiency Stomach Heat channel Gums organ grandchild child Cystitis Ulcer Colitis Stomach Food Stagnation Overeating Indigestible Food Retention of Food in Stomach Disturbed Qi Flow Failure to Transform & Transport Stomach Yin Deficiency Stress Liver Qi Stagnation Chronic Febrile Illness Transformation to Heat/Fire Impairment of Body Fluids Stomach Yin Deficiency 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 Meridian Theory • Oral cavity has two main channels that influence the teeth and gums • Large Intestine meridian • Stomach meridian 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 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 •Oral Exam: Putrid odor, upper and lower arcade have severely inflamed gingiva, with spontaneous bleeding, minimal calculus formation •Lab Data: Elevated WBC, FELV/FIV=Neg •Diagnosis: Hemorrhagic gingivitis •Treatment: Clindamycin 25mg PO BID x 10 •Dental prophylaxis followed by Clavamox 62.5 mg BID x 10 TCVM Exam & Diagnosis •Constitution: Water/Wood •Tongue: body=reddish 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) 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) 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 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 TCVM Approach •Exam: •Treatment Stategy: •Constitution- Water •Tongue- Violet, dry, no coat •Pulse- Deep, thready, and quick •Nourish Stomach Yin and Clear Heat •AP= CV 12 (aqua); SP 3,6; ST 36,44; LI 4,11 •Herbs= Qing Wei San •Gums- dry/breath scorched •Topical= Aloe Gel •Coat Quality-Dry •Diet: Fresh cooked food/ fish-pork-beef-eggsveggies