Oral Cavity Disorders: a TCVM Approach

1. Oral Cavity Disorders: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

2. 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 Oral Cavity Diseases (Western)

3. TCM Spleen Disease Spleen Physiology Spleen Pathology Gingivitis/Stomatitis

4. Sound song Emotion sympathy Climate humid Season late summer Direction center Opening lips/gums Body Part muscles Zang/Fu SP/ST Earth

5. Governs Transportation & Transformation Food & Water Controls Blood Dominates the Muscles Opens in Mouth Lips & Gums (ST) TCM SPLEENPhysiology

6. TCM 24 Hour Clock

7. Earth BALANCED DEFICIENT EXCESS

8. Spleen Pathology

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

10. 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

11. Spleen Pathology Cold Environmental Conditions Cold Food or Drink Cold-Damp in Spleen Disharmony of Qi Flow Transform & Transport Disorder

12. Spleen Pathology Accumulated Heat & Damp Damp Hot Environmental Conditions Damp Hot Food or Drink Damp-Heat in Spleen Disharmony of Qi Flow Transform & Transport Disorder

13. Spleen Qi Deficiency Illness Overeating Overwork Starvation Under Work Spleen Qi Deficiency Disturbed Qi Flow Failure to Transform & Transport

14. Spleen Not Controlling Blood Prolonged Spleen Qi Deficiency Spleen Fails to Hold Blood Hemorrhage General Signs Chronic Hemorrhage

15. Spleen Qi Sinking Illness Overeating Overwork Starvation Under Work Chronic Spleen Qi Deficiency Failure of Holding Chronic Diarrhea Prolapses Incontinence

16. Spleen Pathology Cold Food or Drink Chronic Spleen Qi Deficiency Spleen Yang Deficiency Disharmony of Qi Flow Transform & Transport Disorder Yang Deficiency Signs

17. Stomach Pathology Cold Environmental Conditions Cold Food or Drink Cold in Stomach Disharmony of Qi Flow Transform & Transport Disorder Inhibition of Yang

18. 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

19. Stomach Pathology Damp Hot Environmental Conditions Hot Dry Food or Drink Heat in Stomach Heat Signs Transform & Transport Disorder

20. Pathogenic Heat Yin Deficiency Stomach Heat channel grandchild Gums organ child Cystitis Ulcer Colitis Stomach Heat

21. Stomach Food Stagnation Indigestible Food Overeating Retention of Food in Stomach Disturbed Qi Flow Failure to Transform & Transport

22. Stomach Yin Deficiency Stress Liver Qi Stagnation Chronic Febrile Illness Transformation to Heat/Fire Impairment of Body Fluids Stomach Yin Deficiency

23. 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

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

25. 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

26. 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

27. 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

28. 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)

29. 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)

30. 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

31. 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

32. 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-veggies TCVM Approach