bob doane's easy approach to pulse & herbs...clinical manual of oriental medicine, 2nd...

Bob Doane's Easy Approach to Pulse & Herbs

by Robert Doane, L.Ac.

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Bob Doane's Easy Approach to Pulse & Herbs

Robert DoaneEAMP, L.Ac., Dipl. C.H.

Owner of the Acupuncture & Wellness Center, P.S.

Lotus Institute Of Integrative MedicineTel: (626) 780-7182 Fax: (626) 609-2929

Website: www.eLotus.org Email: [email protected]

© Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine

Course Outline

• Commonly seen pulse deviations on the right hand• Right cun – Lung / Large Intestine

– Normal pulse– Deviations

• Right guan – Spleen / Stomach– Normal pulse– Deviations

• Right chi – Kidney (Urinary Bladder functions)– Normal pulse– Deviations

Course Outline (con’t)

• Commonly seen pulse deviations on the left hand• Left cun – Heart / Small Intestine

– Normal pulse– Deviations

• Left guan – Liver / Gallbladder– Normal pulse– Deviations

• Left chi – Kidney (Reproductive functions) – Normal pulse– Deviations

• Extra Meridian pulses distal to the cun position

RIGHT CUN – Lung / Large Intestine

RIGHT CUNLung / Large Intestine

Review of normal right cun – Lung pulse6 deviations of the right cun

1. Superficial and Forceful or Jumpy2. Deep and Weak 3. Tent pulse4. Constricting/Pulse within a pulse5. Dispersing pulse6. Short pulse

Right cun – Lung / Large IntestineNormal pulse• Normal pulse: Buoyant

– Buoyant pulse is soft and strong– Pushes up against the fingers throughout the

superficial, mid, and deep levels, but softer at mid and deep levels

• Lung should be balance of dryness & dampness– Dry = Slightly floating– Moist = Slightly deep




Right cun – Lung / Large IntestineSuperficial and Forceful or Jumpy• Pulse sign: Superficial and

Forceful or Jumpy– Jumpy = forceful pulse that

lacks rhythm; Impetuous– If the pulse is high in amplitude, use colder heat

clearing herbs. – If lower in amplitude, but still forceful, that means

there is also stagnation involved.

Right cun – Lung / Large IntestineSuperficial and Forceful or Jumpy

• Indications– Upper respiratory infection (bacterial), allergy– Check right chi…why?

• Right chi is both UB and neck/shoulder taiyang channel.• Wind invades taiyang channel• If long, wiry, strong on right chi = wind

– **For all wind invasions, at least the first week, exterior releasing herbs MUST be used.

• Ge Gen Tang 15% (If Du14 is cool or cold)• Yin Qiao San 15% (If Du14 is slightly warm)

– If T1/Ren 22 is hot: more heat and likely asthma– If T1/Ren 22 is cold: cold is present; likely bronchitis


• Indications (con’t)– If there is cough or to prevent coughing, add

Qing Fei Tang or Dun Sou San 20%– How to differentiate dry vs. productive cough?

• Dry = (R) cun very floating and jumpy – The more floating, the more dry the condition

• Productive with phlegm = (R) cun is deep


• Herbal Rx if there is phlegm– Qing Fei Tang 20% for cough or to prevent cough– Ge Gen Tang 15% to release exterior (most 30% if Du14 is cold) – Herbal ABX 30% for infection (more important to clear

infection than to release the exterior, so higher %)– Astringent Complex 20% for phlegm and cough

• The longer the certain condition, the higher % used Astringent Complex (Bai Wei, He Zi, Wu Bei Zi, Tian Hua Fen, Ce BaiYe – equal portions)

– Modification• Ding Chuan Tang for cough w/ deep phlegm• Hai Ge Fen for cough 15%


• Herbal Rx if there is phlegm– Modification cont’d

• If it is pneumonia or a more serious cough/phlegm problem

Jin Yin Hua – 15 Yi Yi Ren – 10Shi Gao – 15 Lian Qiao – 10Lu Gen – 15 Tao Ren – 5Gan Cao – 5 Dong Gua Zi – 10Astringent Complex– 5 Xing Ren – 10


• Dry cough usually combined with ST-fire• Need to moisten dry and clear ST-fire

– Qing Zao Jiu Fei Tang– Gan Lu Yin to replace Ge Gen Tang 20%– Qing Fei Tang 20%– Herbal ABX 20-30%

• Which taste moistens dryness? – Acrid, cold (for dry fire) and salty (for fire)

• Bai Wei, Zhen Zhu Mu, Xuan Shen, Shi Jue Ming, Da Qing Ye




Formulas for Exterior ConditionsSummary• Use 30% formula to release exterior

– Yin Qiao San and Ge Gen Tang• If T1 is cold, use Ge Gen Tang• If T1 is extremely cold, then use Xiao Chai Hu

Tang or Gui Zhi Tang• If Ren 22 is hot, use Yin Qiao San

Formulas for Exterior ConditionsSummary

• Nose – needs to be warm and strong to fight against the exterior– If cold, then use more Ge Gen Tang, Xiao Chai Hu Tang

and Gui Zhi Tang– When the nose is cold, start using fresh ginger soup

• Cheeks – same as nose. If cold, then more severe than just the nose.

• If all s/s are hot, but nose, cheeks, or T1 is cold need to use 20-40% Ge Gen Tang or wind-cold dispelling formulas

Formulas to Exterior ConditionsSummary

• Stomach Fire often is associated with exterior heat or wind heat.

• ST 8 hot = Stomach Fire• GB 20 painful = wind-cold; and catching a

cold

Acupuncture Tx for Exterior Conditions

• Target: Nose, lung, and all sinus cavities• Stomach dysfunction (if present):

ST 36,37,41 (bi-lateral)• Nose: LI 1, 2, 3, 4, 11 (bi-lateral)• Lung: LU 5 (bi-lateral) SP 9 (bi-lateral)• Stomach: ST 36 / GB 34

LI 4, 11SP 9 / LV 8SJ 5 / P 6 / LU 9

Right cun – Lung / Large IntestineDeep and Weak

• Pulse sign: Deep and weak with accompanying cold signs and symptoms

• Indications– Upper respiratory infection (Viral)– Flu

Right cun – Lung / Large IntestineDeep and Weak

• Herbal Rx– Pu Ji Xiao Du Yin 20% BEST for viral

infection. (Yin Qiao San is for bacterial infection.)

– Herbal ABX 20%– Qing Fei Tang 20%– Astringent Complex 20%– Ge Gen Tang 20%– Yu Ping Feng San 10%




Astringent Herbs for Asthma

• Fu Hai Shi: for more dampness• Hai Ge Fen: for more heat• Yuan Zhi: for more phlegm• Loss of voice: Add He Zi 15% and Jie Geng Tang

20% (contains Jie Geng 10% and Gan Cao 10%) • Can also use Shi Wei 6%, She Gan 6%,

Jie Geng 6%

Acupuncture Tx for Asthma

• Target: Diaphragm and Lungs• Tx: LU 5 x3

SP 9 x3ST 36 x3 All bi-lateralLI 10, 11P 6, 7LU 1 (front mu)

Acupuncture Tx for Weak Immune System

• Target: Thyroid and Lung• Tx: LU 1 (front mu)

ST 36, 37, 41SP 8, 9LU 9LI 5SJ 4or All yin points at wrist & ankle

• Important: Pull needles after 8 – 10 minutes to stimulate sympathetic system.

Right cun – Lung / Large IntestineTent pulse

• Pulse sign: Tent pulse– Convex-shaped pulse

that collapses upon pressure– May be in all positions too

• Indications– Lung qi deficiency– Weak immune system– Nasal allergy

Tent pulse


• Allergies: 3 Types– Acute Wind Cold or Wind Heat– Chronic allergies with Lung Qi Deficiency

• Wind Cold Allergy– Either tent pulse that is more wiry than convex

• Wind Heat Allergy– Tent pulse that is more wiry with stronger jump (can be

slightly convex)


• Herbal Rx: Wind Cold– Cang Er San 30%– Jing Jie 8%– Jie Geng 8%– Fang Feng 8%– Si Ni San 10%– Gan Cao 4%– Bai Zhi 8% (for runny nose) – Astringent Complex 10%– Chan Tui 8%





• Herbal Rx: Wind Heat (or more severe sx’s)– Mu Dan Pi 15%– Lian Qiao 6%– Sheng Ma 5%– Bai Zhi 8% (increase to 15 if runny nose)– Xin Yi Hua 6%– Chuan Xiong 6%– Lu Lu Tong 6%– E Bu Shi Cao 6%– Cang Er Zi 6%– Gan Cao 3%– Chan Tui 5%– Huang Qin 5%

If eyes are affected, add: Ju Hua, Sang Ye, Bai Ji Li


• Herbal Rx (should expect more energy in 1 week)– Bu Zhong Yi Qi Tang– Huang Qi Jian Zhong Tang – Sheng Mai San or Wu Wei Zi and Shan Zhu Yu

• Good for Wei Qi deficiency– If patient currently has allergy or cold signs, use 20%

of the above formulation and rest of the 80% should address the symptoms of cold/allergy


• If Allergies (Wind) plus Lung Qi Deficiency– Yu Ping Fen San 25% Chan Tui 5%– Xin Yi Hua 6% Jie Geng 3%– Dang Shen 6% Bai Zhi 6%– Wu Mei 6% Gan Cao 2%– He Zi 3% Wu Bei Zi 5%

If wheezing, add Di Long 6%, Ku Shen 6%If loose stools, add Ge Gen 15%If blood stasis, add Mu Dan Pi 8%, Dang Gui 5%, Lu LuTong 6%

Right cun – Lung / Large IntestineConstricting/Pulse within a pulse

• Pulse sign: Constricting/Pulse within a Pulse– Straight pulse that feels like

there is a bundle of electric wires (that are thin, straight, tight) within the artery

• Indications– Wind-cold (if superficial) or Lung cold– White sputum / post nasal drip / nasal discharge– Severe constriction

Right cun – Lung / Large IntestineConstricting/Pulse within a pulse

• Herbal Rx– Xiao Qing Long Tang 20%– Si Ni Tang (in winter or cold climate area) 20% the most– Openers: Dang Gui 15% and Sheng Ma 15% or Dang Gui

15% and Chuan Xiong 15%. Either pair would be fine.• Opens up and promotes circulation in the capillaries, small

vessels. Transport the WBC, RBC, etc to the area.

– Astringent Complex 30% for inflammation (to bring all the wiry pulses inside together)

– With headache, add Chuan Xiong Cha Tiao San– If drippy nose, add E Bu Shi Cao and Bai Zhi

Right cun – Lung / Large IntestineDispersing pulse

• Pulse sign: Dispersing pulse– Shapeless pulse where its

border is difficult to perceive – Thick (wide), soft, slow, weak,

and deep (can also be strong)




Right cun – Lung / Large IntestineDispersing pulse• Indications

– Sinus infection– Uncontrollable fever d/t meningitis & other infections– Polyps in Large Intestine– Chest pain due to micro-capillary bleeding leading to

dead blood in the chest• Causes include:

– Recent traumatic chest injury– Drinking cold/ice water on a hot day or after exercise– Holding breath for too long– Lifting heavy objects/weights. Weight lifters

Right cun – Lung / Large IntestineDispersing pulse• Herbal Rx

– Circulation SJ. See Clinical Manual of Oriental Medicine for explanation

– After 1 month, replace Circulation SJ with other blood moving formulas: Xue Fu Zhu Yu Tang, Zhe Chong Yin, Fu Yuan Huo Xue Tang.

– If sinus infection, i.e. cheeks are very hot and dispersing pulse will feel firm, use

• Resolve (Lower) 40%• Herbal ABX 15%• Astringent Complex 15% • Huang Lian Shang Qin Wan 15%• Gardenia Complex 15%

Right cun – Lung / Large IntestineDispersing pulse

• **Sports injuries and any dead blood or from operation over a long time will accumulate in the liver. First purge with Tao Ren Cheng Qi Tang. Follow up with Fu Yuan Huo Xue Tang

• Dizziness/Vertigo– Bai Zhu 20%– Ban Xia 20%– Tian Ma 20%– Fu Ling 20%– Ze Xie 20%

Right cun – Lung / Large IntestineShort pulse

• Pulse sign: Short pulse– Convex-shaped pulse

that is shorter than the width of one pulse position, but bigger than a Bean pulse

– Approximately 0.5cm in length• Indications

– Jumpy + superficial = Fire in LI (Constipation w/ dryness)• The more floating more dryness and fire in body

– Diverticulosis / Enteritis


• Indications (con’t)– Amplitude high inflammation = Colitis with or

without diarrhea• Use fire clearing herbs and Astringent Complex

– Wherever the short pulse is found, indicates blockage in that area


• Herbal Rx– Short pulse means blockage

• Determine hardness of pulse – Soft, empty, and can be pushed away – mild condition

such as a soft polyp– Hard – severe condition, may be a stronger obstruction in

the large intestine• Can be a phlegm block in the lung, especially if you

find it in the Yang Wei pulse on the right– This will be Asthma

» Use Ding Chuan Tang for acute symptoms




• Asthma – with a weak and short pulse and a weak Stomach pulse, use:– Zhi Huang Qi 15%– Zhi Gan Cao 3%– Chan Tui 6%– Bai Zhu 6%– Ling Zhi 15%– Dang Gui 5%– Dan Shen 12%– Fang Feng 5%– Astringent Complex 10%– Chen Pi 6%– Ban Xia 6%– Ku Shen 5%


• Asthma – Late onset Asthma with lower back problems, use:– Zhi Huang Qi 15% – Dong Chong Xia Cao 5%– Ling Zhi 12% – Bu Gu Zhi 8% – Shan Zhu Yu 5% – Ku Shen 3%– Tu Si Zi 8% – Fu Ling 6% – Zi Su Zi 8% – Dan Shen 15% – Chen Pi 6%– Astringent Complex 10%– Zhi Gan Cao 3%– Shu Di Huang 12%– Ge Jie 5%

• If cold, add: Fu Zi, Gan Jiang, Rou Gui


Acupuncture Tx for IBS

Target: Entire abdomen above & below navelAll organs of digestion

Tx: LU 9 / LI 5ST 36 / GB 34LI 4 / SJ 5P 6CV 12 (Stomach) LV 14 (Liver)CV 4 (Sm. Int.) ST 25 (Lg. Int.)

RIGHT GUAN – Spleen / Stomach

RIGHT GUANSpleen / Stomach

Review of normal right guan – Spleen pulse5 deviations of the right guan

1. Convex, Forceful, and Superficial2. Wiry, Forceful, and Superficial 3. Wiry, Forceful, and Deep4. Deep and Concave5. Small pulse

Right guan – Spleen / StomachConvex, Forceful, and Superficial• Pulse sign: Convex,

Forceful, and Superficial– Convex = bulging pulse

that has a rounded feeling• Indications

– Acid reflux, H. pylori, bacterial infection• s/s: stomach pain, burning sensation in the abdominal area,

nausea, frequent belching

– If LI-10 feels cold: constitutionally deficient-cold in Stomach, but now has St. fire too

• Add at least 20% warm tonics to the heat-clearing formula




Right guan – Spleen / StomachConvex, Forceful, and Superficial

• Herbal Rx– Astringent Complex 40% (anti-inflammatory formula

for acute and chronic inflammation)– Herbal ABX 40%– Huang Lian Jie Du Tang 20%– Jia Wei Xiao Yao San 20%

Right guan – Spleen / StomachConvex, Forceful, and Superficial

• Check temperature of LI-10 and palm– If different Parasites

• Poor digestion• Sleeping disorders

– Wu Mei Wan• Also for conflicting s/s (20-30%)• Good for KD, ST, and sleeping d/o• Stubborn acid reflux (25-30%)

Right guan – Spleen / StomachConvex, Forceful, and Superficial• For swollen condition

– Add Chai Hu Jia Long Mu Tang• Good if acid reflux is severe• Protects ST lining damage• Also good for acid reflux is Wa Leng Zi and Lu Li in

combination

• If LI-10 is cold constitutionally deficient-cold in stomach, but now has ST-fire – Add An Zhong San 20%

Right guan – Spleen / StomachWiry, Forceful, and Superficial

• Pulse sign: Wiry, Forceful, and Expanding (can be felt on Superficial level)– Wiry = Tight, straight pulse – If strong inflammation w/o bleeding– If empty bleeding

• Indications– Duodenal ulcer – from nervous (look at PC-6)– Stomach pain– Acid reflux– Emotional stress ulcer. LR overacting on SP/ ST


• Herbal Rx– Feng Wei Cao 15% for inflammation of the stomach only – Zhen Ren Huo Ming Yin 20% to stop pain – Chai Hu Jia Long Mu Tang 20%– Astringent Complex 15%– Zhe Chong Yin 15% to stop pain– Huang Lian Jie Du Tang 10-15%– Add Jia Wei Xiao Yao San if too emotional


• If that previous formula does not work then use:– Hu Zhang 15%– Xia Ku Cao 15%– Zhi Zi 15%– Huang Shui Qie 15%– Jia Wei Xiao Yao San 20%– Huang Lian Jie Du Tang 20%





• Jia Wei Xiao Yao San and Yi Gan San are – For emotional aspects of Liver problem. – Both spread Liver qi stagnation and calm the shen– Do not help with the stomach pain.

• Yi Gan San is better than Jia Wei Xiao Yao Sanif the patient also has fast HR or trembling.

• Jia Wei Xiao Yao San is safe for long term use.

Right guan – Spleen / StomachWiry, Forceful, and Deep

• Pulse sign: Wiry, Forceful, and Deep– Wiry = Tight, straight pulse

• Indications– Too much sugar or carbohydrates in diet– Pre-diabetic– May have Type II diabetes

Right guan – Spleen / StomachWiry, Forceful, and Deep

• Herbal Rx– M3 (Xie Huang San, Gan Lu Yin, Huang Lian

Jie Du Tang ) 50% for stomach fire– Wu Mei Wan 20-25%– If there is Kidney fire, use Zhi Bai Di Huang

Wan 30% – If there is Kidney fire but hands are cold, use

Bai Wei Di Huang Wan

Acupuncture Tx for Digestive Problems involving the Liver & Stomach

• Target: Stomach, Liver, Intestines• Tx: ST 25, LV 14, Ren 4, Ren 12

ST 36, 37LV 8GB 34SP 9P 6LU 9 SJ 5LI 4

Right guan – Spleen / StomachDeep and Concave

• Pulse sign: Deep and Concave– Concave = a pulse that is

curved downward– Can feel the curvature

along the sides and bottom

• Indications– Weak stomach – gas, bloating, belching– Chronic superficial gastritis (if pulse is forceful)

Right guan – Spleen / StomachDeep and Concave

• Herbal Rx for Superficial Gastritis– Astringent Complex 25% – GI Care 25%– Herbal ABX 25%– Chai Hu Jia Long Mu Tang 25%– Add Gan Cao 15% if pain is severe

• Not temporary relief – Heals ulcer too • Sweet taste is for thin and tight pulses

– Huang Lian Jie Du Tang 20%– Jia Wei Xiao Yao San 20%– He Zi 15%– Wu Bei Zi 15%– Tian Hua Fen 15%– Bai Wei 15%




Right guan – Spleen / Stomach Small pulse

• Pulse sign: Small pulse– Small pulse is thin and weak– Upon pressure, it disappears

• Indications– LI10 area is cold and muscle feels weak– Middle jiao deficiency – deficient-cold in Stomach– Usually found in very weak people, post surgical,

lupus, etc.

Right guan – Spleen / Stomach Small pulse

• Herbal Rx– An Zhong San for cold stomach– Gui Pi Tang for weak stomach

• Enhances appetite• Changes way of thinking• Can add Jia Wei Xiao Yao San – Great as a pair

to build the middle jiao– Best way to tonify the middle jiao is to change

the diet

Acupuncture Tx for Weak Digestion

• Target: Stomach, Intestines, Pancreas, Liver• Tx: Ren 12, Ren 4

ST 25, LV 4ST 36, GB 34SP 9, LV 8P 6, LU 9SJ 5, LI 4

• Important: Pull needles after 10 minutes and stimulate as you pull.

Formulas for Itchy Skin

• Itchy skin combination #1 – for damp, swollen itchy skin– Dang Gui Nian Tong Tang 60%– Yin Qiao San 20%– Jin Yin Hua 20%

• Itchy skin combination #2 (equal proportions)– Bo He– Chan Tui

• Combination #3– Bai Ji Li– Fang Feng– Chan Tui

Formulas for Itchy Skin

• Itchy skin combination #4 (all equal proportions)– Astringent Complex– Liver DTX– Chai Hu Qing Gan Tang

• Shingles – Wu Bei Zi 15%– He Zi 15%– Tian Hua Fen 15%– Mo Yao 7.5%– Ru Xiang 7.5%– Zhen Men Huo Ming Yin 20%– Lu Feng Fang 20%

RIGHT CHI – Kidney / Urinary Bladder(Neck & Shoulder area)




RIGHT CHIKidney / Urinary Bladder

Review of normal right chi – Kidney pulse6 deviations of the right chi

1. Bird’s beak/Pen tip pulse2. Turtle pulse 3. Scattered pulse4. Taiyang pulse5. Du pulse6. Guitar string/Steel wire pulse or Yinqiao pulse

or Ren pulse

Right chi – Kidney / Urinary Bladder Normal pulse

• Normal pulse: Deep– Deep pulse can only be felt upon pressure– Deeper in level than the cun and guan

positions– Should still have a jump and need strength– Must be lower in level than cun and guan

Right chi – Kidney / Urinary BladderBird’s beak/Pen tip pulse

• Pulse sign: Bird’s beak/Pen tip pulse– Convex-shaped pulse that

is approx. 0.1cm in length– Feels pointy like a pen's tip– Usually hard and cannot be pushed away

with pressure• Indication

– Kidney stones in right ureter

Right chi – Kidney / Urinary BladderBird’s beak/Pen tip pulse

• Herbal Rx– Dissolve (KS)

• Can be used for severe high BP due to kidney problem

**Side note: if BP fluctuates drastically, it’s not arteriosclerosis, it’s caused by the kidneys

Formulas for Kidney Type of High BP

• 1. Kidney stones– Dissolve (KS) – Add Hot or Cold Breaker if there is a cyst in the kidney

• Hot Breaker – Huai Hua, Xuan Shen, Xia Ku Cao• Cold Breaker – San Leng, E Zhu, Wang Bu Liu Xing

– Pulse for cyst – feels bigger than a pen tip• 2. Water metabolism kidney problem; Blockage in ureter

– Shui Ding Xiang 20%– Dan Shen 20%– Xian Feng Cao 20%– Di Long 20%– Li Zhi He 20%

Formulas for Kidney Type of High BP

• 3. Kidney yang deficiency (western kidney) –cold condition– EGFR – filtration rate of kidney is low. – Use Yin Yang Huo 55% + Xian Mao 25% + Si Ni Tang

20%




Acupuncture Tx for Kidney Diseases

• Excess Diseases: Target: Kidneys• Tx: GB 25 (Ren for Kidney Disease)

K 10, 9SJ 8, 7HT 3, P 3LI 11, 10, 9, 8UB 58, 57

• Deficient Diseases: Same points as above but stimulate & remove in 10 minutes

Acupuncture Tx for Bladder Diseases

• Excess Diseases: Target: Bladder & Ureters• Tx: Ren 3

SI 5, 6, 7LU 6, 7, 8, 9UB 59, 60, 40, 58K 3, 4, 5, 6, 7, 10

• Deficient Diseases: Same points as above but stimulate and remove in 10 minutes

Right chi – Kidney / Urinary BladderTurtle pulse

• Pulse sign: Turtle pulse with or without Tail– Convex-shaped pulse that

is 3-D, but flat on the bottom– Tail = thin forceful pulse

extending from the Turtle that is proximal to the chi position

• Indications– 1. NO Tail = soft tissue damage in the shoulder


• Indications (con’t)– 2. With Tail (both neck and shoulder pain)

• Very thin tail (damage to spine & neck – whiplash – bone spur)

• Wider tail (tightness in neck & upper back)

– 3. Both chi = Prostate enlargement, varicocele– More forceful = more inflammation and pain; more

recent the injury; more acute the condition


• Indications (con’t)– Low amplitude = less inflammation; pain may be dull

and intermittent; more chronic and stagnant the condition (more blood stagnation)

• Use more blood movers• Other than Circulation SJ what else can be used?

– Shen Tong Zhu Yu Tang– Shu Jing Huo Xue Tang– Bu Yuan Huan Wu Tang (frozen shoulder)


• Herbal Rx– Soft tissue damage (Turtle pulse with no tail)

• Astringent Complex 60%• Zhen Ren Huo Ming Yin 25%• Ge Gen Tang 15% (channel guiding formula)

– Bone spurs or disk problems (Turtle pulse with tail)• Flex (Spur) see manual for explanation

– Prostate enlargement (Turtle pulse on both chi)• Resolve (Lower) 50%• Astringent Complex 50%




• Headache (migraine) due to neck painChuan Xiong Cha Tiao San 30%Gardenia Complex 30%Ge Gen Tang 20%Flex (Spur) 20%


Right chi – Kidney / Urinary BladderScattered pulse

• Pulse sign: Scattered pulse– Pulse in which its border

is difficult to perceive– Thick (wide), soft, slow,

very weak and deep • Indications

– Frozen shoulder– Past traumatic injuries with dead blood – Must also have numbness of the fingers or arm

because shoulder blocked


• Herbal Rx– Frozen shoulder, dead blood causing upper

body pain• Circulation SJ 30%• Ge Gen Tang 20%• Er Zhu Tang 50%

– If no hypertension can use• Bu Yang Huan Wu Tang 80%• Ru Xiang 10%• Mo Yao 10%


• Herbal Rx– Traumatic injuries

• Circulation SJ 40% • Ge Gen Tang 30%• Flex (Spur) 30%

Right chi – Kidney / Urinary BladderTaiyang pulse

• Pulse sign: Taiyang pulse– Big and long pulse– Straight, thick, expanding,

and forceful in all three levels

– Extends proximally to the chi position– Cun and guan are soft and normal

chi is big and thick


• Indications– Taiyang means coldness

Evil is strong – HeatConstitution is weak – Cold

– Urinary dysfunctions – UTI, burning urination, KD infection or failure.





• Herbal Rx– Urinary dysfunctions

• Ba Zheng San 40%• Herbal ABX 60%

– Hormonal imbalance/conditions with heat s/s• Shan Yao 30%• Zhi Bai Di Huang Wan 20%• Gardenia Complex 50%


• Herbal Rx– Hormonal imbalance/conditions with cold s/s

• Shan Yao 50%• You Gui Wan 20%• Bu Gu Zhi 15%• Jiu Cai Zi 15%

• Salty warm and bitter warm herbs are good to tonify hormones i.e., Bu Gu Zhi, Jui Cai Zi

Right chi – Kidney / Urinary BladderDu pulse

• Pulse sign: Du pulse– Forceful, thick, straight pulse

that extends proximal to the chi position, approximately up 1/2 of the forearm

• Indications– Neck pain, stiffness– Upper body aches and pain


• Herbal Rx– Neck pain

• Gardenia Complex 50% for the inflammation –detoxification• Astringent Complex 30% • Ge Gen Tang 20%

– Upper body pain/joint pain from flu (wind-cold)• Ji Xiang Teng 50% • Dao Di Wu Gong 50%


• Herbal Rx– Migraine / Chronic Headaches

• Chuan Xiong Cha Tiao San 30% • Gardenia Complex 30%• Ge Gen Tang 20%• Flex (Spur) 20%


**Side note• Pulse for Environmental toxin / Heavy

metal poisoning / Multi-chemical sensitivities– 2 Big Kidney Fire + Big Liver Fire




Right chi – Kidney / Urinary BladderGuitar string/Steel wire; Yinqiao; Ren

• Pulse sign: Guitar string/Steelwire pulse or Yinqiao pulse orRen pulse– Guitar string/Steel wire

pulse = straight, thin, tight pulse (more often seen on the left)

– Yinqiao pulse = long, thin, straight, tight pulse that extends proximally to chi position

– Ren pulse = same as Yinqiao pulse, but deeper – closer to the bone – Genital / Reproductive system

Right chi – Kidney / Urinary BladderGuitar string/Steel wire; Yinqiao; Ren

• Indications– Bone spurs or disk problems of the neck

and shoulder area – Severe constriction conditions

– Hemorrhoids; constipation (usually Yinqiao)– Skin allergy – eczema, rash, lesions– Poor peripheral circulation from constriction

LEFT CHI – Kidney / Reproductive Fx(Lower back area)

LEFT CHIKidney / Reproductive Fx

Review of normal left chi – Kidney pulse8 deviations of the left chi

1. Deep and Small pulse2. Bird’s beak/Pen tip pulse 3. Turtle pulse4. Dispersing pulse5. Taiyang pulse6. Du pulse7. Guitar string/Steel wire pulse or Yinqiao pulse8. Ren pulse

Left chi – Kidney / Reproductive FxNormal pulse

• Normal pulse: Deep– Same as right chi

Left chi – Kidney / Reproductive FxDeep and Small pulse

• Pulse sign: Deep and Small pulse– Small = a pulse that is thin and weak– Upon pressure, it disappears

• Indications– Infertility– Low libido – Impotence




Left chi – Kidney / Reproductive FxDeep and Small pulse

• Herbal Rx– You Gui Wan 20%– Ba Wei Di Huang Wan 20%– Ba Ji Tian 15%– She Chuang Zi 15%– Jiu Cai Zi 15%– Yin Yang Huo 15%

Acupuncture Tx for Reproductive Diseases

• Deficiencies: Target: Entire female reproductive area; ovaries, uterus, vagina• Tx: K 11, 12, 13, 14, 15 (Chong Mai)

ST 30Ren 1, 7

(All these points are intersecting points between Ren and Chong Mai vessels)

P 61 GB 34 ST 36SJ 5 LV 8 SP 9LI 4 LU 9

Left chi – Kidney / Reproductive FxBird’s beak/Pen tip pulse

• Pulse sign: Bird’s beak/Pen tip pulse• Indications

– Kidney stones in the left ureter• Herbal Rx

– Dissolve (KS)

Left chi – Kidney / Reproductive FxTurtle pulse

• Pulse sign: Turtle pulse with or without Tail• Indications

– 1. Turtle pulse without tail= Soft tissue damage in the knee.

• If turtle is slightly distal to chi position, soft tissue damage in the hip.

• If turtle is slightly proximal to chi position, soft tissue damage in the ankle or foot.

– 2. Turtle pulse with Tail = Lower back pain, often extending down leg to knee.

– 3. Both chi = Prostate enlargement, varicocele

Left chi – Kidney / Reproductive FxTurtle pulse• Herbal Rx

– Soft tissue damage (Turtle pulse with no tail)• Astringent Complex 60%• Zhen Ren Huo Ming Yin 25%• Dang Gui Nian Tong Tang 15% for lower body

(for upper body, use Er Zhu Tang + Flex (Spur))– Bone spurs or disk problems (Turtle pulse with tail)

• Flex (Spur)– Prostate enlargement or soft tissue damage in knee

(Turtle pulse on both chi)• Resolve (Lower) 50%• Astringent Complex 50%

Left chi – Kidney / Reproductive FxDispersing pulse• Pulse sign: Dispersing pulse

– Pulse in which its border is difficult to perceive

– This pulse is thick (wide), soft, slow, weak and deep

• Indications– Blood stasis from old injuries – low back pain– Lower abdominal surgery, abortion, C-section, IUD,

anesthesia, hysterectomy




Vasectomy

**side notes: a bump between guan and chi in men may indicate vasectomy or something swollen in the genital area– Hot condition – swollen, inflammation

• Hot Breaker (Xia Ku Cao, Xuan Shen, Huai Hua) – Cold condition – blockage with no heat

• Cold Breaker (Wang Bu Liu Xing, San Leng, E Zhu)

Left chi – Kidney / Reproductive FxDispersing pulse

• Herbal Rx– Circulation SJ 50%– Resolve (Lower) 50%– Use for 1 month, then use Resolve (Lower)

only until condition is resolved

Left chi – Kidney / Reproductive FxTaiyang pulse

• Pulse sign: Taiyang pulse • Indications

– Reproductive dysfunctions– Inflammation in lower abdomen– On both chi positions (in women)

• Check palms if hot If yes, ask if taking hormones If yes, possible high risk of breast cancer

Left chi – Kidney / Reproductive FxTaiyang pulse

• Herbal Rx– Gardenia Complex 60%– Astringent Complex 20%– Ba Zheng San 20%

Left chi – Kidney / Reproductive FxDu pulse

• Pulse sign: Du pulse• Indications

– Back pain, stiffness, strain, or sprain• Herbal Rx

– Gardenia Complex 33%– Astringent Complex 33%– Dang Gui Nian Tong Tang 33%


• Uterine bleeding + Hot palm– First ask if female patient is taking hormones– If so, then may be candidate for breast cancer– If not, then pure dysfunctional uterine bleeding, not

related to hormonal imbalance• Left chi = jumpy; Bright red color blood

– Black combo: stop bleeding by all charred herbs (Ce Bai Ye Tan, Di Yu Tan, etc.) 50%– He Zi 17%– Wu Bei Zi 17%– Whatever else is needed depending on pulse





• Uterine bleeding + Hot palm– If not, then pure dysfunctional uterine bleeding, not

related to hormonal imbalance• Left chi = stagnant; Dark colored blood; Pelvic area

on the ear is dark – Black combo 50% (any and all charred herbs

you can find)– Shao Fu Zhu Yu Tang or Yi Mu Cao or Sheng

Hua Tang 25%– Astringent Complex 25%

Left chi – Kidney / Reproductive FxRen pulse

• Pulse sign: Ren pulse• Indications

– Endometriosis, adhesions, ovarian cysts, small fibroids, uterine prolapse

• Herbal Rx– Gynecological conditions

• Resolve (Lower)

LEFT CUN – Heart / Small Intestine

LEFT CUNHeart / Small Intestine

Review of normal left cun – Heart pulse5 deviations of the left cun

1. Reverse hook pulse2. Small pulse3. Constricting/Pulse within a pulse4. Gu pulse5. Rainbow pulse

Left cun – Heart / Small IntestineNormal pulse

• Normal pulse: Hook– Hook pulse is a pulse where the cun position

is higher (more superficial) than the guan and chi positions

• The guan position is mid-level; the chi position is deepest

Left cun – Heart / Small IntestineReverse hook pulse• Pulse sign: Reverse hook pulse

– Pulse where the chi positionis higher (more superficial) than guan and cun positions

• Indications– Long-term emotional imbalance – nervousness, scared,

easily frightened, under constant anxious, frightened state, an existential uneasiness, subliminal fearfulness

• Adrenalines are too active or exhausted from past frightening situations

• Chronic Stage 3 Stress (Fight or Flight)




Left cun – Heart / Small IntestineReverse hook pulse

• Herbal Rx (if hands are warm)– Tian Wang Bu Xin Dan 40% lift the cun– Sheng Mai San 40%– Nourish or Zhi Bai Di Huang Wan 20% lower

the chi– Patient also needs calcium in this condition– If hands are cold

• Long Dan Xie Gan Tang 50%• Ba Wei Di Huang Wan 50%

Acupuncture Tx for Anxiety, Fight or Flight, Heart / Kidney Imbalances

• Target: Heart, Diaphragm, & Kidney• Tx: GB 25

Ren 14P 3, 6GB 34, 41LV 3, 8SJ 3, 8Ear: Shenmen

Left cun – Heart / Small IntestineSmall pulse• Pulse sign: Small pulse

– Small pulse is thin and weak– Upon pressure, it disappears

• Indications– Heart blood def. – poor memory, poor concentration – ADD, overactive, can’t concentrate

• Herbal Rx– Ren Shen Yang Ying Tang, Shi Quan Da Bu Tang, Tian Wang

Bu Xin Dan– Check left guan – if it is too high or overactive, then 1/3 to 1/2 of

formula should be Chai Hu Jia Long Mu Tang

Left cun – Heart / Small IntestineSmall pulse

• ADD, overactive, can’t concentrate– Tian Wang Bu Xin Dan is not strong enough – Use Shi Chang Pu, Yuan Zhi, Suan Zao Ren,

Lian Zi Xin– Add Tian Zhu Huang if you find a slippery pulse

(brain damage pulse according to Jimmy)– Pay attention to the left guan. Need to treat the Liver

if overactive, which usually is. Can use Liver DTX or Zhi Zi

– Can combine Tian Wang Bu Xin Dan with Zhi GanCao Tang

Acupuncture Tx for Deficient Heart

• Target: Heart• Tx: Ren 14

HT 8 K1SI 2 or 3

• Leave needles in no longer that 10 minutes and re-stimulate at time of extraction

Left cun – Heart / Small IntestineConstricting/Pulse within a pulse• Pulse sign: Constricting/

Pulse within a Pulse– Straight pulse that feels

like there is a bundle of electric wires (that are thin, straight, tight) within the artery

• Indications– Severe coldness in the heart – xiong bi, angina

pectoris, myocardial infarction, coronary heart conditions




Left cun – Heart / Small IntestineConstricting/Pulse within a pulse

• Herbal Rx– Si Ni Tang 20%– Circulation 50%– Openers: Dang Gui 15%

Chuan Xiong or Sheng Ma 15%– What herbs are good to clear the plaque on

the vessel wall? Shan Zha, Jue Ming Zi, He Ye, Xia Ku Cao, San Qi, or Cholisma

Acupuncture Tx for Coronary Constriction

• Target: Heart• Tx: Moxa

Ren 17, 14

Left cun – Heart / Small IntestineGu pulse

• Pulse sign: Gu pulse– Refers to when both the upward (systolic) and

downward (diastolic) beat of the pulse are felt– Can be felt on the (R) cun

• Indications– Heart valve problems – aortic valve

regurgitation, stenosis; shortness of breath, chest pain, fainting, dizziness

– MSG, soda, or coffee intake

Left cun – Heart / Small IntestineGu pulse

• Herbal Rx– Mao Dong Qing 50%

• Excellent for water retention in the chest/heart • Edema caused by heart dysfunction (i.e. congestive

heart failure)– Use Mao Dong Qing 100%

– Tian Wang Bu Xin Dan 25%– Yang Xin Tang 25%

Acupuncture Tx for Heart Valve Dysfunction

• Weak Murmur: Mitral Valve Target: Heart• Tx: Ren 14

HT 8K 1SI 2, 3**Take needles out between 8 – 10 minutes

• Strong Murmur: Aortic Target: Heart• Tx: Ren 14

Ear: ShenmenK 1 P6HT 8 K7**Leave needles in for at least 40 minutes

Left cun – Heart / Small IntestineRainbow pulse

• Pulse sign: Rainbow pulse– Convex-shaped pulse that

extends distally beyond the cun position

– Taiyang pulse, big and long curved like a rainbow– Taiyang pulse of hand = SI

• Indications– Gas, bloating, enteritis– Fast = food poisoning or colitis– Headache – b/c Taiyang meridian




Left cun – Heart / Small IntestineRainbow pulse

• Herbal Rx– Gas, bloating, enteritis

• Ge Gen Huang Qin Huang Lian Tang 25%• Shao Yao Tang 35%• Astringent Complex or Herbal ABX 40%

– Food poisoning or colitis• Add Herbal ABX, all equal percentage (25%)

Acupuncture Tx for Intestinal Diseases(Excess in Nature)

• Target: Whole Abdomen• Tx: GB 34 ST 36, 37

SJ 5 LI 4LV 8 SP 9P 6 LU 9

LEFT GUAN – Liver / Gallbladder

LEFT GUANLiver / Gallbladder

Review of normal left guan – Liver pulse6 deviations of the left guan

1. Convex and Forceful2. Wiry, Forceful, and Deep 3. Concave and Deep4. Bird’s beak/Pen tip pulse5. Roof or Blade pulse6. Shaoyang pulse

Left guan – Liver / GallbladderNormal pulse

• Normal pulse: Slightly wiry– Wiry pulse is a pulse that is tight and straight– It is a level pulse – same rebound – Locate at the middle depth

Left guan – Liver / GallbladderConvex and Forceful

• Pulse sign: Convex and Forceful– Convex = bulging pulse

that has a rounded feeling• Indications

– Emotional aspect of Liverinvolved – stress, irritability, excessive thinking, nervousness, mood swings, insomnia

– Positive type of emotional condition – patient does not hold feelings inside. Most likely would like to argue or fight with others.




Left guan – Liver / GallbladderConvex and Forceful

• Herbal Rx– Jia Wei Xiao Yao San 33%– Chai Hu Jia Long Mu Tang 33%–Yi Gan San 33% for fast heart rate

• If that does not work, use– Zhi Zi 15% Hu Zhang 15%– Huang Shui Qie 15% Xia Ku Cao 15%– Long Dan Xie Gan Tang 20%– Astringent Complex 20%

• If no emotional conditions, just fatigue/tired– Chai Hu Qing Gan Tang or Liver DTX– Wu Wei Zi– Shan Zhu Yu

Left guan – Liver / Gallbladder Wiry, Forceful, and Deep

• Pulse sign: Wiry, Forceful, and Deep• Indications

– Actual Liver organ function disorders –hepatitis, elevated Liver enzymes

– Very thin at middle or deep depths is usually due to having mono in the past

Left guan – Liver / GallbladderWiry, Forceful, and Deep

• Herbal Rx– Actual Liver disorder

• Liver DTX 30%• Ge Xia Zhu Yu Tang 20%

– High Liver enzyme• Add Chai Hu Qing Gan Tang 20% and Wu Wei Zi

15% and Shan Zhu Yu 15%

Acupuncture Tx for Excess Liver Conditions

• Target: Liver• Tx: LV 14

ST 36, 37, 38 GB 34LV 8 SP 9, 8, 7P 6 LU 9LI 4 SJ 5

• If gallbladder involved, add: GB 24

Left guan – Liver / Gallbladder Concave and Deep

• Pulse sign: Concave and Deep– Concave = pulse curved downward– Can feel the curvature along the

sides and bottom– Rebound on the guan is low

• Indications– Fatty Liver– Emotional conditions – anxiety, depression, irritability – Damp in the Liver and GB channel– If forceful, damp-heat

Left guan – Liver / Gallbladder Concave and Deep

• Herbal Rx– Fatty Liver

• Ge Xia Zhu Yu Tang 20% Hu Zhang 15%• Yin Chen Hao Tang 20% Xia Ku Cao 15% • Huang Shui Qie 15% Zhi Zi 15%

– Meniere’s, vertigo (taiyin phlegm fainting syndrome)• Ban Xia Bai Zhu Tian Ma Tang 33%• Tian Ma Gou Teng Yin 33%• Long Dan Xie Gan Tang 33%




Left guan – Liver / Gallbladder Bird’s beak/Pen tip pulse

• Pulse sign: Bird’s beak/Pen tip pulse – Convex-shaped pulse that

is approximately 0.1cm in length

– Feels pointy like a pen's tip– Usually hard and cannot be pushed away with

pressure– Usually appears with concave and deep pulse

Left guan – Liver / Gallbladder Bird’s beak/Pen tip pulse

• Indications– Gallstones; Sludge in the Gallbladder– Hepatic Cyst

• Herbal Rx– For Gallstones use:

• Dissolve (GS)– For Hepatic Cyst use:

• Dissolve (GS) 80%• Fu Yuan Huo Xue Tang 20%

Left guan – Liver / Gallbladder Roof or Blade pulse• Pulse sign: Roof or Blade pulse

– Roof = a pulse that is pinchedon top forming a thin, straight pulse on the superficial level, with an increase in diameter as it moves down to the deeper level

– Blade = a more severe constricted Roof pulse• Indications

– Severe constriction – Liver cirrhosis, Liver cancer• Thinner and tighter the pulse, more severe the

condition, both physically and emotionally

Left guan – Liver / Gallbladder Roof or Blade pulse

• Herbal Rx– Liver damage (previous mono or hepatitis)– Liver cirrhosis (many times from drinking, drugs,

overdose of medication)• Resolve (Lower) 40%• Yin Chen Hao Tang 30% opens GB• Openers: Dang Gui 15%

Sheng Ma or Chuan Xiong 15%• If constriction is due to cold: Add Si Ni Tang 20% and

reduce each of the previous herbs by 5%

Extra Meridian Pulses Distal to the Cun Position

Extra Meridian PulsesDistal to the Cun Position

3 extra meridian pulses distal to the cun position1. Yangwei pulse2. Yinwei pulse




Extra meridian pulses Yangwei pulse

• Pulse sign: Yangwei pulse– Distal to the cun position

pointing towards the thumb

• Indications– On right side: Lower respiratory

conditions – bronchitis, deep cough, postnasal drip, common cold

• Ren 22 feels hot – heat condition• Ren 22 feels cold – cold condition

– On left side: Knee and ankle joint arthritis

Yangwei


• Herbal Rx– Lower respiratory conditions

• Astringent Complex 20%• Ge Gen Tang 15%• Hai Ge Fen 13%• Yuan Zhi 13%• Herbal ABX 20%• For heat conditions: add Qing Fei Tang 20%• For cold conditions: add Dun Sou San 20%


• Herbal Rx– Knee and ankle joint arthritis, especially if

the patient has some edema as well• Dang Gui Nian Tong Tang 50%• Astringent Complex 50%

Extra meridian pulses Yinwei pulse

• Pulse sign: Yinwei pulse– Distal to the cun position

pointing towards the little finger

• Indications– Heart conditions – shortness of breath, chest

stuffiness and pressure, palpitation, high low-density lipoprotein high LDL

Yinwei

Extra meridian pulses Yinwei pulse

• Herbal Rx– Si Ni Tang 20%– Circulation 80%

– To tonify the heart by releasing the water, use Mao Dong Qing.

Robert Doane’s Contact Info

• 18870 8th Ave NE, S-108• Poulsbo, WA 98370• 360-394-4357• www.acupuncturewellness.net• [email protected]




• To read articles by today’s speaker, watch online videos, or to see his/her complete seminar/webinar schedule for this year, please visit www.elotus.org

• More information on the classic single herbs mentioned in this seminar/webinar can be found in the Chinese Medical Herbology and Pharmacology

• More information on the classic formulas can be found in the Chinese Herbal Formulas and Applications

• Collection formulas can be found in the Lotus Clinical Manual of Oriental Medicine

• All the above texts are available through www.elotus.org

• Herbs mentioned in this seminar/webinar, are available through our sponsor Evergreen Herbs & Medical Supplies. Please contact them for a catalog and pricing information.

This webinar is sponsored by:

Evergreen Herbs & Medical SuppliesToll-free Tel: 866-473-3697Website: www.evherbs.comEmail: [email protected]

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Evergreen is a family business that is run by professionals like you who care about Chinese medicine. And as a family business, we have the well-being and satisfaction of our customers at the top of our list. We care about the quality of our herbs, because we care about our consumers, and have your best interest at heart.Our goal is to support you in improving your clinical skills, and enhancing the well-being of your patients.

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