Oral Cavity Disorders a TCVM Approach CAPT R

Oral Cavity Disorders: a TCVM Approach CAPT R. M. Clemmons, DVM, Ph. D, 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

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

Stomach Cold Food & Drink Cold Environment Stomach Cold Receiving & Decomposing Anorexia Altered Qi Flow Lassitude Cold Signs 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 Ulcer child grandchild Colitis Cystitis

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

Stomach Yin Deficiency Stress Chronic Febrile Illness Liver Qi Stagnation 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: 4 yr 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 25 mg 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