CMCM311 SN04 Lecture

Session 04
Lecture – Mouth, Nose, Throat

Chinese Medicine
Chinese medicine: mouth anatomy
Spleen opens to the mouth & manifests externally to the lips

Stomach channel encircles the lips
Large intestine channel curves around the upper lip
Liver channel curves around inner surface of lips
Du Mai circulates inside lips
Teeth are the surplus of bone & governed by the Kidney
Yang Ming channels pass through gums
Heart opens to the tongue
Spleen controls muscles
Liver controls tendons
Lung controls body fluids
(Deadman et al., 2007; Maciocia, 2015; Maclean et al., 2018)
CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Channel connections to the mouth
(Deadman et al., 2007)

Lips, gums and teeth: inspection and questioning
Lips should be red, lustrous and moist. They should be free &
flexible, not shaking or painful. They should not be swollen,
atrophied or deviated.
Gums should be moist and pink. They should not be swollen,

ulcerated, bleeding or painful.
Teeth should be painless, bright, moist and clean without tartar. All
teeth should be present. Delayed appearance of baby or adult
teeth, teeth at deviated angles or receding gums are all
pathological.
(Maciocia, 2019; Maclean et al., 2018; Yi & Stone, 2008)

Lips & mouth: signs & symptoms
Colour/lustre/moisture of the lips
Pale Qi/Blood deficiency
Deep red Heat/toxin
Purple Blood stagnation
Black Extreme stagnation or heat
Shape of lips
Swollen Toxic heat
Eroded Heat
Peeled/chapped/dry Dryness
Bearing of mouth
Opened mouth Open (heat), drooping (deficiency), drooling (Spleen deficiency
or wind stroke)
Closed – tight (lockjaw) Wind
Twitching Deficiency
Deviated Wind

6

Gums: Signs & symptoms
Colour of Gums
Red & moist Normal
Deep red, swelling Excess heat in Yang Ming
Pale Blood deficiency
Pale, atrophied Kidney deficiency
Shape of Gums
Swollen, ulcerations, bleeding Stomach Fire flaming upwards
Bleeding Gums
Bleeding with pain & swelling Stomach Fire flaming upwards
Chronic bleeding without pain Deficiency Fire flaming upwards, or Spleen Qi xu

Teeth: Signs & symptoms
Colour of Teeth
White & moist Kidney Qi flourishing
White, dry, without sheen Kidney Yin exhaustion
Sudden change to yellow Kidney deficiency
Purplish black Exhaustion of both Yin & Yang
Tartar
Grimy yellow Evaporated Stomach turbidity
Burnt & dry Kidney & Stomach Yin exhaustion
Shape of teeth
Delayed appearance of baby or adult teeth Jing deficiency
Teeth grow at deviated angles or missing teeth Insufficient Yang Ming Qi
Loss of teeth in adults, or Flaming upwards of deficiency fire (Kid yin xu)
receding gums with exposure of roots of teeth

Tooth abscess: aetiology & risk factors
Dental decay over many months – causes necrosis of dental

pulp.
Poor oral hygiene, smoking, anatomical structures.
Common at end stage of a dental disease.
Infection beyond jaw can obstruct airways and cause
septicaemia.
Antibiotics often insufficient.
Difficult treatment and recovery if patient is
immunocompromised or suffers from cardiovascular or
respiratory disease.
(Bayetto et al., 2020)

9

Tooth abscess (yá yōng): clinical signs & symptoms
Toothache
Sensitivity of the tooth to heat or cold
Swollen gums
Red gums
Bleeding gums
Loose teeth
Headache
(Maciocia, 2019; Maclean et al., 2018; Sionneau & Lü, 1997)
10

PROMs for teeth and mouth
Oral Health Impact Profile (OHIP)

Subjective Oral Health Status Indicators
(ACSQHC, n.d.)
11

Tooth abscess (yá yōng): : special testing, imaging,
investigations
Observation of tooth, gums and cheek

Local palpation of cheek
Dental investigation: possible X-ray
Cautions & contraindications: if not already examined by
dentist – refer for diagnosis.
Often prescribed antibiotics
Surgical drainage may be indicated.
(Anzaldua, 2010; Maclean et al. 2018)
12

Tooth abscess (yá yōng): Chinese medicine aetiology
External pathogens
Alcohol, spicy/fatty/sweet foods
Emotion, chronic disease, taxation, ageing
Poor oral hygeine

(Maciocia, 2019; Maclean et al., 2018; Sionneau & Lü, 1997)
13

Tooth abscess (yá yōng): CM diagnosis
Table 1
Diagnosis
Toxicity Heat Stomach Heat/Fire Kidney Yin Deficiency
Acute. Initially, few other Acute. Associated with diet. Chronic and recurrent.
symptoms. Accumulation of Toothache (especially lower teeth), Constitution, ageing, Yin-depleting
localised Heat breaks down tissue lifestyle.
and creates pus pockets.
Throbbing, red & swollen, firm to Red & swollen gums, possible Slightly red lesion, mild swelling,
touch. Pain may radiate to ear. ulceration/bleeding. Pain may dull ache worse at end of day.
Worse for pressure and chewing. radiate to ear. Pain worse for Loose teeth, atrophied gums,
Better for ice. Relief if ruptured. pressure and chewing. difficulty chewing. Lower back
Possible fever, malaise, nausea, Swollen/tender cervical lymph pain, dizziness, blurred vision,
loss of appetite. Tender cervical nodes. Halitosis, dry mouth. poor memory, tinnitus, weak
lymph nodes. Halitosis, dry mouth. Afternoon fever, dry constipation, knees, night sweats, insomnia, 5
frontal headache, epigastric palm heat. Rubbery, non-tender
discomfort / nausea, thirst. submandibular nodules.
Slippery & rapid pulse. Slippery, flooding, rapid pulse. Floating, empty, rapid pulse
Red tongue tip, yellow coat. Red tongue body with thick, dry, Red, dry tongue body little coat
dark yellow coat
Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd. Ed.)
(p.1417-1423) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
14

Tooth abscess (yá yōng): CM diagnosis
Table 2
Diagnosis
Toxicity Heat Stomach Heat/Fire Kidney Yin deficiency
TP: Resolve toxicity heat, reduce TP: Clear Heat and Fire from TP: Nourish and tonify Stomach
swelling, stop pain. Stomach, resolve toxicity heat and Kidney Yin. Aid discharge of
and reduce swelling. pus and promote healing.
Usually resolves within 10 days. Usually resolves within 7-10 days. 3-6 months treatment. Yin-
Dietary modification required nourishing diet essential.
(heat-clearing).
ST44, LI4, GV10, GV12, ST42, ST44, LI4, GV10, GV12, ST42, CV12, CV4, SP6, ST36, KI6,
LI11, ST6, ST7, PC3 + BL40 LI11, CV12, PC8, ST6, ST7, PC3 LU7, LI4, KI3, BL21, BL20, ST6,
(high fever), LI2 + SI5 (severe + BL40 (high fever), LI2 + SI5 ST7, ST4, GV26.
pain) (severe pain), TE6 (constipation),
GB14 (frontal headache).
Auricular: Tragus apex, mouth, upper jaw, lower jaw, Shén mén Auricular: Stomach, Kidney,
Tragus apex, mouth, upper jaw,
lower jaw, Shén mén
Wu Wei Xiao Du Yin Qing Wei Tang Zhi Bai Di Huang Wan
(p.1417-1423) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
15

Dental pain: Chinese medicine research
Müller et al. (2023) – systematic review and meta-analysis.

Efficacy of acupuncture compared to local anaesthesia or
conventional analgesic medications in acute dental pain.
11 randomised controlled trials (n=668).
Acupuncture groups lower pain scores postoperatively compared to
sham acupuncture.
De Matos et al. (2020) – randomised cross over trial
35 healthy men with dental pain. Manual acupuncture vs sham
acupuncture vs no acupuncture.
Acupuncture reduced pain compared to no acupuncture but no
statistically significant difference between manual and sham
acupuncture.
16

Mouth ulcers (aptha): Biomedical diagnosis & testing
“Single or multiple ulcerations on the gums, buccal cavity and

/or tongue. The ulcerations may be small (<5mm) or large
(>1cm).”
(Maclean & Lyttleton, 2002, p. 696)
May be recurrent and usually self-limiting.

No special testing. Diagnosis made by observation of tooth,
gum and cheeks.
Also called ‘stomatitis’
(Maclean & Lyttleton, 2002; Maclean et al. 2018; Sionneau & Lü, 1997; Yi & Stone, 2008)
17

Mouth ulcers (aptha) kŏu chuāng: cautions &
contraindications
Recurrent mouth ulcers may be a symptom of other conditions

including (refer to GP or Dentist):
Autoimmune diseases: Behcet’s syndrome, Reiter’s

syndrome, ulcerative colitis, Crohn’s disease
Post radiation stomatitis
(Maclean et al., 2018; Saccucci et al., 2018)
18

Mouth ulcers (aptha) kŏu chuāng: clinical signs &
symptoms
Mouth ulcers – painful and red
May scar
Reduced intake (due to discomfort)
If chronic – chewing/fidgeting in mouth, anxiety,

braces, dentures
(Liu & Liu, 2009; Maciocia, 2019; Maclean & Lyttleton, 2002; Maclean et al., 2018; Sionneau & Lü, 1997)
19

Mouth ulcers (aptha) kŏu chuāng: CM aetiology
External pathogen
Spicy/sweet food, alcohol, stimulants
Overindulgence in food or irregular eating
Prolonged worry, anxiety, depression, sudden shock
Overwork, excessive sexual activity, ageing

20

Mouth ulcers (aptha) kŏu chuāng: CM pathogenesis
Figure 1
Pathogenesis
External pathogen Heat easily affects Heart (opens

into tongue)
Dietary → food stagnation Internal Heat causing aptha
Smouldering heat affects the oral
Both transform into heat cavity (Spleen/Stomach)
Overwork, excessive sexual Heart Fire can arise from Heart

activity, anxiety, ageing → all & Kidney Yin → Heat scorches
Yin deficiency causing aptha
contribute to Heart & Kidney not the tongue and manifests as
communicating ulcers
21

Mouth ulcers (aptha) kŏu chuāng: CM diagnosis
Table 3
Diagnosis
Internal Heat (Heart, Spleen, Stomach) Yin deficiency
Acute or chronic. Can be small or large. Burning Acute (post severe febrile disease) or chronic
pain, yellow or white floor (possibly red base) with (persistent, recurrent, slow healing).
red, raised margin. Inflamed, thickish yellow or Mostly small ulcers or joining together to make a
white exudate. Halitosis, cavity in tongue/gums/ large ulcer, cavity in tongue/gums/buccal, margins
buccal. Provoked by diet or stress. may not be red or raised, base may be ash grey or
same colour as tissue. Aggravated by patient
anxiety.
Fever (and/or) chills, muscle aches, dry stools, Fatigue, obvious signs of Spleen and/or Kidney
constipation, hunger, insomnia, thirst, red weakness, dryness and heat (yin xu)
complexion, irritability
Full and rapid pulse (HT/SP/ST positions) Fine (thready) and rapid pulse
Red centre and tip of tongue, dry yellow coat Red and dry tongue with little or no coating, redder
at tip of tongue.
(p. 1033-1040) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
22

Mouth ulcers (aptha) kŏu chuāng: CM treatment
Table 4
Diagnosis
Internal Heat (Heart, Spleen, Stomach) Yin deficiency
TP: Clear Heat from relevant organ system, reduce Nourish Heart, Stomach and/or Kidney Yin, clear
swelling, stop pain Heat.
CV24, ST6, ST4, ST44 + LI4, CV12, PC8, ST36, CV24, ST6, ST4, Qiān zhèng, CV4, SP6, KI6 +
Qiān zhèng, HT9 + HT7 (Heart Fire), ST45 LU7, BL15, BL20, BL21, BL23, HT7, KI3, CV12,
(Stomach Fire), ST41 (severe pain), TE6 + ST25 ST36
(constipation)
Auricular: point zero, mouth, Heart, Stomach, Liver, Auricular: point zero, mouth, sympathetic,
endocrine, subcortex + according to location of endocrine, subcortex + according to location of
ulcers. ulcers.
Pain relief and healing within 1-2 weeks of 3-9 months of treatment. Yin nourishing diet
treatment. Heat-clearing diet essential. essential.
Decoct jin yin hua 15g + bo he 9g. Rinse several Steep 10g of rou gui in 1 cup of hot water and hold
times per day. Apply cool and damp English teabag the cooled liquid in the mouth.
directly to ulcers.
Xie Huang San Tian Wang Bu Xin Dan
Qing Wei Tang
(p. 1033-1040) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean. 23

Mouth ulcers (aptha) kŏu chuāng: Chinese medicine
treatment
Extra point:
Qiān Zhèng
Location: 0.5-1.0 cun anterior to the auricular lobe
Indication: Deviation of the eyes and mouth, ulceration on
tongue and mouth.
Needling: Oblique 0.5-1.0 cun
(Maclean & Lyttleton, 2002; Maclean et al., 2018)
24

Mouth ulcers: case study 1
34-year-old male, musician

Main complaint: feeling run down and has two painful mouth
ulcers.
History of recurrent mouth ulcers when young. Now only gets
them when he’s on the verge of a cold/flu.
Sore throat, cracked and peeling lips.
Pulse: rapid & floating
Tongue: red, thin yellow coat.
Identify the 8PP, diagnosis, treatment principles, acupuncture
point prescription, diet & lifestyle advice, and prognosis.
25

Mouth ulcers: Chinese medicine research
Yan et al. (2022)

18 studies in meta-analysis (n=1422) – acupuncture superior to
WSM for ‘effective rate’ and reducing recurrence and pain.
Combination of acupuncture and WSM best results.
26

Nose: Chinese medicine anatomy
Lungs open to the nose
Centre of the face = middle burner / Earth – governed by

Spleen
Yang Ming channels of the hand & foot directly connect with
nose
Tai Yang channel of foot directly connects with nose
27

Nose: main points
Local points: Distal points:
LI4
LI20, LI19 BL7, BL10, BL12, BL67
Bitong (M-HN-14) GB20
Yintang (M-HN-3)
BL2
GV25, GV26
28

Nose: general inspection & questioning
Shape
Neither swollen, sunken or shrunken. No sores. Flared nostrils may indicate Lung
pathological changes.
Colour/Sheen
Supple and moist without presence of the 5 colours.
Discharge
No particular discharge
Sense of smell
Accurate and clear sense of smell
Pain/discomfort/blockage
Absence of pain, discomfort or sense of blockage.
(Maciocia, 2019; Yi & Stone, 2008)
29

Nose: signs & symptoms
Shape of the nose
Swollen Excess
Sunken Insufficient anti-pathogenic Qi, deficiency condition
Nasal polyp Stagnated heat in Yang Ming channel
Flaring nostrils (high fever) Wind Heat or Phlegm Heat in Lung, or asthma
Colour/sheen of the nose
Withered Exhaustion of Spleen & Stomach Qi / severe disease
White Lung disorder, bleeding, or Qi & Blood deficiency
Blue-green Abdominal pain or excess Cold
Black Water retention due to Kidney deficiency
Red Heat in Spleen & Lung channels
Yellow Internal Damp Heat, or constipation (Spleen Yang deficiency)
Nasal discharge
Nosebleed Heat injury to Lung and Stomach
Clear and thin Wind Cold attack
Yellow or turbid Wind Heat attack
Chronic and turbid Internal Damp

30

PROMs for nose
Rhinosinusitis Outcome Measurement (RSOM)

Chronic Sinusitis Survey (CSS)
Questionnaire of Olfactory Disorders (QOD)
Visual Analog Scale (VAS) of specific symptoms – smell, nasal
obstruction.
(Ta et al., 2021)

31

Sinusitis: special testing, imaging, investigations
Radiography
Nasal endoscopy
Computed tomography
Testing for allergy and immune function
(Rosenfeld et al., 2015)

32

Sinusitis: Biomedical diagnosis
Nonspecific inflammation of the mucous membrane of the

sinuses.
Viral vs bacterial
Acute vs chronic
Risk factors: genetics, cormorbid medical conditions (airway
diseases, gastroesophageal reflux disease, autoimmune
disease) and environmental factors.
(Maclean et al., 2018; Rosenfeld et al., 2015)

33

Sinusitis: cautions & contraindications
Facial pain over sinuses, fever, purulent drainage from nose

continuously for >3 months or recurrently for >6 months.
Refer to GP.
Red flag:
Chronic bacterial sinusitis
Consequence – abscess formation leading to possible
damaged vision, osteomyelitis, meningitis, encephalitis.
(Anzaldua, 2010)
34

Sinusitis: Clinical signs
Fever
Facial pain or pressure, congestion or fullness
Headache or ear pain
Nasal congestion or obstruction
Viscid, purulent discharge from nose
Decreased ability to smell
Dental pain
Fatigue
Halitosis
(Liu & Liu, 2009; Maclean et al., 2018; Rosenfeld et al., 2015)
35

Sinusitis: Chinese medicine aetiology
External pathogen, chemical/environmental factors
Dietary irregularity
Strong anger
Lingering pathogenic factor
(Liu & Liu, 2009; Maciocia, 2019; Maclean et al., 2018)

36

Sinusitis: Chinese medicine pathogenesis
Figure 2
Pathogenesis
Emotional stress, heating diet, Generates Heat → rises to sinuses

Liver & Gall Bladder Fire sinusitis
alcohol → Liver Qi constraint. and dries mucous membranes.
Chemical exposure, smoking, Heat dries mucous

Heat in Lung channel sinusitis
external pathogenic invasion membranes
Poor diet, constitution, Weakened SP & KI unable to

overwork, worry Phlegm sinusitis
transform fluids

37

Sinusitis: CM diagnosis
Table 5
Diagnosis
Liver & Gall Bladder Fire Heat in Lung channel Phlegm
Acute. Aggravation of Liver Qi Chronic. Low-grade persistent. Chronic nasal congestion.

constraint with Heat. Sinus Nasal congestion with scant, Copious thin & white or thick,
congestion with yellow/green sticky, yellow mucous. May be gummy mucous. Sinus blockage
mucous. Purulent or blood only at night as postnasal drip. with frontal headache, facial and
streaked. Frontal and sinus Red & swollen mucous sinus pain. Pale and swollen
pressure severe. Red, swollen membranes. Tender with mucous membrane with polyps.
mucous membranes. palpation. Postnasal drip.
Irritable, short temper, fever, red Frontal headache, irritation/tickle Sore or irritated throat, anosmia,
complexion, sore eyes, bitter in throat, possible halitosis, dry or throat clearing, productive cough,
taste, thirst, dry mouth/throat, slightly productive cough, worse stifling sensation in chest.
concentrated urine, constipation, at night.
tinnitus.
Red tongue (red edges), thick Red, or with red tip, with thin Pink and swollen tongue, with
and dry yellow coat. yellow coat. thick or thin greasy, white coat.
Wiry & rapid pulse. Rapid and strong pulse. Slippery pulse.
38

Sinusitis: Chinese medicine treatment
Table 6
Diagnosis
Liver & Gall Bladder Fire Heat in Lung channel Phlegm
TP: Clear Heat from Liver and TP: Diffuse the Lungs and clear TP: Diffuse the Lungs and
Gall Bladder. Aid discharge of Heat. Alleviate constraint and transform Phlegm. Eliminate
toxins and pus, open the nose. open the nose. turbidity and open the nose.
GB20, GV23, LI20, GB15, BL7, GV23, LI20, BL7, Tài Yáng or Yìn GV23, LI20, BL7, Bí Tōng, Yìn
GB14, GB40, LR2, GB39, TE5, Táng, GB20, LU7, LI11, LI4, BL2, Táng, GB20, LU7, LI4, ST40.
LI4, BL2 or Tài Yáng or Yìn Táng ST2.
(headache location).
Auricular: Liver, Lung, nose, sinus, sympathetic, subcortex.
Pain and discharge decrease in Sinus irrigation helpful. Heat Phlegm-transforming diet
1-2 days. Treat 1-2 weeks. Heat clearing diet helpful. essential. Minimum several
clearing diet essential. months treatment. Sinus irrigation
necessary.
Long Dan Xie Gan Tang Xin Yi Qing Fei Yin Er Chen Tang
39

Allergic rhinitis: biomedical perspective
Commonly called ‘hayfever’

Inflammation of the nasal mucous membranes
Allergic – most common (contact with allergen – pollen, grass,
wheat, dust, tobacco smoke, hair spray, dust mites, mould
spores, perfume). Seasonal pattern.
Non-allergic – chemical, drug / medication, viral/bacterial,
emotion, exercise, hormonal.
Common signs of allergic rhinitis:
‘allergic shiners’ (dark circles under the eyes) and
nasal salute (wiping nose with transverse or upwards moving
hand).
(Hong, 2023; Liu & Liu, 2009; Ma et al., 2018; Maciocia, 2019; McDonald et al., 2013; Pappas, 2018)
40

Allergic rhinitis: biomedical perspective
Table 7
Allergic vs non allergic rhinitis
Allergic Non-allergic
Skin test Positive Negative
Exacerbation Allergen Weather changes, irritants
Family history Positive Negative
Congestion Common Common
Postnasal drip Not common Common
Itching Common Rare
Nasal discharge Common Not common
Sneezing Common Not common
Other atopic conditions Asthma, eczema Absent
Seasonal Spring, Summer Perennial
Note. Adapted from Clinical Handbook of Internal Medicine: The treatment of disease with traditional Chinese medicine (2nd.
Ed.) (p. 1183) by W. Maclean, J. Lyttleton, M. Bayley and K. Taylor, 2018, Eastland Press. Copyright 2018 by William Maclean.
41

Allergic rhinitis: special testing, imaging, investigations
Testing for allergic rhinitis may include:
Skin prick test

RAST blood test – A blood sample will be taken to determine
the level of antibody production in your body.
Nasal smear – nasal secretions may be tested
Nasal endoscopy.
(Testera-Montes et al., 2021)
42

Allergic rhinitis: clinical signs & symptoms
Sneezing
Nasal pruritus
Rhinorrhoea
Nasal congestion
(Hong, 2023; Liu & Liu, 2009; Maciocia, 2019; Maclean et al., 2018)
43

Allergic rhinitis (Bí Qiú): Chinese medicine aetiology
Endogenous factor (Lung, Spleen, Kidney

deficiency)
Exogenous factor (Wind Cold invasion)
(Liu & Liu, 2009; Ma et al., 2018; Maciocia, 2019; Maclean et al., 2018)
44

Allergic rhinitis (Bí Qiú): CM diagnosis
Table 8
Diagnosis
Lung Qi deficiency Spleen Qi deficiency Kidney & Lung deficiency
Typical symptoms of allergic rhinitis
Recurrent episodes of sneezing, Moderate to marked nasal Congenital roots, childhood

nasal itch, clear and watery congestion. Thick white discharge onset, familial history.
discharge or congestion – worse or postnasal drip, sneezing and Nasal itch & sneezing, clear
morning & evening. Worse for nasal itch. Swollen & pale watery discharge. Swollen
exposure to cold & wind. Pale & mucous membranes. Polyps mucous membranes, back &
swollen mucous membranes. Low common. Symptoms worse for shoulders feel cold during
energy, soft & low voice, foods (dairy/wheat). Diminished episode. Tendency to wheezing
shortness of breath, frequent sense of smell. Heaviness in and urticaria. Dark circles under
colds, spontaneous sweating, head, easily fatigued, tired limbs, eyes. Copious, clear urination,
eczema/asthma. loose bowels. enuresis & nocturia. Cold
intolerance, cold extremities.
Weak & deficient pulse. Fine, moderate, soft pulse. Deep, fine & weak pulse.
Pale tongue with thin, white coat Pale, swollen and scalloped Pale, swollen & scalloped tongue
tongue with white coat (possibly with moist white coat.
greasy)
45

Allergic rhinitis (Bí Qiú): CM diagnosis
Table 9
Diagnosis
Lung Qi deficiency Spleen Qi deficiency Kidney & Lung deficiency
TP: Tonify Lung Qi and Wei Qi. TP: Tonify Spleen & Lung Qi. TP: Warm the Kidneys and
Dispel residual pathogen from Fortify the exterior, stop sneezing support Yang. Tonify the Lungs,
surface. and discharge. fortify the exterior, stop itch and
nasal discharge.
Yìn Táng, GV23, LI20, GV14, LU9, LI4, LI11, ST36, BL13, BL20, CV4 + GV4 + BL23 (Kidney deficiency),
ST40 + SP3 (nasal discharge), Bí Tōng (nasal discharge), CV12 + ST25 (digestion), SP6 + CV12 (Blood
deficiency and nasal dryness
Auricular: nose, Lung, Spleen, Kidney, point zero, adrenal, subcortex, Shén Mén
Yu Ping Feng San Shen Ling Bai Zhu San Wen Yang San Feng Tang
46

Allergic rhinitis: case study 1
19-year-old female university student and part time retail

worker.
Headache, nasal blockage and discharge – 2-year duration
Purulent discharge initially, now clear and thin discharge
Cold limbs, spontaneous sweating, fatigue, lack of strength
Pulse: thready and weak
Tongue: pale body, thin white coat
47

Allergic rhinitis: case study 2
38-year-old male office worker with general good health.

Recurrent episodes of nasal itchy & congestion, sneezing and
drainage of clear fluid for 3 years.
No thirst, symptoms worse for exposure to pollen, wind and
cold.
Attacks came abruptly and subsided promptly but recurred
frequently.
Examination: clear secretion in nasal cavity, mucous
membrane swollen & pale.
Pulse: slightly weak
Tongue: pale tip, white coat
48

Chinese medicine: throat anatomy
(Deadman et al., 2007; Liu & Liu, 2009; Maciocia, 2015)

49

Channel connections to the throat
(Deadman et al., 2007; Maciocia, 2015)
50

Throat: inspection & questioning
Should be pink to red colour, moist with normal breathing

sounds and permit smooth swallowing.
Use pen torch to inspect colour, swelling, ulceration/pustules.

Inquire about pain.
Observe and inquire about swallowing, breathing, voice.
Include thorough questioning to differentiate between the

sensation of Plum Pit Qi (emotional) and sore throat
(physical)
(Bo et al., 2010; Maciocia, 2019; Yi & Stone, 2008)
51

Throat: signs & symptoms
Red, swollen, painful Excess Heat
Slight red, slight swelling & Kidney Yin Xu with deficiency

Slight pain fire flaming upwards
Unilateral or bilateral redness, Toxic heat in Lung and Stomach

Swelling, severe pain, possible
Ulceration, white or yellow
pustules
52

Sore throat: biomedical diagnosis
Pharyngitis
“Inflammation or infection of the pharynx, usually causing
symptoms of a sore throat.”
Laryngitis
“Inflammation of the mucous membrane lining the larynx,
accompanied by oedema of the vocal cords with hoarseness
or loss of voice, occurring as an acute disorder caused by a
cold, by irritating fumes, by sudden temperature changes, or
as a chronic condition resulting from excessive use of voice,
heavy smoking or exposure to irritating fumes.”
(Harris, Nagy & Verdaxis, 2010, p. 1337)
53

Sore throat: biomedical diagnosis
54

Sore throat: clinical signs
Itchy throat
Sore throat
Swollen throat
Throat visibly red & inflamed
Tonsils may be swollen, red & with exudate
Difficulty swallowing
Post-nasal drip
Fever
55

Sore throat: cautions & contraindications
Refer if:
A child has a sore throat + high fever (>38.9), inspiratory

stridor and drooling.
Red flag – acute epiglottis.
Fever (>39.7) plus severe sore throat

Red flag – streptococcal throat infection
Severe sore throat, high fever, drooling and difficulty

swallowing in an adult.
Red flag – peritonsillar abscess.
(Anzaldua, 2010)
56

Sore throat: special testing, imaging, investigations
Observation of mouth and throat

Use tongue depressor and pen torch to view tonsils
Palpation of throat including lymph nodes
Medical investigations may include:
Culture swab
Blood test
Rapid Antigen Test
(Maciocia, 2019; Sykes et al., 2020)

57

Sore throat: Chinese medicine aetiology
External pathogen
Lingering pathogenic factor
Excess alcohol, spicy or fatty foods
Chronic disease, taxation, ageing
(Liu & Liu, 2009; Maclean et al., 2018; Sionneau & Lü, 1998)
58

Sore throat: Chinese medicine pathogenesis
Figure 3
Pathogenesis
Gathers where nose and mouth meet

Wind Heat (throat). If reaches Lungs, heat Wind Heat invasion
ascends and burns throat.
External WH or WC not expelled → Pharynx connects Stomach to

Lung & Stomach Heat with Wind
lingers. Dietary factors heat the larynx and Lungs. Heat from Lung
Stomach. and Stomach burns throat. invasion
Congenital insufficiency, sexual taxation, Kidney Yin is depleted – throat not

chronic disease, ageing nourished – empty heat rises to throat Kidney Yin deficiency
(Liu & Liu, 2009; Maciocia, 2019; Maclean et al., 2018; Sionneau & Lü, 1996)
59

Sore throat: CM diagnosis
Table 10
Diagnosis
Wind Heat invasion Lung & Stomach Heat Kidney Yin deficiency
Acute. Worse when swallowing Acute. Severe pain, radiates to jaw / Discomfort or slight pain, slightly
or coughing. Mild to moderate ear. Swollen, red tonsils with white or red & swollen. Feels like a foreign
swelling & redness. Possible yellow exudate on the surface. body is stuck → cough. Dry throat.
white or yellow spots or Swallowing/talking difficult. Tender
exudate on surface. Dry throat, lymph nodes.
sticky sputum difficult to clear.
Mild fever, possibly chills, mild High fever, halitosis, dry constipation, Red cheeks & lips, 5 palm heat,
sweating, frontal headache, dark urine. Cough with profuse, lassitude, symptoms worse in
cough with difficult to sticky, yellow sputum. afternoon/evening. Low back or
expectorate thick/sticky yellow knee pain/weakness, tinnitus.
sputum.
Floating & rapid pulse Flooding, big, slippery & rapid pulse Fine & rapid pulse
Red tongue tip, thin yellow coat Red tongue body with dry, yellow coat Red tongue with little or no coat
60

Sore throat: CM diagnosis
Table 11
Diagnosis
Wind Heat invasion Lung & Stomach Heat Kidney Yin deficiency
TP: Expel Wind Heat, resolve TP: Clear and drain heat from TP: Nourish Lung & Kidney Yin,
toxicity, nourish throat. Lungs & Stomach, reduce clear heat, generate fluids,
swelling & nourish throat. moisten dryness, soothe throat.
SI17, LU11, LI4, TE5, LU10, LU11, LI1, LU10, LI11, LI4, ST44, LU7, KI6, LU9, KI3, Băi Láo
GV14, BL12, BL13, LU5 (cough), CV12, ST45 + LU11 (severe pain (Lung deficiency – chronic),
LI11 (fever), SP9 + SP5 + BL20 & heat), ST25 + TE6 + ST36 BL13, BL43, SP6, BL23, CV4,
(damp heat). (constipation), GV14 (high fever), KI2 + LU10 (deficiency Heat),
LU5 + ST40 (cough + sputum) LI11 + SP9 (damp heat), HT6
(nightsweats).
Auricular: throat, tonsils, Lung, Heart, adrenal, Shén Mén Auricular: Lung, Kidney, adrenal,
Shén Mén
Frequent treatment (twice daily if Frequent & timely treatment Responds gradually to treatment
severe). Responds quickly to (twice daily if severe). Young, 6-12 months. Yin nourishing diet
treatment. Stay warm despite elderly, frail may need antibiotics. essential.
fever. Herbs afterwards to rebuild.
Shu Feng Qing Re Tang Qing Yan Li Ge Tan Yang Yin Qing Fei Tang
61

Sore throat: Chinese medicine research
Zhang et al. (2023) – systematic review and meta-analysis.

Acute pharyngeal infections.
19 randomised controlled trials (RCTs) (n=1701).
Primary outcome (response rate) – acupuncture more effective
than antibiotics.
Reduction of VAS score, sore throat duration, white blood cell
counts – acupuncture more effective than antibiotics.
Modulation of neutrophil percentage and C-reactive protein
levels insignificant.
Fewer adverse events than antibiotic treatment.
62

Chinese Medicine Library Resource Links
APA 7th Edition Referencing Guide reference tips with examples

APA 7 FAQs questions submitted by students with examples provided by librarians
Chinese Medicine Library Guides
Databases, Journals & Web Links:

Anatomy TV
Natural Medicines
Journal of Chinese Medicine Article Archive
A Manual of Acupuncture [App]
Chinese Medicine Formula Image Database
63

References
Anzaldua, D. (2010). An acupuncturist’s guide to medical red flags & referrals. Blue Poppy Press.
Australian Commission on Safety and Quality in Health Care (ACSQHC). (n.d.). Condition specific PROMs. Retrieved January
12, 2024, from https://www.safetyandquality.gov.au/our-work/indicators-measurement-and-reporting/patient-reported-
outcomes/proms-lists/condition-specific-proms
Bayetto, K., Cheng, A., & Goss. A. (2020). Dental abscess: A potential cause of death and morbidity. Australian Journal of
General Practice, 49(9). https://doi.org/10.31128/AJGP-02-20-5254
Bo, P., Chen, Q-M., Zhu, H-H., Zhang, X-D., Xu, H-R., Zhang, Y., Cao, Y-J. (2010). Clinical observations on 46 cases of globus
hystericus treated with modified Banxia Houpu Decoction. Journal of Traditional Chinese Medicine, 30(2), 103- 107.
https://doi.org/10.1016/s0254-6272(10)60023-4
Deadman, P., Al-Khafaji, M. & Baker, K. (2007). A manual of acupuncture. Journal of Chinese Medicine Publications.
Harris, P., Nagy, S. & Vardaxis, N. (2010). Mosby’s dictionary of medicine, nursing and health professions (2nd ed.). Mosby.
64

References
Hong, G. (2023). Research progress on the mechanism of acupuncture in the prevention and treatment of allergic rhinitis.
Alternative Therapies in Health Medicine, AT8386. Advance online publication. http://alternative-
therapies.com/oa/index.html?fid=8386
Lin, Y. C. & Hsu, E. S. Z. (2004). Diagnosis in Chinese medicine. Elsevier Churchill Livingstone.
Liu & Liu, Z. W. & Liu & Liu, L. (Eds.). (2009). Essentials of Chinese medicine (vol. 3). Springer.
Ma, Y., Bu, H., Li, H., & Zhang, X. (2018). Acupuncture-moxibustion therapy of “banking up original qi and consolidating the
foundation” for prevention and treatment of seasonal allergic rhinitis: A randomized controlled trial. World Journal of
Acupuncture – Moxibustion, 28(1), 33-37. https://doi.org/10.1016/j.wjam.2018.03.018
Maciocia, G. (2015). The foundations of Chinese medicine (3rd ed.). Elsevier.
Maciocia, G. (2019). Diagnosis in Chinese medicine: A comprehensive guide (2nd ed.). Elsevier.
Maclean, W. & Lyttleton, J. (2002). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese
medicine (vol. 2). University of Western Sydney.
65

References
Maclean, W., Lyttleton, J., Bayley, M. & Taylor, K. (2018). Clinical handbook of internal medicine: The treatment of disease with
traditional Chinese medicine (2nd ed.). Eastland Press.
McDonald, J. L., Cripps, A. W., Smith, P. K., Smith, C. A., Xue, C. C. & Golianu, B. (2013). The anti-inflammatory effects of
acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-Based
Complementary and Alternative Medicine, 2013, 1-12. https://doi.org/10.1155/2013/591796
Müller, M., Schmucker, C., Naumann, J., Schlueter, N., Huber, R. & Lederer, A-K. (2023). Acupuncture in management of acute
dental pain – A systematic review and meta-analysis. Japanese Dental Science Review, 59, 114-128.
https://doi.org/10.1016/j.jdsr.2023.02.005
Oakley, G. M., Alt, J. A., Schlosser, R. J., Harvey, R. J. & Orlandi, R. R. (2015). Diagnosis of cerebrospinal fluid rhinorrhea: an
evidence-based review with recommendations. International Forum of Allergy & Rhinology, 6(1), 8-16.
https://doi.org/10.1002/alr.21637
Pappas, D. E. (2018). The common cold. Principles and Practice of Pediatric Infectious Diseases, 199-202.e1.
https://doi.org/10.1016/B978-0-323-40181-4.00026-8
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Rosenfeld, R. M., Piccirillo, J. F., Chandrasekhar, S. S., Brook, I., Kumar, K. A., Kramper, M., Orlandi, R. R., Palmer, J. N.,
Patel, Z. M., Peters, A., Walsh, S. A. & Corrigan, M. D. (2015). Clinical practice guideline (update): adult sinusitis.
Otolaryngology – Head and Neck Surgery, 152(S2), S1-S39. https://doi.org/10.1177/0194599815572097
Saccucci, M., Carlo, G. D., Bossu, M., Giovarruscio, F., Salucci, A. & Polimeni, A. (2018). Autoimmune diseases and their
manifestations on oral cavity: Diagnosis and clinical management. Journal of immunology research, 2018, 6061825.
https://doi.org/10.1155/2018/6061825
Sionneau, P. & Lü, G. (1996). The treatment of disease in TCM vol. 2: diseases of the eyes, ears, nose & throat. Blue Poppy
Press.
Sionneau, P. & Lü, G. (1997). The treatment of disease in TCM vol. 3: diseases of the mouth, lips, tongue, teeth & gums. Blue
Poppy Press.
Sykes, E. A., Wu, V., Beyea, M. M., Simpson, M. T. W. & Beyea, J. A. (2020). Pharyngitis: Approach to diagnosis and
treatment. Canadian family physician Medecin de famille canadien, 66(4), 251-257.
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Ta, N. H., Gao, J. & Philpott, C. (2021). A systematic review to examine the relationship between objective and patient-reported
outcome measures in sinonasal disorders: recommendations for use in research and clinical practice. International forum
of allergy and rhinology, 11(5), 910-923. https://doi.org/10.1002/alr.22744
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68

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Session 04

Lecture – Mouth, Nose, Throat

Spleen opens to the mouth & manifests externally to the lips

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

(Deadman et al., 2007)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Gums should be moist and pink. They should not be swollen,

(Maciocia, 2019; Maclean et al., 2018; Yi & Stone, 2008)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

(Maciocia, 2019; Maclean et al., 2018; Yi & Stone, 2008)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

(Maciocia, 2019; Maclean et al., 2018; Yi & Stone, 2008)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

(Maciocia, 2019; Maclean et al., 2018; Yi & Stone, 2008)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Dental decay over many months – causes necrosis of dental

(Bayetto et al., 2020)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

(Maciocia, 2019; Maclean et al., 2018; Sionneau & Lü, 1997)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Oral Health Impact Profile (OHIP)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Observation of tooth, gums and cheek

(Anzaldua, 2010; Maclean et al. 2018)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Alcohol, spicy/fatty/sweet foods

Emotion, chronic disease, taxation, ageing

Poor oral hygeine

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Toxicity Heat Stomach Heat/Fire Kidney Yin Deficiency

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Toxicity Heat Stomach Heat/Fire Kidney Yin deficiency

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Müller et al. (2023) – systematic review and meta-analysis.

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

“Single or multiple ulcerations on the gums, buccal cavity and

May be recurrent and usually self-limiting.

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Recurrent mouth ulcers may be a symptom of other conditions

Autoimmune diseases: Behcet’s syndrome, Reiter’s

Post radiation stomatitis

(Maclean et al., 2018; Saccucci et al., 2018)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Reduced intake (due to discomfort)

If chronic – chewing/fidgeting in mouth, anxiety,

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Spicy/sweet food, alcohol, stimulants

Overindulgence in food or irregular eating

Prolonged worry, anxiety, depression, sudden shock

Overwork, excessive sexual activity, ageing

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

External pathogen Heat easily affects Heart (opens

Overwork, excessive sexual Heart Fire can arise from Heart

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Internal Heat (Heart, Spleen, Stomach) Yin deficiency

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

(Maclean & Lyttleton, 2002; Maclean et al., 2018)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

34-year-old male, musician

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health

Yan et al. (2022)

CMCM311 CHINESE MEDICINE DEPARTMENT / 24-07-2023 © Endeavour College of Natural Health