Bulletin of Clinical Acupuncture & Natural Healing Volume VII Issue 114 May 2012 1 DR. HOLMES KEIKOBAD MBBS, DPH, Dip Ac NCCAOM, LAc Editor in Chief CAROL ANDRADE PHD LAC Editor & Creative Director Anatomy of Heart & Acupuncture Listen to actual blood pressure sounds p 13 Copyright acu-free.com LLC All rights reserved Published by ACUFREE.COM INC Free Online Edition w w w. a c u - f r e e. c o m For educational purposes Copyright acu-free LLC All rights reserved. Published by acufree.com INC http://www.acu-free.com
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Anatomy of Human Heart & Acupuncture 3 Heart and lungs seen through ribcage Heart in TCM is not only the organ but also its spiritual, abstract connotation. Heart [HT for short] Deficiency can mean a deficient HT yin, HT Qi, and this can present clinically in a syndrome, but all the time the actual anatomical HT may be unaffected. On the other hand, and this is important to grasp, one may find HT valve murmurs, or other signs of a physical nature, but all the while the patient shows no clinical problems. HT also houses the Shen, the consciousness, awareness, higher thought, concept of past and future, search for the Essence so to say. In this Issue however we will concentrate of the physical heart and give you insight of how it works. Copyright acu-free LLC All rights reserved. Published by acufree.com INC http://www.acu-free.com
4 Heart & Lungs HT and LU are intimately connected, anatomically and elementally. LU form a canopy, and HT works underneath it. Let us study some structures: Trachea Carotid artery which supplies blood to neck and head Superior vena cava which drains blood from the head and neck and upper chest Aorta, biggest artery in the body Pulmonary artery which takes impure blood from HT to LU The auricle or atrium, a smaller chamber in the heart The ventricle, a larger and stronger chamber in the HT LU left and right Copyright acu-free LLC All rights reserved. Published by acufree.com INC http://www.acu-free.com
Heart & Lungs 5 Try out your hand if you can label structures yourself. Its OK to refer to previous page. Copyright acu-free LLC All rights reserved. Published by acufree.com INC http://www.acu-free.com
6 Heart - structure and functions Think of HT as a 4 chambered box-like structure. 4 smaller boxes go to make it up, 2 above and 2 below. Ones above are called the atriums or auricles. Ones below are called the ventricles. All together the 4 are also called the chambers of the HT. Each chamber has an opening which pumps out blood and one which brings in blood. Each such opening has a valve which lets out blood but prevents re entry. After blood has pumped out, valve for return shuts with a snap, that is the HT sound, Blood circulation 1. Venous [used up] blood drains into 2 right atrium. From there through the valve at 3 it enters 4 the right ventricle. From there it goes to the pulmonary artery 5 into the lung 6. Purified there by breathing, it goes on to pulmonary vein 7 to 8 left atrium. From there it goes via a valve 9 to left ventricle 10 and via a valve to 11 aorta, biggest artery in body, to supply 12 whole body. This uses up the oxygen, and the used blood returns via veins 1 back to right atrium. 6 2 8 7 5 1 3 9 1 5 11 12 4 10 Copyright acu-free LLC All rights reserved. Published by acufree.com INC http://www.acu-free.com
7 Heart - blood circulation Can you remember the pathway? Its OK to see previous page. 6 2 8 7 5 1 3 9 1 5 11 12 4 10 Copyright acu-free LLC All rights reserved. Published by acufree.com INC http://www.acu-free.com
8 Heart - blood circulation Now lets try the circuit on an actual heart: 1. Venous [used up] blood drains into 2 right atrium. From there through the valve at 3 it enters 4 the right ventricle. From there it goes to the pulmonary artery 5 into the lung 6. Purified there by breathing, it goes on to pulmonary vein 7 to 8 left atrium. From there it goes via a valve 9 to left ventricle 10 and via a valve 11 to 12 aorta, biggest artery in body, to supply 13 whole body. This uses up the oxygen, and the used blood returns via veins 1 back to right atrium. 1 6 5 12 5 7 7 7 5 8 7 2 11 9 3 10 4 13 1
9 Heart - blood circulation Now try to follow the circulation without the guiding numbers. Check back to previous pages if you need to. Start with Superior and Inferior vena cava and proceed to right atrium etc. If you follow the path well you will end up at the 3 branches of the aorta.
10 Heart - blood circulation Now visualize that half the heart deals with impure de oxygenated blood and the other half with pure and oxygenated. Start with the superior and inferior vena cava and proceed till you reach the aorta. 4
Heart valves 11 The HT has a one-way blood flow. Once the blood passes a certain point, it never back tracks. It has a one-way traffic. This is insured by a system of valves between chambers and chambers, and between chambers and blood vessels. Right atrium < tricuspid valve > right ventricle Right ventricle < pulmonary valve > pulmonary artery Left atrium < mitral valve > left ventricle Left ventricle < aortic valve > aorta
12 Heart sounds Heart sounds are generated by the beating heart and the turbulence created when the heart valves snap shut. There are 2 normal heart sounds often described as LUP DUP, which occur in sequence at each heartbeat. This is how these are created: 1st HT sound > called S1 > produced by closure of atrio ventricular [mitral & tricuspid] valves 2nd HT sound > called S2 > produced by closure of semi lunar [aortic and pulmonary] valves Note how atrio ventricular valves are synonymous with mitral & tricuspid, and semi lunar, with aortic & pulmonary
13 Blood Pressure sounds The sounds heard during measurement of blood pressure, also called the Korotkoff sounds, are different from the heart sounds LUB DUB. When a stethoscope is placed [see image] over the brachial artery in the arm at the elbow and the cuff of a sphygmomanometer or blood pressure measuring instrument is placed around a patient's upper arm and inflated to a pressure above the patient's systolic blood pressure, there will be no sound audible. This is because the pressure in the cuff is high enough such that it occludes the blood flow. Now if the pressure is gradually dropped to a level equal to that of the patient's systolic blood pressure, the first Korotkoff sound will be heard. As the pressure in the cuff is allowed to fall further, thumping sounds continue to be heard as long as the pressure in the cuff is between the systolic and diastolic pressures. As the pressure in the cuff drops further, the sounds change in quality, then become muted, and finally disappear altogether. This muting of the thumping sound is the next Korotkoff sound which fades away as the cuff pressure drops below the diastolic blood pressure. To listen to actual blood pressure or the Korotkoff sounds Click here
Here is a final image of the heart and its circulation. It shows the structure, chambers, valves and blood vessels, the movement of blood, with striking clarity. 14
15 HT Qi & Acupuncture Practice HT Qi arises out of the element Fire. The yin is HT and yang Small Intestine. It controls blood vessels and blood, as well as Awareness Consciousness Thinking Introspection Intuition Logic and so on. HT Qi is seen mainly in the cheek, and assessed at the pulse. All 6 pulse positions can be felt because of its nature, and so also the differentiation into Cun Guan and Chi. HT Qi is assessed clinically by signs and symptoms, the color of cheek, and by the feel of the pulse, and by the color of tongue substance and coat. HT Qi can express itself freely but is under control of Kidney [K] Qi. If K Qi is deficient, HT Qi will Rise and cause illnesses of an Excess nature. If untreated, a Deficiency condition will set in. Conditions precipitated will include insomnia, chronic sense of sadness, depression, suicidal thoughts, mania, psychological conditions like bipolar illness, ADD, psychosis, schizophrenia, compulsive obsessive disorder etc. Physical conditions can be high or low blood pressure, variations in consciousness etc. When checking HT pulsed, always offset it against the K pulse. When treating HT, always include K points When you have established a condition of K & HT Qi in Disharmony, a useful needle prescription is: Fire point on Water [K] channel K 2 - Vs - Water point on Fire [HT] channel HT 3
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