DIAGNOSIS AND TREATMENT ACCORDING TO VITAL SUBSTANCES

DIFFERENTIAL DIAGNOSIS ACCORDING TO VITAL SUBSTANCESA. DISEASES OF QI

I. QI VACUITY ( QI XU )

a) Organs Affected: Lu, Sp

b) Etiology:

a) Long-standing disease impairs organ function

OR recovery from acute disease

b) Insufficiency of Yuan (Source) Qi leads to hypo-function

Malfunction of Yang Qi

Yuan Qi/ Gu Qi/ Zong Qi XU

  

c) Loss of blood seriously damages Qi.

Qi loses its form or housing; accidents, surgery, hemorrhage, etc.

d) Long time accumulation of Yin pathogens: COLD or DAMP

e) Liver Qi stagnation often involved

f) Old age

  

Symptoms:

FATIGUE AND WEAKNESS: functional, physical, spiritual

  

WEAKNESS:

  

• Lung- poor stamina (worse upon exertion
• Spleen- Lethargy ( Heavy limbs) 
• Kidney – Exhaustion ( sleeping, lying down)

PALLOR: generally reflects failure of QI to transport (circulate) Blood

YUAN QI is differentiated in San Jiao according to level:

Zong Qi Sx: Respiratory problems: Shortness of breath, weak voice, spontaneous perspiration, chill, fatigue upon exertion, susceptibility to colds

Zhong Qi Sx: Weak digestion, lack of appetite, abdominal fullness after eating, impaired bowel function (soft stool), lethargy

   

Kidney Qi: Weakened bladder function, diminished libido, hearing impairment, low back pain, weakness below the waist, exhaustion-need to sleep

  

Tongue: Pale, flabby and weak

  

Pulse: Deficient, weak, soft, (fine, forceless)

   

d) Treatment Principles:

Tonify Qi

Benefit Spleen

e) Herbs:

Codonopsis ( Dang Shen), Ginseng ( Ren Shen)

 Astragalus (Huang Qi), Glycerrhiza (Gan Cao)

f) Prescription:

Si Jun Zi Tang ( Four Gentlemen Decoction)

Ginseng (Ren Shen) or Codonopsis (Dang Shen)

Atractylodes ( Bai Zhu)

Poria (Fuling)

Glycerrhiza ( Gan Cao)

II. QI (SPLEEN) SINKING- also a Qi deficiency syndrome

 a) Organs Affected: Spleen

   

b) Etiology: Upward Qi of Spleen is not strong enough to
support tissue.

c) Symptoms: prolapse of organs, hemorrhoid

sensations of heaviness, fatigue, bearing down sensations, loose stools

Tongue and Pulse: As in Qi deficiency

   

d) Treatment Principle: Raise the Qi

Supplement the Middle

Strengthen the Spleen

  

e) herbs: Astragalus ( Huang Qi ), Bupleurum (Chai Hu), Cimicifuga ( Sheng Ma)

 f) Prescription: Bu Zhong Y Qi Tang

• Supplement the Middle and Raise the QI Decoction
• Tonifies the Qi of the Middle Burner, raises sunken Yang-

 Huang Qi, Ren Shen, Bai Zhu, Gan Cao, Dang Gui, Chen Pi, Chai Hu, Sheng Ma

  

  

III. COUNTERFLOW OF QI- usually Excess, but can be a deficiency syndrome.

  

a) Organs Affected: Stomach, ( Pathology is characterized by counterflow symptoms.)

• Lung- failure of descending function ( cough, asthma)

   

b) Etiology

1. Pathogenic accumulation or attack leads to misdirection in flow of Qi.

• Upward/downward ( Sp/St, Lu, Kid) circulatory (Liver) Reflux

  

2. Qi insufficiency leads to hypofunction

c) Symptoms:

1. Upper Jiao: coughing, Asthma

2. Middle Jiao-: hiccups, belching, vomiting, nausea, Reflux.

3. Liver: (Liver Yang Rising) headache, dizziness, ringing in the ears, fainting, stroke, convulsion,

  

Tongue and Pulse:

• Vary according to pathogenic factor and Excess or Deficiency

d) Treatment Principles

1. Redirect Qi

2. Clear Pathogen

3. Regulate Organ function

.

e) Herbs Pinellia (Ban Xia) and Bambusa (Zhu Ru)

- Redirect St. Qi ( stop vomiting)

Magnolia ( Hou Pu)

-transform dampness and directs Qi downward

Perilla Seed ( Su Zi)

-stops coughing and wheezing, redirects Qi

Cortex Morus ( Sang Bai Pi)

- stops coughing and wheezing and drains heat; used when lung heat obstructs downward movement of Qi.

  

f) Prescription Ju Pi Zhu Ru Tang

(Tangerine Peel and Bamboo Shavings Soup)

  

-directs rebellious QI downward, stops vomiting, harmonizes the Stomach, clears Heat.

  

Red Fu Ling, Chen Pi, Pi Pa Ye, Mai Men Dong, Zhu Ru, Ban Xia, Ren Shen, Gan Cao

  

IV. QI STAGNATION ( Blockage or Non-Flow)

   

a). Organs Affected: LIVER IS ALWAYS INVOLVED

  

b) Etiology: 1. Depressed Emotions-Liver Qi unable to circulate

“Unfulfilled Desires”

2. Accumulation of Pathogen: especially Yin pathogens: Damp, Cold.

3. Qi Deficiency- unable to move Qi

 “Disease Causes and Mechanism Resulting in Liver Depression:”

   

1. unfulfilled desires

2. sequelae of anger

3. insufficient nourishment and emolliating by blood

4. insufficient enrichment and moistening by yin

5. insufficient warming and steaming by yang

6. any four of the Yin Depressions ( see below)

7. Inhibition or damage to Lung D and D

8. Any evil qi ( pathogen) obstructing free flow of Qi

 c) Symptoms: 1. Pain- distending sensations, feelings of oppression. Pain is not fixed.

2. Distention- Fullness or tenderness of ribs, or flanks, as well ass throat, chest, epigastrium,

abdomen

  

3. Masses- soft and moveable

4. Depression/frustration/irritability

Tongue and Pulse: T- Purple body (Maciocia says either normal tongue or red on the sides)

P- Wiry, Excess

d) Treatment Principles:

1. Regulate Qi (Move Qi/ Remove Stagnation)

2. Regulate Liver function

-spread Qi

-regulate menstruation

-dissipate clumps

e) Herbs Cyperus ( Xiang Fu)- Circulates the Qi and resolves constrained Liver Qi, alleviates pain

 Bupleurum-(Chai Hu) Relaxes the Liver

 Citrus (Chen Pi)- moves Qi and strengthens

the Spleen- prevents stagnation of tonic herbs

Melia ( Chuan Lian Zi)- Clears Heat, stops pain

   

f) Prescription Jia Wei Xiao Yao San

Modified Rambling Powder

 -Spreads Liver Qi, strengthens spleen, nourishes blood, clears Heat

  

- Dang Gui, Bai Shao, Fu Ling, Bai Zhu, Gan Cao, Chai Hu, Mu Dan Pi, Zhi Zi

B. DISEASES OF BLOOD

I. BLOOD VACUITY

a) Organs Affected Heart, Liver, Spleen

b) Etiology:

1. Spleen Qi Deficiency- not producing Blood

 2. Blood Loss- hemorrhage from trauma, Menstrual flow- especially with irregular flow surgery

3. Kidney Essence failing to nourish Liver Blood,

4. Shock to Heart

5. Heat (Yang Excess),often from Liver stagnation

c) Symptoms DRYNESS, WEAKNESS, PALLOR, FATIGUE

• a) HE BLOOD XU: insomnia, poor memory, irritability of spirit; anxiety or nervousness

• b) LIVER BLOOD XU: blurred vision, spots in vision, floaters, dry eyes; headache, dizziness, scanty or delayed menstruation, dry skin, dry hair, joint problems

NOTE: Liver Blood Xu often gives rise to Liver wind, and many symptoms often listen as blood xu symptoms are really wind caused by blood xu.

Tongue: small (thin), pale, dry

Pulse: deficient, thready, hesitant, weak, hollow

d) Treatment Principles

1. Tonify the Blood

2. Strengthen Spleen to produce Blood

3. Clear Heat from the blood

4. Calm Shen

e) Herbs: Rehmannia ( Shu Di Huang), nourishes Kidney

Paeonia (Bai Shao), "softens" Liver, promotes Essence

Dang Gui-Heart, Liver Spleen- Tonifies and invigorates blood

f) Prescription Si Wu Tang (Soup of Four Things)

Tonifies the Blood and regulates the Liver

Shu Di Huang, Bai Shao, Dang Gui, Chuan Xiong

II. BLOOD STASIS

a) Organs Affected Heart, Liver

with the exception of trauma, or pathogenic accumulation, all blood stasis derives from a failure of liver function

  

b) Etiology

1. Qi Stagnation

2. Qi Deficiency

3. Trauma

4. Pathogenic Accumulation ( Cold Or Heat)

5. Hemorrhage

6. Long standing illness with phlegm accumulation

c) Symptoms 1. PAIN- fixed and constant

2. Masses and swellings- tumors, fibroids, etc.,
- hard and fixed, “irregular” masses

eding- obstruction of vessels

 - dark purple, clotted bleeding

4. Sooty black complexion

Tongue: Purple

Pulse: string taut, hesitant (choppy)

d) Treatment Principles

1. Move Blood/ remove stasis

2. Stop pain

3. Promote Menstruation

4. Break Up Blood

f) Herbs Curcuma (Yu Jin)- Invigorates Qi and Blood

Salvia ( Dan Shen)- Moves Heart Blood and

Benefits menstruation

Carthamus ( Hong Hua)- Dispels congealed Blood and alleviates pain, benefits Menstruation

 Persica (Tao Ren)- Breaks Up Blood

 Corydalis (Yan Hu Suo)- Moves Qi and Blood.\

Alleviates Pain

g) Prescription Tao He Cheng Qi Tang

Persica Order the Qi Decoction-

Drains Heat and Breaks Up Blood Stasis

Tao Ren, Da Huang, Gui Zhi, Mang Xiao, Gan Cao

III. BLOOD HEAT (HEAT IN THE BLOOD)

a) Organs Affected Heart, Liver

b) Etiology

1. Exogenous Heat- Invasion of Heat penetrates

Ying ( construction) Level According to Four Levels

2. Liver Heat turning to Fire- Liver stores blood;

Liver Fire can make the blood Hot"

3. Heat Toxin- can also penetrate the Four Levels

c) Symptoms 1. Skin eruptions; bright Maculo-papular eruptions and rash, burning sensation of skin.

2. Bleeding- aggravation of heat causes " reckless marauding of blood"

a. hemoptisis, epistaxis, hemafecia, hematuria,

b. menorrhagia, metrorrhagia

3. SHEN Disturbance: mania, anxiety, restlessness, mouth ulcers

Tongue: Red Body

Pulse: Excess, rapid, surging

d) Treatment Principles

1. Cool the Blood

2. Remove Toxin

3. Calm the Spirit

4. Stop Bleeding

5. Nourish Yin

e) Herbs Moutan ( Mu Dan Pi) Clears Heat/Cools Blood, clears deficiency fire

Scrophularia ( Xuan Shen), Clears Heat/ cools Blood, clears toxins, nourishes yin

Raw Rehmannia ( Sheng Di Huang) Clears Heat/ Cools Blood, cools Heart Fire

f) Prescription Qing Ying Tang

Clear the Nutritive Level Decoction

Clears Heat from Nutritive Level (Ying)

Relieves Fire toxin, drains heat, nourishes Yin

- Cornu Bubalus ( Shui Niu Jiao), Xuan Shen,

Sheng Di, Mai Men Dong, Jin Yin Hua, Lian Qiao

Huang Lian, Dan Zhu Yu, Dan Shen

C. THE SIX DEPRESSIONS

1. Qi (Qi Stagnation)

2. Blood (Blood Stasis)

3. Damp (Damp Accumulation)

4. Phlegm (Phlegm Obstruction)

5. Food (Food Stagnation)

6. Fire (Depressive Heat)

The First Five Depressions all lead to Fire:

1 Qi Depression leads to Depressive Heat

2 Food Depression leads to Food Stagnation transforming Heat

3 Damp Depression leads to Damp Heat

4 Phlegm Depression leads to Phlegm Heat

5 Blood Depression leads to Stasis Heat