DIFFERENTIAL DIAGNOSIS ACCORDING TO THE SIX STAGES OF COLD

INTRO- Theory of Exogenous Cold Disease/ Theory of Pathogens Stage by stage development of Febrile Disease- The struggle between Righteous Qi (Resistance) and Pathogenic Qi ( pathogen )

High Fever: reflects a strong pathogen attacking undamaged Righteous Qi

Remittent Fever- Pathogen not yet fully erased, Righteous Qi is compromised


I. YANG STAGES (Resistance is greater than pathogen)


A. TAI YANG “ GREATER YANG” ( Bladder and Small Intestine)


1. Location: surface

2. Symptoms: “Fever” and chill, aversion to wind ( aversion to cold), headache, stiff neck

Pulse-superficial (floating)



3. Treatment method: Diaphoresis (Shang Han) or Harmonize Ying and Wei (Chong Feng)


DIFFERENTIATION:

1) Chong Feng (Wind Attack) Wind Cold Deficiency

Lung Qi is deficient and patient may already be perspiring from Lung QI Xu, therefore symptoms are generally milder

Diaphoresis is contra-indicated.

Symptoms: Milder fever, mild chills, aversion to wind, nasal congestion, headache, neck and shoulders stiff, Spontaneous perspiration

Pulse: floating (superficial) and weak (full on light palpation but empty on firmer pressure)

Treatment Principle: Harmonize Ying and Wei ( See Gui Zhi Tang)

TaiYang Chong Feng cont.,

Prescription: Gui Zhi Tang (Cinnamon Twig Soup)

- Releases pathogenic influences from the muscle layer and regulates the nutritive and protective Qi

- Gui Zhi, Bai Shao, Sheng Jiang, Da Zao, Gan Cao

Gui Zhi disperses Wind Cold, and promotes Yang in the Channels

Bai Shao- Benefits Yin and contains ( astringes) the weak nutritive (Ying) Qi

Together, they enhance the ability of Wei Qi to expel pathogens while strengthening the Ying Qi

2) Shang Han (Wind Cold Excess)

Symptoms: Fever and chills, Cold predominates, and fever will be stronger as well. Pulse: will be more tense on both superficial and deep palpation. Can also enter Bladder through Bladder Channel and cause edema or urinary retention

Treatment Principle: Release Exterior Cold ( Disperse Wind Cold)

Prescription: Ma Huang Tang (Ephedra Decoction)

- Releases Exterior Cold and stops wheezing

B. SHAO YANG “LESSER YANG”( Gall Bladder and San Jiao)



This stage indicates the weakening of the Righteous Qi allowing the pathogen to

penetrate to the Interior. This progression usually takes about seven or eight days. This Stage is considered to be the pivot as the pathogen moves from Exterior to Interior or Interior to Exterior



1. Location: Half surface/Half Interior



2. Symptoms: alternating chills and fever ( malaria)Chest distress ( fullness or congestion), hypochondrial or flank pain, bitter taste, dry mouth or throat, poor appetite, vomiting, cough.



Pulse: is likely to be wiry

Tongue may have one-sided white coating



Treatment Principle: Harmonize Interior and Exterior ( e.g. Harmonize Xiao Yang)



Prescription: Xiao Chai Hu Tang ( Minor Bupleurum Decoction)



-Harmonizes and releases Xiao Yang Stage disorders

- Chai Hu, Huang Qin, Ban Xia, Sheng Jiang, Da Zao, Gan Cao, Ren Shen

C. YANG MING “ BRIGHT YANG” (Stomach and Large Intestine)

1. Location: Internal

2. Chief symptoms: "Four Bigs"-Fever, sweating, thirst, pulse, constipation, with organ syndrome

Pulse: Full and forceful, rapid, surging


3. Treatment Method: Clearing ( Yang Ming Jing)/ Purging (Yang Ming Fu)


DIFFERENTIATION:

1) Yang Ming Jing “WITHOUT FORM” ( Channel pathology)

NB- In general, this is the more deficient syndrome with lethargy instead of delirium, but there are many possibilities in the overlapping of syndromes Heat is considered to be in Stomach

Principle conformation: The Four Great Things

1) High fever

2) Profuse perspiration

3) Great thirst

4) large surging pulse

Treatment Principle: Clear Heat

Prescription: Bai Hu Tang (White Tiger Decoction)

-Shi Gao, Zhi Mu, Geng Mi

- Clears Heat ( Qi Level), drains stomach fire, generates fluids, alleviates thirst;


2) Yang Ming Fu ( Organ pathology)

- The more excess condition. Heat has penetrated caused more damage to fluids, more discomfort (pain)

Principle conformation: Four Great Things plus CONSTIPATION, There is abdominal fullness and "focal" distention, pain

Fever is usually worse in the A.M., there is usually agitation or mania, delirium or restlessness.

Note- With the complexity of overlapping symptoms, the differentiation is usually based primarily upon restlessness vs. lethargy

KEY RULE: If the body is heavy, do not purge

Treatment Principle: Purge and Clear Heat

Prescriptions:

1) Da Cheng Qi Tang ( Major Order the Qi Decoction)

- Vigorously purges Heat Accumulation; This formula is for

100% Yang Ming Excess

- Da Huang, Mang Xiao, Zhi Shi, Hou Pu



2) Xiao Cheng Qi Tang- remove Mang Xiao if slightly more deficiency KEY is perspiration. More perspiration, less fever and fullness indicates more deficiency

3) Tiao Wei Cheng Qi Tang- Da Huang, Mang Xiao, Gan Cao for less severe constipation




II. YIN STAGES (Pathogen is greater than resistance. e.g., metabolic hypofunction)

A. TAI YIN ( Spleen and Lung)

Note- When improperly treated, Tai Yang can advance to Tai Yin, or cold pathogen can penetrate directly to spleen when spleen is weak.

This stage reflects a condition arising from a cold pathogen invading an inherently deficient interior (spleen), creating Spleen Yang Deficiency

1. Location: Interior

2. General conformation: full abdomen, no thirst, abdominal pain, vomiting, diarrhea, chills, fatigue.

3. Treatment Principles: Supplement and Warm


DIFFERENTIATION:

a) Strong: Abdominal pain predominates, spasms of rectus abdominus with weakness underneath
Prescription: Xiao Jian Zhong Tang ( Minor Construct the Center Decoction)

-Warms and modifies the Middle burner and moderates spasmodic pain

- Yi Tang ( Maltose) Gui Zhi, Bai Shao, Gan Cao, Sheng Jiang, Da Zao


b) Weak: weakness and cold predominates; symptoms of vomiting, diarrhea,profuse urination. Pulse: weak

Prescription: Li Zhong Wan ( Regulate the Center Pill)

- Warms the Middle burner and strengthens stomach and spleen

- Gan Jiang, Ren Shen, Bai Zhu, Gan Cao


2. SHAO YIN ( Heart and Kidney)

Note- Like the above, but a deeper level of illness: Kidney deficiency with either cold or heat (Yin Xu or Yang Xu)

a) Location: Interior

b) General conformations: Like Tai Yin, but keynote is DROWSINESS.

Kidney deficiency is characterized by the need to “lie down” or lie “curled up.”

If Yang Xu, coldness is pronounced, if Yin Xu, Heat is pronounced.

There will also be urinary symptoms including frequent, clear or copious urination



c) Treatment Principle: Supplement and warm ( or clear Deficiency Heat)



d)Prescription: Zhen Wu Tang ( True Warrior Decoction)

- Warms the Yang and promotes urination

- Fu Zi, Bai Zhu, Fu Ling, Sheng Jiang, Bai Shao

3. JUEH YIN ( Liver and Pericardium )



1.) Location: Interior



2.) General Symptoms: True Cold/False Heat; separation of Yin and Yang,

coma, icy coldness, vomiting when attempting to eat; hunger with no

appetite, Fever in the upper Jiao: Heat and pain in the chest, congestion of Qi in

the chest, thirst, vomiting of worms, or just vomiting.



3) Treatment Principle: Restore Collapsed Yang, warm, etc.,



4.) Prescription: Si Ni Tang (Frigid Extremities Decoction)



Note: Do not confuse with Si Ni San ( Chai Hu, Zhi Shi, Bai Shao, Gan Cao)



-Rescues devastated Yang, warms the Middle, stops diarrhea

- Fu Zi, Gan Jiang, Gan Cao

A POSITIVE PROCESS: THE FIVE ELEMENTS ARE AN AFFIRMATION OF THE POSITIVE THRUST OF NATURE

FIVE ELEMENTS is the Life Cycle of the creation and control of being- The growth and development of being. ( Hammer)

Being is: the essential qualities of the individual evolved through the conscious process of individuation and differentiation from our common racial unconscious spiritual heritage.



The healthy urge to become something is a positive process:

To live, to expand, combating the restrictive environment.

A POSITIVE PROCESS: THE FIVE ELEMENTS ARE AN AFFIRMATION OF THE POSITIVE THRUST OF NATURE

TOWARDS LIFE AND RENEWAL.



Negative Emotions are Distortions of the process of becoming:



Negative emotions are always the secondary expression of some failure in the realization of a primary positive emotional force or need.



As practitioners, “ we are needed to recognize the positive quest for contact beneath the negative emotion.”



Anger is the emotion of the Soul or spiritual faculties in self urge or birth and growth of ego: The healthy urge to become something



JARRETT:



De ( Virtue): The original endowment of nature prior to moral distinctions and conscious effort



Ming ( Destiny)- Our contract with Heaven, conferred by Heaven upon man; “ Our movement through Life is powered by a wave of destiny that we are given the choice to either fulfill or repudiate with every heart beat.



Jing ( Essence) – Our inherited endowment; the seed of all being, and the wellspring of life’s manifestations. Jing holds the potential for the manifestation of Heaven’s will as it exists uniquely within each human being.



Shen (Spirit); The heavenly brightness emanating from the heart which is the active impulse from heaven to ignite our inborn potential.



Ling ( Spirit)- The substrate of that potential. Pure potential. Together with Shen, it creates a spiritually potent force to live our destiny







FIVE ELEMENTS

WOOD HUN/ ANGER/ BENEVOLENCE

Color is green- Spring, youth, vigor, flexibility



Season is Spring- Beginning of Life. Life begins after dormancy of winter, “ The natural violence of seeds ( Hammer), “ The violence proper to all beginnings,”

( Larre, Seven Emotions)



Hun is Spirit of Liver, “ Ethereal Soul” according to Maciocia, aggressive for experience, amoral, childlike.; moves Mind and vision out into the world and back into self. Eyes create duality. A flexible HUN integrates Inner and Outer Vision. The Qi of the Mind



Boundaries, Flexibility, inner vision, decision-making, judgment (GB)



EMOTION: ANGER- the female slave under the hand of the master

Energy necessary to push through obstruction, frustration.

Aggressive energy, protective: Qualities necessary for a good general: anger, aggression, but flexible and under control



Also: Belligerence, resentment, rigidity, arrogance, determination ( Excess)

Timidity, indecision, flaccidity, humility, impotence,



VIRTUE: BENEVOLENCE; mutual benefit; grow according to your own nature and allow others to grow according to theirs.



Also: Discernment, Flexibility, Esteem, Patience



Wood is the fuel for Heart Fire/ The Liver and the Heart together create the emotional states.

FIRE SHEN/JOY/PROPRIETY- The Emperor/Empress/ Sovereign/ Ruler



Season: Summer, peak of life cycle, yang of Yang



Climate: Heat, warmth; fire made useful by limitations; naturally kinetic, expansive, dynamic. Bonding, passion, desire



Natural tendency for these things to rise; Must be descended to Kidney, bring Fire to Water, Shen to Jing, emotions to wisdom



The Heart must remain open to provide a suitable resting place for Shen;

The original nature of Heart, serene accepting open



EMOTION: JOY- “Joy makes the Heart Larger.” ( Maciocia)



“Appropriate Joy- e.g., contentment, appropriate to Heart, like sweet taste to the spleen; easy to overdo it. Excessive joy and emotionality deplete the heart and lead to sadness.



Speech: “ When you first attain a little insight, if you are delighted and talk too much, your shen leaks out and there is no spiritual refreshment of the light of the body.” ( Taoist Meditation).



VIRTUE: PROPRIETY ( Ceremony/ritual)



Alignment with the Tao allow heavenly spirits to guide from within.

Coming from the Heart.

If you need rules to be kind and just, if you merely act virtuous, this is a sure sign that virtue is missing.



“ He moves in Harmony with the present moment always knowing the truth of just what to do.” Being in the right place at the right time knowing just what to do.

EARTH YI/INTENT / WORRY, OVERTHINKING/ INTEGRITY



Time of Life: Childhood, nourishment

Climate: Earth must be Moist for fruits to ripen

Earth nourishes everyone generously; Earth is what we stand on, our “Bottom Line”, our Integrity

Nourishes Potential into being

Yi procures nourishment for the Mind, just as spleen provides nourishment for the body; This nourishment contains Heart Fire and manages Heart Shen. The Link between Heart and Spleen is the link between inspiration and intention.



Intellect, clarity of thought, concentration, evaluation and storage of data.

Generation of ideas, sustained intention.



Intent, idea, thought, opinion, meaning, intention, taste and tendency

( Larre)

Ability to nurture self and others

POST-Heaven Qi and Blood are the physiological basis for the Intellect



EMOTION: WORRY, OVERTHINKING



Worry creates stagnation, draws too much Qi to the spirit, without intention; worry is part of a self-perpetuating vicious cycle ( just like dampness)



Brooding, obsessive thoughts



VIRTUE: INTEGRITY



Authenticity of Speech ( Spleen governs the mouth); the extent to which our words conform to the truth in our heart.



“ Clever words, an ingratiating demeanor, and excessive respect…I am ashamed of them.” - Confucius



RECIPROCITY



Heaven bestows on great and small alike; reciprocity of nurturance between heaven and earth, meeting the needs of others; symbiosis, nature

METAL PO ( ANIMAL SPIRIT)/ SADNESS/ RIGHTEOUSNESS



Most Yin of the elements, most dense, slowest to change

Po is coming and going of Essences

Hard, permanent; highly-organized, crystalline minerals, can be cast and re-cast, but will maintain molecular identity



Direction- West, setting sun, end of life cycle

Fall- end of growth cycle

Harvest what is valuable, store it, let the rest go fallow during winter

Middle Age, maturity



Metal functions- somatic intelligence; homeostasis, senses, instincts, identity, individuality; Autonomic nervous system; purely somatic



PO is the Animal Spirit/Corporeal Soul

Breathing is the direct manifestation of the corporeal soul

Somatic manifestation of the Soul



EMOTION/ Grief; Sadness

Po reacts to life with sensations and emotions, stores reactions, Hun should raise this information to the Shen, or else it will stay in Po and create disease.



Pain of Loss; deepest, most primal yin emotion; This implies lack of understanding and faith in the Tao, because the only constant in life is loss



Grief comes from attachment to loss or gain;



Lack of understanding of inspiration/exhalation of Life ( Righteousness)



VIRTUE/ RIGHTEOUSNESS



Understanding and accepting the righteousness of the Tao: cycles of gain and loss, inspiration and exhalation, growth and harvest.



The rhythym of the Lungs empowers a broader connection to the breath of the Tao

WATER ZHI/FEAR/WISDOM



“For water benefits all things and goes against none of them. It provides for all people and even cleanses the places a man is loath to go. In this way it is just like the Tao.” TTC 8



“ Nothing in this world is as soft and yielding as water, yet for attacking the hard and the strong none can triumph so easily. It is soft, yet none can damage it. It is yielding, yet none can wear it away.” TTC 78



- Surrendering to your destiny is powerful

Water is a subtle, tenacious force which can dissolve any barrier over time



River flowing to the sea is a return to the origin



Destiny/ Birth and death and rebirth; MING



WINTER- Dissolution, decomposition, hibernation, gestation

The moment when Yin reaches its extremity and spontaneously transforms into yang



BLACK.BLUE/ Color of night of death



EMOTION: FEAR



Discomfort with the unknown, Lacking the “healthy sense of awe.”

Not understanding the nature of death



ZHI- WILL Potency in the mental, physical and spiritual spheres.

Potential, ability and power to manifest

When Intent becomes permanent we speak of the will



WISDOM- accrued through the cycles of life and death

- aligning our will with Heaven’s. Knowing our MING ( destiny)

- Integrating experience into consciousness

DIFFERENTIATION AND TREATMENT ACCORDING TO PATHOGENS.

PATHOGEN : DETERMINES THE PATHWAY OF DISEASE

GENERALLY REFLECTS THE EXCESS COMPONENT OF A PATTERN PATHOGENS



I. WIND


1.) WIND COLD



a) KEY SYMPTOMS: aversion to Cold/wind (chills and fever),

thin secretions, pain, patient is easily chilled. No perspiration. Chill predominant. Headache and upper back pain.

Method: Diaphoresis

Tx Principle: Release Exterior with acrid and warming herbs


Points: GB 20, UB 12, L.I.4, Lu 7

Herbs: MaHuang ( Ephedra), Gui Zhi (Cinnamon), Fang Feng ( Siler)


Prescription: MaHuang Tang (MaHuang, Gui Zhi, Xing Ren, Gan Cao)



2.) WIND HEAT

KEY SYMPTOMS: Feverish, but sensitive to wind (chills and fever)sore throat, thick secretions, with difficulty expectorating. Perspiration. Attacks front of face and eyes. Can cause or aggravate skin eruptions


Method: Diaphoresis


Tx Principle: Release Exterior with acrid and cool herbs.

Points: L.I. 4,L.I. 11, SJ 5, Lu 10

Herbs: Bo He ( Mentha), Niu Bang Zi ( Arctium), Chan Tui

( Cicada).

Prescription; Yin Qiao San ( Lonicera and Forsythia Powder)

Disperses Wind Heat, Clears Heat, Relieves toxicity



- Jin Yin Hua, Lian Qiao, Jie Geng, Niu Bang Zi, Bo He, Dan Dou Chi, Jing Jie, Dan Zhu Ye, Lu Gen, Gan Cao


3.) BI SYNDROME: WIND DAMP WITH COLD OR HEAT


KEY SYMPTOMS: Joint pain with swelling, aggravated by changes in weather or exposure to heat, damp, or cold pathogen, stiffness, decreased mobility.


1) "Rheumatic" pain ( from blockage of Qi),

2) swelling (damp)

3) weakness (with increasing chronicity)

B. TREATMENT PRINCIPLES

1. Expel Wind Dampness

2. Alleviate Pain

3. Activate the Channels

4. Strengthen sinew and bone

5. Reduce Swelling


C. HERBS:

1. Du Huo ( Angelica ) Expels wind damp and alleviates pain, especially lower body (back and legs)

2. Chiang Huo (Notopterygium) : Releases Exterior and disperses Cold; Penetrates through painful obstruction.

" guides Qi to Greater Yang and Governing Channels"

- especially upper limbs ( neck and shoulders)


3. Qin Jiao (Gentiana)- expels wind damp, cramping of extremities

- Clears Deficiency heat

4. Wei Ling Xian ( Clematis ) Expels Wind damp, activatesChannels, alleviates pain:

-Releases Exterior and moves the Qi of the Channels.

Treatment Method: Diaphoresis- but can be combined with activating substances to remove obstruction in the channels

Treatment Principle: Dispel wind-dampness, Remove obstruction from channels, transform damp, relax sinews

Prescription: Shu Jing Huo Xue Tang ( Relax the Channels and Invigorate Blood Decoction) (Clematis and Stephania)


4). INTERNAL WIND

GENERAL WIND SYMPTOMS: erratic movement or lack of movement: trembling, spasmodic movements, convulsions, seizures, uneven movements, opistothonos, twitches, sudden loss of consciousness or movement, dizziness, numbness or hemiplegia


1. EXTREME HEAT

Key Symptoms: convulsions or seizures accompanied by high fever, delirium, perspiration, etc with possible loss of consciousness or paralysis.

Tongue: Red, stiff, quivering

Pulse: Rapid, taut, superificial, replete

Method: Clearing (combined)

Principle: Clear Heat and Subdue Liver Wind
Points: Du 20, 14, Liv 2, 3,

Herbs: Ling Yang Jiao ( Cornus Antelopis), Gou Teng (Uncaria), Niu Xi ( Acyranthes).
Prescription: Ling Jiao Gou Teng Tang ( Antelope Horn and Uncaria Decoction)

- Cools Liver, Extinguishes Wind, increase fluids, relax sinews



2.) YANG RISING
Key Symptoms: dizziness, headache, irritability, hemiplegia, lesser seizure disorders. Stroke, HBP, tinnitus, plus sx of Liver Blood Xu or Kid Yin Xu

Method: Combined- Supplement ( Yin) and Subdue Wind.
Treatment Principle: Extinguish Liver wind and Subdue Yang. Nourish Yin. Regulate Liver.

YANG RISING
Points: Du 20, GB 20, Liv 3

Herbs: Tian Ma ( Gastrodia), Gou Teng ( Uncaria )

Prescription: Tian Ma Gou Teng Yin ( Gastrodia and Uncaria Decoction)

Calms the Liver, Extinguishes Wind, Clears Heat, invigorates the Blood, Tonifies Liver and kidneys

- Tian Ma, Gou Teng, Shi Jue Ming, Zhi Zi, Huang Qin, Yi Mu Cao, Niu Xi, Du Zhong, Sang Ji Sheng, Fu Shen


3) LIVER BLOOD DEFICIENCY WIND (Like Wind in the Channels, but weaker pattern and more predominantly vacuity)

KEY SYMPTOMS: tics, slight tremors, numbness, itchy rash that changes location.

Treatment Method: Combined- Supplement ( Blood) and Subdue Wind

Treatment Principle: Nourish Blood and Subdue Liver Wind

Points: GB 20, Liv 3, Liv 8, Sp 6, 10, Bl. 17

Herbs: Tian Ma, Gou Teng, plus Liver Blood tonics


5) WIND IN THE CHANNELS ( derived from Blood Deficiency but can have varying degrees of severity depending up strength of Yang) Creates “trembling” in limbs

A. SYMPTOMS

a) seizures, strokes, tremors

b) rash, itchy, usually red

c) cramps, spasms

B. TREATMENT PRINCIPLES

1. Extinguish Wind
2. Expel Wind from Sinews (Tremors seizures and strokes)
3. Expel Wind from skin (rashes ands inflammatory skin probs)


C. HERBS
1. Bai Hua She or Wu Shao She ( Agkistrodon or Zaocys)

-Powerfully activate the channels and extinguish wind

- used for wind-stoke or rashes

2. Sang Ji Sheng (Loranthus)- tonifies Liver and Kidneys (Yin) and expels wind dampness

3. Bai Ji Li ( Tribulus) Extinguishes Wind, alleviates pain, brightens the eyes, Liver Yang or Wind Heat in the Liver Channel

-skin lesions with significant itching.


II. HEAT

General symptoms: redness, burning or heat sensation, thickening of secretions, putrescence of smells, hyperactivity and restlessness, rapid movement, perspiration, thirst (for cold); preference for cold, aggravation from warmth

Method: Clearing

Treatment Principles:

Clear Heat and Quell Fire, Clear Heat and Dispel Toxin, Clear Heat and Cool the Blood, Clear Deficiency Heat and Nourish the Yin or Lower the Kidney Fire. Clear heat and generate Fluids .

Herbs: Shi Gao ( Gypsum), Zhi Mu ( Anemarrhena), Zhi Zi (Gardenia)


Prescription: Bai Hu Tang ( White Tiger Decoction)

Clears Qi Level Heat, drains Stomach Fire, generates fluids, alleviates thirst
- Shi Gao, Zhi Mu, Gan Cao, Geng Mi



III. COLD


KEY SYMPTOMS: Chill or subjective feeling of cold, slowness, thin secretions, increased fluid volumes, contractile pain, improved by Heat, preference for warmth and warm drinks, damage to Yang resulting in imbalance of body fluids ( e.g., abundant urination)

Method: Warming

Treatment Principles: Warm the Center and Expel Cold, Warm the Channels, Restore Yang, Warm Yang and promote urination.


Herbs: Gan Jiang ( Dry Ginger), Rou Gui ( Cinnamon Cortex )

Prescription: Li Zhong Wan ( Regulate the Center Pill )

Warms the Middle Burner and strengthens the Spleen and Stomach

- Gan Jiang, Ren Shen, Bai Zhu, Gan Cao


IV. SUMMER HEAT

A. Etiology-

1) Created by Pathogenic Factor, does not develop internally:

invasion of summerheat disease like sunstroke or heat stroke, or invasion of heat toxin; or co-mingling with extremely Yang climate (hot, humid weather) with the body's existing dampness. Attacks Sp/St

2) Seasonal Pathogen: Related to Late Summer.

B. Differentiation

Although essentially a Yang pathogen, Summerheat usually combines elements of heat and dampness, and must be differentiated according to the preponderance of symptoms. The key here is the presence or absence of HIGH FEVER and the resultant damage to BF

C. Key symptoms


1. Summerheat Heat

High fever, with thirst, sparse urination and restlessness. May be profuse sweating or none. Severe symptoms include "inversion syndrome": tetany, convulsion, loss of consciousness; damage to Yuan QI
causes fatigue, exhaustion, dry tongue coating.

Pulse: Full and surging, rapid; or if deficiency thin, rapid, or large but empty and rapid.



2. Summerheat Damp
persistent low grade fever, thirst with no desire to drink, chest oppression, poor appetite, heavy limbs, nausea and vomiting. Sparse urination which is dark and concentrated. Thin, sticky diarrhea

D. Treatment Principles

1. Clear Summerheat
2. Transform dampness
3. Tonify Yin/ nourish fluids


E. Herbs
Heat: Xi Gua (Citrus Vulgaris), Shi Gao (Gypsum), Qing Hao(Artemesia)
1. Prescription : LIU YI SAN ( Six to One Powder): 6 Hua Shi / 1 Gan Cao

INTRODUCTION TO BODY FLUIDS

I. Body Fluids Physiology reflects the dynamic interplay between JIN YE and YUAN QI


A. Jin Ye ( The pure or normal Physiological Fluids)

1) JIN FLUIDS

a) follow the circulation of Qi and Blood, and assist their smooth flow, spreading through the surface of the body, moistening muscles, flesh and orifices. Thin, clear and watery; flow easily.



2) YE FLUIDS



a) A thick, paste-like substance which can seep into the spaces of the bones, and nourish and strengthen the bones and marrow. Thick and viscous, move slowly, function as a lubricant and supplement to Jing Essence LING SHU, ch. 81

Ying (Nutritive) Qi comes out of the Middle Jiao and secretes Jin and Ye fluids like a life-giving fog
From above it pours into the confluences of the tissues, the seeps into the delicate collaterals (SUN MAI), where, if the Jin and Ye are harmonious, through the Qi transformation of the Lungs and Heart they can become RED BLOOD. If this blood remains harmonious, it will first fill the delicate collaterals, then pour into the collaterals proper ( LUO MAI).

When these are full, the blood will pour into the major channels (JING MAI), Both Yin and Yang, ensuring abundance of the protective nourishing Qi and Blood, flowing through the body with the rhythmic impetus of the Lung's breath, Zhang Jing-Yue, 1624:



Jin is the clear portion of Yin and Ye is the murking portion of Jin

Jin is classed as Yang because it travels to the surface and becomes sweat, and Ye is classed as Yin because it pours into the bones and supplements the brain and marrow.

B. Fluid Physiology

A. Spleen: The Separation of the CLEAR (QING) from the MURKY (ZHUO)

- The Fire of Ming Men provides heat for Spleen transformation: The Spleen absorbs

Food and Drink Essences, and sends them upward; - All of the Zang organs (KIDNEY, LUNG, SPLEEN) involved in BF passageways promote this active transformation and transportation

B. The San Jiao is the path for fluid metabolism

- All fluids, both rarified and heavy, move through the energy of the San Jiao.

The Ming Men presides over the Ministerial Fire, and is Director of the separation of the

Yuan Qi in the Kidneys

- The Energy of the San Jiao is the active circulation of the Kidney Yang manifest

as YUAN QI.

In this manner Source Qi is differentiated into "the Three QI".

ZONG QI

GU QI

YUAN QI of lower Jiao

LING SHU, CH. 36:



Of that Qi emerging from the SAN JIAO:

- that which warms the muscles and the flesh and fills out the skin

is called the JIN-FLUIDS.
- that which flows without moving is called the YE-FLUID

C. Other Zang Fu of Fluids Metabolism



Spleen: RULES THE ACSCENT OF THE CLEAR
- Prime Mover and Transformer of the Middle; Root of Post Heaven

- Works with Kidney and Lung to transform and distribute pure fluids

Transforms the Ying and Wei

Lung:
- Transforms Fluids into a fine mist to warm and nourish the surface;
- Promotes the initial descent of the turbid from the top down, promotes movement of "Stomach House" and descent of the murky.
- Wei Qi regulates the pores, travels with fluids
- Works with heart to separate Blood from Fluids and to circulate all Qi and fluids.


Kidney:

- Root of all BF metabolism; power Source for SAN JIAO, Source of all the body's Yang and Yin.
- Rules over the final transformation and storage of Essences; drains the waste from the lower orifices.



STOMACH: RULES THE DESCENT OF THE MURKY

Gateway to the Inner Duct of the San Jiao;

Receives the fullness of foods and fluids and separates the turbid from the murky

Stomach, Large Intestine and Small Intestine

all work in harmony to purify the body by moving waste material and ensuring the

complete transformation of any waste materials still within.



Small Intestine:

-Steams fluids and absorbs essences

-connects energetically to Heart Fire

Large Intestine:

-Final Essences are extracted from mostly solid wastes to support the SOURCE QI And reinforce the JING



Bladder:

- Stores waste fluids for final steaming from Kidney Yang; and ultimate excretion of waste

D. Relationship of JIN YE to other Vital Substances

1. Qi: depends upon QI to transform and transport it

2. Blood: derived from a part of Fluid essences in Upper Jiao

3. Breast Fluids: transformed from the Qi and Blood of the CHONG AND REN

4. Jing Essence

Fluid transformation is directly dependent upon QI transformation, but also promotes Yuan Qi production in the lower Jiao

Ye Fluids/ Jing Essences very close in nature

5. Shen

Integrity of the Blood is dependent on BF physiology SHEN depends upon rarefied Qi

Connection of SHEN to San Jiao; Heart Connects to L.I.; influences Heat, prevents toxic fire
E. FLUIDS OF THE ZANG FU

1. SWEAT - is the Fluid of the Heart;


- fluids that were once Jin become sweat when "steamed" by Yang heat of the Wei Qi



2. TEARS- Fluid of the Liver
- Yang activation of eye fluids is role of Liver


3. (WATERY) SALIVA (XIAN)-Fluid of The Spleen

-Spleen governs the mouth and tongue


4. MUCOID SALIVA (TUO)- Fluid of the Kidney;

-underside of tongue, digestive enzymes, Stomach fluids, jing essences


5. NASAL MUCUS- Lung

-congestion of fluids in URT due to failure of Lung to  descend and disperse fluids.



II. DAMPNESS: PRINCIPLES AND TREATMENT

A. Chief symptoms



- general heaviness, lack of thirst, feelings of fullness and distention,



1. Differentiation according to three Jiaos





Upper Jiao- heavy head, dizziness, stuffiness of chest

and epigastrium





Middle Jiao- Loss of taste and appetite, lack of thirst

abdominal distention and fullness, fullness and stagnation

after eating, nausea, weak-heavy limbs, loose stool and

diarrhea, thick white greasy tongue coating

Lower Jiao- Dampness "pouring down"; edema of feet,

murky, difficult urination, leukorrhea, loose stool





B. Nature



1. Damp is heavy and turbid:



Sinking, heavy, sore sensations



2. Damp Illness tends to be chronic



-Spleen weakness is always root of Dampness



- failure of TRANSFORMATION

transformation implies not only changing but

raising



- dampness obstructs spleen function further,

damaging the energy from which it springs



3. Yin Pathogen



Harms Yang and blocks the flow of Qi



4. Causes wide range of problems



Integrity of Body Fluids protects the Tissues and

the Qi

5. Tends to combine with other pathogens



Wind damp

Damp Heat

Cold Damp



6. Seasonal Pathogen



reflects changes in the weather, and

the transformation of the seasons





C. Treatment Principles



a. Transform the Pathogen



1. Expel with sweet-bland diuretic



- FU LING (PORIA COCOS)

Enters: SPLEEN/STOMACH, HEART,LUNG, KID

Harmonizes Center; Calms the Spirit



- ZHU LING (Polyporous)

More diuretic, less tonifying than Fu Ling



- ZE XIE ( Alisma)

Drains damp heat; Yin deficient Heat





2. Eradicate Damp Heat with cooling diuresis





- MU TONG ( Caulis Akebia)

- Enters Heart, Lung, Small Intestine

Drains Heart and Lung Fire

Promotes BF flow ( Milk, Blood)



- QU MAI (DIANTHUS)

"Slippery, descending nature"

Enters HEART/S.I.: moves blood, cools heat

Damp Heat LIN, and obstructed toxic Heat



- YIN CHEN HAO ( Artemesia Capillaris)

Fragrant, only slightly cold

SP/ST LIV/GB: JAUNDICE







3. Transformation of thick and turbid

with fragrant aromatics





-HOU PO ( CX MAGNOLIA)

Parches the Spleen Qi and

moves the Qi

Promote Descent of Lung Qi by

removing fullness



- SHA REN (AMOMI)

Warm and strongly fragrant:

Parches the Spleen and moves the middle Qi



-HUO XIANG (AGASTACHE/POGOSTEMON)

Lung, Spleen/Stomach

promotes perspiration, relieves summerheat

transform middle jiao, move Qi, piercing fragrance


4. Parch the Spleen with warm-bitter

substances to restore T and T



Pungent warm:


CANG ZHU ( Rhiz Atractylodes)

strengthens spleen, expels wind damp



BAN XIA ( PINELLIA)

strong descending nature

Moves Qi downward: breaks up phlegm

stops NAUSEA

for thin, clear phlegm damp



Bitter Cold :



HUANG QIN (SCUTELLARIA)

- LUNG AND LARGE INTESTINE

Clears Fire and Toxic Heat and damp

HUANG LIAN (COPTIS)

HEART AND MIDDLE JIAO

Clears Damp Heat, obstructed fire



HUANG BAI (PHELLODENDRON)

drain kidney fire, eliminate

lower jiao damp heat

Yin deficiency with Fire flaring





5. Expel Wind-Damp in the surface Tissues

with Wind-dispersing herbs, promote

Spleen transportation of fluids



DU HUO (Rx. Duhuo)

Kidney, Bladder channels

Stops pain of wind-cold-damp in lower body



QIN JIAO ( GENTIANA MACROPHYLLA)

Dispels wind damp in Liver Channel

Cools Yin deficient Heat



SANG JI SHENG (LORANTHUS)

Tonifies Liver and Kidneys;expels wind damp





6. Strengthen Yang to Transform Damp:

PROMOTE WARMTH AND MOVEMENT

REMOVE ACCUMULATED BODY FLUIDS



GAN JIANG ( ZINGIBERIS SICCATUM)

Warms middle and expels cold; warm St and Spleen





ROU GUI (CORTEX CINNAMOMI)

Warms Kidneys and fortifies Yang

III- DAMP HEAT

A. GENERAL SYMPTOMS:

-low grade or afternoon fever, fullness (oppression), obstruction

chest or abdomen, thirst without desire to drink,

heaviness of head and body, lack of appetite,

scanty, dark, difficult urination, loose, explosive stools,

nausea and vomiting

tongue: Thick, greasy yellow tongue coating

pulse: varies according to pathogen


B. ETIOLOGY

1. Invasion of damp pathogen causes Qi and heat to accumulate and combine with dampness



2. Pathogenic fire can cause damage to fluid metabolism leading to damp-heat accumulation



3. Failure of Yang Qi to transform and raise; heat becomes pent-up and combines with BF

C. PATHOLOGY


1. Enter body usually through the Mouth: connection to Stomach



2. Frequently toxic; the fire of damp heat quickly becomes "toxic" fire



3. Easily damages the Sp/St



4. Easily blocks QI mechanism: Ascent and descent of  QI movement is regulated by San Jiao.

Damp Heat is sticky by nature



5. Upsets Fluid Metabolism:

Upper Jiao: can not open and regulate fluid passageways; unable to send downward.


Middle Jiao: Yang is blocked and spleen's power of digestion is lost.

Lower Jiao: Kidneys lose the strength to vaporize:uncontrolled or frequent urination or fluid

retention and scanty urination, kidneys unable to control opening and closing





D. Treatment Principles



1. Differentiate which pathogen is mild and which is serious, then expel damp and cool heat

a) if damp predominates: disinhibit the heat by transforming the damp


b) if heat predominates: clear heat, promote diuresis

2. Differentiate area:

a) damp heat on surface utilize fragrant to release the surface

b) Damp Heat Blocking Upper Jiao, obstructing Lung
Promote Qi flow to move the damp

Fragrant transformation of source


c) Damp Heat Blocking Middle Jiao

Bitter cold herbs to drain heat and parch damp


d) Damp Heat in Lower Jiao, obstructing Kidney Yang

Drain the turbid damp though the urine

3. Treatment Principles


DAMPNESS:

1. Promote Lung Flow to transform damp

a) Open lungs to assist pathogenic influence to reach the surface

b) Open Lungs to transform damp and allow Heat to escape through the surface

c) Open lungs to promote fluid metabolism


2. Combining pungent and Bitter flavors to warm the Yang and disperse obstruction

3.Use Bland flavors to promote urination and leach out damp

4. Using Fragrance to transform damp

5. Strengthening Spleen to parch damp

6. Opening the flow of Yang Qi to transform damp

a) use spreading, dispersing herbs to promote the flow of Yang

b) Warm pungent and warm bitter to restore San Jiao Qi movement

c) use bland herbs to promote urination


HEAT:

7. Use of Bitter-Cold to clear Heat and dry damp

- use sparingly when damp exceeds heat

-also drain toxicity ( anti-bacterial )



8. Clear Heat and relieve toxicity

-exogenous epidemic toxic dampness

- endogenous damp heat producing fire

9. Cool and move the Blood

- Pathogen moves easily to Ying (Nutritive)

Level

- Leads to Blood stagnation



10. Nourish Yin, Cool Heat, Promote urination

- Fragrant herbs damage Yin by Yang nature

- Bitter herbs are too draining in

some cases of Yin deficiency Damp Heat;

- Use herbs that preserve Yin by lightly

spreading and opening, or mild diuretic:

Fu Ling (Poria), Shan Yao ( Dioscorea)

Lian Qiao (Forsythia), Hua Shi (Talc)


E. Contraindications



1. Pungent Warm diaphoresis:
avoid using strong, warm and pungent herbs

( Ma Huang, Gui Zhi)



2. Bitter Cold purging:



purgatives are not effective in treating damp's "sticky" nature; only manage to further weaken and

bring down Spleen Yang



3. Moist greasy (Yin) tonics



aggravate damp obstruction



4. Sweet, warm, obstructing tonics



-tonifying without dispersing only aggravates

damp accumulation





5. Dietary Contraindications



-Heavy greasy foods produce dampness



-Sweet, cold foods promote dampness



-Spicy foods promote heat

BODY FLUIDS

I. DAMPNESS (A YIN EXCESS)

A. Organs Affected DAMPNESS ALWAYS INVOLVES SPLEEN

Also: Lungs, Kids ( Bladder, L.I.)

B. Etiology 1) hypofunction of Spleen leads to accumulation of damp:

a) Yang dysfunction; Qi illness (Kidney)


b) Yin diet: sugar, dairy, wheat,

c) Liver attacking Spleen

2) Climate; Dampness is one of Six Exogenous Evils: Exogenous dampness will aggravate interior dampness



C. Symptoms



GENERAL: FULLNESS, heaviness and slow progression; creates heat and combines easily with Hot or Cold; San Jiao function is diminished by Water Damp



SYMPTOMS: fullness in chest and abdomen, lack of thirst, obstruction of digestion, nausea, vomiting, loose stool, loss of appetite, heaviness of limbs, lethargy, excess salivation, sweetish taste in mouth





1) UPPER JIAO- Dampness obstructs Lungs:

COUGH, with copious phlegm, frothy or thick,

acc. respiratory sx: asthma, Difficult breathing

2) MIDDLE JIAO- Dampness obstructs Spleen:

Abdominal fullness, No hunger or thirst., nausea, heaviness, loose stools, cloudy senses



3) LOWER JIAO- Dampness leads to obstruction

of Kidney YANG: diarrhea, lower body edema,

urinary complaints, polyuria, dysuria, retention

of urine. Urine is typically turbid, cloudy,

Stool may contain mucus





Tongue: swollen, moist body, excess saliva

may have white frothy coating or thick sticky white



Pulse: Slippery (Rolling), soggy, or big but forceless



D. Treatment Principles:



1. Transform (Dry) Damp (Disperse)

2. Strengthen Spleen/Stomach

3. Regulate the Qi

4. Promote urination


E. Herbs Atractylodes (Bai Zhu). Atractylodes (Cang Zhu)

Magnolia ( Hou Pu), Pinellia ( Ban Xia )



F. Prescription Liu Jun Zi Tang

Six Gentlemen Decoction



Strengthens the Spleen, Transforms damp, stops vomiting


SI JUN ZI TANG plus ER CHEN TANG

( Citrus Chen Pi and Pinellia Ban Xia)

IA. PHLEGM (TAN)



Phlegm is Dampness that has been congealed: i.e., “baked or boiled” by depressed Fire into a thick turbid substance that is directly involved in the presentation of many complex diseases like stroke and epilepsy. It is said:



Phlegm is rooted in water and dampness. If these obtain Qi and fire, it leads to binding, making phlegm.



Blood and fluids flow together, so phlegm stagnation may lead to blood stagnation, and blood stagnation may lead to phlegm stagnation. Therefore, in complex diseases, in order to transform phlegm, it is necessary to treat the blood:



To treat phlegm, it is essential to treat the blood.

Quickening the blood leads to the transformation of phlegm.

- Zhu Liang-chun

II. DAMP HEAT



A. Organs Affected Spleen/Stomach, Liver Gall Bladder, L.I., U.B., Lung



B. Etiology Dampness tends to bind with heat (Law of Six Depressions)



1. Damp and Heat produce each other



Dampness leads to stagnation, stagnation leads to heat. Pure Yang cannot ascend.

(Damp Heat is Yang and damages Yin, Dampness

is Yin; this makes the combined entity difficult to

to resolve)



2. Exogenous Factors



Heat can be introduced into a stagnant situation by a toxin

Damp Heat pathogen can invade



3. Endogenous factors



a. Yin deficiency fire can provide heat to mingle with dampness. This is very tricky.

b. Yin Fire

c. emotional factors



4. Dampness and Heat can lead to Phlegm

C. Symptoms GENERAL:

Heaviness and local fullness ( “Oppression” or “uneasy feeling”, or “restlessness”) low grade fever comes on at mid-day, thirst with little desire to drink, scarceness and concentration of body fluids,



1. UPPER JIAO:



HEAT PHLEGM IN LUNGS

coughing, fever, or sensation of heat,

sputum is thick, sticky and difficult to expectorate, yellow, green, possibly blood tinged

depending on how much Fire there is. Phlegm creates sensation of fullness.

The thicker and more difficult the expectoration,

the more heat is present; e.g., Bronchitis, U.R.I.



2. MIDDLE JIAO:



The dynamic is Liver produces Fire when Excess, Spleen produces dampness when deficient.

The source of Heat in the middle burner is most often due to Liver Hyperfunction, or Stomach Heat. When Dampness traps Heat in the center and Spleen is unable to raise, Damp Heat is formed. Otherwise, Heat pathogen (Toxin) entering through the mouth disrupts Sp/St harmony. The stronger the pattern, the more likely it will involve heat from one of these sources; the weaker the pattern, the more Spleen QI deficiency and dampness is involved



a) Excess: Liver/Gall Bladder; Stomach



b) Deficiency: Spleen



Spleen damp heat tends to include more dampness than heat, thus more vacuity than repletion



. Sx include: abdominal fullness, discomfort or pain (may be anywhere on abdomen), heaviness of limbs, poor appetite, thirst w/o desire to drink, general feeling of heat, nausea, vomiting, loose stools with offensive odor, dull or dark yellow complexion ( as opposed to bright yellow), oily sweating which does not cool fever or heat, itchy skin or skin eruptions.

Tongue: red, with sticky yellow coating



3. LOWER JIAO: burning, painful, scanty urination, lower abdominal fullness, with

heaviness, and fever; cystitis



Tongue: Body may be red, coating may be yellow, moist, greasy, etc., Moisture depends upon chronicity and degree of heat; as always reflects damage to body

fluids.



Pulse: Rolling and Rapid, may be String Taut (Wiry)


D. Treatment Principles 1. Clear Heat/ Transform Damp

2. Regulate Organ function


E. Herbs Upper Jiao: Scutellaria (Huang Qin) for

Lungs; also St and L.I.

Middle Jiao: Coptis ( Huang Lian) Stomach also Heart



Lower Jiao: Phellodendron (Huang Bai)

NB: These herbs are very cold; watch out for spleen;

LIV/GB: Gentiana ( Long Dan Cao)

Jaundice: Capillaris (Yin Chen Hao)





F. Prescription Varies according to Jiao:

Er Miao San

TWO MARVEL POWDER

Clears Heat and Dries Dampness

Phellodendron (Huang Bai)/ Atractylodes (Cang Zhu)

For Lower Jiao: SAN MIAO WAN add Achyranthes ( Niu Xi)

III. WATER RETENTION





A. Organs Involved Lungs ( face), (trunk and limbs), Kidney ( lower body)

B. Etiology Damage to Yang and San Jiao

C. Symptoms Lung ( Invasion by Wind Water): Sudden swelling of eyes and face gradually spreading to entire body, bright shiny complexion.

Spleen: Interstitial swelling and fullness over entire body ( Similar to general bloating)

Kidney: Lower body edema----Usually accompanied by urinary retention



D. Treatment Principles 1. Transform Damp/ Dispel Edema

2. Tonify Yang

3. Promote Urination

4. Regulate Qi

5. Strengthen the Spleen

6. Diaphoresis

E. Herbs Ephedra ( Ma Huang) Excess edema,

Astragalus (Huang QI)Deficiency edema

Poria ( Fu Ling ) always

Alisma ( Ze Xie)



F. Prescriptions Generally from the Category: Promote Urination and leech out dampness; they will always include Qi regulating herbs because of the extreme Yin nature of the Pathogens, Qi obstruction occurs.



Wu Ling San

Five Ingredient Powder with Poria promotes urination, drains dampness, strengthens the Spleen, warms the Yang and promotes the transforming functions of Qi,
-Ze Xie, fu Ling, Zhu Ling, Bai Zhu, Gui Zhi

IV. DEFICIENCY OF FLUIDS (DRYNESS)


A. Organs Affected External Dryness: Lung ( from exterior pathogenic dryness

Internal Dryness: St., Kidneys, L.I., (Kids Yin Xu)



B. Etiology This is an intermediate Stage of Yin deficiency,

usually preceding Yin Xu, but sometimes reversible

in the Acute stage. A form of Yin Xu. May be combined with other factors



1. Yin Xu or severe, chronic, Blood Deficiency



2. Prolonged loss of BF (sweating, vomiting, diarrhea, hemorrhaging)



3. Dietary- insufficient fluid intake



4. Exogenous pathogen ( Wind/ Wind Heat)



C. Symptoms Lung: dry cough, dry skin, dry throat, mouth, nose



St.: Thirst, with “desire for small sips”, dry tongue



L.I.: Dry stools, constipation



Kids: scanty urination, dry scratchy throat



Pulse: Deficiency



Tongue: Dry





D. Treatment Principles 1. Moisten Dryness/Generate Fluids ( Often used when Repletion heat has scorched fluids)



2. Nourish Yin



3. Nourish Blood



E. Herbs Dendrobium (Shi Hu)

- generates fluids; for parched mouth, severe thirst

Ophiopogon ( Mai Men Dong)

-moistens lungs, augments stomach Yin, generates fluids





F. Prescription Mai Men Dong Tang (OPHIOPOGON DECOCTION)



-Mai Men Dong, Ren Shen, Da Zao, Ban Xia,



-Benefits the Stomach, generates fluids, and directs rebellious Qi downward

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