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True and False

Q. When heat reaches the Ying-Xue stage, the heat will consume the Yin. The results will be the consumption and disturbance of the Blood.

A. True.

Q. The main treatment for deficiency re is to tonify according to the Zangfu organs, Yin and Yang Qi and Blood.

A. True.

Gap Filling

Q&A. In the cause of a disease, because of the struggle between the genuine Qi and the evil Qi, pathological transformation can happen and excess re can become deficiency re. This transformation is the result of damages to the yin and yang and the destruction to the genuine Qi.

Q. Hypochondriac Pain that is quite severe with other symptoms: bitter mouth, chest distension, poor appetite, nausea and vomit, red and swollen eyes, with or without jaundice, dark and yellow urine. Tongue and pulse: yellow and greasy coating, wiry slippery and rapid pulse is treated by: clear heat and drain dampness. Formula: Long Dan Xie Gan Tang

Q&A. The commonest deficiency re includes: yin deficiency fa re (yin xu fa re), qi deficiency fa re (qi xu fa re) and blood deficiency fa re (xue xu fa re).

Short Answer Questions

Q. What are the possibilities of Fu Tong? State the internal and external causes.

·        Location of Pain

a.      Da Fu Tong (large abdomen): spleen, stomach, small intestine and large intestine

b.      Xiao Fu Tong (Small Abdomen): kidney and urinary bladder

c.      Shao Fu Tong (Outer Small Abdomen): liver jing

d.      Qi Zhou Tong (Around Umbilicus) with clear water: parasites (ascariasis).

Internal medicine

Exogenous evils:

·        Cold invasion into the abdomen which impairs the middle Yang. Cold freezes and causes Qi stagnation resulting in abdominal pain: Tian Xiang Zheng Qi San (gan jiang, su ye, wu yao, xiang fu, chen pi).

·        Summer heat with damp invasion into abdomen, gathering in the middle and obstructing Fu organs Qi resulting in abdominal pain:

Improper diets:

·        Damp-heat: too much spicy, greasy and rich food or alcohol causes damp-heat accumulation and blockage inside resulting in abdominal pain: Da Cheng Qi San (Da Huang, Mang Xiao, Zhi Shi, Huo Po).

·        Cold-damp: too much cold and raw food causes accumulation of cold-damp, impairment of spleen Yang and blockage inside resulting in abdominal pain: Xiao jian Zhong Tang (Yi Tang, Gui Zhi, Shao Yao, Zhi Gan Cao, Sheng Jiang, Da Zao).

·        Food retention: eating spree overloads the stomach and causes retention of food and blockage of Qi resulting in abdominal pain: Bao He Wan (Shan Zha, Shen Qu, Lai Fu Zi, Chen Pi, Ban Xia, Fu Ling, Lian Qiao)

Emotions:

·        Anger causes liver Qi stagnation. Stagnated liver Qi invades spleen resulting in abdominal pain: Chai Hu Shu Gan San (Chen Pi, Chai Hu, Chuang Xiong, Zhi Ke, Bai Shao, Zhi Gan Cao, Xiang Fu)

·        Worry and pensiveness causes spleen Qi deficiency and the weakened spleen fails in transport, resulting in blockage and pain: Fu Gui Li Zhong Tang.

Parasites:

·        Ascariasis. Round worms stirring inside and upsetting normal Qi movement, resulting in abdominal pain: Wu Mei Wan (Wu Mei, Chuan Jiao, Xi Xin, Huang Lian, Huang Bai, Gan Jiang, Fu Zi, Gui Zhi, Ren Shen, Dang Gui)

Other causes:

·        Trauma or operations injure the Zangfu and Jingluo, resulting in Qi stagnation and blood stasis: Shao Fu Zhu Yu Tang (Chao Xiao Hui Xiang, Chao Gan Jiang, Yan Hu Suo, Dang Gui, Chuan Xiong, Mo Yao, Guan Gui, Chi Shao, Pu Huang, Chao Wu Ling Zhi).

·        Weak constitution in Yang Qi, or protracted pain impairs spleen Yang, causing Qi and Blood deficiency, Zangfu jinglou lack of nourishment and sluggish blood movement, resulting in abdominal pain: Bu Zhong Yi Qi Tang.

External medicine:

Irregular menstruation:

·        Qi deficiency (spleen) – Bu Zhong Yi Qi Tang (Huang Qi, Ren Shen, Bai Zhu, Zhi Gan Cao, Dang Gui, Chen Pi, Sheng Ma, Chai Hu)

·        Blood deficiency (liver or heart) – Da Bu Yuan Jian (Shu Di Huang, Su Jiu Gui Ban, Chao Huang Bai, Jiu Chao Zhi Mu)

·        Blood cold (excess cold) – Wen Jing Tang (Wu Zhu Yu, Gui Zhi, Dang Gui, Chuan Xiong, Shao Yao, E Jiao, Mai Men Dong, Mu Dan Pi, Ren Shen, Gan Cao, Sheng Jiang, Ban Xia)

·        Yang deficiency (kidney) – Ai Fu Nuan Gong Wan (Xiang Fu, Ai Ye, Dang Gui, Huang Qi, Wu Zhu Yu, Chuan Xiong, Bai Shao, Shu Di Huang, Rou Gui, Xu Duan)

·        Qi stagnation (liver) – Wu Yao San

Uterine Bleeding:

·        Blood stasis – Si Wu Tang (Shu Di Huang, Bai Shao, Dang Gui, Chuan Xiong)

·        Kidney Yang deficiency – You Gui Wan (Fu Zi, Rou Gui, Lu Jiao Jiao, Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Tu Si Zi, Du Zhong, Dang Gui)

Dysmenorrhoea:

·        Cold-Damp – Shao Fu Zhu Yu Tang

·        Liver Qi stagnation and BS – Ge Xia Zhu Yu Tang

·        Damp-heat – Qing Re Tiao Xue Tang

·        Yang deficiency with internal Cold – Wen Jing Tang

·        Liver and Kidney deficiency – Tiao Gan Tang

·        Qi and Blood deficiency – Sheng Yu Tang

Amenorrhoea:

·        Qi stagnation and BS – Xue Fu Zhu Yu Tang

Q. Differentiate between the various types of abdominal pain.

A.

Q. What are the special features of female pathology?

A. The six climatic evils: cold, heat and dampness are the commonest.

Cold:

Delayed menstrual cycle, dysmenorrhoea/menorrhalgia (period pain), amenorrhoea/ menostasis (no period), masses and gatherings, infertility (due to cold uterus), leucorrhoea problems and abdominal pain in pregnancy.

Heat:

Preceded menstrual cycles, menorrhagia (too much menstruation), metorrhagia and metrostaxis, vicarious haemoptysis (cough up blood during menstruation), menstrual epistaxis (nose bleeding during menstruation), vaginal bleeding during pregnancy, over-movement of foetus, leucorrhoea (persistent lochia), postpartum fever (fever after child birth).

Dampness:

Leucorrhoea problems, infertility, pruritus vulvae (vulva itch), vomit and oedema during pregnancy.

Emotional factors:

Anger, worry, pensiveness and fright are the commonest. From Qi to Blood.

Anger: delayed menstrual cycle, dysmenorrhoea/menorrhalgia (period pain), amenorrhoea/menostasis (no period), masses and gatherings, vicarious haemoptysis menstrual epistaxis, infertility and lack of lactation.

Worry and pensiveness: irregular menstruation, amenorrhoea/menostasis, masses and gatherings

Fright: menorrhagia, metorrhagia and metrostaxis, over-movement of foetus, miscarriage.

Lifestyle factors:

Sexual activity and child birth: too much sexual activity and too many pregnancies.

Diets: too much hot and spicy food or too much cold and raw food.

Physical activity: during menstruation and pregnancy.

Injury: during menstruation and pregnancy.

Congenital constitution:

Hot and cold constitution

Kidney Yin or Yang weakness.

Q. What are the special features of female physiology?

A.

·        The relationship between the extraordinary channels and Chongmai, Renmai, Dumai and Daimai and the uterus.

·        The relationship of Zangfu organs and the uterus:

Kidney and uterus:

·        Channel: direct link; meeting with Ren at Guanyuan (Ren 4); running with Kidney channel.

·        Function: origin of congenital constitution and the root of primordial Qi, storing the essence, controlling reproduction, development and growth, essence – blood.

Liver and uterus:

·        Channel: meeting with Ren at Qugu (Ren 2), with Du at Baihui (Du20) and with Chong at Sanyinjiao (Sp6).

·        Function: storing blood and regulating blood circulation, dominating conveyance and dispersing and controlling the sea of blood.

Spleen and uterus:

·        Channel: meeting with Ren at Zhongji (Ren 3) and Chong at Sanyinjiao (Sp6).

·        Function: source of Qi and Blood generation, commanding the blood.

Stomach and uterus:

·        Channel: meeting with Ren at Chengjiang (Ren24) and Chong at Qichong (St30).

·        Function: source of Qi and Blood, receiving and decomposing food and drink.

Heart and uterus:

·        Channel: a collateral linked directly to the uterus.

·        Function: dominating blood and vessels.

Lung and uterus:

·        Channel: linked with Du and Ren.

·        Function: distributing micro nutrients (dominating Qi and co-ordinating all blood vessels).

Tian Gui:

A special term in TCM with special physiological functions

Origin: congenital

Housed: kidney

Nourished by: pure micro nutrients from food and drink after birth

Neijing: Female “at the age of two sevens a female’s Tian Gui comes, her Renmai begins to flow and her Chongmai is replete. Her menstruation comes regularly and she is able to conceive,” “at the age of seven sevens, her Renmai becomes weakened and her Chongmai is deplete. Her menstruation stops. Her body becomes old and she is no longer able to conceive.”

Qi and blood

Qi and blood are the foundations for all the activities in life

Menstruation, pregnancy, labour and lactation all depend on qi and blood

Qi and blood are produced by zang-fu organs and are transported to the uterus through Chong, Ren, Du, Dai and other collaterals and meridians related to the uterus. Under the influence of Tian Gui, they provide the uterus with fundamental materials to fulfil its special physiological functions in menstruation, pregnancy, and labour and the production of milk by the breasts.

Q. External treatment for Zha Sai (Mumps , epidemic parotitis).

A. Qing Dai (indigo powder): 2g mixed with vinegar or water into loose paste. Apply on parotid area of the face. 2-3 times/day.

Fresh cactus. Cut to thin slices or meshed. Apply as Wing Dai. 1-2 times/day.

Zi Jin Ding:

Chi Xiao Du 30g, Da Huang 25g powdered and mixed with egg white into loose paste. Apply and reapply as many times as necessary.

Shui Niu Jiao (Buffalo Horn): grind into water into thin liquid. Apply and reapply as many times as necessary.

Q. Physiological features of TCM pediatrics

A. Children grow and develop very rapidly. For example, from birth to 3 years, body weight increases by 3 times, height increases by 1.5 times and head circumference increases by 0.5 times. Developments in activities, intelligence and functions of Zang-fu organ are perfecting and maturing.

These dynamic phenomena are summarized as ‘pure yang’ in TCM pediatrics. Pure yang here means children have an ability to grow and develop rapidly. They are like the rising sun in the morning and infant plants flourishing and prospering. It does not mean children do not have yin or they are always in yin deficiency.

Q. What are the pathological features of Pediatrics?

A.

1. Causes:

·        exogenous evils: the six climatic evils and pestilential evils

·        improper diet

·        injuries in the womb and in the course of delivery

·        hereditary constitution

·        seven emotions

Main pathological features:

·        Sudden onset and rapid transmission and transformation

·        Susceptible to exogenous evils

·        Susceptible to impairments by food and drink

·        Change and transformation are rapid, and recovery is usually quick. Rapid change from excess to deficiency and from heat to cold or vice versa.

·        Zang Qi clear and pure and rapid recovery

·        Children are pure yang. Growth and development are rapid with vitality. The process of tissue growth and repair after damage are relatively quick. Causes of pediatric diseases are also relatively simple, as the influence by emotional factors is small. If treatments are appropriate full cure and recovery can be achieved.

Q. What are the features in four diagnostics in Pediatrics?

A.

1. Observation:

·        Shen (vitality), colour, shape and posture and activity.

·        Tongue.

·        Other openings

·        Macole and papule

·        Urine and feces

·        Finger vein, the three passes’, feng (wind), Qi and ming (life). Used for under three year olds.

2. Hearing and smelling:

·        speech, cry, cough, respiration and smells.

3. Asking questions:

Routine enquiries as in TCM diagnostics plus the following:

·        Age.

·        Personal history.

·        Immunisation injections

·        Family history.

4. Touching and palpating:

·        Pulse

Q. Yao Tong (lumbago/lower backache).

A.

Def: A condition marked by pains in the lumbar region. It can be on one side or on both sides. It is closely related to the kidney in TCM.

Causes and pathological mechanisms:

·        Kidney deficiency: overwork physically and sexually; old age; protracted illnesses – kidney essence deficiency, lack of nourishment for the channels and collaterals in lumbar region You Gui Wan (Fu Zi, Rou Gui, Lu Jiao Jiao, Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Tu Si Zi, Du Zhong, Dang Gui) and Zuo Gui Wan (Shu Di Huang, Shan Yao, Gou Qi Zi, Shan Zhu Yu, Chuan Niu Xi, Tu Si Zi, Lu Jiao Jiao, Gui Jiao)

·        Cold-damp: sitting or sleeping on damp ground, living and working in cold and damp condition, soaking in water and dampness, wading in water, rain etc. cold-damp invades and blocks the channels and collaterals: Gan Jiang Ling Zhu Tang modified.

·        Damp-heat: cold-damp transformation into damp-heat, damp-heat evil invasion or accumulation of dam-heat. Damp-heat blocks channels and collaterals: Si Miao Wan (Niu Xi, Huang Bai, Yi Yi Ren, Chang Zhu plus Mu Gua, Luo Shi Teng)

·        Blood stasis: trauma and other injuries. Qi and blood stagnates and channel and collaterals are blocked: Sheng Tong Zhu Yu Tang (Tao Ren, Hong Hua, Mo Yao, Dang Gui, Chuan Xiong, Xiang Fu, Di Long, Qin Jiao, Qiang Huo, Niu Xi, Wu Ling Zhi, Gan Cao)

·        The role of the kidney: kidney deficiency is the root, while evils and trauma are all branches. Kidney deficiency is basic pathology of Yao Tong (lumbago). When the kidney is weak, the lumbar region will be more susceptible to exogenous evil invasion and trauma. Invasion of exogenous evils and trauma can aggravate kidney deficiency.

Q. Explain the importance of the kidney in the pathology and treatment of Yao Tong?

A.

Bian Zheng LunzHi Kidney

·        Strengthening the kidney is the most important principle.

·        When the kidney is weak, there is no question the kidney must strengthened.

·        Even when treating exogenous evils and blood stasis, some attention must be paid to strengthen the kidney.

·        When the exogenous evils are expelled and the stasis of blood removed, one must strengthen the kidney to consolidate the results and to prevent the recurrence of Yao Tong.

Kidney Yin and Yang:

Symptoms

·        Common Symptoms: lower backache with weakness, like massage and palpation, weak knees and legs, worse when overwork and better when rest and lie down

·        Yang deficiency: lower abdomen contraction, pale complexion, cold limbs, pale tongue, deep and thready pulse

·        Yin deficiency: vexation and insomnia, dry mouth and throat, flushed face, hot feeling at 5 centres, red tongue with little coating, thready and rapid pulse

Treatments

·        Yang Deficiency: warm to tonify kidney yang – You Gui Wan (Fu Zi, Rou Gui, Lu Jiao Jiao, Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Tu Si Zi, Du Zhong, Dang Gui)

·        Yin Deficiency: nourishing to tonify kidney yin – Zuo Gui Wan (Shu Di Huang, Shan Yao, Gou Qi Zi, Shan Zhu Yu, Chuan Niu Xi, Tu Si Zi, Lu Jiao Jiao, Gui Jiao)

Q. Explain the pathological mechanisms of Shui Zhong (edema).

A.

·        Three major Zangfu organs, lung, spleen and kidney are involved but the kidney is the controlling organ

·        In Shui Zhong, there are Yang shui (water) and Yin shui (water). Yang shui involves lung and spleen and Yin Shui involves spleen and kidney.

·        Although Shui zhong is classified into Yang shui and Yin shui, impairment of Yang Qi is more prevalent.

·        Yang shui transforming into Yin shui is often seen due to improper treatments.

·        When the spleen and kidney are deficient and water not cleared up, it becomes a ‘root deficiency and branch excess’ syndrome.

Q. What are the differences in the symptoms and treatments of Shui Zhong due to spleen Yang deficiency and Shui Zhong due to kidney Yang deficiency?

A.

Yang Shui – spleen and kidney

Kidney Yang Deficiency

Symptoms

Oedema: face and body swelling, more below the waist, compression test shows deep finger indentation

Other symptoms: palpitation, short of breath, lower back pains and aches with heavy feeling, pale or even dull grey complexion, very cold limbs, aversion to cold, lack of shen, short and scanty urination or profuse urination

Tongue and pulse: pale and swelling tongue with teeth marks and white coating, deep, slow and weak pulse

Treatment

Principle: warm the kidney to remove cold and activate qi to drain water

Formula: Zhen Wu Tang and Ji Sheng Shen Qi Wan

Spleen Yang Deficiency

Symptoms

Oedema: swelling more below the waist, compression test shows deep finger indentation

Other symptoms: stuffy epigastrium and poor appetite, distending abdomen and loose faeces, pale complexion, cold limbs, lack of shen, short and scanty urination

Tongue and pulse: pale and swelling tongue with teeth marks, white and slippery or greasy coating, deep and moderate or weak pulses

Treatment

Principle: warm to invigorate spleen yang and drain water

Formula: Shi Pi Yin (Fu Zi, Gan Jiang, Fu Ling, Bai Zhu, Mu Gua, Hou Po, Mu Xiang, Da Fu Pi, Cao Guo, Zhi Gan Cao)

Q. What is Lin Zheng? What are the 6 LINS?

A.

Def: A syndrome of urination difficulties characterised by frequent, painful and dripping urination, contraction of the lower abdomen and pains connecting the abdomen and the lower back.

There are 6 different “LINS”:

1.      Re (heat) Lin – Excess: Ba Zheng San.

2.      Qi Lin – Excess: Chen Xiang San. Deficiency: Bu Zhong Yi Qi Tang (Huang Qi, Ren Shen, Bai Zhu, Zhi Gan Cao, Dang Gui, Chen Pi, Sheng Ma, Chai Hu)

3.      Xue (blood) Lin – Excess: Xiao Ji Yin Zi (Xiao Ji, Ou Jie, Chao Pu Huang, Shjeng Di Huang, Hua Shi, Mu Tong, Dan Zhu Ye, Zhi Zi, Dang Gui, Zhi Gan Cao) plus Dao Chi San (Sheng Di Huang, Mu Tong, Dan Zhu Ye, Gan Cao Shao). Deficiency: Zhi Bai Di Huang Wan

4.      Shi (stone) Lin – Deficiency: Shi Wei San.

5.      Gao (cream) Lin – Deficiency: Bi Xie Fen Qin Yin. Deficiency: Gao Lin Tang

6.      Lao Lin – Excess: Wu Bi Shan Yao Wan

Q. What are the internal treatments of Chuang-Yang?

A.

Definition:

Chuang-Yang (Sore Ulcer) is the general term for pyogenic infections of the skin in TCM.

Causes:

These include six climatic evils, extraordinary poisons/toxins, external injuries, seven emotions, diet and sexual activities.

Early Stage: Reducing Method (Xiao Fa)

This means in the early stage of Chuang-Yang, the treatment is mainly to remove the evils by using herbs that can reduce, disperse and expel the evils. The purpose of this is to disperse and absorb the early inflammation and prevent the development of pus.

There are a number of methods to achieve this according to different causes (evils).

Examples are: heat-toxin – clearing away heat and detoxification; blood stasis – regulate ying to remove stasis; qi stagnation – regulate qi, exogenous evil – relieve the exterior; cold evil freezing – warm; internal excess – purging; damp blockage – remove dampness.

Among these methods, the commonest method is the first one – clearing away heat and detoxification. Example formulas are:

Wu Wei Xiao Du Yin (jin yin hua, ye ju hua, pu gong ying, zi di ding, tian kui zi)

Middle Stage: Lifting Method (Tuo Fa)

This means in the middle stage of Chuang-Yang, the treatment emphasises on two parts: expel the evils and strengthen the genuine qi. Herbs that can tonify qi and blood and herbs that can lift out the pus (suppurating?) and toxin are used. The purpose of this is to prevent toxic evil moving inwards by simultaneously lifting the toxin out of the body and supporting the genuine qi.

There are two methods to achieve this according to the strength of the genuine qi.

Dissipating – Lifting (Tou Tuo): this method is used when toxin is exuberant while the genuine qi is still strong, usually pus is still being brewed but has not be formed. Used with methods of clearing heat and regulating ying.

Example formula: Tou Nong San (dang gui, huang qi, chuan shan jia, chuan xiong, zhao jiao ci). When using this formula for the purpose of dissipating lifting, heat clearing and detoxifying herbs such as jin yin hua, lian qiao, huang lian, pu gong ying, zi di ding, must be added.

Tonifying – Lifting (Bu Tuo): this method is used when toxin is exuberant but the genuine qi is weakened. The weakened qi is unable to lift the toxin out of the body. The shape of the Chuang-Yang is flat, the swelling is widened and the rotten pus fails to break out. This is a mixture of deficiency and excess.

Example formula: Tuo Li Xiao Du San (huang qi, zao jiao ci, dang shen, bai zhu, fu ling, gan cao, chuan xiong, dang gui, bai shao, jin yin hua, bai zhi, jie geng)

Final Stage: Tonifying Method (Bu Fa)

This means in the final stage of Chuang-Yang, the emphasis of treatment in on strengthening the genuine qi. Herbs that that can tonify qi and blood and strengthen the weakness are used to recover the genuine qi, assist the growth of new flesh and help the healing of the wound. There are four aspects: tonifying qi, tonifying blood, nourishing yin and supplementing yang.

Q. Describe Lian Chuang?

A.

·        Chronic ulcer in the lower 1/3 inner or outer sides of the leg, about 3 cun above the medial and lateral malleoli

·        More on the inner side than the outer side.

·        Often seen in middle or old age workers with varicose veins who standing for long hours

·        Very difficult to heal and recurs easily; easier to heal on the outer side (three yang channels) than the inner side (three yin channels)

·        Ulcer can be as deep as the inner layer of the tibial periosteum

·        Often has necrotic tissue, pus and foul smell from the wound and discolour, malnutrition or eczema  of adjacent skin

·        Can be a complication of diabetes

Q. Describe the concepts of Zou Huang and Nei Xian?

A.

Zou Huang and Nei Xian are sudden and severe complications of Chuang-Yang when the toxic evils are invading inwards and not being expelled.

Zou Huang – running yellow, is a complication of Ding (rooted furuncle).

Nei Xian – inward collapse, is a complication of any other Chuang-Yang.

Q. Describe the Bian Zheng Lun Zhi of Wei Tong.

A.

Bian Zheng

Excess and deficiency:

A. Distending pain with blockages – excess; no distention and no blockages – deficiency.

B. Pain refusing palpation – excess; no pain easing by palpation – deficiency.

C. Pain aggravated after food – excess; pain aggravated by empty stomach – deficiency.

D. Strong pause with strong Qi – excess; weak pulse with weak Qi – deficiency.

E. Severe pain, hard and fixed – excess, slow onset and moving – deficiency.

F. Strong constitution and short history – excess, weak constitution and protracted – deficiency.

G. Worsened by tonifying method – excess; worsened by purgation – deficiency.

Hot and Cold

A. Sudden onset, aggravated by cold and eased by warmth - cold

B. Severe burning pain with yellow or yellow and greasy tongue, wiry and rapid or soggy and rapid pulses – hot.

C. New pain – Qi stagnation; protracted pain – blood stasis.

Lun Zhi

Basic principle: regulate Qi and stomach.

Treat the causes.

A. Evils: remove (undigested food blockage; blood stagnation, liver Qi invasion).

B. Deficiencies: tonify (spleen and stomach deficient cold, stomach yin deficiency).

C. Mixture of excess and deficiency: support the genuine and remove the evil.

D. Understand ‘free flow, no pain’ correctly: do not overuse purgation.

E. Qi regulating herbs are pungent, dry and hot. Do not use them for too long or use very high dosages. Overuse them can cause consumption of Qi and Yin.

Q. What are the pathological mechanisms of Jian Zheng (Epilepsy)?

A.

Qi disorder, blood stasis, internal wind, phlegm and sometimes fire are the focus points for pathological mechanisms.

Most relevant Zangfu organs are the liver, heart, spleen, kidney and brain.

Q. How do you differentiate Jian Zheng from Yu Zheng, Dian Zheng, Kuang Zheng, Zhong Feng and Jue Zheng?

A.

Q. Describe the main Bian Zheng points for Ou Tu?

A.

Q&A. Li Ji is an intestinal infectious disease with frequent discharge of mucous and bloody faeces, abdominal pain and rectal tenesmus as main symptoms.

Q. What is the composition of Chai Hu Shu Gan San?

A. Chen Pi, Chai Hu, Chaun Xiong, Zhi Ke, Bai Shao, Zhi Gan Cao, Xiang Fu.

Q. What is the composition of Long Dan Xie Gan Tang?

A. Long Dan Cao, Huang Qin, Zhi Zi, Chai Hu, Mu Tong (Deng Xin Cao), Che Qian Zi, Ze Xie, Sheng Di Huang, Dang Gui, Gan Cao.

Q. What are the main symptoms of and how do you treat the following types of Xie Tong: Qi stagnation, damp-heat and Yin deficiency?

A.

Def: A syndrome marked by pains on one side or both sides of the hypochondriac region at the 12^th rib

Q. Describe Long Bi (urine retention)

A.

A syndrome characterised by urination difficulties – oliguria, dribbling urination or even anuria.

·        The causes and pathological mechanisms are lung heat accumulation with no pain.

·        Heat suppresses the lung. The lung fails to distribute fluid, leading to waterway blockage

·        Heat moves from the upper jiao to the lower jiao (bladder).

Treatment:

1. Lung heat accumulation: clear lung heat and move the water: Qing Fei Yin (Fu ling, Huang Qin, Sang bai pi, Mai dong, Che qian zi, Zhi zi and Mu tong).
2. Urinary tract blockage: remove stasis and obstruction to promote urination: Dai Di Dang Wan (Da huang, sheng di huang, dang gui wei, mang xiao, tao ren, rou gui and chuan shan jia).
3. Kidney Yang deficiency: Zhen Wu Tang (Fu zi, Fu ling, Bai shao, Bai zhu and Sheng Jiang).

Q. Describe the causes of Yang Wei

A.

Causes:

1. Heart Fire: leads to disharmony between fire and water.
2. Damp heat: hyper sexual activity.
3. Qi fails to control essence: heart and spleen
4. Deficient kidney fails to control essence: intemperance and indulgence of sexual activity, constitutionally deficient kidney.
5. Injury of the kidney caused by fright.

Symptoms:

History of fright which is related to sexual intercourse, impotence, depression and stress, prone to fright, distrustful and full of self doubt, palpitation, insomnia, pale and bluish tongue with thin white coating, wiry and thready pulse.

Treatment:

Tonify kidney Qi and calm shen. Use Da Bu Yuan Jian (shu di huang, shan zhu yu, huai shan yao, gou qi zi, du zhong, zhi gan cao, ren shen and dang gui) plus suan zao ren, yuan zhi

Q. Please differentiate between Wei Zheng and Bi Zheng.

A.

Q. Define Die Da Sun Shang.

A. External traumatic injuries to the skin, muscles, sinews (tendons and ligaments), bones and internal organs by external factors and therefore damages other parts of the body.

Q. List the causes of Die Da Sun Shang.

A.

External causes:

1. Direct violent forces: location of damage in direct contact with violent forces.
2. Indirect violent forces: location of damage in a distance from contact points with violent forces.
3. Muscles’ violent contractions: quadriceps femoris (patella), triceps and biceps brachii (humerus).
4. Repetitive forces: lumbar muscle strain, fatigue fracture of metatarsus.

Six exogenous evils and evil toxins

1. Wind, cold and damp evils invasion after injuries.
2. Evil toxins invasion after injuries.

Internal causes:

1. Age: femoral neck fracture, incomplete fracture, semi-dislocation of the radial head.
2. Constitution: habitual dislocation of the jaw, elbow and patella; hip fracture (femoral neck and interochanter fracture) and wrist fracture (Colles’ fracture) after falling over.
3. Anatomy: borders between compact bone and cancellous bone (distant end of the radius, 2-3cm from the end – Colles’ fracture).
4. Occupation: construction workers, porter, athletes, etc.

Pathology of external traumatic injuries:

Shang Qi (4):

1. Qi stagnation: pain is major compliant. Most common in chest and hypochondriac injuries.
2. Qi arrest: sudden severe injuries, transient loss of consciousness. Common in head injuries.
3. Qi deficiency: common in chronic injuries, weak constitution or old ppl.
4. Qi collapse: mostly following severe blood loss. Seen in open injuries and head injuries.

Shang Xue (4):

1. Blood stasis: more local than general, mostly stabbing pain, with bruises.
2. Bleedings: external and internal.
3. Blood deficiency: blood stasis not yet removed and now blood cannot be generated, so clear and tonify at the same time. Liver and kidney essence exhaustion after bone and sinew injuries.
4. Blood heat: blood stasis transforms into heat or liver fire or evil toxin invasion.

Shang Jin (2):

1. Fluid and blood: loss of blood causes fluid deficiency: blood stasis transforms into heat and consumes fluid.
2. fluid and Qi: Qi collapse following fluid depletion: deficient Qi fails to control fluid, kidney Qi (Yang) deficiency cause transforming dysfunction (oedema and urination difficulties).

Q. Explain the causes and pathological mechanisms of Xiao Ke.

Def: Excessive intake of water, polyphasia, polyuria with sweet smell, loss of weight, emaciation.

A.

Causes:

1. Food and drink: spicy, fatty and sweet food. Alcoholic drinks. Heat accumulation and over consumption of fluid.
2. Extreme emotions: the five emotions. Stagnated heat consumes and impairs fluid.
3. Intemperance of sexual activity: kidney essence consumption. Kidney deficiency leads to fire.
4. Febrile diseases consume Yin fluid.

Pathological mechanisms:

Upper Xiao:

1. Lung Qi deficiency and fire burns up fluid. Lung fails to distribute fluid normally.

Middle Xiao:

Excess fire (stomach):

1. Digest food and drink too rapidly.
2. Stomach fire burns the lung: aggravates upper Xiao.
3. Transfers downwards to the kidney: becomes lower Xiao

Deficient fire (stomach and spleen):

1. Stomach excess fire impairs Yin
2. Overwork impairs Spleen Qi

Lower Xiao:

1. Root of Yin and Yang, the Zang of water and fire.
2. Yin-Yang and water-fire imbalance and disharmony.
3. Upper Xiao and middle Xiao can impair the kidney, leading to ‘combined disease’ of upper, middle and lower Xiao.
4. Kidney water fails to support the lung and stomach, leading to ‘combined disease’ of the upper, middle and lower Xiao.
5. Vital gate fire (kidney yang) extinguishing: leads to lung and stomach cold.

Q. Compare the symptoms and treatments of upper, middle and lower Xiao Ke.

A.

Q. Differentiate between Ji and Ju?

A.

·        Ji literally means accumulation. In TCM, Ji has a specific shape, a fixed position and its pains are fixed in a certain place. It is a zang organ syndrome and the disease is in the blood.

·        Ju literally means gathering. In TCM, Ju has no real shape, no fixed position and its pains are moving from place to place. It is a fu organ syndrome and the disease is in the qi.

·        Ji and Ju can transform into each other, but most of the time it is Ju transforms into Ji

·        The formation of Ji Ju also related to the strength and weakness of the body’s genuine qi

Ju Syndromes

Liver Qi Stagnation

·        Symptoms

Gathering of qi in the abdomen with intermittent attacks of distending and moving pain, discomfort or distension in epigastrium and hypochondriac regions, wiry pulse

·        Treatment

Principle: soothe the liver and regulate qi to relieve stagnation and dissipate gatherings. Xiao Yao San with modifications

Food Retention and Phlegm Obstruction

·        Symptoms

Gathering in the abdomen, stripe-like masses appear and disappear, dislike palpation, abdominal distension or pain, constipation, poor appetite, greasy tongue coating, wiry and slippery pulse

·        Treatment

Principle: regulate qi and resolve phlegm, promote digestion and relieve intestines. Liu Mo Tang (wu yao, mu xiang, tan xiang, da huang, zhi shi, bing lang)

Ji Syndromes

Qi Stagnation and Blood Stasis

·        Symptoms

Soft masses with distension and pain, pain fixed at certain place, bluish tongue with ecchymoses, wiry pulse

·        Treatment

Principle: regulate qi and activate blood, remove collateral obstruction and eliminate masses. Jin Ling Zi San plus Shi Xiao San

Accumulated Blood Stasis

·        Symptoms

Progressively growing masses, hard and painful, pain fixed at certain place, weight loss, darkish complexion, tired, poor appetite, spells of fever and chill, amenorrhoea, dull and purple tongue with ecchymoses, thready and uneven pulse

·        Treatments

Principle: remove blood stasis, soften masses and assist with regulation of the spleen and stomach: Ge Xia Zhu Yu Tang

Accumulated Blood Stasis with Weakened Genuine

·        Symptoms

Hard masses, sever pain, very poor appetite, emaciated and cachectic, pale purple tongue with little or no coating, thready and rapid or wiry and thready pulse

·        Treatment

Principle: vigorously tonify qi and blood, promote circulation and remove stasis: Ba Zhen Tang plus Hua Ji Wan (san leng, e zhu, xiang fu, bing lang, su mu, wu ling zhi, wa leng zi, hai fu shi, xiong huang, a wei) with modifications

                                       Questions on this page are Copyright © 2003 by Attilio P. D’Alberto

                         TCM CENTRAL • John R. Wahnish, MSTOM, L.Ac. • [TCMcentral.com] • Revised: Copyright © 2002 •  E-mail: tcmcentral@nyc.rr.com