Treatment of Disease (Selected Diseases)

1. Treatment of Disease(Selected Diseases) • ACR class 6

2. WINDSTROKE

3. Wind stroke • Emergency case • manifested by falling down in a fit with loss of consciousness, hemiplegia, slurred speech and deviated mouth. • Characterized by abrupt onset with pathological changes varying quickly like the wind, from which the term wind stroke comes.

4. Attack on the zang-fu organs • Tense syndrome: Wind stirred up by upsurge of liver yang sends qi and blood upwards, which together with the accumulated phlegm fire disturb the mind. Disturbance of the mind by the phlegm heat or collection of excessive fire in the heart and liver. • Flaccid syndrome: Deficiency of the primary qi or collapse of the kidney yang • Attack on the meridians and collaterals

5. Tense Syndrome • Clinical manifestations: Collapse with loss of consciousness, tightly closed hands and clenched jaws, flushed face, coarse breathing, retention of urine, constipation, red tongue with thick yellow or dark grey coating, wiry, slippery and forceful pulse. • Treatment principle: Reduce wind fire, resolve phlegm and promote resuscitation • Flaccid Syndrome • Clinical manifestations: Collapse with sudden loss of consciousness with mouth open and eyes closed, feeble breathing, flaccid paralysis of limbs, incontinence of urine, flaccid tongue, thready weak pulse and cold limbs, weak or big floating forceless pulse. • Treatment principle: Restore yang from collapse

6. Attack on the meridians and collaterals • Clinical manifestations • Hemiplegia, numbness of the limbs, deviated mouth , slurring of speech, accompanied by headache, dizziness, vertigo, twitching of muscles, • Treatment principle • Remove obstruction from meridians and collaterals and reduce wind

7. HEADACHE

8. Etiology and pathology • External pathogenic factors • Invasion of wind into the meridians and collaterals • Endogenous factors • Hyperfunction of the liver yang • emotions • overwork • dampness • Accidents • Blood stasis • Deficiency of qi and blood

9. Diagnosis • Diagnosis according to channels • Top of the head, behind eyes -------liver channel • Sides of the head-----shaoyang channel • Forehead------yangming channel • Back of the head (occiput)------ taiyang channel

10. Diagnosis according to the nature of pain • Dull ache, hollow pain, feeling of empty • Feeling of heaviness, heavy, muzzy, wrapped in a cloth • Distending pain, throbbing, bursting, pulsating, wind heat, liver yang rising, liver fire • Stiff, occiput: wind cold • Pulling pain: spasmodic in nature and short in duration—liver wind • Stabbing pain: splitting headache--blood stasis • Diagnosis according to amelioration and aggravation • Time, weather, emotions, posture, menstruation, activity/rest

11. Patterns • Invasion of pathogenic wind • Liver yang rising • Liver fire blazing • Accumulation of dampness • Blood stasis • Qi and blood deficiency

12. Invasion of pathogenic wind • Clinical Manifestations • Headache worse on exposure to wind. The pain may extend to the neck and back region or with a stiffness on the occiput. Acute onset, short duration, thin coat, floating pulse • Treatment principle • Release the exterior and remove the obstruction from the channels

13. Liver yang rising • Clinical Manifestations • Distending, bursting or throbbing headache, irritability, tinnitus and dizziness, symptoms of liver and kidney yin deficiency. Wiry pulse • Treatment principle • Pacify liver, nourish Yin and alleviate pain

14. Liver fire blazing • Clinical Manifestations • Distending, bursting or throbbing headache, irritability, tinnitus and dizziness, thirst, bitter taste, scanty-dark urine, constipation with dry stools, red eyes, a red tongue with yellow coating, wiry rapid pulse. • Treatment principle • Pacify liver and clear fire

15. Accumulation of dampness • Clinical Manifestations • The headache is dull and feels as if the head is wrapped in a cloth or full of cotton wool. Sensation of heaviness and difficulty in thinking. Dizziness. Symptoms worse in the mornings. Nausea, lack of appetite, a feeling of fullness of the chest and epigastrium, loose stool, thick sticky tongue coating and a slippery pulse. • Treatment principle • Resolve dampness and ascend clear yang

16. LIN SYNDROME

17. Pathogenesis • Heat Lin • Full type: full heat • Empty type: empty heat • Stone Lin • Full type: damp-heat • Qi Lin • Full type: stagnation of qi • Empty type: qi deficiency or qi sinking • Blood Lin • Full type: blood heat • Empty type: blood or qi deficiency • Sticky (Cloudy) Lin • Full type: dampness • Empty type: dampness with qi deficiency

18. Heat Lin • Clinical manifestations: • frequent, scanty and difficult urination, burning pain on urination, dark urine with a strong smell, bitter taste in the mouth, pain on the sacrum, constipation, thirst. Red tongue, yellow sticky coating, rapid slippery pulse. • Treatment principle: • Clear heat, drain dampness, and open the water passages

19. Stone Lin • Clinical manifestations: • stone or sand in the urine, difficult urination which may stop suddenly, sacral pain, blood in urine, red tongue with thick-sticky coating. Rapid, wiry pulse. • Treatment principle: • Open the water passages and expel the stones

20. Qi Lin • Clinical manifestations: • Full type: difficult and painful urination, hypochondrium pain and distension, irritability, wiry and deep pulse. • Empty type: difficult urination, weak constitution, tiredness, pale tongue, week pulse • Treatment principle: • Full type: move qi, eliminate stagnation, open the water passage • Empty type: tonify and raise qi, open the water passage

21. Blood Lin • Clinical manifestations: • Full type: difficult urination, burning pain on urination, blood in the urine which could take the form of small clots, mental restlessness, red tongue and rapid pulse. • Empty type: blood in urine, slight pain on urination, low back pain, 5-palms heat, hot flushes. Red tongue without coating, thin rapid pulse. • Treatment principle: • Full type: Clear heat, cool blood, stop bleeding and open the water passage • Empty type: nourish yin, clear heat, stop bleeding and open the water passage

22. Cloudy Lin • Clinical manifestations: • Full type: turbid or cloudy urine like rice soup, difficult urination, a sticky tongue coating and a slippery pulse • Empty type: turbid or cloudy urine like rice soup, slight difficult urination, tiredness, dizziness, lower back pain, pale tongue with sticky tongue coating and a weak pulse • Treatment principle: • Full type: drain dampness, separate the clear from the turbid, open the water passages • Empty type: tonify qi, strengthen kidneys, separate the clear from the turbid, open the water passages

23. Painful Obstruction Syndrome(Bi Syndrome) • Bi syndrome indicates pain, soreness or numbness of muscles, tendons and joints from invasion of external wind, cold, heat or dampness.

24. Etiology and pathogenesis • Invasion of external pathogenic factors such as Wind, Cold, Heat and Dampness causes obstruction in the circulation of Qi and Blood in the channels

25. Differentiation • According to the predominant pathogenic factor • Wandering Bi: pain move from joint to joint and caused chiefly by pathogenic wind • Fixed Bi: fixed pain with soreness, heaviness, numbness and swelling of joints and caused chiefly by pathogenic damp • Painful Bi: severe pain and caused chiefly by pathogenic cold • Heat Bi: severe pain with swollen hot red joints and caused by heat • According to the locality of diseased area • Skin Bi • Muscle Bi • Tendon Bi • Vessel Bi • Bone Bi

26. Wandering Bi • Clinical manifestations: • Wandering pain in the joints, especially the wrists, elbows, knees and ankles, limitation of movement, chills and fevers, thin and sticky tongue coating, superficial and tight or superficial and slow pulse. • Treatment principle: • Dispel wind, clear the collaterals. • Activating and nourishing the blood, based on the principle: “wind will be naturally eliminated if blood circulates smoothly”

27. Fixed Bi • Clinical manifestations: • Numbness and heavy sensation of the limbs, soreness and fixed pain of the joints, aggravated on cloudy and rainy days, white and sticky tongue coating and soft pulse. • Treatment principle: • Dispel dampness, clear the collaterals

28. Heat Bi • Clinical manifestations: • Arthralgia involving one or several joints, local redness, swelling and excruciating pain with limitation of movement, accompanied by fever and thirst, yellow tongue coating, rolling and rapid pulse. • Treatment principle: • Drain heat, clear the collaterals

29. Painful Bi • Clinical manifestations: • Severe stabbing pain in the joints, alleviated by warmth and aggravated by cold, with fixed localization but no local redness and hotness, thin and white tongue coating, string-taut and tense pulse. • Treatment principle: • Dissipate cold, clear the collaterals

30. Infertility • Etiology and pathology • Kidney deficiency • Liver stagnation • Phlegm and dampness • Blood stasis

31. Pattern Identification and Treatment • A. Kidney Deficiency • Clinical Manifestations: Failure to get pregnant long after marriage, delayed menstruation, sparse and light colored menses or amenorrhea, hyposexuality, dark and lusterless face, soreness of the loins and knees, a feeling of coldness in the lower abdomen, thin and clear leucorrhea, profuse thin urine, loose stools, pale tongue with whitish coating, a deep fine or deep slow pulse. • Treatment principle: Tonify kidney and promote conception

32. B. Liver Qi stagnation • Clinical Manifestations: Infertility, Irregular menstruation, premenstrual syndrome, painful period, distension at the hypochondrium region, hot temper, depression, dark red tongue with ecchymosis, wiry pulse. • Treatment Principle: Soothe liver, move qi and promote conception

33. C. Accumulation of Dampness • Clinical Manifestations • Obesity, late scanty period or amenorrhea, hirsute, leukorrhagia, dizziness, stuffiness at the chest and epigastrium, nausea, pale swollen tongue, white sticky tongue coating, slippery pulse. • Treatment Principle • Drain dampness, move stagnation and regulate periods

34. D. Blood Stasis • Clinical Manifestations: Infertility, painful period, menses is dark in color, with clots. Metrostaxis, postcoital bleeding, painful coitus, dark red tongue with spots, thin wiry pulse • Treatment principle: Remove blood stasis, regulate periods and promote conception

35. Diabetes (Wasting Thirst) • Differentiation: • Classical Differentiation of Wasting & Thirsting disorder (Xiao Ke): • Classically, Yin Deficiency with Empty Heat is the root cause of wasting & thirsting disorder. The differentiation is according to the 3 jiao as described below. • Upper Wasting - LU Heat • Middle Wasting - ST Dryness • Lower Wasting - KD Yin & Jing Deficiency

36. Modern Differentiations of Conditions involved with Type-II Diabetes: • These tend to be more lifestyle related involving poor diets &/or lack of exercise among other factors. • SP Qi Deficiency alone, w/dampness or w/damp-heat • LV Qi Stagnation alone or w/fire

37. Upper Wasting - LU Heat • Signs & Symptoms: • Dry throat and mouth, thirst, frequent urination. • Tongue: Red w/dry yellow coat • Pulse: Rapid

38. Middle Wasting - ST Dryness • Signs & Symptoms: • Excessive appetite, thirst, epigastric pain, constipation. • Tongue: Yellow dry coat • Pulse: Rapid

39. Lower Wasting - KD Yin/Jing Xu • Signs & Symptoms: • Sore back/knees, weak lower body, dizziness, blurry vision, frequent copious urination, dry mouth. • Tongue: Red w/no coat • Pulse: Fine, rapid

40. SP Qi Deficiency • Signs & Symptoms: • Fatigue, weakness, poor appetite, loose stools. May also generate dampness over time, which may combine with heat. • Tongue: Pale w/scallops ( thick coating if dampness) • Pulse: Empty (slippery if dampness)

41. LR Qi Stagnation • Signs & Symptoms: • Depression, easily angered, belching or gas, PMS, menstrual irregularities. • Tongue: Normal or Purple (red w/yellow coat with LR Fire) • Pulse: Wiry (w/rapid with LR Fire)