Kevin Dai L.Ac. E-mail: dragondxq@ gmail .com Website: www.AcupuncturePeople.com

1. Kevin Dai L.Ac. E-mail: dragondxq@gmail.com Website: www.AcupuncturePeople.com

2. Development of TCM Internal Medicine • “The Yellow Emperor’s Internal Classic” • 1. A whole conception is stressed • 2. Ying-Yang & Five elements • 3. Channels & Collaterals • 4. Six Exopathic Factors, 7 emotions, diet, internal injuring • 5. Four diagnostic methods • 6. Therapeutic principles

3. 1. Overeating the fat meat and fine grain can cause the occurrence of abscesses. • 2. Medical classics stated that excessive pattern should be reduced, and deficient pattern should be supplemented. • 3. Slackness and weakness of the extremities is caused by the inability of the spleen to spread the essence.

5. Six Channel theory of Diagnosis & Treatment --Determine therapy according to syndrome-- --Give recipe according to therapy-- --Prescribe drugs according recipe-- --Pay attention to influence on curative effect-- Famous formula: MangHuang Tang; GuiZhi Tang; CaiHu Tang; LiZhong Tang; BaiHu Tang; GeGengQingLian Tang “Treatise on Febrile Disease” “Synopsis of Prescriptions of the Golden Chamber” -- Zhang Zhongjing (150-219 AD )

6. Sui & Tang Dynasties (581-907 AD): • Good medical education & Court medical school • Song, Jing & Yuan Dynasties (907 - 1368 AD): • Liu WanSu (1120-1200 AD) “The theory of pathogenic fire” • Zhang ZiHe (1151-1231 AD) “Purgation Specialist” • Li Gao (1180 - 1251 AD) • “Speciality in warming & tonifying spleen and stomach” • Zhu DanXi (1281-1358 AD) “Tonifying Yin specialist” • Ming Dynasty (1368-1644 AD) • Zhang JingYue (1563-1640 AD) • “Yang is not usually redundant while the genuine Ying is often deficient” • Qing Dynasty (1632 - 1912 AD) • Wu YouKe (1582 - 1652 AD) • “Epidemic Febrile Disease”

7. Etiology • Exopathic Factors: a. Wind Character:Moving & changeable;Prevails most widely; chief cause for various disease & often combined with other pathogenic factor Season: Spring Attack: Upper Jiao; Yang meridian; Skin Syndromes:coughing, stuffy or runny nose, headache, dizziness, and sneezing… b. Cold Character: damage body’s yang Qi; cause pain & spasm symptoms Season: Winter Attack: skin; meridians & joints; directly attack the interior of the body Syndromes: fever; avoid cold; headache; body pain; no sweating C. Summer-heat Character: Yang pathogen; damage body’s fluid; Season: only happen in summer Attack: upper jiao; Syndromes: high fever; thirsty; big sweating; excess body heat, profuse sweating, parched mouth and throat, constipation, and heart palpitations

8. d. Dampness Characters: heavy & turbid; sticky and difficult to be removed Season: long summer Attack: usually attack downside of the body Syndromes: take long time to be cured; sticky stools; bad appetite e. Dryness Characters: damage body’s fluids; Season: Autumn Attack: through mouth & nose; easily cause lung damage Syndromes: fever; headache; less sweating; dryness of nose; coughing but less phlegm or phlegm with blood f. Fire Characters: excess of Yang; damage body fluids; causing wind & hurt the blood Other five pathogens could be transformed into fire pathogen Season: any season Attack: Heart & blood Syndromes: irritated; coma; blood syndromes

9. 2. Endopathic Factors <A> Emotions

10. <B> Five internal pathogenic factors i: internal wind cause: hyperactivity of Liver-Yang; deficiency of Yin & excess of phlegm-fire Sym: dizziness; convulsion; syncope; numbness & muscle spasm ii: internal cold cause: deficiency of Qi & Yang Sym: pain in the abdomen; diarrhea; cold limbs; weak pulse iii: internal dampness cause: overeating fatty diet; raw fruit, sweet & greasy food; external dampness Sym: oppressed feeling in the chest; epigastric distention & stuffiness; nausea; vomiting; scanty urine; loose stool; edema iv: internal dryness cause: depletion of blood fluid & blood after febrile disease; overtaking warm & hot drugs, profuse sweating & excessive vomit and purgation Sym: dry skin & eyes; thirst; dry throat; constipation; parched lips v: internal fire cause: hyper-function of 5 Zang organs; deficiency of yin-blood Sym: insomnia; constipation; bitter taste; dizziness; headache; hematemesis; yellow phlegm; dark urine; sore throat; hectic fever; night-sweat; flushed checks; tinnitus; vexation & insomnia

11. <C> Diet “Overeating can impair the intestine & stomach” Cause dampness, phlegm, heat, parasitosis <C> Retention of Phlegm & Fluid Dysfunction of the lung, spleen & kidney <D> Blood Stasis Stagnation of Qi, Deficiency of Qi, Blood cold or heat, deficiency of yin-blood, insufficiency of yang-qi and external injury

12. 3. Non-endo-expopathic factors <A> Excessive Fatigue or Leisure <B> External Injury

13. Pathology (I) Six Principles 1. Exterior & Interior (A) Exterior Pathology: exterior pathogenic factors (wind & cold) attack skin, muscle and the superficial portion of meridians (Tai Yang) Clinical Sym: Chills, fever, headache, general aching Tongue: thin fur Pulse: superficial (B) Interior Pathology: transmission of exogenous pathogenic factors to the interior of the body to affect zang-fu organs or from the functional disturbances of Zang-fu organs. Clinical Sym: see Zang-fu organs theory Tongue:Pulse

14. 2. Cold & Heat (A) Cold Pathology: “exogenous pathogenic cold” or “Deficiency of Yang” Clinical Sym: Pallor, aversion to cold, absence of thirst or drinking a little hot drinks, loose stools, clear urine increased in volume Tongue:Pale body with white & moist coatingPulse:Slow & tight (B) Heat Pathology: “exogenous pathogenic heat” or “Deficiency of Ying” Clinical Sym: Red complexion, fever, thirst with perference for cold drinks, constipation Tongue:Red body with yellow & dry coatingPulseRapid

15. 3. Deficiency & Excess (A) Deficiency Pathology: consumption of essential Qi cause deficiency Clinical Sym:Emaciation, listlessness, lassitude, feeble breathing, dislike of speaking, pallor, palpitations, shortness of breath, insomnia, poor memory, spontaneous & night sweating, nocturnal emission, nocturnal enuresis, pain alleviated by pressure Tongue:Dry body with no or little coating Pulse Pulse of deficiency type (B) Excess Pathology: Hyperactivity of the pathogenic factor cause excess Clinical Sym:Sturdiness, agitation, sonorous voice, coarse breathing, distension and fullness in the chest and abdomen, pain aggravated by pressure, constipation or tenesmus, dysuria Tongue:Thick & Stick coatingPulse all excess type

16. II Qi & Blood theory (A) Qi (a) Deficiency of Qi Pathology: weakness after long illness…bad nutrition… Clinical Sym: dizziness, blurring of vision, dislike of speaking, lassitude, spontaneous sweating Tongue: pale Pulse weak or thin (b) Sinking of Qi Pathology: due to weakness of Qi Clinical Sym: prolapse of the anus or uterus, gastroptosis Tongue: pale Pulse weak

17. (C) Stagnation of Qi Pathology: mental depression; improper diet; invasion of exogenous pathogenic factors; sprains & contusions Clinical Sym: distension & pain Tongue:Pulse string (D) Perversion of Qi Pathology: Lung, Stomach & Liver Clinical Sym: coughing & asthma; belching, hiccups, nausea & vomiting; headache, dizziness & vertigo, coma Tongue:Pulse

18. (III) Zang-Fu Organs Theory 1. The Heart ( Small Intestine) Pathology:disturbance of blood circulation & abnormality of thinking activities Clinical Sym:Palpitation; cardialgia; amnesia; insomnia; spermatorrhea; madness; coma; asthma; haematemesis; boil of tongue; hematuria (1) Deficiency Syndrome: (a) Heart-Yang (Qi) deficiency Pathology: Heart-Qi defi & excessive mental activity Clinical Sym:palpitation; asthma; oppressed feeling in the chest + Yang deficiency symptoms Tangue: whitish & slip fur Pulse: thready & feeble (b) Heart-Yin (blood) deficiency Pathology: excessive mental activity damage the blood, depletion of yin-essence Clinical Sym:heart symptoms + Yin deficiency Tangue:scanty fur or dry red tongue tip Pulse: thready & fast

19. (2) Excessive syndrome: (a) Mental disorder due to excessive Phlegm-fire Pathology: long retention of damp phlegm to cause fire-transmission Clinical Sym:+ phlegm-fire symptoms Tongue: red dry tongue & yellow fur Pulse slippery & rapid (b) Stagnation of heart-blood Pathology: stagnation of heart-blood & disorder of collaterals Clinical Sym:+restlessness, prickling pain in the chest Tongue: dark red with purple spot; scanty fur Pulse uneven (C) Obstruction heart-yang due to Fluid Retention Pathology: long retention of water in the chest Clinical Sym: + oppressed feeling in chest, dizziness, vomiting, Tongue: white & greasy fur Pulse slippery or deep&tense

20. Lung ( Large Intestine) Pathology: insufficiency of Zong qi & dysfunctions n respiration, dispersing & descending. First organ to be affected when… (1) Excessive (a) Wind (cold / heat) invasion lung Pathology: impairs lung’s function in dispersing & descending; disharmony of ying qi & wei qi Clinical Sym: cough with sputum, watery nasal discharge, fever, chills, headache; (/ thirst, sore throat, yellow phlegm) Tongue: thin white coating or yellow Pulse superficial, tense or rapid (b) Retention of phlegm damp in the lung Pathology: phlegm blocks the passage of qi & impairs lung qi Clinical Sym: cough with phlegm, stuffiness in the chest, asthma Tongue:white sticky coatingPulse rolling

21. (c) retention of phlegm heat in the lung Pathology : invasion of wind cold turns into heat Clinic sym: cough, asthmatic breathing, chest pain & yellow stick sputum, dryness of the mouth & yellow urine, constipation tongue: yellow stick coating Pulse: rolling, rapid Deficiency (d) Deficiency of lung qi Pathology : prolonged cough or illness Clinic sym: feeble cough, shortness of breath, clear sputum, lack of desire to talk, low voice, aversion to wind tongue: thin white coating Pulse: weak

22. (e) insufficiency of the lung yin Pathology : prolonged cough which consumes the lung yin; dryness damages yin; Clinic sym: small amount of sputum, dryness, cough produces blood tinged sputum + yin deficiency sym.. tongue: red body less coating Pulse: thready rapid

23. 3. Spleen & Stomach Pathology: dysfunction in transportation & transformation Clinic Sym: poor appetite, abdominal distention & fullness, loose stools (a) Deficiency of Spleen Qi Pathology : prolonged illness; improper diet; Clinic sym: sallow complexion, emaciation, lassitude, dislike of speaking, prolapse of the anus tongue: pale Pulse: slowing-down weak or soft thready (b) Deficiency of Spleen Yang Pathology : raw, cold, greasy & sweat food; herbs of cold nature; Clinic sym: cold limbs; dull abdominal pain but prefer warmth & pressure tongue: pale Pulse: deep-slow

24. (d) Damp-cold invades spleen Pathology : damp environment, raw & cold food, Clinic sym: sticky saliva, heaviness of the head & body, tongue: white sticky coating Pulse: soft (e) Damp-heat in Spleen & Stomach Pathology : exogenous pathogenic damp heat; greasy & sweat food; alcoholic drinking; Clinic sym: nausea, vomiting, bitter taste & stickiness in the mouse, heaviness of the body, scanty yellow urine tongue: yellow sticky coating Pulse: soft rapid (f) Hyperactivity of fire in the stomach Pathology : excessive eating of hot & greasy food; liver fire invasion Clinic sym: burning sensation & pain; getting hungry easily; foul breath; bleeding gums; constipation; scanty yellow urine tongue: red body with yellow coating Pulse: rapid

25. 4 Liver & Gallbladder Pathology : in dysfunction of the liver in storing blood, promoting the free flow of qi, and in disorders of the tendons Clinic sym: pain in the costal & hypochondriac regions + digestion problems (a) Stagnation of the liver Qi Pathology : mental irritation Clinic sym: depression; irritability; irregular menstruation & dysmenorrhea in women; tongue: purplish dark or spots Pulse: string-taut (b) excessive liver fire Pathology : Clinic sym: headache; dizziness; vertigo; redness, swelling & pain of the eyes; bitter taste & dryness in the mouth; tinnitus like the sound of waves; yellow urine & constipation tongue: red body & yellow coating Pulse: string-taut rapid

26. (c) Rising of the liver yang Pathology : Clinic sym: distending headache; dizziness; vertigo; tinnitus; flushed face & red eyes; irritability; insomnia; palpitations; poor memory; soreness & weakness of the low back & knees tongue: red body Pulse: string-taut thready rapid (d) Insufficiency of the liver blood Pathology : insufficient production of blood; prolonged illness Clinic sym: pallor; dizziness & vertigo; blurring of vision; dry eye; night blindness; numbness of limbs; spasms of the tendons; scanty menstrual flow; tongue: pale Pulse: thready (e) Damp heat in the liver & gallbladder Pathology : Exogenous pathogenic damp heat; greasy food Clinic sym: bitter taste in the mouth; scanty & yellow urine; yellow sclera & skin; tongue: yellow sticky coating Pulse: string-taut rapid pulse

27. 5. Kidney and Bladder Pathology: Dysfunction in storing essence, disturbance in water metabolism, abnormality in growth, development & reproduction Clinic Sym: soreness & weakness of the lumber region & knee joints; abnormal urination; dizziness; tinnitus (a) Deficiency of the kidney Yang Pathology : Constitutional deficiency of yang, or in old age, prolonged illness; or to excessive sexual activity Clinic sym: cold limbs; infertility; tongue: pale body with white coating Pulse: deep weak pulse (b) Insufficiency of Kidney Yin Pathology : …… Clinic sym: insomnia; poor memory; nocturnal emission; dry mouth; afternoon fever; malar flush; night sweating; yellow urine; constipation tongue: red body with little coating Pulse: thready rapid

28. IV Complicated Syndromes of Zang-Fu Organs • Disharmony between the Heart & lung • Deficiency of the qi of the lung & kidney • Deficiency of the Lung Yin & Kidney Yin • Deficiency of the Liver Yin & Kidney Yin • Deficiency of Spleen Yang & Kidney Yang • Deficiency of Lung Qi & Spleen Qi • Imbalance between Liver & Spleen • Disharmony between Liver & Stomach • Deficiency of both the heart & Spleen • Invasion of the lung by the liver fire