Week 4

Quiz List 4 patterns for Night Sweats, Dizziness, and Spontaneous Sweating.

Let's talk about Headaches
Pain in general
If there's pain, there's no free flow
Repletion pain is usually sudden, severe, and aggravated by pressure

San Bi Theory = Impediments = Wind Cold Damp Ext invasion... Transforms into Heat
Wind Bi = Wandering Bi
Arthritis = type of Joint Bi
Cold Bi = Painful Bi, Cold is contracting and congealing, so intense pain, use Fu Zi
Heat Pain = Burning Pain
Phlegm causes numbness
Food Stagnation also calls pain.

Vacuity = gradual, insidious onset, relieved by pressure.

Distending pain = qi stagnation "zhi" = paroxysmal
Stabbing Pain = Blood stasis
Radiating pain = look to the sinews (livers)
Burning Pain = Fire scorching Luo Mai - relieved by the cold
Cold Pain = Cold, heat helps, either replete cold, or cold vacuity
Dull Pain = Vacuity, chronic, lingering, look at Qi and Blood vacuity

Head and body Pain
Dizziness and shaking
Presence of Pain
location - channels
nature of the pain (distending, stabbing, radiating, burning, cold, dull)
time of occurance - time of day, or activity around that time
relationship of pain to the weather
Body movements
Other sensations
Heaviness - damp
Numbness - phlegm, blood vacuity
Flexibility

Headaches
Head = Confluence of all Yang Mai
All yin channels connect via yang divergent channels

Qi Xu = worse with exertion
Yang Xu = >AM Yin Xu = >PM < AM

External Invasion
Evils obstructs the Clear Yang

Internal
Liver Channel ends at Bai Hui
GB is around the Temporal and parietal bones on the skull
Liver Qi > Hyperactive of Yang > Fire Ascending harasses the clear portals
Ying undernourishing the Liver Yin..> LV Yin Xu > KD Yin Xu
Insufficent Jing = KD Qi Xu headache, vacuity headache, dull, constant
KD Yang Xu = fail to warm, constricting of vessels
Sp Qi Xu = unable to upbear the Clear Qi, Qi is commander of Blood, Qi moves blood moves
Damp blocking the clear Qi
Wind can draft Dampness up to the head, blocking Qi -> Wet towel wrapped around the head
Blood Stasis = Yin Turbid evil that obstructs the network vessels, look for past injuries
New Diseases are in the Channels, Enduring Diseases are in the Network Vessels
Tree Sap/Bugs herbs get into the network vessels

TaiYang = Occiput and Nape
YangMing = Forehead = Bai Je
ShaoYang = Parietal and Temporal = Chai Hu/Chuan Lian Zi
JueYin = Vertex stretching from corner of the forehead
ShaoYin = Radiates to the teeth, throat and deep in the brain
TaiYin = Combines heaviness and Possible Diarrhea

Generalized Pain
If there's pain, there's no freeflow, if there's no freeflow, theirs pain

Windcold Binding the Exterior, Qi unable to nourish the flesh, use Ma Huang Tang
If pain radiates wider, throughout the body, add Du Hou, Chong Hou
Acrid Warm, Ext Warming
Use Lu-7, Du-14, LI-4


Yang Xu
Chilled limbs, Loose stools, Fu Zi, Rou Gui, generalized, dull pain,
use Guan Yuan, Ming Men, Ren 4, Du 4, Du 14

Damp
Heavy Limbs, All heavy sensations are attributed to damp
Aversion to cold and fever,
possible damp in exterior

Damp-Heat
Sticky fever
thirst, no desire to drink
sweat stops, fever goes up
heavy limbs
Bai Zhe, Fu Ling, Huang Qin,

Wei Syndrome, Wilting Syndrome
Cang Zhu Huang Bai, generalized damp heat

Blood Stasis
pricking/stabbing/boring
inhibits movement
Dizzy,
lackluster complexion

Qi and Xue Dual Vacuity
Fatigue


Chest Pain
Phlegm Damp In the Lungs
Coughing up Copious amount of clear phlegm that's easy to expectorate
wheezing

Heat in the Lungs
Depressive/Transformative Heat
Can Boil the Blood into Pus and burns flesh into abcess
Expectorates something with foul smell

Chest Bi
Radiates to the back, or the arm, or back pain that radiates to teh chest
Cold-congelation of stasis of the Heart
suspect heart attack
look for cyanosis
Chuan Gou Lo

Stagnation and Stasis
Distending, sighing
fixed, stabbing, spider nevi

Yin Vacuity with Effulgent Fire
Qing Ying Tang
Febrile disease invading the lower jiao devastating kidneys/yin/ying

Cough Ke Sou,
ke- Non-productive cough
Sou - productive cough
proximal to lungs
distal, liver
Tx Principle for Wind Cold Cough
LU 7 with LI 4
GB 20, UB 14

Wind Heat Cough
GB 20
LI-11
Sj-5
Ren 22
Lu-10

Wind Dry, Dry Evil
Moisten Dryness
Disperse Dryness
Moisten Lungs
Release Exterior
Stop Cough
San Ye, Bai Bu, Bi Ba
Lu-7, LI-4

Phlegm Damp congests in the Lung
Sp-9
ST-40
ren-12

Phlegm Heat Congesting in the Lung
coughing
Clear Heat, Transform Phlegm
organ level heat
ma xin she gan tang
LU-5, Du 14, drain heat, St 44, St 40
Qing Qi Hua Ten Wan

Huang Qin
Chu Bei Mu

Phlegm Damp Obstructing the Lungs
Soft cough
worse after exertion

SP Qi Xu
Weak SP engenders Phlegm Damp
Shi/Xu pattern
fatigue,
postprandial somnolence

Lung Yin Xu
Cough dry, hacking cough, non-productive, difficult to expectorate

Week 3

To Bribe Steve Woodley
The Shape of the Turtle
The Heir and the Sage
East Asian
Zhunao Yin
The Chinese Sky During the Han Constellation

Sweat
Yang acting on Yin
Sweat is a body fluid, therfore is Yin
When the Wei Qi opens the cou li, the intersticies, and goes out into the exterior, it carries the sweat out.
Normal Sweat harmonizes the Ying and Wei
Lose fluid, lose qi.
Qi seals the exterior, to contain sweat, so to contain sweat needs qi.
If weak in Qi, sweats easily, losing Qi, making sweat easier.
Wind-cold will bind the Wei Qi, thus stopping sweat
Damp will bind the Wei Qi

Improper Sweat
Evil Qi
Yang Qi Xu - Weak Wei Qi - Catches cold easily, easily complicated/lingering
Acute or Chronic?
If Acute - Gui Zhi Tang
If Chronic, Warm Kidneys, Supplement Qi
Secure Exterior
Huang Qi - Boost Wei
Bai Zhu - Secure Ext
Damp Heat
Depressed and steaming Fever, sticky
Water-rheum
Tan Yin - Sweating inappropriately
Heat in the Yang Ming- Channel or Fu - 4 Big
Summerheat -

Night Sweats/Thief Sweats
Nightsweats repeatedly drains Yin because of the tan ye, Draining Qi and Yin, leading to Yang losing root.
Leading to higher suspectibility disease and etc.
Older the age, more aggravation to the Yang, vacuity heat.
Yin Xu, Vacuity Heat
Could be complicated with Sp Xu w/ Damp
Yellow, Swallow/Dusky Face
Sp Xu w/ Damp-heat
Bright Yellow Complexion
Loose, smelly stools
Burning Urine
Blood Xu- Heart Blood Xu
Pale, Magnitudial Insomnia

Dizziness
Phlegm Damp
Liver Yang Hyperactivity- Yin Vacuity/Vacuity below
Wind-Fire- Febrile Disease
Central Qi insufficiency - Sp qi unable to upbear the clear to the head quickly enough
Kidney Jing insufficiency - aging or premature/devastating disease
Mental/memory problems - dementia/senile
Ht-Sp Dual Vacuity - Empty headed dizziness... Shen/Yi relationship, concentration/memory

Week 2 The 10 Questions

The 10 Questions:

Link questions to pattern differentition

Classical 10 Questions
Sensitivity to Cold or Heat.
Sweat
Head and Limbs
Urination and Defacation
Diet
Chest
Deafness
Thirst
Complexion
Odor & Spirit

Modern 10 Questions (even tho there is 12)
Cold/Heat -
Aversion to cold or emission of heat/Chills or Fever
Sweat
Body - Head Observation/complain
Stool/Urine observation
Diet
Chest
Deafness-vision
Disease History
Sleep
Emotions
Gender Specific Questions

Use Algorithmic Thinking/OCD Deductive Reasoning/Global Thinking
Establish Hypothesis from the instant somebody walks through the door
Tell Chief Complaint (C/C)
Cross reference Hypothesis-C/C = New Theory
Then Use 10 Questions to TARGET and CONFIRM OR DENY New Theory
Select questions to work with the C/C


Details
Aversion to Cold and Emission of Heat
Wu Han - Aversion to Cold (Nigel Wisemen
Chills = Giovanni
Practical - Sensitive to the cold?
Literal - Fear/Hate Cold (Stronger version) - Does Clothing help? Yes - Fear Cold, No - Aversion to cold
If No, Wei Qi is either Bound/Fettered or Vacuous. If Wei Qi Bound - Ma Huang Tang
Wei Qi Xu = Gui Zhi Tang
If Wei Qi is bound, use attack, if Wei Qi Xu, support

Heat
Fa Re, Objective OR subjective
Emit Heat - touch, or feel,
"I feel warm, but I took my temperature and its ok" Perfect answer for us

Yang Replete Evil - Exterior Heat
Yin Replete Evil - Internal Cold
Yang Vacuity - Exterior Cold - Wei Qi
Yin Vacuity - Interior Heat - Yin Yang... if Yin is Xu, then part of Yang is unanchored



Try to do active learning:
Think of something BEFORE looking it up to confirm corrections
IE cheater books in clinic

Aversion to cold WITH Emission of FeverWu Han with Fa Re
1% Chills = 1% Exterior
WCold - WHeat, WDry, WDamp, Summerheat (high humidity high heat), Malarial Evils, Sore Toxins/Heat Toxins (hospital potential)

Fear Cold
*Yang Vacuity Depletion of Heat

Gan Yu Qi Zhi = Liver Qi Stag
Gan Qi Yu Jie = LV Qi Stag with emotions
Liver Qi Depression and Binding
LV Qi collects heat and binds the Yang qi and keep it from flowing

True Heat/False Cold
Depends on what one wants to drink.
Hot Drinks + Hot = False Heat, True Cold
Cold Drinks + Hot = True Heat
Hot Drinks + Cold = True Cold, False Heat
Cold Drinks + Cold = True Heat, False Cold

Phlegm/Tan Yin Obstructing/Collecting
Confined pulse, holding the Yang Qi
Warm drinks may help because warm moves yin

Cold Strike/Shao Yin
Underlying Yang vacuity. Shaoyin = Heart/Kidney Axis = All Fire comes from Fire
Fu Zi Warms Heart to Warms KD

Aversion to Cold > Fever = WC with External replete
Floating, Tight, Chills/Fever, White/Clear snot - Cowboy
Fever > Aversion to Cold = WH
Cough, Throat, Heat Toxin, Slightly yellow snot, Floating, Rapid, Red Tongue Tip
Fever with Aversion to wind = WC with External Vacuity
Chills with a draft. Ying-Wei Disharmony- Gui Zhi Tang, Floating, Moderate

Fever No Chills
Heat Congesting in the Lungs = Heat in Yang Ming Channel 4 Bigs
Damp Heat steaming internally = Heat in Yang Ming Fu 4 Bigs
Summer Heat = Heat enters Ying and Xue
Heat Toxins = Qi Vacuity
Blood Vacuity = Yin Vacuity

Febrile Disease = Diseases with Fever


Tidal Fever comes and goes like the tide
Yin Vacuity/Vacuity Heat = Internal Heat = PM
Sp Qi Xu = AM Tai Yang time Sp time, worst with taxation, use Dang Gui Liu Huang Tang
Dang Gui
Huang Qi
Huang Lian
Huang Qiao
Huang
Shu Di Huang
Shen Di Huang
Yang Ming = ST Qi vacuity Closing of Yang
DampHeat = Sticky Fever, sweaty but no relief.
Ying and Xue = Leads to Qi Xu, that can lead to Yang Xu. All transformation of Qi is warm transformations. Not a fever, but hot when on exertion. Heat Boom = Flash. Hot Flash
Use Sweet and Warm to Clear Fever = Huang Qi and Ren Shen.
HQ boosts Wei Qi/Moving, Upbear
RS boosts Yuan Qi/Fixed
Chai Hu,
Dang Gui, Build Blood
Chen Pi - Regulate Qi, Downbear Turbid
Bai Zhu - Dry Spleen


Alternating Cold and Heat
Shao Yang - Inbetween Ext Int
Shao Chai Hu Tang
Heat entering Blood Chamber
7 Xie Nui = Malarial Disease


Quiz
10 Patterns for Fever, no Chills
5 Patterns for Fever with Chills

Week 1

TCM Methodologies
One Disease, Different Treatments, Different Disease, Same Treatments
Basis of Pattern Discrimination
Pattern Discrimination is based on Signs and Symptoms
Thus Know Patterns (about 60-200 patterns)
Gather Signs and Symptoms through the 4 Examinations -
Questioning/Observing/Listening-Smelling/Palpitation
Know Statement of Fact (TCM Physiology) to Understand manifestation of Signs and Symptoms
to come to a conclusion on Patient Pattern
In the State of CA, it is legally required for TCM Doctors to ONLY use the 4 Examinations to come to the conclusions of Pattern Discrimination to form a treatment plan. It is illegal/immoral to use "modern" tools, technology to use as evidence for signs and symptoms.

A typical examination should be 20 minutes total.
The ultimate Doctor will be able to do pattern discrimination through only Observation
The efficient Doctor will ask Questions
The technical Doctor will Palpitate to confirm the pattern discrimination.

Thus, strive to become a Doctor through pattern discrimination based on Observation. From the Tongue, Age, Gender, Complexion, Gait, Body constitution, etc, 70-80% of the diagnosis.
Question to confirm the diagnosis.
Palipate to become 100%.

The Nei Jing says that the mediocre Doctor will know the Right hand, (needling hand). The Master Doctor will know the Left Hand (palpitating/point location hand)

Zhang Jie Bin - Doctor who made up the 10 Questions of Examination.
Use the hypothesis that comes from Observation to GUIDE the 10 questions to gather more complete details.
Use the Chief complaint to guide the 10 questions. CC is usually in modern disease or physical complaint. TCM LEGALLY requires us to ignore Modern Disease noclemanture.
Always know what the patients MEAN in terms of their experience.
"I have allergies" "What do you mean? Running nose, is it the eyes, skin? Reaction? Frequency?" "ohhh, I sneeze a lot, itchy eyes, and runny nose in Spring"
Boom, translate Modern medical terms down to Key Clinical Manifestations.
Therefore, it is illegal for TCM practioniers to use lab tests, imaging, x-rays, etc to come to conclusions about Pattern Diagnosis.

CC- Allergies
What is it? - Allergric Rhinitis - running nose, clear, watery discharge. sneezing
Pattern Discrimination - Wind Cold Invasion - Acute Stage
Treatment Principle - Resolve Exterior, Warm, Expel Wind.
Use Cang Zu Er/Xin Yi Hua (Resolves Ext/Warms/Expels Wind)

Translate ALL CC and signs and symptoms into the clinical manifestations, then use that to create the pattern discrimination basis.

TCM Disease = Sometimes same disease, sometimes not. Infertility = Inferitility, Back pain = back pain, Read up on Nigel Wiseman's Practical Dictionary.

Acupoints 1-3 = Points and Channels From CAM (Chinese Acupuncture Moxibustion) (first half of the book)
Acutech 4 = Techniques from CAM
Actech 5-6 = Last half of CAM - Treatment Principles

Questions shouldn't be "random". Only Ask with a Purpose. Confirm or Deny Patterns.
Questions can follow up from main questions.


Follow up questions should be location, quality, severity, frequency, triggers, palitive, provocative. Use follow up questions to triangulate signs/symptoms.

Questions should be targeted. Only ask questions about related targets. Become efficient. People want to show up, talk about a problem, and pay less, get the problem resolved, and let them go on fucking themselves up. Be effective, Resolve the problem first. Then the patients will come running back. Then do the rest of the "holistic" treatments.

TCM Hypothesis -
1 - Watch House MD. Use algorithmic thinking. Cause and effect.
2 -Watch Monk - Think OCD. Use Deductive Reasoning.
3 - Use Global Thinking. Think the least number of explanations to describe the manifestation. Try to draw an individual thread back to a common cause.

1 Acquire Info - 4 Exams
2 Evaluate - Triangulate/Cross Reference - Potential Patterns. Prioritize.
3 List hypothesis
4 Confirm or Deny Hypothesis - Clinical Reasoning

State Law requires retention of appropriate patient records for 7 years. Appropriate is to withstand the scrutiny of peer review. A record should be able to show another doctor of what the problem is, what the reasoning of behind the problem, and why the reasoning of the treatment.



Treatment Room-
Lighting
Location
Comfort
Appearance and mood
Use Reveal bulbs. No Flourescent lights.
Inquiry - get information from the patient directly
Everybody leaves during intake.

F
35
Tai Yin
Pale

Hypothesis
Ht-Sp Dual Xu
Damp
Lv Qi

CC- Insomnia
Algorimithic Thinking - Ht Blood/Yin Xu
Ht-Sp Dual Xu
Ht- Kd not joined
Lv Fire
Phlegm Fire
Food Stagnation
Retained Heat
Liv Blood Xu w/ Heat

Triangulate -
HT-Sp Dual Xu
Two types of Insomnia - Onset/Magnitudial (Replete/Vacuity)

Doctor's Efferent.
Patient, Compassionate, Confident, but in Control.
Be present in the moment all the time. "what does it mean?"
Don't space out.
Try not to burn out.
Schedule Availability
Mentally arouse the patients, in the beginning, open ended, in the end, confirm details with yes/no
Reframe things into TCM
Ammanesis - Patient version of disease history

1 Primary pattern - 1 Treatment Principles
2 2nd pattern - 2 2nd treatment principles
3 Treatment PLAN - Things to Do
4 Reassess