TCM Diagnosis 2 Notes

Week 12

2007-11-29T09:12:00.000-08:00

Review of Diagnosis
Case Study + Treatment Principles + Treatment Plan

34 Year old Female, Tai Yin with Shao Yang
Insomnia, Onset and Magnitudial
Nightmares, Anxiety, wakes up in a fright
Fatigue
No appetite
Stress induces Diarrhea
Reoccuring Yeast Infection, thick, copious, yellow, odor discharge
Grinds teeth at night
Complexion - Malar flushing, pale lips, acne,
Tongue - Red, distended, LV/GB area, Toothmarks, Red in the anterior
Thick yellow greasy coating
Pulse - Sp- soggy wiry, LV - Forceful wiry, HT - Faint - KD - Hidden

Ht-Sp Dual Vacuity - Magnitudial Insomnia
Liver Fire - Onset Insomnia
Wood - Earth Disharmony - Diarrhea with Stress
Damp Heat - Bowels + Vaginal discharge
Phlegm - Plumpit throat

Gui Pi Tang
Jia Wei Xao Yao San
Er Miao San
Er Chen Tang

Huang Qi + add Qi in the exterior, moves
Ren Shen + add Qi to the Center, static
Dang Gui + moving blood nourisher
Chen Pi + regulates Qi, harmonizes stomach
Chai Hu + Courses the Chai Hu, plunders Qi
Bai Zhu - Constructs Sp
Huang Lian + Clears Lv Fire, Gb fire St Fire (light doses, bitter, cold, and draining)
Ban Sha + Dries transform phlegm, downbears the turbid
Fu Ling - Constructs Sp, Bai Zhu + Fu Ling, Perculates Damp, Calms Shen
Bai Shao + Nourishes the LV Blood, astringes to temper Chai Hu
Sheng Jiang + Warms st, Wei Qi
Da Zao + Supplements Sp, Ying Qi
Zhi Gan Cao + Harmonizer
Long Gu + Drain Liver Fire
Mu Li + Drain Liver Fire
Wu Mei + Attacking, Supplementing, Heat Clearing, and Calming

Suan Zao Ren - Heart Lv Hun
Bai Zi Ren - Heart Liver Lungs Po
Fu Shen - Calm spirit
Zhi Mu - Clears heat moistens, Yin vacuity with vacuity heat
Yuan Zhi - Calms Spirit, Transform phlegm misting the portals, reinstate connection of Heart and Kidney
Huang Lian - drain liver
Long Yan Rou - Supplements Qi and Blood, Sp, Special use for damage by overthinking
Bai He - Nourish Yin, Clear Heat for severe vexation (bored stubbornness)
He Shou Wu - Nourishes KD Yin, Calms the Spirit, Moisten intestines
Long Gu - Drain Liver
Mu Li - Drain Liver

P 8
St 36, ST 40
St 44
Lv-3 to Kd-1
Gb 41?

Children Physiology and pathology is different than adults
Onset of Puberty = Onset of Adult physiology
Organs are weak and tender
5 Zang and 6 Fu = Forming and not complete, and not complete, not vigorous
Ministerial Fire is entrusted to the Gall Bladder Sanjiao and Pericardium
Children have the young yin and young yang.
Under 3, the body is pure yang.
Children go through growth spurts, each spurt = flaring of Ministerial Fire
2 = first Flare.
As they age, the Yin is engendered and flourishes.
Easily damaged by food and drink. the Yang Ming is fragile
Sinews and Tendons are tender so easily invaded by wind and cold.
Liver has Surplus
Liver Qi Stagnation easy.
Easy to transform Wind
Children are extremely reactive, responds quickly.
Food stagnation is pretty common
Causes of Disease is simple
Observe Shen
JingShen is lively, and flexible
Tendacy to sleep prone = food stagnation or parasites
Map tongue is common.
Sp/St vacuity problem
Moldy coat = food stagnation sign
Sloppy stool with white clots = trouble digesting milk
Diarrhea from Wind Cold - frothy bubbles
Febrile diseases have papules and rashes (measles)
If wind-heat invasion, the back of the mouth has white dots, then about to invade blood level
Papules start back of the neck
Bo He will vent rashes, prevent sinking of measle toxins, will express through the legs
Look for masses in neck lymph nodes
Ear Infections
Rooted in Food stagnation
St-Int = Weak
Often includes nausea and vomitting
Bad food = Sugar, Cheese, Nut Butters, Wheat and Corn products, uncooked chilled foods
In general, no high allergic food for children
Soy based formulas are bad, too cold.
Sp vacuity
+ Heat = Phlegm
+ Heat + Phlegm = Yang + San Jiao
Post Antibiotic Spleen Vacuity Syndrome?

Ear aches 2-3
strep throat in 3-5
tonsillitis,
bronchitis
long term asthma

Crystal Geyser Lemon Water will remove the taste of herbs

Week 11

2007-11-08T09:33:00.000-08:00

Somnolence - Jing Shen - Alertness, consciousness, body/mind
Yang Qi
Yang Governs activity, Yin governs rest
If Yang is Xu, then there is going to be less activity - Weak Pusle,
Or If Yang is repressed - Confined Pulse
Its going to be combinations of both.
Yang Xu due to qi xu
Engenders damp, etc, giving excess

Yang functions to warm and nourish
1) Limbs
2) Spirit Light - Jing Shen

Yang Qi is rooted in the Kidneys, Spleen, Heart, and Brain
Patterns
Spleen Qi Xu
Spleen Upbears Clear Qi to empower the Jing Shen
Use herbs to boost the qi right after the eating if postpernial somnolence

Heart blood sp qi xu = magnitudial insomnia
Insufficient Essence = Severe disease or over-rioteousness
Spleen encumbered by damp/phlegm - usually with the others

Ht-Kd dual vacuity

Ht-GB vacuity - susceptible to fear and fright

ht-lv - susceptible to stress

Sp-1 treats profuse dreaming.

LV-Sp disharmony lv 3, li 4, lv 13, sp 14

week 8

2007-11-01T09:16:00.000-07:00

Appetite
and Poor Appetite

Wood-Earth Disharmony vs Liver Qi and Sp Qi Xu
LV Qi + Sp Qi Xu = LV Qi attack with stress, and Sp Qi Xu symptoms because of Sp Qi Xu
Wood-Earth = Earth problems because of Stress
Tong Xue Yao Fan = Painful Diarrhea Miracle Cure, = LV-Sp
- Sp = \/
- St = /\
- Wood /\ + Heat = St heat /\ Appetite

St Yin Xu
Hunger without appetite
Clamouring St = Bensky indeterminate gnawing hunger

Sp-St Yang Xu
Undigested food particles (with KD yang)
Cold Hands/Cold Nose
Dull abdominal pain with worse with cold

Sp-St Damp Heat
Loose Stools with stronger smell
Heavy feeling in limbs,
sticky fever,
dry mouth, no desire to drink
worse with alcohol, greasy food
- Food Stagnation - Dual pattern = food that is borderline bad, unclean food

Food Stagnation
Too much food, poor digestible food.
Digestion = all process of passing through body
Meaty foods, Oils, Nuts, Greasy Fried Fatty = hard to digest
Eating too fast
episodic.
Particular in babies/elderly
belching, ab distension, pain, poor appetite

Signs of strange food (raw rice, dirt, etc)
Signs of Chong, Malnutrition due to Chong

Taste
Lack of taste/tastes like cardboard = poor appetite
Sp-St Qi Xu,
When Earth is strong, the tongue can distinguish the 5 flavors
Suspect 1) Depression
2) Diabetes
Central Qi Vacuity + damp
Use Bai Kou Ren

Sour Taste, Acidic taste
LV-Sp with Heat

Bitter Taste
Lv-GB
Heart Fire
Shao Yang

Bland = earth/qi xu, cold, + lack of taste

Sweet Taste
Sp Damp Heat, more damp than heat

Salty
Kidney problem
Vacuity heat
Cold in UB - wu ling san

Greasy/slimy - Sp encumbered by Damp

Hot taste = yin vacuity, vacuity heat

metallic taste = ancient times peppery/acrid taste
Lung Heat - Huang Qin - small dose.

Foul Breath
1) Food Stagnation
2) ST heat
3) Lung Heat

Foul smell
Abcess

Absence of Thirst
With bland Taste = Cold

Thirst with dryness
Damp with deep lingering heat

Dry mouth - Statis, binds Wet
2 Blood Thirst = Heat leating to blood stasis.

Drinks
Thirst for Cold Drinks
Heat
- St Heat
Febrile Disease

Warm drinks
Yang Xu
- Damp obstruction
Water-Rhuem repletion

Drink then Vomit
Water-rhuem in the stomach/intestines

Vomit then desire to drink
St fluid damaged

Thirst with Polydypsia and Polyuria
Xiao Ke = Wasting and thirsting/wasting thirst
Diabetes/Diabetic disease
3 Stages
Upper/Middle/Lower
Manifestation is delayed for signs and symptoms
Upper = Increased Intake/Thirst Normal Appetite
Middle = Increased Intake/Thirst, Above Average Appetite
Lower = Late stage Diabetes
Upper Stage = Qi and Yin Dual Vacuity
Qi tonics = heating harms Yin, Yin tonics = slimy/damp harms Sp

2) Insufficient Jin Ye - abnormal sweating/liquid loss

Thirst with Little or No Drinking

Yin Xu- tidal fever, malar flush, night sweats
Damp-Heat - Sticky Fever, heavy sensation
Water-Rhuem in the LI = Thirst with no drinking
Blood stasis = Blood Thirst

Sleep
1)Time and Quantity of Sleep
When you go to bed is important.
Sun cycle lecture - Consider going to bed by 10, do deep sleep by the time the sun is on the other side of the world. Yang super charges Yin.
Wake up by Sunrise
2) Time to fall asleep
a) staying asleep
b) 15 minutes to fall asleep. not more not less
3) Somnolance
4) soundness, solidity
5) awoken by fever

Insomnia
Heart -Kidney
Heart Yin/Blood Xu
Ht-Sp Dual
Ht-GB Qi timidity
Ht-Fire
Phlegm Fire
Liver Fire
Liver blood w/ Heat
Food Stagnation
Retained Heat

2 types
1) can't fall asleep - typically replete - evil qi
2) staying asleep - typically vacuity - insufficient righteous qi
a) vivid dreams
Liver treasures blood - Shen/Hun
Hun turns inward when carried back tot he LV during sleep, and dreams
Shen goes to Heart (5 patterns)
Hun goes to Liver (3 patterns)
when not getting good results, think of stasis complicating the patterns.
Ht-Sp
Ask for loss of strength as a sign of Sp Qi Xu
Post prenial somnlence
loose stools

Ht-Kid - nightmare insomnia
steaming bone
trouble falling asleep, stays awake, then falls asleep only to wake up again
Replete above, vacuity below
E Jiao - Huang Lian

Ht-GB qi timidity
Waking in a fright/variations of
not wanting to sleep alone
look for hot phlegm
Wan Dan Tang

Liver-Fire
Long Dan Xie Gan Tang

Liver-Blood
Suan Zao Ren Tang

Midterm Review Diagnosis

2007-10-25T11:17:00.000-07:00

Review face
Review Eye map
Jokes = to entertain Steve, not the class.

1)Inferility
2) Heat harassing the portals
3) Pre-cordial pain
4) Loss of strength of arms
5) Insomnia (inner canthus = heart area)
6) Intercranial Tumor
7) Cause
8) Blood Vacuity
9) Sp
10) Heart
11) Bi
12) Phlegm
13)Frequent Dark Urine
14) Food Stag
15) Blood Xu
16) Straitened Sp
17) Kid Yin
18) Lu-Sp Qi Xu
19) Lu-Qi

Case Studies... Don't forget to state the "Stop" part
Stop Diarrhea, Stop Sweat, Free Flow of Stools
Patterns don't have to involve Organs

Qi = Supplement, Fortify, Boost
Blood = Nourish
Yin = Enrich
Yang - Warm, Warm/Invigorate

Dampheat in LI, Clear Heat, Drain Damp, Stop Diarrhea

Sp qi Xu, Fortify Sp, Stop Diarrhea

Water-Rheum in the Intestines, Fortify Sp, Free Yang, Transform Phlegm

Lu-Sp Qi Xu, Supplement LU Qi, Fortify Sp, Free Flow of Stools

(part 2 incomplete)

Liver Fire, Drain Fire

Side Notes

2007-10-18T12:29:00.001-07:00

Treatment Principles, precise
Example:

Disease = Constipation
Pattern: Liver Qi Stagnation
Principle: Move Liver Qi, Free Stools.

Principle is Main action for the pattern + specific actions for the disease.
Add in immediate resolutions.
Stop -
Bleeding
Coughing
Sweating
Vomiting
Diarrhea
Urination
Pain
Constipation (free)

week 7

2007-10-18T09:27:00.000-07:00

Diarrhea
Wind Cold
Sudden onset
Wind = Invasion, exterior, Centered by change
Cold = Constrain, Constrict, Congeal, Clear fluids,
Cold vs Heat, Palative vs Provocative
No Smell, or Strong Fishy Smell
Tx Principle: Resolve the Ext, Warm the Intestines
Use Ge Gen, Zi Su ye

Cold Damp
Sudden Onset
Cold, Clear, Damp/Wet, No Smell, Heavy Body, Fatigue, Poor Appetite..-> Sp Damp
Tx Warm and Scatter Cold, Dispel Damp/Disinhibit
Zhi Zhong Ju

Damp Heat
Sudden Onset
Frequent, Urgent Burning, Painful.
Explosive, Foul Smell, burning anus
Yellow color
Tenesmus
Generalized signs, Sticky fever, Dry Mouth, little thirst, sticky stool

Food Stagnation
Sudden Onset
Ab-pain
Borborygmus
Undigested food, unbearably bad smell, rotten eggs.
After bowel movement, feels better.
lactose intolerance = food stagnation

Liver Qi - Diarrhea, Emotions
Sudden onset, but predictable
Stress, Story of Diarrhea on first dates.

Kidney Yang Xu (Sp-Kd Yang Xu)
Older, Bright White, Weak, Low back pain, Poor flesh tone, puts on weight
Cold Feet, maybe Kidneys
Swill Diarrhea = Food in it, Due to Lack of Fire
5th Watch, 5 Am, Cock's Crow Diarrhea,
Insidious onset
Tx Astringe Intestines, + Supplement Kidney/Sp

Phlegm (Rhuem/Water Rhuem) in Intestines (and St/aka Yang Ming)
Enduring
Clear and Watery
Borborygmus
Vomit clear fluids, possibly triggered by cold drinks
Possible sloshly sound in the abdomen
Tx Warm and transform fluids

Constipation
Yang Ming - Lots of Qi, Lots of Blood... pathogens Transform Heat, becomes Exuberant Heat
becomes 4 bigs
Qi Division - Middle Jiao - no bowel movements for 5-8 days
Heat Binding the Stools.. Scorching the stools itself.
Glomus (focal distension) Fullness, Pain, dryness,
Tongue - Red, Thick dry, yellow, old looking
Da Cheng Qi Tang - Hospital useage
Possible Diarrhea with circumfulence

Dry Heat in St-Inst
Dry, Bound Stools, Heat,
Dark urine, frequent urination
Sores around Mouth/tongue
Red complexion,
Dry Earth/metal with heat.
Tx Moisten + purge heat
Ma Zi Ren Wan
Too much baked food, not enough liquids, too much fried foods.

Liver Fire/GB Fire
Enduring Lv Qi Stag + Depressive Heat + Yin Xu
Dizzines, vertigo, irrascible, constipation
Tx Drain Fire, Free the stool
Use Lu Hui, Lv2, SJ6,

Sp/Lu Qi Xu
Pale, bright white complexion
sweat easily
struggles to defecate
not much discomfort
constipation
frequent desire to defecate, but not much
poor zhong qi

Yang Xu
Dark complexion
flatulance
constipation
frequent voiding,
long, clear urine,
frequent nocturia
terminal dribbling
cold limbs, likes warmth, fear cold
tx Warm the Yang, or Warm and Invigorate
1) Fu zi, Rou Gui, Gan Jiang, 2) Ro Song Rong

LV-Sp
Spleen qi weak + emotional = LV getting stuck, unable to discharge LI
All organs relies on the LV to discharge and course for their own Qi Ji.
Desire to defecate..
Belches a lot.
Bad breath
Tx principle, Move Qi. Abduct Stagnation, Free Stools.
Chen pi
6 milled ingredients, liu

Week 6

2007-10-11T09:33:00.000-07:00

Painful Urination
1 UB Damp Heat
Frequent Urgent Burning Painful
Damp from SP Xu, Heat from LV
External Invasion = Hygene or disease
thick yellow greasy tongue coat, slipper rapid pulse
sticky fever, heaviness in limbs
Tx Clear Heat, Disinhibit Damp
scanty dark, urine reddish like food dye
2 Exuberant HT Fire
Blazing LV Fire... causing HT Fire
Palpitations, bitter taste, red prickles on tongue
Sores on the tongue, heat scorches the blood, causing puss
Tx Drain HT fire through Urination: Use Chi Dao San Guide Red Down Formula
HT fire potential sure sign is the HT crack
3 Kidney Yin Xu, Xu Re
Low back and knees weak and sore, + Vacuity Heat signs
Xu Re in KD leads to UB heat.
4 LV Qi Stagnation
6 Depressions
5 Blood Stasis
6 Depressions

Case example
Disease = Freq Urination
Pattern = Liv Qi stag
Tx principle = Course LV, Recitfy the Qi, eliminate damp, disinhibit damp
LV 3, Ren 3, UB 32,

Frequent Urination
UB Damp Heat
LV Qi Stagnation
Straitened Spleen ( Dry Heat ST or Intestines [Yang Ming]) + Sp Yin Xu
Blood stasis
Blood stasis inhibits the Qi Dynamic, and the Qi Dynamic is what voids the bladder, and blood stasis will stop urination.
Kidney Yin Xu
Kidney Qi Xu, Not Securing Front Yin

Stool
Color
Food will change color of stool. Salts will make it darker, Beets can dye red. Blueberries turn purple.
Stable diet, stable color.
dark with yellow = heat binding in the intestines
black tar like stool = melanoma = far bleeding from anus.
Red and white = dysentery (10x a day diarrhea)
SHOULD BE baby turd brown. ideally clean getaway.
in the morning, around sunrise (LI time)

Feeling
Should be able to relax, and comes out quickly with 1 breath
Burning = heat
unsmooth feeling, like sticky, difficult to discharge, = damp
pebbly, hard "tips" is from incomplete movements due to damp. (ungratifying)
stickiness + heat + smell = damp heat.
LV attacking = IBS
Tenesmus
Ab. pain w/ uneasy passage of feces
- urgent desire to defecate w/ heavy sensation in the rectum, possible delayed bowel movement
- TCM mechanisms evils combine with and obstruct the free flow of qi and blood, congesting and stagnating the intestines - this affects the conveynce and conducting
- a)internal urgency b) heavy sensations (burning sensation, explosive diarrhea, foul smell)
- Evils = A) damp heat (burning sensation, explosive diarrhea, foul smell)
B) epidemic toxins (heavy, sagging sensation, red and pus)
C) cold damp

Heat in the LI
Dry and Dark, water can be yellow
Blood Vacuity
Extremely Dry and Hard
Body fluid insufficiency
Extremely Dry and Hard
SP/ST vacuity
loose stools, shapeless (breaks up in water, cloudy water)
Damp Heat in the LI
Front part dry, hard pebbles, + soft, shapeless rear part.
Lv-Sp Disharmony
Possibly irregular, alternating diarrhea and constipation, relates to stress.
Sp-Kd yang vacuity
Undigested food, less smell, maybe fishy/clammy.
Food stagnation
Undigested food, rotten, foul smell.

If there is pus, sign of pus. Bai jiang sao
Go to MD.
Dysentery
Blood and Pus, Red and White, 10x a day.

Diarrhea vs loose stools
Urgency, consistency, thin, possible liquid

Damp Heat
Rich, spicy, thick, greasy, fried foods + alcohol = irritation of damp heat
More Heat = Dry bound
More Damp = Diarrhea
GB 34 = DampHeat in Lower Jiao
with ST 25 Alarm point
more Heat = LI-11 ST 44?
Huang Lian
Hou Po
Ban Shao
Mu Xiang

Food stagnation
poorly digested food, putrid belching, acid regurgitation, st distention, pain, poor appetite, nausea, loose fowl smelling food.
food stagnation = hard to digest foods, or hasty eating.
Tx principles: Abduct food stagnation (UFP [undigested food particles] Adbudction)
ST 21, Ren 12/10,
"you're right if it works" - multiple ways to treat same problem
Ji Nei Jing
Shang Jiang,
Shan Ja

LV-SP disharmony
Sp fails to upbear the clear qi + sp fail to circulate the body fluids, acomlinating in damp peculating down.
Lv-3 with Sp 6
+ st 36
ST 25,
Tong She

Week 5

2007-10-04T09:09:00.001-07:00

Formulas takes half a life time to understand,
from the multiple levels of understanding

Respiratory issues in TCM can be a class by itself.

Wheezing IS a sound of phlegm
Panting, hasty panting, tuan, rapid and shallow.
Possible to have panting without wheezing, but wheezing has to be with panting
Short of breath, easily winded, is also part of panting.

Zong Qi is Lung/Heart Qi combo, + throat qi, + others
Lack of Zhong Qi would be disinclination to speak

Replete Heat, heavy respiration
Deficient = faint resperation, slow, shallow.
Lungs governs the exhale
KD governs the inhale

Bowel Sounds
Thunder-like sounds = wind cold damp.
Vacuity = low volume sounds
Water Rheum - ST/Intestines (Yang Ming)= Water sounds Rhuem is thicker than water, thus traps water.
If Yang Ming is weak, then bowel sounds + feeling like hunger. = Vacuity Cold
Wind = Bowel sounds + diarrhea maybe flatulance
Damp = Sounds + distension
Cold = High pitch, grey whales sound + spasms, ab pain.

Sighing
Both voluntary and involuntary
Classic
Breath - Sudden in/out = rib side distension, = LV Qi Stagnation

Hiccups/Hiccough
Acute = Replete Heat or Cold
Enduring = Go see Doctor.
Heat binding the stool leads to hiccups Purge LI with Da Huang
Vacuity Hiccups = Sp Yang Xu
Loudest hiccups = Food Stagnation/ possible heat binding the stool, do both.

Eructation (Belching)
Replete/Vacuity
Replete = Longer belches
Food stagnation transforming heat/bad breath + distention + acid regurgitation
Vacuity = Shorter belches
Sp Qi Xu = leads to no smell, no taste
LV Qi = LV attack St = Stress, frequent, loud and clear belches

Speech
1 Zong Qi
2 Heart
Taciturn = disinclination to speak
Vacuity/Cold = disclined = quite volume
LV Qi
Replete (heat) = Chatter
Disinclined = Xu = Qi Xu
OR LV Qi = Pissed off so not to talk
High Fever = Heart unable to house the Spirit = Incoherent Speech
Heat agitation = Phelgm Fire harassing the portals = unintentional/mistaken

Voice
1 Zong Qi
2 Lung Qi
Volume = Replete/Vacuity
Coarseness = Wind Cold
Complete loss of voice = aphonia = Stroke or Wind Cold/Wind Damp

Vomiting and Nausea
Replete/Vacuity
Differentiate

Urination
Frequency
Hot or Cold = KD Qi governs front Yin
Quantity
Hot or Cold = Totalness
Color
Hot or Cold

Week 4

2007-09-27T09:11:00.000-07:00

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

2007-09-20T09:27:00.000-07:00

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

2007-09-13T09:20:00.000-07:00

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

2007-09-06T10:08:00.000-07:00

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