Class #: / 2
Got here late (stupid Mopac), started at Causes of Disease power point, slide 17
Slide 17
Re blood stagnation/stasis, there are different degrees and herbs to use in these cases:
Mild cases:
For milder cases, you could choose dang gui and/or mu dan pi to tonify/move.
Stronger stasis/stagnation
When progressing further, go to chuan xiong, hong hua, tao ren, chi shao – this group is called “the 4 King Kongs” of moving blood and will treat blood stasis anywhere in the body.
If more severe still, go to wu ling zhi, san leng, and e zhu to move blood more vigorously – very strong to eliminate blood stagnation/stasis. These are critter bits and are said to “break” blood stasis. For this reason, are often used to treat tumors. This is a very concentrated solid type of blood stasis rather than a generalized blood stasis in an area.
Zhe chong and meng chong (horsefly) as well as shui zhi (leeches) are all insects for ever stronger eliminaton of blood stasis. Zhang Zhongjing loved to use these to treat severe blood stagnation.
Any disease lingering a long time will affect Kidney and deplete resources. With severe blood stasis hong hua and tao ren may not be strong enough….if that’s the case, move to insects.
Slide 18
Per Yellow Emperor
Eating of rich, greasy food can cause gangrene, larger lesions with pus.
This is especially true for diabetics – lack of awareness in the diet or consumption of these kinds of food can cause impediment in the circulation and thus gangrene and lesions in the extremities.
Slide 19
Yang Qi rises and declines all day long. When moving toward dusk the yang qi is weakest – you must close it at this time. Don’t be too active when it’s getting dark as you must protect the yang qi. Is this why you get so tired after a night of dancing or sports?
Slide 22 / Seasonal causesIn spring time the wind is the cause of disease – if not expelled will attack the spleen and cause diarrhea, especially in the summer and for seemingly no reason. If you trace it back, will find that in the spring they had some sort of wind attack, like a common cold, that was not fully eliminated. The pathogenic factor lingers from one season to the next.
Cold invading in winter will damage the body and percolate into a febrile disease (heat) in the spring. Will cause sudden high fevers without any sort of infection. When severe, a coma.
This is the clause in the texts that helped other docs develop the heat injured and cold injured disease theories and treatment strategies.
Slide 25 / Five flavors and five zang are related to seasons. For best health, sue the flavors in your choices of herb and food treatments.
Spleen xu patients – choose more sweet herbs. Liver xu – choose more sour. Likewise, cravings for flavors will reflect deficiency in an organ. The most commonly used flavor theories:
Acrid + Sweet Yang
Sour + Sweet Yin
Combined together these flavors will balance yin and yang. Gui zhi, sheng jiang, gan cao, bai shao, da zao combination for instance – Zhang Zhongjing combined this and you know it as gui zhi tang.
Most typical usages in summer: wu mei + gan cao are sour and sweet to generate body fluids, eliminating dryness and thirst.
Slide 26 / Sour in excess causes liver hyperactivity and suppression of the spleen qi, injuring the spleen qi. Salty is related to kidney and thus so is bone. If too salty can overcontrol heart qi.
Slide 27 / Note that the 2 first paragraphs and a bit in conflict. This is probably a mistake of copying over the years. Bitter should be related to heart, sweet should be associated with spleen.
Slide 28 / Keeps the normal circulation of qi and blood
Zang Xiang Theory
See Zang Xiang power point.
Slide 1 / Translations of organ systems are less than perfect when moving from Chinese to English. The organs don’t translate exactly – Spleen for instance doesn’t refer to the biomedical spleen, but to the digestive system and the energy therein. Better to call it by the Chinese systems – Xin = ‘heart’ or fire related organ. Gan = ‘liver’ or wood related organ. More on that in Slide 4.You also talk about the physical manifestations related to the organs. I.e., when you speak of Liver or Gan, you talk about the manifestations – tears, emotional changes, etc.
First, know physiology of each organ – what they look like and how they behave under healthy and balanced states. Liver for instance stores the blood so blood related problems (like irregular menstrual bleeding).
Su Wen discusses Zang Xiang. Spiritual Pivot, Ling shu, also addresses the theory.
Ling shu, Chapter 8.States that all Zang can have both excess or deficiency….which is different than we learned in Foundations (remember Kidney can have no excess?)
Liver stores blood and blood houses the Hun. With Liver Qi xu causes terrors and fears. With Liver Qi excess, there is anger.
The Spleen stores nutritive Qi – Nutritive Qi stores Ying which supplies the limbs. Spleen excess is also addressed – this is abdominal distention and irregular menstruation as well as irregular bowel movements.
Kidney stores essence/Jing
When Kidney has excess, causes distention (like edema) and disharmony of all other Zang. If the Kidney is deficient, cannot close the lower orifices – incontinence of urine/poop. If the Kidney is in excess, won’t open the lower orifices, causing accumulation of water or constipation.
Slide 2-3 / Five Element theory chart, a la Foundations.
These theories are used frequently in China…doesn’t refer to Four Needle, which is Korean in nature. It’s called “acupoints compatibility” in China.
Slide 4 / Heart = Xin 心
Liver = Gan 肝
Spleen = Pi 脾
Lung = Fei 肺
Kidney = Shen 肾
The glyph at the beginning of Gan, Pi, Fei, and at the bottom of Shen is the character for Flesh. Note that Xin doesn’t have that – it is above flesh, and is heaven related.
Slide 5 / Xin or Heart. 心
The heart is a lantern with orifices on it. This is an organ of fire which gives us light through the orifices cut into it. The heart is said to have 9 orifices. Are there literally 9 orifices? No. This is a number to express fullness. You can be clear about your motivations and actions because you have the light to light the way so you can see what road you are going to walk.
If the orifices are blocked by pathogenic factors the patient will lose their way…or lapse into coma. Some disease, especially with phlegm blocking the orifices, can manifest as epilepsy – phlegm blocking the orifices of the heart/xin.
The shell of the 心is the Pericardium. This is the armor of the 心. The heart is never directly attacked by pathogenic factors, but instead is protected by the Pericardium. When you suspect there is an attack against the Heart, always treat the Pericardium first! The Heart is the King and has this body guard.
Slide 6 / Heart 心
“Regulates the Yang qi that circulates on the exterior.” (52 contradictions in acupuncture)
Heart is a Yin organ, but is the most Yang of the five zang. It is said to be Yang in Yin.
Slide 7-9 / Case discussion.
Most common treatment for skin problem is Lung. But in this case doesn’t seem to bear out. Diagnosis was given as “heart channel oppressed heat.” Don’t need to know the herbs given here. The important point is why the doc chose the heart channel for treatment.
It is because the Heart regulates the Yang qi, the most external and exterior portioins of the body. (Kidney is yin in yin, so treats the extreme interior of the body.) When Yang is attacked, you would of course consider Lung which is related to skin, but you’d also see Lung qi problems such as wheezing or coughing and probably exterior pathogenic evidence. You might use sang ju yin.
Bladder might also be implicated because it is related to the exterior (because it covers so much territory), but you’d see UB channel problems like pain on the neck or back, water metabolism problems like dysuria or edema. If so, you could use xiao qing long tang or yue bi tang.
In both the Lung and Bladder case, you’d have an external cause and will see that kind of evidence.
Heart is the next Zang to consider. Skin problems originating from the Heart will be internally generated and is manifesting exteriorly in this case. If there is an external attack, it will be heat and it’s likely to be summertime. Summer heat vibes with the heat of the heart.
Heart also dominates the blood vessels and circulation. Itching is a problem of blood circulation also.
Slide 8 / Secondary complaints for this case also indicate Heart related problems.
Slide 10 / Case discussion.
Dong gua pi targets the skin, eliminates water there. Use wind herbs to treat dampness and dry it. That’s what the dong gua, ma huang rong and fang feng are doing there.
Slide 11 / “If illness occurs in heart or lung, will manifest in the nose.”
Spleen distributes the 5 flavors into different organs. If there is an inability to taste with the tongue, find out what’s wrong with the spleen. Liver also works on the flavor aspect.
Slide 12 / Case discussion.
Inability to smell. If not due to primary cause and no clear reason why, look the lung and look at heart. Soothe lung qi especially. This particular diagnosis was for Phlegm damp accumulation with damp stagnation. Also opened the heart channel.
Why can we differentiate smells? It’s just like taste. We breathe in the smells and the tastes, then it is distributed to the organs. You cannot distinguish smells because they are not separated and distributed. This is a force of the heart in cooperation with the lung. The heart pumps it out, the lung will hold it while this happens.
Note that the patient in the case has heart problems.
Note also that COPD patients often start with breathing problems and then manifest with heart problems.
Slide 14 / Wood is equated to trees: needs to spread out or disease will occur. The liver/gan is like a tomboy – it’s a girl, but acts like a boy. It’s a yin body with yang functions. Needs blood to nourish it and to maintain. Needs to stretch out in order to maintain it’s functions.
Slide 15 / Eye problems, first think about the Liver. That said, remember the 5 wheel theory and know that all organs connect to the eyes.
Slide 16-18 / Vision problem case discussion.
Dx is Lv qi stagnation heat. This is like a tree covered. You could remove the cover or you could also use metal scissors (lung/metal) to cut the overgrowth. There is thus less obstruction. That’s why zhe bei mu is in this formula listed on slide 17 – it normally treats lung phlegm, but here it is used to trim the overgrowth.
On slide 18 note that the formula was kept the same. If it works, don’t change it! If the formula fails to work, could be because 1) wrong herbs or 2) dose isn’t strong enough. If you thing your dx is correct, keep the formula, increase doses.
Slide 19 / Insomnia with dry eyes, dry mouth and night sweats for 1 year. In the background, know that the patient was a primary caregiver for her husband who had been incapacitated the previous year. She was very stressed and overworked.
This is a worse case than the previous one, even though the previous case seems more dramatic. This a longer term problem and will develop into more severe conditions than the acute problems.
At the beginning of a problem with the eyes as the case previous to this one is, the problem is likely to be Liver qi stagnation. You could use chai hu shu gan san as a base formula. The next stage, if it develops further, will be stagnation heat or fire in the Liver. You would use xie qing wan as a base.
Further progressions would include liver yin deficiency. This is an impact to the body constitution. If it is mild, use liu wei di huang wan. With more severe cases, use yi guan jian.
Figure out what stage your patient is in. If you use xie qing wan inappropriately will dry the body too much as it clears fire and will create the yin xu.
Herbal Classics 1 – Fall 2010 – Class 2
Page 1 of 6
Disclaimer: This is not an official AOMA document, is intended for reference only and is not a replacement for your own class notes. This document is available for your use As Is and may contain errors and omissions. Cat Calhoun retains full copyright ownership, rights and protection in all material contained herein. You may use this document for your own purposes and distribute it to other people provided you 1) do not charge for it and 2) attribute it as having been generated by Cat Calhoun and disclose that it available free of charge on CatsTCMNotes.com. © 2010 Catherine (Cat) Calhoun