Bleeding
Disorders
Epistaxis
(Nosebleeds)BIOMEDICAL CAUSES
•
Dryness or erosion of the nasal mucous membrane•
Trauma•
Foreign body•
Nasal infection•
Thrombocytopenia (is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood. A normal human platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.)•
Hemophilia•
Hypertension•
Nasopharyngeal cancer•
Thromboembolism•
Anticoagulants•
Blood dyscrasia (abnormal condition of the blood)•
Epidemic hemorrhagic disease (A syndrome caused by a hantavirus which is transmitted to humans by contact with infected rodents urine or feces. ... The Ebola virus is a notorious cause of this).•
The LU govern Qi and respiration. For this
reason, and because they influence the skin,
they are the intermediary organ b/n the
organism and the environment.
•
They are the most “external” of the Yin
Organs.
•
They control the blood vessels in that the Qi
of the LU assists the HT in controlling blood
circulation.
•
Open into the nose
•
The Lungs control exhalation, the Kidneys
control inhalation. (Classic of Difficulties)
•
Giovanni say Lung controls inhalation.
•
They also control the “Water passages” by
way of regulating and moving the Body
Fluids.
Yang Ming (Yang Brightness)
Syndromes
•
As the pathogenic factor invades the interior of the body in the
Yang Ming stage, both the Zheng (Upright) Qi and the Evil (Xie)
Qi are strong, turning the excess pathogen in to heat within the
body. Yang Ming fevers are therefore more severe than fevers in
the Tai Yang stage. In the Yang Ming Syndrome, there are no
chills. There are two types of Yang Ming Syndromes, one that
involves the channel, and the other involves the related Zang Fu
(Stomach and Large Intestine organs). Both of these syndromes
can occur at the same time.
Yang Ming Jing
(Channel) Syndrome
•
Big fever•
- This indicates Interior Excess Heat•
- This may be accompanied by mental restlessness or irritability if the Heat affects the mind•
Big sweat•
- Interior Excess Heat is evaporating fluids or forcing fluids out•
Big thirst•
- From consumption of body fluids and excess heat.•
- A preference for cold drinks•
Big pulse.•
- Strong pathogenic and anti-pathogenic factors•
Red Face•
No aversion to cold•
Tongue: Red Body with Thick Yellow Coat (or drycoating).
Yang Ming Fu
(Organ) Syndrome
•
The Four Big's (As Above)•
Constant Fever, but more pronounced in the afternoon.•
Abdominal distention•
The Yang Ming Fu (Organ) syndrome will also have abdominal bloating or in more severe cases, abdominal masses. This is due to the heat dryingthe fluids, causing Qi Stagnation in the organs
•
Constipation (heat has damaged fluids)•
The main distinguishing symptom of the Organ (Fu) and Channel (Jing) syndrome•
Due to interior heat consuming fluids•
Tongue: Thick, Dry, Yellow Coat.•
Most NP of all the Yang organs due to its relationship with the SP & Post-Heaven Qi (it is the origin of all Qi and Blood produced after birth).•
Controls “receiving” (food and drink and keeps them down).•
Controls the rotting and ripening of food (extract and separate refined essence from food).•
If ST Qi is good then prognosis is good (this manifests in a good appetite, thin white coat on the tongue).•
Sends Qi downwards, if it does not we will see belching and nausea.•
Is the origin of fluids (needed toferment food properly) = “hates dryness”
Epistaxis
HEADACHE, PGS. 288-295
•
HA is one of the most common presenting symptoms in
Western patients. It is important to ask systematically about
onset, time, location, character of pain and ameliorating or
aggravating factors. A dull ache usually indicates Deficiency
whereas an intense, sharp pain usually indicates Excess. A
throbbing and distending pain indicates Liver Yang rising, a
pulling pain indicates Liver Wind and a fixed boring pain
indicates Blood stasis. A dull ache, with the head feeling as if it
were wrapped in cotton wool, and a sensation of heaviness
indicates Dampness or Phlegm. Headache that is experienced
‘inside’ the head is usually due to Kidney deficiency.
Headache
Locations
•
Occiput: here the location is the Tai Yang channel (the headache can be from the exterior invasion of Wind-Cold if the pain is severe or from KD deficiency if the pain is dull)•
Vertex: here the location is the JueYin channels (the headache is usually from deficiency Liver-Blood)•
Forehead: here the location is the Yang Ming channels (the headache can be from Stomach-Hear of Blood deficiency)•
Temples and side of the head: here the location is Shao Yang channels (the headache can be from exterior Wind in the Lesser-Yang or from Lover-Yang rising)•
Temple, side of the head and eye: here the location is the Shao Yang channels (the headache is usually from Liver-Yang rising)•
Behind the eyes: here to location is the Liver channel (the headache cause is either Liver-Yang rising or Liver-Blood deficiency)•
Whole head: this is caused by exterior invasion of Wind-Heat or KD deficiencyFu Mai
(Floating,
Superficial) Pulse
Description: Located in the exterior.
With the finger raised, it has a
surplus, when pressing down it is
insufficient, weak, or disappears.
When pressure is released, it regains
full strength.
Indications: External invasion, Yin
Xu with Yang floating upwards, Qi or
Yang Xu
Etiology: Mainly an exterior
condition, syndromes due to Xu, or
Yang Qi loosing its root in the lower
part of the body and floating to the
upper regions.
Shuo Mai (Rapid)
•
Description: Above 90 BIM, or more than 5 beats per breath.
•
Indications: Heat Syndromes. Forceful and rapid = excess
heat. Weak and rapid = Deficiency Heat.
•
Etiology: Hyperactivity of heat accelerating Qi and Blood.
Rapid pulse may be weak when it's Yin Xu due to a chronic
disease resulting from interior deficient heat. Rapid pulse, when
seen in cases of floating of Yang Xu, must be large and weak
SJ 5 WAIGUAN (OUTER GATE)
•
Luo Connecting Point, Opening Point of the Yang Wei Mai•
Expels Wind Heat (febrile disease, aversion to cold, fever, earache,alternation of aversion to cold and aversion to heat).
•
Benefits the ears (tinnitus, deafness, earache, itching of the ears, redness, pain and swelling of the ear).•
Clears Heat in the head (redness, pain and swelling of the eyes, stiffness of the tongue, mouth ulcers, cracked lips, nosebleed, mumps).•
Subdues Liver Yang (headache, dizziness, one sided headache, vertical headache, neck ache).•
Removes obstructions from the channel (pain of the shoulder and neck, stiff neck, arm pain, contraction of elbow, elbow and wrist pain,paralysis of the arm, swelling and redness of arm, pain in the fingers with inability to grasp, tremor of hand).
GB 20 Fengchi (Wind Pool)
•
Expels Exterior Wind (aversion to cold, fever, body aches, occipital stiffness and ache)
•
Extinguishes Interior Wind (vertigo, Wind-Stroke, hemiplegia, lockjaw, deviation of the
eye and mouth, epilepsy)
•
Subdues LIV Yang (h.a., dizziness, blurred vision)
•
Brightens the eyes (blurred vision, diminished night vision, redness and pain of the
eyes, redness & pain of the outer canthus, excessive lachrymation) – often from Liver
Fire
•
Benefits the ears (tinnitus, deafness, blocked ears) - usually from a rising of Liver Yang
•
Clears Heat
•
Nourishes Marrow and clears the Brain (poor memory, dizzness & vertigo)
•
Note: some doctors say that GB 20 expels exterior Wind by virtue of its being a point of
the Yang Wei Mai, while it extinguishes interior Wind by virtue of its being a GB channel
pt.
Epistaxis
IRRITABILITY, PGS. 385-386
•
A common emotional complaint. It includes feeling irritable
frequently, flying off the handle easily, feeling frustrated, and
similar emotional states. Note that a propensity to anger is
generally due to Liver patterns, whereas irritability may be
caused my many different patterns affecting most organs.
May be due to Full or Empty causes; in general, the irritability
from Empty causes is mild and somewhat vague, whereas that
due to Full causes is more intense.
•
Most Common Patterns: Qi Stagnation, Blood Stasis, Liver
Yang Rising, Blood Deficiency, Yin Deficiency (with or without
Empty Heat), Heat (including Damp Heat) & Empty Heat.
Shi Mai (Excess,
Full, Replete,
Forceful)
•
Description: Bowstring, large, hard and replete pulse which has a surplus at all 3 levels of cunkou. Longer, wider and more forcefull•
Indications: Excess condition where both pathogenic andanitpathogenic factors are strong.
•
Etiology: Blood vessels are full with both Qi and BloodDu 26 Renzhong (Middle of
Person)
•
Sun Si Miao Ghost Point
•
Benefits the face and nose and expels wind
•
Indicated for ceaseless nosebleed
•
Used to promote resuscitation.
•
Opens nasal passages.
•
Empirical point as a distal point for acute sprain of the lower back,
but only when the pain is on the spine itself (needle patient when
standing and as them to gently bend forwards and backwards).
•
Regulates the Water Passages of the Upper Burner and can therefore
resolve edema of the face and hands.
Epistaxis
Du 23 Shangxing (Upper
Star)
•
Sun Si Miao Ghost Point
•
Clears nasal cavity, disperses wind heat
conditions of the face, nose and eyes.
•
Mostly used for chronic nose disorders such
as allergic rhinitis or sinusitis, to open the
nose and resolve Dampness from the nose
and sinuses.
Epistaxis
LU 5 Chi Ze (Cubit
Marsh)
•
He Sea and Water point•
Clears Lung Heat.•
Promotes the descending of Lung Qi.•
Resolves Phlegm from the Lungs.•
Regulates the Water Passages and benefits the Bladder.•
Relaxes the sinews.•
COMMENTS•
Mostly used for interior patterns of an Excess nature characterized by Heat in the Lungs (Qi level diseases). Can be used in chronic conditions characterized by retention of Phlegm and Heat in the Lungs, such as chronic bronchitis. Can be used for interior patterns of Excess Cold with retention of Cold Phlegm.Epistaxis
KD 1 Yong Quan
(Bubbling Spring)
•
Jing Well and Wood Point
•
Nourishes Yin and clears Empty Heat (dry
tongue, dry throat, dizziness, tinnitus, night
sweats).
•
Regulates the Lower Burner (constipation,
difficult defecation, difficult urination,
abdominal pain in pregnancy with urinary
retention, abdominal fullness, umbilical pain,
infertility, impotence).
•
‘Extinguished Interior Wind (epilepsy,
headache, vertigo).
•
Clams the Mind (agitation, insomnia, poor
memory, fear, rage with desire to kill people,
manic behavior).
Epistaxis
SP 1 Yin Bai (Hidden
White)
•
Jing Well, Wood and Sun Si Miao Ghost Pt.
•
Regulates the Spleen (usually used in Excess
patterns).
•
Stops bleeding (with direct moxa, stops
bleeding from any part of the body and
particularly the uterus).
•
Calms the Mind (mental restlessness and
depression in Excess patterns resulting from
Blood Stasis).
Hemoptysis
(Coughing Blood)BIOMEDICAL CAUSES
•
Acute infections (bronchitis, lobar pneumonia)•
Chronic bronchitis•
Bronchiectasis•
Tuberculosis•
Lung and laryngeal tumors•
Pulmonary infarction•
HIV•
Foreign body•
Thromboembolism•
Lung abscess•
Anticoagulants•
Trauma•
Blood dyscrasia•
Epidemic hemorrhagic diseases•
Mitral stenosis•
Goodpasture’s syndrome (is an autoimmune disorder. It occurs when the immune system mistakenly attacks and destroys healthy body tissue. People with this syndrome develop substances that attack a protein called collagen in the tiny air sacs in the lungs and the filtering units (glomeruli) of the kidneys)Hemoptysis
LU 6 Kong Zui
(Convergence Hole)
•
7 cun above LU 9, Xi-Cleft Point•
Regulates Lung Qi in the Channel.•
Promotes the descending of LU Qi.•
Clears Heat.•
Stops bleeding.COMMENTARY
•
Often used in acute conditions. Physically this may be an acute lung infection. Mentally and spiritually this may be acute sorrow and sadness that is arising from the Lungs. This may be due to grief experiences when a person is bereaved or the acute sense of pain due to losing someone orHemoptysis
Parched lips
pgs. 96-97
•
The most common causes of dry lips are ST and SP Yin Deficiency or Liver Blood Deficiency. Severe long standing Blood Deficiency as well. In acutecases, invasion of Wind-Heat can cause dry lips. If the upper lip is dry, it
indicates Lung-Heat or Heat in the LI. If the lower lip is dry, it indicates Heat in the ST. If the lips are dry but red the condition is not severe. If dry and dark this is harder to treat.
LU 10 Yu Ji (Fish Border)
•
Ying Spring and Fire Point•
Clears Lung Heat.•
Promotes the descending of Lung Qi and stops cough.•
Benefits the throat.•
Calms the Mind.•
Warms up deficient and Cold Lung Qi (Hicks).•
COMMENTS•
It may be used to warm a person who is detached and inert and has difficulty making contact with other people (Hicks, Pg. 300).Hemoptysis
LU 7 Lie Que (Branching
Cleft)
•
Luo Connecting, opening point of Ren Mai andHeavenly Star point of Ma Dan Yang
•
Promotes the descending and diffusing of the Lung Qi.•
Releases the Exterior and expels Exterior Wind.•
Opens the Directing Vessel.•
Benefits the Bladder and opens Water passages.•
Benefits the head and neck.•
Opens the nose.•
Communicates with the LI.•
May make Qi rise to the head to treat sadness and poor memory.•
Can encourage a person to weep, especially if repressed a long time (Hicks, pg. 300)The heavenly star points of Ma Dan-yang
•
Lieque LU-7
•
Neiting ST-44
•
Kunlun BL-60
•
Hegu L.I.-4
•
Tongli HE-5
•
Huantiao GB-30
•
Quchi L.I.-11
•
Weizhong BL-40
•
Yanglingquan GB-34
•
Zusanli ST-36
•
Chengshan BL-57
•
Taichong LIV-3
Hemoptysis
RN 17 Shanzhong
(Middle of Chest)
•
Front Mu of PC, Hui meeting of Qi, Point of the Sea of Qi, Meeting of Ren with SP, KID, SI & SJ•
Very NP point to tonify Qi (mostly for the LU) add ST 36, RN 12 & RN 6.•
Indicated for coughing blood•
Moves Qi and eliminates stagnation of Qi in the chest (feeling of constriction, tightness,oppression or pain in the chest).
•
Dispels fullness from the chest and promotes the descending of LU Qi and helps in breathing (used for breathlessness from any origin).•
Benefits the breasts and can be used to treat insufficient lactation both from Qi or Blood deficiency or Qi stagnation (needle towards the affected breast).Hemoptysis
Cough (Acute) pg. 322 & 659
An acute cough may have any of three causes:
1.
Very beginning stages of invasion of Wind, when the PF is still
on the Exterior. Cough will be accompanied by signs of external
invasion such as aversion to cold, fever, sore throat, a runny
nose, floating pulse, etc.
2.
PF (such as Heat or Phlegm-Heat – produces a barking cough
with yellow mucus, feelings of heat and thirst an Overflowing
Rapid pulse) in the Interior following an External invasion.
3.
Residual PF (such as Dryness or Phlegm) following an External
invasion. The cough is dry with difficult expectoration of scanty
sputum after repeated bouts of coughing, and a tickling in the
throat.
LU 1 Zhong Fu (Central Palace)
•
Front Mu•
Promotes the descending of Lung Qi and stops cough.•
Resolves Phlegm from the Lungs.•
Disperses fullness from the chest and stops chest pain (use with PC 6).•
Upper shoulder and upper back pain from a Lung channel dysfunction such as Lung Heat, Damp Heat or Phlegm Heat obstructing the Lungs.COMMENTS
•
Can reinvigorate the mind and spirit. When the Lung Qi becomes depleted people can have difficulty receiving inspiration from Heaven. People whose Lungs have become deficient often feel grief and sadness and easily become melancholy or lifeless or lose a sense of purpose. Enhancing the Lung Qi and the Qi of the chest enables the person to reconnect with inspiration form Heaven and experience greater meaning in their life (Hicks, pg. 300).Channel problems come from:
1.
invasion of ExPF
2.
overuse of a limb or part of the body = local Qi Stagnation
3.
sports injuries causing local Qi Stagnation
4.
from Internal Organ disharmonies
•
Channel problems can affect the orifices and sense organs (not always due
to an Internal Organ…) Ex. KD opens to ear, but many ear problems are
related to SJ. Tinnitus can be LV. Etc.
•
Full conditions Sx: intense pain, stiffness, contractions and cramps, hot or
cold sensation along the Channel
•
Empty conditions Sx: dull ache, weakness of the MMs, atrophy of the
MMs, numbess, pale streak along the course of the Channel, which feels
cold to the touch
Hemoptysis
LIV 2 Xing
Jian(Temporary
In-Between)
•
Spring and Fire point•
Drains Liver Fire and subdues Liver Yang (most INP point for this).•
Extinguishes Interior Wind.•
Cools Blood and stops bleeding.•
Calms the Mind.•
Resolves Damp Heat in the genitourinary system.•
COMMENTS•
The main point to clear Liver Fire when this causes cough from Liver insulting the Lungs.Hemoptysis
•
Steaming Bone Disorder - Basics
•
TCM term describing a condition of deep internal heat arising from severe yin
deficiency. The patient will describe a heat that seems to come from the
LU 9 Tai Yuan (Supreme Abyss)
•
Yuan Source, Shu Stream, Earth and Hui Gathering of the arteries andveins
•
Resolves Phlegm.•
Promotes the descending of Lung Qi and stops cough.•
Tonifies Lung Qi and Lung Yin.•
Tonifies Zong (Gathering) Qi.•
Promotes the circulation of blood and influences the pulse.•
Clears Lungs and Liver Heat.COMMENTS
•
It can strengthen and restore people who are depleted or who have low reserves. It can also help a person whose mind and spirit are metaphorically stuck in an abyss. In this case it can help to raise people out of the depths of despair and enable them to have greater stability and control (Hicks.Pg. 300)LU-7 Lieque LU-9 Taiyuan
For exterior problems For interior problems For excess patterns For deficiency patterns Has an outward movement Has an inward movement
Affects Qi Affects Qi and Blood
For channel problems Not so much for channel problems Better for emotional problems Not so much for emotional problems Good for acute conditions Good for chronic conditions
Opens water passages Does not open Water passages Affects Bladder Does not affect Bladder
Hemafecia
(Blood in Stool)BIOMEDICAL CAUSES
Upper gastro-intestinal
•
Gastric and duodenal ulcers or erosion•
Leaking esophageal varices•
Erosive esophagitis•
Vascular malformation•
Angioma•
Malignancy Lower gastro-intestinal•
Diverticulitis•
Chron’s disease and ulcerative colitis•
Colonic carcinoma•
Polyps•
Hemorrhoids•
Anal fissures•
Hook work•
Systemic•
Leukemia, thrombocytopenia, vasculitis.Key Diagnostic Points
Colour of the blood and location of bleeding
•
In general the darker the blood the higher in the gut the source of the bleeding,
although be aware that massive bleeding from upper gastrointestinal tract that
passes rapidly through the gut may appear red.
•
Bright red blood – anus or rectum
•
Dark or purplish blood – large and small intestine
•
Black or tarry blood – stomach or duodenum
Timing and location of the bleeding
•
Blood passes before a bowel movement – anus and rectum
•
Blood passes after a bowel movement – middle and upper GIT
Hemafecia
Yang Ming (Bright Yang) Syndromes
•
As the pathogenic factor invades the interior of the body in the Yang Ming stage, both
the Zheng (Upright) Qi and the Evil (Xie) Qi are strong, turning the excess pathogen in
to heat within the body. Yang Ming fevers are therefore more severe than fevers in the
Tai Yang stage. In the Yang Ming Syndrome, there are no chills. There are two types of
Yang Ming Syndromes, one that involves the channel, and the other involves the
related Zang Fu (Stomach and Large Intestine organs). Both of these syndromes can
occur at the same time.
SP 10 – Xue Hai (Sea of
Blood)
•
Treats menstrual irregularity, fulminant (sudden and quick) uterine bleeding and other blood and circulatory disorders.•
Invigorates the blood, Dispels stagnation, Coolsthe blood, Harmonizes menstruation, Benefits the
skin
•
Xuehai, as its name implies is a primary point of choice for many blood disorders. In fact some authorities recommend it for all disorders of the blood.•
Modern day can be used for fibromyalgia and lupus.ST 37 Shang Ju Xu
(Upper Great
Emptiness)
•
Lower He Sea of the LI and point of the Sea of Blood•
Clears heat in the ST•
Regulates the Stomach and Intestines and resolves retention of Food.•
Eliminates Damp Heat.•
Subdues Rebellious Qi.COMMENTS
•
Affects the LI directly to treat a wide range of intestinal symptoms, especially chronic diarrhea. ST 37 also opens to the chest and subduesrebellious Qi, which makes it applicable in the treatment of asthma and breathlessness.
Hemafecia
Hemafecia
URINARY BLADDER 32 CILIAO (SECOND
CREVICE)
•
ACTIONS
•
Benefits the urination and defecation
•
Regulates menstruation and resolves Dampness
•
Strengthens the lower back
COMMENTS
•
UB 32 is the most important of the four points (Baliao or the 4 ‘crevices’), with the broadest
indications and the one that is the most tonifying to the Kidneys and the Essence. It is an
important point to use for the treatment of infertility in women. It is used for painful
periods when the pain is on the sacrum.
Hemafecia
SP 15 Daheng (Big
Horizontal Stroke)
•
Pt. of Yin Wei Mai•
Quite an NP pt. for abdominal complaints•
Strengthens the function of the SP, especially in relation to bowel movements•
Often used in chronic constipation of the deficiency type•
Can be used for weak and cold limbs as itstimulates the Spleen to transport food essences to the limbs
•
Resolves Dampness in the Intestines and is used in chronic diarrhea with mucus in the stools•
Regulates Qi in the abdomen and promotes its smooth flow of Liver Qi•
“horizontal stroke” in this context means, a line drawn across the umbilicus including RN 8, KI 16, ST 25 and SP 15Hemafecia
•
Lower He-Sea point of SI•
Point of the Sea of Blood•
Lower abdominal pain, lumbar pain that radiates to the testicles.•
Diarrhea, diarrhea containing undigested food, dysenteric disorder, pus and blood in thestool, insufficiency of Small Intestine qi, dark
urine.
•
Breast abscess, manic raving, sudden fright, drooling, dry lips, throat painful obstruction, absence of sweating, no pleasure in eating, pallor.•
Painful obstruction and atrophy disorder of the lower limb, hemiplegia of the leg, atrophy disorder of the foot, pain of the heel, extreme sensation of cold and heat in the shoulder, heat sensation in the area between the ring and little fingers, burning sensation in front of the ears.Hemafecia
Du 20 Baihui (Hundred
Meetings)
•
Can either expel excess Yang from the head or promote rising of Yang to the head.•
Extinguishes interior Wind subduing Liver Yang or rising Liver Wind (h.a).•
Is the meeting point of many channels (UB, GB, SJ, and LV + sea of marrow). Very good for ascending clear Yang to the head, esp. with moxa (forprolapse or internal organs, esp. the anus, which lies on the Du M, also for incontinence of urine, frequent urination and general sinking of Qi).
•
Has a lifting action on Yang which has a powerful effect in lifting depression and clearing the Mind.•
Promotes resuscitation in unconsciousness when combined with DU 26 & P 6.Hemafecia
RN 6 Qihai (Sea of Qi)
•
Powerful tonifying effect on Qi and Yang, especially if used with direct moxibustion.•
Can be used for extreme physical and mental exhaustion and depression.•
It tonifies Kidney Yang and Yuan Qi, especially with moxa for symptoms of chilliness, loose stools, profuse pale urination, physical weakness, mental depression, and lack of will power.•
Used for sinking Qi in the lower abdomen causing prolapse of the uterus, profuse menstrual bleeding from Qi deficiency, chronic persistent vaginal discharge, frequent urination, incontinence of urine, and a feeling of bearing down.•
When combined with GB 34 good for moving Qi in the lower abdomen relieving pain and distention in this area.Hemafecia
Kidney 6 Zhaohai (Shining Sea)
•
Opening point of the Yin Qiao Mai•
Actions•
Nourishes Kidney Yin.•
Benefits the eyes.•
Calms the Mind.•
Invigorates the Yin Qiao Mai.•
Benefits the throat.•
Regulates the Uterus and menstruation through Yin Qiao Mai.Comments
•
The best point on the Kidney channel to nourish Kidney Yin, also useful to nourish fluids and moisten dryness.Hematemesis
(Vomiting Blood)BIOMEDICAL CAUSES
•
Stomach•
Peptic ulcers (most common)•
Vascular lesions•
Gastritis•
Gastric carcinoma•
Hiatus hernia•
Foreign body•
Post operative•
Ingestion of toxins•
Esophgeal•
Ruptured esophageal varicesHematemesis
THE 4 LEVELS
-BASICS
INTRODUCTION
•
A brilliant theory that provides the most clinically useful tool to diagnose, interpret and treatdiseases caused by external Wind Heat and their consequences.
•
Clinically more relevant then the 6 stages, for example, one of the most common consequences of an invasion of Wind Heat is the transformation of external Wind Heat into interior Phlegm Heat in the Lungs causing chest infection.•
The brilliance of the theory lies in its identification of three different depths of penetration of interior pathogenic Heat. Each level has its own distinctive pathology and treatment.DEFENSIVE QI LEVEL
(WEI)
•
Is the beginning stage of invasion of Wind Heat: it is the only exterior level. The Defensive Qi level comprises 4 different patterns according to the nature of the pathogenic factor: namely, Wind Heat, Summer Heat, Damp Heat and Dry Heat. Of these four, the most common is Wind Heat.QI LEVEL (QI)
•
The Qi level is interior, that is, the pathogenic factor has penetrated into the Interior and it
has also transformed into Heat. However, the Qi level is the most superficial of the 3 interior
levels. There is a saying about the Qi level stating ‘Nobody dies at the Qi level’: this means
that, in the context of acute febrile diseases, contrary to the Ying and Xue levels, the Qi level
is never life threatening.
•
Characterized by Full Interior Heat with symptoms of fever, thirst, feeling of heat, mental
restlessness, Red tongue with thick yellow coating and a Rapid and Full pulse. These are
general symptoms as other manifestations depend on the pattern involved of which there are
5 (Lung Heat, Stomach Heat (similar to Yang Ming Channel pattern), Intestines Dry Heat
(similar to Yang Ming Organ pattern), Gall Bladder Heat and Damp Heat in the Stomach and
Spleen).
NUTRITIVE LEVEL
(YING)
•
The Heat has penetrated to a deeper energetic layer and begun to injure the Yin. At this level, Heat is obstructing the Mind and the Pericardium, causing delirium and even coma. Fever at night is a distinctive sign of Ying Qi level.•
The tongue appearance is an important sign that differentiates this level from the Qi level, the tongue now becomes Deep Red without coating (while at the Qi level, it is Red with a thick coating).•
2 patterns at this level: Heat in the Ying Level and Heat in the Pericardium.BLOOD LEVEL (XUE)
•
The deepest energetic layer, with Heat affecting the Blood. There areseveral different patterns with varying clinical manifestations but the chief clinical features of the Blood level are as follows:
•
There is Yin deficiency•
Heat is affecting the Blood, causing bleeding•
Heat is affecting the Mind, causing delirium or coma•
Heat in the Blood causes bleeding under the skin with the appearance ofmacules
•
Internal Wind develops, causing convulsions and tremors•
Collapse of Yin or Yang may occur•
There are 5 patterns: Heart victorious moving Blood, Heat victorious stirring Wind, Empty Wind agitating in the Interior, Collapse of Yin and Collapse of Yang.Hong Mai (Surging
or Flooding)
•
Description: Floating, large (i.e. wide) comes on exuberant, departs debilitated. “Coming onto the shore with force and retreating without force”.•
Indications: Extreme heat; if with thirst, high fever it can be Yangming heat orinternal heat. If surging and forceless, this is Xu surging.
•
Etiology: The Yang is floating excess and upward, this is a manifestation of firefloating upward and water drying internally (i.e. loss of blood, diarrhea).
PC 3 Qu Ze (Crooked Marsh)
•
He Sea and Water point•
The water referred to in PC 1 is a pool, where its power is contained. In PC 2 it is surging and active. At this point the flow has slowed and has combined with the earth to form a marsh which the Chinese consider is a fertile place.•
As the Water point, this point can be used to transfer Qi across the (controlling) Ke Cycle from the Kidneys or to regulate Water within the Pericardium. Putting Water on the Fire will calm and cool a patent who is restless, agitated and anxious due to too much Heat in the Pericardium (Hicks, p. 316).CONTROLLING/KE
CYCLE AKA
RESTRICTION
The Controlling Cycle represents
relationships which prevent any given element from becoming overwhelming --too powerful in relation to the system as a whole. We can think of this as being akin to a legislative “checks and balances” system, or to the “tough love” of a guardian, that sets clear boundaries, for a child’s own good. In terms of our family-relationships metaphor, it is the “grandmother” that exerts this healthy control over the “grandchild” element.
•
Wood breaks up the soil and holds it in place•
Earth contains water in many places, and as dam prevents flooding•
Water extinguishes fire, and therefore, controls its spread•
Fire controls metal by its ability to melt it•
Metal can be made into an axe that cuts wood into piecesHematemesis
Foul Breath
(Halitosis) pg. 729
•
Stomach Heat – foul breath, thirst,
sour regurgitation, nausea, excessive
hunger, burning epigastric pain, a
feeling of heat.
•
Other patterns are: Phlegm Heat in
the Lungs & Retention of Food.
PC 4 Xi Men (Cleft Gate)
•
Xi Cleft point•
Commonly used to strengthen the Qi of the Pericardium. It is especially useful in acutesituations. Physically it can soothe the
Pericardium if a patient has pain in the chest. It also has a strong emotional effect and can be used to calm a person who feels anxious, fearful or
frightened (Deadman et al., p. 374) or who has had a sudden emotional upset affecting the PC. It can be paired with SJ 7 (Hicks, p. 316).
Hematemesis
LI 11 Qu Chi (Crooked Pond)
•
He Sea and Earth Point
•
Strengthens the Qi of the Large Intestine. This point is beneficial when stability
is needed. Extremely invigorating and can strongly tonify a patients Qi (Hicks,
p. 293)
ST 37 Shang Ju Xu (Upper Great Void)
•
Lower He-Sea point of the Large Intestine
•
Point of the Sea of Blood
•
Regulates the intestines and transforms stagnation
•
Clears damp heat and alleviates diarrhea and dysenteric disorder
•
Regulates the Spleen and Stomach
ST 37 Shang Ju Xu (Upper Great Void) Cnt’
•
“The three yang channels of the arm (Large Intestine, Small Intestine and Sanjiao)
are unique in that whilst the channels traverse the upper jiao, their respective fu
belong to the lower jiao. Thus although the Spiritual Pivot states that the “He-sea
points treat disorders of the internal fu”, the he-sea points of these three channels
(Quchi L.I.-11, Xiaohai SI-8, and Tianjing SJ-10 respectively) have relatively little
action on their related fu. The Large and Small Intestines and the Sanjiao,
however, each have a lower he-sea point (Shangjuxu ST-37, Xiajuxu ST-39 and
Weiyang BL-39) which predominantly treat disorders of their respective fu.”
Hematemesis
Liver Fire Blazing
•
Red face and eyes, irritability, angry outbursts, tinnitus, deafness, temporal headache, ormigraine, dizziness (LIV Fire rising to the head).
•
Thirst (heat damaging fluids).•
Bitter taste in the mouth (LIV Fire rising to the mouth).•
Constipation with dry stools (Heat damaging fluids).•
Insomnia with dream disturbed sleep (LIV Fire disturbing Shen).•
Dark yellow urine (Heat burning fluids).•
Possible epistaxis, hemoptysis, hematemesis (LIV Heat causes Blood to extravasate).Liver-Yang Rising vs Liver-Fire
Liver-Yang Rising
Liver-Fire
Common
Characteristics
Aetiology
Emotional Stress
Emotional stress
and diet
Excessive
ascending of
Liver-Qi
Pathology
Imbalance between Yin
and Yang, excessive
ascending of Liver-Qi, no
real heat
Full-Heat
Eight Principles
-
Full-Heat
Symptoms
Headahces
Headaches and eye
problems
•
Anger includes: resentment,
repressed anger, irritability,
frustration, rage, hatred,
indignation, animosity and
bitterness. If they are not resolved,
they can cause Liver Qi Stagnation
or Blood Stasis, Liver Yang Rising or
Liver Fire Blazing.
•
Anger makes Qi rise, S&S are:
headaches (very common),
dizziness, tinnitus, neck stiffness,
red blotches on the front part of the
neck and a red face.
If anger is bottled = Liver Qi Stagnation
If anger is expressed = Liver Yang Rising or Liver Fire Blazing
In women LV Qi Stag may easily turn into LV Blood Stag
If concurrent KD Yin Def = tends to develop into LV Yang Rising
If concurrent Heat signs = tends to cause LV Fire Blazing
PC 8 Lao Gong Palace of
Weariness
•
Ying Spring and Fire Point
•
The horary point between 7 p.m. and 9 p.m. when it can be
used to shake up and enhance the Qi of the PC. When the PC
lacks warmth it is unable to fulfill its role of being the source of
‘elation and joy’ (Su Wen 8).
•
Lack of joy is the consequence of a PC that has become cold
and lifeless. As long as there is no risk of overheating the
Organ, moxibustion can be very effective at enlivening the
Protector of the Heart (Hicks, p.316)
PC Channel
•
The Pericardium primary and divergent
channels pass through the diaphragm to the
middle and lower jiao and the Pericardium
channel is interiorly-exteriorly coupled with
the Sanjiao channel. Like many points of the
Pericardium channel, therefore, P-8 also has a
strong action on the middle jiao and is
indicated in cases where fire disrupts the
descent of Stomach qi resulting in foul
breath, vomiting and difficult ingestion.
Hematemesis
PC 6 Nei Guan (Inner
Gate)
•
Luo Connecting point•
It lies on the opposite side of the arm from the Luo connecting point of the SJ, the Outer Gate. Using PC 6 and SJ 5 together can bring harmony andstability to the Fire Element when these two organs are out of balance. The name Inner Gate describe the point’s ability to reach the inner aspect of a person. It enhances the Qi of the PC, especially when a person becomes oppressed by sadness or lack of joy. Opening this gate can ease a constricted chest. This allows patients to brighten and settle in their mind and spirit. Great for symptoms of nausea (Hicks, p. 316)
Hematemesis
Eyes Pgs. 357-360
•
The eyes are the orifice of the Liver, but this does not
mean that all eye problems are related to the Liver;
other organs are the Heart, Kidneys and GB. The Heart
influences the eyes as both its Main and Connecting
channels go to the eyeballs. For this reason, many eye
problems are due to Heart Heat deriving from
emotional problems. The Kidneys nourish and
moisten the eyes, and eye problems in the elderly are
frequent. The GB Channel also goes through the eyes
and it may cause eye problems, usually in conjunction
with Liver Fire or Liver Yang Rising.
Abnormal Color of
the Eye Sockets P. 85
•
Dark: Phlegm•
Dark Purple: Blood Stasis•
Bluish: Kidney Deficiency•
Swelling of the lower part of socket extendingtowards cheek: Large Intestine pathology
•
Pale Greenish: Liver Qi Stagnation•
Dark Blue: Cold in the Liver ChannelHematemesis
ST 36 Zu San Li (Leg
Three Miles)
•
He Sea and Water point of the ST•
Gao Wu Command point•
Ma Dan-yang Heavenly Star Point•
Point of Sea of Water and Grain•
At a physical level this point can enhance the immune system and strengthen resistance todisease. Mentally and spiritually it can bring great stability to people who are feeling emotionally unstable or insecure. It helps calm the mind and spirit if patients are worried, anxious or obsessive. It can clear the mind if people have been
SP 1 Yin Bai (Hidden White)
•
Jing-Well and Wood point of the
•
Spleen channel
•
Sun Si-miao Ghost point
•
According to the Supplement to the Thousand Ducat
Formulas “The Spleen gathers the blood; when the Spleen
is deficient it is unable to unite the blood”, whilst the
Treatise on Disorders of Blood states “When Spleen yang is
deficient it is unable to gather the blood”. SP-1, the
jing-well point of the Spleen channel, is one of the foremost
acupuncture points for strengthening the Spleen’s function
of holding blood in its proper place.
Hematemesis
Dry Skin P. 178
The most common cause of dry skin
is Liver Blood deficiency; this is
especially common in women. Liver
Yin and Kidney Yin deficiency are a
common cause of dry skin in the
elderly. In some cases, dry skin may
be due to Stomach Yin deficiency.
A particular type of dry skin is that
due to chronic Blood stasis; due to
the interaction and mutual exchange
between Blood and Body Fluids,
stagnant Blood may impair the
circulation of Body Fluids and this
may cause the skin to become dry.
Dry skin from Blood stasis occurs
only in chronic cases when the Blood
stasis is severe and it is more
Dry Skin Continued…
•
It is fairly easy to distinguish between dry skin due to Blood stasis and that
due to Yin and Blood deficiency because in the former the skin is also dark
and lack luster and the nails are often dark or purple and dry and withered.
Kidney 6 Zhaohai
(Shining Sea)
•
Opening point of the Yin Qiao Mai•
As a sea it can be seen as a huge reservoir of water. This is a very moistening point and can be used if a person has become too hot and dry. This isgenerally a very dynamic and invigorating point. It is especially powerful due to its role as the opening point of the Yin Wei Mai (Hicks, p. 312)
KD-6 KD-3
• Benefits the throat
• Nourishes the Kidneys and clears deficiency heat
• Regulates the Yin Motility vessel
• Calms the spirit
• Regulates the lower jiao
• Nourishes Kidney yin and clears deficiency heat • Tonifies Kidney yang
• Anchors the qi and benefits the Lung
