Get Homework/Assignment Done

Homeworkping.comHomework Help https://www.homeworkping.com/

Research Paper helphttps://www.homeworkping.com/

Online Tutoringhttps://www.homeworkping.com/

click here for freelancing tutoring sitesTCM MethodologyBian Zheng Lun Zhi = Treatment is based on pattern discriminationYi Bing, Tong Zhi-Tong Bing, Yi Zhi =

Different diseases, same treatment Same disease, different treatment... Pattern discrimination: In multi-organ patterns, the 1st element stated is the most importantTreatment principles: 1st element in pattern should be mirrored in 1st element in treatment principlesGuiding Formula: must be taken from the category of formulas corresponding to the 1st element in the treatment principlesAdditions & subtractions: depend on the exact presenting signs & symp.Pattern discriminationMust have a firm grasp of the basic "statements of fact"Must memorize the signs and symptoms of each simple patternSearch for the signs and symptoms in a focused way

A Pattern is NEVER established based on a single sign or symptom!***** By it's very name, pattern means more than a single thing

In complex, real-life cases, there will be more than one pattern involved. One will not see all of the signs & symptoms given in the book. Therefore, it is crucial to study KEY signs for each pattern.

Treatment principles

These are theoretical statements about what needs to be done to rectify the imbalance implied by the name of the pattern

1

Most of the time, treatment principles are addressed to the ben or root of the imbalance implied in the pattern's nameSometimes the biao or branch must also be addressed and are stated in the treatment principles. For example, vomiting involves a loss of fluids, the finest essence of the digestate, and qi. Therefore, vomiting is a branch symptom that must be dealt with. So, one must add: "stop vomiting"

Treatment principles are the bridge between the pattern discrimination and the treatment plan. They are quite important!!!! You will always be expected to give them to me!!!!Disease Causing FactorsIn TCM theory, health is seen as dynamic movement and transformation in a balanced and harmonious manner. We see the various stages of opposition and interdependence seen in Yin - Yang relationships.

When a person is in dynamic harmony with the environment, there is health. When this harmony is lost, there is disease. Those factors that cause this imbalance are Bin Yin (disease causing factors)

These factors can be weather changes, epidemic qi, emotional, dietary, taxation, sprain & strain, weapon injuries, insect/animal bites.

Pathological changes result from these causative factors and can become new causative factors. History

Nei JingNan Jing Shan Han Lun Wen BingTCM

Holistic ViewTCM as a style

Yi Bing Tong Zhi, Tong Bing Yi Zhi4 methods

Looking -- Listening/smelling -- Inquiry -- PalpationPattern Differentiation

Yin-yang -- 5 phase -- Zang Fu -- Qi, Blood, Fluids – Channels & VesselsDiagnosis

8 principles = Yin - yang -- Internal - External -- Cold - Heat -- Xu - ShiTreatment Principles

Based on the pattern "...if there is cold, warm it..."Basic Concept of Yin & Yang

Yin~YangYANG YIN

Light Darkness Sun MoonActivity Rest Heaven Earth Time Space

2

Immaterial Material Energy Form/Matter

Insubstantial Substantial Ascending Descending

Fire WaterTransformation Storage Restless Quiet

4 Aspects of Yin~Yang1) Opposition2) Interdependence3) Mutual consumption4) Inter-transformation

In the human body, Yin is represented by the Blood....Yang by Qi

1500 BC - Shang DynastyAgriculturalAnimal & Plant worldAnimal ~ respected, but also killed & eaten

Killed, consumed, worn as clothesLead to a covenant between human & animal ~~ Give life through taking life

Plant ~ also killed and eatenORDER OF NATURE Seasonal festivals

NOT to control natureBring us IN ACCORD WITH NATURETo bring forth the fruits of nature, one lives properly in relation to what has to be done

COSMIC ORDER High civilization

WritingMathematicsAstronomy

Extreme attention to the cycle of the planets through the constellationsCombination of these allowed knowledge to be passed from generation to generation

Lead to the notion of a COSMIC ORDER!!

Cycle of the HeavensIdea to bring society into accord w/ HeavenHeavenly signs are signs of spiritual world

3

Something transcends our existenceSomething drives the cycles of natureThe deities are manifestation of this transcendentTHE DAOThere is something obscure which is complete before heaven and earth arose;tranquil, quiet,standing alone without change,moving around without peril.It could be the mother of everything.I don't know its name,and call it DAO.

The great DAO flows everywhere......All things depend on it to exist,

From Dao arises One, from One arises Two, from Two arises Three, from Three arises Ten Thousand [all] thingsThe Dao that can be spoken of is not the Absolute Dao

Cheng Yi (1033-1107)

Yin and yang are everywhere. In front and behind,To our left and to our right,Above us and below us,Darkness is the same as diminished light,Light is the same as diminished darkness, They are complementary, Universal counterparts,Yin does not exist without yang and yang does not exist without yin,Two in one and one in two

Su wen 5

Yin and yang, they are the Way of heaven and earthThe fundamental principles governing the 10,000 beingsFather and mother to all changes and transformations,The basis and beginning of generating and killing,The palace of spirit brilliance

Heaven and earthThey are the above and below of the 10,000 beings…Yin and yang,They are the beginning of the 10,000 beings

4

Mawangdui

Heaven is yang, earth is yinSpring is yang, fall yinSummer is yang, winter is yinDaytime is yang, nighttime yin…All of the yang categories emulate heaven. Heaven exalts proper order.

All of the yin categories emulate the earth. The virtue of the earth is being placid and quiet,properly ordered and tranquil

Su wen 6

Heaven is yang The earth is yin

The sun is yang,The moon is yin.

Su wen 5

Yin is tranquilityYang is agitation

Yang gives lifeYin stimulates growth

Yang transforms qiYin completes physical appearance.

The clear yang is heaven;The turbid yin is earth

Water is yin Fire is yang

Yang is qiYin is wei (flavor)

Su wen 7

That which leaves is yin; that which arrives is yang.That which is quiet is yin; that which moves is yang.That which is retarded is yin; that which is accelerated is yang.

5

Su wen 4

Speaking of the yin and yang of Man,Then the outside is yang, the inside is yin.

Speaking of the yin and yang of the human body,Then the back is yang, the abdomen is yin.

Speaking of the yin and yang among the viscera and bowels…Then the viscera are yin and the bowels are yang

The liver, the heart, the spleen, the lung, and the kidneysAll these 5 viscera are yin

The gallbladder, the stomach, the large intestine, the small intestine, the bladder and the triple burnerall these 6 bowels are yang.

Su wen 6

Those in the outer region, they are yangThose inside, they are yin.

Su wen 1

The people of high antiquity, those who knew the WayThey modeled their behavior after yin and yang

In high antiquity there were the true men.They upheld the patterns of heaven and earth, andThey grasped the regularity of yin and yang

Su wen 25

The physical appearance of human life,It doesn’t leave yin and yang.

Su wen 4

In yin is yin; in yang is yang.From dawn to noon, this is the yang of heaven;It is the yang in the yang.

6

From noon to dusk, this is the yang of heaven;It is the yin in the yang.From early evening to the crowing of the cocks, this is the yin of heaven;It is the yin in the yin.From the crowing of the cocks to dawn, this is the yin of heaven;It is the yang in the yin

Su wen 4

The back being yang, the yang in the yang is the heart.The back being yang, the yin in the yang is the lung.The abdomen being yin, the yin in the yin are the kidneys.The abdomen being yin, the yang in the yin is the liver.The abdomen being yin, the extreme yin in the yin is the spleen.

Huang di nei jing tai su

In yin there is yang, in yang there is yin. When one is knowledgeable about yin and yang, he can apply needle treatment methodically. When the origins of illness have been comprehended, the application of needles can be carried out on the basis of the proper principles. Carefully assess the causes of the affliction and the correspondences to the four seasons. The human body consists of an inner region, comprising of the 5 viscera and the six bowels, and an outer region, containing sinews, bones and skin. Thus yin and yang are present in both inner and outer regions. In the inner region the five viscera belong to the yin and the six bowels to the yang. In the outer region, the sinews and bones belong to yin and the skin to yang.

MedicinalsSu wen 5

That which is of strong flavor is yin;That with weak flavor is yang of yin.

That which is of strong qi is yang;That with weak qi is yin of yang.

Acrid flavor and sweet flavor effuse and disperse and are yang,Sour flavor and bitter flavor cause gushing up and outflow and are yin.

Su wen 5

Yin and yang, they areThe way of heaven and earth,The fundamental principles governing the myriad beingsFather and mother to all changes and transformations

7

The source and origin of generating and killingThe palace of spirit brilliance

Lao zi

The Dao that can be expressed is not the unchanging Dao;The name that can be defined is not the eternal name.

Hence the wise man depends on non-action (wu wei)Continues teaching his lessons of silenceYet the multitudinous creatures are influenced by him;He does not reject them.He nurtures them, but claims no possession of them,Oversees them, but puts no pressure on them.Accomplishes his purpose, but does not dwell on his achievements;And precisely because he calls no attention to his actionsHe is not banished from the completion of his tasks.

Nothing under heaven is weaker and softer than water,Yet nothing surpasses it in battling the hard and strong.

Look at it, but one sees nothing,It is called illusory.Listen to it, but one hears no sound,It is called undetectable.Feel for it, but one touches a void,It is called minuscule.These three, because they elude us,Meld to become one.

Existence and non-existence are dependent on each other,Difficult and easy give rise to the same concept,Long and short are derived by comparison,High differs from low only by position,Sound and echo blend into one harmonyFront and back follow one another sequentially

Thirty spokes are joined at the nave to build a wheel, But it is the space between the wheels that provide the function.Chunks of clay are fashioned into a vessel,But is it the emptiness within that renders it useful.Windows and doors are cut to build a room,But it is the enclosure that furnishes shelter.As we benefit from that which exists,Let us recognize the utility of that which does not.

8

Lao zi

Something nebulous and yet compositely formed,Existing before heaven and earthInaudible and limitless,Independent and never changingPresiding over all constantly,She may be regarded as the “mother of everything”I do not know it’s nameDao is what I call it.If pressured to assign it a titleI dub it Great

Dao de jing

Man emulates earth for the order of his ways, While earth emulates heaven,Heaven acts according to the laws of the Dao,But the Dao does that which is natural to itself.

Zhuang zi

How do I know that wanting to be alive is not a great mistake?How do I know that hating to die is not like thinking one has lost one’s way, when all the time one is on the path that leads to home?

While a man is dreaming, he does not know that he dreams; nor can he interpret a dream till the dream is done.It is only when he wakes, that he knows it was dream.Not till the great wakening can he know that all this was one great dream…

Kwang zu

“The 10,000 things come into being,and I have watched them return.No matter how luxuriantly they flourishEach must go back to the root from which it came.This returning to the root is called quietness.It is the fulfillment of one’s destiny.That each must fulfill his destiny is the eternal pattern.”

5 PHASES

WOOD:

9

"Wood is the bending and the straightening" having the characteristics of upbearing and effusion (upward and outward movement)

Liver-Wood The liver's physiologic characteristic is that it thrives by orderly reaching. It governs upbearing and stirring and is like the "sprouting of trees and plants in Spring" Spring corresponds to wood in 5 phases, so that the liver is ascribed to wood.

FIRE "Fire is the flaming upward," having the quality of heat and upward movement

Heart-Fire: The physiologic characteristic of the heart is that it governs the blood vessels. It has the function of propelling qi and blood to warm and nourish the whole body. It is likened to the heat of summer, when the whole of creation thrives. Summer corresponds to fire, and so the heart is ascribed the quality of fire

EARTH"Earth is the sowing and reaping" representing the planting and harvesting of crops and the bringing forth of phenomenon

Spleen--Earth: The spleen's physiologic characteristic is that it governs movement and transformation of the essence of grain and water and is the basis of the formation of blood and qi. IF is associated with late summer and humid weather, when the whole of nature is at its peak. Late summer corresponds to earth, so that the spleen is ascribed to the attribute of earth

METAL"Metal is the working of change" having the qualities of purification, elimination, and reform

Lung-Metal: The physiologic characteristic of the lung is that it thrives by purity and governs downbearing. It is likened to the clear fresh air and purifying frost frosts of autumn, when nature is withdrawing into itself For this reason, it is ascribed the attribute of metal

WATER"Water is the moistening and descending to low places" having the qualities of moistening, downward movement, and coldness

Kidney-Water: The kidney has the physiologic function of storing essence and of governing fluids. It is associated with the bitter cold of winter, when nature is dormantThe five phases,The first is water,The second is fire,The third is wood,The fourth is metal,The fifth is earth.Water is moistening that which is below.Fire is flaming upward.Wood is bent and straight.

10

Metal is compliance and resistance.Earth, then, is sowing and reaping.

Moistening that which is below generates salty flavor.Flaming upward generates bitter flavorBent and straight generates sour flavor.Compliance and resistance generates acrid flavor.Sowing and reaping generates sweet flavor.

Su wen 4

The eastern region; green-blue color.Having entered, it communicates with the liver;Its orifice opens in the eyes.It stores essence in the liver.

Its flavor; sour;Its class: herbs and tress;Its anima: chicken;Its grain: wheat.Its correspondence with the four seasons, above it is Jupiter.Hence the qi of spring is in the head.Hence one knows that its diseases are located in the sinews.

Su wen 5

The east generates wind;Wind generates wood.Wood generates sour flavor.Sour generates the liver.The liver generates the sinews.The sinews generate the heart.The liver rules the eyes.The spirit,In heaven it is wind,On the earth it is wood,In the body it is sinews.

Among the zang it is the liver;Among the color it is qingAmong the voices it is shouting;Among the changes and movements of the body it is grasping;Among the portals it is the eyesAmong the flavors it is sour;Among the states of mind it is anger.

11

If anger causes harm, it harms the liver; sadness dominates anger.If wind causes harm, it harms the sinews; dryness dominates wind.If sour flavor causes harm, it harms the sinews; acrid flavor dominates sourSu wen 25

When wood meets metal, it is felled.When fire meets water, it is extinguished.When earth meets wood, it is penetrated.When metal meets fire, it is destroyed.When water meets earth, it is interrupted in its flow.These five processes apply to the interactions among all the myriad beings;Their validity is never exhausted.Su wen 19

If a massive depletion results from joy,Then the qi of the kidneys takes advantage.From anger,The then qi of the liver takes advantageFrom sadness,Then the qi of the lung takes advantageFrom fear,Then the qi of the spleen takes advantageFrom anxiety,Then the qi of the heart takes advantageSu wen 65

In the case of a heart disease, first the patient experiences heartache.After one day he coughs.Within the next three days the flanks experience propping fullness and painWithin the next five days there is obstruction (no passage), the body aches and the limbs are heavy.If the disease has not ended within the next three days the patient will die,Su wen 9

The heart, Its fullness manifests in the vesselsThe lung,Its fullness manifests in the skinThe kidneys,Its fullness manifests in the bonesThe liverIts fullness manifests in the sinewsThe spleenIts fullness manifests in the musclesSu wen 10

The tissue of the heart is the vessels,

12

Its splendor appears in the complexionThe tissue of the lung is the skin,Its splendor appears in the body hairThe tissue of the liver is the sinews,Its splendor appears in the nailsThe tissue of the spleen is the flesh,Its splendor appears in the lipsThe tissue of the kidneys is the bones;Its splendor appears in the head hair.

Su wen 23

The heart generates sweat.The lung generates snivel.The liver generates tears.The spleen generates saliva.The kidneys generate spittle.

Su wen 11

As for the so-called five zang,They store the essence qi and do not drain it.Hence, even if they are full, they cannot be replete.As for the six fu,They transmit and transform things but do not store them.Hence they may be replete, but they cannot be full.The reason is as follows.When water and grain enter the mouth,Then the stomach is replete and the intestines are empty.When the food moves down,Then the intestines are replete and the stomach is empty.Hence the text states; “replete but not full, full but not replete.”

Su wen 17

The vessels, they are the mansion of the blood.The head, it is the mansion of essence brilliance.The back, it is the mansion of that which is in the chest.The lower back, it is the mansion of the kidney.The knees, they are the mansion of the sinews.The bones, they are the mansion of the marrow.

Dong Zhong Shu (179-104 BCE)

13

Within the universe exists this qi of yin and yang in which man is constantly immersed, just as fish are immersed in water. The only difference between qi and water is that water is visible whereas qi is not. But man’s existence is as much dependent on this qi as fish’s life is dependent on water. Qi is found everywhere in the universe but is less visible than water. Thus, although the universe seems to be empty, yet there is substance at the same time. Man is engulfed in this vortex and, regardless of whether he is orderly or disorderly, is carried along on and on, in a common current.

Tang Rang Chuan (1865-1918 CE)A person’s body is composed of nothing outside of yin and yang, and the two words yin and yang mean water and fire, respectively. Further, the two words water and fire in terms of the human body mean qi and blood, for water transforms the qi and fire transforms the blood.One might ask, how can it be that water transforms the qi? Qi resides in all material things, and all revert to water.

The Basic Concept of Qi, it's Formation, Movement and Classification

1) Basic concept of QiQi is the basic substance by which all movement and all mutations of phenomenon in the

universe ariseQi means all of the physiological functions or activities of the internal organs and channels

and network vessels2) The formation of Qi

Former Heaven Qi is inherited from our parents, it is finite in amount and treasured by the kidneys

Latter Heaven Qi is transformed by the Spleen from the water and grains consumed daily. 3) Qi movement = Qi Ji

The dynamic of qi is its capacity to undertake the four primary movements that occur in the organs and channels: upbearing, downbearing, outward & inward movement Su Wen "there is no organ in which upbearing, downbearing, outward and inward movement of original qi does not occur" When this movement stops, life ceases.

In a healthy normal situation, the Qi movement is harmonized and balanced, otherwise, pathological movement = Qi stagnation, Qi counterflow, central qi fall, etc4) Different forms of original Qi, manifesting as physiological activityOrgan Qi : each organ has its own qi, which is the basis of its physiologic activity and manifests as a major aspect of its physiologic function.

Channel Qi: movement is seen in the channels' functions of transmission and conveyance

Construction Qi: the qi that forms the blood and flow with it in the vessels, helping to nourish the entire body

Defense Qi: flows outside the vessels ... it is fierce, bold and uninhibited, so it cannot be contained by the vessels. Its main function in the chest and abdomen is to warm the organs. Its function on the exterior is to flow through the skin and flesh, regulate the opening and closing of the interstices

14

(cou li), protect the exterior, keep the skin lustrous and healthy, and prevent invasion of external evils

Ancestral Qi: gathers in the chest, the "sea of qi" (qi hai ). It ascends to the trachea and descends into the qi thoroughfare. Ling Shu: "ancestral qi accumulates in the chest, issues through the throat, goes through the heart and vessels, and moves respiration"Main Functions: enters the respiratory tract and controls breathing: its health is reflected in the strength of respiration and in the voice. It also causes the qi derived from the breath to descend into the qi thoroughfare. Breath control in qigong makes use of this function.Ancestral qi penetrates the heart and vessels, driving the heart and regulating the pulses. Thus, the circulation of qi and blood and the temperature and movement of the limbs are largely dependent on it.

5) Functions of Qi -- 5 Fx are interrelated

Activation: human growth and development, physiologic activity and metabolism, are manifestations of the activation of qi

Warming: body temperature and the ability of the organs and tissues to perform their functional activities are dependent on the warming action of qi

Defense: Qi is the outer defense of the body and prevents evil influences from entering.

Transformative action: formation of blood and fluids, distribution of fluids, and conversion of fluids into sweat and urine are all the result of the transformative action of qi.

Containment: extravasation of blood or loss of body fluids is prevented by the containing function of qi.

6) Pathologies of qi... main pathologies are qi vacuity and qi stagnation

Qi vacuity: may be caused by enduring illness, old age, weak constitution, malnutrition, or taxation fatigue. Characterized by fatigue, weakness and loss of strength but affects each of the viscera and bowels differentlyLungs = shortness of breath and a faint voiceSpleen-Stomach = poor appetite and loose stoolsKidneys = frequent, long voidings of clear urine

Qi stagnation: normally the qi flows smoothly and freely throughout the body. If the qi dynamic is disturbed, it is known as qi stagnation. It may be caused by emotional constraints, dietary irregularities, contraction of external evils, and external injury.

The main signs are local distention and possibly pain, feelings of oppression or distending pain of fluctuating intensity and unfixed location.

15

Liver channel there may be distention and pain in the rib-side, premenstrual breast distention and pain or perhaps pain and heaviness in the lateral aspects of the lower abdomen

Qi Counterflow denotes stagnation and counterflow ascent of qi that normally bears downward.Lungs shortness of breath, panting or coughStomach nausea, belching or vomiting

Central Qi fall: The Qi of the spleen normally bears upward. If the spleen becomes vacuous and weak, it may fail in its duty to upbear the clear yang qi and may lead to dizziness, enduring diarrhea, prolapse of the rectum or uterus

SPIRIT - SHEN: The spirit is what normally makes us conscious and alert during the day. It is what becomes inactive during sleep.Thus, the spirit is abundant qi in the Heart....

"The Heart stores the spirit"Storage is a yin function (?), it is primarily the Heart Blood and yin that have the function of nourishing the Heart and providing the material basis for the Heart to house the spirit(?)

MIND - ZHI: Presence of mind or concentration power

The mind is the experience of Qi and the movement of QiIt is similar in meaning to the spirit shen, with which it is often combined to form shen zhi

Shen disturbances: insomnia, profuse dreaming, dream disturbed sleep,forgetfulness, feeble-mindedness, vexation and agitation, irritability, etc

Full condition = something "harassing the heart spirit"

Empty condition = "Heart failing to keep its abode"

Full/Replete/excess Vs. Empty/Vacuous/deficientFull = characterized by the presence of a pathogenic factor of any kindEmpty = characterized by weakness of the body's Qi

“Essence is the basis of the body"Broad Sense: Blood, Qi & FluidsAcquired essence = Latter heaven essence

That which is essential to maintain life

16

Absorbed by the body after birthSynonymous with "essence of water & grain".. nutrients absorbed by Sp/St

Narrow Sense: stored by Kidneys and controls birth, growth, aging & death

Reproductive essence:What male & female combine to produce offspring

Congenital essence = Former heaven essenceReceived from parents From birth it's gradually strengthened by

ACQUIRED ESSENCEBody grows to full stature & reproductive maturity

After Prime essence wains.....body decays

BLOOD FORMATION

From essential Qi from food derived by Spleen/Stomach

Becomes red blood after transformation by constructive Qi

Blood flows through the vessels and is pumped around the whole body by the heart

Blood is treasured and regulated by the Liver

Blood is prevented from spilling out of the vessels by the containing power of the Spleen

Blood's relationship to internal organs

Heart governs the blood & vessels

Lungs govern Qi~~ "Qi is the commander of blood"

Spleen is the latter heaven root of engenderment and transformation of Qi & Blood

Spleen "manages" or contains blood in the vessels

The Liver treasures Blood and regulates its volume

Kidneys are the former Heaven root of the engenderment and transformation of Blood

Kidneys Treasure Jing (Essence)"Blood and essence share a common source"

Relationship of Qi & Blood

Qi engenders Blood

Qi is the commander of BloodIf Qi moves, the Blood movesIf Qi stops, the Blood stops

17

Qi is the commander of BloodIt is the Qi that contains the Blood in its vessels

Qi & Blood flow together. Therefore, the Qi deserts with the Blood

Blood is the Mother of Qi, it is the material basis to anchor the Qi

Blood's Function

Nourish the whole body

Moisten body tissues

The material foundation to House the Spirit

Blood is the Mother of Qi

Blood PathologyStasis = the impairment or cessation of the normal freeflow of Blood

Emptiness or Vacuity = the manifestation of insufficiency of the Blood

Blood Heat = characterized by HEAT & Blood signs

Blood Cold = Congealing cold and Qi stagnation inhibiting movement of BloodBlood stasis

PAIN stabbing, fixed, boring in character and fixed in location

Masses fixed, palpable

Bleeding recurrent, purple/black with clots Gynecology

Complexion dull, dark facial complexion

Tongue static macules on the tongue

Skin spider nevi -- bruises -- "dry lusterless skin""...in curious diseases, think of stasis....""new diseases are in the channels, enduring diseases are in the network vesselsBlood vacuityDizziness

Palpitations

PALE sallow complexion tongue, lips, nailsFine pulse

Flowery vision (blurry)

18

Hypertonicity (stiffness, tension, spasms)

DRY ~skin... lifeless hairBlood heat"primarily" due to febrile disease

"primarily" due to Liver Heat

Blood Stasis"knocks & falls" = Trauma

Bleeding

Qi Stagnation

Qi vacuity (emptiness)

Blood Cold

Blood Heat

Blood VacuityHeavy Blood loss

Diminished production

Failure to eliminate stasis & engender new Blood

Blood HeatEjection of bright, red Blood

Maculopapular eruptions

Vexation (p206)

Crimson Tongue

Delirious Mania

ComaFluids = Jin YeAll normal fluid substances flowing within the human body

Sweat, saliva, stomach juice, urine, etc

FUNCTIONSMOISTEN -- organs, sinews, flesh, skin, mucous membranes, orificesLUBRICATE -- JointsNOURISH -- Brain, Marrow, Bones

19

JIN (fluids, liquids) -- relatively thin, more mobile & yangLocate -- surface of flesh, mucous membranesFunction -- moisten flesh, skin, hair, eyes, ears, nose, mouth & other

YE (humours) -- thicker, less mobile, yinLocate -- Zang Fu, Brain, BonesFunction -- lubricate joints

Relationship to QI & BLOODQI -- Production, distribution & discharge of Fluids relies on ^ v >< <> movement of QIIntimate relationship on the D action of San Jiao (waterways) & other rel organs

DISTURBANCE OF QI MECHANISM FLUID DISORDERAbnormal accumulation of fluids = water QiInsufficiency of the source of fluid formation

Vacuous Qi fails to perform containing function => heavy fluid loss => => Qi desertHOW?~~ great sweat, long voidings of urine

BLOOD - Important constituent of Blood.. the richest part of JinYe & Ying Qi travels via vessels of Lung > Heart and D to Blood"When fluids are harmonious, they transform into Blood"Blood & Fluids share the same source"Fluid depletion leads to Blood insufficiencyPathologies of Jin YeWATER SWELLING (SHUI ZHONG) &PHLEGM-RHEUM (TAN YIN)Abnormal accumulations of body fluidsORGANS

LungSpleenKidney

Water SwellingImpairment of Lu Fx of Diff. & DownbearImpairment of Sp Fx of Move & DImpairment of transformative action of Kidney Qi

affects the upbearing of the clear & the downbearing of the turbid& the production & discharge of urine

Phlegm RheumCauses are similar to water swelling"The spleen is the source of phlegm engenderment and the lungs are the place where phlegm is stored"

Pathologies of Jin YeDamage to Jin (fluids) and desertion of Ye

Damage to Jin = minorDamage to Ye = major

Causes ~ great fever, enduring fever, great sweat, profuse urine, vomiting and diarrheaCommon pathomechanisms ~ scorching fluids by evil Heat, wearing of fluids from enduring illness

20

Iatrogenic~ Inappropriate or over use of:Sweat effusing agents, urine disinhibitors, draining purgatives, warm, drying agents

Damage to Jin (liquids) = temporary Signs = thirst, rough dry tongue coat, dry throat/lips/tongue/skin/ stool, short voidings of scant urine

Depletion of Ye (humors) = seriousSigns = more pronounced slower Txpoor general health, dry mouth with strong desire for fluids

ZANG - FU5 ZANG/VISCERA

HEART-SPLEEN-LUNG-KIDNEY-LIVERPERICARDIUM IS CONSIDERED 6TH VISCUS IN CHANNEL THEORYFX = PRODUCE AND STORE ESSENCE6 FU/ BOWELSSM. INTEST-STOMACH-LG. INTEST-UB-GB[-SAN JIAOFX = DECOMPOSE FOOD AND CONVEY WASTE

"... 5 viscera store essential qi and do not discharge waste. Thus they are full, but cannot be filled. The six bowels process and convey matter, and do not store. Thus, they are filled, but are not full"

6 EXTRAORDINARY ORGANSBRAIN, MARROW, BONES, VESSELS, UTERUS, GB[DISTINGUISHED FROM THE BOWELS IN THAT THEY DO NOT DECOMPOSE FOOD AND CONVEY WASTE.DISTINGUISHED FROM THE VISCERA IN THAT THEY DO NOTPRODUCE AND STORE ESSENCE.

GB Is an exception and is classed as both a bowel and an extraordinary organ.It plays a role in the processing and conveyance of food, and stands in an interior-exterior

relationship with a viscus, the liver. The bile that it produces is regarded as a "clear fluid" rather than as waste.

LIFE GATE FIRE = The basic fire of life Lives within Kidney Yin* The basis of sexual and reproductive function Warms and nourishes the 5 viscera and 6 bowels Intimately involved in growth, development, and aging

21

The Spleen requires the warming action of lifegate fire to perform its' function of moving and transforming

Qi Movements"...yang floats.." -- Yang by nature upbears and effuses (ascends and thrusts outwards)"...yin sinks..." -- Yin by nature is turbid and heavy and downbears or descends"...yang descends..." Interaction of Heaven and earth, yin&yang... classical Chinese

anatomical position...yang channels descend. Heart fire must descend to interact with Kidney water"...yin ascends.." Yin channels ascend the body...Kidney water ascends to interact with Heart fire

Zang-FuSpleen upbears the clear Yang -- Stomach descends the turbidLungs diffuse and downbear Qi -- Lg Int. conveys dregs downwardKidney Qi contains & astringes -- UB descends for excretionLiver Qi bears up& out like branches of a tree -- GB ?Heart qi descends -- Sm Int. descends

Spleen - Stomach"the latter heaven root of the engenderment of Qi & Blood""spleen upbears the finest essence of food and drink to the Lungs & Heart where it is

transformed into Qi & Blood""Stomach rottens and ripens the food and drink taken in and descends the turbid down the

Sm Int... it is the source of body fluids

Pathology of Qi TransformationSpleen upbears the clear, if the spleen is vacuous and weak, it may fail its' duty and the clear

will descend mixed with the turbid. OR, if a yin turbid substance (evil damp, phlegm, etc) obstructs the flow of qi, it may also cause a failure of the arisal of the clear.

Stomach descends the turbid, if, for any reason, the qi mechanism of the stomach is inhibited, it may counterflow upward (belching, acid regurg., etc)

Liver governs free coursing and discharge of the Qi, if the liver is damaged, it may fail in its' duty and counterflow upward to the lungs or horizontally to the Sp/ ST

The lungs diffuse and downbear the Qi. If, for any reason, the qi mechanism of the lungs is inhibited, the lung qi may counterflow (cough, hasty panting)

The Kidney yin is supposed to check heart yang and maintain the proper balance between heart fire and kidney water. Being vacuous, kidney yin fails in that function and heart fire may consequently become exuberant. Heart fire flares upward in the upper Jiao, disquieting the heart spirit.

The Liver governs coursing & discharge (shu xie)The Liver stores the BloodThe Liver thrives on orderly reaching (tiao da)

22

The Liver governs the sinewsThe Liver opens at the eyesThe Liver governs frightThe Liver stands in interior-exterior relation with the Gall BladderThe Liver, it's bloom is in the nailsThe Liver is averse to windThe Liver forms tearsThe Liver holds the office of general, whence strategies emanateThe Liver stores Blood

The Liver is capable of retaining blood and regulating the amount of blood in the body. "When the body moves, the blood flows through the channels, and when the body is at rest,

the blood flows back to the liver where it is stored""..the legs receive blood and walk, the hands receive blood and grip.." 2 scenarios from loss of blood storing function......

1 tissues are undernourished and fail to function2 cause a tendency towards bleeding

The Liver governs free coursing and discharge (shu xie)1) Reflected in the regularity and smoothness of the qi mechanism. When this function is normal, qi dynamic is smooth and regular, so that qi and blood remain in harmony, the channels are kept free, and the organs all function normally2) Production and secretion of bile depends on surplus of qi from the liver being channeled into the Gall Bladder.3) Emotional disturbances may affect the qi dynamic...impairment of free coursing can lead to emotional disturbances such as mental depression, rashness, impatience or irascibility

Shu = to enhance flow (of qi, esp. depressed liver qi)to free (the liver or digestive tract of qi stagnation and depression)to eliminate (evils such as wind in the exterior)to free (the exterior of channels from evils such as wind)

Chinese Character contains a picture of water and is used in the combination shu jun to dredge...course = freeing the course of qi

xie = spontaneous or induced outward (or downward) movement{coursing the Liver & rectifying the Qi shu gan li qi}

restoring the normal free coursing of liver qi in the treatment of liver depression{The Liver thrives on orderly reaching (tiao da) }{The Liver governs upbearing effusion (sheng fa) }Liver qi bears upward &outward like the branches of a tree stretch up and out

Gall Bladder

Gall Bladder holds the office of justice, from which decision emanatesThe ability to maintain balanced judgement in the face of adversity

Gall Bladder stands in exterior-interior relationship with the LiverGall Bladder governs secretion of Bile

The gallbladder is a "curious organ" since it's Bile is considered a "clear fluid"

23

HEARTLing Shu Chapter 8 “The heart holds the office of lord and sovereign. The radiance of the spirit stems from it.”The Heart governs blood and vesselsThe Heart stores the spiritThe Heart opens at the tongueThe Heart stands in interior-exterior relation with the Small IntestineThe Heart governs the tongueThe Heart governs speechThe Heart governs sweatThe Heart, it's bloom is in the faceThe Heart is averse to heat

Small IntestineLing Shu Chapter 8 “The small intestine is responsible for receiving and making things thrive. Transformed substances stem from it”The Small Intestine governs separation of the clear and the turbid

Diseases of the small intestine are attributable to failure to separate the clear and the turbid, manifesting as stool and urinary disturbances

It receives water and grain that has been decomposed in the stomach.It transforms this food further, extracting nutrients for the body.It passes waste on to the large intestines and "clear" to the bladder

SPLEENLing Shu Chapter 8 “The spleen and stomach are responsible for the storehouses and granaries. The five tastes stem from them”From Wang Kentang and Wu Mianxue, The Compendium of Traditional Diagnosis (Gu Jin Yitong Zhengmai Quanshu), 1601:

The Spleen governs movement and transformationThe Spleen is the latter heaven root

Sheng hua zhi yuan = the source of engendering transformationThe basis of qi and blood

The Spleen governs upbearing of the clearThe Spleen governs the management of the BloodThe Spleen governs the flesh and limbsThe Spleen stands in interior-exterior relation with the StomachThe Spleen opens at the mouthThe Spleen, it's bloom is in the lipsThe Spleen is averse to dampnessThe Spleen forms drool

24

StomachThe Stomach governs intake

The Stomach receives ingested foods and perform the initial stage of digestionThe Stomach governs rotting and ripening

Allows the essence to be extracted by the SpleenThe Stomach governs downbearing of the turbid

The Stomach sends food down to the Small IntestineThe Clear is upborne by the Spleen, the turbid is downborne by the Stomach

LUNGLing Shu Chapter 8 “The lung holds the office of minister and chancellor. The regulation of the life-giving network stems from it.”The Lung governs QiThe Lung governs diffusionThe Lung governs depurative downbearingThe Lung governs regulation of the waterwaysThe Lung governs the exterior of the entire bodyThe Lung governs the skin & {body} hair The Lung governs the voiceThe Lung stands in interior-exterior relation with the Large IntestineThe Lung is the delicate viscusThe Lung is the florid canopyThe Lung opens at the noseThe Lung, it's bloom is in the {body} hairThe Lung is averse to coldThe Lung forms snivel

Large Intestine

25

Ling Shu Chapter 8 “the large intestine is responsible for transit. The residue from transformation stems from it.”The Large Intestine governs conveyance

The Large Intestine conveys waste downward and out of the body, transforming it into stool as it does soThe Large Intestine governs liquids

Absorbs fluid from the food waste to form firm stoolThe Large Intestine hold the office of conveyance, whence transformation emanates

KIDNEYSLing Shu Chapter 8 “the kidneys are responsible for the creation of power. Skill and ability stem from them”From Li Zhongzi, A Primer of Medical Objectives (Yizong Bidu), 1637:

The Kidneys govern WaterThe Kidneys store Essence (Jing)The Kidneys are the root of former heavenThe Kidneys govern the bones and engender marrowThe Kidneys open at the 2 yinThe Kidneys open at the earsThe Kidneys govern fearThe Kidneys stand in interior-exterior relation with the Urinary BladderThe Kidneys govern qi absorptionThe Kidneys are the gate of the StomachThe Kidney, it's bloom is in the {head} hairThe Kidneys are averse to drynessThe Kidneys form spittle The Kidneys hold the office of labor, whence agility emanates

Urinary Bladder

26

Ling Shu Chapter 8 “the bladder is responsible for regions and cities. It stores the body fluids. The transformations of the qi then give out their power”Urinary Bladder holds the office of Regional Rectifier

Su Wen "Bladder...stores fluid, and by Qi Hua {Qi Transformation}let's it out

PericardiumXin Bao = Heart "wrapper"

The outer cover of the heart.Evils invading the heart 1st affect the pericardium...high fever --> delirium = heat entering the pericardiumphlegm turbidity --> mental derangement = phlegm clouding the pericardium

Pericardium stands in interior-exterior relationship with the San Jiao

San JiaoLing Shu Chapter 8 “The triple heater is responsible for the opening up of passages and irrigation. The regulation of fluids stems from it” San Jiao manifests as waterways

The main functions of the San Jiao are the processing of fluids and ensuring free flow through the waterways.Qi transformation in the San Jiao is a global expression for the roles played by the lung, spleen, kidney, stomach, small intestine, large intestine and bladder in regulating the body’s water metabolism.San Jiao refers to specific body areas:

The upper refers to the head & chest, the heart & lungsThe middle refers to the upper abdomen the stomach & spleenThe lower refers to the lower abdomen inferior to the umbilicus

San Jiao stands in exterior-interior relationship with the PericardiumSan Jiao is also a concept in pattern identification

Know this!!!

The Heart governs the Blood and the spleen manages bloodThe heart governs blood while the spleen is the latter heaven root of the engenderment and transformation of blood and manages the blood within its vesselsMental-emotional disturbances wear the blood taxing the spleenSpleen vacuity may cause an insufficiency of blood leading to heart blood vacuity not nourishing the spirit leading to shen disturbancesThe heart and the kidneys interactThe heart fire and the kidneys water contribute to the normal balance between fire (yang) and water (yin) in the body. If heart and kidney yin are vacuous, their interaction may be broken and exuberant fire and vacuous water result. In this case, the heart spirit will become disquietedThe lungs govern qi and the heart governs bloodThe blood in all the channels of the body must pass through the lungs."The lung faces the hundred vessels"Only after being combined with and diffused by lung qi can blood nourish the organs and convey essence to the skin and [body] hair

27

Zong Qi {ancestral qi}, which gathers in the upper jiao, pervades heart vessels and powers respirationThe lung governs qi and the kidneys are the root of qiThe lungs draw in the Da qi from the environment, but cannot do so unless the essential qi of the kidney is exuberant {Lungs govern qi kidneys governs qi absorption}The spleen is the source of phlegm engenderment and the lungs are the receptacle that holds the phlegmThis relationship centers around fluid distribution. The spleen governs the movement and transformation of body fluids and the lungs ensure the regulated flow of fluids through the waterways.Liver qi influences spleen-stomach movement and transformationThe normal function of the stomach and spleen is related to the liver's governing of free coursing."When there is liver disease, first treat the spleen"Kidney yang influences spleen-stomach movement & transformationThe normal activities of the spleen and stomach are greatly dependent upon yang which is supposed to supply warmth and movement. The process of digestion in Chinese medicine is a process of warm transformation likened to cooking and distillation. The liver stores blood and the heart governs bloodThe blood is produced by the spleen, stored by the liver and propelled throughout the body by the heart. Mental-emotional disturbances wear the blood taxing the spleen. Spleen vacuity may cause an insufficiency of blood leading to heart blood vacuity not nourishing the spirit leading to shen disturbancesThe liver can only function, ie, only course and discharge, as long as it receives sufficient nourishment from blood. Therefore, liver depression and blood vacuity mutually reinforce one another."When there is liver disease, first treat the spleen"The liver stores the blood and the kidneys store essence.Blood and essence share the same source. Liver and kidneys share the same source.The kidneys are the former heaven root of the engenderment and transformation of the blood. It takes essence to make blood. Liver diseases such as hyperactivity of liver yang or liver fire may consume yin blood and, ultimately, the kidney essenceThe liver governs free coursing and the kidneys govern storageManifest as menstruation in females and discharge of semen in males

Categories1174 CE Jin Dynasty ---- Chen Yen = San Yin Ji Bing Zheng Fang LunTreatise on 3 categories of Path. factors & symptomsNei Yin -- Internal CausesWai Yin -- External CausesBu Nei Bu Wai Yin -- Neither Internal nor External CausesWai Yin = Liu Yin -- 6 evils...wind, cold, heat, summerheat, dry , dampNei Yin = 7 emotionsBu Nei Bu Wai Yin -- Diet, talking/shouting, violence, strains, anything beyond human control

28

Wai Yin = Liu Yin ... under normal conditions, these are simply 6 Qi. When these qi happen too suddenly, too strongly, out of season or the person`s righteous qi is empty and weak, the normal qi become pathologic.

6 evils are mostly environmental... dry diseases in autumn, dry diseases when living in a dessert etc.6 evils are promiscuous and may attack in combinations..wind-cold.... damp-heat...etc6 evils may transform into each other... cold D heat etc6 evils attack from the surface.... skin, nose, mouth

ZHENG vs XIEZheng= 1) True qi -- especially in opposition to disease

2) The active aspect of all components in maintaining health and resisting disease including: Zang-Fu, Xue, Jing, JinYe, Qi3) Forces that maintain normal Fx and seek to re-establish them when evil is present

Zhen = "True qi is the product of that which is received from Heaven combined w/ grain qi, and which makes the body full" (Heaven=congenital)

Xie = 1) Any entity in its active aspect of harming the body -- especially in opposition to right2) Since evil actively fights right or summons activity of right to eliminate it, it is often called evil qi3) Su Wen "for evil to encroach, the qi must be vacuous"

Zheng vs. Xie 1) Relationship between disease and the potential of the Zheng

A)If Right qi is strong, the fight between Right & Xie will also be strongB)If Right qi is weak, it can't fight XieA tends to be of repletion typeB tends to be of vacuity type or mixed vacuity and repletion

2) Relationship between disease and the quality of the XieA) If Xie is Yang type, it will tend to injure the body's YinB) If Xie is Yin type, it will tend to injure the body's YangA tends to manifest as replete heat typeB tends to manifest as replete cold type or damp-cold type

3) Relationship between disease and the degree of the XieA) If Xie is virulent, the disease is more seriousB) If Xie is not, the disease is easier to treat

4) Relationship between disease and the locationA) Most Xie have a tropism to certain areas of the body

WIND Wind is a Yang evil which is opening & discharging by nature.... it is light & buoyant and most easily invades the upper & outer parts of the body. Wind is swift &changeable. Wind diseases are characterized by changeability & symptoms of unfixed location. Wind is blusterous, violent, and impetuous it can cause severe damage within a short time.

29

Wind, although associated with movement, has the power to check normal movement. Wind diseases may cause stiffness like facial paralysis Wind is a promiscuous evil and readily combines with other evils.

Wind Disease1-Nature = Wind is a Yang evil which is opening & discharging by nature.... Wind is light and

buoyant by nature and most easily invades the upper body and the fleshy exterior. Area = Tends to affect the head and face, causing HA, dizzy, red swollen face and eyes

Often first invades the lung => nasal congestion, sore pharynx & cough2 - Nature - Wind is swift and changeable by nature... wind diseases are characterized by

changeability and symptoms of unfixed locationSigns = wandering pain in the muscles and joints, itching of unfixed loc., fluctuating papular

outthrusts3 - Nature Wind is blusterous, violent, and impetuous...cn cause severe damage with short

space of time.... Signs = Deviated mouth and eyes, clenched jaw, rigidity of limbs....Skin is tissue of the Lung...WH evils often invade mouth & nose which connect w/ Lu. If WH congests in Lu may D Heat =>force Qi to move frenetically Wind is nothing more than frenetic Qi. If it forces the qi in & out through the interstices =>itchy skin

Dryness "When dryness prevails, there is aridity" In Autumn, the weather is dry and dry air entering the lung can cause damage to the liquid (JinYe) of the lung. Signs/symptoms = dry cough with no phlegm or scant sticky phlegm dry lips, tongue, pharynx and nose

Summerheat ALWAYS from external cause Summerheat - heat ---- associated with torrid weather... basically heat stroke or sun stroke Signs/symptoms = high fever, thirst, heart vexation, absence of sweat surging pulse (Hong mai)

*** High fever... "Fire eats Qi" & damages JinYe => lack of strength, short hasty breathing, dry tongue coat Summerheat-damp --- associated with hot, humid weather Signs/symptoms = fluctuating generalized heat effusion, fatigued limbs, poor appetite, chest oppression, nausea & vomit, sloppy diarrhea with ungratifying defecation soggy pulse (ru mai) thick, slimy coat Summerheat-warmth --- infectious encephalitis B

HEAT

30

Fire is a yang evil, it’s nature is upbearing and moving which can lead to non-constrainment. Fire consumes yin fluids. When Fire causes movement of Blood, it leads to reddening. Yellow excretions are ascribed to Heat Heat is yang Qi, qi moves fluids up and out leading to sweating

COLD Cold causes Qi to contract

When cold Qi damages the skin and flesh, the pores close, yang qi contracts, and sweat ceases to flow. When it damages the sinews, the sinews become contracted and tense -- this indicates that the evil has invaded the channels...."Cold is associated with contracture and tautness"

Cold causes contracture and tensionSimilar to first statement but also explains cold's tendency to cause qi to stagnate and blood to become static leading to severe pain. "When cold prevails, there is pain"

"All disease with watery humors that are clear, pure and cold are ascribed to cold"Zhu bing shui ye, sheng che qing leng, jie shu yu hanSigns & Symptoms: Cold, thin, clear excretae.g. runny nose with clear mucusclear phlegmwatery vomituslong voidings of clear urineclear watery diarrhea

The nature of cold as and it's clinical manifestations are similar to those of cold in the natural environmentSigns & symptoms: low temperature, deceleration of activity, and congealingGeneralized or local signs of cold =

desire for warmthaversion to cold pronounced lack of warmth in the extremitiescold and pain in the lower abdomen

Differentiate invasion of cold evil and insufficiency of yang qiDAMPDampness is heavy and turbid --

Heavy -- "All heavy sensations are ascribed to dampness"e.g. heavy-headedness, general heaviness, poss. general aches and sorenessTurbid -- excretions and discharges associated with dampness are turbid or uncleare.g. abnormal discharges of the facial orifices, diarrhea or BM when it is sticky, cloudy

urine, vaginal discharge, weepy skin rashesDampness is a Yin pathogen -- Damp is heavy, turbid and it's nature is watery...all attributed to Yin

Substantial-- Yin pathogens are substantial and will obstruct the Qi Ji or Qi mechanisme.g. oppression of the chest, epigastrium, or abdomen MAY be attributed to dampness, scant urination, uncomfortable bowel movementsMutual consumption of Yin & Yang -- Dampness as a Yin pathogen tends to damage

Yang. Spleen likes dry and is averse to damp, damp evil obstructs the Qi Ji of the spleen (a Yang

31

aspect) and damages the spleens movement and transformation function...which can lead to more dampnessDampness is clammy, viscous and persistent --

Discharge -- discharges due to dampness are usually viscous and turbidDamp diseases -- dampness is persistent so diseases involving dampness are lingering and

become chronice.g. Damp Bi (painful obstruction) eczema, excess body weight

Dampness percolates in the body as in nature --In nature, dampness percolates and seeps down into the ground. In the body, internal

dampness seeps down to the lower burner to cause problems theree.g. edema of the lower extremities, diarrhea, abnormal vaginal discharge

Heavy-headedness Dampness is a yin evil and is heavy and sticky in nature, while wind is a yang evil and tends to attack the upper part of the body. When wind and dampness attack in combination, they first affect the head and block the clear yang, making the clear portals cloudy. If the clear portals become clouded and dampness accumulates, heavy-headedness occurs.Heavy Body Dampness causing heavy body usually arises form enduring exposure to water dampness, such as working in the water, repeatedly being caught in the rain, or from living in a damp environment. Dampness is a yin evil which is sticky, stagnant, heavy and fixed by nature. If dampness invades the body and fixes in the fleshy exterior, the tissues will be filled with more fluid than usual and therefore will be heavier. Thus a feeling of heaviness of the body may occur.drowsiness and fatigue after eating -- The spleen is the latter heaven root of qi and blood engenderment and transformation. It governs the 4 limbs and the flesh and muscles. It also upbears the clear to boost the spirit. If, for any reason, spleen qi becomes vacuous and weak, the spleen will fail to move and transform water and grains or upbear the clear efficiently. As a result, first the spleen will engender less qi and blood, providing less nourishment to the limbs and muscles and giving rise to fatigue and lack of strength. Secondly, the spleen will not upbear the clear to boost the spirit, leading to drowsiness. Water dampness is a yin evil which can obstruct yang, also resulting in drowsiness. When we eat the food adds a load to the vacuous spleen and thus gives rise to drowsiness and fatigue after eating.

Phlegm and dampness are yin turbid evils and are, by nature, heavy and sticky. If phlegm and dampness accumulate in the middle burner, they may encumber the spleen and obstruct or depress spleen yang. if the spleen is encumbered, it will engender less qi and blood, thus providing the limbs...

IF spleen yang is encumbered and depressed, the clear yang...Therefore, if there is phlegm and dampness encumbering the spleen, drowsiness...

6 depressions: qi, blood, damp, food, phlegm, fire. Since Qi is responsible for the movement and transformation of blood, damp, phlegm, and food, if qi becomes depressed, this may result in the stoppage and accumulation of any of these other 4. Any of these 4 yin substances accumulate and obstruct the flow of qi which is yang, this will tend to transform into heat. Qi and blood as the 2 most important. Qi and therefore blood flow is closely related to emotions. Treat diseases by jie yu resolving depression.

PHLEGM-RHEUMTan YinTan = Phlegm Wider meaning than Western idea of sputum

Denotes a viscus fluid that can accumulate anywhere in the body causing a variety of diseaseYin = Rheum

Denotes a thinner, clearer form of accumulated fluidProduction --

32

1) Impaired movement and transformation of fluids associated with disease of the Lung, Spleen &/or Kidney "The spleen is the root of phlegm engenderment" Phlegm Rheum (tan yin) usually arises from dietary irregularities or vacuous yang which

fails to transform dampness.2) Depressive fire (aka transformative fire) "stewing or boiling the juices" (body fluids) may form phlegm but not rheum

6 depressions all transform Fire Overeating spicy, hot, fried foods which ferment dampness, engender heat, and damage

the spleen may lead to formation of phlegm Fire may "stew the juices" causing them to congeal into phlegm

Phlegm-Rheum in clinicAny form of rheum arising as a result of disturbances of the lung, spleen &/or kidney

preventing the movement and transformation of fluid Treatment = Warming & supplementing the spleen & kidney (root)Disinhibiting water & expelling tan yin (branch)

The method of transforming phlegm takes different forms depending on the location and cause of the phlegm patternTransform phlegm and suppress coughDiffuse the Lung and transform phlegmDry Damp and transform phlegmDispel cold and transform phlegmClear heat and transform phlegmDisperse phlegm and soften hardness Treatment for DampnessDispel Dampness = Qu Shi

Any method used to eliminate dampness... each Jiao has a specific methodUpper = Transform DampnessMiddle = Dry DampnessLower = Disinhibit DampnessTransform Dampness Hua Shi -- treat Damp Evil with aromatic medicinalsDry Dampness Zao Shi -- drying Damp Evil with dry bitter medicinalsDisinhbit Dampness Li Shi -- cause Damp Evil to pass out in the urine by the use of dampness-percolating water-disinhibiting medicinals

Yin & YangYin = interior, cold, emptiness (vacuity)Yang = exterior, heat, fullness (repletion)Yin Pattern = Any interior, cold &/or vacuity patternYang Pattern = Any exterior, warm &/or repletion patternYin Evil = Any evil that is yin in nature e.g. cold, dry, damp, phlegmYang Evil = Any evil that is yang in nature e.g. wind, heat, summerheatYin Exuberance with Yang debility = Exuberant yin cold with resulting debilitation of yang qi.

A) Water-damp damaging yang B) Excessive use of cold or cool medicinals

Yin Exuberance with Yang vacuity = Exuberant internal yin cold with emptiness of yang qi

33

Characteristic signs = aversion to cold, cold limbs, diarrhea, water swelling (?) and pale glossy tongue

Yang VacuityInsufficiency of Yang Qi. This is a reduction of the warming and activating power of the bodySigns& SymptomsFatigueLack of strengthShortage of Qi & laziness to speakFear of ColdCold LimbsSpontaneous SweatPale complexionLong voidings of clear urineSloppy stoolTongue: pale, tenderPulse: large, empty or faint,fineTreatment Principle Warming yang and boosting qi

Occassionally watery diarrhea The spleen is the latter heaven root and the Kidneys are the former heaven root. The former heaven warms and steams the spleen yang, promoting its function of dispersing and transforming water and grains. Thus, if, for any reason, kidney yang becomes vacuous and weak, then the spleen will not be warmed and steamed sufficiently and it will not be able to disperse and transform properly. In that case, clear and turbid will not be separated but will pour downward into the intestines. Since Kidney yang also plays a role in the movement and transformation of water fluids, a kidney yang vacuity will only make such water dampness all the worse. In addition, the kidney qi seals and stores, opens and closes, and governs the 2 lower yin. If Kidney Yang qi becomes vacuous and weak, the kidneys may lose control of the securing and astringing of the rear yin or anus. Thus for all of these reasons, there may be diarrheaLong, clear urination Urine is a form of body fluids. It is a turbid fluid not needed by the body and thus excreted. the formation and distribution of fluids depend mainly on the spleen and lungs, while the excretion of the fluids depends mainly of the kidneys. "the kidneys are the water viscus and govern the liquids" It is the qi transformation of kidney qi and yang that steams and evaporates liquids, dividing them into the clear and the turbid. The evaporated clear flows along with qi to moisten the body, while the turbid remainder is excreted as urine. Thus, if for any reason, the kidney yang becomes vacuous and weak, it may not be able to evaporate the clear,. This then will be excreted together with the turbid, giving rise to long, clear urination.Fear of Cold Yang vacuity usually develops from constitutional insufficiency, aging, enduring disease, etc. Yang is responsible for warming the body. Therefore, if yang becomes vacuous and insufficient, it may not be able to warm the body, thus leading to a fear of cold. "Yang Vacuity causes external cold"Fatigue Yang qi is responsible for activity, movement and warming. If, for any reason, the yang qi becomes vacuous, the functions of the Zang Fu lessen and the spirit and the body are not supported. This then leads to fatigueCold hands & feet Yang is supposed to warm the body." The spleen governs the 4 limbs" and the kidneys are where the original yang stays. IF there is yang vacuity, the hands and feet won't get sufficient warmth

34

White complexion Yang qi is responsible for promoting the movement of blood. If there is a yang vacuity, the blood circulation will consequently lack its dynamism and cannot circulate normally. Somnolence If yang is vacuous while yin is exuberant, yang will be repressed and cannot be upborne to warm the spirit light, As it is said, "Yang exuberance leads to insomnia, while yin exuberance leads to hypersomnia" disinclination to speak "the spleen is the source of qi and blood engenderment and transformation" Therefore, if there is spleen qi vacuity, water and grain can't be transformed into essence. Without the finest essence of water and grain, there is nothing from which to make the qi and blood. "the lungs govern qi and control breathing" if there is lung qi vacuity, there will be weak breathing and a disinclination to speakloss of strength in the 4 limbs "the spleen governs the 4 limbs -- the stomach is the sea of the five viscera and six bowels and is responsible for nourishing the sinews" The spleen & stomach are the latter heaven root of the engenderment of qi and blood...if the spleen and stomach become vacuous and weak there will be insufficient qi and blood leading to weakness of the 4 limbs

Yin VacuityThe manifestation of insufficiency of the yin aspect and depletion of liquids and bloodSigns & SymptomsLow-grade feverHeat in the hearts of the palms and solesPostmeridian heat effusionemaciationnight sweatingdry mouth and throatshort voidings of "reddish" urineTongue: red with little or no coatPulse: Forceless, fine, rapidTreatment Principles Enrich Yin (clear heat)Vexation & agitation Yin vacuity easily leads to effulgent yin vacuity fire if vacuous yin fails to check yang. IF this vacuity fire flames upward and disturbs the heart spirit, vexation and agitation will occur.night sweats yin vacuity arises from the loss of blood &/or essence, enduring disease, excessive sexual activity or aging. "yin vacuity causes internal heat, and over-strong yang causes failure to constrain" If internal heat is strong enough to cause non-constrainment of the interstices and forces fluids out, sweating may occur. Yang flows outward when awake and inward when sleeping. Therefore, yin vacuity with internal heat may cause night sweats because any internal heat will become even stronger when yang flows inward at night..."the kidneys store the original yin*vexatious heat in the 5 centers Yin is responsible for controlling yang. If yin becomes vacuous and weak, yang typically becomes hyperactive, thus giving rise to internal heat. The palms of the hands, soles of the feet and the heart and chest all pertain to yin and the interior from the point of view of Chinese anatomy. Therefore, vexatious heat due to yin vacuity manifests in those areas described as anatomically yin* chronic dry sore throat May be due to congenital insufficiency, sexual taxation, chronic disease or aging. IF there is kidney yin vacuity, the throat will not be sufficiently nourished. In

35

addition, yin vacuity fire may ascend, congesting in and burning the throat. Therefore sore swollen throat

If there is kidney yin vacuity, yang will not be checked properly ad the frenetic movement of ministerial fire may ensue. If this fire flames upward and burns the throat, fluids there will be damaged and thus a dry throat may occur.* wasting & thirsting disorder If for any reason, yin becomes vacuous, yang may become hyperactive, giving rise to internal heat. Heat is a yang evil which may consume and damage yin. If internal heat continuously consumes already vacuous fluids, yin fluids will become even more vacuous. Therefore, doubly damaged yin fluids will be even less able to control yang and hence give rise to even more effulgent yin vacuity fire. This then forms a pathological loop or cycle -- heat damages yin giving rise to more heat which damages yin even more. Blood and fluids share the same source, and both are responsible for nourishing and moistening the flesh. If the above pathological chain reaction continues to deteriorate, yin fluids will become exhausted, and the flesh will not receive sufficient nourishment and moistening, thus emaciation may occur.EPIDEMIC QI & FIRE TOXINSEpidemic disease - transmissible disease affecting many in a communityPestilential Qi - any disease that is highly contagious... formerly believed to be the result of abnormal weather conditions.Fire Toxin - Evil Qi due to Fire that causes painful reddening and swelling, suppuration, or weeping discharge

36

Internal Damage by 7 AffectsAnger causes Qi to rise (is Qi rising) & damages the LiverLiver qi thrives by orderly reaching and is averse to repression. Excessive emotional stimulus violates the doctrine of the mean and damages the liver causing it to fail to perform it's duty of coursing and discharge. Signs & Symptoms Those of liver depression qi stagnation gan yu qi zhiTreatment Principles Course the liver rectify the qi & RELAX!!!Fear causes Qi to precipitate & damages the kidney (xia)Kidneys govern securing and astringing the two lower yin. Fear causes precipitation of qi and damages kidney qi.Signs & Symptoms Those of Kidney qi vacuity shen qi xuTreatment Principles Supplement & Boost Kidney QiFright causes derangement of Qi & damages the Heart & Kidneys (luan)Fright upsets the qi dynamic and throws qi & blood into disorder causing disquietude of the heart spirit and even mental derangementSigns & Symptoms & Treatment Principles depends on the damageJoy causes qi to slacken and damages the heart (huan)Excessive joy leads to a dissipation of the essence-spiritSigns & Symptoms Those of heart qi vacuity xin qi xuTreatment Principles Supplement & Boost heart QiSorrow disperses qi and damages the lung (xiao)Excessive sorrow and grief cause depression in the upper burner that transforms into heat, which disperses and wears the lung qiSigns & Symptoms crying, heat vexation and agitation, insufficient spirit qiTreatment Principles clear depressive heat in the lungsThought & worry bind the qi and damage the spleen & lungs (jie)Excessive thought causes binding depression of spleen qi, affecting movement and transformation In TCM, excesses of the 7 affects is seen to cause disturbances of the qi and depletion of the true yin of the viscera & bowels (ZangFu) causing heat signs... "the 5 minds transform fire" wu zhi hua huo206

37

DIETFormer Heaven Essence -- finite amount received from parents determines the length and quality of lifeLatter Heaven Essence -- manufactured from the food and drink ingested and bolsters the Former Heaven

At night, when we sleep, the excess qi and blood that was not consumed during the day is converted to latter heaven essence and stored in the kidneys. This is why proper diet and good digestion as well as proper rest and sleep are so important!!!Digestion -- The stomach is like a cooking pot where the food "rottens and ripens" The spleen is the fire beneath the pot and the "distillation mechanism" to which the pot is attached. The clear (qing)& the turbid (zhuo) The spleen "distills" the purest part of food and drink and sends this upwards. The pure of foods goes to the lungs and the pure part of the liquids goes to the heart.

The stomach descends the turbid part of the food to the large intestine for further absorption and the turbid part of the liquids to the small intestine for further separation of the clear and the turbid.

The stomach is averse to dryness -- the stomach wants to create a soup in the potThe spleen is averse to dampness -- too much water or dampness can douse the fire

Cooked vs Raw Cooking is predigestion and makes food more digestible. Most people, most of the time, should eat cooked food. This begins the "rottening and ripening"Cold food & drinks -- All transformation in the body is warm transformation as the host qi of the body is warm. Thus, to "cook" the mash in the stomach, the spleen must expend more Qi to warm the cold food to the proper temperature. This weakens the spleen/stomach which then fail to adequately move and transform foods and liquids and a type of sludge accumulates. This sludge is stagnated food and dampness.Damp & Phlegm -- Too large portions, too much cold food and drinks or too much difficult to digest foods cause the spleen/stomach to weaken and lead to accumulation of stagnant food in the stomach.

The stomach heats up in an attempt to burn off the accumulation and may become chronically hot. This heat in the stomach is sensed as hunger.The stagnant food tends to obstruct the qi ji of the spleen, further weakening the spleen which may fail in it's duty to move and transform body fluids. These body fluids may accumulate to form evil dampness and when combined with heat (perhaps from the stomach) may then congeal to form evil phlegm.Qi & Wei All foods (all things) are a combination of qi and wei. Qi is the light, airy, aromatic and yang part of a thing. Wei literally means taste and refers to the heavier, more substantial, more nourishing, yin aspectDairy products, meats, nuts, eggs, oils and fats are rich is Wei and thus can nourish the yin aspect of the body. In excess, they damage the spleen and lead to the accumulation of evil dampness and phlegm.Flavors & Spices -- We think of all things as a combination of 5 flavors: sweet, acrid, salty, bitter, sour...sometimes we acknowledge a 6th flavor = blandSmall amount of sweet is good and supplements Qi (nobody does this either)Most spices are acrid and warm or hot. In moderation, they aid digestion by strengthening the middle burner fireGood ones = cardamom, cinnamon, ginger, nutmeg, mace, clovesSpices are rich in Qi and less weiModerate use is good for the spleen....overuse heats up and dries the stomach (doesn't like it)Sum it up -- Humans are omnivoires and should consume a wide variety of foods. Eat mostly vegetables and grains and small amounts of everything elseDietary Therapy -- 1)Treat based on the PATTERN!!!!!2) Protect and promote the Spleen & Stomach3) Avoid prohibited foods

38

Damage by the 5 TaxationsProlonged vision damages the bloodProlonged lying damages the QiProlonged sitting damages the FleshProlonged standing damages the bonesProlonged walking damages the sinews

Damage by the 5 FlavorsToo much sour causes the liver qi fullness with consequent spleen qi xuToo much salt taxes the qi of the large bones and wither the flesh in addition to repressing the heart qiToo much sweet causes the heart qi to be full and stuffy, the facial color blackish, and the kidney qi not balancedToo much bitter causes the spleen qi to lose its moisture and the stomach qi to become too broad (distended)Too much acrid causes the sinews to be slack and the vessels stopped up while the essence spirit suffers disaster.

7 DamagesGreat overeating damages the spleenGreat anger and qi counterflow damages the liverExertion or lifting heavy weights and long sitting on wet ground damages the kidneyCold in the body and cold drinks damage the lungAnxiety, worry, and thought and cognition damage the heartWind, rain, cold and summerheat damage the bodyGreat fear damages the mind

Loss of harmony of qi & blood: the main cause of diseaseQi & Blood disharmony of the heart = palpitations and shortness of breath aggravated by movement. The heart spirit will not be quiet and there will be insomnia, poor memory, and excessive dreamsQi & Blood disharmony of the lungs = cough and panting with copious phlegm worse with movement as well as spontaneous sweatQi & Blood disharmony in the spleen = sallow yellow complexion, weakness and fatigue of the 4 limbs, abdominal distention after eating, loose stools, poss. uterine bleeding or bloody stoolsQi & Blood disharmony of the liver = emotional depression, timidity, dry eyes or diminished vision, numbness in the extremities, lusterless nails, and spasms of the sinews and vesselsQi & Blood disharmony of the kidney = low back soreness, weak knees, tinnitus, deafness, poor memoryLoss of harmony of the qi and blood manifests pathologically as disease within the human body and loss of regulation of viscera and bowels. These both have a close relationship with the production of various pathological metabolic products, such as blood stasis and phlegm turbidity By coursing, freeing the flow, regulating, and harmonizing the qi and blood, one can regulate the functions of the viscera and bowls and the body's tissues, disperse and eliminate static blood, phlegm turbidity and other such evils and convert a pathological situation into normalQi & Blood vacuity weaknessQi vacuity is a diminishment of the function of the ZangFu and a lowering of the resistance to disease. The production and spread of qi are closely related to the lungs, spleen and kidneys

39

Blood vacuity means an insufficiency of constructing and nourishing blood in the body. Pathological changes in the blood are most prominent in the liver, spleen and kidneysQi & Blood vacuity weakness refers to the pathological condition of blood vacuity caused by qi vacuity...the vacuous qi is unable to engender bloodQi vacuity & Blood stasisQi vacuity results in the movement of the blood being inhibited. Qi vacuity is the root and blood stasis is merely a branch symptom, this is repletion in the midst of vacuity. After taxation and fatigue, the symptoms of blood stasis become worse. The over-taxation aggravates the qi vacuity, making it more difficult to propel the bloodQi stagnation & blood stasisThere is not only qi stagnation leading to blood stasis...but also blood stasis leading to qi stagnation. Commonly observed to do with loss of the liver's coursing and discharge. Liver depression leads to qi stagnation. If qi stagnation endures, it will lead to the formation of blood stasisQi counterflow & Blood counterflow There is confusion and chaos of the qi mechanism. The qi mechanism counterflows and does not flow normally which results in pathological symptoms of reckless movement of the blood. This mostly manifests as diseases of the cerebral blood vesselsQi not containing the BloodVacuous qi in not able to contain and restrain the blood which exits causing various types of hemorrhagic conditions. This in mostly due to enduring illness damaging spleen qi.Joining and binding of phlegm & stasisThis is qi stagnation and phlegm obstruction resulting in the blood's not moving uninhibitedly. If blood stasis stagnates internally, it may cause stoppage of the fluids and humors and this may also cause the pathological pattern of phlegm and stasis mutually binding togetherPhlegm is a yin turbid evil and will cause stagnation in the coming and going of the qi. This will gather and the blood will congeal and even more phlegm will be produced.Static blood obstructing internally may also affect the functioning of the viscera and bowels leading to their loss of command of the spread of fluids and humors with the subsequent engenderment of phlegm turbidity

40

41