treatment 3) bleeding under the skin a) blood heat signs & symptoms: –main sym. : suddenly...

TreatmentTreatment 3) Bleeding under the skin

A) Blood heatSigns & Symptoms:

– Main Sym. : Suddenly onset, purple spots or plague in skin– Concurrent sym.: blood from other sites such as nose, intestines

or bladder, mental restlessness, thirsty, constipation, fever at night.

– Tongue: red body without coating, red points all over

– Pulse: rapid & fine

• Treatment Protocol:

– Expel poison– Clear away heat– Cool blood to stop bleeding

Formula:

Modifications:

Harmonize blood (stop bleeding, eliminate stasis, calm & nourish blood)

-- Qian Cao Geng, Di Yu, Gou Qi ZiAstringe

-- Shan Zhu YuAbdomen pain + hematochezia

-- Mai Dong, Yu Zhu , Tian hua fengBlood heat is very pronounced

-- Zi Cao

Xi Jiao Di Huang Tang

Shui Niu Jiao Shen Di Mu Dan Pi Chi Shao Shi Gao Zhi Mui

Zhi Zi Ce Pai Ye Gan Cao


B) Yin def. type empty heatSigns & Symptoms:

– Main Sym. : purple spots or plague under the skin– Concurrent sym.: blood from other sites such as nose, intestines

or bladder, flush cheek, restless, hot sensation in the palms & soles. Thirsty, lower fever, night sweating.

– Tongue: red body without coating, red points all over

– Pulse: floating-empty or slightly-rapid


– Nourish Yin– Clear empty heat– Stop bleeding

Formula:

Modifications:

Yin Def.

-- Gui Ban, Bie Jia, xuan sheng, nu zhen zi, han lian cao

Kidney Yin Def.

-- Liu Wei Di Huang Wan

Qian Gen San

Qian Cao Gen Huang Qi Er Jiao Ce Bai Ye


C) Qi Def. fail to govern the bloodSigns & Symptoms:

– Main Sym. : Chronic purple spots or plague under the skin opens from time to time

– Concurrent sym.: dizziness, poor appetite, mental & physical lassitude, pale or swallow complexion

– Tongue: swollen light color with white thin fur

– Pulse: thready & weak


– Tonify Qi to govern blood

Formula:

Modifications:

Stop Bleeding -- Xian He Cao, Zhong Lu Tan, San Qi, Pu

Huang, Qian Geng Tan, Xue Yu TanLoose stools

-- Shan Yao, Lian Zi rou, Qian ShiKid Def.

-- Tu Si Zi, Shan Yu Rou, Xu DuanKid Yang Def.

-- Xian Mao, Rou Gui

Gui Pi Tang

Dang Shen Huang Qi Bai Zhu Dang Gui Fu Ling Suan Zhao Ren

Long Yan Mu Xiang Yuan Zhi Sheng Jiang Da Zhao

TreatmentTreatment 4) Coughing blood

A) Wind-Dry-HeatSigns & Symptoms:

– Main Sym. : Itchy throat, cough with blood-tinged sputum– Concurrent sym.: dry mouth & nose, light aversion to cold, stuff

nose & headache, nosebleed, – Tongue:

Red on the sides and front part, dry– Pulse:

Floating rapid


– Expel wind– Clear heat– Stop bleeding

Formula:

Modifications:

Lung heat -- Shi Gao

Stop bleeding-- Qian Cao, Ou Jie

Wind-heat-- Yin Hua, Lian Qiao, Niu Pang Zi, Ju Hua

Fluid damage-- Mai Dong, Xuan Shen, Tian Hua Feng

Sang Xing Tang

Sang Ye Xing Ren Sha Shen Bei Mu Zhi Mu Huang Qin

Shan Zhi Zi Sang Bai Pi Ce Bai ye Bai Mao Gen

Dan Dou chi


B) Liver fire invading lungSigns & Symptoms:

– Main Sym. : Cough with fresh-red blood in sputum– Concurrent sym.: Hypochondrial pain, irritability, easily lose

temper, a bitter taste– Tongue:

Red with yellow coating– Pulse:

wiry & rapid


– Clear Liver-Fire– Clear the lungs– Cool blood to stop bleeding

Formula:

Modifications:

Lung heat -- Huang Qin, Zhi Mu, Shi Gao

Stop bleeding-- Ce Bai Ye, Bai Mao Geng, Han Lian Cao, Da Ji, Xiao Ji,

Qian Cao, Ou JieLiver Fire

-- Dan Pi, Zhi Zi, Huang QinAbundant fresh-red color blood

-- Xi Jiao Di Huang Tang + San Qi, Da Huang To treat Qi Rebellion

-- Mu Li, Niu Xi

Xie Bai San + Dai Ge San

Sang Bai Pi Di Gu Pi Gan Cao Jin Mi Qin Dai Hai Ge Ke


C) Lung-Yin Def. with empty heatSigns & Symptoms:

– Main Sym. : Cough with scanty blood-tinged sputum– Concurrent sym.: dry throat, afternoon fever or feeling of heat,

night sweating, 5-palm heat– Tongue:

Red without coating, dry– Pulse:

float empty


– Nourish Lung Yin– Clear empty-heat– Stop bleeding

Formula:

Modifications:

Lung heat -- Bai Wei, Qin Hao, Bie Jia

Stop bleeding-- Ce Bai Ye

Night sweating-- Ru Dao Geng, Fu xiao mai, wu wei zi, Mu li

Bai He Gu Jing Wan

Bai He Sheng di Mai Dong Xuan Shen Bai shao Di Gu Pi

Bei Mu Ce bai ye Bai Mao gen Bai Ji Gan Cao Dang Gui

Case History

1. Female 67 years Medical history:Medical history: She had TB of the lungs for 40 years, had been suffering from breathlessness for many years. First visiting:First visiting:

Main complain: coughing of blood-specked sputum breathlessness on exertion, general exhaustion and

coughing of blood sputum. Night sweating, dry throat, and fever in the afternoon, was very prone to cold which immediately affected her chest and caused bronchitis with the expectoration of profuse yellow-greenish sputum. Overweight body type,

Tongue: slightly red, swollen with a rootless coating in the front part Pulse: Slippery

TCM diagnose: Lung Yin Def. + Spleen Qi Def.

Treatment protocol:Nourish Lu. Yin, Clear Empty-heat, Tonify Sp Qi &

resolve Phlegm Formula:

Bai He Gu Jing Wan

TreatmentTreatment 5) Blood in the stools

A) Damp-heat in the intestinesSigns & Symptoms:

– Main Sym. : Fresh blood in the stools– Concurrent sym.: loose and frequent stools with mucus, burning

sensation in the anus, abdominal pain– Tongue:

Red with yellow-sticky coating on root, with red spots– Pulse:

slippery-rapid


– Resolve dampness– Clear heat– Stop bleeding

Formula:

Modifications:

Yin Def.

-- Bai Shao, E Jiao, Shen Di

Stop bleeding

-- Bai Ji

Di Yu San

Di Yu Qian Cao Geng Huang Qin Huang Lian Zhi Zi Fu ling

TreatmentTreatment 5) Blood in the stools

B) Stomach & Spleen Def.Signs & Symptoms:

– Main Sym. : Profuse fresh blood in the stools– Concurrent sym.: slight abdominal pain, pale face, exhaustion,

depression, loose & frequent stools with mucus– Tongue:

pale tongue– Pulse:

thready weak


– Strength the spleen– Warm the centre– Stop bleeding

Formula:

Modifications:

Yang Def.

-- Lu Jiao Shuang, Pao Jiang, Ai Ye

Stop bleeding

-- Bai Ji, Wu Zei Gu

Huang Tu Tang

Zao Xing Tu Gan Cao Shen Di Huang Bai Zhu Fu Zi Er Jiao

Huang Qin

Case History

1. male 60 years First visiting:First visiting:

Main complain: Blood in the stools for 2 years No abdomen pain and his bowl movements were loose and

very frequent. The blood was fresh-red and haemorrhoids were excluded as a cause of bleeding. He felt very tired most of the time and felt the cold very much. Even in summertime on a hot day when he came for his consultation he had a jumper and a jacket on.

Tongue: Pale swollen and had a white-sticky coating Pulse: Generally weak, especially so on the right-middle position

TCM diagnose: Spleen Yang Def. + Internal cold

Treatment protocol:Tonify & warm Sp yang

Formula:Li Zhong Tang

TreatmentTreatment 6) Blood in the Urine

A) Bladder HeatSigns & Symptoms:

– Main Sym. : Scanty-dark urine with fresh blood– Concurrent sym.: Mental restlessness, thirsty, insomnia,

red face, tongue ulcers, bitter taste– Tongue:

Red with redder tip, with yellow spots, or red spots on the root

– Pulse: Rapid, slightly overflowing


– Clear heat from bladder– Stop bleeding

Formula:

Modifications:

Xiao Ji Ying Zi

Sheng Di Xiao Ji Hua Shi Tong Cao Pu Huang Dan Zu Ye

Ou Jie Dang Gui Shan Zhi Zi Gan Cao


B) Kidney Yin def. with empty-heatSigns & Symptoms:

– Main Sym. : Scanty-dark urine with blood– Concurrent sym.: dizziness, tinnitus, back-ache, exhaustion,

feeling fever in the afternoon, night sweating– Tongue:

Red without coating– Pulse:

floating-empty


– Nourish kidney Yin– Clear empty heat– Stop bleeding

Formula:

Modifications:Empty Heat

-- Han Lian Cao, Qing Hao

Zhi Pai Di Huang Wan

Zhi Mu Huang Bai Shu di Shan yao Ze xie Fu ling

Mu Dan Pi Zhi Mu


C) Spleen Def. not controlling bloodSigns & Symptoms:

– Main Sym. : Chronic bleeding in the urine– Concurrent sym.: dizziness, tiredness, pale face, no

appetite, depression– Tongue:

Pale– Pulse:

weak


– Tonify the spleen – Stop bleeding

Formula:

Modifications:

Stop Bleeding -- Xian He Cao, Zhong Lu Tan, San Qi, Pu

Huang, Qian Geng Tan, Xue Yu TanLoose stools

-- Shan Yao, Lian Zi rou, Qian ShiTo treat Qi

-- Shen Ma, Cai Hu

Gui Pi Tang


Long Yan Mu Xiang Dang Gui Yuan Zhi Sheng Jiang Da Zhao


B) Kidney Qi not firmSigns & Symptoms:

– Main Sym. : Chronic bleeding in the urine with pale blood– Concurrent sym.: dizziness, tinnitus, sore-back,

exhaustion– Tongue:

Pale & swollen– Pulse:

weak


– Tonify kidney Yang– Stop bleeding

Formula:

Modifications:

Stop Bleeding

-- Xian He Cao, Zhong Lu Tan, San Qi, Pu Huang, Qian Geng Tan, Xue Yu Tan

Wu Bi Shang Yao Wan

Shao Yao Rou Cong Rong Tu Si Zi Ba Ji Tian Du Zhong Shu Di

Niu Xi Shan Zhu Yu Ze Xie Wu Wei Zi Chi Shi Zhi Fu Shen

Case History

1. Male 75 years First visiting:First visiting:

Main complain: bleeding in the urine for 3 months no pain on urination and the blood was dark,

sometimes with tiny clots. He felt generally hot and his mouth felt very dry and hot

Tongue: Red dry and nearly completely peeled Pulse: Floating-empty

TCM diagnose: Kid. Yin def. + empty fire

Treatment protocol:Nourish Kidney yin, clear empty fire, stop

bleeding Formula:

Sheng di 6, Shan Zhu Yu 3, Shan Yao 6, Ze Xie 4, Fu Ling 6, Mu Dan Pi 6, Zhi Mu 4, Huang Bo4, Xiao Ji 6, Pu Huang 4, Dang Gui 6, Mu Li 12

PalpitationPalpitation TCM Diagnoses and Treatments Palpitation involves pavor and severe palpitation which

denote the subjective symptoms of the patients: pulsation, terror & unease

Etiology & Pathology:Main pathogenesis of bleeding: The focus of the disease is at Heart (Sp. Kid. Liv.

Lu.)1) Lacking of self-confidence & timid2) Heart blood insufficient3) Hyperactivity of fire due to Yin

def.4) Heart Yang Def.5) Excessive fluid invades the heart6) Blood stasis blocked channels

TreatmentTreatment 1) Timid

Signs & Symptoms:

– Main Sym. : Palpitation, usually frightened and liable to anger

– Concurrent sym.: feel restless, sleeplessness, dreaminess

– Tongue: thin and whitish fur or normal

– Pulse: weakly rapid, knotted or intermittent or string-like


– Calming the mind– Nourish the heart

Formula:

Modifications:

Calm the mind -- Ci Shi, Hu Po,

Heart Qi Def.-- Dang Shen, Zhi Gan Cao

Heart Yin Def.-- Bo Zi Ren, Wu Wei Zi, Suan Zhao Ren

An Shen ding Zhi Wan

Fu Ling Fu Shen Yuan Zhi Ren Sheng Shi Chang Pu Long Chi

TreatmentTreatment 2) Heart blood insufficient

Signs & Symptoms:

– Main Sym. : Palpitation, dizziness & weakness

– Concurrent sym.: pale complexion, tiredness, fatigue– Tongue:

light red– Pulse:

thin & weak


– Nourish heart blood– Calm down mind

Formula:

Modifications:

Tonify heart Qi

-- Zhi Gan Cao

Gui Pi Tang


Long Yan Mu Xiang Dang Gui Yuan Zhi Sheng Jiang Da Zhao

TreatmentTreatment 3) Hyperactivity of fire due to Yin def.

Signs & Symptoms:

– Main Sym. : Palpitation, unease, vexation, sleeplessness

– Concurrent sym.: feverish sensation in the palms and soles, soreness of waist, tinnitus, dizziness,

– Tongue: red tongue, without coating

– Pulse: thin & rapid


– Nourish yin & purging fire– Calm down mind

Formula:

Modifications:

Empty fire of heart sym. ( dry mouth, throat, restless)-- Huang Lian, or Zhi Bai Di Huang Wan

Heart Qi Def.-- Dang Shen, Zhi Gan Cao

Heart Yin Def.-- Bo Zi Ren, Wu Wei Zi, Suan Zhao Ren

Tian Wang Bu Xing Dan

Ren Sheng Dan Sheng Fu Ling Wu Wei Zi Yuan Zhi Jie Geng

Dang gui Tian Dong Mai Dong Bo Zi Ren Suan Zhao Ren Shen Di

TreatmentTreatment 4) Heart Yang Def.

Signs & Symptoms:

– Main Sym. : Palpitation, restlessness, oppressed feeling in chest, shortness of breath

– Concurrent sym.: pale complexion, cold limbs– Tongue:

light whitish tongue, – Pulse:

weak or deep thin or infrequent, knotted or intermittent


– Warm heart yang– Calm down mind

Formula:

Modifications:Warm Yang

-- Fu Zhi, Gan Jiang

Tonify Heart Qi

-- Huang Qi, Huang Jing

Gui Zhi Gan Cao Long Gu Mu Li Tang

Gui Zhi Long Gu Mu Li Gan Cao

TreatmentTreatment 5) Excessive fluid invades heart.

Signs & Symptoms:

– Main Sym. : Palpitation, restlessness, oppressed feeling in chest, dyspnea, edema

– Concurrent sym.: dizziness, cold limbs, feeling of stuffiness and fullness in the chest, thirst, nausea and vomiting of water fluid

– Tongue: whitish & slippery coating,

– Pulse: taut & slippery pulse


– Activating the heart yang– Promoting the circulation of qi to induce diuresis

Formula:

Modifications:Nausea & vomiting

-- Ban Xia, Chen Pi, Sheng JiangKidney Yang def.

-- Zhen Wu Tang

Lin Gui Zhu Gan Tang

Gui Zhi Fu Ling Bai Zhu Gan Cao

TreatmentTreatment 6) Heart blood stasis

Signs & Symptoms:

– Main Sym. : Palpitation, restlessness, chest pain

– Concurrent sym.: oppressed feeling in chest, unease, dark purple lips and nails

– Tongue: dark purple ,

– Pulse: knotted, intermittent or uneven


– Remove blood stasis

Formula:

Modifications:Warm heart Yang

-- Gui Zhi, Gan CaoCalm mind

-- Long Gu, Mu LiPhlegm block the channel

-- Gua Lou xie bai Ban Xia Tang

Tao Ren Hong Hua Tang

Tao Ren Hong Hua Dan shen Chi Shao Chuan Xiong Yuan Hu

Xiang Fu Qing Pi Shen Di Dang Gui

Case History

1. Female 54 yearsMedical History:Medical History: Patient had a fever 2 month ago, after the fever was gone, patient started feeling palpitation. She had looked for several doctors, but no one can help her, which caused her feel depressed. She could sit whole day quietly without talking to anyone… First visiting:First visiting:

Main complainMain complain: Palpitation for 2 month Insomnia, lower fever sometimes, small quantity of menstrual

flow with light color blood Tongue:Tongue: Pale body with thin white coating PulsePulse: Floating-empty

TCM diagnoseTCM diagnose: Depression damage Sp. FunctionSp Qi & Heart Blood Def.

Treatment protocolTreatment protocol:Tonify Sp Qi & heart blood

Formula:Formula:Ren Shen 5, Bai Zhu 10, Huang Qi 10, Zhi Gan Cao

10, Dang Gui 10, Fu Shen 10, Yuan Zhi 10, Suan zhao ren 30, Mu Xiang 3, Ye Jiao Teng 15, Bai shao 15, Sheng Jiang 5 p, Da Zhao 3 p

treatment 3) bleeding under the skin a) blood heat signs & symptoms: –main sym. : suddenly...

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