CASE STUDIES - Com Cold & Influenza Quiz Flashcards
Common Cold & Influenza
The common cold and flu are viral infections of the upper respiratory tract. The common cold may be caused by a variety of viruses including the adenovirus, echovirus, parainfluenza virus, respiratory syncytial virus and rhinovirus
Influenza may be caused by the influenza viruses A, B or C.
In TCM, both the common cold and flu correspond to invasions of exterior Wind. This can manifest as WC, WH, Wind damp heat, Wind dry heat.
WC and WH are the 2 most common types and the 2 types that encompass exterior manifestations.
Wind in TCM
If Wind combines with Cold with a prevalence of the latter, there will be no sweating because Cold contracts the pores. The pulse will be Tight: this corresponds to Attack of Cold of the Tai Yang in the Six stage division.
This is more likely to happen when a person has a relatively strong constitution and a tendancy to Excess patterns; then the body’s defensive Qi reacts strongly, the pores will be closed and there will be no sweating. This is an Exterior-Full pattern.
Wind in TCM
Aversion to Cold or Wind is a characteristic and essential symptom of invasion of exterior Wind and consists not only in feeling cold and shivering but also in reluctance to go outside in the cold. The aversion is not relieved by covering oneself.
Wind in TCM
The Lungs control the spreading of Wei Qi in the exterior of the body and also the opening and closing of pores. The presence of Wind in the space between the skin and the muscles interferes with the diffusing and descending of Lung Qi preventing the spreading and descending of Lung fluids, resulting in a runny nose with profuse white discharge.
Wind in TCM
The fight between the pathogenic Wind and Defensive Qi in the skin and muscles may cause fever, which is not necessarily an actual fever but an objective feeling of the patient’s body on palpation. It is the simultaneous occurrence of aversion to cold (subjective) and emission of heat (objective) that marks an invasion of external Wind.
Wind in TCM
Wind attacks the most superficial channels first, which are the Tai Yang channels and obstructs the circulation of Wei Qi within them: this causes stiffness and pain along these channels and particularly in the back of the neck.
Wind attacks the top part of the body and often lodges in the throat, causing an itchy sensation in the throat.
Wind in TCM
If Wind combines with Cold with a prevalence of the latter, there will be no sweating because Cold contracts the pores. The pulse will be Tight: this corresponds to Attack of Cold of the Tai Yang in the Six stage division.
This is more likely to happen when a person has a relatively strong constitution and a tendancy to Excess patterns; then the body’s defensive Qi reacts strongly, the pores will be closed and there will be no sweating. This is an Exterior-Full pattern.
Wind in TCM
If in a WC attack, Wind predominates, the pores are open, the person sweats slightly and the pulse will be slow: this corresponds to the Attack of Wind pattern of the Tai Yang Stage within the Six Stages.
This is more likely to happen with someone of a weak constitution and a tendency to deficiency patterns: then the Ying Qi is weak the pores are open and there will be slight sweating. This is an Exterior-Empty pattern.
With the invasion of exterior Wind, Wei Qi reacts by rushing to the Exterior of the body, and this is reflected on the pulse which becomes more superficial or floating.
Wind in TCM
Summary: S/S of invasion of Exterior Wind: Aversion to cold or wind “fever” or emission of heat Sneezing or cough Runny nose Occipital stiffness and ache Itchy throat Sweating depending on whether Wind or Cold is predominant Floating Pulse
Wind in TCM
External Wind combines with other Pathogenic factors primarily Cold, Heat, Dampness and Water.
The following is an outline of the clinical manifestations of five types of exterior Wind:
Wind-Cold
Wind-Heat
Wind-Dampness
Wind-Dryness
Wind-Water
Wind in TCM
Wind-Cold S/S:
Aversion to cold, sneezing, cough, runny nose with white-watery mucus, fever, severe occipital stiffness and ache, no sweating, no thirst, Floating-Tight pulse, tongue body color unchanged, thin-white coat.
Wind in TCM
Wind-Heat S/S:
Aversion to cold, fever, sneezing, cough, runny nose with slightly yellow mucus, occipital stiffness and ache, slight sweating, itchy throat, sore throat, swollen tonsils, thirst, Floating-rapid pulse. Tongue body Red on the tip or sides, thin-white coating.
Wind in TCM
Wind-Dampness S/S:
Aversion to cold, fever, swollen neck glands, nausea, sweating, occipital stiffness, body aches, muscle aches, feeling of heaviness of the body, swollen joints, Floating-Slippery pulse.
Wind in TCM
Wind-Dryness S/S:
Fever, slight aversion to cold, slight sweating, dry skin, nose, mouth and throat, dry cough, sore throat, dry tongue with thin-white coating. Floating-rapid pulse
Wind in TCM
Wind-Water S/S:
Aversion to cold, fever, edema especially on the face, swollen face and eyes, cough with profuse white and watery mucus, sweating, no thirst, Floating pulse.
The concept of Warm Disease/ Wen Bing
The meaning of Warm Disease is outlined by 2 principles of understanding:
The School of Warm Disease postulates that some exterior pathogenic factors go beyond the natural characteristics of Wind and are so virulent and strong that no matter how strong a person’s body’s Qi may be, men, women and children fall ill by the dozen.
More importantly, for the first time ever in the history of Chinese medicine, these doctors recognized that some external pathogenic factors are infectious.
A further innovative idea stemming from this school was that the pathogenic factors causing Warm diseases, all of them fall under the category of Wind-Heat, enter the nose and mouth, rather than via the skin as happens for Wind-Cold.
The concept of Warm Disease/ Wen Bing
The essential characteristics of Warm diseases are therefore as follows:
They manifest with the general symptoms and signs of Wind-Heat in the early stages (Wind-Heat is intended here in a broad sense and includes Damp Heat, Summer Heat, Winter Heat, Spring Heat and Dry Heat.)
There is always a fever
They are infectious
The WH penetrates via the nose and mouth
The pathogenic factor is particularly strong.
The concept of Warm Disease/ Wen Bing
All pathogenic factors contemplated by the School of Warm Diseases fall under the broad definition of WH, not all diseases that are WH are Warm diseases.
Examples of Warm Diseases: measles, chickenpox, German measles, polio-myelitis, smallpox, scarlet fever, whooping cough or meningitis.
Examples of Wind Heat disease that are not Warm Disease: common cold with WH S/S, flu, glandular fever or mononucleosis, or any other non-specific upper respiratory infection manifesting with symptoms of WH.
The concept of Warm Disease/ Wen Bing
As Wind is a pathogenic factor in the early stages of any exterior disease (whether Warm disease or not), by releasing the Exterior and expelling Wind we may stop any exterior invasion at its beginning.
Although this is possible for simple invasions of WH, this is not possible for Warm disease.
Since symptoms are similar in the beginning and it’s impossible to tell whether it’s WH or Warm disease, the exterior should still be released. Warm disease may not be stopped completely, but Chinese medicine can alleviate symptoms, shorten the course of the disease and prevent complications.
The concept of Warm Disease/ Wen Bing
Common Cold and Flu have a prominent place in TCM because Chinese medicine views these diseases differently from Western medicine, believing that if external Wind is allowed to penetrate the interior it can trigger many different diseases; it is therefore important to eliminate the pathogenic factor as early as possible.
The treatment of exterior invasions is also important because they can have very serious consequences in children and the elderly. It is important to treat the manifestations early.
Etiology and Pathology
An invasion of an exterior pathogenic factor is due to a temporary and relative imbalance between it and the body’s Qi.
This imbalance may occur either because the body’s qi is temporarily and relatively weak or because the pathogenic factor is very strong.
On the other hand, a particularly strong pathogenic factor may cause an exterior invasion of Wind no matter how strong the body’s Qi is.
Etiology and Pathology
Wind indicates both an etiological factor and a pathological condition.
Etiologically it refers to climatic influences and especially sudden changes of weather to which the body cannot adapt.
Pathologically, “Wind” refers to a complex of symptoms and signs manifesting as WC or WH.
There are chronic conditions that manifest as “Wind” and are treated as such even though they have no relation to climatic factors, such as allergic rhinitis.
ID of Patterns and Treatment
The treatment principle of common cold and flu must be solidly based on the differentiation between Wei Qi and Qi levels.
At the Wei Qi level it is imperative to release the exterior and expel wind.
At the Qi Level, the treatment principle is to clear heat at the Qi level.
ID of Patterns and Treatment
Exterior Patterns, Wei Level Wind-Cold, prevalence of Cold Wind-Cold, prevalence of Wind Wind-Heat Wind-Damp Heat Wind-Dry Heat
ID of Patterns and Treatment
Interior Patterns at the Qi Level: Lung Heat Lung Phlegm Heat Stomach Heat Stomach and Intestines Dry Heat Gall Bladder Heat Shao Yang pattern Stomach and Spleen Damp Heat
ID of Patterns and Treatment
Wind-Cold, prevalence of Cold:
Clinical Manifestations:
Aversion to cold, shivering, fever, no sweating, occipital headache, stiff neck, body aches, slight cough, runny nose with white discharge, sneezing. T: no change in initial stages. P: Floating and Tight
This is Tai Yang pattern with Cold predominence.
ID of Patterns and Treatment
Wind-Cold, prevalence of Cold:
Treatment Principle-Release the exterior, expel Wind, scatter Cold, restore the diffusing and descending of Lung Qi
Points:
Lu 7, LI 4, UB 12, (3 most important points to expel WC) GB 20, Du 16, ( these two points expel wind for headache and stiff neck) UB 13, ( diffuse and descend Lung Qi), LI 20, Du 23, (expel wind and clear the nose) Du 20, ( expels wind and relieves headache) Ki 7. ( used with LI 4 to induce sweating) Reducing method, cupping on UB 12, Direct moxa can be used after withdrawing the needles.
Some doctors reinforce points first and then reduce them in order to summon the Wei Qi first and then expel the pathogenic factor. This is used for WC and WH
ID of Patterns and Treatment
Wind-Cold, prevalence of Wind
Clinical manifestations: aversion to cold, shivering, fever, slight sweating, occipital headache, stiff neck, body aches, slight cough, runny nose with white discharge, sneezing. T: No change in initial stages. P: Floating-Slow
This is classical pattern of Tai Yang when the body is weak and the Ying and Wei are not harmonized. The deficient Ying Qi fails to hold fluids in and causes slight sweating.
ID of Patterns and Treatment
Wind-Cold, prevalence of Wind
Treatment Principle: Release the exterior, expel WC and harmonize the Ying and the Wei
Points:
Lu 7, LI 4 and UB 12 with cupping (these are the three most important points to expel WC. Cupping on UB 12 is extremely effective.
St 36 harmonizes Ying and Wei
UB 18 some doctors use this point to nourish Ying and blood and therefore harmonize Ying and Wei Qi.
