Flashcards in WK11 - Syndromes, S/Sx Deck (30):
Internal Cold can be Excess. What could create this situation?
- cold food, raw food, and cold drinks could all cause Excess Internal Cold
- treatment involves warming and scattering cold
Internal Cold can be from Deficiency. What in the patient is deficient to create this situation?
- Yang Deficiency in patient
- treatment involves warming, scattering cold, and tonifying yang
What are the signs & symptoms of Internal Cold?
- aversion to cold, white facial complexion, pale tongue, glossy coat, slow pulse
- pain: Bi, abdominal, epigastric (location of pain depends on location of cold)
- fluid accumulation: damp phlegm, clear profuse urination, watery diarrhea with undigested food (undigested food refers to KD Yang Def)
- hernial disorders: Shan Qi (KD & LV channels)
Cold pain is fixed & severe in nature. How can you tell if it is due to Deficiency or Excess?
- if press & feels good, it's Deficiency
- if press & feels bad, it's Excess
Why is fluid accumulation an issue with Excess Cold?
- cold congeals
- cold or raw food & drinks don't move fluids
Why is fluid accumulation an issue with Deficiency Cold?
because Yang is deficient, things don't move and fluids accumulate
Do herbs that Warm the Interior and Expel Cold treat External Invasion of Cold or Internal Cold? Do the herbs treat Cold of an excess or deficient nature?
Internal Cold, which can be due to Excess or Deficiency
FYI: What are the 3 organs that tend towards Yang Deficiency?
- KD Yang Deficiency
- SP Yang Deficiency
- HT Yang Deficiency
(KD & HT are Shao Yin)
What is an herb we've learned in the category of Warm the Interior and Expel Cold? What are its key characteristics?
Zhi Fu Zi - Aconiti Radix Lateralis Preparata:
- signature herb for Shao Yin disorders in Shang Han Lun
- revives devastated Yang Qi
- tonifies the fire at the gate of vitality (Ming Men Fire / KD Yang)
- guides the actions of the other herbs into all 12 channels
- expels cold-damp painful obstruction
What is "true heat, false cold"?
- "true heat" bc heat is constraining the middle
- "false cold" bc heat is trapped in center and doesn't move to extremities; therefore hands & feet are cold
What is "4 limbs reversal"? What 2 patterns must we differentiate between when we see 4 limbs reversal?
4 limbs reversal is the presentation cold hands & feet, and it has 2 separate causes:
1) Heat constraining the middle, which is often caused by LV Qi Stagnation (so we cannot use Zhi Fu Zi)
2) KD Yang Deficiency, where the whole body is cold bc warmth goes to the middle to protect vital organs (we can use Zhi Fu Zi in this case)
Herbs that Tonify the Qi primarily treat LU and SP. What are some LU Qi Deficiency signs & symptoms?
- shortness of breath
- shallow breathing
- dyspnea on exertion
- weak voice
- pale complexion
- spontaneous sweating
Herbs that Tonify the Qi primarily treat LU and SP. What are some SP Qi Deficiency signs & symptoms?
- fatigue, lethargy, weak limbs
- lack of appetite
- abdominal distention
- loose stools
- general edema
What are the signs & symptoms that distinguish a not-so-severe SP Qi Deficiency from a severe SP Qi Deficiency?
- Not Severe: lethargy, lack of appetite, chest & abdominal distention, chronic diarrhea
- Severe: prolapse of stomach, uterus, or rectum
What is the 1st herb we learned in the category of Tonify the Qi? What are its key characteristics?
Ren Shen - Ginseng Radix (LU & SP channels):
- powerfully tonifies the primal qi of the five organs
- nourishes the yin
- revives from collapse, stops heavy bleeding
What is the 2nd herb we learned in the category of Tonify the Qi? What are its key characteristics?
Dang Shen - Codonopsis Radix (LU & SP channels):
- tonifies the middle burner
- augments the SP & LU Qi
What is the 3rd herb we learned in the category of Tonify the Qi? What are its key characteristics?
Tai Zi Shen - Pseudostellariae Radix (LU & SP channels):
- tonifies the Qi & Yin, but rather weakly (therefore need high dosing)
What is the 4th herb we learned in the category of Tonify the Qi? What are its key characteristics?
Bai Zhu - Atractylodis Macrocephalae Rhizoma (SP & ST channels):
- tonifies the SP Qi
- dries dampness
- quiets the fetus
What is the 5th herb we learned in the category of Tonify the Qi? What are its key characteristics?
Gan Cao - Glycyrrizae Radix (Licorice):
- tonifies the SP Qi
- moistens the Lungs
- moderates urgency & toxicity
- drains fire
- enters all 12 channels, but primarily HT, LU, SP, ST (Tai Yin & Earth pairs)
Is it always good to tonify yin? Explain.
- If there is an external pathogen, don't tonify because you would also strengthen the pathogen.
- Ideally, if there is an external pathogen, you would first release the exterior to release the pathogen. If the patient is deficient, get rid of pathogen before tonifying.
- Less ideally, if a patient is deficient, use a formula that releases the exterior AND tonifies simultaneously.
Why is Tai Zi Shen often used in oncology? Why is it used for unrelenting fever or summerheat in children?
- Chemo patients tend to have a deficiency of Qi, fluid, and Yin. Tai Zi Shen generates fluids.
- Children have an abundance of Yang and Tai Zi Shen doesn't generate heat (due to it's neutral temperature).
Bai Zhu is said to "quiet the fetus." What is the primary cause of restlessness of the fetus in this case?
The mother has SP deficiency, which causes restlessness in the fetus.
Which of the herbs in the category "Tonify the Qi" can be used for SP Qi Deficiency with dampness? Why?
- function: dries dampness & promotes water metabolism
- indication: for edema & reduced urination due to SP deficiency and its failure to transform & transport
Which of the herbs in the category "Tonify the Qi" can be used to stop sweating? Does it astringe the pores or does it treat the root of the problem?
- it stabilizes the exterior & stops sweating (this astringes the pores but does not treat the root of the problem)
- therefore it's good for spontaneous sweating due to LU Qi deficiency
- can be used for other types of sweating when combined with appropriate herbs
Which of the herbs in the category "Tonify the Qi" is often used as an envoy in formulas? Why?
Gan Cao -- because it is said to enter all 12 channels and is neutral when unprepared, it is often used to harmonize formulas (though it can also moderate the toxicity of herbs).
If a patient has Qi Deficiency with lack of fluids or Yin Deficiency, which are the best Tonify Qi herbs to use?
best to use Tai Zi Shen, since it tonifies Qi & Yin and generates fluids
(Ren Shen not a good option if there is Yin Deficiency. Dang Shen doesn't generate fluids.)
If a patient has Qi Deficiency with lack of fluids or Yin Deficiency, which Tonify Qi herbs would not be a good choice, since they are drying?
avoid Bai Zhu, since it dries dampness and is contraindicated when there is fluid exhaustion
What is the name of the basic formula to Tonify the Qi? What are the ingredients? Chief actions?
Si Jun Zi Tang ("4 Gentlemen Decoction"):
- ingredients: Ren Shen (chief), Bai Zhu (deputy), Fu Ling (assistant), Zhi Gan Cao (envoy)
- actions: tonifies the Qi & strengthens the SP
What are the indications for the use of Si Jun Zi Tang ("4 Gentlemen Decoction")? What is the cause of this pattern?
classic presentation of SP Qi Deficiency:
- pallid complexion, low & soft voice, reduced appetite, loose stools, weakness in limbs, tongue body pale, thin and/or frail pulse
- etiology: improper eating habits, excess deliberation, or overworking