CASE STUDES - Zang Fu Theory & Cough Flashcards
LV Excess Patterns
Stagnation of Liver Qi Stagnation of Liver Blood Liver Fire blazing upwards Liver wind agitating within Damp Heat in the Liver/GB Stagnation of cold in the liver channel
LV Deficiency Patterns
Deficiency: Liver Blood deficiency
Deficiency-Excess: Liver Yang Rising
LU Deficiency Patterns
Lung Qi deficiency
Lung Yin deficiency
Lung Dryness
LU Excess Patterns
Invasion of Lungs by WC, WH, Wind Water,
Damp Phlegm obstructing the Lungs
Phlegm Heat obstructing the Lungs
Phlegm Fluids obstructing the Lungs
SP Deficiency Patterns
Spleen Qi deficiency
Spleen Yang deficiency
Spleen not controlling Blood
Spleen Qi sinking
SP Excess Patterns
Cold Dampness invading the Spleen
Damp Heat invading Spleen
KD Deficiency Patterns
Kidney Yin deficiency Kidney Yang deficiency Kidney Qi not Firm Kidney failing to receive Qi Kidney Essence deficiency
KD Combined Patterns
Combined Patterns Kidney/Liver Yin deficiency Kidney and Heart not harmonized Kidney and Lung Yin deficieny Kidney and Spleen Yang deficiency
KD Deficiency/Excess Patterns
Kidney Yang deficiency, water overflowing
Kidney Yin deficient, empty fire blazing
Zhang Jie Bin said “ The doctor who wants to nourish life has to tonify _______ and _______”
Stomach & Spleen
Is the origin of fluids, Is the source of Qi
“likes wetness and dislikes dryness” (opposite to the _______)
Stomach
Opposite to the Spleen
ST Deficiency Patterns
Stomach Qi deficiency
Stomach Deficient cold
Stomach Yin deficiency
ST Excess Patterns
Stomach Fire or Phlegm Fire Cold invading Stomach Stomach Qi rebelling upwards Retention of Food in the Stomach Stagnation of Blood in the Stomach
SI Deficient Pattern
SI deficient and cold
SI Excess Patterns
Full Heat in the SI
SI Qi pain
SI Qi tied
Infestation of worms in the SI
Receive food/drink from SI, absorbs fluids and excrete
Large Intestine
LI Deficient Patterns
LI dryness
Collapse of LI
LI cold
LI Excess Patterns
DH in the LI
Heat in the LI
Heat obstructing the LI
Cold invading the LI
Provides Qi to the sinews and ensures movement and agility, the Liver nourishes the sinews with Blood.
Gall Bladder
GB Deficiency & Excess Patterns
Deficiency Pattern: GB deficient
Excess Pattern: DH in the GB
UB Deficiency & Excess Patterns
Deficiency Patterns: UB deficient and cold
Excess Patterns: DH in the UB, Damp Cold in UB
San Jiao / Triple Burner
Performs the letting out function:
- Defensive Qi in Upper Jiao directing it to LU
- Nutritive Qi in Middle Jiao to all other organs
- Body Fluids in Lower Jiao to the UB.
In other words it controls the movement of various types of Qi at different stages of energy production.
“Classic of Difficulties” states that Original Qi resides
In the lower abdomen between Kidney
It spreads to the 5 Yin and 6 Yang organs via the Triple Burner,
It then enters the 12 channels.
Upper Burner affects
Upper Burner: Heart, Lungs, Pericardium, throat, head; controls receiving but not excreting.
Middle Burner affects
Middle Burner: Stomach, Spleen, Gall Bladder; controls rotting and ripening food and drinks.
Lower Burner affects
Lower Burner: Liver, Kidneys, Intestines, Bladder; excreting but not receiving.
6 Extraordinary Organs
All related directly or indirectly to KD
Blood Vessels Bones Brain Gall Bladder Uterus Marrow
Uterus
The most important of the 6 Ext. Yang Organs
Fx: Reg menses, conception and pregnancy
Closely related to Kidneys
Directs/Ren Vessel providing Qi
If Kidney Essence weak, Ren and Chong will be empty and _____ is not going to receive adequately supply of Qi and Blood
Uterus
Uterus relies on abundant supply of Blood…
HT governs Blood while LV stores Blood SP controls Blood All 3 (HT, LV, SP) related to Uterus - In particular SP in producing the Blood Chong Vessel provides Blood to Uterus
Kidney Essence deficiency related to disorder of reproduction - W/M
W: Infertility, Habitual Miscarriage
M: Corresponds to Room of Essence in the Dan Tian where sperm is produced and stored
Is closely related to Kidneys and Governing /Du Vessel
LV - Causes of issues w/Menses
LV Blood Stagnation often causes painful periods
LV Qi stagnation could cause irregular periods
LV Blood Def may cause scanty or absence of period
Considered an Extraordinary Yang Organ because unlike other Yang organs is STORES bile which is “pure” fluid
Gall Bladder
COUGH - Etiology: EPF
External wind is the main cause of Ext. cough.
Wind attacks the Wei Qi that is controlled by the Lungs and can impede the descending fx of the Lungs.
COUGH - Etiology: Emotional
Worry knots Qi preventing Lung Qi from descending;
Sadness/grief depletes Lung Qi;
Anger stagnates Liver Qi can convert into Liver Fire and it can then invade the Lungs
COUGH - Etiology: Diet
Sweet, greasy, dairy can all produce phlegm which can settle in the Lungs and prevent Lung Qi from descending;
Spicy/hot food and alcohol can cause Heat, Cold/raw foods can impair the T & T and may lead to phlegm.
COUGH
Chronic Illness can weaken ______ &/or _____
LU Qi and/or LU Yin
COUGH Diagnosis - Sound:
weak sound = deficiency
loud sound = excess
barking cough = Heat
loose/rattling = phlegm
COUGH Diagnosis - Time of Day:
Worse in late afternoon = Yin deficiency
Worse in the morning = usually phlegm
COUGH Diagnosis - Sputum:
Without sputum = deficiency or heat
Abundant = phlegm
Yellow = heat; white = cold
White sticky = prev of damp or phlegm over cold
White diluted = prev of cold over phlegm/damp
Blood = Full or Empty heat
Greenish = heat
White very watery and frothy = phlegm-fluids
COUGH DIAGNOSIS
Lung Qi deficiency is almost always be accompanied by ____ Qi deficiency
Lung Yin deficiency nearly always accompanied by ____ and or ____-Yin deficiency
LU Qi deficiency is almost always be accompanied by SP Qi deficiency
LU Yin deficiency nearly always accompanied by ST and or KD-Yin deficiency
COUGH Identification - Acute (Exterior)
Wind-Cold
Wind-Heat
Wind-Dryness
COUGH Identification - Acute (Interior)
Lung-Heat
Lung Phlegm-Heat
COUGH Identification - Chronic (Full)
Damp Phlegm in the Lungs
Phlegm-Heat in the Lungs
Phlegm-Fluids in the Lungs
Liver-Fire insulting the Lungs
COUGH Identification - Chronic (Empty)
Lung-Qi deficiency
Lung-Yin deficiency
Lung-Dryness
COUGH: Wind-Cold
Sx, Tongue, Pulse
Sx: cough, sneezing, runny nose with white discharge, aversion to cold, chills, body aches, maybe slight increase in body temp, stiff neck, HA
Tongue: no evident change
Pulse: Floating-Tight
COUGH: Wind-Cold (Acute Exterior)
Treatment (Points)
Treatment:
Lu 7- release ext, restores descending of Lung Qi, stops cough
Bl 12- expels exterior Wind, good to use cupping
Bl 13- releases exterior, restores descending of Lung Qi, use cupping
Li 4 & Ki 7- promotes sweating, releases exterior
Lu 6- stops acute cough
COUGH: Wind-Heat (Acute Exterior)
Sx, Tongue, Pulse
Sx: dry cough, aversion to cold, chills, fever, sore throat, slight sweating, body aches, headache, runny nose with yellow discharge, sneezing, slight thirst and slightly dark urine
Tongue: slight Red sides and/or front part
Pulse: Floating-Rapid
COUGH: Wind-Heat (Acute Exterior)
Treatment (Points)
Lu 7 – release ext, expels Wind, restores descending of Lung Qi and stop cough.
Li 4 & Li 11 – expels Wind-Heat
Bl 12 – releases exterior
Lu 11 – expels Wind-Heat, clear Heat from throat.
Du 14 – used if symptoms of Heat are pronounced
Lu 6 – xi-cleft point, stops acute cough
COUGH: Wind-Dryness (Acute Exterior)
Sx, Tongue, Pulse
Sx: dry cough, dry itchy-sore throat, dry lips, dry mouth, soreness of the upper chest
Tongue: slightly red sides and/or front part
Pulse: Floating
COUGH: Wind-Dryness (Acute Exterior)
Treatment (Points)
Lu 7 - release ext, expels Wind, restores descending of Lung Qi and stop cough.
Lu 9 – nourishes the Lung’s fluids
Ki 6 – promotes fluids
Sp 6 – promotes fluids
COUGH: Lung Heat (Acute Interior)
Sx, Tongue, Pulse
Sx: barking cough, chest pain, breathlessness, fever, thirst, flaring of alae nasi, restlessness and feeling of heat
Tongue: Red with yellow coat
Pulse: Rapid and Overflowing
COUGH: Lung Heat (Acute Interior)
Treatment (Points)
Lu 5 – clears Lung-Heat and restores descending of Lung Qi
Lu 1 – clears Lung-Heat, treats acute patterns of the Lungs
Du 14 & Li 11 - clears Heat
Lu 6 – xi-cleft, treats acute patterns of Lung, stops cough
COUGH: Phlegm Heat (Acute Interior)
Sx, Tongue, Pulse
Sx: barking cough with expectoration of profuse sticky yellow sputum, fever, restlessness, thirst, feeling of heat and sensation of oppression in the chest
Tongue: Red with sticky yellow coat
Pulse: Rapid and Slippery
COUGH: Phlegm Heat (Acute Interior)
Treatment (Points)
Lu 5 – expels phlegm and clears Heat from Lungs
Lu 1 – front-mu of the Lung, clear Lung-Heat, stop cough
Lu 6 – xi-cleft of the Lung, acute cases, clear Lung-Heat stop cough
Ren 12, Ren 9, Sp 6 & St 40 – resolve phlegm
Du 14 & Li 11 – clear Heat
Sj 6 & Sp 15 – clear Heat, move downward
COUGH: Lung Phlegm-Heat (Chronic Full
Sx, Tongue, Pulse
Lung Phlegm-Heat
Symptoms: barking cough with expectoration of profuse sticky yellow sputum, fever, restlessness, thirst, feeling of heat and sensation of oppression in the chest
Tongue: Red with sticky yellow coat
Pulse: Rapid and Slippery
COUGH: Lung Phlegm-Heat (Acute Interior)
Treatment (Points)
Lu 5 – expels phlegm and clears Heat from Lungs
Lu 1 – front-mu of the LU, clear Lung-Heat, stop cough
Lu 6 – xi-cleft of the Lung, acute cases, clear Lung-Heat, stop cough
Ren 12, Ren 9, Sp 6 & St 40 – resolve phlegm
Du 14 & Li 11 – clear Heat
Sj 6 & Sp 15 – clear Heat, move downward
COUGH: Damp Phlegm (Chronic Full)
Sx, Tongue, Pulse
Sx: repeated attacks of cough, profuse expectoration of white sticky sputum, breathlessness, worse AM and after eating, feeling of oppression in the chest, nausea, poor appetite, tiredness, feeling of heaviness, loose stools
Tongue: Pale or normal, Swollen, sticky/thick white coat
Pulse: Slippery
COUGH: Damp Phlegm (Chronic Full)
Treatment (Points)
Lu 5 – resolves phlegm, restores descending of Lung Qi
Lu 1 – restores descending of Lung Qi
Ren 12, Bl 20 & St 36 – tonify SP to resolve Phlegm
Ren 9, St 40 & Sp 6 – resolve Damp and Phlegm
BL 13 – Back-Shu of the LU, use for chronic patterns, restores descending of Lung Qi.
COUGH: Phlegm-Heat (Chronic Full)
Sx, Tongue, Pulse
Sx: repeated attacks of a barking cough with profuse expectoration of yellow or blood-flecked purulent sputum, breathlessness, rattling sound in the throat, feeling of oppression in the chest, red face, feeling of heat, dry mouth, thirst, tiredness, loose stools
Tongue: Red, Swollen with sticky yellow coat
Pulse Slippery and Rapid
COUGH: Phlegm-Heat (Chronic Full)
Treatment (Points)
Du 14 & Li 11 – clear Heat
Lu 5 – resolves phlegm, restores descending of Lung Qi
Lu 1 – restores descending of Lung Qi
Ren 12, Bl 20, St 36 – tonify SP to resolve Phlegm
Ren 9, St 40, & Sp 6 – resolve Damp and Phlegm
BL 13 – Back-Shu of the Lung, use for chronic patterns, restores descending of Lung Qi.
COUGH: Phlegm-Fluids (Chronic Full)
Sx, Tongue, Pulse
Phlegm-Fluids
Symptoms: cough with a low sound, expectoration of watery diluted sputum, feeling of cold, feeling of oppression in the chest, tiredness, poor appetite and low spirit
Tongue: Pale, Swollen with sticky white coat
Pulse: Soggy
COUGH: Phlegm-Fluids (Chronic Full)
Treatment (Points)
Du 14 & Bl 23 – reinforce with moxa if Kidney Yang deficient
Bl 22 – promote TFj of fluids thus resolve phlegm
Lu 5 – resolves phlegm, restores descending of Lung Qi
Lu 1 – restores descending of Lung Qi
Ren 12, Bl 20, & St 36 – tonify Spleen to resolve Phlegm
Ren 9, St 40, & Sp 6 – resolve Damp and Phlegm
BL 13 – Back-Shu of the Lung, use for chronic patterns, restores descending of Lung Qi.
COUGH: Liver-Fire Insulting LU (Chronic Full)
Sx, Tongue, Pulse
Sx: sudden bouts of cough, red face often elicited by emotional stress, dry throat, a feeling of phlegm in the throat, expectoration on scanty phlegm, hypochondrial pain/distention, pain on coughing, bitter taste, dark urine, dry stools, irritability, and dry mouth
Tongue: Red sides, dry yellow coat
Pulse: Wiry Rapid
COUGH: Liver-Fire Insulting LU (Chronic Full)
Treatment (Points)
Liv 2 – drain Liver-Fire
Gb 34 – pacifies LV, eliminate stag from hypochondrial
Li 11 – clears heat
Lu 5 & Lu 1 – clear Lung-Heat, restores descending of Lung Qi
Ren 17 – subdues rebellious Qi in chest, restores descending of Lung Qi
Gb 21 – subdues rebellious Qi and makes Qi descend
COUGH: Lung-Qi Deficiency (Chronic Empty)
Sx, Tongue, Pulse
Sx: slight cough with low sound, no phlegm, spontaneous sweating, easy catch cold, weak voice, tiredness
Tongue: Pale
Pulse: Empty
COUGH: Lung-Qi Deficiency (Chronic Empty)
Treatment (Points)
Lu 9 & Bl 13 – tonify Lung Qi and stop cough
Lu 7 – restores the descending Lung Qi
Bl 43 – nourishes Lung Yin, and specific for chronic Lung problems
Ren 12, St 36 7 Sp 6 – tonify Spleen and Lungs (since Lu channel starts in Middle Burner)
COUGH: Lung-Yin Deficiency (Chronic Empty)
Sx, Tongue, Pulse
Sx: dry cough in short bursts and low sound, scanty or no phlegm, blood-flecked sputum, dry throat, feeling of heat in evening, night sweats, thin body, extreme tiredness
Tongue: No coat, dry, if empty heat then also Red body
Pulse: Def/Thin or Thready & Rapid
COUGH: Lung-Yin Deficiency (Chronic Empty)
Treatment (Pulse)
Lu 9 & Lu 1 – nourish Lung-Yin
Lu 10 – clears Lung Empty-Heat
Ren 12, St 36 & Sp 6 – tonify Spleen to nourish LU
Lu 7 & Ki 6 – open Ren Mai, benefit throat, nourish Lung-Yin, restores descending of Lung Qi, stop cough from Yin deficiency
COUGH: Lung-Dryness (Chronic Empty)
Sx, Tongue, Pulse
Sx: dry cough with low sound, dry throat and mouth. Seen in people with predisposition to Lung deficiency who (through work) have to use voice a lot in this case there could also be Stomach Yin deficiency. Can also occur after invasion of Wind-Heat.
Tongue: Dry
Pulse: Floating –Empty, Thready, Deficient
COUGH: Lung-Dryness (Chronic Empty)
Treatment (Points)
Lu 9 & Lu 1 – nourish Lung-Yin
Lu 10 – clears Lung Empty-Heat
Ren 12, St 36 & Sp 6 – tonify Spleen to nourish LU
Lu 7 & Ki 6 – open Ren Mai, benefit throat, nourish Lung-Yin, restores descending of Lung Qi, stop cough from Yin deficiency
COUGH - Western Diagnosis
Tracheitis
Following upper respiratory infection (Wind-Heat), cough is harsh and painful and throat/trachea feels raw and sore, usually worse at night
COUGH - Western Diagnosis
Acute Bronchitis
Follows upper respiratory infection, cough with expectoration of yellow, green, or purulent sputum, temperature and pulse raised
COUGH - Western Diagnosis
Chronic Bronchitis
Repeated bouts of acute bronchitis, cough is productive white, yellow, or blood flecked sputum
COUGH - Western Diagnosis
Whooping cough
Occurs in children mostly under 5, starts with ordinary cold with cough then a the characteristic “whoop” appears, cough comes in bouts, worse at night and very distressing, coughing bouts often ends in vomiting, child might get flushed or cyanosed and looks frightened
COUGH - Western Diagnosis
Pleurisy
Inflammation of pleura, usually appearing after a upper `respiratory infection, cough is unproductive and distressingly painful, chest pain and temperature raised
COUGH - Western Diagnosis
Pneumonia
Inflammation of the lung alveoli, may begin abruptly with shivering, headache, high temperature, and breathlessness, at first, cough is short and unproductive, then develops scanty sputum with rust coloured and blood sputum, mostly accompanied by pleurisy giving pain, temperature is high, face flushed pulse and breath rapid,
COUGH - Western Diagnosis
Tracheitis: TCM Diagnosis
Lung Dryness following Wind-Heat invasion.
COUGH - Western Diagnosis
Acute Bronchitis: TCM Diagnosis
Phlegm-Heat in the Lungs (Qi level)
COUGH - Western Diagnosis
Chronic Bronchitis: TCM Diagnosis
TCM diagnosis Damp Phlegm or Phlegm Heat in the Lungs with background of Spleen Qi deficiency.
COUGH - Western Diagnosis
Whooping cough: TCM Diagnosis
Started with Wind-Heat/Wind-Cold then Lung Heat and late stage Stomach and Lung Yin deficiency
COUGH - Western Diagnosis
Pleurisy: TCM Diagnosis
Lung Phlegm-Heat at Qi level
COUGH - Western Diagnosis
Pneumonia: TCM Diagnosis
Lung Heat at Qi level
COUGH - Western Diagnosis
Carcinoma of the bronchi
Most common cancer of all, most common in men between 40 and 55, dry cough, breathlessness and deep-seated thoracic pain, maybe some scanty blood flecked sputum, patient is weak and lacks appetite,
COUGH - Western Diagnosis
Carcinoma of the bronchi: TCM Diagnosis
TCM diagnosis Lung Yin deficiency late stage
COUGH - Western Diagnosis
Tuberculosis of the lungs (TB)
Cough is dry or with scanty, blood flecked sputum, chest pain, SOB and night sweating, patient very tired/debilitated and may have low grade fever in afternoons
COUGH - Western Diagnosis
Tuberculosis of the lungs (TB): TCM Diagnosis
TCM diagnosis Lung Yin deficiency with Empty Heat
COUGH - Western Diagnosis
Bronchiectasis
Permanent dilation of bronchi and bronchioles, alveoli become distended and filled with mucus, cough occurs more in morning with productive profuse purulent sputum with fruity odour, breath is offensive after bout of coughing, during acute episodes temperature increases,
COUGH - Western Diagnosis
Bronchiectasis: TCM Diagnosis
TCM diagnosis Turbid Phlegm in Lungs
COUGH - Western Diagnosis
Heart Disease
In elderly, cough may occur with heart disease, productive watery cough at night, if white and frothy it may indicate impeding left ventricular failure and which can then cause pulmonary embolism which manifests with sudden severe chest pain with dyspnoea follow by cough with blood stained sputum
