Diagnosis 2 Flashcards
Using + restoring qi
Using qi: work or exercise
Restoring qi: rest
Post-heaven Qi
Formed by SP/ST daily
Constantly replenished: quickly created, quickly used
Normally used for daily activities, esp. Yang post-heaven qi
Under normal circumstances: qi used by work = quickly restored by rest + diet
Overwork + yin substances
If someone works beyond the capacity of post-Heaven qi to restore itself
–> Draws upon foundational yin substances –> signs of yin xu
7 injuries to Zangfu
Overeating –> SP
Prolonged anger –> LIV
Lifting excess weights/sitting on damp ground –> KID
Exposure to cold/drinking cold liquids –> LU
Worry, sadness, pensiveness –> HT
Wind, cold, rain, summerheat –> Body
What did scholars believe to be the major cause of exhaustion?
SP, ST - Li Dong-Yuan
SP, LU, KID yin xu, LIV yin xu - Zhu Dan Xi
KID - Zhang Bie Jin
LU, SP, KID - Zhu Qi Shi
Etiology of chronic tiredness
Deficiency: qi, blood, yin
Excess: damp, phlegm, qi stag
–> Slippery, wiry, full/excess pulse = damp, phlegm (heavy), qi stag
–> Red tongue sides = severe qi stag
chronic tiredness, desire to lie down, poor appetite, loose stools
SP qi xu
+ cold = SP yang xu
chronic tiredness, weak voice, easily catching colds
LU qi xu
+ cold = LU yang xu
chronic tiredness, backache, lassitude, feeling cold, depression, frequent urination
KID yang xu
chronic tiredness, slight depression, dizziness, scanty periods
LIV blood xu
chronic tiredness, anxiety, insomnia, dry mouth at night, tongue w/o coat
KID yin xu
chronic tiredness, body heaviness, head muzziness
damp retention
chronic tiredness, chest oppression, dizziness, head muzziness
phlegm retention
chronic tiredness, anxious + tense person, wiry pulse
LIV qi stag
short-term tiredness, alternating hot/cold, irritability, unilateral tongue coat, wiry pulse
Shaoyang pattern
Chinese medicine + excess sexual activity
Depletes KID jing (sexual essence = manifestation of KID jing) when there isn´t enough time for the body to replenish
Ejaculation is approximately equivalent to childbirth or menorrhagia in terms of loss of essence
what marks ´excessive´ sexual activity?
results in marked fatigue afterwards:
dizziness, blurred vision, low back ache, weak knees, frequent urination
+ more in spring, summer
- less in fall, winter; qi and/or blood xu esp. KID
Recommended ejaculation by age, according to the classics
Age, in good health, in average health
15, 1/day, 2/day
20, 1/day, 2/day
30, 1/day, every other day
40, every 3 days, every 4 days
50, every 5 days, every 10 days
60, every 10 days, every 20 days
70, every 30 days, none
OR divide age in years by 5
Tian Gui age
14 female-assigned
16 male-assigned
effect of too many childbirths in a short time
weakens Uterus, KID
Chinese medical perspective on period sex
Causes blood + qi stag by bringing upward qi motion when the direction needs to go down
Sexual activity too early: Chinese medical perspective
Damages Ren, Chong
Blood stasis
KID xu
Insufficient sexual activity: CM
Cause of disease, emotional stress
Sexual desire = Ming Men fire/Xiang Huo
Healthy appetite = abundant Ming Men
Desire builds, orgasmic release is normally a beneficial discharge of Yang qi that promotes free flow of qi; benefits HT PC
Effect of insufficient sexual activity: CM
Accumulated Minister Fire can –> Blood-heat, Blood or qi stag in LJ
–> Further stirs Ming Men, harasses Shen
–> LJ qi stag can lead to dysmenorrhea/gyn issues
- N/A if there is no desire present. This refers to repressed sexuality
Unhappy sex life: Chinese Medicine
Lack of warmth/affection
Inability to orgasm
Deep unhappiness, anxiety
= disease
Healthy sexual desire relates to which organ?
Reflects healthy KID energy
Deficient KID yang and sexuality
Lack of sexual desire
Inability to enjoy sex
Inability to orgasm
Severely deficient KID yin –> empty heat affects sexuality how?
Excess sexual desire, never satiated
LIV full-heat
HT full-heat
and sexuality
Excess sexual desire
Vivid sexual dreams leading to nighttime orgasms/emission
What is one way to treat lack of sexual desire?
Strengthen KID yang
One way to dampen excess sexual desire
Nourish KID yin
What does healthy sexual desire reflect?
Strong KID energy
Benefits of sexual intercourse
Meeting of water + fire that can tonify partners´ respective Yin, Yang
Beneficial exchange of energy + fluids from Ren + Du
Spanning bridge of Ren + Du in the tongue/mouth mobilizes energy
Diagnosis of LIV qi depression: what formula would you think of
Chai Hu Shu Gan San
What does sleep reflect in CM?
State of Shen, Hun
Sleep questions in CM
Easy to fall asleep?
Wake up at night?
Dream excessively? = waking up at night, impacting the next day, nightmares, recurring dreams
In CM what determines sleep?
LIV, HT Blood + yin (other organs as well)
* Yin time = Shen + Hun should be anchored in HT Blood, LIV Blood
Shen + Hun not anchored at night: potential causes
Insufficient Blood/yin to anchor
PF (ex. heat) agitates these Spirits
Empty sleep disturbance
Shen + Hun float at night –> insomnia
What does difficulty falling asleep indicate?
Blood xu: HT, SP, LIV
What does difficulty staying asleep + tendency to wake up at night indicate?
Yin xu
Full patterns that correspond to waking up during the night?
Heat
Fire
Phlegm-fire
Food retention
Full conditions w/ very restless sleep, heat, agitation, excess dreaming
LIV fire
Phlegm-fire harassing HT
HT fire
Residual heat in the diaphragm
insomnia, propensity to angry outbursts, headaches, restless sleep, feeling of heat, agitation, excess dreaming
red tongue w/ redder sides + dry yellow TC
wiry rapid pulse
LIV fire
restless sleep
insomnia
dream-disturbed sleep
sputum in throat
red tongue w/ redder tip + sticky-yellow TC
slippery-overflowing-rapid pulse
Phlegm-fire harassing the HT
restless sleep
dream-disturbed sleep
palpitations
agitation
red tongue w/ redder tip + yellow TC
overflowing-rapid pulse
HT fire
acute insomnia after WH invasion –>
restless sleep
preferring to sleep propped-up
inability to fall asleep
mental restlessness
diaphragm sense of oppression
red points in front/center of tongue
slightly rapid pulse
residual heat in the diaphragm
sleep: excess/ deficiency
empty: unable to fall asleep or stay asleep w/o red tongue, feeling of heat
insomnia w/ difficulty falling asleep
palpitations
pale tongue
choppy or fine pulse
HT blood xu
insomnia w/ difficulty falling asleep
palpitations
tiredness
pale tongue
choppy pulse
SP + HT qi + blood xu
insomnia w/ difficulty falling asleep
palpitations
tongue w/o coat
floating-empty pulse
HT yin xu
insomnia w/ difficulty falling asleep
dreaming
dizziness
blurred vision
pale tongue
choppy or fine pulse
LIV blood xu
insomnia w/ difficulty falling asleep
dreaming
dizziness
blurred vision
dry eyes
tongue w/o coat
floating-empty pulse
LIV yin xu
insomnia w/ difficulty falling asleep
dizziness
tinnitus
tongue w/o coat
floating-empty pulse
HT + KID yin xu
insomnia
waking up frequently during the night
anxiety
night sweats
dizziness
tinnitus
red tongue w/o TC
floating-empty + rapid pulse
HT + KID yin xu with HT empty-heat
Etiology of excess dreaming
Pathogenic factor ex. Fire, Phlegm-Fire
or
Yin deficiency empty-heat
Excess dreaming in CM
Pleasant or unpleasant dreaming that makes the sleeper restless or awakens them
Nightmares, especially recurrent
“Ye You” Hun wandering at night
Excess patterns of excess dreaming
LIV fire
HT fire
Phlegm-fire harassing HT
ST phlegm-fire
excessive dreaming, nightmares, restless sleep, headaches, Red tongue with redder sides and dry yellow coating, Wiry-Rapid pulse
LIV fire
excessive dreaming, restless sleep, palpitations, insomnia, Red tongue with redder tip and yellow coating, Overflowing-Rapid pulse
HT fire
excessive dreaming, restless sleep, insomnia, waking from nightmares, palpitations, agitation, sputum in throat, Red tongue with redder tip and a sticky-yellow coating, Slippery Overflowing-Rapid pulse
Phlegm-fire harassing HT
excessive agitated dreams, restless sleep, burning epigastric pain, insomnia, Red tongue with a sticky-yellow or dark-yellow (or even black) coating, Stomach crack with a rough, sticky-yellow coating inside it, Slippery-Rapid and slightly Overflowing pulse on the Right-Middle position
Phlegm-fire in ST
dream-disturbed sleep, insomnia, Red tongue with redder tip and without coating, Floating-Empty and Rapid pulse
HT-yin deficiency with empty-heat
dream-disturbed sleep, insomnia, blurred vision, dry eyes, Red tongue without coating, Floating-Empty and slightly Rapid pulse
LIV yin xu with empty heat
dream-disturbed sleep, palpitations, dizziness, tinnitus, Red tongue with redder tip without coating, mid-line Heart crack, Floating-Empty and Rapid pulse or Deep-Weak on both Rear positions and relatively Overflowing on both Front positions
HT- and KID-yin xu with empty-heat
excessive dreaming, waking easily from dreaming, absent-minded, emotionally unstable, anxiety and palpitations
HT and GB xu
Somnolence in CM
Dozing off frequently in the daytime or early evening
Some Chinese books also add that the patient wakes up as they breathe out and then doze off again
‘Somnolence’ also includes some people’s physiological need of sleeping a longer time than normal
* not pathological if the person works long hours
Somnolence etiology
Deficiency: Qi and/or Yang
Excess: ex. Phlegm, Damp
Most common cause of somnolence
Combined deficiency (SP, KID) and excess (damp, phlegm)
somnolence, desire to lie down, loose stools, Pale tongue, Weak pulse
SP yang xu
somnolence, listlessness, backache, dizziness, tinnitus, Pale-Swollen tongue, Deep-Weak pulse
KID yang xu
somnolence after eating, feeling of heaviness, sticky coating, Slippery pulse
Dampness
somnolence after eating and in the morning, muzziness of the head, dizziness, Swollen tongue with sticky coating, Slippery pulse
Phlegm
Shen and pre-natal essence relationship
Jing in KID is the biological foundation of Zhi
Shen activity is founded on Jing + Qi
Zhi: memory
Shen + post-natal essence
Harmonious ST + intestines –> Blood harmonized, Shen draws on refined essence of water + food
Shen + Essence
Both pre-natal (KID) and post-natal (SP) essence support Shen
7 emotional factors
Anger
Joy
Worry
Sorrow
Thought/pensiveness
Fear
Fright
Anger qi movement
LIV qi rises
Joy qi movement
HT qi slows, relaxes
Sorrow qi movement
LU, disperses/dissolves qi
Worry qi movement
LU, knots qi
Pensiveness qi movement
SP, qi knots
Fear qi movement
KID, qi descends
Fright qi movement
HT, KID - scatters qi
Fatigue in CM: definition
Abnormal weariness
Inability to perform normal movements
Fatigue in CM etiology
Lassitude of spirit (lack of mental strength)
Organs: SP, LU, LIV
Deficiency: Qi, Blood, Yang
Damp patterns
Emotional depression in CM might be:
Depressed LIV qi / Hun not moving freely
Exacerbated by phlegm –> easily becomes fire
Depression vs despondency
Not the temporary response to adverse life events
Mood is fixed and persists w/ changes in behavior, attitude etc
Depression clinical definition
Absence of an organic factor, normal bereavement, delusions or hallucinations in the absence of mood symptoms, schizophrenia, delusional/psychotic symptoms
Physical symptoms that cue for depression
Extreme tiredness
Lack of motivation
Feeling cold
Complexion + eyes lacking luster, grey/green face
Tongue w/ red tip + deep HT crack
Voice low, lacking vitality
FULL: wiry, wiry/slippery pulse
EMPTY: Weak, choppy, short, lacks a ‘wave’
Depression + Hun
Lack of Hun movement:
LIV qi stag
LIV blood + LIV qi xu
SP, KID xu
Excess movement of Hun
Fire
Phlegm-fire
LIV blood and/or LIV yin xu
Depressed LIV qi (ganqi yu)
LIV qi stag + depression
Anger, frustration, distention + pain in the chest/hypochondrium/lower belly, menstrual irregularities, sighing, plump pit qi, goiter/scrofula, distention/pain in breasts, menstrual pain, symptoms worse with bad moods
T: thin white TC
P: wiry
Possible other symptoms: stomach duct pain, belching, vomiting, diarrhea, accumulation
Treatment of Ganqi Yu/ depressed LIV qi
Soothe the LIV, resolve depression
RX Chai Hu Shu Gan San
Depressed LIV qi + LIV/SP disharmony: additional symptoms
distention
fullness
loose stool
gas borborygmus
withered complexion
Depressed LIV qi + LIV/ST disharmony: additional symptoms
distention
belching
acid regurgitation
palpitations/”scurrying” pain in the ST duct
Depression, moodiness, irritability
LIV qi stag
Depression, irritability, red tongue
Stagnant LIV qi transforming into heat
Depression
Moodiness
Lump in the throat
LIV qi stag with Qi-phlegm
Depression
Anxiety
Agitation
Expectorating phlegm
Swollen tongue
Phlegm-fire harassing the Shen
Depression
Agitation
Purple tongue
HT blood stasis
Depression
irritability
Bitter taste
Hypochondrial fullness
GB heat
Depression
Anxiety
Feeling stuffy in the chest after a WH invasion
Diaphragm heat
Full/Excess patterns of depression
LIV qi stag
Stagnant LIV qi transforming to heat
LIV qi stag + qi phlegm
Phlegm-fire harassing the Mind
HT blood stasis
GB heat
Diaphragm heat
Deficient depression patterns
SP- and HT-blood xu
HT yang xu
LIV blood xu
KID- and HT-yin xu + HT empty heat
KID yang xu
depression
insomnia
palpitations
tiredness
SP- and HT-blood xu
depression
palpitations
cold hands
HT-yang xu
depression,
no sense of direction
sadness
LIV blood xu
depression
anxiety
night sweats
palpitations
red tongue w/o coat
KID- and HT-yin xu with HT empty heat
depression
lack of motivation
lack of willpower
feeling cold
frequent urination
KID-yang xu
Anxiety in CM
fear + worry (seven emotions)
Anxiety in CM etiology
DEFICIENCY: Blood, Yin
EXCESS: Heat
COMBO: Yin xu, empty heat
Shen + Hun lose “residence” in HT-blood + LIV-blood: etiology + effects
Etiology: blood, yin xu
Results: anxiety, poor sleep
Pathogenic factors agitating Shen + Hun: which? Results?
PF: qi stag, Blood stasis, heat, phlegm-heat
Results: Anxiety, insomnia
Physical cues of anxiety
Restless appearance
Quivering voice
Fidgeting
FULL: speaking a lot
EMPTY: quiet
* may be preoccupied about needles
Cues of hidden anxiety/fear
Tongue with red tip, deep HT crack
Wiry (full) or Floating-empty (empty) + rapid
Eyes: ‘unstable’ or without control
Empty/deficient fear/anxiety patterns
HT-blood xu
HT-yin xu
LIV blood xu
LIV yin xu
KID yin xu
HT- and GB-qi xu
Mild anxiety, insomnia, palpitations
HT blood xu
Anxiety that is worse in the evening
Palpitations
Night sweats
HT yin xu
Mild anxiety
Depression
Insomnia
LIV blood xu
Mild anxiety
depression
insomnia
Tongue without coat
LIV yin xu
Anxiety that is worse in the evening
Lack of willpower
Dizziness
Tinnitus
KID yin xu
Mild anxiety
Insomnia
Timidity
HT- and GB-qi xu
Excess fear/anxiety patterns
HT fire
HT blood stasis
Phlegm-fire harassing Shen
LIV qi stag
LIV fire
LIV yang rising
Rebellious qi of Chong/Penetrating
Diaphragm-heat
Severe anxiety
Palpitations
Red tongue with coat
HT fire
Severe anxiety
Palpitations
Purple tongue
HT-blood stasis
Severe anxiety
Manic behavior
Swollen tongue
Phlegm-fire harassing the Shen
Anxiety
depression
irritability
Hypochondrial distension
LIV qi stag
Severe anxiety
Headache
Thirst
Red tongue
Wiry pulse
LIV fire
Anxiety
headache
dizziness
LIV yang rising
anxiety
panicky feeling
throat constriction
palpitations
chest tightness
abdominal fullness
firm pulse
Chong vessel rebellious qi
anxiety
stuffiness in region under the HT
following WH invasion
diaphragm heat
anxiety that is worse in the evening
palpitations
red tongue without coat
HT yin xu with empty heat
anxiety that is worse in the evening
dizziness
tinnitus
palpitations
KID- and HT-yin xu with HT empty heat
Irritability in CM
feeling annoyed frequently
easily angered
frustration
= like anger but larger range of emotional states
Anger vs. Irritability
Anger: LIV
Irritability: many organs
CM diagnoses and irritability
Qi stag
Blood stasis
LIV yang rising
Blood xu
Yin xu (with or without empty heat)
Heat (incl. dampheat)
Deficient heat
“I feel extremely irritable before my periods and take it out on my family” might be
LIV qi stag
“I feel this lump in my throat; I’m on edge and feel like bursting into tears” might be
LU qi stag
“I seethe with resentment” might be
LIV blood stasis
“My mind is constantly judging and I feel resentful” might be
HT-blood stasis
“I fly off the handle easily” might be
LIV yang rising
“I explode into a rage” might be
LIV fire
“I feel irritable, impatient and angry” might be
HT fire
“I feel frustrated, weepy, irritable” might be
LU heat
“I often feel angry and obsessive” might be
ST heat
“I feel lost, overwhelmed, on edge, can’t cope” might be
LIV blood xu
“I feel helpless, unmotivated, on edge in the evening” might be
KID yin xu
“I feel sad, on edge, can’t cope” might be
HT blood xu
“I feel hot and bothered” might be
KID yin xu with empty heat
“I feel sad, hot, bothered” might be
HT yin xu with empty-heat
“I feel heavy, yucky, and irritable” might be
Damp-heat
Worry vs Overthinking/pensiveness
Worry: LU
Overthinking: SP (unable to empty the mind of repetitive thoughts, trivial things)
Overthinking in CM
Mostly empty
Mixed: LU qi stag or Yin xu + empty-heat
Full worry
More intense and consuming vs lurking in the background (empty)
Worry
Slightly obsessive thinking
Slight depression
Overthinking
Pale tongue
Empty pulse
HT- and SP-qi deficiency
Worry
depression
pale tongue
empty pulse
LU qi xu
Worry
mild irritability
depression
Lump in the throat
Tongue slightly red on the sides in chest area
Pulse very sl. tight on right-front position
LU qi stag
worry
depression
pale thin tongue
choppy or fine pulse
HT blood xu
Worry which increases after the period
Pale tongue
Choppy or fine pulse
LIV blood xu
worry
insomnia
dream-disturbed sleep
poor memory
anxiety
propensity be startled
mental restlessness
uneasiness
feeling hot and bothered
floating-empty pulse esp. on left-front position
HT yin xu
worry esp. in evening
anxiety
propensity to be startled
mental restlessness
uneasiness
feeling hot and bothered
red tongue, redder on the tip, no coat
floating-empty + rapid pulse
HT yin xu with empty-heat
sadness vs lack of joy
sadness: LU weakness, pale complexion, weepy weak voice full or empty quality of LU pulse
lack of joy: HT, lack of vitality from HT deficiency, flatness, lack of fire
sadness and ancestral/gathering/chest qi
depletes LU- and HT-qi
–> may lead to qi stag in chest
slight tightness in the chest, sadness felt in the chest, sighing, slight palps
stagnation of chest qi
sadness
crying
depression
pale tongue
empty pulse
LU- and HT-qi xu
sadness
crying
mental confusion
aimlessness
pale tongue
choppy or fine pulse
LIV blood xu
sadness
crying
depression
pale thin tongue
choppy or fine pulse
HT blood xu
sadness
mild irritability
depression
tongue slightly red on the sides in chest area
pulse very slightly tight on right-front position
LU qi stag
Grief in CM
like sadness, usually due to loss
depletes LU and HT qi –> chest qi stag
normal joy in CM
power, complete body integration
expansiveness
urge to spread the limbs
Sudden extreme elation impacts
makes qi rise
expands HT
excess joy
life characterized by excess stimulation/excitement
hypomania, mania
–> qi rising, may lead to HT fire
Excess joy diagnoses
HT fire
HT empty heat
Phlegm-fire harassing HT
Fan Zao
“vexation and restlessness”
Fan (vexation) is due to Full Heat and pertains to the Lungs – yang state
Zao (restlessness) is due to Empty Heat and pertains to the Kidneys – yin state
How modern patients might describe Fan Zao symptoms
Patients may also describe having ‘difficulty in concentration’, ‘not being able to focus on one thing for any length of time’ or ‘not being able to sit still and do nothing’.
Symptoms may also includes restless legs
Mental restlessness diagnoses
Yin xu + empty heat
Phlegm-heat in ST, HT
HT Fire
Lu Heat
Vague mental restlessness which worsens in the evening, restless legs, red tongue w/o coat, floating-empty rapid pulse
Yin xu + empty heat
mental restlessness, mental confusion, agitation, rash behavior, tendency to hit/scold people, shouting, depression, manic behavior, tongue red in the center with sticky-yellow coating and a ST/HT crack with a rough sticky-yellow coat within it, slippery-rapid pulse
Phlegm-heat in ST + HT
pronounced mental restnessness
agitation
red tongue w/ redder tip + yellow coat
overflowing-rapid pulse
HT fire
mental restlessness
worry
red tongue yellow coat
overflowing-rapid pulse
LU heat
Symptom that worsens after sex indicates what?
Qi xu
Usually kidneys, also LIV HT
Tiredness after sexual activity, especially if accompanied by dizziness, backache, weak knees, etc
KID qi xu
What patterns are mostly behind impotence?
KID xu
with backache, weak knees, dizziness, tinnitus, poor memory
especially KID yang xu
What organs might you think of for impotence in young men?
KID (as usual)
HT often involved
Impotence, dizziness, palpitations, choppy pulse
HT blood xu
impotence, palpitations, insomnia, dream-disturbed sleep, rapid-overflowing pulse
HT fire
impotence, heaviness in the scrotum, urethral discharge, sticky-yellow tongue coat
DH in LIV channel
Patterns for lack of libido
Usually Qi or yang xu (frequently KID)
Severe SP, HT, LU qi xu
HT xu (more than KID)
Full: LIV qi stag
Patterns for premature ejaculation
Usually KID
–> KID qi not firm
Also HT patterns
–> HT qi or HT blood xu
Tiredness + dizziness after ejaculation
KID xu
Nocturnal emissions indicates what?
KID xu
Nocturnal emission in ancient China
nighttime intercourse with ghosts that rob essence
Nocturnal emissions without sexual dreams
Pure deficiency, usually KID
Nocturnal emissions w/o sex dreams
usually due to heat (full or empty), generally HT
- empty heat due to KID xu
- full-heat often of LIV and/or HT
What is the CM root of sexual desire?
KID yang
Minister fire
–> patterns usually = KID or HT xu
Deficient minister fire can cause what?
Lack of sexual desire
LIV/HT fire and empty-heat from KID yin xu can lead to what?
excess sexual desire
What organ would you think of in regards to sexual arousal/orgasm in cycling people?
HT
Where does aroused physiological minister fire of the KID go?
HT
PC
–> flushed face, increased HT rate
CM pattern of low sexual desire?
deficient Minister Fire, KID yang
CM understanding of orgasm
Minister Fire which rose during sexual arousal –> suddenly discharged downwards by the HT
What organ would you think of in regards to cycling people unable to reach orgasm?
HT xu
Fire/Water Daoist sexual alchemy
Fire: flares up easily, easily extinguished
Water: slow to boil, slow to cool down
Questions to ask about menses
Age of menarche
Cycle
Quantity of blood
Color of blood
Clots
Pain
PMS
What is breast milk derive from in CM?
Blood
Gyno questions
Childbirth
Abortion
Miscarriage
Contraception
Intrauterine coil
HRT
Pelvic inflammatory disease
Gyn. surgical interventions