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Formulas, Diagnosis, Chinese Medical Nutrition > Diagnosis 2 > Flashcards

Diagnosis 2 Flashcards

1
Q

Using + restoring qi

A

Using qi: work or exercise
Restoring qi: rest

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2
Q

Post-heaven Qi

A

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

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3
Q

Overwork + yin substances

A

If someone works beyond the capacity of post-Heaven qi to restore itself
–> Draws upon foundational yin substances –> signs of yin xu

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4
Q

7 injuries to Zangfu

A

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

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5
Q

What did scholars believe to be the major cause of exhaustion?

A

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

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6
Q

Etiology of chronic tiredness

A

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

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7
Q

chronic tiredness, desire to lie down, poor appetite, loose stools

A

SP qi xu
+ cold = SP yang xu

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8
Q

chronic tiredness, weak voice, easily catching colds

A

LU qi xu
+ cold = LU yang xu

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9
Q

chronic tiredness, backache, lassitude, feeling cold, depression, frequent urination

A

KID yang xu

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10
Q

chronic tiredness, slight depression, dizziness, scanty periods

A

LIV blood xu

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11
Q

chronic tiredness, anxiety, insomnia, dry mouth at night, tongue w/o coat

A

KID yin xu

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12
Q

chronic tiredness, body heaviness, head muzziness

A

damp retention

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13
Q

chronic tiredness, chest oppression, dizziness, head muzziness

A

phlegm retention

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14
Q

chronic tiredness, anxious + tense person, wiry pulse

A

LIV qi stag

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15
Q

short-term tiredness, alternating hot/cold, irritability, unilateral tongue coat, wiry pulse

A

Shaoyang pattern

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16
Q

Chinese medicine + excess sexual activity

A

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

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17
Q

what marks ´excessive´ sexual activity?

A

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

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18
Q

Recommended ejaculation by age, according to the classics

A

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

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19
Q

Tian Gui age

A

14 female-assigned
16 male-assigned

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20
Q

effect of too many childbirths in a short time

A

weakens Uterus, KID

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21
Q

Chinese medical perspective on period sex

A

Causes blood + qi stag by bringing upward qi motion when the direction needs to go down

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22
Q

Sexual activity too early: Chinese medical perspective

A

Damages Ren, Chong
Blood stasis
KID xu

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23
Q

Insufficient sexual activity: CM

A

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

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24
Q

Effect of insufficient sexual activity: CM

A

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
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25
Q

Unhappy sex life: Chinese Medicine

A

Lack of warmth/affection
Inability to orgasm
Deep unhappiness, anxiety

= disease

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26
Q

Healthy sexual desire relates to which organ?

A

Reflects healthy KID energy

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27
Q

Deficient KID yang and sexuality

A

Lack of sexual desire
Inability to enjoy sex
Inability to orgasm

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28
Q

Severely deficient KID yin –> empty heat affects sexuality how?

A

Excess sexual desire, never satiated

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29
Q

LIV full-heat
HT full-heat

and sexuality

A

Excess sexual desire
Vivid sexual dreams leading to nighttime orgasms/emission

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30
Q

What is one way to treat lack of sexual desire?

A

Strengthen KID yang

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31
Q

One way to dampen excess sexual desire

A

Nourish KID yin

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32
Q

What does healthy sexual desire reflect?

A

Strong KID energy

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33
Q

Benefits of sexual intercourse

A

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

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34
Q

Diagnosis of LIV qi depression: what formula would you think of

A

Chai Hu Shu Gan San

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35
Q

What does sleep reflect in CM?

A

State of Shen, Hun

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36
Q

Sleep questions in CM

A

Easy to fall asleep?
Wake up at night?
Dream excessively? = waking up at night, impacting the next day, nightmares, recurring dreams

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37
Q

In CM what determines sleep?

A

LIV, HT Blood + yin (other organs as well)
* Yin time = Shen + Hun should be anchored in HT Blood, LIV Blood

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38
Q

Shen + Hun not anchored at night: potential causes

A

Insufficient Blood/yin to anchor
PF (ex. heat) agitates these Spirits

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39
Q

Empty sleep disturbance

A

Shen + Hun float at night –> insomnia

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40
Q

What does difficulty falling asleep indicate?

A

Blood xu: HT, SP, LIV

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41
Q

What does difficulty staying asleep + tendency to wake up at night indicate?

A

Yin xu

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42
Q

Full patterns that correspond to waking up during the night?

A

Heat
Fire
Phlegm-fire
Food retention

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43
Q

Full conditions w/ very restless sleep, heat, agitation, excess dreaming

A

LIV fire
Phlegm-fire harassing HT
HT fire
Residual heat in the diaphragm

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44
Q

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

A

LIV fire

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45
Q

restless sleep
insomnia
dream-disturbed sleep
sputum in throat
red tongue w/ redder tip + sticky-yellow TC
slippery-overflowing-rapid pulse

A

Phlegm-fire harassing the HT

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46
Q

restless sleep
dream-disturbed sleep
palpitations
agitation
red tongue w/ redder tip + yellow TC
overflowing-rapid pulse

A

HT fire

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47
Q

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

A

residual heat in the diaphragm

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48
Q

sleep: excess/ deficiency

A

empty: unable to fall asleep or stay asleep w/o red tongue, feeling of heat

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49
Q

insomnia w/ difficulty falling asleep
palpitations
pale tongue
choppy or fine pulse

A

HT blood xu

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50
Q

insomnia w/ difficulty falling asleep
palpitations
tiredness
pale tongue
choppy pulse

A

SP + HT qi + blood xu

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51
Q

insomnia w/ difficulty falling asleep
palpitations
tongue w/o coat
floating-empty pulse

A

HT yin xu

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52
Q

insomnia w/ difficulty falling asleep
dreaming
dizziness
blurred vision
pale tongue
choppy or fine pulse

A

LIV blood xu

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53
Q

insomnia w/ difficulty falling asleep
dreaming
dizziness
blurred vision
dry eyes
tongue w/o coat
floating-empty pulse

A

LIV yin xu

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54
Q

insomnia w/ difficulty falling asleep
dizziness
tinnitus
tongue w/o coat
floating-empty pulse

A

HT + KID yin xu

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55
Q

insomnia
waking up frequently during the night
anxiety
night sweats
dizziness
tinnitus
red tongue w/o TC
floating-empty + rapid pulse

A

HT + KID yin xu with HT empty-heat

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56
Q

Etiology of excess dreaming

A

Pathogenic factor ex. Fire, Phlegm-Fire
or
Yin deficiency empty-heat

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57
Q

Excess dreaming in CM

A

Pleasant or unpleasant dreaming that makes the sleeper restless or awakens them
Nightmares, especially recurrent
“Ye You” Hun wandering at night

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58
Q

Excess patterns of excess dreaming

A

LIV fire
HT fire
Phlegm-fire harassing HT
ST phlegm-fire

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59
Q

excessive dreaming, nightmares, restless sleep, headaches, Red tongue with redder sides and dry yellow coating, Wiry-Rapid pulse

A

LIV fire

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60
Q

excessive dreaming, restless sleep, palpitations, insomnia, Red tongue with redder tip and yellow coating, Overflowing-Rapid pulse

A

HT fire

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61
Q

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

A

Phlegm-fire harassing HT

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62
Q

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

A

Phlegm-fire in ST

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63
Q

dream-disturbed sleep, insomnia, Red tongue with redder tip and without coating, Floating-Empty and Rapid pulse

A

HT-yin deficiency with empty-heat

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64
Q

dream-disturbed sleep, insomnia, blurred vision, dry eyes, Red tongue without coating, Floating-Empty and slightly Rapid pulse

A

LIV yin xu with empty heat

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65
Q

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

A

HT- and KID-yin xu with empty-heat

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66
Q

excessive dreaming, waking easily from dreaming, absent-minded, emotionally unstable, anxiety and palpitations

A

HT and GB xu

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67
Q

Somnolence in CM

A

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

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68
Q

Somnolence etiology

A

Deficiency: Qi and/or Yang
Excess: ex. Phlegm, Damp

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69
Q

Most common cause of somnolence

A

Combined deficiency (SP, KID) and excess (damp, phlegm)

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70
Q

somnolence, desire to lie down, loose stools, Pale tongue, Weak pulse

A

SP yang xu

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71
Q

somnolence, listlessness, backache, dizziness, tinnitus, Pale-Swollen tongue, Deep-Weak pulse

A

KID yang xu

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72
Q

somnolence after eating, feeling of heaviness, sticky coating, Slippery pulse

A

Dampness

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73
Q

somnolence after eating and in the morning, muzziness of the head, dizziness, Swollen tongue with sticky coating, Slippery pulse

A

Phlegm

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74
Q

Shen and pre-natal essence relationship

A

Jing in KID is the biological foundation of Zhi
Shen activity is founded on Jing + Qi
Zhi: memory

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75
Q

Shen + post-natal essence

A

Harmonious ST + intestines –> Blood harmonized, Shen draws on refined essence of water + food

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76
Q

Shen + Essence

A

Both pre-natal (KID) and post-natal (SP) essence support Shen

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77
Q

7 emotional factors

A

Anger
Joy
Worry
Sorrow
Thought/pensiveness
Fear
Fright

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78
Q

Anger qi movement

A

LIV qi rises

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79
Q

Joy qi movement

A

HT qi slows, relaxes

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80
Q

Sorrow qi movement

A

LU, disperses/dissolves qi

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81
Q

Worry qi movement

A

LU, knots qi

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82
Q

Pensiveness qi movement

A

SP, qi knots

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83
Q

Fear qi movement

A

KID, qi descends

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84
Q

Fright qi movement

A

HT, KID - scatters qi

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85
Q

Fatigue in CM: definition

A

Abnormal weariness
Inability to perform normal movements

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86
Q

Fatigue in CM etiology

A

Lassitude of spirit (lack of mental strength)
Organs: SP, LU, LIV
Deficiency: Qi, Blood, Yang
Damp patterns

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87
Q

Emotional depression in CM might be:

A

Depressed LIV qi / Hun not moving freely
Exacerbated by phlegm –> easily becomes fire

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88
Q

Depression vs despondency

A

Not the temporary response to adverse life events
Mood is fixed and persists w/ changes in behavior, attitude etc

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89
Q

Depression clinical definition

A

Absence of an organic factor, normal bereavement, delusions or hallucinations in the absence of mood symptoms, schizophrenia, delusional/psychotic symptoms

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90
Q

Physical symptoms that cue for depression

A

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’

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91
Q

Depression + Hun

A

Lack of Hun movement:
LIV qi stag
LIV blood + LIV qi xu
SP, KID xu

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92
Q

Excess movement of Hun

A

Fire
Phlegm-fire
LIV blood and/or LIV yin xu

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93
Q

Depressed LIV qi (ganqi yu)

A

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

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94
Q

Treatment of Ganqi Yu/ depressed LIV qi

A

Soothe the LIV, resolve depression
RX Chai Hu Shu Gan San

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95
Q

Depressed LIV qi + LIV/SP disharmony: additional symptoms

A

distention
fullness
loose stool
gas borborygmus
withered complexion

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96
Q

Depressed LIV qi + LIV/ST disharmony: additional symptoms

A

distention
belching
acid regurgitation
palpitations/”scurrying” pain in the ST duct

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97
Q

Depression, moodiness, irritability

A

LIV qi stag

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98
Q

Depression, irritability, red tongue

A

Stagnant LIV qi transforming into heat

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99
Q

Depression
Moodiness
Lump in the throat

A

LIV qi stag with Qi-phlegm

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100
Q

Depression
Anxiety
Agitation
Expectorating phlegm
Swollen tongue

A

Phlegm-fire harassing the Shen

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101
Q

Depression
Agitation
Purple tongue

A

HT blood stasis

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102
Q

Depression
irritability
Bitter taste
Hypochondrial fullness

A

GB heat

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103
Q

Depression
Anxiety
Feeling stuffy in the chest after a WH invasion

A

Diaphragm heat

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104
Q

Full/Excess patterns of depression

A

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

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105
Q

Deficient depression patterns

A

SP- and HT-blood xu
HT yang xu
LIV blood xu
KID- and HT-yin xu + HT empty heat
KID yang xu

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106
Q

depression
insomnia
palpitations
tiredness

A

SP- and HT-blood xu

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107
Q

depression
palpitations
cold hands

A

HT-yang xu

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108
Q

depression,
no sense of direction
sadness

A

LIV blood xu

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109
Q

depression
anxiety
night sweats
palpitations
red tongue w/o coat

A

KID- and HT-yin xu with HT empty heat

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110
Q

depression
lack of motivation
lack of willpower
feeling cold
frequent urination

A

KID-yang xu

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111
Q

Anxiety in CM

A

fear + worry (seven emotions)

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112
Q

Anxiety in CM etiology

A

DEFICIENCY: Blood, Yin
EXCESS: Heat
COMBO: Yin xu, empty heat

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113
Q

Shen + Hun lose “residence” in HT-blood + LIV-blood: etiology + effects

A

Etiology: blood, yin xu
Results: anxiety, poor sleep

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114
Q

Pathogenic factors agitating Shen + Hun: which? Results?

A

PF: qi stag, Blood stasis, heat, phlegm-heat
Results: Anxiety, insomnia

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115
Q

Physical cues of anxiety

A

Restless appearance
Quivering voice
Fidgeting
FULL: speaking a lot
EMPTY: quiet
* may be preoccupied about needles

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116
Q

Cues of hidden anxiety/fear

A

Tongue with red tip, deep HT crack
Wiry (full) or Floating-empty (empty) + rapid
Eyes: ‘unstable’ or without control

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117
Q

Empty/deficient fear/anxiety patterns

A

HT-blood xu
HT-yin xu
LIV blood xu
LIV yin xu
KID yin xu
HT- and GB-qi xu

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118
Q

Mild anxiety, insomnia, palpitations

A

HT blood xu

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119
Q

Anxiety that is worse in the evening
Palpitations
Night sweats

A

HT yin xu

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120
Q

Mild anxiety
Depression
Insomnia

A

LIV blood xu

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121
Q

Mild anxiety
depression
insomnia
Tongue without coat

A

LIV yin xu

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122
Q

Anxiety that is worse in the evening
Lack of willpower
Dizziness
Tinnitus

A

KID yin xu

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123
Q

Mild anxiety
Insomnia
Timidity

A

HT- and GB-qi xu

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124
Q

Excess fear/anxiety patterns

A

HT fire
HT blood stasis
Phlegm-fire harassing Shen
LIV qi stag
LIV fire
LIV yang rising
Rebellious qi of Chong/Penetrating
Diaphragm-heat

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125
Q

Severe anxiety
Palpitations
Red tongue with coat

A

HT fire

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126
Q

Severe anxiety
Palpitations
Purple tongue

A

HT-blood stasis

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127
Q

Severe anxiety
Manic behavior
Swollen tongue

A

Phlegm-fire harassing the Shen

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128
Q

Anxiety
depression
irritability
Hypochondrial distension

A

LIV qi stag

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129
Q

Severe anxiety
Headache
Thirst
Red tongue
Wiry pulse

A

LIV fire

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130
Q

Anxiety
headache
dizziness

A

LIV yang rising

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131
Q

anxiety
panicky feeling
throat constriction
palpitations
chest tightness
abdominal fullness
firm pulse

A

Chong vessel rebellious qi

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132
Q

anxiety
stuffiness in region under the HT
following WH invasion

A

diaphragm heat

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133
Q

anxiety that is worse in the evening
palpitations
red tongue without coat

A

HT yin xu with empty heat

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134
Q

anxiety that is worse in the evening
dizziness
tinnitus
palpitations

A

KID- and HT-yin xu with HT empty heat

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135
Q

Irritability in CM

A

feeling annoyed frequently
easily angered
frustration
= like anger but larger range of emotional states

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136
Q

Anger vs. Irritability

A

Anger: LIV
Irritability: many organs

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137
Q

CM diagnoses and irritability

A

Qi stag
Blood stasis
LIV yang rising
Blood xu
Yin xu (with or without empty heat)
Heat (incl. dampheat)
Deficient heat

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138
Q

“I feel extremely irritable before my periods and take it out on my family” might be

A

LIV qi stag

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139
Q

“I feel this lump in my throat; I’m on edge and feel like bursting into tears” might be

A

LU qi stag

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140
Q

“I seethe with resentment” might be

A

LIV blood stasis

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141
Q

“My mind is constantly judging and I feel resentful” might be

A

HT-blood stasis

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142
Q

“I fly off the handle easily” might be

A

LIV yang rising

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143
Q

“I explode into a rage” might be

A

LIV fire

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144
Q

“I feel irritable, impatient and angry” might be

A

HT fire

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145
Q

“I feel frustrated, weepy, irritable” might be

A

LU heat

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146
Q

“I often feel angry and obsessive” might be

A

ST heat

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147
Q

“I feel lost, overwhelmed, on edge, can’t cope” might be

A

LIV blood xu

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148
Q

“I feel helpless, unmotivated, on edge in the evening” might be

A

KID yin xu

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149
Q

“I feel sad, on edge, can’t cope” might be

A

HT blood xu

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150
Q

“I feel hot and bothered” might be

A

KID yin xu with empty heat

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151
Q

“I feel sad, hot, bothered” might be

A

HT yin xu with empty-heat

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152
Q

“I feel heavy, yucky, and irritable” might be

A

Damp-heat

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153
Q

Worry vs Overthinking/pensiveness

A

Worry: LU
Overthinking: SP (unable to empty the mind of repetitive thoughts, trivial things)

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154
Q

Overthinking in CM

A

Mostly empty
Mixed: LU qi stag or Yin xu + empty-heat

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155
Q

Full worry

A

More intense and consuming vs lurking in the background (empty)

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156
Q

Worry
Slightly obsessive thinking
Slight depression
Overthinking
Pale tongue
Empty pulse

A

HT- and SP-qi deficiency

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157
Q

Worry
depression
pale tongue
empty pulse

A

LU qi xu

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158
Q

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

A

LU qi stag

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159
Q

worry
depression
pale thin tongue
choppy or fine pulse

A

HT blood xu

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160
Q

Worry which increases after the period
Pale tongue
Choppy or fine pulse

A

LIV blood xu

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161
Q

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

A

HT yin xu

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162
Q

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

A

HT yin xu with empty-heat

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163
Q

sadness vs lack of joy

A

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

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164
Q

sadness and ancestral/gathering/chest qi

A

depletes LU- and HT-qi
–> may lead to qi stag in chest

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165
Q

slight tightness in the chest, sadness felt in the chest, sighing, slight palps

A

stagnation of chest qi

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166
Q

sadness
crying
depression
pale tongue
empty pulse

A

LU- and HT-qi xu

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167
Q

sadness
crying
mental confusion
aimlessness
pale tongue
choppy or fine pulse

A

LIV blood xu

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168
Q

sadness
crying
depression
pale thin tongue
choppy or fine pulse

A

HT blood xu

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169
Q

sadness
mild irritability
depression
tongue slightly red on the sides in chest area
pulse very slightly tight on right-front position

A

LU qi stag

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170
Q

Grief in CM

A

like sadness, usually due to loss
depletes LU and HT qi –> chest qi stag

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171
Q

normal joy in CM

A

power, complete body integration
expansiveness
urge to spread the limbs

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172
Q

Sudden extreme elation impacts

A

makes qi rise
expands HT

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173
Q

excess joy

A

life characterized by excess stimulation/excitement
hypomania, mania
–> qi rising, may lead to HT fire

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174
Q

Excess joy diagnoses

A

HT fire
HT empty heat
Phlegm-fire harassing HT

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175
Q

Fan Zao

A

“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

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176
Q

How modern patients might describe Fan Zao symptoms

A

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

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177
Q

Mental restlessness diagnoses

A

Yin xu + empty heat
Phlegm-heat in ST, HT
HT Fire
Lu Heat

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178
Q

Vague mental restlessness which worsens in the evening, restless legs, red tongue w/o coat, floating-empty rapid pulse

A

Yin xu + empty heat

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179
Q

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

A

Phlegm-heat in ST + HT

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180
Q

pronounced mental restnessness
agitation
red tongue w/ redder tip + yellow coat
overflowing-rapid pulse

A

HT fire

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181
Q

mental restlessness
worry
red tongue yellow coat
overflowing-rapid pulse

A

LU heat

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182
Q

Symptom that worsens after sex indicates what?

A

Qi xu
Usually kidneys, also LIV HT

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183
Q

Tiredness after sexual activity, especially if accompanied by dizziness, backache, weak knees, etc

A

KID qi xu

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184
Q

What patterns are mostly behind impotence?

A

KID xu
with backache, weak knees, dizziness, tinnitus, poor memory
especially KID yang xu

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185
Q

What organs might you think of for impotence in young men?

A

KID (as usual)
HT often involved

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186
Q

Impotence, dizziness, palpitations, choppy pulse

A

HT blood xu

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187
Q

impotence, palpitations, insomnia, dream-disturbed sleep, rapid-overflowing pulse

A

HT fire

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188
Q

impotence, heaviness in the scrotum, urethral discharge, sticky-yellow tongue coat

A

DH in LIV channel

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189
Q

Patterns for lack of libido

A

Usually Qi or yang xu (frequently KID)
Severe SP, HT, LU qi xu
HT xu (more than KID)
Full: LIV qi stag

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190
Q

Patterns for premature ejaculation

A

Usually KID
–> KID qi not firm
Also HT patterns
–> HT qi or HT blood xu

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191
Q

Tiredness + dizziness after ejaculation

A

KID xu

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192
Q

Nocturnal emissions indicates what?

A

KID xu

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193
Q

Nocturnal emission in ancient China

A

nighttime intercourse with ghosts that rob essence

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194
Q

Nocturnal emissions without sexual dreams

A

Pure deficiency, usually KID

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195
Q

Nocturnal emissions w/o sex dreams

A

usually due to heat (full or empty), generally HT
- empty heat due to KID xu
- full-heat often of LIV and/or HT

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196
Q

What is the CM root of sexual desire?

A

KID yang
Minister fire
–> patterns usually = KID or HT xu

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197
Q

Deficient minister fire can cause what?

A

Lack of sexual desire

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198
Q

LIV/HT fire and empty-heat from KID yin xu can lead to what?

A

excess sexual desire

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199
Q

What organ would you think of in regards to sexual arousal/orgasm in cycling people?

A

HT

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200
Q

Where does aroused physiological minister fire of the KID go?

A

HT
PC
–> flushed face, increased HT rate

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201
Q

CM pattern of low sexual desire?

A

deficient Minister Fire, KID yang

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202
Q

CM understanding of orgasm

A

Minister Fire which rose during sexual arousal –> suddenly discharged downwards by the HT

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203
Q

What organ would you think of in regards to cycling people unable to reach orgasm?

A

HT xu

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204
Q

Fire/Water Daoist sexual alchemy

A

Fire: flares up easily, easily extinguished
Water: slow to boil, slow to cool down

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205
Q

Questions to ask about menses

A

Age of menarche
Cycle
Quantity of blood
Color of blood
Clots
Pain
PMS

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206
Q

What is breast milk derive from in CM?

A

Blood

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207
Q

Gyno questions

A

Childbirth
Abortion
Miscarriage
Contraception
Intrauterine coil
HRT
Pelvic inflammatory disease
Gyn. surgical interventions

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208
Q

Menarche ages

A

10-16, mean 12.8 (younger in industrialized contexts)
Early may indicate blood-heat
Late (after ~16) may indicate Blood and/or KID xu or Cold in the Uterus

209
Q

Early or late menstruation in CM

A

7 days (of ideal 28 day cycle)

210
Q

Period always early

A

Qi xu
Blood-heat
Empty-heat in the blood from Blood/Yin xu

211
Q

Period always late

A

Blood xu
Blood stasis
Cold stasis

212
Q

Irregular period - sometimes late/early

A

LIV blood stasis
SP xu
KID xu

213
Q

Periods that stop and start

A

Blood stasis

214
Q

Periods that start/end with a brownish discharge

A

Blood stasis

215
Q

Mid-cycle bleeding

A

Damp-heat (esp if there’s also pain)
Qi xu
LIV- and KID-yin xu

216
Q

Heavy menstrual bleeding that may come early with a flood, pale blood
Pale tongue

217
Q

Heavy menstrual bleeding, pale blood, irregular periods, backache, feeling cold, loose stools
Pale wet tongue

A

SP- and KID-yang xu

218
Q

Heavy menstrual bleeding, trickling after the proper time, irregular periods, infertility, dizziness, tinnitus, night-sweating
No tongue coat

A

LIV- and KID-yin xu

219
Q

Heavy menstrual bleeding, bright-red or dark-red blood, feeling of heat, mental restlessness, red face, thirst
Red tongue with coat

A

Blood heat

220
Q

Heavy menstrual bleeding, headaches, dizziness, tinnitus, irritability
Red tongue with redder sides, yellow coat

221
Q

Heavy menstrual bleeding, irregular periods, trickling after the proper time, infertility, dizziness, tinnitus, night-sweating, feeling of heat in the evening, five-palm heat
Red tongue without coat

A

LIV- and KID-yin xu with blood empty heat

222
Q

Heavy menstrual bleeding, painful periods with dark blood + dark clots, periods that start/stop

A

Blood stasis

223
Q

Range of blood loss in menstruation

224
Q

Heavy menstruation definition

A

Profuse
Prolonged

225
Q

Period duration in CM

226
Q

General menstrual colors

A

Dark-red
Beginning: lighter
Middle: deep-red
End: pinkish

227
Q

Dark-red or bright-red blood

A

Blood heat

228
Q

Pale menstural blood

229
Q

Blackish, very dark menstruation

A

Blood stasis

230
Q

Purplish menstrual blood

231
Q

Brownish + diluted menstruation

A

Empty-cold

232
Q

Scarlet-red menstrual blood

A

empty-heat in BL

233
Q

Clotted menses with dark dull clots

A

Blood stasis or Cold in the uterus

234
Q

Clotted blood with dark but fresh-looking clots

235
Q

Large menstrual clots

A

Blood stasis

236
Q

Small dark clots but menstrual blood isn’t dark

A

Cold in the uterus

237
Q

Watery menstrual blood

A

Blood or Yin xu

238
Q

Sticky menses

A

Dampness or Damp-Heat in the Uterus

239
Q

Pain before the period

A

Qi stag or Blood stag
*Blood stasis usually relieved by the onset of the period

240
Q

Pain during the period

A

Blood-heat or blood stasis

241
Q

Pain after the period

A

Blood deficiency

242
Q

Severe stabbing period pain

A

Blood stasis

243
Q

Severe cramping pain eased by application of heat

A

Cold stasis

244
Q

Mild pain in menses

A

Blood-heat or Blood xu

245
Q

Dragging feeling in the lower abdomen with mild pain

A

Qi sinking

246
Q

Feeling of heaviness in the lower abdomen with pain

247
Q

Pain on ovulation

248
Q

Abdominal distension and pain before/during period
Normal tongue or slightly red sides

A

LIV qi stag

249
Q

Severe period pain alleviated by the passage of clots
Purple sides

A

LIV blood stasis

250
Q

Severe spastic cramp-like menstrual pain that is alleviated by the application of heat, small-stringy clots on bright red blood, feeling cold during period
Pale tongue

251
Q

Painful periods with a feeling of heaviness extending to the sacrum, mid-cycle pain, small-red clots
Red tongue with sticky-yellow coat

252
Q

Painful periods, heavy periods, irritability, thirst, bitter taste
Red tongue sides

A

Stagnant LIV qi turning to LIV fire

253
Q

Dull menstrual pain towards the end of/after the period, pain relieved by pressure, scanty periods
Pale tongue

A

Qi and Blood Xu

254
Q

Dull period pain during/after the period, scanty bleeding, no clots
Pale or slightly swollen on the sides (tongue)

A

SP-yang and LIV-blood xu

255
Q

Dull period pain during/after the period, scanty period, backache, dizziness, tinnitus, night-sweating
No tongue coat

A

LIV- and KID-yin xu

256
Q

Most common cause of premenstrual tension

A

LIV qi stag

257
Q

Irritability, depression, tendency to cry, abdominal/breast distension

A

LIV qi stag

258
Q

Premenstrual tension w/ propensity to outbursts of anger, irritability and agitation

A

LIV-fire and/or HT fire

259
Q

Premenstrual tension with mental confusion, premenstrual breast swelling + pain

A

Phlegm-Fire

260
Q

Deficiency causes of premenstrual tension

A

LIV-blood xu
LIV- and KID-yin xu
SP- and KID-yang xu
SP-Qi xu with dampness

261
Q

Deficient premenstrual tension

A

With depression, crying, lack of motivation, only mild irritability

262
Q

Weepiness, crying, depression, mild irritability

A

LIV-blood xu with secondary LIV-qi stag

263
Q

Weepiness, crying, depression, lack of motivation, insomnia, PMS

A

LIV- and KID-yin xu

264
Q

Weepiness, crying, depression, lack of motivation, tiredness, lassitude, PMS

A

SP- and KID-yang xu

265
Q

Weepiness, tiredness, lassitude, feeling of heaviness, swollen breasts, PMS

A

SP-qi xu with dampness and secondary LIV-qi stag

266
Q

Nausea or vomiting before the period

A

stagnant LIV-qi invading ST

267
Q

Premenstrual constipation

A

stagnant LIV-qi invading intestines and SP

268
Q

Headaches before the period

A

LIV-qi stag or LIV-yang rising

269
Q

Distension of the breasts in PMS

A

LIV qi stag

270
Q

Breasts become very swollen and painful = possibly

A

Phlegm
with premenstrual problems, usually also qi stag

271
Q

Acute breast pain may be:

A

toxic heat in the breast

272
Q

Retention of water with edema before the period

A

SP-yang and/or KID-yang xu

273
Q

Abnormal vaginal discharge is

A

not the normal transparent, egg white-like secretion of ovulation
*increase in secretions mid-cycle and during pregnancy = normal

274
Q

How do we differentiate vaginal discharge?

A

Color
Consistency
Smell

275
Q

White vaginal secretions

A

Cold
SP- or KID-yang xu OR exterior cold-damp

276
Q

Yellow vaginal secretions

A

Heat
usually DH in the LJ

277
Q

Greenish vaginal secretions

A

DH in the LIV channel

278
Q

Red and white vaginal secretions

279
Q

Yellow, red vaginal secretions with white pus after menopause

A

Toxic heat

280
Q

Watery vaginal secretions

A

Cold-damp and/or Deficient condition

281
Q

Thick vaginal secretions

A

DH and/or excess condition

282
Q

Fishy-smelling vaginal secretions

283
Q

Leathery-smelling vaginal discharge

284
Q

Nausea/vomiting in pregnancy

A

Slight nausea in first 3 months = normal
Persistent vomiting in the first 3 months + ongoing = pathological sign

285
Q

Persistent vomiting in the first 3 months + ongoing in gestation

A

usually rebellious qi in the Penetrating/Chong vessel affecting ST channel
* can occur against background of ST xu or ST heat

286
Q

Edema during pregnancy

A

KID-yang xu

287
Q

High blood pressure in pregnancy

A

KID xu with LIV-yang xu –> may herald preeclampsia (+headache, dizziness, blurred vision)

288
Q

full eclampsia state with convulsions

A

LIV-wind from LIV- and KID- xu

289
Q

What does it mean if symptoms get worse or better with pregnancy? (ex asthma, migraine, rheumatoid arthritis)

290
Q

Possible CM causes of infertility

A

Blood Xu
KID xu
Blood stasis
Cold in the uterus
Damp-phlegm

291
Q

Nausea and heavy bleeding after labor

A

exhaustion of the Chong/Penetrating vessel

292
Q

Sweating and fever after labor

A

exhaustion of qi and blood

293
Q

postnatal depression

A

LIV-blood and HT-blood xu

294
Q

Postnatal psychosis

A

stasis of blood in the uterus + HT

295
Q

Breast milk not flowing (agalactia) after childbirth

A

Blood xu
ST and SP xu
LIV-qi stag

296
Q

spontaneous flow of milk after childbirth

A

SP-qi xu
ST-heat
LIV-fire

297
Q

Mastitis after childbirth

A

Toxic heat in ST channel

298
Q

What channels pertain to the breasts?

A

ST + Penetrating channel (main tissues + lactiferous ducts)
LIV channel (nipple)
LIV/GB (lateral breast side)
Penetrating vessel (connective tissues/membranes)
Muscle channels of GB, HT, PC

299
Q

Chong/Penetrating and breasts - relationship

A

Chong originates from uterus + connects to breasts
Breast milk = transformed menstrual blood
Chong = sea of blood = source of breast milk
* many breast pathologies (lumps, menopause) - background of Chong disharmony = either deficiency or Blood stasis

300
Q

Bile is what?

A

Gallbladder Qi

301
Q

Zangfu involved in breast pathologies

A

PMS - typically LIV qi stag
LU qi stag/sadness in the chest

302
Q

pronounced breast distension, irritability, wiry pulse

A

LIV qi stag

303
Q

yin xu pulse

A

superficial/floating
rapid

304
Q

slight breast distension, sadness, weak pulse

A

LU qi stag

305
Q

swollen painful breasts, swollen tongue

A

LIV qi stag with phlegm

306
Q

painful breasts, purple tongue

A

LIV blood stasis

307
Q

mild breast distension, choppy pulse

A

LIV blood xu

308
Q

relatively soft, movable, painless multiple breast lumps with distinct edges

A

Phlegm (fibrocystic disease)

309
Q

single, movable, relatively hard breast lump with distinct edges

A

Phlegm with blood stasis (fibroadenoma)

310
Q

Single, NOT movable, relatively hard breast lump with indistinct edges

A

Blood stasis (carcinoma)

311
Q

breast pathology that is more common ages 20-30

A

fibroadenoma

312
Q

breast pathology that is more common ages 30-50

A

fibrocystic conditions

313
Q

breast pathologies more common ages 50+

314
Q

Chinese medical understanding of menopause

A

natural decline of Kidney Essence

315
Q

Menopausal symptoms etiology

A

can be both Kidney Yin and Yang xu
LIV yang rising
HT yin xu with empty heat
Phlegm

316
Q

Headaches in menopause

A

LIV yang rising

317
Q

insomnia, anxiety, agitation, poor memory in menopause

A

HT yin xu + empty heat

318
Q

Wood phase: age

A

birth to puberty/15/18+

319
Q

Fire phase: age

A

15-30+ years

320
Q

Earth phase: age

A

20-40/30-45+

321
Q

What is wood’s role in nature?

A

Controls earth by absorbing water (generating, balancing cycle)

322
Q

Metal phase: age

323
Q

Water phase: age

324
Q

Three causes of disease in early childhood

A

weak hereditary constitution
irregular feeding
climate

325
Q

Main causes of older children’s disease

A

Diet
Climate
Emotions
Traumas

326
Q

Skin problems in adolescence

A

aggravation of Blood xu with onset of menarche

327
Q

Painful periods since their onset

A

invasion of Cold in the Uterus while the Uterus is vulnerable

328
Q

Digestive problems later in life often have their root when?

329
Q

LU pulse is somewhat full
Patient looks sad

A

Unexpressed sadness

330
Q

Weak LU pulse without wave
Eyes lack luster

331
Q

HT pulse overflowing
HT tongue crack

332
Q

Choppy HT pulse
Dull complexion
Lusterless eyes
Weak weepy voice

A

Long-standing sadness

333
Q

Wiry pulse in all positions

A

Life situation causing frustration

334
Q

Primary cause of disease in earth stage

A

Emotions
Overwork! (leads to KID xu)
Diet

335
Q

Diagnostic questions for treating children

A

digestion
respiration (kids are prone to wind invasions)
earache
sleep
birthing parent’s pregnancy, immunizations

336
Q

Shaoyang L/R + formulas

A

LEFT - Taiyang opening - GUI ZHI TANG
RIGHT - Yangming closing - DA CHAI HU TANG

337
Q

baby cries a lot at night and vomits frequently

338
Q

premature cutting umbilical cord, induction, Caesarean can cause what from CM perspective?

339
Q

Lack of breast-feeding or too short breast-feeding in CM

A

ST xu
ST food retention
*children inherently have weak SP/ST

340
Q

2 main causes of children’s abdominal pain

A

retention of cold in the ST/intestine
Intestinal qi stag

341
Q

aversion to cold
listless desire to sleep
lying with the body curled up
diarrhea with undigested food
frequent pale urination
pale tongue
white coat
weak pulse

A

Shaoyin cold

342
Q

irritability, insomnia, dry mouth, dry throat, night sweats, dark urine, red tongue with little coat, thready rapid pulse

A

Shaoyin heat

343
Q

History of repeated bouts of cough and wheezing in a child

A

residual PF (usually LU phlegm-heat) following invasions of external wind

344
Q

chronic earache in kids

A

residual PF (usually DH in the GB channel)

345
Q

chronic mucus in kids

A

residual pathogenic factor after repeated wind invasions + SP xu –> phlegm

346
Q

disturbed sleep with loud crying in babies

A

food retention
ST heat

347
Q

disturbed sleep with quiet crying in babies

A

prenatal shock

348
Q

disturbed sleep in older kids: common causes

A

LIV fire
ST heat
retention of food

349
Q

slow development in children

A

congenital weakness of LIV KID
postnatal: ST (walking), HT (speech)

350
Q

how to diagnose children under 2

A

venules on the index fingers
L index (boys) R (girls)
rub finger towards the body

351
Q

joint diagnosis on children

A

base crease Gate of Wind
second crease Gate of Qi
third crease Gate of Life

352
Q

after rubbing the finger towards the body, venules appear only beyond the Gate of Wind

A

invasion by an exterior PF
mild disease

353
Q

Venules extending beyond the Gate of Qi

A

interior and more severe disease

354
Q

venules beyond gate of life

A

serious life-threatening disease

355
Q

bluish venules beyond the gate of life

A

Cold pattern

356
Q

red venules beyond the gate of life

A

Heat pattern

357
Q

Zhang Zhong-Jing lived when?

A

Han dynasty

358
Q

When did the Shanghanlun become two books?

A

Song dynasty

359
Q

What was cold damage referring to in the Shanghanlun?

A

Generic term for any acute, potentially epidemic, febrile illness

360
Q

Types of injury from cold

A

attack of wind
attack of cold
damp-warmth
heat disease
warm disease

361
Q

What method does the Shanghanlun present?

A

understanding
anticipating
treating
the various transformations of exterior disease

362
Q

What does the Shanghanlun provide in matching selections?

A

Clinical application of a group of symptoms -> corresponding formulas + modifications (according to change of the disease)

363
Q

Ying Level characteristics

A

Shen disturbance “delirium”
macular rashes
PC heat
PC 3,4,5 = SAM
PC 3 - Severe sunstroke
PC 4 - Arythmia, angina
PC 5 - Malaria

364
Q

Shang Han Lun is based on:

A

8 principle differentiation
6 syndrome identification
Formula pattern ID

365
Q

8 principles

A

hot/cold
excess/deficiency
exterior/interior
yang/yin

366
Q

Traditional order of Sanyin Sanyang

A

Taiyang
Yangming
Shaoyang
Taiyin
Shaoyin
Jueyin

367
Q

What does Taiyang progress to?

A

Yangming OR Shaoyang

368
Q

What does Shaoyang progress to?

369
Q

SHL combo patterns

A

He Bing (combo disease)
Usually Taiyang/Yangming or Taiyang/Shaoyang or all 3 Yang

370
Q

Zhi Zhong / Direct strike

A

In debilitated patients, evils may go direct to Yin levels

371
Q

Factors that determine the progression of disease

A

Relative strength of Zheng + Xie qi
Appropriate or incorrect meds
Patient constitution
Presence/absence of other disease

372
Q

Does 6 syndrome ID equate to acupuncture channels with the same name?

A

NO
layer/depth format

373
Q

chills
fever
aversion to cold/wind
body heaviness
joint pain
skin diseases
headache
floating pulse

A

Taiyang syndrome (overview)

374
Q

Symptoms in chest/abdomen
Can affect any organ(s)
Chest discomfort
Pain/stiffness in rib sides
Dry mouth
Alternating C/F
Bitter taste in mouth

A

Shaoyang syndrome

375
Q

Disease characterized by internal excess heat
Fever w/o chills
Distended abdomen
Irritability
Easily emotional
Constipation
Rapid pulse

A

Yangming syndrome

376
Q

Feeling of severe internal cold
Chills
Distended abdomen
Occasional pain
Diarrhea/loose stool

A

Taiyin syndrome

377
Q

Drowsiness
Chills
Cold extremities
Aversion to cold
Joint/body pain
Deep, constrained pulse

A

Shaoyin syndrome

378
Q

Symptoms in chest/abdomen
Can affect any organ(s)
Increased symptoms of heat in the upper body
Severe cold in lower limbs/abdomen
Thirst
Diff. urination
Physical weakness
Lethargy
Deep/weak pulse

A

Jueyin syndrome

379
Q

Taiyang channel differentiation

A

Wind attack
Cold attack

380
Q

Taiyang Fu differentiation

A

Acc. water
Acc. blood

381
Q

Yangming differentiation

A

Channel: ST heat
Fu: Fire in ST + intestines

382
Q

Shaoyin patterns

A

Cold transformation
Heat transformation

383
Q

8 SHL treatment methods

A

Sweat
Vomiting
Purge
Harmonize
Warm
Clear
Tonify
Disperse

384
Q

Essential Taiyang symptoms

A

Aversion to cold
Headache/stiff neck
Floating/superficial pulse

385
Q

Slight aversion to cold, aversion to wind, slight fever, slight sweat, headache, stiff neck, sneezing, floating-slow pulse

A

Wind-attack
(WC invasion wind prevalent)

386
Q

Wind Attack treatment principle

A

Release exterior
Expel WC
restore diffusion of LU qi
Harmonize Ying + Wei

387
Q

Wind-attack formula

A

Gui zhi tang

388
Q

AVersion to cold, slight fever, no sweat, headache, stiff neck, sneezing, runny nose w white discharge, breathlessness, floating-tight pulse

A

Cold attack

389
Q

Diff. b/w wind-attack and cold-attack

A

WIND - slight sweat
COLD - no sweat

390
Q

Cold attack treatment principle

A

Release exterior
Expel WC
restore diffusion + descending of LU qi

391
Q

Cold attack treatment

A

Ma Huang Tang
MOXA

392
Q

Common symptoms of Taiyang channel pathology

A

floating pulse
headache
shivers
aversion to cold

393
Q

Aversion to cold, fever, urine retention, slight thirst, vomiting fluids soon after drinking, floating-rapid pulse

A

Taiyang Fu/acc. water

394
Q

What are symptoms of exterior wind in Taiyang Fu - water accumulation?

A

C/F
floating pulse

395
Q

Taiyang Fu water accumulation treatment principles

A

release exterior
promote Bladder’s function of qi transformation
promote excretion of fluids

396
Q

Taiyang Fu - water accumulation formula

A

WU LING SAN
XIAO QING LONG TANG

397
Q

Hypogastric distension, fullness and urgency
Blood in urine
Mental restlessness
Red-purple tongue w/o coat
Deep-fine-rapid OR deep-choppy pulse

A

Taiyang Fu acc. of blood

398
Q

Taiyang Fu acc. blood treatment principle

A

Invigorate blood
Eliminate LJ stasis
Clear Bladder heat

399
Q

Taiyang Fu acc. blood formula

A

TAO HE CHENG QI TANG

400
Q

High fever, profuse sweat, intense thirst, red face, feeling of heat, irritability, delirium,
Red tongue yellow coat
Overflowing-rapid or Big-rapid pulse

A

Yangming Channel AKA Interior Full Heat

401
Q

Yangming channel pattern

A

Heat WITHOUT Form (heat)

402
Q

Yangming organ pattern

A

Heat WITH form (Fire)

403
Q

4 bigs

A

thirst
sweat
fever (actual measurable fever)
pulse
Yangming CHANNEL

404
Q

What is the sign that Taiyang has become Yangming?

A

End of aversion to cold
Onset of aversion to heat

405
Q

Yangming Channel pathology treatment principle

A

clear ST heat

406
Q

Yangming Channel pathology formula

A

BAI HU TANG

407
Q

High fever that worsens in afternoon, profuse sweat, sweating on limbs, abdominal fullness + pain, constipation, dry stool, thirst, dark urine
Red tongue thick dry yellow coat
Deep-full-slippery rapid pulse

A

Yangming Fu pathology

408
Q

Yangming Fu treatment principle

A

drain Fire from ST and intestines
move downward

409
Q

Yangming Fu formula

A

TIAO WEI CHENG QI TANG
DA CHENG QI TANG

410
Q

what symptoms in Yangming channel pathology are not present in Yangming Fu?

A

profuse sweat
overflowing pulse
thin tongue coat

411
Q

what symptoms in Yangming Fu pathology are not present in Yangming channel pathology?

A

constipation
abdominal pain/fullness
deep-full pulse
thick TC

412
Q

Common symptoms in both yangming patterns

A

fever
no chills
feeling of heat
thirst
red tongue w yellow coat

413
Q

What makes GB “curious?”

A

only Fu that stores a clean fluid (bile is pure/precious)

414
Q

Shaoyang elemental energies

A

Fire (SJ) - open waterways
Wood (GB) - course qi
Ministerial Fire

415
Q

Alternating C/F, bitter taste, dry throat, blurred vision/balance issues, hypochondrial fullness/distension, no desire to eat/drink, irritability, nausea, vomiting, HT vexation, unilateral thin white TC, wiry-fine (string-taut) pulse

A

Shaoyang pathology

416
Q

What is the PF doing in Shaoyang

A

bounces between exterior (Taiyang/chills) and interior (Yangming/fever)

417
Q

These symptoms are typical of what channel?
bitter taste, dry throat, blurred vision, hypochondrial fullness/distension, irritability, nausea/vomiting, unilateral TC

418
Q

Shaoyang pathology -> treatment principle

A

Harmonize Shaoyang

419
Q

Shaoyang pathology formula

A

XIAO CHAI HU TANG
DA CHAI HU TANG

420
Q

Opening in SHL theory

A

Taiyang: motion up + out (back of body)
Taiyin: opens yin processes to Yang

421
Q

Pivot in SHL theory

A

Shaoyang: regulating in/out, up/down (side body)
Shaoyin: regulates yin/yang HT-KID

422
Q

Closing in SHL theory

A

Yangming: down/in (front body)
Jueyin: prevents movement from being chaotic

423
Q

3 hinges in SHL theory

A

eyes
mouth
throat
* all affected by Shaoyang pathology

424
Q

Taiyin - Yangming connection

425
Q

How is the central location of the SP related to disease?

A

Interchange of qi from above + below
Pi = obstruction

426
Q

Taiyin elemental correspondency

A

Water
Earth

427
Q

causes of Taiyin pathology

A

patient w/ constitutional SP yang xu contracts WC/internal damage leads to WC

progression of PF to taiyin

428
Q

What characterizes Taiyin pathology

A

SP-yang xu + cold

429
Q

Interior empty-cold is what SHL stage?

430
Q

Abdominal fullness w periodic pain alleviated by pressure/warmth, feeling cold, vomiting, no appetite (can’t get food down), DIARRHEA (severe/spontaneous), NO THIRST, tiredness, pale tongue w/ sticky white coat, Deep-weak-slow pulse (moderate/weak)

A

Taiyin pathology

431
Q

Taiyin pathology treatment principle

A

Tonify SP yang
expel cold

432
Q

Taiyin pathology formula(s)

A

Moxa
LI ZHONG TANG
SI NI TANG

432
Q

Taiyin pathology formula(s)

A

Moxa
LI ZHONG TANG
SI NI TANG

433
Q

Shaoyin cold transformation

A

Kidney yang xu with empty-cold

434
Q

Shaoyin heat transformation

A

Kidney yin with empty-heat

435
Q

What SHL stage should you think of with these cardinal symptoms?
Lying with body curled, listlessness, desire to sleep + cold signs

A

Shaoyin cold transformation

436
Q

Chills, feeling cold, lying w/ body curled, listlessness, desire to sleep, cold limbs, diarrhea w undigested food, no thirst, frequent pale urination, pale wet tongue w white TC
Deep-weak-slow pulse

A

Cold transformation

437
Q

Cold transformation treatment principle

A

tonify KID-yang
expel cold

438
Q

Shaoyin cold transformation treatment (SHL)

A

Moxa
SI NI TANG

439
Q

Feeling of heat, irritability, insomnia, dry mouth/throat at night, dark urine, night sweats, red tongue w/o coat, Fine-rapid pulse

A

Shaoyin heat transformation

440
Q

Shaoyin heat transformation SHL treatment

A

Nourish KID-yin
Clear empty-heat

441
Q

Shaoyin heat transformation formula(s)

A

Huang Lian E Jiao Tang

442
Q

Where are cold/heat located in Jueyin?

A

Heat above
Cold below

443
Q

Persistent thirst, qi surging up to the heart, HT heat pain/vexation, hunger w/ no desire to eat, cold limbs, diarrhea, vomiting, vomiting roundworms, wiry pulse
* may be alternating C/F
* may be wood overacting on earth

444
Q

Jueyin treatment prohibition

445
Q

Jueyin treatment principle

A

Clear Heat above
Expel cold below
Harmonize LIV channel

446
Q

Jueyin formula(s)

A

WU MEI WAN
Gan Jiang Huang Qin Huang Lian Ren Shen Tang
MA HUANG SHENG MA TANG

447
Q

Vesicles vs. papules vs. macules

A

VESICLE: small, raised + filled with clear fluid dampness
PAPULE: raised/elevated, palpable usually Qi-level heat esp. LU ST
MACULE: flat + color change Nutritive or Blood heat

448
Q

Timidity, a lack of courage, indecision, palpitations and
insomnia (in particular, waking up in the early hours of
the morning)

A

Wood not generating Fire
Corresponds to the Internal Organ pattern of Deficient
Gall Bladder or Deficient Liver
• Manifests primarily on a psychological level: Hun not coming/going enough to provide sufficient movement to the Shen

449
Q

Loose stools, chilliness and weakness of the limbs
+ accompanied by some Heart Yang symptoms
• Palpitations, shortness of breath, tiredness, depression,
spontaneous sweat, stuffiness in the chest, feeling cold,
cold hands, bright pale face, slightly dark lips

A

Fire not generating Earth
Spleen-Yang deficiency due to failure of the physiological
Fire of the body in providing Heat to the Spleen to transform
and transport

450
Q

Phlegm in the chest, cough and tiredness

A

Earth not generating Metal
Spleen deficiency –> phlegm formation, disrupting LU

451
Q

Cough, breathlessness, loss of voice and asthma
Difficulty inhaling, cold limbs, clear urination, lower backache

A

Metal not generating Water
KID not receiving qi

452
Q

Dizziness, blurred vision, headaches and vertigo

A

Water not generating Wood
KID- and LIV-yin xu

453
Q

Hypochondriac and epigastric pain, a feeling of distension, irritability,
loose stools, poor appetite and greenish face

A

Wood overacting on Earth
Greenish face –> Wood is the root of the problem
LIV invading SP –> Xiao Yao San

454
Q

Edema, difficult urination and a yellow face

A

Earth overacting on Water
Spleen failing to transform and transport fluids which accumulate and
obstruct the Kidney function of transformation and excretion of fluids

455
Q

Edema of the ankles, backache, feeling cold, dizziness, expectoration of
thin watery sputum, palpitations

A

Water overacting on Fire
Kidney- Yang deficient Water overflowing to the Heart
• Jin gui shen qi wan and wu ling san

456
Q

Cough with profuse yellow sputum, a feeling of heat and a red face

A

Fire overacting on Metal
Excess-Heat in the Lungs – Qian Jin wei Jing Tang

457
Q

Tiredness, irritability, a feeling of distension, cough and a white face

A

Metal overacting on Wood
Deficient descending Lung-Qi impairs the free flow of Liver-Qi

458
Q

Cough, asthma and a feeling of distension of chest and hypochondrium
Breathlessness, asthma, cough with yellow or blood tinged sputum, thirst, bitter taste, bloodshot eyes, scanty dark urine, constipation

A

Wood insulting Metal
The Liver channel influences the chest and stagnant Liver-Qi or Liver-Fire can obstruct the chest and prevent Lung-Qi from descending
–> Long Dan Xie Gan Tang

459
Q

Palpitations, insomnia and breathlessness
Slight cough, weak voice, dislike speaking, tendency to catch colds,
tiredness, depression, listlessness, spontaneous sweat, sighing

A

Metal insulting Fire
LU and HT-qi xu
–> Sheng Mai San, Si Jun Zi Tang, Bu Fei Tang

460
Q

Palpitations, mental restlessness, insomnia, dizziness, lower backache and night
sweating, dream disturbed sleep, anxiety, poor memory, tinnitus, heat in the
evening, dry throat at night, thirst/small sips, scanty dark urine, dry stools

A

Fire insulting Water
HT/KID disharmony; Kidney-Yin deficiency with Heart Empty-Heat

461
Q

Loose stools, edema, tiredness and weakness of the limbs

A

Water insulting Earth
SP- and KID-yang xu
Li Zhong Wan, Jin Gui Shen Qi Wan

462
Q

Jaundice and hypochondriac pain and distension

A

Earth insulting Wood
Spleen failing to transforming fluids, leading to Dampness
• Dampness accumulates and obstructs the smooth flow of Liver-Qi, impeding the
free flow of bile
–> San Ren Tang

463
Q

UJ contains and does

A

chest, heart, lungs
disperses qi + distributes blood (transformed from digested food as refined vapor)

464
Q

MJ contains and does

A

LIV, SP, ST, SI
grinds, transports food as substantial refined/ripened “foam”

465
Q

LJ contains and does

A

KID, UB, LI
Separates clear/turbid + discharges the turbid

466
Q

SanJiao and 4 levels

A

UJ: Wei, Qi, Ying
MJ: Qi
LJ: Blood

467
Q

When do UJ patterns occur in warm disease?

A

Early: LU (gen mild), PC (very serious)

468
Q

Fever, aversion to cold, headache, sore throat, slight sweating, runny nose with yellow
discharge, swollen tonsils, body aches, slight thirst, tongue Red in the front or sides with a thin
white coating, Floating-Rapid pulse

A

Wind-Heat in the Lungs’ Defensive (Wei) Qi portion
= Wind-Heat at the Wei Qi Level of the Four Levels

469
Q

WH in LU Wi qi: treatment principle, formulas

A

Treatment principle: release the Exterior, expel Wind-Heat, restore the diffusing and
descending of Lung-Qi

RX: Yin Qiao San and Sang Ju Yin

470
Q

Fever, sweating, cough, breathlessness, thirst, feeling of oppression and pain of the chest, Red tongue with yellow coating, Rapid-Overflowing pulse
May appear with Phlegm - expectoration of profuse sticky yellow sputum

A

Heat in the LU (Qi level)

471
Q

Qi-level heat in the LU treatment, formulas

A

Treatment principle: clear Lung-Heat, resolve Phlegm, restore the descending of Lung-Qi

Ma Xing Shi Gan Tang, Wu Hu Tang, Xie Bai San, Qing Qi Hua Tan Tang

472
Q

Pathological progressions of qi-level heat in the LU

A

Vertical: ST excess heat, LI dry stool
Transverse: PC

473
Q

Aversion to cold, fever, slight sweating, head feels tight, wrapped in a bandage,
heaviness and aching of the body, cough, difficult breathing, chest and epigastric
distention, poor appetite, white and greasy tongue coat, soggy and moderate pulse

A

Combination Upper and Middle Burner pattern
LU qi fails to descend/disseminate
SP qi stag
If not resolved –> MJ

474
Q

High fever at night, a burning sensation of the epigastrium, cold limbs, delirium, aphasia,
Deep-Red and Stiff tongue without coating, pulse Fine and Rapid

A

Wen Bing PC Heat in the Ying level
UJ: PC (sanjiao differentiation)

475
Q

Heat in the PC treatment, formulas

A

Treatment principle: clear Heat in the Pericardium, restore consciousness, promote fluids
Qing Ying Tang

3 outcomes:
Ø If resolved, antipathogenic qi is restored
Ø Blockage of the pericardium may lead to yang collapse
Ø Or the Disease may progress to the lower burner

476
Q

Yang vs. Yin MJ patterns

A

More yang (heat) –> ST –> LI
More yin (damp) –> SP

477
Q

High fever that is worse in the afternoon, no aversion to cold, feeling of heat, intense thirst, profuse sweating, Red tongue with yellow coating, Overflowing-Rapid pulse

A

Heat in the Yangming
Qi-level ST heat

Direct attack of summerheat OR progression from LU

Treatment principle: clear Stomach-Heat
Bai Hu Tang

478
Q

Yangming heat in ST outcomes

A

Ø If heat is cleared, the disease is successfully treated
Ø It can progress to the Large Intestine
Ø Or the heat can damage yin of the liver and kidney

479
Q

Obstruction of qi in the Large Intestine by dry stool and heat with severe constipation
Ø Fever in the afternoon (3-7pm), yangming peak
Ø Constipation and concentrated urine
Ø LI blockage and concentration of heat
Ø Yellow, black, dry tongue coat
Ø Submerged and excessive pulse
Ø (interior dryness and heat from excess)

A

Heat in the Yangming (LI)

Treatment principle: Clear Large Intestine heat through purging, nourish fluids
Tiao Wei Cheng Qi Tang or Da Cheng Qi Tang

480
Q

Pathological progression of Yangming heat in the LI

A

Ø The heat from this excess may disturb the heart shen and/or stir up liver wind
Ø The may also transform into toxic heat, damaging the collaterals – bleeding, maculopapular rashes
Ø Or the patterns may progress to the lower burner, damaging the liver and kidney

481
Q

Fever, epigastric fullness, a feeling of heaviness of the body and head, nausea, vomiting, Red
tongue with sticky yellow coating, Soggy and Rapid pulse

A

DH in the SP
= Qi level SP/ST heat in 4 levels
Treatment principle: clear Heat and resolve Dampness in the Spleen
Lian Po Yin
This pattern can be viewed as the pivot between upper and lower burner
Ø If the heat or damp heat can discharged quickly via the stool or urine, the progress of the
disease can be stopped

482
Q

Where can patterns of the LJ show up?

483
Q

Fever in the afternoon and evening, five-palm heat, dry mouth and throat, night sweating,
deafness, lassitude, Deep-Red tongue without coating, Floating-Empty and Rapid pulse

A

Heat in the KID
= Shaoyin heat transformation (SHL)
Treatment principle: nourish Kidney-Yin, clear Empty-Heat
Huang Lian E Jiao Tang, Xi Jiao Di Huang Tang

484
Q

High fever at night, coma, convulsions, clenched teeth, Deep-Red tongue without coating,
Wiry-Fine-Rapid pulse

A

LIV-heat stirring wind
= Blood-level heat stirring wind (WenBing)
Treatment principle: clear Heat, extinguish Wind, stop convulsions, restore consciousness
Ling Jiao Gou Teng Tang

485
Q

Low-grade fever, cold limbs, dry and black teeth, dry and cracked lips, convulsions, tremor of limbs,
Deep-Red tongue without coating, Deep-Fine-Rapid pulse

A

LIV empty wind
= Blood level, empty-wind agitating the interior
Treatment principle: nourish Yin, extinguish Wind, stop convulsions
Zhen Gan Xi Feng Tang, San Jia Fu Mai Tang, Da Ding Feng Zhu

486
Q

San Jiao patterns that don’t fit

A

Ø Summer-heat pathogens without dampness may attack the stomach in the middle burner in the
early stage of summer-heat attacks
Ø The early stages of damp-heat often affect the spleen
Ø Summer-heat can directly attack the pericardium or liver
Ø Lurking summer-heat can progress from the lower burner to the middle burner

487
Q

Phlegm heat in the lung can lead to Large Intestine Qi stagnation, producing heat
Ø Heat pathogen in the lungs impairs water producing capacity of the lungs
Ø Kidney and Lung yin deficiency

A

LU-LI combo pattern

488
Q

yangming (LI/ST) and the stomach collaterals connect to the heart
– Severe heat in the LI can invade the PC
Ø LI heat and PC heat

A

LI, ST combo pattern

489
Q

LJ: extreme heat in the LI can damage Kidney yin
Ø LI heat and Kidney yin deficiency

A

LI and KID combo pattern

490
Q

Characteristics of warm diseases

A

Characterized by more intense Heat
Ø They develop rapidly (rapid onset)
Ø They have a strong tendency to injure Yin (severe ramifications)
infectious, epidemic, seasonal and geographic
Manifest with fever
PF enters thru nose/mouth (externally contracted)

491
Q

Wen-Bing external WH

A

They all manifest with fever
Ø The pathogenic factor enters through the nose and mouth
Ø Externally contracted pathogens, not the six qi

492
Q

Wen Bing zangfu progression

A

LU –> yangming or PC
Final stage: LIV damage and/or KID yin

493
Q

Exterior Wen Bing patterns

A

Wind-heat
Summer-heat
Damp-heat
Dry-heat

494
Q

Fever (real, not just palpation), aversion to cold, headache, sore throat, slight sweating, runny
nose with yellow discharge, swollen tonsils, body aches, slight thirst,
tongue Red in the front or sides with a thin white coating, Floating-Rapid
pulse

A

Wen Bing ext WH
Release exterior, expel WH, restore diffusing and descending of LU qi
RX: Yin qiao san, Sang ju yin

495
Q

Fever, aversion to cold, sweating, headache, a feeling of heaviness, an uncomfortable
sensation in the epigastrium, irritability, thirst, tongue Red in the front or sides with a white sticky coating, Soggy and Rapid pulse

A

Summer-heat (frequently combined with dampness)
Release the exterior, expel summerheat, clear heat, promote fluids
RX: Qing Luo Yin

496
Q

Fever that is worse in the afternoon, body hot to touch, aversion to cold, SWOLLEN GLANDS,
headache, a feeling of heaviness, a feeling of oppression of the epigastrium, sticky taste, thirst with no desire to drink, sticky white tongue coating, Soggy pulse

A

Damp-heat at the Wei qi level
* sticky taste w/o desire to drink = typical DH
* swollen glands (dampness) = distinctive for this pattern
–> release exterior, resolve damp, clear heat
Huo Xiang Zheng Qi San

497
Q

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

A

Dry-Heat at the Wei level
–> Release exterior, clear Heat, promote fluids
RX: Xing Su San, Sang Xing Tang

498
Q

Fire vs. Heat

A

Ø Fire is more intense (intense thirst, high fever, intense feeling of heat)
Ø Fire affects the Mind more (mental restlessness, delirium)
Ø Fire dries up more (intense thirst, dry stools, constipation, very dry tongue
coating)
Ø Fire is at a deeper energetic layer than Heat
Ø Fire has a deep pulse compared to Overflowing in Heat
Ø Fire may cause bleeding
Ø In acute febrile diseases in children, fire may cause internal Wind quickly

499
Q

High fever, feeling of heat, no aversion to cold, thirst, cough with thin yellow sputum,
shortness of breath, sweating, Red tongue with yellow coating, Slippery- Rapid pulse

A

Qi-level LU heat
Treatment principle: clear Qi, clear Lung-Heat, resolve Phlegm, restore
descending Lung-Qi
RX: Ma Xing Shi Gan Tang, Xie Bai San, Qing Qi Hua Tan Tang, Wu Hu Tang

500
Q

High fever that is worse in the afternoon, no aversion to cold, feeling of heat, intense thirst,
profuse sweating, Red tongue with yellow coating, Overflowing-Rapid pulse

A

Qi-level ST heat
= Yangming Jing in SHL
Clear Qi, clear ST-heat
RX: Bai Hu Tang

501
Q

High fever that is higher in the afternoon, constipation, dry stools, burning in the anus,
abdominal fullness and pain, irritability, delirium, Red tongue with thick yellow dry
coating, Deep-Full-Rapid pulse

A

Qi-level Fire in the ST + intestines
= Yangming Fu in SHL
Drain fire, clear ST + intestines, move downward
Tiao Wei Cheng Qi Tang

502
Q

Alternating hot and cold feeling with a prevalence of heat, bitter taste, thirst, dry throat,
hypochondrial pain, nausea, a feeling of fullness in the epigastrium, Red tongue with
unilateral sticky yellow coating, Wiry- Rapid pulse

A

Qi-level GB heat
= SHL Shaoyang stage + more heat + some damp
Harmonize Shaoyang, clear GB heat
Hao Qin Qing Dang Tang

503
Q

Continuous fever which decreases after sweating but soon increases again, a feeling of
heaviness of the body and head, a feeling of oppression of the chest and epigastrium,
nausea, loose stools, Red tongue with sticky yellow tongue coating, Soggy-Rapid pulse

A

Qi-level SP/ST damp-heat
Clear heat in SP/ST, resolve damp
RX: Lian Po Yin

504
Q

Distinctive diagnostic signs of the Ying/Nutritive level

A

Fever at night
Deep red tongue w/o coat
vs. Qi-level (red w/ thick coat)

505
Q

Fever at night, dry mouth with no desire to drink, mental restlessness, insomnia,
delirium, incoherent speech or aphasia, macules, Red tongue without coating,
Fine-Rapid pulse

A

Nutritive level heat
Clear nutritive Qi heat, promote fluids
Qing Ying Tang

506
Q

Fever at night, mental confusion, incoherent speech or aphasia, delirium, body hot,
hands and feet cold, macules, Red tongue without coating, Fine-Rapid pulse

A

Ying-level heat in the PC
= Nutritive level heat + more mental signs
clear Nutritive Qi Heat, clear Pericardium-Heat,
restore consciousness, promote fluids
Qing Ying Tang

507
Q

Xue level diagnostic signs

A

Definitive: MACULES
Ø Yin deficiency
Ø Bleeding
Ø Heat –> Mind, causing delirium or coma
Ø Internal Wind - convulsions and tremors
Ø Collapse of Yin or Yang may occur

508
Q

High fever, mental restlessness, manic behavior, dark macules, vomiting of blood, epistaxis,
blood in stools, blood in urine, Dark-Red tongue without coating, Wiry-Rapid pulse

A

Heat agitating Blood (Xue level)
Clear blood heat, stop bleeding
Xi Jiao Di Huang Tang

509
Q

High fever, fainting, twitching of limbs, convulsions, rigidity of neck, opisthotonos, eyeballs
turning up, clenching of teeth, Dark-Red tongue without coating, Wiry-Rapid pulse

A

Heat stirring wind at the Xue level
Full internal wind
Clear blood-heat, extinguish wind
Ling Jiao Gou Teng Tang

510
Q

Low-grade fever, tremor of limbs, twitching, loss of weight, malar flush,
listlessness, Dark-Red tongue without coating and Dry, Fine-Rapid pulse

A

Empty-wind agitating the interior (Xue level)
Empty internal wind
Clear blood-heat, nourish LIV- and KID-yin, extinguish wind
RX: Zhen Gan Xi Feng Tang

511
Q

Low-grade fever, night sweating, mental restlessness, dry mouth with desire to sip liquids,
five-palm heat, malar flush, emaciation, Dark-Red and Dry tongue without coating, Fine-
Rapid pulse
Abundant perspiration, skin hot to the touch, hot limbs, a dry mouth with desire to drink cold
liquids in small sips, retention of urine, constipation, a Floating-Empty and Rapid pulse and a Red-Peeled, Short and Dry tongue

A

Yin Collapse (Xue)
Rescue Yin, restore consciousness
Da Bu Yin Wan

512
Q

Feeling cold, cold limbs, bright-white complexion, profuse sweating on the forehead,
listlessness, Pale-Swollen and Short tongue, Hidden, Slow, Scattered pulse
Chilliness, cold limbs, weak breathing, profuse sweating with an oily sweat, no thirst, frequent
profuse urination or incontinence, loose stools or incontinence, a Minute-Deep pulse and a
Pale-Wet-Swollen-Short tongue

A

Yang Collapse (Xue)
Rescue Yang, restore consciousness
Shen Fu Tang

513
Q

Ø Acute onset
Ø Thirst
Ø Irritability
Ø Insomnia
Ø Sudden tiredness and lassitude
Ø Weary limbs
Ø Dark urine
Ø Red tongue
Ø Rapid pulse

A

Latent heat

514
Q

Alternation of chills and fever, bitter taste, hypochondrial pain, red eyes,
deafness, vomiting, a feeling of oppression of the diaphragm, Red
tongue with unilateral yellow coating, Wiry pulse

A

Shaoyang latent heat

515
Q

Fever, abdominal fullness and pain, constipation, Red tongue with dry
brown coating, Deep-Full pulse, irritability, insomnia, sudden tiredness, weary limbs, dark urine

A

yangming Fu latent heat

516
Q

A feeling of weariness of the limbs before the onset of other symptoms, insomnia,
irritability, dry mouth and throat, scanty dark urination, headache, backache,
tiredness, Red tongue, Rapid pulse

A

Shaoyin latent heat

517
Q

Oily beads on forehead, dry mouth and teeth, irritability, delirium, scanty urine,
blood in urine, Deep-Red tongue without coating, Fine-Rapid pulse

A

Ying level latent heat

518
Q

Delirium, faint feeling, dry limbs, sweating, irritability, macules, blood in urine,
epistaxis, Deep-Red tongue without coating, Fine-Rapid pulse

A

Xue level latent heat

Formulas, Diagnosis, Chinese Medical Nutrition (3 decks)

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