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Foundations Board Exam NCCAOM by oRen > Four Levels > Flashcards

Four Levels Flashcards

1
Q

Who created the 4 Levels pattern identification system, in what book, and what is it useful for?

A

Ye Tian Shi in Wen Bing Lun, “A Discussion on Warm Diseases,” for diseases from invasion of Wind-Heat

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2
Q

What are the special characteristics for diseases from Wind-Heat (i.e. Warm Diseases)?

A
  1. fever 2. pathogen enters through nose and mouth 3. infectious 4. rapid pathological developments 5. pathogen has strong tendency to injure Yin
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3
Q

What special characteristics of Warm Disease school resemble germ theory?

A

Pathogens entering through mucous membranes of nose and mouth, and infectious nature of diseases

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4
Q

Are all Wind-Heat invasions Warm Diseases?

A

No - warm diseases are more virulent, more infectious, characterized by more intense Heat, develop rapidly, and have tendency to injure Yin.

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5
Q

Can the 4 Levels be used for only Warm Diseases?

A

No, 4 Levels can be used for any Wind-Heat invasion, whether it is a Warm Disease or not.

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6
Q

What are the Four Levels?

A

Defensive-Qi (Wei) Level, Qi Level, Nutritive-Qi (Ying) Level, and Blood (Xue) Level

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7
Q

Which is the only exterior level of the 4 Levels?

A

Wei Level

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8
Q

What are the 4 patterns for Wei Level disease in the 4 Levels?

A

Wind-Heat, Summer-Heat, Damp-Heat and Dry-Heat

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9
Q

Which is the more superficial of the 3 Interior Levels in the 4 Levels?

A

Qi Level

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10
Q

Does anybody die from the Qi Level?

A

Nobody dies at the Qi Level.

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11
Q

What is the Qi Level in terms of 8 Principles?

A

Interior Full-Heat

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12
Q

What are the 5 patterns of the Qi Level in the 4 Levels?

A

Lung-Heat, Stomach-Heat, Intestinese Dry-Heat, Gallbladder-Heat, and Damp-Heat in Stomach and Spleen

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13
Q

Which pattern of Qi Level Heat is actually characterized by Fire?

A

Intestines Dry-Heat

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14
Q

What is the difference between Fire and Heat?

A

Fire is more intense (thirst, fever, feeling of heat); affects Mind more (delirium, restlessness); dries more (thirst, dry stools, constipation, very dry tongue coat), deeper energetic layer than Heat (Deep Pulse vs overflowing Pulse in Heat); may cause bleeding; in acute febrile disease in children may cause internal Wind quickly.

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15
Q

The 4 Levels pattern of Stomach Heat is equal to what pattern in 6 Stages?

A

YangMing (Bright Yang) channel pattern

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16
Q

Both Stomach-Heat and Intestines-Dry-Heat have what manifestations?

A

Fever, feeling of heat, thirst T: red w/thick yellow t.c. P: rapid

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17
Q

What is different between Stomach-heat and Intestines-Dry-Heat?

A

Stomach-Heat is Heat and includes profuse sweating, overflowing pulse and tongue coat not too dry, VS. Intestines-Dry-Heat is Fire and includes constipation, abdominal fullness/pain, mental restlessness, dry mouth. T: thick, dry t.c. and P: deep-full

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18
Q

The 4 Levels pattern of Intestines-Dry-Heat is equal to what pattern in 6 Stages?

A

YangMing (Bright Yang) channel pattern

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19
Q

What is a distinctive sign that Heat has penetrated to the Nutritive-Qi (Ying) Level and why?

A

Fever at night, because yin is being injured

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20
Q

What are the 2 patterns at the Ying Level of the 4 Levels?

A

Heat in Nutritive-Qi (Ying) Level and Heat in the Pericardium

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21
Q

What is the deepest level of the 4 Levels?

A

Blood (Xue) Level

22
Q

What are the chief clinical features of all patterns at the Blood (Xue) Level of the 4 Levels?

A

yin deficiency; bleeding (d/t Heat affecting Blood); delirium/coma (d/t Heat affecting Mind); macules from bleeding under skin; convulsions and tremors (internal Wind); may be collapse of Yin or Yang

23
Q

What are the 5 patterns of the Blood Level of the 4 Levels?

A

Heat victorious moving Blood; Heat victorious stirring Wind; Empty-Wind agitating in the Interior; Collapse of Yin; Collapse of Yang

24
Q

What does “exanthematous” mean?

A

“Manifesting with a rash”

25
Q

What is the difference between vesicles, papules, and macules and what do they indicate?

A

Vesicles: blister-like spots filled with clear fluid, never on face (always indicate Dampness). Papules: red, solid spots (usually heat at Qi level esp in LU and ST). Macules: big circular spots under skin, impalpable at surface, mostly on face (always indicate Heat at Ying or Xue Levels).

26
Q

Wei Level Wind-Heat: s/s and tx?

A

Fever (actual if Warm Disease, maybe only upon palpation if regular Wind-Heat), aversion to cold (d/t Wind obstructing Wei Qi between skin and muscles so it is unable to warm body), HA, sore throat (Wind invades LU channel in throat), slight sweat, runny nose w/yellow discharge, swollen tonsils, body aches, slight thirst T: red in front/sides w/thin white t.c. P: floating-rapid. Tx: release exterior, expel Wind-Heat, restore diffusing & descending of LU Qi. LI4, LI11, LU11, TW5, GV14, BL12 with cupping. Yin Qiao San (Lonicera-Forsythia Decoction) or Sang Ju Yin (Morus-Chrysanthemum Decoction).

27
Q

Wei Level Summer-Heat: s/s and tx?

A

Fever, aversion to cold, sweating, HA, feeling of heaviness and uncomfortable sensation in epigastrium (Damp component), irritability, thirst (b/c Summer-Heat moves to Qi level almost immediately). T: red in front/sides w/sticky white t.c. P: soggy, rapid. Tx: release exterior, expel Summer-Heat, clear Heat, promote fluids. LI4, LI11, TW5, GV14, GV26, BL40, PC9. Qing Luo Yin (Clearing the Connecting Channels Decoction).

28
Q

What 3 pathogenic factors are involved in Wei Level Summer-Heat, usually?

A

External Wind, Dampness, Interior Heat

29
Q

Wei Level Damp-Heat: s/s and tx?

A

Fever worse in afternoon, body hot to touch, aversion to cold, swollen glands, HA (usually frontal), feeling of heaviness, feeling of oppression in epigastrium, sticky taste, thirst w/no desire to drink. T: sticky white t.c. P: soggy. Tx: release exterior, resolve Dampness, clear Heat. LI4, LI11, SP9, SP6, CV12, CV9. Huo Xiang Zheng Qi San (Agastache Upright Qi Powder).

30
Q

Wei Level Dry-Heat: s/s and tx?

A

Fever, slight aversion to cold, slight sweating, dry skin, dry nose/mouth/throat, dry cough, sore throat. T: dry, thin white t.c. P: floating, rapid. Tx: release Exterior, clear Heat, promote fluids. LI4, LI11, TW5, SP6, LU9, CV12, ST36. Xing Su San (Prunus-Perilla Powder) or Sang Xing Tang (Morus-Prunus Decoction).

31
Q

Qi Level Lung-Heat: s/s and tx?

A

High fever, feeling of heat, NO aversion to cold, thirst, cough w/thin yellow sputum, S.O.B., sweating. T: red w/yellow t.c. P: slipper-rapid. clear Qi, clear LU-Heat, resolve Phlegm (IF Phlegm), restore descending of LU Qi. LI5, LU10, GV14, LI11, LU1, BL13. Ma Xing Shi Gan Tang (Ephedra-Prunus-Gypsum-Glycyrrhiza Decoction) or Xie Bai San (Drain the White Powder) or Qing Qi Hua Tan Tang (Clearing the Qi and Resolving Phlegm Decoction - IF profuse sticky yellow sputum)

32
Q

Qi Level Stomach-Heat: s/s and tx?

A

High fever worse in afternoon, NO aversion to cold, feeling of heat with INTENSE thirst, PROFUSE sweating. T: red w/yellow t.c. P: overflowing-rapid. Tx: clear Qi, clear ST Heat. ST44, ST34, ST21, ST43, LI11, ST25. Bai Hu Tang (White Tiger Decoction).

33
Q

Qi Level Inestines Dry-Heat: s/s and tx?

A

High fever higher in afternoon, constipation, dry stools, burning anus, abdominal fullness and pain, irritability, delirium. T: red, thick yellow dry t.c. P: Deep-Full-Rapid. Tx: drain Fire, clear ST and Intestines, move downward. LI11, ST25, SP15, ST37, ST39. Tiao Wei Cheng Qi Tang (Regulating the Stomach, Condicting Qi Decoction).

34
Q

Qi Level GB-Heat: s/s and tx?

A

(=Shaoyang of 6 Stages but more Heat and some Damp) Alternating hot and cold feeling with pevalence of heat, bitter taste, thirst, dry throat, hypochondrial pain, nausea, feeling of fullness in epigatrium. T: red with unilateral sticky yellow t.c. P: Wiry-Rapid. Tx: harmonize ShaoYang and clear Gallbladder Heat. GB34, GB43, TW6, TW5. Hao Qin Qing Dan Tang (Artemesia-Scutellaria Clearing the Gallbladder Decoction).

35
Q

Qi Level Damp-Heat in ST and SP: s/s and tx?

A

Continuous fever that decreases after sweating but soon increases again, heaviness of body and head (Damp obstructing muscles), feeling oppression of chest and epigastrium (Damp obstructing MB), nausea, loose stools (Damp impairing t&t of SP). T: red, sticky yellow t.c. P: soggy, rapid. Tx: clear Heat in ST and SP, resolve Damp. CV12, SP9, SP6, CV9, ST36, LI11, CV12, BL20, BL22. Lian Po Yin (Coptis-Magnolia Decoction).

36
Q

Heat in Ying (Nutritive-Qi) Level - clinical manifestations and pathology? Tx?

A

Fever at night, dry mouth with no desire to drink, mental restlessness, insomnia, delirium, incoherent speech or aphasia (Heat affecting mind), macules (Bood affected by Heat). T: red, no coat (Heat injuring Yin). P: fine-rapid. Tx: clear Nutritive-Qi Heat, promote fluids. PC9, PC8, HT9, KD6, ShiXuan extra points. Qing Ying Tang (Clearing Nutritive Qi [Heat] Decoction).

37
Q

Ying Level Heat in PC: s/s and tx?

A

Fever at night, mental confusion, incoherent speech/aphasia, delirium (mental signs d/t Heat invading PC), body hot w/cold hands and feet (False Cold d/t Heat stopping Qi circulation to hands), mascules. T: red, no coat. P: fine-rapid. Tx: clear Nutritive-Qi Heat, clear Pericardium-Heat, restore consciousness, and promote fluids. PC9, PC3, PC8, HT9, KD6, LI11, ShiXuan. Qing Ying Tang (Clearing the Nutritive-Qi Decoction).

38
Q

Blood Level Heat: Heat victorious moving Blood: s/s and tx?

A

High fever, mental restlessness, manic behavior, dark macules, vomiting blood, epitaxis, blood in stools, blood in urine. T: dark-red w/o coat. P: wiry-rapid. Tx: clear Blod-Heat, stop bleeding. BL17, SP10, LIV5, SP4, LI11, LIV2, KD6, HT9, ShiXuan. Xi Jiao Di Huang Tang (Cornus Rhinoceri-Rehmania Decoction).

39
Q

Blood Level Heat: Heat victorious stirring Wind: s/s and tx?

A

(Full internal wind, Heat affecting Liver.) High fever, fainting, twitching limbs, convulsions, neck rigidity, opisthotonos, eyeballs turning up, clenching teeth. T: dark-red w/o coat. P: wiry-rapid. Tx: clear Blood-Heat, extinguish Wind. SP10, LI11, LIV2, KD6, HT9, LIV3, GV16, GB20, SI3 + BL62, ShiXuan. Ling Jiao Gou Teng Tang (Cornu antelopis-Uncaria Decoction).

40
Q

Blood Level Heat: Empty-Wind agitating in Interior

A

Low-grade fever, tremor of limbs, twitching, loss of weight, malar flush, listless. T: drk-red w/o coat. P: dry, fine-rapid. (Heat injuring Yin of LIV, KD -> stirring internal Wind, Empty -> tremors/twitching limbs. Tx: clear Blood-Heat, nourish Liver and Kidney Yin, extinguish Wind. LIV3, GV16, GB20, SI3 + BL62, LIV8, KD6, KD3, SP6. Zhen Gan Xi Feng Tang (Pacifying the Liver and Extinguishing Wind Decoction).

41
Q

Blood Level Heat: Collapse of Yin, s/s and tx?

A

Low-grade fever, night sweating, mental restlessness, dry mouth with desire to sip liquids, five-palm heat, malar flush, emaciation. T: dark red, dry, no coat. P: fine-rapid. (Final consequence of Heat at Blood level.) Tx: rescure Yin, restore consciousness. ST36, KD3, SP6, KD6, CV4. Da Bu Yin Wan (Great Tonify Yin Pill).

42
Q

Blood Level Heat: Collapse of Yang, s/s and tx?

A

Feeling cold, cold limbs, bright-white complexion, profuse sweat on forehead, listless. T: pale, swollen, short. P: hidden, slow, scattered. Tx: rescue Yang, restore consciousness. ST36, CV6, CV4, CV8. Moxa applicable. Shen Fu Tang (Ginseng-Aconitum Decoction).

43
Q

What is Latent Heat?

A

Occurs when external pathogen penetrates without causing apparenty s/s and ‘incubates’ - turns to Interior Heat, then emergences as Latent Heat. Kidney deficiency causes weak immune response to invasion, therefore no acute symptoms.

44
Q

Main clinical manifestations of Latent Heat?

A

acute onset, thirst, irritability, insomnia, sudden tiredness and lassitude, weary limbs, dark urine, red tongue, rapid pulse

45
Q

Latent Heat ShaoYang (Lesser Yang) Type

A

Alternation of chills and fever, a bitter taste, hypochondrial pain, red eyes, deafness, vomiting, a feeling of oppression of the diaphragm. T: red, unilateral yellow t.c. P: wiry.

46
Q

Latent Heat YangMing Channel Type

A

Feeling of heat, thirst, sweat, fever, big pulse.

47
Q

Latent Heat YangMing Organ Type

A

Fever, abdominal fullness and pain, constipation. T: red, dry brown t.c. P: deep-full.

48
Q

Latent Heat 3 patterns, and which are Qi vs Blood level?

A

ShaoYang and YangMing channel and organ are Qi level, ShaoYin is Blood Level Heat

49
Q

Latent Heat ShaoYin (Lesser-Yin) s/s?

A

Feeling of limb weariness before onset of other symptoms, insomnia, irritability, dry mouth and throat, scanty dark urine, HA, backache, tiredness. T: red P: rapid.

50
Q

Latent Heat ShaoYin (Lesser-Yin) at Ying Level s/s?

A

Oily beads on forehead, dry mouth and teeth, irritability, delirium, scanty urine, blood in urine. T: deep-red, no t.c. P: fine-rapid.

51
Q

Latent Heat ShaoYin (Lesser-Yin) at Blood Level s/s?

A

Delirium, faint feeling, dry limbs, sweating, irritability, macules, blood in urine, epitaxis. T: deep-red, no t.c. P: fine-rapid

Foundations Board Exam NCCAOM by oRen (3 decks)

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