Internal Med 2 Exam 2_ bleeding - Sheet1

Question 1

Bleeding - the major pathologies are?

Answer 1

1. Deficient Qi fails to hold blood in vessels. 2. Heat (excess or empty) damages blood-connecting channels, makes blood reckless, forces it to extravasate. 3. Stasis of blood obstructs the blood-connecting channels so that new blood, which is being continuously formed, cannot enter vessels and leaks out.

Question 2

Bleeding General Tx Principles

Answer 2

1. Tx underlying cause (if H/F - clear and drain excess H/F; nourish yin and reduce empty H. if SP Qi def - tonify SP Qi to control blood). 2. Stop bleeding (cool/restrain/invigorate/warm) and direct to opposite (direct down if bleeding from upper orifices, direct up if bleeding from lower orifices).

Question 3

Nosebleed due to Heat Attacking the LU - Indications?

Answer 3

Usually person has W-H cold or flu. Acute onset. Very fresh red blood. Heat and dryness aggravate it. Heat sx: fever, sore throat, thirsty, dry mouth/lips, body achy, dry cough, sometimes thick, yellow phlegm. Dry nose, skin, complexion red. T: red, red edge/tip, TWC or thin yellow. P: floating, rapid

Question 4

Nosebleed/epitaxis due to Heat Attacking the LU - Tx Principles?

Answer 4

Clear and drain LU Heat, cool blood, and stop bleeding

Question 5

Nosebleed/epitaxis due to Heat Attacking the LU - Formula?

Answer 5

Sang Ju Yin

Question 6

Nosebleed/epitaxis due to Vigorous ST Heat - Indications?

Answer 6

Yangming passes close to the nose. Excess type. Nose bleeding can be large quantity and bright red. Eating a lot. Bowel movements are dry and constipated, bad breath, heart burn, thirsty, red face, hot body. T: red, yellow coating
P: forceful, rapid, slippery (d/t heat)

Question 7

Nosebleed/epitaxis due to Vigorous ST Heat - Tx Principles?

Answer 7

Clear and drain the ST heat, cool the blood and stop bleeding

Question 8

Nosebleed/epitaxis due to Vigorous ST Heat - Formula?

Answer 8

Yu Nu Jian

Question 9

Nosebleed due to LIV Fire Rising - Indications?

Answer 9

Acute onset nosebleeding, large volume, fresh bright red blood. Usually following strong emotions (irritable), LV fire sx: temple or vertex HA, eyes red/buring/pressure. LV sx: hypochondrial pain, bitter taste in mouth, tinnitus, high-pitched, red face, feels hot esp upper body, constipation, thirsty for cold. T: Edges red, coating yellow. P: Wiry, forceful, rapid

Question 10

Nosebleed due to LIV Fire Rising - Tx Principles?

Answer 10

Clear and drain LV fire, cool the blood and stop bleeding

Question 11

Nosebleed due to LIV Fire Rising - Formula?

Answer 11

Long Dan Xie Gan Tang

Question 12

Gum Bleeding due to Vigorous ST Heat - Indications?

Answer 12

Blood is fresh red, can be acute onset, large volume, can be triggered by ETOH or spicy food. Gum color very bright red, maybe inflamed. Excess ST heat sx: frequent hunger, constipation, red complexion, acid regurg, heart burn, bad breath, heavy sweating. May also have toothache. T: Red with yellow coating. P: forceful, slippery, rapid.

Question 13

Gum Bleeding due to Vigorous ST Heat - Tx Principles?

Answer 13

Clear the ST, drain fire, cool blood and stop bleeding

Question 14

Gum Bleeding due to Vigorous ST Heat - Formula?

Answer 14

Jia Wei Qing Wei San (Augmented Clear the ST Decoction) + Xie Xin Tang (Drain the Epigastrium Decoction)

Question 15

Gum Bleeding due to Yin deficiency with Vigorous Fire - Indications?

Answer 15

Empty heat. KD water is not enough so fire blazes upwards. Also a lot of teeth problems, toothache, chronic gum disease, gums recede, teeth sensitive to temp, often bleeding gums – lighter blood, small amt. Aggravated by lack of sleep, spicy food, stress, dehydrated, loose teeth, feels their teeth are weak. Warm at night, dry lips/mouth, light sleep, night sweats, knee/ankle weakness, lower back weak, heel pain, hot palms/soles, hot flashes, dry eyes, hair loss/dry, dizziness. T: red, less coating, cracks, dry. P: thin, rapid.

Question 16

Gum Bleeding due to Yin deficiency with Vigorous Fire - Tx Principles?

Answer 16

Nourish yin, clear heat, cool the blood and stop bleeding

Question 17

Gum Bleeding due to Yin deficiency with Vigorous Fire - Basic Formula?

Answer 17

Liu Wei Di Huang Wan (Six-ingredient Pill with Rehmannia) + Qian Gen San (Madder Root Powder)

Question 18

Ingredients to cool the blood and stop bleeding: (remember 6)

Answer 18

Bai Mao Gen, Da Ji, Xiao Ji, Di Yu, Ce Bai Ye, Huai Hua, Qian Cao Gen

Question 19

Ingredients to Restrain the blood and stop bleeding: (remember 4)

Answer 19

Xian He Cao, Bai Ji, Zong Lu Pi, Xue Yu Tan, Ou Jie

Question 20

Ingredients to invigorate the blood and stop bleeding: (remember 4)

Answer 20

Pu Huang, Qiang Cao gen, San Qi, Jiang Xiang, Ou Jie, Hua Rui Shi

Question 21

Coughing Blood due to Dryness and Heat Injuring the LU - indications?

Answer 21

Relatively mild condition. Acute onset, cough is dry, maybe tiny amt of thicker phlegm, difficult to expectorate. Aversion to wind, HA, body aches, fever, nose/lips/mouth dry, skin and stool are dry. LU is unable to distribute fluids. Stuffy nose, congested chest, prefers to drink cold water. Not much blood but fresh red. Can also have nose bleeding. T: red, dry, thin white or yellow coating P: floating, rapid

Question 22

Coughing Blood due to Dryness and Heat Injuring the LU - tx principles?

Answer 22

Clear heat, moisten the LU, and stop bleeding

Question 23

Coughing Blood due to Dryness and Heat Injuring the LU - basic formula?

Answer 23

Sang Xing Tang (Mulberry Leaf and Apricot Kernel Decoction)

Question 24

Coughing blood due to LV Fire Invading the LU - indications?

Answer 24

Related to emotion! Usually feels excess anger (yang qi excess constitution usually) the coughing sound is very loud and forceful. While coughing the eyes and face turn red, neck red. Can have vertex HA. Large volume of blood. Intense red color, bright. Tinnitus, hypochondrial pain, chest tightness, agitated, irritated, bitter taste in mouth, constipation, concentrated urine, cold drinks, restless sleep. T: Edges very red, coating yellow P: forceful, wiry, rapid

Question 25

Coughing blood due to LV Fire Invading the LU - tx principles?

Answer 25

Clear heat from the LV and LU, cool the blood and stop bleeding

Question 26

Coughing blood due to LV Fire Invading the LU - basic formula?

Answer 26

Xie Bai San (Drain the White Powder) + Dai Ge San (Indigo and Conch Powder)

Question 27

Coughing blood due to Yin Deficiency with Heat in the LU - indications?

Answer 27

Either LU yin xu or LU/KD yin xu depending on the length/duration or age of pt. Worse at night. Mostly dry cough or thick/difficult to expectorate. Worse with dry weather. Small amt of blood but persistent, chronic. Loses weight easily, face is flushed, lips are bright red and dry. Drinking water doesn’t help. Warmer at night, night sweats, hot palms/soles, dry throat, low grade sore throat at night, restless sleep, dry skin. KD – tinnitus, lower back/knee weak. Worse with exertion, lack of sleep, dehydration, spicy food. General fatigue.T: small, narrow, dry, red, less coating or peeled P: thin, weak, rapid

Question 28

Coughing blood due to Yin Deficiency with Heat in the LU - tx principles?

Answer 28

Nourish the Yin, moisten the LU, clear heat and stop bleeding

Question 29

Coughing blood due to Yin Deficiency with Heat in the LU - basic formula?

Answer 29

Bai He Gu Jin Tang (Lily Bulb Decoction to Preserve the Metal)

Question 30

Hematemesis/vomiting blood due to Excessive ST Heat - indications?

Answer 30

Acute onset, suddenly vomiting large volume of fresh or dark blood. ST pain, acid reflux, heart burn, N, hiccups, frequent hunger, likes cold beverage, constipation, bad breath, red complexion, body runs hot, urine is concentrated, gum and nose bleeding. T: red with yellow coating P: forceful, strong, rapid

Question 31

Hematemesis/vomiting blood due to Excessive ST Heat - tx principles?

Answer 31

Clear ST heat, drain fire, cool the blood and stop bleeding

Question 32

Hematemesis/vomiting blood due to Excessive ST Heat - basic formula?

Answer 32

Xie Xin Tang (Drain the Epigastrium Decoction) + Shi Hui San (Ten Partially-charred Substances Powder)

Question 33

Hematemesis/vomiting blood due to LV Fire Invading the ST - indications?

Answer 33

Excess anger builds up and turns into LV fire. Fire can blaze up and go into ST. Large volume of bright red or dark (bc mixed with acid). Both LV and ST have heat. ST heat: heart burn, thirsty for cold, constipation, could have black stools, freq hunger, bad breath, bitter taste in mouth. T: red, esp edges. Yellow coating, red dots (static heat) P forceful, wiry, rapid, flooding

Question 34

Hematemesis/vomiting blood due to LV Fire Invading the ST - tx principles?

Answer 34

Drain the LV, clear the ST, cool the blood and stop bleeding

Question 35

Hematemesis/vomiting blood due to LV Fire Invading the ST - basic formula?

Answer 35

Long Dan Xie Gan Tang (Gentian Decoction to Drain the LV)

Question 36

Hematochezia/blood in stool due to Damp-heat in the Intestines - indications?

Answer 36

Can have acute gastric ulcer, ulcerative colitis, Crohn’s or hemorrhoids. Fresh red blood or deep red, could be pure blood or mixed with stool. Can have mucus (white or yellow if UC). If hemorrhoids could have constipation with no mucus. Hx of eating too much rich, fried, spicy food or ETOH. Improper diet. Burning, itching in anus. Can also have increased BM frequency, incomplete BMs, bloating, distention, cramping, urgency. T: Coating yellow, greasy, thicker. P: Slippery, rapid

Question 37

Hematochezia/blood in stool due to Damp-heat in the Intestines - tx principles?

Answer 37

Clear heat, resolve dampness, cool the blood and stop bleeding

Question 38

Hematochezia/blood in stool due to Damp-heat in the Intestines - basic formula?

Answer 38

Di Yu San (Sanguisorba Powder)

Question 39

Hematochezia/blood in stool due to SP and ST Yang Deficiency - indications?

Answer 39

Chronic bleeding, long term ST or intestinal problem (ulcers or colitis) If ST ulcers then will have black stools. SPI qi xu + cold symptoms. ST or abdomen feel cold, doesn’t like cold beverages (bloating). Cold 4 extremities, aversion to cold. General fatigue, requires lots of sleep, poor appetite, if abdominal – likes warmth and pressure. T: puffy, dark or pale, TWC P: slow, deep, weak, thin

Question 40

Hematochezia/blood in stool due to SP and ST Yang Deficiency - tx principles?

Answer 40

Strengthen the SP, warm the middle burner, nourish blood and stop bleeding

Question 41

Hematochezia/blood in stool due to SP and ST Yang Deficiency - basic formula?

Answer 41

Huang Tu Tang (Yellow Earth Decoction)

Question 42

Hematuria/blood in urine due to Heat Accumulating in Lower Burner - indications?

Answer 42

Very similar to blood lin but without pain. Acute onset with fresh red blood. Could have some urgency, frequency, irritation. KD sx: lower back pain, incomplete urination. Urination can be scanty and very yellow if not much blood. Thirsty, irritable, hot, ulcers in mouth. T: red. P: slippery, rapid

Question 43

Hematuria/blood in urine due to Heat Accumulating in Lower Burner - tx principles?

Answer 43

Clear heat, drain fire, cool the blood and stop bleeding

Question 44

Hematuria/blood in urine due to Heat Accumulating in Lower Burner - basic formula?

Answer 44

Xiao Ji Yin Zi (Small Thistle Drink)

Question 45

Hematuria/blood in urine due to KD Yin Deficiency with Heat - indications?

Answer 45

Most cases are from acute conditions and repeated heat ends up damaging yin. Chronic bleeding, sometimes many times a year. Blood volume is less than excess type. Color is pink red. Slight discomfort, burning with urination. Lower back sore/weak, worse with dehydration, XS sexual activity, lack of sleep, overexertion, too much wine or spicy food. KD xu: LBP/weak, dizziness, eyes dry or tired, tinnitus, hearing problems. Feels warm at night, night sweats, thirsty, dry throat, easy to lose weight, insomnia. T: Small, less coating, dry or peeled P: thin, rapid, KD yin down

Question 46

Hematuria/blood in urine due to KD Yin Deficiency with Heat - tx principles?

Answer 46

Nourish KD yin, clear heat, cool blood and stop bleeding

Question 47

Hematuria/blood in urine due to KD Yin Deficiency with Heat - basic formula?

Answer 47

Zhi Bai Di Huang Wan (Anemaerrhena, Phellodendron and Rehmannia Pill)

Question 48

Hematuria/blood in urine due to KD Qi Deficiency - indications?

Answer 48

Qi is weak and unable to hold the blood. Chronic bleeding. Chronic disease like KD or BL disease. Pink red, no clots, no pain. Aggravated by overexertion, sexual activities, standing up too long. KD qp xu sx: LB sore/weak, knee pain, no cold or heat signs. Urine drippy, cannot hold it – incontinence, significant fatigue, feels sleepy, body puffy, could have freq urination at night. T: puffy, swollen, pale. P: weak, deep, KD down

Question 49

Hematuria/blood in urine due to KD Qi Deficiency - tx principles?

Answer 49

Tonify the KD, strengthen retention and stop bleeding

Question 50

Hematuria/blood in urine due to KD Qi Deficiency - basic formula?

Answer 50

Wu Bi San Yao Wan (Incomparable Dioscorea Pill)