Internal Med 2 Exam 2_ bleeding - Sheet1 Flashcards
Bleeding - the major pathologies are?
- 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.
Bleeding General Tx Principles
- 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).
Nosebleed due to Heat Attacking the LU - Indications?
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
Nosebleed/epitaxis due to Heat Attacking the LU - Tx Principles?
Clear and drain LU Heat, cool blood, and stop bleeding
Nosebleed/epitaxis due to Heat Attacking the LU - Formula?
Sang Ju Yin
Nosebleed/epitaxis due to Vigorous ST Heat - Indications?
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)
Nosebleed/epitaxis due to Vigorous ST Heat - Tx Principles?
Clear and drain the ST heat, cool the blood and stop bleeding
Nosebleed/epitaxis due to Vigorous ST Heat - Formula?
Yu Nu Jian
Nosebleed due to LIV Fire Rising - Indications?
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
Nosebleed due to LIV Fire Rising - Tx Principles?
Clear and drain LV fire, cool the blood and stop bleeding
Nosebleed due to LIV Fire Rising - Formula?
Long Dan Xie Gan Tang
Gum Bleeding due to Vigorous ST Heat - Indications?
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.
Gum Bleeding due to Vigorous ST Heat - Tx Principles?
Clear the ST, drain fire, cool blood and stop bleeding
Gum Bleeding due to Vigorous ST Heat - Formula?
Jia Wei Qing Wei San (Augmented Clear the ST Decoction) + Xie Xin Tang (Drain the Epigastrium Decoction)
Gum Bleeding due to Yin deficiency with Vigorous Fire - Indications?
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.
Gum Bleeding due to Yin deficiency with Vigorous Fire - Tx Principles?
Nourish yin, clear heat, cool the blood and stop bleeding
Gum Bleeding due to Yin deficiency with Vigorous Fire - Basic Formula?
Liu Wei Di Huang Wan (Six-ingredient Pill with Rehmannia) + Qian Gen San (Madder Root Powder)
Ingredients to cool the blood and stop bleeding: (remember 6)
Bai Mao Gen, Da Ji, Xiao Ji, Di Yu, Ce Bai Ye, Huai Hua, Qian Cao Gen
Ingredients to Restrain the blood and stop bleeding: (remember 4)
Xian He Cao, Bai Ji, Zong Lu Pi, Xue Yu Tan, Ou Jie
Ingredients to invigorate the blood and stop bleeding: (remember 4)
Pu Huang, Qiang Cao gen, San Qi, Jiang Xiang, Ou Jie, Hua Rui Shi
Coughing Blood due to Dryness and Heat Injuring the LU - indications?
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
Coughing Blood due to Dryness and Heat Injuring the LU - tx principles?
Clear heat, moisten the LU, and stop bleeding
Coughing Blood due to Dryness and Heat Injuring the LU - basic formula?
Sang Xing Tang (Mulberry Leaf and Apricot Kernel Decoction)
Coughing blood due to LV Fire Invading the LU - indications?
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
Coughing blood due to LV Fire Invading the LU - tx principles?
Clear heat from the LV and LU, cool the blood and stop bleeding
Coughing blood due to LV Fire Invading the LU - basic formula?
Xie Bai San (Drain the White Powder) + Dai Ge San (Indigo and Conch Powder)
Coughing blood due to Yin Deficiency with Heat in the LU - indications?
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
Coughing blood due to Yin Deficiency with Heat in the LU - tx principles?
Nourish the Yin, moisten the LU, clear heat and stop bleeding
Coughing blood due to Yin Deficiency with Heat in the LU - basic formula?
Bai He Gu Jin Tang (Lily Bulb Decoction to Preserve the Metal)
Hematemesis/vomiting blood due to Excessive ST Heat - indications?
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
Hematemesis/vomiting blood due to Excessive ST Heat - tx principles?
Clear ST heat, drain fire, cool the blood and stop bleeding
Hematemesis/vomiting blood due to Excessive ST Heat - basic formula?
Xie Xin Tang (Drain the Epigastrium Decoction) + Shi Hui San (Ten Partially-charred Substances Powder)
Hematemesis/vomiting blood due to LV Fire Invading the ST - indications?
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
Hematemesis/vomiting blood due to LV Fire Invading the ST - tx principles?
Drain the LV, clear the ST, cool the blood and stop bleeding
Hematemesis/vomiting blood due to LV Fire Invading the ST - basic formula?
Long Dan Xie Gan Tang (Gentian Decoction to Drain the LV)
Hematochezia/blood in stool due to Damp-heat in the Intestines - indications?
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
Hematochezia/blood in stool due to Damp-heat in the Intestines - tx principles?
Clear heat, resolve dampness, cool the blood and stop bleeding
Hematochezia/blood in stool due to Damp-heat in the Intestines - basic formula?
Di Yu San (Sanguisorba Powder)
Hematochezia/blood in stool due to SP and ST Yang Deficiency - indications?
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
Hematochezia/blood in stool due to SP and ST Yang Deficiency - tx principles?
Strengthen the SP, warm the middle burner, nourish blood and stop bleeding
Hematochezia/blood in stool due to SP and ST Yang Deficiency - basic formula?
Huang Tu Tang (Yellow Earth Decoction)
Hematuria/blood in urine due to Heat Accumulating in Lower Burner - indications?
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
Hematuria/blood in urine due to Heat Accumulating in Lower Burner - tx principles?
Clear heat, drain fire, cool the blood and stop bleeding
Hematuria/blood in urine due to Heat Accumulating in Lower Burner - basic formula?
Xiao Ji Yin Zi (Small Thistle Drink)
Hematuria/blood in urine due to KD Yin Deficiency with Heat - indications?
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
Hematuria/blood in urine due to KD Yin Deficiency with Heat - tx principles?
Nourish KD yin, clear heat, cool blood and stop bleeding
Hematuria/blood in urine due to KD Yin Deficiency with Heat - basic formula?
Zhi Bai Di Huang Wan (Anemaerrhena, Phellodendron and Rehmannia Pill)
Hematuria/blood in urine due to KD Qi Deficiency - indications?
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
Hematuria/blood in urine due to KD Qi Deficiency - tx principles?
Tonify the KD, strengthen retention and stop bleeding
Hematuria/blood in urine due to KD Qi Deficiency - basic formula?
Wu Bi San Yao Wan (Incomparable Dioscorea Pill)
