Internal Med I Test 1- intro, common cold, cough, wheezing, sinusitis & nasal congestion Flashcards
What two key issues are related to identifying diagnosis?
Nature and location of disorder
Complete diagnosis has two parts -
NAME of disease + PATTERN/pathology (nature&location)
General treatment principles for all cases
Balance and regulate yin and yang; treat roots and branches/manifestations of disease; reinforce right qi and eliminate evil qi; treat according to seasons, weather, geographical region, individual conditions.
Excess Wind-Cold indications, symptoms, and signs
Acute simultaneous fever & chills, chills more prominent.NO sweating. Occipital HA. Muscle aches, stiff neck, sneezing, cough/wheezing with watery thin mucus. T normal, twc. P: floating, maybe tight.
Excess Wind-Cold treatment principles
Dispel Wind, dissipate Cold, resolve exterior
Excess Wind Cold principle formula
Jing Fang Bai Du San
Add to Jing Fang Bai Du San for severe headache?
Chuan Xing Cha Tiao San
Excess Wind-Heat indications, symptoms, and signs
Acute fever with mild/no chills. Sore/dry/scratchy throat. Mild sweating. HA (usually frontal). Thirst. Cough with thick/sticky yellow mucus. Nasal obstruction/discharge, yellow/green. T: normal or red tipped, thin yellow tc. P: floating and rapid.
Excess Wind-Heat principle formula
Yin Qiao San OR Sang Ju Yin
Excess Wind-Heat treatment principles
Disperse wind, clear Heat, resolve exterior
Cool Wind-Dryness indications, symptoms, and signs
Phlegm, post-nasal drip
Cool Wind-Dryness treatment principles
GENTLY* disperse cool-dryness, disseminate LU qi *(excess sweat easily damages fluids because already dry)
Cool Wind-Dryness principle formula
Xing Su San (Apricot kernel and perilla leaf powder)
Excess warm Wind-Dryness treatment principles
Disperse warm-dryness, moisten dryness, nourish yin and sooth the Lungs
Excess warm Wind-Dryness principle formula
Sang Xing Tan (Mulberry Leaf and Apricot Kernel Decoction)
Excess Summerheat-Dampness indications, symptoms, and signs
Heat signs, nausea/vomiting, loose stools/diarrhea, heavy limbs, body aches, thirst, dark urine and maybe cloudy, irritability, may be sore throat. T: swollen, slightly greasy, slightly thick, white/yellow t.c. P: soft, soggy, maybe floating, moderate
Excess Summerheat-Dampness treatment principles
Clear summerheat, transform dampness, harmonize middle burner, and release the exterior
Excess Summerheat-Dampness principle formula
Xin Jia Xian Ru Yin (originally 5 ingredients: Xiang Ru, Jin Yin Hua, Bian Dou, Lian Qiao, Hou Po; in textbook added Hua Shi (to clear S-H, promote urination to clear dampness), and Huo Xiang and Pei Lan (transform Damp, harmonize ST), He Ye (clear S-H) and Gan Cao (harmonize MB).
Exterior Wind-Cold with Internal Heat indications, symptoms, and signs
High fever, severe chills, severe headache, body aches, NO SWEAT (because W-C is in exterior pores are closed), maybe nasal congestion. Irritability d/t internal Heat. Restless. Cough is very heavy, loud. Phlegm is productive, thick white/yellow. Red face. Dark urine. Maybe constipation. Very thirsty for cold beverage. T: Red edge and tips, yellow/white t.c. depending on stage of illness. P: very forceful, floating, rapid if high fever.
Exterior Wind-Cold with Internal Heat treatment principles
Release exterior wind-cold, clear internal heat
Exterior Wind-Cold with Internal Heat principle formula
Shuang Jie Tang - has Ma Huang to induce sweat, Shi Gao to clear internal Heat. See page 3 in handout; this formula is not in your textbook. Alternatives are Jiu Wei Qiang Huo Tang and Da Xing Long Tang.
Exterior disorder with qi deficiency indications, symptoms, and signs
Mild chills, mild fever, HA, maybe slight sweating d/t qi deficiency (prior to W-C invasion as well), nasal congestion/runny nose, slight tight chest, fatigue, no voice, SOB, pale complexion. T: pale, twc. P: floating, weak.
Exterior wind-cold-damp with qi deficiency indications, symptoms, and signs
Add damp signs like greasy t.c., more phlegm
Exterior disorder with yang deficiency indications, symptoms, and signs
Strong chills and shivering, maybe mild fever. Cold body and extremities. Fatigued, exhausted, unable to function. Sneezing, runny nose. Chronic aversion to cold. No sweat or spontaneous sweating which exacerbates aversion to cold. Low, soft voice with reluctance to speak. Waxy, pale complexion. May be cough with thin white phlegm. T: pale, swollen, twc. May be darker d/t poor circulation d/t cold. P: weak, deep, maybe floating and forceless.
Exterior disorder with blood deficiency indications, symptoms, and signs
Acute HA, fever, mild chills, little or no sweating, fatigue, palpitations, dizziness. T: PALE, twc (can turn yellow if illness lingers). P: floating, slightly rapid if fever, weak, thin.
Exterior disorder with yin deficiency indications, symptoms, and signs
Acute HA, fever, maybe mild chills, no/slight sweating (preexisting night sweat d/t yin def), sore/itchy/scratchy throat, thirsty, maybe irritable, dry cough may have bloody mucus. T: red, twc or no coat with cracks depending on severity. P: thin, rapid, maybe floating.
Exterior disorder with qi deficiency principle formula and tx principles
Shen Su Yin - relieve exterior tonify qi (to fight evil qi). More mildly/gently releases exterior since excess sweat can further damage qi. Gently disperse - can add Jing Jie, Fang Feng for more dispersing. NO powerful herbs like Ma Huang, Gui Zhi!
Exterior wind-cold-damp with qi deficiency principle formula
Ren Shen Bai Du San
Recurrent colds formula
Yu Ping Feng San
Exterior disorder with yang deficiency principle formula
Zai Zao San
Exterior disorder with blood deficiency principle formula and tx principles
Cong Bai Qi Wei Yin - gently disperses (Cong Bai, Sheng Jiang), clears Heat (Ge Gen), tonifies blood (Sheng Di Huang) and LIV yin (Mai Men Dong). Text adds Jing Jie to disperse gently and E Jiao to tonify blood (but this is very cloying for exterior invasion - Yan Ping does not recommend).
Exterior disorder with yin deficiency principle formula
Jia Jian Wei Rui Tang
External causes of cough
Wind-Cold, Wind-Heat, Wind-Dryness
Internal causes of cough
Damp-Phlegm, Heat-Phlegm, Liver Fire, Lung Yin Deficiency, Lung Qi Deficiency
Etiology of cough
- 6 excesses (External Wind mainly, Wind-Cold most commonly); 2. Emotional factors (constrained LIV qi turns to Fire, attacks Lungs); 3. Irregular diet (generates heat or damp); 4. Lung disease.
Pathology of cough
Lung qi fails to disseminate and descend due to blockage of Lung qi by pathogens or disorder or the organs (LU, LIV, SP)
Cough due to Wind-Cold diagnosis
Acute cough (frequent, loud, moderate production of clear/white mucus). Fever and chills, chills predominant. NO sweat. Occipital/frontal HA. Muscle aches, stiff neck. Nasal obstruction/discharge with thin watery mucus. Dyspnea and wheezing. Sneezing. T: normal twc. P: floating, maybe tight.
Cough due to Wind-Cold treatment
San Ao Tang + Zhi Sou San (expel Wind, scatter Cold, release exterior, disseminate LU qi, stop cough)
Cough due to Wind-Heat diagnosis
Acute cough (hacking and dry OR with sticky, yellow, difficult to expectorate sputum). Mild fever with little/no chills. Nasal obstruction/discharge thick, yellow/green. Sore/dry/scratchy throat. Thirst. Mild sweating.HA usually frontal. T: normal or red tip, thin white or yellow coat. P: floating and rapid.
Cough due to Wind-Heat treatment
Sang Ju Yin (dispel Wind, clear Heat, diffuse Lungs, relieve cough)
Cough due to Warm-Dryness dx
Cough is dry, hacking, non-productive, may cause chest pain. Any mucus is scant, sticky, thick, difficult to expectorate, maybe blood-streaked. Dry throat, mouth, nose, lips. HA. Mild fever/chills. T: normal or with red tip and thin yellow dry tc. P: thready and rapid.
Cough due Warm-Dryness treatment
Sang Xing Tang (disperse Wind, clear Heat, moisten dryness, disseminate Lungs, stop cough)
Cough due to Cool-Dryness diagnosis
Cough with little/no mucus, throat is dry and ticklish/itchy, dry nose, dry lips, mild HA, chills, mild fever, no sweating. T: thin white dry tc. P: floating and tight.
Cough due to Cool-Dryness treatment
Xing Su San (disperse cool-dryness, moisten dryiness, disseminate Lungs, stop cough)
Cough due to Damp-Phlegm diagnosis
Face puffy, body heavy, nausea, loose stools, low appetite, maybe bloating/distention/gas, foggy head. T: slipper, greasy, thicker white t.c. with very moist tongue. P: modeate, weak, sometimes slippery.
Cough due to Damp-Phlegm treatment
Er Chen Tang + San ZiYang Qi (dry Dampness, transform Phlegm, regulate Qi in LU and MB, stop cough)
Cough due to Heat-Phlegm diagnosis
Hacking cough with heavy sound, any time of day, usually thick yellow/green mucus, maybe smelly. Full, congested sesation in chest that may extend to diaphragm. Heat signs (red face, lips, irritability) and Damp signs (low appetite, nausea, fatigue). May have constipation d/t H or diarrhea d/t Damp.
Cough due to Heat-Phlegm treatment
Qing Jin Hua Tan Tang (clear Metal and transform phlegm decoction) (clear Heat, resolve phlegm, restore the descending function of Lung qi, stop cough) - Heat is already in Lung, needs to be drained. Qing Dan drains LIV Fire. Hai Ge Ke clears Heat in LU, transforms phlegm.
Cough due to Liver Fire diagnosis
Cough that suddenly occurs, usually related to anger (LIV Fire insulting LU). Cough is loud, frequent, usually with minimal phlegm. Maybe some blood due to Fire entering blood vessels. Complexion red. Tension/temporal HA. Chest tightness, hypochondrial pain. Bitter taste in mouth. High pitched tinnitus. Very irritable. Red eyes. Very thirsty for cold beverage. Tendency to constipation. Urine is concentrated. Body feels warm/hot. T: red esp edges, yellow tc. P: forceful, rapid, wiry.
Cough due to Liver Fire treatment
Xie Bai San (Drain the White Powder) (clear the LIV, drain the LU, transform phlegm, stop cough)
Cough due to Lung Yin Deficiency diagnosis
Chronic, probably lifestyle-related (smoker, spicy foods, alcohol use, chronic dehydration). Usually dry cough worse in late afternoon/evening/night. Little sticky sputum or no sputum. Dry mouth, throat, skin, lips, nose, skin, stool (LU cannot distribute fluids). May have night sweats, hot palms/soles, warm upper body. Poor sleep, disturbed by cough or empty heat. Tend to lose weight. General fatigue, easily tired. T: very narrow, small, dry, with cracks, red, little or no tc. P: thing, rapid.
Cough due to Lung Yin Deficiency treatment
Bai He Gu Jin Tang (nourish yin, moisten LU, transform phlegm, stop cough)
Cough due to Lung Qi Deficiency from Cold diagnosis
Usually in winter or chronic cough worse in winter. White clear sputum. Sensation of cold in chest, back, and four extremities. Aversion to cold. May have SOB, spontaneous sweating. T: pale, twc. P: thin, weak, deeper and weaker in LU position.
Cough due to Lung Qi Deficiency from Cold treatment
Wen Fei Tang (Warm LU decoction) (tonify qi, warm LU, transform phlegm, resolve coughing). Once cough resolves, tonify SP to tx roots.
General principles for treating wheezing
- Acute attacks - treat meanifestations. During remission - treat root of disease. 2. Excess: eliminate evil qi from LU (W/H/C/Ph), redirect LU qi downward & calm wheezing 3. Deficiency: supplement LU, KID, SP and stop wheezing.
Wheezing etiology and pathology
Failure of LU Qi to descend due to causes that may be external (Wind-Cold, Wind-Heat) or internal (diet leading to turbid phlegm, emotions leading to constrained LIV qi, prolonged diseases, stress and overstrain)
Wheezing due to Invasion of LU by Wind-Cold diagnosis
After exposure to wind, cold air. White/watery Phlegm. Not too much mucus. With typical W-C s/s (chills, fever, HA, maybe nasal congestion, sinus HA).
Wheezing due to Invasion of LU by Wind-Cold treatment
Ma Huang Tang (disperse Wind-Cold, reslease exterior, disseminate LU qi, calm wheezing)
Wheezing due to Invasion of Heat/Wind-Heat diagnosis
Acute wheezing and cough with scant, sticky yellow, hard to expectorate mucus. Fullness/tightness in chest. Mild fever, little/no chills. Thirst. Nasal obstruction/discharge thick yellow/green. Sore/dry/scratchy throat. Mild sweating. HA (usually frontal). T: normal or red tip with thin white/yellow coat. P: floating rapid.
Wheezing due to Invasion of Heat/Wind-Heat treatment
Ma Xing Shi Gan Tang (clear Heat, expel Wind, facilitate flow of LU qi, calm wheezing)
Wheezing due to Accumulation of Phlegm-Heat in the LU diagnosis
Wheezing and cough, worse at night and first thing in morning. With profuse thick, yellow/green, hard to expectorate mucus, maybe with blood. Fullness, tightness, stuffiness and burning in chest. Red complexion. Bitter taste in mouth, dry mouth. Nausea, loss of appetite. Loose stools OR constipation. Lethargy and weakness. Maybe sore/congested throat. T: thick, greasy, yellow tc though maybe only the root. P: soft/slippery and rapid.
Wheezing due to Accumulation of Phlegm-Heat in the LU treatment
Sang Bai Pi Tang (clear LU, transform Phlegm, reglate LU qi and calm wheezing)
Wheezing due Accumulation of Turbid Phlegm in the LU treatment
Er Chen Tang + San Zi Yang Qin Tang (transform Phlegm, direct Lung qi downward, calm wheezing)
Wheezing due to Liver Qi Stagnation Damaging the LU diagnosis
Tightness in chest, dyspnea, SOB, difficulty getting a deep breath, little/no mucus, related to emotion. Tightness/fullness in chest. Frequent sighing. Plum pit qi. Poor appetite. Insomnia. Palpitations. Vague chest pain. PMS including breast tenderness. Irregular menstruation. T: normal or with brown/purplish spots on edges. P: wiry
Wheezing due to Liver Qi Stagnation Damaging the LU treatment
Wu Mo Yin Zi (regulate LIV qi, redirect LU qi downward, stop wheezing)
Wheezing due to LU Qi Deficiency tx
Bu Fei Tang + Yu Ping Feng San (supplement LU, boost Qi)
Wheezing due to LU Qi Deficiency dx
Wheezing, panting, SOB worse with exertion. Spontaneous sweating. Weak/soft voice with little desire to talk. ???? this is not in textbook I guess??
Wheezing due to LU Qi and Yin Deficiency dx
Dry throat/mouth/tongue, pale complexion with red cheeks, may have neigh sweats, weight loss, Empty Heat signs. T: narrow, small, dry, maybe peeled or maybe thin coat, some cracks. P: thing, rapid, weak in LU, weak in left third position indicated KD yin def. This pattern can be LU and/or KD yin def.
Wheezing due to LU Qi and Yin Deficiency tx
Sheng Mai San + Sha Shen, Yu Zhu, Bai He (augment LU, nourish LU yin)
Wheezing due to KID yang deficiency dx
Chronic wheezing with inhalation more difficult. Worse with exertion, when fatigued or cold, and following sex. Lethargy and listlessness. Spontaneous sweating. Frequent colds. Pale complexion, dark rings under eyes, facial puffiness. Pitting edema with scanty urination or nocturia and urinary frequency. Weak/sore lower back and knees. Cold extremities. T: swollen and pale or purplish/bluish with twc. P: deep, thready and slow or imperceptible OR large, deficient and without root.
Wheezing due to KID yang deficiency tx
Shen Qi Wan + Shen Ge San (Tonify KD yang, assist KID to grasp qi)
Common ingredients that calm wheezing
Ma Huang, Chen Xiang, Su Zi, Xing Ren, Sang Bai Pi, Ting Li Zi, Bai Guo, Di Long, Ge Jie, Dong Chong Xia Cao, He Tao Ren
For Wind-Cold invasion, use Ma Huang Tang (disperse Wind-Cold, reslease exterior, disseminate LU qi, calm wheezing) - list ingredients and dosage
Ma Huang (9g), Gui Zhi (6g), Xing Ren (9-12g), Zhi Gan Cao (3g)
For Heat or Wind-Heat - Ma Xing Shi Gan Tang (clear Heat, expel Wind, facilitate flow of LU qi, calm wheezing) ingredients and dosage
Ma Huang (12g), Shi Gao (24g), Xing Ren (18g, 50 pcs), Zhi Gan Cao (6g)
For Phlegm-Heat in LU - Sang Bai Pi Tang (clear LU, transform Phlegm, reglate LU qi and calm wheezing) ingredients and dosage
Sang Bai Pi, Huang Qin, Huang Lian, Zhi Zi (these clear and drain LU Heat). Xing Ren, Bei Mu, Ban Xia, Si Zi (these descend qi downward and transform phlegm)
For turbid Phlegm in LU - Er Chen Tang + San Zi Yang Qin Tang (transform Phlegm, direct Lung qi downward, calm wheezing) ingredients and dosage
Er Chen Tang [Zhi Ban Xia (15g), Ju Hong (15g), Fu Ling (9g) Zhi Gan Can (4g)] + SanZi Yang Qin Tang (Bai Jie Zi, Zi Su Zi, and Lai Fu Zi, all 6-9g)
For LIV qi stagnation damaging the LU - Wu Mo Yin Zi (regulate LIV qi, redirect LU qi downward, stop wheezing) ingredients and dosage
Mu Xiang (6g), Chen Xiang (6g), Bing Lang (9g), Zhi Shi (9g), Wu Yao (9g)
For LU Qi Deficiency, use Bu Fei Tang Lung Supplementing Decoction + Yu Ping Feng San (supplement LU, boost Qi) ingredients and dosage
Bu Fei Tang [Ren Shen, Huang Qi, Shu Di Huang, Wu Wei Zi, Sang Bai Pi, Zi Yuan] + Yu Ping Feng San [Mi Zhi Huang Qi (60g), Bai Zhu (60g), Fang Feng (30g)]
For LU Qi and Yin deficiency - Sheng Mai San + what 3 herbs (to augment LU, nourish LU yin) ingredients and dosage
Sheng Mai San [Ren Shen (9-15g), Mai Men Dong (9-12g), Wu Wei Zi (7 seeds, 3-6g)] + She Shen, Yu Zhu, Bai He
Sinusitis and nasal congestion Etiology and Pathology
- External pathogens (W-H or W-C enter LU, obstruct LU qi flow, block nose) 2. Excessive emotions (leading to LIV qi stagnation, disruprint flow of LU qi, and prolonged constrated generates H/Fand weakens SP leading to interior D-H) 3. Improper diet (spicy, heavy, greasy, rich, sweet foods or alcohol generate H-D and weaken SP) 4. LU, SP, or KD deficiency (due to overwork, chronic illness, excessive mental activity, irregular eating habits)
Treating sinusitis and nasal congestion - what are general principles?
Excess patterns: disperse evil qi, regulate LU qi, open nasal orifice. Deficiency patterns: tonify LU, SP, and KD, transform Phlegm, open nasal origice.
Common ingredients to open nasal passages?
Cang Er Zi (use lower dose, slightly toxic), Xin Yi Hua, E Bu Shi Cao (smell can cause nausea in decoction, also available in patent), Shi Cang Pu
Common ingredients to relieve headache associated with nasal congestion/sinusitis?
Chuan Xiong (helps circulation to nose), Bai Zhi (warm, moving herb for frontal HA), Gao Ben (warming, for top of head HA), Xi Xin (very warming for cold patterns, for HA around and behind eyes, use no more than 3g), Man Jing Zi, Ju Hua (last two both cold for Heat patterns)
How do you dx sinusitis/nasal congestion due to Wind-Cold invasion?
MC is sinus pressure/HA, maybe lost sense of smell, with W-C exterior s/s (runny nose with white/clear mucus, maybe post-nasal drip, aversion to wind and cold, maybe fever, muscle aches, HA, NO sweat, NO sore throat, NO thirst, though may have cough or scratchy throat). T: normal. P: floating, tight.
How do you tx sinusitis/nasal congestion due to Wind-Cold invasion?
Xin Yi San Magnolia Flower Powder (disperse Wind-Cold, diffuse LU Qi, unblock nasal passages) - many ingredients for sinus HA, opening orifices. Chuan Xiong reduces HA by invigorating blood, moving qi, and expels Wind to tx body aches. Mu Tong unblocks vessels (can sub. Tong Cao). Sheng Ma guides formula to upper body. Very well designed, with powerful herbs (Xi Xin, Chuan Xiong, Qiang Hou). Add a couple slices fresh ginger to aid dispersion.
How do you dx sinusitis/nasal congestion due to Wind-Heat invasion?
MC nose issues. Nasal congestion is thicker, sticky, yellow/green. Nasal passages bright red. HA - forehead, cheekbones more sever. May have lost sense of smell. Nasal discharge may have strong odor, may contain blood. Can have sore throat. If cough, phlegm is yellow. Some thirst especially for cold beverage. May have fever or may not. Maybe slight sweat. Very short-term chills, a few mins-hours, only at onset. T: red, esp edges and tip, yellow tc. Face may also be red. P: floating, rapid, slightly strong.
How do you tx sinusitis/nasal congestion due to Wind-Heat invasion?
Can Er Zi + Sang Ju Yin (disperse Wind, clear Heat, open nasal orifices) - acrid herbs disperse Wind-Heat. Cang Er Zi San is warm to open orifices. Can add Man Jing Zi which is more cooling. Sang Ju Yin is more mild formula. For worse bleeding add Mu Dan Pi to cool, Bai Mao Gen to stop bleeding and cool. If bleeding is mild indirect treatment ok.
How do you dx sinusitis/nasal congestion due to Phlegm-Heat accumulation?
Lots of nasal discharge, red nasal passages, heavy head, sensitive to touch, nodules around neck, some sore throat. Heat signs (red face, irritable, fever, thirst). T: red, greasy yellow thick tc. P: Slippery, rapid.
How do you tx sinusitis/nasal congestion due to Phlegm-Heat accumulation?
Dan Xi Bi Yuan Fan (clear Heat, transform Heat Phlegm, open the nasal passages)
