Lecture 7 & 8 Zang Pathomechanism Flashcards
HT is susceptible to disorders of?
Qi, Blood, Yin, or Yang
Lung is susceptible to pathologies of?
why?
yin and qi
bc LU governs skin and qi, diffuses, and downbears, therefore cough, panting, weak defense qi are seen as LU disorder
SP, ST, and Intestines are prone to disorders of…?
prone to disorders of Qi and Yang
SP: governs T & T
ST: ingestion
Intestines - movt and transformation of waste
vomiting, abdominal distention, fullness, and diarrhea are associated with disease of the …?
SP, ST, Intestines
Liver is susceptible to diseases of
Yin, Yang, Qi, and Blood
Liver governs free coursing and stores blood, LV yang is prone to upbearing.
Therefore, ribside pain, blood loss dizziness, and spasms indicated Liver disease
Disease that include palpitation, interrupted pulses, and derangement of shen are ascribed to which organ?
HT
kidney disease may include disorders of …?
yin, yang, or essential qi
KD governs water, stores essence, governs bones and engenders marrow, therefore, water-swelling, urinary block, enuresis, seminal emission, limp, painful lumbus and knees and sluggish movt are all associated with KD disease
some symptoms of KD yin def
-mild heat signs such as tidal fever, malar flush, 5 center heat, night sweating
weak voice, tiredness, poor appetite, loose stools, pale face, pale tongue, empty pulse are signs of?
qi def (qi xu)
what is organ pattern of SOB, weak voice
LUNG qi def (xu)
what is organ pattern tiredness, poor appetite, loose stools?
Spleen qi def (xu)
what are some things to consider in organ pattern ID according to Macioca?
- in practice, not all patterns will present as they do in the text (mixed patterns, fewer symptoms - generally advanced case presentation)
- Do not try to fit symptoms in to “patterns” aim to understand the eitiology of the disease in front of you
- no correlation b/t Eastern Pattern ID and Western Disease Diagnosis
- changes to tongue and pulse may be the only clinical manifestations of a pattern
what are the main fx of HT?
- governs blood*
- engender blood
- commands blood vessels
- houses the shen*
- emotion is joy
- maintains sleep
- manifest in face complexion*
- opens into tongue
- controls speech
- controls sweat* (actual formation of sweat is related to HT qi, bc sweat is an off shoot of blood)
which organ is “like an emperor and is the source of spirit light”?
Heart
what causes HT qi (yang xu)?
Wisman:
- vacuity of Zong qi peventing it from entering the HT
- cater qi intimidating the HT (KD Yang vacuity)
- wind-cold damp settling in HT
- damp turbidity or static blood obstructing the HT and vessels
Macioca:
- emotional problems (particularly sadness or grief)
- blood loss
what are the signs and symptoms of HT Qi Def?
palpitations shortness of breath (SOB) on exertion pale face spontaneous sweating tiredness possible depression pulse is weak, fine, and slow, interrupted (W) pulse is empty, maybe overflowing in left cun (HT) position (GM)
what are signs and symptoms of HT Yang DEF
all sings of HT Qi xu and:
pronounced cold signs
dark, gray, qing, or purple facial complexion
signs of static blood
in advances cases (HT yang collapse) - profuse, streaming perspiration, swelling of limbs, clouded spirit and faint pulse Cyanosis of lips, bluish tongue, coma* (*GM)
pathomechanism same as HT qi xu, also KD Yang xu
What are the etiology of HT BLOOD XU and HT YIN XU?
Wiseman:
- enduring illness causing damage to yin-blood
- fire as a result of “excess of the 5 minds (fear, anger, worry, joy, pensiveness)
- HT Blood xu often occurs with Sp vacuity
- HT Yin xu often with KD Yin Xu
Macioca: Blood -diet-poor nourishment (SP qi xu) -emotional stress -severe blood loss
Yin
the above plus:
overwork
external heat injuring yin
what are the signs and symptoms of HT BLOOD DEF
- pale, white facial complexion, lusterless
- pale tongue
- fine pulse
- palpitation
- dizziness
- poor memory
- insomnia
- profuse dreaming
- emotional disturbance
GM adds:
- propensity to be startled
- pale lips
- thin tongue
- choppy or fine pulse
what are signs and symptoms of HT YIN DEF
signs of HT BLOOD DEF plus: (signs of def heat) vexing heat in the 5 centers upbearing fire night sweats tongue that is red pulse is fine and rapid
GM adds:
dry mouth and throat
fidgetiness
tongue with no coat
what is the etiology of HT FIRE?
Wiseman:
often concurrent with LV Fire or KD yin vacuity
(without KID YIN, which is water, balancing the fire, the fire will become too strong)
Macioca:
emotional stress: anxiety, constant worry
Diet: hot spicy, alcohol
What are the signs and symptoms of HT FIRE?
GM (Wiseman is similar) palpitations (if HT is involved, we see this) thirst mouth and tongue ulcers restlessness and agitation insomnia with dream-disturbed sleep red face, red tongue (redder tip) dark urine or blood in urine bitter taste pulse is full, rapid, overflowing
HT impediment is caused by?
- stoppage in the vessels (ex. cardiac plaque, heart attack, etc.)
- blood stasis: inadequate blood movt as a result of qi or yang def
- phlegm turbidity impeding flow
what are the signs and symptoms of HT impediment?
gripping heart pain, green-blue facial complexion (or purple, which is the blood stasis), faint, fine pulse (due to severe obstruction)
which organ holds the office of prime minister and is the issuer of management and regulation?
LUNG
what are the main functions of LU?
- governs qi and respiration
- controls diffusing and descending of qi and body fluid
- regulates water passages
- controls channels and blood vessels (rules 100 vessels)
- *assists heart in circulation of blood in the blood vessels
- *circulates qi in the channels
- control the skin and space bt skin and muscles (cou li space/ interstices)
- manifests in body hair
- opens into nose
- houses the Po
- *emotion is grief
what are LUNG patterns of disase?
Wiseman
-Non diffusion of LU qi (attributed to external evil invading the LU, or heat evil or cold rheum congesting the LU)
-impaired depurative downbearing of LU qi
(attributed to heat caused by transformation of exterior cold, or by brewing phlegm-damp)
-lung qi vacuity
-lung yin vacuity
Macioca: -LU qi def -LU yin def -LU dryness -invasion of LU by wind cold, heat, or water -LU heat -damp-phlegm in LU -cold-phelgm in LU -phlegm-heat in LU dry-phlegm in LU Phlegm-fluids obstructing the LU LU - HT Qi def
what are the signs and symptoms of LU pattern of NON DIFFUSION of LUNG Qi?
- initial stage of Wind-heat, or wind-cold invasion
- cough, itchy throat, loss of voice
- evil heat congesting the LU: high fever, flaring of nostrils, rapid panting, rough breathing, thick sticky yellow phlegm sometimes containing pus or blood
- tongue is red or crimson with yellow fur
- pulse is slippery and rapid
what are the signs and symptoms of LU pattern of impaired depurative downbearing of LU qi (attributed to heat caused by transformation of exterior cold, or by brewing phlegm-damp)?
- caused by dry-heat: cough (counterflow), dry cough, dry throat, loss of voice
- caused by phlegm-damp: cough (counterflow), thick, sticky phlegm, chest oppression. Tongue fur is slimy, pulse is slippery
what are the causes of LU qi xu?
chronic illness emotional stress result of exterior attach (w/h or w/c) spleen and kidney def overexertion
Sign and symptoms of LU qi def
general physical weakness, weak voice, cough, shortness of breath
tongue is pale
pulse is empty and weak
maybe: weakened defense so susceptible to invasion from external pathogens and spontaneous sweating (weakness of exterior)
Causes of LU YIN XU?
- pathogenic dry heat (or lingering lung heat over time)
- accumulation of phlegm and fire
- emotional stress
- smoking (contributing factor)
- *KD Yin Xu (contributing factor)
signs and symptoms of LU yin xu?
emaciation cough with dry or little phlegm dry mouth and throat hoarse voice perhapse blood flecked sputem
if KD-LU yin def
red cheeks, tidal fever, night sweats, sore low back, seminal emission
tongue: red
pulse: fine
what causes phlegm-damp?
recurrent exterior attacks weaken LU and SP
diet-excessive consumption of cold, raw, or greasy food
(excess interior cold pattern)
signs and symptoms of phlegm-damp?
cough coming in bouts, with sticky, white sputum that is easy to expectorate white complexion phlegm in throat shortness of breath dislike of lying down wheezing heaviness in body and muzziness in head
what causes phlegm-heat?
diet
emotional stress
exterior attack (of heat in general)
smoking (contributory)
signs and symptoms of phlegm-heat?
barking cough with sticky yellow or green sputum shortness of breath wheezing chest oppression phlegm in throat heat signs - thirst, insomnia, agitation heaviness tongue: red, swollen, sticky yellow coat pulse is slipper and rapid
what are main fx of SP?
governs transformation and transportation controls ascending qi directs gu qi to the lungs keeps internal organs in place controls blood production of blood management of blood controls muscles and the 4 limbs opens into the mouth and manifest in the lips controls saliva houses the Yi
4 spleen patterns are?
spleen qi xu
spleen yang xu
center qi fall
failing to manage blood
what are the causes of sp qi xu?
improper diet
chronic illness
emotional strain
overstrain
what are the sign/symptoms of spleen qi xu?
abd pain (esp. post-prandial) diarrhea decreased appetite fatigue lack of strength pale complexion pale tongue soft, soggy pulse
what are the causes of spleen yang xu?
spleen qi def
diminished lifegate fire/KD yang xu
what are the signs and symptoms of spleen yang xu?
spleen qi def
dimished life gate fire/mingmen fire/KD yang xu
what are signs and symptoms of spleen yang xu
spleen xu signs cold signs bright white facial complexion lassitude physical cold abd pain that likes warmth/pressure diarrhea with undigested food
what causes center qi fall?
diminished uplifting of spleen qi/yang
severe spleen qi xu so similar causes (untreated)
what are the signs and symptoms of center qi fall?
similar signs and symptoms plus:
abd distention and sagging worse after eating, prolapse of stomach, enduring diarrhea, prolapsed rectum of uterus
what signs and symptoms of “failing to manage blood”? (blood management failure / qi xu)
blood in stool
flooding and spotting
somber, white, or withered sallow complexion (SP Qi Xu signs / symptoms)
pulse” fine
what are the causes of cold damp encumbering the SP?
diet: cold, raw food
SP YANG xu
wind-damp invasion (usually SP already weak) - SP is already weak, and this is the tipping point
what are the signs and symptoms of cold damp encumbering the SP?
abdominal distention and fullness (excess situation)
heavy headedness
fatigue (bc SP is not functioning and you are not creating qi, also leaden so its tiring)
torpid intake (you feel like you can’t eat, idea of food is nauseating)
upflow nausea (stomach not descending)
bland taste, no thirst (damp accumulation), sloppy stool (sticky & loose), inhibited urination
tongue gray-white glossy fur
pulse-slow or moderate and soggy (fee like a damp sponge)
foul smelling leukorrhea
what are the causes of damp heat invading the spleen?
generally thought of as damp-heat of the center or of the SP and ST
damp-heat arising in middle burner
- diet (hot spicy food, alcohol)
- emotional stress (weaken qi, and create heat)
- external invasion
what are the signs and symptoms of damp heat invading the SP
sloppy stool, torpid intake, glomus (feeling like something is stuck in your throat) and distention in the ST, nausea
yellow urine
red tongue with slimy yellow fur
pulse is soggy
what are the main fx of Liver?
stores blood
regulates menstruation (LV more movt of menses, SP holds things)
controls sinews
maintains a free coursing of qi (dredges and drains he pathways of qi)
opens into the eyes
houses the HUN
what are the causes of Liver qi stagnation (binding depression of LV qi according to Macioca)?
disruption in the LV’s “free coursing” function
- mental or emotional disorder
- invasion of damp-heat (obstructing movt)
- LV blood def (not enough blood to fill the liver, it wont be nourished and things wont move as freely, it’ll be brittle)
what are the signs and symptoms of binding depression of LV qi?
-mental/emotional disorders - depression bc things are not moving or rashness, impulsivity, impatience, exaggerated responses,
-stagnation along the LV channel
- distention of breasts
- plum pit qi (glombus)
- goiter (swelling on neck)
- genital pain
GI disturbances (relationship bt wood and earth - wood overacting on earth, upper GI - stomach counter qi, lower GI - diarrhea, etc.)
menstrual irregularities - blood storage and issues with CHONG and REN
what are the causes of upflamming of LV Fire?
transformation of LV qi depression into fire (chronic)
severe emotional disturbance (more acute)
over indulgence of fatty greasy foods
depressed internal damp-heat, or latent LV-GB heat transform into fire
what are the signs and symptoms of upflamming of LV Fire?
fire flares upward attacking the head
- severe headache (generally vertex, pounding strong)
- red face, red eyes
- dry mouth
- sudden tinnitus or deafness
- vomiting of sour, bitter fluid
- stool is dry and hard
- pulse is slippery(excess dampness) and string-like/wiry
- tongue is re with dry yellow fur
emotional signs and symptoms:
irascibility
rashness
impatience
if Blood affected - signs of bleeding (expectoration of blood, nose bleed, profuse bring red menstruation)
- purely upper body signs with upflamming LV fire - impetus of fire to rise
(vs. with LV yin def see lower body signs)
what are the causes of ascendant upbearing of LV yang (aka liver yang rising)
imbalance bt LV yin and LV yang (also KD yin xu may be causative factor)
Def yin does not counterbalance yang and allows it to rise unchecked
all LV patterns discussed to this point are mutually conducive (may give rise to one another)
- LV (binding depression, upflamming of fire, ascendant yang - they all can be cause and factors to one another)
signs and symptoms ascendant upbearing of LV yang are?
- signs of upper body exuberance of LV yang and signs of yin/blood xu that is root of condition
- mental excitation, irascibility, dizziness, headache, insomnia (yang in the head, upper body signs)
- palpitation, aching low back, weakness in legs - (signs of KD yin def / lower body root signs)
- pulse is thin (yin or blood def)
- tongue is red (also sign of root def)
- can see red face, and headache, sometimes high blood pressure
what are the causes of LV wind stirring internally (LV wind)
-excessive depletion of LV and/or KD yin-blood. leading to upbearing of LV yang
-this generates internal wind “internal wind is the stirring of body
‘s yang qi”
-in blood def - not enough blood to fill the vessel, as it move wind can develop in that empty space
what are the signs and symptoms of LV wind?
-severe dizziness and headache
-rigidity of neck
-tingling or numbness of limbs
-jerking of sinews and twitching flesh (spasm and/or seizures)
-if severe:
pulling of face and eyes (bell’s palsy, strokes)
trembling fingers and lips with difficult speech
pulse is wiry
tongue is red with dry fur
what are the causes of LV blood vacuity (xu)?
chronic illness damaging liver blood
- deprives it of proper storage and nourishment
chronic bleeding issues
- blood management issues (menstrual, nosebleed, etc.)
what are the signs and symptoms of liver blood vacuity
general blood vacuity signs
- pale, withered complexion, dizziness, flowered vision, pale tongue and fine pulse, palpitations, insomnia, and numbness of extremities
Liver blood xu
- blood fails to nourish LV, sinews or eyes, and disharmony of chong and ren
- dizziness, flowery vision, insomnia, profuse dreaming (hyperactivity of Hun), blurred vision, inhibited movt of sinews, lusterless nails, scant menstrual flow, menstrual block alternating with flooding and spotting
which organ is the forceful accomplishment and the source of mysterious ability?
Kidney
driving force of entire body, but also the receptive force of entire body
what are the main fx of kidney?
- stores jing and governs birth, growth and development
- produces marrow and controls bones
- governs water
- controls the reception of qi
- opens into ears
- houses the zhi
- controls the ming men
- controls 2 lower orifices
what are the major patterns related to Kidney
KD yin vacuity
KD yang vacuity
insufficiency of KD essence
insufficiency of KD qi
what are the causes of KD YIN DEF
most commonly occurs in dual vacuity patterns bc KD yin is yin of the whole body
KD - HT yin vacuity
KD - LU yin vacuity
KD LV yin vacuity
(vice versa, HT yin vacuity leads to KD vacuity, bc HT yin vacuity can draw on the HT yin, etc.)
what are other causes of KD YIN XU
- congenital def
- pathogenic yang that damages yin
- unbalanced emotions (qi stagnation) that turn into fire and damages yin
- chronic disease
- overexertion (mental)
- hot food / warming herbs given appropriately
- natural decline that comes with aging
what are the signs and symptoms of KD YIN XU?
dizziness, tinnitus, vertigo, dry throat mouth, tidal heat, night sweating, malar flush, seminal emission, lumbar pain, fine-rapid pulse, red tongue with no coat, can have crack in the middle (damage to the st fluids as result of damage to ST yin) and/or ice-float cracks on tongue
severe cases: shedding of flesh and loss of bulk (emaciating), red-mirror tongue - smooth tongue surface with no coat, indicative of yin def (*if pale - qi or possibly blood def)
KD - LV yin xu signs and symptoms
KD YIN XU signs plus
loss of visual acuity headache flowery/blurry vision irregular menses sterility
signs and symptoms of KD-HT YIN XU
kidney yin xu signs plus:
insomnia
palpitations
forgetfulness
profuse dreaming
signs and symptoms KD-LU YIN XU
Kidney Yin Xu signs plus:
cough
expectoration of blood
steaming bone (intense heat situation, it’s like a deep seated heat as if the bones are steaming) - related to dispersal of fluid, if this is not happening bc movt of LU is impeded, then bc of KD it affects the bones; also bc things are not circulating, no cooling effect
what is the root of yang in the body (life-gate fire)?
kidney yang
kidney yang is closely associated with
spleen yang
heart yang
lung yang
(vice versa, weaknss of SP Yang can lead to KD yang def, etc.)
signs and symptoms of Kidney Yang Xu?
-bright white face coldness, fear of cold, no thirst, desire for hot drinks, torpor of essence, aching lumbus and knees, seminal efflux, sterility, infertility, impotence, menstrual irregularities, loose stools, frequent pale urination/nocturia (transformative fx impaired),
pulse is weak
pale wet tongue (may include other qi xu signs)
signs and symptoms of KD-SP YANG XU
kidney yang xu signs plus
pronounced edema
enduring diarrhea
cock’s crow diarrhea
clear food diarrhea
signs and symptoms of KD-HT YANG XU
Kidney yang xu signs plus:
palpitations panting edema reversal cold of the limbs (marked cold in extremities, you may see abd pain) oils sweating (may be profuse)
signs and symptoms of KD-LU YANG XU
kidney yang xu signs plus:
rapid breathing at the slightest exertion
(qi absorption failure - root is lung qi xu
what causes insufficiency of KD Essence?
enduring illness
excessive sexual activity (GM) (includes giving multiple birth in short time period of time)
in children:
improper development in fetal stage
hereditary weakness of KD Esscence (GM) (jing or preheaven def)
what are the patterns of insufficiency of KD Essence
no discernible heat or cold sings
2 patterns:
essence-marrow depletion
sea of marrow vacuity
general signs and symptoms of insufficiency of KD essence
general:
dizziness, tinnitus, weak and sore low back and knees ( limp aching lumbus and knees), impaired reproductive fx, loss of head hair, loosening of teeth
in children:
delayed growth and maturation, low intelligence, sluggishness, weak bones, slow closure of fontanel
in adult:
premature senility, weakness in legs, decreased or impaired fertility
insecurity of KD qi is described by wiseman as?
wiseman describes this as an impairment of KD’s ability to secure essence, and regulating discharge of urine and semen
what are causes of insecurity of KD qi
intemperate sexual practices
old age
weakened pre-heaven constitution or post-heaven in childhood
what are signs and symptoms of insecurity of KD essence?
-frequent, long voiding of urine
-incontinence
-enuresis
-dribbling urination
-seminal emission/nocturnal emission(via wet dream at night, with stimulus)
-seminal efflux (spontaneous emission that happens any time of day without stimulus)
-pre-mature ejaculation
-general sings of KD vacuity
- fatigued spirit, low back pain, weak knees, pale tongue, fine weak pulse, minor cold signs
-in women Stirring of Fetus is a sign of insecurity of KD qi
(movt of fetus, sagging of abd, discharge of blood, impending miscarriage, heavy pressure) - bc KD qi is not strong enough to hold it
