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TCM Foundations II > Zang Fu Patterns: LV Invading; GB Patterns > Flashcards

Zang Fu Patterns: LV Invading; GB Patterns Flashcards

1
Q

Liver Qi Invades Spleen Etiology

A
  1. Mental depression or irritation (anger, frustration, restentment) injures Liver
  2. Irregular food intake injures Spleen
  3. Overstrain, overwork, stress
  4. Liver excess with a Spleen insufficiency will lead to a “Wood” attack on “Earth”
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2
Q

Liver Qi Invades Spleen Western Conditions

A
  • Colitis
  • Gastroenteritis
  • Hyperthyroidism
  • Infectious hepatitis
  • Irritable Bowel Syndrome
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3
Q

Liver Qi Invades Spleen Complications

A

This syndrome does not involve blood complications as this is usually not seen in Liver Qi Invading Spleen. This syndrome involves a Liver Qi stagnation over-controlling Spleen resulting in a Spleen deficiency.

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4
Q

Liver Qi Invading Spleen Sn/Sx

A

Abdominal Distention and pain

Borborygmus (wind in the abdomen)

Diarrhea or loose stools (possibly with pain)

Flatulence

Irritability, Mental depression

Pain in the costal/hypochondriac regions

Poor appetite

Stool sometimes loose sometimes small and dry

Tongue: White, thin coat. Tongue coat is unremarkable as the damp is directed downward and not upward. Possibly red or pale sides.

Pulse: Wiry, thin. Weak on right, wiry on left

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5
Q

Patterns of Differentiation for Liver Qi Invading Spleen

A

Liver Qi Invading Spleen may occur with Liver Qi Invading Stomach

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6
Q

Liver Qi Invading Spleen Principle of Treatment

A
  • Soothe Liver
  • Invigorate Spleen
  • Harmonize LV and SP
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7
Q

Liver Qi Invading Spleen Herbal Formulas

A
  • Xiao Yao San (Rambling Powder)
  • Tong Xie Yao Fang (Important Formula for Painful Diarrhea)
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8
Q

Liver Qi Invading Spleen Point Prescription

Method?

A

LV3 (Taichong Great Rushing) Shu Stream, Earth Pt, Yuan Source, Heavenly Star; Spreads Liver Qi

LV13 (Zhangmen Completion Gate) Front Mu of SP, Meeting Pt of Zang; Harmonize LV and SP, Spreads Liver Qi, Invigorates Spleen

SP6 (Sanyinjiao Three Leg Yin) Spreads Liver Qi (diarrhea). Strengthens spleen (abd pain, borb.)

RN12 (Zhongwan Middle Cavity) Front Mu of ST, Meeting Pt of Fu; Invigorate SP and ST. Harmonize MJ.

ST25 (Tianshu Heaven’s Pivot) Front Mu of LI; Regulates Qi. Regulates SP and ST.

ST36 (Zusanli Three Leg Mile) Heavenly Star, Command Pt of Abdomen, He Sea, Earth, Sea of Water and Grain; Regulate SP & ST

ST37 (Shangjuxu Upper Great Void) Lower He Sea Pt of LI, Sea of Blood; Regulates SP and ST

Method: Reducing for points to harmonize the Liver (LV13, LV14, GB34, LV3) and reinforcing for points to tonify Spleen (SP6, RN6, RN12, ST25, ST36, ST37)

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9
Q

Liver Qi Invades Stomach Etiology

A
  1. When Liver Qi stagnates, Liver fails to promote smooth flow of Qi which affects the function of the Stomach.
  2. Mental depression or irritation
  3. Irregular food intake
  4. Overstrain or stress
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10
Q

Liver Qi Invades Stomach Western Conditions

A
  • Chronic gastritis
  • Cirrhosis of liver
  • Gastric or duodenal ulcer
  • Hepatitis
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11
Q

Liver Qi Invades Stomach General Sn/Sx

(Think of LV, ST, hormonal, sn/sx)

A

Liver:

  • Suffocating sensation in chest
  • Tendency to sigh
  • Melancholy, depression, anxiety
  • Irritability, sudden inappropriate anger

Stomach:

  • Epigastric pain (worse when emotionally upset)
  • Belching with acid regurgitation
  • Nausea, vomiting
  • Anorexia
  • Distension of epigastrium
  • Uncomfortable sensation in Stomach

In people with a uterus:

  • Irregular menses
  • Dysmenorrhea
  • Distension and pain in breasts before and during menses

Tongue: Scanty, white coat

Pulse: Wiry

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12
Q

What will you see if there are heat signs accompnay the Liver Qi Invades Stomach pattern?

A
  • Gnawing hunger
  • Bitter taste

Tongue: Red body, yellow coat

Pulse: Wiry, rapid

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13
Q

How can you differentiate Liver Qi Invades Stomach from other Stomach disorders?

A

Look for the presence of sn/sx of Liver Qi Stagnation such as irritiability, depression, suffocating sensation in chest, sighing, wiry pulse

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14
Q

Liver Qi Invades Stomach Principle of Treatment?

A
  • Soothe the Liver
  • Harmonize the Stomach
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15
Q

Liver Qi Invades Stomach Herbal Formula

A

Zuo Jin Wan - Left Metal Pill

  • Huang Lian - Coptis Rhizome (Cold, Bitter)
  • Wu Zhu Yu - Evodia Fruit (Hot slightly toxic, Bitter)
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16
Q

Liver Qi Invades Stomach Point Px

A

Primary Points:

LV3 - (Taichong - Great Rushing) Shu Stream, Earth, Yuan Source, Heavenly Star; Smooth flow of Liver Qi

LV13 - (Zhangmen - Completion Gate) Front Mu of SP, Influential Pt of Zang; Courses the Liver and rectifies qi.

LV14 - (Qimen - Cycle Gate) Front Mu of LV; Spreads Liver Qi, Good for acid reflux, benefits St

ST36 - (Zusanli - Leg Three Mile) He Sea, Earth, Heavenly Star, Command of Abdomen, Point of Sea of Water and Grain; Harmonizes Stomach

GB34 (Yanglingquan - Yang Mound Spring) He Sea, Earth, Inf. Pt. of Sinews, Heavenly Star, Lower He Sea of GB; Spread Liver Qi, Course damp and stagnation

Secondary Points:

SP6 - (Sanyinjiao - Three Yin Intersection) Spreads Liver Qi, Tonifies Sp and St

PC6 (Neiguan - Inner Pass) Luo Connecting, Confluent of Yin Wei; Spread Liver Qi, Harmonize ST

ST44 (Neiting - Inner Courtyard) Ying Spring, Water, Heavenly Star; Regulate Qi, Clear Stomach heat, Acid regurgitation

RN10 (Xiawan - Lower Cavity) Harmonize ST and regulate qi, Dispel food stagnation

RN12 (Zhongwan - Middle Cavity) Front Mu of ST, Meeting Point of Fu; Regulates ST Qi, Suppress rebellious qi

RN13 (Shangwan - Upper Cavity) Harmonize ST and regulate qi, Descend rebellion and alleviate vomiting

UB21 (Weishu - Stomach Shu) Harmonize ST, disperse stagnation

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17
Q

Liver Fire Invades Lungs Etiology

A
  1. Mental depression and anger –> obstruction of liver qi –> fire –> upward attacking of lung by fire
  2. Excessive consumption of hot and greasy food
  3. Prolonged Liver Qi Stagnation
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18
Q

Liver Fire Invades Lungs General Sn/Sx

A
  • Asthma/SOB
  • Bitter taste
  • Burning pain in costal and hypochondriac region
  • Constipation
  • Cough - paroxysmal
  • Dizziness
  • Headache
  • Irritability, quick temper
  • Red eyes and face
  • Restlessness
  • Scanty, dark urine
  • Yellow or blood tinged sputum, sticky

Tongue: red body, redder on sides, maybe swollen in front, thin white or yellow coating

Pulse: wiry and rapid, maybe slippery

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19
Q

Liver Fire Invades Lungs POT

A
  • Clear Liver fire
  • Harmonize Liver
  • Stimulate descending of Lung Qi
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20
Q

Liver Fire Invades Lungs Point Px

A

LV2 (Xingjian - Moving Between) Ying Spring, Fire Pt, Sedation; Drain Liver Fire

LV14 (Qimen - Cycle Gate) Front Mu LV, Exit Point; Calm Liver and disinhibit qi, Transform phlegm and disperse stasis

RN17 (Shanzhong - Chest Centre) Front Mu of PC, Point of Sea of Qi, Upper Energizer; Clear lungs, stimulate descending of Lung Qi

RN22 (Tiantu - Heavenly Prominence) Window of Heaven Pt; Stimulate descending of Lung Qi

LU7 (Lieque - Broken Sequence) Luo Connecting, Heavenly Star, Command of Head and Neck, Confluent Pt of Ren, Exit Point; Diffuse the lung, Descend Lung Qi

LI11 (Quchi - Pool at the Crook) Ghost Point, He Sea, Earth, Heavenly Star; Harmonize qi and blood, Clear pathogenic heat

21
Q

What are the three main functions of the Gallbladder?

A
  1. Stores and releases bile
  2. Controls judgment
  3. Controls Sinew (tendons) with Liver
22
Q

Why is the Gallbladder considered a curious organ as as well as a Yang organ?

A

The GB does not deal with food, drink or waste as do the other yang organs. It also does not communicate with the exterior of the body as do the other yang organs. It stores bile which is considered a refined substance and this makes imore similar to the Yin organs.

23
Q

Talk about GB function of storing and excreting bile. What happens if Liver Qi stagnates and bile does not flow smoothly?

A

FB receives bile from the Liver and stores it, releasing it when needed during digestion (same as in Western biomedicine).

Smooth flow of bile aids Stomach and Spleen digestive functions.

When Liver Qi stagnates and bile does not flow smoothly, digestive signs such as nausea and belching occur.

24
Q

What does it mean that Gallbladder controls judgment? What does it look like if someone has a deficient GB?

A

(Liver controls planning), Gall Bladder controls ability to make decisions. These two functions are interdependent.

Gall Bladder gives a person courage and initiative, i.e., courage to make decisions, act, make changes: positive and decisive action. A deficient Gall Bladder can result in indecision, timidity and easily becoming discouraged.

25
Gallbladder controls sinews along with Liver. What is the difference between the way these two organs affect the sinews (tendons)?
Wood element (Gall Bladder and Liver) control sinews. Liver nourishes tendons with Blood, Gall Bladder provides Qi to ensure correct movement and flexibility of tendons, correct muscle tightness. The influential point for tendons is Gall Bladder 34, i.e., on Gall Bladder channel.
26
What are the 4 common symptoms of GB disharmony?
* Bitter taste in mouth * Hypochondriac pain * Insomnia (fear of giong to bed at night) * Jaundice (3 yellow: eyes, skin, urine)
27
Damp-Heat in LV and GB Etiology
1. Long term overindulgence in alcohol, fats and sweets internally generates damp and heat. 2. Excessive feelings of anger over a long time lead to stagnation of Liver Qi which leads to heat 3. External pathogenic damp-heat invades SP/ST directly causing failure of T &T. This leads to damp-heat in LV/GB 4. Stagnation of Liver Qi transforms into heat. 5. Liver Qi may also invade SP, weakening SP T & T leading to damp stagnation in the Spleen. Heat from Liver combines with Damp from Spleen. 6. Spleen Qi or Yang Deficiency leads to damp stagnation which then transforms into heat. This can lead to Damp-Heat in LV and GB
28
Damp Heat in LV/GB Western Diseases
* Acute hepatitis * Acute pancratitis * Acute orchiditis * Cholecystitis * Cholelithiasis * Cirrhosis of Liver * Cervicitis * Vulvitis
29
Possible complications of Damp-Heat in LV/GB
If heat becomes extreme, Damp-Heat can transform into fire producing Liver Fire Flaring Up
30
Damp-Heat in LV and GB General Sn/Sx
* Abdominal distention * Abdominal masses * Alternating chills and fever (possibly) * Bitter taste in mouth * Dark and scanty urine * Distention and burning in hypochondrium * Fever * Nausea * Poor appetite * Vomiting sour and bitter fluid * "Yang Jaundice" - sclera and skin bright yellow
31
Damp Heat in LV/GB Tongue and Pulse
_Tongue:_ Slightly red to red body, Thick and sticky yellow coat _Pulse:_ Wiry (string taut) and rapid, or slippery and rapid
32
Damp-heat in LV/GB extra Sn/Sx relating to genitals
* Yellow vaginal discharge with foul smell * Pruritis vulvae * Pain, swelling and burning sensation in testicles
33
How do you differentiate Damp-Heat in SP/ST from Damp-Heat in LV/GB?
Generally there is no need to differentiate as Damp-Heat in SP/ST is often included as part of the syndrome of Damp-Heat in LV/GB... may be referred to as Damp-Heat in SP/ST steaming the LV/GB. Damp-Heat affecting SP/ST without LV/GB involvement can be differentiated by sweet taste in the mouth and slippery pulse but no bitter taste or wiry pulse. Damp- Heat affecting LV/GB without SP/ST involvement you will see the bitter taste, wiry pulse, distention and burning in hypochondrium and may see alternating chills and fever. You will never see alternating chills and fever with just SP/ST involvement.
34
Damp Heat in LV/GB POT
* Clear damp * Purge heat from LV and GB * Stimulate the smooth flow of Liver Qi
35
Damp-Heat in LV/GB Herbal Formulas
* *Long Dan Xie Gan Tang* (Dragon Gallbladder Decoction to drain the Liver) * *Dai Chai Hu Tang* (Major Bupleurum Decoction)
36
Damp-Heat in LV/GB Primary Point Px
**GB24** (Riyue - Sun and Moon) *Front Mu of GB*; Eliminates damp-heat from LV and GB **GB34** (Yanglingquan - Yang Mound Spring) *Inf Pt of Tendons, Lower He Sea of GB, He Sea, Earth, Heavenly Star*; Clears damp, cools heat GB24 and 34 with electricity can stop a gallstone attack. If in acute phase, get them on herbs, off rich food, hook them up to electro-acupuncture. Can get fever in very acute phase. **LV3** (Taichong - Great Rushing) *Shu Stream, Earth, Heavenly Star, Yuan Source*; Spreads LV Qi **LV14** (Qimen - Cycle Gate) *Front Mu of LV, Exit Pt;* Clears damp-heat from LV and GB, Promotes smooth flow of LV qi **RN12** (Zhongwan - Middle Cavity) *Front Mu of ST, Inf Pt of Fu*; Tonifies SP to resolve damp, Jaundice **DU9** (Zhiyang - Reaching Yang) Jaundice **SP9** (Yinlingquan - Yin Mound Spring) *He Sea, Water*; Regulates SP, Resolves dampness, Jaundice _Method:_ Reducing except for RN12
37
Damp Heat in LV/GB Secondary Point Px
**UB18** (Ganshu - Liver Shu) Dispels damp heat from LV **UB19** (Danshu - GB Shu) Dispels damp heat from GB, Good for nausea, difficult digestion, good for acute stage **UB20** (Pishu - Spleen Shu) Support SP to resolve damp **EX-LE-6** (Dannangxue Gallbladder Point) Cholecystitis, cholelithiasis. Stimulates the smooth flow of Liver Qi. Resolves Dampness and Clears heat. (Only used if tender on pressure-choose between this and GB34) **LI11** (Quchi - Pool at Crook) *Heavenly Star, Ghost Point, He Sea, Earth*; Clears damp, Courses pathogenic heat **SJ6** (Zhigou - Branch Ditch) *Jing River, Fire Pt*; Stimulates the smooth flow of Liver Qi and Clears Heat in the Shao Yang channels. **GB40** (Qiuxu - Mound of Ruins) Yuan Source; Spreads Liver Qi and clears GB damp-heat _Method:_ Reducing except for UB20
38
Deficient GB Heat (Disturbance of phlegm d/t stagnation of GB) Etiology
1. Stomach fails to harmonize, descend and transport 2. Emotional turmoil --\> qi stagnation --\> phlegm formation --\> phlegm-heat --\> internal disturbance 3. Gallbladder fails to dredge and purge
39
Deficient GB Heat (Phlegm Disturbance d/t GB Stagnation) Western Diseases
* Hypertension * Meniere's disease * Mental health problems: early stages of manic psychosis (later stage becomes Phlegm-Fire Disturbing Heart) * Menopausal syndrome
40
Complications of Deficient GB Heat
When phlegm and heat disturb GB they can also affect Heart and/or Liver creating: Phlegm Fire Disturbing Heart, Heart Fire Flaring Up, Liver Fire Flaring Up
41
Deficient GB Heat General Sn/Sx
* Annoyance at little things * Anxiety * Bitter taste in mouth * Blurry vision * Dizziness/Vertigo * Frequent sighing * Insomnia * Indecision, suspiciousness * Irritability, restlessness * Nausea/Vomiting * Palpitations * Suffocating sensation in chest * Timid, easily startled * Tinnitus
42
GB Deficient Heat Tongue and Pulse
_Tongue:_ * Tongue body is pale or normal * Yellow greasy, or thin, white coating _Pulse:_ * Wiry and slippery _or_ * Wiry and fine * may be rapid
43
Deficient GB Heat POT
* Clear heat * Transform phlegm * Harmonize Stomach * Calm Heart
44
Deficient GB Heat Formulas
* Wen Dan Tang (Warm the GB Decoction) * Huang Lian Wen Dan Tang
45
GB Deficient Heat (Disturbance of Phlegm d/t Stagnation of GB) Point PX
**GB40** (Qiuxu - Mound of Ruins) *Yuan Source*; Tonify GB, good effect on the mental aspects **UB48** (Yanggang - Yang's Key Link) Outer back shu of GB; Regulates GB, Clears damp-heat Reinforcing and moxa of GB40 and UB48 if no heat signs. **GB34** (Yanglingquan - Yang Mound Spring) *Heavenly Star, He Sea, Earth, Influential Pt of Tendons, Lower He Sea GB*; Eliminates phlegm fire from ST **ST40** (Fenglong - Abundant Bulge) Luo Connecting of ST; Resolves phlegm **UB19** (Danshu - GB Shu) Cools and drains heat from LV and GB, Calms ST **HT7** (Shenmen - Spirit Gate) *Yuan Source, He Sea, Earth*; Pacifies Heart and calms Shen **PC5** (Jianshi - Intermediate Messenger) Jing River, Metal; Transforms phlegm esp. from heart, Harmonizes ST, Calms Shen **PC6** (Neiguan - Inner Gate) *Luo Connecting, Confluent of Yin Linking*; Calms the Heart and Shen, Regulates ST/SP, Stops nausea and vomting Method: Sedate or Even method ? other than GB40 and UB48
46
Differentiate Severe Phlegm Fire Disturbs Heart from GB Deficient Fire
Severe Phlegm Fire Disturbs Heart: * Manic behaviour * Incoherent speech, rapid, abusive * Violent, alternating between extreme agitation and euphoria
47
Differentiate GB Deficient Heat from Hyperactivity of Heart Fire
_GB Deficient Heat_ * Dizziness, blurred vision * Evidence of phlegm * Nausea, vomiting Tongue: Greasy Pulse: Slippery Hyperactivity of Heart Fire * Tongue ulcers * Thirs, likes cold drinks * No phlegm signs Tongue: Red tip, papillae, yellow coat Pulse: Rapid, forceful
48
Differentiate GB Deficient Heat from Liver Fire Flaring Up
_GB Deficient Heat_ * Deficient heat with phlegm * No headaches * Dizziness, blurred vision Tongue: Greasy yellow coat Pulse: Slippery, wiry, may be rapid _Liver Fire Flaring Up_ * Excess fire (extreme heat) * Violent headaches * Red, swollen, painful eyes Tongue: Dry rough yellow coat Pulse: Wiry, rapid and forceful
49

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