Zang Fu Patterns: SP/ST Flashcards
1
Q
What are the two major functions of the spleen in TCM?
A
1) Transformation and transportation of food (Gu Qi) and fluids
2) Controlling blood - holding blood in blood vessels
2
Q
Talk about T & T of the pure part of food/water by the Spleen.
A
Food from the ST/SP in the middle jiao is sent up to the LU/HT in the upper jiao where it combines with Qing Qi (air) to form Zong Qi (chest qi). Zong Qi is catalyzed by Yuan Qi to form Zhen Qi (true qi). From Zhen Qi comes both Wei (defensive) and Ying (nutritive) Qi.
Gu Qi is also passed from the Lung to the Heart and transforms into blood with the help of Yuan Qi (original qi). Ying Qi plus Ye portion of Body Fluid forms Xue (blood).
Fluids from the ST/SP are sent to the upper jiao where they becomes Jin Ye. Part of it goes to the lungs for distribution to the skin.
3
Q
Talk about transformation and transportation of the impure fraction of food/water by the Spleen.
A
Impure or “turbid” fluids and solids are sent to the lower jiao, first to Xiao Chang (SI) then the Da Chang (LI) where solids are excreted as faeces. Finally the impure fluids are sent to Pang Guang (BL) to be excreted as urine.
4
Q
What happens if transformation and transportation by the Spleen (Pi) is impaired?
A
If the Pi function is deficient, there may be deficient Qi and Xue. There may also be an accumulation and stagnation of Jin Ye as Damp and Phlegm. SP/Pi is the main digestive organ so there may be a variety of GI problems such as poor appetite, bad digestion, loose stools, abdominal distention etc.
5
Q
After Shen the ________ energies of the body, Pi is considered since it is the foundation of ________ life.
A
Prenatal; postnatal
6
Q
The Spleen likes ________ and hates _______.
What can be impaired by excessive consumption of cold liquids?
A
Dryness; dampness
Spleen Yang
7
Q
What are the aspects of SP controlling Xue (blood)?
A
1) It holds blood in blood vessels. This is different from governing blood by the heart that is associated with circulation.
If SP Qi or especially SP Yang is deficient then Xue is not held in Xue Mai and it may leak out and lead to bleeding signs and hemorrhages such as melaena (dark, black, tarry faeces associated with upper GI bleeding), petechia, menorrhagia etc.
2) The SP also plays an important role in blood formation as mentioned in the T & T section. Gu Qi is sent to LU and then HT to form blood with the help of Yuan Qi. To tonify blood always tonify SP!
8
Q
What are the three main causes of bleeding in TCM?
A
1) Heat burning BV
2) SP failing to hold blood in BV
3) Blood Stasis
9
Q
How do you distinguish between heat burning BV and SP failing to hold blood in BV?
A
With heat the colour of the blood is bright and fresh red. It is more acute. Heat goes up therefore more bleeding in the upper body and a large amount.
With SP failure it is chronic, not acute, so the colour is more pale and thin, often there is poor nutrition. The amount may be large or small and seen mostly in the lower body. EG. Excessive menstruation, varicose veins, hemorrhoids etc.
10
Q
What vital substances are involved in the SP?
A
Qi and Yang
11
Q
What are the 3 most important Sn/Sx for SP disharmony?
A
- Poor appetite
- Abdominal distention/pain
- Loose stools
12
Q
What are other common Sn/Sx of SP disharmony?
A
Muscular weakness or atrophy, low energy (lassitude), overweight, too much phlegm, edema, damp retention, different types of bleeding (hemorrhage esp.), sometimes excessive appetitie if SP and LV are not harmonized
13
Q
What are the functions of the spleen in Western medicine?
A
The spleen acts primarily as a blood filter. It removes old and damaged red blood cells and recycles iron. It also holds about a cup of blood as reserve. As part of the mononuclear phagocyte system it metabolizes hemoglobin. The globin portion is broken down to constituent amino acids while the heme is transformed into bilirubin and removed by the liver.
The spleen synthesizes antibodies in its white pulp and removes antibody coated bacteria/blood cells by way of blood and lymph node circulation. The red pulp contains a reservoir of over half of the body’s monocytes.
Just as in TCM the spleen plays a role in blood formation. This is primarily true during the first 5 months of gestation where it can create red blood cells. After this and throughout the life cycle it retains the ability to produce lymphocytes and therefore remains a hematopoietic organ.
14
Q
The pancreas is also considered to be a part of the Pi or SP functional system in TCM. What is it’s role in Western medicine?
A
The pancreas is part of the digestive and endocrine system. As an endocrine gland it produces insulin, glucagon, somatostatin and pancreatic polypeptide. As a digestive organ it acts as an exocrine gland and secretes pancreatic juice containing bicarbonate as well as digestive enzymes. The enzymes assist the SI in digestion and absorption of nutrients.
15
Q
What are the other primary functions of the SP in TCM?
- Rules the…
- Holds up the …
- Opens into…
- Manifests in the…
- Houses…
A
- Rules the Muscles and Limbs
- Holds up the Organs (controls raising of Qi)
- Opens into the Mouth
- Manifests in the Lips
- Houses Thought, residence of Yi
16
Q
How does the SP rule the muscles and limbs?
A
Food Qi eventually goes to nourish all tissues in the body, transported throughout body by Spleen. Particularly directed to the muscles. Weak Spleen Qi: fatigue, muscles weak or even atrophied. Tonify Spleen in fatigue.
Fair amount of overlap between Muscles ruled by Pi and Tendons ruled by Gan.
17
Q
How does the SP hold up the Organs (control the raising of Qi)?
What are th main organs/tissues affected by sinking SP Qi?
A
The SP has a lifting effect along the midline of the body which ensures that organs stay in their proper place. When this raising or holding function is impaired and SP Qi sinks, prolapse can occur.
The prolapse occurs primarily in the lower body so uterus, anus, bladder, kidneys but also stomach.
SP also raises pure Food Qi to LU/HT.
18
Q
Talk about how the SP opens into the mouth and manifests in the lips.
A
If Pi Qi is abundant the mouth can differentiate the five flavours and the lips are red and moist. If Pi Qi is deficient there may be a loss of taste and the lips may be pale and dry. If there is heat in Pi and Wei the lips may be cracked and dry.
19
Q
SP houses thought (Yi)
A
Spleen is the residence of Yi or thought. It influences our capacity for thinking, studying, concentration, memorizing etc. Weak SP Qi results in poor concenctration and memory, dull thinking etc. Excessive mental work or worry can damage the SP.
20
Q
What are the three primary etiological factors for Spleen disharmonies?
A
- Mental factors: Excessive thinking, studying, brooding, obsessing etc. weakens SP
- Diet: This one is very important. Spleen likes foods that are warm (in temp and energy) eg. meat, ginger, pepper, orange peel and dry foods. Excessive consumption of cold foods will impair the spleen’s function of transformation/transportation and cause interior dampness and digestive problems. Also eating in a hurry, when stressed out, skipping meals or eating unhealthy foods.
- Exogenous pathogens: Exogenous Dampness can invade when people damp places, remain in wet clothing, wade in water or work in watery areas. Women are prone to the invasion of Exogenous Dampness during menses and after childbirth. Exterior dampness can combine with heat or cold.
21
Q
Spleen Qi Deficiency Etiology
A
- Improper diet: Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
- Mental strain: Excessive thinking over a long time. Discussing work or studies over lunch.
- Climate: prolonged exposure to damp weather or damp house
- Chronic disease: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
This pattern forms the basis for all other SP disharmonies. Very common in our culture.
22
Q
Spleen Qi Deficiency Western Dx
A
Chronic gastritis
Chronic enteritis
Chronic hepatitis
Cirrhosis of liver
GI dysfunciton
Peptic ulcer
23
Q
Spleen Qi Deficiency Sn/Sx
A
NO Appetite Spleen Qi weak
Abdominal distention after eating Impairment of Spleen’s transformation & transportation function
FATIGUE, lassitude, weakness of limbs Spleen transports food essences to the four limbs
Sallow complexion, disinclination to speak General Qi Deficiency
LOOSE STOOLS Impaired transformation/transportation function
If Deficient Spleen Qi leads to Internal Dampness:
Nausea Dampness obstructs epigastrium & prevents Stomach Qi from descending
Stuffiness of chest & epigastrium Dampness obstructs chest area
Feeling of heaviness in head and limbs (head in bag) Dampness interferes with the clear Yang in the head, obstructs muscles
Tongue: Pale or normal
Chronic: swollen sides in the MIDDLE SECTION only of the Tongue. Very severe cases have swollen sides with transverse cracks) Spleen area of Tongue
Coating: thin, white sticky, greasy (Deficient Spleen Qi
Dampness)
Pulse: Empty, weak (Deficiency)
24
Q
Spleen Qi Deficiency POT and Herb Px
A
POT:
Tonify Spleen Qi
Herbs:
Sheng Lin Bai Zhu San (Ginseng, Poria, Atractylodis Macrocephelae Powder)
25
SP Qi Xu Point Px
REN-12 (Zhong wan Middle Cavity) - *Front Mu of ST, Meeting Pt of Fu*; Tonifies Spleen Qi
ST-36 (Zu san li Three Leg Mile) - *He Sea/Earth Pt, Heavenly Star, Sea of Water and Grain, Command Pt of Abdomen;* Fortifies Spleen Qi and resolves Dampness
SP-3 (Tai bai Supreme White) - *Shu Stream/Earth Pt, Yuan Source point;* Tonifies Spleen Qi
SP-6 (San Yin jiao Three Yin Intersection); Tonifies Spleen Qi
BL-20 (Pi shu), BL-21 (Wei shu) - Tonifies Spleen Qi (esp. important combo Tonifies Spleen and Stomach Qi) where the Spleen and Stomach are both chronically Deficient.
Method:Tonification. Moxa is applicable.
26
Sinking of Zhong (Spleen) Qi Etiology
1. _Improper diet:_ Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
2. _Mental strain_: Excessive thinking over a long time. Discussing work or studies over lunch.
3. _Climate:_ prolonged exposure to damp weather or damp house
4. _Chronic disease_: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health); especially prolonged diarrhea or dysentery
5. _Overstrain_: more likely in people who stand for long periods
27
Sinking of Zhong (SP) Qi Western Dx
Chronic enteritis (inflammation of SI)
Chronic dysentery
Functional disorder of intestine
Prolapse of viscera (ST, KD)
28
Sinking of SP Qi Sn/Sx
SP Qi Xu Sn/Sx plus at least ONE sign of PROLAPSE: uterus, anus, stomach (gastroptosis), kidney (nephroptosis), vagina, heavy sensation in abdomen, e.g. of bearing down, frequent/urgent urination, hemorrhoids, varicose veins
Shortness of breath, unwillingness to speak, low voice, vertigo and blurred vision
Tongue: Pale
Pulse: Empty/weak; rootless at middle position (Guan) on right side
29
What things will make SP Qi Sinking sx (prolapse) worse? Better?
Epigastric sag and distention which becomes worse after eating (food has weight therefore more heaviness).
Worse after heavy work (consuming qi eg. shortness of breath)
Prolapses usually better with laying down (may complain of backache from ST or KI prolapse)
30
Sinking of Zhong (Spleen) Qi POT and Herb Px
_POT:_
Tonify SP Qi
Raise SP Qi
_Herb:_
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction - Ginseng and Astragalus)
31
Sinking of SP Qi Point Px
Du 20 (Bai hui Hundred Meetings) - *Point of Sea of Marrow;* Raises Qi (apply cones of moxa). Esp. good for prolapse of uterus
Ren 6 (Qi Hai - Sea of Qi) - Tonifies Qi, raises Qi: use for any prolapse
ST 21 (Liang men - Beam Gate) - Tonifies Stomach: use for prolapse of Stomach
Du 1 (Cheng Qiang - Long Strong) - *Luo Connecting Pt of GV;* Use for prolapse of anus
Method:Tonification. Moxa applicable
32
Spleen Yang Deficiency Etiology
1. _Improper diet:_ Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
2. _Mental strain_: Excessive thinking over a long time. Discussing work or studies over lunch.
3. _Climate:_ prolonged exposure to damp weather or damp house
4. _Chronic disease:_ tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
5. 1-4 all lead to SP Qi Xu ---\> SP Yang Xu
6. Kidney Yang Xu ---\> fail to promote earth ---\> SP Yang Xu
33
Spleen Yang Deficiency Western Diseases
Chronic gastritis
Gastric and duodenal ulcer
Functional disorder of ST/intestines
Chronic enteritis
Chronic hepatitis
Cirrhosis of Liver
Chronic nephritis
34
SP Yang Deficiency Sn/Sx
Lack of Appetite *SP Qi weak*
Abdominal distention after eating, General edema *Impaired Spleen function of transporting/transforming*
Bright white or sallow complexion Qi Deficiency
FATIQUE, Weakness of the four limbs *Deficient Spleen not sending food essences to limbs*
LOOSE STOOLS (often with undigested food) *Deficient Spleen Yang fails to transform digestate*
CHILLINESS - Cold LIMBS, abdominal pain relieved by warmth or pressing *Signs of Cold*
Difficult urination, Profuse dilute leucorrhea *Yang Deficiency*
Tongue: Pale, swollen, wet *Deficient Yang causes accumulation of untransformed fluids on Tongue.*
Pulse: Weak, slow, deep *Deficient Yang*
35
Spleen Yang Deficiency POT and Herb Px
_POT:_
Tonify and warm SP Yang
_Herbs:_
Li Zhong Tang (Decoction to Regulate the Middle)
36
Spleen Yang Deficiency Point Px
NOTE: If edema or Dampness is present, the following Points are SEDATED:
SP-9 (Yin ling quan - Yin Mound Spring) *He Sea/Water Pt*; Regulate SP and resolve dampness
REN-9 (Shui fen - Water Separation) Resolve Dampness in lower burner
ST-28 (Shui dao Water Passage) Regulate the lower jiao
BL-22 (San jiao shu) Regulates SP/ST, Enable Spleen to transform/transport fluids
Method: Tonification and Moxa
37
Spleen Unable to Control Blood Etiology
1. Improper diet: Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
2. Mental strain/Physical Strain: Excessive thinking over a long time. Discussing work or studies over lunch.
3. Climate: prolonged exposure to damp weather or damp house
4. Chronic disease: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
5. Spleen Qi Deficiency (caused by 1-4) ---\> Spleen unable to control blood
38
Spleen Unable to Control Blood Western Disease
Thrombocytopenic purpura
Allergic purpura
Aplastic anemia
Dysfunctional uterine bleeding
39
Spleen Unable to Control Blood Sn/Sx
Signs of Spleen Qi Deficiency (eg. sallow complexion, SOB, plus Signs of Bleeding and maybe signs of blood deficiency
Examples: Petechiae, ecchymoses (bleeding into the skin), blood in stool or urine, menorrhagia (excessive menstrual bleeding), metrorrhagia (abdnormal menstrual bleeding), metrostaxis (small but continuous hemorrhage from uterine lining), hematuria, hematohidrosis
Tongue: Pale (xu), white coating
Pulse: Thready, weak, fine - Deficient Blood
40
SP Unable to Control blood POT and Herb Px
POT: Supplement qi to stop bleeding
Herbs: Gui Pi Tang
41
Spleen Unable to Control Blood Pathology... Is this an excess or deficiency?
Spleen function of keeping Blood in the vessels is impaired: therefore bleeding occurs. Bleeding is of Deficiency kind rather than the Excess type of bleeding that occurs when there is Heat in the Blood.
42
SP Unable to Control Blood Pt Px
Same as for Spleen Qi Deficiency:
REN-12 (Zhong wan Middle Cavity) - *Front Mu of ST, Meeting Pt of Fu*; Tonifies Spleen Qi
ST-36 (Zu san li Three Leg Mile) - *He Sea/Earth Pt, Heavenly Star, Sea of Water and Grain, Command Pt of Abdomen*; Fortifies Spleen Qi and resolves Dampness
SP-3 (Tai bai Supreme White) - *Shu Stream/Earth Pt, Yuan Source point*; Tonifies Spleen Qi
SP-6 (San Yin jiao Three Yin Intersection); Tonifies Spleen Qi
BL-20 (Pi shu), BL-21 (Wei shu) - Tonifies Spleen Qi (esp. important combo Tonifies Spleen and Stomach Qi) where the Spleen and Stomach are both chronically Deficient.
plus:
SP-10 (Xue hai / Sea of Blood) - Strengthens Spleen function of controlling Blood & returns Blood to Vessels
BL-17 (Ge shu / Diaphragm Shu) *Meeting Point (Influential Pt) of Blood*; Tonifies Blood & stops bleeding, when needled (not with moxa)
SP-1 (Yin bai / Hidden White) *Jing Well/Wood Pt, Ghost Pt, Entry Pt from ST42*; with moxa cones to strengthen Spleen function of controlling Blood; stops uterine bleeding. Use moxa on this point to stop bleeding only of a Deficient nature (esp. uterine)
DU4 (Ming Men / Life Gate) Strengthen Yang Qi
KI7 (Fu Liu / Returning Current) *Jing River/Metal Pt/Mother*; Strengthen yang qi
Method: Tonification. Moxa is applicable
43
Damp-Cold Invading Spleen Etiology
Exposure to external Dampness (Cold/raw food/drink or climate, etc.) or from Deficient Spleen Qi or Deficient Spleen Yang ---\> Obstruction of Qi ---\> Disorder of SP/ST
1. _Improper diet_: Excessive cold and raw foods, irregular eating, too much or too little and not enough protei
2. _Mental Strain/Physical Strain_: Excessive thinking over a long time. Discussing work or studies over lunch.
3. _Climate_: prolonged exposure to damp weather or damp house
4. _Chronic disease_: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
5. Spleen Qi Xu from 1-4
6. Spleen Yang Xu from 5 or from Kidney Yang Xu
44
Damp-Cold Invading Spleen Western Disease
Chronic gastritis
Chronic enteritis
Chronic hepatitis
Cirrhosis of liver
Chronic nephritis
45
Damp-Cold Invading Spleen Pathology
Pathology: Cold or Damp will predominate
If Cold predominates, this pattern is commonly associated with the pattern of retention of fluid in Stomach due to Cold and with Deficient Spleen Yang.
If Dampness predominates, it can be Internal or External.
External Dampness is usually acute and of more sudden onset. It can be caused by too much Cold or raw food & drink as well as by damp climatological factors.
Internal Dampness gradually accumulates from Deficiency of Spleen Qi and Spleen Yang being unable to transform/transport Fluids. (This is a Deficiency pattern turning into Excess).
46
Damp-Cold Invading Spleen Sn/Sx
Loss of Appetite
Nausea (ST Qi Rebellion)
Stuffy and painful chest and epigastrium (Dampness obstructs and prevents normal movement of Qi, impairs T & T)
Cold feeling in epigastrium improved by warmth (Cold)
Heavy feeling in head (Damp prevents the clear Yang ascending to head)
Heavy limbs, lethargy, no taste (meaning they prefer heavy salt and sugar) or sweetish taste in mouth (Spleen Qi Xu)
Yellow eyes and skin (jaundice), itchy skin (pale yellow as bright yellow means damp heat)
Turbid secretions/excretions: white vaginal discharge, loose stool or diarrhea (Dampness tends to sink diarrhea downwards to the lower burner)
No thirst (Patient already excessively Damp, not burning BF)
Stickiness of eyes and fluid filled skin eruptions. May be retention or dribbling urine & edema (Dampness impairs fluid metabolism. Fluid goes to the skin instead of bladder.)
Tongue: Pale and puffy with thick white coating (Dampness)
Pulse: slippery, slow (Dampness and Cold)
47
Damp-Cold Invading Spleen POT and Herb
POT: Dry dampness to strengthen Spleen
Herbs: Wei ling tang (Calm the ST and Poria Decoction)
Wu Ling San (5 Ingredient Decoction with Poria)
48
Damp-Cold Invading Spleen Point Px
SP-9 (Yin ling quan / Yin Mound Spring) *He Sea/Water Pt:* Resolves Dampness from Lower Burner
SP-6 (San Yin jiao / Three Yin Intersection); Resolves Dampness
REN6 (Qi Hai / Sea of Qi) Strengthens qi so as to retain fluids. Invigorates Qi circulation to disperse Damp.
REN-12 (Zhong Wan / Middle Cavity) *Front Mu of ST, Meeting Pt of Fu;* Tonifies Spleen to resolve Dampness
SP-3 (Tai bai / Supreme White) *Shu Stream/Earth Pt; Yuan Source Pt*; Resolves Dampness
ST-8 (Tou wei / Head Corner) *Meeting Pt for all Arm Yang Sinew Channels;* Resolves Dampness from head; particularly good for HA or heavy head from Dampness
ST25 (Tian Shu / Heaven's Pivot) *Front Mu of LI;* Regulates Qi of ST and intestines, when used together with RN12 it invigorates SP and reduces Damp
ST37 (Shang Ju Xu / Upper Great Void) *Lower He Sea of LI;* Regulates Qi of ST and intestines, invigorates SP and reduces damp.
Method: Sedation or neutral (even) method
49
Damp-Heat Accumulates in SP Etiology
Overlaps with the pattern Damp-Heat in Large Intestine or if bile flow is Obstructed, as Damp-Heat in Liver and Gallbladder.
1. Invasion of exogenous pathogenic damp-heat ---\> obstructs SP/ST ---\> damp-heat stagnates in MJ ---\> affects LV/GB
2. Indulgence in greasy and sweet food or alcohol ---\> produce damp heat internally
50
SP Damp-Heat Invasion Pathology
Distinguish between predominance of Damp or of Heat
Subdivided into predominance of Damp or of Heat
Damp predominating: no thirst or thirst without desire to drink not particularly rapid Pulse, not very red Tongue body.
Heat predominating: thirst, rapid Pulse, red Tongue body.
51
SP Invasion by Damp-Heat Pathology
Distinguish between External or Internal
Subdivided into External Damp-Heat or Internal Damp-Heat
External Damp-Heat; usually acute & of sudden onset: arises from exposure to hot, humid climate or from contaminated food.
Internal Damp-Heat usual chronic, gradual onset; arises from excess consumption of greasy foods & alcohol etc. over long time.
52
SP Invasion by Damp Heat Pathology
Distinguish between whether bile flow obstructed or not
Subdivided into whether bile flow Obstructed or not
If bile flow is not obstructed the signs and treatment are similar to those of Blazing ST Fire i.e. burning pain, vomiting undigested or sour food, bleeding gums, foul breath, constipation. Treat with ST44, RN12, LV3, ST21.
Bile flow Obstructed: Signs are similar to Damp-Heat in Liv & GB i.e. jaundice, bitter taste in mouth. Tx as for the latter. (Common disease patterns would include hepatitis, cholecystitis & cirrhosis) Tx: GB26, RN6, SP6, SP9, RN3, LV5
53
Why is this an unusual pattern?
Signs of Heat are not usually associated with the Spleen and some texts do not include this pattern. Patterns of hepatitis, cholecystitis and cirrhosis are of course generally included under Damp-heat in LV/GB.
54
SP Damp-Heat Invasion Western Diseases
Acute or chronic gastroenteritis
Acute hepatitis
Cholecysitis
Cirrhosis
55
SP Damp Heat Invasion Sn/Sx
No Appetite; General lethargy - *Damp depressing SP*
Feeling of heaviness; Stuffiness/distention of epigastrium & lower abdomen - *Damp accumulating and obstructing flow of Qi*
Thirst without desire to drink or desire to drink small sips - *Damp or if there is moderate thirst that would be more Heat*
Nausea, vomiting, abdominal pain - *more of this if bile flow not obstructed*
Loose stool with offensive odor; Burning sensation of anus, Low grade fever or rising and falling fever - *Heat signs*
Scanty, dark yellow urine - *Damp accumulating and obstructing flow of Qi, Heat making it dark yellow, if less heat then lighter*
More severe jaundice than with Damp-Cold
Tongue: sticky, yellow coating, maybe slightly red body
Pulse: slippery, soft, rapid
56
SP Damp Heat Invasion POT and Herbs
POT: Reduce/clear heat and resolve dampness
Herbs: Gan Luo Xiao Du Dan (Sweet Dew Special Pill to Eliminate Toxins)
57
SP Damp Heat Invasion Point Px
SP-9 (Yinlingquan / Yin Mound Spring) *He Sea/Water Pt*
SP6 (SanYinjiao / Three Yin Intersection) Resolve Dampness and drain Damp-Heat from lower burner
DU-9 (ZhiYang / Extremity of Yang) Resolves Damp-Heat
LI-11 (Quchi Pool at the Crook) *He Sea/Earth Pt, Ghost Pt, Heavenly Star Pt*; Clears Heat, resolves Dampness
BL-20 (Pishu / Spleen Shu) Resolves Dampness
GB-34 (Yanglingquan / Yang Mound Spring) *Meeting Pt of Sinews, Lower He Sea Pt of GB, Heavenly Star Pt*; Resolves Damp-Heat
Method: sedation, no moxa
58
What are the major functions of the stomach in TCM?
1. Rotting and ripening of food
2. Transportation of food essences
3. Descending of Qi
4. Origin of Fluids
59
Stomach (Wei) is the Sea of ______ and _____ or the Sea of ______ and \_\_\_\_\_\_
Sea of Grains and Water
Sea of Food and Fluid
60
Describe the Wei function of rotting and ripening of food
1. Stomach transforms the food that we drink and ingest. "Rotting and ripening" is the process of fermentation which prepares the way for the spleen to extract nutrients or the refined essence from food.
2. After the refined part of food and fluid has been extracted by the spleen, the stomach passes the remainder on to the small intestine (Xiao Chang) for further separation and absorption.
61
Describe the Stomach (Wei) function of transportation of food essences. What happens in cases of strong or deficient Wei Qi?
Together with the Spleen the Stomach controls the transportation of the food essence to the whole body including the limbs.
Strong Stomach Qi = Strong Energy
Deficient Stomach Qi = weak food essences, not enough nutrients and also Stomach will not have the energy to transport them to the whole body hence fatigue and weak limbs
62
How does the Stomach affect the tongue coating?
Tongue coating or "fur" is formed by turbid dampness that is a byproduct of the stomach's rotting and ripening.
Thin white coating on = Stomach functioning properly
No coating or peeled = Stomach digestive function is impaired, Stomach Qi and possibly Yin are damaged
63
Talk about how the Stomach controls the descending of Qi.
The stomach sends the transformed food down to the Small Intestine (Xiao Chang) for further separation. Therefore in health Stomach Qi moves downward. If ST qi fails to descend, food can stagnate in the ST and cause feelings of fullness/distention, sour regurgitation, belching, hiccup, nausea and vomiting.
64
How/why is the Stomach the origin of fluids?
1. The stomach needs plenty of fluids in order to perform its rotting and ripening function
2. Fluids themselves are actually derived from ingested food and fluids
* i) Stomach ensures that part of food and drink goes to form essences (extracted by the SP)
* ii) Other part of food and fluids is extracted to form body fluids
65
The stomach likes ________ and dislikes \_\_\_\_\_\_\_\_
What happens if ST fluids are deficient?
wetness; dryness
Deficient Stomach Fluids (Deficient Stomach Yin) leads to poor digestion, thirst, dry, cracked tongue
66
What are some causes of deficient ST fluids?
1. Eating large meals late at night
2. Deficiency of Kidney Yin from long term loss of fluids
67
What essences relate to the ST?
Qi, Yin, Yang
68
Does Food Retention belongs to yin or yang xu?
It can relate to either.
69
Stomach = _____ Earth
Spleen = ______ Earth
Stomach Qi \_\_\_\_\_\_\_
Spleen Qi \_\_\_\_\_\_\_
Yang; Yin
descends; ascends
70
What happens if the Stomach is too dry?
Spleen too wet?
Stomach qi cannot descend and food cannot be moved down to the Small Intestine (Xiao Chang)
If the Spleen is too wet/damp, Spleen Qi cannot ascend, food and fluids cannot be transformed.
71
Stomach easily suffers from \_\_\_\_\_\_
Spleen easily suffers from \_\_\_\_\_\_
Excess;
Deficiency
72
Stomach is prone to \_\_\_\_\_
Spleen is prone to \_\_\_\_\_
Heat;
Cold (produces dampness)
73
Stomach more likely to suffer from Deficiency of \_\_\_\_
Spleen more likely to suffer from Deficiency of \_\_\_\_\_
Yin
Yang
74
Stomach Yin Deficiency Etiology
1. Prolonged Stomach diseases
2. Consumption of Yin by febrile disease
3. Indulgence in hot and dry food/drugs (antibiotics or diuretics)
4. Irregular diet and eating habits: eating too late at night, too quickly, worrying while eating, hurrying back to work
5. Emotional frustration ---? Fire
6. 1-5 all deplete Stomach Qi and eventually damage Stomach Yin leading to failure of nourishment and upflow of Stomach Qi
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Stomach Yin Xu Western Diseases
Atrophic gastritis
Diabetes mellitus
Febrile disease at late stage
Gastric neurosis
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Stomach Yin Xu Pathology
Signs of deficient yin, for exampe constipation, thin rapid pulse, red tongue with no coat, are accompanied by signs of reduced Jin Ye in Wei, and in the mouth and lips which are ruled by Pi. Lack of appetite is a sign of Deficient Wei and Pi.
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Stomach Yin Xu Sn/Sx
* Dull epigastric pain, no appetite, feeling of fullness/distention after eating; *Stomach Deficient*
* Fever or feeling warm in PM; *Yin Xu*
* DRY Mouth and throat, especially in afternoon, constipation with dry stools; *Signs of dryness, ST origin of fluids*
* Hiccups, vomiting*; Stomach Qi fails to descend, Rebellious Stomach Qi*
* Tongue: Red and peeled in centre or coating without root;*Yin Xu Stomach*
* Pulse: Floating, empty in right middle; thready and rapid;*Yin Xu Stomach*
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Stomach Yin Deficiency POT and Herbs
POT: Nourish Stomach Yin and fluids
Herbs: Yang Wei Tang (Nourish the Stomach Decoction)
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Stomach Yin Deficiency Point Px
REN-12 (Zhong wan - Middle Cavity) *Front Mu of Stomach, Meeting Point of Fu*; Tonifies Stomach Yin
ST-36 (Zu san li - Three Leg Mile) *He Sea/Earth Pt, Heavenly Star, Sea of Water and Grain; Command Pt of Abdomen*; Tonifies Stomach Qi and Stomach Yin
SP-6 (San yin jiao - Three Yin Intersection)Tonifies Stomach Yin and nourishes Fluids
SP-3 (Tai bai - Supreme White) *Shu Stream/Earth Pt, Yuan Source*; Nourishes Fluids
Method: Tonification. No moxa
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Retention of Food in Stomach Etiology
1. Irregular eating, eating too fast, standing while eating
2. Emotions: worrying while eating
3. Overeating
4. Eating of food that is difficult to digest
5. 1-4 ---\> Indigestion ---\> Qi Stagnation
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Retention of Food in Stomach Pathology
Wei Qi is obstructed and the Wei functions of receiving, storing and digesting food are impaired, with loss of appetite, distention and pain in epigastric regions. Retained food may become rotten so that if Wei Qi rebels there may be foul belching or sour regurgitation. Stool becomes foul and movement of stool may be impaired with diarrhea or constipation depending on the situation. The slippery pulse and greasy tongue reflect retention of Phlegm and Damp.
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Retention of Food in Stomach Western Diseases
Indigestion
Acute Gastritis
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Retention of Food Sn/Sx
* Loss of appetite, fullness and distention of epigastrium (relieved by vomiting); *Food obstruction in Stomach prevents Stomach Qi from descending*
* Foul belching and sour regurgitation, nausea, vomiting; *Fermented food in Stomach*
* Diarrhea with foul stool or constipation; *Qi stagnation causing foul stool*
* Tongue: Thick greasy coat (white or yellow); *Excess Condition*
* Pulse: Full and slippery; *Heat and Food Retention*
* Rare symptom: Insomnia; *Food retention in Stomach burner prevents heart Qi from descending, disturbs Shen*
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What type of pattern is Stomach Food Retention?
Interior Excess Pattern (may be hot or cold)
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Stomach Food Retention POT and Herbs
**POT:**
Invigorate middle jiao to aid digstion
Remove retention of food
Stimulate descending function of Stomach
**Herbs:** Bao He Wan
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Stomach Food Retention Point Px
REN-13 (Shang wan - Upper Cavity) Subdues rebellious Stomach Qi
REN-10 (Xia wan Lower Cavity) Stimulates descending of Stomach Qi
ST-21 (Liang men - Beam Gate) Stimulates descending of Stomach
ST-44 (Nei ting Inner Courtyard) *Ying Spring/Water Pt, Heavenly Star;* Resolves stagnant food and clears Heat
ST-45 (Li dui - Strict Exchange) *Jing Well/Metal*; Resolves stagnant food & calms mind in case of insomnia
SP-4 (Gong sun Grandfather Grandson) *Luo Connecting, Confluent of Chong;* Resolves stagnant food
PC-6 (Nei guan - Inner Pass) *Luo Connecting, Confluent of Yin We*i; Stimulates descending of Stomach Qi
Method: Reducing
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Cold Invasion of Stomach Etiology
This is an interior EXCESS condition and requires different points, especially to dispel excess cold in acute conditions.
1. Exposure of gastric region to cold
2. Excess intake of cold food
3. Constitutional deficiency of Stomach Yang complicated by invasion of exogenous pathogenic cold
4. 1-3 ---\> Retention of cold in ST
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Cold Invasion of Stomach Western Diseases
Acute gastritis
Gastric and duodenal ulcer
Pyloric obstruction
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Cold Invasion of Stomach (may have retained fluid) Sn/Sx
Epigastric pain which is continuous in mild cases and shows contracture and megalgia in severe cases and which is aggravated by cold and relieved by warmth
If... Severe epigastric/abdominal pain with vomiting of clear fluid. Then...*Excess condition of Stomach
Cold; Rebellion of Wei Qi upwards results in vomiting of clear fluid*
Splashing/gurgling sound in stomach*; movement of retained fluid*
Tongue: Thick white coat *Excess condition*
Pulse: Deep, slow, and TIGHT Excess condition
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Cold Invasion of Stomach POT
POT: Expel Cold, warm the Stomach
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Stomach Cold Invasion Point Px
ST-21 (Liang men Beam Gate) Expels Stomach cold if moxa used after needles
SP-4 (Gong sun - Grandfather Grandson) *Luo Connecting Pt, Confluent of Chong Mai coupled with PC6 of Yin Wei Mai;* Expels Stomach cold, clears obstruction in Stomach
REN-13 (Shang wan Upper Cavity) Stimulates descending of Stomach Qi
ST-34 (Liang qiu Beam Hill) Xi Cleft point: for acute painful patterns; Stops pain and clears obstructions from Stomach
Method:Sedation. Moxa applicable with needles.
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Cold in Stomach (Retention of Fluid and/or Qi Xu) Etiology
1. Exposure of gastric region to cold
2. Excess intake of cold food
3. Constitutional deficiency of ST yang complicated by invasion of exogenous pathogenic cold
4. 1-3 ---\> Retention of cold in ST
2. Dietary: faulty nourishment, lack of protein in diet accompanied by excessive consumption of cold foods and beverages, salads, ice water and ice cream.
3. Result of prolonged illness which damages Spleen and Stomach Yang or any other cause of Stomach and Spleen Qi Deficiency, in conjunction with dietary irregularities
3. Invasion of Exterior Cold
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Cold in ST (Xu) Western Disease
Chronic gastritis
Gastric and duodenal ulcer
Pyloric obstruction
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Cold in ST (Retention of Fluid and/or Qi Xu) Sn/Sx
Discomfort in the epigastrium: Worse after bowel movements, aggravated by cold, continuous in mild cases *Deficient type pain. Stomach and Large Intestine related. Accumulation of cold in Wei results in stagnation of Qi and thus pain.*
No thirst: *Cold injures Wei Yang*
Pain better after eating, or with massage or with warmth. No appetite; *Deficient Cold condition. Stomach Deficient*
Vomiting of clear fluid, gurgling or splashing sounds in epigastric region: *Retained fluid due to Cold affecting Wei Yang and Pi Yang (unable to transform and transport), Rebellion of Wei Qi upwards*
Prefers warm drinks & foods, Loose stools, Lack of thirst, Cold limbs, Fatigue, Weakness; *Internal Empty Cold (Yang of Spleen Deficient)*
Tongue: Pale, swollen *Deficient Yang;* White and slippery coating; *Cold and retained fluid*
Pulse: Deep, slow, weak, ESP Stomach position *Internal Cold*
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Cold in Stomach (Qi Xu and/or retained fluid) POT and Herbs
POT: Tonify and warm Stomach and Spleen Yang
Warm and strengthen Middle Jiao to disperse Cold
Herbs: Wen Wei San Han Xiao Shi
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Cold in Stomach (Xu of Qi and/or Retained Fluid) Point Px
ST-36 (Zu san li Three Leg Mile) *He Sea/Earth Pt, Lower He Sea Pt of ST; Command Pt of Abdomen, Sea of Water and Grain*;Tonifies Stomach Qi, Regulate Wei Qi, aid gastralgia and vomiting
ST21 (Liang Men Beam Gate) Regulate Wei Qi, aid in gastralgia and vomiting, esp. in combination with ST36
REN 12 (Zhong wan Middle Cavity) *Front Mu of Stomach, Meeting Pt of Fu;* Tonifies Stomach and Spleen Qi
BL-20 (Pi shu) Tonifies Spleen Qi
BL-21 (Wei shu) Tonifies Stomach Qi
RN12, BL20 - combination of Mu and Shu points for Wei can regulate Wei Qi, warm the middle jiao and disperse cold
REN 6 (Qi hai Sea of Qi) Tonifies Qi. Moxa ideal. Combined with RN12 it warms and invigorates Qi and Yang, disperses cold
Method:Tonification. Moxa essential.
RN6
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Stomach Fire (Phlegm Fire) Etiology
1. Excessive consumption of hot energy foods and smoking.
2. If Phlegm present, this can be caused by excessive consumption of hot and greasy foods (e.g. deep fried foods).
3. Emotional frustration ---\> depression of Qi
4. Invasion of pathogenic heat
5. 1-4 ---\> fire/retention of heat in stomach ---\> burns body fluids and stagnates qi and blood
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Stomach Fire (Phlegm Fire) Western Diseases
Acute gastritis
Diabetes mellitus
Periodontitis
Ulcerations of oral cavity
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Stomach Fire (Phlegm Fire) Sn/Sx
Burning Sensation/Pain in Epigastric Area *- Excess Heat in Stomach*
Nausea, Vomiting soon after eating, Sour regurgitation - *Excess Heat interferes with Stomach Qi descending*
Halitosis - *Excess Heat in Stomach*
Strong Thirst for Cold Drinks, Constipation - *Stomach Fire burns fluids (less if Phlegm present)*
Constant hunger, Gum swelling, pain & bleeding - *Excess Heat in Stomach. Heat rises in Stomach channel (Wei Jing Luo) and causes Blood to extravasate*
Tongue: Red, Thick Yellow and Dry Coat (sticky if Phlegm present, or yellow prickles inside midline crack)
Pulse: Full (flooding), Rapid (slippery if Phlegm)
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Stomach Fire (Phlegm Fire) POT and Herbs
_POT:_
Clear Stomach heat/fire
Stimulate Stomach descending function
_Herbs:_
Qing Wei San (Clear the Stomach Powder)
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Stomach Fire (Phlegm Fire) Point Px
ST-21 (Liang men Beam Gate) Clears Stomach Heat; makes Stomach Qi descend, Regulates Wei and Pi and used for epigastric pain
REN-13 (Shang wan Upper Venter) Subdues rebellious Stomach Qi (vomiting and epigastric pain)
ST-44 (Nei ting Inner Courtyard) *Ying Spring/Water Pt;* Clears Stomach Heat, Excess and pain
ST-45 (Li dui Severe Mouth) *Jing Well/Metal Pt*; Clears Stomach Heat, calms Mind
SP-6 (San yin jiao Three Yin Crossing) Nourishes fluids & calms Mind
REN-12 (Zhong wan Middle Cavity) Clears Stomach Heat, regulate Rebelliuos Wei Qi
PER-6 (Nei guan Inner Pass) Subdues rebellious Stomach Qi, calms Shen
LV3 (Tai Chong Great Surge) Pacify Liver and Liver Fire if present
Method: Reducing method
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Stomach Blood Stagnation Etiology
May be a chronic condition.
May be associated with Stomach Fire, Liver Qi invading Stomach or Retention of Food. May be caused by the above patterns or by long-standing Stagnation of Liver Qi from long term emotional problems involving anger and frustration.
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Stomach Blood Stagnation Western Diseases
Acute or periodic perforation of peptic ulcers
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Stomach Blood Stagnation Sn/Sx
* Stabbing Pain in Epigastrium (Intense, fixed pain, worse with heat and pressure) - *Stasis of Blood, Excess condition*
* Pain AFTER eating - *Excess condition*
* Vomiting of Dark Blood, Blood in the stools - *Stasis of Blood, Stomach related to Large Intestine*
* Tongue: Purple with purple spots (maybe just in center, Stomach position) *Stasis of Blood* Possibly a thin yellow coat if there is heat
* Pulse: Wiry or choppy
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Stomach Blood Stagnation POT
Remove stasis
Stimulate descending of Stomach Qi
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Stomach Blood Stagnation Point Px
REN-10 (Xia wan Lower Venter) Stimulates descending of Stomach Qi
ST21 (Liang men Beam Gate) Removes obstructions
ST34 (Liang qiu Beam Hill) XI Cleft point: moves Qi and Blood in channel, Acute issues of ST and chest
SP 10 (Xue hai Sea of Blood) Revives Blood, removes Stagnation
BL-17 (Ge shu Diaphragm Shu) Removes Stasis, revives Blood (needle only)
BL-18 (Gan shu Liver Shu) Removes stagnation of Liver Blood
Method: Sedation. No moxa.
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Rebellious Stomach Qi Sn/Sx
Nausea, belching, hiccup, vomiting *Stomach Qi fails to descend*
Tongue: normal
Pulse: wiry or tight in Stomach position
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Rebellious Stomach Qi POT
Subdue rebellious qi
Stimulate descending of ST qi
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Rebellious ST Qi Pt Px
REN-13 (Shang wan Upper Cavity) When Stomach Qi fails to descend
REN-10 (Xia wan Lower Cavity) When Stomach Qi fails to descend
PER-6 (Nei guan Inner Pass) *Luo Connecting, Command pt, Confluent with Yin Wei Mai coupled with SP4;* Stimulate descending of Stomach Qi
SP-4 (Gongsun Grandson) *Luo Connecting Pt, Confluent with Chong Mai*; Stimulate descending of Stomach Qi
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Stomach Qi Xu Etiology/Pathology
Diet lacking in nourishment/protein, or under-eating.
Aftermath of chronic disease that weakens the Qi.
ANALYSIS: The Stomach begins the Qi production process. Food enters the Stomach and the Spleen extracts the pure essences which are sent onwards as Food Qi. If the Stomach is weak, Qi will be Deficient and other Organs may become affected (especially the Spleen, which is closely interrelated)
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Stomach Qi Xu Sn/Sx
Epigastric Discomfort *Deficient Stomach Qi fails to descend.*
Mild pain *Deficiency*
Lack of appetite, lack of taste, loose stools *Spleen Qi affected by Stomach Qi Deficiency*
Fatigue Especially in the Morning *7-9AM is Stomach time on Horary cycle*
Weak limbs *Food Essences not transported to the limbs*
Tongue: Pale *Deficiency of Qi*
Pulse: Empty Pulse, Esp. Stomach position *Deficiency of Qi*
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Stomach Qi Xu POT
Tonify ST Qi
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ST Qi Xu PT Px
ST-36 (Zusanli Three Leg Mile) Moxa especially effective
REN-12 (Zhongwan Middle Cavity) *Front Mu of ST, Meeting of Fu;* Tonifies Qi of Stomach and Spleen
BL-21 (Weishu) *Back Shu point of Stomach*: moxa useful. Tonifies Stomach Qi
REN-6 (Qihai) "Sea of Qi" especially good if condition is chronic and accompanied by loose stools
Needling Method: Tonify. Moxa is applicable.
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