Bioclock Chat

Bioclock chat

There are 2 according to meridian circulation, which is what we learn in the advanced acu classes – that’s what you use for acupuncture. However, when using/treating with herbs, use the Zangfu clock – 4 sections of the day.

Insomnia – treat the yangming organs. Our wei qi is circulating 25 times around the outside of the body during the day and 25 times internally at night. If the wei qi doesn’t enter the internal area, there’s not a lot of sleep!

Liver and Spring

“Morning is related to the spring phase.”

--Ling Shu 44

“In the spring the wind comes frmt eh east. Illness then occurs in the Liver channel.”

--5 Truths from the Golden Chamber

Case 4 – slide 15

Restlessness for 2 years and depressed about son’s death. This is the emotional aspect – Liver. Note that she feels better after 3pm.

Initially: Liv GB qi stagnation with phlegm heat, Chai Qin Wen Dan Tang, but no change after 6 weeks. Can be 1) not the right formula or 2) insufficient dosage strength. Since there is some improvement the doc keeps the formula, but adds a couple of herbs and the patient gets better. These are metal herbs – strengthening metal to cut the wood. Cuts back the over-stretching wood to solve the stagnation.

Zhe Bei Mu – 10 g

Transforms Phlegm Heat and Stops cough
One of the best herbs for stopping coughs due to exterior pathogen or interior disharmony. For productive cough due to acute Lung Heat pattern

Clears Heat and Disperses Nodules
For neck swellings, scrofula, sores, carbuncles, goiter, and breast and lung abscesses. For sores and abscesses that have not ulcerated especially in the neck and breast area.

Xing Ren

Stops cough, calms wheezing
Note that it does not resolve phlegm...but does treat various types of cough disorders, Exterior wind-cold, Exterior wind-heat, Phlegm heat, Dryness

Moistens intestines, unblocks bowels
Very useful herb for treating constipationdue to dryness

Morning is related to the Liver organ, that’s why her sx get worse in the morning. Liver Qi stretches out in the morning. If there is a blockage (stagnation), there is discomfort because the Liver Qi cannot stretch. Kind of like wearing tight shoes. 

Heart and Summer

“Midday is related to the Summer phase.”

--Ling Shu 44

In the summer the wind arises from the southern…affects the heart…

--5 Truths from the Golden Chamber

Case 5

Male 36

The patient has paroxysmal dyspnea every summer about several years. He had the dyspnea onset every midday and midnight. No other symtoms

T- red tongue body, yellow coating

Which organ? Heart. Treating a cough isn’t just lung. Breathing can be related to heart and Kidney too. Mid-day and summer are both related to the Heart. The Heart gets stronger then – heart qi can float upward causing this dyspnea. Why midnight? The element here is water….Kidney. Water is weak and cannot control fire of the Heart. Kidney cannot grasp, in this case cannot grasp the Heart fire.

Diagnosis is excess Heart fire, disharmony with Kidney.

Doc uses Jiao Tai Wan which treats insomnia due to heart/kidney problem. Huang Lian and Rou Gui are the 2 key here – builds communication between fire and water. Xing ren treats the symptom – dyspnea. Liu Yi San clears summer heat (this actually 2 ingredients combined together so in China it’s treated as a single herb) and is combined with Pei Lan which also treats summer heat. This is treating an organ of summer, not literal summer heat.

After taking, had no problem for 2 years after taking the formula. Remember that all 5 zang can influence the system.

The whole formula is:

Jiao Tai Wan modi

For test: don’t need to know the ingredients! We need to learn the theory that the doctor is using to treat the problem.

Dusk and Autumn and the Lung

“Dusk is related to the Autumn phase.”

--Ling shu 4

The northern winds of winter will affect the kidneys …

--5 Truths from the Golden Chamber

Case 6

–Male 60

–The patient has dizziness and can’t stand every afternoon at 4~5 p.m. about 2 weeks

–Dry stools, once defecation per day.

–T- red tongue body with thin yellow coating

–P-with strength

Is this due to Spleen qi xu? No. Not enough deficiency sx. Not enough phlegm signs either. Look at the formula structure below:

Cheng Qi Tang

Treating the yangming LI and yangming ST. Remember that according to Zangfu, this is when metal is getting stronger. Metal qi is growing with support of the environment. Dizzy at 4-5pm, dry stool, defecate once per day.

Patient has an excess and stagnation in the yangming – excess heat and turbidity here. When the metal phase hits and the heat of the environment is at it’s height makes it worse. This steams the turbidity upward and doesn’t support the downward energy of the LI. . . also makes the patient dizzy.

OK, for boards you need to know these, what’s in them and when they are in other formulas.

Da cheng qi tang – the big one. Da huang, hou po, zhi shi, mang xiao. Clears pi, man, shi

Xiao Cheng Qi Tang – da huang, hou po, zhi shi. Focuses on qi stagnation.

Tiao Wei Cheng Qi Tang – da huang, mang xiao, and gan cao. More dryness and heat.

Winter and Midnight and Kidneys

Midnight is related to the Winter phase.

--Ling shu 4

The northern winds of winter will affect the kidneys …

--5 Truths from the Golden Chamber

•Case 7

–Female 31

–The patient has gastric pain for 10 years. It happened every midnight from 11:30 p.m~12:00 a.m. The pain is not severe but affects her sleep. The western medicine diagnose is chronic gastritis.

–She had operation left ovary cyst ectomy last year. Lumber region pain, infertility, normal menstruation

–T-red tip, thin white coating

–P-weak on Chi

Doc’s Dx: Earth accumulation weakens Water

Any time a patient has a disease for a long time, Kidney is almost always affected. Gastric pain is due to earth which is overacting on the Kidney, weakening the water. Think 5 element thoughts. If water is weakened due to long chronic problem further weakens the Kidney.

The 3 across the top are used to loosen the hardness of the earth. Zhe bei mu helps resolve phlegm damp. He ye is the lotus leaf which 1) eliminates summer heat, 2) disperses the Earth qi. Shu fu pian (processed fu zi), xu duan both strengthen. Han lian co and nu zhen zi combined = Er zhi wan. One is harvested at winter solstice, one at summer solstice. This tonifies Kidney yin/water.

Spleen

Spleen is part of all seasons and does not have one of it’s own. It is the last 18 days of each season and at the end phase of every day. Regulating spleen is very important in every disease.

Huang Di asked,”why is the spleen does not correspond to an individual season?”

Qi Bo replied,”the spleen’s placement is in the middle. It is the earth. In the divisions of the four seasons, the time of the spleen is the last eighteen days of each season. It does ont really have adistinct season of its own”

--29 THE TAIYIN AND YANGMING CHANNELS

Discussion of Stomach and Spleen by Li Dong Yuan would be a great thing to check out. Bu zhong yi qi tang is his work, along with a whole truckload of others.

•Case 8

–Male 20

–The patient has lassitude, somnolence, dazed about 2 years. He sleeps 11~12 hours per night, but still sleep during day time.

–Bitter taste, a lot of sweating

–T-red tongue body with thin white coating

–P-wiry rapid

Doc’s diagnosis is phlegm damp obstructed yang qi.

Note that there is no specific time…affects him all the time. Sleepy all the time because spleen clear yang cannot ascend and keep him awake.

Da Yuan Yin

Further info:

•No cold, greasy, sour food

•After 6 bags, his lassitude gets better, but still sleepy for 10 min at 7~9 a.m.

•Bitter taste, sweating relived

•T- red tongue body with thin white coating

•P- wiry rapid slippery

+ Chao Zhi Zi 10, Dan Pi 10

We draw 5 element in the circle. Like so:

But really the Earth is in the center

Pathogenesis

For TCM, always focus on syndrome dx.

Symptoms

Symptoms are the patient’s feelings. You have to take their word for this and you can’t observe these. We ask questions to pinpoint the nature of each of these.

Body signs

These are things that you as the doctor can observe and note.

Syndrome

Gathering all of the symptoms and signs, you then see how the data stacks up and use that to pinpoint the syndrome. TCM diagnosis is not flat and 2 dimensional – it’s multidimensional and dynamic.

This refers to the condition of the body at a given moment.

Disease

Disease can be a variety of syndrome diagnoses. Diabetes for instance is a long term problem that might manifest as a variety of syndromes that changes over time.

This refers to a long term problem that goes along a time continuum.

Intermittent Pulse

“If the pulse is intermittent, this means that the qi is collapsing.”

--Chapter 17 THE METHODS OF PULSE EXAMINATION

Dai Mai is regularly intermittent – a bouncing pulse.

Jie Mai is irregularly intermittent, also called a “knotted pulse.” This refers to uneven knots on a rope if you slide it through your fingers.

Which is worse? Dai mai. It is said that the jie mai is alive, but the dai mai is dead. Dai mai is frequently related to heart disease. It’s similar to a malfunction engine that regularly misses – it accepted as a regular function of the engine – in other words, you get used to it, but the engine is dying.

Probably board exam material.

There’s also a racing pulse that is regularly intermittent. There are a lot of weird pulses, as a matter of fact. There’s one called a “woodpecker” pulse – really really intermittent much like a woodpecker pecks.

Case 1

•Female 21

•The patient has oppressed chest, dizzy, fatigue after a common cold since 1 year before.

•The symptoms getting worse this week because of common cold attack. She’s been treated in hospital as viral myocarditis. But the symptoms remain still.

•HR: 42/min

•Hospital suggestion: heart pacer, but she refused

•She has the above symptoms accompanied with short of breath after activities, palpitation, aversion to cold

•T-swollen tongue body with thin white coating

•P-slow with regularly /irregularly intermittent pulse (Jie & Dai)

Jie and Dai combination. Zhi Gan Cao Tang is typically used to treat this. Sheng Mai San might be tempting too, but Zhi Gan Cao Tang. Use a large dosage of Gan Cao.

Gan Cao is a qi tonifying herb, but is honey roasted and thus more tonifying. Qi isn’t enough to push the pulse. It is important to add 10 drops of liquor to this decoction in order to enhance the effect of the herbs and increasing the circulation.

Always remember that you are focusing on people, not on a disease. You must balance the constitution.

Once the pulse gets regular, add Fu zi 15g. Takes 32 bags total to get the pulse normal. Look back at the pulse truism at the beginning: “If the pulse is intermittent, this means the Qi is collapsing.”

Wind

Symptoms of tremors and shaking of the limbs, dizziness, and vertigo are usually caused by wind and associated with the liver

--74 ESSENTIALS OF DISEASE AND THERAPY

Slight tremors = gallbladder. Bigger convulsions = liver.

Male 35

•The patient has trembling hands and worse on the right hand. He even can’t spell normally, nor handle a cup. He was diagnosed as Writer' s cramp syndrome.

•Distention in epigastrium, bad sleep with dreams, normal stools

•P- wiry slow on right pulse, wiry thin on left side

•T-red tongue body with thin yellow coating

Nervous nellies, no guts, skeerdy cats – these are all “Small Gallbladder” people. I’m babysitting a Jack Russell terrier that is like this. Loud noises expose his ‘small gallbladder’ nature. 

Doc’s dx: Liv GB heat with phlegm

Chai Qin Wen Dan Tang

Later the doc adds si gua lou 10 and sheng di huang 12. Sheng di is to moisten, nourish yin. Patients suffers from dampness leading to (ironically) a lack of lubrication for the hands and hence the tremors.

Edema

Sx of edema, bloating and distention are due to the dampness of the spleen.

Case 4

•Female 60

•The patient has edema in face and limbs, the edema area sunken while pressing it.

•Epigastric and abdominal distention, upset in epigastrium, dry mouth without desire for water, poor appetite, once defecation in 2 days

•P-deep slow

•T-thin white greasy coating

3 organs to blame for edema: lung, spleen, and kidney. Shi pi yin modified is used – spleen yang xu formula.

Dryness

Lung is related to dryness.

Case 5

•Male 6

•The patient has cough for 2 months with little phlegm.

•The hospital give him diagnose of bronchitis and prescribed anti-inflammation drugs but without effects.

•Normal stools, appetite

•T-normal

San Ao Tang is used in modified formula. Lung qi is failing to disperse and there is some body fluid injury.

Diarrhea/watery stools

Remember the kid 8 years old who had the watery saliva? Look at that case. There’s another one about a dude who drools and the saliva dries hard. Look at that case too.

Quality of the water indicates heat/cold. When the water is clear/profuse = yin and cold. When water is smelly and more turbid = heat.

Case 10

•Female 39

•The patient has lumber region pain for 4 years, fatigue, short of breath, bad sleep with dreams

•Large quantity of watery leucorrhea, swollen eye lids, normal urine and stools

•T- Dark swollen tongue body with thin white coating

•P-deep slow

•Urine test: clear

Watery leucorrhea due to cold damp accumulation. Shen Zhuo Tang is the formula. This is from the Golden Chamber. Cold damp is accum in the lower areas – sitting in cold water and heaviness feelings.

•Shen Zhuo Tang

–Fu Ling 15, Gui Zhi 10, Chao Bai Zhu 10

–Gan Jiang 8, Zhi Gan Cao 6, Chao Suan Zao Ren 15

–Ban Xia 10, Xing Ren 10, Yi Yi Ren 15

•After taking 4 bags of formula, her lumbago, leucorrhea, swollen eye lids all get better, but still has dreamy sleep, swollen tongue body

•+ Huo Xiang 10, Cao Guo 10, He Hua Pi 20

•After 5 bags, cured

Treatment

•An illness located above the diaphragm and chest can be treated with emetics to induce vomiting

•--5 MANIFESTATION OF YIN AND YANG

If it’s in the stomach – i.e., above the diaphragm – vomit it out!

Case 1

•Male Adult 1228 A.D

•Mania

•Sudden onset, can’t recognize his folks, creasy and can’t be controlled by 3 people

•Niu Huang, Bing Pian, She Xiang were useless for him.

•Zhang Zihe gives D.D: phlegm fire glued on heart.
(i.e., obstruction of the heart)

His treatment was to make the dude vomit by making him very dizzy. This guided the pathogenic factor away through vomiting. If you don’t have a wagon wheel handy, you might use herbs! Gua Di San will promote vomiting to guide out pathogens.

If it’s below the diaphragm, purge it out. Guide the pathogens out through the urine and through defecation.

Case 2

•Female 71

•The patient suffers from headache for several years. She takes 1-2 tablets anodyne several times every day.
note not wind cold type headache . . . too long term, no cold sx.

•Poor appetite, bad sleep, fatigue, dry stools with difficult defecation, once bowel movement in couple of days.