Golden Chamber 4

Violet Song

• Chapter 9 On Pulse Syndrome Complex and Treatment of Chest Obstruction, heart Pain and Shortness of Breath

• Chest Bi pain obstruction

• Heart Pain

• Shortness of Breath

Shortness of Breath

Chest Bi Heart Pain

Symptom Part of chest Bi symptom

pain

Disease position

Upper Jiao

Etiology & pathology

Similar

Xiong Bi

• Chest Bi Syndrome, Chest Obstruction

• Concept: a kind of disease manifested as fullness, distention, oppressed in chest, possibly with pain.

• Cause and pathogenesis– Feeble yang pulse, Wiry yin pulse: upper jiao yan

g deficiency with excessive yin coldyin pathogen occupies yang position and obstructed chest yang 【 1 】

• Pulse – Cun pulse (Yang position) weak upper Jiao Yang defici

ency– Chi pulse (Yin position) wiry Yin cold evils and fluid rete

ntion

– Ben deficiency with Biao excess• 【 1 】• 【 2 】

– No exterior syndrome– difficult breathing

• Chief symptoms: panting, coughing, spitting, shortness of breath 【 3 】

• Chief pulse: deep slow of Cun Kou pulse, tight rapid in Guan Shang 【 3 】

• Differentiation and treatment– Typical pattern

• Panting, cough, chest pain radiating to the shoulder, difficult breathing

• deep and slow pulse at Cun upper Jiao Yang deficiency

• tense pulse at Guan Yin cold excess and fluid retain in the middle Jiao

– Gua lou xie bai bai jiu tang 栝蔞薤白白酒汤 (disperse obstruction, dredge yang, eliminate phlegm, descend qi ) 【 3 】

• 栝蔞 gua lou (Fructus Trichosanthis)• 薤白 xie bai (Bulbus Allii)• Wine/liquor

• Differentiation and treatment – Phlegm & turbid excess pattern

– chest pain radiated to the back – can not lie down

• 栝蔞薤白半夏汤 gua lou xie bai ban xia tang(disperse obstruction, dredge yang, eliminate phlegm retention, descend qi ) 【 4 】

– 栝蔞 gua lou (Fructus Trichosanthis)– 薤白 xie bai (Bulbus Allii)– 半夏 ban xia (Rhizoma Pinelliae Ternatae)– Wine

• Differentiation and treatment– Qi obstruction in chest

• Excessive type– Fullness in the chest, hypochondria distention

• zhi shi xie bai gui zhi tang 枳实薤白桂枝汤 ( disperse obstruction, dredge yang, dissolve fullness, descend qi) 【 5 】

– 枳实 zhi shi (Fructus Immaturus Aurantii)– 厚朴 hou po (Cortex Magnoliae Officinalis)– 薤白 xie bai (Bulbus Allii)– 栝蔞 gua lou (Fructus Trichosanthis) – 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)

• Differentiation and treatment– Qi obstruction in chest

• Deficient type• 人参汤 ren shen tang(tonify middle jiao, strengthen

yang) 【 5 】– Regulate the Middle jiao pill 理中丸 li zhong wan – 人参 ren shen (Radix Ginseng)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)– 干姜 gan jiang (Rhizoma Zingiberis Officinalis)– 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)

• Differentiation and treatment– Mild pattern

• Water retention>Qi stagnation– fu ling xing ren gan cao tang

茯苓杏仁甘草汤 (disperse Lung, resolve water retention) 【 6 】 – 茯苓 fu ling (Sclerotium Poriae Cocos)– 杏仁 xing ren (Semen Pruni Armeniacae)

Regulates qi of the chest– 甘草 gan cao (Radix Glycyrrhizae Uralensis)

Regulates formula

• Differentiation and treatment– Mild pattern

• Water retention<Qi stagnation w/slight damp accum• ju zhi jiang tang

橘枳姜汤 (move qi, resolve water retention, ) 【 6 】– 陈皮 chen pi (Pericarpium Citri Reticulatae)

move qi, resolve phlegm– 枳实 zhi shi (Fructus Immaturus Aurantii)

break qi stagnation– 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

harmonize formula

• Differentiation and treatment– Acute pattern

• Yi yi fu zi san薏苡附子散 (warm & dredge yang to stop pain, eliminate dampness to disperse Bi syndrome) 【 7 】

– 薏苡仁 yi yi ren (Semen Coicis Lachryma-jobi)eliminate damp, but also disperses bi syndrome. Not a common function.

– 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata) pao fu zi – stops pain. Common to use for acute angina.

Xin Tong

• Heart Pain?No, refers to epigastrium area.

• Concept: a type of disease with chief symptom of pain in the area below the Heart (epigastria).

• Cause and pathogenesis: Feeble yang pulse, Wiry yin pulse

• Differentiation and treatment– Adversely upward qi flowing due to cold & water ret

ention coagulation– Epi/Heart pain fluid retention

• gui zhi sheng jiang zhi shi tang桂枝生姜枳实汤 (Warm & dissolve water retention, descend adversely upward flow qi) 【 8 】

– 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)– 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)– 枳实 zhi shi (Fructus Immaturus Aurantii)

opens blockage

• Differentiation and treatment– Cold coagulation

• Severe pain from heart to chest, from chest to heart• wu tou chi shi zhi wan

乌头赤石脂丸 (warm yang, disperse cold, eliminate yin pathogen) 【 9 】

– 川椒 chuan jiao (Pericarpium Zanthoxyli Bungeani)– 乌头 wu tou (Radix Aconiti)

very strong to treat pain, esp due to cold. – 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)– 干姜 gan jiang (Rhizoma Zingiberis Officinalis)– 赤石脂 chi shi zhi (Halloysitum Rubrum)

• Chapter 13 On Pulse Syndrome Complex and Treatment of Xiaoke (Diabetes), Dysuria and urinary disturbance.

Xiao Ke

• Wasting thirst, Consumptive thirst, Diabetes.

• Concept: a type of diseases manifested as drink too much, eat too much, too much urine and thin body form.

• Classification: Upper Xiao, Middle Xiao, Lower Xiao– Upper Jiao thirsty lung– Middle Jiao hungry stomach– Lower Jiao diuresis kidney

• Causes and pathogenesis 【 2 】 – Ying and Yin deficiency with interior heat– Cun kou pulse upper Jiao lung & heart

• Lung Wei Qi • Heart Ying and blood

– Floating deficient Yang up floating – Slow insufficient t Ying and blood

– Fu Yang pulse 趺阳脉 Jiexi (St 41 解溪 ) area Stomach

• Floating stomach Qi • Rapid hyperactive of stomach heat

– Symptom • Frequent urine

• Constipation

• Differentiation and Treatment– Upper Xiao 【 12 】

• heat evil impair body fluid thirsty– thirst– dry mouth

• 白虎加人参汤 bai hu jia ren shen tang – 石膏 shi gao (Gypsum) – 知母 zhi mu (Radix Anemarrhenae Asphodeloidis)– 粳米 jing mi (Nonglutinous Rice)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)– 人参 ren shen (Radix Ginseng)

• Differentiation and Treatment– Middle Xiao 【 8 】

• pathogenesis for xiao ke stomach heat– Fu Yang pulse Jiexi (St 41 解溪 ) rapid stomach h

eat – Over ate– Constipation– frequent urine

• Differentiation and Treatment– Lower Xiao 【 3 】

• Symptom and treatment for kidney Yang deficiency xiao ke消渴 disease Lower Jiao diuresis 多尿

– Thirsty– More urine

• Kidney Qi Pill from the Golden Cabinet 金匮肾气丸 jin Gui shen qi wan 【 3 】

– 熟地黄 shu di huang (Radix Rehmanniae Glutinosae Conquitae) – 山药 shan yao (Radix Dioscoreae Oppositae)– 山茱萸 shan zhu yu (Fructus Corni Officinalis) – 泽泻 ze xie (Rhizoma Alismatis Orientalis)– 茯苓 fu ling (Sclerotium Poriae Cocos)– 牡丹皮 mu dan pi (Cortex Moutan Radicis)– 桂枝 gui zhi (Ramulus Cinnamomi Cassiae) – 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)

Lin Disease

• Lin Syndrome

• Concept: a kind of disease manifested as drops of urine, urine pain, even stabbing pain.

Lin Disease

• Classification: Shi Lin (Stone), Xue Lin (Bleeding), Re Lin (Heat), Gao Lin (Cloudy), Lao Lin (Overstrain)– Shi lin 石淋 stone lin– Xue lin 血淋 blood lin– Gao lin 膏淋 cloudy lin– Qi lin 气淋

• when fatigue deficiency syndrome• when stress excess syndrome

– Lao lin 劳淋 on exertion

• Main symptoms of Stone Lin 【 7 】 – symptom of stone lin

• painful urine• radiate to lower abdomen

• Cautions: should not promote sweating 【 9 】 – Urinary Disturbance disease 淋家 kidney deficiency

with bladder damp heat Yin fluid deficiency contraindicated for sweating bloody Lin .

– no sweating bloody urine

Urinary Disturbance

• Concept: a kin of disease manifested as difficulty in urinary, drops or little urine, without pain.– symptom of many diseases

Urinary Disturbance

• Differentiation and Treatment– Lower cold with upper dryness– treatment for kidney Qi deficiency difficult urine with

thirsty• difficult urine • thirst

– 栝蔞瞿麦丸 wua lou qu mai wan 【 10 】 • 天花粉 tian hua fen (Radix Trichosanthis Kirilowii) • 茯苓 fu ling (Sclerotium Poriae Cocos)• 山药 shan yao (Radix Dioscoreae Oppositae)• 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)• 瞿麦 qu mai (Herba Dianthi)

Urinary Disturbance

• Differentiation and Treatment– Damp heat with blood stasis, SP K deficiency 【 1

1 】 – 蒲灰散 pu hui san

• 蒲黄 pu huang (Pollen Typhae) • 滑石 hua shi (Talcum)

– 滑石白鱼方 hua shi bai yu fang • 滑石 hua shi (Talcum)• xue yu tang • fish ？

– 茯苓戎盐方 fu ling rong yan fang • 茯苓 fu ling (Sclerotium Poriae Cocos)• 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)• salt

Urinary Disturbance• Differentiation and Treatment

– Difficulty in urine with UB qi transforming dysfunction• Treatment for difficult urine Dysuria Qi fail to disperse b

odyfluid water retention – not xiao ke disease – floating pulse– difficult urine– slightly fever– thirst– vomiting when drink

• Five Ingredient Powder with Poria 五苓散 wu ling san 【 4 】 【 5 】

– 茯苓 fu ling (Sclerotium Poriae Cocos)– 猪苓 zhu ling (Sclerotium Polypori Umbellati)– 泽泻 ze xie (Rhizoma Alismatis Orientalis)– 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)– 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)

Urinary Disturbance

• Differentiation and Treatment– Difficulty in urine with Heat injures yin

• water retention with heat damage Yin – floating pulse– fever– thirst– difficult urine

• Polyporus Decoction 猪苓汤 zhu ling tang 【 13 】 – 猪苓 zhu ling (Sclerotium Polypori Umbellati)– 茯苓 fu ling (Sclerotium Poriae Cocos)– 阿胶 e jiao (Gelatinum Corii Asini)– 滑石 hua shi (Talcum)– 泽泻 ze xie (Rhizoma Alismatis Orientalis)