How To Diagnose And Treat Lin Zi

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1 Course: Acupuncture Treatment of Disease 2 Date: January 12, 2009 Class #: 2 - UTI and Profuse Vaginal Discharge Homework Due Week 12 Evaluate and discuss the differences of the diagnosis and treatment of Parkinson s disease between Oriental medicine and Biomedicine. Note: stress in clinic can be TCM dx of Yu syndrome Today: UTI and Profuse Vaginal Discharge UTI is a biomedical dx. In TCM it s is called Lin Zheng or Painful Urination Syndrome. Profuse vaginal discharge is called Dai Xia. UTI Or Lin Zheng Biomedical Discussion In biomedicine this is infection of KI, ureter, BL or urethra. Not everyone with a UTI has these symptoms. Common symptoms include a frequent urge to urinate and painful burning when urinating. More likely for females to get it than males since 1) the urinary tract is so much shorter for women than it is for men and 2) the opening to the urinary tract is closer to the anus than it is for men. Underlying conditions that impair the normal urinary flow can lead to complex UTIs. Infection of the BL is better known as cystitis. Definition By definition, this is a common infection which occurs when bacteria enters the opening of the urethra and multiplies in the urinary tract. Types can include: Urethritis cystitis or interstitial cystitis ureteritis pyelonephritis and nephritis Etiology The etiology is a gram negative bacteria, specificially Escherichia coli, pseudomonas and/or proteus to name some. Usually this is limited to the urinary tract, but can spread to the bladder and then on to the kidneys where blood and pus can accumulate here. This would be toxic heat in TCM. The upper UT links the kidneys and ureters. The lower urinary tract is the connection between the bladder to the urethra and to the opening. As a result, the upper urinary tract is likely to be cleaner than the lower. Page 1 of 13

2 Anything in the upper areas such as the upper respiratory tract, i.e., that which attacks the Yang area, is a Yang pathogen, a gram positive bacteria. That which attack the lower body, i.e., the urinary tract is likely to be a Yin pathogen, or a gram negative bacteria. Types of UTI s Lower Urinary Tract Urethritis. Inflammation in the urethra. Symptoms will include brown urine and other UTI symptoms covered below. Cystitis Inflammation and infection in the urinary bladder. Will have pus and cloudy urine. Upper Urinary Tract This has more general symptoms including chills, fever, pain in the lower back Ureteritis Comes with pain under the ribs Pyelonephritis or nephritis This is in the kidneys. There is pain upon percussion. Palpate this way for tenderness. If your patient has this, send them to an MD!! Don t jerk around here. This is big serious. Symptoms Include the following. However, older patients may have far fewer symptoms! The first 4 symptoms are the more common ones to see. Urgent urination Sharp pain Burning pain Scanty urine that is yellow or bloody (or streaked with blood) Back pain Chills and/or fever Nausea/vomiting Severe cases usually. UTI s can come along with blood, stones, sand, cloudy or milky urine. Stones usually result in a colicky pain. It also blocks here and there in the migration downward resulting in bleeding and in muscle cramps in the area. Can also result in the stone blocking the flow of urine, causing water retention in the Kidney. This compresses the Kidneys leading to Kidney failure. Jing Qian Cao and Hai Jin Sha are 2 herbs very helpful to lessen the size of the stones. This is diagnosed by a urinalysis with a clean catch urine sample. The sample is tested for culture and sensitivity. Treatment after dx includes antibiotics, vitamin C, cranberry juice and herbal remedies. Cranberry juice is a way to change the environment, lowering the ph of the area to make the environment hostile for bacteria. This virus can go latent, so in a hospital a patient is tested 3 times in a month. Once one has tested negative 3 times in a month the patient is considered clean and cured. UTI s can be prevented by personal hygiene, urination after sexual intercourse to clear the UT, drinking plenty of water (same reason keep urinary tract clear), and don t hold the urine too long when you need to go. Basically, promote frequent urination to keep the bacteria from lodging in the tract. Page 2 of 13

3 TCM Etiology 1. Invasion of external pathogens Damp or Damp heat. Can also be Wind, a Yin pathogen. Can include Summer Heat also. According to the Shang Han Lun, accumulation of water in the UB, a Taiyang organ pattern, which is related to PUD. 2. Irregular diet Heat or Damp heat accumulating in the lower jiao or intestines 3. Overwork This decreases the immune system, decreasing zong an zheng qi, and allows for an external pathogen to invade 4. Emotional disorder This refers to Liver Fire or Heart Fire. Heart fire transfers to the Small Intestine while Liver Fire runs through the genital area causing the problem. This occurs often in middle aged women. Note that this is an internal organ disorder, not a bacterial infection!!! TCM Mechanism Excess in the UB + Deficiency in the Kidneys For chronic UTI s you must also protect the Kidneys, not just remove the heat/damp heat excess. This prevents the infection from returning time after time. A PUD, or painful urinary disorder, is anything painful and related to urination. This is the 2 nd most common ailment, 2 nd to respiratory disorders. PUDs and UTI s are called Lin Syndromes in TCM. These come in six flavors: Re Lin Heat, acute and intense burning. According to my herbs class this is the basic type upon which other types build. Shi Lin Stony PUD Qi Lin Qi is just plain Qi! Might relate to emotional conditions affecting the heart or liver as discussed in etiologies. Xue Lin Blood in the urine. Gao Lin Cloudy, milky, foamy, greasy or cloudy. This is actually protein passing through. Often with kids, with adults more common with festivity foods richer, oiler, more proteins. Lao Lin Exhaustion and taxation. This is a chronic type, generally recurrent and mild. Page 3 of 13

4 TCM Differential Diagnosis and Treatment There are excess and deficient types of Lin syndrome. Some of the types of Lin syndrome can be in either category. Excess o Heat or Re Lin o Stony or Shi Lin o Qi Lin o Xue or Bloody Lin o Gao or Cloudy/Milky Lin Deficiency o Qi Lin o Xue Lin o Gao Lin For ANY Lin Syndrome, always check for Kidney involvement by using the thump and percussing the Kidney. If there is no lower back pain then they Kidney is not yet affected. If there is pain upon palpation of the Kidney, then percuss to check for pain. If painful, send them to the Doc! Basic Points These are applicable for all types of Lin Syndromes. Points are 1) local, 2) water and 3) damp related. Ren 3 is the FM of the UB and also where the 3 foot Yin mixes with the Ren channel. Ren 2 is Dr. Luo s favorite point. Good for emergency conditions. Also good post surgery when patients have difficulty urinating. UB 22 is the San Jiao back shu water passage organ UB 28 is the Back Shu of the UB. This is the part that is in excess in Lin syndrome ST 28 is the water passage point by translation SJ 5 is a water passage and is good for phlegm and damp heats. UB 63 is the Xi Cleft point of the Bladder Channel good for acute syndromes and good for emergencies. UB 66 good for fevers due to Lin. Ren 9 is the Shui fen or water division point. Located over the Small Intestine which separates pure from turbid. Be able to give the name of the Lin Syndrome, know the basic symptoms. Page 4 of 13

5 Heat or Re Lin This is a typical UTI, usually caused by a gram negative bacteria. Urination may be less because heat is burning off the body fluids. Patient may like drinking water, probably cold. Might have constipation. Depends upon whether the heat is external (chills/fever) or internal. Internal heat will manifest depending on what organ has the heat heart is sleeping problems, dreaming, restlessness. Liver heat will have sides of tongue red, bitter taste, probably emotional difficulties. LV 2 liver heat GB 41 exit point of gallbladder this is where the heat exits. GB 43 is the ying spring point. HT 8 is strongest to release heat. P 8 parallels this, but not quite as strong. UB 12 to release an external heat, same for UB 13. DU 14 for external heat release LI 4 and 11 for damp heat SP 9 release dampness SP 6 SI 2 LU 7 Ba Zheng San clears heat. Can do in powder or pills. Raw is strongest. Bear in mind some ppl are allergic to Mu Tong a little toxic to the Kidney. There are actually 2 Mu Tong s the ones coming from the north of China is more toxic. Page 5 of 13

6 Stony or Shi Lin Be sure to check the size and properties of stones. If the stones are soft they can be broken up by herbs, which is actually not recommended this can cause more blockage, so you d best be working with an MD on this one. If the stones are hard, the patient will need something like ultrasound to blast the stones in to passable pieces. This is probably a chronic problem stones don t form overnight, but due to damp + heat and/or phlegm + heat for a long time. This is a case of the heat cooking the water down and concentrating the minerals. Can also come from stasis and trauma. Urination suddenly stops in this form of the syndrome when the stone hits a blockage point. There may be blood if the stones are jagged if they are round, maybe not. If the stones are small enough they will be passed and may look sandy. Pulse may be wiry especially during the pain. Deep, slippery can indicate long term and internal + dampness. If fast, indicates heat as well. KI 2 + UB 63 + UB 39 Use these 3 point if you see the stones. Helps stones get smaller/softer and to pass. KI 2 clears the heat and good to melt the stones UB 63 = xi cleft and emergency use for pain UB 39 3 jiao he points. Helps pull stones out. SP 9 for dampness Ren 6 Page 6 of 13

7 Qi or Qi Lin Infrequent diagnosis. This is a combination of Excess (anger, emotion, stress related Liver syx) which can cause acute onset and Deficiency of SP, KI, or LU. Points for deficiency depend upon the organ affected. Note that all 3 of the deficiencies relate to water metabolism upper, middle, and lower jiao. LIV 3 or LIV 2 can be used UB 18 back shu of Liver. GB 39 lv gb damp heat Deficiency points depend upon what organ(s) affected For either Excess of Deficiency: o Female: LU 7 + KI 6 LU 7 connects to Ren channel while KI 6 connects to Yin Qiao. Combined = lung, throat, and chest. o Male: SI 3 + UB 62 SI 3 opens up the Du while UB 62 connects to Yang Qiao. Combined together = eye canthus, posterior ear, neck and shoulder problems. Definitely choose this for fevers will clear the heat. Page 7 of 13

8 Bloody or Xue Lin If there is blood, this is the diagnosis. Can be due to excess (any organ) or deficiency of yin causing heat. UB 40 for excess heat. Bleed if there is a lot of heat. SP 10 also for excess heat in the blood. UB 17 on the back is more for xu of xue. KI 1 not often used. Can tonify SP 10 instead. SP 1 helps stop bleeding SP 20 tonifies Spleen. Gao or Cloudy Lin Can be excesses where damp heat is predominant or can be due to deficiency, usually of Qi resulting in cloudy urine. Greasy coating, Slippery pulse are the key points. Excess SP 9 for dampness ST 40 for phlegm more severe condition SP 6 could use alone for regulating water metabolism for a mild case Deficiency More severe than the excess type it s been going on longer, has progressed and gotten stronger. Points are more for tonification of yin and essence. Back shu treatment is the best for this type. Ren 4 Ren 6 Page 8 of 13

9 Ren 17 UB 20 UB 23 UB 13 Lao or Fatigue/Exhaustion Very chronic, often late stage of a disease. This is a Kidney Yang Xu. Patient may look very exhausted. GB 39 tonify yin essence if deficient Ren 4 Ren 6 Du 4 tonify yang essence if deficient Bailiao w/ moxa Du 20 ST 36 SP 6 SP 9 Page 9 of 13

10 Profuse Vaginal Discharge Leukorrhea is called Dai Xia or Bai Dai. Bai is white, dai is leucorrhea or Girdling vessel. Xia means going downward. Biomedicine says normal discharge is white, pasty, no odor, not profuse/painful/itchy/irritating. Especially occurs during ovulation, sexual response, and prior to menstrual cycle. Abnormal discharge is viscid whitish or yellowish excessive discharge from the uterus or vagina. Etiology can be due to gram negative bacteria or fungi grichomonad or candida albicans. Can be related to menstrual cycle, emotional stress, preggers, OTC or prescribed meds (such as the pill), sexual excitement, breast feeding, ovulation and diet. All of these factors can influence what the discharge looks like. Symptoms Bacterial cause: White or yellowish with a fishy odor Candidiasis: itching or burning Trichomoniasis: yellow, green, grayish discharge. Diagnosis comes from a lab test and is treated with antibacterials or antifungals. TCM Etiology This is related to either the channel of the Dai or the points on the channel. Dai Xia is the channel relation dai channel related. Dai Meridian Syndrome is discussed below. Invasion of external pathogens Especially due to Yin pathogens Irregular Diet Greasy and sugary foods can create dampness or lead to Spleen qi xu. Emotional Disorder This is due to the Dai channel pathway and it s connection with other meridians. The Dai channel originates from Liver 13, the front mu of the Spleen. It runs downward and obliquely to cross the Gallbladder channel at GB 26, 27, and 28. It then goes to the back and connects with UB channel at BL 23, 52 and to Du at Du 4 Overwork Look for cloudy urination without bacterial infection. TCM Mechanism Dai meridian syndrome Also related to/part of dai syndrome SP Qi Xu w/ lower pouring of dampness Page 10 of 13

11 The Dai channel originates from Liver 13, the front mu of the Spleen. It runs downward and obliquely to cross the Gallbladder channel at GB 26, 27, and 28. It then goes to the back and connects with UB channel at BL 23, 52 and to Du at Du 4. There are 3 Dai syndromes: Profuse leucorrhea Caused by o Deficiency of Qi or Yang in Spleen and Kidney o Excess Dampness: damp heat, damp cold, or toxic damp heat o The resulting imbalance between upper and lower body per Li Shi Zhen. Lower back pain Sp Xu Symptoms of a Dai Syndrome include the following. Note that there are upper body and lower body symptoms because the Dai channel connects the two. A problem in the Dai channel will disconnect the two and cause disharmony! o Distention and fullness in the abdomen o Weakness, coldness and pain in the lumbar area as if sitting in cold water o Profuse leucorrhea o Prolapse of the uterus o Toothache o Headache o Sore throat o Dizziness Weakness and motor impairment of the lower limbs. Category Types Graded by color of discharge: Red dai Heat and fire related White dai Damp, damp cold, Spleen deficiency or can be normal Yellow dai Damp heat or fire related Green dai Liver Qi stagnation Liver and spleen disharmony Black dai Ew! Toxic heat. Very bad prognosis. It s very important to check the smell, color and amount of the profuse vaginal discharge. Send clients in for lab tests when there is any abnormality. Page 11 of 13

12 TCM Differentiations and Treatment Basic Points GB 41 + SJ 5 opens and treats the Dai Channel. GB 26, 27 and 28 points along the Dai Channel Ba Liao SP 9 ST 36 SP 6 Beyond the basic points, there are several differentiations for profuse vaginal discharge detailed in the following notes. Du 20 is good for deficiency patterns. Because it lifts, it s also good for prolapses which can follow a long term or severe Spleen Qi deficiency (generally called Spleen Qi Sinking when they progress that far). Page 12 of 13

13 Key points are the coloration and heaviness. Can also use GB 34 for this pattern. SP 9 also to drain damp. SJ 5 is damp/water related. Look for severe heat signs. Might even see black/brown coating. UB40 bleed it to really release the heat. Wu Wei Xiao Du Yin = 5 herb detoxicant liquid very good to treat condition. 4 gates, though Liver 2 would be better to clear heat. Liver 14 front mu of Liver. Choose this with hypochondriac pain, but if symptoms are general, use 4 gates. GB 41 good to clear heat Points plus herbs are best to treat this disease. Page 13 of 13

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