Linda Boggie, DVM, CVA (IVAS)

Transcription

1 Linda Boggie, DVM, CVA (IVAS)

2 History lesson Legend has it the emperor Shen Nong ( BCE) was fascinated with plants and studied their medicinal properties Self-experimentation in a manner of speaking Tasting, feeling, physical and, in some cases mental effects Shen Nong Ben Cao Jing (Classic Materia Medica) Included approximately 360 medicinals Plants, minerals and animal substances Over 5000 years ago! (5700 or so)

3 Huang Di The Yellow Emperor Said to have lived circa 2700 BCE Huang Di Nei Jing Su Wen Ling Shu Credited to Huang Di but actually a compilation from many authors Encompasses the developing knowledge of Chinese medical philosophy Yin and Yang, Naturalism and Daoism reflected Describing processes of nature and applying to human Living in balance First written copy is attributed to Warring States period ( BCE) First written copy in survival from Han Dynasty (206 BCE- 220 CE) This book in turn influenced Chinese Herbal medicine

4 Zhang Zhong Jing Han Dynasty Chinese physician Witnessed many deaths caused by infectious diseases Wrote the Shang Han Za Bing Lun Discussion of Cold-Induced Disorders and Miscellaneous Diseases Later divided into two foundational herbal texts Shang Han Lun, Treatise on Febrile Diseases caused by Cold Jin Gui Yao Lue, Essentials from the Golden Cabinet

5 Hua tuo Famous physician, also circa 200 CE Best known for his Hua-tuo-jia-ji points effective for relieving pain First used pain relieving decoctions Song Dynasty ( CE) 1200 CE, narcotic teas were developed Minor surgical procedures Close to 1000 plants, minerals, and animal substances were documented as to medicinal qualities and effects

6 Jin-Yuan period Northern tribes took control of part or all of China from Song Dynasty First Jin then Mongolians who established the Yuan Dynasty Changes in Chinese culture Development of neo-confucianism by Zhu Xi ( ) Incorporated Naturalistic and Daoist philosophies into the rigid Confucius doctrine Zhang Yuansu wrote Zhenzhu Nang, A Bag of Pearls zhenzhu = pearl; nan = bag

7 Zhengzhu Nang A double meaning Fundamental contents of the book are valuable - like a pearl Book itself is entirely expendable: it is a bag, not a permanent repository, such as a golden chamber (jingui, as in the title Jin Gui Yao Lue). Title also indicates that one must rely on oneself Training, experience, self-cultivation, and intuition that goes into becoming a medical practitioner Not to follow some dogmatic system that is going to eventually change anyway

8 Zhang Yuansu and Zhenzhu Nang Presented ideas about disease causation Incorporated medicinal materials into the five element framework (wuxing) The organizing principle of Chinese medicine at the time Defined the association of herb tastes and their effect on the different organs Concept of herbs entering into and influencing the channels Channel attributions were an effort to link the physiological effects of herbs with the concept-originally depicted in the Neijing Suwen: pathogens influencing channels Linked the actions of herbs with the effects induced by acupuncture Unified the theories of disease causation and treatment and the practices of herbal medicine and acupuncture

9 Zhang Yuansu "The method of appropriately using herbs in accordance with the symptom and sign presentation of the patient entails determining substances with the correct qi, taste, yin and yang, and thick and thin properties as well as the pathogenic factor involved and the channel it has entered." Li Dong Yuan Famous Student

10 Li Shi Zhen Famous herbalist of 16 th century Stated that Zhang's book contributed much to the spread of medical principles Ben Cao Gang Mu, Grand Materia Medica; 1596 Described 1,892 Chinese herbs and 11,096 Chinese herbal formulas Additionally published in many other countries allowing dissemination of Chinese herbal medicine knowledge

11 Decline of Chinese medicine 1700 s Protestant missionaries introduced Western medicine into China During the colonial period of China s history Western medical practice became more popular and both Chinese herbal medicine and acupuncture were forced underground

12 Chinese Veterinary Herbal Medicine Developed alongside the human field Sun Yang (later called Bo Le) and Wang Liang The fathers of Chinese veterinary medicine Spring and Autumn Period ( BCE) Established the principles of diagnosis in animals, theories of internal and external disorders, treatment methods and classification of medicinal substances

13 Sui Dynasty ( CE) Veterinary medicine began to branch out and develop into areas of specialty Chi Ma Niu To Lu ching Various treatises on the Treatment of Horses, Cattle, Camels and Donkeys Liao ma Fang Prescriptions for Horses Bo Le Zhi Ma Za Bing Jing Treatise on Treatment for Sick Horses by Bo Le Note absence of specialty in canine or feline practice

14 Tang Dynasty ( CE) Rapid advancements in veterinary medicine Horses were a prized possession Indicating wealth and status Military requirements for healthy horses also stimulated veterinary development Comprehensive veterinary education system was established Xin Xiu Ben Cao, Newly Revised Materia Medica Published by government in 659 CE Described 844 Chinese herbal medicines China s earliest pharmacopeia for human and veterinary medicine

15 Ming Dynasty ( CE) Li Shi Zhen s Ben Cao Gang Mu Yuan Heng Liao Ma Ji Fu Niu Tuo Jing, Yuan-Heng s Therapeutic Treatise of Horses Two brothers, Yu Ben-Yuan and Yu Ben-Heng Representative work of the knowledge and treatment of equine diseases using acupuncture and herbal medicine Many texts were published concerning the treatment of veterinary agricultural species

16 Decline and Rebirth : China was a semi-colonial semi-feudal society After introduction of western medicine in 1700 s traditional Chinese medical practices fell into decline During this period acupuncture and Chinese herbal medicine suffered greatly Acupuncture was banned from the Imperial College 1949 Cultural Revolution The rebirth of Traditional Chinese Medicine 1956 governmental policy on teaching and improvement of Traditional Chinese Veterinary Medicine

17

18 Herbal and Food Energetics Herbs are concentrated food Energetics and properties apply to both Use of both is in accordance with the philosophical medical principles ingrained in the Chinese culture Naturalism, Daoism, Confucianism A proper Chinese Medical Diagnosis is crucial! Acupuncture is forgiving Foods not as forgiving but a bit Herbs you gotta know! Your diagnosis determines treatment strategy!

19 Treatment Strategies Sweating pathogen has invaded the superficial layers of body In patients that don t sweat a mild increase in panting and heat intolerance is observed Weak patients combine with tonification Vomiting Strong patients with acute presentation of food stagnation or toxins in upper half of body Modern emetics are stronger than traditional herbs Draining downward or Purging Strong treatment method; use with caution Toxins or accumulations in the lower half of the body Weak patients must balance with tonification

20 Treatment Strategies Harmonizing Attack and tonify simultaneously Complicated cases with conflicting clinical signs Hot and cold Different parts of the body are affected, such as Spleen and Liver Shaoyang disorders Disharmonies of Blood and Qi Will often be employed in our patients

21 Treatment Strategies Warming Warms the channel, Organ or specific body part affected Discern if there is Cold due to Cold invasion or lack of Yang Clearing Formulas are cooling Clear heat and purge fire toxins from all three levels of the body Weak patients also tonified Reducing Eliminate stagnation and transform phlegm Dissolves nodules and hardenings Works gradually Chronic conditions with stubborn accumulations

22 Treatment Strategies Tonifying Replenishes deficiencies of the Fundamental Substances Qi, Xue, Jin-ye, Jing, Yin and Yang Deficient patients with concurrent excess pathogenic processes must be treated with tonification as well as other clearing, draining or reducing strategies They should ever be treated with tonification alone you will feed the guest in your house. Patients with Bi and Wei syndromes more than one of these strategies be employed In fact this can be said of any chronic condition

23 Classification of Chinese Temperature Taste Direction Channel influence Herbs and Foods Herbs are chosen based on these inherent properties which can address the characteristics of the imbalance Toxicity is also considered If there is an herb needed that has potential toxicity other herbs are included to offset toxic aspect and/ or have similar action allowing a lower dosage Fu Zi, Aconite

24 Temperature Herbal medicine is a heteropathic therapy If something is cold you warm it up If something is hot you cool it down Same applies to food therapy Cucumber vs. Hot pepper Avocado vs. lemon Temperature or energetic gradient is also on the Yin/ Yang continuum Cold and cooling are Yin Hot and warming are Yang

25 Five Energies Cold TCVM Actions Physiologic Effects Examples Purge Heat and Fire Cool Blood Anti-inflammatory Anti-spasmodic, sedative Coptis Huang lian Lycium bark Di gu pi Gardenia fruit Zhi zi Cooling Relieves Heat Resolves Toxin Reduces fevers, detoxifies Lowers blood pressure Soothes nerves Bupluerum Chai hu Morus Sang ye Pueraria root Ge gen Neutral Mediates Cold, Cool, Hot and Warm herbs Gentle effects, regulates Glycyrrhiza Gan cao Jujube Da zao Warming Warms the Interior Disperses Cold Promotes circulation Alleviates chills Ledebouriella Fang feng Cinnamon twig Gui zhi Angelica root Du huo Eucommia bark Du zhong Hot Tonifies Yang Qi Activates the Channels Improves Organ functions Stimulates and strengthens Zingiberis Gan jiang Cinnamon bark Rou gui Aconite Fu zi

26 Sensation perceived by Chinese healers and scholars Combined with clinical results Taste reflects biochemical components of herbs (foods) Hawthorne berry, Shan zha, sour taste High percentage of acids including flavonoids Coptis, Huang lian, bitter!!!! Five Flavors High percentage of berberine an isoquinolone alkaloid with antibacterial effect Sixth category not often discussed Bland Little to know distinct flavor

27 Six Flavors Acrid or Pungent TCVM Actions Physiologic Effects Examples Other qualities Ephedra Ma huang Activate Qi and Blood Vladimiria Chuan mu xiang Diaphoretic Zingiberis Sheng jiang Stimulate blood circulation Distribute energy from the interior to the surface Can induce sweating to remove pathogenic Qi Cloves, garlic, fennel, chives, ginger, nutmeg, radish, pepper, wine White Pale Lungs Metal Sweet Tonify Nourish Harmonize soothe and regulate Tend to moisten, calm and cool Tonify deficiency Soothe acute diseases Regulate internal organ functions Ginseng Ren shen Glycyrrhiza Gan cao Astragalus Huang qi Rehmannia Shu di huang Apple, banana, corn, egg, carrot, yam, sugar, wine Yellow Brown Spleen Earth Sour Astringe Stabilize and Bind Prevent fluid loss Maintain integrity of respiratory and digestive tracts Contracts flaccid tissues Stop abnormal secretions or discharges Promote digestion Stimulate enzyme secretion and liver function Alter blood conditions Schisandra Wu wei zi Mume fruit Wu mei Hawthorne fruit Shan zha Apricot, grape, mango, peach, pineapple, plum, vinegar, tomato Green Yellow-green Liver Wood

28 Bitter Clear Heat toxins Eliminates Damp-Heat Purges intestines Many have antiviral, antibacterial, anti-inflammatory and antipyretic properties Detoxify Enhance secretion of bile through the liver Promote gastric secretion of HCl Anti-cholesterolemic actions Coptis Huang lian Rhubarb Da huang Gentiana Long dan Asparagus, celery, coffee, porcine and ovine bile Red Heart Fire Salty Soften hardness Dissolve stagnation Purges accumulations by sinking Qi downwards Purge intestines Diuretic properties Softens hard masses and resolves bumps Relieves constipation through purgation Helps maintain fluid balance Mirabilite Mang xiao Sargassum Hai zao Oyster shell Mu li Abalone, barley, clam, crab, duck, ham, kelp, pork kidney, oyster, mussel, human milk Black Dark Kidney Water Bland Diuretic effect Treat edema and dysuria Poria Fu ling Polyporus Zhu ling Talcum Hua shi Job s tears, button mushrooms

29 Direction How or where an herb will send its energy within the body Think of eating wasabi.. Now, think of eating an avocado. Now, think of drinking peppermint tea. Herbs have the same variety of actions Bupleurum, Chai hu, raises Qi head, chest, upper limbs Rhubarba, Da huang, purges pathogens via stool or urine Ephedra, Ma huang, outward directing make you sweat or consolidate the exterior Schisandra, Wu wei zi, inward directing protect Zang and Fu or conserve Essence

30 Channel Entered Guides the formula to a specific channel or Organ Some will help to clear obstructions from channels Cinnamon, Gui zhi Earthworm, Di long Herbal formulas for Bi syndromes contain channel clearing herbs as well as those with affinity for Bladder and Kidney channels Herbal formulas for Wei syndromes contain herbs to nourish Qi, Yin, Yang, Xue as needed

31 Composition of Chinese Herbal Formulas Built using a metaphorical hierarchy based on a model discussed in the Nei Jing Su Wen Construct a balanced formula to address the pattern and minimize side effects from any individual herbal component There are four components in a formula: the chief herb (or emperor) the deputy herb (minister) the assistant herb the envoy

32 Composition and purpose Chief herb addresses the main pattern imbalance Essential to the herbal formula Deputy herb aids the chief in the principle imbalance Also serves to address any secondary issues Assistant herb has multiple duties Reinforces chief and deputy by addressing contributing issues to pathology Also often offset any toxic properties of the chief or deputy In large complex formulas may have opposite effect of the chief To provide balance to the formula The envoy herb delivers the action of the formula to a specific area of the body, channel, or organ Also often harmonizes the entire formula

33 Complex, chronic vs. Simple and acute Patient with a complex problem may require a very complex formula A Chief with a number of ministers and assistants Superficial or acute imbalance generally only requires a simple formula A chief with a few deputies It is possible, sometimes necessary to modify Chief is almost never changed Assistants or minor deputies can be changed Sometimes the addition of another herb to address the pathology is done Corydalis, Yan hu suo, very good for pain

34 Formulas for Bi Syndrome Primarily classic formulas Reference to herbal formulas created by Dr. Steve Marsden for veterinary species To choose the correct formula means to have the correct TCM/ TCVM diagnosis A patient with a Kidney Qi and Yin deficiency pattern will be made worse with a formula that is warming!

35 Shen tong zhu yu tong Tao Ren Persica Hong Hua Carthamus Relieve pain, activate Blood Chuan Xiong Ligusticum Qiang Huo Notoptergium Dang Gui Angelica Nourish and move Blood Mu Xiang Sausserea Relieve pain, move Qi Niu Xi Achyranthes Strengthen bones, limbs Qin Jiao Gentiana Clear Wind-Damp, Nourish Yin Di Long Earthworm Move channels, Clear Wind-Damp Mo Yao Myrrh Move Blood, Qi; Resolve stagnation *Caution pregnant animals, can cause abortion

36 Du huo Angelica Clear Wind-Damp Sang ji sheng Loranthus Warm interior, Dispel Cold Fang feng Qin jiao Siler Gentiana Niu xi Achyranthes root Clear Wind-Cold Fu ling Poria Clear Wind-Damp Xi xin Asarum Du zhong Eucommia bark Tonify Kidney Yang Rou gui Chuan xiong Cinnamonn bark Ligusticum Dang gui Angelica Nourish and Move Blood Bai shao yao White peony Resolve Stagnation Sheng di huang Du huo ji sheng tang Kidney Qi Def, Liver Blood Def Rehmannia Ren shen Ginseng Tonify Qi Gan cao Licorice Harmonizer LIV/KI Qi Def, Blood Def Aversion to Cold

37 Supple Spine nourishes tendons and ligaments Du huo Angelica Clear Wind-Damp Sang ji sheng Loranthus Warm interior, Dispel Cold Fang feng Siler Qin jiao Gentiana Clear Wind-Cold Fu ling Poria Clear Wind-Damp Xian Mao Circuligo stronger strengthening bone Du zhong Eucommia bark Tonify Kidney Yang Rou gui Cinnamonn bark Chuan Niu Xi Cyathula Root Stronger blood mover & Chuan xiong Ligusticum Nourish and Move Blood Bai shao yao White peony Resolve Stagnation Shu di huang Rehmannia more warming, Blood nourish Ren shen Ginseng Tonify Qi Gan cao Licorice Harmonizer

38 Xiao huo luo dan Quick River Cao Wu Aconite Warm Channels, dispel Wind-Cold-Damp Chuan Jiang Huang Wu Turmeric Aconite Tian Nan Xing Arisaema Transforms phlegm, Resolve stagnation Di Long Lumbricus Activate the Channel Mo Yao Myrrh Resolve stagnation, Ru Xiang Olibanum relieve pain (Boswelia) Caution: Aconite is toxic! Use short period - 2 months Qi and Blood Obstruction Also wind-stroke with numbness and pain

39

40 Yi Yi Ren Free the Sinews Du Huo Ma huang Ephedra Dispel WC from exterior Gui zhi Cinnamon Drain damp through urine Gui zhi also opens channels in extremities Dang gui Angelica Activate Blood Bai shao Peony Relieve Pain Cang zhu Atractylodes Drain Damp Yi yi ren Angelica Coix Zhi gan cao Glycyrrhiza Harmonize Sheng jiang Zingiberis Harmonize Using Du Huo brings formula to back and neck as well Gui Zhi maintains effectiveness in peripheral channels Can add Sang Zhi, Morus twig to help smaller joints, esp. FL

41 Benefit Hips and Knees Xiao Chai Hu Jia Qin Jiao Tang Chai Hu Bupleurum root Relieves LIV Qi Stag, raises Qi Ren Shen Ginseng root Tonifies primary Qi: SP/ LU/ HT Qin Jiao Large-leaf gentian root Dispels WD, relaxes sinews drains DH, clears deficient Heat Huang Qin Scuttelaria clears DH, relieves toxicity Fa Ban Xia Pinellia root, treated dries D, resolves Phlegm, LU Qi, Reb. ST Qi Gan Cao Licorice root harmonizer, stops spasms & pain Gan Jiang Dried ginger root warms middle, dispels cold Hong Zao Red jujube fruit harmonizer, tonifies SP/ST XCHT: Opens TH longitudinal circulation and expels pathogenic factors to exterior Qin Jiao further enhances distribution to joints, esp Hip and Stifle (GB Affinity)

42 Bupleurum and Kudzu Clearing Formula Jia Wei Chai Ge Jie Ji Tang Chai Hu Bupleurum root Relieves LIV Qi Stagnation, raises Qi Du Huo Angelica pubescens Clear Wind-Damp Huang Qin Scuttelaria clears DH, relieves toxicity Ge Gen Kudzu root disperses WH, dispels pathogens from muscles Bai Shao Yao White peony root tonifies Blood, Yin; moves LIV Qi, nourishes LIV Qiang Huo Notopterygium root expels WCD, unblocks channel osbtruction Hong Zao Red jujube harmonizer, tonifies SP/ST Sheng Shi Gao Gypsum clears H from Wei level and Yangming channel Bai Zhi Angelica root expels W and WC, releases exterior, alleviates pain Jie Geng Platycodon opens Lung, resolves phlegm, guides other herbs Gan Jiang Dried ginger warms middle, dispels cold Gan Cao Licorice harmonizer, stops spasms and pain Main thrust is to expel pathogenic factors from the different Yang levels Chai Hu Shaoyang; Shi Gao and Bai Zhi Yangming; Ge Gen and Qiang Huo Taiyang Bai Shao, Hong Zao, Gan Cao, Gan Jiang nourish and protect inner

43 Sublime Joint Formula Xian Fang Huo Ming Yin Chuan Bei Mu Fritillary bulb resolves phlegm, Dang Gui Wei Angelica root tail tonifies and moves Blood, alleviates pain Bai Zhi Pungent Angelica expels W, WC, rel. exterior Fang Feng Siler alleviate pain Mo Yao Myrrh Invigorate blood, break blood stasis, move Qi, Ru Xiang Frankincense (Boswelia) reduce swelling, generate flesh Chi Shao Red Peony clears heat, cools blood, dispels blood stasis Gua lou Trichosanthes root clears heat, resolves phlegm Zao Jiao Ci Gleditsia spine eliminates toxicity, drains pus, activates blood circulation, reduces swelling Jin Yin Hua Honeysuckle clears heat, relieves toxicity, disperses WH Chen Pi Tangerine peel regulates Qi, harmonizes middle, dries D Gan Cao Licorice harmonizer, nourishes Spleen Chronic accumulation of Damp, Heat and Phlegm with significant Blood Stasis Hemorrhagic disorders, chronic lameness, osteoarthritis with heat and swelling, poorly healing wounds and even inflamed tumors. Contraindicated in Qi deficient, Yin or Blood deficiency

44 Herbal Formula: Bai hu si miao tang Zhi mu Anemarrhena Clear Heat Shi gao Gypsum Hai tong pi Erythrina Clear Wind-Cold-Damp Gui zhi Cinnamon twig Cang zhu Atracylodes Huang bai Phellodendron Clear Damp Yi yi ren Coix Clear Heat Niu xi Achyranthes Last four herbs are Si miao tang Infectious arthritis, rheumatoid arthritis, immune-mediated arthritis

45 Single Herbs Yan hu suo : corydalis tuber Blood Invigorating Promotes movement of Qi Alleviates pain all kinds Jie geng : platycodon root Phlegm Resolving Opens lung, resolves phlegm Directs other herbs to upper jiao

46

47 Respiratory Disease According to Chinese Physiology

48 Chinese Correspondences The Lung is the Canopy It covers and protects Lung Hand Tai Yin channel Connected to Leg Tai Yin channel - Spleen Paired with Large Intestine Hand Yang Ming Autumn Metal

49 Chinese Physiology The Lung is the Canopy It covers and protects Most exterior of all Zang Fu First interface with the environment Breathing Extracts Qing Qi (O 2 ) from air Utilized in production of Ying Qi which circulates in blood vessels to nourish all organs and tissues Lung Qi Infuses the Ying Qi into the blood vessels Qi moves the Blood as Blood nourishes Qi LU 9 : Hui-Influential point for Vessels Descends and Disseminates Qi and Fluids First Organ exposed to airborne pathogens!

50 Lung Physiology Wei Qi Strong affiliation with Wei QI Immune system humoral and cell- mediated IgA, Alveolar macrophages ( Giant cell capsules) Instinctive body mechanisms for survival Microvilli anatomical defense system! Regulation of opening and closing of pores Thermoregulation Protection from External Physical Environment Shivering when cold Allows us to live harmoniously in our physical environment Wei Qi travels under surface of the skin cuo li Wei Qi travels internally as well mucous membranes of gastrointestinal system (GALT.) Association with Large Intestine

51 Lung Physiology Fluids Descends Fluids Moistens the skin and tissues Suppleness of skin, integrity Suppleness of fascia to some extent Liver Blood is most important but Lung fluids supplement Serosal and mucosal surfaces of internal organs Fluids descend to Kidney Turbid excreted as urine Pure replenish Kidney Yin Kidney Yin balances Heart Fire Action of Kidney Yang on Kidney Yin creates Kidney Qi and steams fluids back up to the Lung Lung and Kidney important role in circulation of fluids

52 Lung Physiology Extension of Spleen Lung is Hand channel of Tai Yin Spleen is Foot channel of Tai Yin They are two aspects of the same channel Lung Primary channel begins in the area between the Stomach and Spleen Spleen supports the Lung Ascends the Gu Qi to the Lung where this combines with Qing Qi to form the Wei Qi and Ying Qi Both the Spleen and the Lung are crucial to the manufacture and circulation of Qi in the channels In part this is our energy ATP production Both the Lung and the Spleen are important in Ying Qi Manufacture and Circulation

53

54 Physiology in summary Lung affects all movements of Qi Ascending, Descending, In and Out Most external Organ thus affected most by EPF Harmonizes flow of Blood due to flow of Qi Opens and regulates water channels LU 7 LU Qi descends the fluids; Received by KI Qi Connected with skin, body hair Pores opening and closing, sweating, skin resistance Open into nose and connects with throat Connects with Large Intestine

55 Pathophysiology Disharmony reflected in: Water or fluid regulation Air movement Qi movement Diseases of nose, throat and large intestine Closely related Organs Spleen Qi and Phlegm relation Kidney Qi and Fluid relation

56 Acute versus Chronic Rebellious Lung Qi Coughing! In acute infections should be viewed as normal body response to invading pathogen Viruses, bacteria, foreign bodies, pollen Production of mucous As the normal movement of Qi and Wei Qi is disturbed so is the movement of fluids Fluids accumulate in nasal and bronchial passageways To some extent also a normal body response to help move insulting organisms/ pathogenic factors out of the body Sweating Another normal mechanism of the body to rid an EPF In acute conditions a good thing! Body s normal response

57 Wind-Cold Acute onset, sneezing, nasal congestion clear Muscle aches, chills Aversion to Wind and Cold Pale tongue or normal, thin white coat Pulse superficial and tight Exterior Excess Cold or Lung Wind-Cold Typical cold Acute Respiratory Generally think URI Wind Heat Acute onset Sneezing, nasal obstruction with think yellow mucous Sore throat Fever more than chills, thirst Avoids wind and cold Tongue +/- red, thin yellow coating Pulse superficial and rapid Exterior Heat Excess Lung Wind Heat

58 Treatment with AP and Chinese Herbs Acute Wind Cold Dispel Wind-Cold LU 7, LI 4 Expel Exterior Wind (cold and heat) BL 12 Feng men BL 13 Fei Shu Aches in upper body GB 20 Feng chi Additional Points GV 14 Expels Ext. Wind BL 10 Wind, aches LI 20 local, nasal CV 22 local, throat Herbs Ge gen wan Pungent Warm Exterior Relieving Ge gen, Ma huang, Gui zhi, Bai shao yao, Sheng jiang, Da zao, Zhi gan cao Taiyang stage - aches Xiao Qing Long wan Minor Blue Dragon Pungent Warm Exterior Relieving Ma huang, Gui zhi, Bai shao yao, Gan jiang, Xi xen, Wu wei zi, Ban xia, Zhi gan cao Pre-existing SP Qi Def

59 Acute Wind-Heat Dispel Exterior Wind Heat GV 14 also relaxes neck, tonifies Wei Qi LI 4 Tonifies Wei Qi TH 5 Tonifies Wei Qi LI 11 clears Wind-Heat Sore throat: LU 10 removes LU Heat LU 11, expels LU Heat SI 17 local point, expels Heat or Damp of the throat Additional Points: GB 20 clears Heat and Wind in upper body BL 12, BL 13 Herbals Yin Qiao Jie Du Pian Lonicera, Forsythia Resolve Toxin tablet Dispels W. clears Heat, resolves toxin, benefits the throat, relieves thirst, diffuses LU Qi Within first hours Not appropriate if EPF in lung Fang Feng Tong Sheng Wan Ledebouriella Opened by the Sage Decoction Dispels W, Clears H, resolves Toxins, frees the stool Tai Yang and Yangming stages

60 Chronic or Recurring URI Underlying Deficiency of either Qi (Yang) or Yin Chronic Deficiency Yang Interior Cold Def Easy to catch colds and flus Overweight, lethargic cats Qi def plus Cold T: pale, flabby, moist P: slow, weak Can include the chronic rhinitis/ sinusitis cats Chronic Yin Deficiency Interior Heat Def Frequent colds with Heat symptoms Herpes Virus cats; FeLV, FIV cats With stress develop URI usually with heat Nasal discharges with heat yellowish Tired, restless, feverish, sore throat or dry cough T: red, no coating P: rapid and weak, sometimes floating

61 Chronic Recurring URI or rhinitis/ sinusitis Address Acute Pattern Wind Cold Wind Heat Local points for Sinuses LI 20 Bi tong Yin tang BL 2 Phlegm will be underlying SPLEEN Phlegm Cold in Lung Transform Phlegm-Cold: BL 13 dispels WC in LU LU 5 disperses LU Phlegm Hot or Cold ST 40, LI 4 Tonify LU and SP: LU 9, SP 3, SP 6 Herbal San Zi Yang Qin Tang Three seeds to nourish one s parents Cold Phlegm transforming Bai jie zi White mustard seed Warms lungs, eliminates phlegm, promotes movement of Qi Zi su zi Perilla seed Descends rebellious Lung Qi, stops coughing and wheezing, resolves phlegm Lai fu zi Radish seed Improves digestion, relieves food stagnation, descends rebellious LU Qi, resolves phlegm

62 Chronic rhinitis Heat pattern Phlegm Heat in Lung Transform Phlegm-Heat: LI 4 Clears Wind- Heat, tonifies Wei Qi LU 5, ST 40 Phlegm, Hot or Cold GB 20 for Heat especially in upper body BL 13 Tonify SP: SP 3, SP 6, SP 9 TH 5 clears heat LU 6 Disperses Phlegm-Heat Cang er zi External Wind Expelling Nasal congestion w/ thick nasal discharge Cang er zi Xanthium fruit Pungent, bitter, warm: Opens nasal passages, expels W-D, relieves pain Xin yi Magnolia flower Pungent, warm: Expels W-C, opens nasal passages Bai zhi Angelica root Pungent, warm: Expels W-C releases exterior, alleviates pain Bo he Peppermint Pungent, cool: Disperses W-H, releases exterior, clears head, moves Liver Qi

63 Chronic rhinitis May need to support Spleen Si jun zi tang Four Gentlemen Ren shen, Bai zhu, Fu ling, Zhi gan cao If Yin deficiency is prevalent or Yin is damaged Zuo gui wan Liu wei di huang wan Both contain Shu di huang which can be too much for patients with SP Qi Deficiency Mai men dong tang Mai men dong nourishes LU and ST Yin; Contains Ren shen, Da zao, Gan cao that help support SP

64 Lower Airway disease Chronic coughing, bronchitis, asthma Because Lungs are Exterior can have direct invasion of Lungs leading to deeper problems Affecting bronchi and lung tissue Wind-Heat, Wind-Cold and Wind-Dryness Can also have the transference of an EPF that was affecting only the nose and upper passageways travel deeper as Wei Qi is weakened Bordetella turning into chronic bronchitis or pneumonia Again will have some mixed patterns Excess symptoms but underlying Deficiencies Deficiency in Lung, Spleen, Kidney

65 Deeper invasion Same patterns as with URI but now Lung Organ affected Wind Cold Cough External invasion of Wind and Cold Cough, laryngeal, pharyngeal irritation Acute Onset Exterior Cough Chills T: thin white coating P: superficial and tight Wind Heat Cough Invasion of Wind-Heat Transformation of Wind- Cold to Wind-Heat Acute onset Cough Heat signs Fever, sore throat, thick yellow sputum T: red, thin dry white or yellow coating P: rapid; superficial

66 Chronic Coughing Patterns Deficiency of Lung Qi Weakened by antibiotic or steroid use May also be associated with Kidney Qi Deficiency Decreased ability of LU to descend Qi Decreased ability of KI to Grasp descending Lung Qi LU Qi deficiency signs Weak cough, chronic; weak voice Gets cold easily Short breath Clear diluted sputum Edema in forelimbs KI Qi Deficiency Signs Weakness in hindlimbs Cool in lower back and extremities Incontinence Edema in hindlimbs

67 Chronic Coughing Lung Qi Deficiency combined with Yin Deficiency Yin Deficiency of Kidney or Lung or Both Signs of Qi Deficiency Signs of Yin Deficiency Chronic weak cough, dry Tires easily Back soreness Kidney Frequent urination, scanty Tongue: Pale, thin, white coating Qi Deficiency Red, dry, no coating Yin Deficiency Pulse Weak, deep Qi deficiency Thin, rapid Heat from Yin Deficiency

68 Chronic Coughing Patterns Phlegm cough say hello to Spleen Chinese saying: Phlegm produced by Spleen but held by Lung Can be a cold or heat pattern differentiate based on pulse and tongue General signs Rattling Cough Heaviness in chest Decreased appetite - phlegm Difficulty breathing Sputum White cold pattern Yellow, green colors of heat T: pale, thick white coat Cold; red w/ yellow Heat P: Slippery, Full; tight Cold, rapid Heat

69 Chronic Coughing Again address Heat or Cold symptomatology For Cold signs: LU 7, LI 4, BL 13, BL 12 CV 22 for cough For Excess Heat signs: GV 14, LI 4,LI 11, LU 7, TH 5, GB 20 LU 10 Clears LU Heat CV 22 for cough Address Phlegm if present Transform Phlegm: LU 9, ST 40; LU 5 Benefit Spleen SP 6, SP 9, SP 3 If heat or damage to Yin KI3, KI 6, BL 23, LU 5

70 Underlying Deficiency with Chronic Cough Lung Deficiency Benefit Qi and circulation: ST 36, CV 17 Tonify Lung, Kidney; LU 7, LU 9, BL 13, LU 5 clears LU Heat and Benefits LU Yin KI 3, BL 23, BL 26 Herbals Bu Fei Tang Benefit Lung Decoction LU Qi deficiency without Heat signs Huang Qi, Ren Shen Huge Qi tonics for Spleen Shu Di Huang, Wu Wei Zi nourish and astringe Yin

71 Lung and Kidney Qi Def Ren Shen Yang Ying Tang Ginseng and Walnut Decoction Coughing or wheezing due to def of Lung and Kidney with slight cold signs Ren Shen - ginseng Hu tao ren juglans (walnut) Sheng jiang fresh ginger Da zao Chinese plum Su Zi Jiang Qi Tang Perilla Fruit Decoction for Directing Qi Downward Lung Phlegm Damp with underlying Kidney Qi Def causing wheezing with profuse Phlegm Zhi gan can Fried Licorice Ban Xia Pinellia Zi Su Zi Perilla seed Dang Gui Angelica Hou Po Magnolia Qian Hu Hogfennel root Rou Gui Cinnamon Sheng Jiang Fresh ginger Zi Su Ye Perilla leaf Da Zao Chinese Date

72 Chronic Cough with Qi and Yin Deficiency Same point to nourish and circulate Qi Benefit Yin and Clear Heat gently KI 3, KI 6, BL 23, CV 4, SP 6 Benefit Yin LU 10 clears LU Heat, LU 5 Clears Yin Def heat, LU 6 cool LU Heat Circulate Yin Fluids LU 7, KI 6 (Ren Mai)

73 Lung Qi and Yin Deficiency Ren Shen Huang Qi San Ginseng and Astragalus Powder Lung Yin Deficiency with false heat and Spleen Qi Deficiency causing cough with scanty sputum and fatigue Ren shen, Huang Qi, Fu Ling Jie geng, Ban xia Nourish and move Qi Drain or transform Damp Sheng di huang, Di gu pi, Tian men dong, Chi shao yao, Zhi mu, Qin jiao, Sang Bai Pi Nourish Yin and clear false heat Chai hu, Gan cao Bai He Gu Jin Tang Lily Bulb Decoction to Preserve Metal Bai he, Mai men dong, Sheng di huang, Shu di huang, Xuan shen, Bai shao yao All nourish Yin, clear false heat Xuan shen (scrophularia) also softens hard masses Bai shao yao also moves Liver Qi Bei mu, Jie geng Transform phlegm Dang gui, Gan cao

74 Asthma Wheezing Difficulty breathing Acute attacks but there is a general underlying deficiency Lung Qi Deficiency Kidney Qi Deficiency Spleen Qi Deficiency Yin Deficiency Acute triggers can include EPF - Wind Cold, Wind Heat Emotional stress Direct effect on Lung, Kidney Stress effect on Liver which disturbs normal movement of Qi

75 Lung Qi Deficiency Overwork Chronic exposure to irritants Smoke, pollen Emotional factors Chronic disease History of chronic URI Treatment with antibiotics and steroids further weaken the Qi Bu Fei San Weak cough, Non- to slightly productive Worse with movement Spontaneous sweating Dry coat hair breaks Clear nasal discharge if any Weak voice Avoids cold and wind Lassitude and weakness T: pale, thin white coat, superficial cracks P: thin, weak and deep

76 Kidney Deficiency Asthma Overwork, poor lifestyle, stressful Chronic disease Age Over time Kidney Qi is damaged or depleted Ren Shen Yang Ying Tang Jin Gui Shen Qi Wan Chronic asthma, lethargy Back problems +/- Weakness Qi Def If signs of Cold Yang def as well Urinary problems Incontinence, slow urination Tongue: pale, moist, swollen Pulse: weak, thready

77 Lung and Spleen Qi Deficiency Chronic illnesses, improper lifestyle Raw foods; processed foods Emotions Weak cough, tired, weak voice, spontaneous sweating Poor appetite, loose stools, Worse with movement Hair breaks easily (LU) and falls out (SP) T: pale, superficial cracks, ±moist, may be wide P: weak, deep, thin, may be slippery Su Zi Jiang Qi Tang Support Kidney and thus support Spleen

78 Lung Yin Deficiency Prolonged fever or illness Excessive sexual activity Mismanagement of diet or work Emotional Ren Shen Huang Qi San Bai He Gu Jin Tang Weak, DRY cough Prevalent at NIGHT Spontaneous sweating at NIGHT Avoids Heat Thirst for small amounts of water Dry mouth, nose, skin, hair Sticky, crusty nasal discharge T: red, no coat, small and dry P: thin, rapid, superficial or floating

79 Bai He Gu Jing Tang Lily Bulb Decoction to Consolidate the Metal Sheng Di Huang Rehmannia Nourish Yin Shu Di Huang Rehmannia, prepared Clear Deficiency Fire Mai Dong Ophiopogon Nourish Yin, moisten Lung Bai He Lily Bulb Dissolve Phlegm, stop coughing Zhe Bei Mu Fritillaria Xuan Shen Scrophularia Cool Blood, clear deficiency fire Dang Gui Angelica Nourish Yin Bai Shao White Peony Tonify Blood Jie Geng Platycodon Smooths the Lung Qi, dissolves phlegm Gan Cao Glycyrrhiza Harmonizes Treats Lung and Kidney Yin Deficiency Kidneys and Lungs both important in production and circulation of Qi and Yin Evaluate in any Wei Syndrome patient

80 Additional Considerations Sometimes Liver will be involved Personality Secondary Treat what you see. LIV 2, LIV 3 if Liver involved BL 17 Empirical point based on anatomy Ge Shu Diaphragm Shu : Relaxes diaphragm Huge structures pass through the diaphragm Aorta, vena cava, vagosympathetic trunk Also Influential point for Blood so helpful if signs of Blood def

81 If Phlegm is significant address Spleen Six GentlePets (Liu Jun Zi Tang) Bai Zhu Angelica root Fu Ling Poria Si Jun Zi Tang Ren Shen Ginseng root Gan Cao Licorice root Ban Xia Pinellia Er Chen Tang Chen Pi Tangerine peel

82 Herbs for Common Digestive Imbalances

83 Spleen and Stomach Stomach receives the food and is the ripening and rotting vat It likes to be warm and moist A good cauldron Gu Qi that is present in the food and drink ingested is released and is transformed into useful substances for the body Qi, the thin fluids, (Jin), and the thick fluids, (Ye) The Stomach is said to be the source of all fluids the Jin and the Ye, with assistance from the Spleen

84 Spleen Further Transformation and Transportation of the Qi taken from ingested material Chinese scholars considered the pancreas to be part of the spleen; describing it anatomically as being 3 cun wide, 5 cun long and containing an additional 0.5 jin [approximately 250gm] of tissue spreading around it. D. Kendall, Dao of Chinese Medicine, p.46 Also responsible for transporting the clear fluids or essence of the food and drink ingested upwards to the Lungs The Spleen prefers to remain dry Balancing the Stomach s need for moisture

85 Spleen and Stomach Vital to the balance and harmony of the fluids in the body The Spleen is often involved with the pathologic production of fluids when transformation of moisture in the food to the Jin-Ye is incomplete and an unusable form of Yin is produced called Dampness

86 Clinical signs Spleen chief source of nourishment for the body Responsible for maintaining the flesh and bulk of the body, including limb musculature With dysfunction atrophy, muscle loss Spleen opens to the mouth Pathology may be reflected with changes in the mouth. Accumulation of Dampness due to dysfunction of the Spleen is reflected by a thick coating on the tongue and a wide tongue Inflammation of the gums is seen with excessive heat and dryness in the Stomach

87 Injuries to Spleen/ Stomach Spleen is prone to damage by excess dampness Environment Diet High in sugars and short-chained carbohydrates, raw Stomach is prone to damage by heat and dryness Excess heat in the body, as with a fever Ingested food is too hot Spicy (jalapeño or habañero peppers) Energetically, such as lamb or dry food

88 Formulas to discuss Acute disruption of Stomach function Spleen Qi Deficiency Formulas Formulas to address more significant Dampness Formulas to address the Liver

89 Huo Xiang Zheng Qi Wan Agastache Pills Huo xiang Agastache Transforms Damp, regulates middle, stops vomiting, exterior patterns! Bai zhu Atractylodes Tonifies SP Qi, Dries Damp Hou po Magnolia Directs rebellious Qi, Transforms Damp Jie geng Platycodon Resolves Phlegm, ventilates Lung Chen pi Citrus Regulates Qi, Dries Damp, Resolves Phlegm, Ban xia Pinellia Dries Damp, Resolves Phlegm, Harmonizes ST, Qi Da fu pi Areca Directs rebellious Qi, Dries Damp Bai zhi Angelica Expels WC, Expels Dampness Zi su ye Perilla Expels WC, moves Qi in middle burner Fu ling Poria Dries Damp, Tonifies SP Da zao Jujube Tonifies SP, Harmonize formula Gan jiang Ginger Warms middle, dispels Cold Expels WC, releases exterior; transforms Damp, moves Qi, harmonizes middle burner Synergistic effect of Huo xiang and Zi su ye against aerobic bacteria (salmonella)

90 Huo Xiang Zheng Qi Wan Acute invasions of external pathogenic factors including modern day viruses and bacteria. Developed to use against Wind-Cold-Damp invasions that led to acute gastroenteritis complaints, (diarrhea, indigestion, and nausea) commonly producing high fevers Modern day applications include food poisoning, indigestion, hematemesis, hematochezia as well as acute or chronic refractory diarrhea High concentration of aromatic herbs biomedical effect of killing microbes, regulating peristalsis and relaxing spasticity, improving mucosal blood flow and enhancing absorption and digestive power

91 Protect the Middle Follows the classical formulation closely Da Huang, rhubarba, is substituted for Da fu pi, areca, as the FDA discourages its use Gan cao, licorice, replaces Da Zao and Gan Jiang as a harmonizer and contributing a bit to Spleen tonification

92 Tonification for Spleen Qi Deficiency Si Jun Zi Tang (Four Gentlemen) Ren shen Ginseng Tonify Qi Bai zhu Atractylodes Strengthen SP Fu ling Poria Strengthen SP, drain Damp Gan cao Licorice Harmonize, tonify Qi A base formula Nourishes the Spleen function Qi and Blood Ginseng a powerful adaptogen augments function of any organ system Lassitude, lethargy, diarrhea, decreased appetite, abdominal bloating Chronic gastritis, dysentery, peptic ulcer, anemia

93 Liu Jun Zi Tang Six GentlePets Ren Shen Ginseng 9g Bai Zhu Atractylodes 9g Si Jun Zi Tang Fu Ling Poria 9g Gan Cao Licorice 6g Chen Pi Tangerine peel 9g From Er Chen Tang Ban Xia Pinellia 12g Ban Xia and Chen Pi has a profound effect in directing this formula more towards the resolution of Dampness that is affecting the digestive function Phlegm-Dampness affecting the appetite and stomach function with clinical signs of decreased appetite, nausea, vomiting, fullness in chest and epigastrium. Loose stools may also be seen. Chronic gastroenteritis, peptic ulcer, sour regurgitation, indigestion, chronic bronchitis

94 Bu Zhong Yi Qi Tang Tonify the Middle and Augment the Qi Decoction Lift the Qi - Kan Huang Qi Astragalus Tonifies Zhong Qi, ascends Yang Qi, strengthen Wei Qi Ren Shen Ginseng Strengthen Spleen Bai Zhu Atractylodes Benefit Qi Zhi Gan Cao Glycyrrhiza Tonify middle jiao Dang Gui Angelica Tonifies and invigorates Blood Chen Pi Tangerine peel Regulates Qi and harmonizes Stomach Chai Hu Bupluerum Ascend Yang Qi Sheng Ma Cimicifuga Lift prolapsed organs This formula Tonifies Zhong Qi, or middle Qi, as well as raising the Qi Huang Qi, astragalus, further boosts the immune system function and Wei Qi production. Dang Gui, angelica, helps to nourish Liver Blood that has suffered due to the suboptimal Spleen function

95 Bu Zhong Yi Qi Tang Stimulate the production and circulation of Qi, including Wei Qi Effective formula not only for digestive issues Also where digestive dysfunction extends to other body processes Shortness of breath, weak voice, lassitude Prolonged diarrhea, prolapse of organs, fecal or urinary incontinence Chronic uterine bleeding Anxiety or emotional disorders Immune deficiency Ginseng, Astragalus and Licorice are all powerful adaptogens Account for its ability to treat seemingly opposite conditions Fatigue and insomnia Diarrhea and constipation Low blood pressure and hypertension Reduces smooth muscle spasticity thus being useful in cases of diarrhea or constipation where this is an underlying cause Contraindication: low grade fevers due to Yin deficiency

96 Herbs for Dampness Wei Ling Tang Spleen Support Combination of two classic formulas Ping Wei San (Calm the Stomach Powder) Cang zhu Atracylodes Transforms D, Strengthens SP Hou po Magnolia bark Move Qi, dispel damp, Relieve food stag. (bloating) Chen pi Citrus Regulates Qi, Transform Phlegm Gan cao Licorice Tonifies SP, Harmonize Sheng jiang Ginger Harmonize SP/ST, warming Da zao Jujube Harmonize SP/ST Dampness Drying, Stomach Harmonizing category Dries Damp, strengthens Spleen, Regulates Qi movement in middle jiao Dampness obstructs Qi movement of SP/ST - Abdominal distension, fullness Decreased appetite, nausea, vomiting Belching, sour regurgitation Heaviness in body, loose stools Gastroenteritis and hepatitis

97 Wu Ling San Fu Ling Poria Tonifies SP, Drains Damp Zhu Ling Polyporous Promotes urination, eliminates Dampness Ze Xie Alisma Promote urination, eliminate Damp Bai Zhu Atracylodes Tonifies SP, Dries Damp Gui Zhi Cinnamon twig Expels WC, warm channels, warms Yang Downward Dampness Draining category Induces diuresis, warms the Yang, tonifies Spleen and strengthens the transformational function of Qi Safe and effective herbal diuretic Supports Spleen and elimination of dampness from the urinary system Acute gastroenteritis, acute and chronic nephritis, CRF CHF Ascites from liver cirrhosis, retention of urine and Meniere s syndrome

98 Wei Ling Tang Cang zhu Atracylodes Hou po Magnolia bark Ping Wei San Chen pi Citrus Gan cao Licorice Sheng jiang Ginger Da zao Jujube Fu Ling Poria Zhu Ling Polyporous Wu Ling San Ze Xie Alisma Bai Zhu Atracylodes Gui Zhi Cinnamon twig Downward Dampness Draining category Dispels Damp, regulates Qi in the middle burner, strengthens the Spleen and harmonizes the Stomach Chronic gastritis, enteritis, cardiac and nephritic edema and retention of urine Kan - Spleen Support Tong Cao for Zhu Ling Gan Jiang and Rou Gui replace Sheng Jiang and Gui Zhi - formula is more warming and more supportive of SP Ratio is also different to support diuretic function Hepatic Lipidosis cats, chronic pancreatitis, colitis, IBD

99 Xiao Yao San Happy Wanderer Chai hu Bupleurum Relieves LIV Qi Stagnation Dang gui Angelica Tonifies and Moves Blood Bai zhu Atractylodes Tonifies SP Qi, Dries Damp Bai shao yao Paeonia Blood Moves Liver Qi, Stops pain, Nourishes Fu ling Poria Tonifies SP, Drains Damp Sheng jiang Ginger Warms middle burner Gan cao Glycyrrhiza Tonifies Spleen, Harmonizer Bo he Menthe Moves Liver Qi Soothes the Liver, dispels Liver stasis, harmonizes LIV and SP, Moves Qi, invigorates Blood, Tonifies SP Qi, tonifies Blood, and regulates menses Irritable bowel, gastrointestinal neuroses, irritability, depression and estrogen imbalance, hepatitis, microvascular portosystemic shunts, skin conditions

100 Clinical Cases

101 Rexa Fischer 30 June year, GSD, SF Hx: arthritis since 4 yr Rad s in 2004: Signif hip osteoarthritis LS sclerosis and spondylosis Spondylosis L5L6,T8T9,T9,T10 Tried homeopathics-no help Presented on Devil s claw mixture

102 Rexa Fischer Hair coat dry and dull, more caudally Appetite and water okay better in pm Limited ROM both hips - 45 Severe atrophy both HL Owner now noticing weakness in FL BSP: tense in thoracic area, BL 18,19, BL23,24 tender and deficient; weak in LS Tongue: pinkish grey (lovely), slightly dry Pulses: deep, slow, thin, left pulse almost impossible to find

103 TCM Diagnosis? Excess or Deficiency? Interior or Exterior? Heat or Cold? Fundamental Substances? Organs? Deficiency Interior Chronic No clear signs, tendency to cool Qi and Blood Def Jing Deficiency Qi stagnation Kidney, Spleen, Lung

104 Rexa Fischer Working diagnosis Bony Bi with secondary Wei Syndrome Kidney Qi and Jing Deficiency Lung and Spleen Qi Deficiency AP: BL60/KI3, Ancestral Sinew treatment releasing iliopsoas and diaphragm muscles, BL 26, 23, jian jiao-b, GB 30r, SI9r, LI10L, SP4L Herbal? Du huo ji sheng tang

105 Rexa, 1 week later Relaxed after tx; slept well, walking better, even wanted to play with her ball! BSP: tight knot in BL17 region, weak BL 20,21; tight in LS region Pulses: still weak but more rounded, slightly tight Tongue: wide, pale pink, lavender in center AP: BL 60/KI3b,LIV3L, Ancestral Sinews-iliopsoas and diaphragm muscles, Weigen, BL 26, GV5 Continue Du huo ji sheng tang

106 Rexa, 20 Feb 2 weeks later Was sore after last treatment Pulses: better, still tight but not as turgid Tongue: pinkish lavender, still flabby and moist AP: continued with similar points Herbal change: added Yan hu suo (corydalis) to Du huo ji sheng tang 7 March Continues to improve slowly, more strength, playing more T: pale pink, thin white coat, little spongy P: blood side weaker, Qi side soft and narrow Began using Si jun zi tang plus the Du huo ji sheng tang with Yan hu suo combination

107 Rexa, 26 March Doing well, going upstairs easily now, stands more square, playing more and more P: Qi side better, Blood side still weak T: warm, pink, not as spongy Began using Shi quan da bu tang (kind of) Si jun zi tang (50g) + Si wu tang(50g) + Huang Qi(10g) Continue with Du huo ji sheng tang + Yan hu suo Doing SUPER!

108 Luna Rinck 5 year old, spayed female cat 6 months previous diagnosed with Chronic Bronchitis Long history (2 yr) digestive complaints Treated with metoclopramide, prednisone Fine now as long as eats Hill s D/D Overweight cat, fleshy Bumpy fat deposits along sterilization scar Always a bit eater, water normal Sneezes; Nasal discharge sticky, yellow, greenish Coughs occasionally can t see discharge swallows Def or excess? Def Spleen/ Stomach Really fine? SP Qi def Phlegm ST heat? Phlegm-Heat Rebellious LU Qi

109 Sensitive to laryngeal palpation Symptoms worse with damp Stools don t know, goes outside but when defecates inside are dry, small Resentful to palpation of hypochondriac region Generally friendly but did try to have another cat at home - became very irritable Tongue: pale, thick white coat, dry Pulse: right side very weak; left slightly thin BSP: BL 18, 20 sensitive, BL 24, 25 deficient Qi Stagnation Damp Spleen Luna Deficient fluids or Heat Hello Liver Liver Def Qi or Blood, Phlegm Heat or Blood Def Qi, Yin/Blood/Fluid Def LIV, SP, Qi Shu, LI

110 Luna TCM diagnosis? Predominant signs Qi def SP and Lung Signs of stagnation LIV Signs of Heat chronic heat consumes fluids Lung-Phlegm Damp, beginning Heat signs Sp Qi Deficiency underlying cause Liver Qi stagnation SP 3, BL 13, ST 36 LIV 13, BL 18 Yin tang, Bi tong Herbal Treatment: Si Jun Zi Ke Li Four Gentlemen San Zi Yang Qin - Three Seeds Nourishing Parents

111 Stuffie Schmidt DSH, CM 23 April 1991 First seen 3 Nov 2006 (16 years old) Chronic problem with GI On Metacam for pain, 10 drops/day and Zymoral Vomits occasionally Increased thirst Sensitive to diet change Stools thin, often little balls Pain in hypochondriac region T: pale, moist P: slippery, wiry BSP: BL 18-21, 23 Chronic Excess or Deficiency? Interior Problem Deficiency Rebellious ST Qi Excess? ST Fire? SP Qi Deficiency SP Qi Deficiency with Qi Stagnation LIV Qi Stagnation Qi Deficiency Qi Deficiency, Dampness LIV, GB, SP, ST, KI Spleen Qi Deficiency, Liver Qi Stagnation AP: LIV 13b, BL 17+1, SP 9r Herbal: Xiao yao san

112 Stuffie progress 15 Nov (2 weeks) Normal stool Eating canned food well, not eating as much grass Still some pain in hypochondriac Metacam 6 drops daily T: pale pink better, moist, slimy P: tight, thin, rapid, slippery on right BSP: BL 18,19,23 AP: LIV 13b, LIV 3r, LI 4l, CV 12, GV 3, 7, SP 9l 6 Dec (3 weeks) Normal stool, no Metacam, no vomiting Attitude much better more social, not as grouchy 85% better Maintain Xiao yao san and Zymoral

113 Stuffie, 2 and 3 months later 2 Jan more problems with defecation slightly painful and would cry after defecating Slightly tense in abdomen, stools sometimes hard, sometimes soft and smelly Stool had 2 colors, twisted? T: pale pink, moist P: right turgid, left weaker BSP: BL 18-20, weak BL 23 AP: Dai mai: GB 41r,BL 17, GB 26b, LIV 13b, CV 6 Added Wu Ren Wan(5 Seed Pill) to lubricate Large Intestine 2 Feb 07 No vomiting, normal stool No strong smell Maintained on Xiao Yao San and Si Jun Zi Tang

114 Herbal References Kan Essentials Handbook for Veterinarians Steve Marsden; describes certain formulas he has modified from classics Chinese Herbal Patent Medicines Jake Fratkin; gives brief description of many classic patented formulas. These are some of the oldest and most commonly used formulas. The Chinese Herbalist s Handbook Dagmar Ehling Organizes herbal formulas according to TCM diagnosis, great and easy reference once you are accomplished at reaching a TCM diagnosis Pocket Handbook of Chinese Herbal Medicine: ISBN-13: Zong Lan Xu Lists 300 individual herbs quick and efficient materia medica Pocket Handbook of Chinese Herbal Prescriptions: ISBN: Zong Lan Xu Lists 350 common herbal formulas Really want to learn need to take a course CIVT distance learning course offered by IVAS Chi Institute On line Hand s on course best working on a course to offer here in the Netherlands!

115