Asm202 - Lecture Notes 3

ASM 102 Lecture Week 3 Structure by which you can diagnose in TCM: 8 principles 6 pathogens 7 emotionals Zang-fu-yin/yang organs and their pathologies Pathogenic Factors - repeated throughout TCM - attacks from the outside - wind=yang, cold=yin, heat=yang, damp=yin, dryness=yang, summerheat=yang (summer heat is for only one aspect of time…in the summer…no guff) - you can get these 6 external pathogens in combination (ie heat-damp) - a pathology that is more yang in nature is sudden, acute and short lived - yin disorders tend to be internal disorders - WIND tends to be the carrier of most of these pathological factors 6 External Pathologies: Yang is more external in nature 1) Wind - aids in the movement of all other factores = the CARRIER – brings pathologies along with it - heat does not have a portal of entry in to his body – it can only attack the nape of the neck - in the summer-you will see more wind-cold due to airconditioning - in the winter you will see a lot of wind-heat because people are inside more often with the heat on - used as a carrier for other factors to enter the body…we are very susceptible to wind invasion around the occiput and the nape of the neck - wind rarely comes along (often seen with heat or cold) - wind moves around rapidly, however wind-cold does not move as fast as wind-heat - Lungs are affected first (Wei qi is distributed by the lungs). This is why : (1) The lungs send wei qi to the surface, where it is the first area of attack (2) the upper burner is more yang in nature-wind is yang in nature as well so it tends towards more yang organs because it wants to stay in Yang environment (3) The lung is the highest situated organ (Yang) and the closest to the nape therefore will see Lung pathologies first Wind Cold Sxs • KI is the most susceptible organ to cold in the body. Vitality fire burns between the two kidneys (MING MEN) and creates warmth in the body – therefore if cold wind affects the KI, then they need to work harder to keep Mingmen burning

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Pulses react more acutely than tongue diagnosis, which shows more chronic signs Wind-cold can easily turn in to wind-heat sneezing occurs because the nose is an outlet of the lungs (sending wei-qi to the surface). The nose is the first outlet area because it is the most exterior, even more so than the throat. refined qi is ying qi and wei qi discharge from a runny nose can also be clear, and tends to be in a larger amount because wind-cold than in wind-heat because cold is more yin in nature (and yin is more material) floating, tight pulse can be evident even without symptoms. this indicates wei qi moving towards the surface occipital stiffness and aches are very superficial – Wei qui competing with external pathogent thin, white coat on the tongue means it is cold and not an internal problem wind-cold can turn into wind-heat in the body. NO SWEATING is key to external pathology with cold influence  Wei Qi closes pores during cold invasion – cold causes contraction

Wind Heat Sxs • AVERSION to cold is key • sneezing and coughing is present with ANY external pathogen • slight sweating is different from internal pathology presentation • sore throat is also characteristic – heat will dry fulid from the throat, causing it to become dry and sore • Thirsty – heat will dry oral buccal membranes • floating and rapid pulse is more yang in nature • excess = excess heat 2) Cold - contracts with both external and internal pathogens - twisting ie. Cramps in women - CONTRACTING key factor - has no affinity for chest because heart and lung very Yang in nature - lower back VERY susceptible – KI belt - severe localized pain is keynote with pain due to cold - lack of thirst- you already have enough yin and water is Yin - loose stool- stools have more fluid (Yin) – most common indicator - sleepiness - severe localized pain – keynote because not moving (LOCALIZED) – Yang moves around a lot 3) Heat - true opposite of cold - slight sweating occurs even with high fever

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thirst-result of evaporating fluids…you need replenishment constipation- result of evaporating fluids as well scanty, dark, yellow urine is due to more concentrated urine due to evaporated

4) Dampness - Yin in nature - synonymous with spleen - stools are sticky and difficult to get rid of, stain the bowl or are harder to wipe - HEAVY AND SLOW - very characteristic - patient will experience these sensations in head, limbs, etc… - lower body invasion- similar to cold because it is more yin in nature 5) Dryness - Yang in nature - sxs include dry eyes, dry skin, dry nose, etc - will not feel anything with it, just dry - internal dryness is from yin deficiency; lacking substance/moisture/yin…but its not like heat symptoms - post menopausal women-many women have yin deficiency…treatment would be to tonify YIN. For example eating yin foods (raw, fat and protein) - note: carbs are very yang, must be turned into yin (fat) to be stored 6) Summer-Heat - only in summer…like a heat stroke or sun stroke, only provided by the sun - treatment- remove from heat and apply cold compresses Emotional Factors - emotional balance is key to healthy organ function – need to have a bit of emotion to see how an organ is functioning • eg. Suppressing emotions – ie anger – may be a liver pathology, but expressing emotions too much can also lead to pathology - above and beyond the typical symptoms - around exam time: diet is SOOOOO important people!!! It keeps spleen in better health…spleen is associated with pensiveness 8 Principles - yin and yang principles apply still, just broken down that much further - exterior=yang, interior=yin, excess=yang, deficiency=yin, cold=yin, heat=yang 1) Exterior/interior - referes to location – inside or outside - channels mentioned are the superficial meridians (the ones we are locating in practicals) - does not mean external pathogens make external symptoms and internal pathogens make internal symptoms – can have both at same time

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ie – Arthritis is internal pathology, but has external symptoms; keep this in mind with diagnosis!!! very specific - chills without fever and fever without chills – if have one or the other, most likely to be internal Px

Exterior patterns - can be wind-cold or wind-heat Interior patterns - fever without chills is a heat patient, chills without fever is a cold patient - tongue body changes are more gradual - zang-fu organ pathologies are organ changes - ie patient will feel temperature more intensely 2) Excess/Deficiency (full/empty) - measure of too much or too little - can be in varying degrees - need to see what type of heat: yin deficiency or yang excess - no sign of a weakened body – if there is no weakness, then it’s probably excess Excess - no voids - rule excess in only after you look at deficiency and determined they did not exist - ask the patient: what type of heat are they expressing? thirst-wise- do they gulp (xs heat) or do they sip (yin deficiency) - characterized by anything aggravated by pressure • ie. Worse with pressure, better by heat – excess cold, but whole body does not have to have excess cold Deficiency - feeble voice; as opposed to boisterous - listlessness; lack of desire, apathetic - ANYTHING ALLEVIATED BY PRESSURE; filling in gap by applying pressure (think of balloon analogy and the idea that you want to feel more full) - spontaneous sweating because pores cannot stay closed, sweating even without stimulus such as physical exertion 3) Yin/Yang - qi deficient is yang in nature and blood is yin - yang deficiency = qi def + cold sxs may be more subtle and slow at first - if yin is unopposed yang will rise Yin/Yang Pathologies - yang deficiency will show cold sxs, interior cold deficiencies - there is no such thing as a heat deficiency: heat is always in an excess pattern… you will only have heat sxs

Exterior cold - ABSENCE OF sweating - Exterior pathogen: attacks wei qi and cold closes pores Exterior heatExterior Deficiency - very rare…not a heat deficiency - wei qi is deficient (usually keeps ying qi inside vessels) - since wei qi is deficient here, it cannot keep ying qi in vessels: results in lots of sweating - ying qi can escape if wei qi is deficient. Shown in people who are affected with colds or flus constantly…they are depleting qi and essence - you cannot go further with labeling because there are no other exterior deficiencies except for this one Exterior Excess (cold, heat) - general and hard to label cold or heat - symptoms are excess and exterior but not enough information to diagnose otherwise - can label as a general excess condition Interior Cold - can be excess yin= strong, cold, worse with pressure - or yang deficiency - ie interior cold deficiency is essentially a yang deficiency internally - ie. Interior cold excess is essentially a yin excess internally Interior Heat - can be excess yang or yin deficiency *** only ime you can have yang deficiency is on the interior! no external deficiencies except for the one eg. external excess cold = excess YIN, but not yang deficiency because you can’t have a deficiency externally