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TCM Knowledge ~ Formula Selection Guide ~ Terms & Definitions
 

TCM Knowledge  


7. Disease Profiles

ARTHRITIS ASTHMA COLD AND FLU INSOMNIA

   The following disease profiles are intended to illustrate how TCM practitioners approach particular illnesses and to further familiarize practitioners with using Chinese herbs. We believe these disease profiles will illuminate thought processes and steps in choosing herbal treatments and will serve as a helpful clinical tool.

    In order to draw connections between TCM and allopathic medicine, we have used common Western terms like asthma and arthritis instead of terms specific to TCM. However, the key to success with using Chinese herbal treatments is locating the specific condition or conditions underlying the problem. In TCM, every allopathic disease or disorder can have a number of underlying conditions or patterns. Different conditions and patterns require different treatments. For the following disease profiles, only basic and major patterns are included.

   In order to provide thorough profiles, we have included formulas that were not chosen for the Newcomer’s Guide. Descriptions of formulas not found here can be located in our Professional Handbook

 
ARTHRITIS

Definition --
   Here we are using the word "arthritis" as a general term that would include almost all kinds of joint pain, regardless of the type of "arthritis"; associated with a conventional medicine disease diagnosis. This would also include body aches and muscle pain which come from some disorders like bursitis, tendonitis, etc.

Etiology --
   In TCM there are many factors, pathogens, and conditions involved in the etiology of arthritis, but generally they can be divided into three kinds:

External pathogens primarily include Wind-Cold, Damp-Heat, etc.
Internal conditions mainly include Dampness, Mucus, Stagnation, etc.
Zhen Qi Deficiency generally includes the Defense Qi, immune function, Spleen and Kidney Yang, Liver Yin, etc.


Diagnosis --
   The diagnosis focuses on differentiating between Cold or Heat, External or Internal, Excess or Deficiency conditions:

External Wind there will be some cold or flu symptoms and the pain will move around
Blood Stagnation pain is usually sharp and tingling and its location is fixed
Damp or Mucus this condition is associated with numbness and/or heaviness
Deficiency these people usually have fatigue, weakness, shortage of breath, cold hands and feet, lower back pain with weakness, muscle spasm, hot flash and night sweating, and a tendency to catch colds or flu easily
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Treatment Principle --
   The treatment principle for arthritis is to clear the External pathogens, correct the disordered Internal condition, tonify the Deficiency, and restore the natural internal balance.

Notable Trends --

   The majority of people with chronic arthritic conditions will be of the Cold type. If there is redness, joint swelling, and hot, burning pain, consider an Excess Heat condition, especially if the case is acute. For difficult cases, pay attention to Blood Stagnation, Mucus, and Deficiency.

Formulas --

Wind-Cold Condition LG + BT
Wind-Cold Damp LG + BT + WLS or DUHO
Wind-Cold + general Deficiency XG + DUHO
Wind-Heat RG + GJTF
Wind-Heat-Damp RG + GJTF + DHT
Heat + Damp GJTF + DHT
Heat + Damp + Stagnation GJTF + DHT + B
Cold + Damp HGWT + WLS or DUHO
Cold-Damp + Stagnation HGWT + BYHW or + WLS
Cold-Damp + general Deficiency DUHO + HGWT
Cold-Damp + Stagnation + Yang Deficiency DUHO + DSN or BYHW+YYT2
Stagnation + Yin Deficiency B + YGJ or LWDH or BY

For all of the above Cold-Damp conditions:

Add BT for pain in the neck, shoulders, arms, or upper part of the body
Add JING for pain in the lower body
Add YYT2 for pain in the lower back

For all of the above Heat-Damp conditions:

Add RG for pain in the upper body
Add QXR for pain in the lower body


If chronic pain is related to an old injury, add B or JBJW.

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ASTHMA

Definition --
    Conventionally, the term "asthma" has been translated into Chinese as Xiao Chuan and vice-versa. But in TCM, the term Xiao Chuan actually should be divided into two kinds of similar and related disorders: xiao and chuan. Chuan covers a much broader scope of diseases and disorders in which the main symptoms are breathing difficulty and/or shortage of breath. Xiao is more equal to the Western medicine concept of asthma. So, in the broader sense, the term asthma includes both Xiao and Chuan, but in the narrow sense it refers only to Xiao. In this index we will be discussing asthma only in the narrow sense of the term.

Etiology --

External pathogens Wind, Cold, Heat (including toxic Heat), Damp
Internal pathogenic conditions Dampness, Qi and Blood Stagnation related to emotional factors and diet, etc.
Deficiency Lung Qi Deficiency, Spleen and Kidney Deficiency, (especially Yang Deficiency) etc.

These types of Deficiency are often due to long term emotional problems, physical exhaustion, etc.

Genetic Factors

  • Allergic factors: Pollen, dust, chemicals, cat and dog hair, many different foods, etc. According to TCM, with the exception of chemical pollutants, people become allergic to fundamentally harmless natural materials because of pre-existing internal disorders. Contact with these materials makes people sick, causing them to be more allergic, which in turn aggravates their symptoms and so on in a vicious cycle.

  •  
  • Phlegm: Most TCM textbooks designate phlegm and mucus as the key pathological causes of asthma. Actually, phlegm and mucus are merely pathological by-products of this condition, not the causes of the condition in and of themselves. For the true causes, we must look to those conditions mentioned above.

  •  
  • Similar to the vicious allergic cycle mentioned above, there are two other cycles relating to asthma and the production of phlegm and mucous that are important to mention:
     
    • Phlegm and mucus will often aggravate a condition like Stagnation, Deficiency, etc., in the production of more phlegm and mucus, which will then further aggravate the underlying conditions.
    • Shortness of breath, another symptom of asthma, intensifies Qi and Blood Stagnation, Uprising Qi, Mucus and Phlegm, which in turn aggravates the underlying condition. A worsened condition leads to intensified symptoms and so on.

    •  
  • Other Factors: Catching a cold or flu, excess physical activity, over-eating, and emotional upset can all trigger an asthma attack or make one worse.
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Diagnosis --
    The diagnosis focuses on differentiating between External or Internal, Excess or Deficiency, Cold or Heat condition:

External conditions mainly include Wind-Cold and Wind-Heat, with symptoms such as: sneezing, cough, headache, fever, chills, stuffy and runny nose, body aches, and other cold or flu-like symptoms The symptoms usually exist at the onset of asthma or at the beginning of an attack
For Excess conditions primarily differentiate between Cold-Phlegm and Heat-Phlegm, Qi congestion or Qi Uprising, Blood Stagnation, Liver Stagnation, etc.
For Deficiency conditions differentiate between Deficiencies of Defence Qi, Spleen and Kidney Yang, Lung and Kidney Yin , etc
    • At the early stage, or at the beginning of a severe attack when breathing is difficult, pay more attention to the possibility of an Excess condition.

    •  
    • For the allergic type, pay more attention to the possibility of Heat-Damp-Phlegm.

Treatment Principle --

  • The treatment principle and the final goal is to clear the pathogens, strengthen the Zhen Qi, restore and maintain the balance, especially between Qi and Blood, and Yin and Yang.
     
  • If external pathogens still exist, usually, these should be cleared first.
     
  • Although clearing mucus and phlegm is important in the treatment of asthma, only clearing mucus and phlegm will just work temporarily, if at all. It is necessary to correct the underlying condition at the same time.
  •    At the beginning or during an attack of asthma, one must first clear the pathogens, but during the remission periods, especially if the condition is chronic, one must pay more attention to and work on the Deficiency and Stagnation, etc.

    Formulas --
    With External Wind-Cold LG or XG + XI
    w/Wind-Cold type sinus XI + CB
    With External Wind-Heat RG + XI
    w/Wind-Heat type sinus XI + HB
    Cold Mucus LXW or + XI
    Cold Mucus w/Qi Stagnation LXW + SHT or + XI or SZY or BHT
    Cold Mucus w/ Blood Stagnation LXW + DSN + XI
    Cold Mucus w/Defense Qi Deficiency LXW + GBS + XI
    Cold Mucus w/ Spleen Deficiency LXW + SLBZ or JP + XI
    Cold Mucus w/Kidney Yang Deficiency LXW + YYT2 or ZBWW + XI
    Heat Mucus XI + PBY or WDT
    Heat Mucus w/Qi (especially Liver ) Stagnation XI + SHT + JXY
    Heat Mucus w/Blood Stagnation XI + B
    Heat Mucus w/Lung Yin Deficiency XI + QCJF

    Heat Mucus w/ Spleen Damp-Heat
    XI + DHT or QLP
    Heat Mucus w/ Liver/Kidney Yin Deficiency XI + YGJ or LWDH
    Asthma w/ Food Allergy XI + DHT or + BHW or JSH

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    COLD AND FLU

    Definition --
       According to TCM, all of the six External pathogens can invade the human body and cause a variety of disorders and illnesses, depending on their location and depth, the length of time they remain in the body, the person's general condition, etc. Our discussion of colds and flu here will be limited to only those conditions or disorders in which the pathogens, mainly Wind, invade and stay in the superficial areas of the body, like the skin and nose areas.

    Etiology --
    External pathogens Wind is the most active pathogen, existing all year around, but especially in spring and autumn. External Wind is the main and primary pathogen that causes colds and flu. Second in importance is Cold. Wind quite often invades the human body in combination with other pathogens; most commonly with Cold, secondly with Heat, then Damp. If there is extreme and abnormal weather, external pathogens become more active and invasive.
    Epidemic toxic pathogens These are similar to conventional medicine's special viral epidemics.
    Deficiency Under normal circumstances, External pathogens can invade the human body only if a person has Deficiency conditions, such as Deficiency of Qi and Blood, or Yin and Yang. Chronically ill persons, especially those with asthma, chronic fatigue, etc. catch colds and flu often and are slow to recover. These minor external problems often penetrate deeper in the chronically ill and turn into other diseases like pneumonia.
    Temporary Deficiency The following may cause a temporary Deficiency: exhaustion, emotional upset, not dressing warm enough during a sudden weather change, entering a cold place or air-conditioned room while sweating, etc.

    Under the causes mentioned above, the following conditions will develop:

    Yin-Wei or Defense function disharmony or dysfunction symptoms usually include fever, chills, headache, body ache, etc.
    Lung Qi dysfunction symptoms mainly include sneezing, stuffy or runny nose, sore throat, cough, etc.
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    Diagnosis --

  • Differentiate between Wind-Cold or Wind-Heat conditions. About 70 to 80% of colds and flu are Wind-Cold type. If the cold or flu started with a red face, high fever, sore throat, itchy and burning eyes, fast pulse, yellow tongue coating, consider the likelihood of Wind-Heat.

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  • Pay attention to whether or not any internal conditions get involved, especially after the cold or flu has lasted for more than five days.

  •  
  • Determine if the person has Deficiency or not. If so, what kind? This is especially important for one who catches cold or flu frequently, or who cannot easily recover, or who has fatigue, chills, sweating, dry cough, and a weak, thin, empty pulse.
  •  
    Treatment Principle --

  • Clear the External pathogens first.

  •  
  • The main condition in colds and flu is the external pathogens which invade and occupy the superficial areas, causing Yin-Wei or Lung Qi disharmony. So the treatment principle is to clear these pathogens and restore the harmony and balance.

  •  
  • Even if the pathogens get into the Deep and Internal areas, it is still necessary to clear the external pathogens first, or at least at the same time as internal areas are treated.
  • Note
        Before the external pathogens are cleared, do not work on the Internal condition only; for example, do not just tonify, clear Internal Heat, etc.
    For Deficiency conditions, do not use an excessive or protracted dose of spicy and dispelling herbs that cause heavy sweating.

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    Formulas --

    A. Early Stage: usually 3 days, not more than 5 days

    At the beginning of a cold or flu, when the first symptoms arise use First Defense
    During the first few days of a cold or flu, if there is difficulty differentiating between Wind- Cold or Wind-Heat use First Defense
    For persons with fatigue, weakness, or who catch cold or flu easily First Defense + XG or XG only

    If the type of cold or flu can be recognized, then:

    Wind-Cold First Defense or LG or JFBD, or any two of these
    Wind-Cold + Deficiency First Defense + XG or XG only
    Wind-Heat RG or RG + First Defense
    Wind-Heat + Toxic Heat (e.g. severe sore throat at beginning) RG + YANT or + JYH
    Wind-Damp or Wind-Cold Damp First Defense + HXS
    Wind-Heat Damp RG + HXS
    Stomach Flu HXS


    B. If the cold or flu lasts more than 3 to 5 days, observe which direction the condition takes:

    If Cold pathogen stays deep in the Tai Yang Channel, with symptoms of severe body aches, neck and back stiffness LG or XG + BT
    If the Wind-Cold goes deeper into the Lung area, with more severe cough or wheezing XG + CK or XG + XI
    If Wind-Heat goes deeper into the Lungs with severe sore throat RG + YANT
    If there is more cough or wheezing RG + PBY or RG + XI
    If the pathogens move into the Shao Yang Channel with symptoms such as: alternating fever and chills, bitter taste in the mouth, loss of appetite, chest and side area congestion, bloating and pain XCH
    If the pathogens go even deeper, completely turning into internal disorders such as sinus or ear infections, bronchitis, or asthma treatment should be aimed at this specific internal disorder

     
    C. After the cold and flu is over:

    For those who catch cold or flu often or who cannot recover quickly take GBS for 2-4 weeks
    For those with Qi and Blood Deficiency or general fatigue and weakness SHBU
    For those with Yang Deficiency GBS + ZBWW or YYT2
    For those with Yin Deficiency GBS + LWDH or YGJ


    D. After the cold or flu is over, but only the following symptoms remain:

    Excess sweating GBS
    Sinus problems CB + HB
    Ear Congestion XCH
    Dry cough QCJF
    Hoarse voice Voice Clear Tea + QCJF

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    INSOMNIA

    Definition --
       During the night time, Yin is dominant. During the daytime, Yang is dominant. Shen belongs to Yang and, during the day, Shen directs our activities. During the night, Shen needs to go back to the Heart (entering Yin) in order to rest and recuperate.

    Note:
       Throughout this disease profile, we are referring to insomnia when it is the major complaint. Many other complaints, such as pain or sinus problems, can lead to insomnia. In these cases, it is important to treat the primary problem.

    Etiology --
       Both Excess and Deficiency conditions can prevent Shen from entering into Yin.

    • Excess Conditions:
      1. Liver-Gallbladder Heat disturbs the Shen. This is often caused by stress that leads to Liver Qi Stagnation which in turn transforms into Heat. Heart Fire exhausts Heart Yin; Shen cannot harmonize with Yin. Worrying and thinking too much are the main causes. Spleen and Stomach Fire.a) Overeating or eating too much greasy or spicy food can result in Stomach Heat and Spleen Yin Fire. Heat and Mucus then rise up to disturb Shen.
        b) Spleen Yin Fire can result in Yang rising prematurely (at 4 or 5 AM). Heat/Mucus condition: Heat and Mucus rise up, block the Heart orifices which, in turn, disturbs the Shen.
      2. External Wind-Cold, Wind-Heat, and Dryness can disturb the harmony of Qi and Blood and can lead to insomnia.
    • Deficiency Conditions:
      1. Heart and Spleen Blood Deficiency - Blood belongs to Yin and nourishes Shen. If Blood is Deficient, Shen can be Deficient as well.
      2. Kidney Yin Deficiency - When Kidney Yin is Deficient, Heart Yang rises up and cannot house Shen.
      3. Heart – Gallbladder Deficiency - Fright, shock, and terror can cause Heart – Gallbladder Deficiency which disperses Heart and Gallbladder Qi.


    Diagnosis --
       It is possible to generalize that difficulty falling asleep is usually related to Excess conditions whereas waking up easily is usually related to Yin or Blood Deficiency. Overactive dreaming is usually related to Damp-Heat or Mucus-Heat in the Liver-Gallbladder area. Since these are generalities, it is always important to do differential diagnosis in order to detect the underlying condition.

    Formulas --

    Excess Conditions:
     
    Liver Heat and Fire JXY or LDXG or GH
    Heart Heat and Fire DAOC or GH
    Stomach Heat JSH or DHT or XK
    Stomach Heat w/ constipation XM
    Heat Mucus in Gallbladder area WDT
    External pathogens Choose according to condition

    Deficiency Conditions:
     
    Heart and Spleen Blood Deficiency GPT + SHM
    Kidney Yin Deficiency BY or SHM or LWDH + JTW
    Heart-Gallbladder Deficiency SHM + LM
    Liver Yin Deficiency w/ Fire SHM + SH-JXY or YGJ + GH

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    *These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

     

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