Spleen Stomach by liaoqinmei


									Course: Diagnostics II                                                 Date:   10/24/07
Class #: 5

Midterm next week

Many diseases are related to the St/Sp. For instance:
   ♦ Digestion problems of all kinds
   ♦ Wei syndrome: muscle weakness, atrophy due to MS, wind stroke. No pain, but weakness of
   ♦ Blood deficiencies such as anemia
   ♦ Bleeding problems where spleen cannot hold the blood
   ♦ Organ prolapses due to Qi
   ♦ Edema
   ♦ Overweight

                                  Once upon a time during the Jin and Yuan dynasties there were 4
                                  famous doctors who created different theories. Li Dong Yuan, known
                                  to friends and family as Li Gao, was one of these famous dudes who
                                  created a theory which stated that all problems are due to Spleen and
                                  Stomach problems, mostly due to dumbass lifestyle choices. The name
                                  of his theory was the Spleen and Earth Theory.

Today’s focus is, in the spirit of Li Gao, Spleen and Stomach. Here are the things we need to be able to
define based on the material covered in this class.
    ♦ Spleen Qi Deficiency
       What is the manifestation?
    ♦ Spleen Yang Deficiency
       What the heck is this and how is it different from the first one?
    ♦ Spleen Qi Sinking
    ♦ Food Retention in the Stomach
    ♦ Excessive Fire in the Stomach
    ♦ Cold Retention in the Stomach
    ♦ Stomach Yin Deficiency
       What is it? How is it related to excessive fire in the stomach? (hint: empty heat/full heat)

Review of Spleen functions
   ♦ Govern transformation and transportation
   ♦ Control ascending of Qi
   ♦ Raise Clear Yang upwards
   ♦ Control Blood
   ♦ Control muscle and the 4 Limbs
                                          Diagnostics II – Fall 2007
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Spleen                                                    Spleen Qi Deficiency
                                                          Spleen Yang Deficiency
                                                          Spleen Qi sinking
                                                          Dysfunction of spleen in Controlling Blood
                                                          Damp Cold Accumulation in Spleen

Know each of the above details (see below), make the chart, memorize the chart, love the chart,
become one with the chart.

Spleen Qi Deficiency
You will see this often in the clinic.
   ♦ Sallow complexion
           o Indicates dampness along with the deficiency. Qi deficiencies can also be pale, but with
               Spleen qi def usually see sallow rather than pale.
   ♦ Lassitude
           o Classic qi deficiency thang
   ♦ Dislike of Speaking
           o Due to qi deficiency
   ♦ Reduced appetite
           o Often the first symptom of this condition.
   ♦ Gas and bloating
           o Spleen cannot digest qi/water well, qi is moving abnormally
           o Indicates Middle Jiao problem
   ♦ Abdominal distension, worse after eating
           o Very typical symptom
           o When you eat need a lot of qi to digest food…patient is already qi deficient, so this
               depletes it further. (Moral: if you want to eat a lot of deliciousness, tonify the Spleen Qi!)
   ♦ Loose stools
           o Spleen qi is deficient, so instead of ascending as it should, it descends.
   ♦ Tongue: pale with white coat
   ♦ Pulse: weak and soft
           o Middle position on the right will be weak especially as this is the spleen position.

The 3 highlighted things above will be seen in several other conditions. Spleen Yang deficiency may
have this as well.

               Here’s a mini quiz:
               Which one of these is rarely found in spleen disease?
                  ♦ Abdominal distension/pain
                  ♦ Loose stool
                  ♦ Nausea/hiccup
                  ♦ Bloating
                                            Diagnostics II – Fall 2007
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               If you guessed nausea and hiccupping, way to go!! Go get yourself something delicious.

Treatment: you can use Ginseng (Ren shen) to tonify the Qi, but find the balance or it will generate fire,
burns off body fluid, face gets red, etc. You can use Huang Qi too, which is mild, but tonifies the Qi.
Another lovely thing is you can cook this in food rather than drinking the probably icky tasting raw herb
tea. Some folks are allergic, however, so be aware of such things…please exactly make sure!

Yu Ping Feng (Jade Screen) is a tonifying formula often used prior to allergy season. ZZ recommends
you take this about 2 months prior to allergy season to put a barrier in place which keeps you from being
affected. Some people are on it year round.

Stomach 36 is a good tonification point for this. Add Spleen 6 to this point and you are too cool for
school. LI 10 + ST 36 is another good combination to balance upper and lower jiao. According to Dr.
Luo, both are 3 miles below the joints. Damn, that’s a big guy! UB 20 will help Spleen Qi def also.

Spleen Yang Deficiency
(I colored them like he colored them… the blues denote differences from Spleen Qi Deficiency
symptoms. )
    ♦ Pale and sallow
            o Qi and yang deficiency.
            o Cold and blood deficienty
    ♦ Lassitude
    ♦ Dislike of speaking
    ♦ Reduced appetite
    ♦ Abdominal distension, worse after eating
    ♦ Loose stools
    ♦ Cold 4 limbs
    ♦ Dull pain in abdomen, better w/warmth and pressure
            o This reflects deficiency and cold
    ♦ Tongue: Pale and swollen with white and slippery coating
    ♦ Pulse: Deep, slow and weak.

What’s the difference between Sp qi def and Sp yang def? All the Spleen qi def’s plus cold symptoms.

And here’s a question:
What would be different about the disease history between spleen qi def and spleen yang def? Spleen qi
is more short term. Yang deficiencies, strictly speaking, should have come from Spleen Qi deficiency
which leads to the Yang deficiency. First you feel sleepy after eating, poor appetite, fatigue, then cold
and perhaps diarrhea.

Herbal treatment – use some ginger and brown sugar. Cook the 2 together. Not too much, though as it
can be a little strong for the stomach. White parts of the scallion, too. (Yum, that would make a good
stirfry marinade!)

Points – Moxa at St 36. Ren 12 (can also moxa here—moxa stick or warm needle).

                                           Diagnostics II – Fall 2007
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Spleen Qi Sinking
Very special pattern in tcm. Very chronic and very severe condition.
   ♦ Sallow complexion
          o Indicates dampness along with the deficiency. Qi deficiencies can also be pale, but with
               Spleen qi def usually see sallow rather than pale.
   ♦ Lassitude
          o Classic qi deficiency thang
   ♦ Dislike of Speaking
          o Due to qi deficiency
   ♦ Reduced appetite
   ♦ Heavy and distending (bearing down) sensation in abdomen, worse after meals
          o Abdominal area…due to qi sinking down
   ♦ Loose stools
   ♦ Frequent bowel movements, even long-term diarrhea
   ♦ Heavy sensation in anus
   ♦ Prolapse of rectum and/or uterus
          o Typical of spleen qi sinking
   ♦ Extreme fatigue, lassitude, low voice, dizziness
   ♦ Tongue: pale body with thin white coat
   ♦ Pulse: feeble
          o Extremely weak

Treatment: Du 20, Bl 20. Can use moxa. Can also use ginger with holes in it, put a moxa cone on it, put
it over the belly button and burn that sucker.

Dysfunction of Spleen in Controlling Blood

   ♦   Pale/sallow complexion
   ♦   Lassitude
   ♦   Dislike of speaking
   ♦   Reduced appetite
   ♦   Abdominal distension
   ♦   Loose stools
   ♦   Purpura
          o Bleeding beneath skin
   ♦   Bloody stools
          o Spleen qi sinking thing.
   ♦   Excessive menstrual flow
   ♦   Uterine bleeding
          o Post labor/delivery
          o Any other time as well.
   ♦   Tongue: pale
   ♦   Pulse: weak, thready
                                          Diagnostics II – Fall 2007
                                                Page 4 of 8
Treatment: Xi cleft point – SP 8, UB 17, SP 10. Tonify: Sp 6, St 36.

Damp Cold Accumulation in Spleen

   ♦ Fullness and cold in epigastria and abdomen
   ♦ Poor appetite
   ♦ Sticky saliva
          o Indicates dampness/water related
          o Not phlegm, but rather condensed saliva
   ♦ Nausea
          o Damp retention in MJ causes nausea/vomit. Looks like stomach problem
   ♦ Heaviness of head and body
   ♦ Edema
          o dampness
   ♦ Loose stools
          o Spleen deficiency
   ♦ Tongue: pale with white and greasy coating
          o White = not heat
          o Greasy = dampness
   ♦ Pulse: slow and slippery
      Pay attention to the diff between this and spleen yang deficiency
          o Slow = cold
          o Slippery = damp
Treatment: moxa at ST 36.

Stomach functions:
   ♦ Controls receiving
   ♦ Controls rotting and ripening of food
   ♦ Controls transportation of food essence
   ♦ Controls descending of Qi
   ♦ Likes wetness, dislikes dryness and heat

       Stomach Syndromes                            Excessive Fire in Stomach
                                                    Cold Retention in Stomach
                                                    Food Retention in Stomach
                                                    Stomach Yin Deficiency

Excessive Fire in Stomach
Acute disease. Compare to Stomach Yin Deficiency below

   ♦ Burning pain in epigastric region
                                          Diagnostics II – Fall 2007
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   ♦ Sour regurgitation
        o Indicates abnormal movement of qi
   ♦ Thirst with pref for cold drinks
        o Indicates heat
   ♦ Voracious appetite and easily hungry
     Bulimea is treated as Stomach Fire in TCM, fyi.
        o Why voracious? Fire!
   ♦ Vomiting
        o Abnormal ascension of stomach qi
   ♦ Foul breath
   ♦ Swelling and pain or ulceration and bleeding of gums
        o Especially upper gums
   ♦ Constipation
        o Stomach qi cannot go down.
        o Much heat burning body fluids.
   ♦ Scanty and yellow urine
        o Again, burning body fluids, so scanty, then deep yellow
   ♦ Tongue: red with yellow coating
   ♦ Pulse: rapid

St 44

Cold Retention in Stomach
Relatively excess condition
   ♦ Cold/contracted pain in Stomach, better after warm meals
   ♦ Worse in cold temp
   ♦ No thirst
   ♦ Prefer to warmth
   ♦ May have aversion to touch
   ♦ May have nausea and vomiting
   ♦ Tongue: slight pale, white coat
   ♦ Pulse: slow and deep.

Will this person have nausea and vomiting? Yes. If stomach qi is moving abnormally, then can have n/v.
Might also have aversion to touch due to the excessive nature of condition

Treat: ST 36 moxa

Food Retention

   ♦ Distension, fullness and pain in eqigastria and abdomen
   ♦ Foul belching
        o Sour belching. Food is rotting per stomach’s function, but not moving.
   ♦ Anorexia
        o Cant hold any more food!
   ♦ Vomiting
                                         Diagnostics II – Fall 2007
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        o Abnormal movement of qi
   ♦ Tongue: slightly red, thick/sticky or curdy coating
        o Red tongue maybe or maybe not. Food retention over long period = heat, then red tongue
        o Curdy coating is large, thick, easily scraped off
   ♦ Pulse: slippery
        o Slippery = food retention (as well as damp heat in other symptom groupings)

Stomach Yin Deficiency
Empty heat in stomach. Compare to excessive fire. Happens more to elderly patient. Chronic disease.

   ♦ Obscure and burning pain in epigastric region
        o Obscure = pain not so obvious
   ♦ Empty and uncomfortable sensation in Stomach
   ♦ Hunger without desire to eat
        o Empty fire causes the hunger
        o Often recommend these patients eat more frequently, but eat little meals.
   ♦ Dry vomiting and hiccups
        o Dry: yin deficiency
   ♦ Dryness of mouth and throat
        o Dry: yin deficiency
   ♦ Constipation
        o Due to dryness—cannot nourish
   ♦ Tongue: red with less coat
        o Shape will be narrow, might be cracks, all is thin & less due to yin def.
   ♦ Pulse: thready and rapid.

Body shape could be (probably will be) slender, tongue thin and crackish with less/mirror coating. Pulse
is thin and fast. Dry light cough perhaps.

What disease? Anorexia.

Treatment: nourish and tonify st/sp yin. SP 6 is first choice. Ren 12 is another good one.
Herbs – Yu zhi to nourish stomach.

Case Discussion time
30 yo female
Eats uncontrollably, purges, strict dieting, fasting, vigorous exercise; vomiting or abusing laxatives or
diuretics in an attempt to loose weight. She vomits blood and uses the bathroom frequently after meals.
She’s preoccupied with body weight. Suffers from depression and mood swings. Feels out of control.
Swollen glands in neck and face
Heartburn, bloating, indigestion, constipation, irregular periods, dental problems, sore throat, weakness,
exhaustion, blood shot eyes.
Burning pain in epi region w/pref for cold water. Strong smell. Ulcer on upper gums. Doesn’t feel good
with pressure. Red tongue with yellow coat, rapid pulse.

                                           Diagnostics II – Fall 2007
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DX: Bulemia disease. Excessive fire in stomach

28yo female
Body wt that is not consistent with age, build, height—abt 15% below normal weight. Loss of at least 3
consecutive menstr periods. Doesn’t want or is refusing to eat in public. Anxiety, weakness, brittle skin,
shorntess of breath, obsessive about caloric intake.

She has obscure burnin pain w empty sensation in epi region. Hunger w/o desire to eat. Dry vomit and
hiccups. Dryness of mouth/throat. Constipated. Red tongue, less coat. Thready and rapid pulse.

DX: Anorexia. Stomach yin deficiency.

Mterm: 40 q’s. Covering all in this class:
   ♦ 8 principles (ext/int, cold/heat, def/excess, yin/yang)
   ♦ different Zangfu relationships covered thus far.
      Know different patterns, different emphases covered.
   ♦ Review all exercises!

                                           Diagnostics II – Fall 2007
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