Development of TCM Internal Medicine by PUHLP0J7

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									                          Sweating
TCM Diagnoses and Treatments
  Spontaneous Sweating + Night Sweating

 Etiology & Pathology:
   Etiology:
       1) Spontaneous Sweating:
              Interior & Exterior injuries
              Def. : disharmonize of Ying & Wei
                         Yang Def.
                         Lung Qi def.
              Excess: Liver fire
                        Interior heat
                        Damp heat
       2) Night Sweating:
                Yin Def. type of heat
                (Qi Def. Yang Def. or Damp-heat)
Treatment for differentiation

   Harmonize Ying & Wei
                -- Gui Zhi
   Clear Heat + expel fire
                -- Long Dan Cao, Shi Gao
   Clear the damp-heat
                -- Ze Xie
   Tonify Qi & consolidate superficial resistance
                -- Huang Qi, Bai Zhu
   Tonify Yin & Clear def. type of fire
                -- Gui Ban, Bie Jia
   Warm Yang Qi to stop sweating
                -- Fu zi, Gui Zhi
Treatment
  1) Disharmony between Ying & Wei
         Signs & Symptoms:

     – Main Sym. : sweating now &again, or sweating only at the head,
       foot or half of the body

     – Concurrent sym.: aversion to wind, pain in whole body, slight
       fever, headache
     – Tongue:
              normal body with thin white coating
     – Pulse:
              floating & slow

•   Treatment Protocol:

     – Dispelling wind
     – Regulating Ying & Wei
Formula:
                            Gui Zhi Tang
 Gui Zhi     Bai Shao   Sheng Jiang    Da Zhao   Gan Cao

Modifications:
  Sweating
        -- Long Gu, Mu li
  Qi Def.
        -- Huang Qi, Dang Shen
  Yang Def.
        -- Fu zi
  half body or local area sweating
        -- Gan Mai Da Zao Tang
  sweating+ heaviness of body
        -- Fang Feng, Dou Juan
  wind-heat attacking
        -- Sang Ju Yin + xuan Shen, Yin Hua
  Some insomnia patients: sweating after emotional change
        -- Gui Zhi Jia Long Gu Mu Li Tang
Treatment
  2) Lung Qi Def. & fail to protect body
       Signs & Symptoms:

   – Main Sym. : sweating & aversion to wind, sweating even
     more after activity.

   – Concurrent sym.: Pale complexion, anorexia, lassitude &
     tending to have a cold
   – Tongue:
           thin coating
   – Pulse:
           thready & weak

• Treatment Protocol:

   – Tonify Qi to consolidate superficial resistance
Formula:
                         Yu Ping Feng San
Huang Qi     Bai Zhu    Fang Feng


Modifications:
  sweating
        -- Fu Xiao Mai, Ru Dao Geng, Mu Li, Long Gu
  Qi Def.
        -- Dang Sheng, Huang Jing
  Yin Def.
        -- Mai Dong, Wu Wei Zi
  Sweating on hands & feet: Sp Qi Def.
        -- Huang Qi Jian Zhong Tang
          ( Huang Qi, Bai Shao, Gui Zhi, Zhi Gan Cao, Sheng Jiang, Da
   zhao, Yi Tang)
Treatment
  3) Hyperactivity fire due to yin def.
  Signs & Symptoms:

   – Main Sym. : Night sweating, sometime spontaneous
     sweating.

   – Concurrent sym.: Insomnia, low fever, dysphoria with
     feverish sensation in the chest, palms & soles, thirsty.
   – Tongue:
            red body with little coating
   – Pulse:
           thready, rapid

• Treatment Protocol:

   – Nourish Yin to reduce fire
Formula:
                           Dang Gui Liu Huang Yin
 Dang Gui    Shu Di      Sheng Di      Huang lian   Huang Qi
 Huang Bai   Huang Qin




Modifications:

  Abundent sweating:
      -- Mu Li, Fu Xiao Mai, Ru Dao Geng
  Feverish sensation:
      -- Yin Cai Hu, Bai Wei, Gui ban, Bie Jia
  Yin Def.
      -- Mai Wei Di Huang Wan
Treatment
  4) Interior Excess Fire
     Caused by interior dampness, stagnated liver Qi
    Signs & Symptoms:

     – Main Sym. : Continuous sweating with greasy or yellow sweating,
       sometimes sweating only at head, or at hands and feet

     – Concurrent sym.: Red face, thirsty like drinking cold water, fever ,
       restlessness, constipation, brown urination
     – Tongue:
              red tongue with thick yellow fur or yellow greasy fur
     – Pulse:
              slippery & rapid or full

•   Treatment Protocol:

     – Clearing away st. heat, or eliminating damp-heat
Formula:

                               Bai Hu Tang
  Shi Gao   Zhi Mu          Lu Geng    Tian Hua Feng   Xuan Sheng
  Zhi Zhi   Sheng Gan Cao

Modifications:

   thirsty
         -- Tian Hua Feng
   Constipation:
         -- Xiao Cheng Qi Tang
   Damp-heat
         -- Long Dan Xie Gan Tang
   Lower limbs sweating
         -- Niu Xi
   Chest oppression or stuffiness & tightness sensation
         -- Huang Lian, Hou Pu
Case History1

1. Male 67 years
     Medical history: Patient always has spontaneous sweating in normal days, worse
     after activity. Even in winter, sweating on the head. Easy to get cold outside.
     First visiting:
     Main complain: Night sweating for 3 month
           3 month ago, daily spontaneous sweating turn to night sweating. After
     waking up, the cover and clothing are all wet. Aversion to wind & cold. Oppressed
     feeling in the chest, palpitation, cold limbs, shortness of breath, overweight body
     type, dry skin, dry mouth…
           Tongue: little dark of the body with little yellow coating
            Pulse: deep & thready

       TCM diagnose:
                   Yang Qi Def. + Yin Def..
       Treatment protocol:
                   Tonify Yin & strengthen Yang Qi
        Formula
          Fu Xiao Mai 20, Huang Qi 20, Long Gu 30, Mu Li 30, Shan Yu Rou 15, Ru
     Dao Geng 10, Shen Di 15, Shu Di 15, Huang Bai 10g , JIng Yin Zi 15, Qian Shi
     10
                     ,
Case History2

1. Male 35 years

     First visiting:

     Main complain: Spontaneous sweating on head for 10 years
          Pale complexion, lassitude, thirsty and prefer to have a drink, continuously
     sweating upper neck, worse on day time, also worse after meal and activity.
     Patient has been treated by Yang Qi & Yin def. for years but no working.
           Tongue: stasis purple color on both sides of tongue body with yellow greasy
     coating
           Pulse: weak

       TCM diagnose:
            Yin blood stasis after long illness, Wei Qi Def. fail to protect the body
       Treatment protocol:
                    Move blood stasis, tonify Qi to stop sweating
        Formula
          Xue Fu Zhu Yu Tang
          Tao Ren 6, Hong Hua 6, Dang Gui 10, Sheng Di 12, Chi Shao 10, Niu Xi 10,
     Chuan Xiong 5, Zhi Ke 6, Jie Geng 5, Zhi Gan Cao 3, Huang Qi 15, Fu Xiao Mai
     30, Ru Dao Geng 30

                            X 14 Bags
Case History3
Female 27 y
  First visiting:
    Main complains: spontaneous sweating & night sweating for half of year
        Patient just procreated a baby half of year before. Since that time, patient
     started sweating, short of breath on activity, continuously sweating, bad
     sleeping, sweating can even wet the clothing when in the sleep. Lower back
     pain, two hands joints & lower limbs feel numbness & ache in the morning.
     Pale complexions.
         Tongue: reddish tongue body with white coating.
         Pulse: empty & thready

         TCM diagnose:
           Liver & kidney yin def. Empty fire due to yin def. force fluid out
        Treatment protocol:
            Nourish Liver & kid, tonify yin to stop sweating
        Formula

           Dang Gui 10, bai shao 10, shu di huang 15, shan yao 10, wu wei zi
     6, di gu pi 10, dan pi 10, sha sheng 10, mai dong 10, ze xie 10

                      ,
Second visiting:
 Main complains: Spontaneous sweating
       lower back pain & night sweating were gone. Hands & joints pain
    & numbness reduced.
        However, patient started feeling feverish & irritability at 4 – 6
    o’clock in every morning, following with sweating on the chest &
    back. Panting.
  Tongue: reddish body with thin slight yellow & dry fur
  Treatment protocol:
        Tonify Liver blood, stop sweating

     Bai Shao 30, He shou wu 30, shan Yao 15, Qian Shi 10, Jing Yin Zi
     10, Long Dan Cao 6, Shen Gan Cao 6
          Blood syndrome
TCM Diagnoses and Treatments
  Blood does not follow normally within its
vessels, but bleed from the muscle or skin.

Etiology & Pathology:
   Main pathogenesis of bleeding:
        1) Hyperactivity
        2) Damage of Qi
        3) Blood stasis
Main Points for differentiation



   1) Location
        Nose bleeding: Lu. St. or Liv.
   2) Def. & Excess
        Yin def. Qi Def. Excess Fire
   3) Coexistence of two or more syndromes
        Cold & Heat
        Exterior & Interior
        Qi Stag. & Blood Stasis
        Qi Def. & Blood Stasis
Main Points for therapeutic Principles


   Stop bleeding
        -- Bai Ji, San Qi, Ai Ye, Pu Huang, Ou Jie, Xian He Cao,

   Eliminating blood stasis
        -- Chuan Xiong, Ru Xiang, Mo Yao, Er Zhu, San Ling, Dan Sheng, Ji
   Xue Teng, Tao Ren, Hong Hua, Shui Zhi, Di Bie Chong, Yan Hu Suo,
   Chuan san Jia, Ze Lan, Wang Bu Liu Xing

   Cool blood
        -- Da Ji, Xiao Ji, Di Yu, Bai Mao Geng, Huai Hua, Ce Bai Ye, Qian
   Cao,


   Tonify def. and blood
        -- Dang Gui, Shu Di, He shou wu, Bai Shao, E Jiao, Long Yan rou
Treatment
  1) Nasal Bleeding (Epistaxis)
    A). Evil-heat attacking Lu.
    Signs & Symptoms:

     – Main Sym. : Dry nose & nasal bleeding

     – Concurrent sym.: fever, dry mouth & throat, cough with little
       sputum
     – Tongue:
            red body with thin yellowish coating
     – Pulse:
            rapid

•   Treatment Protocol:

     – Clearing Lung heat
     – Cooling blood to stop bleeding
Formula:
                            Sang Ju Yin
 Sang Ye   Ju hua        Bo He      Lian Qiao   Jie Geng
 Gan Cao   Lu Geng       Xin Ren

Modifications:

   Cooling blood to stop bleeding
        -- Dan Pi, Bai Mao Geng, Ce Bai Ye
   Lu. Heat without exterior sym.:
        -- Huang Qin, Zhi Zi (- Jie Geng, Bo He)
   Yin Def.
        -- Xuan Sheng, Mai dong, Shen Di
   Constipation
        -- Da Huang, Gua Lou
   Sore throat
        -- Niu Pang Zi
Treatment
  1) Nasal Bleeding (Epistaxis)
    B) Excess of st. heat
    Signs & Symptoms:

     – Main Sym. : Nasal bleeding with scarlet blood

     – Concurrent sym.: Gum bleeding, dry mouth, foul breath,
       restlessness, constipation or swelling & soreness of the gums
     – Tongue:
              red body with yellowish coating
     – Pulse:
              rapid

•   Treatment Protocol:

     – Clearing stomach heat
     – Cooling blood to stop bleeding
Formula:
                             Yu Nu Jian
 Shi Gao   Zhi Mu     Mai Dong       Sheng Di   Niu Xi




Modifications:

   Cooling blood to stop bleeding
        -- Da Ji, Xiao Ji, Ou Jie, Ce Bai Ye
   Excess St. heat:
        -- Huang Qin, Zhi Zi, Dan Pi
   Yin Def.
        -- Tian Hua Feng, Shi Hu, Yu Zu
   Constipation
        -- Da Huang, Gua Lou
Treatment
  1) Nasal Bleeding (Epistaxis)
    C) Liver Fire Up
    Signs & Symptoms:

     – Main Sym. : Nasal bleeding , headache, blurred vision & bitter
       taste

     – Concurrent sym.: red eyes, tinnitus, irritability & emotional
       changing,
     – Tongue:
            red body with thin yellowish coating
     – Pulse:
            taut & rapid

•   Treatment Protocol:

     – Clearing away liver fire
     – Cooling blood to stop bleeding
Formula:
                            Long Dan Xie Gan Tang
 Long Dan Cao   Huang Qin    Zhi Zi      Ze Xie     Mu Tong
 Che Qian Zi    Cai Hu       Sheng di    Dang gui   Gan Cao


Modifications:

   Cooling blood to stop bleeding
        -- Bai Mao Geng, Pu Huang, Da Ji, Xiao Ji, Dan
   Pi, Ou Jie
   Liver fire :
        -- Xia Ku Cao, Qin Dai
   Yin Def.
        -- Xuan Sheng, Mai dong, Wu Wei Zi, Nu
   ZhengZi, Han Lian Cao
Treatment
  1) Nasal Bleeding (Epistaxis)
    D) Qi & Blood Def.
    Signs & Symptoms:

     – Main Sym. : Nasal bleeding with light red color, bleeding from
       gums & muscles

     – Concurrent sym.: pale complexion, mental fatigue, lassitude,
       dizziness, palpitation
     – Tongue:
             pale body
     – Pulse:
             thready weak or hollow

•   Treatment Protocol:

     – Tonify Qi to hold the blood
Formula:
                              Gui Pi Tang
 Dang Shen   Bai Zhu    Huang Qi   Fu Shen    Suan Zhao Ren   Yuan Zhi
 Long Yan    Mu Xiang   Gan Cao    Dang Gui   Sheng Jiang     Da Zhao




Modifications:

   Stop bleeding
      -- Xian He Cao, Er Jiao, Pu Huang
Treatment
  2) Bleeding Gums
  A) Stomach-Heat
  Signs & Symptoms:

   – Main Sym. : scarlet bleeding, painful & swollen gums

   – Concurrent sym.: frontal headache, foul breath, thirst,
   – Tongue:
          red body with yellow fur
   – Pulse:
          rapid, overflowing on the right middle postion

• Treatment Protocol:

   – Clear St.-heat
   – Cool blood to stop bleeding
Formula:
                        Jia Wei Qin Wei San
 Sheng Di   Dan Pi    Dang Gui   Huang Lian   Lian qiao   Shui Niu Jiao
 Shen Ma    Gan Cao

Modifications:

   Harmonize blood (stop bleeding, eliminate stasis, calm &
   nourish blood)
        -- Da Ji, Xiao Ji, San Qi, Bai Shao
   Swollen gum
        -- Jin Yin Hua, Pu Gong Yin, Zi Hua Di Ding
   Thirsty
        -- Shi Gao, Zhi Mu, Tian Hua Feng
   St. heat turn to St. Fire (constipation)
        -- Xie Xing Tang ( Huang Lian, Huang Qin, Da Huang)
Treatment
  2) Bleeding Gums
    B) Stomach-Yin Def. with empty-heat
    Signs & Symptoms:

     – Main Sym. : slight bleeding from gums, swelling of gums
     – Concurrent sym.: mental restlessness, gums diseased, loose
       tooth, hot sensations in the palms & soles.
     – Tongue:
              red body with little fur
     – Pulse:
              rapid, thready

•   Treatment Protocol:

     – Nourish St. – Yin
     – Clear Empty heat
     – Cool blood to stop bleeding
Formula:
                             Qin Wei San
 Sheng Di   Mu Dan Pi   Dang Gui   Huang Lian   Shen Ma



Modifications:

   Harmonize blood (stop bleeding, eliminate stasis,
   calm & nourish blood)
       -- Di Yu, San Qi, Er Jiao
   Nourish Yin
       -- Mai Dong, Yu Zhu , Tian hua feng
   Astringe
       -- Lian zi
Treatment
  3) Bleeding under the skin
    A) Blood heat
    Signs & Symptoms:

     – Main Sym. : Suddenly onset, purple spots or plague in skin
     – Concurrent sym.: blood from other sites such as nose, intestines
       or bladder, mental restlessness, thirsty, constipation, fever at
       night.
     – Tongue:
              red body without coating, red points all over
     – Pulse:
              rapid & fine

•   Treatment Protocol:

     – Expel poison
     – Clear away heat
     – Cool blood to stop bleeding
Formula:

                             Xi Jiao Di Huang Tang
 Hui Niu Jiao   Shen Di     Dan Pi    Chi Shao       Shi Gao   Zhi Mui
 Zhi Zi         Ce Pai Ye   Gan Cao

Modifications:

   Harmonize blood (stop bleeding, eliminate stasis, calm &
   nourish blood)
        -- Qian Cao Geng, Di Yu, Gou Qi Zi
   Astringe
        -- Shan Zhu Yu
   Abdomen pain + hematochezia
        -- Mai Dong, Yu Zhu , Tian hua feng
   Blood heat is very pronounced
        -- Zi Cao

								
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