World Century Compendium To Tcm - Volume 4: Introduction To Chinese Internal Medicine

Volume 4: Introduction to Chinese Internal Medicine

Xiang Xia, Xiao-heng Shen, Min Chen, Yan-qian Xiao, Yebo He

• Publisher: WCPC
• Year: 2013
• eBook ISBN: 9781938134210

Chinese internal medicine is a clinical subject which explains, using traditional Chinese theories, the etiology, pathology and therapeutic rules of the diseases or syndromes belonging to internal medicine. It is also the foundation for learning and research in other clinical branches of Chinese medicine, thus playing a vital role in traditional Chinese medicine (TCM).

Chinese internal medicine has had a long history. Its origins can be traced back several thousand years. Through long-term diagnostic and therapeutic practices, a rich collection of experiences and theories in Chinese internal medicine has been accumulated and this has gradually evolved into a complete, distinctive and effective clinical branch. In recent decades, Chinese internal medicine has also undergone more significant developments, especially in the treatment of cardiac or cerebral vascular diseases, digestive tract diseases, renal diseases and autoimmune diseases.

In order to popularize Chinese internal medicine and allow readers to grasp its basic theories as well as diagnostic and therapeutic methods, we wrote this book in a language easily comprehensible by the layman. For ease of learning by modern doctors, we proceeded from the current clinical practice and outlined the contents with Western disease names. There are more than 80 diseases discussed in this book. For each disease, the Chinese syndrome differentiation and treatment as well as modern diagnostic key points are provided, to make it more convenient for the readers to study and understand.

The study of each disease should begin from its etiology, pathology and diagnostic key points, followed by the differentiated patterns and corresponding treatments. The respective points of caution for each disease should also be well-noted. Finally, the questions forming the “Daily Exercises” are useful for readers to check their comprehension and recall of the material. Given the chance, the theoretical knowledge should also be applied in clinical practice so that past knowledge is tested and new clinical knowledge and skills can be learned.

This book is suitable for those who are enthusiastic about TCM and with basic medical knowledge, as well as clinical TCM doctors, nursing personnel and TCM students.

Contents:

• Common Ailments
• Diseases of the Respiratory System
• Cardiovascular Diseases
• Disorders of the Digestive System
• Disorders of the Urinary System
• Disorders of the Hematological System
• Disorders of the Endocrine System
• Neuropsychic Diseases
• Connective Tissue Diseases
• Metabolic Diseases

Readership: Medical professionals, both Western medical doctors and TCM practitioners, particularly those practicing in Australia, Europe and America; Chinese medicine educators, clinical and basic Chinese medicine researchers and health science students (particularly Chinese medicine students); herbalists, gerontology researchers, nutritionists, public health specialists (health policy departments in ministries of health and universities); professionals at the World Health Organization and affiliated institutions, and pharmaceutical companies; librarians of TCM professional associations and teaching institutes and the lay reader who either wants general knowledge or wishes to understand how TCM can help a friend, relative or loved one.

CHAPTER 1

Common Ailments

Headache

Week 1: Monday

Headache is a subjective symptom frequently encountered in the clinic. It may occur on its own or be experienced in a variety of acute or chronic diseases, such as hypertension, cerebrovascular accidents, brain tumor and angioneurotic headache. Headache discussed herein belongs to the category of miscellaneous internal diseases, marked by pain in the head.

Etiology and Pathology

TCM holds that headache can be caused by either exogenous or endogenous factors. The former refers to pathogenic wind (the leading pathogen), cold, dampness and heat, while the latter refers to disorders of the liver, spleen and kidneys. In addition, traumatic injuries due to falls and knocks may affect the collaterals in the long run, bringing about obstruction of qi and blood in the vessels or collaterals, eventually leading to headache.

The pathological changes of headache are characterized by exogenous invasion of the six abnormal climatic factors into the vertex, obstructing the lucid yang and inducing headache. There are two factors attributed to the liver: The first is emotional depression resulting in transformation of stagnated liver qi into fire, which flames upward and disturbs the mind; the other is deficiency of liver yin resulting from either exuberance of fire or insufficiency of kidney water, both of which will lead to hyperactivity of liver yang, which harasses the clear orifices upwardly. There are similarly two factors attributed to the kidneys: The first is congenital deficiency or prolonged consumption of kidney essence, causing failed nourishment of the brain marrow and thereby triggering headache; the other is deficiency of yin involving yang, rendering the kidney yang debilitated and the lucid yang encumbered, finally bringing about headache. The remaining two factors attributed to the spleen are deficiency and excess. The former refers to malnutrition of the brain marrow and collaterals due to insufficient blood supply caused by irregular diet, overstrain, chronic diseases or childbirth (which makes the spleen and stomach become too weak to produce sufficient blood) and loss of blood; the latter refers to the clouding of the clear orifices and the encumbrance of lucid yang by phlegm and dampness, which ensue from malfunction of the spleen due to excessive intake of fatty and sweet food.

Diagnostic Key Points

1. The patient has a history of hypertension or arteriosclerosis.

2. The pain may be in the temples or the vertex, or without a fixed location.

3. The onset is characterized by pricking, dull or distending pain.

4. Physical examination reveals no positive signs.

Syndrome Differentiation

The following three types of headache described below are due to exogenous pathogenic factors:

1. Headache due to wind-cold

Symptoms: Headache by fits and starts, pain radiating to the nape and back, aggravation by wind, aversion to wind, intolerance of cold and absence of thirst; thin white coating on the tongue and floating pulse.

Analysis of symptoms: The head is the region where all yang meridians convene, so when pathogenic wind-cold attacks the body from the exterior, it will reach the vertex along the taiyang meridian, obstructing the lucid yang and triggering headache; the taiyang meridian dominates the superficies of the body, passes through the back and nape and arrives at the vertex, so the pain can radiate to the nape and neck; pathogenic wind-cold fetters the skin and muscles and stagnates the defensive yang, which explains the aversion to wind and intolerance of cold. Since there is no heat, thirst is absent; the thin white tongue coating and floating pulse are both manifestations of wind-cold in the exterior.

2. Headache due to wind-heat

Symptoms: Headache with distension or even a splitting sensation in the head, fever or aversion to wind, reddened eyes and flushed face, thirst with a desire to drink, constipation and yellowish urine, a reddened tongue with yellowish coating and floating, rapid pulse.

Analysis of symptoms: Heat is a yang pathogen marked by flaming up, so wind-heat attacks the yang collateral and disturbs the clear orifices upwardly, giving rise to distending headache or even a splitting sensation in the head; reddened eyes and a flushed face are attributable to a flaming up of pathogenic heat; wind-heat invades the defensive phase, bringing about fever and aversion to wind; abundant heat consumes body fluid, so there is thirst, constipation and yellowish urine; reddened tongue with yellowish coating and floating, rapid pulse are both manifestations of exuberant wind-heat.

3. Headache due to wind-dampness

Symptoms: Headache as if the head was being wrapped, heaviness in the limbs, a poor appetite, chest distress, difficulty in micturition and loose stools; white greasy tongue coating and soggy pulse.

Analysis of symptoms: Pathogenic wind-dampness invades the vertex and obstructs the clear orifices, so there is pressure around the head as if it is being wrapped by something; the spleen governs transformation and dominates the four limbs, so when turbid dampness is retained in the interior and encumbers the spleen yang, there will be heaviness in the limbs, poor appetite and chest distress. Since there is internal obstruction of pathogenic dampness, the small intestine may fail to separate the lucid from the turbid, with such symptoms as difficulty in micturition or loose stools; white greasy tongue coating and soggy pulse are both attributable to obstruction of turbid dampness in the interior.

The following four types of headache are due to endogenous pathogenic factors:

4. Headache due to hyperactivity of liver yang

Symptoms: Headache with dizziness, vexation, irascibility, insomnia at night which may be accompanied by hypochondriac pain, flushed face and a bitter taste in the mouth; thin and yellow tongue coating, as well as taut and forceful pulse.

Analysis of symptoms: All wind disorders, such as tremors and vertigo, are attributable to the liver, so when the liver qi is stagnated and the liver yang is hyperactive, the clear orifices will be affected, resulting in headache with dizziness; hyperactive liver fire can disturb the heart spirit, leading to vexation, irascibility and insomnia at night; stagnated liver qi and gallbladder qi produce fire and a predisposition to hyperactivity of the liver yang, marked by hypochondriac pain, a bitter taste in the mouth and a flushed face; thin and yellow tongue coating and taut and forceful pulse are both manifestations of hyperactive liver yang.

5. Headache due to deficiency of the kidneys

Symptoms: Headache with an empty sensation, often accompanied by dizziness or soreness and weakness of the waist, lassitude, nocturnal emissions, leukorrhea, tinnitus and poor sleep; reddish tongue with scanty coating and thin pulse.

Analysis of symptoms: The brain is known as the “sea of marrow” which is governed by the kidneys, so if the kidney essence is too deficient to nourish the brain marrow, there will be empty pain in the head, dizziness and tinnitus; the waist is the “house of the kidney”, and if the kidneys are too weak, there will be nocturnal semen emission in males; the belt vessel becomes deficient, so it will fail to perform its function of controlling abnormal vaginal discharge in females; insomnia, reddish tongue with scanty coating and thin pulse are due to insufficiency of kidney yin.

6. Headache due to deficiency of blood

Symptoms: Headache with dizziness, palpitations and restlessness, lassitude, bright pale complexion and a pale tongue; thin white tongue coating, as well as thin and feeble pulse.

Analysis of symptoms: Deficient blood generates deficient fire, which attacks the head, leading to pain with dizziness; deficiency of blood brings about malnutrition of the heart spirit, so there are palpitations and feelings of uneasiness; deficiency of blood also involves qi, leading to symptoms of qi deficiency such as listlessness or lassitude; wan complexion, pale tongue with thin white coating, as well as thin and feeble pulse are all manifestations of blood deficiency.

7. Headache due to turbid phlegm

Symptoms: Headache with a befuddled mind, sensation of fullness and stuffiness in the chest, nausea with vomiting of sputum and saliva; white greasy tongue coating and slippery or taut, slippery pulse.

Analysis of symptoms: Dysfunction of the spleen in transportation and transformation may lead to internal obstruction of turbid phlegm which clouds the clear orifices and encumbers lucid yang, this is marked by headache with a befuddled mind; obstruction of turbid phlegm in the diaphragm can produce a sensation of fullness and stuffiness in the chest; adverse rising of turbid phlegm is characterized by nausea and vomiting of sputum and saliva; the white greasy tongue coating and slippery or taut, slippery pulse are caused by internal retention of phlegm and dampness.

Differential Treatment

1. Headache due to wind-cold

Treatment principle: Dispersing wind and dispelling cold.

Prescription and herbs: Modified Chuanxiong Chatiao Powder.

Chuanxiong (Szechwan Lovage Rhizome) 9 g, Jingjie (Fineleaf Schizonepeta Herb) 9 g, Fangfeng (Divaricate Saposhnikovia Root) 9 g, Qianghuo (Incised Notoptetygium Rhizome or Root) 12 g, Baizhi (Dahurian Angelica Root) 12 g, Xixin (Manchurian Wildginger) 6 g, Bohe (Peppermint) 6 g and Gancao (Liquorice Root) 6 g.

Modification: If pathogenic cold invades the jueyin channel, causing such manifestations as parietal headache and retching, Wuzhuyu (Medicinal Evodia Fruit) 9 g and Banxia (Pinellia Tuber) 9 g are added to warm the body, dissipate pathogens and reduce adverseness.

2. Headache due to wind-heat

Treatment principle: Dispersing wind and clearing heat.

Prescription and herbs: Modified Xiongzhi Shigao Decoction.

Chuanxiong (Szechwan Lovage Rhizome) 9 g, Baizhi (Dahurian Angelica Root) 12 g, Juhua (Chrysanthemum Flower) 9 g, Shengshigao (Unprepared Gypsum) 30 g, Huangqin (Baical Skullcap Root) 15 g, Bohe (Peppermint) 6 g and Zhizi (Cape Jasmine Fruit) 9 g.

Modification: If there is consumption of body fluid by intense heat, causing such manifestations as red and dry tongue and dry mouth with thirst, Zhimu (Common Anemarrhena Rhizome) 12 g, Shihu (Dendrobium) 15 g and Tianhuafen (Trichosanthin) 15 g are added to promote fluid production and quench thirst; for dry stools, oral and nasal sores and obstructed intestinal qi, Huanglian (Golden Thread) 3 g and Dahuang (Rhubarb) 9 g (decocted later) are added to bring down fire, cleanse the intestine and eliminate heat.

3. Headache due to wind-dampness

Treatment principle: Dispelling wind and eliminating dampness.

Prescription and herbs: Modified Qianghuo Shengshi Decoction.

Qianghuo (Incised Notoptetygium Rhizome or Root) 9 g, Duhuo (Doubleteeth Pubesscent Angelica Root) 9 g, Chuanxiong (Szechwan Lovage Rhizome) 9 g, Fangfeng (Divaricate Saposhnikovia Root) 9 g, Manjingzi (Shrub Chastetree Fruit) 12 g, Gaoben (Chinese Lovage) 12 g and Gancao (Liquorice Root) 6 g.

Modification: If there is internal obstruction by turbid dampness, causing such signs as chest distress, poor appetite and loose stools, Cangzhu (Atractylodes Rhizome) 12 g, Houpu (Magnolia Bark) 9 g, Chenpi (Dried Tangerine Peel) 9 g and Zhiqiao (Orange Fruit) 12 g are added to reduce dampness and relieve the middle energizer; for nausea and vomiting, Banxia (Pinellia Tuber) 9 g and Shengjiang (Fresh Ginger) 5 slices are used to bring down the adverse flow of qi and arrest vomiting.

4. Headache due to hyperactivity of liver yang

Treatment principle: Calming the liver and subduing yang.

Prescription and herbs: Modified Tianma Gouteng Decoction.

Tianma (Tall Gastrodis Tuber) 12 g, Gouteng (Gambir Plant) 15 g, Shijueming (Sea-ear Shell) 30 g, Huangqin (Baical Skullcap Root) 15 g, Zhizi (Cape Jasmine Fruit) 9 g, Niuxi (Two-toothed Achyranthes Root) 12 g, Duzhong (Eucommia Bark) 12 g, Sangjisheng (Chinese Taxillus Herb) 12 g, Yejiaoteng (Caulis Polygoni Multiflori) 30 g, Fushen (Indian Bread with...

Table of contents

• Cover
• Halftitle
• World Century Compendium to TCM
• Title
• Copyright
• Contents
• Foreword to the English Edition
• Preface
• Chapter 1 Common Ailments
• Chapter 2 Diseases of the Respiratory System
• Chapter 3 Cardiovascular Diseases
• Chapter 4 Disorders of the Digestive System
• Chapter 5 Disorders of the Urinary System
• Chapter 6 Disorders of the Hematological System
• Chapter 7 Disorders of the Endocrine System
• Chapter 8 Neuropsychic Diseases
• Chapter 9 Connective Tissue Diseases
• Chapter 10 Metabolic Diseases
• Index