Tiêu đề Diagnosis in Chinese Medicine 103-Index.pdf ✅

946 Part 6: IDENTIFICATION OF FATTERNS, Section 3 Table 103.2 Differentiation between Wind-Cold and Wind-Heat mani- festations Wind-Cold Wind-Heat Pathology Wind-Cold obstructing Wind-Heat obstructlng the space the space between skin between skin and muscles and and muscles impairing the descending of Symptoms Fever slight Lung.Q, High and signs Shivers Pronounced sl,ght Aches Pronounced Slight ThJrst No Yes Urine Clear Slightly dark Headache Occipital Deep inside, severe Sweating lf sweating, in top part, head Slight sweating Sore throat Itchy throat Very sore throat Tongue No change Slightly Red on the sidesrfront Pulse Floating-Tight Floating-Rapid Treatment Pungent-warm herbs to PiJngent-cool herbs to release the ca use sweating Exterior 3. Deficiency of Liver-Blood Finally, deficiency of Liver-Blood can also give rise to Empty Liver-Wind. This is due to the deficiency of Blood creating an empty space within the blood vessels, which is taken up by interior Wind. This could be compared to the draughts generated sometimes in certain underground (subway) stations. The clinical manifestations are numbness, dizziness, blurred vision, tics and slight tremors (in Chinese called `chicken feet Wind' as the tremors are like the jerky movements of chickens' feet when they are scouring the ground for food). Empty- Wind can also result from Liver-Yin deficiency. Box 103.3 summarizes the patterns of interior Wind. BOX 103.3 INTERIOR WIND • Extreme Heat generating Wind (Blood level of Four Levels) • Liver-Yang rising turnlng Into Liver-Wind • Liver-Blood (or Liver-Yin) deficiency giving rise to (Empty) Wind COLD Cold is a Yin pathogenic factor and, as such, it tends to injure Yang. Cold can be exterior or interior. Exterior Cold Cold, spearheaded by Wind, can invade the Extel.ior of the body and give rise to symptoms of Wind-Cold, already described above. Cold can also invade the channels directly and cause Painful Obstruction Syndrome, with pain in one or more joints, chilliness and contraction of the tendons. Apart from invading muscles, channels and joints, Cold can also invade three of the Internal Organs directly. These are the Stomach (causing epigastric pain and vomiting), the Intestines (causing abdominal pain and diarrhoea) and the Uterus (causing acute dysmenorrhoea). In all three cases the symptoms would be accompanied by chilliness and the pain would be alleviated by the application of heat. Box 103 .4 summarizes the patterns of external Cold invasion. BOX 103.4 EXTERNAL COLD INVASION _ • External Cold (with Wind) Invasion in the Lung Defensive-Qi portion (common cold) • Invasion of Cold in the channels and jc)ints (Painful Obstruction Synd rome) • Invasion of external cold in organs directly (Stomach, _ Intestines and Uterus) -Stomach: vomiting and epigastric pain ~lnte5tines: diarrhoea and abdominal pain -Uterus: acute dysmenorrhoea
Chapter 103: IDENTIFICATION OFPATTERNS ACCORDING TO PATHOGENIC FACTORS 947 Cold contracts tissues and it obstructs the circula- tion of Yang Qi and Blood causing pain. Hence there is a saying.. ` Retention oj` Colcl calises pain.' 2 Pain is therefore a frequent manifestation of Cold. Other symptoms are stiffness, contraction of tendons and chilliness. Cold can invade any part of the body and any joint, but the most common places it invades are the hands and arms, feet and knees, lower back and shoulders. Cold is often manifested with thin, watery and clear fluid discharges, such as a clear white discharge from the nose, very pale urine, watery loose stools and clear watery vaginal discharges. Another saying clarifies this characteristic of Cold: .A dz.seflsc c/mmc- terized bu thlii, cleal., wateru ancl cool disclmrges is due to Cold.` 3 Box 103.5 summarizes the signs of symptoms of exterior Cold. BOX 103.5 SYMPTOMS AND SIGNS OF-EXTERIOR COLD • Severe pain (ameliorated by application of heat) • Stiffness of muscles • Contraction oftendons • Feelingofcold • Thin, watery fluid discharges Interior Cold Interior Cold can be Full or Empty. The clinical mani- festations of Full- and Empty-Cold are very similar as they are the same in nature. Tlie main difference is that Full-Cold is characterized by an acute onset, severe pain and a tongue and pulse of the Excess type; for example the tongue would have a thick white coating and the pulse would be Full and Tight. Empty-Cold is characterized by a gradual onset, dull pain and a tongue and pulse of the Deficiency type; for example the tongue would have a thin white coating and be Pale and the pulse would be Empty or Weak. Interior Full-Cold Interior Full-Cold originates from climatic cold, which either invades the channels, causing Painful Obstruc- tion Syndrome, or invades certain organs directly. Both these cases have been mentioned above. Generally speaking, Interior Full-Cold can last only a relatively short time. After prolonged retention, inte- rior Cold consumes the Yang of the Spleen, giving rise to Empty-Cold. Thus a Full-Cold pattern can turn into an Empty-Cold one. Interior Empty-Cold Interior Empty-Cold arises from deficiency of Yang, usually of the Spleen, Lungs or Kidneys. In this case the Cold does not come from outside the body, but is interiorly generated by deficiency of Yang. The general symptoms are chilliness, dull pain, cold limbs, a desire to drink warm liquids, lack of thirst, a pale face, a thin white tongue coating and a Deep, Weak and Slow pulse. Other symptoms vary according to which organ is mostly affected. The Heart, Lungs, Spleen, Kidneys can all suffer from deficiency of Yang and interior Cold. Table 103.3 lists the clinical manifestations of Full- and Empty-Cold. Ti)ble 103.3 Differentiation between Full- and Empty-Cold Full-Cold Empty-Cold Onset Acute ChronicDull Pain Intense, crampy Tongue Thick white coating Thin white coating, Pale body Pulse Full-Tight-Slow Weak-Deep-Slow The symptoms of Heart-Yang deficiency (in addition to the above-mentioned general symptoms) with inte- rior Cold are stuffiness and pain in the chest, purple lips and a Knotted pulse. In Lung-Yang deficiency they are a tendency to catch colds. sweating and a cough with white mucus. In Spleen-Yang deficiency they are diar- rhoea or loose stools and lack of appetite. In Kidney- Yang deficiency they are fl-equent, pale and profuse urination. lower backache, cold feet and knees and impotence in men or white leucorrhoea in women. The manifestations of Yang deficiency of the vai-ious organs have been discussed in greater detail in the chapters on the identification of patterns according to the Intel-nal Organs. Box 103 .6 summarizes the types of Empty-Cold. BOX 103.6 EMPTY-COLD • Heart-Yang deficiency • Spleen-Yang de ciency • Lung-Yang defic ency • Kidney-Yang deficiency
948 Part 6: IDENTIFICATION 0F PATTERNS, Section 3 SUMMER-HEAT Summer-Heat is a Yang pathogenic factor and. as such, it tends to injure Yin. This pathogenic factor is slightly different from the others. in so far as it is definitely re[atcd to a speciric season since it can occur only in summer. The main clinical manifestations are aversion to cold, sweating, headache, scanty dark urine, dry lips, thirst, a Floating-Rapid pulse and a Red tongue on the sides and front. Note that there is aversion to cold in the beginning stages because the Summer-Heat invades the Defensive-Qi portion and Defensive Qi fails to warm the muscles. In severe cases, Heat can invade the Pericardium and cause c[ouding of the mind, manifesting with delirium. slurred speech or unconsciousness. Box 103. 7 summarizes the clinical manifestations of Summer-Heat. BOX 103.7 SUMMER-HEAT • Aversion to cold • Sweat,ng • Headache • Scanty dark urine • Dryl,ps • Thirst • Floating-Rapid pulse • Tongue Red on sides and front DAMPNESS Dampness is a Yin pathogenic factor and it tends to injure Yang. The term refers not only to damp weather, but also to such conditions as living in a damp house. Exterior Dampness can also bc caught by wearing wet clothes, wading in water, working in damp places or sitting on damp ground. The characteristics of Dampness are that it is sticky, it is difficult to get rid of, it is heavy, it slows things down, it infuses downwards and it causes repeated attacks. When exterior Dampness invades the body, it tends to invade the lower part first. typi- cally the legs. From the legs, it can flow upwards in the leg channels to settle in any of the pelvic cavity organs. If it settles in the female genital system it causes vaginal discharges. if it settles in the Intestines it will cause loose stools and if it settles in the Bladder it will cause difficulty. frequency and burning of urination. The clinical manifestations of Dampness are extremely varied according to its location and nature (hot or cold), but the general ones are a feeling of heaviness of body or head, lack of appetite. a feeling of fullness of chest or epigastrium, a sticky taste. urinary difficulty, a white sticky vaginal dis- charge, a sticky tongue coating and a Slippery or Soggy pulse. Box 103.8 summarizes the manifestations of Dampness. BOX 103.8 GENERAL MANIFESTATIONS OF DAMPNESS • Feeling of heaviness • Poor appetite • Feeling of fullness • Stickytaste • Urinary difficulty • Vaginal discharge • Stickytongue coating • Slippery or soggy pulse The clinical manifestations of Dampness can be classified according to its location as follows: • Head: feeling of heaviness and muzziness of the head • Eye s: red swollen eyelids, eyes oozing fluid. styes a Mouth: mouth ulcers on gums, swollen-red lips ® Stomach and Spleen: feeling of fullness/oppression of epigastrium, feeling of fullness alter eating, sticky taste, loose stools, poor appetite, Soggy pulse a Lower Burner: excessive vaginal discharge, painful periods , infertility, turbid urine, difficult and painful urination, scrotal sweating or eczema, genital eczema , genital itching • Skin: papules (Damp-Heat with more Heat), pustules, vesicles (Dampness without Heat), greasy sweat, boils, any oozing skin lesion a Joints: swollen-painful joints (Fixed Painful Obstruction Syndrome, also Wandering Painful Obstruction Syndrome if mixed with Wind) ® Connecting channels: numbness and loss of sensaLtion.
Chapter 103: IDENTIFICATION OF PATTERNS ACCORDING TO PATHOGENIC FACTORS 949 The various clinical manifestations can be correlated to the following main characteristics of Dampness. Hcflviness This causes a feeling of tiredness. heavi- ness of limbs or head, or a `muzzy' feeling of the head. Since Dampness is heavy it causes a feeling of fullness and oppression of chest or epigastrium, and it tends to settle in the Lower Burner. However, Dampness often affects the head too causing the above-mentioned symptoms. This happens because it prevents the clear Yang from ascending to the head to brighten the sense orifices and clear the brain. Djrfjriess Dampness is dirty and is reflected in dirty discharges, such as cloudy urine, vaginal discharges or skin diseases characterized by thick and dirty fluids oozing out, such as in certain types of eczema. Stjchiness Dampness is sticky and this is reflected in a sticky tongue coating, sticky taste and Slippery pulse. The sticky nature or Dampness also accounts for its being very difficult to get rid of. It often becomes chronic, manifesting in frequent, recurrent bouts. Dampness can also cause a large variety of diseases according to its location. There are three locations: the Internal Organs, the channels and the skin. The range of disease according to the location of Dampness is as follows. mternHJ 0rgflns In the stomach and spleen there may be epigastric pain and fullness, poor digestion, feeling of fullness. a sticky taste, or a poor appetite. In the Gall-Bladder hypochondrial pain and fullness are seen. In the bladder there may be difficult and painful urination, and cloudy urine. In the Uterus Dampness may cause infertility, or excessive vaginal discharge. In the Intestines there may be loose stools with mucus, abdominal pain and fullness. Dampness in the Kidneys may manifest as cloudy urine, or difficult urination. In the Liver it may cause hypochondrial fullness, disten- sion and pain, or jaundice. CJlflHrieJs In the joints Dampness can cause painful Obstruction Syndrome. In the head there may be a feeling of heaviness of the head, or headache. Skin Dampness isthecause of an enormous number of skin diseases manifesting with oozing skin lesions, papules, vesicles or pustules. The classification of Dampness is quite complex and can be divided into the two broad categories of external or internal Dampness. Within each of these al.e a number of subcate- gories. Box 103.9 summarizes the classification of Dampness. BOX 103.9 CATEGORIES OF EXTERNAL AND INTERNAL DAMPNESS invasion of Dampness in the Internal Organs ~External of Dampness in Bladder -External invasion Of Dampne-ss in Stomach -External -External Invasion Of lnvas;on Of -External Internal Chronic • Internal Of Dampness in Intestines invasion Of Dampness in Uterus in Gall-Bladder acute, external Dampness in channels External Damp-Heat at Defensive-Qi level Damp-Heat Summer-Heat with Dampness ass in Internal Organs Stomach and Spleen in gladder -I LLDampness in Intestines -Dampness in Utei.us ~Dampness jn Gall-Bladder -Dampness in Liver -Dampness in Kidneys • Chronic Dampness in chamels • Internal Dampness in Skin Acute • Damp-Heat at Qi Level External Dampness There are three possible types of invasions of external Dampness: 1. A `simple' invasion of Dampness in the Internal Organs, which may affect the Bladder, Stomach, Intestines, Uterus and Gall-Bladder 2. - An invasion of Dampness in the channels causing Painful Obstruction Syndrome in its acute stage 3. An invasion of Damp-Heat of the Won Bjng type at the Defensive-Qi ( Wej) level, manifesting with fever. 'Simple' invasion of external Dampness in Internal Organs Invasion of external Dampness in Bladder Difficulty and pain on urination, scanty but frequent urination, cloudy urine, a feeling of heaviness in the lower abdomen, tongue with a thick sticky coating on the root. pulse perhaps Slippery on the left Rear position.