DIFFERENTIATION OF TRADITIONAL CHINESE MEDICAL SYNDROME

Onset

Ba Gang: Foundation

Qi and Xue

San Jiao

Four Portions

Six Levels

Twelve Meridians/

Zang-Fu

 Common Western Syndromes

Acute

Yang

Biao (Exterior)

Re (Hot)

Shi (Excess)

Qi

Upper Warmer

Wei

Taiyang

SI/UB

Shaoyang

TW/GB

Qi

Middle Warmer

Yangming

LI/S

Chronic

Yin

Li (Interior)

Han (Cold)

Xu (Deficiency)

Xue

Ying

Taiyin

L/Sp

Lower Warmer

Shaoyin

H/K

Xue

Jueyin

P/Lv

SOURCES FOR COMMON SYNDROMES

COMMON SYNDROME DEFINITIONS: (Merck), (Mosby), (Pocket), (New American), (Healing People)

DIFFERENTIATION:

Syndromes: Etiology/Causes: (Shanghai 567-692), (Mann, Treatment 89-159), (CAM 373-490), (Acusource 116-159), (Healing People)

Pathogenesis: Symptoms/Effects: (Merck), (Kaptchuk 275-299), (Mann, Treatment 89-159), (CAM 373-490), (Acusource 116-159), (Healing People)

TREATMENT:

Acupuncture: (Shanghai 567-692), (Mann, Treatment 89-193), (CAM 373-490), (Acusource 116-159), (Healing People)

Herbs: (Bensky), (Fratkin), (Healing People)

KEY

Acupuncture

Meridians/Vessels:

L = Lung

LI = Large Intestine

S = Stomach

Sp = Spleen

H = Heart

SI = Small Intestine

UB = Urinary Bladder

K = Kidney

P = Pericardium

TW = Triple Warmer

GB = Gall Bladder

Lv = Liver

GV = Du/Governing Vessel

CV = Ren/Conception Vessel

PV = Chong/Penetrating Vessel

YgH = Yangqiao/Yang Heel (Motility) Vessel

YnH = Yinqiao/Yin Heel (Motility) Vessel

YgL = Yangwei/Yang Linking Vessel

YnL = Yinwei/Yin Linking Vessel

Warmers:

UW = Upper Warmer

MW = Middle Warmer

LW = Lower Warmer

Diagnosis:

(found under functions/ indications)

S = signs/symptoms

T = tongue

P = pulse

[only for principal formulas]

TCM: TCM diagnosis

WCI: western clinical impression (western medicine diagnosis)

Treatment:

TX = treatment

RX = pharmaceutical/herbal (oral) medication

PX = prognosis

pt = patient

PT = physical therapy

? = General acupuncture

ACU = acupuncture

MX (group of points) /mx (designated after specific point) = Moxibustion

ES = Electrical stimulation

CP = Cupping

BL = Blood letting

HP = Hot pack

O = Auricular acupuncture

( ) = method description of one course of treatments may include:

acupt/s = acupuncture points

ins = insertion depth

stim = level of stimulation (mod = moderate)

ret = retention duration (min = minutes; hr = hour; wk = week; w/d = withdraw)

x = times

alt = alternating days

crs = # of treatments per course (x = times; alt = alternating days)

freq = frequency

cont = continuous

®       = remarks regarding treatment

c = cun

Western Medicine:

HA = Headache

BP = blood pressure

HBP = High Blood Pressure

LBP = Low Blood Pressure

TB = tuberculosis

GI = gastrointestinal

PID = pelvic inflammatory disease

SCM = sternocleidomastoid

URI = upper respiratory infection

DM = diabetes mellitus

CVA = cerebrovascular accident

CV = cardiovascular

FM = fibromyalgia

CFS = chronic fatigue syndrome

HT = hypertension

RBC = red blood cell

WBC = white blood cell

ic = intercostals

si = sacroiliac joint

Herbs

Note: Refer to the principal formula (PF) for specific ‘preparations,’ ‘cautions and contraindications’, ‘TCM’ diagnosis, and ‘WCI’ of their associated formulas.

[ ] = Action Categories (Bensky):

[E] = release exterior

[E-e] = release early stage exterior

[E-c] = release exterior cold

[E-w] = release exterior wind-heat

[E-h] = release exterior w/ head and neck disorders

[E-¯] = release exterior w/ interior deficiency

[E-­] = release exterior w/ interior excess

[H] = clear heat

[H-q] = clear heat from qi level

[H-b] = clear heat from nutritive level and cool blood

[H-t] = clear heat, relieve toxicity

[H-o] = clear heat from organs

[H-¯] = clear deficient heat

[H-s] = clear and relieve summer heat

[¯] = drain downward

[¯-h] = purge heat accumulation

[¯-i] = moisten intestines, unblock bowels

[¯-c] = warm yang, guide out accumulation

[¯-w] = drive out excess water

[R] = harmonize

[R-s] = harmonize shaoyang disorders

[R-h] = regulate liver and spleen (hepatic)

[R-d] = regulate stomach and intestines (digestion)

[Y] = moisten dryness

[Y-d] = gently disperse, moisten dryness

[Y-n] = enrich yin, moisten dryness

[D] = expel dampness

[D-u] = promote urination, leech out dampness

[D-t] = transform damp turbidity

[D-h] = clear damp heat

[D-c] = warm and transform water and dampness

[D-w] = dispel wind dampness

[C] = warm interior cold

[C-c] = warm channels, disperse cold

[C-m] = warm middle, dispel cold

[C-g] = rescue devastated yang

[T] = tonify

[T-q] = tonify qi

[T-b] = tonify blood

[T-qb] = tonify qi and blood

[T-g] = warm and tonify yang

[T-n] = nourish and tonify yin

[Q] = regulate qi

[Q-m] = promote movement of qi

[Q-¯] = direct rebellious qi downward

[B] = invigorate blood

[B-i] = invigorate blood, dispel blood stasis

[B-m] = warm menses, dispel blood stasis

[B-t] = invigorate blood w/ traumatic injury

[Bs] = stop bleeding

[Bs-h] = clear heat, stop bleeding

[Bs-t] = tonify and stop bleeding

[SB] = stabilize and bind

[SB-e] = stabilize exterior and lungs

[SB-i] = restrain leakage from intestines

[SB-k] = stabilize kidneys

[SB-w] = stabilize womb

[S] = calm spirit

[S-h] = nourish heart, calm spirit

[S-s] = sedate and calm spirit

[W] = expel wind

[W-s] = release wind from skin and channels

[W-i] = extinguish internal wind

[O] = open orifices

[O-h] = clear heat, open orifices

[O-c] = warm and open orifices

[O-p] = scour phlegm, open orifices

[P] = treat phlegm

[P-d] = dry dampness, expel phlegm

[P-h] = clear heat, transform phlegm

[P-y] = moisten dryness, transform phlegm

[P-n] = transform phlegm, dissipate nodules

[P-c] = warm and transform cold-phlegm

[P-w] = transform phlegm, extinguish wind

[P-v] = induce vomiting to discharge phlegm

[FS] = relieve food stagnation

[X] = expel parasites

{P} = Recommended Patent Groups (Fratkin):

1 = pills for problems due to exogenous wind invasion

2 = patents for cough, phlegm, and labored breathing

2a = pills

2b = syrups

3 = pills to remove internal, toxic, and damp heat

3a = pills to remove internal and toxic heat

3b = pills to remove damp-heat

3c = fevers in infants and young children

4 = pills, liniments, and plasters for removing wind-damp

4a = pills

4b = plasters for external application

5 = products for blood stagnation, bleeding, and pain

5a = pills

5b = pills for heart congestion, angina, and stroke

5c = patents for external application

6 = pills for promoting digestion and relieving congestion at the center

7 = pills and extracts for tonifying and nurturing

7a = pills and extracts to tonify qi

7b = pills and extracts to nourish blood

7c = tonics for deficiency of yang

7d = tonics for deficiency of yin or fluids

7e = general and combination tonics

8 = pills to calm shen (restlessness and insomnia)

9 = pills to control endogenous liver wind and hypertension

Dosage:

pt/pts = parts

s = slice

p = pieces

DERMATOLOGICAL

ACNE: a common inflammatory pilosebaceous disease characterized by comedones (blackheads), papules (small elevation of skin), inflamed nodules (swelling), pustules (superficial pus filled cysts), and (in extreme cases) canalizing and deep, inflamed, sometimes purulent (pus filled) sacs

DERMATITIS (Eczema): superficial skin inflammation, characterized by vesicles (skin blister) (when acute), redness, edema, oozing, crusting, scaling, and usually itching [scratching or rubbing may lead to lichenification (thickening of skin)]

Neurodermatitis: a nonspecific, pruritic skin disorder accompanied by an itching rash seen most commonly on the neck, and the folds of the elbows and knees, encountered mostly w/anxious, nervous individuals (esp. women) [sim to stress hives]

Contact: an acute or chronic inflammation, often sharply demarcated, produced by substances in contact with the skin

Seborrheic: an inflammatory scaling disease of the scalp, face, and occasionally other areas (sebum flows are usually normal)

Seborrhea: greasy condition due to overactive sebaceous glands which usually occurs on the scalp, face and sternal regions

Nummular: chronic dermatitis characterized by inflamed, coin-shaped, vesicular, crusted, scaling, and usually pruritic lesions

Chronic hand and feet:

Contact: see above

Housewife: caused by household irritants (cleaners, etc.)

Pompholyx: skin blisters on hands and feet

Psoriasis: chronic skin disease w/ erythematous and scaling that can occur in any part of the body but characteristically occurring at the extensor surfaces of the knees and elbows; when the scales are scraped they produce a shiny silver sheen; not infectious; a small percentage of patients have rheumatoid arthritis

Recalcitrant (resistant) pustulant

Fungal Infection

Generalized exfoliative: a severe, widespread erythema and scaling/shedding of the skin

Stasis: persistent inflammation of the skin of the lower legs with a tendency toward brown pigmentation, commonly associated with venous incompetency.

Localized scratch: a chronic, superficial, pruritic inflammation of the skin, characterized by dry, scaling, demarcated, lichenified plaques (thickened skin w/accentuated markings) of oval, irregular, or angular shape

FOLLICULITIS: a superficial or deep bacterial infection and irritation of the hair follicles, usually caused by staphylococcus aureus

FURUNCLES (Boil): acute, tender, perifollicular inflammatory nodules resulting from infection by staphylococcus

CARBUNCLES: a cluster of furuncles w/spread of infection subcutaneously, resulting in deep suppuration (formation of pus), often extensive local sloughing [septic (infected w/pus producing organisms) tissue that becomes necrosed and separated from healthy tissue], slow healing, and a large scar

SHI ZHEN: damp rash

Heat and poison collecting in the organs:

1)     Stagnation of qi and blood

2)     In infants and children: stagnant food; evil qi in Sp

3)     In adults: damp-heat

4)     Acute: wind-damp-heat penetrating the skin

5)     Chronic: heat in blood (w/deficient blood)

Causes:

1)     Excessive intake of alcohol or greasy foods

2)     Exogenous pathogenic invasion

Neurodermatitis (chronic lichen simplex): ‘ox-skin rash’

 E ZHANG FENG: ‘goose-foot wind;’ wind scorches and congeals blood

S: eruption of small white pustules over whole body, lesions (typically on flexor surfaces, neck, face, and hands), itching, redness, dry cracked skin, sudden fever, yellow pus, eosinophilia (an increase in a particular white blood cell during allergy or parasitic infection)

P: rapid, slippery

Goose-foot wind: center of palm is mottled purple and white, hard, thick, dry, cracked skin, gradually spreading to whole hand

Drain GV, eliminate heat from blood:

? GV10, GV12, LI4, UB40, Sp10, local acupts

(BL; strong stim; 1-2x/day)

Face: S2-3, M-UE-9, M-HN-3

High fever: GV14, LI11, Sp10

Delirium: GV26, M-UE-1, SI8, P4

Neurodermatitis: LI11, Sp10, LI4, Sp6

(mod-strong stim; surround affected area; transverse ins criss-cross)

Acne vulgaris: H9, Sp2, UB54, Lv11, K12

O allergy, cheek, neurogate, endocrine, testis, lung

Eczema: GV14, LI11, Sp6, H7

Chronic eczema: Sp10, S36; (CP)

Weeping eczema: UB60, UB54, TW5, SI3, Sp9

O local body area, allergy, neurogate, endocrine, adrenal, lung, large intestine, occiput

®       Consider the location of eczema lesions in relation to the meridians

Psoriasis: L5, Sp10

Furuncles: L11, H9

(BL head of furuncle)

MX: warm affected area (to activate blood)

CP: tap affected area then apply

O neurogate, adrenal, subcortex, lung, occiput, urticaria (allergy), endocrine, large intestine, pts of affected sites

(2-3 acupts w/mod-strong stim; ret 1-2 hrs; TX 1-2x/day)

®       Squeezing or incising furuncle too early can cause infection

®       If furuncle develops into septicemia (bacteria in blood), use another RX

®       ACU is supplementary to lancing

Clear goose-foot wind, activate blood: P6-8, H8

Carbuncles:

O local body areas, neurogate, occiput, adrenal

Cold Sores/Herpes Simplex:

O mouth, urticaria, neurogate, adrenal, lung, occiput, kidney

Sunburn:

O local body area, spinal cord, urticaria, neurogate, endocrine, adrenal, lung

Scleroderma:

O local body area, neurogate, endocrine, adrenal, lung, brain, occiput, liver, spleen

Rash from Poison Oak/Ivy:

O local body area, spinal cord, urticaria, neurogate, endocrine, allergy, lung, thyroid

[H-b] xi jiao di huang tang (76)

Swelling w/o color change:

[H-t] nei shu huang lian tang (80)

Stubborn limb sores:

[H-t] si miao yong an tang (85)

[H-t] qing wen bai du yin (82)

[H-t] wu shen tang (86) (popliteal region)

[C-c] yang he tang (217)

[C-c] zhong he tang (218)

Lower extremity sores:

[D-h] er miao san (195)

Early stage measles, sores:

[E-¯] yin qiao bai du san (54)

Diaper Rash:

[W-s] xiao feng san (395)

Acne:

[E-­] fang feng tong sheng san (58)

[T-b] shao yao gan cao tang (252)

+ chan tui, da zao, di fu zi

{3a} cai feng zhen zhu an chuang wan (43) (blood heat)

{3b} chuan shan jia qi shi qing du wan (55) (skin itching)

Carbuncles:

[H-t] xian fang huo ming yin (83)

[H-t] wu wei xiao du yin (84)

[H-t] chong he tang (84)

Furuncles:

[H-t] wu wei xiao du yin (84)

[¯-h] liang ge san (120)

[O-h] zi xue dan (420)

Clear toxic heat:

[H-t] huang lian jie du tang (78) (purulent skin lesions)

{3a} chuan xin lian kang yan pian (36) (fever w/sore throat)

{3a} yao zhi gui ling gao (38)

{3a} lian qiao bai du pian (40) (fever)

{3a} cai feng zhen zhu an chuang wan (43)

{3a} niu huang xiao yan wan (50) (fever)

{5a} yun nan bai yao (97) (bleeding, swelling)

Weeping eczema:

[E-c] gui zhi tang (37)

[H-o] long dan xie gan tang (97)

[T-b] wen qing yin w/huang lian jie du tang (249)

Skin itching:

{3b} chuan shan jia qu shi qing du wan (55)

{4a} hua she jie yang wan (74)

Tinea:

[W-s] xiao feng san (395)

[W-s] xiao feng san (395)

Uneven rash:

[E-w] xuan du fa biao tang (48)

Measles/viral:

[E-w] sheng ma ge gen tang (47)

{3a} chuan xin lian kang yan pian (36)

{3c} hou zao san (64) (fits, cough)

URTICARIA (hives): local wheals and erythema in the dermis

Angioedema: eruption w/larger edematous areas that involve both dermis and subcutaneous structures

PEI LEI: rash

1)     Wind-heat

2)     Wind-damp

3)     Accumulated heat in S and intestines

Eliminate heat, wind, and damp, activate blood: 

? LI11, Sp10, Sp6, S36

(can use plum-blossom needle on diseased regions)

O affected area, endocrine, lung, adrenal, urticaria, neurogate, thyroid, occiput, spleen, kidney (ret 1hr)

®       If symptoms include abdominal pain, diarrhea, and dyspnea, other TX methods should be used

[D-u] wu pi san (178) (edema)

[T-b] si wu tang (248)

[S-h] tian wang bu xin dan (378) (stress)

{3a} lian qiao bai du pian (40) (fever)

{3a} cai feng zhen zhu an chuang wan (43)

{5c} jing wan hong (108) (trauma)

Wind-heat

S: red rash w/severe itching

P: superficial, rapid

Expel wind, eliminate heat in blood: GV14, TW5, UB13, LI4, UB40, UB17-18

[E-w] xuan du fa biao tang (48)

[E] ge gen tang (51)

{3a} cai feng zhen zhu an chuang wan (43)

{3b} chuan shan jia qu shi qing du wan (55)

Wind-damp: stagnation of wind-damp in skin and muscles

S: white or light red rash, heaviness of body

T: white and sticky coating

P: superficial, slow

Expel wind, drain damp:

Sp9, GV12, UB40

Purple face: L9

[W-s] xiao feng san (395)

[E-c] gui zhi tang (35)

[C-c] dang gui si ni tang (216)

[B-i] xue fu zhu yu tang (314)

[W-s] xiao xu ming tang (396)

Accumulation of heat in S and intestines: may be due to intestinal parasites or seafood poisoning

S: red rashes, abdominal pain, constipation or diarrhea

T: thin, yellow coating

P: rapid

Clear heat from S/intestines, expel parasites, relieve poison: S25, S36, UB25

[E-­] fang feng tong sheng san (58)

ERYSIPELAS (herpes zoster/shingles):  an acute infection caused by reactivation of the varicella-zoster virus involving the dorsal root ganglia (a superficial cellulitis caused by Group A b-hemolytic streptococci); causes eruptions and neuralgia on the skin corresponding to the distribution of the affected root ganglia; most prevalent among those 50 years and over, although it may strike at any age, particularly in immunosuppressed patients; it only effects people who have had chickenpox; reactivation may be idiopathic or follow immunosuppression, stress, trauma including surgery, radiation, CVA, etc.

External wind-heat or damp-heat from S or intestines into blood, skin, and muscles:

1)     Stagnant qi and blood

2)     Lv yang excess

Problem areas:

1)     Geniculate zoster: ear pain w/transient paralysis of the face on the involved side; eruptions are visible on the external auditory canal and on the pinna (external ear), the soft palate, and the anterior pillars of the fauces (area of mouth opening into pharynx that encloses the tonsils); involving nerve ganglia in temple (facial cranial nerves VII-IX)

2)     Ophthalmic herpes zoster: eruption occurs on the ophthalmic branch of the cranial nerve V; if vesicles appear on the tip of the nose, then corneal involvement may occur and can lead to corneal ulcers and opacities

3)     Recurrence rate is high

S: lesions (shiny, red, edematous, tender, w/developing vesicles) rapid onset, burning pain, rapidly extending in size

Healing process: bright red to dull red in several days followed by desquamation; erythematous base (over production of red blood cells), linear patches of grouped vesicles, intense pain, lesions stop abruptly on the midline of the body, new crops may continue to appear for 3-5 days after the lesions begin to dry and crust

Internal: high fever, vomiting, GI disorders, delirium, convulsion, malaise

Recurrent: w/chronic lymphadema

Eliminate heat, relieve toxins:

? GV14, LI11, S43, UB40, Sp10

(strong stim)

CP: (BL toxins) jing-wells, P8

O neurogate, adrenal, subcortex, occiput, endocrine, lung, occiput, allergy, chest, thoracic vertebrae, helix #1-6

(2-3 acupts w/mod-strong stim; ret 30 min-1 hr)

O Post Herpetic Neuralgia: chest, thoracic vertebrae, urticaria, neurogate, endocrine, spinal cord

Erysipelas: GB34, GB41, P7, UB54, GB31, TW6

HA: M-HN-9, LI4

Nausea: P6, Sp4, S36

[E-w] sheng ma ge gen tang + zi cao (47)

[E-­] fang feng tong sheng san (58)

[E-­] shi gao tang (61)

[H-t] wu wei xiao du yin (84)

[H-t] wu shen tang (86)

[H-o] long dan xie gan tang (96)

[D-t] chu shi wei ling tang (182)

[W-s] xiao feng san (395)

{3a} long dan xie gan wan (42) (Lv/GB fire, damp-heat)

Damp-heat

T: red w/thick yellow coating

P: rapid, slippery, deep

Drain damp, clear heat: Sp6

[D-t] chu shi wei ling tang (182)

Wind-heat

S: chills and fever, acute HA

T: red w/thin yellow coating

P: superficial, rapid

Expel wind, clear heat: GB20

®       Inappropriate for eye region erysipelas

®       Erysipelas complicated by infection should consider Western TX in conjunction

®       Very effective in TX lower leg erysipelas

[E-w] xuan du fa biao tang (48)

[E-­] fang feng tong sheng san (58)

[E-­] shi gao tang (61)

[W-s] xiao feng san (395)