Treatment principle

Lesson 6
Liver / G. Bladder Diseases
1. Headache
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• Headache is pain in the whole or a part of
the head. It is common in a variety of illnesses,
including both acute and chronic illnesses.
Depending on the underlying condition there
may be other associated symptoms.
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Etiology and Pathogenesis
1. External Pathogens (外感
外感)
外感
• The main external pathogens are wind, cold,
heat and dampness.
• Wind is a yang pathogen, diseases caused by
wind could go up to the top of the body i.e. the
head.
• Cold is yin pathogen, when wind and cold are
combined, cold could injure the yang as well
as create blood stasis. This leads to the under
nourishment of mai luo 脉络 (microcirculation),
result in sudden onset of headache.
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• Wind and heat together could injure
Jing (essence), blood, qi. As a result,
qi and blood could be away from their
normal pathway, thus result in headache.
• Wind and dampness together, wind
attack the top of the head, dampness
blocks the clear yang to the top, the brain
and the head are deprived of
nourishment, thus headache occurs.
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2. Internal Injuries (内伤
内伤)
内伤
• Liver, spleen & kidney pathologies are involved.
• For liver pathology, liver yin deficiency or kidney
yin deficiency could lead to liver yang raising.
• Excessive emotional anger could throw liver
out of balance, repressed anger could lead to
fire, prolongation of such state could lead to
liver yin deficiency and thus liver yang raising.
• These could lead to mai luo under nourishment,
thus headache.
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• For spleen pathology, mostly due to
inappropriate intake of food and drink, or
overwork could also be the cause.
• These reasons affect the transport function of
spleen, thus accumulation of dampness, clear
yang (清阳) can not goes up, turbid yin (浊阴
浊阴)
浊阴
cannot come down (清阳不升 浊阴不降), like
wise this lead to mai luo under nourishment.
• For kidney pathology, it could be prenatal,
over work, injuries or long standing illness
could also deplete the kidneys energy, result
in mai luo under nourishment, thus headache.
• Neither Internal Nor
External Causes
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Syndrome Differentiation and Therapeutic Principles
A. Syndrome differentiation
(a) Severity of pain
• Generally, external pathogens triggered
headache with cold, one side headache are
more severe in pain.
• Internal injuries, blood deficiency, qi
deficiency, liver and kidney deficiency, the
pain is less severe.
• Qi deficiency headache is worse in the
morning, blood deficiency headache is
worst in the afternoon.
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(b) Nature of pain
• Headache caused by phlegm and
dampness, the pain has a heavy nature.
• Headache caused by cold has penetrating
characteristics.
• Yang raising headache has expanding
nature.
• Qi and blood, liver kidney yin deficiency
headache, the pain is less severe and the
head feels empty.
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(c) Causes of the pain
• Qi deficiency headache is related to tiredness.
• Cold and dampness headache changes with
the change of weather.
• Liver fire headache changes with the emotional
instability.
• Yang raising headache often get worse after
drinking excessive alcohol or eating
inappropriately.
• Liver and kidney yin deficiency headache
often get worse with insomnia or other
diseases’ progression.
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(d) Location of pain
• Headache due to deficiency of Qi and blood,
or of liver and kidney Yin, tends to affect the
whole head.
• Headache of hyperactive yang tends to be in
the occiput (枕骨) with radiation to the neck
muscles.
• Headache of Liver-Fire tends to be in the
temples.
• Headache due to illness affecting the
Yang Ming Meridian tends to be in the
forehead and supra-orbital bone.
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• Headache due to illness affecting the Tai Yang
Meridian tends to be in occiput with radiation to
the posterior neck.
• Headache due to illness in the Shao Yang
Meridian tends to be in both temples with
radiation to the ears.
• Headache due to illness
in the Jue Yin Meridian
tends to be in the vertex
with radiation to the eyes.
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B. Treatment principles
• Headache caused by external pathogens,
the strategy here is to eliminate the
external pathogens concerned and
invigorate the luo mai.
• Headache caused by internal unbalances,
the strategy here is to
tonify the deficiency
concerned and
eliminate the excess
in concerned.
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• Choice of Envoy Herbs
In the treatment of the various types of headache,
different envoy herbs may be selected that guide the
other herbs into the appropriate meridians, thereby
enhancing the therapeutic effect.
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Example of treatment according to specific meridian
Jiu Wei Qiang Huo Tang
Envoy Herbs
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Preventive measure
• Patients who suffer from headache during
attack phase, should take rest, avoid fried
& spicy food, avoid cigarettes & alcohol.
• When the patient is nervous and agitated,
try to calm the patient with gentle words
or other means.
• When the headache is gone, the patient
should pay attention to his/her mood,
food and living space’s environmental
control, this will help to avoid the
headache to recur.
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Classification and Treatment
A. External Pathogen Headache
(a) Wind-Cold
• Symptoms:
Rapid onset headache of tearing quality,
radiating to the neck and upper back;
aggravated by wind and cold; and absence of
thirst. The tongue coating is thin
and white, and the pulse floating
and tight.
• Treatment principles:
Dispel Wind and disperse Cold.
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Prescription:
Chuan Xiong Cha Tiao San
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(b) Wind-Heat
• Symptoms:
Distending headache; if severe, splitting
headache; fever, wind aversion; thirst with
desire to drink; constipation and dark urine.
The tongue is red, with yellow coating. The
pulse is floating and rapid.
• Treatment principles:
Dispel Wind and clear Heat.
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Prescription: Formula A + Formula B
Formula A
Xiong Zhi Shi Gao Tang 芎芷石膏汤
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Formula B
Sang Ju Yin
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(c) Wind-Dampness
• Symptoms:
Headache as though the head is being bound;
heaviness in the body and limbs; anorexia (胃
呆); chest tightness; and difficulty with
urination. The tongue coating is white and
greasy, and the pulse is soft.
• Treatment principles:
Dispel Wind and eliminate Dampness.
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Prescription:
Qiang Huo Sheng Shi Tang
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B. Internal Injury Headache
(a) Hyperactive Liver-Yang
• Symptoms:
Distending headache, dizziness; restlessness,
irascibility (易怒); restless sleep; subcostal pain;
flushed face and bitter taste in the mouth. The
tongue coating is thin and yellow, and the pulse
is wiry and rapid.
• Treatment principle:
Calm the liver and subdue hyperactive Yang.
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Prescription:
Tian Ma Gou Teng Yin
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Hyperactive Liver-Yang + Dominating Shao Yang Symptoms
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(b) Kidney Deficiency
• Symptoms:
Headache that feels empty; often dizziness;
aching weakness in the waist; lassitude,
weakness; tinnitus; insomnia; and
spermatorrhea or vaginal discharge. The
tongue is red with scant coating, and the pulse
is deep, threadlike and forceless.
• Treatment principle:
Strengthen the kidney and nourish Yin.
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Prescription: Formulae A+B ≈ Da Bu Yuen Jian 大补元煎
A Bu Zhong Yi Qi Tang
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B
Zuo Gui Wan
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(c) Deficiency of Qi and Blood
• Symptoms:
Headache with dizziness, aggravated by
exertion; palpitation of the heart, restlessness;
spontaneous sweating; shortness of breath;
lassitude, weakness; and a pale complexion.
The tongue is pale, with a thin white coating.
The pulse is deep, threadlike and feeble.
• Treatment principle:
Tonify both QI and blood.
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Prescription: Below + ju hua (Chrysanthemum) to enter the
Liver Meridian and to enhance the actions of removing Heat
from the head and the eyes.
Ba Zhen Tang
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(d) Turbid Phlegm (≈
≈Meniere's syndrome?)
• Symptoms:
Headache with mental clouding; chest
and epigastric fullness; nausea and vomiting of
sputum and saliva. The tongue coating is white
and greasy, and the pulse slippery.
• Treatment principles:
Tonify the spleen and eliminate the phlegm.
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Prescription: Ban Xia Bai Zhu Tian Ma Tang 半夏白朮天麻汤
Ban Xia Bai Zhu Tian Ma Tang minus Tian Ma
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plus
or
Tian Ma
Tian Ma Mi Huan Ju
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(e) Blood Stasis
• Symptoms:
Persistent headache, fixed in location and
prickling in quality; or history of traumatic injury
to the head. The tongue is cyanotic or speckled
with purpuric spots. The pulse is impeded.
• Treatment principles:
Mobilize blood, eliminate stasis,
open orifices and relieve pain.
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Prescription:
Tong Qiao Huo Xue Tang (modified) 通窍活血汤
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Exercise 6
1. Which are the usual causes found in the Liver disease of headache?
(a) external pathogens
(c) neither internal nor external causes
(b) internal injuries
(d) all of the above
2. Headache that tends to be in the forehead and supra-orbital bone is
(a) Tai yang headache
(c) Yang ming headache
(b) Shao yang headache
(d) Tai yin headache
3. For the syndrome differentiation of insomnia, which of the following is
usually not used?:
(a) Zang-fu and Body Fluids syndrome differentiation
(b) 5 internal evil qi’s syndrome differentiation
(c) 5 elements syndrome differentiation
(d) Meridians syndrome differentiation
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6. Symptoms: Distending headache, dizziness, restless, irascibility, restless
sleep, subcostal pain, flushed face and bitter taste in the mouth. The
tongue coating is thin and yellow, and the pulseis wiry and rapid.
The syndrome differentiation for the above is headache of
(a) wind heat
(b) insufficiency of qi and blood
(c) impairment of heart by fluid retention
(d) stagnation of heart-blood
5. Symptoms: Palpitations, restlessness, timidness, insomnia dreamfulness,
thin white tongue coating and feeble, rapid or slow irregular
pulse.
The syndrome differentiation for the above is palpitation of
(a) deficiency of heart and gallbladder
(b) insufficiency of qi and blood
(c) impairment of heart by fluid retention
(d) stagnation of heart-blood
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6. Symptoms: Palpitations, restlessness, insomnia, dizziness, feverish
sensation of palms and soles, lumbago (腰酸), tinnitus, red tongue with
little coating and thready and rapid pulse.
For the disease of palpitation, which of the following should be prescribed?
(a) spleen nourishing tablet
(b) emperor’s tablet
(c) pulse activating tablet
(d) blood stasis dispelling tablet
归脾片
天王补心片
生脉片
血府逐瘀片
7. Symptoms: Palpitations, dizziness, pallor, fatigue, reddish tongue and
thready and weak pulse.
For the disease of palpitation, which of the following should be prescribed?
(a) spleen nourishing tablet
(b) emperor’s tablet
(c) pulse activating tablet
(d) blood stasis dispelling tablet
归脾片
天王补心片
生脉片
血府逐瘀片
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Liver / G. Bladder Diseases
2. Dizziness
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• Dizziness is a sensation of unsteadiness combined
with a feeling of movement within the head.
• The symptoms in a mild case may be relieved by
closing the eyes, while the serious case may
manifest itself as an illusion of bodily rotation and
be accompanied by nausea, vomiting, sweating and
even fainting.
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Etiology and Pathogenesis
• The cause of dizziness is either an
exogenous pathogenic factor, impairment
of an internal organ or trauma.
• Its mechanism may be summarized as
wind, phlegm, deficiency, fire and blood
stasis and the organ chiefly involved is
the liver and also the spleen and kidneys.
• The above indicate great similarities
when compared with headache.
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Syndrome Differentiation and Therapeutic Principles
A. Syndrome differentiation
• Similar to or nearly the same as the Liver
disease of headache.
B. Treatment principles
• Based on the TCM treatment theory of
“homotherapy for heteropathy 异病同治”,
异病同治
the same treatment methods for headache
would apply for dizziness if they share
similar syndromes.
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Classification and Treatment
(a)Hyperactivity of liver-yang Tian Ma Gou Teng Yin 天麻钩藤饮
(b) Insufficiency of kidney-essence
Da Bu Yuen Jian 大补元煎
(c) Deficiency of qi and blood Ba Zhen Tang 八珍汤
Gui Pi Teng 归脾汤spleen deficiency phlegm dizziness
(d) Obstruction of middle jiao by phlegm Ban Xia Bai Zhu Tian Ma Tang
半夏白朮天麻汤
(e) Obstruction of collaterals by blood-stasis Tong Qiao Huo Xue Tang
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通窍活血汤
Thank You
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