Transcript Golden Chamber 4

Golden Chamber 3
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• Chapter 17 On Pulse Syndrome
Complex and Treatment of Nausea and
Vomiting, Retching and Diarrhea
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• Concepts
– Vomiting: vomitting with sound and things out
of mouth is named as Ou, while without sound
is named as Tu
– Retching: Belching
– Diarrhea
• Combined in one chapter because:
– Location: ST
– Etiology: Middle Jiao dysfunction
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• Causes and pathogenesis
– Water retention【2】
• Differential diagnosis for vomiting caused by water
retention
• Vomiting  thirst  relief
• Thirst  vomiting  water retention (in Stomach)
• Vomiting  no thirst  water retention 支饮
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• Causes and pathogenesis
– Deficient cold
• 【3】 Pathogenesis for deficiency cold in stomach
– Rapid pulse 
– Should be heat in stomach 
» Vomiting ?
» Promoting sweat  Yang deficiency
» Rapid pulse  deficiency heat
» deficiency cold in stomach
– Wiry pulse  stomach deficiency
– Vomiting
» Purging  weaken the stomach  wood overacting on earth
• 【5】Pathogenesis and prognosis for both spleen and stomach
deficiency vomiting
Fu Yang pulse  Jiexi (St 41 解溪)
Floating  deficiency
Hesitant  spleen deficiency  fail to digestive food
Vomiting with undigested food  spleen Qi deficiency with adverse
rising of stomach Qi
– If see tense pulse  difficult to treat  excess cold in stomach
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• Cautions and Forbidden Stuff
– 【1】Treatment principle for vomiting with stomach
ulcer
• Vomiting w/ pus – let px vomit.
This is a way to eliminate the pus/pathogen accumulation.
Do not treat vomiting only.
– 【6】Evils in upper position contraindicate to
purging  not middle Jiao stagnation
• Vomiting
• No purging
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Ou Tu
• Vomiting
• Differentiation and Treatment
– Deficient cold type of vomiting
• Liver stomach deficient cold
– Vomiting w/fullness in the chest/epigastrium area
• –Wu zhu yu tang 【8】 Evodia Decoction 吴茱萸汤
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吴茱萸wu zhu yu (Fructus Evodiae Rutaecarpae)
人参ren shen (Radix Ginseng)
生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
大枣da zao (Fructus Zizyphi Jujubae
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Ou Tu
• Vomiting
• Differentiation and Treatment
– Deficient cold type of vomiting
• Extreme Yin rejects yang – severe case
– Sx: Vomiting, weak pulse, no urinary difficulties, fever,
cold limbs
– Difficult to treat (due to severe Ki yang qi collapse)
• si ni tang 【14】 Frigid Extremities Decoction 四
逆汤
– 附子fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)
– 干姜gan jiang (Rhizoma Zingiberis Officinalis)
– 甘草gan cao (Radix Glycyrrhizae Uralensis)
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Ou Tu
• Vomiting
• Differentiation and Treatment
– Deficient cold type of vomiting
• Deficient cold in Middle Jiao w/vomiting
• da ban xia tang 【16】大半夏汤
– 半夏ban xia (Rhizoma Pinelliae Ternatae)
– 人参ren shen (Radix Ginseng)
– 蜂蜜feng mi (Honey)
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Ou Tu
• Vomiting
• Differentiation and Treatment
– Excessive heat type of vomiting
• Excessive heat in stomach and intestines
– Vomiting right after eat d/t excess heat rejecting food
• da huang gan cao tang【17】大黄甘草汤
– 大黄da huang (Radix et Rhizoma Rhei)
– 甘草gan cao (Radix Glycyrrhizae Uralensis)
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Ou Tu
• Vomiting
• Differentiation and Treatment
– Excessive heat type of vomiting
• Heat obstructed in Shaoyang
– Sx: Vomiting, fever
– Rx: xiao chai hu tang 【15】 Minor Bupleurum Decoction 小柴
胡汤
» 柴胡chai hu (Radix Bupleuri)
» 黄芩huang qin (Radix Scutellariae Baicalensis)
» 半夏ban xia (Rhizoma Pinelliae Ternatae)
» 人参ren shen (Radix Ginseng)
» 甘草gan cao (Radix Glycyrrhizae Uralensis)
» 生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
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» 大枣da zao (Fructus Zizyphi Jujubae
Ou Tu
• Vomiting
• Differentiation and Treatment
– Excessive heat type of vomiting
• Heat type of vomiting with diarrhea, retching
– Heat in ST (vomiting) and LI (diarrhea)
– Damp heat diarrhea with blood and pus
• huang qin jia ban xia sheng jiang
【11】黄芩加半夏生姜汤
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黄芩huang qin (Radix Scutellariae Baicalensis)
半夏ban xia (Rhizoma Pinelliae Ternatae)
白芍bai shao (Radix Paeoniae Lactiflorae)
甘草gan cao (Radix Glycyrrhizae Uralensis)
生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
大枣da zao (Fructus Zizyphi Jujubae
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– Water retention type of vomiting
• Cold water retention
– With Vomiting
• xiao ban xia tang
【12】小半夏汤
– 半夏ban xia (Rhizoma Pinelliae Ternatae)
– 生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
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– Water retention type of vomiting
• Severe cold water retention
– Vomiting with watery saliva
• Ban Xia Gan Jiang San 【20】 半夏干姜散
– 半夏ban xia (Rhizoma Pinelliae Ternatae)
– 干姜gan jiang (Rhizoma Zingiberis Officinalis)
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– Water retention type of vomiting
• water retention above diaphragm
– Thirsty, drink, vomit
• zhu ling san fang 【13】猪苓散方
– 猪苓zhu ling (Sclerotium Polypori Umbellati)
– 茯苓fu ling (Sclerotium Poriae Cocos)
– 白术bai zhu (Rhizoma Atractylodis Macrocephalae)
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– Water retention type of vomiting
• Qi disorder due to water retention, vomiting with thirst
– Vomiting then thirst afterwards.
• Fu ling ze xie tang【18】茯苓泽泻汤
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茯苓fu ling (Sclerotium Poriae Cocos)
泽泻ze xie (Rhizoma Alismatis Orientalis)
甘草gan cao (Radix Glycyrrhizae Uralensis)
桂枝gui zhi (Ramulus Cinnamomi Cassiae)
白术bai zhu (Rhizoma Atractylodis Macrocephalae)
生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
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Yue
• Retching
– Treatment principle 【7】
Based on soothing Qi stagnation. Qi stagnation causes ST qi to
go upward.
Retching and hiccups are related. Hiccups are usually due to
Liver and diaphragm spasms.
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Yue
– Differentiation and Treatment
• Stomach cold with qi disorder
– Retching and cold extremities
• Ju Pi Tang 【22】橘皮汤
– 橘皮 ju pi (pericarpium Citri Reticulatae )
– 生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
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Yue
– Differentiation and Treatment
• with stomach heat
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Retching
Restlessness
Thirst
Rapid pulse
• Ju Pi Zhu Ru Tang 【23】 橘皮竹茹汤
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橘皮 ju pi (pericarpium Citri Reticulatae )
竹茹 zhu ru (caulis bambusae in taeniis )
大枣da zao (Fructus Zizyphi Jujubae）
人参ren shen (Radix Ginseng)
生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
甘草gan cao (Radix Glycyrrhizae Uralensis)
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Xia Li
• Diarrhea
• Treatment principles and contraindication
– Damp type—promote urination 【31】
– Contraindication to deficient cold type—do not
promote sweating 【33】
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• Differentiation and Treatment
– Deficient cold type
• Deficient cold type of diarrhea with exterior syndrome
– Rescue interior first
• si ni tang 【36】 Frigid Extremities Decoction 四逆汤
– 附子fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)
– 干姜gan jiang (Rhizoma Zingiberis Officinalis)
– 甘草gan cao (Radix Glycyrrhizae Uralensis)
• Gui Zhi Tang 【36】
– Cinnamon Twig Decoction 桂枝汤 (Gui Zhi Tang) . regulate
Ying and Wei
» 桂枝gui zhi (Ramulus Cinnamomi Cassiae)
» 白芍bai shao (Radix Paeoniae Lactiflorae)
» 甘草gan cao (Radix Glycyrrhizae Uralensis)
» 生姜sheng jiang (Rhizoma Zingiberis Officinalis Recens)
» 大枣da zao (Fructus Zizyphi Jujubae)
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• Differentiation and Treatment
– Deficient cold type
• Extreme yin rejects yang
– Diarrhea, sweating, cold extremities
• Tong Mai Si Ni Tang 【45】通脉四逆汤
– 附子fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)
– 干姜gan jiang (Rhizoma Zingiberis Officinalis)  double dosage
– 甘草gan cao (Radix Glycyrrhizae Uralensis)
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• Differentiation and Treatment
– Excessive heat type
– 大承气汤Da Cheng Qi Tang【37】【38】【39】
【40】
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大黄da huang (Radix et Rhizoma Rhei)
厚朴hou po (Cortex Magnoliae Officinalis)
枳实zhi shi (Fructus Immaturus Aurantii)
芒硝mang xiao (Mirabilitum)
– 小承气汤Xiao Cheng Qi Tang【41】
– 大黄da huang (Radix et Rhizoma Rhei)
– 厚朴hou po (Cortex Magnoliae Officinalis)
– 枳实zhi shi (Fructus Immaturus Aurantii)
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• Differentiation and Treatment
– Diarrhea with pus and blood
• Deficient cold
– Diarrhea with pus and blood
• 桃花汤Tao Hua Tang 【42】
– 赤石脂 chi shi zhi (hallyositum rubrum )
– 干姜gan jiang (Rhizoma Zingiberis Officinalis)
– 粳米 geng mi (rice)
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• Differentiation and Treatment
– Diarrhea with pus and blood
• Heat toxin type of diarrhea with tenesmus
– Fever, thirst, tenesmus, blood in stool with more blood than pus
– Red tongue, yellow coating
– rapid pulse
• Bai Tou Wen Tang【43】白头翁汤
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白头翁 bai tou weng (Radix Pulsatillae Chinensis )
黄连 huang lian (rhizoma coptidis chinesis )
黄柏 huang bai (cortex phellodendri )
秦皮 qin pi (Cortex Fraxini )
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• Differentiation and Treatment
– Diarrhea with pus and blood
• diarrhea with restlessness
• Zhi Zi Chi Tang 【44】栀子豉汤
– 栀子 zhi zi （gardeniae jasminoidis ）
– 淡豆豉 dan dou chi （Semen Sojae Praeparatum ）
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