Transcript Megaesophagus_Megacolon.ppt

TCVM Approach to Megacolon and
Megaesophagus
“Mega-” Introduction
• If normal directional motion is
inhibited in a tubular organ
• A type of Qi Deficiency
• May be a congenital disharmony
• Yang Jing Deficiency if associated with
other signs of Yang Deficiency
• Yin Jing Deficiency if associated with
other signs of Yin Deficiency
“Mega-” Introduction
• “Directional” or propulsive Qi Deficiency
• May be acquired
• Exogenous Pernicious influences
• E.g. distemper virus, trauma, toxins, poor quality
foods for that species or individual constitution
• Endogenous Pernicious influences
• E.g. hypothyroidism, systemic lupus erythematosus,
hypoadrenocorticism, myasthenia gravis
• Remember that “sthenia” means “full” or “excess”
• “asthenia” means “empty” or “weak” or “deficient”
“Mega-” Introduction
• “Directional” Qi Deficiency
• May be associated with concurrent
Blood or Yin Deficiency
• Subsequent Dryness fails to lubricate
either ingesta or feces
• Megaesophagus swallowing inhibited
• Regurgitate dry ingesta
• Megacolon defecation inhibited
• “Cannot float the boat in a dry river”
Megaesophagus and Megacolon: Types of Wei
Syndromes?
• Wei means “withered” in Chinese to
describe the withering of muscles
• Classical Wei or Atrophy Syndrome is a
condition characterized by a weakness of
the four limbs, progressively leading to
atrophy, a limp state of muscles and
tendons, an inability to walk properly and
eventually paralysis
• This weakness generally occurs without
pain
• So are these “Megas” localized Wei?
Wei Syndrome Pattern Differentiation
• Heat in the Lungs injuring Yin fluidsExcess
• Invasion of Damp-Heat- Excess
• Invasion of Cold-Dampness- Excess
• Stomach and Spleen deficiency- Deficiency
• Spleen and Heart collapse- Deficiency
• Liver and Kidney deficiency- Deficiency
• Blood Stasis in the channels- Combination
of Excess and Deficiency
Relationship Between Pattern
and Pathoetiology
• Wind-Heat causes only Lung-Heat injuring Yin
fluids
• External Dampness leads to Damp-Heat or ColdDampness
• Irregular Diet causes the patterns of Damp-Heat,
Cold-Dampness and Stomach-Spleen deficiency
• Excessive sex and overwork cause the patterns of
Kidney-Liver deficiency and Blood stasis in the
channels
• Trauma causes the pattern of Blood stasis in the
channels
• Shock leads to the pattern of Heart-Spleen
collapse
“Mega-” Primary treatment principles
• Tonify global and local Qi
• Assist directional Qi Flow
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood
• Invigorate Blood
Megaesophagus: Pattern Differentiation
• Qi Deficiency or Yang Deficiency
• may be seen with hypothyroidism, systemic lupus
erythematosus, hypoadrenocorticism, myasthenia
gravis, poor quality foods for that species or
individual constitution
• Blood Deficiency +/- Blood Stagnation
• may be seen with trauma, toxins, poor quality foods
for that species or individual constitution
• Heat Patterns
• may be seen with distemper infection or other febrile
diseases
Megaesophagus Treatment
• Physical assistance with raised
feeding station and soft, highly
digestible foods
• Suggest slow-cooked foods based upon
Bian Zheng (see following lecture)
• Acupuncture based upon global and
local Patterns
• Herbal Formula based upon global
and local Patterns
Megaesophagus: Qi Deficiency
• Clinical Signs
• Fatigue, weight loss, muscle mass loss,
decreased/depressed back Shu points
• Tongue
• Pale, moist
• Pulse
• Feeble, especially middle and upper jiao
Megaesophagus: Qi Deficiency
• Acupuncture: Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach (esophagus
“belongs to” the Stomach)
• BL 13, 14, 15 as local Shu for upper Sea of Qi
• LI 4, LIV 3 to move Qi
• LI 10, ST 36, CV 6 to nourish Qi
• LI 1, LU 11, ST 45 to clear fullness of the chest
in the region of the Heart
Megaesophagus: Qi Deficiency
• Spleen Qi Deficiency
• Si Jun Zi Tang or Four Gentlemen
Decoction
• the chief herb Panax ginseng ren shen is
sweet, warm and tonifies Spleen Qi
• the deputy herb Atractylodis macrocephalae
bai zhu is bitter, warm and strengthens
Spleen Qi and dries Dampness
Megaesophagus: Qi Deficiency
• Spleen Qi Deficiency
• Si Jun Zi Tang
• assistant herb Poria cocos fu ling is sweet, bland and
leeches out Dampness and mildly Tonifies Spleen Qi
• the envoy Glycyrrhiza uralensis gan cao is warm,
sweet and warms and regulates the middle burner
• modify with Hou Po magnolia bark to promote Qi flow,
transform Dampness, relieve food stagnation, direct
rebellious Qi downward for a stifling sensation in the
chest
• Or modify with Platycodon jie geng resolve phlegm
and guide other herbs to upper burner
Megaesophagus: Blood Deficiency
• Clinical Signs
• Dry fur, dry pads, firm, dry stools,
decreased firmness in back Shu points
• Tongue
• Pale, dry, may have slight lavender hue
• Pulse
• Weak, thin, especially middle and upper
jiaos
Megaesophagus: Blood Deficiency
• Acupuncture: Use electro-AP!!
• PC 6 master of the chest
• CV 17 front Mu of the upper Sea of Qi
• CV 12 front Mu for the Stomach for post-heaven
Blood
• BL 17, 18 to engender Blood
• LI 4, LIV 3 to move Qi with Blood
• SP 10, ST 36 to engender Blood and benefit
Spleen and Stomach
• LI 1, LU 11, ST 45 to clear fullness of the chest
in the region of the Heart
Megaesophagus: Blood Deficiency
• Tao Hong Si Wu Tang Four Substances
Decoction with Peach Kernel and Safflower
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Shu di huang prepared rehmannia
Dang gui angelica sinensis
Bai shao yao white peony
Chuan xiong ligusticum
Tao ren peach kernel
Hong hua safflower
• Nourish Blood, promote Blood circulation,
removes Blood Stasis
Megaesophagus: Blood Stagnation
• Clinical Signs
• Pain in chest, front Mu and back Shu
points, uncomfortable lying in ventral
recumbency
• Tongue
• Lavender, usually slightly pale and dry
• Pulse
• Wiry, choppy, commonly thin
Megaesophagus: Blood Stagnation
• Acupuncture: Use electro-AP!!
• LI 4, LIV 3, LIV 14 to move Blood
• PC 6 master of the chest, reduce
stagnation
• CV 17 front Mu of the upper Sea of Qi
• BL 17, 18, SP 10 to engender and
circulate Stagnant Blood
• CV 12, GB 21, GV 1 to descend Qi
• LI 1, LU 11, ST 45 to clear fullness of the
chest in the region of the Heart
Megaesophagus: Blood Stagnation
• Xue Fu Zhu Yu Tang Remove Stasis from the Mansion of
Blood Decoction
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Tao ren peach kernel
Hong hua safflower
Dang gui angelica sinensis
Sheng di huang prepared rehmannia
Chuan xiong ligusticum
Chi shao yao red peony
Chuan niu xi cyathula
Jie geng platycodon
Chai hu bupleurum
Zhi ke bitter orange
Gan cao licorice
• Promotes the circulation of Blood and Qi, removes Blood
Stasis, relieves pain
Megacolon: Pattern Differentiation
• Qi Deficiency
• seen with chronic poor quality foods for felids in general
or individual constitution
• Blood Deficiency +/- Blood Stagnation
• seen with trauma, poor quality foods for that species or
individual constitution
• Heat Patterns
• may be seen with chronic Stagnation of Qi or Blood
• Yin Deficiency
• usually a consequence of Chronic Heat
• Mixed Qi and Blood Deficiency
• is very common
Megacolon: Primary treatment principles
• Tonify global and local Qi
• Assist directional Qi Flow
• Tonify Qi of all Bowels (i.e. Stomach
System)
• Increase Moisture
• Tonify Yin
• Increase Body Fluids
• Nourish Blood
Megacolon: Qi Deficiency
• Clinical Signs
• Firm to moderate stools that are difficult
to expel, thin, small muscles, easily
fatigued
• Tongue
• Pale, normal to moist
• Pulse
• Weak, deep
Megacolon: Qi Deficiency
• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish the
Spleen and Stomach
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for
Large Intestine
• TH 6, TH 5 empirical points for moving
the Qi of the intestines for constipation
Megacolon: Qi Deficiency
• Si Jun Zi Tang or Four Gentlemen
Decoction
• Panax ginseng ren shen is sweet, warm and tonifies
Spleen Qi
• Atractylodis macrocephalae bai zhu is bitter, warm
and strengthens Spleen Qi and dries Dampness
• Poria cocos fu ling is sweet, bland and leeches out
Dampness and mildly Tonifies Spleen Qi
• Glycyrrhizae uralensis gan cao is warm, sweet and
warms and regulates the middle burner
• Modify with Rhubarb da huang as a bitter, cold
herb to move the bowels and dispel stasis
Megacolon: Qi Deficiency
• Fan Xie Ye (I8001)
• Fan Xie Ye senna leaf
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Sweet, bitter, cold
Enters the Large Intestine Channel
Drains downward and guides out stagnation
For constipation due to heat accumulation in the
Intestines
• Contains anthraquinone glycosides
• Hepatic metabolites stimulate pelvic ganglion
• Purge Large Intestine, resolve food stasis
Megacolon: Blood Deficiency
• Clinical Signs
• Hard, dry stool, dry hair, dry and flakey
skin
• Tongue
• Pale and dry
• Pulse
• Thin, weak
Megacolon: Blood Deficiency
• Acupuncture
• BL 20, 21, ST 36 and CV 12 to nourish
post-heaven Blood production via SP/ST
• BL 17 and SP 10 to nourish Blood
• ST 37 lower He Sea for Large Intestine
• BL 25, ST 25 back Shu and front Mu for
Large Intestine
• TH 6, TH 5 empirical points for moving
the Qi of the intestines for constipation
Megacolon: Blood Deficiency
• Dang Gui Cong Rong (A0250)
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Dang gui angelica sinensis
Rou cong rong cistanche
Qu mai dianthus
Shen qu massa fermentata
Fan xie ye senna leaf
Hou po magnolia
Mu xiang saussurea
Xiang fu zi cyperus seed
Zhi ke bitter orange
Tong cao tetrapanax
• Moisten Large Intestine, resolve impacted Large
Intestine
Megacolon: Dryness due to Heat
• Clinical Signs
• Constipation with hard stool difficult to
expel, frequent urination
• Tongue
• Dry, yellow coating
• Pulse
• Deep, rapid or floating and choppy
Megacolon: Dryness due to Heat
• Ma Zi Ren Wan Hemp Seed Pill
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Huo ma ren cannabis seed
Xing ren apricot seed
Shao yao peony
Zhi shi immature bitter orange
Hou po magnolia cortex
Da huang rhubarb
• Moisten the Intestines, drains Heat,
promotes Qi movement, unblocks the
bowels
Megacolon: Yin Deficiency
• Clinical Signs
• Constipation, thirst
• Tongue
• Dry, red
• Pulse
• Thin and slightly rapid or weak and
feeble
• Consequence of warm-febrile disease
in weak or Yin Deficient patient
Megacolon: Yin Deficiency
• Acupuncture
• BL 25, ST 25 back Shu and front Mu of
Large Intestine
• SP 6, KI 3, , CV 4, BL 23 to nourish the
Yin
• TH 6, ST 37 to unblock the Large
Intestine
Megacolon: Yin Deficiency
• Zeng Ye Tang Increase the Fluids
Decoction
• Xuan shen scrophularia
• Mai men dong ophiopogon
• Sheng di huang fresh rehmannia
• Generates fluids, moistens dryness
and unblocks the bowels
Megacolon: Stagnation with Heat
• Clinical Signs
• Severe constipation and flatulence, focal
distention and abdominal fullness,
abdominal pain which increases with
pressure, tense and firm abdomen
• Tongue
• Dry, yellow or dry and dark coating
• Pulse
• Deep, excessive
Megacolon: Stagnation with Heat
• Acupuncture
• Ren 4 tonifies Yin and fluids
• LI 11 clears Heat in the Large Intestine
• ST 37 lower He Sea for Large Intestine to
harmonize LI
• ST 44 clears Stomach Heat
• LI 2 clears Large Intestine Heat
• SP 6, KI 6, Ren 12 promote body fluids
Megacolon: Stagnation with Heat
• Da Cheng Qi Tang Major Order the Qi
Decoction
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Da huang rhubarb
Mang xiao mirabilitum
Zhi shi immature bitter orange
Hou po magnolia cortex
• Vigorously purges Heat accumulation
Conclusion
• Megaesophagus and Megacolon are
predominantly types of localized Qi
Deficiency
• Although heritable (Jing) factors may be
involved, Exogenous Pathogens and poor
quality foods are root cause
• Blood Deficiency with or without Blood
Stagnation may be a complicating factor
• Acupuncture and Herbal formula based
upon Pattern Differentiation may improve
quality of life