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Linda Boggie, DVM, CVA (IVAS)

History lesson…   Legend has it the emperor Shen Nong (3737-3697 BCE) was fascinated with plants and studied their medicinal properties  Self-experimentation in a manner of speaking

 Tasting, feeling, physical and, in some cases mental effects

 Shen Nong Ben Cao Jing (Classic Materia Medica)  Included approximately 360 medicinals  Plants, minerals and animal substances  Over 5000 years ago! (5700 or so)

Huang Di

The Yellow Emperor



 Said to have lived circa 2700 BCE  Huang Di Nei Jing Su Wen Ling Shu

 Credited to Huang Di but actually a compilation from many authors

 Encompasses the developing knowledge of Chinese medical philosophy

 Yin and Yang, Naturalism and Daoism reflected  Describing processes of nature and applying to human  Living in balance

 First written copy is attributed to Warring States period (475-221 BCE)  First written copy in survival from Han Dynasty (206 BCE- 220 CE)  This book in turn influenced Chinese Herbal medicine

Zhang Zhong Jing   Han Dynasty Chinese physician  Witnessed many deaths caused by infectious diseases  Wrote the Shang Han Za Bing Lun  Discussion of Cold-Induced Disorders and Miscellaneous Diseases

 Later divided into two foundational herbal texts  Shang Han Lun, Treatise on Febrile Diseases caused by Cold  Jin Gui Yao Lue, Essentials from the Golden Cabinet

Hua tuo    

Famous physician, also circa 200 CE Best known for his Hua-tuo-jia-ji points effective for relieving pain First used pain relieving decoctions

Song Dynasty (970-1279 CE)  1200 CE, narcotic teas were developed  Minor surgical procedures

 Close to 1000 plants, minerals, and animal substances were documented as to medicinal qualities and effects

Jin-Yuan period 1127-1368



 Northern tribes took control of part or all of China from Song Dynasty  First Jin then Mongolians who established the Yuan Dynasty

 Changes in Chinese culture  Development of neo-Confucianism by Zhu Xi (1120-1200)  Incorporated Naturalistic and Daoist philosophies into the rigid Confucius doctrine

 Zhang Yuansu wrote Zhenzhu Nang, A Bag of Pearls  zhenzhu = pearl; nan = bag

Zhengzhu Nang   A double meaning  Fundamental contents of the book are valuable - like a pearl  Book itself is entirely expendable: it is a bag, not a permanent repository, such as a golden chamber (jingui, as in the title Jin Gui Yao Lue).

 Title also indicates that one must rely on oneself  Training, experience, self-cultivation, and intuition that goes into becoming a medical practitioner  Not to follow some dogmatic system that is going to eventually change anyway

Zhang Yuansu and Zhenzhu Nang



 Presented ideas about disease causation  Incorporated medicinal materials into the five element framework (wuxing)

 The organizing principle of Chinese medicine at the time

 Defined the association of herb tastes and their effect on the different organs  Concept of herbs entering into and influencing the channels  Channel attributions were an effort to link the physiological effects of herbs with the concept-originally depicted in the Neijing Suwen: pathogens influencing channels  Linked the actions of herbs with the effects induced by acupuncture

 Unified the theories of disease causation and treatment and the practices of herbal medicine and acupuncture

Zhang Yuansu   "The method of appropriately using herbs in accordance with the symptom and sign presentation of the patient entails determining substances with the correct qi, taste, yin and yang, and thick and thin properties as well as the pathogenic factor involved and the channel it has entered."

Li Dong Yuan Famous Student

Li Shi Zhen   Famous herbalist of 16th century  Stated that Zhang's book contributed much to the spread of medical principles  Ben Cao Gang Mu, Grand Materia Medica; 1596  Described 1,892 Chinese herbs and 11,096 Chinese herbal formulas  Additionally published in many other countries allowing dissemination of Chinese herbal medicine knowledge

Decline of Chinese medicine

  1700’s Protestant missionaries introduced Western medicine into China  During the colonial period of China’s history Western medical practice became more popular and both Chinese herbal medicine and acupuncture were forced underground

Chinese Veterinary Herbal Medicine



 Developed alongside the human field  Sun Yang (later called Bo Le) and Wang Liang  The fathers of Chinese veterinary medicine  Spring and Autumn Period (770-476 BCE)

 Established the principles of diagnosis in animals, theories of internal and external disorders, treatment methods and classification of medicinal substances

Sui Dynasty (581-618 CE)

  Veterinary medicine began to branch out and develop into areas of specialty  Chi Ma Niu To Lu ching  Various treatises on the Treatment of Horses, Cattle, Camels and Donkeys

 Liao ma Fang  Prescriptions for Horses

 Bo Le Zhi Ma Za Bing Jing  Treatise on Treatment for Sick Horses by Bo Le

 Note absence of specialty in canine or feline practice…

Tang Dynasty (618-907 CE)



 Rapid advancements in veterinary medicine  Horses were a prized possession

 Indicating wealth and status  Military requirements for healthy horses also stimulated veterinary development

 Comprehensive veterinary education system was established  Xin Xiu Ben Cao, Newly Revised Materia Medica  Published by government in 659 CE

 Described 844 Chinese herbal medicines  China’s earliest pharmacopeia for human and veterinary medicine

Ming Dynasty (1368-1644 CE)

  Li Shi Zhen’s Ben Cao Gang Mu  Yuan Heng Liao Ma Ji Fu Niu Tuo Jing, Yuan-Heng’s Therapeutic Treatise of Horses  Two brothers, Yu Ben-Yuan and Yu Ben-Heng  Representative work of the knowledge and treatment of equine diseases using acupuncture and herbal medicine  Many texts were published concerning the treatment of veterinary agricultural species

Decline and Rebirth

  1840-1949: China was a semi-colonial semi-feudal society  After introduction of western medicine in 1700’s traditional Chinese medical practices fell into decline

 During this period acupuncture and Chinese herbal medicine suffered greatly  Acupuncture was banned from the Imperial College  1949 – Cultural Revolution  The rebirth of Traditional Chinese Medicine

 1956 – governmental policy on teaching and improvement of Traditional Chinese Veterinary Medicine

Herbal and Food Energetics

  Herbs are concentrated food  Energetics and properties apply to both  Use of both is in accordance with the philosophical medical principles ingrained in the Chinese culture  Naturalism, Daoism, Confucianism

 A proper Chinese Medical Diagnosis is crucial!  Acupuncture is forgiving  Foods – not as forgiving but a bit  Herbs – you gotta’ know!

 Your diagnosis determines treatment strategy!

Treatment Strategies   Sweating  pathogen has invaded the superficial layers of body  In patients that don’t sweat a mild increase in panting and heat intolerance is observed  Weak patients combine with tonification

 Vomiting  Strong patients with acute presentation of food stagnation or toxins in upper half of body  Modern emetics are stronger than traditional herbs

 Draining downward or Purging  Strong treatment method; use with caution  Toxins or accumulations in the lower half of the body  Weak patients must balance with tonification

Treatment Strategies   Harmonizing  Attack and tonify simultaneously  Complicated cases with conflicting clinical signs  Hot and cold  Different parts of the body are affected, such as Spleen and Liver  Shaoyang disorders  Disharmonies of Blood and Qi

 Will often be employed in our patients

Treatment Strategies   Warming  Warms the channel, Organ or specific body part affected  Discern if there is Cold due to Cold invasion or lack of Yang

 Clearing  Formulas are cooling  Clear heat and purge fire toxins from all three levels of the body  Weak patients also tonified

 Reducing    

Eliminate stagnation and transform phlegm Dissolves nodules and hardenings Works gradually Chronic conditions with stubborn accumulations

Treatment Strategies   Tonifying  Replenishes deficiencies of the Fundamental Substances – Qi, Xue, Jin-ye, Jing, Yin and Yang  Deficient patients with concurrent excess pathogenic processes must be treated with tonification as well as other clearing, draining or reducing strategies  They should ever be treated with tonification alone – you will feed the “guest” in your house.

 Patients with Bi and Wei syndromes more than one of these strategies be employed  In fact this can be said of any chronic condition

Classification of Chinese Herbs and Foods    

Temperature Taste Direction Channel influence



 Herbs are chosen based on these inherent properties which can address the characteristics of the imbalance  Toxicity is also considered

 If there is an herb needed that has potential toxicity other herbs are included to offset toxic aspect and/ or have similar action allowing a lower dosage  Fu Zi, Aconite

Temperature   Herbal medicine is a heteropathic therapy  If something is cold you warm it up  If something is hot you cool it down

 Same applies to food therapy  Cucumber vs. Hot pepper  Avocado vs. lemon

 Temperature or energetic gradient is also on the Yin/ Yang continuum  Cold and cooling are Yin  Hot and warming are Yang

Five Energies

TCVM Actions

Physiologic Effects

Examples

Cold

Purge Heat and Fire Cool Blood

Anti-inflammatory Anti-spasmodic, sedative

Coptis Huang lian Lycium bark Di gu pi Gardenia fruit Zhi zi

Cooling

Relieves Heat Resolves Toxin

Reduces fevers, detoxifies Lowers blood pressure Soothes nerves

Bupluerum Chai hu Morus Sang ye Pueraria root Ge gen

Neutral

Mediates Cold, Cool, Hot and Warm herbs

Gentle effects, regulates

Glycyrrhiza Gan cao Jujube Da zao

Warming

Warms the Interior Disperses Cold

Promotes circulation Alleviates chills

Ledebouriella Fang feng Cinnamon twig Gui zhi Angelica root Du huo Eucommia bark Du zhong

Hot

Tonifies Yang Qi Activates the Channels

Improves Organ functions Stimulates and strengthens

Zingiberis Gan jiang Cinnamon bark Rou gui Aconite Fu zi

Five Flavors     

Sensation perceived by Chinese healers and scholars Combined with clinical results Taste reflects biochemical components of herbs (foods) Hawthorne berry, Shan zha, sour taste  High percentage of acids including flavonoids

 Coptis, Huang lian, bitter!!!!  High percentage of berberine – an isoquinolone alkaloid with antibacterial effect

 Sixth category not often discussed – Bland  Little to know distinct flavor

Six Flavors Acrid or Pungent

Sweet

Sour

TCVM Actions

Physiologic Effects

Examples

Activate Qi and Blood Diaphoretic

Stimulate blood circulation Distribute energy from the interior to the surface Can induce sweating to remove pathogenic Qi

Ephedra Ma huang Vladimiria Chuan mu xiang Zingiberis Sheng jiang White Pale Cloves, garlic, fennel, Lungs chives, ginger, nutmeg, Metal radish, pepper, wine

Tonify Nourish Harmonize – soothe and regulate Tend to moisten, calm and cool

Tonify deficiency Soothe acute diseases Regulate internal organ functions

Ginseng Ren shen Glycyrrhiza Gan cao Astragalus Huang qi Rehmannia Shu di huang

Astringe Stabilize and Bind Prevent fluid loss

Apple, banana, corn, egg, carrot, yam, sugar, wine Maintain integrity of respiratory and digestive tracts Contracts flaccid tissues Stop abnormal secretions or discharges Promote digestion Stimulate enzyme secretion and liver function Alter blood conditions

Schisandra Wu wei zi Mume fruit Wu mei Hawthorne fruit Shan zha Apricot, grape, mango, peach, pineapple, plum, vinegar, tomato

Other qualities

Yellow Brown Spleen Earth

Green Yellow-green Liver Wood

Bitter

Salty

Bland

Many have antiviral, antibacterial, anti-inflammatory Clear Heat toxins and antipyretic properties Eliminates Damp-Heat Detoxify Purges intestines Enhance secretion of bile through the liver Promote gastric secretion of HCl Anti-cholesterolemic actions

Soften hardness Dissolve stagnation Purges accumulations by sinking Qi downwards Purge intestines

Diuretic effect

Diuretic properties Softens hard masses and resolves bumps Relieves constipation through purgation Helps maintain fluid balance

Treat edema and dysuria

Coptis Huang lian Rhubarb Da huang Gentiana Long dan Asparagus, celery, coffee, porcine and ovine bile

Mirabilite Mang xiao Sargassum Hai zao Oyster shell Mu li Abalone, barley, clam, crab, duck, ham, kelp, pork kidney, oyster, mussel, human milk Poria Fu ling Polyporus Zhu ling Talcum Hua shi Job’s tears, button mushrooms

Red Heart Fire

Black Dark Kidney Water

Direction 

 How or where an herb will send its energy within the body  Think of eating wasabi…..  Now, think of eating an avocado….  Now, think of drinking peppermint tea…. Herbs have the same variety of actions Bupleurum, Chai hu, raises Qi – head, chest, upper limbs Rhubarba, Da huang, purges pathogens via stool or urine Ephedra, Ma huang, outward directing – make you sweat or consolidate the exterior  Schisandra, Wu wei zi, inward directing – protect Zang and Fu or conserve Essence    

Channel Entered   Guides the formula to a specific channel or Organ  Some will help to clear obstructions from channels  Cinnamon, Gui zhi  Earthworm, Di long  Herbal formulas for Bi syndromes contain channel clearing herbs as well as those with affinity for Bladder and Kidney channels  Herbal formulas for Wei syndromes contain herbs to nourish Qi, Yin, Yang, Xue as needed

Composition of Chinese Herbal Formulas



 Built using a metaphorical hierarchy based on a model discussed in the Nei Jing Su Wen  Construct a balanced formula to address the pattern and minimize side effects from any individual herbal component  There are four components in a formula:    

the chief herb (or emperor) the deputy herb (minister) the assistant herb the envoy

Composition and purpose

  Chief herb addresses the main pattern imbalance  Essential to the herbal formula

 Deputy herb aids the chief in the principle imbalance  Also serves to address any secondary issues

 Assistant herb has multiple duties  Reinforces chief and deputy by addressing contributing issues to pathology  Also often offset any toxic properties of the chief or deputy  In large complex formulas may have opposite effect of the chief  To provide balance to the formula

 The envoy herb delivers the action of the formula to a specific area of the body, channel, or organ  Also often harmonizes the entire formula

Complex, chronic vs. Simple and acute



 Patient with a complex problem may require a very complex formula  A Chief with a number of ministers and assistants

 Superficial or acute imbalance generally only requires a simple formula  A chief with a few deputies

 It is possible, sometimes necessary to modify  Chief is almost never changed…  Assistants or minor deputies can be changed

 Sometimes the addition of another herb to address the pathology is done  Corydalis, Yan hu suo, very good for pain

Formulas for Bi Syndrome

  Primarily classic formulas  Reference to herbal formulas created by Dr. Steve Marsden for veterinary species

 To choose the correct formula means to have the correct TCM/ TCVM diagnosis  A patient with a Kidney Qi and Yin deficiency pattern will be made worse with a formula that is warming!

Shen tong zhu yu tong  Tao Ren  Hong Hua  Chuan Xiong  Qiang Huo  Dang Gui  Mu Xiang  Niu Xi  Qin Jiao

Persica Carthamus Ligusticum Notoptergium Angelica Sausserea Achyranthes Gentiana

Relieve pain, activate Blood

Nourish and move Blood Relieve pain, move Qi Strengthen bones, limbs Clear Wind-Damp, Nourish Yin  Di Long Earthworm Move channels, Clear Wind-Damp  Mo Yao Myrrh Move Blood, Qi; Resolve stagnation *Caution pregnant animals, can cause abortion

Du huo ji sheng tang Kidney Qi Def, Liver Blood Def               

Du huo Sang ji sheng Fang feng Qin jiao Niu xi Fu ling Xi xin Du zhong Rou gui Chuan xiong Dang gui Bai shao yao Sheng di huang Ren shen Gan cao

Angelica Clear Wind-Damp Loranthus Warm interior, Dispel Cold Siler Gentiana Achyranthes root Clear Wind-Cold Poria Clear Wind-Damp Asarum Eucommia bark Tonify Kidney Yang Cinnamonn bark Ligusticum Angelica Nourish and Move Blood White peony Resolve Stagnation Rehmannia LIV/KI Qi Def, Ginseng Tonify Qi Blood Def Aversion to Cold Licorice Harmonizer

Supple Spine         

Du huo Sang ji sheng Fang feng Qin jiao Fu ling Xian Mao Du zhong Rou gui Chuan Niu Xi

Angelica Loranthus Siler Gentiana Poria Circuligo Eucommia bark Cinnamonn bark Cyathula Root

    

Chuan xiong Bai shao yao Shu di huang Ren shen Gan cao

Ligusticum White peony Rehmannia Ginseng Licorice

Clear Wind-Damp Warm interior, Dispel Cold Clear Wind-Cold Clear Wind-Damp stronger strengthening bone Tonify Kidney Yang

Stronger blood mover & nourishes tendons and ligaments Nourish and Move Blood Resolve Stagnation more warming, Blood nourish Tonify Qi Harmonizer

Xiao huo luo dan → Quick River  Cao Wu

Aconite

Warm Channels, dispel Wind-Cold-Damp

Jiang Huang Turmeric  Chuan Wu Aconite  Tian Nan Xing Arisaema

 Di Long  Mo Yao

Lumbricus Myrrh

 Ru Xiang

Olibanum

Transforms phlegm, Resolve stagnation Activate the Channel Resolve stagnation, relieve pain

(Boswelia) Caution: Aconite is toxic! Use short period - 2 months

Qi and Blood Obstruction Also wind-stroke with numbness and pain



Yi Yi Ren →Free the Sinews Du huang Huo  Ma  Gui zhi

Angelica Ephedra Cinnamon

Dispel WC from exterior Drain damp through urine

 Gui zhi also opens channels in extremities

 Dang gui  Bai shao  Cang zhu  Yi yi ren  Zhi gan cao  Sheng jiang

Angelica Peony Atractylodes Coix Glycyrrhiza Zingiberis

Activate Blood Relieve Pain Drain Damp Harmonize Harmonize

Using Du Huo brings formula to back and neck as well Gui Zhi maintains effectiveness in peripheral channels Can add Sang Zhi, Morus twig to help smaller joints, esp. FL

Benefit Hips and Knees Xiao Chai Hu Jia Qin Jiao Tang  Chai Hu  Ren Shen  Qin Jiao     



Bupleurum root Relieves LIV Qi Stag, raises Qi Ginseng root Tonifies primary Qi: SP/ LU/ HT Large-leaf gentian root Dispels WD, relaxes sinews drains DH, clears deficient Heat Huang Qin Scuttelaria clears DH, relieves toxicity Fa Ban Xia Pinellia root, treated dries D, resolves Phlegm, ↓LU Qi, Reb. ST Qi Gan Cao Licorice root harmonizer, stops spasms & pain Gan Jiang Dried ginger root warms middle, dispels cold Hong Zao Red jujube fruit harmonizer, tonifies SP/ST

XCHT: Opens TH – longitudinal circulation and expels pathogenic factors to exterior Qin Jiao further enhances distribution to joints, esp Hip and Stifle (GB Affinity)

Bupleurum and Kudzu Clearing Formula Jia Wei Chai Ge Jie Ji Tang Chai Hu Du Huo Huang Qin Ge Gen Bai Shao Yao Qiang Huo Hong Zao Sheng Shi Gao Bai Zhi Jie Geng Gan Jiang Gan Cao

Bupleurum root Angelica pubescens Scuttelaria Kudzu root White peony root Notopterygium root Red jujube Gypsum Angelica root Platycodon Dried ginger Licorice

Relieves LIV Qi Stagnation, raises Qi Clear Wind-Damp clears DH, relieves toxicity disperses WH, dispels pathogens from muscles tonifies Blood, Yin; moves LIV Qi, nourishes LIV expels WCD, unblocks channel osbtruction harmonizer, tonifies SP/ST clears H from Wei level and Yangming channel expels W and WC, releases exterior, alleviates pain opens Lung, resolves phlegm, guides other herbs warms middle, dispels cold harmonizer, stops spasms and pain

Main thrust is to expel pathogenic factors from the different Yang levels Chai Hu – Shaoyang; Shi Gao and Bai Zhi – Yangming; Ge Gen and Qiang Huo – Taiyang Bai Shao, Hong Zao, Gan Cao, Gan Jiang – nourish and protect inner

Sublime Joint Formula Xian Fang Huo Ming Yin             

Chuan Bei Mu Dang Gui Wei Bai Zhi Fang Feng Mo Yao Ru Xiang Chi Shao Gua lou Zao Jiao Ci Jin Yin Hua Chen Pi Gan Cao



Fritillary bulb resolves phlegm, Angelica root tail tonifies and moves Blood, alleviates pain Pungent Angelica expels W, WC, rel. exterior Siler alleviate pain Myrrh Invigorate blood, break blood stasis, move Qi, Frankincense (Boswelia) reduce swelling, generate flesh Red Peony clears heat, cools blood, dispels blood stasis Trichosanthes root clears heat, resolves phlegm Gleditsia spine eliminates toxicity, drains pus, activates blood circulation, reduces swelling Honeysuckle clears heat, relieves toxicity, disperses WH Tangerine peel regulates Qi, harmonizes middle, dries D Licorice harmonizer, nourishes Spleen

Chronic accumulation of Damp, Heat and Phlegm with significant Blood Stasis Hemorrhagic disorders, chronic lameness, osteoarthritis with heat and swelling, poorly healing wounds and even inflamed tumors. Contraindicated in Qi deficient, Yin or Blood deficiency

Herbal Formula: Bai hu si miao tang  Zhi mu  Shi gao  Hai tong pi  Gui zhi  Cang zhu  Huang bai  Yi yi ren  Niu xi

Anemarrhena Gypsum Erythrina Cinnamon twig Atracylodes Phellodendron Coix Achyranthes

Clear Heat Clear Wind-Cold-Damp

Clear Damp Clear Heat

 Last four herbs are Si miao tang  Infectious arthritis, rheumatoid arthritis, immune-mediated arthritis

Single Herbs  Yan hu suo : corydalis tuber  Blood Invigorating  Promotes movement of Qi  Alleviates pain – all kinds

 Jie geng : platycodon root  Phlegm Resolving  Opens lung, resolves phlegm  Directs other herbs to upper jiao

Respiratory Disease According to Chinese Physiology

Chinese Correspondences • The Lung is the Canopy – It covers and protects

• • • • •

Lung Hand Tai Yin channel Connected to Leg Tai Yin channel - Spleen Paired with Large Intestine – Hand Yang Ming Autumn Metal

Chinese Physiology • The Lung is the Canopy – It covers and protects

• Most exterior of all Zang Fu – First interface with the environment – Breathing – Extracts Qing Qi (O2) from air – Utilized in production of Ying Qi which circulates in blood vessels to nourish all organs and tissues

• Lung Qi Infuses the Ying Qi into the blood vessels – “Qi moves the Blood as Blood nourishes Qi” – LU 9 : Hui-Influential point for Vessels

• Descends and Disseminates Qi and Fluids • First Organ exposed to airborne pathogens!

Lung Physiology Wei Qi • Strong affiliation with Wei QI – Immune system – humoral and cell- mediated • IgA, Alveolar macrophages (“Giant cell” capsules)

– Instinctive body mechanisms for survival • Microvilli – anatomical defense system! • Regulation of opening and closing of pores – Thermoregulation – Protection from External Physical Environment

• Shivering when cold

– Allows us to live harmoniously in our physical environment

• Wei Qi travels under surface of the skin – cuo li • Wei Qi travels internally as well – mucous membranes of gastrointestinal system (GALT….) – Association with Large Intestine

Lung Physiology Fluids • Descends Fluids • Moistens the skin and tissues – Suppleness of skin, integrity – Suppleness of fascia to some extent • Liver Blood is most important but Lung fluids supplement

– Serosal and mucosal surfaces of internal organs

• Fluids descend to Kidney – Turbid excreted as urine – Pure replenish Kidney Yin • Kidney Yin balances Heart Fire

– Action of Kidney Yang on Kidney Yin creates Kidney Qi and steams fluids back up to the Lung

• Lung and Kidney important role in circulation of fluids

Lung Physiology Extension of Spleen • Lung is Hand channel of Tai Yin • Spleen is Foot channel of Tai Yin – They are two aspects of the same channel

• Lung Primary channel begins in the area between the Stomach and Spleen • Spleen supports the Lung – Ascends the Gu Qi to the Lung where this combines with Qing Qi to form the Wei Qi and Ying Qi

• Both the Spleen and the Lung are crucial to the manufacture and circulation of Qi in the channels – In part this is our energy – ATP production – Both the Lung and the Spleen are important in Ying Qi • Manufacture and Circulation

Physiology in summary • Lung affects all movements of Qi – Ascending, Descending, In and Out

• Most external Organ thus affected most by EPF • Harmonizes flow of Blood due to flow of Qi • Opens and regulates water channels – LU 7 – LU Qi descends the fluids; Received by KI Qi

• Connected with skin, body hair – Pores – opening and closing, sweating, skin resistance

• Open into nose and connects with throat • Connects with Large Intestine

Pathophysiology • • • • • •

Disharmony reflected in: Water or fluid regulation Air movement Qi movement Diseases of nose, throat and large intestine Closely related Organs – Spleen – Qi and Phlegm relation – Kidney – Qi and Fluid relation

Acute versus Chronic • Rebellious Lung Qi • Coughing! – In acute infections should be viewed as normal body response to invading pathogen – Viruses, bacteria, foreign bodies, pollen

• Production of mucous – As the normal movement of Qi and Wei Qi is disturbed so is the movement of fluids – Fluids accumulate in nasal and bronchial passageways – To some extent also a normal body response to help move insulting organisms/ pathogenic factors out of the body • Sweating – Another normal mechanism of the body to rid an EPF • In acute conditions a good thing! Body’s normal response

Acute Respiratory Generally think URI • Wind-Cold – Acute onset, sneezing, nasal congestion – clear – Muscle aches, chills – Aversion to Wind and Cold – Pale tongue or normal, thin white coat – Pulse superficial and tight

• Exterior Excess Cold or Lung Wind-Cold

Typical cold

• Wind Heat – Acute onset – Sneezing, nasal obstruction with think yellow mucous – Sore throat – Fever more than chills, thirst – Avoids wind and cold – Tongue +/- red, thin yellow coating – Pulse superficial and rapid

• Exterior Heat Excess – Lung Wind Heat

Treatment with AP and Chinese Herbs • Acute Wind Cold • Dispel Wind-Cold

– LU 7, LI 4 – Expel Exterior Wind (cold and heat) – BL 12 – Feng men – BL 13 – Fei Shu

• Aches in upper body – GB 20 – Feng chi

• Additional Points – – – –

GV 14 – Expels Ext. Wind BL 10 – Wind, aches LI 20 – local, nasal CV 22 – local, throat

• Herbs • Ge gen wan – Pungent Warm Exterior Relieving – Ge gen, Ma huang, Gui zhi, Bai shao yao, Sheng jiang, Da zao, Zhi gan cao – Taiyang stage - aches

• Xiao Qing Long wan – Minor Blue Dragon – Pungent Warm Exterior Relieving – Ma huang, Gui zhi, Bai shao yao, Gan jiang, Xi xen, Wu wei zi, Ban xia, Zhi gan cao – Pre-existing SP Qi Def

Acute Wind-Heat • Dispel Exterior Wind Heat – GV 14 – also relaxes neck, tonifies Wei Qi – LI 4 – Tonifies Wei Qi – TH 5 – Tonifies Wei Qi – LI 11 – clears Wind-Heat

• Sore throat: – LU 10 – removes LU Heat – LU 11, expels LU Heat – SI 17 – local point, expels Heat or Damp of the throat

• Additional Points: – GB 20 – clears Heat and Wind in upper body – BL 12, BL 13

• Herbals • Yin Qiao Jie Du Pian – Lonicera, Forsythia Resolve Toxin tablet – Dispels W. clears Heat, resolves toxin, benefits the throat, relieves thirst, diffuses LU Qi – Within first 12-24 hours – Not appropriate if EPF in lung

• Fang Feng Tong Sheng Wan – Ledebouriella Opened by the Sage Decoction – Dispels W, Clears H, resolves Toxins, frees the stool – Tai Yang and Yangming stages

Chronic or Recurring URI Underlying Deficiency of either Qi (Yang) or Yin • Chronic Deficiency Yang – Interior Cold Def – Easy to catch colds and flus – Overweight, lethargic cats – Qi def plus Cold – T: pale, flabby, moist – P: slow, weak

Can include the chronic rhinitis/ sinusitis cats

• Chronic Yin Deficiency – Interior Heat Def

– Frequent colds with Heat symptoms – Herpes Virus cats; FeLV, FIV cats • With stress develop URI – usually with heat

– Nasal discharges with heat – yellowish – Tired, restless, feverish, sore throat or dry cough – T: red, no coating – P: rapid and weak, sometimes floating

Chronic Recurring URI or rhinitis/ sinusitis • Address Acute Pattern – Wind Cold – Wind Heat

• Local points for Sinuses – – – –

LI 20 Bi tong Yin tang BL 2

• Phlegm will be underlying – SPLEEN

• Phlegm Cold in Lung

– Transform Phlegm-Cold:

• BL 13 – dispels WC in LU • LU 5 – disperses LU Phlegm – Hot or Cold • ST 40, LI 4

– Tonify LU and SP: LU 9, SP 3, SP 6

• Herbal • San Zi Yang Qin Tang

– Three seeds to nourish one’s parents – Cold Phlegm transforming – Bai jie zi – White mustard seed • Warms lungs, eliminates phlegm, promotes movement of Qi

– Zi su zi – Perilla seed

• Descends rebellious Lung Qi, stops coughing and wheezing, resolves phlegm

– Lai fu zi – Radish seed

• Improves digestion, relieves food stagnation, descends rebellious LU Qi, resolves phlegm

Chronic rhinitis – Heat pattern • Phlegm Heat in Lung • Transform Phlegm-Heat:

– LI 4 – Clears Wind- Heat, tonifies Wei Qi – LU 5, ST 40 – Phlegm, Hot or Cold – GB 20 for Heat especially in upper body – BL 13

• Tonify SP: SP 3, SP 6, SP 9 • TH 5 – clears heat • LU 6 – Disperses Phlegm-Heat

• Cang er zi – External Wind Expelling – Nasal congestion w/ thick nasal discharge – Cang er zi – Xanthium fruit • Pungent, bitter, warm: Opens nasal passages, expels W-D, relieves pain

– Xin yi – Magnolia flower • Pungent, warm: Expels W-C, opens nasal passages

– Bai zhi – Angelica root • Pungent, warm: Expels W-C releases exterior, alleviates pain

– Bo he – Peppermint • Pungent, cool: Disperses W-H, releases exterior, clears head, moves Liver Qi

Chronic rhinitis • May need to support Spleen – Si jun zi tang – Four Gentlemen • Ren shen, Bai zhu, Fu ling, Zhi gan cao

• If Yin deficiency is prevalent or Yin is damaged – Zuo gui wan – Liu wei di huang wan – Mai men dong tang

Both contain Shu di huang which can be too much for patients with SP Qi Deficiency

• Mai men dong – nourishes LU and ST Yin; • Contains Ren shen, Da zao, Gan cao that help support SP

Lower Airway disease Chronic coughing, bronchitis, asthma • Because Lungs are Exterior can have direct invasion of Lungs leading to deeper problems – Affecting bronchi and lung tissue • Wind-Heat, Wind-Cold and Wind-Dryness

• Can also have the transference of an EPF that was affecting only the nose and upper passageways travel deeper as Wei Qi is weakened – Bordetella turning into chronic bronchitis or pneumonia

• Again will have some mixed patterns – Excess symptoms but underlying Deficiencies – Deficiency in Lung, Spleen, Kidney

Deeper invasion Same patterns as with URI but now Lung Organ affected • Wind Cold Cough • External invasion of Wind and Cold • Cough, laryngeal, pharyngeal irritation • Acute Onset – Exterior • Cough • Chills • T: thin white coating • P: superficial and tight

• Wind Heat Cough • Invasion of Wind-Heat • Transformation of WindCold to Wind-Heat • Acute onset • Cough • Heat signs – Fever, sore throat, thick yellow sputum

• T: red, thin dry white or yellow coating • P: rapid; superficial

Chronic Coughing Patterns • Deficiency of Lung Qi

– Weakened by antibiotic or steroid use

• May also be associated with Kidney Qi Deficiency – Decreased ability of LU to descend Qi – Decreased ability of KI to Grasp descending Lung Qi

• LU Qi deficiency signs – – – – –

Weak cough, chronic; weak voice Gets cold easily Short breath Clear diluted sputum Edema in forelimbs

– – – –

Weakness in hindlimbs Cool in lower back and extremities Incontinence Edema in hindlimbs

• KI Qi Deficiency Signs

Chronic Coughing • Lung Qi Deficiency combined with Yin Deficiency – Yin Deficiency of Kidney or Lung or Both

• Signs of Qi Deficiency • Signs of Yin Deficiency

– Chronic weak cough, dry – Tires easily – Back soreness – Kidney – Frequent urination, scanty • Tongue:

– Pale, thin, white coating – Qi Deficiency – Red, dry, no coating – Yin Deficiency

• Pulse

– Weak, deep – Qi deficiency – Thin, rapid – Heat from Yin Deficiency

Chronic Coughing Patterns • Phlegm cough – say hello to Spleen • Chinese saying: Phlegm produced by Spleen but held by Lung • Can be a cold or heat pattern – differentiate based on pulse and tongue • General signs – – – –

Rattling Cough Heaviness in chest Decreased appetite - phlegm Difficulty breathing

• Sputum – White – cold pattern – Yellow, green – colors of heat

• T: pale, thick white coat – Cold; red w/ yellow – Heat • P: Slippery, Full; tight – Cold, rapid – Heat

Chronic Coughing • Again address Heat or Cold symptomatology – For Cold signs: LU 7, LI 4, BL 13, BL 12 • CV 22 for cough

– For Excess Heat signs: GV 14, LI 4,LI 11, LU 7, TH 5, GB 20 • LU 10 Clears LU Heat • CV 22 for cough

• Address Phlegm if present

– Transform Phlegm: LU 9, ST 40; LU 5 – Benefit Spleen – SP 6, SP 9, SP 3

• If heat or damage to Yin– KI3, KI 6, BL 23, LU 5

Underlying Deficiency with Chronic Cough • Lung Deficiency

– Benefit Qi and circulation: ST 36, CV 17

• Tonify Lung, Kidney;

– LU 7, LU 9, BL 13, – LU 5 – clears LU Heat and Benefits LU Yin – KI 3, BL 23, BL 26

• Herbals • Bu Fei Tang – Benefit Lung Decoction – LU Qi deficiency without Heat signs

• Huang Qi, Ren Shen – Huge Qi tonics for Spleen • Shu Di Huang, Wu Wei Zi – nourish and astringe Yin

Lung and Kidney Qi Def • Ren Shen Yang Ying Tang – Ginseng and Walnut Decoction – Coughing or wheezing due to def of Lung and Kidney with slight cold signs – Ren Shen - ginseng – Hu tao ren – juglans (walnut) – Sheng jiang – fresh ginger – Da zao – Chinese plum

• Su Zi Jiang Qi Tang – Perilla Fruit Decoction for Directing Qi Downward – Lung Phlegm Damp with underlying Kidney Qi Def causing wheezing with profuse Phlegm – Zhi gan can – Fried Licorice – Ban Xia – Pinellia – Zi Su Zi – Perilla seed – Dang Gui – Angelica – Hou Po – Magnolia – Qian Hu – Hogfennel root – Rou Gui – Cinnamon – Sheng Jiang – Fresh ginger – Zi Su Ye – Perilla leaf – Da Zao – Chinese Date

Chronic Cough with Qi and Yin Deficiency • Same point to nourish and circulate Qi • Benefit Yin and Clear Heat gently – KI 3, KI 6, BL 23, CV 4, SP 6 – Benefit Yin

• LU 10 – clears LU Heat, • LU 5 – Clears Yin Def heat, LU 6 – cool LU Heat • Circulate Yin Fluids – LU 7, KI 6 (Ren Mai)

Lung Qi and Yin Deficiency • Ren Shen Huang Qi San – Ginseng and Astragalus Powder – Lung Yin Deficiency with false heat and Spleen Qi Deficiency causing cough with scanty sputum and fatigue – Ren shen, Huang Qi, Fu Ling Jie geng, Ban xia • Nourish and move Qi • Drain or transform Damp

– Sheng di huang, Di gu pi, Tian men dong, Chi shao yao, Zhi mu, Qin jiao, Sang Bai Pi • Nourish Yin and clear false heat

– Chai hu, Gan cao

• Bai He Gu Jin Tang

– Lily Bulb Decoction to Preserve Metal – Bai he, Mai men dong, Sheng di huang, Shu di huang, Xuan shen, Bai shao yao

• All nourish Yin, clear false heat • Xuan shen (scrophularia) also softens hard masses • Bai shao yao also moves Liver Qi

– Bei mu, Jie geng

• Transform phlegm

– Dang gui, Gan cao

Asthma • Wheezing • Difficulty breathing • Acute attacks but there is a general underlying deficiency – – – –

Lung Qi Deficiency Kidney Qi Deficiency Spleen Qi Deficiency Yin Deficiency

• Acute triggers can include – EPF - Wind Cold, Wind Heat – Emotional stress • Direct effect on Lung, Kidney • Stress effect on Liver which disturbs normal movement of Qi

Lung Qi Deficiency • Overwork • Chronic exposure to irritants – Smoke, pollen

• Emotional factors • Chronic disease – History of chronic URI

• Treatment with antibiotics and steroids further weaken the Qi

Bu Fei San

• Weak cough, Non- to slightly productive • Worse with movement • Spontaneous sweating • Dry coat – hair breaks • Clear nasal discharge if any • Weak voice • Avoids cold and wind • Lassitude and weakness • T: pale, thin white coat, superficial cracks • P: thin, weak and deep

Kidney Deficiency Asthma • Overwork, poor lifestyle, stressful • Chronic disease • Age • Over time Kidney Qi is damaged or depleted

• Chronic asthma, lethargy • Back problems +/– Weakness – Qi Def – If signs of Cold – Yang def as well

• Urinary problems – Incontinence, slow urination

Ren Shen Yang Ying Tang Jin Gui Shen Qi Wan

• Tongue: pale, moist, swollen • Pulse: weak, thready

Lung and Spleen Qi Deficiency • Chronic illnesses, improper lifestyle • Raw foods; processed foods • Emotions

• • • •

Weak cough, tired, weak voice, spontaneous sweating Poor appetite, loose stools, Worse with movement Hair breaks easily (LU) and falls out (SP)

• T: pale, superficial cracks, ±moist, may be wide • P: weak, deep, thin, may be slippery

Su Zi Jiang Qi Tang Support Kidney and thus support Spleen

Lung Yin Deficiency • Prolonged fever or illness • Excessive sexual activity • Mismanagement of diet or work • Emotional

Ren Shen Huang Qi San Bai He Gu Jin Tang

• Weak, DRY cough • Prevalent at NIGHT • Spontaneous sweating at NIGHT • Avoids Heat • Thirst for small amounts of water • Dry mouth, nose, skin, hair • Sticky, crusty nasal discharge • T: red, no coat, small and dry • P: thin, rapid, superficial or floating

Bai He Gu Jing Tang

Lily Bulb Decoction to Consolidate the Metal



Sheng Di Huang Shu Di Huang Mai Dong Bai He Zhe Bei Mu Xuan Shen Dang Gui Bai Shao Jie Geng Gan Cao

Rehmannia Rehmannia, prepared Ophiopogon Lily Bulb Fritillaria Scrophularia Angelica White Peony Platycodon Glycyrrhiza

Nourish Yin Clear Deficiency Fire Nourish Yin, moisten Lung Dissolve Phlegm, stop coughing Cool Blood, clear deficiency fire Nourish Yin Tonify Blood Smooths the Lung Qi, dissolves phlegm Harmonizes

Treats Lung and Kidney Yin Deficiency Kidneys and Lungs both important in production and circulation of Qi and Yin Evaluate in any Wei Syndrome patient

Additional Considerations • Sometimes Liver will be involved – Personality – Secondary – Treat what you see….

• LIV 2, LIV 3 if Liver involved • BL 17 – Empirical point based on anatomy – Ge Shu – Diaphragm Shu : Relaxes diaphragm – Huge structures pass through the diaphragm • Aorta, vena cava, vagosympathetic trunk…

– Also Influential point for Blood so helpful if signs of Blood def

If Phlegm is significant – address Spleen Six GentlePets (Liu Jun Zi Tang) • Bai Zhu Angelica root • Fu Ling Poria Si Jun Zi Tang • Ren Shen Ginseng root • Gan Cao Licorice root • Ban Xia Pinellia Er Chen Tang • Chen Pi Tangerine peel

Herbs for Common Digestive Imbalances

Spleen and Stomach • Stomach receives the food and is the ripening and rotting vat • It likes to be warm and moist – A good cauldron

• Gu Qi that is present in the food and drink ingested is released and is transformed into useful substances for the body – • Qi, the thin fluids, (Jin), and the thick fluids, (Ye) • The Stomach is said to be the source of all fluids – the Jin and the Ye, with assistance from the Spleen

Spleen • Further Transformation and Transportation of the Qi taken from ingested material • Chinese scholars considered the pancreas to be part of the spleen; – describing it anatomically as being 3 cun wide, 5 cun long and containing an “additional 0.5 jin [approximately 250gm] of tissue spreading around it.” – D. Kendall, Dao of Chinese Medicine, p.46

• Also responsible for transporting the clear fluids or essence of the food and drink ingested upwards to the Lungs • The Spleen prefers to remain dry – Balancing the Stomach’s need for moisture

Spleen and Stomach • Vital to the balance and harmony of the fluids in the body • The Spleen is often involved with the pathologic production of fluids – when transformation of moisture in the food to the Jin-Ye is incomplete and an unusable form of Yin is produced called Dampness

Clinical signs • Spleen chief source of nourishment for the body • Responsible for maintaining the flesh and bulk of the body, including limb musculature – With dysfunction – atrophy, muscle loss

• Spleen opens to the mouth – Pathology may be reflected with changes in the mouth.

• Accumulation of Dampness due to dysfunction of the Spleen is reflected by a thick coating on the tongue and a wide tongue • Inflammation of the gums is seen with excessive heat and dryness in the Stomach

Injuries to Spleen/ Stomach • Spleen is prone to damage by excess dampness – Environment – Diet • High in sugars and short-chained carbohydrates, raw

• Stomach is prone to damage by heat and dryness – Excess heat in the body, as with a fever – Ingested food is too hot • Spicy (jalapeño or habañero peppers) • Energetically, such as lamb or dry food

Formulas to discuss • Acute disruption of Stomach function • Spleen Qi Deficiency Formulas • Formulas to address more significant Dampness • Formulas to address the Liver

Huo Xiang Zheng Qi Wan “Agastache Pills” • Huo xiang

Agastache

• • • • •

Bai zhu Hou po Jie geng Chen pi Ban xia

Atractylodes Magnolia Platycodon Citrus Pinellia

• • • • • •

Da fu pi Bai zhi Zi su ye Fu ling Da zao Gan jiang

Areca Angelica Perilla Poria Jujube Ginger

Transforms Damp, regulates middle, stops vomiting, exterior patterns! Tonifies SP Qi, Dries Damp Directs rebellious Qi ↓, Transforms Damp Resolves Phlegm, ventilates Lung Regulates Qi, Dries Damp, Resolves Phlegm, Dries Damp, Resolves Phlegm, Harmonizes ST, Qi ↓ Directs rebellious Qi ↓, Dries Damp Expels WC, Expels Dampness Expels WC, moves Qi in middle burner Dries Damp, Tonifies SP Tonifies SP, Harmonize formula Warms middle, dispels Cold

Expels WC, releases exterior; transforms Damp, moves Qi, harmonizes middle burner Synergistic effect of Huo xiang and Zi su ye – against aerobic bacteria (salmonella)

Huo Xiang Zheng Qi Wan • Acute invasions of external pathogenic factors – including modern day viruses and bacteria.

• Developed to use against Wind-Cold-Damp invasions that led to acute gastroenteritis complaints, (diarrhea, indigestion, and nausea) commonly producing high fevers • Modern day applications include food poisoning, indigestion, hematemesis, hematochezia as well as acute or chronic refractory diarrhea • High concentration of aromatic herbs – biomedical effect of killing microbes, regulating peristalsis and relaxing spasticity, improving mucosal blood flow and enhancing absorption and digestive power

Protect the Middle • Follows the classical formulation closely • Da Huang, rhubarba, is substituted for Da fu pi, areca, as the FDA discourages its use • Gan cao, licorice, replaces Da Zao and Gan Jiang as a harmonizer and contributing a bit to Spleen tonification

Tonification for Spleen Qi Deficiency • • • • •

Si Jun Zi Tang (Four Gentlemen) Ren shen Ginseng Tonify Qi Bai zhu Atractylodes Strengthen SP Fu ling Poria Strengthen SP, drain Damp Gan cao Licorice Harmonize, tonify Qi

• A base formula • Nourishes the Spleen function – Qi and Blood • Ginseng a powerful adaptogen – augments function of any organ system • Lassitude, lethargy, diarrhea, decreased appetite, abdominal bloating • Chronic gastritis, dysentery, peptic ulcer, anemia

Liu Jun Zi Tang Six GentlePets • • • • • •

Ren Shen Bai Zhu Fu Ling Gan Cao Chen Pi Ban Xia

Ginseng Atractylodes Poria Licorice Tangerine peel Pinellia

9g 9g 9g 6g 9g 12g

Si Jun Zi Tang

From Er Chen Tang

• Ban Xia and Chen Pi has a profound effect in directing this formula more towards the resolution of Dampness that is affecting the digestive function • Phlegm-Dampness affecting the appetite and stomach function with clinical signs of decreased appetite, nausea, vomiting, fullness in chest and epigastrium. Loose stools may also be seen. • Chronic gastroenteritis, peptic ulcer, sour regurgitation, indigestion, chronic bronchitis

Bu Zhong Yi Qi Tang Tonify the Middle and Augment the Qi Decoction Lift the Qi - Kan Huang Qi Ren Shen Bai Zhu Zhi Gan Cao Dang Gui Chen Pi Chai Hu Sheng Ma

Astragalus Ginseng Atractylodes Glycyrrhiza Angelica Tangerine peel Bupluerum Cimicifuga

Tonifies Zhong Qi, ascends Yang Qi, strengthen Wei Qi Strengthen Spleen Benefit Qi Tonify middle jiao Tonifies and invigorates Blood Regulates Qi and harmonizes Stomach Ascend Yang Qi Lift prolapsed organs

This formula Tonifies Zhong Qi, or middle Qi, as well as raising the Qi Huang Qi, astragalus, further boosts the immune system function and Wei Qi production. Dang Gui, angelica, helps to nourish Liver Blood that has suffered due to the suboptimal Spleen function

Bu Zhong Yi Qi Tang • Stimulate the production and circulation of Qi, including Wei Qi • Effective formula not only for digestive issues • Also where digestive dysfunction extends to other body processes – – – – –

Shortness of breath, weak voice, lassitude Prolonged diarrhea, prolapse of organs, fecal or urinary incontinence Chronic uterine bleeding Anxiety or emotional disorders Immune deficiency

• Ginseng, Astragalus and Licorice are all powerful adaptogens • Account for its ability to treat seemingly opposite conditions – Fatigue and insomnia – Diarrhea and constipation – Low blood pressure and hypertension

• Reduces smooth muscle spasticity thus being useful in cases of diarrhea or constipation where this is an underlying cause • Contraindication: low grade fevers due to Yin deficiency

Herbs for Dampness Wei Ling Tang – Spleen Support Combination of two classic formulas Ping Wei San (Calm the Stomach Powder) • Cang zhu Atracylodes Transforms D, Strengthens SP • Hou po Magnolia bark Move Qi, dispel damp, Relieve food stag. (bloating) • Chen pi Citrus Regulates Qi, Transform Phlegm • Gan cao Licorice Tonifies SP, Harmonize • Sheng jiang Ginger Harmonize SP/ST, warming • Da zao Jujube Harmonize SP/ST • • • • • • •

Dampness Drying, Stomach Harmonizing category Dries Damp, strengthens Spleen, Regulates Qi movement in middle jiao Dampness obstructs Qi movement of SP/ST - Abdominal distension, fullness Decreased appetite, nausea, vomiting Belching, sour regurgitation Heaviness in body, loose stools Gastroenteritis and hepatitis

Wu Ling San • • • • •

Fu Ling Zhu Ling Ze Xie Bai Zhu Gui Zhi

Poria Polyporous Alisma Atracylodes Cinnamon twig

Tonifies SP, Drains Damp Promotes urination, eliminates Dampness Promote urination, eliminate Damp Tonifies SP, Dries Damp Expels WC, warm channels, warms Yang

• Downward Dampness Draining category • Induces diuresis, warms the Yang, tonifies Spleen and strengthens the transformational function of Qi • Safe and effective herbal diuretic – Supports Spleen and elimination of dampness from the urinary system

• Acute gastroenteritis, acute and chronic nephritis, CRF • CHF • Ascites from liver cirrhosis, retention of urine and Meniere’s syndrome

Wei Ling Tang Cang zhu Hou po Chen pi Gan cao Sheng jiang Da zao Fu Ling Zhu Ling Ze Xie Bai Zhu Gui Zhi

Atracylodes Magnolia bark Citrus Licorice Ginger Jujube Poria Polyporous Alisma Atracylodes Cinnamon twig

Ping Wei San

Downward Dampness Draining category Dispels Damp, regulates Qi in the middle burner, strengthens the Spleen and harmonizes the Stomach

Wu Ling San

Chronic gastritis, enteritis, cardiac and nephritic edema and retention of urine

Kan - Spleen Support Tong Cao for Zhu Ling Gan Jiang and Rou Gui replace Sheng Jiang and Gui Zhi - formula is more warming and more supportive of SP Ratio is also different to support diuretic function Hepatic Lipidosis cats, chronic pancreatitis, colitis, IBD

Xiao Yao San Happy Wanderer • • • •

• • • •

Chai hu Bupleurum Dang gui Angelica Bai zhu Atractylodes Bai shao yao Paeonia Blood Fu ling Poria Sheng jiang Ginger Gan cao Glycyrrhiza Bo he Menthe

Relieves LIV Qi Stagnation Tonifies and Moves Blood Tonifies SP Qi, Dries Damp Moves Liver Qi, Stops pain, Nourishes

Tonifies SP, Drains Damp Warms middle burner Tonifies Spleen, Harmonizer Moves Liver Qi

• Soothes the Liver, dispels Liver stasis, harmonizes LIV and SP, • Moves Qi, invigorates Blood, Tonifies SP Qi, tonifies Blood, and regulates menses • Irritable bowel, gastrointestinal neuroses, irritability, depression and estrogen imbalance, hepatitis, microvascular portosystemic shunts, skin conditions

Clinical Cases

Rexa Fischer 30 June 2008 8 year, GSD, SF Hx: arthritis since 4 yr Rad’s in 2004: Signif hip osteoarthritis LS sclerosis and spondylosis Spondylosis L5L6,T8T9,T9,T10 Tried homeopathics-no help Presented on Devil’s claw mixture

Rexa Fischer • • • • • •

Hair coat dry and dull, more caudally Appetite and water okay – better in pm Limited ROM both hips - 45° Severe atrophy both HL Owner now noticing weakness in FL BSP: tense in thoracic area, BL 18,19, BL23,24 tender and deficient; weak in LS • Tongue: pinkish grey – (lovely), slightly dry • Pulses: deep, slow, thin, left pulse almost impossible to find

TCM Diagnosis? • Excess or Deficiency? • Interior or Exterior? • Heat or Cold? • Fundamental Substances? • Organs?

• Deficiency • Interior – Chronic • No clear signs, tendency to cool • Qi and Blood Def • Jing Deficiency • Qi stagnation • Kidney, Spleen, Lung

Rexa Fischer • Working diagnosis – Bony Bi with secondary Wei Syndrome – Kidney Qi and Jing Deficiency – Lung and Spleen Qi Deficiency

• AP: BL60/KI3, Ancestral Sinew treatment releasing iliopsoas and diaphragm muscles, BL 26, 23, jian jiao-b, GB 30r, SI9r, LI10L, SP4L • Herbal? • Du huo ji sheng tang

Rexa, 1 week later • Relaxed after tx; slept well, walking better, even wanted to play with her ball! • BSP: tight knot in BL17 region, weak BL 20,21; tight in LS region • Pulses: still weak but more rounded, slightly tight • Tongue: wide, pale pink, lavender in center • AP: BL 60/KI3b,LIV3L, Ancestral Sinews-iliopsoas and diaphragm muscles, Weigen, BL 26, GV5 • Continue Du huo ji sheng tang

Rexa, 20 Feb – 2 weeks later • • • • •

Was sore after last treatment Pulses: better, still tight but not as turgid Tongue: pinkish lavender, still flabby and moist AP: continued with similar points Herbal change: added Yan hu suo (corydalis) to Du huo ji sheng tang

7 March • • • •

Continues to improve slowly, more strength, playing more T: pale pink, thin white coat, little spongy P: blood side weaker, Qi side soft and narrow Began using Si jun zi tang plus the Du huo ji sheng tang with Yan hu suo combination

Rexa, 26 March • Doing well, going upstairs easily now, stands more square, playing more and more • P: Qi side better, Blood side still weak • T: warm, pink, not as spongy • Began using Shi quan da bu tang (kind of) – Si jun zi tang (50g) + Si wu tang(50g) + Huang Qi(10g)

• Continue with Du huo ji sheng tang + Yan hu suo • Doing SUPER!

Luna Rinck 5 year old, spayed female cat • 6 months previous diagnosed with Chronic Bronchitis • Long history (2 yr) digestive complaints – Treated with metoclopramide, prednisone – Fine now as long as eats Hill’s D/D • Overweight cat, fleshy • Bumpy fat deposits along sterilization scar • Always a bit eater, water normal • Sneezes; Nasal discharge – sticky, yellow, greenish • Coughs occasionally – can’t see discharge – swallows

• Def or excess? – Def • Spleen/ Stomach – Really fine?

• SP Qi def • Phlegm • ST heat? • Phlegm-Heat • Rebellious LU Qi

• Sensitive to laryngeal palpation • Symptoms worse with damp • Stools – don’t know, goes outside…but when defecates inside are dry, small • Resentful to palpation of hypochondriac region • Generally friendly but did try to have another cat at home - became very irritable • Tongue: – pale, thick white coat, dry

• Pulse: right side very weak; left slightly thin • BSP: BL 18, 20 sensitive, BL 24, 25 deficient

Luna

• Qi Stagnation • Damp – Spleen • Deficient fluids or Heat • Hello Liver

• Liver • Def Qi or Blood, Phlegm Heat or Blood Def • Qi, Yin/Blood/Fluid Def • LIV, SP, Qi Shu, LI

“Luna” • • • • • • • • • •

TCM diagnosis? Predominant signs Qi def – SP and Lung Signs of stagnation – LIV Signs of Heat – chronic heat consumes fluids Lung-Phlegm Damp, beginning Heat signs Sp Qi Deficiency underlying cause Liver Qi stagnation SP 3, BL 13, ST 36 Herbal Treatment: Si Jun Zi Ke Li – Four Gentlemen LIV 13, BL 18 San Zi Yang Qin - Three Seeds Yin tang, Bi tong Nourishing Parents

“Stuffie” Schmidt DSH, CM 23 April 1991 • First seen 3 Nov 2006 (16 years old) – Chronic problem with GI – On Metacam® for pain, 10 drops/day and Zymoral®

• • • • • • • •

Vomits occasionally Increased thirst Sensitive to diet change Stools thin, often little balls Pain in hypochondriac region T: pale, moist P: slippery, wiry BSP: BL 18-21, 23

• Chronic – Excess or Deficiency? – Interior Problem – Deficiency

• • • •

• • • •

Rebellious ST Qi Excess? ST Fire? SP Qi Deficiency SP Qi Deficiency with Qi Stagnation LIV Qi Stagnation Qi Deficiency Qi Deficiency, Dampness LIV, GB, SP , ST, KI

Spleen Qi Deficiency, Liver Qi Stagnation AP: LIV 13b, BL 17+1, SP 9r

Herbal: Xiao yao san

Stuffie progress • 15 Nov (2 weeks) – – – – – – – –

Normal stool Eating canned food well, not eating as much grass Still some pain in hypochondriac ↓ Metacam – 6 drops daily T: pale pink – better, moist, slimy P: tight, thin, rapid, slippery on right BSP: BL 18,19,23 AP: LIV 13b, LIV 3r, LI 4l, CV 12, GV 3, 7, SP 9l

• 6 Dec (3 weeks) – – – –

Normal stool, no Metacam, no vomiting Attitude much better – more social, not as grouchy 85% better Maintain Xiao yao san and Zymoral

Stuffie, 2 and 3 months later • 2 Jan – more problems with defecation – slightly painful and would cry after defecating – Slightly tense in abdomen, stools sometimes hard, sometimes soft and smelly – Stool had 2 colors, twisted…? – T: pale pink, moist – P: right turgid, left weaker – BSP: BL 18-20, weak BL 23 – AP: Dai mai: GB 41r,BL 17, GB 26b, LIV 13b, CV 6 – Added Wu Ren Wan(5 Seed Pill) to lubricate Large Intestine

• 2 Feb 07 – No vomiting, normal stool – No strong smell – Maintained on Xiao Yao San and Si Jun Zi Tang

Herbal References • Kan Essentials Handbook for Veterinarians – Steve Marsden; describes certain formulas he has modified from classics

• Chinese Herbal Patent Medicines – Jake Fratkin; gives brief description of many classic “patented” formulas. These are some of the oldest and most commonly used formulas.

• The Chinese Herbalist’s Handbook – Dagmar Ehling – Organizes herbal formulas according to TCM diagnosis, great and easy reference once you are accomplished at reaching a TCM diagnosis

• Pocket Handbook of Chinese Herbal Medicine: ISBN-13: 978-0-9679935-3-9 – Zong Lan Xu – Lists 300 individual herbs – quick and efficient materia medica

• Pocket Handbook of Chinese Herbal Prescriptions: ISBN: 0-9679935-2-0 – Zong Lan Xu – Lists 350 common herbal formulas

• Really want to learn – need to take a course – CIVT distance learning course offered by IVAS – Chi Institute On line …… – Hand’s on course best – working on a course to offer here in the Netherlands!