NMT100 TCM Review Notes - Weeks 1-6.docx

NMT100 – TCM REIVEW NOTES [WEEKS 1-6] Traditional Chinese Medicine (TCM): ancient and natural form of healing that recognizes the inseparable relationship of body, mind, spirit and nature Pattern differentiation: diagnostic approach used to understand a patient’s health condition; used to categoriz...

NMT100 – TCM REIVEW NOTES [WEEKS 1-6] Traditional Chinese Medicine (TCM): ancient and natural form of healing that recognizes the inseparable relationship of body, mind, spirit and nature Pattern differentiation: diagnostic approach used to understand a patient’s health condition; used to categorize signs and symptoms in a way that reflects imbalances in the body History of TCM Acupuncture and Chinese herbal remedies – back 2200 years Shang Dynasty (1000 BCE) archeological findings of acupuncture needles and divination bones with medical problems engraved Huang Di Nei Jing (The Yellow Emperor’s Inner Classic; 300BCE) – earliest known written record of TCM Five Elements (Xu Wing) 1000-770 BC Book of Changes (Yi Jing) 700 BC – earliest reference to yin and yang Established firmly in Han Dynasty (206BCE-220 CE) – yin and yang, five elements, channel theory, pharmacopeia Medical classics that laid foundations for TCM – 400AD Principles of TCM Your body is integrated as a whole – mind, body, spirit and physical body = interrelated system Connection to nature – considers season, geographical location, time of day; also age, genetics, and condition of body Innate self-healing capacity – body has a microcosm that reflects the macrocosm Prevention is the best cure – body expresses signs about the state of our health (tongue, pulse, signs, symptoms) TCM methods of treatment Acupuncture – traditional, auricular, electro-stim Cupping Botanical – plant, mineral, animal Moxibustion Massage (Tui Na) Nutrition Bleeding techniques Gua Sha Tai Chi and Qi Gong TCM in ND practice and North America CNPBC Acupuncture Certification requirements – need supervised clinical training and study hours in Traditional Oriental Medicine Provinces and States have their own regulation of acupuncture Canada – ND programs have concurrent acupuncture courses in curriculum US – must pursue additional studies Accredited TCM programs – Diploma in Acupuncture eligible for CTCMA and NCCAOM Eligibility for Acupuncture Programs Yin and Yang Most important and distinctive theory of Chinese Medicine All physiology, pathology, treatment can eventually be reduced to Yin-Yang Symbol: White = yang Black = yin Dots = seeds; seed of yang and seed of yin Four aspects of yin/yang Opposition – yin and yang are opposite and always changing; never exactly 50/50 Interdependence – cannot exist without the other Mutual consumption – too much of one will deplete the other (excess and deficiency) Inter-transformation – yin and yang transform into one another; occurs when timing is right (cycles) YIN YANG Description Material, matter Produces form, grows Contraction Descending, below Water Female, feminine Cloudy, shady, negative electrical charge Immaterial Produces energy, generates Expansion Rising, above Fire Male Sun, positive electrical charge Function Cooling Nourishes Provides space for rest Substance that is moved Creates space for conception Warming Transforms Protects Moves Holds Creates the spark for conception In medicine Female Cold Heavy, obscured Earth, night Downward and inward movement Autumn and Winter Lower body, interior, abdomen Male Hot Light, radiant Heaven, day Upward and outward movement Spring and Summer Upper body, exterior, back YIN EXCESS YANG DEFICIENCY YANG EXCESS YIN DEFICIENCY Cold symptoms Abdominal pain and dysmenorrhea better with warmth Local pain better with heat Chills Cold symptoms Fatigue, tired after bowel movement Low libido Edema Heat symptoms Hot all day Red face Thirst for cold drinks (gulps) Heat symptoms Red cheeks, hot flushes, 5 centre heat Dry stools Anxiety at night, night sweats Thirst for cold drinks (sips) Tongue Examining the tongue; characteristics can include: Body colour Reflects condition of yin organs, blood, and nutritive Qi Reflects true condition of the body irrespective of temporary conditions (ex. physical exertion or emotions) Body shape Features can include: physical contours of the tongue, consistency, texture, mobility Thin or swollen Long or short Cracks – major and minor Tongue coating Physiological by-product of the stomach’s digestion; consists of the tips of papillae Tongue moisture Indication of the body’s fluids Can be: dry, moist, wet Spirit/Shen Normal tongue Colour – pale, red and fresh-looking Shape – supple, not cracked, no tremble/quiver, not swollen or thin Coating – thin and white Moisture – slightly moist; not too try or wet Spirit/Shen – radiant, brilliant Pulse Pulse diagnosis balance of the body as a whole (state of Qi, blood, yin and yang, constitution) and state of individual organs Feel for rate, width or amplitude, length, how close it is to the surface, how deep and close to the bone, strength and other qualities Taking the pulse 3 fingers on radial artery with patient relaxed – middle finger at level of styloid process Looking for: Rate Strength Fullness Location Yin and Yang in Tongue and Pulse Yin deficiency Tongue Coating: absence of coating Colour: Greater deficiency => brighter heat; more pink/red Less deficiency => duller heat; more pale Pulse: fast, thin pulse Yang deficiency Tongue Coating: dependent on accumulation of dampness Colour: pale Pulse: deep, slow, weak pulse 5 Elements and Corresponding TCM Organs History of the 5 Elements Aristotle – 4 elements and conflict between them 5 Elements originated in the Zhou Dynasty (1000-770 BC) Used for government and power issues Tapered off around 100 AD Song Dynasty (960-1279) – regained status and incorporated into mainstream Chinese medicine 5 Elements: used to explain the properties of the organs, their mutual relationship, and pathological changes; five natural substances we cannot do without Qualities of the 5 Elements: Wood – can be bent and straightened Workable and solid Direction: expansion Season: spring Earth – permits sowing, growing and reaping Nutrition Direction: central Season: between seasons; late summer or last 18 days of every season Metal – can be molded and can harden Solid and mouldable Direction: contraction Season: winter Water – moistens downwards Fluid and moveable Direction: downward Season: winter Fire – flares upwards Combustible and warming Direction: upward Season: summer Generating, Controlling and Insulting Cycles Generating cycles: relationship between each element, how each is created, and how each is nourished Mother always creates Child Generating cycle: Wood creates Fire from burning Fire creates Earth from ashes Earth creates Metal by hardening Metal creates Water by containing Water creates Wood by nourishing Controlling cycle: each element is controlled by another element in order to maintain balance When controller is in excess relative to the controlled, pathology will exist in the controlled When the controller is in deficiency relative to the controlled, pathology will exist in the controller Controlling cycle: Wood controls Earth by covering Fire controls Metal by melting Earth controls Water by damming Metal controls Wood by cutting Water controls Fire by extinguishing Insulting cycle: when an element “back-lashes” its controller; occurs when the controller is relatively weaker than the controlled Wood insults Metal Fire insults Water Earth insults Liver Metal insults Fire Water insults Earth 5 Element Pathology and Correspondences For each element, 4 conditions can occur When an element is deficient: Fail to nourish the child on the generating cycle Allow an insult to occur on itself by creating a relative excess along the controlling cycle (Yin deficiency and heat symptoms) When an element is in excess: Draw excessively from the mother Over-act on the controlling cycle (Yang excess causing dry symptoms Wood element Organs: liver and gall bladder Secretion: tears Emotions: anger and jealousy Flavour: sour Sense: vision Fire element Organs: heart and small intestines; pericardium and San Jiao Secretion: sweat Emotions: joy and anxiety Flavour: bitter Sense: speech and taste Earth element Organs: spleen and stomach Secretion: saliva Emotions: pensiveness, overthinking Flavour: sweet Sense: taste Metal element Organs: lungs and large intestine Secretion: mucous Emotions: sadness and grief Flavour: pungent Sense: smell Water element Organs: kidney and urinary bladder Secretion: urine Emotions: fear and shock Flavour: salty Sense: hearing TCM Organs Triple Warmer/San Jiao: functional organ system responsible for regulating the movement and distribution of fluids and energy (Qi) throughout the body Upper burner (Shang Jiao) mist; lungs, heart Middle burner (Zhong Jiao) maceration chamber; stomach, spleen, liver, gallbladder Lower burner (Xia Jiao) draining ditch; large intestine, small intestine, bladder, kidney Pulse Left and right pulses; can line up with Triple Burners Characteristics to note at each location: Speed – below 60bpm or over 90bpm Rhythm – regular or irregular Size – long, short Width – thin, thready, thick Shape – wiry, soft, tense Quality – choppy, rushing, slippery 8 Principles and 6 Pathogenic Factors Pattern differentiation – ways to look at the whole picture and determine patters that can be treated The 8 Principles – yin-yang, heat-cold, internal-external, excess-deficiency The 5 Elements – controlling, generating, insulting cycles The Vital Substances – Qi, blood, body fluids, essence The Zhang-Fu Organs – 5 Yin and 6 Yang organs and 6 extraordinary organs Pathogenic Factors – wind, cold, heat/fire, dampness, dryness, summer-heat The 6 Stages – Tai Yang, Yang Ming, Shao Yang, Tai Yin, Shao Yin, Jue Yin The 4 Levels – Wei, Qi, Ying, Blood 3 Jiao (Burners) – upper, middle, and lower Jiao The Meridians Causes of disease – can be internal or external factors External factors – pathogens that attack the body from the outside (ex. diet, drugs, alcohol) Internal factors – often from stress and emotional problems that can damage individual organ systems leading to lack of functioning The 8 Principles: diagnostic framework to assess and categorize a patient’s condition; divided into four pairs with two opposing principles Exterior and interior Exterior Comprises skin, muscles and channels – including the space between skin and muscles where Wei Qi and sweat are located (area where invasion by external pathogenic factors enter first) Patterns aversion to cold, fever, aching body, stiff neck and a floating pulse Interior Internal organs – may have arisen from an exterior pathogenic factor but once considered interior once penetrated Patterns internal organ patterns Heat and cold Heat – feeling hot, fever, sweating, thirst Empty vs. full-heat – dependent on if it is a manifestation of excess Yang or if Yang is relatively in excess Cold – feeling cold, cold limbs, absence of thirst Empty vs. full-cold – depends on Yin, if it is in excess or relative excess of Yang Excess and deficiency Excess Characterized by the presence of a pathogenic factor while Upright Qi is relatively intact and actively fighting against the pathogenic factor Pain – worse with pressure or pain that is acute in onset Irritability, restlessness Strong voice Deficiency Characterized by emptiness of the Upright Qi and the absence of a pathogenic factor Empty Qi pale face, weak voice, slight sweating, slight shortness of breath, fatigue, loose stools, poor appetite Empty Yang bright pale face, cold limbs, absence of thirst, desire for hot drinks, frequent pale urination Empty Yin heat in the afternoon, dry throat at night, night sweats Empty Blood dull-pale face, pale lips, dry hair, blurred vision, tiredness, poor memory, insomnia, scanty periods 6 Pathogenic Factors Wind Yang in nature Used as source for other factors to enter; moves around, arises quickly and changes rapidly Lungs are affected first; liver affected for internal wind Causes tremors or convulsions, stiffness/rigidity of muscles, paralysis, pain that moves from joint to joint Wind Cold DDX Aversion to cold/wind Sneezing, chills, coughing and runny nose with white discharge Body stiffness and aches Pulses – maybe floating; tongue – no change from normal Wind Heat DDX Aversion to heat/wind Fever, sneezing, cough with yellow discharge and runny nose with yellow mucus, itchy/sore throat, swollen tonsils, red back of throat Pulses – maybe superficial; tongue – no change from normal Internal wind Tremors, tics, itchy Severe dizziness, vertigo, cases of convulsions, unconsciousness, hemiplegia Deviation of mouth/tongue Cold Injures Yang Contracts and congeals Causes clear discharge Sleepiness, severe localized pain improved by heat, craves warmth, aversion to cold and feels cold, pale complexion, lack of thirst, loose stool Pulse – slow; tongue – white coating/bluish/purple Day or night Heat Yang in nature; potential to generate Wind when severe Blazes upwards Drying, high fever, desires cold, aversion to heat, heat sensation, redness Constipation or foul-smelling diarrhea May cause bleeding – cough, vomit, nose, gums, urine, stool, skin Scanty/dark yellow urine Affects the mind, restlessness, irritability Rapid anything – pulse/breathing rate; tongue – yellow coating or red tongue body Dampness Excess of Yin From damp environments, lack of movement Sticky and difficult to get rid of; heavy and slow Feeling of heaviness, pain, swollen, oozing No appetite, bloating, made worse with food Cloudiness of discharges Pulse – slippery; tongue – sticky coat and/or fat, swollen tongue Dryness Internal dryness is a form of Yin deficiency without heat signs or symptoms From very dry and/or hot weather, internal heat, dry warming foods/herbs, lack of fluid intake, not enough fruits/veggies, salty processed food Symptoms are dry Summer heat Yang in nature; only in summer and usually 1st aid situations Heat stroke, combination of heat and damp Aversion to heat, sweating, headache, thirst (none if severe), feeling of heaviness, dry lips, scanty dark urine, irritability, delirium, slurred speech and unconsciousness Pulse – rapid; tongue – red on sides and tip Pathogenic factor on the tongue Cold – white coating, bluish-purple Heat – yellow coat, red tongue Wind – quiver, stiffness, and deviation of tongue Damp – very wet tongue Dry – very dry tongue Vital substance on the tongue Blood deficiency => pale tongue Blood stasis => dark red to purple