Development of TCM Internal Medicine

Development of TCM Internal Medicine

Throat disease Character of Throat disease: -- Acute diseases more than chronic diseases -- Heat diseases more than cold diseases -- Excess diseases more than deficient diseases Organs Related: Lung & Stomach are most related Kidney: kidney Yin def. def. fire attack the throat Kidney Qi def. low voice Heart: Heart in charge of the voice Heart fire sore throat Liver: especially for chronic throat disease Spleen: nourish the Qi & blood Etiology & Pathology 1. Exterior evil poison (wind-heat or wind-cold) attack throat 2. Spleen & Stomach excess heat or fire 3. Damp-heat attacking throat

4. Fire toxin ( Excess or Def. fire) 5. Lung Yin def. or lung dryness 6. Liver Qi Stag. : Mei He Qi 7. Kidney def. fire 8. Phlegm or blood stasis 9. Over talking or crying Diagnosis 1. Inquiring: pain location; pain time; degree of the pain; character of the pain Chronic or Acute diseases. : with fever or not Caused by other diseases: swollen condition: voice changing condition: living enviroment medical history

2. Observation: spirit status Face color throat color: swollen: erosion or ulcer Deep red Fire Toxin: with white pus spot Epidemic disease: red & purple color Over eating hot spicy food: red as mirror Slight red Deficient disease: slight red or dark red

Kidney Yin def. : dark red & moisten Red without swollen Wind : Wind-cold Dry Qi & Yin def. Treating method 1. Internal medicine: Release the exterior pathogen Clear fire toxin transform the phlegm

Invigorate the blood Strengthen the Spleen Tonify the deficiency 2. Externally applied Medicine: bloating the powder direct to the throat gargle externally applied: needles Common herbs for throat diseases 1. Disperse external wind & release exterior herbs 2. Clear fire toxin herbs 3. Clear interior heat drain fire herbs 4. Nourish Yin clear def. heat herbs 5. Transform phlegm & clear heat herbs External applied herbs

Bing Pian; Zhu Sha; Peng Sha; Qing Dai; Bai Fan (6 major herbs used in throat diseases) Neurosis disease ( Throat ) Mei He Qi ( Neurosis 1. A psychological or behavioral disorder in which anxiety is the primary characteristic; defense mechanisms or any phobias are the adjustive techniques that a person learns to cope with this underlying anxiety. In contrast to the psychoses, people with a neurosis do not exhibit gross distortion of reality or gross disorganization of personality but in severe cases, those affected may be as disabled as those with a psychosis. 2. A functional nervous disease, or one in which there is no evident lesion. 3. A peculiar state of tension or irritability of the nervous system; any form of nervousness.

Syn: neurotic disorder 1. Qi Stag. type Main Sym: blocked feeling in the throat Concurrent sym: no pain, oppressed feeling in the chest sometime, good appetite, no phlegm, only feel the sym, after hard working or after emotional changing. Tongue: thin white coating Pulse: slightly wiry Treatment principle: Promote the Qi circulation Formula Yue Ju Wan ( Cang Zhu, Xiang Fu, Chuan Xiong, Shen Qu, Zhi Zi ) 2. Qi & stag. With phlegm rebellion Main Sym: blocked feeling in the throat, with phlegm Concurrent sym: first feel the uncomfortable in the throat, after coughing out the phlegm, patient feel comfortable. Oppressed feeling in the chest, coughing or vomiting phlegm in severe case

tongue: thick greasy white coating Pulse: wiry & slippery Treatment: moving qi & resolve phlegm Formular: Ban Xia Hou Pu Tang + Chai Hu Shu Gan San 3. Liver Qi Stag. Main Sym: blocked feeling in the throat, with emotional changing history Concurrent sym: easy to lose temper, rib sides distention, prefer sighing all the time, tireness, bad appetite, headache, dizziness tongue: white coating Pulse: wiry Treatment: smooth the liver Qi Formular: Xiao Yao San or Dan Zhi Xiao Yao San 4. Yin def. fever Main Sym: blocked feeling in the throat

Concurrent sym: irritability, insomnia, dizziness, sore lower back, weak knee, dry throat, uncomfortable feeling in rib area tongue: red body with less coating Pulse: wiry & fine Treatment: Nourish Yin Formular: Yi Guan Jian + Xiao Yao San pharyngitis Chronic pharyngitis, a chronic inflammation of the pharyngeal mucous membrane and submucous lymphoid tissues, is often caused by unsatisfactory treatment of acute pharyngitis or repeated occurrences of upper respiratory tract infection and it is related to high-dust environment. Clinically it manifests itself as --Itching --dryness --soreness of the throat --cough

--a feeling of foreign body or obstruction in the throat. In TCM it belongs to the category of "hou bi," or inflammation of throat. 1. Dryness of the Lung due to Yin-Deficiency Main Sym: dryness, slight pain or a sensation of burning heat or foreign body in the throat Concurrent sym: Congestion, diffuse dark redness and dilatation of micrangium of the pharyngeal mucous membranes and thickening of the lateral pharyngeal bands may be present, accompanied with itching of the throat, cough with little sputum, fidgets due to deficiency and dreaminess. Tongue: red body with less coating Pulse: thready & rapid Treatment principle: Nourishing yin, moistening dryness and purging pathogenic fire to relieve sore throat. Formula : Formula:

Sha Shen 12 Mai Dong 12 Shen Di 20 Dan Pi 10, Chuan Bei Mu 9 Bai Shao 10 Bo He 6 Lu E Mei 6 Gan Cao 6 Modifications: dry throat -- Shi Hu; Bai He

sore lower back, insomnia -- Yi Zhi Ren; Gou Ji; Wu Wei Zi, Huai Xiao Mai sticky white secretion on the wall of the throat -- Tian Hua Feng, Lu Gen, Gou Qi Zi cough -- Qian Hu; Pi Pa Ye; Xin Ren; Xuan Shen Dry stools -- Huo Ma Ren; Quan Gua Lou Bai He Gu Jin Tang; Yang Yin Qin Fei Tang; Zhi Bai Di Huang Wan, Yi Guan Jian 2. Stasis of Qi and Stagnation of Phlegm Main Sym: a sensation of obstruction or foreign body in the throat, often wants to "hang ka" (make a "hang ka" sound of cough) and feels nausea when getting up in the morning. Concurrent sym: He may have hyperplasis of lymphoid follicles in the retropharyngeal wall and thickening of the lateral pharyngeal bands, accompanied

with chest distress. Tongue: dark red with yellow fur Pulse: thready and slippery Treatment principle: Promoting circulation of qi, alleviating mental distress and reducing phlegm to resolve masses. Formula: Chai hu 9 Zhi Ke 9 Lu E Mei 6 She Gan 4.5 Gan Cao 6 Gan Song 9

Bai shao 9 Bo he 6 Jie Gen 4.5 Modifications: cough with profuse sputum -- Zi Wan, Zhe Bei Mu; Gua Lou Pi rib area pain or distention -- Dang Gui; Tao Ren; Dan Shen; Yu Jin reddish & sore throat -- Chi Shao; Niu Xi food stag. -- shen qu; ji nei jin Other formula: Chai Hu Shu Gan San; Xiao Yao San; Si Ni San; Ban Xia Hou Pu Tang;

3. Blood Stasis Main Sym: dry & sore throat with burning sensation or blocked feeling but with no difficult to swollen Concurrent sym: He may have hyperplasis of lymphoid follicles in the retropharyngeal wall and thickening of the lateral pharyngeal bands, dark red color Tongue: purple body color with spots Pulse: deep & acerbity Treatment principle: Formula : moving blood & resolveing blood stasis & benefit throat Dang gui 12 Formula: Shen di 12 Tao ren 15 Chuan

shan jia 9 Jiang chan 9 Chuan xiong 10 Jie gen 6 Chai hu 6 Chi shao 12 Dan pi 10 Modifications: headache or dizziness -- Shi Jue Ming; Zhen Zhu Mu sore throat -- jin yin hua; Xuan Shen

constipation -- da Huang; Quan Gua Lou sore & reddish throat -- Sang Lin, E Zhu dry throat -- Bai Mao Gen; Lu Gen; Xuan Shen Other formula: Xue Fu Zhu Yu Tang; Tao Hong Si Wu Tang; Bu Yang Huan Wu Tang; tonsillitis Tonsillitis is an infection of the tonsils and will often, but not necessarily, cause a sore throat and fever. There are 3 main types of tonsillitis: acute, subacute and chronic. Acute tonsillitis can either be bacterial or viral in origin. Subacute tonsillitis is caused by the bacterium Actinomyces. Chronic tonsillitis, which can last for long periods if not treated, is mostly caused by bacterial infection.

Acute type Pathogenesis: 1.External pathogenic factors attacking 2.Lung or Stomach heat 3.Liver Qi stagnation 4.Phlegm-dampness 5.Weak body constitution Diagnosis: Seasons: frequent occurred in Spring & winter Ages: 10-40 years 1. Wind-heat type Main Sym: swollen tonsils on one or both sides; Concurrent sym: hot sensation; swollen difficulty; with high fever; slightly aversion to cold or not; cough with phlegm; headache; whole body ache; Tongue: red body with thin yellow coating Pulse: floating & rapid Treatment principle:

--release the exterior wind heat -- Clear fire toxin & benefit the throat Formula: Qing Yan Tou Biao Fang JingJie 9g Bo He 9g(add later) Lian Qiao 9g Jing Yin Hua 15-30g Shan Dou Gen9g

Sheng Shi Gao 15-30g Niu Pang Zi 9g Jie Gen 6g Gan Cao 6g Peng Sha 1.5g Modifications: With excessive heat toxin -- Da Qing Ye; Ban Lan Gen with excessive Lung & stomach heat -- Huang Qin; Sang Bai Pi Dry mouth:

-- Flesh Lu Gen; Shi Hu Headache: -- Ju Hua; bai Zhi Severe cough -- qian Hu; xing Ren; Sang Bai Pi Pyosis: -- Zao Jiao Ci; Jie Gen Zhe Bei Mu 9g 2. Excessive Lung & Stomach Heat Main Sym: swollen tonsils on one or both sides; Concurrent sym: high fever; thirsty; coughing with yellow sticky phlegm; constipation; scanty dark urine; In severe case, could combine with difficult breathing. tongue: red body with thick yellow coating Pulse: big & rapid Treatment principle: -- Clear fire toxin & benefit the throat

-- promote bowl movement San Huang Liang Ge San Formula: Huang Qin 9g Huang Lian 6g Da Huang 6-15g Shan Zhi Zi 9-15g JingYinHua 15-30g

Shi Gao 15-30g Da Qin Ye 9-15g Lian Qiao 9g Xuan Shen 9g Chuan Bei Mu 9g Mang Xiao 6-9g Bo He

6g Jie Gen 6g Gan Cao6g Modifications: With excessive heat toxin -- Ling Yang Jiao; tu Niu Xi; Scanty dark urine -- Mu Tong; Dan Zhu Ye Severe cough with yellow sticky phlegm -- Tian Zhu Huang; Fu Ling Thirsty -- Tian Hua Feng; Mai Dong Chronic type Pathogenesis: 1.Remaining fire toxin 2.Liver Qi stagnation

3.Yin def. fire 4.Weak body constitution Diagnosis: Seasons: Could occurred in 4 seasons Ages: Female or adults Frequent occurred 1. Lung Yin def. Main Sym: frequent occurred uncomfortable throat ; Concurrent sym: dry or sore throat; slightly pain; dry cough; tidal fever; night sweating; five palms hot sensation; fatigue; dry mouth; bad mouth smelling tongue: red body with less coating Pulse: fine & rapid Treatment principle: -- Nourish lung Yin & clear def. heat -- Generate the fluids & benefit throat For Sheng Di

mula: Huang 30g Yan Yin Qing Fei Tang Mai Dong 18g Bai Shao 12g Bo He 8g add later Chuan Bei Mu 12g Modifications: With excessive heat toxin -- Xuan Shen tu Niu Xi; Jin yin Hua itchy & sore throat

-- she Gan; Zhi Pi Pa Ye Dry stools: -- Quan Gua Lou; Huo Ma Ren; Tidal fever & night sweats -- Bai Wei; Di Gu Pi Heart fire: -- Huang Lian; DanZhu Ye Xuan Shen 24g Mu Dan Pi 12g 2. Kidney Yin def. Main Sym: frequent occurred tonsils inflamation; Concurrent sym: chronic diseases; sore & uncomfortable throat; dizziness; tinnitus; dry mouth;sore & weak lower back; night sweats; insomnia; fatigue tongue: red body with less coating

Pulse: fine & weak Treatment principle: -- Nourish Kidney Yin & clear def. heat Formula: Liu Wei Di Huang Wan Case History 1 1. Male 45 years First visiting: Main complain: Nasopharyngenl Carcinoma NPC patient had suffered from chronic pharyngitis for years, and patient just finished the chemical threapy for the cancer, no stuff nose, no blood secretion, only feel dry throat , even drinking water cant resolve the dry feeling; pain throat sometime; tire four limbs, bad appetite Tongue: slightly greasy coating Pulse: thready & weak TCM diagnose: Qi & Yin Def. Empty fire rising up Treatment protocol:

-- Tonify Spleen & Qi -- Nourish Yin & clear empty fire Formula: Tai Zi Shen 10; Mai Dong 10; Wu Wei Zi 10; Shan Yao 10; Bai Bian Dou 10; Wu Mei 10; Xuan Shen 10; Shi Hu 10; Gan Cao 3 Case History 3 1. Male 9 years First visiting: Main complain: allergic rhinitis 4 y symptoms occurred every time, when patient catched little cold; stuffed nose; feel headache in severe case; even had profuse secretion in normal time and with yellow & white color; easy sweating during the whole year; Tongue: thin white coating Pulse: even TCM diagnose: Qi def. Treatment protocol: -- Tonify the defensive Qi

Formula: Ru Dou Yi 10; Huang Qi 10; Fang Feng 6; Gan Di Long 10; Xu Chang Qin 10; Wu Mei 10; Bai Zhu 6; Shi Liu Pi 10; Chan Yi 3; Xing Yi Hua 6 X7

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