6.20.1 What is thc Hiccup?
Hiccup is a morbid state characterized by uncontrolled, frequent and short sound coming from thnaat caused by the adverse rising Qi,
6. 20.2 What are the characteristics of deficiency, excess, cold, heat syndromes of hiccup?
Continuous, loud and strong sound of hiccup at the beginni rig of a disease usually belongs to excess syndrome. Intermittent, low and weak und oi hiccup mostly belongs to deficiency syndrome. The condition of hiccup aggravated by coldness and alleviated by warmth, manifested as cold feeling over the epigastrium and whitish fur on the (ongue, usuaLly belongs w cold syndrome. The case with symptoms of halitosis, polydipsia, costipation, red tongue with yellowish fur usually belongs to heat syndrome.
6-20. 3 How many common types are there in the excess-syndrome of hiccup? I-Tow do you differentiate and treat them?
(1) Retention of cold in the stomach
[Main points of differentiation] Deep, slow and strong sound of hiccup which can be alleviaTed by warmth and aggravated by coldness
[Treatment] Expelling cold by warming middle-Jiao smoothing hiccup hy lowering the advetse-rising Qi.
[Redpe] Ding Xiang San
(2)Rising up of stomach-fire
[Main points of differentiation] Snomus sound of hiccup, halitosis, polydispia, deep-coloured urine, costipation.
[Trcatrnent] Clearing away stomach-fire, lowering adverse- rising Qi to stop hiccup.
[Recipe] Zhu Ye Shi Gao with Calyx kaki. Caulis Barnbusae in Taenian.
(3)Stagnation of Qi
[Mairi points of differentiation] Continuous sound of hiccup which is often induced and aggravated by emotional upset.
[Treatment] Lowering the adverse-rising Qi, regulating the stomach to stop hiccup.
[Recipe] Wu Mo Yin Zi
6. 20 .4 Acupuncture Treatment
Select points mainly from the Ren, Hand-Jueyin and FootYangnting meridian. The reducing and reinforcing method of needling are chosen to used according to different syndromes. Moxihustion is used to warm Yang when it is a cold syndrome (both excess and deficient); needling is used to clear heat and regulate Qi when it is beat and qi stagnation syndrome.
Zhongwan, Neiguan, Zusanli. Geshu
[Modifications with various syndromes]
Cold in the stomach: Moxibust ion on Lzangrnen.
Heat in the stomach Neiting.
Liver Qi afflicting the stomach: Qimen , Taichong.
Deficiency of spiecn and stomach Yang: Moxibustion on Qihai
Deficiency of stomach Yin Taii-i with reinforirig mcthcd.
6 21 How should you distinguish the cold, heat, excess and deficiency types of diarrhea clinically?
Cold type: Loose stool with indigest.ed load, chilliness, cold feeling in abdomen, abdominal pain with a preference for warmth.
Heal type.: Yellow-brown colour stool with offensive odour, hurried diarrhea burning feeling in the anus.
Excess type: Acute onset of loose stool, abrupt abdominal pain with refusal of pressing, pain alleviated after diarrhea.
Deficiency type: Prolonged course, less limes of diarrhea, dull pain in the abdomen with a preference for pressure.
6.21.2 How many types is diarrhea classified into? What are the key points of differentiation ,therapeutic principles and recipes of each type?
(1)Cold-dampness blocking the spleen
[Main points of differentiation] Thin and loose stool, abdominal pain with borborygmus.
[Treatment] Ehminating dFimpriess with drugs of fragrant flavour 1 expelling cold evil to relieve superficies syndrorne
[Recipe] Huo Xiang Zheng Qi San
(2) Accumulation of danLprless-heat
[Main poirns of differentiation] Hurried discharge of yellow- brown fetid loose stools, burning sensation of the anus ye1lowsh and greasy fur, rapid pulse.
[Treatment] Clearing away heat and promoting diuresis. [Recipe] Ge Gen Qin Lian Tang
(3) Retention of food in stomach and intestines
[Main points of differentiation] Stool with the smell of rotten eggs, eructation with acid and fetid odour, loss of appetite, thick and greasy fur, slippery pulse.
[Treatment] Promoting digestion to relieve dyspepsia.
[Recipe] Bao He Wan
(4)Hyperactive liver-attacking the spleen
Muin points of clifferentiation]The occurrence of diarrhea is related to emotional changes, especially depression and anger. Feeling of distension in the hypochondria, wiry pulse.
[Treatment] Checking hyperf unction of the liver and strengthening the spleen.
(5) Insufficiency of the spteen and stonmeb
[Main points of differentiation] Sometimes loose stool and somaimes diarrhea, sailow complexion, lassitude, prolonged course.
[Treaunet] Invigoratrng the spleen and benefiting the stomach.
[Recipe] Shen Ling Bai Zhu San
(6)Deficiency of kidney-Yang
[Main pxnnts of differentiation] Morning diarrhea (cock-crowing diarrhea ) , intolerence of cold, soreness 0f loins, deep and thready pulse
[Treatrnent] Wanning the kidney and invigorating the spleen stopping diarrhta with asningent method.
[Recipe] Si Shen, Wan
6.21 3 Acupuncture Treatment
(I) Acute diarrhea
Select points from the Yangining meridians and use the reducing method of needling. Moxibustion can be added in a case of cold, but in a case of heat, pricking to cause bleeding is applicable.
Tianshu, Hegu, Yinlingquau, Shangjuan and xiajuxu
(2) Chronic diarrhea
Select points niainly from the Ren Foot-Yangrning meridians and back Shu points as main points. The reinforcing nerhod or even of needling s used and moxibustion can be added.
Zitungwan, Tianshu and Zusanli
[Modfication with various syndromes]
Spleen deficiency: Pishu, Gaanyuanshu;
verdepression: Ganshu Taichong;
Kidney deficiency: Shenshu and mingmen.
6. 22.1 What is dysentery? How many types is it classified into?
Dysentery is a inrestnal infectious disease with frequent discharge of mucous and bloody stool, abdornnal pain, tenesrnus as main symptoms and commonly seen in summer and autumn.
There are six types: Dampness-heat dysentery, lulminant dysentery, cold-dampness dysentery, yin-deficiency dysentery, deficiency-colci dysentery arid recurrent dysentery.
6. 22.2 Hov do you dfferenuia1 treat dampness-heat dysentery and recurrent dysentery?
[Main points of differentiation] Burning sensation in The anus, oliguria with deep-coloured urine.
[Treatment] Clearing away heat and relieving accumujadon, regulation qi and promoting the circulation of blood.
[Recipe] Shao Yao lung
(2) Recurrent dysentery
[Main points of differentiation] Dysentery with a chronic course and a tendency of relapsc.
[Treatrnern] Warming the middle-jiao and clearing away the pathogens in the interestines, regulating Qi and relieving stngnation,
[Recipe] Lian Li Tang with modification
6. 22 3 Try to describe the pathogenic characteristics, clinical manifestations and therapeutic method of Iuhninant dysentery.
[Syrnpwrns] Sudden onset, high fever, thirst, headache, irritability, intense abdominal pain, even coma and convujsion, frequent
discharge of bright, purplish, bloody and purulent stool, tenesmus which is more severe than that in dampness-heat type, crmin tongue with yellowish and dry fur, slippery and rapid pulse.
[Main points of differentiation] Sudden onset, high fever, irritabi ity. serious patients have svniptorns of sense, abdominal pain, severe tenesmus.
[Preatrnent] Clearing away heat pathogen and cooling blood, removing toxic? material and elirninating stagnation.
[Recipe] Bai Tou Weng Tang
6.22.4 Acupuncture Treaiinent
Select points mainly from the Yangrning meridians, and use the reducing met liixl of ncedling.
Hegu, Tianshu and Shangjuxu
[Modification with various syndromes]
Damp-hent dysentery: Quchi , Neiting:
Cold-damp dysentery: Zhongwan, Qihai;
Epidemic toxic dysentery: Pricking Iiazhui and Shixuan ?to cause bleeding;
Appetlte- prohibiting dysentery; Zhongwan, Neiguan and Neitzng
Intermittent dysentery: Pishu Weishu, Guanyuan, and Shenshu.
6. 23 Try to describe the etiology arid pathogenesis of constipation
(1) Accumulation of dryness-hear in stomach and intestines di!licuhy in defecation due to the failure of distributing and going down of body fluid caused by the accumulation of dryness-heat in stomach and intestines which results from exuberant Yang, or indulgence in drinking, or overeating of greasy and pungent food; or by tetention of dryness-heat in intestines resulting from the consumpalion of body fluid after febrile diseases.
(2) Stagnation of Qi Constipation due to residue staying inside instead of going dowr] whiˇ§1h is caused by the stagnation of Qi, and the functional disorder of stomach and intestines in digestion, descent n ii transport result i ng f ron me 1 arichol y and worry, or from lack of movement during prolonged sitting.
(3) Deficiency of Qi and blood Deficiency of Qi and blood often results from overstrain, or illness or senility. The deficiency of Qi can cause the dysfunction of the intestines in transport, while that of blood and body fluid can cause failure in moistening the intestines. Thus follows the difficulty in dcfacation.
(4) Accumulation of Yin -cold difficulty in defecation due to the accumulation of Yin -cold caused by the deficiency of genuine-Yang (kidney- Yang) and the dysfunction of the kidney resulting from weakness, or senility.
2.23. 2 I-low do you use purganve therapy correctly for treating constipat ion?
Purgation should be used as the main method for treating constipation, but purgatives can not be used singly, It should be used togedier with oiher drugs which are chosen according to the paihogenesis. The treatment of excess-syndrome should be aimed at clearing away heat and nourishing the irnestines, promoting the circulation ofQi and dispersing stagnation; the treatment of deficiency-syndrome should be aimed at ton ifying Qi and nourishing blond, eliminating constipation by using some warm-natured purgatives.
6.23.3 How many types is the constipation commonly classified into? What are the key points of differentiation, therapeutic principles and recipes for each type?
[Main points of differentiation] Dry stool, fever, deep-coloured urine, distending pain in the abdomen.
[Treatment] Clearing away heat and moisturizing intestines.
[Recipe] Ma Zi Ren Wan
Stagnation of Qi
[Main points of differentiation] Dry and hard stool, desire for defecation but nothing defecated, frequent belching, feeling of fullness arid oppression over the chest and hvpochndria.
[Treatment] Promoting the circulation of Qi and dispersing stagnation.
[Recipe] Liu Mo Tang
[Main points of differentiation] Defecating with great efforts, sweating, shortness of breath, fatigue, timidness, fecblc pulse.
[Treatment] Tonifying Qi and moisturizing the intestines. [Recipe] Huang Qi Tang
[Main points of differentiation] Dry and hard stool, pale cornplexion, pale tongue and lips, thready pulse.
[Treatrnerit] Moisturizing dryness by nourishing blood.
[Recipe] Run Chang Wan
[Main points of differentiation] Difficulty in defecation, cold pain of abdomen, cold extremities -
[Treatment] Wamiing Yang and relaxing bowels.
[Recipe] Ji Chuan jian
6.24 Parasitic Syndrome
6. 24. 1 What are the clinical manifestations when roundworrns stay in intestines?
[Symptoms] Intermittent abdominal pain around the anvel, gastric upset, even vomiting Or defecating of roundworrns, abdominal mass caused by roundworrns; in severe case, manifested as poor appetite, sallow complexion, emaciation, tchng in the nostril, teeth grinding and salivation during sleep.
[Treatment] Expelling or calming rounciworms, invigorating spleen and regulating stomach.
[Recipe] Hua chong Wan, Wu Mei Wan