Alon-Marcus-Acute-Abdominal-Syndromes (1).pdf

Acute Abdominal Sydromes Their Dagnoss & Tatment Accodg to Combnd Chins-Wsten Mdcine

by Aon Marcus, OMD

Acute Abdominal Syndromes Their Diagnosis & Treatmet Accoding to Combined Chnese-Wester Medicie

Aon Marcus, OMD

Blue Poppy

Press

Pubihed by: BUE PPPY PRESS 1775 DE V BUDE  8004 FRST EDT VMBER 1991 SB 0-961857 ira of ongress ataog # 9077707 PYGHT o BUE PPPY PESS A rights reseed o pat of thi book ay be epoduced

toed in a etieva yte o tancibe in any o  by any ean eectonic echanic a photocopy ecodin o  any othe en ithout the pio itten peiion of the pubihe Pinted at Wetvie Pe Boude CO i book i pited on achive quaity acid fee eced pape wth oy baed ink

vt eiher he auhor or pubiher reoed or ed ore ef reae by aypero y reader wihig o avai he eve o f he re ae derib ed i hi book  houd oy eek profeioa reae fro quaied praiioer of Tradiioa Chiee Mediie M . I addiio hey houd uderad ha uh reae doe o eude iuaeou reae by oe Weer   ero eperieig aue abdoia pai houd reeive a diagoi by a Weer MD. Thi book i ea a a ii aua for profeioa praiioer of TCM I i o a ebook for begier Oy hoe profeioay raiedThe i CM aep oake ueo he prooo oaied herei auhorhoud ad pubiher repoibiiy for he effa of ay prooo or preripio iude d i hi book Profeioa praiioe r u e he appropriaee of ay prooo or forua give i uh a book i er of eah idivdua paie diee odiio ig ad ypo ad preribe or odi ha prooo acordigy T he forua  ad prooo giv e i hi bo ok are o ea  o be appied by roe bu are ea oy  eape ad guide whe foruaig idividuaized reae pa acordig o he ee of

TCM.

Forword   F Aute abdonal yndroe nlude a nuber of panl ondt on nvoln the abdoen and t ontent In th book Aon Maru due the obned ChneeWete edal dano and treatent of a nuber of thee nludn  pept uler appendt pertont holett holetha bary aara ntetna obtruton and ntetna adhe on. In the eople' Republ of Chna today  zhon  y or obned Chnee-Wetern edne refer to the ue of odern Wetern deae dano pathophyooy tan and treatent n tande wth TCM pattern dano and tradtonal oneatve Chnee treatent uh a herbal edne and aupunture  obned ue of the bet of both modern We tern and tradtonal Ch nee ed ne how reat proe and epeally n thoe deae reurn the ore hero treatent for whh odern Wetern edne  o faou There are two broad ntane t ee to e where the ue of uh hero therapy  warranted Fr n the treatent of uh deepeated hron proreve and fe-threatenn deae a aner. Blue opy re ha already publhed a book on t ubet han Dazhao he retment of ner wth Interted hneeWete Mednee eond ntane where I beleve the nterated ue of Chnee and Wetern edne  alo aed for  n the treaten of aute proreve and fethreatenn deae uh a the aute

  s

abdona yndoe dued n th book Beaue thee ondton ay eut n death f danoed and anaed wt and opeenve teatent  all the oe neeay In patula uh ondton often eque uey to effet tely fe-avn teatent On the othe and Weten pattone of altenatve edne ae quk to pont out that hee n the Wet at eat ue  eoted to fa too oten. Th  beaue Weten  oten eot to uey too oon n the oue and poeon of deae. Rate tan ben a odalty of lat eot t  ued a the tandad theapy fo uh ondton a appendt and holelta. n th book D Mau debe the atona nteaton of oneatve tadtonal Chnee t eatent  wth o e oneatve Weten teatent He then oe on to debe the tan and poeon of thee deae fo both a M and oden Weten pont of vew o that one an detene when n fat ual nteenton  waanted and ndeed neea The obned potool D Mau ve ae deved fo tanlaton of Chnee oue and h lnal obeaton n hoptal n te eope Republ of Chna. Muh needle uey ht be avoded f u onevatve potool a D Mau debe wee moe wdely avalable and pated n the Wet Suey  fauht wt neent dane ee ae te dane of anetea te dane of potual nfeton the dane of blood lo and the dane of pot-ual weakne ndeton and eupeaton. thou ue  a eat lfeavn tehnque nevet hee  t houd not be eoted to htly Wheneve any phya adnte any teatent one ut alway weht e eet ve the k. If two teatent both affet the ae benet bu one doe o wth edued k the that houd e the theapy of ft oe. No one an deny tat 

Frewd

uey  a  k teapy ompaed to ntenally admnteed Cnee ebal medne. In t book D Mau peent tep by tep potool aodn to te Weten tan of thee vaou deae leadn up to and ulmnatn when abolutey neeay n ual nt eenton  y un ebal an d aupuntue teapy baed on C patten dmnaton dano and oneatve Wete n medaton u teatment  wtout the dane and al too feuent de effet of moe eo Weten theapy Su ombned oneatve theapy ao addee and attempt to ede te undelyn o fundamental dyaa aun the patholoy That mean tat uh teapy  not ut pallatve but potentally adally uatve. Aodn to C teoy ual nteenton may ee te te of ome tal patoloy but t doe not neeay abot te pathophyooal poe Teefoe all too oen u deae poee ontnue to aue patholoal hane n ome ote oan o t ue  Some of the potoo D. Mau debe nvolve ebal f omula wh ae unded and even touand of yea od Othe ae eatvely moden. ut a ave been teted n nal pate n hopta n the eope Repub o f Cna whee u nteat ed o ombned Chnee Weten teapy  wdely avaabe Atou a D Mau pont out aute abdomna yndome s ae bet teated n an npatent falty wt ae to moden Weten danot  tehnue and teatment modate I peonay an attet to C' abty to uefuly and nonually teat a numbe of AS a lon  te C teatment  ntated ealy enou In my twelve yea of pate I ave teated a numbe of ae of aute appendt both wth aupuntue and Cnee heb a numbe of ae of hoeyttoletha and eveal ae v

ce nl Sndres

of nephroltha and none of thee patent have had to have urery for thee ondton However when one attept to treat uh eerene outde a hoptal ettn, t  a very tene and nee-wrakn tuaton If the protol derbed n th book ould beoe ore wdely known and publzed n the Wet and f uh treatent ould be arred out n odern n-pat ent falte I aree wth Dr Maru th would be the bet pobe tuaton erefore we at Bl ue oppy re are pleaed to publh on Maru' book on the obned ChneeWetern edal treatent of aute abdomnal yndrome We hope th book wll aue Wetern prattoner of C to reeane ther poton reardn uh a ombned Chnee-Wetern edne. We are not talkn about yptoat uae of Chnee herb and forula approprated by Wetern medal prattoner untraned n C but treatent baed on profeonal C bn zhen dano At the ae te we alo hope prattoner of odern Wetern edne wll be ore open and reeptve to entern nto profeonal aoaton wth prattoner of C baed n part on uh ratonal and reponbe protool a derbed n th book.

v

Prc Ae oletn y eduaton at te Aean Collee of Tadtonal Cnese Medne n San Fanso n 194 I beae nteested n studyn te lts of C atulaly n te natent settn In 195 I ontnued y studes by ntenn at te uanzou Munal C Hostal n Canton, Cna wt te ead of te ntenal edne deatment, D an. Soon a e y aval, I uly ealzed ta t unle n te sA wee atents ome to us aleady danosed and seldom autely ll n Cna  was faed wt autely ll atents wee desons of a dffeent tye ad to be made Does te atent need adsson? Does e need suey? Is C o Westen edal nte venton oe aoate? Altou  I ae eae to ate C elusvely, my teaes wee u to o nt out te otane of also avn a Westen danoss In fat evey atent n ou ostal ad to ave bot a C as well as a Westen edal danoss In eatn ts new aae betwen te two systes, I saw one dane many of tese new C destons and danoses ae teoetal, and altou lnal evdene to suot tem s abundant, by natue of te ben new tey ave not endued te test of te. Teefoe, tey la te eal stent of Cnese edne I oe tat ove te tese teoes ove te effay Neveteless I esonally saw aute abdonal syndoes teated n an natent settn by nteatn Cnese and Westen medne suessfully In addton to onvesatons wt D Jan, u of te nfomaton esented n ts boo s based on a

e  Ses

onoeaton of oa tanaton of te book oned Methods for the retmnt of Aute Abdomn Syndromes n Y Medal Colee and Aute Abdomn Syndromes, Shana Collee of TCM, eople Health uble e  , and of te hoptal potool Te tanlaton  wee povded by D  Fan Yaohu uan awon and Se Mnn, to wo I a deeply ateful. Infoaton on Weten ed ne wa obtaned fo te Merk Mnu and Hson's npes of Inte Medne I would alo lke to thank D. Rta eey fo e edtn of te ona  anupt fo w t  book   baed, y wfe Rut oldenbe,  fo tean e oe about Wete edn e, y fate oep Ma u,  wo pent any ou tanbn y wok nto opute fo, y ote Ca Mau wo away beleved n e and enouaed e to puue y tude, and nally to Bob Faw fo vn e the oppotunty to hae th ateal wt ote

X

Contents Caveat iii Foreword v Preface ix Contents  Introduction 1

Section I Gn Concpt n t U o Cobnd CnWtn Mdcn n t Ttnt o Act Abdonl Syndo 1

troduction to S 

2

Z Y B Z TCM Patte Disimiatio 21

3

Combied Chiese-Wete Digosi Stage, Degee,  hate o Diease 31

4

Seleti  AAS atiets  mbie hiese Weste Teatmet 35

5

Z Y, Z F Teatmet iiples Teatmet Meths 39

6

st-Sgial Repeati  Teatmet 5

7

mlas  Exteal Appliati 

Section II T Dignoi  Tetnt o Spciic S by Cobind Cin-Wtn Mdicin 1

  K epti Ules  eatis 

2

hlelithiass D S B 83

3

D N Y hleystitis 99

4

D D  Biliay Asaiasis

5

Y  Y Ate aeatitis 

B

6

J   Acte Abdomil

7

L  Y Appedicitis 

dex 55

Z

29

Introduction Modern Wetern edne usually onder aute abdonal yndroe () to be sural ondton ot oen treated n npatent f ate However due t o the daner nherent n urery any prattoner of both odern Wetern edne and Tradtonal Chnee Medne (  n Chna are atteptn to prove upon the one atve treatent of thoe ase whh ay posby be ured wthout reoure to urery Beaue  ut be treated n an n-patent settn Wetern prattoner of C who prate so far olely on an out patent ba have evdened ttle nteret n th roup of dseae. kewe ttl e nfora ton on the r treaten t by C  avalable n Enlsh Neverthels t  portant for C prattoners to be auanted both theoretally and pratally wth th area of edne Athouh few C prattoners pratn n the Unted States oe aro these ondtons or attept to treat the a C beoe ore wdepread and reonzed C prattoner wll n fat be workn wthn varous ettn nludn n-patent falte where we wll ee uh patent. If we apre to the role and tatu of dotor albet dotor of C our knowlede ust be oplete and omenu rate wth that role.

  Snds

Te concept of specf dsease enttes s, peraps not as developed n C as t s n odern Western edne Altou C does ave and uses danostally te ateorzaton of bn or dseases, opared to odern Western edne, ts ateorza ton s less sp ecc Althou two dseases as las sfed by od ern Western edcne ay be classfed as only a snle dsease by Tradtonal Cnese Med ne, nevertheless, tere oen are portant d fferenes n te course treatent, and pronoss of suc dfferent Western dsease cateores For nstane, altou   and RA are all cateorzed as we zhen or aton ondtons n C eah of tese dseases as ts own natural story and eprcl response to certan treat ents and ed nals Terefore, t s portant n ts day and ae for  prattoners to be fully acqanted wt te Western ste of asscaton of sns and symptos and desrptons of te natura hstory and corse of Western dsease cateores Ts enabes one to better understand te any possble varetes of patoloy wtn a spe dsease entty ea of w requres spef treatent  In pursut of ts a odern Cnese pr acttoners ave developed wat tey all  zhn x y or cobned ChneseWestern edne Ts also soetes referred to n Cna as n y or New Medcne Ts s a conceptual fraework wtn wc knowlede fro bot C and Western edne are nterated n te descrpton and ateorzaton of patoloy as well as n te desrpton of staes of dsease dfferental danoss, and deternaton of treatent In soe nstanes su  a cobned teoretcal syste allows one to sply use ore onseatve, safer C terapes n plae of modern Western medne. In ote nstanes, t aows one to use ore onseatve Western therapes n tandem wth benn yet effetve C terapes nstead of ore heroc terapes fraht wt ore rsk of atrogeness In stll oter ases such a obnaton allows for 

r

the ue of C therape to treat or prevent the othee unavodable de effet of o uh of odern Wetern edne And n yet other ae the obnaton of C therapy and odern Wetern hero therapy uh a heothe rapy and radat on ak e that Weter n therapy even ore effetve n elnatn the patholoy than when that ae Wetern therapy  eployed alone Th  epeally portant n deae whh are reatrant to a treatent, uh a aner a nd for whh C alone  uually not effetve Aute abdonal ondton, uh a appendt, pept uler perforaton ntetnal obtruton and panreatt are both potentally lfethreatenn and autely panful Beaue a patent ay de fro one of thee ondton wthn a relatvely hort perod of te wft and hero therapy uh a Wetern urery  ofen aed for. And beaue even n C the toppn of pan althouh t  a bo o branh ypto,  ven preedene n treatent, the nterated ue of both odern Wetern and tradtonal Chnee edne  warranted



Section I

Gl    U         Au Al 

1 ntrodction to AAS Acute abdoina syndoes () incude a nube of conditions causing acute inta-abdoina pain Suc pain ay eanate fo te viscea esentey peitoneu and pevic ogans and ay be caused by inaation uceation vacua disodes and vaious ecanica pocesses suc as obstucion tosion and spastic contaction Tis book descibes e cobined ChineseWesen diagnosis and teatent of a nube of te ost coony encounteed  Tese incude peptic uces and pefoation coestitis, coeitiasis biiay ascaiasis intestina obstuction intestina adesions p anceatitis peitonitis and appendicit is

U o odrn Wtrn dical diagnoi The use of ode n Wesen  edica dagnoses in te cobined Cinese-Westen teatent of  is necessa to deteine patogenic factos stage of disease and te ocation and natue of te condition An eape of tis is te Westen diagnosis of pefoated gastic uce Suc a diagnosis gives te ocation (stoac) te natue of te condition (acute pefoatio n) and te stage of te pocess (suc as idde stage wit infecton)  A coect Westen diagnosis is essentia

e  Sdres

because te C signs and syptos aone ay not give a ceacut pictue and ay not be sufficient to ake a cinicay accuate diagnosis Tis can be vey dangeous Fo instance if a uptued aneuis wee considee d a peptic uce and teated tus, te esut coud be fata O, if a tuo o coonay eat disease pesenting wit abdoina pain wee isdiagnosed as a gastone, tis coud aso ead to  disastous consequences Theefoe, coect oden Westen diagnosis is essentia in cases of acute abdo ina syndoe 

Abdoin pn In ode n Westen edicine, abdoina pai n is divided into 3 categoies viscea, soatic, and efeed

Vsra pan Pain aising i n t e abdoina ogans enveoped by te viscea peitoneu and fet at te site of te piay esion o stiuation is caed viscea pain t is sua y du and acing pooy ocaied, and ay be associated wit efeed pain

Sat pan So atic pain i s defined as discofot aising in t e abdoina wa paticuay te paieta peitoneu, oot of te esenteies, and espiatoy diapag It is sape tan viscea pain and is usuay we ocaied to te site of te esion of stiution

frrd pan Refeed pa in is pe ceived at a site wic is dif feent fo te site of iitation o diseased viscus Howeve, it is peceived in 8

Inrduion  S

an aea which is suppied by the sae o adacent neual segent

Locton o pn eltve to pecc ogn Ogan sopagus

Aeas of peceived pa in Substenal casionally in te neck aw a o back

Stoach

Epigtiu occasionay et uppe quadant o back

Dodenal bulb

Epigastiu occasionally ight uppe quadant o back

Sall intestine

Peiubilical occasionally above the esion

ge intestine

Below the ubilicus on the side of the lesion

Spleen

Let uppe quadant

Rectosigoid

Supapubic egion

Rectu

Posteioy ove the sacu

Panceas

Epigastiu o back

ivegallbladde

Rigt uppe quadant ight shoulde and posteio cest

9

e nl Synres

Ipotnt css o bdonl pn ccodn to Wstn dcn I Pan orgnatng n t abdon  Paieta peitonea inaation

1 Bacteia containation, e, pefoated appedi pevic iaato dieae B. Mecanica obtuc tion of oow ogan e intetine toac biiay tact, uete) C Vacua ditbace   boi  toboe

2  Nonoccve teta iheia 3 Ruptue of abdoina aneui

4. Sicke ce aneia D Abdoina wa  Dito tio o tacti o of eetey

2 Taua o infection of ue 3 Ditent ion of vicea uface e ve o kidney)



  S

II  f rr d pan  Thoa

1  Pne ona

2 Coo na occson B Spine (ahiis) C. Genaia (osion of esices)

I Mtaboc causs  ogenos (posonng fo ead o ohe ons of

fo anas  bac wdowposonos spde be) B ndogenos 1 Ueia

2 Diabeic coa 3 Pophia

4 Aegc facos IV  Nu rog n c ca us s  Hepes zose

B Casaga



  

C Tabe doa D Funtona aue

Gn n  ypto o S  Acut gastonts A oexa, nauea, and votn  B Cap, due abdona pan C Daea  eve ad euoto ae oon

 Ac andcs A Epat o peuba pan, eventuay tn to te t ower quadant o te abdoen B Votn and anoexa C Contpaton  oon but darhea ay ou D Tenderne ue pa and rebound tenderne n the ht owe quadrant E ever uua y t to o deate F Modea te euoto wt neutopa



  

 Acut cocystts A Histoy of fatty food intoeance, atuence postpanda funess, and ght uppe quadant diofot B Steady and seee pain in the ight uppe quadant of epgastu C Tend eness, usce guading, and ebound tende ne ae coon; the gabad de ay be papabe D Anoeia nausea and oiting E ee and euyosis F Hypebiiubnea and biubnuia

V Ac vcus A owe abdoina pain especiay in the eft owe quadant B Tende ness,

ue

guadng,

and

eboun d

tendeness C ee ad euotoss D Constipaton  Nausea and d oiting

3

Ace Anl Syndres

F Te fndngs a sa o ose of acue aendcs bu ae on e ef sde

V Acut pancatts 

Coon n acoocs B. Coon n cases of coe ass C Pan s aabe ca egasc and adang o e back; a be acoaned b osaon, seang and sock D ausea and ong E Abdona dsenon and endeness F Eeaed aase ees G Hebubnea and ocacea a occu

VI Act  ntstna  ost c t n  Sos deend on e se and degee of

obsucon B. Ca abdona an C Vong oe coon   oa esons D Consaon and enua coee nab o ass gas E Heesass and bobogus



Inroduion o S

V Prorat vscus A. Mo coony poduced by pefoaion of gaic uce B Sudden one ofbyevee abdoina pain wic i aggavaed oveen C. Tenden e abdoina  igidity and eboun d endene D Abdoina dienion E Obieaion of epaic dune F Ai deonaed beow e diapag G Hypoenion ock

VIII Msntrc vasca nfatn A Congeive e a faiue a ia biaion o vicea ypopefuion B Modeae o evee abdoina pain C. Voiing D Boody diaea E Abdoina dienion endene and in evee cae abdoina igidiy F. Hypoenion ock

5

Ac A yns

I Acut sa pnt s A Lowe abdoina pain B Feve and cis C. Adnea ass D Histo of seua eposue E Vagina discage F. Gonococca infection Many patients with acute abdoina pan ae actuay patients with chonic and ecuing abdoina pain whee the n has been pesent in a id fo fo a ong tie Te wok-up of such patients ust be a te oe detaied and deibeate The patient soud be caefuy questioned about te ocation, intensity caacte and conoogy of the pain One shoud seac fo factos tat aggavate o aeviate te pain and caefuy assess a te signs and syptos which have appeaed Tei eationship to te tie of appeaance of the pain is ost ipotant Te foowing ae soe coon pain pattens

ptc uc Tee is epigastic pain descibed as a sensation of buning hunge o aching About 0 of the tie it occus 3 hous ate a ea and the patient ay be awakened in the idde of the night b y pain Most ofen it i s easiy and quicky eieved by te ingestion of food o antacids Howeve soe patients with

6

Inroduion o 

gatic uce ave inceaed pain foowing te ingeton of food Te pain i aot away epiodic ating fo day o week  and te n it i foowed by a pei od of eiion tat ay at fo ont

Bary tract sorrs The ajo ypto of biiay tact diode incude nauea voiting and pain in te epigatic egion o igt uppe quadant Te pain i contant and not coicky Potpandia fune euctation atuence and fatty food intoeance ae nonpecic and ae coony aociated wit any ote diode Pancratc sorrs The pain in tee diode i ocated in te epigatiu and ten d to boe d iecty tou g to t e back auea and voitin g ae coon Te pain i contant and ating and i aey coicky Pata eief ay be obtained by adopting a feta poition A itoy of ecent and eavy acoo ingetion o a pat itoy of bay dode ae gy uggetive of pain due to panceatic oigin

Intstna sorrs In cae of diode of te a intetine te pain i ocated in te peubiica egion Te pain i capy and ay be aociated wit nauea and voiting Tee i a cange in bowe abit If tee  poia mecanica intetina obtuction voiting occu eay in te coue If te obtuction i in te age intetine contipation and te inabiity to pa atu ae oe ikey



 n ynrs

Ita o syndo Hee pan i ay ocated in te ypogai o he et owe qa dan Ony aey doe it peent n he pei bica egion It ao aey awaken te patien fo te eep nke e pain in te above conditon Th pan ay be aggavaed by e ngeton of food and i ay eieved by te paage of at and by bowe oveent I ay be aociaed wt contipaon o wi atenang conipaon and diaea

Coon cancr bdona pan  coon n o whch ae poa o e god coon I  e feqen n cae o f eca neopa andbe eion of he god coon I ay aocaed whda ecenpoon chan geofn he bowe hab 

Mscanous causs 1 Conic divetcit

2. Inteitte nt o conc intena obtction 3 Tbeca peit oniti

4 Syeic dieae and intocaton ( connective e diode ead poioning diabete popyia and abe doa)  Panceac cance 6 Tcoona  of e gabad de



Inroduon o 

Tng o ttnt e tiing of teatent i a vey ipotant eeent in te coect cobined appoac to AS An eape of ti i te tiing of te teatent of peptic uce pefoation Duing te t fit ting to be and doneedce i to coe pefoation One tage hodtee acpnctue te te pee in te toac and intetine Ti i neceay in ode to iniize peitai and t o aow te qi and boo d to ecove and ea te pefoation On the othe and ding te idde tage of an uce pefoation (wic i efeed to a te antiinfection tage one ut de a wit poib e iitation of te peitone u and infection caued by te gtic uid wic ave enteed te abdoina cavity toug te pefoation At ti tie i t i appopiate to cea eat nd eove toin in ode to pevent infection na tage oud enance te epai poce oDuing tat tete toac wa one i etoed to it noa tate Anote eape invoving pope tiing i baed on undeta nding te poce of te condition Ti aow one to focu on te eevant apect at a paticua point in tie Fo intance in cae of coeitiai nepoitiai o intetina obtuction knowedge of te eact natue and tage of te patoogy peit te pactitione to concentate on the pope tiey ue of te u xe o attacking evi etod witout being ide-tacked by econday ign and ypto Undetanding te patoogy ao aid te pactitione in cooing te appopiate edicina and in knowing ow to adinite te eg wen to adinite by out wen to inect wen to ue an enea etc

9

 na ynrs

Concton wit t ptnt Te pysician ust aso counicate to te patient wat te couse of te cosen teatent wi be and epain to te patient wen it is necessay to infict pain tat is obigatoy fo te successofofstones te Te teatent eape of tis eiination patient An soud undestand watis tote epect Tey soud be tod tat te pain is a esut of te stone's oveent and is, teefoe a positive esponse to teapy Tus t e patients u ndestanding of te pess is aso teapeutic and enabes te to undego teatent wit ess anety and oe coopeation



2 o  B  TM Patrn Discminan Accoding to the tenets of  zhn x y o cobined Chinese Westen edicine in te teatet of  one sod integate knowedge of C togethe with Westen edica diagosis and ony te coose te appopiate teatet ethods (zh  Based on C patten disciinatio diagosis one then foates the ogica C teatent pincipes (zh yuan which wi ebaance the dyscasia ipied in the noencate of te C patte. Based on tese teatent pincipes oe ten seects te acta teatet ethods which ebody these pincipes Cobined Chiese Westen edic ine does n ot ean te boowig of cetai C teate nt pincipes eto ds o odaites ad appyig these soey on te basis o a Westen disease diagosis aoe The haak o C ethodooy is teatet based o patten disciination (an heng n h Teefoe the cobinatio of C ad oden Weste edicine shod ot oit sc  an heng diagosis t is pecisey the basing o teatet on sc idiidaied and hoisic patten diagnosis ich aows C to teat itot iatogeesis o side eects Oe sod ot o eape insist

Ace Al Sydes

on using  zhn o spoing  e igeous  eapy based on Wesen disase diagnosis aone Sc an appoac ay no be appopiae if e ei i (x  is oo sog n suc a case e u x o aacking ei eod is idicaed accoding o TCM an zhng o a disciminaion o paens Paen disciinaion is e aak of TCM as a style of Cinese edicine and is wa akes TCM oisic and noniaogenic. I is e os ipoan ing a TCM bings o e aiage o inegaion of adiiona Cinese and oden Wesen edicines



TC

      �  {

disciinaion Tese ae

1  pincipe pa en dis ciinai on (a gang an zhng 2. 5 pase paen disciinaion (u xng an zhng 3 Oganowe pan disciinaion (zang  an zhng

4. Canne and connecing vessel paen disciinaion ng u an zhng 5 i  bood paen disciinaion ( xu an zhng 6 Body uids pae n disciinaion n y an zhng  6 sage paen disciinaion

(u n an zhng

Mny pns o men Wsn mdn  pon o bo   g o spn  os m nd s    n fo spsy mpon  n's mmn sm S s s oneos odn o TC moo nd n y nd p mn  n os no b



C Pern Drinion

8 4 tae patten dicmnatin (e  yng xue an zheng 9 Tipe hea te patten diciinatin (an ja an zheng 10 Dieae caue patten diciinatin (ng yn an heng Of thee 10 way f dciinatin patten in cntempay TCM n te f AS 8 pincipe ang u, and dieae caue patten diciinatin ae the thee mt imptant

I Ba gang bian zheng Egt prncpl pattrn dscrnaton Becaue S ae acute cnditin it i t imptant t diffeentiate and caefuy ditinuih between cd (han and ht  fune andihteu eptine Emptine uuay (ret efe emptine(h f the qi (xu. (heng  and fune uuay efe t fune f e q (xe 

A Sh zheng  parns Fune ipie fu t vetuffed  methin amed packed fu Thi i why thi wd i metime a tanated a id n fu patten whee ihteu qi and evi qi ae bth tn the main ympt ae the f fune f e q Thee incude hih feve, ed face etene cntipatn cant dak uine deiiu abdina pain and muce uadin ca pain fim papabe ae evee abdmina ditentin and fune f the chet and hypchndium The tnue catin i uuay yew (hang and iy (n and the

3

Ac Aon ynros

pue  focefu u  Thee  eukocyto Such anfetaton ae often found n aendct choett panceatt pefoated uce petont and eay ntetna obtucton

B Xu zheng Em t

ee ae uuay due to emptne of hteou q, the n and ypto of whch ae many ack of eney and pt a pae, aow face, weakne pooned dahea o of conto of the una badde phncte a pae ed tonue wth ant fu, and theady , focee (u  pue bdona pan  not ocazed o evee and tend to e ntettent e abdoen  not eveey dtended Eptne  oen een n condton adheon ntetnaby tubecuo uch whch a ead ntetna to obtucton and ae and accopaned hock Epty condton ae uuay found n chonc dode wth acute eacebaton o n the ate tae of deae

C Han re Cod & o Mot comony hot patt ae aocated wth fune n tun due to ethe ntena o etena caue They ae, theefoe typcay yan condton Cod patten ae mot





Puls diagnoss is on of h thr main cagois of sgns an poms in sabshng a M bn ng dagnoss. It is mativ a  coec nomncatu b us wn sbng  ps bas on   csca p caacts o ing o, w av ncu t pnn o t ss so as to mna conson and pomot a g  of ps dscmnon

C Paern Drmnaon

ften aciated with intenal ety cnditin and ae thu eneally efeed t a yin cnditin

II ang f ban zheng Orgn/bowel pttern discriintion lthuh   uually affect the lie/allbladde and leen/tach they ay etie al affect the lae and all intetine the kidney and the uinay bladde Oten uch cnditi n inle e than  inle an t f thee dieae ae lcated in the  bwel  yan an bt aiu dieae ay al affect the ang deendin un the xe yn  eil caue

I. Bng yn ban zheng Disese cuse pttern discriintion Thee ae 8 itant ecie f bng yn  dieae caue in : qi , bld (xue cld (han heat (re dane (h fd tanatin (h h w (hong and tne (h iffeent bng yn ay caue diffeent athcndit n

A  Thee ae 4 diffeent dide f the qi They ae tanatin f qi ( h cuntew f qi ( n etine f qi ( xu and lae  deetin f qi (tuo   Q z  stagnation

The anifetatin f thi cnditin ae abdinal ain abdinal ditentin accanied by a feelin f fullne

5

Ace Amnal Synrme

miatin pain and a feein f tufne in the chet Fune and ditentin deceae with bechin and pain f a If qi i tanated in the peen  tmach thee ae in f indietin and a feein f fune in the abdmen If the qi tanatin i in the ive thi i manifeted by in f menta/emtina dituba nce abdmina ditentin incudin the hypchndium and pain Qi tanatin i a maj caue f many  

  onterow qi

Thi i cmmny een in dieae f the tmach and intetine It ead t nauea vmitin and hiup Typicay cuntew qi i  a cmpicatin f  and a pein fm qi tanatin 3.

 x Ep qi

The main symptm f thi ae tne f beath withdawa wth a tendency twad ience faint  feebe vice, a feein f tiedne pntaneu pepiatin, and a theady (x) fcee (u ) pue In  empty qi cnditin ae uuay encunteed in the ecupeative tae, in the chnicay weakened and i and in the edey 4 To



i polapse or deserton

Thi mainy efe t inkin f the centa qi (zhong q) It i accmpanied by pned diahea and pape f the tmach, intetne uteu badde,  kidney

6

M  D

B Xu Boo Xueyu

Bood ssis

The maj CM patten f the bd acated wth AS  bd ta ue yu Th uay manfet a ca  ed pan whch  pckn  hap nd nceae at nht the pee nce f papabe mae and p pe pt  petechae n the tne  abdmen e pe may be dffcut t dmnate and, dependn pn the cncmtant  cmpcatn patten may be deep (chen atn/atnent (se  kntted e  , w an ),  ppey (hua   

2Xuexu Empt o od

nthe pbe patten acated wth the bd and pb y peentn wth AS  bd emptne (xue xu n th cae the ymptm ncde pae, dy kn dzzne paptatn a pae tne and a theady pue Thee may a be  f bd de hemhae eadn t c ape  deet n (tu f q and hck n th cae, thee w be fantn  f cncne and pntane weatn wth a cacay hw ften, bd emptne nt caue bt(u  thepe eutMt f a ntandn deae de ptca  hemhac bd 

AS

Xue re

ot ood

Fnay thee may a be bd heat (xue re eadn t hemhae The n and ymptm f bd heat ncde



Ace Aonal Synoe

bleedng, rases delrum and ectablty, a red tongue and a (shu) fast pulse Dependng upon weter the eat s emp or ful te pulse may also be oodng (hong) tready ( or slppery (hua)

C Cod H Cold as a bng yn or dsease cause may be eter nternal or eternal n orgn empty or full For eample yang deserton sock s an n terna l empty cold (nei  han) condt on Eternal full cold (a sh han) obstructng te ntestnes can lead to appendcts Cold, weter eternal or nternal n orgn, tends to mpede te free ow of q and blood Ful cold causes contracton and stass wereas empty cold means emptness of yang If yangand q tus s empty cannot move or p sh blood and body luds stasstand stagnaton tend to te arse

D R 

Most often n terms of AS evl eat pesents as a full ot condton (h re) eat may be generated nternally due to depresson u re) or smlar transformaton (hua re) or may be eternally nvadng as n bacllary dysente However sometmes tere alsoxu) empty heat re)wc emptness of yn sn mpty heat(xu s due to an accompanes nsufcen of yn and, terefore ts nablty to control and restran yang If full eat perssts or s vey strong t may eaust or consume yn u ds and tus transfom nto emp heat



TCM Pae Da

E. Sh

Dmpss Dampness n AS may be eter nternally generated or eternaly nvadng Dampness may combne wt any of te oter evls leadng to tongue turbd coatng, slmy, eavy symptoms nclude a tck smy a slppe pulse, (hua)Tese and eavness of te mbs Te most commony encountered patterns nvolvng a combnaton of dampness n varetes of AS are damp cold (sh han), damp eat (sh re), and blood stass due to cold nd dampness (han sh heng u)

F Sh zh Fd stgt ood may occur to overeatng n genera,  n partcular eatngstagnaton ard to dgest eavydue food and alsoover as a result of long term spleen/stoac nsufcen mparng ter ablty to transp ort un) and transport (hua) foods and lquds. Because ood stagnaton s an ev  yn accumulaton t te nds to obstruct te q Because te q moves te bood and body uds, food sta gnaton can gve r se to or complcate a number of oter assocated patterns of dsarmony. Te man manfestatons of food stagnaton are abdomna dstenton, belcng a bad taste n and a foul smel emttng from te mout, nause(hua) a vomt andtongue restlessness Te pulse and slppery andngte fur s smy (n) s ful (sh)

  Chong Wrms Te word hong n general refers n Cnese to all "creepy crawers It ncudes nsects aracnds anneds, many mollusca, many ampbans and even many reptles owever

9

Ace Aoma Synome

wen used n modern C ts term many descrbes parastoss by varous types of worms Worm parastoss n terms of AS usuay manfests as parosma pan Tere may aso be bus dots or nes n te era of te eyes Tese are caed chong ban or worm spots n Cnese Te most commony encountered acute abdomna syndrome assocated wt worm stagnaton/accumuaton (chong j) resutng n acute abdomna pan s bary ascarass . hi

Ss Te stones assocated wt AS prmary refer to gastones and kdney stones Accordng to  dease mecansm teoy stones are many due to ong term accumuaton and congeaton damp eatTe and symptoms pegm dampness wc brew and condenseofnto stones of gastones ncude abdomna dstenton, severe cocky pan and sometmes jaundce and wte stoos. f te stones are n te urnary tract tere are cocky back pans tat may radate to te ower adomen or move from te back to te front foowng te course of te ureters as te stone attempts to descend One may fnd stones n te feces or te urne Stones or sand may aso be patogens or bng yn eadng to ntestna dysfuncton

3

3 Combined Chinese-Wsr Dignss Stae, Degre, & Chrr f Dis  te teatm et of acte abdomina syndome s sing zhon x  one sod diagose tiizig moden esten bn bn o discimiatio of disease categoies in combinatio n ith CM bn hen o patte dieentiation. One should aso incopoate the concepts of stage degee and chaacte of disease into sc a integated bn bn bn zhendiagnosis Diseases may be fthe clinically descibed accoding to 3 categoies beyond thei bn bn o bn zhen These thee categoies ae ) fo ealy to late stage 2 fom ight to sevee degee and 3) eithe fnctional o stuctual in chaacte Ma ng such futhe distinctions a s its pactical use in the clinic

Stg o d In the ealy stage of a disease te patients geea conditio is sal y good and tee ae ony fnctiona o sigt st ctal cages in t ei ogas. As te disease pogesses ad develop s tee ae oe seios stuctual changes in the tissues and

 mna Synrme

ogans and te patients genea condition as also stated to deteioate d in te ate stages of disease tee may be seious stuctua canges suc as peoation tei patients condition may be seious due to elease of toins and tei geneal co nditio n may be poo as evide nced by s ock n te same o simia ay te CM ban hen diagnosis also i tend to cange as te patient moves toug te vaious stages of tei disea se Tese canges in patten diimination ae efected in canges in te patient's puse canges in tei signs and symptoms eated to te state of te evi qi and in canges in t e state of tei igteo us qi o geneal condition Tus tee tends to aso be identifable stages in te pogession of disease even fom a CM ban hen point of vie ese stages include tat in ic te igteous qi is stong and te evi qi is eak; te igteous qi is stong but te evil qi is even stonge te igteous qi is empty and te evil qi is full and te evi is eiminated and te igteous qi is ecoveing Te CM disease mecanisms o bn j of te pogession of patology in acute abdominal syndmes may usually be summaied as follos At fist te e is a dysfunction of te qi Tis usually means stagnation of te qi ( h is stagnant qi ten tansfoms into eat (re o fie (hu  is evil eat can ten lead to emoage folloed by desetion o collapse of qi and nay sock is pogession usuay efects te stages of te condition as deibed by te tee stages above and also te canging balance beteen evil an igteous qi Tese stages usualy pogess fom one to te net Hoeve, in some cases te condition can pogess in a non-odely manne o even emain at te same stage fo some time

3

Comned Cnese-Wesen Dagnoss

Condeton n dgno   One mu st alays obtain a complete histo, both ecent and past Although  usually pesent as acute diseaes they ae often, in fact chonic diseases but ith an acute eacebaton o attack Theefoe, the pactitione should take a compete histoy A cea eample of this is the pefoation of a peptic ulce In such a case, the decson to choose a medical o sgica appoach to teatment depends not ony on the eistence of pefoaton but also on the histoy of the patients eaction to pevious teatment in the past 2 Te chonoogy of symptoms must be caefuly consideed Pain, distention, vomtn, constipatio and feve ae a common  symptoms The time at hich these symptoms appea has eat sinfcance man a dffeential diagnosishoeve Fo eample, if one finds thatin feve and vomitin peceded the abdominal pain, the condition is one hich can oen be teated by inte nal medicne ut if the pan appeaed fist and as then foloed by feve the condition tends to be a sugica one If the vomiting is sevee but the bdomina distention is only slight, the conditon is usualy located in the uppe intestinal tact But, if the vomitin appeas late in the couse and is accompaned by sevee distention of the abdomen the dsease pocess is usuay in the oe intestinal tact If a high feve appeas at an eay stage this sually indicates the pesence of an infectous disease o an inammation If the disease is n the gabadde o uinay tact, a high feve most denitely indcates infection ut if a high feve appeas ding the late stae of an intestinal obstuction, this usualy signals the development of tissue necoss Thus one must pay caeful attention to the tming and couse o f developme nt of such diffeent c ondtions

33

  ys

3 Maked emptiness in edely o decient patients may mask the seiosness of he condition. Olde patients may have sevee diseases ithot ehibitin pominent symptomoloy Theefoe the pacitione ms pay special aenion to sch patients Dianosis in sch patients is usally made fom thei hisoy and physical eamination ith the physical sins bein the most impotan boatoy tests ae seconday and becase of the defcient state of sch patients, shold only be sed to confm he dianosis Fo insance, an empy patien ith sevee infection may not have a vey hih wsc cont ding the ealy sae In an empy patient the pesentin symptoms ae sally not svee Th is is no  becase he con diti on itself is not seve e b becase symptoms sally ee ct the stle bete en ihteos and el. eak iheos qi cannot ive ise to a bi bate Theefoe the typical sins and symptoms ae not vey pononced o appaent.

3

4 Selection o AAS Patients or mbined hinese-Western Treatmnt Most patients ith  do not equie sugica intevention Nonetheess one must aays emembe that some do. Theefoe it is mpeative that the cincian be abe to ceay discmnate beteen those hose conditon is amenabe fo combined Chineseesten medica teatmnt and those equiing sugey

ndction o non-ugil tetet The man indications of such conditions ae   A pthoo  hich cause s ony functiona distuban ce of the ogans ith minima stuctua cha nges 2 A continued state of good genea heath amps of ths ae simpe intestna obstuction o mino pefoaton of a peptic uce ith minima secetion nto the abdomina cavity. Othe eampes ae qi stagnation conditions such as may be encounteed n the common vaieties of

 n Syne

cholestitis and cholelithiasis 9 of cases of os (ascaiasis) in the biiay tact; sall stones in the uinay tact; and uncoplicated acute appendicitis of 2 types e., blood stagnation and abscess types.

Idcts CsWstr r t us  ck v ( leprprg trpy r cmbd trmt  pssb surgry In these cases one ust caefully obsee and onito the condition of the patient. aples of conditions falling ithin this categoy incude ealy tosion o intussuception of the intestines acute puulent and ild toic appendicitis o uceative appendicitis Othe eaples ae dap heat type cholecystitis and cholelithiasis and o fe (chong huo) in the bilia tact dcts r mprtv surc trv Thee ae 3 categoies of such cases   The fst is a sevee local condition in a patient ith poo geneal condition. apes incude intestina stangulation volvuus ith toic shock panceatitis ith septic sho ck a lage pefoation of a eptic ulce and soe cases of acte puuent choestitis ith obstuction 2 The second is a patient hose initial genea condition is good but ho has a oe sevee o pogessive oca condition o a patient hose geneal condition is beginning to deteioate. aples of this include an incacecated henia ecessively lage bile o uinay tact stones hich can becoe ipacted a odeate peptic lce pefoa tion accopanied by pyloic obstuction intestinal obstuction due to tuo and nce

36

Seleion o Patients or Comined reament

3 e thd ndcaton fo mpeatve sucal nteventon s a dsease hch may not be sevee but n a patent hose eneal condton s poo and ho has not esponded to non-sucal teatme nt aple s of such cond tons nclude stanant q type cholelthass o cholecystts th fequent ecuent attacks accompaned by lve dysfuncton

3

5  ,  F eatent Pinciples, reatent Methds I  Bc qnt n tnn ttnt ncl n S A mbg trd s r dgss & mdr Wstr dss dgss   eea o r ea a proper ago efore oepuang C reaen prpe (hi an an hene wrg a prerpon. I C gung prerpo are eee on he a of he ae reae prpe Thee reae prpe are ogay ere fro e  ian hn agno  eahg he paen C ian hn ago one hou ue he 4 agoe (i hn)  he hou  e ue  oge her wh  oer Wee r eae a gno an he reu of aoraoy e In oher wor one ou one a Weer enf owege of he pahoo an a C aay of he pae oera a oyra oo i her ian hn agno n orer o en e era or ey ue a ha T ea wheher e pae' oo  ep or  o or o e

 mna Synrm

B Bfrsk yss ay cooe te afet and mot efcient teatment ic i give te patient te be t e t. On e od b e vey caef in making te diagnoi ie contanty obeing te deveopment of te patient condition and at te ame time emembeing tat te ndeying ppoe of teapy i none ote tan to ppot te igteo  hn) and eiminate evi (quxi) Te tgge beeen igteo qi and evi mt be conideed togot te entie coe of te dieae One od ty to pp ot te igteo o tat te patient can f gt te dieae temef and t avoid neede gey en aeing te body abiity to fgt dieae one od ak temeve te fooing qetion:  I te patient genea condition good o bad? 2 at i te intena baance of te body ytem i te tate of body id te acid/bae baance eectoyte baance peence o abence of feve and ovea baance of yin and yang? 3 Ho e ae te majo ogan fnctioning? 4 at i te bood pee pe tonge ign and intetina ond etc? Tee vita ign mt be contanty monitoed 5 at i  te baic condton o f te bodi y contittion? I it tong o eak? And o do e it eac t to te envionment? In m te pyician mt gide tei teatment o tat tey i add tengt to te body ate tan to eaken o inibit it abiity to gt dieae T tey od not adminite

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reamen Prncile, eamen eod

sedatives ad aagesics ess asotey ecessay Atog CM teatm et metods ae cosevative vi a vi sgey tey ae poactive fom a oistic poit of vie ad as sc ae categoicay diffeet fom mee passive obseatio

II Slcton o TCM ttnt thods in S Te pactitioe sod se te basic picipes of CM ad este medicie to aive at te pope teatmet picipes (zhi yan) As may CM tetbooks poit ot teatmet picipes ae te itemediay step i ogicay decidig po te gidig fom a ad medici as i a teatmet pa foded po a ian zheng diagosis Fo istace if oe makes a patte discimiatio of qi stagatio ad ive depessio (qi zhi gan y te coect CM teatmet picipes fo the ebaacig of tis disamoy aetis to cose tesod ive egate te qi ad esove depessio I case oe pick a foma fom te  qi o qiegatig categoy of fomas makg se tat te igediets i tat foma cose te ive ad esove depessio Fo tis CM ian zhng diagosis pickig a foma fom ay ote categoy ote tha i qi is categoicay og Teefoe it is of tmost impotace to state ad ecod te teatmet picipes ate makg a CM ian zheng diagosis ad befoe itig a pesciptio o coosig medicias  tems of  te 5 majo sigs ad symptoms ae pai obstctio distetio vomitig ad eat ese 5 a poit toads a disease mecaism of obstctio Pai i Ciese medicie i s deed as ack of fee o Teefoe obs tctio o stoppage ofte goes aog it tat Distetio is ikeise see as stagatio ad accmatio of qi e qi accmates past a cetai poit it i ted to vet itsef o coteo ad ts te tede to vomitig Ad sice qi

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 inal Synr

s yang an yang s warth, auuatons an ostrutons aso ten to e hot or war Ostruton s a prnpa sease ause an ehans n nuerous seases an s a aor fator n ost AS None theess, n eng whethr or not to use the attang etho, the physan shou e gue y the patents onton th onton of the e q, an the fferenta agnoss of oth the sease (in) an the pattern (hen) Xi 

Purgt e funtons of the  owes are to sharge an not to store to ower an not to rase, to e fu ut not stene, an to oe freey an soothy herefore, when sease auses ostruton an thus storage, an non freefowng oeent, one ust rsng, purge stenton, or sharge the owes. Purgaton ereases the pan an s a wey use treat ent etho  n the C treatent of AS In fat, t s t he eang treatent etho n he C treatent of AS In ost aute aona naatons, suh as appents, panreatts, pertonts, an asesses n the aona aty, one an use the etho of o purgaton (han xia fa) hs s ofen one wth the prnpes of earng heat (qin re) an resong ust arefu ie d ) Howeer, when usng otoxns pu rgate ena s sneone these an e nure an aage the spee nstoah, the postnata root of q an oo  prouton It s portant to reguate the osages aorng to hages n the patents onton. 

In ases of aute ntestna ostruton one an use purgate enas n hgh oses Howeer, one the patent has ha a owe oeent, one ust stop usng the purgaton etho.



ramn Princils ramn Mods

One oud ue ether ot or od purgtion depending upon the C ian zhen or pttern diriintion dgnoi In oth er word  for  o t tgntio n o uuton ue od purgt ion nd for  od tgntion or uution ue w or hot purgtion. Cod purgtie inude R d t Rhizo Rhei (Da ) Han) Mirbiitu (Man Xiao  Foiu Senne (Fan Xie Ye d Her Aoe (L Hi) Wr purgtie inude Rho Det Zingiberi  (Gan Jian) Frutu oi Crdooi (Bai Do )  nd Rdx Preprtu Aoni ti Crihei (F Zi) in obintion wth Rdix t Rhio Rhei (Da Han) If te p tien t i pregnnt  d  proonged diee o r i n edery defiient ptient wth ontiption or ditention their ptoondition  uuy due to eptine of bood nd uid dyne In uh e one houd ue oitening purgtie uh  b or ny other  ben oi penut oi Seen Cnnbi Sti (Ho Ma Ren) Seen Pruni (Y Li Ren) Seen Se Indie (H Ma Ren  et. In e where te ptient h wor  in rii of the biiry trt one houd ue ediin whih expe wor (q chon) nd i wor (ha chon) in obintion wt purgtie. h of tee enhne the other' tion when ued together in thi nner. T edin whih q chonor ha chon nude Frutu Quiqui Indie (Shi Jn Zi) Cortex Rd Meie Aerdh (K Lian Gen P)Seen Torreye Grnd (Fei Zi) Frutu Crpeii Abrotnoid (He Shi) et T downwrd-dr ning e diin with whi tee re oft en obined for nre ed efy inude Seen Aree Ctehu (Bin Lan) nd Seen Phrbiditi (Qian Ni Zi)

3

 nal Synr

Q r du Crg t rsvg txs Tee are te 2 a CM eto or prcpe for treatg fecto an ran), aato an) a to (d) The Chee materia cota uerou dicaepeg qin re ie d greet Howeer, upo further eae crato, fferet eca are epoye o te a of te ae tr eatet pr cpe  cae of toc heat (re d) ag the hao an fenoe hou aroe te hao an together wth cearg heat a eatg to The et ow forua for harog the hao an are Xiao hai H Tan f there  a preoace of co, ie prooce c, a Hao Qin  a preoace of heat there  Qin Danproouce Tanf there heat pu ypto of ape, the fDa Yan n  the gug forua of coce A tree of thee fora cota a oe of ther taar greet Ra Sctearae Bacae (Han Qin) whch cear heat a reoe to or ee troger heatcearg a to-reovg oe ca ao a eca uch a Fructu Fothae Supeae (Lian Qiao) o Locerae Japocae (lin n Ha),a Hera C Race Taraac Mogoc  Gon n)  cae eca of eat accuatg  the an heat minoe purgg together wth cearg Dahou henue Qi Tan a Bai H Tan are repreetate forua fug thee prcpe  the treatet of   cae of fu heat a to eterg the e fen or oo phae, te reqte treatet prcpe are to coo the oo a ece fre Xi Jiao Di Han Tan  oe of te coo forua avg thee fucto

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Tramn Princils Tramn hds

n ases of ap hea in either he iergaader or the speenstoah, the prinipes are o er heat an disinhiit apness Yn hen Ha Tangand Lng Dan Xe Gan Tang are representaie guiding forus for the reatnt of dp hea in he iergaer and Ba T Weng Tangis a representaie foua for ering het and disinhibiting apness fro he speenstoah n ases of ap hea in he urinary aer, one shoud free strangury or n see p wer, an ea r hea t Ba Zheng Tangis represe nttie of hose funtions o r prinipes Ll qi ji yu

gut t q rsv dpss This approah usedn to  eiinate es the funion of he isang Typicy in by this regutng ase one uses eiinas to ourse the ier (h gan) dsinhiit the gaader  dan) nd resoe depresson e ) ha H Sh Gan San is  oony presried guiding foru for these purposes in whih se Rhoa Cyperi Rotundi (Xang F) regues the qi, Radix Bupeuri Fcai ( ha H) disinhibi the gaadder, nd Frutus Citri Seu Poniri (Zh Ke) resoes epressi on ese et hods are ost ofen used in two pes of   They are used in the eary sage of rious  when suh eary stges are hraeried s depressie qi ptterns apes inude hoestitis, ppendiitis of the qi stasis type n i panreiis 2 They are aso used in diseases uring their reoe stge, suh s perforted pepi uer reoering after surgery where here is uh gas and oaing The use of these ehos or

5

c mina Synrm

prncpes n conaton wth other approprate ethos can enhance these other ethos such as activating the oo an transforing stasis (huo xue hua u) These ethos use in conaton are capae of eang to asorpton of aoina asses once the stage of acute inaation has passe 

Huo xu hua yu

Actvt t bd trsfrm stss These two associate ethos shou e use carefuy n the treatent of  If they are use inappropratey they can cause unwante eeing Therefore they shou ony e use when a patients TCM ian heng iagnosis ceary eviences signs an syptos of oo stasis. These incue pricing sharp ancnating pain which s e n aton an worsens at night purpish or ecchyotic purpe spots on athe tonguetongue an possie papaepatches asses orincuing papae enageent of the ver or speen One coony use forua for the treatent of  ue to oo stasis is Ge Xia Zhu Yu Tang In cinica practice there are actuay three ifferent eves or egrees of eiinating oo stasis e rst is activating the oo an transforing stasis This etho uses eicinas such s Rhioa Ligustici Waichii (huan Xiong) an Rhioa Coryais proote (Yanaway Hu stasis Suo)toThis circuation a thus Yanhusuo wash or sweep is the oo east attacing of the three CM ethos for treating oo stasis. The secon etho is to ispe stasis an activate the oo (qu u huo xue)  In this case the stasis is first ispee an this resuts in the activation of oo circuation Raix Rurus Paeonae ctorae (hi Shao) an Fos Cartha Tnctor (Hong Hua) are representative CM eicinas for this purpose. The thir etho is cracing stasis an ispersing ass o u

6

reame Priciles reame eods

xiao zeng) This s the ost rastic etho f eiiatig oo stasis a is resee for cases of sustatia stagat oo I this case there is usuay papae asses ioa Spargaii (San Leng) Rhizoa Curcuae eoariae (£ Zhu) a See Pru Perscae (Tao Ren) are cooy use C eicias whic crac stasis a i sperse asses If too strog a etho is chose for the treatet of oo stasis ot oy ay ths cause heorrhagig ut it ay aso waste or jure the oo a y

A fourth etho  of treatig oo stasis is ow as ispeig stasis a ge eratig the ew o r fresh is is ca e i Chese qu yu heng xin his etho is use i cases where oo stasis is ipeig the geeratio of fresh oo a aso urig recuperatio where a resue of oo stasis ipees the geeratio or growth of heaty ew tissue I the treatet of AS te atter is the ost coo use of these treatet pricpes a ethos where oo estagatig eicas are ae to foruas urig te recuperative perio i orer to ehace their curative eect Bu pi h wi

Suppmt t sp am  smac This etho is ote use i the foowig coitios

1. I the recovery perio of isease 2 Durg the postsurgica recovery perio 3 I cases where patiets have use itter co eicias for a og tie I such situatios f oe as spee suppeetig a stoach aroizig eicias oe ca prevet aage a ijury of the speestoach



 mial Sym

 ecas whch suppee he spee cue Ra

Paacs Gseg (Ren Shen)  Ra Cooopss Posuae (Dang Shen) a Rhoa Atractyos Macrocephaae (Bai Zhu) Mecas whch haroe he soach cue Frucus Zyph Jujubae (Da Zao), Rax Gycyrrhzae (Gan ao) a Rhoa Reces Zgbers (Sheng Jiang) The best ow C forua eboyg these prcpes s Xiang Sha Liu un Zi Tang Jig i zhi u

Dcnd cunrf sp vn ausea a votg are very cooy ecoutere syptos assocate wth AS a they ae gesto of eca ecocos ffcut for the pate o ae  such casesassess oe ust carefuy agosesaccorg to C zheng a whether the votg ue to heat, co,bian fuess, or eptess Oe represetatve forua for esceg couterow a stoppg votg ue to heat s Huang Lian Wen Dan Tang. For votg ue to co, a coo forua s Li Zhong Wan For fuess ue to ver q attacg the stoach oe ca use Ban Xia Hou Bu Tangcobe wth Zuo lin Wan For fuess ue to apess a heat, oe ght use Huo Xiang Zheng Qi San.For eptess of the spee a stoach oe ght use Xiang Sha iu un Zi TangA for y eptess, forua oe gh seec Mai Men Dong Tangas a gug Sheg shui zi yi

nra ar nc yn Ths eho s os cooy use  he treate of AS after fu heat has jure y  hs case, to prote recuperato, oe shou geerate boy us a erch y



Ta Pl an h

Oe us furher isiguish wheher oy soach yin has ee iure  which ase oe ay se eicias sch as er Ophiopogonis Japoicae (Mai Don) an Hera Denroii (Shi H) wheher iney yin has aso ee aage I ha case, oe igh seec a forua such as  Gan !ian. B ql yang x

uppmt t q urs t bd ese ehos or pricipes are use i he as or a sages of AS or wih wea an efcie paiens For epiness of qi oe shou sppeen he qi Qi-sppeening eicinas ince Raix Panacis Ginseng (Ren Shen), Rax Asragai Se Heysari (Han Qi) Raix Coonopsis Piosae (Dan Shen) an Rhioa Aracyois Macrocephaae (BaiRehanniae Zh ). Boo ourishig eicias ce Raix Coqis (Sh Di) Raix Angeicae Sinesis (Dan Gi) Raix Aus aeoiae Laciorae (Bai Shao )  a Cauis Mieiae (Ji Xe Ten) In cinica pracice, ecase qi coans he oo an oo is he oher of qi, he sppeenaion of oh qi an oo is ine repenen Therefore, when sppeening he qi, i is coon o ince soe oo-norishi ng eic inas an  ice vera xapes of his are he incsion of Rax Angeicae Sinensis in B Zhon  Qi Tanan he incsion of Raix Y Asragai Shen Tan. Se Heysari an Raix Panacis Ginseng in Qu chong sha chog

Expg rms kg rms One ay se eiher singe ingreiens or enire foras in orer o i wors Accoring o TCM heo, wors or chon are he aifesaion of ap hea an arise or are geerae

9

 nal Synr

y a dap hot itera eiroet Sice the root of dap heat is ofte a wea dap spee wor-expeig igrediets are ote added to speestregtheig dapesseiiatig foruas such as Si n Zi Tang Coo or represetatie TC foruas for parasitosis, such as W Mei Wan ad B Dai Wan a icude edicias for stregtheig the spee

5

6 PostSurgical Rcurati & Trtmt Postsrca reatent prncples During post-surgica recuperation any of 3 treat ent principes or ethods be deterined seected depending indiidua needs of the ay patient by anupon diagnosis hengthe Li qi kai pi xie chang

uat t q pn u pur t b The et hods of reguating the qi  openi ng gous  and purging or discharging the bowes can proote the recoery of gastric and ntestina function during the post-surgica period These ethods can hep eiinate the retention of food and assist in the conduction of ofintestina intestna adhesions contents Tis then heps preent the foration

 minal Synrm

Qig re jie du, huo xue hu yu

Car at & rv txn actvat t bd & tranfr ta Te etods of cearing eat and resoing toxins and actiating te oodinfections. and transforing eiinate residua Tis instasis turn,are canoften eadused to ato decrease in te a ount of antiio tics wic are nee ded and can sorten te course of te patients recoery tie Bu pi he wei yi q yg xue

Sppnt t pn & anz t tac bt t q & nur t bd Tese etods support te root of te ody and aid and support in tu rn, teantiodies, odys resistance uanand qi Tis to disease increases testrengtens nuer of tus enancing and quicening recoery A tree of tese etods soud not necessariy e used siu taneousy in eac post-operati e patient Depending upo n teir signs and syptos as anayed y te a gang or 8 principes one soud do a TCM ian zhengdiagnosis and seect te ost appropriate principes and etods for eac indiidua patient Howeer te second two groups are often adinistered togeter since te ood speenStrengtening is te root itofand te postnata creation of ot qi and aroniing te speen is accopised in CM y using edicinas wic aso oost te qi and nouris te od suc as adix Panacis Ginseng (Ren Shen), adix Codonopsis Piosuae (Dang Shen), ioa Atractyods Macrocepaae (Bai Zhu  , adix Astragai Seu Hedysari (Huang Qi) ad Gyrriae (Gan a) Fructus Ziypi ujuae (Da Zao) and ioa ecens Zingieris (Sheng Jiang)

5

Pssrgical Recran & reamen

1  Intestnal iobilty ter surge, the qi is usuay suggish or stagnant (zhi) an igestie function is poor Therefore one shou proote qi circuation in orer to eiinate stagnation re peristasis pereate an ai the speen an stoachor This is necessa apness, to aow recoery of intestina function these purposes one ay choose fro the foowing 3 foruas with appropriate aitions an eetions epening upon the nees of the presenting ca se as ete rine y ian zheng a Raix Pseuosteariae Heterophyae (Tai Zi Shen) os nuae (Xuan Fu Hua) ructus Citri Seu Ponciri (Zhi Ke)

RaixSeu Saussureae Vaiirae (Mu Xiang) Pericarpiu Citri Reticuatae (Chen i) Pericarpiu Viriis Citri Reticuatae (Qing P)  Raix Coonopsis Piosuae (Dang Shen) Raix us Paeoniae ctiorae (Bai Shao) Scerotiu Poriae Cocoris (Fu Ling)

Raix Saussureae Seu Vaiiriae Pericarpiu Citri Reticuatae (Chen(Mu P) Xiang) Pericarpiu Viriis Citri Reticuatae (Qing i) Massa Meica erentata (Shen Qu) ructus Gerinatus Horei Vugaris (Mai Ya) ructus Crataegi (Shan Zha) Seen Raphani Satii (Lai Fu Zi) Raix t Rhizoa Rhei (Da Huang)

25 g 2 5 5 5 5 25 g  5 5 5 5 5 5 25 5

3

 omina Synom

c. Da han o Tan

Cortex Magnoiae Ofinais ( han o) Seen Praeparatus Raphani Satii (hao Lai F Zi) Frutus aturus Citri Seu Poniri (Zhi Shi) Seen Pruni Persiae (Tao Ren) Raix Rurus Paeoniae tiorae (hi Shao) Raix t Rhioa Rhei (Da Han) Miraiitu (Man Xiao) Foiu Sennae (an Xie Ye)[steep at en]

25 g 50 15

5 25 15 10-25 15

Acupunctur One shoud hoose po ints to reguate and ati ate the qi of the intestines as Z San (Spay 6 Li (St San uring Yin Jiao On the daysuh of surgery neede that , 2,36orand 3 ties On the next ay nee e 23 ties for 20-30 inutes e ah tie One shoud isten for intestina sounds efore an after neeing When intestina sounds reappear uring the aupunture treatent it is tie to terinate the treatent and withdraw· the neees

2 Pan If pain seere, one shoud use oern Western ediation for painisreief

3 Nasea  votn a rba mdn In ases due to dap heat use Pn Wei San pus Cauis Bausae n Taeiniis (Zh R) an Rhioa Pineiae

5

Prgica Rcain & Tan

Ternaae (Fa Xia) In cases due o soach dishaony use hai H Sh Gan Tanpus Cauis Bausae In Taenis (Zh R)

b Acupuctur Neede i an (Per 6) Z San Li (S 36) and Tian Sh (S 25) wh srong suaon One ay aso nec 5 cc of aropn e and a u i aeray a  San Li (S 36)

4 ccps a rba mdcn U Xa  ai Zh Shi Ta Haeu (ai Zh Shi) os uae (Xan F Ha) hoa Pneiae Ternaae (Fa Xia) ad Co donopsis Posuae (an Shn) hoa ecens Zngiers (Shn Jian) ad Gyrhae ( Gan ao) rucus Zph Juuae (Da Zao)

2 g 5 5 5 5 5 3 ps.

Or use os Caophy (in Xian) pus Tuer Curcuae (Y lin) powder 55 g

b Acupunctur Neede i Gan (Per 6) and Zhon Wan 2) wh sron g suaon f he hccups are recaciran o reaen add Tian T (CV 22) 5 cn n deph wh srog suaon ang care ha he nge of he ee de does no de ae o he e or rgh and ha   s no saned acwards or poserory.



  

5 Aonal stenton  ba mdcn If he senon s ony sgh an s accopane by ngeson use Bao H Wan Jia Wi Percarpu Cr Recuaae (hn P) Rhoa Pneae Ternaae (Fa Xia) Scerou Porae Cocors (F Ling) Seen Raphan Sa (Lai F Zi) Frucus Forsyhae Suspensae (Lian Qiao) Massa Medca Ferenaa (Shn Q) Frucus Gernaus Hore Vugars (Mai Ya) Frucus Craaeg (Shan Zha)

15 g 15 15 25 15

15 15

15

If e c ondon s o eraey bad use e foowng forua Corex Magnoae Ofcnas (han o) Frucus Iaurus Cr Seu Poncr (Zhi Shi) Rax  Roa Re (Da Hang) Rauus Cnnao ( Gi Zhi) Rhoa Recens ngbers (Shng Jiang) 5 Frucus y Jujubae (Da Zao)

15 g 15 15 5 5 ps

If e senon s seere use Da han o Tangaboe

b Acupunctur For o erae abd ona ds enon acupunc ure sou a so be eoyed  eede Z San Li S 3), Ni Ting S 44) Tian Sh S 25, and San Yin JiaoSp ) w srong suaon

6

srca cra & Tramn

6 Constpaton Usuay ostipatio is a opiatig pto aopayig other ore proiet syptos post-operatiey. Therefore oe a add tong chang or opeig the owe hers, suh as Foiu (Fan Xe Ye) to guidig foruas seeted to address Seae those other opaits

7 Preventon o sock There are 2 ypes of sho as ate goried y Wes ter edii e Oe pe has a high ardia output ad iia oage of the periphera iruatio Therefore the patiet's etreities ted to e war This is ae d n tuo or yi desertio i M The seod type of sho has a ow ardia output ad a high degree of oage the periphera ir uatio Therefore the etreities are odo fThis is aed ang desertio tuo or yag i M

a Yn son Pathognomi anifestatns3 War etreities red  d si or sight sweatig a war body thirst a thready (x) rapid (hu) forefu ou  puse ad a deep red togue with yeow

fur or a white togue with dy fur  I order to boost the qi ad geerate uids oe shoud use

Sheng Ma San Ja We

W hv hon o ns h hng  phognom mnsonsZh ms hos o ms  nd d sgn On hs s nsld s mn. Hov h mnng s hos sgns nd sympoms hh  dnv o hho pn n hs sns hs mnsons hn  phognom

5

 a ys

Raix Panacis Ginseng (Rn Shn) 20 g Tuer Ophiopogonis Japonicae (Mai Dong) 20 Frcus Schianrae Chinensis (W Wi Zi) 20 25 Rhioa Ciicifugae (Shng Ma) Ra Praeparaus Gycyrrhiae (Zhi Gan ao) 9

b Yang dson Pathognomic manifestations: Faigue exhausion co oy

pae sin wih co swea, pae ongue wih saia an hin whe fur an a wea (o) nue (i) puse  In orer o oos he qi an raise yang one shou use

Si

Ni Tang Jia Wi (F Zi) Raix Praeparaus Carichaei Rhioa Dessicaa Aconii Zingieris (Gan Jiang) Raix Paeparaus Gyrrhiae (Zhi Gan ao) Secreio Moschus Moschiferi (Sh Xiang)

5 9 g 0 05

8 Electrolyte balance a If ho eis aage oy uis or in y one shou cear hea an purge e Hera Cu Raice aci(lin Mongoici Fos Lonicerae Japonicae Yin Ha)  Gong ng) Gypsu Firosu (Shi Gao) Spica Pruneae Vugars (Xia K ao) Hera Vioae Yeoensis (Di Ding) Frucus Forsyhiae Suspensae (Lian Qiao) Rhioa Anearrhenae (Zhi M) Rax E Rhioa Rhei (Da Hang)

5

Porcal Recraon & reamen

b. If eis he stgnted in the stoch nd rge intestine one shoud free or open the bowes. Rdx t Rhizo Rhei (Da Huang) Mirbiitu (Mang Xao) Rd x uphorbie nsui (Gan Su) Foiu Senne (Fan Xe Ye) c. If there is upwrd counterow of stoch qi with frequent oiting one shoud hronize the stoch nd descend counterow Rhizo Pineie Ternte (Fa Xa) Cuis Bbuse In Teniis (Zhu Ru) uice o f Rhizo Phrgits Counis (Sheng Lu Geng Ye) uice of Tuber Ophiopo gons ponic e (Ma Dong Ye) per uice (L Ye) uice of Fuctus Lycii Chnensis ( Gou Q Ye) sugr cne uice d If there is eptiness of qi one shoud suppeent it by using Rdix Pncis Ginseng (Ren Shen) Tuber Ophiopogonis ponic e (Ma Dong) Fructus Schizndre Chinensis (Wu We Z) Fructus Zizyphi uube (Da Zao) Rdx Gyrhze (Gan ao) e If the ptent is dehydrted during the recoery stge this is oen due to excessie purgtion Here one shoud enrich yin, noursh the stoch nd generte uids. Rdix Gehnie Littoris (Sha Shen) Rdix Rehnnie (Sheng D)

59

 n Syn

Tuber Ophopogos Japocae (Mai Dong) Rhzoma Polygoat Odorat (Y Zh) Oza Satva (Mi) ructus Zzyph ujubae (Da Zao) rock sugar

9. Urnary retenton Ura reteto should be treated by acupucture Needle San n Jiao (Sp 6) Yin Ling Qan(Sp 9, Gan Yan CV 4) ad Shi Mn CV 

6

7 Formulas or External Applcatn Oe may o oy admiise eba medicias ieay fo e eame of AS bu aso use vaious exea appicaios suc as pouices. Sice ese ae acue sydomes equiig speedy ad compeesive iao o bach eame a muimoda appoach is waaed.  o app ediciis masses caused by if ecio ad peioiis use

Coex Phe ode di (Huang Bai) Boeoum (Bing Pan) Gypsum Paepaaum (Duan Shi Gao)

40

g

5 50

Powde e above 3 igedes ad m ix wih wae o  viega. Spead aof03-0.4 hisapase vecea he affeced aeahis o ocaio he paim . aye eofape sh eeoof pasic ove pe Cage his appicaio -3 imes pe day beig sue ha e pae is kep mois

 Oe ca aso use 6-8 pieces of gaic wih 0-30 gams of Miabiium (Mang Xiao) Cush he gac bubs ad mix ogee wi powdeed Miabiium Spead a hi aye of

 minal Synr

vasli ovr th ski abov th affctd ara ad th sprad this past o top of that Bcaus garlic as a vry strog stimulatig actio o th ski o  must watch carfully for th apparac of blistrs. If blistrs apar rmov th applicatio immdiatly Othis lav th applicatio o th ski for 05 miuts

62

Section II

The Diagnosis & Treatment of Spcific S by Combined C h i nese -Western M e di c i n e

1   Ko Petic U lers & Perrats Peptc ulces ae defed as a ccumscbed ulceato of the mucous mem bae pe etatg thou gh the musculas mucosa ad occug  aeas to hydochloc ad peps. Depedg upo wheeexposed the ulces ae located acd aatomcally mode Weste medce detfes seveal dffeet types duodeal gastc, chael, postbulba, magal, ad jejual Although peptc ulces occu oly f the stomach secetes hydochloc acd oly less tha   10 people who secete hydochloc acd develop ulces Recetly Weste eseach has mplcated ceta gems  the occuece of peptc ulces.

Ba gang bian zheng Eit principle pattern iscriination I the  tal stage peptc ulce s ad pefoatos ae pma ly dsode s of splee/stoma ch q a d of the bloo d As the dsease pogesses q ad blood become stagat ad gve se to tasfomatve heat (hua re ) . As heat teses t may tu to hot toxs re ) o fe (huo ) . Thus most ofe these codtos ae usually mafestatos of teal full heat I

 na Syn

some sevee o choc cases they may also be a combato of both emptess ad fulless Dug the ecovey stage the patet's codto s most ofte categozed as a state of emptess

ang f bianpHern zhengdscrnton Orn/bowel Accod g to TCM th affectd zan  i thse codtios a the splee stomach ad lv although maly the splee ad stomach

ing yin bin ji Dsese cases, sese ecanss ese coditios mosty aise du to disodes of the splee/stomach q ad blood Because ths poblem always icludes pa oe must immedately emembe the basc TCM dctum egadg pai: Ton z bu ton Bu ton z ton

If thee's fee ow the's o pa If thee's ot fee fow thee s pa. e fst aso fo these pathocodtos may be empty cold of the splee/stomach    han) Cold causes cotacto ad a lack of yag esuts  sufcecy  taspotato  s the cases pa Empty cold of the spee/stomach may be cased b y pologed wo  o aiey o chocay oveeat g aw cod (hn /n) foods e secod cause of peptic lce pa ad pefoatio is qi stagatio ve depessio (q zh an u) The lve cotols cousg ad dhage If lve q

66

Peptic Ulrs & Pefoations

bcoms stagat ths rsuts  q stagato ad accumuato whch  tur rsuts  a. Lvr q s ot caud by frustrato ad strss ad t s aggravatd by ovratg  g ra ad at g hard to dgst food  art cuar I f vr q  stagato bcoms bad ough t may trasform to drs sv u re or trasformatv hat (hua re)  Ths v hat may th trasform f urthr to hot tos (re u) or r (huo) Ev hat orchs ad jurs y uds ad ths may ad to y mtss of th stomach Ev hat may ao cau th bood to ru rckssy outd ts ao or athways rutg  bdg Or sc q commad th bood whch ma that t s th q whch movs th bood f th q bcoms suggh or stagat ovr tm th b ood w  aso bcom sta tc (xue yu) Othr comcato ca cud  mts causg damss whch wh combd wth trasformatv hat may gv rs to dam hat Th foowg aro dcrbs th tyca cours of ths dsa basd o th abov da mchasm. Th att sss sudd a  th gastrum or ara of th stomach. Ths may radat to both ds ad may b accomad by ausa ad vomtg O amato th owr abdom or th tr abdom may b hard ad fu Th a s ot dcrbd a rcg or acatg "k bg cut by a kf " . Th four trmt may b cod aog wth a cod swat Th como may b grh or aow Th us s oft d thrady ad rad Latr ths cogs to may tur to hat Thr s a ad dtto  th abdom ad th abdoma wa s hard to th touch Th att rcs tr sstvty to touch or rssur o th abdom. A fvr dvos accomad by dryss of th mouth ad costato or dry hard to Th ur s yow ad th togu  s rd wth dy yow fur Th us  w ry ad rad or forcfu ad rad. If hat cogts tray ad

6

 n Synr

caot dissipate this may lead to ehaustio of yi ad yag with shk

erees o severty ere are 3ofdegrees of severity recogized i the diagos is ad treatmet peptic ucer perforat io 1. Simple perforatio

 Compe perforatio 3 Dstetio  shock Tab of dgrs of svr

Pathg

Sts  Sgns

ratnt dats

al

lal itoniti

genea condition g and ign no evee

Ue intenal medicine.

Genealized

mall foation, minimal amount of fluid in abdominal cavity whih lead to widepead  i

geneal condition till g, no evi dent hange in cuion gn, light ditenion of abdomen

U intenal medicine fo 8 hou  no relief ue uge'

gene ondition i  txic ymp tom and ign and hk

Ue uge

toniti Ditention ad Shk

lage oation meae to lage amount of d in abdomen, evere infetion

One hould not wat 8 ho in edely patient  thi pe extenive adheion that make uge even moe dit

6

eptic ces  efoatios

In te fist degee tee is liitd ocal peioiis T Cinese use te te peitonitis  o yan in o ays Oe efes to a qualiy of sevee pain eanaing fo te stoc and ines tines a nd e oe to a descip ion of e paooic state of a iaed peioneu n te second degee e is idespead peitoitis ypicaly copicaed by pefoatio i eoage obstuction of te pylous o cace  suc cases sugey is ipeaiv n te tid degee  is distentio ad sock

Stages o treament Tee ae 3 stages of eae of peptic uce it pfoaio in cobied Ciese-Weste edicie

Sta I Stage I is knon as cove e uce stage Tis is te iiia stage and usually cotinues fo fo  2 ous to 2 days Duig tis ie te pefoation is coveed and sealed Te sigs and syptos pese nted duing is sa ge ae pesiste and include sevee genealied abdoia pain ic iceass i pessue on te abdoinal al ad bound tedeess Te abdoinal al is ad and ee is a decease i boel souds Patology at tis stae includes leakage of te astic coes io te abdoinal cavitytis ic ten poduces stog ceical Afte 6 ous iitatio eads  o t deveopnt iitatio of bactei peitonitis Te TCM ban heng diagosis at tis stage of tis disode is ypicay dysfuctio of te idde bune (hong jao bu i sai on of qi ad blood (  xue yu Te equisie eaet pincipes ae to egulae e qi sop pain and poot te epai of te pefoatio

69

Acue Abdmal Sydrmes

Sa II Sage  s called e mddle sage ad also correpods o e combang nfecon kng n) sage  srs a e end of Sage  ad coues un e perons subsdes d dsap pears Ts usually occurs secod o e e pos perforaon day Te sgnsfrom and e sympoms durng s sae conss of decreasng a bdomna l pa and ncreasg ormala on o f e pu lse dsappearance of perons or slg resdual localed per ons recovery of e appee  ad recurrence of normal boel sounds Paology a s sage s due o e recovery process nvolvng e per oneum Te C bn zheng dagnoss a s sage s ypcay based on dngs confrmng connued sagnaon of q and blood along  damp ea h re and ons ( Terefore e reuse reme prc pes a sand sae usuallyons nclude clerg ea dbg dampness resolvng along  openng o freeng e boes

Sa  Ts  e lae or s se d  cld e ucrrpr    commeces  e dpprc e  prs d l ul e ulcer s complely led  re uull  more a  dys Te s d ymm dur s sage re  e absece o pero c of uds  e  abdome normal emperaure  d n e orml lbor ory fdng Paology s reled o e formo o scar ssue Te T n heng dagoss durng s sage s commoy derena ed beee 4 paerns



Pec lr  Peroraton

 w x  Spleen/somach empy cold

Ths pattr s charactrzd by ptss ad cld f th spl/stach Ths as thr ar sgs ad sypts f spl q ptss cbd wth sgs ad sypts f chllg ad cld. Sgs ad sypts clud fatgu lss f apptt ls stls cld hads ad ft a pal tgu wth wht catg ad a suk (chen) slw (ch) puls Th tratt prcpls ar t war th ctr strgth th spl ad harz th stach.

 y x Somach yn empness

Ths pattr s charactrzd by ptss f y ad suf c f stach uds As t s sad Th spl fars dapss but th stach dtsts dryss. Dryss ad y ptss at ths stag s usually du t th jn e havg b urd by vl hat Typcally ths hat s  tur du t dshary btw th lvr ad spl ad th arsal f trasfratv r dprssv hat. Th sgs ad sypts clud a gawg pa thr hugr r a lss f apptt thrst a dry yllw r scat yllw tgu catg ad a thrady (x) rapd (hu) puls Th tratt prcpls ar t ursh y ad grat uds supplt th spl ad harz wd ad arth.

G  w Lver aackng he smach

Ths pattr s du t ctu d lvr q  stagat whch vts tslf  ad attacks th stach. Ths causs lss f stach hary ad typcally upward cutrw Th sgs ad



  Sy

symptoms clud abdomal dstto blchg hccup gugtato wos wth stss a omal o daksh togu wth wht o yllow coatg ad a w puls. Th tatmt pcpls a to cous th lv gulat th q ad hmo z th stomach

  x y

Q sagnaon, boo sass

Ths patt s chaactzd by sgs ad symptoms of q stagato md wth blood stass Blood stass blocks th jng o o chals ad coctg vssls. At th sam tm  th s hat  th stomach du to ths blockag ad obstucto Th sgs ad symptoms clud pckg fd pa a pupl togu o ptcha ad a wy (xan gatastgt se puls Th tatmt pcpls a to cous th lv ad gulat th q actvat th blood ad tasfom stass ad cla stomach hat

Tretent I about 23 of all cass of pptc ulc ad pfoato o ca us tal mdc as opposd to sugy.

Cobnd nonsurca tod Indcaons  paen selecon

O of th most mpotat ssus  th tatmt of  by t al m dc  s th caful ad pop slc to of patts Gally ths cluds most ptts wth localzd lsos Th followg s a summay of th spcfc cta to b usd  th s lcto of pat ts fo whom tal mdcal tatmt s dc atd 



epc lr  erforaon

 Th patt s hould b  good ga codt o Th majo ogas should ot b svy affctd

2 Th cod to s hould b o of shot duato o th patt may hav a log stoy but of oly fqut attacks 3 Th pfoto should b small ad th should oy b aty ud  th abdomal cavty. To dtm ths o shoud tact ad masu ths ud by dl aspso. O ca dtm th tt of th pfoato by assssg th amout of ud ad th as by whch t s tactd

4 Th patt may hav a hstoy of pvous attacks whch w succssfully tatd by cosvatv thapy I ths catgoy of patt s thos wth galzd o  sv codtos qu tmly clo s obsvato ad motog If thy do ot act pomp tly to t al md cato o must pocd to sugcal tto I cass of th ldly o patts who hav gstd lag quatts of food o must mak a dcso accodg to th gal codto If a sgs ad symptoms ft th local o galzd typ o may us th osgcal appoach

Teatment methods duing the

3 stages

Eary Sta I ths stag lakag of uds to th abdoma cavty causs ptots du to chmcal tato. If ths s sv t may lad to toc ptots Thfo th tatmt pcpls cosst of mmdatly pomotg apd closu of th pfoa to so as to dc gal body posog.  Rduc stomach ad tsal pssu.

3

  Sy

2 Keep the patiet i a semi-recumbet positio 3. Use acupucture to reduce pai ad rel the musculature To do this eedle Zhog W (CV 12) ad Zu S L (St 36). If there is ausea a d vomitig use Ne Gu (Per 6)

4  Ope  th e test es (tog chg) to promote their free ow Accord g to C theoy the 6  bowels ike to be empty ad free owig Whe they are ot freelowig this leads to accumulatio stagatio ad pai Oe must therefore pay more attetio to regulatig the qi of the stomach ad ites ties ad especially whe this coditio is accompaied by costpato erefore oe ca use Fu Fg D Cheg Q Tg wth saltwater as a eea 5 Pucture ad asprate the abdomial cavity.

6 Give a fusio ( uid)  Prescribe approprate atibiotics

8 Give othig by mouth. Mdd stag Followig the successful treatet of the iital stge of ths coditio as described above durig the midde or cobattig ifectio stage the righteous qi should become stroger ad the evil qi weaker At this poit the codtio is chagig i a positve directio. The symptoms which characterize this stage clude decreased abdomal pai more localized peritoitis proved appetite ad more ormal itestial fuctio The bowel ovemets wll have resumed Pathology at this stage is characterzed by decreasg pertotis



Peptic ls & Peroratons

Theefoe the majo eed a ths tme s to emove all lud accumulato fom the ta-abdomal cavy to clea ay remag fecto ad o pepae the teses fo a etu to omal fucog Thus he  teamet pcples ae to clear heat resolve os egulate the q ad acheve a bowel movemet Oe may fuse hebal medcals hough a stomach tube wth the pupose of hasteg the elmao of taabdomal ud accumulao. Oe may choose ehe of the 2 formulas beow fo the gudg formula.   Fu Fng D Ch Hu ng Rad Bupleu alcat ( Ch Hu) Rad Albus Peoae cloae (B Sho) Rhz oma P ell ae Teatae (F X) Rhzoma Desscata Zgbes (Gn Jng) Rad Scutellaae Bacaless (Hung Qn) Heba Patae Heyeophyllae (B Jng Co) uctus mmatuus C Seu Poc (Zh Sh) Rad Et Rhzoma Rhe (D Hung)

2

20

gams 

1 1 2



0



20



2



2 Fu Fng D Cheng Q ng Rad Scutellaae Bacaless (Hung Qn) ucus Paepaatus adeae  asmods (Cho Zh Z)

1 gams 1

5

Acute omnal Syndromes

Rad Et Rhzoma Rh (a Huang) Mabltum (Mang Xao) Fuctus Fosytha Suspsa (Lan Qao) Rad Glycyhza (Gan Cao) Fuctus Immatuus Ct Su Poc (Zh Sh) Rad Rubus Paoa Lactoa (Ch Shao) Os Spa S u Sp lla (Ha ao Xao)

1 2



1 10



10



1







20

I cass wh th s copous vomtg, o ca add to th  of th abov omulas Cauls Bambusa I Tas (Zhu Ru) Rhzoma Plla Tata (Fa Xa) I cass wth cssv gastc acd, add Fuctus Schzada Chss (Wu We Z) Rhzoma Bllla Stata (Ba J) I cass wth sv ptots add Cauls Sagtodoa (Hong eng) Cot Radcs Mouta (an ) Flos Catha Tcto (Hong Hua) Rad Salva Mltoha (an Shen) To lv sv pa add Rhzoma Coydals Yahusuo (Yan Hu Suo)



eptc lces  eoratos

I cass accompad by sv dpsso of apptt add Edothm Co Gga Ga ( e n) Massa Mdca mtata (Shen Qu) I cass wth sv fcto add: os Loca J apoca (n Yn Hua) cts osytha Sspsa (Lan Qao) o Mo b (San Ye) Rhzoma Coptds Chss uan Lan) To v costpato add: Mabltm (Man ao) I cass complcatd by blood stass add: Sm P Psca (Tao Ren) os Catham Tcto (Hon Hua) Pll Typha hen  Huan) Rhzoma Lgstc Wallch (Chuan on) Gv 50 cc of th abov dcoctos by stomach tb ad wat fo 2 hos If th s o cas  abdoma pa o dscomfot gv a scod ad th a thd dos I th follow g days stat admstg ths hbs by moth o  o pscpto o bao packt p day Acuuncue

Us th sm potocol as pscbd dg th pcdg stag



  

De1

The patet may be gve some fluds but oly f ths does ot cause ay abdomal dsteto.

Fna stag I the last or fal stage there s o loger ay pertots There are  o complcatos The tempera ture s ormal ad he urat o ad defecato are becomg more ormal Patholog y at ths stage s due to the exstece of resdual ulcerato but wthout ay perforato The ma treatmet rcple s to promote the growth of healthy ew tssue Needle pots Zu San  St 36) P Shu Bl 20) We Shu Bl 21 ) Zhong Wan (CV 12) ad ang Men St 21 ) . Gve medces to rel e. spasms ad reduce gastrc acdty spasmolytcs ad atac ds  herbal medcals should be admstered based o

ban

zheng dagoss

 w x  Sleen/s1omch em1y cold

Treatment princip1es: Warm the mdd le stregthe the splee Rx: Xao  Zhong Wan Ja We

Maltose Y Tang) 18-30 grams  Ramulus Camom  Gu Zh) 9 Radx Albus Paeoae Lactorae  a Shao) 18 Radx Praeparatus Glycyrrhzae  Zh Gan Cao) 6 Rhzoma Reces gbers 8

Petc Urs & Peroratons

(Sheng Jng) 9 ructus Zzyph Jujuba (D Zo) 12 Rhz oa Pl a Trata 1 (F X) ructus Evoda Rutcarpa 1 (Wu Zhu Yu) Os Spa Su Splla (H Po Xo) 0



ps. 





 y x Somch yn emness

Treatment priniples: Noursh y ad grat luds, haro

z vr ad stoach  Yng We Tng

Radx lha  Lttorals (Sh Shen) Rhzoa Polygoat Odorat (Yu Zhu) Radx Trchosaths rlow (Tn Hu Fen) Tubr Ophopogo s Japoca (M Dong) Radx Rhaa (Sheng D) rock sugar

G q Lver q

Treatment priniples: Cours th lvr rgulat th q haro

z th stoach  Ch Hu Tng

Radx Buplur alcat ( Ch Hu) Rhzoa pr Rotud (ng u)

9

Ace Aominal Syndromes

Frucus Ctr Su Pocr (Zh K) Rad Saussura Su Vladmra (Mu Xng) Prcarpum Ctr Rculata (Chn P) Frucus Su Sm Amom (Sh Rn) Rad Albus Paoa Lacora (B Sho) Os Spa Su Splla (H Po Xo)

X y Bld stasis

Trtn prinips ctva th bood ad rasform sass

cours th lvr ad rgulat th q cla hat from h stomach  Xu Yu Sn

Pol Typha (Shng u Hung) Fcs Trogoptror Su Prom (Wu Lng Zh) Rad Agca Sss (Dng Gu) Rd Rubrus Paoa Lacora (Ch Sho) Rho ma Corydals Yahusuo (Yn Hu Suo) or Rhoma Cypr Rotud (Xng u) Rhoma  lll a Strata (B J) la u Cor As E Jo) Os Spa Su Splla (H o Xo n)

Evaluain f esus Wh vauatg  h rsults of th abo v tram pas hr ar 3 catgo rs of rspos o tram  Ths ar rcovrd mprovd ad o mprovmt



Petc Urs 6 Peoratons

cvrd The sgs ad syptos have dsappeared ad there are o resdual coplca tos or fecto

Imprvd The perforato s cosed but soe abdoal tederess reas or there ay be soe palpabe asses due to adhe sos N mprovmnt ollowg tre atet there ar e o sgs of proveet ad the patets codto cotues to deterorate I ths case, oe ust resort to surgery



2 D S B hlelithiai Cholelthass or gallstones reer to the presence o calcl n the all bladder o b lay dcts Most cl ncal dsord ers o the etahepatc bary tac are n act eated to gallstones The maor component o most gallstones  s cholesterol sk actors or the de veloment o sch gallstones ae age obe sty detn dmnshed d ntake a hgh at det and beng emale Cholesterol s not only ond n the det rncpally n atty oly oods bt s also seceted by the body as a ecso to the omaton o homones Ths helps elan hy eales ae moe pone to ths condton than men and hy t also tends to occ later n le as homonal balance ndeoes a sht The eneral sgns and sytos o cholelthass ae the same as o cholecystts lbladder attacks tycally ben th acte colcky pan As he an becoes more severe t tends to ocale n the rht per adrant and oten adates arond to the rght loe scala asea and vomtng ae common and thn a e hours o onset there s nvolntary gadng o the rght abdomnal mscles The allbladder becoes palpable n less than 12 o atents A typcal epsode

Ace Aomnal Syndromes

o cholcytt uually pov wth 23 day ad olv tl wth a wk I t do ot th uggt o ou coplcato  ollowg ban hng dago cov both cholltha ad cholcytt a a gl da catgoy Th  ollowd by a dcuo o a cobd ChWt tatmt o gallto Fo ca o choltt ot volvg gallto th ollow a uth cto o that

Ba gang bian zheng Eght prncple pattern dscraton Biao 

Ena/ntrna Acut gallbladd d a a tal codto bc au thy pcpally act th ang ad  H re

Cod/ot Acut gallbladd attack uually volv ull hat (sh r) o dap hat (sh ) Howv wh th udlyg codto  bacally choc th ca alo b pty cold o th pltoach Shi xu

Fnss/ptnss Mot ot acut gallbladd da a du to a ull vl o sh  Howv   advacd ca uch a  v ad al tag ghtou q ay b daagd ad th vl ay hav

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Choelhass

trd th yng ad xue fen  lad to a comlx codto of mxd full ad mt. Yn yang

Yn/yang A h codto ar uually tral ad full thy rta to yag But ic  om ca thr may b cold dam ad y jaudc th codto may alo b clafd a yi

ang f bian zheng Organ/bowel pattern discriination  codto maly affct th lvr ad gallbladdr Nothl thy may alo affct th l ad tomach cally i ca du to a udrlyg chroc da

ing yin bing ji Disease causes, disease echaniss  codto ar uually du to tagat q ad blood ta. A dcrbd abov q  th commadr of th blood f th lvr lo t cotrol ovr courg ad dcharg of th q du to r frutrato adta. tr luggh tagat q wll vtually ult   blood Stagat q my alo traform to drv hat Hat may tw th juc ad traform to dam hat or comb wth l dam to bcom dam hat Dam hat may furthr traform to u or tox or cogal to to. Aca ra or worm chong ar aothr cau of th gallbladdr da Accordg to TCM thory dam ad hat ar th factor whch crat a tral vromt coducv to th ourhg of chong f vl ar

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 minal rm

choic o may aso d cod ad dampss du to poo sp fucio. Suc poo sp fuctio may b du to xcssiv woy ad axity ad/o ovatig cold ad aw foods.

Bian zhengaon ln zhi to paHn scnaton Tant Gan dan qi zhi

Lv rga ba r q  stagnaton Pathgnmic manifestatins Pai is usually dul ad migatig

 coms ad gos It is wosd by motioa stss t may adiat to th should ad th may b ausa ad vomitig oss of apptit ad abdomial disttio. Th togu is dakish ad spcially th dgs Its coatg may b omal. Th puls is tight n) ad wiy (xn ). eatment pincipes: Cous th iv ad guat t qi

disihibit th galbadd ad stop pai  D Ch H Tn

Radix Buplui alcati ( Ch H) Radix Scutllaia Baicalsis (Hn Qn) uctus Immatuus Citi Su Pocii (Zh Sh) Radix Et Rhizoma Rhi (D Hn) Radix Albus Paoia ctioa (B Sho) Rhizoma Pilia Tata (F X) Rhizoma Rcs Zigibis (Shen Jn) uctus Zizyphi Juuba (D Zo)

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Ceasis

Xue yu

Bood stass Pathogoi aifestatios Pologd o pooucd lv q

stagato vtually lads to blod stass I such cass th pa s mo sv colcky ad psstt  ts locato patt xhbts xtm abdomal tdss O mayTh o may ot d a palpabl mass Th togu s dak ad v puplsh Th puls may b suk (chen, gatgastgt (se hasty (c, o kottd e Treatmet priples: Cous th lv ad gulat th q

actvat th blood ad tasom stass stop pa   Ge  Zh  ng

cs Togopto Su Ptom (W Lng Zh Radx glca Sss (Dng G Rhzoma Lgustc Wallch (Chn ong Sm Pu Psca (o Ren Cot Radcs Mouta (Dn P Radx Rubus Paoa Lactoa (Ch Sho Radx Ld a Stychola (W o Rhzoma Coydal s Yahusuo (Yn H So Radx Glycyhza (Gn Co Rhzoma CypTcto Rotud (Hong (Xng F los Catham H uctus Ct S u Poc (Zh Ke Re du

ot toxns Pathogom maifestos Pologd stagato o q ad

blood may tasom to hot toxs Th accompayg



e ia Sys

symptoms ae feve tht ad a dy mouth wth btte tate If heat tasfom to e ad etes the yng ad xue oe may see hgh feve d stool ad scat dak yellow ue. The pule may be ethe oodg (hng) ad apd (shu) wy (xan) ad apd o wy apd ad foceful u  The togu may be deep ed wth yellow dy fu. If heat sk to the yn ad blood t may lea to ehauto of y ad yag wth accompayg sgs of cold lmbs ad a mute (we) pule Teatment piniple: Clea heat ad esolve to  Ln Dan Xe Gan Tang a We

Radx Getaae Scabae (n Dan Ca) Radx Scutellaae Bacales (Huang Qn) Fuctu Gadeae Jasmod (Zh Z) Cauls Akebae Mutog (Mu Tng) Seme Platag ( Che Qan Z) Rhzoma Amat (Ze Xe) Radix Bupleu Falcat ( Cha Hu) Radx Rehmaa e (Shen D) Radx Agelcae Se (Dan Gu) Radx Glyhzae ( Gan Ca) Radx Et Rhzoma Rhe (Da Huan) Shi re

Damp at Whe dampe ad heat combe ad tew togethe oe typcally d ymptom of audce. Thee may be ethe low o hgh feve o a feveh eato. Dsteto ad fule ae foud  the hypocho dac ego ad epgatum accompayg pa at these ste. Pathognomi manifetaion:



Chlelhss

The ue may be the colo of tea. The togue s d wth slmy, yllow coatg. The puls s slppy (hu ad apd. Tatmt piips Cla hat ad dshbt dampess

dshbt the gallbladd ad cede jaudc   n Cen H Tn

Heb a Atemesae Ca pllas (Yn Chen H uctus Gada e Jasmods (Zh Z Radix Et Rhzoma R h (D Hun Han shi

C ampnss Patogomi maifstatios I som cho cass th s eteto of dampss  th mddl bue ad/o mptss

of mddle q The accompayg symptoms a those of y jaudce wthout ay fvsh sesato The s the fev o thst ad th bowl movmts may b loos Th togu s glossy (hu ad th  puls s suk (hen ad slow (ch o led (hun ad sodd ( m  

Tatmt piips Stgth th spl ad tasfom

dampss wam the sple ad ecd jaudc  Yn Chen Zhu u Tn

Hba Atemesa Capllas (Yn Chen Ho Rhzoma Atactylods Macocphaa (B Zhu Rhzoma Desscata Zgbes (Gn Jn Radix Papaatu s Acot Camchal (u Z Cotx Ca mom (Rou Gu Rad Papaatus Glycyhza (Zh Gn C

9

 a Sys

I the treatmet of most cholestts the ma patter dscrmato s betwee lver q ad damp heat Therefore practtoers should be absolutel y clear about the dffereces  sgs ad symptoms betwee these two heng Lver q s characterzed by dull pa fulless ad dsteto The pa may radate to the back ad shou lder The appet te s poor ad usually there s o fever or jaudce The togue s lght red or slghtly dark wth th whte fur The pulse s wry or an I damp heat there s usually geeralzed severe pa wth hard abdomal muscles acute abdom al tede ress ad hgh fever If the case s severe there may be the oset of shk asa bleedg ad purple or cyaotc sk The togue s red wth slmy yellow coatg ad the pulse s slppery (hua ad rapd shu)

Te obne neseWesern reaen o oeass Dn Do P Shi Fng

Gatonxpng formua There are 6 dferet versos of ths formula Ther adm stra to usually s ot accompaed by sde effects. I a few cases oe may wtess ausea ad headache If ths occurs oe should decree the amout of the formula admstered spreadg t out through the day or cease s admstrato altogether I durg a dmstrato o these formulas there s a sudde crease  pa (oe followed by loose stools) ths may be see as a good sg. It dcates that the stoe s attemptg to move ad may have become dslodged As metoed above there are 6 dfferet versos of ths formua Below are the 2 most commoy used

9

ChoHhass

 sed mostly we q stagato sgs ad symptoms are omet ructus Ctr Se u Pocr (Zh Ke) 15 grams Radx Saussureae Seu Vlamrae  15 (M Xan) ructus Melae Toosedas  15 (Chan Lan Z) Herba Desmod Styracfol  (ln Qan Ca) 50 Radx Et Rzoma Re  (Da Han) 1 2 sed mostly we sgs of dampess ad eat are prom et (Zh Ke) 15 ructus Ct r S eu Pocr grams Radx Saussureae Seu Vladmrae  (M Xan) 15 Rzo ma Corydals Yausuo  (Yan H S 5 ructus ardeae Jasmods  (Zh Z) 20 Rzo ma Polygo Cuspdat  (H Chan) 50 Herba Desmod Styracfol 

(ln Et Qan Ca) Re Radx Rzoma (Da Han)

5 5



 cases wt fulless ad dsteto  te cest or tercostal a add Radx Bupleur alcat ( Cha H) Radx Rubrs Paeoae Lactorae (Ch Sha)

9

 a 

Radx Albus Paeoae Lacorae (Bai Sha) I cases w h audce add : Herba Aemesae Caplls (in hen Ha) uber Curcumae ( lin) rucus Geae asos hi Zi) I cases wh srog hea add los Locerae apoe (lin in Ha) Herba Volae edoess (Di Din) I cases wh omg add: os Iuae (Xan F Ha) Cauls Bambusae I aes (Zh R) Rhzoma Pellae eraae (Fa Xia) I caes wh a deep red ogue ad hrs add: Gypsum brosum (Shen Shi Ga) Rhzoma Aemarrheae (Zhi ) Radx rchosahs row (Tian Ha Fen) Herba De drob (Shi H) I cases wh poor appee add Edohelum Core Ggerae Gall (li Nei lin) Frucus Germaus E Praeparaus Horde Vulgars (ha Mai a) Masa Me ca ermeaa Shen Q) Frucus Seu Seme om (Sha Ren) Frucus Craaeg (Shan Zha)

9

ce Gallladder Dseas

Fk eees Use waluts rock sugar, ad sesame ol Ths s good for q stagato ad damp heat type stoes. Or use: Pulvs ( Tubers ln Fen)Curcumae a Fen4  Shao Fen Puvs Tac (Ha Sh Fen) Pvs Radcs Gyrzae (Gan Cao Fen)

 gram 08  " 6  3 0



Ths formula s good specfcally for the q stagato tpe of coethass

Attckng ev expellng stone cobne metho ncatons Ths method s dcated  cases of q stagato damp heat or stoe  the gallbladder or ble duct.

Cours of tratmnt Ts treatmet usuay takes abot   hours, but oe st od t aordg to te codto of the patet ad ter respose to the tal treatmet O the bass of these factors oe must decde o the umber of repettos that are appro prate for each patet If the patets geeral codto s

4

Bo of ee ngeen ae y of mabltum

93

 mina Synrm

good o may carry ot hs tram 2 ms pr day 23 ms pr wk If th pat ts gra l codo s w ak th  o shold oly do  ram pr day 46 tratms ar cosdrd o whol cors. Th pat shold b allowd a rst btw ach cors Drg hs tm h q ad blood ad spl ad somach shold b sppord.

Sd fcts Ev f th patt s cosdrd o b a good cadda or tram thy may sll dvlop jadc  spt of hs ram

Dtas  aackg mtd 

830 AM Gv 2 of Gallsoxpllg formla 930 AM Gv sbcaos jcto of  mg morph 00  Hav patt ha 02  of amylrat 0 AM Hav pat drk 40  of a 33% solto of magsm slpha 020 AM Hav pat drk 30  of 0% solo of hydrochlorc acd 02 AM Hav patt a 2 ggs frd  a abdat amot of ol 030 AM Admstr  lcroacpctr N dl Dan Sh (Bl 9) o th rght sd ad coct  o h gatv pol. Coct h postv pol o hr R Y (GB 24) a Cng (Lv 3) or

9

Chlelthass

ether R Yue B 24) a Chng Lv 3), or ang Men St 21 ) .

Note Oe must rst ask the surgeo about gvg oly food f

the patet has a hstory of prevous gallbladder surgery If there s a sudde decrease  pa, ths usually dcates dslodgemet ad elmato of the stoe. If there s tal termttet abdomal pa whch chages to costat, severe pa ths dcates that th e patet' s codto s w orseg ad surgery s requred O the other had, f ths teral medcal treatmet s followed by a decrease  pa fever ad jaudce the stoe may have bee elmated ad oe should look for the stoe  the stools or perform approprate laboratory tests to corm ths hypothess If the geeral codto s severe ad the patet s very weak or f treatmet the codto s deteroratg , oe should proceed wth surgca

Patnt scton Sone sze

Dfferet crte ra are used  dfferet Chese hosptas So me use a crtero of stoe sze uder 1 m  dameter ad other use 1 1/2 m The stoe must be smooth or be a coglomera to of small partcles ocon

If the stoe s  the commo bary duct, the above treatmet s more lkey to be successful tha  cases where the stoe s stl sde the gallbadder tself.

95

u nal Snrs

Number  shape of stones

If the stoes ae oud ad smooth they ae ease to dslodge ad ca mo e easly pass though the ducts If thee ae o e o oly a few stoes the passage s also ease. If thee ae may stoes the passage s moe dfcult Sze of the bile duct

If the b le duct s abomally shaped f thee ae fect o ad edema, o f thee ae adhesos aoud the duct these codtos wll aow the passageway ad thus the passage of stoes wll be moe dfcult. If lve ad gallb ladde fucto s abomal ad the seceto of uds s abomal o f the sphcte of Odd s  spas, the passage of stoes aga wll be moe dfcult. Howeve o ma tte  whe e the stoe s locate d  t he hepato blay system ths method may stll be used If thee s fecto peset, oe must fst clea the fecto Ths method should oly be used ate fecto ad ts accompay g ammato ad edema ae elmated

acn  an If the stoe s small  sze t wll usually pass wth lttle eacto If the stoe s lage thee may be stog eacto ad the physca should obsee the patet closely. Stog eactos clude the followg  If feve pa, apd pulse o jaudce appea dug o afte teatmet but the suddely dsappea look fo sgs of passage of the sto e by eamg the feces ad do g laboato y tests

96

 Gllld s

2 If abdomial pai ad distetio ad a feelig of stiess cotie if thee is sdde sevee pai that pesists if feve ad chills ad especially chills develop o if jadice ets ad coties oe mst immediately esot to sgical teat met I cases whee this teatm et doe s ot wok well the easo is sally that the stoe is ogh o thee is a choic iitated coditio

Acupunctur cpcte is capabe of stoppig pai elievig asea ad vomitig ad descedig coteow Comoly sed poits iclde Dan hu (Bl 19) Zhon Wan(CV 12) Zu an L (St 36) pai (GB4 )34) anse Ln Dan Nan u(MLE23) o oad jadice se n HQuan Gu (LI Gu(Bl 64) o feve s e Qu Ch  1 1) d fo vomitig se N Guan (Pe 6) Choose 23 poits each tie ad se deep stog stimlatio Teat 23 times pe day

Ectroacupuntur Needle Dan hu (Bl 19) o the ight side ad coec it to the egative pole The positive pole shold be coected to gallbadde poits 24)3)Zhon (CVwith 12) R Chon Yu (GB Wan (St 21 ) o oa (Liv t fist stat Lan Mn foot weak stimla tio ad icease its stegth slowly Coti e this fo 2030 mites 34 times pe day I pactice the sccess ate fo the above descibed combied ChieseWeste teatme t meth od is abot 72% wi th a fatality ate of 06% accodig to a stdy doe at the Shaghai Medi cal

9

 inal Sy

College n  97 Tere were 582 ses n is sudy of wom 4  9 psed be soes Ony 3 pesons ded

9

3  N Y Cholecystitis Accordig to oder Wester edicie ost cases of acute choecystitis are due to bacterial ifectio ad biliary tract obstructio . Chro ic cholecystitis o the other had, is usualy associated with the presece of gastoes

Act cocystts The sigs ad syptos of acute choestitis are persistet pai i the right upper quadrat which begis suddey ad ay radiate to the right shou der This is ofte accopaied by ausea voitig ad fever If there i s obstructio of the bili ary tract patiets will aso be jaudiced There is proouced abdoial tederess reboud tederess ad uscuar guardig or tesio i the right upper abdoe Occasioaly oe ca palpate a earged gallbadder There is also eukotosis eevated icterus idex ad esios o the iver ay also be preset

ce nal Snres

Cron oleystts Suffs of chonc cholss usually hav such chronc coplas as dscofo  h gh upp quada vagu pa adonal dson avson o gasy oy foods acd ucaon ad oh ndgso hr b slgh o no sypos ndnss ofupon palpaonr I s ay no uncomon fo suffrs of chronc cholss o hav pso ds of acu cho lcyss

a gag bia zheg Egt prnple pattern dsmnaton Cholss s osly an nrnal  full condo n Howvr  s sos classd n TCM  a ho yngfen dsas and ay aso b a d ful and py codo Whn  s a spl fu condon  s usually classfd as h a dap ha parn or a lvr q blood sass pan n  s a d full/py parn  s usually a cobnaon of dapnss ha and lv q wh spln/soach pnss

ag t bia zhg ag t pattern dsrmnaton Chols s s osly cagorzd spln/soach condon n CM as  h a lvr dsas o  a Bi yi bi ji

Dsas causs dsas mcansms  dsas causs and chanss of cholss and s gnral am n pncpls and hods a ssally slar o hos of chollhass In fac bcaus Wsr dcn



Choecys

ow beleves that soes ae volved  most f ot all cases of cholestts the pcple of expellg stoes s ow ouely used by coempoay Chese pacttoes of TC  the teatmet of all gallbladd e attacks As meoed above he dsease causes ad mechasms of cholests ae maly lve q ad blood stass causg pa due to obstucto damp heat  ad empess of the splee ad stomach Lve q s mostly due o emooal sess ad fustato Damp hea s mostly due o detay dsceto Ths mostly meas ove-eatg aw cold foods sweet sugay foods ad fatty geasy oly foods Splee/somach emptess ae lkewse caused by ove-eatg aw cold foods sweet foods ad damp foods such  mlk meat eggs etc. ad also by lack of execse ad excessve woy ad axety.

Ban zheng n zh

Treatent accordng to paHern dscrmnaton Gan dan shi re

vr/gabaddr dap at Pathognomic manistation Alteatg feve ad chlls o

feve wth o chlls pa  the ght uppe abdome o ght bs loss of appete a btte taste  the mouth possble ausea ad vomtg costpat o ed ue possble jaudce a ed togue wh yellow slmy coatg ad a wy (xan) slppey (hua ) apd (shu) pulse Tratmnt principls: Clea hea ad dshbt dampess

exted o elax the lve ad dshbt the gallbladde



 onal ynres

 n Chen H Tn

Heba eesiae Capiais (Yn Chen H) ucus adiae Jasioidis (Zh Z) Radix E Rhizoa Rhei (D Hn)

12 gas

6



-9



o aenaig fee ad chis add Radix Bupleui alcai ( Ch H) Raix Scuellaiae Baicalesis (Hn Qn) o hypochodiac ai a abdoial fuess add Tube Cucumae ( ln) ucus Iauus Cii Seu Pocii (Zh Sh) o ausea voiig ad idigesio add Caul is Babusae I Taeiis (Zh R) Rhizoa Pieiae Teaae (Bn X) In ce o f high feve add  os Loiceae Jaoicae (n H) ucus osyhiae Suspesae (Ln Q) Radix Isaidis Seu Baphicacahi (Bn Ln Gen) Gypsu ibosu (Sh G) o oss of appeie add ucus Paeaaus Caaegi (Tn Shn Zh)



Choleiis

Massa Medca ermetata (hen Qu) ructus Germatus Et Praeparatus Horde (Xang Ma Ya) Gan dan yu zh

Lvr/gabaddr dprsson & stagnaton Pathognomic maniestations Rght-sded hypochodrac pa sometmes radatg to the rght shoulder ad upper back epgastrc fulless ad dsteto aggravato by ager or eatg greasy oly foods loss of appette acd eructato ausea a red togue wth th yellow coatg ad a wry (xan) pulse Teatment pincipes: Relax or exted the lver ad dshbt

the gall bladder  Da Cha Hu Tang Radx Bupleur alcat ( Cha Hu) Radix Scutellarae Bacaless (Huang Qn) ructus Immaturus Ctr Seu Pocr (Zh h) Radix Et Rhzoma Rhe

9 grams 9

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



9



(Da Huang) Rhzoma Pellae Teratae 9 (Ban Xa) Rad Abus Paeoae Lactorae (Ba hao) 9 Rhzoma Reces Zgbers 3 (heng Jang) ructus Zzyph Jujubae (Da Zao) 3

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



ps

3

  

If here s audce add Herba Aemesae Capllars  e Hao) rucus Gardeae Jasmods Zi Zi) Corex Pheodedr Hua Bai) If here s om g add  Radx Scuellarae Bacaless Hua Lia) rucus odae Ruecarpae Wu Zu u) Cauls Bambusae I Taes Zu u) If here s cospao add Mrabum a Xiao) or prome sg s of splee empes s add Rhzoma Aracylods Macrocephalae Bai Zu) Scleroum Porae Cocors Fu Li) Radx Codoopss Plosulae Da Se) Te followg s a lsg of he os commoly used herbal medcals  he reame of cholecyss  Commo

CM

qregulag  edcals

rucus Cr Seu Pocr Z Ke) Radx Saussureae Seu Vadmrae u Xia) Percarpu Vrds Cr Reculaae Qi P Percarpum Cr Reculaae e P Radx Bupeur alca  ai Hu) uber Curcumae Yu li) Core Magolae Ocas  ua o)



Chliis

2 Stasstasfog dcals

Tub Cucua (u n) Rhzoa Coydals Yahusuo (an Hu uo) Cotx Radcs Mouta (Dn ) S Pu Psca (ao Ren) Radx Cyathula ( Chuan Nu X) 3 Hatclag dass-dshbtg toxsolvg

dcals Radx Scutllaa Bacalss (Huang Qn) Rhzoa Cotds Chss (Huang Lan) Fuctus ad a Jasods (h ) Radx taa Scaba (Long Dan Cao) Radx Bulu Falcat (Cha Hu) Flos Loca Jaoca (n n Hua) Hba Vola Ydoss (D Dng) Hba Atsa Callas (n Chen Hao) Rhzo a Polygo Cusdat (Hu Chang) Hba Dsod Styacho (n Qan Cao) Cauls Akba Mutog (Mu ong) S Platags ( Che Qan ) g bl (hu Dan h) 4 Pugatvs

Radix Et Rhzoa Rh (Da Huang) Mabltu (Mang Xao) 5 Sl-stgthg stoach-boostg dcals

Radx Abus Paoa ctoa (Ba hao) Radx Doscoa Oosta (Hua han ao) Rhzoa Atactylods ( Cang hu)

5

 omna Syndroms

Hba Agastachs Su Pogostm (Huo Xang) Hba Eupato otu (e Lan) Sm Rapha Sav (La Fu Z) Edothlum Co ga all ( Ne n) uctu matus Hod Vugas (Ma Ya) uctus Catag (Shan Zha) Massa Mdca mtata (Shen Qu)

6

4 D Do H o B Bilay Ascaass Ascas codesfecto may cause sympoms  both the lugs ad arge teste It may also cause obstructo of the blary tract Heavy testal fecto may cause abdomal crampg ad oasoally, testal obstructo. Besdes obstructg the ble duct adult worms may also though rarely obstruct the apped or pacreatc duct I Asa, Conorchs snenss s a commo cause of obstructve audce wth trahepatc ductal ammato promal stass stoe formato, ad cholagts I moder Wester medce such worm festato s usualy dagosed by dg eggs  the sool.

Ba gang bianpatern zheng dscrnaon Eght prcple Worm festatos ar e usually caegorzed a s speces of fuless However they are also ofe assocated wth splee/stomach empess as well Whether, full empty, or med they are a teral dsease.

 nl rs

ang f ban zheng ang f patter dscrnaton As wt h cholcystts a d chollthas s abov wom dsass a mostly assocatd wth th galbladd ad splnstomach Howv, as wll  thy may also b atd wth th lag tst

Bng yn bng j Dsease cause dsease ecans Woms o cho a catgozd as a b nei b wai yin o th tal o xt caus of dsas Thy a assocatd both wth dampss ad hat ad wth spl/stomach mptss As sadobfo damp hataccodg s th vomt coducv to cho woms/paasts to TM thoy It s also sad that cho a a mafstato of dampss ad hat Whth dampss gds hat o hat gds dampss oc damp hat allows fo wom fstato ths y vl futh obstuct  th low of q ad blood Ths may th futh aggavat hat whch may stw th jucs ad v cogal thm to stos

Ban zheng ln zh Treatent based on paHern dscrnaton Chong ji

Wor stanaton/accuuaton Pathognomic maniestations I ths codto th s

paoxysmal pa wth a dllg ssato Th may also b a btt tast  th mouth as wll as vomtus cotag woms. Th patt s usually foud lyg o h back ad guadg



Ba ara

teir abdome. Tey may aso be sweatig ad ave cod extremit ies. Their face may be greeis i ue wit wite spots Weever tere is o pai tere are usualy also o oter mptoms ad te patiet may fee orma. Durig acute episodes te puse is ypicay wi xan or tigt n ) Te abdomia musces are sot temperature i s usualy ormal ad ws may be sigty eevated eatment pnples Regulate te qi ad disiibit te

gallbladder activate te blood ad trasform stasis expel worms ad armoize te stomac  W e Wan

ructus Prui Mume W e 0-15 grams   Herba Asari Seiboldi  n Rizoma Desiccata Zigiberis  9 Gan an   ructus Zatoi S ao  9 Ramulus Ciamomi G  Radix Praeparatus Acoiti  6-9 Carmicaei F  Radix Coptidis Ciesis  - an Lan  Cortex Pellodedri an a 9  Radix Paacis Giseg Ren Sen 9  Radix geicae Siesis Dan G 9 To icrease atiemitic effect, add: ructus Quisquais Idicae S n  Seme Arecae Catecu n Lan Cortex Radicis Meliae Azerdacis K Lan Gen P Seme Torreyae Fe 

9

 n Syr

I order to purge woms va the bowes add Rad  Et Rhzoma Rhe (Da ang If here s o codess  the hads ad feet delete Ramu us Camom (G Z Rad Praeparatus Acot Camchael (F Z B

c



Seme Aecae Catechu (Bng Lang uctus Qusquals Idcae (S n Z Cote Magolae Ofcals (an o Rhzoma Coydas ahusuo (Yan  So Rad Saussueae Seu Vladmrae (M Xang Rad Et Rhzoma Rhe (Da ang Cote Poae Cocos (F Lng P)

5 grams 3



15



25



25



25



25



Seme Arecae Catechu (Bng Lang 3 gams uctus Qusquals Idcae (S  n Z 3 ructus Pru Mume (W Me 5 ps. uctus Zathoy Bugea  ( an ao 3 Heba Cum Radce Asa Sebold  (X Xn 3 Rad Saussueae Seu Vladmae  (M Xang 12

Bl ri

ructus Immaturus Citri Seu Pociri (Zh h Mirabilitum (Man ao Rhizoma Dessicata Zigiberis (Gan an Cortex Poriae (Fu Ln PCoris

 9



9



25





hong r

Wm a athognomic manifetation I this coditio the mai sigs

ad sptoms are similar to the previous coditio but with additioal digs There are alteratig fever ad chills a bitter taste i the mouth dry throat ad audice e togue is red orwith yellow fur ad ad rapid the pulse wiry ad rapid (an slippery The isw cout is high (hu (hua eatment incie Harmoize the hao an n clear heat

ad purge the bowels recede jaudice A. Da Cha Hu Tan a W (if fever  chills are promiet) Radix Bupleuri alcati ( Cha Hu Radix Scutellariae Baicalesis (Huan Qn ructus Immaturus Citri Seu Pociri (Zh h Radix Et Rhizoma Rhei (Da Huan Rhizo ma Pielli ae Teratae (Ban a Radix Albus Paeoiae Lactiorae (Ba hao

9 grams 

12 9



9



9



9





  Sy

Rhzoma Reces Zgbers  (Shen Jan 36 rucus Zzyh uubae (Da Za 35  Seme ecae (Bn Lan rucus Qusquas Idcae (Sh n Z Herba Desmod  Sryrachfo (n Qan Ca rucus Pru Mume (We Me I case of audce add Herb a Aremesae Calars (Yn Chen Ha rucus Gardeae asmods (Zh Z Core Pheodedr (Han Ba or omg add Rad Cods Chess (Han Lan rucus Eodae Ruecarae (W Zh Y or cosao add: Mrabum (Man a B Da Chen Q Tan Ja We(f hea   he somacheses s more rome ) Rad E Rhzoma Rhe (Da an 9 grams " 69 Mrabum (Man a Core Magoae Ofcas  (H B 9 cus Immaurus Cr Seu  Pocr (Zh Sh 9 Sem e Arecae (Bn Lan rucus Qusquas Idcae (Sh n Z



Blr rss

Hera Desod Styrachfol ln Qan Cao ructus Pru Mue W M or audce add Hera Arteesa Capllars n Chn Hao Cng u

rm fr Ptbognomc mnfesttions: Ths codto s accopaed y

hgh fever coa delru severe audce geeralzed adoal pa hard adomal ules ad reoud teder ess. The lver ad gallladder may e palpa le. Th e togue s deep red wth yellow fur The pulse s oodg hong The C hghcold as setremtes lood amylase. vpressure severe cases patetscout ay shave low  lood ad septc shock.  that ce the togue wll have scat fur The treatet for wor re s surgery u cng

dd rms Pthognomic manfestations  I t hs codt o the patet ma y

have slghtdsteto adoalHowever tederess o are deepopressure ad some soe adoal there other sgs of dsturace Teatment pinciples: Clear heat ad dsht dampess

regulate the q ad dsht the gallladder A Gallladder Stoeepellg orula

3

 n 

See above under cholelithiasis for this formula's ingredients

B

Concha Ostreae (Mu Li) Herba Desmodii Sachifolii (li Qi Co) erba Arteesiae Capillaris ( Che Ho) Fructus Gdeniae Jainoidis (Zhi Zi) Radix Saussureae Seu Vladimiriae (Mu Xig) uctus Immaturus Citri Seu Ponciri (Zhi Shi) Tuber Curcumae (Yu li) Radix Et Rhizoa Rhei (D Hug) Cortex Porae Cors (Fu Lig 

 5 grams





5











 



6





2



5



2



25



25



5



2



For convaleent or recovery stage:

A.



Semen Arecae Catechu (Big Lg) Fructus Quisquals Indicae (Shi fu Zi) ructication Polyori Mylittae (Lei W) Cortex Poriae Cocoris (Fu Lig Cortex Maoliae Ocinalis (Chu Po) Radix Et Rhizoma Rhei (D Hug)

Bl rss

B. Same  above plus ucus C Seu Poc (Zh Ke If he pae s vey cold add Radx Paepaaus Aco amchal (F Z Ramulus Camom ( G Zh If he pae has much hea add Heba Aemesae Capllas (n hen Ho ucus Gadeae Ja smods (Zh Z Radx E Rhzoma Rh (D Hng Heba Desm od Sachfol (ln Qn o Rhzoma Poygo Cuspda (H hng

5

5    Act Pcrtts Acut pacatts s usually assocatd wth bl ay tact dsa ad alcoholsm A moty of patts suffg fom pacatts about 2% do so bcaus of hdtay factos hyplpdma hyppaathyodsm hypcalcma tauma dugs stuctual abomalts vascula dsas sugcal atogss fctos tc. Th ga sgs ad symptoms of pacatt s cud sv abdoma pa adatg though to th back sudd ost sv stady bog pa uvd by posto chags but pottally aggavatd by coughg vgoous movmt ad dp bathg Most patts xpc ausa ad vomtg v to th pot of dy havs Patts appa acutly ll ad a swatg Rspat o s shallow ad tmpatu  tds to as as th pa cotus Th may b dlum ad smcoma ad possbl yowg of th sa. Th s always abdoma tdss whch s oft sv  th upp abdom ad ss sv  th low Th may b mld to modat muscula gdty  th upp abdom ad also dmshd bowl souds

 nal Synds

Ba gang bian zheng Egh prncples paern dscrmnaon Ts codto s a ta o. Bcaus t s mostly assocatd wt dampss ad at t s ypcally also a full o Bcaus tssv fullss ad att  t s o catg ozd as yag Howv codos may b sock  wc cas t codto may b catgozd as mpty cold ad tfo y

ang t bian zheng ang t pattern dscrmnaton Pacatts s most commoly catgozd as a spl/stomac CM

dsas acodg to It c owv also somtms b classfd as a lv/gallbladd codto

Bng n bng j Dsease causes dsease mechansms Pacatts s ypcally assocatd wt a umb of ot dsas codtos Tfo t a may typs of vs wc may accout fo t dpdg  tu upo ts ot codtos o stac f pacats s du to aloolsm cald ju p  Cs ts s a t tal o tal caus wc tds to gd dampss ad at tally If t s du to blay tact dsas ts a also mostly du to dampss d at but may volv stagat q du to sss ad fustato Log tm q stagato tds to gv s to blood stass atg gasy fatty foods kws gs s to h hang o food uy ad sults  dampss ad at Damp a t may g s to hong o woms ad may also bw ad stw ad cogal to stos. ut damp at may



Acu Pancra

tansfom into hot tons I addition ay of these auses ad mechanisms may be compliatd by food stagation

Bian zheng ln zhi Tatnt basd on patten iscriination Because of the lage umbe of disease auses potetially associated with acute paceatitis it is possble to diimiate the followig discete pattes: Qi zhl

 stagnaton e mai symptoms of this codition ae nausea ad vomitig and migating pai

X  Bod stass In this conditio one can fnd subcutaeous puple spots ad localized shap pain due to echymosis.

R  ot toxns is pathocodition is most oen the esult of qi and blood stagnation leading to ongestion and accumulation i n the ang mng with heat sigs ad symptoms. If e etes the ng o xue fen the esultig sigs ae cold limbs ad a miute we) pulse which idicates a collapse of yag

9

 on Synoes

Shi re

Damp at Ths codto s maly evdecd by jaudce ad slmy, yellow togue fu Cng ji

Worm stagnaton/aumuaton The sgs ad symptoms of ths pathocodto clude paosmal ad sve e pa c old sweats ad whte spots o the face o feulum Shi zhi

Fo stagnaton Whe food sagato occus ts sgs ad symptoms ae a feelg of fulless abdomal dsteto abdomal pa sou vomtus belchg ad a thck slmy coatg o the togue Shl zhi

Ston stagnaton  ths pathocodto thee s dull pa whc h causes a feelg of dstet o o colc  the ght hypochodu m Tee s also feve ad chlls costpato ad the occuece of whte stools.

Cobned Chnese-Westen dagnoss Atough TCM detfes all the above dete pattes assocated wth acute paceatts  clcal pactce t s muh ease ad tue to clcal eaty to maly focus o the dmato of 4 dstct pattes These 4 CM pattes ca



ue Pnes

aso e correated to moder Wester desriptios of specc ypes of pacreatts Zng jia qi zi

Mdd burnr q stagnaton The ma  sympoms of ths patter are migratg itermittet pa asea ad vomtg ad a asece of adomia distetio I moder Wester medice this patter s eqvaet to the sghty edeatous type of pacreatts i wei si re

pn stomac fu at Ths patter s due o q ad ood cogestio gig rise to depressve or cude rasformatve The sgs ad ths coditio fuess heat. ad sharp pai  thesyptoms abdome of associated wth te deress pus evi eterg the yang mngsigs ad symptoms I moder Wester medicie this codto correspods to he h eorrhagc or severey edematous ypes of pacreatits Zng ji sh re

Mdd burnr damp at Here the sigs ads symptos associted withstoe stagatio There distetomay paiead tederess the upper abdome sat cocetrated ure ad i ost cases jadice I moder Weste medce these sgs ad symptoms are cassified as pacreatitis acopayg iver/gaadder dsease



c na Snres

hong ji

 stagnatnaccatn he sypos of his codiio ar he exisece o a drillig pai ogeher wih oher sigs ad sypos of wor ifesaio I oder Weser edicie, his is cassied as iiary aariasis.

Zi ya tt pcp I cases of dap hea pacrea iis h e requisie  M reae pricipes are o clear hea ad disihibi dapess, diharge he iver ad disihibi he gallbladder, regulae he qi ad sop pai I cases of fu hea i he splee ad soach he priciples are o clear hea ad purge he ierior d i cases of wor sagaio/accuuaio, oe should cear hea disihii d apess diharge dowward ad expe wors or qi sagaio, he pricipes are o regulae he qi ad sop ausea ad voiig d i wor sagaio/accuuaio, he pricipes are o expe wors acivae he ood ad eiiae sagaio

Bia zeg l zhi Teatent ased on paHen dscmnaton Zhong jiao qi hi shi re

Mdd burnr q stagnatn & damp at Radix E Rhizoa Rhei (Da Han Radx Geiaa Scabrae (Lon Dan Cao Radix bus Paeoiae ciorae (Ba Shao Radix Saussureae Seu Vladiiriae (M an



cute Pncretts

Rhzoa oydas Yhusuo (Yan H So) Pi wei shi e

Snstmac u at Rad Rehaae (Sheng D) Mrabtu (Mang Xao) uctus Gardeae Ja sod s (Zh Z) Rad Abus Paeoae ctorae (Ba Shao) Rad Saussureae Seu Vladrae (M Xang) Cote Magolae Offcals han o) Rad Rubus Paeoe ctoe (h Shao) Rhzoa Coydas Yahusuo (Yan H So) Chong ji

Wrm stagnatnaccumuaton Rad t Rhzoa Rhe (Da Hang) Mrabltu (Mang Xao) ructus Garde ae Jasod s (Zh Z) Rad Abus Paeoae Lactoae (Ba Shao) Rad S aussureae S eu Vladae (M Xang) ructus Qusquals Idcae (Sh n Z) See Arecae Catechu (Bng Lang) Rhzoa Coydas Yahusuo (Yan H So) A the above forulas shoud be oded wth approprate addtos ad subtactos depedg upo the coplcatos ad sgs ad syptos of each ddual case However the rst foula s appopate as a gudg foula  the jorty of clcally pese tg cases of pacreatts

3

 ia Sys

For hot tois add Rhizoa Coptidis Chisi s (Hang Lan) Hrba Cu Radic Taaici Mogolici  Gong Yng) For dap hat add Hrba Artsia Capillaris (Yn Chen Hao) Hrba Ds odii Styrachifolii (ln Qan Cao) Radi Gtiaa Scabra (Long Dan Cao) Talcu (Ha Sh) Caulis Akba Mutog (M Tong) For coutrflow ivrsio of qi with voitig add Hamititum (Da Zhe Sh) Flos Iula (Xan F Ha) For food stagatio add S Raphai Sativi (La F Z) Fructus Iaturus Citri Su Pociri (Zh Sh) For uppr bac k pai  (e tong) add Fructus Trichosathis Kirlowii (Ga Lo) Bulbus Alii Chisis (J Ba) Radi Ldbourilla Ssloidis (Fang Feng) Rad Gtiaa Macrophylla (Qn Jao) For da ad uid rttio add Radi Euphorbia Kasui ( Gan S)



Ace Pns

or asses ad odulatios add Squaa Maitis Chun Shn J) Rhizoa Spargaii Sn Leng) Rhizoa Curcuae Zedoariae E Zhu) Durig the recuper atio stage the pathocoditio is ostly due to eptiess o f the sp lee  ad stoach. erefore oe should use S un Z Tngas the guidig forula. Radix Paacis Giseg Ren Shen) 9 gras Rhizoa Atractylodis Macocephalae   Zhu) 9 Sclerotiu Poriae Cocoris  9 Fu Lng)  Radix Glyrrhizae Gn Co) 3 If eptiess is accopaied by food stagatio use either: Png We Sn

Rhizoa Atractylodis  Cng Zhu) 9 Cortex Magoliae Ofcialis Hou u) 9 Pericarpiu Citri Reticulaae Chen P) 6 3 Radix Glyrrhizae  Gn Co) Rhiz oa Reces Zigib eris Sheng Jng) 3 ructus Zizyphi Juubae D Zo) 3





 





or o He Wn ructus Crataegi Shn Zh) Massa Medica eretata

9   gras



 a y

(n Q 9 Seme Raphai   F  9-12 Rhizoma Pielliae Teraae (Ban a 9 Pericarpium Ciri Reiculaae (Cn P 6 Scleroium Poriae Cocoris (F Ln 9 rucus orsyhiae Suspesae (Lan Qao 6-9

 









If there are sympoms of dampess bu wihou obvious hea use an Rn Tan: Seme Prui Aeiace (n Rn 9 grs rucus Amoi Cardomomi  (Ba Ko Rn 6 Seme Coicis chra-jobi  (  Rn 15 Rhizoma Pielliae Teraae  (Ban a 9 Corex Magoliae Ocialis  (Ho B 9  Talcum (Ha  115 Medulla Terapaacis Papferi  6 (Ton Cao Herba Lophaheri Gracilis (Z  6 Reak

1 f e paie is voiig rs perform acupucure a Z an L S 36 ad N Gan Per 6 ad he follow is wih

6

 Pacraii

gradual admisraio o small doses o oe of he above ormulas. 2 Do o purge oo srogly I he acue sage here should o be more ha 23 bowel movemes per day Reduce purgao as he sympoms mprove ad also begi o suppo he splee ad somach 3 U lower d osages o purgg edicals  preg a paes ad avoid blood-acvaig medicals o  ao uless idcaed by he sgs ad sympoms Eve he such medici als should be admisered wih car

Co o tpy  mos caseswih he eperaure reurs oThe ora aereds 3 days o reame he above proocols ogue o recover  4 days d e abdomal pa ad edere ed o disappear i 5 days



6 Ji Xing Chang Geg Zhu Ate Abdo i na  Obstrutin Mecacal obstcto o cessato o pestalss ca obstuct ete te lage o small teste Most oe ts s due to mecacal blockage de to bous bads ad adesos o caceato o a ea l c I  addto mecacal blkage ca also be cased by pmay o metastatc tumos mpacted eces stctu es due to pevous o  actve ammatoy dseases o te bowels testal woms gallstoes ad volvulus Adyamc leus o paalytc leus esultg  falue of oma testal pestalss s ost ote assated wt ta o eto petoeal fecto but may also volve mesetec sc ema sugcal atogeess taabdoal ematoa ea l o thoacc dsease ad etabolc dstubace such as hypokale ma Te geeal sgs ad symptoms of ths dsease deped upo whethe the testal obstucto s hgh o low patal o complete mple o stagulatd mechacl o paalytc. Vomtg campy pa ad dse to ae como I geal te hge the obstucto the less uppe abdoal dsteto ad te eale ad moe sevee th occuece o votg Complete mecacal obtucto of the small teste causes

Ace Amnal Sydrmes

svr trmttt colcky uppr abdomal pa usually rfrrd to th m dl but somtms radatg ovr th tr abdom Partal obstructo of th small tst causs smar but ss svr symptoms Obstructo of th arg tst s usually mor sdous  ost Abdoma dstto ad fulss of th aks ar mor promt Paraytc lus tds to caus svr abdomal dstto ad dstrss ad bst bowl souds. Stra gulato may b dcu t to dffrtat from smp obstructo Ost my b rapd wth svr cocky pa Th sgs ad symptoms tay ar smlar t o thos of mchacl obstruct o but gradually bcom thos of us ad prtots

a gang bian zheng Eight principle pattern discrimination I ts acut stags tstal obstructo s usually classd  as bg tr al, full ad hot Howvr  th  d stags  vry svr codtos or  th ldrly or chrocally l th may also b mptss of rghtous q

TCM

ang f bian zheng ang t pattern discrimination Th TCM orgabowl locato of ths dsas  th acut stags s  th tsts but at th d stag thr may also b damag ad jury (un hang of th q ad bood y ad yag of th tr body. I th rcovry stag thr may b damag ad mptss xu hang of th sp ad stomach

3

e min Orin

Bng yn bng j Dss ss dss ensms There are 8 evil qi aociaed wih acue abdomial obsrucio These are: qi, bood ( ho (, cold (ha food (h worms a dcomplicae soes (hoe These 8 evis or also (ch (haad oe ed o sad combie aoher isace i is vey commo o see qi ad bo od sagaio wih hea aumuaio ( ch

C CesWestn tt f te nstl sttn  e co mbied Chiese-Weser reame of acue iesia obsrucio is disease is divided ciicay io hree sages ad reame durig each sage is fouded upo boh ba h ad a Weser medical udersadig of he course of developme ad resouio o f his disea se Accordig o f h  or he combied CieseWeser medica approac o he diagosis ad reame of his codiio, ere are  sages  . Sagaio of qi 2 Blood sasis 3 Necrosis Eac of ese hree sages deribes he relaiv srugge beee igeous ad evi qi The usual course is ouied i e foowig diagram.

3

cut oinal Syndros

T C ours  f t stia  Ob strutio Eight Evil

Dyntin f Intetine u Bdy Funtin

�

0itetie ogeto i Qi congesion becomes bloo congeson.

Acmato  ogeti o of blood i tetie Seco nd sage changes ino hea,  hea daage to blood  ines tinal wall.

Neo

Sage I: Ileus, incread uppe inestinal moiit y, accumuation of Qi  ui,  istention of inesine

Stage II: Uppe abdoen is disended, was o f in esine  blo od vels of inestina embanes ae comped  obstced leading to dysfncion of blood ccuation Sage III: Intesina l wals ack blood whch leads to necoss  pefoaion Fluid  bacteial leak age then cause peionitis  eptic shock

Stag  The ig ad ymptom of itetal obtuto  patet with obut ghteou q ad oly mld evl q clude mld dteto ad o petoiti The pule  wy xan ad foceful u  I mode Wete medce th tage coepod to ucompcated leu the eay tage of mpe mechaial leu o ealy paalyt ile

3

  

Stag II I hs sage hee s sog evl q b u he g heous s s also sog The sgs ad sympoms of hs sage clude sevee abdomal pa wh dseo  he mddle of he abdome Papabe masses may be foud ad he abdome s ede. Thee s s o obous peos The pulse s wy an , sppe ha ad apd h The Wese dagoses fo hs sage cudes volvuus ad usep o A hs sage hee s also md faue of bood ccuao.

Stag I A hs sage hee s shock ad obsuco of he eus wh obvous bood sass The ev s deep  he eo ad gheous q s empy eThe pae poo h sp ad heady he geea codo s poo puses sapd  o mue wei) Abdomal pa ad dseo ae obvously aggavaed by peos. e Wese dagoses of hs sage cude sagulao obsuco of he leus ad pefoao

Bian hng ln zhi Tt bs o ptt scato The follow g eames may be used fo al  es of esa obsuco  The physca should f ollow he paes cod o vey closey wachg fo ay sg of ecoss o pefoao Should ehe of hese occu suge s he mpeave

33

Ace Aona Syndroes

Da chang qi zhi

arg ntstn q stagnaton The pcpal sg of ths patte s dsteto wth mmal pa fesh tup Mabltum (Mang Xao)

1 kg 1 g

o the edely o  tose who ae empty ad decet use Radx gelcae Sess (ang Gu) 25 gams  Seme Pu Pescae (ao Rn) 1 Pecapum Ct Retculatae 

(hn ) Vds Ct Retculatae 1 Pecapum (Qng )  Radx Lde ae Stychfol (a Wu) 5



Da chag xue yu

ar ntn bood stass I ths codto thee s moe pa ad less dsteto. The stools may be the colomay of coffee gouds localzed ad statoay Thee be palpable massad adpa thestoge s ethe dak o  pups h. Seme Pu Pescae (ao Rn) 5 gams Radx Rubus Paeoae coae  (h Shao) 25 Fos Catham Tcto

3

Ace Aoal Oro

Hong Ha) Radx Agelcae Sess Dang G) Corex Magolae Ofcals han o) Radx E Rhzoma Rhe Da Hang)

15



25



25



15



These are admsred 24 mes per day. Oe may also chose sead he follo g gudg form ula. Corex Magolae Ofcals 25 grams han o) Radx Saussureae Seu Vladmrae  15  Xang) Sem e Pru Perscae  15 ao Ren) Radx Lderae Srychfol  15 Ta W) Seme Rapha Sav  1525 La F Z) Radx Rubrus Paeoae Lacorae  15 h Shao)  1 Mrablum ang Xao)  olu Seae Fan Xe Ye) 15 Da chang re cheng

at accumuatng n t arg ntstn I hs case here s pa ad ederess fever hrs ay ure ad  severe cases coa ad delrum. Here oe should use he followg edcals. Corex Magolae Ofcals

35

e a e

(Chuan o) 2550 gams Sm Rahai Sativi  (La Fu Z) 25-50  uctus Citi Su Pocii (Zh Ke) 20  Sm Pui Psica (ao Rn) 15 Radi Rubus Paoia ctioa  25 (Ch Shao) Radix Et Rhizoma Rhi  (Da Huang) 25  Miabilitum (Mang Xao) 1525

Th ati t shoud dik this dcoctio o it shoud b admiis td though a stomach tub Th hbs shoud th b cookd ad admiist d 2 h ous lat as  ma Aoth altativ fomua cosists of: Rad Et Rhizoma Rhi (Da Huang) Miabilitum (Mang Xao) Radix Euhobia Kasui (Gan Su) Th atit should b watchd vy closly ad sugical ittio cos idd. Da chang han cheng

ar nttn cod accuuaton Th mtoms of this athocoditio a a acut attack of sv ai itolac of cold o th abdom a gish o dak facal comlio ad a d (chn) o tight n) uls o this coditio o should us 50 gams ach of th followig mdicials Radix Et Rhizoma Rhi (Da Huang)

36

e ial Oi

Rhzo ma D sscata Zgbs (Gn Jng) uctus Amom Cadamom (B D [wthout sk Powd th abov 2 hbs ad tak 5-15 gams of ths powd ach tm wth hot wat vry 46 hous Atatv omula: M Pulvs uctus Amom Cadamom (B D en wth lactos. Mak  ths  to plls a d gv a 4 gam dos Th thd altatv s to us Rad t Rhzoma Rh (D Hn 5 gams Rad apaatus Acot  5 Camchal (F Z Hba Cum Radc Asa Sbold  4 (X Xn Dcoct ths  wat ad admst tally 23 tms p day Da hang shi heng

Larg ntstn accumuaton of dampnss Th sgs ad symptoms of ths patt cosst of a flg of fullss ad dstto of th abdom galzd abdomal tdss watry abdomal souds slmy togu fu ad a ull (h ad slppry puls. Mdcals appopat fo us  ths ca a ulvs Radcs uphoba Kasu (Gn Si Fen dssolv at d a oth gdts hav

3

  Syns

15 grams bee decocted 1 Seme Prui Persicae (ao Ren) 15 Radx Rubrus Paeoiae ctiorae  25 (Ch Shao) Radx Achyrathis Bidetatae  (Sheng Nu X) 15 Cortex Magoli ae Ocialis  (Chuan o) 255 Radix Et Rhizoma Rhei  154 (Da uang) Radix Saussureae Seu Vladimiriae  (Mu Xang) 15 Before givig this formula orally oe mus asirate the stomach uids ad the give the decoctio via a stomach ube This should be doe 12 times er day Shi zhi

Food stanaton This coditio occurs followig a meal ad may occur ater excessive postpradial movemet or followig igestio of excessively rich foods It is characterized by the sudde oset of abdomial pai The patiet is ucomfortable whether erect or proe There is frequet vomitig ad the togue fur is slimy yellow The guidi g formul a cosists of Radix Et Rhizoma Rhei (Da uang) 15 grams Cortex Magoliae Ofcialis  ( Chuan o) 2  ructus Citri Seu Pociri (Zh Ke) 15  Mirabilitum (Mang Xao) 25 Massa Medica ermetata

3

Aute Aomnal Oruon

Shen Q) 15 ructus Germatus H orde Vulgars Ma a) 15 Seme Rapha Sat La F Z) 25 Percarpum Ctr Retculate 1 Chen P) Radx Glyrrhzae  Gan Cao) 1



 

 

Chong ji

Worm stanaton/accumuaton The symptoms cosst of a drllg pa vomtg of worms restessess ad paroxysmal umblcal pa Chnese herbal medcals approprate for use  ths codto are Seme BngArecae Lang) Catechu Cortex Porae Cocors F Lng P) ructus Qusquals Idcae Sh Jn Z) ructus Pru Mume W Me) Herba Desmod Styrachfol n Qan Cao) Cortex Magolae Ofcals

3 grams 3



3 15



3



Chan o)Seu Pocr Zh Ke) 9 ructus Ctr Rad Et Rhzoma Rhe Da Hang) 9 Mrabltum Mang Xao) 9



 

 

2  of the above decto should be gve by stomach tube ad left  the stomach for 2 hours after whch t should

1 39

Ac Amnl Snrms

be emoved. An altenative teatment fo empty patients with constipation is to use any vaiety of bean oil Xu xing

Empt parns Thee ae two basic empty pattens one may encounte in the teatment of acute abdomina obstuction These ae yin and blood emptiness and qi and bood emptiness Yin xue xu

Yn and bood mptnss Radix Rehmanniae (Shng D) Radix Panacis Qinquefolii

25 gams

(X Ophiopogonis ang Shn) aponicae Tube (Ma Dong) Radix t Rhzoma Rhe (Da Huang) Miabilitm (Mang Xao)

25 20





15



0



Ql xue ing xu  & bood dua mptnss Radix t Rhizoma Rhei (Da Huang) 0 gas Cotex Magnoiae Ocinais  (Chuan o) 0  ucts Citi Seu Poncii (Zh K) 0  Miabilitum (Mang Xao) 0 Radix Codonopsi s Pilosulae  (Dang Shn) 25 Radix Angeicae Sinensis



  

(Dng Gu Rad Glyrrha (Gn Co

2 5

 n

Fu mo ian /ian Pronal asons ntstnal adhsns n mdrn M ar dussd undr th hadng f ntstnal bstructn r ar bcaly  M patts asscatd wth ntstnal adhsns

Ql zhl   Th sgns and mptms f ntstnal r abdmnal adhsns du t stagnant q ar smlar t ths f q stagnatn typ abdmnal bstructn  pan tnds t m and g r mgrat. Thr s mr dstntn than pan And th pulse s w (xn)  M tratmnt prncpls fr rctng ths typ f ntstnal adhsns ar t mv th q and purg th bwls

Re heng H m mlar t th abv, th sgns and mptms f ths att ar smlar t th sgns and mtms f ht aumulatn ntstnal bstructn Th M tratmnt prncpls ar t clar hat and purg th bwls Th abv 2 attrns ar th mst cmmn ns atd wth ntstna adhsns



Ac Ainal Syndrs

H cheg

Cod accumuaton Lkws th gral sgs ad symptoms of ths typ of adhsos hav b  gv abov Th tratmt pr cpl s to warmly purgtubrculoss pattr s dblty commoly (we x) Ths  abdomal post-surgcal or coutrd  patts wth rpatd attacks. Xu cheg

Accumuaton du to mptnss Ths pattr s foud followg prologd dsas postsu rgcal ly  ldrly patts  q ad y dc patts or  patts w th ful vls bu t mptss of rghtous q  If drastc s usd  such patts t may damag purgato ad jur u thr x) rghtous q Thrfor o must us mostg mdcals to mldly purg ( x) or a comba to of both dschargg ad supplmtg mdcals Fu zhog xi yi uxie f

Combnd CnsWstrn aackn v mtod Mtod I Ths protocol s usd for th  osurgcal tratmt of varous sorts of obstructos ad tstal adhsos

rparaton Lowr th gastrc prssur for 1-2 hours promot vomtg gv uds travously ad prform a bopsy f cssary 7  Admstr a dcocto of th followg hrbs



 n Oon

Corex Magoliae Ofcialis Chuan ) 255 gras See Raphai Saivi  255 La Fu Z) Radix Rubrus Paeoiae Laciorae  Ch Sha) 25 Radix E Rhizoa Rei  Da Huan) 25  Mirabiliu Man Xa) 525 Give 2  of his decocio by soach ube ad he cap he ube Add or subrac edicias fro he above guidig forula depedig upo he ididual paies preseig codiio 8  Adiiser eecroacupucure. Neede Z San L S 6) biaera ly ad coec he posi ive pole o i. Neede Tan Sh (S 25) biaerally ad coec he egaive pole o i 8  Massage he abdoe for 5 iues Seec a sigle direcio eiher cockwise or couerckwise 9  Give a  eea wih he sae forua as used ab ove bu adiise r aog wih sal waer .

Mtod II This eh od is used for paies who are ep y ad decie.

Prparaton Decrease he soach pressure for /2 hour ad give uids iraveousy.

3

Ace Aoial Syndoes

7 AM v 2-3   ba l thugh a stach tub ad th clap th tub 8 AM Adst th sa hbal ula as usd  Mthd I s 1  ad admst by stach tub. 9 AM v a a wth th sa pscpt tgt h wth th salt  sapy wat. 90 AM Adst acupuctu wat dl (hu zhe) pt ct. Ict 0 g  stg (a uscl stulat) at Zu Sa  (St 36) 70-80%  patts wll xpc l  sypts 12-24 hus a ths cus  tatt I s patts hwv ths g ust b patd 6-7 ts.

Mtod  Ths ptcl  s usd  tstal bst uct du  t ws

rparaton Sa as abv 

7 AM ct 12 g tub.  a chld 1 ya ldus ly tugh 1-10 th.gastc Adst th xyg slwly s that th cplt ds s gv v a pd  1-2 hus Th patt ust b pstd  a sclg pstu. 8 AM v 2   vgtabl l  sy ba l by gastc tub.



 nal Oin

8:5  Massage the abdomen  descibed above. 83  Admnste eecto acupunctue Need e Da Hng(Sp 5) bilateally and attach to the negative poe Needle Z San Li (St 36) blateally and attach to the positive pole Ue egula waves fo 3045 minutes 9  Give an enema conssting of a wam 2% soluton of satwate Use 5-8 cc of wate heated to 445° C O, use 8 cc of suga wate The patients mptoms should be e duce d in 1224 hous If this does not occu suge should be consideed



7 Lan Wei Yan A p pe   c  t  s Aute appendiitis is due to bateial infetio of the veifo appendix It is os oonly seen in adoleents and young adults between the ages of 1524 Clinial sigs and sptos va depending upon the ause and eten of peitonitis Typially, onset is ked by sevee loalized o diffuse abdoinal pain Thee is usually odeate abdoinal distention nausea voiting ad oasionally diaea in the ealy stage In additio, thee is diet abdoinal tedeness, ebound tendeess and aked usula spas As the ondion pogesses bowel souds ease Feve, tahyadia hills apid beathing, and leukotosis e sigs of sepsis Ealy leukoosis ay give way to leukopenia in fulinant ases Dehydation and aidosis develop if the disease is not teated

e mnl Syndrmes

Ba gang ban zheng Et pncpe patten scnat Acute appendiciti i pimaily an intenal, ful hot, yang dieae

ang f ban zheng ang f patten scrnat Acute append iciti i alo called chang yongo intetinal abce in Chinee Theefoe, thi dieae i categoied a a age intetine dieae.

Bng n bng j Dsease causes sease mechanss Thi dieae i moty due to qi tagnation eading to blood tai Thi tagnatin tanfom into heat and thi heat may futhe tanfom into toin Adoecent typically epeience a cetain amount of futation. At the ame time, thei mng men zh huo o ife gate fie i jut matuing and i buning bighty. Thi then tend to enhance the tanfomation of tagnation into heat and epeciay in the loe bune. Thi condition i ao oen compicated by damp heat due t o young adult' tenden oveeat geay, fatty and toeet food.and alo to eat typically pi

Cbned CneseWestern stagn  acute appendcts In the pactice of combined ChineeWeten medicine, thee ae 3 mao tage in the coue of development of acute appendiciti Thee ae



ndcHs

Stage 1: Blood sasis and accumulaionockage Stage II Iniial fomaon of us Stage III Toic ulceaion Stage Il Puulece  selling

n ace

Th cose ad he developmen of appendcs can be seen in he folloing

T Cours & Patoo  o Appdts PATHOLOGY Lge inteine Fu gn dyuntin

CAUSES Fd, entl iit tin h & ld ut  hny

Dycto ad Sta ga io  of Qi -   aa tio of bood  bood i appdix obtct th appdx

1-

_ _ 

Cogio of Q i   - fcio  bood t ito ha

Act pt gago appdc fom p typ)

Accumua ton of   - Celu it is,

hat  io p

Simp appdiciti (bood agaio yp)

phgm p gag

I

P  po a io    fo a io  - -  Pioii

�Ga

Loca

I

Ab  appdx abc typ)

I

Proi  pr oc )

9

e ona Syndroe

Sian zheng ln zhi Teatet base  atte isciiati Qi zhi xue xu

 stanaton bood stass Pathgni anifestatins h i abdomial pai aoud

th mbilic o localizd pai  i th iht low  quadat. Th pai i ot v ad th i oly a mall aa of localid td Th i o had of th abdomial wall Th to ha a thi whit coati ad th pu i ith wiy (xan o ld (huan )  If th pul i wiy thi idicat taatio If th pul i huan o ad thi idicat pl mpti complicat i th patit coditio I thi ca th liv ad pl a ot hamoio with liv wood bi full ad pl ath bi pty. Th patit tmpat ad wac cot a both omal eatent pinples Co th liv ad ulat th qi

activat th blood ad tafom tai hamoi wood ad ath ad top pai Cau i Satodo a (Da Xue Teng Hba Viola Ydoi (D Dng Fct Mlia Toodai ( Chuan Lan Z

9 am 3 -45



155



Q xue yu hua e

 & bood stanaton transform nto at Pathgn anifestatins I thi patt, i ad ymp

tom of taat qi ad blood pit bt ymptom of vil hat

5

cHs

ae oe ponent. Abonal pan  oe evee the aboen  akely tene, an the panful aea  we pea The tongue  e wth ye llow fu an the ul e  w (xan) an ap (hu) o lppey (hua an ap (hu) The w ount  lghtly elevate at aout 1   Treatment principles: Move the q an atvate the bloo lea

heat an puge the bowel Caul Sagentooae (J Xu Tng) Cote Bebe Sagentanae (an K Zhn) Ra Et Rhzoa Rhe (Da Huang) Mabltu (ang Xao)

6090 ga -4



1-2 -

 

Th foula ay alo be ue fo oe evee ae of q an bloo tagnaton a ebe n the pevou patten o fo lght ae of the followng patten Lan wei l yang chuang kong

Toxc ucraton Pathognomic manifestations: Th onto n evelop fo the

peeng one The abe uptue at th pont Abo nal pan beoe even oeay evee the ule ae ha an g, an thee  aute tenene The panful aea  wepea . Thee  hgh feve tht , an  the tool  ha an y Une  anty an ak The tongue  e wth yellow y fu The pule  loong (hong) an ap (hu) o lppey (hua) an ap (hu) W ae akely elevate If the onton  etemely eve e, t ay ehaut both n an yang.

5

Ace Aoal Sdroes

The paien will hen appea o be wihou spii Thee is sweaing and he eeiies ae cold Th e pulse hen is inu e Tx: These cases us always be eaed sugically

du

Re he knot and bnd Hat &jie toxns Pathognom manfestatons: Thi is an alenae senaio o

he peceding paen which can also develop fo sagnaion of qi and blood ansfoing ino evil hea In his case paiens ae vey song and have vey song and abundan igheous qi Theefoe hea and oins kno and bind ogehe and fo a ass The pain is localied in he igh lowe quadan Thee is ende ness of he abdoinal wa ll and a ass ay Thee be palpable heisabdoen ae sof is soeHoweve feve andohe hisaeas The of uine yellow The ongue is dak puple wih ecchyoic spos o paches and he fu is eihe hin, whie o yellowish in hue The pulse is slippey, wiy, o hidden ) Treatment prnples: Clea hea and esolve oins, dispese

swelling and scae nodulaion sop pain Caulis Sagenodoae Da Xue eng) Coe Radicis Mouan Dan ) Fos Loniceae aponicae n Yn Hua) Seen Puni Pesicae ao en) Spina Gledischiae Zao Jao C)

5

6090 gas " 0 2 0



0



s

Flos Lonca J aponca (huan ua Squa ma Papaat a Mants (Duan Chuan han Ja Fuctus Mla Toosndans (Chuan an 

115 15

II

15

I

Fo p atn s suffng fom th st zhn o pattn, us   o ao pac p day Dcoct n wat and ta n 2 ddd doss Fo patn's wth th scond and fouth zhn o pattns, us 2 ao  day i.e, doubl t do and fqun of admnstaon

53

Index aneism 8 0 4 4 5 6 8 8

diagnes 39 stage patten dicrimination 23 phe patten dirimination 22 stage pattern discrimination 22 principle patern discriminaion 22 principles 52

A abdomin disention 14, 15, 23 25, 26, 29, 30, 33, 56 72, 78 86, 00,  13 120  12 , 29, 130 14 7 abdomina musces hard 90 1 13 abdomina pn cr 4 abdomina pan merate to vere 15

oexa 2, 13 antacids 6, 79 ibi 52 anxiety 20, 67, 86 0 apndiciis 3, 7, 2, 4, 24  36 42, 45, 6, 147-49 apndicii ace 2, 36 47149 apndiciis mild oc 36 apndiciis uceraive  apie, l of 7, 72, 86, 01, 03 ahitis   Asca rd 07 atonic conditions 2 aopine 55 aackng evil meh 9 22 42

B

abomina igidty 5 abscees in he abdomina vity 42 aching 8 16 acid eaion 00, 03 acid/ baance  acidosis 147 acupuncre 9 54-56, 60 74, 78 95, 97, 26 143145

ba ga 22, 23, 52 66 84 00, 07 18,  1 ba gang bian ng 22, 23 66, 84 100 107,  8, 130, 4 8 Ba Z a 45 back pans coic 30

ace abdomina syndromes 1,  7, 31, 32 acue gtrneitis 12 adhesions intesina 7, 24, 5, 14, 42 adhesions onea 14 adnexa ms 6 aavaion b y nge 03 egic facors 1 1 yl evel 4 ylnirae 94

bactei conamination 0 Bai Hu ang  Bai ou Wng 45 Ban Xia Hou Bu ang 48 Bao H Wan 56 25 Bao H Wan ia Wi 56 beching 25 29, 72, 120 beneiisk naysi  bian ng un z 2 86 0 08, 119, 22, 133 150 biia iis 7 30 07 122

55

c onal Synros biliay diorder t hitory of 7 bilia tract 0, 7 36 3 8,  00 07,  7,  8 bing ji 3, 66 85, 0 , 08,  8, 3 , 8 bing in bin e 3 5 bioy 

bitter e i the mou  9 0  6

0 09

97 98 Bl 78 B 78 B B 97  ayl 3  rere 0,  3 iy coitutio  y id ater dirimiatio  orom  oel abi cae i 7

reathi Bu Di Wnraid 50 7 Bu Zhg  Qi ng 9

c cer 3, 8, 36, 69 cer colo  8 cacer acreatic  8 cardiac outut o 57 caulia   hi Hu Shu n Sn 5 hi Hu ng , 75 80, 86 03    chng ong 8 cael ad coecti vee atte dicrimiato  chemotheray 3 choletii 7, 3 , 36, 37, 5, 8, 90, 990, 0, 08 cholelithiai 7, , 9 36, 37, 83, 8, 90, 93, 0 , 08,   coleterol 8 chong 5, 9, 30, 36, 3, 9 86, 07,

56

08, , 3 9, 0  3, 3, 39 chong bn  chong huo  3 chong ji  08 0 , 3, 39 chroic diverticliti 8 chrooo of mtom 33

onh sinei 07 cold ad ra f 86 coma , 3, 7, 35 comatti ifeio ae 75 comied CieeWete medicie  5, , 63 69, 8 coetive ea failure 5 cocious o of 7 coiatio -, 7, 8, 3 33, 3 57, 68, 7, 77, 0  0,  , 0, 39 cotiaio ad diea alteati 8 coroa ear diea 8 coro cio   "cover the cer" ae 70 cra 

     



55, 7, 78, 97, 98 55  60 5 60

D D hai Hu ng 75 86, 03,  D hi Hu ngJi Wei  Da heng Qi ng 7, 76,  D huan Po ng5, 56 D Heng 5 Da un n  Dn Shu 95 97, 98 dehydraio 7 delirium 3 7, 3, 7, 35 diabeic coma   diaoi, Weter dieae , , 39

Inx

dirhea 12, 15, 18, 2, 26 1 diarrhea bly 15 drhea prolonge 2, 26 eta nreton 101 ierental diagnosis 2, 33 2 diuse abdomn pan 12, 1

fever and chlls 16 9 101 102, 111 120 fever an chl, altenatng 101, 102,

disee cau pae discrmnaion 23 25 ese mechanms 66, 101, 118, 131 18 dsenton  shk 68 stenton of vcera suaces 10 dizne 2 drugs 11 du 2   52 66, 6 0, 86, 88 1 19 152 uenal bulb 9

fever wt n o chills 101 atulen 13 1 aus inabiliy to ps 1 ud reention 12 f stgnation 25 29, 119, 120 12 125, 138 fenulum whte s  on the 120 frusaon 6, 86 101, 118, 18 Fu Fang Da Chi Hu Tg5 Fu Fang Da Chng Qi Tang , 6  zhg 22,  fu zhg xi yi 2 21, 31 131 12

E edema 96, 12 electoacupuncure 95, 9, 13, 15 eectole baance  embolsms 10 enema 19,  136 1315 eucations 1 eophagus 9 ev q 22, 23, 32 2, 5, 131133 exen applitons 61 exemiies, wam 5

F faintng 2 faigue 58, 1 fatty f noleance 13, 1 fec impacted 129 fetal siion 1 fever 12, 13, 16 23, 33,   68, 8890, 95, 9, 1-102, 111 113 120, 135, 1, 151, 152

Ill fever hih 23, 33 88 102, 113, 151

G glbladde 9, 13 18, 25, 33, 5, 83-86, 89, 996, 98 1 102 103, 108 109, 113, 11, 118, 121, 122 gasone 8 , 9 Gsone-ellng Fomula , 9 gan ran  g, png of 25 gaic ulcer  1 GB 2 95, 98 GB 3 9 Ge Xia Zhu Yu Tang  8 Guan Yn 60

H hds and feet cold 1 Hao Qin Qng DanTang  He Gu 9 hematoma ntraabomna 129 hemorhang 



e Amnal Syndrme eatic d lle oberao o 15 eedita aco 117 e ter 1 1 icc 6 55 ito o exal exe 6 Hg Li We D g8 nge 6 7 o Xg Zheg Qi S 8 dloic acid 65, 66, 95 bibinemia 3 1 lpidemia 17 paratroidim 117 rrta 1 acemia 1 kalemia 9 teion 5

cem meeterc 19

J jandi ce 3 85, 89 9 9 9, 9597 , 1 7 13  

adice evee 13  e i zheg  ig  97

K kde oe 3 kidne  5 6

L laboao tet 3 39 95 97 icte idex elevated   ile adnamic 9 ie paratic 19 13 13 digeio 6 56  1 iectio gocal 16 inection o mce  inection retoitoneal 19 inection  5  7 inammation 7 , 33, 6, 96 7 inammation paietal itonea  intetinal abce 8 intetinal adeion 7  5,  

ea obco 3 7, 1, 1719  33 35 36 , 17 19, 333 ,  ntetina obtction eal 

intetina intetinal iteinal intetinal intetinal iitation

5



obtction mecanc 7 ond , 5 tact lowe 33 tract p 33 becloi  cemical 7 7

lage ntetine 9, 7 59 7 8 3 337 8

eakage o d   o e abdomna cavit 7 lektoi 1 3  1, 7 lekonia 7

u 11 97 u  97 Li Zhog W 8, 79 Lig Me 78 95 98 i fe i zheg  Liv 3 95, 98

ver 9,671,75, 6 37 1 5, 8 73 79 8 8587  9 96 66, 113 113, 118 11 , 15

live leon on te  lver/gabadde 9 5 5, 86  3, 18  Log D ie  g 5, 88

lo o contol o te ina badde 



M M2 97 magneium ulphate 95 Mai Men Dong Tang 8 ms 3ulato  megead 25 m palpable 23 27 6 7 8 33 mechancal pree 7 metaVemotiona diturbce 26 meenterc ichemia 29 meenteric vula infction 5 mente 7 0 morphne 9 MS 2 muce gurding 3 23 mucular rigdity 8 mucular muco 65

N nauea 2 7 26 29  5 68 7 8 86 9  97 00 02 03  7   9 2 22 7 necoi 33 3 33 Nei Guan 55 7 97 26 Nei Ting 56 eotigmie  epholithia 9 neul egmet 9 euophilia 2 New Medcie 2 nonluive ntetinal ichema 0

0 ey 8 obrucon 3 7 0  79 2 33 35 36  2 69 72  00 0

07 2933 0   oga/owe paer dicrimaton 22 25  85 oxygen 

p pain, abdomial 25 00 pain crampy 29 pan hyhodiac 02 03 pain lowe abdomina 3 6 pain migatg 25 9 pa meate o evee abdomina 5 pain paoxyma 0 0 pan paoma with  dr  ng naion 09 pan rcrng abdoma 6 pan evere colck 30 pan hap due o ecchymo 9 pai omatc 8 pai vcera 8 papable me 23 27  7 8 33 palpitatio 27 pac 9 paceatic ce 8 panceatiti  7  2 6 2 5 723 paito 30 50 parieta ioeal inammation 0 lvic ammatoy ieae 0 lvc ogan 7 pin 65 pc ulce oaio 3 9  68 ptc ucer 7 65 66 Pe 6 55 7 97 26 rforaon compex 68 rforaion mpe 68 rta 9 53 29 tona adhon 

1 59

Acu Aonal ynro oem 7 8 19 69 70 o 7 18 24 42 61 69-71 74

75 77 78 130 132 133 147 rmblc  12 rro eo 26 eche o he oe 27 hycl emo 34

68 69 90 113 11 133

yoc yor obrco obrco 36 of he 69

Q 22

R

RA

2

rdo 3 rebod edee 12 70 100 1 13

147 ecovey  47 recm 9 eco 47 48 51 125 eo 72 ero dhrm 8 reee 23 29 139 R  95 98

6

 sn jo bn hng 23 Sn Rn ng 126 Sn n Jo 54 56 60 r e 7 1 cer yeow of e 30 118 ec hk 36 113 Shh Medc Coee 98 sho ng fndee 1  Shn u Tng 49 Shng M Sn J W 57 Shi n 60 hk 14 15 24 27 28 32 36 57

hyc  34 P Shu 78 Png Wi Sn 54 125 o 11 18 74 o, ed 18 r 11 18 dl flle 13 17 ce 6 1 oo 1 4 ro 42 43 59 127 142 o cold 42 43 e moe 43

q & b er dcmo q . bin zhng 22 Q l 97 qu : 19 22 36 40 142

re of bdom erm 1 0

hk reeo of 57 hoe of beh 26 Si Jn Z Tng 50 125 Si N Tng J Wi 58 i hn 39 ckle ce em 1 0 mod coo 1 8 k d 27 57 SLE 2 m ee 9 17 129 130 S 6 54 56 60 S 9 60 moc 79 c coco 7 hce of Odd 96 e 1 1 ee 9 25 29 42 458 50 52 53

66 67 71 72 79 85 86  94 100 101 104 106 108 118 121-123 125 27 30 150 eeomc 25 29 42 45 47 66 67 71 79 85 100 101 108 118 S 21 78 95 98 S 25 55 56 143 S 36 5456 74 78 97 26 14 314 5

Idx

St  6 stages o eae 2, 2 31 32 tagng 1  tomah , 9,  9, 2 26 29, 2, , 9 2 3, , 9 66, 6 68 69, 1 88, 8, 9  11 16 8 19 12, 18, 2-123 12, 12 13 136 38 39, 13 1 stones 2, 2, 3 36, 86 93 96 98 1 1 8,  19, 31 ts  1, 9 st whte 3, 2 stguaon 36, 3 133 te 6 2, 86,  18 tutua abnomaltes 11 suptng the ghteous 22 supapub egion 9

suge 1, 3 3,   1 , 3  69, 3, 81, 9 13 33  suga aogenesis  29 ea od 8, 68 eatng 1 2 , 19, 1 1, 1 2 eatn sntaneous 2 temi ses 8

T

12 taton o meente 1 auma 1 11 eaen based on paen diminaon 2  8  9 22, 33, 1 ent ehs 21 39 ,  eaent pnpes 21 39, ,  , 1, 2  , 9, 8 86 89 1113 19, 111 11 122 11  1 12 thomonis 18 tipe heate patten iminaion 2 tubeua ionts 18 tumos 18 129 tumos mettat 129

u "ueepaiing stage 1 ueaton , 6 8, 19 1 uema   uete  3 una adde 2, ,  una etenion  uteu 26

tabes os  2 tahyada 1

v

Ta Chong 9, 98 tesies toion o  1 this  2 88 89 92 , 3 1  1 , 2 tho  1 hooses    Shu , 6 13 wn T  teness 26 toion  1 , 36 tons  19, 32, 2,  2,  6, , 1, , 86, 88, 119, 2, 8

vaum  vua disease 1 vu disodes  vemfo apnd  viea  vta signs  voe fan o eebe 26 volvuus  29 133 vomtng 12,  26 29, 33, 1, 8   9 68, , 6 8, 86 92 9,

6

Ace Aoa Sydoes 000 0 , 7, 9    6 9, 3 39  7 omng md 3 oms ontanng oms 09

w

0 0 7 3 7 ang Lng Qn 97 ang Wi ang 0  an Jan 9 n hn ao ang , 9 0 n hn h F ang 90 n Lng Qan 60

an q  WBC on 3     3 0  aknss   q ng  an zhng 3 W h 7  zhng  h ss on h ac 0 om f 36 3 om ss 30 30, om sanaon/acmaon 0 0  3 39 oms  9, 30 36, 3 9, 6, 07-0 3 9  9 3, 39  o 67 6 0 W  Wan0 09  ng an hng 

X X Jao D ang ang  Xng a L n  ang  Xao h  ang Xao L hng Wan ja W 79  a    q  3  n  n   Xa  Da h h ang X  an0

y an  6 69 70 77   9 99

6

z ang  an hng   66  00 0  30  h a  39 h an  39   hg Wan   7 7 79 97 9  an L -6 7 7 97 6, 3 o n Wan 

About he Author Ate stdyng as an ndegadate at Columba College n Chicago and at UC Beeley Alon Macs gaduated om te Ameican College o Taditonal Chinese Medicine in San Fancsco Followng gadaton he contned his stud es n te clincs o  Agela Wu and D Miam ee Upon comple tion o license in te state o Calonia n 984, D. Macus tavelled to China whee he did an ntenshp in the Gang zho Mncipal TCM ospital. te tuning om China e eceived his O degee om Sama Unvesity in os geles. . Macus i cuently in pivate pactice in Beeley Caliona whee e wos n a amly pactce setting wth Westen medical pactitiones.