Treatment 3) Bleeding under the skin A) Blood heat Signs & Symptoms: –Main Sym. : Suddenly onset, purple spots or plague in skin –Concurrent sym.: blood from other sites such as nose, intestines or bladder, mental restlessness, thirsty, constipation, fever at night. –Tongue: red body without coating, red points all over –Pulse: rapid & fine Treatment Protocol: –Expel poison –Clear away heat –Cool blood to stop bleeding

Formula: Modifications: Harmonize blood (stop bleeding, eliminate stasis, calm & nourish blood) -- Qian Cao Geng, Di Yu, Gou Qi Zi Astringe -- Shan Zhu Yu Abdomen pain + hematochezia -- Mai Dong, Yu Zhu, Tian hua feng Blood heat is very pronounced -- Zi Cao Xi Jiao Di Huang Tang Shui Niu JiaoShen DiMu Dan PiChi ShaoShi GaoZhi Mui Zhi ZiCe Pai YeGan Cao

Treatment 3) Bleeding under the skin B) Yin def. type empty heat Signs & Symptoms: –Main Sym. : purple spots or plague under the skin –Concurrent sym.: blood from other sites such as nose, intestines or bladder, flush cheek, restless, hot sensation in the palms & soles. Thirsty, lower fever, night sweating. –Tongue: red body without coating, red points all over –Pulse: floating-empty or slightly-rapid Treatment Protocol: –Nourish Yin –Clear empty heat –Stop bleeding

Formula: Modifications: Yin Def. -- Gui Ban, Bie Jia, xuan sheng, nu zhen zi, han lian cao Kidney Yin Def. -- Liu Wei Di Huang Wan Qian Gen San Qian Cao GenHuang QiEr JiaoCe Bai Ye

Treatment 3) Bleeding under the skin C) Qi Def. fail to govern the blood Signs & Symptoms: –Main Sym. : Chronic purple spots or plague under the skin opens from time to time –Concurrent sym.: dizziness, poor appetite, mental & physical lassitude, pale or swallow complexion –Tongue: swollen light color with white thin fur –Pulse: thready & weak Treatment Protocol: –Tonify Qi to govern blood

Formula: Modifications: Stop Bleeding -- Xian He Cao, Zhong Lu Tan, San Qi, Pu Huang, Qian Geng Tan, Xue Yu Tan Loose stools -- Shan Yao, Lian Zi rou, Qian Shi Kid Def. -- Tu Si Zi, Shan Yu Rou, Xu Duan Kid Yang Def. -- Xian Mao, Rou Gui Gui Pi Tang Dang ShenHuang QiBai ZhuDang GuiFu LingSuan Zhao Ren Long YanMu XiangYuan ZhiSheng JiangDa Zhao

Treatment 4) Coughing blood A) Wind-Dry-Heat Signs & Symptoms: –Main Sym. : Itchy throat, cough with blood-tinged sputum –Concurrent sym.: dry mouth & nose, light aversion to cold, stuff nose & headache, nosebleed, –Tongue: Red on the sides and front part, dry –Pulse: Floating rapid Treatment Protocol: –Expel wind –Clear heat –Stop bleeding

Formula: Modifications: Lung heat -- Shi Gao Stop bleeding -- Qian Cao, Ou Jie Wind-heat -- Yin Hua, Lian Qiao, Niu Pang Zi, Ju Hua Fluid damage -- Mai Dong, Xuan Shen, Tian Hua Feng Sang Xing Tang Sang YeXing RenSha ShenBei MuZhi MuHuang Qin Shan Zhi ZiSang Bai PiCe Bai yeBai Mao GenDan Dou chi

Treatment 4) Coughing blood B) Liver fire invading lung Signs & Symptoms: –Main Sym. : Cough with fresh-red blood in sputum –Concurrent sym.: Hypochondrial pain, irritability, easily lose temper, a bitter taste –Tongue: Red with yellow coating –Pulse: wiry & rapid Treatment Protocol: –Clear Liver-Fire –Clear the lungs –Cool blood to stop bleeding

Formula: Modifications: Lung heat -- Huang Qin, Zhi Mu, Shi Gao Stop bleeding -- Ce Bai Ye, Bai Mao Geng, Han Lian Cao, Da Ji, Xiao Ji, Qian Cao, Ou Jie Liver Fire -- Dan Pi, Zhi Zi, Huang Qin Abundant fresh-red color blood -- Xi Jiao Di Huang Tang + San Qi, Da Huang To treat Qi Rebellion -- Mu Li, Niu Xi Xie Bai San + Dai Ge San Sang Bai PiDi Gu PiGan CaoJin MiQin DaiHai Ge Ke

Treatment 4) Coughing blood C) Lung-Yin Def. with empty heat Signs & Symptoms: –Main Sym. : Cough with scanty blood-tinged sputum –Concurrent sym.: dry throat, afternoon fever or feeling of heat, night sweating, 5-palm heat –Tongue: Red without coating, dry –Pulse: float empty Treatment Protocol: –Nourish Lung Yin –Clear empty-heat –Stop bleeding

Formula: Modifications: Lung heat -- Bai Wei, Qin Hao, Bie Jia Stop bleeding -- Ce Bai Ye Night sweating -- Ru Dao Geng, Fu xiao mai, wu wei zi, Mu li Bai He Gu Jing Wan Bai HeSheng diMai DongXuan ShenBai shaoDi Gu Pi Bei MuCe bai yeBai Mao genBai JiGan CaoDang Gui

Case History 1. Female 67 years Medical history: Medical history: She had TB of the lungs for 40 years, had been suffering from breathlessness for many years. First visiting: Main complain: coughing of blood-specked sputum breathlessness on exertion, general exhaustion and coughing of blood sputum. Night sweating, dry throat, and fever in the afternoon, was very prone to cold which immediately affected her chest and caused bronchitis with the expectoration of profuse yellow-greenish sputum. Overweight body type, Tongue: slightly red, swollen with a rootless coating in the front part Pulse: Slippery TCM diagnose: Lung Yin Def. + Spleen Qi Def. Treatment protocol: Nourish Lu. Yin, Clear Empty-heat, Tonify Sp Qi & resolve Phlegm Formula: Bai He Gu Jing Wan

Treatment 5) Blood in the stools A) Damp-heat in the intestines Signs & Symptoms: –Main Sym. : Fresh blood in the stools –Concurrent sym.: loose and frequent stools with mucus, burning sensation in the anus, abdominal pain –Tongue: Red with yellow-sticky coating on root, with red spots –Pulse: slippery-rapid Treatment Protocol: –Resolve dampness –Clear heat –Stop bleeding

Formula: Modifications: Yin Def. -- Bai Shao, E Jiao, Shen Di Stop bleeding -- Bai Ji Di Yu San Di YuQian Cao GengHuang QinHuang LianZhi ZiFu ling

Treatment 5) Blood in the stools B) Stomach & Spleen Def. Signs & Symptoms: –Main Sym. : Profuse fresh blood in the stools –Concurrent sym.: slight abdominal pain, pale face, exhaustion, depression, loose & frequent stools with mucus –Tongue: pale tongue –Pulse: thready weak Treatment Protocol: –Strength the spleen –Warm the centre –Stop bleeding

Formula: Modifications: Yang Def. -- Lu Jiao Shuang, Pao Jiang, Ai Ye Stop bleeding -- Bai Ji, Wu Zei Gu Huang Tu Tang Zao Xing TuGan CaoShen Di HuangBai ZhuFu ZiEr Jiao Huang Qin

Case History 1. male 60 years First visiting: Main complain: Blood in the stools for 2 years No abdomen pain and his bowl movements were loose and very frequent. The blood was fresh-red and haemorrhoids were excluded as a cause of bleeding. He felt very tired most of the time and felt the cold very much. Even in summertime on a hot day when he came for his consultation he had a jumper and a jacket on. Tongue: Pale swollen and had a white-sticky coating Pulse: Generally weak, especially so on the right-middle position TCM diagnose: Spleen Yang Def. + Internal cold Treatment protocol: Tonify & warm Sp yang Formula: Li Zhong Tang

Treatment 6) Blood in the Urine A) Bladder Heat Signs & Symptoms: –Main Sym. : Scanty-dark urine with fresh blood –Concurrent sym.: Mental restlessness, thirsty, insomnia, red face, tongue ulcers, bitter taste –Tongue: Red with redder tip, with yellow spots, or red spots on the root –Pulse: Rapid, slightly overflowing Treatment Protocol: –Clear heat from bladder –Stop bleeding

Formula: Modifications: Xiao Ji Ying Zi Sheng DiXiao JiHua ShiTong CaoPu HuangDan Zu Ye Ou JieDang GuiShan Zhi ZiGan Cao

Treatment 6) Blood in the Urine B) Kidney Yin def. with empty-heat Signs & Symptoms: –Main Sym. : Scanty-dark urine with blood –Concurrent sym.: dizziness, tinnitus, back-ache, exhaustion, feeling fever in the afternoon, night sweating –Tongue: Red without coating –Pulse: floating-empty Treatment Protocol: –Nourish kidney Yin –Clear empty heat –Stop bleeding

Formula: Modifications: Empty Heat -- Han Lian Cao, Qing Hao Zhi Pai Di Huang Wan Zhi MuHuang BaiShu diShan yaoZe xieFu ling Mu Dan PiZhi Mu

Treatment 6) Blood in the Urine C) Spleen Def. not controlling blood Signs & Symptoms: –Main Sym. : Chronic bleeding in the urine –Concurrent sym.: dizziness, tiredness, pale face, no appetite, depression –Tongue: Pale –Pulse: weak Treatment Protocol: –Tonify the spleen –Stop bleeding

Formula: Modifications: Stop Bleeding -- Xian He Cao, Zhong Lu Tan, San Qi, Pu Huang, Qian Geng Tan, Xue Yu Tan Loose stools -- Shan Yao, Lian Zi rou, Qian Shi To treat Qi -- Shen Ma, Cai Hu Gui Pi Tang Dang ShenHuang QiBai ZhuDang GuiFu LingSuan Zhao Ren Long YanMu XiangDang GuiYuan ZhiSheng JiangDa Zhao

Treatment 6) Blood in the Urine B) Kidney Qi not firm Signs & Symptoms: –Main Sym. : Chronic bleeding in the urine with pale blood –Concurrent sym.: dizziness, tinnitus, sore-back, exhaustion –Tongue: Pale & swollen –Pulse: weak Treatment Protocol: –Tonify kidney Yang –Stop bleeding

Formula: Modifications: Stop Bleeding -- Xian He Cao, Zhong Lu Tan, San Qi, Pu Huang, Qian Geng Tan, Xue Yu Tan Wu Bi Shang Yao Wan Shao YaoRou Cong RongTu Si ZiBa Ji TianDu ZhongShu Di Niu XiShan Zhu YuZe XieWu Wei ZiChi Shi ZhiFu Shen

Case History 1. Male 75 years First visiting: Main complain: bleeding in the urine for 3 months no pain on urination and the blood was dark, sometimes with tiny clots. He felt generally hot and his mouth felt very dry and hot Tongue: Red dry and nearly completely peeled Pulse: Floating-empty TCM diagnose: Kid. Yin def. + empty fire Treatment protocol: Nourish Kidney yin, clear empty fire, stop bleeding Formula: Sheng di 6, Shan Zhu Yu 3, Shan Yao 6, Ze Xie 4, Fu Ling 6, Mu Dan Pi 6, Zhi Mu 4, Huang Bo4, Xiao Ji 6, Pu Huang 4, Dang Gui 6, Mu Li 12

Palpitation TCM Diagnoses and Treatments Palpitation involves pavor and severe palpitation which denote the subjective symptoms of the patients: pulsation, terror & unease Etiology & Pathology: Main pathogenesis of bleeding: The focus of the disease is at Heart (Sp. Kid. Liv. Lu.) 1) Lacking of self-confidence & timid 2) Heart blood insufficient 3) Hyperactivity of fire due to Yin def. 4) Heart Yang Def. 5) Excessive fluid invades the heart 6) Blood stasis blocked channels

Treatment 1) Timid Signs & Symptoms: –Main Sym. : Palpitation, usually frightened and liable to anger –Concurrent sym.: feel restless, sleeplessness, dreaminess –Tongue: thin and whitish fur or normal –Pulse: weakly rapid, knotted or intermittent or string-like Treatment Protocol: –Calming the mind –Nourish the heart

Formula: Modifications: Calm the mind -- Ci Shi, Hu Po, Heart Qi Def. -- Dang Shen, Zhi Gan Cao Heart Yin Def. -- Bo Zi Ren, Wu Wei Zi, Suan Zhao Ren An Shen ding Zhi Wan Fu LingFu ShenYuan ZhiRen ShengShi Chang PuLong Chi

Treatment 2) Heart blood insufficient Signs & Symptoms: –Main Sym. : Palpitation, dizziness & weakness –Concurrent sym.: pale complexion, tiredness, fatigue –Tongue: light red –Pulse: thin & weak Treatment Protocol: –Nourish heart blood –Calm down mind

Formula: Modifications: Tonify heart Qi -- Zhi Gan Cao Gui Pi Tang Dang ShenHuang QiBai ZhuDang GuiFu LingSuan Zhao Ren Long YanMu XiangDang GuiYuan ZhiSheng JiangDa Zhao

Treatment 3) Hyperactivity of fire due to Yin def. Signs & Symptoms: –Main Sym. : Palpitation, unease, vexation, sleeplessness –Concurrent sym.: feverish sensation in the palms and soles, soreness of waist, tinnitus, dizziness, –Tongue: red tongue, without coating –Pulse: thin & rapid Treatment Protocol: –Nourish yin & purging fire –Calm down mind

Formula: Modifications: Empty fire of heart sym. ( dry mouth, throat, restless) -- Huang Lian, or Zhi Bai Di Huang Wan Heart Qi Def. -- Dang Shen, Zhi Gan Cao Heart Yin Def. -- Bo Zi Ren, Wu Wei Zi, Suan Zhao Ren Tian Wang Bu Xing Dan Ren ShengDan ShengFu LingWu Wei ZiYuan ZhiJie Geng Dang guiTian DongMai DongBo Zi RenSuan Zhao RenShen Di

Treatment 4) Heart Yang Def. Signs & Symptoms: –Main Sym. : Palpitation, restlessness, oppressed feeling in chest, shortness of breath –Concurrent sym.: pale complexion, cold limbs –Tongue: light whitish tongue, –Pulse: weak or deep thin or infrequent, knotted or intermittent Treatment Protocol: –Warm heart yang –Calm down mind

Formula: Modifications: Warm Yang -- Fu Zhi, Gan Jiang Tonify Heart Qi -- Huang Qi, Huang Jing Gui Zhi Gan Cao Long Gu Mu Li Tang Gui ZhiLong GuMu LiGan Cao

Treatment 5) Excessive fluid invades heart. Signs & Symptoms: –Main Sym. : Palpitation, restlessness, oppressed feeling in chest, dyspnea, edema –Concurrent sym.: dizziness, cold limbs, feeling of stuffiness and fullness in the chest, thirst, nausea and vomiting of water fluid –Tongue: whitish & slippery coating, –Pulse: taut & slippery pulse Treatment Protocol: –Activating the heart yang –Promoting the circulation of qi to induce diuresis

Formula: Modifications: Nausea & vomiting -- Ban Xia, Chen Pi, Sheng Jiang Kidney Yang def. -- Zhen Wu Tang Lin Gui Zhu Gan Tang Gui ZhiFu LingBai ZhuGan Cao

Treatment 6) Heart blood stasis Signs & Symptoms: –Main Sym. : Palpitation, restlessness, chest pain –Concurrent sym.: oppressed feeling in chest, unease, dark purple lips and nails –Tongue: dark purple, –Pulse: knotted, intermittent or uneven Treatment Protocol: –Remove blood stasis

Formula: Modifications: Warm heart Yang -- Gui Zhi, Gan Cao Calm mind -- Long Gu, Mu Li Phlegm block the channel -- Gua Lou xie bai Ban Xia Tang Tao Ren Hong Hua Tang Tao RenHong HuaDan shenChi ShaoChuan XiongYuan Hu Xiang FuQing PiShen DiDang Gui

Case History 1. Female 54 years Medical History: Patient had a fever 2 month ago, after the fever was gone, patient started feeling palpitation. She had looked for several doctors, but no one can help her, which caused her feel depressed. She could sit whole day quietly without talking to anyone… First visiting: Main complain: Palpitation for 2 month Insomnia, lower fever sometimes, small quantity of menstrual flow with light color blood T ongue: Pale body with thin white coating P ulse: Floating-empty T CM diagnose: Depression damage Sp. Function Sp Qi & Heart Blood Def. reatment protocol: Tonify Sp Qi & heart blood F ormula: Ren Shen 5, Bai Zhu 10, Huang Qi 10, Zhi Gan Cao 10, Dang Gui 10, Fu Shen 10, Yuan Zhi 10, Suan zhao ren 30, Mu Xiang 3, Ye Jiao Teng 15, Bai shao 15, Sheng Jiang 5 p, Da Zhao 3 p