1. Bleeding: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

2. Bleeding Primary HemostasisPrimary Hemostasis Complex chain of events involving interaction ofComplex chain of events involving interaction of PlateletsPlatelets Vessel WallVessel Wall von Willebrand’s factorvon Willebrand’s factor FibrinogenFibrinogen Secondary HemostasisSecondary Hemostasis Complex interaction of the intrinsic and extrinsic clotting cascadesComplex interaction of the intrinsic and extrinsic clotting cascades Stabilize the platelet plugStabilize the platelet plug

3. Primary Hemostasis Evaluated by the bleeding timeEvaluated by the bleeding time Platelet numberPlatelet number Amount and Quality of the von WIllebrand’s factor VIII:AgAmount and Quality of the von WIllebrand’s factor VIII:Ag Fibrinogen concentrationFibrinogen concentration Other alterations due to vessel wall disordersOther alterations due to vessel wall disorders

4. Secondary Hemostatis Assessed byAssessed by ACT (activated clotting time)ACT (activated clotting time) APTT (activated partial thromboplastin time)APTT (activated partial thromboplastin time) PT (prothrombin time)PT (prothrombin time)

5. TCM Pathoetiology HeatHeat TongueTongue Red & DryRed & Dry PulsePulse Superficial (forceful) & fastSuperficial (forceful) & fast Spleen Qi DeficiencySpleen Qi Deficiency TongueTongue Pale & moistPale & moist PulsePulse Deep & weak (particularly on right)Deep & weak (particularly on right)

6. Spleen Pathology Damp Hot Food or Drink Damp Hot Environmental Conditions Damp-Heat in Spleen Transform & Transport Disorder Disharmony of Qi Flow Accumulated Heat & Damp

7. Heat Hemorrhage Herbal treatment depends upon locationHerbal treatment depends upon location BladderBladder Red Front DoorRed Front Door GI tractGI tract Sophora PowderSophora Powder Great Saussurea CoptisGreat Saussurea Coptis Red Back DoorRed Back Door PulmonaryPulmonary Red LungRed Lung NoseNose Single ImmortalSingle Immortal UterusUterus Wu Bei SanWu Bei San

8. Spleen Not Controlling Blood Hemorrhage Spleen Fails to Hold Blood Chronic Hemorrhage General Signs Prolonged Spleen Qi Deficiency

9. Darby SignalmentSignalment 5 yr FS Doberman5 yr FS Doberman HistoryHistory Generalized weaknessGeneralized weakness EcchymosisEcchymosis Abdominal bleedingAbdominal bleeding TCVM ExamTCVM Exam Tongue: paleTongue: pale Pulses: deep & weakPulses: deep & weak Dx: Spleen Qi Deficiency (not holding blood in vessels)

10. Darby Western RxWestern Rx Compressive bandageCompressive bandage Hemorrhage controlHemorrhage control CryoprecipitateCryoprecipitate Whole BloodWhole Blood Thyroid medicationThyroid medication TCVM Rx AP SP Qi Tonic BL-20/21, SP-6, SP-9 & CV-6 Stop Hemorrhage Tian Ping & BL-17 Herbal Yunnan Pai Yao Huang Tu Tang

11. AtractylodesBai ZhuStrength Spleen & tonify Qi Yellow EarthZao Xin TuWarm Spleen & stop diarrhea AconiteFu ZIWarm Spleen AsinumEr JiaoNourish Blood RehmanniaSheng Di HuangNourish Yin ScutellariaHuang QinStop bleeding & prevent excess heat LicoriceGan caoHarmonize

12. Muscle Wasting: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

13. TCM Muscle View Muscle volume & strength is under the domain of the SpleenMuscle volume & strength is under the domain of the Spleen Spleen transforms food and transports it to the body to provide energy & building blocks.Spleen transforms food and transports it to the body to provide energy & building blocks. Spleen Qi provides muscle strengthSpleen Qi provides muscle strength Liver blood provides enduranceLiver blood provides endurance Continued delivery of Spleen Qi to musclesContinued delivery of Spleen Qi to muscles

14. Western View of Muscle Wasting Generalized WastingGeneralized Wasting MalnutritionMalnutrition Insufficient intake of materials to support Spleen QiInsufficient intake of materials to support Spleen Qi Cardiac CachexiaCardiac Cachexia Heart failure leads to stagnation of bloodHeart failure leads to stagnation of blood Liver is unable to support distribution of blood & QiLiver is unable to support distribution of blood & Qi Leads to accumulation of Damp in SpleenLeads to accumulation of Damp in Spleen Results in Spleen Qi Deficiency with failure to provide energy and building materials to the musclesResults in Spleen Qi Deficiency with failure to provide energy and building materials to the muscles Cancer CachexiaCancer Cachexia Tumor Necrosis Factor poisons metabolism leading to Spleen Qi DeficiencyTumor Necrosis Factor poisons metabolism leading to Spleen Qi Deficiency Diminished effective delivery of energy to musclesDiminished effective delivery of energy to muscles Localized Wasting Trauma Local damage of muscle Disuse Atrophy Local stagnation results in Liver failure to support Spleen/Stomach Accumulation of Damp alters Spleen function Local stagnation decreases delivery of nutrients Neurogenic Atrophy Denervation leads to local liver stagnation Results in failure to support spleen Qi Leads to decreased delivery of local channel energy

15. Wei Syndrome Damp Heat Earth personalityEarth personality ObesityObesity History of damp heat in skin or GIHistory of damp heat in skin or GI Muscle atrophyMuscle atrophy WeaknessWeakness LethargyLethargy Greasy wet tongueGreasy wet tongue Fast pulseFast pulse Si Miao San Qi/Yang Deficiency Lethargy, shortness of breath, weaknessLethargy, shortness of breath, weakness Too weak to get up to walkToo weak to get up to walk Loose lipsLoose lips Loose stoolLoose stool Anorexia & EmaciationAnorexia & Emaciation Dry-burnt hairDry-burnt hair EdemaEdema Heat seekingHeat seeking Pale wet tonguePale wet tongue Thready & weak pulseThready & weak pulse Bu Yang Huan Wu Qi/Yin Deficiency EmaciationEmaciation Weakness in lumbar regionWeakness in lumbar region Heat seekingHeat seeking Dry skinDry skin Pale or red & dry tonguePale or red & dry tongue Weak & thready pulseWeak & thready pulse Hindquarter formula

16. Jake HistoryHistory Progressive weakness in rear legsProgressive weakness in rear legs Cool seekingCool seeking Rear leg muscle atrophyRear leg muscle atrophy Dry hair & skinDry hair & skin TCVM ExamTCVM Exam Pulses deep & weak (< R)Pulses deep & weak (< R) Red dry tongueRed dry tongue DX: Qi/Yin Deficiency

17. Jake’s Treatment APAP EAEA SP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai huiSP6-SP9 (b), ST36 (b), LI10 (b), GV14-Bai hui DNDN BL20, BL23, BL26, KID3BL20, BL23, BL26, KID3 AquaAqua SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26 HerbalHerbal Jia Bing FangJia Bing Fang

18. Jia Bing Fang Astragalus Huang Qi Tonify Qi Condonopsis Dang Shen Tonify Qi Polygonum He Shou Wu Nourish Blood and Jing Rehmannia Shu Di Huang Nourish Blood, Yin and Jing Paeonia Bai Shao Yao Nourish Blood and soothe Liver Qi Dioscorea Shan Yao Tonify Qi and nourish Jing Prunella Xia Ku Cao Soothe Liver Qi, clear Heat Cyperus Xiang Fu Move Liver Qi and relieve nodules Bupleurum Chai Hu Soothe Liver Qi Sargassum Hai Zao Transform phlegm, clear Heat, soften the hardness the hardness Laminaria Kun Bu Transform phlegm, soften the hardness, drain water hardness, drain water

19. Sam HistoryHistory Chronic rear leg weakness and muscle wastingChronic rear leg weakness and muscle wasting Dry hairDry hair Weight lossWeight loss TCVM ExamTCVM Exam Red dry tongueRed dry tongue Weak thready pulses (< R)Weak thready pulses (< R) DX: Qi/YinDeficiency

20. Sam’s Treatment APAP DNDN GV20, BL20, BL23, BL26GV20, BL20, BL23, BL26 AquaAqua SP6, ST36, BL23, BL26SP6, ST36, BL23, BL26 HerbalHerbal Hindquarter formula (tea pills)Hindquarter formula (tea pills)

21. Hindquarter Formula Eucommia Du Zhong Tonify Kidney & strengthen back AchyranthesNiu Xi Tonify Kidney & strengthen the hind limbs Lindera Wu Yao Move Qi and relieve pain Astragalus Huang Qi Tonify Qi Apis Feng Hua Fen Tonify Qi and Yin Morinda Ba Ji Tian Warm and strengthen the back Angelica Dang Gui Nourish Blood Rehmannia Shu Di Huang Nourish Yin and Jing Cinnamon Gui Zhi Warm the Channels and benefit the limbs