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Golden Chamber 3

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• Chapter 17 On Pulse Syndrome Complex and Treatment of Nausea and Vomiting, Retching and Diarrhea

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• Concepts– Vomiting: vomitting with sound and things out

of mouth is named as Ou, while without sound is named as Tu

– Retching: Belching– Diarrhea

• Combined in one chapter because: – Location: ST– Etiology: Middle Jiao dysfunction

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• Causes and pathogenesis– Water retention 【 2 】

• Differential diagnosis for vomiting caused by water retention

• Vomiting thirst relief• Thirst vomiting water retention (in Stomach)• Vomiting no thirst water retention 支饮

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• Causes and pathogenesis– Deficient cold

• 【 3 】 Pathogenesis for deficiency cold in stomach– Rapid pulse – Should be heat in stomach

» Vomiting ?» Promoting sweat Yang deficiency » Rapid pulse deficiency heat » deficiency cold in stomach

– Wiry pulse stomach deficiency– Vomiting

» Purging weaken the stomach wood overacting on earth• 【 5 】 Pathogenesis and prognosis for both spleen and stomach de

ficiency vomiting – Fu Yang pulse Jiexi (St 41 解溪 ) – Floating deficiency– Hesitant spleen deficiency fail to digestive food– Vomiting with undigested food spleen Qi deficiency with adverse risin

g of stomach Qi – If see tense pulse difficult to treat excess cold in stomach

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• Cautions and Forbidden Stuff– 【 1 】 Treatment principle for vomiting with stoma

ch ulcer • Vomiting w/ pus – let px vomit.

This is a way to eliminate the pus/pathogen accumulation. Do not treat vomiting only.

– 【 6 】 Evils in upper position contraindicate to purging not middle Jiao stagnation

• Vomiting • No purging

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Ou Tu

• Vomiting• Differentiation and Treatment

– Deficient cold type of vomiting• Liver stomach deficient cold

– Vomiting w/fullness in the chest/epigastrium area

• –Wu zhu yu tang 【 8 】 Evodia Decoction 吴茱萸汤– 吴茱萸 wu zhu yu (Fructus Evodiae Rutaecarpae)

– 人参 ren shen (Radix Ginseng)

– 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

– 大枣 da zao (Fructus Zizyphi Jujubae

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Ou Tu

• Vomiting

• Differentiation and Treatment– Deficient cold type of vomiting

• Extreme Yin rejects yang – severe case– Sx: Vomiting, weak pulse, no urinary difficulties, fever, co

ld limbs– Difficult to treat (due to severe Ki yang qi collapse)

• si ni tang 【 14 】 Frigid Extremities Decoction 四逆汤

– 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)

– 干姜 gan jiang (Rhizoma Zingiberis Officinalis)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)

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Ou Tu

• Vomiting

• Differentiation and Treatment– Deficient cold type of vomiting

• Deficient cold in Middle Jiao w/vomiting• da ban xia tang 【 16 】大半夏汤

– 半夏 ban xia (Rhizoma Pinelliae Ternatae)– 人参 ren shen (Radix Ginseng)– 蜂蜜 feng mi (Honey)

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Ou Tu

• Vomiting

• Differentiation and Treatment– Excessive heat type of vomiting

• Excessive heat in stomach and intestines– Vomiting right after eat d/t excess heat rejecting food

• da huang gan cao tang 【 17 】大黄甘草汤 – 大黄 da huang (Radix et Rhizoma Rhei)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)

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Ou Tu

• Vomiting• Differentiation and Treatment

– Excessive heat type of vomiting• Heat obstructed in Shaoyang

– Sx: Vomiting, fever – Rx: xiao chai hu tang 【 15 】 Minor Bupleurum Decoction 小

柴胡汤» 柴胡 chai hu (Radix Bupleuri) » 黄芩 huang qin (Radix Scutellariae Baicalensis)» 半夏 ban xia (Rhizoma Pinelliae Ternatae)» 人参 ren shen (Radix Ginseng)» 甘草 gan cao (Radix Glycyrrhizae Uralensis)» 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)» 大枣 da zao (Fructus Zizyphi Jujubae

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Ou Tu• Vomiting• Differentiation and Treatment

– Excessive heat type of vomiting• Heat type of vomiting with diarrhea, retching

– Heat in ST (vomiting) and LI (diarrhea)– Damp heat diarrhea with blood and pus

• huang qin jia ban xia sheng jiang 【 11 】黄芩加半夏生姜汤

– 黄芩 huang qin (Radix Scutellariae Baicalensis)– 半夏 ban xia (Rhizoma Pinelliae Ternatae)– 白芍 bai shao (Radix Paeoniae Lactiflorae)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)– 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)– 大枣 da zao (Fructus Zizyphi Jujubae

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– Water retention type of vomiting• Cold water retention

– With Vomiting

• xiao ban xia tang 【 12 】小半夏汤

– 半夏 ban xia (Rhizoma Pinelliae Ternatae)– 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

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– Water retention type of vomiting• Severe cold water retention

– Vomiting with watery saliva

• Ban Xia Gan Jiang San 【 20 】 半夏干姜散– 半夏 ban xia (Rhizoma Pinelliae Ternatae)– 干姜 gan jiang (Rhizoma Zingiberis Officinalis)

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– Water retention type of vomiting• water retention above diaphragm

– Thirsty, drink, vomit

• zhu ling san fang 【 13 】猪苓散方– 猪苓 zhu ling (Sclerotium Polypori Umbellati)– 茯苓 fu ling (Sclerotium Poriae Cocos)– 白术 bai zhu (Rhizoma Atractylodis Macrocephalae)

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– Water retention type of vomiting• Qi disorder due to water retention, vomiting with thirst

– Vomiting then thirst afterwards.

• Fu ling ze xie tang 【 18 】茯苓泽泻汤– 茯苓 fu ling (Sclerotium Poriae Cocos) – 泽泻 ze xie (Rhizoma Alismatis Orientalis)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)– 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)– 白术 bai zhu (Rhizoma Atractylodis Macrocephalae) – 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

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Yue

• Retching– Treatment principle 【 7 】

Based on soothing Qi stagnation. Qi stagnation causes ST qi to go upward.

Retching and hiccups are related. Hiccups are usually due to Liver and diaphragm spasms.

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Yue

– Differentiation and Treatment• Stomach cold with qi disorder

– Retching and cold extremities

• Ju Pi Tang 【 22 】橘皮汤– 橘皮 ju pi (pericarpium Citri Reticulatae )– 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)

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– Differentiation and Treatment• with stomach heat

– Retching– Restlessness– Thirst– Rapid pulse

• Ju Pi Zhu Ru Tang 【 23 】 橘皮竹茹汤– 橘皮 ju pi (pericarpium Citri Reticulatae )– 竹茹 zhu ru (caulis bambusae in taeniis )– 大枣 da zao (Fructus Zizyphi Jujubae ）– 人参 ren shen (Radix Ginseng)– 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)

Yue

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Xia Li

• Diarrhea

• Treatment principles and contraindication – Damp type—promote urination 【 31 】– Contraindication to deficient cold type—do not

promote sweating 【 33 】

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• Differentiation and Treatment– Deficient cold type

• Deficient cold type of diarrhea with exterior syndrome– Rescue interior first

• si ni tang 【 36 】 Frigid Extremities Decoction 四逆汤– 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)– 干姜 gan jiang (Rhizoma Zingiberis Officinalis)– 甘草 gan cao (Radix Glycyrrhizae Uralensis)

• Gui Zhi Tang 【 36 】– Cinnamon Twig Decoction 桂枝汤 (Gui Zhi Tang) . regulate Yi

ng and Wei » 桂枝 gui zhi (Ramulus Cinnamomi Cassiae)» 白芍 bai shao (Radix Paeoniae Lactiflorae)» 甘草 gan cao (Radix Glycyrrhizae Uralensis)» 生姜 sheng jiang (Rhizoma Zingiberis Officinalis Recens)» 大枣 da zao (Fructus Zizyphi Jujubae)

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• Differentiation and Treatment– Deficient cold type

• Extreme yin rejects yang– Diarrhea, sweating, cold extremities

• Tong Mai Si Ni Tang 【 45 】通脉四逆汤– 附子 fu zi (Radix Lateralis Aconiti Carmichaeli Praeparata)– 干姜 gan jiang (Rhizoma Zingiberis Officinalis) double dosage– 甘草 gan cao (Radix Glycyrrhizae Uralensis)

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• Differentiation and Treatment– Excessive heat type– 大承气汤 Da Cheng Qi Tang 【 37 】【 38 】【 3

9 】【 40 】– 大黄 da huang (Radix et Rhizoma Rhei) – 厚朴 hou po (Cortex Magnoliae Officinalis)– 枳实 zhi shi (Fructus Immaturus Aurantii)– 芒硝 mang xiao (Mirabilitum)

– 小承气汤 Xiao Cheng Qi Tang 【 41 】– 大黄 da huang (Radix et Rhizoma Rhei) – 厚朴 hou po (Cortex Magnoliae Officinalis)– 枳实 zhi shi (Fructus Immaturus Aurantii)

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• Differentiation and Treatment– Diarrhea with pus and blood

• Deficient cold– Diarrhea with pus and blood

• 桃花汤 Tao Hua Tang 【 42 】– 赤石脂 chi shi zhi (hallyositum rubrum )– 干姜 gan jiang (Rhizoma Zingiberis Officinalis)– 粳米 geng mi (rice)

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• Differentiation and Treatment– Diarrhea with pus and blood

• Heat toxin type of diarrhea with tenesmus – Fever, thirst, tenesmus, blood in stool with more blood than pus– Red tongue, yellow coating– rapid pulse

• Bai Tou Wen Tang 【 43 】白头翁汤– 白头翁 bai tou weng (Radix Pulsatillae Chinensis )– 黄连 huang lian (rhizoma coptidis chinesis )– 黄柏 huang bai (cortex phellodendri )– 秦皮 qin pi (Cortex Fraxini )

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• Differentiation and Treatment– Diarrhea with pus and blood

• diarrhea with restlessness

• Zhi Zi Chi Tang 【 44 】栀子豉汤– 栀子 zhi zi （ gardeniae jasminoidis ）– 淡豆豉 dan dou chi （ Semen Sojae Praeparatum ）