Tuesday, February 21, 2012

Symptomatic Diagnosis: Head & Neck

Health complaints that arise from the neck and head and lumped together in Chinese medicine diagnostics. Here, we see common complaints complete with their differential diagnosis, treatment principles and formulas.
Flaccidity of neck and head due to weakened muscles – Involuntary twitching of Head Muscles – Tinnitus (ear ringing) – Sore gums – Bleeding gums – Dark black teeth – Stiffness of neck – Goiter (enlargement of the thyroid gland)



Flaccidity of Neck and head due to weakened muscles

A serious condition, wherein the patient is unable to raise the head.
  • Zhong qi deficiency

    More often effects children with sever malnutrition, jing deficiency, Down’s syndrome. Clinical manifestations:
    • severe emaciation
    • Pale or sallow complexion
    • disorientation, confusion, extreme fatigue
    • indigestion, loose stool
    • middle jiao deficiency leads to zhong deficiency
  • Bone Marrow deficiency

    A critical condition Clinical manifestations:
    • Comes due to old age, sexual hyperactivity, associated with tinnitis, low back pain, difficulty in walking or straightening back.
    • T: Pale with scanty coating
    • P: Deep, very weak, or feeble
    Treatment principle
    • Tonify Kidney jing
    Formulas
    • Herbs made of animal products to quickly tonify.

Involuntary Twitching of Head Muscles

  • Liver Wind, Liver Fire (Acute excess condition)

    Clinical manifestations:
    • Twitching, acute, dizziness, bodily twitches in extremities especially.
    • Red face, eyes, bitter taste in mouth
    • T: Red with yellow coat
    • P: Rapid and wiry
    Formula
    • Ling Jiao Gou Teng Tang (Antelope Horn and Uncaria Decoction)
    • Removes wind, clears heat
  • Liver wind (chronic deficiency condition) i.e. Parkinson’s Disease

    Clinical manifestations:
    • Tidal Fever, night sweats, insomnia, fatigue
    • T: Red with scanty coat
    • P: Thready and rapid
    Treatment principle
    • Tonify yin, soothe Liver, disperse wind
    Formula
    • Da Ding Feng Zhu (Major Arrest Wind Pearl)

Tinnitus Cranii (ringing in the ears or head)

  • Bone marrow deficiency

    Clinical Manifestations
    • Tinnitus
    • Weakness/soreness in the lower back and/or knees.
    • Vertigo/dizziness
    • Possibly associated with ear tinnitus
    • T: Pale with scanty coat
    • P: Deep, thready, weak
    Etiology
    • Constitution, age, over sexed, jing deficiency fails to produce jing
    Treatment Principle:
    • Tonify jing
    Formula:
    • Zuo Gui Yin (Restore the Left (Kidney) Decoction)
    • He Che Da Zao Wan (Placenta and Date Pills)
    • Animal derivative herbs are good for jing deficiency
  • Damp Heat accumulation

    Clinical Manifestations
    • Tinnitus
    • Headache, heavy sensation in head
    • Nausea /Vomiting
    • Low appetite
    • Dizziness
    • Chuan yang (carbuncles on head)
    • T: Red with greasy yellow coat
    • P: Slippery, rapid
    Etiology
    • excess conditions due to diet of sweet, greasy, alcohol, or over eating creates damp heat in the channels which obstructs the flow of yang qi.
    • Obstruction in upper jiao effects the head channels.
    Treatment Principle
    • Clear heat, dry damp.
    Formula:
    • Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity) plus blood activators such as Chuan Xiong (Rz. Chuanxiong) for sharp fixed pain.
  • Liver qi stagnation

    Clinical Manifestations
    • Tinnitus triggered by anger or emotion.
    • Distention or pain in the hypochondrium, chest tightness
    • Bitter taste in mouth
    • Irritability, restlessness
    • T: Normal
    • P: Wiry and rapid
    Etiology
    • Anger leads to disturbance in flow of qi leads to stagnation of qi in the head.
    Treatment Principle
    • Soothe Liver qi
    Formula
    • Xiao Yao Wan (Rambling Powder)
    • Long Dan Xie Gan Tang (Gentianna Drain the Liver Decoction) if Fire is present.

Sore Gums

  • Deficiency of Kidney and Spleen (teeth and gums)

    Clinical Manifestations
    • Sore gums aggravated mostly by cold drinks and weather, sometimes hot drinks as well.
    • Teeth feel weak while chewing.
    • T: Pale
    • P: Deep and Weak
    Etiology
    • Old age, chronic conditions.
    Treatment Principle
    • Tonify Spleen and Kidney
    Formula
    • Zuo Gui Yin (Restore the Left (Kidney) Decoction)
    • You Gui Yin (Restore the Right (Kidney) Decoction)
    • Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia)
    • Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet)
    • Chew and eat walnuts (Hu Tao Ren (Sm. Persicae))
  • Wind Cold

    Clinical Manifestations
    • Sore gums, prefer warm drinks and food to cold
    • T: White slippery coat (slightly greasy)
    • P: Floating and Tense
    Formula
    • Xi Xin (individual herb) can be chewed raw, or decocted as a tea.
    • Ma Huang Xi Xin Fu Zi Tang (Ephedra Asarum and Prepared Aconite Decoction)
    • Ma Huang (Hb Ephedra) and Xi Xin (Herba cum Radice Asari) are currently unavailable in the US due to misuse.

Bleeding Gums (ulcerative gingivitis)

  • Heat & Fire in Stomach/Large Intestine (excess condition, acute)

    Clinical Manifestations
    • Swollen, red aching bleeding gums
    • Fresh, bright red blood
    • Bad breath, prefers cold drinks, constipation
    • T: Red body, thick yellow coat
    • P: Forceful and rapid
    Formula
    • Qing Wei San (Clear the Stomach Powder) + Yu Nu Jian (Jade Woman Decoction) + herbs to cool and activate blood
  • Stomach yin deficiency (deficiency condition, chronic)

    Clinical Manifestations
    • Swollen gums with pale blood, gums not bright red, sometimes painful, sometimes not.
    • T: Red with scanty coat
    • P: Slippery, rapid, thready
    Formula
    • Yu Nu Jian (Jade Woman Decoction) + herbs to cool and activate blood
  • Kidney yin deficiency with excess heat (associated with old age, a chronic condition)

    Clinical Manifestations
    • Slightly sore gums combined with loose teeth.
    • Dizziness, tinnitus
    • Sore back and weak knees
    • T: Red body with scanty coat
    • P: Thready and rapid
    Formulas
    • (with heat) Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)+ Gu Sui Bu (Rz. Drynariae) and/or Xu Duan (Radix Dipsaci)
    • (without heat) You Gui Yin (Restore the Right (Kidney) Decoction) or Zuo Gui Yin (Restore the Left (Kidney) Decoction) + Gu Sui Bu (Rz. Drynariae) and/or Xu Duan (Radix Dipsaci)
  • Spleen qi deficiency (Spleen unable to govern blood, chronic condition)

    Clinical Manifestations
    • Pale gums, lips, and nails due to blood deficiency
    • Easily bruised
    • T: Pale with white coat
    • P: Soft, weak
    Formula:
    • Gui Pi Tang (Bolster the Spleen Decoction)

Dark Black Teeth (Black from inside of teeth, not a stain due to
coffee etc.)

  • Blood stage heat in the lower Jiao

    Clinical Manifestations
    • High fever, delirium, semi-conscious, coma, convulsions
    • Irritability
    • Shriveling and dry lips
    • T: Red with very dry coat, shrunken
    • P: Extremely rapid
    Etiology
    • Heat has damaged yin and jin-ye (body fluids), Stomach qi damaged (shrunken mouth). Kidney unable to nourish teeth, turning them black, the color of the Kidneys.
    Formula
    • Salty, cold, sweet and moist herbs
    • Fu Mai Tang (Restore the Pulse Decoction)

Stiffness of Neck

  • Wind Cold

    Clinical Manifestations
    • More chills than fever, etc.
    • T: White slippery coat (slightly greasy)
    • P: Floating and Tense
    Formula
    • Ge Gen Tang (Kudzu Combination)
  • Wind Cold damp (a Bi syndrome such as arthritis)

    Clinical Manifestations
    • Heavy sensation in the head, head ache, aching joints, fever/chills sometimes
    • T: Greasy coat
    • P: Floating and slippery
    Formula
    • Ge Gen Tang (Kudzu Combination) + Qiang Huo (Rz. et Rx. Notopterygii), Jian Huang (Rz. Curcumae) and/or Sang Zhi (Rm. Mori)
  • Blood Stage Heat

    Clinical Manifestations
    • High fever, stiffness of head
    • Irritability, delirium
    • Possibly associated with convulsions, muscle spasms
    • “Extreme Heat leads to Liver Wind”
    Formula
    • Ling Yang Ge Gen Tang (Antelope Horn and Kudzu Decoction)

Goiter (enlargement of the thyroid gland)

  • Accumulation of phlegm and qi Stagnation

    Clinical Manifestations
    • Swelling of thyroid, which is soft without pain
    • Sense of obstruction in throat
    • Chest constriction and hypochondriac distending pain
    • Irritability
    • T: Greasy white coat
    • P: Wiry and slippery
    Etiology
    • Stress leads to qi stagnation leading to impairment of body fluid metabolism, leading to phlegm congealing in throat.
    Formula
    • Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) + Hai Zao (Sargassum) and Kun Bu (Laminariae)
  • Qi and blood Stagnation

    Clinical Manifestations
    • Tumors or cancer of the thyroid gland developing from accumulation of phlegm and qi stagnation.
    • Swelling is harder than simple phlegm and qi stagnation
    • More defined pain and sense of obstruction effecting ability to breath and/or swallow.
    • Chest constriction and hypochondriac distending pain
    • Irritability
    • T: Dark purple
    • P: Deep and choppy
    Etiology
    • Prolonged qi stagnation with phlegm leads to hardening of the phlegm leading to tumor
      formation
    Formula
    • Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) + blood activators such as E Zhu (Rz. Curcumae), San Leng (Rz. Sparganii), Dan Shen (Salviae Miltiorrhizae), Ru Xiang (Olibanum), Mo Yao (Myrrha) and anti-cancer herbs (not available in the US).
  • Yin deficiency of the Heart and Liver

    Clinical Manifestations
    • Typical hyperthyroidism, swollen thyroid, though not hard
    • Palpitations, insomnia, nervous, trembling
    • Easily sweats, shortness of breath, irritability,
    • dizziness/vertigo
    • Dry eyes, hot flashes, night sweats
    • Nocturnal emissions, premature ejaculation
    • irregular menstruation
    • T: Red with scanty coat
    • P: Wiry and rapid, or thready and rapid
    Treatment principle
    • Tonify yin and clear fire
    Formulas
    • Suan Zao Ren Tang (Sour Jujube Decoction)
    • Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)
    • Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart)
    • Yi Guan Jian (Linking Decoction)

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